Psychological impact of quarantine on healthcare workers.

OBJECTIVES: Exposure to infection is an inherent occupational risk for healthcare workers and may lead them to undergo quarantine during disease outbreaks. Both front-line battle and quarantine are stressful experiences that may make psychological support for healthcare workers necessary. Psychological support measures based on the best available evidence should be included in emergency plans worldwide. We summarise the research evidence on the psychological impact of quarantine on healthcare workers. METHODS: We retrieved 470 articles on the psychological impact of quarantine on healthcare workers from the Web of Science and included in this review all 12 articles that met our inclusion criteria. RESULTS: The reviewed studies reported acute stress during quarantine and long-lasting depressive, post-traumatic stress and alcohol dependency and abuse symptoms. Healthcare workers fear infection for themselves, but more so for their loved ones, and are also concerned about the stigma that may affect their families, most especially their children. CONCLUSIONS: The safety of healthcare workers and their families during disease outbreaks needs to be ensured. Suitable alternative accommodation and personalised monitoring during quarantine are useful intervention measures to prevent adverse effects in healthcare workers. Clear public health communication will help reduce uncertainty, guilt and stigma. Financial aid should be considered for the more severely affected workers. Finally, mental healthcare for healthcare workers should be a priority, as quarantines can be a mental distress trigger. The development of efficient referral paths and the provision of counselling or psychotherapy during the confinement period are an opportunity for early mental health interventions.

Paediatricians' Practice About SUDDEN Infant Death Syndrome in Catalonia, Spain.

Background SIDS is the major cause of death among healthy born infants in developed countries. Its causes are still unclear, but its risk can be reduced by implementing some simple active interventions. In Spain, limited attention was given to SIDS by the national healthcare system, and actual data on healthcare professionals' practice on this topic was not available. This study explored for the first time paediatricians' knowledge and practice about SIDS. Methods A cross-sectional survey was carried out between November 2012 and April 2013 in Catalonia, and reached 1202 paediatricians. The response rate was 46%. Results 94% of respondents perceived themselves as qualified for giving advice and recommendations about SIDS to parents, but only 58% recognized the supine position as the safest position and recommended the supine position exclusively to parents. Seniority and 'having received a specific training about SIDS' were detrimental to paediatricians' knowledge. Discussion Efforts should be made in order to improve paediatricians' knowledge and practice about SIDS. Specific refresher trainings are highly recommended, and should especially target paediatricians with higher seniority. These trainings could be provided as optional modules, as we could see that the paediatricians who would most benefit from them are already aware of the need to refresh their knowledge.

Medical Professional Liability in Psychiatry.

INTRODUCTION: The safety of patients and the risk of malpractice claims are overriding concerns in medicine and psychiatry. MATERIAL AND METHODS: Claims for alleged malpractice in psychiatry managed by the Council of Colleges of Physicians of Catalonia between 1986 and 2009 were analyzed to evaluate their clinical and legal characteristics. RESULTS: Ninety-four malpractice claims were found in a 23-year period, mainly claims related to diagnosis (63.83%, including assessment of suicide risk) and the legal figure of serious professional negligence resulting in death (46.8%). Most claims were for hospital (62.77%), emergency (52.5%), and team (53.75%) care. The possible affected party was male (51.58%) with a mean age of 36.6 years. In one-half of the cases, the harm claimed was death. The cases involved 139 specialists, predominantly male (69.57%), with a mean age of 41 years, and of Spanish nationality (91.4%). The time between the medical act and the respective claim was 1.28 years and the time to resolution was 2.68 years. Most of the cases (77.66%) were processed through the courts. The outcome of the cases was filing or dismissal in 91 (95.77%), conviction in 2 (2.81%), and settlement in 1 (1.41%). CONCLUSIONS: The cumulative incidence of 0.013 claims (1.35%) in 23 years suggests that there is a very low risk of lawsuits in psychiatry, with a similarly low rate of sentences of professional liability and awards for financial compensation. Specific actions could improve clinical safety, particularly in suicide risk assessment.

Professional liability claims in vascular surgery practice.

