Work-Related Stress Questionnaire: confirmatory factor analysis for construct validation by the PHRASI study.

OBJECTIVE: The purpose of this study is to validate the 13-item version of the Work-Related Stress Questionnaire (WRSQ) on a representative sample of Italian public health residents. MATERIALS AND METHODS: The WRSQ was administered as part of the Public Health Residents' Anonymous Survey in Italy (PHRASI) from 14 June to 26 July 2022. Collinearity between each questionnaire item was assessed with Kendall's τ statistic. The latent factors identified associating similar items based on the authors' observations were workplace, job demand, support and unpleasant workplace. Goodness-of-fit was assessed with confirmatory factor analysis calculating: Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), Standardized Root-Mean-Residual (SRMR). Cronbach's alpha (α) and Omega McDonald (ω) were calculated to evaluate the reliability of the questionnaire. R 4.2.2 was used to perform the analyses. RESULTS: 379 Public Health residents (58% women) responded to the questionnaire. No significant collinearity was found between the items (τ range -0.31 to 0.49). Confirmatory Factor Analysis showed CFI = 0.975, TLI = 0.967, RMSEA = 0.041 and SRMR = 0.051. Internal consistency of the WRSQ Total Score was α = 0.80 and ω = 0.85. CONCLUSIONS: Although validated in a sectorial subpopulation of healthcare workers, the WRSQ proved to be an excellent tool for assessing work-related stress. Unpleasant workplace latent factors showed lower factor loading and internal consistency than others. This could be due to the fact that topics investigated with unpleasant workplace items (e.g., abuse and discrimination) are experienced on a less regular basis than the ones assessed through the other items.

S100B as a new fecal biomarker of inflammatory bowel diseases.

OBJECTIVE: S100 proteins are demonstrated to exert a protective role in the gastrointestinal tract. In the present study, we investigated whether S100B protein, that is typically expressed by enteroglial cells, is detectable in feces and could be a useful noninvasive indicator of gut chronic inflammation. PATIENTS AND METHODS: This clinical prospective study included n=48 patients suffering Crohn's disease (CD) or ulcerative colitis (UC) and non IBD-controls. The clinical disease activity was evaluated using Harvey-Bradshaw or Mayo Score Index while the diagnosis of IBD was defined based on standard endoscopic and histological criteria. S100B and calprotectin were extracted and analyzed using commercial enzyme-linked immunosorbent assay (ELISA) kits. RESULTS: Unlike calprotectin, S100B was significantly decreased in both CD and UC compared to non IBD-patients. The strongest quantitative alterations of S100B were detected concomitantly with signs of active or quiescent disease, including high/normal expression of fecal calprotectin, mucosal damage/cryptitis, mucin depletion and inflammatory infiltrate, as defined by endoscopic evaluation and histological analysis. At the onset of disease and under no Infliximab-based therapy, the lowest was detected suggesting that S100B in feces could have a potential diagnostic value for IBD. CONCLUSIONS: Testing for S100B and calprotectin could be a useful screening tool to better predict IBD activity.

Biomarkers, imaging and disease activity indices in patients with early axial spondyloarthritis: the Italian arm of the SpondyloArthritis-Caught-Early (SPACE) Study.

