Evaluation of the Factors Associated with Reinfections towards SARS-CoV-2 Using a Case Control Design.

OBJECTIVE: The risk of reinfection with SARS-CoV-2 has been rapidly increased with the circulation of concerns about variants. So, the aim of our study was to evaluate the factors that increase the risk of this reinfection in healthcare workers compared to those who have never been positive and those who have had only one positivity. METHODS: A case-control study was carried out at the Teaching Hospital Policlinico Umberto I in Rome, Sapienza University of Rome, in the period between 6 March 2020 and 3 June 2022. Cases are healthcare workers who have developed a reinfection with the SARS-CoV-2 virus, while controls were either healthcare workers who tested positive once or those who have never tested positive for SARS-CoV-2. RESULTS: 134 cases and 267 controls were recruited. Female gender is associated with a higher odds of developing reinfection (OR: 2.42; 95% CI: 1.38-4.25). Moreover, moderate or high alcohol consumption is associated with higher odds of reinfection (OR: 1.49; 95% CI: 1.19-1.87). Diabetes is also associated with higher odds of reinfection (OR: 3.45; 95% CI: 1.41-8.46). Finally, subjects with increased red blood cell counts have higher odds of reinfection (OR: 1.69; 95% CI: 1.21-2.25). CONCLUSION: From the prevention point of view, these findings indicate that particular attention should be paid to subjects with diabetes mellitus, women and alcoholic drinkers. These results could also suggest that contact tracing represents a fundamental approach model against the SARS-CoV-2 pandemic, together with the health information of participants.

Synergistic Effect between SARS-CoV-2 Wave and COVID-19 Vaccination on the Occurrence of Mild Symptoms in Healthcare Workers.

BACKGROUND: Since the beginning of the pandemic, five variants of epidemiological interest have been identified, each of them with its pattern of symptomology and disease severity. The aim of this study is to analyze the role of vaccination status in modulating the pattern of symptomatology associated with COVID-19 infection during four waves. METHODS: Data from the surveillance activity of healthcare workers were used to carry out descriptive analysis, association analyses and multivariable analysis. A synergism analysis between vaccination status and symptomatology during the waves was performed. RESULTS: Females were found at a higher risk of developing symptoms. Four SARS-CoV-2 waves were identified. Pharyngitis and rhinitis were more frequent during the fourth wave and among vaccinated subjects while cough, fever, flu syndrome, headache, anosmia, ageusia, arthralgia/arthritis and myalgia were more frequent during the first three waves and among unvaccinated subjects. A correlation was found between vaccination and the different waves in terms of developing pharyngitis and rhinitis. CONCLUSION: Vaccination status and viruses' mutations had a synergic effect in the mitigation of the symptomatology caused by SARS-CoV-2 in healthcare workers.

How Has COVID-19 Affected Mental Health and Lifestyle Behaviors after 2 Years? The Third Step of a Longitudinal Study of Italian Citizens.

The COVID-19 pandemic and its protective measures had a tremendous effect on the general population's mental health and deeply affected their lifestyle. The present study carried out a longitudinal analysis to evaluate the long-lasting psychological effects of the pandemic and its impact on the general population's day-to-day routine. Three points in time were considered: the initial period of the lockdown (T1; n = 2766; March 2020), the final period of the lockdown (T2; n = 439; May 2020) and two years after the lockdown (T3; n = 268; July 2022). Frequency analyses were carried out to examine which behavioral changes were maintained following the COVID-19 pandemic and lockdown; furthermore, a repeated measures ANOVA test was run to measure differences in depression, stress, and anxiety levels between the three periods considered; lastly, multivariable ordinal logistic regression analyses were carried out to examine which variables were associated with psychological distress more than two years after the lockdown. The results highlighted that depression at T3 was associated with depression at T2 and negative affect, whereas stress at T3 was associated with stress at T2 and detachment. The psychological effects and lifestyle changes are also discussed.

Flu Vaccination among Healthcare Professionals in Times of COVID-19: Knowledge, Attitudes, and Behavior.

The seasonal flu vaccine is the most important way to prevent influenza epidemics, so it is useful to increase the awareness of health professionals. The aim of our study is to evaluate knowledge, attitudes, and behavior about flu vaccination among healthcare professionals in times of COVID-19. METHODS: A cross sectional study was carried out between November 2020 and April 2021. Participants were recruited in teaching hospital 'Policlinico Umberto I' of Rome. A survey of 24 questions about flu vaccination was administered, evaluating their knowledge, attitude, and practice about this topic. RESULTS: 872 healthcare professionals were involved in the study (36.9% men, 63.1% women). More than 90% of the HCWs, especially physicians, recognize the importance of getting influenza vaccination: The main reasons for not getting vaccinated were fear of vaccine side effects (20.3%) and fear of the needle (6.4%). Nevertheless, 40.7% of the healthcare providers consider mandatory vaccination as unethical, especially if they work in low-intensity wards. CONCLUSION: a high percentage of healthcare workers agree with the importance of influenza vaccination and only a small percentage is still opposed. It is therefore important to continue to promote the influenza vaccination through communication and health education programs.

