Long-term symptoms after SARS-CoV-2 infection in a cohort of hospital employees: duration and predictive factors.

PURPOSE: To evaluate the frequency, duration and patterns of long-term coronavirus disease 2019 (COVID-19) symptoms and to analyse risk factors for long-lasting COVID-19 sequelae among a cohort of hospital employees (HEs). METHODS: We conducted a survey regarding persistent COVID-19 related symptoms with all HEs from three medical centres in Cologne, Germany, who were tested SARS-CoV-2 PCR positive from March 2020 until May 2021. Duration of symptoms and possible risk factors for protracted COVID-19 course were analysed. RESULTS: Of 221 included HEs, a number of 104 HEs (47.1%) reported at least one persisting symptom for more than 90 days after initial SARS-CoV-2 detection. Each one cycle higher initial Ct value significantly increased the chances of overcoming symptoms (odds ratio [OR] 1.05; 95% confidence interval (95%CI) 1.01-1.09; p = 0.019). The occurrence of breathlessness within the first ten days (OR 7.89; 95%CI 1.87-41.43; p = 0.008), an initial Ct value under 30 (OR 3.36; 95%CI 1.22-9.94; p = 0.022) as well as the occurrence of anosmia or ageusia within the first ten days (OR 3.01; 95%CI 1.10-8.84; p = 0.037) showed a statistically significant association with increased odds of illness duration over 90 days. CONCLUSION: About half of the HEs suffered from long lasting symptoms over 90 days after almost entirely mild acute COVID-19. Predictive factors could possibly be used for early treatment to prevent development of long-term symptoms after COVID-19 in future.

Hair corticosterone concentration as a potential stress marker in pet rabbits.

BACKGROUND: As a prey species, rabbits tend to hide their illnesses and injuries. Consequently, pet rabbit owners often do not notice that their pet may be suffering. METHODS: Data on the housing and health of 34 dwarf rabbits were collected from a total of 22 rabbit owners. A score from 0 (not stressed) to 3 (highly stressed) was assigned to each rabbit based on the owners' reports. Afterwards, the hair corticosterone concentration (HCC) of the rabbits was analysed as an indicator of long-term stress. RESULTS: The mean HCC of all rabbits was 1.54 ± 0.64 pg/mg. Animals with a stress score of 3 had a higher HCC (2.17 pg/mg) than those with a score of 0 (1.09 pg/mg) or 1 (1.44 pg/mg) (p < 0.05). HCC was not significantly affected by sex or age (p > 0.05). LIMITATION: Only a small number of rabbits were included in the study. Therefore, the findings need to be confirmed in a larger cohort of animals. CONCLUSION: HCC seems to be a promising stress marker in pet rabbits.

A Systematic Review and Meta-Analysis of Cognitive Effects of rTMS in Caucasian Patients with Mild Cognitive Impairment.

In recent years, repetitive transcranial magnetic stimulation (rTMS) has received much attention as a non-invasive, effective treatment modality for mild cognitive impairment (MCI). Although several meta-analyses have reported that rTMS can improve cognitive abilities, improvements in individual memory domains (speech, language, concentration, and memory) are poorly understood. In addition, stimulation parameters may be flawed in studies of global populations because of ethnic differences between Caucasians and Asians. This meta-analysis aimed to systematically characterize the efficacy of different combinations of rTMS parameters on different cognitive domains in Caucasian patients with MCI. We conducted a systematic literature search in Medline PubMed, Pubpsych, and Embase on the use of rTMS in MCI patients through November 2022. Randomized, double-blind, and sham-controlled trials (RCTs) from the Caucasian patient population were included. The studies reported outcome measures for different domains of cognition, such as language, concentration, or memory. Possible effects of covariates were examined using meta-regressions. The search yielded five publications. The analyses found that rTMS improved cognitive functions, memory, concentration, and language in patients with MCI and treatment with rTMS compared with the sham stimulation group. The statistical analysis results of the studies showed that rTMS could improve various cognitive functions, such as memory and concentration, in Caucasian MCI patients. A particular effect was found at a frequency of 10 Hz and stimulation of the LDLPFC. However, further studies are needed to validate these findings and explore more effective stimulation protocols and targets.

Physical Injuries and Hair Corticosterone Concentration in Rabbit Kits from Single- and Group-Housed Does Kept on a Commercial Farm.

In intense breeding programs, rabbits are exposed to numerous stress factors which could affect their welfare and health. It has been suggested that group housing is more comfortable for does and similar to the living conditions of European wild rabbits. In this study, we compared three different housing systems­single housing; housing in pairs; and housing in groups of three does­to test whether there is a measurable impact on skin lesions, health, and hair corticosterone concentration (HCC) of their kits. The number of kits with lesions increased with the number of does kept together. The probability of kits getting injured was higher in groups of three does than in pens of single-housed does (p = 0.041). When does were pair-housed, kits seemed to have fewer disease symptoms compared to the other treatments. Concerning HCC of kits, there was no significant difference between the housing systems (p > 0.05). The mean HCC of kits was 2.94 pg/mg, while pair housing had the lowest HCC (2.59 pg/mg). This study focused on the welfare of kits from group-housed does. From this perspective, pair housing of does may be appropriate to allow social interaction between does without unduly affecting the welfare of their kits.

