COVID-19 Frontline Research Articles

Association between quarantine and sleep disturbance in Hong Kong adults: The mediating role of COVID-19 mental impact and distress.

COVID-19 quarantine has been associated with increased sleep problems and prolonged psychological responses to the pandemic could mediate this relationship. The present study attempted to examine the mediating role of COVID-19 mental impact and distress between quarantine and sleep disturbance. The present study recruited 438 adults (109 with quarantine experience) in Hong Kong via an online survey between August and October 2021. The respondents completed a self-report questionnaire on quarantine, Mental Impact and Distress Scale: COVID-19 (MIDc), and Pittsburgh Sleep Quality Index (PSQI). The MIDc was treated as a latent mediator and continuous PSQI factor and poor sleep quality (PSQI score > 5) were the study outcomes. We evaluated the direct and indirect effects of quarantine on sleep disturbance via MIDc using structural equation modeling. Analyses were adjusted for gender, age, education level, knowing confirmed COVID-19 cases, COVID-19 frontline work, and primary income source of the family. More than half (62.8%) of the sample reported poor sleep quality. Quarantine was associated with significantly higher levels of MIDc and sleep disturbance (Cohen d = 0.23 - 0.43, p < 0.05). In the structural equation model, the MIDc mediated the relationship between quarantine and sleep disturbance (αβ = 0.152, 95% CI = 0.071 to 0.235). Quarantine significantly increased the proportion of poor sleep quality by 10.7% (95% CI = 0.050 to 0.171) indirectly via MIDc. The results provide empirical support to the mediating role of the MIDc as psychological responses in the relationship between quarantine and sleep disturbance.

Impact of long working hours on depressive symptoms among COVID-19 frontline medical staff: The mediation of job burnout and the moderation of family and organizational support.

During the COVID-19 pandemic, the frontline medical staff faced more workload and heavier physical and mental stress, which increased their job burnout and negative emotions. However, little is known about the potential factors mediating and moderating these relations. This study investigates the association between long working hours and depressive symptoms among frontline medical staff in China, and explores the potential mediating effect of job burnout, and moderating effect of family and organizational support on these associations. Data of 992 frontline medical staff who participated in the prevention and control of COVID-19 was obtained from the online survey conducted in November to December 2021 in China. Depressive symptoms were evaluated using the Patient Health Questionaire-9 (PHQ-9). Moderated mediating model was employed to understand the relationship between long working hours (X), depressive symptoms (Y) mediated through job burnout (M), moderated by family support (W1) and organizational support (W2), while controlling all possible covariates. 56.96% of participants worked more than 8 h per day. 49.8% of them had depressive symptoms (PHQ-9 ≥ 5) and 65.8% experienced job-related burnout. Long working hours was positively associated with depressive symptoms score (β = 0.26, 95% CI:0.13 ~ 0.40). Mediation analyses revealed that job burnout significantly mediated this relationship (indirect effect = 0.17, 95% CI: 0.08 ~ 0.26). Moderated mediation further indicated that both two interactions of social support (family support W1, organizational support W2) and job burnout were negatively related to depressive symptoms among frontline medical staff, indicating that higher social support being less job burnout with lower depressive symptoms. Longer working hours and higher job burnout may contribute to worse mental health among frontline medical staff. Social support could buffer the detrimental effects by reducing their job burnout. The main contribution of this study was to estimate the negative effect of long working hours on depressive symptoms among frontline medical staff and explore the potential mediating role of job burnout and moderating role of social support on these associations.

Health and safety of Covid-19 frontline healthcare workers: A case of Masvingo Urban, Zimbabwe

Health and safety of Covid-19 frontline healthcare workers: A case of Masvingo Urban, Zimbabwe

Early Treatment with Fluvoxamine among Patients with COVID-19: A Cost-Consequence Model.

