Anxiety, depression, trauma-related, and sleep disorders among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis.

OBJECTIVE: The COVID-19 pandemic has placed health care workers under psychological stress. Previous reviews show a high prevalence of mental disorders among health care workers, but these need updating and inclusion of studies written in Chinese. The aim of this systematic review and meta-analysis was to provide updated prevalence estimates for depression, anxiety and post-traumatic stress disorder (PTSD) among health care workers during the COVID-19 pandemic, benefitting from the inclusion of studies published in Chinese. METHODS: Systematic search of EMBASE, MEDLINE, PsycINFO, Global Health, Web of Science, CINAHL, Google Scholar and the Chinese databases SinoMed, WanfangMed, CNKI and CQVIP, for studies conducted between December 2019 and August 2020 on the prevalence of depression, anxiety and PTSD in health care workers during the COVID-19 pandemic. Studies published in both English and Chinese were included. RESULTS: Data on the prevalence of moderate depression, anxiety and PTSD was pooled across 65 studies involving 97,333 health care workers across 21 countries. The pooled prevalence of depression was 21.7% (95% CI, 18.3%-25.2%), of anxiety 22.1% (95% CI, 18.2%-26.3%), and of PTSD 21.5% (95% CI, 10.5%-34.9%). Prevalence estimates are also provided for a mild classification of each disorder. Pooled prevalence estimates of depression and anxiety were highest in studies conducted in the Middle-East (34.6%; 28.9%). Subgroup and meta-regression analyses were conducted across covariates, including sampling method and outcome measure. CONCLUSIONS: This systematic review and meta-analysis has identified a high prevalence of moderate depression, anxiety and PTSD among health care workers during the COVID-19 pandemic. Appropriate support is urgently needed. The response would benefit from additional research on which interventions are effective at mitigating these risks.

/pdf/prevalence-of-depression-anxiety-and-post-traumatic-stress-3swt6lckqw.pdf

Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis.

Prevalence of stress, depression, anxiety and sleep disturbance among nurses during the COVID-19 pandemic: A systematic review and meta-analysis.

Background: Nurses represent the major proportion of frontline health care professionals delivering 24/7 services to patients with an increased vulnerability towards COVID-19 infection. Mental health issues among nurses during the COVID-19 pandemic are poorly reported across the globe. Henceforth, a systematic review and meta-analysis was performed to explore the prevalence and determinants of mental health outcomes (anxiety, stress, depression, PTSD, insomnia) among nurses across the globe due to the COVID-19. Methods: A PRISMA compliant systematic review (PROSPERO-CRD 42020204120) was carried out to identify articles from multiple databases reporting the prevalence of mental health outcomes among nurses. Proportion random effect analysis, I2 statistic, quality assessment, and sensitivity analysis were carried out. Results: Pooled data on mental health outcomes were generated from 25 cross-sectional studies: 32% anxiety (95% confidence interval (CI) = 21%-44%, n (number of studies) = 21, N (sample size) = 13 641), 40.6% stress (95% CI = 25.4%-56.8%, n = 10, N = 4204), 32% depression (95% CI = 21%-44%, n = 17, N = 12 294), 18.6% PTSD (95% CI = 4.8%-38%, n = 3, N = 638), 38.3% insomnia (95% CI = 5.8%-78.6%, n = 2, N = 261) and significant risk factors for mental ailments includes; caring for COVID-19 patients, being a female, low self-efficacy, resilience, social support and having physical symptoms (sore-throat, breathlessness, cough, lethargy, myalgia, fever). Conclusion: The study results highlighted a higher proportion of poor mental health outcomes namely, anxiety, stress, depression, PTSD and insomnia among nurses from different parts of the world. Poor mental health outcomes among nurses warrants the need to implement proactive psychological interventions to deter the collapse of health care systems in responding to the pandemic and in particular all possible efforts should be undertaken to mitigate the risk factors. Health care organizations should provide support to nurses with sufficient flexibility. The disaster preparedness plan envisaged by nations should have provisions to address the mental health of nurses. Greater investment in addressing the global shortage of nurses should be given priority in national health policies. Attractive salary packages should be offered to nurses to prevent their emigration from low- and middle-income countries (LMICs). Registration: PROSPERO (CRD42020204120).

/pdf/decline-in-the-mental-health-of-nurses-across-the-globe-u1j2yrdax9.pdf

Decline in the mental health of nurses across the globe during COVID-19: A systematic review and meta-analysis.

The Global Prevalence of Depression, Anxiety, Stress, and, Insomnia and Its’ Changes among Health Professionals during COVID-19 Pandemic: A Rapid Systematic Review and Meta-Analysis

Anxiety and related factors in frontline clinical nurses fighting COVID-19 in Wuhan.

