Social network characteristics and well-being in Italy: insights from the PHRASI Study

Background

Mental well-being should be prioritized in public health as it represents a valuable resource for individuals and communities, influencing behavior, social cohesion and social inclusion. The support individuals receive from their social networks can have a significant impact on mental well-being. This study used data from the Public Health Residents' Anonymous Survey in Italy, a nationwide cross-sectional survey. The objective was to assess the level of well-being among the Public Health Residents and investigate the association between the social network characteristics and the well-being in this population.

Study design

The current cross-sectional study targeted 1,600 public health residents enrolled in various Italian public health specialization schools between June 14 and July 26, 2022.

Methods

Participants self-reported both functional and structural characteristics of social network. Well-being was assessed using the WHO-5 well-being index. Linear regression models, adjusted for age and sex, were applied to examine the association between WHO-5 score and social network characteristics.

Results

Out of 379 participants, 51.5% reported bad well-being. Those with bad well-being are more likely women, experience lower peer-to-peer and supervisor support, face higher work-to-private life interference, and less frequently have a partner. Greater peer-to-peer support (β=1.13, 95% CI=0.68; 1.57), and increased supervisor support (β=1.26, 95% CI=0.86; 1.67), were associated with higher levels of well-being. Conversely, higher work-to-private life interference was associated with lower perceived well-being. Having a partner resulted in a better perceived well-being (β=1.96, 95% CI=0.94; 2.98). In logistic regression analysis, higher peer-to-peer support (OR=0.68, 95% CI = 0.55;0.85) greater supervisor support (OR=0.60, 95% CI=0.49;0.74) and having a partner (OR=0.51, 95% CI = 0.32;0.82) were associated with reduced odds of bad well-being. Conversely, increased WLI was associated with higher odds of bad well-being (OR=1.47, 95% CI = 1.19;1.82).

Conclusions

The characteristics of an individual's social network play a crucial role in her/his well-being and should be considered both in personal and professional contexts when aimed to enhance mental well-being in communities.

Costs and healthcare utilisation due to respiratory syncytial virus disease in paediatric patients in Italy: a systematic review

OBJECTIVES

Respiratory syncytial virus (RSV) is a frequent cause of acute lower respiratory infection in children, imposing a substantial economic burden on healthcare systems. This systematic review aimed to assess the economic burden and healthcare utilisation of RSV in children aged 0-59 months in Italy.

STUDY DESIGN

Systematic review.

METHODS

A systematic search of PubMed, Embase, Scopus, and the International HTA Database, including studies published in English or Italian, was conducted between January 2000 and July 2022. Inclusion criteria required studies to be conducted in Italy and provide data on the economic costs and healthcare resource utilisation related to RSV infections.

RESULTS

Out of 20,845 records screened, 18 articles met the inclusion criteria. Only one study provided comprehensive data on RSV disease costs, including hospitalisation, diagnostic tests, and medical procedures for infants with RSV-bronchiolitis. The mean cost per inpatient was higher for RSV-positive children (€5753.43 ± €2041.62) than that for RSV-negative children. Additionally, five studies reported a median length of hospital stay of 5 days for RSV-infected children, and four studies indicated a higher frequency of intensive care unit admissions for RSV-infected children than for those with other viral infections.

CONCLUSIONS

This is the first systematic review to examine the economic burden and healthcare utilisation of RSV in children aged 0-59 months in Italy. While limited data were available, the findings underscore the urgency to conduct further research and gather additional evidence on the costs and healthcare resource utilisation associated with RSV infections. Such efforts are essential for informing the development of effective prevention strategies for paediatric RSV infections in Italy.

Work-Related Stress Questionnaire: confirmatory factor analysis for construct validation by the PHRASI study

OBJECTIVE

The purpose of this study is to validate the 13-item version of the Work-Related Stress Questionnaire (WRSQ) on a representative sample of Italian public health residents.

MATERIALS AND METHODS

The WRSQ was administered as part of the Public Health Residents' Anonymous Survey in Italy (PHRASI) from 14 June to 26 July 2022. Collinearity between each questionnaire item was assessed with Kendall's τ statistic. The latent factors identified associating similar items based on the authors' observations were workplace, job demand, support and unpleasant workplace. Goodness-of-fit was assessed with confirmatory factor analysis calculating: Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), Standardized Root-Mean-Residual (SRMR). Cronbach's alpha (α) and Omega McDonald (ω) were calculated to evaluate the reliability of the questionnaire. R 4.2.2 was used to perform the analyses.

RESULTS

379 Public Health residents (58% women) responded to the questionnaire. No significant collinearity was found between the items (τ range -0.31 to 0.49). Confirmatory Factor Analysis showed CFI = 0.975, TLI = 0.967, RMSEA = 0.041 and SRMR = 0.051. Internal consistency of the WRSQ Total Score was α = 0.80 and ω = 0.85.

CONCLUSIONS

Although validated in a sectorial subpopulation of healthcare workers, the WRSQ proved to be an excellent tool for assessing work-related stress. Unpleasant workplace latent factors showed lower factor loading and internal consistency than others. This could be due to the fact that topics investigated with unpleasant workplace items (e.g., abuse and discrimination) are experienced on a less regular basis than the ones assessed through the other items.

Social Network Characteristics and Depressive Symptoms of Italian Public Health Medical Residents: The Public Health Residents' Anonymous Survey in Italy (PHRASI)

Despite the high impact of the COVID-19 pandemic on social interactions and healthcare workers' (HWs') mental health, few studies have investigated the association between social network characteristics and HWs' mental health, particularly during the pandemic. Therefore, we aimed to assess the associations between public health residents' (PHRs') social network characteristics and depression. We used data from the Public Health Residents' Anonymous Survey in Italy (PHRASI), a nationwide cross-sectional study. Social network characteristics were self-reported. Depressive symptoms were assessed using the nine-item Patient Health Questionnaire. Linear and logistic models adjusted for age, sex, physical activity, and alcohol were used. A moderation analysis by sex was also performed. A total of 379 PHRs participated in the survey (58% females, median age of 30 years). More peer-to-peer (odds ratio OR = 0.62 (0.47-0.83)) and supervisor support (OR = 0.49 (0.36-0.68)), more social participation ((OR) = 0.36 95% CI (0.25-0.50)), and having a partner (OR = 0.49 (0.25-0.96)) were significantly associated with a lower risk of clinically relevant depressive symptoms. Work-to-private-life interference was significantly associated with a higher risk of clinically relevant depressive symptoms (OR = 1.77 (1.28-2.45)). Promoting a supportive work environment and social participation as well as reducing work-to-private life interference can contribute to reducing the high burden among PHRs.

The Activity of Special Continuity Care Units in the City of Florence During the COVID-19 Pandemic

Objectives: Worldwide, countries adopted different strategies in primary care (PC) to cope with the COVID-19 pandemic. This study aims to describe and evaluate the functions and activity load of a specific PC organizational model called "Special Continuity Care Units" (SCCU) in Florence, Italy, and to investigate the characteristics of the COVID-19 patients assisted by the service. Methods: The retrospective cross-sectional design used daily updated reports by SCCU team members to evaluate the activity load. The retrospective cohort study analyzed data of the demographics, clinical characteristics, and process outcomes of patients assisted during the second pandemic wave. Results: The analysis shows how the service activity load changed along with the epidemiological trend. Regarding people assisted by the SCCU, the median follow-up duration of symptoms was 6 days; male gender and being symptomatic were predictors of hospitalization. Conclusion: Some key characteristics can be described as indispensable in PC services facing health emergencies: model flexibility, the availability of resources, networking among services to enhance coordination and resource optimization, and close collaboration with general practitioners.

