The impact of psychological stress on physiological indicators in healthcare workers: a cross-sectional study.

Background: Medical health workers play an essential role in the healthcare system and face unique workplace stressors. However, the impact of psychological stress on their physical health has received less attention compared to the general population. Methods: We retrospectively analyzed the Self-rating Depression Scale (SDS) questionnaires and blood testing results from 1963 medical health workers. Multivariate linear regression analysis using a backward stepwise selection strategy to identify physical examination indicators that were significantly affected by depression. Results: Depression severity, as measured by SDS index score, was positively correlated with the levels of hemoglobin (coefficient 0.0027, p = 0.0412), platelet count (coefficient 0.0005, p = 0.0198), and uric acid (coefficient 0.0004, p = 0.0492), while negatively correlated with red blood cell count (coefficient-0.0895, p = 0.0406). Similar results were observed in the subgroup analysis stratified by age and sex. Conclusion: Our study found a significant association between higher levels of depression and specific physiological indicators in healthcare professionals, including elevated hemoglobin, platelet counts, and uric acid levels, as well as decreased red blood cell counts. These changes in blood parameters may reflect underlying physiological stress and inflammation, potentially increasing overall health risks for healthcare workers. Addressing these physiological changes may be crucial for mitigating the health risks associated with depression. To validate our findings and develop targeted interventions, larger multi-center studies are needed to further explore the relationship between depression severity and blood parameters in healthcare professionals.

Proteomic biomarkers of long-term lung function decline in textile workers: a 35-year longitudinal study.

BACKGROUND: Occupational exposures contribute significantly to obstructive lung disease among textile workers. However, biomarkers associated with such declines are not available. OBJECTIVES: We conducted a large-scale proteomic study to explore protein biomarkers potentially associated with long-term lung function decline. METHODS: Shanghai Textile Workers Cohort was established in 1981 with 35 years of follow-up, assessing textile workers' lung functions every five years. Quantitative serum proteomics was performed on all 453 workers at 2016 survey. We employed four distinct models to examine the association between forced expiratory volume in one second (FEV1) and proteins, and consolidated the findings using an aggregated Cauchy association test. Furthermore, proteomic data of UK Biobank (UKB) was used to explore the associations of potential protein markers and decline of FEV1, and the interactions of these proteins were examined through STRING database. Associations were also externally validated using two-sample Mendelian randomizations (MR). RESULTS: 15 of 907 analyzed proteins displayed potential associations with long-term FEV1 decline, including two hemoglobin subunits: hemoglobin subunit beta (HBB, FDR-qACAT = 0.040), alpha globin chain (HBA2, FDR-qACAT = 0.045), and four immunoglobulin subunits: immunoglobulin kappa variable 3-7 (IGKV3-7, FDR-qACAT = 0.003), immunoglobulin heavy chain variable region (IgH, FDR-qACAT = 0.011). Five proteins were significantly associated with the rate of decline of FEV1 in UKB, in which RAB6A, LRRN1, and BSG were also found to be associated with proteins identified in Shanghai Textile Workers Cohort using STRING database. MR indicated bidirectional associations between HBB and FEV1 (P < 0.05), while different immunoglobulin subunits exhibited varying associations with FEV1. IMPACT STATEMENT: We performed a large-scale proteomic study of the longest-follow-up pulmonary function cohort of textile workers to date. We discovered multiple novel proteins associated with long-term decline of FEV1 that have potential for identifying new biomarkers associated with long-term lung function decline among occupational populations, and may identify individuals at risk, as well as potential pharmaceutical targets for early intervention.

Digital entanglements: Medical drones in African healthcare systems.

The intensified scramble for the digitalisation of healthcare across Africa, coupled with the general drive for digital economies, has ushered in digital health innovations that are reconfiguring national discourses on humanitarian and development contexts. Through these innovations, imaginaries of health have become entangled with aspirations for universal health coverage (UHC) and the actualisation of the health-related sustainable development goals (SDGs). Among these innovations, drones promise to leapfrog and transform conventional African healthcare systems, which have suffered from structural bottlenecks for years, offering citizens on the margins of care critical biomedical gazes. By using drones, African states hope to improve revenue collection, curb corruption, redress health insecurities and deliver life-saving medicines, vaccines and laboratory diagnostics through a last-mile distribution schedule. Ethnographic fieldwork from 2022 to 2023 in Ghana and Malawi on the use of drones found distortions to the health workforce, disruptions to health work, and a pervasive internal brain drain, all exacerbating health-worker shortages. This paper explores how drones are reconfiguring health work and its available labour force in practice amid persistent shortages of health-workers.

