Maria Gabriella Verso

A literature review was performed to highlight which work-related diseases express sex/gender differences in health outcomes and focus the main limits of studies in this field. The research, carried out on PubMed by specific search string, identified 4828 articles (1997-2017 period) of which 381 are eligible for review (4-22%, depending on the disease). Among them, 68% reported sex/gender differences in health outcomes, which in most cases appear to be due to different exposure and/or work segregation rather than to biological differences. However, few studies place this assessment among the research goals and results are almost never discussed and hypothesis are seldom formulated about any observed differences. It seems necessary to use research methodologies and study design that can detect and explain the described complexity and useful in defining appropriate preventive strategies.

The COVID-19 pandemic has significantly disrupted human life demonstrating also a substantial impact on cardiac diseases. In particular, some researchers have reported an increased incidence of cardiac arrhythmias in patients with COVID-19, emphasizing the need for further investigations. Accordingly, this study aimed to evaluate the prevalence of cardiac arrhythmias in university students before and after COVID-19, in order to better understand if this risk increased over time. Cross-sectional study conducted on students attending the University of Palermo from 2015 to 2024. For each subject demographic data, patient medical history information and information relating to vaccination against Sars-CoV-2 were recorded. Moreover, each visit was associated with the execution of a 12-lead ECG performed at rest in order to assess for alterations of the electrical heart rhythm. During the study period 1,217 patients were visited, including 401 (33%) males and 815 (67%) females. The median age at the visit was 20.40 years. Overall, we observed a statistically significant increase in the risk of coronary sinus rhythm and respiratory arrhythmia in subjects with a previous diagnosis of COVID-19 (OR=5.0, 95% CI=1.6-16.0 and OR=3.4, 95% CI= 2.4-4.8, respectively). This study is especially compelling as it focuses on an increased risk of respiratory arrhythmia and coronary sinus rhythm in young healthy subjects after the COVID-19 pandemics. If our results should be confirmed by other more extensive studies they could be relevant to clinicians since they should be aware of cardiac arrhythmias as one of the complications attributable to COVID-19 emergence.

In the context of sustainable development, the occupational sphere must be integrally considered within health promotion frameworks, ensuring an equitable work–life balance while recognizing and amplifying the capabilities of every employee. Concurrently, there is a notable trend of physicians transitioning from public to private healthcare sectors, with burnout frequently cited in scholarly discourse as a primary catalyst for this shift. The objective of our study was to examine the vulnerability of medical staff to burnout. To achieve this, we conducted a cross-sectional analysis involving 1084 physicians from various specialties, employed in urban hospital settings. This research was executed via the distribution of an anonymous questionnaire, utilizing the Google Forms platform during work hours. The questionnaire was based on the Maslach Burnout Inventory (MBI) scale, specifically adapted for medical professionals, requiring respondents to provide insights into their experiences. Analysis of the collected data from a total of 614 respondents indicated a moderate predisposition towards burnout among the sample. These findings underscore the necessity for interventions targeting organizational flexibility and, notably, the restructuring of remuneration practices. Salaries often do not reflect the terms of employment contracts across numerous EU jurisdictions, necessitating urgent reforms. In conclusion, the reinforcement of interpersonal dynamics within medical teams and between healthcare institutions and their practitioners emerges as a critical strategy. Enhancing these relationships is essential for revitalizing the healthcare delivery system, ensuring that medical professionals are adequately compensated in alignment with the principles of sustainable employment.

In the context of sustainable development, integrating the work aspect into health promotion systems is essential, ensuring that employees maintain a healthy balance between their professional and personal lives, which respects and amplifies the potential of every individual. Lately, there has been a noticeable shift of medical professionals from the public to the private sector. This trend paints a bleak picture, highlighting the vulnerabilities of a system teetering on the brink of failure, with significant impacts on patient care. Among the myriad reasons behind this shift, burnout stands out prominently. Medical professionals face increasing pressures due to understaffing, limited organizational support, and insufficient resources, leading to feelings of cynicism, exhaustion, and detachment from their roles. Utilizing the Maslach et al. questionnaire, we assessed the risk of burnout among physicians in public hospitals to identify and underscore preventive measures and improvements, correlating our findings with key aspects of organizational empowerment. Our research indicates that enhancing interpersonal relationships and resources—both within teams and between the organization and its physicians—is crucial for the revival of the healthcare system. This approach aims at improving the delivery of healthcare services and offering appropriate recognition to healthcare professionals, aligning with the principles of sustainable employment.

