Psychological Health Issues of Medical Staff During the COVID-19 Outbreak

Background: The outbreak of novel coronavirus disease 2019 (COVID-19) has caused public panic and psychological health problems, especially in medical staff. We aimed to investigate the psychological effect of the COVID-19 outbreak on medical staff. Methods: A cross-sectional study was conducted to examine the psychological impact of medical staff working in COVID-19 designated hospitals from February to March 2020 in China. We assessed psychological health problems using the Symptom Check List 90 (SCL-90). Results: Among 656 medical staff, 244 were frontline medical staff and 412 general medical staff. The prevalence of psychological health problems was 19.7%. The SCL-90 scores in frontline medical staff were significantly higher than that in general medical staff (mean: 141.22 vs. 129.54, P < 0.05). Furthermore, gender [odds ratio (OR) = 1.53, 95% CI = (1.02, 2.30), P = 0.042 for female vs. male] and the burden of current work [OR = 7.55, 95% CI = (3.75, 15.21), P < 0.001 for high burden; OR = 2.76, 95% CI = (1.80, 4.24), P < 0.001 for moderate burden vs. low burden] were associated with increased risk of poor psychological status. Conclusions: Medical staff experienced a high risk of psychological health problems during the outbreak of COVID-19, especially for frontline medical staff. Psychological health services are expected to arrange for medical staff in future unexpected infectious disease outbreaks.

Less Social Support for Patients With COVID-19: Comparison With the Experience of Nurses

Context: Since December 2019, more than 80,000 patients have been diagnosed with coronavirus disease 2019 (COVID-19) in China. Social support status of COVID-19 patients, especially the impact of social support on their psychological status and quality of life, needs to be addressed with increasing concern. Objectives: In this study, we used social support rating scale (SSRS) to investigate the social support in COVID-19 patients and nurses. Methods: The present study included 186 COVID-19 patients at a Wuhan mobile cabin hospital and 234 nurses at a Wuhan COVID-19 control center. Responses to a mobile phone app-based questionnaire about social support, anxiety, depression, and quality of life were recorded and evaluated. Results: COVID-19 patients scored significantly lower than nurses did on the Social Support Rating Scale (SSRS). Among these patients, 33.9% had anxiety symptoms, while 23.7% had depression symptoms. Overall SSRS, subjective social support scores and objective support scores of patients with anxiety were lower than those of patients without anxiety. This result was also found in depression. In addition, all dimensions of social support were positively correlated with quality of life. Interestingly, in all dimensions of social support, subjective support was found to be an independent predictive factor for anxiety, depression, and quality of life, whereas objective support was a predictive factor for quality of life, but not for anxiety and depression via regression analysis. Conclusion: Medical staffs should pay attention to the subjective feelings of patients and make COVID-19 patients feel respected, supported, and understood from the perspective of subjective support, which may greatly benefit patients, alleviate their anxiety and depression, and improve their quality of life.

Junior doctor perceptions of education and feedback on ward rounds

AIM

The literature suggests that feedback is wanted and needed in clinical medicine and specifically on ward rounds, yet it is often lacking. This study aimed to examine junior doctor perceptions of education and feedback on ward rounds in one clinical department at a tertiary paediatric hospital and the key influences on these perceptions.

METHODS

Six semi-structured focus groups were conducted over a period of 9 months comprising of 20 participants (post-graduate year 1-5) in a general medical department of a tertiary paediatric hospital. Qualitative analysis was performed on focus group transcripts using an inductive approach and codes and themes were generated in an iterative fashion with checking of themes between two researchers.

RESULTS

Feedback experiences were largely positive compared to previous rotations. Three overarching themes were identified which influenced trainee perceptions of education and feedback on ward rounds. These were: consultant influences (e.g. educational engagement), trainee influences (e.g. active seeking of feedback), and structural factors (e.g. organisational constraints).

