La Medicina del Lavoro
type: channel
description: La Medicina del Lavoro is a bimonthly magazine founded in 1901 by L. Devoto, and then directed by L. Preti, E. Vigliani, V. Foà, P.A. Bertazzi (Milan), and now by A. Mutti (Parma). It is owned by and is the official journal of the Italian Society of Occupational Medicine (SIML), aimed at training and updating professionals concerned with Occupational Health. Language: English Frequency: Bi-monthly (6 issues per year) Format: 20 x 27 cm ISSN: 0025-7818 eISSN: 2532-1080 La Medicina del Lavoro is indexed by: Index Medicus/MEDLINE; Embase/Excerpta Medica; the Elsevier BioBASE, Abstracts on Hygiene; Industrial Hygiene Digest; Securitè et Santè au Travail Bit-CIS; Sociedad Iberoamericana de Informaciòn Cientifica (SIIC); Science Citation Index Expanded (SciSearch); Journal Citation Report/Science Edition; ISI Web of Science; Scopus; PubMed/Medline; Portico. 2024 IMPACT FACTOR 2.0 2024 Cite Score (Scopus) 4.3 last updated 23 June 2025
publisher: Mattioli 1885
language: en
publication name: La Medicina del Lavoro
issn: 0025-7818
copyright: All Journal's articles are Open Access papers distributed under the terms of the Creative Commons Attribution License CC BY-NC 4.0 Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Reproductions with commercial intent will require written permission and payment of royalties.
items: Artificial Intelligence in Occupational Medicine: Upholding Disciplinary Integrity and Editorial Standards
items: Artificial Intelligence in Occupational Health Surveillance: Evaluating AI-Assisted ILO Classification of Radiographs of Pneumoconioses
items: Reference Values for Maximal Isometric Handgrip and Pinch Strength in Healthy Italian Adults Without Occupational Biomechanical Overload
items: Alcohol Consumption at Work in Construction Workers Employed in Small Italian Companies
items: Self-Reported Non-Auditory Effects of High Sound Pressure Levels Exposure in Academic Musicians in Uruguay
items: Thanks to our Reviewers
items: Occupational Exposure to Inhalation Anesthetics in Operating Room and Adverse Health Outcomes: A Systematic Review
items: General and Toxicologic Aspects of Occupational Fatalities in the Metropolitan Area of Lyon From 2000 to 2020, a Retrospective Study
items: Breathing the Job: Impaired Pulmonary Function in Hairdressers due to Occupational Chemical Exposure
items: Headaches in Hospital Nurses - Authors' Reply
items: Diagnostic Utility of Serum Krebs von den Lungen-6 (KL-6) and Surfactant Protein-D (SP-D) Levels in Hypersensitivity Pneumonitis
items: Where Are We Going by Applying AI Tools? Are We Going to Lose Our Jobs?
items: Effectiveness of Occupational Health Promotion Programs on Cardiometabolic risk factors: A Systematic Review and Three-Level Meta-Analysis
items: Prevalence and Multivariate Impact of Musculoskeletal Disorders on General Health, Occupational Fatigue, and Productivity in an Industrial Workforce
items: The Micronucleus Test for Occupational Safety
items: Human Biomonitoring of Butylated Hydroxytoluene (BHT) in Germany: Methods, Exposure Levels, and Health-Based Interpretation
items: From Subjects to Partners: Rethinking Research Methodologies through Citizen Science
items: Cognitive Effects of Aluminum Exposure in Cement Factory Workers: A Mini-Mental State Examination (MMSE) Assessment
items: Investigation of the Association Between COVID-19 and Hepatitis B Vaccination Among Healthcare Workers: A Cross-Sectional Study in Turkey
items: Work-Related Accidents and Their Predictors Among Delivery Drivers in Egypt: A Cross-Sectional Study
items: Occupational Risk for Headache Disorders in Female Registered Nurses. A Retrospective Study
items: Evaluation of the Hearing Function in the Orchestra Professional Musicians of the Teatro alla Scala in Milan
items: Call for Applications for the Enrico C. Vigliani Award
items: The Silent Strain: Grip Strength, and Wrist/Hand Musculoskeletal Disorders among Meat Cutters
items: Workplace Violence and Patient Management Time in the Emergency Department: An Observational Study
items: Strength and Perceived Effort in Repetitive Upper-Limb Tasks: An OCRA Method Analysis of 900 Workers
items: Occupational Asthma Due to Subtilisin: The Power of Specific Inhalation Challenge
items: Steady-State Auditory Evoked Potentials in Workers Exposed to Occupational Noise
items: Longitudinal Changes in Work Ability, Well-Being, and Psychosocial Risk Factors Among Older Workers: The ProAgeing Study
items: Neurosensory Response of the Hand and Foot to Vibration Exposure

Artificial Intelligence in Occupational Medicine: Upholding Disciplinary Integrity and Editorial Standards
type: item
subject: Editorial
  topic: section
subject: -
  topic: keywords
creator: Antonio Mutti
rights: Copyright (c) 2026 Antonio Mutti https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-22
publication date: 2026-04-22
starting page: 18996
ending page: 18996
doi: 10.23749/mdl.2026.18996

Artificial Intelligence in Occupational Health Surveillance: Evaluating AI-Assisted ILO Classification of Radiographs of Pneumoconioses
type: item
description: Background: Pneumoconioses remain an important occupational health issue, particularly in low- and middle-income countries. The International Labour Organization (ILO) Classification standardizes chest radiograph interpretation but requires trained readers and is affected by inter-reader variability. This study evaluated whether generative multimodal artificial intelligence (AI) models can approximate ILO-based diagnostic reasoning. Methods: Eighty-two chest radiographs from the official NIOSH B Reader syllabus were analysed using four AI systems (GPT-4o, GPT-5, MedGemma-4B, MedGemma-27B). Each image was evaluated with a standardized prompt based on the 2022 revised ILO guidelines using deterministic settings. Model outputs were mapped to ILO codes and compared with the official answer keys of the ILO Standard Radiograph Set used for B Reader training and examination. Performance metrics included balanced accuracy, sensitivity, specificity, precision, and Matthews correlation coefficient (MCC). Bootstrap 95% confidence intervals, McNemar’s test, and Cohen’s κ assessed performance variability and agreement. Results: All four AI models showed moderate diagnostic performance, with balanced accuracy ranging from 60.8% to 70.3%. Sensitivity remained limited (35.5%–54.9%), while specificity was consistently high (84.6%–86.2%). MedGemma-27B performed best for small opacities, GPT-5 for pleural abnormalities and for technical quality. Large opacities and rare findings were systematically under-detected. Statistical comparisons showed significant differences between models, although agreement patterns were broadly similar. Conclusion: All AI models partially followed structured ILO radiographic criteria but did not achieve expert-level performance, confirming that they cannot replace certified B Readers. Larger, real-world datasets are needed to assess their potential clinical utility as supportive tools in occupational health surveillance programs.
subject: Original articles
  topic: section
subject: ILO International Classification of Radiographs of Pneumoconioses
  topic: keywords
subject: Artificial Intelligence
  topic: keywords
subject: Occupational Medicine
  topic: keywords
creator: Antonio Baldassarre
creator: Martina Padovan
creator: Alessandro Palla
creator: Augusto Quercia
creator: Rita Leonori
creator: Stefano Dugheri
creator: Nicola Mucci
creator: Veronica Traversini
rights: Copyright (c) 2026 Antonio Baldassarre, Martina Padovan, Alessandro Palla, Augusto Quercia, Rita Leonori, Stefano Dugheri, Nicola Mucci, Veronica Traversini https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-22
publication date: 2026-04-22
starting page: 18371
ending page: 18371
doi: 10.23749/mdl.2026.18371

