[Depressive Symptoms in Healthcare Workers Two Years After the Start of the COVID-19 Pandemic in Bogotá, Colombia]. / Síntomas depresivos en trabajadores de la salud dos años después del inicio de la pandemia COVID-19 en Bogotá, Colombia.

Introduction: During the COVID-19 pandemic, different events arose worldwide, including the impact on the mental health of health personnel. Our main aim was to determine the association between sociodemographic, clinical, tobacco and alcohol abuse, and fear of COVID-19 variables with the presence of depressive symptoms in a healthcare facility, in Bogotá DC, in 2022. Materials and methods: Analytical cross-sectional study. Sociodemographic and clinical variables, alcohol and tobacco abuse, and fear of COVID-19 were explored. The presence and severity of depressive symptoms were evaluated with the PHQ-9 scale. Descriptive analysis and chi-square tests were performed. Statistically significant variables (P < .05) were entered into a logistic regression model with depressive symptoms as the dependent variable. Results: 597 people were included, 80% female. The median age was 34 years (Interquartile Range [IQR]: 28-41. The prevalence of depressive symptoms was 12.4% (95% CI: 9,74-15,05). The multivariate analysis showed that fear of COVID-19, tobacco use, age under 28, and middle socioeconomic status were the factors that best explained the presence of depressive symptoms. Conclusions: Two years after COVID-19 was declared a pandemic, the prevalence of depressive symptoms is 12.4%. It is necessary to carry out strategies to promote mental health in health professionals.

[Depressive Symptoms in Healthcare Workers Two Years After the Start of the COVID-19 Pandemic in Bogotá, Colombia]. / Síntomas depresivos en trabajadores de la salud dos años después del inicio de la pandemia COVID-19 en Bogotá, Colombia.

Introduction: During the COVID-19 pandemic, different events arose worldwide, including the impact on the mental health of health personnel. Our main aim was to determine the association between sociodemographic, clinical, tobacco and alcohol abuse, and fear of COVID-19 variables with the presence of depressive symptoms in a healthcare facility, in Bogotá DC, in 2022. Materials and methods: Analytical cross-sectional study. Sociodemographic and clinical variables, alcohol and tobacco abuse, and fear of COVID-19 were explored. The presence and severity of depressive symptoms were evaluated with the PHQ-9 scale. Descriptive analysis and chi-square tests were performed. Statistically significant variables (P < .05) were entered into a logistic regression model with depressive symptoms as the dependent variable. Results: 597 people were included, 80% female. The median age was 34 years (Interquartile Range [IQR]: 28-41. The prevalence of depressive symptoms was 12.4% (95% CI: 9,74-15,05). The multivariate analysis showed that fear of COVID-19, tobacco use, age under 28, and middle socioeconomic status were the factors that best explained the presence of depressive symptoms. Conclusions: Two years after COVID-19 was declared a pandemic, the prevalence of depressive symptoms is 12.4%. It is necessary to carry out strategies to promote mental health in health professionals.

Time Does Matter: Reduced Internal Medicine Clerkship Clinical Experiences Due to COVID-19.

