Culture, conditions and care support mental health of healthcare workers during crises

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has presented immense challenges to health systems worldwide and significantly impacted the mental health of frontline healthcare workers.

AIMS

This study drew on the experiences of frontline healthcare workers to examine organizational strategies needed to support the mental health and well-being of healthcare workers during times of crisis.

METHODS

Semi-structured focus groups or individual interviews were conducted with healthcare workers to examine their perspectives on organizational strategies for enhancing staff mental health and well-being during crises. Data were analysed thematically. Following this, evidence for the identified strategies was reviewed to assess alignment with participant views and recommendations.

RESULTS

Thirty-two healthcare workers from diverse disciplines (10 allied health, 11 nursing, 11 medical) participated in the study. Data analysis identified three broad themes contributing to supporting mental health and well-being. These themes can be encapsulated as the 'Three Cs'-culture (building an organizational culture that prioritizes mental health); conditions (implementing proactive organizational strategies during crises) and care (ensuring fit-for-purpose strategies to support mental health and well-being).

CONCLUSIONS

Study findings underscore the necessity of an integrated and systemic organizational approach to address mental health and well-being in the healthcare workplace. This approach must be long term with the components of the 'Three Cs', particularly cultural change and conditions, viewed as a part of a suite of strategies to ensure crisis preparedness. It is imperative that organizations collaborate with their staff, providing support and fostering a safe and inclusive work environment that ultimately benefits patients, their care and staff well-being.

Exploring views of members of the public and policymakers on the acceptability of population level dietary and active-travel policies: a qualitative study

BACKGROUND

There is limited evidence on what shapes the acceptability of population level dietary and active-travel policies in England. This information would be useful in the decision-making process about which policies should be implemented and how to increase their effectiveness and sustainability. To fill this gap, we explored public and policymakers' views about factors that influence public acceptability of dietary and active-travel policies and how to increase public acceptability for these policies.

METHODS

We conducted online, semi-structured interviews with 20 members of the public and 20 policymakers in England. A purposive sampling frame was used to recruit members of the public via a recruitment agency, based on age, sex, socioeconomic status and ethnicity. Policymakers were recruited from existing contacts within our research collaborations and via snowball sampling. We explored different dietary and active-travel policies that varied in their scope and focus. Interviews were transcribed verbatim and analysed using thematic reflexive analysis with both inductive and deductive coding.

RESULTS

We identified four themes that informed public acceptability of dietary and active-travel policies: (1) perceived policy effectiveness, i.e., policies that included believable mechanisms of action, addressed valued co-benefits and barriers to engage in the behaviour; (2) perceived policy fairness, i.e., policies that provided everyone with an opportunity to benefit (mentioned only by the public), equally considered the needs of various population subgroups and rewarded 'healthy' behaviours rather than only penalising 'unhealthy' behaviours; (3) communication of policies, i.e., policies that were visible and had consistent and positive messages from the media (mentioned only by policymakers) and (4) how to improve policy support, with the main suggestion being an integrated strategy addressing multiple aspects of these behaviours, inclusive policies that consider everyone's needs and use of appropriate channels and messages in policy communication.

CONCLUSIONS

Our findings highlight that members' of the public and policymakers' support for dietary and active-travel policies can be shaped by the perceived effectiveness, fairness and communication of policies and provide suggestions on how to improve policy support. This information can inform the design of acceptable policies but can also be used to help communicate existing and future policies to maximise their adoption and sustainability.

SDG5 Gender Equality during the COVID-19 pandemic: an international comparative policy assessment

Background

The COVID-19 pandemic caused severe disruptions in healthcare systems and societies and exacerbated existing inequalities for women and girls across every sphere. Our study explores health systems responses to gender equality goals during the COVID-19 pandemic and which role these goals play in pandemic recovery policies.

Methods

We apply a qualitative comparative approach. Country case studies (expert information, secondary sources) were collected in March/April 2022. The sample comprised Australia, Brazil, Germany, United Kingdom and USA, reflecting conditions of high to upper-middle income countries with established public health systems, democratic political institutions and gender equality policies. Selected topics: maternity care/reproductive services, violence against women, and gender equality/female leadership.

Results

All countries tried to keep essential maternity and reproductive services open, but strong limitations applied especially for prevention and counselling services; at the same time, digitalisation/telemedicine supported service expansion. Violence against women and children strongly increased during the pandemic. Routine services were partly kept open and new helplines occasionally established, but no action was taken to scale-up mental health support and respond to new demand. A push-back of gender equality was observed across countries in all areas of health and social care, often coupled with strong increase in intersecting social inequalities; participation of women in decision-making bodies was generally weak and not monitored.

