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.

[Go to the health center or go to the drug store? Pharmacy offices as a primary care resource]. / Ir al centro de salud o bajar a la farmacia? Las oficinas de farmacia como recurso de atención primaria.

OBJECTIVE: To find what the pharmacy office represents socially to the population that uses it most. DESIGN: Qualitative study. Analysis of the contents of two discussion groups. PARTICIPANTS: Women from 30 to 60 years old, urban residents of the Community of Madrid. MEASUREMENTS AND MAIN RESULTS: The pharmacy offices were identified by the user as a primary care resource which was accessible--both because of its closeness and opening hours--and trustworthy. They provided health care support for treating minor ailments ("assisted self-medication") and also advised on medical technicalities and use of medication. Users with potentially serious clinical pictures were referred from the pharmacy to the doctor. The images associated with "going to the doctor" lacked the nearness and familiarity of "dropping round to the pharmacy". CONCLUSIONS: Integrating pharmacy office pharmacists into a general primary care framework would improve the health of the general population.

¿Ir al centro de salud o bajar a la farmacia? Las oficinas de farmacia como recurso de atención primaria / Go to the health centre or drop round to the chemist's? pharmacy offices as a primary health care resource

Objetivo. Conocer las representaciones sociales que sobre la oficina de farmacia tiene la población más frecuentadora. Diseño. Estudio cualitativo. Análisis del discurso producido por 2 grupos de discusión. Participantes. Mujeres de 30-60 años, residentes urbanas de la Comunidad de Madrid. Mediciones y resultados principales. Las oficinas de farmacia son identificadas por el usuario como un recurso de atención primaria accesible -tanto por su cercanía como por sus horarios- y de confianza. En ellas se realiza una actividad asistencial de apoyo para el tratamiento de dolencias menores ('automedicación asistida'), y por otro lado se aconseja sobre tecnicismos médicos y sobre el uso de la medicación. Desde la farmacia se deriva al médico a los usuarios con cuadros potencialmente graves. Las imágenes asociadas a 'ir al médico' carecen de la cercanía y familiaridad que se asocia a 'bajar a la farmacia'. Conclusiones. La integración de los farmacéuticos de la oficina de farmacia dentro de un marco global de atención primaria supondría una mejora para la salud de la población (AU)

[Outbreak of cryptosporidiosis in Guadarrama (Autonomous Community of Madrid)]. / Brote de criptosporidiosis en Guadarrama (Comunidad Autónoma de Madrid).

BACKGROUND: In spring of 1998, an acute gastroenteritis outbreak, which mainly affected preschool children, took place in Guadarrama (Community of Madrid, Spain). METHODS: A descriptive and analytical (cases and controls) study of the outbreak was done. Stool samples of the cases were taken to microbiological investigation. The tap water getting system of the municipality was inspected and samples were collected to microbiological analysis. RESULTS: Twenty one children from 0 to 5 years-old had liquid diarrhea which lasted more than five days. A significant statistical association was found within tap water consumption and gastroenteritis [OR = 5.73 (1.18-43.30); p < 0.05]. It did not have association with other variables investigated. Cryptosporidium parvum (Cp) oocysts were detected in stool samples of eight cases. Deficiencies were observed in the tap water getting and treatment system of the municipality but no oocysts were found in the analysis of the water. CONCLUSIONS: The results of the epidemiological investigation support that the source of the gastroenteritis outbreak was tap water, likely contaminated with Cp. While this parasite was not detected in the analysis of the water, it is explainable for the difficulties which this technique involves. In our review similar descriptions of outbreaks have not been found in Spain, but it seems that this reports are not infrequent in neighbour countries. Therefore, Cp should be borne in mind in diagnostic and management of these situations.

[Hepatitis B prevention and risk of HIV infection in children injured by discarded needles and/or syringes]. / Prevención de hepatitis B y riesgo de infección por VIH en niños accidentados con agujas y/o jeringuillas abandonadas.

OBJECTIVES: Main aim: to study the application of mixed prophylaxis against Hepatitis B viral infection (HB) in children injured by discarded needles and/or syringes. Secondary aim: to find in the group under study the incidence of HIV infection caused by these accidents. DESCRIPTION: Descriptive study. SETTING: 12 de octubre University Hospital, Madrid. PATIENTS: Children injured by discarded needles and/or syringes and referred to the Preventive Medicine Service between May 1988 and April 1995 (7 years). INTERVENTIONS: 1) Serological study for HB and HIV; 2) application to unprotected children of HB mixed prophylaxis (specific Immunoglobulin--IGHB--plus vaccination) and 3) Post-vaccination serological check-ups for HB and HIV at 6 and 12 months from the incident. MEASUREMENTS AND MAIN RESULTS: 249 children, whose average age was 5.8 +/- 3.37, were seen (158 boys, 63.5% and 91 girls, 36.5%). 189 (75.9% of the total) received a dose of IGHB and 171 (71.8%) completed the HB vaccinations. Post-vaccination serological check-ups covered 144 children (84.2%). 101 children (40.6%) completed the HIV check-ups. No HIV infection was detected. CONCLUSIONS: 1) HB mixed prophylaxis in children without serological protection is adequate for dealing with these incidents. 2) The risk of HIV infection should not be discounted, but is probably very slight. 3) The procedure should be put into practice in PC, with some shortening of HIV follow-up periods, as a measure to improve compliance.