Department Of Occupational Medicine Research Articles

Telephone consultation as a sustainable method of service delivery in occupational medicine: results of a qualitative study

Since the pandemic, telephone consultation is still widely used in Occupational medicine practice, but with a seemingly huge variety depending on the different occupational medicine departments and companies. Telephone consultation could be considered a sustainable alternative to face-to-face consultation in the long term. The aim of this research project was to start an evidence base for the opinions of Occupational Health Physicians (OHPs) regarding telephone consultation. This study also sought to gather further information on the perceived benefits and limitations of telephone consultation as per its current users (OHPs) and identify ways to improve the practice of telephone consultation. This research project involved interviewing Occupational Health Physicians and analysing the data collected (using thematic analysis) so that the utility of telephone consultation as a means of consultation could be reviewed [12-16]. Semi-structured interviews were carried out with eighteen specialist occupational medicine physicians in Ireland. Data was initially coded and then organised into themes. The main findings from this research project identified five themes: Quality of Care, Professional Standards, Barriers to Telephone Consultation, Optimal Use of telephone Consultation, and Potential Improvements and Useful Change for Telephone Consultation. Some of these themes have previously been identified in research from other medical specialities. Upon consideration of the themes and subthemes identified in this study, telephone consultation could be used by Occupational Health Physicians as an adjunct to face-to-face consultations and in some cases as a direct alternative. Further research into this area with pilot studies or comparative trials will provide definitive answers as to the role of telephone consultation in occupational medicine into the future. Telephone consultation would appear to be a sustainable method of service delivery in occupational medicine. Clinical governance for telephone consultation in Ireland is currently lacking with no clinical guidance available specific for occupational medicine. If telephone consultation is to be considered a sustainable method of service delivery in Occupational medicine, a solid foundation of clinical guidance and governance will be required.

Effet du tabagisme sur le profil clinique et allergologique de la dermatite de contact

Several clinical and epidemiological data point to a possible link between smoking exposure and contact dermatitis (CD). To identify the clinical and epidemiological differences of CD in smoking and non-smoking subjects, and to determine the influence of smoking on the allergological profile of CD. Retrospective descriptive study who consulted the Department of Occupational Medicine and Occupational Pathology of the Farhat Hached University Hospital of Sousse (Tunisia) during a period of 8 years for exploration of CD and who were tested with the European Standard Battery (ESB). A total of 767 patients were enrolled during the study period, 40% of whom were smokers. The group of smokers was characterized by a male predominance (p=10-3) and a greater professional seniority compared to non-smokers (p=0.01). Personal history of atopy was predominant in non-smokers (p=0.02). Among the ESB allergens, there was a significant association between smoking and CD due to metals (chromium, cobalt) and conservatives. After binary logistic regression, the variables associated with smoking exposure were male gender (OR=12.12 ; 95% CI=[6.07 - 24.21]; p=10-3), Kathon CG allergy (OR=3.69 ; 95% CI=[1.24 - 10.81]; p=0.018), and right hand involvement (OR= 2.83; 95% CI=[1.29 - 6.17]; p=0.005). Our study revealed an effect of smoking on the clinical and allergological characteristics of CD.

The systemic immune-inflammation index is significantly associated with the severity of silicosis: a 9-year retrospective study in Beijing.

