Symptoms in Health Care Workers during the COVID-19 Epidemic. A Cross-Sectional Survey

Burnout experience among healthcare workers post third COVID-19 wave in India; findings of a cross-sectional study

Background

The pandemic exacerbated burnout experienced by healthcare personnel, whose mental health had long been a public health concern before COVID-19. This study used the Copenhagen burnout inventory (CBI) tool to assess burnout and identify predictors among Indian healthcare workers managing COVID-19.

Methods

A cross-sectional study was conducted from June to December 2022, after the third pandemic wave. A web-based, fillable Google form was used to recruit COVID-19 management professionals from multiple Jaipur district hospitals. Healthcare professionals provided socio-demographic, work-related, and CBI scores. Multiple linear regression was used to control for model covariant independent variables.

Results

We evaluated the responses of a total of 578 participants with a mean age of 36.59 ± 9.1 years. Based on the CBI cut-off score of 50, 68.1% reported burnout. A total of 67.5%, 56.4%, and 48.6% of healthcare workers reported work-related, personal, and patient-related burnout, respectively. High burnout scores were significantly associated with the nursing profession (β = 7.89, 95% CI; 3.66, 12.11, p < 0.0001). The p-value indicates the probability of observing the data if the null hypothesis is true, and the confidence interval shows the range within which we can be 95% confident that the true effect lies. An independent relationship exists between male gender and higher personal-related burnout scores (β = 4.45, 95% CI 1.9-6.9).

Conclusion

This study identified key indicators that need further emphasis and the need for organizational and individual-level burnout monitoring in healthcare delivery sectors. Health workers continue to experience burnout due to a combination of personal, professional, and patient-related factors. This underscores the need for targeted organizational and individual interventions. The findings also suggest that the CBI tool could identify healthcare worker burnout risk groups.

Foreign-born nurses as COVID-19 survivors in the Nordic region: A descriptive phenomenological study

OBJECTIVE

In 2020, amid limited COVID-19 vaccination access, many nurses from Black, Asian and Minority Ethnic (BAME) groups in the United States of America and United Kingdom succumbed to the virus. No fatalities among Filipino foreign-born nurses (FBNs) in the BAME groups were recorded in the Nordic region. This study explored the experiences of Filipino FBNs in the Nordic region who, during the initial 2020 pandemic wave, cared for COVID-19 patients, contracted the virus and subsequently recovered.

METHODS

The research employed a descriptive phenomenological methodology to explore the experiences of six Filipino FBNs who had recovered from COVID-19 in various regions of the Nordic countries, including Finland (n = 1), Sweden (n = 1), Denmark (n = 2), Norway (n = 1) and Iceland (n = 1). Data collection occurred through online videoconferencing between September 2020 and February 2021, utilising a semi-structured approach. The data analysis was conducted following Sundler and colleagues' qualitative thematic analysis, which is grounded in descriptive phenomenology.

RESULTS

The data analysis yielded three primary themes and twelve sub-themes, which explored the experiences of Filipino FBNs with COVID-19 infection. The study demonstrated that unclear national guidelines impacted nurses' preparedness in caring for COVID-19 patients, contributing to their susceptibility to contracting the virus. The lack of occupational healthcare services for nurses during and after the pandemic affected their work morale in an unfamiliar setting.

CONCLUSION

The study provided valuable insights into the experiences of Filipino FBNs during the COVID-19 pandemic, emphasising the need for clearer guidelines, enhanced training and improved support for healthcare workers. It highlighted the psychological impact of COVID-19, emphasising the importance of mental health support and stigma reduction efforts. The study also emphasised the significance of improving occupational health services to support the well-being and recovery of healthcare workers during and after the pandemic, with implications for developing comprehensive strategies to protect frontline healthcare workers in health crises.

How Mental Health Nurses Report Their Compassion Fatigue and Compassion Satisfaction: A Cross-Sectional Study and the Implications for Healthcare Leaders

Compassion fatigue is the cost of caring for others in emotional pain where the helping professional absorbs the trauma of those they help and cannot detach emotionally at the end of the day. Stressful and perceived unsupportive work environments may leave the caregiver at a heightened risk for compassion fatigue. To study the level of compassion fatigue and compassion satisfaction experienced by mental health nurses. A descriptive, cross-sectional, electronic survey design was utilized. The Professional Quality of Life Scale-5 was used. The study was conducted at a large, urban hospital that exclusively treats patients with mental health and addiction issues located in Ontario, Canada. The sample included all nurses who were listed on the hospital's Email list. All nurses who are displayed on this list are mental health nurses. Analyses were conducted to assess for differences between the characteristics and the subscales of professional quality of life. One hundred and forty-eight mental health nurses completed a questionnaire. The response rate was 21%. Seventy-six percent reported moderate levels of burnout, 59% reported moderate levels of secondary traumatic stress, and 21% reported high levels of compassion satisfaction. Predictors were seen for the characteristics of gender, ethnicity, marital status, area, exposure to violence and support felt. Compassion fatigue has clear implications. Organizations willing to invest in reducing it, have the potential to improve patient outcomes and the well-being of nurses. The majority of mental health nurses reported moderate levels for each of the subscales.

Predictors of professional burnout and fulfilment in a longitudinal analysis on nurses and healthcare workers in the COVID-19 pandemic

AIMS AND OBJECTIVES

(1) To investigate the vulnerability of nurses to experiencing professional burnout and low fulfilment across 5 months of the COVID-19 pandemic. (2) To identify modifiable variables in hospital leadership and individual vulnerabilities that may mitigate these effects.

BACKGROUND

Nurses were at increased risk for burnout and low fulfilment prior to the COVID-19 pandemic. Hospital leadership factors such as organisational structure and open communication and consideration of employee opinions are known to have positive impacts on work attitudes. Personal risk factors for burnout include symptoms of depression and anxiety.

METHODS

Healthcare workers (n = 406 at baseline, n = 234 longitudinal), including doctors (n = 102), nurses (n = 94), technicians (n = 90) and non-clinical administrative staff (n = 120), completed 5 online questionnaires, once per month, for 5 months. Participants completed self-report questionnaires on professional fulfilment and burnout, perceptions of healthcare leadership, and symptoms of anxiety and depression. Participants were recruited from various healthcare settings in the southeastern United States. The STROBE checklist was used to report the present study.

RESULTS

Both at baseline and across the 5 months, nurses working during the COVID-19 pandemic reported increased burnout and decreased fulfilment relative to doctors. For all participants, burnout remained largely steady and fulfilment decreased slightly. The strongest predictors of both burnout and fulfilment were organisational structure and depressive symptoms. Leadership consideration and anxiety symptoms had smaller, yet significant, relationships to burnout and fulfilment in longitudinal analyses.

CONCLUSIONS

Burnout and reduced fulfilment remain a problem for healthcare workers, especially nurses. Leadership styles and employee symptoms of depression and anxiety are appropriate targets for intervention.

RELEVANCE TO CLINICAL PRACTICE

Leadership wishing to reduce burnout and increase fulfilment among employees should increase levels of organisational support and consideration and expand supports to employees seeking treatment for depression and anxiety.

The Factors Associated With COVID-19 Infection Among Healthcare Workers at a Tertiary Care Institution in North India: A Case-Control Study

Background and objective Healthcare workers (HCWs) are at a higher risk of contracting coronavirus disease 2019 (COVID-19) since they regularly come into direct contact with infected patients and their surroundings. In light of this, it is critical to study the potential risk factors for SARS-CoV-2 infection among HCWs to help determine its transmission patterns and prevent infections among HCWs, as well as healthcare-associated COVID-19. Methods We conducted a case-control study at a tertiary healthcare center from December 2020 to August 2021. HCWs who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, by RT-PCR were included as cases and those who tested negative for RT-PCR and SARS-CoV-2 antibodies were recruited as controls. We interviewed 316 HCWs (187 cases and 129 controls) by using the WHO questionnaire titled "Protocol for assessment of potential risk factors for coronavirus disease 2019 among health workers in a health care setting" to assess infection prevention and control (IPC) knowledge and practices, including the use of personal protective equipment (PPE). The odds ratio (OR) for factors associated with infection was determined by multivariable logistic regression. Results The majority (87.2%) of the cases were symptomatic. Adherence to IPC measures was higher among controls as compared to cases. A significantly higher number of controls used PPE compared to cases. The proportions of HCWs involved in cleaning, patient transport, reception, and catering were higher among cases (37.9%) compared to controls (19.1%). In multivariable analysis, undergoing training on care for COVID-19 patients was associated with a lower risk of infection (OR: 0.40, 95% CI: 0.24-0.69). Conclusions Adherence to IPC and use of PPE were significantly higher among controls as compared to cases. Receiving training in COVID-19 patient care and compliance with IPC measures were associated with a lower risk of COVID-19 infection among HCWs in this study.