Background Loss to follow-up (LTFU) is a significant barrier to the completion of anti-tuberculosis (TB) treatment and a major predictor of TB-associated deaths. Currently, research on LTFU-related factors in China is both scarce and inconsistent. Methods We collected information from the TB observation database of the National Clinical Research Center for Infectious Diseases. The data of all patients who were documented as LTFU were assessed retrospectively and compared with those of patients who were not LTFU. Descriptive epidemiology and multivariable logistic regression analyses were conducted to identify the factors associated with LTFU. Results A total of 24,265 TB patients were included in the analysis. Of them, 3,046 were categorized as LTFU, including 678 who were lost before treatment initiation and 2,368 who were lost afterwards. The previous history of TB was independently associated with LTFU before treatment initiation. Having medical insurance, chronic hepatitis or cirrhosis, and providing an alternative contact were independent predictive factors for LTFU after treatment initiation. Conclusion Loss to follow-up is frequent in the management of patients with TB and can be predicted using patients’ treatment history, clinical characteristics, and socioeconomic factors. Our research illustrates the importance of early assessment and intervention after diagnosis. Targeted measures can improve patient engagement and ultimately treatment adherence, leading to better health outcomes and disease control.

Factors associated with loss to follow-up before and after treatment initiation among patients with tuberculosis: A 5-year observation in China

With rapidly aging populations, family care functions can become weakened, and community health services often lack unified standards. A standardized and professional community home-based long-term care model (CHLCM) for the elderly is urgently needed in many regions of China and in other countries. Here, we explored the indicators of the need for a CHLCM among elderly individuals, and we constructed a CHLCM. We created and distributed a questionnaire regarding the requirement of long-term care services, based on a literature review. The two-rounds Delphi method was used, involving 20 experts who were randomly selected from among the medical universities, community health service centers, and nursing homes in Nanning, Guangxi, China. The experts' enthusiasm rates in the questionnaire's two rounds were 95% and 100%, respectively. The authentic coefficient of the experts' consulting was 0.857, and that of the experts' academic level was 0.835; the judgement coefficient was 0.880 and the familiar coefficient was 0.855. The CHLCM includes service content and an evaluation. The coordination coefficients for the two primary, eight secondary, and 29 tertiary indicators were 0.200, 0.386, and 0.184, respectively (p<0.05). The experts' enthusiasm and authority were high. The coordination of the experts' agreement was sufficient, and the analysis results were reliable. The CHLCM includes 29 items that provide a foundation and references for the formulation of concrete indicators and subsequent research.

The Construction of a Community Long-term Care Model for Home-based Elderly Individuals.

c 2022 The Korean Society of Neurogastroenterology and Motility J Neurogastroenterol Motil, Vol. 28 No. 2 April, 2022 www.jnmjournal.org TO THE EDITOR: Factors that can contribute to bile reflux gastritis are generally categorized as primary biliary reflux and secondary biliary reflux after gastric resection with ablation of the pylorus. Primary biliary reflux is excessive bile in the duodenum retrograding to the stomach. Risk factors include gallbladder dyskinesia, gastric or duodenal dysmotility, and surgical resection such as cholecystectomy and sphincterotomy. Recently, a new analysis for the old problem of primary bile reflux gastropathy has been reported, in which a total of 262 patients with functional dyspepsia (FD) were stratified into 3 cohorts: bile gastropathy (BG), non-bile gastropathy (NBG), and no gastropathy (NG). The evaluations based on phenotype, symptoms, endoscopic and histological changes, etc. were compared using chi-square test for continuous data, Kruskal– Wallis test (one-way analysis of variance) for continuous data, and multivariate regression for 2 binary modeling. The findings of this study are mainly featured or established with some characteristics to BG, in contrast to BNG and NG. Following aspects from BG, versus to BNG and NG, are significantly more severe or increased: (1) abdominal pain, (2) prevalence of cholecystectomy, (3) prevalence of gastric erythema in endoscopic examination, (4) prevalence of gastritis, (5) edema, and (6) chronic active inflammation on pathological examination. Indeed, this is a more comprehensive study, and its cohort analysis could be potentially informative in the diagnosis of bile reflux gastritis in clinical practice though it is not the criteria. However, a few of concerns raised from this study may be worth to further discussing for clarification and understanding. First, the subjects included in the study were patients with FD, therefore, delayed gastric emptying was crucial and expected. In the literature, significantly longer delayed gastric emptying and higher bilirubin concentrations were observed in patients with bile reflux gastritis. The validation of the wireless motility capsule testing used in the study may need to adjust/compare with traditional or universally accepted measurements, since the supplementary results showing delayed gastric emptying in BG, NBG, and NG are respectively 38.6%, 40.4%, and 39.1% (P = 0.981), as seen in Table. At least, a further explanation on why there is no correlation with the degree of bile reflux among cohorts is expected by audiences. Second, the differential of heartburn was not discernable among the cohorts as seen in Figure. In the contrary, the amplitude of that from BG is obviously lower than other cohorts which looks different enough to be statistically significant. Then, the patients who did not have cholecystectomy could be more informative if such cohorts could be analyzed. Since the diagnosis of bile reflux gastritis is very challenging, any difference from BG, NBG, and NG may be guides for the diagnosis, treatment, and prognosis. As commented, “role of bile reflux in functional dyspepsia: areas that need further research,” there are few studies on the association of bile reflux, FD, the severity of symptoms, and response to Table. Assessment of Motility

