Prevalence and Associated Factors of Depression and Anxiety Among Healthcare Workers During the Coronavirus Disease 2019 Pandemic: A Nationwide Study in Korea.

BACKGROUND: A healthcare system's collapse due to a pandemic, such as the coronavirus disease 2019 (COVID-19), can expose healthcare workers (HCWs) to various mental health problems. This study aimed to investigate the impact of the COVID-19 pandemic on the depression and anxiety of HCWs. METHODS: A nationwide questionnaire-based survey was conducted on HCWs who worked in healthcare facilities and public health centers in Korea in December 2020. Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to measure depression and anxiety. To investigate factors associated with depression and anxiety, stepwise multiple logistic regression analysis was performed. RESULTS: A total of 1,425 participating HCWs were included. The mean depression score (PHQ-9) of HCWs before and after COVID-19 increased from 2.37 to 5.39, and the mean anxiety score (GAD-7) increased from 1.41 to 3.41. The proportion of HCWs with moderate to severe depression (PHQ-9 ≥ 10) increased from 3.8% before COVID-19 to 19.5% after COVID-19, whereas that of HCWs with moderate to severe anxiety (GAD-7 ≥ 10) increased from 2.0% to 10.1%. In our study, insomnia, chronic fatigue symptoms and physical symptoms after COVID-19, anxiety score (GAD-7) after COVID-19, living alone, and exhaustion were positively correlated with depression. Furthermore, post-traumatic stress symptoms, stress score (Global Assessment of Recent Stress), depression score (PHQ-9) after COVID-19, and exhaustion were positively correlated with anxiety. CONCLUSION: In Korea, during the COVID-19 pandemic, HCWs commonly suffered from mental health problems, including depression and anxiety. Regularly checking the physical and mental health problems of HCWs during the COVID-19 pandemic is crucial, and social support and strategy are needed to reduce the heavy workload and psychological distress of HCWs.

Correlates of burnout among healthcare workers during the COVID-19 pandemic in South Korea.

Burnout is a form of negative emotional and physical response to job stress. This study aimed to investigate the prevalence of burnout among healthcare workers responding to the coronavirus disease 2019 (COVID-19) outbreak in Korea and to explore correlates of burnout among healthcare workers. A nationwide questionnaire-based survey was conducted from December 1, 2020, to January 29, 2021 on 1425 healthcare workers who worked in one of the 16 healthcare facilities designated for COVID-19 care, in public health centers, or as paramedics in Korea. Burnout was assessed using 16 Korean-adapted items based on the Oldenburg Burnout Inventory (OLBI). Data were collected using a structured questionnaire and analyzed using the R version 4.1.1 software program. OLBI results indicate clinically exhaustion in 84.5% (1204/1425) and clinically disengagement in 91.1% (1298/1425), and 77.3% (1102/1425) met the score criteria for both the exhaustion and disengagement subscales for burnout. Burnout rate was significantly increased in the group with chronic fatigue symptoms (Fatigue Severity Scale ≥ 3.22) after the outbreak of COVID-19 (OR, 3.94; 95% CI 2.80-5.56), in the female group (OR, 2.05; 95% CI 1.46-2.86), in the group with physical symptoms (Patient Health Questionnaire-15 ≥ 10) after the outbreak of COVID-19 (OR, 2.03; 95% CI 1.14-3.60), in the group with a higher Global Assessment of Recent Stress scale (OR, 1.71; 95% CI 1.46-2.01), in the group with post-traumatic stress symptoms (Primary Care Post-Traumatic Stress Disorder-5 ≥ 2) (OR, 1.47; 95% CI 1.08-2.01), and in the younger age group(OR, 1.45; 95% CI 1.22-1.72). The chronic fatigue symptoms were correlated with cumulative days of care (OR, 1.18; 95% CI 1.02-1.37). The physical symptoms were correlated with average contact hours with COVID-19 patients per day (OR, 1.34; 95% CI 1.17-1.54), and cumulative days of care (OR, 1.21; 95% CI 1.06-1.38). Most Korean healthcare workers suffered from burnout related to excessive workload during the COVID-19 pandemic. During a widespread health crisis like COVID-19, it is necessary to regularly check the burnout status in healthcare workers and reduce their excessive workload by supplementing the workforce and providing appropriate working hours sufficient rest hours.

Workload of Healthcare Workers During the COVID-19 Outbreak in Korea: A Nationwide Survey.

