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1.
Pak J Med Sci ; 36(COVID19-S4): S6-S11, 2020 May.
Article in English | MEDLINE | ID: covidwho-1726836

ABSTRACT

OBJECTIVE: Recognizing the huge potential ramifications of COVID-19 pandemic, this study explores its impact on health professionals personally and professionally along with the associated challenges. METHODS: A descriptive cross-sectional qualitative survey was conducted from March-April 2020. Participants included health professionals from various disciplines in both public and private-sector institutions of Pakistan. The sample size was not predetermined, and an iterative approach of simultaneous data collection and analysis was taken until data and time saturation were reached. Thematic analysis of the qualitative data was carried out by two analysts. RESULTS: Two hundred and Ninety health professionals responded. They reported an impact on their mental, physical and social well-being. The clinicians mentioned facing an unprecedented workload in overstretched health facilities, while those in academia become engaged with planning/providing emergency remote teaching for the students affecting work-life balance. Some challenges associated with work-from-home and in the hospitals were identified. CONCLUSION: During COVID-19, the health professionals are anxious, overworked and financially unstable while planning, creating and caring for others and their families. We need to support them to do their jobs, be safe and stay alive. Future research should explore the fears and coping strategies of health professionals during pandemics.

2.
Pak J Med Sci ; 36(COVID19-S4): S37-S42, 2020 May.
Article in English | MEDLINE | ID: covidwho-1726820

ABSTRACT

OBJECTIVES: The aim of this study was to explore the expectations and fears faced by doctors during Covid-19 Pandemic. METHODS: This is a mixed method exploratory survey. A questionnaire exploring expectations of doctors from administration and seniors as well as their fears while working during pandemic, was developed on Google survey Forms. It included eight closed ended questions and four open ended questions. Data was collected through online Google survey Forms during month of March and April 2020. Doctors were approached through email and WhatsApp group. RESULTS: The mean age of participants was 33.58±4.21 years. Female 150(67.5%) and Male 72(32.4%) participated. 29(13.1%) Associate Professor, 34(15.3%) Assistant Professor, 56(25.2%) Senior Residents and 103(46.3%) residents, medical officers and house officers responded to the survey. 134(60.3%) doctors were working in hospitals which were not dealing with Covid-19. Fear included, infecting family members 177(79.7%), rapid spread of disease 140(63%), complications of disease 134(60.3%), becoming a carrier in 64(28.8%) and 62(27.9%) feared missing the diagnosis. More than 80% expected from seniors and administration, of providing PPE, facilitation, continue chain of supply of essential items, ensuring doctor safety, avoiding exposure of all doctors and keeping reserve workforce, limiting routine checkups, avoid panic and 20% had no expectations. CONCLUSION: It was concluded that doctors had their fears and perceptions regarding pandemic which need to be addressed while policy making. They fear wellbeing of their families and contacting Covid-19, if not provided proper PPE. Our study provides insight of expectations, fears and perceptions of our frontline which invariably gives insight of the views of healthcare workers.

3.
PLoS One ; 15(10): e0240499, 2020.
Article in English | MEDLINE | ID: covidwho-1388890

ABSTRACT

During the current SARS-CoV-2 pandemic there is unprecedented demand for personal protective equipment (PPE), especially N95 respirators and surgical masks. The ability of SARS-CoV-2 to be transmitted via respiratory droplets from asymptomatic individuals has necessitated increased usage of both N95 respirators in the healthcare setting and masks (both surgical and homemade) in public spaces. These precautions rely on two fundamental principles of transmission prevention: particle filtration and droplet containment. The former is the focus of NIOSH N95 testing guidelines, and the latter is an FDA guideline for respirators and surgical masks. While studies have investigated droplet containment to provide guidance for homemade mask production, limited work has been done to characterize the filtration efficiency (FE) of materials used in home mask making. In this work, we demonstrate the low-cost (<$300) conversion of standard equipment used to fit-test respirators in hospital and industrial settings into a setup that measures quantitative FEs of materials based on NIOSH N95 guidelines, and subsequently measure FEs of materials found in healthcare and consumer spaces. These materials demonstrate significant variability in filtration characteristics, even for visually similar materials. We demonstrate a FE of 96.49% and pressure drop of 25.4 mmH20 for a double-layer of sterilization wrap used in surgical suites and a FE of 90.37% for a combination of consumer-grade materials. The excellent filtration characteristics of the former demonstrate potential utility for emergent situations when N95 respirators are not available, while those of the latter demonstrate that a high FE can be achieved using publicly available materials.