Reference Values for Maximal Isometric Handgrip and Pinch Strength in Healthy Italian Adults Without Occupational Biomechanical Overload
type: item
description: Background: Handgrip strength (HGS) and pinch strength are key indicators of hand function with relevant clinical and ergonomic implications. In Italy, normative reference values based on combined measurements of grip and pinch strength in healthy adults not exposed to upper-limb biomechanical overload are currently lacking. The primary aim of this cross-sectional study was to provide descriptive reference values for HGS and three pinch types, stratified by sex and age group, in a healthy Italian adult population (18–65 years) not exposed to occupational biomechanical overload. The secondary aim was to investigate the influence of sex, age, body mass index (BMI), and hand dominance, as well as the relationships among strength measures. Methods: A total of 813 participants (319 men and 494 women) were evaluated. Measurements were performed using a calibrated Baseline® hand dynamometer and pinch gauge according to the standardized protocol of the American Society of Hand Therapists (ASHT). Results: Men showed higher strength values than women across all measures. The association between body mass index (BMI) and strength was more pronounced and consistent in women than in men, reaching statistical significance only for selected pinch measures in males. Strength values showed a non-linear distribution across age groups, with peak levels observed between 30 and 49 years in men and between 40 and 49 years in women. Hand dominance showed a selective effect in both sexes, influencing specific pinch tasks but not handgrip strength. Conclusions: This study provides the first national joint normative dataset for intergrip and pinch strength in healthy Italian adults aged 18–65 years not exposed to occupational biomechanical overload. These findings may support clinical and occupational assessments and contribute to the development of broader Italian normative reference tables.
subject: Original articles
  topic: section
subject: handgrip strength; pinch strength; reference values; occupational health; biomechanical load
  topic: keywords
creator: Emma Sala
creator: Nicola Riolfi
creator: Alessandro De Bellis
creator: Andrea Bisioli
creator: Cesare Tomasi
creator: Francesco Romagnoli
creator: Giuseppe De Palma
rights: Copyright (c) 2026 Emma Sala, Nicola Riolfi, Alessandro De Bellis, Andrea Bisioli, Cesare Tomasi, Francesco Romagnoli, Giuseppe De Palma https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-22
publication date: 2026-04-22
starting page: 18834
ending page: 18834
doi: 10.23749/mdl.2026.18834

Alcohol Consumption at Work in Construction Workers Employed in Small Italian Companies
type: item
description: Background: Alcohol consumption is an important occupational risk factor, especially in safety-sensitive sectors such as construction. Alcohol-related psychomotor impairment may increase the risk of workplace injuries and may also affect the safety of third parties. However, data on alcohol-related behaviors, workers’ risk perception, and alcohol-focused health surveillance among Italian construction workers are still limited. Methods: We conducted a cross-sectional survey between September 2023 and June 2024 in 315 construction workers employed in small Italian companies. All participants performed work activities for which local legislation mandates alcohol-use and alcohol-dependence checks as part of occupational health surveillance. Data were collected through an anonymous 27-item questionnaire exploring sociodemographic characteristics, alcohol consumption (AUDIT-C; cut-off ≥5 for men and ≥4 for women), alcohol use at work, knowledge of national regulations, alcohol-related risk perception, and accident/injury indicators. Nonparametric tests and multivariable linear regression were used to identify factors associated with AUDIT-C scores. Logistic regression analyses examined associations between perceived alcohol-related risks and awareness of, and exposure to, alcohol-dependence checks during health surveillance. Results: The sample was predominantly male (274/315; 86.98%), and 26.03% of workers were aged 46–55 years. The mean AUDIT-C score was 2.85±2.49 (3.13±2.47 in men; 0.95±1.75 in women); 32.7% of workers screened positive, mainly men. Alcohol consumption during the work shift was reported by 1.9% of participants (7.94% occasionally), and during breaks by 5.08% (19.37% occasionally). Most workers were aware of the workplace alcohol ban (90.48%), and 83.49% reported having undergone alcohol-related checks. Higher AUDIT-C scores were associated with alcohol consumption during the work shift and occasional drinking during breaks. Conclusions: Although averag…
subject: Original articles
  topic: section
subject: AUDIT-C; construction workers; occupational health surveillance; alcohol use; risk perception; workplace sa-fety; injury prevention
  topic: keywords
creator: Ivan Borrelli
creator: Luca Fontana
creator: Antongiulio Perrotta
creator: Paolo Zita
creator: Mauro Fedele
creator: Ivo Iavicoli
rights: Copyright (c) 2026 Ivan Borrelli, Luca Fontana, Antongiulio Perrotta, Paolo Zita, Mauro Fedele, Ivo Iavicoli https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-22
publication date: 2026-04-22
starting page: 18756
ending page: 18756
doi: 10.23749/mdl.2026.18756

Self-Reported Non-Auditory Effects of High Sound Pressure Levels Exposure in Academic Musicians in Uruguay
type: item
description: Background: While hearing loss is the most emblematic effect of exposure to high sound pressure levels, it is not neither the first nor the only one. This article explores self-reported effects of exposure to high sound pressure levels among a population of 306 academic musicians (singers, choir members and instrumentalists) in Uruguay. Methods: A special anamnesis form was prepared for use in interviews of each of the participants. The collected information was anonymized and processed. Some interesting results were found, both through direct processing and PCA analysis. Results: Most participants reported several non-auditory effects. These were classified by sex, age, and role (singer or instrumentalist, voice type, or played instrument). Conclusions: Among the reported effects, the most prevalent were muscle contractures, fatigue/tiredness, difficulty sleeping, and noise sensitivity, followed by arthralgia and headaches. The most frequent effects in women were muscle contracture (86%), followed by tiredness/fatigue, noise susceptibility, and tinnitus. The most frequent effects in men were muscle contracture (68%), followed by tinnitus, noise susceptibility, and irritability after musical activity. It was possible to establish some “effects profiles” according to instrument and gender. For example, woodwind players experience muscle contracture, tinnitus, post-musical activity irritability, noise susceptibility, and decreased performance, while soprano singers have a higher prevalence of muscle contracture, tiredness/fatigue, noise sensitivity, difficulty sleeping, arthralgia, digestive disorders, headache, tinnitus, and vertigo. They are the second most affected category of musicians, according to their effect profile.
subject: Original articles
  topic: section
subject: musicians' health
  topic: keywords
subject: sound exposure effects
  topic: keywords
subject: extra-auditory effects of noise
  topic: keywords
creator: Alice Elizabeth González
creator: Fernando Tomasina
creator: Julián D. Ortiz Umaña
creator: Lady Carolina Ramírez
creator: Bettina Tellechea
creator: Adriana Pisani
rights: Copyright (c) 2026 Alice Elizabeth González, Fernando Tomasina, Julián D. Ortiz Umaña, Lady Carolina Ramírez, Bettina Tellechea, Adriana Pisani https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-22
publication date: 2026-04-22
starting page: 18730
ending page: 18730
doi: 10.23749/mdl.2026.18730

Thanks to our Reviewers
type: item
subject: Acknowledgement to Scientific Reviewers
  topic: section
subject: -
  topic: keywords
creator: La Redazione
rights: Copyright (c) 2026 La Redazione https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-24
publication date: 2026-02-24
starting page: 18655
ending page: 18655

Occupational Exposure to Inhalation Anesthetics in Operating Room and Adverse Health Outcomes: A Systematic Review
type: item
description: Summary: Volatile anesthetics (VA) are essential agents for inducing and maintaining unconsciousness during specific surgical procedures, but they pose several health risks for exposed workers. The aim of the systematic review was to assess the effects of long-term VA occupational exposure in operating rooms. The review was conducted in accordance with the PRISMA Statement, and the search was conducted in PubMed, Scopus, and Web of Science to identify articles published between January 1, 1994, and December 31, 2024, that reported data from observational, quasi-experimental, and experimental studies. The protocol was registered in PROSPERO (ID: CRD42024500838). The quality of the studies was assessed using the standard Newcastle-Ottawa Scale versions for cohort and case–control studies, and an adapted version for cross-sectional studies. A total of 65 studies were included. Adverse effects were categorized into four groups: reproductive and Adverse pregnancy or offspring outcomes, neurotoxic alterations, laboratory parameter changes, and cyto- and genotoxicity. Overall, no significant associations were found between VA exposure and reproductive or pregnancy outcomes. One study reported neurological alterations (prolonged reaction times). Additionally, some studies have documented impairments in immune function and minor alterations in renal and hepatic function parameters. Finally, several studies indicated an increased risk of genotoxicity and oxidative stress. Given this evidence, protective measures and health surveillance for exposed workers remain crucial preventive measures.
subject: Reviews, Commentaries, Perspectives
  topic: section
subject: Volatile anaesthetics; Operating room; Exposure; Adverse health effects; Systematic review
  topic: keywords
creator: Andrea Caronna
creator: Katia Vitale
creator: Laura Ciccariello
creator: Andrea De Giorgi
creator: Sergio Gazzanelli
creator: Lidia Ricci
creator: Matteo Vitali
creator: Carmela Protano
rights: Copyright (c) 2026 Andrea Caronna, Katia Vitale, Laura Ciccariello, Andrea De Giorgi, Sergio Gazzanelli, Lidia Ricci, Matteo Vitali, Carmela Protano https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-24
publication date: 2026-02-24
starting page: 17428
ending page: 17428
doi: 10.23749/mdl.2026.17428

