Implications of COVID-19 for the busy gastroenterologist.

Coronavirus disease 2019 (COVID-19) is an infection caused by a novel coronavirus (SARS-CoV-2) originated in China in December 2020 and declared pandemic by WHO. This coronavirus mainly spreads through the respiratory tract and enters cells through angiotensin-converting enzyme 2 (ACE2). The clinical symptoms of COVID-19 patients include fever, cough, and fatigue. Gastrointestinal symptoms (diarrhea, anorexia, and vomiting) may be present in 50% of patients and may be associated with worst prognosis. Other risk factors are older age, male gender, and underlying chronic diseases. Mitigation measures are essential to reduce the number of people infected. Hospitals are a place of increased SARS-CoV-2 exposure. This has implications in the organization of healthcare services and specifically endoscopy departments. Patients and healthcare workers safety must be optimized in this new reality. Comprehension of COVID-19 gastrointestinal manifestations and implications of SARS-CoV-2 in the management of patients with gastrointestinal diseases, under or not immunosuppressant therapies, is essential. In this review, we summarized the latest research progress and major societies recommendations regarding the implications of COVID-19 in gastroenterology, namely the adaptations that gastroenterology/endoscopy departments and professionals must do in order to optimize the provided assistance, as well as the implications that this infection will have, in particularly vulnerable patients such as those with chronic liver disease and inflammatory bowel disease under or not immunosuppressant therapies.

Occupational health: the role of demographic factors in the condition of increased risk.

OBJECTIVES: The paper analyses the impact of socio-demographic characteristics of the employees in conditions of uncertainty in the organizations. MATERIAL AND METHODS: The study was conducted on a sample of 210 employees using the Mental Health Inventory - 38 (MHI-38), Satisfaction with life scale (SWLS), and the Center for Epidemiological Studies - Depression (CES-D). RESULTS: The results showed that female respondents had significantly higher scores on ANX (t = 2,278, p < 0.05), while male employees had higher scores on life satisfaction (t = 2.103, p < 0.05). Older employees have a higher tendency for loss of emotional-behavioral control (F = 4.427, p < 0.05). Respondents who have satisfying living standards have also higher scores on SWLS (t = 2.257, p < 0.05). Respondents who have dissatisfying living standard have higher scores on generally positive affect (t = 3.152, p < 0.01), life satisfaction (t = 3.571, p < 0.01), psychological distress (t = 2.929, p < 0.01) and loss of emotional- behavioral control (t = 2.361, p < 0.05). Employees with different levels of educational background have similar tendencies in life satisfaction, mental health, and depressive symptoms (p > 0.05). CONCLUSIONS: The study showed that the specific socio-demographic profile of the employees is related to higher levels of mental health issues. Specifically, the mental health of female and older employees have been especially affected and disturbed by uncertain conditions. The results can be potentially used both in the terms of designing activities that support the mental health of the population, as well as in relation to the mental health of employees. Int J Occup Med Environ Health. 2023;36(2):250-62.

Predictors of COVID-19 Vaccination Among EMS Personnel.

