Tourism Review

Abstract Background Case reports implicate disulfiram treatment in causing parkinsonism, but these observations lack epidemiological confirmation. Aim of the present study was to estimate the risk of incident parkinsonism associated with disulfiram dispensing in a large Italian population. Methods In this observational cohort study, administrative data were used, linking records at the individual level from civic registries, population census, mortality registers, hospital admissions, archives of drug prescriptions, and direct ambulatory drug distribution. Participants included all residents in the Piedmont region of Italy aged ≥ 40 years participating in 2011 census, still resident and alive at the beginning of 2013, followed-up from 2013 to 2019. The outcome was incident parkinsonism identified through multiple prescriptions of levodopa or a hospital admission for Parkinson’s disease or atypical parkinsonism. Exposure to disulfiram and to neuroleptics was assessed through regional drug prescription archives. The association between disulfiram and parkinsonism onset was assessed using Cox proportional hazards models, adjusted for gender, age and neuroleptic use. Results The study population included 2,498,491 individuals (mean age: 62 years). During follow-up, 19,072 parkinsonism cases were identified, 8 of whom had been prescribed disulfiram. Exposure to disulfiram was associated with a three-fold increased risk of parkinsonism (HR = 3.10, 95% CI = 1.55–6.21) that remained significant when adjusted for neuroleptic use (HR = 2.04, 95% CI = 1.01–4.10). The association was stronger among persons unexposed to neuroleptics and among those with more than four disulfiram prescriptions. Conclusions These results support the hypothesis that disulfiram may cause parkinsonism. Clinicians and drug regulatory agencies should consider parkinsonism when assessing the risks and benefits of disulfiram use.

Abstract The safety assessment of combined exposure to xenobiotics has been an emerging topic for several years. Methodologies and approaches for cumulative risk assessment (CRA) are being developed primarily for the dietary risk assessment of pesticides, thus focusing only on consumer exposure. However, as highlighted in recent years, non-dietary exposures, such as those encountered by professionals in agricultural settings, may pose a significant risk due to their higher levels compared to dietary exposure. Despite this, existing methodologies for cumulative risk assessment (CRA) have not adequately addressed this critical aspect. In the EU, even if several legislations highlight the need to address the non-dietary CRA, no legal requirements are in place yet, therefore, there are no harmonized methodologies and approaches currently available. In a first step to fill this gap, this study is aimed at exploring CRA methodology applied to non-dietary exposure to pesticide in agricultural settings, specifically targeting operators, re-entry workers, and bystanders. The primary objective of the study was to verify the feasibility of an electronic register of plant protection treatments as data source for identifying and characterizing in field mixtures and consequently estimating cumulative non-dietary systemic exposure in real life. The relevant active substances selected for this investigation were those listed in foetal craniofacial alterations cumulative assessment groups (CAGs), established by the European Food Safety Authority (EFSA) for dietary CRA. Exposures to pesticides were estimated using European Union agreed mathematical models. The preliminary findings of this investigation effectively revealed the value of the register of treatments in assessing real-life plant protection products (PPP) usage in professional agricultural settings. In conclusion, the study provides encouraging insights into using the pesticide dietary CRA approach for non-dietary risk assessment in agricultural settings, underlining the necessity for further research and investigation of its feasibility for the evaluation of other acute effects but also for long-term effects related CAGs.