To date, two published randomized trials have indicated a clinical benefit of early treatment with fluvoxamine versus placebo for adults with symptomatic COVID-19. Using the results of the largest of these trials, the TOGETHER trial, we conducted a cost-consequence analysis to assess the health system benefits of preventing progression to severe COVID-19 in outpatient populations in the United States. A decision-analytic model in the form of a decision tree was constructed to evaluate two treatment strategies for high-risk patients with confirmed, symptomatic COVID-19 in the primary analysis: treatment with a 10-day course of fluvoxamine (100 mg twice daily) and current standard-of-care. A secondary analysis comparing a 5-day course of nirmatrelvir-ritonavir was also conducted. We used a time horizon of 28 days. Reported outcomes included cost-savings and hospitalization days avoided. The results of our analysis indicated that administration of fluvoxamine to symptomatic outpatients at high risk of progressing to severe COVID-19 was substantially cost-saving, in the amount of $232 per eligible patient and prevented an average of 0.15 hospital days per patient treated, compared with standard of care. Nirmatrelvir-ritonavir was also shown to be cost-saving despite its higher acquisition cost and provided savings to the healthcare system of $625 per patient treated. These findings suggest that fluvoxamine is likely to be a cost-effective addition to frontline COVID-19 mitigation strategies in many settings, particularly where access to nirmaltrevir-ritonavir or monoclonal antibodies is limited.

Delivering care with competence on the Covid-19 frontline.

By replacing bedside clinical training with online lectures and simulation-based case scenarios, the Covid-19 pandemic has transformed the healthcare and medical education system of India. The compromise in clinical competency, patient interaction, coping strategies, and lack of resources and preparedness were the major constraints in delivering quality healthcare services during the pandemic. The pandemic taught us key lessons on empathy, preparedness and patience. Here is my experience as a student from the batch of MBBS students who had received their final year training through online lectures and then, as an intern having my first hospital posting amidst the second wave of Covid-19.

"No matter what, I will not give up": Community practice on the front lines of COVID-19.

The COVID-19 pandemic has required frontline health care workers to cope with an unexpected and almost unprecedented emergency situation. Community social workers had played a crucial role during the pandemic, working to alleviate its adverse effects on marginalized communities. The present study investigated community social workers' experiences and hardships in coping with the "age of COVID-19." Drawing on in-depth interviews with 30 frontline community social workers in Israel, the findings highlighted three main themes: (a) the hope for recognition and the reality of underutilization; (b) the impact of the dysfunctional state on community social workers; and (c) realizing the core values and activities of community social work practice during the pandemic. Findings pointed to community social workers' professionalism and integrity despite the hardships they endured at the local and national levels. Committing on an altruistic level seemed to be an adaptive coping style, alongside facing "the politics of pandemics." Implications for community practice are outlined. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PROBLEMAS ÉTICOS VIVENCIADOS POR ENFERMEIROS DURANTE À COVID-19: RELAÇÃO COM O SOFRIMENTO MORAL

ABSTRACT Objective: to analyze associations between moral distress and ethical issues experienced by nurses during COVID-19. Method: this is a quantitative, cross-sectional study, carried out with 101 nurses working in university hospitals, between March and May 2022, through socio-occupational issues, ethical implications that lead to moral distress, and the Ethical Issues Experienced by Nurses in Emergency Questionnaire, adapted and validated for Brazilians. Descriptive statistics, ANOVA, Pearson’s chi-square and multiple linear regression were used, and p&lt;0.05 was adopted. Results: the 9 elements attributed to ethical implications were classified with some degree of importance for moral distress, with the highest average in the following items: I feel a commitment, responsibility and moral obligation to provide care to the infected population (4.26) and I have the knowledge or experience to work on the frontline of COVID-19 (3.44). The association of moral distress with ethical issues showed that individuals who attributed high importance to ethical implications also had ethical issues at a moderate/high level, emphasizing a higher mean in questions of “patient care” (4.07). It was evident that participants’ moral distress was more affected by the following constructs: “perception of hospital measures against COVID-19” (p=.000), “ethical issues in patient care” (p=.000) and “perception of social stigmatization” (p=.000). Conclusion: when relating ethical issues to moral distress, it was possible to show that COVID-19 generated an abrupt change in nurses’ work routine, which hinders adequate decision-making in situations involving issues beyond care, but also at a professional and organizational level, leading to the experience of moral distress.

