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Ferrario MM, Martire G, Gianfagna F, Lasalvia P, Cremonesi F, Tozzi M, Franchin M, Campana F, Roncaioli M, Cavicchiolo M, Borchini R, Iacoviello L, Veronesi G. Occupational class differences in ankle-brachial index and pulse wave velocity measurements to detect subclinical vascular disease. Med Lav 2021; 112:268-278. [PMID: 34446685 PMCID: PMC8436821 DOI: 10.23749/mdl.v112i4.11415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022]
Abstract
Background: High pulse wave velocity (PWV) and low ankle brachial index (ABI) have been proposed as surrogate end-points for cardiovascular disease (CVD). Objectives: In a cross-sectional setting, we aimed at assessing the distributions of PWV and ABI among occupational classes (OC) in a population-based ever-employed salaried sample. Methods: We enrolled 1388 salaried CVD-free workers attending a CVD population-based survey, the RoCAV study, and classified them into four OC, based on current or last job title: manager/director (MD), non-manual (NMW), skilled-manual (SMW) and (UMW) unskilled-manual workers. We derived brachial-ankle PWV and ABI from four-limb blood pressures measurements, then carotid-femoral PWV (cfPWV) was estimated. We estimated the OC gradients in cfPWV and ABI using linear and logistic regression models. Results: Compared to MD (reference category), UMW had higher age- and BMI-adjusted cfPWV mean values both in men (0.63 m/s; 95%CI:0.11-1.16) and women (1.60 m/s; 0.43-2.77), only marginally reduced when adjusting for CVD risk factors. Decreased ABI mean values were also detected in lower OC. The overall detection rate of abnormal cfPWV (≥12 m/s) or ABI (≤0.9) values was 28%. Compared to MD, the prevalence of abnormal cfPWV or ABI was higher in NMW (OR=1.77; 95%CI:1.12-2.79), SMW (1.71; 1.05-2.78) and UMW (2.72; 1.65-4.50). Adjustment for CVD risk factors used in risk score equations did not change the results. Discussion: We found a higher prevalence of abnormal values of arterial stiffness measures in lower OC, and these differences were not explained by traditional CVD risk factors. These may be presumably determined by additional work- and environmental-related risk factors.
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Affiliation(s)
- Marco Mario Ferrario
- EPIMED Research Centre, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy; and Occupational Medicine Unit, University Hospital of Varese, Varese, Italy .
| | - Giulia Martire
- School of Specialization in Occupational Medicine, University of Insubria, Varese, Italy.
| | - Francesco Gianfagna
- EPIMED Research Centre, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy; and Mediterranea Cardiocentro, Napoli, Italy.
| | - Paolo Lasalvia
- EPIMED Research Centre, Department of Medicine and Surgery, School of Medicine, University .
| | - Federico Cremonesi
- School of Specialization in Occupational Medicine, University of Insubria, Varese, Italy; .
| | - Matteo Tozzi
- Vascular Surgery Unit, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy.
| | - Marco Franchin
- Vascular Surgery Unit, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy.
| | - Francesca Campana
- School of Specialization in Occupational Medicine, University of Insubria, Varese, Italy; .
| | - Mattia Roncaioli
- School of Specialization in Occupational Medicine, University of Insubria, Varese, Italy; .
| | - Marco Cavicchiolo
- School of Specialization in Occupational Medicine, University of Insubria, Varese, Italy; .
| | | | - Licia Iacoviello
- EPIMED Research Centre, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy; and Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
| | - Giovanni Veronesi
- EPIMED Research Centre, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy; .