Introduction The coronavirus disease 2019 (COVID-19) pandemic has affected medical education in many ways. The Association of American Medical Colleges (AAMC) temporarily suspended clinical student rotations, calling for a transition to remote learning. Unfortunately, due to the heavy impact of COVID-19 in our South Florida community, medical students were not able to return to in-person activities for a significant time. During this period, students had remote clerkship learning activities, didactic sessions, narrative projects, and small-group learning sessions, which were front-loaded using Zoom technology (Zoom Video Communications, Inc., San Jose, California, United States) and web-based learning tools. Once in-person clinical experiences resumed, the duration of all third-year clerkships for the remainder of the year was reduced to five weeks to allow for timely graduation. The Herbert Wertheim College of Medicine (HWCOM) Internal Medicine (IM) clerkship has traditionally been an eight-week-long rotation. Other clerkships that varied from six to eight weeks were similarly reduced to five weeks. We hypothesized that the shortened duration of the IM clerkship would have negative impacts on National Board of Medical Examiners (NBME) exam performance and clerkship clinical experiences would likely be affected. Methods We compared the NBME subject exam results and end of clerkship evaluations from the Class of 2021 (CO2021) which had the traditional eight weeks of patient care, with the CO2022, which had only five weeks of in-person patient care. A T-test analysis was performed comparing performance on the NBME medicine clinical subject exam between students who completed the usual eight-week rotation versus those who completed a five-week rotation. We also evaluated the IM clerkship course evaluation and analyzed student responses and ratings to assess any areas that were statistically significant when comparing the traditional eight-week IM clerkship to the shortened five-week clerkship. Results There was no statistically significant difference (t=0.68, p<0.4951) in mean NBME subject exam performance between cohorts. Students who completed the shortened five-week IM clerkship indicated there was limited volume and diversity of patients, which consequently affected their ability to complete all the required clinical experiences for the IM clerkship. These results indicated a statistically significant difference between the two cohorts (t =3.33, p<.001). Conclusion Students with shortened IM clerkship clinical care time (five weeks) were found to have no significant statistical differences in NBME subject exam performance compared to the traditional eight-week cohorts. However, students felt there was a decreased volume and diversity of patients, and they reported greater difficulties in completing the required clinical experiences, with diminished clinical confidence. Time does matter, and clinical time is very valuable for a student's undergraduate medical education. If another pandemic were to arise, the duration of different clerkships should be carefully assessed and individualized, and methods to assess and reclaim lost clinical time during the advanced clinical and postgraduate years should be considered.

SÍNTOMAS DEPRESIVOS EN TRABAJADORES DE LA SALUD DOS AÑOS DESPUÉS DEL INICIO DE LA PANDEMIA COVID-19 EN BOGOTÁ, COLOMBIA DEPRESSIVE SYMPTOMS IN HEALTHCARE WORKERS TWO YEARS AFTER THE START OF THE COVID-19 PANDEMIC IN BOGOTÁ, COLOMBIA

Introducción: Con el advenimiento de la pandemia por COVID-19, surgieron diferentes acontecimientos a nivel mundial, entre ellos la afectación de la salud mental del personal sanitario. El objetivo de este estudio fue determinar la asociación entre variables sociodemográficas, clínicas, de consumo de tabaco y alcohol y miedo al COVID-19 con la aparición de síntomas de depresión en una Institución Prestadora de Servicios de Salud (IPS), en Bogotá DC, en 2022. Métodos: Estudio transversal analítico, se exploraron variables sociodemográficas, clínicas, consumo de alcohol, tabaco, miedo al COVID-19. La presencia y gravedad de los síntomas depresivos se evaluó con la escala PHQ-9, se realizó un análisis descriptivo de las variables independientes, se realizaron pruebas de chi cuadrado y se consideró un valor p<0.05 como estadísticamente significativo. Las variables que resultaron estadísticamente significativas fueron ingresadas a un modelo de regresión logística con "síntomas depresivos” como variable dependiente. Resultados: Se incluyeron 597 personas (80% mujeres), con una edad mediana de 34 años (RIC 28-41). La prevalencia de síntomas depresivos fue 12.4% (IC95%=9,74-15,05). El análisis multivariado mostró que los factores que mejor explicaron la presencia de síntomas depresivos fueron: miedo al COVID-19, consumo de tabaco, edad menor a 28 años, estrato socioeconómico medio. Conclusiones: A dos años de que el COVID-19 fuera declarado una pandemia, la prevalencia de síntomas depresivos es del 12.4%. Se requiere implementar estrategias en pro la salud mental de los profesionales sanitarios.

