Fabrizio Caldi

Emotional dysregulation (ED) reflects a heightened reactivity to stimuli, characterized by excessive negative affect and impulsive behaviors. This study aimed to evaluate ED in workers seeking care for occupational stress and to examine its associations with sociodemographic characteristics, occupational stress, and the severity of anxiety and depressive symptoms. Eighty-seven workers referred for work-related stress were assessed using the Psychological Stress Measure (PSM) and the Job Content Questionnaire (JCQ) for stress, the Beck Depression Inventory-II (BDI-II) and the Self-Rating Anxiety Scale (SAS) for psychopathology, and the RIPoSt-40 for ED. Group comparisons and correlation analyses were conducted using parametric or non-parametric tests, as appropriate. Forty-six percent of participants met criteria for Adjustment Disorders and 54% for Major Depressive Disorder. No significant differences between diagnostic groups emerged for ED or symptom severity. Women reported higher perceived stress and anxiety than men. Negative ED domains—affective instability, negative emotionality, and emotional impulsivity—showed moderate-to-strong positive correlations with stress, anxiety, and depressive symptoms. Affective instability was also related to job stress dimensions, correlating negatively with decision latitude and positively with job demands. Negative emotional dysregulation appears to be a transdiagnostic vulnerability factor for stress-related psychopathology. Screening for ED may support early detection and targeted preventive interventions in occupational settings.

Introduction: Decreased plasma BDNF (pBDNF) levels have been proposed as a biomarker in the illness phases of mood disorders. This cross-sectional study aimed to evaluate the pBDNF and BDNF promoters’ DNA methylation levels in workers exposed to occupational stress and suffering from work-related stress disorders. Methods: the pBDNF and BDNF exon I and IV promoters’ methylation levels were measured by specific immunoassays and methylation-sensitive high-resolution melting (MS-HRM) in 62 patients with adjustment disorders (AD), 79 patients with major depressive disorder (MDD) and 44 healthy controls. Occupational stress was evaluated in the patients and controls using the Job Content Questionnaire (JCQ). Results: the pBDNF levels were significantly higher in the MDD (p < 0.001) and AD (p < 0.0001) patients than in the controls. The MDD patients showed significantly lower pBDNF levels than the AD ones (p = 0.01). The BDNF exon I and IV promoters’ methylation levels were significantly higher in the MDD patients than in the AD ones (exon I promoter: p = 0.0001, exon IV promoter: p < 0.0001) and controls (exon I promoter: p = 0.0001, exon IV promoter: p < 0.0001). In the patients, but not in the controls, the BDNF promoters’ methylation levels showed significant negative correlations with occupational stress. Conclusions: BDNF could play a key role in the pathophysiology of stress-related disorders and the peripheral elevation of it observed in patients exposed to occupational stress could suggest a protective mechanism for neurons from stress-mediated damage. The elevation of the pBDNF levels, even in MDD, may characterize a “reactive” subtype of depressive episode, while the significant elevation of the BDNF promoters’ methylation levels in depressed patients could indicate a predisposition to more severe illness under stress. Further research is needed, focusing on biomarkers for stress-related disorders as a potential tool for the diagnosis and prevention of occupational diseases.

The recent standard ISO 30415-2021 - Human resources management - Diversity and inclusion - was developed internationally within the technical committee ISO/TC 260 "Human resources management" (Working group WG 8 "Diversity and inclusion") and underlines the need for actions to create a work environment that is inclusive of diversity (e.g. in terms of health, gender, age, ethnicity, culture). Developing an inclusive work environment requires ongoing commitment and input from the entire organization regarding policies, processes, organizational practices, and individual behavior. As far as the role of occupational medicine is concerned, this direction can be supported by the correct management of disabled workers and workers with chronic pathologies that affect their fitness for duty. The "reasonable accommodation" is the way by which the European Union first, and the United Nations then intended to support the inclusion of disabled people in the world of work. The Personalized Work Plan includes different approaches (organizational, technical, procedural) meant for modifying the work activity envisaged for the disabled worker or for any worker suffering from chronic diseases or dysfunctions. The adoption of the Personalized Work Plan implies the effort of redesigning the workstation, the work procedures, or even the planning of different micro and macro tasks etc., in order to prioritize the adaptation of the working environment to the worker, safeguarding the value of the worker's productivity according to the principle of reasonable accommodation.

