Health outcomes and psychosocial risk exposures among healthcare workers during the first wave of the COVID-19 outbreak

The Associated Factors of Work Engagement, Work Overload, Work Satisfaction, and Emotional Exhaustion and Their Effect on Healthcare Workers: A Cross-Sectional Study

Background: In today's fast-paced work environment, work engagement is crucial for both organizational success and individual well-being. Objective: Our aim is this study was to analyze the associated factors of work engagement, work overload, work satisfaction, and emotional exhaustion and describe their effect on nurses and physicians in the Central Catalonia Health Region during 2023. Methods: A multicenter cross-sectional study was conducted using an online questionnaire at the Territorial Management of Central Catalonia (Spain). The questionnaire was accessible from 28 November 2022 to 12 March 2023. The analysis was performed using the SPSS software. CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines were followed for communicating research results. Results: A total of 321 professionals answered the questionnaire, 60.7% of whom were nursing professionals and 39.3% of whom were medical professionals. Work overload, work satisfaction, and emotional exhaustion were associated with work engagement. Being a physician, permanent contracts, irregular work shifts, overtime, and salary were related to work overload and emotional exhaustion. Being a woman, salary, academic level, and irregular work shifts were related to work satisfaction. There was a gender inequality in work engagement among nursing professionals to the detriment of men. In terms of class inequality, there was a difference between occupational groups with respect to work overload and emotional exhaustion among women. Conclusions: Organizational practices need to be improved to promote greater engagement and work satisfaction, as well as to reduce emotional overload and exhaustion. This may include regulating unpaid overtime and promoting more stable working hours.

Correlations between well-being of nurses and psychosocial working conditions - a descriptive cross-sectional study

Introduction

Work in health care is classified as a difficult profession and nurses are considered among the professional group that is exposed to the permanent impact of occupational stress. Psychosocial working conditions and related hazards are defined as those aspects that have the potential to cause harm to an employee's mental or physical health. Lack of psycho-physical health well-being reduces job satisfaction and thus job commitment.

Aim

The aim of this study was to assess the overall well-being of nurses and examine the correlation between nurses' well-being and their assessment of psychosocial working conditions in conjunction with occupational and demographic factors.

Materials and methods

A descriptive cross-sectional survey was conducted among 526 nurses employed in a selected public clinical hospital in Poland. All nurses provided labor during the survey. A diagnostic survey method using the standardized Psychosocial Working Conditions questionnaire based on the demands-control-support stress model was used for measurement.

Results

The examined nurses rated highly job demands (mean 3.46) as well as the scale of desired changes (mean 3.44). The ability to control their work (mean 3.19) and the level of social support (mean 3.21) were rated at a slightly lower level. The scale of well-being was rated highest by respondents (mean 3.68). Several statistically significant correlations (p < 0.05) can be observed between the well-being scale and the other scales of psychosocial working conditions across age categories. The least correlated are the well-being and demands scales, although as age increases with higher levels of well-being, the demands scale scores decrease.

Conclusion

The well-being of the examined nurses was closely related to sociodemographic data and the individual scales of the Psychosocial Working Conditions questionnaire. Chronic diseases are associated with greater demands at work and reduced well-being. Respondents who receive higher levels of support at work experience higher levels of well-being.

Disclosing Strain: How Psychosocial Risk Factors Influence Work-Related Musculoskeletal Disorders in Healthcare Workers Preceding and during the COVID-19 Pandemic

