Emotional Processing and Psychological Well-Being of Healthcare Workers During the COVID-19 Pandemic

Objectives: The present cross-sectional web-based survey study aimed to examine the impact of gender and frontline/non-frontline condition on psychological health (depression and peritraumatic distress) of a sample of Italian healthcare workers, and to explore the mediating effects of emotional processing in these relationships. Methods: Emotional processing styles and depressive and peritraumatic distress symptoms were assessed between March and December 2021, a period which in Italy corresponds to the third and the start of the fourth wave of COVID-19, along with gender, frontline versus non-frontline role in the pandemic emergency, and other sociodemographic and background variables. Results: Results showed that emotional processing mediated the relationship between gender and frontline/non-frontline role with depressive and peritraumatic distress symptomatology. Being a woman, working on the frontlines, and having a maladaptive emotional processing style increased the negative effects of stress during the pandemic. Conclusions: The obtained results strengthen the importance of providing useful psychological support for health professionals to facilitate the expression and management of emotions as well as the learning of healthy and functional styles of emotional processing.

Emotional distress during the first year of the COVID-19 pandemic-large sample serbian study

The COVID-19 pandemic has significantly impacted mental health, with healthcare professionals being particularly vulnerable. This study explores the emotional distress experienced in Serbia, focusing on factors that contribute to symptoms of depression, anxiety, and stress. A total of 3328 participants from the general and healthcare populations were surveyed using the Depression Anxiety Stress Scales-Short Form (DASS-21). The analysis revealed that certain groups, such as women, non-psychiatrist doctors, individuals with a history of mental disorders, and those dissatisfied with their financial, familial, and living circumstances, were more likely to experience heightened levels of emotional stress. Moreover, healthcare professionals, especially those working in challenging conditions, may be at increased risk for mental health issues. These findings underscore the need for targeted interventions and ongoing support for those most affected, particularly within the healthcare sector, to mitigate the long-term mental health impacts of the pandemic.

The best approaches and doses of exercise for improving sleep quality: a network meta-analysis and dose-response relationship study

BACKGROUND

Poor sleep quality not only diminishes people's quality of life and work efficiency but is also closely associated with various diseases. A reasonable exercise regimen can improve sleep quality to some extent, but there is a lack of comparative studies on the effects of different types of exercise, especially varying exercise doses, on sleep quality.

OBJECTIVE

To systematically evaluate the effects of different exercise modalities and doses on sleep quality.

METHODS

A search was conducted in PubMed, Web of Science, EBSCO, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases for randomized controlled trials (RCTs) on the effects of different exercise modalities on sleep quality, from database inception to November 2024. Two researchers independently screened the literature, extracted data, and assessed the risk of bias in the included studies. Network meta-analysis and dose-response analysis were performed using Stata 16.0 and R software with a random-effects model.

RESULTS

A total of 86 RCTs involving 7,276 participants were included. Six types of interventions were assessed: Aerobic Exercise (AE), Resistance Training (RT), Combined Aerobic and Resistance training (AE + RT), Yoga, Pilates, and Traditional Chinese Sports (TCS). The network meta-analysis results showed that compared to the control group, AE (SMD = -1.21, 95% CI: -1.50, -0.91, P < 0.01), RT (SMD = -1.12, 95% CI: -1.80, -0.44, P < 0.01), AE + RT (SMD = -1.11, 95% CI: -1.56, -0.66, P < 0.01), YOGA (SMD = -0.82, 95% CI: -1.22, -0.42, P < 0.01), Pilates (SMD = -1.65, 95% CI: -2.42, -0.88, P < 0.01), and TCS (SMD = -0.94, 95% CI: -1.28, -0.60, P < 0.01) all significantly improved sleep quality. The cumulative ranking probability (SUCRA) ranking showed that Pilates (91.7%) was the most effective, followed by AE (69.7%), AE + RT (59.4%), RT (58.6%), TCS (40.5%), and YOGA (30.1%). Additionally, the relationship between exercise dose and sleep quality was nonlinear, following a U-shaped curve. The overall optimal exercise dose for improving sleep quality was 920 MET-min/week. The optimal doses varied across exercise types, ranging from 390 MET-min/week for Pilates to 1,100 MET-min/week for aerobic exercise.

CONCLUSION

This study provides strong support for non-pharmacological interventions to improve sleep quality. For individuals aiming to improve their sleep through exercise, Pilates and aerobic exercise are recommended as the preferred options. Additionally, controlling the exercise dose within the optimal range (e.g., 920 MET-min/week) can significantly enhance the intervention effect.

CLINICAL TRIAL NUMBER

Not applicable.

Transient receptor potential vanilloid 4 blockage attenuates pyroptosis in hippocampus of mice following pilocarpine‑induced status epilepticus

Pyroptosis contributes to the neuronal damage that occurs during epilepsy. Calcium-activated neutral protease (calpain) dissociates cysteinyl aspartate specific proteinase-1 (caspase-1, cas-1) from the cytoskeleton, and the activated cas-1 is responsible for the production of N-terminus of gasdermin D (N-GSDMD), the final executor of pyroptosis. Blocking transient receptor potential vanilloid 4 (TRPV4) can reduce neuronal injury in temporal lobe epilepsy (TLE) model mice. This study investigated the role of TRPV4 in pyroptosis during TLE. In the hippocampus of pilocarpine-induced status epilepticus (PISE) mice, the ratio of inactive calpain 1 protein level to its total protein level (inactive/total calpain 1) significantly decreased, while the ratio of inactive calpain 2 protein level to its total protein level remained unchanged. The protein levels of NLRP3, cleaved cas-1 (c-cas-1), interleukin (IL)-1β, and N-GSDMD increased, with more GSDMD-immunofluorescence-positive (GSDMD+) cells and fewer surviving pyramidal neurons observed in the hippocampus of PISE mice. Calpain inhibition with MDL-28170 reversed these changes, except for the elevated NLRP3 levels. Inhibitors targeting NLRP3 (MCC950) and cas-1 (Ac-YVAD-cmk) blocked the increase in c-cas-1, IL-1β, and N-GSDMD levels in the hippocampus of PISE mice. TRPV4 inhibition via HC-067047 increased the inactive/total calpain 1 ratio, decreased NLRP3, c-cas-1, IL-1β, and N-GSDMD protein levels, reduced GSDMD+ cells number, and improved pyramidal neuron survival in the hippocampus of PISE mice. Conversely, TRPV4 activation with GSK1016790A decreased the inactive/total calpain 1 ratio, elevated NLRP3, c-cas-1, IL-1β, and N-GSDMD levels, and increased GSDMD+ cells number in the hippocampus. In the hippocampus of GSK1016790A-injected mice, the inactive/total calpain 1 ratio was increased by MDL-28170, and c-cas-1, IL-1β, and N-GSDMD protein levels were markedly attenuated by MDL-28170, MCC950, and Ac-YVAD-cmk, respectively. In conclusion, TRPV4 inhibition mitigates pyroptosis in PISE mice by downregulating the calpain 1-NLRP3/cas-1-GSDMD pathway, ultimately reducing neuronal damage.

Barriers and limitations to the development of a telemental health service for workers in Peru- A user-centered approach

INTRODUCTION

Over the past decade, the surge in digital healthcare services has transformed traditional healthcare, requiring multidisciplinary engagement to adapt to the digital realm. The rise of telehealth services, particularly amid COVID-19, has been widely embraced globally, but its implementation in Peru faces unique challenges, including infrastructure issues and economic constraints. Therefore, this research aims to identify the barriers and limitations in developing a telemental health service for screening, evaluation, and timely referral of vulnerable occupational groups.

MATERIALS AND METHODS

A qualitative study was undertaken. We adopted a phenomenological approach, utilizing semi-structured interviews with vulnerable occupational groups and decision-makers. We conducted 23 interviews: 5 providers of telemental health services, 5 teachers users, 5 police officers users and 5 health professionals of telemental health services, and 3 decision-makers involved in telemental health regulation in Peru.; exploring experiences, barriers, and facilitators related to mental telemental health. The interviews were recorded and transcribed verbatim, furthermore, a thematic analysis was done to identify key themes.

RESULTS

The research identified barriers and limitations to developing a telemental health services screening service based on the experiences of workers, some of them were related to user dissatisfaction, emphasizing the need for personalized solutions beyond technical aspects. Scheduling issues call for flexibility and improved communication. Healthcare professionals' varied experiences highlight the necessity for targeted training, while successful telemental health services integration demands addressing resource limitations through a comprehensive approach.

CONCLUSION

The study advocates for a holistic, user-centred paradigm in telemental health services implementation, addressing both technological aspects and human and systemic elements. Multifaceted challenges inherent in telemental health, particularly in Peru, emphasize the need for strategic interventions by stakeholders. The study calls for a policy shift towards enhancing telemental health equity through system-level changes and eliminating structural barriers for marginalized populations.

Psychological distress in health care workers during the beginning, the middle, and the last part of the COVID-19 pandemic

The COVID-19 pandemic placed significant psychological strain on healthcare workers. Our study tracked health care workers in the Czech Republic throughout the pandemic to examine the impact of stressors on psychological distress over time and explore gender differences in these associations. We studied health care workers from the Czech arm of the international COVID-19 HEROES Study who took part in all three waves of data collection in 2020, 2021 and 2022 (n = 264). We employed a path model to examine the relationships among six stressors (low trust in workplace, assignment of new tasks, prioritization of patients, experience of death due to COVID-19, experience of discrimination or violence, contact with COVID-19 patients), psychological distress (measured by General Health Questionnaire), and covariates (age, gender, occupation). We incorporated autoregressive paths and interactions to assess the longitudinal impact of stressors. Prior levels of distress predicted subsequent distress, with significant carry-over effects observed between each wave. Stressors had direct association to distress in the same wave of data collection (2020 and 2021), but not in subsequent waves, and stressors in 2022 did not have a significant direct effect to distress. Men reported lower distress in 2020 and 2021, but not in 2022. Furthermore, no significant interactions between stressors and gender were found. Age and occupation were not related to distress levels. There is a need for adaptable mental health support that addresses current stressors through targeted interventions, while also providing ongoing monitoring beyond crises, particularly for individuals with high distress levels.

