Search Results (1,026)

Background/Objectives: This retrospective multicenter study, conducted within the ORCHESTRA Project, investigated SARS-CoV-2 reinfections among 5777 healthcare workers (HCWs) from four University Hospitals (Modena, Verona, Padova and Trieste) in northern Italy, aiming to assess the risk of reinfection and its determinants, comparing the clinical characteristics of reinfections with those of first infections, and examining the impact of preventive measures and vaccination strategies. Methods: HCWs completed an online questionnaire between June and August 2022. The survey collected demographic, occupational, and clinical data, including information on first infections and reinfections. Statistical analyses were performed using SPSS 28.0, through bivariate and multivariate approaches. Results: Response rates were 41.8% for Modena, 39.5% for Verona, 17.9% for Padova, and 17.4% for Trieste. Among the respondents, 4.8% (n = 276) experienced 2 infections and 0.5% (n = 27) reported 3 infections, out of a total of 330 reinfection cases. Additionally, 43.0% (n = 2787) reported only one infection, while 51.5% were never infected. Reinfection rates increased across five study phases (based on the epidemiological context), likely due to the emergence of new SARS-CoV-2 variants. A booster vaccine dose significantly reduced reinfection risk. Higher reinfection risk was found among HCWs aged ≤30 years, those with chronic respiratory diseases, and those working in COVID-19 wards, particularly nurses and allied health professionals. Reinfections were associated with a lower frequency of symptoms both during the period of swab positivity and after a negative swab, as well as with a shorter duration of swab positivity. No significant differences in symptom duration were found between first infections and reinfections. Conclusions: Despite its limitations, the online questionnaire proved a useful tool. Natural infection and vaccination reduced both reinfection risk and symptom severity. Prior infections should be considered in planning vaccination schedules and prioritizing HCWs. Full article

Background: Since the election of Hamas in 2006, Gaza has endured eight major military conflicts, culminating in the ongoing 2023–2025 war, now surpassing 520 days. This protracted violence, compounded by a 17-year blockade, has resulted in the near-total collapse of Gaza’s health system. Over 49,000 deaths, widespread displacement, and the destruction of more than 60% of health infrastructure have overwhelmed both local capacity and international humanitarian response. Objectives: This narrative review aims to examine and synthesize the current literature (October 2023–April 2025) on the health crisis in Gaza, with a specific focus on identifying key themes and knowledge gaps relevant to rebuilding a sustainable health system. The review also seeks to outline strategic pathways for recovery in the context of ongoing conflict and systemic deprivation. Methods: Given the urgency and limitations of empirical data from conflict zones, a narrative review approach was adopted. Fifty-two sources—including peer-reviewed articles, editorials, reports, and correspondence—were selected through targeted searches using Medline and Google Scholar. The analysis was framed within a public health and political economy perspective, also taking health system building blocks into consideration. Results: The reviewed literature emphasizes emergency needs: trauma care, infectious disease control, and supply chain restoration. Innovations such as mobile clinics and telemedicine offer interim solutions. Gaps include limited attention to mental health (including that of health workers), local governance, and sustainable planning frameworks. Conclusions: Sustainable reconstruction requires a durable ceasefire; international stewardship aligned with local ownership; and a phased, equity-driven strategy emphasizing primary care, mental health, trauma management, and community engagement. Full article

Introduction: Nurses are the largest group of healthcare workers, and healthcare managers should pay attention to the quality of work life and the health and working capacity of nurses in order to ensure a sufficient number of nurses and a stable workforce. Aim: The present study aimed to determine nurses’ quality of work life, work ability index and intention to leave the nursing profession and to examine the associations between nurses’ quality of work life, work ability index and intention to leave the nursing profession. Methods: An online cross-sectional study was conducted. A total of 498 nurses completed the instrument, consisting of demographic data, Brooks’ Quality of Nursing Work Life Survey (BQNWL), Work Ability Index Questionnaire (WAIQ) and questions on their intention to leave their current job or the nursing profession. Results: Most nurses had a moderate quality of work life (QWL) (73.7%) and a good work ability index (WAI) (43.78%). Men (p = 0.047), nurses who study (p = 0.021), nurses who do not have children (p = 0.000) and nurses who do not take care of their parents (p = 0.000) have a statistically significantly higher total WAIQ score. Most nurses (61.1%) had considered changing jobs in the last 12 months, and 36.9% had considered leaving the nursing profession. A statistically significant positive correlation was found between the total BQNWL and the total WAI. The study found no correlation between QWL, WAI and intention to change jobs or leave the profession, which was unexpected. Conclusions: To ensure the provision of necessary nursing care and a healthy working environment for nurses, it is necessary to regularly monitor QWL and WAI and take measures to ensure the highest quality of working life. Further longitudinal and mixed-methods research is needed to understand the relationship between QWL, WAI and intention to leave. Full article

