Stressors, manifestations and course of COVID-19 related distress among public sector nurses and midwives during the COVID-19 pandemic first year in Tasmania, Australia

Impacts of the COVID-19 pandemic on the mental health of healthcare workers has been established, linking workplace factors with high levels of stress, anxiety, depression, insomnia and burnout. Less established is how COVID-19 affects both work, home and social life of nurses and midwives concurrently. This study describes the prevalence and severity of anxiety, depression, post-traumatic stress disorder (PTSD) and insomnia and examines their associations with stressors within the work, home and social environment, among nurses and midwives. A longitudinal, mixed-methods, online survey explored the psychological health of public sector nurses and midwives during the COVID-19 pandemic first year. Surveys were conducted in April (initial) and June 2020 (3-month), and April 2021 (12-month) and consisted of psychological tests including the Patient Health Questionnaire, General Anxiety Disorder, Insomnia Severity Index, and the Impact of Events Scale-Revised; workplace and lifestyle questions, together with free-text comments. The relative strengths of the associations between predictor and outcome variables were estimated using repeated measures ordered logistic regression, and free text responses were themed. Data show diagnostic levels of anxiety (23%, 18%, 21%) at surveys one, two and three respectively, depression (26%, 23% and 28%), PTSD (16%, 12% and 10%) and insomnia (19%, 19% and 21%). The strongest predictors of psychological distress were current home and family stress and poor clinical team support. Factors which will help preserve the mental health of nurses and midwives include strong workplace culture, reducing occupational risk, clear communication processes, and supporting stable and functional relationships at home. The COVID-19 pandemic has increased the visibility of mental distress on nurses and midwives and established they are pivotal to healthcare. The health service has a duty-of-care for the welfare of nurses and midwives who have entered this psychologically taxing profession to future proof service delivery and safeguard its service-response capacity.

Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trial

Background

Preoperative education and breathing exercise training by a physiotherapist minimises pulmonary complications after abdominal surgery. Effects on specific clinical outcomes such as antibiotic prescriptions, chest imaging, sputum cultures, oxygen requirements, and diagnostic coding are unknown.

Methods

This post hoc analysis of prospectively collected data within a double-blinded, multicentre, randomised controlled trial involving 432 participants having major abdominal surgery explored effects of preoperative education and breathing exercise training with a physiotherapist on postoperative antibiotic prescriptions, hypoxemia, sputum cultures, chest imaging, auscultation, leukocytosis, pyrexia, oxygen therapy, and diagnostic coding, compared to a control group who received a booklet alone. All participants received standardised postoperative early ambulation. Outcomes were assessed daily for 14 postoperative days. Analyses were intention-to-treat using adjusted generalised multivariate linear regression.

Results

Preoperative physiotherapy was associated with fewer antibiotic prescriptions specific for a respiratory infection (RR 0.52; 95% CI 0.31 to 0.85, p = 0.01), less purulent sputum on the third and fourth postoperative days (RR 0.50; 95% CI 0.34 to 0.73, p = 0.01), fewer positive sputum cultures from the third to fifth postoperative day (RR 0.17; 95% CI 0.04 to 0.77, p = 0.01), and less oxygen therapy requirements (RR 0.49; 95% CI 0.31 to 0.78, p = 0.002). Treatment effects were specific to respiratory clinical coding domains.

Conclusions

Preoperative physiotherapy prevents postoperative pulmonary complications and is associated with the minimisation of signs and symptoms of pulmonary collapse/consolidation and airway infection and specifically results in reduced oxygen therapy requirements and antibiotic prescriptions.

Trial registration

ANZCTR 12613000664741; 19/06/2013.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13741-021-00206-3.

