The Covid-19 infection: An opportunity to develop systematic vitamin D supplementation in psychiatry

Psychiatric patients are at risk of hypovitaminosis D and Covid-19-related mortality. In addition to the mental health benefits, vitamin D supplementation may be potentially effective in preventing severe forms of Covid-19 infections. Vitamin D supplementation is not necessary and is not reimbursed in France for this indication. A monthly supplementation of 50,000 IU may be sufficient in most cases. Double the dose is recommended for obese patients. The risk of renal lithiasis is not increased at these doses, even when supplemented in a patient without vitamin D deficiency. The Covid-19 crisis is an opportunity to disseminate vitamin D supplementation in psychiatric patients, as it has been shown to be effective in other respiratory diseases such as mild upper respiratory tract infections and influenza.     

Impact of ultra-low dose CT acquisition on semi-automated RECIST tool in the evaluation of malignant focal liver lesions

PurposeTo compare the evaluation of malignant focal liver lesions (FLLs) using a semi-automated RECIST tool with a standard and an ultra-low dose (ULD) computed tomography (CT) protocol.Materials and methodsThirty-four patients with malignant FLLs underwent two abdominal-pelvic CT examinations one using a standard protocol and one using an ULD protocol. There were 23 men and 11 women with a mean age 64.3 ± 14.4 (SD) years (range: 22–91 years). Dosimetric indicators were recorded, and effective dose was calculated for both examinations. Mean malignant FLL attenuation, image noise and contrast-to-noise-ratio (CNR) were compared. The largest malignant FLL per patient was evaluated using the semi-automated RECIST tool to determine longest axis length, longest orthogonal axis length, volume and World Health Organisation area.ResultsDosimetric values were significantly reduced by −56% with ULD compared to standard protocol. No differences in mean malignant FLL attenuation values were found between the two protocols. Image noise was significantly increased for all locations (P < 0.05) with ULD compared to standard protocol, and CNR was significantly reduced (P < 0.05). On the 34 malignant FLLs analyzed, six semi-automated shapes non-concordant with radiologist's visual impression were highlighted with the software, including one FLL (1/34; 3%) with standard CT acquisition only, three FLLs (3/34; 9%) with ULD CT acquisition only and two FLLs (2/34; 6%) with both CT acquisitions. After manual editing, the concordance of the values of the studied criteria between both acquisitions was good and no significant difference was reported.ConclusionSemi-automated RECIST tool demonstrates good performances using ULD CT protocol. It could be used in routine clinical practice with a ULD protocol for follow-up studies in patients with known malignant FLL.     

L’effet de l’âge et de la durée d’incarcération sur la santé mentale des détenus âgés

Inmate aging is considered to start at the age of 50, which is early in relation to aging in the general population. The aging of the criminal population in France poses a real public health problem. There is very little research on the mental health (mental and cognitive disorders) of older inmates.ObjectivesThe objective of this study was to evaluate the effect of age and time spent in prison on mental disorders and cognitive performance of elderly prison inmates. We put forward the hypothesis that age and amount of time spent in prison are associated with the deterioration of older inmates’ mental health, that is, an increase in the prevalence of psychiatric disorders and a decrease in cognitive performance.MethodsWe recruited 138 men aged 50 and over in seven French prisons. The research protocol included a semi-directive interview, the Mini International Neuropsychiatric Interview (MINI DSM-IV) for the assessment of mental disorders, as well as the Rapid Battery for Frontal Efficiency (BREF) and the Mini Mental State Examination (MMSE) for the evaluation of cognitive performance.ResultsThe average age of the inmates (N = 138) was 59.7 years (range 50–84, SD = 8.02). The average sentence was approximately 13.5 years (SD = 7) and the average time spent in prison was 6.9 years (SD = 5.9). The results showed a very high prevalence of mental disorders, notably depression and anxiety, and cognitive disorders. However, the probability of occurrence of certain psychiatric diagnoses decreases with age (major depressive episode, agoraphobia, post-traumatic stress disorder and generalized anxiety). In addition, logistic regression estimates showed no significant relationship between time spent in prison and mental disorders. However, there is a significant link between time spent in prison and cognitive impairment.ConclusionOur hypothesis is partially validated. Indeed, age is not associated with mental or cognitive disorders. However, the amount of time spent in prison has an effect on the deterioration of certain cognitive functions. It appears that after the age of 50, it is not chronological age but environmental factors that mainly explain cognitive decline. Our study shows that the longer the detention period, the greater the inmate's cognitive decline. These results highlight the very high vulnerability of elderly prisoners in terms of mental health and emphasize the importance of implementing appropriate detection and care measures to address the needs of this segment of the criminal population. Routine screening for cognitive impairment in all older prisoners should be carried out by caregivers in penitentiary institutions. Furthermore, better follow-up and cognitive assessment of prisoners aged 50 or more and whose length of incarceration exceeds five years could make it possible to detect subjects at risk and to propose appropriate activities to reduce and/or delay the effects of aging in detention.     

