Psychological Distress and Work Environment Perception by Physical Therapists from Southern Italy during COVID-19 Pandemic: The C.A.L.A.B.R.I.A Study

METER (Mental health emergency response) program: Findings of psychological impact status and factors associated with depression, anxiety and stress among healthcare workers in public hospital in Malaysia during the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic has become the greatest challenge of the new millennium. Most healthcare workers (HCWs) experienced unprecedented levels of workload since the pandemic. This study aims to identify the prevalence and factors of depression, anxiety and stress among HCWs in Malaysian healthcare facilities in the midst of the pandemic due to the SARs-CoV-2.

METHODS

An emergency response programme on mental health was conducted from June to September 2020. A standardized data collection form was distributed among the HCWs in the government hospital in Klang Valley. The form contained basic demographic information and the self-reported Malay version of the Depression, Anxiety and Stress scale (BM DASS-21).

RESULTS

Of the1,300 staff who attended the Mental Health and Psychosocial Support in Covid-19 (MHPSS COVID-19) programme, 996 staff (21.6% male, 78.4% female) completed the online survey (response rate: 76.6%). Result showed that staff aged above 40 years old were almost two times more likely to have anxiety (AOR = 1.632; 95% CI = 1.141-2.334, p:0.007) and depression (AOR = 1.637; 95% CI = 1.1.06-2.423, p:0.014) as compared to staff who were less than 40 years old. Those who had direct involvement with COVID-19 patients were likely to suffer stress (AOR = 0.596; 95% CI = 0.418-0.849, p:0.004), anxiety (AOR = 0.706; 95% Ci = 0.503-0.990, p:0.044) and depression (AOR = 0.630; 95% Ci = 0.427-0.928, p:0.019). HCWs with stress (AOR = 0.638; 95% CI of 0.476-0.856, p = 0.003), anxiety (AOR = 0.720; 95% CI 0.542-0.958, p = 0.024) and depression (AOR = 0.657; 95% CI 0.480-0.901, p = 0.009) showed less confidence to treat critically ill patients and need psychological help during outbreak.

CONCLUSION

This study showed the importance of psychosocial support to reduce psychological distress among HCWs when working or coping during the COVID-19 pandemic or outbreak.

Effects of the COVID-19 pandemic on the mental health of rehabilitation area professionals: A systematic review

Background

The role of the physiotherapist is vital in the recovery of post-COVID-19 patients, but fear of contagion is a possible feeling among healthcare professionals. The objective of this study is to assess the mental health effects that COVID-19 has had on healthcare workers, including rehabilitation care, in times of pandemic.

Methods

A systematic review was conducted using the PRISMA format in the Pubmed, SCOPUS, and Web of Science databases between July and September 2022. Keywords included were "healthcare providers," "COVID-19," "Mental Health," and "Psychological Distress." Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools.

Results

A total of 14 studies were included in this review. The study population was healthcare professionals including the rehabilitation services. In total, 4 studies reported exclusively on anxiety and stress levels in physiotherapists providing care during the pandemic.

Conclusions

The mental health of healthcare professionals has been compromised during the pandemic. However, initially, research was only focused on physicians and nurses, so the need arises to include those professionals, such as physiotherapists, who are also in direct contact with COVID-19 patients.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=367664, identifier: CRD42022367664.

Intelligent System for Detecting Deterioration of Life Satisfaction as Tool for Remote Mental-Health Monitoring