The Prevalence and Associated Factors of Job Burnout Among Medical Workers at COVID-19 Vaccination Sites: A Cross-Sectional Study

Background: During the pandemic period of the COVID-19, temporary centralized vaccination sites were set up in each administrative district in Nanjing to efficiently manage the vaccination campaign. Medical workers at COVID-19 vaccination sites are exposed to burnout syndrome due to repetitive and overload vaccination work. The purpose of our study was to investigate the prevalence of burnout among these medical workers and to explore its associated factors. Methods: A cross-sectional study was conducted at COVID-19 vaccination sites in May 2021 in Nanjing, China. The online questionnaire included demographic, job and COVID-19-related characteristics, Chinese Maslach Burnout Inventory, and Social Support Rating Scale. The hierarchical multiple regression model was used to identify the risk factors for job burnout of medical workers. Results: Of the 425 respondents, 189 had job burnout. The overall prevalence of burnout symptoms among medical workers at COVID-19 vaccination sites was 44.5% with a breakdown in severity as follows: 122 (28.7%) mild, 53 (12.5%) moderate, and 14 (3.3%) severe cases. Hierarchical multiple linear regression analysis indicated that education level, job titles, self-reported increased work intensity, self-assessment risk of contracting COVID-19 during work, and social support were significantly related to job burnout (p < 0.05), which explained 28.2% of the variance of job burnout score (F = 14.879, p < 0.01). Conclusion: The burnout symptoms were relatively common among medical workers at COVID-19 vaccination sites. More attention should be paid to medical workers with master degree or higher, junior job titles, increased work intensity, high risk of contracting COVID-19 during work, and low level of social support. Interventions that aim to reduce workload and increase social support can be effective approaches to prevent job burnout among medical workers during controlled COVID-19 period.

Exploration of the multiomics-based mechanisms of Gancao Nourishing-Yin decoction in regulating mitochondrial metabolic genes CYB5R3 and PICK1 to influence glioma progression

BACKGROUND

Glioma is the most common malignancy of the central nervous system, characterised by its high invasiveness and recurrence, which significantly limit therapeutic outcomes. Energy metabolism reprogramming, especially mitochondrial dysfunction, plays a pivotal role in tumour growth, survival, and progression. Mitochondria serve as the central hub for energy production and biosynthesis, adapting through alterations in oxidative phosphorylation, lipid metabolism, and the tricarboxylic acid cycle to meet the high metabolic demands of gliomas. Gancao Nourishing-Yin (GCNY) decoction, a traditional herbal compound, has demonstrated potential antitumour effects, particularly in modulating mitochondrial metabolic pathways and oxidative stress, which are critical for tumour cell adaptation.

METHODS

Genomic data from the glioma GWAS dataset in the Finnish R11 database and eQTL data from 13 distinct brain regions were analysed using Summary-data-based Mendelian Randomization(SMR) to identify glioma-associated genes. MitoCarta3.0, a database of mitochondrial genes, was used to pinpoint mitochondrial-related genes. Differentially expressed genes (DEGs) in human microglial cells treated with GCNY were extracted from the GEO dataset GSE210945 and cross-referenced with SMR results to identify key genes. Colocalisation analysis, validation using the TCGA database, survival analysis, and functional annotations of mitochondrial energy pathways were performed to explore the mechanisms of action.

RESULTS

Integration of SMR and MitoCarta3.0 identified 19 mitochondrial-related genes linked to gliomas, primarily involved in amino acid and fatty acid metabolism. Among these, CYB5R3 and PICK1 emerged as key genes with strong genetic links to glioma GWAS signals (PPH4 = 1). CYB5R3, upregulated in gliomas, was associated with enhanced oxidative phosphorylation, elevated reactive oxygen species (ROS) production, and poor survival outcomes (HR = 2.23, P < 0.001). PICK1, despite being downregulated, showed context-dependent roles in mitochondrial energy metabolism and tumour progression, with its high expression linked to worse prognosis (HR = 2.86, P < 0.001). PICK1 demonstrated moderate predictive capacity for one-year survival (AUC = 0.695).

CONCLUSION

This study highlights the critical roles of mitochondrial energy metabolism in glioma progression, identifying CYB5R3 and PICK1 as key regulators influenced by GCNY. By modulating mitochondrial pathways, including ROS production and oxidative phosphorylation activity, GCNY offers a novel multitarget strategy for glioma therapy. These findings underscore the importance of energy metabolism as a therapeutic target in gliomas and provide new insights into the potential of GCNY for integrated tumour management.

Gender differences of the association between work-related stressors and mental health among Chinese medical professionals: a nationwide cross-sectional study

Background

Chinese medical professionals are under tremendous work pressure, which greatly undermines their mental health, hinders professional performance and impairs the quality of healthcare. However, the specific work-related stressor that affects mental health most and whether gender difference plays a role are not yet known. This study aims to investigate the association between work-related stressors and mental health among medical professionals in China.

Methods

A cross-sectional online survey was conducted from September 29, 2022 to January 18, 2023 by recruiting 2,976 medical professionals from three representative provinces in China through purposive sampling. Anxiety and depressive symptoms were measured by the 7-item Generalized Anxiety Disorder (GAD-7) scale and Patient Health Questionnaire-9 (PHQ-9) scale. Logistic regression models were performed to identify work-related stressor significantly associated with mental health and stratified by gender.

Results

The prevalence of major depressive and anxiety symptoms among Chinese medical professionals was 28.2% (839/2976) and 24.0% (714/2976), respectively. Among the subjects, 43.7% (1,302/2976) of subjects reported having ≥3 work-related stressors, which was positively related to both major depressive and anxiety symptoms. The following work-related stressors were positively associated with major depressive symptoms: violence against medical staff and promotion pressure among males; medical dispute among females. The following work-related stressors were positively associated with major anxiety symptoms: medical dispute and promotion pressure among males. While no work-related stressor showed significant association with major anxiety symptoms among females.

Conclusion

These findings identified the specific work-related stressors related with the mental health, and gender differences are indicated in this relationship. Interventions directing at improving doctor-patient relationship may help to improve mental health of Chinese medical professionals. Reforming promotion system may mitigate the anxiety symptoms of male medical professionals.

A vaccine chatbot intervention for parents to improve HPV vaccination uptake among middle school girls: a cluster randomized trial

Conversational artificial intelligence, in the form of chatbots powered by large language models, offers a new approach to facilitating human-like interactions, yet its efficacy in enhancing vaccination uptake remains under-investigated. This study assesses the effectiveness of a vaccine chatbot in improving human papillomavirus (HPV) vaccination among female middle school students aged 12-15 years across diverse socioeconomic settings in China, where HPV vaccination is primarily paid out-of-pocket. A school-based cluster randomized trial was conducted from 18 January to 31 May 2024. The study included 2,671 parents from 180 middle school classes stratified by socioeconomic setting, school and grade level in Shanghai megacity, and urban and rural regions of Anhui Province. Participants were randomly assigned to either the intervention group (90 classes, 1,294 parents), which engaged with the chatbot for two weeks, or the control group (90 classes, 1,377 parents), which received usual care. The primary outcome was the receipt or scheduled appointment of the HPV vaccine for participants' daughters. In intention-to-treat analyses, 7.1% of the intervention group met this outcome versus 1.8% of the control group (P < 0.001) over a two-week intervention period. In addition, there was a statistically significant increase in HPV vaccination-specific consultations with health professionals (49.1% versus 17.6%, P < 0.001), along with enhanced vaccine literacy (P < 0.001) and rumor discernment (P < 0.001) among participants using the chatbot. These findings indicate that the chatbot effectively increased vaccination and improved parental vaccine literacy, although further research is necessary to scale and sustain these gains. Clinical trial registration: NCT06227689 .

Psychological status of healthcare workers in the post-COVID 19 period in China: a retrospective multicentric cross-sectional study

Objective

This study aimed to assess the depression, anxiety, sleep disorders, and post-traumatic stress disorder (PTSD) among healthcare workers (HCWs) in Huizhou in the post-pandemic period.

Methods

A retrospective multicentric cross-sectional study was conducted from April 25 to May 25, 2023, involving 4,618 HCWs from 46 hospitals in Guangdong Province, China. Psychological well-being was measured using the PHQ-9, GAD-7, Insomnia Severity Index (ISI), and PTSD scales. Chi-square test and multivariable logistic regression were used to identify factors associated with depression, anxiety, insomnia and PTSD.

Results

The rates of anxiety, depression, insomnia, and PTSD were 45.0%, 59.4%, 40.5%, and 10.5%, respectively. HCWs who did not experience negative events were more likely to show anxiety (OR=2.082, 95%CI:1.734-2.499), depression (OR=2.013, 95%CI:1.647-2.460) and insomnia (OR=2.013, 95%CI:1.683-2.409).

Conclusion

There was a high prevalence of anxiety, depression, insomnia, and PTSD in the HCWs after the COVID-19 pandemic.

Fear of childbirth among pregnant women during crises: the role of resilience and social support

BACKGROUND

Fear of childbirth (FOC) can be significantly distressful for pregnant women, especially during a crisis. However, how FOC manifests during different types of crises has not been extensively investigated. This study aims to examine the contribution of women's perinatal characteristics, resilience, social support from their family, partners, and friends, and concern for the foetus to their FOC, and to compare their FOC in two different crisis periods: the COVID-19 pandemic and the Israel-Hamas war.

METHODS

Pregnant women were recruited through social media during two periods: One hundred and ninety-one women were recruited during the COVID-19 pandemic, and 173 during the Israel-Hamas war. The participants were 20-46 years old and completed self-report questionnaires.

