Kriteriji za ocjenu sposobnosti za rad u zdravstvenih radnika inficiranih virusima hepatitisa B i C

The aim of this study was to propose a protocol for assessment of markers of infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) in exposed health care professionals and to define criteria for evaluation of fitness for the job of the infected personnel. The study comprised 800 persons involved in operative procedures, including 414 surgeons, 275 nurses, and 111 anaesthetists. A graduated protocol was created for monitoring markers of HBV and HCV infection. A well-defined combination of markers of antigenantibody systems enabled identification of four groups of persons with HBV infection differing in fitness for work: 1) HBsAg-positive, HBeAgpositive, HBV DNA-positive; 2) HBsAg-positive, anti-HBe-positive, HBV DNA-positive; 3) HBsAgpositive, anti-HBe-positive, HBV DNA-negative; and 4) anti-HBs-positive, anti-HBc-positive, anti-HBe-positive group. For HCV infection, two groups with different job fitness were identified: 1) anti-HCV-positive, HCV RNA-negative and 2) anti-HCV-positive, HCV RNA-positive. Screening of hospital personnel at risk to HBV and HCV infection requires a well-defined protocol which may help to evaluate the fitness of the infected personnel for a specific job.U priopćenju je predložen stupnjevani protokol za procjenu pokazatelja infekcije virusom hepatitisa B (HBV) i virusom hepatitisa C (HCV) u profesionalno izloženih zdravstvenih radnika kao i za utvrđivanje kriterija za ocjenu sposobnosti za rad inficiranog osoblja. U istraživanju je obuhvaćeno 800 zdravstvenih radnika koji sudjeluju u operativnim zahvatima: 414 kirurga, 275 medicinskih sestara i 111 anesteziologa. Prema definiranim kombinacijama ispitivanih pokazatelja u sustavima antigen-antitijelo, ispitanici inficirani virusom hepatitisa B razvrstani su u četiri skupine s različitom sposobnošću za rad, prema ovim nalazima: 1) HBsAg pozitivan, HBeAg pozitivan, HBV DNK pozitivan; 2) HBsAg pozitivan, anti-HBe pozitivan, HBV DNK pozitivan; 3) HBsAg pozitivan, anti-HBe pozitivan, HBV DNK negativan; 4) anti-HBs pozitivan, anti-HBc pozitivan, anti-HBe pozitivan. Slično su razvrstane osobe inficirane virusom hepatitisa C u dvije skupine, prema ovim nalazima: 1) anti-HCV pozitivan, HCV RNK negativan; 2) anti-HCV pozitivan, HCV RNK pozitivan. Zaključeno je da, budući da u Italiji Služba medicine rada nema u nadležnosti nadzor medicinskog osoblja koje je u povećanom riziku od infekcije HBV-om i HCV-om, valja usvojiti jasno definirani protokol za utvrđivanje pokazatelja infekcije u profesionalno izloženih osoba. Takav protokol mogao bi poslužiti za donošenje kriterija za ocjenu sposobnosti za rad inficiranog osoblja

Očna hipertonija i zamućenja leće u zdravstvenih radnika izloženih ionizirajućem zračenju

