Determinants of Anti-S Immune Response at 9 Months after COVID-19 Vaccination in a Multicentric European Cohort of Healthcare Workers-ORCHESTRA Project.

Background: The persistence of antibody levels after COVID-19 vaccination has public health relevance. We analyzed the determinants of quantitative serology at 9 months after vaccination in a multicenter cohort. Methods: We analyzed data on anti-SARS-CoV-2 spike antibody levels at 9 months from the first dose of vaccinated HCW from eight centers in Italy, Germany, Spain, Romania and Slovakia. Serological levels were log-transformed to account for the skewness of the distribution and normalized by dividing them by center-specific standard errors. We fitted center-specific multivariate regression models to estimate the cohort-specific relative risks (RR) of an increase of one standard deviation of log antibody level and the corresponding 95% confidence interval (CI), and combined them in random-effects meta-analyses. Finally, we conducted a trend analysis of 1 to 7 months' serology within one cohort. Results: We included 20,216 HCW with up to two vaccine doses and showed that high antibody levels were associated with female sex (p = 0.01), age (RR = 0.87, 95% CI = 0.86-0.88 per 10-year increase), 10-day increase in time since last vaccine (RR = 0.97, 95% CI 0.97-0.98), previous infection (3.03, 95% CI = 2.92-3.13), two vaccine doses (RR = 1.22, 95% CI = 1.09-1.36), use of Spikevax (OR = 1.51, 95% CI = 1.39-1.64), Vaxzevria (OR = 0.57, 95% CI = 0.44-0.73) or heterologous vaccination (OR = 1.33, 95% CI = 1.12-1.57), compared to Comirnaty. The trend in the Bologna cohort, based on 3979 measurements, showed a decrease in mean standardized antibody level from 8.17 to 7.06 (1-7 months, p for trend 0.005). Conclusions: Our findings corroborate current knowledge on the determinants of COVID-19 vaccine-induced immunity and declining trend with time.

Healthcare Workers and Manual Patient Handling: A Pilot Study for Interdisciplinary Training.

Manual patient handling (MPH) is a major occupational risk in healthcare settings. The aim of this study was to propose an MPH training model involving interdisciplinary aspects. A scheduled training program was performed with 60 healthcare workers (HCWs) from a hospital in Naples, Italy, providing training divided into three sections (occupational health-section one; physical therapy-section two; psychosocial section-section three) and lasting six hours. Fifty-two HCWs performed the training session. In section one, a questionnaire about risk perception related to specific working tasks was administered. Section two provided specific exercises for the postural discharge of the anatomical areas most involved in MPH. The last section provided teamwork consolidation through a role-playing exercise. The training program could also be useful for risk assessment itself, as they can examine the perceptions of the specific risk of the various workers and incorrect attitudes and therefore correct any incorrect procedures, reducing exposure to specific risks in the field. This pilot study proposes a training model that explores all aspects related to MPH risk exposure and also underlines the need for standardization of this formative model, which could represent a useful tool for studying the real effectiveness of training in workplaces.

HBV vaccination status among healthcare workers: A cross-sectional study.

OBJECTIVE: The development of a vaccine against hepatitis B virus (HBV) is one of the improvements in strategy prevention during the last decades. AIM: To evaluate HBV-related vaccine status in healthcare workers (HCW) exposed to biological risk. METHODS: The serum markers for HBV were collected from HCWs in two tertiary care hospitals in Naples (Italy). Multivariate statistical analysis was then performed to identify associated factors linked to the long-term immunogenicity of the HCWs. RESULTS: All HBV vaccinated individuals were screened for whole marker patterns; all were HBsAg/anti-HBc negative. Of individuals, 20% had an anti-HB antibody titre < 10 IU/L. Multivariate statistical analysis highlighted that women were more protected than men (73.6% vs. 26.4%, P < 0.05). Additionally, nurses seem to maintain a higher antibody titre than doctors and other staff, such as auxiliary technicians (P < 0.05). CONCLUSIONS: Our data support the evidence of a strong immunogenicity against HBV, assessed through the circulating antibody titre, when prophylactic vaccination is conducted in non-infantile age, particularly for women. The outcome of the study supports the central role of occupational physicians within the hospital districts in terms of primary prevention and maximum protection of HCWs.

Risk agents related to work and amyotrophic lateral sclerosis: An occupational medicine focus.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive muscular paralysis reflecting degeneration of motor neurons. In recent years, in addition to several studies about genetic mechanisms leading to motor neurons damage, various epigenetic theories have been developed, involving the study of the patients' work and lifestyle. The work aims at focusing the role of occupational exposure related to ALS by literature data analysis. Articles, selected on the basis of keywords, year of publication and topics, are related to occupational exposure, suggesting an impact on ALS onset. The literature review shows that there are still a lot of biases in the studies design, which actually do not allow to draw unequivocal conclusions.