Healthcare workers, particularly nurses, engage in a daily work routine that takes a toll on their emotional well-being, rendering them vulnerable to psychosocial risk factors. This research seeks to analyse the influence of psychosocial risk factors on the occurrence of work-related musculoskeletal disorders among nurses. An additional analysis was performed to understand the role of age in work-related musculoskeletal disorders and the perception of psychosocial risk factors. The study was conducted during two separate periods-pre-pandemic and pandemic times-involving a sample of 456 nurses from both public and private hospitals in Portugal. The INSAT-Health and Work Survey-was used as measuring instrument. The primary observations indicated a consistency between psychosocial risk factors and the occurrence of work-related musculoskeletal disorders. The findings revealed a significant exposure to psychosocial risk factors, with work pace, intensity, work relationships, and emotional demands exhibiting higher global average percentages during both periods, pre-pandemic and pandemic. Nonetheless, we find that the psychosocial risk factors change when we analyse the pre-pandemic and pandemic results. During the period before the pandemic, the psychosocial risk factors that were most commonly reported included the demanding pace of work, long working hours, and emotional demands. Through the pandemic, the most pronounced psychosocial risk factors were work relationships, employment relationships, and ethical and values conflicts. Therefore, research in this domain is essential to understanding psychosocial risk factors and assessing the less obvious links between work and health.

Stress and burnout in the context of workplace psychosocial factors among mental health professionals during the later waves of the COVID-19 pandemic in Hungary

Background

While literature is abundant on the negative mental health impact of the COVID-19 outbreak, few studies focus on the Central and Eastern European region.

Objectives

We examined stress, burnout, and sleeping troubles among mental health professionals in the context of psychosocial risk factors related to participation in COVID care during the fourth and fifth waves.

Materials and methods

Mental health professionals (N=268) completed an online cross-sectional survey in Hungary, between November 2021 and April 2022. Of the respondents, 58.2% directly participated in COVID care. The main data collection instrument was the Copenhagen Psychosocial Questionnaire (COPSOQ II), including 20 subscales on work-related psychosocial factors and 3 outcome scales (stress, burnout, and sleeping troubles). We added a question on competence transgression, and items on sociodemographic and professional background.

Results

Participation in COVID care was associated with higher work pace (59.08 versus 49.78), more role conflicts (55.21 versus 45.93), lower scores on the influence at work (38.18 versus 51.79), predictability (44.71 versus 57.03), reward (55.82 versus 65.03), role clarity (70.19 versus 75.37), social support from supervisor (59.24 versus 65.55), job satisfaction (54.36 versus 62.84), trust regarding management (55.89 versus 67.86), justice and respect (44.51 versus 54.35) scales. Among those involved in COVID care, only the stress score was higher (47.96 vs. 42.35) in the total sample; however, among psychiatrists, both stress (52.16 vs. 38.60) and burnout scores (58.30 vs. 47.06) were higher. Stepwise multiple regression revealed that work-family conflict, emotional demands and workplace commitment were independent predictors of higher stress and burnout scores; furthermore, competence transgression had a significant effect on stress, and being a psychiatric specialist had a significant effect on burnout. These models explained 40.5% of the variance for stress and 39.8% for burnout.

Conclusion

During the fourth and fifth waves, although COVID care was more well-organized, psychiatrists, as specialist physicians responsible for the quality of the care, were still experiencing challenges regarding their competence and influence at work, which may explain their increased levels of stress and burnout.

Psychosocial risk in healthcare workers after one year of COVID-19

BACKGROUND

The COVID-19 pandemic overwhelmed the capacity of the healthcare system, affecting the volume of demands and the care tasks of healthcare workers.

AIMS

To examine the health indicators and exposure to psychosocial risks of Spanish healthcare workers 1 year into the COVID-19 pandemic and compare them with the results of the first wave.

METHODS

We conducted a cross-sectional study using an online questionnaire (April-May 2020 and 2021). The data stem from the COTS 1 project database, corresponding to the first wave of COVID-19 (n = 1989) and COTS 2 (n = 1716) corresponding to 1 year later. The samples were independent. The prevalence of exposure to psychosocial risks and adverse health indicators was estimated for every occupational group, segregating the data by sex.

RESULTS

Professionals of all types presented worse perception of health. In general, the results were worse for women, while geriatric assistants presented the greatest exposure to psychosocial risk in COTS 2 compared to COTS 1. Sleep problems, high quantitative demands and high concern about becoming infected and spreading COVID-19 were cross-disciplinary in COTS 1, while worse perception of health, high pace of work, high work-life conflict and low development opportunities stood out in COTS 2.