RESULTS

Being pregnant during the COVID-19 pandemic, poorer physical health, at-risk pregnancy, and lower resilience were associated with higher FOC. Furthermore, women perceived greater support from their family and partner, higher concerns for their foetus, and higher FOC during COVID-19 than during wartime.

CONCLUSIONS

The results highlight the vulnerability of having at-risk factors such as worse physical health and at-risk pregnancy, as well as the essential role of resilience as a powerful resource in women's FOC. They uncover that FOC is a context-dependent phenomenon and may be expressed to different extents under different circumstances. Professionals working with pregnant women should consider intervention programmes to develop psychological resilience to reduce the risk of severe FOC.

Heterogeneous treatment effects of stress ulcer prophylaxis among ICU patients at risk for gastrointestinal bleeding

BACKGROUND

While randomized clinical trials of stress ulcer prophylaxis (SUP) have generally shown no overall benefit, subgroup analyses suggest the benefit or harm of SUP in specific patients, indicating heterogeneity of treatment effects (HTE). Understanding HTE is crucial for tailoring SUP to individual treatment.

METHODS

This cohort study included patients admitted to intensive care unit (ICU) with at least one risk factor for clinically important gastrointestinal bleeding (GIB). The primary exposure was the use of SUP within 48 h after ICU entry; the primary outcome was 28-day mortality. We employed conventional subgroup analysis, risk-based analysis, and effect-based analysis to explore the HTE of SUP.

RESULTS

A total of 25,475 patients were included, of whom 6199 (24.3%) received SUP, with famotidine being the most commonly prescribed (53.7%). Baseline characteristics were well-balanced between treatment groups after weighting. SUP was not associated with the 28-day mortality in the overall population (median value for the posterior distribution of the odds ratio (OR), 1.03; 95% credible interval (CrI), 0.96-1.11). In conventional subgroups, the impact of SUP on 28-day mortality varied substantially between patients with an age of higher than or equal to 77 years in comparison with other age subgroups (posterior probability of difference in OR, 99.3%), between patients with and without chronic liver disease (posterior probability of difference in OR, 99.9%), between patients with and without coagulopathy (posterior probability of difference in OR, 92.1%), and between patients with and without malignant cancer (posterior probability of difference in OR, 100%). In risk-based analysis, patients at high risk of death exhibited the highest propensity for benefit from SUP (posterior probability of an OR > 1, 1.9%). In effect-based analysis, patients with malignant cancer and a higher Charlson comorbidity index identified at high probability of benefit.

CONCLUSIONS

Among ICU patients with at least one risk factor for clinically important GIB, those who are younger, have chronic liver disease, coagulopathy, or malignant cancer are more likely to benefit from SUP.

Analysing the effect of social jetlag on burnout among shift nurse using a chained mediation model

The purpose of the present research is to explore the relationship between social jetlag and burnout among Chinese shift nurses. Furthermore, we seek to demonstrate how perceived stress and sleep quality play as chain mediators in this relationship. A cross-sectional study. There are 429 Chinese shift nurses data records included through one-on-one format using the subjects' sociodemographic information, the Munich Chronotype Questionnaire for shift workers (MCTQshift), the Chinese version of the 14-item Perceived Stress Scale (CPSS-14), the Pittsburgh Sleep Quality Index (PSQI), and the Chinese version of Maslach Burnout Inventory-General Survey. The positive correlations are found between social jetlag and burnout among Chinese shift nurses; perceived stress and sleep quality, respectively, play a partial mediating role in this relationship. Furthermore, perceived stress and sleep quality play a chain mediating role between social jetlag and burnout. These findings contribute to understanding the impact mechanism of social jetlag on shift nurses' burnout and provide a theoretical foundation for nurses managers to develop programs designed for reducing the burnout that affects shift nurses.

Telemedicine as an Approach to the Mental Health of Healthcare Workers in Angola

INTRODUCTION

African healthcare professionals face significant mental health challenges; therefore, telemedicine can overcome geographical barriers and improve access to mental healthcare.

OBJECTIVE

The objective of this study was to identify the key factors influencing the adoption of telemedicine as a tool to support healthcare workers' mental health in an Angolan healthcare network and develop a telemedicine model tailored to this context.

METHODOLOGY

This mixed-method study collected quantitative data from a questionnaire applied to healthcare workers (n = 275), which were analyzed using descriptive statistics and logistic regressions. Qualitative data were obtained through structured interviews (n = 5) with psychologists and psychiatrists, and analyzed using thematic analysis in MAXQDA (Version 2022, VERBI Software, Germany), to identify recurring patterns and themes. The data were triangulated to ensure the rigor and consistency of the findings. Participation was anonymous and voluntary, and informed consent was obtained from all participants.

RESULTS

Previous experiences with mental health consultations, perceptions of teleconsultations, and doctor-patient relationship were significant in influencing telemedicine adoption by workers. The thematic analysis revealed four themes: perception and ease of telemedicine use, intention to use, and the perception of mental health in Angola. The key adoption factors for providers included project feasibility, management support, training, payment policies, and adherence to legal, ethical, and deontological standards.

CONCLUSIONS

The adoption of telemedicine for occupational mental health requires culturally adapted interventions and compliance with technological and data protection standards. Hospital management must address infrastructure challenges and mental health perceptions, and implement sustainable strategies that promote occupational well-being within the organization.

Sociocultural and perinatal health factors associated with Autism spectrum disorder (ASD) in children

While previous research has examined perinatal factors in the context of Autism Spectrum Disorder (ASD), studies focusing on sociocultural factors is limited. We conducted a cross-sectional analysis utilizing data from the Australian Autism Biobank (AAB), which encompasses autistic children aged 2-17, their siblings, parents, and unrelated controls. Employing multivariable regression analyses, we aimed to identify factors associated with ASD across various domains, spanning health and lifestyle, perinatal, and postnatal contexts. Importantly, our analyses were adjusted for critical sociodemographic covariates. Advanced maternal age, male sex at birth, and identifying as from culturally and linguistically diverse (CALD) background, were found to be associated with risk of ASD. Pre-existing chronic health conditions in both parents and paternal medication use before conception were also associated with ASD risk in children. Associations with complications during pregnancy, caesarean delivery, and maternal medication use during pregnancy were also found. Postnatal factors of interest included the presence of health conditions (e.g., epilepsy), infections in early-life (e.g., respiratory infections), and atypical development in the first six months of life (e.g., hypotonia). These insights can guide closer monitoring and support for those with pre-existing vulnerabilities especially in terms of certain perinatal and sociocultural characteristics.

Podocyte Injury and Long-Term Kidney Prognosis in Patients with Lupus Nephritis

Key Points

Podocyte injury, as indicated by early growth response 1 expression, was correlated with the clinical and histopathological activities of lupus nephritis (LN). Podocyte injury was associated with poor long-term kidney prognosis in patients with active LN. To improve the prognosis of patients with LN, treatment strategies on the basis of the degree of podocyte injury may be considered.

Background

Lupus nephritis (LN) is a major complication of SLE. Like other types of GN, podocyte injury has been observed in patients with LN. However, the association between podocyte injury and kidney prognosis in patients with LN has not been well elucidated. The aim of this study was to explore the association between podocyte injury and clinical and histological status and kidney prognosis in patients with LN.

Methods

Seventy-five patients histopathologically diagnosed with LN were enrolled in this study. Early growth response 1 (EGR1) expression in podocytes, representing podocyte injury, was detected through immunohistochemistry. The correlation between the proportion of glomeruli with podocytes expressing EGR1 (%EGR1glo) and the clinical and histological features of LN were evaluated. Subsequently, the association between %EGR1glo and kidney prognosis was examined in a group of patients with LN class 3, 4, or 5 who showed ≥0.5 g/g of urinary protein–creatinine ratio and received immunosuppressive therapy. Hazard ratio was calculated using univariate Cox proportional hazards regression.

Results

%EGR1glo was highest in patients with LN class 4, significantly correlated with the SLE Disease Activity Index score, urinary protein level, and prevalence of glomeruli showing cellular/fibrocellular crescents, endocapillary hypercellularity, and fibrinoid necrosis and inversely correlated with eGFR. Higher %EGR1glo was significantly associated with sustained ≥30% eGFR decline over 10 years in patients with LN class 3, 4, or 5 (n =42; hazard ratio, 1.58 [95% confidence interval, 1.07 to 2.36] per 10% increase in %EGR1glo). There was no significant interaction between patients grouped by kidney function, urinary protein level, presence of cellular/fibrocellular crescents, degree of tubulointerstitial fibrosis, and LN classification.

Conclusions

Podocyte damage, as indicated by EGR1 expression, was associated with poor long-term kidney prognosis in patients with active LN. Treatment strategies on the basis of the extent of podocyte injury may be necessary.

Work Disability Prevention and Management

OBJECTIVE

This abbreviated version of the American College of Occupational and Environmental Medicine's (ACOEM) Work Disability Prevention and Management Guideline reviews the available evidence and provides recommendations to clinicians regarding interventions to help patients remain at or return to work.

METHODS

Systematic literature reviews were conducted. Studies were graded and evidence tables were created, with involvement of a multidisciplinary expert panel that evaluated the evidence and finalized recommendations for all clinical questions. Extensive peer review was performed. Consensus recommendations were formulated when evidence was lacking.

RESULTS

Evidence-based recommendations have been developed to guide work disability prevention and management.

CONCLUSIONS

Clinicians should utilize quality evidence in determining treatment methods to prevent and alleviate work disability for workers. This guideline offers an evidence-based framework for preventing and mitigating work disability for individual adults in the active workforce. It is designed for use by healthcare clinicians who desire to minimize the negative impact of health conditions on working people's lives and livelihoods.

