Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Teachers’ emotions, technostress, and burnout in distance learning during the COVID-19 pandemic

During the Covid-19 pandemic, Distance Learning (DL) supported teachers and students, allowing them to have a virtual educational context in which continuing to teach, study, and interact. However, several difficulties were reported by teachers in using Information and Communication Technologies (ICT), which in turn negatively influenced their emotional state and contributed to technological stress (technostress) and burnout onset. In this study, we wanted to investigate whether experiencing negative emotions while using DL, the instruction delivery mode (i.e., online; face-to-face; blended), and the risk of technostress could predict teachers' burnout; whether active technical support from participants' institutions could represent a protective factor against burnout; if there is a difference between female and male participants in experiencing technostress. Results confirmed that negative emotions and technostress, but not the instruction delivery mode, predict burnout; support from institutions may represent a protective factor; there were no differences between male and female teachers in experiencing anxiety linked to technostress. Possible explanation for these results and implications for practice are discussed

Describing the children's body shape by means of Geometric Morphometric techniques

Introduction: Large shape variations take place during the growth process of children, including quantitative mass and size increase plus qualitative changes in their body shape. The aim of the present study is to apply Geometric Morphometric techniques in order to visualize and quantify such body shape differences in healthy children aged 6–59 months with optimal nutritional status. Materials and methods: Anthropometrical measurements of weight, height, and middle-upper arm circumference were used to assess nutritional status on a sample of 258 Senegalese (n = 154) and Spanish (n = 104) children. A set of 36 anatomical and/or osteologically-based landmarks were identified on the body of the children along with 108 semi-landmarks used to capture curvature attributes on the frontal view of the body image. A specific method was developed to place and photograph children, as well as to locate landmarks, treat images and calculate semi-landmarks. Shape differences among children were analyzed in terms of age, sex, and population origin, taking into consideration allometry effects. Results: Our results indicate significant differences in shape and size for all the three factors under study before removing size effect (p <.0001), and in shape after the size correction (p <.01). Only the ontogenetic effect persisted in the size of studied individuals after size-effects correction (p <.0001). Morphometric significant differences were described regarding age for PC1 and population origin in PC2 before removing size effect. Between-population morphometric differences were sorted along PC1 after size correction. Discussion: Geometric Morphometric techniques are useful to study morphometric changes in the anterior whole-body view of children under 5 years old, allowing a precise description of shape changes observed when age and population origin are considered.Fil: Medialdea, Laura. Universidad Autónoma de Madrid; España. Action Against Hunger Foundation; EspañaFil: Bazaco, Cayetana. Action Against Hunger Foundation; EspañaFil: D'angelo del Campo, Manuel Domingo. Universidad Nacional del Centro de la Provincia de Buenos Aires; Argentina. Universidad Autónoma de Madrid; EspañaFil: Sierra Martínez, Carlos. Action Against Hunger Foundation; EspañaFil: González José, Rolando. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto Patagónico de Ciencias Sociales y Humanas; ArgentinaFil: Vargas, Antonio. Action Against Hunger Foundation; EspañaFil: Marrodán, María Dolores. Universidad Complutense de Madrid; Españ

SURTO DE INFECÇÃO DE CORRENTE SANGUÍNEA RELACIONADO A HEPARINA POR ENTEROBACTER CLOACAE MULTIRRESISTENTE EM PACIENTES DIALÍTICOS INTERNADOS EM HOSPITAL TERCIÁRIO

