Prophylactic proton pump inhibitor usage and new-onset acute kidney injury in critically ill patients: a retrospective analysis

Background

Proton pump inhibitors (PPIs) are widely prescribed for stress ulcer prophylaxis (SUP) in intensive care unit (ICU) patients. However, the potential association between prophylactic PPIs and the development of new-onset acute kidney injury (AKI) remains unclear.

Methods

Patients without AKI or end-stage renal disease and not undergoing renal replacement therapy upon admission to the ICU were identified from the Medical Information Mart for Intensive Care (MIMIC-IV) database. The exposure factor for the study was the initiation of prophylactic PPIs within 48 h of admission, with the primary outcome being the occurrence of new-onset AKI after 48 h. Multivariable regression models were employed to investigate the association between prophylactic PPIs and the risk of new-onset AKI. Various propensity score analyses, along with stratified and subgroup analyses and E-value calculations, were conducted to further evaluate the reliability of the results.

Results

A total of 7498 ICU patients were analyzed. The multivariable analysis showed a higher incidence of new-onset AKI in the PPI group (30.7%) compared with the control group (24.1%), yielding an adjusted odds ratio (OR) of 1.43 (95% confidence interval 1.22-1.67). Propensity score analyses confirmed these results, with ORs ranging from 1.34 to 1.49 (P ≤ .005). Results from multiple sensitivity analyses further supported these findings, with an E-value of 2.34 indicating robustness against unmeasured confounders.

Conclusions

Prophylactic PPI use is associated with an increased risk of new-onset AKI in ICU patients. Indiscriminate use of PPIs should be avoided.

Psychosocial status and COVID-19 outcome are significantly associated

Covid-19 pandemic raised both physical and mental threat to human. Globally, 607,497,755cases of infection and 6,492,948 deaths were recorded until August, 2022. The psychosocial-conditions in pre-infection-period might influence disease. Here, we delineate the impact of socio-economic status, pre- or post- Covid-19 psychosocial and other factors (lockdown/self-isolation/diagnosis)on this disease outcome. Pre-Covid mental-status (depression-anxiety, tobacco-smoking and suicide-mortality), quality-of-life (QOL) and Global-Health-Security (GHS) were correlated with total-infection and case-fatality-rate (CFR) in > 170 countries. The database of World-Health-Organization/World-Bank/United-Nations and the Johns-Hopkins-Center for Health-Security was utilized. The Student's t test, multivariate-ANOVA, correlation and linear-regression were performed. Psychological wellbeing indicators (happiness/GSH/QOL) and mental-impairments like depression-anxiety positively correlated with infection and CFR (p < 0.05-p < 0.001). The happiness-index positively associated with QOL/GSH/anxiety and depression. Higher CFR was noticed in congested/populated territories. Canonical regression strongly suggests this result. Variable host-virus interactions associated with race/ethnicity and body-composition. Positive correlations between mental state-QOL and anxiety-depression paralleled with adverse outcome of Covid-19.

The underlying mechanisms of family function on anxiety among nurses during the public health emergency

The occurrence of public health emergency in China often makes nurses more susceptible to anxiety. The present study aimed to investigate the prevalence of anxiety among Chinese nurses during the public health emergency and explore the association between family function and anxiety and its underlying mechanisms. Family care index questionnaire, Connor-Davidson Resilience scale, physical activity rating scale and 7-item Generalized Anxiety Disorder Scale were employed to measure family function, resilience, physical activity and anxiety among 779 Chinese nurses during public health emergency. The prevalence of anxiety among nurses during public health emergency was 29.9%. Resilience partially mediated the association of anxiety with family function. Physical activity moderated the direct and indirect effects of family function on anxiety. The direct effect became insignificant when the standard scores of physical activity were 0.629 and over. In contrast, the indirect effect of family function on anxiety through resilience was stronger when the levels of physical activity increased. The present study suggested for nurses with low levels of physical activity, intervention enhancing family function should be designed to prevent anxiety. For those with higher levels of physical activity, programs aimed at strengthening family function and supporting resilience should be developed to manage anxiety.

Gender Differences in Coping Strategies and Life Satisfaction Following Cognitive-Behavioral and Mindfulness-Based Intervention for Crohn's Disease: A Randomized Controlled Trial

Background and Objective: Crohn's Disease (CD) is a chronic inflammatory condition with significant physical and psychological impacts, often requiring comprehensive self-management. This study examines the effects of COBMINDEX (Cognitive-Behavioral and Mindfulness Intervention with Daily Exercise) on coping strategies and life satisfaction in CD patients, focusing on gender-specific responses. Study objectives were to assess the impact of COBMINDEX on adaptive and maladaptive coping strategies and life satisfaction in CD patients, and to examine gender differences in these outcomes. Materials and Methods: A pre-planned secondary analysis of a randomized controlled trial, conducted from 2018 to 2021, at two public tertiary hospitals in Israel. A total of 120 CD patients (45 men and 75 women) were randomly assigned to either theCOBMINDEX group or a wait-list control group. Participants were assessed at baseline and post-intervention for coping strategies, mindfulness, psychological symptoms, and life satisfaction using validated scales. Quantile regression explored the gender-specific predictors of life satisfaction. This study was registered at ClinicalTrials.gov (NCT05085925) and Israel Ministry of Health (MOH_2020- 02- 24_008721. asp). Results: Both genders showed significant improvements in mindfulness, emotion-focused coping, and active coping (p < 0.05). Women exhibited reduced dysfunctional coping and greater emotional support use. For men, emotion-focused coping and mindfulness positively predicted life satisfaction, while for women, reductions in psychological symptoms and dysfunctional coping were significant predictors (p < 0.01). Conclusions: COBMINDEX enhances coping strategies and life satisfaction in CD patients, with notable gender differences. These findings highlight the importance of gender-tailored psychological interventions to improve overall patient well-being.

Prospective Audit and Feedback of Targeted Antimicrobials Use at a Tertiary Care Hospital in the United Arab Emirates

Background/Objectives: Antimicrobial stewardship programs improve antimicrobial use and help combat antimicrobial resistance. The Infectious Disease Society of America's (IDSA) recommended core interventions include prospective audit and feedback along with formulary restriction and preauthorization. IDSA recommends any one of these interventions be implemented in acute care hospitals to improve antimicrobial stewardship. The objective of this project was to implement a prospective audit and feedback system using selected antimicrobials at a tertiary care hospital in the United Arab Emirates as the foundation to build an antimicrobial stewardship program. Results: A total of 497 patients met the inclusion and exclusion criteria during the study period; the post-intervention group had 260 patients, and the control group had 237 patients. After the implementation of the program, a total of 186 interventions were recommended, and 76% were accepted. The length of stay, length of therapy, and days of therapy were lower in the intervention group compared to the control group (p < 0.05). There was no statistically significant difference in clinical outcome measures (e.g., 30-day readmission, 30-day all-cause mortality, 30-day emergency visit with the same infection, and 60-day readmission). Methods: This single-center quasi-experimental research was conducted from August 2023 to July 2024. A pharmacist-led prospective audit and feedback system was initiated in February 2024 after review and approval of the medical staff, in addition to formulary restrictions. Data from patients receiving the selected antimicrobial before February 2024 were collected from their charts and related medical records without any intervention; this was used by our control group. After implementation, the hospital pharmacy's records were evaluated during the night shift to determine whether they met the inclusion criteria. The records of the eligible patients were then evaluated by the clinical pharmacist. In case of antimicrobial inappropriateness, feedback was provided to the prescriber. If the recommendation was not accepted, succeeding reviews and feedback were provided on subsequent days. The effectiveness of the intervention was measured using clinical and antibiotic use measures. Conclusions: Implementation of a pilot pharmacist-led antimicrobial stewardship program resulted in modification in antimicrobial use measures (i.e., defined daily doses of targeted antimicrobials and days of antimicrobial therapy) without an increase in length of stay or readmissions or mortality.

Effectiveness of psychological crisis interventions during infectious disease outbreaks in low- and middle-income countries: a systematic review of Randomized Control Trials

The huge mental health treatment gap in low- and middle-income countries (LMICs) is further exacerbated when infectious disease outbreaks occur. To address the increasing mental health needs during outbreaks, the availability of flexible and efficient mental health interventions is paramount, especially in low-resource settings where outbreaks are more common. Psychological interventions may help to address these mental health needs with efficient implementation costs. However, there is a huge paucity of quality evidence to inform psychosocial interventions during outbreaks. This systematic review sought to update the existing evidence to inform the effectiveness of psychological interventions that addresses mental health issues during outbreaks in LMICs. Six electronic databases were searched - Scopus, PubMed, PsycINFO, Embase, Cochrane library and CINAHL. We included randomised controlled trials of psychological interventions aimed to address common mental health conditions among adults affected by infectious disease outbreaks in LMICs. Studies were excluded if they were done among all age groups, used mixed interventions with pharmacotherapies, addressed severe mental health conditions and were published other than in English. The quality of evidence in the included trials was assessed using the Cochrane Collaboration risk of bias tool. We included 17 trials that examined the effectiveness of psychological interventions among outbreak-affected adults in LMICs. The quality of studies was generally average but tended to provide evidence that brief psychoeducational interventions based on cognitive restructuring, mindfulness, relaxation and stress management techniques were effective in reducing perceived stress and anxiety symptoms, and in improving resilience and self-efficacy. Similarly, mindfulness-based interventions and mindfulness stress reduction treatments were effective in addressing depression, anxiety and generalised anxiety disorder. Brief psychological interventions that can be delivered by non-specialists could have value in addressing the huge mental health needs in outbreak contexts.

Health workers' conceptualisationand experiences of common mental symptoms and work-related psychosocial stressors in Central and Southern Ethiopian regions: a qualitative study

OBJECTIVES

Despite the growing recognition of mental health challenges among health workers, limited information regarding their self-identification of common mental symptoms (CMSs) and their perceptions of causal pathways to work-related psychosocial stressors exists. This study aimed to explore how health workers recognise CMSs, perceive their exposure to work-related psychosocial stressors, conceptualise causal pathways, evaluate the impact of these stressors on the professional quality of life (PQoL), employ coping strategies and encounter barriers to mitigating stressors and seeking support.

