Hospital workers mental health during the COVID-19 pandemic: methods of data collection and characteristics of study sample in a university hospital in Milan (Italy)

BACKGROUND

The COVID-19 pandemic is currently a severe challenge for healthcare workers, with a considerable impact on their mental health. In order to focus preventive and rehabilitation measures it's fundamental to identify risk factors of such psychological impairment. We designed an observational longitudinal study to systematically examine the psychological wellbeing of all employees in a large University Hospital in Italy, using validated psychometric scales in the context of the occupational physician's health surveillance, in collaboration with Psychiatric Unit.

METHODS

The study started after ethical approval in August 2020. For each worker, the psychological wellbeing is screened in two steps. The first level questionnaire collects sociodemographic characteristics, personal and occupational COVID-19 exposure, worries and concerns about COVID-19, general psychological discomfort (GHQ-12), post-traumatic stress symptoms (IES-R) and anxiety (GAD-7). Workers who score above the cut-off in at least one scale are further investigated by the second level questionnaire composed by PHQ-9, DES-II and SCL-90. If second level shows psychological impairments, we offer individual specialist treatment (third level). We plan to follow-up all subjects to monitor symptoms and possible chronicization; we aim to investigate potential risk factors through univariate analysis and multivariate logistic regressions.

RESULTS

Preliminary results refer to a sample of 550 workers who completed the multi-step evaluation from August to December 2020, before vaccination campaign started. The participation rate was 90%. At first level screening, 39% of the subjects expressed general psychological discomfort (GHQ-12), 22% post-traumatic stress symptoms (IES-R), and 21% symptoms of anxiety (GAD-7). Women, nurses, younger workers, subjects with COVID-19 working exposure and with an infected family member showed significantly higher psychological impairment compared to colleagues. After the second level screening, 12% and 7% of all workers showed, respectively, depressive and dissociative symptoms; scorings were significantly associated with gender and occupational role. We are currently extending sample size and evaluating subjects over a period of further 12 months.

CONCLUSIONS

The possibility to perform a systematic follow-up of psychological wellbeing of all hospital workers, directly or indirectly exposed to pandemic consequences, constitutes a unique condition to detect individual, occupational, and non-occupational risk factors for psychological impairment in situations of prolonged stress, as well as variables associated with symptoms chronicization.

Anorexia of Aging Associated with Nutrients Intake in Brazilian Elderly

This study evaluated the association between anorexia of aging and nutrients intake. It was a cross-sectional study with 130 individuals aged 60 years or older, undergoing outpatient care in the city of Campinas, São Paulo. Anorexia of Aging (AA) was assessed using the Simplified Nutrition Appetite Questionnaire (SNAQ), and food consumption was evaluated using the 24-hour recall (24HR). The prevalence of AA was 27.7%, in which 66.7% were women and 38.9% were older than 80 years. Elderly with AA presented lower intake of calories (1172.6 kcal vs 1477.9 kcal; p = 0.003), carbohydrates (158.5 g vs 194.1 g; p = 0.015), proteins (49.9 g vs 68.5 g; p = 0.004) and lipids (34.6 g vs 46.1 g; p = 0.006). They also had lower intake of fibers (12.6 g vs 19.4 g; p < 0.001), iron (6.4 mg vs 8.9 mg; p < 0.001) and zinc (6.0 mg vs 8.5 mg; p = 0.004). Our results show that intake of most nutrients is significantly lower in AA elderly, except carbohydrates, which may point to worse-quality diets. The diagnosis of AA, as well as the evaluation of elderly food intake, are essential to prevent undernutrition, vulnerabilities, and increased morbidity and mortality.