Changing from Epidural to Multimodal Analgesia for Colorectal Laparotomy: An Audit

In April 2002 our practice ceased routine use of epidural analgesia for colorectal laparotomy in favour of a six-drug multimodal regimen comprising ketamine, clonidine, morphine, tramadol, paracetamol and a nonsteroidal antiinflammatory drug. The records of 54 patients who received this multimodal analgesia regimen (MM) after April 2002 were compared to the 59 patients who had previously received epidural analgesia (EPI). Patients had the same surgeon and anaesthetist. Daily pain score (verbal rated 0-10) at rest (mean) over the first three postoperative days was satisfactorily low with both MM (1.2 ± 1.2) and EPI (0.4 ± 0.4). Over this period there was little difference between the maximum pain score at rest (MM 2.3 ± 1.9 vs. EPI 2.2 ± 1.7, P=0.58). Major complications and side-effects occurred solely in EPI patients: epidural abscess (1), respiratory depression (2), pneumonia (3), venous thromboembolism (3), delirium (7), high block (7) and motor block (3). Hypotension requiring intervention was 4.8 times more frequent in the EPI group (95% CI 2.1-11). Antiemetic use was similar between groups; on average 13 patients in the MM groups (24%) and 15 patients in the EPI groups (26%) received antiemetics each day. MM patients had shorter anaesthetic preparation time (20±8 min vs. 32±8 min, P<0.001), shorter high-dependency unit stay (0.4 ± 1.2 days vs. 4.5 ± 0.9 days, P <0.001), and shorter hospital stay(10±4 days vs. 13±8 days, P=0.003). In our practice, changing from epidural to multimodal analgesia produced comparable pain relief with reduction in anaesthesia preparation time, high-dependency unit stay and hospital stay and the requirement for staff interventions. There was also a reduction in the incidence of major complications and side-effects.

A prospective randomized, controlled trial of intravenous versus oral iron for moderate iron deficiency anaemia of pregnancy

BACKGROUND

Iron deficiency anaemia is the most common deficiency disorder in the world, affecting more than one billion people, with pregnant women at particular risk.

OBJECTIVES AND DESIGN

We conducted a single site, prospective, nonblinded randomized-controlled trial to compare the efficacy, safety, tolerability and compliance of standard oral daily iron versus intravenous iron.

SUBJECTS

We prospectively screened 2654 pregnant women between March 2007 and January 2009 with a full blood count and iron studies, of which 461 (18%) had moderate IDA. Two hundred women matched for haemoglobin concentration and serum ferritin level were recruited.

INTERVENTIONS

Patients were randomized to daily oral ferrous sulphate 250 mg (elemental iron 80 mg) with or without a single intravenous iron polymaltose infusion.

RESULTS

Prior to delivery, the intravenous plus oral iron arm was superior to the oral iron only arm as measured by the increase in haemoglobin level (mean of 19.5 g/L vs. 12 g/L; P < 0.001); the increase in mean serum ferritin level (222 microg/L vs. 18 ug/L; P < 0.001); and the percentage of mothers with ferritin levels below 30 microg/L (4.5% vs. 79%; P < 0.001). A single dose of intravenous iron polymaltose was well tolerated without significant side effects.

CONCLUSIONS

Our data indicate that intravenous iron polymaltose is safe and leads to improved efficacy and iron stores compared to oral iron alone in pregnancy-related IDA.

A Retrospective Study to Determine Whether accessing Frequency Affects the Incidence of Microbial Colonisation in Peripheral Arterial Catheters

Peripheral arterial catheters are used for the continuous monitoring of blood pressure and repeated blood sampling in critically ill patients, but can be a source of catheter-related bloodstream infection. A common assumption is that the more frequently an arterial catheter is accessed, the greater the likelihood of contamination and colonisation to occur. We sought to determine whether the accessing frequency has an influence on the rate of colonisation in a peripheral arterial catheter.

A retrospective, unmatched, nested case control study was conducted in our intensive care unit. The intensive care unit charts of 96 arterial catheters from 83 patients were examined to measure the number of times each respective arterial catheter was accessed. Multivariate Cox proportional hazards regression was used to compare the rate of accessing of arterial catheters and account for varying arterial catheter in situ duration. Arterial catheters which had a high access rate of 8.1 or more times/day (five colonised of 32 patients: hazards ratio 1.69, 95% confidence interval 0.52 to 5.49; P=0.77), or a medium access rate of 6.7 to 8.0 times/day (six colonised of 32 patients: hazards ratio, 1.35, 95% confidence interval, 0.37 to 4.92: P=0.65) were not significantly more colonised when compared to arterial catheters which had a low access rate of 0 to 6.6 times/day (six colonised of 32 patients), adjusted for arterial catheter insertion site and place in hospital where the arterial catheter insertion was performed.

