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.

Information sources, trust and public health sector communication on the Covid-19 pandemic: a study on the Italian citizens' perception

Introduction: In the context of infodemic disorder Covid-19 pandemic is a health emergency which also became a communication one. Objectives: The research purpose was to understand how Italians have informed themselves about the pandemic, which sources they have mainly used, and their assessments of public health sector communication at a national and local level. Methodology: The quantitative research consists of a survey conducted through telephone interviews (CATI+CAMI techniques) with a structured questionnaire to a sample of Italians in June and July 2021. Results: On average, watching TV, talking with friends, relatives, or acquaintances, and consulting the Internet are the leading ways of gaining information on the pandemic. Official online sources of information are the most used, followed by institutional websites which played a leading role during the pandemic: regions, the Ministry of Health, and the Presidency of the Council of Ministers. 34% of respondents claim to consult official social media pages or messaging apps of national or local authorities. Conclusions: In the pandemic communication, Italians recognize the crucial role of national and local authorities and online information media systems, but diverse challenges are open for the future of public health sector communication.

Monitoring of Cardiovascular Events in Covid 19 Positive Subjects: The Biobeat System

Background: Connected health technology can enable healthcare professionals to provide multiple solutions to meet the growing demand of care and control of COVID-19 infected patients, by optimizing economic resources and extending the scope of monitoring beyond the hospital. A connected patient has the ability to monitor his state of health with tools that remotely transmit data to his doctor, help him to perform the right therapy thanks to reminder systems or electronic alerts and identifies cardiovascular alterations predictive of a worsening of the disease. An innovative mobile device, the BioBeat System with an APP that can be downloaded directly to the Smart Phone, is characterized by sensors already validated according to the regulations of the Food and Drug Administration for vital signs, the European Society Hypertension for the detection of blood pressure. Purpose(s): Wearable medical devices and the BioBeat software platform are appropriate for use in different settings for the management of acute, chronic cardiovascular, respiratory and inflammatory pathology, a tool capable of early identification of the instrumental signs of deterioration even before the exclusively clinical recognition that becomes even more difficult if we consider the patients at home. The aim of this study is to test the sensitivity and specificity of the biobeat wearable system applied in patients with paucisymptomatic COVID-19 infection (group A) and in those with previous SARS-COV2 disease discharged from the hospital who still needed post-acute monitoring (group B) and compared with clinical control, managing to determine early the clinical signs of worsening. Method(s): The data recorded by individual patients are systolic and diastolic blood pressure, heart and respiratory rate, peripheral oxygen saturation and body temperature. Thanks to these parameters it is possible to calculate the NEWS by being able to predict any adverse events early with the automatic calculation of the score. The criteria of deterioration or worsening of the clinical condition are represented by the need to hospitalize the patient, alteration of one of the criteria grouped in the ABCDE. Result(s): Table 1 summarises the demographic data of the cases enrolled. We calculated the sensitivity of the methodology related to the alerts detected and the outcome of the patients. Sensitivity was 86.3% with a 95% CI of 0.71 to 1.03 and a specificity of 7.7%. Conclusion(s): Continuous monitoring with biobeat watch showed a high sensitivity in detecting early any alerts predictive of worsening of the disease..

Sensitivity And Specificity Of The Biobeat Watch In Monitoring Covid19 Patients: Preliminary Data

Background: Connected health technology can enable healthcare professionals to provide multiple solutions to meet the growing demand of care and control of COVID-19 infected patients, by optimizing economic resources and extending the scope of monitoring beyond the hospital. An innovative mobile device, the BioBeat Watch, developed in Israel, with an APP that can be downloaded directly to the Smart Phone, is characterized by sensors already validated according to the regulations of the Food and Drug Administration for vital signs, the ECG track and the European Society Hypertension for the detection of blood pressure. Purpose(s): Wearable medical devices and the BioBeat software platform are appropriate for use in different settings for the management of acute, chronic cardiovascular, respiratory and inflammatory pathology, a tool capable of early identification of the instrumental signs of deterioration even before the exclusively clinical recognition that becomes even more difficult if we consider the patients at home.The aim of this study is to test the sensitivity and specificity of the biobeat wearable system applied in patients with paucisymptomatic COVID-19 infection (group A) and in those with previous SARS-COV2 disease discharged from the hospital who still needed post-acute monitoring (group B) and compared with clinical control, managing to determine early the clinical signs of worsening. Method(s): The data recorded by individual patients are systolic and diastolic blood pressure, heart and respiratory rate, peripheral oxygen saturation and body temperature. The criteria of deterioration or worsening of the clinical condition are represented by the need to hospitalize the patient, alteration of one of the criteria grouped in the ABCDE. Result(s): We calculated the sensitivity of the methodology related to the alerts detected and the outcome of the patients. Sensitivity was 86.3% with a 95% CI of 0.71 to 1.03 and a specificity of 7.7%. Conclusion(s): Continuous monitoring with biobeat watch showed a high sensitivity in detecting early any alerts predictive of worsening of the disease.

