Impact of COVID-19 first wave on the mental health of healthcare workers in a Front-Line Spanish Tertiary Hospital: lessons learned.

Healthcare workers (HCWs) were at high risk of experiencing psychological distress during COVID-19 pandemic. The objective of this study was to evaluate the impact on HCWs' mental health in a Spanish hospital. Cross-sectional study of HCW, active between May and June 2020. A web-based survey assessed probable current mental disorders (major depressive disorder [PHQ-8 ≥ 10], generalized anxiety disorder [GAD-7 ≥ 10], panic attacks, post-traumatic stress disorder [PTSD; PLC-5 ≥ 7], or substance use disorder [CAGE-AID ≥ 2]). The Sheehan Disability Scale (SDS) was used to assess severe impairment and items taken from the modified self-report version of the Columbia Suicide Severity Rating Scale (C-SSRS) assessed suicidal thoughts and behaviors. A total of 870 HCWs completed the survey. Most frequent probable mental disorders were major depressive disorder (33.6%), generalized anxiety disorder (25.5%), panic attacks (26.9%), PTSD (27.2%), and substance use disorder (5.0%). Being female, having aged 18-29 years, being an auxiliary nurse, direct exposure to COVID-19-infected patients, and pre-pandemic lifetime mental disorders were positively associated with mental issues. Hospital HCWs presented a high prevalence of symptoms of mental disorders, especially depression, PTSD, panic attacks, and anxiety. Younger individuals and those with lifetime mental disorders have been more vulnerable to experiencing them.

Vaccination adjuvated against hepatitis B in Spanish National Healthcare System (SNS) workers typed as non-responders to conventional vaccines.

TRIAL DESIGN: An interventional, phase 4, single group assignment, without masking (open label), preventive clinical trial was carried out in health workers with biological risk in their tasks, who have been filed as non-responders to conventional vaccination against Hepatitis B. METHODS: 67 health workers with biological risk in their tasks, who have been filed as non-responders to conventional vaccination against Hepatitis B, were enrolled in the Clinical Trial. All participants were from 18 years up to 64 years old. INCLUSION CRITERIA: NHS workers -including university students doing their internships in health centres dependent on the National Health System (inclusion of students is regulated and limited by specific instructions on labour prevention in each autonomous community)- classified as non-responders. The criteria defining them as non-responders to the conventional hepatitis B vaccine is anti HBsAb titers < 10 mUI/ml following the application of six doses of conventional vaccine at 20 µg doses (two complete guidelines). The objective of this study was to provide Health workers-staff with an additional protection tool against hepatitis B infection, and to evaluate the efficacy of the adjuvanted vaccine in healthy non-responders to conventional hepatitis B vaccine. The primary outcome was the measurement of antibody antiHBs before the first Fendrix® dose and a month after the administration of each dose. Other outcome was collection of adverse effects during administration and all those that could be related to the vaccine and that occur within 30 days after each dose. In this study, only one group was assigned. There was no randomization or masking. RESULTS: The participants were recruited between April 13, 2018 and October 31, 2019. 67 participants were enrolled in the Clinical Trial and included the analyses. The primary immunisation consists of 4 separate 0.5 ml doses of Fendrix®, administered at the following schedule: 1 month, 2 months and 6 months from the date of the first dose. Once the positivity was reached in any of the doses, the participant finished the study and was not given the following doses. 68.66% (46 out 67) had a positive response to first dose of Fendrix®. 57.14% (12 out 21) had a positive response to second dose of Fendrix®. 22.22% (2 out 9) had a positive response to third dose of Fendrix and 42.96% (3 out 7) had a positive response to last dose of Fendrix®. Overall, 94.02% (64 out 67) of participants had a positive response to Fendrix®. No serious adverse event occurred. CONCLUSIONS: The use of Fendrix®, is a viable vaccine alternative for NHS workers classified as "non-responders". Revaccination of healthy non-responders with Fendrix®, resulted in very high proportions of responders without adverse events. TRIAL REGISTRATION: The trial was registered in the Spanish National Trial Register (REEC), ClinicalTrials.gov and inclusion has been stopped (identifier NCT03410953; EudraCT-number 2016-004991-23). FUNDING: GRS 1360/A/16: Call for aid for the financing of research projects in biomedicine, health management and socio-health care to be developed in the centres of the Regional Health Management of Autonomous Community of Castile-Leon. In addition, this work has been supported by the Spanish Platform for Clinical Research and Clinical Trials, SCReN (Spanish Clinical Research Network), funded by the Subdirectorate General for Research Evaluation and Promotion of the Carlos III Health Institute (ISCIII), through the project PT13/0002/0039 and project PT17/0017/0023 integrated in the State Plan for R&D&I 2013-2016 and co-financed by and the European Regional Development Fund (ERDF).