The study aimed to evaluate biomarkers facilitating early diagnosis of axial spondyloarthritis (axSpA) and correlations between them and disease activity parameters and imaging indexes. Patients with low back pain (LBP) (≥3 months, ≤2 years, onset ≤45 years) participating in the Italian arm of the SpondyloArthritis-Caught-Early SPACE study underwent a physical examination, questionnaires, laboratory tests, X-rays and MRI of the spine and sacroiliac joints (SIJ). An expert rheumatologist formulated axSpA diagnosis in accordance with Assessment of SpondyloArthritis International Society (ASAS) criteria. Disease activity and physical functioning were assessed using imaging, clinical and serological indices. Spine and SIJ MRI and X-rays were scored independently by 2 readers using the SPARCC, mSASSS and NY-criteria. Patients were classified as: subjects with signs of radiographic sacroiliitis (r-axSpA), subjects with signs of sacroiliitis on SIJ-MRI but not on X-rays (nr-axSpA MRI SIJ+) or subjects with no signs of sacroiliitis on MRI/X-rays but with >2 SpA features and signs of bone oedema on MRI spine (nr-axSpA MRI SIJ-/undifferentiated SpA). Significant differences were found in the prevalence of radiographic sacroiliitis, active sacroiliitis on MRI and SPARCC SIJ scores. Biomarker levels were not significantly increased in any of the patient groups. The correlations between IL-17 and IL-23 and other indices were not significant; correlations were found between IL-22 and BASFI, BASG1, HAQ, VAS pain, between mSASSS and MMP3, and between the latter and hsCRP. Although not significantly higher in any of the three groups, IL-22, MMP3 and hsCRP values were correlated with some disease activity indexes and with mSASSS. Large observational studies are required to confirm these preliminary findings.

Definition of the upper reference limit for thyroglobulin antibodies according to the National Academy of Clinical Biochemistry guidelines: comparison of eleven different automated methods.

PURPOSE: In the last two decades, thyroglobulin autoantibodies (TgAb) measurement has progressively switched from marker of thyroid autoimmunity to test associated with thyroglobulin (Tg) to verify the presence or absence of TgAb interference in the follow-up of patients with differentiated thyroid cancer. Of note, TgAb measurement is cumbersome: despite standardization against the International Reference Preparation MRC 65/93, several studies demonstrated high inter-method variability and wide variation in limits of detection and in reference intervals. Taking into account the above considerations, the main aim of the present study was the determination of TgAb upper reference limit (URL), according to the National Academy of Clinical Biochemistry guidelines, through the comparison of eleven commercial automated immunoassay platforms. METHODS: The sera of 120 healthy males, selected from a population survey in the province of Verona, Italy, were tested for TgAb concentration using eleven IMA applied on as many automated analyzers: AIA-2000 (AIA) and AIA-CL2400 (CL2), Tosoh Bioscience; Architect (ARC), Abbott Diagnostics; Advia Centaur XP (CEN) and Immulite 2000 XPi (IMM), Siemens Healthineers; Cobas 6000 (COB), Roche Diagnostics; Kryptor (KRY), Thermo Fisher Scientific BRAHMS, Liaison XL (LIA), Diasorin; Lumipulse G (LUM), Fujirebio; Maglumi 2000 Plus (MAG), Snibe and Phadia 250 (PHA), Phadia AB, Thermo Fisher Scientific. All assays were performed according to manufacturers' instructions in six different laboratories in Friuli-Venezia Giulia and Veneto regions of Italy [Lab 1 (AIA), Lab 2 (CL2), Lab 3 (ARC, COB and LUM), Lab 4 (CEN, IMM, KRY and MAG), Lab 5 (LIA) and Lab 6 (PHA)]. Since TgAb values were not normally distributed, the experimental URL (e-URL) was established at 97.5 percentile according to the non-parametric method. RESULTS: TgAb e-URLs showed a significant inter-method variability. Considering the same method, e-URL was much lower than that suggested by manufacturers (m-URL), except for ARC and MAG. Correlation and linear regression were unsatisfactory. Consequently, the agreement between methods was poor, with significant bias in Bland-Altman plot. CONCLUSIONS: Despite the efforts for harmonization, TgAb methods cannot be used interchangeably. Therefore, additional effort is required to improve analytical performance taking into consideration approved protocols and guidelines. Moreover, TgAb URL should be used with caution in the management of differentiated thyroid carcinoma patients since the presence and/or the degree of TgAb interference in Tg measurement has not yet been well defined.

137Cs contamination over Transylvania region (Romania) after Chernobyl Nuclear Power Plant Accident.

