RESUMO
The aim of this study was to examine the self-perceived reasons of suicide attempts among sexual and gender minorities (SGM). We surveyed SGM living in Canada (n = 2778) and respondents who had attempted suicide answered open-ended questions about their perceived reason(s) of their first/only attempt (FOA) and last attempt (LA) (for those who attempted multiple times). Responses were double-coded and categorized as discrete findings. A quarter (25%, n = 695) of the total sample reported a history of suicide attempt, of whom 72% reported multiple attempts. Respondents described a wide variety of reasons for their suicide attempts, with an important number of individuals reporting multiple reasons (corresponding to 47.5% of FOA and 43% of LA). Emotional issues (FOA:42.1%, LA:44.0%) were the most prevalent category of reasons for suicide attempts followed by experience of mental illness (FOA:30.1%, LA:36.1%). Other common reasons included violence (FOA:23.2%, LA:10.2%), interpersonal conflict (FOA:13.4%, LA:6.0%), stress related to life circumstances (FOA:9.5%, LA:16.7%), relationship issues (FOA:7.9%, LA:13.3%), and minority stress related to sexuality (FOA:11.1%, LA:6.2%) and gender identity (FOA:5.0%, LA:6.8%). SGM assessments of the reasons underlying their suicide attempts yielded a variety of factors, many of which were absent from the literature on SGM suicide but amenable to tailored interventions.
RESUMO
BACKGROUND: Public health measures in response to the COVID-19 pandemic forced individuals to spend more time at home. We sought to investigate the relationship between housing characteristics and sleep duration in the context of COVID-19. METHODS: Our exploratory study was part of the COvid-19: Health and Social Inequities across Neighborhoods (COHESION) Study Phase-1, a pan-Canadian population-based cohort involving nearly 1300 participants, launched in May 2020. Sociodemographic, household and housing characteristics (dwelling type, dissatisfaction, access to outdoor space, family composition, etc.), and self-reported sleep were prospectively collected through COHESION Study follow-ups. We explored the associations between housing and household characteristics and sleep duration using linear regressions, as well as testing for effect modification by income satisfaction and gender. RESULTS: Our study sample involved 624 COHESION Study participants aged 50 ± 16years (mean±SD), mainly women (78%), White (86%), and university graduates (64%). The average sleep duration was 7.8 (1.4) hours. Sleep duration was shorter according to the number of children in the household, income dissatisfaction, and type of dwelling in multivariable models. Sleep was short in those without access to a private outdoor space, or only having a balcony/terrace. In stratified analyses, sleep duration was associated with housing conditions dissatisfaction only in those dissatisfied with their income. CONCLUSION: Our exploratory study highlights the relationship between housing quality and access to outdoor space, family composition and sleep duration in the context of COVID-19. Our findings also highlight the importance of housing characteristics as sources of observed differences in sleep duration.
RESUMO
AIM: Epidemiological research on resistance and resilience can build on models of health developed in health promotion. Nevertheless, these models need to be adjusted to approaches currently employed in epidemiology; namely, included concepts should be easy to operationalize, and links between them should be simple enough to enable statistical modeling. In addition, these models should include both individual and environmental assets. The objective of this study is to consolidate the current knowledge on health assets, adjust them to epidemiological research needs, and propose a new model of health assets for epidemiological studies on health. DESIGN: The conceptual paper was conducted according to the guidelines for the model development. METHODS: The development of the new model was made from the perspective of salutogenesis - the branch of health promotion studying the origins of health. The analysis of literature on health promotion, public health, and positive psychology was conducted to find the links connecting individual and environmental assets. RESULTS: The newly developed Dynamic Model of Health Assets circularly links individual characteristics, actions, environments, and support. Each preceding component of the model contributes to the following one; each component also independently contributes to resistance and resilience. The new model may guide large-scale epidemiological research on resistance and resilience. The model's components are easy to operationalize; the model allows for constructing multilevel models and accounting for the dynamic nature of the relationships between components. It is also generic enough to be adjusted to studying contributors to resistance and resilience to different specific diseases. CONCLUSION: The new model can guide epidemiological studies on resistance and resilience.
