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BackgroundAn understanding vaccine-dependent effects on protective and sustained humoral immune response is crucial to planning future vaccination strategies against coronavirus disease 2019 (COVID-19).MethodsIn this multicenter, population-based, cohort study including 4601 individuals after primary vaccination against COVID-19 ≥ 4 months earlier we compared factors associated with residual antibody levels against severe acute respiratory syndrome coronavirus-2 receptor-binding domain (RBD) across different vaccination strategies (BNT162b2, mRNA-1273, or ChAdOx1).ResultsOur main model including 3787 individuals (2 × BNT162b2, n = 2271; 2 × mRNA-1273, n = 251; 2 × ChAdOx1, n = 1265), predicted significantly lower levels of anti-RBD antibodies after 6 months in individuals vaccinated with ChAdOx1 (392.7 binding antibody units per milliliter [BAU/mL]) compared with those vaccinated with BNT162b2 (1179.5 BAU/mL) or mRNA-1273 (2098.2 BAU/mL). Vaccine-dependent association of antibody levels was found for age with a significant predicted difference in BAU/ml per year for BNT162b2 (−21.5; 95% confidence interval [CI], −24.7 to −18.3) and no significant association for mRNA-1273 (−4.0; 95% CI, −20.0 to 12.1) or ChAdOx1 (1.7; 95% CI, .2 to 3.1). The predicted decrease over time since full immunization was highest in mRNA-1273 (−23.4; 95% CI, −31.4 to −15.4) compared with BNT162b2 (−5.9; 95% CI, −7 to −4.8).ConclusionsOur study revealed population-based evidence of vaccine-dependent effects of age and time since full immunization on humoral immune response. Findings underline the importance of individualized vaccine selection, especially in elderly individuals.

The aim of this study was to investigate the relationship among daily activities (paid work, childcare, caregiving, voluntary work, sports, and social contact), occupational balance, and depressive symptoms during the COVID-19 pandemic.We analyzed data from the Austrian Corona Panel Project (four time points, 6-month period) using regression models with logarithmically transformed data and nonparametric repeated-measures tests (N = 871).Results showed higher depressive symptoms among women. Family caregivers (either parents or those caring for other relatives) were at the highest risk for occupational imbalance and depressive symptoms. Sports and social contact were initially associated with better outcomes, but the effects waned. There was a main effect for time point driven by the last wave (amidst the second lockdown), but no significant interaction effects between predictors and time point were found.The results provide a nuanced depiction of the relationship between different daily activities and health-related outcomes during the pandemic, highlighting groups at risk.

SummaryIn view of the recent revival of interest in circadian biology and circadian epidemiology at the Medical University of Vienna, it seems appropriate to highlight the rich and pioneering history of circadian research in Austria. Among the forefathers of circadian research in Vienna are Otto Marburg (1874–1948), who discovered important elements of the pineal gland physiology, Robert Hofstätter (1883–1970), who used pineal gland extract in obstetrics/gynecology, and Paul Engel (1907–1997), who discovered that the pineal gland was controlled by light. More recently, Vera Lapin (1920–2007) showed that surgical removal of the pineal gland increased tumor growth, while Franz Waldhauser (*1946) investigated melatonin in conjunction with night work. Michael Kundi (*1950) and his team conducted among the first studies demonstrating differences in rhythms of night workers and early evidence for health impairments among them. Furthermore, Vienna-born Erhard Haus (1926–2013) pioneered the discovery of the role and importance of melatonin in relation to numerous diseases. This rich pioneering contribution of scientists in Vienna or with roots in Vienna is continued today by a new generation of chronobiologists, epidemiologists and clinicians in Vienna whose new insights contribute to the rapidly developing field of circadian rhythms research. Current topics and contributions relate to the impact of circadian rhythm disruption on health, and the application of chronotherapeutic approaches in clinical and preventive settings.

Summary Background In aging healthcare professionals, multiple stressors such as night work may affect life and work satisfaction and risk for chronic diseases (e.g. cardiovascular disease [CVD]). In this pilot study we compared workability, quality of life (QoL), and CVD risk markers between night shift and day workers. Methods We included 70 hospital employees (mean age 52 ± 4 years, 91.4% female): 32 rotating night shift workers (> 3 nights/month) and 38 permanent day workers. In addition to sociodemographic, lifestyle, and sleep characteristics, we assessed i) workability index (WAI), ii) QoL (World Health Organization Quality of Life [WHOQOL-Bref]) and iii) CVD risk markers, i.e. carotid ultrasound measurements, and biomarkers (NTproBNP, CRP, IL‑6, LDL, ferritin, copper, zinc, and selenium). WAI, QoL, and CVD risk markers were compared between night and day workers. In a subgroup of participants (N = 38) with complete data, we used quantile regression analysis to estimate age and multivariate adjusted differences in biomarker levels. Results We found no differences in the domains of QoL (physical health, psychological, social relationships, and environment) and WAI scores between night and day workers. Night shift workers were less likely to report excellent workability than day workers, although differences were not statistically significant. Night shift workers reported more sleep problems (73.1% vs. 55.6%) and tended to have lower zinc levels and higher inflammatory markers (CRP, IL‑6, ferritin), but differences were not significant after adjusting for potential confounders. Conclusions Workability, QoL and CVD markers did not significantly differ between rotating night shift and day workers in this small pilot study. Sleep problems and inflammatory marker levels carry implications for occupational health.