Subject(s)
Air Filters/standards , Betacoronavirus , Coronavirus Infections/prevention & control , Equipment Safety/methods , Masks/standards , Materials Testing/methods , Pandemics/prevention & control , Personal Protective Equipment/standards , Pneumonia, Viral/prevention & control , Respiratory Protective Devices/standards , Aerosols , COVID-19 , Coronavirus Infections/virology , Equipment Safety/instrumentation , Health Personnel , Humans , Materials Testing/instrumentation , Occupational Exposure/prevention & control , Pneumonia, Viral/virology , SARS-CoV-2
4.
BMC Med ; 18(1): 160, 2020 05 29.
Article in English | MEDLINE | ID: covidwho-1388759

ABSTRACT

BACKGROUND: Understanding of the role of ethnicity and socioeconomic position in the risk of developing SARS-CoV-2 infection is limited. We investigated this in the UK Biobank study. METHODS: The UK Biobank study recruited 40-70-year-olds in 2006-2010 from the general population, collecting information about self-defined ethnicity and socioeconomic variables (including area-level socioeconomic deprivation and educational attainment). SARS-CoV-2 test results from Public Health England were linked to baseline UK Biobank data. Poisson regression with robust standard errors was used to assess risk ratios (RRs) between the exposures and dichotomous variables for being tested, having a positive test and testing positive in hospital. We also investigated whether ethnicity and socioeconomic position were associated with having a positive test amongst those tested. We adjusted for covariates including age, sex, social variables (including healthcare work and household size), behavioural risk factors and baseline health. RESULTS: Amongst 392,116 participants in England, 2658 had been tested for SARS-CoV-2 and 948 tested positive (726 in hospital) between 16 March and 3 May 2020. Black and south Asian groups were more likely to test positive (RR 3.35 (95% CI 2.48-4.53) and RR 2.42 (95% CI 1.75-3.36) respectively), with Pakistani ethnicity at highest risk within the south Asian group (RR 3.24 (95% CI 1.73-6.07)). These ethnic groups were more likely to be hospital cases compared to the white British. Adjustment for baseline health and behavioural risk factors led to little change, with only modest attenuation when accounting for socioeconomic variables. Socioeconomic deprivation and having no qualifications were consistently associated with a higher risk of confirmed infection (RR 2.19 for most deprived quartile vs least (95% CI 1.80-2.66) and RR 2.00 for no qualifications vs degree (95% CI 1.66-2.42)). CONCLUSIONS: Some minority ethnic groups have a higher risk of confirmed SARS-CoV-2 infection in the UK Biobank study, which was not accounted for by differences in socioeconomic conditions, baseline self-reported health or behavioural risk factors. An urgent response to addressing these elevated risks is required.


Subject(s)
Betacoronavirus , Biological Specimen Banks , Coronavirus Infections/epidemiology , Ethnicity/statistics & numerical data , Health Status Disparities , Pneumonia, Viral/epidemiology , SARS Virus , Severe Acute Respiratory Syndrome/epidemiology , Adult , COVID-19 , Female , Humans , Male , Middle Aged , Pandemics , Residence Characteristics/statistics & numerical data , Risk Factors , SARS-CoV-2 , Self Report , United Kingdom/epidemiology
5.
J Infect Dis ; 224(1): 14-20, 2021 07 02.
Article in English | MEDLINE | ID: covidwho-1294728

ABSTRACT

BACKGROUND: Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity among asymptomatic subjects reflects past or future disease may be difficult to ascertain. METHODS: We tested 9449 employees at Karolinska University Hospital, Stockholm, Sweden for SARS-CoV-2 RNA and antibodies, linked the results to sick leave records, and determined associations with past or future sick leave using multinomial logistic regression. RESULTS: Subjects with high amounts of SARS-CoV-2 virus, indicated by polymerase chain reaction (PCR) cycle threshold (Ct) value, had the highest risk for sick leave in the 2 weeks after testing (odds ratio [OR], 11.97; 95% confidence interval [CI], 6.29-22.80) whereas subjects with low amounts of virus had the highest risk for sick leave in the 3 weeks before testing (OR, 6.31; 95% CI, 4.38-9.08). Only 2.5% of employees were SARS-CoV-2 positive while 10.5% were positive by serology and 1.2% were positive in both tests. Serology-positive subjects were not at excess risk for future sick leave (OR, 1.06; 95% CI, .71-1.57). CONCLUSIONS: High amounts of SARS-CoV-2 virus, as determined using PCR Ct values, was associated with development of sickness in the next few weeks. Results support the concept that PCR Ct may be informative when testing for SARS-CoV-2. Clinical Trials Registration. NCT04411576.


