ABSTRACT
Introduction: Poor management in healthcare can have significant consequences in the workers' health, performance, and quality of care. Several risks worsened during the COVID-19 pandemic, namely among the workforce caring for patients with suspected/ confirmed COVID-19 infection. Objective(s): We aimed to assess psychosocial risks among a sample of 235 healthcare workers deployed in COVID-19-related services in Portugal's Lower Alentejo. Method(s): Participants filled out with ten sociodemographic questions and the Euro-Portuguese medium version of the COPSOQ II questionnaire. Data collection occurred February 2021. Tertiles were used to render a traffic light risk categorization. Results were processed with qualitative and quantitative descriptive statistical analysis. To compare groups relative to each outcome, t-tests were used for variables with two categories. Whenever data was not normally distributed, Mann-Whitney tests were used. For variables with more than two groups non-parametric Kruskal-Wallis was applied. Bonferroni correction was also applied, testing each individual hypothesis at the level of significance of alphai=0.05/29. A statistically significant difference between two groups did not necessarily yield a different risk colour. Result(s): Overall, cognitive demands, emotional demands and influence at work showed the highest risk, while 19 domains showed intermediate risk. The burnout domain showed to be highest among nurses and operational assistants working in the Intensive Care Unit. Several associations between COPSOQ domains and sociodemographic variables are also discussed. Conclusion(s): Assessment of psychosocial stressors in healthcare units is needed to promote risk reduction policies and workplace reforms. Accessible occupational services, therapeutic and rehabilitative strategies should play a role in improving health hazards in unhealthy workplaces.
ABSTRACT
A Síndrome de Steven-Johnson é uma reação adversa a drogas rara e grave, sendo ainda mais rara quando acontece após uma exposição à vacina. Relatamos neste texto um caso de reação alérgica classificada como Síndrome de Steven- Johnson após exposição a primeira dose da vacina contra COVID-19 fabricada pela AstraZeneca/Fiocruz. Paciente Feminina de 40 anos, sem comorbidades prévias, apresentou nos primeiros três dias da primeira dose da vacina quadro clínico progressivo, inicialmente com edema em região auricular à esquerda, e máculas em membros superiores, prosseguindo com disseminação ao restante do corpo, evoluindo com eritema polimorfo, lesões bolhosas em regiões de membros superiores, edema na palma das mãos, plantas dos pés, e acometimento de mucosa oral com lesões aftoides, sangramentos espontâneos, e exsudação. Em relação à etiologia medicamentosa, quando questionada, a paciente referiu uso crônico apenas de venlanfaxina e informou que fez uso de dexametasona 4mg/dia, durante 2 meses, para quadro articular de arbovirose, suspendendo sem desmame, no final de junho/2021. Visando descartar atividade e influência de infecções virais, foram coletados exames sorológicos, com resultados negativos. Inicialmente, foi levantada hipótese diagnóstica de eritema polimorfo Major, mas histopatológico foi sugestivo de Síndrome de Stevens-Johnson (SSJ), caracterizada por reação de hipersensibilidade tardia com depósito do complemento e imunoglobulina (IgG) na junção dermo-epidérmica e em torno dos pequenos vasos da derme, progredindo para necrose da epiderme. Apesar de a patologia apresentar regressão espontânea, o tratamento no início do quadro, com suporte clínico adequado é essencial para o melhor prognóstico do paciente.
ABSTRACT
Background: Poor management in healthcare institutions can have significant consequences for the workplace and for the physical and mental health of its workers. The exposure to unsustainable pressure and demand can impair the worker's performance and the quality of care provided. Four common issues are sleeping troubles, stress, burnout, and depressive symptoms. Several of these risks were exacerbated during the COVID-19 pandemic, especially among healthcare workers working with patients either suspected of, or confirmed, COVID-19 infection. Methods: Using the Copenhagen Psychosocial Questionnaire (COPSOQ) II questionnaire, we aimed to assess the psychosocial risks among a sample of 235 healthcare workers deployed in COVID-19-related services in the Local Health Unit of Baixo Alentejo (Portugal). The participants filled out a questionnaire, which comprised ten sociodemographic questions and the Euro-Portuguese medium version of the COPSOQ II questionnaire. Data collection occurred February 15th-28th 2021. As recommended by the COPSOQ authors, tertiles cut-off points of 33.3 and 66.6 (percentage scale) were used, rendering a traffic light risk classification where green represents a favourable situation, red a health risk and yellow an intermediate risk. [1] The results were processed with qualitative and quantitative descriptive statistical analysis. To compare groups relative to each outcome, t-tests were used for variables with two categories. Whenever data was not normally distributed, Mann-Whitney tests were used. For variables with more than two groups non-parametric Kruskal-Wallis was applied. Bonferroni correction was also applied, testing each individual hypothesis at the level of significance of αi=0.05/29. Note that a statistically significant difference between two groups does not necessarily yield a different risk colour. The mean (and categorial) values of the COPSOQ's sleep, stress, burnout and depressive symptoms domains were also compared to a dataset from a previous assessment (same institution) performed in 2017 [2]. Results: Except for depressive symptoms in the paediatric and general emergency services, domains such as stress, burnout, sleep issues and depressive symptoms showed an intermediate health risk. The burnout domain showed the highest level of risk among nurses and operational assistants working in the Intensive Care Unit. Several associations, with sociodemographic variables, are also discussed, such as a statistically significant association between the burnout domain and the number of hours spent in COVID-19 services, as well as (in medical doctors) time of service with COVID-19 patients, or between stress and age group. Overall, comparing with a similar evaluation made in 2017 [1], depressive symptoms worsened in nurses, slightly ameliorated in medical doctors, while the rest of the four domains remained in the yellow risk category, even though most of them exhibited a numerical aggravation, though not sufficient to change risk category. Conclusions: Working in COVID-19 services can worsen sleep troubles, stress, burnout and depressive symptoms among health care workers. These results support the assessment of psychosocial stressors in healthcare units, to promote risk reduction policies in healthcare workers through workplace reforms. Accessible occupational services, therapeutic and rehabilitative strategies are also crucial. Neuropharmaceuticals may play a role in improving some health hazards in unhealthy workplaces. No conflict of interest