[⇓][1] 

SERIES “ATS/ERS TASK FORCE: STANDARDISATION OF LUNG FUNCTION TESTING” 

Edited by V. Brusasco, R. Crapo and G. Viegi 

Number 2 in this Series

 [1]: #F13

/pdf/standardisation-of-spirometry-1dkqxgifvl.pdf

Standardisation of spirometry

Background COVID-19 pandemic has the potential to significantly affect the mental health of healthcare workers (HCWs), who stand in the frontline of this crisis. It is, therefore, an immediate priority to monitor rates of mood, sleep and other mental health issues in order to understand mediating factors and inform tailored interventions. The aim of this review is to synthesize and analyze existing evidence on the prevalence of depression, anxiety and insomnia among HCWs during the Covid-19 outbreak. Methods A systematic search of literature databases was conducted up to April 17th, 2020. Two reviewers independently assessed full-text articles according to predefined criteria. Risk of bias for each individual study was assessed and data pooled using random-effects meta-analyses to estimate the prevalence of specific mental health problems. The review protocol is registered in PROSPERO and is available online. Findings Thirteen studies were included in the analysis with a combined total of 33,062 participants. Anxiety was assessed in 12 studies, with a pooled prevalence of 23·2% and depression in 10 studies, with a prevalence rate of 22·8%. A subgroup analysis revealed gender and occupational differences with female HCPs and nurses exhibiting higher rates of affective symptoms compared to male and medical staff respectively. Finally, insomnia prevalence was estimated at 38·9% across 5 studies. Interpretation Early evidence suggests that a considerable proportion of HCWs experience mood and sleep disturbances during this outbreak, stressing the need to establish ways to mitigate mental health risks and adjust interventions under pandemic conditions.

/pdf/prevalence-of-depression-anxiety-and-insomnia-among-mgzryfjla1.pdf

Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis.

The COVID-19 pandemic has had a significant impact on public mental health Therefore, monitoring and oversight of the population mental health during crises such as a panedmic is an immediate priority The aim of this study is to analyze the existing research works and findings in relation to the prevalence of stress, anxiety and depression in the general population during the COVID-19 pandemic In this systematic review and meta-analysis, articles that have focused on stress and anxiety prevalence among the general population during the COVID-19 pandemic were searched in the Science Direct, Embase, Scopus, PubMed, Web of Science (ISI) and Google Scholar databases, without a lower time limit and until May 2020 In order to perform a meta-analysis of the collected studies, the random effects model was used, and the heterogeneity of studies was investigated using the I2 index Moreover data analysis was conducted using the Comprehensive Meta-Analysis (CMA) software The prevalence of stress in 5 studies with a total sample size of 9074 is obtained as 296% (95% confidence limit: 243–354), the prevalence of anxiety in 17 studies with a sample size of 63,439 as 319% (95% confidence interval: 275–367), and the prevalence of depression in 14 studies with a sample size of 44,531 people as 337% (95% confidence interval: 275–406) COVID-19 not only causes physical health concerns but also results in a number of psychological disorders The spread of the new coronavirus can impact the mental health of people in different communities Thus, it is essential to preserve the mental health of individuals and to develop psychological interventions that can improve the mental health of vulnerable groups during the COVID-19 pandemic

/pdf/prevalence-of-stress-anxiety-depression-among-the-general-2ofbkbmkf3.pdf

Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis.

https://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1006&context=covid19

SARS-CoV-2

BACKGROUND: Individuals often avoid or delay seeking professional help for mental health problems. Stigma may be a key deterrent to help-seeking but this has not been reviewed systematically. Our systematic review addressed the overarching question: What is the impact of mental health-related stigma on help-seeking for mental health problems? Subquestions were: (a) What is the size and direction of any association between stigma and help-seeking? (b) To what extent is stigma identified as a barrier to help-seeking? (c) What processes underlie the relationship between stigma and help-seeking? (d) Are there population groups for which stigma disproportionately deters help-seeking? METHOD: Five electronic databases were searched from 1980 to 2011 and references of reviews checked. A meta-synthesis of quantitative and qualitative studies, comprising three parallel narrative syntheses and subgroup analyses, was conducted. RESULTS: The review identified 144 studies with 90,189 participants meeting inclusion criteria. The median association between stigma and help-seeking was d = - 0.27, with internalized and treatment stigma being most often associated with reduced help-seeking. Stigma was the fourth highest ranked barrier to help-seeking, with disclosure concerns the most commonly reported stigma barrier. A detailed conceptual model was derived that describes the processes contributing to, and counteracting, the deterrent effect of stigma on help-seeking. Ethnic minorities, youth, men and those in military and health professions were disproportionately deterred by stigma. CONCLUSIONS: Stigma has a small- to moderate-sized negative effect on help-seeking. Review findings can be used to help inform the design of interventions to increase help-seeking.

/pdf/what-is-the-impact-of-mental-health-related-stigma-on-help-4umw0hpq34.pdf

What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies.

