NURSES’ PHYSICAL AND PSYCHOLOGICAL SYMPTOMS DURING THE FIRST COVID-19 LOCKDOWN IN ITALY

Background and objective: Northern Italy was one of the first European territories to deal with the Coronavirus Disease 2019 (COVID-19) outbreak. Drastic emergency restrictions were introduced across the country to contain the spread and limit pressure on healthcare facilities. Nurses were at high risk of developing physical, mental and working issues due to professional exposure. The aim of this cross-sectional study was to investigate these issues among nurses working in Italian hematopoietic stem cell transplant (HSCT) programmes during the COVID-19 pandemic. Methods: Data were collected online immediately after the first "lockdown" period in order to investigate the prevalence of physical issues, sleep disorders and burnout symptoms and explore correlations with COVID-19 territorial incidence in Northern Italian regions versus Central and Southern Italian regions. Results: Three hundred and eight nurses working in 61 Italian HSCT Units responded to the survey. Depression, cough and fever were more frequently reported by nurses working in geographical areas less affected by the pandemic (p=0.0013, p<0.0001 and p=0.0005 respectively) as well as worst sleep quality (p=0.008). Moderate levels of emotional exhaustion (mean±SD - 17.4±13.0), depersonalization (5.3±6.1) and personal accomplishment (33.2±10.7) were reported without significant differences between territories. Conclusions: different COVID-19 incidence among territories did not influenced nurses’ burden of symptoms in HSCT setting. However, burnout and insomnia levels should be considered by health care facilities in order to improve preventive strategies.

Ռաֆայել Շիշմանյանի որմնանկարչական աշխատանքները

The artist and expert of art theory Raphael Chichmanyan’s works of art have correspondingly been covered in professional literature. However, his mural artworks, besides some brief references, still need some detailed professional exposure. The paper submitted is dedicated to the mural artworks by Chichmanyan housed in the Nubar Library of Paris and the House of Armenian Students in Paris. The subject-matter artworks have been created in line with the depiction technique typical of medieval ornamentation; nevertheless, nowadays, the artistic solutions of the interior of the institutions mentioned above ascribe an absolutely novel framework to Chichmanyan’s murals, deserving the admiration of art buffs.

COVID-19 Detection Using Deep Learning Algorithm on Chest X-ray Images

COVID-19, regarded as the deadliest virus of the 21st century, has claimed the lives of millions of people around the globe in less than two years. Since the virus initially affects the lungs of patients, X-ray imaging of the chest is helpful for effective diagnosis. Any method for automatic, reliable, and accurate screening of COVID-19 infection would be beneficial for rapid detection and reducing medical or healthcare professional exposure to the virus. In the past, Convolutional Neural Networks (CNNs) proved to be quite successful in the classification of medical images. In this study, an automatic deep learning classification method for detecting COVID-19 from chest X-ray images is suggested using a CNN. A dataset consisting of 3616 COVID-19 chest X-ray images and 10,192 healthy chest X-ray images was used. The original data were then augmented to increase the data sample to 26,000 COVID-19 and 26,000 healthy X-ray images. The dataset was enhanced using histogram equalization, spectrum, grays, cyan and normalized with NCLAHE before being applied to CNN models. Initially using the dataset, the symptoms of COVID-19 were detected by employing eleven existing CNN models; VGG16, VGG19, MobileNetV2, InceptionV3, NFNet, ResNet50, ResNet101, DenseNet, EfficientNetB7, AlexNet, and GoogLeNet. From the models, MobileNetV2 was selected for further modification to obtain a higher accuracy of COVID-19 detection. Performance evaluation of the models was demonstrated using a confusion matrix. It was observed that the modified MobileNetV2 model proposed in the study gave the highest accuracy of 98% in classifying COVID-19 and healthy chest X-rays among all the implemented CNN models. The second-best performance was achieved from the pre-trained MobileNetV2 with an accuracy of 97%, followed by VGG19 and ResNet101 with 95% accuracy for both the models. The study compares the compilation time of the models. The proposed model required the least compilation time with 2 h, 50 min and 21 s. Finally, the Wilcoxon signed-rank test was performed to test the statistical significance. The results suggest that the proposed method can efficiently identify the symptoms of infection from chest X-ray images better than existing methods.

Ethnic background and risk of SARS-CoV-2 infection among the healthcare workforces: Results of a large occupational cohort study in rural United Kingdom.

