Factors Associated With Worsened Mental Health of Health Care Workers in Canada During the COVID-19 Pandemic: Cross-Sectional Survey Study.

BACKGROUND: Health care workers (HCWs) in Canada have endured difficult conditions during the COVID-19 pandemic. Many worked long hours while attending to patients in a contagious environment. This introduced an additional burden that may have contributed to worsened mental health conditions. OBJECTIVE: In this study, we examine the factors associated with worsened mental health conditions of HCWs as compared to before the start of the pandemic. METHODS: We use data from a survey of HCWs by Statistics Canada. A regression model is used to estimate the odds ratios (ORs) of worsened mental health after the start of the pandemic. The estimated odds ratio (OR) is associated with different independent variables that include demographics (age, sex, immigration status, and geographic area), occupational factors (work status, occupational group, and exposure category), and different access levels to personal protective equipment (PPE). RESULTS: Of 18,139 eligible participants surveyed, 13,990 (77.1%) provided valid responses. We found that HCWs younger than 35 years old were more likely (OR 1.14, 95% CI 1.03-1.27; P=.01) to exhibit worsened mental health as compared to the reference group (35-44 years old). As for sex, male HCWs were less likely (OR 0.76, 95% CI 0.67-0.86; P<.001) to exhibit worsened mental health as compared to female HCWs. Immigrant HCWs were also less likely (OR 0.57, 95% CI 0.51-0.64; P<.001) to exhibit worsened mental health as compared to nonimmigrant HCWs. Further, HCWs working in Alberta had the highest likelihood of exhibiting worsened mental health as compared to HCWs working elsewhere (Atlantic provinces, Quebec, Manitoba, Saskatchewan, Ontario, British Columbia, and Northern Territories). Frontline workers were more likely (OR 1.26, 95% CI 1.16-1.38; P<.001) to exhibit worsened mental health than nonfrontline HCWs. Part-time HCWs were less likely (OR 0.85, 95% CI 0.76-0.93; P<.001) to exhibit worsened mental health than full-time HCWs. HCWs who reported encountering COVID-19 cases were more likely (OR 1.55, 95% CI 1.41-1.70; P<.001) to exhibit worsened mental health as compared to HCWs who reported no contact with the disease. As for PPE, HCWs who never had access to respirators, eye protection, and face shields are more likely to exhibit worsened mental health by 1.31 (95% CI 1.07-1.62; P<.001), 1.51 (95% CI 1.17-1.96; P<.001), and 1.41 (95% CI 1.05-1.92; P=.02) than those who always had access to the same PPE, respectively. CONCLUSIONS: Different HCW groups experienced the pandemic differently based on their demographic and occupational backgrounds as well as access to PPE. Such findings are important to stakeholders involved in the planning of personalized support programs and aid mental health mitigation in future crises. Certain groups require more attention.

Determinants of Public Health Personnel Spending in Spain.

Public health is funded with government funds gathered from tax revenues, whether national, provincial or municipal. The health system therefore suffers during economic crisis periods, whether due to disinvestment, loss of purchasing power among health care personnel or the decrease in the number of professionals. This worsens the situation, as it is necessary to cover the needs of an increasingly elderly population and with a longer life expectancy at birth. The present study intends to show a model which explains the determination of the "Public Health Personnel Expenditure" in Spain for a determined period. A multiple linear regression model was applied to the period including the years 1980-2021. Macroeconomic and demographic variables were analyzed to explain the dependent variable. Variation in health personnel expenditure: "We included those variables which presented a high or very high correlation above r > 0.6. The variables which explain the behavior of Variation in health personnel expenditure". It was a determining factor in the present study to consider that the variables with the greatest repercussions on health policy were mainly macroeconomic variables rather than demographic variables, with the only significant demographic variable that had a specific weight lower than macroeconomic variables being "Birth Rate". In this sense, the contribution made to the scientific literature is to establish an explanatory model so that public policy managers and states in particular can consider it in their public spending policies, bearing in mind that health expenditures in a Beveridge-style health system, as Spain has, are paid with funds drawn from tax revenues.

Assessment of Predictors for SARS-CoV-2 Antibodies Decline Rate in Health Care Workers after BNT162b2 Vaccination-Results from a Serological Survey.