We were unable to demonstrate that the accessing frequency of an arterial catheter was a major predisposing factor for the likelihood of colonisation. Other mechanisms other than hub colonisation should be investigated further.

Selenium status in Southern Tasmania

OBJECTIVE

To assess the selenium status of Southern Tasmanians.

DESIGN

Cross-sectional.

SETTINGS

One thousand and five hundred adults randomly selected from the electoral roll living in the Greater Hobart region of Southern Tasmania, Australia, were invited to participate.

SUBJECTS

The overall response rate was 22% (335/1500).

INTERVENTIONS

A venous blood sample was collected and a questionnaire administered (consisting of brief demographic details and health questions) to subjects who granted informed consent. A previously validated assay using magnetic sector ICP-MS was employed for plasma analysis.

RESULTS

Total plasma selenium levels for this sample population were normally distributed with a mean level of 110 microg/l (range 67-268 microg/l) indicating that the majority of the subjects were not selenium-depleted (71% with levels greater than 100 microg/l). Adjustment for differential age/gender response rates produced similar values. More women under 50 (42%) and men over 50 (32%) had selenium levels <100 microg/l with the potential for sub-optimal selenoprotein activity. Low education attainment was associated with low total selenium level (P<0.02).

CONCLUSIONS

The majority of participants were not deficient in selenium. Given the narrow therapeutic window of supplementation, dietary advice to increase foods rich in selenium, particularly to higher risk groups, may be an effective means of increasing plasma selenium toward target levels.

Dietary supplementation with chickpeas for at least 5 weeks results in small but significant reductions in serum total and low-density lipoprotein cholesterols in adult women and men

AIM

To compare the effects of a chickpea-supplemented diet and those of a wheat-supplemented diet on human serum lipids and lipoproteins.

METHODS

Forty-seven free-living adults participated in a randomized crossover weight maintenance dietary intervention involving two dietary periods, chickpea-supplemented and wheat-supplemented diets, each of at least 5 weeks duration.

RESULTS

The serum total cholesterol and low-density lipoprotein cholesterol levels were significantly lower (both p < 0.01) by 3.9 and 4.6%, respectively, after the chickpea-supplemented diet as compared with the wheat-supplemented diet. Protein (0.9% of energy, p = 0.01) and monounsaturated fat (3.3% of total fat, p < 0.001) intakes were slightly but significantly lower and the carbohydrate intake significantly higher (1.7% of energy, p < 0.001) on the chickpea-supplemented diet as compared with the wheat-supplemented diet. Multivariate analyses suggested that the differences in serum lipids were mainly due to small differences in polyunsaturated fatty acid and dietary fibre contents between the two intervention diets.

CONCLUSIONS

Inclusion of chickpeas in an intervention diet results in lower serum total and low-density lipoprotein cholesterol levels as compared with a wheat-supplemented diet.

Baseline serum lipids and renal function in chronic kidney disease patients entering the LORD trial

OBJECTIVE

Previous studies investigating associations between serum lipids and renal disease have generally not taken into account dietary intake or physical activity both known to influence circulating lipids. Furthermore, inclusion of patients on HMG-CoA reductase inhibitors may also have influenced findings due to the pleiotropic effect of this medication. Therefore, the aim of this study is to determine the relationships between serum lipids and renal function in a group of patients not taking lipid-lowering medication and taking into account dietary intake and physical activity.

METHODS

Data from 100 patients enrolled in the Lipid Lowering and Onset of Renal Disease (LORD) trial were used in this study. Patients were included with serum creatinine > 120 micromol/l, and excluded if they were taking lipid-lowering medication. Unadjusted and adjusted relationships were determined between fasting serum lipid concentrations (total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides and total cholesterol/HDL ratio) and measures of renal function (estimated glomerular filtration rate (eGFR), creatinine clearance and serum creatinine) and urinary protein excretion.