Background/Objectives: Despite the health benefit of regular physical activity, many adults often discontinue it within 3–6 months due to various obstacles. The purpose of this study was to investigate factors affecting physical activity adherence of male office workers based on self-determination theory by constructing a structural equation model. Methods: In total, 257 full-time male office workers who engage in regular physical activity participated. The participants from 15 companies completed a survey asking about perceived physical activity barriers, autonomy support, psychological need satisfaction in physical activity, autonomous motivation, and physical activity adherence. Data analysis was performed using the SPSS 28.0 and the AMOS 26.0 programs to verify the fit of the hypothetical model and identify the direct and indirect effects of variables on physical activity adherence for male office workers. Results: As a result, the path significance test results for the hypothetical model showed that five of the nine paths were significant. The results show that psychological need satisfaction in physical activity and autonomous motivation were significant variables that had a direct effect on physical activity adherence, while autonomy support from significant others and perceived physical activity barriers had a significant indirect effect through psychological need satisfaction and autonomous motivation, explaining 62.0%. Conclusions: Based on these findings, it is recommended to implement customized workplace-specific physical activity interventions to enhance autonomous motivation and the autonomy, competence, and relatedness aspects of psychological need satisfaction in physical activity. Full article

Background/Objectives: Healthcare workers (HCW) have increased the risk of occupational stress injuries and adverse mental health outcomes, which were exacerbated during the COVID-19 pandemic. Understanding HCW psychological distress patterns and help-seeking behaviors can inform responsive resource development that may mitigate negative outcomes in future crises. This paper provides insights on monthly trends in HCW distress and support utilization at a large Canadian hospital over a 14-month period. Methods: As part of a hospital-wide wellness initiative during COVID-19, the STEADY program emailed monthly confidential wellness assessments to hospital staff from April 2020 to May 2021. The assessments included screens for burnout, anxiety, depression and posttraumatic stress, types of support accessed, and demographic information. Repeated cross-sectional data were summarized as monthly proportions and examined alongside longitudinal COVID-19 data. Results: A total of 2498 wellness assessments were submitted (M = ~168 monthly, range: 17–945). Overall, 67% of assessments had at least one positive screen for distress. Average positive screens were 44% for anxiety, 29% for depression, 31% for posttraumatic stress, and 53% for burnout. Despite high distress, most respondents used informal supports (e.g., family/friends), highlighting limited formal support use. Conclusions: HCWs experienced sustained high levels of psychological distress during the COVID-19 pandemic, with burnout remaining a predominant and persistent concern. The limited use of formal support services may indicate barriers to accessing these types of supports. Our findings underscore the need for accessible and acceptable mental health supports for HCW during prolonged crises. Full article