The research described in this article is a continuation of work on a computational model of quality of life (QoL) satisfaction. In the proposed approach, overall life satisfaction is aggregated to personal life satisfaction (PLUS). The model described in the article is based on well-known and commonly used clinimetric scales (e.g., in psychiatry, psychology and physiotherapy). The simultaneous use of multiple scales, and the complexity of describing the quality of life with them, require complex fuzzy computational solutions. The aim of the study is twofold: (1) To develop a fuzzy model that allows for the detection of changes in life satisfaction scores (data on the influence of the COVID-19 pandemic and the war in the neighboring country were used). (2) To develop more detailed guidelines than the existing ones for further similar research on more advanced intelligent systems with computational models which allow for sensing, detecting and evaluating the psychical state. We are concerned with developing practical solutions with higher scientific and clinical utility for both small datasets and big data to use in remote patient monitoring. Two exemplary groups of specialists at risk of occupational burnout were assessed three times at different intervals in terms of life satisfaction. The aforementioned assessment was made on Polish citizens because the specific data could be gathered: before and during the pandemic and during the war in Ukraine (a neighboring country). That has a higher potential for presenting a better analysis and reflection on the practical application of the model. A research group (physiotherapists, n = 20) and a reference group (IT professionals, n = 20) participated in the study. Four clinimetric scales were used for assessment: the Perceived Stress Scale (PSS10), the Maslach Burnout Scale (MBI), the Satisfaction with Life Scale (SWLS), and the Nordic Musculoskeletal Questionnaire (NMQ). The assessment was complemented by statistical analyses and fuzzy models based on a hierarchical fuzzy system. Although several models for understanding changes in life satisfaction scores have been previously investigated, the novelty of this study lies in the use of data from three consecutive time points for the same individuals and the way they are analyzed, based on fuzzy logic. In addition, the new hierarchical structure of the model used in the study provides flexibility and transparency in the process of remotely monitoring changes in people's mental well-being and a quick response to observed changes. The aforementioned computational approach was used for the first time.

Differences in Stakeholders' Perception of the Impact of COVID-19 on Clinical Care and Decision-Making

Background: Pandemics are related to changes in clinical management. Factors that are associated with individual perceptions of related risks and decision-making processes focused on prevention and vaccination, but perceptions of other healthcare consequences are less investigated. Different perceptions of patients, nurses, and physicians on consequences regarding clinical management, decisional criteria, and burden were compared. Study Design: Cross-sectional OnCoVID questionnaire studies. Methods: Data that involved 1231 patients, physicians, and nurses from 11 German institutions that were actively involved in clinical treatment or decision-making in oncology or psychiatry were collected. Multivariate statistical approaches were used to analyze the stakeholder comparisons. Results: A total of 29.2% of professionals reported extensive changes in workload. Professionals in psychiatry returned severe impact of pandemic on all major aspects of their clinical care, but less changes were reported in oncology (p < 0.001). Both patient groups reported much lower recognition of treatment modifications and consequences for their own care. Decisional and pandemic burden was intensively attributed from professionals towards patients, but less in the opposite direction. Conclusions: All of the groups share concerns about the impact of the COVID-19 pandemic on healthcare management and clinical processes, but to very different extent. The perception of changes is dissociated in projection towards other stakeholders. Specific awareness should avoid the dissociated impact perception between patients and professionals potentially resulting in impaired shared decision-making.

Fatigue In Covid-19 Survivors: The Potential Impact Of A Nutritional Supplement On Muscle Strength And Function

Background

Fatigue with reduced tolerance to exercise is a common persistent long-lasting feature amongst COVID-19 survivors. The assessment of muscle function in this category of patients is often neglected.

Aim.

To evaluate the potential impact of a daily supplementation based on amino acids, minerals, vitamins, and plant extracts (Apportal®) on muscle function, body composition, laboratory parameters and self-rated health in a small group of COVID-19 survivors affected by fatigue.

Methods

Thirty participants were enrolled among patients affected by physical fatigue during or after acute COVID-19 and admitted to the post-COVID-19 outpatient service at Fondazione Policlinico Gemelli in Rome between 1st March 2021 and 30th April 2021. All participants were evaluated at first visit (t0) and at control visit (t1), after taking a daily sachet of Apportal® for 28 days. Muscle function was analyzed using hand grip strength test, exhaustion strength time and the number of repetitions at one-minute chair stand test. Body composition was assessed with bioelectrical impedance analysis (BIA). Laboratory parameters, including standard blood biochemistry and ferritin levels, were evaluated at the first visit and during the control visit. A quick evaluation of self-rated health, before COVID-19, at t0 and t1, was obtained through a visual analogue scale (VAS).