CONCLUSIONS

Exposure to psychosocial risks was already high during the first wave and a significant decline in working conditions was observed. The prolongation of the pandemic exacerbated these results and seems to have multiplied the pre-existing inequalities between the axes of segregation in the labour market.

The effects of precarious employment and calling on the psychosocial health and work well-being of young and older workers in the care sector: a longitudinal study

OBJECTIVE

Employment conditions in the care sector are changing, and precarious employment (PE) is becoming more widespread, manifesting as undervaluation, adverse leadership, work overload, and inadequate control over work. This study aimed to examine changes in psychosocial health, work well-being, PE, and calling over time and explore the effects of PE and calling on psychosocial health and work well-being.

METHODS

The longitudinal study collected follow-up panel data in the three time points (2020, 2022, and 2023) from care workers (n = 1502), linear mixed effects models.

RESULTS

PE decreased (β =  - 0.02), and perceived work well-being increased (β = 0.04), but there were no change in psychosocial health (β =  - 0.01) and calling (β = 0.01) during the three-year period. Younger (< 39) care workers perceived higher levels of PE and had poorer psychological health. Moreover, PE had a negative effect on psychosocial health (β =  - 0.63) and work well-being (β =  - 0.68) and calling had a positive effect on psychosocial health (β = 0.41) and work well-being (β = 0.49) in multivariate models.

CONCLUSION

PE conditions affect work performance and employee well-being and may threaten patient care; therefore, it should be further investigated in the care sector. It is noteworthy that calling still seems to be central in care work. The results deepen the understanding of the current shortage crisis in health and social care workplaces but can also provide keys to resolving the crisis.

Exploring Novice Nurses' Experiences During the First Wave of the COVID-19 Pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic affected how nurses learn and prepare for their future careers. This study explored the experiences of college-prepared, novice nurses pursuing a baccalaureate degree during the first wave of the pandemic.

METHOD

This qualitative descriptive study analyzed students' individual reflective assignments describing the effects of the COVID-19 pandemic on novice nurses' personal, professional, and educational lives.

RESULTS

Three themes emerged: (1) emotions generated in the clinical workplace due to the lack of control and the unknown of working as novice nurses during a pandemic; (2) cognitive dissonance of the nursing role regarding novice nurses' moral distress and their growing empowerment within the scope of practice; and (3) a disconcerted image of nursing with contrasting views of nursing from the public's perspective and a disconnect between frontline workers and decision makers.

CONCLUSION

Novel pedagogical strategies are needed to help novice nurses cope with stress, uncertainty, and role challenges to foster healthy learning in academic and working environments. [J Nurs Educ. 2023;62(8):461-466.].

LCCNN: a Lightweight Customized CNN-Based Distance Education App for COVID-19 Recognition

In the global epidemic, distance learning occupies an increasingly important place in teaching and learning because of its great potential. This paper proposes a web-based app that includes a proposed 8-layered lightweight, customized convolutional neural network (LCCNN) for COVID-19 recognition. Five-channel data augmentation is proposed and used to help the model avoid overfitting. The LCCNN achieves an accuracy of 91.78%, which is higher than the other eight state-of-the-art methods. The results show that this web-based app provides a valuable diagnostic perspective on the patients and is an excellent way to facilitate medical education. Our LCCNN model is explainable for both radiologists and distance education users. Heat maps are generated where the lesions are clearly spotted. The LCCNN can detect from CT images the presence of lesions caused by COVID-19. This web-based app has a clear and simple interface, which is easy to use. With the help of this app, teachers can provide distance education and guide students clearly to understand the damage caused by COVID-19, which can increase interaction with students and stimulate their interest in learning.