The influence of occupational noise exposure on blood pressure and hearing loss among female workers of childbearing age.

OBJECTIVES: Women exposed to occupational noise experience adverse pregnancy outcomes. Therefore, we initiated a large, population-based, cross-sectional study to further investigate the effects of occupational noise on hearing and blood pressure among female workers of childbearing age. STUDY DESIGN AND SETTING: A total of 6981 childbearing-aged female workers were selected for this cross-sectional study. Basic characteristics of participants were analyzed by comparing the exposed and control groups. Logistic regression models were employed to calculate the odds ratios (ORs) and 95% confidences intervals (CIs) for the associations of occupational noise with levels of hearing loss and blood pressure. The associations were further explored through stratification by age and duration of noise exposure. RESULTS: Compared with participants not exposed to occupational noise, increasing years of occupational noise exposure were independently associated with an elevated risk of hypertension after adjustment of age, industry classification, enterprise size and economic type. Compared to participants not exposed to occupational noise, only the prevalence of bilateral hearing loss was significantly higher after adjustments for age, industry classification, enterprise size and economic type. Compared with those with normal hearing, the ORs and 95% CIs were 1.97 (0.95-4.07), 2.22 (1.05-4.68) and 1.29 (1.06-1.57) for bilateral, unilateral and any ear hearing loss, respectively. CONCLUSIONS: Occupational noise exposure is positively associated with both hypertension and bilateral hearing loss among female workers of childbearing age. Those exposed to occupational noise show an increased risk of hypertension after adjusting for potential confounders.

The requirements of providing health education for rural people through electronic methods: the experiences and perspectives of community health workers.

BACKGROUND: Reliance solely on traditional approaches in health education is no longer considered sufficient, and electronic/digital education can be a complementary approach. Implementing electronic methods in health education requires identifying the requirements from the perspective of the service providers. Therefore, this study aimed to elucidate the experiences and perspectives of community health workers (Behvarzan) regarding the requirements for providing health education for rural people through electronic/digital means. METHODS: This descriptive qualitative study was conducted in 2022 at Alborz University of Medical Sciences. Data were collected through semi-structured interviews with 14 Behvarzan from Health Houses (HH) in Karaj City. The data were analyzed using the inductive Elo & Kyngas approach and conventional content analysis facilitated with MAXQDA software. RESULTS: After analyzing the results, we extracted 139 open codes, and by merging them for more precise coding and to facilitate the research process, we formed three main themes and ten subthemes. The themes included Technology (technical infrastructure, content production, content delivery methods, and content delivery channels), Facilities and equipment (communication equipment and electronic content repositories), and Stakeholders (training of providers, motivating providers, persuading learners and target groups, and reference groups). CONCLUSION: From the perspective of rural healthcare workers, the implementation of electronic education requires necessary technology, equipment, facilities, processes, and content should be pursued and provided through specialized working groups, extending from the Ministry of Health and Medical Education to local HHs. These resources should be available to the healthcare workers and their target populations. Concurrently, educational programs and incentives should be defined and offered at the university level and within health networks for rural healthcare workers and their populations.

Reducing the particles generated by flushing institutional toilets. Part II: Assessing a portable and reusable toilet cover in U.S. hospitals.

