SSRIs in the course of COVID-19 pneumonia: Evidence of effectiveness of antidepressants on acute inflammation. A retrospective study.

INTRODUCTION: Relationships between inflammation and mood have been observed in terms of pro-inflammatory effects induced by depressive conditions and, in parallel, by an antidepressant-induced favorable effect on the recovery of inflammatory states. Selective serotonin reuptake inhibitor (SSRI) drugs were hypothesized to improve the prognosis of COVID-19 pneumonia, a typical acute inflammation, in terms of decreased mortality rate and pro-inflammatory cytokine serum levels. METHODS: The medical records of COVID-19 pneumonia inpatients at Careggi University Hospital (Florence) were analyzed for prognosis and Interleukin 6 (IL-6) after admission for over a period of 22 months. Medical records of patients treated at admission and not discontinued until discharge with an SSRI or with vortioxetine were identified. Two groups, one treated with antidepressants, the other not treated, were evaluated according to the mentioned parameters. Multiple linear regression and logistic regression were performed. RESULTS: The entire sample composed of 1236 records (recovered patients 77.1%, deceased patients 22.9%). The treated group (n = 107) had a better prognosis than the untreated group in spite of age and comorbidity both being greater than in the untreated group. Correspondingly, IL-6 levels in the treated group were significantly lower (p < 0.01) than the levels in the untreated group, in every comparison. CONCLUSIONS: Outcomes of this study support the hypothesis of the favorable influence of some antidepressants on the prognosis of COVID-19, possibly mediated by IL-6 modulation. Reduction in acute inflammation induced by the action of antidepressants was confirmed.

Physiotherapy as part of primary health care, Italy.

Objective: To describe the Family and Community Physiotherapist model, which aims to incorporate rehabilitation services within primary health care in Tuscany, Italy. Methods: The Department of Health Professions of the Central Tuscany local health authority designed the model during 2020-2021. We describe the four phases of the organizational case study implementation of the model, namely: (i) analysis of the political and organizational framework, as well as determination of changing health-care needs; (ii) model co-design and training of multiprofessional health-care workers (local general practitioners, physiatrists and geriatricians); (iii) delivery and surveillance of rehabilitation services; and (iv) evaluation. Findings: During the initial roll-out of the project in April-December 2021, general practitioners referred 165 patients with a mean age of 83.7 years (standard deviation: 11.1) to the Family and Community Physiotherapist. Interventions were mainly activated for patients with comorbidities (64/165; 38.8%), followed by those with long-term immobilization issues (36/165; 21.8%). The most commonly provided intervention was counselling, contributing to the achievement of objectives for 127 patients (77.0%). A full rehabilitation path was proposed for only 10 patients (6.1%). No additional costs were incurred by the health authority during the implementation of the model. Conclusion: Our model facilitated the provision of rehabilitative care in the community, preventing the exacerbation of chronic conditions and meeting the population health needs in non-hospital environments. The model overcame the typical lack of integration within health-care services with flexibility, promoting care proximity solutions to cope with health challenges such as an ageing population and the coronavirus disease.

Integrating physiotherapy into primary health care in Italy: qualitative focus group study examining perspectives of involved professionals.

INTRODUCTION: The Community Physiotherapist model is an on-call service within the primary care setting, consisting of four consultations for people with chronic functional limitations. It was designed, developed and introduced as a project for the first time in Italy in 2021 and it has been shown to be effective and safe. PURPOSE: Given the novelty of the model, this focus group study aims to explore the perspectives of involved physiotherapists, general practitioners and medical specialists on the perceived efficiency and quality of the service. A qualitative design was used with two balanced multidisciplinary focus groups of 12 participants. The Focus groups were audio recorded and transcribed verbatim. Data were analyzed using thematic analysis. RESULTS: Five themes emerged from the analysis, related to the speed of both referral and intervention, tailored interventions and perceived quality: Efficiency, Perceived quality, Project implementation, Training, and Project dissemination. CONCLUSION: The study findings showed that the model was appreciated by the professionals involved, although some aspect about communication between professionals and with patients/caregivers, as well as some organizational aspects, needed improvement. Further research should address the perspectives of the patients/caregivers involved.