Following the radionuclide releases due to Chernobyl Nuclear Power Plant accident, various studies were completed by researchers all over the world in order to measure the surface contaminations by artificial radionuclides. The aim of this study was to evaluate 137Cs surface contamination and to create an inventory distribution for Transylvania region (Romania) after the Chernobyl event using γ spectrometric measurements on soil samples collected from 153 locations. The results were compared to measured data from the Danube Delta and Moldova Republic, as well as to 137Cs concentrations from the rest of Europe reported by literature. The 137Cs surface concentrations in soil samples ranged between 0.4±0.1kBqm-2 and 301.1±3.0kBqm-2, having an average of 8.3±0.2kBqm-2, with more elevated values in the mountain areas (18.3±0.6kBqm-2) compared to the hills and plains (2.6±0.1kBqm-2). Taking into consideration the cardinal regions, the northern and western regions received the least amount of 137Cs (2.9±0.1kBqm-2), while the southern part received 16.3±0.6kBqm-2. Sampling points with eastern slope exposure received the highest average (27.8±0.5kBqm-2), while southern, north-western and north-eastern ones received less than 8kBqm-2. Two hotspots are reported at Iezer-Ighiel (72.7±5.9kBqm-2) and Tulgheș areas (51.5±0.6kBqm-2).

Results from time integrated measurements of indoor radon, thoron and their decay product concentrations in schools in the Republic of Macedonia.

As part of a survey on concentrations of radon, thoron and their decay products in different indoor environments of the Balkan region involving international collaboration, measurements were performed in 43 schools from 5 municipalities of the Republic of Macedonia. The time-integrated radon and thoron gas concentrations (CRn and CTn) were measured by CR-39 (placed in chambers with different diffusion barriers), whereas the equilibrium equivalent radon and thoron concentrations (EERC and EETC) were measured using direct radon-thoron progeny sensors consisting of LR-115 nuclear track detectors. The detectors were deployed at a distance of at least 0.5 m from the walls as well as far away from the windows and doors in order to obtain more representative samples of air from the breathing zone; detectors were exposed over a 3-month period (March-May 2012). The geometric mean (GM) values [and geometric standard deviations (GSDs)] of CRn, CTn, EERC and EETC were 76 (1.7), 12 (2.3), 27 (1.4) and 0.75 Bq m(-3) (2.5), respectively. The equilibrium factors between radon and its decay products (FRn) and thoron and its decay products (FTn (>0.5 m)) were evaluated: FRn ranged between 0.10 and 0.84 and FTn (>0.5 m) ranged between 0.003 and 0.998 with GMs (and GSDs) equal to 0.36 (1.7) and 0.07 (3.4), respectively.

Radon and radium concentration in water from North-West of Romania and the estimated doses.

In the present study, the measurements of radon were carried out using the LUK-VR system based on radon gas measurements with Lucas cells. The radium concentration in water was determined, with the same device, immediately after was established the radon equilibrium with radium. The results presented here are from a survey carried out in the N-W region of Transylvania (Romania) in which were investigated the radon concentrations in natural (spring, well and surface) and drinking (tap) waters. The results showed radon concentrations within the range of 0.4-187.3 Bq l(-1) with an average value of 15.9 Bq l(-1) whereas radium concentration varied between 0.05 and 0.825 Bq l(-1) with an average value of 0.087 Bq l(-1) for all types of water covered within this survey. The corresponding annual effective ingestion dose due to radon and radium from water was determined from drinking water used by the population inhabiting the area.

Lung cancer risk due to residential radon exposures: estimation and prevention.