Hintergrund: Mit den neu zugelassenen Impfungen gegen COVID-19 kam es zu ersten Berichten uber allergische beziehungsweise Unvertraglichkeitsreaktionen. In der Folge stellte sich die Frage, ob von diesen Impfstoffen eine erhohte Gefahr fur Unvertraglichkeitsreaktionen ausgeht und ob Allergiker gegebenenfalls hierfur ein hoheres Risiko aufweisen. Ergebnisse: Allergische Reaktionen nach COVID-19-Impfungen wurden berichtet, jedoch meist von mildem Auspragungsgrad und in bei Impfstoffen normaler (Moderna®) oder nur gering erhohter Frequenz (BioNTech/Pfizer®). Das Risiko einer allergischen Reaktion auf die neu zugelassenen Vektorimpfstoffe (AstraZeneca®, Johnson & Johnson®) kann noch nicht abschliesend beurteilt werden, scheint jedoch ebenfalls gering. Es gibt aktuell keinen Hinweis, dass Patienten mit Allergien haufiger oder schwerer reagieren. Man geht momentan davon aus, dass Unvertraglichkeitsreaktionen vom Soforttyp einerseits Typ-I-allergisch (IgE-vermittelt) oder uber Komplement-Aktivierung (CARPA, "complement activation-related pseudoallergy") stattfinden. Als Ausloser hierfur werden Polyethylenglycol (PEG) oder Polysorbat, die als Stabilisatoren in den Impfstoffen vorhanden sind, vermutet. Diskussion: Die bisher verfugbaren Daten zeigen kein wesentlich erhohtes Risiko hinsichtlich allergischer Reaktionen vom Soforttyp bei Allergikern. Allergiker konnen zumeist problemlos geimpft werden. Standardisierte Testungen zur Nachverfolgung moglicher Allergien oder CARPA-vermittelten Reaktionen sind derzeit nur begrenzt verfugbar. Zitierweise: Altrichter S, Wohrl S, Horak F, Idzko M, Jordakieva G, Untersmayr E, Szepfalusi Z, Zieglmayer P, Jensen-Jarolim E, Wiedermann U, Rosenkranz A, Hotzenecker W. Answers to burning questions for clinical allergologists related to the new COVID-19 vaccines. Allergo J Int 2021; 30:169-75 https://doi.org/10.1007/s40629-021-00177-3

Allergo journal international 30(5), 155-168 (2021). doi:10.1007/s40629-021-00178-2, Published by Urban & Vogel, München

Im Rahmen seiner Markteinfuhrung wurde ein neuartiges Lebensmittel fur besondere medizinische Zwecke von einem multidisziplinaren Expertengremium als Option fur Allergiepatienten diskutiert. Die neu entwickelte Lutschtablette enthalt neben dem Molkeprotein β-Lactoglobulin (BLG) auch die Mikronahrstoffe Eisen, Zink und Vitamin A. Das mit Liganden beladene BLG (holo-BLG) wird als ein Faktor des allergieprotektiven Bauernhof-Effekts in zahlreichen wissenschaftlichen Studien diskutiert. Studien zeigen weiterhin, dass holo-BLG seine Liganden gezielt zu Immunzellen bringt, dort den spezifischen Nahstoffbedarf deckt und somit zu Immunresilienz fuhren kann. Basierend auf dem wissenschaftlichen Hintergrund, sehen die Experten die Einsatzmoglichkeiten von holo-BLG in Form einer Lutschtablette breit aufgestellt, zum Beispiel bei Patienten mit multiplen Allergien, mit Sensibilisierungen auf seltene Allergene (u. a. Arbeitsplatzallergene), mit baumpollenassoziierten Nahrungsmittelallergien oder in allgemein schwierigen Behandlungssituationen (Tierhaarallergiker, Ablehnung einer allergenspezifischen Immuntherapie). Die Expertenrunde sieht in der holo-BLG-Lutschtablette eine innovative, zusatzliche Option fur die allergologische Praxis. Zitierweise: Bergmann C, Ehmann R, Jordakieva G, Kohler H-J, Straub D, Untersmayr E, Dollner R, Sperl A. Targeted micronutrition for allergic patients - possible applications of a food for special medical purposes. Allergo J Int 2021;30:150-3 https://doi.org/10.1007/s40629-021-00172-8

