A Survey on forensic odontologists' activity in Italy during the COVID-19 pandemic

Few information on virus contagion at the beginning of the covid-19 pandemic led to severe restrictions in the dental and forensic activity in Italy, the introduction of procedural guidelines and implementation of preventive measures. A specific survey on Italian forensic odontologists (FOds) activity was conducted to investigate the COVD-19 pandemic impact on daily practices, the preventive measures adopted to manage the risks of contagion procedures performed on living and dead people and the possible peculiar cases that required the intervention of a medical examiner. A total of 122 FOds answered, mostly males over 46 years coming from northern Italy. The results highlight the lack of specific guidelines for the procedures on living people compared to those on the dead but the regulations for the daily clinical practice resulted more than sufficient: in fact, more than 80% of FOds adopted the preventive and safety measures provided for dental practices. The forensic activity significantly decreased during the initial period (more than 75%) and gradually normalized to pre-pandemic numbers in approximately 50% of cases after the implementation of the vaccination campaign. 13 cases of occupational contagion have been reported, most of them (more than 85%) in northern and central Italy. In two cases members of the dental staff sued the employer for responsibility in the contagion. The decrease of the overall ID activity during the pandemic time can be more likely attributed to the of the dental data than the real impact of the pandemic regulations. The use of telematic tools, such as teleconferences, for many procedures proved to be an important resource useful for application even in post-pandemic times.

Spread of viruses, which measures are the most apt to control COVID-19?

The persistent debate about the modes of transmission of SARS-CoV2 and preventive measures has illustrated the limits of our knowledge regarding the measures to be implemented in the face of viral risk. Past and present (pandemic-related) scientific data underline the complexity of the phenomenon and its variability over time. Several factors contribute to the risk of transmission, starting with incidence in the general population (i.e., colonization pressure) and herd immunity. Other major factors include intensity of symptoms, interactions with the reservoir (proximity and duration of contact), the specific characteristics of the virus(es) involved, and a number of unpredictable elements (humidity, temperature, ventilation…). In this review, we will emphasize the difficulty of "standardizing" the situations that might explain the discrepancies found in the literature. We will show that the airborne route remains the main mode of transmission. Regarding preventive measures of prevention, while vaccination remains the cornerstone of the fight against viral outbreaks, we will remind the reader that wearing a mask is the main barrier measure and that the choice of type of mask depends on the risk situations. Finally, we believe that the recent pandemic should induce us in the future to modify our recommendations by adapting our measures in hospitals, not to the pathogen concerned, which is currently the case, but rather to the type of at-risk situation.

Risk perception, knowledge about SARS-CoV-2, and perception towards preventive measures in Italy: a nationwide cross-sectional study

Introduction

After COVID-19 outbreak, governments adopted several containment measures. Risk perception and knowledge may play a crucial role since they can affect compliance with preventive measures. This study aimed to explore the extent and the associated factors of risk perception, knowledge regarding SARS-CoV2, and perception towards preventive measures among the Italian population.

Methods

A nationwide cross-sectional study involving adults was conducted in April-May 2021: an online survey was distributed through social media. The outcomes were: Knowledge Score (KS) (0 to 100%: higher scores correspond to higher COVID-19 related knowledge); Risk Perception Score (RPS) (1 to 4: higher values indicate higher concern); Preventive measures Perception Score (PPS) (1 to 4: higher values indicate higher confidence). Multivariable regression models were performed.

Results

A total of 1120 participants were included. Median KS was 79.5% (IQR = 72.7%-86.4%). Lower education and poor economic conditions were negatively associated with the KS. Median RPS was 2.8 (IQR = 2.4-3.2). Female gender, sharing house with a fragile person, suffering from a chronic disease, having a family member/close friend who contracted SARS-CoV-2 infection were positively associated with the RPS. Median PPS was 3.1 (IQR = 2.8-3.4). Lower educational level was negatively associated with the PPS. Vaccine hesitancy was negatively associated with all three outcomes. The three scores were positively associated with each other.

