Background: Research has shown the substantial impact of the COVID-19 pandemic on healthcare workers’ (HCWs) mental health, however, it mostly relies on data collected during the early stages of COVID-19. The aim of this study is to assess the long-term trajectory of HCWs’ mental health and the associated risk factors. Methods: a longitudinal cohort study was carried out in an Italian hospital. At Time 1 (July 2020–July 2021), 990 HCWs took part in the study and completed the General Health Questionnaire (GHQ-12), the Impact of Event Scale (IES-R), and the General Anxiety Disorder (GAD-7)questionnaire. McNemar’s test measured changes in symptoms’ trajectories, and random effects models evaluated risk factors associated with scores above the cut-off. Results: 310 HCWs participated to the follow-up evaluation (Time 2; July 2021–July 2022). At Time 2, scores above cut-offs were significantly lower (p < 0.001) than at Time 1 for all scales (23% vs. 48% for GHQ-12; 11% vs. 25% for IES-R; 15% vs. 23% for GAD-7). Risk factors for psychological impairment were being a nurse (IES-R: OR 4.72, 95% CI 1.71–13.0; GAD-7: OR 2.82, 95% CI 1.44–7.17), a health assistant (IES-R: OR 6.76, 95% CI 1.30–35.1), or having had an infected family member (GHQ-12: OR 1.95, 95% CI 1.01–3.83). Compared to Time 1, gender and experience in COVID-19 units lost significance with psychological symptoms. Conclusions: data over more than 24 months from the pandemic onset showed improvement of HCWs’ mental health; our findings suggested the need to tailor and prioritize preventive actions towards healthcare workforce.

Background The COVID-19 pandemic is currently a severe challenge for healthcare workers, with a considerable impact on their mental health. In order to focus preventive and rehabilitation measures it’s fundamental to identify risk factors of such psychological impairment. We designed an observational longitudinal study to systematically examine the psychological wellbeing of all employees in a large University Hospital in Italy, using validated psychometric scales in the context of the occupational physician’s health surveillance, in collaboration with Psychiatric Unit. Methods The study started after ethical approval in August 2020. For each worker, the psychological wellbeing is screened in two steps. The first level questionnaire collects sociodemographic characteristics, personal and occupational COVID-19 exposure, worries and concerns about COVID-19, general psychological discomfort (GHQ-12), post-traumatic stress symptoms (IES-R) and anxiety (GAD-7). Workers who score above the cut-off in at least one scale are further investigated by the second level questionnaire composed by PHQ-9, DES-II and SCL-90. If second level shows psychological impairments, we offer individual specialist treatment (third level). We plan to follow-up all subjects to monitor symptoms and possible chronicization; we aim to investigate potential risk factors through univariate analysis and multivariate logistic regressions. Results Preliminary results refer to a sample of 550 workers who completed the multi-step evaluation from August to December 2020, before vaccination campaign started. The participation rate was 90%. At first level screening, 39% of the subjects expressed general psychological discomfort (GHQ-12), 22% post-traumatic stress symptoms (IES-R), and 21% symptoms of anxiety (GAD-7). Women, nurses, younger workers, subjects with COVID-19 working exposure and with an infected family member showed significantly higher psychological impairment compared to colleagues. After the second level screening, 12% and 7% of all workers showed, respectively, depressive and dissociative symptoms; scorings were significantly associated with gender and occupational role. We are currently extending sample size and evaluating subjects over a period of further 12 months. Conclusions The possibility to perform a systematic follow-up of psychological wellbeing of all hospital workers, directly or indirectly exposed to pandemic consequences, constitutes a unique condition to detect individual, occupational, and non-occupational risk factors for psychological impairment in situations of prolonged stress, as well as variables associated with symptoms chronicization.

IntroductionItaly was the first Western country affected by the COVID-19 pandemic that still constitutes a severe challenge for healthcare workers (HCWs), with a deep impact on their mental health. Several studies confirmed that a considerable proportion of HCW developed adverse psychological impairment (PsI). To focus on preventive and rehabilitation measures, it is fundamental to identify individual and occupational risk factors. We systematically assessed possible PsI among all employees in a large university hospital in Italy, using validated psychometric scales in the context of occupational health surveillance.MethodsIn the period of July 2020 to July 2021, we enrolled 990 HCWs. For each subject, the psychological wellbeing was screened in two steps. The first-level questionnaire collected gender, age, occupational role, personal and occupational COVID-19 exposure, general psychological discomfort (GHQ-12), post-traumatic stress symptoms (IES-R), and anxiety (GAD-7). Workers showing PsI (i.e., test scores above the cutoff in at least one among GHQ-12, IES-R, and GAD-7) have been further investigated by the second-level questionnaire (psycho-diagnostic) composed by PHQ-9, DES-II, and SCL-90 scales. If the second-level showed clinically relevant symptoms, then we offered individual specialist treatment (third level).ResultsThree hundred sixteen workers (32%) presented signs of PsI at the first-level screening questionnaire. Women, nurses, and subjects engaged in the COVID-19 area and with an infected family member showed significantly higher PsI risk. PsI prevalence was strongly associated with the pandemic trend in the region but sensibly decreased after January 2021, when almost all workers received the vaccination. A proportion of subjects with PsI presented clinically relevant symptoms (second-level screening) on PHQ-9 (35%), DES (20%), and SCL-90 (28%). These symptoms were associated neither to direct working experience with patients with COVID-19 nor to COVID-19 experience in the family and seemed not to be influenced by the pandemic waves or workers vaccination.ConclusionsThe evaluation of psychological wellbeing of all hospital workers, directly or indirectly exposed to pandemic consequences, constitutes a unique condition to detect individual, occupational, and non-occupational risk factors for PsI in situations of high stress and/or disasters, as well as variables associated with symptom chronicization.

AimMisconceptions and non‐evidence‐based practices toward childhood fever are reported worldwide. Medical students might be ideal candidates to introduce long‐lasting changes in clinical practice. However, no study has gauged the effectiveness of an educational intervention to improve fever management in this population. We conducted an educational, interventional study on childhood fever among final‐year medical students.MethodsWe conducted a prospective, multicentre interventional study employing a pre/post‐test design. Participants from three Italian Universities filled in a questionnaire just before the intervention (T0), immediately after (T1) and 6 months later (T2) in 2022. The intervention was a two‐hour lecture focused on the pathophysiology of fever, recommendations for its treatment and risks associated with improper management.Results188 final‐year medical students (median age of 26 years, 67% females) were enrolled. Relevant improvements in the criterion for treating fever and conceptions about the beneficial effects of fever were observed at T1 and T2. Similar data were found for the reduction of physical methods advice to decrease body temperature and concerns for brain damage from fever.ConclusionThis study shows for the first time that an educational intervention is effective in changing students' conceptions and attitudes toward fever both in the short and medium term.