Assessment of the factors affecting health profession students' emergency transition during the COVID-19 pandemic: A cross-sectional study

Objective: This study aimed to identify the factors that affected health profession students' emergency transition during the COVID-19 pandemic and to explore strategies that may help students be better prepared for any future health crises. Participants: This study population included 73 students that were originally enrolled in one online section (n = 49) and one face-to-face section (n = 24) of a healthcare administration course before the transition. Methods: The cross-sectional study was conducted and the anonymous survey data were analyzed using SPSS and a Man-Whitney U test. Results: Of the 73 students, 48 completed the survey, with a response rate of 66% (48/73). There was a statistically significant difference in the perceived COVID-19 impact (z=-3.339, p = 0.001) and difficulty transitioning during the pandemic (3-2.142, p = 0.032) between both groups. The top three hindering factors were stress and anxiety, difficulty focusing on studying at home, and time management due to uncertainty. Conclusions: The study findings suggest strategies that may help students with adequate knowledge and capabilities in managing stress, anxiety, and unprecedented challenges in the future.

Two-year follow-up of post-traumatic stress disorder symptoms in healthcare workers after the COVID-19 pandemic in China

OBJECTIVES

This study aimed to conduct a 2-year follow-up of mental disorders in healthcare workers (HCWs) in a region of China outside the epidemic's core zone who happened to be directly or possibly exposed to persons with COVID-19.

MATERIAL AND METHODS

A cognitive analysis scale was utilized in the evaluation the mental or emotional state of HCWs at Xuzhou Medical University's affiliated hospital in the city of Xuzhou, China (a non-core epidemic area) 2 years after the first assessment during the COVID-19 pandemic. A total of 165 HCWs were selected as the study subjects. In accordance to the exposure risk of COVID-19 patients, the subjects were separated into 2 categories: a group with a high risk HCW (HHCW) (HCWs working in COVID-19-positive wards; N = 91) and a group with a minimal risk HCW (LHCW) (HCWs who worked in wards without COVID-19 patients at the same hospital; N = 75). The clinical as well as demographic information of every HCWs were collected.

RESULTS

The demographic data revealed significant differences in terms of occupation, remuneration, and selfless concerns amidst both categories (p < 0.05). There lacked a statistically notable difference in the occurrence of PTSD between the 2 groups. Data was analyzed for factors associated with PTSD, and the results showed that psychological resilience, job risk, and stress in the workplace were risk factors for PTSD. Additionally, the results of the logistic regression analysis showed that psychological resilience was a significant shared risk factor for PTSD in HCWs after the COVID-19 pandemic.

CONCLUSIONS

The 2-year follow-up showed no statistical difference in the incidence of PTSD between the HHCW group and the LHCW group. Workplace stress, occupational hazards, and psychological resilience were the major contributing risk factors for PTSD in HCWs. Int J Occup Med Environ Health. 2023;36(3):324-32.

Supporting Return to Work after Breast Cancer: A Mixed Method Study

Breast cancer (BC) is the most common invasive cancer in the world. Most BC survivors (BCSs) continue working while dealing with cancer-related disabilities. BCSs' return-to-work (RTW) after cancer treatment is an important stage of their recovery and is associated with a higher survival rate. In this study, we addressed the RTW of BCSs with the intention of facilitating this process through direct action in the workplace. Thirty-two women who requested assistance from January to December 2022 were enrolled in the study. Semi-structured interviews and medical examinations were conducted by a team of three physicians. Interviews were analyzed using Thematic Analysis. Moreover, a quantitative cross-sectional study was conducted to compare the health status of BCSs with that of a control group of 160 working women, using standardized questionnaires on work ability, fatigue, sleep problems, anxiety, depression, and happiness. BCSs were also asked to rate the level of organizational justice they perceived at work prior to their illness. From the qualitative analysis emerged three facilitating/hindering themes: (1) person-related factors, (2) company-related factors, and (3) society-related factors. In the quantitative analysis, BCSs had significantly higher scores for anxiety, depression, sleep problems and fatigue, and lower levels of happiness than controls. The RTW of BCSs entails adapting working conditions and providing adequate support. The work-related analysis of each case made it possible to highlight the measures that need to be taken in the workplace to promote RTW. The treatment of cancer should be paired with advice on the best way to regain the ability to work.

Lessons on the COVID-19 pandemic: who are the most affected

The COVID-19 pandemic has led to significant changes in work and lifestyle, impacting occupational mental health. This study examines the time and individual heterogeneity in the pandemic's effects on occupational mental health using panel data from job stress checks spanning 2018 to 2021. On average, there was an initial alleviation of high-stress risk in 2020, followed by a deterioration in 2021. Based on the job demand-resource theory, we identify the group of employees most affected by the pandemic. The findings highlight that employees in unfavorable workplace conditions are more likely to experience substantial adverse impacts. Adequate workplace support, including factors like interpersonal relationships, managerial support, job meaning, control, and work-life balance, is crucial for mitigating high-stress risk. Additionally, during the early phase of the pandemic, engaged employees experienced a slight decline in occupational mental health, while those lacking job resources at their worksite faced higher levels of occupational stress in the subsequent year. These findings offer practical suggestions for person-centered coping strategies to mitigate the pandemic's adverse impact.

Sleep disturbance and anxiety symptoms among asymptomatic COVID-19 carriers in Shanghai, China: the mediating role of entrapment and defeat

BACKGROUND

The COVID-19 pandemic increases the risk of psychological problems, especially for the infected population. Sleep disturbance and feelings of defeat and entrapment are well-documented risk factors of anxiety symptoms. Exploring the psychological mechanism of the development of anxiety symptoms is essential for effective prevention. This study aimed to examine the mediating effects of entrapment and defeat in the association between sleep disturbance and anxiety symptoms among asymptomatic COVID-19 carriers in Shanghai, China.

METHODS

A cross-sectional study was conducted from March to April, 2022. Participants were 1,283 asymptomatic COVID-19 carriers enrolled from the Ruijin Jiahe Fangcang Shelter Hospital, Shanghai (59.6% male; mean age = 39.6 years). Questionnaire measures of sleep disturbance, entrapment, defeat, anxiety symptoms, and background characteristics were obtained. A mediation model was constructed to test the mediating effects of entrapment and defeat in the association between sleep disturbance and anxiety symptoms.

RESULTS

The prevalence rates of sleep disturbance and anxiety symptoms were 34.3% and 18.8%. Sleep disturbance was positively associated with anxiety symptoms (OR [95%CI] = 5.013 [3.721-6.753]). The relationship between sleep disturbance and anxiety symptoms (total effect: Std. Estimate = 0.509) was partially mediated by entrapment (indirect effect: Std. Estimate = 0.129) and defeat (indirect effect: Std. Estimate = 0.126). The mediating effect of entrapment and defeat accounted for 50.3% of the association between sleep disturbance and anxiety symptoms.

CONCLUSION

Sleep disturbance and anxiety symptoms were prevalent among asymptomatic COVID-19 carriers. Entrapment and defeat mediate the association between sleep disturbance and anxiety symptoms. More attention is needed to monitoring sleep conditions and feelings of defeat and entrapment to reduce the risk of anxiety.

Post-COVID Symptoms in Occupational Cohorts: Effects on Health and Work Ability

Post-acute COVID-19 syndrome is frequently observed in workers and has a substantial impact on work ability. We conducted a health promotion program to identify cases of post-COVID syndrome, analyze the distribution of symptoms and their association with work ability. Of the 1422 workers who underwent routine medical examination in 2021, 1378 agreed to participate. Among the latter, 164 had contracted SARS-CoV-2 and 115 (70% of those who were infected) had persistent symptoms. A cluster analysis showed that most of the post-COVID syndrome cases were characterized by sensory disturbances (anosmia and dysgeusia) and fatigue (weakness, fatigability, tiredness). In one-fifth of these cases, additional symptoms included dyspnea, tachycardia, headache, sleep disturbances, anxiety, and muscle aches. Workers with post-COVID were found to have poorer quality sleep, increased fatigue, anxiety, depression, and decreased work ability compared with workers whose symptoms had rapidly disappeared. It is important for the occupational physician to diagnose post-COVID syndrome in the workplace since this condition may require a temporary reduction in work tasks and supportive treatment.

Change in depression during the COVID-19 pandemic among healthcare providers in Addis Ababa, Ethiopia

Background

The COVID-19 pandemic has increased mental health problems among healthcare workers globally. However, studies from low- and middle-income countries on this matter were minimal. This study assessed the change in depression prevalence during the first year of the COVID-19 pandemic and associated factors among healthcare providers in Addis Ababa, Ethiopia.

Methods

We conducted surveys among healthcare workers in Addis Ababa at two-time points, September 2020 and October 2021. A total of 577 study participants were randomly selected based on registers obtained from professional associations. Computer-assisted telephone interviewing technique was used for data collection. The Patient Health Questionnaire (PHQ-9) was used to screen for depression. Multivariable logistic regression analysis was performed to identify potential factors associated with depression.

Result

The prevalence of depression among healthcare workers was 2.3% (95% CI [1.1-4.8]) in Time 1 and 6.5% (95% CI [4.1-10.1]) in Time 2; nearly a three-fold increase in Time 2 compared to Time 1. The most frequently reported symptoms at both times based on the PHQ-9 item were having poor energy, sleep problem, and anhedonia, while reported suicidal ideation was less than 5%. Depression showed a positive and significant association with a positive COVID-19 test result (AOR 7.25 95% CI [1.32-39.4]) in Time 1, and with being a female healthcare provider (AOR 3.96 95% CI [1.08-14.51]) and lack of COVID-19 related policy or guidelines at the workplace (AOR 3.22 95% CI [1.11-9.35]) in Time 2.