Conclusions

Fair levels of knowledge, risk perception and perception towards preventive measures were reported. Reciprocal relationships between the outcomes and a relevant relationship with vaccine hesitancy were highlighted. Further investigations should be focused on studying underlying determinants and consequences.

[2022 ESC guidelines on cardio-oncology : Understanding and treating cardiovascular side effects from cancer therapy]

The continuous improvement in cancer treatment leads to a growing number of long-term survivors. Arguably, the treatment of cardiovascular side effects from cancer therapy is therefore of major importance for the morbidity and mortality affected patients. The 2022 ESC guidelines on cardio-oncology of the European Society of Cardiology (ESC) aim to improve the treatment of affected patients across the entire continuum of therapy and in the long term by establishing standardized procedures for prevention, diagnostics, and treatment of cardiovascular side effects. Suitable diagnostic and therapeutic measures for specific substance classes are defined on the basis of fundamental recommendations for cardio-oncological care in individual therapy phases. Furthermore, the guidelines provide a comprehensive focus on individual risk assessment before the start of therapy as the basis for determining the type and intensity of cardio-oncological care in the further course. In addition, the risk assessment serves as a basis for the initiation of suitable preventive measures to avoid or minimize the development of cardiovascular side effects during therapy. The present article provides an overview of the most important innovations of the 2022 ESC guidelines on cardio-oncology with respect to general definitions and recommendations as well as a summary of the most important recommendations for some specific forms of therapy with relevance for cardio-oncology in the future.

Enhance Safety in Aneurysm Surgery: Strategies for Prevention of Intraoperative Vascular Complications

Complications during surgery for intracranial aneurysms can be devastating. Notorious pitfalls include premature rupture, parent vessel occlusion, local cerebral injury and brain contusion, and incomplete neck obliteration. These unfavorable intraoperative events can result in major neurological deficits with permanent morbidity and even mortality. Herein, the author highlights the relevant surgical strategies used in his daily practice of aneurysm surgery (e.g., aneurysm clipping with adenosine-induced temporary cardiac arrest), application of which may help prevent vascular complications and enhance surgical safety through reduction of the associated risks, thus allowing improvement of postoperative outcomes. Overall, all described methods and techniques should be considered as small pieces in the complex puzzle of prevention of vascular complications during aneurysm surgery.

Major Internal Carotid Artery Injury During Endoscopic Skull Base Surgery: Case Report

Major vascular structures are always at risk during complex skull base surgery, particularly with use of the endoscopic endonasal approach, and intraoperative damage of the internal carotid artery (ICA) can be a devastating complication. Herein, we report a case of a young patient who had a major injury of the left ICA during endoscopic resection of a recurrent petrous bone chordoma. Massive bleeding was controlled by a Foley balloon inserted and kept in the resection area. Urgent angiography revealed a persistent leak from the petrous segment of the left ICA, and the vessel was sacrificed with coiling, since a balloon occlusion test showed good collateral blood flow. The patient woke up from anesthesia without a neurological deficit. Salvage resection of recurrent skull base neoplasms deserves specific attention because of the possibility of major vascular damage. In cases of intraoperative ICA injury, its management requires immediate decisions, and the available possibilities for endovascular therapy should always be considered.

