Singing for people with advance chronic respiratory diseases: Qualitative meta-synthesis

Introduction/Aim: Although there remains insufficient evidence regarding singing programs as effective strategies for achieving clinically significant health outcomes, this non-pharmacological intervention appears to be subjectively low-risk and well-tolerated by people with advanced chronic respiratory diseases (CRD). Method(s): A meta-synthesis was undertaken to examine the current qualitative evidence regarding the experiences of singing for lung health programs in adults with advanced CRD and their careers. Electronic databases (Medline, CINAHL, PsycINFO, and EMBASE) were searched for qualitative studies published in English. Qualitative data was extracted and analysed, which generated descriptive and analytical themes. Result(s): Themes identified from seven included studies consisted of anticipation and reluctance to participate;physical and psychological benefits;new sense of purpose and enjoyment;social connection and achievement;and broad views regarding program structure and content. The themes were categorised into three time points to explore participants' perspectives before, during and after engaging in the singing program. Over time participants transitioned from anxiety to mastery of their chronic condition as the singing program progressed. Participants, however, raised concerns regarding several singing technicalities, the lack of ongoing support after the singing programs' conclusion and the social impacts of transitioning the sessions online during the COVID-19 pandemic. Conclusion(s): The increasing body of qualitative literature suggests that participants enjoyed the singing program and derived psychological, social and health benefits, not necessarily captured in quantitative studies. Future work should explore participants' experiences through qualitative, longitudinal methods to gain further insight into the acceptability and feasibility of singing programs and inform broader implementation of the intervention.

Fostering landscape immunity to protect human health: a science-based rationale for shifting conservation policy paradigms

Anthropogenic land use change is a major driver of zoonotic pathogen spillover from wildlife to humans. According to the land use-induced spillover model, land use change alters environmental conditions that in turn alter the dynamics between zoonotic pathogens and their wildlife hosts. Thus, in response to the global spread of the SARS-CoV-2 virus (the agent of COVID-19 disease), there have been renewed calls for landscape conservation as a disease preventive measure, including by the G7 Ministers responsible for Climate and the Environment. Landscape immunity, as a new construct, points to four paradigm shifts the world must favor to effectively mitigate pandemic risks. We provide a landscape immunity primer for policy makers and make the case for "world views" that place Homo sapiens within ecological systems, regard human health as an ecological service, prioritize investments in prevention, and apply ecological restoration to human health goals. Crisis is a conversation starter for reimagining and recommitting ourselves to what is most vital and generative. We urge world leaders to make the move to a nature-positive world.

Climate Action Failure Highlighted as Leading Global Risk by Both Scientists and Business Leaders

Despite the increased salience of infectious disease risk due to the COVID-19 pandemic, two recent surveys of the business and scientific communities have found a continued belief in the prominence of environmental risks. In particular, failure to take action on climate change was seen as a highly likely risk whose impacts would become locked-in barring an immediate global response. These expert opinions are consistent with a growing body of evidence and give us insight into the priorities of global thought leaders who study and respond to risk. Given this alignment in priorities, we argue for the importance of integrating climate and environmental action into responses to emerging threats.

Strengthening health systems from the bottom up: example from Lesotho

In Africa, there is frequently an extreme need for nurses and other healthcare professionals. Overcrowding, a lack of administrative oversight, and a lack of resources are all problems in health settings. Health professionals may develop psychological damage referred to as "insufficient resource trauma" as a result of these difficulties, which can lower morale and motivation. Such trauma reduces the standard of treatment provided and causes professional "burn-out," a problem that has become more significant in the wake of the SARS-CoV-2 pandemic. One of the nurses who received training in PSBH-N in 2006 was promoted to the position of MoH Nursing Director by 2019. This nurse reflected on her personal experience and said, "The nurses trained in PSBH are among the top nurses in the country today," when she learned of the new PSBH training for MoH QAU employees. In order to train all 877 registered nurses and 373 licensed practical nurses (LPNs) in the nation during the following three to five years, the director requested that LeBoHA host PSBH-N workshops. The countrywide rollout's training and evaluation are now under progress. Priority setting may result from centralized, "top-down," problem-solving techniques that are not always appropriate for the district. A poll of healthcare professionals in South African hospitals revealed that administrators of hospitals were regarded as effective leaders if their leadership style encouraged engagement and problem-solving. An emphasis on a decentralised and egalitarian (equity-fostering) approach, where problem-solving is the duty of all health workers, is emphasized in a national quality assurance plan that includes PSBH.

