Risk of SARS-CoV-2 in a car cabin assessed through 3D CFD simulations.

In this study, the risk of infection from SARS-CoV-2 Delta variant of passengers sharing a car cabin with an infected subject for a 30-min journey is estimated through an integrated approach combining a recently developed predictive emission-to-risk approach and a validated CFD numerical model numerically solved using the open-source OpenFOAM software. Different scenarios were investigated to evaluate the effect of the infected subject position within the car cabin, the airflow rate of the HVAC system, the HVAC ventilation mode, and the expiratory activity (breathing vs. speaking). The numerical simulations here performed reveal that the risk of infection is strongly influenced by several key parameters: As an example, under the same ventilation mode and emitting scenario, the risk of infection ranges from zero to roughly 50% as a function of the HVAC flow rate. The results obtained also demonstrate that (i) simplified zero-dimensional approaches limit proper evaluation of the risk in such confined spaces, conversely, (ii) CFD approaches are needed to investigate the complex fluid dynamics in similar indoor environments, and, thus, (iii) the risk of infection in indoor environments characterized by fixed seats can be in principle controlled by properly designing the flow patterns of the environment.

A systematic review and meta-analysis of tertiary interventions in clinical burnout.

Clinical burnout is one of the leading causes of work absenteeism in high- and middle-income countries. There is hence a great need for the identification of effective intervention strategies to increase return-to-work (RTW) in this population. This review aimed to assess the effectiveness of tertiary interventions for individuals with clinically significant burnout on RTW and psychological symptoms of exhaustion, depression and anxiety. Four electronic databases (Ovid MEDLINE, PsychINFO, PubMed and CINAHL Plus) were searched in April 2016 for randomized and non-randomized controlled trials of tertiary interventions in clinical burnout. Article screening and data extraction were conducted independently by two reviewers. Pooled odds ratios (ORs) and hazard ratios (HRs) were estimated with random-effects meta-analyses. Eight articles met the inclusion criteria. There was some evidence of publication bias. Included trials were of variable methodological quality. A significant effect of tertiary interventions compared with treatment as usual or wait-list controls on time until RTW was found, HR = 4.5, 95% confidence interval (CI) = 2.15-9.45; however, considerable heterogeneity was detected. The effect of tertiary interventions on full RTW was not significant, OR = 1.33, 95% CI = 0.59-2.98. No significant effects on psychological symptoms of exhaustion, depression or anxiety were observed. In conclusion, tertiary interventions for individuals with clinically significant burnout may be effective in facilitating RTW. Successful interventions incorporated advice from labor experts and enabled patients to initiate a workplace dialogue with their employers.

Self-reported sleep lengths ≥ 9 hours among Swedish patients with stress-related exhaustion: Associations with depression, quality of sleep and levels of fatigue.

BACKGROUND: Insomnia-type sleep disturbances are frequent among patients suffering from stress-related exhaustion disorder. However, clinical observations indicate that a subgroup suffer from sleep lengths frequently exceeding 9 hours, coupled with great daytime sleepiness. AIMS: The aim of the present study was to investigate differences in socio-demographic variables, use of medications, sleep parameters, anxiety, depression and fatigue, between individuals with varying sleep lengths, in a sample of 420 Swedish patients (mean age 42 ± 9 years; 77% women) referred to treatment for exhaustion disorder. Patients were allocated to the groups: "never/seldom ≥ 9 hours" (n = 248), "sometimes ≥ 9 hours" (n = 115) and "mostly/always ≥ 9 hours" (n = 57), based on their self-rated frequency of sleep lengths ≥ 9 hours. METHODS: The design was cross-sectional and data was collected by means of questionnaires at pre-treatment. RESULTS: Univariate analyses showed that patients in the "mostly/always ≥ 9 hours" group were more often on sick leave, and reported more depression and fatigue, better sleep quality and more daytime sleepiness, than patients in the other groups. Multivariate analyses showed that these patients scored higher on measures of fatigue than the rest of the sample independently of gender, use of antidepressants, sick leave, depression and quality of sleep. CONCLUSIONS: Patients suffering from exhaustion disorder and reporting excessive sleep seem to have a generally poorer clinical picture but better quality of sleep than their counterparts with shorter sleep lengths. The mechanisms underlying these differences, together with their prognostic value and implications for treatment remain to be elucidated in future studies.

