[COVID-19 vaccination status among nurses and associated factors in long-term care facilities : Results of a cross-sectional survey within the Covid-Heim project]

BACKGROUND

Nurses working in long-term care facilities were vaccinated first before residents as a matter of priority to protect the latter. Although the vaccination rate of nursing staff eventually rose due to a facility-based vaccination requirement, studies on associated factors of vaccination status are currently not available for the long-term care setting in Germany.

OBJECTIVE

Associated factors of COVID-19 vaccination status among nursing staff in long-term care facilities were explored.

METHODS

An online survey was conducted between October 26th 2021 and January 31st 2022. A total of 1546 nurses working in long-term care in Germany responded to questions concerning the Covid-19 vaccination campaign. Logistic regression analyses were performed.

RESULTS

In this study 8 out of 10 nurses were vaccinated against COVID-19 (80.6%). Approximately 7 out of 10 nurses thought at least a few times about quitting their job since the pandemic began (71.4%). A positive COVID-19 vaccination status was associated with older age, full-time employment, COVID-19 deaths at the facility and working in northern or western Germany. Frequent thoughts of quitting their job were associated with negative COVID-19 vaccination status.

CONCLUSION

The present findings provide evidence on factors associated with the COVID-19 vaccination status of nurses in long-term care facilities in Germany for the first time. Further quantitative as well as qualitative studies are necessary for a more comprehensive understanding of the COVID-19 vaccination decision-making among nurses in long-term care, in order to implement target-oriented future vaccination campaigns in this care setting.

Hospital admissions and deaths due to acute cardiovascular events during the COVID-19 pandemic in residents of long-term care facilities

Hospital admissions due to acute cardiovascular events dropped during the COVID-19 pandemic in the general population; however, evidence for residents of long-term care facilities (LTCF) is sparse. We investigated rates of hospital admissions and deaths due to myocardial infarction (MI) and stroke in LTCF residents during the pandemic. Our nationwide cohort study used claims data. The sample comprised 1,140,139 AOK-ensured LTCF residents over 60 years of age (68.6% women; age 85.3 ± 8.5 years) from the largest statutory health insurance in Germany (AOK), which is not representative for all LTCF residents. We included MI and stroke admission and compared numbers of in-hospital deaths from January 2020 to end of April 2021 (i.e., during the first three waves of the pandemic) with the number of incidences in 2015-2019. To estimate incidence risk ratios (IRR), adjusted Poisson regression analyses were applied. During the observation period (2015-2021), there were 19,196 MI and 73,953 stroke admissions. MI admissions declined in the pandemic phase by 22.5% (IRR = 0.68 [CI 0.65-0.72]) compared to previous years. This decline was slightly more pronounced for NSTEMI than for STEMI. MI fatality risks remained comparable across years (IRR = 0.97 [CI95% 0.92-1.02]). Stroke admissions dropped by 15.1% (IRR = 0.75 [CI95% 0.72-0.78]) in the pandemic. There was an elevated case fatality risk for haemorrhagic stroke (IRR = 1.09 [CI95% 1.03-1.15]) but not for other stroke subtypes compared to previous years. This study provides first evidence of declines in MI and stroke admissions and in-hospital deaths among LTCF residents during the pandemic. The figures are alarming given the acute nature of the conditions and the vulnerability of the residents.

Effort-reward imbalance and its association with sociocultural diversity factors at work: findings from a cross-sectional survey among physicians and nurses in Germany

OBJECTIVE

Due to staff shortages and reports of high work stress, work conditions of hospital physicians and nurses receive wide attention. Additionally, sociocultural diversity of the workforce and patient population is increasing. Our study aim is to analyze how individual and organizational diversity-related factors are associated with the experience of staff's work stress.

METHODS

A cross-sectional online survey was conducted with healthcare staff from 22 acute hospitals operated by two healthcare organizations in Germany in 2018. Sociodemographic, occupational and organizational factors were surveyed. Participants further reported work conditions related to the sociocultural diversity of colleagues and patients. Effort-reward imbalance (ERI) was measured with the German short version. Multivariable regression models were calculated with ER ratio as an outcome.

RESULTS

N = 800 healthcare staff were included. Variables associated with higher ERI were longer work experience (β = 0.092, p < 0.05), not holding a leading position (0.122, < 0.01), being a witness (0.149, < 0.001) or victim (0.099, < 0.05) of discrimination at one's own ward, reporting frequent burden due to language barriers with patients (0.102, < 0.01) and colleagues (0.127, < 0.001), and having restricted access to translators at work (0.175, < 0.001). Factors associated with lower ERI were having a first generation migration background (- 0.095, < 0.05) and being a physician (- 0.112, < 0.05).