Subject(s)
Asymptomatic Diseases , COVID-19/epidemiology , COVID-19/virology , Health Personnel , SARS-CoV-2 , Adult , Aged , Antibodies, Viral , COVID-19/diagnosis , Disease Progression , Female , Hospitals, University , Humans , Male , Mass Screening , Middle Aged , Polymerase Chain Reaction , RNA, Viral , SARS-CoV-2/genetics , Serologic Tests , Sick Leave/statistics & numerical data , Sweden/epidemiology , Young Adult
6.
Sci Total Environ ; 792: 148341, 2021 Oct 20.
Article in English | MEDLINE | ID: covidwho-1275700

ABSTRACT

Public toilets and bathrooms may act as a contact hub point where community transmission of SARS-CoV-2 occurs between users. The mechanism of spread would arise through three mechanisms: inhalation of faecal and/or urinary aerosol from an individual shedding SARS-CoV-2; airborne transmission of respiratory aerosols between users face-to-face or during short periods after use; or from fomite transmission via frequent touch sites such as door handles, sink taps, lota or toilet roll dispenser. In this respect toilets could present a risk comparable with other high throughput enclosed spaces such as public transport and food retail outlets. They are often compact, inadequately ventilated, heavily used and subject to maintenance and cleaning issues. Factors such as these would compound the risks generated by toilet users incubating or symptomatic with SARS-CoV-2. Furthermore, toilets are important public infrastructure since they are vital for the maintenance of accessible, sustainable and comfortable urban spaces. Given the lack of studies on transmission through use of public toilets, comprehensive risk assessment relies upon the compilation of evidence gathered from parallel studies, including work performed in hospitals and prior work on related viruses. This narrative review examines the evidence suggestive of transmission risk through use of public toilets and concludes that such a risk cannot be lightly disregarded. A range of mitigating actions are suggested for both users of public toilets and those that are responsible for their design, maintenance and management.


Subject(s)
Bathroom Equipment , COVID-19 , Aerosols , Humans , SARS-CoV-2 , Toilet Facilities
7.
Disaster Med Public Health Prep ; : 1-5, 2021 Mar 25.
Article in English | MEDLINE | ID: covidwho-1270638

ABSTRACT

OBJECTIVE: The aim of this study was to assess the stigma associated with coronavirus disease - 2019 (COVID-19) among health care workers (HCWs) in Indonesia during the early phase of the pandemic. METHODS: A cross-sectional study was conducted in 12 hospitals across the country in March, 2020. A logistic regression was employed to assess the association between stigma and explanatory variables. RESULTS: In total, 288 HCWs were surveyed, of which 93.4% had never experienced any outbreaks. Approximately 21.9% of the respondents had stigma associated with COVID-19. HCWs who were doctors, had not participated in trainings related to COVID-19, worked in the capital of the province, worked at private hospitals, or worked at a hospital with COVID-19 triage protocols were likely to have no stigma associated with COVID-19. CONCLUSIONS: The stigma associated with COVID-19 is relatively high among HCWs in the early phase of the COVID-19 pandemic in Indonesia. Adequate dissemination of knowledge and adequate protection are necessary to reduce stigma among HCWs.

8.
Future Healthc J ; 7(3): e32-e33, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1257102
9.
JMIR Med Inform ; 9(6): e28497, 2021 Jun 03.
Article in English | MEDLINE | ID: covidwho-1256269