Risks posed by COVID-19 to healthcare workers.

Background Correspondence from occupational physicians to GPs is infrequent, despite evidence that good communication leads to earlier return to work of sick-listed patients and is cost effective.

Optimal communication from occupational physicians to GPs

ObjectiveTo quantify occupational risks of Covid-19 among healthcare staff during the first wave of the pandemic in England MethodsUsing pseudonymised data on 902,813 individuals continuously employed by 191 National Health Service trusts during 1.1.19 to 31.7.20, we explored demographic and occupational risk factors for sickness absence ascribed to Covid-19 during 9.3.20 to 31.7.20 (n = 92,880). We estimated odds ratios (ORs) by multivariable logistic regression. ResultsWith adjustment for employing trust, demographic characteristics, and previous frequency of sickness absence, risk relative to administrative/clerical occupations was highest in additional clinical services (including care assistants) (OR 2.31 [2.25-2.37]), registered nursing and midwifery professionals (OR 2.28 [2.23-2.34]) and allied health professionals (OR 1.94 [1.88-2.01]), and intermediate in doctors and dentists (OR 1.55 [1.50-1.61]). Differences in risk were higher after the employing trust had started to care for documented Covid-19 patients, and were reduced, but not eliminated, following additional adjustment for exposure to infected patients or materials, assessed by a job-exposure matrix. For prolonged Covid-19 sickness absence (episodes lasting >14 days), the variation in risk by staff group was somewhat greater. ConclusionsAfter allowance for possible bias and confounding by non-occupational exposures, we estimated that relative risks for Covid-19 among most patient-facing occupations were between 1.5 and 2.5. The highest risks were in those working in additional clinical services, nursing and midwifery and in allied health professions. Better protective measures for these staff groups should be a priority. Covid-19 may meet criteria for compensation as an occupational disease in some healthcare occupations. Key messagesO_LIWhat is already known about this subject? Healthcare workers and other keyworkers (workers whose job was considered essential to societal functioning) had a higher likelihood of testing positive for COVID-19 than other workers during the first lockdown in England. Amongst healthcare workers, those working in inpatient settings had the highest rate of infection. C_LIO_LIWhat are the new findings? Between March and July 2000, the overall risk of COVID-19 sickness absence in National Health Service staff in England was lower at older ages, higher in non-white staff, and (in comparison with administrative and clerical staff) more than doubled in registered nurses and among workers such as healthcare assistants providing support to health professionals. Risk in health care scientists was little different from that in administrative and clerical occupations C_LIO_LIHow might this impact on policy or clinical practice in the foreseeable future? Our results suggest that the risk reduction strategies that were in place for healthcare scientists were effective. However, the protection for nursing and supporting health professionals was insufficient. In the event of a further wave of infections resulting in high hospital admissions, attention should be paid to ensuring that risk reduction strategies for nurses and supporting health professionals are improved. C_LI

/pdf/occupational-risks-of-covid-19-in-nhs-workers-in-england-2xq59zdl8v.pdf

Occupational risks of COVID-19 in NHS workers in England

Contemporary Topics in Women’s Mental Health. Global Perspectives in a Changing Society

(i) Rationale, aims, objectives
Little is known about the quality of occupational health care provided to NHS staff. We designed the first national clinical audits of occupational health care in England. We chose to audit depression and back pain as health care workers have high levels of both conditions compared with other employment sectors. The aim of the audits was to drive up quality of care for staff with these conditions. The object of this paper is to describe how we developed an audit methodology and overcame challenges presented by the organisation and delivery of occupational health care for NHS staff. 

(ii) Method 
We designed two retrospective case note audits which ran simultaneously. Sites submitted up to 40 cases for each audit. We used duplicate case entry to test inter-rater reliability and performed selection bias checks. Participants received their sitei?½s audit results, benchmarked against the national average, within four months of the end of the data entry period. We used electronic voting at a results dissemination conference to inform implementation activities.

(iii) Results
Occupational Health departments providing services to 278 (83%) trusts in England participated in one or both audits. Median Kappa scores were above 0.7 for both pilot and full audits, indicating i?½goodi?½ levels of inter-rater reliability. 
79% of participants at a dissemination conference said that they had changed their clinical practice either during data collection (52%) or following receipt of their audit results (27%). 

(iv) Conclusions 
Clinical audit can be conducted successfully in the occupational health setting. We obtained meaningful data that has stimulated local and national quality improvement activities. Our methodology would be transferable to occupational health settings outside the NHS and in other countries.

Ira Madan

Papers

Risks posed by COVID-19 to healthcare workers.

Optimal communication from occupational physicians to GPs

Occupational risks of COVID-19 in NHS workers in England

Contemporary Topics in Women’s Mental Health. Global Perspectives in a Changing Society

Measuring how well the NHS looks after its own staff: methodology of the first national clinical audits of occupational health services in the NHS