Acinetobacter baumannii Isolates from COVID-19 Patients in a Hospital Intensive Care Unit: Molecular Typing and Risk Factors.

Infections caused by Acinetobacter baumannii represent a major concern for intensive care unit (ICU) patients. However, the epidemiology of these infections among COVID-19 patients has not been fully explored. The aims of this study were (i) to characterize the clonal spread of A. baumannii among COVID-19 patients admitted to the ICU of the Umberto I hospital of Rome during the first year of the pandemic and (ii) to identify risk factors for its acquisition. Isolates were analysed by pulsed-field gel electrophoresis, and a multivariable regression model was constructed. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. Overall, 193 patients were included, and 102 strains were analysed. All isolates had highly antibiotic-resistant profiles and derived from two genotypes. The cumulative incidence of A. baumannii acquisition (colonization or infection) was 36.8%. Patients with A. baumannii had higher mortality and length of stay. Multivariable analysis showed that previous carbapenem use was the only risk factor associated with A. baumannii acquisition (aOR: 4.15, 95% CI: 1.78-9.64). We documented substantial A. baumannii infections and colonization and high levels of clonal transmission. Given the limited treatment options, effective prevention and containment strategies to limit the spread of A. baumannii should be implemented.

Assessment of the Impact of COVID-19 Lockdown on the Nutritional Status and Lipid Profile of Employees in a Teaching Hospital in Rome: A Retrospective Cohort Study.

BACKGROUND: on the 9 March 2020, the Italian government declared a state of lockdown on the entire national territory aimed at reducing the spread of SARS-CoV-2, causing strong repercussions for people's lifestyles. The aim of the study was to analyze the impact of the lockdown on the nutritional status and lipid profile of employees of an Italian teaching hospital. METHODS: an observational retrospective cohort study was carried out at the Department of Occupational Medicine of the Umberto I General Hospital of Rome, including all employees who underwent two consecutive occupational medical examinations before and after the first lockdown (9 March 2020-18 May 2020). Employee medical records were used as a data source. RESULTS: 1014 employees were involved in the study (50.6% nurses, 31% physicians, 14.8% technical staff, 3.6% administrative staff). Post lockdown BMI, total cholesterol and LDL values increased statistically significantly compared to pre lockdown ones. Nurses showed a significant association with increased BMI (p < 0.001), while workers with heart disease were inversely associated with total cholesterol (p < 0.001) and LDL (p < 0.001). CONCLUSION: this study showed that lockdown had a significant impact on employees' lifestyles. Further studies are needed to understand changes in health-related behaviors, such as diet and physical activity, of specific categories of workers over time under lockdown conditions.

Acinetobacter baumannii Isolates from COVID-19 Patients in a Hospital Intensive Care Unit: Molecular Typing and Risk Factors

Infections caused by Acinetobacter baumannii represent a major concern for intensive care unit (ICU) patients. However, the epidemiology of these infections among COVID-19 patients has not been fully explored. The aims of this study were (i) to characterize the clonal spread of A. baumannii among COVID-19 patients admitted to the ICU of the Umberto I hospital of Rome during the first year of the pandemic and (ii) to identify risk factors for its acquisition. Isolates were analysed by pulsed-field gel electrophoresis, and a multivariable regression model was constructed. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. Overall, 193 patients were included, and 102 strains were analysed. All isolates had highly antibiotic-resistant profiles and derived from two genotypes. The cumulative incidence of A. baumannii acquisition (colonization or infection) was 36.8%. Patients with A. baumannii had higher mortality and length of stay. Multivariable analysis showed that previous carbapenem use was the only risk factor associated with A. baumannii acquisition (aOR: 4.15, 95% CI: 1.78–9.64). We documented substantial A. baumannii infections and colonization and high levels of clonal transmission. Given the limited treatment options, effective prevention and containment strategies to limit the spread of A. baumannii should be implemented.

Comparing the Occurrence of Healthcare-Associated Infections in Patients with and without COVID-19 Hospitalized during the Pandemic: A 16-Month Retrospective Cohort Study in a Hospital Intensive Care Unit.

