Burnout in healthcare workers in COVID-19-dedicated hospitals.

BACKGROUND: Considering the prolongation of the COVID-19 pandemic, the lack of studies on burnout, particularly in healthcare workers, needs to be addressed. This report aimed to identify the risk factors of burnout by comparing the level of burnout between nurses in general wards and those in COVID-19-dedicated wards in a national university hospital. METHODS: A survey based on the Korean version of Burnout Assessment Tool (BAT-K) was conducted on nurses between 10 January and 31 January 2022. The BAT-K consists of exhaustion, mental distance, cognitive impairment, emotional impairment and secondary symptoms. RESULTS: A total of 165 nurses, including 81 nurses from the COVID-19-dedicated ward, completed the questionnaire. The percentage of general-ward nurses with an emotional impairment score above the clinical cutoff was higher than that of COVID-19 ward nurses. General ward compared to the COVID-19 ward increased the risk of presenting with total-core symptoms. Two factors increased the risk regarding mental distance: short career length and underlying disease. CONCLUSIONS: In contrast to previous studies, the risk of burnout in the COVID-19-ward nurses was lower than that of the general ward nurses. The risk regarding mental distance was correlated with short career length and presence of an underlying disease.

Restitution as the Consequence of Frustration under English Law and Korean Law in a Comparative Perspective

Purpose - This paper examines the admissibility of restitution as the legal consequence where a contract is frustrated under the Law of Reform (Frustrated Contracts) Act 1943 in comparison with Korean Civil Code (KCC). In order to provide practical guidelines and advice regarding choice of and application of law for contracting parties in international trade, the paper comparatively evaluates requirements and the scope of restitution under the Act 1943 and KCC. Design/methodology - This paper executes a comparative study to analyze whether the parties may claim restitution of money paid or non-money benefit obtained before or after the time of discharge under English law and KCC. To achieve the purpose, it focuses on the identifying characteristics of each statute, thereby providing guidelines to overcome difficulties in legal application and interpretation as to restitution as the consequence of frustration. Findings - Under English law, the benefit may be restituted according to Art 1943 or the common law rule, mistake of fact or law. Under the KCC, restitution is considered based on the principle of the obligation to recover the original obtained regardless of the time when the benefit is conferred. Whilst Act 1943 does not require careful analysis of the grounds of restitution, requirements to justify restitution according to the principle of unjust enrichment, mistake of fact or law, and the KCC should be met. Meanwhile, the KCC may provide more opportunities to award restitution because it does not require the burden of proof related to the defendant's good faith, unlike the principle of unjust enrichment. Originality/value - Where the contract is frustrated by the effect of COVID-19, one legal issue is a consequence of frustration. Therefore, this paper analyzes requirements and the scope of restitution under English law as compared with the KCC in a timely manner. It provides contracting parties with practical guidelines and advice to reduce unpredictability when they choose the governing law in a contract.

A Systemic Review and Meta-analysis of the Effect of SARS-CoV-2 Infection on Sperm Parameters

Objective. Several studies examined the putative effects of SARS-CoV-2 infection on sperm parameters. However, the results remain controversial. In this study, we conducted the most up-to-date systematic review and meta-analysis to investigate the effect of SARS-CoV-2 infection on sperm quality in COVID-19-positive and COVID-19-negative male participants. Method. Seven databases were searched for literature released through June 10, 2022, containing estimates for the outcomes of interest. Using a random-effects model (REM) or a fixed-effects model (FEM), we analyzed the pooled results. The quality of all included studies was assessed by the Newcastle-Ottawa scale. In addition, we performed a quantitative and subgroup analysis of semen data across all included studies. Results. Fourteen studies were extracted from 10 publications, involving a total of 1174 participates for meta-analysis. Sperm parameters of 521 COVID-19 male patients and 653 controls were analyzed. In 8 case-control studies, the pooled mean difference (MD) of total sperm motility was -5.37% (95% confidence interval (CI): -8.47 to -2.28;p< 0.05), suggesting that total motility was significantly impaired in male COVID-19 cases. Subgroup analysis showed a significant decrease in semen volume, sperm concentration, and total motility in 238 patients with a recovery time of less than 90 days. Moreover, in the other 6 included pre- to post-COVID-19 studies, the pooled MDs of sperm concentration, total sperm count, total motility, progressive motility, and normal morphology were -6.54 x 106/ml (95% CI: -10.27 to -2.81;p< 0.05), -38.89 x 106 (95% CI: -59.20 to -18.58;p< 0.05), -7.21% (95% CI: -14.36 to -0.07;p< 0.05), -5.12% (95% CI: -8.71 to -1.53;p< 0.05), and -1.52% (95% CI: -2.88 to -0.16;p< 0.05), respectively, which indicate SARS-CoV-2 infection significantly affected these five sperm parameters. Conclusion. Our results revealed that SARS-CoV-2 infection was significantly correlated with decreased sperm quality. Of six sperm parameters, total motility and sperm concentration were the most significantly decreased parameters. These results suggest a possible negative influence of SARS-CoV-2 infection on testicular function and male fertility. Given the potential detrimental effect of SARS-CoV-2 on semen quality, male reproductive health should be monitored closely in patients with COVID-19. This trial is registered with CRD42021275823.