General and Toxicologic Aspects of Occupational Fatalities in the Metropolitan Area of Lyon From 2000 to 2020, a Retrospective Study
type: item
description: Over the past two decades, fatal workplace accidents have accounted for between 300,000 and 400,000 deaths a year worldwide. The aim of this study was to investigate the general characteristics and the toxicological profile of work-related deaths. A descriptive retrospective study was carried out on occupational-related deaths occurred in the Lyon metropolitan area from 2000 to 2020 from the autopsy reports of the University Institute of Legal Medicine. A total of 476 cases of work-related deaths were identified, of which 91% were men. The median age was 48 years, 44% of the deaths were due to cardiac origin, 34% to mechanical accidents and 18% to suicide. 16 homicides were also recorded. The cause of death differed significantly between socio-professional categories: suicide was the main cause of death among managers & intellectual occupations (50%), cardiovascular death among non-manual elementary workers (53%), manual elementary workers (49%) and craftsmen, shop keepers & business owners (33%), and physical accidents among farmers (50%) and manual elementary workers (48%). The main cause of death varied by sector: physical accidents in construction (61%), cardiovascular events in transportation and storage (67%) and manufacturing (51%). 27% (n = 130) tested positive for at least one psychoactive substance, including 75 for alcohol, 43 for sedative anxiolytics and 33 for cannabis. These results may help occupational health professionals to design policies and campaigns to prevent deaths among the workers concerned. Specific studies to assess the proportion of fatal accidents attributable to the use of alcohol, cannabis or benzodiazepines could contribute to reducing work-related deaths.
subject: Original articles
  topic: section
subject: autopsy
  topic: keywords
subject: Work accidents
  topic: keywords
subject: Cardiovascular disease
  topic: keywords
subject: alcohol
  topic: keywords
subject: fatal occupational accidents
  topic: keywords
creator: Céline Lamouroux
creator: Guillaume Pouliquen
creator: Emmanuel Fort
creator: Marie Epain
creator: Florent Marfaing
creator: Barbara Charbotel
creator: Laurent Fanton
rights: Copyright (c) 2026 Céline Lamouroux, Guillaume Pouliquen, Emmanuel Fort, Marie Epain, Florent Marfaing, Barbara Charbotel, Laurent Fanton https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-24
publication date: 2026-02-24
starting page: 17546
ending page: 17546
doi: 10.23749/mdl.2026.17546

Breathing the Job: Impaired Pulmonary Function in Hairdressers due to Occupational Chemical Exposure
type: item
description: Background: Hairdressers are occupationally exposed to harmful factors in the working environment and many cosmetic products. During the professional use of these products, there is exposure to many irritating, allergic, and carcinogenic chemicals, mainly through the skin and respiratory tract, and it is known that these occupational exposures are much more frequent and long-lasting than personal exposures. Hairdressing is one of the occupational groups with a high risk of respiratory diseases. In this study, we aimed to determine the extent to which the hairdressing profession affects respiratory functions. Methods: The present study included 50 people who had worked in hairdressing for at least three years, especially with hair products, had not been diagnosed with respiratory disease before this job, and did not smoke, and 50 healthy people with similar demographic characteristics. All respiratory complaints and sociodemographic information of the hairdressers were determined. Pulmonary function tests (PFTs) were performed on hairdressers and a healthy group, including FEV1, FVC, PEF, and FEV1/FVC ratio. Results: In the present study, we found that the hairdressing profession significantly increased the risk of respiratory symptoms. In addition, the increase in working hours as a hairdresser was associated with increased respiratory complaints, while hairdressers showed a statistically significant decrease in PFT values compared to the healthy group. Conclusions: Exclusion of smoking in our study reveals the occupational exposure more clearly. Our study provides additional evidence of a possible significant association between chemical exposure and increased respiratory symptom prevalence and decreased lung function.
subject: Original articles
  topic: section
subject: Occupational Disease
  topic: keywords
subject: Respiratory System
  topic: keywords
subject: Hairdresser
  topic: keywords
creator: Zeliha Demir Giden
creator: Elif Demir
creator: Ramazan Giden
creator: Hasret Yağmur Sevinç Akın
rights: Copyright (c) 2026 Zeliha Demir Giden, Elif Demir, Ramazan Giden, Hasret Yağmur Sevinç Akın https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-24
publication date: 2026-02-24
starting page: 18075
ending page: 18075
doi: 10.23749/mdl.2026.18075

Headaches in Hospital Nurses - Authors' Reply
type: item
subject: Letters to the Editor
  topic: section
subject: tension-type headaches
  topic: keywords
subject: migraine
  topic: keywords
subject: workload
  topic: keywords
subject: female nurses
  topic: keywords
subject: stress
  topic: keywords
creator: Carla Scorza
creator: Fulvio Scorza
creator: Josef Finisterer
creator: Elif Reyhan Sahin
creator: Gabriele d'Ettorre
creator: Andrea Baldassarre
creator: Roberta Tornese
rights: Copyright (c) 2026 Carla Scorza, Fulvio Scorza, Josef Finisterer, Elif Reyhan Sahin, Gabriele d'Ettorre, Andrea Baldassarre, Roberta Tornese https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-24
publication date: 2026-02-24
starting page: 18423
ending page: 18423

Diagnostic Utility of Serum Krebs von den Lungen-6 (KL-6) and Surfactant Protein-D (SP-D) Levels in Hypersensitivity Pneumonitis
type: item
description: Background: This study aimed to investigate the diagnostic and prognostic values of serum Krebs von den Lungen-6 (KL-6) and ve Surfactant Protein-D (SP-D) levels in patients with hypersensitivity pneumonitis (HP). Methods: Serum samples were collected from patients diagnosed with HP and from a healthy control group. KL-6 and SP-D levels were measured using the ELISA method. HP cases were further compared according to fibrotic and non-fibrotic subgroups, as well as whether they were receiving treatment or not. The relationships between respiratory function tests (DLCO, FEV₁, FVC) and biomarker levels were examined. Results: Both KL-6 (median 5.95 ng/ml vs 5.4 ng/ml, p<0.001) and SP-D (median 14.87 ng/ml vs 14.72 ng/ml, p<0.05) levels were significantly higher in HP patients than in the control group. In non-fibrotic HP patients, KL-6 levels were higher than in the fibrotic group (median 6.07 ng/ml vs 5.62 ng/ml, p<0.05), while no significant difference was observed for SP-D (p=0.71). KL-6 levels were significantly higher in untreated cases compared to treated cases (median 6.30 ng/ml vs 5.65 ng/ml, p<0.01), while the difference in SP-D was not significant (p=0.26). Conclusion: KL-6 emerges as a sensitive biomarker in the diagnosis of HP, assessing of disease activity, and monitoring treatment response. SP-D, although reflecting inflammatory processes, seems to be have limitations in evaluating fibrotic progression.
subject: Original articles
  topic: section
subject: Krebs von den Lungen-6 (KL-6)
  topic: keywords
subject: Surfactant Protein (SP-D)
  topic: keywords
subject: Hypersensitivity Pneumonitis
  topic: keywords
creator: Asuman Aslan Kara
creator: Adem Koyuncu
creator: Gülden Sarı
creator: Tuğçe Şahin Özdemirel
creator: Berna Akıncı Özyürek
creator: Cebrail Şimşek
rights: Copyright (c) 2026 Asuman Aslan Kara, Adem Koyuncu, Gülden Sarı, Tuğçe Şahin Özdemirel, Berna Akıncı Özyürek, Cebrail Şimşek https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-22
publication date: 2026-04-22
starting page: 18283
ending page: 18283
doi: 10.23749/mdl.2026.18283

