ABSTRACT
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for public health and has caused the loss of millions of lives worldwide. Hospital workers play a key role in averting the collapse of the health system, but the mental health of many has deteriorated during the pandemic. Few studies have been devoted to identifying the needs of workers on frontline duty. AIM: To investigate dimensions of common emotional symptoms and associated predictors among Brazilian workers in a COVID-19 reference hospital. METHODS: This is an observational study of the mental health of professionals in a COVID-19 hospital in the city of São Paulo. We invited all hospital employees to respond to an online survey between July and August 2020, during the first peak of the pandemic. Data of 1000 participants who completed the survey were analyzed (83.9% were women and 34.3% were aged 30 to 40). Hospital workers self-reported the presence of symptoms of depression, anxiety, trauma-related stress, and burnout through the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Impact of Event Scale-Revised and the Mini-Z Burnout Assessment respectively. Responses were assembled and subjected to exploratory factor analysis to reveal workers' core emotional distress. Multiple linear regression models were subsequently carried out to estimate the likelihood of dimensions of distress using questions on personal motivation, threatening events, and institutional support. RESULTS: Around one in three participants in our sample scored above the threshold of depression, anxiety, post-traumatic stress disorder, and burnout. The factor analysis revealed a three-factor structure that explained 58% of the total data variance. Core distressing emotional domains were avoidance and re-experience, depression-anxiety, and sleep changes. Regression analysis revealed that institutional support was a significant protective factor for each of these dimensions (ß range = -0.41 to -0.20, P < 0.001). However, participants' personal motivation to work in healthcare service was not associated with these emotional domains. Moreover, the likelihood of presenting the avoidance and re-experience dimension was associated with having a family member or close friend be hospitalized or die due to COVID-19 and having faced an ethical conflict. CONCLUSION: Distressing emotional domains among hospital workers were avoidance and re-experience, depression and anxiety, and sleep changes. Improving working conditions through institutional support could protect hospital workers' mental health during devastating public health crises.
ABSTRACT
Este artigo apresenta a análise sobre o relacionamento da cobertura da Estratégia Saúde da Família (ESF) e a disponibilidade de respiradores com a taxa de transmissäo e mortalidade da COVID-19 no estado de Santa Catarina entre o início da pandemia e o final do mēs de maio de 2020. Trata-se de um estudo ecológico, que utiliza modelos computacionais de análise geoespacial sobre o avanço da COVID-19 no estado para 295 municípios. Foi calculada a correlaçâo entre a cobertura da ESF e a quantidade de respiradores agrupados das mesorregiÐes com as variáveis de transmissäo e mortalidade da COVID-19. Como resultados das análises, detectou-se que o estado apresentou baixas taxas de infecçâo de 0,07% e mortalidade de 1,42%, quando comparado aos outros estados do Brasil. Houve aumento de casos em municípios menores, indicando a interiorizaçâo da pandemia. Näo houve correlaçâo entre a Cobertura pela ESF com infecçâo e mortalidade. Porém os respiradores estäo associados a uma menor mortalidade. Como conclusÐes, pode-se afirmar que foi encontrada uma disparidade regional na presença de respiradores nas microrregiÐes do estado, sugerindo um desequilíbrio na qualidade do atendimento a pacientes críticos durante a pandemia.Alternate abstract:This paper presents the analysis of the relationship between the coverage of the Family Health Strategy (FHS) and the availability of respirators with the transmission and mortality rate of COVID-19 in the state of Santa Catarina between December 2019 and May 2020. This is an ecological study, which uses computational models of geospatial analysis on the progress of COVID-19 in the state for 295 cities the correlation between the FHS coverage and the number of respirators grouped in the mesoregions was calculated with the transmission and mortality variables of COVID-19. As a result of the analysis, it was found that the state had low infection rates of 0.07% and mortality of 1.72%, when compared to other states in Brazil. There was an increase in cases in smaller cities indicating the interiorization of the pandemic. There was no correlation between FHS coverage with infection and mortality. However, respirators are associated with lower mortality. As conclusions, it can be said that a regional disparity was found in the presence of respirators in the state's micro-regions, suggesting an imbalance in the quality of care for critically ill patients during the pandemic.