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.

Background: A proportion of patients’ ailments may last after recovering from acute COVID-19, with episodic and systemic symptoms of unclear etiology potentially involving different organs. Study aim: The aim of this study was to investigate the persistence of symptoms 15 months since COVID-19 diagnosis in patients referring to the post-COVID-19 clinic in Trieste (north-eastern Italy). Methods: Two-hundred-forty-seven patients were medically examined between 8 December 2020–6 April 2021, after a median time of 49 days since first positive swab test for SARS-CoV-2. After a median time of 15 months since COVID-19 diagnosis, the same patients were contacted over the phone and investigated by standardized questionnaire collecting information on any persisting symptoms and work ability index (WAI). Four multivariable logistic regression models were fitted to investigate factors associated with persistence of any respiratory, neurological, dysautonomic, or psychiatric symptoms at first (median time 49 days since COVID-19 diagnosis) as well as second (median 15 months since COVID-19 diagnosis) follow up. A multiple linear regression was also employed to investigate factors associated with higher mean WAI, assessed only at second follow up. Additionally, factors associated with persistence of symptoms 200+ days since COVID-19 diagnosis between first and second follow-up were investigated by multivariable Generalized Estimating Equation (GEE). Results: At first follow up (median time of 49 days since COVID-19 diagnosis) symptoms more frequently reported were fatigue (80.2%), shortness of breath (69.6%), concentration deficit (44.9%), headache (44.9%), myalgia (44.1%), arthralgia (43.3%), and anosmia (42.1%). At second follow-up (median time of 15 months since COVID-19 diagnosis) 75% patients returned to their baseline status preceding COVID-19. At first follow up males were less likely to experience neurological (OR = 0.16; 95% CI: 0.08; 0.35) as well as psychiatric (OR = 0.43; 95% CI: 0.23; 0.80) symptoms as compared to females. At first follow up, the risk of neurological symptoms increased also linearly with age (OR = 1.04; 95% CI: 1.01; 1.08) and pre-existing depression was a major risk factor for persisting dysautonomic (aOR = 6.35; 95% CI: 2.01; 20.11) as well as psychiatric symptoms (omitted estimate). Consistently, at second follow up only females experience psychiatric symptoms, whereas males exhibited significantly higher mean WAI (RC = 0.50; 95% CI: 0.11; 0.88). Additionally, neurological symptoms at second follow up were more likely in patients with pre-existing comorbidities (OR = 4.31; 95% CI: 1.27; 14.7). Finally, persistence of symptoms lasting 200+ days since COVID-19 diagnosis increased linearly with age (OR = 1.03; 95% CI 1.01–1.05) and were more likely in patients affected by pre-existing depression (OR = 2.68; 95% CI 1.60; 4.49). Conclusions: Following a median time of 15 months since first positive swab test, 75% patients with symptoms returned to their baseline health status preceding COVID-19. Females had a significantly lower WAI and were more likely to experience psychiatric symptoms at second follow up (15 months since COVID-19 diagnosis). Furthermore, the risk of symptoms persisting 200+ days since COVID-19 diagnosis increased with history of depression, endorsing the hypothesis that long-COVID-19 symptoms may be at least partially explained by pre-existing psychological conditions. Patient rehabilitation and psychological support may therefore play a key role in caring patients with the so called long COVID-19 syndrome.

Background: This study explored facilitators and barriers to return to work (RTW) after acute cardiovascular events or elective cardiac surgery, integrating clinical, functional, and occupational factors. Methods: A prospective cohort study was conducted at the Occupational Medicine and Cardiac Rehabilitation Units of the Maggiore Hospital in Trieste, Italy. Employed adults (18–67 years) admitted for acute coronary syndrome, valve replacement, or thoracic aortic surgery between January 2024 and July 2025 were enrolled. Sociodemographic, clinical, and occupational data were collected alongside functional and psychosocial assessments, including the Work Ability Index (WAI) and EQ-5D-5L. Predictors of RTW were analyzed with Cox regression models. Results: Among 103 patients (mean age 56.8 years; 92.2% male), 77.7% returned to work after a mean of 58.9 days. Independent predictors of earlier RTW were self-employment (HR 5.08, 95% CI 2.52–10.27), occupational responsibility (HR 2.12, 95% CI 1.01–4.45), and percutaneous coronary intervention (HR 2.72, 95% CI 1.47–5.06). Higher job-related physical demands, arrhythmias, and cardiac rehabilitation participation were associated with delayed RTW. Mean WAI (37.2 ± 5.1) and EQ-5D index (0.92 ± 0.09; EQ-VAS 77.4 ± 12.9) indicated preserved function and quality of life. Conclusions: RTW after cardiovascular events is multifactorial. Integrating occupational medicine into cardiac rehabilitation is key to ensuring safe, sustainable reintegration.

The Marano and Grado lagoon (Northern Adriatic Sea, Italy) has been affected by long-standing mercury (Hg) pollution due to inputs from the Isonzo River—mainly in the form of cinnabar (HgS)—and inorganic Hg conveyed into the lagoon by discharges from the chlor-alkali plant of Torviscosa. The present study compared different occupational sub-groups along the Marano and Grado lagoon against residents of the Dolomites Alps. Seventy-three local fishermen, 81 workers of the fish industry, and 76 local workers (52 employees of a large adhesive factory and 24 workers of an oil mill) of Porto Nogaro were recruited by convenience sampling. Hair mercury levels of the latter three groups were compared with those of 93 residents of the Dolomites Alps. Linear and logistic regression analyses were used to assess the association of hair mercury with various factors collected by a structured questionnaire. Median hair Hg levels were significantly lower in Dolomites’ residents (0.58 mg/Kg) compared to Porto Nogaro workers (1.31 mg/Kg), workers of the fish industry (2.32 mg/Kg) or fishermen (2.56 mg/Kg), following an upward trend. After adjusting for a number of potential confounders, the concentration of hair Hg progressively increased with fish intake at linear and logistic regression analysis. Advising to limit the consumption of locally caught fish to no more than one meal per week should not be restricted to pregnant women and children, but should also be extended to adults, in order to avoid the potential long-term neurological effects of low-dose Hg exposure. It is crucial to remain vigilant and continue monitoring Hg environmental contamination in the lagoon across various environmental matrices, such as sediments, water, fish, shellfish and birds. Regardless of Hg levels measured in the workplace, occupational health protocols of steel plants along the coastal area of the Marano and Grado lagoon should include biological monitoring of Hg, to disentangle the effect of occupational exposure from non-occupational exposure to the metal.