Stress-related exhaustion disorder--clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout.

The aim of this paper was to provide an overview of the literature on clinically significant burnout, focusing on its assessment, associations with sleep disturbances, cognitive impairments, as well as neurobiological and physiological correlates. Fifty-nine English language articles and six book chapters were included. The results indicate that exhaustion disorder (ED), as described in the Swedish version of the International Classification of Diseases, seems to be the most valid clinical equivalent of burnout. The data supports the notion that sleep impairments are causative and maintaining factors for this condition. Patients with clinical burnout/ED suffer from cognitive impairments in the areas of memory and executive functioning. The studies on neuro-biological mechanisms have reported functional uncoupling of networks relating the limbic system to the pre-frontal cortex, and decreased volumes of structures within the basal ganglia. Although there is a growing body of literature on the physiological correlates of clinical burnout/ED, there is to date no biomarker for this condition. More studies on the role of sleep disturbances, cognitive impairments, and neurobiological and physiological correlates in clinical burnout/ED are warranted.

Validation of Karolinska Exhaustion Scale: psychometric properties of a measure of exhaustion syndrome.

BACKGROUND: The syndrome of exhaustion is currently a medical diagnosis in Sweden. The description of the syndrome largely corresponds to the suggested core component of burnout, that is exhaustion. Karolinska Exhaustion Scale (KES) has been constructed to provide specific assessment of exhaustion in clinical and research settings. AIM: The purpose of the present study was to examine the psychometric properties of this scale in its original and revised versions by examining the factorial structure and measures of convergent and discriminant validity. METHODS: Data gathered from two independent samples (n1 = 358 & n2 = 403) consisting of patients diagnosed with 'reaction to severe stress, and adjustment disorder' were subjected to confirmatory factor analysis. The study's instruments were Karolinska Exhaustion Scale and Shirom Melam Burnout Measure. Correlation analyses were employed to follow up the established factorial structure of the scale. The study was ethically approved by Karolinska Institute regional ethic committee. RESULTS: The findings demonstrated adequate fit of the data to the measurement model provided by the revised version of KES Limitations: The main limitation of the present study is the lack of a gold standard of exhaustion for direct comparison with KES. (KES-26) and partially supported convergent validity and discriminant validity of the scale. CONCLUSION: The demonstrated psychometric properties of KES-26 indicate sound construct validity for this scale encouraging use of this scale in assessment of exhaustion. The factorial structure of KES-26 may also be used to provide information concerning possible different clinical profiles.

Stress symptoms among adolescents: the role of subjective psychosocial conditions, lifestyle, and self-esteem.

Stress-related problems are increasing among Swedish adolescents, especially among females. The aims of this study were to survey the incidence of stress symptoms among 16-year-olds, to investigate the related gender differences, and to understand the factors that may contribute to stress symptoms. The study is questionnaire based, and the sample included 304 first-year high school students from two comparable schools. More than 30% of the high school students reported serious stress symptoms. Almost every second girl and every fifth boy reported that they felt stressed to a high degree. 8.2% were found to have severe stress symptoms, which would be considered a sign of chronic stress in adults. Besides the perception of high demands, low levels of global self-esteem, sleep disturbances, and poor social support played a crucial role in the prediction of stress symptoms. The findings highlight the need to develop and implement adequate stress prevention measures for adolescents.

Efficacy and Safety of Intramuscular Insulin Lispro vs. Continuous Intravenous Regular Insulin for the Treatment of Dogs With Diabetic Ketoacidosis.