Some activities performed by healthcare workers may still involve total or partial exposure to ionising radiation exceeding the limit values. In addition to the appearance of crystalline lens opacities which may lead to rays-cataract, recent studies have indicated possible induction of ocular hypertonia in occupationally exposed subjects. The aim of this study was to establish the actual prevalence of ocular hypertonia and crystalline lens opacities in a group of healthcare workers exposed to ionising radiation. The collected data failed to show significant risk of ocular hypertonia and suggested that crystalline lens opacity was not an important indicator of exposure. Notwithstanding, preventive and periodic (every 5 years) ophthalmologic control may prove helpful for medicolegal purposes. Namely, such control would record congenital crystalline lens opacities in many individuals and would thus rule out unjustified claims of occupational disease due to exposure to ionising radiation. Additionally, ophthalmologic control should focus on different and probably more important ocular risks for the radiologists such as the ocular fatigue resulting from a prolonged use of a video display terminal or other diagnostic screens or electrodiaphanoscopes.Neke od djelatnosti zdravstvenih radnika još uključuju rizik od potpune ili djelomične izloženosti ionizirajućem zračenju u razinama koje nadilaze granične vrijednosti. Osim različitih stupnjeva od zamućenja leće do katarakte, nova su istraživanja upozorila na mogućnost pojave očne hipertonije i zamućenja leće u profesionalno izloženih osoba. Cilj je ovoga istraživanja bio utvrditi pravu incidenciju očne hipertonije i zamućenja leće u zdravstvenih radnika koji su povremeno izloženi ionizirajućem zračenju. Rezultati pokazuju da nema značajnoga rizika od očne hipertonije u toj populaciji te upućuju na to da zamućenje leće nije značajan pokazatelj izloženosti ionizirajućem zračenju. Bez obzira na to, periodični i preventivni oftalmološki pregledi (svakih pet godina) mogli bi se pokazati korisnima u medicinskom i pravnom pogledu. Naime, ovakva bi kontrola mogla registrirati uro|ena zamućenja leće u mnogih pojedinaca, što bi isključilo mogućnost neopravdanih zahtjeva za odštetu za profesionalnu bolest zbog izloženosti ionizirajućem zračenju. Osim toga, oftalmološki bi pregledi trebali uzeti u obzir i druge, možda i važnije rizike za zdravlje oka u radiologa kao što je umor oka zbog dugotrajnog naprezanja pri uporabi videoterminala ili ostalih ekrana, odnosno elektrodijafanoskopa

Psychopathological Burden among Healthcare Workers during the COVID-19 Pandemic Compared to the Pre-Pandemic Period

This retrospective observational study on hospital staff requesting an “application visit” (from 2017 to 2022) at the Occupational Medicine department aimed at comparing a “pre-COVID group” (2017–2019) with a “COVID group” (2020–2022) regarding (a) sociodemographic data (i.e., age, sex, occupation, years of employment at the hospital), (b) rate and type of psychiatric diagnoses in both groups and rate of psychiatric diagnoses per subject, and (c) rate of drug/psychotherapeutic prescriptions. Two hundred and five healthcare workers (F = 73.7%; mean age = 50.7 ± 10.33) were visited. Compared with the pre-COVID group, healthcare workers evaluated during COVID-19 were significantly younger and reported fewer years of employment at the hospital. Although rates of primary psychiatric diagnoses were similar in both samples, an increased number of psychopathologies per subject and associated treatment prescriptions in the COVID group was observed. In the COVID group, 61% had one psychiatric diagnosis, and 28% had 2+ psychiatric diagnoses, compared with 83.8% and 6.7% of pre-COVID. Furthermore, 56.2%/1.9% in pre-COVID and 73%/6% in the COVID group were prescribed drugs/psychotherapy, respectively. The findings of the present study highlighted an increase in both younger workers’ requests and psychiatric comorbidities during the pandemic, representing a burden on the Italian healthcare system. It is thus relevant to address the mental health challenges of healthcare workers accordingly

Vrtlarski rad i izloženost teškim metalima u gradskom okružju

Urban soil may be a source of occupational exposure to various pollutants in gardening and land cultivation. This paper presents data of a one-year follow-up of lead, cadmium, nickel, chromium, and vanadium in the environment of the city of Bologna. Samples of soil and leaves were collected at three locations; gardens from the inner-city high-traffic area, parks in moderatetraffic area, and parks in suburban, low-traffic area. The top and deeper layers of soil and leaves were mainly polluted by lead at all locations, which corresponded to the traffic density. Personal samplers recorded greater concentrations of airborne metals than did the area samplers but the values kept below the threshold limit established by the American Conference of Governmental Industrial Hygienists for the working environment. Due to cumulative nature and interactive effects of toxic metals with other toxic and essential elements, long-term exposure to metals in the urban environment may be a health risk for occupationally exposed gardeners.Gradsko tlo može biti izvorom profesionalne izloženosti različitim onečišćivačima u vrtlara, uključujući otrovne teške metale koji se talože iz onečišćenog zraka na tlo i lišće. U radu su prikazani podaci jednogodišnjeg praćenja koncentracija olova, kadmija, niklja, kroma i vanadija u talijanskom gradu Bologni. Uzorci tla i lišća skupljani su na tri mjesta s različitom gustoćom prometa; u središtu grada s velikom gustoćom prometa, u parkovima s umjerenim prometom u okolišu i u prigradskim parkovima sa slabim prometom. Na svim lokacijama gornji i dublji slojevi tla bili su podjednako onečišćeni ponajprije olovom i to je bilo u svezi s prometnom gustoćom. Koncentracije metala u zraku utvr|ene u filtrima osobnih skupljača bile su više od koncentracija u skupljačima na tlu. Vrijednosti metala u zraku bile su niže od graničnih vrijednosti utvr|enih za radni okoliš od Američke konferencije vladinih industrijskih higijeničara (American Conference of Governmental Industrial Hygienists). Zaključeno je da vrtlari, u usporedbi s općim stanovništvom, i pri niskim razinama izloženosti u gradskom okolišu imaju povećan zdravstveni rizik za štetna djelovanja otrovnih metala i drugih onečišćivača okoliša zbog dugotrajne izloženosti u svezi s njihovim radom

