Proportion Of Healthcare Workers Research Articles

Determinants of COVID-19 vaccine hesitancy among health care workers in Amhara region referral hospitals, Northwest Ethiopia: a cross-sectional study.

Vaccine hesitancy remains a serious global threat to achieve herd immunity, and this study aimed to assess the magnitude and associated factors of coronavirus disease-19 (COVID-19) vaccine hesitancy among healthcare workers (HCWs) in Amhara regional referral hospitals. A web-based anonymised survey was conducted among 440 HCWs in the Amhara region referral hospitals. The questionnaire was designed using Google Forms and distributed using telegram and e-mail from 15 May to 10 June 2021 to the randomly selected participants in each hospital. The data were analysed with Stata 14.0 and described using frequency tables. A multivariable binary logistic regression model was fitted and model fitness was checked with the Hosmer-Lemeshow goodness of fit test. Out of 440 participants, 418 were willing to participate in the study and the mean age was about 30 years. Overall, 45.9% (n = 192) of participants reported vaccine hesitancy. After applying multivariate analysis, age ≤25 years (adjusted odds ratio (aOR) = 5.6); do not wear a mask (aOR = 2.4); not compliance with physical distancing (aOR = 3.6); unclear information by public health authorities (aOR = 2.5); low risk of getting COVID-19 infection (aOR = 2.8); and not sure about the tolerability of the vaccine (aOR = 3.76) were associated with COVID-19 vaccine hesitancy. A considerable proportion of HCWs were hesitant towards COVID-19 vaccine, and this can be tackled with the provision of clear information about the vaccine.

Türkiye ve Bulgaristan’ın Sağlık Sistemlerinin Karşılaştırılması

The health system as a whole consists of inputs, processes, outputs and result elements that are contained within all kinds of services in order to improve health. Today, countries have developed different health systems in order to control the health expenditures while maintaining the effectiveness of health systems. The aim of this study was to compare the infrastructure of health systems in Turkey and Bulgaria. Population of Bulgaria is much younger compared to Turkey’s population. However, although higher number of hospitals are located in Turkey; the number of hospital beds per person and the proportion of healthcare workers are lower than that of Bulgaria. It was also observed that the aim is to ensure a state guarantee to all citizens within the scope of health services in Turkey. However, in Bulgaria, it was observed that low income citizens were excluded from these services by individual health contracts. While the provision of health services in Turkey is carried out under state responsibility, in Bulgaria provision of health services is not under state responsibility but these services are purchased with premiums paid by individuals.

Impact of the coronavirus disease 2019 pandemic on critical care healthcare workers' depression, anxiety, and stress levels

AimThe aim of the study was to determine levels of depression, anxiety, and stress symptoms and factors associated with psychological burden amongst critical care healthcare workers in the early stages of the coronavirus disease 2019 pandemic. MethodsAn anonymous Web-based survey distributed in April 2020. All healthcare workers employed in a critical care setting were eligible to participate. Invitations to the survey were distributed through Australian and New Zealand critical care societies and social media platforms. The primary outcome was the proportion of healthcare workers who reported moderate to extremely severe scores on the Depression, Anxiety, and Stress Scale-21 (DASS-21). ResultsOf the 3770 complete responses, 3039 (80.6%) were from Australia. A total of 2871 respondents (76.2%) were women; the median age was 41 years. Nurses made up 2269 (60.2%) of respondents, with most (2029 [53.8%]) working in intensive care units. Overall, 813 (21.6%) respondents reported moderate to extremely severe depression, 1078 (28.6%) reported moderate to extremely severe anxiety, and 1057 (28.0%) reported moderate to extremely severe stress scores. Mean ± standard deviation values of DASS-21 depression, anxiety, and stress scores amongst woman vs men was as follows: 8.0 ± 8.2 vs 7.1 ± 8.2 (p = 0.003), 7.2 ± 7.5 vs 5.0 ± 6.7 (p < 0.001), and 14.4 ± 9.6 vs 12.5 ± 9.4 (p < 0.001), respectively. After adjusting for significant confounders, clinical concerns associated with higher DASS-21 scores included not being clinically prepared (β = 4.2, p < 0.001), an inadequate workforce (β = 2.4, p = 0.001), having to triage patients owing to lack of beds and/or equipment (β = 2.6, p = 0.001), virus transmission to friends and family (β = 2.1, p = 0.009), contracting coronavirus disease 2019 (β = 2.8, p = 0.011), being responsible for other staff members (β = 3.1, p < 0.001), and being asked to work in an area that was not in the respondents' expertise (β = 5.7, p < 0.001). ConclusionIn this survey of critical care healthcare workers, between 22 and 29% of respondents reported moderate to extremely severe depression, anxiety, and stress symptoms, with women reporting higher scores than men. Although female gender appears to play a role, modifiable factors also contribute to psychological burden and should be studied further.