BACKGROUND: Patient safety is a major concern worldwide, but particularly high rates of adverse events are reported in the surgery setting. Angiology and vascular surgery is of special interest due to the complexity of the pathologies involved and the esthetic component of some of its procedures. In this study we identified the most frequent factors that apply to vascular surgery claims to determine areas of special risk in vascular surgery, with an aim to improve patient safety. METHODS: We performed a retrospective and descriptive study of the claims pertaining to vascular surgery from the database of the Service of Professional Liability (SRP) of the Official College of Physicians of Barcelona. The time frame of data collection was from 1986 to 2009. We analyzed both the clinical and legal characteristics of the cases. RESULTS: Of the total of 6952 registered claims during the 23-year period, 91 (1.3%) were related to the practice of vascular surgery. Of these, 53.8% were related to venous pathology and 46.1% to arterial pathology. Neurologic damage was the main motive for claims (15.3%), followed by thromboembolic disease (14.2%), burns as a result of cosmetic treatment (12%), and amputation (10.9%). The neurologic damage in relation to vein pathology registered the greatest proportion of cases with professional liability (30.8%), followed by burns (19.2%), forgotten gauze (11.5%), and amputations (11.5%). CONCLUSIONS: Angiology and vascular surgery does not seem to be a specialty with a high risk for claims, but complications, such as thromboembolic disease and neurologic damage after varicose vein intervention, do occur and deserve special attention so improvements can be made to patient safety.

Nonconsensual Condom-Use Deception: An Empirically Based Conceptualization of Stealthing.

In recent years, the act of stealthing, also termed nonconsensual condom removal (NCCR), has become an emerging important topic related to nonconsensual sexual experiences. We performed a rapid review by searches in Web of Science (245 articles), Medline (157 articles), and PsycINFO (72 articles). The studies, in English, French, Italian, or Spanish, that reported empirical data on stealthing were included, except for those focusing on the legal response to the phenomenon. The final sample of 16 articles of various design is analyzed. According to this review, more than 10% of women experience stealthing in their lifetime, and men having sex with men also experience stealthing. The article describes the empirical research literature in the field, explores terminological and conceptual challenges, and proposes a new and more comprehensive term (nonconsensual condom-use deception), and a revised definition and categorization of the behavior, according to the concrete manifestation of consent breach, the associated practices, or the underlying motivation. We argue that research, as well as policy and practice responses to this growing problem need to be guided by a conceptual framework that uses information gathered directly from those who experienced it.

Physical restraints in nursing homes: A qualitative study with multiple stakeholders.

AIM: This study aims to understand the perceptions regarding physical restraints of the elder-care professional's stakeholders. DESIGN: A qualitative methodology was employed. METHODS: Semi-structured interviews were conducted with a convenient sample of 19 participants, which included nursing homes' managers, nurses and physicians; law, ethics, quality or patient rights' protection experts in care and public servers with responsibilities in the field. The data were collected, recorded and verbatim transcribed. A thematic analysis approach was used to analyse the data. RESULTS: Three main themes emerged: the use of restraints, organizational issues and regulation. Although professionals involved in nursing care agree that improvements have been made, they highlight the negative impact of restraints and the need for a change in culture about their use. Yet, they have concerns about the 'zero restraints' feasibility, with divergent views on the need for a stronger regulatory framework.

Measles, mumps, and rubella vaccination coverage: an ecological study of primary health care and socio-economic factors in Catalonia, Spain.

This study examined the association of socio-economic factors and the structure of primary care centres (PCCs) with measles, mumps, and rubella (MMR) vaccination coverage among the 8-year-old population in Catalonia, Spain. We conducted an ecological study to retrospectively assess the MMR vaccination-recorded status of children born in 2012, using public health data extracted in December 2020. For each of 300 PCCs serving 70,498 children, we calculated vaccination coverage rates from electronic health records and linked these rates to a composite deprivation index corresponding to the territory served by each PCC. We identified a relationship between unfavourable socio-economic factors and higher recorded vaccination coverage. On average, directly managed PCCs had higher vaccination coverage rates than indirectly managed PCCs. Greater utilisation of primary care services by the population was also associated with higher vaccination coverage rates. Further research is needed to generate knowledge valuable for informing more equitable child-vaccination service delivery models.