TRENDS in STI SCREENING during COVID-19 and MISSED CASES among ADOLESCENTS

Background: Sexually transmitted infection (STI) diagnosis serves as an important linkage to HIV testing and pre-exposure prophylaxis (PrEP) for adolescents. The COVID-19 pandemic disrupted sexual health services for young people, with a potential consequence of increasing undiagnosed STIs. This study aimed to describe STI testing changes and estimate undiagnosed STI cases during the pandemic. Methods: We analyzed electronic medical records for chlamydia, gonorrhea, and trichomonas testing encounters from six pediatric primary care clinics in Philadelphia, July 2014-November 2020. We assessed whether testing was asymptomatic screening, risk-based testing, or symptomatic testing, and whether any result was positive. We evaluated STI trends over time, comparing pre-pandemic (before March 1st, 2020) and pandemic periods (after March 1st, 2020). Missed STI cases during the pandemic were estimated using decreases in patient volume and asymptomatic screening as compared to the previous year. Generalized linear mixed-effects models estimated the effects of patient-level and neighborhood-level characteristics on STI outcomes. Results: 35,548 STI testing encounters were analyzed, including 2,958 during the pandemic period. The median patient age was 17.5 years, 57% of patients were female, and 84% were Black/African American. Mean monthly STI testing encounters decreased from 479/month pre-pandemic to 329/month during the pandemic. Test positivity increased from 12.5% pre-pandemic to a peak of 27.5% in April 2020. The percent of STI tests performed as asymptomatic screening dropped from 72.5% pre-pandemic to a nadir of 54.5% in April 2020 (Figure). We estimate that the decrease in asymptomatic screening in the pandemic period would be associated with 159 missed cases (23.8% of expected cases) based on patient volume from the previous year. In multivariate models controlling for testing type (asymptomatic screening, risk-based testing, or symptomatic testing), the odds of test positivity were 50% higher during the pandemic (OR: 1.50, p<0.001). Conclusion: STI test positivity increased during the pandemic while asymptomatic screening decreased. Test positivity was higher for asymptomatic patients, suggesting increased STI prevalence. These changes likely resulted in a substantial number of undiagnosed STIs, representing missed opportunities for PrEP linkage. Efforts are needed to re-establish and sustain access to STI services for adolescents in response to disruptions caused by the pandemic.

Financial risk assessment on Chinese Enterprises’ overseas investment in the post epidemic Era based on text analysis and factor analysis

The COVID-19 in 2020 precipitating global economy makes the problems of geopolitics and protectionism more significant, economy development among host countries is imbalance, and the investment enterprises in the post epidemic era face various risks. The paper based on text analysis adopts factor analysis method to construct finance risk assessment index system and gives an assessment on finance risk of overseas investment countries as well as reasonable advices after analysis. © ISPM 2021.All right reserved.

Global impact of the COVID-19 pandemic on stroke care and intravenous thrombolysis

Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods. Background: The COVID-19 pandemic led to widespread repercussions on the delivery of health care worldwide. Design/Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by ICD-10 codes and/or classifications in stroke center databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI,-11.7 to-11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI,-13.8 to-12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI,-13.7 to-10.3, p=0.001). There were greater declines in primary compared to comprehensive stroke centers (CSC) for stroke hospitalizations (-17.3% vs-10.3%, p<0.0001) and IVT (-15.5% vs-12.6%, p=0.0001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) months of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and CSC. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months, with greater recovery in hospitals with lower COVID-19 hospitalizations, high volume stroke centers, and CSCs.