Clinical Trial: Precise Administration of Sucralfate Powder in Prevention of Delayed Postpolypectomy Bleeding. A Randomized Controlled Trial

INTRODUCTION

Delayed postpolypectomy bleeding occurs in approximately 1%-2% of all patients undergoing colonoscopic polypectomy, and this rate increases to 6% in patients with large (>2 cm) colon polyps. Sucralfate can protect the mucosa and promote its healing. This study was conducted to investigate whether colonoscopic spraying of sucralfate powder on polypectomy wounds can prevent delayed postoperative bleeding.

METHODS

This randomized controlled trial included patients with polyps (size ≥0.5 cm) who had undergone colonoscopic polypectomy at our hospital between May 2023 and January 2024. After polypectomy, the patients received standard treatment for immediate bleeding. Then, they were randomly allocated to either a sucralfate group (prophylactic spraying of sucralfate powder [3 g] on polypectomy wounds) or a control group. All patients were monitored for delayed bleeding within 28 days after colonoscopy.

RESULTS

A total of 160 patients were divided into the sucralfate and control groups (80 per group). The baseline characteristics were balanced between the groups. The rate of delayed postpolypectomy bleeding (0% vs 6.3%, respectively; P = 0.029) and postpolypectomy overt bloody stool (2.4% vs 18.8%, respectively; P = 0.001) were lower in the sucralfate group than in the control group. The duration of freedom from delayed bleeding was longer in the sucralfate group than in the control group ( P = 0.024). Multivariate Cox regression analysis confirmed the additional sucralfate spray as an independent factor against postpolypectomy overt bloody stool (relative risk, 0.03; 95% confidence interval, 0.003-0.43; P = 0.009).

DISCUSSION

Colonoscopic spraying of sucralfate powder is a safe approach with potential to reduce the risk of delayed postpolypectomy bleeding. Trial registration: NCT05817656.

Neural responses to social decision-making and their associated factors among nonsuicidal self-injured adolescents: An event-related potentials study

OBJECTIVE

The neuroelectrophysiology mechanisms of the connection between nonsuicidal self-injury (NSSI) and impairment of social decision-making function remain unknown. As the event-related potentials (ERPs) technique has been widely used in neurobiology research because of its advantage of high temporal resolution, we conducted this study to explore the ERPs of decision-making function among adolescents with NSSI.

METHOD

This study was designed to compare patients with mood disorder plus NSSI with mood disorder patients without NSSI using a 2:1 ratio. Participants aged 12-18 years were recruited from the outpatient department of psychiatry at Nanfang Hospital. Sociodemographic and psychological data were collected. The Ultimatum Game, a task examining individuals' social decision-making, was conducted with the ERP technique to record participants' neural responses. The associations between ERPs characteristics and psychological factors were examined by using correlation analysis and regression analysis.

RESULTS

In total, 90 participants were eligible, with 60 in the NSSI group and 30 in the non-NSSI group. N1 latency in the unfair condition was positively correlated with Difficulties in Emotion Regulation Scale scores (r = 0.257), whereas P2 latency in the fair condition was correlated with agreeableness personality (r = 0.250). Regression analysis revealed that N1 latency in the unfair condition was positively associated with NSSI (ORs ranged 1.07-1.10), whereas P2 latency in the fair condition was negatively associated (ORs ranged 0.95-0.97).

CONCLUSION

NSSI patients tended to exhibit impairment in decision-making function including initial cognitive value judgment, attentional allocation, and working memory process. ERPs characteristics including N1 latency and P2 latency may be predictors of NSSI.

Implication of Admission Eosinophil Count and Prognosis of Coronavirus Disease 2019 (COVID-19) in Elderly Patients With COPD: A Territory-Wide Cohort Study

OBJECTIVES

This study aims to investigate the association between elderly patients with COPD with different blood eosinophil on admission and those without COPD and the prognosis of COVID-19.

METHOD

A territory-wide retrospective study was conducted to investigate the association between elderly COPD patients with different blood eosinophil on admission and the prognosis of COVID-19. Elderly patients admitted to public hospitals and community treatment facility in Hong Kong for COVID-19 from January 23, 2020, to September 31, 2021, were included in the study. Severe diseases were defined as those who develop respiratory complications, systemic complications and death.

RESULTS

Among the 1925 patients included, 133 had COPD. Forty had admission blood eosinophil count ≥ 150 cells/μL, and 93 had blood eosinophil count < 150 cells/μL. Patients with COPD and admission blood eosinophil count ≥ 150 cells/μL, but not those with admission blood eosinophil count < 150 cells/μL, had severe COVID-19 with the development of respiratory and systemic complications. They were more likely to develop respiratory failure (OR = 5.235, 95% CI = 2.088-13.122, p < 0.001) and require invasive mechanical ventilation (OR = 2.433, 95% CI = 1.022-5.791, p = 0.045) and intensive care unit admission (OR = 2.214, 95% CI = 1.004-4.881, p = 0.049).

DISCUSSION

Our study suggested that the blood eosinophil count on admission could have significant prognostic implications among elderly patients with COPD. Patients with COPD and admission blood eosinophil count ≥ 150 cells/μL, but not those with admission blood eosinophil count < 150 cells/μL, have significantly increased risks of developing respiratory and systemic complications from COVID-19, when compared with non-COPD patients.

Crisis Management and Problem-Solving Skill Levels of Nurses Caring for Patients With COVID-19 and Affecting Factors: A Cross-Sectional Survey

This study aims to assess the crisis management and problem-solving skills of nurses caring for patients with COVID-19. The participants of this descriptive cross-sectional were 132 nurses who cared for patients with COVID-19 in a public hospital. The crisis management scale (CMS), problem-solving inventory (PSI), and Nurse Introduction Form were used to collect data. In this study, the nurses' CMS total score average was 3.75 ± 0.442, the average PSI total score was 86.32 ± 24.420, and it was determined that their crisis management ability was at a good level and their problem-solving skills were at a medium level. A significant difference was found between the nurses' descriptive characteristics of having children (P = .029), being informed about crisis management (P = .035), and their total average score on the CMS (P < .05). A statistically significant negative relationship was found between the nurses' total CMS and PSI scores (P < .05).This study showed that the problem-solving skill levels of nurses caring for patients with COVID-19 affected their crisis management skills.

"Having Support at Work 'Is Different' and Important": A Qualitative Study of Virtual Peer Discussion Groups With Medical School Faculty

PURPOSE

In response to the need to support health care professionals during the COVID-19 pandemic, an innovative, peer-led discussion group program for medical school faculty, called CIRCLE (Colleague Involved in Reaching Colleagues through Listening and Empathy), was developed at Rutgers Health. This article describes results of a qualitative analysis of the participants' experiences, explores virtual communication platform use during this peer support program, and identifies the program's beneficial elements.

METHOD

CIRCLE was inaugurated in October 2020 at Rutgers New Jersey Medical School and Rutgers Robert Wood Johnson Medical School using evidence-informed topics. The inaugural CIRCLE peer-led discussion groups included 50 physicians who met twice monthly in groups of 5 to 8 between October 2020 and April 2021. Deidentified transcript data were iteratively reviewed using conventional content analysis, including familiarization, thematic framework creation, indexing, charting, mapping, and interpretation. Themes were grouped into 4 conceptual framework categories based on social support theory in context of work-related stress: emotional, appraisal, informational, and instrumental support.

RESULTS

Themes emerged based on the framework: emotional support (connecting on a deeper level, importance of support at work, COVID-19 made virtual connections needed and relevant), appraisal support (feeling "not alone," safe space to connect and share), informational support (sharing self-care strategies), and instrumental support (incentives to join are helpful but connection leads to engagement, some structure but "not too much" is important, virtual modalities are convenient and conducive to connection).

CONCLUSIONS

Benefits of peer discussion groups include deeper connections at work, reduced isolation, safe sharing, and exchange of information on self-care. Connection and balancing structure and autonomy were important to engagement. Virtual modalities were viewed as feasible, convenient, and conducive to connection. This article highlights the benefits and convenience of virtual peer-led discussion groups for medical school clinical faculty and provides evidence for content development of these programs.

Psychological health of healthcare workers during Shanghai lockdown: Prevalence and associated factors

The 2022 Shanghai COVID-19 lockdown may lead to mental health issues among healthcare workers (HCWs). A cross-sectional study was conducted to investigate psychological health and its associated factors among HCWs. A total of 253 hCWs were recruited in Shanghai, China, through convenience sampling method. Demographic Questionnaire, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Insomnia Severity Index, and The Impact of Event Scale-Revised were used to assess demographic information, anxiety, depression, insomnia, and post-traumatic stress disorder (PTSD), respectively. The associated factors of psychological health were identified by binary logistic regression analysis. The prevalence of anxiety, depression, insomnia, and PTSD was 6.3%, 10.3%, 9.9% and 17.8%, respectively. Female HCWs were more likely to report anxiety (OR = 5.50, 95%CI = [1.45-20.82], p < 0.05) and PTSD (OR = 3.20, 95%CI= [1.23-8.28], p < 0.05). Besides, being a nurse was associated with a lower level of PTSD symptoms (OR = 0.23, 95%CI = [0.07-0.76], p < 0.05). Symptoms of psychological health were screened positive in HCWs during the 2022 Shanghai COVID-19 lockdown. Gender and occupation were associated with psychological health. The hospital authorities of Shanghai need to pay special attention to female HCWs.

Unraveling the fear of COVID-19 reinfection: insights from frontline doctors in China

Considering the end of global emergency status of Coronavirus-19 (COVID-19) and the persistent risk of reinfection for healthcare workers (HCWs), it is important to evaluate the attitude of the HCWs toward reinfecting with COVID-19. To gather information about participants' concerns regarding reinfection with COVID-19, a comprehensive online questionnaire was administered to all individuals involved in the study. DASS-21 was used to assess their mental health. Logistic regression was used to evaluate the factors associated with fear of reinfection. A total of 982 questionnaires were collected for this study, with only 503 questionnaires included in the final analysis. Of the 503 respondents, 201 (39.96%) feared reinfection with COVID-19. Three factors emerged as significantly associated with the fear of reinfection: (a) having been infected with COVID-19 before, (b) feeling that COVID-19 had a lasting effect on one's life, and (c) experiencing anxiety. The most common factors reported by those who feared reinfection were: concern about the negative effects of reinfection on their physical health, worry about the possible long-term complications of reinfection, and belief that reinfection would not have a big impact. And the mental state of HCWs has improved and become more optimistic. Although the morale of HCWs has improved, it remains evident that a significant portion of them still have concerns about reinfection and continue to experience anxiety. Moving forward, it is crucial to provide timely psychological care and support to HCWs, alongside reinforcing efforts in epidemic management.