Where Are We Going by Applying AI Tools? Are We Going to Lose Our Jobs?
type: item
subject: Editorial
  topic: section
subject: -
  topic: keywords
creator: Antonio Mutti
rights: Copyright (c) 2025 Antonio Mutti https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-16
publication date: 2025-12-16
starting page: 18255
ending page: 18255
doi: 10.23749/mdl.v116i6.18255

Effectiveness of Occupational Health Promotion Programs on Cardiometabolic risk factors: A Systematic Review and Three-Level Meta-Analysis
type: item
description: Background: This study aimed to evaluate the effectiveness of workplace-based health promotion programs targeting cardiometabolic risk factors. Methods: We conducted a systematic review and three-level random-effects meta-analysis following PRISMA guidelines, covering studies published from January 2019 to September 2024. Eligible studies included randomized controlled trials (RCTs) and quasi-experimental (QE) designs assessing workplace interventions to reduce cardiometabolic risks in adult workers. Twelve outcomes were considered. Subgroup analyses and meta-regressions were performed to explore sources of heterogeneity. Certainty of evidence was evaluated using GRADE assessment tool. Results: Forty-four studies (30 RCTs, 14 QE) involving 49,813 participants were included. Significant improvements were found in nine of twelve outcomes. These included reductions in BMI (–0.61kg/m²; [–0.93; –0.29]), body weight (–2.43kg; [–3.48; –1.38]), waist circumference (–3.46cm; [–5.21; –1.71]), body fat (–1.58%; [–2.40; –0.76]), systolic (–3.75mmHg: [–5.67; –1.82]) and diastolic (mmHg; [-3.58; -1.29]) blood pressure, LDL cholesterol (–5.9 mg/dL; [–11.6; –0.12]), and an increase in HDL cholesterol (2.76 mg/dL; [0.42; 5.09]). All significant outcomes were supported by moderate-to-high certainty evidence except LDL cholesterol, which was rated very low. Non-significant results were observed for total cholesterol, triglycerides and FBG. High heterogeneity was observed. Pre-existing health conditions, author and duration of intervention partially explained between-study heterogeneity. Conclusions: Workplace health promotion programs were associated with improvements in various cardiometabolic health indicators. Greater effectiveness was observed in interventions targeting high-risk populations, delivered by physicians or qualified health professionals, and implemented over shorter durations. Findings support the integration of such programs into occupational health policies and broa…
subject: Reviews, Commentaries, Perspectives
  topic: section
subject: Prevention strategies
  topic: keywords
subject: health education and promotion
  topic: keywords
subject: occupational medicine
  topic: keywords
subject: cardiovascular disease
  topic: keywords
subject: systematic review
  topic: keywords
creator: Alessandro Godono
creator: Veruscka Leso
creator: Ettore Paradisi
creator: Elisa Carena
creator: Maria Vittoria Picciaiola
creator: Anna Schneider-Kamp
creator: Catalina Ciocan
creator: Fabrizio Bert
creator: Franco Veglio
creator: Paolo Boffetta
creator: Ivo Iavicoli
rights: Copyright (c) 2025 Alessandro Godono, Veruscka Leso, Ettore Paradisi, Elisa Carena, Maria Vittoria Picciaiola, Anna Schneider-Kamp, Catalina Ciocan, Fabrizio Bert, Franco Veglio, Paolo Boffetta, Ivo Iavicoli https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-16
publication date: 2025-12-16
starting page: 18179
ending page: 18179
doi: 10.23749/mdl.v116i6.18179

Prevalence and Multivariate Impact of Musculoskeletal Disorders on General Health, Occupational Fatigue, and Productivity in an Industrial Workforce
type: item
description: Background: Musculoskeletal disorders represent a leading occupational health challenge in heavy‐industry settings, yet their combined impact on workers’ general health, fatigue, and productivity remains underexplored. This study aims to quantify the relationship between multisite musculoskeletal symptom burden and key health and performance outcomes among copper‐industry employees. Methods: A cross-sectional survey of 585 workers used the Standardized Nordic Musculoskeletal Questionnaire, the 28-item General Health Questionnaire, the SOFI-20 fatigue inventory, and the HPQ-26 productivity survey. Spearman’s rank correlation was used to examine bivariate relationships, and multivariable linear regression models adjusting generally for demographic, work-related, and psychosocial factors were employed to estimate the independent effect of the number of painful sites on health, fatigue, and productivity outcomes. Results: Fifty-seven percent of workers reported pain in at least one region during the preceding 12 months, with an average of 2.6 painful sites per person (standard deviation 2.4). The number of painful sites showed a moderate positive correlation with poorer general health scores (ρ = 0.43, p < 0.001) and higher fatigue scores (ρ = 0.53, p < 0.001), and a moderate negative correlation with productivity ratings (ρ = –0.30, p < 0.001). In adjusted regression analyses, each additional painful site was associated with a 1.9-point worsening in general health score (95% CI 1.5 to 2.2), an 8.4-point increase in fatigue score (95% CI 7.3 to 9.6), and a 1.6-point decrease in productivity score (95% CI –2.0 to –1.2), all with p-values < 0.001. Conclusions: There is a clear dose–response relationship between the number of painful anatomical sites and declines in health, increases in fatigue, and reductions in productivity among copper-industry workers. To address this multifaceted impact, interventions should integrate ergonomic workstation design, task rotation, optim…
subject: Original articles
  topic: section
subject: Musculoskeletal Disorders
  topic: keywords
subject: Occupational Fatigue
  topic: keywords
subject: Productivity
  topic: keywords
subject: Copper Industry
  topic: keywords
subject: Occupational Health
  topic: keywords
creator: Alireza Choobineh
creator: Mohammad Karami
creator: Yaser Sahranavard
creator: Mohammad Reza Fakhraei
creator: Fatemeh Ghanbari Mohammad
creator: Fatemeh Alibeygian
creator: Somayeh Hossainie Nasab
creator: Azam Alizadeh
creator: Mina Shahbazi
creator: Reza Tahmasebi
rights: Copyright (c) 2026 Alireza Choobineh, Mohammad Karami, Yaser Sahranavard, Mohammad Reza Fakhraei, Fatemeh Ghanbari Mohammad, Fatemeh Alibeygian, Somayeh Hossainie Nasab, Azam Alizadeh, Mina Shahbazi, Reza Tahmasebi https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-24
publication date: 2026-02-24
starting page: 18043
ending page: 18043
doi: 10.23749/mdl.2026.18043

The Micronucleus Test for Occupational Safety
type: item
description: Although less commonly used than internal dose indicators, biological effect indicators can be valuable for Risk Assessment. Among the numerous biomarkers used to date, those that indicate DNA damage could be especially useful for occupational safety, as they predict the risk of carcinogenesis. The most common among these assays is the micronucleus test. Unfortunately, this test cannot be performed on human erythrocytes; to apply it to lymphocytes, it requires invasive blood sampling, limiting its use to scientific research. We have developed a new method that enables the micronucleus test to be conducted in a rapid, non-invasive, and cost-effective manner. The test is performed on immature erythrocytes (reticulocytes) in human blood smears collected via a finger prick and stained with Acridine Orange. This new protocol allows the micronucleus test to be applied to human blood samples in a manner compatible with occupational safety procedures.
subject: Reviews, Commentaries, Perspectives
  topic: section
subject: Biomonitoring
  topic: keywords
subject: Carcinogen
  topic: keywords
subject: early detection
  topic: keywords
subject: erythrocyte
  topic: keywords
subject: Howell-Jolly Body
  topic: keywords
subject: Mutagenicity
  topic: keywords
subject: Reticulocyte
  topic: keywords
subject: Risk Assessment
  topic: keywords
subject: Work
  topic: keywords
creator: Ion Udroiu
creator: Claudia Giliberti
creator: Antonella Sgura
rights: Copyright (c) 2026 Ion Udroiu, Claudia Giliberti, Antonella Sgura https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-22
publication date: 2026-04-22
starting page: 17996
ending page: 17996
doi: 10.23749/mdl.2026.17996

