Pattern of emergency department accesses before and during the Covid-19 pandemic

Objectives. To evaluate how the characteristics of paediatric emergency department (ED) visits have changed during the SARS-CoV-2 pandemic. Methods. In a period of three months, from January 1 to March 31, for three consecutive years (2019, 2020 and 2021), paediatric accesses to the San Gerardo hospital's ED were evaluated. Sociodemographic data, information on the ED visit, the diseases that led to the ED access, and the outcome of the visit were extracted and analysed. Records were deidentified, and data were analysed using an anonymous subject code. χ2 for trend test was used for comparing the characteristics of the accesses in the 3 trimesters. Results. The overall number of ED visits decreased from 4,106 to 1,193 (-71%) over time. Independently of the observation period, the majority of visits had a low priority code (93% in 2019 and 97% in 2021), while in 2021 35% of accesses were potentially avoidable. The rate of hospitalisation after the visit increased from 10% to 18%. Upper respiratory tract infections were the most common reason for ED attendance in all the trimesters, but their prevalence decreased from 33 to 16%. On the contrary, visits for psychiatric disorders increased from 2% in 2019 to 9% in 2021. Conclusions. Despite the decrease in number of ED visits during the pandemic period, and the increase in hospitalisation rate, most of the accesses during the first trimester of 2021 were also non-urgent and one-third were potentially avoidable, underlying the need of interventions aimed at reducing the inappropriate use of the ED.

Adolescenti con disturbi psichiatrici Il Pronto soccorso dell’Ospedale San Paolo di Milano prima e durante la pandemia da SARS-CoV-2

Teenagers with psychiatric disorders in the emergency room of the San Paolo Hospital in Milan before and during the SARS-CoV-2 pandemic ►Objectives. To evaluate how the frequency and characteristics of emergency department (ED) visits made by adolescents with mental disorders have changed during the SARS-CoV-2 pandemic. ►Methods. A retrospective chart review of adolescents (11-17 years) visited in the ED of the San Paolo University Hospital in Milan for a mental disorder between January 2019 and December 2020 was conducted. We extracted and analysed sociodemographic data, information about the ED visit, the mental disorder that led to the visit, and the outcome of the visit. An anonymous code was assigned to each subject. ►Results. The overall number of ED visits decreased from 4,330 to 2,678 (-38%), and those for mental disorders from 242 to 203 (-16%). An increase in the proportion of the total number of visits was observed, from 5,6 to 7,6% (χ2M-H=11,0, p=0,001). No significant differences across years were recorded in the distribution of the accesses by the urgency code at the triage and by mental disorders. A significantly lower percentage of patients (39 vs 54%, p=0,003) received a psychotropic drug (administered or prescribed) in the ED in 2020. There were no differences in the hospitalization rate (21.9 in 2019 versus 23.6% in 2020). ►Conclusions. During the first year of the Covid-19 pandemic a surge in the prevalence of ED visits associated with mental disorders was observed. This may be related to the impact of the pandemic, and the restrictive measures implemented, on mental health in the developing age.

Psychological distress and changes in routine during quarantine: interviews with students living in Milan

▸Background. The Covid-19 outbreak has resulted in governments implementing disease containment measures such as school closures, social distancing, and home quarantine. To date, only a few studies have drawn attention to the psychological impact of lockdown on Italian children's mental health. The present study aimed to investigate the psychological distress (anxiety and mood symptoms) and perceived changes in routine among Italian primary and middle school students during the Covid-19 quarantine. ▸Methods. This interview study was performed between the 18th of May and 7th of June 2020: it involved a sample of 82 children and adolescents living in Milan (Italy), attending primary and middle school (aged 6 to 14 years), and their parents. ▸Results. Almost 30% of the subjects reported having struggled to adjust to home learning. 36 responders completely changed their dietary habits during the lockdown: they were not eating the same amount of food and were consuming more junk food. Sleep habits were also affected by the lockdown measures: 28% of the sample had difficulties sleeping and wished to sleep in their parents' bed. Concerning psychological distress, 64 (78%) children and adolescents had anxiety symptoms;43.9% of the students reported significant mood symptoms. ▸Conclusions. Children are not indifferent to the dramatic impact of the Covid-19 epidemic: our data confirm their difficulties in adapting to the quarantine measures. The effects of stress exposure may not manifest later on during the children's development, and, for this reason, it would be interesting to follow up on these participants to improve our understanding of how long these outcomes may last.