Epidemiological studies proved that cumulative exposure to radon is the second leading cause of lung cancer, the world's most common cancer. The objectives of the present study are (i) to analyse lung cancer risk for chronic, low radon exposures based on the transformation frequency-tissue response (TF-TR) model formulated in terms of alpha particle hits in cell nuclei; (ii) to assess the percentage of attributable lung cancers in six areas of Transylvania where the radon concentration was measured and (iii) to point out the most efficient remediation measures tested on a pilot house in Stei, Romania. Simulations performed with the TF-TR model exhibit a linear dose-effect relationship for chronic, residential radon exposures. The fraction of lung cancer cases attributed to radon ranged from 9 to 28% for the investigated areas. Model predictions may represent a useful tool to complement epidemiological studies on lung cancer risk and to establish reasonable radiation protection regulations for human safety.

The activity concentration of 210Po in Romanian commercial cigarettes and the radiation exposure estimation derived from their regular consumption.

Due to the relatively high activity concentrations of (210)Po that are found in tobacco, cigarette smoking has been found to be the principal pathway of the intake of this radionuclide. The (210)Po concentrations in the lung tissues may contribute significantly to an increase in the internal radiation dose and in the number of instances of lung cancer observed among smokers. The study of (210)Po in tobacco is required due to its potential for human radiation exposure through ingestion and inhalation. The risk factor caused by (210)Po in Romanian commercial cigarettes is not yet evaluated. Ten of the most frequently smoked brands of cigarettes sold in Romania were investigated in this work for this purpose. The activity concentration of (210)Po was determined by alpha spectrometry using a PIPS detector after chemical leaching and spontaneous deposition of (210)Po on a stainless steel disc from diluted HCl solution. The samples were spiked with (209)Po for chemical recovery calculation. The (210)Po activity concentrations of the measured types of cigarettes ranged from 4.65 to 10.22 mBq sample(-1) and the resulted average concentration of (210)Po isotopes is 8.35±0.80 mBq cigarette(-1) (the errors form a 2σ interval of confidence). When comparing the results of this study with the activity concentration values reported by other countries it was found that the results of this study are in the lower end of the world range. The estimation of this study shows that cigarette smokers, who are smoking one pack (20 cigarettes) per day, are exposed to an effective dose of 75.51 µSv y(-1).

Comparative assessment of erosion and deposition rates on cultivated land in the Transylvanian Plain of Romania using ¹³7Cs and ²¹°Pbex.

Soil erosion and sedimentation are natural landscape forming processes. However, they can be accelerated by human activities and therefore increase negative impacts on agricultural production as well as disturbing watershed management. Romania currently faces major environmental challenges and pressure on soil and water resources due to unsustainable farming practices and inappropriate tillage practices. The present work represents the first attempt to test the combined use of radionuclide approaches (i.e. (137)Cs and (210)Pb(ex)) to quantify soil erosion changes in cultivated Transylvanian fields (Romania) at different temporal scales. Fourteen soil cores were collected along two transects in a cultivated field and two reference sites were selected to establish the mean reference inventories for both (137)Cs and (210)Pb(ex). A value of 5460 ± 880 Bq m(-2) (n = 10; CV = 16%) was determined for the (137)Cs mean reference inventory for both sites, given as areal activity ± standard deviation, at 2σ confidence interval. As regarding (210)Pb(ex) reference inventory, its value (9640 Bq m(-2)) is only given by the areal activity of one soil core from the second site. The high erosion rates obtained with the (210)Pb(ex) approach are an effect of the up and down ploughing practices which took place at the time of the local agricultural cooperative starting in the late 1950s. The middle-term redistribution rates provided by the (137)Cs technique highlighted preponderant deposition processes in the field investigated, reflecting the changes in the cultivation system with ploughing across the slope at the beginning of 1990s.

Preliminary results regarding the first map of residential radon in some regions in Romania.