To investigate immunogenicity and safety of BNT162b2 booster vaccination with and without a tetravalent influenza vaccine.A prospective, open-label cohort study on immunogenicity and safety of COVID-19 booster vaccination with or without a tetravalent influenza vaccine was performed. 838 health care workers were included in the following study arms: BNT162b2 booster-only, influenza-vaccine-only or combination of both. Levels of antibodies against SARS-CoV-2 spike receptor binding domain (RBD), and haemagglutinine inhibition (HAI) tested for four different influenza strains (A(H1N1)pdm09, A(H3N2), B/Victoria, B/Yamagata) were measured at time of vaccination and four weeks later.After four weeks, median [IQR] anti-RBD antibody levels and relative change from baseline were higher in individuals who received BNTb162b2 booster vaccination only (absolute: 16,600 [10,980-24,360] vs. 12,630 [8,198-18,750] BAU/mL (p0·0001); relative increase: 49% [23·6-95·3] vs. 40% [21·9-80·6](p = 0·048); booster-only n=521 vs. combination-arm n=229 respectively). Results were confirmed after matching for sex, age, BMI, baseline antibody levels and vaccine compound received for primary immunization (absolute: 13,930 [10,610 - 22,760] vs. 12,520 [8,710 - 17,940]; p = 0·031); relative increase: 55·7% [27·8-98·5] vs. 42·2% [22·9-74·5]; p = 0·045). Adverse events were almost identical in the booster-only and the combination-arm, but numerically lower in the influenza arm (525/536[97·9] % vs.235/240 [97·9%] vs. 26/33 [78·8 %]).While no safety concerns occurred, our study provides evidence on reduced immunogenicity of a BNT162b2 booster vaccination in combination with a tetravalent influenza vaccine. Further studies investigating new influenza variants as well as potential differences vaccine effectiveness are needed.

SummaryA novel and recently launched food for special medical purposes was discussed by a multidisciplinary expert panel as an option for allergic patients. The newly developed lozenge contains the whey protein beta-lactoglobulin (BLG) as well as the micronutrients iron, zinc and vitamin A. BLG loaded with ligands (holo-BLG) is discussed as one factor of the allergy-protective farm effect in numerous scientific studies. Further studies reveal that holo-BLG shuttles its ligands specifically to immune cells, where it balances the specific nutrient demand and can thus lead to immune resilience. Based on the scientific background, the experts see a broad range of possible applications for holo-BLG in the form of a lozenge, for example in patients suffering from multiple allergies, with sensitisation to rare allergens (including occupational allergens), tree pollen-associated food allergies or in general difficult treatment situations (e.g. allergies to animal dander or refusal of allergen immunotherapy). The expert panel describes the holo-BLG lozenge as an innovative and additional option for allergic patients.

Sleep impairment is highly prevalent in night shift workers, but evidence on the association of former night shift work (NSW) and its metrics (duration and frequency) in relation to sleep complaints is lacking. We evaluated the association of former and current NSW with chronic insomnia or circadian rhythm sleep disorder in a sample of the general worker (GW) population and in hospital workers (HW) in Austria. Information on sleep, NSW history, sociodemographic, and lifestyle factors was collected through an online cross-sectional survey in a representative sample of GW (

Understanding vaccine-dependent effects on protective and sustained humoral immune response are crucial to plan further vaccination strategies against COVID-19. Population-based data comparing different vaccination strategies are lacking.This multicenter, population-based cohort study included 4,601 individuals ≥18 years of age after primary vaccination against COVID-19 at least four months ago (full immunization). We compared factors associated with residual antibody levels against SARS-CoV-2 receptor binding domain (RBD) across different vaccination strategies (BNT162b2, mRNA-1273, or ChAdOx1 nCoV-19 [ChAdOx1]).Our main model including 3,787 individuals (2xBNT162b2 n = 2,271, 2xmRNA-1273 n = 251, 2xChAdOx1 n = 1,265) predicted significantly lower levels of anti-RBD-antibodies after 6 months in individuals vaccinated with ChAdOx1 (392.7 BAU/ml) compared to those vaccinated with BNT162b2 (1179.5 BAU/ml) or mRNA-1273 (2098.2 BAU/ml). Vaccine-dependent association of antibody levels was found for age with a significant predicted difference in BAU/ml per year for BNT162b2 (-21.5 [95%CI -24.7 to -18.3]) and no significant association for mRNA-1273 (-4.0 [95%CI -20.0 to 12.1]) or ChAdOx1 (1.7 [95%CI 0.2 to 3.1]). The predicted decrease over time since full immunization was highest in mRNA-1273 (-23.4 [95%CI -31.4 to -15.4]) compared to BNT162b2 -5.9 [95%CI -7 to -4.8]). Higher antibody levels were observed for individuals with systemic adverse events upon vaccination and current smoking (BNT162b2), for days between first and second vaccination (BNT162b2 and ChAdOx1) and for absence of comorbidities (all).Our study revealed population-based evidence of vaccine-dependent effects of age and time since full immunization on humoral immune response. Findings underline the importance of an individualized vaccine selection, especially in elderly individuals.

