Inequality on the frontline: A multi-country study on gender differences in mental health among healthcare workers during the COVID-19 pandemic.

Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women's well-being and ensure healthcare system preparedness during future public health crises.

Second language learning role-play: effects of patient and doctor roles on motivation and competence.

Objectives: Role-playing has motivated foreign language learners for decades. In doctor-patient medical consultation role-plays, the doctor role has always been considered an important learning opportunity, whilst the patient role remained obscured. Our study, therefore, had a dual focus. We first explored how intrinsic motivation changes medical second-language (L2) learning through the lens of self-determination theory. We subsequently examined if playing the role of the patient provides additional value to medical L2 learning. Methods: We performed a mixed-methods study using a one-group pretest-posttest design. Participants were 15 student volunteers learning medical Dutch through peer role-play in medical consultations. Students completed a questionnaire before and after the course that measured changes in their intrinsic motivation to experience stimulation (IMES), feeling of relatedness, and feeling of competence. We also measured students' competence through a peer-rated checklist and the final course grades. At the end of the course, the students participated in semi-structured interviews to discuss their experience acting as patients. The data were subjected to the Wilcoxon signed-rank test and a thematic analysis. Results: The pre- and post-questionnaires revealed that students' IMES as well as their feeling of relatedness increased. Their self-perceptions, feeling of competence, peer assessments, and final course grades demonstrated that students were competent in medical L2. Our thematic analysis led to the identification of five themes of the role-play exercise for medical L2 learning: (1) motivational experience, (2) supportive peer interaction, (3) setting up a role-play environment for medical L2 learning, (4) utilizing the patient role to benefit medical L2 learning, and (5) a novel patient perspective on the doctor's role. Discussion: Our study found that role-play, by enhancing students' intrinsic motivation, feeling of relatedness, and competence development, aids the medical L2 learning process. Interestingly, playing a patient role in medical consultation was also found to support this process. We welcome future controlled experiments to confirm the positive impact of playing the role of the patient in medical consultation.

Stroke care in Armenia: Recent developments.

Introduction: Armenia is an upper-middle-income country with a population of nearly 3 million. Stroke is one of its major public health problems and ranks as the sixth leading cause of death, with a mortality of 75.5 per 100,000. Methods and results: Until recently, modern stroke care was not available in Armenia. During the past 8 years substantial advances have been made in building medical infrastructure and delivering acute stroke care. This manuscript describes contributors to this progress, including extensive and long-term collaboration with international stroke experts, the development of hospital-based stroke teams, and a funding commitment for stroke care by the government. Conclusion: The results of acute stroke revascularization procedures during the past 3 years are reviewed and found to meet international standards. Future directions are discussed including the immediate need to expand acute stroke care to underserved parts of the country by adding primary and comprehensive stroke centers. An active educational program for nurses and physicians and the TeleStroke system development will help support this expansion.