Insufficient Personal Protective Equipment Research Articles

Prevalence of tuberculosis among healthcare workers in India: a systematic review and meta-analysis.

Tuberculosis (TB) poses a significant occupational hazard for healthcare workers (HCWs) in India, a country bearing a substantial portion of the global TB burden. This systematic review and meta-analysis aim to determine the prevalence of TB among HCWs in India. Analyzing ten studies up to 2024, we found a pooled prevalence of 2391.6 cases per 100,000 individuals, underscoring the critical occupational risk. Factors contributing to this high prevalence include inadequate ventilation, insufficient personal protective equipment, and frequent exposure to multidrug-resistant TB strains. Our findings emphasize the urgent need for stringent infection control measures, routine TB screening, and comprehensive educational programs. Policy recommendations include developing national TB screening guidelines and improving healthcare infrastructure. Protecting HCWs is crucial to achieving India's goal of TB elimination by 2025.

Health worker perspectives on barriers and facilitators of tuberculosis investigation coverage among index case contacts in rural Southwestern Uganda: a qualitative study

BackgroundIn 2012, the World Health Organization recommended screening and investigation of contacts of index tuberculosis patients as a strategy to accelerate detection of tuberculosis (TB) cases. Nine years after the adoption of this recommendation, coverage of TB contact investigations in Uganda remains low. The objective of this study was to examine health care providers’ perceptions of factors influencing coverage of TB contact investigations in three selected rural health facilities in Mbarara district, southwestern Uganda.MethodsThis study identified provider opinions on the barriers and facilitators to implementation of TB contact investigation using the Consolidated Framework for Implementation Research. Using an exploratory qualitative study design, semi-structured interviews with 19 health workers involved in the TB program at district, health facility and community levels were conducted from April 2020 and July 2020. Analysis was conducted inductively using reflexive thematic analysis in six iterative steps: familiarizing with the data, creating initial codes, searching for themes, reviewing themes, developing theme definitions, and writing the report.ResultsNineteen health care workers participated in this study which translates to a 100% response rate. These included two district TB and leprosy supervisors, five nurses, five clinical officers, six village health team members and one laboratory technician. The three themes that emerged from the analysis were intervention-related, health system and contextual factors. Health system-related barriers included inadequate or delayed government funding for the TB program, shortage of human resources, insufficient personal protective equipment, and a stock-out of supplies such as Xpert MTB cartridges. Contextual barriers included steep terrain, poverty or low income, and the stigma associated with TB and COVID-19. Facilitators comprised increased knowledge and understanding of the intervention, performance review and on-the-job training of health workers.ConclusionsThis study found that most of the factors affecting TB contact investigations in this rural community were related to health system constraints such as inadequate or delayed funding and human resource shortages. This can be addressed by strengthening the foundational elements of the health system - health financing and human resources - to establish a comprehensive TB control program that will enable the efficient identification of missing TB patients.

Working conditions and common mental disorders in nurses facing Covid-19

Introduction: The Coronavirus disease pandemic represents the biggest public health emergency faced globally in decades, with repercussions on the mental health of nursing professionals. Aims: This study analyzed working conditions and their impact on the mental health of nurses facing COVID-19. Methods: A total of 192 nurses answered an electronic questionnaire. Screening for Common Mental Disorders (CMD) was performed using the Self-Reporting Questionnaire (SRQ-20), and associations between the dependent and independent variables were tested. Results: The prevalence of suspected CMD was 53.1%, and this outcome was associated with female gender (p<0.005), insufficient personal protective equipment in quantity and quality (p<0.006), insufficient biosafety standards (p<0.045), being at risk of transmitting COVID-19 (p<0.001), and having a family member with COVID-19 symptoms (p<0.029). Discussion and Conclusions: The study demonstrates the negative impact of the COVID-19 pandemic on nurses' mental health and reinforces the need for psychological support for health workers.

