Rising level of pulmonary dioxin might trigger CMV and HSV-1 reactivation via bHLH/PAS/AhR:ARNT transcription pathway in lungs of immunocompetent COVID-19 patients with ARDS

Study objective. It has been shown that human common viruses are new target genes for host cell dioxin receptor transcriptional (AhR-ARNT) complex initially proven to up-regulate mammalian genes containing dioxin-response elements (DRE) in the promoters [doi:10.1016/j.ijid.2012.05.265]. Initially, transactivation of HIV-1 and HBV by 2,3,7,8-tetrachlodibenzop- dioxin (TCDD) at low nanomolar range was demonstrated [doi:10.3109/00498259309057034]. Noteworthy, transactivation of human cytomegalovirus (CMV) was shown with 0.3 ppt dioxin, i.e. lower than its current background level in the general population (~3.0 ppt). Recently, reactivation of CMV infection was found to influence worse clinical outcome following SARS-CoV-2 infection (doi: 10.1186/s12979-020- 00185-x). Other findings showed that CMV and herpes simplex virus 1 (HSV-1) reactivation were observed in immunocompetent patients with COVID-19 acute respiratory distress syndrome (ARDS) (doi.org/10.1186/s13054-020-03252-3). Addressing occurrence of Herpesviridae reactivation in severe COVID-19 patients, and still unspecified real triggers of CMV and HSV-1 reactivations, we tested TCDD, which current body burden (DBB) ranges from 20 pg/g (TEQ in fat) in general population to 100 pg/g in older people. Methods. In Silico quantitation of active DRE in promoters of viral genes. Virus DNA hybridization assay. Clinical and epidemiological analyses. Results and Discussion. In this study, a computational search for DRE in CMV and HSV-1 genes was performed by SITECON, a tool recognizing potentially active transcriptional factor binding sites. In silico analysis revealed in regulatory region of CMV IE genes from 5 to 10 DRE, and from 6 to 8 DRE in regulatory region of HSV-1 IE genes.We established that a low picomolar TCDD can trigger up-regulation of CMV and HSV-1 genes via AhR:Arnt transcription factor in macrophage(doi.org/10.1016/ j.ijid.2012.05.265) and glial human cell lines (doi.org/10.1016/j. jalz.2016.06.1268), respectively. In fact, viral reactivation may be triggered in COVID-19 ARDS patients by higher pulmonary TCDD concentrations, because "lipid storm" within lungs of severe COVID-19 patients has been recently reported (doi.org/ 10.1101/2020.12.04.20242115). TCDD is known as the most potent xenobiotic, which bioaccumulates and has estimation half-life in humans of up to 10 yr. Due to hydrophobic character (Log P octanol/water: 7.05), TCDD partitions into inflammatory lipids in lung tissue thus augmenting its local concentration. Population-based epidemiological data on SARS-CoV-2 first wave of pandemic revealed high level of CMV seropositivity and cumulative mortality rate 4.5 times in Lombardi region of Italy, where after Seveso industrial accident TCDD plasma level in pre-exposed subjects is 15 times the level in rest of Italy (doi. org/10.3389/fpubh.2020.620416). Also, Arctic Native (AN) peoples consume dioxin-contaminated fat in seafood and have TCDD DBB, i.e. 7 times that in general population. To the point of this paper, their COVID-19 mortality is 2.2 times of that among non-AN Alaskans (doi: 10.15585/mmwr.mm6949a3). Conclusion(s): TCDD in the picomolar range may trigger CMV expression in lung cells and commit virus to the lytic cycle, which can be applied to reactivation of Herpesviridae infection in immunocompetent patients with COVID-19 ARDS syndrome.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

Reducing Secondary Trauma and Promoting Self-Compassion Through a Graduate Medical Education (GME) Wellness Elective (Sch456)

