Frontline Healthcare Worker Research Articles

A low-cost approach to upskilling tutors in frontline health care worker production value chain.

Nigeria, like many countries, struggles with a shortage of healthcare professionals including frontline healthcare providers at the primary healthcare (PHC) level. While the country is pitched towards producing more healthcare professionals, the existing infrastructure to produce them is inadequate. Producing healthcare professional with the required skills to deliver quality services is impeded by several factors including the use of outdated curricula for their training, low application of technology in teaching, and weak tutor capacity that is worsened by the paucity and high cost of opportunities for tutor continuing professional development. To address these issues, the Health Workforce Management Activity (HWM), an initiative of the United States Agency for International Development (USAID), in 2023 designed and implemented a low-cost programme called TutorConnect that offered low-cost continuing professional development to tutors. TutorConnect is a Zoom-based monthly training programme that is facilitated by subject matter experts. The programme offered topics spanning effective learning, enhanced instructional design, and improved student engagement in the 14 months of its operation with over 700 tutors from more than 10 states in Nigeria that benefited from it. Utilising WhatsApp for additional support and peer-to-peer learning was crucial to providing more hands-on support, and institution-specific solutions. This low-cost approach to build competencies enabled access to continuing professional development by tutors, limiting effects of location and finances as barriers to continuing professional development. Developing the teaching capacity of tutors is pivotal to enhancing the quality of frontline healthcare worker training.

Vaccinating the Frontlines: A Qualitative Exploration of Hospital Healthcare Worker Perspectives on Influenza and COVID-19 Immunization.

Although they face higher occupational risk of contracting viral respiratory infections, hospital healthcare worker vaccine hesitancy persists. While most studies have used survey methods to quantify the prevalence of and reasons for healthcare worker vaccine hesitancy, this study employs a qualitative approach to understand their attitudes and beliefs associated with influenza and COVID-19 vaccination. To understand frontline healthcare worker experiences and perspectives on influenza and COVID-19 vaccination, 30 semi-structured interviews were conducted in summer/fall 2022 with staff recruited from two Johns Hopkins hospitals in Maryland. An in-depth, key informant interview was conducted with an expert in public health audience engagement. Interviews were audio recorded and transcribed for thematic and Framework analysis using NVivo software (QSR International, Melbourne, Australia). Healthcare workers engaged in little influenza vaccine information seeking due to their familiarity with the disease and low perceived disease severity. Approximately half (n=16) of healthcare workers reported no vaccine hesitancy towards influenza or COVID-19 vaccines. No physicians or physician assistants expressed any vaccine hesitancy, while most nurses expressed some (n=10). More than half of the women (n=14) expressed COVID-19 vaccine hesitancy compared to none of the men. Structural factors including hospital tier, unit assignment, and professional role influenced perceived risk of disease exposure and subsequent healthcare worker vaccination decisions. Institutional policies, including mandates and a pro-vaccine environment encouraged vaccination uptake. Healthcare workers reported being more receptive to vaccine messaging that focused on protection from disease, scientific and public health data and their heightened occupational exposure to pathogens. Despite their medical knowledge, healthcare workers are susceptible to vaccine hesitancy. Strategies to address specific concerns are needed and can be informed by our findings. A flexible and multi-pronged approach that considers individual anxieties, workplace structures, and the need for open communication with tailored messaging is necessary to promote vaccine acceptance in healthcare settings. What is already known on this topic: Healthcare worker vaccine hesitancy has been associated with many factors including race, gender, age and concerns about vaccine safety.What this study adds: Much of the research on healthcare worker vaccine hesitancy has used surveys and questionnaires giving a broad description of the prevalence and patterns of vaccine hesitancy in the healthcare workforce. This qualitative study examines vaccine behavior (rather than merely intent) through a cross comparison of healthcare workers' experiences and attitudes towards influenza and COVID-19 vaccination.How this study might affect research, practice or policy: Study findings can be used to help tailor vaccine messaging to hospital healthcare workers which could offset concerns regarding vaccine efficacy and risk, to promote vaccine uptake.