Flushing uncovered toilets in hospitals has been shown to produce toilet plume aerosols (TPA) in a wide size ranging from nanometers to micrometers. Studies have shown that TPA can carry infectious pathogens and hazardous drugs used in cancer treatment. To mitigate the risk of exposure, some researchers have recommended covering the toilet during flushing, and guidelines from the Oncology Nursing Society have specifically recommended covering the toilet when flushing excreta from patients receiving chemotherapy. Because existing literature primarily focused on controlled laboratory settings or small case studies, there has been a need for a real-world, multi-center study in clinical settings to measure TPA by flushing both covered and un-covered toilets. To address this gap, the authors initiated a multicenter study to measure TPA in clinical settings and to assess the effectiveness of a commercially available, portable, and reusable toilet cover. The study enrolled 15 hospital centers (145 toilets) in nine U.S. states which included seven National Cancer Institute (NCI)-designated comprehensive cancer centers. The particle number concentrations were measured using a TSI optical particle counter (TSI 9306) with six size bins (0.3 to 25.0 µm) positioned 22 inches above the floor. The results showed that the ambient particle number concentrations in the HEPA-filtered floor bathrooms (376 ± 857#/L) are significantly lower than the non-HEPA-filtered ones (7,432 ± 9,207#/L). The mean particle number concentrations generated by flushing are 3,951 ± 8,606#/L with a median of 1,916#/L, ranging from 136#/L to 71,959#/L. Results with cover demonstrated a reduction in the total number of particles of 101 ± 11% regardless of the HEPA filter usage (p = 0.0002 in the Mann-Whitney U test). Mixed-effects modeling revealed that the overall level of particle reduction is substantial regardless of state (nine total), floor levels, flush volumes, and inpatient versus outpatient. This study provides evidence supporting the use of the tested portable toilet cover as an intervention to reduce healthcare workers', patients', and visitors' exposure to toilet plume aerosols in clinical settings.

Tailoring HIV Care for Black Populations: A Pilot Feasibility Prospective Cohort Study.

BACKGROUND: Research has shown that integrating community health workers (CHWs) into the formal health care system can improve outcomes for people living with HIV, yet there is limited literature exploring this framework among marginalized minority populations. OBJECTIVE: Herein, we discuss the feasibility of a clinic-embedded CHW strategy to improve antiretroviral therapy adherence among Black people living with HIV in Miami-Dade County, Florida, a designated priority region for the US Department of Health and Human Services' Ending the HIV Epidemic Initiative. METHODS: From December 2022 to September 2023, three CHWs were trained and integrated into the hospital workflow to provide support as members of the clinical team. Ten Black adults with an HIV viral load over 200 copies/mL were enrolled to received 3 months of CHW support focused on navigating the health system and addressing poor social determinants of health. Intervention feasibility was based on 4 criteria: recruitment rate, demographic composition, study fidelity, and qualitative feedback on CHW perceptions. RESULTS: Participants were recruited at a rate of 5.7 participants per month, with the sample evenly distributed between men and women. Retention was moderately strong, with 7 (70%) of the 10 participants attending more than 75% of CHW sessions. Qualitative feedback reflected CHW perceptions on clinical interactions and intervention length. CONCLUSIONS: Outcomes indicate that a clinic-integrated CHW approach is a feasible and acceptable methodology to address adverse social determinants and improve HIV treatment adherence. By offering targeted social and clinical support, CHWs may be a promising solution to achieve sustained viral suppression and care engagement for Black people living with HIV.

Exploring Empathic Communication Among Community Health Workers: Applying the ENACT Tool in Two South African Sites.

Introduction. Effective empathic communication between health care providers and patients is an essential part of health care. In resource-poor contexts, evidence is needed to understand the quality and content of health care communication within real-life clinical engagements. We used the existing Enhancing Assessment of Common Therapeutic Factors (ENACT) tool to measure empathic communication skills among a group of community health workers (CHWs) receiving a novel quality improvement intervention called Nyamekela4Care in South Africa. Methods. In two resource-limited sites in the Western Cape, South Africa, we audio-recorded CHWs, with consent, in routine client consultations at baseline and postintervention. All sessions were in Afrikaans. We used the adapted ENACT tool to rate recordings at both timepoints, assessing 11 items including communication skills, emotional engagement, process and interaction. We used ANOVA to assess preimplementation and postimplementation differences in empathic communication, and analyzed coders' feedback on the coding process itself. Results. We analyzed n = 66 recordings from 11 CHWs, observing positive directionality overall, with most skills improving over time. Despite near-significant improvements in communication delivery (p = .083), self-confidence/groundedness (p = .029) significantly changed but in the opposite direction. Large effect sizes were observed in verbal communication, responsiveness to client, and identifying external resources, with no significant difference between timepoints. ENACT was feasible to apply to audio recordings; inter-coder reliability was suboptimal despite coder training and ongoing monitoring and support. Discussion. Quality improvement interventions may improve empathic skills in diverse contexts, and our results demonstrate how empathic skills could be more routinely assessed in low-resource health care settings.

Behind the Headset: Predictive Accuracy of Patient-Reported Outcome Measures for Voice Symptoms in Call Centers.