DESIGN AND SETTINGS

Our study employed an interpretive and descriptive phenomenological approach, informed by theoretical frameworks. We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) with purposely selected health workers between January and February 2023. Interviews were audio recorded, transcribed and translated into English. Data was processed and analysed using MAXQDA 2020 software, with thematic findings supported by illustrative participants' quotations.

PARTICIPANTS

The study included 34 health workers who participated in 10 IDIs and three FGDs.

RESULTS

Five themes emerged from the study, guided by combined theoretical frameworks: (1) conceptualisation of occupational stress, anxiety and depression symptoms; (2) exposure to work-related stressors; (3) perceived impact of work-related stressors on PQoL; (4) experiences with coping strategies; and (5) barriers to mitigating stressors and seeking support. Accordingly, our findings revealed a low self-identification with CMSs (SICMSs), an increased perception to link work-related stressors with CMSs and their negative impact on PQoL, limited use of adaptive coping strategies and the presence of multiple barriers to effective coping and support-seeking practices among health workers across the respective themes.

CONCLUSIONS

The findings of this study highlight the need for targeted interventions, including updated training on CMSs, addressing resource-related stressors, improving workplace communication and conflict resolution, enacting policy reforms to ensure equitable compensation and promoting adaptive coping strategies to enhance health workers' mental well-being and their PQoL. Furthermore, we advocate for a more robust exploration of the perceived causal link supported by lived experiences of health workers with chronic occupational stress, occupational depression and occupational anxiety to provide stronger evidence using longitudinal qualitative and quantitative studies.

What is behind the high turnover intention among hospital nurses during the full liberalization of COVID-19 and the postpandemic era in China: a 2-wave multicentre cross-sectional comparison study

BACKGROUND

The COVID-19 pandemic has posed unprecedented challenges to the nursing profession, exacerbating occupational stress, attrition rates, and staffing shortages. Although prior studies have examined factors influencing nursing turnover intention, no research has compared turnover intention among Chinese hospital nurses during the full liberalization of COVID-19 and the postpandemic era. The aim of this study was to investigate the prevalence and associated factors of turnover intention during these two critical periods.

METHOD

A 2-wave multicentre cross-sectional online survey was conducted in 25 hospitals in Guangdong, China. Data were collected during the full liberalization of COVID-19 (T1: 27 December 2022 to 7 January 2023, N = 1,766) and the postpandemic era (T2: 11 May to 23 May 2023, N = 2,643). A structured questionnaire was used to assess sociodemographic and work-related factors, such as perceived stress (10-item Perceived Stress Scale), depression (9-item Patient Health Questionnaire), anxiety (7-item Generalized Anxiety Disorder), insomnia (Insomnia Severity Index), intolerance of uncertainty (Intolerance of Uncertainty Scale), life satisfaction (Satisfaction with Life Scale), and turnover intention (Turnover Intention Scale). Statistical analyses, including descriptive statistics, chi-square tests, Pearson correlation, binary and multiple logistic regression, and hierarchical regression, were performed using SPSS 26.0.

RESULTS

The prevalence rates of turnover intention were 73.33% and 72.34% at T1 and T2, respectively. Dissatisfaction with nursing work (aOR: 2.393-8.659, Ps < 0.001), lack of interest in nursing (aOR: 2.713-3.077, Ps < 0.001) and depression (aOR: 1.437-2.113, Ps < 0.05) were associated with an increased risk of turnover intention. In addition, life satisfaction (aOR: 0.282-0.687, Ps < 0.05) was associated with a reduced risk of turnover intention.

CONCLUSIONS

Turnover intention among hospital nurses remained alarmingly high during both the full liberalization of COVID-19 and the postpandemic era. Dissatisfaction with work, lack of interest in nursing, and depression were significant risk factors, whereas life satisfaction served as a protective factor. Early identification of turnover intention and targeted interventions are essential to address these challenges and improve nurse retention during and after public health crises.

CLINICAL TRIAL NUMBER

Not applicable.

Machine learning selection of basement membrane-associated genes and development of a predictive model for kidney fibrosis

This study investigates the role of basement membrane-related genes in kidney fibrosis, a significant factor in the progression of chronic kidney disease that can lead to end-stage renal failure. The authors aim to develop a predictive model using machine learning techniques due to the limitations of existing diagnostic methods, which often lack sensitivity and specificity. Utilizing gene expression data from the GEO database, the researchers applied LASSO, Random Forest, and SVM-RFE methods to identify five pivotal genes: ARID4B, EOMES, KCNJ3, LIF, and STAT1. These genes were analyzed across training and validation datasets, resulting in the development of a Nomogram prediction model. Performance metrics, including the area under the ROC curve (AUC), calibration curves, and decision curve analysis, indicated excellent predictive capabilities with an AUC of 0.923. Experimental validation through qRT-PCR in clinical samples and TGF-β-treated HK-2 cells corroborated the expression patterns identified in silico, showing upregulation of ARID4B, EOMES, LIF, and STAT1, and downregulation of KCNJ3. The findings emphasize the importance of basement membrane-related genes in kidney fibrosis and pave the way for enhanced early diagnosis and targeted therapeutic strategies.

A hybrid inception-dilated-ResNet architecture for deep learning-based prediction of COVID-19 severity

Chest computed tomography (CT) scans are essential for accurately assessing the severity of the novel Coronavirus (COVID-19), facilitating appropriate therapeutic interventions and monitoring disease progression. However, determining COVID-19 severity requires a radiologist with significant expertise. This study introduces a pioneering utilization of deep learning (DL) for evaluate COVID-19 severity using lung CT images, presenting a novel and effective method for assessing the severity of pulmonary manifestations in COVID-19 patients. Inception-Residual networks (Inception-ResNet), advanced hybrid models known for their compactness and effectiveness, were used to extract relevant features from CT scans. Inception-ResNet incorporates the dilated mechanism into its ResNet component, enhancing its ability to accurately classify lung involvement stages. This study demonstrates that dilated residual networks (dResNet) outperform their non-dilated counterparts in image classification tasks, as their architectural designs allow the systems to acquire comprehensive global data by expanding their receptive fields. Our study utilized an initial dataset of 1548 human thoracic CT scans, meticulously annotated by two experienced specialists. Lung involvement was determined by calculating a percentage based on observations made at each scan. The hybrid methodology successfully distinguished the ten distinct severity levels associated with COVID-19, achieving a maximum accuracy of 96.40%. This system demonstrates its effectiveness as a diagnostic framework for assessing lung involvement in COVID-19-affected individuals, facilitating disease progression tracking.

COVID-19 Pandemic Impact on Sickness Absences Among Healthcare Workers: A Cohort Study in a Spanish Hospital (2018-2023)

BACKGROUND

Like other European systems, the Spanish national health system (NHS) is reaching a critical point. This article analyses sickness absence (SA) trends, as a direct indicator of this crisis, among healthcare workers (HCWs) in Spain, comparing the pre-pandemic, pandemic, and post-pandemic periods.

METHODS

This study was based on a retrospective cohort of HCWs (n=7.918) hired at Hospital del Mar in Barcelona for at least three months during 2018-2023. The primary outcome was incident SA episodes. Incidence rates (IR) per 1,000 persons-day and 95% confidence intervals (95% CI) were calculated by sex, period, and occupational variables. Longitudinal entropy regression models were estimated to identify the factors influencing the frequency of transitions between the different HCWs' employment states (active or on SA).

RESULTS

Increasing trends in IR (95%CI) were observed, rising from 1.77 (1.71; 1.83) episodes of SA per 1,000 workers-day during the pre-pandemic period to 5.04 (4.93; 5.15) during the post-pandemic among women, and from 1.23 (1.14; 1.31) to 3.79 (3.64; 3.95), respectively, among men. Nurses, nurse aides, orderlies/technicians, workers under 30, and those in intensive care units and emergency rooms showed the highest IR during and after the pandemic, with longitudinal entropy analysis revealing increased state changes, primarily affecting these groups.

CONCLUSIONS

This study demonstrates a significant rise in SA incidence among HCWs during and after the pandemic and identifies vulnerable groups with higher incidence. Several hypotheses, such as poor working conditions, burnout, and patient complexity, have been suggested to explain these results. Urgent interventions are needed to safeguard HCWs' health, thus maintaining the sustainability and safety of the NHS.

Deep vein thrombosis in patients with patellar fractures: Assessing incidence rates and identifying risk factors

BACKGROUND

Deep Vein Thrombosis (DVT) represents a significant complication following orthopedic injuries, particularly patellar fractures. Despite the prevalence, comprehensive studies assessing the incidence rates and identifying specific risk factors in patellar fracture patients are limited.

METHODS

This retrospective analysis reviewed electronic medical records from 3311 patients treated for patellar fractures at two tertiary hospitals between November 2013 and January 2023. The study focused on patient demographics, fracture characteristics, comorbidities, and laboratory parameters to evaluate the incidence and predictors of DVT. DVT prophylaxis measures and diagnostic criteria, including Doppler Ultrasound Scans, were rigorously applied.

RESULTS

In patients with patellar fractures, the DVT incidence was 30.8%, with 1,790 clots identified in 1,021 diagnosed individuals, predominantly on the injured side (96.7%), and a minor portion on the uninjured side (3.2%). Key risk factors included older age (P<0.001, OR = 1.038), the presence of open injuries (P = 0.002, OR = 1.521), multiple injuries (P<0.001, OR = 3.623), and prolonged time from injury to surgical treatment (P<0.001, OR = 1.097). Conversely, higher levels of albumin (ALB) (P = 0.029, OR = 0.983) and sodium (Na) (P = 0.028, OR = 0.971) were identified as protective factors against DVT. Besides, ROC curve analysis revealed that the age of 52 years and a duration of 4 days from injury to surgery serve as predictive cut-off values for assessing the risk of DVT.

CONCLUSION

Our study investigates the incidence of thrombosis in patellar fracture patients and identifies key risk factors for DVT, including age, open and multiple injuries, and the time from injury to surgery. Additionally, we highlight sodium and albumin levels as protective factors. By establishing threshold values for age and surgical delay, our findings improve DVT risk assessment, facilitating earlier and more targeted interventions.

Acute stress exposure in healthy oil and gas field workers and early post-traumatic stress disorder symptoms: A lesson from the COVID-19 crisis

INTRODUCTION

During the COVID-19 pandemic, the oil and gas industry had to adopt coping strategies. These changes might contribute to early increased mental health issues among workers. This study aimed to assess the prevalence and associated factors to early post-traumatic stress disorder (PTSD) symptoms among healthy Indonesian oil and gas field workers during the COVID-19 pandemic.

