Fatal Hymenoptera Venom-Triggered Anaphylaxis in Patients with Unrecognized Clonal Mast Cell Disorder-Is Mastocytosis to Blame?

Hymenoptera venom-triggered anaphylaxis (HVA) affects up to 8.9% of the general population and is the most frequent cause of anaphylaxis in adults, accounting for approximately 20% of all fatal anaphylaxis cases. Quite often, a fatal reaction is a victim's first manifestation of HVA. Mastocytosis represents one of the most important risk factors for severe HVA. We analyzed patients with documented fatal HVA for the presence of underlying clonal mast cell disorder (cMCD). Here, we report three cases of fatal HVA, with undiagnosed underlying cMCD identified by the presence of the peripheral blood and/or bone marrow KIT p.D816V missense variant postmortem. In the first case, anaphylaxis was the initial episode and was fatal. In the other two cases, both patients were treated with specific venom immunotherapy (VIT), nevertheless, one died of HVA after VIT discontinuation, and the other during VIT; both patients had cardiovascular comorbidities and were taking beta-blockers and/or ACE inhibitors. Our results point to the importance of screening all high-risk individuals for underlying cMCD using highly sensitive molecular methods for peripheral blood KIT p.D816V variant detection, including severe HVA and possibly beekeepers, for proper management and the need for lifelong VIT to prevent unnecessary deaths. Patients at the highest risk of fatal HVA, with concomitant cardiovascular and cMCD comorbidities, might not be protected from field stings even during regular VIT. Therefore, two adrenaline autoinjectors and lifelong VIT, and possibly cotreatment with omalizumab, should be considered for high-risk patients to prevent fatal HVA episodes.

Indoor air quality and the associated health risk in primary school buildings in Central Europe - The InAirQ study.

The indoor air quality (IAQ) was investigated in sixty-four primary school buildings in five Central European countries (Czech Republic, Hungary, Italy, Poland, and Slovenia). The concentration of volatile organic compounds, aldehydes, PM2.5 mass, carbon dioxide, radon, as well as physical parameters were investigated during the heating period of 2017/2018. Significant differences were identified for the majority of the investigated IAQ parameters across the countries. The median indoor/outdoor ratios varied considerably. A comprehensive evaluation of IAQ in terms of potential health effects and comfort perception was performed. Hazard quotient values were below the threshold value of 1 with one exception. In contrast, 31% of the school buildings were characterized by hazard index values higher than 1. The maximum cumulative ratio approach highlighted that the concern for non-carcinogenic health effects was either low or the health risk was driven by more substances. The median excess lifetime cancer risk values exceeded the acceptable value of 1 × 10-6 in the case of radon and formaldehyde. PM2.5 mass concentration values exceeded the 24 h and annual guideline values set by the World Health Organization in 56 and 85% of the cases, respectively. About 80% of the schools could not manage to comply with the recommended concentration value for carbon dioxide (1000 ppm).

Sick building syndrome among healthcare workers and healthcare associates at observed general hospital in Slovenia.

OBJECTIVE: The aim of this study was to assess the possible associations between self-perceived sick building syndrome (SBS) symptoms among healthcare workers and healthcare associates and self-perceived parameters of indoor work environment quality. METHODS: The cross-sectional study was conducted from February to April 2019. Validated standardized evaluation tools (MM 040 NA Hospital 2007 and MM 040 NA Office 2007) were used for estimating the prevalence of SBS among observed populations. Chi-square and Mann-Whitney U tests for assessing possible associations in SBS symptoms between healthcare workers and associates were used. RESULTS: The response rate was 69.8%. The results showed a lower prevalence of six or more SBS symptoms in healthcare associates (6.4%) compared to healthcare workers (12.0%). Healthcare workers perceived the most frequent risk factors for SBS to be poor air quality, an inappropriate level of relative humidity, and inappropriate room temperature, while the least frequently self-perceived risk factors were inappropriate lighting and noise levels. CONCLUSIONS: This study represents a platform for further analyses - the identification of health risk factors with environmental monitoring.

Microbiological and chemical quality of indoor air in kindergartens in Slovenia.

