COVID-19 and Its Impact on Healthcare Workers: Understanding Stigma, Stress, and Quality of Life.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted public health systems worldwide and created anxiety and stress among communities, resulting in the stigmatization of patients infected with the virus. Stigmatization of individuals who are sick or thought to be infected has a long history and can lead to discrimination and prejudice. This study aims to evaluate the prevalence of COVID-19-related stigma in Jordan, assess the relationship between stigma and the quality of life (QoL) in healthcare workers, and identify possible measures to decrease stressful events. Understanding the psychological effects of healthcare workers' jobs and reducing their burden is essential to improving medical outcomes and the QoL of patients. METHODOLOGY: This cross-sectional study was conducted in three primary hospitals in Amman, Jordan, from July to December 2021. Healthcare workers were recruited through convenience sampling and completed a self-administered questionnaire, which included demographic information, a validated COVID-19 stigma questionnaire, work conditions during the pandemic, the Depression, Anxiety and Stress Scale - 21 Items (DASS-21) questionnaire to measure depression, anxiety, and stress, and the EUROHIS-QOL questionnaire to assess the QoL. Data were analyzed using descriptive and inferential statistics, including chi-square tests and post hoc analysis. The study was approved by the institutional review board, and participation was voluntary and confidential. RESULTS: The study was conducted among 683 healthcare workers in Jordan, with 77.7% based in the capital city, Amman. Most of the participants were between 18 and 30 years of age, and slightly more than half were female. The study found that 38.1% of healthcare workers would not take the COVID-19 vaccine once it became available. More than half (56%) reported experiencing stress, 61% reported anxiety, and 65% reported depression during the pandemic. Internal medicine specialties and frontline nurses reported the highest levels of stress, and healthcare workers with greater exposure to COVID-19 patients reported higher levels of anxiety and stress. Only 3% of participants reported experiencing stigmatization (p=0.043), with low-income participants reporting it more frequently. Stigmatization was significantly correlated with feelings of depression, anxiety, and stress (p<0.001). CONCLUSION: Healthcare workers' mental well-being has been affected negatively by the COVID-19 pandemic, resulting in depression, anxiety, and stress. Widespread mental surveillance for healthcare workers is crucial to protect healthcare workers from psychological issues and to improve the healthcare service provided to patients. Stigma among healthcare workers can be a major factor that may increase depression, anxiety, and stress.

The development and validation of a novel COVID19 stigma scale among healthcare workers (COVISS-HCWs).

BACKGROUND AND AIM: Fear of coronavirus disease 2019 (COVID-19) and its complications may result in stigmatization of individuals who may carry the virus. This is of special concern to healthcare workers who tolerate additional physical and emotional stress at times of pandemic. The aims of this study are to (1) develop and validate the COVID-19 Stigma Scale (COVISS-HCWs) survey; and (2) investigate the experience of stigma among healthcare workers possibly dealing with COVID-19 patients in five major public hospitals in Damascus, Syria. METHODS: We divided the sample into two parts and then underwent EFA on the first 350 participants, dividing the 14 questions into two dimensions. Furthermore, CFA was conducted on the other 350 participants to confirm how correctly a hypothesized model matched the factor structure by EFA, as described above. Moreover, the coefficient of determination (R2) and item-scale correlations (standardized factor loading) were estimated to establish the acceptability of the final structure of the COVISS-HCWs. Through a cross-sectional study, a convenience sample of 700 healthcare workers participated in a self-administered questionnaire containing a section for demographic variables and another for newly designed COVISS-HCWs. The scale comprises 14 adapted and novel items that measure two subscales: feelings of perceived harm and inferiority, and avoidance. Descriptive statistics, reliability, and validity were evaluated. RESULTS: The 14 COVISS-HCWs items were reduced to 11 items with a high Cronbach's α of 0.909. A significant correlation was observed between the responses to each COVISS-HCWs item and the corresponding subscale, and between each subscale and the overall scale. Feeling stigmatized was reported by 9.86% of the participants. Younger age, low socioeconomic status, and higher intensity of contact with COVID-19 patients significantly correlated with higher stigmatization. CONCLUSIONS: The novel COVISS-HCWs is a reliable and valid tool to evaluate stigma among healthcare workers during the COVID-19 pandemic. The Stigma prevalence among healthcare workers was 9.86%. Therefore, this must be addressed to prevent possible psychosocial and public health repercussions.

