Keeping the Pace between Research and Clinical in Covid-19 Pandemic: A Psychological Experience in a High-Risk Pregnancy Ward

Background: From the literature emerges that having a pregnancy and especially a high-risk pregnancy in time of pandemic can lead to an increase of the levels of anxiety, which are usually already higher in relation to maternal-fetal disease. Furthermore, the literature shows that significant organizational and methodological changes have been introduced in the detection of psychological conditions, such as the introduction of telehealth intervention. Particularly in our experience about psychological health screenings there was a period of care interruption (between 11.03.2020 and 04.05.2020) and a clinical activity restructuring on the ward according to the new needs that have accrued. The aim of this experience is to analyze the progress of psychological health perinatal screening in women during the Covid-19. Specifically, we aimed to understand the percentage of positive screening and management compared to the pre-pandemic period. Method(s): Perinatal psychological screening was administered to women with high-risk pregnancy hospitalized in a Obstetric ward in a period between May 2020 to December 2021. The data were then compared with those recorded from September 2019 to February 2020 (pre-Covid-19). Screening consists in the description of the Obstetrical Psychology Service, the case history, the self-administration questionnaire GHQ-12 (General Health Questionnaire- 12) and the assessment interview if necessary. Result(s): A total of 469 screenings were administered during the pandemic, about 30% of which were found to be positive in the screenings (2020-21). Specifically in 2020, the positivity amounted to 28.69%. Of these 64 women, 56 performed the assessment, and in particular 22 were taken to the Psychology Service, 6 were referred to the territorial counseling centers, and 28 didn't receive further treatment indication. In 2021, the positivity was 32.93%. Especially of these 81 women, 32 were taken to the Psychology Service, 10 were sent to the territorial counseling centers and, 16 refused the assessment interview, 6 were already in treatment, 11 didn't receive further treatment indications and 6 cases dropped out. In the pre-pandemic phase the rate of positivity was 27%. Of the 30 women who tested positive at the screening, 5 were taken to the Psychology Service, 9 were referred to family counseling centers in the area, 11 refused the assessment interview, and 5 didn't receive further therapeutic indication. Conclusion(s): The importance of psychological care continuity and the feasibility of administering psychological health screenings clearly emerges in the ward despite the changed health situation due to Covid-19. The results show how the positivity rate for psychological health screening increases over the years (27% from September 2019 to February 2020/pre-Covid-19, 28,69% from May to December 2020 and 32,93% in 2021).

Short Time: Postnatal Hospital Care during Covid-19 Pandemic. The Results of a Psychological Wellbeing Screening in the Immediate Postpartum