Purpose To evaluate the impact of high-intensity interval training (HIIT) on health-related outcome parameters in the prehabilitation of patients diagnosed with cancer. Methods A systematic review and meta-analysis of comparative studies on HIIT in cancer prehabilitation conducted by screening standard databases from their inception to March 30, 2020. Outcomes of interest included cardiorespiratory fitness, feasibility, safety, clinical, and patient-reported outcomes. Results Of the 855 identified studies, 8 articles met the inclusion criteria (7 randomized, 1 non-randomized controlled trial) with a total of 896 patients. The study protocols were heterogeneous, but the methodological quality ranged from good to high according to PEDro scale. Meta-analysis revealed a significant improvement of peak oxygen consumption (VO2peak) achieved with HIIT compared to usual care. Furthermore, HIIT was feasible and safe, showing low risk of adverse events and positive effects on health-related outcomes in prehabilitative settings. Conclusion In the phase of prehabilitation, HIIT has potential health benefits in patients diagnosed with cancer and is feasible and safe to perform. Nonetheless, larger randomized controlled trials focusing on long-term effects (such as cancer recurrence or survival rates) are missing, to underline the potential relevance of HIIT for cancer patients.

SummaryBackgroundMatrix metalloproteinases (MMPs) are involved in systemic inflammatory responses and organ failure. The aim of this study was to evaluate early circulating plasma levels of MMP‑2, MMP‑9 and their inhibitors TIMP‑1 and TIMP‑2 and their prognostic significance in critically ill patients on admission to the intensive care unit (ICU).MethodsIn a single center prospective study 120 consecutive patients (72.5% male, mean age 66.8 ± 13.3 years, mean simplified acute physiology score [SAPS II] score 52.9 ± 21.9) were enrolled on transfer to the ICU of a cardiology department. The most common underlying conditions were cardiac diseases (n = 42.5%), respiratory failure (n = 10.8%) and sepsis (n = 6.7%). Blood samples were taken within 12 h of ICU admission. The MMP‑2, MMP‑9, TIMP‑1 and TIMP‑2 levels in plasma were evaluated in terms of 30-day survival, underlying condition and clinical score.ResultsOn ICU admission 30-day survivors had significantly lower plasma MMP‑9 (odds ratio, OR 1.67 per 1 SD; 95% confidence interval, CI 1.10−2.53;p = 0.016) and TIMP‑1 (OR 2.15 per 1 SD; 95% CI 1.27−3.64;p = 0.004) levels than non-survivors; furthermore, MMP‑9 and TIMP‑1 correlated well with SAPS II (bothp p = 0.002) and TIMP‑1 (p = 0.01) were independent predictors of survival (Cox regression). No significant correlation was found between MMP‑2 and TIMP‑2 levels, MMP/TIMP ratios and 30-day mortality.ConclusionThe MMP‑9 and TIMP‑1 levels are significantly elevated in acute critical care settings with increased short-term mortality risk, especially in patients with underlying heart disease. These findings support the value of MMPs and TIMPs as prognostic markers and potential therapeutic targets in conditions leading to systemic inflammation and acute organ failure.

ObjectivesVarious commercial anti-Spike SARS-CoV-2 antibody tests are used for studies and in clinical settings after vaccination. An international standard for SARS-CoV-2 antibodies has been established to achieve comparability of such tests, allowing conversions to BAU/ml. This study aimed to investigate the comparability of antibody tests regarding the timing of blood collection after vaccination.MethodsFor this prospective observational study, antibody levels of 50 participants with homologous AZD1222 vaccination were evaluated at 3 and 11 weeks after the first dose and 3 weeks after the second dose using two commercial anti-Spike binding antibody assays (Roche and Abbott) and a surrogate neutralization assay.ResultsThe correlation between Roche and Abbott changed significantly depending on the time point studied. Although 3 weeks after the first dose, Abbott provided values three times higher than Roche, 11 weeks after the first dose, the values for Roche were twice as high as for Abbott, and 3 weeks after the second dose even 5-6 times higher.ConclusionsThe comparability of quantitative anti-Spike SARS-CoV-2 antibody tests is highly dependent on the timing of blood collection after vaccination. Therefore, standardization of the timing of blood collection might be necessary for the comparability of different quantitative SARS-COV-2 antibody assays.Abstract Figure

