Search Results (299)

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: Despite the widespread implementation of childhood vaccination programmes, hepatitis B virus (HBV) infection remains an ongoing occupational risk for healthcare students. In multi-ethnic and international university settings, differences in vaccination programmes and immune responses must be considered. This retrospective study aimed to assess the prevalence of protective levels of anti-HBs among medical students at an international university in Rome, exploring associations with demographic and vaccination-related factors. Methods: Data were collected from routine occupational health surveillance conducted in 2023. Anti-HB titres were measured in 507 students, and information on age, sex, country of birth, age at vaccination, and time since the last dose was analysed. Results: Overall, 55.0% of students had antibody levels of at least 10 mIU/mL, indicating serological protection. Higher seroprotection rates were observed among students vaccinated in the first year of life compared to those vaccinated later. A significant decline in antibody titres was also associated with longer intervals since vaccination. Students born outside Europe tended to show lower levels of protection. Conclusions: These results emphasise the importance of screening future healthcare professionals and continuously monitoring antibody titres to help reduce HBV infections. Full article

Thyroid nodules are a common clinical finding, with their prevalence influenced by multiple environmental and occupational factors, including exposure to ionizing radiation. Healthcare workers, particularly those operating in radiology, nuclear medicine, interventional cardiology, and radiation oncology, are potentially at increased risk due to chronic low-dose radiation exposure. This review aims to evaluate the current evidence regarding the association between occupational radiation exposure and the development of thyroid nodules among healthcare professionals. The findings suggest a higher prevalence of thyroid nodules in radiation-exposed workers compared to the general population, although data heterogeneity and methodological limitations exist. Factors such as the duration of exposure, radiation protection practices, and frequency of monitoring play critical roles in modulating the individual risk. While some studies report no significant difference in malignancy rates, the increased detection of nodules underlines the need for regular thyroid surveillance in at-risk populations. Further longitudinal and multicentric studies are warranted to clarify the causality and guide preventive strategies. This review highlights the importance of occupational health protocols, including radiation shielding and periodic thyroid evaluation, in safeguarding the long-term endocrine health of healthcare workers. Full article

Background and Objectives: We have previously reported that omega-3 polyunsaturated fatty acids (PUFAs) derived from fish oil (FO) is an effective treatment for type 1 and type 2 diabetes neural and vascular complications. As omega-3 PUFAs become more widely used as a nutritional and disease modifying supplement an important question to be addressed is what is the preferred source of omega-3 PUFAs? Methods: Using a type 2 diabetic rat model and early and late intervention protocols we examined the effect of dietary treatment with omega-3 PUFAs derived from menhaden (fish) oil (MO), krill oil (KO), algal oils consisting primarily of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) or combination of EPA + DHA, or pharmaceutical-derived ethyl esters of EPA, DHA or combination of EPA + DHA. Nerve related endpoints included motor and sensory nerve conduction velocity, heat sensitivity of the hind paw, intraepidermal nerve density, cornea nerve fiber length, and cornea sensitivity. Vascular reactivity to acetylcholine and calcitonin gene-related peptide by epineurial arterioles that provide blood to the sciatic nerve was also examined. Results: The dose of each omega-3 PUFA supplement increased the content of EPA, docosapentaenoic acid (DPA), and/or DHA in red blood cell membranes, serum and liver. Diabetes caused a significant decrease of 30–50% of neural function and fiber occupancy of the skin and cornea and vascular reactivity. Treatment with MO, KO or the combination of EPA + DHA provided through algal oil or ethyl esters provided significant improvement of each neural endpoint and vascular function. Algal oil or ethyl ester of EPA alone was the least effective with algal oil or ethyl ester of DHA alone providing benefit that approached combination therapies for some endpoints. Conclusions: We confirm that omega-3 PUFAs are an effective treatment for DPN and sources other than fish oil are similarly effective. Full article