Human Biomonitoring of Butylated Hydroxytoluene (BHT) in Germany: Methods, Exposure Levels, and Health-Based Interpretation
type: item
description: Butylated hydroxytoluene (BHT) is an antioxidant which is used in a vast array of consumer products. The most sensitive toxicological endpoints of BHT are hepatic enzyme induction and reproductive effects. Because of its wide dispersive use and its potential relevance for human health, BHT was included in the human biomonitoring (HBM) cooperation between the German Federal Ministry for the Environment and the German Chemical Industry Association. An analytical method for the sensitive determination of 3,5‑di‑tert‑butyl‑4‑hydroxybenzoic acid (BHT acid)—an oxidized metabolite of BHT which is excreted in urine—was developed. This method was then applied in several environmental and occupational HBM surveys, and BHT acid was detected in the vast majority of samples. Health-based guidance values as well as reference values for the interpretation of HBM results were derived for BHT acid. Thus, a fine-grained picture of the current state of BHT exposure in different populations in Germany is now available. Uncertainties arise from large variability in the fraction of dose excreted as BHT acid and incomplete understanding of human metabolism, which limits reverse dosimetry and risk assessment, particularly for children.
subject: Reviews, Commentaries, Perspectives
  topic: section
subject: Antioxidant
  topic: keywords
subject: Urinary Biomarker
  topic: keywords
subject: Analytical Method
  topic: keywords
subject: Occupational Medicine
  topic: keywords
subject: Health-based Guidance Value
  topic: keywords
subject: Environmental Exposure
  topic: keywords
subject: Reference Values
  topic: keywords
creator: Christoph Schmidtkunz
creator: Isabell Schönrath
creator: Aline Murawski
creator: Katja Küpper
creator: Nora Lemke
creator: Till Weber
creator: Gabriele Leng
creator: Marike Kolossa-Gehring
rights: Copyright (c) 2025 Christoph Schmidtkunz, Isabell Schönrath, Aline Murawski, Katja Küpper, Nora Lemke, Till Weber, Gabriele Leng, Marike Kolossa-Gehring https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-16
publication date: 2025-12-16
starting page: 18008
ending page: 18008
doi: 10.23749/mdl.v116i6.18008

From Subjects to Partners: Rethinking Research Methodologies through Citizen Science
type: item
description: The article will first introduce a general definition of Citizen Science (section 1), followed by an excursion of its foundations and of the different understandings and ways of applying it, with examples drawn from diverse research and policy areas (section 2). It will then focus more closely on the field of health and the environment (section 3), including occupational medicine (subsection 3.1), community response to environmental risks (section 3.2), biomonitoring (sub-section 3.3), and human biomonitoring (subsection 3.4). Section 4 will address some of the advantages (section 4.1) and challenges (section 4.2) of adopting CS in research and policy. Finally, section 5 will trace the legislative and normative background of participatory approaches and points to the challenges ahead.
subject: Reviews, Commentaries, Perspectives
  topic: section
subject: Citizen Science, participation, integration, inter-disciplinarity, trans-disciplinarity, occupational medicine, biomonitoring, human biomonitoring.
  topic: keywords
creator: Bruna De Marchi
rights: Copyright (c) 2025 Bruna De Marchi https://creativecommons.org/licenses/by-nc/4.0
date: 2025-10-24
publication date: 2025-10-24
starting page: 18007
ending page: 18007
doi: 10.23749/mdl.v116i5.18007

Cognitive Effects of Aluminum Exposure in Cement Factory Workers: A Mini-Mental State Examination (MMSE) Assessment
type: item
description: Background: Aluminum (Al) is a widely encountered heavy metal with known neurotoxic effects. Occupational exposure, particularly in industrial settings, may impair cognitive functions. This study aimed to evaluate the relationship between Al exposure and cognitive function. Methods: A retrospective study was conducted at Gazi University Faculty of Medicine Hospital, Occupational Diseases Outpatient Clinic, between December 5, 2024, and January 5, 2025. The exposed group consisted of 20 male cement factory workers with elevated urinary Al expressed as a function of creatinine, and the control group included 40 age-matched males without occupational Al exposure (1:2 matching). Cognitive status was assessed using the Mini Mental State Examination (MMSE). Urinary Al levels were measured by inductively coupled plasma mass spectrometry (ICP-MS). Statistical analyses were performed with SPSS 29.0. Results: The mean MMSE score was significantly lower in the exposed group compared with controls (24.3±3.7 vs. 28.5±2.3, p<0.001). Subscale scores for orientation, attention/calculation, recall, and language were also lower in exposed workers. All such workers had elevated aluminum (mean 42.3±21.4 mcg/g creatinine). Urinary Al was positively correlated with working duration (r=0.453, p=0.045) and negatively correlated with MMSE (r=-0.486, p=0.030) and orientation scores (r=-0.494, p=0.027). Conclusion: Workers occupationally exposed to aluminum exhibited significantly lower cognitive performance than non-exposed controls. Higher urinary Al levels were associated with poorer cognitive outcomes, suggesting neurotoxic effects of aluminum and underscoring the importance of preventive strategies and cognitive monitoring in exposed populations.
subject: Original articles
  topic: section
subject: Occupational aluminium exposure
  topic: keywords
subject: Cognitive function
  topic: keywords
subject: MMSE
  topic: keywords
subject: Biomarker
  topic: keywords
creator: Fatma Bozdağ
creator: Sultan Pınar Çetintepe
creator: Mümüne Bozdağ Kiraz
creator: Sevgi Suna Karatay-Rassmus
creator: Mustafa Necmi İlhan
rights: Copyright (c) 2026 Fatma Bozdağ, Sultan Pınar Çetintepe, Mümüne Bozdağ Kiraz, Sevgi Suna Karatay-Rassmus, Mustafa Necmi İlhan https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-22
publication date: 2026-04-22
starting page: 18002
ending page: 18002
doi: 10.23749/mdl.2026.18002

Investigation of the Association Between COVID-19 and Hepatitis B Vaccination Among Healthcare Workers: A Cross-Sectional Study in Turkey
type: item
description: Backgrounds: Vaccination is a cornerstone of public health. While COVID-19 vaccination became globally prioritized during the pandemic, Hepatitis B immunization has remained a mandatory occupational requirement in Turkey, particularly among healthcare workers (HCWs). This study evaluated Hepatitis B immunization and factors associated with COVID-19 vaccination among Turkish HCWs. Methods: A retrospective cross-sectional study was conducted between February 1 and August 15, 2024, at Mersin City Training and Research Hospital. Employees and trainee students who underwent periodic health examinations were included. Participants were grouped as physicians, non-physician HCWs, and non-healthcare professionals. Data included demographics, vaccination history, hematological and biochemical parameters, and clinical characteristics. Logistic regression identified factors associated with COVID-19 vaccination status. Results: Of 4,048 participants, 92.1% received at least one COVID-19 vaccine dose and 90.0% were vaccinated against Hepatitis B. Physicians demonstrated the highest coverage for both vaccines. Male gender (OR=1.37, 95% CI: 1.04–1.80), non-physician HCW status (OR=2.51, 95% CI: 1.33–4.75), non-healthcare professional status (OR=2.99, 95% CI: 1.55–5.77), and behaviorally linked elevated platelet count (OR=1.54, 95% CI: 1.04–2.28) were independently associated with COVID-19 non-vaccination. A prior history of Hepatitis B vaccination showed a strong protective effect against COVID-19 non-vaccination (OR=0.30, 95% CI: 0.23–0.40). Conclusions: Vaccine uptake varied across occupational groups, with physicians achieving the highest rates. Prior compliance with mandatory Hepatitis B vaccination was positively associated with COVID-19 vaccine acceptance, emphasizing the role of previous immunization behavior in new vaccine adoption. Occupational health policies integrating vaccination counseling and follow-up are essential to improve coverage among non-physician HCWs.
subject: Original articles
  topic: section
subject: COVID-19
  topic: keywords
subject: Hepatitis B
  topic: keywords
subject: vaccine
  topic: keywords
subject: healthcare worker
  topic: keywords
creator: Seval Müzeyyen Ecin
creator: Abdulsamet Sandal
rights: Copyright (c) 2026 Seval Müzeyyen Ecin, Abdulsamet Sandal https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-24
publication date: 2026-02-24
starting page: 17965
ending page: 17965
doi: 10.23749/mdl.2026.17965