Professional Quality of Life and Psychological Impact on Frontline Healthcare Worker during the Fourth Wave of COVID-19

Aim. This research study aims to examine the professional quality of life (ProQOL) among healthcare workers (HCWs) in Pakistan during the fourth wave of COVID-19. Background. Under intense pressure to fight the coronavirus disease 2019 (COVID-19) pandemic, HCWs are more likely to experience psychological problems. Numerous investigations carried out in the past at various points during the pandemic have shown that COVID-19 has had important detrimental effects on HCWs. However, there are many unknowns with regard to ProQOL for HCWs. Methods. This is a cross-sectional study conducted with Pakistani HCWs who performed their duties during the fourth wave of COVID-19. Data were collected between January 1 and March 31, 2022. A total of 258 HCWs took part in the study evaluating ProQOL. The significance level was <0.05. Results. Most respondents were males (79.1%), and 20.9% were females. The scores of secondary traumatic stress (STS), burnout (BO), and compassion satisfaction (CS) were 24.03 ± 3.79, 19.18 ± 2.92, and 35.29 ± 4.37, respectively. Compared with higher-income groups, HCWs with lower incomes were significantly (P<0.001) more likely to experience psychological issues. Males had lower BO and STS than female HCWs (P<0.001). Similarly, doctors had a lower STS than nurses (P<0.05). HCWs who worked hours per day longer had a heavier STS (P<0.001). Conclusion. This study shows low BO levels, moderate CS levels, and STS levels among HCWs. HCWs with lower salary were at a higher risk of mental distress due to the pandemic. HCWs who worked for long hours and had less income had more STS and BO. HCWs who were dissatisfied with their works had poor CS. Implications for Nursing Management. It is supposed that these results may help HCW managers to improve job satisfaction and rewards while reducing working hours and workload to improve the ProQOL of HCWs fighting COVID-19. The government should focus on the mental health of HCWs, enhancing their satisfaction and allocating sufficient resources.

Nutrition education and counselling by frontline health and nutrition care workers is associated with improved iron adherence among pregnant women: evidence from the National Family Health Surveys, 2015-21

Background: Anaemia is a global public health problem affecting developing and developed countries with major consequences for human health and social and economic development. Methods: This paper attempted to understand the determinants of iron adherence among women of reproductive age during their last pregnancy in India and states/union territories, the iron deficiency being associated with anaemia, using multiple logistic regression analyses of data from the fourth (2015-16) and fifth (2019-21) rounds of the India National Family Health Survey. The individual unit-level data were analysed using Stata 17 software. Results: After adjusting for standard covariates, it was found that those who reported receiving counselling by a frontline health worker and/or antenatal care visits were much more likely to consume at least 90 days of iron-containing supplements. Results shows that for NFHS-4 women who had received counselling from a frontline health and nutrition care worker were 1.489 times (95% CI: 1.429-1.553) to adhere to at least 90 days of iron tablets or syrup after adjusting for potential confounders and for NFHS-5 women who had received counselling from a frontline worker were 1.162 times (95% CI :1.124-1.200) more likely to adhere to IFA supplements or syrup for at least 90 days. Conclusions: Based on insights from these analyses, it appears that counselling seems to be effective in making women aware of the benefits of IFA, thus increasing the likelihood of intake of iron-containing supplements. Counselling seems to be an important predictor of adherence to iron intake in India.