Characteristics of coal resources in China and statistical analysis and preventive measures for coal mine accidents

In the process of green and smart mine construction under the context of carbon neutrality, China's coal safety situation has been continuously improved in recent years. In order to recognize the development of coal production in China and prepare for future monitoring and prevention of safety incidents, this study mainly elaborated on the basic situation of coal resources and national mining accidents over the past five years  (2017-2021), from four dimensions (accident level, type, region, and time), and then proposed the preventive measures based on accident statistical laws. The results show that the storage of coal resources has obvious geographic characteristics, mainly concentrated in the Midwest, with coal resources in Shanxi and Shaanxi accounting for about 49.4%. The proportion of coal consumption has dropped from 70.2% to 56% between 2011 and 2021, but still accounts for more than half of the all. Meanwhile, the accident-prone areas are positively correlated with the amount of coal production. Among different levels of coal mine accidents, general accidents had the highest number of accidents and deaths, with 692 accidents and 783 deaths, accounting for 87.6% and 54.64% respectively. The frequency of roof, gas, and transportation accidents is relatively high, and the number of single fatalities caused by gas accidents is the largest, about 4.18. In terms of geographical distribution of accidents, the safety situation in Shanxi Province is the most severe. From the time distribution of coal mine accidents, the accidents mainly occurred in July and August, and rarely occurred in February and December. Finally, the "4 + 4" safety management model is proposed, combining the statistical results with coal production in China. Based on the existing health and safety management systems, the managements are divided into four sub-categories, and more specific measures are suggested.

Potential effect of heat adaptation on association between number of heatstroke patients transported by ambulance and wet bulb globe temperature in Japan

This study analyzed the association between heatstroke incidence and daily maximum wet bulb globe temperature (WBGT) for all 47 prefectures in Japan by age group and severity using time-series analysis, controlling for confounders, such as seasonality and long-term trends. With the obtained association, the relative risk between the reference WBGT (defined as the value at which heatstroke starts to increase) and the daily maximum WBGT at 30 °C (RR_wbgt30) of each prefecture were calculated. For the heatstroke data, the daily number of heatstroke patients transported by ambulance at the prefecture level, provided by the Fire and Disaster Management Agency, was utilized. The analysis was conducted for age groups of 7-17 y, 18-64 y, and ≥65 y, and for severity of Deceased, Severe, Moderate (combined as DSM), and Mild. The analysis period was set from May 1 to September 30, 2015-2019. Finally, the correlation between RR_wbgt30 and the average daily maximum WBGT during the analysis period (aveWBGTms) of each prefecture was analyzed to examine the regionality of heatstroke incidence. The result showed that RR_wbgt30 is negatively correlated with aveWBGTms for the age group 18-64 y and ≥65 y (except for the age group 7-17 y) and for severity. The natural logarithm of the RR_wbgt30 of all 47 prefectures ranged from 2.0 to 8.2 for the age group 7-17 y, 1.1 to 4.0 for the age group 18-64 y, 1.8 to 6.0 for the age group ≥65 y, and 1.0 to 3.6 for DSM, and 0.9 to 4.0 for Mild. This regionality can be attributed to the effects of heat adaptation, where people in hotter regions are accustomed to implementing measures against hot environments and are more heat acclimatized than people in cooler regions.

Injury of the Internal Carotid Artery During Dissection of a Craniopharyngioma via the Pterional Approach: Case Report

Among the various causes of intraoperative neurosurgical complications, a major arterial injury is one of the most devastating. Herein, the authors present a case of a 76-year-old patient who underwent removal of a craniopharyngioma via the pterional approach and experienced severe damage of her sclerotic left internal carotid artery because it was retracted excessively by a brain spatula, which resulted in complete sacrifice of the vessel. Despite stable parameters on intraoperative monitoring of motor evoked potentials and sufficient collateral blood flow, confirmed by Doppler flowmetry, a large infarct in the left cerebral hemisphere was noted after surgery. Although retraction of movable arteries, veins, and cranial nerves can often be done safely during neurosurgical procedures for effective exposure of the operative field, forced displacement of a sclerotic internal carotid artery in its paraclinoid portion anchored to the fixed distal dural ring should definitely be avoided because it poses a significant risk of major vessel damage.