Conclusions

Across countries, gender equality policies cracked under the pressure of the COVID-19 pandemic; this is true for countries with male and female political leaders, and for different areas of SDG5 and health. There is an urgent need for more effective intersectional gender equality policies and improved participation of women in global health and in health system recovery plans.

Key messages

• Health systems failed to take action to protect SDG5 goals; gender and intersecting inequalities strongly increased during the pandemic.

• Building back better after COVID-19 will only be possible with an intersectional gender equality programme and feminist policy approaches.

Self-release of ski-binding

We investigated whether twenty-five male and female downhill skiers of different ages (11 - 63 years) and skiing skills were able to self-release their ski binding by an inward twist of the foot and leg. We also studied possible correlations between thigh muscle torques and the ability to release the binding. All subjects used the same ski and binding, Marker Titanum M48, individually set according to weight, height, skiing skill, age, and boot sole length. Prior to the test we used a special torque wrench, the Vermont Release Calibrator, to verify that the settings of the binding corresponded to the appropriate torque (Nm) to produce a release. Isokinetic concentric and eccentric quadriceps and hamstring torques were measured. EMG was used to study which muscles are engaged in this self-test. Nineteen skiers were able to release the binding, while four children and the two muscularly weakest skiers were not. The medial hamstrings produced the highest degree of muscle activity during the inward twist release of the binding. There was a highly significant correlation between thigh muscle torques and the ability to release the binding.

Periodic limb movement disorder and restless legs syndrome in children with attention-deficit hyperactivity disorder

Sleep disruption can lead to symptoms of attention-deficit hyperactivity disorder (ADHD) in children. Since periodic limb movement disorder and/or restless legs syndrome can cause sleep disruption, we assessed whether these two specific sleep disorders are likely to occur in children with ADHD. We asked a series of 69 consecutive parents of children with ADHD questions about the symptoms of periodic limb movement disorder. Based on a positive response to these periodic limb movement disorder queries, 27 children underwent all-night polysomnography. Eighteen children (aged 2 to 15 years) of the 27 (26% of the 69 children with ADHD) had 5 or more periodic leg movements in sleep per hour of sleep and had complaints of sleep disruption, thus fulfilling the criteria for periodic limb movement disorder. A comparably age- and sex-matched group of children referred to a sleep laboratory for sleep complaints but without ADHD showed only a 5% prevalence (2 of 38 subjects) of periodic leg movements in sleep (P=.017). Eight of the 18 children with ADHD and periodic limb movement disorder and one of the two control patients with periodic limb movement disorder had both a personal and parental history of restless legs syndrome symptomatology. This study further documents the occurrence of periodic limb movement disorder and restless legs syndrome in children and is the first large-scale study establishing a possible comorbidity between ADHD and periodic limb movement disorder. We propose that the sleep disruption associated with periodic limb movement disorder and restless legs syndrome and the motor restlessness of restless legs syndrome while awake could contribute to the inattention and hyperactivity seen in a subgroup of ADHD-diagnosed children.

Building community networks: a road trauma education and training program for rural areas

The work of the Road Trauma Support Team highlights the ongoing impact of road trauma on rural communities. Small population size and close social networks mean that road trauma can have a negative effect on social relations across the whole community. Much of the 'flow-on' effect of road trauma, in the form of community distress, can be alleviated by increased skills, information about responding to road trauma, and the establishment of supportive community networks. This paper reports on the implementation and evaluation of a project that addressed knowledge, skills and awareness of road trauma in rural communities. Funded by the Rural Health Support Education and Training (RHSET) program and conducted by the Road Trauma Support Team, the project focused on the impact of traumatic events in small communities and strategies to maximise effective participation of community members and health workers in response to trauma. Piloted in six rural communities in northern Tasmania, the project has developed an educational resource package.

