COVID-19 reduces cardiorespiratory fitness even months after a mild to moderate acute phase: a retrospective cohort study.

BACKGROUND: COVID-19 survivors may experience long-term health problems, including deterioration of cardiorespiratory fitness (CRF), as demonstrated by several cross-sectional studies that compared the results of cardiopulmonary exercise tests (CPET) performed only after COVID-19 with predicted values. This study aimed to analyze a change in CRF between repeated CPETs in response to suffered COVID-19. METHODS: A total of 127 healthcare workers (HCWs; mean age 55.7 years) underwent two CPETs with a mean interval of 762 days. Forty HCWs suffered from COVID-19 (mild to moderate severity) in the interim (321 days before the second CPET), and 87 HCWs formed a control group. Mixed-effects regression with multiple adjustment and interaction terms was used for two response variables - maximum oxygen uptake (VO2 max) and power output. RESULTS: Between both CPETs, mean VO2 max decreased statistically significantly in the COVID-19 subgroup (by 3.12 mL/kg/min, p = .034) and insignificantly in controls (by 0.56 mL/kg/min, p = .412). The proportion of HCWs achieving predicted VO2 max decreased from 75.9% to 59.5% (p = .161) in COVID-19 survivors, while it increased from 73.8% to 81% (p = .274) in controls. COVID-19 (ß = -0.66, p = .014) and body mass index (ß = -0.49, p < .001) were independent negative predictors of VO2 max change. COVID-19 was not associated with a change in power output. CONCLUSIONS: On the basis of repeated CPETs, COVID-19 significantly, albeit rather modestly, reduces CRF almost one year after infection. The reduction persists even after the acute phase with mild or moderate severity.

Predictors and characteristics of post-acute COVID-19 syndrome in healthcare workers.

BACKGROUND: Post-acute COVID-19 syndrome (PCS) is a multisystem disorder degrading the quality of life. The study determined characteristics and predictors of PCS in unvaccinated healthcare workers (HCWs) suffering from PCS based on a comparison with their fully recovered counterparts. METHODS: 305 HCWs were examined at least 12 weeks post COVID-19 symptom onset to obtain data about their acute phase of COVID-19 and current health status and tested for complete blood count, C-reactive protein (CRP), electrophoresis of plasma proteins and SARS-CoV-2-specific immunoglobulin (Ig) G and M. RESULTS: 181 (59.3%) HCWs reported persisting symptoms attributable to PCS during the examination and 124 (40.7%) HCWs stated no symptoms. In the entire sample, the mean CRP level slightly exceeded the normal range (6.63 mg/L, 95% confidence interval [CI] 5.96-7.3) while all other laboratory results were within the normal range. No statistically significant differences in laboratory results were revealed between both subgroups except for the mean Ig levels, which were higher in HCWs with PCS. The average number of symptoms of PCS was 1.9 (median 2). The most frequent symptoms of PCS were fatigue that interfered with daily life (47.5%), shortness of breath (38.1%), muscle or joint aches (16%), loss of smell (14.9%), headache (14.9%) and sleep disorders (11%). The only statistically significant predictors of PCS were female sex (odds ratio [OR] 1.48, 95% CI 1.059-2.067, p = .022) and increasing age (OR 1.04, 95% CI 1.01-1.07, p = .008). CONCLUSIONS: PCS appears to be a prevalent condition determined by female sex and increasing age.

Network Analysis for Uncovering the Relationship between Host Response and Clinical Factors to Virus Pathogen: Lessons from SARS-CoV-2.

Analysing complex datasets while maintaining the interpretability and explainability of outcomes for clinicians and patients is challenging, not only in viral infections. These datasets often include a variety of heterogeneous clinical, demographic, laboratory, and personal data, and it is not a single factor but a combination of multiple factors that contribute to patient characterisation and host response. Therefore, multivariate approaches are needed to analyse these complex patient datasets, which are impossible to analyse with univariate comparisons (e.g., one immune cell subset versus one clinical factor). Using a SARS-CoV-2 infection as an example, we employed a patient similarity network (PSN) approach to assess the relationship between host immune factors and the clinical course of infection and performed visualisation and data interpretation. A PSN analysis of ~85 immunological (cellular and humoral) and ~70 clinical factors in 250 recruited patients with coronavirus disease (COVID-19) who were sampled four to eight weeks after a PCR-confirmed SARS-CoV-2 infection identified a minimal immune signature, as well as clinical and laboratory factors strongly associated with disease severity. Our study demonstrates the benefits of implementing multivariate network approaches to identify relevant factors and visualise their relationships in a SARS-CoV-2 infection, but the model is generally applicable to any complex dataset.

