Healthcare workers exposed to coronavirus 2019 (COVID-19) patients could be psychologically distressed. This study aims to assess the magnitude of psychological distress and associated factors among ...hospital staff during the COVID-19 pandemic in a large tertiary hospital located in north-east Italy.
All healthcare and administrative staff working in the Verona University Hospital (Veneto, Italy) during the COVID-19 pandemic were asked to complete a web-based survey from 21 April to 6 May 2020. Symptoms of post-traumatic distress, anxiety and depression were assessed, respectively, using the Impact of Event Scale (IES-R), the Self-rating Anxiety Scale (SAS) and the Patient Health Questionnaire (PHQ-9). Personal socio-demographic information and job characteristics were also collected, including gender, age, living condition, having pre-existing psychological problems, occupation, length of working experience, hospital unit (ICUs and sub-intensive COVID-19 units vs. non-COVID-19 units). A multivariable logistic regression analysis was performed to identify factors associated with each of the three mental health outcomes.
A total of 2195 healthcare workers (36.9% of the overall hospital staff) participated in the study. Of the participants, 35.7% were nurses, 24.3% other healthcare staff, 16.4% residents, 13.9% physicians and 9.7% administrative staff. Nine per cent of healthcare staff worked in ICUs, 8% in sub-intensive COVID-19 units and 7.6% in other front-line services, while the remaining staff worked in hospital units not directly engaged with COVID-19 patients. Overall, 63.2% of participants reported COVID-related traumatic experiences at work and 53.8% (95% CI 51.0%-56.6%) showed symptoms of post-traumatic distress; moreover, 50.1% (95% CI 47.9%-52.3%) showed symptoms of clinically relevant anxiety and 26.6% (95% CI 24.7%-28.5%) symptoms of at least moderate depression. Multivariable logistic regressions showed that women, nurses, healthcare workers directly engaged with COVID-19 patients and those with pre-existing psychological problems were at increased risk of psychopathological consequences of the pandemic.
The psychological impact of the COVID-19 pandemic on healthcare staff working in a highly burdened geographical of north-east Italy is relevant and to some extent greater than that reported in China. The study provides solid grounds to elaborate and implement interventions pertaining to psychology and occupational health.
•GIS-based Mixed-Integer Linear programming (MILP) approach for DNs expansion planning.•Grouping secondary substations in primary substation clusters to obtain a cost-efficient, reliable, DN both in ...normal and in single contingency operating conditions.•Savings in terms of network extension reduction while maintaining a high level of reliability.•Proposed approach validates with real data.
This paper presents a novel methodology for the Distribution Networks expansion planning based on Geographic Information Systems. The proposed methodology combines Delaunay Triangulation with a Mixed-Integer Linear Programming model in a 2-steps approach. Secondary substations are grouped in primary substation clusters, considering both normal and contingency operation. Topological and electrical constraints have to be fulfilled as well as a given level of reliability; the mathematical formulation includes feeder and substation constraints. The proposed methodology is expected to be only the first step of the whole network expansion planning. Hence, it has to be able to give macro information that planners can refine in the following steps of the planning process. A numerical case study on a real network illustrates the effectiveness of the proposed approach for the Distribution Network expansion planning problem.
Abstract
There is increasing evidence that psycho-social factors can influence antimicrobial prescribing practice in hospitals and the community, and represent potential barriers to antimicrobial ...stewardship interventions. Clinicians are conditioned both by emotional and cognitive factors based on fear, uncertainty, a set of beliefs, risk perception and cognitive bias, and by interpersonal factors established through social norms and peer and doctor–patient communication. However, a gap is emerging between research and practice, and no stewardship recommendation addresses the most appropriate human resource allocation or modalities to account for psycho-social determinants of prescribing. There is a need for translation of the evidence available from human behaviour studies to the design and implementation of stewardship interventions and policies at hospital and community levels. The integration of behaviour experts into multidisciplinary stewardship teams seems essential to positively impact on prescribers’ communication and decision-making competencies, and reduce inappropriate antibiotic prescribing.
Asthma control and monitoring still represents a challenge worldwide. Although the international guidelines suggest the interplay between secondary and primary care services as an effective strategy ...to control the disease, community pharmacies' are seldom involved in asthma control assessment. The present cross-sectional study aimed at providing a picture of the relationship between asthma severity and control in community pharmacies within the health district of the city of Verona (Veneto Region, North-Eastern Italy).