Arthroscopic treatment of osteoarthritis of the knee: a prospective, randomized, placebo-controlled trial. Results of a pilot study

The reasons why many patients seemingly benefit from arthroscopic treatment of osteoarthritis of the knee remain obscure. The purpose of this pilot study was to determine if a placebo effect might play a role in arthroscopic treatment of this condition. After giving full informed consent, including full knowledge of the possibility and nature of a placebo surgery, five subjects were randomized to a placebo arthroscopy group, three subjects were randomized to an arthroscopic lavage group, and two subjects were randomized to a standard arthroscopic debridement group. The physicians performing the postoperative assessment and the patients remained blinded as to treatment. Patients who received the placebo surgery reported decreased frequency, intensity, and duration of knee pain. They also thought that the procedure was worthwhile and would recommend it to family and friends. Thus, there may be a significant placebo effect for arthroscopic treatment of osteoarthritis of the knee. The small numbers in this preliminary study preclude a valid statistical analysis, and no conclusions can be drawn regarding the superiority of one treatment over another. A larger study is needed to evaluate fully the efficacy of an arthroscopic procedure for this condition and to decide if it is reasonable to expend health care resources for this treatment; the larger study should include a placebo control group.

Education for change in a post-modern world: redefining revolution

Social and behavioural sciences are established components in the curriculum of undergraduate nursing degrees. The purpose is to introduce future and practising nurses to the social and political influences which inform their workplaces and practices. Inevitably an awareness of the structural barriers and the powerful political interests involved in health can lead to feelings of powerlessness and despair of achieving change. Yet the skills of critical analysis and political awareness developed in study such as this are essential for health workers in the increasingly complex and politically charged domain in which they work. This paper will explore problems and barriers encountered in development of curriculum and teaching social and behavioural sciences in health. It will propose an alternative conceptual model, based on post-structuralism, as one way of addressing these barriers. This approach shifts the focus from meta-theoretical sociological concepts such as class, gender and culture, to one of examining subject positions, discourse, contestation and local action, thus enabling the exploration and development of possibilities for change. The paper will also provide a case study to illustrate this alternative approach.

Continuous infusion bleomycin in AIDS-related Kaposi's sarcoma

PURPOSE

To determine the toxicity, response, and survival rate of 72-hour continuous infusion bleomycin administered to patients with AIDS-related Kaposi's sarcoma.

PATIENTS AND METHODS

Seventeen patients with biopsy-proven and measurable-disease AIDS-related Kaposi's sarcoma were treated with a continuous infusion of bleomycin at a dose of 20 mg/m2/d for 3 days every 3 weeks. All patients were evaluated for toxicity, response, and survival using the National Cancer Institute common toxicity criteria, and both the Eastern Cooperative Oncology Group (ECOG) and AIDS Clinical Trials Group (ACTG) response criteria. Fourteen of 17 patients (82%) enrolled had at least two on-study poor-risk factors by ACTG staging criteria.

RESULTS

A total of 59 cycles of therapy were administered. Only one cycle (2%) was complicated by an absolute neutrophil count less than 500, and there were no episodes of febrile neutropenia. Fifty-four percent of cycles were associated with fever during the infusion, and five cycles (8%) were complicated by grade 3 rash. There were no other clinically significant (> or = grade 3) toxicities. There were seven partial remissions (41%) by ECOG criteria (95% confidence interval, 18% to 64%) and 11 partial remissions (65%) by ACTG criteria (95% confidence interval, 42% to 88%). Three of five (60%) previously treated patients had a partial remission with this schedule of bleomycin. The median survival duration was 7 months, with a range of 2.5 to 25 months.

CONCLUSION

This continuous infusion schedule of bleomycin is active in patients with advanced-stage AIDS-related Kaposi's sarcoma and has acceptable toxicity. This regimen should be further evaluated in patients with earlier stage Kaposi's sarcoma and as salvage therapy.

Crystallization and preliminary crystallographic studies of the crystals of the azurin Pseudomonas fluorescens

The Azurin Pseudomones fluorescens has been crystallized in the presence of ammonium sulfate and Tris buffer at pH 7.5. The crystals diffract to 2.05 A using a FAST system. The space group is P2(1)2(1)2(1) with a = 31.95, b = 43.78, and c = 78.81 A.

Hearing-impaired children's rhythm perception and speech

The role of rhythm in the speech intelligibility of 18 hearing-impaired children, aged 15 years with hearing losses from 40 to 108 db, was investigated. Their perceptual judgement of visual rhythm sequences was superior to that of the hearing controls, but their scores were not correlated with their speech intelligibility.

Operantly based treatment procedure for stair avoidance by a severely mentally retarded adult

The use of contingent social and edible reinforcement and physical guidance-without desensitization-in the treatment of stair avoidance behavior by a severely mentally retarded adult was tested. Results indicate that this operantly based procedure was effective in increasing stair use, both ascent and descent, in staircases containing 5 and 11 stairs.