Results

Participants aged 60 years and older were 13 (43%). Females represented the 70% of the study sample. Participants hospitalized for COVID-19 with low-flow oxygen supplementation represented the 43.3% of the study sample while 3.3% received noninvasive ventilation (NIV) or invasive ventilation. Hand grip strength improved from 26.3 Kg to 28.9 Kg (p < 0.05) at t1 as compared to t0. The mean time of strength exhaustion increased from 31.7 s (sec) at t0 to 47.5 s at t1 (p < 0.05). Participants performed a higher number of repetitions (28.3 vs. 22.0; p < 0.05) during the one-minute chair stand test at t1 as compared to t0. A trend, although not significant, in reduction of ferritin levels was found after nutritional supplementation (94.4 vs. 84.3, respectively; p = 0.01). The self-rated health status increased by at least 13 points (t0, mean 57.6 ± 5.86; t1, mean 71.4 ± 6.73; p < 0.05).

Conclusions

After 28 days of nutritional supplementation with Apportal® in COVID-19 survivors affected by fatigue with reduced tolerance to exercise, we found a significant improvement in means of muscle strength and physical performance, associated with enhancement of self-rated health status between t0 and t1.

Effect of COVID-19 on Selected Characteristics of Life Satisfaction Reflected in a Fuzzy Model

The general goal of the research in this article is to devise an algorithm for assessing overall life satisfaction—a term often referred to as Quality of Life (QoL). It is aggregated to its own proposition, called personal life usual satisfaction (PLUS). An important assumption here is that the model is based on already known and commonly used solutions, such as medical (psychological and physiotherapeutic) questionnaires. Thanks to this, the developed solution allows us to obtain a synergy effect from the existing knowledge, without the need to design new, complicated procedures. Fuzzy multivariate characterization of life satisfaction presents a challenge for a complete analysis of the phenomenon. The complexity of description using multiple scales, including linguistic, requires additional computational solutions, as presented in this paper. The detailed aim of this study is twofold: (1) to develop a fuzzy model reflecting changes in life satisfaction test scores as influenced by the corona virus disease 2019 (COVID-19) pandemic, and (2) to develop guidelines for further research on more advanced models that are clinically useful. Two groups affected by professional burnout to different degrees were analyzed toward life satisfaction twice (pre- and during pandemy): a study group (physiotherapists, n=25) and a reference group (computer scientists, n=25). The Perceived Stress Score (PSS10), Maslach Burnout Inventory (MBI), Satisfaction with Life Scale (SWLS), and Nordic Musculoskeletal Questionnaire (NMQ) were used. The resultant model is based on a hierarchical fuzzy system. The novelty of the proposed approach lies in the combination of the use of data from validated clinimetric tests with the collection of data from characteristic time points and the way in which they are analyzed using fuzzy logic through transparent and scalable hierarchical models. To date, this approach is unique and has no equivalent in the literature. Thanks to the hierarchical structure, the evaluation process can be defined as a modular construction, which increases transparency and makes the whole procedure more flexible.

Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain)

Background

Old age is one of the most important risk factors for severe COVID-19. Few studies have analyzed changes in the clinical characteristics and prognosis of COVID-19 among older adults before the availability of vaccines. This work analyzes differences in clinical features and mortality in unvaccinated very old adults during the first and successive COVID-19 waves in Spain.

Methods

This nationwide, multicenter, retrospective cohort study analyzes unvaccinated patients ≥ 80 years hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). Patients were classified according to whether they were admitted in the first wave (March 1-June 30, 2020) or successive waves (July 1-December 31, 2020). The endpoint was all-cause in-hospital mortality, expressed as the case fatality rate (CFR).

Results

Of the 21,461 patients hospitalized with COVID-19, 5,953 (27.7%) were ≥ 80 years (mean age [IQR]: 85.6 [82.3–89.2] years). Of them, 4,545 (76.3%) were admitted during the first wave and 1,408 (23.7%) during successive waves. Patients hospitalized in successive waves were older, had a greater Charlson Comorbidity Index and dependency, less cough and fever, and met fewer severity criteria at admission (qSOFA index, PO2/FiO2 ratio, inflammatory parameters). Significant differences were observed in treatments used in the first (greater use of antimalarials, lopinavir, and macrolides) and successive waves (greater use of corticosteroids, tocilizumab and remdesivir). In-hospital complications, especially acute respiratory distress syndrome and pneumonia, were less frequent in patients hospitalized in successive waves, except for heart failure. The CFR was significantly higher in the first wave (44.1% vs. 33.3%; -10.8%; p < 0.001) and was higher among patients ≥ 95 years (54.4% vs. 38.5%; -15.9%; p < 0.001). After adjustments to the model, the probability of death was 33% lower in successive waves (OR: 0.67; 95% CI: 0.57–0.79).