Introduction: During the Covid-19 pandemic, isolation, fear of contagion, changes in care circumstances, and suspended or restricted visitor access impacted the psychological wellbeing of puerperae. As shown in literature [1,2], Covid-19 pandemic increased depressive and post-traumatic stress related symptoms in mothers in the postnatal period. Moreover, it could determine serious psychological challenges for pregnant and postpartum women, with potential "short" and "long" term consequences for the health of mothers and their children [2]. Healthcare providers should guarantee easy access to mental health services, as a primary strategy to support the health of both mothers and children [2]. After the worldwide spread of Covid-19 the organization of every hospital ward changed, including the obstetric and neonatal units. Compared to the pre-pandemic period, a reduction of the average length of stay in hospital for the new mothers was instituted [3]. This was the result of a reduction of the hospital beds, mostly because of the need to allocate mothers tested positive for Covid-19 in a separate area and to lower the risk of Covid-19 transmission in hospitals. The Obstetric Psychological Service of the Spedali Civili hospital in Brescia started a screening program for the wellbeing of the perinatal period in 2018, with a gradual development and improvement of the organization of this activity [4]. Screening was suspended during the first wave of Covid-19 pandemic from 6th of March to 4th of May 2020. Nevertheless, it was necessary to cope with the Covid-19 pandemic changing demands and methods in order to continue with the screening of women admitted in obstetrics ward. Method(s): A screening of psychological perinatal wellbeing was performed in puerperae admitted to the Second Department of Obstetrics at Spedali Civili hospital in Brescia. Screening consisted in a psychological consult, during which the psychologist illustrated the Obstetric Psychological Service to the woman and identified her psychological need, without using tests. This was eventually followed by an assessment consultation, specialist care and referral to the out-of-hospital psychological services, if required by the woman or considered necessary by the psychologist. It was made a comparison between data collected from October 2019 to January 2020 and from May 2020 to December 2021. Result(s): Compared to the pre-pandemic period, average length of stay in the Second Division of Obstetrics was reduced. In particular, starting from March 2020, the expected discharge of the puerpera was about 24 hours after vaginal birth and 48 hours after cesarean delivery, if no complications occurred for both mother and newborn. Previously, discharge was expected after about 48 hours and 72 hours, respectively. Discharge that occurs 24 hours after vaginal birth is named "Early discharge" and requires the activation of the out-of-hospital services, with home visits by an obstetrician. From October 2019 to January 2020, 470 admitted women were screened, of which 23 (4,9%) demanded a further psychological consultation[4]. Between May 2020 and December 2021, 5145 screening were performed. Among them 550 (10.7%) demanded a further psychological consultation. From those data we can affirm that there was an increase in psychological consultations (from 4.9% to 10.7%), after exhibiting a psychological need during the postnatal screening. Conclusion(s): Covid-19 pandemic changed the care conditions of the woman during the pregnancy and the immediate post-partum. The reduction of the average length of hospital stay of the women in the postpartum did not stop the Psychological Service prevention program. The Obstetric Psychological Service of the Spedali Civili hospital in Brescia implemented his activity increasing the pace of work, to be able to screen as many admitted women as possible. It was noticed that, after the Covid-19 first outbreak, the demand for psychological consultation after the screening consult was more than doubled in comparison to the pre-pandemic perio . This emphasized the benefit of an early interception of the psychological need of the women in the immediate post-partum period, especially during the Covid-19 pandemic.

Mortality risk model validation in a prospective cohort of patients from the sixth wave of the COVID-19 pandemic in a hospital emergency department

Objective. To validate risk factors for mortality in patients treated for COVID-19 in a hospital emergency department during the sixth wave of the pandemic. Method. Prospective observational noninterventional study. We included patients over the age of 18 years with a confirmed diagnosis of COVID-19 between December 1, 2021, and February 28, 2022. For each patient we calculated a risk score based on age 50 years or older (2 points) plus 1 point each for the presence of the following predictors: Barthel index less than 90 points, altered level of consciousness, ratio of arterial oxygen saturation to fraction of inspired oxygen less than 400, abnormal breath sounds, platelet concentration less than 100 x 109/L, C-reactive protein level of 5 mg/dL or more, and glomerular filtration rate less than 45 mL/min. The model was assessed with the area under the receiver operating characteristic curve (AUC). Results. Of the 1156 patients included, 790 (68%) had received at least 2 vaccine doses. The probability of 30-day survival was 96%. A risk score was calculated for 609 patients. Four hundred seventeen patients were at low risk of death, 180 were at intermediate risk, and 10 were at high risk. The probability of death within 30 days was 1%, 13%, and 50% for patients in the 3 risk groups, respectively. The sensitivity, specificity, and positive and negative predictive values of a risk score of 3 points or less were 88%, 72%, 19%, 99%, respectively.The AUC for the model was 0.87. Conclusion. The risk model identified low risk of mortality and allowed us to safely discharge patients treated for COVID-19 in our tertiary-care hospital emergency department. Copyright © 2023, Saned. All rights reserved.

COVID-19 LESSON ON FACILITY MANAGEMENT OF PUBLIC BUILDINGS

The emergence caused by the COVID-19 pandemic caused a strong impact even on people interaction with building environments. Public buildings were closed, while the regular access to public and private offices, industries and schools were significantly limited, requiring a quick transition towards different organizations. To reduce the number of people inside the buildings, web services were enhanced, and the practice of smart-working was extended. Nevertheless, during the pandemic, most buildings were normally left open, to allow the regular functioning of the services necessary to ensure smart-working and the necessary changes to HVAC systems to improve ventilation. Pandemic obliged facility managers to change operational and maintenance plans, mainly given the increase of HVAC requirements and the reduction of other types of services, with an important impact on building Operation and Maintenance (O&M) cost and previously defined maintenance strategies. This contribution analyses the impact of the pandemic on operation and maintenance activities on 20 buildings, part of the building stock of Università Politecnica delle Marche (Italy), using data mining approaches. About 12000 end-users’ maintenance requests, generated after and during the different phases of the pandemic, were analysed and information about the change in facility management (FM) activity was collected, to understand how the postpandemic use scenario will impact the O&M (type and amount) and consequently how to improve FM outsourced contracts. © 2022, University of Cantabria - Building Technology R&D Group. All rights reserved.

