OCCUPATIONAL PSYCHOLOGY AND MEDICINE FOR WORK-RELATED STRESS PREVENTION: A PROTOCOL ADMINISTERED IN TIMES OF COVID-19 TO MONITOR PSYCHO-PHYSICAL SYMPTOMS

Preventing stress is a primary goal for organizations. To achieve this goal in an effective way, integration between the three levels of intervention — primary, secondary, and tertiary — and between different professional figures is fundamental. A protocol (named OPhy-WRS protocol) has been imple-mented to allow occupational physicians (OPhys) and occupational psychologists (OPsys) to cooperate for secondary and tertiary prevention. The protocol aims to measure anxiety, emotional, and somatic symptoms, and sleep disorders, as well as behavioral responses that can be traced back to work-related stress. The protocol consists in a worksheet compiled by the OPhy as a result of a structured interview to be conducted during healthcare surveillance. Prior to the administration of the protocol, in the perspective of multidisciplinary cooperation, OPhys received training by OPsys. The physicians administered the protocol to 804 employees in a big Italian company. Five hundred eighty-six employees were interviewed before the pandemic outburst, the remaining 218 after March 2020: This condition created two subgroups (pre-pandemic and pandemic) that could be compared. The data obtained are useful to isolate clusters and workers that need further investigation and closer monitoring by occupational physicians. The comparison between the two groups shows a worsened scenario in terms of stress symptoms. © 2022 Cises Open Access under CC BY-NC-ND 4.0 International License.

Have we changed our work during Covid19 pandemic

Background: Pain is one of the most debilitating symptoms in oncological diagnosis, and is present in most cancer patient (in the literature range 20 to 95%). Cancer pain is a chronic pain with multifactorial pathogenesis with which intense episodic transient acute pain can coexist (Btcp). Hence the need to assess / correctly measure pain to set an appropriate drug therapy (treatment based on the 'three steps of pain' -OMS 1986-) and it is possible to have a more objective evaluation of the results of the established analgesic therapy. During the emergency period, outpatient visits were reduced both in terms of organization and frequency and the reduction in the number of doctors available and the limitations of patient access to hospital clinics for their protection led to a new approach to taking load. Material (patients) and methods: Experience of our center, from 1 March 2020 to 31 May 2020, during the covid 19 emergency compared with the pre-covid period from 1 November 2019 to 31 January 2020 regarding the evaluation of pain, the need to set specific analgesic therapy, the need to modify this therapy in the course of time (switching between opioids or association between opioids of two different classes) and the need to add adjuvant drugs. Results: During this time we followed 15 patients versus 17 patients in pre-covid period. Pain was measured in all the first evaluation (using one-dimensional measurement scales-numerical scale -), in 90% of cases this was done by telephone (versus 0% pre covid). Furthermore, the cargiver's telephone involvement was necessary, especially in monitoring over time to evaluate pain control, Btcp episodes and side effects (in the pre-covid period it was the patient who exposed these data during the visit). On the other hand, as regards the specific analgesic therapy set, the need to rotate the opioids or to associate two opioids of different classes, the prescription of the rescue dose and the adjuvant drugs, there were no differences compared to the pre-emergency period. Conclusions: During the emergency period, in consideration of the high frequency of pain and the impact on the patient's quality of life, it was necessary to modify our approach to manage the patient with cancer, make a correct assessment (repeated over time) and set up an effective analgesic therapy.

Penalty for simultaneous care during the emergency covid-19

Background: Simultaneous care represents an organizational model based on the global care of the cancer patient through continuous assistance and a progressive integration between cancer therapies and palliative care. The model responds to global needs (physical, psychological, social) of the patient and his family managed by a multidisciplinary team made up of oncologists, palliativists, radiotherapists, psychologists. As compared with cancer patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life and longer survival. In the province of Sondrio ASST Valtellina and Alto Lario has activated simultaneous care for cancer patients for about a year. Material (patients) and methods: The simultaneous care clinics are structured on defined days and times, managed by a multidisciplinary team which always involve family members. During the emergency period the surgeries underwent changes in terms of organization and frequency. The reduction in the number of doctors available and the limitations of patient access to hospital clinics for their protection have led to a significant reduction in the numbers of cancer patients treated early in simultaneous treatment. The analysis of the data defines a number of 12 cancer patients followed simultaneously in a pre-covid period from 1 November 2019 to 31 January 2020. During the covid-19 emergency, in the period from 1 March 2020 to 31 May 2020, they were followed 5 patients. On average 3 patients versus 1 in the emergency period. Results: During the covid-19 emergency, the results show a significant reduction in simultaneous care paths. In this phase, the simultaneous care clinic was managed as needed by a single professional with telephone consultations and few home visits without the direct involvement of family members. Conclusions: The reduction in simulataneous care during the emergency period penalized cancer patients who, in a moment of clinical fragility, experienced a lived experience of abandonment that affected their quality of life. In memory of dr. Fabio Rubino, Responsible for the Palliative Care Service.

