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Survey reveals physical and mental problems among health workers during pandemic

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Poor physical and mental health was frequent among Brazilian health workers employed in the public sector during the COVID-19 pandemic, according to a study by researchers at the Federal University of São Carlos (UFSCar) in São Paulo state, Brazil. The study showed that 86% reported burnout and 81% suffered from stress. They slept badly, experienced depression and complained of aches and pains. On the other hand, most said they were happy to provide meaningful services to society.

The study is still in progress. An analysis of the initial findings is reported in an article published in the journal Healthcare. The initiative as a whole is supported by FAPESP and is now in the final stage of data collection and analysis.

“The paper offers a snapshot of the situation, and we can’t blame the pandemic for all the problems we found, but we believe the particularly heavy effects of COVID-19 in Brazil contributed to these very negative results,” said Tatiana de Oliveira Sato, a professor of physical therapy at UFSCar’s School of Biological and Health Sciences (CCBS).

“Overwork, tough decisions and dramatic experiences all intensified because of the pandemic, affecting all health workers but especially those on the front line,” Sato said. Brazil has had more deaths of healthcare professionals from COVID-19 than any other country, according to the article.

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“The original idea for the survey arose just before the pandemic. Even outside the context of the pandemic, health workers have to deal with a heavy schedule and burden of responsibility. We wanted to assess the effects of all this on their physical and mental health. However, when the pandemic arrived, we decided to measure the impact of the public health emergency on the well-being of these workers,” Sato said.

Change of course

The researchers initially planned to interview volunteers on the job. They would all be health workers for the SUS, Brazil’s public health service, in São Carlos. However, the formalities required to prepare for the survey (permits, questionnaires, etc.) became irrelevant between late 2020 and early 2021, when the pandemic was raging across Brazil and vaccine rollout was still incipient.

“Instead, we created an online form and widened the search for respondents throughout the country,” Sato explained. “The criteria for inclusion were working for the SUS, being over 18, and being directly involved in patient care.”

The form was publicized via social media, emails and newspapers. It contained five questionnaires, each designed to quantify an aspect of the respondent’s life. They included the Copenhagen Psychosocial Questionnaire, the Pittsburgh Sleep Quality Index, the Nordic Musculoskeletal Questionnaire, and the Beck Depression Inventory.

The form was 10 pages long. “We reckoned it took 20-30 minutes to answer all the questions. The questionnaires were only included in the analysis if they were completely filled out,” Sato said. Local respondents also used equipment to measure the amount of physical activity for inclusion in the survey.

Eventually, 125 health workers took part in the study. The first stage of data collection lasted from June 2021 to April 2022. The data published so far constitutes a baseline and does not yet cover physical activity, but the project calls for four more steps to take place three, six, nine and 12 months after the first collection.

“We called this cohort HEROES. We thought a lot about the name because we didn’t want it to be taken as implying that health workers are superhuman and never get tired or dejected. The name is intended as a homage. We also wanted to call attention to the need to valorize health workers, who were disproportionately affected by the pandemic,” Sato said. Some 60 respondents participated in all stages.

Initial findings

The data presented in the article show a high prevalence of musculoskeletal symptoms: 64% reported neck pain, 62% shoulder pain, 58% upper back pain and 61% lower back pain.

For Sato, all this was certainly due largely to long hours, being on their feet most of the time, lifting patients and working flat out. “But mental stress can also trigger these kinds of pain because of the tension it creates in the body,” she noted.

The frequency of psychosocial problems is striking, according to the authors, with stress affecting 81% of the participants and 86% suffering burnout. Symptoms of mild depression were detected in 22%, moderate depression in 16% and severe depression in 8%. In addition, 74.4% said they slept badly.

It is still necessary to analyze the evolution of the indicators over time, however. According to Sato, prevalence levels tend to be lower in studies of other populations. For example, five meta-analyses mentioned in the article found burnout rates ranging from 25% to 37%, while nine such studies found that between 17% and 57% of the respective samples suffered from stress. These proportions are far lower than those reported in the study by the researchers at UFSCar.

Workplace climate

Other psychosocial factors were assessed via the Copenhagen questionnaire, with a large majority of respondents giving negative scores to the emotional demands of their work (75%), its pace and intensity (61%), and its unpredictability (47%). These were the psychosocial factors with the worst ratings in the survey.

