Probability of exposure to the wild measles virus in adult population - Estimation from seroepidemiology and historical data.

Vaccination against measles is one of the most effective public health interventions which has saved millions of lives and interrupted circulation of the natural virus in the population. However, it is widely accepted that the immunity after vaccination can wane, especially in those who have had no contact with the virus. This study aimed to classify the particular birth cohorts of adults with regard to their exposure to the wild measles virus in the population with a long history of mandatory vaccination. We introduced two methods. In the first, we estimated the probability of exposure to the wild virus through an analysis of antibody levels from the Immunologic Survey performed in the Slovak Republic in 2018, while the second was based on historical epidemiological data. Both methods resulted in similar estimations. Cohorts born in Slovakia before 1964 can be considered to be cohorts in which most people were exposed to the wild measles virus. Cohorts born after 1977 can be designated as cohorts that most likely did not come into the contact with the wild virus. Cohorts born between 1965 and 1976 are composed of a mixture, with a decreasing proportion of people exposed to the wild virus with increasing year of birth. The proposed methods can help identify potential immunity gaps in the adult population. They can be applied in other countries with high measles vaccination coverage to estimate the probability of exposure to the wild measles virus in particular birth cohorts.

Validation of the Slovakian Version of the "Post­acute (Long) COVID­19 Quality of Life Instrument" and Pilot Study.

Purpose: The aim of our study was to validate a Slovakian translation of the PAC­19QoL instrument among Slovakian patients with post COVID-19 syndrome. Patients and Methods: The PAC-19QoL instrument was translated into the Slovakian language and administrated to patients with post COVID-19 syndrome. Cronbach's alpha coefficient was used to analyse the internal consistency of the instrument. Construction validity was evaluated by using Pearson's correlation coefficient and Spearman's rank correlation. Scores of patients and controls were compared using Mann-Whitney U-test. Results: Forty-five asymptomatic and forty-one symptomatic participants were included. Forty-one patients with post COVID-19 syndrome completed the PAC-19QoL and EQ-5D-5L questionnaires. PAC-19QoL domain scores were significantly different between symptomatic and asymptomatic participants. All items achieved a Cronbach alpha greater than 0.7. There was a significant correlation between all domains on the test (p < 0.001), with the highest correlation of Total (r = 0.994) and Domain 1 (r = 0.991). Spearman's rank correlation analysis confirmed that the instrument items correlated with the objective PAC-19QoL examination findings. Conclusion: The Slovakian version of the instrument is valid, reliable and can be a suitable tool for research and daily clinical practice among patients with post COVID-19 syndrome.

Quantification of Waning Immunity After Measles Vaccination-Evidence From a Seroprevalence Study.

We aimed to quantify rates of waning immunity after measles vaccination from seroprevalence data collected in a study of a population with high vaccination coverage and a fixed vaccination schedule. Data were collected during a national survey (the Immunological Survey) carried out in the Slovak Republic in 2018. The average rate of waning immunity against measles after the first dose of measles, mumps, and rubella (MMR) vaccine (ages 1.5-10 years) was 9.7% per year from the geometric mean titer value of 2,634 mUI/mL. The average waning rate after the second dose of MMR vaccine (ages 10-33 years) was significantly lower: 4.8% per year from the lower geometric mean titer of 1,331 mUI/mL. This decline in antibody levels suggests that vaccine-induced protection may be compromised and results in an increase in the proportion of seronegative/borderline individuals. These outcomes may provide a valuable source for critical assessment of direct and indirect effects of MMR vaccination.

Prevalence of Burnout in Healthcare Workers of Tertiary-Care Hospitals during the COVID-19 Pandemic: A Cross-Sectional Survey from Two Central European Countries.