Kumulativni traumatski poremećaji gornjih udova u radnika na poljoprivrednom dobru

The work associated with repetitive efforts and inadequate resting periods, strong physical exertion, awkward postures or static positioning exposes workers to the risk of cumulative trauma disorders of the upper limbs. These risk factors are present in many agricultural activities. A study was carried out among workers on an agricultural farm. The workers\u27 histories were taken and they were given periodical medical check-ups. The presence of upper limb disorders was shown in a group of workers. A sample of 42 people was selected for the study by means of specific tests: electromyography, ultrasonography and laser-doppler ftowmetry. The tests showed a high incidence of carpal tunnel syndrome and microcirculation disorders. The study confirmed that electromyography, ultrasonography and/or laser-doppler flowmetry are highly useful tools for identifying cumulative trauma disorders.Pokreti koji se ponavljaju, neprimjereni odmori, teška fizička opterećenja te nefiziološki položaji tijela dovode do povećanog rizika razvoja bolesti kumulativne traume gornjih udova. Ovi čimbenici rizika prisutni su u mnogim poljoprivrednim djelatnostima. Od 74 radnika na poljoprivrednom dobru podvrgnuta periodskim pregledima, u 42 je primijenjena elektromiografija, ultrasonografija i mjerenje krvnog protoka laser-doppler metodom. Testovima je utvrđena visoka učestalost sindroma karpalnog tunela i poremećaja mikrocirkulacije. Ispitivanje je potvrdilo da su eiektromiografija, ultrasonografija i/ili laser-doppler mjerenje krvnog protoka veoma korisne metode u dijagnostici bolesti kumulativne traume

Izostanak mutacija humanoga interferon alfa-2b gena u radnika kronično izloženih ionizirajućem zračenju

Individuals chronically exposed to low-level ionising radiation (IR) run the risk of harmful and long-term adverse health effects, including gene mutations and cancer development. The search for reliable biomarkers of IR exposure in human population is still of great interest, as they may have a great implementation potential for the surveillance of occupationally exposed individuals. In this context, and considering previous literature, this study aimed to identify mutations in the human interferon alpha-2b (hIFNα-2b) as a potential biomarker of occupational chronic low-dose IR exposure linking low-IR exposure to the effects on haematopoiesis and reduced immunity. The analysis was performed in the genomic DNA of 51 uranium miners and 38 controls from Kazakhstan, and in 21 medical radiology workers and 21 controls from Italy. hIFNα-2b gene mutations were analysed with the real-time polymerase chain reaction (PCR) or Sanger sequencing. However, none of the investigated workers had the hIFNα-2b mutation. This finding highlights the need for further research to identify biomarkers for early detection of health effects associated with chronic low-dose IR exposure.Kronična izloženost niskim razinama ionizirajućega zračenja povezana je s rizikom od dugoročnih štetnih posljedica za zdravlje, što obuhvaća i mutacije gena te nastanak raka. U tijeku je potraga za pouzdanim biopokazateljima izloženosti ionizirajućem zračenju u ljudi, budući da njihova primjena može značajno unaprijediti praćenje profesionalno izloženih osoba. U tom smislu, a s obzirom na ranija saznanja, cilj je ovoga istraživanja bio utvrditi mutacije gena za proizvodnju humanoga interferona alfa-2b (hIFNα-2b gena) kao mogućega biopokazatelja profesionalne kronične izloženosti niskim dozama ionizirajućega zračenja, koje je usto povezano s djelovanjem na hematopoezu i pad imuniteta. Analiziran je genomski DNA 51 rudara u rudnicima uranija te 38 kontrolnih ispitanika iz Kazahstana, odnosno genomski DNA 21 zdravstvenoga radnika na radiologiji i 21 kontrolnoga ispitanika iz Italije. Mutacije hIFNα-2b gena utvrđivane su metodom lančane reakcije polimerazom u stvarnom vremenu (engl. real-time PCR) odnosno sekvenciranjem prema Sangeru, ali se pokazalo da niti jedan radnik nije imao niti jednu od deset traženih mutacija toga gena. Stoga ne preostaje drugo nego i dalje tražiti pouzdane biopokazatelje za rano otkrivanje štetnih zdravstvenih učinaka povezanih s kroničnom izloženosti niskim dozama ionizirajućega zračenja