Background: SARS-CoV-2 is a novel human pathogen causing Coronavirus Disease 2019 that has caused widespread global mortality and morbidity. Since health workers in Israel were among the first to be vaccinated, we had a unique opportunity to investigate the post-vaccination level of IgG anti-S levels antibodies (Abs) and their dynamics by demographic and professional factors. Methods: Prospective Serological Survey during December 2020−August 2021 at Barzilai Medical Center among 458 health care workers (HCW) followed for 6 months after the second BNT162b2 vaccine dose. Results: Antibody levels before the second dose, and 30, 90 and 180 days after were 57.1 ± 29.2, 223 ± 70.2, 172.8 ± 73.3 and 166.4 ± 100.7 AU/mL, respectively. From GEE analysis, females had higher Abs levels (ß = 26.37 AU/mL, p = 0.002). Age was negatively associated with Abs, with a 1.17 AU/mL decrease for each additional year (p < 0.001). Direct contact with patients was associated with lower Abs by 25.02 AU/mL (p = 0.009) compared to working with no such contact. The average decline rate overall for the study period was 3.0 ± 2.9 AU/mL per week without differences by demographic parameters and was faster during the first 3 months after vaccination than in the subsequent 3 months. Conclusions: All demographic groups experienced a decline in Abs over time, faster during the first 3 months. Findings of overall Abs lower in males, workers with direct contact with patients, and older workers, should be considered for policy-making about choosing priority populations for additional vaccine doses in hospital settings.

Factors correlating with prolonged fatigue among emergency department nurses.

BACKGROUND: Fatigue affects nurses negatively and leads to physical, cognitive and emotional problems that may influence nurses' quality of life. However, there is a lack of studies about prolonged fatigue and its relationship with socio-demographic characteristics and job-related psychosocial factors among nurses, especially emergency nurses, worldwide and in Jordan. AIMS: This study aims to assess the relationship between demographic factors, physical health, psychological distress and job-related psychosocial factors (psychological job demands, job control and social support) and prolonged fatigue among emergency department nurses in Jordan. METHODS: A descriptive correlational study using a convenience sample was used to recruit 153 emergency nurses. Physical health Questionnaire, General Health Questionnaire, Job Content Questionnaire and Checklist Individual Strength were used. RESULTS: The majority of emergency nurses experienced abnormally prolonged fatigue, moderate health, high psychological distress, high job demands and low job control and social support. Significant negative relationships were addressed between job control, social support and prolonged fatigue, whereas income had a negative weak relationship. Psychological distress and job demands had a positive weak relationship with prolonged fatigue. There was a significant positive weak relationship between psychological distress, job demands and prolonged fatigue. Job-related psychosocial factors (with exception of social support) and mental health were the predictors of prolonged fatigue. CONCLUSIONS: Prolonged fatigue is a multidimensional phenomenon that can be affected by several factors such as job-related psychosocial factors and psychological health. These factors should be taken into consideration when testing and developing interventions to minimise prolonged fatigue among emergency nurses.

The relationship between some demographic characteristics and organizational commitment of nurses working in the Social Security Hospital of Khorramabad.

BACKGROUND: Reduction in organizational commitment of nurses results in deficiency of care services. Some demographic factors affect organizational commitment. OBJECTIVE: The present study is intended to determine the organizational commitment of nurses and its relationship with demographic characteristics. METHODS: This study was a descriptive correlation (cross-sectional) study in January and February of 2016 on 126 nurses who held Bachelor of Science (B.Sc.) or Master of Science (M.Sc.) and at least one year of work experience in the Social Security Hospital of Khorramabad, selected using the census method. Data collection tools included a demographic characteristics form and Allen and Meyer questionnaire. Data analysis was performed using SPSS 20. Independent-samples t-test and one-way ANOVA were used to determine the relationship between organizational commitment and demographic characteristics. RESULTS: The majority of nurses had moderate organizational commitment, the highest score belonging to the continuance commitment (22.33%), and the lowest score belonging to the normative commitment (19.16%). Also, there was a significant correlation between the continuance commitment and work experience (p=0.001), the staff posts (p=0.01) and shifts (p=0.04). CONCLUSION: Considering the moderate level of subjects' organizational commitment in the present study, managers should take necessary measures to increase the attachment and organizational commitment of nurses and provide the ground for improving nursing services.

