Long term sleep disturbances in Tunisian COVID-19 patients discharged from hospital: a cohort study

Background: A spectrum of long-term COVID19 effects have been reported. Much less data areavailable about how COVID19 will affect sleep over time in recovered patients. We Assessed the long-term impact of COVID 19 infection on sleep. Methodology:A prospective cohort study including 84 Tunisian COVID19 patients discharged fromhospital. Patients were asked about the period before SARS COV2 related hospital stay, and the 6-9 month-period after hospital discharge, using several self- reported evaluation scales (Pittsburgh Sleep Quality Inde, the Insomnia Severity Index, Epworth Sleepiness Scale, Patient Health Questionnaire (PHQ)-9 and the EuroQol five-dimension five-level questionnaire). Result(s): The mean age was 57,59 years with 46 men and 38 women. As compared with baseline statue of patients, all assessed outcomes were significantly impaired (VAS pain: 1,71+/-1,1 Vs 3,8+/-2,84;PSQI: 3,25+/-2,4 VS 6,39+/-4,73;ESS: 1,94+/-2,44 VS 3,59+/-4,53;ISI: 1,95+/-2,76 VS 6,07+/-5,96, and PHQ-9: 1,45+/-2,74 VS 7,47 +/- 6,61;p=0.0001). The percentage of poor sleepers (PSQI global score higher than 5) and patients with insomnia had significantly increased from 15,5% to 48,8% and from 1,2 to 11%, respectively (p=0.0001). The percentage of patients experiencingdepression symptoms has also doubled (25% to 58,3%), while severe pain was reported by more than one out of five patients against only 1,2% at baseline. The post-COVID -19 PSQI was significantly correlated with body mass index (r=0,328, p=0,003);the post-COVID-19 VAS pain (r=0,479, p=0,0001) as well as the post-COVID-19 PHQ-9 scale (r=0,712, p=0,0001). Conclusion(s): Sleep disturbances, depression symptoms as well as chronic pain are highly prevalent in long-term follow-up period in hospitalized COVID19 survivors therefore,they should be systematically screened.

Factors Associated With The Covid-19 Infection Severity In Patients With Mental Disorders

Introduction: Recent research showed that persons with mental disorders may represent a population at increased risk for coronavirus disease (COVID-19) infection with more adverse outcomes. Objective(s): We aimed to analyze clinical profile of psychiatric inpatients during their infection with COVID-19, and to explore factors associated with the disease progression. Method(s): Weanalyzed retrospectively the medical records of 32 psychiatric inpatients, hospitalized in psychiatry "B" department at Hedi Chaker hospital (Sfax, Tunisia), and who contracted the COVID-19 infection. We used "Charlson Comorbidity Index Score" (CCIS), predicting 10-year survival in patients with multiple comorbidities. Result(s): Somatic history was reported in 50% of patients. The CCIS ranged between 0 and 4. Psychiatric diagnosis was schizophrenia in 81.3% and bipolar disorder in 18.7% of cases. The clinical symptoms reported were fever (50%), dry cough (75%);dyspnea (34.4%). Biological assessment showed a lymphopenia in 40.6% and a high C-Reactive Protein (CRP) in 53.1%. Among our patients, 37,5% needed oxygen, and 25% were transferred to the intensive care unit. The COVID-19 complications were mostly bacterial pulmonary superinfections (21.9%) and pulmonary embolism (9.4%). Only three (9.4%) patients died from the virus. Patients with medical history were more likely to need oxygen (p<0.001). Clinical and paraclinical parameters associated with oxygen need were: fever (p<0.001);dyspnea (p<0.001);lymphopenia (p<0.001);high CRP (p=0.001). Patients presenting pulmonary superinfection or embolism were more likely to require oxygen (p=0.006 and p=0.044 respectively). Conclusion(s): This study highlighted factors that may worsen the COVID-19 infection evolution, and which require special attention, in order to improve the prognosis of this disease.

Bidirectional Associations Between Covid-19 Infection And Mental Disorders

Introduction: The COVID-19 pandemic brought unbearable psychological pressure to people worldwide, because of serious threats to one's physical health and life. From early stages of this pandemic, concerns have been raised about its effect on mental health. However, we still know little whether pre-existing psychiatric disorder (PD) affects the susceptibility and evolution of this infection. Objective(s): We aimed to assess the interactions between COVID- 19 infection and PD. Method(s): We conducted a litterature review through pubmed database, using the keywords :COVID 19, psychiatry, mental disorders, schizophrenia , anxiety , depression , insomnia. Result(s): On one hand, prior surveys suggested that the infection is associated with increased incidence of a first psychiatric symptom. Mental health disturbances mostly include anxiety, depression, sleep disturbances, cognitive impairment and posttraumatic stress disorder. On the other hand, recent studies showed that patients with pre-existing mental disorders were associated with high susceptibility to be infected, increased risk of intensive care unit admission and a high mortality. The susceptibility to contracting COVID-19 was associated with preexisting mood disorders, anxiety, and attention-deficit hyperactivity disorder. Infection severity was associated with preexisting or subsequent mood disorders and sleep disturbances;or a pre-extisting schizophrenia. Mortality is increased in patients diagnosed with schizophrenia. Conclusion(s): The complicated interactions between COVID-19 infection and PD have several implications. Enhanced psychiatric follow-up should be considered for survivors of COVID-19. Besides, early detection and intervention for PD are needed to control morbidity and mortality induced by the COVID-19 infection.