METHOD

A cross-sectional study was conducted from November 2020 to January 2021. We investigated healthy field employees working during the pandemic. Data on the subjects' PTSD symptoms were collected using the PTSD Checklist-Civilian (PCL-C) Version.

RESULTS

A total of 1542 completed forms were analyzed. The prevalence of PTSD symptoms was 44.8%, with 9.1% of very severe forms. Independent factors associated with PTSD symptoms were female gender (p = .013, OR 1.72 [95% CI 1.12-2.63]), change in work system (p = .006, OR 1.37 [95% CI 1.09-1.71]), increased workload (p < .001, OR 2.10 [95% CI 1.63-2.71]), and decreased income (p = .041, OR 1.44 [95% CI 1.02-2.05]).

CONCLUSION

The COVID-19 crisis and its impact on working conditions were significant stressors that contributed to a high prevalence of PTSD symptoms among oil and gas company workers. Therefore, implementing well-being programs is essential during acute challenges that lead to changes in work systems.

Exploring the interconnections of loneliness, anxiety, and depression among nursing students: a network analysis approach

Objective

Nursing students experience higher rates of anxiety and depression than students in other disciplines due to the demanding academic requirements and clinical training challenges. Loneliness and symptoms of anxiety and depression occur simultaneously; however, the specific interrelationships between these states remain inadequately investigated. This study aimed to utilize network analysis to examine the item-level reciprocal action between loneliness, anxiety, and depression among nursing students.

Methods

A total of 888 nursing students were assessed using the short-form UCLA Loneliness Scale (ULS-6), the Generalized Anxiety Disorder 7-item Questionnaire (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9) on loneliness, anxiety, and depression, respectively. Descriptive analyses were conducted using SPSS 26.0, whereas other statistical analytical procedures were performed using R software. The Gaussian graphical model was used to estimate network, and the Network Comparison Test was applied to compare differences in networks across gender and grades.

Results

The results indicated that 58.6% of nursing students exhibited varying degrees of loneliness. Network analysis revealed that loneliness formed a separate cluster with limited connections to anxiety and depression communities. The edges between PHQ3-PHQ4 (insomnia or hypersomnia and fatigue), GAD1-GAD2 (feeling anxious and excessive worrying), ULS1-ULS2 (lonely and no one) showed the strongest positive edges within their communities, respectively. And the strongest inter-community edges were observed between GAD5-PHQ8 (fidgety-retardation), ULS6-PHQ4 (isolation-fatigue), and ULS1-GAD1 (lonely-feeling anxious). The centrality analysis identified GAD2 (excessive worrying), ULS6 (isolation), PHQ4 (fatigue), and PHQ2 (feeling down) as the most central node, indicating their significant influence on the overall network structure. Additionally, PHQ8 (retardation), PHQ2 (feeling down), GAD5 (fidgety), and GAD1(feeling anxious) played a crucial role as bridging symptoms that linked the three communities. In addition, there is no statistically significant difference in the network structure except strength of GAD3 (generalized anxiety) and GAD6 (irritable) between sexes.

Conclusions

This study highlights the high prevalence of loneliness among nursing students and its distinct yet limited connection to anxiety and depression, emphasizing its unique role as a standalone psychological construct. The central symptoms in the network and important bridge symptoms across different psychological communities highlight the complexity of mental health symptom networks. This underscores the importance of targeting central symptoms for domain-specific interventions and addressing bridge symptoms to mitigate comorbidities across psychological conditions among nursing students.

Sleep Alterations in the Population of the Metropolitan Area of Mexico and Their Association with Lifestyle Changes During COVID-19 Confinement

Home confinement due to Coronavirus Disease 2019 (COVID-19) led to lifestyle changes that increased sleep disturbances, particularly in areas with higher infection and mortality rates. This study is a retrospective study based on data collected through an online survey conducted during the COVID-19 confinement. It aims to analyze changes in sleep quantity and quality and their association with lifestyle changes in the metropolitan area of Mexico City. A total of 899 adults from this area completed an online questionnaire between June 2020 and February 2021. This study assessed sleep quantity, sleep quality, insomnia symptoms, and lifestyle changes during the confinement period. Results showed that sleep quantity increased (7.10 ± 1.37 vs. 7.43 ± 1.42 h, p < 0.0001), with more participants, especially young adults and women, reporting later bed and wake-up times. The Pittsburgh Sleep Quality Index increased by 1.4 units, with poor sleep quality associated with lifestyle during confinement. Insomnia symptoms, sleep latency, and poor sleep quality also increased, particularly in women. Males and those without chronic comorbidities were less likely to experience poor sleep quality, while tobacco use and later bedtimes increased this risk. This study concludes that, while sleep quantity increased, sleep quality declined, particularly among young adults, women, and those with unhealthy lifestyles. These findings could guide sleep health initiatives tailored to specific lifestyle changes in different population groups.

Associations between mobile phone involvement, BMI levels, and sleep quality among Chinese university students: evidence from a multi-regional large-scale survey

Objective

This study aims to explore the association between mobile phone involvement, body mass index (BMI) levels, and the sleep quality of Chinese university students.

Methods

Using a cluster sampling method, we selected 17,085 university students from three universities in eastern, central, and western China as the study subjects. Demographic information such as age and sex were collected. The Pittsburgh Sleep Quality Index (PSQI) and the Mobile Phone Involvement Questionnaire (MPIQ) were utilized to measure their sleep quality scores and mobile phone involvement scores, respectively. Pearson correlation analysis, two-way ANOVA, and multiple linear regression were employed to examine the relationship between BMI levels, mobile phone involvement, and sleep quality.

Results

The results show that 15.87% (2,712 participants) are classified as overweight, and 18.45% (3,151 participants) are classified as obese. Additionally, 35.87% (6,125 participants) exhibit mobile phone involvement, while 57.94% (9,899 participants) reported poor sleep quality. Pearson correlation analysis indicates a significant negative correlation (p < 0.01) between sleep quality and both BMI levels and mobile phone involvement. Two-way ANOVA shows the significant effect of BMI levels (p < 0.001) and mobile phone involvement (p < 0.001) on sleep quality, and there is no interaction effect between the two. Additionally, the sleep quality of overweight and obese individuals is significantly poorer than that of those with normal weight (p < 0.05), while the sleep quality of overweight individuals is significantly lower than that of obese individuals (p < 0.05). Multiple linear regression analysis indicates that, after controlling for age and gender, both BMI (β = -2.69) levels and mobile phone involvement (β = -1.34) are significantly negatively associated with sleep quality (p < 0.001), accounting for 19% of the variance in poor sleep quality.

Conclusion

This study found that BMI levels and mobile phone involvement are both independently associated with sleep quality among Chinese university students. However, among individuals with excess BMI, although their sleep quality is worse than individuals with normal weight, overweight individuals may have poorer sleep quality than obese individuals. This study also revealed high rates of overweight and obesity, with over half of participants reporting poor sleep quality, highlighting the need for targeted interventions to address weight management and mobile phone usage to improve sleep health in this population.

Work stressors and intention to leave among nurses in isolation nursing units during COVID-19: a cross-sectional study

BACKGROUND

Work stressors are associated with physical and psychological health problems among workers and thus increase their intentions to leave work. Various factors, including fear of infection, workload, and inadequate support, caused nurses especially those on the front lines during the COVID-19 pandemic greater stress.

AIM

This study aims to identify Jordanian nurses' perceptions of work stressors and their intention to leave, and to investigate the relationship between these variables among nurses working in isolation units during the COVID-19 pandemic.

METHODS

A descriptive cross-sectional study was conducted. A convenience sample of 154 nurses who worked with COVID-19 patients participated in this study. Questionnaires were distributed online.

RESULTS

A total of 154 nurses participated in the study, with an average age of 29.59 years. A majority of nurses (61.1%) were employed in COVID-19 isolation units for a duration of 6 to 8 months. Of the work-related stresses, the mean score was 3.17; 85.7% of respondents reported a positive level of stress. Intent to leave had a mean score of 4.03; 57.8% of respondents showed a slightly positive intention. Work stresses and intention to leave showed a modest, positive significant correlation (r = 0.52, p = 0.001).

CONCLUSIONS

In COVID-19 isolation units, Jordanian nurses' work stresses were positively correlated with their intention to leave. Lower-educated and single nurses were more stressed and likely to leave. Based on the findings, targeted stress-reduction programs are needed. Nursing retention and healthcare system sustainability amid public health emergencies depend on supportive, well-resourced workplaces.

San Huang Xiao Yan recipe promoted wound healing in diabetic ulcer mice by inhibiting Th17 cell differentiation

ETHNOPHARMACOLOGICAL RELEVANCE

Diabetic ulcer is a serious diabetes complication and a primary reason for amputations. For many years, the San Huang Xiao Yan (SHXY) recipe has served as a conventional remedy for these ulcers, effectively reducing inflammatory factors and exhibiting considerable therapeutic efficacy. However, the precise mechanism remains incompletely understood.

AIM OF THE STUDY

To explore the efficacy and mechanisms of SHXY and its active ingredients in treating diabetic ulcer.

MATERIALS AND METHODS

A diabetic ulcer mouse model was established using C57BL/6J mice on a high-fat diet, followed by streptozotocin injection and skin damage. We investigated the bioactive compounds, key targets, and pharmacological mechanisms of SHXY in addressing diabetic ulcers through network pharmacology, molecular docking, both in vitro and in vivo validation experiments.

RESULTS

One week after intragastric administration, SHXY can reduce inflammation and edema, increase collagen synthesis, and reduce the expression of RORγT and IL-17A without affecting Treg cells. In vitro, SHXY-containing serum inhibited the differentiation of Th17 cells but did not affect Treg and Th1 cells. Network pharmacology found that SHXY acts through inflammatory pathways, including TNF, IL-17, Th17 cell differentiation, HIF-1, and PI3K-Akt.

CONCLUSIONS

SHXY and its candidate enhance healing in diabetic ulcers by modulating CD4+ T cells, particularly by inhibiting Th17 cell differentiation.

Mental health of LGBTQ+ workers: a systematic review

BACKGROUND

Members of the lesbian, gay, bisexual, transgender, queer, and other sexual and gender minorities (LGBTQ+) community have greater risk of mental health disorders compared to the general population, however most evidence is from young people. We sought to systematically review and summarise the evidence for the burden and risk of mental health disorders.