Conclusion

The prevalence of depression among healthcare workers tripled during the first year of the COVID-19 pandemic. Panic reaction to positive COVID-19 test result seems to have a negative effect at the beginning while lack of disease-specific prevention guidelines and comprehensive psychological interventions for healthcare providers had an adverse effect on the mental health of health workers.

Analysis of the sense of occupational stress and burnout syndrome among physiotherapists during the COVID-19 pandemic

The nature of physiotherapists' work involves an increased risk of occupational stress and burnout, particularly during the COVID-19 pandemic. Therefore, the aim of the study was to analyse the level of perceived generalised stress, the occupational stress and the occupational burnout syndrome among physiotherapists during the COVID-19 pandemic. One hundred seventy professionally active physiotherapists participated in the study: 100-during the pandemic and 70 before the COVID-19 pandemic. The study was carried out using the authors' survey, the Subjective Work Assessment Questionnaire (SWAQ), the Oldenburg Burnout Inventory (OLBI), the Perceived Stress Scale (PSS-10), and the Brief Coping Orientation to Problems Experienced (Mini-COPE) inventory. The physiotherapists examined prior to the pandemic exhibited a higher level of generalised stress and higher level of occupational stress and occupational burnout (p = 0.0342; p < 0.00001; p < 0.00001, respectively). The key factors which caused intensified occupational stress in both groups included the lack of rewards at work, social interaction, and the lack of support. The results suggest that healthcare professionals including physiotherapists are exposed to occupational stress and a high risk of occupational burnout, not only during the COVID-19 pandemic. Occupational stress prevention programmes should be based on the identification and elimination of all occupational risks.

COVID-19-related stress among emergency physicians: a scoping review protocol on the stressors and coping strategies

OBJECTIVE

This scoping review aims to identify the COVID-19-related stressors and the corresponding coping strategies among emergency physicians during and following the pandemic.

INTRODUCTION

In the midst of an unprecedented COVID-19 crisis, healthcare professionals confront a diverse set of difficulties. Emergency physicians are under immense pressure. They must provide frontline care and make quick decisions in a high-pressure environment. This can lead to a variety of physical and psychological stressors, including extended working hours, increased workload, personal risk of infection and the emotional toll of caring for infected patients. It is critical that they be informed of the numerous stressors they face, as well as the various coping methods accessible to them, in order to deal with these pressures.

INCLUSION CRITERIA

This paper will summarise the findings of primary or secondary investigations on emergency physicians' stressors and coping strategies during and following the COVID-19 epidemic. All journals and grey literature in English and Mandarin published after January 2020 are eligible.

METHODS

The Joanna Briggs Institute (JBI) method will be used to conduct the scoping review. A thorough literature search will be performed on OVID Medline, Scopus and Web of Science to find eligible studies, using the keywords related to emergency physicians, stress and coping strategies. Two reviewers will independently revise all of the full-text articles, extract data and evaluate the study quality. A narrative overview of the findings from included studies will be given.

ETHICS AND DISSEMINATION

This review will involve secondary analysis of published literature, and therefore ethics approval is not required. The Preferred Reporting Items for Systematic reviews and Meta-Analyses checklist will be used to guide translation of findings. Results will be disseminated through peer-reviewed journals and presented in conferences via abstract and presentation.

Levels of Anxiety and Fear among Nurses During the COVID-19 Pandemic: A Systematic Review

Aim. The aim of this review is to find out what levels of anxiety and fear have been shown by nurses during the COVID-19 pandemic. Background. Health security crises affect not only physical health but also the mental health and wellbeing of healthcare professionals due to a higher level of exposure. Evaluation. A systematic review was carried out following the PRISMA statement. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. The literature search was carried out in the PubMed, Scopus, and Web of Science (WoS) electronic databases based on the keywords that the research question yielded following the PECOT strategy. For the selection of articles, original articles, meta-analyses, systematic reviews, short communication articles, and case reports were included. Then, a series of inclusion and exclusion criteria were applied, screening the results to obtain a total of 18 articles, which were used to elaborate the study. Key Issues. Fear and anxiety levels were described in a total of 18 selected studies. The main fear-related concerns of the nurses were associated with the fear of infecting their family or friends and the fear of the death of a family member or friend. Conclusions. The main psychological impact on nurses during the COVID-19 pandemic was related to fear, anxiety, stress, and depression. Fear of infecting family members or of being infected were the main impacts perceived by nurses. Implications for Nursing Management. In general, high scores were found for levels of fear and anxiety, although the figures varied by country and time of data collection. Resilience was considered the main tool for coping with the loss and trauma experienced by nurses.

Physical and psychological fatigue, and work performance among Brazilian workers during the SARS-CoV-2 (COVID-19) pandemic in Brazil

The lockdown requirement, caused by SARS-CoV-2 (COVID-19), led to people having to follow a work from home regime. This pandemic made workers more vulnerable, causing emotional disorders that impacted their work performance. This online survey aimed to identify the psychological and emotional impacts of the COVID-19 pandemic on Brazilian workers, testing the predictive effect between physical and emotional fatigue factors, and expectations about their performance. The participants were 153 workers from different sectors or departments of the University of Brasilia following the work from home modality. To achieve the main aim of this study, the questionnaire 'Feeling Fatigue Scale' by Yoshitake, and the nine items of the 'Achievement' factor of the 'Well-being at Work' questionnaire by Paschoal and Tamayowere applied. Study data were collected between February and August 2020. Statistically significant differences were found between cognitive aspects (difficulties in attention to work, p = .001,) expectations regarding performance (p = .035), and the impact of fatigue on the body (p = .021) when comparing the profile of workers from the areas of exact sciences, health, and social and human sciences. Workers who reported more extreme difficulty in attention had lower expectations regarding the performance achieved in the exercise of their duties (R² adjusted = .271, p < .001). The results demonstrate the importance of planning public policies aimed at promoting mental and physical health at work.

Psychological Distress of Healthcare Workers in 4 Hospitals Compared to General Population During the First Italian Wave of COVID-19 Pandemic

COVID-19 caused important consequences on public health, economy, physical, and mental health of people. The aim of this study was to evaluate the impact of COVID-19 on frontline workers, comparing them with their colleagues who had no contact with the patients and with the general population, by administering an online questionnaire based on the Distress Questionnaire-5 (DQ5). The study was carried out during the first Italian wave of COVID-19 pandemic from 1st to 30th of April. Participants were divided in 3 groups: group 1 is general population group that includes the general population which are quarantined but not isolated, group health care staff not working in COVID-19 hospitals, and group 3 healthcare staff group working in COVID-19 hospitals. The survey was carried with the Distress Questionnaire-5 (DQ5) as a tool to detect the psychological distress and mental health problems. A total of 2983 people participated in this survey. Seven hundred and twenty four out of 1123 (64%) were employers of the 4 hospitals included in this study. Particularly among the respondents, 2259 (75.7%) were general population, 502 (16.8%) were health care staff not working in COVID-19 hospitals, while 222 (7.4%) were health care staff working in covid-19 hospitals. Health care personnel working in COVID-19 hospitals (DQ-5 = 13, 10-16) had less psychological distress compared with health care staff not working in COVID-19 hospitals (DQ-5 = 14, 11-16) and general population (DQ-5 = 14, 11-17; P = .04). The regression model showed that people aged 26 to 35 (OR: 2.06, 95% CI: 1.21-3.48) and female (OR: 2.35, 95% CI: 1.95-2.83) were significantly at risk to develop a DQ-5 ≥ 11. During the first Italian wave of COVID-19 pandemic, healthcare personnel working in COVID-19 hospitals had less psychological distress compared with health care staff not working in COVID-19 hospitals and general population, probably because they were prepared to face situations like outbreak or emergencies.

Effects of COVID-19 pandemic on mental health among frontline healthcare workers: A systematic review and meta-analysis

Background

As some countries announced to remove Coronavirus Disease 2019 (COVID-19) border, it indicates that the COVID-19 may have entered its terminal stage. In this COVID-19 pandemic, the mental health of frontline healthcare workers (HCWs) experienced unprecedented challenges. However, the impact of the COVID-19 pandemic on mental health among frontline HCWs lacks a high-quality and long-term systematic review and meta-analysis.

Methods

We conducted a systematic review and meta-analysis according to PRISMA guidelines. The system searches EMBASE, MEDLINE, PsycINFO, Cochrane Library, ScienceNet, and ERIC. Analyze the mental health problems of frontline HCWs in different regions and periods, including insomnia, stress, anxiety and depression. This study was registered in PROSPERO under the number CRD42021253821.

Results

A total of 19 studies on the effects of COVID-19 pandemic on mental health among frontline HCWs were included in this study. The overall prevalence of insomnia was 42.9% (95% CI, 33.9-51.9%, I 2 = 99.0%) extracted from data from 14 cross-sectional studies (n = 10 127), 1 cohort study (n = 4,804), and 1 randomized controlled trial (RCT; n = 482) in 10 countries. The overall prevalence of stress was 53.0% (95% CI, 41.1-64.9%, I 2 = 78.3%) extracted from data from nine cross-sectional studies (n = 5,494) and 1 RCT study (n = 482) from eight countries. The overall prevalence of anxiety and depression was 43.0% (95% CI, 33.8-52.3%, I 2 = 99.0%) and 44.6% (95% CI, 36.1-53.1%, I 2 = 99.0%) extracted from data from 17 cross-sectional studies (n = 11,727), one cohort study (n = 4,804), and one RCT study (n = 482) from 12 countries. The prevalence of stress and depression was higher in 2020, while the prevalence of insomnia and anxiety was higher in 2021. The prevalence of mental health problems among physicians was higher than that of other frontline HCWs. The prevalence of mental health problems among frontline HCWs is higher in South America and lower in North America.