COVID-19 has led to an unprecedented strain on healthcare workers (HCWs). This study aimed to determine the prevalence of burnout in hospital employees during a prolonged pandemic-induced burden on healthcare systems. An online survey among employees of a Czech and Slovak university hospital was conducted between November 2021 and January 2022, approximately when the incidence rates peaked in both countries. The Maslach Burnout Inventory-Human Services Survey was applied. We obtained 807 completed questionnaires (75.1% from Czech employees, 91.2% from HCWs, 76.2% from women; mean age of 42.1 ± 11 years). Burnout in emotional exhaustion (EE) was found in 53.2%, depersonalization (DP) in 33%, and personal accomplishment (PA) in 47.8% of respondents. In total, 148 (18.3%) participants showed burnout in all dimensions, 184 (22.8%) in two, and 269 (33.3%) in at least one dimension. Burnout in EE and DP (65% and 43.7%) prevailed in physicians compared to other HCWs (48.6% and 28.8%). Respondents from COVID-19-dedicated units achieved burnout in the EE and DP dimensions with higher rates than non-frontline HCWs (58.1% and 40.9% vs. 49.9% and 27.7%). Almost two years of the previous overloading of healthcare services, caused by the COVID-19 pandemic, resulted in the relatively high prevalence of burnout in HCWs, especially in physicians and frontline HCWs.

Secondary School Teachers and Outpatient Physicians: Differences in Attitudes towards Vaccination against COVID-19 in Slovakia.

The aim of this study was to evaluate the differences in attitudes towards vaccination against COVID-19 among secondary school teachers and outpatient physicians. A cross-sectional study was realised using anonymous questionnaires. The EPI Info 7 program and R software, version 4.0.2 were used for statistical analysis. The questionnaire was completed by 868 respondents (teaching staff N = 451; outpatient physician N = 417). The number of employees vaccinated against COVID-19 was 742 (85.5%). The number of those vaccinated against COVID-19 and influenza (last season) was 192 (21.9%). The statistically significant predictors were the level of fear of COVID-19 (OR 1.40; 95% CI 1.29-1.52), profession-outpatient physicians (OR 2.56; 95% CI 1.55-4.23), history of COVID-19 (OR 0.34; 95% CI 0.22-0.54), gender (OR 0.55; 95% CI 0.33-0.89) and influenza vaccination at any time in the past (OR 3.52; 95% CI 1.10-11.31). The strongest motivation for vaccination against COVID-19 among physicians was the prevention of the spread of COVID-19 during the performance of their profession (N = 336; 87%); among teachers, it was the protection of family members (N = 258; 73%). The most common reason for vaccine hesitancy was concern about vaccine safety (N = 80; 63.5%).

Prevalence of Burnout Syndrome in COVID-19 and Non-COVID-19 Units in University Hospital: A Cross-Sectional Study.

The aim of this study was to assess prevalence and associated risk factors of burnout syndrome among healthcare workers (HCWs), especially among nurses during the pandemic of COVID-19. The sample of the cross-sectional study consists of 201 employees of University Hospital. The Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS MP) was used. An anonymous questionnaire was administered between 15 January and 1 February 2022. The majority of HCWs were female (79.4%). Overall, 69.2% displayed high levels of emotional exhaustion (EE), 35.3% high levels of depersonalization (DP), and 35.5% low levels of personal accomplishment (PA). Burnout was frequent among staff working in COVID units (EE 76.1%; DP 47.8%; and PA 46.7%). Burnout in EE and DP (70.7% and 36.6%, respectively) significantly prevailed in nurses working in COVID-19 units compared to non-frontline nurses (59.6 and 21.1%, respectively). Prevalence of burnout in PA was significantly higher in nurses working in non-COVID-19 units (47.4% vs. 29.3%). It is crucial to pay attention to the high prevalence of burnout syndrome in HCWs, especially in nurses, and not only in the frontline.

Acceptance of COVID-19 Vaccination among Healthcare and Non-Healthcare Workers of Hospitals and Outpatient Clinics in the Northern Region of Slovakia.