Do demographic and socio-economic factors predict Sense of Coherence among university students?

INTRODUCTION

The COVID-19 pandemic and related containment measures have been threatful for psychological well-being, particularly for young people such as university students. Sense of Coherence (SoC) can help in coping with stressful and anxiety-provoking situations.

AIM

The aim of this study is to describe the levels of SoC and to investigate the socio-economic, and demographic predictors in a sample of students attending Florence University, in the timespan between August, 17th and October, 3rd 2020.

METHOD AND RESULTS

The cross-sectional online survey was completed by 2,996 students. Higher levels of SoC have been found among males and for respondents reporting a better socioeconomic condition. Regarding the dimensions of SoC, lower levels were reported for comprehensibility and manageability, higher for meaningfulness.

CONCLUSIONS

These results reinforce the need to plan and implement health promotion interventions aimed to support and sustain university students in general and specifically those at higher risk of low level of SoC.

Human Respiratory Syncytial Virus Epidemiological Burden in Pediatric Outpatients in Italy: A Systematic Review

BACKGROUND

Human respiratory syncytial virus (hRSV) is a key contributor to lower respiratory tract infections (LRTIs), affecting children aged 0-5 years and often leading to outpatient visits, emergency department utilization, and hospitalization. With the development of hRSV vaccines for mitigation, understanding the epidemiological impact of hRSV infections among 0-5-year-old pediatric outpatients in Italy is crucial.

METHODS

This systematic review conducted searches on PubMed, Embase, Scopus, and the International HTA Database, yielding 20,845 English and Italian records from January 2000 to July 2022.

RESULTS

Six eligible articles were identified following inclusion and exclusion criteria. These studies demonstrated hRSV-positivity proportions ranging from 18% to 41% in pediatric outpatients with respiratory infections. However, data comparability was hindered by diverse diagnostic approaches, data sources, sample populations, and study designs. Notably, hRSV-positivity showed temporal variability, rising from 23.8% (2001-2002) to 40.6% (2019-2020). This trend could stem from evolving epidemiological factors, heightened clinician awareness in hRSV diagnosis, or more sensitive molecular techniques.

CONCLUSION

As the first review of its kind, this study underscores the need for more comprehensive data to inform effective preventive strategies against hRSV-related burdens in pediatric outpatients.

Depressive Symptoms of Public Health Medical Residents during the COVID-19 Pandemic, a Nation-Wide Survey: The PHRASI Study

Depression is a widespread condition, which increased during the COVID-19 pandemic among healthcare workers as well. The large workload of the pandemic response also affected Public Health Residents (PHRs) who played an important role in infection prevention and control activities. This work aims to assess depression in Italian PHRs, based on data collected through the PHRASI (Public Health Residents' Anonymous Survey in Italy) study. In 2022, 379 PHRs completed the self-administered questionnaire containing Patient Health Questionnaire-9 to evaluate clinically relevant depressive symptoms (PHQ-9 ≥ 10). Multivariate logistic regression shows that the intention (aOR = 3.925, 95% CI = (2.067-7.452)) and the uncertainty (aOR = 4.949, 95% CI = (1.872-13.086)) of repeating the test to enter another postgraduate school/general practitioner course and the simultaneous attendance of two traineeships (aOR = 1.832, 95% CI = (1.010-3.324)) are positively related with depressive symptoms. Conversely, the willingness to work in the current traineeship place (aOR = 0.456, 95% CI = (0.283-0.734)) emerged as a protective factor. Similar results were obtained considering mild-to-severe (PHQ-9 ≥ 5) depressive symptoms and/or stratifying by sex. The findings, suggesting the protective role of job satisfaction toward depression, might entail future interventions to improve the learning experience and promote work-life balance.

[Post-SMILE-What myopes know about their secondary emmetropic eyes]

BACKGROUND

Small incision lenticule extraction (SMILE) is popular among young myopic adults for long-term correction of myopia; however, the excessive axial lengths of myopic eyes and the associated risks for more serious eye diseases later on remain with surgical correction of the refractive error. These risks are greater the higher the myopia is. Are patients well informed about this and to what extent does further eye growth occur even after SMILE?

MATERIAL AND METHODS

Myopic young adults who underwent binocular SMILE before 2019 were given the opportunity to have their eyes examined at a follow-up visit (biometry using IOL-Master 700 [Zeiss, Oberkochen, Germany], subjective refraction, examination of the anterior and posterior segments of the eye using the slit lamp) and to participate in a survey. Patients with a preoperative axial length ≥ 25.5 mm and a preoperative axial length < 25.5 mm (high myopia) were statistically evaluated separately.

RESULTS

A total of 44 patients (age 30.39 ± 2.39 years) appeared at the visit and the SMILE was 3.18 ± 0.82 years ago: The spherical equivalent at the follow-up visit was -0.05 ± 0.21 dpt in the weaker myopes and -0.18 ± 0.23 dpt in the high myopes. Of the respondents 27% estimated that SMILE would reduce the risk of retinal detachment and cataract, with 80% of high myopes underestimating the individual risk of retinal detachment. Also, 57% said they would not see an ophthalmologist until within 1 week if they had symptoms consistent with acute retinal detachment, and only 27% would go to an emergency room immediately. In general, 59% reported having normal health awareness and 41% reported going for annual ophthalmological check-ups.

CONCLUSION

The collected axial lengths and refractions show no relevant change in the eyes regarding progression of myopia; however, the patients' statements in the survey point out that most patients are not aware of the risk of serious eye diseases (retinal detachment, cataract). Therefore, repeated risk education and close postoperative care are needed, especially in preoperatively highly myopic patients.

Role and challenges to digital technologies in community health promotion programs in Italy during the COVID-19 pandemic: a multiple embedded case study protocol

BACKGROUND AND AIM

Due to the COVID-19 pandemics, The Italian League Against Cancer (LILT), a national federation of local associations promoting cancer prevention, had to face the challenge to find new ways and technologies to promote health in their territories. This study aims to explore how LILT associations led their health promotion interventions during the COVID-19 pandemic and to understand which interventions had a greater impact, for which population group, and why.

METHODS

In this descriptive multiple embedded case study, each case will focus on the activities of a local LILT association and their collaborators on the perception and experience of the use of digital technology for health promotion and prevention, through interviews, observations, and a study of products and artifacts. A general overview of each case study will be provided, along with an introduction of the unit(s) of more in-depth analysis. The logical models that emerge from the analysis of each case will be described by using realist analysis, producing a list of possible CMO configurations (Context; Mechanisms; Outcomes). The final report will consist of a cross-case analysis (a comparison between the different case studies).

DISCUSSION

This multiple case study will help generate a first "theory of the use of digital technology in health promotion in local LILT communities. The observation of what local LILT associations in Italy have done during COVID-19 will help identify new and useful health promotion strategies based on these technologies.

