bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceived Stress related to COVID-19 among Tunisian adults during the lockdown period
Authors: Bannour R , Ghammem R , Mlouki I , Ben Fredj S , Zammit N , Ben Nasrallah C , Horri N , Maatoug J , Ghannem H 
Published: October 2021

Abstract

Background
Public health emergencies such as the Covid-19 pandemic can affect the health, safety and well-being of individuals and communities. This pandemic may lead to emotional reactions such as stress, anxiety and depression in the general population.

Aim
To evaluate the perceived stress among Tunisian adults during the period of lockdown.

Methods
A cross-sectional study was conducted during the lockdown period targeting adults using online social networks. The data was collected through a “Google Form” questionnaire published on Face book. Perceived stress was measured using the ‘Perceived Stress scale'.

Results
A total of 164 adults participated in our study with a majority of women (77.4%) and a mean age of 34.57 ± 12.1 years. Almost half of our participants (48.1%) were from the Governorate of Sousse. Among the respondents, 58.5% felt in perpetual threat and only 15.4% knew how to manage their stress. Univariate analyses showed that perpetual threat was significantly associated with age (p = 0.015), being single (p = 0.03) jobless (p = 0.02), and spending more than one hour documenting on COVID-19 (p = 0.02). After adjusting to sex and age; the multivariate analysis showed a statistically significant association between stress level and anxiety p &lt; 10-3; OR: 8.62; IC [3.1-23.8]); fear of catching the virus (p = 0.031; OR: 3.10; IC [1.1-6.7]) and insomnia (p = 0.001; OR: 7.46; IC [2.4-24.7]).

Conclusions
Our results showed that there is a high prevalence of stress in the general population during confinement. A national program of population mental health management should be implemented along with the pandemic management.

Key messages
The COVID 19 may lead to emotional reactions such as stress, anxiety and depression in the general population. A national program of population mental health management should be implemented along with the pandemic management.
Field evaluation of BNT162b2 COVID-19 vaccine response in healthcare workers: a 3-month follow-up
Authors: Ferrara P , Madotto F , Conti S , Vitale A , Della Ragione G , Romano ML , Borrelli M , Schiavone B , Mantovani LG , Ponticelli D 
Published: October 2021

Abstract

Background
Effective and rapid immunologic response to vaccines is a crucial strategy for the control SARS-CoV-2 pandemic. Here, we present the results of an ongoing longitudinal observational study conducted among the healthcare workers (HCWs) of the Pineta Grande Hospital (Castel Volturno, Italy), who were administered the two-dose prime-boost mRNA vaccine BNT162b2.

Methods
Volunteer HCWs underwent either (i) six RT-PCR assay for qualitative detection of SARS-CoV-2 nucleic acid in nasopharyngeal/oropharyngeal swabs; (ii) or six quantitative serology testing for the research of virus-specific immunoglobulins (Ig) through chemiluminescent immunoassay with a reactivity cut-off of an Index of ≥ 1.0. The first tests were taken before the administration of the vaccine and then according to a predefined timeline. An active surveillance follow-up of SARS-CoV-2 infections was set amongst the vaccinees after the end of the study.

Results
Overall, among the 435 HCWs who accepted to participated in the study, 9.3% reported a previous laboratory-confirmed infection with SARS-CoV-2, though all subjects tested negative at the time of first vaccine dose. In the swab cohort, seven subjects tested positive in the first 15 days after the first vaccine dose and one about a week from the second dose. At 45- and 60-day follow-ups all vaccinees tested negative, but two positive tests were registered at the third month. In the second cohort, two weeks after the first vaccine dose anti-SARS-CoV-2 antibodies exceeded the reactivity cut-off in 82.5% the participants. At one-month follow-up, almost all (98.4%) the vaccinees had reached the maximum Index value of 10. No statistically significant associations were found between antibody response and HCWs' characteristics.

Conclusions
Our results showed that surveillance is a critical component of providing safe healthcare during COVID-19 pandemic, also after extended vaccination campaigns, thus enhancing the protection of patients and HCWs.