Training in forensic psychiatry when no nationally recognised scheme exists.

BACKGROUND: In some European countries, forensic psychiatric training is formalised within a psychiatric framework. In others, the approach is radically different, but the end result may be a practitioner who is qualified to practise forensic psychiatry in all European jusrisdictions. AIM: The aim of this study is to describe the context of training to work with offender-patients in Spain. INFORMATION AND DISCUSSION: There is no nationally recognised training scheme in forensic psychiatry in Spain but rather a dichotomy between legal doctors, trained to assess offenders and provide reports for the courts but not necessarily in psychiatry, and psychiatrists, trained in clinical management and treatment but not necessarily in relation to offender patients. This dichotomy arose as training pathways diverged historically, legal medicine being the older discipline. In this system, the courts are always assured of an independent medical opinion, although treating psychiatrists would generally advise on release decisions. Almost all offender-patient treatment is in prisons. The system is heavily dependent on the goodwill and drive of practitioners who seek to provide themselves with dual skills in the absence of national guidance and support for such training.

Clinical and epidemiological aspects of suicide in patients with schizophrenia.

Suicide is a major cause of death among patients with schizophrenia. Suicide phenomenon's characterization is the best available approach for improved prediction and prevention of suicide. Patients at high risk for suicide need a more intensive monitoring and intervention. The aim of this review is to characterize, from a clinical-epidemiological point of view, the phenomenon of completed suicide in schizophrenia. We performed a systematic review to identify the most relevant studies published between 1994 and 2009, by searching on the international database Medline and among previous reviews references. Patients with schizophrenia experience higher mortality rates than the general population, especially due to the suicide. Most patients with schizophrenia who commit suicide are likely to be young and males, with a higher risk around illness onset and hospitalization periods. Previous suicide attempts are an important risk factor for completed suicide. Suicide risk is associated to psychotic positive symptoms, affective symptoms, depression and substance abuse. Treatment adherence is as protective factor. Patients with schizophrenia are likely to commit suicide by violent means. Suicide prevention should focus on treating affective symptoms and syndromes, improving treatment compliance and providing intensive monitoring to those patients at high risk of suicide, specially around hospitalization periods. Further studies are needed to clarify differential characteristics between suicide behaviour and completed suicide.

On-call-related sleep deprivation and hypomania in healthcare workers.

OBJECTIVE: Acute sleep deprivation can induce antidepressant effects. We hypothesized that overnight calls can trigger symptoms of hypomania during the post-on-call period. METHODS: Online anonymous cross-sectional survey among Spanish-speaking healthcare professionals, including the Hypomania Symptom Checklist-32 (HCL-32). RESULTS: 2099 respondents. Most of them reported that they usually feel worse on their post-on-call period (91,3%), but the 51,6% acknowledged having felt better at least once and 33,4% reported it happened in at least at 50% of their calls. Up to 4,9% reached the cut-off at HCL-32. Males, younger professionals, those with less years of practice and residents were more likely to full fit hypomania criteria. Participants and their environment correctly identified the symptoms and their negative consequences. CONCLUSIONS: On-calls with sleep deprivation may trigger hypomanic symptoms with reported negative consequences among healthcare professionals, showing how working conditions' impact in professionals' wellbeing and raising concerns about decision-making performance after long-lasting working shifts.

Psychopathological aspects of sexting and IBSA perpetrators: A brief research report.