Background and objective: Environmental and occupational exposure to toxic metals poses a significant risk to neurological health, particularly affecting motor-related brain structures. Essential metals like manganese, copper, and iron become neurotoxic when homeostasis is disrupted, while non-essential metals such as lead, mercury, and cadmium are inherently toxic, even at low exposure levels. We aimed to investigate the state of the art on neuroimaging evidence of the effects of exposure to toxic metals on motor related brain structures and functions. Methods: PRISMA guidelines were followed. We included studies that reported neuroimaging studies exploring the link between metal exposure and neural changes in motor areas. Results: We identified 518 papers, but only 20 articles were included. Our findings indicate that manganese is the most extensively studied metal in relation to the motor system using neuroimaging, but studies have also investigated the effects of other metals, including lead, mercury, and copper. Across these studies, the brain regions most consistently affected by metal exposure include the globus pallidus, caudate nucleus, frontal cortex, and cerebellum. Some studies exhibit structural or functional reductions in these areas that correlate with increased levels of metal exposure, suggesting a dose-dependent neurotoxic effect. Conclusions: This review synthesizes current neuroimaging evidence on metal-induced neurotoxicity, emphasizing its impact on motor function and highlighting critical gaps to guide future research and public health strategies. Full article

Background: There is substantial evidence supporting the role of genetic alterations in chemically induced carcinogenesis. We analyzed the existing literature to gather data on genetic alterations linked to human carcinogens and their possible connection to genotoxic outcomes. The review emphasizes carcinogenic substances and occupational exposures identified as “carcinogenic to humans”. In particular, we searched for studies describing genotoxic alterations linked to agents and occupational exposures for which the International Agency for Research on Cancer has found sufficient evidence of an association with bladder cancer. Methods: The review was carried out in compliance with the PRISMA standards. A comprehensive search of the PubMed database was conducted to identify studies published through March 2024. Results: We identified 60 studies that evaluated genetic alterations for 16 carcinogenic agents and occupations (such as aluminum production, 4-aminobiphenyl, auramine production, benzidine, chlornaphazine, cyclophosphamide, firefighters, magenta production, 2-naphthylamine, opium consumption, ortho-toluidine, painters, the rubber manufacturing industry, Schistosoma haematobium infection, X-radiation, gamma-radiation) in healthy humans. Conclusions: The genotoxic effects of chemical agents in healthy individuals have been well studied and characterized. Additionally, this review presents numerous studies concerning occupational exposure but not exclusively. Genotoxicity assessments have mainly been conducted on biological materials such as blood, peripheral blood lymphocytes, urine, and buccal epithelial cells. The most frequently examined genotoxic effects were DNA damage, chromosomal abnormalities, and micronuclei. Standardized data to clearly define a dose–response relationship for predicting delayed health effects are still lacking. Full article

Path tracking is an essential task for autonomous driving (AD), for which controllers are designed to issue commands so that vehicles will follow the path of upper-level decision planning properly to ensure operational safety, comfort, and efficiency. Current path-tracking methods still face challenges in balancing tracking accuracy with computational overhead, and more critically, lack consideration for Motion Sickness (MS) mitigation. However, as AD applications divert occupants’ attention to non-driving activities at varying degrees, MS in self-driving vehicles has been significantly exacerbated. This study presents a novel framework, the Hybrid Supervised–Reinforcement Learning (HSRL), designed to reduce passenger discomfort while achieving high-precision tracking performance with computational efficiency. The proposed HSRL employs expert data-guided supervised learning to rapidly optimize the path-tracking model, effectively mitigating the sample efficiency bottleneck inherent in pure Reinforcement Learning (RL). Simultaneously, the RL architecture integrates a passenger MS mechanism into a multi-objective reward function. This design enhances model robustness and control performance, achieving both high-precision tracking and passenger comfort optimization. Simulation experiments demonstrate that the HSRL significantly outperforms Proportional–Integral–Derivative (PID) and Model Predictive Control (MPC), achieving improved tracking accuracy and significantly reducing passengers’ cumulative Motion Sickness Dose Value (MSDV) across several test scenarios. Full article