Post-COVID fatigue significantly limits recovery and return-to-work in COVID-19 survivors. We aimed to assess the effects of physical exercising on post-COVID-19-symptoms, physical/mental capacities and workability within a workplace-health-promotion project in health-care personnel. Thirty-two HCWs were enrolled in two groups based on Post-COVID-Functional Scale (PCFS) scores: (1) severe (SSG, n = 11) and (2) mild (MSG, n = 21) symptoms. The participants underwent an eight week exercise intervention program consisting of two supervised resistance exercise sessions per week plus individual aerobic exercise recommendations. Primary outcome-parameter for physical fitness was VO2peak. Further, physical function (6MWT, 30 s sit-to-stand test (30secSTS)), mental health (anxiety (GAD-7), depression (PHQ-9), stress (PSS-10), fatigue (BFI), resilience (BRS)), cognitive capacity (MoCA) and workability (WAI) were assessed at baseline, after 4 weeks and after completion of exercise intervention. VO2peak improved significantly in the SSG by 2.4 ml/kg/min (95% CI [1.48; 3.01], adj.p < 0.001) and non-significantly in the MSG by 1.27 ml/kg/min (adj.p = 0.096). Both groups significantly improved their 30secSTS (p = 0.0236) and 6MWT (p = 0.0252) outcomes in both follow-ups (4 weeks and 8 weeks after inclusion). The SSG improved more than the MSG in VO2peak and 6MWT both after 4 and 8 weeks, respectively, although not statistically significant; findings were vice versa for the 30secSTS. 30secSTS outcomes correlated significantly with mental health outcomes and workability. Post-COVID exercise intervention improved physical fitness, psychological outcomes and workability in HCWs. Cases with severe fatigue showed higher benefit levels compared to those with mild symptoms. The safe and highly feasible 30secSTS correlated well with physical and mental outcomes and better workability in COVID-19 survivors.Implications for rehabilitationPhysical exercising showed to be an effective intervention method in the rehabilitation of COVID-19 survivors suffering from post-COVID syndrome by positively affecting both physical and mental health.In health care workers suffering from post-COVID syndrome, increases in physical performance are directly related to improvements in work ability.The 30 s sit-to-stand test (30secSTS) showed promising results as clinical assessment tool.The results of this study indicate that physical exercising will need to play a large and substantial role over the next years in the rehabilitation of COVID-19 survivors suffering from post-COVID-19-syndrome as it positively affects both physical and mental dimensions of the post-COVID-19-syndrome as well as work ability. Physical exercising showed to be an effective intervention method in the rehabilitation of COVID-19 survivors suffering from post-COVID syndrome by positively affecting both physical and mental health. In health care workers suffering from post-COVID syndrome, increases in physical performance are directly related to improvements in work ability. The 30 s sit-to-stand test (30secSTS) showed promising results as clinical assessment tool. The results of this study indicate that physical exercising will need to play a large and substantial role over the next years in the rehabilitation of COVID-19 survivors suffering from post-COVID-19-syndrome as it positively affects both physical and mental dimensions of the post-COVID-19-syndrome as well as work ability.

ObjectivesOur objective was to determine whether SARS-CoV-2 antibody levels after the first dose can predict the final antibody response and whether this is dependent on the vaccine type.Methods69 BNT162b2 (Pfizer/BioNTech) and 55 AZD1222 (AstraZeneca) vaccinees without previous infection or immunosuppressive medication were included. Anti-body levels were quantified 3 weeks after dose 1, in case of AZD1222 directly before boostering (11 weeks after dose 1) and 3 weeks after dose 2, with the Roche SARS-CoV-2 S total antibody assay.ResultsPre-booster (BNT162b2: 80.6 [25.5-167.0] BAU/mL, AZD1222: 56.4 [36.4-104.8] BAU/mL, not significant) and post-booster levels (BNT162b2: 2,092.0 [1,216.3-4,431.8] BAU/mL, AZD1222: 957.0 [684.5-1,684.8] BAU/mL, pConclusionsIn conclusion, our data suggest that antibody levels quantified by the Roche Elecsys SARS-CoV-2 S assay before the booster shot could infer post-booster responses to BNT162b2, but not to AZ1222. In addition, we found a vaccine-dependent effect on antibody responses, suggesting a possible link between vaccine response and vector immunity.

Gastric acid suppression promotes allergy in mechanistic animal experiments and observational human studies, but whether gastric acid inhibitors increase allergy incidence at a population level remains uncharacterized. Here we aim to assess the use of anti-allergic medication following prescription of gastric acid inhibitors. We analyze data from health insurance records covering 97% of Austrian population between 2009 and 2013 on prescriptions of gastric acid inhibitors, anti-allergic drugs, or other commonly prescribed (lipid-modifying and antihypertensive) drugs as controls. Here we show that rate ratios for anti-allergic following gastric acid-inhibiting drug prescriptions are 1.96 (95%CI:1.95–1.97) and 3.07 (95%-CI:2.89–3.27) in an overall and regional Austrian dataset. These findings are more prominent in women and occur for all assessed gastric acid-inhibiting substances. Rate ratios increase from 1.47 (95%CI:1.45–1.49) in subjects 60 year olds. We report an epidemiologic relationship between gastric acid-suppression and development of allergic symptoms., Gastric acid inhibitors promote experimental allergy in animals, and have been linked to allergy risk in observational human studies. Here the authors show in a country-wide medical record analysis that allergy development risk is doubled in gastric acid inhibitor users, and is higher in women and in older age.