Conclusions

This systematic review and meta-analysis showed that the COVID-19 pandemic have significant effects on mental health among frontline HCWs. The overall prevalence of insomnia, stress, anxiety and depression among frontline HCWs is high. Therefore, the health policy-makers should pay attention to and respond to the mental health problems of frontline HCWs in the context of public health emergencies.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/.

Long-term Complications of COVID-19 in Nursing Staff; a Retrospective Longitudinal Study

Introduction

Although the lungs are the main target of coronavirus disease (COVID-19), infection is also associated with a high rate of extra-pulmonary complications. This study aimed to evaluate the one-year incidence of long-term COVID-19 complications among the nursing staff.

Methods

This study is a retrospective longitudinal study. All nursing staff working in public hospitals affiliated with Shahid Beheshti University of Medical Sciences who had been affected with COVID-19 were included in the study via convenience sampling method. The patients were recruited from 20_th February 2020 to 20_th March 2021.

Result

1762 nursing staff with a mean age of 35.08 ± 8.02 (Range: 22-66) years were studied (73.5% female). The results showed that among those who reported at least one type of complication, the duration of complications was significantly longer than 1 week and the median was 8 weeks. The findings demonstrated that complications occurred in 65% of infected females. For men, this rate was 62.3%. Generalized pain, anxiety disorders, and skin complications were among the complications that were significantly more common in women than in men. Additionally, the incidence of anosmia, ageusia, anxiety disorders, and skin complications was significantly higher in younger people than in older people. The comparison of complications revealed that nurses were significantly more likely than other occupations to experience respiratory complications, anosmia and ageusia, generalized pain, and skin complications and that outpatients experienced significantly more complications than hospitalized patients.

Conclusion

The one-year cumulative incidence of long-term complications in nursing staff with COVID-19 was 64.3%. The most common complications were respiratory complications, generalized pain, anosmia, and ageusia, respectively.

Causal Model Analysis of the Effect of Formalism, Fear of Infection, COVID-19 Stress on Firefighters' Post-Traumatic Stress Syndrome and Insomnia

As the front line of epidemic prevention, firefighters are responsible for the transportation of infected cases. Firefighters are under a lot of stress from the new COVID-19, especially the fear that they may contract the virus at work and spread the virus to their families. In particular, the framework of this study incorporates Riggs' formalism variables. When firefighters think that the epidemic prevention regulations are inconsistent with the actual epidemic prevention, it will increase their work pressure on COVID-19. In this study, firefighters from all over Taiwan were used as the respondents, and a total of 453 respondents were obtained. This study uses confirmatory factor analysis and structural equation modeling to test the established hypotheses. The findings confirm that formalism, fear of self and family infection are positively influencing COVID-19 stress. COVID-19 stress positively affects PTSD and insomnia. COVID-19 stress negatively affects problem-focused strategies. Problem-focused strategies negatively affect post-traumatic stress disorder.

Long-Term COVID-19 Smell and Taste Disorders Differ Significantly from Other Post-Infectious Cases

INTRODUCTION

COVID-19 is causing a wide range of clinical manifestations. Severe complications and long-lasting sequelae have been identified. Thus, olfactory disorders are reported in up to 86% of cases in mild and moderate COVID-19 infections. We present the first study comparing simple and complex post-COVID-19 cases with matched non-COVID-19 post-infectious smell and taste disorders.

METHODS

A total of 328 patients were recruited from the University Clinic for Flavour, Balance and Sleep, Ear-nose-throat Department, Goedstrup Hospital, Denmark. A non-COVID -19 post-infectious population of 148 individuals was identified from the Redcap database, and was matched by duration of smell and taste disorders. Post-COVID-19 patients were divided into 99 patients with simple smell and taste disorders (only suffering from smell and taste disorders after COVID-19); and (81 patients with complex smell and taste disorder plus several other post-COVID-19 complaints). Besides patient-reported outcome measures (PROM) questionnaires and quality of life score (QoL), ear-nose-throat examination, Mini-Mental State Examination (MMSE), orthonasal smell test (Sniffing's sticks), retronasal quick test, and taste screening were performed.

RESULTS

Cases with post-COVID-19-related smell and taste disorders deviated from non-COVID-19 post-infectious cases; the patients were younger, had a lower occurrence of anosmia/ageusia, and had higher overall smell test scores. In contrast, patients with post-COVID-19-related smell and taste disorders more frequently complained of distorted senses. Parosmia and phantosmia were more prevalent among patients with simple post-COVID-19 complaints than among complex cases and their QoL were more negatively affected.

CONCLUSION

Smell and taste function differ significantly between post-COVID-19 and other non-COVID-19 post-viral cases.

LEVEL OF EVIDENCE

3 Laryngoscope, 133:169-174, 2023.

Taste loss as a distinct symptom of COVID-19: a systematic review and meta-analysis

Chemosensory scientists have been skeptical that reports of COVID-19 taste loss are genuine, in part because before COVID-19 taste loss was rare and often confused with smell loss. Therefore, to establish the predicted prevalence rate of taste loss in COVID-19 patients, we conducted a systematic review and meta-analysis of 376 papers published in 2020-2021, with 235 meeting all inclusion criteria. Drawing on previous studies and guided by early meta-analyses, we explored how methodological differences (direct vs. self-report measures) may affect these estimates. We hypothesized that direct measures of taste are at least as sensitive as those obtained by self-report and that the preponderance of evidence confirms taste loss is a symptom of COVID-19. The meta-analysis showed that, among 138,015 COVID-19-positive patients, 36.62% reported taste dysfunction (95% confidence interval: 33.02%-40.39%), and the prevalence estimates were slightly but not significantly higher from studies using direct (n = 15) versus self-report (n = 220) methodologies (Q = 1.73, df = 1, P = 0.1889). Generally, males reported lower rates of taste loss than did females, and taste loss was highest among middle-aged adults. Thus, taste loss is likely a bona fide symptom of COVID-19, meriting further research into the most appropriate direct methods to measure it and its underlying mechanisms.

Computational approach investigation bioactive molecules from Saussurea Costus plant as SARS-CoV-2 main protease inhibitors using reverse docking, molecular dynamics simulation, and pharmacokinetic ADMET parameters

SARS-COV-2 virus causes (COVID-19) disease; it has become a global pandemic since 2019 and has negatively affected all aspects of human life. Scientists have made great efforts to find a reliable cure, vaccine, or treatment for this emerging disease. Efforts have been directed towards using medicinal plants as alternative medicines, as the active chemical compounds in them have been discovered as potential antiviral or anti-inflammatory agents. In this research, the potential of Saussurea costus (S. Costus) or QUST Al Hindi chemical consistent as potential antiviral agents was investigated by using computational methods such as Reverse Docking, ADMET, and Molecular Dynamics with different proteases COVID-19 such as PDB: 2GZ9; 6LU7; 7AOL, 6Y2E, 6Y84. The results of Reverse Docking the complex between 6LU7 proteases and Cynaropicrin compound being the best complex, as the same result, is achieved by molecular dynamics. Also, the toxicity testing result from ADMET method proved that the complex is the least toxic and the safest possible drug. In addition, 6LU7-Cynaropicrin complex obeyed Lipinski rule; it formed ≤5 H-bond donors and ≤10 H bond acceptors, MW < 500 Daltons, and octanol/water partition coefficient <5.

COVID-19 Traumatic Disaster Appraisal and Stress Symptoms Among Health Care Workers: Insights From the Yale Stress Self-assessment

OBJECTIVE

To determine to what extent did health care workers experience the pandemic as a severe stress event.

METHODS

This cross-sectional evaluation of 8299 health care workers, representing a 22% response rate, utilized machine learning to predict high levels of escalating stress based on demographics and known predictors for adverse psychological outcomes after trauma.

RESULTS

A third of health care workers experienced the pandemic as a potentially traumatic stress event; a greater proportion of health care workers experienced high levels of escalating stress. Predictive factors included sense of control, ability to manage work-life demands, guilt or shame, age, and level of education. Gender was no longer predictive after controlling for other factors. Escalating stress was especially high among nonclinical academics and clinical private practitioners.

CONCLUSION

Findings suggest adverse effects on total worker health, care quality, professionalism, retention, and acute and chronic mental health.

Seroprevalence, correlates and kinetics of SARS-CoV-2 nucleocapsid IgG antibody in healthcare workers and nonclinical staff at a tertiary hospital: A prevaccine census study

BACKGROUND

Healthcare workers and nonclinical staff in medical facilities are perceived to be a high-risk group for acquiring SAR-CoV-2 infection, and more so in countries where COVID-19 vaccination uptake is low. Serosurveillance may best determine the true extent of SARS-CoV-2 infection since most infected HCWs and other staff may be asymptomatic or present with only mild symptoms. Over time, determining the true extent of SARS-CoV-2 infection could inform hospital management and staff whether the preventive measures instituted are effective and valuable in developing targeted solutions.