The concentrations of microorganisms, aerosol black carbon and carbon dioxide (CO2) in indoor and outdoor air of two kindergartens were investigated during four seasons. The highest mean concentrations of aerobic mesophilic microorganisms in indoor air were detected in spring. Cladosporium, Penicillium and Aspergillus were the most common fungi in all air samples. The concentrations of Staphylococci, Enterobacteria and CO2 had a positive correlation with the number of persons in the rooms. The highest mean concentration of black carbon in indoor and outdoor air was obtained in winter. Concentrations of CO2 exceeded 1000 ppm in 89.3% of the indoor air measurements. The reduction of the number of children in individual playrooms and more frequent ventilation are recommended for lowering the concentration of CO2 and the number of microorganisms in the air, especially potential pathogen fungi. The renovation of buildings with installation of effective artificial ventilation is recommended as well.Abbreviations: CFU, Colony-Forming Unit; HPC, Heterotrophic Plate Count (Aerobic Mesophilic Microorganisms); YGC, Yeast Extract Glucose Chloramphenicol Agar; BC, Aerosol Black Carbon Particles; CO2, Carbon Dioxide; PM, Particulate Matter.

Ambient air pollution and pregnancy outcomes: A comprehensive review and identification of environmental public health challenges.

There is a growing number of studies on the association between ambient air pollution and adverse pregnancy outcomes, but their results have been inconsistent. Consequently, a comprehensive review of this research area is needed. There was a wide variability in studied pregnancy outcomes, observed gestational windows of exposure, observed ambient air pollutants, applied exposure assessment methods and statistical analysis methods Gestational duration, preterm birth, (low) birth weight, and small for gestational age/intrauterine growth restriction were most commonly investigated pregnancy outcomes. Gestational windows of exposure typically included were whole pregnancy period, 1st, 2nd, 3rd trimester, first and last gestational months. Preterm birth was the outcome most extensively studied across various gestational windows, especially at the beginning and at the end of pregnancy. Particulate matter, nitrogen dioxide, ozone, and carbon monoxide were the most commonly used markers of ambient air pollution. Continuous monitoring data were frequently combined with spatially more precisely modelled estimates of exposure. Exposure to particulate matter and ozone over the entire pregnancy was significantly associated with higher risk for preterm birth: the pooled effect estimates were 1.09 (1.03-1.16) per 10 µg/m3 increase in particulate matter with an aerodynamic diameter of 10 µm or less (PM10),1.24 (1.08-1.41) per 10 µg/m3 increase in particulate matter with an aerodynamic diameter of 2.5 µm or less (PM2.5), and 1.03 (1.01-1.04) per 10 ppb increase in ozone. For pregnancy outcomes other than PTB, ranges of observed effect estimates were reported due to smaller number of studies included in each gestational window of exposure. Further research is needed to link the routine pregnancy outcome data with spatially and temporally resolved ambient air pollution data, while adjusting for commonly defined confounders. Methods for assessing exposure to mixtures of pollutants, indoor air pollution exposure, and various other environmental exposures, need to be developed.

Methods of health risk and impact assessment at industrially contaminated sites: a systematic review.

BACKGROUND: this paper is based upon work from COST Action ICSHNet. Industrially contaminated sites (ICSs) are a serious problem worldwide and there is growing concern about their impacts on the environment and public health. Health risk assessment methods are used to characterize and quantify the health impacts on nearby populations and to guide public health interventions. However, heterogeneous methods and inconsistent reporting practices compromise comparability risk and impact estimates. OBJECTIVES: to review the literature on assessment of the adverse health effects of ICSs. Specifically, we: - collect published, peer-reviewed literature addressing health assessment of ICSs; - identified and evaluated the methods and tools for the assessment of health impacts related to ICSs; - analysed the methods and tools used in different conditions; - discussed the strengths and weaknesses of the identified approaches; - presented an up-to-date understanding of the available health risk and impact assessment in ICSs. In addition, the terminologies were described and harmonization was proposed. METHODS: we systematically searched PubMed and Web of Science to identify peer-reviewed reviews and original studies from January 1989 to December 2017. We used a qualitative approach for analysing the different elements (type of ICSs, Country of research, active years of working, distance from sources, pollutants, affected population, methods and tools, health outcomes, main founding, method stage, dose-response assessment, risk characterization) of included studies. We divided risk assessment methods used in the papers into four stages: semi-quantitative, quantitative, health impact, and health burden stage. RESULTS: a total of 92 relevant original papers at ICSs were found and analysed. In current practice, the health risks have been characterized mainly as hazard quotients or hazard indexes (23 studies), and as cancer risk probabilities (60 studies). Only 8 studies estimated the number of cases and one study evaluated years of life lost. CONCLUSION: hazard quotients and cancer probabilities are suitable for semi-quantitative and quantitative personal risk estimation, respectively. More comparable risk characterization on public health level requires specificity on the type of outcome and corresponding number of cases. Such data is needed for prioritization of action at low to medium risk sites. We found limited amount of studies that have quantified the health impact at industrially contaminated sites. Most of the studies have used semi-quantitative risk characterization approaches and the adopted methods are mostly of toxicological origin, while epidemiological analysis is almost lacking. There is a need to improve quantitative risk assessment and include health impact and environmental burden of disease assessments at ICSs.