The use of rapid-acting insulin analogs as routes of administration other than IV has never been described for the treatment of dogs with diabetic ketoacidosis (DKA). This study aims to compare the efficacy and safety of a new protocol based on IM administration of insulin lispro with that of low-dose IV continuous rate infusion of regular insulin in the treatment of canine DKA. Client-owned dogs with naturally occurring DKA were included. Dogs treated with IM insulin lispro (Group L, n = 11) received 0.25 U/kg. The goal was to achieve a drop of at least 10% in blood glucose between 1 h and the next. If this goal was not achieved, the insulin dose was repeated hourly; otherwise, the insulin dose was not repeated up to a maximum of 3 h, after which the insulin dose was repeated anyway. When blood glucose was ≤250 mg/dL, the insulin dose was reduced to 0.125 U/kg IM every 3 h. Cases receiving IV continuous rate infusion of regular insulin (Group R, n = 13) were treated according to a previously published protocol. The median time to resolution of ketosis was significantly shorter in Group L (12 h; range, 4-27 h) compared to Group R (23 h; 10-46 h; P = 0.04). The median times to resolution of acidemia and ketoacidosis were 13 h (4-35 h) and 17.5 h (4-35 h) in Group L, and 22 h (9-80 h) and 23.5 h (10-80 h) in Group R, respectively. These differences were not significant (P = 0.06 and P = 0.09, respectively). The median length of hospitalization did not differ significantly between groups (P = 0.67). There were no differences in the frequency and severity of adverse events (hypoglycemia, hypokaliemia, and hypophosphatemia) between groups. The new protocol based on IM administration of insulin lispro preliminarily appears effective and safe for treatment of canine DKA.

Conventional treatment of a metaldehyde-intoxicated cat with additional use of low-dose intravenous lipid emulsion.

CASE SUMMARY: An adult male intact domestic shorthair cat was presented for acute onset of generalised tremors, stupor, horizontal nystagmus, anisocoria and bilateral absence of pupillary light and palpebral reflexes. Response to intravenous (IV) administration of benzodiazepines was minimal; thus, the induction of general anaesthesia with propofol, midazolam and dexmedetomidine was necessary to control clinical signs. Following a clinical suspicion of neurotoxicosis, a low-dose constant rate infusion (CRI) of IV lipid emulsion (ILE) was started. Phenobarbital and a low-dose CRI of ketamine were also used for neuroprotective purposes. Metaldehyde intoxication was confirmed by qualitative faecal toxicological analysis after discharge. Anaesthetic drugs were progressively tapered and stopped after 28 h and extubation was possible after 44 h. The cat was discharged 8 days after admission with a complete recovery of the clinical signs. RELEVANCE AND NOVEL INFORMATION: To the authors' knowledge, this is the first report to describe a case of metaldehyde toxicosis in a cat treated with intensive supportive care and an additional low-dose CRI of ILE.

Evaluation of Serum Apolipoprotein A1 in Canine Sepsis.