METHODS

This was a census survey study conducted at the Aga Khan University Hospital, Nairobi, between November 2020 and February 2021 before the implementation of the COVID-19 vaccination. The SARS-CoV-2 nucleocapsid IgG test was performed using a chemiluminescent assay.

RESULTS

One thousand six hundred thirty-one (1631) staff enrolled, totalling 60% of the workforce. The overall crude seroprevalence was 18.4% and the adjusted value (for assay sensitivity of 86%) was 21.4% (95% CI; 19.2-23.7). The staff categories with higher prevalence included pharmacy (25.6%), outreach (24%), hospital- based nursing (22.2%) and catering staff (22.6%). Independent predictors of a positive IgG result after adjusting for age, sex and comorbidities included prior COVID-19 like symptoms, odds ratio (OR) 2.0 [95% confidence interval (CI) 1.3-3.0, p = 0.001], a prior positive SARS-CoV-2 PCR result OR 12.0 (CI: 7.7-18.7, p<0.001) and working in a clinical COVID-19 designated area, OR 1.9 (CI 1.1-3.3, p = 0.021). The odds of testing positive for IgG after a positive PCR test were lowest if the antibody test was performed more than 2 months later; OR 0.7 (CI: 0.48-0.95, p = 0.025).

CONCLUSIONS

The prevalence of anti- SARS-CoV-2 nucleocapsid IgG among HCWs and nonclinical staff was lower than in the general population. Staff working in clinical areas were not at increased risk when compared to staff working in non-clinical areas.

Narrative review on century of respiratory pandemics from Spanish flu to COVID-19 and impact of nanotechnology on COVID-19 diagnosis and immune system boosting

The rise of the highly lethal severe acute respiratory syndrome-2 (SARS-2) as corona virus 2019 (COVID-19) reminded us of the history of other pandemics that happened in the last century (Spanish flu) and stayed in the current century, which include Severe-Acute-Respiratory-Syndrome (SARS), Middle-East-Respiratory-Syndrome (MERS), Corona Virus 2019 (COVID-19). We review in this report the newest findings and data on the origin of pandemic respiratory viral diseases, reservoirs, and transmission modes. We analyzed viral adaption needed for host switch and determinants of pathogenicity, causative factors of pandemic viruses, and symptoms and clinical manifestations. After that, we concluded the host factors associated with pandemics morbidity and mortality (immune responses and immunopathology, ages, and effect of pandemics on pregnancy). Additionally, we focused on the burdens of COVID-19, non-pharmaceutical interventions (quarantine, mass gatherings, facemasks, and hygiene), and medical interventions (antiviral therapies and vaccines). Finally, we investigated the nanotechnology between COVID-19 analysis and immune system boosting (Nanoparticles (NPs), antimicrobial NPs as antivirals and immune cytokines). This review presents insights about using nanomaterials to treat COVID-19, improve the bioavailability of the abused drugs, diminish their toxicity, and improve their performance.

Depression, anxiety, and stress among frontline health workers during the second wave of COVID-19 in southern Vietnam: A cross-sectional survey

Health workers around the world have taken on massive frontline roles in the fight against COVID-19, often under intense pressure and in the face of uncertainty. In this study, we determined the rates of depression, anxiety, stress and related factors among health workers in COVID-19 designated hospitals in southern Vietnam during the second wave of COVID-19. From July-September 2020, we collected self-administered surveys from 499 health workers in 14 hospitals that were designated for the care and treatment of patients with COVID-19. The survey included sections on demographics, co-morbid health conditions, symptoms experienced during patient care, a depression, anxiety and stress assessment (DASS-21), and other related factors. We used logistic regression models to identify factors associated with depression, anxiety and stress, and adjusted for confounding factors. 18%, 11.5%, 7.7% of participants had symptoms of depression, anxiety, and stress, respectively with the majority at mild and moderate levels. The risk factors for increased mental health impact included long working hours, experiencing physical symptoms, fear of transmission to family, COVID-19 related stigma, and worry when watching media about COVID-19. Psychological counseling and training in infection prevention were protective factors that reduced the risk of mental health problems. Further exploration of the association between physical symptoms experienced by health workers and mental health may guide interventions to improve health outcomes. More routine COVID-19 testing among health workers could reduce anxieties about physical symptoms and alleviate the fear of transmitting COVID-19 to family and friends. Medical institutions need to ensure that health workers have access to basic trainings prior to initiation of work, and mental health support during the pandemic and into the future.

Effects of Return Air Inlets' Location on the Control of Fine Particle Transportation in a Simulated Hospital Ward

The COVID-19 pandemic has made significant impacts on public health, including human exposure to airborne pathogens. In healthcare facilities, the locations of return air vents in ventilation systems may have important effects on lowering airborne SARS-CoV-2 transmission. This study conducted experiments to examine the influence of different return air vents' heights (0.7 m, 1.2 m, and 1.6 m) on the particle removal effects in a simulated patient ward. Three different ventilation systems were examined: top celling air supply-side wall return (TAS), underfloor air supply-side wall return (UFAS) and side wall air supply-side wall return (SAS). CFD simulation was applied to further study the effects of return air inlets' heights (0.3 m, 0.7 m, 1.2 m, 1.6 m, and 2.0 m) and air exchange rates. The technique for order of preference by similarity to ideal solution (TOPSIS) analysis was used to calculate the comprehensive scores of 60 scenarios using a multi-criterion method to obtain the optimal return air inlets' heights. Results showed that for each additional 0.5 m distance in most working conditions, the inhalation fraction index of medical staff could be reduced by about 5-20%. However, under certain working conditions, even though the distances between the patients and medical personnel were different, the optimal heights of return air vents were constant. For TAS and UFAS, the optimal return air inlets' height was 1.2 m, while for SAS, the best working condition was 1.6 m air supply and 0.7 m air return. At the optimum return air heights, the particle decay rate per hour of SAS was 75% higher than that of TAS, and the rate of particle decay per hour of SAS was 21% higher than that of UFAS. The location of return air inlets could further affect the operating cost-effectiveness of ventilation systems: the highest operating cost-effectiveness was 8 times higher than the lowest one.

Risk Perception Related to COVID-19 and Future Affective Responses Among Healthcare Workers in Switzerland: A Mixed-Methods Longitudinal Study

Objectives: Whereas early findings suggest that risk perceptions related to COVID-19 affect psychological well-being in healthcare workers (HCWs), the temporal associations between these variables need to be clarified and HCWs lived experience further explored. This study proposes a mixed evaluation of COVID-19-related risk perception and affective responses among HCWs.

Methods: A longitudinal mixed-method study was conducted. HCWs (N = 138) completed measures of COVID-19 risk perceptions, depression, anxiety, burnout and secondary traumatic stress (STS) at baseline and 6 months later. A subsample (n = 20) participated in semi-structured interviews exploring both risk perceptions and affective responses.

Results: Main quantitative findings showed positive associations between worry to contaminate others and depression (IRR = 1.04, p < 0.05), anxiety (IRR = 1.03, p < 0.01), STS (b = 0.3, p < 0.05), and perceptions of lacking protection (IRR = 1.04, p < 0.05) with anxiety scores. Four themes emerged from the thematic content analysis: 1) life was turned upside down; 2) skills were put in quarantine; 3) dealing with patient discomfort; 4) balance to be found between protection and restrictions.

Conclusion: These findings emphasize the importance to develop tailored interventions, such as group discussion sessions, to optimize risk perception and help manage uncertainty.

Psychosocial outcomes of COVID-19 pandemic on healthcare workers in maternity services

AIM

We investigated the effects of the COVID-19 outbreak on social support and anxiety levels in healthcare professionals working in maternity services situated in Trabzon, Turkey.

MATERIALS AND METHODS

Our study was designed retrospectively and observationally. Social support to the participants was measured using a scale called the multidimensional scale of perceived social support (MSPSS). State anxiety scale (STAI TX-1) and trait anxiety scale (STAI TX-2) were used to determine the level of anxiety. All scales were measured before and during the pandemic. Independent t-test and one-way ANOVA were used to analyze the data where p < 0.05 was considered significant.

RESULTS

The participants' demographic data (n = 96) included the mean age of doctors (n = 30), midwives (n = 34), and nurses (n = 32) which were 41.38 ± 4.16/38.58 ± 1.79/37.34 ± 2.19, respectively. Mean gravida was 1.69 ± 2.87/2.23 ± 0.12/2.31 ± 0.14, respectively. Mean BMI was 24.69 ± 2.87/26.04 ± 0.8/25.69 ± 1.98 in the same order (p > 0.05). The total mean values of the MSPSS, STAI TX-1, STAI TX-2 scales before and during the pandemic were found as 66.55 ± 6.63 - 55.25 ± 4.76, 36.71 ± 10.04 - 50.08 ± 11.65, 37.33 ± 8.09 - 53.32 ± 9.94, respectively. A significant difference was found for the mean of all scales amongst the groups (p < 0.05).

CONCLUSION

During the COVID-19 pandemic, a significant number of healthcare workers were deprived of social support and their anxiety levels increased.