Absorption and antidysrhythmic activity of oral disopyramide phosphate after acute myocardial infarction

1 In a prophylactic, double-blind, randomized placebo-controlled trial of oral disopyramide phosphate, initiated within 12 h of suspected acute myocardial infarction (MI), antidysrhythmic effect was evaluated. The loading dose was 150, 200, or 300 mg followed 6 h later by 100, 150, or 200 mg every 6 h for patients assessed to weigh <55, 55-85, or >85 kg, respectively. After each loading dose and a maintenance dose on one of days 4-7, 2 and 6 h venous blood samples were obtained for determination of plasma disopyramide and mono-N-dealkylated disopyramide (MND) concentrations (expressed herein as levels), by a technique incorporating fluorescence photometry and thin layer chromatography. Of 121 patients entering the trial, 101 had confirmed acute MI and of these, 12 on active drug were recalled during convalescence and restudied after a loading dose.

2 In acute MI patients on disopyramide phosphate, an important degree of antidysrhythmic effect was observed (on active drug and placebo, 19% v 37%, respectively (P = 0.047), received lignocaine for `warning arrhythmias'), even though in the first 6 h post-loading dose, disopyramide and MND levels were low and variable.

3 Disopyramide levels 2 h post-loading dose were lower in acute MI than in non-MI patients (P = 0.004), and similarly in the limited within patient study corresponding levels after acute MI were lower than during convalescence (P = 0.013). At 6 h post-loading dose, the levels had increased in acute MI patients but decreased in non-MI patients, this change being significantly different (P = 0.048). A similar significant difference existed in the limited within patient data available during acute MI and convalescence (P = 0.002).

4 Acute MI patients on active drug developing `warning arrhythmias' had lower post-loading dose, 2 and 6 h levels than in those without `warning arrhythmias' (P = 0.012 and P = 0.0002, respectively).

5 One patient who developed renal insufficiency developed excessive disopyramide levels.

6 On any given dose, there was no significant correlation between disopyramide level and body weight.

7 In acute MI patients given oral disopyramide phosphate (a) there was marked interindividual variation in the ensuing drug and metabolite levels, (b) absorption of disopyramide into the circulation was delayed, (c) prophylactic antidysrhythmic activity was present at levels of about 1.5 mg/l which is about half the minimal level recommended hitherto, (d) disopyramide accumulated in renal insufficiency, (e) elaborate dosage adjustments based on body weight are not useful.

Absence of parasympathetic denervation of the iris in alcoholics

Forty patients with a history of alcohol abuse were treated with a 2% solution of methacholine to determine the prevalence of iridic parasympathetic denervation. Three (8%) of the alcoholics showed iris constriction of 1.0 mm or more, compared with three (8%) control subjects. In contrast, damage to the iridic parasympathetic nerve supply occurs in approximately 80% of patients with diabetes mellitus as determined by the same pharmacological technique.

Congenital fistula between an aberrant systemic artery and a pulmonary vein without sequestration. A report of three cases

Three children had an arteriovenous fistula between an aberrant vessel from the descending aorta and a normal pulmonary vein in the posterior basal segment of a lung. The affected lung was otherwise normally developed. Only a few similar cases could be found in the literature.

Oxygen consumption in infants and children during cardiac catheterization under different sedation regimens

We measured oxygen consumption in 426 infants and children during cardiac catheterization using an open circuit, flow-through technique. Since this method does not require the cooperation of the patient, determinations were readily made in 170 infants. The purpose of this study was to determine those factors which significantly influence oxygen consumption and to determine the potential errors incurred in using predictive equations for estimating oxygen consumption. The type of sedation or anesthesia given was found to be one of the most important variables influencing oxygen consumption; therefore patients were classified into five anesthetic groups. Stepwise regression analysis revealed that each group had a distinctive set of hemodynamic or physical factors which significantly affected oxygen consumption; hence each group required a different predictive equation. Body size in terms of surface area or weight was the only significant variable common to all five patient groups. Using the predictive equations the estimated values differed from measured values by more than 20 percent in approximately one-fifth of the cases. These data indicate that frequently oxygen consumption cannot be accurately estimated from predictive equations. Therefore if blood flow is to be accurately determined by the Fick method in infants and children, oxygen consumption should be measured during the catheterization procedure.