Stella Andreadi

Background: Healthcare workers (HCWs) remain at risk of occupational exposure to Mycobacterium tuberculosis. Although workplace-related risk factors have been extensively investigated, the contribution of host metabolic factors to tuberculosis infection (TBI) susceptibility remains poorly understood. This study evaluated QuantiFERON-TB Gold Plus (QFT-Plus) conversion and its association with demographic, occupational, and metabolic risk factors. Methods: A retrospective cohort study was conducted among 3309 HCWs undergoing annual routine occupational health surveillance at Policlinico Tor Vergata in Rome (Italy) from 2017 to 2025. Data included age, sex, job category, night-shift work, departmental risk level, and biochemical parameters (lipid profile, blood glucose, and vitamin D levels). Associations with QFT-Plus conversion were assessed using univariate analyses, binary logistic regression, and multivariate Cox regression models. Results: During follow-up, 87 participants (2.6%) experienced QFT-Plus conversion. In univariate analysis, age ≥ 40 years (3.98% vs. 1.50%; p < 0.001) and hypercholesterolemia (3.8% vs. 2.1%; p = 0.004) were significantly associated with conversion. However, neither variable remained statistically significant in multivariate analyses (age: p = 0.734; hypercholesterolemia: p = 0.834). Occupational factors, including job category, night-shift work, and assignment to high-risk departments, were not significantly associated with QFT-Plus conversion. Likewise, hyperglycemia and vitamin D deficiency showed no significant associations. Conclusions: QFT-Plus conversion incidence was low, supporting the effectiveness of current hospital infection control measures in this low-incidence setting. No demographic, occupational, or metabolic factor emerged as an independent predictor of conversion. These findings should be interpreted considering the limited number of conversion events and the multifactorial nature of TBI susceptibility.

Background: Fasting plasma glucose, glycated hemoglobin (HbA1c), and oral glucose tolerance testing remain central to the diagnosis and monitoring of dysglycemia, but they mainly reflect the average glycemic exposure or discrete time-point measurements and may not capture intraday and interday glucose fluctuations. Glycemic variability (GV) has been associated with oxidative stress, endothelial dysfunction, inflammation, and diabetes-related complications, although much of the evidence derives from experimental, clinical, and diabetes-care settings rather than occupational cohorts. Aim: This narrative review examines the physiological basis, measurement, and potential occupational relevance of GV and continuous glucose monitoring (CGM) in working populations. Methods: Literature was narratively selected from biomedical databases, major guidelines, consensus statements, and occupational-health sources, prioritizing reviews, clinical guidelines, cohort studies, mechanistic studies, and CGM studies. No systematic search, risk-of-bias assessment, or quantitative synthesis was performed. Main findings: CGM is an established technology in selected diabetes-care contexts and provides metrics such as coefficient of variation, time in range, time above range, and time below range. Its use in occupational medicine, however, remains investigational outside selected clinical circumstances. Work-related factors such as shift work, circadian disruption, sleep loss, psychosocial stress, irregular meal timing, sedentary behavior, and variable physical workload may influence glucose regulation, but direct evidence linking these exposures to CGM-measured GV in workers remains limited. Implications: Potential applications include research on occupational determinants of metabolic health, monitoring of workplace lifestyle interventions, and individualized management of workers with diabetes in safety-sensitive roles, provided that consent, confidentiality, clinical follow-up, equity, and data-governance safeguards are ensured. Conclusions: GV assessment may complement traditional metabolic markers in selected occupational-health contexts, but routine CGM-based surveillance of general worker populations is not currently supported by sufficient evidence. Further longitudinal and interventional studies are required.

Background: The cardiovascular effects of SARS-CoV-2, including autonomic dysregulation, are becoming increasingly recognized, even following mild infections. However, long-term electrocardiographic (ECG) changes remain poorly characterized. Methods: We conducted a prospective study of 151 unvaccinated healthcare workers with RT-PCR-confirmed mild to moderate SARS-CoV-2 infection. Standard 12-lead ECGs were recorded before infection (T0) and at 6–12 months (T1) and >12 months (T2) after infection. Key parameters included heart rate (HR), PR interval, QRS duration, and corrected QT interval (QTc). Results: Heart rate (HR) increased transiently at T1 (p < 0.05) and normalized by T2. Mild but persistent PR interval shortening was observed at both follow-ups (p < 0.01). There were no significant changes in QRS or QTc intervals. No arrhythmias or conduction blocks occurred. ECG alterations were not associated with sex or age, except for greater PR shortening in males. Conclusions: Mild SARS-CoV-2 infection can result in transient sinus tachycardia and subtle PR shortening, which is likely to be a post-viral autonomic effect. Long-term ECG surveillance appears unnecessary in asymptomatic cases.

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.

The circadian rhythm of cortisol, a key hormone essential for maintaining metabolic balance and stress homeostasis, is profoundly disrupted by night-shift work. This narrative review examines the physiological mechanisms underlying cortisol regulation, the effects of shift work on its circadian rhythm, the associated health risks, and potential mitigation strategies. Night-shift work alters the natural secretion pattern of cortisol, leading to dysregulation of the hypothalamic–pituitary–adrenal axis, which in turn can contribute to metabolic disorders, cardiovascular diseases, and impaired cognitive function. Understanding the physiological pathways mediating these changes is crucial for developing targeted interventions to mitigate the adverse effects of circadian misalignment. Potential strategies, such as controlled light exposure, strategic napping, and personalized scheduling, may help to stabilize cortisol rhythms and improve health outcomes. This review aims to provide insights that can guide future research and inform occupational health policies for night-shift workers by addressing these challenges.