Complication Avoidance in Neurosurgery with Use of Intraoperative Ultrasonography

Intraoperative ultrasonography is an extremely valuable tool for avoidance of complications during neurosurgical procedures, including resection of intracranial and spinal cord tumors, removal of spontaneous intracerebral hemorrhages and arteriovenous malformations, and ventricular access for shunt placements. Nevertheless, application of this highly useful technique may be accompanied by some challenges and difficulties, as well as human errors; thus, it requires specific knowledge and continuous training.

How to cope with emerging viral diseases: lessons from South Korea's strategy for COVID-19, and collateral damage to cardiometabolic health

South Korea is a unique country in many aspects in terms of its strategy against the COVID-19 pandemic. From February 2020, the South Korean government adopted active epidemiological investigations, strict isolation of affected patients, and extensive public lockdowns, which were helpful in controlling spread until the end of 2021. This stable situation in South Korea has changed dramatically since the Omicron variant-reportedly less severe but more infective than the original strain-became dominant from January 2022. From mid-February to mid-April 2022, daily cases of COVID-19 in South Korea increased steeply, reaching > 600,000 cases/day: the highest incidence rate in the world at that time. Despite this rapid increase, the South Korean government has eased its preventive strategies progressively, based on the belief in the efficacy of >80% of vaccine coverage in the population. Now, in June 2022, the COVID-19 situation in South Korea is improving. The mortality rate is 0·13%: the lowest among the 30 countries with the highest case counts. High vaccine coverage rate (87·7%), the efficient healthcare system, and active co-operation between private sectors and the central government seem to have contributed to this. However, it should also be noted that the COVID-19 pandemic and its preventive measures have had a negative influence on cardiometabolic profiles in the country. Considering the likelihood of another novel variant of SARS-CoV-2 or new infectious disease emerging in the future, understanding the situation in South Korea and the strategies flexibly adopted by its government could be beneficial for many countries.

Cottonoid Retention After Craniotomy: Causes and Ways to Avoid It

Nonabsorbable surgical material left in an surgical wound may cause early postoperative infections and specific types of granulomas; thus, it represents a dangerous complication in neurosurgery. The authors have analyzed their experience and present four cases of cottonoid retention after intracranial tumor resection. During 5-year period (from 2013 until 2017), the incidence of such an undesirable event after craniotomy for various indications was 0.07%. It was not related to the professional experience of the operating neurosurgeon, but cases of deep-seated lesions, the presence of brain edema or excessive bleeding of neoplastic or peritumoral tissue, prolonged surgeries, use of cottonoids without marking thread, and inadequate counting of disposable surgical materials at the end of the procedure may increase the risk of this complication. In all of the presented cases, the retained cottonoids were clearly seen on postoperative computed tomography because of the presence of radiopaque identifiers. All of the patients underwent an urgent reoperation for removal of the foreign body within 24 h after completion of the primary surgery, and they subsequently experienced an uneventful postoperative course without any complications. Well-coordinated work of the surgical team-in particular, appropriate communication between the surgeon and the circulating nurse during counting of surgical materials at the end of the procedure-is absolutely necessary for prevention of cottonoid retention after brain surgery.

Managing Complications Related to Peripheral Nerve Surgery: Selected Illustrative Cases

Peripheral nerve surgery mostly involves elective procedures; thus, the associated complications are of great clinical, social, and medicolegal importance. Apart from the general perioperative morbidity, complications during interventions on peripheral nerves are extremely rare. However, iatrogenic peripheral nerve injuries during unrelated surgical procedures performed by those not specialised in peripheral nerve surgery remain the most significant group of complications, accounting for up to approximately 17% of all cases. The aims of this review are to provide better insight into the multifaceted nature of complications related to peripheral nerve surgery-from the perspective of their causes, treatment, and outcome-and to raise surgeons' awareness of the risks of such morbidity. It should be emphasized that intraoperative complications in peripheral nerve surgery are largely "surgeon-related" rather than "surgery-related"; therefore, they have great potential to be avoided.