Conclusions

Mortality declined significantly between the first and successive waves in very old unvaccinated patients hospitalized with COVID-19 in Spain. This decline could be explained by a greater availability of hospital resources and more effective treatments as the pandemic progressed, although other factors such as changes in SARS-CoV-2 virulence cannot be ruled out.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03191-4.

We Need Engaged Workers! A Structural Equation Modeling Study from the Positive Organizational Psychology in Times of COVID-19 in Chile

The COVID-19 pandemic has substantially impacted mental health—workers at institutions are not exempt. In our research, from positive organizational psychology, specifically from the healthy and resilient organization (HERO) model, we analyzed the relationship between healthy organizational practices−engagement and workers’ burnout, and evaluated the mediation role of engagement between healthy organizational practices and worker burnout levels during the COVID-19 pandemic, through structural equation models of a cross-sectional survey-based study. We collected data from a sample of 594 Chilean workers. Our results of the correlations and structural equations demonstrate the relationship between PHOs with engagement (β = 0.51; p < 0.001) and burnout (β = −0.44; p < 0.001), in addition to the mediating effect of engagement between HOP with burnout (β = −0.66; p < 0.001). In conclusion, our findings suggest that healthy organizational practices promoted worker engagement and decreased worker burnout during the COVID-19 pandemic, contributing to the postulates of the HERO model. In addition, we were able to visualize a similar scenario, which showed that burnout during a pandemic decreases when worker engagement mediates the relationship with HOP.

Telephone-based Frontal Assessment Battery (t-FAB): standardization for the Italian population and clinical usability in neurological diseases

Background

Despite the relevance of telephone-based cognitive screening tests in clinical practice and research, no specific test assessing executive functioning is available. The present study aimed at standardizing and providing evidence of clinical usability for the Italian telephone-based Frontal Assessment Battery (t-FAB).

Methods

The t-FAB (ranging 0–12), comprising two subtests, has two versions: one requiring motor responses (t-FAB-M) and the other verbal responses (t-FAB-V). Three hundred and forty-six Italian healthy adults (HPs; 143 males; age range = 18–96 years; education range = 4–23 years) and 40 participants with neurological diseases were recruited. To HPs, the t-FAB was administered along with a set of telephone-based tests: MMSE, verbal fluency (VF), backward digit span (BDS). The in-person version of the FAB was administered to both HPs and clinical groups. Factorial structure, construct validity, inter-rater and test–retest reliability, t-FAB-M vs. t-FAB-V equivalence and diagnostic accuracy were assessed. Norms were derived via Equivalent Scores.

Results

In HPs, t-FAB measures yielded high inter-rater/test–retest reliability (ICC = .78–.94), were internally related (p ≤ .005) and underpinned by a single component, converging with the telephone-based MMSE, VF, BDS (p ≤ .0013). The two t-FAB versions were statistically equivalent in clinical groups (ps of both equivalence bounds < .001). Education predicted all t-FAB scores (p < .001), whereas age only the t-FAB-M score (p ≤ .004). t-FAB scores converge with the in-person FAB in HPs and clinical groups (r_s = .43–.78). Both t-FAB versions were accurate in discriminating HPs from the clinical cohort (AUC = .73-.76).

Discussion

The t-FAB is a normed, valid, reliable and clinically usable telephone-based cognitive screening test to adopt in both clinical and research practice.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-022-02155-3.