Decreased serum apolipoprotein A1 (Apo-A1) concentration is associated with mortality in human sepsis. The diagnostic and prognostic role of serum Apo-A1 concentrations in canine sepsis was evaluated. Serum samples from septic dogs (n = 91) and healthy controls (n = 15) were retrospectively analyzed. According to the sepsis origin, four categories were identified: parvoviral enteritis (n = 26), pyometra (n = 20), septic peritonitis (n = 19), and miscellanea (n = 26). The canine acute patient physiologic and laboratory evaluation fast score (APPLEfast), serum C-reactive protein (CRP) and albumin concentrations were reviewed in all enrolled dogs. Increased CRP (252.6 ± 119.2 mg/L; Reference Interval: 0-8.5 mg/L) and significant lower serum albumin and Apo-A1 concentrations were documented in dogs with sepsis (22.8 ± 5.3 g/L and 1.17 ± 0.27 g/L, respectively) compared to healthy ones (33.1 ± 2.5 g/L and 1.32 ± 0.05 g/L, respectively) (P < 0.0001). According to the origin of sepsis, only the subgroup of dogs with septic peritonitis had significantly lower Apo-A1 (1.03 ± 0.26 g/L) concentrations compared to healthy dogs (P < 0.001). No significant differences were found in serum albumin and CRP concentrations, and in APPLEfast score values among the different subgroups of sepsis. Diagnosis of septic peritonitis was associated with a higher frequency of death (P = 0.006). In septic dogs, significant lower Apo-A1 concentrations were detected in non-survivors (1.02 ± 0.28 g/L; n = 27) compared to survivors (1.23 ± 0.24 g/L; n = 64; P = 0.0007). Moreover, significant higher values of the APPLEfast score were calculated in non-survivors (26 ± 4; n = 19) compared to survivors (23 ± 4; n = 51) (P = 0.0114). According to the area under the ROC curve analysis, Apo-A1 <96 mg/dl had a fair accuracy (AUC = 0.72) to correctly predict mortality (P = 0.0004). Apo-A1 might support a diagnosis of canine septic peritonitis with a potential prognostic significance. Further prospective studies are warranted.

Iodine-restricted food versus pharmacological therapy in the management of feline hyperthyroidism: A controlled trial in 34 cats.

Background: Hyperthyroidism is a common endocrinopathy of middle-aged and elderly cats. Dietary treatment has been proposed as an alternative to traditional therapies. Aim: The aim of this prospective study was to compare the efficacy of iodine-restricted food versus pharmacological therapy with methimazole in client-owned cats with hyperthyroidism. Methods: Indoor cats with newly diagnosed hyperthyroidism (consistent clinical signs and serum total thyroxine concentration greater than 50 nmol/l) were assigned to one of three groups: (A) received an iodine-restricted food as a single therapy; (B) received transdermal methimazole in pluronic lecithin organogel; and (C) received oral methimazole. In all groups, clinical parameters, biochemistry, and serum total thyroxine were evaluated at baseline and 10, 30, 60, and 90 days after treatment began. Results: Thirty-four cats were enrolled in the study (group A: n = 14; group B: n = 11; group C: n = 9). No significant differences were found between groups at diagnosis for signalment, clinical and laboratory findings, including serum total thyroxine concentrations. In all the groups, serum total thyroxine concentration decreased significantly following the baseline measurement. After 90 days of treatment, serum creatinine increased significantly only in the methimazole-treated groups. Liver enzyme activities decreased significantly only in group B, while no significant decreases were detected in groups A and C at any time. Conclusion: These results suggest that iodine-restricted food is effective at reducing the total thyroxine concentration in the serum of hyperthyroid cats. Moreover, the iodine-restricted food did not cause any increase in serum creatinine concentrations and failed to improve liver enzymes abnormalities. These findings could indicate a persistent hyperthyroid state in cats treated with iodine-restricted food despite normalization of serum total thyroxine concentrations.

Psychosocial correlates of hopelessness among men.

This study examined overall hopelessness, explored differences in various variables (e.g. burnout) between men reporting no/mild hopelessness and moderate/severe hopelessness, and scrutinized factors associated with hopelessness. The study design was cross-sectional, and the participants were 517 men randomly selected from the general population. About 12% of men reported moderate/severe hopelessness, and men with moderate/severe hopelessness were more often older, divorced/widowed, low educated, employed in blue-collar positions, on sick leave/other/unemployment/retirement, and financially strained. They also reported more depression, posttraumatic symptoms, and burnout. Only unemployment/retirement, depression, and posttraumatic symptoms were independently associated with an increased risk for moderate/severe hopelessness in the regression analysis, with unemployment and retirement as the most important factors. In conclusion, this study seems to corroborate previous findings and may provide new insights into men's experiences and predictors of hopelessness. More research into the predictors of hopelessness in men is warranted.

The morning salivary cortisol response in burnout.