ABSTRACT

BACKGROUND: The COVID-19 pandemic spread worldwide in 2020. Notably, in the countries dealing with massive casualties, clinicians have worked in new conditions characterized by a heavy workload and a high risk of being infected. The issue of clinician burnout during the pandemic has attracted considerable attention in health care research. Electronic health records (EHRs) provide health care workers with several features to meet a health system's clinical needs. OBJECTIVE: We aim to examine how the use of EHR features affects the burnout of clinicians working in hospitals that have special wards for confirmed COVID-19 cases. METHODS: Using an online survey, we collected data from 368 physicians, physician assistants, and nurses working in six hospitals that have implemented EHRs in the city of Tehran in Iran. We used logistic regression to assess the association between burnout and awareness of EHR features, EHR system usability, concerns about COVID-19, technology solutions, hospital technology interventions, hospital preparedness, and professional efficacy adjusted for demographic and practice characteristics. RESULTS: The primary outcome of our study was self-reported burnout during the COVID-19 pandemic. Of the 368 respondents, 36% (n=134) reported having at least one symptom of burnout. Participants indicated that the leading cause of EHR-related stress is inadequate training for using technology (n=159, 43%), followed by having less face-to-face time with patients (n=140, 38%). Positive perceptions about the EHR's ease of use were associated with lower odds of burnout symptoms. More interventions, such as clear communication of regulations; transparency in policies, expectations, and goals regarding the use of technology in the clinical workflow; and hospital preparedness to cope with the challenges of the pandemic, were associated with lower odds of burnout. CONCLUSIONS: The use of EHR applications, hospital pandemic preparation programs, and transparent technology-related policies and procedures throughout the epidemic can be substantial mitigators of technology-based stress and clinician burnout. Hospitals will then be better positioned to devise or modify technology-related policies and procedures to support physicians' and nurses' well-being during the COVID-19 pandemic. Training programs, transparency in communications of regulations, and developing a clear channel for informing clinicians of changes in policies may help reduce burnout symptoms among physicians and nurses during a pandemic. Providing easily accessible mentorship through teleconsultation and 24-hour available information technology support may also help to mitigate the odds of burnout.

10.
BMC Psychiatry ; 21(1): 271, 2021 05 25.
Article in English | MEDLINE | ID: covidwho-1243806

ABSTRACT

BACKGROUND: Healthcare workers (HCWs) who are in the frontline during the COVID-19 pandemic are often under significant pressures that may predispose them to symptoms of poor mental health. This study aimed to investigate the prevalence of anxiety and depression among HCWs and factors correlated with mental health concerns during the COVID-19 pandemic in Bangladesh. And, it also aimed to evaluate the psychometric properties of the Bangla version of the Hospital Anxiety and Depression Scale (HADS). METHODS: A cross-sectional survey was conducted between July and August, 2020. A self-reported online questionnaire was utilized to collect data. The survey included questions concerning socio-demographic, lifestyle, and work setting, as well as the HADS. A confirmatory factor analysis (CFA) and multiple linear regression analysis were performed. RESULTS: Data from 803 HCWs (50.7% male; mean age: 27.3 [SD = 6.9]; age range: 18-58 years) were included in the final analysis. The Bangla HADS was psychometrically sound, and demonstrated good internal consistency and reliability (α = 0.83), and excellent construct validity. Prevalence estimates of anxiety and depression were 69.5%, and 39.5%, respectively, for less severe symptomology (at least borderline abnormal), and 41.2% and 15.7% for more severe (at least abnormal) symptomology. Regression analyses with the total HADS score as a dependent variable revealed significant (p < 0.05) associations with female gender, moderate and poor health status, infrequent physical exercising, smoking, having had regrets about one's profession because of the pandemic and associated experiences, not updating on the latest COVID-19-related research, experiencing discrimination in the workplace, and facing social problems due to working in a lab or hospital during the COVID-19 pandemic. CONCLUSIONS: Symptoms of anxiety and depression are prevalent among HCWs during the COVID-19 pandemic in Bangladesh. The findings suggest a need for screening for mental health concerns, and employing early intervention to help these individuals.


Subject(s)
COVID-19 , Pandemics , Adolescent , Adult , Anxiety/epidemiology , Bangladesh/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Female , Health Personnel , Humans , Male , Middle Aged , Prevalence , Reproducibility of Results , SARS-CoV-2 , Young Adult
11.
Vaccine ; 39(26): 3467-3472, 2021 06 11.
Article in English | MEDLINE | ID: covidwho-1240641

