ABSTRACT
OBJECTIVE: Long-term changes in burnout and its predictors in hospital staff during the COVID-19 pandemic were investigated in an international study. METHODS: Two online surveys were distributed to hospital staff in seven countries (Germany, Andorra, Ireland, Spain, Italy, Romania, Iran) between May and October 2020 (T1) and between February and April 2021 (T2), using the following variables: Burnout (emotional exhaustion and depersonalization), job function, age, gender, and contact with COVID-19 patients; individual resources (self-compassion, sense of coherence, social support) and work-related resources and demands (support at the workplace, risk perception, health and safety at the workplace, altruistic acceptance of risk). Data were analyzed using linear mixed models repeated measures, controlled for age. RESULTS: A total of 612 respondents were included (76% women). We found an increase in burnout from T1 to T2. Burnout was high among personnel with high contact with COVID-19 patients. Individual factors (self-compassion, sense of coherence) and work-related factors (support at the workplace, risk perception, health and safety at the workplace) showed associations with burnout. Low health and safety at the workplace at T1 was associated with an increase in emotional exhaustion at T2. Men showed an increase in depersonalization if they had much contact with COVID-19 patients. CONCLUSION: Burnout represents a potential problematic consequence of occupational contact with COVID-19 patients. Special attention should be paid to this group in organizational health management. Self-compassion, sense of coherence, support at the workplace, risk perception, and health and safety at the workplace may be important starting points for interventions. REGISTRATION: Müller, M. M. (2020, August 30). Cope-Corona: Identifying and strengthening personal resources of hospital staff to cope with the Corona pandemic. Open Science Foundation.
Subject(s)
Burnout, Professional , COVID-19 , Male , Humans , Female , Pandemics , COVID-19/epidemiology , Burnout, Professional/epidemiology , Burnout, Professional/psychology , Personnel, Hospital , Surveys and Questionnaires , Longitudinal Studies , Job SatisfactionABSTRACT
BACKGROUND: Antiretroviral therapy has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals. METHODOLOGY: We developed a new internet-based home care model covering the entire management of chronic HIV-infected patients. This was called Virtual Hospital. We report the results of a prospective randomised study performed over two years, comparing standard care received by HIV-infected patients with Virtual Hospital care. HIV-infected patients with access to a computer and broadband were randomised to be monitored either through Virtual Hospital (Arm I) or through standard care at the day hospital (Arm II). After one year of follow up, patients switched their care to the other arm. Virtual Hospital offered four main services: Virtual Consultations, Telepharmacy, Virtual Library and Virtual Community. A technical and clinical evaluation of Virtual Hospital was carried out. FINDINGS: Of the 83 randomised patients, 42 were monitored during the first year through Virtual Hospital (Arm I) and 41 through standard care (Arm II). Baseline characteristics of patients were similar in the two arms. The level of technical satisfaction with the virtual system was high: 85% of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system. Neither clinical parameters [level of CD4+ T lymphocytes, proportion of patients with an undetectable level of viral load (p = 0.21) and compliance levels >90% (p = 0.58)] nor the evaluation of quality of life or psychological questionnaires changed significantly between the two types of care. CONCLUSIONS: Virtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients. Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection. TRIAL REGISTRATION: Clinical-Trials.gov: NCT01117675.
Subject(s)
HIV Infections/therapy , HIV-1/physiology , Home Care Services/standards , Standard of Care , Telemedicine/methods , Adult , Antiretroviral Therapy, Highly Active , CD4 Lymphocyte Count , Chronic Disease , Female , HIV Infections/virology , Humans , Male , Telemedicine/instrumentation , Telemedicine/standards , Viral LoadABSTRACT
The present study evaluated the efficacy of a group therapy program in improving psychosocial adjustment to HIV infection, and tried to identify variables predictive of greater improvement. The outcome of 47 completing patients was analyzed, comparing the measures between T1 (1 month before therapy), and T2 (first session), and between T2 and T3 (last session) using the Wilcoxon matched-pairs signed-ranks test for each dimension of the Psychosocial Adjustment to Illness Scale (PAIS). The therapy consisted of 16 weekly 2-hour sessions following a structured time-limited cognitive-behavioral group psychotherapy program. During the intervention (between T2 and T3) a significant improvement was observed in health care orientation, vocational environment, domestic environment, sexual relation, extended family relationships, social environment, and total PAIS. There were no changes during baseline (between T1 and T2) in any of the PAIS subscales, or in the total PAIS score. Sexual route of transmission was independently associated with an improvement in health care orientation (beta = 2.525). Time since HIV diagnosis (beta = 0.022) and being employed (beta = 2.548) were independently associated with an improvement in adjustment to vocational environment. Men who have sex with men showed a poorer improvement in adjusting to family relations after the intervention (beta = -2.548). Finally, a lower CD4 count (beta = -0.005) and being employed (beta = 3.054) were independently associated with an improvement in adjustment to social environment. Our psychotherapy program improved psychosocial functioning in a heterogeneous sample of HIV-1-infected patients referred to a consultation-liaison psychiatry unit.