Public Health Residents' Anonymous Survey in Italy (PHRASI): Study Protocol for a Cross-Sectional Study for a Multidimensional Assessment of Mental Health and Its Determinants

The COVID-19 pandemic has evolved into a severe psychosocial crisis affecting patients, their relatives, friends, and healthcare professionals. In Italy, public health residents (PHRs) remain essential to the national response to the pandemic. To assess their mental sphere, the "Public Mental Health" working group of the medical residents' Assembly of the Italian Society of Hygiene and Preventive Medicine has designed the Public Health Residents' Anonymous Survey in Italy (PHRASI). This is a nation-wide cross-sectional study based on an 88-item self-administered voluntary survey that evaluates how sociodemographic variables are associated with mental issues, including wellness, eating disorders, sleeplessness, alcohol misuse, depression, and anxiety. Data will be gathered by disseminating a Google Forms link across the Assembly network of medical residents. All PHRs enrolled in a four-year program in one of the Italian postgraduate schools of public health will be qualified as participants. PHRASI aims to draw a comprehensive and detailed picture of the mental health state of Italian PHRs. PHRs are a significant group of healthcare professionals that may serve as a future benchmark for developing and enacting regulations intended to support the mental health of healthcare professionals.

Effectiveness of pneumococcal vaccination on hospitalization and death in the adult and older adult diabetic population: a systematic review

INTRODUCTION

Diabetic patients are at a higher risk of getting pneumococcal disease and are therefore recommended to get vaccinated. The aim of our systematic review is the retrieval and analysis of all available evidence on the effect of pneumococcal vaccination on the risk of hospitalization and death in adult patients with diabetes.

RESEARCH DESIGN AND METHODS

MEDLINEand EMBASE were searched from inception until January 2023. We included all studies investigating whether pneumococcal vaccination reduces the risk of dying or being hospitalized in diabetic patients. The Newcastle-Ottawa scale was used to assess risk of bias.

RESULTS

Only two studies, encompassing a total of 68,246 subjects, were considered eligible for inclusion and of high quality. In both studies polysaccharide pneumococcal vaccination was associated with a reduction of the risk of hospitalization or death in adult diabetic patients (aHR: 0.76 in one study, aOR: 0.97 in the other one). However, in neither of the two included studies the lower risk was statistically significant.

CONCLUSIONS

Further research is needed due to the potentially major clinical implications for diabetic patients. The results of this systematic review can serve as a foundation for future studies, indicating the importance of continuing research in this area to improve patient outcomes.

The Contribution of Cultural Heritage Owned by Local Health Authorities in the Humanization of Care: The Point of View of Top Management

After the COVID-19 pandemic, reforms in healthcare systems have the purpose to fully recover the relationship of healthcare organizations with their patients. For centuries, art was used throughout Europe in the healthcare context for its power to engage and support patients in their illnesses. This approach can be rediscovered by utilizing the cultural heritage owned by Local Health Authorities. In this context, tradition, art, innovation, and care coexist. This study aims to investigate the interest in developing projects for the humanization of care by the top management of Italian Local Health Authorities, in particular exploiting their cultural heritage. The evaluation of the proposal was conducted using semi-structured interviews with the top management of two Local Health Authorities, in which the Santa Maria Nuova hospital in Florence and the Santo Spirito in Sassia Hospital in Rome are located, as the two selected cases for this study. The interviewees welcomed the proposal to develop humanization of care projects involving the use of their cultural heritage. Moreover, they expressed their desire to invest human, economic, and structural resources in the development of these initiatives. The implementation of humanization of care projects using cultural heritage owned by Local Health Authorities is useful to apply specific policies to enhance the governance of the cultural heritage according to the health mission. On the other hand, it permits the search for additional or ad hoc resources. Finally, it is possible to humanize and improve patients' experience while increasing awareness among the health workforce and trainees.

The Role of Gender in the Association between Mental Health and Potentially Preventable Hospitalizations: A Single-Center Retrospective Observational Study

Psychiatric disorders and substance abuse are barriers that limit access to timely treatment and can lead to Potentially Preventable Hospitalizations (PPH). The aim of this study is to identify the role played by gender in the association between mental health and PPH. Hospital discharge records (HDRs) from the Local Health Authority of Pescara (Italy) from 2015 to 2021 were examined and PPH were measured according to Prevention Quality Indicators (PQIs) provided by the Agency for Healthcare Research and Quality. In total, 119,730 HDRs were eligible for the study and 21,217 patients fell into the PQI categories. Mental health disorders and addictions were extracted from the HDRs through the Elixhauser Enhanced ICD-9-CM algorithm. The association between PQI hospitalization and some predictors considered was evaluated with multivariate logistic regression models. In males and females, alcohol abuse showed a protective role towards preventable admissions for PQI-90 (all types of conditions) and PQI-92 (chronic conditions). In contrast, there is a gender gap in accessibility to primary health care, especially for acute conditions leading to PPH. Indeed, in males, PQI-91 admissions for acute conditions were found to be positively associated with drug abuse, psychosis, and depression, whereas this was not the case for females.

USCA service utilization in the city of Florence (Italy) during the COVID-19 pandemic

Background

In order to support primary care during the first pandemic wave (March 2020), the Italian Government instituted multiprofessional health teams called “USCA” (Special Continuity Care Units), which ensured continuity of care for COVID-19 patients who do not need hospitalization. The aim of our study was to compare the volumes of USCA service utilization in Florence (Tuscany, Italy) during the peak of home visits of three pandemic waves.

Methods

This single-center study followed a retrospective cross-sectional design. The USCA of the Heath District of Florence served a population of 366,190 people. The following data were collected: home medical visits, nursing home (NH) visits, visits in health-care hotels. The peak periods of three epidemic waves were considered in the analyses: the second wave (23 October - 20 November 2020), the third wave (25 March - 22 April 2021), and the Omicron period (27 December 2021 - 6 February 2022). The maximum 7-day moving averages of the daily number of visits during the three periods were calculated. Relative percent differences for visits comparing the considered periods were computed.

Results

Home visits during the third pandemic wave increased by 14% compared to the second wave (second wave: N = 1370, third wave: N = 1562), while a decrease was observed during the Omicron period (Omicron vs third wave: -21%; peak value: 41 vs 60). Visits in health-care hotels during the third wave doubled compared to the second wave. After the start of the COVID-19 vaccination campaign, NH visits steeply declined (third wave vs second wave: -95%; N = 323 vs 15; peak value= 14 vs 2 visits per day). During the Omicron period, NH visits increased by almost four times compared to the third wave period.

Conclusions

The USCA service utilization was significant in all the analyzed periods. In a pandemic context, it is necessary to strengthen primary care services such as USCA, which have proved to respond to rapidly changing health needs.

Key messages

• The USCA service is an innovative model of integrated home care that has proved to respond to rapidly changing health needs during all phases of the COVID-19 pandemic.

• The USCA service utilization was significant during all phases of the pandemic. The USCA service has introduced new ways of working and new relationships between services in primary care.

The humanization of care after the COVID-19 pandemic in Italian historical hospitals

 

Globally, the reforms of healthcare systems aim to bring back the patient at the centre of these organisations after the issues related to the COVID-19 outbreak. The patient returns to be fully considered, as an individual whose must be protected physical and psychological health as well as social well-being. Humanization of care is returning to the foreground. For centuries, art has been used throughout Europe in the health context for its power to support patients in their disease. Today, this approach can be rediscovered in historical hospitals, where tradition, art and assistance coexist. This study aims to investigate the interest for the development of projects for the humanization of care exploiting the artistic heritage of the historical hospitals owned by Health Authorities. The cross-case analysis was chosen as study design. The case studies are the historical hospitals in the city centre of Venice, Florence, and Rome. The evaluation of the proposal was carried out through semi-structured interviews with the general managers of the Health Authorities, the medical directors of the selected hospitals and the delegates for the protection and promotion of cultural heritage. The results were analysed using a qualitative model (coding). All respondents welcomed the proposal to launch projects for the humanization of care that foresee the use of the artistic heritage of the historical hospitals to involve patients in the field of health care. Interviewees expressed the desire to invest human and structural resources in the development of these projects. Moreover, directors suggest choosing a specific target with which to start the experimentation and to dispense a specific training to future engaged social and health personnel. The implementation of projects for the humanization of care using the artistic heritage of historical hospitals can be replicated worldwide where healthcare institutions have a cultural wealth to be handed down, shared and valued.

