Impact of nurses' roles and burden on burnout during the COVID-19 pandemic: Multicentre cross-sectional survey.

AIM: To identify groups of nurses engaging in coronavirus disease (COVID-19) care who are most in need of organizational support. BACKGROUND: Overwhelming stress and susceptibility to burnout have been reported in nurses during the COVID-19 pandemic. METHODS: Nurses working at five hospitals that accepted COVID-19 patients answered the questionnaire. The Tokyo Metropolitan Distress Scale for Pandemic, Self-Diagnosis Check List for Assessment of Workers' Accumulated Fatigue and Japanese Burnout Scale were evaluated. Multiple regression analysis was performed to examine the relationship between engaging in COVID-19 care and psychosocial/physical burden. RESULTS: In total, 895 questionnaires were analysed. With experience in caring for COVID-19 patients as the independent variable, nurses caring for suspected cases had significantly higher standardized Tokyo Metropolitan Distress Scale for Pandemic scores for 'concerns for infection' (standardized partial regression coefficient ß = .921, P = .004), Assessment of Workers' Accumulated Fatigue (ß = .445, P = .022) and Japanese Burnout Scale 'emotional exhaustion' (ß = .136, P = .021) than those caring for confirmed cases. CONCLUSIONS: Nurses caring for suspected COVID-19 patients have the highest psychological/physical burden and propensity for burnout. IMPLICATIONS FOR NURSING MANAGEMENT: Extensive support systems are required for nurses caring for confirmed and suspected COVID-19 cases.

A case of schizophrenia comorbid for tetralogy of Fallot treated with clozapine: further considerations on a role for 22q.11.2 in the proneness for seizures.

We present a case of schizophrenia comorbid for tetralogy of Fallot, without chromosome 22q.11.2 deletion or duplication, treated successfully with a combination of clozapine and antiepileptic drugs. Although clozapine by itself initially triggered convulsive seizures, we continued it with co-administration of valproate and topiramate. This combined treatment did not affect cardiac function of the patient, who experienced a favorable clinical course in terms of symptomatology and functional outcomes. To our knowledge, we provide the first report on a patient with tetralogy of Fallot, in whom 22q.11.2 was not deleted and clozapine-induced seizures were observed.

[Maternal filicide in Japan: analyses of 96 cases and future directions for prevention].

OBJECTIVE: Maternal filicide is not an isolated phenomenon. When a mother kills her child, she may be affected by many factors and confronted with different problems based on the child's developmental stage. In this study in Japan, a judicial sample of 96 adult women, convicted in their first trial for the murder or attempted murder of their children, was divided into four groups of mothers according to the age of the victim (25 women killed neonates, 22 women infants, 27 women preschool children, and 22 women schoolchildren and/or teenagers) in order to identify the factors that have a major impact on filicide in each group. METHODS: The socio-demographic, clinical, forensic, circumstantial, and offense characteristics, and legal disposition of 96 cases drawn from judicial records were compared among the four groups using the Kruskal-Wallis test; comparison of two groups was conducted using the Mann-Whitney test. RESULTS: Neonaticide cases were distinguished from the other three groups by marked differences: a significantly higher rate of unmarried mothers, financial difficulties, absence of mental illness, and admission of not wanting an illegitimate child. In the other groups, mental disorders were frequent; in particular, post-partum depression was the primary cause of infanticide. For the two groups of cases involving a child older than one year, filicidal mothers were more affected by circumstantial factors such as health problems of the child or severe marital discord. These problems may then have caused a reactive mental disorder among these mothers. The risk of fatal abuse or neglect was higher for handicapped preschool children. Filicide-suicide was most frequently seen among school-aged children and/or teenagers who had serious behavioral problems, and these children often had a mental disorder. CONCLUSIONS: The classification of maternal filicide by age of the child demonstrated that there are specific issues for each group. Based on these findings, future directions for prevention include: appropriate sex education for youths to avoid unwanted pregnancy; organization of specialized mental health services for mothers with post-partum mental disorder; careful psychiatric risk assessment of mentally ill mothers; and development of diversified social support measures for child-bearing parents, especially those with identifiable financial or social difficulties.