Few studies have been conducted on women of childbearing age with chronic mercury poisoning caused by mercury vapor exposure. Occupational exposure, clinical symptoms and signs, laboratory tests, auxiliary examinations, treatment, and follow-up of 31 female workers with chronic mercury poisoning from a mercury thermometer processing factory who received inpatient treatment at our hospital between September 2021 and August 2022 were analyzed. In 31 female workers of childbearing age (23–43 years) who were chronically exposed to mercury vapor (3–31 months), urinary mercury levels exceeded the normal range. The clinical manifestations were primarily neurological (96.77%). Renal pathology of the two female workers suggested membranous nephropathy in the first stage. Some female workers experienced menstrual abnormalities, anxiety, depression, and sleep disorders. Treatment was mainly chelation therapy supplemented with antioxidants and other symptomatic supportive treatments. All patients achieved good results after discontinuing exposure to mercury vapor and receiving treatment. However, follow-up after discharge revealed that some female workers still had insomnia. Occupational mercury vapor exposure is hazardous to female workers of childbearing age and increases the risk of adverse effects on their reproductive health. Occupational protection and prevention of mercury exposure in female workers of reproductive age must be emphasized.

Understanding the nature and consequences of hazards and risks in the workplace is critical to protecting people from harm. We review the fictional example of “Indiana” Jones as an educational vector to illustrate principles of occupational medicine in real-world scenarios. After reviewing the Jones saga regarding potential hazards (physical – biological – chemical – psychosocial), we provide a practical outlook on the workplace health for readers with a non-occupational medicine background.

Silicosis remains a major occupational health challenge in India. This review systematically examines the prevalence, risk factors, regional differences, and diagnostic tools specific to India’s high-risk industries. Additionally, it assesses policy gaps and offers insights from diverse clinical and qualitative studies, aiming to inform targeted public health interventions and support the development of effective occupational health policies. For this review, data were extracted for each study, including author, location, design, study aims, sample size and characteristics, participant age, duration of silica exposure, diagnostic criteria, and primary outcomes. As an add-on analysis included, a random-effects meta-analysis was used to estimate the pooled prevalence of silicosis and assess variability among studies. The review also included qualitative analyses on awareness, diagnostic tools (e.g., CC16 protein), and differences in prevalence across various occupational groups and regions within India. The review initially identified 263 articles, narrowed down to 49 eligible studies on silicosis in India after exclusions and quality assessment. Among these, 11 prevalence studies (total sample size: 2072) showed an average silicosis rate of 31.39%. Specific studies reported high rates, including 52% among Rajasthan mine workers and 69.1% among Khambhat agate workers. Additionally, screening tools, like CC16 protein levels, showed promise for early diagnosis, while qualitative studies highlighted gaps in awareness and regulatory practices. Meta-analysis revealed a significant pooled prevalence (25.98%) and marked variability (I2 = 98.86%), underscoring the need for targeted interventions and worker protections. This review of current knowledge on silicosis in India finds silicosis highly prevalent among workers in mining and stone industries, with gaps in regulatory enforcement and awareness. Biomarkers like CC16 offer the potential for early diagnosis, underscoring the need for preventive measures. Policy recommendations include stricter dust exposure limits, enhanced workers’ education, routine screening, and improved access to protective equipment and health monitoring to reduce the risk of silicosis and health disparities in vulnerable occupational groups.

Chronic exposure to pesticides causes various adverse health effects, mainly at a neurological level. However, there is little evidence focused on liver tissue injury and transaminase activity as indicators of effect. A cross-sectional study was designed based on medical-occupational records of workers from an agro-export company in Peru to associate the levels of butyrylcholinesterase (BChE) transaminases (ALT and AST). Occupational medical records were reviewed to obtain demographic and occupational information and laboratory values of BChE activity and transaminases. We evaluated 459 records, and 69.9% were men. The mean age was 34.9 ± 11.5 years. BChE, ALT, and AST levels were 6238.8 ± 709.1 U/l, 34.4 ± 12.5 U/l, and 22.4 ± 8.5 U/l, respectively. The proportion of inhibited BCHE and elevated transaminase levels was 15.3% and 21.6%, respectively. We found a significant association between BChE inhibition and elevation of transaminases (AST: PR = 0.798, 95%CI: 0.716–0.889; ALT: PR = 0.419, 95%CI: 0.239–0.736). The potential usefulness of transaminases is shown as a biomarker of exposure and monitoring in occupational health programs for the agro-industry.