Background/Objectives: Although eating disorders (EDs) affect a large portion of the population and have a significant impact on health and productivity, they are understudied in the workplace. We assessed the frequency of EDs and studied the relationship between EDs and occupational and individual factors. Methods: All workers undergoing health surveillance were invited to fill in the Eating Disorder Examination Questionnaire, short form (EDE-QS) and, before their routine medical examination that included metabolic tests, measure their level of health literacy, stress, quality of sleep, anxiety, depression, and happiness. Out of a total of 2085 workers, 1912 (91.7%) participated. Results: Suspected EDs affected 4.9% (CI95% 3.9; 5.9) of workers, with no notable difference in gender (5.3% CI95% 4.1; 6.7 in female workers vs. 4.2%, CI95% 2.9; 5.9 in male). Cases were significantly associated with trauma and emotional factors (anxiety, depression, unhappiness), but also with work-related stress and poor sleep quality, and negatively associated with health literacy. Using a hierarchical logistic regression model, suspected cases of EDs were significantly predicted in Model II by life trauma (OR 2.21 CI95% 1.40; 3.48, p < 0.001) and health literacy (OR 0.94 CI95% 0.90; 0.98, p < 0.001), in Model III also by work-related stress (OR 2.57 CI95% 1.68; 3.94, p < 0.001), and in Model IV by depression (OR 1.19 CI95% 1.02; 1.38, p < 0.05) and happiness (OR 0.88 CI95% 0.78; 0.99, p < 0.05). An association was also found between EDs and overweight, obesity, increased abdominal circumference, hypercholesterolemia, hypertriglyceridemia, hyperglycemia, arterial hypertension, atherogenic index of plasma, and metabolic syndrome. Conclusions: The workplace is an ideal setting for the prevention of EDs and their consequences. Occupational health intervention should promote health literacy, improve sleep quality, and reduce work-related stress. Full article

Background/Objectives: The COVID-19 pandemic has caused sickness and death among many health care workers. However, the apparent resistance of health care workers to SARS-CoV-2 infection despite their high-risk work environment remains unclear. To investigate if inflammation and circadian disruption contribute to resistance or diminished susceptibility to the SARS-CoV-2 virus, we retrospectively evaluated a cohort of volunteer hospital nurses (VHNs). Methods: A total of 246 apparently healthy VHNs (mean age 37.4 ± 5.9 years) who had received the BNT162b2 mRNA vaccine were asked to report their sleep quality, according to the Pittsburgh Sleep Quality Index, and number of SARS-CoV-2 infections during the observational study period (from the end of December 2020 to April 2025). The expression of inflammation-associated mediators and circadian transcription factors in peripheral blood mononuclear cells, as well as sleep quality, were examined. Results: Our findings revealed no anthropometric, biochemical, or inflammation-associated parameters but demonstrated significantly greater levels of NFE2L2, also known as nuclear factor erythroid-derived 2-like 2 (NFR2), gene expression in peripheral blood mononuclear cells among VHNs who had never been infected with SARS-CoV-2 (n = 97) than in VHNs with only one (n = 119) or with two or more (n = 35) prior SARS-CoV-2 infections (p < 0.01). This result was confirmed through one-to-one propensity score matching (p < 0.01). Moreover, NRF2 gene expression was not associated with the number of COVID-19 vaccinations (p = 0.598). Finally, NRF2 gene expression was higher among participants who reported better sleep quality (p < 0.01). Conclusions: Our findings suggest possible interactions among NRF2 gene expression, protection against SARS-CoV-2 infection, and the modulation of COVID-19 vaccination efficacy. Full article

Natural and man-made disasters are occurring more frequently, making household emergency preparedness essential for an effective response. Enrollees of the World Trade Center Health Registry have been found to be less prepared than the US national average despite their prior disaster exposure. The purpose of this study was to evaluate and compare the effectiveness of two interventions—a mailed brochure and a structured phone call—for increasing emergency preparedness knowledge among this population. We conducted a two-arm parallel group trial between February 2019 and August 2020. Participants were Registry enrollees who completed the Wave 4 Registry (2015–2016) survey, whose primary language was English or Spanish, who lived in New York City, and who did not report being a rescue and recovery worker affiliated with FDNY or NYPD. Enrollees were randomized to receive either a brochure by mail summarizing the components of emergency preparedness or a 15 min phone call describing the same. The primary outcome measure was the number of “yes” responses to the ten-item CDC CASPER emergency preparedness questionnaire, measured at baseline and post-intervention. Enrollees were sequentially alternatively assigned to either the brochure or phone call groups. In total, 705 enrollees were assigned to the brochure (n = 353) or phone call (n = 352) groups, and a total of 702 enrollees were analyzed. The Incident Rate Ratio (IRR) for the effect of time was 1.17 (95% CI = (1.14, 1.20)) and for intervention was 1.00 (95% CI = (0.95, 1.05)) Both the brochure and phone call interventions improved knowledge of emergency preparedness from baseline to post-intervention assessment, and to the same extent. Full article