INTRODUCTION: Unvaccinated emergency medical services (EMS) personnel are at increased risk of contracting coronavirus disease 2019 (COVID-19) and potentially transmitting the virus to their families, coworkers, and patients. Effective vaccines for the severe acute respiratory syndrome coronavirus 2 virus exist; however, vaccination rates among EMS professionals remain largely unknown. Consequently, we sought to document vaccination rates of EMS professionals and identify predictors of vaccination uptake. METHODS: We conducted a cross-sectional survey of North Carolina EMS professionals after the COVID-19 vaccines were widely available. The survey assessed vaccination status as well as beliefs regarding COVID-19 illness and vaccine effectiveness. Prediction of vaccine uptake was modeled using logistic regression. RESULTS: A total of 860 EMS professionals completed the survey, of whom 74.7% reported receiving the COVID-19 vaccination. Most respondents believed that COVID-19 is a serious threat to the population, that they are personally at higher risk of infection, that vaccine side effects are outweighed by illness prevention, and the vaccine is safe and effective. Despite this, only 18.7% supported mandatory vaccination for EMS professionals. Statistically significant differences were observed between the vaccinated and unvaccinated groups regarding vaccine safety and effectiveness, recall of employer vaccine recommendation, perceived risk of infection, degree of threat to the population, and trust in government to take actions to limit the spread of disease. Unvaccinated respondents cited reasons such as belief in personal health and natural immunity as protectors against infection, concerns about vaccine safety and effectiveness, inadequate vaccine knowledge, and lack of an employer mandate for declining the vaccine. Predictors of vaccination included belief in vaccine safety (odds ratio [OR] 5.5, P=<0.001) and effectiveness (OR 4.6, P=<0.001); importance of vaccination to protect patients (OR 15.5, P=<0.001); perceived personal risk of infection (OR 1.8, P=0.04); previous receipt of influenza vaccine (OR 2.5, P=0.003); and sufficient knowledge to make an informed decision about vaccination (OR 2.4, P=0.024). CONCLUSION: In this survey of EMS professionals, over a quarter remained unvaccinated for COVID-19. Given the identified predictors of vaccine acceptance, EMS systems should focus on countering misinformation through employee educational campaigns as well as on developing policies regarding workforce immunization requirements.

An Agenda for Advancing Research and Prevention at the Nexus of Work Organization, Occupational Stress, and Mental Health and Well-Being.

Work characteristics and worker well-being are inextricably connected. In particular, the characteristics of work organization shape and perpetuate occupational stress, which contributes to worker mental health and well-being outcomes. Consequently, the importance of understanding and addressing connections between work organization, occupational stress, and mental health and well-being-the focus of this Special Issue-increasingly demand attention from those affected by these issues. Thus, focusing on these issues in the long-haul truck driver (LHTD) sector as an illustrative example, the purpose of this commentary is as follows: (1) to outline current research approaches and the extant knowledge base regarding the connections between work organization, occupational stress, and mental health; (2) to provide an overview of current intervention strategies and public policy solutions associated with the current knowledge base to protect and promote worker mental health and well-being; and (3) to propose a two-pronged agenda for advancing research and prevention for workers during the 21st century. It is anticipated that this commentary, and this Special Issue more broadly, will both echo numerous other calls for building knowledge and engaging in this area and motivate further research within complementary current and novel research frameworks.

Factors affecting the implementation of employee whole health in the veterans health administration: a qualitative evaluation.

BACKGROUND: There is increasing recognition of the need to focus on the health and well-being of healthcare employees given high rates of burnout and turnover. Employee wellness programs are effective at addressing these issues; however, participation in these programs is often a challenge and requires large scale organizational transformation. The Veterans Health Administration (VA) has begun to roll out their own employee wellness program-Employee Whole Health (EWH)-focused on the holistic needs of all employees. This evaluation's goal was to use the Lean Enterprise Transformation (LET) model for organizational transformation to identify key factors-facilitators and barriers-affecting the implementation of VA EWH. METHODS: This cross-sectional qualitative evaluation based on the action research model reflects on the organizational implementation of EWH. Semi-structured 60-minute phone interviews were conducted in February-April 2021 with 27 key informants (e.g., EWH coordinator, wellness/occupational health staff) knowledgeable about EWH implementation across 10 VA medical centers. Operational partner provided a list of potential participants, eligible because of their involvement in EWH implementation at their site. The interview guide was informed by the LET model. Interviews were recorded and professionally transcribed. Constant comparative review with a combination of a priori coding based on the model and emergent thematic analysis was used to identify themes from transcripts. Matrix analysis and rapid turnaround qualitative methods were used to identify cross-site factors to EWH implementation. RESULTS: Eight common factors in the conceptual model were found to facilitate and/or hinder EWH implementation efforts: [1] EWH initiatives, [2] multilevel leadership support, [3] alignment, [4] integration, [5] employee engagement, [6] communication, [7] staffing, and [8] culture. An emergent factor was [9] the impact of the COVID-19 pandemic on EWH implementation. CONCLUSIONS: As VA expands its EWH cultural transformation nationwide, evaluation findings can (a) enable existing programs to address known implementation barriers, and (b) inform new sites to capitalize on known facilitators, anticipate and address barriers, and leverage evaluation recommendations through concerted implementation at the organization, process, and employee levels to jump-start their EWH program implementation.