Complete Street strategies in cycleways applied in district with high delivery demand to reduce travel costs

Currently, the implementation of bicycle lanes is one of the main ways to improve the dense traffic existing in the main cities of each country. This is because they take the bicycle and use it as a sustainable means of transportation that, in addition to caring for the environment, helps to reduce the vehicular load directly. However, many cities have started with a distribution of their streets that initially focused only on motorized vehicles and did not consider the consequences that this would entail. This, and with the advent of COVID-19, many of the bicycle lanes have been implemented in an improvised manner, sacrificing aspects such as safety, connectivity and the level of impact on other modes of transport. Faced with this problem, the study proposes an analysis from a different point of view than the conventional one, applying "Complete Street"(CS) strategies, seeking a new proposal that satisfies not only the needs of cyclists, but also the balance between all users who interact with the streets. This article will take the current scenario of an area with a high demand for delivery in the city of Lima, Peru;an area that includes 5 districts of Lima with a high population rate, will compare it with a proposal for a regularized bicycle lane layout under the criteria of CS, and will analyze with the software Grafos under the Graph Theory the trip times between the main points of demand and supply. The effectiveness of the proposal was validated through projected user surveys, meeting all the criteria that make up the CS and the acceptance of all stakeholders. The results obtained through the graph compared the travel times for both the current scenario and the proposed bicycle lanes, which managed to demonstrate an existing improvement in travel times (minutes) between the main generating and attracting points, reducing them by 75% and 60% compared to the current scenario. © 2022 IEEE.

Time Does Matter: Reduced Internal Medicine Clerkship Clinical Experiences Due to COVID-19

Introduction The coronavirus disease 2019 (COVID-19) pandemic has affected medical education in many ways. The Association of American Medical Colleges (AAMC) temporarily suspended clinical student rotations, calling for a transition to remote learning. Unfortunately, due to the heavy impact of COVID-19 in our South Florida community, medical students were not able to return to in-person activities for a significant time. During this period, students had remote clerkship learning activities, didactic sessions, narrative projects, and small-group learning sessions, which were front-loaded using Zoom technology (Zoom Video Communications, Inc., San Jose, California, United States) and web-based learning tools. Once in-person clinical experiences resumed, the duration of all third-year clerkships for the remainder of the year was reduced to five weeks to allow for timely graduation. The Herbert Wertheim College of Medicine (HWCOM) Internal Medicine (IM) clerkship has traditionally been an eight-week-long rotation. Other clerkships that varied from six to eight weeks were similarly reduced to five weeks. We hypothesized that the shortened duration of the IM clerkship would have negative impacts on National Board of Medical Examiners (NBME) exam performance and clerkship clinical experiences would likely be affected. Methods We compared the NBME subject exam results and end of clerkship evaluations from the Class of 2021 (CO2021) which had the traditional eight weeks of patient care, with the CO2022, which had only five weeks of in-person patient care. A T-test analysis was performed comparing performance on the NBME medicine clinical subject exam between students who completed the usual eight-week rotation versus those who completed a five-week rotation. We also evaluated the IM clerkship course evaluation and analyzed student responses and ratings to assess any areas that were statistically significant when comparing the traditional eight-week IM clerkship to the shortened five-week clerkship. Results There was no statistically significant difference (t=0.68, p<0.4951) in mean NBME subject exam performance between cohorts. Students who completed the shortened five-week IM clerkship indicated there was limited volume and diversity of patients, which consequently affected their ability to complete all the required clinical experiences for the IM clerkship. These results indicated a statistically significant difference between the two cohorts (t =3.33, p<.001). Conclusion Students with shortened IM clerkship clinical care time (five weeks) were found to have no significant statistical differences in NBME subject exam performance compared to the traditional eight-week cohorts. However, students felt there was a decreased volume and diversity of patients, and they reported greater difficulties in completing the required clinical experiences, with diminished clinical confidence. Time does matter, and clinical time is very valuable for a student's undergraduate medical education. If another pandemic were to arise, the duration of different clerkships should be carefully assessed and individualized, and methods to assess and reclaim lost clinical time during the advanced clinical and postgraduate years should be considered.