Pharmacological prevention of gastrointestinal bleeding in critically Ill patients

PURPOSE OF REVIEW

Despite advances in critical care medicine, the incidence of clinically important upper gastrointestinal bleeding (UGIB) remains consistent. One therapy that reduces UGIB is the use of stress ulcer prophylaxis (SUP). In the past year, several key manuscripts have been published regarding SUP, providing updated recommendations for its prescription. In this review, we provide commentary on these recommendations and areas for future research.

RECENT FINDINGS

Risk factors for UGIB include chronic liver disease, coagulopathy, severe neurologic illness or injury, and shock. The prescription of SUP is associated with a decreased occurrence of UGIB but no benefit in mortality. Although both histamine-2 receptor antagonists and proton pump inhibitors (PPIs) are recommended for SUP, it is possible that PPIs may be associated with increased mortality in critically ill patients. The short-term use of SUP is not expected to be associated with most adverse drug events, but inappropriate continuation of SUP increases this risk.

SUMMARY

Patient-specific considerations based on recent data help with improving the prescription of SUP, although additional research is necessary. The use of artificial intelligence may be able to predict at risk patients with the potential to influence appropriate prescription of SUP and reduce the occurrence of UGIB.

Perceived Trauma Among Nurses During the COVID-19 Pandemic: A Qualitative Descriptive Study

The COVID-19 pandemic has caused disruption to healthcare services worldwide, and although the pandemic was declared over, nurses continue to experience burnout and mental health implications because of events experienced since 2020. The aim of this study was to explore the experiences of trauma among nurses during the COVID-19 pandemic, using a qualitative descriptive study design. This paper used secondary analysis of qualitative, semi-structured interviews conducted with 55 Australian nurses exploring their alcohol consumption, due to the frequent narratives of trauma and traumatic events arising during this process. Data were analysed using structural coding and reported in accordance with the Consolidated Checklist for Reporting Qualitative Data (CORE-Q guidelines). Four themes emerged during data analysis: managing the traumatic stress of the clinical environment in COVID ('it doesn't feel like it's gone away'), post-pandemic trauma ('it was like war, wasn't it?'), bonding over shared trauma ('I was not expecting the camaraderie that developed') and managing trauma after the event ('If something bad happens whilst you're on shift, you just have to pretend like it hasn't happened'). Participants in this study described lasting mental health effects from working clinically during the COVID-19 pandemic that they described as trauma. These effects have lasted since governments worldwide have announced an end to the pandemic, and although participants described bonding over these shared experiences, they continue to have a detrimental impact on workforce well-being and sustainability.

Post COVID-19 infection and quality of life of healthcare workers at Sahloul University Hospital of Sousse in Tunisia

BACKGROUND

Since the COVID-19 pandemic, health care workers (HCWs) faced an enormous physical and mental burden, sometimes altering their quality of life due mainly to persistent challenges stemming from their frontline position.

AIMS

Todetermine the prevalence of post-COVID-19 syndrome, and its impact on the Health-Related Quality of Life (HRQoL) among HCWs.

METHODS

This is an exhaustive cross-sectional study with analytical scope, conducted among all HCWs of the University Hospital Sahloul of Sousse, Tunisia, who have contracted COVID-19 between September 2020 and 30 March 2021 (N=529 cases).The post-covid medical check-up was carried out three months after the acute phase of the COVID-19 infection (December 2020 to June 2021). HRQoL was assessed using the SF-12 (12-item Short Form Health Survey) questionnaire. Bivariate study and multiple linear regressions were performed to identify the different factors influencing the quality of life of HCWs.

RESULTS

During the study period, 529 HCWs were diagnosed with SARS CoV-2 infection, out of them 249 participants were included (47% participation rate). Post covid-19 syndrome was reported in 65% of cases. A low overall quality of life (QoL) score was reported in 28.6% of cases. Low physical and mental composite scores were reported in 34.3% and 29.4% of cases respectively. In the multiple linear regression analysis, gender, post COVID-19 syndrome and time off work were significantly associated with SF12 scores.

CONCLUSION

In our study, HCWs experienced a significant deterioration in HRQoL after COVID-19 with a high incidence of post-COVID-19 syndrome. The need of long-term follow-up after SARS-CoV-2 infection remains essential to support HCWs and mitigate long-term impacts.

Bariatric Surgery and Remission of Metabolic Syndrome: A Meta-analysis of Randomised Controlled Trials and Prospective Studies

BACKGROUND

Studies have discussed the efficacy of bariatric surgery (BS) in remission of individual components of metabolic syndrome (MS). We aimed to analyse the prevalence of MS following BS.

METHODS

On October 5, 2023, we conducted a literature search on PubMed, Scopus, Web of Science, and Cochrane. RevManv5.4 was used for the analysis.

RESULTS

MS patients who underwent BS had lower odds of MS within the first year post-BS (OR 0.14, 95%CI 0.12-0.17); patients who had a preoperative BMI < 50 showed a higher reduction in MS post-BS compared with patients who suffered from super obesity (OR 0.12 versus OR 0.17). Older patients (age > 42) had lower odds of MS post-BS compared with younger patients (OR 0.05 versus OR 0.17). There was not a difference in MS prevalence between 1 and 2 years postoperatively (OR 1.07, 95%CI 0.72-1.58). Asians reported the highest reduction in MS post-BS (OR 0.08). MS patients who received medical treatment had three times the odds of having MS compared with patients who underwent BS. Patients who had BS reported a decline in their anti-hypertensives and oral anti-diabetic drugs (OR 0.26, 95%CI 0.15-0.46, OR 0.11, 95%CI 0.07-0.16, respectively). There was not a significant difference in MS prevalence between patients who underwent RYGB and those who had SG (OR 2.16, 95%CI 0.74-6.26).

CONCLUSIONS

BS is superior to medical treatment in the remission of MS. Age, preoperative BMI, and country of origin affect the rates of MS remission. BS results in a sustainable resolution of MS across 1, 2, and 5 years post-surgery. A tailored approach is warranted to achieve the best outcomes.

Psychometric Properties and Gender Invariance of the Positive Mental Health Scale in Spanish Nurses During the COVID-19 Pandemic

AIM

Positive mental health (PMH) can be considered a key aspect of mental health in the face of potentially stressful healthcare situations such as the COVID-19 pandemic. The aim of this study was to analyse the psychometric properties of the Spanish version of the Positive Mental Health Scale (PMS) in Spanish nurses during the COVID-19 pandemic.

DESIGN

Descriptive analysis, confirmatory factor analysis, gender invariance analysis and convergent and divergent analyses were performed, and reliability indices were calculated.

METHODS

A total of 661 nurses (425 women and 236 men) participated in the study. They completed various questionnaires during August-October 2021.

RESULTS

Factor analysis demonstrated a unidimensional structure with very good indices of model fit, high positive convergent validity, especially with social support, self-efficacy and resilience to suicide attempts, and high divergent validity with anxiety and, to a lesser extent, with depression. There was also strong invariance between genders and high reliability indices. In conclusion, the data show that the PMS has adequate validity and reliability in nurses. Furthermore, this study allows us to confirm gender invariance, which has not been examined in other studies. The data show that PMS is a suitable measure for assessing the mental health of healthcare professionals exposed to high-stress situations.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contributions.

Prevalence of the symptoms of post-traumatic stress disorder (PTSD) and burnout syndrome (BOS) among intensive care unit (ICU) healthcare workers during the COVID-19 pandemic

Pandemic COronaVIrus Disease-19 (COVID-19) was a traumatic event that had a significant impact on the mental health of healthcare workers (HCWs), especially intensive care units (ICUs). Months of exposure and the threat of death can lead to post-traumatic stress disorder (PTSD), and high physical and emotional strain can lead to burnout syndrome (BOS). The purpose of this study was to assess the prevalence of PTSD and BOS among ICU HCWs during the COVID-19 pandemic. A case-control study was conducted in 2022 using a diagnostic survey method with 148 hCWs from two intensive care units: a temporary intensive care unit (tICU, n = 93) and a general intensive care unit (gICU, n = 55) in Cracow, Poland. The Impact of Events Scale (IES-R), Oldenburg Burnout Inventory (OLBI) and a proprietary questionnaire were used. The results obtained indicate that 46.62% (69) of HCWs had pronounced PTSD symptoms. In the tICU HCWs, 47.31% (44) had severe symptoms of PTSD, and in the gICU HCWs, 45.45% (25) were affected. HCWs in the tICU reported the highest score in the Hyperarousal domain (x = 1.52; SD = 0.87), while HCWs from the gICU reported higher scores in the Avoidance domain (xx = 1.45 SD = 0.81). HCWs presented moderate levels of job BOS in the domains of exhaustion (50.68%; 75) and lack of commitment (64.86%; 96). It was shown that lack of commitment to work was significantly more frequent in the tICU group than in the gICU group (p = 0.022). It was shown that the greater the level of exhaustion or withdrawal, the greater the severity of each PTSD symptom. Activity responsibility and fatigue were found to be the most stressful in the workplace. PTSD symptoms co-occurred with BOS. It is necessary to provide employees with targeted psychological support in dealing with the post-pandemic emotional crisis and support the retention of nurses in the profession.