RESUMO
This interpretative descriptive study explores how public health measures implemented during the first wave of the COVID-19 pandemic in Quebec, Canada, affected the well-being of older adults. Twenty-six participants aged 60-81 took photographs to depict how COVID-19 public health measures affected their well-being and were invited to discuss their photographs in virtual focus groups. Data were analyzed using thematic analysis. The impacts of health measures on the well-being of participants were framed according to three overarching themes. First, participants endured an intensification of ageism, feeling diminished and excluded from their social spheres. Second, they faced a burden of loneliness due to the loss of connections with their communities, particularly for those who were single and without children. Third, participants highlighted navigating a degradation of social cohesion. This manifested through tensions and distrust in both the public and private spheres, as well as acts of resistance in response to rules deemed unjust. While public health measures were essential to prevent onward transmission of COVID-19 and mortality, they negatively impacted older adults' self-image, loneliness, and trust in society. This study argues for a rethinking of public health norms specific to older adults to address potential sources of inequality. In particular, a greater emphasis is needed on social connectedness and addressing the unique needs of older adults during pandemics.
RESUMO
BACKGROUND: With the advent of the COVID-19 pandemic, in-person social interactions and opportunities for accessing resources that sustain health and well-being have drastically reduced. We therefore designed the pan-Canadian prospective COVID-19: HEalth and Social Inequities across Neighbourhoods (COHESION) cohort to provide a deeper understanding of how the COVID-19 pandemic context affects mental health and well-being, key determinants of health, and health inequities. METHODS: This paper presents the design of the two-phase COHESION Study, and descriptive results from the first phase conducted between May 2020 and September 2021. During that period, the COHESION research platform collected monthly data linked to COVID-19 such as infection and vaccination status, perceptions and attitudes regarding pandemic-related measures, and information on participants' physical and mental health, well-being, sleep, loneliness, resilience, substances use, living conditions, social interactions, activities, and mobility. RESULTS: The 1,268 people enrolled in the Phase 1 COHESION Study are for the most part from Ontario (47%) and Quebec (33%), aged 48 ± 16 years [mean ± standard deviation (SD)], and mainly women (78%), White (85%), with a university degree (63%), and living in large urban centers (70%). According to the 298 ± 68 (mean ± SD) prospective questionnaires completed each month on average, the first year of follow-up reveals significant temporal variations in standardized indexes of well-being, loneliness, anxiety, depression, and psychological distress. CONCLUSIONS: The COHESION Study will allow identifying trajectories of mental health and well-being while investigating their determinants and how these may vary by subgroup, over time, and across different provinces in Canada, in varying context including the pandemic recovery period. Our findings will contribute valuable insights to the urban health field and inform future public health interventions.
Assuntos
COVID-19 , Saúde Mental , Interação Social , Feminino , Humanos , Masculino , COVID-19/epidemiologia , COVID-19/psicologia , Depressão , Ontário , Pandemias , Quebeque , Determinantes Sociais da SaúdeRESUMO
BACKGROUND: Whether obstructive sleep apnea (OSA) increases the risk of cognitive decline and how sex and age influence this association is not clear. Here, we characterized the sex- and age-specific associations between OSA risk and 3-year cognitive change in middle-aged and older adults. METHODS: We included 24,819 participants aged 45-85 (52% women) from the Canadian Longitudinal Study on Aging. OSA risk was measured at baseline using the STOP combined to body mass index (STOP-B). Neuropsychological tests assessed memory, executive functioning, and psychomotor speed at baseline and at 3-year follow-up. We conducted age- and sex-specific linear mixed models to estimate the predictive role of baseline STOP-B score on 3-year cognitive change. RESULTS: Men at high-risk for OSA aged 45-59 years showed a steeper decline in psychomotor speed (+13.2 [95% CI: -1.6, 27.9]) compared to men at low-risk. Men at high-risk for OSA aged 60-69 showed a steeper decline in mental flexibility (-1.2 [-1.9, -0.5]) and processing speed (+0.6 [0.3, 0.9]) than those at low-risk. Women at high-risk for OSA aged 45-59 showed a steeper decline in processing speed (+0.1 [-0.2, 0.4]) than women at low-risk, while women at high-risk ≥70 years had a steeper decline in memory (-0.2 [-0.6, 0.1]) and processing speed (+1.0 [0.4, 1.5]). CONCLUSIONS: Associations between OSA risk and cognitive decline over 3 years depend on age and sex. Being at high-risk for OSA is associated with a generalized cognitive decline in attention and processing speed, while a memory decline is specific to older women (≥70 years).