Outcomes: 1. Explore the ways that palliative and mental health providers can collaborate to offer a novel, interdisciplinary wellness curriculum. 2. Evaluate impacts of a wellness course on secondary trauma, self-compassion, and burnout. Background(s): Palliative care and mental health providers possess skill sets that, when combined, can uniquely foster the well-being of colleagues within and beyond our specialties. The need for such peer support has become more urgent during the COVID pandemic. Self-care, compassion satisfaction, and trauma-informed training have been positively associated with an ability to cope with stressors in healthcare. We designed a 2-week GME elective intended to increase self-compassion and connection and reduce secondary trauma and burnout. Description: The course has been offered annually since 2019 to cohorts of 12-15 trainees across 14 specialties. Trainees participated in-person (2019, 2021) and virtually (2020). Coursework includes psychological safety, burnout/suicide prevention, self-compassion, occupational trauma and recovery, expressive art, medical error, cultural humility/upstanding, narrative medicine, conflict resolution, mindfulness, and others. We sought to evaluate the impact of the elective on burnout, self-compassion, and secondary trauma using the Professional Quality of Life (PROQOL) survey in the 2021 cohort. We evaluated trainee satisfaction with the course in all three cohorts (2019-2021). Result(s): 1 month after the elective, trainees reported a reduction in secondary trauma (p<0.0001) and an increase in self-compassion (p<0.005). The effect on burnout was not significant (p=0.57). Over 3 years, 100% of trainees (n=43) strongly agreed that the course was worth their time. Participants reported the course gave them "skills to better tolerate distress about things I cannot change" as well as self-agency through connection: "My peers helped me find new power that I didn't know I had." Conclusion(s): We generated a curriculum that impacted self-compassion and secondary trauma. We did not see an effect on burnout, which could be related to returning to an unchanged stressful environment following the course. Expanding access to this curriculum would afford opportunities to assess impact on a larger scale.Copyright © 2023

Intrinsic asthma after SARS-CoV-19-infection

We report the case of a 40-year-old previously lung-healthy male who became infected with SARS-CoV-2 from a named index person while working in charity care. He developed intrinsic bronchial asthma during its course. Discussed are bronchial hyperreactivity following viral infection, occupational accident and occupational disease (number 3101 – German register of occupational diseases). ©2022 Dustri-Verlag Dr. K. Feistle.

OCCUPATIONAL ACCIDENT DUE TO COVID-19 INFECTION IN HEALTH AND SOCIAL-HEALTH WORKERS IN THE FIFTH SANITARY AREA OF ASTURIAS

Introduction: In Spain, COVID-19 infection in the health and socialhealth workers is considered as an occupational accident (OA) if the Occupational Risk Prevention Services (ORPS) certificate it.The aim of our study was to verify it in our area and to correct deficiencies. Material and Method: Descriptive study from May 28, 2020 to January 27, 2021.The health Inspection Unit of our area required OA certificate to the ORPS, and the assessment by the National Institute of Social Security (NISS) when the private insurance fund denied OA. Results: Total of 204 cases (55.4% healthcare workers, 52.5% from public centres (33.3% in our area). ORPS OA certificate: 61.8%. NISS recognised OA: 41.2%. OA recognition was greater in socio-health and private workers than in sanitary and public workers.The medical inspection Unit intervention partially improve the results. Conclusions: Despite complying with legal requirements there were no OA recognition in all cases of COVID-19 infection in these workers. The medical inspection Unit was not guarantor enough.

[Neurological and psychiatric expert assessment of post-COVID syndrome]. / Neurologisch-psychiatrische Begutachtung des Post-COVID-Syndroms.

Infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to a multiorgan disease and subsequently to very different clinical manifestations of coronavirus disease 2019 (COVID-19). In addition to acute symptoms, the long-term complaints in the context of the infection, known as long or post-COVID syndrome, are increasingly attracting attention. With respect to social insurance systems, expert opinions of such problems will become more and more important, whereby neurological and psychiatric symptoms are the most frequent complaints. In addition to the legal principles of the medico-legal assessment with a focus on statutory accident insurance, this overview article discusses the principles of expert assessment and presents landmarks for the expert opinion of the most frequent neurological and psychiatric symptoms occurring in the context of post-COVID syndrome.