POLITICAL COMMUNICATION AND VOTER PARTICIPATION IN THE 2020 REGIONAL HEAD ELECTIONS IN BANGLI REGENCY

This research analyzes political communication in voter participation during the 2020 simultaneous regional head elections in Bangli Regency amidst the Covid-19 pandemic. It examines forms of political communication, underlying ideology, and implications. Using a qualitative approach, data were collected through in-depth interviews and document studies, applying theories such as persuasive communication, critical hegemony, social practice, and power-knowledge relations. Findings indicate that online political communication during the pandemic facilitated interaction between election actors and voters but had drawbacks. Issues included limited election information, outdated voter data, and inaccurate permanent voter lists. Additionally, budget constraints, insufficient personal protective equipment, and health protocol violations were significant challenges. The ideology behind political communication was the hegemony of community figures, political elites, and successful teams over voters, resulting in power-knowledge relations and transactional political practices. Elderly and disabled voters in mountainous areas were particularly marginalized. Practical findings show that online political communication limited voter references, reducing freedom in choosing candidates. Theoretical findings indicate that online political communication disrupts social interaction during Covid-19, and hegemony theory is effectively applied in the Bangli community, which practices local culture. However, power- knowledge relation theory cannot be universally applied, as traditional figures dominate voters and the central executive board determines coalitions and candidate pairs. Keywords: political communication, participation, regional elections, Bangli Regenc

Causal Model Analysis of the Effect of Policy Formalism, Equipment Insufficiency and COVID-19 Fear on Construction Workers’ Job Burnout, and Insomnia during the Epidemic

During the epidemic, construction site workers suffered from COVID-19 fear, job burnout, and job insecurity due to insufficient personal protective equipment. This study mainly explores the effect of policy formalism, equipment insufficiency, COVID-19 fear, and job insecurity on construction workers’ job burnout and insomnia during the epidemic. The main contribution of this article is to introduce policy formalism into the exploration of the causes of insomnia among construction site workers during the epidemic. This study collected 733 valid samples of construction site workers. We tested the established hypotheses using confirmatory factor analysis and structural equation modeling. The research results found that equipment insufficiency positively affects COVID-19 fear. Policy formalism and COVID-19 fear positively affect job burnout. Social support negatively affects job burnout. Job burnout and job insecurity positively affect insomnia. The government should establish clear policy evaluation standards and implement policies to reduce construction site workers’ perceptions of policy formalism. The government should prepare sufficient personal protective equipment so that workers on construction sites can cope with the spread of the epidemic.

Risk Factors and Prevention of Needlestick Instruments in the Medical Field: Systematic Review

Introduction: Needlestick and sharp object injuries represent a significant occupational hazard faced by healthcare workers worldwide. A systematic review focusing on needlestick and sharp object injuries among healthcare workers is essential due to the heterogeneous nature of existing research. The aim of this systematic review is to comprehensively synthesize existing literature to provide a comprehensive understanding of the prevalence, risk factors, and prevention strategies related to needlestick and sharp object injuries among healthcare workers. Methods: This thorough examination adheres to PRISMA principles and implements a pre-planned research plan to promote transparency and minimize partiality. It encompasses investigations involving medical personnel (such as nurses and physicians) centered on puncture wounds and sharp instrument mishaps, exploring contributing factors, occurrence rate, aftermaths, and preventative measures. A thorough exploration is conducted through various databases, with two separate evaluators examining and evaluating the studies. Suitable studies encompass both observational and intervention-based studies without constraints on publication dates. Information is extracted using a standardized format, and ethical clearance is not required as the review solely relies on already published data. Results: In our systematic review, we initially identified 1,523 articles through a database search, which underwent a stepwise screening process, resulting in 198 articles after assessing titles and abstracts. Subsequently, these 198 articles underwent a rigorous full-text evaluation. After this thorough assessment, 14 studies were included that met our predefined eligibility criteria. Our synthesis of the observational studies revealed recurring risk factors for needlestick and sharp object injuries among healthcare workers, including inadequate training, the impact of fatigue and extended working hours, and insufficient personal protective equipment (PPE). Additional factors like job category, experience level, and compliance with safety protocols were also highlighted in specific studies. Conclusions: This systematic review highlights the importance of standardized approaches to enhance healthcare worker safety, particularly in addressing risk factors like inadequate training, fatigue, and inadequate personal protective equipment (PPE). The effectiveness of prevention strategies, as demonstrated in our meta-analysis, underscores the value of comprehensive programs in reducing injury rates, emphasizing the need for more standardized and multifaceted safety measures across healthcare settings.