METHODS

A PRISMA-compliant literature search was conducted in MEDLINE, Embase, PsycInfo, Scopus, and CINAHL for articles published from 2000 to 2024. Quantitative or mixed-methods studies that reported mental health outcomes among LGBTQ+ workers were included. Effect measures included prevalence and odds ratios, with variations in mental health across occupations and specific sexual or gender minorities reported where possible. This systematic review was prospectively registered through PROSPERO (CRD42024587605).

RESULTS

Out of 5736 unique articles screened, 33 articles (32 individual studies) fulfilled eligibility criteria, including 8369 LGBTQ+ workers. Other than studies of sex workers, only 12 studies had research questions specific to LGBTQ+ workers' mental health. Most studies (30/32) were cross-sectional and reported increased odds of depression, anxiety, or suicidality among LGBTQ+ compared to non-LGBTQ+ workers. Prevalence estimates and methodology varied widely. Factors associated with adverse mental health outcomes among select groups of LGBTQ+ workers included internalised stigma, heterosexism, job stress and low income. We found no studies comparing workers across industries and no studies involving workplace interventions.

CONCLUSIONS

There are limited objective data regarding LGBTQ+ workers' mental health. Given the heterogeneity of the LGBTQ+ population, dedicated longitudinal research into the mental health of specific sexual and gender minorities across all industries and occupations is needed to determine causal factors, the impact of intersectionality, and the effectiveness of workplace interventions.

G protein-coupled receptor 107 deficiency promotes development of diabetic nephropathy

Diabetic nephropathy (DN) is characterized by glomerular basement membrane (GBM) thickening, primarily due to the abnormal accumulation of collagen type IV (COL4) in the extracellular matrix (ECM) of podocytes. Podocytes endocytosis is crucial for maintaining COL4 balance and GBM integrity. Previous studies have shown that G protein-coupled receptor 107 (GPR107) facilitates clathrin-dependent transferrin internalization and recycling in murine embryonic fibroblast cells. Therefore, the aim of the study is to investigate the role of GPR107 in regulating COL4 balance within the podocytes ECM and its potential as a therapeutic target for DN. Here, we found a significant decrease in GPR107 expression in renal tissues from DN patients and streptozocin (STZ)-induced DN mice. Furthermore, GPR107-deficient mice with STZ-induced DN exhibited more severe kidney damage, marked by increased GBM thickening and COL4 accumulation. In vitro, GPR107 deficiency under high-glucose conditions promoted COL4 accumulation in the ECM of podocytes due to increased COL4 production and decreased COL4 degradation. Mechanistically, we demonstrated that GPR107 contributes to angiotensin II receptor type 1 (AT1R) internalization through clathrin-mediated endocytosis (CME) in podocytes. Therefore, GPR107 deficiency impairs AT1R internalization, leading to increased membrane-bound AT1R. This, in turn, activates the AT1R/Ca2+ signaling pathway to promote phosphorylation of cAMP-response element-binding protein (CREB), ultimately enhancing COL4 synthesis and inhibiting the expression of matrix metalloproteinase 2 (MMP-2). These findings shed light on new functions of GPR107 in DN and offer new insights into a therapeutic target for DN.

Impact of moral distress on burn-out: a cross-sectional survey of front-line family physicians during the initial wave of the COVID-19 pandemic

OBJECTIVES

Primary care clinicians are especially prone to burn-out. The primary objective of this study was to investigate factors contributing to burn-out and moral distress and their relationship among practising family physicians (FPs) in California early in the COVID-19 pandemic.

DESIGN

Cross-sectional study, online survey evaluating burn-out, moral distress and associated factors.

SETTING

California FPs between July and August 2020 practising in community health centres, hospital systems, private clinics and university systems were surveyed with a 22-item online questionnaire.

PARTICIPANTS

FPs practising in California were eligible. The final sample included 218 physicians.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary independent variable was frequency of moral distress and the primary outcome variable was worsening burn-out. Moderator variables included gender and employer support.

RESULTS

FPs experiencing higher burn-out and moral distress were more likely to report concerns regarding personal COVID-19 risk and lack of personal protective equipment. Practising self-care and personal wellness were associated with decreased moral distress. Female physicians were 3.86-fold more likely to report worsening burn-out compared with male physicians. Employer support was associated with a 59% reduced burn-out risk and 54% reduction in frequent moral distress. Frequent moral distress was associated with a 3.12- fold higher burn-out risk. Gender moderated the relationship between moral distress and burn-out. Moral distress was associated with a 3.55-fold increase in burn-out risk among females.

CONCLUSIONS

Female FPs experienced greater levels of moral distress and burn-out than male physicians. Moral distress was differentially associated with increased burn-out among female physicians. Employer support was a protective factor against moral distress and burn-out.

Optimization of toilet bowl ventilation technology for odor control and energy efficiency enhancement in public toilet

In the operation of public toilets, a significant amount of ventilation is commonly employed to maintain proper air quality. However, this inevitably leads to energy wastage and compromises the thermal comfort within the area during winter. To enhance and optimize the ventilation of traditional toilets, this research adopts computational fluid dynamics simulation techniques. It conducts both qualitative and quantitative analyses of the performance of toilet bowl ventilation (TBV) technology across various airflow conditions, commode models, H2S and NH3 odors. Additionally, it compares the exhaust effectiveness of different ventilation strategies and evaluates the energy-saving capabilities of the TBV technology. In both models under study, the wind direction was directed towards the interior of the toilet. Even when the mass concentration exceeded the allowable limit, the iso-surface revealed that all excessive H2S and NH3 volumes were successfully contained within the toilet bowl. The findings indicate that by applying TBV technology in public toilets, the airflow can be reduced to 10 m³/h during toilet usage while still fulfilling the requirements for air quality and energy conservation. This method exhibits a thermal energy saving efficiency of 8.2 W/°C. This investigation effectively minimizes air heat dissipation resulting from the ventilation process and reduces fan power consumption while ensuring proper effluent discharge, thus laying a solid foundation for the promotion and application of the TBV technology.

Clinicians' experience with infographic summaries from the BMJ Rapid Recommendations: a qualitative user-testing study among residents and interns at a large teaching hospital in Switzerland

OBJECTIVE

Clinicians need trustworthy clinical practice guidelines to succeed with evidence-based diagnosis and treatment at the bedside. The BMJ Rapid Recommendations explore innovative ways to enhance dissemination and uptake, including multilayered interactive infographics linked to a digitally structured authoring and publication platform (the MAGICapp). We aimed to assess user experiences of physicians in training in various specialties when they interact with these infographics.

DESIGN

We conducted a qualitative user-testing study to assess user experience of a convenience sample of physicians in training. User testing was carried out through guided think-aloud sessions. We assessed six facets of user experience using a revised version of Morville's framework: usefulness, understandability, usability, credibility, desirability and identification.

SETTING

Setting include Geneva's University Hospital, a large teaching hospital in Switzerland.

PARTICIPANTS

Participants include a convenience sample of residents and interns without restriction regarding medical field or division of care.

RESULTS

Most users reported a positive experience. The infographics were understandable and useful to rapidly grasp the key elements of the recommendation, its rationale and supporting evidence, in a credible way. Some users felt intimidated by numbers or the amount of information, although they perceived there could be a learning curve while using generic formats. Plain language summaries helped complement the visuals but could be further highlighted. Despite their generally positive experience, several users had limited understanding of key GRADE (Grading of Recommendations Assessment, Development and Evaluation) domains of the quality of evidence and remained uncertain by the implication of weak or conditional recommendations.

CONCLUSION

Our study allowed to identify several aspects of guideline formats that improve their understandability and usefulness. Guideline organisations can use our findings to adapt their presentation format to enhance their dissemination and uptake in clinical practice. Avenues for research include the interplay between infographics and the digital authoring platform, multiple comparisons and living guidelines.

Evaluating post-traumatic growth among healthcare workers

Background

Recent studies have considered the psychological resilience and growth experienced by healthcare professionals, particularly those facing stressors and traumatic events.

Aims

To study post-traumatic growth in healthcare workers caring for patients, determine the internal consistency of the Post-traumatic Growth Inventory (PTGI) and PTGI-Short Form (PTGI-SF) instruments, and carry out confirmatory analyses of their five-factor structures.

Setting

Healthcare workers based in Greece.

Methods

Cross-sectional design. Linear regression analysis with tested independent variables consisting of demographic, professional, health facility, and patient contact data. Confirmatory five-factor analyses of PTGI and PTGI-SF results were performed to validate their associated factors. Unidimensional reliability of the PTGI and PTGI-SF results was calculated.

Results

The final regression model included sex and whether the internet was the source of health-related knowledge (F 2102 = 11.979, p < 0.0001). The confirmatory factor analysis of the PTGI confirmed its five-factor structure (χ2 189 = 1233.642, p < 0.0001), root mean square error of approximation (RMSEA = 0.229, p < 0.0001), and internal consistency (Cronbach α = 0.971). Similarly for the PTGI-SF (χ2 35 = 535.965, p < 0.0001; RMSEA = 0.369, p < 0.0001; Cronbach α = 0.935).

Conclusion

Being female and not using the internet as the principal source of information about diseases were each associated with increased post-traumatic growth. The internal consistencies of both the PTGI and the PTGI-SF were confirmed, as were the robustness of the five-factor structure of each instrument.

Dengzhan Shengmai capsule ameliorates cognitive impairment via inhibiting ER stress in APP/PS1 mice

ETHNOPHARMACOLOGICAL RELEVANCE

Alzheimer's disease (AD) is a common type of neurodegenerative disease with the β-amyloid plaques (Aβ) deposition. Previously, Dengzhan Shengmai capsule (DZSM) has been shown to reduce the pathology associated with AD, but the underlying mechanism is unclear.

AIM OF STUDY

This study investigated the potential mechanisms of DZSM against AD.

