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.

     

Ebstein's anomaly with the Wolff-Parkinson-White syndrome

Thirty-three patients were studied with Ebstein's anomaly, associated to Wolff-Parkinson-White syndrome with the purpose of analyze their electrophysiologic characteristics. In this patients the right preexcitation was before the activation of the right ventricle mass, overshadowing the manifestations of the right bundle branch block (usual in patients with Ebstein's anomaly without preexcitation). In conclusion the absence of manifestations of right bundle branch block in the presence of Ebstein's anomaly diagnosed by hemodynamic study or echocardiography let us think in the coexistence of the preexcitation and suggest the pertinent electrophysiologic study; as the association of supraventricular tachycardia in this group is very high (94%) most of them paroxysmal orthodromic tachycardia.     

Disorders of the rhythm and conduction in patients operated on for a total correction of tetralogy of Fallot

The purpose of this paper is to analyze the incidence of arrhythmias and conduction disturbances in 81 patients after total surgical repair of tetralogy of Fallot. The study was done at the National Institute of Cardiology "Ignacio Chávez" from 1974 to 1989. Sixty five patients (78.9%) developed a pattern of right bundle block and ten patients (12.3%) had additional left anterior hemiblock following surgery. Two patients had complete heart block so pacemaker was implanted. The incidence of serious ventricular arrhythmias was found in 11 patients often polymorphic ventricular premature complexes. One case sustained monomorphic ventricular tachycardia. Electrophysiological study demonstrated that it source was the scar of the right ventricle outflow tract. This tachycardia is now under control with specific antiarrhythmic therapy.