Key messages

• In the post COVID-19 era, it is strategic to exploit artistic heritage owned by the Health Authority for the positive impact in the patient’s experience.

• Artistic heritage claims its role as a health service for supporting patients, caregivers and also health workforce.

The role of gender in the association between mental health and avoidable hospitalization

Background

Hospital discharge records (HDR) can indirectly assess the quality of primary care through algorithms proposed by the Agency for Health Research and Quality (AHRQ). Mental illnesses or substance addictions represent barriers to accessibility to medical care which, can lead to hospitalizations deemed potentially preventable. The aim of this study is to evaluate the gender differences in the association between potentially preventable acute hospitalizations whether mental health or addiction.

Methods

The study examined HDRs of the Local Health Authority of Pescara, Abruzzo, period 2015-2021. The aggregate Prevention Quality Acute Composite 91 (PQI-91) has been coded according to the indications of the AHRQ. Were selected HDRs with a diagnosis of depression, psychosis, alcohol or substance abuse according to Enhanced ICD-9-CM Elixhauser algorithm. Four univariate logistic regression models were implemented correcting for age.

Results

In the study period 252,775 HDRs of which 3,459 PQI-91 were analyzed. A diagnosis of depression is positively associated with a PQI-91 hospitalization only in the male gender (aOR 3.16; 95%CI 2.18-4.58) and not in the female one (aOR 1.13; 95%CI 0.75-1.72). The same is true for a diagnosis of psychosis, males (aOR 2.41; 95%CI 1.66-3.48) and females (aOR 1.19; 95%CI 0.67-2.12). In both genders there was an association with substance abuse, males (aOR 3.92; 95%CI 2.65-5.81) and females (aOR 2.68; 95%CI 1.19-6.07), while for the alcohol abuse the female gender is positively associated (aOR 2.52; 95%CI 1.11-5.73) and not the male one (aOR 1.24; 95%CI 0.80-1.92).

Conclusions

Gender is an innovative approach to health inequalities: women and men respond to a different diagnostic-prescriptive appropriateness, which depends both on biology and on social, cultural, psychological and economic distances. Research efforts must be made to observe the effect healthcare access disparities have on patients who experience mental illness or addiction.

Key messages

• Mental health can limit access to primary care for other comorbidities or acute diseases; poor-quality primary care can result in preventable hospitalizations that increase the cost of health care.

• The gender differences for the same diagnosis of mental illness/addiction that cause potentially preventable acute hospitalizations impose gender-specific strategies aimed at modifying care pathways.

The role of neutralizing antibodies by sVNT after two doses of BNT162b2 mRNA vaccine in a cohort of Italian healthcare workers

OBJECTIVES

Evaluating anti-SARS-CoV-2 antibody levels is a current priority to drive immunization, as well as to predict when a vaccine booster dose may be required and for which priority groups. The aim of our study was to investigate the kinetics of anti-SARS-CoV-2 Spike S1 protein IgG (anti-S1 IgG) antibodies and neutralizing antibodies (NAbs) in an Italian cohort of healthcare workers (HCWs), following the Pfizer/BNT162b2 mRNA vaccine, over a period of up to six months after the second dose.

METHODS

We enrolled 57 HCWs, without clinical history of COVID-19 infection. Fluoroenzyme-immunoassay was used for the quantitative anti-S1 IgG antibodies at different time points T1 (one month), T3 (three months) and T6 (six months) following the second vaccine shot. Simultaneously, a commercial surrogate virus neutralization test (sVNT) was used for the determination of NAbs, expressed as inhibition percentage (% IH).

RESULTS

Median values of anti-S1 IgG antibodies decreased from T1 (1,452 BAU/mL) to T6 (104 BAU/mL) with a percent variation of 92.8% while the sVNT showed a percent variation of 34.3% for the same time frame. The decline in anti-S1 IgG antibodies from T1 to T6 was not accompanied by a loss of the neutralizing capacity of antibodies. In fact at T6 a neutralization percentage <20% IH was observed only in 3.51% of HCWs.

CONCLUSIONS

Our findings reveal that the decrease of anti-S1 IgG levels do not correspond in parallel to a decrease of NAbs over time, which highlights the necessity of using both assays to assess vaccination effectiveness.

Course and Lethality of SARS-CoV-2 Epidemic in Nursing Homes after Vaccination in Florence, Italy

Evidence on the effectiveness of SARS-CoV-2 vaccines in nursing home (NHs) residents is limited. We examined the impact of the BNT162b2 mRNA SARS-CoV-2 vaccine on the course of the epidemic in NHs in the Florence Health District, Italy, before and after vaccination. Moreover, we assessed survival and hospitalization by vaccination status in SARS-CoV-2-positive cases occurring during the post-vaccination period. We calculated the weekly infection rates during the pre-vaccination (1 October-26 December 2020) and post-vaccination period (27 December 2020-31 March 2021). Cox analysis was used to analyze survival by vaccination status. The study involved 3730 residents (mean age 84, 69% female). Weekly infection rates fluctuated during the pre-vaccination period (1.8%-6.5%) and dropped to zero during the post-vaccination period. Nine unvaccinated (UN), 56 partially vaccinated (PV) and 35 fully vaccinated (FV) residents tested SARS-CoV-2+ during the post-vaccination period. FV showed significantly lower hospitalization and mortality rates than PV and UV (hospitalization: FV 3%, PV 14%, UV 33%; mortality: FV 6%, PV 18%, UV 56%). The death risk was 84% and 96% lower in PV (HR 0.157, 95%CI 0.049-0.491) and FV (HR 0.037, 95%CI 0.006-0.223) versus UV. SARS-CoV-2 vaccination was followed by a marked decline in infection rates and was associated with lower morbidity and mortality among infected NH residents.

Caring for nursing home residents with COVID-19: a "hospital-at-nursing home" intermediate care intervention

Background

Nursing home (NH) residents have been dramatically affected by COVID-19, with extremely high rates of hospitalization and mortality.

Aims

To describe the features and impact of an assistance model involving an intermediate care mobile medical specialist team (GIROT, Gruppo Intervento Rapido Ospedale Territorio) aimed at delivering “hospital-at-nursing home” care to NH residents with COVID-19 in Florence, Italy.

Methods

The GIROT activity was set-up during the first wave of the pandemic (W1, March–April 2020) and became a structured healthcare model during the second (W2, October 2020–January 2021). The activity involved (1) infection transmission control among NHs residents and staff, (2) comprehensive geriatric assessment including prognostication and geriatric syndromes management, (3) on-site diagnostic assessment and protocol-based treatment of COVID-19, (4) supply of nursing personnel to understaffed NHs. To estimate the impact of the GIROT intervention, we reported hospitalization and infection lethality rates recorded in SARS-CoV-2-positive NH residents during W1 and W2.