A consolidated framework for implementation research (CFIR) guided exploration of key informant perspectives on establishing a pharmacist-led anticoagulation service in primary care: a qualitative study

BACKGROUND

Globally, pharmacist-led anticoagulation services have improved patient outcomes in secondary and tertiary care settings. However, there is a paucity of literature about establishing such services within primary care settings.

AIM

This study explored key informants' perceptions regarding the systemic and procedural factors influencing development and implementation of a pharmacist-led anticoagulation service in a primary care setting.

METHOD

A descriptive qualitative study was conducted at Qatar's largest primary healthcare institution, the Primary Health Care Corporation (PHCC). Selected key informants, including healthcare center managers, pharmacy leads, physician leads and primary care physicians with cardiology privileges, were purposively recruited. Semi-structured interviews were guided by the Consolidated Framework for Implementation Research (CFIR) and analyzed using framework analysis.

RESULTS

Elven key informants were interviewed. The participants expressed confidence in the feasibility and effectiveness of implementing anticoagulation service in primary care to address patients' needs. Key factors (mapped to CFIR domains) included ensuring pharmacist competency (Characteristics of Individuals), establishing effective internal and external communication (Inner and Outer Setting), and addressing staffing shortages (Inner Setting). Participants also emphasized on developing standardized operational protocols and training programs (Process), as well as integrating services with secondary care (Outer Setting). Despite challenges such as staffing, participants believed the service would effectively address patient needs if adequately supported.

CONCLUSION

The implementation of pharmacist-led anticoagulation services in primary care settings was identified as both feasible and essential for improving patient outcomes. The insights from this study can inform future initiatives aimed at enhancing anticoagulation management in primary care settings.

Promoting real-world evidence use for antimicrobial stewardship in Latin America: evaluation of impact of a two-part educational webinar series

Background

Educational programs on the use of real-world evidence (RWE) in antimicrobial stewardship (AMS) are scarce in Latin America (LATAM).

Objectives

To develop and evaluate an online educational program supporting LATAM healthcare professionals (HCP)'s ability to use and generate RWE for effective antimicrobial agent use, aligned with AMS principles.

Methods

Two 90-min webinars were developed by subject matter experts. Changes in knowledge, skills, confidence and attitudes were measured via paired PRE-and POST-intervention survey questions. Satisfaction, intent to change and remaining barriers were surveyed POST-intervention. McNemar and Wilcoxon Signed Rank statistical tests assessed differences in paired dichotomous and ordinal data, respectively. Unpaired data underwent descriptive analysis. Open-ended responses were subject to thematic content analysis (inductive reasoning approach).

Results

The analysis sample included 741 PRE-intervention survey completers (epidemiologists, infection control specialists, chemists, pharmacists, biologists, microbiologists, bacteriologists and other physicians), with 47 completing the full POST survey (33 following webinar 1, and 14 following webinar 2). A significant increase in the percent of completers who were confident of 'what constitutes RWE' was found PRE (31%) to POST (73%) intervention (P < 0.001). Median self-reported skill levels changed from '2-basic' to '3-intermediate' for providing examples of RWE and applying RWE in the context of AMS (P < 0.05). Barriers included low perceived value of RWE by administrators and limited access to appropriate data.

Conclusions

This education improved HCPs' confidence in knowing what constitutes RWE. Findings provide direction for future interventions aimed at enhancing access to and appropriate use of RWE to inform AMS in LATAM.

Kotter's 8-step change model to improve hand hygiene compliance in intensive care unit: A 41-month prospective longitudinal quality improvement study

BACKGROUND

Despite numerous studies assessing bundled interventions to enhance hand hygiene compliance (HHC), compliance rates persist at suboptimal levels. Our objective was to employ Kotter's Change Model (KCM) to enhance HHC and conduct a comprehensive process evaluation among medical staff within the intensive care unit (ICU).

METHODS

KCM was implemented at the ICU of Zhongnan Hospital of Wuhan University from March 2018 to August 2021, with a 41-month longitudinal monitoring of HHC. The primary outcome focused on the absolute monthly change in HHC. Secondary outcomes encompassed the HHC characteristics across different phases, varying trends in HHC concerning different hand hygiene opportunities and occupations, quarterly incidences of central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI).

RESULTS

This study included 20,222 hand hygiene actions and 24,195 opportunities. The overall HHC was 83.58 % (95 %CI, 83.11 %-84.04 %). Following the KCM implementation, HHC surged from 35.71 % (95 % CI, 22.99 %-50.83 %) to 87.75 % (95 % CI, 85.53 %-89.67 %), reflecting a notable increase of 145.73 %. The most rapid growth in HHC occurred post-patient contact, elevating from 35.29 % to 89.8 %. Despite escalating patient numbers and treatment complexities annually, the quarterly rates of CLABSI (0 ‰-3.53 ‰) and CAUTI (0.96 ‰-4.26 ‰) remained consistently low.

CONCLUSION

Utilizing KCM systematically alters healthcare providers' perception of hand hygiene, fostering an environment that advocates for and sustains improved HHC among ICU personnel.

IMPLICATIONS FOR CLINICAL PRACTICE

The Kotter's change model can be an effective framework for healthcare organizations to systematically improve and maintain hand hygiene compliance among healthcare providers, which can in turn help reduce healthcare-associated infections.

Mental health during the Covid-19 pandemic: An international comparison of gender-related home and work-related responsibilities, and social support

PURPOSE  : To assess gender differences in COVID-19 related changes in home and work responsibilities longitudinally, and determine whether these differences, together with other potential risk and protective factors, are associated with depression, anxiety, and post-traumatic stress disorder (PTSD) symptomatology.

METHOD

Symptoms of depression, anxiety, and PTSD were measured using an online survey instrument, between May 2020 and April 2021, in four waves completed at 3-monthly intervals. Analyses were based on data from the COvid MEntal healTh (COMET) survey which investigated the mental health effects of the COVID-19 outbreak spanning 13 countries on five continents in N = 7,909 participants.

RESULTS

From the first to the last wave, women reported a greater increase in home and work responsibilities, and had higher depression, anxiety and PTSD scores compared to men. Women who reported a reduction in income due to the pandemic had higher depression scores. Working harder and experiencing a reduction in income were also associated with higher anxiety scores in women but not in men. Women were more likely to score above the cut-off for depression (32.5% vs 23.6%, p < .001), anxiety (21.2% vs 14.4%, p < .001) and PTSD (21.2% vs 14.4%, p < .001) than men during the first wave. Stronger reliance on socially supported coping mechanisms was a risk factor for depression, anxiety and PTSD in men and women.

CONCLUSION

Women were more likely to report mental health problems which may be related to the gender disproportionate increase in home and work responsibilities but not necessarily due to COVID-19 stressors.

[Factors associated with health workers' quality of diet during the fight against the COVID-19 pandemic]

The study characterized the quality of the diet of healthcare workers at a teaching hospital in Pelotas-RS, Brazil, after the first peak of the COVID-19 pandemic, between October and December 2020. A cross-sectional study was conducted with 1,159 hospital workers, assessing their food frequency in the last week and examining the association between sociodemographic, behavioral, and occupational factors and the Diet Quality Index using multinomial logistic regression. Female respondents (OR = 1.58), those aged 50 or older (OR = 3.70), with more years of schooling (OR = 1.32), and physically active individuals (OR = 5.37) had better diet quality. Conversely, those with high alcohol consumption (OR = 0.39), support workers (security, cleaning, and maintenance) (OR = 0.36), and those who ate their meals on the street (restaurants, snack bars) (OR = 0.40) had poorer diet quality. During the pandemic, 48.7% reported weight gain, 25% reported a deterioration in diet quality, and 43.1% reported an increase in the quantity of food consumed. The prevalence of overweight was 63.4%. Workers consumed both healthy and unhealthy foods, and the pandemic negatively impacted diet quality.

The relationship between young adults' time use, occupational diversity, and occupational balance

BACKGROUND

Research has shown that work-life balance is not only about job satisfaction and performance. It is also related to a good occupational balance. In this way, a balanced working pattern can improve health. The impact of smartphones, which have become ubiquitous in contemporary society, on this balance is a topic of ongoing debate.

OBJECTIVE

This study aims to investigate the relationship between time use, smartphone use, occupational balance, and occupational self-competence among working young people and university students. The findings of this study may contribute to the development of effective strategies to improve the work-life balance of young people who are either working or about to start their working life.

METHODS

The study involved 158 healthy young adults. The research instruments used included a socio-demographic information form, the Modified Occupational Questionnaire, the Occupational Self-Assessment, and the Turkish Occupational Balance Questionnaire. The results were then analyzed using SPSS 24.0.

RESULTS

A significant relationship was found between the time allocated to sleep and occupational balance (p = 0.009), as well as between the time allocated to work and productive activities and occupational self-competence (p = 0.010). Furthermore, a statistically significant relationship was found between the duration of smartphone usage and occupational balance (p = 0.04).

CONCLUSION

The study emphasizes occupational balance as an important concept for identifying and addressing time use problems among young workers and university students. The study suggests that achieving work-life balance requires consideration of the positive effects of time allocated sleep and the negative effects of smartphone use.

Mental Health Status and the Intention to Leave the Profession of Nurses Employed Across Catalonia, Spain: A Cross-Sectional Study

INTRODUCTION

The relationship between nurses' mental well-being and intention to leave the profession remains a pressing issue.

AIM

To determine the mental health status and the intention to leave the profession of nurses employed across diverse healthcare sectors in Catalonia, Spain.

METHODS

This cross-sectional study included 1051 Registered Nurses in Catalonia, Spain, using convenience sampling through social media platforms and personal contacts. Participants completed four standardised instruments online to measure anxiety, insomnia, depression and posttraumatic stress disorder, along with an ad hoc sociodemographic questionnaire. The methodology of this study was guided by the STROBE checklist.