MATERIALS AND METHODS

The six-month-old wild-type male mice and APP/PS1 double transgenic male mice were administered 0.9 % saline or DZSM for 8 weeks by gavage. Open field test, new object recognition test, and Morris Water maze test were used to assess spatial learning and memory. Aβ plaques in brains were visualized using ThT staining. Nissl staining, TUNEL staining, and Western blot analyses were used to detect the neuronal function and apoptosis level. The superoxide dismutase (SOD), glutathione peroxidase assay kit (GSH-Px), and malondialdehyde (MDA) kits were performed to assess oxidative stress levels. Then, immunofluorescence and Western blot analysis were applied to evaluate ER stress pathway protein levels. Finally, HT22 cells were treated by Aβ1-42 with or without DZSM medicated serum. Cell viability was assessed using the CCK-8 assay, and Western blot analysis was applied to evaluate ER stress pathway protein levels.

RESULTS

Open filed test, new object recognition test and Morris Water maze test showed that DZSM restored cognitive disorders in APP/PS1 mice. Immunohistochemistry and Thioflavin T staining results indicated that DZSM reduced Aβ plaques in the brain. Deeper and denser Nissl bodies were found in APP/PS1 mice after DZSM administration. Besides, APP/PS1 mice treated with DZSM showed a lower level of TUNEL and Bax/Bcl-2 ratio. DZSM improved the acetylcholine (ACh), choline acetyltransferase (ChAT), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) activity while reducing acetylcholinesterase (AChE) and malondialdehyde (MDA) activity. In addition, the levels of ER stress pathway containing Phospho-PKR-like ER kinase (P-PERK), phosphorylate eukaryotic initiation factor 2 (P-eIF2α), activating transcription factor 4 (ATF4), glutamine-rich protein 1 (QRICH1), phosphorylate inositol-requiring protein 1α (P-IRE1α), the spliced form of X-box binding protein 1 (XBP1s), activating transcription factor-6 (ATF6) and C/EBP homologous binding protein (CHOP) were decreased by DZSM. CCK-8 results indicated that DZSM medicated serum played cytoprotective effects on Aβ1-42-induced HT22 cells. Western blot results suggested DZSM possibly inhibited ER stress pathways in Aβ1-42-induced HT22 cells.

CONCLUSION

The potential protective mechanism of DZSM on cognitive impairment in AD might be related to ER stress pathways.

Perceived coercion amongst healthcare workers during the COVID-19 pandemic

Direct and prolonged exposure to stress and uncertainty among healthcare workers (HCWs) during the COVID-19 pandemic likely had a significant negative impact on their mental health and general wellbeing. Although the contributors to such distress remain to be fully understood, the construct of perceived coercion appears to be relevant. Among HCWs, perceived coercion is conceptualised as appraisals about lack of control/'freedom to choose' and pressure to perform patient-care duties in the context of unprecedented threat of contagion from patients. To improve our understanding of perceived coercion amongst HCWs, we developed a 10-item scale-the Pandemic-specific Perceived Coercion Scale for Healthcare Workers (PPCS-HCW) scale-designed to be adaptable and applicable for use in future mass-contagion emergencies. A preliminary (exploratory) factor analysis (N = 546) showed that relevant items coalesced around three factors-'internal pressure', 'external pressure' and 'perceived coercion', that partly overlap with previous conceptualisations of perceived coercion. The exploratory conceptual and psychometric structure was confirmed in a separate sample of HCWs from the UK and Norway (N = 483). On average, across the three PPCS-HCW scale factors, HCWs showed low levels of perceived coercion (M = 0.22 (95% CI [0.11, 0.33] on a - 3 to + 3 scale). However, cluster analysis identified three groups: low (- 1.09 (95% CI [- 1.20, - 0.99]), moderate (0.17 (95% CI [0.08, 0.25]) and high scoring (1.57 (95% CI [1.47, 1.67]) PPCS-HCW clusters. High scoring participants showed higher levels of psychological distress, avoidance coping and compassion fatigue. In summary, our findings suggest that perceived coercion is a relevant construct in understanding the adverse psychological impact of large-scale contagion emergencies on HCWs.

SARS-CoV-2 infection rates and associated risk factors in healthcare workers: systematic review and meta-analysis

To protect healthcare workforce during the COVID-19 pandemic, rigorous efforts were made to reduce infection rates among healthcare workers (HCWs), especially prior to vaccine availability. This study aimed to investigate the prevalence of SARS-CoV-2 infections among HCWs and identify potential risk factors associated with transmission. We searched MEDLINE, Embase, and Google Scholar from 1 December 2019 to 5 February 2024. From 498 initial records, 190 articles were reviewed, and 63 studies were eligible. ROBINS-E tool revealed a lower risk of bias in several domains; however, some concerns related to confounding and exposure measurement were identified. Globally, 11% (95% confidence interval (CI) 9-13) of 283,932 HCWs were infected with SARS-CoV-2. Infection rates were associated with a constellation of risk factors and major circulating SARS-CoV-2 variants. Household exposure (odds ratio (OR) 7.07; 95% CI 3.93-12.73), working as a cleaner (OR 2.72; 95% CI 1.39-5.32), occupational exposure (OR 1.79; 95% CI 1.49-2.14), inadequate training on infection prevention and control (OR 1.46; 95% CI 1.14-1.87), insufficient use of personal protective equipment (OR 1.45; 95% CI 1.14-1.84), performing aerosol generating procedures (OR 1.36; 95% CI 1.21-1.52) and inadequate hand hygiene (OR 1.17; 95% CI 0.79-1.73) were associated with an increased SARS-CoV-2 infection. Conversely, history of quarantine (OR 0.23; 95% CI 0.08-0.60) and frequent decontamination of high touch areas (OR 0.52; 95% CI 0.42-0.64) were protective factors against SARS-CoV-2 infection. This study quantifies the substantial global burden of SARS-CoV-2 infection among HCWs. We underscore the urgent need for effective infection prevention and control measures, particularly addressing factors such as household exposure and occupational practices by HCWs, including cleaning staff.

Interventions for the management of post-COVID-19 condition (long COVID): protocol for a living systematic review and network meta-analysis

BACKGROUND

Up to 15% of survivors of COVID-19 infection experience long-term health effects, including fatigue, myalgia and impaired cognitive function, termed post-COVID-19 condition or long COVID. Several trials that study the benefits and harms of various interventions to manage long COVID have been published and hundreds more are planned or are ongoing. Trustworthy systematic reviews that clarify the benefits and harms of interventions are critical to promote evidence-based practice.

OBJECTIVE

To create and maintain a living systematic review and network meta-analysis addressing the benefits and harms of pharmacologic and non-pharmacologic interventions for the treatment and management of long COVID.

METHODS

Eligible trials will randomise adults with long COVID to pharmacologic or non-pharmacologic interventions, placebo, sham or usual care. We will identify eligible studies by searching MEDLINE, EMBASE, CINAHL, PsycINFO, AMED and CENTRAL from inception, without language restrictions.Reviewers will work independently and in duplicate to screen search records, collect data from eligible trials, including trial and patient characteristics and outcomes of interest and assess risk of bias. Our outcomes of interest will include patient-reported fatigue, pain, postexertional malaise, changes in education or employment status, cognitive function, mental health, dyspnoea, quality of life, physical function, recovery and serious adverse events.For each outcome, when possible, we will perform a frequentist random-effects network meta-analysis. When there are compelling reasons to suspect that certain interventions are only applicable or effective for a subtype of long COVID, we will perform separate network meta-analyses. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach will guide our assessment of the certainty of evidence.We will update our living review biannually, on the publication of a seminal trial, or when new evidence emerges that may change clinical practice.

CONCLUSION

This living systematic review and network meta-analysis will provide comprehensive, trustworthy and up-to-date summaries of the evidence addressing the benefits and harms of interventions for the treatment and management of long COVID. We will make our findings available publicly and work with guideline-producing organisations to inform their recommendations.

ETHICS AND DISSEMINATION

The study describes the protocol for a systematic review that uses data from published trial reports. Therefore, the study is exempt from ethics review. We intend to deposit all data in a public repository and publish each iteration of the living review online.

Safety of health workers during the COVID-19 pandemic and beyond: piloting WHO framework in Iran

BACKGROUND

Health Workers Safety (HWS) is a global health priority and essential at all times, in stable situations, in emergencies, in disease epidemics or pandemics. This study aimed to assess HWS during the COVID-19 Pandemic.

METHODS

This cross-sectional study was conducted in 2022 in east Azerbaijan province, Iran. HWS was assessed based on 22 indicators suggested by WHO EMRO. We selected 15 PHC facilities and six wards from two hospitals randomly. Data collected (qualitative and quantitative) using national digital health records, staff records, and indicator-specific tools. In addition to measuring the indicator's value, the indicators' feasibility was also assessed. Descriptive and inferential statistics with SPSS-16 were used for data analysis.

RESULTS

Totally, 325 Health Workers (HWs) (218 from PHC facilities and 107 from hospitals) participated in the study. Most of the participants in PHC facilities and hospitals were Community Health Workers (CHWs) (Moragheb Salamat) (45.4%) and nurses (37.38%), respectively. Most of HWs had completed the full vaccination schedule for Hepatitis B and COVID-19. Personal Protective Equipment (PPE) safety protocols were adhered by most of HWs within a healthcare facility. None of managers had attended nationally certified training for mental health support for health and care workers. Less than 20% of HWs participated in the work burnout prevention courses and most of HWs complained about work overload, or burnout. The job satisfaction level of hospital HWs (60.20%) was significantly higher than that of HWs from PHC facilities (57.18%) (P < 0.001).

CONCLUSION

Even though the mental health of HWs was not as expected, the indicators related to physical health and occupational health were at a suitable level. Also, there is not a system in PHC to audit the application of safety measures to mitigate the risk of contracting COVID-19. We recommend creating a specific system (precise and detailed) for HWs' safety and applying safety measures in the PHC routine programs.

Does perceived social cohesion moderate the effect of parental stressors on depressive symptoms? A longitudinal, multi-level analysis before and during the COVID-19 pandemic

BACKGROUND

Perceived social cohesion (PSC) is a protective factor for mental health. Yet, evidence on social mechanisms influencing mental health is scarce.

AIMS

We examined the moderating role of PSC between parental stressors and depressive symptoms before and during the COVID-19 pandemic.

METHODS

We performed a multilevel moderated linear regression analysis using German Socio-Economic Panel (G-SOEP) data to investigate the interaction of PSC in 2018 and in 2020 with parental stressors (having pre-school-aged child(-ren), concerns about COVID-19 infection, financial insecurity, working from home, changes at work) and depressive symptoms (PHQ-4) in 2020 and 2021.