Qualite de vie professionnelle et resilience chez les professionnels de sante en Tunisie au cours de la pandemie a COVID-19

During the COVID-19 pandemic, repeated exposure of health care workers to unpre-dictable challenges in practice can affect their professional quality of life. The objectives of this study were to assess professional quality of life among healthcare workers during the COVID-19 pandemic and to investigate the relationships between professional quality of life and resi-lience. We conducted a cross-sectional, descriptive, and analytical study, carried out in October and November 2020, among 250 health professionals, practicing in Tunisia. Data were collec-ted through an online questionnaire distributed on social networks. We used the "Professional Quality of Life Scale-5" to assess professional quality of life and the "Brief Resilience Scale"to assess resilience. Compassion satisfaction was low to moderate in 77.6% of participants. Most participants (90.4%) had moderate burnout. Compassion fatigue was low to moderate in 98% of cases. Healthcare professionals with higher resilience scores had significantly higher compassion satisfaction scores, and significantly lower burnout and compassion fatigue scores. In addition, higher burnout scores were associated with significantly lower compassion satisfac-tion scores and significantly higher compassion fatigue scores. These associations were found after multivariate analysis using multiple linear regression. Our results highlight the altered professional quality of life among healthcare workers during the COVID-19 pandemic. Imme-diate interventions are essential to improve psychological resilience and build health systems capacity.

Perceived stigma among Tunisian healthcare workers during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: Stigma was a major issue during the COVID-19 pandemic. It posed a serious threat to the lives of healthcare workers (HCWs) who were expected to experience higher levels of stigma and increased psychological distress. This is the first survey to investigate forms and correlates of perceived stigma in Tunisian HCWs during the COVID-19 pandemic. METHODS: A cross-sectional web-based survey was conducted between October 8th and November 10th 2020, among 250 Tunisian HCWs. Data were collected using an online questionnaire using the Google Forms® platform. We used a self-reported instrument measuring COVID-19-related stigma, and the Multidimensional Scale of Perceived Social Support (MSPSS) to measure the perceived adequacy of social support from three sources: family, friends, and significant other. RESULTS: The mean stigma score was 18.6±8. Participants sometimes to often experienced stigma in their relationships with friends (22%), neighbors (27.2%), parents (22,4%), and in social activities (30.8%). This stigma was perceived mainly through avoidance (68.4%), and rarely through verbal (6%) or physical aggression (1.2%). The mean MSPSS total score was 5.26±1.24. In multivariate analysis, depression history (P<0.001), long working experience (P<0.001), having presented ageusia/anosmia (P=0.007) and lower total social support scale (P<0.001) were significantly associated with higher perceived stigma score. CONCLUSION: Our findings showed that HCWs perceived stigma in professional, societal and familial domains. Social support from family, friends and others seemed to protect against perceived stigma. Proper health education targeting the public appears to be an effective method to prevent social harassment of both HCWs and COVID-19 survivors.

Professional quality of life and resilience strategies among Tunisian healthcare workers during the COVID-19 pandemic

During the COVID-19 pandemic, repeated exposure of health care workers to unpredictable challenges in practice can affect their professional quality of life. The objectives of this study were to assess professional quality of life among healthcare workers during the COVID-19 pandemic and to investigate the relationships between professional quality of life and resilience. We conducted a cross-sectional, descriptive, and analytical study, carried out in October and November 2020, among 250 health professionals, practicing in Tunisia. Data were collected through an online questionnaire distributed on social networks. We used the “Professional Quality of Life Scale-5” to assess professional quality of life and the “Brief Resilience Scale” to assess resilience. Compassion satisfaction was low to moderate in 77.6% of participants. Most participants (90.4%) had moderate burnout. Compassion fatigue was low to moderate in 98% of cases. Healthcare professionals with higher resilience scores had significantly higher compassion satisfaction scores, and significantly lower burnout and compassion fatigue scores. In addition, higher burnout scores were associated with significantly lower compassion satisfaction scores and significantly higher compassion fatigue scores. These associations were found after multivariate analysis using multiple linear regression. Our results highlight the altered professional quality of life among healthcare workers during the COVID-19 pandemic. Immediate interventions are essential to improve psychological resilience and build health systems capacity. © 2022 Elsevier Masson SAS

Qualité de vie professionnelle et résilience chez les professionnels de santé en Tunisie au cours de la pandémie à COVID-19 Professional quality of life and resilience strategies among Tunisian healthcare workers during the covid-19 pandemic