Effect of Spacer Length and Solvent on the Concentration-Driven Aggregation of Cationic Hydrogen-Bonding Donor Polythiophenes

Aggregation of cationic isothiouronium polythiophenes with alkoxy-spacers of different lengths at the 3-position of the thiophene ring was studied in solvents of different polarities. Hydrogen-bonding capacity was assessed by steady-state absorption and fluorescence spectroscopy, whereas the aggregation in aqueous solutions was studied by electron paramagnetic resonance spectroscopy, using paramagnetic probes of different polarities. The two polymers displayed similar features in respect to conformation, effect of cosolvents on aggregation, unstructured absorption-fluorescence spectra, Stokes shifts when aggregated, solvatochromic effect, and self-quenching concentration. However, these polymers also showed different specific interactions with water, Stokes shifts in water, effect of the solvent on the extent of dominant state of the S1 level, and also different inner cavities and hydrophobic-hydrophilic surface area in aqueous solution aggregates. Water maximized the difference between the polymers concerning the effect of specific increases in concentration, whereas the presence of 1,4-dioxane generated almost identical effects on both polymers.

Kinetics of amyloid and prion fibril formation in the absence and presence of dense shell sugar-decorated dendrimers

The aggregation behavior of the amyloid peptide Aβ(1-28) and the prion peptide PrP(185-208) - both responsible for neurodegenerative disorders - was analyzed in the absence and in the presence of poly(propylene imine) (PPI) dendrimers at generation 5 (G5) with a dense shell of maltose and maltotriose units. Thioflavin T (ThT) fluorescence assay and circular dichroism (CD) experiments indicated that fibril formation is enhanced at low dendrimer concentration, while it is prevented at relatively high dendrimer concentrations. Computer aided EPR analysis by means of the selected spin probe 4-octyl-dimethylammonium,2,2,6,6-tetramethyl-piperidine-1-oxyl bromide (CAT8) further demonstrated this behavior, but also provided detailed information on the mechanism of fibril formation and on the different behavior of the differently decorated dendrimers. The CAT8 radicals were progressively trapped at the peptide interphase when peptide aggregates were formed, also monitoring pre-fibrillar structures. At later time, a phase separation of the CAT8 radicals monitors the formation of further supramolecular structures where the probes become squeezed among fibrillar aggregates. The addition of small amounts of dendrimers promotes the formation of peptide fibrils breaking them and providing a larger amount of ends that serve as sites of replications. Conversely, a high amount of dendrimers allows the peptides to well separate from each other such preventing their aggregation. EPR results also indicate that the perturbation played by PPI(G5)-Maltose are more effective onto PrP(185-208) than onto Aβ(1-28), while PPI(G5)-Maltotriose is less effective towards PrP(185-208) in both promoting aggregation and preventing it by changing the dendrimer concentration. These results provide useful information about the mechanism and interactions which regulate the ability of macromolecules like the dendrimers to favor, prevent or cure neurodegenerative diseases.

Influence of blood pressure profile on frailty phenotype in community-dwelling elders in Brazil - FIBRA study

Frailty is a clinical condition associated with pathological aging and biological vulnerability. In the spectrum of events related to frailty, aging of the cardiocirculatory system and abnormalities in arterial blood pressure (BP) partly explain the changes in tissue perfusion and, potentially, the decrease in physiological reserves. This study investigated the relationship between BP levels, systemic arterial hypertension (SAH) and the frailty phenotype by analyzing frailty criteria in a cross-sectional model into the FIBRA network, a populational sample of community-dwelling elders in Southeastern Brazil. Study participants with ≥65 years were selected by probabilistic sampling of residents in the urban area of the municipality of Campinas (n=900). Considering frailty as a whole and the difference between genders, there was a greater proportion of frail or pre-frail individuals among women than men. Analysis of individual frailty criteria showed that weight loss and fatigue were more common among women (18.3% vs. 12.5%, p=0.034 and 22.5% vs. 11.9%, p<0.001, respectively). Comparison of individuals with or without SAH failed to reveal any differences related to frailty criteria. Nevertheless, averages of diastolic blood pressure (DBP) and mean arterial blood pressure values were lower among elderly individuals with reduced grip strength, physical activity and the frailty classification as a whole (OR 0.986, IC 0.975-0.997) (for every 1 mmHg reduction in MBP values, the likelihood of being frail increased 1.4%). Our findings corroborate the relationship between BP values and frailty in the elderly and contribute to an understanding of the pathophysiological mechanisms of the syndrome.

