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ObjectivesHigher levels of individual health literacy have been associated with better health outcomes, greater medication adherence and improved self-management of chronic conditions. Hence, higher health literacy levels are expected to be indirectly associated with lower healthcare costs. The aim of this review is to identify and synthesise available studies on the relationship between individual health literacy and healthcare costs.DesignSystematic review with qualitative evidence synthesis.Data sourcesMEDLINE, Scopus, Web of Science Core Collection and CINAHL were searched up to 7 March 2025.Eligibility criteriaWe considered only studies that investigated and quantified the relationship between individual health literacy and healthcare costs sustained by individuals, insurance companies or health providers.Data extraction and synthesisArticle screening and data extraction were performed by two authors independently. We critically appraised the identified study by using the AXIS checklist and evaluated the methodology adopted for cost analysis. Finally, we performed a qualitative synthesis of the study results.ResultsOf a total of 5801 articles identified, 23 studies met the inclusion criteria. Almost half of the studies were conducted in the USA and about one-third in European countries. The included studies showed fair average quality and great heterogeneity in health literacy measures and cost analyses. The analyses considered general medical, treatment-related, inpatient, outpatient and emergency costs, out-of-pocket expenses and financial hardship. Fifteen studies reported statistically significant results, estimating the association between health literacy and costs or evaluating the difference in costs incurred by different health literacy subgroups. All study results supported the hypothesised negative association between health literacy levels and healthcare costs.ConclusionIndividual health literacy was found to be negatively associated with a range of healthcare costs, although the supporting evidence was not always robust. Interventions aimed at containing healthcare expenditure should consider this association, while further research is needed to define its nature.PROSPERO registration numberThe review has been registered in the PROSPERO International prospective register of systematic reviews (registration code CRD42023435502).

Background Herpes Zoster (HZ) is caused by the reactivation of the varicella zoster virus (VZV). Although aging is the most well-known risk factor for herpes zoster, little is known about the strength of the association between patient-related characteristics, including comorbidities, and their contribution to an increased risk of mortality, among patients hospitalized for HZ. The aim of this study was to assess hospitalization trends and the strength of this association. Methods This retrospective population-based study, conducted among all patients hospitalized with HZ in Italy, between January 1st 2011 and December 31st 2023, analysed Hospital Discharge Records (HDR) reporting the ICD-9-CM codes related to HZ infection. Comorbidities that induce a reduced response of VZV-specific cell-mediated immunity - such as malignant neoplasms, chronic obstructive pulmonary disease, kidney diseases, diabetes mellitus, autoimmune diseases - were considered. Poisson regressions models, adjusted for age classes and sex, were used to identify factors associated with an increased risk of death. Results Between 2011 and 2023, 47,933 hospitalizations with HZ were recorded. HZ comorbidities were diagnosed in 27.71% of cases (13,280 hospitalizations). The analysis revealed that the presence of neoplasms (IRR: 3.15; 95% C.I. 2.61–3.78) and kidney disease (IRR: 2.05; 95% C.I. 1.66–2.53) increased the risk of death among patients hospitalized with HZ. In the presence of comorbidities, males had a higher risk of death than females, and age was the strongest predictor. The risk increased significantly after the age of 40, reaching an IRR of 37.16 in patients over 80 years old with neoplasms. Conclusions The findings of this Real-World study may raise awareness of the risks associated with HZ and support vaccination efforts to prevent infection, particularly among older adults and individuals with comorbidities.

Background Following the COVID-19 pandemic, distance education (DE) replaced traditional “face-to-face” teaching and has become the main method of teaching. The aim of this study was to 1) evaluate the impact of DE by teachers in our department during the second semester of the 2019–20 academic year following the March–May 2020 Italian national lockdown and 2) evaluate the relationship between DE and the emotional well-being of teachers during the period of home confinement. Methods Ninety-seven university teachers (51.5% women; most represented age group 60–69 years range, 40.2%) responded to an anonymous online cross-sectional survey between July 15 – September 30, 2020, on the advantages and disadvantages of DE, developed by one online teacher focus group. The emotional conditions were assessed by a short version of the Beck Depression Inventory-II (BDI-II). The internal consistency reliability survey and the 10-item BDI-II were measured by Cronbach’s alpha. A correlation analysis (r-Pearson) was conducted between the overall evaluation of the experience of DE and the variables included in the study. Results Teachers reported difficulties in technical aspects, and in psychological factors, as the discomfort of “speaking in the void” (64.7%). The absence of “face-to-face” eye contact with the students was complained by 81% of teachers. Significant impairments in sleep patterns and loss of energy were reported, with female teachers having greater difficulty concentrating than their male colleagues. A quarter of teachers showed depressive symptoms of varying severity. The most satisfied teachers were those most stimulated by DE (r = 0.752, p  < 0.000), who showed a lower impact of depressive symptoms (r = − 0.289, p  = 0.005). The teaching load in hours influenced the perception of disadvantages (r = 0.214, p  = 0.035) and contributed to a lower appreciation of the challenges of DE. The more significant the manifestation of depressive symptoms during the lockdown was, the greater the subjective recovery of a good emotional condition once the domestic confinement was over (r = 0.344, p  = 0.001), despite maintaining DE. Conclusions Our study highlights the impact of technical, didactic, and psychological difficulties of DE, reported by our teachers. The appreciation of their new learning promoted by DE seemed related to better emotional well-being of university teachers accepting this “challenge” in their important role in the high-education system, influencing good learning and promoting students’ professional success.