RESULTS

Significant (p < 0.05) negative unadjusted relationships were found between lipids (total cholesterol, LDL and HDL cholesterol) and serum creatinine. In support of these findings, logarithmically-transformed lipids (total cholesterol, LDL and HDL cholesterol) were significantly associated with eGFR and creatinine clearance although the effects were of a smaller magnitude. Adjustment for dietary saturated fat intake and physical activity did not substantially change these effects.

CONCLUSION

These data do not support the premise that lipids are associated with renal dysfunction in patients with normocholesterolemia.

The effect of 4-week chilli supplementation on metabolic and arterial function in humans

OBJECTIVE

To investigate the effects of regular chilli ingestion on some indicators of metabolic and vascular function.

DESIGN

A randomized cross-over dietary intervention study.

SETTING

Launceston, Australia.

SUBJECTS

Healthy free-living individuals.

INTERVENTION

Thirty-six participants (22 women and 14 men), aged 46+/-12 (mean+/-s.d.) years; BMI 26.4+/-4.8 kg/m(2), consumed 30 g/day of a chilli blend (55% cayenne chilli) with their normal diet (chilli diet), and a bland diet (chilli-free) for 4 weeks each. Metabolic and vascular parameters, including plasma glucose, serum lipids and lipoproteins, insulin, basal metabolic rate, blood pressure, heart rate, augmentation index (AIx; an indicator of arterial stiffness), and subendocardial-viability ratio (SEVR; a measure of myocardial perfusion), were measured at the end of each diet. In a sub-study, during week 3 of each dietary period, the vascular responses of 15 subjects to glyceryl-trinitrate (GTN) and salbutamol were also studied.

RESULTS

For the whole group, there were no significant differences between any of the measured parameters when compared at the end of the two dietary periods. When analysed separately, men had a lower resting heart rate (P=0.02) and higher SEVR (P=0.05) at the end of the chilli diet than the bland diet. In the sub-study, baseline AIx on the chilli diet was lower (P<0.001) than on the bland diet, but there was no difference in the effects of GTN and salbutamol between the two diets.

CONCLUSION

Four weeks of regular chilli consumption has no obvious beneficial or harmful effects on metabolic parameters but may reduce resting heart rate and increase effective myocardial perfusion pressure time in men.

Coronary angiography and coronary artery revascularisation rates in public and private hospital patients after acute myocardial infarction

OBJECTIVE

To determine the rates of coronary angiography or coronary artery revascularisation procedures in patients with acute myocardial infarction (AMI) managed in private versus public hospitals.

DESIGN

Case record linkage analysis of data from the Victorian Inpatient Minimum Dataset for admissions for AMI in the 12 months after the index admission.

SETTING

Victorian acute care hospitals from July 1995 to December 1997.

PATIENTS

Victorian residents aged 15-85 years admitted to hospital with AMI.

MAIN OUTCOME MEASURES

Rates of coronary angiography or coronary artery revascularisation procedures after AMI.

RESULTS

Compared with public patients in public hospitals, patients with AMI managed in private hospitals were more likely to undergo coronary angiography (rate ratio [RR], 2.17; P< 0.001; 95% CI, 2.06-2.29), coronary angioplasty or stenting (RR, 3.05; P<0.001; 95% CI, 2.82-3.31), and coronary artery bypass grafting (RR, 1.95; P<0.001; 95% CI, 1.79-2.14). Once coronary angiography had been performed, patients in private hospitals were more likely to undergo angioplasty or stenting (RR, 1.94; P<0.001; 95% CI, 1.79-2.11), but were only marginally more likely to undergo coronary artery bypass grafting (RR, 1.17; P<0.001; 95% CI, 1.07-1.28).

CONCLUSIONS

In Victoria, management of patients with acute myocardial infarction is influenced by the public or private status of the patient, and by whether management occurs in private or public hospitals. Patients are more likely to undergo coronary angiography and coronary artery revascularisation procedures in private hospitals.

Is there an effect of menopause on CHD mortality? Asia Pacific comparisons

This study examines the mortality rates of men and women from coronary heart disease (CHD) in a number of Asia-Pacific countries with very different incidences of this disorder. In all countries, mortality rates from CHD were higher in men. In women, no unequivocal change in mortality rate from CHD attributable to the menopause could be detected.