Results

The GIROT activity involved 21 NHs (1159 residents) and 43 NHs (2448 residents) during W1 and W2, respectively. The percentage of infected residents was higher in W2 than in W1 (64.5% vs. 38.8%), while both hospitalization and lethality rates significantly decreased in W2 compared to W1 (10.1% vs 58.2% and 23.4% vs 31.1%, respectively).

Discussion

Potentiating on-site care in the NHs paralleled a decrease of hospital admissions with no increase of lethality.

Conclusions

An innovative “hospital-at-nursing home” patient-centred care model based on comprehensive geriatric assessment may provide a valuable contribution in fighting COVID-19 in NH residents.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-01959-z.

POS1221 SARS-COV2 SEROLOGY SCREENING IN SPONDYLOARTHRITIS PATIENTS IN NORTH-EASTERN ITALY: A PILOT STUDY

Background:

Serology could help defining the real extent of Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV2) diffusion in the population, especially in individuals considered at higher risk of SARS-CoV2 infection (COVID-19), such as Spondiloarthritis (SpA) patients undergoing immunosuppressive therapy or health care workers (HCW). In fact, COVID-19 detection is complicated by the fact that many patients can be asymptomatic. In these cases, it has also been suggested that a weaker immune response might be elicited.

In this context, the role of anti-cytokine targeted therapy –commonly used as treatment in SpA- is uncertain, as it is not clear whether it is detrimental or protective towards severe disease forms.

Objectives:

The aim of the study was to explore the potential role of serology in detecting previous contact with SARS-CoV2 in SpA patients and HCW, and compare the frequency of positive findings with a control population.

Methods:

Consecutive patients affected by axial or peripheral SpA, classified according to Assessment of SpondyloArthritis international Society (ASAS) criteria and undergoing cytokine-targeted therapy, as well as HCW and controls from the pre-COVID-19 era (control group, 2015) were recruited. In SpA patients, disease activity was assessed by Ankylosing Spondylitis Disease Activity Score (ASDAS) and Disease Activity Score on 28-joint-count (DAS28).

Sera from all patients were analysed through chemiluminescent analytical system (CLIA) for the presence of IgG and IgM anti-SARS-CoV2. Patients with a positive serological test (either IgM or IgG) additionally underwent real time Polymerase Chain Reaction (RT-PCR) in nasopharyngeal swabs in order to test for active infection. In SpA patients, serology was repeated after 3 months. Data across the 3 groups were compared by ANOVA or Chi-square, while comparison between 2 groups were conducted by Wilcoxon signed rank test or Chi-Square, for continuous and categorical data respectively. P ≤ 0.05 were considered as significant.

Results:

A total of 396 patients were recruited: 200 SpA, 95 HCW and 101 healthy controls. SpA patients were mostly (54%) males, with mean age 49.6 ±14.7 years, and all were treated with anti-TNFα (78%), anti-IL-17 (9%) and anti-IL-23 drugs (7%), or small molecules (6%). Their disease activity level was moderate-low as assessed by ASDAS (1.95 ±0.98) and DAS28 (2.33 ±2.02). Among HCW and controls, 35% and 62% were male, with mean age 46.7 ±12.9 and 50.6±10.6 respectively.

Positive serology (IgM or IgG, or both) was found in 12.5% SpA patients, 8.4% HCW, 0% controls (p=0.001). Among these, IgM titres were higher in the SpA group than in HCW (2.76±2.94 versus 0.80±0.67 KU/L, p= 0.016), while IgG mean titres were lower in the SpA group than in HCW (0.88±3.18 KU/L versus 1.05±0.88, p= 0.035). SpA patients with positive serology more frequently reported COVID-19 like symptoms than those with negative serology (20% vs 4%, p=0.009) and 2 had COVID-19 as confirmed by RT-PCR, none with a severe disease course. None of the HCW reported symptoms or tested positive by RT-PCR. In the SpA patients, at 3 months, the mean IgM titre decreased from 2.76±2.93 to 2.38±2.95 (p=0.001), while the IgG titres decreased from 0.89±3.25 to 0.31±0.87 (p=ns). Interestingly, the IgM or IgG titer at a single-patient level did not seem to change much in terms of absolute value (Figure 1), except in one patient, with documented COVID-19 (positive RT-PCR), in whom IgG level even decreased at 3 months.

Conclusion:

Serology revealed that exposure to COVID-19 in SpA patients, as well as HCW, was higher than expected based on reported symptoms. Targeted anti-cytokine therapy could act as a protective factor for a severe disease course in SpA patients. However, in this population, IgG and IgM titres did not change in a clinically significant manner at 3 months, and patient did not seem to develop an immune profile consistent with durable response. This result could be due to a weaker immune response in mild infections, but further studies are warranted to clarify the pathophysiology beyond these observations.

Figure 1.

Disclosure of Interests:

Augusta Ortolan: None declared, Chiara Cosma: None declared, Mariagrazia Lorenzin: None declared, Giacomo Cozzi: None declared, Andrea Doria Speakers bureau: Novartis, Abbvie, Pfizer, MSD, Janssen, Glaxosmithkline, Mario Plebani: None declared, Roberta Ramonda Speakers bureau: Novartis, Abbvie, Pfizer, MSD, Janssen

S100B as a new fecal biomarker of inflammatory bowel diseases

OBJECTIVE

S100 proteins are demonstrated to exert a protective role in the gastrointestinal tract. In the present study, we investigated whether S100B protein, that is typically expressed by enteroglial cells, is detectable in feces and could be a useful noninvasive indicator of gut chronic inflammation.

PATIENTS AND METHODS

This clinical prospective study included n=48 patients suffering Crohn's disease (CD) or ulcerative colitis (UC) and non IBD-controls. The clinical disease activity was evaluated using Harvey-Bradshaw or Mayo Score Index while the diagnosis of IBD was defined based on standard endoscopic and histological criteria. S100B and calprotectin were extracted and analyzed using commercial enzyme-linked immunosorbent assay (ELISA) kits.

RESULTS

Unlike calprotectin, S100B was significantly decreased in both CD and UC compared to non IBD-patients. The strongest quantitative alterations of S100B were detected concomitantly with signs of active or quiescent disease, including high/normal expression of fecal calprotectin, mucosal damage/cryptitis, mucin depletion and inflammatory infiltrate, as defined by endoscopic evaluation and histological analysis. At the onset of disease and under no Infliximab-based therapy, the lowest was detected suggesting that S100B in feces could have a potential diagnostic value for IBD.

CONCLUSIONS

Testing for S100B and calprotectin could be a useful screening tool to better predict IBD activity.

137Cs contamination over Transylvania region (Romania) after Chernobyl Nuclear Power Plant Accident

Following the radionuclide releases due to Chernobyl Nuclear Power Plant accident, various studies were completed by researchers all over the world in order to measure the surface contaminations by artificial radionuclides. The aim of this study was to evaluate ¹³⁷Cs surface contamination and to create an inventory distribution for Transylvania region (Romania) after the Chernobyl event using γ spectrometric measurements on soil samples collected from 153 locations. The results were compared to measured data from the Danube Delta and Moldova Republic, as well as to ¹³⁷Cs concentrations from the rest of Europe reported by literature. The ¹³⁷Cs surface concentrations in soil samples ranged between 0.4±0.1kBqm^-2 and 301.1±3.0kBqm^-2, having an average of 8.3±0.2kBqm^-2, with more elevated values in the mountain areas (18.3±0.6kBqm^-2) compared to the hills and plains (2.6±0.1kBqm^-2). Taking into consideration the cardinal regions, the northern and western regions received the least amount of ¹³⁷Cs (2.9±0.1kBqm^-2), while the southern part received 16.3±0.6kBqm^-2. Sampling points with eastern slope exposure received the highest average (27.8±0.5kBqm^-2), while southern, north-western and north-eastern ones received less than 8kBqm^-2. Two hotspots are reported at Iezer-Ighiel (72.7±5.9kBqm^-2) and Tulgheș areas (51.5±0.6kBqm^-2).