Objective: This study examines factors predicting self-reported voice symptoms in call center workers. Methods: Multivariate analysis and predictive modeling assess personal, work-related, acoustic, and behavioral factors. Generalized Linear Models (GLMs) and Receiver Operating Characteristic (ROC) curves are employed. Results: Age and sleep patterns impacted voice quality and effort, while workplace factors influenced symptom perception. Unhealthy vocal behaviors related to tense voice and increased effort, while hydration was protective. Voice acoustics showed diagnostic potential, supported by ROC data. These findings emphasize voice symptom complexity in call center professionals, necessitating comprehensive assessment. Limitations: This study recognizes its limitations, including a moderate-sized convenience sample and reliance on PROM metrics. Future research should incorporate more objective measures in addition to self-reports and acoustic analysis. Value: This research provides novel insights into the interplay of personal, occupational, and voice-related factors in developing voice symptoms among call center workers. Predictive modeling enhances risk assessment and understanding of individual susceptibility to voice disorders. Conclusion: Results show associations between various factors and self-reported voice symptoms. Protective factors include sleeping more than six hours and consistent hydration, whereas risk factors include working conditions, such as location and behaviors like smoking. Diagnostic models indicate good accuracy for some voice symptom PROMs, emphasizing the need for comprehensive models considering work factors, vocal behaviors, and acoustic parameters to understand voice issues complexity.

Objetivo: Este estudio examina los factores que predicen los síntomas de voz en los trabajadores de call centers. Métodos: Se utilizan análisis multivariados y modelos predictivos para evaluar factores personales, laborales, acústicos y de comportamiento. Se emplean Modelos Lineales Generalizados (GLM) y curvas ROC. Resultados: La edad y los patrones de sueño afectaron la calidad vocal y el esfuerzo, mientras que los factores laborales influyeron en la percepción de síntomas. Los comportamientos vocales no saludables se relacionaron con voz tensa y mayor esfuerzo, mientras que la hidratación fue protectora. Los parámetros acústicos de voz mostraron potencial diagnóstico respaldado por datos de ROC. Los hallazgos subrayan complejidad de síntomas vocales en profesionales de centros de llamadas, requiriendo una evaluación integral. Limitaciones: Este estudio reconoce sus limitaciones, que incluyen una muestra de conveniencia de tamaño moderado y la dependencia de medidas PROMs. Futuras investigaciones deberían incorporar medidas objetivas, además de los autorreportes y análisis acústico. Importancia: Esta investigación aporta nuevos conocimientos sobre factores personales, laborales y síntomas de voz en trabajadores de call centers. El modelado predictivo mejora la evaluación de riesgos y la comprensión de la susceptibilidad individual a trastornos de la voz. Conclusión: Los resultados muestran asociaciones entre diversos factores y los síntomas vocales reportados. Los factores de protección incluyen dormir más de seis horas y una hidratación constante; los factores de riesgo incluyen las condiciones de trabajo, como la ubicación y comportamientos como fumar. Los modelos de diagnóstico indican una buena precisión para algunas PROMs de síntomas de la voz, lo que subraya la necesidad de modelos integrales que tengan en cuenta los factores laborales, los comportamientos vocales y los parámetros acústicos para comprender la complejidad de los problemas de la voz.

Implementation research on registering cancer cases in primary health centres of Puducherry through community health workers.

Background & objectives Hospital-based cancer registry does not represent the true burden of cancer in the community. Initiating a Primary Health Centre (PHC)-based cancer registry may better estimate population-level data for cancer cases in an area. This study aimed to set up a system for facilitating a PHC-based cancer registry and to assess the registration status of cancer cases in various PHCs of Puducherry. The facilitating and limiting factors while setting up this registry were also assessed. Methods A quasi-experimental study with an embedded mixed-method design was conducted in 31 PHCs/Community Health Centres (CHCs) from March 2021 to November 2022. The interventions were implemented in all PHCs/CHCs of Puducherry with the involvement of the State Non-Communicable Diseases (NCD) cell. The line list of cancer cases from the Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) Hospital-based cancer registry was shared with all PHCs/CHCs. Sensitization sessions for all Community Health Workers (CHWs) were conducted, and feedback on cancer registration status was given to the State NCD cell. Focus group discussion (FGD)/Key informant interview (KII) was undertaken to understand strengths, challenges, and suggestions. The logic model was used to understand the various indicators while setting up this PHC-based cancer registry. Results Over a one-year intervention period, 1270 cancer cases were registered at Puducherry's PHCs/CHCs, 1203 (88%) from the shared list and 67(5%) from other facilities. However, only 53 per cent of the expected living cases were captured in the various PHCs. Major limitations for registration were the COVID-19 pandemic, stigma, inadequate manpower, infrastructure issues, and privacy concerns during screening. Interpretation & conclusions It was feasible to set up a PHC-based cancer registry in all PHCs of Puducherry. However, registration of cancer cases was suboptimal, as population-based screening of cancer cases, as recommended in the National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD) programme, was weak due to the COVID-19 pandemic. Once this is strengthened, the PHC-based cancer registry will better represent the population.