Working conditions and mental health: Results from the CARESUN study.

The authors conducted a work-related stress surveillance study in 2013 on 6,558 public-sector employees in Italy, examining how they perceived their jobs, via the Job Content Questionnaire, and their mental health status, via the General Health Questionnaire 12 (GHQ-12). Of the 2,094 employees completing the questionnaires, 60% were male, 52% had a medium-level education, and 76% had a medium-level job. Three hundred and eighty-five employees (18%) had a GHQ-12 score >3 and were classified as GHQ-12 cases: these were more often female (54%), medium-to-highly educated (54%), and had more often reported health problems over the previous year (51%). Thus, GHQ-12 cases represented a significant percentage of the examined population, indicating that work-related stress surveillance programs are needed for the planning of psychosocial interventions aimed at the reintegration of individuals with mental health problems.

[Amyotrophic lateral sclerosis and exposure to metals and other occupational/environmental hazardous materials: state of the art]. / Sclerosi laterale amiotrofica ed esposizione a metalli ed altri agenti di rischio di natura occupazionale/ambientale: stato dell'arte.

In recent years, scientific literature has been giving more and more importance to the study of the occupational/environmental exposure to risk agents related to the onset of Amyotrophic Lateral Sclerosis (ALS), a neurodegenerative disease characterized by progressive muscular paralysis reflecting degeneration of motor neurons in the primary motor cortex. Aim of this work is to verify the state of art about the eventual role of occupational/environmental exposure to risk agents. Selected articles, on the basis of keywords, year of publication and topics, are related to occupational and environmental exposure to xenobiotics, and, in particular, to the exposure to heavy metals that could lead to neuronal damage mechanisms involved in ALS onset. The review shows that although the scientific production has increased the interest in the evaluation of extra-genetic causes of ALS onset, there are still few studies concerning the careful study of the work activities of the individual patient, and the inferences that can be drawn to date about the possible connection between occupational exposure to risk factors and the onset of ALS are still lacking.

Tuberculin skin test and Quantiferon test agreement and influencing factors in tuberculosis screening of healthcare workers: a systematic review and meta-analysis.

OBJECTIVE: A systematic review and meta-analysis was conducted to evaluate the agreement between Tuberculin Skin Test (TST) and Quantiferon (QFT) in screening for tuberculosis (TB) infection among healthcare workers (HCWs) and to estimate associations between TST and QFT agreement and variables of interest, such as Bacillus Calmette-Guérin (BCG) vaccination and incidence of TB. METHODS: Cross-sectional and longitudinal studies on HCWs, published in English until October 2013, comparing TST and QFT results, were selected. For each study Cohen's κ value and a 95% confidence interval were calculated. Summary measures and indexes of heterogeneity between studies were calculated. RESULTS: 29 studies were selected comprising a total of 11,434 HCWs. Cohen's κ for agreement between TST and QFT for 24 of them was 0.28 (95% CI 0.22 to 0.35), with the best value in high TB incidence countries and the lowest rate of BCG vaccination. CONCLUSION: Currently, there is no gold standard for TB screening and the most-used diagnostic tools show low agreement. For evidence-based health surveillance in HCWs, occupational physicians need to consider a number of factors influencing screening results, such as TB incidence, vaccination status, age and working seniority.

Blood lead, manganese, and aluminum levels in a regional Italian cohort of ALS patients: does aluminum have an influence?

OBJECTIVES: To study aluminum (Al), manganese (Mn), and lead (Pb) influence on amyotrophic lateral sclerosis (ALS) development. METHODS: A total of 34 patients (10% of the regional ALS population) and 25 controls of an Italian region were enrolled. Metal concentrations were determined by atomic absorption spectroscopy. RESULTS: Serum Al concentrations in patients and controls were similar and lower than those provided by the Italian Society of Reference Values. No differences were observed in serum Mn concentrations, while, as expected, blood Pb levels were significantly higher in patients with ALS than those in controls. CONCLUSIONS: Results confirmed the association between high Pb blood levels and ALS; on the contrary, Al and Mn did not differ significantly in patients and controls, suggesting that Mn and especially Al may play a less important role in the ALS pathogenesis.

5-Fluorouracil induces apoptosis in rat cardiocytes through intracellular oxidative stress.