OBJECTIVES: The aim of the present study was to examine the free salivary cortisol response to awakening in men and women reporting low, moderate, and high levels of burnout. METHODS: Twenty-two patients on sick leave due to burnout were compared with 22 working participants with low and 20 working participants with intermediate scores on the Shirom-Melamed Burnout Questionnaire (SMBQ), with regard to the free salivary cortisol response to awakening. Saliva samples were collected upon awakening and at +15, +30, and +60 min thereafter. RESULTS: Female burnout patients had higher cortisol levels than did the females with low burnout at awakening and at +15, +30, and +60 min after awakening. They also had a greater area under the curve (AUC) for salivary cortisol than did the female participants with low burnout. Male participants with moderate levels of burnout had higher cortisol levels at +60 min after awakening compared with males with low burnout. CONCLUSIONS: The results of the present study indicate a dysregulation in hypothalamic-pituitary-adrenocortical axis (HPA axis) activity, characterised by elevated morning salivary cortisol levels, among female burnout patients. Among males, increased cortisol levels were observed among participants with moderate levels of burnout, but not among patients or healthy controls.

Psychosocial correlates of long-term sick-leave among patients with musculoskeletal pain.

We studied the associations between psychosocial variables and sick-leave among patients with musculoskeletal pain. Patients (n = 586) seeking care to relieve their pain at health care and physiotherapy centres, completed a questionnaire about such variables as clinical characteristics (e.g. pain intensity), psychological well-being (e.g. burnout, depression) and coping strategies. The results show that the patients who had been on sick-leave for >30 days (n = 217), were significantly more often divorced, immigrants, blue-collar workers and less educated than the rest of the sample. Compared with the rest of the patients, they rated their pain as significantly more severe, frequent, complex and functionally impairing. They reported using more pain medication and tranquillizers, and having undergone more somatic treatments. These patients also showed higher scores on job strain, more symptoms of burnout, anxiety/depression and posttraumatic stress reactions, and poorer coping capacity. Logistic regression analyses revealed that an index related to perceived disability was a major predictor of sick-leave within the group. After controlling for possible confounders, multivariate regression analyses showed that the strongest predictors of the disability index were symptoms of burnout and posttraumatic stress reactions. The results confirm that emotional distress, coping style and perceived disability are associated with sick-leave, after controlling for pain parameters and sociodemographic variables. The high levels of emotional distress and the poor coping capacity reported by the patients with a long history of absence due to illness suggest that cognitive behavioural interventions ought to be integrated in the treatment of musculoskeletal pain.

The stress of musculoskeletal pain: a comparison between primary care patients in various ages.

OBJECTIVES: To analyse differences in demographic/financial/pain/health variables, disability, General Health Questionnaire (GHQ; i.e., depression symptoms) and coping among 949 primary care pain patients in various ages (20-65+ years) and to identify predictors of disability and coping. METHOD: Patients completed scales about various areas (e.g., coping). The design was cross-sectional and data were collected during 15 consecutive days at 20 randomly selected primary care centres in Stockholm. RESULTS: Univariate analyses showed that older patients (a) were more often divorced, blue-collar workers, less educated and had greater difficulties with living expenses, (b) had pain of longer duration, more frequently and of more complexity, and felt more disabled, (c) consumed more painkillers, analgesics, sedatives and other medications, had received more pain treatments and had more health problems and (d) more often used passive coping for pain. Younger patients (a) had more severe pain, were financially strained and were more often unemployed and (b) more often used active coping for pain. There were no significant differences concerning GHQ scores. Multivariate regression analyses showed that active coping was associated with younger age. High disability and passive coping were associated with older age. CONCLUSION: We corroborated previous findings and may provide new insights into the experiences of older and younger pain patients. Further research concerning, for example, the elderly at risk of developing pain problems is needed.

Physiological correlates of burnout among women.