Experiences of primary eye care use among adults in Southern Ethiopia: A qualitative study.

Background: Primary eye care (PEC) is an important component of comprehensive eye care services that allows communities to enjoy basic high-quality services. However, because of various determinants, communities do not use this service. Aim: This study aimed to explore and describe the experience of adults who used PEC services in the last 6 months. Setting: This study was carried out in four districts in southern Ethiopia from June to September 2023. Methods: An exploratory descriptive qualitative study design was used to understand the experiences of adults 40 years and older who had used PEC services. Six focus group discussions were conducted with a total of 48 participants. A nonprobability purposive sampling technique was used to draw participants. Data were analysed thematically using ATLAS.ti software version 23.2.2. Results: Primary eye care service use experiences of adults 40 years and above were discussed in terms of three emerging themes: the experience of community service use, barriers to service and suggestions to improve service. The study identified poor access to services, service provider-related factors and quality and awareness gaps as barriers to the use of PEC services. Conclusion: Attention to PEC services, integration of eye care with other primary health care services, deployment of service providers, awareness creation and expansion of PEC units are needed to improve PEC service use. Contribution: The findings will guide community-based intervention plans to reduce avoidable blindness and low vision, thus improving quality of life.

Inclusive education and related policies in special needs schools in South Africa.

Background: Post-apartheid, the education system shifted its focus from a segregated education system to an inclusive education system, which resulted in greater consideration of the role and function of special needs schools. In 2014 the National Department of Basic Education developed and implemented an inclusive approach and policies to provide guidelines on the running of special needs schools (SNS). The study was conducted in six SNS in Ekurhuleni South District, South Africa. Objectives: The study explored the experiences of teachers and healthcare workers when implementing policies in SNS in the study area. Method: This exploratory qualitative study used purposive sampling to select 13 teachers and healthcare workers for in-depth interviews. Collected data were analysed using inductive thematic analysis and ATLAS-ti version 23. Results: Teachers and healthcare workers had different working experiences and understandings about inclusive education and policies, as well as their role in implementing these policies. Experienced challenges included lack of training, limited resources, lack of parental support, issues with differentiated curriculum, an unacceptable teaching environment; and poor referral systems. These challenges evoked strategies such as improvising, collaborating, and referring. Participants indicated that they required further training, resources, and support to successfully implement inclusive policies. Conclusion: Both teachers and healthcare workers agreed that resources were lacking at all SNS represented. Staff training was urgently needed as the current curricula at SNS were differentiated for learners with physical and intellectual disabilities. Contribution: Findings may inform policy implementation and change in SNS.

Moral distress and protective work environment for healthcare workers during public health emergencies.

BACKGROUND: Public health emergencies, such as the Covid-19 pandemic, put great pressure on healthcare workers (HCW) across the world, possibly increasing the risk of experiencing ethically challenging situations (ECS). Whereas experiencing ECS as a HCW in such situations is likely unavoidable, mitigation of their adverse effects (e.g., moral distress) is necessary to reduce the risk of long-term negative consequences. One possible route of mitigation of these effects is via work environmental factors. OBJECTIVES: The current study aimed to examine: [1] risk factors associated with ECS among HCW [2], intensity of moral distress associated with ECS across various occupational factors (i.e., profession, degree of exposure to patients with Covid-19), and [3] the impact of work environmental factors on this association, in a sample of HCW during the pandemic. METHODS: We employed multiple logistic and linear regression to self-report data from 977 HCWs at four Norwegian hospitals responding to a survey at the fourth wave of the pandemic. RESULTS: About half of HCW in this study had experienced ECS during the pandemic, and levels of moral distress associated with such were higher than in previous studies using similar assessment methods. Younger age, female sex, geographical work area (mid-north of Norway), and profession (nurse) were all associated with higher odds (range of OR: 1.30-2.59) of experiencing ECS, as were direct contact with patients with Covid-19. Among those participants who reported that they had experienced ECS during the pandemic, moral distress levels when recalling those situations were moderate (Mean 5.7 on a 0-10 scale). Men reported somewhat lower intensity of moral distress (partial eta squared; ηp2 = 0.02). Reporting a manageable workload (ηp2 = 0.02), and greater opportunity to work according to best practice (ηp2 = 0.02), were associated with lower levels of moral distress. CONCLUSIONS: Our findings suggest that moral distress could potentially be mitigated on an organizational level, particularly by focusing on ensuring a manageable workload, and an ability to work according to best practice. To build sustainable healthcare systems robust enough to withstand future public health emergencies, healthcare organizations should implement measures to facilitate these aspects of HCWs' work environment.