Silicosis shows an increasing trend with the development of new industries. However, the potential biomarkers for predicting the disease severity are lacking. A novel inflammatory marker, the systemic immune-inflammation Index (SII), has not been studied in silicosis. In this retrospective study, we used data from a big database platform of a tertiary general hospital in Beijing, which was established based on the electronic medical records of the hospital. The clinical data of adult patients diagnosed with silicosis at the Department of Occupational Medicine and Toxicology from 2013 to 2022 were collected. The data extracted from the database were in de-identified form. Only patients with a first diagnosis of silicosis and without conditions that might affect the parameters of routine blood tests were included in the analysis. Analyses were performed to assess the relationship between SII and the advanced stage of silicosis. A total of 246 participants were included in the study. Most of the patients were exposed to silica particles during excavation and digging (n = 149, 60.6%). SII level was significantly higher in patients with advanced stages of silicosis. A multivariate logistic regression analysis revealed that a higher SII level was associated with the advanced stage of silicosis [odds ratio (OR) = 1.002; 95% confidence interval (CI): 1.000-1.003, p < 0.001] after adjusting for all covariates. The best cutoff value of SII was 444.1. The results of the subgroup analysis also showed a significant correlation between SII level over 444.1 and the advanced stage of silicosis in groups stratified by gender, history of smoking, and duration of silica exposure. Moreover, our results showed a significant but weak negative correlation between the level of SII and some lung function parameters in silicosis. Higher SII is associated with the advanced stage of silicosis and impaired lung function. More long-term, large-scale studies are needed to confirm these findings.

Perioperative Rehabilitation in Collaboration with the Department of Occupational Medicine for Patients with Cholangiocarcinoma: A Case Report

Perioperative Rehabilitation in Collaboration with the Department of Occupational Medicine for Patients with Cholangiocarcinoma: A Case Report

Case-Control Study of Occupational Acute Myeloid Leukemia in the Republic of Korea

BackgroundWe conducted a case-control study to identify high-risk occupations and exposure to occupational hazards for acute myeloid leukemia (AML). MethodsWhen patients with AML admitted to the Department of Hematology in the study hospital for the first time are referred to the Department of Occupational and Environmental Medicine, data on occupation are collected by investigators to evaluate work-relatedness. Community-based controls were recruited through an online survey agency, and four controls per case were matched. Occupational information was estimated using structured questionnaires covering 27 specific occupations and 32 exposure agents. Conditional logistic regression analysis was performed by pairing cases and controls. ResultsIn the analysis of the risk of AML according to occupational classification, a significant association was found in paint manufacturing or painting work (OR = 2.22, 95% CI: 1.03–4.81) and aircrew (OR = 6.00, 95% CI: 1.00–35.91) in males, and in pesticide industry (OR = 6.89, 95% CI: 1.69–28.07) and cokes and steel industry (OR = 2.00, 95% CI: 1.18–22.06) in ≥60 years old. Moreover, the risk of AML increased significantly as the cumulative exposure to thinners increased. In the analyses stratified by sex and age, the association between pesticide exposure and AML was significant in males (OR = 3.28, 95% CI: 1.10–9.77) and in ≥60 years old (OR = 6.22, 95% CI: 1.48–26.08). ConclusionThis case-control study identified high-risk occupational groups in the Republic of Korea including paint manufacturers and painters, aircrew, and those who are occupationally exposed to pesticides or paint thinners.

Long-term follow-up study of work status among patients with work-related mental disorders referred to departments of occupational medicine in Denmark

ObjectivesTo describe the 5 year work status in patients referred for suspected work-related common mental disorders. To develop a prognostic model.DesignRegister-based nationwide longitudinal follow-up study.SettingAll departments of occupational medicine in...

Developing prognostic models for health care utilization in patients with work-related mental health problems

BackgroundThe long-term prognosis for employees with work-related mental health problems is unclear. We aim to describe long-term trends in health care utilization (HCU) and develop multivariable prognostic models for long-term mental health care utilization.MethodsFrom the Danish Occupational Medicine Cohort we included mental health patients (N = 17,822) assessed from 2000 to 2013 at Departments of Occupational Medicine. Outcomes were general health (general practitioner, somatic hospital) and mental health (psychiatrist/psychologist, psychiatric hospital) HCU obtained from registries five years before/after assessment. The 10-year period was divided into phases relative to assessment: 5 − 3 years before, 2 years before/after, and 3–5 years after. We developed gender-stratified Lasso-penalized multivariable prognostic models for HCU 3–5 years after assessment assessing both calibration and discrimination.ResultsPrevalent HCU for general practitioner, psychiatrist/psychologist and psychiatric hospital services was relatively stable 5 − 3 years prior to assessment, then rising during the 2 years before/after. At 3–5 years after assessment prevalent general practitioner HCU declined to previous levels, while prevalent HCU for psychologist/psychiatrist and psychiatric hospital services remained elevated compared to previous levels during years 5 − 3. Prognostic models for long-term psychologist/psychiatrist and psychiatric hospital HCU indicated acceptable calibration and modest discrimination.ConclusionsPrevalent HCU rose two years before/after assessment and remained elevated for psychiatrist/psychologist and psychiatric hospital HCU 3–5 years after. Gender-stratified prognostic models were developed for long-term mental health HCU, but discrimination and calibration should be further improved before out-of-sample application for personal prognosis.Trial registrationThe study was registered at clinicaltrials.gov (Identifier: NCT04459793) prior to analyses.