Work-related stress presents a significant impact on work performance and physical health. It has been associated with the onset of a multitude of symptoms that can lead to occupational stress diseases, namely Adjustment Disorder and Post-Traumatic Stress Disorder. The literature has evidenced that “exposure therapy” of cognitive-behavioral training (CBT-E) seems to be the most effective technique to manage stress symptoms, including work stress diseases, and several studies have considered Virtual Reality (VR) as an adjuvant tool to exposure-based psychotherapy (CBT-VR) for the treatment of multiple psychiatric disorders. The aim of this study is to evaluate the effectiveness of CBT with exposure to stressful work scenarios in imaginative (CBT-E) and in immersive virtual reality (CBT-VR) scenarios in a group of workers affected by work-related stress disorders and compare the clinical and physiological outcomes between the two exposure techniques. A long-term goal would be to develop an evidence-based rehabilitation program as a treatment for the reintegration into work of patients affected by these psychiatric disorders.

With the development of SARS-CoV-2 vaccines, many authors started evaluating the immunization efficacy of the available vaccines mainly through sero-positivity tests or by a quantitative assessment of the IgG against the spike protein of SARS-CoV-2 virus in vaccinated subjects. In this work, we compared the titers resulting from vaccination and tried to understand the potential factors affecting the immune response to the available SARS-CoV-2 vaccines. This study was conducted on 670 volunteers employed at the University of Pisa and undergoing a health surveillance program at the University Hospital of Pisa. For each participant, 10 mL of blood, information about contacts with confirmed cases of COVID-19, age, sex, SARS-CoV-2 vaccination status, previous SARS-CoV-2 infection and symptoms, type of vaccine and the date of administration were collected. In the multivariate analysis, the type of vaccine, the presence of symptoms in SARS-CoV-2 positive individuals, and the distance from the second dose significantly affected the antibody titer; the combined vaccination resulted in a faster decay over time compared with the other types of vaccination. No significant differences were observed between Spikevax and Comirnaty (p > 0.05), while the antibody levels remain more stable in subjects undergoing Vaxzevria vaccination (p < 0.01) compared with mRNA-based ones.

The adult autism subthreshold spectrum model appears to be a useful tool for detecting possible vulnerability factors in order to develop mental disorders in the contest of work-related stress. The aim of the present study is to analyze the relationship between autism, mood, and post-traumatic spectrum in a cohort of subjects complaining of work-related stress before the COVID-19 pandemic. The authors carried out a retrospective investigation of both medical records and self-assessment tools of a sample of subjects evaluated at the Occupational Health Department of a University hospital in central Italy. Data showed significant correlations between the AdAS spectrum, TALS-SR, and MOODS total and domain scores. A multiple linear regression evidenced that both the AdAS spectrum and TAL-SR significantly predict the MOODS scores. In particular, mediation analysis showed both a direct and indirect, mediated by TALS-SR, effect of the AdAS Spectrum on the MOODS-SR. These results corroborate the role of autistic traits in influencing the traumatic impact of work-related stress and the development of mood spectrum symptoms.