The Prevalence of Self-Reported Systemic Allergic Reaction to Hymenoptera Venom in Beekeepers Worldwide: A Systematic Literature Review and Meta-Analysis.

Background: Beekeepers represent a high-allergic risk population group due to their unavoidable seasonal or persistent exposure to the elicitors of Hymenoptera venom allergy, bees in particular. A systematic literature review and meta-analysis aimed to estimate the prevalence of self-reported systemic allergic reaction to Hymenoptera venom among beekeepers worldwide. Methods: We rigorously reviewed and conducted meta-analysis on observational studies retrieved from seven electronic databases (MEDLINE via PubMed, Web of Science Core Collection, Scopus, Academic Search Complete, ScienceDirect, Cumulative Index to Nursing and Allied Health Literature, Zoological Record), spanning data from inception to August 1, 2023. The Joanna Briggs Institute Prevalence Critical Appraisal Tool was employed to assess the risk of bias. A meta-analysis was conducted to synthesize evidence. Results: Out of 468 studies, eight original articles met the inclusion criteria. The estimated overall lifetime and one-year prevalence of self-reported systemic allergic reaction to bee venom were 23.7% (95% CI: 7.7-53.4) and 7.3% (95% CI: 5.8-9.2), respectively. The estimated lifetime prevalence of self-reported systemic allergic reaction to bee venom for grades III-IV (severe systemic allergic reaction) was 6.0% (95% CI: 3.0-11.7). In general, substantial heterogeneity and a high risk of bias were observed across the majority of studies. The impact of geographical location and climate differences on the estimated lifetime prevalence is suggestive for severe systemic allergic reaction. Conclusions: Future observational cross-sectional studies should employ rigorous study designs, using validated questionnaires, and thoroughly report the observed health outcomes, verified by physicians.

Risk Factors Associated with Severe Systemic Allergic Reaction after Wasp Sting in Subjects with a History of European Hornet Sting Allergy.

Aim: To make the treatment approach in patients suffering a European hornet sting allergy reaction more personalized, preparing them also for possible future risks. Methods: In Slovenia an extended retrospective observational cohort epidemiological study about the natural history of Hymenoptera venom sensitivity is in progress. The study is based on data from the healthcare records of the University Clinic Golnik (UCG) and data collected by a questionnaire sent to patients from May 2019 to April 2021. For a pilot study, we selected patients who were referred to UCG because of an allergic reaction to European hornet sting and had been re-stung later by a wasp (n=68). The association between severe systemic allergic reactions (SSAR) after wasp sting and potential risk factors in subjects with a history of hornet sting allergy was assessed univariately using the likelihood ratio test. Results: Among 68 European hornet allergic patients 27 reacted with an SSAR and 41 reacted with a mild SAR. Among 27 patients with SSAR, 4 reacted with an SSAR also to a subsequent wasp sting. Among 41 patients with a mild European hornet sting SAR nobody reacted with an SSAR to a subsequent wasp sting. The association between the severity of the wasp SAR reaction in European hornet allergic patients was statistically significant (p=0.022). Conclusion: Our results suggest that patients with severe European hornet SAR should be considered for wasp venom immunotherapy or prophylactic prescription of epinephrine auto-injector as they are at risk for an SSAR also after wasp string.