Evaluation of right ventricular function using two-dimensional speckle tracking echocardiography and analysis of the risk factors for right ventricular dysfunction in patients with silicosis

Objective: To evaluate the right ventricular function using two-dimensional speckle tracking echocardiography (2-D STE) and analyze the associated risk factors of right ventricular dysfunction in patients with silicosis. Methods: All 104 patients with silicosis treated in the Department of Occupational Medicine and Toxicology in Beijing Chao-Yang Hospital, Capital Medical University from May 2021 to September 2022 were enrolled in this study in October 2022. The clinical information of patients such as general data, arterial blood gas analysis and pulmonary function test were collected. The right ventricular function of patients was evaluated by 2-D STE-derived right ventricular free wall longitudinal strain (RVFWLS) and conventional echocardiographic-derived parameters, including right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and doppler tissue imaging-derived tricuspid lateral annular systolic velocity (S'), respectively. Based on their RVFWLS, the patients were divided into right ventricular dysfunction group and normal right ventricular function group. Risk factors for right ventricular dysfunction in patients with silicosis were analyzed using binary logistic regression analysis. Results: A total of 104 silicosis patients were enrolled, with aneverage age (65.52±11.18) years old, among whom including 57 cases diagnosed with stage Ⅰ/Ⅱ silicosis and 47 cases diagnosed with stage Ⅲ silicosis. 26 (25.00%) patients concurrent right ventricular dysfunction. The abnormal rates of RVFAC, TAPSE and S' in patients were 16.35% (17 cases), 21.15% (22 cases) and 6.73% (7 cases), respectively. The RVFAC and TAPSE in right ventricular dysfunction group were lower than those in normal right ventricular function group, and the incidence of pulmonary arterial systolic pressure ≥36 mmHg was higher than that in normal right ventricular function group (P<0.05). Logistic regression analysis showed that arterial partial pressure of oxygen (OR=0.932, 95%CI: 0.885-0.981, P=0.007) was the protective factor, and the forced expiratory volume in 1 second (FEV(1)) /forced vital capacity (FVC) ratio<70% (OR=5.484, 95%CI: 1.049-28.662, P=0.044) and stage Ⅲ silicosis (OR=6.343, 95%CI: 1.698-23.697, P=0.007) were the risk factors for silicosis patients concurrent right ventricular dysfunction. Conclusion: The incidence of right ventricular dysfunction is higher in patients with stage Ⅲ silicosis than that in patients with stage Ⅰ/Ⅱ silicosis. Using 2-D STE can help the early detection of silicosis with right ventricular dysfunction. Hypoxemia, airflow limitation and the stage Ⅲ silicosis are the risk factors for silicosis patients concurrent right ventricular dysfunction.

Response to the Letter to the Editor From Jeffrey Brent, MD, PhD. Re: Mesothelioma Associated With the Use of Cosmetic Talc.

Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, Great Neck, NY Conflicts of interest: The author has served as an expert witness in asbestos litigation on behalf of plaintiffs, including in cases in which patients with cosmetic talc exposure developed mesothelioma. Address correspondence to: Jacqueline Moline, MD, MSc, FACP, FACOEM, Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, 175 Community Dr, Suite 206, Great Neck, NY 11021 ([email protected]).