ABSTRACT

BACKGROUND: There has been a recent recognized shift towards a whole-of-life or life-course approach to immunisation. However, coverage amongst at-risk adults for recommended vaccines continues to be suboptimal. This study examined the perceptions of middle and older aged Australian adults towards hospital-based immunization programs and their previous exposures to receiving vaccines via tertiary care. METHODS: A cross-sectional survey was conducted with Australian adults 45 years and older in late 2019 to capture influenza and pneumococcal vaccine uptake, exposure to hospital-based immunization programs, missed opportunities to vaccinate and receptiveness towards the promotion and/or delivery of vaccines in the hospital setting. RESULTS: Only 13 respondents reported receiving a vaccine at hospital, yet 72.2% (931/1292) indicated that they were willing to be vaccinated in that setting. Amongst those who attended hospital during 2019 and were eligible for vaccination, 57.2% and 28.3% of respondents were not immunized for pneumococcal and influenza, respectively. Missed opportunities for both vaccines were significantly higher amongst those at low-risk for influenza (≤65 years (low-risk): 52.9%, ≤65 years (high-risk): 18.3%, >65 years: 15.1%; p < 0.001) and pneumococcal (≤65 years (low-risk): 79.1%, ≤65 years (high-risk): 52.4%, >65 years: 44%; p < 0.001). Among those with a missed opportunity for hospital-based vaccination, the most common reason for not getting immunized was a lack of recommendation. Most (86.4%) reported that their general practitioner was the person or group they trusted most to receive vaccine information from. CONCLUSIONS: The findings from this Australian study support international work that shows very low rates of opportunistic vaccination in hospitals despite national recommendations to vaccinate prior to discharge. Considering the need for high levels of uptake of the COVID-19 vaccine, hospitals may need to be considered to opportunistically capture those not accessing the vaccine in other settings.


Subject(s)
COVID-19 , Influenza Vaccines , Adult , Aged , Australia , COVID-19 Vaccines , Cross-Sectional Studies , Hospitals , Humans , Immunization , Immunization Programs , Middle Aged , Pneumococcal Vaccines , SARS-CoV-2 , Vaccination
12.
Death Stud ; : 1-10, 2021 May 21.
Article in English | MEDLINE | ID: covidwho-1238094

ABSTRACT

The aim of the study was to examine the role of the obsession with COVID-19 thoughts and coronaphobia in the relationship of death anxiety with burnout among staff working at infectious diseases hospitals in the front-line of the fight against COVID-19. A cross-sectional online survey (N = 110) was conducted during the second wave of the COVID-19 pandemic. Results showed that obsession with COVID-19 and coronaphobia mediated the relationship of death anxiety with burnout. Most of the participants reported higher levels of death anxiety compared with the general population and nurses reported higher levels of death anxiety than physicians.

13.
Front Psychiatry ; 12: 611223, 2021.
Article in English | MEDLINE | ID: covidwho-1231402

ABSTRACT

Background: The outbreak of novel coronavirus disease 2019 (COVID-19) has caused public panic and psychological health problems, especially in medical staff. We aimed to investigate the psychological effect of the COVID-19 outbreak on medical staff. Methods: A cross-sectional study was conducted to examine the psychological impact of medical staff working in COVID-19 designated hospitals from February to March 2020 in China. We assessed psychological health problems using the Symptom Check List 90 (SCL-90). Results: Among 656 medical staff, 244 were frontline medical staff and 412 general medical staff. The prevalence of psychological health problems was 19.7%. The SCL-90 scores in frontline medical staff were significantly higher than that in general medical staff (mean: 141.22 vs. 129.54, P < 0.05). Furthermore, gender [odds ratio (OR) = 1.53, 95% CI = (1.02, 2.30), P = 0.042 for female vs. male] and the burden of current work [OR = 7.55, 95% CI = (3.75, 15.21), P < 0.001 for high burden; OR = 2.76, 95% CI = (1.80, 4.24), P < 0.001 for moderate burden vs. low burden] were associated with increased risk of poor psychological status. Conclusions: Medical staff experienced a high risk of psychological health problems during the outbreak of COVID-19, especially for frontline medical staff. Psychological health services are expected to arrange for medical staff in future unexpected infectious disease outbreaks.

14.
Am J Orthopsychiatry ; 91(2): 149-161, 2021.
Article in English | MEDLINE | ID: covidwho-1226413

ABSTRACT

There is concern for the mental health of healthcare providers during the COVID-19 pandemic. In this article, we focus on the protective strategies that all people, but in this case healthcare providers, use when facing danger and how specific preventive responses could reduce the mental health burden to nurses, doctors, and emergency medical personnel working in hospitals. Our primary contributions are to demonstrate that healthcare providers are not a homogeneous group regarding mental health risks and that, consequently, individuals might need different forms of preventive and ameliorative response. We propose some (a) universally beneficial approaches, (b) strategy-specific approaches, and (c) strategy-specific contra-indicated approaches. Our two central points are that there are important psychological differences among healthcare providers and that these create different mental health needs in the COVID-19 crisis and require different protective solutions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
COVID-19/psychology , Health Personnel , COVID-19/prevention & control , COVID-19/therapy , Health Personnel/psychology , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Occupational Stress/prevention & control
15.
Healthcare (Basel) ; 9(5)2021 May 11.
Article in English | MEDLINE | ID: covidwho-1223987