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Ferrario MM, Veronesi G, Borchini R, Cavicchiolo M, Dashi O, Dalla Gasperina D, Martinelli G, Gianfagna F. Time Trends of Percutaneous Injuries in Hospital Nurses: Evidence of the Interference between Effects of Adoption of Safety Devices and Organizational Factors. Int J Environ Res Public Health 2021; 18:ijerph18084371. [PMID: 33924104 PMCID: PMC8074301 DOI: 10.3390/ijerph18084371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 01/14/2023]
Abstract
Few studies have focused on the combined effects of devices and work organization on needlestick injuries trends. The aim of the study was to estimate trends of percutaneous injury rates (IR) in nurses (N) and nurse assistants (NA) over a 10 year period, in which passive safety devices were progressively adopted. Percutaneous and mucocutaneous injuries registered in a University Hospital in Northern Italy in Ns and NAs in 2007–2016 were analyzed. Organizational data were also available on shift schedules, turnover, downsizing and age- and skill-mix. We estimated IRs per 100 full-time equivalent workers from Poisson models and their average annual percent changes (APC) from joinpoint regression model. In the entire period, monotonic decreases in percutaneous IRs occurred among day-shift Ns (APC = −20.9%; 95% CI: −29.8%, −12%) and NAs (APC = −15.4%; −32.9%, 2.2%). Joinpoint modeling revealed a turning point in 2012 for night-shift Ns, with a steady decline in 2007–2012 (APC = −19.4%; −27.9%, −10.9%), and an increase thereafter (APC = +13.5%; 1.5%, 25.5%). In comparison to 2008 and 2012, in 2016 night-shift Ns were 5.9 and 2.5 times more likely to be younger and less qualified or experienced than day-shift Ns. The observed declines in percutaneous injury rates occurred in a time period when safety devices were progressively implemented. The causal nature of multiple exposures and organizational procedures in affecting injury time trends should be further addressed by quasi-experimental studies.
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Affiliation(s)
- Marco M. Ferrario
- Department of Medicine and Surgery, School of Medicine, University of Insubria, 21100 Varese, Italy; (G.V.); (D.D.G.); (F.G.)
- Occupational, Preventive and Toxicology Unit, ASST Sette Laghi, 21100 Varese, Italy
- Correspondence:
| | - Giovanni Veronesi
- Department of Medicine and Surgery, School of Medicine, University of Insubria, 21100 Varese, Italy; (G.V.); (D.D.G.); (F.G.)
| | - Rossana Borchini
- Occupational and Preventive Medicine Unit, ASST Lariana, 22100 Como, Italy;
| | - Marco Cavicchiolo
- School of Specialization in Occupational Medicine, University of Insubria, 21100 Varese, Italy; (M.C.); (O.D.)
| | - Oriana Dashi
- School of Specialization in Occupational Medicine, University of Insubria, 21100 Varese, Italy; (M.C.); (O.D.)
| | - Daniela Dalla Gasperina
- Department of Medicine and Surgery, School of Medicine, University of Insubria, 21100 Varese, Italy; (G.V.); (D.D.G.); (F.G.)
| | | | - Francesco Gianfagna
- Department of Medicine and Surgery, School of Medicine, University of Insubria, 21100 Varese, Italy; (G.V.); (D.D.G.); (F.G.)
- Mediterranea Cardiocentro, 80122 Napoli, Italy
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Veronesi G, Cavicchiolo M, Ferrario MM. Allostatic load as a mediator of the association between psychosocial risk factors and cardiovascular diseases. Recent evidence and indications for prevention. G Ital Med Lav Ergon 2019; 41:333-336. [PMID: 32126604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/01/2019] [Indexed: 06/10/2023]
Abstract
Aims. Some categories of workers are more vulnerable to the detrimental effect of job strain on cardiovascular risk. We investigate allostatic load, the physiological "wear and tear" resulting from adaptation to chronic stress, as a candidate pathway to explain such vulnerability. Methods. We selected 25-64 years old salaried workers participants to three population-based cohorts. We defined allostatic load (AL) as the sum of z-scores of 9 selected biomarkers; occupational classes (OCs) from the Erikson- Goldthorpe-Portocarero schema; and job strain (JS) according to Karasek's demand-control model. We adopted the Oaxaca- Blinder decomposition to disentangle the OC gradient in AL into the differential exposure (attributable to different JS prevalence across OCs) and the differential vulnerability (attributable to a different effect of JS on AL across OCs) components. Results. In the n=2010 workers (62% men, 34% manuals), OCs, but not JS categories, were associated with AL, independently of age and gender (p-value: 0.02). In the overall sample, JS did not have an effect on the OC gradient in AL. Conversely, in workers with sleep impairment, depression, or not engaged into physical activity, JS had a positive differential vulnerability coefficient of 0.63 (95%CI 0.05 to 1.21). Conclusions. In manual workers with impaired capacity of response, job strain is associated with a disproportional allostatic load accumulation.