Subject(s)
Anxiety/therapy , Cognitive Behavioral Therapy , Depression/therapy , HIV Infections/psychology , HIV-1 , Adaptation, Psychological , Adult , Anxiety/etiology , Depression/etiology , Female , HIV Infections/complications , Humans , Male , Middle Aged , Pilot Projects , Psychotherapy, Group , Referral and Consultation , Treatment OutcomeABSTRACT
La depresión se ha asociado a disfunciones inmunitariasy peor pronóstico en diferentes enfermedades crónicas.Los estudios realizados en pacientes infectados por elvirus de la inmunodeficiencia humana (VIH) muestranresultados contradictorios. Estos estudios utilizan medidasde estado emocional en las que aparecen síntomassomáticos que pueden confundirse con síntomas del propioVIH.Objetivo: Determinar la supervivencia a 10 años de pacientesVIH+ y otros parámetros de evolución de la infección(enfermedades oportunistas) en función del estadoemocional, evaluado mediante una escala en la que noaparezcan síntomas somáticos.Métodos: Se incluyeron pacientes VIH+ que realizaronuna primera visita en nuestro servicio de interconsultasde psiquiatría entre 1995-97. Se determinaron HADSbasal, CD4 basal y variables sociodemográficas. Se realizóel seguimiento a 10 años evaluando mortalidad yenfermedades oportunistas.Resultados: No observamos relación entre la HADS basaly la supervivencia de pacientes VIH+ a 10 años (controlandolos CD4). Tampoco encontramos relación entre laHADS basal y la aparición de enfermedades oportunistas.Conclusiones: Después de mejorar algunos aspectosmetodológicos respecto previos estudios, no encontramosrelación entre el estado emocional y la supervivenciade pacientes VIH
Depression has been related with immune supression andpoor health outcomes in several chronic diseases . Studiesin HIV patients show contradictory results. However, thesestudies use scales to evaluate emocional status wheresomatic symptoms are also evaluated and can beconfounding factors.Objective: Evaluate HIV patients survival over 10 yearsand other health outcome parameters (opportunisticinfections) depending on emocional status, measured byan scale where somatic symptomas aren't evaluated.Methods: HIV+ patients that came between 1995-1997to our liasion psychiatric unit for the first time whereincluded. Baseline HADS scores, CD4 cell count andsociodemographic measures were determined. Theirmortality and the presence of opportunistic infections wereevaluated over ten years.Results: We didn't find a relationship between baselineHADS scores and survival (after controlling for baselineCD4 cell count). We didn't find a relationship betweenbaseline HADS scores and the emergence of opportunisticinfections.Conclusions: Despite improving some methodologicissues, we didn't find a relationship between emocionalstatus and HIV patients survival
Subject(s)
Male , Female , Humans , Depressive Disorder/epidemiology , HIV Infections/epidemiology , Survival Rate , Risk Factors , Anxiety Disorders/epidemiology , CD4 AntigensABSTRACT
A standardized questionnaire was used to assess the impact of lipodystrophy (LD) on quality of life (QoL). Eighty-four consecutive asymptomatic human immunodeficiency virus type 1 (HIV-1)-infected outpatients with clinical LD completed a modified version of the Dermatology Life Quality Index (DLQI) survey to measure the impact of body fat changes on their QoL. Body changes influenced dressing for 55 patients (65%), produced feelings of shame for 41 (49%), and disrupted sexual life for 23 (27%). There was a greater impact on the DLQI due to body changes among women, injection drug users, patients with abdominal or breast lipoaccumulation, and patients with a high number of non-LD side effects. Multivariate proportional odds model analysis showed that the severity of non-LD-associated side effects and the presence of breast lipoaccumulation were associated with impaired psychosocial functioning. Specific characteristics of patients, antiretroviral-based side effects, and breast lipoaccumulation exert a greater impact on QoL in HIV-1-infected patients with LD.