Comparison of Culture-Dependent and Culture-Independent Methods for Routine Identification of Airborne Microorganisms in Speleotherapeutic Caves.

The effective identification of bacterial and fungal isolates is essential for microbiological monitoring in environments like speleotherapeutic caves. This study compares MALDI-TOF MS and the OmniLog ID System, two high-throughput culture-based identification methods. MALDI-TOF MS identified 80.0% of bacterial isolates to the species level, while the OmniLog ID System identified 92.9%. However, species-level matches between the methods were only 48.8%, revealing considerable discrepancies. For discrepant results, MALDI-TOF MS matched molecular identification at the genus level in 90.5% of cases, while the OmniLog ID System matched only in 28.6%, demonstrating MALDI-TOF MS's superiority. The OmniLog ID System had difficulties identifying genera from the order Micrococcales. Fungal identification success with MALDI-TOF MS was 30.6% at the species level, potentially improvable with a customised spectral library, compared to the OmniLog ID System's 16.7%. Metagenomic approaches detected around 100 times more microbial taxa than culture-based methods, highlighting human-associated microorganisms, especially Staphylococcus spp. In addition to Staphylococcus spp. and Micrococcus spp. as indicators of cave anthropisation, metagenomics revealed another indicator, Cutibacterium acnes. This study advocates a multi-method approach combining MALDI-TOF MS, the OmniLog ID System, culture-based, and metagenomic analyses for comprehensive microbial identification. Metagenomic sampling on nitrocellulose filters provided superior read quality and microbial representation over liquid sampling, making it preferable for cave air sample collection.

Linkage Health and Environmental Data: A Case Study on Asthma Prevalence in Children and Adolescents in Slovenia.

For the last 10 years there is no data on the prevalence of asthma in Slovenian children. To ensure accurate and high-quality data we will conduct a cross-sectional survey Health Interview (HIS) and Health Examination Survey (HES) design type. Therefore, we first prepared the study protocol. To get the data for the HIS part of the study we developed a new questionnaire. The exposure to outdoor air quality will be evaluated from the National Air Quality network data. In Slovenia the problems with health data should be addressed with the common unified system at the national level.

The APISS Questionnaire: A New Tool to Assess the Epidemiology of Systemic Allergic Reactions to Bee Venom in Beekeepers.

Aim: To develop and validate a comprehensive questionnaire to be used as an instrument in cross-sectional studies among beekeepers. Methods: A comprehensive questionnaire in Slovenian was validated by an expert panel (n=13) for content relevance and a rater panel (n=14) for clarity and comprehensibility. The content validity indices (an item-level content validity index and scale-level content validity index based on the average and universal agreement method) and item-level face validity index were calculated in accordance with the recommended number of both the review panels with their implications on the acceptable cut-off scores. Piloting was performed in a sample (n=50) of the target population (N=1.080) using telephone interviews. Results: The item-level content validity index and scale-level content validity index based on the average method exhibited excellent content validity (0.97), while the scale-level content validity index based on the universal agreement method reached a value of 0.72. The item-level face validity index of 1.00 indicated that all items were clear and comprehensive. Conclusions: The new instrument may be considered valid and feasible for use in nationwide population-based studies among Slovenian beekeepers and eventually in other populations.

Effects of Anthropogenic Disturbance and Seasonal Variation on Aerobiota in Highly Visited Show Caves in Slovenia.

Aerosols in caves are natural tracers and, together with climatic parameters, provide a detailed insight into atmospheric conditions, responses to climatic changes and anthropogenic influences in caves. Microbiological air monitoring in show caves is becoming increasingly useful to understand changes in cave ecosystems and to implement and review measures for sustainable cave use and tourism development. In 2017 and 2018, air along tourist trails in caves Postojnska jama and Skocjanske jame (Slovenia) was sampled before and after tourist visits. Samples were analysed using culture-dependent methods, flow cytometry, detection of ß-D-glucan and lipopolysaccharide and compared with CO2 and temperature data to measure anthropogenic influences and seasonality on aerobiota. While the presence of tourists significantly increased concentrations of airborne microorganisms (p < 0.05), ß-D-glucan and CO2 did not show such a trend and were more dependent on seasonal changes. Locally, concentrations of cultivable microorganisms above 1000 CFU/m3 were detected, which could have negative effects on the autochthonous microbiota and possibly on human health. A mixture of bacteria typically associated with humans was found in the air and identified with MALDI-TOF MS. Using MALDI-TOF MS, we achieved a 69.6% success rate in identification. Micrococcus luteus, Streptococcus mitis, Staphylococcus epidermidis and Moraxella spp. were recognized as good indicators of cave anthropisation.