The purpose of this study was to analyse attitudes, motivation, and reasons for hesitancy toward COVID-19 vaccination among healthcare workers (HCWs) in northern Slovakia. A cross-sectional study was conducted between 30 August 2021 and 30 September 2021. An anonymous questionnaire was administered. The study was completed by 1277 employees. Multivariate logistic regression was used to identify predictors of COVID-19 vaccination status. A total of 1076 (84.3%) were vaccinated, and 201 (15.7%) were unvaccinated. Physician job type (OR = 1.77; CI95 1.13-2.78), history of COVID-19 (OR = 0.37; CI95 0.26-0.37), influenza vaccination at any time (OR = 1.97; CI95 1.12-3.46), compulsory vaccination for HCWs (OR = 9.15; CI95 2.92-28.62), and compulsory vaccination for selected groups (OR = 9.71; CI95 2.75-34.31) were the predictors significantly associated with COVID-19 vaccination acceptance. Non-physician HCWs, employees in hospitals, and employees without a history of COVID-19 significantly more distrusted the efficacy of vaccines against COVID-19. Results of our study confirmed that physicians have higher vaccination rates and lower hesitance to get vaccinated than non-physician HCWs. HCWs play an important role in influencing vaccination decisions and can be helpful in vaccine advocacy to the general public.

Odds Ratio Estimation of Medical Students' Attitudes towards COVID-19 Vaccination.

This study investigated the attitudes of Slovak medical students to COVID-19 vaccination. A cross-sectional study was conducted between 10 March 2021 and 24 March 2021, as the second wave of coronavirus spread in Slovakia. It was performed in four medical faculties with students in years 1-6. An online anonymous questionnaire was distributed through official university platforms. The survey was completed by 1228 of 5374 medical students. The vaccinated group of students had received at least one dose of the COVID-19 vaccine. The study was conducted on 1228 students, of which 880 (71.7%) were vaccinated and 348 unvaccinated (28.3%). The median age was 22 years (range 18-33 years), and 70.6% were women. The lowest vaccination rate was among first (32.7%) and second-year students (61.6%), students living at home with their family (63.8%) and students living in urban areas (69.8%). Only 22.4% of medical students were concerned about serious side effects from the COVID-19 vaccine, and 38.8% were concerned that the COVID-19 vaccine may not be effective. This study provides key information related to medical student vaccination in Slovakia and education about COVID-19 vaccination.

Private wells as potential sources of heavy metal exposure: a pilot study in northwest Slovakia.

OBJECTIVES: The aim of this study is to analyse levels of selected heavy metals: chromium (Cr), cadmium (Cd), copper (Cu), manganese (Mn), and lead (Pb), and to recognize factors related to wells' stewardship. METHODS: The pilot study was realized in May 2018 in three villages in northwest of Slovakia. We analysed 69 water samples from private wells. The data on wells and well owners were obtained by self-administered questionnaire. The samples were analysed by atomic absorption spectroscopy with graphite furnace GF AAS (AAS GBC XplorAA 5000 with GBC GF 5000) equipped with hollow cathode lamps. Levels of heavy metals were compared with parametric values for drinking water stated in the Resolution of the Ministry of Health of the Slovak Republic No. 247/2017 Coll. RESULTS: The results indicated spatial variability in some heavy metal levels. Cadmium was not quantified in any sample. Copper and chromium levels were below the parametric value. Parametric values for manganese and lead were exceeded in 19 (27.5%) and 2 (2.9%) samples, respectively. Only 18 owners tested water quality. Busyness and financial cost most frequently discouraged users to carry out the water quality analysis. CONCLUSIONS: The presence of heavy metals in well water can pose a serious public health problem, especially in rural areas without public water supply. Education on heavy metals' risks targeted at well owners could increase the awareness of the issue and minimize possible public health consequences.

Determination of Cadmium and Chromium in Fruit Spirits Intended for Own Consumption Using Graphite Furnace Atomic Absorption Spectrometry.

INTRODUCTION: Analysis of the occurrence of cadmium and chromium in selected samples of fruit spirits intended for own consumption. MATERIAL AND METHODS: In our pilot study, we analysed 89 samples of fruit spirits intended for own consumption. The samples were mineralized with use of microwave decomposition system MULTIWAVE 60 50 Hz and analysed by atomic absorption spectrometry with a graphite furnace (AAS GBC XPLORAA 5000 with GF 5000). RESULTS: Most of the analysed samples originated from plums (39), apples (38) and pears (5). The average ethanol concentration was 53.7%. Cadmium and chromium were detected in all samples. The highest concentration of chromium and cadmium was found in the apple spirit (31.9 ± 6.6 µg/l and 40.1 ± 8.3 µg/l). CONCLUSIONS: The ethanol concentration in the samples was higher than in distribution spirits. Concentrations of chromium in all samples did not exceed the limit given by the Slovak legislation or the limit of the AMPHORA. The permissible cadmium concentration (10 µg/l according to the AMPHORA) was exceeded in 9 samples. This indicates the potential importance of cadmium compared to chromium. Due to the lack of information in this field, the study presents an important starting point for further research.

