While many studies have shown that COVID-19 pandemic-era school closures had negative effects on student mental health, a new study in JAMA Network Open shows the opposite: the re-opening of schools trigged an increased incidence of acute psychiatric emergencies, suggesting school can be a substantial source of stress for some students. 

The study is based on 13,014 psychiatric emergency department (ED) visits at 9 university hospitals in Italy from January 1, 2018, to December 31, 2021.

The number of ED visits increased across the study period. The authors found school opening, but not social lockdown restrictions, were associated with an increase in the number of ED psychiatric visits (incidence rate ratio [IRR]1.29; 95% confidence interval [CI], 1.23 to 1.34).

Eating disorders, suicide attempts increased 

For psychiatric visits overall, there was a notable increase in both females (IRR, 1.29; 95% CI, 1.25 to 1.33) and males (IRR, 1.18; 95% CI, 1.14 to 1.2).

Three areas of mental health saw the biggest jump in ED visits during the study period: eating disorders (increase of 294.8%), suicidal ideation (297.8%), and suicide attempt (249.1%).

For some students, the avoidance of stress-provoking social situations in school may translate into a temporary relief when school is closed

" For some students, the avoidance of stress-provoking social situations in school may translate into a temporary relief when school is closed," the study authors wrote. "The lack of habituation to managing social stress during school closure may then be associated with greater distress upon school reopening. Possible stress from risk of contagion upon returning to school is another factor to consider." 

Cambodia's health ministry on August 3 announced a second human H5N1 avian influenza in less than a week, which involves a 16-year-old girl who is hospitalized in serious condition, according to a statement translated and posted by Avian Flu Diary, an infectious disease news blog. 

The girl is from the same province (Svay Rieng), but a different town, as a case announced earlier in the week.

About 4 days before her symptoms began, she touched and held dead chickens that died at her house and her neighbor's house. The girl's illness marks Cambodia's ninth case this year. So far, the clade isn't known, but the country's earlier cases were linked to an older 2.3.2.1c clade that circulates in some Asian countries, including Cambodia. 

Since early 2023, Cambodia has reported a rise in H5N1 infections, which are often severe of fatal. The country has now reported 15 cases since February 2023.

The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) has confirmed three more H5N1 avian influenza outbreaks in dairy cattle, raising the national total to 181 from 13 states.

The latest confirmations are from Colorado, South Dakota, and Texas. 

In other updates, APHIS also reported more detections in wild birds in mammals. The group reported about more than 100 more H5N1 detections in wild birds across several states. Some were waterfowl taken by hunters and were sampled last fall. However, several were agency-harvested birds from Colorado's Weld County, which has been a recent hot spot for dairy cow outbreaks, poultry outbreaks, and human illnesses. Species in Weld County that tested positive included doves, sparrows, starlings, and pigeons.

Regarding mammals, APHIS over the past few days has reported 27 more detections, raising its confirmed number to 373. Most of the newly confirmed positives involve deer mice and house mice from Weld County in Colorado. The group also included three domestic cats from Larimer County in Colorado, plus a rabbit and a vole from Weld County. 

A single-center study found that giving hematopoietic stem cell transplant (HSCT) recipients preventive doses of oral vancomycin was associated with a significant decrease in the risk of Clostridioides difficile infection (CDI), researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

Because of their immunocompromised state, HSCT patients have a nine-fold increased risk of CDI compared with the general population. To reduce this risk, the bone marrow transplant team at Robert Wood Johnson University Hospital (RWJUH) in New Jersey implemented a protocol in December 2019 for universal oral vancomycin prophylaxis (OVP) for all patients undergoing HSCT. Prior to this protocol, the decision to use OVP was made by the provider and was not routine.

To assess the effectiveness of the OVP protocol, researchers with RWJUH and Rutgers University reviewed the medical records of all HSCT patients admitted from January 2015 through August 2022. The primary end point was the incidence of in-hospital CDI. Secondary endpoints included incidence of vancomycin-resistant enterococci (VRE) and gram-negative bloodstream infections, hospital survival, and length of hospital stay.

Promising results, but clinical trials needed

A total of 156 HSCT patients met inclusion criteria, with 75 in the pre-universal prophylaxis era (no OVP) and 81 in the post-universal prophylaxis era (OVP). The most common indicators for transplant were multiple myeloma, acute myeloid leukemia, and Hodgkin lymphoma. Among the 81 patients in the OVP group, there was 1 (1.23%) case of CDI, compared with 8 (10.67%) of 75 in the no OVP group. No positive VRE cultures were found in either group. There were no significant between-group differences in the incidence of gram-negative bloodstream infections, hospital survival, and length of stay.  

"These findings are promising considering infections such as CDI are among the most common complications affecting HSCT patients," the study authors wrote. But they caution that more research is needed to better understand the potential implications of using OVP on HSCT patients' enteric microbiota, increased VRE colonization, and the risk of the emergence of vancomycin-resistant C difficile strains.

"Prospective clinical trials and cost-effectiveness studies are needed to more definitively assess the safety and efficacy of this practice," they concluded.

These findings are promising considering infections such as CDI are among the most common complications affecting HSCT patients.