Background/Objectives: Cyclophosphamide is one of the most commonly used cytotoxic drugs in chemotherapy protocols. Its preparation in the hospital setting involves handling concentrated solutions, which pose occupational exposure risks and potential variations in the final dose administered. The aim of this study was to evaluate the effect of aspiration devices on the concentration of cyclophosphamide in reconstituted solutions. Methods: An analytical method was validated using high-performance liquid chromatography coupled to a diode-array detector (HPLC-DAD) for quality control. Cyclophosphamide solutions were prepared and aspirated using either a conventional needle or spike device with or without a filtration system. Results: The validated method demonstrated linearity (R² = 0.9999), high precision (0.22–4.59%) and accuracy (88.9–99.4%), with a limit of quantification of 4.03 µg/mL. Significant differences (p < 0.001) were observed between samples aspirated with a needle and those aspirated with a spike fitted with a 5 µm filter, with the latter showing lower cyclophosphamide concentrations, suggesting partial retention of the drug. No significant differences were found between the needle and filterless spike preparations. Conclusions: These results suggest that the choice of aspiration device influences the final drug concentration, potentially affecting therapeutic efficacy. Standardisation of preparation techniques and an awareness of device limitations are essential to ensure accurate chemotherapy dosing and patient safety. Full article

Interventional radiology offers minimally invasive procedures guided by real-time imaging, reducing surgical risks and enhancing patient recovery. While beneficial to patients, these advancements increase occupational hazards for physicians due to chronic exposure to ionizing radiation. This exposure raises health risks like radiation-induced cataracts, cardiovascular disease, and cancer. Despite regulations like the European Council Directive 2013/59/EURATOM, which sets limits on whole-body and eye lens doses, no dose limits exist for the brain and meninges, since the brain has traditionally been considered a radioresistant organ. Recent studies, however, have highlighted radiation-induced brain damage, suggesting that meningeal exposure in interventional radiology may be underestimated. This study evaluates the entrance air Cumulative mean annual entrance air kerma to the skullull during interventional radiology procedures, using thermoluminescent dosimeters and controlled exposure simulations. Data were collected by varying the exposure time and analyzing the contribution to the entrance air kerma on each side of the head. The results indicate that, considering the attenuation of the cranial bone, the absorbed dose to the brain, obtained by averaging the head entrance air kerma for the right, front, and left sides of the operator’s head, could represent 0.81% to 2.18% of the annual regulatory limit in Italy of 20 mSv for the average annual effective dose of exposed workers (LD 101/2020). These results provide an assessment of brain exposure, highlighting the relatively low but non-negligible contribution of brain irradiation to the overall occupational dose constraint. Additionally, a correlation between entrance air kerma and the Kerma-Area Product was observed, providing a potential method for improved dose estimation and enhanced radiation safety for interventional radiologists. Full article

Long-term exposure to radon, thoron, and gamma radiation from building materials poses a significant health risk to occupants. Current methods for estimating radiation doses often fail to consider the combined impact of these sources. Based on commonly used building materials available on the Irish market, this paper advocates for the development of a comprehensive dose estimation model that accounts for radon, thoron, and gamma radiation. To achieve this, several models and various scenarios (e.g., ventilation conditions and building characteristics) are integrated to convert radon and thoron gas doses into a common unit recognized in the existing literature. This approach enables the comparison of combined dose values with accepted radiation thresholds for building materials, typically set at 1 mSv, alongside data on material compositions. Previous studies suggested gamma radiation doses in Irish materials are unlikely to exceed 1 mSv annually. Our findings confirm this, showing gamma doses <0.4 mSv for all materials. However, combined radon–thoron doses exceeded thresholds in altered granites (e.g., Galway granite: 3.90 mSv), with thoron contributing ≤93% of total exposure due to uranium/thorium-rich minerals (e.g., monazite, zircon). Ventilation proved critical—high airflow (10 m³/h) reduced thoron doses by 90–95%, while current gamma-focused safety indices (I-index ≤ 1) inadequately addressed combined risks. These results highlight the previously underestimated importance of thoron and the necessity of multi-parameter models for regulatory compliance. The study establishes a novel framework to evaluate holistic radiation risks, urging revised standards that prioritize ventilation strategies and material mineralogy to protect public health in residential and commercial built environments. Full article