Assuntos
Disfunção Cognitiva , Apneia Obstrutiva do Sono , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Envelhecimento , Canadá/epidemiologia , Cognição , Disfunção Cognitiva/complicações , Estudos Longitudinais , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/epidemiologia , Idoso de 80 Anos ou maisRESUMO
Social policies determine the distribution of factors (e.g. education, cardiovascular health) protecting against the development of dementia in Alzheimer's disease (AD). However, the association between social policies and the likelihood of AD without dementia (ADw/oD) has yet to be evaluated. We estimated this association in an ecological study using systematic review and meta-analysis. Four reference databases were consulted; 18 studies were included in the final analysis. ADw/oD was defined as death without dementia in people with clinically significant AD brain pathology. The indicators of social policy were extracted from the Organisation for Economic Co-operation and Development database (OECD). The probability of ADw/oD with moderate AD brain pathology was inversely associated with the Gini index for disposable income, poverty rate, and certain public expenditures on healthcare. ADw/oD with advanced AD brain pathology was only associated with public expenditures for long-term care. Social policies may play a role in maintaining and sustaining cognitive health among older people with AD.
RESUMO
Older adults faced significant challenges during the COVID-19 pandemic but also demonstrated great resilience. Investigating these strengths may enhance and inform strategies to mitigate the impacts of the pandemic. To gain insight into the resilience processes of older adults during the first year of the pandemic, we conducted a photovoice study with 26 older adults (aged over 60) in the province of Quebec, Canada. Participants met online weekly for three weeks in small groups to discuss their photographs and share their resilience strategies. The thematic analysis revealed three interrelated themes. First, participants distanced themselves from the pandemic by engaging in activities that took their focus away from COVID-19 and that afforded much-needed respite. Second, participants regained their bearings by reorganizing their schedules and establishing new routines that bolstered occupation rather than rumination. Third, participants used the pandemic to self-reflect and revise their priorities, leveraging the pandemic as an opportunity for growth. Together, these themes demonstrate the strengths, coping strategies and resilience of older adults and contrast the stereotypes of older adults as vulnerable and resourceless. These findings have the potential to inform the implementation of strength-based health promotion initiatives to mitigate the harms of the pandemic.
RESUMO
An agreed definition, model, and indicators of positive health would contribute to a better understanding and wider use of the term, thus favoring the development of the positive health approach in public health. However, there is no consensus even on the definition of positive health. In this study, we systematically reviewed its definitions. We conducted a scoping review as per PRISMA guidelines. We queried the MEDLINE, Embase, PsychINFO, and Web of Science databases. The PubMed search equation was: 'positive health' [Title/Abstract] AND ('health' [MeSH] OR 'health status' [MeSH] OR 'health status indicators' [MeSH]). Definitions of positive health referring to a 'one-dimensional' conceptualization of health are: (i) positive health as a state 'far beyond a mere absence of disease'; (ii) positive health as wellbeing; and those referring to a 'two-dimensional' conceptualization are (iii) positive health as resilience and (iv) positive health as (a reserve in) capacities. This work contributes to the refining of the salutogenic vocabulary. At this stage of the ongoing discussion on health promotion vocabulary, we propose the 'reserve in capacities' as the candidate for the definition of positive health.