Work-Related Accidents and Their Predictors Among Delivery Drivers in Egypt: A Cross-Sectional Study
type: item
description: Background: The rapid growth of the delivery sector, driven by online shopping and the COVID-19 pandemic, has raised safety concerns for delivery drivers, particularly work-related accidents and injuries. This study aimed to estimate the frequency of work-related accidents and injuries among delivery drivers and to identify potential predictors associated with these accidents in Egypt. Methods: A descriptive cross-sectional study with an analytical component was conducted among 172 delivery drivers recruited from gathering areas in Mansoura, Egypt. Participants were interviewed using a semi-structured questionnaire. Results: Among participants, 57.0% reported at least one work-related road accident during their career, with most accidents (91.8%) resulting from collisions with other vehicles. All injured drivers sustained at least one post-accident injury, most commonly contusions (93.9%). The lower limbs were the most frequently affected body parts (80.6%). After adjusting for confounders, the multivariable logistic regression analysis revealed that the following workplace exposure factors were significantly independent predictors of work-related accidents: being a university student or graduate (AOR = 2.86, 95% CI: 1.35-6.08), having more than five years of driving experience (AOR = 4.62, 95% CI: 2.15-9.94), and using mobile phones while driving (AOR =3.22, 95% CI: 1.56-6.64). Conclusions: This study showed a high frequency of work-related road accidents among delivery drivers in Egypt. Key predictors included higher education, extensive driving experience, and mobile phone use while driving. These findings underscore the need for targeted interventions, including safety training, regulation of mobile phone use, and awareness campaigns, to mitigate accident risk among delivery drivers.
subject: Original articles
  topic: section
subject: delivery
  topic: keywords
subject: driver
  topic: keywords
subject: work-related accident
  topic: keywords
subject: injuries
  topic: keywords
subject: predictors
  topic: keywords
creator: Omnia Ahmed Mahmoud Yousef
creator: Mohamed El-Helaly
creator: Adel El-Wehedy
creator: Khadija Abdel Fattah Denewar
rights: Copyright (c) 2026 Omnia A. M. Yousef, Mohamed El-Helaly, Adel El-Wehedy, Khadija A. F. Denewar https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-24
publication date: 2026-02-24
starting page: 17721
ending page: 17721
doi: 10.23749/mdl.2026.17721

Occupational Risk for Headache Disorders in Female Registered Nurses. A Retrospective Study
type: item
description: Background: Prevention of headache disorders (HDs) among healthcare workers in hospital settings remains a challenge for organizations and employees worldwide. The goals of the present retrospective study were both to analyze the 1-year prevalence of any primary HDs among female registered nurses (RNs) employed in hospital settings and to investigate the relationship between occupational risk factors and HDs. Methods: We analyzed the occupational medicine database of RNs employed in a large hospital. The sample included 975 female RNs; the diagnostic criteria were based on the International Classification of Headache Disorders, 3rd edition (beta version). Results: One-year prevalence of any HD was 45.9%; tension-type headache (TTH) was the most commonly reported headache type (by 25.6% of participants), followed by migraine (17.5%). No association was found between the different headache types and work schedules; TTH was linked to age ≥40 years (OR=1.91; 95% CI=1.41-2.72), duration of service ≥15 years (OR=1.61; 95% CI=1.24-2.38), and number of night shifts >5 per month (OR=1.71; 95% CI=1.09-2.68). A high level of WRS was a significant predictor of TTH. Conclusions: We found a link between TTH and modifiable risk factors at both the individual and organizational levels. These findings suggest interventions in occupational settings to minimize the occurrence of TTH among RNs. Policy-makers and employers should implement preventive measures to reduce the incidence of HDs among RNs by minimizing modifiable risk factors associated with increased occupational risk.
subject: Original articles
  topic: section
subject: Headache disorder; Shift-work; Work-related stress;
  topic: keywords
creator: Gabriele d'Ettorre
creator: Roberta Tornese
creator: Andrea Baldassarre
rights: Copyright (c) 2025 Gabriele d'Ettorre; Roberta Tornese; Andrea Baldassarre https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-16
publication date: 2025-12-16
starting page: 17715
ending page: 17715
doi: 10.23749/mdl.v116i6.17715

Evaluation of the Hearing Function in the Orchestra Professional Musicians of the Teatro alla Scala in Milan
type: item
description: Background: This study was conducted to determine whether occupational exposure to high sound levels, typical of an opera orchestra, can cause hearing loss. Methods: The orchestra professors at Teatro alla Scala in Milan underwent ear examinations, pure-tone audiometry, and other audiological tests. The hearing thresholds of these musicians were compared with those of populations not exposed to occupational noise and with populations exposed to industrial noise. Noise exposure levels were estimated through a phonometric survey conducted at our theater in 2011, which largely confirmed the exposure levels outlined in European guidelines. Results: The average audiometric thresholds of the orchestra musicians were slightly worse than the median thresholds of a healthy, non-noise-exposed population. In three subjects (2.8%), bilateral hearing impairment (PTA 0.5, 1, 2, 3, 4 kHz > 25 dB HL) was observed; in four violinists (3.7%) left unilateral hearing impairment was found. This rate is lower than the expected risk from similar industrial noise exposures. Comparing these audiometries with those from about ten years earlier shows that the hearing threshold decline in the study group is comparable to that caused by presbycusis. Conclusions: The risk of noise-induced hearing loss among professional orchestra musicians appears lower than predicted by the UNI ISO 1999:2015 standard. A few cases of hearing loss due to chronic acoustic trauma were noted, particularly among violinists who demonstrated a higher incidence of left unilateral hearing loss. The high levels of sound exposure and the presence of some hearing loss cases highlight the need for targeted preventative measures in this work activity.
subject: Original articles
  topic: section
subject: Opera; Music; Orchestral Professional Musicians; Musicians Hearing Threshold; Hypoacusis; Hearing Disorders; Occupational Workers; Noise-Induced Hearing Loss
  topic: keywords
creator: Terenzio Cassina
creator: Alessia Tomasin
creator: Orietta Calcinoni
creator: Umberto Ambrosetti
creator: Eliana Filipponi
creator: Valeria Castelli
creator: Riccardo Bianchin
creator: Valentina Teodorani
creator: Laura Magnoni
creator: Leonardo Braga
creator: Linda Parati
creator: Federica Di Berardino
rights: Copyright (c) 2025 Terenzio Cassina, Alessia Tomasin, Orietta Calcinoni, Umberto Ambrosetti, Eliana Filipponi, Valeria Castelli, Riccardo Bianchin, Valentina Teodorani, Laura Magnoni, Leonardo Braga, Linda Parati, Federica Di Berardino https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-16
publication date: 2025-12-16
starting page: 17437
ending page: 17437
doi: 10.23749/mdl.v116i6.17437

Call for Applications for the Enrico C. Vigliani Award
type: item
description: La SIML – Società Italiana di Medicina del Lavoro è lieta di annunciare l’apertura delle candidature per il prestigioso Premio Vigliani, riconoscimento annuale riservato a giovani ricercatori che si siano distinti per l’impegno e la qualità della propria attività scientifica nel campo della Medicina del Lavoro. SCADENZE IMPORTANTI Candidatura: data limite 31 agosto 2025, ore 18 COMUNICAZIONE DEL VINCITORE: 15 settembre 2025 Premiazione ufficiale: 1 ottobre 2025, Bologna – 87° Congresso Nazionale SIML Scarica il PDF per saperne di più...
subject: News
  topic: section
subject: Vigliani award
  topic: keywords
creator: Antonio Mutti
rights: Copyright (c) 2025 Antonio Mutti https://creativecommons.org/licenses/by-nc/4.0
date: 2025-08-04
publication date: 2025-08-04
starting page: 17448
ending page: 17448