Overview of Activities in the Field of Occupational Health and Safety during the COVID-19 Period Taken by Polish SMEs.

The safety of work, employees, and clients of micro, small, and medium-sized enterprises (SMEs) is important because it is significantly related to the proper functioning and development of the entity and determines the decision-making process. The purpose of this publication is to show what actions aimed at increasing the sense of occupational safety and health during the COVID-19 pandemic were undertaken by Polish SMEs from the central Pomeranian region. The analysis of the literature most often presents the effects of the COVID-19 pandemic and the actions of governments in the field of protecting the public but does not present analyses of activities strictly taken by entrepreneurs. A survey was addressed to 300 business entities, of which 195 took part, determining the effectiveness rate at the level of 65%. Unfortunately, research shows that as many as 56% of the surveyed entities were negatively affected by the COVID-19 pandemic. Organizations used a number of safeguards aimed at increasing the sense of occupational health and safety, e.g., by using gels or liquids for disinfecting hands and surfaces during working hours (77%); regular cleaning and disinfection of equipment and workstations (84%); and maintaining social distance (76%). The analysis of the collected data covering the year 2021 indicates that this study should be treated as a survey study. This provides an opportunity to expand the area and scope of research. The presented research results indicate that, depending on the type of activity, as well as legal epidemic restrictions, SMEs increased the safety of employees and customers in different ways and with different tools during the development of the COVID-19 pandemic.

The 'Mine Medical': an opportunity for preventative and primary care.

INTRODUCTION: For many rural and remote regions of the world, the resources sector forms a necessary part of the local economy. Many workers and their families live in the local community and contribute to the social, educational and business fabric of that community. More still fly into rural areas where medical services exist and are required to support them. Australian coal mines require that all workers undertake a periodic medical examination to assess their fitness for their duties and to monitor for specific diseases inclusive of respiratory, hearing and musculoskeletal conditions. This presentation contends that the 'mine medical' is an untapped opportunity for the primary care clinician to gather data about the health of the mine employees and to understand, not only their health status, but also the incidence of preventable diseases. This understanding may assist a primary care clinician to design interventions for coal mine workers at a population and individual level that will improve the health of communities, while reducing the burden of avoidable disease. METHODS: In this cohort study, 100 coal mine workers, working in an open cut coal mine in Central Queensland, were examined to the Queensland coal mine workers medical standards, and their data recorded. The data were then deidentified, apart from the principal job role, and collated against measured parameters including biometrics, smoking, alcohol consumption (audit), K10, Epworth Sleepiness Score, spirometry and chest X-ray imaging. RESULTS: At the time of submission of the abstract, data acquisition and analysis is continuing. Preliminary data analysis reveals higher levels of obesity, poorly controlled blood pressure, elevated blood sugar levels and chronic obstructive pulmonary disease. The author will present their findings of the data analysis and discuss formative opportunities for intervention.

Health and Safety Reps in COVID-19-Representation Unleashed?

The paper explores the role of UK union health and safety representatives and changes to representative structures governing workplace and organisational Occupational Health and Safety (OHS) during COVID-19. It draws upon a survey of 648 UK Trade Union Congress (TUC) Health and Safety (H&S) representatives, as well as case studies of 12 organisations in eight key sectors. The survey indicates expanded union H&S representation, but only half of the respondents reported H&S committees in their organisations. Where formal representative mechanisms existed, they provided the basis for more informal day-to-day engagement between management and the union. However, the present study suggests that the legacy of deregulation and the absence of organisational infrastructures meant that the autonomous collective representation of workers' interests over OHS, independent of structures, was crucial to risk prevention. While joint regulation and engagement over OHS was possible in some workplaces, OHS in the pandemic has been contested. Contestation challenges pre-COVID-19 scholarship suggestingthat H&S representatives had been captured by management in the context of unitarist practice. The tension between union power and the wider legal infrastructure remains salient.

