The impact of the COVID-19 pandemic on the mental health of healthcare workers: study protocol for the COVID-19 HEalth caRe wOrkErS (HEROES) study

Background

Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and Asia.

Methods

Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country’s income level.

Results

As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start shortly.

Conclusions

This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of settings.

     

Bone marrow transplantation in two multiply transfused patients with thalassaemia major

Bone marrow transplantation has generally been unsuccessful when applied to patients with thalassaemia major over the age of 6 years. We report here two successful transplants for this disorder in a 7 1/2-year-old boy and an 11-year-old girl following a pre-transplant cytoreductive/immunosuppressive regimen of total body irradiation and cyclophosphamide. Complete durable engraftment of donor haematopoietic and lymphoid populations was documented through several approaches, including cytogenetic analysis, haemoglobin electrophoresis, globin chain synthetic ratios, red cell typing and DNA restriction enzyme analysis. Both patients are surviving in good health, 28 and 9 months from transplantation. The successful outcome in these patients demonstrates the feasibility of marrow transplantation for the treatment of thalassaemia in multiply transfused and, presumably, highly sensitized patients.     

Hemispheric asymmetry in long-term semantic relationships

Latencies in a category membership decision task were used to investigate hemispheric organisation of concepts in long-term semantic memory (LTSM). The experiment used the hemi-field technique to lateralise pictures representing high versus low typicality instances of pre-designated concepts to the right and left hemispheres. The results demonstrated hemispheric asymmetries in storage/retrieval of category members. In the right hemisphere, latencies were shorter for high than for low typicality members, consistent with previously reported prototypicality effects in free vision (Rosch, 1975), whereas for the left hemisphere, no dissociation was found. The results are interpreted in terms of two distinct conceptual organisations in the brain, one specialised in the right hemisphere and based on family resemblances/prototypicality, and one specialised in the left hemisphere and possibly based on necessary and sufficient/logical definitions. The view adopted is that typicality effects are not obligatory in all classification systems.     

Detection of a new embryonic antigen (ESA-10) in the blood of patients with cancer: preliminary results in the United States

ESA-10 is an embryonic antigen expressed by tumor cells. A method to detect the antigen in the blood based on alterations in the erythrocyte sedimentation rate that occur when antiserum to ESA-10 is bound to the antigen in blood was devised and used here to determine the sensitivity and predictive value of the test in patients with biopsy proven non-hematologic malignancies, and in normal control subjects. The test was positive in 22 of 24 cancer patients tested, and negative in 30 of 35 control subjects. Of the five positive control subjects, one female had recently given birth and was lactating. Another control subject was recently diagnosed with prostate cancer, just months after having participated in this study. Therefore, this tumor marker test (Turtest^®) had a sensitivity of 91.7% and a positive predictive value of 81.5% in patients with biopsy proven cancer, and a specificity and negative predictive value in control subjects of 88.2 and 93.8%, respectively, if the control subject who subsequently developed prostate cancer is removed from the control group. Therefore, this simple test has potential as a clinically useful tumor marker with sensitivity and specificity equal to or greater than other commercially available tumor markers and should be explored further in larger studies.     

Endothelial Trophic Support of Neuronal Production and Recruitment from the Adult Mammalian Subependyma

Vascular endothelial cells are among the first cells that ventricular zone neuroblasts encounter during early development. The ventricular zone cells promote angiogenesis by the invading vasculature, with the release of endothelial mitogens. Yet the feedback support of young neurons by endothelial cells (ECs) has not hitherto been explored. We therefore asked whether ECs might participate in neuronal recruitment, by providing neurotrophic support to newly generated neurons. We used the neurogenic subependymal zone (SZ) of the adult rat forebrain as a model system, because of its well-characterized and relatively homogeneous population of neuronal precursor cells. We found that explants of the adult rat SZ raised on ECs generated more neurons, which survived longer, than explants raised on astrocytes, fibroblasts, or laminin. This endothelial trophic effect was humoral, in that it was also noted in SZ explants raised in noncontiguous coculture with ECs grown on porous inserts. RT-PCR for neurotrophin family members revealed that cultures of both human brain- and umbilical cord-derived ECs produced brain-derived neurotrophic factor (BDNF) mRNA, but no detectable NGF, NT-3, or NT-4 mRNA. ELISA revealed that BDNF protein was secreted by ECs into the medium at >1 ng/ml. The neurotrophic effect of ECs could be replaced by added BDNF, and was blocked by addition of 5 microg/ml trkB-Fc to endothelial-SZ cocultures. Thus, endothelial cells can act as sources of secreted BDNF, through which the capillary microvasculature may act to support neuronal recruitment and survival in the CNS.     

Unmet Needs for Mental Health Services for Latino Older Adults: Perspectives from Consumers, Family Members, Advocates, and Service Providers

This study qualitatively assessed the need for mental health services among Latino older adults in San Diego, California. The primary mental health issue was depression. Primary organizational barriers to accessing services were language and cultural barriers secondary to a lack of translators, dearth of information on available services, and scarcity of providers representative of the Latino community. Other challenges included a lack of transportation and housing, and the need for socialization and social support. Latino older adults experienced their unmet needs in ways associated with their cultural background and minority status. Age- and culturally-appropriate services are needed to overcome these barriers.     

Surgery: Should lysis of adhesions be performed when in-vitro fertilization and embryo transfer are available?

This study was undertaken to report the results of microsurgicallysis of peri-adnexal adhesions and identify the patients whoshould be offered surgery and those who should be treated byin-vitro fertilization (IVF). In all, 19 women had filmy adhesionsand 32 had dense adhesions; 68.4% of women with filmy adhesionsconceived compared with 34.4% of women with dense adhesions(P=0.02). In patients with filmy adhesions, the cumulative pregnancyrate 2 years after operation (47%) is similar to that reportedafter five cycles of IVF (52%), leading us to conclude thatsuch patients should be offered surgery first. Dense adhesionsare best treated by IVF. Lysis of filmy adhesions produces asimilar intra-uterine pregnancy rate whether performed by laparotomy(57.9%) or laparoscopy (56.6%). As operative laparoscopy offersthe greatest patient comfort, it is the treatment of choicein these patients.     

Hyperfractionated total body irradiation for bone marrow transplantation: I. early results in leukemia patients

Bone marrow transplantation following cytoreduction with total body irradiation and cyclopbospbamide has previously been shown to be of value in treating refractory leukemias. Major problems, however, have been fatal interstitial pneumonitis and leukmmac relapse. In an attempt to minimize these problems, we initiated a new hyperfractionsted regimen for total body irradiation, with partial long sparing. From May, 1979 throughJuly, 1980, we treated 48 leukemia patients according to this regimen, varying in age from 1.5 to 42 years old (mead age: 18 y). Analysis in September, 1980, with follow-up from 2–16 mos, showed that we have a significantly reduced incidence of interstitial pneumonitis compared with single dose (1000 rad) irradiation (33 vs 70%), as well as decreased deaths attributable to interstitial pneumonitis (23 vs 50%). This is reflected in the survival curves, with loss of the early drop in survival previously observed with single dose irradiation. One year actuarial survival was 65% for acute lympbocytic leukemia (n - 16) and 72% for acute non-lymphocytic leukemia (n - 29). This compares with only 17% for acute non-lympbocytic leukemia patients (n = 12) on our previous single dose regimen. Age was: also found to be an important parameter for both survival and interstitial pneumonitis.