The proportions who reported offensive behavior were also strikingly high: 15% said they had been the object of unwanted sexual attention or harassment, while 26% had been threatened, 17% bullied, and 9% physically assaulted.

“This is deplorable. All these numbers should be zero. Occurrences of this kind in any workplace are unacceptable,” Sato said. Sexual harassment was reported most by younger women, she noted. Threats of violence came mainly from patients and their relatives, while fellow workers were more often bullies than supervisors.

On the positive side, more than 90% said they believed their work was very meaningful and some 80% said they were committed to their work despite the stress.

Limitations and implications

For Sato, the relatively small number of respondents to the first form (125) and the even smaller number (about 60) remaining in the last stage of the survey were a limitation because they prevented extrapolation and analysis of data for other regions. “Nevertheless, the survey was valuable because of its depth,” she said.

The information obtained, she added, is sufficient to lobby top management of the SUS and the authorities for improvements to working conditions. Physically and mentally distressed professionals cannot always provide the best patient care.

“This has to lead to increased staffing, better pay, less exhausting hours and proper training,” Sato said. Simple matters such as providing training for staff on the best ways to lift and carry patients without injuring themselves could lead to significant improvements in musculoskeletal terms. Similarly, creation of support networks would help nursing and other staff cope with the emotional impact. “Health workers need a lot of support. They’re people, too,” she said.

About São Paulo Research Foundation (FAPESP)

The São Paulo Research Foundation (FAPESP) is a public institution with the mission of supporting scientific research in all fields of knowledge by awarding scholarships, fellowships and grants to investigators linked with higher education and research institutions in the State of São Paulo, Brazil. FAPESP is aware that the very best research can only be done by working with the best researchers internationally. Therefore, it has established partnerships with funding agencies, higher education, private companies, and research organizations in other countries known for the quality of their research and has been encouraging scientists funded by its grants to further develop their international collaboration. You can learn more about FAPESP at www.fapesp.br/en and visit FAPESP news agency at www.agencia.fapesp.br/en to keep updated with the latest scientific breakthroughs FAPESP helps achieve through its many programs, awards and research centers. You may also subscribe to FAPESP news agency at http://agencia.fapesp.br/subscribe


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Kevin Neil Friesen Obituary 2024 – Crossings Funeral Care

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It is with heavy hearts that we announce the peaceful passing of Kevin Neil Friesen age 53 on Thursday, March 28, 2024 at the Bethesda Regional Health Centre.

A funeral service will be held at 2:00 pm on Thursday, April 4, 2024 at the Bothwell Christian Fellowship Church, with viewing one hour prior to the service.

A longer notice to follow.  

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Spring allergies: Where is it worse in Canada? – CTV News

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The spring allergy season has started early in many parts of Canada, with high levels of pollen in some cities such as Toronto, Ottawa and Montreal.

Daniel Coates, director of Aerobiology Research Laboratories in Ottawa, expects the elevated amounts to continue next week for places, such as most of Ontario, if the temperature continues to rise. Aerobiology creates allergen forecasts based on data it collects from the air on various pollens and mould spores.

Pollens are fertilizing fine powder from certain plants such as trees, grass and weeds. They contain a protein that irritates allergy sufferers.

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Although pollen levels declined after a cold spell in some places, he said they are soaring again across parts of Canada.

“So the worst is definitely British Columbia right now, followed by Ontario and Quebec and then the Prairies and Atlantic Canada for the upcoming weeks,” said Coates in a video interview with CTVNews.ca. “We are seeing pollen pretty much everywhere, including the Maritimes.”

He said pollen has increased over the past 20 years largely due to longer periods of warm weather in Canada.

Meanwhile, the Maritimes is one of the best places to live in Canada if you have seasonal allergies, in part because of its rocky territory, Coates said.

With high levels of cedar and birch pollen, British Columbia is the worst place for allergy sufferers in Canada, he added.

“British Columbia is going strong,” Coates explained, noting the allergy season started “very early” in the province in late January. “It has been going strong since late January, early February and it’s progressing with high levels of pollen, mostly cedar, but birch as well, and birch is highly allergenic.”