The role of primary care during the pandemic: shared experiences from providers in five European countries

BackgroundThe COVID-19 pandemic necessitated wide-ranging adaptations to the organisation of health systems, and primary care is no exception. This article aims to collate insights on the role of primary care during the pandemic. The gained knowledge helps to increase pandemic preparedness and resilience.MethodsThe role of primary care during the pandemic in five European countries (Austria, Denmark, France, Hungary, Italy) was investigated using a qualitative approach, namely case study, based on document analysis and semi-structured interviews. In total, 31 interviews were conducted with primary care providers between June and August 2022. The five country case studies were subjected to an overarching analysis focusing on successful strategies as well as gaps and failures regarding pandemic management in primary care.ResultsPrimary care providers identified disruptions to service delivery as a major challenge emerging from the pandemic which led to a widespread adoption of telehealth. Despite the rapid increase in telehealth usage and efforts of primary care providers to organise face-to-face care delivery in a safe way, some patient groups were particularly affected by disruptions in service delivery. Moreover, primary care providers perceived a substantial propagation of misinformation about COVID-19 and vaccines among the population, which also threatened patient-physician relationships. At the same time, primary care providers faced an increased workload, had to work with insufficient personal protective equipment and were provided incongruous guidelines from public authorities. There was a consensus among primary care providers that they were mostly sidelined by public health policy in the context of pandemic management. Primary care providers tackled these problems through a diverse set of measures including home visits, implementing infection control measures, refurbishing used masks, holding internal meetings and relying on their own experiences as well as information shared by colleagues.ConclusionPrimary care providers were neither well prepared nor the focus of initial policy making. However, they implemented creative solutions to the problems they faced and applying the learnings from the pandemic could help in increasing the resilience of primary care. Attributes of an integrated health system with a strong primary care component proved beneficial in addressing immediate effects of the pandemic.

코로나19 팬데믹 상황에서 근무환경이 작업치료사의 직무 스트레스에 미치는 영향

Objective: This study investigated the effects of work environment on the job stress of occupational therapists during the COVID-19 pandemic. Methods: We surveyed occupational therapists providing face-to-face occupational therapy during the COVID-19 pandemic. The independent variables included 11 items on general characteristics and 11 items on work environment, whereas the dependent variable consisted of 24 items on job stress. The survey, comprised of a total of 46 items, was conducted using a shared link to an online questionnaire. Online surveys were collected over a three month period beginning from September 2022, and a final amount of 216 surveys were analyzed. The data were analyzed through their descriptive statistics, correlation analysis, and multiple regression analysis to identify factors influencing job stress, including variables showing a correlation. Results: As the results of the correlation analysis indicate, the working institution, patient, increased musculoskeletal pain, difficulties in intra-departmental communication, difficulties in co-work with other departments, difficulties in the use of personal protective equipment, insufficient personal protective equipment, and an increase in the burden of infection risk were significant correlation factors. Through a multiple regression analysis, insufficient personal protective equipment and an increased burden of risk of infection were identified as factors affecting job stress. Conclusion: The results of this study indicate that insufficient personal protective equipment and an increased burden of infection risk affected the job stress of occupational therapists during the COVID-19 pandemic. It is therefore necessary to provide adequate personal protective equipment to occupational therapists who work face-to-face with patients under situations of infectious disease outbreaks in order to help them reduce their risk of infection.

Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic.