The moderation of satisfaction with working conditions in the association between workload and mental health among healthcare workers collecting test samples in the post-COVID-19 era

Background

This study aimed to examine the associations between workload and satisfaction with working conditions and mental health (i.e., anxiety disorder, depression, and somatization) of healthcare workers collecting test samples during the local outbreaks of COVID-19, and explore satisfaction with working conditions as a moderator of these relationships.

Methods

A total of 1,349 participants were obtained via an online survey in Zhengzhou, Henan Province, China. Multivariate regression was used to assess the associations between workload and satisfaction with working conditions and anxiety disorder, depression, and somatization. The simple slope analysis and Johnson-Neyman technique were used to assess the effect value and change trend of the moderator.

Results

The prevalence of anxiety disorder, depression, and somatization were 8.6, 6.9, and 19.2% of healthcare workers collecting test samples, respectively. High levels of workload were associated with an increased risk of an anxiety disorder (OR = 1.81, 95%CI = 1.17-2.78), depression (OR = 1.92, 95%CI = 1.19-3.10), and somatization (OR = 1.90, 95%CI = 1.40-2.57), while high satisfaction of working conditions was associated with a reduction in the risk of these outcomes, and ORs (95%CI) were 0.35 (0.20-0.64), 0.27 (0.13-0.56), and 0.32 (0.21-0.48), respectively. The findings also indicated that a weaker association between workload and anxiety disorder, as well as depression and somatization, has been reported in those with a high level of satisfaction with working conditions.

Conclusion

Workload significantly increased the risk of healthcare workers suffering from psychological problems, while satisfaction with working conditions alleviated these negative effects, and effective resource support was crucial for healthcare workers.

Psychosocial risks emerged from COVID-19 pandemic and workers' mental health

This paper examines the impact of work in a pandemic context on workers' mental health. Psychosocial risks have always been a challenging aspect of workplace health and safety practices. Moreover, the COVID-19 pandemic has affected workplaces in all sectors causing unexpected changes in work organization and working conditions, leading to the emergence of new psychosocial risks for health and wellbeing of workers. This mini-review aims to identify the main work stressors during pandemic period and related mental health problems to suggest recommendations and adjust health and safety practices regarding workplace mental health. A literature search has been performed using MEDLINE/PubMed, ResearchGate and Google Scholar databases, selecting articles focusing on work-related stressors and workers' mental health problems related to the pandemic. Specific psychosocial risks have been identified, including fear of contagion, telework-related risks, isolation and stigmatization, rapid digitalization demands, job insecurity, elevated risk of violence at work or home, and work-life imbalance, among others. All those risks can lead to elevated levels of stress among workers and affect their mental health and wellbeing, especially in terms of psychological distress, anxiety, and depression. As one of the social determinants of health, the workplace has an important and moderating role in workers' health. Therefore, in the pandemic context more than ever health protection practices at the workplace should be devoted to mental health problems. Recommendations provided in this study are expected to contribute to workplace practices to preserve and promote workers' mental health.

The Influence of Psychosocial Factors according to Gender and Age in Hospital Care Workers

Even though psychosocial risks can affect the entire working population regardless of demographic variables, multiple publications claim that women are more exposed to psychosocial risks and that psychosocial risks affect people in a different way, depending on their age. This study aims to investigate demographic differences (i.e., sex and age) in health care workers, with an aim which is twofold: (i) To know if these geographic differences lead to differences in perception of psychosocial risks; and (ii) to identify the job demands and resources with the highest impact on work engagement and performance. A sample of 4,451 people from the sanitary sector, pertaining to 75 Spanish hospitals, was analyzed to test the hypotheses. ANOVA results demonstrated that women show significantly higher impact values in job demands than men, as well as higher values in job resources. Moreover, the group of younger people (< 40 years) showed significantly lower levels in demands, and significantly higher in job resources, wellbeing, and organizational outcomes. Finally, multi-group SEM analyses showed that the impact of job demands and resources on work engagement and performance is significant, regardless of sex and age, although there are changes in the coefficients. The differences in the perception of job demands and resources of the different demographic groups can be used to develop specific psychosocial intervention in health care workers.