Causes of high pollen levels

Coates expects a longer allergy season if the warm weather persists. He notes pollen is increasing in Canada and worldwide, adding that in some cases the allergy season is starting earlier and lasting longer than 15 years ago.

He says tree pollen produced last year is now being released into the air because of warmer weather.

“Mother nature acts like a business,” he said. “So you have cyclical periods where things go up and down. … So when it cooled down a little bit, we saw (pollen) reduce in its levels, but now it’s going to start spiking.”

Along with warmer weather, another factor in higher pollen levels is people planting more male trees in urban areas because they don’t produce flowers and fruits and are less messy as a result, he said. But male trees produce pollen while female ones mostly do not.

Moulds

Coates said moulds aren’t as much of a problem.

“They’ve been mainly at lower levels so far this season,” he explained. “Moulds aren’t as bad in many areas of Canada, but they’re really, really bad in British Columbia.”

In B.C., moulds are worse because of its wet climate and many forested areas, he said.

Coping with allergies

Dr. Blossom Bitting, a naturopathic doctor and herbal medicine expert who works for St. Francis Herb Farm, says a healthy immune system is important to deal with seasonal allergies.

“More from a holistic point of view, we want to keep our immune system strong,” she said in a video interview with CTVNews.ca from Shediac, N.B. “Some would argue allergies are an overactive immune system.”

Bitting said ways to balance and strengthen the immune system include managing stress levels and getting seven to nine hours of restful sleep. “There is some research that shows that higher amounts of emotional stress can also contribute to how much your allergies react to the pollen triggers,” Bitting said.

Eating well by eating more whole foods and less processed foods along with exercising are also important, she added. She recommends foods high in Omega-3 Fatty Acids such as flaxseeds, flaxseed oil, walnuts and fish. Fermented foods with probiotics such as yogurt, kimchi and miso, rather than pasteurized ones, can keep the gut healthy, she added. Plant medicines or herbs such as astragalus, reishi mushrooms, stinging nettle and schisandra can help bodies adapt to stressors, help balance immune systems or stabilize allergic reactions, she said.

To cope with allergies, she recommends doing the following to reduce exposure to pollen:

  • Wear sunglasses to get less pollen into the eyes;
  • Wash outdoor clothes frequently, use outer layers for outside and remove them when you go inside the house;
  • Use air purifiers such as with HEPA (high efficiency particulate air) filters;
  • Wash pets and children after they go outside;
  • Keep the window closed on days with high pollen counts.

Mariam Hanna, a pediatric allergist, clinical immunologist and associate professor with McMaster University in Hamilton, Ont., says immunotherapy can help patients retrain their bodies by working with an allergist so they become more tolerant to pollens and have fewer symptoms.

“Some patients will need medications like over-the-counter antihistamines or speaking with their doctor about the right types of medications to help with symptom control,” she said in a video interview with CTVNews.ca.

Coates recommends people check pollen forecasts and decrease their exposure to pollen since no cure exists for allergies. “The best is knowing what’s in the air so that you can adjust your schedules, or whatever you’re doing, around the pollen levels.”

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Do you need a spring COVID-19 vaccine? Research backs extra round for high-risk groups

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Recent studies suggest staying up-to-date on COVID shots helps protect high-risk groups from severe illness

New guidelines suggest certain high-risk groups could benefit from having another dose of a COVID-19 vaccine this spring — and more frequent shots in general — while the broader population could be entering once-a-year territory, much like an annual flu shot.

Medical experts told CBC News that falling behind on the latest shots can come with health risks, particularly for individuals who are older or immunocompromised.

Even when the risk of infection starts to increase, the vaccines still do a really good job at decreasing risk of severe disease, said McMaster University researcher and immunologist Matthew Miller.

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Who needs another COVID shot?

Back in January, Canada’s national vaccine advisory body set the stage for another round of spring vaccinations. In a statement (new window), the National Advisory Committee on Immunization (NACI) stated that starting in spring 2024, individuals at an increased risk of severe COVID may get an extra dose of the latest XBB.1.5-based vaccines, which better protect against circulating virus variants.

That means:

  • Adults aged 65 and up.
  • Adult residents of long-term care homes and other congregate living settings for seniors.
  • Anyone six months of age or older who is moderately to severely immunocompromised.

