Mental impact of Covid-19 among Spanish healthcare workers. A large longitudinal survey.

AIMS: Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors. METHODS: 8996 healthcare workers evaluated on 5 May-7 September 2020 (baseline) were invited to a second web-based survey (October-December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview. RESULTS: 4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar. CONCLUSIONS: Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565.

Four-month incidence of suicidal thoughts and behaviors among healthcare workers after the first wave of the Spain COVID-19 pandemic.

Healthcare workers (HCW) are at high risk for suicide, yet little is known about the onset of suicidal thoughts and behaviors (STB) in this important segment of the population in conjunction with the COVID-19 pandemic. We conducted a multicenter, prospective cohort study of Spanish HCW active during the COVID-9 pandemic. A total of n = 4809 HCW participated at baseline (May-September 2020; i.e., just after the first wave of the pandemic) and at a four-month follow-up assessment (October-December 2020) using web-based surveys. Logistic regression assessed the individual- and population-level associations of separate proximal (pandemic) risk factors with four-month STB incidence (i.e., 30-day STB among HCW negative for 30-day STB at baseline), each time adjusting for distal (pre-pandemic) factors. STB incidence was estimated at 4.2% (SE = 0.5; n = 1 suicide attempt). Adjusted for distal factors, proximal risk factors most strongly associated with STB incidence were various sources of interpersonal stress (scaled 0-4; odds ratio [OR] range = 1.23-1.57) followed by personal health-related stress and stress related to the health of loved ones (scaled 0-4; OR range 1.30-1.32), and the perceived lack of healthcare center preparedness (scaled 0-4; OR = 1.34). Population-attributable risk proportions for these proximal risk factors were in the range 45.3-57.6%. Other significant risk factors were financial stressors (OR range 1.26-1.81), isolation/quarantine due to COVID-19 (OR = 1.53) and having changed to a specific COVID-19 related work location (OR = 1.72). Among other interventions, our findings call for healthcare systems to implement adequate conflict communication and resolution strategies and to improve family-work balance embedded in organizational justice strategies.

Impacto en prensa escrita tras el primer caso de difteria en España desde 1986 / No disponible

Objetivo: Investigar la cobertura mediática y el contenido de los mensajes comunicados por la prensa escrita ante el caso de un menor no vacunado, fallecido por difteria en España en junio de 2015. Métodos: Estudio cualitativo, basado en el análisis de contenido de las noticias publicadas en los 6 periódicos nacionales de mayor difusión, del 1 al 30 de junio de 2015. Se analizó también el tipo de titular, la ubicación y extensión de la noticia, la existencia de fotografías e infografías, y el día de la semana de publicación. Resultados: Se identificaron 40 noticias relacionadas; 5 de ellas fueron portada (13%), 27 (68%) se publicaron en días laborables, y 5 (13%) contenían infografías. Se observaron importantes cambios cronológicos, tanto en la extensión como en la cobertura y el contenido de las noticias relacionadas. Conclusiones: La cobertura mediática y el tipo de mensajes difundidos presentó importantes áreas de mejora. El modo y frecuencia de difusión de noticias de relevancia sanitaria condicionan el éxito de autoridades y profesionales de la salud en el control de las enfermedades inmunoprevenibles. Es crucial la olaboración mutua con los profesionales de la comunicación, para asegurar una información sanitaria útil, completa, contrastada y veraz

Objective: To investigate the media coverage and content of the messages communicated by the written press in the case of an unvaccinated minor, who died of diphtheria in Spain in June 2015. Methods: Qualitative study, based on content analysis of news published in 2015 in the 6 most widely distributed national newspapers, from June 1 to 30. The type of headline, the location and extent of the news, the existence of graphic support, and the day of the publication were also analyzed. Results: 40 related news were identified; 5 of them were front page (13%), 27 (68%) were published on working days, and 5 (13%) contained infographics. Important chronological changes were observed, both in the extensión, coverage and contents of the news. Conclusions: Media coverage and the type of messages disseminated presented important areas for improvement. How and how often news of high health relevance are disseminated condition significantly the success of health authorities and professionals in the control immunopreventable diseases. Mutual collaboration with communication professionals is crucial to ensure useful, complete, contrasted and truthful information

[Identification of adverse events in hospitalised influenza patients]. / Identificación de eventos adversos en pacientes hospitalizados por gripe.