Key messages
All healthcare facilities should implement continuous post-vaccination surveillance programs in order to ensure patients and healthcare workers safety, and limit in-hospital transmission of SARS-CoV-2. Longer field follow-ups are indispensable to investigate immunogenicity trends and effectiveness of COVID-19 vaccines over time, and to consider booster doses, especially in high-risk population.
COVID-19 prevention and outbreak control in a large Spanish prison: an intersectoral approach
Authors: Boned-Ombuena A , Bonet Igual MJ , Sáez-Lloret I , Martí-Serra J , Deltoro MG , Cardona C Gimeno , Melero-Garcia MM , Soriano P , Orts-Ríos E , Roig Sena J 
Published: October 2021

Abstract

Issue
The COVID-19 pandemic poses a challenge for prison settings, given their population vulnerability and the complexity of their internal functioning. We summarize the actions and outcomes concerning outbreak prevention and control in the Antoni Asunción Hernández (AAH) Prison (Valencian Region, Spain), one of the largest in Europe.

Description
An intersectoral commission was established in March 2020 at the Valencia General Hosp Health Dept to coordinate the COVID-19 response in penitentiary centres. A contingency plan was developed, with successive contention layers: general measures, restriction of interaction with the community (including suspension of visits), 14 days quarantine on admission and return, reduction of activities, modular confinement, voluntary confinement in cells, occupational risks prevention, vaccination, epi surveillance, outbreak management (incl sectorisation), isolation of cases (PCR at discharge), contact tracing and 14d quarantine (PCR at 0,7&14d), expanded testing and healthcare services.

Results
On 8 Jan 2021, with a regional 14d cum incidence of 394/100,000 pop, an outbreak was declared. The index case initiated symptoms the 14th day after return from leave, after quarantine discharge. In 57 days 281 confirmed cases were diagnosed: 274 inmates (out of 1,823) and 7 workers (of 890). Mean age 40,7 years (SD 12,0), 9 cases + 65 year-olds, 99,3% men. 7 out of 32 modules and the nursing unit were affected, with an overall attack rate of 38,5% (range 6,1-77,4%). 5 inmates were hospitalised, of which 2 in ICU. All patients had an uneventful recovery. Case fatality rate 0. No new variant was detected.

Lessons
Intersectoral coordination mechanisms, involving prison officials, public health authorities and healthcare services, are crucial to unfold an appropriate COVID-19 response. Tailored, rigorous, dynamic and proportionate measures are essential to reduce COVID-19 impact on the health and well-being of prisons' population and their communities.

Key messages
Prisons are at risk of large COVID-19 outbreaks, with potentially severe consequences, given their population vulnerability and organisational complexity. We recommend a 14d quarantine duration. Intersectoral coordination mechanisms are crucial to unfold an appropriate COVID-19 response, wich should include tailored, rigorous, dynamic and proportionate prevention and control measures.
Differences in COVID-19 mortality between pandemic phases in a southern Italian region
Authors: Meo F , Di Giovanni P , Cedrone F , D'Addezio M , Di Martino G , Scampoli P , Torzi G , Di Girolamo A , Staniscia T 
Published: October 2021

Abstract

Background
Overall mortality is a relevant indicator of the population burden during COVID-19 pandemic, reflecting the overload and preparedness of the healthcare system. This study aimed to analyse the distribution of deaths in SARS-CoV-2 positive patients between pandemic phases and to evaluate the characteristics of COVID-19 patients deceased during the year.

Methods
Data on confirmed COVID-19 cases were collected from the recording system of the Department of Prevention of the Local Health Authority of Abruzzo Region, Italy. The course of the epidemic was stratified in 4 phases: the first wave (March-May 2020), the low incidence phase (June-September 2020), the second wave (October 2020-December 2021), and the variants spread phase in our region (January-March 2021).

Results
From March 2020 to March 2021 we registered 17,082 cases of SARS-CoV-2 infection, of these patients 571 (3.35%) had a fatal outcome. The mortality was the highest during the first ‘peak' phase, interesting the 14.20% of the notified cases, and the lowest during the last phase (2.50%). Mortality due to COVID-19 mainly affected men (54.99%) and geriatric patients (median age: 84; IQR: 75-90). Women dying for SARS-CoV-2 infection had a more advanced median age (87; IQR: 79-92) than men (81; IQR: 73-87). The lowest median age was registered in patients deceased during the low incidence phase (75.5; IQR: 71-82). The median time span, in days, from a SARS-CoV-2 positive test to death was significant lower in the phase 1 (days:10; IQR:4-20) then in phase 4 (days:14; IQR:8-22) (p &lt; 0.001).