Background: Hand–arm vibration syndrome (HAVS) is a well-recognized occupational condition resulting from prolonged exposure to hand-transmitted vibration (HTV), characterized by vascular, neurological, and musculoskeletal impairments. While vibration exposure is a known risk factor for HAVS, less is understood about the role of personal risk factors and, particularly regarding neurosensory dysfunction. This study aimed to examine the association between vibrotactile (VPT) and thermotactile perception thresholds (TPT) and individual risk factors and comorbidities in HTV-exposed workers. Methods: A total of 235 male HTV workers were evaluated between 1995 and 2005 at the University of Trieste’s Occupational Medicine Unit. Personal, occupational, and health-related data were collected, and sensory function was assessed in both hands. VPTs at 31.5 and 125 Hz and TPTs (for warm and cold) were measured on fingers innervated by the median and ulnar nerves. Results: Multivariable regression analysis revealed that impaired VPTs were significantly associated with age, higher daily vibration exposure (expressed as 8 h energy-equivalent A(8) values), BMI ≥ 25, smoking, vascular/metabolic disorders, and neurosensory symptoms. In contrast, TPTs showed weaker and less consistent associations, with some links to smoking and alcohol use. Conclusions: These findings suggest that, in addition to vibration exposure, individual factors such as aging, overweight, smoking, and underlying health conditions significantly contribute to neurosensory impairment and may exacerbate neurosensory dysfunction in a context of HAVS. The results underscore the importance of including personal health risk factors in both clinical assessment and preventive strategies for HAVS and may inform future research on its pathogenesis. Full article

Background: Dietary patterns impact blood pressure (BP) levels, but the potential impact of replacing specific types of fats with proteins or carbohydrates, in isocaloric models, on BP remains unclear. Objective: This study evaluates the longitudinal association between the substitution of different types of fats with proteins or carbohydrates and changes in BP in a Mexican population. Methods: We analyzed data from 1448 adults (mean age at baseline: 45 years; 73.3% women) from the Health Workers Cohort Study, followed over 13 years. Trained personnel measured systolic (SBP) and diastolic (DBP) blood pressure following standard procedures and techniques at baseline and follow-up. Macronutrient intake was assessed with a validated semi-quantitative food frequency questionnaire. Generalized Estimating Equations (GEE) for hypertension and fixed-effects linear regression for BP were conducted using isocaloric substitution models. Each estimate reflects the effect of a 3% energy substitution of specific fats for carbohydrates or proteins. Results: Substituting 3% of energy intake of polyunsaturated fat (PUFA) in place of vegetable protein (β = −2.94, 95% CI: −5.02, −0.86), animal protein (β = −2.68, 95% CI: −4.73, −0.63), low glycemic index (LGI) carbohydrates (β = −2.63, 95% CI: −4.40, −0.86), and high glycemic index (HGI) carbohydrates (β = −2.52, 95% CI: −4.31, −0.74) was associated with a significant reduction in SBP. Substituting 3% of the energy intake of PUFA in place of different types of carbohydrates was associated with lower odds of hypertension. PUFA was not associated with changes in DBP. Conclusions: Our findings suggest that exchanging PUFA for carbohydrates or proteins is associated with reduced SBP and a lower risk of hypertension, highlighting the importance of macronutrient composition independent of total energy intake and other fat types, which may have a substantial impact at the population level. Full article