RESUMO
BACKGROUND: The association between belonging to a disadvantaged socio-economic status or social class and health outcomes has been consistently documented during recent decades. However, a meta-analysis quantifying the association between belonging to a lower social class and the risk of dementia has yet to be performed. In the present work, we sought to summarise the results of prospective, longitudinal studies on this topic. METHODS: We conducted a systematic review and meta-analysis of prospective, longitudinal studies measuring the association between indicators of social class and the risk of all-cause/Alzheimer's dementia. The search was conducted in four databases (Medline, Embase, Web of Science and PsychInfo). Inclusion criteria for this systematic review and meta-analysis were: (a) longitudinal prospective study, (b) aged ⩾60 years at baseline, (c) issued from the general population, (d) no dementia at baseline and (e) mention of social class as exposure. Exclusion criteria were: (a) study of rare dementia types (e.g. frontotemporal dementia), (b) abstract-only papers and (c) articles without full text available. The Newcastle-Ottawa scale was used to assess the risk of bias in individual studies. We calculated the overall pooled relative risk of dementia for different social class indicators, both crude and adjusted for sex, age and the year of the cohort start. RESULTS: Out of 4548 screened abstracts, 15 were included in the final analysis (76,561 participants, mean follow-up 6.7 years (2.4-25 years), mean age at baseline 75.1 years (70.6-82.1 years), mean percentage of women 58%). Social class was operationalised as levels of education, occupational class, income level, neighbourhood disadvantage and wealth. Education (relative risk (RR)=2.48; confidence interval (CI) 1.71-3.59) and occupational class (RR=2.09; CI 1.18-3.69) but not income (RR=1.28; CI 0.81-2.04) were significantly associated with the risk of dementia in the adjusted model. Some of the limitations of this study are the inclusion of studies predominantly conducted in high-income countries and the exclusion of social mobility in our analysis. CONCLUSIONS: We conclude that there is a significant association between belonging to a social class and the risk of dementia, with education and occupation being the most relevant indicators of social class regarding this risk. Studying the relationship between belonging to a disadvantaged social class and dementia risk might be a fruitful path to diminishing the incidence of dementia over time. However, a narrow operationalisation of social class that only includes education, occupation and income may reduce the potential for such studies to inform social policies.
Assuntos
Demência , Classe Social , Humanos , Feminino , Idoso , Estudos Prospectivos , Escolaridade , Mobilidade Social , Demência/epidemiologiaRESUMO
OBJECTIVES: Inadequate social support make way for peer support initiatives to complement the health system delivery of diabetes self-management education programs for type 2 diabetes (T2D). This review synthesizes knowledge about T2D peer support in terms of their various models and impact, endorsement, and contextual information in high-income nations. METHODS: A scoping review was conducted on published and grey literature in four electronic bibliographic databases between January 2007 to December 2021. RESULTS: 76 records were included. Face-to-face self-management programs and telephone-based peer support seem the most promising modalities given the largest scientific coverage on T2D outcomes. Face-to-face self-management programs were the most preferred by ethnic minority groups. Unlike peer supporters, healthcare professionals had mixed views about T2D peer support interventions. Managers of peer support programs perceived cultural competency as a cornerstone for peer support implementation. Care must be taken in recruiting, training and retaining peer supporters for sustainable practice. CONCLUSIONS: Various T2D peer support models lie at the interface between primary care and community-based settings. PRACTICE IMPLICATIONS: Fostering the role of peer support beyond healthcare organizations should be encouraged to engage the hardly reached, and to leverage community support to complement the health system.
Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Mellitus Tipo 2/terapia , Etnicidade , Humanos , Grupos Minoritários , Grupo Associado , Atenção Primária à SaúdeRESUMO
COVID-19 had a huge impact on healthcare systems globally. Institutions, care teams and individuals made considerable efforts to adapt their practices. The present longitudinal, mixed-methods study examined a large sample of healthcare institution employees in Switzerland. Organisational resilience processes were assessed by identifying problematic real-world situations and evaluating how they were managed during three phases of the pandemic's first year. Results highlighted differences between resilience processes across the different types of problematic situations encountered by healthcare workers. Four configurations of organisational resilience were identified depending on teams' performance and ability to adapt over time: "learning from mistakes", "effective development", "new standards" and "hindered resilience". Resilience trajectories differed depending on professional categories, hierarchical status and the problematic situation's perceived severity. Factors promoting or impairing organisational resilience are discussed. Findings highlighted the importance of individuals', teams' and institutions' meso- and micro-level adaptations and macro-level actors' structural actions.