Relationship between Acute-Phase Symptoms and Immunoglobulin G Seropositivity up to Eight Months after COVID-19.

Background and Objectives: Given the limited knowledge of antibody responses to COVID-19 and their determinants, we analyzed the relationship between the occurrence of acute-phase symptoms and infection-induced immunoglobulin (Ig) G seropositivity up to 8 months post-symptom onset. Materials and Methods: In this cross-sectional study, 661 middle-aged unvaccinated healthcare workers (HCWs) were interviewed about the presence of symptoms during the acute phase of their previously confirmed COVID-19 and were tested for specific IgG, targeting the spike protein (S1 and S2). The dependence of seropositivity on the symptom occurrence was explored through multiple logistic regression, adjusted for the interval between symptom onset and serology testing, and through classification and regression trees. Results: A total of 551 (83.4%) HCWs showed seropositivity and, inversely, 110 (16.6%) HCWs were seronegative. The chance of IgG seropositivity was increased by dyspnea (odds ratio (OR) 1.48, p < 0.001) and anosmia (OR 1.52, p = 0.021). Fever in HCWs with dyspnea resulted in the highest detected seropositivity rate, and anosmia in HCWs without dyspnea significantly increased the proportion of seropositivity. Conclusion: Clinical manifestation of the acute phase of COVID-19 predisposes to the development of infection-induced antibody responses. The findings can be applied for assessing the long-term protection by IgG, and thus, for creating effective surveillance strategies.

The kinetics and predictors of anti-SARS-CoV-2 antibodies up to 8 months after symptomatic COVID-19: A Czech cross-sectional study.

The presence of neutralizing SARS-CoV-2-specific antibodies indicates protection against (re)infection, however, the knowledge of their long-term kinetics is limited. This study analyzed the presence of COVID-19-induced antibodies in unvaccinated healthcare workers (HCWs) over the period of 1-8 months post symptom onset (SO) and explored the determinants of persisting immunoglobulin (Ig) seropositivity. Six hundred sixty-two HCWs were interviewed for anamnestic data and tested for IgG targeting the spike protein (S1 and S2) and IgM targeting the receptor-binding domain. A Cox regression model was used to explore potential predictors of seropositivity with respect to the time lapse between SO and serology testing. 82.9% and 44.7% of HCWs demonstrated IgG and IgM seropositivity, respectively, with a mean interval of 83 days between SARS-CoV-2 detection and serology testing. On average, HCWs reported seven symptoms in the acute phase lasting 20 days. IgG seropositivity rates among HCWs decreased gradually to 80%, 50%, and 35% at 3, 6, and 8 months after SO, while IgM seropositivity fell rapidly to 60%, 15%, and 0% over the same time intervals. The number of symptoms was the only predictor of persisting IgG seropositivity (odds ratio [OR] 1.096, 95% confidence interval [CI] 1.003-1.199, p = 0.043) and symptom duration a predictor of IgM seropositivity (OR 1.011, 95% CI 1.004-1.017, p = 0.002). Infection-induced anti-SARS-CoV-2 IgG rates drop to a third in seropositive participants over the course of 8 months. Symptom count and duration in the acute phase of COVID-19 are both relevant to the subsequent kinetics of antibody responses.

Motivation for COVID-19 Vaccination in Priority Occupational Groups: A Cross-Sectional Survey.

Due to the limited availability of COVID-19 vaccines, occupational groups with priority access were identified prior to vaccination. The study aimed to analyze motives for vaccination in these occupational groups. METHODS: Members of occupational groups, who were vaccinated at the vaccination center of University Hospital Olomouc before 30 April 2021, were asked to fill in an online questionnaire. RESULTS: A total of 3224 completed questionnaires were obtained from 1332 healthcare workers, 1257 school employees, 363 social service workers, 210 security force members, and 62 critical infrastructure workers. The most frequent motive for vaccination was the effort to protect family members (76.2%), the effort to prevent the spread of COVID-19 in one's profession (72.3%), followed by concerns about COVID-19 itself (49.1%) and exemptions from anti-epidemic measures (36.8%). Only for social services, the motive focused on one's profession was mentioned more often (75.2%) than the motive focused on the family (71.1%). At the level of detailed profession-oriented motives, a collegial effort of security force members to protect co-workers and not to endanger the workplace was dominant. CONCLUSIONS: The effort to prevent the spread of COVID-19 in the professional environment is a strong motive for vaccination, and strongest among social service workers.

Motivation to COVID-19 Vaccination and Reasons for Hesitancy in Employees of a Czech Tertiary Care Hospital: A Cross-Sectional Survey.