[Low-dose flutamide in the treatment of hyperandrogenism in adolescents]

AIM

The aim of the study was to evaluate the results of the use of flutamide at low doses for the therapy of the iperandrogenism in adolescents.

METHODS

The study enrolled 35 young women with acne and irsutism; 31 had polycystic ovary syndrome (PCOS) and 4 periferic iperandrogenism. In other 8 young women, sexually active, the flutamide has been associated with the hormonal contraceptive. On the three young women with iperinsulinism it has been decided to associate the flutamide with the metformina. All the young women were checked each month for the liver functional. Before the beginning of the therapy the menstrual situation, the Body Mass Index (BMI), the Ferriman' s and Cremoncini's score, the ovary's ultrasound aspect, and the hormonal order were evaluated. Follow-up was made after three months and after six months after the beginning of the therapy with flutamide 62.5 mg/die.

RESULTS

Only in 4 cases the therapy has been suspended due to collateral effects, soon regressed after one week of the treatment interruption. The results have demonstrated a overwhelming improvement of the peripheral symptoms of iperandrogenism in all patients.

CONCLUSION

The authors hope that flutamide could enter in the list of medicines normally used to treat the beauty flaws of policistic acne and to restore a hormonal order associated to an effective contraception.

Hb Indianapolis [beta112 (G14) Cys-->Arg] as the probable cause of moderate hemolytic anemia and renal damage in a Brazilian patient

Hemoglobin (Hb) Indianapolis [beta112 (G14) Cys-->Arg] is a rare and slightly unstable beta-globin variant. All carriers described to date were clinically normal with only mild reticulocytosis. We report here a case of a Brazilian patient in whom hemolytic anemia and acute renal failure were probably caused by the presence of this variant.

Molecular identification of Sicilian (deltabeta) degrees-thalassemia associated with beta-thalassemia and hemoglobin S in Brazil

We describe the clinical and molecular characteristics of two unrelated Brazilian families with an association of the Sicilian form of (deltabeta) degrees -thalassemia with hemoglobin S and beta-thalassemia. Direct sequencing of the beta-globin gene showed only the hemoglobin S mutation in patient 1 and the beta-thalassemia IVS1-110 in patient 2. The other allele was deleted in both patients and PCR of DNA samples of the breakpoint region of both patients showed a band of approximately 1,150 bp, expected to be observed in the DNA of carriers of Sicilian (deltabeta) degrees -thalassemia. The nucleotide sequence of this fragment confirmed the Sicilian deletion. There are few reports concerning the Hb S/(deltabeta) degrees -thalassemia association and patient 2 is the first reported case of Sicilian type of (deltabeta) degrees -thalassemia in association with beta-thalassemia documented at the molecular level.

Renal SPECT with Tc-99m DMSA in children with upper urinary tract infections using a triple-headed gamma camera

Renal cortical scintigraphy with Tc-99m DMSA provides an excellent imaging modality for the assessment of cortical damage secondary to upper urinary tract infection (UTI).

METHODS

The authors evaluated 48 children with UTI, 12 of whom had a history of vescico-ureteral reflux (from first of fourth degree), by planar scintigraphy and SPECT using a triple-headed gamma camera equipped with parallel-hole, high-resolution collimators.

RESULTS

SPECT images yielded positive findings in 36 kidneys, whereas planar scans yielded positive findings in 18 kidneys. The total number of lesions detected by SPECT was 51, whereas the number found with the planar technique was 23.

CONCLUSION

This study demonstrates the superiority of SPECT scanning in detecting kidney lesions in children with UTI.

[Therapeutic abortion intrauterine fetal death in the second trimester. Treatment with a gemeprost-sulprostone combination]

This study reports the results obtained in the medical introduction of abortion during the second trimester of pregnancy in 52 patients following intrauterine fetal death or the diagnosis of fetal malformations.