Implementation of a Pig Toilet in a Nursery Pen with a Straw-Littered Lying Area.

In this study, a pig toilet was installed on an organic pig farm, which enabled pigs to use a lying area littered with straw and keep it clean. The pig toilet was separated into a defaecation area and a urination area and nursery pigs were trained to use the urination area by means of a rewarding system. A total of 24 piglets were weaned at 6-7 weeks of age and housed in the experimental system for four-week periods. Per trial, a group of four pigs was formed, and videos were recorded on two days per week (08:00 to 18:00). Direct observation was carried out in the first and last week of each trial. In total, 1500 eliminations were video-analysed. An individual pig had an average of 7.1 ± 1.4 defaecations and 4.8 ± 0.8 urinations per day. In total, 96.4% of all urinations and 97.4% of all defaecations were performed in the pig toilet. However, most urinations took place in the defaecation area as well (90.4%). Even if the training to spatially separate defecation and urination behaviour was not successful, we showed that a pig toilet offers the possibility to create littered lying areas, possibly increasing animal welfare.

Does Nursing Behaviour of Sows in Loose-Housing Pens Differ from That of Sows in Farrowing Pens with Crates?

Sows confined to farrowing crates are restricted in performing natural behaviour such as maternal behaviour. Loose-housing farrowing pens (LH) and farrowing pens with crates (FC) were compared regarding sows' nursing behaviour via video analyses over four weeks per batch (one day per week). Nursing frequency was similar in LH and FC pens (1.25 ± 0.82 vs. 1.19 ± 0.75 nursings/sow/hour; p > 0.05). However, nursing duration differed between the two systems (LH: 5.7 ± 4.6 min vs. FC: 7.0 ± 5.0 min; odds ratio (OR) 1.168, p = 0.011). In LH pens, more nursing bouts were sow-terminated than in FC pens (OR 0.427, p = 0.001). The probability of sow-terminated nursing occurring increased from week 1 to week 4 (OR 3.479, adjusted p (padj) < 0.001), while that of observing unnursed piglets decreased from week 1 to week 4 (OR 0.301, padj < 0.001) and rose with increasing litter size (OR 1.174, p = 0.010). We conclude that nursing behaviour was affected by the farrowing system, with shorter nursing duration and more nursing terminations by the sow in LH than in FC pens. Since this corresponds to the nursing behaviour of sows in semi-natural conditions, it can be assumed that sows in LH pens are more likely to exhibit natural nursing behaviour.

Standardized aseptic dressing change procedure: Optimizations and adherence in a prospective pre- and postintervention cohort study.

BACKGROUND: The "HygArzt" project investigated the effectiveness of hygiene measures introduced by an infection prevention link physician (PLP). OBJECTIVE: To investigate whether the introduction of a standardized aseptic dressing change concept (ADCC) by a PLP can increase hand hygiene adherence and adherence to specific process steps during an aseptic dressing change (ADC) in a trauma surgery and orthopedic department. METHODS: We defined 4 required hand disinfection indications: (1) before the preparation of ADC equipment, (2) immediately before the ADC, (3) before the clean phase, and (4) after the ADC. A process analysis of the preintervention phase (331 ADCs) was used to develop a standardized ADCC. The ADCC was introduced and iteratively adopted during the intervention phase. The effect was evaluated during the postintervention phase (374 ADCs). RESULTS: Hand hygiene adherence was significantly increased by the introduction of the ADCC for all indications: (1) before the preparation of the ADC equipment (from 34% before to 85% after, P <.001), (2) immediately before an ADC (from 32% before to 85% after; P < .001), (3) before the clean phase (from 42% before to 96% after; P < .001), and (4) after an ADC (from 74% before to 99% after; P < .001). Overall hand hygiene adherence was analyzed before the indications for an ADC (from 9.6% before to 74% after; P < .001). The same strategy was applied to the following process parameters: use of a clean work surface, clean withdrawal of equipment from the dressing trolley, and appropriate waste disposal. CONCLUSIONS: A PLP sufficiently implemented a standardized concept for aseptic dressing change during an iterative improvement process, which resulted in a significant improvement in hand hygiene and adherence to other specific ADCC process steps.

Evidence of the medical and economic benefits of implementing hygiene measures by a prevention link physician in trauma surgery: Study protocol for a biphasic multicenter prospective interventional pre-post cohort study using a structured intervention bundle development and tools of behavior change management.