RESULTS

3,112 observations from 1,621 participants were included in the regression analyses. The parental stressors had mostly negative, although not always significant effects on PHQ-4. Both PSC measures positively moderated the association between experienced financial insecurity and PHQ-4. PCS 2020 positively moderated the association between the stressors "not working from home" and "being unemployed in 2020 or 2021" compared to "having no changes at work" for those employed. It negatively moderated the association between "having some concerns about infection" and PHQ-4.

CONCLUSIONS

PSC can act as a buffer for parental mental health. Social cohesion should be promoted in public health interventions, especially during pandemics or disasters.

Ursodeoxycholic acid relieves clinical severity of COVID-19 in patients with chronic liver diseases

Background

The potential effect of ursodeoxycholic acid (UDCA) on the clinical outcomes of SARS-CoV-2 in patients with chronic liver diseases has been a subject of ongoing debate since the onset of the SARS-CoV-2 pandemic in 2019. This study aims to investigate the effect of UDCA on the prognosis of SARS-CoV-2 infection in patients with chronic liver diseases.

Methods

A total of 926 patients with chronic liver diseases who contracted their first SARS-CoV-2 infection during December 2022 to January 2023, were included in this study. Participants were divided into two groups based on the use of UDCA: the UDCA cohort (n = 329) and the non-UDCA cohort (n = 597). After performing a 1:1 age-and sex-matching, the analysis proceeded with 309 patients from each group for further evaluation.

Results

In the UDCA-treated cohort, the incidence of asymptomatic SARS-CoV-2 infections was significantly higher, with 30.1% of patients affected, compared to 6.47% in the non-UDCA group (p < 0.0001). Multivariable analysis identified UDCA as a protective factor against symptomatic infections, yielding an odds ratio (OR) of 4.77 (95% CI: 2.70-8.44, p < 0.001). Furthermore, age over 50 was found to be a risk factor for asymptomatic infections in the UDCA cohort, with an adjusted OR of 1.51 (95% CI: 1.01-2.24, p = 0.05).

Conclusion

The study suggests that UDCA therapy may improve clinical outcomes in patients with chronic liver diseases patients who are infected with SARS-CoV-2, highlighting its potential role in improving prognosis within this vulnerable population. However, further research is required to validate these findings and to elucidate the mechanisms underlying UDCA's protective effect.

The associations of obesity with demographic and lifestyle factors among Hong Kong adults

Background: Obesity is a risk factor for leading causes of death. Aim: This study investigated the associations of obesity with demographic and lifestyle factors among adults aged 18-64 in Hong Kong. Methods: The study uses data (n = 24,855) from the government online database. It uses T-tests to compare mean values for body mass index (BMI), waist circumference, and weight-to-height ratio obese; analysis of variance for not-obese, BMI-obese-only, central-obese, and BMI + central-obese; Pearson chi-square tests for categorical variables; and multinomial logistic regression to obtain the odd ratios. It uses IBM SPSS version 26 to conduct all analyses, and at a 95% confidence level. Results: The analyses show that the risks of central-obese, and BMI + central-obese increase by 4%, and 4%/year of age, respectively. Females have 60%, 38%, and 60% lower risks of BMI-obese-only, central-obese, and BMI + central-obese, respectively, and people with tertiary education have 28%, 20%, and 20% lower risks, respectively. Employed people have a 40% higher risk of BMI-obese-only when compared with the unemployed; students have a 46% lower risk of BMI + central-obese and home-makers have a 38% higher risk. The risk of central-obese decreases by 14%/10 min/day of moderate physical activity, but could be different among females, and vigorous physical activity yielded mixed results. The risk of BMI + central-obese decreases by 9%/day/week of vegetable intake. Conclusions: Obesity is associated with multiple demographic and lifestyle factors. Keep doing vigorous and moderate physical activity but state alert to obesity risk factors, and frequent vegetable intake are recommended. Lifelong learning and continuing education could be an effective strategy to combat obesity.

Impact of Antimicrobial Stewardship and Infection Prevention and Control Programmes on Antibiotic Usage and A. baumannii resistance: A 2016-2023 Multicentre Prospective Study

Objective

This study assesses the efficacy of antimicrobial stewardship (AMS) and infection prevention and control programmes (IPCP) in guiding the use of antibiotics and the control of A. baumannii (AB) resistance at multiple medical centres.

Methods

We evaluated the effectiveness of the policy on antibiotic consumption and AB resistance by determining the relationship between the defined daily doses (DDD) for antibiotics - or alcohol-based hand gel (ABHG) consumption - and the incidence of carbapenem-resistant AB (CR-AB), multidrug-resistant AB (MDR-AB) and extensively drug-resistant AB (XDR-AB) at two medical centers from 2016-2023.

Results

In total, 4057 AB isolates were collected; 64.95% of the AB isolates were CR, 59.48% were MDR and 1.41% were XDR. The major categories of the AB clinical strains collected were extracted primarily from patients' respiratory tract specimens, the ICU wards and patients over 65 years old, accounting for 76.98%, 67.98% and 63.72%, respectively. The incidence of CR-AB, MDR-AB and XDR-AB based on AMS and IPCP measures ranged from 70.04% to 58.42% (P<0.0001), 64.26% to 52.16% (P<0.0001) and 2.27% to 0.60% (P=0.0167), respectively. The DDD of total antibiotics administered per 1000 patient days (PD) decreased significantly from 51.25±4.22 to 40.92±2.48 (P<0.0001), and ABHG consumption per 1000 PD increased significantly from 5.25±0.98 to 13.51±5.12 (P<0.0001). We found a statistically significant positive correlation between the DDD of antibiotic consumption and the incidence of CR-AB, MDR-AB and XDR-AB (r=0.9755 and P<0.0001, r=0.9571 and P=0.0002, r=0.9230 and p=0.0011, respectively). In addition, a statistically negative correlation was found between ABHG consumption and the incidence of CR-AB, MDR-AB, and XDR-AB (r=-0.9473 and P=0.0004, r=-0.9123 and P=0.0016, r=-0.9138 and P=0.0015, respectively).

Conclusion

Comprehensive AMS and IPCP intervention measures can successfully achieve a sustained amelioration in the resistance and transmission of CR-AB, MDR-AB and XDR-AB, which are regarding potential applicability to other hospitals.

Cross-Cultural Comparison of Burnout, Insomnia and Turnover Intention Among Nurses in Eastern and Western Cultures During the COVID-19 Pandemic: Protective and Risk Factors

Background/Objectives: The COVID-19 pandemic has adversely impacted the mental health of nurses worldwide. Nurse burnout results from chronic workplace stress and is characterized by exhaustion, negative or cynical feelings about work, and a diminished sense of accomplishment. This can lead to turnover intention. Therefore, psychological capacities, such as psychological flexibility, that could help nurses regulate and minimize the impact should be studied. This study aimed to compare burnout, insomnia and turnover intention among nurses from an Eastern and Western cultural context and to investigate the role of psychological flexibility as a protective factor against mental health and related problems such as insomnia and turnover intention. Methods: Nurses from Hong Kong (n = 158) and Switzerland (n = 294) involved in patient care during the COVID-19 pandemic participated in an online mental health survey. Results: We observed high levels of burnout, subthreshold insomnia and turnover intention in nurses from both Switzerland and Hong Kong, with higher burnout rates among Hong Kong nurses and higher turnover intentions among nurses from Switzerland, and that psychological flexibility is a crucial factor that may protect nurses from burnout and insomnia. Conclusions: The nurses from both regions involved in patient care one year after the onset of the pandemic suffered from poor mental health. Psychological flexibility was identified as a critical factor in improving nurses' mental health. The results of this study should be incorporated into health promotions for nursing professionals and help develop specific and effective interventions for practical nursing application.

Comparison of bullying victimization and depression symptoms among Chinese adolescents before and after the end of the dynamic zero-COVID-19 policy: a repeated cross-sectional study

BACKGROUND

The COVID-19 pandemic has had a significant impact on the physical and mental health of human beings. Most adolescents in mainland of China have been infected with COVID-19 after the adjustment of the dynamic zero-COVID-19 policy. This study aims to analyze the relationship between the COVID-19 pandemic effect and depressive symptoms among adolescents in mainland China.

METHODS

This school-based repeated cross-sectional study was conducted on students aged 11-19 years from September to October 2022 and September to October 2023 in Ningbo, Zhejiang Province, China, using a stratified cluster, multistage sampling method. Data analysis occurred from January to June 2024. Depression symptoms and bullying victimization, exclusion of cyberbullying, were assessed using the 20-item Center for Epidemiological Studies Depression Scale (CES-D) and Bully/Victim Questionnaire, respectively.

RESULTS

In the first survey wave in 2022 during the dynamic zero-COVID-19 policy period in Mainland China, 10,224 participants completed the questionnaires. In wave 2 survey in 2023 which was the first year after lifting of the dynamic zero-COVID-19 policy, 11,604 participants completed the questionnaires. This resulted in a sample of 10,224 in wave 1 and 11,604 in wave 2. The mean age in wave 1 was 15.2 (SD = 1.7) and 15.1 (SD = 1.8) in wave 2. The prevalence of depression symptoms in adolescents in wave 2 was higher than in wave 1 (17.0% vs. 14.6%, P < 0.05). The prevalence of bullying victimization and types of bullying victimization in school among adolescents were higher in 2023 than in 2022. A total of 3.2% of the 2023 participants and 1.7% of the 2022 participants experienced bullying victimization in school (P < 0.05). The odds ratio of experiencing depression (CES-D Score ≧ 16) and bullying victimization in school were 1.18 (95% CI, 1.10-1.28) and 1.86 (95% CI, 1.55-2.24) times higher, respectively, in 2023 than in 2022 (P < 0.01). The mediated regression analysis revealed that after lifting of the dynamic zero-COVID-19 had a significant association with an increase in depression symptoms, which was partially mediated by bullying victimization in school (total association:β = 0.175; SE = 0.038; P < 0.001; direct association:β = 0.138; SE = 0.039; P < 0.001; indirect association: a*b = 0.037; P < 0.001; the proportion of mediation: 20.88%, P < 0.001).