Hepatitis B Virus Vaccination Status and Anti Hepatitis B Surface Antibody Titer among the Health Care Workers of a Hemodialysis Unit

Background: Health care workers are in high risk of getting infected with hepatitis B virus. A large proportion of them do not receive a 3-dose series of hepatitis B vaccination and have anti hepatitis B surface antibody titer &lt;10 mIU/ml.&#x0D; Materials and Methods: Health care workers of the hemodialysis unit were included from March 2019 to March 2020 and were interviewed about hepatitis B vaccination status. Serum samples of the participants were analyzed for anti hepatitis B surface antibody titer. Participants with antibody titer of &lt;10mIU/ml were given a 3-dose series of hepatitis B vaccination and antibody titer was again measured 1-2 months after the last dose.&#x0D; Results: Among 30 participants, 19 (63.3%) had 3-dose series of hepatitis B vaccination, and all of them had anti hepatitis B antibody titer of &gt;10 mIU/ml. Remaining 11 participants (36.7%), with either partial (6) or no hepatitis B vaccination (5), had antibody titer of &lt;10mIU/ml. The mean ranks of antibody titer was significantly associated with the hepatitis B vaccination status (P&lt;0.001). All 11 participants with antibody titer of &lt;10 mIU/ml received a 3-dose series of hepatitis B vaccine and all of them achieved antibody titer &gt;10 mIU/ml.&#x0D; Conclusion: Our study shows that a large proportion of health care workers of hemodialysis unit were either partially or not vaccinated with hepatitis B vaccination and were having anti hepatitis B antibody titer of &lt;10 mIU/ml. However, with complete 3-dose series of hepatitis B vaccination all of them achieved a protective antibody titer of ≥10 mIU/ml.

Improving injection safety practices of Cambodian healthcare workers through training.

BackgroundThis study evaluated the impact of a safe injection safety training on healthcare worker (HCW) practice and knowledge following an HIV outbreak in Roka commune, Cambodia.MethodsSurveys were conducted at baseline (September 2016) and seven months after a training intervention (March 2018) using the World Health Organization standardized injection practices assessment tool. HCWs were sampled at 15 purposively government health facilities in two provinces. HCWs were observed during injection practices and interviewed by trained experts from Becton-Dickinson and the Ministry of Health Cambodia. The Rao-Scott chi square test was used test for differences between baseline and follow-up.ResultsWe completed 115 observations of practice at baseline and 206 at post-training follow-up. The proportion of patients whose identification was confirmed by HCWs prior to procedure being performed increased from 40.4% to 98% (p <0.0001). The proportion of HCWs who practiced correct hand hygiene increased from 22.0% to 80.6% (p = 0.056) [therapeutic observations] and 17.2% to 63.4% (p = 0.0012) [diagnostic observations]. Immediate disposal of sharps by HCWs decreased from 96.5% to 92.5% (p = 0.0030).ConclusionsWe found significant improvements in the practice of patient identity confirmation and hand hygiene but not in the immediate disposal of sharps in the post-training intervention. However, findings are not representative of all HCWs in the country. Further pre-service and in-service training and monitoring are necessary to ensure sustained behavior change.

Minimum healthcare worker influenza immunization rates required to decrease influenza transmission in two acute-care hospitals.