Self-selection and intermunicipal migration in Canada.

"This paper investigates individual intermunicipal migration behaviour in Canada within the context of a human capital model that adjusts for the migrant's selectivity in computing expected income gains. In addition to the typical regional determinants of migration, housing and labour market characteristics are found to influence intermunicipal migration significantly, the effects differing with age. Structural coefficients remained more or less stable during the decade 1971-1981. It is shown that the failure to adjust income gains for selectivity bias results in an underestimation of the migration-impacts of income gains and municipal-specific factors."

The underemployment of American rural women: prevalence, trends and spatial inequality.

PIP: The growing numerical significance of women in the US nonmetropolitan labor force has not been matched by parallel efforts to document the changing quality of their employment. In this paper. Lichter uses the labor utilization framework of Clogg and Sullivan to examine the prevalence and spatial convergence of various forms of female underemployment during 1970-1985. Data from the March annual demographic files of the Current Population Survey reveal that underemployment has been a significant aspect of the employment experiences of nonmetropolitan women during this period. There has been little evidence of spatial or sex convergence in labor market outcomes. Roughly 1 of every 3 rural female workers today is a discouraged worker, jobless, employed part-time involuntarily, or working for poverty-level wages. Moreover, rural women continue to suffer substantially higher levels of economic underemployment than urban women and rural men. This study reinforces the view that rural women remain a seriously underutilized labor resource in the US.^ieng

Afro-Caribbean migrants in France: employment, state policy and the migration process.

"Afro-Caribbean labour in France plays a distinctive role relative to the French population as a whole and the foreign immigrant population. Using a variety of qualitative and quantitative sources, this paper demonstrates that the role of the state in the process of migration from the French Caribbean islands of Martinique and Guadeloupe from the early 1960s onwards was crucial.... Aggregate sources are used to describe detailed occupational distributions while records of individual migrants illustrate the process of migration and the influences on employment. At a time usually characterized by lack of direct involvement in migration by the French state, for Afro-Caribbeans state intervention in recruitment, training and settlement is shown to be very substantial."

International migration and real wages: a resolution note.

PIP: The authors examine the impact of international labor migration on wages in country of origin. Two types of emigration are distinguished: bundled emigration, which can result in a reduction of real wages; and pure labor emigration, which results in an increase in real wages.^ieng

Anganwadi worker's participation in rural newborn care.

Anganwadi worker was involved in rural newborn care as a link between a dai and a health worker. She was trained to ensure that, (i) borderline LBW/preterm baby was kept warm at home and (ii) a very small baby was referred to hospital. The training was conducted during routine monthly meetings and cost of equipping each anganwadi worked out to be Rs 110. Newborn survival, infant survivals and overall MCH performance improved. Thus, newborn care formed an ideal entry point into MCH activities.

PIP: The Rural Neonatal Care Program was initiated in January 1988 in Ganjad Primary Health Center, Dahanu, India, with the training of dais in care of the newborn. Later in the year training was conducted for anganwadi workers, who would follow-up newborn care until the child was 6 years of age. The anganwadi worker was a link between the dai and health worker and the health center. Home visits were made on the day of birth. The infant was measured and an health assessment made. If the infant was preterm or low birth weight and with a foot length of between 6.5 and 7 cm, repeat home visits were made to assess the breast feeding progress, the infant activity level, and general signs of health, as reflected in warm and pink feet. Training was conducted at monthly meetings at the block level, at the primary health care level, and during field visits to show how to care for hypothermic babies. A training manual and record book were developed and used. Footprints were made, and referrals were made to the hospital for those with feet under 6.5 to 7 cm. General observations were that birth registration improved, and infants were more easily identified for immunization. Newborn referral improved, and infant mortality declined. There was an important role for the anganwadi worker in providing continuity of care, identification of referrals, and training in the home for how to keep a baby warm. The number of referrals averaged 1-2 per month and 1-2 with special home attention. The training of the anganwadi worker in newborn care was included in the normal course of training and cost about Rs. 110 per worker.

Migration, remittances, and inequality: estimating the net effects of migration on income distribution.