RESUMO
Healthcare workers (HCWs) have significantly suffered during the COVID-19 pandemic, reporting a high prevalence of anxiety, depression and post-traumatic stress disorder (PTSD). We investigated with this survey whether HCWs benefitted from supportive measures put in place by hospitals and how these measures were perceived. This cross-sectional survey, which was conducted during the first wave of COVID-19 at the Geneva University Hospitals, Switzerland, between May and July 2021, collected information on the use and perception of practical and mental health support measures provided by the hospital. In total, 3461 HCWs participated in the study. Regarding the practical support measures, 2896 (84%) participants found them useful, and 2650 (76%) used them. Regarding the mental health support measures, 3149 (90%) participants found useful to have the possibility of attending hypnosis sessions, 3163 (91%) to have a psychologist within hospital units, 3202 (93%) to have a medical nursing psychiatric permanence available seven days a week, and 3171 (92%) to have a hotline available seven days a week. In total, 436 (13%) HCWs used at least one of the available mental health support measures. During the COVID-19 pandemic, the support measures were valued by HCWs. Given the high prevalence of psychiatric issues among HCWs, these measures seem necessary and are likely to have alleviated the suffering of HCWs.
RESUMO
Photovoice is a participatory action research method in which participants take and narrate photographs to share their experiences and perspectives. This method is gaining in popularity among health researchers. Few studies, however, have described virtual photovoice data collection despite the growing interest among qualitative health researchers for online data collection. As such, the aim of this article is to discuss the implementation of a virtual photovoice study and presents some of the challenges of this design and potential solutions. The study examined issues of social isolation and mental health among older adults during the COVID-19 pandemic in the Canadian province of Québec. Twenty-six older adults took photographs depicting their experience of the pandemic that were then shared in virtual discussion groups. In this article, we discuss three key challenges arising from our study and how we navigated them. First, we offer insights into managing some of the technical difficulties related to using online meeting technologies. Second, we describe the adjustments we made during our study to foster and maintain positive group dynamics. Third, we share our insights into the process of building and maintaining trust between both researchers and participants, and amongst participants. Through a discussion of these challenges, we offer suggestions to guide the work of health promotion researchers wishing to conduct virtual photovoice studies, including with older adults.
RESUMO
Determining the prevalence and characteristics of individuals susceptible to present with obstructive sleep apnea (OSA) is essential for developing targeted and efficient prevention and screening strategies. We included 27,210 participants aged ≥45 years old (50.3% women) from the Canadian Longitudinal Study on Aging. Using the STOP questionnaire combined to the percentage of body fat (%BF), we estimated the prevalence of individuals at high-risk for OSA in a sex and age-specific manner, and tested the relation with comorbidities, menopause and systemic inflammation. The prevalence was 17.5%, and was lower in women (13.1%) than in men (21.9%). A high level of high-sensitivity C-reactive protein was the strongest factor associated with OSA risk and this association was 1.3-2.3 times higher in women than in men. OSA risk increased with age, cardiovascular diseases, diabetes mellitus, anxio-depressive symptoms, asthma and arthritis. In women, post-menopausal status was associated with a high OSA risk. Nearly 1 adult out of 5 older than 45 is at risk for OSA in Canada. Comorbidities, menopause and systemic inflammation, more than age, explain increased OSA prevalence. Considering this high prevalence and associations with medical and mental comorbidities, health care practitioners should incorporate systematic OSA screening in their clinical procedures.