Background: Annual influenza immunization of healthcare workers (HCWs) is widely recommended to reduce the risk of healthcare-associated influenza (HAI). Although there is a clear association between higher HCW immunization and reduced incidence of HAI, data in acute care are lacking compared to the nursing home setting. Objective: Our goal was to assess the association between HCW influenza immunization and the incidence of HAI across 2 acute-care facilities. Methods: A multicenter prospective cohort study was undertaken at 2 acute-care hospitals including 1 university and 1 community-based academic hospital. Any patient prospectively identified with HAI was included between 2013–2014 and 2018–2019, whereas 2017–2018 was excluded due to vaccine mismatch. The HCW influenza immunization rate was defined as the proportion of HCWs (nurses and other allied and support staff but excluding physicians) immunized prior to December 15. A case of HAI was defined as laboratory-confirmed influenza A or B with symptom onset >72 hours after admission. The association between inpatient ward HCW influenza immunization rate and the incidence of HAI was compared using a Poisson regression analysis adjusting for hospital and influenza season. Results: Over 5 influenza seasons, the incidences of HAI at either facility were 0.24 and 0.22 per 1,000 patient days, whereas the median HCW influenza immunization rates were 57.3% (IQR, 42.5%–66.4%) and 66.6% (IQR, 50.6%–76.8%), respectively. When adjusting for hospital and influenza season in the multivariate analysis, HCW influenza immunization rates of 65% and 70% were not associated with HAI incidence. In contrast, HCW influenza immunization rates ≥75% was associated with a trend toward reduced HAI (IRR, 0.65; 95% CI, 0.39–1.08; P = .096) whereas inpatient wards above 80% immunization had significantly lower risk of HAI (IRR, 0.28; 95% CI, 0.089–0.89; P = .03). Conclusions: The risk of HAI across 2 acute-care hospitals was significantly lower among inpatient wards achieving HCW influenza immunization rates >80%. Acute-care facilities should aim for this minimum HCW immunization rate to protect patients from the complications of HAI. Funding: None Disclosures: None

Minimum Healthcare Worker Influenza Immunization Rates Required to Decrease Influenza Transmission in Acute-Care Inpatients

Background: Annual influenza immunization of healthcare workers (HCWs) is widely recommended to reduce the risk of healthcare-associated influenza (HAI). Although there is a clear association between higher HCW immunization and reduced incidence of HAI, data in acute care are lacking compared to the nursing home setting. Objective: Our goal was to assess the association between HCW influenza immunization and the incidence of HAI across 2 acute-care facilities. Methods: A multicenter prospective cohort study was undertaken at 2 acute-care hospitals including 1 university and 1 community-based academic hospital. Any patient prospectively identified with HAI was included between 2013–2014 and 2018–2019, whereas 2017–2018 was excluded due to vaccine mismatch. The HCW influenza immunization rate was defined as the proportion of HCWs (nurses and other allied and support staff but excluding physicians) immunized prior to December 15. A case of HAI was defined as laboratory-confirmed influenza A or B with symptom onset &gt;72 hours after admission. The association between inpatient ward HCW influenza immunization rate and the incidence of HAI was compared using a Poisson regression analysis adjusting for hospital and influenza season. Results: Over 5 influenza seasons, the incidences of HAI at either facility were 0.24 and 0.22 per 1,000 patient days, whereas the median HCW influenza immunization rates were 57.3% (IQR, 42.5%–66.4%) and 66.6% (IQR, 50.6%–76.8%), respectively. When adjusting for hospital and influenza season in the multivariate analysis, HCW influenza immunization rates of 65% and 70% were not associated with HAI incidence. In contrast, HCW influenza immunization rates ≥75% was associated with a trend toward reduced HAI (IRR, 0.65; 95% CI, 0.39–1.08; P = .096) whereas inpatient wards above 80% immunization had significantly lower risk of HAI (IRR, 0.28; 95% CI, 0.089–0.89; P = .03). Conclusions: The risk of HAI across 2 acute-care hospitals was significantly lower among inpatient wards achieving HCW influenza immunization rates &gt;80%. Acute-care facilities should aim for this minimum HCW immunization rate to protect patients from the complications of HAI.Funding: NoneDisclosures: None

Mental health of frontline healthcare workers exposed to COVID-19 in Egypt: A call for action.