Hazardous noise exposure is an important health concern in many workplaces and is one of the most common work-related injuries in the United States. Dental professionals are frequently exposed to high levels of occupational noise in their daily work environment. This noise is generated by various dental handpieces such as drills, suctions, and ultrasonic scalers. Prolonged exposure to such noise levels is known to have adverse effects on hearing health. Despite the prevalence of occupational noise in dentistry, there is a paucity of research specifically examining the prevalence of hearing loss and tinnitus in dental professionals. To evaluate the prevalence of hearing loss and tinnitus, data were collected from 60 dental professionals, including participant demographics and audiometric thresholds. Thresholds were compared to the age- and sex-based reference ranges from the International Standards Organization (ISO 7029:2017). Results showed that 15–25% of males and 13–18% of females had hearing thresholds that exceeded 95th percentile limits based on the ISO normative age- and sex-distributions. Tinnitus was reported in 40% of the participants. This study is the first to examine the characteristics and prevalence of auditory dysfunctions in dental professionals compared to the ISO normative age and sex distributions of hearing status. Findings from this study highlight the need for increasing the awareness of occupational noise hazards among dental professionals and the importance of routine audiological monitoring.

Farmers around the world are at risk of depression, anxiety, and suicidal ideation yet many avoid seeking help. In Ireland, farmers’ mental health is a national concern, as farmers face barriers of masculine norms around help-seeking. This study aimed to examine the prevalence and relationship between mental health literacy and mental health help-seeking in the Irish farming community. It also aimed to identify if mental health literacy or mental health help-seeking differed depending on gender, age, education, health status and income level. We conducted a cross-sectional assessment of 351 Irish farmers’ mental health literacy and help-seeking using validated psychometric measures: the Mental Help Seeking Intention Scale (MHSIS), the Attitudes Toward Seeking Professional Psychological Help Short Form (ATSPPH-SF), and the Multicomponent Mental Health Literacy Measure (MMHL). Irish farmers’ mental health literacy and help-seeking scores were interrelated. Though low, farmers’ scores were comparable to the general population and higher than some European samples. Despite broadly favourable attitudes towards seeking professional mental health help, Irish farmers perceived significant barriers to accessing care and exhibited stoic health attitudes. Farmers with less education and men were particularly at risk. Irish farmers’ stoic attitudes may be a response to their perceived lack of services. Interventions providing mental health literacy education and improving access to existing mental health services are particularly important for this population of farmers.

Police officers constitute a work force at high risk due to their highly demanding work conditions. In a realistic paradigm, these conditions, and other determinants of their psychological health, can be linked to a multitude of variables that interplay altogether. However, current literature that simultaneously models–quantitatively from observed data–such a multitude of variables is sparse. This study took upon this objective to further theoretical and applied understandings through a measurement framework on empirical data, and allow the data to drive some features of model development, such as variable groupings into factors, and paths between factors. A total of 1312 officers from various police bureaus fully responded to a questionnaire composed of validated instruments for assessing factors related to psychological and occupational health, consisting of more than 25 variables. Statistical analyses were performed in progressing complexity, namely t-tests, correlations, multiple regression, factor analysis, and path analysis with latent factors. The regression analysis identified 10 significant variables, in which decision latitude, organizational justice, and work recognition/meaning were the most protective, and these 10 variables coincided with those found significant in the t-test and correlational results. In higher complexity, the latent path analysis resulted in a model of 6 factors: Psychological Health, Organizational Constraints, Trauma Exposure, Perceived Resources, Sense of Agency, and Esteem. Organizational Constraints (β = -0.32, inferred by psychological demands and role conflict), Perceived Resources (β = 0.31, social support, a self/work-esteem subfactor, and organizational justice), Sense of Agency (β = 0.30, decision latitude, hierarchical position, right to carry a firearm), and Trauma Exposure (β = -0.14, frequency/time since event, used a firearm, years of service) were found significantly associated with Psychological Health. Within each factor, specific variables could be identified as the most associated, such as role conflict for constraints, self/work-esteem for resources, decision latitude for agency, and frequency of and time since trauma for trauma exposure. Our results therefore encourage us to take into account not only agency, but also past professional experiences in models for managing well-being. Providing police officers with social support at work, recognition, work meaning, fair proceedings and pay (organizational justice, especially for female and young officers), decision-making power (decision latitude), and minimizing conflictual information and procedures (role conflict) is of utmost importance. Officers with higher years of service, working in lower population cities, and who recently used their firearm, should be considered for trauma counseling. The degree of psychological demands of police officers should be regularly assessed, and reduced if possible. Reminders of support and integration in the force for officers with variables linked to a perceived lack of agency may be useful in their facing work challenges. Future integrative modeling research may be crucial to better understanding the relative contribution of each variable and their interplay in realistic settings, providing also a framework for measurement.

