Mental health of Spanish nurses working during the COVID-19 pandemic: A cross-sectional study.

AIM: To explore the impact of the COVID-19 pandemic on the mental health of nurses working in primary, secondary, and tertiary healthcare centers in Navarre (Spain). BACKGROUND: Healthcare workers, especially nurses, are at high risk for developing mental health problems during the COVID-19 pandemic. INTRODUCTION: Spain ranks among the European countries with the highest incidence of and mortality from COVID-19 and has a 31% deficit in the number of nurses compared with the average for the European Union. METHODS: This was a cross-sectional study involving 800 Registered Nurses in Navarre, Spain. Four standardized instruments, along with a self-administered online questionnaire, were used to measure the impact in terms of depression, anxiety, insomnia, and posttraumatic stress disorder. The STROBE checklist for cross-sectional studies was used to report this study. RESULTS: Of the 800 nurses, 68% had some level of depression, anxiety, insomnia, and distress, and of these, 38% had moderate or severe symptoms. Those who worked in hospital COVID units and in nursing homes showed a higher impact on their mental health. DISCUSSION: The sustained pressure that nurses have experienced in their work during the COVID-19 pandemic has negatively affected their mental health. CONCLUSION: This study found that nurses who worked in hospital COVID units and in nursing homes during the pandemic had worse mental health outcomes. IMPLICATIONS FOR NURSING/POLICY: Recommendations for nursing policy include the need to implement coaching and emotional programs to support nurses on the frontlines of the pandemic. There is also an urgent need for the implementation of national training programs to strengthen health emergency preparedness, improve response capacity, and increase the resilience of nurses to disasters.

Conhecimento e atitude sobre a diatebes tipo 2 em idosos: estudo de base populacional / Knowledge and attitude towards type 2 diabetes among older adults: a population-based study

Resumo Esta pesquisa teve por objetivo verificar os fatores associados entre o conhecimento e a atitude sobre diabetes mellitus tipo 2 em idosos com a doença. Realizou-se um estudo transversal de base populacional com 204 idosos da rede pública de saúde de Passo Fundo, RS. Para a coleta de dados utilizou-se os questionários: sociodemográfico, de conhecimento DKN-A, de atitudes psicológicas do diabetes ATT-19 e o IPAQ para atividade física. Foi utilizada a regressão logística para as variáveis sociodemográficas, de saúde e os indicadores de adiposidade corporal. Foram realizadas análises brutas e ajustadas com um intervalo de confiança de 95%. Os resultados deste estudo identificaram que o bom conhecimento está associado com a idade maior ou igual 70 anos (OR = 0,44; IC95%: 0,18-1,08), ter atitude positiva para o tratamento da diabetes (OR = 10,4 IC95%: 4,20-18,70) e ser ativo fisicamente (OR = 12,7; IC95%: 6,8-30,10). Na associação com a atitude positiva se manteve associada significativamente a idade maior ou igual 70 anos (OR = 0,35; IC95%: 0,15-0,78), ter um bom conhecimento da diabetes (OR = 8,9; IC95%: 4,30-18,9) e ser ativo fisicamente (OR = 10,1; IC95%: 6,34-20,1). Portanto, o bom conhecimento e a atitude positiva estão associados à idade de 70 anos a mais e ser ativo fisicamente.

Abstract The aim of this study was to identify the factors associated with knowledge and attitude towards type 2 diabetes mellitus among older adults with the disease. A cross-sectional population-based study was conducted on 204 older adults from the public healthcare network of Passo Fundo, RS. Sociodemographic data were collected and the DKN-A, ATT-19 and IPAQ were used for the assessment of diabetes knowledge, psychological attitudes towards diabetes and physical activity, respectively. Logistic regression was applied to evaluate the association with sociodemographic and health variables and indicators of body adiposity. Crude and adjusted analyses were performed with a 95% confidence interval. The results showed that good knowledge is associated with age ≥ 70 years (OR = 0.44; 95%CI: 0.18-1.08), having a positive attitude towards diabetes treatment (OR = 8.9; 95%CI: 4.3-18.9), and being physically active (OR = 10.1; 95%CI: 6.34-20.1). In conclusion, good knowledge and a positive attitude towards diabetes are associated with age older than 70 years and being physically active.

Mind the GAP! Pathological gambling, a modern defy to public health.