Serious Flaws Challenge the Conclusions in a Revision of a Retracted Meta-Analysis.

Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark [email protected]

MEDICAL FITNESS IN WORKERS WITH PSYCHIATRIC DISORDERS

IntroductionMental health disorders are among the most burdensome health concerns in the world; it affects more than 970 million people in 2019. These disorders deteriorate all aspects of life, especially the professional field, impacting mainly physical capability, daily functioning, and productivity among the working-age population.ObjectivesTo study the socio-professional and medical characteristics of workers with psychiatric disorders and to assess the repercussions of these pathologies on work ability.MethodsA descriptive and retrospective study included all the medical files of workers with psychiatric disorders who were referred to the occupational medicine department at Charles Nicolle Hospital for a medical opinion of fitness for work during the period from January 1, 2014, to December 31, 2020.ResultsThe average age of the 224 cases collected was 41.74± [25-60 years] with a sex ratio of 0.67. The average professional seniority was 13.4 years±8.27 years. The most common occupational sectors were health (38.1%) and communication (20.2%). The patients were mainly suffering from either an anxiety-depressive disorder (36.6%) or psychosis (11.6%). These included 21 cases of bipolar disorder, 21 cases of schizophrenia, two cases of chronic hallucinatory psychosis and 3 cases of delusional psychosis. Forty-three patients were fit to continue working, 133 patients were fit with restrictions and twenty-six were unfitted to work.A professional reclassification was recommended for 37 patients in positions with a lower mental load. One employee suffering from advanced schizophrenia was offered early retirement on grounds of disability. Permanent unfitness was pronounced in 11.6% of cases.ConclusionsThe impact of mental disorders on cognitive abilities can be so significant as to result in temporary or permanent unfitness for work. However, the decision of medical fitness for work for the same psychiatric pathology may vary from one individual to another and from one workstation to another.Disclosure of InterestNone Declared

Socio-professional stigmatization among healthcare workers with COVID-19

IntroductionThe COVID-19 pandemic had deeply altered the social and professional lives of people with SARS-COV2. The anxiety of being contaminated by the virus during the first waves had created avoidance behaviors and established a climate of rejection towards healthcare workers (HW) with COVID.ObjectivesThe aim of this study was to assess stigmatization among healthcare workers with COVID-19MethodsThis is a retrospective cross-sectional study carried out on HWs in a university hospital in Tunis who were affected by COVID-19 and who consulted the occupational medicine department. The study was conducted between March 2021 and June 2021. Data collection was based on pre-established forms. The questionnaire assessing stigmatization was inspired by the questionnaire assessing stigma in AIDS patientsResultsThe study included 100 health personnel. The sex ratio (M/W) = 0.29. The average age was 39.22 ± 9.3 with extremes ranging from 24 to 58 years. The average professional seniority was 11.39±9.4. Nurses were the most represented professional category (26%). The psychiatric history was: Depressive disorder (14%) and anxiety disorder (10%). Eighty HW were infected with SARS-COV2 for the first time. Contamination was intra-hospital in 50% of cases. Eighteen HW had been rejected. Verbal abuse towards HW with COVID was noted in 8% and physical abuse in 11%. Twenty-six HW had lost their friends and 36 of them no longer had as much social activity as before. In the workplace, rejection was noted in 21% cases, 10 health personnel reported a discriminatory orientation for the care of patients with COVID and 19 HW felt useless at work.ConclusionsSocio-professional stigmatization should help us to understand the vulnerability and psychological impact of this health crisis on health workers. Control and prevention strategies need to be established.Disclosure of InterestNone Declared