An increased incidence of pleural mesotheliomas in Biancavilla (Italy) was attributed to the environmental exposure to fluoro-edenite (FE). Results from the Ramazzini Institute (RI) in vivo long-term study confirmed the evidence that exposure to FE fibres is correlated with an increase of malignant pleural mesotheliomas in Sprague–Dawley rats. Recently asbestosis-like features were substantiated in Biancavilla residents without known occupational exposures. Aim of this work was to establish whether FE induce lung fibrosis with a pathogenetic mechanism similar to other asbestiform fibres. Original slides from the RI study were systematically re-examined to characterize the FE-induced lesions. Quantitative analysis of lung fibrosis was assessed following the Ashcroft method. Immunohistochemical analysis of protein involved in fibrotic responses and histochemical staining for FE-fibres identification were performed. Like asbestos, FE caused fibrotic lesions, pleural plaques or nodules and mesotheliomas. A significant increase of lung fibrosis (p < 0.001) was observed in the FE-treated groups compared to untreated controls. In the fibrotic responses to FE, vimentin was the most expressed protein, followed by collagen-I and alpha-SMA. Finally, ferruginous bodies, characterized by iron deposits and ferritin expression, were observed in FE-induced lesions. This study confirmed that FE exposure promotes the onset of fibrotic lesions at pleural level, as fibrous plaques or nodules and fibrosis, through a mechanism similar to other form of asbestos. These results combined with epidemiological study reported in Biancavilla residents, corroborate the need to promote health and epidemiological surveillance plans of respiratory diseases in population living in FE contaminated sites.

Abstract Background During the COVID-19 pandemic, increased hand hygiene practices using water, soap and hand disinfectants, became prevalent, particularly among frontline workers. This study investigates the impact of these practices on the skin’s ability to retain the allergenic metals nickel, cobalt, and chromium. The study constitutes three parts: (I) creating an impaired skin barrier, (II) exposing treated and untreated skin to nickel alone, and (III) in co-exposure with cobalt and chromium. Methods Using full-thickness skin from stillborn piglets, in vitro experiments were conducted to assess retention of metals in skin at conditions mimicking intense hand hygiene practices. Treatment of skin with varying concentrations of sodium lauryl sulphate (SLS), to impair its barrier integrity was assessed. This was followed by exposure of treated and untreated skin to the metals, that were dissolved in Milli-Q water, 0.5% SLS, and ethanol respectively. Results Results showed that pre-treatment with 5% SLS impaired the skin barrier with regards to the measure of trans epidermal water loss (TEWL). Metal amounts retained in the skin were generally higher in treated than untreated skin. The highest amounts of metal retained in skin were observed for exposure to nickel in ethanol. Co-exposure to nickel, cobalt, and chromium in 0.5% SLS resulted in the highest amounts of total metal retention. Conclusions The in vitro findings highlight the increased risk of metal retention in skin due to an impaired barrier. The SLS concentration used in the current study corresponds to those used in many hand hygiene products. Hence, occupational settings with frequent exposure to water, soap and disinfectants need to consider protective measures not only for the irritant exposures themselves but also simultaneous exposure to allergenic metals.