The COVID-19 pandemic has increased the healthcare-associated infection (HAI) risk in intensive care unit (ICU) patients. However, a comparison between patients with and without COVID-19 in terms of HAI incidence has been rarely explored. In this study, we characterized the occurrence of HAI among patients with and without COVID-19 admitted to the ICU of the Umberto I hospital of Rome during the first 16 months of the pandemic and also identified risk factors for HAI acquisition. Patients were divided into four groups according to their ICU admission date. A multivariable conditional risk set regression model for multiple events was constructed for each admission period. Adjusted hazard ratios and 95% confidence intervals were calculated. Overall, 352 COVID-19 and 130 non-COVID-19 patients were included, and a total of 361 HAIs were recorded. We found small differences between patients with and without COVID-19 in the occurrence and type of HAI, but the infections in the two cohorts mostly involved different microorganisms. The results indicate that patient management was likely an important factor influencing the HAI occurrence during the pandemic. Effective prevention and control strategies to reduce HAI rates should be implemented.

A Nationwide Survey of Psychological Distress among Italian People during the COVID-19 Pandemic: Immediate Psychological Responses and Associated Factors.

The uncontrolled spread of the coronavirus disease 2019 (COVID-19) has called for unprecedented measures, to the extent that the Italian government has imposed a quarantine on the entire country. Quarantine has a huge impact and can cause considerable psychological strain. The present study aims to establish the prevalence of psychiatric symptoms and identify risk and protective factors for psychological distress in the general population. An online survey was administered from 18-22 March 2020 to 2766 participants. Multivariate ordinal logistic regression models were constructed to examine the associations between sociodemographic variables; personality traits; depression, anxiety, and stress. Female gender, negative affect, and detachment were associated with higher levels of depression, anxiety, and stress. Having an acquaintance infected was associated with increased levels of both depression and stress, whereas a history of stressful situations and medical problems was associated with higher levels of depression and anxiety. Finally, those with a family member infected and young person who had to work outside their domicile presented higher levels of anxiety and stress, respectively. This epidemiological picture is an important benchmark for identifying persons at greater risk of suffering from psychological distress and the results are useful for tailoring psychological interventions targeting the post-traumatic nature of the distress.

The COVID-19 Outbreak and Psychological Distress in Healthcare Workers: The Role of Personality Traits, Attachment Styles, and Sociodemographic Factors

The COVID-19 outbreak has exposed healthcare professionals (HPs) to increased workloads and a high risk of contagion. The present study aimed at examining the effects of the COVID-19 outbreak on the mental health of HPs in Italy, investigating the role of attachment style, personality traits, and sociodemographic variables. An online survey was administered from 18 to 22 March 2020. Respondents were 296 HPs (77% female, 23% male;aged 21–77 years). The measures employed were a sociodemographic questionnaire, the Personality Inventory for DSM-5-BF (PID-5-BF), the Attachment Style Questionnaire (ASQ), and the Depression, Anxiety and Stress Scale–21 (DASS-21). The findings showed that PID-5-BF Negative Affect, female gender, and ASQ Preoccupation with Relationships predicted high levels of stress, anxiety, and depression, respectively. Furthermore, PID-5-BF Detachment predicted higher psychological distress, as captured in the DASS-21 total score and DASS-21 Depression score, and having an infected loved one was associated with high psychological distress. Overall, the results suggest that HPs are experiencing high rates of psychological distress during the pandemic, and that specific attachment styles and personality traits might be useful in identifying those at greatest risk for developing mental health symptoms.

The COVID-19 lockdown and psychological distress among Italian parents: Influence of parental role, parent personality, and child difficulties.

The Italian lockdown following the spread of COVID-19 exposed residents to a long and unexpected period of managing offspring at home. Throughout this time, most parents continued to work remotely. The present research aimed at assessing multiple sociodemographic and psychological variables for parental well-being during the lockdown. An online survey was administered from 6 to 11 April 2020. Respondents were 917 parents aged 23-67 years with up to six children, aged 3-13 years. The measures employed were: 14 demographic questions, the Big Five Inventory (BFI-10), the Emotional Symptoms and Hyperactivity-Inattention subscales of the Strength and Difficulties Questionnaire (SDQ-P), and the General Health Questionnaire (GHQ-12). Multiple moderated linear regression analyses were performed. Motherhood, higher levels of education, higher neuroticism, lower extroversion, and more child emotional and hyperactivity-inattention symptoms were found to be significant predictors of parent distress. Furthermore, a significant two-way interaction between child emotional problems and parent extroversion was found. Overall, parents showed high rates of psychological distress, signalling severe difficulties during the lockdown. Families with a child suffering from emotional and behavioural difficulties should immediately be detected by social services to activate support interventions to prevent chronic and amplified manifestations of these problems.

How to Improve Compliance with Protective Health Measures during the COVID-19 Outbreak: Testing a Moderated Mediation Model and Machine Learning Algorithms.

