The bronchiolitis epidemic in 2021-2022 during the SARS-CoV-2 pandemic: experience of a third level centre in Northern Italy.

BACKGROUND: The aim of this study is to compare the 2021-2022 bronchiolitis season to the four previous years (2017-2018, 2018-2019, 2019-2020, 2020-2021) to see if there was an anticipation of the peak, an overall increase of cases, and an increased need of intensive care. METHODS: A retrospective single-centre study in the San Gerardo Hospital Fondazione MBBM, Monza, Italy was performed. Emergency Departments (ED) visits of patients aged < 18 years and ≤ 12 months were analyzed: the incidence of bronchiolitis on total assessments, the urgency level at triage and the hospitalization rate were compared. Data of children admitted to the Pediatric Department due to bronchiolitis were analyzed in terms of need of intensive care, respiratory support (type and duration), length of hospital stay, main etiological agent, patient characteristics. RESULTS: During 2020-2021 (first pandemic period) an important reduction in the ED attendance for bronchiolitis was observed, while in 2021-2022 there was an increase in incidence of bronchiolitis (13% of visits in infants < 1 year) and in the rate of urgent accesses (p = 0.0002), but hospitalization rates did not differ compared to previous years. Furthermore, an anticipated peak in November 2021 was observed. In the 2021-2022 cohort of admitted children to the Pediatric Department, a statistically significative increased need of intensive care unit was detected (Odds Ratio 3.1, 95% CI 1.4-6.8 after adjustment for severity and clinical characteristics). Instead, respiratory support (type and duration) and length of hospital stay did not differ. RSV was the main etiological agent and RSV-bronchiolitis determined a more severe infection (type and duration of breathing support, intensive care need and length of hospital stay). CONCLUSIONS: During Sars-CoV-2 lockdowns (2020-2021), there was a dramatic decrease of bronchiolitis and others respiratory infections. In the following season, 2021-2022, an overall increase of cases with an anticipated peak was observed and data analysis confirmed that patients in 2021-2022 required more intensive care than children in the four previous seasons.

Social media analysis of Twitter tweets related to ASD in 2019–2020, with particular attention to COVID-19: topic modelling and sentiment analysis

Background Social media contains an overabundance of health information relating to people living with different type of diseases. Autism spectrum disorder (ASD) is a complex neurodevelopmental condition with lifelong impacts and reported trends have revealed a considerable increase in prevalence and incidence. Research had shown that the ASD community provides significant support to its members through Twitter, providing information about their values and perceptions through their use of words and emotional stance. Our purpose was to analyze all the messages posted on Twitter platform regarding ASD and analyze the topics covered within the tweets, to understand the attitude of the various people interested in the topic. In particular, we focused on the discussion of ASD and COVID-19. Methods The data collection process was based on the search for tweets through hashtags and keywords. After bots screening, the NMF (Non-Negative Matrix Factorization) method was used for topic modeling because it produces more coherent topics compared to other solutions. Sentiment scores were calculated using AFiNN for each tweet to represent its negative to positive emotion. Results From the 2.458.929 tweets produced in 2020, 691.582 users were extracted (188 bots which generated 59.104 tweets), while from the 2.393.236 total tweets from 2019, the number of identified users was 684.032 (230 bots which generated 50.057 tweets). The total number of COVID-ASD tweets is only a small part of the total dataset. Often, the negative sentiment identified in the sentiment analysis referred to anger towards COVID-19 and its management, while the positive sentiment reflected the necessity to provide constant support to people with ASD. Conclusions Social media contributes to a great discussion on topics related to autism, especially with regards to focus on family, community, and therapies. The COVID-19 pandemic increased the use of social media, especially during the lockdown period. It is important to help develop and distribute appropriate, evidence-based ASD-related information.

Economic sanctions on countries are indiscriminate weapons and should be banned

Economists have studied the effect of economic sanctions on 98 countries over a period of 35 years.2 Their results suggest that UN sanctions reduce life expectancy by 1.2–1.4 years and that sanctions by the USA reduce life expectancy by 0.4–0.5 years.2 Their work suggests that an increase in child mortality and deaths due to cholera alongside decreased spending on public health were the main reasons for the decreased life expectancy.2 They also identified that women were more severely affected by sanctions. The availability of medicines in Iran was significantly reduced during the UNSC sanctions.11 Concern was raised that publishers of medical journals were refusing to consider papers from Iran in case they were in breach of US sanctions.12 A systematic review identified 55 papers documenting the adverse health effects of sanction on the population of Iran.13 The impact of economic sanctions on the most disadvantaged is highlighted by a review of the impact of economic sanctions on 71 countries from 1990 to 2012 and HIV in children.14 AIDS-related death rates increased by approximately 1% in children with HIV and new infection rates increased by 2.5%.14 The USA has imposed economic sanctions on more countries than any other country.7 One country in particular, Cuba, has experienced economic sanctions by the USA for 60 years. A comprehensive report by Oxfam details the impact of the US sanctions on Cuba.17 It highlights difficulties in obtaining basic medical supplies such as syringes, masks, ventilators, medicines as well as the raw materials needed to produce vaccines, medicines and sanitary hygiene products.17 Shortages of food and other basic products affect the most vulnerable in Cuba and the tightening of the sanctions has increased inequalities in Cuba.17 Even collaboration between Cuban and American scientists has been blocked by the US sanctions.18 President Obama and others have recognised that the sanctions against Cuba were ineffective.19 20 Unfortunately, both President Trump and Biden have expanded the sanctions. The Fourth Geneva Convention of 1949 was an attempt to protect civilians from harm during wars.26 Subsequent protocols adopted in 1977 tried to ensure greater protection for civilians.26 As health professionals, we are concerned about the indiscriminate effect of economic sanctions on countries on the human rights and health of civilians.

