The Cooperation Between Occupational and Public Health Stakeholders and Its Decisive Role in the Battle Against the COVID-19 Pandemic

Referring psychiatric patients to occupational health services for earlier return to work - a qualitative implementation study of barriers and facilitators

BACKGROUND

Mental disorders are a major public health challenge, and their prevalence is globally increasing. They substantially affect work ability, quality of life, and the number of years of disability. A new model for referring psychiatric patients to occupational health services (OHS) aims to improve the continuity of care and to promote the early return to work (RTW) of workers with diagnosed mental health conditions. The purpose of this qualitative implementation study was to identify the facilitators of and barriers to implementing the new model.

METHODS

We used the Quality Implementation Framework and the Consolidated Framework for Implementation Research (CFIR) as theoretical frameworks. We interviewed the developers of the model and the psychiatrists and occupational health physicians who deliver it. We invited forty participants to join the study, 17 of whom consented. We conducted nine semi-structured group and individual interviews. Data analysis consisted of analysing the sessions, systematically coding the transcribed texts according to the main domains of CFIR, thematic analysis, and identifying the overarching themes and context-related mechanisms.

RESULTS

We identified three overarching themes crucially related to the implementation of the model: uncertainty about the scope and boundaries of the cooperation in the model, ambiguity about the size of the target group, and the existing sociocultural and self-stigma related to mental illness. Shared belief in the importance and the positive effects of the model and trust in the developers were the main facilitators of the implementation of the model. The main barriers were the limited availability of the e-referral system between the psychiatrists and OHS, uncertainty regarding the number of eligible patients, and the low number of actual referrals during implementation.

CONCLUSION

Collaborative models in mental health care should accommodate various stakeholders from different sectors involved in the treatment and rehabilitation of workers with diagnosed mental health conditions. Helping health care workers contact possible cooperation partners and knowing how to address important individual, workplace-related and sociocultural factors such as stigma may strengthen collaboration between different sectors and stakeholders in mental health care. Future studies should focus on the multi-actor feasibility of the new collaborative models and include the patients' perspective.

Factors associated with occurrence of workplace violence against healthcare workers during the COVID-19 pandemic: a meta-analysis

Objectives. Healthcare systems all over the world are increasingly alarmed by the prevalence of workplace violence (WPV) directed at healthcare workers (HCWs) during the COVID-19 pandemic. Therefore, the aim of the current review was to investigate the factors associated with WPV against HCWs during the COVID-19 pandemic. Methods. This study was conducted in December 2021. Four international databases along with two Iranian databases were searched. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement served as the foundation for the reporting procedure. Results. A total of 13 articles were included in the analysis. Results showed that females are less at risk of WPV (odds ratio [OR] 0.76, 95% confidence interval [CI] [0.67, 0.84], p = 0.000 based on a fixed-effects model). Moreover, significant association was found between education level (OR 1.09, 95% CI [1.05, 1.14]), age (correlation = 0.025, 95% CI [0.014, 0.036]) and work experience (correlation = 0.028, 95% CI [0.016, 0.016]) and WPV. Conclusion. The primary factors linked to WPV exposure were found to be gender, education level, age and work experience. Additional research is necessary to provide more accurate and detailed data.

Securing the future of IoT-healthcare systems: A meta-synthesis of mandatory security requirements

INTRODUCTION

Healthcare-based Internet of Things (Healthcare-IoT) is a turning point in the development of health information systems. This emerging trend significantly contributes to enhancing users' awareness of their health, ultimately leading to an extension in life expectancy. Security and privacy are among the greatest challenges for H-IoT systems. To establish complete safety and security in these systems, the implementation of mandatory security requirements is imperative. For this reason, this study identifies the necessary security requirements for H-IoT systems using a Meta-Synthesis approach.

METHODS

Initially, following the Seven-Stage Sandelowski & Barroso approach, the existing literature was searched in the Scopus and Web of Science databases. Among the 844 extracted articles from the period of 2010 to 2020, 78 final articles were reviewed and analyzed, leading to the identification of 51 security requirements. Subsequently, to assess the quality of the identified requirements and their overlap, interviews were conducted with two experts.

RESULTS

Finally, 14 security requirements, predominantly with technical and quantitative aspects, were identified for designing a Healthcare-IoT system and implementing security mechanisms.

CONCLUSION

The findings of this study emphasize that addressing the identified 14 security requirements is crucial for safeguarding Healthcare-IoT systems and ensuring their robustness in the evolving health information landscape.

The prevalence, related factors and interventions of oncology nurses' burnout in different continents: A systematic review and meta-analysis

BACKGROUND

Burnout is a significant occupational problem among oncology nurses, affecting their physical and mental health and the quality of medical care. Besides, there is a gradually increasing trend that we should pay more attention to.

OBJECTIVES

To investigate the prevalence, influencing factors and interventions of oncology nurses' burnout among different continents.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

English literature in PubMed, EMBASE, MEDLINE/EBSCOhost, CINAHL Complete and Web and of Science were searched before 1 March 2022.