CONCLUSIONS

Despite positive feedback experiences, the need to improve feedback for our junior doctors is clear, but how to do this remains challenging when navigating work-learning tensions. The notion of the educational alliance between the consultant and trainee is a potential useful solution, but it requires deliberate effort and dedicated time to establish given our increasingly complex and busy clinical environments.

The correlation analysis between the appearance anxiety and personality traits of the medical staff on nasal and facial pressure ulcers during the novel coronavirus disease 2019 outbreak

Aim

To investigate the psychological status of medical staff with medical device-related nasal and facial pressure ulcers (MDR PUs) during the outbreak of COVID-19, analyse the correlation between their psychological status and personality traits, so as to provide a reference for personalized psychological support.

Design

A total of 207 medical staff who were treating the COVID-19 epidemic from Hunan and Hubei provinces were enrolled in this analytic questionnaire-based study.

Methods

We used these measures: Eysenck Personality Questionnaire Short Scale (EPQ-RSC), Social Appearance Anxiety Scale (SAAS), Positive and Negative Affect Scale (PANAS) and demographic information forms online.

Results

Medical staff wearing protective equipment are particularly susceptible to nasal and facial MDR PUs, which is increasing their social appearance anxiety; neuroticism is significantly related to social appearance anxiety and negative emotion. We should pay more attention to their psychological state, cultivate good personality characteristics and reduce negative emotions, and thereby alleviate their MDR PUs-related appearance anxiety.

Psychological Distress, Social Support, Coping Style, and Perceived Stress Among Medical Staff and Medical Students in the Early Stages of the COVID-19 Epidemic in China

Background: The COVID-19 pandemic has had impact that may contribute to a rise in mental health problems. The present study was aimed to better understand psychological status among medical staff and medical students during the early epidemic and to explore the influence factors of psychological distress. Methods: A cross-sectional survey was conducted online from February 2-14, 2020. We collected general information related to the COVID-19 outbreak. Respondents were assessed using the Kessler-6 Psychological Distress Scale (K6), Social Support Rating Scale (SSRS), Perceived Stress Scale (PSS) and Simplified Coping Style Questionnaire (SCSQ). Stepwise multiple linear regression was performed to identify factors influencing psychological distress. Results: Five hundred and twenty-eight respondents returned valid questionnaires. Medical staff and Medical students scored averages of 6.77 ± 5.04, 15.48 ± 8.66 on the K6, 37.22 ± 11.39, 22.62 ± 11.25 on the SSRS and 18.52 ± 7.54, 28.49 ± 11.17 on the PSS, respectively. Most medical staff (279, 91.77%) and 148 medical students (66.07%) showed a positive coping style. Social support, perceived stress, hours spent watching epidemic-related information per day and frequency of epidemic-related dreams were identified as factors influencing psychological distress among medical staff and medical students. Coping style emerged as a determinant of psychological distress among medical staff. Conclusions: In the early stages of the COVID-19 epidemic in China, medical staff and medical students were at moderate to high risk of psychological distress. Our results suggest that psychological interventions designed to strengthen social support, reduce perceived stress and adopt a positive coping style may be effective at improving the mental health of medical staff and medical students.

Analysis of Doctor-Patient Relationship in Post-COVID-19 Period: Perspective Differences Between Citizen and Medical Staff

