A Multi-Center Study Investigating Long COVID-19 in Healthcare Workers from North-Eastern Italy: Prevalence, Risk Factors and the Impact of Pre-Existing Humoral Immunity-ORCHESTRA Project

Introduction: The impact of long-COVID-19 syndrome is rather variable, since it is influenced by several residual confounders. This study aimed to investigate the prevalence of long COVID-19 in healthcare workers (HCWs) from four university hospitals in north-eastern Italy: Trieste, Padua, Verona, and Modena-Reggio Emilia. Methods: During the period June 2022-August 2022, HCWs were surveyed for past COVID-19 infections, medical history, and any acute as well as post-COVID-19 symptoms. The prevalence of long COVID-19 was estimated at 30-60 days or 61+ days since first negative swab following first and second COVID-19 episode. Furthermore, the risk of long COVID-19 was investigated by multivariable logistic regression. Results were expressed as the adjusted odds ratio (aOR) with a 95% confidence interval (95%CI). Results: 5432 HCWs returned a usable questionnaire: 2401 were infected with SARS-CoV-2 at least once, 230 were infected at least twice, and 8 were infected three times. The prevalence of long COVID-19 after a primary COVID-19 infection was 24.0% at 30-60 days versus 16.3% at 61+ days, and 10.5% against 5.5% after the second SARS-CoV-2 event. The most frequent symptoms after a first COVID-19 event were asthenia (30.3%), followed by myalgia (13.7%), cough (12.4%), dyspnea (10.2%), concentration deficit (8.1%), headache (7.3%), and anosmia (6.5%), in decreasing order of prevalence. The risk of long COVID-19 at 30-60 days was significantly higher in HCWs hospitalized for COVID-19 (aOR = 3.34; 95%CI: 1.62; 6.89), those infected with SARS-CoV-2 during the early pandemic waves-namely the Wuhan (aOR = 2.16; 95%CI: 1.14; 4.09) or Alpha (aOR= 2.05; 95%CI: 1.25; 3.38) transmission periods-and progressively increasing with viral shedding time (VST), especially 15+ days (aOR = 3.20; 95%CI: 2.07; 4.94). Further determinants of long COVID-19 at 30-60 days since primary COVID-19 event were female sex (aOR = 1.91; 95%CI: 1.30; 2.80), age >40 years, abnormal BMI, or administrative services (reference category). In contrast, HCWs vaccinated with two doses before their primary infection (aOR = 0.57; 95%CI: 0.34; 0.94), undergraduate students, or postgraduate medical trainees were less likely to experience long COVID-19 at 30-60 days. Apart from pandemic waves, the main determinants of long COVID-19 at 30-60 days were confirmed at 61+ days. Conclusions: The risk of long COVID-19 following primary infection increased with the severity of acute disease and VST, especially during the initial pandemic waves, when more virulent viral strains were circulating, and susceptibility to SARS-CoV-2 was higher since most HCWs had not been infected yet, COVID-19 vaccines were still not available, and/or vaccination coverage was still building up. The risk of long COVID-19 therefore decreased inversely with humoral immunity at the individual level. Nevertheless, the prevalence of long COVID-19 was remarkably lower after SARS-CoV-2 reinfections regardless of vaccination status, suggesting that hybrid humoral immunity did not increase protection against the syndrome compared to immunity mounted by either natural infection or vaccination separately. Since the risk of long COVID-19 is currently low with Omicron and patients who developed the syndrome following SARS-CoV-2 infection in the early pandemic waves tend to return to a state of full health with time, a cost-effective approach to screen post-COVID-19 symptoms during the Omicron time could be restricted to vulnerable individuals developing severe disease and/or with prolonged VST.

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BACKGROUND

Because of their frequent occurrence, in various situations it may be appropriate to carry out screening of skin disorders in groups of workers. For this purpose the self-administered standardized questionnaires are of great use. Among the best known is the Nordic Occupational Skin Questionnaire (NOSQ-2002), which had not yet been translated and validated in Italian.

OBJECTIVES

The aim of the study was to translate the NOSQ-2002 into Italian and validate the resulting Italian version.

METHODS

The original English text of the NOSQ-2002 was subjected to the ISPOR task force's procedures for translation and cultural validation of questionnaires in health care. Subsequently, the Italian version was tested on a sample of 52 individuals to assess comprehensibility and reliability through analysis of internal consistency and stability over time and the predictive value of the clinical history through assessment of sensitivity and specificity in 32 subjects.

RESULTS

The Italian version of the NOSQ produced proved very true to the original, needing only minor changes. From interviews on the comprehensibility of the questionnaire no significant difficulties in understanding the text were detected. The results of the evaluation of internal consistency (Cronbach's Alpha: 0.88 and 0.97) and stability (K Cohen> 0.81 in 52/57 items) indicated that the Italian version of the NOSQ may be considered reliable for the purposes proposed. There were also excellent sensitivity and specificity results, which were 86% and 89% respectively.

CONCLUSIONS

The Italian version of the NOSQ presented here is appropriate for self-administration and is reliable for use in studies on skin diseases in groups of workers.

[Early effects of PCE exposure on visual function among dry cleaning workers]

BACKGROUND

A number of studies have shown a possible correlation between exposure to perchlorethylene (PCE) in dry cleaning workers and impairment of colour perception.