Accelerating Success of HIV/AIDS Control Programs: The Significance of Health-Care Workers' Competence.

Background: - Despite the competence-building framework and interventions, the success of HIV/AIDS prevention and treatment programs remains unsatisfactory with scanty empirical evidence on the significance of professional competence to the success of HIV/AIDS control programs. Methods: - Using a triangulation of quantitative and qualitative data, from 40 health-care workers and 9 managers of the HIV/AIDS program in Kagadi District, this article analyzes the professional and cultural competencies among health-care workers and the significance of the competencies to the success of HIV/AIDS control programs. Descriptive statistics were generated to describe health-care workers' opinions on their competence and success of HIV/AIDS control programs. In addition, a regression model was fitted to estimate the contribution of health-care workers' competence to the success of HIV/AIDS control programs. This quantitative analysis was triangulated with a thematic analysis of key informants' views. Results: - Findings indicate that health-care workers' competence bears a positive statistically significant contribution to the success of HIV/AIDS control programs. Employee competence is necessary but not sufficient to foster the full realization of desired results from HIV/AIDS control programs. Conclusion: - Managers of HIV/AIDS control programs need to prioritize and continuously train health-care workers to boost their professional and cultural skills to effectively deliver interventional activities under HIV/AIDS control programs. Additionally, improving the working environment of health-care workers is critical to improve their motivation towards greater success of HIV/AIDS control programs.

COVID-19-Related Risk Factors for Developing Occupational Contact Dermatitis Along With Its Incidence, Prevention, and Management: A Systematic Review.

Occupational contact dermatitis (OCD) is an eczematous local inflammatory skin irritation caused by repeated use of hand sanitizer and other chemical substances. Occupational irritant contact dermatitis (OICD) and occupational allergic contact dermatitis (OACD) are the two variants of CD that cannot be identified clinically. Hand dermatitis (HD) is typically assessed as a clinical consequence because it affects the hands most frequently at work as per epidemiological studies on OCD. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 standards were followed when conducting this umbrella review. We used the search terms "Occupational Contact Dermatitis AND COVID-19" to search for the most pertinent papers in full text on the databases PubMed/MedLine, ScienceDirect, and PubMed Central (PMC). Additionally, the reference section of the papers was used to find more articles. A total of 11,646 results were found, and eight papers remained after applying the inclusion criteria (full-text papers, English language, studies published in the previous 10 years, involving humans, and only systematic reviews). After completing the title and abstract screening, we obtained five papers. Next, the full-text screening and AMSTAR quality check were completed, yielding the same five papers. After searching ScienceDirect, five papers that met the inclusion criteria were included, and six papers were selected from the references, yielding a total of 11 papers. The causes of occupational dermatitis from protective face masks are discussed in this review. We anticipate an increase in the incidence of occupational dermatitis linked to face mask use given that a large segment of healthcare workers (HCWs) wear protective face masks. To understand the prevalence and available therapies for mask-related occupational dermatitis, further well-designed research is required.

'Pain free if I ever will be': lived experience of workers seeking care for pain attributed to musculoskeletal disorders.