Introduction: IBSA has been defined as taking, distributing, and/or making threats to distribute, a sexual image without a person's consent, and up to date there is still limited research on IBSA perpetration and characteristics of IBSA perpetrators. Thus, the aim of this study was to identify characteristics of IBSA perpetrators, in order to guide future intervention and prevention programs. Methods: An online survey was conducted regarding IBSA related behaviors and psychopathology. The original sample comprised 1,370 Spanish college students (74% females). Results: The IBSA perpetrator subsample comprised 284 participants (49.5% females). Our findings indicate that perpetrators are more commonly males, with higher psychopathology scores, especially in hostility scales, with previous IBSA victimization experiences, and who usually target friends, to have fun or as a joke, or partners, to flirt. Furthermore, when examining intragroup differences regarding perpetration level of severity, results showed that those who reported engaging in the most severe forms of IBSA reported higher rates of psychopathology and hostility. Yet, to intervene in those who present more severe behaviors, we must also pay attention to depression, somatization and sleep disturbances. Conclusions: IBSA perpetrators share key factors that could be targeted in forensic and clinical interventions, and that should be taken into account when designing effective offender intervention programs. Intervention programs should focus on anger-management issues that help reduce perpetrators' hostility and anxiety symptoms, and should also be aimed at modifying attitudes that justify perpetration behaviors and contribute to harmful interactions with their friends or to intimate partner violent dynamics.

The Impact of Malpractice Claims on Physicians' Well-Being and Practice.

OBJECTIVES: Malpractice litigation causes extreme stress. We examine the psychological impact of malpractice claims on physicians' well-being and the consequences on patient care. METHODS: A confidential telephone survey, administered to physicians with both open and closed claims from the previous year, explored symptoms, well-being changes, needs, impairments, and practice changes. RESULTS: Of the 282 respondents, more than half (56.38%) reported a notable psychological reaction to the malpractice claim, with no differences between the open and closed claims (P = 0.2477) or between closed claims with and without a payout (P = 1). Physicians facing criminal proceedings were more likely to experience a notable psychological impact (P = 0.0206). Almost half of the respondents (45.39%) acknowledged practice changes: viewing patients as potential plaintiffs (45.39%), paying more attention to recordkeeping (42.19%), obtaining medicolegal training (37.94%), ordering more tests (36.17%), and avoiding specific kinds of patients (21.63%) or procedures (19.85%). Acknowledging a psychological impact was positively and significantly associated with professional practice changes (P < 0.0001), and the mean number of symptoms was significantly higher among those who acknowledged practice changes (P = 0.0001). CONCLUSIONS: Our results confirm the psychological impact of a malpractice claim and that impacted physicians are more likely to change their care practices, involving defensive medicine practices. Therefore, care for physicians facing malpractice claims needs to be considered under the umbrella of health care quality. Timely mental health referral paths could help mitigate the psychological impact and avoid the pernicious effects of negative practice changes.

COVID-19 Pandemic Psychological Impact and Volunteering Experience Perceptions of Medical Students after 2 Years.

Undergraduate healthcare students were mobilized to support healthcare systems during the COVID-19 pandemic, but we have scarce information regarding their experience and its impact on their wellbeing. An anonymous online survey was conducted among undergraduate students and recently graduated physicians of a medical university in Spain, regarding their symptoms and volunteering experience during the initial months of the Spanish COVID-19 pandemic. Respondents showed a high prevalence of perceived stress, anxiety, and depressive symptoms, measured by the PHQ-9 and GAD-7. 14.5% reported healthcare-related volunteering tasks. Volunteering was a satisfactory experience for most of the respondents and the majority felt ready to do volunteering tasks (66.6%). Yet, 16.6% acknowledged not getting appropriate specific-task education before starting, 20.8% reported not having appropriate supervision, and 33.3% feel they did not have proper protective equipment. More than half of volunteers feared getting infected, more than 70% feared infecting their relatives or friends, and 54.2% reported stigmatization. Volunteers showed significantly higher stress, anxiety, and depression scores than the rest of the respondents, and 32% reported a highly traumatic event during volunteering, with high scores on the IES-R in the 16% of volunteers. Our results should help guide future potential volunteering processes in emergencies, enhance academic programs at medical schools and provide valuable data for psychological support services.

Help Seeking of Highly Specialized Mental Health Treatment before and during the COVID-19 Pandemic among Health Professionals.