Evaluar la implantación de campañas y consultas antitabaco en un hospital de tercer nivel / Evaluate the implantation of campaigns and anti-smoking consultations in a hospital of the third level

Programas de deshabituación tabáquica en el lugar del trabajo son una herramienta útil en la lucha contra el tabaquismo. Objetivo: evaluar la implantación de campañas y consultas antitabaco en trabajadores de un hospital de III nivel. Metodología: se diseñó un programa con dos fases. La primera consistió́ en la realización de campañas informativas. La segunda en un programa de tratamiento especializado, durante 1 año, según los perfiles y necesidades de cada trabajador. El análisis se realizó mediante porcentajes, frecuencias y prueba 2. Resultados: asistieron 66 trabajadores, 33 participaron en las consultas. La edad media fue de 49,75 ± 8,5 años, 47 (71.2%) mujeres y 19 (28,8%) hombres. El grado de dependencia fue moderado-alto, con una media de 5,24 ± 1,85 puntos y una motivación alta del 54%, con una media de 6,7 ± 1,64. El cumplimiento del tratamiento fue del 87.8%, con un índice de abstinencia del 48,48% al año. Conclusiones: los resultados indican que este tipo de programa en el entorno laboral puede contribuir a reducir el tabaquismo

Programs of smoking cessation in the workplace are a useful tool in the fight against smoking. Objective: to evaluate the implementation of campaigns and anti-smoking consultations in workers of a hospital of III level. Methodology: a program with two phases was designed. The first consisted of conducting information campaigns. The second in a specialized treatment program, for 1 year, according to the profiles and needs of each worker. The analysis was performed using percentages frequencies and χ2 test. Results: 66 workers attended, 33 participated in the consultations. The mean age was 49.75 ± 8.5 years, 47 (71.2%) women and 19 (28.8%) men. The degree of dependence was moderate-high, with an average of 5.24 ± 1.85 points and a high motivation of 54%, with a mean of 6.7 ± 1.64. Compliance with treatment was 87.8%, with an abstinence rate of 48.48% per year. Conclusions: the results indicate that this type of program in the workplace can contribute to reducing smoking

Anorexia nerviosa en una trabajadora / Anorexia nervosa in a worker: a case report

Se describe la gestión de un caso de anorexia nerviosa (índice de masa corporal IMC 13,6 kg/m2) en una cajera de una oficina bancaria. El caso se detectó durante un reconocimiento rutinario de vigilancia de la salud. Tras ser valorada por distintos especialistas (medicina de familia, psiquiatría y endocrinología) y de un estrecho seguimiento (por psicología, enfermería y medicina del trabajo) recupera peso hasta casi la normalidad (IMC 17 kg/m2) en menos de año y medio. Los trastornos de la conducta alimentaria son considerados patología común (no laboral), pero su alta prevalencia (5% de la población a lo largo de la vida) y su repercusión laboral y social (afectando a más del 20% de los casos), los convierten en foco potencial de atención desde la promoción de la salud en el trabajo. La prevención, promoción y vigilancia de la salud de la población pueden ser reforzadas desde la empresa

We describe the management of a case of anorexia nervosa (body mass index, -BMI-, 13,6 Kg/m2) in a bank teller. The case was detected through routine occupational health surveillance. After being evaluated by different specialists (general practitioner, psychiatrist and endocrinologist) and being closely monitored (by psychology, nursing, and occupational medicine), the worker regained weight to a near normal BMI (17 Kg/m2) in less than a year and a half. Eating disorders area common pathology (non-occupationally related), but their high prevalence (5% of the population over a lifetime) and social and job-related impact (affecting more than 20% of cases), make them a necessary focus of attention for health promotion in the workplace. Health prevention, promotion and surveillance may be also reinforced at the workplace

[Anorexia nervosa in a worker: a case report]. / Anorexia nerviosa en una trabajadora.