Safety in workplaces is a requirement for work sustainability. Construction workers are frequently exposed to dangerous airborne substances. While previous studies examined chemical risks in other sectors, there is limited research on occupational chemical risk perception (OCRP) among construction workers. This study focuses on evaluating OCRP in construction workers and identifying its association with socio-demographic, occupational, and training variables. In L’Aquila, Italy, a sample of male construction workers involved in post-earthquake reconstruction were enrolled in this cross-sectional study. Chemical hazard perception, occupational exposure, personal protective equipment (PPE) use, and training were all covered by our questionnaire. Although the involved 117 workers appear to be aware of dust-related risks and asbestos-related diseases, 53% think that there is no asbestos at their worksite. Respiratory protection equipment was used by 36% of the respondents. OCRP was associated with refresher training (OR = 2.56; p = 0.025); perception of noise (OR = 10.03; p = 0.027); and solar radiation (OR = 26.07; p = 0.001). Although we observed an appropriate awareness of some occupational hazards, gaps between awareness, hazard perception, and protective behavior were evident. Comprehensive site inspections and improved risk communication are necessary to assess chemical hazards and enhance work sustainability.

This study aimed to qualitatively analyze the identified use of dusty construction products in relation to hazard characteristics, occupational exposure limits, Safety Data Sheet features, and material composition. The secondary aim of the study was to explore the relationship between sustainability, expressed as Portland clinker percentage, and health-related indicators. A total of 283 Safety Data Sheets (SDSs) from six large construction companies operating in central Italy were analyzed. Data were extracted on identified use, risk classification, hazard score (H-score), occupational exposure limits (TLVs), composition, SDS update status, and clinker content. Associations between identified use and qualitative variables were explored, while differences in hazard score and clinker percentage were assessed across product categories. Univariate regression analyses were conducted to evaluate predictors of clinker content. The results show marked differences among construction products in terms of hazard profiles, exposure limits, and composition, closely linked to their intended use. Cement-containing products were predominant and associated with higher hazard scores and lower TLVs. Clinker percentage increased with product hazardousness and H-score, indicating a link between sustainability indicators and occupational risk. This study provides the first identified-use–based analysis of powdery construction materials. Overall, these findings emphasize the importance of use-specific risk assessment and targeted safety training in the construction sector.

Objectives Following an earthquake that occurred in middle Italy in 2009, the involved territory hosted in 10 years thousands of construction sites. The aim of this study is to assess inhalable, respirable, and respirable crystalline silica exposure of the construction workers involved in the rebuilding activities. Methods Six construction companies joined the study and hosted the air sampling activities. We identified four work tasks: bricklayer and similar; scaffolder and carpenter; manual demolition; other tasks. We reported 8‐h time‐weighted concentrations. Results The “All tasks” geometric mean concentration of inhalable dust was 4.73 mg/m3 and the higher, TLV exceeding exposure was observed for “Manual demolition workers” (13.92 mg/m3, GM). The “All tasks” geometric mean concentration of respirable dust was 0.25 mg/m3 and no TLV‐exceeding exposure (geometric mean values) was observed among the work‐related groups. About the respirable crystalline silica dust exposure, the “All tasks” average concentration was 0.004 mg/m3. No TLV‐exceeding exposure was observed among the whole data sample. Conclusions The comparison of the results shows that manual demolition workers are exposed to high levels of inhalable dust, exceeding the TLV‐TWA (Threshold Limit Values‐Time Weighted Average) limit of 10 mg/m3. About the respirable dust concentration, none of the analyzed work task dust concentrations exceeded the TLV‐TWA limit of 3 mg/m3 (geometric mean values). Measurements of respirable crystalline silica dust have shown levels below the threshold limit value of 0.025 mg/m3. Our findings overall match with the available scientific data.

Introduction Malignant mesothelioma is an aggressive cancer that arises from the mesothelial cells lining the pleura, peritoneum, pericardium, or tunica vaginalis. While occupational exposure accounts for most cases, nonoccupational exposures (to ionizing radiation, carbon nanotubes, and different natural fibers) remain important and under-recognized. The rarity of nonoccupational pleural mesothelioma cases with prolonged survival substantiates a detailed analysis of the presented clinical case to increase awareness and review and contribute to the scientific literature. Case presentation We present a clinical case of a 64-year-old Caucasian male patient still alive after a diagnosis in 2017 of epithelial-type pleural mesothelioma and three episodes of pleuritis accompanied by dyspnea, fever, and chest pain. The patient lived near a contaminated area but no other exposure was reported. The diagnosis was established by thoracic computed tomography scan and thoracentesis. The patient subsequently underwent chemotherapy and pneumonectomy, followed by semiannual follow-up visits that showed no evidence of disease recurrence. Conclusion This case highlights the importance of considering nonoccupational risk factors in patients with pleural mesothelioma and suggests that long-term survival can be achieved with early diagnosis and multimodal treatment. This literature review supports the need for further studies to improve the understanding and management of nonoccupational pleural mesothelioma. Learning Outcomes Recognize the significance of non-occupational risk factors in the development of pleural mesothelioma. Understand the potential benefits of early diagnosis and multimodal treatment in achieving long-term survival for patients with nonoccupational pleural mesothelioma. Analyze the presented case study and associated literature to identify gaps in current knowledge, highlighting the need for further research to improve the understanding and management of this rare condition.