Introduzione: La gestione dei lavoratori portatori di disabilità psichica rappresenta un argomento attuale e di grande interesse. L’obiettivo dell’articolo è quello di presentare l’esperienza di gestione dei casi di disabilità psichica presenti all’interno del personale dipendente di una azienda ospedaliero-universitaria italiana e di descrivere gli interventi relativi alle tutele preventive adottate e ai percorsi terapeutici specialistici intrapresi. Metodi: Un gruppo di 100 lavoratori affetti da disturbi psichiatrici è stato inserito in un programma di sorveglianza medica della durata di almeno 6 mesi. I lavoratori sono stati seguiti nell’ambito di un protocollo che ha incluso visite psichiatriche, interventi psicoterapici, visite del medico competente e valutazioni medico-legali. Sono state somministrate scale di valutazione della gravità di malattia e dell’efficacia dei trattamenti (CGI) e del funzionamento globale (GAF) al baseline e dopo 6 mesi di follow-up. Risultati: Il campione è risultato composto principalmente da infermieri (44%) e da Operatori Socio Sanitari (24%) e i più comuni disturbi diagnosticati sono stati i disturbi dell’umore e d’ansia. La partecipazione al programma di sorveglianza medica con la messa in atto di strategie terapeutiche specialistiche e di interventi organizzativi ha comportato una riduzione statisticamente significativa della gravità di malattia e un miglioramento del funzionamento globale e ha consentito di conservare mansione e sede lavorativa nella quasi totalità dei casi. Discussione: I risultati di questa esperienza consentono di affermare che l’integrazione delle competenze costituisce un valido strumento sia per l’inquadramento diagnostico multidisciplinare che per il monitoraggio e la gestione dei lavoratori con disabilità psichica nell’ambito della sorveglianza sanitaria periodica.

The protection of the worker affected by neoplastic pathologies and his reintegration into work represent subjects of undoubted relevance for the occupational physician. Many are the workers affected by neoplastic diseases and more are those who are able to regain good living conditions and sufficient work capacity to be reintegrated into profitable work. Several rights are related to the assessment of a certain percentage of disability, the recognition of "Handicap in a serious situation", and others according to the requirements of the Italian law for the right to work of disabled people (L. 68/99 s.m.i.).The Occupational Physician manages the oncology patient through the targeted placement ex L. 68/99 s.m.i. or, more often, during the activity of health surveillance has to assess whether the job, considering the risks connected to it, is compatible with the conditions of biological validity of the worker, identifying, possibly, prescriptions or limitations.In our experience, customized working plan is an operational methodology that has proved to be very useful.In practice, the Occupational Physician uses a method to help the back to work of the worker with disability, formalizing before the limits to the performance of the work activity.The assessment of fitness for work is related to a work plan presented by the employer, based on the indications of the occupational physician, based on disability (health conditions/worker's susceptibility) that modulates or avoids job tasks that could prove harmful or aggravating the health condition of the employee. Teleworking and smart working can also be considered among the possible protection measures.Finally, it is useful to recall the role of INAIL for workers with a recognized neoplastic pathology related to work.With the Italian law 190/2014 art. 1, paragraph 166 are assigned to the INAIL the skills relating to the reintegration and work integration of people with disabilities from work with expenses for the INAIL. There are therefore a number of reference measures by the ¡INAIL and the types of interventions for reintegration are identified.

The protection of the worker affected by neoplastic pathologies and his reintegration into work represent subjects of undoubted relevance for the occupational physician. Many are the workers affected by neoplastic diseases and more are those who are able to regain good living conditions and sufficient work capacity to be reintegrated into profitable work. Several rights are related to the assessment of a certain percentage of disability, the recognition of "Handicap in a serious situation", and others according to the requirements of the Italian law for the right to work of disabled people (L. 68/99 s.m.i.). The Occupational Physician manages the oncology patient through the targeted placement ex L. 68/99 s.m.i. or, more often, during the activity of health surveillance has to assess whether the job, considering the risks connected to it, is compatible with the conditions of biological validity of the worker, identifying, possibly, prescriptions or limitations. In our experience, customized working plan is an operational methodology that has proved to be very useful. In practice, the Occupational Physician uses a method to help the back to work of the worker with disability, formalizing before the limits to the performance of the work activity. The assessment of fitness for work is related to a work plan presented by the employer, based on the indications of the occupational physician, based on disability (health conditions / worker's susceptibility) that modulates or avoids job tasks that could prove harmful or aggravating the health condition of the employee. Teleworking and smart working can also be considered among the possible protection measures. Finally, it is useful to recall the role of INAIL for workers with a recognized neoplastic pathology related to work. With the Italian law 190/2014 art. 1, paragraph 166 are assigned to the INAIL the skills relating to the reintegration and work integration of people with disabilities from work with expenses for the INAIL. There are therefore a number of reference measures by the INAIL and the types of interventions for reintegration are identified.