ABSTRACT

(1) Background: The COVID-19 pandemic has changed the living conditions of many people. Many people felt significantly constrained. However, for individuals who are both parents and healthcare professionals, the situation seems more troubling in other ways. (2) Objectives: Based on this, we planned a study evaluating demographic characteristics, COVID-19-related anxiety levels, and parenting-related stress levels of the health care professionals who were working in the University Hospital. We also evaluated the parameters that affect COVID-19-related anxiety and parenting stress. (3) Methods: The level of COVID-19-related anxiety is assessed by the coronavirus anxiety scale. The parenting stress index-short form is used for evaluation of parenting stress. Statistical analysis was done by SPSS version 22. (4) Results: Female gender, working as a nurse, a history of COVID-19, and having a child attending daycare were parameters that increased the level of COVID-19-related anxiety. Occupation, being a parent of a schoolchild and/or primary school child, being a parent of a child receiving face-to-face education, and having more than two children were found to be risk factors for parenting stress. Clinically significant parenting stress was found to increase threefold in healthcare workers with more than two children (R2 = 0.101, p = 0.039). (5) Conclusions: Healthcare professionals, who are also parents, play a huge role both at home and in the hospital in the pandemic. Therefore, it is inevitable that their stress and anxiety levels increase. It is important to determine the factors that cause stress and anxiety and to take measures in this direction to get through this process well.

16.
Sci Prog ; 104(2): 36850421998487, 2021.
Article in English | MEDLINE | ID: covidwho-1207543

ABSTRACT

The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic had a significant impact on the Italian healthcare system, although geographical differences were present; regions in northern Italy have been the most severely affected while regions in the south of the country were relatively spared. Otolaryngologists were actively involved in the management of the pandemic. In this work, we analyzed and compared the otolaryngology surgical activity performed during the pandemic in two large public hospitals located in different Italian regions. In northern Italy, otolaryngologists were mainly involved in performing surgical tracheotomies in COVID-19 positive patients and contributed to the management of these patients in intensive care units. In central Italy, where the burden of the infection was significantly lower, otolaryngologists focused on diagnosis and treatment of emergency and oncology patients. This analysis confirms the important role of the otolaryngology specialists during the pandemic, but also highlights specific differences between two large hospitals in different Italian regions.


Subject(s)
COVID-19/epidemiology , Medical Oncology/organization & administration , Otolaryngology/organization & administration , Pandemics , SARS-CoV-2/pathogenicity , COVID-19/pathology , COVID-19/surgery , COVID-19/virology , Geography , Hospitals , Humans , Intensive Care Units , Italy/epidemiology , Patient Admission/statistics & numerical data , Surveys and Questionnaires , Tracheotomy
17.
Lancet ; 397(10286): 1725-1735, 2021 05 08.
Article in English | MEDLINE | ID: covidwho-1201329