Psychiatric disorders in teleoperators : A series of 27 cases

IntroductionBy its nature, the activity of teleoperators seems to be a propitious environment for the development of psychosocial disorders, sometimes severeObjectivesTo study the frequency of psychiatric disorders among teleoperators and their impact on medical fitness for workMethodsThis is a retrospective descriptive epidemiological study. We examined the files of teleoperators who were referred to the occupational medicine department of Charles Nicolle between 2014 and 2022 for a medical opinion of aptitudeResultsA total of 82 cases were identified, 27 of which had psychological complaints. A clear female predominance was noted (21). The average age was 38.22+-6.536 years. All the patients were telephonists at the call-taking station with an average professional seniority of 9.3+-3.395 years. The symptoms noted were: sad mood (19), irritability (15), anxiety (10), sleep disorders (8), loss of vital impetus (8), neurovegetative signs (6), psychomotor slowing (5), concentration and memory disorders (3). Only one patient had suicidal thoughts. Symptoms had been evolving for an average of 34.32+-34.527 months. Psychiatric follow-up was noted in 16 patients. The diagnoses retained were: anxiety and depressive disorder (19), adjustment disorder (4), panic disorder (2), obsessive-compulsive disorder (1), and a satisfactory state of health (1). In some cases, the evolution was marked by complications: addiction(1), tonic stuttering with phobic disorder(1) and speech disorder(1). The prescribed treatments were: an antidepressant(2), an antidepressant-anxiety combination(8) and psychotropic drugs(2). Concerning the ability to work, 21 patients required an eviction from call taking (definitive (9) or temporary for 3 months (7) or 6 months (5) with re-evaluation of the medical ability to work at the end of this period), 1patient had an eviction from night work and an other had a reduction of the working hours.ConclusionsTeleoperators are exposed to several risks which can affect both their mental and physical health and put their medical fitness for work at risk.Disclosure of InterestNone Declared

Assessment of the quality of life of workers exposed to organic solvents: Study of 33 cases

IntroductionExposure to organic solvents (SO) is a significant occupational hazard in industrial settings. This can lead to neurobehavioural and physical effects that can affect the quality of life of workersObjectivesTo assess, using a validated questionnaire, the quality of life of workers exposed to SO.MethodsCross-sectional descriptive study conducted at the occupational medicine department of the Charles Nicolle Hospital in Tunis, which interested patients exposed to SO who had consulted for a medical opinion on fitness for duty during the period from January 1, 2017 to August 31, 2022. The data collection was carried out by a telephone call using the SF12 questionnaire. Socio-demographic and medical data were completed from medical records.ResultsWe identified 51 workers exposed to OS. Thirty-three employees agreed to answer the SF12 questionnaire, for a response rate of 65%. The average age was 44 8 years with a clear male predominance of 75%. The most represented sectors of activity were the automobile industry (34%), followed by the leather and footwear industry (15%) and the plastics industry (12%). The jobs most exposed to SO were manual workers (54%) and painters (9%). The median occupational seniority was 15[10; 23] years. Comorbidities were observed in 72% of employees. The average physical composite score was 48%. The average mental composite score was 49%. The average overall score was 49%. Average quality of life (overall SF12 score above 50) was noted in 60% of the population. Moderate disability (overall SF12 score between 30 and 39) was found in 18% of respondents. Twenty-one percent of workers had a severe disability (overall SF12 score below 30).ConclusionsIn addition to socio-professional conditions, exposure to SO may be implicated in altering the quality of life of exposed workers. This implies the need to strengthen preventive measures in order to preserve the mental and physical health of these workers.Disclosure of InterestNone Declared

Study of the association of work-related musculoskeletal disorders and anxiety-depressive diseases