BackgroundThe COVID-19 pandemic has placed a significant burden on health care systems worldwide with health care workers (HCWs) delivering care under unprecedented conditions. This study deals with HCWs’ physical, mental, emotional and professional challenges of working during the COVID-19 pandemic and seeks to understand structural determinants of those challenges.MethodsWe carried out an exploratory qualitative study in public and private hospitals in Vienna, Austria. HCWs such as medical doctors, qualified nursing staff, nurse assistants, technical and cleaning staff in direct and indirect contact with COVID-19 patients were included. Collected data was analyzed using content analysis.FindingsWe conducted 30 semi-structured interviews in person and per phone from June 2020 to January 2021. Three overall themes resulted as relevant: challenges due to lack of preparedness, structural conditions, and physical and mental health of HCWs. Lack of preparedness included missing or delayed infection prevention and control (IPC) guidelines, shortages of personal protective equipment (PPE) combined with structural conditions such as staff shortages and overworked personnel. Physical and mental strains resulted from being overworked and working permanently on alert. Further, working in PPE, facing medical uncertainties and the critical conditions of patients were challenging factors. HCWs lacked recognition on multiple levels and dealt with social stigma and avoidance behavior of colleagues, especially in the beginning of the pandemic.InterpretationTo mitigate HCWs’ occupational health risks and staff turnover, we propose the following context-specific recommendations: Required medical personnel in care of COVID-19 patients, especially nursing staff, should be carefully planned and increased to avert chronic work overload. Intensive training and education in palliative care, as well as in IPC for all HCWs is important. Providing supportive supervision is as essential as appropriate recognition by higher level management and the public.FundingThis article has received funding from The Vienna Science and Technology Fund (WWTF) COVID-19 Rapid Response Funding 2020. The funders did not play a role in the decision to publish the article.

Background Along with the newly approved vaccines against coronavirus disease 2019 (COVID-19), first reports of allergic or intolerance reactions were published. Subsequently, questions arose whether these vaccines pose an increased risk for intolerance reactions and whether allergic patients may be at higher risk for this. Results Allergic reactions following COVID-19 vaccinations have been reported, but mostly of mild severity and at normal (Moderna®) or only slightly increased frequency (BioNTech/Pfizer®) compared to established conventional vaccines. The risk of allergic reaction to the newly licensed vector vaccines (AstraZeneca®, Johnson&Johnson®) cannot be conclusively assessed yet, but also appears to be low. There is currently no evidence that patients with allergic diseases (atopic patients) react more frequently or more severely to these vaccines. It is currently assumed that intolerance reactions of the immediate-type are either type I allergic (IgE-mediated) reactions or occur via complement activation (CARPA, “complement activation-related pseudoallergy”). Polyethylene glycol (PEG) or polysorbate, which are present as stabilizers in the vaccines, are suspected as triggers for this. Conclusion The data available so far do not show a significantly increased risk of immediate-type allergic reactions in atopic persons. In almost all cases, atopic patients can be vaccinated without problems. Standardized follow-up tests after suspected allergic reactions or CARPA-mediated reactions are currently limited.

Since the discovery of IgE, almost all attention was given to conditions with elevated specific or total IgE levels such as atopy, type I hypersensitivity reactions, or parasitic infestations. Recent prospective and retrospective studies show that having very low IgE levels, such as those seen in IgE deficiency (IgE

Epidemiologic studies report varying estimates of prevalence of orthostatic hypotension. These are mostly due to differences in age, gender, and ethnicity of study samples as well as different methods used to measure and determine orthostatic hypotension. Even as orthostatic hypotension is largely asymptomatic or only followed by minimal symptoms, studies have named orthostatic hypotension as an independent factor associated with cerebro- and cardiovascular morbidity and mortality. Orthostatic hypotension is a result of a dysfunction in the normal adaptive mechanisms of blood pressure regulation. Although the exact etiology is still unclear, different risk factors have been proposed including age, hydration status, use of medication, deconditioning as well as a number of cardiovascular and neurologic illnesses. As orthostatic hypotension remains the second most common cause of syncope and its high prevalence among older adults influencing in terms of the incidence of falls, injury, institutionalization, and hospitalization, it presents an important public health issue. The following chapter outlines studies investigating prevalence, risk factors, and the role of orthostatic hypotension in the etiological pathways of other chronic illnesses and mortality.