Background: Hepatitis B virus (HBV) infection remains a significant occupational health concern for healthcare workers (HCWs), including trainees exposed to biological risks. Although vaccination is the most effective preventive measure, the persistence of immunity over time and the need for booster doses remain subjects of debate. Objective: The present study aims to assess the prevalence of protective anti-HB antibody titers among healthcare trainees at the “SS Annunziata” Hospital in Chieti, comparing those vaccinated in infancy with those vaccinated during adolescence. Methods: A retrospective observational study was conducted on 2028 healthcare trainees from 2021 to 2024. Participants were divided into two groups based on vaccination timing: infancy (PED group) and adolescence (ADO group). Serological tests were performed to measure anti-HB titers, with a protective threshold set at ≥10 IU/L. Statistical analyses were conducted to evaluate differences in immunity persistence between the two groups. The results showed that the overall prevalence of protective anti-HB titers was 50.7%, with significant differences between the PED and ADO groups. Protective immunity was observed in 79.2% of individuals vaccinated during adolescence, compared to 44.6% of those vaccinated in infancy (p < 0.001). No significant differences in antibody persistence were found between males and females. Notably, 92.4% of participants with non-protective titers received a booster dose within two months of testing. Conclusions: The study confirms a significant decline in anti-HB titers over time among individuals vaccinated in infancy, suggesting a potential need for booster doses later in adulthood. The high adherence to vaccination recommendations among healthcare trainees is a promising finding, reinforcing the importance of continuous education and immunization programmes in healthcare settings. Further research, including longitudinal studies and additional HBV biomarkers, is necessary to optimize vaccination strategies and long-term immunity monitoring in HCWs. Full article

Background/Objectives: Although medical radiation practice is essential for current medical care, many nursing students and nurses lack sufficient basic knowledge about radiation, and they are unfamiliar with learning about it. This study aimed to evaluate the usefulness of self-made video teaching materials for radiation education for nursing students and nurses after clarifying their basic knowledge of radiation. Methods: Educational video materials were developed to provide basic radiation knowledge. The video materials included scenes of radiation measurement, such as the attenuation of scattered X-rays with distance, and illustrations drawn by nursing students to make them familiar to nursing staff. This study included 29 nursing students and 16 nurses. The participants were instructed to answer 20 questions regarding the characteristics of radiation and its influence and protection measures. The same questions were asked again after watching the video materials. Results: Nursing students and nurses correctly recognized the classification of medical or occupational exposure and the three principles for reducing external exposure; however, it became clear that dose limits do not apply to medical exposure and that radiation units and their effects on the human body were not correctly recognized. Furthermore, the educational materials were effective because the scores and the percentage of correct answers increased after viewing the video materials. Furthermore, positive comments were expressed regarding the scenes of the experiments and the illustrations drawn by the students about the teaching materials. Conclusions: The contents that should be addressed more intensively were clarified, and the effectiveness of using video teaching materials in radiation nursing education was demonstrated. Full article