World Health Organization (WHO) declared Coronavirus disease 2019 (COVID-19) as a pandemic in March 2020. Such widespread outbreaks are associated with adverse mental health consequences. To evaluate mental health outcomes among Egyptian healthcare workers (HCW) treating patients with confirmed or suspected Coronavirus Disease 2019 (COVID-19) to direct the promotion of mental wellbeing, by screening for symptoms of anxiety, insomnia, depression and stress, and analyzing potential risk factors. This cross-sectional, hospital-based survey study collected demographic data and mental health measurements from 502 HCW dealing with COVID-19. HCW were surveyed in 20 hospitals (Fever, Chest, and Quarantine hospitals) in different parts of Egypt, in April and May 2020. Among the 502 HCW surveyed; 60.0% were physicians, 16.1% were specialized nurses, and 23.9% were non-specialized nurses. About 35.3% worked in chest hospitals, 17.5% in fever hospitals, and 47.2% in quarantine hospitals. A considerable proportion of HCW had symptoms of anxiety, insomnia, depression, and stress. Females were at higher risk of experiencing symptoms of severe anxiety (odds ratio [OR], 1.85; 95% CI, 1.12-3.05; p = .016), severe depression (OR, 2.013; 95% CI, 1.17-3.4; p = .011), and severe stress (OR, 2.68; 95% CI, 1.5-4.6; p < .001). Fever hospital workers were at higher risk of severe depression (OR, 1.52; 95% CI, 1.11-2.09; p < .01), compared to Quarantine hospital workers. Ensuring proper mental health support for HCW is an important component of public health measures for addressing the COVID-19 epidemic and safeguarding the continuity of appropriate medical service.

Risk factors for depression and anxiety in healthcare workers deployed during the COVID-19 outbreak in China

PurposeThis study was conducted to evaluate the status of depression and anxiety of healthcare workers and to explore the risk factors during the outbreak of COVID-19 in China.MethodsA cross-sectional study was designed using convenience sampling to obtain a sample of healthcare workers. A structured questionnaire was designed to collect the information of the basic characteristics, workload, and the health condition. Burnout, coping style, anxiety, and depression were measured by specific scales. Multiple logistic regression model was performed to explore the risk factors of anxiety or depression.ResultsThere were 902 questionnaires received between February 9, 2020 and February 11, 2020. The proportion of healthcare workers with symptoms of moderate/severe anxiety and moderate/severe depression were 16.63% and 18.29%, respectively. There were 24.50% healthcare workers experiencing moderate/severe anxiety and depression at the same time. The increased workload, respiratory symptoms, digestive symptoms, having done specific test(s) related to COVID-19, having family member needs to be taken care of, negative coping style, and job burnout were the independent risk factors of anxiety. Furthermore, the increased workload, respiratory symptoms, digestive symptoms, having done specific test(s) related to COVID-19, negative coping style, and job burnout were the independent risk factors of depression.ConclusionMore attention should be paid to the mental health of frontline healthcare workers at the outbreak of COVID-19 in China. Taking steps to reduce the intensity of the work and burnout will be effective to stabilize the mental state of them.Electronic supplementary materialThe online version of this article (10.1007/s00127-020-01954-1) contains supplementary material, which is available to authorized users.

Transmission of infection from non-isolated patients with COVID-19 to healthcare workers

Insufficiently protected healthcare workers (HCWs), defined as high-risk contacts of patients with coronavirus disease 2019 (COVID-19), are routinely quarantined. This study evaluated the transmission of infection from a symptomatic patient with COVID-19 to 60 HCWs exposed at ≤2 m for ≥15 min or during aerosol-generating procedures. Following ≥106 unique high-risk contacts, none of the HCWs tested positive for severe acute respiratory syndrome coronavirus-2 RNA or developed antibodies. The HCWs reported adherence to basic infection control procedures. These results are in accordance with other reports, and should reassure HCWs and further stimulate broader evaluation of the foundation for the current practice of home quarantining non-symptomatic HCWs.

The impact of healthcare worker influenza vaccination on nosocomial influenza in a tertiary hospital: an ecological study

BackgroundTo protect hospitalized patients, who are more susceptible to complications of influenza, seasonal influenza vaccination of healthcare workers (HCW) has been recommended internationally. However, its effectiveness is still being debated. To assess the effectiveness of HCW influenza vaccination, we performed an ecological study to evaluate the association between healthcare worker influenza vaccination and the incidence of nosocomial influenza in a tertiary hospital within Singapore between 2013 and 2018.MethodsNosocomial influenza was defined as influenza among inpatients diagnosed 7 days or more after admission by laboratory testing, while healthcare worker influenza vaccination rate was defined as the proportion of healthcare workers that was vaccinated at the end of each annual seasonal vaccination exercise. A modified Poisson regression was performed to assess the association between the HCW vaccination rates and monthly nosocomial influenza incidence rates.ResultsNosocomial influenza incidence rates followed the trend of non-nosocomial influenza, showing a predominant mid-year peak. Across 2,480,010 patient-days, there were 256 nosocomial influenza cases (1.03 per 10,000 patient-days). Controlling for background influenza activity and the number of influenza tests performed, no statistically significant association was observed between vaccination coverage and nosocomial influenza incidence rate although a protective effect was suggested (IRR 0.89, 95%CI:0.69–1.15, p = 0.37).ConclusionNo significant association was observed between influenza vaccination rates and nosocomial influenza incidence rates, although a protective effect was suggested. Aligning local HCW vaccine timing and formulation to that of the Southern Hemisphere may improve effectiveness. HCW vaccination remains important but demonstrating its effectiveness in preventing nosocomial influenza is challenging.