Long COVID-Challenges in diagnosis and managing return-to-work.

OBJECTIVES: Long COVID may be a public health concern resulting in a hidden toll of the pandemic years later, on workers and their work ability in the workforce. We illustrate the challenges in diagnosing long COVID in a patient, its associated psychological impact on work and how return-to-work can be better managed and supported from an occupational health perspective. METHODS: An Occupational Health trainee working as a government public health officer experienced persistent fatigue, decreased effort tolerance, and difficulties in concentration after contracting COVID-19. There were unintended psychological effects arising from the functional limitations that were not explained with a proper diagnosis. This was further complicated with a lack of access to occupational health services for return-to-work. RESULTS: He developed his own rehabilitation plan to improve his physical tolerance. Progressive efforts to build up his physical fitness complemented with workplace adjustments helped to overcome his functional limitations and allowed him to effectively return-to-work. CONCLUSION: Diagnosing long COVID continues to remain challenging due to a lack of consensus on a definitive diagnostic criterion. This may give rise to unintended mental and psychological impact. Workers with long COVID symptoms can return-to-work, involving a complex individualized approach to the symptoms' impact on work, and workplace adjustments and job modifications available. The psychological toll on the worker must also be addressed. Occupational health professionals are best placed to facilitate these workers in their journey to return-to-work, with multi-disciplinary delivery models providing return to work services.

Occupational health in the framework of the COVID-19 pandemic: a scoping review.

OBJECTIVE: To collect the available evidence related to occupational health in the face of the introduction of the new SARS-CoV-2 coronavirus pandemic. METHODS: Scoping review developed from the Arksey and O'Malley framework. The search was performed in the databases PubMed, Academic Search Complete, Science Direct, Medline, Scopus, Web of Science and Google Scholar. Documents on COVID-19 and its relationship with occupational health published in English, Portuguese and Spanish were included. The review, selection and characterization of the studies was carried out by five reviewers. RESULTS: The search and selection identified 43 documents published between December 2019 and April 2020. The topics covered include occupational exposure, protection measures, psychosocial affectations of workers, particularly health, as well as conditions of work organization that can influence contagion. CONCLUSIONS: Health workers are the most exposed workforce. Accompaniment, coaching and training in relation to patient care and the use of personal protection equipment are essential to reduce contagion among health personnel. In other work activities, social distancing is the standard measure for the mitigation of transmission, as well as the continuous disinfection of workplaces.

Hospital infection control and occupational medicine services in the face of the COVID-19 pandemic in occupational health / Serviços de controle de infecção hospitalar e de medicina do trabalho no enfrentamento à pandemia de COVID-19 na saúde ocupacional

In this article, the actions developed by the Hospital Infection Control Service (HICS) and Occupational Medicine (OM) to face the COVID-19 pandemic and track cases of infection among employees of a large hospital in Belo Horizonte, Minas Gerais, Brazil. Training actions, guidelines on how to collect a swab sample, Code 19 (COVID-19) simulation, dressing/undressing, hand hygiene, the definition of flows, and the quantification of cases infected by COVID-19 among employees in care areas were highlighted. The engagement of HICS and OM in the prevention and promotion of health were fundamental to facing the pandemic. It is estimated that SARS-CoV-2 infection rates among staff at the study hospital were similar to those at other hospitals. The experience report is important for expanding knowledge about action planning in the context of a large hospital (AU).