OBJECTIVE: To test the inter-observer agreement in identifying adverse events (AE) in patients hospitalized by flu and undergoing precautionary isolation measures. METHODS: Historical cohort study, 50 patients undergoing isolation measures due to flu, and 50 patients without any isolation measures. RESULTS: The AE incidence ranges from 10 to 26% depending on the observer (26% [95%CI: 17.4%-34.60%], 10% [95%CI: 4.12%-15.88%], and 23% [95%CI: 14.75%-31.25%]). It was always lower in the cohort undergoing the isolation measures. This difference is statistically significant when the accurate definition of a case is applied. The agreement as regards the screening was good (higher than 76%; Kappa index between 0.29 and 0.81). The agreement as regards the accurate identification of AE related to care was lower (from 50 to 93.3%, Kappa index from 0.20 to 0.70). CONCLUSIONS: Before performing an epidemiological study on AE, interobserver concordance must be analyzed to improve the accuracy of the results and the validity of the study. Studies have different levels of reliability. Kappa index shows high levels for the screening guide, but not for the identification of AE. Without a good methodology the results achieved, and thus the decisions made from them, cannot be guaranteed. Researchers have to be sure of the method used, which should be as close as possible to the optimal achievable.

Identificación de eventos adversos en pacientes hospitalizados por gripe / Identification of adverse events in hospitalised influenza patients

Objetivos: Testar la fiabilidad interobservador de la guía de cribado y del formulario modular de revisión (MRF2) para identificar eventos adversos (EA). Comparar la incidencia de EA entre un grupo de pacientes sometidos a precauciones de aislamiento de contacto y gotas por gripe frente a un grupo de pacientes no aislados. Método: Estudio de casos y controles anidados en una cohorte. Los casos son 50 pacientes sometidos a precauciones de aislamiento por gripe, y los controles son 50 pacientes ingresados y no aislados. Resultados: La incidencia de EA varía entre el 10 y el 26% por efecto del observador (26% [IC 95%: 17,4-34,60%]; 10% [IC 95%: 4,12-15,88%]; 23% [IC 95%: 14,75-31,25%]). Es siempre menor en la cohorte expuesta al aislamiento que en la no expuesta, y esa diferencia alcanza significación estadística cuando aplicamos el criterio de máxima exigencia en la definición de caso. La concordancia respecto del cribado fue buena (porcentaje simple de concordancia superior al 76%; índice Kappa entre 0,29 y 0,81). La concordancia respecto de la identificación precisa de EA relacionado con la asistencia fue menor (porcentaje de concordancia entre el 50 y el 93,3%; índice Kappa de 0,20 a 0,70). Conclusiones: Antes de realizar un estudio epidemiológico sobre EA hay que analizar la fiabilidad interobservador para mejorar la precisión de los resultados y, por ende, la validez del estudio. Los revisores presentan diferentes grados de concordancia. El índice Kappa muestra niveles elevados para la guía de cribado, no así para la identificación de EA. Sin una buena metodología no se pueden garantizar los resultados alcanzados y, consecuentemente, las decisiones tomadas a partir de ellos. Por tanto, los investigadores han de ser garantes del método utilizado y este debe acercarse lo más posible al óptimo alcanzable (AU)

Objective: To test the inter-observer agreement in identifying adverse events (AE) in patients hospitalized by flu and undergoing precautionary isolation measures. Methods: Historical cohort study, 50 patients undergoing isolation measures due to flu, and 50 patients without any isolation measures. Results: The AE incidence ranges from 10 to 26% depending on the observer (26% [95% CI: 17.4%-34.60%], 10% [95% CI: 4.12%-15.88%], and 23% [95% CI: 14.75%-31.25%]). It was always lower in the cohort undergoing the isolation measures. This difference is statistically significant when the accurate definition of a case is applied. The agreement as regards the screening was good (higher than 76%; Kappa index between 0.29 and 0.81). The agreement as regards the accurate identification of AE related to care was lower (from 50 to 93.3%, Kappa index from 0.20 to 0.70). Conclusions: Before performing an epidemiological study on AE, interobserver concordance must be analyzed to improve the accuracy of the results and the validity of the study. Studies have different levels of reliability. Kappa index shows high levels for the screening guide, but not for the identification of AE. Without a good methodology the results achieved, and thus the decisions made from them, cannot be guaranteed. Researchers have to be sure of the method used, which should be as close as possible to the optimal achievable (AU)