"This paper examines the net effects of migration and remittances on income distribution. Potential home earnings of migrants are imputed, as are the earnings of non-migrants in migrant households, in order to construct no-migration counterfactuals to compare with the observed income distribution including remittances. The earnings functions used to impute migrant home earnings are estimated from observations on non-migrants in a selection-corrected estimation framework which incorporates migration choice and labor-force participation decisions. For a sample of households in Bluefields, Nicaragua, migration and remittances increase income inequality when compared with the no-migration counterfactual."

The earnings of Mexican immigrants in the United States.

"This paper documents the trends in the earnings of Mexican immigrants during the 1970-1990 period. The empirical evidence indicates that there has been a decline in the relative wage of successive Mexican immigrant waves in the past three decades and that little wage convergence occurs between the typical Mexican immigrant and the typical native worker. The data also suggest that the increasing importance of Mexican immigration is partly responsible for the deterioration in relative skills observed in the aggregate immigrant population, but that there has also been a decline in relative skills even among non-Mexican immigrants."

Primary school teacher as a primary health care worker.

School children (1608) were examined for three items (nails, scalp hairs and teeth) relating to personal hygiene and relevant infective conditions from two sets of villages i.e. one set where primary school teacher was working as primary health care worker (Group I) and the other set where Community Health Volunteer (CHV) was delivering primary health care (Group II). The objective was to evaluate the efficiency of school teachers' role vis-a-vis CHVs' in imparting health education to school children. Out of 1608 school children, 801 belonged to Group I villages and the remaining 807 to Group II villages. From the results, it was evident that children of Group I villages were better with respect to all the items related to personal hygiene and infective conditions excepting scalp infections, where difference was not statistically significant, indicating teachers' superiority over the CHVs' in imparting health education to school children.

Population pressure, intensification of agriculture, and rural-urban migration.

"In this paper I provide an analytical basis for why labor absorption [in agriculture] may improve with higher population density. My argument is in two parts. First, analysing agriculture in isolation, I use the Boserup insight to show that higher population density is associated with more intensive techniques of land use. Second, using a two-sector model, I show that the rate of labor absorption (defined as the rate of natural population growth minus the rate of rural-urban migration) increases with the intensity of land use." Cross-sectional data for Iran are used to illustrate the model.

PIP: This paper considers the Malthusian implication that population density leads to the inability of agriculture to absorb labor. The argument is presented that higher population density is associated with more intensive techniques of land use, based on the Boserup model, and that the rate of labor absorption (natural population growth minus the rate of rural-to-urban migration) increases with the intensity of land use. The model reveals that the availability of jobs in urban areas slows agricultural intensification and increases migration. The Asian model is different in that urbanization and intensification occur simultaneously. The model is empirically tested with Iranian data. Results indicate negative signs for the intensity coefficients (irrigation ratio and cropping intensity), which means a negative influence on rural out-migration. Population density has a positive coefficient. The effect of the percentage of land tilled by tractors is positive, while the number of diesel pumps in operation reduces out-migration. The contrasting results of Annable, Bilsborrow, and Winegarden are considered plausible, since an intensification factor is not included and population density is picking up the negative effect of the intensity of cultivation. High rates of out-migration from low population density areas usually are explained by the poor natural resources available. It is argued that poor soil quality is related to cultivation intensity, and thus, soil fertility is exogenous. The results are intended not as a definitive proof of the direct effect of population density on agricultural employment, but as an alternative explanation for out-migration from low density areas. Population increases clearly cause declines in wages in the proposed model and may not lead to intensification but to out-migration. Increases in agricultural prices or lowering the cost of inputs can promote intensification. Population density will always reduce the potential of a region to absorb population. Government has the ability to influence public investment in agriculture and trading through its regulations, which can speed up intensification and the capacity to provide agricultural employment. Government can also indirectly encourage out-migration through the promotion of attractive urban labor markets.

Utilising dais to impart health and nutrition education: impact on growth.