(1) Background: Ongoing specialized programs for health professionals (HPs) adapted their treatment services during the COVID-19 pandemic. (2) Methods: We conducted a retrospective observational study of medical e-records of HPs with mental disorders working in Catalonia that were consecutively admitted to the Galatea Care Program Clinical Unit. The sample (N = 1461) was divided into two periods: 21.5 months before (n = 637) and after (n = 824) 14 March 2020. (3) Results: There was a significant increase (29.4%) in the number of referrals to the specialized Clinical Unit during the pandemic, especially with respect to physicians compared to nurses. The percentage of HP women at admission and the clinical severity of the first treatment episode remained without changes before and after the COVID-19 pandemic. The most prevalent main diagnoses also remained similar: adjustment disorders (41.5%), mood disorders (24.9%), anxiety disorders (14.4%), and substance use disorders (11.8%). (4) Conclusions: HPs, particularly physicians, more frequently sought voluntary help from specialized mental health programs during the COVID-19 pandemic. Future studies are needed to analyze the reasons behind this finding and the evolution of referrals to these types of programs after the COVID-19 outbreak.

Victimization as a Result of Non-Consensual Dissemination of Sexting and Psychopathology Correlates: An Exploratory Analysis.

Sexting is generally known as creating, sending and/or forwarding of sexual content using electronic devices. When such content is non-consensually disseminated, it becomes a criminally relevant behavior. To date, very few empirical studies have examined the prevalence of non-consensual dissemination of sexting, and none of them have analyzed the relationship with psychopathology and further victimization outcomes. Therefore, the aims of this study were (1) to examine the prevalence of non-consensual dissemination of sexual content, (2) to analyze the prevalence of further victimization as a result of non-consensual dissemination of sexting and (3) to investigate the association between secondary victimization as a result of non-consensual dissemination of sexting and psychopathology. The sample comprised 1370 Spanish college students (73.6% female; mean age = 21.4 years; SD = 4.85) who answered an online survey about their engagement in sexting behaviors, online sexual victimization and psychopathology, measured by a sexting scale and the Listado de Síntomas Breve (LSB-50), respectively. Overall, 43 participants (3.14) were victims of non-consensual dissemination of sexting, and results showed those participants who had suffered further victimization reported higher psychopathology scores than those who were not victimized and that being victimized by an ex-partner was associated with poorer mental health outcomes in the victim. Further implications are discussed.

Exploring Sexting and Online Sexual Victimization during the COVID-19 Pandemic Lockdown.

The COVID-19 pandemic lockdown has impacted daily routines, forcing people to stop socializing in person and changing the way people express their feelings and their romantic or sexual interactions. Social distancing has changed the way people behave online, and we expect that engagement in sexting and online sexual victimization behaviors have increased during lockdown. The aim of this paper is to study the prevalence of sexting and online sexual victimization behaviors during the COVID-19 lockdown in Spanish adults in order to explore how social distancing has affected these behaviors. The sample comprised 293 Spanish adults (mean age = 30.3; 66.2% female) who took part in an online survey about their engagement in sexting behaviors and online sexual victimization experiences. Overall results were apparently not supportive of our main hypothesis, showing that both sexting engagement and online sexual victimization decreased during lockdown despite the increase in internet use. Apart from differences in time period of reference, some alternative hypotheses relate to the increased presence of capable guardians according to the routine activities theory and to forced distance as a demotivation to sext. Possible explanations and hypotheses for these results are discussed further in the paper.

Intellectual disability rates among male prison inmates.

While only a small percentage of people with intellectual disabilities are responsible for criminal behaviors, the literature points to their overrepresentation in prisons, although not enough attention has been paid to intellectual disability data for inmates. We retrieved studies - in English, Spanish, Italian or French and indexed in Medline between 2000 and 2018 - that provided intellectual disability data for prisons collected by the administration of validated tests to male inmates. Identified were 13 studies involving more than 15,000 inmates referring to intellectual disability and borderline intellectual disability. The general findings of our review corroborate the overrepresentation of people with ID in prisons, although prevalence rates range widely, from as low as 1% to as high as 69.9% (p<0.000001), reflecting to differences in methodology, in local, social and cultural factors and in judicial procedures. Published studies clearly underline the overrepresentation of people with intellectual disabilities in prisons, differences between countries, the vulnerabilities of persons with intellectual disabilities and the need for proper assessment and management policies in prisons worldwide.