Pathophysiology of stress cardiomyopathy: A comprehensive literature review.

Introduction: Takotsubo cardiomyopathy is a transient type of acute heart failure with distinct wall motion abnormalities and unclear pathophysiology. This review focuses on the proposed pathophysiological mechanisms that could be involved in the occurrence takotsubo cardiomyopathy. Main body: Acute stress and subsequent excessive activation of the sympathetic nervous system are major factors in the pathophysiology of takotsubo cardiomyopathy. The high levels of catecholamine work in a triggering manner, generate reactive oxygen species, release inflammatory cytokines, and induce endothelial injury. The incidence of Takotsubo cardiomyopathy has increased following COVID-19 infection and vaccination, which suggests that neurohormonal and psychological factors (i.e., fear and anxiety of infection or vaccination) may have an additional role in the pathophysiology. In addition, inflammatory state, cytokine storm, augmented sympathetic activity, and endothelial dysfunction during the acute phase of COVID-19 infection may participate in Takotsubo cardiomyopathy. Chronic stress is also linked to this complex mechanism by accelerating cripple of endocrinal hypothalamic-pituitary-adrenal axis activity, which influences the cortisol effect on releasing catecholamine, which is directly related to the pathogenesis of takotsubo cardiomyopathy. Conclusion: The excessive activation of the sympathetic nervous system and subsequent high levels of catecholamines could initiate the process. The catecholamines, in turn, generate reactive oxygen species and release inflammatory cytokines (i.e., IL-1, IL-2, IL-6, IL-7, IL-8, CXCL1, TNF-α, and IFN-γ), which causes endothelial injury.

Clinical Characteristics and Prognosis of COVID-19 patients in Syria: A cross-sectional multicenter study.

Background: COVID-19 ignited a global pandemic that, in Syria, further strained a nation and its healthcare system already ravaged by years of war and sanctions. The first case in Syria was reported on March 22, 2020, and this is the first study that aimed to describe the clinical characteristics, comorbidities, and prognosis of COVID-19 patients in Syria. Materials and methods: Demographic and clinical data for this cross-sectional prospective study were collected on COVID-19 patients with positive polymerase chain reaction tests who were admitted to Al Assad and Al Mouwasat university hospitals between April 1 and January 31 of 2021. Results: This study included 701 patients. The majority were over age 60 (59%) and male (67.9%). The commonest symptoms were fever (86.6%) and shortness of breath (75.6%). The commonest comorbidities were hypertension (53.9%) and diabetes mellitus (41.5%). On multivariable analysis, risk factors found to be significantly associated with poor outcomes were advanced age (≥60 years); male gender; high respiratory rate (>35); respiratory failure (PaO2/FiO2 ratio<100); heart failure; chronic lung disease; elevated white blood cell counts, lactate dehydrogenase, c-reactive protein; prolonged international normalized ratio; and low lymphocyte counts. The clinical outcomes of our patients were as follows: 59.2% improved and were discharged from the hospital, 3.5% were discharged with persistent symptoms and 37.2% died. Conclusion: Several biomarkers can serve as early warning and prognostic indicators of severe illness and mortality from COVID-19 in the highest risk patients, especially males with multiple comorbidities over 60 years of age. In the context of a national healthcare system stretched thin by years of civil war and sanctions, and high COVID-19 mortality rates as a consequence, extra care should be taken to use the predictive power of these biomarkers to stratify high-risk patients in the earliest possible stages of the disease to minimize severe illness and reduce fatalities.