RESULTS

Twenty studies included 5904 oncology nurses in this review. Meta-analysis was performed in 19 of the studies. First, the pooled mean scores estimate for emotional exhaustion (EE) was 22.13 (95% CI: 19.69-24.58), depersonalization (DP) was 6.89 (95% CI: 5.67-8.10) and personal accomplishment (PA) was 32.86 (95% CI: 29.34-36.37). A high level of burnout was defined as a high level of EE (score ≥ 27), a high level of DP (score ≥ 10), and a low level of PA (score ≤ 33). Of these, 36.40% of nurses reported high EE, 28.26% reported high DP and 28.68% reported low levels of PA. Furthermore, there are differences in the prevalence, influencing factors and intervention measures of burnout among oncology nurses in different regions. The highest pooled mean scores for EE and DP were found in Asia. And the highest pooled mean scores for PA were found in the Americas. The factors that influence burnout among Asian oncology nurses are mostly personal-related factors such as empathy and personality traits, while the factors that influence burnout among European oncology nurses are work-related factors. This review included three intervention studies from Europe and the Americas, with fewer intervention studies on burnout in oncology nurses in Asia.

CONCLUSION

Oncology nurses in Asia had the highest pooled mean scores for EE and DP, and the highest mean scores for the PA pool in the Americas. There are regional differences in the prevalence and factors influencing burnout among oncology nurses, but there are few interventions for it. Therefore, future interventions should be developed to address the differences that exist in different regions.

RELEVANCE TO CLINICAL PRACTICE

Burnout among oncology nurses in different regions is a concern, and this review may provide a reference for managers to target interventions to alleviate burnout among oncology nurses.

Nurse burnout before and during the COVID-19 pandemic: a systematic comparative review

Introduction

This review aimed to compare available evidence examining burnout using the Maslach Burnout Inventory (MBI) in nurses before and during the COVID-19 pandemic. The specific objective was to compare nurse burnout scores in terms of emotional exhaustion, depersonalization, and personal accomplishment.

Methods

A comprehensive search was conducted for studies on nurses' burnout using the MBI published between 1994 and 2022. In total, 19 studies conducted prior to the pandemic and 16 studies conducted during the pandemic were included and compared using the criteria from the Joanna Briggs Institute Critical Appraisal Tool.

Results

Surprisingly, the results indicated that nurses' burnout scores did not differ significantly before (N = 59,111) and during (N = 18,629) the pandemic. The difference observed was qualitative rather than quantitative.

Discussion

The outbreak of the COVID-19 pandemic exacerbated an already critical situation, and while COVID-19 may serve as an additional triggering factor for staff mental illness, it cannot solely explain the observed burnout levels. These findings underscore the need for long-term clinical and preventive psychological interventions, suggesting that psychological resources should not be limited to emergencies but extended to address the ongoing challenges faced by nurses.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=399628, identifier: CRD42023399628.

Occupational Health Services Have a Relevant Role in Protecting the Health and Safety of Paramedics

In this Letter to the Editor, the authors point out occupational health and safety risks for paramedics, and highlight the relevant role carried out by multidisciplinary occupational health services in the prevention of occupational risks and the promotion of physical and mental well-being of these workers.

Epidemiological Characteristics of a COVID-19 Outbreak in a Psychiatric Hospital in Chung-buk

This study investigated the causes and risks for infection spread in three psychiatric hospitals in Chung-buk, South Korea, to strategize measures to block transmission and prevent a large-scale epidemic. From December 2020 to January 2021, 358 inpatients of Psychiatric Hospitals A, B, and C were enrolled to identify the epidemiological characteristics of confirmed patients. Epidemic curves and propagation relationships were constructed and a genotype analysis was conducted. The index case inpatient from Hospital A transmitted the infection to patients in Hospitals B and C; the infection was confirmed in 47, 193, and 118 patients in Hospitals A, B, and C, respectively. The patient characteristics hampered communication and the close identification of symptom onset. The incidence rate was 10 (2.9%) among employees and 348 (35.8%) among inpatients. The relative risk was 12.1 (95% CI: 6.6-22.5) times higher among inpatients than employees. Next-generation sequencing confirmed the probable infection source as a genotype identical to that of two different outbreaks, although the infection spread was undetermined. Direct risk factors emerged from patient characteristics, wherein cohort isolation was meaningless due to uncontrolled communication. Indirect risk factors included hospital-specific problems due to external factors (non-patient system deficiencies or employee negligence). Prior inspections, a confirmation of non-infection, and institutional emergent measures are needed.

Impact of tiered measures on social contact and mixing patterns of in Italy during the second wave of COVID-19

BACKGROUND

Most countries around the world enforced non-pharmaceutical interventions against COVID-19. Italy was one of the first countries to be affected by the pandemic, imposing a hard lockdown, in the first epidemic wave. During the second wave, the country implemented progressively restrictive tiers at the regional level according to weekly epidemiological risk assessments. This paper quantifies the impact of these restrictions on contacts and on the reproduction number.