To evaluate the current views on doctor–patient relationship (DPR) between citizens and medical staff in post-Corona Virus Disease 2019 (COVID-19) period and predict the possible factors of DPR, we distributed questionnaires by a online questionnaire platform--Questionnaire Star (https://www.wjx.cn) to evaluate DPR in post-COVID-19 period. Overall, 312 questionnaires for citizens and 421 questionnaires for medical staff were completed. Citizens felt that service attitude and communication with medical staff, and registering process have been improved. And their trust in doctors has increased by 86.8%. Majority of citizens (66.0%) preferred the tertiary hospitals. If doctor–patient contradictions occurred, 62.9% citizens preferred internal negotiation (with the doctor involved, 44.6%; with hospital management department, 18.3%). There was significant difference of views on the causes of medical violence incidents and the reasons for doctor–patient conflicts in the future between citizens and medical staff. The DPR score of medical staff was lower than citizens at each stage, and even showed a downward tendency in post-COVID-19 period. Furthermore, 20.4% medical staff believed that harmonious DPR would not be maintained, which was distinct from that of the citizens. Combating the COVID-19 provided an important opportunity to improve the DPR. However, unbalanced allocation of high-quality medical resources, gap between the actual treatment efficacy and patient’s expectation, fairness and efficiency issues, financial conflicts, and medical information symmetry were still the influencing factors of DPR.

Knowledge, Anxiety, Depression, and Sleep Quality Among Medical Staff in Central South Areas of China During the Break of COVID-19: Does the Level of Hospitals Make a Difference?

Purpose: To evaluate the knowledge, anxiety, depression, and sleep quality toward COVID-19 among Chinese medical staff from tertiary and basic-level hospitals in central south areas of China. Method: A structured questionnaire was composed of Demographic and clinical characteristics of medical staff, Knowledge toward COVID-19 including epidemiology and clinical manifestations, The Self-rating anxiety scale (SAS), Center for Epidemiologic Studies Depression Scale (CES-D), and The Pittsburgh Sleep Quality Index (PSQI). It was administered to medical staff from tertiary hospitals (Group A) (n = 407) and basic-level hospitals (Group B) (n = 388) during February 2020 and May 2020. Results: Medical staff in group A had a stronger knowledge toward COVID-19 than group B (23.69 ± 5.83 & 18.15 ± 6.35, p < 0.001). Mild anxiety symptoms were found in both groups. The SAS scores (Mean ± SD) of group B were 58.87 ± 10.17, which was significantly higher than that of group A (52.59 ± 12.09, p < 0.001). There were no significant differences in CES-D scores between the two groups (p = 0.981). The mean score of total PSQI in group B (8.41 ± 3.03) was statistically higher than that of group A (7.31 ± 3.74, p < 0.001). Additionally, the scores of sub-components of group B, including subjective sleep quality, sleep latency, sleep disorder, sleeping medication use and daytime dysfunction, were significantly higher compared to Group A (p < 0.05). Conclusions: Our study showed greater anxiety, more severe depression and poorer sleep quality among medical staff in central south areas of China during the COVID-19 outbreak. Additionally, compared to the tertiary hospital group, medical staff from basic-level hospitals had poorer knowledge toward COVID-19 and worse mental health conditions. In addition, residence, specialty, title and education level may also be factors of knowledge of COVID-19 and psychiatry problems. In light of this information, more attention should be paid to early identification and intervention of symptoms of anxiety and depression in susceptible medical staff from the basic-level hospitals.

Corrigendum: Prevalence and Influencing Factors of Anxiety and Depression Symptoms in the First-Line Medical Staff Fighting Against COVID-19 in Gansu

[This corrects the article DOI: 10.3389/fpsyt.2020.00386.].

Anxiety disorders and mood disorders in hospital doctors: a literature review

This paper is focused on mental health among hospital doctors. This is a review of the literature dated January 1, 2005-December 31, 2019, from the MedLine and Scopus databases. The prevalence of post-traumatic stress disorder and anxiety disorders ranged 2.2-14.6% and 10.5-19.3%, respectively. Several risk factors were significant, such as having had blood exposure accidents, or the interaction between family and work life. The prevalence of mood disorders ranged 7.8-48%. Occupational constraints, such as night work or psychological demand, were related to the presence of mood disorders. This literature review showed the prevalence of disorders that can be reactive at work in hospital doctors. The risk factors studied can guide prevention policies within hospitals. Med Pr. 2021;72(2):163-71.