Although the anti-COVID-19 vaccination has proved to be an effective preventive tool, “breakthrough infections” have been documented in patients with complete primary vaccination courses. Most of the SARS-CoV-2 neutralizing antibodies produced after SARS-CoV-2 infection target the spike protein receptor-binding domain which has an important role in facilitating viral entry and the infection of the host cells. SARS-CoV-2 has demonstrated the ability to evolve by accumulating mutations in the spike protein to escape the humoral response of a host. The aim of this study was to compare the titers of neutralizing antibodies (NtAbs) against the variants of SARS-CoV-2 by analyzing the sera of recovered and vaccinated healthcare workers (HCWs). A total of 293 HCWs were enrolled and divided into three cohorts as follows: 91 who had recovered from SARS-CoV-2 infection (nVP); 102 that were vaccinated and became positive after the primary cycle (VP); and 100 that were vaccinated with complete primary cycles and concluded the follow-up period without becoming positive (VN). Higher neutralization titers were observed in the vaccinated subjects’ arms compared to the nVP subjects’ arms. Differences in neutralization titers between arms for single variants were statistically highly significant (p < 0.001), except for the differences between titers against the Alpha variant in the nVP and in VP groups, which were also statistically significant (p < 0.05). Within the nVP group, the number of subjects with an absence of neutralizing antibodies was high. The presence of higher titers in patients with a complete primary cycle compared to patients who had recovered from infection suggested the better efficacy of artificial immunization compared to natural immunization, and this further encourages the promotion of vaccination even in subjects with previous infections.

Although the anti-COVID-19 vaccination has proved to be an effective preventive tool, "break-through infections" have been documented in patients with complete primary vaccination course. Most of the SARS-CoV-2 neutralizing antibodies pro-duced after SARS-CoV-2 infection target the spike protein receptor-binding domain which has an important role in facilitating viral entry and infection of the host cells. SARS-CoV-2 has demonstrated the ability to evolve by accumulating mutations in the spike protein to escape the humoral response of the host. The aim of this study is to compare the titers of neutralizing an-tibodies against the variants of SARS-CoV-2 by analyzing the sera of recovered and vaccinated healthcare workers (HCWs). 293 HCWs were enrolled and divided into three cohorts as follows: 91 recovered from SARS-CoV-2 infection (nVP); 102 vac-cinated who became positive after the primary cycle (VP); 100 vaccinated with complete primary cycle who concluded the follow-up pe-riod without becoming positive (VN). Higher neutraliza-tion titers were observed in the vaccinated subjects’ arms com-pared to the nVP arm. Differences in neutralization titers between arms for single variant were statistically significant (p<0.001) except for titers against the Alpha variant (p<0.05) between nVP and VP. Within the nVP group, the number of subjects with the absence of neutralizing antibodies was high. The presence of high-er titers in patients with a complete primary cycle compared to patients recovered from the infec-tion suggests a better efficacy of artificial immunization compared to natural im-munization, further encouraging the promotion of vaccination even in subjects with previous infection.

Rotavirus (RV) infection is a leading cause of severe diarrhea among children younger than 5 years old and a considerable cause of RV gastroenteritis (RVGE) hospitalization. This study aimed to evaluate the impact of vaccination in Italy in the reduction of the burden of RV‐related disease, estimating the relation between vaccination coverage and hospitalization rates. RVGE‐related hospitalizations that occurred in Italy from 2008 to 2018 among children aged 0−35 months were assessed by consulting the Hospital Discharge Record database and including records whose ICD‐9‐CM diagnosis code was 008.61 in the first or in any diagnosis position. In the 2008−2018 period, a total of 17 535 791 at‐risk person‐years were considered and 74 211 (423.2 cases × 100 000 per year) RVGE hospitalizations were observed. Higher hospitalization rates occurred in males (456.6 vs. 387.9 × 100 000 per year) and in children aged 1 year (507.8 × 100 000 per year). Poisson regression analysis showed a decrease of −1.25% in hospitalization rates (−1.19% to −1.31%, p < 0.001) per unit increase in vaccination coverage. This is the first study that correlates hospitalization rate reduction with a percentage increase in vaccination coverage. Our findings strongly support RV vaccination as an effective public health strategy for reducing RVGE‐related hospitalizations.