A call for participation was launched through the Pharmacists' Association of Verona. Patients referring to the participating pharmacies with an anti-asthmatic drug medical prescription and an asthma exemption code were asked to complete the Asthma Control Test (ACT) and a brief questionnaire collecting information on their age, sex, smoking status, aerobic physical exercise and usual asthma therapy, which also defined asthma severity. A multinomial logistic regression model was fitted to investigate the risk of uncontrolled as well as poorly controlled vs. controlled asthma (base). Results were expressed as relative risk ratios (RRR) with 95% confidence interval (95%CI).
Fifty-seven community pharmacies accepted to participate and 584 asthmatic patients (54% females; mean-age: 51 ± 19 years) were consecutively recruited from 1st January to 30th June 2018 (6 months). Based upon ACT score 50.5% patients had a controlled asthma, 22.3% a poorly controlled and 27.2% uncontrolled. A variable proportion of patients with uncontrolled asthma were observed for every level of severity, although more frequently with mild persistent form of asthma. Most patients (92%) self-reported regular compliance with therapy. At multinomial regression analysis, patients under regular asthma treatment course (RRR = 0.33; 95%CI: 0.15; 0.77) were less likely to have an ACT< 16 compared to those not taking medications regularly.
Overall, our findings highlighted an unsatisfactory asthma control in the general population, independently of the severity level of the disease. Community pharmacies could be a useful frontline interface between patients and the health care services, supporting an effective asthma management plan, from disease assessment and monitoring treatment compliance to referral of patients to specialist medical consultancies.
Renewable energy sources, such as wind and photovoltaic solar, have added additional uncertainty to power systems. These sources, further to the conventional sources of uncertainty due to stochastic ...nature of both the load and the availability of generation resources and transmission assets, make clear the limitations of the conventional deterministic power flow in power system analysis and security assessment applications. In order to manage uncertainties, probabilistic approaches can provide a valuable contribution.
In this paper, we propose a new scheme for probabilistic security assessment. The model can deal with various types of probability distributions modeling power injections and can explicitly represent the effects on system security of correlation among nodal power injections (such as wind power) and of contingencies due to branch and generating unit outages. In addition, the steady-state behavior of the frequency regulation is explicitly included in the model. A new approach to deal with current limits is also proposed.
Extensive testing on both the modified IEEE-14 bus test system and the Sicilian power system indicates good performance of the proposed approach in comparison with the result obtained by the computationally more demanding Monte Carlo approach.
•A new scheme for probabilistic security assessment is proposed.•A technique to account for various types of probability distributions is developed.•Probabilistic evaluation of currents can be performed.•Impacts of contingencies and correlations on security are explicitly assessed.•The proposed model is suitable for large-scale power systems.
Biologics for severe asthma can significantly impact on the burden of disease and also have the potential to reduce asthma mortality. By reviewing the literature and contacting the pharmaceutical ...companies, the present paper aims at providing a worldwide snapshot of biologic drugs availability, related with the trend of asthma mortality rate, as a marker of the burden of the disease.
A decline in the global rate of annual asthma mortality was observed until the 1980s, but overall no further reduction occurred, and the current mortality estimation is 0.19 deaths per 100.000 people. A higher mortality rate has been registered in low and middle-income countries (LMICs), where poor socioeconomic conditions and lack of access to the medical resources are more relevant. The availability of monoclonal antibodies is mainly limited to the developed and high-income countries. Furthermore the overall “asthma management system” in LMICs suffers from a number of restrictions that hamper the widespread availability of biologics besides their costs. The availability of generic drugs in the field of biologics for severe asthma could contribute to facilitate their widespread accessibility. But before that, awareness and expertise regarding severe asthma, and proper tools to assess and manage it, deserve to be shared worldwide. Collaboration projects involving physicians from all the countries through the scientific Academies network and with the support of the Companies active in the field may provide an initial concrete opportunity.
Plasma levels of certain ceramides are increased in patients with ischemic heart disease (IHD). Many risk factors for IHD are also risk factors for chronic kidney disease (CKD), but it is currently ...uncertain whether plasma ceramide levels are increased in patients with CKD.
We measured six previously identified high-risk plasma ceramide concentrations Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/20:0), Cer(d18:1/22:0), Cer(d18:1/24:0) and Cer(d18:1/24:1) in 415 middle-aged individuals who attended our clinical Cardiology and Diabetes services over a period of 9 months.