[Current hygiene regulations in the operating theatre with special focus on constructional and functional measures]

The article provides an overview of the most important innovations in hygiene recommendations that were published in 2018 by the Committee for Hospital Hygiene and Infection Prevention (KRINKO) on the prevention of postoperative wound infections. This summarizes several older recommendations and supplements, updates and extends them. The article focusses on technical and constructional hygiene regulations for operating theaters and includes the position of the German Statutory Accident Insurance (DGUV).

[The ambivalent role of spirituality in explaining conspiracy belief and protest intentions in the context of the COVID-19 pandemic]

In the course of the COVID-19-pandemic, groups that present themselves as anchors in problem solving and provide supposed solutions for dealing with insecurities are becoming increasingly visible. There seems to be a tendency for conspiracy belief and esoteric attitudes, which are increasingly being expressed in the protests against measures to contain the pandemic. This raises the question of the role of religious affiliations and spiritual worldviews within such groups. In the present study, spirituality is differentiated and measured independently of religion in order to shed light on these questions. The results show two forms of spirituality that differ in the dimensions of worldviews and ethics, values and meaning of life. Both forms can be found in religious as well as non-religious groups. Analyses show different effects of these forms of spirituality on the openness towards alternative and esoteric explanations of the world as well as a skepticism towards science. Additionally, all spiritual elements also contribute to clarifying the belief in conspiracy stories, the support of COVID-related demonstrations and the willingness to participate in these demonstrations. Active spirituality acts as a protective factor and passive spirituality as a reinforcing (risk) factor for these phenomena. Overall, this multi-dimensional measurement of spiritual worldviews can explain attitudes relevant to conspiracy belief and protests, and in this way can break down the previous ambivalent effects of spirituality as a resilience vs. risk factor for such attitudes.

Congregational Worshiping and Implementation of the COVID-19 Preventive Behavioral Measures During the Re-opening Phase of Worship Places Among Indonesian Muslims

This research aimed at exploring the congregational form of worshiping and the preventative behaviors against COVID-19 among Indonesian Muslims during the re-opening phase of worship places. One thousand and ninety-seven (1097) participants who were a part of one of the largest Indonesian socio-religious organizations (Muhammadiyah) were included in the study. This study found most of the respondents to have performed tarawih prayers (66.7%) and Eid prayers (67.4%) at home during the pandemic. Furthermore, some Muslim worshipers did not observe COVID-19 preventive behavioral measures during the congregational prayers, and the attended mosques had inadequate facilitation for COVID-19 prevention. Neverthless, mosques are important settings for health promotion programs, whose religious leaders can be partners in delivering health related messages to their attending members.

Acute occupational exposures reported to the Dutch Poisons Information Center: a prospective study on the root causes of incidents at the workplace

BACKGROUND

Hazardous substances at the workplace can cause a wide variety of occupational incidents. This study aimed to investigate the nature and circumstances of acute occupational intoxications reported to the Dutch Poisons Information Center.

METHODS

During a one-year prospective study, data on the circumstances and causes of the incident, the exposure(s) and clinical course, were collected by a telephone survey with victims of an acute occupational intoxication.

RESULTS

We interviewed 310 patients. Most incidents occurred in industry (25%), building and installation industry (14%) and agriculture (10%). Patients were often exposed via multiple routes. Inhalation was the most common route of exposure (62%), followed by ocular (40%) and dermal contact (33%). Acids and alkalis were often involved. Exposure often occurred during cleaning activities (33%). The main root causes of these accidents were: technical factors such as damaged packaging (24%) and defective apparatus (10%), organizational factors such as lack of work instructions (44%) and poor communication or planning (31%), and personal factors such as disregarding work instructions (13%), not (adequately) using personal protective equipment (12%) and personal circumstances (50%) such as inaccuracy, time pressure or fatigue. The majority of the patients only reported mild health effects and recovered quickly (77% within 1 week).

