Mental health outcomes in patients discharged after COVID-19 hospitalization: the case report of a male nurse in the context of occupational surveillance program of health care workers

This case study draws attention on mental health sequelae that emerged in the context of the COVID-19 outbreak after recovery from hospitalization, even in subjects without personal psychiatric history. The case involves a 65-year-old male shift nurse who took SARS-COV-2 infection through a co-worker and that had been hospitalized for interstitial pneumonia from April 6 to April 17. After recovery, he developed psychiatric symptoms overlapping between different dimensions of psychiatric disorders and started to be followed by the Occupational Health Department of a Major University Hospital in central Italy. He reported a score of 28 at the Peritraumatic Distress Inventory and of 39 at the Self-Rating Anxiety State. He was treated with a combination therapy of SSRI and NaSSA antidepressants with clinical remission. In this case study, authors discuss the possible overlapping role of post-traumatic stress and anxiety symptoms in patients discharged after COVID-19 hospitalization that may deserve appropriate classification, treatment and follow up with the future goal to refine clinical management of post and long COVID syndromes of subjects who present low abnormalities in other specialty investigations.Copyright © 2022 EDIZIONI MINERVA MEDICA.

Stratification of patients admitted for SARS-CoV2 infection: prognostic scores in the first and second wave of the pandemic.

To test the prognostic performance of different scores, both specifically designed for patients with COVID-19 and generic, in predicting in-hospital mortality and the need for mechanical ventilation (MV). We retrospectively collected clinical data of patients admitted to the Emergency Department of the University Hospital AOU Careggi, Florence, Italy, between February 2020 and January 2021, with a confirmed infection by SARS-CoV2. We calculated the following scores: Sequential Organ Failure Assessment (SOFA) score, CALL score, 4C Mortality score, QUICK score, CURB-65 and MuLBSTA score. The end-points were in-hospital mortality and the need for MV. We included 1208 patients, mean age 60 ± 17 years, 57% male sex. Compared to survivors, non-survivors showed significantly higher values of all the prognostic scores (4C: 13 [10-15] vs 8 [4-10]; CALL: 11 [10-12] vs 9 [7-11]; QUICK: 4 [1-6] vs 0 [0-3]; SOFA: 5 [4-6] vs 4 [4-5]; CURB: 2 [1-3] vs 1 [0-1]; MuLBSTA: 11 [9-13] vs 9 [7-11], all p < 0.001). Discriminative ability evaluated by the Receiver Operating Curve analysis showed the following values of the Area under the Curve: 0.83 for 4C, 0.74 for CALL, 0.70 for QUICK, 0.68 for SOFA, 0.76 for CURB and 0.64 for MuLBSTA. The mortality rate significantly increased in increasing quartiles of 4C and CALL score (respectively, 2, 8, 24 and 54% for the 4C score and 1, 17, 33 and 68% for the CALL score, both p < 0.001). 4C and CALL score allowed an early and good prognostic stratification of patients admitted for pneumonia induced by SARS-CoV2.

Suicidal ideation and suicide commitment in Health Care Workers during COVID-19 pandemic: a review of the literature

Introduction: Suicide represents an important public health concern since it leads to more annual deaths globally than violence, war and natural disasters combined. During this pandemic year, the phenomenon acquires even greater importance especially in the categories at risk, such as health care workers (HCWs). This review aims to analyze literature evidence regarding health care providers' suicidal ideation (SI) and suicide commitment during the first year of the COVID-19 pandemic. Methods: International databases and digital worldwide media reports were screened between March 2020 to March 2021. The authors conducted a systematic review and described evidence using a narrative approach with some focus points based on the PICO framework. Inclusion or exclusion of literature is done according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. Results: The review showed range of SI varied from 4% to 8% and the main risk factors seemed to be loneliness, not having children and personal history of mental disorders. Conclusion: SI, and in worst cases suicide commitment, seem mental health outcomes not to be underestimated, especially in an emergency that is protracting. They require monitoring by health surveillance systems with a goal of prevention and support. © 2022 Occupational Health and Safety Society of Nepal. All right reserved.

Different COVID-19 outcomes in male and female healthcare workers of University Hospital in Italy

We analyzed the different clinical outcomes in male and female healthcare workers (HCWs) infected with Covid-19, followed up over the first three months after the COVID-19 outbreak in Italy. The population under study was composed of 64 healthcare workers among the 3585 HCWs infected with COVID-19. Patients reporting dyspnea and/or needing hospitalization were classified into the “severe disease” group;HCWs with mild symptoms of Covid-19 (such as fever, dry cough, etc.), with no need for hospitalization, were classified into the “mild disease” group. The 19 % and 25.6 % of workers, among the males and females’ groups respectively, were asymptomatic. Males showed higher percentage of severe symptoms (47.1 %, vs 15.6 %). Furthermore, as regards symptomatic workers, the hospitalization was more frequent in men than in women (52.9 % vs 15.1 %). Through a binary logistic regression, with prevalence of “severe symptoms” considered as a dependent variable and “sex” and “age” as an independent variable, the Odds ratio M/F was equal to 4.8 (CI: 1.247, 18.482), whilst “age” seemed to play no role. Despite the limited size of the population under study, our results confirmed that HCW men are more likely than women to experience worse clinical outcomes. © 2022 Elsevier Masson SAS