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Affiliation(s)
- Giovanni Veronesi
- Centro Ricerche EPIMED - Epidemiologia e Medicina Preventiva, Dipartimento di Medicina e Chirurgia, Università degli Studi dell'Insubria, Varese
| | - Marco Cavicchiolo
- Scuola di Specializzazione in Medicina del Lavoro, Università degli Studi dell'Insubria, Varese
| | - Marco M Ferrario
- Centro Ricerche EPIMED - Epidemiologia e Medicina Preventiva, Dipartimento di Medicina e Chirurgia, Università degli Studi dell'Insubria, Varese
- Scuola di Specializzazione in Medicina del Lavoro, Università degli Studi dell'Insubria, Varese
- SC Medicina del Lavoro e Tossicologia, ASST Sette Laghi, Varese
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Ferrario MM, Roncaioli M, Veronesi G, Holtermann A, Clays E, Borchini R, Cavicchiolo M, Grassi G, Cesana G. Differing associations for sport versus occupational physical activity and cardiovascular risk. Heart 2018; 104:1165-1172. [PMID: 29440185 DOI: 10.1136/heartjnl-2017-312594] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/28/2017] [Accepted: 01/05/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES We investigate the independent and interacting long-term associations of occupational physical activity (OPA) and sport physical activity (SpPA) with the incidence of coronary heart disease (CHD) and cardiovascular diseases (CVD; CHD plus ischaemic stroke) in North Italian male workers. METHODS 3574 employed men aged 25-64 years, free of CVD at baseline, recruited in three population-based and one factory-based cohorts, were included in the analysis. The Baecke Questionnaire was used to assess OPA and SpPA in 'minutes per week' of moderate or vigorous PA. We estimated the associations between different domains of PA and the endpoints, adjusting for major CVD risk factors, using Cox models. RESULTS During a median follow-up of 14 years, 135 and 174 first CHD and CVD events, fatal and non-fatal, occurred. Compared with the intermediate OPA tertile, the HRs for CHD among low and high OPA workers were 1.66 (95% CI 1.06 to 2.59) and 1.18 (0.72 to 1.94), respectively (P value=0.07). Decreasing trends in CHD and CVD rates across increasing levels of SpPA were also found, with an HR for CVD of 0.68 (0.46 to 0.98) for intermediate/recommended SpPA compared with poor SpPA. We also found a statistically significant SpPA-OPA interaction, and the protective effect of SpPA was only found among sedentary workers, for both endpoints. Conversely, high OPA workers with intermediate/recommended SpPA levels had increased CHD and CVD rates compared with the poor SpPA category. CONCLUSIONS Our results provide further evidence on the health paradox of OPA, with higher CVD rates among workers with intense PA at work. Moreover, the protective effect on CVDs of SpPA is prominent in sedentary workers, but it attenuates and even reverses in moderate and strenuous OPA workers.
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Affiliation(s)
- Marco Mario Ferrario
- Department of Medicine and Surgery, School of Medicine, Research Center in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy.,Occupational Medicine Unit, University hospital of Varese, Varese, Italy.,School of Occupational Medicine, University of Insubria, Varese, Italy
| | - Mattia Roncaioli
- School of Occupational Medicine, University of Insubria, Varese, Italy
| | - Giovanni Veronesi
- Department of Medicine and Surgery, School of Medicine, Research Center in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
| | - Andreas Holtermann
- The National Research Centre for the Working Environment, Copenhagen, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Els Clays
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Rossana Borchini
- Occupational Medicine Unit, University hospital of Varese, Varese, Italy
| | - Marco Cavicchiolo
- Department of Medicine and Surgery, School of Medicine, Research Center in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,IRCCS Multimedica, Sesto San Giovanni, Italy
| | - Giancarlo Cesana
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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