Assessment of Knowledge, Attitudes, and Practices towards New Coronavirus (SARS-CoV-2) of Health Care Professionals in Greece before the Outbreak Period.

Introduction: The ongoing severe acute respiratory syndrome (SARS)-CoV-2 pandemic has expanded globally. The aim of the current study is to investigate the knowledge, attitudes, and practices (KAP) of health care professionals in Greece towards SARS-CoV-2. Methods: From 10–25 February 2020, 500 health care workers were approached. Knowledge, attitudes, and practices towards SARS-CoV-2 were assessed via a personal interview questionnaire. For knowledge, each correct answer was given 1 point; attitudes, or concerns aimed at prevention of SARS-CoV-2 infection, and practices, or behaviors towards performing preventive practices, were assigned 1 point each. Points were summed and a score for each category was calculated. Results: A total of 461 health care workers returned the questionnaire and were included in the analysis (mean age ± SD: 44.2 ± 10.78 years, 74% females). The majority were nurses (47.5%), followed by physicians (30.5%) and paramedics (19%). The majority of subjects (88.28%) had a good level of knowledge (knowledge score equal to 4, or more). The majority of participants (71%) agreed with the temporary traveling restrictions ban. The uptake of a future vaccine against SARS-CoV-2 was estimated at 43%. Knowledge score was significantly associated with both attitudes score (p = 0.011) and practices score (p < 0.001), indicating that subjects with a high knowledge score demonstrated a more positive perception on preventive measures and would practice more preventive measures. Attitudes score was significantly associated with practices score (p = 0.009) indicating that subjects with a higher attitudes score are more likely to perform practices towards the prevention of SARS-CoV-2 transmission. Conclusion: There is a high level of knowledge concerning SARS-CoV-2 pandemic among Greek health care workers and this is significantly associated with positive attitudes and practices towards preventive health measures. The high level of knowledge of health professionals about SARS-CoV-2 may have contributed considerably to the successful management of the pandemic in Greece. Tailored educational campaigns aiming to increase the proportion of health care workers willing to accept a potential SARS-CoV-2 vaccine could be of paramount importance in future proactive vaccine educational campaigns.

The Role of Language Capability in Migration Choice of International Medical Students

Background:An alarming proportion of healthcare workers from low- and middle-income countries (LMICs) migrate to foreign countries, especially to high-income countries (HICs), to seek employment. The aim of this study was to explore the role of language capability in migration choice of China-educated international medical students (IMSs), mainly from LMICs in Asia and Africa. Methods:A questionnaire was delivered electronically to final-year IMSs at 4 universities in China from June, 2019 to July, 2019. The questionnaire comprised questions on language capability and migration choices of IMSs. Chi-square test was used to determine whether participants’ English language proficiency, Chinese language proficiency, and capability of speaking multi-languages were associated with their migration choices. Results:A total of 202 valid responses were obtained and 91 (45%) participants showed intention of choosing a foreign country. The intention of staying outside the home country was associated with the capability of speaking multi-languages (speaking at least another non-English foreign language apart from Chinese) by IMSs. Higher-level Chinese proficiency certificate holders were more likely to choose China as the destination country. The capability of speaking a non-English/non-Chinese foreign language did not correspond to the intention of migrating to the country where this language is spoken. Furthermore, the intention of migrating to a non-English/non-Chinese speaking foreign country did not correspond to the capability in the language spoken in this foreign country. Conclusion:The effect of language capability on migration choice of China-educated IMSs was explored in this study. The findings indicate that language capability has played some role in IMSs’ migration choice. However, migration decision-making process is complex and is affected by various factors. Therefore, further studies should be conducted to explore correlations among factors affecting migration choice of IMSs.