The Silent Strain: Grip Strength, and Wrist/Hand Musculoskeletal Disorders among Meat Cutters
type: item
description: Background: Meat cutters are a working group engaged in awkward posture, repetitive motion, and forceful exertion in wrists/hands. This study was conducted a) to examine the prevalence of musculoskeletal symptoms among Iranian meat cutters, b) to assess the wrist musculoskeletal disorders risk assessment and hand grip strength. Methods: Ninety-five male meat cutters in Iran (≥ 1 year tenure) completed a demographic/occupational questionnaire, the Nordic Musculoskeletal Questionnaire (NMQ), and the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Ergonomic risk was assessed via the ACGIH-TLV hand activity method, and maximum hand-grip force was measured. Results: With 69.5% reporting point prevalence and 70.5% reporting period prevalence of wrist/hand musculoskeletal symptoms, the study indicated that meat cutters had a significant prevalence of these symptoms. Most participants demonstrated mild to moderate severity in self-reported wrist symptoms while retaining asymptomatic functional status. The ACGIH-HAL assessment indicated most participants operated at or above the action level (AL), suggesting potential ergonomic risks. Moreover, The ACGIH-HAL ratio had a weak negative association with hand grip strength (β = − 0.0071, p = 0.12). Conclusions: These findings highlight the ergonomic challenges associated with meat-cutting tasks.
subject: Original articles
  topic: section
subject: Grip strength
  topic: keywords
subject: Meat cutters
  topic: keywords
subject: Musculoskeletal symptoms
  topic: keywords
creator: Hamid Jahangiri
creator: Fatemeh Ghasemi
creator: Mojgan Zoaktafi
creator: Hamid Salmani Nodooshan
creator: Mohebat Vali
creator: Hadi Daneshmandi
rights: Copyright (c) 2026 Hamid Jahangiri, Fatemeh Ghasemi, Mojgan Zoaktafi, Hamid Salmani Nodooshan, Mohebat Vali, Hadi Daneshmandi https://creativecommons.org/licenses/by-nc/4.0
date: 2026-02-24
publication date: 2026-02-24
starting page: 17299
ending page: 17299
doi: 10.23749/mdl.2026.17299

Workplace Violence and Patient Management Time in the Emergency Department: An Observational Study
type: item
description: Background: Workplace violence is steadily rising, and the healthcare sector is one of the most impacted areas. Several studies have shown that patients’ long management times are a key factor in workplace violence in this setting. Objective: This study aims to analyze the prevalence and characteristics of aggressions against healthcare workers (HCWs) that occurred in 2023 in the Emergency Rooms (ER) of a large university hospital and to evaluate the potential relationship between the management time of a patient in the ER and the risk of violence incidents.Methods: To evaluate the prevalence and characteristics of aggressive events against HCWs that occurred in 2023, data from the “incident reporting” form were analyzed. Then, using the 2023 report on daily ER accesses, the management time of a patient at the ER was calculated. Finally, the average management times of patients on days when there were no aggressions were compared with those on days when there was one or more assaults against HCWs to evaluate the potential relationship between the average length of stay of a patient at the ER and the risk of aggression. Results: In 2023, 271 violent incidents were reported. Verbal aggressiveness was the most common (82.7%), and working the night shift was riskier (42.8%). In 36.2% of cases, patient management time was identified as a potential predictor of aggression. Other identified potential predictors included the patient and/or caregiver relationship with HCW (30.6%), the refusal to accept diagnostic-therapeutic protocols (27.3%), and the cultural background and temperamental traits of the patient or caregiver (18.8% and 11.8%, respectively). According to the logistic regression analysis, the likelihood of a violent incident during a 150-minute stay was less than 10%; it increased to 53% after 650 minutes. Conclusion: Workplace violence in healthcare settings results from a complex interaction of internal and external factors. Understanding how these elements in…
subject: Original articles
  topic: section
subject: Healthcare Workers
  topic: keywords
subject: physical violence
  topic: keywords
subject: verbal violence
  topic: keywords
subject: workplace aggression
  topic: keywords
subject: emergency care unit
  topic: keywords
creator: Chiara Di Giorgio
creator: Isabella Cucchi
creator: Marco Mendola
creator: Maria Cristina Costa
creator: Fabio Tonelli
creator: Elisa Turchet
creator: Matteo Marrazzo
creator: Paolo Carrer
rights: Copyright (c) 2025 Chiara Di Giorgio, Isabella Cucchi, Marco Mendola, Maria Cristina Costa, Fabio Tonelli, Elisa Turchet, Matteo Marrazzo, Paolo Carrer https://creativecommons.org/licenses/by-nc/4.0
date: 2025-10-24
publication date: 2025-10-24
starting page: 17113
ending page: 17113
doi: 10.23749/mdl.v116i5.17113

Strength and Perceived Effort in Repetitive Upper-Limb Tasks: An OCRA Method Analysis of 900 Workers
type: item
description: Background: Work-related musculoskeletal disorders pose a significant burden on the population. The OCRA method plays a key role in assessing the risk associated with repetitive actions of the upper limbs. In this method, muscular force is evaluated based on the rate of perceived effort (RPE) reported by the worker, which can introduce subjective bias into the assessment. This study aims to determine whether testing the worker’s handgrip strength can improve the accuracy of the force assessment in the OCRA method. Methods: Handgrip strength was measured during the risk assessment process following the OCRA method. Data were divided into specific percentile ranks based on age, gender, height, and handedness. Results: 903 workers from 43 different Italian companies were surveyed. There was a significant difference in handgrip strength percentiles stratified by report of an RPE > 2 and those without (p = 0.047). Additionally, significant differences were found in perceived effort rates (based on the OCRA method) among workers with different levels of stratified handgrip strength (dominant hand: p = 0.04, non-dominant hand: p = 0.02). Conclusions: Workers performing repetitive upper limb actions at various strength levels experience different perceived effort rates during tasks. These findings suggest that measuring handgrip strength is a crucial component of risk assessments using the OCRA method. To date, this study's sample size is among the largest for this evaluation method; we believe these results could be a significant step forward in improving the risk assessment process for biomechanical overload
subject: Original articles
  topic: section
subject: Musculoskeletal disorders
  topic: keywords
subject: Risk assessment
  topic: keywords
subject: OCRA
  topic: keywords
subject: Handgrip
  topic: keywords
subject: Ergonomics
  topic: keywords
creator: Stefano Gobbo
creator: Valentina Bullo
creator: Francesco Favro
creator: Davide Pavan
creator: Beatrice Doro
creator: Alessandro Bortoletto
creator: Giuseppe De Palma
creator: Emma Sala
creator: Stefano Mattioli
creator: Andrea Di Blasio
creator: Marco Bergamin
rights: Copyright (c) 2025 Stefano Gobbo, Valentina Bullo, Francesco Favro, Davide Pavan, Beatrice Doro, Alessandro Bortoletto, Giuseppe De Palma, Emma Sala, Stefano Mattioli, Andrea Di Blasio, Marco Bergamin https://creativecommons.org/licenses/by-nc/4.0
date: 2025-08-04
publication date: 2025-08-04
starting page: 16856
ending page: 16856
doi: 10.23749/mdl.v116i4.16856

Occupational Asthma Due to Subtilisin: The Power of Specific Inhalation Challenge
type: item
description: We report the first confirmed case in Italy of occupational asthma caused by subtilisin in a healthcare worker involved in cleaning surgical instruments. The diagnosis was confirmed through a specific inhalation challenge (SIC) performed one year after the last exposure and after stopping inhaled corticosteroid therapy. An immediate reaction was observed after three minutes of exposure to diluted Neogiozym ™, with a 30% decrease in FEV1. This case highlights the diagnostic importance of SIC even for high-molecular-weight (HMW) agents and emphasizes the need to reconsider occupational asthma as a complex, evolving disease influenced by both host and environmental factors. The patient exhibited a Type-2-high phenotype despite negative skin prick tests and normal IgE levels, reinforcing the value of dynamic, multi-marker assessment in occupational endotyping. This case supports the broader use of SIC in occupational settings where allergen-specific IgE testing is limited.
subject: Case report
  topic: section
subject: Enzyme Allergy
  topic: keywords
subject: FeNO Monitoring
  topic: keywords
subject: Type-2 Inflammation
  topic: keywords
subject: Workplace Sensitization
  topic: keywords
subject: Respiratory Biomarkers
  topic: keywords
subject: Endotyping
  topic: keywords
subject: Healthcare Workers
  topic: keywords
subject: Bronchial Provocation Test
  topic: keywords
subject: Allergen Exposure
  topic: keywords
subject: Negative Skin Tests
  topic: keywords
creator: Filippo Liviero
creator: Laura Fabris
creator: Marco Biasioli
creator: Francesco Favretto
creator: Paola Mason
rights: Copyright (c) 2025 Filippo Liviero, Laura Fabris, Marco Biasioli, Francesco Favretto, Paola Mason https://creativecommons.org/licenses/by-nc/4.0
date: 2025-10-24
publication date: 2025-10-24
starting page: 17219
ending page: 17219
doi: 10.23749/mdl.v116i5.17219