Addressing frontline healthcare worker perspectives on hand-hygiene monitoring badges

Background: Hand-hygiene technology (HHT) intends to monitor and promote hand washing by healthcare workers, a critical measure of infection control. Healthcare worker noncompliance with HHT is a major limitation to its implementation and utility in clinical settings. We assessed perspectives on HHT in an academic hospital system. Methods: Hand-hygiene team members created an anonymous, 37-question, Likert-scale survey to assess healthcare worker attitudes toward HHT. Surveys targeted nursing staff, advanced practice providers, care partners, and internal medicine physicians. Clinical coordinators from 5 distinct nursing units and 1 physician department emailed surveys to eligible employees. Research coordinators and clinical coordinators also posted a QR code for survey fliers at nursing stations. Results: Overall, 120 surveys were completed. Most surveys were completed by nurses and physicians (66.4% and 14.0%). Most respondents (67.5%) do not find HHT useful. Additionally, 78.3% of respondents believe that HHT does not accurately record hand-washing events. Most (78.3%) do not like using HHT, and 75.8% find it annoying. Only 10.8% believe that patient care suffers because of HHT. Conclusions: Most healthcare workers dislike the HHT badges, primarily due to perceived inaccuracies, lack of utility, burden of use, and pressure to comply. Distrust and effect on patient care do not appear to be substantial factors contributing to negative perceptions of HHT. Weaknesses of the study include overrepresentation of nursing staff and potential bias because respondents may have provided exceptionally negative responses believing it could lead to the removal of HHT.Disclosures: None

Containment of cholera outbreak in a rural community in Rivers State, Nigeria: a case report on health care in danger

Health care in danger (HCiD) is a public health menace affecting patients, healthcare workers, health facility properties/buildings or/and ambulance services due to the violence experienced in the course of accessing healthcare delivery services. This study was a case report of violence against a healthcare worker during the containment of a cholera outbreak in a rural community in Rivers State, Nigeria. The incident was observed between the 3rd to 5th of May 2022, during the containment of a cholera outbreak within the affected rural community. The victim was a frontline healthcare worker and a member of the rapid response team who was abducted while transporting samples to a reference laboratory for diagnostic confirmation. The abductors demanded ransom but the victim was subsequently released after family members bargained with the assailants. Upon release, she received medical care at the state tertiary facility. She continues to render healthcare services to date. As a follow-up, the State security agencies are currently embedded within the PHEOC response at various levels of healthcare. Communities and stakeholders are encouraged to respect and support healthcare and its resources.

The Investigation of musculoskeletal disorders, sleep quality, and fatigue of frontline healthcare workers during the COVID-19

The purpose of the study is to compare musculoskeletal system complaints, fatique, and sleep quality in front-line and second-line healthcare worker trating COVİD-19 patients. 152 healthcare worker between the ages of 18 and 65 who worked in outpatient clinics, services, COVİD-19 units, or administrative management were included in this study. Healthcare worker who had mission in the diagnosis, treatment, and isolation of patients diagnosed with COVİD-19 were determined as front-line workers (26F, 45M) and healthcare worker who didn’t have this kind of mission were defined as second-line workers (40F, 41M). After the collection of the participants “demographic data” the Nordic Musculoskeletal Questionnaire (NMQ), the Fatique Severity Scale (FSS), and the Jenkins Sleep Scale (JSS) were used to assess the participant musculoskeletal pain, fatique, and sleep quality, respectively. A significant difference was found in the training time, job experience, and number of weekly shifts of healthcare workers working on the front-line healthcare workers compared to operating the second-line healthcare workers (p≤0.05). Front-line healthcare workers reported more neck and back pain, while second-line healthcare workers reported more lower back pain. It was found that front-line healthcare workers had higher levels of fatique severity (t(150): 4.264, p≤0.001, Cohen’s d:0.69), lower levels of sleep quality (t(150): 4.479, p≤0.001, Cohen’s d:0.72). Shift programs should be arranged to reduce fatique and sleep problems of front-line healthcare workers, and protective neck and back muscles exercise programs should be given for front and second-line healthcare workers.

Knowledge and Attitude Regarding Monkeypox Virus among Physicians in Saudi Arabia: A Cross-Sectional Study.