Vitamin D Fortification of Eggs Alone and in Combination with Milk in Women Aged 44-65 Years: Fortification Model and Economic Evaluation.

Introduction: For almost nine decades, the fortification of foods with vitamin D has been proven effective in preventing rickets. This study aims to build and economically evaluate a fortification model based on egg biofortification and milk (including yoghurt) fortification. Methods: A cross-sectional study was carried out between 1. March and 31. May 2021. Three hundred and nineteen healthy women from the Central Slovenian region aged between 44 and 65 were recruited for the study, with 176 participants included in the final analysis. For the fortification model calculations, the vitamin D contents of unenriched milk (including yoghurt) and eggs were replaced by enriched foods containing vitamin D. The economic evaluation was done using available drug and food supplement prices. Fortification costs were calculated using vitamin D prices provided by suppliers. Results: Mean vitamin D intake from food was 2.19±1.34 µg/d. With fortification Model 1 (enriched eggs), it would be: 6.49±4.45 µg/d, and with Model 2 (enriched eggs and milk): 10.53±6.49 µg/d. Without fortification, none of the participants would reach a daily vitamin D intake >10 µg. With fortification Model 1 (egg fortification), 15.3% would reach >10 µg and with Model 2 (egg and milk fortification) 46.2% would reach >10 µg. The economic comparison of the annual cost of 10 µg vitamin D/d/person was EUR 6.17 for prescription drugs, EUR 6.37 for food supplements, EUR 0.09 for direct milk fortification and EUR 0.12 for egg biofortification with vitamin D. Conclusions: Egg and milk (including yoghurt) fortification could cost-effectively increase vitamin D intake in the Slovenian population of women between 44 and 65 by almost five-fold, and could significantly lower the prevalence of vitamin D deficiency. Additional research and changes to legislation are needed before this can be introduced.

Correction: Vicic et al. Assessment of Vitamin D Status in Slovenian Premenopausal and Postmenopausal Women, Using Total, Free, and Bioavailable 25-Hydroxyvitamin D (25(OH)D). Nutrients 2022, 14, 5349.

In the original publication [...].

Natural History of the Hymenoptera Venom Sensitivity Reactions in Adults: Study Design.

BACKGROUND: Allergic reactions to Hymenoptera stings can have varying levels of severity, according to the Müller grading system. METHODS: By an epidemiological concept, this is a retrospective cohort study. The observed cohort was represented by patients referred to the University Clinic Golnik due to Hymenoptera allergic reaction in the period from 1997 to 2015. From the immunological database of the University Clinic Golnik, we obtained laboratory data (sIgE, skin tests and basophil activation test). The clinical characteristics of patients were obtained from BIRPIS. With the help of a questionnaire, which was sent to each patient in the period from May 2019 to April 2021, we obtained epidemiological data. For the assessment of the association between the severity of allergic reaction for the observed outcome, the severity of the first allergic reaction after Hymenoptera sting was used. Other variables were grouped according to risk factors. DISCUSSION: We will identify the risk factors that could play an important role in a severe systemic reaction: the aetiology of the Hymenoptera sting, sex, age, history and severity of previous systemic reactions, being re-stung in an interval of two months, the frequency of re-stings, atopy, genetic predisposition, preventive medication use, other medication use, beekeeping or living next to beehives and why immunotherapy was not taken. Laboratory data will also be analysed to determine if there is any association with laboratory tests and the severity of the allergic reactions after Hymenoptera stings. CONCLUSIONS: Several new approaches are introduced in the study design. The most important is that the protocol covers epidemiological data gained from the questionnaire, as well as clinical data gained from the Immunological database and BIRPIS database. We expect to obtain significant results that will explain the risk factors for the natural history of Hymenoptera sting allergic reactions and will help allergologists, as well as general doctors, when facing those patients allergic to Hymenoptera venom without immunotherapy.