Zinc (Zn)- and copper (Cu)-containing welding fumes elevate inflammatory markers (CRP, TNF-α, IL-6, IL-8) in healthy individuals and welders. Zn- and Cu-containing nanoparticles are toxic to human macrophages. Therefore, ZnO exposure limits are under discussion. In this study, the effects of Zn/Cu-containing welding fume suspensions on A549 alveolar epithelial cells (exposure concentrations: 0.01/0.1/1/10/100 µg/mL) and THP-1 macrophages (additionally 0.001 µg/mL) were investigated over a period of 48 h. Effects on apoptosis, cytotoxicity, genotoxicity, superoxide dismutase (SOD) activity, and cytokine levels (IL-6, IL-8, MIP-1β/CCL4, TNF-α) were evaluated. Welding fume exposure increased SOD activity, and it increased Annexin-V binding and cytotoxicity effects starting at 10 µg/mL in A549 cells and particularly in THP-1 macrophages. A549 cells showed increased IL-6 at 10 and 100 µg/mL, and significant IL-8 release occurred at 10 µg/mL for A549 and 0.1 µg/mL for macrophages. Exposed macrophages released TNF-α at 1 µg/mL after 24 and 48 h and MIP-1β/CCL4 at 0.01 µg/mL after 6 h and at 0.001 µg/mL after 48 h. No genotoxic effects were detected. MIP-1β/CCL4 is a sensitive new biomarker for human macrophages exposed to Zn/Cu-containing welding fumes. The findings suggest that Zn/Cu particles affect lung cells already at doses below current occupational thresholds. Full article

Background: Alcohol consumption is a major public health concern, influencing metabolic health and insulin resistance (IR). While moderate alcohol intake has been associated with potential metabolic benefits, excessive consumption is linked to IR and related disorders. This study examines the association between sociodemographic variables, health habits, and IR risk using validated metabolic indices. Methods: A dual-phase study was conducted, including a cross-sectional analysis of 139,634 Spanish workers and a retrospective longitudinal follow-up of 40,431 participants (2009–2019). Data on sociodemographic factors (age, sex and socioeconomic status) and health habits (smoking, alcohol consumption, diet and physical activity) were collected through standardized occupational health assessments. IR risk was assessed using the Triglyceride-Glucose Index (TyG), Metabolic Score for Insulin Resistance (METS-IR), and Single-Point Insulin Sensitivity Estimator (SPISE-IR). Binary logistic regression was used for statistical analysis. Results: Age, male sex, lower socioeconomic status, smoking, alcohol consumption, physical inactivity and low adherence to the Mediterranean diet were significantly associated with higher IR risk across all indices (p < 0.001). Alcohol consumption exhibited a dose-dependent relationship with IR, with excessive intake significantly increasing the risk of IR. Longitudinal data revealed a worsening IR profile over time, particularly among older, low-income and physically inactive individuals. Conclusions: Sociodemographic factors and lifestyle habits strongly influence IR. Preventive strategies focused on reducing alcohol consumption, smoking cessation and promoting physical activity and dietary improvements are essential to mitigate the risk of IR, especially in vulnerable populations. Further longitudinal studies are needed to establish causal relationships and refine intervention strategies. Full article

Aim: This study aimed to evaluate the knowledge and attitudes of family physicians and family health personnel who are responsible for childhood vaccination services in primary care regarding meningococcal, rotavirus, and human papillomavirus vaccines. Methods: This cross-sectional study was conducted between October 2021 and January 2022. A total of 700 healthcare professionals from all geographical regions in Turkey were included in the study. The participants filled out an online questionnaire consisting of 39 questions created with Google Forms. Results: Of the participants, 340 (48.6%) are family physicians, and 360 (51.4%) are family health personnel. Most participants are from the Marmara region, Turkey’s most densely populated region. The most recommended vaccine among the participants was rotavirus (84.3%), while the least recommended vaccine was human papilloma virus (47.6%). The number of family physicians recommending meningococcal and human papilloma virus vaccines was significantly higher than that of family health personnel (p < 0.001). Furthermore, there was a statistically significant correlation between seeing a patient with these viruses in one’s professional life or considering the severity of these three diseases to be severe and recommending these vaccines (p < 0.001 for both). However, lack of knowledge about vaccines and doses, the high cost of vaccines, and concerns about side effects were among the reasons for not recommending vaccines. Conclusions: Healthcare professionals involved in childhood immunization should be trained to increase their knowledge and awareness on this issue. The training plan and curriculum should take into account the issues raised in our research, such as age, occupation, region of residence, and professional experience. In general, knowledge about the efficacy and safety of vaccines will help healthcare professionals develop their confidence in vaccines and willingness to recommend childhood vaccines to others. Full article