Psychological impact of the quarantine during the COVID-19 pandemic on the general European adult population: a systematic review of the evidence.

AIMS: Due to the coronavirus disease 2019 (COVID-19) different countries implemented quarantine measures to limit the spread of the virus. Many studies analysed the mental health consequences of restrictive confinement, some of which focused their attention on specific populations. The general public's mental health also requires significant attention, however. This study aimed to evaluate the effects of the COVID-19 quarantine on the general population's mental health in different European countries. Risk and protective factors associated with the psychological symptoms were analysed. METHODS: A systematic search was conducted on four electronic databases (PubMed, PsycINFO, Scopus and Google Scholar). Studies published up until 20th April 2021, and following eligibility criteria were selected for this review. One thousand three hundred thirty-five (1335) studies were screened, 105 of which were included. Via network analysis, the current study investigated the pathways that underlie possible risk factors for mental health outcomes. RESULTS: Anxiety, depression, distress and post-traumatic symptoms are frequently experienced during the COVID-19 quarantine and are often associated with changes in sleeping and eating habits. Some socio-demographic and COVID-19-related variables were found to be risk factors for an individual's wellbeing. In particular, being female, young, having a low income, being unemployed and having COVID-19-like symptoms or chronic disorders, were found to be the most common risk factors for mental health symptoms. CONCLUSIONS: The COVID-19 pandemic represented an unprecedented threat to mental health globally. In order to prevent psychological morbidity and offer support tailored to short-, medium- and long-term negative outcomes, it is essential to identify the direct and indirect psychosocial effects of the lockdown and quarantine measures, especially in certain vulnerable groups. In addition to measures to reduce the curve of viral transmission, policy makers should urgently take into consideration provisions to alleviate hazards to mental health.

Risk of sequelae of COVID-19 in children cared for by primary care pediatricians

148 Italian children (n=148) suspected of and evaluated for COVID-19 infection during the first phase of the pandemic were followed-up for 6 months. During the follow-up period, no difference in the prevalence of new-onset respiratory, dermatological or neurological symptoms, nor in psychological distress, were observed in children who were positive and negative for SARS-CoV-2.

Risk of Sequelae of COVID-19 in Children Cared for by Primary Care Pediatricians

148 Italian children (n=148) suspected of and evaluated for COVID-19 infection during the first phase of the pandemic were followed-up for 6 months. During the follow-up period, no difference in the prevalence of new-onset respiratory, dermatological or neurological symptoms, nor in psychological distress, were observed in children who were positive and negative for SARS-CoV-2.

Risk of Sequelae of COVID-19 in Children Cared for by Primary Care Pediatricians

148 Italian children (n=148) suspected of and evaluated for COVID-19 infection during the first phase of the pandemic were followed-up for 6 months. During the follow-up period, no difference in the prevalence of new-onset respiratory, dermatological or neurological symptoms, nor in psychological distress, were observed in children who were positive and negative for SARS-CoV-2.

Interviewing children: the impact of the COVID-19 quarantine on children's perceived psychological distress and changes in routine.

BACKGROUND: The COVID-19 outbreak has resulted in governments implementing disease containment measures such as school closures, social distancing, and home quarantine. To date, only a few studies have drawn attention to the psychological impact of lockdown on Italian children's mental health. The present study aimed to investigate the psychological distress (anxiety and mood symptoms) and perceived changes in routine among Italian primary and middle school students during the COVID-19 quarantine. METHODS: This interview study was performed between the 18th of May and 7th of June 2020: it involved a sample of 82 children and adolescents living in Milan (Italy), attending primary and middle school (aged 6 to 14 years), and their parents. RESULTS: Almost 30 % of the subjects reported having struggled to adjust to home learning. 36 responders completely changed their dietary habits during the lockdown: they were not eating the same amount of food and were consuming more junk food. Sleep habits were also affected by the lockdown measures: 28 % of the sample had difficulties sleeping and wished to sleep in their parents' bed. Concerning psychological distress, 64 (78 %) children and adolescents had anxiety symptoms; 43.9 % of the students reported significant mood symptoms. CONCLUSIONS: Children are not indifferent to the dramatic impact of the COVID-19 epidemic: our data confirm their difficulties in adapting to the quarantine measures. The effects of stress exposure may not manifest later on during the children's development, and, for this reason, it would be interesting to follow up on these participants to improve our understanding of how long these outcomes may last.