BACKGROUND: Cardiotoxicity is a major complication of anticancer drugs, including anthracyclines and 5-fluorouracil(5-FU) and it can have detrimental effects both in patients and workers involved in the preparation of chemotherapy. METHODS: Specifically, we have assessed the effects of increasing concentrations of 5-FU and doxorubicin (DOXO) on proliferation of H9c2 rat cardiocytes and HT-29 human colon adenocarcinoma cells by MTT assay. Cells were treated for 24, 48 and 72 h with different concentrations of the two drugs alone or with 5-FU in combination with 10(-4) M of levofolene (LF). RESULTS: 5-FU induced a time- and dose-dependent growth inhibition in both cell lines. The 50% growth inhibition (IC:50) was reached at 72 h with concentrations of 4 µM and 400 µM on HT-29 and H9c2, respectively. The addition of LF to 5-FU enhanced this effect. On the other hand, the IC:50 of DOXO was reached at 72 h with concentrations of 0.118 µM on H9c2 and of 0.31 µM for HT-29. We have evaluated the cell death mechanism induced by 50% growth inhibitory concentrations of 5-FU or DOXO in cardiocytes and colon cancer cells. We have found that the treatment with 400 µM 5-FU induced apoptosis in 32% of H9c2 cells. This effect was increased by the addition of LF to 5-FU (38% of apoptotic cells). Apoptosis occurred in only about 10% of HT-29 cells treated with either 5-FU or 5-FU and LF in combination. DOXO induced poor effects on apoptosis of both H9c2 and HT-29 cells (5-7% apoptotic cells, respectively). The apoptosis induced by 5-FU and LF in cardiocytes was paralleled by the activation of caspases 3, 9 and 7 and by the intracellular increase of O(2-) levels. CONCLUSIONS: These results suggest that cardiotoxic mechanism of chemotherapy agents are different and this disclose a new scenario for prevention of this complication.

Functional changes in human peripheral neutrophils in workers with different exposure to noxious agents.

Peripheral neutrophils (PMN) are a useful model to study cell activation and to evaluate the multiple stressors' interference with signalling pathways. This study aimed to evaluate the effects of different exposure to noxious agents on PMN activity by chemiluminescence assays. Two groups of office workers were recruited: peripheral whole blood cells and isolated PMNs were analyzed, performing intra- and extra-cellular chemiluminescence evaluation to study compartmental release of radical species. The exposed group shows a higher emission in resting whole blood chemiluminescence than in controls; the intracellular chemiluminescence emission in urban employees was increased, whereas the extracellular was not affected. After stimulation, the extracellular chemiluminescence was decreased in urban employees, whereas the intracellular emission did not show differences. We hypothesize that once stimulated, exposed subjects' PMNs respond to stimuli less than unexposed: PMNs could be considered indicators of chronic exposure to noxious agents.

Solid-phase microextraction-gas chromatography-mass spectrometry method validation for the determination of endogenous substances: urinary hexanal and heptanal as lung tumor biomarkers.

Hexanal and heptanal are endogenous aldehydes coming from membrane lipid oxidation, found in lung cancer patients' blood, and suggested as lung tumor biomarkers. Here the urinary matrix was investigated instead of blood and the difficulties related to the determination of endogenous substances in biological matrices were faced by developing an external calibration HS-SPME/GC/MS method. The methodology was validated according to international validation procedures and it was verified analyzing unknown biological samples from cancer patients and healthy subjects. Percentage accuracy and precision, ranging from -11.25 to 10.85% and from 0.45 to 4.46%, respectively, were obtained, together with limits of detection (LODs) and lower limits of quantification (LLOQs) of 0.11 and 0.23 pg µL(-1) for hexanal and of 0.10 and 0.21 pg µL(-1) for heptanal. Analytes percentage recoveries (66.3%, hexanal and 70.5%, heptanal) and stability were evaluated. No analytes degradation was found at room temperature, while the remarkable analytes loss found after 1 month storage suggests analyzing biological samples within a week from storage. Results coming from the analysis of unknown biological samples showed no evident differences of heptanal urinary excretion between lung cancer patients and healthy subjects (0.22-0.95 and 0.21-0.69 pg µL(-1), respectively), while hexanal urinary concentrations in cancer patients (0.24-4.36 pg µL(-1)) were slightly higher than those found in control group ones (0.23-1.26 pg µL(-1)). The obtained results highly suggest to do further investigations in order to collect statistically significant biological data to discriminate between the pathological state of lung cancer patients and physiological conditions of healthy subjects, using the simple, rapid and cheap method here reported for the quantification of urinary aldehydes.