BACKGROUND: Pain attributed to musculoskeletal disorders are a significant hinderance to work ability and economic growth, especially in developing countries. Quality of life and lived experience of workers with musculoskeletal disorders have not been explored enough to determine whether person-centred care is provided. There is a wealth of evidence for using the biomedical approach in the management of workers with musculoskeletal disorders, which has proved ineffective in reducing absenteeism and symptoms experienced by workers. The purpose of this study was to explore the lived experience of workers seeking care for musculoskeletal disorders and how their pain attitudes and beliefs influenced their experience. METHODS: A qualitative approach with thematic analysis was used. Purposive sampling was used to recruit six participants for semi-structured interviews. All participants were either experiencing pain attributed to a musculoskeletal disorder or had received care for a musculoskeletal disorder. RESULTS: Pain attitudes and beliefs of workers with a musculoskeletal disorder and healthcare professionals greatly influenced the care and recovery process of musculoskeletal disorders. There is a primary biomedical lens informing care of workers with musculoskeletal disorders received. Workers expect healthcare professionals to explore their concerns further, but the focus of care for most participants was their presenting complaint. There is also a need for the autonomy of workers to be preserved, and communication between healthcare professionals and workers with musculoskeletal disorders needs to improve. CONCLUSIONS: Many stakeholders are involved in the recovery process from musculoskeletal disorders. There is a need for a biopsychosocial informed practice to improve return-to-work (RTW) in workers with musculoskeletal disorders. Change is needed at all healthcare system levels to reduce the negative experiences of workers and maladaptive pain beliefs that is associated with persisting symptoms and extended absenteeism.

Risky Business. Interventions to Prevent Aggression Against Health Workers From Patients at Risk: An Integrative Review.

AIM: To identify best practices to prevent violence against healthcare workers by patients at risk for aggression in the adult inpatient setting. DESIGN: An integrative review. METHODS: Conducted using the Johns Hopkins Evidence-based Practice for Nurses and Healthcare Professionals Model. Title and abstract screening on 4186 articles resulted in 156 for full text review. Full text screening yielded 14 articles that met inclusion criteria. DATA SOURCES: A search of the databases PubMed, CINAHL, Embase, and JBI from January 2019 to February 2023. RESULTS: The review revealed behavioural intervention teams, environmental changes, and coordinated communication plans were the most used strategies, however none demonstrated significant decreases in violence. CONCLUSIONS: Health systems can implement strategies shown to decrease the incidence of violence in healthcare settings globally. Lack of consistency in the evidence suggests the need for further research to assess mitigating strategies for violence against healthcare workers in inpatient hospital settings. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Patient safety is a cornerstone of nursing practice; however, healthcare workers need to feel safe in their work environment. Violent events are chronically underreported, ill defined, and when reported, do not address change in the practice setting. Identifying strategies to address escalating behaviour before it results in violence is crucial for everyone's safety. IMPACT: This integrative review exposes the scarcity of evidence available to address rising concerns about patients on healthcare provider violence (Type II) in the workplace. Although several assessment tools for identifying violent patients exist, evidence regarding prevention is woefully absent. The review highlights potential interventions for further study to equip healthcare workers to manage patients safely and effectively before an escalation occurs. REPORTING METHOD: PRISMA checklist for integrative reviews. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was part of this review.

Factors predicting the level of vaccine protection against hepatitis B virus infection among physicians and nurses in Sabac, Serbia.

As healthcare workers run a high and constant occupational risk of hepatitis B virus (HBV) infection through exposure to biological material, vaccination is mandatory as well as the monitoring of antibody levels one to two months after complete immunisation. The aim of this descriptive cross-sectional study was to determine HBV vaccine coverage of 200 primary and secondary healthcare workers (100 each) from Sabac, Serbia and their blood anti-HBs titre. We also wanted to identify factors that could predict the titre. Anti-HBV vaccination covered all participants, of whom 89.5 % were fully vaccinated, and 85 % had a protective antibody titre. We found a statistically significant association between antibody titre and the number of received vaccine doses, chronic jaundice, autoimmune disease, and cancer in our participants. The fact that 15 % did not achieve the protective antibody titre confirms the necessity of its control after immunisation, which is not routinely carried out in most countries, Serbia included. It is, therefore, necessary to develop a detailed strategy for monitoring vaccination and serological status of healthcare workers in order to improve their safety at work. An important role should also be given to continuous education of healthcare workers from the beginning of schooling to the end of their professional career.

Waning immune response to CoronaVac in health care workers from different age groups.