Introduction Internationally, the teaching of medical humanities (MH) in medical schools is often limited to elective courses. It is therefore important to understand students’ views in order to increase their participation in these courses. Three elective courses in medical humanities have been activated at the University of L’Aquila, which constitute a single educational pathway for medical students: a course in Visual thinking strategies, a course in Narrative medicine and a course in Reflective practices. This study aims to investigate medical students’ opinions and satisfaction with these three medical humanities courses. Materials and methods We administered a questionnaire to all medical students who took a medical humanities course in the academic year 2023–2024 at the University of L’Aquila. The questionnaire aimed to assess students’ opinions on the content and usefulness of the course and to gather suggestions for improving it. The data collected were analysed both quantitatively and qualitatively, by using various qualitative analysis techniques. Results Thirty-eight students took an MH course during the selected academic year and were recruited for the survey. The survey revealed higher course participation among female students. The courses proved to be important opportunities for students to compare themselves with their colleagues. The students were very satisfied with the three courses (especially the VTS and RP courses), considering them useful for their personal, professional and social growth. They reported improving their observational, reasoning and communication skills (VTS course), developing an empathic attitude towards patients (VTS and NM courses), and learning to work in groups (RP course). They appreciated more workshops than theoretical lectures and suggested increasing the chances to practice what they learnt, also in real life. Conclusions Although some aspects can still be improved, medical humanities courses have been very successful among medical students due to their educational and social value.

Background Inorganic lead exposure is a relevant occupational health issue in many industry sectors. European regulations set specific limits for time-weighted chemical airborne exposure and for biological exposure. While blood lead monitoring is the current standard, saliva sampling offers a less invasive alternative for biomonitoring. This study evaluates the potential of salivary lead assessment as an alternative biological matrix for occupational exposure monitoring. Methods An observational study was conducted at a lead-acid battery production facility in Central Italy from July to December 2024. Ninety-two male workers participated: 46 occupationally exposed and 46 non-exposed workers. Salivary lead levels were measured using ICP-MS in all participants. Blood lead levels and personal airborne lead assessments were performed in the exposed group. Socio-demographic data were collected through self-administered questionnaires. Results Mean salivary lead levels were significantly higher in exposed workers (23.3 ± 41.4 ng/swab) compared to non-exposed workers (0.3 ± 0.6 ng/swab, p  < 0.001). A moderate positive correlation was found between environmental and salivary lead levels (ρ = 0.5587, p  = 0.0003). No significant correlations were observed between blood and salivary lead levels or between environmental and blood lead levels. Occupational exposure and alcohol consumption were significant predictors of salivary lead levels. Conclusions Saliva appears to be a promising alternative matrix for recent lead exposure monitoring, showing better correlation with environmental exposure than blood lead levels. Further research is needed to establish reference values and standardize salivary lead biomonitoring protocols.

Background Medical humanities can contribute positively to clinical practice and medical education. Therefore, in many countries, medical schools have been progressively incorporating medical humanities into their curriculum. In Italy, only a few medical schools offer a variety of medical humanities courses, often as elective. What induces Italian medical students to take a medical humanities course has not yet been explored. The aim of this study is to fill this gap by investigating whether academic performance, sociodemographic and psychological variables may influence student motivation. Methods We conducted a cross-sectional study in a medical school and collected data from 260 medical students, from the 3rd to the 6th year of the degree course. The students who chose to take a course in Medical Humanities were compared with those who chose not to take such a course, analysing numeric variables (age, grade point average, psychometric scores) and categorical variables (gender, nationality, educational level, living conditions). Motivations were investigated by open-ended questions and categorized prior to analyses. Results The two subgroups showed no significant differences in sociodemographic characteristics, except for age, which was lower for the students who chose to take a medical humanities course ( p  < 0.001). Among the psychometric scores, only the anxiety score differed significantly between the groups, being lower for the students who chose a medical humanities course ( p  < 0.05). Regarding academic performance, the number of examinations passed was similar between the groups, while the average grade was lower for the students taking the course ( p  < 0.01). Interest in the humanities and their educational potential were the main reasons for choosing to take a course in medical humanities (76.2%). Concurrent commitments and lack of time were the major obstacles to this choice (39%). Conclusions Age, anxiety levels and academic performance seem to be inversely associated with the choice to take a medical humanities course. Considering the workload due to curricular activities when planning elective courses could increase student participation.