Psychotherapy and Follow-Up in Health Care Workers After the COVID-19 Epidemic: A Single Center's Experience

Objective

The present study aims to analysis the mental health of high-risk health care workers (HHCWs) and low-risk HCWs (LHCWs) who were respectively exposed to COVID-19 wards and non-COVID-19 wards by following up on mental disorders in HCWs in China for 6 months.

Methods

A multi-psychological assessment questionnaire was used to follow up on the psychological status of HCWs in the Affiliated Hospital of Xuzhou Medical University in Xuzhou City (a non-core epidemic area) at 6 months after the first evaluation conducted during the COVID-19 epidemic. Based on the risk of exposure to COVID-19 patients, the HCWs were divided into two groups: high-risk HCWs, who worked in COVID-19 wards, and low-risk HCWs, who worked in non-COVID-19 wards.

Results

A total of 198 HCWs participated in the study, and 168 questionnaires were selected for evaluation. Among them, 93 (55.4%) were in the HHCW group and 75 (44.5%) were in the LHCW group. Significant differences were observed in salary, profession, and altruistic behavior between the two groups (P < 0.05). There were no significant differences in the anxiety, depression, insomnia, or posttraumatic stress disorder (PTSD) scores between the two groups. Logistic regression revealed that work stress was a major joint risk factor for mental disorders in HCWs. Among all the HCWs, a total of 58 voluntarily participated in psychotherapy; the analysis showed a significant decrease in anxiety, depression, PTSD, work stress, and work risk after attending psychotherapy. There were also significant differences in positive and negative coping styles before and after psychotherapy.

Conclusion

In the present follow-up, work stress was the major contributing factor to mental disorders in HCWs. Psychotherapy is helpful in terms of stress management and should be provided to first-line COVID-19 HCWs.

Clinical Spectrum of Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Protection From Symptomatic Reinfection

BACKGROUND

There are few data on the full spectrum of disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across the lifespan from community-based or nonclinical settings.

METHODS

We followed 2338 people in Managua, Nicaragua, aged <94 years from March 2020 through March 2021. SARS-CoV-2 infection was identified through real-time reverse transcription polymerase chain reaction (RT-PCR) or through enzyme-linked immunosorbent assay. Disease presentation was assessed at the time of infection or retrospectively by survey at the time of blood collection.

RESULTS

There was a large epidemic that peaked between March and August 2020. In total, 129 RT-PCR-positive infections were detected, for an overall incidence rate of 5.3 infections per 100 person-years (95% confidence interval [CI], 4.4-6.3). Seroprevalence was 56.7% (95% CI, 53.5%-60.1%) and was consistent from age 11 through adulthood but was lower in children aged ≤10 years. Overall, 31.0% of the infections were symptomatic, with 54.7% mild, 41.6% moderate, and 3.7% severe. There were 2 deaths that were likely due to SARS-CoV-2 infection, yielding an infection fatality rate of 0.2%. Antibody titers exhibited a J-shaped curve with respect to age, with the lowest titers observed among older children and young adults and the highest among older adults. When compared to SARS-CoV-2-seronegative individuals, SARS-CoV-2 seropositivity at the midyear sample was associated with 93.6% protection from symptomatic reinfection (95% CI, 51.1%-99.2%).

CONCLUSIONS

This population exhibited a very high SARS-CoV-2 seropositivity with lower-than-expected severity, and immunity from natural infection was protective against symptomatic reinfection.

Exploring the Associated Factors of Depression, Anxiety, and Stress among Healthcare Shift Workers during the COVID-19 Pandemic

Background: The recent pandemic of COVID-19 has had a tremendous impact on healthcare frontliners. This study sought to assess healthcare shift workers’ depression, anxiety, and stress and its associated factors. Methods: The sampling frame includes healthcare shift workers directly managing COVID-19 cases around Klang Valley, Malaysia. The participants’ mental health status was assessed using the Depression, Anxiety, Stress Scale-21 (DASS-21). The associated factors specified in this study include sleep quality, physical activities, and eating habits. Pearson’s χ2 and simple and multivariable binary logistic regression models were constructed following the Hosmer–Lemeshow approach to determine the potential associated factors. Results: A total of 413 participants were recruited. Overall, 40.7% of participants had one or more symptoms of depression, anxiety, or stress. Poor sleep quality was significantly associated with all mental health outcomes of depression, anxiety, and stress. Inactivity was found to be strongly associated with symptoms of depression and anxiety. At the same time, eating habits were strongly associated with anxiety and stress. Conclusions: Sleep quality, inactivity, and eating habits that were found to be associated with the mental health status of healthcare shift workers are modifiable factors that must be addressed to curb mental health issues among this group of workers.

Evaluation of COVID-19 Patient Safety Compared to Non-COVID-19 Patients and Predisposing Factors of Nursing Errors

Objectives: The present study aims to determine Patient Safety in hospitalized patients with COVID-19 compared to non-COVID-19 ones and find predisposing factors of nursing errors according to nurses’ perceptions. Methods: This descriptive-comparative research employed data from 800 nurses in eight Iranian hospitals in 2021 using three researcher-made questionnaires of sociodemographic, patient safety indicators, and predisposing factors of nursing errors, with high reliability and validity. The collected data were analyzed using ANOVA, independent t-test, and the SPSS22 software. Results: The mean patient safety scores in patients with and without COVID-19 were 3.42 ± 0.17 and 3.74 ± 0.06, respectively. The highest differences in patient safety were attributed to infection control (0.66) and patient fall (0.56) dimensions. The most common causes of nursing errors were related to management (2.67 ± 1.39), and the most common predisposing factors of nursing errors were high workload, low ratio of nurses to patients, and fatigue. Conclusions: COVID-19 patients have lower safety than non-COVID ones. Also, improper management and high workload lead to nursing errors. Therefore, the authorities must devise appropriate strategies to reduce the nurses’ workload and improve patient safety, especially in COVID-19 patients.

Health System- and Patient-Related Factors Associated with COVID-19 Mortality among Hospitalized Patients in Limpopo Province of South Africa's Public Hospitals

South Africa has recorded the highest COVID-19 morbidity and mortality compared to other African regions. Several authors have linked the least amount of death in African countries with under-reporting due to poor health systems and patients' health-seeking behaviors, making the use of clinical audits more relevant for establishing the root causes of health problems, and improving quality patient care outcomes. Clinical audits, such as mortality audits, have a significant role in improving quality health care services, but very little is documented about the outcomes of the audits. Therefore, the study sought to determine the health care system and patient-related factors associated with COVID-19 mortality by reviewing the COVID-19 inpatient mortality audit narration reports. This was a retrospective qualitative research approach of all hospitalized COVID-19 patients, resulting in death between the first and second COVID-19 pandemic waves. Thematic analysis employed inductive coding to identify themes from mortality audits from all 41 public hospitals in Limpopo Province, South Africa. Four themes with seventeen sub-themes emerged: sub-standard emergency medical care provided, referral system inefficiencies contributed to delays in access to health care services, the advanced age of patients with known and unknown comorbidities, and poor management of medical supplies and equipment, as a health system and patient-related factors that contributed to the high mortality of COVID-19 patients. There is a need to routinely conduct clinical audits to identify clinical challenges and make recommendations for health promotion, risk communication, and community engagement. We recommend reviewing and expanding the scope of practice for health-care providers during epidemics and pandemics that include aspects such as task-shifting.

Influence of Workload, Personality, and Psychological Flexibility on Occupational Stress Among Medical Staff: A Fuzzy-Set Qualitative Comparative Analysis

Objective

During the COVID-19 pandemic, the occupational stress of medical staff has been a major issue. This study aimed to suggest a new strategy to identify high-risk factor sets of occupational stress in medical staff using fuzzy-set qualitative comparative analysis (fs-QCA) and provide ideas for the prevention and intervention of occupational stress.

Methods

A total of 1,928 medical staff members were surveyed and tested using the Acceptance and Action Questionnaire-II (AAQ-II), Occupational Stress Inventory-Revised edition (OSI-R), and Eysenck Personality Questionnaire-Revised Short Scale (EPQ-RSC). The fs-QCA was used to explore the high-risk factors for occupational stress among medical staff.

Results

The psychological strain (PSY) score of the medical staff was 26.8 ± 7.13, and the physical strain (PHS) score was 24.3 ± 6.50. Low psychological flexibility score-introversion-high role overload, introversion-neuroticism-high role overload, and low psychological flexibility score-neuroticism were high-risk factor sets for PSY. Low psychological flexibility score-introversion-high role overload, low psychological flexibility score-introversion-neuroticism, low psychological flexibility score-neuroticism-high role overload, low psychological flexibility score-psychoticism-neuroticism, and psychoticism-neuroticism-high role overload were high-risk factor sets for PHS.

Conclusion

There are different combinations of high-risk factors for occupational stress among the medical staff. For occupational stress intervention and psychological counseling, targeted and individualized health intervention measures should be implemented according to specific characteristic combinations of different individuals.