Introduction: The waning of serum antibodies against severe acute respiratory syndrome coronavirus 2 observed in several studies raises questions about long-term immunity. Lower antibody levels are associated with new cases of COVID-19 even postvaccination, leading to the administration of booster doses. Objectives: To evaluate the postvaccination immune humoral response and the relationship between postvaccination seropositivity rates and demographic data among health care workers 6 months after CoronaVac vaccination. Methods: This was a cross-sectional study including health care workers vaccinated with two doses of CoronaVac after 6 months or more. The present study was conducted with the analysis of postvaccination serology test to assess the level of humoral response (anti-receptor binding domain IgG) after vaccination. Results: A total of 325 participants were enrolled, of whom 76% were female, with a median age of 42 years (20-85; interquartile range 31-53). Overall, 18.8% (61) of the participants results were seropositive for anti-receptor binding domain IgG; 81.2% did not have sufficient quantitative titers. The IgG titers obtained from female health care workers did not differ from those obtained from seropositive male health care workers, regardless of age. Conclusions: A group of positive quantitative titers was identified in the serology test for IgG antibodies against severe acute respiratory syndrome coronavirus 2. Further studies are needed to determine the durability of postvaccination antibodies and how serology testing can be used to determine the ideal timing for booster doses of the vaccine.

Introdução: O declínio dos anticorpos séricos contra a síndrome respiratória aguda grave do coronavirus 2 observado em vários estudos levanta questões sobre a imunidade a longo prazo. Níveis mais baixos de anticorpos estão associados a novos casos de covid-19 mesmo após a vacinação, levando à administração de doses de reforço. Objetivos: Avaliar a resposta imunitária humoral após a vacinação e a relação entre as taxas de soropositividade após a vacinação e dados demográficos em trabalhadores da saúde por mais de 6 meses após a imunização com CoronaVac. Métodos: Estudo transversal incluindo profissionais de saúde vacinados com duas doses de CoronaVac após 6 meses ou mais. O estudo foi realizado com a análise do teste sorológico após a vacinação para avaliar os níveis de resposta humoral (anti-domínio de ligação ao receptor IgG) após a vacinação. Resultados: Neste estudo foram incluídos 325 participantes, 76% do sexo feminino e a idade mediana foi de 42 anos (20-85; intervalo interquartil 31-53). No geral, 18,8% (61) dos resultados dos participantes foram soropositivos para IgG anti-domínio de ligação ao receptor; 81,2% não apresentaram títulos quantitativos suficientes. Os títulos de IgG obtidos para os profissionais de saúde do sexo feminino não foram diferentes daqueles obtidos para os participantes do sexo masculino com soropositividade, independentemente da idade. Conclusões: Foi possível identificar um grupo com títulos quantitativos positivos no teste sorológico para anticorpo IgG contra a síndrome respiratória aguda grave do coronavírus 2. Mais investigações são necessárias para determinar a durabilidade dos anticorpos após a vacinação e como os testes sorológicos podem determinar o momento ideal das doses de reforço da vacina.

Comparing personality traits of healthcare workers with and without long COVID: Cross-sectional study.

Aim: Pathological mechanisms of "long COVID" after recovery from the main symptoms of COVID-19 are unclear. We compared psychological differences between individuals with and without long COVID symptoms after initial COVID-19 infections. Methods: This study includes medical workers with and without history of COVID-19. We assessed the degree of depression, health-related quality of life (HRQOL), the degree of anxiety and fear of COVID-19, and we used an original questionnaire. In the COVID-19 group, we also assessed personality traits and anxiety. The COVID-19 group was subclassified into those with and without long COVID to examine differences in circumstantial and psychological examinations. Results: Of 310 participants (141 men, 169 women, median age: 40 years), 167 had history of COVID-19 (83/84, 37 years) and 143 did not (58 men/85 women, 46 years). In the COVID-19 group, 26 had long COVID (12/14, 32 years) and 141 did not (58/85, 46 years). Fewer participants in the COVID-19 group had had COVID-19 vaccinations. The long COVID group had higher number of symptoms at the time of illness and higher NEO Five Factor Inventory Neuroticism scores than the non-long COVID group. They also had poorer mental health according to HRQOL than those without. Conclusion: Risk factors for long COVID may include the number of symptoms at the time of illness and neurotic tendency on NEO Five Factor Inventory. Participants with long COVID had poorer mental health according to HRQOL. People with long COVID might be especially sensitive to and pessimistic about the symptoms that interfere with their daily lives, resulting in certain cognitive and behavioral patterns. They may benefit from early psychiatric intervention.