Contactless Food Supply and Delivery System in the COVID-19 Pandemic: Experience from Raytheon Mountain Hospital, China

The contactless food supply and delivery system of Raytheon Mountain Hospital is an innovative action to solve the dining problem and balance nutrition for medical staff and patients. The system was established according to five approval criteria, including localization, experience in hospital meal service, sufficient raw materials and supporting facilities, food safety, and high execution in dispatching. From the preparation phase to service optimization and improvement, the service model of the full collection of food and beverage information, point-to-point distribution, contactless food delivery, one-stop ordering, and full coverage of separately eating is established to safeguard the contactless food supply and delivery system operating smoothly. As of April 15, 2020 Raytheon Mountain Hospital had been operating safely for 68 days with no occurrence of food safety accident.

Risk factors and prevention strategies for the occupational exposure of medical staff during the coronavirus disease-19 pandemic (Review)

During the sudden epidemic of this novel coronavirus-induced pneumonia, a number of medical staff were infected and even succumbed to coronavirus disease-19 (COVID-19). Based on the experience of medical professionals from The Hubei 672 Orthopedics Hospital of Integrated Chinese and Western Medicine on this COVID-19 pandemic, the present review summarizes the risk factors associated with the occupational exposure of front-line medical staff. Challenges encountered include insufficient understanding, lack of early protection, environmental factors and routine procedures and the lack of adequate prevention strategies. Overcoming these challenges can potentially enhance awareness of COVID-19 prevention and control among medical staff, in addition to strengthening the personal protection of front-line medical staff, rational area layout, regular disinfection, standardization of daily procedures, reasonable scheduling and early psychological intervention. The present article may serve as a referencing point for the prevention and control of this epidemic.

Effects of Occupational Radiation Exposure on Job Stress and Job Burnout of Medical Staff in Xinjiang, China: A Cross-Sectional Study

BACKGROUND Although the potential effects of long-term and low-dose radiation exposure on physical health have attracted considerable attention, few systematic evaluations have been reported regarding the mental health of occupational groups. This study sought to investigate the effects of occupational radiation exposure on job stress and job burnout of medical radiation staff. MATERIAL AND METHODS Using cluster random sampling, a total of 1573 medical radiation workers were initially selected from 10 hospitals in Xinjiang, China, and 1396 valid questionnaires were finally collected. Job stress and job burnout were assessed using the Effort-Reward Imbalance (ERI) questionnaire and the Chinese Maslach Burnout Inventory (CMBI), respectively. RESULTS The percentages of medical radiation staff experiencing job stress and job burnout were 53.08% and 63.32%, respectively. A statistically significant difference in job stress was observed in association with age, ethnicity, professional title, marital status, radiation work type, radiation working years, family history, hypertension, obesity, smoking, and drinking (P<0.05). A statistically significant difference in job burnout was observed in association with age, sex, ethnicity, professional title, educational level, marital status, job post, radiation work type, radiation working years, family history, hypertension, diabetes, and obesity (P<0.05). Female (odds ratio [OR]=0.75, 95% confidence interval [CI]: 0.58-0.98), senior professional title (OR=0.64, 95% CI: 0.43-0.96), and radiation work types of nuclear medicine (OR=0.15, 95% CI: 0.07-0.33) and radiotherapy (OR=0.54, 95% CI: 0.36-0.79) were protective factors, and job stress (OR=4.57, 95% CI: 3.55-5.91) was the risk factor for job burnout of medical radiation staff. CONCLUSIONS Medical radiation staff experience high levels of job stress and job burnout. The interventions of occupational physical examination, personal dose monitoring, occupational health education, and management optimization are recommended to relieve job stress and job burnout and enhance occupational health of medical radiation staff.

JAAM Nationwide Survey on the response to the first wave of COVID-19 in Japan. Part I: How to set up a treatment system in each hospital

Aim

To clarify how the medical institutions overcame the first wave of coronavirus disease 2019 (COVID-19) in Japan and to discuss its impact on the medical labor force.