The growing incidence of human monkeypox cases emphasizes the significance of prevention, early detection, and prompt responses for healthcare providers. The aim of this study was to assess the knowledge and attitudes toward monkeypox infection among physicians, a frontline healthcare worker group, in Saudi Arabia. A cross-sectional survey assessing knowledge and attitudes towards monkeypox infection on multiple-item scales was sent to physicians in Saudi Arabia. The associations between independent factors and either knowledge or attitude were assessed. The final analysis included 398 participants. Approximately 55% of the surveyed participants had a "good knowledge" score about human monkeypox. The adjusted logistic regression analysis showed that being a female physician, working in the private sector, and having information on human monkeypox during medical school or residency years were the only factors associated with a good level of knowledge about human monkeypox. However, physicians' knowledge and attitudes regarding monkeypox infection are inadequate and influenced by various factors. There is a significant knowledge gap between the therapeutic management of monkeypox and its vaccination. Training and knowledge assessments are important, especially when studies show significant improvement in related and specific knowledge.

‘It hurts your heart’: frontline healthcare worker experiences of moral injury during the COVID-19 pandemic

ABSTRACT Background: Moral injury is defined as the strong emotional and cognitive reactions following events which clash with someone’s moral code, values or expectations. During the COVID-19 pandemic, increased exposure to Potentially Morally Injurious Events (PMIEs) has placed healthcare workers (HCWs) at risk of moral injury. Yet little is known about the lived experience of cumulative PMIE exposure and how NHS staff respond to this. Objective: We sought to rectify this knowledge gap by qualitatively exploring the lived experiences and perspectives of clinical frontline NHS staff who responded to COVID-19. Methods: We recruited a diverse sample of 30 clinical frontline HCWs from the NHS CHECK study cohort, for single time point qualitative interviews. All participants endorsed at least one item on the 9-item Moral Injury Events Scale (MIES) [Nash et al., 2013. Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646–652] at six month follow up. Interviews followed a semi-structured guide and were analysed using reflexive thematic analysis. Results: HCWs described being routinely exposed to ethical conflicts, created by exacerbations of pre-existing systemic issues including inadequate staffing and resourcing. We found that HCWs experienced a range of mental health symptoms primarily related to perceptions of institutional betrayal as well as feeling unable to fulfil their duty of care towards patients. Conclusion: These results suggest that a multi-facetted organisational strategy is warranted to prepare for PMIE exposure, promote opportunities for resolution of symptoms associated with moral injury and prevent organisational disengagement. HIGHLIGHTS Clinical frontline healthcare workers (HCWs) have been exposed to an accumulation of potentially morally injurious events (PMIEs) throughout the COVID-19 pandemic, including feeling betrayed by both government and NHS leaders as well as feeling unable to provide duty of care to patients. HCWs described the significant adverse impact of this exposure on their mental health, including increased anxiety and depression symptoms and sleep disturbance. Most HCWs interviewed believed that organisational change within the NHS was necessary to prevent excess PMIE exposure and promote resolution of moral distress.

Evidence of Interventions and Strategies to Bridge the Quality Improvement Gap Led by HCW at the Frontline in SSA: A Scoping Review

Abstract Introduction Poor quality health care is a significant cause of preventable deaths, especially in low- and middle-income countries (LMICs). Quality improvement is multifaceted and includes strategies such as standard setting, quality assurance and clinic audits. In order to move quality improvement in health care into every day practice it is essential to fully engage the frontline where health care is delivered. The objective of this scoping review is to investigate front line health care worker line led quality improvement in Sub Saharan Africa (SSA). Methods We conducted a scoping review to identify, map and synthesize evidence on health care worker led quality improvement initiatives in Sub Sahara Africa using electronic databases PubMed, Cochrane, Embase, CINAHL, Scopus and Psychinfo to identify peer-reviewed literature published between January 2000 and January 2021. To identify grey literature, we used the same search terms in google search to a maximum of 10 pages or when there was no new information. All evidence was scored based on the 6 criteria described by Backhouse et al., which clearly distinguish quality improvement from clinical audit and research. Inclusion criteria were studies that involved frontline health care workers to test “change ideas” and used data systems to measure improvement in service delivery. Results A total of 75 records were identified and including 52 from the peer review search and 23 records from the grey literature search. Only 15 of 47 countries had publications (peer-review or grey literature) describing QI initiatives. Most quality improvement (QI) initiatives were multicomponent and included knowledge transfer, skills building, mentorship and learning visits. Most publications reported QI initiatives aimed at reproductive, maternal, neonatal and child health (n=23) and HIV (n=14) service delivery. Only 6 had experimental designs. No publications were identified prior to 2012 and a rapid escalation of published quality improvement initiatives from 2012 to 2020 was seen. Conclusion QI is in the very nascent stage in SSA. Most large-scale public health QI initiatives are sector specific, siloed, and donor driven. QI initiatives within sector specific programs have not moved horizontally and have had limited ability to change the broader system. Energy must be exerted to change the status quo. Making health care safer and more effective is not spontaneous.