The 1918 Influenza Pandemic Versus COVID-19: A Historical Perspective From an Italian Point of View.

The ongoing COVID-19 pandemic has a major precedent almost exactly a century ago: the world-famous H1N1 influenza virus pandemic, sometimes known to the general public as the Spanish flu. From a history of medicine perspective, it is possible to underline many potential common traits between the two. In this article, hygiene and prophylaxis strategies are analyzed in a review of the most popular Italian general medical journals at the time of Spanish flu, Il Policlinico being the most representative of them. The analysis included 40 original journal articles as well as important references to the most influential coeval national manuals and international journals. The main issues in the context of public hygiene are prophylaxis with quinine and quinine derivatives, vaccinations, face masks, disinfection, and social distancing. We draw a comparison between these and the most recent international World Health Organization and Italian national guidelines on the topic. Sadly, little has changed since those times in terms of most of the prevention techniques, even with technical improvements, showing how shortsighted doctors and physicians can be when dealing with medical history. (Am J Public Health. 2021;111(10):1815-1823. https://doi.org/10.2105/AJPH.2021.306412).

Distance Learning in Children with and without ADHD: A Case-control Study during the COVID-19 Pandemic.

OBJECTIVE: This research involved the parents of ADHD students to explore how their children coped with online distance learning during COVID-19 pandemic and what implications this schooling method had on their emotional and behavioral well-being. METHOD: Data were collected during lockdown using an online questionnaire addressed to 100 mothers and were compared with 184 matched controls from a national survey launched in the same period. RESULTS: Attention span, spontaneous commitment, and autonomy in distance learning was found to be more limited in ADHD group. Compared to controls, 21.7% of ADHD students were not assessed and 40.9% did not receive grades. Behavioral changes were reported in both groups (64.2%), represented mainly by restlessness, aggressiveness, and anxiety. CONCLUSION: Distance education increases academic difficulties, especially in ADHD pupils. The effects of lockdown should be adequately evaluated upon school reopening and appropriate recovery interventions should be planned.

Burnout in Intensive Care Unit Workers during the Second Wave of the COVID-19 Pandemic: A Single Center Cross-Sectional Italian Study.

The COVID-19 pandemic had a massive impact on the Italian healthcare systems, which became overwhelmed, leading to an increased risk of psychological pressure on ICU workers. The present study aimed to investigate the prevalence of distress (anxiety, depression and insomnia symptoms), burnout syndrome and resilience in healthcare workers during the COVID-19 pandemic and to detect potential factors associated with their psychological response. This cross-sectional, survey-based study enrolled 136 healthcare workers assisting COVID-19 patients in the new COVID-19 ward (Intensive Care Unit), at Milano Fiera, Lombardy. Participants completed an online survey that comprised different validated and standardized questionnaires: Maslach Burnout Inventory (MBI), Resilience Scale for adults (RSA), Hospital Anxiety and Depression scale (HADS) and Insomnia Severity Index (ISI). Socio-demographic and work characteristics were also collected. Out of 136 ICU specialists, there were 84 nurses (62%) and 52 physicians (38%). Over half (60%) met the criteria for burnout, with nearly the same percentages among nurses and physicians. Nurses reported significantly higher scores of anxiety and insomnia levels. Forty-five percent of participants reported symptoms of depression (of whom 13.9% in the clinical range) and most of the staff showed moderate to high levels (82.4%) of resilience. The COVID-19 pandemic can have a significant impact on ICU staff. Effective interventions are needed to maintain healthcare professionals' mental health and relieve burnout. Follow-up and tailored procedures should be provided to alleviate the psychological burden in the frontline staff at highest risk.

Distance learning in Italian primary and middle school children during the COVID-19 pandemic: a national survey.