Association of the role of personal variables and nonoccupational risk factors for work-related carpal tunnel syndrome.

OBJECTIVES: The purpose of this study was to identify personal variables and nonoccupational risk factors for carpal tunnel syndrome and to analyse the strength of association of these factors. METHODS: We performed a case-control study with 162 cases and 300 controls. We studied consecutive patients with an electrophysiologically confirmed diagnosis of symptomatic carpal tunnel syndrome. Univariate analysis was performed in the case group and control comparing them for presence of various risk factors. Multivariate analysis was carried out through logistic regression. RESULTS: The mean BMI and age were greater in the case group than in the control. Multivariate analysis showed that BMI (OR = 1.05, 95% CI = 1.01-1.11) and arterial hypertension (OR = 4.63, 95% CI = 2.88-7.44) were the only factors significantly associated with carpal tunnel syndrome. The age, cigarette smoking and alcohol drinking were at the edge of significance. CONCLUSIONS: Carpal tunnel syndrome is the most common peripheral neuropathy and has been related to occupational activities in some but not all studies. Clarifying this relationship has important implications for workers' compensation systems. Based on our findings, BMI and arterial hypertension are considered to be the most significant risk factors of carpal tunnel syndrome in our study.

Measles Outbreak in a Roma Community in the Eastern Region of Slovakia, May to October 2018.

BACKGROUND: Despite the effective National Immunization Programme of Slovakia, some population groups are incompletely vaccinated or unvaccinated. We aimed to describe the measles outbreak spread in Eastern Slovakia between May and October 2018, affecting the Roma communities in relation to the existing immunity gaps. METHODS: We defined a group of persons living in socially closed communities with low vaccination coverage. RESULTS: Of 439 measles cases (median age: 10 years), 264 (60.1%) were vaccinated, 137 (31.2%) received two doses and 127 (28.9%) one dose of measles vaccines, 155 (35.3%) were unvaccinated and 20 (4.6%) had an unknown vaccination status. Samples from 102 patients (with two-dose vaccination status) were additionally tested for antibodies against rubella and mumps. Of 102 cases, 68 (66.7%) cases had a positive IgM and 23 (22.5 %) IgG antibodies against measles. For rubella, only 20 (19.6%) cases had seropositive IgG levels, for mumps higher positivity was detected in 60 persons (58.8%). We could detect only a small percentage with positive serology results of rubella IgG antibodies across all age groups. We have assumed that rubella antibodies had to be produced following the vaccination. Their absence in the cases with two doses of MMR suggests that these vaccines could not have been administrated despite the fact that this data was included in the medical records. Sequential analysis of two samples showed measles genotype B3. CONCLUSION: This outbreak can outline the existence of a vulnerable group of the Roma. Low vaccinate coverage represents a serious public health threat.

Selected Behavioural Factors Affecting Oral Health in Schoolchildren: Results from the Health Behaviour in School-Aged Children (HBSC) Slovak Study.

Oral diseases, particularly dental caries, affect as much as nine in 10 persons globally. Its development starts during childhood. Behavioural factors play an important role in its aetiology. The aim of the research was to analyse the prevalence of selected behavioural factors associated with dental caries in Slovak adolescents. Selected factors, such as toothbrushing less than once a day, consumption of sweets and sweetened soft drinks daily and their combination, were analysed using data from Health Behaviour in School-Aged Children surveys carried out in 2005/2006, 2009/2010, 2013/2014 and 2017/2018 in Slovakia. The target group consisted of 11- to 13-year-old schoolchildren. The results were analysed by sex and socioeconomic status. The consumption of sweets and sweetened soft drinks, despite declining, remains widespread (41.3% of boys and 39.6% of girls in 2017/2018). The absence of daily toothbrushing, similarly as a co-occurrence of factors, were more frequent in boys (10.6% and 5.0% in 2017/2018, respectively) than in girls (5.1% and 2.3% in 2017/2018, respectively). The absence of daily toothbrushing was associated with a lower socioeconomic situation. In conclusion, behavioural risk factors affecting oral health are widespread in Slovak adolescents. Despite the positive development of the epidemiological situation, effective interventions, as well as the improvement of oral hygiene in lower socioeconomic groups, are needed.