Early increase of serum ferritin among COVID-19 patients is associated with need of invasive mechanical ventilation and with in-hospital death.

BACKGROUND: COVID-19 may trigger an acute hyperinflammatory syndrome characterised by heightened levels of acute phase reactants and is associated with adverse outcomes among hospitalised individuals. The relationship between 48-hour changes in acute phase reactants and adverse outcomes is unclear. This study evaluated the relationship between change in four acute phase reactants (interleukin-6, procalcitonin, ferritin, and C-reactive protein), and the risk for in-hospital death and invasive mechanical ventilation. METHODS: A retrospective cohort among 2,523 adult patients hospitalised with COVID-19 pneumonia was conducted. Changes in IL-6, procalcitonin, ferritin, and CRP from admission to 48 h after admission were recorded. Delta was calculated using the difference in each acute phase reactant at admission and at 48-hours. Delta in acute phase reactants and the risk for in-hospital death and invasive mechanical ventilation was assessed using logistic regression models adjusting for demographics and comorbidities. RESULTS: Patients with both admission and 48-hour measurement for interleukin-6 (IL-6) (n = 541), procalcitonin (n = 828), ferritin (n = 1022), and C-reactive protein (CRP) (n = 1919) were included. Baseline characteristics were similar across all four populations. Increases in ferritin associated with a heightened risk of in-hospital death (OR 1.00032; 95%CI 1.00007- 1.00056; p < .001) and invasive mechanical ventilation (OR 1.00035; 95%CI 1.00014- 1.00055; p = .001). Therefore, for every 100 ng/mL increase in ferritin, the odds for in-hospital death and invasive mechanical ventilation increase by 3.2% and 3.5%, respectively. CONCLUSIONS: Delta in ferritin is associated with in-hospital death and invasive mechanical ventilation. Other acute phase reactants were not associated with these outcomes among COVID-19 inpatients.

Novel Models of Genetic Education and Testing for Pancreatic Cancer Interception: Preliminary Results from the GENERATE Study.

Up to 10% of patients with pancreatic ductal adenocarcinoma (PDAC) carry underlying germline pathogenic variants in cancer susceptibility genes. The GENetic Education Risk Assessment and TEsting (GENERATE) study aimed to evaluate novel methods of genetic education and testing in relatives of patients with PDAC. Eligible individuals had a family history of PDAC and a relative with a germline pathogenic variant in APC, ATM, BRCA1, BRCA2, CDKN2A, EPCAM, MLH1, MSH2, MSH6, PALB2, PMS2, STK11, or TP53 genes. Participants were recruited at six academic cancer centers and through social media campaigns and patient advocacy efforts. Enrollment occurred via the study website (https://GENERATEstudy.org) and all participation, including collecting a saliva sample for genetic testing, could be done from home. Participants were randomized to one of two remote methods that delivered genetic education about the risks of inherited PDAC and strategies for surveillance. The primary outcome of the study was uptake of genetic testing. From 5/8/2019 to 5/6/2020, 49 participants were randomized to each of the intervention arms. Overall, 90 of 98 (92%) of randomized participants completed genetic testing. The most frequently detected pathogenic variants included those in BRCA2 (N = 15, 17%), ATM (N = 11, 12%), and CDKN2A (N = 4, 4%). Participation in the study remained steady throughout the onset of the Coronavirus disease (COVID-19) pandemic. Preliminary data from the GENERATE study indicate success of remote alternatives to traditional cascade testing, with genetic testing rates over 90% and a high rate of identification of germline pathogenic variant carriers who would be ideal candidates for PDAC interception approaches. PREVENTION RELEVANCE: Preliminary data from the GENERATE study indicate success of remote alternatives for pancreatic cancer genetic testing and education, with genetic testing uptake rates over 90% and a high rate of identification of germline pathogenic variant carriers who would be ideal candidates for pancreatic cancer interception.

Severe COVID-19 is marked by dysregulated serum levels of carboxypeptidase A3 and serotonin.

