The COVID-related mental health load of neonatal healthcare professionals: a multicenter study in Italy

Background: The COVID-19 pandemic has dramatically affected healthcare professionals’ lives. We investigated the potential mental health risk faced by healthcare professionals working in neonatal units in a multicentre cross-sectional observational study. Methods: We included all healthcare personnel of seven level-3 and six level-2 neonatal units in Tuscany, Italy. We measured the level of physical exposure to COVID-19 risk, self-reported pandemic-related stress, and mental health load outcomes (anxiety, depression, burnout, psychosomatic symptoms, and post-traumatic symptoms) using validated, self-administered, online questionnaires during the second pandemic wave in Italy (October 2020 to March 2021). Results: We analyzed 314 complete answers. Scores above the clinical cutoff were reported by 91% of participants for symptoms of anxiety, 29% for post-traumatic symptoms, 13% for burnout, and 3% for symptoms of depression. Moreover, 50% of the participants reported at least one psychosomatic symptom. Pandemic-related stress was significantly associated with all the measured mental health load outcomes, with an Odds Ratio of 3.31 (95% confidence interval: 1.87, 5.88) for clinically relevant anxiety, 2.46 (1.73, 3.49) for post-traumatic symptoms, 1.80 (1.17, 2.79) for emotional exhaustion, and 2.75 (1.05, 7.19) for depression. Female health care professionals displayed a greater risk of anxiety, and male health care professionals and nurses, of depressive symptoms. Conclusions: Despite the low direct clinical impact of COVID-19 in newborns, neonatal professionals, due to both living in a situation of uncertainty and personal exposure to contacts with parents and other relatives of the newborns, and having to carry out activities once routine and now fraught with uncertainty, displayed clear signs of mental health load outcomes. They must be considered a specific population at risk for psychological consequences during the pandemic

ADOZIONE DI UN SISTEMA DI ALERT ELETTRONICO PER LA SORVEGLIANZA E IL CONTROLLO DELLE INFEZIONI DA ACINETOBACTER BAUMANII NELL’AZIENDA OSPEDALIERO UNIVERSITARIA PISANA (A.O.U.P)

Introduzione. Acinetobacter baumannii è un importante patogeno opportunista responsabile di gravi infezioni correlate all’assistenza (ICA) La resistenza agli antimicrobici rappresenta il principale vantaggio selettivo che consente al microrganismo di diffondere in ambiente ospedaliero, considerata anche la capacità intrinseca del batterio di persistere nell’ambiente a lungo. In Italia Acinetobacter baumanii è responsabile del 5,7% delle ICA e nel 50% degli isolati è stata riscontrata resistenza combinata. La conoscenza precoce di pazienti infetti o colonizzati attraverso sistemi di alert elettronici generati dal laboratorio di microbiologia in tempo reale permette al gruppo aziendale di intervenire attraverso le misure di controllo e la terapia antiinfettiva appropriata. Metodi. A partire dai referti degli alert elettronici è stato creato un database in cui sono riportati gli identificativi del paziente, il reparto richiedente e il tipo di campione. Quotidianamente viene valutata la presenza di cluster epidemici nei reparti a maggior rischio e mensilmente viene restituito ai direttori di dipartimento un report sulle infezioni nei reparti afferenti. Sulla base della positività a campioni richiesti a scopo diagnostico o di sorveglianza, i pazienti sono distinti in colonizzati o infetti. Risultati. Dei 101 pazienti per cui abbiamo avuto almeno un alert positivo, 66 (65,3%) erano infetti e 35 (34,6%) colonizzati. I reparti ad alta intensità di cure sono risultati i più critici: Anestesia e Rianimazione di Urgenza con 17 pazienti infetti (26%) e 3 (8,5%) colonizzati; Chirurgia generale dei trapianti con 13 (20%) infetti e 10 (28,5%) colonizzati; Centro Ustioni con 5 (7,6%) infetti e 2 (5,8%) colonizzati. Il rapporto colonizzati infetti è 0,53. Conclusioni. L’implementazione del sistema di alert elettronico rappresenta un valido strumento di sorveglianza delle infezioni da Acinetobacter baumanii al fine di adottare tempestivamente misure di controllo

Convergence and divergence in Kawasaki disease and multisystem inflammatory syndrome in children: the results from the COVASAKI survey

Objective To compare Kawasaki disease (KD) and multisystem inflammatory syndrome (MIS-C) in children. Methods Prospective collection of demographics, clinical and treatment data. Assessment of type 1 interferon (IFN) score, CXCL9, CXCL10, Interleukin (IL)18, IFNγ, IL6, IL1b at disease onset and at recovery. Results 87 patients (43 KD, 44 MIS-C) were included. Age was higher in MIS-C compared to KD group (mean 31±23 vs. 94±50 months, p<0.001). Extremities abnormalities (p=0.027), mucosal involvement (p<0.001), irritability (p<0.001), gallbladder hydrops (p=0.01) and lymphadenopathy (p=0.07) were more often recorded in KD. Neurological findings (p=0.002), gastrointestinal symptoms (p=0.013), respiratory involvement (p=0.019) and splenomegaly (p=0.026) were more frequently observed in MIS-C. Cardiac manifestations were higher in MIS-C (p<0.001), although coronary aneurisms were more frequent in KD (p=0.012). In the MIS-C group, the multiple linear regression analysis revealed that a higher IFN score at onset was related to myocardial disfunction (p<0.001), lymphadenopathy (p=<0.001) and need of ventilation (p=0.024). Both CXCL9 and CXCL10 were related to myocardial disfunction (p<0.001 and p=0.029). IL18 was positively associated to PICU admission (0.030) and ventilation (p=004) and negatively associated to lymphadenopathy (0.004). IFNγ values were related to neurological involvement and lymphadenopathy (p<0.001), IL1b to hearth involvement (0.006). A negative correlation has been observed between IL6 values, heart involvement (p=0.013) and PICU admission (p<0.001). Conclusion The demographic and clinical differences between KD e MIS-C cohorts confirm previous reported data. The assessment of biomarkers levels at MIS-C onset could be useful to predict a more severe disease course and the development of cardiac complications