COVID-19 lockdown and hip arthroplasty rehabilitation changes: mid-term clinical outcomes.

OBJECTIVE: Hip arthroplasty is one of the most performed surgeries in orthopedics. Rehabilitation process after surgery allows rapid recovery of joint functions in absence of pain in most patients. During COVID-19 pandemic, rehabilitation clinics have reduced the number of beds available. Thus, an increasing number of patients were forced to home rehabilitation programs. Our study aimed at determining any significant differences in clinical and functional outcomes between those patients who underwent a home rehabilitation program and those others who were granted a place in a Rehabilitation clinic during COVID-19 pandemic, at mid-term follow-up. PATIENTS AND METHODS: An observational retrospective single-center study was designed. The patients included were 63, divided into two groups: Group A (29 patients) for home rehabilitation, and Group B (34 patients) for clinic rehabilitation. Follow-up was performed at 1, 6 and 12 months after surgery. Clinical evaluation was assessed through Oxford Hip Score for hip function, Visual Analogue Scale (VAS) for pain and hip range of motion (ROM) to evaluate joint recovery. RESULTS: ROM was compared at follow-up with significant differences 12 months after surgery (107.93° group A vs. 104.7° group B; p=0.0168). Pain felt by patients according to the VAS scale showed no significant differences at follow-up (1 month 3.27 vs. 3.65 p=0.1489; 6 months 1.89 vs. 2.18 p=0.105; 12 months 0.58 vs. 0.68 p=0.6263). Regarding the Oxford Hip score, significant differences emerged at 1-month follow-up (38.75 group A vs. 37.94 group B; p=0.0498). CONCLUSIONS: At mid-term follow-up, little differences were found between patients who went through home rehabilitation and those who went to a rehabilitation clinic. Therefore, decreasing the number of beds available in rehab clinics during COVID-19 pandemic was not an obstacle for elective surgery for orthopedic surgeons.

Risk score for mortality due to COVID-19: a prospective temporal validation cohort study in the emergency department of a tertiary care hospital

Objective. To validate a previously described hospital emergency department risk model to predict mortality in patients with COVID-19. Methods. Prospective observational noninterventional study. Patients aged over 18 years diagnosed with COVID-19 were included between December 1, 2020, and February 28, 2021. We calculated a risk score for each patient based on age >= 50 years (2 points) plus 1 point each for the presence of the following predictors: Barthel index <90 points, altered level of consciousness, ratio of arterial oxygen saturation to fraction of inspired oxygen <400, abnormal breath sounds, platelet concentration <100 x 10(9)/L, C reactive protein level >= 5 mg/dL, and glomerular filtration rate <45 ml/min. The dependent variable was 30-day mortality. We assessed the score's performance with the area under the receiver operating characteristic curve (AUC). Results. The validation cohort included 1223 patients. After a median follow-up of 80 days, 143 patients had died;901 patients were classified as having low risk (score, <= 4 points), 270 as intermediate risk (5-6 points), and 52 as high risk (>= 7 points). Thirty-day mortality rates at each risk level were 2.8%, 22.5%, and 65.4%, respectively. The AUC for the score was 0.883;for risk categorization, the AUC was 0.818. Conclusion. The risk score described is useful for stratifying risk for mortality in patients with COVID-19 who come to a tertiary-care hospital emergency department.

