The Impact of COVID-19 Pandemic on Psychiatric Emergencies in Two Different Settings: Emergency Room and Community Mental Health Service

Background: The SARS-CoV-2 pandemic caused a public health emergency with profound consequences on the physical and mental health of individuals. Emergency Rooms (ER) and Community Mental Health Services (CMHS) played a key role in the management of psychiatric emergencies during the pandemic. The purpose of the study was to evaluate urgent psychiatric consultations (UPCs) in the ERs of the General Hospitals and in the CMHS of a Northern Italian town during the pandemic period. Methods: This monocentric observational study collected UPCs carried out in ER from 01/03/2020 to 28/02/2021 (the so-called “COVID-19 period”) and the demographic and clinical characteristics of patients who required UPCs in the 12-months period, comparing these data with those collected from 01/03/2019 to 29/02/2020 (the so-called “pre-COVID-19 period”). The same variables were collected for UPCs carried out in CMHS from 01/03/2020 to 31/01/2021 and compared with those collected from 01/03/2019 to 31/01/2020. The data were statistically analyzed through STATA 12-2011. Results: In ER, we reported a 24% reduction in UPCs during the COVID-19 period (n = 909) in comparison with the pre-COVID-19 period (n = 1,194). Differently, we observed an increase of 4% in UPCs carried out in CMHS during the COVID-19 period (n = 1,214) in comparison with the previous period (n = 1,162). We observed an increase of UPCs in ER required by people who lived in psychiatric facilities or with disability pension whereas more UPCs in CMHS were required by older people or those living in other institutions compared to the previous period. In the COVID-19 period, the most frequent reasons for UPCs in ER were aggressiveness, socio-environmental maladjustment and psychiatric symptoms in organic disorders whereas in CMHS we reported an increase of UPCs for control of psychopharmacology therapy and mixed state/mania. Conclusion: In light of our findings, we conclude that the most vulnerable people required more frequent attention and care in both ER and CMHS during pandemic, which disrupted individuals’ ability to adapt and induced many stressful reactive symptoms. In order to reduce the impact of the COVID-19 pandemic on mental health, psychological support interventions for the general population should be implemented, having particular regard for more psychologically fragile people

"It's All COVID's Fault!": Symptoms of Distress among Workers in an Italian General Hospital during the Pandemic

Background: Since the outbreak of the COVID-19 pandemic, healthcare workers (HCWs) have been faced with specific stressors endangering their physical and mental health and their functioning. This study aimed to assess the short-term psychological health of a sample of Italian HCWs and the related influencing factors. In particular, the study focused on the differences related to HCWs' gender and to having been directly in charge of COVID-19 patients or not. Methods: An online survey was administered to the whole staff of the Modena General University Hospital three months after the onset of the pandemic, in 2020. Demographic data and changes in working and living conditions related to COVID-19 were collected; mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale-Revised (IES-R). Results: 1172 out of 4788 members returned the survey (response rate = 24.5%), the male/female ratio was 30/70%. Clinically significant symptoms assessed according to the DASS-21 emerged among 21.0% of the respondents for depression, 22.5% for anxiety and 27.0% for stress. Symptoms suggestive of a traumatic reaction were reported by 19.0% of the sample. Symptoms of psychological distress were statistically associated with female gender, job role, ward, changes in lifestyle, whereas first-line work with COVID-19 patients was statistically associated with more stress symptoms. HCWs reported a significant level of psychological distress that could reach severe clinical significance and impact dramatically their quality of life and functioning. Conclusions: Considering the persistence of the international emergency, effective strategies to anticipate, recognize and address distress in HCWs are essential, also because they may impact the organization and effectiveness of healthcare systems

Instrumentos de participación pública en plusvalías urbanas en una ciudad turística intermedia: el caso de Bariloche, Argentina

Currently, intermediate tourist cities have accelerated population growth, social and spatial fragmentation, and excessive speculation that distorts the value of local land. Likewise, their local governments depend economically on resource transfers from other jurisdictions, which implies a weakening of their relative autonomy from other levels of political decision-making and conditioning to fulfill their role as a catalyst for sustainable development. The aim of the article is to investigate the instruments of public participation in urban capital gains, from a conceptual and empirical point of view. We analyze two case studies in the city of Bariloche, Argentina: obtaining land for the new Bus Terminal and the construction of the Ñireco Bridge. The results indicate that, if they are well designed in their technical aspects and have legitimacy, the instruments contribute to obtaining resources to finance urban development and contribute to a more equitable financing structure for local governments. On the one hand, the local government obtains resources, not necessarily monetary, on which it can decide freely, granting it greater autonomy in urban planning. For example, creating value in privately owned land and appropriating part of it to be used for projects of public interest. On the other hand, by reducing the expected benefit of speculating with land, they regulate the land market positively. We provide useful empirical evidence for other local governments to apply these mechanisms and promote more equitable development of cities.En la actualidad, las ciudades intermedias turísticas presentan un crecimiento poblacional acelerado, fragmentación social y espacial y una especulación excesiva que distorsiona el valor del suelo local. Asimismo, sus gobiernos locales dependen económicamente de transferencias de recursos de otras jurisdicciones, lo que supone un debilitamiento de su autonomía relativa ante otros niveles de decisión política y un condicionamiento para cumplir con su rol de dinamizador del desarrollo sostenible. El objetivo del artículo es indagar sobre los instrumentos de participación pública en las plusvalías urbanas, desde un punto de vista conceptual y empírico. Analizamos dos casos de estudio en la ciudad de Bariloche, Argentina: la obtención de tierras para la nueva terminal de ómnibus y la obra del puente del Ñireco. Los resultados indican que, si están bien diseñados en sus aspectos técnicos y tienen legitimidad, los instrumentos contribuyen a obtener recursos para financiar el desarrollo urbano y aportan a una estructura de financiamiento de los gobiernos locales más equitativa. Por un lado, el gobierno local obtiene recursos, no necesariamente monetarios, sobre los cuales puede decidir libremente, otorgándole una mayor autonomía en la planificación urbana. Por ejemplo, creando valor en el suelo de propiedad privada y apropiándose de una parte para destinarlo a proyectos de interés público. Por otro lado, al disminuir el beneficio esperado de especular con la tierra, se contribuye a regular de manera positiva el mercado del suelo. Aportamos evidencia empírica útil para que otros gobiernos locales apliquen estos mecanismos y promuevan un desarrollo de las ciudades más equitativo