Allergen immunotherapy (AIT) is the only setting in which a vaccine is applied in patients allergic exactly to the active principle in the vaccine. Therefore, AIT products need to be not only effective but also safe. In Europe, for subcutaneous AIT, this has been achieved by the allergoid strategy in which IgE epitopes are destroyed or masked. In addition, adjuvants physically precipitate the allergen at the injection site to prevent too rapid systemic distribution. The choice of adjuvant critically shapes the efficacy and type of immune response to the injected allergen. In contrast to TH2-promoting adjuvants, others clearly counteract allergy. Marketed products in Europe are formulated with aluminum hydroxide (alum) (66.7%), microcrystalline tyrosine (16.7%), calcium phosphate (11.1%), or the TH1 adjuvant monophosphoryl lipid A (5.6%). In contrast to the European practice, in the United States mostly nonadjuvanted extracts and no allergoids are used for subcutaneous AIT, highlighting not only a regulatory but maybe a “historic preference.” Sublingual AIT in the form of drops or tablets is currently applied worldwide without adjuvants, usually with higher safety but lower patient adherence than subcutaneous AIT. This article will discuss how AIT and adjuvants modulate the immune response in the treated patient toward immune activation, modulation, or—with new developments in the pipeline—immune resilience.

Elevated serum IgE levels are associated with allergic disorders, parasitosis and specific immunologic abnormalities. In addition, epidemiological and mechanistic evidence indicates an association between IgE-mediated immune surveillance and protection from tumour growth. Intriguingly, recent studies reveal a correlation between IgE deficiency and increased malignancy risk. This is the first review focusing on IgE levels and links to pathological conditions, with special focus on the potential clinical significance of ultra-low serum IgE levels and risk of malignancy. In this Position Paper we discuss: a) the utility of measuring total IgE levels in the management of allergies, parasitosis, and immunodeficiencies, b) factors that may influence serum IgE levels, c) IgE as a marker of different disorders, and d) the relationship between ultra-low IgE levels and malignancy susceptibility. While elevated serum IgE is generally associated with allergic/atopic conditions, very low or absent IgE may hamper anti-tumour surveillance, indicating the importance of a balanced IgE-mediated immune function. Ultra-low IgE may prove to be an unexpected biomarker for cancer risk. Nevertheless, given the early stage of investigations conducted mostly in cohort of patients with diseases that influence IgE levels, in-depth mechanistic studies and stratification of malignancy risk based on associated demographic, immunological and clinical co-factors are warranted.

Summary Purpose The purpose of the study was to investigate whether additional reminders could enhance adherence to a 12-week program consisting of regular physical activity. Methods The study collective consisted of pensioners insured with the Austrian Insurance Fund for Civil or Public Servants. They were made aware of our program through the public service union. The subjects were randomized to an intervention group (group A) that received reminders and to a control group (group B) that did not receive such notifications. Adherence to physical activity was assessed by the use of diaries. Results Group A performed 96 min more moderate intensity regular physical activity per week than group B (group A median 269 min, r = 0–1560 min; group B median 173 min, r = 0–2700 min). The Mann–Whitney U-test showed no significant differences (p = 0.080) between the study groups. There was no difference in muscle strengthening activity (group A: median: 2, r = 0–13 sessions; group B: median: 2, r = 0–20 sessions). Conclusion The major positive observation was that both the experimental and control group participants exceeded the recommended level of physical activity. Nevertheless, there were some differences concerning the minutes of physical activity performed in favor of the intervention group.

Kidney transplantation (KTx) in end-stage renal disease is associated with a significant increase in quality of life (QoL) and self-perceived health, optimally leading to the maintenance of employment or return to work (RTW) in working-age patients. The aim of this study was to assess individual factors including the QoL and mental health of kidney transplant recipients (KTRs) associated with employment after transplantation. A cross-sectional study including working-age patients with a history of KTx after 2012 was conducted at two Austrian study centers (Vienna and Graz). Brief Symptom Inventory (BSI-18), World Health Organization Quality of Life (WHOQOL-Bref) and Workability Index (WAI) were assessed along with detailed questionnaires on employment status. Out of n = 139 KTRs (43.2 &plusmn, 9.07 years, 57.6% male), 72 (51.8%) were employed. Employed patients were more frequently in a partnership (p = 0.018) and had higher education levels (p = 0.01) and QoL scores (&lt, 0.001). Unemployed KTRs reported fatigue and mental health issues more often (p &lt, 0.001), and had significantly higher anxiety, depression and somatization scores (BSI-18). In unadjusted logistical regression, workability score (WAS, odds ratio (OR) = 3.39, 95% confidence interval (CI) = 1.97&ndash, 5.82, p &lt, 0.001), partnership (OR = 5.47, 95% CI 1.43&ndash, 20.91, p = 0.013) and no psychological counseling after KTx (OR = 0.06, 95% CI = 0.003&ndash, 0.969, p = 0.048) were independently associated with employment. Self-assessed mental health, workability and QoL were significantly associated with employment status after KTx. Thus, in order to facilitate RTW after KTx in Austria, vocational rehabilitation and RTW programs addressing KTRs should focus on increasing social support and care for their mental health.