BACKGROUND: School closure created difficulties for parents, who were asked to care for their children and help them with schooling, while working at home. We aimed to explore the experiences in organising school for children at home and its implications on children's psychological well-being and educational progress during the quarantine for the COVID-19 pandemic. METHODS: A nationwide online survey of mothers of primary and middle school students was conducted during the COVID-19 pandemic. Demographic data and information on distance learning organisation and children's attitudes and behavioural changes were collected. RESULTS: 2149 mothers completed the survey, with a final sample of 1601 subjects. Large differences between primary and middle school emerged: lessons were less organised and routines were more instable for the youngest, who could not pay attention for more than 20 min (28.3%) and needed breaks every 10 min (21.6%), with lower quality of learning (40.6%), increased restlessness (69.1%), and aggressiveness (33.3%). A large use of screens was reported, with an abuse in screen time in 2%. Two thirds of mothers did not approve of distance learning (72.2%) because of their role in replacing teachers (77.8%), the effort required (66%), and the great commitment required (78.3%). CONCLUSIONS: Distance learning increased educational deprivation and social inequalities, especially for the youngest children, who lost almost one year of school. The situation was even worse for children with disabilities, who were neglected by the institutions. This period should be considered as an opportunity to correct the weaknesses of our school system.

Psychological distress among Italians during the 2019 coronavirus disease (COVID-19) quarantine.

BACKGROUND: Quarantine as a preventive action to reduce people's exposure to a contagious disease has substantial psychological impact. We aimed to collect information on psychologically distressing experiences of Italians living in quarantine during the COVID-19 pandemic. METHODS: From 6 to 20 April 2020 participants filled out an online questionnaire. Demographic and physical symptoms data from the prior 14 days of quarantine were collected. Psychological impact of quarantine was assessed by the COVID-19 Peritraumatic Distress Index (CPDI). RESULTS: In all, 20,158 participants completed the online survey. Of these, 11,910 (59.1%) were from Lombardy, the region with 37.7% of positive cases identified during the survey period. 30.1% of responders were male. About half (55.9%) of responders were 18-50 years old, 54.3% had a tertiary level of education, 69.5% were workers, 84.1% were living in houses with ≥3 rooms, and 13.7% were living alone. 9.7% had had contact with COVID-19 positive people. Of all responders, 9978 (48.6%) reported a psychological impact, 8897 (43.4%) of whom reported mild or moderate and 1081 (5.2%) severe psychological impact. The multivariate analysis, after adjustments, showed that an increasing CPDI score was associated with gender (female), first-second educational level, being unemployed, living in a ≤2 room house, having had new health problems during the previous 14 days, and not having been out of the house in the previous week. Concerning the type of psychological distress, 2003 responders (9.9%) reported moderate to severe depressive symptoms, 1131 (5.5%) moderate to severe anxiety symptoms, and 802 (3.9%) moderate to severe physical symptoms. A positive correlation was found between responder rate (per 10.000 residents) and positive COVID-19 cases (per 10.000 residents) by region (rs = + 0.83, p = < 0.0001), and between responder rate and region latitude (rs = + 0.91, p = < 0.0001), with a greater response rate in the north. Considering Lombardy Region responders, a negative correlation between CPDI score and distance from place of residence to the red zone (Nembro-Alzano) was found. Higher prevalence of psychological distress was found up to 25 km away from the red zone and, in particular, severe distress up to 15 km. CONCLUSIONS: Policy makers and mental health professionals should be aware of quarantine's adverse mental health consequences. Factors influencing the success of quarantine and infection control practices for both disease containment and community recovery should be identified and additional support to vulnerable persons at increased risk of adverse psychological and social consequences of quarantine should be guaranteed.

Psychological distress in adults with and without cystic fibrosis during the COVID-19 lockdown.

BACKGROUND: Hundreds of papers have been published on the COVID-19 pandemic, and several of them on psychological themes connected with it, but very little is so far known on how adult patients with Cystic Fibrosis (pwCFs) are coping with this dramatic event. METHODS: An online questionnaire was developed according to the Italian validated COVID-19 Peritraumatic Distress Index (CPDI) and addressed to the general population (GP). A similar questionnaire, augmented with CF specific questions, targeted pwCFs. The two web-based surveys were accessible for some weeks during the lockdown mandated by the Italian government. RESULTS: The CF questionnaire was completed by 712 adult pwCFs (422 females), matched for sex and age with a 1/5 ratio to GP questionnaire respondents. Mild or medium distress affected 40.2% of pwCFs and 43.9% of GP controls, severe distress 5.3% of pwCFs and 6.2% of GP controls. The level of psychological distress was not correlated with the degree of pulmonary function impairment. When symptoms of anxiety and depression, and physical manifestations were independently analyzed, the control group featured a 55% higher level of mild-moderate anxiety symptoms. Signs of psychological distress, symptoms of anxiety and depression, and physical manifestations were significantly more frequent in female pwCFs compared to males, similarly to GP. CONCLUSION: Adult pwCFs seem to have equal, and in some domains, lower levels of psychological distress than GP controls. This might be sustained by lifelong experiences in coping with the demands of their chronic disease. These results may orient future psychological interventions.