Neste artigo, são relatadas as ações desenvolvidas pelo Serviço de Controle de Infecção Hospitalar (SCIH) e Medicina do Trabalho (MT) para o enfrentamento da pandemia de COVID-19 e rastreamento dos casos de infecção entre funcionários de um hospital de grande porte de Belo Horizonte, Minas Gerais, Brasil. Destacaram-se as ações de treinamentos, orientações de como coletar amostra de swab, simulação Código 19 (COVID-19), paramentação/desparamentação, higiene das mãos, definição de fluxos e quantificação dos casos infectados por COVID-19 entre funcionários de áreas assistenciais. O engajamento do SCIH e da MT na prevenção e promoção da saúde foi fundamental no enfrentamento da pandemia. Estima-se que os índices de infecção pelo SARS-CoV-2 entre os funcionários do hospital em estudo foram similares aos de outros hospitais. O relato de experiência é importante para a ampliação do conhecimento sobre o planejamento de ações no contexto de um hospital de grande porte (AU).

Estimation of the number of working population at high-risk of COVID-19 infection in Korea.

OBJECTIVES: We aimed to identify occupational groups at high-risk of coronavirus disease 2019 (COVID-19) infection in Korea, to estimate the number of such workers, and to examine the prevalence of protective resources by employment status. METHODS: Based on the sixth Standard Occupational Classification codes, 2015 census data were linked with data from the fifth Korean Working Conditions Survey, which measured how frequently workers directly come into contact with people other than fellow employees in the workplace. RESULTS: A total of 30 occupational groups, including 7 occupations from the healthcare and welfare sectors and 23 from other sectors, were classified as high-risk occupational groups involving frequent contact with people other than fellow employees in the workplace (more than half of the working hours). Approximately 1.4 million (women, 79.1%) and 10.7 million workers (46.3%) are employed in high-risk occupations. Occupations with a larger proportion of women are more likely to be at a high-risk of infection and are paid less. For wage-earners in high-risk occupations, protective resources to deal with COVID-19 (e.g., trade unions and health and safety committees) are less prevalent among temporary or daily workers than among those with permanent employment. CONCLUSIONS: Given the large number of Koreans employed in high-risk occupations and inequalities within the working population, the workplace needs to be the key locus for governmental actions to control COVID-19, and special consideration for vulnerable workers is warranted.

COVID-19 pandemic from an ophthalmology point of view.

Coronavirus disease 2019 (COVID-19) is caused by a highly contagious RNA virus termed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Ophthalmologists are at high-risk due to their proximity and short working distance at the time of slit-lamp examination. Eye care professionals can be caught unaware because conjunctivitis may be one of the first signs of COVID-19 at presentation, even precluding the emergence of additional symptoms such as dry cough and anosmia. Breath and eye shields as well as N95 masks, should be worn while examining patients with fever, breathlessness, or any history of international travel or travel from any hotspot besides maintaining hand hygiene. All elective surgeries need to be deferred. Adults or children with sudden-onset painful or painless visual loss, or sudden-onset squint, or sudden-onset floaters or severe lid oedema need a referral for urgent care. Patients should be told to discontinue contact lens wear if they have any symptoms of COVID-19. Cornea retrieval should be avoided in confirmed cases and suspects, and long-term preservation medium for storage of corneas should be encouraged. Retinal screening is unnecessary for coronavirus patients taking chloroquine or hydroxychloroquine as the probability of toxic damage to the retina is less due to short-duration of drug therapy. Tele-ophthalmology and artificial intelligence should be preferred for increasing doctor-patient interaction.

Proceedings of a roundtable event 'Workplace Diet and Health - priorities for researchers and practitioners'.

Understanding how the work environment impacts health behaviours is essential to a life course approach in public health nutrition. A roundtable event 'Workplace Diet and Health - priorities for researchers and practitioners' was held by the Nutrition Society in October 2022. The overarching aims of the roundtable event were to consider (i) the relevance of nutritional wellbeing for employers and organisations, (ii) the research priorities for workplace diet and health and (iii) how researchers and practitioners can work with stakeholders in the development and testing of workplace diet and health interventions and nutritional education. Participants represented a range of stakeholders including dietetic and nutrition professionals working in workplace health, academics and science communication with an interest in workplace diet and health, non-governmental organisations and providers of workplace nutritional health and wellbeing programmes. All roundtable participants agreed that good nutrition and access to healthy food at work was part of corporate responsibility comparable to that of health and safety provision. It was recognised that nutritional wellbeing was not seen as a priority by many companies due to the complexity and wide range of employee health and wellbeing options available and the perceived lack of clear financial benefit. Three priority areas were identified and agreed upon by roundtable participants: (1) strengthening the evidence base to demonstrate the tangible benefit of nutritional wellbeing interventions in the workplace, (2) creating a knowledge exchange hub to share best practices and experiences of working across sectors and (3) expand stakeholder engagement in workplace nutritional wellbeing.