Background: Immunization coverage in Nigeria is low, with many children missing out on important lifesaving vaccines. To enable a better understanding of contextual factors towards increasing uptake, we piloted a Decentralized Immunization Monitoring (DIM) approach in the Kumbotso local government area (LGA) of Kano state, Nigeria, to identify wards with low vaccination rates and understand why this is happening. The findings were used to improve routine immunization (RI) programs and reduce the number of unvaccinated children and children yet to receive their first dose of diphtheria–pertussis–tetanus (DPT) vaccine, referred to as Zero-Dose children (ZD). Methods: This study adopted a cross-sectional design approach using the Behavioural and Social Drivers of Vaccination (BeSD) framework and the Lot Quality Assurance Sampling (LQAS). The study population comprised caregivers of children aged 0–11 months and 12–23 months across the 11 wards in Kumbotso District, Kano State, Nigeria, using a segmentation sampling approach. The study covered 209 settlements selected using probability proportionate to size (PPS) sampling from the wards. Univariate and bivariate analyses were performed to show patterns and relations across variables. Results: Out of 418 caregivers surveyed, 98.1% were female. Delayed vaccination was experienced by 21.9% of children aged 4.5–11 months, while the prevalence of ZD was estimated at 26.8% amongst the older cohort (12–23 months). A total of 71.4% of the delayed group and 89.1% of the ZD group remained unvaccinated. Caregiver education, rural residence, and home births correlated with delayed/ZD status (p < 0.05). Logistic regression associated higher caregiver education with reduced delayed vaccination odds (OR:0.34, p < 0.001) and urban residence with lower ZD odds (OR:1.89, p = 0.036). The antigen coverages of BCG (81.5%), DPT3 (63.6%), and measles 1 (59.7%) all surpassed the national dropout thresholds. Kumbotso, Unguwar Rimi, and Kureken Sani wards were all identified as underperforming and therefore targeted for intervention. Negative vaccine perceptions (50% delayed, 53.6% ZD) and distrust in health workers (46.4% delayed, 48.2% ZD) were significant barriers, though the caregiver intent to vaccinate was protective (OR: 0.27, p < 0.001). The cost of accessing immunization services appeared to have a minor effect on coverage, as the majority of caregivers of delayed and ZD children reported spending less than 200 Naira (equivalent to USD 0.15) on transport. Conclusions: This pilot study highlighted the utility of LQAS and BeSD in identifying low-performing wards, barriers, and routine immunization gaps. Barriers included low caregiver education, rural residence, and negative vaccine perceptions/safety. Caregiver education and urban residence were protective factors against delayed and ZD vaccination, suggesting social and systemic barriers, particularly in rural and less educated populations. Antigen-specific coverage showed disparities, with dropouts for multi-dose vaccines exceeding the national thresholds of 10%. Targeted measures addressing education, trust, and systemic issues are needed. Findings emphasize decentralized monitoring, community engagement, and context-specific strategies to reduce ZD children and ensure equitable vaccination in Nigeria. Full article

Introduction. Atherosclerosis is the histopathological lesion underlying most cardiovascular diseases. Several scales assess the risk of developing atherosclerosis, with the most recognized being atherogenic dyslipidemia (AD) and atherogenic indices (AIs). The aim of this study is to assess the associations between shift work, sociodemographic variables, and lifestyle with atherogenic risk, as determined by atherogenic indices, atherogenic dyslipidemia, and the lipid triad. Material and Methods. This is a descriptive, cross-sectional study involving 53,053 workers (28,808 shift workers and 24,245 non-shift workers) from various autonomous communities in Spain and multiple occupational sectors. The association between sociodemographic variables such as age, sex, and socioeconomic status, health habits including tobacco and alcohol consumption, physical activity (PA), adherence to the Mediterranean diet (MD), and shift work with the presence of AD and high values of three AIs (Cholesterol/HDL-c, LDL-c/HDL-c, and Triglycerides/HDL-c) were assessed. Results. All variables analyzed were associated with AD and AIs values. Among the variables, the strongest associations were observed for physical activity, with odds ratios (ORs) ranging from 7.70 (95% CI: 6.86–8.55) for high LDL-c/HDL-c to 14.10 (95% CI: 9.05–14.16) for AD; adherence to the Mediterranean diet, with ORs ranging from 1.98 (95% CI: 1.60–2.37) for high LDL-c/HDL-c to 5.89 (95% CI: 4.92–6.86) for AD; and age, with ORs of 2.11 (95% CI: 1.84–2.38) for high Triglycerides/HDL-c and 4.66 (95% CI: 4.04–5.28) for high Total Cholesterol/HDL-c. Conclusions. The profile of a worker with the highest atherogenic risk in our study is a male, older in age, with low socioeconomic status, a smoker, a habitual alcohol consumer, physically inactive, with low adherence to the Mediterranean diet, and engaged in shift work. Full article