CONCLUSIONS

The findings of this repeated cross-sectional study suggest that an increased risk of depression symptoms or bullying victimization has been associated with the COVID-19 pandemic in mainland China after lifting the dynamic zero-COVID-19 policy. In addition, bullying victimization may play a mediating role in the associations between the pandemic and depression symptoms. These findings indicated that additional support should be offered to Chinese adolescents in the period of post-pandemic COVID-19.

CLINICAL TRIAL NUMBER

Not applicable.

"It was simply disturbing" - evaluation of the stress factors of nursing staff on special COVID-19 wards during the pandemic: a qualitative study

BACKGROUND

The COVID-19 pandemic has posed enormous challenges for healthcare systems worldwide. The strain on nursing staff working in special COVID-19 wards during the pandemic increased dramatically. To support nursing staff more effectively in similar situations in the future, it is important to identify specific stress factors to design effective support measures.

OBJECTIVE

To collect the experiences and lessons learned from nursing staff who have been affected by COVID-19 pandemic on a special COVID-19 ward that were perceived as stressful. The findings should contribute to the development of specific support measures for healthcare professionals.

DESIGN

Qualitative interview study.

SETTING

We interviewed 14 members of nursing staff who worked on COVID-19 wards at two University Hospitals about their working experiences during the pandemic.

RESULTS

We were able to identify 10 key stress factors. These included an increased workload, communication deficits, a difficult personnel situation, subjective pressure, the establishment of a new ward, a shortage of material resources, inadequate hygiene conditions, a lack of opportunities to cope with the situation, the absence of relatives and decision making.

CONCLUSION

The identification of various stress factors highlights the urgent need for comprehensive support measures. These measures could include concepts for dealing with physical and psychosocial stress, the provision of resources and sufficient personnel support. It remains crucial to proactively take preventive and supportive measures to reduce the burden and moral distress of nursing staff and protect their health in the long term. Despite the pandemic, the implications of our findings remain relevant for the future.

Influence of sleep duration and quality on depression symptoms among nurses during the Omicron outbreak: a cross-sectional survey

BACKGROUND

Nurses who work during the global pandemic are known to experience physical and psychological exhaustion, as well as severe anxiety and depression symptoms. This study aimed to explore the relationships between sleep duration, sleep quality, and depression symptoms among nurses during the outbreak of the Omicron variant.

METHODS

A cross-sectional study was conducted between August 2022 and September 2022. Participants (N = 2140) were evaluated for depression symptoms via the Hospital Anxiety and Depression Scale (HADS), and sleep was evaluated via the Pittsburgh Sleep Quality Index (PSQI), and "short sleep duration" was defined as ≤ 5 h per day. Demographic information was also collected. Binary and multivariate logistic regression was performed to assess the relationships between sleep duration, sleep quality, and depression symptoms.

RESULTS

In total, 2140 nurses were included in this study; 1481 (69.2%) had poor sleep quality, while 866 (40.4%) had depression symptom scores > 7 according to the HADS criteria. Both duration and quality of sleep were significantly correlated with depression symptoms among nurses (P < 0.001). In multivariable analyses adjusted for potential confounders, short sleep duration (≤ 5 h) was associated with an odds ratio (OR) of 2.26 (95% confidence interval [CI] 1.25-4.07), whereas poorer sleep quality was associated with an OR of 1.97 (95% CI 1.32-2.94) for experiencing depression symptoms.

CONCLUSIONS

Following the COVID-19 pandemic, there was a strong association between the sleep quality, sleep duration and depression symptoms among nurses. We recommend the development of targeted interventions to increase sleep duration, enhance sleep quality and alleviate depression symptoms.

Chapter 11: Treatment modalities

Treatment modalities for primary hyperparathyroidism must take account of the expected benefits and risks of each treatment envisaged, before choosing the definitive option to be proposed to the patient. In this section, a Foreword puts in perspective the difficulties involved in choosing the criteria for a particular treatment method. Treatments are then considered one after the other: surgery, local destruction and medical management. This section does not consider therapeutic indications, which are dealt with in a section 9.

Family affluence and bullying victimisation affect life satisfaction in large-bodied adolescents: Evidence from 37 high-income countries

BACKGROUND

Adolescents with large body sizes often experience bullying which likely affects their overall well-being. Yet, there is limited research on how bullying victimisation affects overall life satisfaction among this cohort of adolescents, and how family affluence moderates this relationship.

OBJECTIVE

This study investigates the moderation effects of family affluence in the association between bullying victimisation and life satisfaction among adolescents with large bodies.

SETTING AND PARTICIPANTS

This research involved 16,240 adolescents with large bodies based on the World Health Organization's Body Mass Index Chart/Classification for ages 13 to 15 years from 37 high-income countries in Europe and North America.

DESIGN

The study used data from the Health Behaviour in School-aged Children (HBSC) survey, a cross-national study of adolescent health and well-being. Hypotheses were assessed through mixed effects binary logit models with random intercepts, accounting for data clustering and variations across regions.

RESULTS

After controlling for covariates, both cyberbullying (AOR = 1.72; 95 % CI = 1.48-2.00) and traditional bullying (AOR = 1.74, 95 % CI: 1.53-1.99) were significantly associated with lower life satisfaction compared with no bullying experience among participants. Family affluence partly moderated these associations, wherein the highest level of affluence reduced the effects of cyberbullying (AOR = 1.57, 95 % CI: 1.09-2.27) and traditional bullying (AOR = 1.41, 95 % CI: 1.02-1.96) on life satisfaction compared to lower levels.

CONCLUSION

Both traditional and cyberbullying significantly reduced life satisfaction among adolescents with large body sizes. However, higher family affluence moderates (reduces) these negative effects, suggesting a protective role of socioeconomic status. These findings highlight the need for targeted interventions to support bullied adolescents, particularly those with large bodies and from lower socioeconomic backgrounds.

Perceptions and practices regarding pesticide exposure among pregnant women in a south Indian teaching institution

Introduction

Agriculture is the primary source of livelihood for about 58% of India's population. In recent years, there have been pressing public health and food safety concerns related to pesticide residues. Pesticides are a class of man-made environmental chemicals that can affect the body's development, growth, and hormone balance. Pregnant women are a particularly vulnerable group when it comes to pesticide exposure. Focusing on this population provides crucial data for designing protective interventions. Hence for formulating effective intervention strategy to combat this problem, proper quantification of the root cause was needed, hence the study was being conducted.

Methods

Hospital-based, cross-sectional study was conducted among 151 pregnant mothers. The questionnaire was administered by the principal investigator in a simple local language. Chi-square test was done to find the association between socio-demographic variables and knowledge of pregnant mothers about fetal complications due to pesticide.

Results

The overall knowledge about pesticide was through newspaper (44.3%) and social media (24.5%) whereas 84.1% believed pesticide has adverse effects on the fetus. It is shown that age <35 years, third trimester participants, educated participants, higher socio-economic status participants showed adequate knowledge about fetal complications due to pesticides.

Conclusions

The study concluded that knowledge is adequate about pesticide exposure, but the practice is not. Safe pesticide practices during pregnancy are necessary to protect the developing fetus.

The Relation Between Fear of COVID-19, Burnout Levels of Intensive Care Nurses

We aimed to examine the relation between the fear of COVID-19 and depression, anxiety and burnout of intensive carenurses. This cross-sectional and descriptive research was conducted with 116 intensive care nurses. The data were obtained with a web-based questionnaire created with the "Descriptive Information Form", "COVID-19 Fear Scale", "Depression, Anxiety and Stress Scale Short Form" and "Burnout Short Version". A significant positive correlation was found between depression (r = 0.498, p < .001), anxiety (r = 0.633, p < .001), stress (r = 0.589, p < .001) and burnout (r = 0.299, p = .001) levels of intensive care nurses with a mean age of 30.18 ± 6.55 with the help of the "COVID-19 Fear Scale". It was determined that the mental health of intensive care nurses was at risk and they reached the level of burnout. Intensive care nurses should be supported in understanding the symptoms of psychological problems and in stress management, personal and professional self-care. Receiving professional mental health support when necessary.

Understanding the impact of the pandemic on university students: Changes in sleep, eating patterns, and psychological well-being

BACKGROUND

Covid-19 is one of the world's major pandemics. It has affected millions of people in various ways.

OBJECTIVE

This study investigates the influence of pandemic-induced shifts in eating and sleeping behaviors on the psychological well-being of university students.

METHODS

The study adopted a cross-sectional research design. A total of 604 students participated in the study. The Personal Form, the Psychological Well-Being Index, and the Pittsburgh Sleep Quality Index were used to collect data. The research was conducted between October 2021 and December 2022.

RESULTS

The participants reported a mean psychological well-being score of 40.76 ± 9.38, alongside a Pittsburgh Sleep Quality Index score of 7.46 ± 3.30. Analysis revealed a significant negative correlation between the mean psychological well-being scores and the Pittsburgh Sleep Quality Index scores (p < 0.01). Throughout the pandemic, the participants experienced a decline in physical activity, an increase in their body weight, and a change in their eating habits. While psychological well-being remained relatively high, sleep quality was notably poor. Notably, improvements in psychological well-being corresponded with enhancements in sleep quality, suggesting a reciprocal relationship between the two variables.

CONCLUSIONS

The pandemic negatively impacted the physical activity and body weight of young adults. This study highlights the importance of promoting physical activity among university students during pandemics and similar crises to reduce adverse effects on body weight. It also highlights the importance of educating students about the importance of healthy sleep and how to maintain good sleep hygiene.

Association between social jetlag and anxiety symptoms: Findings from a nationally representative sample of the Korean working population

OBJECTIVES

Social jetlag (SJL), which arises from the misalignment of biological and social rhythms, is associated with adverse health outcomes. We explored the association between SJL and anxiety symptoms in Korean workers.

METHODS

This cross-sectional study included a nationally representative sample, consisting of 2731 adult workers. SJL was calculated as the absolute difference in the midpoint between sleep onset and offset times on workdays and free days. The Generalized Anxiety Disorder-7 scale was used to assess anxiety symptoms. Logistic regressions were used to estimate the odds ratios (ORs) and 95 % confidence intervals (CIs).