Conclusions
Our results showed that mortality markedly decreased during the COVID-19 epidemic, and this could be likely related to an improved organisation and delivery of care, in addition to a better knowledge of disease treatment. Elderly patients were more likely to progress toward fatal outcome. The healthcare systems should pay special attention to them in order to effectively manage possible future pandemics.

Key messages
The COVID-19 mortality reduction highlights an improvement of health care; the elderly remains at major risk of death. Providing pandemic prevention and care models focused also on vulnerable groups is a major public health challenge.
Health system saturation in managing COVID-19 patients in Monastir, Tunisia
Authors: Ben Hassine D , Zemni I , Dhouib W , Ben Fredj M , Bennasrallah C , Kacem M , Abroug H , Chriaa C , Bouanene I , Belguith Sriha A 
Published: October 2021

Abstract

Background
COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aimed to determine the average length of stay, occupancy bed rate and bed turnover rate for COVID-19 patients in Monastir university hospital between the 1st October 2020 and 28th february 2021.

Methods
This is a cross-sectional study that enrolled all hospitalizations for COVID19 in Monastir University hospital, the unique third level healthcare in this region, between the 1st October 2020 and 28th february 2021. The following indicators: the average length of stay, the occupancy bed rate and the bed turnover rate were calculated during the study period.

Results
We included 762 hospitalizations for COVID-19 during the study period. The average age of our population was 64,22 years (standard deviation= 14,17). Male predominance was noted with sex ratio=1,63. The median length of stay was significantly longer in the intensive care unit (ICU) than in the other departments (11 (7;16) days, versus 7(2;14) days), p = 0.008. The average number of beds available for COVID-19 patients during the study period was 13 in the ICU and 65 in the other wards. The bed turnover rate and the bed occupancy rate per month were respectively 2,66 patient/bed/month and 96,26% in the ICU versus 1,74 patient/bed/month and 62,26% in the other wards. The occupancy bed rate in the ICU exceeded the 100% during the outbreak of January and February 2021 (129,72% and 120,66% respectively).

Conclusions
Despite the efforts by the health services and social isolation measures in Tunisia, this study highlighted the saturation of our health system with an overload in intensive care units.

Key messages
Length of stay for patients with Covid-19 was significantly the longest in ICU. The occupancy bed rate, exceeding 100% in ICU, highlighted the health system collapse in managing COVID-19 patients.
Addictive behaviours during the COVID-19 pandemic: results from a nationwide study in Portugal
Authors: Virgolino A , Santos O , Fialho M , Heitor MJ , Costa A , Rasga C , Martiniano H , Costa J , Vicente A , Caldas de Almeida T 
Published: October 2021

Abstract

Background
Evidence shows that individuals can engage in maladaptive behaviours as a response to a pandemic context, which can compromise their health and wellbeing. This project aims to characterize self-reported changes in addiction-related behaviours and associated factors in the adult population during the first COVID-19 lockdown, in Portugal.

Methods
Cross-sectional study, with an online survey conducted between May 22 and July 20, 2020, targeting a non-probabilistic sample of adults (18 years of age or more) dwelling in Portugal (mainland and autonomous regions). The following data were collected: alcohol drinking, smoking, use of cannabis and other substances, gambling, and sugar-sweetened food intake, work-related variables, and sociodemographics. After data cleaning and weighting (by sex, age group, NUTS II and educational level), logistic regression models were conducted to assess potential determinants of addiction-related behaviours.

Results
Overall, 3.982 individuals participated in the study (79.1% women; mean age of 45.15 years). Women, young adults (18-34 years) and individuals with difficulties in work-life balance had higher odds for self-reported increase of sweets intake. Men, young adults (18-34 years) and those with work-life balance difficulties presented higher odds for alcohol drinking increase. Those unemployed (or with suspended activity or in layoff) and those with lower income had higher odds for gambling behaviour increase.

Conclusions
Some segments of the Portuguese population reported to have increased their engagement in addictive-related behaviours, during the COVID-19 lockdown, which can have negative consequences for mental health. The study of the correlates of maladaptive responses under this scenario is pivotal to inform public health interventions and alleviate the potential deleterious impacts of this pandemic.

