“Laboratorium Repository”: a training tool for the Healthcare Workforce

Background

The COVID-19 pandemic highlighted the need to redefine the healthcare workforce (HCW) competencies to face future emergencies linked to emerging infectious diseases, environmental, climate and social crises. As recently stated by WHO, there is a need to identify standards for education and competencies training for HCW in emergency and preparedness (E&P). The Italian National Institute of Health, in agreement with the deliberation of the G20 Health Ministers under the Italian Presidency, is developing an educational program named “Laboratorium” which includes a free access digital repository aimed to share selected documents and tools at the International Public HCW (PHCW) to increase the competencies in E&P response.

Objectives

A range of web domains selected according to their reliability was monitored using a keyword search tool for any relevant material published from February 14th up to April 28th, 2022. We included any publications, training materials, epidemiological data, initiatives, and communication items that addressed the topic of interest. Each item was submitted for approval by a scientific board and, if appropriate, classified by typology, language, topic, and country before publication.

Results

To date, out of 6197 items, 418 fulfilled the inclusion criteria. For the type of content, we included guidelines/recommendations (75), epidemiological data (58), websites (34), online courses (15) and books (16). PHCW was the most representative target group (361), followed by other stakeholders (127), hospital practitioners (90), primary care (87). The most represented topic was infectious diseases/SARS-CoV-2 (277) followed by vaccines (88), emergency interventions (34), emerging diseases (17), policies (26), public health preparedness (32).

Conclusions

Future training for PHCW should be designed with a modular approach with different levels of usability. The Laboratorium Repository provides a core of items for learning according to one's training needs

Key messages

How helpful are the European AIDS Clinical Society cognitive screening questions in predicting cognitive impairment in an aging, well-treated HIV-positive population?

Objectives

Diagnosing neurocognitive impairment (NCI) in HIV infection requires time‐consuming neuropsychological assessment. Screening tools are needed to identify when neuropsychological referral is indicated. We examined the positive and negative predictive values (PPVs and NPVs, respectively) of the three European AIDS Clinical Society (EACS) screening questions in identifying NCI.

Methods

The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study recruited patients aged ≥45 years enrolled in the Swiss HIV Cohort Study between 1 May 2013 and 30 November 2016. NAMACO participants (1) answered EACS screening questions, (2) underwent standardized neuropsychological assessment and (3) completed self‐report forms [Center for Epidemiologic Studies Depression Scale (CES‐D)] rating mood. NCI categories were defined using Frascati criteria. PPVs and NPVs of the EACS screening questions in identifying NCI categories were calculated.

Results

Of 974 NAMACO participants with complete EACS screening question data, 244 (25.1%) expressed cognitive complaints in answer to at least one EACS screening question, of whom 51.3% had NCI (26.1% HIV‐associated and 25.2% related to confounding factors). The PPV and NPV of the EACS screening questions in identifying HIV‐associated NCI were 0.35 and 0.7, respectively. Restricting analysis to NCI with functional impairment or related to confounding factors, notably depression, the NPV was 0.90. Expressing cognitive complaints for all three EACS screening questions was significantly associated with depression (P < 0.001).

Conclusions

The EACS screening questions had an NPV of 0.7 for excluding patients with HIV‐associated NCI as defined by Frascati criteria. The PPV and NPV may improve if NCI diagnoses are based on new criteria.

The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study: baseline participant profile

Objectives

The aim of the study was to examine baseline neurocognitive impairment (NCI) prevalence and factors associated with NCI among patients enrolled in the Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study.

Methods

The NAMACO study is an ongoing, prospective, longitudinal, multicentre and multilingual (German, French and Italian) study within the Swiss HIV Cohort Study. Between 1 May 2013 and 30 November 2016, 981 patients ≥ 45 years old were enrolled in the study. All underwent standardized neuropsychological (NP) assessment by neuropsychologists. NCI was diagnosed using Frascati criteria and classified as HIV‐associated or as related to other factors. Dichotomized analysis (NCI versus no NCI) and continuous analyses (based on NP test z‐score means) were performed.

Results

Most patients (942; 96.2%) had viral loads < 50 HIV‐1 RNA copies/mL. NCI was identified in 390 patients (39.8%): 263 patients (26.8%) had HIV‐associated NCI [249 patients (25.4%) had asymptomatic neurocognitive impairment (ANI)] and 127 patients (13%) had NCI attributable to other factors, mainly psychiatric disorders. There was good correlation between dichotomized and continuous analyses, with NCI associated with older age, non‐Caucasian ethnicity, shorter duration of education, unemployment and longer antiretroviral therapy duration.

