The Impact of COVID-19 on the Mental-Emotional Wellbeing of Primary Healthcare Professionals: A Descriptive Correlational Study

The present study aimed to examine work environment related factors and frontline primary healthcare professionals’ mental-emotional wellbeing during the COVID-19 pandemic in school communities of Hong Kong. A total of 61 (20%) school health nurses (frontline primary healthcare professionals) participated in a cross-sectional online survey from March to June 2020. Outcomes of mental-emotional health were measured using the Mental Health Continuum-Short Form (14-item scale with three subscales related to emotional, social and psychological wellbeing); the Perceived Stress Scale (10-item scale with two subscales related to perceived helplessness and lack of self-efficacy; and the Coping Orientation to Problems Experienced Inventory (Brief COPE), a 28-item inventory with two subscales related to adaptive and maladaptive strategies. Almost half (42.6%) of participants experienced mental health problems. Those employed in government subsidized schools had signifi- cantly lower scores in mental health wellbeing than those who worked in private schools. Factors relating to increased mental health problems included lack of emotional support, inadequate training relating to infection prevention and control measures, disengagement and self-blame. A variety of factors influencing school health nurses’social, emotional and psychological wellbeing in their work environment during the COVID-19 pandemic were also reported. The mental-emotional wellbeing of school nurses may relate to their subjective feeling of loneliness as participants were the sole frontline primary healthcare professional working in the school community during the COVID-19 pandemic. Study findings provide relevant evidence for management teams to build a culture of psychological and social support into workplace policies and procedures. Continuous staff development and adequate social support are important to promote the mental-emotional wellbeing of primary healthcare professionals in school communities as they play a significant role in safeguarding resources during pandemics.     

Identifying patients at risk of emergency admission for colorectal cancer

Background:

Patients whose colorectal cancer is treated after an emergency admission tend to have late-stage cancer and a poor prognosis. We identified risk factors for an emergency admission by linking data from the National Bowel Cancer Audit (NBCA) and the English Hospital Episode Statistics (HES), an administrative database of all admissions to English National Health Service hospitals, which includes data on mode of admission.

Methods:

We identified all adults included in the NBCA with a primary diagnosis of bowel cancer, excluding cancer of the appendix, between August 2007 and July 2011 whose record could be linked to HES. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) for an emergency admission for colorectal cancer. All risk factors were adjusted for cancer site and calendar year.

Results:

97 909 adults were identified with a primary diagnosis of bowel cancer and 82 777 patients could be linked to HES. Patients who were older, female, of a non-white ethnic background, and more socioeconomically deprived, and those with dementia or cardiac, neurologic and liver disease had an increased risk of presenting as an emergency admission. The strongest risk factors were age (90 compared with 70 years: OR 2.99, 95% CI 2.84 to 3.15), dementia (OR 2.46, 2.18 to 2.79), and liver disease (OR 1.87, 1.69 to 2.08).

Conclusions:

Our study identifies risk factors that may impair health-seeking behaviour and access to healthcare. An earlier recognition of symptoms in patients with these risk factors may contribute to better outcomes.     

Initiation of postpartum contraception: A survey among health centre physicians and nurses in Finland

Objective

To examine self-reported professional practices of postpartum contraceptive counselling at Finnish community health centres.

Design

A survey study with self-administered online questionnaires.

Setting

All local municipalities (n = 107) in the Expert Responsibility Area of Tampere University Hospital in Western Finland in 2005.

Subjects

A total of 69 (64% of 107) health centre physicians and 80 (75%) nurses performing postpartum check-ups.

Main outcome measures

Contraceptive method most often initiated or recommended to breastfeeding women at postpartum visit; timing of postpartum initiation of hormonal and intrauterine contraceptive methods in relation to breastfeeding and resumption of menses.

Results

The most common contraceptive method initiated or recommended to breastfeeding women by both physicians (41%) and nurses (45%) was the condom, followed by progestin-only pills and intrauterine contraception. Few professionals recommended breastfeeding (lactational amenorrhea) as the only contraceptive method. Only eight (12%) physicians inserted a copper-releasing intrauterine device and five (7%) a levonorgestrel-releasing intrauterine system typically at the postpartum visit; the majority delayed the insertions until the resumption of menses. Fifty-three (77%) physicians initiated combined oral contraceptives mostly when breastfeeding was terminated and menses had returned. Over half of the municipalities involved in the study did not provide any medical contraceptives free of charge postpartum.

Conclusion

Professionals’ reports indicate that initiation of effective contraceptive methods is delayed after childbirth. In order to promote better postpartum contraception practices, updated evidence-based guidelines are needed.     

Women’s Cancers in Developing Countries: From Research to an Integrated Health Systems Approach

The article focuses on two women’s cancers, breast and cervical cancer, that are much more deadly indeveloping countries than in developed countries. Early detection can make a significant difference for thetreatment outcome of these two cancers and there are now cost-effective tools for prevention and screening. Theauthors propose a new public health approach to these two cancers in developing countries where resources foreffective cancer control are very limited and offer a framework for putting women’s cancers in developingcountries on the global public health agenda. The key areas are: 1. Proposals for a new, integrated public healthapproach to women’s cancers (breast and cervical) in resource poor settings; 2. Reviews of the evidence forcost-effective screening and early detection of breast and cervical cancer, and discussion of some of the lessonslearned from HIV/AIDS on an integrated health systems approach; 3. Outlines of ways to make a priority ofwomen’s cancers in developing countries on the political agenda of international agencies.