Résumé La pandémie à COVID-19 a mis à rude épreuve les systèmes de santé partout dans le monde. L’exposition répétée des professionnels de la santé à des défis imprévisibles dans la pratique pourrait retentir sur leur qualité de vie professionnelle.Les objectifs de cette étude étaient d’évaluer la qualité de vie professionnelle chez les professionnels de santé au cours de la pandémie du COVID-19 et d’étudier la nature des liens entre les différentes composantes de la qualité de vie professionnelle et la résilience. Notre étude est de type transversal, descriptif et analytique. Elle a été réalisée aux mois d’octobre et novembre 2020, auprès de 250 professionnels de santé, exerçant en Tunisie. Les données ont été collectées au moyen d’un questionnaire en ligne diffusé sur les réseaux sociaux. Nous avons utilisé l’échelle « The Professional Quality of Life Scale–5 » pour évaluer la qualité de vie professionnelle et l’échelle « Brief Resilience Scale » pour évaluer la résilience. La satisfaction de compassion était faible à moyenne chez 77,6% des participants. La plupart des participants (90,4%) présentaient un burnout moyen. La fatigue de compassion était faible ou moyenne chez 98% des participants. Les professionnels de santé ayant des scores plus élevés de résilience avaient des scores de satisfaction de compassion significativement plus élevés, et des scores de burnout et d’usure de compassion significativement moins élevés. Ces mêmes associations ont été retrouvées après analyse multivariée par régression linéaire multiple.Nos résultats mettent en exergue l’altération de la qualité de vie professionnelle chez les professionnels de santé au cours de la pandémie du COVID-19. Des interventions immédiates sont essentielles pour améliorer la résilience psychologique et renforcer les capacités des systèmes de santé.

Pharmaceutical Supply Chain Risk Assessment in the Time of COVID 19/Case Study

As of March11, 2020 the world Health Organization (WHO) declared Corona virus disease 2019 (COVID-19) as a pandemic. The disastrous outbreak of Covid-19 is described as humanity’s worst crisis since World War II. Effectively, not only has it caused severe disruptions around the world at different levels–social, economic, political-but it has also acutely disrupted supply chains worldwide. Pharmaceutical supply chain is a significant component of the health system as to supplying medicines. Today, pharmaceutical companies face a tremendous array of risks. The purpose of this research is to assess different risks in Tunisian pharmaceutical supply chain during this challenging period due to COVID-19 pandemic by providing quantified empirical results. Based on the review of literature, some major risks affecting the pharmaceutical supply chain are identified as regulatory risk, inventory risk, counterfeit risk and financial risk. The fuzzy AHP method is used, in this work, in order to identify the most important risk. It has to be noted that the top risk identified in pharmaceutical supply chain is that related to the Supply and suppliers. © 2021, IFIP International Federation for Information Processing.

Evaluation of anxiety and coping strategies among tunisian health professionals in the pandemic of the covid 19

IntroductionThe rapid spread of coronavirus has forced the healthcare systems in Tunisia to reorganize its structures, thus mobilizing all caregivers. Their professional and emotional burden was put to the test.ObjectivesTo evaluate the level of anxiety and to study coping strategies among caregivers during this pandemic.MethodsA cross-sectional descriptive and analytical study among150 caregivers in two hospitals in Sfax in Tunisia;during April 2020. We used anonymous questionnaire, the Spielberger State Anxiety Scale(STAI) to assess tension felt at anxiety-producing situations;and the Coping Inventory Scale for Stressful Situations (CISS): to assess coping strategies.ResultsThe average age was 30.33± 6,93 years and the sex-ratio M/W = 0,29. Caregivers followed the news of this pandemic with these means of communication: 96% Facebook, 80%TV. The increase of the time spent in front of media:84% Sleep disorders were present in 64.7%: insomnia (36%), chopped sleep(34%). Caregivers used sleeping pills in 12% of case. STAI: The mean ascore =48.85 and a high anxiety level was noted in72% of case. CISS: Task-oriented coping strategies : a mean score= 47.90 and Emotion-centered coping : a mean score = 40,49 High anxiety was correlated with: age>40 years old (p=0.042). The increase of the time spent in front of media, chopped sleep and use of sleeping pills are correlated respectively (p= 0,043, p=0,003, p=0,003) with an emotionally focused coping strategy.ConclusionsHealth professionals had a painful psychological experience with significant anxiety. Strengthening prevention strategies, management of health crises should be a priority of our health-system.

Is there a shift contagion among stock markets during the COVID-19 crisis? Further insights from TYDL causality test

Using the Toda-Yamamoto-Dolado-Lutkepohl measure of causality, namely the TYDL procedure, which is reliable whatever the variables' integration order, this study attempts to investigate the existence of shift contagion effect between a set of global, regional, country and US sectoral indices during the COVID-19 crisis. The empirical findings not only reveal that the Chinese stock index has no influence on the rest of the studied stock market indices during the COVID-19 crisis, but also that the European stock index seems to become the major node influencing the market sentiment and, therefore, the other indices during the crisis.