Shift from black swan to brown swan approach during the COVID pandemic

The pandemic of COVID-19 and the lockdown imposed which took the entire world by storm has not only tested our physical health but also impacted our mental health in ways no one had envisaged! It led to a situation of socioeconomic crisis and mental anguish among the general population. It was indeed a black swan event as the response to the pandemic with worldwide lockdown was highly unpredictable having a colossal impact on the world and its functioning, however, several explanations have now come into view that has made the event explainable and predictable. The outbreak of a novel virus unknown to the medical fraternity and its explosive spread every day, conflicting messages from the government, lack of infrastructure for treatment, the spread of misinformation on media platforms, and an incessant quarantine have led to a sense of fear, apprehension, stress, desolation, weariness, frustration, and depression among the masses. The imposition of lockdown in the nation not only undermined personal freedom but also lead to huge financial losses, unemployment, work, and school closure, uncertainty, boredom, and stigma which had been major stressors leading to widespread emotional affliction and an increased risk of developing psychiatric illness during the time of the pandemic. People who were already suffering from some form of psychiatric disorder had been prone to exacerbations due to the pandemic. Individuals living with confirmed or suspected COVID-19 cases, frontline workers, unemployed people, and people in quarantine were at a higher risk of developing some form of mental illness such as anxiety, insomnia, and depression. Resilience and good social support are the protective factors against this mental health epidemic that has begun. In this article, we reflect upon the impact of the COVID-19 pandemic and lockdown on the mental health of people in India.

The impact of COVID-19 pandemic on the quality of life of healthcare workers and the associated factors: A systematic review.

The COVID-19 pandemic has exacerbated health issues in healthcare workers which in turn impacts their quality of life. This review aimed to (i) analyze the impact of the COVID-19 pandemic on the quality of life of healthcare professionals and (ii) identify the associated factors with quality of life. We conducted a systematic review using the PRISMA guidelines previously registered in PROSPERO (CRD42021253075). The searched in Web of Science, Scopus, MEDLINE and EMBASE databases included original articles published till May 2021. We found 19 articles and 14,352 professionals in total, the median age ranged from 29 to 42.5 years and 37% of the studies used the WHOQOL-BREF instrument to assess the outcome. The report was heterogeneous, 7 studies described global scores and 9 by domains. Depression, anxiety and stress were commonly reported factors affecting professional's quality of life and this was significantly lower among professionals working with COVID-19 patients compared to their counterparts. COVID-19 frontline workers perceived lower quality of life, which was mainly associated with psychological states such as the aforementioned besides to working conditions like not being previously trained in COVID-19 cases. On the other hand, social support, resilience and active coping could improved their quality of life.

Factors Related to Psychological Distress Among Nursing Students Volunteering in Covid-19 Frontline Prevention In Vietnam.

Factors Related to Psychological Distress Among Nursing Students Volunteering in Covid-19 Frontline Prevention In Vietnam.

Burnout and Its Associated Factors Among COVID-19 Frontline Healthcare Workers

Burnout and Its Associated Factors Among COVID-19 Frontline Healthcare Workers

Effect of COVID-19 Frontline Nurses' Profession Perception on Their Intention to Stay: The Mediating Role of Job Satisfaction.

Understanding the factors affecting the intention of frontline nurses during the coronavirus disease (COVID-19) pandemic to stay in the nursing profession is essential for developing strategies to overcome the challenges associated with the pandemic. This study aimed to examine the mediating effect of nurses' job satisfaction on the relationship between their sense of calling, job-esteem, and the intention to stay in their profession. The study used a previously collected dataset, sourced from a dedicated COVID-19 hospital in Seoul City, South Korea. Original data were collected from June to July 2021. The study sample consisted of 134 nurses who provided direct care to patients. The intention to stay was measured with the following question: "Are you willing to work during this COVID-19 pandemic?". The Job Satisfaction Scale from the Korean Labor and Income Panel Study, Korean version of a Multidimensional Calling Measure, and Job-Esteem Scale for Hospital Nurses were utilized. Associations between the study variables were estimated using bivariate correlation analyses and bootstrapping mediation analyses. In the bivariate correlation analysis, nurses' sense of calling (r = .36, p < .001), job-esteem (r = .32, p < .001), and job satisfaction (r = .39, p < .001) were significantly associated with the intention to stay. In the mediation analysis, job satisfaction partially mediated the relationship between the sense of calling and the intention to stay (total effect; B = 0.410, p < .001) and fully mediated the relationship between job-esteem and the intention to stay (total effect; B = 0.549, p < .001). Enhancing nurses' job satisfaction is crucial for fostering the retention of the nursing workforce amid the pandemic. Consequently, it is imperative to closely examine the job satisfaction and work environment of frontline nurses to identify areas in need of improvement. Addressing the factors that impede nurses' job satisfaction is essential to unlock the positive effects of a sense of calling and job-esteem.

