Differences in psychosocial distress among rural and metropolitan health care workers during the COVID-19 pandemic.

OBJECTIVE: The Australian COVID-19 Frontline Healthcare Workers study examined the prevalence and severity of mental health symptoms during the second wave of the COVID-19 pandemic. This substudy examined the differences in psychological well-being between rural and metropolitan health care workers (HCWs). DESIGN: A nationwide survey conducted between August and October 2020. SETTING AND PARTICIPANTS: Australian HCWs were recruited through multiple strategies. MAIN OUTCOME MEASURES: Demographics, mental health outcomes (anxiety, depression, post-traumatic stress disorder [PTSD] and burnout). RESULTS: Complete responses were included from 7846 participants, with 1473 (18.8%) in regional or remote ('rural') areas and 81.2% in metropolitan areas. Rural participants were older, more likely to work in allied health, nursing or in health administration, and had worked longer in their profession than metropolitan participants. Levels of resilience were similar (p = 0.132), but there was significantly higher prevalence of pre-COVID-19 pandemic mental illness in the rural workforce (p < 0.001). There were high levels of current mental health issues: moderate-severe PTSD (rural 38.0%; metropolitan 41.0% p = 0.031); high depersonalisation (rural 18.1%; metropolitan 20.7% p = 0.047); and high emotional exhaustion (rural 46.5%; metropolitan 43.3% p = 0.002). Among rural participants, mental health symptoms were associated with younger age, worry about being blamed if they contracted COVID-19, fear of transmitting COVID-19 to their family, experiencing worsening relationships and working in primary care or allied health. CONCLUSION: Despite having low COVID-19 case numbers in rural Australian health services compared with metropolitan counterparts over the course of 2020, there were widespread mental health impacts on the workforce. Rural health services need specific and flexible training, education, work policies and practices that support psychological well-being now in preparedness for ongoing or future crises.

Pattern and Causes of Oral and Maxillofacial Injuries Presented to a Tertiary Care Public Dental Hospital in Strictly Imposed COVID-19 Lockdown Scenario

The unprecedented COVID-19 pandemic has indelibly impacted routine healthcare provision across the globe. Nevertheless, management of traumatic injuries has remained a priority patient care service of oral and maxillofacial (OMF) practice. This study aimed to explore the pattern and mechanisms of OMF injuries presenting at a major public dental hospital during a COVID-19 lockdown period in Sri Lanka. An enhanced OMF injury surveillance system was established at the National Dental Hospital (Teaching) Sri Lanka (NDHTSL) on 1 March 2020. OMF injury surveillance data from 1 March 2020 to 31 May 2020 were collated from the “enhanced injury surveillance form”. This period overlapped with the strictly imposed island-wide COVID-19 community lockdown. Pre-COVID-19 period (November 2017 to January 2020) OMF injury data were compared with this period. OMF injuries were categorized as hard tissue, extra-oral or intra-oral soft tissue, upper and middle face fractures and mandibular fractures. Data were analyzed with descriptive statistics, Fisher’s exact and Chi-square tests of significance. A total of 361 OMF injuries were identified among 208 patients who were predominantly males (71.6%);mean age was 24.95 ±2.76 years. Injuries to gingivae and oral mucosa (26.9%) were the leading type, followed by extra-oral soft tissues (22.1%), periodontal injuries (20.7%) and hard tissue injuries (20.2%). Upper face and mandibular fractures accounted for 2.9% and 1.9%, respectively. Most patients sustained their injuries due to falls at their homes and surrounds. This was significantly increased compared to the pre-COVID-19 period (p = 0.0001). The significant increase in OMF injuries associated with falls around the home during the COVID-19 lockdown scenario in Sri Lanka compared to the pre-COVID-19 period may need further investigation in order to understand the how these injuries may be prevented.