Usefulness of Combined Renin-Angiotensin System Inhibitors and Diuretic Treatment In Patients Hospitalized with COVID-19

Antecedent use of renin-angiotensin system inhibitors (RASi) prevents clinical deterioration and protects against cardiovascular/thrombotic complications of COVID-19, for indicated patients. Uncertainty exists regarding treatment continuation throughout infection and doing so with concomitant medications. Hence, the purpose of this study is to evaluate the differential effect of RASi continuation in patients hospitalized with COVID-19 according to diuretic use. We used the Coracle registry, which contains data of hospitalized patients with COVID-19 from 4 regions of Italy. We used Firth logistic regression for adult (>50 years) cases with admission on/after February 22, 2020, with a known discharge status as of April 1, 2020. There were 286 patients in this analysis;100 patients (35.0%) continued RASi and 186 (65%) discontinued. There were 98 patients treated with a diuretic;51 (52%) of those continued RASi. The in-hospital mortality rates in patients treated with a diuretic and continued versus discontinued RASi were 8% versus 26% (p = 0.0179). There were 188 patients not treated with a diuretic;49 (26%) of those continued RASi. The in-hospital mortality rates in patients not treated with a diuretic and continued versus discontinued RASi were 16% versus 9% (p = 0.1827). After accounting for age, cardiovascular disease, and laboratory values, continuing RASi decreased the risk of mortality by approximately 77% (odds ratio 0.23, 95% confidence interval 0.06 to 0.95, p = 0.0419) for patients treated with diuretics, but did not alter the risk in patients treated with RASi alone. Continuing RASi in patients concomitantly treated with diuretics was associated with reduced in-hospital mortality.

Sero-survey on Long-term Care Facility Residents Reveals Increased Risk of Sub-optimal Antibody Response to BNT162B2: Implications for Breakthrough Prevention (preprint)

Background: The impact of coronavirus disease 2019 caused by Severe Acute Respiratory Syndrome Coronavirus 2 on hosts of Long Term Care Facilities (LTCFs) has been dramatic at global scale as aging and comorbitities pose individuals at increased risk of severe disease and death. Methods: Aim of this study was to evaluate SARS-CoV-2 S-IgG antibodies titers in 478 residents and 649 health care workers of the largest Italian nurse facility two months after the complete vaccination with BNT162B2. Associations among host-related factors and predictors of humoral response were investigated. Results: By stratifying levels of humoral responses, we found that 62.1%, 21.6%, 12.1% and 4.2% of hosts has high (>1,000 BAU/ml), medium (101-1,000), low (1-100) and null (<1 BAU/mL) S-IgG titers, respectively. Hosts with previous COVID-19 and those with SARS-CoV-2 N-IgG positive serology showed higher level of serological response (p<0.001 and p<0.001, respectively), while the administration of corticosteroid or cancer diminished all levels of specific antibodies (p=0.019 and p=0.004). Significant associations were observed for these parameters in those with suboptimal response (p<0.001, p<0.001, p=0.028 and p=0.005) and with a null one (p=0.005, p<0.001 and p=0.039). Predictors of an increased risk of null response were advanced age, corticosteroid therapy and diabetes mellitus (p=0.025, p=0.017 and p=0.037). In contrast, previous diagnosis of COVID-19 resulted strongly associated with a reduced risk of null response to vaccination (p<0.001). Conclusions: SARS-CoV-2 specific antibodies in elderly individuals need to be measured to consider a third dose of vaccine after mass vaccination for prevention of reinfections in LTCFs despite the maintenance of barrier measures.

Measurement of the muon flux in the bunker of Monte Soratte with the CRC detector (preprint)

In the context of the PTOLEMY project, the need for a site with a rather low cosmogenic induced background led us to measure the differential muon flux inside the bunker of Monte Soratte, located about 50~km north of Rome (Italy). The measurement was performed with the Cosmic Ray Cube (CRC), a portable tracking device. The simple operation of the Cosmic Ray Cube was crucial to finalise the measurements, as they were carried out during the COVID-19 lockdown and in a site devoid of scientific equipment. The muon flux measured at the Soratte hypogeum is above two orders of magnitude lower than the flux observed on the surface, suggesting the possible use of the Mt. Soratte bunker for hosting astroparticle physics experiments requiring a low environmental background.