Biomarkers, imaging and disease activity indices in patients with early axial spondyloarthritis: the Italian arm of the SpondyloArthritis-Caught-Early (SPACE) Study

The study aimed to evaluate biomarkers facilitating early diagnosis of axial spondyloarthritis (axSpA) and correlations between them and disease activity parameters and imaging indexes. Patients with low back pain (LBP) (≥3 months, ≤2 years, onset ≤45 years) participating in the Italian arm of the SpondyloArthritis-Caught-Early SPACE study underwent a physical examination, questionnaires, laboratory tests, X-rays and MRI of the spine and sacroiliac joints (SIJ). An expert rheumatologist formulated axSpA diagnosis in accordance with Assessment of SpondyloArthritis International Society (ASAS) criteria. Disease activity and physical functioning were assessed using imaging, clinical and serological indices. Spine and SIJ MRI and X-rays were scored independently by 2 readers using the SPARCC, mSASSS and NY-criteria. Patients were classified as: subjects with signs of radiographic sacroiliitis (r-axSpA), subjects with signs of sacroiliitis on SIJ-MRI but not on X-rays (nr-axSpA MRI SIJ+) or subjects with no signs of sacroiliitis on MRI/X-rays but with >2 SpA features and signs of bone oedema on MRI spine (nr-axSpA MRI SIJ-/undifferentiated SpA). Significant differences were found in the prevalence of radiographic sacroiliitis, active sacroiliitis on MRI and SPARCC SIJ scores. Biomarker levels were not significantly increased in any of the patient groups. The correlations between IL-17 and IL-23 and other indices were not significant; correlations were found between IL-22 and BASFI, BASG1, HAQ, VAS pain, between mSASSS and MMP3, and between the latter and hsCRP. Although not significantly higher in any of the three groups, IL-22, MMP3 and hsCRP values were correlated with some disease activity indexes and with mSASSS. Large observational studies are required to confirm these preliminary findings.

Definition of the upper reference limit for thyroglobulin antibodies according to the National Academy of Clinical Biochemistry guidelines: comparison of eleven different automated methods

Purpose

In the last two decades, thyroglobulin autoantibodies (TgAb) measurement has progressively switched from marker of thyroid autoimmunity to test associated with thyroglobulin (Tg) to verify the presence or absence of TgAb interference in the follow-up of patients with differentiated thyroid cancer. Of note, TgAb measurement is cumbersome: despite standardization against the International Reference Preparation MRC 65/93, several studies demonstrated high inter-method variability and wide variation in limits of detection and in reference intervals. Taking into account the above considerations, the main aim of the present study was the determination of TgAb upper reference limit (URL), according to the National Academy of Clinical Biochemistry guidelines, through the comparison of eleven commercial automated immunoassay platforms.

Methods

The sera of 120 healthy males, selected from a population survey in the province of Verona, Italy, were tested for TgAb concentration using eleven IMA applied on as many automated analyzers: AIA-2000 (AIA) and AIA-CL2400 (CL2), Tosoh Bioscience; Architect (ARC), Abbott Diagnostics; Advia Centaur XP (CEN) and Immulite 2000 XPi (IMM), Siemens Healthineers; Cobas 6000 (COB), Roche Diagnostics; Kryptor (KRY), Thermo Fisher Scientific BRAHMS, Liaison XL (LIA), Diasorin; Lumipulse G (LUM), Fujirebio; Maglumi 2000 Plus (MAG), Snibe and Phadia 250 (PHA), Phadia AB, Thermo Fisher Scientific. All assays were performed according to manufacturers’ instructions in six different laboratories in Friuli-Venezia Giulia and Veneto regions of Italy [Lab 1 (AIA), Lab 2 (CL2), Lab 3 (ARC, COB and LUM), Lab 4 (CEN, IMM, KRY and MAG), Lab 5 (LIA) and Lab 6 (PHA)]. Since TgAb values were not normally distributed, the experimental URL (e-URL) was established at 97.5 percentile according to the non-parametric method.

Results

TgAb e-URLs showed a significant inter-method variability. Considering the same method, e-URL was much lower than that suggested by manufacturers (m-URL), except for ARC and MAG. Correlation and linear regression were unsatisfactory. Consequently, the agreement between methods was poor, with significant bias in Bland–Altman plot.

Conclusions

Despite the efforts for harmonization, TgAb methods cannot be used interchangeably. Therefore, additional effort is required to improve analytical performance taking into consideration approved protocols and guidelines. Moreover, TgAb URL should be used with caution in the management of differentiated thyroid carcinoma patients since the presence and/or the degree of TgAb interference in Tg measurement has not yet been well defined.

Radon and radium concentration in water from North-West of Romania and the estimated doses

In the present study, the measurements of radon were carried out using the LUK-VR system based on radon gas measurements with Lucas cells. The radium concentration in water was determined, with the same device, immediately after was established the radon equilibrium with radium. The results presented here are from a survey carried out in the N-W region of Transylvania (Romania) in which were investigated the radon concentrations in natural (spring, well and surface) and drinking (tap) waters. The results showed radon concentrations within the range of 0.4-187.3 Bq l(-1) with an average value of 15.9 Bq l(-1) whereas radium concentration varied between 0.05 and 0.825 Bq l(-1) with an average value of 0.087 Bq l(-1) for all types of water covered within this survey. The corresponding annual effective ingestion dose due to radon and radium from water was determined from drinking water used by the population inhabiting the area.

Results from time integrated measurements of indoor radon, thoron and their decay product concentrations in schools in the Republic of Macedonia

As part of a survey on concentrations of radon, thoron and their decay products in different indoor environments of the Balkan region involving international collaboration, measurements were performed in 43 schools from 5 municipalities of the Republic of Macedonia. The time-integrated radon and thoron gas concentrations (CRn and CTn) were measured by CR-39 (placed in chambers with different diffusion barriers), whereas the equilibrium equivalent radon and thoron concentrations (EERC and EETC) were measured using direct radon-thoron progeny sensors consisting of LR-115 nuclear track detectors. The detectors were deployed at a distance of at least 0.5 m from the walls as well as far away from the windows and doors in order to obtain more representative samples of air from the breathing zone; detectors were exposed over a 3-month period (March-May 2012). The geometric mean (GM) values [and geometric standard deviations (GSDs)] of CRn, CTn, EERC and EETC were 76 (1.7), 12 (2.3), 27 (1.4) and 0.75 Bq m(-3) (2.5), respectively. The equilibrium factors between radon and its decay products (FRn) and thoron and its decay products (FTn (>0.5 m)) were evaluated: FRn ranged between 0.10 and 0.84 and FTn (>0.5 m) ranged between 0.003 and 0.998 with GMs (and GSDs) equal to 0.36 (1.7) and 0.07 (3.4), respectively.