Methods

We analyzed questionnaire data from the end of May 2020 from 180 hospitals (102,578 beds) certified by the Japanese Association for Acute Medicine.

Results

Acute (emergency) medicine physicians treated severe COVID-19 patients in more than half of hospitals. Emergency medical teams consisted of acute medicine physicians and other specialists. Frontline acute care physicians were concerned about their risk of infection in 80% of hospitals, and experienced stress due to a lack of personal protective equipment. Twenty-six of the 143 hospitals that had a mental health check/consultation system in place indicated that there was a doctor who experienced mental health problems. Of the 37 hospitals without a system, only one hospital was aware of the presence of a doctor complaining of mental health problems.

Conclusion

Acute care physicians and physicians in other departments experienced high levels of stress as they fought to arrange COVID-19 treatment teams and inpatient COVID-19 wards for infected patients. Medical materials and equipment may be sufficient for a second or third wave; however, active support is needed for the physical and mental care of medical staff. Mental health problems may be missed in facilities without mental check and consultation system.

Psychological Case Conference Following the Death of a Patient With Neuromuscular Disease: A Source of Emotional Support for Participating Medical Staff

Healthcare professionals involved in the treatment and care of patients with intractable diseases, such as muscular dystrophy, increasingly encounter situations that can elicit emotional distress for them as well as the patients. Therefore, medical professionals also need support. This article describes a psychological case conference of multidisciplinary professionals involved in the treatment of a deceased patient with Duchenne muscular dystrophy. The conference aimed to support medical professionals in reflecting on and sharing their thoughts, feelings, and conflicts. Such a practice could support medical professionals in reflecting patients' thoughts and sharing their personal experiences with other staff members, which may alleviate emotional and personal conflicts. Reflecting on their interactions and dealings with patients serves this supportive function. Psychological case conferences for medical staff may serve as an opportunity for participants to feel emotionally supported and may perhaps help prevent burnout.

Clinical characteristics and in-hospital outcome of medical staff infected with COVID-19 in Saudi Arabia. A retrospective single-center study

OBJECTIVES

To analyze the clinical characteristics and in-hospital outcomes among coronavirus disease 2019 (COVID-19) positive medical staff compared with those of public. Methods: A total of 108 COVID-19-positive medical staff patients were included in the study from March 23, 2020 to June 15, 2020. Patients were analyzed for demographic data, clinical presentations, and in-hospital outcomes and compared against 661 COVID-19-infected patients of non-medical personel. Results: Mean age of medical staff patients was 44.05±13.9 years, most of whom were women (63.9%). The infected medical staff members consisted of 63 nurses (58.3%), 37 physicians (34.3%), 5 technicians (4.6%), and 3 pharmacists (2.8%). Smoking (60.2%) was the most frequent, followed by diabetes mellitus (37%). Of 108 COVID-19 infected medical staff, 18 (16.6%) were isolated in the intensive care unit (ICU), of which 14 (77.8%) were male, 16 (88.9%) were smokers, and 16 (88.9%) presented with pneumonia. Fatality ratio among medical staff patients was 4.6%. Male gender with odds ratios (OR) of 7.771 and 95% confidence intervals (CI) of 0.837-72.195 and a history of chronic kidney disease of (OR=10.778, 95% CI: 1.503-77.287) were predictors of death among the medical staff group. Conclusion: The incidence of COVID-19 infection among medical staff is quite high, but the occurrence of extreme illness and death is significantly low compared with the general community. Training should be implemented for all hospital staff on infection prevention techniques. Reliable and quick access for testing medical personnel is essential to maintain health, safety, and availability of health care workers during this pandemic.