Background Human Papillomavirus (HPV) is associated with development of oropharyngeal cancer. Aim of this review was to assess airborne transmission risk of infectious particles from HPV lesions to airway mucosa of medical staff during established ablation procedures. Methods A systematic review of human and animal studies, published before 09/2020, relevant to airborne HPV transmission. Controlled studies reporting prevalence of HPV-associated upper airway (nasal/oral/pharyngeal) disease in staff performing ablation procedures (laser, loop electrosurgical excision [LEEP], cryosurgery) on HPV lesions were included in meta-analysis. Additionally, we aimed for a comprehensive systematic overview of studies regarding occupational risk of airborne HPV transmission and safety measures during ablation procedures. Results A total of n = 30 original studies report outcomes related to HPV transmission risk in medical staff conducting ablation procedures. HPV DNA detection in ablation smoke (n = 7), matching HPV genotypes on ablated HPV lesions and face/airways of medical staff after ablation (n = 2), and evidence for infectivity of papillomavirus in ablation smoke (n = 3, animal models only) were reported. Three case reports describe occupational HPV disease of upper airway mucosa. Three controlled studies assessed warts (in CO2 laser-users only); when pooling all controls (general population, non-laser users), nasal/oral/pharyngeal lesion sites were more common amongst laser-users (OR = 5.75; 95%CI[1.55, 21.38]; p Discussion Airborne HPV dispersal with matching “high-risk” HPV-genotypes in airways of medical staff after ablations (LEEP and CO2-laser) and cases of HPV-associated upper airways neoplasms based on exposure to laser and LEEP smoke are documented. Upper airway mucosa is a more common anatomical site for warts in CO2 laser users compared to controls. Simple safety measures greatly reduce HPV contamination and transmission risk.

IgE-mediated inflammatory responses upon allergen contact in allergic rhinitis (AR) are associated with rapid alterations of circulating blood cell numbers detectable in a complete blood count (CBC). Aim of this study was to evaluate whether intake of antihistamines may modulate allergen-induced CBC dynamics in male and female patients. A total of N = 112 specific allergen challenges were performed in otherwise healthy AR subjects. Seventy-two (n = 72) subjects received placebo and forty (n = 40) received cetirizine (H1-receptor antagonist) per os prior to allergen exposure in a randomized, double-blind trial at the Vienna Challenge Chamber (VCC); a subgroup of twenty-five (n = 25) subjects received cetirizine and placebo on different study days (parallel group). Blood samples and symptom scores were taken at baseline and immediately after 6 h of airway challenge simulating ambient allergen contact. Female sex was associated with a pronounced circulating monocyte increase (p .01) and male sex with an eosinophil decrease (p .05) in the placebo group, but not in cetirizine treated subjects. The significant increase in segmented neutrophils (p .001) and decrease in circulating erythrocytes (p .01) upon allergen challenge was less prominent after cetirizine intake in both sexes. A more prominent thrombocyte increase in female subjects (p .05) was noted upon allergen exposure, regardless of prior cetirizine intake. Cetirizine inhibited the mobilization of neutrophils, lymphocytes and decline in erythrocyte numbers, but did not affect thrombocyte increase upon allergen challenge. It further diminished gender-specific blood cell dynamics. Overall, as reflected in a simple CBC, cetirizine critically diminished immediate and late innate immune responses subsequent to allergen exposure.

Elevated serum IgE levels are associated with allergic disorders, parasitosis and specific immunologic abnormalities. In addition, epidemiological and mechanistic evidence indicates an association between IgE-mediated immune surveillance and protection from tumour growth. Intriguingly, recent studies reveal a correlation between IgE deficiency and increased malignancy risk. This is the first review discussing IgE levels and links to pathological conditions, with special focus on the potential clinical significance of ultra-low serum IgE levels and risk of malignancy. In this Position Paper we discuss: (a) the utility of measuring total IgE levels in the management of allergies, parasitosis, and immunodeficiencies, (b) factors that may influence serum IgE levels, (c) IgE as a marker of different disorders, and d) the relationship between ultra-low IgE levels and malignancy susceptibility. While elevated serum IgE is generally associated with allergic/atopic conditions, very low or absent IgE may hamper anti-tumour surveillance, indicating the importance of a balanced IgE-mediated immune function. Ultra-low IgE may prove to be an unexpected biomarker for cancer risk. Nevertheless, given the early stage of investigations conducted mostly in patients with diseases that influence IgE levels, in-depth mechanistic studies and stratification of malignancy risk based on associated demographic, immunological and clinical co-factors are warranted.

Background Inhalation exposure to fine and ultrafine particles (UFPs) has been associated with respiratory diseases. However, little is known on the quality, threshold levels and concentration of these particles causing adverse health effects. Methods The impact of occupational exposure to submicrometer and UFPs was assessed in 30 healthy police shooting instructors by clinical investigation, self-assessment questionnaire, sputum and spirometry and compared to a control group. General laboratory chemistry parameters, circulating cytokines (interleukin [IL]-2, IL-4, IL-5, IL-6, IL-8, interferon-gamma [IFN-γ]), and granulocyte macrophage colony-stimulating factor (GM-CSF) in serum were measured. UFP exposure was recorded by Scanning Mobility Particle Sizer. Results Concentrations of submicrometer sized airborne particles (