The COVID-19 pandemic affected access to antenatal care in low and middle-income countries where anaemia in pregnancy is prevalent. We analyse how health workers provided antenatal care and the factors affecting access to antenatal care during the COVID-19 pandemic in Kapilvastu district in the western plains of Nepal. We used qualitative and quantitative methodologies, conducting eight semi-structured interviews with health workers who provided antenatal care during the pandemic, and a questionnaire containing open and closed questions with 52 female community health volunteers. Antenatal care was severely disrupted during the pandemic. Health workers had to find ways to provide care with insufficient personal protective equipment and guidance whilst facing extreme levels of stigmatisation which prevented them from providing outreach services. Pregnant women were fearful or unable to visit health institutions during the pandemic because of COVID-19 control measures. Pre-pandemic and during the pandemic health workers tried to contact pregnant and postpartum women and families over the phone, but this was challenging because of limited access to phones, and required pregnant women to make at least one antenatal care visit to give their phone number. The pandemic prevented new pregnancies from being registered, and therefore the possibilities to provide services over the phone for these pregnancies were limited. To reach the most marginalised during a pandemic or other health emergency, health volunteers and households need to exchange phone numbers, enabling proactive monitoring and care-seeking. Strengthening procurement and coordination between the municipal, provincial, and federal levels of government is needed to ensure adequacy of antenatal supplies, such as iron folic acid tablets, in health emergencies. Community engagement is important to ensure women and families are aware of the need to access antenatal care and iron folic acid, and to address stigmatisation of health workers.

The Psychosocial Impact of Treating Patients with COVID-19 on Psychiatry Residents in a Community Hospital: a Qualitative Study.

The authors explored the experiences of psychiatry residents caring for patients during the COVID-19 pandemic on a medical unit. From June 2020 through December 2020, structured, individual interviews were conducted with psychiatry residents deployed to internal medicine wards in a community hospital to provide medical care to COVID-19 patients for greater than or equal to 1week. Interviews were recorded, transcribed verbatim, and analyzed using thematic analytical methods. Psychiatry residents (n = 16) were interviewed individually for approximately 45min each. During the interviews, many residents described emotions of fear, anxiety, uncertainty, lack of preparedness, and difficulty coping with high patient mortality rates. Many of the residents expressed concerns regarding insufficient personal protective equipment, with the subsequent worries of their own viral exposure and transmission to loved ones. Multiple residents expressed feeling ill-equipped to care for COVID-19 patients, in some cases stating that utilizing their expertise in mental health would have better addressed the mental health needs of colleagues and patients' families. Participants also described the benefits of processing emotions during supportive group sessions with their program director. The COVID-19 pandemic represents a public health crisis with potential negative impacts on patient care, professionalism, and physicians' well-being and safety. The psychiatry residents and fellows described the overwhelmingly negative impact on their training. The knowledge gained from this study will help establish the role of the psychiatrist not only in future crises but in healthcare as a whole.

Prevalence and factors associated with academic burnout risk among nursing and midwifery students during the COVID-19 pandemic: A cross-sectional study.

The aim of the study was to assess the prevalence of academic burnout (AB) and its associated factors among nursing and midwifery students during the COVID-19 pandemic. A correlational cross-sectional study. An online survey was distributed from November to December 2020 to nursing and midwifery students in Belgium. The risk of AB was assessed using the MBI-SS Academic Burnout Inventory scale. Factors associated with AB were related to the personal life and level of education of the student and to the COVID-19 pandemic. The prevalence of overall AB risk was 50.0% (95% CI 48.5-53.1). Factors significantly associated with higher risk of AB were having a child, having a job, the level of academic training, working overtime, insufficient personal protective equipment against viral contamination during the last internship, work overload due to the pandemic, personal proven or possible SARS-CoV-2 infection and having a relative who died related to COVID-19.