High vaccination coverage among healthcare workers (HCWs) is crucial for managing the COVID-19 pandemic. The aim was to determine the demand for vaccination among all employees (n = 4553) of a tertiary care hospital after several weeks of the vaccine's availability, and to analyze motives for acceptance and reasons for hesitancy through an anonymous online questionnaire. Upon the completion of data collection, the hospital's vaccination coverage was at 69.8%. A total of 3550 completed questionnaires were obtained (2657 from vaccinated, 893 from unvaccinated employees). Significant predictors of vaccine acceptance were: age (odds ratio (OR) 1.01, 95% confidence interval (CI) 1.01-1.02), sex (OR (females) 0.58, 95% CI 0.45-0.75), job type (OR (non-physician HCWs) 0.54, 95% CI 0.41-0.72; OR (non-HCWs) 0.51, 95% CI 0.37-0.71), fear of COVID-19 (OR 1.4, 95% CI 1.34-1.46), history of COVID-19 (OR 0.41, 95% CI 0.34-0.49) and of influenza vaccination (OR 2.74, 95% CI 2.12-3.57). The most frequent motive for acceptance was the effort to protect family members (84%), while concerns about vaccine safety and side effects (49.4%), followed by distrust in the vaccine's efficacy (41.1%) were the top reasons for hesitancy. To increase vaccination coverage among HCWs, it is necessary to raise awareness of vaccine safety and efficacy.

Demand and motivation for influenza vaccination among healthcare workers before and during the COVID-19 era: a cross-sectional survey.

Protection of healthcare workers (HCWs) against influenza is essential for patient health and a functional health system. The study aimed to analyze the demand for seasonal influenza vaccination (SIV) among various groups of HCWs in a tertiary care hospital before and during the COVID-19 pandemic and to identify their motives for this season's SIV. Before this influenza season (2020/21), the hospital management offered free SIV to all HCWs and promoted it on the internal network. Out of 4,167 HCWs, 630 HCWs expressed interest in SIV and were vaccinated in the hospital. They filled in a total of 603 self-administered pen-and-paper questionnaires. The mean age of the respondents (374 females and 229 males) was 45 ± 12 years. Physicians accounted for 48% of the vaccinated persons but for only 24% (p < .001) of all HCWs to whom SIV was offered. Only 16% of respondents vaccinated this year also received SIV before the last season (2019/20), with the proportion of physicians (19%) being statistically significantly higher than that of non-physicians (13%, p = .045) and the proportion of chronically ill HCWs (22%) being higher than that of healthy individuals (13%, p = .004). Most frequently, respondents' motivation to get vaccinated this year was self-protection (61%), that is concerns about contracting influenza together with COVID-19 or alone, followed by family protection (58%) and patient protection (53%). In conclusion, COVID-19 contributed to an increased demand for SIV among HCWs and the threat of contracting it together with influenza was the most frequent motive.

Occurrence of asbestos-related occupational diseases in the Czech Republic in the last 20 years.

OBJECTIVES: Asbestos-related diseases are still a current problem worldwide. What is their occurrence in the Czech Republic? The answer is the subject of this study, which aims to provide a general and regional overview of the situation over the last 20 years with a more detailed focus on mesothelioma, the development of which is highly associated with asbestos exposure and the issue of their recognition as an occupational disease. METHODS: In its retrospective reviews, the study is based on analyses of data from the Institute of Health Information and Statistics of the Czech Republic and data from the Czech National Cancer Registry, which also interconnects. RESULTS: In the last 20 years, 512 new cases of occupational diseases from asbestos have been reported, namely 228 cases of pleural thickening, 133 mesotheliomas, 92 asbestoses, and 59 cases of lung cancer. In the last 5 years, mesotheliomas (n = 39) predominated among the reported diseases with a 45% proportion in the total number of 86 cases. The trend in their incidence, as the only one among asbestos-related diseases, is not declining. There was a significant difference in the overall incidence of mesothelioma in a general population and the incidence of occupational mesotheliomas. At the national level, occupational aetiology was acknowledged in only 11.3% of cases of mesothelioma on average. The highest proportion of occupational mesotheliomas and the highest incidence of all asbestos-related diseases were found in regions where the largest asbestos processing plants were located. CONCLUSION: The authors emphasize the importance of work history for the diagnostic process of asbestos-related diseases and also the need to perform follow-up examinations for their early detection.

Measles immunity in a Czech tertiary care hospital.