Black and South Asian healthcare workers have been found at higher risk of SARS-CoV-2 infection in the United Kingdom. However, many studies do not consider all potential confounders (e.g., professional exposure, living environment) and those conducted during the second wave of the COVID-19 outbreak remain scarce. Using 1-year-folow-up data from a cohort of 13,366 healthcare workers employed in 119 facilities in Lincolnshire, we aimed to quantify the risk of SARS-CoV-2 infection among ethnic minority healthcare staff and to elucidate pathways of infection. Overall, 1258 individuals (9.4%) recorded a positive SARS-CoV-2 test during the observation period, incidence per person-year was 5.2% [Cluster adjusted 95% CI: 3.6–7.6%] during the first COVID-19 wave (Jan-Aug 2020) and 17.2% [13.5–22.0%] during the second wave (Sep 2020-Feb 2021). Compared to Whites, Black and South Asian employees were at higher risk of SARS-CoV-2 infection during both the first wave (Clustered adjusted Hazard Ratio, 1.58 [0.91-2.75] and 1.69 [1.07-2.66] respectively) and the second wave (HR 2.09 [1.57-2.76] and 1.46 [1.24-1.71]). Higher risk of SARS-CoV-2 infection significantly persisted even after controlling on age, gender, pay grade, residence environment, type of work and time exposure at work. Higher adjusted risk of SARS-CoV-2 infection were also found among lower-paid health professionals. Black and South Asian health workers continue to be more exposed to SARS-CoV-2 infection compared to their white counterparts. Urgent interventions are required to reduce SARS-CoV-2 exposure with these ethnic groups.

BIOLOGICAL MONITORING OF WORKERS EXPOSED TO MERCURY AND ITS COMPOUNDS

Biological monitoring is used to assess the toxic effect of mercury on the human body and to identify risk groups for the development of mercury intoxication at various stages of clinical and laboratory examination of workers who have contact with mercury vapor. A comprehensive analysis of changes in the biomarkers of exposure and effect in the conditions of professional exposure to mercury on the body of workers allows us to identify groups at increased risk of developing health disorders and optimize therapeutic and preventive measures taking into account the individual characteristics of the body. Biological monitoring should be implemented at the stage of preliminary, periodic medical examinations and in-depth examination of workers in contact with mercury vapor. Correlation and regression analysis of the data obtained showed a significant positive relationship between the average concentration of mercury in the air of the working area and the average concentration of mercury in the urine of the main occupational groups of mercury production workers.

Effect of Professional and Extra-Professional Exposure on Seroprevalence of SARS-CoV-2 Infection among Healthcare Workers of the French Alps: A Multicentric Cross-Sectional Study

We aimed to report SARS-CoV-2 seroprevalence after the first wave of the pandemic among healthcare workers, and to explore factors associated with an increased infection rate. We conducted a multicentric cross-sectional survey from 27 June to 31 September 2020. For this survey, we enrolled 3454 voluntary healthcare workers across four participating hospitals, of which 83.4% were female, with a median age of 40.6 years old (31.8–50.3). We serologically screened the employees for SARS-CoV-2, estimated the prevalence of infection, and conducted binomial logistic regression with random effect on participating hospitals to investigate associations. We estimated the prevalence of SARS-CoV-2 infection at 5.0% (95 CI, 4.3%–5.8%). We found the lowest prevalence in health professional management support (4.3%) staff. Infections were more frequent in young professionals below 30 years old (aOR = 1.59, (95 CI, 1.06–2.37)), including paramedical students and residents (aOR = 3.38, (95 CI, 1.62–7.05)). In this group, SARS-CoV-2 prevalence was up 16.9%. The location of work and patient-facing role were not associated with increased infections. Employees reporting contacts with COVID-19 patients without adequate protective equipment had a higher rate of infection (aOR = 1.66, (95 CI, 1.12–2.44)). Aerosol-generating tasks were associated with a ~1.7-fold rate of infection, regardless of the uptake of FFP2. Those exposed to clusters of infected colleagues (aOR = 1.77, (95 CI, 1.24–2.53)) or intra-familial COVID-19 relatives (aOR = 2.09, (95 CI, 1.15–3.80)) also had a higher likelihood of infection. This report highlights that a sustained availability of personal protective equipment limits the SARS-CoV-2 infection rate to what is measured in the general population. It also pinpoints the need for dedicated hygiene training among young professionals, justifies the systematic eviction of infected personnel, and stresses the need for interventions to increase vaccination coverage among any healthcare workers.