CONCLUSIONS

Poison Center data on occupational exposures provide an additional source of knowledge and an important basis for poisoning prevention strategies related to hazardous substances at the workplace. These data are useful in deciding which risk mitigation measures are most needed in preventing future workplace injuries.

Management of patients with monkeypox virus (MPXV) infection and contacts in the community and in healthcare settings: A French position paper

Scope

Since April 2022, a large number of monkeypox (MPX) cases have emerged across the globe in regions that are known to be totally free of zoonotic reservoir. The High Council for Public Health is a national institute commissioned to provide guidelines to the French Ministry of Health. The objective of these guidelines and recommendations is to inform the public, people at risk of severe MPX infection, infected patients and their families and contacts and healthcare workers in charge of infected patients.

Methods

A review of the literature from the MEDLINE database was carried out using the single keyword ‘monkeypox’, including recent and older articles from January 2000 to June 2022. There was no filter for the type of study, except English language. The titles and summaries of all the articles were read by the experts to select articles of interest. The High Council for Public Health brought together specialists with expertise in the field to analyse the scientific literature and international recommendations. Recommendations were classified with clinical practice methodology using four levels (strong recommendation, recommendation, optional recommendation and no recommendation) without grading the level of evidence. To develop and methodologically validate the recommendations, the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE-II)chart was partially used.

Questions addressed by the guidelines and recommendations

(a) What are the therapeutic management measures for hospitalized patients with severe forms of MPX infection, and what are the preventive measures to protect healthcare professionals? (b) What are the isolation and prevention measures in the community for patients with mild or moderate severity MPX infection? (c) what are the preventive measures for contacts of an MPX-infected person? (d) Who should be vaccinated? (e) What are the specific prevention measures for children and schools?

Knowledge and understanding risk factors and preventive measures for osteoporosis in women: results of a survey in 502 women with and without a migration background

BACKGROUND

Osteoporosis is a disease of the skeletal system associated with loss of bone mass and an increased risk of fractures affecting women more often than men. Identification of the knowledge about osteoporosis and its preventive methods is the backbone of any awareness program. This study investigates the knowledge with a special focus on women with and without a migration background.

METHODS

Data from systematic patient interviews based on a questionnaire were collected at three different sites in Berlin between February and June 2021. The survey included questions assessing migrant background, demographic characteristics, lifestyle habits including physical exercise and smoking, prevention by vitamin D intake and bone densitometry, and information on personal and family medical history. According to the responses, a scale was created to assess the level of knowledge of preventive osteoporosis measures. The ethic committee of the Charité, Medical faculty has approved this study. SPSS (version 24.0) was used for the statistical analyses.

RESULTS

The survey of 502 female patients revealed that 25% had low and 34% no previous knowledge of osteoporosis. Older age and a better education level correlate with a higher knowledge. Patients with gynecologic cancer are less well informed. There is a significant difference in vitamin D intake between migrant and non-migrant women (57% vs. 49%). There were no significant differences regarding the use of bone densitometry.

CONCLUSION

Knowledge of osteoporosis and the possibility of a bone densitometry as well as the implementation of preventive measures is low among women. Therefore, informing patients better should be a priority, with particular attention on the risks and needs of women with a migration background. Specific programs for women with and without migration background should be developed to increase the awareness of osteoporosis.

Delayed arterial symptomatic epidural hematoma on the 14th day after posterior lumbar interbody fusion: A case report

BACKGROUND

Delayed arterial symptomatic epidural hematoma (SEH) on the 14^th day after posterior lumbar interbody fusion (PLIF) is rare but it may lead to severe complications if not identified and treated in a timely manner. After diagnosis of the current case, early surgical removal of the hematoma and strict hemostasis treatment was accomplished. This case report highlights the importance of swift diagnosis and treatment in SEH patients.