Assuntos
Apneia Obstrutiva do Sono , Idoso , Envelhecimento , Canadá/epidemiologia , Feminino , Humanos , Inflamação/complicações , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Apneia Obstrutiva do Sono/complicaçõesRESUMO
BACKGROUND: The association between obstructive sleep apnea and cognitive functioning is not yet fully understood and could be influenced by factors such as sex, age and systemic inflammation. We determined the sex- and age-specific association between obstructive sleep apnea risk and cognitive performance, and the influence of systemic inflammation on this association. METHODS: We included 25,899 participants from the Canadian Longitudinal Study of Aging comprehensive cohort, aged 45-85 years (51% women). We conducted sex- and age-specific (45-59; 60-69; ≥70) general linear models between obstructive sleep apnea risk and cognitive scores, and tested the moderating and mediating effects of high-sensitivity C-reactive protein levels. Obstructive sleep apnea risk was estimated by combining the STOP and whole-body fat percentage. Cognitive tests assessed episodic verbal memory, executive functions and psychomotor speed. Levels of high-sensitivity C-reactive protein were obtained through blood samples. RESULTS: Higher obstructive sleep apnea risk was associated with poorer episodic memory in women aged 45-59 years, and poorer executive function (p < 0.05 on multiple tests) in women aged 45-59 and 60-69 years. No such association was found in men. High-sensitivity C-reactive protein levels mediated some associations between obstructive sleep apnea risk and executive function in women and men aged <70 years. CONCLUSIONS: Being at high-risk for obstructive sleep apnea is associated with poorer cognition in women aged <70 years. These associations were partly mediated by systemic inflammation. These results underscore the importance of obstructive sleep apnea diagnosis, treatment and appropriate follow-up, particularly in middle-aged women who might already show signs of early cognitive impairments.
Assuntos
Proteína C-Reativa , Apneia Obstrutiva do Sono , Envelhecimento , Canadá/epidemiologia , Cognição , Feminino , Humanos , Inflamação/complicações , Estudos Longitudinais , Masculino , Transtornos da Memória/complicações , Pessoa de Meia-Idade , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologiaRESUMO
BACKGROUND: Adults with chronic conditions who also suffer from mental health comorbidities and/or social vulnerability require services from many providers across different sectors. They may have complex health and social care needs and experience poorer health indicators and high mortality rates while generating considerable costs to the health and social services system. In response, the literature has stressed the need for a collaborative approach amongst providers to facilitate the care transition process. A better understanding of care transitions is the next step towards the improvement of integrated care models. The aim of the study is to better understand care transitions of adults with complex health and social care needs across community, primary care, and hospital settings, combining the experiences of patients and their families, providers, and health managers. METHODS/DESIGN: We will conduct a two-phase mixed methods multiple case study (quantitative and qualitative). We will work with six cases in three Canadian provinces, each case being the actual care transitions across community, primary care, and hospital settings. Adult patients with complex needs will be identified by having visited the emergency department at least three times over the previous 12 months. To ensure they have complex needs, they will be invited to complete INTERMED Self-Assessment and invited to enroll if positive. For the quantitative phase, data will be obtained through questionnaires and multi-level regression analyses will be conducted. For the qualitative phase, semi-structured interviews and focus groups will be conducted with patients, family members, care providers, and managers, and thematic analysis will be performed. Quantitative and qualitative results will be compared and then merged. DISCUSSION: This study is one of the first to examine care transitions of adults with complex needs by adopting a comprehensive vision of care transitions and bringing together the experiences of patients and family members, providers, and health managers. By using an integrated knowledge translation approach with key knowledge users, the study's findings have the potential to inform the optimization of integrated care, to positively impact the health of adults with complex needs, and reduce the economic burden to the health and social care systems.
Assuntos
Transferência de Pacientes , Apoio Social , Adulto , Canadá/epidemiologia , Família , Grupos Focais , Humanos , Pesquisa QualitativaRESUMO
INTRODUCTION: Hypoxaemia is a frequent complication of chronic obstructive pulmonary disease (COPD). To prevent its consequences, supplemental oxygen therapy is recommended by international respiratory societies. However, despite clear recommendations, some patients receive long-term oxygen therapy (LTOT), while they do not meet prescription criteria. While evidence suggests that acute oxygen supply at high oxygenation targets increases COPD mortality, its chronic effects on COPD mortality remain unclear. Thus, the study will aim to evaluate through a systematic review and individual patient data meta-analysis (IPD-MA), the association of LTOT prescription outside the guidelines on survival over time in COPD. METHODS: Systematic review and IPD-MA will be conducted according to Preferred Reporting Items for a Systematic Review and Meta-Analyses IPD guidelines. Electronic databases (PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, OpenGrey and BioRxiv/MedRxix) will be scanned to identify relevant studies (cohort of stable COPD with arterial oxygen tension data available, with indication of LTOT filled out at the moment of the study and with a survival follow-up). The anticipated search dates are January-February 2022. The main outcome will be the association between LTOT and time to all-cause mortality according to hypoxaemia severity, after controlling for potential covariates and all available clinical characteristics. Quantitative data at the level of the individual patient will be used in a one-step approach to develop and validate a prognostic model with a Cox regression analysis. The one-step IPD-MA will be conducted to study the association and the moderators of association between supplemental oxygen therapy and mortality. Multilevel survival analyses using Cox-mixed effects models will be performed. ETHICS AND DISSEMINATION: As a protocol for a systematic review, a formal ethics committee review is not required. Only studies with institutional approval from an ethics committee and anonymised IPD will be included. Results will be disseminated through peer-reviewed publications and presentations in conferences. PROSPERO REGISTRATION NUMBER: CRD42020209823.