We describe the management of a case of anorexia nervosa (body mass index, -BMI-, 13,6 Kg/m2) in a bank teller. The case was detected through routine occupational health surveillance. After being evaluated by different specialists (general practitioner, psychiatrist and endocrinologist) and being closely monitored (by psychology, nursing, and occupational medicine), the worker regained weight to a near normal BMI (17 Kg/m2) in less than a year and a half. Eating disorders are a common pathology (non-occupationally related), but their high prevalence (5% of the population over a lifetime) and social and job-related impact (affecting more than 20% of cases), make them a necessary focus of attention for health promotion in the workplace. Health prevention, promotion and surveillance may be also reinforced at the workplace.

Se describe la gestión de un caso de anorexia nerviosa (índice de masa corporal IMC 13,6 kg/m2) en una cajera de una oficina bancaria. El caso se detectó durante un reconocimiento rutinario de vigilancia de la salud. Tras ser valorada por distintos especialistas (medicina de familia, psiquiatría y endocrinología) y de un estrecho seguimiento (por psicología, enfermería y medicina del trabajo) recupera peso hasta casi la normalidad (IMC 17 kg/m2) en menos de año y medio. Los trastornos de la conducta alimentaria son considerados patología común (no laboral), pero su alta prevalencia (5% de la población a lo largo de la vida) y su repercusión laboral y social (afectando a más del 20% de los casos), los convierten en foco potencial de atención desde la promoción de la salud en el trabajo. La prevención, promoción y vigilancia de la salud de la población pueden ser reforzadas desde la empresa.

Recomendaciones en la profilaxis postexposición(PPE) a VIH con agentes antirretrovirales en trabajadores sanitarios / Recommendations on hiv post-exposure prophylaxis with antirretroviral agents in health care workers

El control de la enfermedad con el tratamiento antirretroviral ha hecho que hayan aumentado las personas con el VIH que viven en el mundo. Este aumento de la prevalencia de seropositivos a VIH hace que se incremente la frecuencia de la exposición en los profesionales sanitarios a pacientes VIH+, y probablemente también las exposiciones de riesgo, por lo que los médicos del trabajo debemos seguir en guardia sobre la protección de los profesionales sanitarios en este sentido. Aunque no existan estudios que demuestren que la profilaxis postexposición (PPE) con 3 o 4 fármacos sea mejor que con 2, prevalece la opción de indicar triple terapia en base a la eficacia demostrada en la reducción de la carga viral en personas infectadas con VIH, siempre que la PPE esté indicada. Por tanto, ya no se estratifica el tratamiento en PPE básica y PPE ampliada para las exposiciones de mayor riesgo biológico a VIH, sino que se establece que la PPE, cuando está indicada, debe considerar la conjunción de 3 o 4 agentes antirretrovirales. Cuando esté indicada, la PPE debe establecerse en las primeras horas (según las diferentes guías entre 1 y 6 horas). El tiempo en el que deja de ser efectiva la PPE, tampoco está cuantificado en humanos, y dependiendo de las guías y opiniones de expertos varía entre 36 y 72 horas. Las combinaciones recomendadas en Europa son TDF/ FTC 300/200 (1/24 h), junto con lopinavir (LPV) potenciado con ritonavir (RTV) LPV/r 200/50 (2/12 h) (AU)

The control of the disease with the antirretroviral therapy has caused that has increased the people who live in the world with HIV. This increase of the prevalence of seropositive in HIV, causes that it probably also increases to the frequency of the exhibition in the health care workers to patients HIV+ and the exhibitions of risk, reason why the occupational physicians should remain vigilant about the protection of health professionals in this regard. Although there are no studies showing thatpost-exposure prophylaxis (PEP) with 3 o 4 drugs is better than 2, prevails the option to indicate triple therapy based on the demonstrated efficacy in reducing viral load in HIV-infected patients, whenever the PPE is indicated. Therefore, it is not longer recommends treatment stratification in basic prophylaxis for a low risk exposures and extended prophylaxis for a greater biological risk exposures to HIV. When PEP is indicated, it should consider the combination of 3 or 4 antiretroviral agents. When it is indicated, the PPE should be established in the early hours, according to the different guides between 1 - 6 hours. The time it ceases to be effective the PPE, is not quantified in humans and depending on the guidelines and expert opinion varies between 36 and 72 hours.Combinations recommended in Europe are TDF/ FTC 300/200 (1/24h) with Lopinavir (LPV) boosted with ritonavir (RTV) LPV/r 200/50 (2/12 h) (AU)