Work context and clinical manifestations of COVID-19 in health professionals

To analyze associations between work context and clinical manifestations of COVID-19 in health professionals. Methods: This is a cross-sectional study, with health professionals from the northeast of Brazil, from the medical, nursing and physiotherapy categories from different areas of expertise. A Google Forms questionnaire was sent through social networks, gathering demographic, academic, work context, clinical manifestations and data related to testing for COVID-19 (the test performed was not specified) and whether the result confirmed infection active or presence of antibodies (categorized as positive). Pearson's chi-square test and multivariate binary logistic regression analysis were performed, with Wald's chi-square test, considering p-value <0.05, Odds Ratio and 95% confidence interval. Results: A total of 1,354 professionals agreed to participate in the study. Of these, 324 reported a positive test for COVID-19, with a prevalence of 23.9% (324/1,354). There was a statistical association between symptom onset and positive result (p=0.000). The work context characteristics related to the number of jobs, practice setting, contact with critically ill patients and employment in the capital were the independent variables associated with a positive result for COVID-19 (p<0.05). It was identified that 54.8% of the dependent variable can be related to the work sector, number of jobs, fever, loss of smell and taste. Conclusion: Health professionals from urban centers, hospitals, critical care units and those with more than one job are more affected by COVID-19, with the positive test result being closely related to the symptoms of fever, loss of smell and taste that are characteristic of the illness. © 2022 Departamento de Enfermagem/Universidade Federal de Sao Paulo. All rights reserved.

Exploring experiences of proculturation in international students during the COVID-19 pandemic

This study intends to find what are the experiences of international students semiotically adapting to unfamiliar signs in the United Kingdom before and during the COVID-19 pandemic. Semi-structured interviews were conducted with six international university students to learn about their experiences of adapting to a new country. Data were analysed using thematic analysis. Two themes were classified as dialogical self in interpersonal adaptation and linguistic elements of semiotic adaptation, each with two subthemes. Participants' experiences of merging self-constructs seem reflective of proculturation theory. The researchers termed ‘language bridges' to refer to social representations dependent on language-specific signs. Some of the participants' self-constructs relied on signs not provided by the environment during the COVID-19 pandemic. Overall, proculturation offers insight into the complex psychological and social processes of adapting to unfamiliar signs. © The Author(s) 2023.

Antibiotic use for respiratory tract infections among older adults living in long-term care facilities: a systematic review and meta-analysis.

BACKGROUND: Antibiotics are commonly prescribed for respiratory tract infections (RTIs) among older adults in long-term care facilities (LTCFs), and this contributes to the emergence of antimicrobial resistance. The objective of this study was to determine the antibiotic prescribing rate for RTIs among LTCF residents, and to analyse the antibiotic consumption patterns with the AwaRe monitoring tool, developed by the World Health Organization. METHODS: MEDLINE, EMBASE and CINAHL were searched from inception to March 2022. Original articles reporting antibiotic use for RTIs in LTCFs were included in this review. Study quality was assessed using the Joanna Briggs Institute's Critical Appraisal Checklist for Prevalence Data. A random-effects meta-analysis was employed to calculate the pooled estimates. Subgroup analysis was conducted by type of RTI, country, and study start year. RESULTS: In total, 47 articles consisting of 50 studies were included. The antibiotic prescribing rate ranged from 21.5% to 100% (pooled estimate 69.8%, 95% confidence interval 55.2-82.6%). The antibiotic prescribing rate for lower respiratory tract infections (LRTIs) was higher than the rates for viral and general RTIs. Compared with Italy, France and the USA, the Netherlands had lower antibiotic use for LRTIs. A proportion of viral RTIs were treated with antibiotics, and all the antibiotics were from the Watch group. Use of antibiotics in the Access group was higher in the Netherlands, Norway, Switzerland and Slovenia compared with the USA and Australia. CONCLUSION: The antibiotic prescribing rate for RTIs in LTCFs was high, and AWaRe antibiotic use patterns varied by type of RTI and country. Improving antibiotic use may require coordination efforts.