Evaluation of humoral and cellular response to four vaccines against COVID-19 in different age groups: A longitudinal study

To date there has been limited head-to-head evaluation of immune responses to different types of COVID-19 vaccines. A real-world population-based longitudinal study was designed with the aim to define the magnitude and duration of immunity induced by each of four different COVID-19 vaccines available in Italy at the time of this study. Overall, 2497 individuals were enrolled at time of their first vaccination (T0). Vaccine-specific antibody responses induced over time by Comirnaty, Spikevax, Vaxzevria, Janssen Ad26.COV2.S and heterologous vaccination were compared up to six months after immunization. On a subset of Comirnaty vaccinees, serology data were correlated with the ability to neutralize a reference SARS-CoV-2 B strain, as well as Delta AY.4 and Omicron BA.1. The frequency of SARS-CoV-2-specific CD4+ T cells, CD8+ T cells, and memory B cells induced by the four different vaccines was assessed six months after the immunization. We found that mRNA vaccines are stronger inducer of anti-Spike IgG and B-memory cell responses. Humoral immune responses are lower in frail elderly subjects. Neutralization of the Delta AY.4 and Omicron BA.1 variants is severely impaired, especially in older individuals. Most vaccinees display a vaccine-specific T-cell memory six months after the vaccination. By describing the immunological response during the first phase of COVID-19 vaccination campaign in different cohorts and considering several aspects of the immunological response, this study allowed to collect key information that could facilitate the implementation of effective prevention and control measures against SARS-CoV-2

Quantitative MRI Harmonization to Maximize Clinical Impact: The RIN-Neuroimaging Network

Neuroimaging studies often lack reproducibility, one of the cardinal features of the scientific method. Multisite collaboration initiatives increase sample size and limit methodological flexibility, therefore providing the foundation for increased statistical power and generalizable results. However, multisite collaborative initiatives are inherently limited by hardware, software, and pulse and sequence design heterogeneities of both clinical and preclinical MRI scanners and the lack of benchmark for acquisition protocols, data analysis, and data sharing. We present the overarching vision that yielded to the constitution of RIN-Neuroimaging Network, a national consortium dedicated to identifying disease and subject-specific in-vivo neuroimaging biomarkers of diverse neurological and neuropsychiatric conditions. This ambitious goal needs efforts toward increasing the diagnostic and prognostic power of advanced MRI data. To this aim, 23 Italian Scientific Institutes of Hospitalization and Care (IRCCS), with technological and clinical specialization in the neurological and neuroimaging field, have gathered together. Each IRCCS is equipped with high- or ultra-high field MRI scanners (i.e., ≥3T) for clinical or preclinical research or has established expertise in MRI data analysis and infrastructure. The actions of this Network were defined across several work packages (WP). A clinical work package (WP1) defined the guidelines for a minimum standard clinical qualitative MRI assessment for the main neurological diseases. Two neuroimaging technical work packages (WP2 and WP3, for clinical and preclinical scanners) established Standard Operative Procedures for quality controls on phantoms as well as advanced harmonized quantitative MRI protocols for studying the brain of healthy human participants and wild type mice. Under FAIR principles, a web-based e-infrastructure to store and share data across sites was also implemented (WP4). Finally, the RIN translated all these efforts into a large-scale multimodal data collection in patients and animal models with dementia (i.e., case study). The RIN-Neuroimaging Network can maximize the impact of public investments in research and clinical practice acquiring data across institutes and pathologies with high-quality and highly-consistent acquisition protocols, optimizing the analysis pipeline and data sharing procedures