COVID-19 in health care workers – A systematic review and meta-analysis

Background and objectivesIt is essential to know the proportion of health care workers (HCW) who are COVID 19 positive, as well as the severity and mortality among them. MethodsThis systematic review was performed according to the Preferred Reporting Items for Systematic review and meta-analysis. Databases including PubMed, EMBASE and Web of Science were searched from December-31, 2019 to April-23, 2020. The search was limited to the studies that reported the data on the number of COVID-19 positive healthcare workers, among the COVID-19 positive patients. Case reports, duplicate publications, reviews, and family-based studies were excluded. The methodological quality of studies was assessed by the Appraisal tool for Cross-Sectional Studies (AXIS) tool. ResultsIn this systematic review and meta-analysis, we pooled eleven studies to investigate the above factors. The overall proportion of HCW who were SARS-CoV-2 positive among all COVID-19 patients was 10.1% (95%CI: 5.3–14.9). This proportion varied according to the country of study i.e. China (7 studies) - 4.2%, 95%CI:2.4–6.0; United States (3 studies) – 17.8%, 95%CI:7.5–28.0; and Italy (1 study) – 9.0%, 95%CI:8.6–9.4. The incidence of severe or critical disease in HCW (9.9%, 95%CI:0.8–18.9) was significantly lower (p < 0.001) than the incidence of severe or critical disease in all COVID-19 positive patients (29.4%, 95%CI:18.6–40.2). Similarly, the mortality among HCW (0.3%, 95%CI:0.2–0.4) was also significantly lower (p < 0.001) as compared to that of all patients (2.3%, 95%CI:2.2–2.4). ConclusionHealth care workers who are COVID-19 positive constituted a significant proportion of all COVID-19 patients; but the severity and mortality were lower among them.

COVID-19 Flexible and transparent aerosol box

Poor access to basic personal protective equipment (PPE) is the primary reason for a high proportion of healthcare workers being infected with the 2019-nCoV virus worldwide (1). Intubating a COVID-19 patient is considered an extremely high-risk procedure for the healthcare workers in an emergency room or ICU. Current guidelines recommend a negative pressure room for the aerosol-generating procedures. However, the number of such rooms is limited in low- and middle-income countries. Clinicians rely on personal protective equipment (PPE) to protect themselves from airborne transmission especially during the aerosol-generating procedures. To help the healthcare professionals with an extra line of protection and free range of motion during resuscitation of COVID-19 patients, we have started to use a modified aerosol box in the pediatric emergency department. Our design is based on an open-source original plan presented by Dr. Hsien Yung Lai from Taiwan (2). The fluorescent dye experiment conducted by Robert Canelli and colleagues have suggested that the transparent aerosol box provides additional protection during the endotracheal intubation; however, the restricted hand movement during the procedure was its main limitation (3). We have found that a design based on a light frame and a flexible transparent plastic cover enclosing it could facilitate greater hand movement and enhance the efficacy of the procedure.

Barriers to healthcare workers reporting adverse events following immunization in four regions of Ghana

Despite didactic training on adverse events following immunization (AEFI) in Ghana, the reporting ratio of AEFI was 1.56 per 100,000 surviving infants in 2015, below the minimum reporting ratio of 10. We aimed to estimate the proportion of health care workers (HCWs) reporting AEFI and to identify barriers to reporting.We conducted a cross-sectional survey of HCWs in four regions in Ghana. A simple random sample of 176 health facilities was selected and up to two HCWs were randomly selected per facility. We used the Rao-Scott Chi-squared test to compare factors associated with reporting of AEFI in the last year. We used an open-ended question to identify reasons for low reporting. One supervisor from each facility, responsible for overall reporting and management of AEFI, was also interviewed.A total of 306 HCWs from 169 facilities were interviewed. Of these, 176 (57.5%) reported they had ever encountered an AEFI. Of the 120 who had encountered an AEFI in the last year, 66 (55.0%) indicated they had reported the AEFI, and 38 (31.7%) completed a reporting form. HCWs (n = 120) reported multiple barriers to reporting of AEFI; the most common barriers were fear of personal consequences (44.1%), lack of knowledge or training (25.2%), and not believing an AEFI was serious enough to report (22.2%). Discussion of AEFI during the last supervisory visit was significantly associated with reporting in the past year (OR 7.39; p < .001). Of 172 supervisors interviewed, 65 (37.8%) mentioned their facilties had ever encountered an AEFI; over 90% of facilities had reporting forms.We identified low reporting of AEFI and multiple barriers to reporting among HCWs in the four selected regions of Ghana. Discussing AEFI during supervisory visits with HCWs might improve reporting. Additionally, strategies to address fear of personal consequences as a barrier to reporting of AEFI are needed.