Inventory of Sources of Stress During Medical Education - Further Validation

Introduction: The Inventory of Academic Sources of Stress in Medical Education (IASSME) evaluates the presence and intensity of the main sources of academic stress for Portuguese Medicine students in five dimensions: Course demands/CD, Human demands/HD, Lifestyle/LS, Academic competition/AC, and Academic adjustment/AA. Objective(s): To further validate the ISSME using Confirmatory Factor Analysis and to analyze[ATP1] the psychometric properties of a new version including additional sources of stress. Method(s): Participants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls);they answered an online survey including the ISSME and other validated questionnaires: Maslach Burnout Inventory - Students Survey (MBI-SS) and Depression Anxiety and Stress Scales (DASS). Result(s): Confirmatory Factor Analysis showed that the second order model composed of five factors (the original structure by Loureiro et al. 2008), but excluding item 11 (loading=.371), presented good fit indexes (chi2 /df=3.274;RMSEA=.0581, p<.001;CFI=.917;TLI=.904, GFI=.919). The Cronbach's alfas were alpha=.897 for the total and from alpha=.669 (F2-HD) to alpha=.859 (F1-CD) for the dimensions. The expanded version, including two additional items related to lack of interest in medicine/dentistry (F6, alpha=.543) and two additional COVID-19 stress-related-items (F7, alpha=.744) also showed acceptable fit indexes (chi2 /df=3.513;RMSEA=.061, p<.001;CFI=.88.;TLI=.866, GFI=.892). This new version's alpha was of .896. Pearson correlations between ISSME and the other measures were significant (p<.01) and high: >.55 with DASS and >.50 with MBI-SS. Girls presented significantly higher ISSME scores. F6 score was significantly higher in dentistry students. Conclusion(s): This further validation study underlines that IASSME presents good validity (construct and convergent) and reliability.

Impact of the COVID-19 Pandemic on General Hospital Physicians Work and Mental Health: An International Cross Sectional Study

COVID-19 pandemic had an important impact in mental health across all countries and populations. However, health care professionals, particularly those in the front line have been subjected to increased levels of stress, workload, deterioration of work environment and working conditions while potentially being afraid of contracting the infection themselves or infecting love ones due to the higher risk of contagion when dealing with infected patients. Some studies have stressed out this impact showing increased levels of burnout, depression, hopelessness, stress and post-traumatic stress in all physicians however, the impact of the pandemic may have been different depending on the specialty. We intended to study the impact of COVID-19 pandemic for doctors working at general hospitals and liaison psychiatrists dealing with COVID-19 patients in Europe. We developed and applied online questionnaires to physicians working at general hospitals and psychiatrists working at liaison services, in different European countries (Portugal, Italy, Belgium, Greece, Poland, Croatia), in order to determine what were their working conditions and it they reported mental health symptoms during the pandemic. This questionnaire included demographic data, questions about working conditions when dealing with general and COVID patients and the Hospital Anxiety and Depression scale (HADS). It was distributed thought email and social media platforms used by doctors. This work has been approved by each local Ethics committee and all participants signed an informed consent.

"Delirium and COVID-19": From Symptomatology to Laboratorial and Neuroimaging Findings'

Introduction: The infection caused by the SARS-CoV-2 virus called COVID-19 may affect not only the respiratory system but also the central nervous system (CNS). Delirium is a frequent and serious condition in COVID-19 patients and may be caused by the direct invasion of the CNS or the induction of CNS inflammatory mediators or by indirect effects due to the systemic inflammatory status, other organ failure, prolonged mechanical ventilation time, immobilization but also social isolation. We aim to critically review literature reporting this syndrome in patients infected by the SARSCoV-2 virus with a particular emphasis on reported clinical, laboratorial and neuroimaging findings. Method(s): A state-of-the-art literature review was performed using PubMed, Embase and Web of Knowledge using the following keywords: delirium, COVID-19, SARS-Cov-2, neuroimaging, laboratorial findings. Result(s): More than 50% of patients with COVID-19 may present with delirium and in about 20% of the cases this is the primary presentation of the disorder. Previous data suggests that these patients may show a higher frequency of certain symptoms such as agitation, myoclonus, abulia, and alogia. Some distinct neuroinflammatory syndromes have been identified in patients presenting with delirium associated with the virus, namely, autoimmune encephalitis, Acute Disseminated Encephalomyelitis (ADEM) and stroke showing its potential for CNS involvement. Many of these patients present normal brain imaging, EEG and CSF findings but others have more specific laboratorial changes such as elevated creatinine kinase, elevated D-dimer levels, abnormal coagulation parameters and positive SARS-Cov-2 PCR in CSF or meningeal enhancement, ischemic stroke and perfusion changes in MRI imaging.