Impact of hand hygiene knowledge on the hand hygiene compliance.

Aim Hand hygiene practice is still burdened by inadequate compliance, whether in the professional sphere by health professionals or in the non-professional sphere by lay population. Aim of this study was to map the hand hygiene knowledge and its compliance in the monitored group of people. Methods The research was conducted at the Jessenius Faculty of Medicine in Martin of Comenius University in Bratislava (JFM CU) among seventy 3rd year students of General Medicine (medical study program), and Nursing, Midwifery and Public Health (non-medical study programs). Knowledge of hygienic hand washing according to the WHO guidelines from 2009 was investigated, as well as differences in the level of microbial contamination of hands after routine hand washing between the group that had been acquainted with hand hygiene protocols and the group that had not sufficiently. Results The results have shown that 32.9% of the students did not perform hygienic hand washing properly. The differences between the groups of students with and without the proper hand hygiene compliance in routine hand washing were not statistically significant. Conclusion The results of our survey have suggested that the reasons for decreased compliance with hand washing protocols may be related to forgetting to wash the hands or not being acquainted with hand washing protocols at all. The strategies focused only on one aspect of hand hygiene are, according to scientific literature, ineffective in the long term.

Validation of the Slovakian version of Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ).

INTRODUCTION: The most common occupational disease is carpal tunnel syndrome. The aim of this study was to translate and validate the Slovakian version of BCTSQ. METHODS: The original questionnaire was translated into the Slovakian language by two expert translators. Cronbach's alpha coefficient was used to analyze the internal consistency of the questionnaire. Construction validity was evaluated by using Pearson's correlation coefficient and Spearman's rank correlation. The results were processed in the statistical program SPSS 24. The level of significance p > 0.05 was considered significant. To analyze the validity, a factor analysis of the BCTSQ and the correlation between BCTSQ and SF-36 were obtained. RESULTS: A total of 32 employees at risk of local muscular overload completed the BCTSQ and Health Questionnaire SF-36. Cronbach's alpha for SSS was >0.8. The alpha coefficient for FSS was >0.9. The Pearson's coefficient and Spearman's rank correlation was >0.9 for each domain. Cronbach's alpha for SF-36 was >0.7 and the Pearson's coefficient and Spearman's rank correlation was >0.6 and p-values <0.001. CONCLUSIONS: The questionnaire has sufficient reliability, validity and can be a suitable tool for the evaluation of subjective response of employees at the risk of local muscular overload, as well as of patients with carpal tunnel syndrome.

Exposure to Mental Load and Psychosocial Risks in Kindergarten Teachers.

INTRODUCTION: Published research studies in Central Europe have been mostly oriented toward occupational stress among schoolteachers. The aim of this study is to investigate the level of occupational stress in kindergarten teachers and to specify psychosocial risks associated with their work. METHODS: The study was conducted by using a Meister questionnaire and a Psychosocial risk questionnaire. The data collection was obtained from kindergarten teachers in 2017. The survey link with request was sent to participants via email. A total 287 questionnaires from 67 kindergarten schools were collected. RESULTS: 192 (66.9%) teachers perceived their work as mentally burdensome. Teachers who perceived their work as mentally non-burdening were more likely to report autonomy in their work (p=0.001), fair performance evaluation (p=0.010), sufficient family time (p=0.005), a health-protected workplace (p=0.000) and absence of violence and bullying (p=0.042). Teachers with a university degree perceiving work as mentally burdensome reported that their work was not adequately assessed (p=0.034). Teachers over 45 years of age with school practice of over 20 years reported injustice in evaluating work performance against younger colleagues (p=0.000). CONCLUSION: Kindergarten teachers reported overloading, time pressure, and high responsibility, but considered their work interesting. However, changing the way teachers work in schools can reduce teacher resignation and improve teachers' well-being.