CONCLUSIONS

Catering to the needs of healthcare personnel in dealing with the additional effort related to language barriers at work, e.g., readily available translator services, and creating non-discriminatory work environments might be one cornerstone for the prevention of work-related ill health and retention of qualified hospital staff.

General practitioner care in nursing homes during the first wave of the COVID-19 pandemic in Germany: a retrospective survey among nursing home managers

BACKGROUND

Though evidence on the detrimental impact of the COVID-19 pandemic in nursing homes is vast, research focusing on general practitioners' (GP) care during the pandemic in nursing homes is still scarce.

METHODS

A retrospective online survey among 1,010 nursing home managers in Germany was conducted during the first wave of the COVID-19 pandemic between November 2020 and February 2021. Associations between perceived deficits in GP care (routine and acute visits) and both general and COVID-19-related characteristics of nursing homes were analysed using multiple logistic regression analyses.

RESULTS

The majority of nursing home managers reported no deficits in GP care (routine visits, 84.3%; acute visits, 92.9%). Logistic regression analyses revealed that deficits in GP care (routine visits) were significantly associated with visiting restrictions for GPs and nursing home size. Small nursing homes (1-50 residents) were significantly more likely to report deficits in GP care (routine visits) compared to medium (51-100 residents) and large nursing homes (> 100 residents). Further, deficits in GP care (acute visits) were significantly associated with dementia as a focus of care and the burden of insufficient testing for SARS-CoV-2 among residents. Moreover, visiting restrictions for GPs were significantly associated with dementia as the focus of care and the COVID-19 incidence at the federal state level. Finally, COVID-19 cases in nursing homes were significantly associated with size of nursing homes, COVID-19-incidence on the federal state level and the burden of insufficient testing capacities for SARS-CoV-2 among residents.

CONCLUSION

We found structural factors associated with GP care deficits during the pandemic. New concepts for GP care should be implemented in pandemic preparedness plans to ensure high quality, consistent, and reliable GP care as well as effective infection prevention measures in nursing homes.

Soziale Teilhabe in Pflegeheimen mit Covid-19-Schutzmaßnahmen in der zweiten Pandemiewelle?

Zusammenfassung. Hintergrund: Die Umsetzung von Schutzmaßnahmen in Pflegeheimen während der Covid-19-Pandemie war mit dem Wegfall sozialer Teilhabeangebote in der ersten Covid-19-Welle verbunden, für die zweite Covid-Welle ist dies unzureichend untersucht. Ziel: Die Evaluation des Zusammenhangs von Schutzmaßnahmen und Einschränkungen der sozialen Teilhabe für die zweite Covid-19-Welle zur Ausarbeitung von Handlungsempfehlungen. Methode: Mixed-Methods-Online-Survey von Pflegeheimleitungen ( n = 873) in der zweiten Welle. Mithilfe binärlogistischer verallgemeinerter Schätzgleichungen wurde die Wahrscheinlichkeit für das Wegfallen sozialer Teilhabeangebote in den Pflegeheimen in Abhängigkeit gesetzlicher Schutzmaßnahmen evaluiert. Offene Antworten zur Aufrechterhaltung sozialer Teilhabe wurden inhaltsanalytisch untersucht ( n = 1042). Ergebnisse: Mehr als jede zweite Pflegeheimleitung berichtet über untersagte Gruppenveranstaltungen (66,6%), mehr als jede dritte untersagte kreative Angebote (42,3%). Besuchseinschränkungen (85,2%) waren in der zweiten Welle weit verbreitet. Der Wegfall von Teilhabeangeboten und die angeordneten Schutzmaßnahmen waren eng assoziiert. Qualitative Daten zeigten, dass zum Beispiel das Anschaffen mobiler Einkaufsläden Maßnahmen waren, der sozialen Exklusion der Bewohnenden entgegenzuwirken. Diskussion: Der Zusammenhang zwischen dem Wegfall sozialer Teilhabeangebote und der Umsetzung von Schutzmaßnahmen war deutlich ausgeprägt. Die Pflegepraxis sollte die Umsetzung von sozialer Teilhabe ermöglichen und gleichzeitig einen bestmöglichen Infektionsschutz garantieren.