Implementation of community physiotherapy in primary care: one-year results of an on-call physiotherapy service.

BACKGROUND: Primary health care systems have a key role in meeting health needs of community, including function. The aim of this paper is to describe the population involved in the Community Physiotherapist project and their health outcomes over a one-year period. METHODS: The Community Physiotherapist is an on-call service which requires a request by general practitioners or medical specialists. Reason for prescription, waiting time for service delivery, diagnostic categories, provided intervention, number of interventions and outcomes were recorded for everyone included in the project. Possible differences in characteristics between individuals referred by medical specialists and general practitioners were also investigated. RESULTS: From January to December 2022, 409 individuals were referred to the Community Physiotherapist pathway. Functional goals were achieved in 79.5% of interventions, without reported adverse events. In most cases physiotherapists provided counselling or caregiver training and 3.3% of individuals needed a full rehabilitation program. The groups of individuals referred by the two types of prescribers showed no significant differences, apart, as expected, from their median age. CONCLUSIONS: The introduction of the Community Physiotherapist model within the primary care setting allows to provide appropriate, effective and safe interventions. Sharing the project among all the health professionals helped to support its appropriateness and effectiveness. Results also indicate that a new organizational model, such as the Community Physiotherapist, will take a long time to be implemented.

Can selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitor antidepressants decrease the "cytokine storm" in the course of COVID-19 pneumonia?

BACKGROUND: Lots of research has been conducted to fight COVID-19 since the outbreak of the pandemic in 2020. The role of "cytokine storm" in the pathogenesis of COVID-19 pneumonia is well known. Relationship between interleukins and depression is still subject matter of the research, but a correlation between interleukin-6 and depressive disorders is proven by now. The aim of this study is to verify differences among interleukin-6 blood levels of inpatients treated with selective serotonin reuptake inhibitors and/or serotonin and norepinephrine reuptake inhibitor before and during hospitalization and of inpatients not treated with these drugs. METHODS: This is an observational study performed during the first wave of SARS Cov-2 pandemic in Italy for three months. The hospitalized patients of Internal Medicine wards and Infectious and Tropical Diseases ward of Azienda Ospedaliero-Universitaria Careggi of Florence for COVID-19 pneumonia have been divided into two subgroups (treated / not treated with antidepressants). Patients admitted to Intensive Care Unit previously have been excluded. Each patient has been evaluated concerning demographic, clinical and therapeutic features. The first dosage of interleukin-6 detected during hospitalization has been noticed. RESULTS: The entire sample included 402 patients and 8.5% (N.=34) had been treated with an antidepressant of the two considered categories before admission until discharge from hospital. Significant lower levels of interleukin-6 of recovered patients of the treated subgroup have been highlighted as compared to recovered patients of not-treated subgroup (12.1 vs. 25.4 P<0.001). These results have been pointed out in spite of higher mean age and more serious comorbidities of the treated subgroup. Nevertheless, the incidence of severe acute respiratory distress syndrome is significantly lower in the subgroup of patients with antidepressant treatment (20.6% vs. 43.2% P<0.02) as well as endotracheal intubation employment (0.0% vs. 11.7% P<0.04). The rate of deceased patients of treated-subgroup is not significantly lower than the rate of not-treated subgroup (23.5% vs. 26.4% P=0.13). CONCLUSIONS: During COVID-19 pneumonia, the production of interleukin-6 seems to be modulated in presence of antidepressant therapy. Further proofs and broader surveys are necessary.

Publication productivity of Allied Health Professions in an Italian Local Health Authority: prevalence and bibliometric analysis.