ABSTRACT

BACKGROUND: BNT162b2 mRNA and ChAdOx1 nCOV-19 adenoviral vector vaccines have been rapidly rolled out in the UK from December, 2020. We aimed to determine the factors associated with vaccine coverage for both vaccines and documented the vaccine effectiveness of the BNT162b2 mRNA vaccine in a cohort of health-care workers undergoing regular asymptomatic testing. METHODS: The SIREN study is a prospective cohort study among staff (aged ≥18 years) working in publicly-funded hospitals in the UK. Participants were assigned into either the positive cohort (antibody positive or history of infection [indicated by previous positivity of antibody or PCR tests]) or the negative cohort (antibody negative with no previous positive test) at the beginning of the follow-up period. Baseline risk factors were collected at enrolment, symptom status was collected every 2 weeks, and vaccination status was collected through linkage to the National Immunisations Management System and questionnaires. Participants had fortnightly asymptomatic SARS-CoV-2 PCR testing and monthly antibody testing, and all tests (including symptomatic testing) outside SIREN were captured. Data cutoff for this analysis was Feb 5, 2021. The follow-up period was Dec 7, 2020, to Feb 5, 2021. The primary outcomes were vaccinated participants (binary ever vacinated variable; indicated by at least one vaccine dose recorded by at least one of the two vaccination data sources) for the vaccine coverage analysis and SARS-CoV-2 infection confirmed by a PCR test for the vaccine effectiveness analysis. We did a mixed-effect logistic regression analysis to identify factors associated with vaccine coverage. We used a piecewise exponential hazard mixed-effects model (shared frailty-type model) using a Poisson distribution to calculate hazard ratios to compare time-to-infection in unvaccinated and vaccinated participants and estimate the impact of the BNT162b2 vaccine on all PCR-positive infections (asymptomatic and symptomatic). This study is registered with ISRCTN, number ISRCTN11041050, and is ongoing. FINDINGS: 23 324 participants from 104 sites (all in England) met the inclusion criteria for this analysis and were enrolled. Included participants had a median age of 46·1 years (IQR 36·0-54·1) and 19 692 (84%) were female; 8203 (35%) were assigned to the positive cohort at the start of the analysis period, and 15 121 (65%) assigned to the negative cohort. Total follow-up time was 2 calendar months and 1 106 905 person-days (396 318 vaccinated and 710 587 unvaccinated). Vaccine coverage was 89% on Feb 5, 2021, 94% of whom had BNT162b2 vaccine. Significantly lower coverage was associated with previous infection, gender, age, ethnicity, job role, and Index of Multiple Deprivation score. During follow-up, there were 977 new infections in the unvaccinated cohort, an incidence density of 14 infections per 10 000 person-days; the vaccinated cohort had 71 new infections 21 days or more after their first dose (incidence density of eight infections per 10 000 person-days) and nine infections 7 days after the second dose (incidence density four infections per 10 000 person-days). In the unvaccinated cohort, 543 (56%) participants had typical COVID-19 symptoms and 140 (14%) were asymptomatic on or 14 days before their PCR positive test date, compared with 29 (36%) with typical COVID-19 symptoms and 15 (19%) asymptomatic in the vaccinated cohort. A single dose of BNT162b2 vaccine showed vaccine effectiveness of 70% (95% CI 55-85) 21 days after first dose and 85% (74-96) 7 days after two doses in the study population. INTERPRETATION: Our findings show that the BNT162b2 vaccine can prevent both symptomatic and asymptomatic infection in working-age adults. This cohort was vaccinated when the dominant variant in circulation was B1.1.7 and shows effectiveness against this variant. FUNDING: Public Health England, UK Department of Health and Social Care, and the National Institute for Health Research.


Subject(s)
COVID-19 Vaccines/supply & distribution , Health Personnel , Occupational Diseases/prevention & control , Occupational Exposure/prevention & control , RNA, Messenger , COVID-19 Vaccines/administration & dosage , Cohort Studies , England , Humans , Prospective Studies , Treatment Outcome
18.
JMIR Form Res ; 5(5): e27473, 2021 May 26.
Article in English | MEDLINE | ID: covidwho-1197485

ABSTRACT

BACKGROUND: The COVID-19 pandemic has accelerated the worldwide need for simple remotely delivered (digital) scalable interventions that can also be used preventatively to protect the mental health of health care staff exposed to psychologically traumatic events during their COVID-19-related work. We have developed a brief behavioral intervention that aims to reduce the number of intrusive memories of traumatic events but has only been delivered face-to-face so far. After digitalizing the intervention materials, the intervention was delivered digitally to target users (health care staff) for the first time. The adaption for staff's working context in a hospital setting used a co-design approach. OBJECTIVE: The aims of this mixed method exploratory pilot study with health care staff who experienced working in the pandemic were to pilot the intervention that we have digitalized (for remote delivery and with remote support) and adapted for this target population (health care staff working clinically during a pandemic) to explore its ability to reduce the number of intrusive memories of traumatic events and improve related symptoms (eg, posttraumatic stress) and participant's perception of their functioning, and to explore the feasibility and acceptability of both the digitalized intervention and digitalized data collection. METHODS: We worked closely with target users with lived experience of working clinically during the COVID-19 pandemic in a hospital context (registered nurses who experienced intrusive memories from traumatic events at work; N=3). We used a mixed method design and exploratory quantitative and qualitative analysis. RESULTS: After completing the digitalized intervention once with remote researcher support (approximately 25 minutes) and a brief follow-up check-in, participants learned to use the intervention independently. All 3 participants reported zero intrusive memories during week 5 (primary outcome: 100% digital data capture). Prior to study inclusion, two or more intrusions in the week were reported preintervention (assessed retrospectively). There was a general pattern of symptom reduction and improvement in perceived functioning (eg, concentration) at follow-up. The digitalized intervention and data collection were perceived as feasible and rated as acceptable (eg, all 3 participants would recommend it to a colleague). Participants were positive toward the digital intervention as a useful tool that could readily be incorporated into work life and repeated in the face of ongoing or repeated trauma exposure. CONCLUSIONS: The intervention when delivered remotely and adapted for this population during the pandemic was well received by participants. Since it could be tailored around work and daily life and used preventatively, the intervention may hold promise for health care staff pending future evaluations of efficacy. Limitations include the small sample size, lack of daily intrusion frequency data in the week before the intervention, and lack of a control condition. Following this co-design process in adapting and improving intervention delivery and evaluation, the next step is to investigate the efficacy of the digitalized intervention in a randomized controlled trial.