Psychosocial burden and associated factors among nurses in care homes during the COVID-19 pandemic: findings from a retrospective survey in Germany

Background

Care homes were hit hard by the COVID-19 pandemic. Although high levels of psychosocial burden (i.e., anxiety, depression and stress) during the pandemic have been described for healthcare workers in hospitals, evidence on the psychosocial burden for nurses in care homes during the pandemic is scarce.

Methods

A total of 811 nurses participated in a retrospective online survey between November 2020 and February 2021. Information about the COVID-19 situation (i.e., working demands, COVID-19 cases in their facility, and COVID-19-related burden) of nurses in German care homes during the first wave of the pandemic (March 2020 to June 2020) was gathered. The Stress Scale of the Depression Anxiety and Stress Scales (SDASS-21), the Generalized Anxiety Disorder Scale-2 (GAD-2), the Patients-Health-Questionnaire-2 (PHQ-2), and the Copenhagen Psychosocial Questionnaire (COPSOQ) were used to screen for psychosocial burden.

Results

Among nurses, 94.2% stated that working demands since the COVID-19 pandemic increased. Further, 59.1% showed clinically relevant levels of either stress, anxiety, and/or depression. Multiple regression analysis showed significant associations between COVID-19-related burden and qualification (p < .01), dissatisfaction with COVID-19 management of care home manager (p < .05), COVID-19-related anxiety (p < .001), and dementia as a focus of care (p < .05). Stress, depression, and anxiety showed associations with COVID-19 related burden at work (p < .01), COVID-19-related anxiety (p < .001), social support (p < .01), and sense of community (p < .05). Stress was also associated with COVID-19 cases among residents (p < .05), and size of care home (p < .05).

Conclusion

Short- and long-term strategies (i.e., psychosocial counseling, mandatory team meetings, more highly qualified nurses, additional training) in the work environment of nursing, in crises, but beyond, should be encouraged to reduce the burden on nursing staff in care homes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00807-3.

[Covid-19 protections and social life limitations in nursing homes - Analysis of prescriptions and survey data]

Covid-19 protections and social life limitations in nursing homes - Analysis of prescriptions and survey data Abstract. Background: The tension between health protection and restrictions of social life in nursing homes during the pandemic has been little addressed. Aim: The aim of the study was to systematize state-specific regulations and actual prioritizations as well as implementations of the pandemic measures and to relate them to life changes for residents. Methods: In a mixed-methods design, 450 protective measures for nursing homes nationwide were categorized and fed into a survey of nursing home managers (n = 1,260) on the handling of these measures in a protective measures model. The association of protective measures and limitations of social services in nursing homes was analyzed with binary logistic generalized estimation equations. Results: The prescriptions were categorized into five themes. Primary data show that "visitation bans" (98.3 %) and "physical contact reduction" (90.5 %) represented the largest proportion of restrictions. The regulations were variously associated with the "restriction of social services". Thus, across all offers prohibitions and for most offers "contact reductions" were significantly associated, for example that giving up "group opportunities" was almost two times as high when the protective measure "reduction of physical contact" was implemented. "Visit restrictions" on the other hand showed little significant association. Conclusions: The results provide evidence of an association between protective measures and social restrictions in the care homes during the pandemic. However, as these lost exchanges are of high value for the residents, aversive long-term effects must be assumed.

Informal caregivers during the COVID-19 pandemic perceive additional burden: findings from an ad-hoc survey in Germany

Background

While the relation between care involvement of informal caregivers and caregiver burden is well-known, the additional psychosocial burden related to care involvement during the COVID-19 pandemic has not yet been investigated.

Methods

A total of 1000 informal caregivers, recruited offline, participated in a cross-sectional online survey from April 21 to May 2, 2020. Questionnaires were used to assess COVID-19-specific changes in the care situation, negative feelings in the care situation, problems with implementation of COVID-19 measures, concerns/excessive demands, loss of support, change in informal caregivers’ own involvement in care and problems with provision, comprehension & practicability of COVID-19 information, and to relate these issues to five indicators of care involvement (i.e., being the main caregiver, high expenditure of time, high level of care, dementia, no professional help). Binomial and multiple regression analyses were applied.

