Epidemiological model of COVID-19 in healthcare workers: occupational vs. environmental disease

This study aims to estimate the occupational etiology of COVID-19 in the healthcare sector and obtain a risk matrix for the burden of disease across occupations and specific activities. The study population included 4515 cases and 133077 controls. We have used an epidemiological model that included data collected over one year from employed persons with confirmed SARS-CoV-2 infection, age group 20-64, and residing in Sibiu County. We measured the incidence rate (IR), relative risk (RR), and risk of COVID-19 attributable to the occupational exposure (AR), respectively, statistical analysis based on frequency distribution and the portion of cases to compute the risk levels in social- and healthcare workers. According to this model, approximately 70.5% of COVID-19 risk could be attributable to occupational exposure. The workplace is a strong predictor of infection risk (RR 3.4), particularly in residential long-term care facilities, hospitals, and ambulance services. The highest-risk job functions are nurse, nursing assistant, ambulance worker, and dentist. In conclusion, we believe in having demonstrated that epidemiological modeling may be helpful for risk management and notification of COVID-19 as an occupational disease in frontline staff and essential healthcare personnel.

Successful management of a professional viola player with a complex playing related musculoskeletal disorder

Objective: This paper presents the case of a 53-year-old female professional violist with chronic disabling neck and shoulder pain who had failed standard conservative management. A multimodal approach including Mulligan Concept manual therapy techniques resulted in a successful return to the workplace. Methods: Mobilization with Movements and Sustained Natural Apophyseal Glides as part of Mulligan Concept manual therapy approach, were the main treatment techniques utilized. Neuro-dynamic exercises, strengthening exercises, ergonomic interventions, alterations in playing load, and posture training were also implemented. Pain, range of motion and disability levels were monitored throughout treatment. Results: Significant improvements were seen in both neck and shoulder range of motion alongside considerable pain reduction in both regions. Clinically meaningful improvements were also noted in Neck Disability Index and Shoulder Pain and Disability Index scores. Discussion: Ergonomic intervention with postural correction and replacement with a lighter viola also contributed to patient recovery and return to the workplace. The Mulligan approach has proved to be effective in a wide variety of conditions. Still, it has not previously been considered in managing complex neck and upper limb disfunctions in string players. Conclusion: This paper highlights how an intensive manual therapy program had better results compared with standard conservative management. Multimodal intervention with occupational, ergonomic, and physiotherapy approaches was effective, leading to progressive re-integration into the workplace. Mulligan Concept manual therapy techniques should be considered in the management of playing related musculoskeletal disorders.

E-learning during the COVID-19 pandemic: the impact on medical students’ perceived academic progress

The Covid-19 pandemic created one of the most stressful situations all around the world and affected almost all activity sectors, including medical education. Sudden restrictions on social interactions forced an abrupt transition from amphitheatres and physical examinations to online lectures and, despite difficulties, the academic community rallied to continue teaching. The swift transition left academia with no time to design custom platforms and confined the university to choose among a set of readily available tools: Google Classroom and Google Meet, Zoom and Moodle, which offer a basic framework for substituting the students’ needs. In some countries, ours included, most of the summer term took place online. Although pandemics are, hopefully, rare events, the experience with online classes should be used to improve and expand current teaching models, since this improvement could be a means to a general improvement of the medical teaching system. On the other hand, the COVID-19 pandemic is not finished yet and many restrictions continue, affecting at least 20% of the total undergraduate training of several generations of doctors. The study aims to identify – within the medical students’ community - transferable aspects of online classes to the post-pandemic teaching in the perspective of blended learning. We deliberately chose to omit the examination part of the educational process in order to set the focus on the delivery of teaching. In this first analysis of the results, the degree of progress in reaching a high professionalism level was analyzed starting from the self-assessment of professional growth, that was previously found to be in good agreement with the actual achievements as derived from the traditional formative examination. [1]

Contact dermato-allergology - review of the literature

European Baseline Series (EBS) of haptens (contact allergens) is used throughout Europe, containing patch tests essential for the diagnosis of contact allergy (Tables I and II) [1]. Exposure to environmental allergens is constantly evolving and the EBS must be adapted accordingly in order to guarantee its relevance of the molecules tested, in particular by the addition of emerging allergens [1].

The questionnaire as a tool for collecting information in support of medical researchers

In medical and epidemiological research, multi-item questionnaires are often used to assess changes in the health of a particular group of subjects over a certain period. They can target a selected population sample based on specific exposure characteristics or target the whole population. Also, they can constitute an objective tool to help health professionals improve the quality of life and guide patients to the most appropriate care suitable [1,2]. Trying to complete an entirely new questionnaire or translating an existing questionnaire from another language can be difficult. The biggest challenge is making a questionnaire that is effective for use in research and clinical conditions. This article tries to guide for adapting validated and translated questionnaires to apply them to various population categories. We want to support readers less familiar with the process of developing and adapting validated questionnaires. Although using an existing questionnaire will save time and resources, a questionnaire that includes all items of interest to the researcher may not be available, or the current questionnaire may not be translated into the language required for respondents. If no already validated questionnaires are available or suitable, it is necessary to design a new questionnaire. For this, there are several steps to follow that one must take into account.