19.
Trop Med Health ; 49(1): 30, 2021 Apr 16.
Article in English | MEDLINE | ID: covidwho-1190116

ABSTRACT

INTRODUCTION: The new coronavirus disease 2019 is an emerging respiratory disease caused by the highly contagious novel coronavirus which has currently overwhelmed the world. Realizing a comprehensive set of infection prevention measures is a key to minimize the spread of this virus and its impacts in all healthcare settings. Therefore, this study was aimed to assess the compliance towards COVID-19 preventive measures and associated factors among health professionals in selected public hospitals, southeast Ethiopia. METHODS: A descriptive hospital-based cross-sectional study was conducted among 660 health professionals in public hospitals of southeast Ethiopia from October 1 to 31, 2020. A multistage sampling technique was used to select the study participants. Data were collected by interview using structured and pretested questionnaires. Ordinary logistic regression modeling was used to estimate the crude and adjusted odds ratio. To declare the statistical significance of factors associated with the outcome variable, P-value < 0.05 and 95% confidence interval were used. RESULTS: A total of 654 health professionals were involved in the study; of whom, 313 participants were nurses. The overall good compliance and knowledge of health professionals regarding COVID-19 preventive measures were 21.6 and 25.5%, respectively. Working in the general hospital (AOR = 0.55; 95% CI 0.38, 0.79), service year (AOR = 2.10; 95% CI 1.35, 3.21), knowledge (AOR = 1.80; 95% CI 1.14, 2.89), and water availability (AOR = 3.26; 95% CI 2.25, 4.72) were some of the factors found to have a statistically significant association to compliance of health professionals regarding COVID-19 preventive measures. CONCLUSION: In this study, nearly one fifth of health professionals had good compliance towards COVID-19 prevention practices. Thus, a consistent supply of COVID-19 prevention materials, facilities, and improving the knowledge of health professionals through on and off-job training are crucial.

20.
Risk Manag Healthc Policy ; 13: 2927-2936, 2020.
Article in English | MEDLINE | ID: covidwho-1186660

ABSTRACT

PURPOSE: Mental health is an important component of the protection strategy for healthcare workers (HCWs). However, it has not been well described in Vietnam during the COVID-19 outbreak. This study aims to measure the psychological distress and health-related quality-of-life among frontline healthcare workers during the peak of the outbreak in Vietnam. PATIENTS AND METHODS: We conducted a cross-sectional survey on 173 health workers at two national tertiary hospitals in Hanoi, Vietnam from March to April 2020. The psychological distress was measured by the Depression, Anxiety, and Stress Scale - 21 Items (DASS-21), Impact of Event Scale - Revised (IES-R), and the Insomnia Severity Index (ISI). EQ-5D-5L was used to determine the health-related quality-of-life (HRQoL) outcomes. RESULTS: Among 173 HCWs, the proportion of reported depression symptoms, anxiety symptoms, and stress was 20.2%, 33.5%, and 12.7%, respectively. The median EQ-5D-5L index score was 0.93 (IQR=0.85-0.94), and the anxiety/depression aspect had the highest reported problems. The most COVID-19-specific concerns among frontline HCWs were the reduction of income (59%) and the increase of living costs (54.3%). HCWs working in the COVID-19-designated hospital had a significantly higher rate of mental health problems and had a lower HRQoL outcome than those working in non-COVID-19-designated hospitals. Other factors associated with psychological distress and sleep problems include age, job title, income, chronic diseases status, and years of working in healthcare settings. HCWs who were ≥30 years old, had higher working years, had higher incomes, and had mental health and sleep problems were more likely to have lower HRQoL scores. CONCLUSION: We reported a moderate rate of psychological distress and lower HRQoL outcomes among frontline HCWs during the COVID-19 outbreak in Vietnam. Various factors were found to be associated with mental health and HRQoL that might be useful for implementing appropriate interventions for HCWs in low-resource settings.

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