PAKISTAN 2021: IN PURSUIT OF A PIVOTAL ROLE IN POST-PANDEMIC SOUTH ASIA

In 2020, the government of Prime Minister Imran Khan launched an economic diplomacy project titled Economic Outreach Initiative. It aims to unlock Pakistan’s growth potential and showcase national trade, tourism and foreign investment capacities through a paradigm shift of foreign policy from geopolitics to geoeconomics. The Khan administration is committed to capitalising on the ongoing strategic partnership with China and to enhancing the relationship with Washington. In parallel, Pakistan intends to strengthen connectivity with South and Central Asian countries. South Asian regional stability is the linchpin to engineering such a transition. The United States’ disengagement with Afghanistan and the Taliban’s Kabul takeover have offered Islamabad the opportunity to become a pivotal player in the regional scenario. Islamabad’s efforts to support the Afghan peace process include consolidating solid relationships with the new rulers in Kabul and adopting a leading role in moulding the future of Afghanistan. These efforts provide impetus to galvanising Pakistan’s international legitimacy, enhancing its regional influence and fostering regional stability, allowing investments and flourishing economic relations with partner countries. Similarly, Pakistan eased its tense relations with India and announced, together with New Delhi, a ceasefire in February 2021. In an environment where the Government is unchallenged by a political opposition mainly engaged in planning the general elections of 2023, Pakistan managed to contain the Coronavirus pandemic despite facing a resurgence of internal militancy. © Viella s.r.l. & Associazione Asia Maior.

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.

P.0196 Post-traumatic stress symptoms among parents of children with covid-19 suspected infection in the acute phase of covid-19 pandemic in Italy

Background: Since the identification of a cluster of pneumonia cases in China (Wuhan) in December 2019, the COronaVIrus Disease-19 (COVID-19) outbreak rapidly spread across different countries. Italy was the first European Country to face COVID-19 Emergency and one of the most affected. The COVID-19 Emergency has forced people to change everyday life habits in response to restrictions, stimulating people's feelings of fear and physical health threat, increasing the risk of psychological adverse outcomes, such as anxiety, depression and Post-Traumatic Stress Symptoms (PTSS) [1]. A severe illness in one's child is acknowledged to be a destabilizing event, having a negative impact on parent psychological wellbeing with an increased risk of negative mental health consequences, among which PTSS throughout the development of Post-Traumatic Stress Disorder (PTSD) [2,3]. Consistently with this evidence, parents who interfaced with suspected COVID-19 infection in their children, particularly in the early acute phase of the pandemic, may have resulted a challenging population at risk for negative psychological consequences [4]. However, scant data explored this issue. Objective: The aim of the present study was to investigate psychological outcomes on parents who accessed Pediatric Emergency Departments of three University Hospitals in Italy (Azienda Ospedaliero-Universitaria Pisana, Pisa;Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi, Bologna;Fondazione IRCSS Policlinico San Matteo, Pavia) for symptoms of suspicious COVID-19 in their children during the acute phase of the COVID-19 outbreak (April, 2020), with particular attention to the onset of PTSS. Methods: 110 parents of children with suspected COVID-19 were recruited within one month from diagnostic assessment for COVID-19 and were assessed through the Impact of Event Scale-Revised (IES-R), to evaluate PTSS. Comparison of socio-demographic and clinical features between subjects with and without PTSS was performed. A logistic regression model was used to identify the factors associated with the development of PTSS. Results: 39 (35.4%) parents reported moderate to severe PTSS (IES-R score≥24). Results showed parents of children tested positive for COVID-19 being more prone to develop PTSS as compared to those whose children were negative (p<0.001). Similarly, PTSS rates were significantly higher among mothers with respect to fathers (p=0.012), among those tested positive themselves for COVID-19 compared to those negative (p=0.026) and among those who received indication to quarantine with respect to ones who had not (p<0.001). Mean age of participants was significantly lower among subjects with PTSS than those without (p=0.025). Finally, having a child tested positive for COVID-19 showed a positive association with the onset of PTSS (p=0.007). Conclusions: These results highlight the traumatic burden of children's illness on parents, particularly on the mothers that, besides representing the most vulnerable gender to post-traumatic stress reactions, often represent the principal caregiver and suggest the need of further studies to address tailored prevention and intervention strategies, also in the framework of the ongoing COVID-19 pandemic. No conflict of interest

Post-traumatic stress, anxiety, and depressive symptoms in caregivers of children tested for COVID-19 in the acute phase of the Italian outbreak.

BACKGROUND: The recent COVID-19 pandemic pointed out new burdens for researchers on mental health and that evidence-based (EB) studies on vulnerable populations are timely needed. The present paper aims at analysing the impact of suspicious of SARS-COV-2 infection in a cohort of parents presented at 3 major hospitals (spread between north and center of Italy) during the Italian COVID-19 pandemic phase 1. METHODS: Participants of the present cross-sectional, multicenter study were parental couples of children suspected to have COVID-19 who underwent testing with nasopharyngeal swabbing. All subjects were assessed by means of the: Impact of Event Scale-Revised (IES-R), Generalized Anxiety Disorder 7-Item (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) in order to evaluate Post-traumatic stress (PTSS), anxiety, and depressive symptoms, respectively. OUTCOMES: Results evidenced that parents whose children tested positive for COVID-19 were more prone to developing PTSS, anxiety and depressive symptoms. The same results emerged for parents who had quarantined as opposed to those who had not. Moreover, patients who suffered economic damage showed a higher prevalence of anxiety and depressive symptoms, whereas PTSS was more common among unemployed subjects and among mothers. INTERPRETATION: This study identified a mental health strain represented by parenting a child who tested positive for SARS-CoV-2 infection. Further EB research is needed to develop evidence-driven strategies to reduce adverse psychological impacts and related psychiatric symptoms in caregivers of COVID-19 infected children during the next phases of the pandemic.