OBJECTIVES

to ascertain the possible presence of alterations in visual function in a group of workers exposed to current limit value levels of PCE.

METHODS

The study was conducted on 38 workers exposed to PCE in 21 dry cleaning establishments in the district of Modena and 60 controls selected according to criteria of comparability. We measured exposure to PCE among the dry cleaning workers using environmental monitoring (mean exposure 16.9 mg/m3). Both groups then answered a medical history questionnaire and underwent the Ishihara test for evaluating exclusion criteria followed by Lanthony D15d and Visual Acuity in Contrast Reduced (VCS) tests to evaluate changes in visual function. The results of Lanthony's test were expressed using Index Confusion Chromatic (ICC).

RESULTS

In the cases the average value of ICC was 1.28 (DS 0.21) and in the controls 1.15 (SD 0.21); the difference was statistically significant (p <0.01). The values of ICC tended to be worse in subjects engaged only in the washing phase, who also had higher levels of exposure to PCE (mean exposure 26.8 mg/m3). The values of VCS for each frequency did not show, however, significant differences between the two groups.

CONCLUSIONS

On this basis, our data indicate that occupational exposure to PCE well below the current limit values may still be able to induce impairment of colour perception and that such levels are therefore not adequately protective, at least against these effects.

[The perception of the risk related to nursing activities in Bachelor student of Modena and Reggio Emilia university: An observational study]

Professional risk and security in the health sector is becoming ever more important : the number of accidents in hospital environments during 2005 was 19,000 and nurses were the most frequently involved category. This study deals with clinical risk perception . A questionnaire was issued to 259 student and 100 professional nurses at the Modena and Reggio Emilia University Hospital., comprising 70 questions regarding 5 dimensions: general risk perception, personal risk perception, nursing skills, observed experience and direct experience. Results were evaluated using the ANOVA and t-tests and showed significant differences among the various groups (first, second and third-year students and professional nurses) in relation to each dimension. On the whole , the perception of risk was relatively low in comparison to its real level in the working environment. Therefore, specific training for a correct perception of health risks is required, not only for students but also for trained nurses, so that the culture of risk management becomes a routine issue.

[The Italian version of Nordic Musculoskeletal Standardized Questionnaire]

We translated into Italian the Nordic musculoskelethal questionnaire, as completed by Canadian IRSST with Authors' agreement in 2001, according to OMS recommendations. This translation involved the following items: aches and troubles of neck, dorsal region, low back, shoulders, elbows, hands and wrists, hips and thighs, ankles and feet in the last 12 months. The questionnaire was then submitted to reliability and stability tests. The Italian version of the questionnaire, already used in different languages, proved to be suitable and reliable also for self administration.

Occupational and environmental exposure to perchloroethylene (PCE) in dry cleaners and their family members

Perchloroethylene exposure in 28 dry-cleaning establishments and in 25 homes occupied by dry cleaners in Modena, Italy, was investigated. Environmental air samples and alveolar air samples from dry cleaners (n = 60) and from their family members (n = 23) were collected. The degree of perchloroethylene on the dry-cleaning premises varied widely from establishment to establishment. Spot sampling ranged from 0.6 to 75 mg/m3, whereas sampling by personal passive dosimeters ranged from 2.6 to 221.5 mg/m3 (8-h time weighted average values). Perchloroethylene in alveolar air samples collected at the end of the work day correlated closely with the 8-h time weighted average values (r = .750, p = .001), and correlated also with alveolar air samples collected at home in the evening (r = .665, p = .001) and the following morning (r = .549, p < .001). Perchloroethylene levels inside the homes of dry cleaners appeared significantly higher than in 29 houses selected as controls (Mann Whitney U test, p < .001). Perchloroethylene in alveolar air samples collected at home suggests that nonoccupational exposure to perchloroethylene for family members of dry cleaners exists.

Visual fatigue in video display terminal operators: objective measure and relation to environmental conditions

The lighting conditions, luminance, contrast, and design of the workplace were studied in video display terminal (VDT) work stations operated by a group of female VDT data-acquisition clerks. VDT-induced symptoms were assessed by means of subject answers to a questionnaire. To measure VDT-induced ocular fatigue objectively, refraction power was determined before and at the end of workshift by an infrared autorefractometer. Job-induced refraction changes were then related to visual complaints and conditions in the workplace. The results confirmed that VDT data-acquisition work can lead to temporary myopia (myopization) in a remarkable percentage of operators; a significant correlation between eye discomfort, ocular asthenopia, and myopization was also found. Illumination levels, luminance, and contrast seem to be of paramount importance regarding visual symptoms: neither asthenopia nor myopization was observed when all of these conditions were adequate. If the ergonomic design of the workplace and the viewing distance are adequate, there are also usually fewer musculoskeletal symptoms. Our results suggest that changes in the ocular refraction status before and at the end of the work-shift, as determined by an automatic refractometer, provide a good objective index of VDT-induced "ocular fatigue", which in our study proved to be significantly related to workplace conditions.

[Platelet changes and occupational carbon disulfide poisoning. I. Variations of platelet adhesiveness]

Platelet adhesiveness was studied in 83 workers exposed to CS2 and 47 controls. Results show an increase of platelet adhesiveness statistically significant in workers in comparison with controls and in workers with high exposure vs. workers with mild exposure. Authors suggest the usefulness of platelet adhesiveness evaluation for prevention and early diagnosis of CS2 intoxication.