Resilience, Occupational Stress, Job Satisfaction, and Intention to Leave the Organization among Nurses and Midwives during the COVID-19 Pandemic

The current study on the intention to leave the organization among nurses and midwives aligns with the broader direction of research on the consequences of demanding jobs. This is particularly important in the context of the COVID-19 pandemic, which began in 2020 and is ongoing. The aim of the current study was to identify the levels of intention to leave the organization and job satisfaction in a sample of 390 Polish nurses and midwives. A multiple stepwise linear regression was carried out to establish which variables are predictors of job satisfaction and intention to leave the organization. The following measures were used in the study: Nurses’ Occupational Stressor Scale, The Brief Resilience Coping Scale, The Turnover Intention Scale, The Job Satisfaction Scale, and an occupational questionnaire (number of workplaces, weekly number of evening and night shifts, working at a unit dedicated to treating COVID-19, working as a supervisor/executive). The current study showed that almost 25% of the sample reported high turnover intention, and a similar proportion reported low job satisfaction. Resilience was related to nurses’ job satisfaction. In the predictive models for job satisfaction, the organizational factor of the number of workplaces was significant (positively related), while job experience was a negative predictor of intention to leave. The practical implications of the results and the need to continue research on this topic are also discussed.

Health Occupation and Job Satisfaction: The Impact of Psychological Capital in the Management of Clinical Psychological Stressors of Healthcare Workers in the COVID-19 Era

The COVID-19 pandemic greatly impacted global health. Frontline healthcare workers involved in the response to COVID-19 faced physical and psychological challenges that threatened their wellbeing and job satisfaction. The pandemic crisis, alongside pre-existing critical issues, exposed healthcare workers to constant emotional fatigue, creating an increased workload and vulnerability to stress. Maintaining such stress levels increased their levels of anxiety, irritability and loneliness. Evidence shows that the Psychological Capital (PsyCap) was a strong protective factor against these stressors. The aim of this study was to analyze the level of job satisfaction among health workers facing the COVID-19 pandemic. The possible antecedent factors to satisfaction and the role that PsyCap plays in preserving and fostering higher levels of job satisfaction were investigated. A total of 527 healthcare workers from different areas of Italy were recruited for the study. The results revealed that psychological stress factors have a considerable impact on job satisfaction. All four predictors (Stress Vulnerability, Anxiety Symptoms, Loneliness and Irritability) had the potential to decrease job satisfaction. Loneliness had a more significant effect than other factors assessed in this study. Moreover, the results showed how PsyCap could decrease the effects of psychological stressors on job satisfaction. Consistent with previous studies, our findings show that PsyCap could alleviate negative impacts in work-related circumstances.

The Role of Moral Distress on Physician Burnout during COVID-19

The purpose of this study was to explore the role of moral distress on physician burnout during COVID-19. Physicians in the US were interviewed between February and March 2021; 479 responded to our survey. The results indicated that moral distress was a key mediator in explaining the relationship between perceived organizational support, medical specialization, emotional labor, and coping with burnout. Results did not support increased burnout among female physicians, and contracting COVID-19 likewise did not play a role in burnout. Our findings suggest that physician burnout can be mitigated by increasing perceived organizational support; likewise, physicians who engaged in deep emotional labor and problem-focused coping tended to fare better when it came to feelings of moral distress and subsequent burnout.

Is the Systemic Agency Capacity of Long-Term Care Organizations Enabling Person-Centered Care during the COVID-19 Pandemic? A Repeated Cross-Sectional Study of Organizational Resilience

The COVID-19 pandemic has strained long-term care organization staff and placed new demands on them. This study examines the role of the general ability and power of a long-term care organization to act and react collectively as a social system, which is called systemic agency capacity, in safeguarding the provision of person-centered care during a crisis. The question of how the systemic agency capacity of long-term care organizations helps to ensure person-centered care during the pandemic is an open research question. We conducted a pooled cross-sectional study on long-term care organizations in Germany during the first and second waves of the pandemic (April 2020 and December 2020–January 2021). The sample consisted of 503 (first wave) and 294 leaders (second wave) of long-term care organizations. The top managers of these facilities were asked to report their perceptions of their facility’s agency capacity, measured by the AGIL scale, and the extent to which the facility provides person-centered care. We found a significant positive association between the leaders’ perceptions of systemic agency capacity and their perceptions of delivered person-centered care, which did not change over time. The results tentatively support the idea that fostering the systemic agency capacity of long-term care organizations facilitates their ability to provide quality routine care despite environmental shocks such as the COVID-19 pandemic.