Lessons from the frontline: The COVID-19 pandemic emergency care experience from a human resource perspective in the Pacific region

BackgroundThis study explores emergency care (EC) and other frontline healthcare worker (HCW) experiences responding to the COVID-19 pandemic in the Pacific region. The crisis has reinforced the crucial role well-trained, resourced, and supported EC providers play in supporting vital health systems and services in all global regions not only during ‘business as usual’ periods, but in times of tremendous stress and surge.MethodsQualitative data were collected from EC providers and relevant stakeholders in three research phases in 2020 and 2021. Data on the World Health Organization's (WHO) Human Resources Building Block, adapted for the Pacific EC context, was thematically analysed. Key findings were further analysed to identify enablers and barriers to effective EC pandemic management.Findings116 participants from across the Pacific region participated in this study. Five themes emerged: (1) EC providers performed multiple pandemic roles; (2) Importance of authorities’ valuing frontline HCWs; (3) HCW mental health and exhaustion; (4) HCW tension managing stigma, personal/professional expectations, and chronic health needs; and (5) Building health and human resource capacity.InterpretationThis study significantly contributes to the limited scientific literature on HCW experiences responding to COVID-19 across the Pacific. Recommendations arising out of this research align with consensus priorities and standards that were identified pre-pandemic by health stakeholders across the Pacific for enhancing EC system development. With limited HCWs available for many Pacific nations, it is imperative the dignity and welfare of local HCWs is genuinely prioritised.FundingEpidemic Ethics/WHO, Foreign, Commonwealth and Development Office/Wellcome Grant 214711/Z/18/Z. Co-funding: Australasian College for Emergency Medicine Foundation, International Development Fund Grant.

Supporting teachers during the COVID-19 pandemic: A community-partnered rapid needs assessment.

Using a community-partnered research framework, the goal of this study was to rapidly assess coronavirus disease (COVID-19) impact on teachers, students, and families and guidance received to navigate distance learning. Participants were teachers (N = 430) working in elementary schools (n = 301), middle schools (n = 56), high schools (n = 60), and other schools (n = 13) in two large urban school districts heavily impacted by COVID-19. Results indicated teacher concerns regarding student instructional loss and exposure to direct and indirect COVID-related trauma. There were mean differences in teacher concern by school level (p = .001, η² = .033) with elementary teachers reporting the greatest concerns regarding instructional loss. Over 40% of teachers reported that more than 20% of their students had a family member infected with COVID-19 or employed as a frontline healthcare worker. Approximately 99% of teachers reported a significant gap in student access to the internet and distance learning devices. Teachers reported receiving more school than district guidance regarding distance learning, student engagement, and using social emotional learning (SEL) programs. Results informed professional development priorities for educators and immediate supports needed for students and families. Study limitations and future directions for research and practice are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