Lung cancer risk due to residential radon exposures: estimation and prevention

Epidemiological studies proved that cumulative exposure to radon is the second leading cause of lung cancer, the world's most common cancer. The objectives of the present study are (i) to analyse lung cancer risk for chronic, low radon exposures based on the transformation frequency-tissue response (TF-TR) model formulated in terms of alpha particle hits in cell nuclei; (ii) to assess the percentage of attributable lung cancers in six areas of Transylvania where the radon concentration was measured and (iii) to point out the most efficient remediation measures tested on a pilot house in Stei, Romania. Simulations performed with the TF-TR model exhibit a linear dose-effect relationship for chronic, residential radon exposures. The fraction of lung cancer cases attributed to radon ranged from 9 to 28% for the investigated areas. Model predictions may represent a useful tool to complement epidemiological studies on lung cancer risk and to establish reasonable radiation protection regulations for human safety.

The activity concentration of 210Po in Romanian commercial cigarettes and the radiation exposure estimation derived from their regular consumption

Due to the relatively high activity concentrations of (210)Po that are found in tobacco, cigarette smoking has been found to be the principal pathway of the intake of this radionuclide. The (210)Po concentrations in the lung tissues may contribute significantly to an increase in the internal radiation dose and in the number of instances of lung cancer observed among smokers. The study of (210)Po in tobacco is required due to its potential for human radiation exposure through ingestion and inhalation. The risk factor caused by (210)Po in Romanian commercial cigarettes is not yet evaluated. Ten of the most frequently smoked brands of cigarettes sold in Romania were investigated in this work for this purpose. The activity concentration of (210)Po was determined by alpha spectrometry using a PIPS detector after chemical leaching and spontaneous deposition of (210)Po on a stainless steel disc from diluted HCl solution. The samples were spiked with (209)Po for chemical recovery calculation. The (210)Po activity concentrations of the measured types of cigarettes ranged from 4.65 to 10.22 mBq sample(-1) and the resulted average concentration of (210)Po isotopes is 8.35±0.80 mBq cigarette(-1) (the errors form a 2σ interval of confidence). When comparing the results of this study with the activity concentration values reported by other countries it was found that the results of this study are in the lower end of the world range. The estimation of this study shows that cigarette smokers, who are smoking one pack (20 cigarettes) per day, are exposed to an effective dose of 75.51 μSv y(-1).

Comparative assessment of erosion and deposition rates on cultivated land in the Transylvanian Plain of Romania using ¹³⁷Cs and ²¹⁰Pbex

Soil erosion and sedimentation are natural landscape forming processes. However, they can be accelerated by human activities and therefore increase negative impacts on agricultural production as well as disturbing watershed management. Romania currently faces major environmental challenges and pressure on soil and water resources due to unsustainable farming practices and inappropriate tillage practices. The present work represents the first attempt to test the combined use of radionuclide approaches (i.e. (137)Cs and (210)Pb(ex)) to quantify soil erosion changes in cultivated Transylvanian fields (Romania) at different temporal scales. Fourteen soil cores were collected along two transects in a cultivated field and two reference sites were selected to establish the mean reference inventories for both (137)Cs and (210)Pb(ex). A value of 5460 ± 880 Bq m(-2) (n = 10; CV = 16%) was determined for the (137)Cs mean reference inventory for both sites, given as areal activity ± standard deviation, at 2σ confidence interval. As regarding (210)Pb(ex) reference inventory, its value (9640 Bq m(-2)) is only given by the areal activity of one soil core from the second site. The high erosion rates obtained with the (210)Pb(ex) approach are an effect of the up and down ploughing practices which took place at the time of the local agricultural cooperative starting in the late 1950s. The middle-term redistribution rates provided by the (137)Cs technique highlighted preponderant deposition processes in the field investigated, reflecting the changes in the cultivation system with ploughing across the slope at the beginning of 1990s.

Preliminary results regarding the first map of residential radon in some regions in Romania

Radon represents the most important contribution of population exposure to natural ionising radiation. This article presents the first indoor radon map in some regions of Romania based on 883 surveyed buildings in the Ştei-BăiŢa radon-prone region and 864 in other regions of Romania. Indoor radon measurements were performed in the last 10 y by using CR-39 nuclear track detectors exposed for 3-12 months on ground floor levels of dwellings. Excluding the Ştei-BăiŢa radon-prone region, an average indoor radon concentration of 126 Bq m(-3) was calculated for Romanian houses. In the Ştei-BăiŢa radon-prone area, the average indoor concentration was 292 Bq m(-3). About 21 % of the investigated dwellings in the Ştei-BăiŢa radon-prone region exceed the threshold of 400 Bq m(-3), while 5 % of the dwellings in other areas of Romania exceed the same threshold. As expected, indoor radon concentration is not uniformly distributed throughout Romania. The map shows a high variability among surveyed regions, mainly due to the differences in geology. The radon emanation rate is substantially influenced by the soil characteristics, such as the soil permeability and soil gas radon concentration. Since higher permeability enables the increased migration of soil gas and radon from the soil into the building, elevated levels of indoor radon can be expected in more permeable soil environments.

Indicators of the Fukushima radioactive release in NW Romania

As a result of the Fukushima nuclear release, (131)I was found in different environmental media (rainwater, sheep and cow milk, herbage, sheep meat and thyroid tissue) in north-west Romania. On April 4, 2011 a maximum value of 1.40 ± 0.21 Bq/L in (131)I activity was found in rainwater obtained from the Arad region. The obtained value corresponded with the maximum of (131)I concentration in air, as measured by Toma et al. (2011) for the Piteşti area. One day later, sheep milk from the Cluj area was found to contain a maximum activity of 9.22 ± 0.95 Bq/L. A value of 0.85 ± 0.07 μSv was calculated as the total monthly effective dose received by the population as a result of the ingestion of sheep milk and sheep meat contaminated with (131)I. Only rainwater samples contained (134)Cs and (137)Cs at levels close to minimum detectable activity. Since the determined values could be influenced by Chernobyl (137)Cs, the (137)Cs concentrations are subject to uncertainty. The radioiodine transfer coefficients (Fm) and the concentration ratio (CR) from herbage to sheep milk, as well as sheep meat, from the Cluj-Apahida area are also presented.

Thoron and radon measurements in Romanian schools

A new thoron/radon survey was started in the north-western part of Romania, covering three counties, using discriminative detectors (RADUET). All detectors were deployed throughout 3 months, covering the spring period. The measured radon and thoron concentration ranged from 31 to 414 Bq m(-3) and from below the detection limit to 235 Bq m(-3), respectively. In this survey, 35 schools were submitted to investigation; 21 of the schools included in this study presented radon concentrations higher than 100 Bq m(-3), the reference level recommended by the World Health Organization in 2009. The seasonal effective dose calculated from these exposures, overlapping all three counties, ranged between 0.32 and 0.54 mSv.

Low serum 25-hydroxyvitamin D levels are associated with left ventricular hypertrophy in essential hypertension

BACKGROUND AND AIM

Low serum 25-hydroxyvitamin D [25(OH)D] levels may have an important role in predisposing to hypertension and myocardial disease. We investigated the relationship between 25(OH)D and left ventricular (LV) structure and function, assessed by echocardiography, in a series of patients with essential hypertension (EH).