Radon represents the most important contribution of population exposure to natural ionising radiation. This article presents the first indoor radon map in some regions of Romania based on 883 surveyed buildings in the Stei-BaiTa radon-prone region and 864 in other regions of Romania. Indoor radon measurements were performed in the last 10 y by using CR-39 nuclear track detectors exposed for 3-12 months on ground floor levels of dwellings. Excluding the Stei-BaiTa radon-prone region, an average indoor radon concentration of 126 Bq m(-3) was calculated for Romanian houses. In the Stei-BaiTa radon-prone area, the average indoor concentration was 292 Bq m(-3). About 21 % of the investigated dwellings in the Stei-BaiTa radon-prone region exceed the threshold of 400 Bq m(-3), while 5 % of the dwellings in other areas of Romania exceed the same threshold. As expected, indoor radon concentration is not uniformly distributed throughout Romania. The map shows a high variability among surveyed regions, mainly due to the differences in geology. The radon emanation rate is substantially influenced by the soil characteristics, such as the soil permeability and soil gas radon concentration. Since higher permeability enables the increased migration of soil gas and radon from the soil into the building, elevated levels of indoor radon can be expected in more permeable soil environments.

Thoron and radon measurements in Romanian schools.

A new thoron/radon survey was started in the north-western part of Romania, covering three counties, using discriminative detectors (RADUET). All detectors were deployed throughout 3 months, covering the spring period. The measured radon and thoron concentration ranged from 31 to 414 Bq m(-3) and from below the detection limit to 235 Bq m(-3), respectively. In this survey, 35 schools were submitted to investigation; 21 of the schools included in this study presented radon concentrations higher than 100 Bq m(-3), the reference level recommended by the World Health Organization in 2009. The seasonal effective dose calculated from these exposures, overlapping all three counties, ranged between 0.32 and 0.54 mSv.

Indicators of the Fukushima radioactive release in NW Romania.

As a result of the Fukushima nuclear release, (131)I was found in different environmental media (rainwater, sheep and cow milk, herbage, sheep meat and thyroid tissue) in north-west Romania. On April 4, 2011 a maximum value of 1.40 ± 0.21 Bq/L in (131)I activity was found in rainwater obtained from the Arad region. The obtained value corresponded with the maximum of (131)I concentration in air, as measured by Toma et al. (2011) for the Pitesti area. One day later, sheep milk from the Cluj area was found to contain a maximum activity of 9.22 ± 0.95 Bq/L. A value of 0.85 ± 0.07 µSv was calculated as the total monthly effective dose received by the population as a result of the ingestion of sheep milk and sheep meat contaminated with (131)I. Only rainwater samples contained (134)Cs and (137)Cs at levels close to minimum detectable activity. Since the determined values could be influenced by Chernobyl (137)Cs, the (137)Cs concentrations are subject to uncertainty. The radioiodine transfer coefficients (Fm) and the concentration ratio (CR) from herbage to sheep milk, as well as sheep meat, from the Cluj-Apahida area are also presented.

Low serum 25-hydroxyvitamin D levels are associated with left ventricular hypertrophy in essential hypertension.

BACKGROUND AND AIM: Low serum 25-hydroxyvitamin D [25(OH)D] levels may have an important role in predisposing to hypertension and myocardial disease. We investigated the relationship between 25(OH)D and left ventricular (LV) structure and function, assessed by echocardiography, in a series of patients with essential hypertension (EH). METHODS AND RESULTS: Sixty-two newly diagnosed never-treated patients (32 male/30 female), aged 18-65 years, with grade 1-2 hypertension, no diabetes, no obesity, no hyperlipidemia, and no cardiopulmonary, renal, or hepatic disease, were studied. Twenty-four healthy normotensive sex-, age-, BMI-matched subjects served as controls. Hypertensive patients with 25(OH)D deficiency, defined as serum 25(OH)D levels <50 nmol/L, had higher prevalence of LV hypertrophy (LVH) than their 25(OH)D-sufficient counterparts (57.1 vs 17.6%, P = 0.02); no differences between the two groups were found in blood pressure levels as well as in other biochemical and hormone parameters. There was an inverse correlation between LV mass index and 25(OH)D levels (r = -0.366, P < 0.003) and a direct correlation between LV mass index and BMI (r = 0.333, P < 0.006) in the entire hypertensive population. The two variables remained independently associated with LVH at multivariable logistic regression analysis (OR 1.05, P < 0.005 and OR 1.25, P = 0.03, respectively). Prevalence of 25(OH)D deficiency was similar in EH patients and controls (45.1 vs 41.6%, P = 0.89), whereas no correlation between echocardiographic parameters and hormone levels was found. CONCLUSIONS: In the absence of major cardiovascular risk factors, 25(OH)D deficiency is a frequent finding in EH patients and is independently associated with LVH.