Effects of COVID-19 on mental health of health care workers in the context of COVID-19 Pandemic: A scoping review

The COVID-19 pandemic has affected both physical health and mental health of Health Care Workers (HCWs), which should be prioritized to analyze to better understand the associated factors that could affect their mental health and to help improve the working conditions and tailor suitable interventions of the multi - variant coronavirus. The scoping review method is used to describe existing literature and other sources of information, commonly includes findings from different study designs and methods, following PRISMA-ScR. All 39 reviewed studies indicated the prevalence of popular mental health problems as consequences of COVID-19 on HCWs, including depression, insomnia, post-traumatic stress disorders, stress and anxiety. Main associated factors are ranged from low - to high - risk, including fears of getting infected, long working hours and intensive night shifts, insufficient personal protective equipment, isolation from family and friends, lack of social supports, reading COVID-19 related news. A small portion of HCWs reported with positive health outcomes thanks to their good self-coping strategies to fight off bad influence of COVID-19. Mental health of HCWs is important in COVID-19 pandemic. This review provides evidence for researchers and policy makers to develop guidelines, evidence-based intervention, and policies to back up healthy working conditions and a work-life balance of HCWs.

The Association Between Exposure to COVID-19 and Mental Health Outcomes Among Healthcare Workers.

Due to the unprecedented impact of the COVID-19 pandemic on health care systems, there has been great interest in the mental wellbeing of healthcare workers. While most studies investigated mental health outcomes among frontline vs. non-frontline healthcare workers, little is known about the impact of various work-related variables. The present study aimed to examine the association between work-related [i.e., having contact with COVID-19 patients, being redeployed due to the pandemic and availability of sufficient personal protective equipment (PPE)] and subjective (i.e., worries about getting infected or infecting others) exposures and self-reported mental health outcomes (i.e., psychological distress, depressive symptoms, and posttraumatic stress symptoms). Between February and May 2021, 994 healthcare workers employed at a variety of healthcare settings in the Netherlands filled out an online survey as part of the COVID-19 HEalth caRe wOrkErS (HEROES) study. Mental health outcomes were measured using the General Health Questionnaire-12, the Patient Health Questionnaire-9, and the Primary Care PTSD Screen for DSM-5. Approximately 13% reported depressive symptoms, 37% experienced psychological distress, and 20% reported posttraumatic stress symptoms. Multilevel linear models consisted of three levels: individual (work-related and subjective exposures), healthcare center (aggregated redeployment and availability of sufficient PPE), and regional (cumulative COVID-19 infection and death rates). Worries about infection were associated with all three mental health outcomes, whereas insufficient PPE was associated with psychological distress and depressive symptoms. There were no differences in outcomes between healthcare centers or provinces with different COVID-19 infection and death rates. Our findings highlight the importance of adequate PPE provision and the subjective experience of the COVID-19 pandemic. These factors should be part of interventions aimed at mitigating adverse mental health outcomes among healthcare workers during the COVID-19 pandemic.

Experiences of personal protective equipment by Australian healthcare workers during the COVID-19 pandemic, 2020: A cross-sectional study.

The aim of this study was to capture Australian frontline healthcare workers’ (HCWs) experiences with personal protective equipment (PPE) during the COVID-19 pandemic in 2020. This was a cross-sectional study using an online survey consisting of five domains: demographics; self-assessment of COVID risk; PPE access; PPE training and confidence; and anxiety. Participants were recruited from community and hospital healthcare settings in Australia, including doctors, nurses, allied health professionals, paramedics, and aged care and support staff. Data analysis was descriptive with free-text responses analysed using qualitative content analysis and multivariable analysis performed for predictors of confidence, bullying, staff furlough and anxiety. The 2258 respondents, comprised 80% women, 49% doctors and 40% nurses, based in hospital (39%) or community (57%) settings. Key findings indicated a lack of PPE training (20%), calls for fit testing, insufficient PPE (25%), reuse or extended use of PPE (47%); confusion about changing guidelines (48%) and workplace bullying over PPE (77%). An absence of in-person workplace PPE training was associated with lower confidence in using PPE (OR 0.21, 95%CI 0.12, 0.37) and a higher likelihood of workplace bullying (OR 1.43; 95% CI 1.00, 2.03) perhaps reflecting deficiencies in workplace culture. Deficiencies in PPE availability, access and training linking to workplace bullying, can have negative physical and psychological impacts on a female dominant workforce critical to business as usual operations and pandemic response.