https://www.jnmjournal.org/journal/download_pdf.php?doi=10.5056/jnm21207

A New Analysis for Old Problem of Bile Reflux

c 2017 The Korean Society of Neurogastroenterology and Motility J Neurogastroenterol Motil, Vol. 23 No. 3 July, 2017 www.jnmjournal.org TO THE EDITOR: We read with great interest and enthusiasm the article from Colak et al regarding the possible diagnostic indication for impaired gallbladder motility by increased gallbladder volume and/or gallbladder wall thickness in patients with nonalcoholic fatty liver disease (NAFLD). In the study, out of 50 patients with NAFLD, 10 (20%) were identified with steatosis, 22 (44%) had borderline nonalcoholic steatohepatitis, and 18 (36%) had definitive nonalcoholic steatohepatitis, in contrast to 38 healthy controls in order to validate a diagnostic panel referenced to bile movement identified under real-time 2-dimensional ultrasonography. Colak et al obtained measurements including fasting gallbladder wall thickness (FGWT), fasting gallbladder volume (FGV), and postprandial gallbladder volume. In overall, those 3 measurements are significantly greater in patients with NAFLD than control subjects (P = 0.001, P = 0.019, and P < 0.001, respectively). Interestingly, there are significant correlations between FGV and presence of NAFLD (r = 0.30), also FGV and body mass index (r = 0.36); moreover, the linear stepwise regression analyzed body mass index which was an independent predictor of FGV (beta = 0.29, t = 2.33, P = 0.022). In terms of gallbladder size or volume, we agree that the bigger the volume of gallbladder reflects the lower of the motility; therefore, a difference of volume between fasting and postprandial statues could be reasoning gallbladder contractility, ie, the bigger of the difference is the stronger contractility, similarly, the timing of volume change quicker means the stronger of the contractility. Although there are some other issues in the study, such as the sample size and representing area, which need to be further clarified for elucidating the relationship of gallbladder measurements and gallbladder dysmotility, as well NAFLD, however, it is an excellent study encouraging for clinicians and researchers. Use of real-time 2-dimensional ultrasonography to screen gallbladder dysmotility relevant to NAFLD is indeed imperative for currently increasing prevalence of gallstones upon the association with obesity and diabetes. For example, the prevalence of gallstones in the USA is approximately 10-15%; it was, in China, about 6.29% in 1989, and 11.1-15.5% in 2009. This means that gallstone occurrence is increasing approximately 2-fold every 10 years. On the other hand, the changes of size and contractility of the gallbladder is due to the alternation of the intrinsic property of the gallbladder, therefore, the altered gallbladder motility constitutes a primary factor in the pathogenesis of gallstone and other biliary diseases. Gallbladder muscle tone and motility formed up by slow waves and associated contractions, which are similar to slow waves in gastrointestinal smooth muscle cells. Intestinal slow waves are produced by interstitial cells of Cajal (ICC) in the myenteric plexus; similarly, ICC-like cells in gallbladder initiate the spontaneously rhythmic pacemaker potentials that depolarizations smooth muscle in triggering and synchronizing action potentials for bile movement. Some gastrointestinal motility disorders, such as diabetic gastroparesis, slow transit constipation and post-operational gut dysmotilities, have been attributed to the impaired pacemaker activity of ICC. Whether or not the dysfunctions of biliary system correlated to the architectures of the nerve and ICC-like cells in gallbladder is essentially critical to characterize these type of cells the possible biological and physiological roles, and establish those of FGWT, FGV, and postprandial gallbladder volume as biomarkers for varieties of the gallbladder dysmotilities.

Gallbladder Volume Indicated for Gallbladder Dysmotility.

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