Mental illness among NHS health care workers: a survey

The literature suggests that mental illness among UK health care staff is common. This study reports health care workers' knowledge and experience of mental illness. Medical staff, administration staff and other staff members employed in four NHS Trusts (n=2073) responded to a questionnaire survey. A proportion of health care workers in the NHS reported having personal (colleagues, family and self) experience of mental illness. Some health care workers held causal explanations of mental illness that are not evidence based. This study found that almost half of health care workers reported experiencing a mental illness, which could have significant implications for service delivery. Some health care workers held causal explanations of mental illness that were not evidence based; for example, some respondents reported that demonic possession or possession by evil spirits was a very good explanation for mental illness.

Mental illness among NHS health care workers: a survey

The literature suggests that mental illness among UK health care staff is common. This study reports health care workers' knowledge and experience of mental illness. Medical staff, administration staff and other staff members employed in four NHS Trusts (n=2073) responded to a questionnaire survey. A proportion of health care workers in the NHS reported having personal (colleagues, family and self) experience of mental illness. Some health care workers held causal explanations of mental illness that are not evidence based. This study found that almost half of health care workers reported experiencing a mental illness, which could have significant implications for service delivery. Some health care workers held causal explanations of mental illness that were not evidence based; for example, some respondents reported that demonic possession or possession by evil spirits was a very good explanation for mental illness.

Professionalism Lapses and Adverse Childhood Experiences: Reflections From the Island of Last Resort.

This Invited Commentary highlights the prevalence of adverse childhood experiences and the potential effect that such experiences can have in the medical education setting on trainees, colleagues, and faculty. The author draws on 20 years of experience working in organizations devoted to helping physicians with disruptive behavior learn new behavioral skills to enable them to function within the complex medical environment. A case example-an amalgam of individuals who have presented for remediation-is used to illustrate the issues that result from adverse childhood experiences. There is a broad and well-understood literature demonstrating a correlation between early life trauma and medical and mental health issues. Adverse early life experiences can also contribute to attachment-related difficulties including problems with boundaries, trust, and suspiciousness; lack of reciprocity; lack of attunement with others' emotional states; as well as regulation issues, including difficulties labeling and expressing feelings and internal states. Difficulties with self-concept, including a lack of continuous and predictable sense of self, low self-esteem, and shame and guilt, are also associated with exposure to adverse childhood experiences. Given the documented high proportion of health care workers, including physicians, who are trauma survivors, trauma-sensitive education must be a priority, not only in medical school but across the educational continuum.

Post exposure prophylaxis for occupational and non occupational exposure to HIV in a tertiary care hospital in central Nepal

Introduction: Post exposure prophylaxis (PEP) to HIV is the short term use of prescribed dose of antiretroviral therapy among persons exposed to high risk behaviors in order to prevent them from HIV infection. While occupationally exposed cases among health care workers are the major target of PEP, it is equally applicable to non occupational exposure to HIV including sexually exposed cases. This study was carried out to know the current scenario of PEP for HIV in terms of various determinants/ risk factors and outcomes of HIV positivity after prophylaxis.&#x0D; Methods: A prospective study was carried out by Antiretroviral therapy center of Tribhuvan University Teaching Hospital. The study period was between August 2006 and September 2016. Altogether 50 cases exposed to known HIV seropositive persons were included in this study.&#x0D; Results: The majority of the occupationally exposures were interns (48.6%), followed by staff nurse (18.9%), CMLT student (13.5%), hospital staff (10.8%) and resident doctor (8.1%). Majority (70.3%) were exposed to needle prick injury. Six-month follow-up showed zero seroconversion for HIV ELISA among the exposed cases.&#x0D; Conclusion: Intern constituted the greater proportion of health care workers exposed to accidental needle stick injury. Timely administration of prophylaxis might have resulted zero seroconversion for HIV ELISA among the exposed cases.