Tracking of airborne radionuclides from the damaged Fukushima Dai-ichi nuclear reactors by European networks.

Radioactive emissions into the atmosphere from the damaged reactors of the Fukushima Dai-ichi nuclear power plant (NPP) started on March 12th, 2011. Among the various radionuclides released, iodine-131 ((131)I) and cesium isotopes ((137)Cs and (134)Cs) were transported across the Pacific toward the North American continent and reached Europe despite dispersion and washout along the route of the contaminated air masses. In Europe, the first signs of the releases were detected 7 days later while the first peak of activity level was observed between March 28th and March 30th. Time variations over a 20-day period and spatial variations across more than 150 sampling locations in Europe made it possible to characterize the contaminated air masses. After the Chernobyl accident, only a few measurements of the gaseous (131)I fraction were conducted compared to the number of measurements for the particulate fraction. Several studies had already pointed out the importance of the gaseous (131)I and the large underestimation of the total (131)I airborne activity level, and subsequent calculations of inhalation dose, if neglected. The measurements made across Europe following the releases from the Fukushima NPP reactors have provided a significant amount of new data on the ratio of the gaseous (131)I fraction to total (131)I, both on a spatial scale and its temporal variation. It can be pointed out that during the Fukushima event, the (134)Cs to (137)Cs ratio proved to be different from that observed after the Chernobyl accident. The data set provided in this paper is the most comprehensive survey of the main relevant airborne radionuclides from the Fukushima reactors, measured across Europe. A rough estimate of the total (131)I inventory that has passed over Europe during this period was <1% of the released amount. According to the measurements, airborne activity levels remain of no concern for public health in Europe.

Prediction of lung cancer risk for radon exposures based on cellular alpha particle hits.

To explore the role of the multiplicity of cellular hits by radon progeny alpha particles for lung cancer incidence, the number of single and multiple alpha particle hits were computed for basal and secretory cells in the bronchial epithelium of human airway bifurcations. Hot spots of alpha particle hits were observed at the branching points of bronchial airway bifurcations. The effect of single and multiple alpha particle intersections of bronchial cells during a given exposure period, selected from a Poisson distribution, on lung cancer risk were simulated by a transformation frequency--tissue response model, based on experimentally observed cellular transformation and survival functions. Calculations of lung cancer risk at low radon exposure levels suggest that single hits produce a linear-dose response relationship, while the superposition of single and increasing multiple hits at higher exposure levels may also be approximated by a quasi-linear dose-effect curve. The simulations predict a carcinogenic enhancement effect for radon progeny accumulations at bifurcation branching sites, which may increase current risk estimates.

Thermoluminescence and optically stimulated luminescence properties of the 0.5P2O5-xBaO-(0.5-x)Li2O glass systems.

Thermoluminescence and optically stimulated luminescence properties of phosphate glasses doped with BaO and Li(2)O at various concentrations were studied. Lithium-doped glasses show a broad TL peak in the 200-300°C region with poor dosimetric characteristics. Barium-doped glasses feature at least two TL peaks, approximately at 200 and 400°C, which were attributed to Ba(2+) ions. They also produce a fast-decaying OSL signal correlated with the lower-temperature TL peak. Responses of both TL emissions to radiation doses up to 100 Gy are linear (R² >0.99). Due to its encouraging characteristics such as acceptable batch homogeneity, good measurement reproducibility and weak signal fading, the P2O5-xBaO glass can be considered as a candidate material for dosimetry in the high-dose range (>10 Gy).