METHODS AND RESULTS

Sixty-two newly diagnosed never-treated patients (32 male/30 female), aged 18-65 years, with grade 1-2 hypertension, no diabetes, no obesity, no hyperlipidemia, and no cardiopulmonary, renal, or hepatic disease, were studied. Twenty-four healthy normotensive sex-, age-, BMI-matched subjects served as controls. Hypertensive patients with 25(OH)D deficiency, defined as serum 25(OH)D levels <50 nmol/L, had higher prevalence of LV hypertrophy (LVH) than their 25(OH)D-sufficient counterparts (57.1 vs 17.6%, P = 0.02); no differences between the two groups were found in blood pressure levels as well as in other biochemical and hormone parameters. There was an inverse correlation between LV mass index and 25(OH)D levels (r = -0.366, P < 0.003) and a direct correlation between LV mass index and BMI (r = 0.333, P < 0.006) in the entire hypertensive population. The two variables remained independently associated with LVH at multivariable logistic regression analysis (OR 1.05, P < 0.005 and OR 1.25, P = 0.03, respectively). Prevalence of 25(OH)D deficiency was similar in EH patients and controls (45.1 vs 41.6%, P = 0.89), whereas no correlation between echocardiographic parameters and hormone levels was found.

CONCLUSIONS

In the absence of major cardiovascular risk factors, 25(OH)D deficiency is a frequent finding in EH patients and is independently associated with LVH.

Tracking of airborne radionuclides from the damaged Fukushima Dai-ichi nuclear reactors by European networks

Radioactive emissions into the atmosphere from the damaged reactors of the Fukushima Dai-ichi nuclear power plant (NPP) started on March 12th, 2011. Among the various radionuclides released, iodine-131 ((131)I) and cesium isotopes ((137)Cs and (134)Cs) were transported across the Pacific toward the North American continent and reached Europe despite dispersion and washout along the route of the contaminated air masses. In Europe, the first signs of the releases were detected 7 days later while the first peak of activity level was observed between March 28th and March 30th. Time variations over a 20-day period and spatial variations across more than 150 sampling locations in Europe made it possible to characterize the contaminated air masses. After the Chernobyl accident, only a few measurements of the gaseous (131)I fraction were conducted compared to the number of measurements for the particulate fraction. Several studies had already pointed out the importance of the gaseous (131)I and the large underestimation of the total (131)I airborne activity level, and subsequent calculations of inhalation dose, if neglected. The measurements made across Europe following the releases from the Fukushima NPP reactors have provided a significant amount of new data on the ratio of the gaseous (131)I fraction to total (131)I, both on a spatial scale and its temporal variation. It can be pointed out that during the Fukushima event, the (134)Cs to (137)Cs ratio proved to be different from that observed after the Chernobyl accident. The data set provided in this paper is the most comprehensive survey of the main relevant airborne radionuclides from the Fukushima reactors, measured across Europe. A rough estimate of the total (131)I inventory that has passed over Europe during this period was <1% of the released amount. According to the measurements, airborne activity levels remain of no concern for public health in Europe.

Prediction of lung cancer risk for radon exposures based on cellular alpha particle hits

To explore the role of the multiplicity of cellular hits by radon progeny alpha particles for lung cancer incidence, the number of single and multiple alpha particle hits were computed for basal and secretory cells in the bronchial epithelium of human airway bifurcations. Hot spots of alpha particle hits were observed at the branching points of bronchial airway bifurcations. The effect of single and multiple alpha particle intersections of bronchial cells during a given exposure period, selected from a Poisson distribution, on lung cancer risk were simulated by a transformation frequency--tissue response model, based on experimentally observed cellular transformation and survival functions. Calculations of lung cancer risk at low radon exposure levels suggest that single hits produce a linear-dose response relationship, while the superposition of single and increasing multiple hits at higher exposure levels may also be approximated by a quasi-linear dose-effect curve. The simulations predict a carcinogenic enhancement effect for radon progeny accumulations at bifurcation branching sites, which may increase current risk estimates.

Recent changes in Red Lake (Romania) sedimentation rate determined from depth profiles of 210Pb and 137Cs radioisotopes

This work presents a first estimation of the sedimentation rate for the Red Lake (Romania). The sediment accumulation rates were determined by two well-known methods for recent sediment dating: (210)Pb and (137)Cs methods. Both techniques implied used the gamma emission of the above-mentioned radionuclides. The (210)Pb and (137)Cs concentrations in the sediment were measured using a gamma spectrometer with a HpGe detector, Gamma-X type. Activities ranging from 41+/-7 to 135+/-34Bq/kg were found for (210)Pb and from 3+/-0.5 to 1054+/-150Bq/kg for (137)Cs. The sediment profile indicates acceleration in sedimentation rate in the last 18 years. Thus, the sedimentation process for the Red Lake can be divided in two periods, the last 18 years, and respectively, the period before that. Using the Constant Rate of (210)Pb Supply method values between 0.18+/-0.04 and 1.85+/-0.5g/cm(2) year (0.32+/-0.08 and 2.83+/-0.7cm/year) were obtained. Considering both periods, an average sedimentation rate of 0.87+/-0.17g/cm(2) year (1.17cm/year) was calculated. Considering an average depth of 5.41m for the lake and the sedimentation rate estimated for the last 18 years, it could be estimated that the lake will disappear in 195 years.

Relationship between glyco-oxidation, antioxidant status and microalbuminuria in type 2 diabetic patients

AIMS/HYPOTHESIS

This study examined the relationship, if any, between glucose-induced oxidative stress, antioxidant status and microalbuminuria in patients with type 2 diabetes.

METHODS

The study involved 99 consecutive type 2 diabetic patients (57 men, 42 women). Patients with persistent microalbuminuria were identified and the following variables evaluated: fasting plasma glucose, HbA(1c), malonyldialdehyde (MDA), pentosidine, AGE, the total radical-trapping antioxidant parameter (TRAP), vitamin E, creatinine, estimated GFR and lipid profile.

RESULTS

Patients were divided into two groups, i.e. 37 individuals without microalbuminuria (AER <20 microg/min) and 62 with microalbuminuria (AER > or =20 microg/min). The following variables were significantly higher in patients with microalbuminuria than in those without microalbuminuria (mean +/- SD): fasting plasma glucose 9.41 +/- 2.88 vs 8.19 +/- 1.93 mmol/l, p < 0.05; HbA(1c) 7.97 +/- 1.51 vs 7.39 +/- 1.03%, p < 0.05; MDA 1.18 +/- 0.35 vs 1.02 +/- 0.29 micromol/l, p < 0.05; pentosidine 98.5 +/- 24.6 vs 82.9 +/- 20.9 pmol/ml, p < 0.005; and AGE 13.2 +/- 4.8 vs 10.6 +/- 3.8 microg/mg protein, p < 0.01. However, vitamin E and TRAP did not differ between the two groups. Serum creatinine values and estimated GFR were similar in the two groups. Only in patients with microalbuminuria were significant linear correlations seen between AER and both oxidation (HbA(1c) r = 0.33, p < 0.01; MDA r = 0.59, p < 0.001; pentosidine r = 0.48, p < 0.001; and AGE r = 0.44, p < 0.001) and antioxidation variables (vitamin E r = -0.55, p < 0.001; TRAP r = -0.49, p < 0.001). Considering all variables together, multiple regression revealed a correlation between microalbuminuria and vitamin E, TRAP, HbA(1c) and MDA, but not pentosidine or AGE.

CONCLUSIONS/INTERPRETATION

Our data suggest that microalbuminuria in type 2 diabetic patients might be promoted by an insufficient counter-regulation of the antioxidant system in the event of increased glyco-oxidation/glycation.