Why we need to bridge the gap between research in occupational health and safety and human resources management?

Introduction: Occupational health and safety (OHS) is a complex field where all disciplines intersect. Currently, it is not only a question of taking into account the physical health of the worker, but also of including the psychological health and social aspects of the worker. Over the past decades, OSH has seen a lot of advancement, especially in recent years. In addition, this analysis is important in view of the economic costs that work-related accidents cause to the global economy. Method: Through a meta-analysis, a focus on existing research in OHS was made, with the objective of identifying gaps and mapping future research for academics in human resources management (HRM). Results: The review of the literature showed, identified and classified the articles into five distinct themes: antecedents and work-related factors influencing OHS;industrial policy and regulations surrounding OHS;OHS management practices;OHS management approaches and models and OHS management results. OHS research is poorly integrated into HRM research. The importance of the latter was accentuated during the Covid-19 pandemic, by revealing the gaps to be filled in OHS. Thus, the benefits of OHS management in organizations have a huge impact on increasing productivity, performance and decreasing absenteeism rate. Conclusion: There are many opportunities for HRM researchers to add value to the field, but also for organizations. To respond to the problem, the transfer of knowledge remains an essential element for the advancement of OHS practices.

A model proposal to ensure the health maintenance in a Colombian University during the Pandemic Covid-19

Introduction: The Covid -19 Pandemic had caused a worldwide crisis leading to many negative consequences on healthy habits, biomechanical system, and mental health to students and workers. The National University is the main University in Colombia;it has around 30.000 students and 10.000 workers. Due to the Pandemic, many workers had to work from home, which generated consequences that had to be interrupted. Material and Methods: Through the application of many virtual surveys, we could choose the main topics to be included in this strategy. Finally we selected the next ones and worked on them from our office: - biomechanical, due to the new physical ergonomics conditions. - psychosocial, related to many factors as epidemic Pandemic behavior, new family issues at home, addictions, etc. - nutrition facts, because of inadequate eating habits. - cardiovascular, due to the aspects listed above, and sedentary lifestyle. - occupational health facts, remembering the importance of preventing work-related injuries. Results and Conclusions: Many employees and students at our university had been highly motivated to go back on having healthy habits, which, in some cases have had a positive impact on their families;who have been sharing the same home space with the workers during the Pandemic. According to the intervention developed by our Occupational Health Office, in alliance with the University´s Faculty of Medicine, we are improving our workers lifestyle, which will have positive impacts on them and their families. It represents such an important aspect that will ameliorate our community public health results.

A methodological framework to guide the Covid-19 prevention strategies in Italian workplaces

Introduction: COVID-19 pandemic affected health and safety of workers worldwide showing several types of working conditions at risk of infection. A methodology to assess the risk of SARS-CoV-2 infection in the workplace, has been developed in Italy and adopted by the Government authorities to guide the National prevention strategies. Material and Methods: A model that includes the analysis of proximity between employees and potential exposure while they work, has been integrated with social aggregation, a specific factor connected to the job due to the involvement of third parties in work processes. The comparative analysis between risk levels and insurance claims for occupational injuries by sector, supported the model validation. The estimated risk class and the incidence of compensation claims were used also as quantitative indicators to prioritize the vaccination campaign in workplaces. Results: According to the NACE classification, the activity sectors have been classified into four levels of risk (high, medium-high, medium-low, low). By June 2021, the economic sectors at high or medium-high risk of COVID-19 infection (i.e. ‘Human health and social work activities’ and ‘Public administration’) included 75% of applications with occupational origin. Conclusions: This methodological approach guided the modular reopening of work activities for a safe reactivation of businesses. The prioritization of the workplace vaccination strategy taking into account the risk by different productive sectors, may contribute to the fastest achievement of the whole population immunity as progressive “exit strategy” from Covid-19 pandemic.