THE STUDY OF PSYCHOLOGICAL IMPACT OF COVID-19 ON HEALTHCARE PROFESSIONALS AND GENERAL POPULATION IN INDI

Introduction- Covid 19 pandemic is having a psychological impact not only on the frontline healthcare worker but also on the general population. The comparative data on psychological impact of covid 19 pandemic on healthcare professional and general population is limited. Objective: To study the psychological impact of covid-19 pandemic on healthcare workers and general populations and also comparing the results between the two groups. Material and Methods: A cross sectional study was conducted on 840 consecutive participants according to inclusion/exclusion criteria. The participants were assessed using semi-structured sociodemographic details, medical history proforma and Depression Anxiety Stress Scales-21 (DASS-21) using digital platform (Google Forms). Chi-square test and Independent Samples Mann-Whitney U test were used to explore association between these aspects. Results: The signicant difference was found between the two groups i.e. the healthcare professionals and general population in the prevalence of stress (P=0.033) with level higher among the healthcare workers. The healthcare professionals, who were involved in direct care of covid 19 patients were found to have signicantly higher level of stress( P= 0.006 ) and anxiety (P=0.002) than those who were not directly involved. Conclusion: Study reveals that signicant difference was found in prevalence of stress among healthcare workers but the prevalence of depression and anxiety was not signicantly different among the two. Signicant difference was found in prevalence of anxiety and stress in healthcare workers involved in the care of Covid-19 patients and the healthcare professionals not involved. Psychological intervention may be considered for the healthcare professionals involved covid-19 patients

Factors affecting dementia care practitioners' decision-making on moves to a care home for persons living with dementia: A factorial survey.

Deciding if and when might be the 'optimal' time for a person living with dementia to move to a care home is often difficult for the individual, family and practitioners. In this study, we describe the outcome of a factorial survey conducted with 100 dementia care practitioners (a frontline health or social care worker who works with people living with dementia) in England, which investigated factors used in deciding when a person living with dementia moves to a care home. Using findings from qualitative interviews with older people living with dementia, family carers, care home managers and social workers, we identified four factors that appeared to influence the decision to move to a care home: (1) Family carers' ability to support the person with daily activities, (2) amount of support provided by home care workers, (3) level of risk of harm and (4) the person living with dementia's wishes. These factors were then randomised within skeleton vignettes that told the story of a fictitious woman (Jane) living with dementia at home with her husband. Fifty-four variations of the vignettes were produced and randomly assigned to 100 surveys. A total of 100 volunteer dementia care practitioners (78% female, 54% over 50years of age) received their own personalised online survey link via email and were asked to read each vignette and decide whether to suggest Jane (a) move to a care home or (b) continue living at home. Results indicated that Jane's wishes principally drove most dementia care practitioners' decision on whether to suggest a move to a care home or stay living at home (odds ratio=6.5-19.5). Findings will inform a better understanding of the factors that contribute toward a decision to move to a care home and be of relevance to policy, practice, training and support.

Exploring Frontline Healthcare Worker's Stress and Recovery Off-Shift during the COVID-19 Pandemic

I completed my practicum with 4YouandMe, a non-profit created to aid individuals who are interested in sharing health-related data using smartphones and other wearable devices so that they can better understand and navigate health conditions. The Stress and Recovery Study used the Oura ring and smartphones to track and understand the multidimensional components of stress and recovery off-shift in frontline healthcare workers during the current COVID-19 pandemic. My role in this study was actively working as a clinical research coordinator and digital participant engagement expert. This role consisted of calling participants and asking them about their overall study experience, details regarding their stress triggers, their home and work environments, and use of their Oura ring. I was responsible for maintaining contact with about 70 participants and creating contact logs after each phone call. The purpose of these phone calls is to provide support and encourage participant adherence to the study tasks. In addition to this primary role, I also completed an emerging COVID-19 hotspot map that was used in the recruitment process of the study. I outlined regions in the U.S that may become hotspots for COVID cases and may subsequently translate to a higher stressed group of healthcare workers in those areas. Additionally, I contributed to developing adherence tracking frameworks and other study materials used by team members. This study is contributing to the public health literature by using novel methodologies including digital approaches to understanding stress. Looking at digital stress responses and biometric data as signals to predict infection may inform other tools to aid in early detection. Finally, the study aims to determine whether resiliency factors and some social determinants of health modify stress and recovery.