Work-related Musculoskeletal Disorders Among Physiotherapists and Physiotherapy Students in Croatia and their Association with Physical Fitness.

Introduction: Among physiotherapists, work-related musculoskeletal disorders (WMSDs) are the most common health problem. This study aimed to provide evidence for planning evidence-based health promotion programmes for ensuring and maintaining adequate physical fitness (PF) to decrease WMSDs among physiotherapists which would have started already during the study. Methods: A cross-sectional study involved the participation of a total of 100 physiotherapy students and 62 physiotherapists. Observed variables were prevalence of WMSDs in the last 12 months, lasting >3 days during physiotherapeutic activities and five PF components: body composition, cardiorespiratory and muscle endurance, muscle strength, and flexibility. A chi-square test and binary logistic regression were used as the main analytical methods. Results: Prevalence of WMSDs in physiotherapists was 63.9% (the most common locations: lower back, shoulders, neck), while in physiotherapy students it was 46.5% (the most common locations: lower back, neck, upper back) (p=0.031). Among the PF components, the results showed statistically significantly worse flexibility among students compared to physiotherapists (about two thirds of students had poor or very poor results of flexibility testing) (p=0.002) in comparison to physiotherapists. A statistically significant positive association between WMSDs and PF was observed only between knee pain and poor cardiorespiratory endurance (OR=4.03 with 95% CI 1.12-14.58; p=0.033). Conclusion: The study showed poor flexibility among students indicating that it is necessary to direct them to perform activities that will increase the extensibility of muscles. The awareness of this problem should be increased. A specific role should be played by staff involved in clinical practice.

Epidemiology and risk factors of self-reported systemic allergic reactions to a Hymenoptera venom in beekeepers worldwide: a protocol for a systematic review of observational studies.

INTRODUCTION: Systemic allergic reaction (SAR) to a Hymenoptera venom is a potentially life-threatening disorder. The rate of SAR between beekeepers in comparison with a healthy individual is different. The risk for an SAR is particularly high in beekeepers due to their persistent or seasonal exposure to the stinging Hymenoptera. We aim to provide a critical appraisal and a synthesis of evidence-based data from epidemiological observational studies, focusing on SARs to a Hymenoptera venom and the associated risk factors for SARs in beekeepers worldwide. METHODS AND ANALYSIS: Searching will include seven electronic databases for published studies without language restrictions, from inception up to 3 August 2021, and it will be rerun for all electronic databases prior publication. Only epidemiological observational studies in beekeepers will be included. The risk of bias in the included studies will be appraised by using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies and the Newcastle-Ottawa Scale, adapted for cross-sectional studies. For the certainty of evidence, the Grading of Recommendations Assessment, Development and Evaluation approach will be used. Qualitative synthesis will be presented in a tabulated format with the selected characteristics across primary studies and the main outcome of interest. A meta-analysis is planned to be performed if there will be a sufficient number of homogeneous studies with complete data. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 statement will guide the reporting of this systematic literature review. ETHICS AND DISSEMINATION: No ethics approval is needed to conduct the systematic literature review since it will be solely based on the published literature. Findings will be disseminated through the relevant conferences, peer-review and open-access journals.PROSPERO registration numberCRD42021260922.

Determinants of seropositivity for SARS-CoV-2 in hospital staff in the second wave of the pandemic in Slovenia.