CASE SUMMARY

A 41-year-old male patient with a single-segment lumbar disc herniation underwent left-side PLIF. On the 14^th post-operative day, the patient complained of lumbar incision pain with sudden onset accompanied by left limb radiation pain and aggravated cauda equina symptoms. Magnetic resonance imaging examination and a puncture blood draw at the incision site confirmed a delayed arterial SEH. Emergency surgical removal of the hematoma and hemostasis was performed. About 70 mL of hematoma was found in the left incision. Continuous bleeding was found in the anterior branch of the transverse process of the 4^th lumbar artery in the muscle area about 2 cm below the transverse process of the 4^th lumbar vertebra. A blood jet of about 10 cm in height was observed and bipolar electrocoagulation was used to stop the bleeding. Post-operative lumbar incision pain and left lower limb pain were relieved immediately and gradually disappeared. There was no recurrence during the 12-mo follow-up.

CONCLUSION

For delayed arterial SEH on the 14^th day after PLIF, preventive measures including pre-, intra- and post-operative prevention should be implemented.

SARS-CoV-2 in a tropical area of Colombia, a remarkable conversion of presymptomatic to symptomatic people impacts public health

Background

The ability of SARS-CoV-2 to remain in asymptomatic individuals facilitates its dissemination and makes its control difficult. Objective. To establish a cohort of asymptomatic individuals, change to the symptomatic status, and determine the most frequent clinical manifestations. 

Methods

Between April 9 and August 9, 2020, molecular diagnosis of SARS-CoV-2 infection was confirmed in 154 asymptomatic people in contact with subjects diagnosed with COVID-19. Nasopharyngeal swabs were performed on these people in different hospitals in Córdoba, the Caribbean area of Colombia. The genes E, RdRp, and N were amplified with RT-qPCR. Based on the molecular results and the Cq values, the patients were subsequently followed up through telephone calls to verify their health conditions.

Results

Overall, of 154 asymptomatic individuals, 103 (66.9%) remained asymptomatic, and 51 (33.1%) changed to symptomatic. The most frequent clinical manifestations in young people were anosmia and arthralgia. Adults showed cough, ageusia, and odynophagia; in the elderly were epigastralgia, dyspnea, and headache. Mortality was 8%.

Conclusions

A proportion of 33% of presymptomatic individuals was found, of which four of them died. This high rate could indicate a silent transmission, contributing significantly to the epidemic associated with SARS-CoV-2.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07575-0.

Adapting teaching and learning in times of COVID-19: a comparative assessment among higher education institutions in a global health network in 2020

BACKGROUND

This research examines the ways in which higher education institutions (HEIs) across the tropEd Network for Education in International Health (tropEd) began to adapt their teaching and learning approaches in response to the COVID-19 pandemic in 2020. Already during this early phase of the pandemic HEIs' responses demonstrate global health approaches emphasising cooperation and communication, rather than national health driven strategies that emphasise quarantine and control. Key lessons learnt for multiple dimensions of teaching and learning in global health are thus identified, and challenges and opportunities discussed.

METHODS

Data collection includes a cross-sectional online survey among tropEd member institutions (n = 19) in mid-2020, and a complementary set of open-ended questions generating free-text responses (n = 9). Quantitative data were analysed using descriptive statistics, textual data were analysed using a Framework Analysis approach.

RESULTS

While early on in the pandemic the focus was on a quick emergency switch to online teaching formats to ensure short-term continuity, and developing the administrative and didactic competence and confidence in digital teaching, there is already recognition among HEIs of the necessity for more fundamental quality and longer-term reforms in higher education in global health. Alongside practical concerns about the limitations of digital teaching, and declines in student numbers, there is a growing awareness of opportunities in terms of inclusivity, the necessity of cross-border cooperation, and a global health approach. The extent to which the lack of physical mobility impacts HEI programmes in global health is debated.

CONCLUSION

The COVID-19 pandemic has brought about preventive measures that have had a considerable impact on various dimensions of academic teaching in global health. Going forward, international HEIs' experiences and response strategies can help generate important lessons for academic institutions across different settings worldwide.