Beneficial effect of hyperbaric oxygen therapy in solving a nosocomial COVID-19 infection. Case report and short literature review

The infection with the new coronavirus SARS-CoV-2 was declared a global health emergency in early 2020 and, two months later, became recognized as a pandemic, affecting the world’s population regardless of age, ethnicity, geographical area. COVID-19 generally presents with altered general condition (fever, chills, marked fatigue, muscle aches, headache), respiratory manifestations from cough to dyspnea, acute respiratory distress, and multiorgan damage in critical forms. Manifestations can occur between 2 days and two weeks after exposure, the disease evolving from mildly symptomatic to moderate, severe, and even fatal forms. Our reported clinical case of COVID-19 is that of a 59-year-old nurse with diabetes and hypertension as risk factors. Accidental occupational exposure to SARS-CoV-2 infection occurred due to non-compliance with the existing dressing-undressing protective equipment protocols in facilities with treatment beds. We diagnosed a moderate-severe COVID-19, displaying bilateral lung damage and mild desaturation, complicated by bacterial superinfection with Klebsiella spp. The patient underwent antiviral, antibiotic, anticoagulant, cortisone treatment during hospitalization. In the first two months after discharge, we recommended seven hyperbaric therapy sessions to relieve respiratory symptoms and enhance regression of fibrotic lung lesions.

COVID-19: the first pandemic of the 21th century. A review of the literature

The new coronavirus SARS-CoV-2 (COVID-19) was recognized in December 2019 as a cause of severe pneumonia and has now led to a global pandemic [1, 2]. Respiratory illnesses caused by COVID-19 cover a whole range of severities. Identifying the risk factors and protective factors for the severity of COVID-19 disease is essential to direct the development of new treatments and infection prevention strategies. The first large series of cases identified several risk factors for severe forms of the disease, including advanced age, hypertension, diabetes, cardiovascular disease, exposure to tobacco, and obstructive pulmonary chronic disease [1, 3]. The Chinese Center for Disease Control and Prevention published a significant case series study of coronavirus disease 2019 (COVID-19) (72 314 cases, updated through February 11, 2020) [4, 5]. The authors of this paper summarized key findings from this report and discussed emerging understanding of and conclusions from the COVID-19 epidemic.

Different perspectives of doctors and nurses about the continuation of usage of some of the protection measures after the end of the COVID-19 pandemic

The current pandemic pointed toward a revision of the protection measures against infectious diseases. For any given new pathogen against which human species showed no immunity, isolation and personal protection equipment proved to reduce disease transmission. In medical settings, when there is inevitable contact with infected patients, these preventive measures have undoubtedly change the process of care delivery. The study aims to investigate the opinion of the healthcare workers about the utilization of the personal protective equipment after the pandemic stops. For this purpose, we conducted an online survey about changes related to the COVID-19 pandemic. For the healthcare workers, the survey also included several questions related to personal protective equipment. A total of 512 responders, doctors, and nurses answered to the survey. We performed comparisons between these two categories of personnel using the χ test. Overall, the results show that doctors are keener to follow the recommendations for the personal protective equipment in the future; there was a statistically significant difference (p<0.001) for the usage of gloves and masks while examining febrile patients, and for the handwashing after the examination of each patient. The type of service (outpatient or inpatient procedures) and direct contact with a COVID-19 patient were other factors to modulate the responses regarding using personal protective equipment in the future. The fact that 14.06% of the responders did not consider it necessary to wash hands after examining each patient underlines the urgent need for safety education in all healthcare workers and nurses.

ORCHESTRA project in Romania - a prospective occupational cohort to study the impact of COVID-19 pandemic on healthcare workers

ORCHESTRA is a three-year international research project funded by the European Union’s Horizon 2020 research and innovation programme, led by the University of Verona and involving 26 partners (extending to a wider network of 37 partners) from 15 countries. Romania is partner in ORCHESTRA project and is represented by The National Institute of Public Health. The challenge for the Romanian team is to enroll a prospective cohort of more than 1 000 health care workers and to follow-up, for at least 12 months, the impact of the pandemic at three main levels: mental health, long term consequences of COVID-19 and variation of the immune response in vaccinated. Secondary objectives are: the variation of risk perception during the pandemic, the preventive measures at workplace and how these evolved during the pandemic, vaccination acceptance and reasons of refusal. This paper aims to present a brief overview of the study design in Romania and the cohort description at baseline.

Occupational Extrinsic Allergic Alveolitis in a poultry farmer

Hypersensitivity pneumonitis is a group of inflammatory interstitial lung diseases caused by hypersensitivity immune reactions to the inhalation of various antigens: fungal, bacterial, animal protein, or chemical sources, finely dispersed, with aerodynamic diameter <5μ, representing the respirable fraction. The national register for interstitial lung diseases records very few cases of hypersensitivity pneumonitis (extrinsec allergic alveolitis), a well defined occupational disease. Although not an eminently of occupational origin, the extrinsec allergic alveolitis can occur secondary to occupational exposure to organic substances (animal or insect proteins, bacteria, fungi) or inorganic (low molecular weight chemical compounds) and the occupational doctor is a key actor in the diagnosys. The disease has chronic evolution and exposure avoidance, as early as possible, has major prognostic influence. The occupational anamnesis remains the most important step and the occupational physician is the one in charge for monitoring and detection of the presence of respiratory symptoms in all employees with risk exposure. Next, we present the case of a farmer, without other comorbidities, who develops various respiratory and systemic diseases and manifestations due to repeated exposure to animal proteins and molds, in order to review the risk factors and the consequences of exposure in poultry farms.