Implementation of occupational safety and health measures at German schools during the SARS-CoV-2 pandemic-cross-sectional results from 31,089 teachers.

Background: The SARS-CoV-2 pandemic exacerbated existing health-related challenges in schools and created new ones. Under pandemic conditions, health risks increased, and with them the requirements for occupational safety and health (OSH) measures. The aim of the study was (a) to examine the status quo of OSH measures in German schools, (b) to analyze whether the implementation of OSH measures was associated with preferable outcomes and (c) to identify predictors for the implementation of OSH measures. Methods: A nationwide cross-sectional online survey was conducted among teachers at all school types in Germany in March 2021. Data on the implementation of OSH measures (risk assessments, infection protection instructions and instructions on occupational safety), associated health-related parameters (e.g., somatic symptoms, PHQ-15) and predictor variables (e.g., gender, age or federal states) were assessed using descriptive statistics, analysis of variance and multiple linear regression analysis. Results: Less than 10% of surveyed teachers (N = 31,089) reported that their schools met legal requirements for occupational safety and health measures. Beneficial associations became apparent where more measures were implemented, e.g., significantly better somatic and mental health. Predictors for the implementation of OSH measures were found, especially on a systemic level (e.g., federal states schools were located in). Conclusions: Our study can serve as a basis for future studies. It provides a status quo regarding the implementation of, associations with and predictors for OSH measures in German schools. Our results are best understood as evidence-based arguments to encourage political decision makers to improve the implementation of OSH measures in German schools and thereby foster teachers' health.

Outcomes and process evaluation of a cluster-randomised participatory organisational intervention among German healthcare workers.

BACKGROUND: In the present investigation the results of the outcome and process evaluation of a participatory workplace intervention are reported. The intervention aimed to increase the workers' self-assessed physical and mental work ability. METHODS: The intervention was a two-arm, cluster-randomised trial with healthcare workers in 10 hospitals and one elderly care centre in Germany. Outcome data on workers were collected in questionnaires at baseline, and two follow-ups between 2019 and 2021. The intervention consisted of interviews and workshops, in which employees proposed measures for reducing the physical and psychosocial load and strengthening resources at work. Outcome data were analysed with linear-mixed regression models. The process evaluation was based on the thematic criteria proposed in previous literature and the collection of the type of intervention measures and their implementation status. RESULTS: The regression analysis did not provide evidence of treatment differences or reductions of psychosocial load in the intervention wards. The process evaluation suggested that the measures did not address specifically the self-assessed work ability. In addition, there was no indication that the intervention measures were causally related to the intended goals. CONCLUSIONS: The planning and implementation of organisational interventions require a careful consideration of the definition of intervention goals, the theoretical rationale of the intervention and a project-oriented action plan during the delivery phase.

"You Have to Keep in Mind That You're Dealing with People's Lives": How Hospital Service Workers Enact an Ethic of Care.

The COVID-19 pandemic heightened the need to examine the health and safety of all workers, especially frontline workers, like hospital service workers (HSWs). Given ongoing pandemic-related challenges like healthcare labor shortages, attention to HSWs is essential. This paper draws from 3 waves of in-depth interviews conducted with HSWs from 2017 to 2020 to understand the evolving nature and challenges of their work from their perspectives. By analyzing the interviews, we found their approach to labor consistent with a feminist ethic of care. The ethic of care framework understands care as a public responsibility necessary for a functioning society. Workers perceived the ethic of care to be consistently violated by their employer, which contributed to poor working conditions, threatening the well-being of workers and patients alike. Drawing from workers' experiences and insights, the ethic of care framework can inform organizational changes to improve both occupational health and patient care.