COVID-19 and Its Psychological Impacts on Healthcare Staff - A Multi-Centric Comparative Cross-Sectional Study

Background

Since the first case of coronavirus disease-19 (COVID-19) in Pakistan was reported in February 2020, the medical and paramedical staff has been working on the frontlines to deal with this disease. They have been facing significant strain and stress due to the pandemic, affecting their social, mental, and personal life. The purpose of this study is to investigate the psychological effects of the COVID-19 pandemic, etiology, personal coping mechanisms, and the strategies that are being adopted to reduce stress by the healthcare workers (HCWs) working in COVID-19 dedicated wards (group 2) and compare it with staff working in other departments but not in COVID-19 wards amid this pandemic (group 1) in various hospitals of Lahore, Pakistan.

Methods

The comparative cross-sectional study was designed which included doctors, nurses, and allied health professionals from various hospitals of Lahore, Pakistan. A questionnaire was designed which consisted of five sections, and 51 questions. A Chi-square test was used to compare the responses between these two groups.

Results

The study questionnaire was submitted by 200 participants, 100 responses for each group (see the Appendix). In group 1, HCWs not working in COVID-19 dedicated floors were afraid of getting infected, transmitting the infection to their families and concerned about using personal protective equipment (PPE) improperly. They reported a lack of concentration and tense muscles. The coping mechanisms of this group were exercise, strict precautions at work, and social distancing measures. While HCWs serving in COVID-19 dedicated wards were concerned and afraid of putting their families at risk by working in the high-risk environment; the major stresses in this group were: lack of knowledge about proper strategies for treatment, they faced insecurity due to physical and verbal violence by caretakers of COVID-19 patients, and lack of concentration. The coping mechanism was the support of their families and taking strict precautions, with self-isolation if required, to avoid any disease transmission to their families. The proposed strategies to be implemented included teaching skills for self-rescue as well as the implementation of policies at the administrative level to reduce working hours and frequent shift rotation.

Conclusion

The COVID-19 outbreak posed a great deal of mental stress among HCWs working on the COVID-19 floor as well as those serving in other departments of the hospital. The HCWs from group 1 were most afraid of getting infected and putting family members at risk, experienced tense muscles and lack of concentration, coped their stress by exercise and being more vigilant, and suggested the strategies of teaching skills for self-rescue and better community awareness. While the staff from the second group were most afraid of being the source of infection and violence from the caretakers of patients, experienced tense muscles, used family support, and strict isolation measures as coping mechanisms and suggested the strategies of self-rescue and increase in wages of directly exposed healthcare workers to deal with such pandemics in future in a better way.

Front-line staff's perspective on patient safety culture in Iranian medical centers: A systematic review and meta-analysis

BACKGROUND

The prerequisite for promoting safety culture is to assess the existing safety culture level of institutes, because safety precautions without appropriate evaluation increase costs and unforeseen risks.

OBJECTIVE

This study aimed to systematically review the status of patient safety culture from the perspective of clinical personnel at Iranian hospitals through a meta-analysis of studies using the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire.

METHODS

The present systematic review and meta-analysis was conducted in 2018. Data were gathered by searching Google Scholar, Scopus, PubMed, and Web of Science databases up to November 2018. Search keywords were "patient", "safety", "culture", "healthcare", "hospital", "medical center", "HSOPSC tool", and "Iran". The search protocol was limited to 10 years. To estimate the PSC score, computer software CMA:2 (Comprehensive Meta-Analysis) was used. The presence of heterogeneity across the studies was assessed with the I2 statistic. A forest plot was used to report the results. Publication bias was assessed through a funnel plot.

RESULTS

The meta-analysis of studies showed that the PSC score based on the random effect model was 52.7% (95% CI: 50.2%-55.2%), (Q = 522.3, df = 54, P < 0.05, I2 = 89.6). A mean of 12 dimensions of HSOPSC showed that the "Teamwork within units" dimension had the highest PSC score (67.2%) and "Non-punitive response to error" had the lowest score (40.4%).

CONCLUSIONS

Managers and policymakers should be directed towards non-punitive responses to errors and persuade staff to report errors and execute the approach to learn from mistakes. Also, a periodic government evaluation of the patient safety culture will help further its sustainable development.

