Post-traumatic stress symptoms and benefit finding: a longitudinal study among Italian health workers during the COVID-19 pandemic.

PURPOSE: Research has highlighted that the exposure of healthcare professionals to the COVID-19 pandemic for over two years can lead to the development and persistence of symptoms characteristic of Post-Traumatic Stress Disorder (PTSD), with serious consequences on both the individual well-being and the quality of care provided. The present study was aimed at investigating the role of benefit finding in moderating post-traumatic stress symptoms (PTSS) over time. METHODS: The longitudinal study, conducted between April and October 2020, involved 226 Italian health workers (44.7% nurses and midwives, 35% doctors, 20.3% technical and rehabilitation professionals), who filled out an online survey at the beginning of the study (T1), after three months (T2), and after six months (T3). Participants (77.4% women; mean age = 41.93, SD = 12.06) completed the PTSD Checklist for DSM-5 (PCL-5) and Benefit Finding, a 17-item questionnaire measuring the perceived level of positive consequences derived from stressful experiences. A hierarchical regression analysis highlighted the moderating effect of benefit finding (T2) on the association between PTSS values at T1 and T3. RESULTS: A buffering effect was observed, with higher benefit finding levels reducing the magnitude of the bivariate association between PTSS assessed at the beginning and at the end of the study. CONCLUSION: Findings suggest the potential mental health related benefits of interventions allowing health professionals to identify positive aspects in the experience of working under prolonged emergency circumstances, such as the pandemic ones.

Reduction in acute coronary syndromes during coronavirus disease 2019 global pandemic: data from the Marche region of Italy.

AIMS: During the novel severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019) pandemic, a worldwide reduction in total acute coronary syndrome (ACS) has been reported. In early 2020, Italy became the most affected country and national lockdown was declared early on in March. We described trends in ACS from all the Marche coronary catheterization laboratories (CCL) during the global pandemic. METHODS: Retrospective study of all consecutive patients admitted to the four regional CCL. The coronavirus disease 2019 period (20 February 2020 to 15 April 2020) was compared with the interyear control period (1 January 2020 to 19 February 2020) and to the intrayear control period (20 February 2019 to 15 April 2019). All patients with an initial diagnosis of ACS were included in the analysis, and further stratified into ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI)/unstable angina. RESULTS: A total of 1239 patients were enrolled. Daily incidence of ACS was 6.1, 6.3 and 4.5 for the interyear control period, the intrayear control period and the case period, respectively. There was no difference in overall STEMI daily incidence while NSTEMI/unstable angina fell from 3.6 and 3.3-1.8 during the case period (P = 0.01). Incidence rate ratios were significantly lower when the case period was compared with the intrayear control period (incidence rate ratios: 0.49, 95% confidence interval 0.41-0.59, P = 0.001) and the interyear control period (incidence rate ratios: 0.67, 95% confidence interval 0.50-0.90, P = 0.008). CONCLUSION: During the global pandemic there was a significant reduction in total ACS and NSTEMI in the Marche region. Unlike previous reports, there was no difference in overall access to CCL for STEMI during the same period.

The relationship between post-traumatic stress and positive mental health symptoms among health workers during COVID-19 pandemic in Lombardy, Italy.

BACKGROUND: The COVID-19 pandemic is exposing health workers (HW) worldwide to extreme burden and risk of developing post-traumatic stress disorder (PTSD). This problem emerged in Lombardy, the Italian region where the pandemic exacted the heaviest toll. Study aims were to assess mental health of HW in Lombardy after the peak of COVID-19 related hospitalizations, through the joint evaluation of PTSD and positive mental health; and to explore the potential role of positive mental health in PTSD development. METHODS: HW completed an online survey including demographic and work-related information; PTSD Checklist for DSM-5; Mental Health Continuum Short-Form. Analyses comprised calculation of percentages of participants meeting a provisional PTSD and mental health diagnosis (flourishing, moderate, languishing); a binary logistic regression with demographics, work-related features, and positive mental health as predictors, and provisional PTSD diagnosis as outcome. RESULTS: Out of 653 participants, 39.8% received a provisional PTSD diagnosis; 33.4% reported flourishing, 57.7% moderate, and 8.9% languishing mental health. Regression analysis highlighted that women vs. men, nurses vs. technical/rehabilitation HW, frontline vs. second-line workers and languishing vs. moderately mentally healthy HW were more likely to receive a provisional PTSD diagnosis, whereas flourishing participants were more likely not to receive it. No role emerged for job seniority. LIMITATIONS: Self-reported PTSD scores, stress symptoms related to COVID-19 considered as a global stressor, cross-sectional study design. CONCLUSIONS: Findings suggest the potential usefulness of supporting vulnerable HW categories during massive disease outbreaks through emergency-focused professional training and psychological intervention addressing both positive mental health promotion and PTSD prevention.

[Elderly and surgery: impact of frailty on surgical outcome. A literature review.] / Anziano e chirurgia: impatto della fragilità sugli outcome chirurgici. Una revisione della letteratura.