BACKGROUND: As the coronavirus disease 2019 (COVID-19) pandemic is ongoing, heavy workload of healthcare workers (HCWs) is a concern. This study investigated the workload of HCWs responding to the COVID-19 outbreak in South Korea. METHODS: A nationwide cross-sectional survey was conducted from September 16 to October 15, 2020, involving 16 healthcare facilities (4 public medical centers, 12 tertiary-care hospitals) that provide treatment for COVID-19 patients. RESULTS: Public medical centers provided the majority (69.4%) of total hospital beds for COVID-19 patients (n = 611), on the other hand, tertiary care hospitals provided the majority (78.9%) of critical care beds (n = 57). The number of beds per doctor (median [IQR]) in public medical centers was higher than in tertiary care hospitals (20.2 [13.0, 29.4] versus 3.0 [1.3, 6.6], P = 0.006). Infectious Diseases physicians are mostly (80%) involved among attending physicians. The number of nurses per patient (median [interquartile range, IQR]) in tertiary-care hospitals was higher than in public medical centers (4.6 [3.4-5] vs. 1.1 [0.8-2.1], P = 0.089). The median number of nurses per patient for COVID-19 patients was higher than the highest national standard in South Korea (3.8 vs. 2 for critical care). All participating healthcare facilities were also operating screening centers, for which a median of 2 doctors, 5 nurses, and 2 administrating staff were necessary. CONCLUSION: As the severity of COVID-19 patients increases, the number of HCWs required increases. Because the workload of HCWs responding to the COVID-19 outbreak is much greater than other situations, a workforce management plan regarding this perspective is required to prevent burnout of HCWs.

Clinical Characteristics and Mortality Predictors of COVID-19 Patients Hospitalized at Nationally-Designated Treatment Hospitals.

BACKGROUND: Coronavirus disease 2019 (COVID-19) was first reported in December 2019 in China, and then it has disseminated worldwide. In Korea, a religious group-related super-spreading event triggered a sudden outbreak in Daegu city and Gyeongsangbuk-do in southeast Korea. This study was undertaken to document the clinical characteristics of patients hospitalized in Gyeongsangbuk-do. METHODS: Three hundred and fifty-two patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection hospitalized at Dongguk University Gyeongju Hospital or at the Andong Medical Center between February 18th and June 30th were enrolled in this study. Medical records were reviewed and demographic and clinical features, including comorbidities, symptoms, radiological and laboratory findings on admission were analyzed. In addition, we sought to identify risk factors of mortality. RESULTS: Mean age of the 352 study subjects was 56 years (range, 14-95). The mortality rate was 6.8% and mean age at death was 81 years (range, 57-91). The most common symptom was cough (31.8%) followed by a febrile sensation (28.4%), sputum (17.0%), sore throat (15.6%), and myalgia (13.1%). Eighty-one (23.0%) patients were asymptomatic, but a half of these patients exhibited pneumonic infiltration at presentation. Chest radiology showed no active lesion in 41.8% of the study subjects, bilateral pneumonia in 46.9%, and unilateral pneumonic infiltration in 11.4%. Among 24 patients that died, 18 subjects were transferred from a care facility. An age of ≥ 70 years, previous history of malignancy or diabetes, and fever (≥ 37.5°C) on admission were found to be significant risk factors of mortality. CONCLUSION: Patients aged ≥ 70 years, those with fever on admission, and patients with an underlying malignancy or diabetes were found to be more likely to succumb to COVID-19. Elderly in care facilities or hospitalized patients with an underlying disease should receive more attention and be considered for preventive quarantine.

Energy Level-Graded Al-Doped ZnO Protection Layers for Copper Nanowire-Based Window Electrodes for Efficient Flexible Perovskite Solar Cells.

Flexible perovskite solar cells (PSCs) have attracted significant interest as promising candidates for portable and wearable devices. Copper nanowires (CuNWs) are promising candidates for transparent conductive electrodes for flexible PSCs because of their excellent conductivity, flexibility, and cost-effectiveness. However, because of the thermal/chemical instability of CuNWs, they require a protective layer for application in PSCs. Previous PSCs with CuNW-based electrodes generally exhibited poor performances compared with their indium tin oxide-based counterparts because of the neglect of the interfacial energetics between the electron transport layer (ETL) and CuNWs. Herein, an Al-doped ZnO (AZO) protective layer fabricated using atomic layer deposition is introduced. The AZO/CuNW-based composite electrode exhibits improved thermal/chemical stability and favorable band alignment between the ETL and CuNWs, based on the Al dopant concentration tuning. As a result, the Al content gradient AZO (g-AZO), composed of three successively deposited AZO layers, leads to highly efficient flexible PSCs with a power conversion efficiency (PCE) of 14.18%, whereas the PCE of PSCs with a non-g-AZO layer is 12.34%. This improvement can be attributed to the efficient electron extraction and reduced charge recombination. Furthermore, flexible PSCs based on g-AZO-based composite electrodes retain their initial PCE, even after 600 bending cycles, demonstrating excellent mechanical stability.

Strain-Mediated Phase Stabilization: A New Strategy for Ultrastable α-CsPbI3 Perovskite by Nanoconfined Growth.