COVID-19-Related Trajectories of Psychological Health of Acute Care Healthcare Professionals: A 12-Month Longitudinal Observational Study

The COVID-19 pandemic hit healthcare professionals (HCPs) hard, potentially leading to mental health deterioration. This longitudinal study investigated the 1-year evolution of psychological health of acute care HCPs during the COVID-19 pandemic and explored possible differences between high and low resilient HCPs. From April 2020 to April 2021, a convenience sample of 520 multinational HCPs completed an online survey every 3 months, up to five times. We used mixed linear models to examine the association between resilience and the variation of COVID-19-related anxiety, depressiveness, perceived vulnerability, and psychological trauma symptomatology. We demonstrated "u-shaped" trajectories for all mental health symptoms. We also explored differences in the abovementioned variables between front-line and second-line acute care HCPs. In contrast to HCP.s with lower levels of resilience (-1SD), those with higher levels of resilience (+1SD) showed increased COVID-19 anxiety and perceived vulnerability over time. Front-line and second-line HCPs differed in their depressiveness and psychological trauma variation during the 1-year analysis. High and average resilient second-line HCPs showed steeper depressiveness increases with time than high and average resilient front-line HCPs. Acute care HCPs reported their most elevated clinical symptoms of depressiveness (5-7%) and psychological trauma symptomatology (26-46%) in April 2020. During the first year of the COVID-19 pandemic, second-line HCPs with more resilience showed a steeper worsening of their depressiveness than more resilient front-line HCPs. HCPs with low resilience may benefit from interventions at the beginning of a pandemic, whereas HCPs with high resilience might benefit from resilience-enhancing interventions at later phases.

Trial Registration

The study protocol was pre-registered with the International Standard Randomised Controlled Trial Number (ISRCTN13694948) published (Fuchs et al., 2020).

"It's All COVID's Fault!": Symptoms of Distress among Workers in an Italian General Hospital during the Pandemic

BACKGROUND

Since the outbreak of the COVID-19 pandemic, healthcare workers (HCWs) have been faced with specific stressors endangering their physical and mental health and their functioning. This study aimed to assess the short-term psychological health of a sample of Italian HCWs and the related influencing factors. In particular, the study focused on the differences related to HCWs' gender and to having been directly in charge of COVID-19 patients or not.

METHODS

An online survey was administered to the whole staff of the Modena General University Hospital three months after the onset of the pandemic, in 2020. Demographic data and changes in working and living conditions related to COVID-19 were collected; mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale-Revised (IES-R).

RESULTS

1172 out of 4788 members returned the survey (response rate = 24.5%), the male/female ratio was 30/70%. Clinically significant symptoms assessed according to the DASS-21 emerged among 21.0% of the respondents for depression, 22.5% for anxiety and 27.0% for stress. Symptoms suggestive of a traumatic reaction were reported by 19.0% of the sample. Symptoms of psychological distress were statistically associated with female gender, job role, ward, changes in lifestyle, whereas first-line work with COVID-19 patients was statistically associated with more stress symptoms. HCWs reported a significant level of psychological distress that could reach severe clinical significance and impact dramatically their quality of life and functioning.

CONCLUSIONS

Considering the persistence of the international emergency, effective strategies to anticipate, recognize and address distress in HCWs are essential, also because they may impact the organization and effectiveness of healthcare systems.

Treating Anti-Vax Patients, a New Occupational Stressor-Data from the 4th Wave of the Prospective Study of Intensivists and COVID-19 (PSIC)

The Prospective Study of Intensivists and COVID-19 (PSIC) is a longitudinal study that besides investigating a cohort of intensivists from one of the two COVID-19 hub hospitals in Central Italy since the beginning of the pandemic (first wave, April 2020), has conducted a new survey at each successive wave. In addition to the variables investigated in previous surveys (job changes due to the pandemic, justice of safety procedures, job stress, sleep quality, satisfaction, happiness, anxiety, depression, burnout, and intention to quit), the latest fourth wave (December 2021) study has evaluated discomfort in caring for anti-vax patients. A multivariate logistic regression model confirmed that high levels of occupational stress (distressed 75.8%) were associated with isolation, monotony, lack of time for meditation, and poor relationships with anti-vaccination patients. Compared to the first phase, there was a reduction in levels of insomnia and anxiety, but the percentage of intensivists manifesting symptoms of depression remained high (58.9%). The study underlined the efficacy of organizational interventions and psychological support.

US soldiers and the role of leadership: COVID-19, mental health, and adherence to public health guidelines

Background

Previous studies have documented the impact of domain-specific leadership behaviors on targeted health outcomes in employees. The goal of the present study was to determine the association between specific leadership behaviors addressing COVID-19 and US soldiers’ mental health and adherence to COVID-19 public health guidelines.

Methods

An electronic, anonymous survey was administered to US Army soldiers across three major commands (N = 7,829) from December 2020 to January 2021. The primary predictor of interest was soldiers’ ratings of their immediate supervisors’ behaviors related to COVID-19. The outcomes were soldiers’ mental health (i.e., depression and generalized anxiety) and adherence to COVID-19 public health guidelines. Covariates were rank, gender, ratings of immediate supervisors’ general leadership, level of COVID-19 concerns, and COVID-19 status (e.g., tested positive, became seriously ill). Logistic regressions were used to model the unique association of COVID-19 leadership behaviors with outcomes after adjusting for covariates.

Results

High levels of COVID-19 leadership behaviors were associated with lesser likelihood of soldiers’ screening positive for depression (AOR = 0.46; 95% CI [0.39, 0.54]) and anxiety (AOR = 0.54; 95% CI [0.45, 0.64]), and greater likelihood of frequent adherence to preventive health guidelines (AORs = 1.58; 95% CI [1.39, 1.80] to 2.50; 95% CI [2.01, 3.11]).

Conclusion

Higher levels of COVID-19 leadership behaviors may support soldiers’ mental health and encourage their adherence to COVID-19 public health guidelines. Given the link between these leader behaviors and soldier adaptation to the pandemic over and above general leadership, training for supervisors should focus on targeting specific health-promoting behaviors. Results can inform leader training for the military and other high-risk occupations.

Professional Quality of Life in Intensive Care Unit Professionals during COVID-19 Pandemic: A Prospective Observational Cross-sectional Study

Background and aims

The coronavirus disease-2019 (COVID-19) has significant positive and negative impacts on the professional life of intensive care unit (ICU) professionals. This study was conducted to evaluate compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) in ICU professionals and to study demographic and occupational variables related to them.

Methods

This prospective observational study was undertaken on ICU professionals involved in direct care of critically ill COVID-19 patients. The online questionnaire consisting of demographic, work-related parameters, and professional quality of life scale version 5 (ProQOL 5) was sent to 1,080 ICU healthcare workers. The subgroups of ProQOL 5, CS, BO, and STS were calculated and compared across study parameters. Linear regression was performed to evaluate variables which were independently associated with ProQOL.

Results

The response rate in the present study was 39.8%, and after evaluation, 320 responses were found eligible for final analysis. There was predominance of average levels of CS, BO, and STS. Female gender, contractual job, lesser work experience, greater workload, and COVID-19 infection in close acquittance of participants were factors observed to independently associated with increase in negative aspects of ProQOL (BO and STS). Further, increase in duty hours and COVID-19 infection in close social circle were observed to independently decrease positive aspects (CS).

Conclusion

This study shows that despite majority of respondents reporting moderate levels BO and STS, CS is maintained during the COVID-19 crisis. The identification of risk factors is vital to support ICU professionals by targeted interventions.

How to cite this article

Kerai S, Doda P, Saxena KN. Professional Quality of Life in Intensive Care Unit Professionals during COVID-19 Pandemic: A Prospective Observational Cross-sectional Study. Indian J Crit Care Med 2022;26(5):604–612.

Hopelessness in Police Officers and Its Association with Depression and Burnout: A Pilot Study

Hopelessness is a particularly critical condition and a risk factor for suicide. Many studies have reported that this condition is common in some occupations and is associated with high stress that is not properly managed. This study examined the prevalence of hopeless status (HS) in a sample of police officers (POs) and the association of hopelessness with depression, burnout, and suicidality. In total, 127 out of 231 POs participated in the survey; they were assessed with the Beck Hopelessness Scale, the Beck Depression Scale, and the Maslach Burnout Inventory. A total of 26.5% of POs reported hopelessness, and a significant association was found with depression and burnout; in individual cases, these conditions were associated with suicidal thoughts. In a multivariate logistic regression model adjusted for confounding variables, depression, emotional exhaustion, and reduction of personal accomplishment were significantly associated with HP status. Depression (OR = 3.02, 95% CI: 1–9.12) and emotional exhaustion (OR = 1.88, 95% CI: 1.06–3.32) significantly increased the risk of hopelessness, while personal accomplishment (OR = 0.57, 95% CI: 0.32–1) was a protective factor. Hopelessness appears to be a very important factor to consider when assessing POs’ mental health.

The effect of the COVID-19 pandemic on health care workers' anxiety levels: a meta-analysis

Background

The COVID-19 pandemic has been declared a public health emergency of international concern, causing excessive anxiety among health care workers. Additionally, publication bias and low-quality publications have become widespread, which can result in the dissemination of unreliable information. A meta-analysis was performed for this study with the following two aims: (1) to examine the prevalence of anxiety among health care workers and determine whether it has increased owing to the COVID-19 pandemic and (2) to investigate whether there has been an increase in publication bias.

Methods

All relevant studies published between 2015 and 2020 were searched in electronic databases (namely Web of Science, PubMed, Embase, PsycInfo, PsyArXiv, and medRxiv). The heterogeneity of the studies was assessed using the I 2 statistic. The effect size (prevalence rate of anxiety) and 95% CI for each study were also calculated. We used moderator analysis to test for the effect of the COVID-19 pandemic on health care workers' anxiety levels and to detect publication bias in COVID-19 studies. We assessed publication bias using funnel plots and Egger's regression.

