After 120 years, the oldest magazine of Occupational Medicine is now an e-journal leaving the printed version

Abstract

In January 2020, I had the honour of taking over from Pier Alberto Bertazzi as editor-in-chief of the journal, adding my name to the shortlist of distinguished scholars who have directed it over the 120 years of history of Occupational Medicine in Italy. According to the four-year mandate entrusted to me by Giovanna Spatari, the President of the Italian Society of Occupational Medicine (SIML), I was expected to: (i) ensure the continuity of the journal, which was going through a period of stagnation; (ii) complete its transition to the official journal of the SIML; (iii) encourage the involvement of all Italian schools in contributing valuable contents; (iv) increase its international visibility and reputation. Full independence was granted to the journal's editorial team to achieve such objectives. The mid-term deadline and the recent decision to go online, unanimously approved by the SIML Board on 15th December 2021, offers the opportunity for careful consideration of our editorial work, of achievements obtained and adjustments needed to keep a trajectory in line with our mandate. The main change has undoubtedly been publishing all scientific articles in English. The journal's international visibility increased, as did its WoS impact factor, which jumped from 0.6 to around 2.0. Such rapid growth might be accounted for by the many papers dealing with COVID-19, a subject storming into occupational medicine. Until recently, infectious diseases were considered irrelevant to occupational medicine, whereas now occupational physicians face all aspects of the pandemic. They are struggling to fight COVID-19 using either clinical medicine or public health tools. The novelty of the challenge and the speed of the comparison on the data developed as they became available to form the basis for subsequent decisions and intervention account for the six-fold increase in the immediacy index. During the previous two years, the number of submissions was increased by 68%, whereas the days to the first decision decreased from 65 to 17 days compared with the journal's performance over the last ten years. Our associate editors and external experts in the field will continue to ensure that only high-quality papers are published after double-blinded peer-review. Our editorial team plays an essential role in evaluating authors' work, struggling to find competent reviewers, assessing their judgment, and providing an overarching perspective to help authors improve their work. The most critical aspect is ensuring that both strengths and flaws of a manuscript are identified, along with the potential for improvements through authors' reasonable effort. However, in our double-blind approach, the reviewers are unaware of the authors' potential. Nor are they aware of the material on which the authors can rely. The skill and commitment of authors are as important as the guidance of reviewers and editors is. Some authors need simple hints to address areas of deficiency, whereas less-skilled authors need more direct advice to achieve what might be possible. Our editorial team meets every two weeks to appoint reviewers, discuss and assess their recommendations, and convey the reviews to authors. Editors should also flag additional issues, providing perspective for reviewers' comments, e.g., prioritizing issues, clarifying comments, and classifying them as "must do" and "consider" as appropriate. As editors, we always wish to strengthen the value of both manuscripts and reviews. Still, authors cannot ask for clarifications, so what they receive must be unambiguous. Sometimes this might disturb authors, who are at a disadvantage in the peer-review process, as they know that making reviewers and editors unhappy can result in rejected manuscripts. Authors and (seldom) reviewers may not agree with editorial decisions. Still, we always try to explain the reasons behind them in the ultimate effort to preserve respect for everyone involved in the process. The editorial team can face a few disappointing situations: (i) receiving submissions that didn't follow instructions to Authors, thus making the editorial process cumbersome; (ii) receiving revisions that didn't follow reviewers' and editors' recommendations, failing to grasp (and to respect) the editorial effort to assist in improving the manuscript; (iii) receiving papers with too many self-citations or with an otherwise distorted references' list; (iv) receiving comments to published articles aimed at disqualifying the authors rather than opening a scientific debate on the subject matter. In all such situations, we usually postpone discussions to the next meeting, letting the first emotional reaction cool off and allowing for more re-readings of the texts received. We recommend that authors do the same when receiving unwelcome feedback on their submissions. The Open Science movement – proposed and developed at the beginning of the new millennium [1] – is changing the landscape of scientific publishing, shifting the cost coverage from the end-user (the reader) to the author and his sponsors. Furthermore, readers' habits have changed, and more and more scientific journals are read on the screen of laptops or PCs, rather than in the printed version. E-journals offer several advantages over a printed version, such as increased speed of production and distribution through electronic interaction between authors, editors, and readers. They are also more flexible in the number and distribution of pages, access to supplementary materials, and even – in advanced stages of evolution – in the use of multimedia such as sound and films. Our e-journal will not be different from the printed journal in the fundamental editorial process. Articles submitted by individuals from the academic and practice community will