Healthcare Workers' Mental Health in Pandemic Times: The Predict Role of Psychosocial Risks

Background

Healthcare workers perform an emotionally exhausting daily work activity, making them prone to occupational hazards, namely psychosocial ones. This study aims to assess the impact of psychosocial risk factors on healthcare workers' mental health.

Methods

A cross-sectional study was developed between May and June of 2021 with 479 healthcare workers from Portuguese hospitals. The Depression, Anxiety and Stress Scale was used to assess mental health, and psychosocial risks were assessed through the Health and Work Survey - INSAT. Statistical analysis was performed to identify the psychosocial risk factors related to anxiety, depression, and stress. Subsequently, a multiple linear regression was performed to identify the models that better explained psychosocial risk factors' relationship with anxiety, depression, and stress.

Results

Data showed a strong exposure to psychosocial risks. Work pace and intensity, work relationships, and emotional demands stood out with higher global average percentages for yes answers to "exposure and discomfort." The analysis of the β values and p-values from the multiple linear regression shows that some cross-sectional psychosocial risks are predictors of anxiety and stress dimensions, and other psychosocial risks differ in the two mental health dimensions. However, it is important to highlight that healthcare workers still showed great joy and pleasure in performing their work activities.

Conclusion

Support network development in the work environment is needed to prevent healthcare workers' emotional stress and promote their psychological well-being. Therefore, new research is essential to understand the psychosocial risks that affect healthcare workers and assess the less visible effects of work-health relationships.

A Nomogram-Based Study: A Way Forward to Predict the Anxiety Status in Medical Staff During the COVID-19 Pandemic

BACKGROUND AND OBJECTIVE

Anxiety influences job burnout and health. This study aimed to establish a nomogram to predict the anxiety status of medical staff during the coronavirus disease (COVID-19) pandemic.

METHODS

A total of 600 medical members were randomized 7:3 and divided into training and validation sets. The data was collected using a questionnaire. Logistic regression analysis and Akaike information criterion (AIC) were applied to investigate the risk factors for anxiety. Odds ratio (OR) and 95% confidence interval (95% CI) were calculated to establish a nomogram.

RESULTS

Participation time (OR=44.28, 95% CI=13.13~149.32), rest time (OR=38.50, 95% CI=10.43~142.19), epidemic prevention area (OR=10.16, 95% CI=3.51~29.40), epidemic prevention equipment (OR=15.24, 95% CI=5.73~40.55), family support (OR=9.63, 95% CI=3.55~26.11), colleague infection (OR=6.25, 95% CI=2.18~19.11), and gender (OR=3.30, 95% CI=1.15~9.47) were the independent risk factors (P<0.05) for anxiety in medical staff. The areas under the receiver operating characteristic (ROC) curves of the training and validation sets were 0.987 and 0.946, respectively. The decision curve's net benefit shows the nomogram's clinical utility.

CONCLUSION

The nomogram established in this study exhibited an excellent ability to predict anxiety status with sufficient discriminatory power and calibration. Our findings provide a protocol for predicting and identifying anxiety status in medical staff during the COVID-19 pandemic.

Mental health inequalities in times of crisis: evolution between 2005 and 2021 among the Spanish salaried population

BACKGROUND

Studying the working population's mental health in times of crisis (such as the 2008 recession or the COVID-19 pandemic) is very relevant. This study aims to assess the prevalence of poor mental health among the Spanish salaried population, according to the labour market inequality axes (2005-2021).

METHODS

Repeated cross-sectional study by comparing different surveys from 2005, 2010, 2016 and 2021 on workers residing in Spain who had been working in a salaried job during the week preceding the survey. n=7197 (2005), n=4985 (2010), n=1807 (2016) and n=18 870 (2021).