Results

Across indicators of care involvement, 25.5–39.7% reported that the care situation rather or greatly worsened during the COVID-19 pandemic, especially for those caring for someone with dementia or those usually relying on professional help. In a multiple regression model, the mean number of involvement indicators met was associated with age (β = .18; CI .10–.25), excessive demands (β = .10, CI .00–.19), problems with implementation of COVID-19 measures (β = .11, CI .04–.19), an increase in caregiving by the informal caregivers themselves (β = .14, CI .03–.24) as well as with no change in the amount of caregiving (β = .18, CI .07–.29) and loss of support (β = −.08, CI −.16–.00). No significant associations with the mean number of involvement indicators met were found for gender, educational level, change in the care situation, negative feelings, and provision, comprehension & practicability of COVID-19 information.

Conclusion

Those caregivers who perceived extensive care burden were those who suffered most during the pandemic, calling for structural support by the healthcare system now and in the future.

Trial registration

This article does not report the results of a health care intervention on human participants.

Dimers and trimers of diphosphenes: a wealth of cyclo-phosphanes

Various new P-based ring systems were synthesised by transferring established reaction routes from NP chemistry to the analogous PP compounds. Due to the different electronic situations of phosphorus and nitrogen with respect to s and p character of the lone pair, different reactivity of the phosphorus compounds was observed, especially with regard to the specificity of the reactions and the stability of the products. Whereas Mes*NPCl (Mes*=2,4,6-tri-tert-butylphenyl) is stable in the solid state and in solution, the formal phosphorus congener Mes*PPCl is highly reactive and could not be observed. Instead, several formal dimers and trimers of Mes*PPCl could be isolated, which constitute an intriguing variety of three- and four-membered ring systems.

Azidophosphenium cations: versatile reagents in inorganic synthesis

This work describes the synthesis and characterization of a series of iminophosphorane-substituted phosphenium cations of the type [R2NPNP(Cl)2NPNR'2][GaCl4] [R = iPr; R' = iPr (7[GaCl4]), SiMe3 (8)], which are directly derived from azidophosphenium salt [iPrNPN3][GaCl4] (2iPr[GaCl4]) and the corresponding chlorophosphane R2NPCl2. The reactivity of 7[GaCl4] toward 2,3-dimethylbutadiene (dmb) and 2,2'-bipyridine (bipy) was investigated, resulting in the formation of 7-dmb[GaCl4] and 7-Cl. In addition, self-condensation of [(Me3Si)2NPN3][GaCl4] (2SiMe3[GaCl4]) was studied in detail, and [(Me3Si)2NPNP(XY)N(SiMe3)2][GaCl4] [X = Cl; Y = Cl (13), N3 (14)] were determined as products on the basis of (31)P NMR spectroscopy. The reaction of 2SiMe3[GaCl4] with [(Me3Si)2NPCl][GaCl4] (1SiMe3[GaCl4]) yielded an unprecedented bicyclic 1,3,2λ(3),4λ(5)-diazadiphosphetidine (15), which was formed via a GaCl3-assisted Me3SiCl elimination starting from 13. Furthermore, cations of the type [R2NPNPR'3][GaCl4] [R = iPr; R' = cHex (19)] were obtained by the effective combination of 2R[GaCl4] (R = iPr, SiMe3) with PR'3 (R' = Ph, cHex). Azidochlorophosphanes R2NP(N3)Cl [R = iPr, SiMe3 (20R)] are shown to be accessible when 2R[GaCl4] was combined with bipy. All new compounds were fully characterized by means of X-ray, vibrational spectroscopy, CHN analysis, and NMR experiments. All compounds were further investigated by means of density functional theory, and the bonding situation was accessed by natural bond orbital analysis.

Structure and bonding of novel acyclic bisaminoarsenium cations

The synthesis and characterization of a salt bearing a labile bisaminoarsenium cation of the type {[(Me3Si)2N]2As}(+) (9a) are described, which was obtained in the reaction of the chloroarsane [(Me3Si)2N]2AsCl (8) with GaCl3. Reacting 8 with AgOTf did not yield an arsenium salt, but the cyclo-diarsadiazane [(Me3Si)2NAs-μ-NSiMe3]2 (11) was obtained in excellent yields. Moreover, the reactivity of the analogous antimony species [(Me3Si)2N]2SbCl (12) was studied. In the reaction with GaCl3, the aminochlorostibenium salt [(Me3Si)2NSbCl](+)[(Me3Si)2N(GaCl3)2](-) (5) was isolated. In the reaction with AgOTf, substitution of the chlorine in 12 resulted in the formation of [(Me3Si)2N]2SbOTf (13), a compound with significant stibenium character. All new compounds have been fully characterized by means of X-ray, vibrational spectroscopy, CHN analysis, and NMR experiments. All compounds were further investigated by means of density functional theory and the bonding situation was accessed by natural bond orbital (NBO) analysis.