Due to its clinical aspects, pathological gambling is of paramount interest for Psychology and Psychiatry; however, it also has such characteristics that call for the interest and the intervention of Public Health, both at national and international level. This pathology is a growing problem in our society, particularly in some groups of vulnerable people; has a strong psycho-social impact on the individuals, their families, their social environment and the society as a whole; requires an organized, competent, structured and integrated intervention of the Public Health care services and of specialized private organizations; and, finally, it represents important economic implications. As far as the Italian situation is concerned, it is estimated that up to 50% of the population has experienced gambling at least once; consequently, the political world has taken interest in the problem, producing in 2016 a governmental Report on Pathological Gambling to the Parliament; moreover, pathological gambling has been included into the 2017 revision of the Essential Levels of Health Care Regulations, whose validity is nationwide, provided that, usually, the Regions legislate autonomously on health assistance aspects. Recently, the Observatory on Contrast to Pathological Gambling and to Serious Gambling Addiction has published specific ad hoc guidelines and the Italian Parliament approved a law forbidding every form of gambling advertising (Law No. 96/2018). However, even considering the interest of the National Health Service in contrasting pathological gambling, the problem is far from its solution; firstly, because the State itself earns a considerable amount of money from the taxation of "legal" gambling, thus creating a resounding conflict of interest; secondly, because the peripheral branches of the National Health Service have responded unevenly so far when trying to organize the contrast. What is needed for the future is an effort of coordination between the National Health Service - at State, Region and local level - and the Non-Governmental Organizations, in order to face the cultural, political, communicational, organizational, technological and public health aspects of such a contrast, balancing incentives and disincentives wisely.

Public health investments and mortality risk in Brazilian peritoneal dialysis patients.

BACKGROUND: End-stage kidney disease (ESKD) treatment is very costly and accounts for a significant percentage of public healthcare expenditures. Beyond direct costs, dialysis patients use other healthcare levels, but the impact of public investment on each of these levels is unclear. This study aimed to investigate the association between direct financing at different healthcare levels and overall mortality in peritoneal dialysis (PD) patients. METHODS: We included all adult incident PD patients from a Brazilian prospective, nationwide PD cohort. Overall mortality was the primary outcome of interest. We used a three-level multilevel survival analysis to investigate whether mortality was associated with the investments destined to different levels of healthcare complexity: (i) primary, (ii) medium and high and (iii) professional healthcare training and community awareness. RESULTS: We evaluated 5707 incident PD patients from 78 Brazilian cities, which were divided into four quartiles for each healthcare level (Groups I-IV). After taking the highest quartile (Group IV) as a reference, investment in the primary health level was not associated with patient survival. Otherwise, medium and high complexity levels were associated with higher mortality risk. Also, investment in healthcare manager training and community awareness had an impact on patient survival. CONCLUSIONS: Investments in different levels of the healthcare system have distinct impacts on PD patient survival. Investment in healthcare manager training and community awareness seems to be a promising strategy on which to focus, given the relatively low cost and positive impact on outcome.

Impact of an integral assistance model between primary care and cardiology on the management of patients with ischemic heart disease or atrial fibrillation.

AIM: To analyze the impact of implementing a program integrating cardiology and primary care in clinical practice. METHODS: In the integrated care model, every cardiologist was assigned to each primary care center. RESULTS & CONCLUSION: The implementation of the new care model was associated with a significant reduction of 31.2% in requests of first visits. In addition, the delay to the cardiologist consultation significantly decreased by 54.5% for the first visits, and by 57.1% for the follow-up visits. The proportion of patients that achieved recommended low density lipoprotein-cholesterol goals significantly increased from 20.8 to 29.6%. The proportion of patients submitted to anticoagulant therapy significantly increased from 69.3 to 74.2%, as well as the proportion of patients taking direct oral anticoagulants (from 7.9 to 28.4%).

Continuity of care after percutaneous coronary intervention: The patient's perspective across secondary and primary care settings.

BACKGROUND: Although patients may experience a quick recovery followed by rapid discharge after percutaneous coronary interventions (PCIs), continuity of care from hospital to home can be particularly challenging. Despite this fact, little is known about the experiences of care across the interface between secondary and primary healthcare systems in patients undergoing PCI. AIM: To explore how patients undergoing PCI experience continuity of care between secondary and primary care settings after early discharge. METHODS: The study used an inductive exploratory design by performing in-depth interviews of 22 patients at 6-8 weeks after PCI. Nine were women and 13 were men; 13 were older than 67 years of age. Eight lived remotely from the PCI centre. Patients were purposively recruited from the Norwegian Registry for Invasive Cardiology. Interviews were analysed by qualitative content analysis. FINDINGS: Patients undergoing PCI were satisfied with the technical treatment. However, patients experienced an unplanned patient journey across care boundaries. They were not receiving adequate instruction and information on how to integrate health information. Patients also needed help to facilitate connections to community-based resources and to schedule clear follow-up appointments. CONCLUSIONS AND IMPLICATIONS: As high-technology treatment dramatically expands, healthcare organisations need to be concerned about all dimensions of continuity. Patients are witnessing their own processes of healthcare delivery and therefore their voices should be taken into greater account when discussing continuity of care. Nurse-led initiatives to improve continuity of care involve a range of interventions at different levels of the healthcare system.