Differential diagnosis of neurodegenerative dementias with the explainable MRI based machine learning algorithm MUQUBIA

Biomarker-based differential diagnosis of the most common forms of dementia is becoming increasingly important. Machine learning (ML) may be able to address this challenge. The aim of this study was to develop and interpret a ML algorithm capable of differentiating Alzheimer's dementia, frontotemporal dementia, dementia with Lewy bodies and cognitively normal control subjects based on sociodemographic, clinical, and magnetic resonance imaging (MRI) variables. 506 subjects from 5 databases were included. MRI images were processed with FreeSurfer, LPA, and TRACULA to obtain brain volumes and thicknesses, white matter lesions and diffusion metrics. MRI metrics were used in conjunction with clinical and demographic data to perform differential diagnosis based on a Support Vector Machine model called MUQUBIA (Multimodal Quantification of Brain whIte matter biomArkers). Age, gender, Clinical Dementia Rating (CDR) Dementia Staging Instrument, and 19 imaging features formed the best set of discriminative features. The predictive model performed with an overall Area Under the Curve of 98%, high overall precision (88%), recall (88%), and F1 scores (88%) in the test group, and good Label Ranking Average Precision score (0.95) in a subset of neuropathologically assessed patients. The results of MUQUBIA were explained by the SHapley Additive exPlanations (SHAP) method. The MUQUBIA algorithm successfully classified various dementias with good performance using cost-effective clinical and MRI information, and with independent validation, has the potential to assist physicians in their clinical diagnosis

Temporal trends of COVID-19 antibodies in vaccinated healthcare workers undergoing repeated serological sampling: An individual-level analysis within 13 months in the ORCHESTRA cohort

Short summaryWe investigated changes in serologic measurements after COVID-19 vaccination in 19,422 subjects. An individual-level analysis was performed on standardized measurements. Age, infection, vaccine doses, time between doses and serologies, and vaccine type were associated with changes in serologic levels within 13 months.BackgroundPersistence of vaccine immunization is key for COVID-19 prevention.MethodsWe investigated the difference between two serologic measurements of anti-COVID-19 S1 antibodies in an individual-level analysis on 19,422 vaccinated healthcare workers (HCW) from Italy, Spain, Romania, and Slovakia, tested within 13 months from first dose. Differences in serologic levels were divided by the standard error of the cohort-specific distribution, obtaining standardized measurements. We fitted multivariate linear regression models to identify predictors of difference between two measurements.ResultsWe observed a progressively decreasing difference in serologic levels from <30 days to 210–240 days. Age was associated with an increased difference in serologic levels. There was a greater difference between the two serologic measurements in infected HCW than in HCW who had never been infected; before the first measurement, infected HCW had a relative risk (RR) of 0.81 for one standard deviation in the difference [95% confidence interval (CI) 0.78–0.85]. The RRs for a 30-day increase in time between first dose and first serology, and between the two serologies, were 1.08 (95% CI 1.07–1.10) and 1.04 (95% CI 1.03–1.05), respectively. The first measurement was a strong predictor of subsequent antibody decrease (RR 1.60; 95% CI 1.56–1.64). Compared with Comirnaty, Spikevax (RR 0.83, 95% CI 0.75–0.92) and mixed vaccines (RR 0.61, 95% CI 0.51–0.74) were smaller decrease in serological level (RR 0.46; 95% CI 0.40–0.54).ConclusionsAge, COVID-19 infection, number of doses, time between first dose and first serology, time between serologies, and type of vaccine were associated with differences between the two serologic measurements within a 13-month period