Relationship between Anti-Spike Protein Antibody Titers and SARS-CoV-2 In Vitro Virus Neutralization in Convalescent Plasma

Newly emerged pathogens such as SARS-CoV-2 highlight the urgent need for assays that detect levels of neutralizing antibodies that may be protective. We studied the relationship between anti-spike ectodomain (ECD) and anti-receptor binding domain (RBD) IgG titers, andSARS-CoV-2 virus neutralization (VN) titers generated by two different in vitro assays using convalescent plasma samples obtained from 68 COVID-19 patients, including 13 who donated plasma multiple times. Only 23% (16/68) of donors had been hospitalized. We also studied 16samples from subjects found to have anti-spike protein IgG during surveillance screening of asymptomatic individuals. We report a strong positive correlation between both plasma anti-RBD and anti-ECD IgG titers, and in vitro VN titer. Anti-RBD plasma IgG correlated slightly better than anti-ECD IgG titer with VN titer. The probability of a VN titer 160 was 80% or greater with anti-RBD or anti-ECD titers of 1:1350. Thirty-seven percent (25/68) of convalescent plasma donors lacked VN titers 160, the FDA-recommended level for convalescent plasma used for COVID-19 treatment. Dyspnea, hospitalization, and disease severity were significantly associated with higher VN titer. Frequent donation of convalescent plasma did not significantly decrease either VN or IgG titers. Analysis of 2,814 asymptomatic adults found 27 individuals with anti-RBD or anti-ECD IgG titers of 1:1350, and evidence of VN1:160. Taken together, we conclude that anti-RBD or anti-ECD IgG titers can serve as a surrogate for VN titers to identify suitable plasma donors. Plasma anti-RBD or anti-ECD titer of1:1350 may provide critical information about protection against COVID-19 disease.

The prevalence of nurse burnout and its association with telomere length pre and during the COVID-19 pandemic.

BACKGROUND: Burnout is a work-related stress syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. Nurse burnout is related to nurses' deteriorating mental health and poorer patient care quality and thus, is a significant concern in healthcare. The Coronavirus Disease 2019 (COVID-19) pandemic has swept the world and distressed the healthcare systems. Because of the body's stress mechanism, it is vital to examine the current prevalence of nurse burnout and understand it at a biological level, using an epigenetic biomarker, telomere length. PURPOSE: To determine the prevalence of burnout among nurses in the Peri-Operative and Labor & Delivery settings pre and during the COVID-19 pandemic and to examine the effects of burnout on absolute telomere length. METHODS: This is a cross-sectional study assessing the prevalence of nurses' burnout and the relationships between nurses' burnout and telomere length. Due to the COVID-19 pandemic, we had to stop the study during the mid of data collection. Even though the study was not designed to capture changes before and during the pandemic, we analyzed two groups' data before and during the pandemic. The study took place in a US hospital. Nurses in the hospital's Operating Room, Post-Anesthesia Care Unit, and Labor & Delivery Unit participated in the study. Maslach Burnout Inventory survey and nurses' demographics were administered online. Telomere length was measured via finger-prick blood. RESULTS: 146 nurses participated in the study, with 120 participants' blood samples collected. The high-level burnout rate was 70.5%. Correlation analysis did not reveal a direct correlation between nurse burnout and telomere length. However, in a multiple regression analysis, the final model contained the burnout subscale of emotional exhaustion, years as an RN, and work unit's nursing care quality. There was a low degree of departure from normality of the mean absolute telomere length in the pre-pandemic group and a substantial degree of departure in the during-pandemic group. CONCLUSIONS: Nurse burnout is a prevalent phenomenon in healthcare, and this study indicates that nurses currently experience high levels of burnout. Nurses' cellular biomarker, telomere length, is shorter in the group of nurses during the COVID-19 pandemic than before. Appropriate measures should be implemented to decrease nurses' burnout symptoms and improve nurses' psychological and physical health. Nurses, especially those younger than 60, report higher burnout symptoms, particularly emotional exhaustion. This study indicates the need for intervention to promote nurses' health during the pandemic and beyond. If not appropriately managed, nurse burnout may continue to be a significant issue facing the healthcare system.