On the synthesis and reactivity of highly labile pseudohalogen phosphenium ions

The synthesis and characterization of salts bearing highly labile pseudohalogen-substituted aminophosphenium cations of the type [(Me3Si)2NPX][GaCl4] (X = NCO, NCS, O(SiMe3)) and their respective reactivity toward Lewis bases (4-dimethylaminopyridine, dmap) and dienes (2,3-dimethyl-1,3-butadiene, dmb; 1,3-cyclo-hexadiene, chd) are described. As π-acidic species, aminophosphenium cations react with dmap at low temperatures to yield adduct salts of the type [(Me3Si)2NP(dmap)X][GaCl4] (X = Cl, N3, NCO) which were fully characterized. In the reaction with dienes at -50 °C, salts bearing phospholenium cations were obtained that could be structurally characterized. The crystal structures of novel 7-phosphanorbornenium cations of the type [(Me3Si)2NP(C6H8)X][GaCl4] (X = Cl, N3, NCO) are reported. All compounds were further investigated by means of density functional theory, and the bonding situation was accessed by Natural Bond Orbital (NBO) analysis.

Primary structure of the Streptomyces enzyme endo-beta-N-acetylglucosaminidase H

We report the DNA and primary amino acid sequences of the Streptomyces plicatus enzyme endo-beta-N-acetylglucosaminidase H. Peptide sequence information was derived from enzyme isolated from Streptomyces culture medium using a combination of mass spectrometric methods and conventional techniques, including Edman degradation and carboxypeptidase Y digestion. The DNA sequence was determined by analysis of the Endo-beta-N-acetylglucosaminidase H gene cloned into the Escherichia coli plasmid pBR322 (Robbins, P. W., Wirth , D. F., and Hering , C. (1981) J. Biol. Chem. 256, 10640-10644). The enzyme from Streptomyces medium is 271 (or 269) amino acids in length and has a ragged NH2-terminal sequence beginning primarily with Ala-Pro-Val or Ala-Pro-Ala-Pro-Val. DNA resection experiments as well as the DNA sequence itself suggest that a proenzyme or, more probably, " prepro " enzyme may be the primary product of translation. The long 42 (or 44) residue leader sequence of the preproenzyme shows striking similarities to leader sequences found on proteins secreted by Bacillus species. The leader sequence is partially removed by E. coli and, as reported previously, endo-beta-N-acetylglucosaminidase H made in E. coli appears in both the periplasmic space and in the cell.

Expression of the Streptomyces enzyme endoglycosidase H in Escherichia coli

Endoglycosidase H is one of a large number of enzymes secreted by Streptomyces plicatus and other Streptomyces species. When the structural gene for this enzyme is introduced into Escherichia coli attached to the plasmid pBR-322 or Charon 4 phage, the enzyme is synthesized and is found in the periplasmic space, culture medium, and cells. Attachment of the UV-5 lac promoter to a site in the plasmid adjacent to the Streptomyces insert stimulates enzyme synthesis as much as 100-fold. This result demonstrates that transcription of the Streptomyces gene can be initiated from sequences outside of the Streptomyces insert. Initiation of transcription on a Streptomyces promoter is also a suggested but unproven possibility. In contrast to the situation in Streptomyces, where the enzyme has a molecular weight of 27,000, the enzyme made in E. coli has a molecular weight of approximately 30,000. Possible explanations for this difference in size are lack of cleavage of the Streptomyces secretion "signal sequence" in E. coli or protein "processing" by enzymes secreted into the medium by STreptomyces.

[Duodenitis]

In 211 bulboscopies 108 normal findings, 29 duodenal ulcers, 44 cases of scar bulb, 4 times erosions of the bulb and 26 times a bulbitis alone (macroscopically) were found. The macroscopic findings duodenitis were confirmed histologically in 85%, the macroscopic findings normal bulbous mucous membrane only in 30% of the cases. In patients with the histological findings duodenitis the bulbous mucous membrane was endoscopically regarded as normal in 70% of the cases. Patients with duodenitis more frequently have an antrum gastritis and less frequently a corpus gastritis than a control group corresponding to age without any macroscopic changes at the stomach and duodenal bulb. On account of its clinico-therapeutic importance is referred to the fact to demarcate the peptic corrosive bulbitis (bulbitis with bulboscopically probable lesion) from the bulbitis without bulboscopic lesion.