AIM: Currently more than 40% of surgical procedures are performed on subjects over65 years. this event has brought to the fore the concept of frailty. The aim of this work is to summarize the knowledge available in the literature in order to better understand what are the essential aspects of frailty, which impact it has on surgical outcomes of the elderly and what action we need to apply to prevent it. METHODS: A narrative literature review was conducted using the principal bibliographic biome- dical and nursing databases. RESULTS: Literature analysis revealed that frailty is a medical syndrome with multiple causes characterized by reduced physiological functions and decreased stress resistance, resulting in several adverse outcome following surgery. In the selected studies, frailty has emerged as a reliable indi- cator of increased morbidity and mortality, long-term hospital stay, post-discharge institutionali- zation, and increased healthcare costs. For frailty prevention and treatment, the most important clinical intervention is physical exercise. CONCLUSION: Identifying a patient like frail in the preoperative period allows the health profes- sional to adequately transmit information about individual perioperative risks. It should provide an opportunity to discuss the expectations and wishes of the patient for whom an adverse posto- perative outcome is expected. In addition, for high risk subjects, a clinical pathway with a well- structured discharge program can be anticipated in order to avoid hospital prolongations, thus reducing hospitalization costs.

[Prevalence and risk factors of overweight and obesity after liver transplantation: retrospective study at three years after transplantation]. / Prevalenza e fattori di rischio di sovrappeso e obesità dopo il trapianto di fegato: studio retrospettivo a tre anni dopo il trapianto.

BACKGROUND AND AIM: Weight gain is frequently observed among liver transplanted patients. This condition is often associated to the development of other post LT morbidities which might influence the long-term post-transplant survival. However, the risk factors asso- ciated have not yet been identified. The aim of this study was to assess the prevalence of over- weight and obesity, to notice Body Mass Index changes and associated risk factors, within three years after LT. METHODS: All the patients consecutively transplanted at the Liver Transplantation Unit of Fondazione IRCCS "Cà-Granda Ospedale Maggiore Policlinico", Milan between January 2005 and June 2014 were retrospectively evaluated for inclusion. Clinical, Biochemical and pharmaco- logical data were collected at hospital discharge and at 1st,2nd and 3rd years post-LT. RESULTS: 145 patients, 95(66%) male, 53 years (44-59 yr), 48(33%) HBV+HDV positive and 30(21%)alcohol abusers pre LT, were enrolled. At hospital discharge patients' BMI was 21.9 Kg/m2 (IQR: 20.1-24.1 Kg/m2) and the prevalence of overweight was 14%. The same para- meters after 1,2 and 3 years of follow-up were 25.6 Kg/m2 and 40%, 25.5 Kg/m2 and 41%, 25.4 Kg/m2 and 37%. The main weight gain was 9.8 Kg during the 1st year after LT while only 0.9 Kg and 0.5 Kg during the 2nd and 3rd year, respectively, No correlation between weight gain and any clinical, biochemical and pharmacological parameters considered was observed. DISCUSSION: The weight gain and the development of obesity are predominant during the first year after LT; this is probably due to an improper diet and lack of physical activity.

[Education, motivations and working conditions of a cohort of nurses attending to an open-competition]. / Profilo formativo, motivazionale e occupazionale di una coorte di infermieri iscritti ad un maxiconcorso.

. Education, motivations and working conditions of a cohort of nurses attending to an open-competition. INTRODUCTION: In the last decade, the progressive reduction of staff turnover decreased together with the number of open competitions, now attended by thousands of candidates, portraying an image of massive unemployment in the nursing profession. AIM: To describe the socio-demographic profile, the studies, previous work experiences and motivations of a cohort of nurses participats a maxi-competition in Lombardy region. METHODS: A questionnaire with 38 questions was administered to collect the socio-demographic data, information on education and work activities, their experiences and skills and the motivations for participating to the competition. RESULTS: The 6365 candidates were mainly women; unmarried and young people (mean age 26 years), with a degree in nursing obtained mainly in three years (44%). Over all 80% of respondents started to work within 1 year post-graduation; 57% were participating for the first time to a competition; 27% of candidates were currently employed on a temporary or permanent basis. Nurses would like to work in specialty areas such as critical care units, emergency departments and operating rooms, although their practical training was mainly in medicines and general surgeries. CONCLUSIONS: Most nurses are employed few months after graduation. The massive participation to public competitions depends on the limited number of procedures and not on the excess of nurses. A public competition with thousands of candidates, does not allow to select the most competent nurses and should be reformed.

Quality of life of patients undergoing surgery for obstructed defecation syndrome: A before-after study.

INTRODUCTION: Obstructed defecation syndrome (ODS) is the inability to evacuate the contents of the rectum. It is a common problem with both social and psychological effects on a patient's quality of life. Surgery has proven effective and safe in reducing symptoms, with subsequent improvement of quality of life (QOL). METHODS: This study evaluates QOL both before and after surgery (three months) in a series of 96 patients. The Short Form-12 (SF-12) and ODS questionnaires were scored and pain during voiding was assessed by means of the Numerical Rating Scale. RESULTS: 92 consecutive patients were studied. After three months, pain and ODS scores improved significantly. General QOL also improved significantly. DISCUSSION: More than three months from surgery might be necessary in order to obtain more useful information regarding the effects of surgery on both physical and mental health. However this study suggests the benefits are seen even in the early post-operative period. CONCLUSION: After three months general quality of life shows a improvement and hopefully these results will be sustained (or even improved) in the longer term.