In the wake of the sudden spread of COVID-19, a large amount of the Italian population practiced incongruous behaviors with the protective health measures. The present study aimed at examining psychological and psychosocial variables that could predict behavioral compliance. An online survey was administered from 18-22 March 2020 to 2766 participants. Paired sample t-tests were run to compare efficacy perception with behavioral compliance. Mediation and moderated mediation models were constructed to explore the association between perceived efficacy and compliance, mediated by self-efficacy and moderated by risk perception and civic attitudes. Machine learning algorithms were trained to predict which individuals would be more likely to comply with protective measures. Results indicated significantly lower scores in behavioral compliance than efficacy perception. Risk perception and civic attitudes as moderators rendered the mediating effect of self-efficacy insignificant. Perceived efficacy on the adoption of recommended behaviors varied in accordance with risk perception and civic engagement. The 14 collected variables, entered as predictors in machine learning models, produced an ROC area in the range of 0.82-0.91 classifying individuals as high versus low compliance. Overall, these findings could be helpful in guiding age-tailored information/advertising campaigns in countries affected by COVID-19 and directing further research on behavioral compliance.

Weight Gain in a Sample of Patients Affected by Overweight/Obesity with and without a Psychiatric Diagnosis during the Covid-19 Lockdown.

The present study aimed at identifying psychological and psychosocial variables that might predict weight gain during the COVID-19 lockdown in patients affected by overweight/obesity with and without a psychiatric diagnosis. An online survey was administered between 25 April and 10 May 2020, to investigate participants' changes in dietary habits during the lockdown period. 110 participants were recruited and allocated to two groups, 63 patients had no psychiatric diagnosis; there were 47 patients with psychiatric diagnosis. ANOVA analyses compared the groups with respect to psychological distress levels, risk perception, social support, emotion regulation, and eating behaviors. For each group, a binary logistic regression analysis was conducted, including the factors that were found to significantly differ between groups. Weight gain during lockdown was reported by 31 of the participants affected by overweight/obesity without a psychiatric diagnosis and by 31 patients with a psychiatric diagnosis. Weight gain predictors were stress and low depression for patients without a psychiatric diagnosis and binge eating behaviors for patients with a psychiatric diagnosis. Of patients without a psychiatric diagnosis, 60% reported much more frequent night eating episodes. The risk of night eating syndrome in persons affected by overweight/obesity with no psychiatric diagnosis should be further investigated to inform the development of tailored medical, psychological, and psychosocial interventions.

A 2-Month Follow-Up Study of Psychological Distress among Italian People during the COVID-19 Lockdown.

The spread of coronavirus disease 2019 (COVID-19) has called for unprecedented measures, including a national lockdown in Italy. The present study aimed at identifying psychological changes (e.g., changes in depression, stress, and anxiety levels) among the Italian public during the lockdown period, in addition to factors associated with these changes. An online follow-up survey was administered to 439 participants (original sample = 2766), between 28 April and 3 May 2020. A paired sample t-test tested for differences in stress, anxiety, and depression over the period. Multivariate regression models examined associations between sociodemographic variables, personality traits, coping strategies, depression, and stress. Results showed an increase in stress and depression over the lockdown, but not anxiety. Negative affect and detachment were associated with higher levels of depression and stress. Higher levels of depression at the start of the lockdown, as well as fewer coping strategies and childlessness, were associated with increased depression at follow-up, whereas higher levels of stress at the start of the lockdown and younger age were associated with higher stress at follow-up. These results may help us to identify persons at greater risk of suffering from psychological distress as a result lockdown conditions, and inform psychological interventions targeting post-traumatic symptoms.

How Personality Relates to Distress in Parents during the Covid-19 Lockdown: The Mediating Role of Child's Emotional and Behavioral Difficulties and the Moderating Effect of Living with Other People.

Since the initiation of the COVID-19 lockdown, Italian parents have been forced to manage their children at home. The present study aimed at investigating the psychological distress of parents during the lockdown, identifying contributing factors. An online survey was administered to 833 participants from 3 to 15 April 2020. Mediation and moderated mediation models were run to explore the association between parent neuroticism and parent distress, mediated by child hyperactivity-inattention and child emotional symptoms, and the moderating effect of living only with child(ren) on the direct and indirect effects of parent neuroticism on parent distress. For parents living only with child(ren), high levels of psychological distress depended exclusively on their levels of neuroticism. For parents living with at least one other person in addition to child(ren), distress levels were also mediated by child behavioral and emotional difficulties. Motherhood emerged as a significant factor contributing to greater distress. Furthermore, parent psychological distress decreased in line with increased child age. The results confirm that neuroticism is an important risk factor for mental health. Preventive measures should be primarily target multicomponent families with younger children and directed towards parents who are already known to present emotional instability and to parents of children who have received local mental health assistance for behavioral and/or emotional difficulties.