be peer-reviewed by our experts and external reviewers to be accepted or rejected and are subsequently published. The only difference will consist of the numbering of the pages, which will start from page 1 for all articles, that will be identified by a progressive number, as already happens for the DOI (digital identification object). Up to now, we have been able to run the editorial process without any article processing charge. We hope to maintain the same policy in the future because SIML (Italian Society of Occupational Medicine) covers the costs of publication in its official journal. SIML's support ensures full free access so that all scientific articles are published as "unlocked content" both on the journal's website and on PMC (Pub Med Central). The final version allows for free use and distribution, as long as the source of information is duly acknowledged, as the publisher and the authors still retain the copyright. Subscriptions will no longer be needed and, therefore, will be terminated. Going only online is a milestone in the 120-year history of our journal, which will be preserved through the digitalization of the entire collection, thanks to an agreement involving the University of Milan, where Luigi Devoto founded the journal in 1901, SIML and the publisher. The first century of the journal will be accessible both in photographic and in a searchable format (pdf) from different sites [2-4]. Asked why he is confident in science, the Nobel laureate Giorgio Parisi recently said that science provides the most honest answers to the questions we ask ourselves because the solution of a problem is offered to peers for discussion. Then, attempts follow to replicate experiments, comparing results and viewpoints. Although Medicine can hardly be defined as a science, it can rely on the scientific approach to obtain honest answers from friends sharing the same view and from a genuinely open debate and evaluation of available data by peers with a different perspective. Such a vision was essential to develop our editorial lines and introduce changes to increase the journal's visibility and access. In this issue, three articles authored by Associate Editors summarize what has been discussed either at the 83rd National Congress of Occupational Medicine (Parma, 15-17 September 2021) or during a webinar organized by the SIML Scientific Committee. Such papers are published in the "Reviews, Commentaries and Perspectives" section and offer personal views which are not necessarily endorsed by SIML and its journal. Indeed, as editors of the official journal of a scientific society, we encourage the publication of different and even contrasting opinions. We aim to stimulate debate on the scope of Occupational Medicine, now challenged by new commitments. Of course, the confrontation must be about ideas and must ensure respect for their authors, who bear full responsibility for their positions. Bonzini et al. [5] discuss risk assessment in low-dose chemical exposure scenarios, considering substances emerging because they are recognized as endocrine disruptors or increasingly used but poorly understood, such as nanoscale materials. For updated risk assessment models, suitable analyses of dose-responses at low concentrations, relying on innovative biomarkers and early effect, along with the proper identification of susceptible populations, may all contribute. These may guide defining preventive measures to control the exposure and develop safe and sustainable chemicals by design. Occupational medicine can offer know-how and instruments to understand and manage such evolution towards a toxic-free environment to protect the safety and health of the workforce and the general population. Using both a Relative Risk (RR) and an Excess Risk (ER) approaches to estimate an intervention's health impact is discussed in a paper suggesting that the ER approach is particularly useful when the RR approach requests the baseline rate equal to zero [6]. In health impact assessments, an additional issue is represented by the most relevant baseline rate to be used in computations. Such a rate might be either due to all known risk factors for a particular disease or attributable just to the risk factor(s) under consideration for the health impact assessment of an intervention (e.g., new industrial settlements). Finally, this paper proposes a method for using the number of attributable cases to mimic the EPA's decision-making approach. Acknowledging Zocchetti's original contribution, we are open to other viewpoints and diverging opinions submitted for publication in forthcoming issues of the journal. P4 (Predictive, Preventive, Personalized, Participatory) medicine is a new paradigm, encompassing multiple trends that are taking place in different medical disciplines. While not all components of P4 can be immediately implemented in any particular healthcare setting, this approach is helpful to drive innovation and set future priorities. The application of P4 to occupational medicine has so far been limited. Yet, Collatuzzo and Boffetta think it shows a novel framework for the discipline, which may result in the recognition of occupational physicians as drivers of medical innovation and wellbeing promotion [7]. This article offers a new perspective to Occupational Medicine, evaluating the possibility of applying the 4Ps to personalized intervention and relying on studies to identify individual workers whose genetic profile would put them at increased risk from low-dose exposure to carcinogens. As the editor-in-chief, I assure our readers that the journal will continue to pursue even higher standard and, therefore, ask for continued support from our scientific community in the field. Working together, we will offer the best service to both the scientific community and the workers, the very reason for our existence, as we work to preserve their health and safety.