To breastfeed or not to breastfeed? Lack of evidence on the presence of SARS-CoV-2 in breastmilk of pregnant women with COVID-19.

A rapid systematic review was carried out to evaluate the current evidence related to the presence of SARS-CoV-2 in breast milk from pregnant women with COVID-19. Eight studies analyzing the presence of SARS-CoV-2 RNA in the breast milk of 24 pregnant women with COVID-19 during the third trimester of pregnancy were found. All patients had fever and/or symptoms of acute respiratory illness and chest computed tomography images indicative of COVID-19 pneumonia. Most pregnant women had cesarean delivery (91.7%) and two neonates had low birthweight (< 2 500 g). Biological samples collected immediately after birth from upper respiratory tract (throat or nasopharyngeal) of neonates and placental tissues showed negative results for the presence SARS-CoV-2 by RT-PCR test. No breast milk samples were positive for SARS-CoV-2 and, to date, there is no evidence on the presence of SARS-CoV-2 in breast milk of pregnant women with COVID-19. However, data are still limited and breastfeeding of women with COVID-19 remains a controversial issue. There are no restrictions on the use of milk from a human breast milk bank.

Se llevó a cabo una revisión sistemática rápida para evaluar la evidencia disponible sobre la presencia de SARS-CoV-2 en la leche materna de mujeres embarazadas afectadas con COVID-19. Se encontraron ocho estudios que analizaron la presencia de ARN de SARS-CoV-2 en la leche materna de 24 mujeres embarazadas con COVID-19 durante el tercer trimestre del embarazo. Todas las pacientes tenían fiebre o síntomas de enfermedad respiratoria aguda e imágenes de tomografía computarizada de tórax indicativas de neumonía por COVID-19. La mayoría de las mujeres embarazadas (91,7%) tuvieron un parto por cesárea y dos neonatos presentaron bajo peso al nacer (< 2 500 g). Las muestras biológicas recogidas inmediatamente después del parto de las vías respiratorias superiores (faringe o nasofaringe) de los neonatos y los tejidos placentarios mostraron resultados negativos para SARS-CoV-2 mediante RT-PCR. Ninguna muestra de leche materna fue positiva para SARS-CoV-2 y, hasta la fecha, no hay evidencia de la presencia de SARS-CoV-2 en la leche materna de las mujeres embarazadas con COVID-19. Sin embargo, los datos disponibles todavía son limitados y la lactancia materna en las mujeres con COVID-19 sigue siendo un tema controvertido. No hay restricciones para el uso de leche materna de banco.

Foi realizada uma revisão sistemática rápida para avaliar as evidências atuais relacionadas à presença da SARS-CoV-2 no leite materno de mulheres grávidas com COVID-19. Foram encontrados oito estudos analisando a presença de RNA do SARS-CoV-2 no leite materno de 24 gestantes com COVID-19 durante o terceiro trimestre de gravidez. Todas as pacientes apresentavam febre ou sintomas de doença respiratória aguda e imagens de tomografia computadorizada do tórax indicativas de pneumonia pela COVID-19. A maioria das gestantes teve parto cesáreo (91,7%) e dois recém-nascidos tiveram baixo peso ao nascer (< 2 500 g). As amostras biológicas coletadas imediatamente após o nascimento do trato respiratório superior (faringe ou nasofaringe) de neonatos e tecidos placentários apresentaram resultados negativos para a presença do SARS-CoV-2 pelo teste RT-PCR. Nenhuma amostra de leite materno foi positiva para o SARS-CoV-2 e, até à data, não há evidências da presença do SARS-CoV-2 no leite materno de mulheres grávidas com COVID-19. No entanto, os dados ainda são limitados e a amamentação de mulheres com COVID-19 continua a ser uma questão controversa. Não há restrições ao uso de leite de um banco de leite materno humano.