Résultats cliniques différents de COVID-19 chez les personnels soignants masculins et féminins de l'Hôpital Universitaire en Italie Different COVID-19 outcomes in male and female healthcare workers of University Hospital in Italy

Nous avons comparé les résultats cliniques de l'infection à la Covid-19 parmi les personnels de la santé masculins et féminins, suivis pendant les trois premiers mois après l'épidémie de COVID-19 en Italie. La population étudiée était composée de 64 des 3585 travailleurs de la santé qui ont développé une infection au COVID-19. Les sujets qui ont signalé une dyspnée et/ou qui ont dû être hospitalisés ont été classés dans le groupe « maladie grave ». Les travailleurs de la santé qui ont signalé la présence de symptômes mineurs (comme fièvre, toux sèche, etc.) sans avoir besoin d’une hospitalisation ont été inclus dans le groupe « maladie bénigne ». Les personnels asymptomatiques à la COVID-19 étaient respectivement de 19 % et 25,6 % dans les groupes d'hommes et de femmes. Les hommes présentaient un taux plus élevé de symptômes graves (47.1%, Vs 15.6%). Aussi, parmi les travailleurs symptomatiques, les hommes ont eu besoin d'unehospitalisation plus fréquemment que les femmes (52.9% Vs 15.1%). Utilisant une régression logistique binaire, avec la prévalence de « symptômes graves » comme variable dépendante et « sexe » et « âge » comme variable indépendante, l’odds ratio H/F était égal à 4,8 (IC 1.247, 18.482), tandis que « âge » ne semblait pas avoir un rôle. Malgré les limites liées à la petite taille de la population étudiée, nos résultats confirment que les soignants hommes sont plus susceptibles que les femmes d'avoir des pires résultats cliniques.

Résultats cliniques différents de COVID-19 chez les personnels soignants masculins et féminins de l'Hôpital Universitaire en Italie

Résumé Nous avons comparé les résultats cliniques de l'infection à la Covid-19 parmi les personnels de la santé masculins et féminins, suivis pendant les trois premiers mois après l'épidémie de COVID-19 en Italie. La population étudiée était composée de 64 des 3585 travailleurs de la santé qui ont développé une infection au COVID-19. Les sujets qui ont signalé une dyspnée et/ou qui ont dû être hospitalisés ont été classés dans le groupe « maladie grave ». Les travailleurs de la santé qui ont signalé la présence de symptômes mineurs (comme fièvre, toux sèche, etc.) sans avoir besoin d’une hospitalisation ont été inclus dans le groupe « maladie bénigne ». Les personnels asymptomatiques à la COVID-19 étaient respectivement de 19 % et 25,6 % dans les groupes d'hommes et de femmes. Les hommes présentaient un taux plus élevé de symptômes graves (47.1%, Vs 15.6%). Aussi, parmi les travailleurs symptomatiques, les hommes ont eu besoin d'unehospitalisation plus fréquemment que les femmes (52.9% Vs 15.1%). Utilisant une régression logistique binaire, avec la prévalence de « symptômes graves » comme variable dépendante et « sexe » et « âge » comme variable indépendante, l’odds ratio H/F était égal à 4,8 (IC 1.247, 18.482), tandis que « âge » ne semblait pas avoir un rôle. Malgré les limites liées à la petite taille de la population étudiée, nos résultats confirment que les soignants hommes sont plus susceptibles que les femmes d'avoir des pires résultats cliniques. We analyzed the different clinical outcomes in male and female healthcare workers (HCWs) infected with Covid-19, followed up over the first three months after the COVID-19 outbreak in Italy. The population under study was composed of 64 healthcare workers among the 3585 HCWs infected with COVID-19. Patients reporting dyspnea and/or needing hospitalization were classified into the “severe disease” group;HCWs with mild symptoms of Covid-19 (such as fever, dry cough, etc.), with no need for hospitalization, were classified into the “mild disease” group. The 19% and 25.6% of workers, among the males and females’ groups respectively, were asymptomatic. Males showed higher percentage of severe symptoms (47.1%, Vs 15.6%). Furthermore, as regards symptomatic workers, the hospitalization was more frequent in men than in women (52.9% Vs 15.1%). Through a binary logistic regression, with prevalence of "severe symptoms" considered as a dependent variable and "sex" and “age” as an independent variable, the Odds ratio M/F was equal to 4.8 (C.I. 1.247, 18.482), whilst “age” seemed to play no role. Despite the limited size of the population under study, our results confirmed that HCW men are more likely than women to experience worse clinical outcomes.

Quarantine and Mental Health Challenges for Occupational Medicine: The Case Report of a Nurse Infected With SARS-CoV-2.

This case study draws attention to the psychosocial difficulties that emerged in the context of the coronavirus disease 2019 (COVID-19) outbreak in relation to the remote management of subjects with psychiatric vulnerabilities following exposure to prolonged quarantine. The case involves a 56-year-old hospital nurse, followed by the Occupational Health Department of a major university hospital in central Italy for mood instability in the context of a cyclothymic temperament. She was quarantined for occupationally acquired COVID-19 and remained positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via swab test for more than 2 months between March and May 2020. In this case study, we discuss the challenges presented by the risk of a prolonged quarantine in a psychologically vulnerable employee, the need for occupational medicine to provide adequate health surveillance of all health care workers during the COVID-19 pandemic, the effectiveness of telepsychiatry, and the difficulties in formulating a proper treatment strategy.