Introdução/objetivo: Surtos de infecções relacionadas à hemodiálise podem ser comuns e associados a alta letalidade, frequentemente em decorrência de falha no tratamento da água ou nos processos assistenciais, desde a manipulação dos cateteres até a infusão de insumos utilizados no procedimento. Esse trabalho tem como objetivo relatar um surto de infecção de corrente sanguínea por Enterobacter cloclae multirresistente, relacionados a heparina contaminada, utilizada durante hemodiálise. Método: Estudo retrospectivo descritivo de uma série de casos de infecção de corrente sanguínea associada a hemodiálise em pacientes hospitalizados em hospital terciário em Sobral, Ceará. Resultado: Em agosto de 2023, o Serviço de Controle de Infecção hospitalar (SCIH) de um hospital terciário identificou 04 resultados de hemoculturas de pacientes com E. cloacae Multidroga-Resistente (MDR) em curto espaço de tempo (fora do padrão habitual de isolamento). Foram revisados então todos os casos ocorridos até então, quando foram identificados 33 pacientes em hemodiálise no leito, realizada por serviço terceirizado, e com resultado semelhante em hemocultura, em 2 meses. Alguns pacientes tinham hemoculturas positivas mesmo após dias de tratamento. Os desfechos foram alta (n=17/33; 56%) ou óbito (n=14/33; 44%). Dentre as fragilidades encontradas pelo Serviço de Controle de Infecção do hospital, juntamente com a equipe técnica da Vigilância Sanitária Estadual, estavam o manuseio, acondicionamento e administração de heparina. A análise microbiológica de frascos de heparina (n=4) de diferentes lotes, preparadas por manipulação pela empresa terceirizada, também evidenciou E. cloacae MDR. Cepas isoladas de sangue (n=19) e da heparina (n=2) foram submetidas a Eletroforese em Gel de campo Pulsado (PGFE), e todas se mostraram com mesmo padrão clonal. Todos os isolados eram portadores do gene blaKPC. Foram intensificadas medidas de prevenção pelo hospital e pelos órgãos reguladores e providenciada a substituição da troca do fornecedor de heparina, com resolução do surto. Conclusão: Surtos relacionados à hemodiálise podem ser de elevada letalidade, especialmente se causados por microrganismos multirresistentes. Heparina multidose aumenta o risco de surtos por fonte comum em hemodiálise. Nesse relato, o preparo, o fracionamento e o uso inadequados de heparina geraram uma fonte comum para um surto de infecção de corrente sanguínea por E. cloacae de difícil tratamento, com frequente desfecho letal

Reduced mortality risk by a polyphenol-rich diet: An analysis from the Moli-sani study

Objectives: The effect of the polyphenol content of the human diet on mortality risk is not yet fully understood. The aim of this study was to evaluate the association of a polyphenol-rich diet with mortality rate and a possible mediation effect by inflammation, in what we believe to be a novel, holistic approach. Methods: We analyzed 21 302 participants (10 980 women and 10 322 men, aged 6535 y) from the Moli-sani cohort. The participants were followed up for a median of 8.3 y. The European Prospective Investigation into Cancer and Nutrition food frequency questionnaire (FFQ) was used for dietary assessment. Flavonol, flavone, flavanone, flavanol, anthocyanin, isoflavone, and lignan intakes were calculated using European Food Information Resource\u2014Bioactive Substances in Food Information Systems and the polyphenol antioxidant content (PAC)-score was constructed to assess the total content of these nutrients in the diet. Results: Participants included in the highest quintile of intake of various polyphenol classes and subclasses presented a significant lower all-cause mortality risk compared with those in the lowest group of consumption (hazard ratio [HR] &lt; 1; P &lt; 0.05). Cox regression analyses adjusted for potential confounders indicated that participants in higher quintiles of PAC-score had lower all-cause mortality risk (HR &lt;1; P &lt; 0.05). When cause-specific mortality rates were considered, similar effects were observed for cardiocerebrovascular and cancer mortality (HR &lt;1; P &lt; 0.05). Conclusions: The polyphenol content of the diet was associated with reduced mortality risk in a Mediterranean population, possibly through an antiinflammatory mechanism

Moderate Alcohol Consumption Is Associated With Lower Risk for Heart Failure But Not Atrial Fibrillation

Objectives The aim of this study was to assess the hypothesis that alcohol consumption is associated with onset of atrial fibrillation (AF) and/or heart failure (HF). Background The connection between ethanol intake and AF or HF remains controversial. Methods The study population was 22,824 AF- or HF-free subjects (48% men, age \ue2\u89\ua535 years) randomly recruited from the general population included in the Moli-sani study, for whom complete data on HF, AF, and alcohol consumption were available. The cohort was followed up to December 31, 2015, for a median of 8.2 years (183,912 person-years). Incident cases were identified through linkage to the Molise regional archive of hospital discharges. Hazard ratios were calculated using Cox proportional hazard models and cubic spline regression. Results A total of 943 incident cases of HF and 554 of AF were identified. In comparison with never drinkers, both former and occasional drinkers showed comparable risk for developing HF. Drinking alcohol in the range of 1 to 4 drinks/day was associated with a lower risk for HF, with a 22% maximum risk reduction at 20 g/day, independent of common confounders. In contrast, no association of alcohol consumption with onset of AF was observed. Very similar results were obtained after restriction of the analyses to regular or only wine drinkers or according to sex, age, social status, or adherence to the Mediterranean diet. Conclusions Consumption of alcohol in moderation was associated with a lower incidence of HF but not with development of AF