A total of 97 patients had CKD (defined as e-GFRCKD-EPI<60ml/min/1.73m2 and/or urinary albumin-to-creatinine ratio≥30mg/g), 117 had established IHD and 242 had type 2 diabetes. Patients with CKD had significantly (P=0.005 or less) higher levels of plasma Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/20:0), Cer(d18:1/22:0), Cer(d18:1/24:0), and Cer(d18:1/24:1) compared to those without CKD. The presence of CKD remained significantly associated with higher levels of plasma ceramides (standardized beta coefficients ranging from 0.124 to 0.227, P<0.001) even after adjustment for body mass index, smoking, hypertension, diabetes, prior IHD, plasma LDL-cholesterol, hs-C-reactive protein levels and use of any lipid-lowering medications. Notably, more advanced stages of CKD and abnormal albuminuria were both associated (independently of each other) with increased levels of plasma ceramides. These results were consistent in all subgroups considered, including patients with and without established IHD or those with and without diabetes.
Increased levels of plasma ceramides are associated with CKD independently of pre-existing IHD, diabetes and other established cardiovascular risk factors.
Aims: Psychosocial and mental health problems are strongly associated with a higher level of dependency and mental-physical multi-morbidity requires special attention. Psychiatric residential ...facilities (RF) accommodate an even higher proportion of individuals with comorbid mental and physical illnesses compared to the community and this could in some way obstacle the rehabilitative paths and recovery of these patients characterized by complex needs. The aim of this study was to investigate the presence of medical diseases and the patterns of medical comorbidities in a population of patients living in rehabilitative residential settings. Methods: Patients living in three different types of RF in the catchment area of the Verona Mental Health Department during an index period were recruited. Medical information were collected from patients' medical charts and were categorized according to the impact and severity of comorbid medical diseases. Results: Out of 191 patients receiving residential treatment, 46.6% had medical comorbidity. The patients with comorbidity compared with those without comorbidity showed a slightly higher but not significant prevalence of males (68.5% vs 62.0%, p-0.363) and a significantly higher age (53.6 SD 11.3 vs 47.5 SD 12.2, p=0.001). Diagnosis was not different in the two groups (schizophrenia and other psychosis: 62.9% vs 64.0%; affective psychosis: 21.3% vs 18.0%; other: 15.7% vs 18.0%; p=0.494). Among those with medical comorbidity, a high percentage (58.4%) had more than a single comorbid medical condition. The most frequent comorbidities were diabetes, obesity, hypertension, mental retardation and alcoholism/ liver diseases. Diabetes affected more frequently patients with hypertension and obesity and vice-versa. No differences were detected among patients with no comorbidities, a single medical comorbidity and multiple comorbidities, with the exception of age (patients with no comorbidities were younger than patients with a single medical comorbidity), educational level (patients with a higher level of education had less frequently medical comorbidities) and the number of total and met service needs (higher in patients with no comorbidities). Conclusion: According with literature, patients with severe psychiatric disorders living in RF had higher medical comorbidities compared to outpatients. However, they did not differ in functioning, psychopathological symptoms, diagnosis, age at onset and quality of life.
The COVID-19 pandemic is putting a huge strain on the provision and continuity of care. The length of sickness absence of the healthcare workers as a result of SARS-CoV-2 infection plays a pivotal ...role in hospital staff management. Therefore, the aim of this study was to explore the timing of COVID-19 recovery and viral clearance, and its predictive factors, in a large sample of healthcare workers.
This is a retrospective cohort study.
The analysis was conducted on data collected during the hospital health surveillance programme for healthcare staff at the University Hospital of Verona; healthcare workers were tested for SARS-CoV-2 through RT-PCR with oronasopharyngeal swab samples. The health surveillance programme targeted healthcare workers who either had close contact with SARS-CoV-2–infected patients or were tested as part of the screening-based strategy implemented according to national and regional requirements. Recovery time was estimated from the first positive swab to two consecutive negative swabs, collected 24 h apart, using survival analysis for both right-censored and interval-censored data. Cox proportional hazard was used for multivariate analysis.
During the health surveillance programme, 6455 healthcare workers were tested for SARS-CoV-2 and 248 (3.8%, 95% confidence interval CI: 3.4–4.3) reported positive results; among those who tested positive, 49% were asymptomatic, with a median age of 39.8 years, which is significantly younger than symptomatic healthcare workers (48.2 years, P < 0.001). Screening tests as part of the health surveillance programme identified 31 (12.5%) of the positive cases. Median recovery time was 24 days (95% CI: 23–26) and 21.5 days (95% CI: 15.5–30.5) in right- and interval-censoring analysis, respectively, with no association with age, sex or presence of symptoms. Overall, 63% of participants required >20 days to test negative on two consecutive swabs. Hospitalised healthcare workers (4.8%) were older and had a significantly longer recovery time compared with non-hospitalised healthcare workers in both analyses (33.5 vs 24 days, P = 0.005).
Recovery from COVID-19 and viral clearance may take a long time, especially in individuals who are hospitalised. To detect asymptomatic cases, screening programmes for healthcare workers is recommended.
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