Key messages
COVID-19 pandemic can increase maladaptive coping behaviours in some segments of the population. Public health interventions are needed to mitigate the negative consequences of this pandemic.
Risky sexual behaviors reported by patients in a free sexual health center in Paris (2017-2020)
Authors: Husson M , Piron P , Duteil C , de La Rochebrochard E , Segouin C , Troude P 
Published: October 2021

Abstract

Background
In France, a national network of free sexual health centers offers prevention, diagnosis and treatment for STI and HIV. These centers help socially disadvantaged and high-risk populations to access STI/HIV testing but few detailed data are available on patients' sexual behaviors. This study aims to describe sexual behaviors among attendees of a Parisian free sexual health center for STI/HIV screening.

Methods
This observational study included 5130 patients who attended the center for STI/HIV testing from August 2017 through January 2020 and completed a self-administered electronic questionnaire. Data obtained from the consultation database and the questionnaire included STI results, sociodemographic characteristics and sexual behaviors. Criteria reported in the literature to define “high-risk sexual behavior (HRSB)” were used to describe sexual practices.

Results
Median age of patients was 26 years [Q1-Q3:23-32] and 8% had no health insurance. Slightly less than one third of patients were women who had sex with men, 37% were men who had sex exclusively with women and 18% were men who had sex with men; 22% had never had HIV testing before the consultation. Regarding sexual practices, 76% reported unprotected sexual intercourse, 3% transactional sex and 8% a history of sexual violence. Depending on the threshold used to define multiple partners (≥6 vs ≥ 2 partners during the previous year), the proportion of patients varied from 31% to 81%. Globally, the proportion of patients reporting at least one HRSB ranged from 87% to 95%. Eleven percent of patients had at least one STI (mostly chlamydia).

Conclusions
Our sexual health center fulfills its missions as most patients consulting for STI/HIV testing reported HRSB and almost one quarter had never previously had an HIV test. The next step will be to explore profiles including sexual behavior, sociodemographic characteristics and HIV knowledge to adapt our prevention strategy to patients' needs.

Key messages
Our sexual health center fulfills its missions as most patients consulting for STI/HIV testing reported HRSB and almost one quarter had never previously had an HIV test. The next step will be to explore profiles including sexual behavior, sociodemographic characteristics and HIV knowledge to adapt our prevention strategy to patients’ needs.
Pap-smear and cervical cancer in Estonia: a population-based case-control study
Authors: Nõmm O , Veerus P , Innos K 
Published: October 2021

Abstract

Backround
Studies have shown the ineffectiveness of Estonian cervical cancer (CC) screening programme. To examine the reasons for high CC incidence in Estonia, a study was conducted, linking individual Pap-smear history to CC incidence.

Methods
In this population-based case-control study, cases were women aged ≥25 years with an in situ/invasive CC diagnosed in Estonia in 2011-2017, derived from cancer registry. Three controls per case were randomly selected from population registry using a density sampling scheme. Exposure was defined as no Pap-smears during seven years prior to diagnosis or index date compared to at least one smear. Multivariate logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Age, place of residence, citizenship, education, marital status and interruption in health insurance were also analysed. The analysis was done separately in screening age group (35-60 years).

Results
Among 1439 cases and 4317 controls, the proportion of women with no Pap-smears was 53% and 35%, respectively. In multivariate analysis, women with no Pap-smears were at a higher risk for CC (OR = 2.42; 95% CI: 1.97-2.97). In screening age group, the impact of no Pap-smears was stronger (OR = 2.62; 95% CI: 2.12-3.24). CC risk decreased with age, was two to three times higher in other regions compared to Northern Estonia; was higher for lower-educated women; and for divorced/widowed women compared to married women. Interruption in health insurance caused a 25% increase in risk. However in screening age group, women with no Pap-smears and an interruption in health insurance experienced a four-fold increase in CC risk.

Conclusions
The study confirmed the importance of screening in preventing CC, also revealing the independent effect of several social factors on CC risk. To reduce CC incidence in Estonia, immediate efforts are necessary to increase the effectiveness of screening, particularly among high-risk and hard-to-reach women.