INTRODUCTION: The German Commission for Hospital Hygiene and Infection Prevention recommends nominating one authorized medical specialist in every medical department as an infection prevention link physician (PLP). It has been roughly described that a PLP serves as a link between the infection prevention team and the respective clinical departments. No detailed evidence about the contribution made by PLPs to the decrease of infection rates is available in Germany. The "HygArzt" project aims to demonstrate the medical and economic benefits of the implementation of hygiene measures by PLP in trauma surgery/orthopedics. METHODS: A multicenter interventional pre/post cohort study design was chosen. The study will run for a three-year period, including a pre-, post-, and an intervention phase, in four different hospitals, one of which will serve as pilot. A complex intervention containing evidence-based infection control measures will be developed and implemented by a PLP to proof efficacy. After the successful implementation of the preventive measures in the pilot hospital, the concept will be transposed to the three remaining trauma and orthopedic departments to confirm the transferability and generalizability. To enable the PLPs of the non-pilot departments, a subject-specific training program will be developed based on the study results of the pilot hospital and offered to the PLPs. DISCUSSION: Data are intended to provide evidence that and, if so, to which extent the implementation of specific preventive measures by a medical department-specific PLP is possible and results in a reduction of nosocomial infections in orthopedic surgery and traumatology. CONTRIBUTION TO THE LITERATURE: The present study describes a novel complex study design to prove the effectiveness of intervention measures for infection prevention. The study design and newly developed methodological approach could serve as a model for similar studies on infection prevention in the future. For the first time, the presented research project "HygArzt" focuses on the implementation of hygiene measures by an infection prevention link physician (PLP) and investigates whether nosocomial infections, especially surgical site infections, can be reduced by the measures implemented. TRIAL REGISTRATION: German clinical Trials register DRKS-ID:00013,296. Registered on March 5, 2018, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013296.

Comparison of the Skin Cancer Quality of Life Impact Tool and the Skin Cancer Index Questionnaire in Measurement of Health-Related Quality of Life and the Effect of Patient Education Brochures in Patients with Actinic Keratosis, Non-melanoma Skin Cancer, and Cutaneous Melanoma.

INTRODUCTION: Few studies have evaluated patient-reported outcome measures and the effect of patient educational materials in German patients with skin cancer. We conducted a prospective study to measure the impact of treatment on health-related quality of life in German patients with skin cancer, identify variables that may contribute to changes in health-related quality of life, and evaluate the effect of providing additional information through a patient education brochure. METHODS: A total of 461 patients diagnosed with actinic keratosis, nonmetastatic nonmelanoma skin cancer, melanoma in situ, or nonmetastatic cutaneous melanoma treated between August 2018 and July 2020 were included. Ninety-seven patients were randomly selected to receive an additional patient education brochure ("Hautkrebs"). The patients completed a Skin Cancer Quality of Life Index Tool (n = 324) or a Skin Cancer Index Questionnaire (n = 137) 1 week after surgical treatment. RESULTS: Ninety-seven patients were provided an additional patient education brochure. We found statistical correlation between sociodemographic factors (young age and female gender) and the location of the skin cancer (head and face) and impairment of health-related quality of life in patients with skin cancer (p < 0.05). Moreover, we found that patients who were presented a brochure showed significantly higher awareness concerning direct sun exposure (p < 0.05). CONCLUSION: Impaired health-related quality of life is correlated with a patient with skin cancer's age, gender, and the location of the lesion. Physicians should consider these factors in clinical practice and advocate the use of patient education brochures as effective assets in preventing the reoccurrence of skin cancer.

Analysis of Hair Cortisol as an Indicator of Chronic Stress in Pigs in Two Different Farrowing Systems.

Confinement to farrowing crates is known to prevent sows from performing natural behavior, impairing animal welfare and possibly causing chronic stress. Hair cortisol analyses are increasingly used to detect chronic stress in animals. In the present study, hair samples were collected in the neck of sows kept either in farrowing crates (FC, n = 31) or in a loose-housing system (LH, n = 30) in six batches. Cortisol was extracted and analyzed using chemiluminescence immunoassay. Mean hair cortisol concentrations (HCC) did not differ significantly between the systems (LH: 1.85 ± 0.82 pg/mg, FC: 2.13 ± 1.53 pg/mg, P = 0.631). HCC was also not affected by other factors, such as sows' parity, number of piglets, skin lesion score or sow's weight loss during the farrowing period. However, highly significant differences were found in hair growth rates between different regions within the 20 × 30 cm shaving area. While the hair in both lateral parts of the shaving area grew almost identically (left: 7.48 ± 3.52 mm, right: 7.44 ± 3.24 mm, P = 1.00), the hair grew more in the area above the spine (12.27 + 3.95 mm, P < 0.001). In both systems, the mean individual lesion score of sows declined from the beginning to the end of the housing period (P < 0.001). No difference was found between FC and LH sows at any time (P > 0.05). Since neither the amount of skin lesions nor HCC differed between LH and FC sows, it may be concluded that confining sows in farrowing crates did not affect chronic stress levels. However, results may be affected by a downregulation of the hypothalamic-pituitary-adrenal axis during long-term stress, resulting in lower cortisol levels over time. HCC in sows may also be influenced by a dominant stressor, such as farrowing or the presence of suckling piglets. Thus, for a comparison of different farrowing systems regarding chronic stress, the use of hair cortisol measurement seems to be limited. The present results revealed that differences in hair growth rate within the same body region exist. This important finding should be considered when collecting hair samples in pigs, since hair cortisol concentrations may vary depending on hair growth and length.