The immune response plays a critical role in the pathophysiology of SARS-CoV-2 infection ranging from protection to tissue damage and all occur in the development of acute respiratory distress syndrome (ARDS). ARDS patients display elevated levels of inflammatory cytokines and innate immune cells, and T and B cell lymphocytes have been implicated in this dysregulated immune response. Mast cells are abundant resident cells of the respiratory tract and are able to release different inflammatory mediators rapidly following stimulation. Recently, mast cells have been associated with tissue damage during viral infections, but their role in SARS-CoV-2 infection remains unclear. In this study, we examined the profile of mast cell activation markers in the serum of COVID-19 patients. We noticed that SARS-CoV-2-infected patients showed increased carboxypeptidase A3 (CPA3) and decreased serotonin levels in their serum when compared with symptomatic SARS-CoV-2-negative patients. CPA3 levels correlated with C-reactive protein, the number of circulating neutrophils, and quick SOFA. CPA3 in serum was a good biomarker for identifying severe COVID-19 patients, whereas serotonin was a good predictor of SARS-CoV-2 infection. In summary, our results show that serum CPA3 and serotonin levels are relevant biomarkers during SARS-CoV-2 infection. This suggests that mast cells and basophils are relevant players in the inflammatory response in COVID-19 and may represent targets for therapeutic intervention.

SEVERE COVID-19 IS MARKED BY DYSREGULATED SERUM LEVELS OF CARBOXYPEPTIDASE A3 AND SEROTONIN (preprint)

The immune response plays a critical role in the pathophysiology of SARS-CoV-2 infection ranging from protection to tissue damage. This is observed in the development of acute respiratory distress syndrome when elevated levels of inflammatory cytokines are detected. Several cells of the immune response are implied in this dysregulated immune response including innate immune cells and T and B cell lymphocytes. Mast cells are abundant resident cells of the respiratory tract, able to rapidly release different inflammatory mediators following stimulation. Recently, mast cells have been associated with tissue damage during viral infections, but little is known about their role in SARS-CoV-2 infection. In this study we examined the profile of mast cell activation markers in the serum of COVID-19 patients. We noticed that SARS-CoV-2 infected patients showed increased carboxypeptidase A3 (CPA3), and decreased serotonin levels in their serum. CPA3 levels correlated with C-reactive protein, the number of circulating neutrophils and quick SOFA. CPA3 in serum was a good biomarker for identifying severe COVID-19 patients, while serotonin was a good predictor of SARS-CoV-2 infection. In summary, our results show that serum CPA3 and serotonin levels are relevant biomarkers during SARS-CoV-2 infection, suggesting that mast cells are relevant players in the inflammatory response in COVID-19, might represent targets for therapeutic intervention.

Telepsychotherapy with Youth at Clinical High Risk for Psychosis: Clinical Issues and Best Practices during the COVID-19 Pandemic.

Early detection and prevention of psychosis has become an international priority. Much of this work has focused on youth presenting with attenuated symptoms of psychosis-those at Clinical High Risk for psychosis (CHR)-given their elevated probability of developing the full disorder in subsequent years. Individuals at CHR may be prone to exacerbated psychological distress during the COVID-19 pandemic and its subsequent physical isolation measures, due to heightened stress sensitivity and comorbid mental health problems. Telepsychotherapy holds promise for reaching this population, especially during the current COVID-19 outbreak. However, there are limited evidence-based guidelines or interventions for use of telepsychotherapy with this population. In this paper, we review common clinical issues for individuals at CHR and how they might be exacerbated by the COVID-19 pandemic; best practices for treatment and adaptations for telepsychotherapy for individuals at CHR; and highlight real clinical issues that we are currently experiencing in a United States-based specialized CHR clinic as we conduct telepsychotherapy via videoconferencing. We conclude with questions for those in the field to contemplate, as well as potential challenges and benefits in using telepsychotherapy with individuals at CHR and their families.