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Mittermeier I, Merlic D, Braschl S, Sealtiel L, Weilnhammer V, Quartucci C, Weinmann T, Adorjan K, Gerstner D, Heinze S, Herr C, Sirrenberg M. Mental health and work-related factors in healthcare workers in a pandemic - meta-analysis. PSYCHOL HEALTH MED 2023; 28:3005-3051. [PMID: 36967568 DOI: 10.1080/13548506.2023.2193750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/08/2023] [Indexed: 03/28/2023]
Abstract
Due to the SARS-CoV-2 pandemic, healthcare workers worldwide faced major challenges in the form of psychological stress. The aim of this systematic literature review and meta-analysis is to identify mental health consequences and associated work-related factors in healthcare workers during a pandemic and to quantify the influence of associated work-related factors on mental health consequences. A systematic literature search according to PRISMA was conducted on 5 August 2021 using the databases PubMed Central and APA PsychInfo. The included studies investigated the mental health consequences and associated work-related factors in healthcare workers in a pandemic. In addition, we performed a risk of bias analysis to assess the study quality of the included studies using the JBI checklists. Random-effect models and pooled effect estimators were used for the meta-analysis. The Chi2 and I2 statistics were used to identify the statistical heterogeneity. Additional sensitivity analysis was performed. From a total of 3,910 publications, 43 studies met the inclusion criteria. These studies provided 15 stress consequences and 20 stress factors. The most frequently reported stress factors were 'contact with COVID-19 patients', 'no education or training in handling infectious diseases' and 'insufficient protective equipment'. Anxiety, stress, and depression were the most common outcomes identified. Analyses showed an increase in anxiety scores among HCWs who cared for COVID-19 patients, as well as a rise in depressive symptoms due to inadequate or no personal protective equipment. In this review, various pandemic-associated stress factors and stress consequences of healthcare workers were observed. With the results, criteria for effective measures and interventions can be developed to minimize the risk of stress consequences.
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Affiliation(s)
- Isabella Mittermeier
- Institute for Occupational Health and Product Safety Environmental Health, Bavarian Health and Food Safety Authority, Munich, Germany
| | - Deborah Merlic
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE) at the Ludwig-Maximilians-University, Munich, Germany
| | - Sophie Braschl
- TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Luca Sealtiel
- TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Veronika Weilnhammer
- Institute for Occupational Health and Product Safety Environmental Health, Bavarian Health and Food Safety Authority, Munich, Germany
| | - Caroline Quartucci
- Institute for Occupational Health and Product Safety Environmental Health, Bavarian Health and Food Safety Authority, Munich, Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Munich, Germany
| | - Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital, Munich, Germany
| | - Doris Gerstner
- Institute for Occupational Health and Product Safety Environmental Health, Bavarian Health and Food Safety Authority, Munich, Germany
| | - Stefanie Heinze
- Institute for Occupational Health and Product Safety Environmental Health, Bavarian Health and Food Safety Authority, Munich, Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Munich, Germany
| | - Caroline Herr
- Institute for Occupational Health and Product Safety Environmental Health, Bavarian Health and Food Safety Authority, Munich, Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Munich, Germany
| | - Manuela Sirrenberg
- Institute for Occupational Health and Product Safety Environmental Health, Bavarian Health and Food Safety Authority, Munich, Germany
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Schutzmeier P, Kutzora S, Mittermeier I, Becker J, Bergmann KC, Böse-O'Reilly S, Buters J, Damialis A, Heinrich J, Kabesch M, Mertes H, Nowak D, Korbely C, Walser-Reichenbach S, Weinberger A, Heinze S, Steckling-Muschack N, Herr C. Non-pharmacological interventions for pollen-induced allergic symptoms: Systematic literature review. Pediatr Allergy Immunol 2022; 33:e13690. [PMID: 34717016 DOI: 10.1111/pai.13690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/28/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Allergic diseases pose a health problem worldwide. Pollen are widespread aeroallergens which can cause symptoms like shortness of breath, cough, itchy eyes, or rhinitis. Apart from preventive measures and pharmacological treatment, also non-pharmacological interventions have been suggested to reduce symptoms. The objective of this work was to review studies investigating the effectiveness of non-pharmacologic interventions to reduce allergic symptoms. METHODS PubMed, EMBASE, and CENTRAL were systematically reviewed in July 2018 and April 2020. Several authors worked on the screening of titles, abstracts, and full texts. One author for each literature search performed the data extraction and the risk of bias assessment. Studies were included if they met the inclusion criteria defined by the PECOs. Studies which investigating the effect of non-pharmacologic interventions on patients with allergic rhinitis were included. RESULTS Twenty-nine studies investigating eleven types of non-pharmacologic interventions to avoid and reduce allergic symptoms due to pollen exposure were included in this review. Out of all studies, seven studies addressed nasal rinsing and 22 included acupuncture, air filtering, artisanal tears, individual allergen avoidance advice, various nasal applications, self-hypnosis, rhinophototherapy, and wraparound sunglasses. CONCLUSION Most studies had a high risk of bias and small sample sizes. There were only a few high-quality studies that give hints about the effectiveness of non-pharmacological interventions. For future research, more high-quality studies are required to confirm the effectiveness of simple, safe, and cost-effective interventions.