OUTCOME VARIABLE

poor mental health (Mental Health Inventory of the 36-item Short Form Health Survey scale). Explanatory variables: gender, age, occupational class and type of contract. Prevalence of poor mental health was estimated for each year by means of logistic regression models with robust clustered SEs, stratifying by the explanatory variables. Additionally, prevalence ratios (PR) were estimated by means of robust Poisson regression models to assess differences between the explanatory variables' categories. All analyses were weighted to address unrepresentativeness.

RESULTS

Poor mental health significantly increased in 2021 (55.92%), compared with the previous years of study (15%-17.72%). Additionally, pattern changes were identified on inequality axes in 2021, with better mental health status among older workers (oldest group PR: 0.76; 95% CI 0.71 to 0.8) and permanent workers (PR: 0.9; 95% CI 0.85 to 0.94).

CONCLUSION

This study shows a steep worsening of mental health among the salaried population in 2021 compared with previous periods. In 2021, health inequalities have apparently narrowed, although not by improving the disadvantaged groups' mental health but by worsening the typically advantaged groups' mental health.

Anxiety, Depression and Post-Traumatic Stress Disorder in Physicians Compared to Nurses during the COVID-19 Pandemic: An Observational, Cross Sectional, Multicentric Study

(1) Background: The coronavirus pandemic has highlighted the precarious health situation of our country, thanks to the grueling workloads caused by understaffing and fear of contracting COVID-19. By considering this critical situation, frontline healthcare professionals who have been directly involved in the diagnosis, treatment, and care of SARS-CoV-2 patients are now at risk of developing psychological distress and other mental health symptoms, accomplices of the fear of contracting the COVID-19 and the exhausting workloads. (2) Methods: An observational, cross-sectional, multicenter study was conducted by administering an online questionnaire to all Italian physicians and nurses who worked during the COVID-19 pandemic. The questionnaire consists of socio-demographic characteristics, an assessment of anxiety levels with the State-Trait Anxiety Inventory (STAI), which also assessed trait and state anxiety, the Beck Depression Inventory (BDI) to evaluate the condition of depressive severity, and, finally, the Impact of Event Scale–Revised (IES–R), which was administered in order to quantify the post-traumatic stress disorder (PTSD) among the participants. (3) Results: A total of 770 Italian healthcare workers were enrolled in this study. Of these, 95 (12.30%) were physicians and 675 (87.70%) were nurses. By considering PTSD, anxiety, and depression levels between the physicians and nurses recruited, a significant difference was reported in the STAI-1 assessment, as both physicians and nurses reported slight and moderate levels (p = 0.033). (4) Conclusions: Physicians and nurses, who have been subjected to physical impoverishment, with the infinite physical forces spent to support the pace of work at the limits of the possible, but above all mental capacity, with the anxiety of having to face an unknown enemy, such as COVID-19. This has resulted in a significant increase in anxiety, depression, post-traumatic symptoms, and sleep disturbances, with possible repercussions not only on the quality of life of the physicians and nurses but also on the quality of assistance provided.

Restarting MSMEs and start-ups post COVID-19: a grounded theory approach to identify success factors to tackle changed business landscape

Purpose

Small businesses and start-ups have started to reopen post coronavirus disease 2019 (COVID-19) lockdowns but are facing numerous challenges mainly due to changed customer preferences and the need to fine-tune the business models. This research aims to identify the important aspects that start-ups need to focus on, as they weather the COVID-19 pandemic storm.

Design/methodology/approach

Research uses constructivist grounded theory methodology to analyse data collected through in-depth semi-structured interviews with entrepreneurs and senior employees at start-ups. A conceptual model based on nine categories impacting a start-up’s performance is investigated. Interview memos are thematically analysed to identify repeated ideas, concepts or elements that become apparent.

Findings

Study reveals that employees’ and customers’ safety, prudent cost management and online presence/doorstep services are key for start-ups to succeed today's changed business landscape due to COVID-19.

Practical implications

Findings act as a practical guide for start-ups in setting mechanisms, optimizing operations and fine-tuning strategy to address COVID-19 challenges. Start-ups are advised to evaluate the implications of the three findings on their respective businesses to successfully tackle the challenges posed by COVID-19.