Seroprevalence of SARS-COV-2 antibodies in Southern Italy's hospital staff

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the first pandemic caused by a coronavirus. Respiratory/aerial droplets transmission and the high number of "hidden" asymptomatic cases play a critical role in the rapid spread of the virus across countries. The seroprevalence of SARS-CoV-2 antibodies in the general population is currently unknown. It has been estimated that undocumented infections were the source for #80% of the documented cases before traveling restriction policies took place. Serological evaluation is essential for investigating the extent of SARS-CoV-2. Even more, assessing the prevalence of anti-SARSCoV-2 in hospital staff offers a unique opportunity to study the correlation between seroconversion and immunization because of their occupational exposure and at higher risk of contagious. Methods: The study enrolled a total of 3242 employees of our hospital, "Policlinico Riuniti" of Foggia. The employees' group was stratified in 3 subgroups according to their relative exposure to SARS-CoV-2 (high, intermediate, and low-risk groups). We used a chemiluminescent immunoassay (CLIA, Shenzhen YHLO Biotech) to study the seroprevalence of SARS-COV-2 specific antibodies (IgG and IgM against nucleocapsid and spike proteins). The cut-off was set to 8 AU/mL for both IgG and IgM (specificity of 98,8% and 100%, respectively). A control group of 83 samples sera collected before the Italian COVID-19 outbreak (2018-19) was also tested. Healthcare workers with IgG or IgM concentration above 6.0 and below 8.0 AU/mL were considered borderline. Nevertheless, all of them were tested for the SARS-CoV-2 viral RNA presence (Allplex™ 2019 n-CoV Assay, Seegene). Results: Sixty-two individuals (1.9%, 1.4-2.3%, 95% CI) tested positive for at least one antibody anti-SARS-CoV-2. Five individuals (8.0% of the positive) had IgG and IgM positive test results, while 32 and 25 had only IgG and only IgM positive results. Instead, viral RNA was detected in only nine individuals (13.8% of Ig positive) by RTPCR. The cumulative proportion of individuals who tested positive (IgG and/or IgM) varied between 1-2.4%. The seroprevalence was lower in the high-risk group 1.4% (6/428,0.5-2.6%, 95% CI) vs. intermediate-risk group 2.0 % (55/2736, 1.5-2.5%, 95% CI). Only one participant (1.3%, 0-3.8%, 95% CI) of the low-risk group tested positive for SARS-CoV-2 IgM antibodies. Conclusions: The low level of seropositivity (1.9%) shows that the COVID-19 containment measures adopted were adequate and effective. Moreover, the combination of both serological and molecular tests can improve the likelihood of identifying asymptomatic subjects.

Surgical management protocol during the COVID-19 pandemic in an Italian non-referral center

BACKGROUND: In the surgical scenario, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diffusion worldwide entails on one end the need to continue to perform surgery at least in case of emergency or oncologic surgery, in patients with or without COrona Virus Disease 2019 (COVID-19), and on the other hand, to avoid the pandemic diffusion both between patients and medical and nursing team. Aim is to report our surgical management protocol during the COVID-19 pandemic in an Italian non-referral center. METHODS: Data retrieved during the outbreak for the COVID-19 pandemic, from March 8 to May 4, 2020 (study period) were analyzed and compared to data obtained during the same period in 2019 (control period). RESULTS: During the study period 41 surgical procedures (24 electives, 17 emergency surgical procedures) underwent surgery in comparison to 99 procedures in the control period. Stratified procedures in elective and emergency surgery, and based on the indication for surgery, the only statistically significant difference was observed in the elective surgery regarding the abdominal wall surgery (0 vs. 13 procedures, p=0.0339). Statistically significant differences were not observed regarding the colorectal and the breast oncologic surgery. All stuff members were COVID-19 free. CONCLUSIONS: The present protocol proved to be safe and useful to prevent SARS-CoV-2 infection before and after surgery for both patients and stuff. The pandemic was responsible for the reduction in number of procedures performed, anyway for the oncologic surgery a statistically significant volume reduction in comparison to 2019 was not observed.