Inventory of Sources of Stress During Medical Education - Further Validation

Introduction The Inventory of Academic Sources of Stress in Medical Education (IASSME) evaluates the presence and intensity of the main sources of academic stress for Portuguese Medicine students in five dimensions: Course demands/CD, Human demands/HD, Lifestyle/LS, Academic competition/AC, and Academic adjustment/AA. Objectives To further validate the ISSME using Confirmatory Factor Analysis and to analyze the psychometric properties of a new version including additional sources of stress. Methods Participants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls);they answered an online survey including the ISSME and other validated questionnaires: Maslach Burnout Inventory – Students Survey (MBI-SS) and Depression Anxiety and Stress Scales (DASS). Results Confirmatory Factor Analysis showed that the second order model composed of five factors (the original structure by Loureiro et al. 2008), but excluding item 11 (loading=.371), presented good fit indexes (χ2/df=3.274;RMSEA=.0581, p<.001;CFI=.917;TLI=.904, GFI=.919). The Cronbach’s alfas were α=.897 for the total and from α=.669 (F2-HD) to α=.859 (F1-CD) for the dimensions. The expanded version, including two additional items related to lack of interest in medicine/dentistry (F6, α=.543) and two additional COVID-19 stress-related-items (F7, α=.744) also showed acceptable fit indexes (χ2/df=3.513;RMSEA=.061, p<.001;CFI=.88.;TLI=.866, GFI=.892). This new version’s α was of .896. Pearson correlations between ISSME and the other measures were significant (p<.01) and high: >.55 with DASS and >.50 with MBI-SS. Girls presented significantly higher ISSME scores. F6 score was significantly higher in dentistry students. Conclusions This further validation study underlines that IASSME presents good validity (construct and convergent) and reliability. Disclosure No significant relationships.

Insomnia and nightmare profiles during the COVID-19 pandemic in Portugal: characterization and associated factors.

OBJECTIVE/BACKGROUND: To describe and characterize insomnia symptoms and nightmare profiles in Portugal during the first six weeks of a national lockdown due to COVID-19. PATIENTS/METHODS: An open cohort study was conducted to collect information of the general population during the first wave of SARS-CoV-2/COVID-19 pandemic in Portugal. We analyzed data from 5011 participants (≥16 years) who answered a weekly questionnaire about their well-being. Two questions about the frequency of insomnia and nightmares about COVID-19 were consecutively applied during six weeks (March-May 2020). Latent class analysis was conducted and different insomnia and nightmare profiles were identified. Associations between individual characteristics and both profiles were estimated using odds ratios (ORs) and 95% confidence intervals (CI). RESULTS: Five insomnia (No insomnia, Stable-mild, Decreasing-moderate, Stable-severe, Increasing-severe) and three nightmares profiles (Stable-mild, Stable-moderate, Stable-severe) were identified. Being female, younger, perceiving their income as insufficient and feelings of fear towards COVID-19 were associated with higher odds of insomnia (Women: OR = 6.98 95%CI: 4.18-11.64; ≥60 years: OR = 0.30 95%CI: 0.18-0.53; Insufficient income: adjusted OR (aOR) = 8.413 95%CI: 3.93-16.84; Often presenting fear of being infected with SARS-CoV-2 infection: aOR = 9.13 95%CI: 6.36-13.11), and nightmares (Women: OR = 2.60 95%CI: 1.74-3.86; ≥60 years: OR = 0.45 95%CI: 0.28-0.74; Insufficient income: aOR = 2.60 95%CI: 1.20-5.20; Often/almost always presenting fear of being infected with SARS-CoV-2 infection: aOR = 6.62 95%CI: 5.01-8.74). Having a diagnosis of SARS-CoV-2 virus infection was associated with worse patterns of nightmares about the pandemic. CONCLUSIONS: Social and psychological individual factors are important characteristics to consider in the development of therapeutic strategies to support people with sleep problems during the COVID-19 pandemic.