Knowledge, attitudes and practices related to Covid-19 among health professionals in El Jadida Province, Morocco.

During the COVID-19 pandemic, concerns were raised about the lack of knowledge and awareness of health workers (HW) in hampering the implementation of COVID-19 preventive strategies in hospitals. This cross-sectional study aims to explore the knowledge, attitudes, and practices (KAP) of the health workers related to COVID-19 in Moroccan hospitals and health facilities. We administered an adapted questionnaire to 242 HW working in Azemmour and El Jadida hospital (two sites) and in 41 health centers in El Jadida province. We carried out a bivariate analysis and used contingency tables and logistic regression models to identify factors associated with different KAP levels. We found that 90.1%, 8.3% and 60.3% of HW had respectively high levels of knowledge, risk perception attitudes and preventive practices towards COVID-19. High level of knowledge was associated with gender (OR: 0.267; 95% CI: 0.113-0.634; p=0.002), and professional profile (p<0.001). Levels of attitudes were associated with gender (OR: 17.143; 95% CI: 5.450-53.932; p<0.001) whereas levels of preventive practices were associated with position of the HW in COVID-19 (frontline or not frontline) (OR: 0.404; 95% CI: 0.236-0.691; p=0.001) and the overworked status of the HW (OR: 0.421; 95% CI: 0.242-0.730; p=0.002). Professionals' knowledge and practice levels were higher than their COVID-19 risk perception attitudes. Therefore, efforts should be made to improve the attitudes of health professionals.

Is It Time to Call 'Code Blue' on Nursing Infrastructure? A Nurse's Perspective from the COVID-19 Front-line.

The COVID-19 pandemic has highlighted the significance of every role within the interdisciplinary team and has exacerbated the challenges posed to every member. From the nursing perspective, many of these challenges were present before the pandemic but have become significantly larger problems that continue to demand global attention. This has provided an opportunity to critically evaluate and learn from the challenges the pandemic has both highlighted and created. We conclude that the nursing infrastructure requires a revolution in order to support, grow and retain nurses, who are vital to the delivery of high-quality healthcare.

Night shifts, insomnia, anxiety, and depression among Chinese nurses during the COVID-19 pandemic remission period: A network approach.

The outbreak of the COVID-19 pandemic imposed a heavy workload on nurses with more frequent night shifts, which led to higher levels of insomnia, depression, and anxiety among nurses. The study aimed to describe the symptom-symptom interaction of depression, anxiety, and insomnia among nurses and to evaluate the impact of night shifts on mental distress via a network model. We recruited 4,188 nurses from six hospitals in December 2020. We used the Insomnia Severity Index, Patient Health Questionnaire-9, and Generalized Anxiety Disorder Scale-7 to assess insomnia, depression, and anxiety, respectively. We used the gaussian graphical model to estimate the network. Index expected influence and bridge expected influence was adapted to identify the central and bridge symptoms within the network. We assessed the impact of night shifts on mental distress and compared the network structure based on COVID-19 frontline experience. The prevalence of depression, anxiety, and insomnia was 59, 46, and 55%, respectively. Nurses with night shifts were at a higher risk for the three mental disorders. "Sleep maintenance" was the central symptom. "Fatigue," "Motor," "Restlessness," and "Feeling afraid" were bridge symptoms. Night shifts were strongly associated with sleep onset trouble. COVID-19 frontline experience did not affect the network structure. "Sleep maintenance," "Fatigue," "Motor," and "Restlessness" were important in maintaining the symptom network of anxiety, depression, and insomnia in nurses. Further interventions should prioritize these symptoms.

