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BACKGROUND: There may be differential impact of the COVID-19 pandemic on mental health and burnout rates of healthcare professionals (HCPs) performing different roles. AIMS: To examine mental health and burnout rates, and possible drivers for any disparities between professional roles. METHODS: In this cohort study, online surveys were distributed to HCPs in July-September 2020 (baseline) and re-sent 4 months later (follow-up; December 2020) assessing for probable major depressive disorder (MDD), generalized anxiety disorder (GAD), insomnia, mental well-being and burnout (emotional exhaustion and depersonalization). Separate logistic regression models (at both phases) compared the risk of outcomes between roles: healthcare assistants (HCAs), nurses and midwives (nurses), allied health professionals (AHPs) and doctors (reference group). Separate linear regression models were also developed relating the change in scores to professional role. RESULTS: At baseline (n = 1537), nurses had a 1.9-fold and 2.5-fold increased risk of MDD and insomnia, respectively. AHPs had a 1.7-fold and 1.4-fold increased risk of MDD and emotional exhaustion, respectively. At follow-up (n = 736), the disproportionate risk between doctors and others worsened: nurses and HCAs were at 3.7-fold and 3.6-fold increased risk of insomnia, respectively. Nurses also had a significantly increased risk of MDD, GAD, poor mental well-being and burnout. Nurses also had significantly worsened anxiety, mental well-being and burnout scores over time, relative to doctors. CONCLUSIONS: Nurses and AHPs had excess risk of adverse mental health and burnout during the pandemic, and this difference worsened over time (in nurses especially). Our findings support adoption of targeted strategies accounting for different HCP roles.
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Introduction: As COVID-19 spread across Southeast Asia (SEA) in 2020-2021, healthcare systems in Cambodia, Laos and Myanmar braced as public health officials closed many outpatient diabetes clinics and healthcare professionals (HCPS) were redeployed to COVID-treatment zones. Action 4 Diabetes (A4D) is a UK non-profit organisation that has been providing free insulin and medical supplies to LMICs in SEA since 2016. With historically limited healthcare coverage in Cambodia, Laos and Myanmar, patients enrolled on A4D's programme travel hundreds of miles to diabetes clinics to collect free insulin, blood glucose strips and other medication. Due to COVID-19 lockdowns, insulin often arrived with short expiry dates due to delays in shipments caused by bottlenecks at international logistic hubs, and patients were known to ration insulin due to lack of supply. For disadvantaged people with Type 1 diabetes (T1D) in SEA low-middle-income countries (LMICs), this posed a serious threat due to inaccessible insulin and medical supplies. Method(s): A4D developed a strategic plan to maintain insulin and medical supplies to LMICs in collaboration with local HCPs on the ground to ensure that the T1D community regained access to insulin and essential medical supplies, as well as supporting the development of remote-consultation with patients. Result(s): Access to medical supplies A4D initiated networks of couriers to rural parts of Myanmar, Laos and Cambodia to deliver medical supplies. In Cambodia, TukTuk drivers who ferried tourists around Angkor Wat were used to deliver insulin to the T1D in farming communities. In Myanmar, truck drivers that transported vegetable crops were used to transport medical supplies to remote areas. During COVID-19, A4D used local suppliers for insulin and had to purchase insulin and blood testing strips at a premium rate. Access to education and consultation Prior to COVID-19, clinic visits were a primary source of advice and management for the patient and family. With clinic closures, A4D initiated remote access consultation working with local HCPs to support disadvantaged families. By end 2021, 3 deaths were reported of patients on the A4D programme as result of the pandemic, and incidence of diabetic ketoacidosis rose sharply among the 350 people with T1D on A4D's programme. Conclusion(s): For many disadvantaged people with T1D in SEA, the COVID-19 pandemic reinforced the fragile nature of their T1D management. Through collaborating closely with HCP and partners on the ground, A4D has developed a more dynamic and resilient logistical system to maintain key life-saving medical supplies.
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Introduction: As COVID-19 spread across Southeast Asia (SEA) in 2020-2021, healthcare systems in Cambodia, Laos and Myanmar braced as public health officials closed outpatient diabetes clinics and healthcare professionals (HCPS) were redeployed to COVIDtreatment zones. Action4Diabetes (A4D) is a non-profit organization providing free insulin and medical supplies to SEA since 2016. With limited healthcare coverage in Cambodia, Laos, and Myanmar, patients enrolled on A4D's program travel hundreds of miles to diabetes clinics to collect free insulin, blood glucose strips and other medication. Due to COVID-19 lockdowns, insulin often arrived with short expiry dates due to delays in shipments caused by bottlenecks at international logistic hubs, and patients were known to ration insulin due to lack of supply. For disadvantaged people with Type 1 diabetes (T1D) in SEA low-middle-income countries (LMICs), this posed a serious threat due to inaccessible insulin and medical supplies. Objective(s): A4D developed a strategic plan to maintain accessible medical supplies and supported the development of remote econsultations. Method(s): Access to medical supplies and e-consultations. A4D initiated e-consultations and networks of couriers to rural parts of Myanmar, Laos, and Cambodia to deliver medical supplies. In Cambodia, TukTuk drivers who ferried tourists around Angkor Wat were used to deliver insulin to the T1D in farming communities. In Myanmar and Laos, agriculture truck drivers that transported vegetable crops were used to transport medical supplies to remote areas. During COVID-19, A4D used local suppliers for insulin and had to purchase insulin and blood testing strips at a premium rate. Result(s): Conclusion(s): For many disadvantaged people with T1D in SEA, the COVID-19 pandemic reinforced the fragile nature of their T1D management. Through collaborating closely with HCPs on the ground, A4D has developed a more dynamic and resilient logistical system to maintain key life-saving medical supplies.