Examining persuasive message type to encourage staying at home during the COVID-19 pandemic and social lockdown: A randomized controlled study in Japan

ObjectiveBehavioral change is the only prevention against the COVID-19 pandemic until vaccines become available. This is the first study to examine the most persuasive message type in terms of narrator difference in encouraging people to stay at home during the COVID-19 pandemic and social lockdown.MethodsParticipants (n = 1,980) were randomly assigned to five intervention messages (from a governor, a public health expert, a physician, a patient, and a resident of an outbreak area) and a control message. Intention to stay at home before and after reading messages was assessed. A one-way ANOVA with Tukey’s or Games–Howell test was conducted.ResultsCompared with other messages, the message from a physician significantly increased participants’ intention to stay at home in areas with high numbers of people infected (versus a governor, p = .002; an expert, p = .023; a resident, p = .004).ConclusionThe message from a physician―which conveyed the crisis of overwhelmed hospitals and consequent risk of people being unable to receive treatment―increased the intent to stay at home the most.Practice implicationsHealth professionals and media operatives may be able to encourage people to stay at home by disseminating the physicians’ messages through media and the internet.     

医学院校卫生信息管理专业创新创业"生态圈"模式构建的思考

本文分析了医学院校卫生信息管理专业创新创业人才培养模式的现状；阐述了医学院校卫生信息管理专业创新创业"生态圈"建设的基本思路；论述了如何在大数据与人工智能背景下，构建以"大数据与人工智能创新创业平台"为中心，以医学院及其附属医院、医疗相关企业、技术公司为主体，以创业学院、创业实验室、创新工作室、创业公司为组织形式的创新创业人才培养"生态圈"。在这"生态圈"中，组织在学生成长的不同阶段逐渐分享利益、资源和发展。     

Postoperative pain assessment in hospitalised patients: National survey and secondary data analysis

BackgroundMeasuring pain is important for the adequate pain management of postoperative patients. The actual compliance with pain assessment in postoperative patients after implementation of a national safety program is unknown.ObjectivesThe aim of this study is to examine the compliance with pain assessment in postoperative patients after implementation of a national safety program, according to the national quality indicators for pain assessment in postoperative patients. Furthermore, organisational factors associated with this compliance were determined.Study designIn this study, two data sources were used: 1) data from an evaluation study of the Dutch Hospital Patient Safety Program; and 2) data from a questionnaire survey.MethodsThe compliance with two different pain process indicators was determined: 1) 3 pain measurements a day, all three full days after surgery; and 2) ≥1 pain measurement a day, all three full days after surgery. Multilevel logistic regression analysis was used to investigate the association between organisational factors in hospitals and compliance with pain process indicators.ResultsData of 3895 patient records from 16 hospitals was included in this study. In 12% of the postoperative patients, pain was measured 3 times a day, all three full days after surgery. In 53% of the postoperative patients, pain was measured ≥1 time a day, all three full days after surgery. Compliance was highest in general hospitals compared to tertiary teaching and academic hospitals, and was statistically significantly higher at the surgery and surgical oncology department compared to the other departments.ConclusionsLow compliance was shown with pain assessment in postoperative patients, according to the process indicator pain after surgery in Dutch hospitals. This suggests that the implementation of measuring pain in hospitals is still insufficient.     

A quality improvement initiative to increase Tdap (tetanus,diphtheria, acellular pertussis) vaccination coverage among direct health care providers at a children’s hospital

ObjectivesHealth care providers (HCP) are at high risk of acquiring and transmitting pertussis to susceptible family members, co-workers, and patients. Public health authorities recommend administering a single dose of Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccine to all adults, including HCP, to increase adult immunity to pertussis. We set a quality improvement goal to increase Tdap vaccination coverage among HCP who provided direct patient care at a children’s hospital from 58% to 90% over 18 months.DesignA multidisciplinary working group comprised of Occupational Health Program (OHP) staff and representatives of various medical services drew from a variety of qualitative methods and previous studies of vaccination programs in the healthcare system to understand barriers to Tdap vaccination within the institution and to develop interventions to increase vaccination rates.InterventionsInterventions included changes to OHP processes, a general education campaign, improved access to vaccine, and personal engagement of HCP by task force members.ResultsOverall vaccination rates increased to 90% over 15 months, a rate that has been sustained by systematically assessing new employees’ vaccination status and vaccinating those without documentation of previous Tdap vaccination.ConclusionsTdap vaccination coverage in our institution was significantly increased by an intensive, multipronged educational campaign, and by improving processes of screening and vaccination of HCP. The use of direct engagement of vaccine hesitant populations to increase vaccination rates warrants further study.