Frontline medical professionals in distress - “Doctor heal thyself”

• According to a recent study by the US Centers for Disease Control and Prevention (CDC), more than half of public health workers have reported symptoms of at least one mental health condition like depression, anxiety, and post-traumatic stress disorder (PTSD) in the recent past (The Weather Channel, 2021, June 30). • A recent study among 422 doctors revealed 63.5% symptoms of depression, and 45% symptoms of stress, among frontline COVID-19 doctors ( Das et al., 2020 ). • A cross-sectional survey of 200 healthcare professionals in India found that healthcare professionals were suffering from acute stress (9.5%), depression (17%), and anxiety (19.5%) which they attributed to the negative professional and personal influence of the ongoing pandemic scenario ( Sharma et al., 2020 ). • The health care sector is the most affected as the pandemic surges ahead of the second wave with new variants. There have been instances of the medical system collapsing multiple times due to the overwhelming number of COVID cases. The health care workers constantly have a fear of infecting their loved ones. • The long working hours coupled with fear and uncertainty have led to job stress and burnout among health care professionals. • This article provides a few strategies for hospital administrators to help medical professionals overcome stress during pandemics. Covid has changed our lives in many ways. People are scared to even step out of their houses, but health care workers have no option but to continue to work and care for the sick. Health care workers play a vital role in providing care to the infected persons, working beyond their capacities and risking their own lives. There is a lot of stress involved in the medical profession, and the pandemic made it worse. Each frontline health worker is at risk of getting infected with Covid during work and carrying it to their families, causing a lot of anxiety and mental health issues among the health care workers. According to a recent by the US Centers for Disease Control and Prevention (CDC), more than half of public health workers have reported symptoms of at least one mental health condition like depression, anxiety, and post-traumatic stress disorder (PTSD) in the recent past. A recent study among 422 doctors revealed 63.5% symptoms of depression, and 45% symptoms of stress, among frontline COVID-19 doctors. Physicians who perceived organizational problems related to procedural and informational justice were exposed to high levels of occupational stress. Every physician should have a personal doctor, and he or she has to seek suitable help as needed. The health care workers' stress is mainly associated with work stress as they are expected to work on a war footing and get very little time to spend with their families. There is a need to set up good psychiatric care for the medical professionals in the hospitals. The administrators of the hospitals should frequently check on the health and well-being of their employees. This article attempts to provide strategies to hospital administrators to help medical professionals reduce their stress levels.

A Review of Challenges of Medical Education in the COVID-19 Crisis

Before the outbreak of COVID-19 pandemic and due to the clinical nature of education in medical sciences, online and virtual educations were not implemented as the dominant methods in medical education; however, they were adopted as immediate solutions to help students pursue their education during the pandemic period. The change from the traditional education method to the electronic and virtual ones represented many challenges for the educational systems. The main challenges can be categorized into four groups: mental health consequences resulting from the quarantine and catching COVID-19, challenges of virtual education, challenges of clinical education, and challenges concerning medical students and COVID-19 frontline. In sum, the COVID-19 crisis was found to pose a number of challenges to faculty and students of medical science as well as to their families. In order to increase the preparedness of the medical education system to cope with similar crises, it was suggested that combined education programs should be implemented in the post-crisis period.

Determinants, predictors and negative impacts of burnout among health care workers during COVID-19 pandemic

The first defense line of the battle, healthcare workers (HCWs), faces a significant challenge in managing the current COVID-19 pandemic. An online electronic survey was sent to HCWs via email and social media networks. Socio-demographic data and work environment-related variables were assessed. Consequences of burnout (BO) were reported, e.g., elicited medical errors. Maslach burnout inventory was used to diagnose BO. Two hundred and eighty-four participants were included with a mean age of 39.83 ± 7.34 years, 70.8% worked in the COVID-19 frontline, 91.9% were followed daily updates about COVID-19, 63.7% were not satisfied with the coordination between triage and isolation, 64.4% got COVID-19 infection, 91.9% had a colleague or family member developed COVID-19 infection, and 21.5% experienced a colleague /a family member died due to COVID-19. Multivariate analysis by linear regression revealed that; working as a frontline HCW (OR 1.28, CI = 0.14–2.55) and sleep deprivation (OR 3.93, CI = 1.88–8.22) were the predictors of burnout.

