Omega-3 index as risk factor in psychiatric diseases: a narrative review.

Numerous studies have described associations between the omega-3 index (defined as the RBC percentage of EPA and DHA) and mental conditions, but no risk stratification or target value has gathered consensus so far. This narrative review aims to summarize the published data on the association between omega-3 index and mental illness and to contribute to the concept of an omega-3 index in the field of mental health. The bibliographic searches have been carried out in PubMed, Scopus and Web of Science databases to find relevant English language original research studies related to that association. The study search and selection process were registered in a PRISMA flow. Thirty-six studies were included in this review examining the links between omega-3 index and postpartum depression (3), major depression (15), major depression and bipolar disorder (1), bipolar disorder (4), schizophrenia and major depression (1), schizophrenia and other psychosis (5) and dementia (7). Thirty of these studies found either significant differences in omega-3 index between patients and controls or inverse relationships between omega-3 index and disease severity. The published evidence is compelling enough to suggest omega-3 index as a risk factor for some psychiatric diseases, specifically, major depression, postpartum depression, psychosis, and dementia. In occidental populations, we propose a risk threshold of (a) 4-5% in major depression and dementia, (b) 5% in postpartum depression, and (c) 4% for psychosis transition.

Burnout in hospital healthcare workers after the second COVID-19 wave: Job tenure as a potential protective factor.

Burnout is an impactful occupational health phenomenon to which doctors and nurses have been more exposed during the COVID-19 pandemic. The objectives of this study were to measure the dimensions of burnout-emotional exhaustion, depersonalization and personal accomplishment-in a hospital healthcare population after the second COVID-19 wave and to study their association with sociodemographic variables and previous COVID-19 infection. We invited 112 healthcare professionals (doctors and nurses) who attended the occupational health department of a tertiary hospital in March-July 2021. Emotional exhaustion, depersonalization and personal accomplishment were measured by the Maslach Burnout Inventory. Linear-regression analyses were conducted to explore relationships between burnout dimensions and sociodemographic variables. Differences between groups according to previous COVID-19 infection were verified using the t-test and when appropriate the Mann-Whitney test (for continuous variables), the chi-square test and when appropriate the Fisher exact test (for categorical variables). We surveyed 106 subjects (95% response rate). High emotional exhaustion and depersonalization were reported by 33.0 and 18.4% of participants, respectively; 21.4% reported low personal accomplishment. Job tenure was associated with depersonalization and personal accomplishment. For each 1-year increase in job tenure, depersonalization decreases 0.14 (95% CI [-0.23, -0.04]) and personal accomplishment increases 0.16 (95% CI [0.06, 0.25]). Gender was associated with emotional exhaustion (being male increases emotional exhaustion 5.62-fold [95% CI: 1.33; 9.92]). The prevalence of high emotional exhaustion, high depersonalization and low personal accomplishment after the second COVID-19 wave was relevant and should not be overlooked. Our findings suggest that job tenure may play a protective role in healthcare workers' burnout.

Workplace Violence in Healthcare: A Single-Center Study on Causes, Consequences and Prevention Strategies.

INTRODUCTION: Workplace violence is one of the main risk factors in the professional world. Healthcare workers are at higher risk when compared to other sectors. Our study aimed to characterize physical and verbal violence in a public hospital and to define occupational health prevention and surveillance strategies. MATERIAL AND METHODS: Single center observational cross-sectional study, carried amongst healthcare workers in a public hospital in Lisbon. A qualitative survey was carried out through six in-depth interviews. A quantitative survey was carried through questionnaires delivered to 32 workers. A significance level of 5% was accepted in the assessment of statistical differences. The Mann-Whitney test and the Fisher's exact test were used to calculate p values. RESULTS: The main results are: (1) 41 violence incidents were reported in the quantitative phase; (2) 5/21 [23.81%] victims notified the incident to the occupational health department; (3) 18/21 [85.71%] victims reported a permanent state of hypervigilance; (4) 22/28 [78.57%] participants self-reported poor or no familiarity with internal reporting procedures; (5) 24/28 [85.71%] participants believed it is possible to minimize workplace violence. DISCUSSION: Workplace violence is favored by unrestricted access to working areas, absence of security guards and police officers or scarce intervention. The low notification rate contributes to organizational lack of action. The state of hypervigilance reported in our study reflects the negative effects of threatening occupational stressors on mental health. CONCLUSION: Our results show that workplace violence is a relevant risk factor that significantly impacts workers' health in a noxious manner, deserving a tailored occupational health approach whose priority areas and strategies have been determined.