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Introduction SARS-CoV-2 vaccine has been the main pillar in battling the coronavirus disease 2019 (COVID-19) pandemic. However, the current vast scale of SARS-CoV-2 vaccination programme has led to inevitable reports of various adverse reactions, one of which include thyroid dysfunction. CASES We describe two patients who manifested hyperthyroidism following BNT162b2 mRNA-based COVID-19 vaccine boosters. Patient 1, a previously euthyroid 46-year-old female, has an eight-year history of type 1 diabetes mellitus. She developed palpitations of increasing severity about two weeks after her COVID-19 booster vaccine on 20th January 2022. She had weight loss of 4 kg and experienced menstrual irregularities in the subsequent three months. Examination revealed tachycardia (112 beats per minute, regular) and bilateral fine tremors of the hands. There was no goitre or neck tenderness. Blood investigations showed overt hyperthyroidism with positive thyroid autoantibodies, consistent with Graves' disease. Treatment with carbimazole led to marked symptomatic improvement. Patient 2, a 38-year-old female with a six-year history of Hashimoto thyroiditis, was clinically and biochemically euthyroid while taking levothyroxine 100 mcg daily prior to her COVID-19 booster vaccine on 5th January 2022. Five weeks following the vaccine, her thyroid function test during her endocrine clinic appointment showed overt hyperthyroidism, which was confirmed by a second blood sample ten days later. There was neither a change in levothyroxine dose nor any additional supplement intake. She was otherwise asymptomatic. Levothyroxine was then withheld. She regained her baseline hypothyroid state two weeks later, during which levothyroxine was resumed. Conclusion SARS-CoV-2 vaccine-induced thyroid dysfunction can affect both euthyroid and hypothyroid patients. A history of recent COVID-19 vaccination should be included in the clinical evaluation of a newly diagnosed hyperthyroid patient or unexplained hyperthyroidism in a long-standing hypothyroid patient.
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During COVID-19 pandemic, people experienced lockdown and associated distress. As face-to-face intervention was unfeasible, an 8-week Strength-based Online Community Intervention (SOCI) was developed and evaluated with a quasi-experimental design in Hubei Province, China from February to April 2020. Participants (N = 150) self-elected to join either the SOCI group or a casual discussion control group. Pre-/post-measures on post-traumatic stress, positive and negative affect, resilience, and spirituality were taken. Multivariate ANOVA revealed a significant combined effect with a medium effect size (partial eta squared = 0.11). Specifically, significant group × time interaction effects were revealed for resilience, spirituality, and positive affect. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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Introduction: The current COVID19 pandemic has resulted in significant disruption to hospital-based teaching as social distancing measures have placed us in a challenging position where education can no longer occur conventionally. Innovative pedagogical methods such as webinars, virtual simulations, webcasting and online chatrooms are growing rapidly within medical education. Methods: PADLET is an online virtual learning platform that allows students and teachers to collaborate, reflect, share links, videos and presentations within a secure location. MS Teams is a chat-based collaboration platform that allows document sharing and online meetings. The aim of this study was to assess the feedback on feasibility and impact of effectiveness via a survey with all participants involved in using PADLET and MS Teams. Results: A total of 52 PADLET and MS Team sessions were held between 1st March 2020 to 20th June 2020. Responses were received from 30 members of the pediatric clinical team. 11 Consultants;6 GP trainees;5 pediatric trainees;4 APNPs, 1 foundation trainee;1 clinical fellow;1 physician associate and 1 ED trainee. 96% surveyed found both the PADLET and MS Teams easy to use. The main benefit of the sessions were ability to access education remotely either whilst shielding, at home or when in hospital due to rota patterns. Technical difficulties e.g. poor audio and lack of social interactions were the most commonly stated disadvantages. 86% of those surveyed accessed PADLET and MS Teams for education and learning with 47% accessing for CPD education points. 30% also accessed the material for guidance on a specific topic. Conclusions: PADLET and MS Teams are shown to be effective in mitigating the disruption of pediatric education due to COVID19 pandemic. Online and virtual learning technologies may provide a solution to current challenges faced in the era of COVID19 and should be considered as an educational strategy transferable to all medical disciplines.
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The global epidemiological and clinical patterns of COVID-19 among children with diabetes are still very limited. In this report Associate Professor May Ng investigates the current outcome data for young people with diabetes and COVID-19 and discusses the need for continued vigilance to ensure emergency paediatric conditions are dealt with urgently, as well as the essential health messages for young people with diabetes.