Abstract Background Rehabilitation plays a crucial role in restoring work ability and facilitating the reintegration of post-COVID patients into the workforce. The impact of rehabilitation on work ability and return to work (RTW) of post-COVID patients remains poorly understood. This study was conducted to assess the work ability and RTW of post-COVID patients before rehabilitation and 12 months after rehabilitation and to identify physical and neuropsychological health factors influencing RTW 12 months after rehabilitation. Methods This longitudinal observational study included 114 post-COVID patients with work-related SARS-CoV-2 infection who underwent inpatient post-COVID rehabilitation with indicative focus on pulmonology and/or psychotraumatology (interval between date of SARS-CoV-2 infection and start of rehabilitation: M = 412.90 days). Employment status, work ability, and the subjective prognosis of employment (SPE) scale were assessed before rehabilitation (T1) and 12 months after rehabilitation (T4). The predictors analysed at T4 were functional exercise capacity, physical activity, subjective physical and mental health status, fatigue, depression, and cognitive function. Longitudinal analyses were performed via the Wilcoxon signed-rank test. Logistic and linear regression analyses identified predictors of work ability and return to work (RTW), whereas mediation analyses examined the relationships between these predictors and work ability. Results At T4, the median of WAI total score indicated poor work ability, which significantly worsened over time (p < 0.001; r = 0.484). The SPE scale significantly increased from T1 to T4 (p = 0.022, r = -0.216). A total of 48.6% of patients had returned to work 12 months after rehabilitation. Fatigue was identified as the main predictor of reduced work ability and RTW, with each unit increase in fatigue severity decreasing the odds of RTW by 3.1%. In addition, physical capacity and subjective health status were significant predictors of perceived work ability. Conclusions The findings highlight the significant challenges that post-COVID patients face in regaining work ability and achieving successful RTW 12 months after rehabilitation. Fatigue appears to be an important predictor of work ability and RTW. To optimize recovery and enhance both biopsychosocial health and work ability, it is crucial to develop and implement personalised interventions that address fatigue, improve physical capacity, and support mental health. Trial registration This study is registered in the German Clinical Trials Register under DRKS00022928.

Abstract Background The knowledge about job demands, control, and support, and their potential associations with burnout risk among physicians in Sweden, is limited. This study aimed to explore (i) factors of the JobDemand-Control-Support (J-DCS) model across different groups of physicians in Sweden, (ii) their association with high burnout risk, and (iii) the potential buffering impact of job control and support. Methods Cross-sectional data from the Swedish Longitudinal Occupational Health in Healthcare Survey (LOHHCS) study cohort was used. In 2021, a total of 2032 respondents submitted questionnaire data comprising J-DCS measures (i.e., job demands, workplace control and task-level control, and social support from peers and managers). Burnout risk was measured using the Burnout Assessment Tool. Binary logistic regression models were used to investigate the associations between the J-DCS variables and high burnout risk. Interaction analysis was performed to explore any moderation of the associations. Results Job demands were significantly associated with increased odds of high burnout risk (odds ratio (OR) 2.71, 95% confidence interval (CI) 1.91–3.84. Workplace control (OR 0.50, 95% CI 0.35–0.71) and peer support (OR 0.61, 95% CI 0.48–0.77) were significantly associated with reduced odds of high burnout risk. The interaction analysis showed no significant moderation of the association between job demands and high burnout risk by either peer support or workplace control, and no buffering impact was found. Conclusion Job demands were associated with high burnout risk among physicians in Sweden. Although workplace control and peer support had inverse associations with high burnout risk, no moderation or buffering impact on the association between job demands and high burnout risk was found. Longitudinal studies are needed to confirm these associations.