Introdução: A violência no local de trabalho é um dos principais fatores de risco no mundo do trabalho. Os trabalhadores da saúde apresentam um risco superior. O nosso estudo teve como objetivo caracterizar a violência física e verbal num hospital público e definir estratégias de prevenção e vigilância em saúde ocupacional. Material e Métodos: Estudo observacional transversal monocêntrico, conduzido num hospital público em Lisboa com trabalhadores da saúde. Foi realizado um inquérito qualitativo com entrevistas em profundidade a seis trabalhadores e um inquérito quantitativo com questionários a 32 trabalhadores. Aceitou-se um nível de significância de 5% na avaliação das diferenças estatísticas. O teste de Mann-Whitney e o teste exato de Fisher foram usados para calcular os valores de p. Resultados: Os principais resultados são: (1) 41 episódios reportados na fase quantitativa; (2) 5/21 [23,81%] vítimas notificaram o incidente; (3) 18/21 [85.71%] vítimas reportaram estados de hipervigilância permanente; (4) 22/28 [78,57%] participantes não conheciam ou conheciam mal os procedimentos de notificação; (5) 24/28 [85,71%] consideravam possível minimizar o problema. Discussão: A violência é favorecida pelo acesso livre às zonas de trabalho, ausência de agentes de segurança e polícia ou falta da respetiva intervenção. A baixa notificação contribui para a ausência de medidas organizacionais. O estado de hipervigilância relatado reflete o efeito prejudicial da exposição a fontes de stress e ameaça. Conclusão: A violência no local de trabalho é um fator de risco relevante, com impacto negativo na saúde dos trabalhadores e merece uma abordagem individualizada no âmbito da saúde ocupacional, cujas áreas e estratégias prioritárias foram definidas neste estudo.

Evidence Associated with the Use of Oxazolidinones for the Treatment of Skin and Skin Structure Infections: A Retrospective Study.

INTRODUCTION: Skin and skin structure infections are an increasing cause of hospitalization. Although mortality is relatively low, skin and skin structure infections are associated with prolonged hospital length of stay and high costs. Oxazolidinones have been suggested as a tool to treat infected patients in the ambulatory setting in order to decrease hospital length of stay. We wanted to address the evidence associated with the use of oxazolidinones in the treatment of skin and skin structure infections. MATERIAL AND METHODS: In this observational retrospective study we analyzed the anonymized diagnosis related group coded information from the Portuguese database for hospital admissions, that included all adult patients with a diagnosis of oxazolidinone use and a SSSI, discharged between 2010 and 2015. RESULTS: During the study period, a total of 5518 patients had a diagnosis of oxazolidinone treatment. We selected 483 of those who were also diagnosed with a skin and skin structure infections. Their mean age was 64.9 years and 62.7% were male. The median hospital length of stay was 27 days (Inter quartile range 13 - 56) and the mortality rate was 12.6%. The prevalence of secondary anemia and of thrombocytopenia in the whole group treated with oxazolidinones was 2.5% and 3%, respectively. DISCUSSION: Despite the high bioavailability of oxazolidinones, we were not able to find evidence that its use was associated with a decrease of mortality or hospital length of stay (due to early discharge) of patients with skin and skin structure infections. CONCLUSION: In this study we were not able to find evidence that oxazolidinones had any clinically significant benefit. A structured approach, including antibiotics with favorable pharmacokinetic and safety profile as well as a carefully planned ambulatory follow up may be needed.

Introdução: As infeções da pele e das estruturas da pele são uma causa crescente de hospitalização. Apesar da baixa mortalidade, as infeções da pele e das estruturas da pele estão associadas a internamentos prolongados e a custos elevados. O uso de oxazolidinonas foi proposto como estratégia para o tratamento ambulatório destes doentes como forma de reduzir a duração do internamento. Pretendeu-se avaliar a evidência associada ao uso de oxazolidinonas no tratamento de infeções da pele e das estruturas da pele. Material e Métodos: Neste estudo retrospectivo observacional analisámos a base de dados portuguesa anonimizada, codificada por grupos de diagnóstico homogéneos. Incluímos adultos com alta hospitalar entre 2010 a 2015 com diagnóstico de alta de utilização de oxazolidinonas. Nesse grupo selecionamos os que apresentavam diagnóstico concomitante de infeções da pele e das estruturas da pele. Resultados: Durante o período em estudo 5518 doentes receberam o diagnóstico de tratamento com oxazolidinona. Destes selecionámos 483 com diagnóstico concomitante de infeções da pele e das estruturas da pele. Destes, 62,7% eram homens e a idade média foi de 64,9 anos. A duração mediana do internamento hospitalar foi de 27 dias (intervalo interquartil 13 ­ 56) e a taxa de mortalidade foi 12,6%. A prevalência de anemia secundária, nos 5518 doentes tratados com oxazolidinonas, foi de 2,5% e a de trombocitopénia foi de 3%. Discussão: Apesar da elevada biodisponibilidade das oxazolidinonas, neste estudo não conseguimos identificar evidência que o seu uso estivesse associado a diminuição da mortalidade ou da demora média hospitalar (relacionado com alta precoce) dos doentes com infeções da pele e das estruturas da pele. Conclusão: Neste estudo não encontramos evidência de que a utilização de oxazolidinonas esteja associada a benefícios clínicos significativos. Estratégias integradas, incluindo antibióticos com bom perfil de segurança e de farmacocinética, bem como planeamento adequado para seguimento em ambulatório parecem ser necessários.