Psychiatric Intervention and Psychiatrist's Role in the COVID-19 Epicenter-Wuhan: Personal Experience and Perspective

This invited commentary is the personal experience of a psychiatrist who assisted in Wuhan, China during the pandemic. From the personal perspective, it explains why psychiatrists need to go to Wuhan, discusses the psychological problems faced by the front-line medical staff and confirmed COVID-19 patients and the corresponding psychological interventions provided to them, describes the particularity and coping methods of psychological issues related to COVID-19 epidemic.

Short report: factors determining perceived stress among medical staff in radiology departments during the COVID-19 outbreak

Medical staff in radiology departments faces a higher risk of infection and a heavier workload during the new coronavirus disease (COVID-19) outbreak. High perceived stress levels endanger physical and mental health and affect work efficiency and patient safety. Therefore, it is urgent to understand the perceived stress levels of medical staff and explore its risk factors. We recruited 600 medical staff from the radiology departments of 32 public hospitals in Sichuan Province, China, to evaluate perceived stress scores via a mobile app-based questionnaire. The results showed that the perceived stress level among medical staff in the radiology departments during the COVID-19 outbreak was high and a sense of tension was strongly present. A positive correlation was found between anxiety score and perceived stress. Multivariate analysis showed that risk factors for perceived stress were female, existing anxiety, and fears of being infected at work, an uncontrollable outbreak, and not being able to pay rent or mortgage. Conversely, good knowledge about COVID-19, being unmarried, and working in a higher-grade hospital were protective factors for perceived stress. Therefore, more attention should be given to medical staff in the radiology departments that present the risk factors outlined above. Timely risk assessment of psychological stress and effective intervention measures should be taken for these high-risk groups to keep their perceived stress within normal limits.

Impact of the Family Environment on the Emotional State of Medical Staff During the COVID-19 Outbreak: The Mediating Effect of Self-Efficacy

During the outbreak of the coronavirus disease 2019 (COVID-19), the medical staff was facing severe work pressure, which led to a negative emotional state. The purpose of this study was to explore the relationship between the family environment and the emotional state of the medical staff members during the COVID-19 outbreak. Due to the importance of self-efficacy in regulating mental health, the mediating role of self-efficacy in the association between family environment and emotional state was also explored. A cross-sectional survey was performed, using an online questionnaire, on 645 medical staff who participated in the epidemic prevention and control tasks during the COVID-19 outbreak in Beijing. Family environment, self-efficacy, anxiety, and depressive symptoms were measured by the Family Environment Scale-Chinese Version (FES-CV), the General Self-Efficacy Scale (GSES), the Generalized Anxiety Disorder Scale-7 (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9), respectively. Correlation analysis and mediating effect analysis were used to explore the relationships between them. First, a higher prevalence of anxiety (39%) and depressive (33%) symptoms were confirmed among the medical staff. Second, the symptoms of anxiety and depression were negatively correlated with the dimensions of cohesion and expressiveness and positively correlated with the dimensions of conflict in the FES-CV scale. Third, self-efficacy significantly mediated the association between the family environment and anxiety symptoms (P < 0.001) as well as the family environment and depressive symptoms (P < 0.001). These findings show that a negative family environment was the main predictor of symptoms of anxiety and depression in the medical staff during the COVID-19 outbreak. Furthermore, we found that self-efficacy played a critical mediating role between the family environment and the symptoms of anxiety and depression. Our study also indicates that improvements in the family environment benefit the mental health care of the medical staff, and high self-efficacy enhances this effect.

