Background: The COVID-19 outbreak is now a pandemic disease reaching as much as 210 countries worldwide with more than 2.5 million infected people and nearly 200.000 deaths. Amplification of viral RNA by RT-PCR represents the gold standard for confirmation of infection, yet it showed false-negative rates as large as 15-20% which may jeopardize the effect of the restrictive measures taken by governments. We previously showed that several hematological parameters were significantly different between COVID-19 positive and negative patients. Among them aspartate aminotransferase and lactate dehydrogenase had predictive values as large as 90%. Thus a combination of RT-PCR and blood tests could reduce the false-negative rate of the genetic test. Methods: We retrospectively analyzed 24 patients showing multiple and inconsistent RT-PCR, test during their first hospitalization period, and compared the genetic tests results with their AST and LDH levels. Results: We showed that when considering the hematological parameters, the RT-PCR false-negative rates were reduced by almost 4-fold. Conclusions: The study represents a preliminary work aiming at the development of strategies that, by combining RT-PCR tests with routine blood tests, will lower or even abolish the rate of RT-PCR false-negative results and thus will identify, with high accuracy, patients infected by COVID-19.

The Oxford-AstraZeneca ChAdOx1 nCoV-19 is a vaccine against the COVID-19 infection that was granted a conditional marketing authorization by the European Commission in January 2021. However, following a report from the Pharmacovigilance Risk Assessment Committee (PRAC) of European Medicines Agency, which reported an association with thrombo-embolic events (TEE), in particular disseminated intravascular coagulation (DIC) and cerebral venous sinus thrombosis (CVST), many European countries either limited it to individuals older than 55–60 years or suspended its use. We used publicly available data to carry out a quantitative benefit–risk analysis of the vaccine among people under 60 in Italy. Specifically, we used data from PRAC, Eudravigilance and ECDC to estimate the excess number of deaths for TEE, DIC and CVST expected in vaccine users, stratified by age groups. We then used data from the National Institute of Health to calculate age-specific COVID-19 mortality rates in Italy. Preventable deaths were calculated assuming a 72% vaccine efficacy over an eight-month period. Finally, the benefit–risk ratio of ChAdOx1 nCoV-19 vaccination was calculated as the ratio of preventable COVID-19 deaths to vaccine-related deaths, using Monte-Carlo simulations. We found that among subjects aged 20–29 years the benefit–risk (B-R) ratio was not clearly favorable (0.70; 95% Uncertainty Interval (UI): 0.27–2.11). However, in the other age groups the benefits of vaccination largely exceeded the risks (for age 30–49, B-R ratio: 22.9: 95%UI: 10.1–186.4). For age 50–59, B-R ratio: 1577.1: 95%UI: 1176.9–2121.5). Although many countries have limited the use of the ChAdOx1 nCoV-19 vaccine, the benefits of using this vaccine clearly outweigh the risks in people older than 30 years. Study limitations included risk of underreporting and that we did not provide age-specific estimates. The use of this vaccine should be a strategic and fundamental part of the immunization campaign considering its safety and efficacy in preventing COVID-19 and its complications.

The second victim phenomenon (SVP) refers to workers negatively impacted by involvement in unanticipated adverse events or errors. While this phenomenon has been extensively studied in healthcare since its acknowledgment over 20 years ago, its presence and management in other high-risk industries have remained unclear. We conducted a scoping review aiming to map the SVP in non-healthcare industries, as well as to explore the available interventions or support programs addressed to help second victims (SVs). A total of 5818 unique records were identified and, after the screening process, 18 studies from eight sectors were included. All industries acknowledged the existence of the SVP, though many did not use a specific term for defining the SV. Similarities in psychological and emotional consequences were found across sectors. Support strategies varied, with the aviation sector implementing the most comprehensive programs. Self-care and peer support were the most reported interventions, while structured clinical support was not mentioned in any industry. Our review highlighted a lack of standardized terminology and industry-specific, evidence-based support interventions for the SVP outside of healthcare. Healthcare appears to be at the forefront of formally recognizing and addressing the SVP, despite traditionally learning from other high-reliability industries in safety practices. This presents opportunities for reciprocal learning and knowledge transfer between healthcare and other high-risk sectors.