The various spring recommendations don’t focus on pregnancy, despite research (new window) showing clear links between a COVID infection while pregnant, and increased health risks. However, federal guidance does note that getting vaccinated during pregnancy can protect against serious outcomes.

Vaccinated people can also pass antibodies to their baby through the placenta and through breastmilk, that guidance states (new window).

What do the provinces now recommend?

Multiple provinces have started rolling out their own regional guidance based on those early recommendations — with a focus on allowing similar high-risk groups to get another round of vaccinations.

B.C. is set to announce guidance on spring COVID vaccines in early April, officials told CBC News, and those recommendations are expected to align with NACI’s guidance.

In Manitoba (new window), high-risk individuals are already eligible for another dose, provided it’s been at least three months since their latest COVID vaccine.

Meanwhile Ontario’s latest guidance (new window), released on March 21, stresses that high-risk individuals may get an extra dose during a vaccine campaign set to run between April and June. Eligibility will involve waiting six months after someone’s last dose or COVID infection.

Having a spring dose is particularly important for individuals at increased risk of severe illness from COVID-19 who did not receive a dose during the Fall 2023 program, the guidance notes.

And in Nova Scotia (new window), the spring campaign will run from March 25 to May 31, also allowing high-risk individuals to get another dose.

Specific eligibility criteria vary slightly from province-to-province, so Canadians should check with their primary care provider, pharmacist or local public health team for exact guidelines in each area.

WATCH: Age still best determines when to get next COVID vaccine dose, research suggests:

 

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Age still best determines when to get COVID vaccines, new research suggests

It’s been four years since COVID-19 was declared a pandemic, and new research suggests your age may determine how often you should get a booster shot.

Why do the guidelines focus so much on age?

The rationale behind the latest spring guidelines, Miller said, is that someone’s age remains one of the greatest risk factors associated with severe COVID outcomes, including hospitalization, intensive care admission and death.

So that risk starts to shoot up at about 50, but really takes off in individuals over the age of 75, he noted.

Canadian data (new window) suggests the overwhelming majority of COVID deaths have been among older adults, with nearly 60 per cent of deaths among those aged 80 or older, and roughly 20 per cent among those aged 70 to 79.

People with compromised immune systems or serious medical conditions are also more vulnerable, Miller added.

Will people always need regular COVID shots?

While the general population may not require shots as frequently as higher-risk groups, Miller said it’s unlikely there will be recommendations any time soon to have a COVID shot less than once a year, given ongoing uncertainty about COVID’s trajectory.

Going forward, I suspect for pragmatic reasons, [COVID vaccinations] will dovetail with seasonal flu vaccine campaigns, just because it makes the implementation much more straightforward, Miller said.

And although we haven’t seen really strong seasonal trends with SARS-CoV-2 now, I suspect we’ll get to a place where it’s more seasonal than it has been.

In the meantime, the guidance around COVID shots remains simple at its core: Whenever you’re eligible to get another dose — whether that’s once or twice a year — you might as well do it.

What does research say?

One analysis, published in early March in the medical journal Lancet Infectious Diseases (new window), studied more than 27,000 U.S. patients who tested positive for SARS-CoV-2, the virus behind COVID, between September and December 2023.

The team found individuals who had an updated vaccine reduced their risk of severe illness by close to a third — and the difference was more noticeable in older and immunocompromised individuals.

Another American research team from Stanford University recently shared the results from a modelling simulation looking at the ideal frequency for COVID vaccines.

The study in Nature Communications (new window) suggests that for individuals aged 75 and up, having an annual COVID shot could reduce severe infections from an estimated 1,400 cases per 100,000 people to around 1,200 cases — while bumping to twice a year could cut those cases even further, down to 1,000.

For younger, healthier populations, however, the benefit of regular shots against severe illness was more modest.

The outcome wasn’t a surprise to Stanford researcher Dr. Nathan Lo, an infectious diseases specialist, since old age has consistently been a risk factor for severe COVID.

It’s almost the same pattern that’s been present the entire pandemic, he said. And I think that’s quite striking.

More frequent vaccination won’t prevent all serious infections, he added, or perhaps even a majority of those infections, which highlights the need for ongoing mitigation efforts.

Lauren Pelley (new window) · CBC News

 

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