RESULTS

The analysis revealed that a significant proportion of participants exhibited mental health issues: 44% showed moderate to severe anxiety, 31% experienced moderate to severe insomnia, 40% suffered from moderate to severe depression and 42% had moderate to severe posttraumatic stress disorder. Participants who had worked in COVID hospital units were 1.38 times more likely to experience poor mental health status. Although not all associations were statistically significant, nurses working in primary healthcare, intensive care units and nursing homes had increased odds of poor mental health. Additionally, 53% of participants had reconsidered their working status, with 69% of them expressing an intention to leave the nursing profession.

LIMITATIONS

The evolving nature of the pandemic and the adaptation of healthcare workers to the new scenario may have influenced their experiences during data collection.

IMPLICATIONS

Highlights the increase in mental health-related needs and high rates of psychiatric symptoms among nurses nowadays.

RECOMMENDATIONS

Addressing mental health needs is crucial to mitigate the intention of nurses to abandon the profession.

Tolerating bad health research (part 2): still as many bad trials, but more good ones too

BACKGROUND

We previously published a study examining the risk of bias of a random selection of Cochrane systematic reviews. The purpose of our current study is to reassess the risk of bias of a cohort of Cochrane reviewed trials to see if our reassessment differs from the original Cochrane assessment and to determine whether the funder, having methodological support, or involving a statistician affected the risk of bias.

METHODS

We extracted data from 140 of 159 included trials from three countries, the UK, Canada, and Ireland, in our original cohort. The 19 remaining trials were excluded for a variety of reasons. We recorded the number of participants in the trial, the funder, if a statistician was involved in the trial, if there was any methodological support from a trials unit or clinical research facility, the sponsor, and whether the sponsor was involved in the design or conduct of the trial. The risk of bias of the 140 trials was re-assessed using the same tool as that used by the Cochrane authors.

RESULTS

Our judgement of overall high risk of bias was broadly consistent with the original Cochrane authors. The proportion of high risk of bias trials remained more or less where it was at 55%, but the proportion of low risk of bias trials increased from 9 to 16%. The proportion of unclear risk of bias trials changed accordingly. Compared to the original assessments, we judged more studies to be low risk of bias across all domains. The greatest variation was in the two blinding categories (participants and personnel; outcome assessor) and 'other bias'.

CONCLUSIONS

More than half of trials in our UK, Canada, and Ireland cohort were at high risk of bias highlighting significant challenges in ensuring the integrity and reliability of research findings. Addressing bias in clinical trials is essential to uphold the credibility of scientific research and to ensure that healthcare interventions are based on sound evidence, ultimately improving patient outcomes.

Presenting a model of a healthy lifestyle in the post-COVID-19 era: A qualitative study

BACKGROUND

The pandemic disease of coronavirus disease 2019 (COVID-19) has caused extensive changes in people's lifestyles with its widespread spread. The current research was conducted with the aim of designing a healthy lifestyle model in the post-COVID-19 era.

MATERIALS AND METHODS

The current research is a qualitative study of the grounded theory type, which was performed by the theoretical sampling method in 2022. Data were collected using semi-structured interviews. The researcher reached theoretical saturation by the end of the 15th interview. Data analysis was performed using the coding obtained from interviews with experts, using MAXQDA software 2020.

RESULTS

A total of 189 initial codes were extracted by the researcher, and after removing those repetitive concepts, 154 final concepts were obtained. The result of the axial coding stage was the identification of 36 main categories, which were placed in the six main categories of the paradigmatic model in the selective coding stage. The results of the research led to the presentation of a healthy lifestyle model in the post-COVID-19 era. According to the paradigm model, a healthy lifestyle in the post-COVID-19 era includes five causal factors, 10 contextual factors, seven interventional factors, 10 strategic factors, and finally five outcomes of social health, mental health, physical health, life expectancy, and movement toward development.

CONCLUSION

To achieve a healthy lifestyle, appropriate behaviors based on this model must be promoted at the community level by health policymakers. Additionally, it is important to give special attention to public health and the prevalence of infectious diseases for the practical implementation of this model.

Cardiac Surgery 2024 Reviewed

For the 11th consecutive time, we systematically reviewed the cardio-surgical literature for the past year (2024), using the PRISMA approach for a results-oriented summary. In 2024, the discussion on the value of randomized and registry evidence increased, triggered by consistent findings in the field of coronary artery disease (CAD) and discrepant results in structural heart disease. The literature in 2024 again confirmed the excellent long-term outcomes of CABG compared with PCI in different scenarios, generating further validation for the CABG advantage reported in randomized studies. This has been reflected in the new guidelines for chronic CAD in 2024. Two studies indicate novel perspectives for CABG, showing that cardiac shockwave therapy in CABG improves myocardial function in ischemic hearts and that CABG guided by computed tomography is safe and feasible. For aortic stenosis, an early advantage for transcatheter (TAVI) compared with surgical (SAVR) treatment has found more support; however, long-term TAVI results keep being challenged, this year by new FDA and registry data in favor of SAVR. For failed aortic valves, redo-SAVR showed superior results compared with valve-in-valve TAVI. In the mitral field, studies showed short-term noninferiority for transcatheter treatment compared with surgery for secondary mitral regurgitation (MR), and significant long-term survival benefit in registries with surgery for primary MR. Finally, surgery was associated with better survival compared with medical therapy for acute type A aortic intramural hematoma. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation but provides up-to-date information for patient-specific decision-making.

Prediction models for sleep quality among frontline medical personnel during the COVID-19 pandemic: cross-sectional study based on internet new media

Background

The factors associated with sleep quality among medical personnel providing support on the frontline during the height of the COVID-19 pandemic remain unclear, and appropriate predictive and screening tools are lacking. This study was designed and conducted to investigate whether factors such as weight change, job title, and tea consumption influence the sleep quality of these workers. Additionally, the study aims to develop predictive models to analyze the sleep problems experienced by healthcare workers during periods of epidemic instability, and to provide relevant data and tools to support effective intervention and prevention strategies.

Methods

A cross-sectional study was conducted from June 25 to July 14, 2022, using a self-administered general information questionnaire and the Pittsburgh Sleep Quality Index (PSQI) to investigate the sleep quality of medical personnel providing aid in Shanghai. The relevant influencing factors were obtained via univariate analysis and multivariate stepwise logistic regression analysis, and 80% of the data were used in the training-test set (n = 1,060) and 20% were used in the independent validation set (n = 266). We used snowball sampling to establish the six models of logistics (LG), deep learning (DL), naïve Bayes (NB), artificial neural networks (ANN), random forest (RF), and gradient-boosted trees (GBT) and perform model testing.

Results

Among the participants, 75.8% were female. Those under 35 years of age comprised 53.7% of the medical staff, while those over 35 years accounted for 46.3%. The educational background of the participants included 402 individuals with an associate degree (30.3%), 713 with a bachelor's degree (53.8%), and 211 with a master's degree or higher (15.9%).Weight, job title, and tea consumption during the aid period were the main factors influencing the sleep quality of medical personnel during the aid period. The areas under the curve (AUC) of LG, DL, NB, ANN, RF, and GBT were 0.645, 0.656, 0.626, 0.640, 0.551, and 0.582, respectively. The DL model has the best prediction performance (specificity = 86.1%, sensitivity = 45.5%) of all the models.

Conclusion

During the height of the COVID-19 pandemic, the sleep quality of frontline medical personnel providing aid in Shanghai was influenced by multiple factors, and the DL model was found to have the strongest overall predictive efficacy for sleep quality.

Targeting metabolic diseases with celastrol: A comprehensive review of anti-inflammatory mechanisms and therapeutic potential

ETHNOPHARMACOLOGICAL RELEVANCE

Tripterygium wilfordii is a traditional Chinese medicine used to treat rheumatic diseases, with properties such as clearing heat, detoxifying, dispelling wind, and relieving pain. In recent years, its active compound, celastrol, garnered significant attention for its potential therapeutic effects on metabolic diseases. Celastrol exhibits bioactivities such as regulating metabolic functions and anti-inflammatory effects, positioning it as a promising candidate for the treatment of obesity, diabetes, atherosclerosis (AS), and non-alcoholic fatty liver disease (NAFLD).

AIM OF THE REVIEW

This review aims to explore the pharmacological mechanisms of celastrol in metabolic diseases, focusing on its anti-inflammatory mechanisms and metabolic regulation effects, providing theoretical support for further investigation of its therapeutic potential in metabolic diseases.

METHODS

Literature was retrieved from PubMed, Web of Science, Scopus, Cochrane, and Google Scholar. This review primarily focuses on anti-inflammatory mechanisms of celastrol, its metabolic regulation, and toxicity studies, by systematically analyzing its effects in obesity, diabetes, AS, and NAFLD, providing scientific evidence for its potential clinical applications.

RESULTS

Celastrol regulates multiple signaling pathways, particularly inhibiting NF-κB and activating AMPK, reducing the production of pro-inflammatory cytokines and improving insulin sensitivity, enhancing its therapeutic potential in metabolic diseases. Additionally, celastrol regulates adipogenesis and energy metabolism by influencing key transcription factors such as PPARγ and SREBP-1c. Numerous studies highlight its role in alleviating oxidative stress and improving mitochondrial function, further enhancing its metabolic benefits.

CONCLUSION

In summary, celastrol holds great promise as a multi-target therapeutic agent for metabolic diseases, offering anti-inflammatory, metabolic regulatory, and antioxidative benefits. Despite these, challenges remain for the clinical application of celastrol due to its poor bioavailability and potential toxicity. Advanced formulation strategies and targeted delivery systems are urgently needed to overcome challenges related to bioavailability and clinical translation.

Exploring the profile and risk factors associated with self-harm ideation and behaviors in adolescents with high psychoticism

Background

As a core personality trait closely linked to mental health outcomes, psychoticism warrants particular attention in adolescent populations. The association between elevated psychoticism levels and self-harm ideation and behaviors (SIB) remained insufficiently characterized, especially regarding specific risk profiles. This study aims to delineate SIB characteristics and identify risk factors among adolescents with high psychoticisme.