The Everyday Life of Patients With Tuberculosis in the Concentration Camp of Mittelbau-Dora (1943-1945)

The everyday life of patients with tuberculosis in the main prisoner infirmary of the Mittelbau-Dora concentration camp is analyzed historically-critically by medical records, documents of the Schutzstaffel (SS) physicians, contemporary medical textbooks and memoirs of former inmates from partly international archives. To compare the medical treatment in the three phases of the concentration camp, the representative months of February 1944, July 1944 and January 1945 were examined. The analysis shows that SS hygienists inspected the place for fear of a collapse of the V-2 rocket production. The primitive medical infrastructure was slowly expanded after its founding in 1943. SS physicians and medics led and supervised the treatment provided by inmates. These were in an ethical dilemma between cooperation with the SS and commitment to the sick prisoners. The Tuberculosis Department was used for isolation. Sputum diagnostics and X-ray equipment were utilized as selection tools. Infectious patients laid usually for weeks in the same bed with two other patients. Significantly more resources were available, however, for non-infectious tuberculosis patients. The therapy was based on the medical expert opinion of the time and was mainly symptomatic such as fever reduction. Rest and vitamins should make prisoners fit for the armament industry. Patients with tuberculosis had a high death rate. The prisoners who survived were discharged, but often did not recover. Several thousand prisoners were selected for transports, which led to special concentration camps for seriously ill prisoners (Lublin-Majdanek, Bergen-Belsen) and the subcamp Boelcke-Kaserne. There, they often died of catastrophic conditions or were killed.

Differences in practice and preferences associated with truth-telling to cancer patients

BACKGROUND

Doctors should disclose the diagnosis to patients according to the principle of autonomy. However, not disclosing the diagnosis and prognosis to cancer patients remains common in mainland China.

OBJECTIVE

The study explored the experiences and attitudes of patients with cancer, family members, and the medical staff in truth-telling.

RESEARCH DESIGN

A quantitative survey with three closed-ended questionnaires was conducted.

PARTICIPANTS

In all, 137 patients with cancer, 134 family members caring for cancer cases, and 54 medical staff were surveyed. Descriptive statistics were used to summarize all characteristics, and the chi-square test was performed to analyze group differences in attitudes toward cancer disclosure.

ETHICAL CONSIDERATIONS

This study was approved by the Committee on Ethics of Biomedicine Research, at the Second Military Medical University (HJEC-2018-YF-001). Informed consent was obtained from all participants prior to study commencement.

FINDINGS

A total of 59.8% of patients were informed about their diagnosis within 1 week, and 19.7% inferred theirs. The medical staff preferred to prioritize family members in informing about patient diagnosis while 77.4% of patients preferred to be told the whole truth at the time of initial diagnosis. More patients than family members and medical staff wanted the patients to be informed about the diagnosis (p < 0.001). A significant difference was found between the patients and family members regarding who should tell the patients.

DISCUSSION

The willingness of patients in knowing the truth was underestimated by their family members as well as the medical staff. Guessing the truth indirectly may exert negative effects on the patients, and not telling the truth is inappropriate in patients who want to be informed.

CONCLUSION

Disclosure of a cancer diagnosis is a complex process involving medical practice, as well as a range of cultural, ethical, and legal factors. The medical staff should first assess each patient's willingness in truth-telling and inform about disease diagnosis with respect. Emotional support and comfort from family members are encouraged. Anyone in the patient's care team, especially nurses, could be integrated in the process of truth-telling.

[Professional satisfaction of the medical staff of the scientific and practical dental complex]

A survey of dentists and managing clinics-branches of the scientific and practical dental complex showed a high level of professional satisfaction. The main advantages in the activities of rapidly developing network-type dental clinics that actively implement the most advanced, unique technologies and tools have been identified. The main motivational factors that positively affect the result of staff activities, as well as reduce their degree of professional satisfaction, are identified. Moreover, according to the results of respondents' answers, approaches were identified to improve the motivating component in personnel management, as well as to level existing problems within the team. Studying the opinions of medical personnel (doctors and managers) will help the administration to analyze the potential of the personnel potential of clinics and will contribute to the development of plans to improve the organization of staff work and network development.