Screening of FDA-Approved Drugs Using a MERS-CoV Clinical Isolate from South Korea Identifies Potential Therapeutic Options for COVID-19

Therapeutic options for coronaviruses remain limited. To address this unmet medical need, we screened 5406 compounds, including United States Food and Drug Administration (FDA)-approved drugs and bioactives, for activity against a South Korean Middle East respiratory syndrome coronavirus (MERS-CoV) clinical isolate. Among 221 identified hits, 54 had therapeutic indexes (TI) greater than 6, representing effective drugs. The time-of-addition studies with selected drugs demonstrated eight and four FDA-approved drugs which acted on the early and late stages of the viral life cycle, respectively. Confirmed hits included several cardiotonic agents (TI > 100), atovaquone, an anti-malarial (TI > 34), and ciclesonide, an inhalable corticosteroid (TI > 6). Furthermore, utilizing the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we tested combinations of remdesivir with selected drugs in Vero-E6 and Calu-3 cells, in lung organoids, and identified ciclesonide, nelfinavir, and camostat to be at least additive in vitro. Our results identify potential therapeutic options for MERS-CoV infections, and provide a basis to treat coronavirus disease 2019 (COVID-19) and other coronavirus-related illnesses.

AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19.

BACKGROUND: AKI is a common sequela of coronavirus disease 2019 (COVID-19). However, few studies have focused on AKI treated with RRT (AKI-RRT). METHODS: We conducted a multicenter cohort study of 3099 critically ill adults with COVID-19 admitted to intensive care units (ICUs) at 67 hospitals across the United States. We used multivariable logistic regression to identify patient-and hospital-level risk factors for AKI-RRT and to examine risk factors for 28-day mortality among such patients. RESULTS: A total of 637 of 3099 patients (20.6%) developed AKI-RRT within 14 days of ICU admission, 350 of whom (54.9%) died within 28 days of ICU admission. Patient-level risk factors for AKI-RRT included CKD, men, non-White race, hypertension, diabetes mellitus, higher body mass index, higher d-dimer, and greater severity of hypoxemia on ICU admission. Predictors of 28-day mortality in patients with AKI-RRT were older age, severe oliguria, and admission to a hospital with fewer ICU beds or one with greater regional density of COVID-19. At the end of a median follow-up of 17 days (range, 1-123 days), 403 of the 637 patients (63.3%) with AKI-RRT had died, 216 (33.9%) were discharged, and 18 (2.8%) remained hospitalized. Of the 216 patients discharged, 73 (33.8%) remained RRT dependent at discharge, and 39 (18.1%) remained RRT dependent 60 days after ICU admission. CONCLUSIONS: AKI-RRT is common among critically ill patients with COVID-19 and is associated with a hospital mortality rate of >60%. Among those who survive to discharge, one in three still depends on RRT at discharge, and one in six remains RRT dependent 60 days after ICU admission.

Association of Initial Viral Load in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Patients with Outcome and Symptoms.

The dynamics of viral load (VL) of the severe acute respiratory syndrome coronavirus 2 and its association with different clinical parameters remain poorly characterized in the US patient population. Herein, we investigate associations between VL and parameters, such as severity of symptoms, disposition (admission versus direct discharge), length of hospitalization, admission to the intensive care unit, length of oxygen support, and overall survival in 205 patients from a tertiary care center in New York City. VL was determined using quantitative PCR and log10 transformed for normalization. Associations were tested with univariate and multivariate regression models. Diagnostic VL was significantly lower in hospitalized patients than in patients not hospitalized (log10 VL = 3.3 versus 4.0; P = 0.018) after adjusting for age, sex, race, body mass index, and comorbidities. Higher VL was associated with shorter duration of the symptoms in all patients and hospitalized patients only and shorter hospital stay (coefficient = -2.02, -2.61, and -2.18; P < 0.001, P = 0.002, and P = 0.013, respectively). No significant association was noted between VL, admission to intensive care unit, length of oxygen support, and overall survival. Our findings suggest a higher shedding risk in less symptomatic patients, an important consideration for containment strategies. Furthermore, we identify a novel association between VL and history of cancer. Larger studies are warranted to validate our findings.