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Affiliation(s)
- Paul Schutzmeier
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Kutzora
- Institute for Occupational Health and Product Safety Environmental Health, Bavarian Health and Food Safety Authority, Munich, Germany
| | - Isabella Mittermeier
- Institute for Occupational Health and Product Safety Environmental Health, Bavarian Health and Food Safety Authority, Munich, Germany
| | - Jana Becker
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Neuherberg, Germany
| | - Karl-Christian Bergmann
- Allergy-Center Charité, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,German Pollen Information Foundation, Berlin, Germany
| | - Stephan Böse-O'Reilly
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria.,University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Clinic St. Hedwig, Regensburg, Germany
| | - Jeroen Buters
- ZAUM, Center of Allergy & Environment, Helmholtz Center Munich/Technische Universität München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Athanasios Damialis
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München, Augsburg, Germany
| | - Joachim Heinrich
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center (CPC) Munich, member DZL, German Center for Lung Research, Munich, Germany.,Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Michael Kabesch
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Clinic St. Hedwig, Regensburg, Germany.,Research and Development Campus Regensburg (WECARE) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Hanna Mertes
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center (CPC) Munich, member DZL, German Center for Lung Research, Munich, Germany
| | - Christine Korbely
- Institute for Occupational Health and Product Safety Environmental Health, Bavarian Health and Food Safety Authority, Munich, Germany
| | - Sandra Walser-Reichenbach
- Institute for Occupational Health and Product Safety Environmental Health, Bavarian Health and Food Safety Authority, Munich, Germany
| | - Alisa Weinberger
- Institute for Occupational Health and Product Safety Environmental Health, Bavarian Health and Food Safety Authority, Munich, Germany
| | - Stefanie Heinze
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Institute for Occupational Health and Product Safety Environmental Health, Bavarian Health and Food Safety Authority, Munich, Germany
| | - Nadine Steckling-Muschack
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
| | - Caroline Herr
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Institute for Occupational Health and Product Safety Environmental Health, Bavarian Health and Food Safety Authority, Munich, Germany
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Weilnhammer V, Schmid J, Mittermeier I, Schreiber F, Jiang L, Pastuhovic V, Herr C, Heinze S. Extreme weather events in europe and their health consequences - A systematic review. Int J Hyg Environ Health 2021; 233:113688. [PMID: 33530011 DOI: 10.1016/j.ijheh.2021.113688] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/16/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Due to climate change, the frequency, intensity and severity of extreme weather events, such as heat waves, cold waves, storms, heavy precipitation causing wildfires, floods, and droughts are increasing, which could adversely affect human health. The purpose of this systematic review is therefore to assess the current literature about the association between these extreme weather events and their impact on the health of the European population. METHODS Observational studies published from January 1, 2007 to May 17, 2020 on health effects of extreme weather events in Europe were searched systematically in Medline, Embase and Cochrane Central Register of Controlled Trials. The exposures of interest included extreme temperature, heat waves, cold waves, droughts, floods, storms and wildfires. The health impacts included total mortality, cardiovascular mortality and morbidity, respiratory mortality and morbidity, and mental health. We conducted the systematic review following PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis). The quality of the included studies was assessed using the NICE quality appraisal checklist (National Institute for Health and Care Excellence). RESULTS The search yielded 1472 articles, of which 35 met the inclusion criteria and were included in our review. Studies regarding five extreme weather events (extreme heat events, extreme cold events, wildfires, floods, droughts) were found. A positive association between extreme heat/cold events and overall, cardiovascular and respiratory mortality was reported from most studies. Wildfires are likely to increase the overall and cardiovascular mortality. Floods might be associated with the deterioration of mental health instead of mortality. Depending on their length, droughts could have an influence on both respiratory and cardiovascular mortality. Contradictory evidence was found in heat-associated morbidity and wildfire-associated respiratory mortality. The associations are inconclusive due to the heterogeneous study designs, study quality, exposure and outcome assessment. CONCLUSIONS Evidence from most of the included studies showed that extreme heat and cold events, droughts, wildfires and floods in Europe have negative impacts on human health including mental health, although some of the associations are not conclusive. Additional high-quality studies are needed to confirm our results and further studies regarding the effects of other extreme weather events in Europe are to be expected.
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Affiliation(s)
- Veronika Weilnhammer
- Department of Occupational and Environmental Health, Bavarian Health and Food Safety Authority, Germany.
| | - Jonas Schmid
- Department of Occupational and Environmental Health, Bavarian Health and Food Safety Authority, Germany; TUM Department of Sport and Health Sciences, Technical University of Munich, Germany
| | - Isabella Mittermeier
- Department of Occupational and Environmental Health, Bavarian Health and Food Safety Authority, Germany
| | - Fabian Schreiber
- Department of Occupational and Environmental Health, Bavarian Health and Food Safety Authority, Germany
| | - Linmiao Jiang
- Department of Occupational and Environmental Health, Bavarian Health and Food Safety Authority, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology (IBE) at the Ludwig-Maximilians-University, Munich, Germany
| | - Vedran Pastuhovic
- Department of Occupational and Environmental Health, Bavarian Health and Food Safety Authority, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology (IBE) at the Ludwig-Maximilians-University, Munich, Germany
| | - Caroline Herr
- Department of Occupational and Environmental Health, Bavarian Health and Food Safety Authority, Germany; Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Centre of the Ludwig-Maximilians- University Munich, Germany
| | - Stefanie Heinze
- Department of Occupational and Environmental Health, Bavarian Health and Food Safety Authority, Germany; Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Centre of the Ludwig-Maximilians- University Munich, Germany
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