Originality/value

This research, being cognizant of a start-up’s unique characteristics and nuances, takes a fresh approach to identify key aspects that start-ups need to focus on and fine-tune in the wake of COVID-19. The paper enriches scientific research of understanding impact of COVID-19 on organizations by specifically surfacing how start-ups can learn and adapt by knowing how other start-ups are surviving today.

The impact of carbon pricing, climate financing, and financial literacy on COVID-19 cases: go-for-green healthcare policies

Climate finance and carbon pricing are regarded as sustainable policy mechanisms for mitigating negative environmental externalities via the development of green financing projects and the imposition of taxes on carbon pollution generation. Financial literacy indicates that it is beneficial to invest in cleaner technology to advance the environmental sustainability goal. The current wave of the COVID-19 epidemic has had a detrimental effect on the world economies' health and income. The pandemic crisis dwarfs previous global financial crises in terms of scope and severity, collapsing global financial markets. The study's primary contribution is constructing a climate funding index (CFI) based on four critical factors: inbound foreign direct investment, renewable energy usage, research and development spending, and carbon damages. In a cross-sectional panel of 43 nations, the research evaluates the effect of climate funding, financial literacy, and carbon pricing in lowering exposure to coronavirus cases. The study utilized Newton-Raphson and Marquardt steps to estimate the current parameter estimates while evaluating the COVID-19 prediction model with level regressors using the robust least squares regression model (S-estimator). Additionally, the innovation accounting matrix predicts estimations over a specific period. The findings indicate that climate finance significantly reduces coronavirus exposure by introducing green financing initiatives that benefit human health, which eventually strengthens the immune system's ability to fight infectious illnesses. Financial literacy and carbon pricing, on the other hand, are ineffectual in controlling coronavirus infections due to rising economic activity and densely inhabited areas that enable the transmission of coronavirus cases across countries. Similar findings were obtained using the alternative regression apparatus. The COVID-19 predicted variable was used as a "response variable," and climate financing was shown to have a favorable impact on containing coronavirus exposure. As shown by the innovation accounting matrix, carbon pricing would drastically decrease coronavirus cases' exposure over a time horizon. The study concludes that climate finance and carbon pricing were critical in improving air quality indicators, which improved countries' health and wealth, allowing them to reduce coronavirus infections via sustainable healthcare reforms.

Nurses' Physical and Psychological Symptoms During the first COVID-19 Lockdown in Italy: a Nationwide Cross-Sectional Study in Stem Cell Transplantation Setting

BACKGROUND AND OBJECTIVE

Northern Italy was one of the first European territories to deal with the Coronavirus Disease 2019 (COVID-19) outbreak. Drastic emergency restrictions were introduced to contain the spread and limit pressure on healthcare facilities. However, nurses were at high risk of developing physical, mental, and working issues due to professional exposure. The aim of this cross-sectional study was to investigate these issues among nurses working in Italian hematopoietic stem cell transplant (HSCT) centers during the COVID-19 pandemic.

METHODS

Data were collected online immediately after the first "lockdown" period in order to investigate the prevalence of physical issues, sleep disorders, and burnout symptoms and explore correlations with COVID-19 territorial incidence in Northern Italian regions versus Central and Southern Italian regions.

RESULTS

Three hundred and eight nurses working in 61 Italian HSCT Units responded to the survey. Depression, cough, and fever were more frequently reported by nurses working in geographical areas less affected by the pandemic (p=0.0013, p<0.0001, and p=0.0005 respectively) as well as worst sleep quality (p=0.008). Moderate levels of emotional exhaustion (mean±SD -17.4±13.0), depersonalization (5.3±6.1), and personal accomplishment (33.2±10.7) were reported without significant differences between territories.

CONCLUSIONS

different COVID-19 incidence among territories did not influence nurses' burden of symptoms in the HSCT setting. However, burnout and insomnia levels should be considered by health care facilities in order to improve preventive strategies.