Lead contamination of fruit spirits intended for own consumption as a potential overlooked public health issue? A pilot study.

OBJECTIVE: The aim of the study was to analyse the occurrence of lead in selected samples of fruit distilled spirits for own consumptions in terms of possible contribution to the occurrence of alcohol-attributable diseases. METHODS: In a pilot study, we analysed 18 samples of fruit spirits for own consumption. Most of the samples were distilled in the local growing distilleries in the Zilina Region with exception of 3 samples collected in the Trnava Region (one of them was of Hungarian origin). Sample preparation included previous mineralization with use of microwave decomposition system Multiwave 60 50 Hz. The samples were analysed by atomic absorption spectroscopy with graphic furnace (AAS GBC XplorAA 5000 with GF 5000). RESULTS: The average ethanol level in our samples was higher in comparison with distributed spirits. We detected lead in all samples. In two of them the concentration was lower than the limit of quantitation (LOQ). The highest lead concentrations were observed in plum spirit from Hungary (581.0 µg/l), and in grape spirit made in the Trnava Region (466.3 µg/l). CONCLUSIONS: Lead is a widespread contaminant of fruit spirits prepared for own consumption. Taking into consideration its common occurrence and possible multiplicative effect with ethanol, we can assume that lead can contribute to the occurrence of several alcohol-attributable chronic diseases. Due to the insufficient information in this field, our results provide significant insight into the issue and present an important starting point for further research.

The Effects of a Workplace Health Promotion Program to Decrease Cadmium Exposure Levels in Nickel-Cadmium Battery Workers.

OBJECTIVE: Cadmium exposure is a common problem in the production of nickel-cadmium batteries. However, keeping the respective legislative occupational and safety policies is essential, but there are problems with compliance. We analysed the effect of strategies to increase compliance with precautions during 20132015 on 59 workers at a nickel-cadmium battery factory. MATERIAL AND METHODS: A health promotion program was implemented in two phases. The first phase included comprehensive education on the importance of appropriate behaviour and changes to the sanitation program. The second phase included renovation of sanitary facilities and modernization of the air exhaust ventilation. RESULTS: The initial median cadmium urinary level in workers was 1.9 µg/g creatinine. After the first phase of interventions, levels dropped to 1.0 µg/g creatinine. After the second phase no significant further decrease was observed. CONCLUSION: Comprehensive education and changes in the sanitation program were able to halve cadmium levels and can be considered a useful and cost-effective preventive tool.

Estimation of the Population Susceptibility Against Measles in Slovakia.

OBJECTIVE: In Slovakia, thanks to a highly effective vaccination programme, no domestic cases of measles have been reported since 1999. However, there are several outbreaks of measles currently hitting some countries in Europe. Difficulties in reaching the goal of measles elimination make it necessary to monitor the status of the population susceptibility to prevent similar outbreaks in the future. We hypothesize that immunity wanes overtime, which can substantially impact the population susceptibility. This work introduces a model that estimates a proportion of individuals susceptible to measles in the Slovak population in 2015. METHODS: Our analysis is based on an age-cohort model that incorporates waning immunity, vaccination schedule and changes in demographic structure. The inputs of the model are data on the vaccination coverage, last seroprevalence survey in 2002 and age structure of the population. RESULTS: In a short-term horizon, waning immunity does not affect the estimated proportion of the susceptible population. However, in a long-term horizon, the antibody titers can fall below the level of protection, which would result in a substantial transfer of initially immune individuals to the compartment of the susceptible ones. Incorporating of waning immunity in the cohort model has indicated that the most susceptible cohorts are not-vaccinated youngest children and cohorts born between 1969 and 1986. CONCLUSIONS: Applying the model to the current situation shows that people aged 30-45 years and unvaccinated infants represent the most susceptible groups. Model partially replaces missing seroprevalence survey, but, because the parameters of model and phenomenon of waning immunity are not exactly known, we suggest reintroducing the regular national serosurveys in order to empirically determine the level of susceptibility for measles in Slovakia.