According to many national legislations, biological agents represent an occupational hazard that must be managed in order to ensure safety at workplace. Bioaerosols have been associated to many pathological conditions but, despite many efforts, precise threshold limit values (TLV) are still undefined. We planned and conducted an environmental study concerning a typical restaurant that aimed to evaluate: (1) the occupational exposure to bacterial and fungal bioaerosol; (2) the efficacy of a photocatalytic air purifier device in mitigating such exposure. This observational study evaluated two dining rooms (Area 1 and Area 2) of a restaurant which can be considered typical during two consecutive weeks. Based on a national protocol, we monitored total bacterial and mycotic loads searching for two typologies of bacteria, psychrophilic bacteria (environmental contamination) along with mesophilic bacteria (human or animal origin source), and two types of fungi, mold and yeast. Baseline total bacterial load was 346.8 CFU/m³ for Area 1 and 412.9 CFU/m³ for Area 2. When the sanitizing device was operative, the total bacterial load decreased to 202.7 CFU/m³ (−41.50%—p value: <0.01) for Area 1 and to 342.2 CFU/m³ ($-1$7.10%—p value: 0.06) for Area 2. Considering the fungal load, the mean baseline value was 189.7 CFU/m³ for Area 1 and 141.1 CFU/m³ for Area 2. When the device was kept on, the total fungal load was 108.0 CFU/m³ ($-4$3.10%—p value: 0.055) for Area 1 and 205.0 CFU/m³ (+45.30%—p value: 0.268) for Area 2. Our findings supported the conclusion that, concerning the occupational risk derived from biological agents, a typical restaurant should be considered relatively safe. In order to mitigate or limit any possible increase of such risk, a photocatalytic device may be helpful, but not against the pollution caused by mold or yeasts. Our research also reaffirmed the need of further research assessing the kind of relationship between diseases and exposure levels, before considering the need of setting precise threshold limit values.

Background: Even if robotic assisted total knee arthroplasty (RATKA) is a widely used technique, there is still a gap of knowledge about whether this technology is effective in improving the patient utility. This measure is of paramount importance for conducting cost effectiveness analysis. The aim of this study was to compare the utility measure derived from self-reported outcomes questionnaires in patients who underwent RATKA compared to patients who underwent the manual surgery. Methods: We compared 72 patients operated with a robotic technique with 70 operated with traditional technique. The utility data were collected with the WOMAC (Western Ontario and McMaster University Osteoarthritis index) self-administrated questionnaire that investigates pain, stiffness and functionality of the patients, an then mapped to a utility value through a validated transforming function. We performed three surveys: the first one before the intervention (t0), the second one 1 year after the surgery (t1) and the third one at the 2 year follow up (t2). Results: we observed higher utility values in both groups. In detail, the mean utility score in the RATKA group increased from 0.37 to 0.71 (t1) and 0.78 (t2), while in the conventional group it increased from 0.41 to 0.78 (t1) and 0.78 (t2). The fixed effect coefficients of t1 and t2 were found to be 0.37 and 0.363 (p < 0.001 for both). The coefficient of the robotic technique, along with its interaction with the t1 and t2 time effect was non-significant. Conclusions: Even if at t1 the utility of patient who underwent RATKA were lower, at longer follow up (t2) we found no significant difference compared to traditional technique, leaving the superiority of robotic assisted technique yet to be proved. Our results may be useful for calculating the gained or lost Quality Adjusted Life Years (QALYs), so that the health care system (or an insurance company) could make an appropriate decision whether to fund the robotic approach or not, after a careful assessment of the incremental costs incurred.

Background: Sickness absenteeism has long been an organizational problem due to the consequent loss of productivity (1–2% of gross domestic product in European Union countries) and job overload for workers. We designed and conducted an observational cohort study to describe and analyze the short sickness events and their derived absence days in a large university tertiary hospital, also incorporating the fit for work assessment and the anti-influenza vaccination coverage. Materials and Methods: The anonymous data of workers with at least one day of certified presence during the period 1 January–31 August 2025 were extracted from the hospital information system. Crude and job-specific absence rates were calculated. The incidence rate ratios (IRRs) along with their 99% confidence intervals for the covariates were obtained by a negative binomial model fit. Results: The overall sickness event rate was 0.54 per 100 person-workdays, ranging from 0.22 (physicians) to 0.92 (technical/administrative staff), while the overall sickness day rate was 0.88 per 100 person-workdays, spanning from 0.31 (physicians) to 1.41 (health and social care assistants). The multi-variable model fit of sickness days returned significant IRRs for being vaccinated (0.74; 99% CI: 0.58–0.93), for male gender (0.77; 99% CI: 0.63–0.95) and for limitations regarding the fitness for work assessment (2.14; 99% CI: 1.51–3.05). Conclusions: Our findings indicate that, in a large tertiary university hospital, an anti-influenza vaccination campaign may effectively protect workers from sickness absences, even accounting for gender, age and regardless of job typology and fit for work assessment. Furthermore, the health risk of the technical/administrative job category might be underestimated. Finally, our results seem to suggest that workers with limitations might be “fragile”, or more vulnerable, than expected in a broader sense of the term, both from nosological and temporal points of view. Further research with a higher level of evidence is needed to verify and confirm these findings.