Conclusions

In this large sample of aging people living with HIV with well‐controlled infection in Switzerland, baseline HIV‐associated NCI prevalence, as diagnosed after formal NP assessment, was 26.8%, with most cases being ANI. The NAMACO study data will enable longitudinal analyses within this population to examine factors affecting NCI development and course.

Why do sub-Saharan Africans present late for HIV care in Switzerland?

OBJECTIVES

Late presentation (LP) to HIV care disproportionally affects individuals from sub-Saharan Africa (SSA). We explored the reasons for late presentation to care among this group of patients in the Swiss HIV Cohort Study.

METHODS

The prevalence of LP was compared between patients from Western Europe (WE) and those from SSA enrolled between 2009 and 2012. Patients were asked about HIV testing, including access to testing and reasons for deferring it, during face-to-face interviews.

RESULTS

The proportion of LP was 45.8% (435/950) among patients from WE, and 64.6% (126/195) among those from SSA (P < 0.001). Women from WE were slightly more likely to present late than men (52.6% versus 44.5%, respectively; P = 0.06), whereas there was no sex difference in patients from SSA (65.6% versus 63.2%, respectively; P = 0.73). Compared with late presenters from WE, those from SSA were more likely to be diagnosed during pregnancy (9.1% versus 0%, respectively; P < 0.001), but less likely to be tested by general practitioners (25.0% versus 44.6%, respectively; P = 0.001). Late presenters from SSA more frequently reported 'not knowing about anonymous testing possibilities' (46.4% versus 27.3%, respectively; P = 0.04) and 'fear about negative reaction in relatives' (39.3% versus 21.7%, respectively; P = 0.05) as reasons for late testing. Fear of being expelled from Switzerland was reported by 26.1% of late presenters from SSA.

CONCLUSIONS

The majority of patients from SSA were late presenters, independent of sex or education level. Difficulties in accessing testing facilities, lack of knowledge about HIV testing and fear-related issues are important drivers for LP in this population.

[Surgical site infection: risk factors, prevention, diagnosis and treatment]

Surgical site infection comprises the cutaneous tissues until the intraabdominal or pleural cavity. The infectious risk depends on the degree of bacterial contamination, the general conditions of the patient and procedure-related factors. The causal microbes originate from the flora of the skin or the mucosal surfaces that have been touched during the operation. Superficial non-complicated infections are treated locally. However, an infected surgical wound can be the top of a deep infection. Infections with foreign material underneath deserve particular attention. Empiric antibiotic therapy is prohibited in these cases. Treatment is normally a combination of surgical debridement and specific antimicrobial therapy.

The mechanically adaptive connective tissue of echinoderms: its potential for bio-innovation in applied technology and ecology

Echinoderms possess unique connective tissues, called mutable collagenous tissues (MCTs), which undergo nervously mediated, drastic and reversible or irreversible changes in their mechanical properties. Connective tissue mutability influences all aspects of echinoderm biology and is a key-factor in the ecological success of the phylum. Due to their sensitivity to endogenous or exogenous agents, MCTs may be targets for a number of common pollutants, with potentially drastic effects on vital functions. Besides its ecological relevance, MCT represents a topic with relevance to several applied fields. A promising research route looks at MCTs as a source of inspiration for the development of novel biomaterials. This contribution presents a review of MCT biology, which incorporates recent ultrastructural, biomolecular and biochemical analyses carried out in a biotechnological context.

[Unilateral pulmonary edema in a dialysis patient with massive fluid overload and mitral valve insufficiency]

A pulmonary edema is not a rare complication in patients with chronic renal failure. Arterial hypertension and fluid overload play a pathogenetically important role. The diagnosis of an unilateral pulmonary edema is often difficult. The following arguments favour the diagnosis: rapid clinical amelioration and disappearance of the alveolar opacities after diuretic treatment alone within 24-72 hours. We describe the case of a 37-year-old patient on dialysis treatment who showed a pulmonary edema of the right lung, predominantly in the upper lobe. This edema was due to fluid overload and mitral insufficiency. After diuretic treatment alone the patient rapidly recovered and the lung infiltrates on the chest X-ray disappeared within a few days.