All-inorganic cesium lead triiodide (CsPbI3 ) perovskite is considered a promising solution-processable semiconductor for highly stable optoelectronic and photovoltaic applications. However, despite its excellent optoelectronic properties, the phase instability of CsPbI3 poses a critical hurdle for practical application. In this study, a novel stain-mediated phase stabilization strategy is demonstrated to significantly enhance the phase stability of cubic α-phase CsPbI3 . Careful control of the degree of spatial confinement induced by anodized aluminum oxide (AAO) templates with varying pore sizes leads to effective manipulation of the phase stability of α-CsPbI3 . The Williamson-Hall method in conjunction with density functional theory calculations clearly confirms that the strain imposed on the perovskite lattice when confined in vertically aligned nanopores can alter the formation energy of the system, stabilizing α-CsPbI3 at room temperature. Finally, the CsPbI3 grown inside nanoporous AAO templates exhibits exceptional phase stability over three months under ambient conditions, in which the resulting light-emitting diode reveals a natural red color emission with very narrow bandwidth (full width at half maximum of 33 nm) at 702 nm. The universally applicable template-based stabilization strategy can give in-depth insights on the strain-mediated phase transition mechanism in all-inorganic perovskites.

All-Solution-Processed Thermally and Chemically Stable Copper-Nickel Core-Shell Nanowire-Based Composite Window Electrodes for Perovskite Solar Cells.

Organic-inorganic hybrid perovskite solar cells (PSCs) have recently attracted tremendous attention because of their excellent efficiency and the advantage of a low-cost fabrication process. As a transparent electrode for PSCs, the application of copper nanowire (CuNW)-network was limited because of its thermal/chemical instability, despite its advantages in terms of high optical/electrical properties and low-cost production. Here, the copper-nickel core-shell nanowire (Cu@Ni NW)-based composite electrode is proposed as a bottom window electrode for PSCs, without the involvement of a high-cost precious metal and vacuum process. The dense and uniform Ni protective shell for CuNWs is attainable by simple electroless plating, and the resulting Cu@Ni NWs exhibit outstanding chemical stability as well as thermal stability compared with bare CuNWs. When the Ni layer with the optimal thickness is introduced, the Cu@Ni NW electrode shows a high transmittance of 80.5% AVT at 400-800 nm, and a sheet resistance of 49.3 ± 5 Ω sq-1. Using the highly stable Cu@Ni NWs, the composite electrode structure is fabricated with sol-gel-derived Al-doped zinc oxide (AZO) over-layer for better charge collection and additional protection against iodine ions from the perovskite. The PSCs fabricated with AZO/Cu@Ni NW-based composite electrode demonstrate a power conversion efficiency (PCE) of 12.2% and excellent long-term stability maintaining 91% of initial PCE after being stored for 500 h at room temperature. Experimental results demonstrate the potential of highly stable Cu@Ni NW-based electrodes as the cost-effective alternative transparent electrode, which can facilitate the commercialization of PSCs.

Investigating Recombination and Charge Carrier Dynamics in a One-Dimensional Nanopillared Perovskite Absorber.

Organometal halide perovskite materials have become an exciting research topic as manifested by intense development of thin film solar cells. Although high-performance solar-cell-based planar and mesoscopic configurations have been reported, one-dimensional (1-D) nanostructured perovskite solar cells are rarely investigated despite their expected promising optoelectrical properties, such as enhanced charge transport/extraction. Herein, we have analyzed the 1-D nanostructure effects of organometal halide perovskite (CH3NH3PbI3- xCl x) on recombination and charge carrier dynamics by utilizing a nanoporous anodized alumina oxide scaffold to fabricate a vertically aligned 1-D nanopillared array with controllable diameters. It was observed that the 1-D perovskite exhibits faster charge transport/extraction characteristics, lower defect density, and lower bulk resistance than the planar counterpart. As the aspect ratio increases in the 1-D structures, in addition, the charge transport/extraction rate is enhanced and the resistance further decreases. However, when the aspect ratio reaches 6.67 (diameter ∼30 nm), the recombination rate is aggravated due to high interface-to-volume ratio-induced defect generation. To obtain the full benefits of 1-D perovskite nanostructuring, our study provides a design rule to choose the appropriate aspect ratio of 1-D perovskite structures for improved photovoltaic and other optoelectrical applications.

Facile Sol-Gel-Derived Craterlike Dual-Functioning TiO2 Electron Transport Layer for High-Efficiency Perovskite Solar Cells.

Organic-inorganic hybrid perovskite solar cells (PSCs) are considered promising materials for low-cost solar energy harvesting technology. An electron transport layer (ETL), which facilitates the extraction of photogenerated electrons and their transport to the electrodes, is a key component in planar PSCs. In this study, a new strategy to concurrently manipulate the electrical and optical properties of ETLs to improve the performance of PSCs is demonstrated. A careful control over the Ti alkoxide-based sol-gel chemistry leads to a craterlike porous/blocking bilayer TiO2 ETL with relatively uniform surface pores of 220 nm diameter. Additionally, the phase separation promoter added to the precursor solution enables nitrogen doping in the TiO2 lattice, thus generating oxygen vacancies. The craterlike surface morphology allows for better light transmission because of reduced reflection, and the electrically conductive craterlike bilayer ETL enhances charge extraction and transport. Through these synergetic improvements in both optical and electrical properties, the power conversion efficiency of craterlike bilayer TiO2 ETL-based PSCs could be increased from 13.7 to 16.0% as compared to conventional dense TiO2-based PSCs.