BACKGROUND AND AIM OF THE WORK: Despite Allied Health Professions (AHPs) represent a substantial part of workforce within the health system and they might give a relevant contribution to research, literature on publication productivity of AHPs working in non-research/academic institutions is scarce. The aim of this investigation was to provide point prevalence of AHPs working in a non- research/academic setting who have written at least one article published in indexed journals, in order to describe their scientific productivity. METHODS: A descriptive cross-sectional study was carried out of AHPs working in large Local Health Authority in Italy, who published in journals indexed in Scopus and/or PubMed. H-index, publications and citations number, journal name, publication year, and journal Impact Factor were extracted. RESULTS: Fifty-two AHP workers were identified as authors, having published 105 articles between 1993 and 2019. The number of papers increased over the years (p < .001). Published papers in journals with Impact Factor were 67.6% (n = 71) of the total, with a median Impact Factor = 2.676 (range = 0.583 - 59.102). The median number of citations was 4 (range = 0 - 99). The prevalence among units ranged from 0.8% to 5.0%, 2.9% in the whole department. There were not significant differences in number of articles (p = .138), citations received (p = .337), and H-Index (p = .661) among units. CONCLUSIONS: In the Local Health Authority under investigation, publication productivity of AHPs workers was found to be low, although it is increasing over time, with no significant differences among units. Further investigations should be carried out to link these results with authors' information and organizational characteristics to study the relationship between authors' profiles and publication productivity.

Principles of Integrated Cognitive Training for Executive Attention: Application to an Instrumental Skill.

One effective cognitive treatment is the rehabilitation of working memory (WM) using an integrated approach that targets the "executive attention" system. Recent neuroscientific literature has revealed that treatment efficacy depends on the presence of various features, such as adaptivity, empathy, customization, avoidance of automatism and stereotypies, and alertness activation. Over the last two decades, an Integrated Cognitive Training (ICT) protocol has been proposed and developed; ICT takes the above-mentioned features and existing literature into account, and has been used to promote the development of reading skills. ICT has been employed in several clinical settings and involves stimulation of a specific deteriorated system (e.g., reading) and the improvement of executive attention components, thus also increasing working memory capacity. In this context, we present two experiments. In Experiment 1, participants diagnosed with dyslexia (aged between 8 and 14 years) underwent two ICT sessions a week, with home supplements, for a duration of 7 months. The participants showed a significant improvement in the reading speed of text, words, and non-words, and in the reading accuracy of text and non-words. In Experiment 2, we replicated Experiment 1, but included a comparison between two groups (experimental group vs. control group) of young participants with diagnosis of dyslexia. The experimental group was subjected to 18 ICT sessions twice a week and with home supplements, using the same protocol as in Experiment 1. The control group was entrusted to the protocol of compensatory tools and dispense/helping procedures provided by the scholastic Personalized Educational Plan. After training, the experimental group gained about 0.5 syllables per second in text reading, and a marked decrease in error rate. The control group showed no significant improvement in reading skills after the same period. Moreover, the improvement observed in the experimental group remained stable 4 months after ICT had ended. The results of these two experiments support the efficacy of the integrated ICT protocol in improving reading skills in children with dyslexia and its sustained effect.

Total hip arthroplasty after hip fracture or osteoarthritis: are there differences in characteristics and outcomes in the early rehabilitative stage?

BACKGROUND: Despite some practitioner perception of an inferior outcome in patients with total hip arthroplasty (THA) following hip fracture (HF) vs. osteoarthritis (OA), few studies have analyzed this issue. PURPOSE: This cohort study compares characteristics and short-term outcomes in patients with THA following HF and OA during the rehabilitative postsurgical period. METHODS: Records of all consecutive patients admitted in a rehabilitation department of a city hospital for THA, following HF or OA, were reviewed. Outcome measures were the Barthel Index, passive range of motion (PROM) for hip flexion and abduction, and length of hospitalization in the rehabilitation department. Participants were assessed at admission to department and at discharge. RESULTS: Five hundred seven patients were included (353 in the OA group). The HF group had a longer length of rehabilitation hospital stay and more comorbidity, whereas the OA group had higher functional performances at admission. Both groups improved in all clinical outcome measures with less improvement in PROM abduction scores in the OA group. CONCLUSIONS: Patients undergoing traumatic and elective surgery have distinctive clinical characteristics. Results support the idea that OA patient can have a reduced PROM when compared with HF patients.