Measuring moral distress in nurses during a pandemic: Development and validation of the COVID-MDS.

The COVID-19 pandemic created novel patient care circumstances that may have increased nurses' moral distress, including COVID-19 transmission risk and end-of-life care without family present. Well-established moral distress instruments do not capture these novel aspects of pandemic nursing care. The purpose of this study was to develop and evaluate the psychometric properties of the COVID-19 Moral Distress Scale (COVID-MDS), which was designed to provide a short MDS that includes both general and COVID-19-specific content. Researcher-developed COVID-19 items were evaluated for content validity by six nurse ethicist experts. This study comprised a pilot phase and a validation phase. The pilot sample comprised 329 respondents from inpatient practice settings and the emergency department in two academic medical centers. Exploratory factor analysis (EFA) was conducted with the pilot data. The EFA results were tested in a confirmatory factor analysis (CFA) using the validation data. The validation sample comprised 5042 nurses in 107 hospitals throughout the United States. Construct validity was evaluated through CFA and known groups comparisons. Reliability was assessed by the omega coefficient from the CFA and Cronbach's alpha. A two-factor CFA model had good model fit and strong loadings, providing evidence of a COVID-19-specific dimension of moral distress. Reliability for both the general and COVID-19-specific moral distress subscales was satisfactory. Known groups comparisons identified statistically significant correlations as theorized. The COVID-MDS is a valid and reliable short tool for measuring moral distress in nurses including both broad systemic sources and COVID-19 specific sources.

A methodological proposal to assess and manage environmental-health risks in Italy

The recent pandemic has affected health and lifestyles, highlighting the vulnerability of cities and territories, such as the ecological-environmental and climate crisis, as a result of progressive urbanization-urban connections. The health emergency was governed in the absence of geographical-territorial references, often generalizing limitations and actions to contain the spread of the Sars- Cov2 virus. In this framework, a methodological policy approach is proposed for cities and territories, for multi-risk management (environment-health) in order to overcome the gap that the health emergency has further highlighted, both in the context of the completion of the reform of intermediate institutions in Italy and in the transitions in progress (energy, ecological and digital). Copyright © FrancoAngeli.

Determinants of Chronic Biological Stress, Measured as Hair Cortisol Concentration, in a General Population of Adolescents: From Individual and Household Characteristics to Neighborhood Urbanicity.

Chronic biological stress may adversely affect adolescents' physical and mental health, but insight in the personal and environmental factors that determine chronic stress is limited. We measured 3-month cumulative hair cortisol concentration (HCC) in 419 adolescents, participating in the Flemish Environment and Health Study. Adolescents' health and lifestyle characteristics, household and neighborhood socio-economic status as well as neighborhood urbanicity were assessed as potential determinants of HCC, using multiple linear regression models. We additionally explored heterogeneity of our results by sex. HCC were significantly higher in boys from densely populated neighborhoods, the association was not significant in girls. Accordingly, boys living outside cities had significantly lower HCC than boys, living in cities. HCC was significantly lower in adolescents with an optimal vitality, a measure of a positive mental health status. In adolescent girls, menarcheal status (pre-/postmenarche) was a significant determinant of HCC. Our findings are the first to suggest that residential urbanicity may have an impact on chronic biological stress in a general population of adolescent boys.

Possible Roles of Permafrost Melting, Atmospheric Transport, and Solar Irradiance in the Development of Major Coronavirus and Influenza Pandemics.

Major pandemics involving respiratory viruses develop semi-regularly and require a large flux of novel viruses, yet their origination is equivocal. This paper explores how natural processes could give rise to this puzzling combination of characteristics. Our model is based on available data regarding the emergence of historic influenzas, early COVID-19 cases and spreading, the microbiome of permafrost, long-distance airborne transport of viruses reaching stratospheric levels, ultraviolet immunosuppression, sunlight variations, weather patterns, Arctic thawing, and global warming. Atmospheric conveyance is supported by hemispheric distribution disparities, ties of COVID-19 cases to air pollution particulate concentrations, and contemporaneous animal infections. The following sequence is proposed: (1) virus emergence after hot Arctic summers, predominantly near solar irradiance maxima or involving wildfires, indicates release of large amounts of ancient viruses during extensive permafrost melting, which are then incorporated in autumn polar air circulation, where cold storage and little sunlight permit survival. (2) Pandemics onset in winter to spring at rather few locations: from climate data on Wuhan, emergence occurs where the North Polar Jet stream hovers while intersecting warmer, moist air, producing rain which deposits particulates with the viral harvest on a vulnerable human population. (3) Spring and summer increases in COVID-19 cases link to high solar irradiance, implicating ultraviolet immune suppression as one means of amplification. (4) Viruses multiplied by infected humans at close range being incorporated in atmospheric circulation explains rapid global spread, periodic case surges (waves), and multi-year durations. Pollution and wind geography affect uptake and re-distribution. Our model can be tested, e.g., against permafrost stored in laboratories as well as Artic air samples, and suggests mitigating actions.

How do low wind speeds and high levels of air pollution support the spread of COVID-19?

The pandemic of coronavirus disease 2019 (COVID-19) is generating a high number of infected individuals and deaths. One of the current questions is how climatological factors and environmental pollution can affect the diffusion of COVID-19 in human society. This study endeavours to explain the relation between wind speed, air pollution and the diffusion of COVID-19 to provide insights to constrain and/or prevent future pandemics and epidemics. The statistical analysis here focuses on case study of Italy and reveals two main findings: 1) cities with high wind speed have lower numbers of COVID-19 related infected individuals; 2) cities located in hinterland zones (mostly those bordering large urban conurbations) with little wind speed and frequently high levels of air pollution had higher numbers of COVID-19 related infected individuals. Results here suggest that high concentrations of air pollutants, associated with low wind speeds, may promote a longer permanence of viral particles in polluted air of cities, thus favouring an indirect means of diffusion of the novel coronavirus (SARS-CoV-2), in addition to the direct diffusion with human-to-human transmission dynamics.

An index to quantify environmental risk of exposure to future epidemics of the COVID-19 and similar viral agents: Theory and practice.

In the presence of the novel Coronavirus Disease (COVID-19) and other new viral agents, one of the fundamental problems in science is the evaluation of environmental and social weaknesses of cities/regions to the exposure of infectious diseases for preventing and/or containing new COVID-19 outbreaks and the diffusion of other viral agents that generate a negative impact on public health and economy of countries. The current monitoring of transmission dynamics of infectious diseases is mainly based on reproduction number (R0) and fatality rates. However, this approach is a real-time monitoring of transmission dynamics for mitigating the numbers of COVID-19 related infected individuals and deaths. Reproduction number does not provide information to cope with future epidemics or pandemics. The main goal of this study is to propose the Index c (as contagions) that quantifies, ex-ante, the environmental risk of exposure of cities/regions to future epidemics of the COVID-19 and similar vital agents. This Index c synthetizes environmental, demographic, climatological and health risk factors of cities/regions that indicate their exposure to infectious diseases. Index c has a range from 1 (environmental and social weakness of urban areas leading to high levels of exposure to infectious diseases) to 0 (environment that reduces the risk of exposure to infectious diseases in society). The statistical evidence here, applied on case study of Italy, seems in general to support the predictive capacity of the Index c as a particularly simple but superior indicator in detecting the global correlation between potential risk of exposure of cities/regions to infectious diseases and actual risk given by infected individuals and deaths of the COVID-19. The Index c can support a proactive environmental strategy to help policymakers to prevent future pandemics similar to the COVID-19.