OBJECTIVES: The purpose of this study was to investigate the immune, endocrine, and metabolic correlates of burnout among women. METHODS: Forty-three participants with high and 20 participants with low scores for the Shirom-Melamed Burnout Questionnaire were compared in terms of subjective symptoms, job strain, social support, plasma levels of prolactin, tumor necrosis factor alpha (TNF-alpha), transforming growth factor beta (TGF-beta), C-reactive protein (CRP), neopterin, serum levels of dehydroepiandrosterone sulphate (DHEAs), progesterone, estradiol, cortisol, and glycated hemoglobin (HbA1C) in whole blood. RESULTS: Besides reporting more job strain, less social support at work, and higher levels of anxiety, depression, vital exhaustion (VE), and sleep impairments, participants with high burnout manifested higher levels of TNF-alpha and HbA1C, independent of confounders including depression. CONCLUSIONS: Among women, burnout seems to involve enhanced inflammatory responses and oxidative stress.

[Emotional exhaustion common among women in the public sector]. / Emotionell utmattning vanlig bland kvinnor i offentlig sektor.

This cross-sectional investigation aimed at assessing levels of emotional exhaustion among female employees within the Swedish public sector. Other aims were to study the associations between self-rated emotional exhaustion and psychosocial factors at work, as well as findings from medical examinations. Data was collected by means of questionnaires including the Maslach Burnout Inventory, among 183 women working in geriatric care and 143 employees at the National Social Insurance Office. We found high proportions of emotional exhaustion in both samples (geriatric care = 34%; Social Insurance Office = 26%). Participants with high scores for emotional exhaustion reported more job-strain, less social support at work and more somatic, emotional and cognitive complaints than those with low or intermediate scores. Medical examinations performed on 19 participants with low scores and 41 with high scores for emotional exhaustion revealed significantly more findings among participants with high emotional exhaustion, particularly fatigue, sleep disturbances and cognitive impairment. There were no group differences in terms of depression or other findings. This study shows that individuals at risk for stress-related disorders may be identified using simple questionnaires. Early interventions for stress in the workplace may prevent incapacitating conditions among a great proportion of women working in the public sector.

Quasi-experimental evaluation of a stress management programme for female county and municipal employees on long-term sick leave due to work-related psychological complaints.

OBJECTIVE: To evaluate the effects of a stress management intervention among 24 female patients on sick leave due to work-related psychological complaints. METHODS: The study design was quasi-experimental. All participants received a standard individual treatment for stress at a company healthcare unit. Half of the sample was also enrolled in a group intervention aimed at coping with psychological/somatic symptoms of stress. Data were collected before and after treatment and at 6- and 12-month follow-ups, through questionnaires and blood sampling. Rates of return to work were assessed for up to 5 years. RESULTS: Levels of depression decreased in both conditions and these improvements were maintained at follow-up. The experimental condition was superior in alleviating burnout, as measured with the Karolinska Exhaustion Scale. Paradoxically, these improvements were accompanied by significant increases in levels of glycated haemoglobin in both groups. At 5-year follow-up 40% of participants in both conditions had returned to work. CONCLUSION: The stress management intervention seems to have beneficial effects on self-rated symptoms, but is comparable to treatment as usual with respect to rates of return to work. More studies are needed to investigate the impact of this intervention on physiological parameters.

Age and musculoskeletal pain.

Using questionnaires, we analyzed associations between different pain variables (e.g., pain intensity) and age (20-65+ years) among 949 primary pain patients. Older patients (a) were more often divorced, were blue-collar workers, were less educated, and had greater difficulties with living expenses; (b) had pain of longer duration, more frequently and of more complexity, and felt more disabled; (c) consumed more painkillers, analgesics, sedatives, and other medications, and had received more pain treatments; and (d) had more health problems. Younger patients had more severe pain, were financially strained, and were more often unemployed. A multivariate regression analysis showed that high disability was more determined by older than young age. However, other factors (e.g., pain complexity) were also important. Thus, older and younger patients experienced their pain differently