ABSTRACT
Work is a fundamental condition of human life, but it can become dysfunctional because in certain situations it may lead to undesirable and harmful consequences. In this context, recovery from work (recovery) is conceived as a counterpoint to the straining processes to which the employee is exposed in the workplace. Among the different recovery strategies adopted by workers, those carried out outside working hours are especially relevant. Scientific interest in this filed is evidenced by the publication of numerous systematic reviews in recent years. The aim of this study is to shed light and provide evidence on the results of the systematic reviews carried out to date. Thus, it was conducted an umbrella review of systematic reviews and meta-analyses on work recovery outside working hours. To this end, a systematic search of potentially relevant documents was implemented in six databases, both thematic and multidisciplinary. Eight systematic reviews and meta-analyses that met the established inclusion criteria were retrieved. The content analysis of the selected papers enabled us to identify different approaches to the study of external work recovery: (a) time period;(b) work characteristics;(c) recovery experiences;(d) recovery activities;(e) processes that hinder effective recovery;and (f) variables proxy to the recovery process. Likewise, the main considered substantive occupational and psychosocial variables were systematized. It is discussed the scarce attention paid in the reviewed studies to possible cultural differences that could potentially influence the recovery process. Furthermore, no research has made special reference to the COVID-19 pandemic in work recovery, nor to the potential influence of new emerging work realities such as teleworking or co-working.
ABSTRACT
Introduction: Multisystem inflammatory syndrome in children (MISC) is a severe and recently described disease affecting pediatric patients, triggered by SARS-CoV2. Current treatment is based upon IVIG and steroids but some patients are resistant to first line therapy. In these patients some authors have used IL1 receptor antagonist (Anakinra) with benefit, but data regarding efficacy, dose and route of administration are lacking. Objectives: To analyze the outcomes of MIS-C patients treated with anakinra (ANK) in Italy since 1/4/20. Methods: We performed an anonymous retrospective multicenter study of patients diagnosed with MIS-C, according to the preliminary WHO case definition, treated with ANK from 1/4/20 to 28/2/21. SARSCoV2 infection was demonstrated either by serology or by positive molecular swab (RT-PCR) in the six weeks prior to admission. After the start of ANK we measured the following outcomes: rate of patients needing further therapeutic step-up, rate of patients achieving clinical (fever defervescence in 24 hours) and laboratory response (CRP halving in 48 hours), rate of Coronary Artery Anomalies (CAA) development during follow-up. Results: In the study period 35 MIS-C patients were treated with ANK: 13 patients (37.1%) in Intensive Care Unit (ICU, Group A) and 22 (62.9%) in non-ICU settings (Group B). Epidemiological, clinical, and laboratoristic features at ANK prescription are described below: In Group A the most common indication for ANK was cardiac function worsening (46.1%), while in Group B ANK was started mostly for persistent elevation in inflammatory markers (ferritin, CRP) unresponsive to IVIG and/or steroids (31.8%). Endovenous (ev) ANK was used in all Group A patients (mean dose 8mg/Kg), while most patients in Group B (72.7%) received subcutaneous (sc) ANK (mean dose 4mg/Kg). Overall only 2 patients (5.7%) needed a step-up treatment after ANK start (1 required IVIG, 1 methylprednisolone dose increase), most of the patients achieved clinical (85.7%) and laboratory response (74.3%). 2 patients had CAA before ANK, none developed CAA after starting ANK. Overall NT-proBNP halved in 2.5 days in Group A and 2 days in Group B, while Ejection Fraction (EF) normalized respectively in 2 and 3 days. None of the patients in Group B needed ICU admission or inotropic support after ANK. The most frequently observed side effect was ALT increase (30.8% in Group A and 9.1% in Group B), only 1 patient had injection site reaction. Conclusion: MIS-C is a severe emerging disease with a high ICU admission rate. Our retrospective data suggest that both ev and sc ANK is effective in controlling inflammation, fever and cardiac dysfunction. Side effects are transient and usually mild. Overall the reported incidence of CAA in MIS-C cohorts is 10%, interestingly in our cohort no patient has developed CAA after beginning ANK, possibly suggesting a protective role of IL1 inhibition in aneurysm formation. Further studies in bigger cohorts are needed to define the most effective timing and dose of ANK in MIS-C.