Insomnia and nightmare profiles during the COVID-19 pandemic in Portugal: characterization and associated factors

Objective/Background To describe and characterize insomnia symptoms and nightmare profiles in Portugal during the first six weeks of a national lockdown due to COVID-19. Patients/Methods An open cohort study was conducted to collect information of the general population during the first wave of SARS-CoV-2/COVID-19 pandemic in Portugal. We analyzed data from 5011 participants (≥16 years) who answered a weekly questionnaire about their well-being. Two questions about the frequency of insomnia and nightmares about COVID-19 were consecutively applied during six weeks (March-May 2020). Latent class analysis was conducted and different insomnia and nightmare profiles were identified. Associations between individual characteristics and both profiles were estimated using odds ratios (ORs) and 95% confidence intervals (CI). Results Five insomnia (No insomnia, Stable-mild, Decreasing-moderate, Stable-severe, Increasing-severe) and three nightmares profiles (Stable-mild, Stable-moderate, Stable-severe) were identified, respectively. Being female, younger, perceiving their income as insufficient and feelings of fear towards COVID-19 were associated with higher odds of insomnia (Women: OR=6.98 95%CI:4.18-11.64;≥60 years: OR=0.30 95%CI:0.18-0.53);Insufficient income: aOR=8.413 95%CI:3.93-16.84;Often presenting fear of being infected with SARS-CoV-2 infection: aOR=9.13 95%CI:6.36-13.11), and nightmares (Women: OR=2.60 95%CI:1.74-3.86;≥60 years: OR=0.45 95%CI:0.28-0.74) Insufficient income: aOR=2.60 95%CI:1.20-5.20;Often/almost always presenting fear of being infected with SARS-CoV-2 infection: aOR=6.62 95%CI:5.01-8.74). Having a diagnosis of SARS-CoV-2 virus infection was associated with worse patterns of nightmares about the pandemic. Conclusions Social and psychological individual factors are important characteristics to consider in the development of therapeutic strategies to support people with sleep problems during COVID-19 pandemic.

Smart Supply Chain Management: The 5W1H Open and Collaborative Framework

During the Covid-19 pandemics, many companies had to cease their activities due to the scarcity of raw material supply or availability of goods' transportation modes. Simulataneously, vehicles from different enterprises were still performing similar routes, delivering goods to the same clients or nearby locations, with a small percentage of their capacity filled. The ability to optimize resource usage, re-adjust, and search for alternatives should depend on an integrated real-time decision. Open collaboration between stakeholders in terms of human resources, assets, and data sharing is vital. Industry 4.0 and mostly additive manufacturing can leverage the production closer to the client, eliminating logistic intermediaries' steps, cutting warehouse expenses and delivery costs, and promoting sustainability. Therefore, this paper proposes an adapted framework from the 5W1H (Who, Why, What, Where, When, and How) quality management methodology to organize the supply chain based on the client's personalized inputs and stakeholders' integration. © 2021 IEEE.

Work context and clinical manifestations of COVID-19 in health professionals Contexto de trabajo y manifestaciones clinicas de la COVID-19 en profesionales de salud

Objective: To analyze associations between work context and clinical manifestations of COVID-19 in health professionals. Methods: This is a cross-sectional study, with health professionals from the northeast of Brazil, from the medical, nursing and physiotherapy categories from different areas of expertise. A Google Forms questionnaire was sent through social networks, gathering demographic, academic, work context, clinical manifestations and data related to testing for COVID-19 (the test performed was not specified) and whether the result confirmed infection active or presence of antibodies (categorized as positive). Pearson's chi-square test and multivariate binary logistic regression analysis were performed, with Wald's chi-square test, considering p-value <0.05, Odds Ratio and 95% confidence interval. Results: A total of 1,354 professionals agreed to participate in the study. Of these, 324 reported a positive test for COVID-19, with a prevalence of 23.9% (324/1,354). There was a statistical association between symptom onset and positive result (p=0.000). The work context characteristics related to the number of jobs, practice setting, contact with critically ill patients and employment in the capital were the independent variables associated with a positive result for COVID-19 (p<0.05). It was identified that 54.8% of the dependent variable can be related to the work sector, number of jobs, fever, loss of smell and taste. Conclusion: Health professionals from urban centers, hospitals, critical care units and those with more than one job are more affected by COVID-19, with the positive test result being closely related to the symptoms of fever, loss of smell and taste that are characteristic of the illness.