Depression, Anxiety and Stress in Health Professionals in the COVID-19 Context

To assess the prevalence of depression, anxiety and stress symptoms in health professionals in the COVID-19 pandemic context. Method: Cross-sectional study with non-probabilistic (snow-ball) sampling method. The assessment was performed using the Depression, Anxiety, and Stress Scale (DASS-21) and the prevalence of symptoms severity was calculated by point and 95% confidence interval. The analysis of the psychometric properties of DASS-21 was performed using confirmatory factor analysis (CFA) and the following goodness of fit indices: χ²/df (chi-square ratio by degrees of freedom), Tucker–Lewis index (TLI), comparative fit index (CFI) and root mean square error of approximation (RMSEA) with a 90% confidence interval. Results: The study participants were 529 health professionals (82.4% women and 66.7% nursing professionals). CFA of the DASS-21 structural model presented adequate fit for the sample (χ²/df = 3.530; CFI = 0.979; TLI = 0.976; RMSEA = 0.069). Regarding prevalence, moderate to extremely severe symptoms of depression, anxiety and stress were found in 48.6%, 55.0% and 47.9% of the participants, respectively. Conclusion: The use of DASS-21 confirmed the validity and reliability of the data. The prevalence of depression, anxiety and stress symptoms in the participants indicated a high risk of mental illness in health professionals in the COVID-19 pandemic.

The Elephant in the Room: A Cross-Sectional Study on the Stressful Psychological Effects of the COVID-19 Pandemic in Mental Healthcare Workers

Despite extensive research on COVID-19’s impact on healthcare workers, few studies have targeted mental health workers (MHWs) and none have investigated previous traumatic events. We investigated psychological distress in MHWs after the first lockdown in Italy to understand which COVID-19, sociodemographic, and professional variables represented greater effects, and the role of previous trauma. The survey included sociodemographic and professional questions, COVID-19 variables, and the questionnaires Life Events Checklist for DSM-5 (LEC-5), Impact of Event Scale—Revised (IES-R), and Depression Anxiety Stress Scales 21 (DASS-21). On the 271 MHWs who completed the survey (73.1% female; mean age 45.37), we obtained significant effects for contagion fear, experience of patients’ death, increased workload, and worse team relationship during the first wave. Nurses were more affected and showed more post-traumatic stress symptoms, assessed by IES-R, and more depressive, anxiety, and stress symptoms, assessed by DASS-21. The strongest risk factors for distress were greater age, professional role, increased workload, worse team relationship, and separation from family members. Previous experience of severe human suffering and unwanted sexual experiences negatively impacted IES-R and DASS-21 scores. Being a psychiatrist or psychologist/psychotherapist and good team relationships were protective factors. Recent but also previous severe stressful events might represent relevant risk factors for distress, reducing resilience skills. Identifying vulnerable factors and professional categories may help in the development of dedicated measures to prevent emotional burden and support psychological health. Highlights: Psychological distress in mental health workers in the COVID-19 pandemic is more frequent in nurses, who experience more depression, anxiety, and post-traumatic stress symptoms. Previous and recent stressful events are risk factors for distress and should guide intervention strategies.

Impact of the COVID-19 Pandemic on Patients with Parkinson’s Disease from the Perspective of Treating Physicians—A Nationwide Cross-Sectional Study

The COVID-19 pandemic has posed challenges to maintaining medical care for patients with Parkinson’s disease (PD). The Parkinson’s Disease during the COVID-19 Pandemic (ParCoPa) survey was conducted as an online, nationwide, cross-sectional survey from December 2020 to March 2021 and aimed to assess the impact of the pandemic on the medical care of PD patients from the physicians’ perspective. Invitations containing a randomly generated registration code were mailed to healthcare professionals from sixty-seven specialty centers in Germany. Confounders for the worsening of subjective treatment quality, perceived health risk due to the profession, and adequate protective measures against SARS-CoV-2 were assessed using logistic regression analysis. Of all forty physicians who responded, 87.5% reported a worsening of motor and nonmotor symptoms in their patients, 97.5% experienced cancellation of appointments, and difficulties in organizing advanced and supplementary therapies were reported by over 95%. Participants offered alternative consultation options, mostly in the form of telephone (77.5%) or online (64.1%) consultations, but telephone consultations were the most accepted by patients (“broadly accepted”, 40.0%). We identified pandemic-related deficits in providing care for patients with PD and areas of improvement to ensure continued care for this vulnerable patient population.