RESULTS

Among the sample, 66.5 % individuals had 0-59 min of SJL, 22.6 % had 60-119 min of SJL, and 10.9 % had ≥120 min of SJL. The prevalence of anxiety symptoms was 3.4 % for those with 0-59 min of SJL, 3.2 % for those with 60-119 min of SJL, and 7.7 % for those with ≥120 min of SJL. Workers with ≥120 min of SJL, compared with those with 0-59 min of SJL, were associated with an increase in the odds of having anxiety symptoms (OR:2.04, 95 % CI:1.10-3.78). A 1-h increase in SJL is associated with a 1.35-fold increase in the odds of anxiety symptoms (95 % CI:1.04-1.75). This positive association remained robust after adjusting for the effect of sleep deprivation using a sleep-corrected formula.

CONCLUSION

≥2 h of SJL is associated with anxiety symptoms in Korean workers. Policy measures are required to mitigate excess SJL and monitor the mental health of workers with high SJL levels.

Genome-Wide Association Analyses of HPV16 and HPV18 Seropositivity Identify Susceptibility Loci for Cervical Cancer

Infection by high-risk human papillomavirus is known to exacerbate cervical cancer development. The host immune response is crucial in disease regression. Large-scale genetic association studies for cervical cancer have identified few susceptibility variants, mainly at the human leukocyte antigen locus on chromosome 6. We hypothesized that the host immune response modifies cervical cancer risk and performed three genome-wide association analyses for HPV16, HPV18 and HPV16/18 seropositivity in 7814, 7924, and 7924 samples from the UK Biobank, followed by validation genotyping in the German Cervigen case-control series of cervical cancer and dysplasia. In GWAS analyses, we identified two loci associated with HPV16 seropositivity (6p21.32 and 15q26.2), two loci associated with HPV18 seropositivity (5q31.2 and 14q24.3), and one locus for HPV16 and/or HPV18 seropositivity (at 6p21.32). MAGMA gene-based analysis identified HLA-DQA1 and HLA-DQB1 as genome-wide significant (GWS) genes. In validation genotyping, the genome-wide significant lead variant at 6p21.32, rs9272293 associated with overall cervical disease (OR = 0.86, p = 0.004, 95% CI = 0.78-0.95, n = 3710) and HPV16 positive invasive cancer (OR = 0.73, p = 0.005, 95% CI = 0.59-0.91, n = 1431). This variant was found to be a robust eQTL for HLA-DRB1, HLA-DQB1-AS1, C4B, HLA-DRB5, HLA-DRB6, HLA-DQB1, and HLA-DPB1 in a series of cervical epithelial tissue samples. We additionally genotyped twenty-four HPV seropositivity variants below the GWS threshold out of which eleven variants were found to be associated with cervical disease in our cohort, suggesting that further seropositivity variants may determine cervical disease outcome. Our study identifies novel genomic risk loci that associate with HPV type-specific cervical cancer and dysplasia risk and provides evidence for candidate genes at one of the risk loci.

Prevalence of Anxiety and Depression among Nurses during the early phase of COVID-19: A meta-analysis

Background & Objective

The COVID-19 pandemic exposed significant mental health challenges among healthcare workers, particularly nurses, who are key frontline responders and are the largest segment of the global health workforce. Given the ongoing threat of Mpox and potential new COVID-19 variants, understanding these challenges is vital. This review estimates the prevalence of anxiety and depression among nurses during the early phase of the pandemic to inform future pandemic responses.

Methods

A systematic review was conducted to identify studies published from January 1st to November 9, 2020. The quality of the included studies was assessed using the JBI Critical Appraisal Checklist. This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis was performed using a random-effects model to estimate the pooled prevalence of anxiety and depression.

Findings

Twenty-seven studies, involving 39,386 nurses from ten countries, were included in the meta-analysis. The pooled prevalence of anxiety across 24 studies was 38.54% (95% CI: 33.99, 43.10) (I2 = 97.89%). The pooled prevalence of depression in 22 studies was found to be 35.52% (95% CI: 26.61, 44.43) (I2 = 99.72%).

Interpretation

The pooled prevalence of anxiety and depression in nurses caring for patients with COVID-19 during the early phase of the pandemic was higher than that in other healthcare workers. With the ongoing Mpox outbreak and the potential for future pandemics, these findings necessitate timely screening and robust mental health strategies to support nurses and enhance healthcare resilience.

Assessing stress among community health workers due to COVID-19 related work: A comparative study from Vietnam

BackgroundCommunity health workers (CHWs) involved in COVID-19 response might be at increased risk of stress, though evidence remains absent.ObjectiveTo assess the effects of COVID-19 related work on stress and identified factors associated with the risk of deteriorating to severe stress among CHWs in Vietnam.MethodsUsing a nation-wide survey among 979 CHWs involved in COVID-19 response, we applied multivariable logistic regression to estimate the risk of deteriorating to high stress levels between before the epidemic (average June-December 2019) and at its peak (January-March 2021). Stress levels were measured using the Perceived Stress Scale (PSS-10).ResultsMedian stress levels among CHWs increased from 10 (IQR = 7-16) before COVID-19 to 15 (IQR = 11-19) on the PSS-10 during the COVID-19 outbreak. The proportion of CHWs with low stress levels decreased from 67.6% to 42.2% (p-value <0.001), while the proportion of CHWs with moderate and high stress levels increased 1.8 and 4.2-fold, respectively. Less sleep and poor sleep quality, working in unfavorable work environments, and being involved in daily high-risk SARS-CoV-2 exposure activities were associated with an increased risk of deterioration to high stress levels.ConclusionsWe found a substantial increase in stress levels among CHWs in Vietnam that is probably due to their COVID-19 related work; the observed 2 and 4-fold increase in CHWs suffering from moderate and high stress levels, respectively, is particularly worrisome. Targeted support for CHWs is crucial to ensure the sustainability of health interventions during COVID-19 and future epidemics.

Internal Structure of the Patient Health Questionnaire-9: A Systematic Review and Meta-analysis

PURPOSE

This review aimed to evaluate the internal structure (structural validity, internal consistency, and measurement invariance) of the Patient Health Questionnaire-9 (PHQ-9), which is one of the most widely used self-administered instruments for assessing and screening depression.

METHODS

The updated COnsensus-based Standards for the selection of health Measurement Instruments methodology for a systematic review of self-reported instruments was used. PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library databases were searched from their inception up to February 28, 2023.

RESULTS

This study reviewed 98 psychometric studies reported on in 90 reports conducted in 40 countries. Various versions of the PHQ-9 were identified: one-factor structures (8 types), two-factor structures (10 types), bifactor structures (4 types), three-factor structure (1 type), and second-order three-factor structure (1 type). There was sufficient high-quality evidence for structural validity of the one-factor structure with nine items scored using a four-point Likert scale based on confirmatory factor analysis, for internal consistency with a quantitatively pooled Cronbach α of .85, and for measurement invariance across sex, age, education level, marital status, and income groups. There was sufficient high-quality evidence for structural validity, internal consistency (Cronbach's α = .76- .92, ω = 0.83- .92), and measurement invariance across sex for the PHQ-8 (which excluded item 9: "suicidality or self-harm thoughts").

CONCLUSION

The one-factor PHQ-9 and PHQ-8 (excluding item 9) scored using a four-point Likert scale have the best internal structure based on the current evidence. The one-factor PHQ-9 and PHQ-8 justify the use of aggregated total scores in both practice and research. The total score of the PHQ-9 using a four-point Likert scale can be used to compare depression levels across sex, age, education level, marital status, and income groups due to the availability of sufficient evidence for measurement invariance across these demographic groups.

Pharmaco-Epidemiological Study and Correlation Between Antibiotic Resistance and Antibiotic Consumption in a Tunisian Teaching Hospital from 2010 to 2022

The exponential rise of bacterial resistance poses a threat to antibiotic efficacy, with a great impact on public health. This study aims to analyze the correlation between antibiotic consumption and the emergence of bacterial resistance. Conducted retrospectively at Charles Nicolle Hospital in Tunis, Tunisia, from 2010 to 2022, this study was based on STKMED® software for antibiotic consumption data, hospital administrative records for the number of hospitalization days, and SIRSCAN® software for bacteriological data. Data processing was performed using Excel® software version 2019, and analysis was conducted using SPSS23®. In 2022, consumption was almost evenly split between the two major "AWaRe" groups, with 49.33% for "Access" and 46.89% for "Watch", and the consumption of the "Reserve" group also increased, accounting for 3.77% of the total. Bacterial resistances, notably carbapenem-resistant Klebsiella pneumoniae, increased. Seventy-four significant correlations were identified, including those between carbapenem consumption and resistance in Escherichia coli and Klebsiella pneumoniae strains. However, no significant correlation was observed with imipenem-resistant Pseudomonas aeruginosa strains. The significant correlations between the emergence of bacterial resistance and antibiotic use, particularly with antibiotics in the "Watch" and "Reserve" groups, underscore the urgent need to continue efforts to combat this threat through rational antibiotic use.

Chapter 9: Indications for the treatment of primary hyperparathyroidism

The choice of therapeutic method for the management of primary hyperparathyroidism depends on the severity of the disease and its complications at the time of diagnosis, the specific situation of each patient and his/her natural history, and assessment of the risk/benefit ratio for each method (surgery, local destruction or drugs). This chapter summarizes the indications for the treatment of primary hyperparathyroidism, based on the international literature available as of December 31st, 2023.

Insular-striatal activation during COVID-19 predicts stress reactivity in high-trait anxiety

The COVID-19 pandemic, unlike natural disasters that cause short-term stress, has led to prolonged psychological strain, increasing attentional biases toward health threats and worsening mental health. Prolonged exposure to pandemic-related stressors has exacerbated these issues, with individual differences, such as anxiety levels, influencing vulnerability and resulting in varied outcomes. Understanding how neurocognitive processes modulate attentional biases, such as prolonged attention (overresponding) to threats or avoidance, is crucial for explaining their effects on mental health during the pandemic. Real-world examination of these biases is needed to confirm their manifestation and better target interventions. This longitudinal study explored the neural network of attentional biases in anxious individuals, focusing on whether initial activation at baseline (T1) could predict changes in perceived stress. High and low trait anxious (HTA, LTA) adults completed an emotional Stroop task during two fMRI visits, one year apart. Results showed insular-fronto-striatal hypoactivation in the HTA group over time, indicating increased avoidance in HTA participants. Initial insular-striatal activation at T1 predicted perceived stress changes in the HTA group. Reduced activation in these regions suggests avoidance and impaired stress coping, highlighting increased stress vulnerability in HTA individuals during the pandemic and underscoring the importance of interventions to enhance resilience.