The COVID-19 pandemic has significantly disrupted human life demonstrating also a substantial impact on cardiac diseases. In particular, some researchers have reported an increased incidence of cardiac arrhythmias in patients with COVID-19, emphasizing the need for further investigations. Accordingly, this study aimed to evaluate the prevalence of cardiac arrhythmias in university students before and after COVID-19, in order to better understand if this risk increased over time. Cross-sectional study conducted on students attending the University of Palermo from 2015 to 2024. For each subject demographic data, patient medical history information and information relating to vaccination against Sars-CoV-2 were recorded. Moreover, each visit was associated with the execution of a 12-lead ECG performed at rest in order to assess for alterations of the electrical heart rhythm. During the study period 1,217 patients were visited, including 401 (33%) males and 815 (67%) females. The median age at the visit was 20.40 years. Overall, we observed a statistically significant increase in the risk of coronary sinus rhythm and respiratory arrhythmia in subjects with a previous diagnosis of COVID-19 (OR=5.0, 95% CI=1.6-16.0 and OR=3.4, 95% CI= 2.4-4.8, respectively). This study is especially compelling as it focuses on an increased risk of respiratory arrhythmia and coronary sinus rhythm in young healthy subjects after the COVID-19 pandemics. If our results should be confirmed by other more extensive studies they could be relevant to clinicians since they should be aware of cardiac arrhythmias as one of the complications attributable to COVID-19 emergence.

Infection caused by hepatitis B virus (HBV) can be prevented through a safe and effective vaccine. This study analysed the kinetics of serum antibodies against hepatitis B surface antigen (HBsAg) (anti-HBs) titers in relation to previous vaccine boosters in Italian nursing students who were followed up for two years. Serum anti-HBs titers were evaluated at the first visit, after vaccine booster (if required) and at visit after two years. Overall, 483 students (mean age = 21.7 years; SD = 3.7) with median anti-HBs IgG titer of 6 mUI/mL (interquartile range (IQR) = 0–34) were enrolled. A total of 254 (52.5%) students with a titer lower than 10 mIU/mL were offered an anti-HBV booster at the first visit. Among these students, an exponential relation between anti-HBs IgG titer, one month after HBV booster and anti-HBs IgG titer two years later was found (y = 3.32 exp (0.0045x); R² = 0.48; p < 0.001). Students with anti-HBV titer higher than 10 mIU/mL (N = 229) were followed up, and anti-HBs IgG titers at follow-up visit linearly correlated with anti-HBV baseline titers (y = 0.86x + 26.2; R² = 0.67; p < 0.001). A decrease in anti-HBs titers can be expected a few years after the anti-HBV booster dose. This reduction is more pronounced than that observed in students not administered the booster dose and is exponential with respect to basal titers assessed after the booster dose.

Background: Tuberculosis screening is part of the standard protocol for evaluating the risk of infection in healthcare workers. The aim of this study was to evaluate the prevalence of latent tuberculosis infection (LTBI) among students attending various healthcare profession degree courses and postgraduate medical courses at the School of Medicine of the University of Palermo, Italy, and assess the possible professional origin of infection. Methods: In total, 2946 students (2082 undergraduates and 864 postgraduates) took part in a screening program for LTBI between January 2014 to April 2019 using the tuberculin skin test (TST). Students with a positive TST result underwent a Quantiferon-TB test (QFT). Results: Among the 2082 undergraduates, 23 (1.1%) had a positive TST; the result was confirmed with QFT for 13 (0.62%) of them. Among the 864 postgraduate students, 24 (2.78%) had a positive TST and only 18 (2.08%) showed a positive QTF. Latent tuberculosis infections were significantly more frequent among postgraduates than undergraduates (2.08% > 0.62%, p < 0.0001). There was a higher number of subjects previously vaccinated for TB (18.87% > 0.24%, p < 0.0001), and of vaccinated subjects found positive for TST and QTF (66.67% > 7.69%, p = 0.001) in the postgraduate group. Conclusion: Latent TB is relatively low among medical school students in our geographic area. Nevertheless, this infectious disease must be regarded as a re-emerging biohazard for which preventive strategies are required to limit the risk of infection, especially among exposed workers.