METHODS

The protocol consisted of the alternate use of intravaginal suppositories of gemeprost and intramuscular injections of sulprostone. The results were analysed using statistical methods and evaluated in relation to the different parameters present (intrauterine fetal death or therapeutic abortion, maternal age, gestation period and parity).

RESULTS

It was seen that the time required to induce abortive labour was significantly shorter in patients with IFD compared to patients with live fetus. The comparison between patients with a gestation period < or > 18 weeks revealed shorter induction times in the former group without reaching statistical significance.

CONCLUSIONS

Maternal age (under and over 30) and parity (P = 0 and P > or = 1) did not influence the results obtained.

Transforming growth factor-beta production during the development of renal fibrosis in rats with subtotal renal ablation

The histologic changes observed in the remnant kidney model include progressive mesangial expansion with collapse of capillary lumina, interstitial fibrosis and mononuclear cellular infiltration. Transforming growth factor-beta (TGF-beta 1) is an important regulator of extracellular matrix formation. The purpose of this study was to investigate the production and distribution of TGF-beta 1 in the kidney during the development of glomerulosclerosis and renal fibrosis in rats with subtotal renal ablation. Eighty-two female Wistar rats weighing 180-220 g were divided into two groups: 49 rats were subjected to 5/6 renal ablation and 33 to sham operation. Urinary albumin excretion, blood pressure and glomerular filtration rate (GFR) were evaluated after the surgical procedure. We also performed histology and immunohistochemistry and determined mRNA for TGF-beta 1 in the kidneys of these rats 8, 15, 30 and 90 days after operation. The results showed progressively higher immunohistochemical TGF-beta 1 staining in rats with subtotal renal ablation. Cortical renal content of TGF-beta 1 mRNA was also higher in these animals and peaked at day 15. The existence of a temporal association between glomerulosclerosis, interstitial fibrosis and intense mononuclear cellular infiltration on the one hand and higher immunohistochemical TGF-beta 1 staining in the renal cortex on the other show that this polypeptide may contribute to the development of renal fibrosis in this model.

[A conservative Taylor's method in the treatment of peptic perforation]

Forty-eight patients affected by perforated ulcer and treated with Taylor's method are examined. Non-operative therapy was successful in forty-two patients; six patients subsequently underwent surgery. All forty-eight patients recovered. The Taylor method is effective in selected cases and represents a therapeutic option which may integrate surgery.

Pregnancy following administration of GNRH by means of portable pump: hormonal evaluation before and during therapy

In a group of three patients affected by severe hypothalamic amenorrhea, gonadotropins behaviour before and during pulsatile GNRH therapy, was investigated with more accuracy for seven cycles. The treatment was administered intravenously with a dosage of 5 ug/90 min. The number of cycles for pregnancy was of 1.75 with a pregnancy rate of 57.1%. The gonadotropins response to an acute test with 100 ug of GNRH performed in the three patients at the 7th day of their first treatment cycle was compared with response to the same test done before the beginning of the pulsatile therapy. Some considerations about the results were suggested.

[Raynaud's disease and syndrome. Presentation of clinical experience]

The Authors report their experience concerning 256 cases of Raynaud's Disease and Syndrome observed from 1968 to 1987; 23 patients underwent surgery for the treatment of dystrophic or gangrenous lesions of the extremities (12 cervico-thoracic and 8 lumbar sympathectomies, 1 popliteal aneurysmectomy, 2 scalenotomies): a significant improvement of the clinical picture was observed in 91.30% of the patients who underwent the operation. The pharmacologic treatment obtained satisfactory results in 51.26% of all the patients. The Authors propose a three stage classification of raynaudian symptoms: I stage: sporadic vasoconstrictive crises; II stage: recurrent vasoconstrictive crises not invalidating working activity and "restitutio ad integrum" between attacks; III stage: recurrent and frequent crises invalidating working activity with asphyxia and/or ulcer-gangrene of the extremities. Both pharmacological and surgical treatment obtained the improvement of the clinical condition to an inferior stage in a high rate of patients. In three patients only (two of whom underwent scalenotomy and one popliteal aneurysmectomy) the complete and definitive cessation of raynaudian crises was observed.