Results

A total of 122 studies with 118,025 participants met the inclusion criteria. Eighty-eight articles (75,066 participants) were related to COVID-19, 13 articles (9,222 participants) were unrelated to COVID-19 (i.e., articles related to other outbreaks, which were excluded), and 21 preprints (33,737 participants) were related to COVID-19. The pooled meta-analysis prevalence was 33.6% (95% CI [30.5-36.8]; 95% PI [6.5-76.3]). Moderator analysis revealed no significant differences between articles related to COVID-19 and those unrelated to COVID-19 (p = 0.824). Moreover, no significant differences were found between articles and preprints related to COVID-19 (p = 0.843). Significant heterogeneity was observed in each subgroup. An Egger's test revealed publication bias in both articles and preprints related to COVID-19 (p < 0.001).

Conclusions

Determining whether the anxiety state of health care workers is altered by the COVID-19 pandemic is currently difficult. However, there is evidence that their anxiety levels may always be high, which suggests that more attention should be paid to their mental health. Furthermore, we found a substantial publication bias; however, the quality of the studies was relatively stable and reliable.

Investigating Predictors of Psychological Distress for Healthcare Workers in a Major Saudi COVID-19 Center

This study investigated the relationship between fear of COVID-19, previous exposure to COVID-19, perceived vulnerability to disease, sleep quality, and psychological distress among healthcare workers (HCWs) in Taif city in Saudi Arabia, which has a population of 702,000 people. A cross-sectional study design was adopted. HCWs (n = 202) completed a survey containing the Fear of COVID-19 Scale (FCV-19S), Perceived Vulnerability to Disease (PVD), Pittsburgh Sleep Quality Index (PSQI), and Depression, Anxiety, and Stress Scale (DASS-21). FCV-19S and sleep quality were significant predictors for psychological distress. Female gender was a significant predictor for depression and stress. Single, divorced, and widowed marital status were predictive for anxiety. FCV-19S was weakly correlated with PVD but moderately with depression, anxiety, and stress. Of the two PVD subscales, perceived infectability was weakly correlated with psychological distress. PVD and previous experience with COVID-19 were not significant predictors. Sleep quality and FCV-19S were major predictors of psychological distress. Findings indicated that poor sleep quality was strongly associated with psychological distress, while fear of COVID-19 had a moderate association. Such results support the need to design and implement psychological programs to assist HCWs in dealing with the psychological impact of this ongoing pandemic.

Hair cortisol change at COVID-19 pandemic onset predicts burnout among health personnel

BACKGROUND

The COVID-19 pandemic has put chronic pressure on worldwide healthcare systems. While the literature regarding the prevalence of psychological distress and associated risk factors among healthcare workers facing COVID-19 has exploded, biological variables have been mostly overlooked.

METHODS

467 healthcare workers from Quebec, Canada, answered an electronic survey covering various risk factors and mental health outcomes three months after the onset of the COVID-19 pandemic. Of them, 372 (80%) provided a hair sample, providing a history of cortisol secretion for the three months preceding and following the pandemic's start. We used multivariable regression models and a receiver operating characteristic curve to study hair cortisol as a predictor of burnout and psychological health, together with individual, occupational, social, and organizational factors.

RESULTS

As expected, hair cortisol levels increased after the start of the pandemic, with a median relative change of 29% (IQR = 3-59%, p < 0.0001). There was a significant association between burnout status and change in cortisol, with participants in the second quarter of change having lower odds of burnout. No association was found between cortisol change and post-traumatic stress disorder, anxiety, and depression symptoms. Adding cortisol to individual-occupational-socio-organizational factors noticeably enhanced our burnout logistic regression model's predictability.

CONCLUSION

Change in hair cortisol levels predicted burnout at three months in health personnel at the onset of the COVID-19 pandemic. This non-invasive biological marker of the stress response could be used in further clinical or research initiatives to screen high-risk individuals to prevent and control burnout in health personnel facing an important stressor.

Building resilience for healthcare professionals working in an Italian red zone during the COVID-19 outbreak: A pilot study

The COVID-19 pandemic has placed considerable strain on healthcare workers showing high rates of stress and psychological health problems. Interventions are urgently needed to help healthcare workers perform under conditions of great risk and uncertainty. In particular, healthcare leadership is known to be critical to supporting healthcare workers to deal with an uncertain and distressing healthcare environment. This pilot study evaluated the impact of the R2 resilience program tailored for healthcare leaders working in a highly affected COVID-19 area in Italy. Through two group cohorts, 21 healthcare leaders completed the intervention, with 17 participants providing pre- and post-intervention assessment data. Sixty-two staff members who benefitted from their coordinators' resilience-focused leadership were also included in the study. Findings show that participation in R2 was associated with reduction in levels of perceived stress and burnout symptoms, and increases in rugged qualities, self-efficacy and in social-ecological resilience. Significant changes in rugged qualities, self-efficacy and perceived stress were also detected in staff members. High rates of participants' program satisfaction have been detected. R2 is a promising intervention for healthcare professionals working in emergency settings designed to enhance the rugged qualities and resources required to deal with heightened exposure to stress.

Headache in the Workplace: Analysis of Factors Influencing Headaches in Terms of Productivity and Health

Headache is a very common condition that can have a significant impact on work. This study aimed to assess the prevalence of headaches and their impact on a sample of 1076 workers from 18 small companies operating in different sectors. The workers who volunteered to participate were asked to fill in the Headache Impact Test-6 (HIT-6) and answer questions designed to assess stressful and traumatic factors potentially associated with headaches. The volunteers subsequently underwent a medical examination and tests for diagnosing metabolic syndrome. Out of the 1044 workers who completed the questionnaire (participation rate = 97%), 509 (48.8%) reported suffering from headaches. In a multivariate logistic regression model, female gender, recent bereavement, intrusive leadership, and sleep problems were significantly associated with headaches. In univariate logistic regression models, headache intensity was associated with an increased risk of anxiety (OR 1.10; CI95% 1.09; 1.12) and depression (OR 1.09; CI95% 1.08; 1.11). Headache impact was also associated with the risk of metabolic syndrome (OR 1.02; CI95% 1.00, 1.04), obesity (OR 1.02, CI95% 1.01; 1.03), and reduced HDL cholesterol (OR 1.03; CI95% 1.01; 1.04). The impact of headache calls for intervention in the workplace not only to promote a prompt diagnosis of the different forms of headaches but also to improve work organization, leadership style, and the quality of sleep.

The psychological outcomes of COVID-19 affected the pandemic-after risk perceptions of nurse clinicians: a latent profile analysis

Background

Risk perception among nurses after the COVID-19 pandemic is a crucial factor affecting their attitudes and willingness to work in clinics. Those with poor psychological status could perceive risks sensitively as fears or threats that are discouraging. This article aimed to determine whether psychological outcomes, including post-traumatic stress disorder (PTSD), depression, anxiety, and insomnia, following the COVID-19 pandemic were differentially related to the risk perceptions of nurses working in clinics and increased perceived risk.

Method

The participants were 668 nurse clinicians from five local hospitals. Risk perceptions and psychological outcomes were measured by adapted questionnaires via the Internet. Latent profile analysis (LPA) identified subgroups of individuals who showed similar profiles regarding the perceived risks in nursing. Multinomial regression and probit regression were used to examine the extent to which sociodemographic and psychological outcomes predicted class membership.

Results

LPA revealed four classes: groups with low-, mild-, moderate-, and high-level risk perceptions. Membership of the high-level risk perception class was predicted by the severity of psychological outcomes. Anxiety significantly accounted for a moderate increase in risk perceptions, while the symptoms of insomnia, depression, and PTSD accelerated the increase to the high level of risk perception class.

Conclusions

By classifying groups of nurse clinicians sharing similar profiles regarding risk perceptions and then exploring associated predictors, this study shows the psychological outcomes after COVID-19 significantly impacted pandemic-associated risk perceptions and suggests intervening in nurses' psychological outcomes while simultaneously focusing on work-related worries is important following the outbreak of COVID-19.

The Robust Italian Validation of the Coping Humor Scale (RI-CHS) for Adult Health Care Workers

The Coping Humor Scale (CHS) is a seven-item tool widely used to assess the use of humor in coping with stressful situations. The beneficial effect of humor in buffering the impact of negative experiences has been investigated in several contexts and populations; for this reason, the CHS has been used in many languages, but its solid validation in Italian is still missing. Our study aimed at building a robust instrument to measure coping humor strategies among Italian health care workers, a category which has been particularly exposed to stressful situations in the last two years. The CHS translated into Italian was administered to a sample of 735 health care workers during the first wave of the COVID-19 pandemic in Italy. Confirmatory factor analysis and Rasch analysis were performed. As a result, a six-item Robust Italian Coping Humor Scale (RI-CHS) was validated and ready to use for future studies on Italian health care workers’ samples. This study gives evidence that our six-item solution works as a ruler (i.e., an instrument that meets the conditions of fundamental measurement in the context of the human sciences) to measure the degree to which Italian health care workers rely on humor to cope with stress.