IntroductionMental disorders, musculoskeletal diseases (MSDs) and their comorbidities are major threats to work and functional ability. The relationship between mental health and the common MSDs has not received enough attentionObjectivesTo study the socio-professional characteristics of workers suffering from work related MSDTo evaluate the association of work related MSDs with anxiety and depression disordersMethodsA descriptive cross-sectional study conducted among workers with work-related MSDs who consulted the occupational medicine department of the Charles Nicolle Hospital between January 2022 and September 2022. A remote survey was conducted among these workers to screen for anxiety and depressive disorders using the Hospital anxiety and Depressive ScaleResultsThe study population consisted of 54 workers with MSDs with a sex ratio (M/F) of 0.74. The average age was 44.4 [27-61 years]. The average professional seniority was 14.9 years±7 years and the sectors with the highest prevalence of MSDs were the health sector (22%), the food industry (13%) and the textile industry (11%). The workers reported MSDs of the lumbar spine in 61%, gonarthrosis in 31%, followed by MSDs of the upper limb in 25%. The prevalence of anxiety and depressive disorders were respectively 46% and 38%. There was no significant association between socio-demographic factors and anxiety depressive disorders. The anxiety disorder was associated with MSDs of the lumbar spine (p: 0.05; OR: 0.32 CI95% [0.1-1.09]).ConclusionsAnxiety and depressive disorders were common among workers with MSDs related to work. Interventions targeting psychological distress and work-related psychosocial characteristics may reduce their musculoskeletal pain.Disclosure of InterestNone Declared

Neuropsychological effects of occupational exposure to organic solvents: A study of 37 cases

IntroductionOccupational exposure to organic solvents can have multiple health effects for exposed employees.Neuropsychic effects represent an important part of these effects and have a significant impact on patients’ ability to workObjectives-To describe the socio-professional and medical characteristics of workers exposed to organic solvents-To screen among the study population for neuropsychological effects related to an organic psychosyndrome using the Q16 questionnaire.MethodsA retrospective descriptive study of workers exposed to organic solvents, who were referred to the occupational medicine department of Charles Nicolle Hospital in Tunis for a medical assessment of their fitness for work over the period from 2016 to 2022. The socio-professional data were collected from the medical records. The Swedish Q16 questionnaire in its French version was used to screen for neuropsychological signs of organic psycho-syndrome.ResultsA total of 37 workers were included. The mean age was 45.38 ± 8.63 years with a clear male predominance (77%). The mean occupational seniority was 21.39 ± 11.11 years. The average duration of the occupational exposure to organic solvents was 18.25 ± 11.29 years. The most represented sectors of activity were the plastics industry (11%), the automotive industry (19%), the carpentry sector (14%) and the aeronautics sector (9%). Our population was represented by polyvalent workers in 49% of cases and by painter in 24% of cases. Psychiatric history was noted in only one case. The main functional signs reported by the workers were wheezing dyspnea with breathing difficulties (13%) and headaches (11%).The Q16 questionnaire was found to be positive in 65% of the cases, with a higher rate of positivity for the items relating to unusual fatigue (73%), irritability for no particular reason (67%), short memory (64%) and headaches (58%). Acquired dyschromatopsia detected by a Lanthony test was found in 39% of the cases, 23% of which was associated with a positive Q16 questionnaire. Additional exploration by specific psychotechnical tests was carried out in five cases, all of which came back positive with significant attentional and cognitive impairment.A declaration of an occupational disease according to the Table n°23 (Halogenated derivatives of aliphatic hydrocarbons) and Table n°40 (other liquid organic solvents for professional use) of the Tunisian list of occupational diseases eligible for compensation was made in three and two cases respectively. A definitive exemption from exposure to organic solvents was indicated for all workers with a positive Q16 questionnaire.ConclusionsExposure to organic solvents is a risk encountered in various occupational sectors. Thus, education of the employees to the dangers encountered with a reinforcement of the collective and individual technical protection means are essential in order to avoid their detrimental effects on health.Disclosure of InterestNone Declared

Notified occupational mental disorders: associations with health and income.