Key messages
This case-control study of cervical cancer in Estonia identified high-risk groups: women with no Pap-smears, interruptions in health insurance, low education, and living outside the capital city area. Reduction in cervical cancer incidence in Estonia can be achieved through more effective screening and communication, tailored to the needs of different population groups, mainly high-risk women.
COVID-19 control measures and the response rate in the organized breast cancer screening in Croatia
Authors: Kovačević J , Musil V , Sovic S , Kosic Bibic N , Zombori D , Juresa V 
Published: October 2021

Abstract

Background
In order to reduce breast cancer mortality, decades of effort have been dedicated to continuous improvements of the organized breast cancer screening program (BCSP). The aim of this research was to analyse effect of the pandemic control measures on BCSP in Croatia, by comparing first (before the pandemic) and the second half of the sixth invitation round (during the pandemic). The implementation of the BSCP in Croatia was paused from March 16th- May 5th 2020). It is challenging to return the BSCP to the pre-pandemic rates.

Methods
Data on 699,877 women who were scheduled to be invited in the sixth invitation round in BCSP were analysed. Measure of government policy response, Stringency Index (SI) was analysed along with number of women invited in BCSP, responded to invitation and response rate.

Results
Of all women invited in the sixth invitation round of BCSP, response rate was 5.7% lower than in the fifth round. Fewer mammograms in the BCSP program and on the doctor's referral were recorded. In comparison of the monthly data, pause of the BCSP and the usual oscillations during the year, such as summer and winter holidays, were observed. Increase in response rate was occurred after the restart of the BCSP (May/June 2019, 41.0%/42.8% vs. May/June 2020, 67.2%/60.1%).

Conclusions
The number of monthly invited and responded women in BCSP did not return to the pre-pandemic values yet, but better response rate after the restart of the program (40% vs. 60%) was observed. Women were less motivated to respond to the invitation during the period of strict measures. Fear of COVID-19 could be addressed with an intensive public health campaign and vaccination of women invited to BCSP.

Key messages
The response rate in the BCSP was 5.7% lower during the COVID-19 pandemic measures. Vaccination against COVID-19 of women involved in the BCSP could improve the response rate.
Epidemiology of New Delhi Enterobacterales in Tuscany during the COVID- 19 pandemic
Authors: Porretta AD , Forni S , Tavoschi L , Righi L , Gemmi F 
Published: October 2021

Abstract

In Tuscany, Italy, colonisation or infection by New Delhi metallo- beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) in hospitalised patients has increasingly been observed since 2018, leading in 2019 to the introduction of enhanced control measures successfully reducing transmission. We describe here the impact of the COVID epidemic on the underlying NDM-CRE prolonged outbreak in Tuscany. Data on patients colonised or infected by NDM-CRE reported by Tuscan laboratory surveillance among hospitalised patients in four Tuscan hospitals were collected from 07/2019 to 10/2020. Since February 2020 COVID-19 diagnosis was recorded. Monthly rates of NDM-CRE cases on hospital days in medical and critical care wards were calculated. In March-October 2020 NDM-CRE rates were calculated and stratified by COVID-19 diagnosis. The number of NDM-CRE cases/hospital days in 2019 decreased due to control interventions, however since March 2020 an increase was observed, temporally associated with COVID-19 admissions. In March-October 2020, compared to previous period, NDM-CRE cases had lower median age (73 yrs vs 75), were less likely to have previous hospitalisation episodes (59% vs 75%) and more likely to be admitted to ICU (32% vs 20%). We observed, in the period March-October 2020 a significantly higher rate of NDM-CRE cases per hospital days (256.71/100,000) in COVID-19 patients, compared to non-COVID-19 ones (452.9/100,000). Our data suggest a resurgence in NDM-CRE spread among hospitalised patients in Tuscany during COVID pandemic, despite evidence of effective control measures in 2019. Risk of NDM-CRE transmission was significantly higher among COVID patients. Several factors may have contributed to this occurrence, including patients case mix, performance of risk-prone procedures (including antibiotic prescriptions), extended length of stay, availability and usage of personal protective equipment and compliance with infection prevention procedures.

Key messages
We observed a relation between admission for COVID-19 and the risk of a hospital acquisition of NDM-CRE. There is the need to conciliate Health Care Associated Infections control measured with COVID-19 protection ones.