Assuntos
Oxigenoterapia , Doença Pulmonar Obstrutiva Crônica , Humanos , Hipóxia/etiologia , Hipóxia/terapia , Oxigênio/uso terapêutico , Oxigenoterapia/métodos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/terapiaRESUMO
The COVID-19 pandemic's first wave required considerable adaptation efforts on the part of healthcare workers. The literature on resilient healthcare describes how the collective regulation strategies implemented by frontline employees make essential contributions to institutions' abilities to cope with major crises. The present mixed-methodology study was thus conducted among a large sample of employees in a variety of Swiss healthcare institutions and focused on problematic real-world situations experienced by them and their managers during the pandemic's first wave. It highlighted the anticipatory and adaptive strategies implemented by institutions, teams and individuals. The most frequently cited problematic situations involved organisational changes, interpersonal conflicts and workloads. In addition to the numerous top-down measures implemented by institutions, respondents also identified personal or team regulation strategies such as increasing staff flexibility, prioritising tasks, interprofessional collaboration, peer support or creating new communication channels to families. The present findings underlined the importance of taking greater account of healthcare support staff and strengthening managerial capacity to support interprofessional teams including those support staff.
RESUMO
BACKGROUND: Intensive care workers are known for their stressful work environment and for a high prevalence of mental health outcomes. The aim of this study was to evaluate the mental health, well-being and changes in lifestyle among intensive care unit (ICU) healthcare workers (HCW) during the first wave of the COVID-19 pandemic and to compare these results with those of HCW in other hospital units. Another objective was to understand which associated factors aggravate their mental health during the COVID-19 outbreak. METHODS: This cross-sectional survey collected socio-demographic data, lifestyle changes and mental health evaluations as assessed by the Generalized Anxiety Disorder 7 items (GAD-7), the Patient Health Questionnaire 9 items (PHQ-9), the Peritraumatic Distress Inventory (PDI) and the World Health Organization Well-Being Index (WHO-5) from the 28th May to 7th July 2020. The study was carried out at Geneva University Hospitals, a group of eight public hospitals in Switzerland. ICU HCW were analyzed for mental health outcomes and lifestyles changes and then compared to non-ICU HCW. A series of linear regression analyses were performed to assess factors associated with mental health scores. RESULTS: A total of 3461 HCW were included in the study, with 352 ICU HCW. Among ICU HCW, 145 (41%) showed low well-being, 162 (46%) symptoms of anxiety, 163 (46%) symptoms of depression and 76 (22%) had peritraumatic distress. The mean scores of GAD-7, PHQ-9 and WHO-5 were worse in ICU HCW than in non-ICU HCW (p < 0.01). Working in the ICU rather than in other departments resulted in a change of eating habits, sleeping patterns and alcohol consumption (p < 0.01). Being a woman, the fear of catching and transmitting COVID-19, anxiety of working with COVID-19 patients, work overload, eating and sleeping disorders as well as increased alcohol consumption were associated with worse mental health outcomes. CONCLUSION: This study confirms the suspicion of a high prevalence of anxiety, depression, peritraumatic distress and low well-being during the first COVID-19 wave among HCW, especially among ICU HCW. This allows for the identification of associated risk factors. Long-term psychological follow-up should be considered for HCW.