Studies indicate that workers' compensation claim processes may affect patients' health negatively. However, few studies focus on patients with mental health claims, and the claim process varies between countries. The aims of this study were to examine whether being notified to the Danish Labour Market Insurance with an occupational mental health condition was associated with changes in visits to the general practitioner (GP), use of medicine and annual income. Study participants were 965 patients with a mental disorder examined at a department of occupational medicine. Of these, 669 patients were notified with an occupational mental disorder, 296 were not. Health-related outcomes, including GP visits and prescriptions of psychotropic drugs, were estimated at baseline during the year of medical examination, while annual income was estimated a year before the examination. The follow-up was the year after the year of examination for all outcomes. Outcomes were collected from the Danish National Bureau of Statistics. Analyses were conducted using Poisson regression and conditional logistic regression. All measured outcomes decreased from baseline to follow-up in both groups. These changes were not significantly different depending on notification status at baseline. This study suggests that being notified with an occupational mental disorder does not significantly affect health-related outcomes. A significant decrease in annual income over time was seen in both groups, the notified and the unnotified group, highlighting the importance of providing support to all employees with a mental disorder.

The history of the Department of Occupational Hygiene of the Federal Scientific Center of Hygiene named after F.F. Erisman” of Rospotrebnadzor

The history of the creation of the Department of Occupational Hygiene of the Federal Scientific Center of Hygiene named after F.F. Erisman of Rospotrebnadzor dates back to 1942, when the subject of scientific research was devoted to the study of sanitary working conditions at defense industry enterprises and the development of personal protective equipment for workers. By 1950, the range of issues under study was expanded with initiation of the comprehensive clinical and hygienic studies in the mining, chemical industries, mechanical engineering and agriculture using hygienic, physiological, biochemical research methods, animal experiments. In 1960-1990, the research was carried out in areas including the study of working conditions, workers’ health and toxicological assessment of new substances in the chemical industry, study of the dust factor and occupational health issues in the coal and mining industries; study of the effects on the body of working physical factors (noise, vibration, ultrasound, magnetic fields) in industry and agriculture, study of working conditions, working and rest regimes with new technological processes and new forms of labour management. During the period of 1957-2001, employees of the Occupational Health Department developed 14 sanitary rules (SP) and sanitary rules and regulations (SanPiN), hygienic norms of infrasound and vibration in the workplace. Maximum permissible concentrations (MPC) in the air of the working area for 42 harmful substances, maximum permissible levels (MPC) of skin contamination of workers for 17 chemicals have been developed and approved, the toxicity of 35 different compounds has been studied. According to the results of the research, 45 candidate’s and 18 doctoral dissertations were defended. In the modern period, the accumulated experience of effective scientific activity of the Department of Occupational Hygiene has been mastered .and implemented by a new generation of researchers of the Department of Occupational Medicine of the Institute of Complex Hygiene Problems of the "Federal Research Center of Hygiene named after F.F. Erisman" of Rospotrebnadzor.