COVID-19 Pandemic Factors and Depressive Symptoms Among Primary Care Workers in São Paulo, Brazil, October and November 2020.

Objectives. To investigate associations between COVID-19-related factors and depressive symptoms among primary care workers (PCWs) in São Paulo, Brazil, and to compare the prevalence of probable depression among PCWs before and during the pandemic. Methods. In a random sample of primary care clinics, we examined 6 pandemic-related factors among 828 PCWs. We used multivariate Poisson regression with robust variance to estimate prevalence ratios for probable depression. We assessed the prevalence of probable depression in PCWs before and during the pandemic in 2 comparable studies. Results. Adjusted prevalence ratios were substantial for insufficient personal protective equipment; experiences of discrimination, violence, or harassment; and lack of family support. Comparisons between PCWs before and during the pandemic showed that the prevalence of probable depression among physicians, nurses, and nursing assistants was higher during the pandemic and that the prevalence among community health workers was higher before the pandemic. Conclusions. Our findings indicate domains that may be crucial to mitigating depression among PCWs but that, with the exception of personal protective equipment, have not previously been examined in this population. It is crucial that governments and communities address discriminatory behaviors against PCWs, promote their well-being at work, and foster family support. (Am J Public Health. 2022;112(5):786-794. https://doi.org/10.2105/AJPH.2022.306723).

COVID-19 Bağlamında Temel Üreme, Anne, Yenidoğan, Çocuk, Ergen Sağlığı ve Beslenme Hizmetlerinin Sürdürülmesine İlişkin Etki Değerlendirmesi: Kuzey-Orta Nijerya'dan İçgörü

Objective: In the context of COVID-19 in North Central Nigeria, a qualitative interview study was conducted to assess the impact on the maintenance of essential sexual, reproductive, maternal newborn, child, adolescent healthy plus nutrition serves (RMNCAH+N). 
 Methods: This proposition aligns with the global crusade of the United Nations Sustainable development goals (UNSDGs 2.3.8) that highlights good nutrition (zero hunger) access to quality healthy and sustainable economic growth path. To this end, a field survey design was done qualitatively. Key informant interviews (KIIs) and focus group discussions (FGDs) were used in the qualitative analysis, which was based on typical interview schedules. During the study period, a total of 258 people from six different communities participated in the KII and FGD interviews. 
 Results: Key study findings outline eight major master essential concepts, such as healthcare workers reporting a variety of tough emotions and psychological issues. These included insufficient medical equipment’s, dissatisfaction with members of the public who did not observe social distancing norms, concerns about protecting their loved ones from infection, increased workload, and changing working conditions, insufficient personal protective equipment kits (PPE), and a sense that their frontline work was being undermined. 
 Conclusion: There was also a significant increase in gender-based violence. Further policy suggestions are outlined in the concluding section.

A Comparative Policy for the COVID-19 Emergency Management of Frontline Health Workers in Selected African Countries

Health workers are often exposed to health risks and danger in the discharge of their duties. This is especially distressing during the COVID-19 pandemic. This study employs a multiple case study design to investigate the COVID-19 emergency management of frontline workers in South Africa, Kenya, Ghana, and Nigeria. The findings from the study reveal that governments in the selected countries prioritize the response phase of the emergency management theory over the mitigation and preparedness phases. The response phase was meted with inevitable consequences. Health workers feared risking their lives, and the majority threatened to abandon their jobs due to insufficient personal protective equipment (PPE) and welfare support. The study concludes that the government should prioritize all the phases of emergency management instead of focusing on the response phase, which involves the use of both human and financial resources on an overwhelming pandemic. They should have prepared the frontline workers adequately and equipped their health systems in preparation for any impending epidemic.