Steady-State Auditory Evoked Potentials in Workers Exposed to Occupational Noise
type: item
description: Background: The present study aims to investigate neural synchrony, as measured by Auditory Steady State Response (ASSR), in individuals with normal hearing who are exposed and not exposed to occupational noise, thereby providing insights into hidden hearing loss within the central auditory nervous system, and justifying the importance of exploring auditory neural function in populations at risk. Methods: A cross-sectional study involved 30 noise-exposed individuals in the Study Group and 30 unexposed individuals in the Control Group, all paired by an average age of 35 years. The following procedures were performed on all individuals: clinical and occupational history, meatoscopy, immitanciometry, pure tone audiometry, speech audiometry, and ASSR (40Hz). We analyzed the audiometric hearing thresholds at frequencies of 1 kHz and 4 kHz, the electrophysiological thresholds estimated by ASSR, and the comparison of the differences between them: the thresholds estimated by ASSR and the audiometry thresholds. The data were analyzed using both descriptive and inferential statistics. P-values ≤ 0.05 were considered significant. Results: When comparing hearing thresholds at 1 kHz and 4 kHz between groups, we found significant differences, with the SG showing higher hearing thresholds than the CG bilaterally. No significant differences were seen in the electrophysiological thresholds estimated by ASSR, nor in the comparison between the ASSR-estimated threshold and the psychoacoustic hearing threshold groups. Conclusions: The results of this study suggest that workers exposed to occupational noise did not show detectable changes in neural synchrony in the midbrain, thalamus, or primary auditory cortex when compared to individuals without occupational noise exposure.
subject: Original articles
  topic: section
subject: Hearing. Noise
  topic: keywords
subject: noise effects
  topic: keywords
subject: auditory evoked potentials
  topic: keywords
subject: hearing tests
  topic: keywords
subject: noise, occupational
  topic: keywords
creator: Mariana Keiko Kamita
creator: Clayton Henrique Rocha
creator: Liliane Aparecida Fagundes Silva
creator: Alessandra Giannella Samelli
creator: Carla Gentile Matas
rights: Copyright (c) 2025 Mariana Keiko Kamita, Clayton Henrique Rocha, Liliane Aparecida Fagundes Silva, Alessandra Giannella Samelli, Carla Gentile Matas https://creativecommons.org/licenses/by-nc/4.0
date: 2025-12-16
publication date: 2025-12-16
starting page: 17196
ending page: 17196
doi: 10.23749/mdl.v116i6.17196

Longitudinal Changes in Work Ability, Well-Being, and Psychosocial Risk Factors Among Older Workers: The ProAgeing Study
type: item
description: Background: As the workforce ages, older employees face increasing challenges in adapting to changing job demands, including technological advances and ongoing occupational risks such as shift work and physically demanding tasks. Work ability is a reliable indicator of older workers’ capacity to meet both physical and mental requirements of their jobs. The ProAgeing study, a multicenter investigation specifically focused on workers over 50 years old, examined long-term patterns in work ability, perceived health, and psychosocial risk factors, along with their interactions across this demographic. Methods: Participants completed self-reported questionnaires at baseline and after one year, including the Work Ability Index (WAI), technostress, sleep quality, perceived stress, health, and psychosocial risk factors. A first-difference linear regression model was used to assess predictors of changes in WAI. Subgroup analyses examined differences across occupational roles (bank employees, administrative employees, and manual workers). Results: Of the 470 workers enrolled, 356 (76%) completed the follow-up. A significant decline in average WAI score was observed over 12 months (-1.2 points, p<0.001), mainly in subscales related to work demands and physical illness. Technostress levels slightly decreased, suggesting adaptation over time. Bank employees showed less favorable trends than manual workers, indicating that digitalization and higher job demands significantly affected employees’ well-being, especially older workers. Improvements in perceived health and reduced stress mostly contributed to enhanced work ability. Conclusions: These findings highlight the importance of targeted interventions to enhance health and lower stress among aging workers, supporting their well-being and subsequently their work ability.
subject: Original articles
  topic: section
subject: aging
  topic: keywords
subject: longitudinal studies
  topic: keywords
subject: occupational stress
  topic: keywords
subject: work ability
  topic: keywords
subject: technostress
  topic: keywords
subject: psychological health
  topic: keywords
creator: Alice Fattori
creator: Teresa Barnini
creator: Anna Comotti
creator: Pasquale Bufano
creator: Marco Laurino
creator: Simone Russo
creator: Luca Ferrari
creator: Catalina Ciocan
creator: Matteo Bonzini
rights: Copyright (c) 2025 Alice Fattori, Teresa Barnini, Anna Comotti, Pasquale Bufano, Marco Laurino, Simone Russo, Luca Ferrari, Catalina Ciocan, Matteo Bonzini https://creativecommons.org/licenses/by-nc/4.0
date: 2025-08-04
publication date: 2025-08-04
starting page: 17195
ending page: 17195
doi: 10.23749/mdl.v116i4.17195

Neurosensory Response of the Hand and Foot to Vibration Exposure
type: item
description: Background: This study investigated the vibrotactile perception threshold (VPT) changes in the fingers and toes of twenty-eight healthy subjects (15 males and 13 females aged 20 to 62 years) exposed to hand- and foot-transmitted vibration. Methods: The VPT was measured before and after the exposure of the hands and feet to 5 minutes of triaxial white noise pseudorandom vibration. The post-vibration VPT was measured immediately after and 15 minutes after the end of the exposure to assess the temporary threshold shift (TTS) of vibration perception. The effects of the anatomical district (index finger and big toe), measurement time (before and after vibration exposure), test frequency (8, 31.5, and 125 Hz), age group (Under30s and Over 40s), and gender (male and female) on the changes in VPT were investigated. Results: The findings revealed that the index finger and the big toe exhibited comparable profiles in the vibrotactile sensitivity at the low-middle vibration frequencies and in the recovery of the perception threshold after vibration exposure. The big toe showed a higher perception threshold than the index finger, and the difference increased with the test frequency. In addition to vibration frequency, age and skin temperature influenced the results of VPT and TTS measurements. Conclusions: The findings of this study can contribute to outlining alternative frequency weighting functions for the neurosensory response of the hand and foot to vibration exposure, and to update the current guidelines for evaluating human vibration exposure.
subject: Original articles
  topic: section
subject: Vibrotactile Perception Threshold
  topic: keywords
subject: Temporary Threshold Shift
  topic: keywords
subject: Foot-Transmitted Vibration
  topic: keywords
subject: Hand-Transmitted Vibration
  topic: keywords
subject: Aging
  topic: keywords
creator: Flavia Marrone
creator: Nicole Sanna
creator: Julio Sánchez García
creator: Federico Ronchese
creator: Enrico Marchetti
creator: Angelo Tirabasso
creator: Massimo Bovenzi
creator: Marco Tarabini
rights: Copyright (c) 2025 Flavia Marrone, Nicole Sanna, Julio Sánchez García , Federico Ronchese, Enrico Marchetti, Angelo Tirabasso, Massimo Bovenzi, Marco Tarabini https://creativecommons.org/licenses/by-nc/4.0
date: 2025-06-17
publication date: 2025-06-17
starting page: 17149
ending page: 17149
doi: 10.23749/mdl.v116i3.17149