PIP: To evaluate the effectiveness of using local dais to provide health and nutrition education to mothers, the weights of infants in an intervention area in the Uttar Pradesh district of Saharanpur were compared to those of infants in a nonintervention control group in the same district. The average weights of infants in the area where trained dais were utilized were significantly higher than those in the nonintervention area in the age groups 4-6 months and 7-9 months; mean weights did not differ significantly in the 0-3 month age group or at 9-12 months. Deviations in relation to age were least at 3 months. Overall, the intervention program was effective in bringing weights closer to all-India standards. Favorable changes were noted in the intervention area in terms of supplementary feedings, use of katori in milk feeding, and the lower incidence of infantile diarrhea. The mean weights of infants in this study were less than 80% of the 50th percentile of Harvard standards, suggesting widespread malnutrition in this area of India. It is hypothesized that after 9 months of age, the more effective functioning of health services, including broader immunization coverage, in the nonintervention area overrode the advantages conveyed by the dais' health education efforts in the study area.^ieng

Management of childhood illness in Africa. Early evaluations show promising results.

PIP: This article reports the positive evaluation results of the integrated management of childhood illness (IMCI) strategy for the last 3 years of operation in 28 countries in Africa. The strategy aimed to improve case management skills of health workers through training with locally adapted guidelines such as the use of clinical algorithms to detect the most common causes of childhood illnesses. In addition, the strategy was designed to improve the health system of the region, including the provision of essential drugs. A final component of the program seeks to optimize family and community practices in relation to child health, particularly care seeking behavior. Overall, the benefits include more rational drug use, increased attendance, improved provider morale, and improved perceptions of quality of care by mothers. Although its initial effects are rather small, it should be recognized that the proper implementation of IMCI should contribute to a steady reduction in childhood mortality in Africa.^ieng

Migration to the United States and Mexican rural development: a case study.

An analysis of the impact of migration to the United States on the sending community and on the labor market in the receiving country is presented based on a case study of Las Animas, Mexico. "As the community becomes increasingly involved in migration, tendencies can be identified regarding changing migration patterns, class differentiation among villagers, impact of migration on village economy, and the changing role of Mexican workers in California labor markets. Results indicate the importance of social networks in determining the outcome of migration; while migration is individually rational, it is a factor of stagnation for village economy, and it helps reproduce segmented California labor markets."

Integrated health programmes.

PIP: Over a period of 10 years, a hospital in rural Africa slowly built an integrated primary and secondary health care program to the point where it has more than 40 elements. In its initial stage (1982-84), hospital staff and community participants were trained, the number of mobile clinics was increased, community participation was sought, and health education was emphasized. During 1985-86, 92 village health committees were organized with 70 trained Village Health Workers (VHWs). This led to a rapid increase in vaccination rates, the use of oral rehydration therapy, and training of traditional birth attendants. In 1987-88, 14 VHW were trained to use basic medical kits and distribute medicines. By 1990, 18,000 of the 72,000 outpatient treatments were administered by VHWs. In 1987, the hospital made a community diagnosis and increased the size of its advisory board (which became 60% female). Because the community identified food, water, and poverty as its priorities, the hospital took steps to improve the food supply, the water supply, and the financial position of the women. In 1989-90, the primary health care (PHC) project added the components of family planning, a weaning food production unit, food coupons, food for work, grain banks, a trust fund, literacy classes, health stamps, a mobile malnutrition clinic, subsidized fertilizer and seed, low-cost care for victims of AIDS, new malaria treatment schedules, and a housing association. The PHC program has resulted in a reduction in under-five deaths from the national average of 330/1000 to 145/1000 (other areas have reduced deaths to 270-300/1000. The program is also becoming increasingly cost-effective, costing about 6 pounds per capita over 10 years for a population of 50,000. Country-wide implementation of the PHC program would require only 30% of the present health budget.^ieng

Immigration from poor to wealthy countries: experience of the United States.

PIP: The U.S. experience with immigration from poor countries is examined using the results of two projects carried out by the National Bureau of Economic Research. Questions considered include what determines the supply of immigrants, how such immigrants fare in the U.S. job market, and how this immigration affects the prospects of native-born workers.^ieng

The determinants of East-West German migration: some first results.

Determinants of the propensity to migrate are explored using data collected in a survey of East German residents following German reunification in 1991. The author notes that in the period 1989-1992, some 870,000 individuals migrated to West Germany, representing about 5% of the total East German population and 10% of the work force. He suggests that "recent developments in the literature on the option value of waiting may yield important insights into these determinants."