Background: This commentary analyzes demographic, clinical, and occupational characteristics associated with Ebola virus disease (EVD) outcomes during the 2018–2020 outbreak in the Democratic Republic of Congo (DRC). Methods: A total of 3477 EVD cases were included. Descriptive statistics and univariate and multivariate Cox regression analyses were performed to evaluate associations between clinical outcomes and patient characteristics. Comorbidity estimates and healthcare worker (HCW) occupational exposure data were incorporated based on the literature. Results: The median age was 26.5 years (SD = 16.1), with the majority (59.7%) aged 20–59. Males represented 51.3% of the cohort. Most patients (81.8%) worked in occupations that were not disease-exposing. Overall, 450 patients (12.9%) died. Although comorbidities initially appeared predictive of mortality (unadjusted HR: 3.05; 95% CI: 2.41–3.87), their effect was not statistically significant after adjustment (adjusted HR: 1.17; 95% CI: 0.87–1.59; p = 0.301). The strongest predictor of death was clinical status at admission: patients classified as “very sick” had an alarmingly high adjusted hazard ratio (HR) of 236.26 (95% CI: 33.18–1682.21; p < 0.001). Non-disease-exposing occupations were also associated with increased mortality (adjusted HR: 1.75; 95% CI: 1.33–2.31; p < 0.001). Conclusions: Despite improvements in outbreak response, mortality remains disproportionately high among patients presenting in critical condition and those outside the health sector. These findings underscore the importance of early detection strategies and enhanced protection for all occupational groups during EVD outbreaks. Full article

In Canada, 67% of unpaid caregivers are simultaneously balancing paid employment with unpaid care, equating to over 5.2 million Canadian Carer-Employees (CEs). This balancing act often incurs negative impacts on CEs’ health and well-being, including burnout, resulting in adverse effects on their labour force participation. To mitigate these social and economic impacts, McMaster University partnered with the Canadian Standards Association (CSA) to develop the CSA B701:17 (R2021) Carer-inclusive and accommodating organizations standard and accompanying handbook B701-18HB Helping worker-carers in your organization. Since publication in 2017, there has been minimal uptake of the Standard across Canadian workplaces, with just 1062 complimentary downloads total. To determine the level of uptake across workplaces in Canada, the present mixed-methods study used purposive sampling to collect survey (n = 71) and semi-structured interview data (n = 11). The survey data was analyzed for descriptive statistics and logistic regression modelling. The interview data were thematically analyzed for common CFWPs and barriers to Standard uptake. It was found that only 24% of workplaces have implemented the Standard into their workplace practices, with full implementation and current supports as strong predictors of formal uptake. Prominent themes around barriers to uptake and existing organizational policies highlight the critical importance of workplace culture in facilitating CFWPs. Full article

(1) Background: Sexual harassment in the workplace is a problem that particularly affects women and is not an exception in the world of work. Factors such as power asymmetry, the predominantly masculinized culture in many organizations, and the potential impunity of perpetrators increase the associated risks. This study aims to analyze the psychometric properties of the Sexual Experiences Questionnaire-Workplace (SEQ-W) to measure sexual harassment at work and assess its validity in Spanish. (2) Methods: A total of 120 active female workers (67.5% European and 32.5% South American) participated, completing validated instruments to measure sexual harassment, workplace bullying, self-perceived health, and job satisfaction. The questionnaires were administered online, ensuring anonymity and explaining the study’s objectives. (3) Results: An exploratory factor analysis revealed a bifactorial structure with the dimensions “Sexual Harassment by Coercion” and “Harassment by Unwanted Sexual Attention.” Both dimensions demonstrated adequate internal consistency, concurrent validity with workplace bullying and well-being scales, and discriminant validity with job satisfaction. Additionally, a pronounced floor effect was observed, indicating a low prevalence of sexual harassment in the sample. (4) Conclusions: the SEQ-W scale is a useful tool for assessing sexual harassment among active Spanish-speaking female workers, considering its validated bidimensional structure in Spanish. Full article