What You Need to Know About Hand Hygiene and Dermatitis During the Coronavirus Pandemic.

Increased attention towards infection control measures during the COVID-19 pandemic have brought to light the dermatological consequences of intensified hand hygiene measures. Healthcare workers are inherently at an increased risk of developing both allergic and irritant contact dermatitis. Individuals with a history of atopy are especially vulnerable given their impaired native skin barriers and increased sensitivities at baseline. Examination gloves not only induce contact allergies from manufacturing chemicals, but also serve as an occlusive catalyst for facilitating contact sensitization and irritant dermatitis. Similarly, handwashing practices with soap and alcohol-based hand rubs (ABHRs) undermine the natural skin barriers with increasing frequency of use. We highlight clinical pearls for the frontline healthcare worker experiencing COVID-19 surges and offer practical measures to minimize the development of hand-based dermatitis.

EVENT-RELATED POTENTIALS STUDIES OF PTSD AFTER INFECTION OF SARS-COV-2 AND NEUROCOVID-19

Coronavirus disease 19 (COVID-19) hospitalisation is a potentially traumatic experience, especially in severe cases. Furthermore, the unprecedented context of the SARS-CoV-2 pandemic, with the daily media bombardment about COVID-19 mortality, may have amplified its life-threatening perception also in patients with moderate infection. The purpose of our study was twofold: 1) to evaluate QEEG/ERPs shows of PTSD associated with severe infection SARS-CoV-2, and neuroCOVID-19, 2) to construct a neurofeedback protocol based on these indices to support the psychotherapy of the case study described herein. Patient N.C. 49, a frontline healthcare worker in the emergency services (an ambulance driver), became ill with Covid-19 on November 14, 2020. Initially, he lost his sense of smell (anosmia), of taste (ageusia), and had latent blinks (heterophila), headaches, and dizziness. After 10 days of illness, the patient had additionally a dry cough and a shortness of breath and he was hospitalized, sedated and mechanically ventilated for 24 days. After a few months he was diagnosed with PTSD (according to the DSM- 5 criteria) and referred to the Reintegration and Training Center of the Polish Neuropsychological Society for further diagnosis and treatment. It was found that the P3 GO and P3 NOGO waves were indeed less in his case (p < 0.01) when compared to the ERPs results of a health group of individuals of a similar age (n = 100), derived from the normative data bases of the Human Brain Index (HBI) in Switzerland. The ERPs wave pattern in our patient reflects the pattern appearing in patients with PTSD. The patient took part in 20 sessions of individually tailored anodal transcranial direct current stimulation (tDCS), with the excitatory stimulation of the left prefrontal cortex and inhibitory stimulation of the right prefrontal cortex which can reduce anxiety, as was proposed in the subject literature. Also, the neuromarker of PTSD obtained with the use of QEEG/ERPs was helpful in choosing the appropriate tDCS protocol. Neurostimulation with the use of tDCS was administered systematically, every day, 15-20 and 30-40 minutes for each session, for 20 days. He also received individual sessions of psychotherapy every day, 30-40 minutes for each session, for 20 day. After the treatment the patient improved and returned to his previous job as a frontline healthcare worker in the emergency services (an ambulance driver) in the fight against COVID-19. Detection of the PTSD neuromarker enabled the development of a proper tDCS protocol and the conduct of effective brain neurostimulation of a patient with PTSD. The proposed protocol of treatment, in combination with goal-oriented individual psychotherapy, offered to the patient, was effective in the reduction of PTSD. ERPs can be useful in the diagnosis of PTSD as well as in selecting an appropriate therapy protocol for these patients.

Psychological Impact During the First Outbreak of COVID-19 on Frontline Health Care Workers in Shanghai.