Methods

In this large scale cross-sectional study, 6,027 adolescents aged 16-18 years scoring ≥70th percentile on the psychoticism dimension (Revised Short Form of the Eysenck Personality Questionnaire, EPQ-RSC) were recruited from 63 schools. Data on demographic characteristics and SIB patterns were collected via standardized electronic questionnaires through a secure online platform. Binary logistic regression analyses with adjusted odds ratios (aOR) identified significant SIB predictors.

Results

Adolescents with high psychoticism demonstrated striking SIB prevalence patterns: 62.8% reported life meaninglessness, 47.2% expressed death wishes, and 34.7% acknowledged suicidal/NSSI ideation within the past year, with 27% specifically endorsing such ideation within the past month. Actual self-harm rates were 4.7% (lifetime), 1.64% (past year), and 0.37% (past month). Predominant triggers included family conflicts (32.9%), while primary motives centered on pain alleviation (51%). SIB incidence showed significant dose-response relationship with psychoticism severity (p<0.05). Rural residency (aOR=1.32, 95% CI 1.04-1.675) and typical high psychoticism (aOR=1.509, 95% CI 1.16-1.963) emerged as key risk factors. Increasing age conferred significant protection against self-harm ideation (aOR=0.687, 95% CI 0.627-0.753), whereas female sex demonstrated differential risk modulation patterns across SIB (lifetime self-harm behavior aOR=2.053 vs. past-month self-harm ideation aOR=0.648).

Conclusion

Our findings highlight the critical need for targeted interventions addressing modifiable determinants. Prioritizing female adolescents and those with higher psychoticism traits is recommended, supported by evidence-based family psychoeducation programs and enhanced accessibility of community mental health services with specific focus on emotion regulation training.

Physical Activity and Mental Health After COVID-19 Recovery: Age and Sex Differences

(1) Background: The relationship between physical activity (PA) and mental health remains a topic of significant interest, particularly in populations recovering from COVID-19. This study aimed to examine the differences in PA levels and mental health parameters (anxiety, depression, and stress) across sex and age groups following COVID-19 recovery; (2) Methods: The sample of participants (n = 288) was selected using a random sampling method and consisted of participants of different ages and both sexes. Participants' self-reported PA was assessed using the International Physical Activity Questionnaire (IPAQ), while the Depression, Anxiety, and Stress Scale (DASS) was used to measure negative emotional states. The influence of COVID-19 recovery on PA and mental health (depression, anxiety, stress) was analyzed using MANOVA and follow-up univariate tests by age and sex. Statistical significance was set at p < 0.05, with SPSS (v23.0) used for data analysis; (3) Results: A statistically significant difference was observed between the initial and final measurements in PA levels (Wilk's Lambda = 0.95; p = 0.000) and mental health (Wilk's Lambda = 0.96; p = 0.000) with older individuals-particularly women-demonstrating improved PA levels and better mental health outcomes. In contrast, younger women exhibited a decline in both domains, with increased anxiety, depression, and stress symptoms. While younger men showed increased PA, their mental health parameters were slightly elevated, though still within normal ranges; (4) Conclusions: Our findings suggest that older individuals were better adapted to post-COVID challenges due to maturity and life experience, while younger populations may require additional support. The study underscored the complexity of the PA-mental health relationship and highlighted the need for further research, particularly among younger individuals recovering from COVID-19.

Psychometric properties and validity of inventory of symptoms of professional traumatic grief among nursing professionals

BACKGROUND

Traumatic grief can exert a considerable influence on the mental and physical well-being of nurses, potentially altering their ability to provide high quality care. This impact is most pronounced in specific contexts such as health emergencies, palliative care and paediatric intensive care units. In the context of the Covid-19 pandemic, health professionals have faced an unprecedented increase in loss and trauma, and this situation is seen as an exacerbating factor in complicated bereavement. Despite the availability of instruments for the assessment of prolonged or pathological grief, there is a pressing need for additional studies that allow for a more accurate understanding and measurement of this phenomenon, filling certain existing methodological gaps. The main purpose of this research is to evaluate the psychometric properties of the Inventory of Symptoms of Professional Traumatic Grief (ISDUTYP), with a view to improving assessment tools in this field.

METHOD

Construct validity, reliability, criterion validity, convergent validity and discriminant validity were assessed. The scale's psychometric properties were tested with 930 nursing professionals. The data were collected between September 2022 and January 2023.

RESULTS

A total of 930 people took part in the study. The factorial analysis of ISDUTYP showed that, according to eigenvalues and the scree plot, the optimal number of factors was 2. These factors consisted of 13 and 12 items, respectively, and had clinical significance. Factor 1 could be termed "Behavioural Symptoms," while Factor 2 could be termed "Emotional Symptoms." Cronbach's alpha values demonstrated excellent reliability for all scores. In particular, Cronbach's alpha was 0.964 for the overall score, 0.950 for the behavioural symptoms subscale, and 0.950 for the emotional symptoms subscale. Regarding criterion validity, all expected correlations were statistically significant. Finally, almost all hypotheses defined of convergent and discriminant validity were fulfilled.

CONCLUSIONS

The high reliability and validity of the scale supports its use in research and clinical practice to assess the impact of professional traumatic grief and enhance its treatment. The validated scale for measuring nurses' grief has significant implications in clinical practice, allowing for the identification and management of nurses' grief, fostering a healthy work environment, and improving patient care quality.

Effect of the coronavirus disease 2019 pandemic on beliefs and practices regarding hand hygiene among intensive care nurses: A repeated cross-sectional study

Hand hygiene is an important factor in the prevention of healthcare-associated infections. Studies show healthcare professionals' hand hygiene practices vary and are not at sufficient levels. This study aimed to examine the effect of the COVID-19 pandemic on the beliefs and practices of nurses working in intensive care units (ICU) towards hand hygiene. This was longitudinal, repeated, and cross-sectional study. The study was conducted in 2 phases between January 2,2020 and March 10,2021 in the intensive care unit of a university hospital in northern Turkey. No sampling method was used. The objective was to reach the entire population. The first phase of this study was completed with 119 (76% of the population) ICU nurses and the second phase with 85 (70% of the population) ICU nurses. The data were collected with the personal information form, hand hygiene belief scale (HHBS), hand hygiene practices inventory (HHPI) and the views of the intensive care nurses related to COVID-19. Descriptive statistics such as mean and standard deviations, frequency, and percentages and analytical statistics such as t-test, Mann-Whitney U test, Kruskal-Wallis test were used for data analysis at the significance level of P < .05. The majority of the nurses who participated in the study were female (75.6%; 69.4%), with a mean age of 30.82 ± 5.51 and 30.58 ± 5.51 years, respectively. There was a significant difference (P < .05) between the median HHBS (P = .002) and HHPI (P = .001) scores before and after COVID-19. All nurses (100%) reported that the pandemic was effective in hand hygiene practices. In this study, it was determined that the hand hygiene beliefs and practices of nurses were high, and the scores of nurses' hand hygiene beliefs and practices after COVID-19 increased significantly. Healthcare professionals must always adhere to stringent standards of hand hygiene, rather than merely during periods of heightened challenges. To ensure the sustainability of optimal hand hygiene practices, it is recommended that motivational interventions that strengthen beliefs and practices related to hand hygiene should be implemented and that studies should be conducted to evaluate their effectiveness.

Differences in biomarker levels and proteomic survival prediction across two COVID-19 cohorts with distinct treatments

Prognostic biomarkers have been widely studied in COVID-19, but their levels may be influenced by treatment strategies. This study examined plasma biomarkers and proteomic survival prediction in two unvaccinated hospitalized COVID-19 cohorts receiving different treatments. In a derivation cohort (n = 126) from early 2020, we performed plasma proteomic profiling and evaluated innate and complement system immune markers. A proteomic model based on differentially expressed proteins predicted 30-day mortality with an area under the curve (AUC) of 0.81. The model was tested in a validation cohort (n = 80) from late 2020, where patients received remdesivir and dexamethasone, and performed with an AUC of 0.75. Biomarker levels varied considerably between cohorts, sometimes in opposite directions, highlighting the impact of treatment regimens on biomarker expression. These findings underscore the need to account for treatment effects when developing prognostic models, as treatment differences may limit their generalizability across populations.

Direct and Indirect Effects of Risk Perception and Risk Information on PTSD in Frontline Healthcare Workers

Background

The COVID-19 Delta variant caused an outbreak in Guangdong in mid-May 2021. The risk information and risk perception of COVID-19 have been considered factors associated with mental health statuses, especially posttraumatic stress disorder (PTSD), in frontline healthcare workers.

Objective

The aim of this study is to investigate the interactive relationship in risk information and risk perception of COVID-19 and PTSD in healthcare personnel from the emergency department.

Design

We conducted a survey one month after the outbreak. A cross-sectional survey design is adopted, and 3078 participants are enrolled. The PTSD checklist for DSM-5 (PCL-5), risk information questionnaire, and risk perception questionnaire are utilized to collect data.

Methods

Bivariate correlation analysis and structural equation modelling are performed to analyze the mediating role of risk perception in the relationship between risk information and PTSD.

Results

The estimated prevalence of PTSD among frontline healthcare workers is 28.2%. The risk information for COVID-19, risk perception, and PTSD symptoms are mutually correlated. The specific paths from risk perception to PTSD show significant effects, in which two had negative effects and one had a positive effect. The risk perception feature in 2020 differed from that in 2019, which is largely due to the risk perception of the virus.

Conclusion

The estimated prevalence of PTSD among frontline healthcare workers remains high. Risk information for COVID-19 has dual effects on PTSD through the mediation of risk perceptions. Unfamiliarity with the SAR-COVID-2 Delta variant increased the risk perception of COVID-19. Effective risk communication regarding COVID-19 can have a positive effect on the mental health of frontline healthcare workers.