Reflotron cholesterol measurement in general practice: accuracy and detection of errors

Comparison of cholesterol determinations by nurses using a Reflotron analyser in a general practice setting showed a good correlation with plasma cholesterol determinations by wet chemistry in a clinical biochemistry laboratory. A limited number of comparisons did, however, give a much lower result on the Reflotron. In an experimental situation, small sample volumes (which could result from poor technique) were shown to produce falsely low readings. A simple method which may immediately detect falsely low Reflotron readings is discussed.

Obesity and body fat distribution in New Zealanders: a pattern of coronary heart disease risk

AIMS

To describe the prevalence of obesity and the body fat distribution of New Zealanders. To discuss this in the context of the coronary heart disease risk.

METHODS

Body weight and height, body mass index (BMI), waist:hip ratio (WHR) and six skinfold measurements were determined for 3204 randomly selected New Zealanders who responded to an invitation to a health check (response rate 56%).

RESULTS

In the study sample BMI generally increased with age. Fifty five percent of men and 38 per cent of women aged 18-64 had a BMI exceeding 25, and of these 13 per cent and 10 per cent were obese (BMI > 30). WHR was greater in men than in women of all ages, and a third of the men and a quarter of the women had values exceeding 0.9 and 0.8 respectively. Central skinfold measurements (subscapular, suprailiac and abdominal) were lowest in young men, but rose markedly with age and were similar to women above age 35. Limb skinfolds were lower in men.

CONCLUSIONS

This survey indicates that a large percentage of New Zealanders are overweight or obese and their excess body fat tends to be centrally distributed, especially in men. Obesity is thus a significant health problem in New Zealand.

Blood lipid levels in New Zealand

OBJECTIVES

the study aimed to determine age and gender specific levels of lipids and lipoproteins in New Zealanders. Participants were randomly selected from 20 general electoral roles, and from a sample of 15-18 year olds.

METHODS

plasma cholesterol, LDL cholesterol, HDL cholesterol and triglyceride levels were measured in 2941 men and women aged 15-99 years.

RESULTS

mean (SD) plasma cholesterol was 6.0 (1.3) mmol/L in men and 6.1 (1.3) mmol/L in women. There was a marked variation in total cholesterol and calculated LDL cholesterol with age, and the pattern was different in men and women. There was also a considerable regional variation; levels tending to increase from north to south. Overall mean cholesterol levels adjusted for age and geographical distribution were 5.8 and 6.0 mmol/L for men and women respectively.

CONCLUSION

the fact that approximately a third of the adult population in New Zealand under 65 years have cholesterol levels greater than 6.5 mmol/L indicates the need for effective diet and lifestyle changes to reduce the high rates of CHD.

Anaesthetic management of the morbidly obese

The problems associated with obesity are brought into sharp focus at the time of a surgical operation. The anaesthetist has a major role to play in preventing serious complications and must be aware of the many potential hazards. Extra vigilance is required to guide these patients safely through the perioperative period.

Lead and iron absorption from rat small intestine: the effect of dietary Fe deficiency

1. When lead is administered in drinking-water iron-deficient rats retain more Pb than Fe-replete rats (Six & Goyer, 1972; Klauder & Petering, 1975). In the present study the relationship between the absorption of Pb and Fe was investigated. 2. Adult male rats were transfered to a milk-based diet fed with or without supplementary Fe (180 mg Fe/kg as ferrous sulphate). After 7--9 d the absorption of duodenally-administered 203Pb and 59Fe was measured as uptake of radioactivity from the gastrointestinal tract after 90 min. 59Fe absorption was increased in rats given the unsupplemented diet for 7 d and was further increased in rats kept on the diet for up to 7 weeks. 203Pb absorption was not consistently increased by either short- or long-term Fe deprivation. 3. Much of the 203Pb in homogenates of the upper small intestine was bound to soluble protein of which up to 85% was dialysable. In contrast little 59Fe was dialysable. Only a small proportion of the soluble musosal Pb was associated with ferritin during gel-filtration chromatography although 203Pb precipitated together with carrier rat-liver ferritin with an antibody to rat-liver ferritin. 4. There appeared to be no direct relationship between the transfer of Fe and Pb across the small intestine of the adult rat.