Subject(s)
HIV Infections/complications , Lipodystrophy/etiology , Quality of Life , Adult , Female , HIV Infections/physiopathology , HIV Infections/psychology , HIV-1 , Humans , Lipodystrophy/physiopathology , Lipodystrophy/psychology , Male , Multivariate AnalysisABSTRACT
INTRODUCTION: Lipodystrophy (LD) represents an important problem for HIV-1-infected patients receiving highly active antiretroviral therapy (HAART), although its impact on quality of life (QoL) has not been properly studied. DESIGN: Cross-sectional, nonrandomized, observational study performed on consecutive, clinically stable outpatients taking HAART for more than 1 year. METHODS: Data on patients' characteristics, HIV-1 infection, treatment adherence and adverse effects, overall QoL measured by the Profil der Lebensqualität Chronischkranker (PLC), and the presence of LD defined by clinical criteria were assessed. RESULTS: Eighty-four (56%) of 150 interviewed patients fulfilled criteria for LD. Patients with LD were older, had been taking antiretroviral treatment longer, and reported a poorer physical status than patients without LD. Surprisingly, LD itself was not found to influence overall QoL. However, homosexual patients, unemployed patients, and those patients undergoing current psychiatric treatment showed greater impairment on some of the QoL subscales related to psychological well-being if they suffered from LD. CONCLUSION: The impact of HIV-related LD on QoL depends on certain patient characteristics, rather than on the presence of LD itself.
Subject(s)
Acquired Immunodeficiency Syndrome/drug therapy , HIV-1 , HIV-Associated Lipodystrophy Syndrome/physiopathology , Quality of Life , Adult , Antiretroviral Therapy, Highly Active , Cross-Sectional Studies , Employment , Female , HIV-Associated Lipodystrophy Syndrome/psychology , Humans , Male , Patient Selection , Social Class , Socioeconomic FactorsABSTRACT
Objetivo: Analizar la calidad asistencial que reciben los pacientes infectados por el virus de la inmunodeficiencia humana (VIH) en nuestro medio, concretamente en relación a la notificación del diagnóstico y a la relación médico-paciente. Pacientes y métodos: Se analizaron un total de 110 encuestas contestadas de forma anónima. Los cuestionarios se repartieron entre los pacientes controlados en el Hospital de Día de un Hospital General. La encuesta fue diseñada por el Instituto de Medicina Tropical de Bruselas con la finalidad de evaluar un amplio espectro de variables psicosociales agrupadas en cuatro apartados. Resultados: El primer apartado hace referencia a la interpretación que hace el paciente de la información recibida en el momento de diagnóstico. Destaca que el 75 por ciento de los pacientes manifestaba no haber discutido con el médico las consecuencias de ser seropositivo. El 66 por ciento decía no haber recibido sugerencias para informar a su pareja sexual. El segundo apartado analizaba la relación médico-paciente. El 84 por ciento refería haber tenido acceso suficiente al tratamiento y el 71 por ciento estaba contento con la duración de las visitas. La mayoría de los pacientes referían no haber discutido suficientemente las consecuencias de ser VIH positivo con su médico. Conclusiones: A pesar de que, en general, la notificación del diagnóstico de la infección por el VIH, no se realizaba en unas condiciones adecuadas, los pacientes mostraron un alto grado de satisfacción en relación a la asistencia médica recibida. (AU)
Subject(s)
Adult , Male , Humans , HIV-1/physiology , Quality of Health Care , Quality of Health Care/trends , Quality of Health Care/organization & administration , Physician-Patient Relations , Data Collection/methods , Surveys and Questionnaires , HIV/physiology , Occupational Accidents Registry , HIV Seropositivity/diagnosis , HIV Seropositivity/epidemiology , HIV Seropositivity/psychologyABSTRACT
BACKGROUND: Most HIV-infected patients attending a consultation-liaison psychiatry service show symptoms of anxiety and depression. The present study sought to evaluate the immediate and long-term efficacy of a structured cognitive-behavioural group therapy reducing anxiety and depression in HIV-infected patients referred to a consultation-liaison psychiatry department, and to identify baseline variables predictive of greater improvement. METHODS: Repeated-measures ANOVA was used to analyse changes in the Beck Depression Inventory (BDI) and the state subscale of the State/Trait Anxiety Inventory (STAI) administered to 39 participants at 4 time points: T1 (1 month before beginning the therapy), T2 (during the first session), T3 (during the last session) and T4 (3 months after the last session). The therapy consisted of 16 weekly 2-hour sessions following a structured time-limited cognitive-behavioural group psychotherapy programme. RESULTS: During the intervention time (between T2 and T3) an improvement was observed in depression and anxiety, which persisted after the 3-month follow-up period (between T3 and T4). No changes were observed during baseline (between T1 and T2). Patients with higher levels of anxiety at baseline showed greater improvement in STAI state subscale scores. Transmission of HIV infection through intravenous drug use was associated with less improvement on the BDI. CONCLUSIONS: This is the first report of an ongoing study which suggests long-lasting efficacy of a structured cognitive-behavioural group psychotherapy programme in a heterogeneous sample of HIV-1-infected patients referred to a consultation-liaison psychiatry unit.