DILEMAS ENFRENTADOS PELOS MÉDICOS PERITOS DIANTE DA PSICOSE PUERPERAL RELACIONADA AO INFANTICÍDIO

Introduction: Puerperal psychosis is defined as a type of brief psychotic disorder occurring within three weeks after delivery, but predominantly within the first 48-72 hours, although rare (0.1 to 0.2%), it is a medical emergency and should be be treated as soon as possible. The presence of prodromal symptoms (irritability, sudden change in behavior, among others) that rapidly progress to a psychotic condition (delusions and hallucinations). In this context, infanticide is the apex for forensic interpretation. In 2021, The Lancet publishes an article questioning whether puerperal psychosis is a new disease. Neither the ICD nor the DSM bring this diagnosis as a distinct disease . Objective: To expose the main conflicts faced by medical experts in the face of the alleged crime of infanticide from the perspective of the Penal Code Conceptual framework: Establishing the nexus between puerperal psychosis and infanticide is a very difficult task and often depends on documents from the attending physician. Material and methods: Study carried out at the Department of Legal Medicine, Bioethics, Occupational Medicine and Physical and Rehabilitation Medicine of the Faculty of Medicine of the University of São Paulo. A narrative review of the literature was carried out, focusing on signs and symptoms suggestive or conclusive of puerperal psychosis in the face of the crime of infanticide. Articles in the Lilacs and PubMed databases were accessed, applying the descriptors “psychotic disorder”, “postpartum psychosis”, “expertise”; Textbooks were also included. No time limit was established for the search, but articles obtained in full were included. Results: Article 123 of the Penal Code, from 1940, determines that the crime of infanticide is “killing, under the influence of the puerperal state, one’s own child, during childbirth or shortly after: Penalty – detention, from two to six years. ”, at this point it is visible the difficulty to assertively define what it is right after, as well as to establish the mental criteria that made this crime an action in which the woman was not aware of the fact performed. Science still struggles to establish nosology and the temporal relationship between the onset of mental changes and childbirth and which biological changes are involved, these are the words of one of the greatest researchers on the subject, Patrick McGorry. The search for a genetic relationship between bipolar disorder and puerperal psychosis has been suggested. But, another issue to be discussed, not all puerperal psychoses are linked to infanticide. Another dilemma faced is the lack of habit in applying the terms infanticide and neonaticide with their individual designations. The first would be the death of a child in the first year of life by its mother and the second would be the death within the first 24 hours of life. The central question for the medical expert is to establish whether the neonaticide stems from a social issue in which the child is unwanted or whether it stems from a dissociative, depersonalization or hallucinatory disorder in which the mother does not have the capacity for understanding and self-determination. The medical literature rarely attributes neonaticide to mental illness. It is up to the medical expert to establish with technical rigor that at the time of the criminal act the woman was under a condition of illness that completely abolished her capacity. In this way, the medical expert must carry out the examination by complying with the technical rite and request medical documentation on the clinical and mental conditions of the expert at the time of the puerperium. The search for risk factors can help the doctor, but it is necessary to know that the profile of women varies according to the typology of the fact, that is, neonaticide and infanticide. Differential diagnoses between delusional misidentification syndrome which may be accompanied by hostility towards delusional erratic identification, Capgras syndrome in which the woman may believe that her child has been switched and that the child in front of her is an imposter. Due to the transience of psychotic symptoms, the psychiatric expertise that determines the imputability of the infanticidal mother is often performed in the absence of any clinical manifestation of psychosis. Conclusion: The psychiatric expertise of the woman who claims puerperal psychosis is challenging due to the elusiveness of the symptomatic picture and the late realization. It is based on an analysis of medical documentation – from the moment of childbirth and the puerperium – symptoms described by close family members, the epidemiology of the condition and its association with mood disorders.

Vaccination Offer during the Occupational Health Surveillance Program for Healthcare Workers and Suitability to Work: An Italian Retrospective Cohort Study.

The active immunization of health care workers (HCWs) is a crucial measure to avoid nosocomial infection; nevertheless, vaccine coverage (VC) among health personnel in Italy is unsatisfactory. To improve VC in the healthcare set, the Hygiene and Occupational Medicine departments of Bari Policlinico General University Hospital applied a specific program. The operative procedure demands that in the context of the occupational medical examination, all workers are evaluated for susceptibility to vaccine-preventable diseases (VDPs), with immunization prophylaxis offered to those determined to be susceptible. This study analyzed data from workers who attended the biological risk assessment protocol from December 2017 to October 2021 (n = 1477), who were evaluated for the immune status for measles, mumps, rubella, and varicella. Among the enrolled subjects, non-protective antibody titers were higher for measles and mumps (13%), followed by rubella (11%) and varicella (8%). Appropriate vaccinations were offered to all susceptible HCWs, and HCWs were re-tested one month after immunization. The seroconversion rate after the administration of one or more booster dose(s) was over 80%. Overall, 2.5% of the subjects refused the offered vaccine(s); the main determinant of immunization compliance was younger age (aOR = 0.86; 95%CI = 0.80–0.92). Especially during the COVID-19 pandemic, VPDs may still present a hazard in nosocomial environment. Our experience suggests that, despite hospital procedures and dedicated human assets, satisfactory VC cannot be reached without the provision of federal regulations. Nevertheless, public health policymakers have to improve the promotion of vaccine prophylaxis and education to reach higher VC.