BACKGROUND: Given the increasing incidence of measles, the aim was to assess the seroprevalence of measles immunity among employees of a Czech tertiary care hospital and to assess their willingness to revaccination. METHODS: 3027 hospital employees (2421 females, 606 males) underwent a serological analysis of their measles antibody levels with an option of revaccination in case of an insufficient level. RESULTS: The median age of participants was 42 years. Seropositivity was noted in 54% of the participants, with the antibody values higher in the oldest study participants and with a decrease around the birth year 1968. Logistic regression analysis confirmed a significant relationship of seropositivity with age (odds ratio 0.97, p < 0.005). Out of the seronegative, 80.9% individuals got revaccinated. CONCLUSIONS: 46% of the participants did not reach a sufficient antibody level set by the assay's manufacturer. Although the routine vaccination system is well established it may be ineffective.

Exposure criteria for evaluating lumbar spine load.

OBJECTIVE: As a part of regular revision of the List of Occupational Diseases in the Czech Republic, efforts have been made to add a new item so that lumbar spine disease caused by overload may be recognized as occupational one, with adherence to the valid national rules, that is, clinical criteria are met and objective assessment confirms working conditions under which, according to recent scientific knowledge, such an occupational disease develops. The aim is to provide information on the use of a proposed method for working condition assessment in a real setting, based on the initial experiences gained from a pilot study carried out to validate the method. METHODS: Working conditions were assessed in 55 individuals with chronic low back pain (25 males, 30 females; mean age 45.6 years; mean length of employment 15.6 years). The assessment was based on estimating compressive force on the L4/L5 intervertebral disc when performing potentially high-risk work tasks which were entered into four types of checklists throughout their work shifts. The compression values were calculated using a special module that was developed. RESULTS: In 24 cases comprehensive assessment of all tasks performed showed fulfillment of the proposed criteria of working conditions needed for recognition of occupational disease. Those included healthcare, foundry and forest workers, production operators, cabinetmakers, locksmiths, bricklayers, etc. In all the cases, lumbar spine overload was associated with work tasks requiring combinations of manual handling of objects and trunk rotation or bending. The criteria were not met in 31 subjects. The mean length of employment was 15.4 and 15.8 years in patients who met and did not meet the proposed criteria, respectively. CONCLUSION: The proposed method proved to be applicable in occupational hygiene evaluation in a real setting.

LOW-BACK PAIN DISORDERS AS OCCUPATIONAL DISEASES IN THE CZECH REPUBLIC AND 22 EUROPEAN COUNTRIES: COMPARISON OF NATIONAL SYSTEMS, RELATED DIAGNOSES AND EVALUATION CRITERIA.

AIM: Low-back pain diseases (LBPD) belong to the most frequent diagnoses determined by general practitioners, and constitute one of the most common reasons for sick leave and permanent disability pension in the Czech Republic and other European countries. Epidemiological studies have shown a statistically significant association between LBPD and certain types of occupational burden. However, in the Czech Republic, LBPD caused by overload and/or whole-body vibrations have not yet been included in the list of occupational diseases. The aim of this study was to collect and compare the systems, criteria and diagnoses used to recognize LBPD as occupational diseases in other European countries. METHODS: A questionnaire focused on LBPD was distributed and answered by specialists in occupational diseases in European countries. It included items concerning LBPD in the national list of occupational diseases, and work-related and diagnostic criteria that need to be fulfilled for recognizing LBPD as occupational diseases and possible awarding compensations to the patients. RESULTS: In 13 countries out of the 23 countries studied, LBPD caused by overload can be recognized as occupational, providing that the diagnosis is sufficiently proven and exposure criteria and/or listed occupation are met and duration of exposure is confirmed (Belgium, Denmark, France, Germany, Hungary, Italy, Lithuania, Macedonia, Netherlands, Romania, Slovakia, Sweden, and Switzerland). LBPD due to vibrations can be also recognized as occupational in 14 countries. In 8 countries LBPD are not accepted as occupational unless they are caused by an injury at work. Specific criteria to evaluate occupational exposure of patients with LBPD were set in Belgium, Denmark, France, Germany, Lithuania, Macedonia, Netherlands, and Slovakia. In other countries, the evaluation is done at an individual basis. CONCLUSIONS: In practice, the assessment of occupational overload and its contribution to the development of LBPD as well as its inclusion in the compensation system are important for several reasons. Firstly, it may be considered essentially preventable. Secondly, cases with a significant contribution of occupational aetiology may be viewed as occupational diseases for which compensation may be claimed, as it is the case in many European countries. Importantly, inclusion of LBPD in the list of occupational diseases or another system of compensation may be viewed as a preventive measure as it increases the visibility of this problem not only for the workers, but especially for the employers.