The Effect of COVID-19 Endemicity on the Mental Health of Health Workers

Objectives

A major surge in COVID-19 cases despite Singapore's high vaccination has strained the health care system in October 2021. Our aim was to assess and compare Healthcare Worker (HCW) mental well-being in 2021 against a previously published cohort in 2020.

Design

Cross-sectional survey study.

Setting and Participants

HCWs from 4 public hospitals and a primary health care system over a 4-week duration in 2021 coinciding with a major surge compared with a similar period in 2020.

Methods

A survey comprising of the Oldenburg Burnout Inventory (OLBI), Hospital Anxiety and Depression Scale (HADS), and Safety Attitudes Questionnaire (SAQ) was distributed via email. Primary endpoints were the proportion meeting OLBI thresholds for both disengagement and exhaustion and being at risk for both Anxiety and Depression using HADS. Multivariate analysis identified significant predictors among demographic, workplace, and SAQ data. Subgroup analysis of overseas HCWs was performed.

Results

We surveyed 1475 HCWs. Significantly more HCWs met primary outcomes using OLBI and HADS than in 2020 (84.1% and 39.6% vs 68.2% and 23.3%, respectively; P < .001). Burnout levels were uniformly high. A HADS score ≥8 in either subscale was significantly associated with meeting burnout thresholds (P < .001). Overseas HCWs (P = .002), South Asian ethnicity (P = .004), preuniversity educational qualifications (P = .026), and longer shift workhours of 8 to <12 (P = .015) and ≥12 (P = .001) were significantly associated with meeting HADS thresholds. Among overseas HCWs (n=407), seeing family more than a year ago was significantly associated with worse OLBI disengagement scores and a greater proportion meeting HADS thresholds vs seeing them within a year or being local HCWs (47.2% vs 37.2% and 35.6%, respectively; P = .001).

Conclusions and Implications

HCW mental health has objectively worsened between 2020 and 2021 in the pandemic’s second year. Avoiding prolonged shifts, adopting preventive mental health strategies, improving patient safety, and attention to HCWs of minority ethnicity, from overseas, and with preuniversity education may help.

A SARS-CoV-2 Infection High-Uptake Program on Healthcare Workers and Cancer Patients of the National Cancer Institute of Naples, Italy

Background: From the beginning of 2020, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) quickly spread worldwide, becoming the main problem for the healthcare systems. Healthcare workers (HCWs) are at higher risk of infection and can be a dangerous vehicle for the spread of the virus. Furthermore, cancer patients (CPs) are a vulnerable population, with an increased risk of developing severe and lethal forms of Coronavirus Disease 19 (COVID-19). Therefore, at the National Cancer Institute of Naples, where only cancer patients are treated, a surveillance program aimed to prevent the hospital access of SARS-CoV-2 positive subjects (HCWs and CPs) was implemented. The study aims to describe the results of the monitoring activity for the SARS-CoV-2 spread among HCWs and CPs, from March 2020 to March 2021. Methods: This surveillance program included a periodic sampling through nasopharyngeal molecular swabs for SARS-CoV-2 (Real-Time Polymerase Chain Reaction, RT-PCR). CPs were submitted to the molecular test at least 48 h before hospital admission. Survival analysis and multiple logistic regression models were performed among HCWs and CPs to assess the main SARS-CoV-2 risk factors. Results: The percentages of HCWs tested with RT-PCR for the detection of SARS-CoV-2, according to the first and the second wave, were 79.7% and 91.7%, respectively, while the percentages for the CPs were 24.6% and 39.6%. SARS-CoV-2 was detected in 20 (1.7%) HCWs of the 1204 subjects tested during the first wave, and in 127 (9.2%) of 1385 subjects tested in the second wave (p < 0.001); among CPs, the prevalence of patients tested varied from 100 (4.6%) during the first wave to 168 (4.9%) during the second wave (p = 0.8). The multivariate logistic analysis provided a significant OR for nurses (OR = 2.24, 95% CI 1.23–4.08, p < 0.001) compared to research, administrative staff, and other job titles. Conclusions: Our findings show that the positivity rate between the two waves in the HCWs increased over time but not in the CPs; therefore, the importance of adopting stringent measures to contain the shock wave of SARS-CoV-2 infection in the hospital setting was essential. Among HCWs, nurses are more exposed to contagion and patients who needed continuity in oncological care for diseases other than COVID-19, such as suspected cancer.

