Purpose: Anti SARS-CoV-2 vaccination initially showed high effectiveness in preventing COVID-19. However, after the surge of variants of concern, the effectiveness dropped. Several studies investigated if this was related to the decrease of the humoral response over time; however, this issue is still unclear. The aim of this study was to understand whether SARS-CoV-2 anti-S IgG levels can be used to predict breakthrough infection risk and define the timing for further booster doses administration. Method: Within the framework of the ORCHESTRA Project, over 20,000 health workers from 11 European centers were enrolled since December 2020. We performed two Cox proportional hazards survival analyses regarding pre-Omicron (from January to July 2021) and Omicron (December 2021–May 2022) periods. The serological response was classified as high (above the 75th percentile), medium (25th-75th), or low (< 25th). Results: Seventy-four (0.33%) and 2122 (20%) health workers were infected during the first and second periods, respectively. Both Cox analyses showed that having high anti-S titer was linked to a significantly lower risk of infection as compared to having medium serological response [HR of high vs medium anti-S titer = 0.27 (95% CI 0.11–0.66) during the first phase, HR = 0.76 (95% CI 0.62–0.93) during the second phase]. Conclusion: Vaccine effectiveness wanes significantly after new variants surge, making anti-S titer unsuitable to predict optimal timing for further booster dose administration. Studies on other immunological indicators, such as cellular immunity, are therefore needed to better understand the mechanisms and duration of protection against breakthrough infection risk.

Aims: We aimed at providing an epidemiological overview on inappropriate use of benzodiazepines (BDZ) and its adverse outcomes. Methods: We performed a narrative review of recent studies focused on the epidemiology of BDZ inappropriate use. We addressed prevalence of use, incidence and possible predictors of life-threatening events, mortality risk, barriers to monitoring their use and to good prescription practice, screening and prevention of inappropriate use of BDZ. Results: Besides being good symptomatic medications, BDZ convey the risk of dependence and addiction, making their long-term use discouraged by the Food and Drugs Administration. BDZ prescription and long-term use are not systematically recorded, and therefore risky behaviors are scarcely documented. This prevents from attributing adverse events to BDZ use. While life-threatening events are well known in polysubstance intoxication, the specific effects of BZD non-medical use remain unrecognized. Ascertainment of cause of deaths often does not include BDZ, and does not distinguish between accidental or intentional overdose. Monitoring of BDZ use, preparedness of emergency departments, screening of at-risk subjects, sensitization of the general public and support for discontinuation treatments might help controlling BDZ inappropriate use. Further data are needed to characterize life-threatening events and deaths, and in turns help preventing a quote of the severe outcomes related to this medical problem. Conclusions: The inappropriate use of BDZ requires public health attention. Effective monitoring systems are needed to record and characterize BDZ use, especially when chronic. Health education programs targeting patients and providers should be promoted to recognize and control inappropriate use of BDZ.

Background: The association between diesel exhaust and cancer other than the lung is not well established. We aimed to conduct a systematic review and meta-analysis on the association between diesel and kidney cancer in workers.Methods: Two trained researchers conducted a systematic review to identify cohort studies examining the relationship between occupational exposure to diesel exhaust and the risk of cancer other than lung cancer. Of the 43 retained studies, 15 reported information on kidney cancer. We performed random-effects meta-analyses for ever-exposure to diesel exhaust. Summary relative risks (RR) and 95% confidence intervals (CI) were calculated for the association between diesel exhaust exposure and kidney cancer. Results: Overall, the RR of kidney cancer was 1.08 (95% CI=1.01-1.15, heterogeneity p=0.1, I2=28.6%). The summary RR was 1.08 for incidence (95% CI=1.01-1.16; I2=36.7%) and 1.09 for mortality (95% CI=0.92-1.30, I2=14.5%), p of heterogeneity=0.914. The summary RR of European studies was 1.08 (95% CI=1.00-1.16, I2=37.8 %), that of USA/Canada studies was 1.10 (95% CI=0.94-1.29, I2=8.5%), p of heterogeneity=0.837. Publication bias was not detected. Conclusions: Workers exposed to diesel exhaust may experience an increased risk of developing kidney cancer, although the evidence is not entirely consistent, and residual confounding cannot be excluded.