Management and Attitudes of Patients Victims Accidental Exposure to Blood at the Day Care Unit of the Central Hospital of Yaoundé (Cameroon) from January 2007 to December 2016

Background: There is little data on Accidental Exposure to Blood (AEB) in Cameroon.Objectives: to learn about the management of AEB among professional and non-professional patient at the day care unit of the Central Hospital of YaoundéMethod: This was a 10-year retrospective study in which data concerning socio-demographic characteristics, exposure and consultation circumstances, measures taken after the accident, the status of the source patient and of the patient consultant and the prescribed ARV protocol were analyzed.Results: Six hundred files were selected, including 49.2% professional exposure and 50.2% non-professional. The mean age was 30 ± 9.7 years with extremes of 11 and 67 years. The main circumstances of AEB were needle stick (professional AEB) and rape (non-professional AEB). Prophylaxis with triple antiretroviral therapy has been prescribed to all patients.Conclusion: Non-professional and professional AEB are found in equivalent proportions in our series. Triple antiretroviral therapy was prescribed for all patients. Staff awareness policies could be developed to respect universal precautionary measures.

Mental health impact among hospital staff in the aftermath of the Nice 2016 terror attack: the ECHOS de Nice study

Background The Nice terror attack of July 14, 2016 resulted in 84 deaths and 434 injured, with many hospital staff exposed to the attack, either as bystanders on site at the time of the attack (‘bystander exposure’) who may or may not have provided care to attack victims subsequently, or as care providers to victims only (‘professional exposure only’). The objective of this study is to describe the impact on mental health among hospital staff by category of exposure with a particular focus on those with ‘professional exposure only’, and to assess their use of psychological support resources. Method An observational, cross-sectional, multicenter study conducted from 06/20/2017 to 10/31/2017 among all staff of two healthcare institutions in Nice, using a web questionnaire. Collected data included social, demographic and professional characteristics; trauma exposure category (‘bystanders to the attack’; ‘professional exposure only’; ‘unexposed’); indicators of psychological impact (Hospital Anxiety and Depression Scale); PTSD (PCL-5) level; support sought. Responders could enter open comments in each section of the questionnaire, which were processed by inductive analysis. Results 804 staff members’ questionnaires were analysed. Among responding staff, 488 were exposed (61%): 203 were ‘bystanders to the attack’, 285 had ‘professional exposure only’. The staff with ‘professional exposure only’ reported anxiety (13.2%), depression (4.6%), suicidal thoughts (5.5%); rates of full PTSD was 9.4% and of partial PTSD, 17.7%. Multivariate analysis in the ‘professional exposure only’ category showed that the following characteristics were associated with full or partial PTSD: female gender (OR = 2.79; 95% CI = 1.19–6.56, p = 0.019); social isolation (OR = 3.80; 95% CI = 1.30–11.16, p = 0.015); having been confronted with an unfamiliar task (OR = 3.04; 95% CI = 1.18–7.85; p = 0.022). Lastly, 70.6% of the staff with ‘professional exposure only’ with full PTSD did not seek psychological support. Conclusion Despite a significant impact on mental health, few staff with ‘professional exposure only’ sought psychological support. Robust prevention and follow-up programs must be developed for hospital staff, in order to manage the health hazards they face when exposed to exceptional health-related events such as mass terror attacks. Study registration Ethical approval for the trial was obtained from the National Ethics Committee for Human Research (RCBID N° 2017-A00812–51).

The Danish sports chiropractic landscape: an exploration of practice characteristics and salient developmental issues

Background As is the case around the globe, the Danish chiropractic community appears to be an active service provider for the athletic sub-population. However, a paucity of evidence elucidating the experiences, perceptions, and practices of individuals who identify as ‘sports chiropractors’ complicates strategic development efforts. Methods A sequential mixed-methods study was conceptualized in which interview responses from seven purposefully selected stakeholders provided context and informed a national descriptive survey exploring practice characteristics and opinions regarding sports chiropractic among Danish chiropractors. Results Thematic highlights included divided opinions on the criteria that define a sports chiropractor, the role of a chiropractor functioning beyond the clinic setting, and the need for a structured approach to developing sports chiropractic as a legitimate sub-specialty. The survey response rate was 34.9% (227 of 651), with 27% of responders identifying as a ‘sports chiropractor’. Compared to non-sports chiropractors, sports chiropractors engaged in a significantly higher level of interprofessional practice (3.8 versus 2.7 partners), in particular medical doctors (p = 0.016) and personal trainers (p < 0.001). Whether participants identified as a sports chiropractor or not, there was consensus that a high-quality post-graduate qualification and continued education was important. Generally speaking, the framing of sports chiropractic into a protected title was not a priority. Conclusion The Danish sports chiropractor tends to be male, has a specialist education and engages other chiropractors, medical practitioners and professional trainers more often as practice partners than generalist chiropractors. The position of the sports chiropractor as a ‘knowledgeable expert’ was seen as more important than establishing a protected title. Experiential training appears to be an untapped resource for developing real-world competency and gaining greater professional exposure. Given the potential for development across Europe, more focus is required on a strategic plan for embedding chiropractic professionals in inter-professional athletic health and performance practice settings.