A probabilistic model to evaluate the effectiveness of main solutions to COVID-19 spreading in university buildings according to proximity and time-based consolidated criteria (preprint)

Crowds in buildings open to the public can alter the occupants’ safety in different emergency conditions, including those related to a pandemic. In this sense, university buildings are one of the most relevant scenarios in which the COVID-19 event clearly pointed out the stakeholders’ needs toward safety issues, especially because of the possibility of day-to-day presences of the same users (i.e. students, teachers) and overcrowding causing long-lasting contacts with possible “infectors” in such closed environments. While waiting for the vaccine, as for other public buildings, policy-makers’ measures to limit (second) virus outbreaks combine individual’s strategies (facial masks), occupants’ capacity and access control to avoid lockdowns and ensure adequate conditions for occupants. Simulators could support effectiveness evaluations of such measures. To fill this gap, this work proposes a quick and probabilistic simulation model based on consolidated proximity and exposure-time-based rules for virus transmission (confirmed by international health organizations). The building occupancy is defined according to university schedule, identifying the main “attraction areas” in the building (classrooms, break-areas). Scenarios are defined in terms of occupants’ densities, mitigation strategies, virus-related aspects. The model is calibrated on experimental data and applied to a relevant university building. Results demonstrate the model capabilities. In the case study, occupants’ capacity limitation could support the adoption of surgical masks by users instead of FFPk masks (thus improving users’ comfort issues). Preliminary correlations to combine acceptable mask filters-occupants’ density are proposed to support stakeholders in organizing users’ presences in the building during the pandemic. 

Sustainable and resilient strategies for touristic cities against COVID-19: an agent-based approach (preprint)

Touristic cities will suffer from COVID-19 emergency because of its economic impact on their communities. The first emergency phases involved a wide closure of such areas to support "social distancing" measures (i.e. travels limitation; lockdown of (over)crowd-prone activities). In the second phase, individual's risk-mitigation strategies (facial masks) could be properly linked to "social distancing" to ensure re-opening touristic cities to visitors. Simulation tools could support the effectiveness evaluation of risk-mitigation measures to look for an economic and social optimum for activities restarting. This work modifies an existing Agent-Based Model to estimate the virus spreading in touristic areas, including tourists and residents' behaviours, movement and virus effects on them according to a probabilistic approach. Consolidated proximity-based and exposure-time-based contagion spreading rules are included according to international health organizations and previous calibration through experimental data. Effects of tourists' capacity (as "social distancing"-based measure) and other strategies (i.e. facial mask implementation) are evaluated depending on virus-related conditions (i.e. initial infector percentages). An idealized scenario representing a significant case study has been analysed to demonstrate the tool capabilities and compare the effectiveness of those solutions. Results show that "social distancing" seems to be more effective at the highest infectors' rates, although represents an extreme measure with important economic effects. This measure loses its full effectiveness (on the community) as the infectors' rate decreases and individuals' protection measures become predominant (facial masks). The model could be integrated to consider other recurring issues on tourist-related fruition and schedule of urban spaces and facilities (e.g. cultural/leisure buildings).

How to restart? An agent-based simulation model towards the definition of strategies for COVID-19 "second phase" in public buildings (preprint)

Restarting public buildings activities in the "second phase" of COVID-19 emergency should be supported by operational measures to avoid a second virus spreading. Buildings hosting the continuous presence of the same users and significant overcrowd conditions over space/time (e.g. large offices, universities) are critical scenarios due to the prolonged contact with infectors. Beside individual's risk-mitigation strategies performed (facial masks), stakeholders should promote additional strategies, i.e. occupants' load limitation (towards "social distancing") and access control. Simulators could support the measures effectiveness evaluation. This work provides an Agent-Based Model to estimate the virus spreading in the closed built environment. The model adopts a probabilistic approach to jointly simulate occupants' movement and virus transmission according to proximity-based and exposure-time-based rules proposed by international health organizations. Scenarios can be defined in terms of building occupancy, mitigation strategies and virus-related aspects. The model is calibrated on experimental data ("Diamond Princess" cruise) and then applied to a relevant case-study (a part of a university campus). Results demonstrate the model capabilities. Concerning the case-study, adopting facial masks seems to be a paramount strategy to reduce virus spreading in each initial condition, by maintaining an acceptable infected people's number. The building capacity limitation could support such measure by potentially moving from FFPk masks to surgical masks use by occupants (thus improving users' comfort issues). A preliminary model to combine acceptable mask filters-occupants' density combination is proposed. The model could be modified to consider other recurring scenarios in other public buildings (e.g. tourist facilities, cultural buildings).