Role of cleaners in establishing and maintaining essential environmental conditions in healthcare facilities in Malawi

Abstract Healthcare facility (HCF) cleaners play an important role in preventing healthcare-acquired infections and promoting a safe and clean healthcare environment. There is little evidence describing cleaner roles in HCFs in low-income countries and factors facilitating and constraining their roles and responsibilities. We analyzed qualitative and quantitative data from 57 in-depth interviews with cleaners in 44 government-run HCFs in Malawi. Cleaner constraints included inadequate training on infection prevention and control (IPC), personal protective equipment (PPE), hand hygiene, and waste management; insufficient PPE and hand hygiene resources; assignment of tasks that are unrelated to core responsibilities and their job description; risk of work-related injuries; and disrespect and stigma from medical staff, patients, and guardians. Facilitators included the positive collaboration and communication with medical staff, high job satisfaction, and a positive working attitude. We recommend the provision of more robust IPC, PPE, hand hygiene, and waste management training (including orientation and refresher). PPE resources must be made available to ensure HCF cleanliness and to keep cleaners, staff, patients, and guardians safe. Clearly defined job descriptions for cleaners will clarify their roles, describe bounds of their work, and ensure cleaners are viewed as essential frontline workers who ensure the safety of staff and patients.

Depression, Anxiety and Stress among health care workers during the COVID-19 pandemic in Jazan city, Kingdom of Saudi Arabia

Background: The mental health impact of a disease outbreak is usually neglected by pandemic management with costly consequences. Early evidence shows that health workers directly involved in the diagnosis, treatment, and care of patients with COVID-19 are at risk of developing mental health symptoms. Similar adverse psychological reactions were reported among healthcare workers in previous studies during the 2003 severe acute respiratory syndrome outbreak. Objectives: to assess the prevalence and determinants of depression, anxiety, and stress among healthcare workers at Prince Mohammed bin Nasser Tertiary Hospital in Jazan City during the COVID-19 pandemic. Methods: This was a cross-sectional study conducted among healthcare worker at Prince Mohammed bin Nasser Hospital. A total of 352 health workers were included in the study. Data was collected through a self-administered questionnaire pertaining to socio-demographic characteristics and the depression anxiety stress scale 21-item questionnaire. Descriptive statistics were calculated for study variables, including frequency and percentage for qualitative variables and the mean and standard deviation for quantitative variables. A chi-square test was used to compare categorical data. P 0.05 was used as an indicator of statistically significant differences. Results: A high proportion of mild depression and anxiety was observed among those who had chronic illness (25.7%) and for those who had insufficient personal protective equipment (16.9%). Those differences were statistically significant, with a high proportion of mild stress observed among 3.4% of those who experienced the death of a relative by COVID-19. Conclusion: There was a considerable prevalence of depression, anxiety, and stress among healthcare workers during the COVID-19 pandemic, especially among those who experienced the death of a relative from COVID-19 and those who had a chronic disease. Keywords: depression, anxiety, stress, healthcare worker, COVID-19, Jizan, Saudi Arabia

Primary Care Practices in Western North Carolina: Adaptation to the COVID-19 Pandemic and Ongoing Challenges.

The COVID-19 pandemic has created unique challenges for primary care practices while also highlighting their importance in the pandemic response. To understand primary care practice needs, a survey was conducted of practices in Western North Carolina. Phase 2 of a primary care needs assessment was administered to 63 practices in Western North Carolina over the course of six weeks, from July 23 to August 31, 2021. Most practices were operating with normal hours, though some still operated with reduced hours. Many practices reported insufficient personal protective equipment (PPE) supplies. While most practices provided at least some care via telehealth, practices cited different barriers to providing telehealth, with patient technology challenges being the most frequently cited. Practices have adapted to the restrictions of the pandemic, but many are still vulnerable, and the patients they serve may face reduced access to care due to practice limitations or barriers to telehealth. Practices play a critical role in providing care to patients throughout the pandemic and continue to assist in pandemic response by providing COVID-19 testing and other services. Primary care practices in Western North Carolina continue to provide care to patients and support the overall pandemic response. The pandemic has highlighted the need to include primary care in emergency response efforts. Ongoing work will allow North Carolina to reach practices more effectively in future crises via the newly created NC Responds system, which allows primary care practices to be contacted in the event of a public health emergency.