METHODS

Representative (with respect to age, sex, and region of residence) longitudinal surveys of the Italian population were undertaken during the second epidemic wave. Epidemiologically relevant contact patterns were measured and compared with pre-pandemic levels and according to the level of interventions experienced by the participants. Contact matrices were used to quantify the reduction in the number of contacts by age group and contact setting. The reproduction number was estimated to evaluate the impact of restrictions on the spread of COVID-19.

RESULTS

The comparison with the pre-pandemic baseline shows a significant decrease in the number of contacts, independently from the age group or contact settings. This decrease in the number of contacts significantly depends on the strictness of the non-pharmaceutical interventions. For all levels of strictness considered, the reduction in social mixing results in a reproduction number smaller than one. In particular, the impact of the restriction on the number of contacts decreases with the severity of the interventions.

CONCLUSIONS

The progressive restriction tiers implemented in Italy reduced the reproduction number, with stricter interventions associated with higher reductions. Readily collected contact data can inform the implementation of mitigation measures at the national level in epidemic emergencies to come.

Italian good practice recommendations on management of persons with Long-COVID

A significant number of people, following acute SARS-CoV-2 infection, report persistent symptoms or new symptoms that are sustained over time, often affecting different body systems. This condition, commonly referred to as Long-COVID, requires a complex clinical management. In Italy new health facilities specifically dedicated to the diagnosis and care of Long-COVID were implemented. However, the activity of these clinical centers is highly heterogeneous, with wide variation in the type of services provided, specialistic expertise and, ultimately, in the clinical care provided. Recommendations for a uniform management of Long-COVID were therefore needed. Professionals from different disciplines (including general practitioners, specialists in respiratory diseases, infectious diseases, internal medicine, geriatrics, cardiology, neurology, pediatrics, and odontostomatology) were invited to participate, together with a patient representative, in a multidisciplinary Panel appointed to draft Good Practices on clinical management of Long-COVID. The Panel, after extensive literature review, issued recommendations on 3 thematic areas: access to Long-COVID services, clinical evaluation, and organization of the services. The Panel highlighted the importance of providing integrated multidisciplinary care in the management of patients after SARS-CoV-2 infection, and agreed that a multidisciplinary service, one-stop clinic approach could avoid multiple referrals and reduce the number of appointments. In areas where multidisciplinary services are not available, services may be provided through integrated and coordinated primary, community, rehabilitation and mental health services. Management should be adapted according to the patient's needs and should promptly address possible life-threatening complications. The present recommendations could provide guidance and support in standardizing the care provided to Long-COVID patients.

Analysis of the sense of occupational stress and burnout syndrome among physiotherapists during the COVID-19 pandemic

The nature of physiotherapists' work involves an increased risk of occupational stress and burnout, particularly during the COVID-19 pandemic. Therefore, the aim of the study was to analyse the level of perceived generalised stress, the occupational stress and the occupational burnout syndrome among physiotherapists during the COVID-19 pandemic. One hundred seventy professionally active physiotherapists participated in the study: 100-during the pandemic and 70 before the COVID-19 pandemic. The study was carried out using the authors' survey, the Subjective Work Assessment Questionnaire (SWAQ), the Oldenburg Burnout Inventory (OLBI), the Perceived Stress Scale (PSS-10), and the Brief Coping Orientation to Problems Experienced (Mini-COPE) inventory. The physiotherapists examined prior to the pandemic exhibited a higher level of generalised stress and higher level of occupational stress and occupational burnout (p = 0.0342; p < 0.00001; p < 0.00001, respectively). The key factors which caused intensified occupational stress in both groups included the lack of rewards at work, social interaction, and the lack of support. The results suggest that healthcare professionals including physiotherapists are exposed to occupational stress and a high risk of occupational burnout, not only during the COVID-19 pandemic. Occupational stress prevention programmes should be based on the identification and elimination of all occupational risks.

Assessing the Feasibility and Effectiveness of a Linkage Into Mental Health Care Program for Adults Affected by Hurricane Sandy

OBJECTIVE

Research indicates that greater exposure to Hurricane Sandy is associated with increased mental health difficulties. This study examined whether Project Restoration, a program that linked adults into mental health care (L2C), was effective in reducing post-Sandy mental health difficulties as compared to a cohort of adults matched on mental health difficulties that were not linked into post-Sandy mental health care.

METHODS

Project Restoration participants (n = 52) with elevated self-reported mental health difficulties had the option to enroll into L2C. Project LIGHT (n = 63) used similar methodologies but did not have a L2C component and served as the matched control group.

RESULTS

Multivariable modeling showed significant decreases in all mental health difficulties except for depression in the Project Restoration group, whereas there were no significant decreases in LIGHT. The decrease in anxiety from baseline to follow-up was significantly greater for Project Restoration as compared to LIGHT.

CONCLUSION

Findings confirm the powerful impact community outreach and treatment have on reducing mental health difficulties after a disaster.