Background: The COVID-19 pandemic is a significant health threat. Health care worker (HCWs) are at a significant risk of infection which may cause high levels of psychological distress. The aim of this study was to investigate the psychological impact of the COVID-19 on HCWs and factors which were associated with these stresses during the first outbreak in Shanghai.Methods: Between February 9 and 21, 2020, a total of 3,114 frontline HCWs from 26 hospitals in Shanghai completed an online survey. The questionnaire included questions on their sociodemographic characteristics, 15 stress-related questions, and General Health Questionnaire-12 (GHQ-12). Exploratory factor analysis was applied to the 15 stress-related questions which produced four distinct factors for evaluation. Multiple linear regression models were performed to explore the association of personal characteristics with each score of the four factors. Binary logistic analysis was used to explain the association of personal characteristics and these four factors with the GHQ-12.Results: There were 2,691 valid surveys received. The prevalence of emotional distress (defined as GHQ-12 ≥ 12) was noted in 47.7% (95%CI:45.7–49.6%) HCWs. Females (OR = 1.43, 95%CI:1.09–1.86) were more likely to have a psychological distress than males. However, HCWs who work in secondary hospitals (OR = 0.71, 95% CI:0.58–0.87) or had a no contact history (OR = 0.45, 95%CI: 0.35–0.58) were less likely to suffer psychological distress. HCWs who were nurses, married, and had a known contact history were highly likely to have anxiety. HCWs working at tertiary hospitals felt an elevated anxiety regarding the infection, a lack of knowledge, and less protected compared to those who worked at secondary hospitals.Conclusions: Our study shows that the frontline HCWs had a significant psychosocial distress during the COVID-19 outbreak in Shanghai. HCWs felt a lack of knowledge and had feelings of being not protected. It is necessary for hospitals and governments to provide additional trainings and psychological counseling to support the first-line HCWs.

Risk factors and protective measures for healthcare worker infection during highly infectious viral respiratory epidemics: A systematic review and meta-analysis.

To investigate risk factors for healthcare worker (HCW) infection in viral respiratory pandemics: severe acute respiratory coronavirus virus 2 (SARS-CoV-2), Middle East respiratory syndrome (MERS), SARS CoV-1, influenza A H1N1, influenza H5N1. To improve understanding of HCW risk management amid the COVID-19 pandemic. Systematic review and meta-analysis. We searched MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL databases from conception until July 2020 for studies comparing infected HCWs (cases) and noninfected HCWs (controls) and risk factors for infection. Outcomes included HCW types, infection prevention practices, and medical procedures. Pooled effect estimates with pathogen-specific stratified meta-analysis and inverse variance meta-regression analysis were completed. We used the GRADE framework to rate certainty of evidence. (PROSPERO no. CRD42020176232, 6 April 2020.). In total, 54 comparative studies were included (n = 191,004 HCWs). Compared to nonfrontline HCWs, frontline HCWs were at increased infection risk (OR, 1.66; 95% CI, 1.24-2.22), and the risk was greater for HCWs involved in endotracheal intubations (risk difference, 35.2%; 95% CI, 21.4-47.9). Use of gloves, gown, surgical mask, N95 respirator, face protection, and infection training were each strongly protective against infection. Meta-regression showed reduced infection risk in frontline HCWs working in facilities with infection designated wards (OR, -1.04; 95% CI, -1.53 to -0.33, P = .004) and performing aerosol-generating medical procedures in designated centers (OR, -1.30; 95% CI, -2.52 to -0.08; P = .037). During highly infectious respiratory pandemics, widely available protective measures such as use of gloves, gowns, and face masks are strongly protective against infection and should be instituted, preferably in dedicated settings, to protect frontline HCW during waves of respiratory virus pandemics.

COVID-19 welbeing study: a protocol examining perceived coercion and psychological well-being during the COVID-19 pandemic by means of an online survey, asynchronous virtual focus groups and individual interviews

IntroductionThe COVID-19 pandemic has resulted in many countries applying restrictive measures, such as lockdown, to contain and prevent further spread. The psychological impact of lockdown and working as a healthcare...