Recommendations for Medical Discharge Documentation and Academic Supports for University Students Recovering From Concussion

Objective: This study sought to (1) collate the experiences of university students with concussion history and academic stakeholders through interviews and (2) develop concussion management recommendations for institutions of higher learning using a multidisciplinary Delphi procedure. Setting: Remote semistructured interviews and online surveys. Participants: The first aim of this study included undergraduate university students with concussion history who did not participate in varsity athletics (n = 21; 57.1% female), as well as academic faculty/staff with experience assisting university students with their postconcussion academic needs (n = 7; 71.4% female). The second aim enrolled 22 participants (54.5% female) to serve on the Delphi panel including 9 clinicians, 8 researchers, and 5 academic faculty/staff. Design: An exploratory-sequential mixed-methods approach. Main Measures: Semistructured interviews were conducted to unveil barriers regarding the return-to-learn (RTL) process after concussion, with emergent themes serving as a general framework for the Delphi procedure. Panelists participated in 3 stages of a modified Delphi process beginning with a series of open-ended questions regarding postconcussion management in higher education. The second stage included anonymous ratings of the recommendations, followed by an opportunity to review and/or modify responses based on the group\u27s consensus. Results: The results from the semistructured interviews indicated students felt supported by their instructors; however, academic faculty/staff lacked information on appropriate academic supports and/or pathways to facilitate the RTL process. Of the original 67 statements, 39 achieved consensus (58.2%) upon cessation of the Delphi procedure across 3 main categories: recommendations for discharge documentation (21 statements), guidelines to facilitate a multidisciplinary RTL approach (10 statements), and processes to obtain academic supports for students who require them after concussion (8 statements). Conclusions: These findings serve as a basis for future policy in higher education to standardize RTL processes for students who may need academic supports following concussion

Correspondence to 'Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort'.

We read with interest the clinical study entitled ‘Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort’ by Pouletty et al.1 In this series, the authors suggest that paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PMIS-TS) may represent a new inflammatory syndrome, different from classical Kawasaki disease (KD) as it occurs at an older age, and with a higher frequency of severe myocarditis.1 Likewise to this study, our Pediatric Tuscany Network (PTN)—16 paediatric units serving a region of 593 606 people aged less than 18 years—worked out the COVASAKI survey to detect the incidence of PMIS-TS cases and the eventual rise of KD in Tuscany during COVID-19 pandemic. Between 1 February 2000 and 30 June 2020, we tracked children with PMIS-TS and KD, aiming to compare the number of KD cases in the same 5 months of the previous 5 years and overall with the total number in the last 5 years. No PMIS-TS cases were reported in our region. Ten KD children were diagnosed in 5 units (incidence two per month). Demographics, clinical and imaging findings, treatment and outcome of patients are reported in table 1. No specific intensive support was required. No coronary involvement was reported. Nasopharyngeal swabs (performed in 7/10) and serological test (available in 6/10) for SARS CoV-2 resulted negative

Sex Differences Across Concussion Characteristics in US Service Academy Cadets: A CARE Consortium Study

Objective: To describe sex differences in concussion characteristics in US Service Academy cadets. Design: Descriptive epidemiology study. Setting: Four US service academies. Participants: 2209 cadets (n = 867 females, n = 1342 males). Independent variable: Sex. Outcome measures: Injury proportion ratios (IPR) compared the proportion of injuries by sex (females referent) for injury situation, certainty of diagnosis, prolonged recovery, recurrent injuries, mental status alterations, loss of consciousness (LOC), posttraumatic amnesia (PTA), retrograde amnesia (RGA), motor impairments, delayed symptom presentation, and immediate reporting. Main results: Concussions from varsity/intercollegiate sports [IPR of 1.73, 95% confidence interval (CI) 1.43-2.10] and intramurals (IPR of 1.53, 95% CI 1.02-2.32) accounted for a larger proportion in males, whereas concussions outside of sport and military activities accounted for a smaller proportion among males (IPR of 0.70, 95% CI 0.58-0.85). The proportion of concussions with prolonged recovery was lower among males (IPR of 0.69, 95% CI 0.60-0.78), while concussions with altered mental status (IPR of 1.23, 95% CI 1.09-1.38), LOC (IPR of 1.67, 95% CI 1.17-2.37), PTA (IPR of 1.94, 95% CI 1.43-2.62), and RGA (IPR of 2.14, 95% CI 1.38-3.31) accounted for a larger proportion among males. A larger proportion of concussions that were immediately reported was observed in males (IPR of 1.15, 95% CI 1.00-2.31). Proportions of other characteristics (e.g., recurrent injuries) were not different between sexes. Conclusions: A higher proportion of concussions occurred outside of sport and military training for female cadets, who also displayed proportionally longer recovery times than males, despite males demonstrating a higher proportion of LOC, PTA, and RGA. Possible factors may include different mechanisms of injury outside of sport and military training, different biopsychosocial states associated with sex or injury context, and delayed injury reporting when outside of an observed environment, possibly secondary to perceived stigma about reporting injuries