Parasympathetic Versus Sympathetic Changes in Heart Rate Variability After a Multimodal Integrative Medicine Intervention for Frontline COVID-19 Personnel.

Frontline healthcare providers (HCPs) working in COVID-19 hospital departments need to deal with considerable physical and emotional stress on a daily basis. We conducted a pilot study to examine changes in heart rate variability (HRV) in frontline COVID-19 personnel after an integrative medicine (IM) intervention. HCPs working in isolated COVID-19 inpatient departments underwent a single 30-minute individually tailored IM sessions combining various IM modalities (acupuncture, mind-body, and/or manual-movement modalities, including anthroposophic medicine). HRV parameters were compared during the first IM session at 3-minute intervals, at the beginning of treatments, and after 20 minutes. Root mean square of successive RR interval differences (RMSSD) was measured, as were domains of time (standard deviation of NN intervals, percentage of successive RR intervals that differ by more than 50 milliseconds) and frequency (low frequency/high frequency [LF/HF] ratio). Preintervention and postintervention concerns were assessed using the Measure Yourself Concerns and Well-being questionnaire, with posttreatment free-text narratives analyzed for clusters of emotional- and spiritual-related keywords (ESKs). A total of 114 HCPs underwent an IM treatment session, and their HRV values were measured, of which 75 (65.8%) expressed ESKs. The RMSSD increased only in the ESK-expressing group ( p < .001). LF/HF ratios decreased in both groups, with HF power increasing in the ESK-expressing ( p = .043) and LF power decreasing in the non-ESK-expressing groups ( p = .004). Increased parasympathetic activity was observed in all HCPs after the IM intervention, particularly among those expressing ESKs. LF/HF parameters suggest different relaxation-associated mechanisms, with increased HF (regulated predominantly by parasympathetic tone) in the ESK-expressing and decreased LF (regulated partially by sympathetic tone) in the nonexpressing group. Additional research needs to explore the relationship between subjective effects of the IM intervention and physiological mechanisms of relaxation in HCPs working in stressful environments. ClinicalTrials.gov identifier NCT05104827.

Psychological Health in Intensive Care Unit Health Care Workers after the COVID-19 Pandemic.

Although the COVID-19 pandemic had an impact on the general population, health care workers (HCWs) constituted one of the groups that were most adversely affected by the associated risks, owing to the significant consequences on their mental health. This study examined these psychological effects on HCWs who cared for COVID-19 patients who were admitted to the intensive care unit in an Italian hospital. Subjects were administered several self-reported questionnaires: Kessler 10 Psychological Distress Scale (K10), Perceived Stress Scale-10 (PSS), Impact of Event Scale Revised (IES-R), and Post-traumatic Growth Inventory (PTGI), as well as two open-ended questions oriented toward understanding their positive and negative emotional experience and differentiating between two phases of the emergency. Overall, 45% of HCWs showed medium-to-high anxiety/depressive symptoms, whereas 60% presented with medium-to-high levels of perceived stress. In addition, 37% of subjects developed symptoms of PTSD and 50% showed post-traumatic growth in the "appreciation of life" and "new possibilities" dimensions. With regard to the open-ended questions, three themes were identified: quality of workplace relationships, sense of emotional-relational competence, and sense of clinical-technical competence. In addition, two macrocategories of responses were identified in the answers: growth and block. The mental health of HCWs who are involved in the front line of COVID-19 was significantly impacted by this experience, showing high levels of post-traumatic stress and anxiety and depressive symptoms more than 1 year after the emergency began. A qualitative analysis of staff experiences can be a useful guide for structuring interventions and prevention.