Knowledge, Attitude, and Practice among Physical Therapists toward COVID-19 in the Kingdom of Saudi Arabia-A Cross-Sectional Study

To curb the COVID-19 pandemic, the knowledge, attitude, and practice (KAP) of preventive measures play an essential role, and healthcare workers have had to endure a burden to care for COVID-19 patients. Thus, this study aimed to assess the weight of the KAP of physiotherapists in Saudi Arabia during the COVID-19 pandemic. This was a cross-sectional study, where we circulated an online KAP questionnaire to 1179 physical therapists, and among those, 287 participated and completed the questionnaire. The collected responses were analyzed using descriptive statistics, t-test, ANOVA, correlation, and regression analyses, and p-value ≤ 0.05 was considered statistically significant. Both males and females participated in almost equal numbers; most of the participants were <40 years, had a bachelor’s level of education, and were from the central region of Saudi Arabia. Social media and the internet were the primary sources of COVID-19-related information (74.6%). Knowledge components A (92%) and B (73.9%) were excellent among most participants. Approximately half of the participants (50.5%) had a moderate attitude toward COVID-19, and regarding the practice component, most participants (74.6%) scored moderately. Correlation analysis showed a low positive relationship between knowledge A, attitude, and practice components. Still, there was a very low positive relationship between knowledge B, attitude, and practice components, but both were statistically significant. Our study showed that physical therapists in Saudi Arabia exhibit good knowledge, attitude, and practice toward COVID-19.

Assistive Technology during the COVID-19 Global Pandemic: The Roles of Government and Civil Society in Fulfilling the Social Contract

The COVID-19 pandemic imposed significant challenges to users of assistive technology (AT). Three key issues emerged from a series of structured qualitative interviews with 35 AT users in six low- and middle-income countries. These were (1) access to information about COVID-19 and available supports and policies, (2) insufficiency of the government response to meet the needs of AT users, and (3) the response of civil society which partially offset the gap in government response. AT users noted the need for better communication, improved planning for the delivery and maintenance of AT during times of crisis, and higher-quality standards to ensure the availability of appropriate technology.

Predicting High-Risk Groups for COVID-19 Anxiety Using AdaBoost and Nomogram: Findings from Nationwide Survey in South Korea

People living in local communities have become more worried about infection due to the extended pandemic situation and the global resurgence of COVID-19. In this study, the author (1) selected features to be included in the nomogram using AdaBoost, which had an advantage in increasing the classification accuracy of single learners and (2) developed a nomogram for predicting high-risk groups of coronavirus anxiety while considering both prediction performance and interpretability based on this. Among 210,606 adults (95,287 males and 115,319 females) in South Korea, 39,768 people (18.9%) experienced anxiety due to COVID-19. The AdaBoost model confirmed that education level, awareness of neighbors/colleagues’ COVID-19 response, age, gender, and subjective stress were five key variables with high weight in predicting anxiety induced by COVID-19 for adults living in South Korean communities. The developed logistic regression nomogram predicted that the risk of anxiety due to COVID-19 would be 63% for a female older adult who felt a lot of subjective stress, did not attend a middle school, was 70.6 years old, and thought that neighbors and colleagues responded to COVID-19 appropriately (classification accuracy = 0.812, precision = 0.761, recall = 0.812, AUC = 0.688, and F-1 score = 0.740). Prospective or retrospective cohort studies are required to causally identify the characteristics of anxiety disorders targeting high-risk COVID-19 anxiety groups identified in this study.