OBJECTIVES: The pandemic caused by the novel coronavirus (SARS-CoV-2) affected a disproportionately high percentage of healthcare workers (HCWs). The aim of the study was to assess the seroprevalence of SARS-CoV-2-specific IgG antibodies in nurses and clinicians working in 2 Slovenian regional hospitals, and to identify the factors associated with seropositivity. MATERIAL AND METHODS: The study was designed as a crosssectional study. Clinicians and nurses were invited to participate in November-December 2020. The respondents (813, 65.8%) completed a questionnaire and consented to provide 10 ml of blood for determining the presence of SARS-CoV-2 IgG antibodies. RESULTS: The authors observed a seroprevalence rate of 20.4%. The results of the univariate analysis proved that the age of a nurse or clinician was the factor most strongly associated with seropositivity - in fact, the youngest nurses and clinicians were 8.33 times more likely to be seropositive than those in the oldest age group (p = 0.041). Being in contact with a family/household member who was SARS-CoV-2-positive was also a very important factor. In the work-related factors group, being in the contact with a SARS-CoV-2-positive colleague (OR = 2.35, p = 0.026) or being in contact with a COVID-19 patient (OR = 1.96, p = 0.004) correlated with seropositivity. In the primary work location/department group, the only significant association appeared among those working in surgical, ENT or ophthalmology departments. The results of the multivariate analysis further supported the thesis that the age of nurses and clinicians was the factor most strongly associated with seropositivity. The youngest nurses and clinicians were 12.5 times more likely to be seropositive than those in the oldest age group (p = 0.024). Being in contact with a SARS-CoV-2-positive family/household member remained the second most important factor. CONCLUSIONS: A significant number of clinicians and nurses working in secondary healthcare were infected in the first 9 months of the pandemic. Int J Occup Med Environ Health. 2022;35(5):571-84.

Assessment of Vitamin D Status in Slovenian Premenopausal and Postmenopausal Women, Using Total, Free, and Bioavailable 25-Hydroxyvitamin D (25(OH)D).

The objective of our study was to evaluate vitamin D status and its predictors in Slovenian premenopausal and postmenopausal women. A cross-sectional study was carried out between 1 March 2021 and 31 May 2021. A total of 319 healthy women from the Central Slovenian region aged between 44 and 65 were recruited; 176 were included in the final analysis. The vitamin D status was determined by measuring the total 25-Hydroxycholecalciferol (25(OH)D) concentration, vitamin D binding protein (DBP), and albumin and calculating the bioavailable 25(OH)D and free 25(OH)D. For the calculation of bioavailable and free 25(OH)D, we developed a new online calculator. The Endocrine Society's thresholds for vitamin D deficiency and insufficiency were used; 29.0% of premenopausal and 24.4% of postmenopausal subjects were found to be vitamin D deficient (total 25(OH)D < 50 nmol/L); 76.8% of the premenopausal and 61.7% of postmenopausal subjects were found to have insufficient levels (total 25(OH)D < 75 nmol/L). Premenopausal women had 11.8% lower total 25(OH)D, 32.2% lower bioavailable 25(OH)D, and 25.2% higher DBP than postmenopausal women. The most important predictors of vitamin D status were vitamin D supplementation and time spent in the sun. Contrary to similar studies, the vitamin D status in Slovenian postmenopausal women was significantly better than in premenopausal women. In postmenopausal women, the measurement of free or bioavailable 25(OH)D instead of the total 25(OH)D could be advantageous.

A Systematic Review of Vitamin D Status and Dietary Intake in Various Slovenian Populations.

AIM: Vitamin D (VitD) is involved in calcium and phosphate homeostasis, bone health, and normal functioning of the immune system. VitD status is monitored using serum 25-hydroxy-vitamin D (25(OH)D) as a biomarker. Serum 25(OH)D concentrations below 30 nmol/L indicate VitD deficiency and below 50 nmol/L indicate insufficiency. VitD can be synthesised endogenously in human skin when exposed to ultraviolet B (UVB) radiation. In the absence of sufficient UVB-light exposure, VitD intake becomes the main source of VitD, with a recommended daily intake of 20 µg. The aim of this study was to conduct a review and meta-analysis on the abovementioned topics, focusing on scientific studies in various Slovenian populations. METHODS: We conducted a systematic review and meta-analysis of published scientific papers, academic theses, or conference contributions reporting serum 25(OH)D status and VitD intake across various Slovenian populations. A search was carried out using Web of Science, Scopus, Medline, and the Slovenian library database. RESULTS: We identified 43 pertinent studies that addressed 25(OH)D status and 16 that addressed VitD intake. Serum 25(OH)D status was generally low across all populations, and notable seasonal variability was observed. VitD intakes were below 5 µg in all studies. CONCLUSIONS: A general observation is that various population groups across Slovenia are at high risk of vitamin D insufficiency and deficiency, particularly during wintertime. Regarding vitamin D intake, all included studies reported daily intakes below the recommended level. We also identified key research gaps that need to be addressed to support further public health decision-making.