Preventive Measures against COVID-19 in Small- and Mid-sized Enterprises from an Early Stage of the Epidemic in Daegu and Gyeongsangbuk-do

Background

In the early stage of the coronavirus disease 2019 (COVID-19) epidemic, small- and mid-sized enterprises (SMEs) may be an important transmission consideration. The study aimed to identify the pattern of COVID-19 prevention measures during the outbreaks in Daegu and Gyeongsangbuk-do at the early stage of COVID-19. Moreover, we investigated whether SME size and past experiences affected the preventive measures implemented in the region.

Methods

A survey detailing the general characteristics and implementation of 12 preventive activities was conducted in 122 SMEs in Daegu and Gyeongsangbuk-do. The survey was analyzed by size and operation period.

Results

The study subjects consisted of 53 (43.4%) workplaces with 1–5 employees, 50 (40.9%) workplaces with 6–30 employees, and 19 (15.6%) workplaces with 31–49 employees. The lowest three items among those surveyed were ‘symptomatic workers to stay home for 3–4 days’ (17.2%), ‘work remotely’ (18.9%), and ‘video meetings’ (20.5%). There were significant differences in the rate of several preventive measures implemented. The larger sized SMEs, the higher the number of implementations (p < 0.01). The operation period had no significant relationship with the implementation of preventive measures. The same pattern was observed in multiple generalized linear regression with covariate adjustment.

Conclusion

Preventive measures among SMEs with fewer than 50 employees were identified. Even within SMEs, a gap in preventive measures according to size was confirmed. To prevent the spread of infection and protect workers' right to health, different support for different sized SMEs is necessary.

Inappropriate urinary catheterisation: a review of the prevalence, risk factors and measures to reduce incidence

Urinary tract infections (UTIs) comprise the second most common type of healthcare-associated infections, with up to 80% of UTIs caused by indwelling urinary catheters. Current research suggests that the best way to prevent catheter-associated UTIs (CAUTIs) is to reduce unnecessary catheterisation. Few reviews have focused on the prevalence, risk factors and preventive measures for inappropriate catheterisation. This article, consequently, sought to evaluate the current evidence on the prevalence, risk factors and measures that can be taken to prevent inappropriate urinary catheterisation.

A case series of severe breakthrough infections observed in nine patients with COVID-19 in a southwestern German university hospital

Purpose

Vaccination is the key element for protection against COVID-19. Increased vaccination breakthroughs raise the question of whether additional prevention is necessary in case of individual risk factors for a severe course with hospitalization or death despite vaccination.

Methods

Since July 13, 2021, there is an extended reporting requirement by German law. We analyzed our hospitalized patients with vaccine breakthrough infection during the first 8 weeks.

Results

Nine of 67 patients (13.4%) hospitalized for COVID-19 (median age 75 years) were fully vaccinated. Five of these patients received intensive care; two patients died. All had received two doses of BNT162b2 vaccines (Pfizer-BioNTech). There was a median of 99 days between complete immunization and symptom onset. All patients suffered from ≥ three comorbidities. Six patients (66.7%) showed a negative Anti-SARS-CoV-2-N titer at the time of vaccine breakthrough, five of these also had Anti-SARS-CoV-2-S titers < 100 U/ml. All determinable cases were Delta variant B.1.617.2.

Conclusion

Advanced age, underlying cardiorespiratory disease, and the Delta variant of SARS-CoV-2 were associated with hospitalization of our patients, suffering from vaccine breakthrough infection. Avoidance of face masks, lack of immunization of close contacts, and travel to high-risk areas have been observed as modifiable behavioural circumstances. Consistent personal protective measures, vaccination of close caregivers, and increased awareness might be effective measures in addition to COVID-19 booster vaccination for patients at a high risk to suffer a severe course of infection.