Dear Editor,
I write in response to your article discussing the perception and experience of healthcare workers during the Covid-19 pandemic. Firstly, I want to state that I found this article to be very intriguing, as I am a healthcare provider working on the frontline during the Covid-19 pandemic. The results of this study revealed that many healthcare workers’ concerns were geared toward the inadequate training, the shortage of personal protective equipment (PPE), inconsistency in guidelines, and prolonged testing of healthcare workers (HCWs). In addition, the results highlighted an increase in anxiety levels as persons fear contracting the virus and infecting their relatives.
Having been a healthcare provider working the frontline of the pandemic, I can relate to many of the negative factors stated in the study. In addition to inadequate training, prolonged results and the shortage of PPE’s, the mental impact and increased workload has also negatively affected the healthcare team. Furthermore, the article stated that some healthcare workers were relieved of their duties as a result of workers having to be quarantined. This is common in many facilities which leaves inadequate staff on the battlefield. Consequently, the shortage of staffing aids in work-related fatigue that also impacts mental health, thereby creating a crisis within a crisis. In another research, Mehdi et al. (2020) alluded to this by stating that in addition to the burnout and occupational...
Dear Editor,
I write in response to your article discussing the perception and experience of healthcare workers during the Covid-19 pandemic. Firstly, I want to state that I found this article to be very intriguing, as I am a healthcare provider working on the frontline during the Covid-19 pandemic. The results of this study revealed that many healthcare workers’ concerns were geared toward the inadequate training, the shortage of personal protective equipment (PPE), inconsistency in guidelines, and prolonged testing of healthcare workers (HCWs). In addition, the results highlighted an increase in anxiety levels as persons fear contracting the virus and infecting their relatives.
Having been a healthcare provider working the frontline of the pandemic, I can relate to many of the negative factors stated in the study. In addition to inadequate training, prolonged results and the shortage of PPE’s, the mental impact and increased workload has also negatively affected the healthcare team. Furthermore, the article stated that some healthcare workers were relieved of their duties as a result of workers having to be quarantined. This is common in many facilities which leaves inadequate staff on the battlefield. Consequently, the shortage of staffing aids in work-related fatigue that also impacts mental health, thereby creating a crisis within a crisis. In another research, Mehdi et al. (2020) alluded to this by stating that in addition to the burnout and occupational stress, exhaustion is correlated with depression and anxiety.
This study brings awareness to and insight on the experience of healthcare workers during the pandemic. While Covid-19 has globally impacted the healthcare system, I personally would like to see more studies addressing the mental health and physical burnout as there is an urgent need for resources to facilitate the physical fatigue and mental impact faced by the healthcare team. According to Zaghini et al., (2020) organizations that provide for the well-being of their employees improves performance and positively influences physical and mental health of healthcare providers. As mentioned in the study, psychological support, comprehensive training, collaboration, support groups, communication and strategic leadership are all factors that can provide confidence and create positive emotions that will motivate the healthcare team to deliver quality patient care amid the Covid-19 pandemic.
References
Mehdi, M., Waseem, M., Rehm, M. H., Aziz, N., Anjum, S., & Javid, M. A. (2020). Depression and anxiety in Health Care Workers during COVID-19. Biomedica, 36, 233–238.
Zaghini, F., Vellone, V., Maurici, M., Sestili, C., Mannocci, A. Eroli, E. Magnavita, N., La Torre, G., Alvaro, R., & Silli, A. (2020). The influence of work context and organizational well-being on psychophysical health of healthcare providers. La Medicina del lavoro, 111 (4), 306-320. doi:10.23749/mld.v111i4.9075
Dear editor,
This response is concerning your article exploring “Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the Uk”, published in 2020. The study is both informative and intriguing as it provided thorough information on what healthcare workers experienced during the pandemic. It is interesting to me because I am a nursing student who will be on the frontlines one day and possibly face similar circumstances like this. I empathize with healthcare workers who had to withstand the atrocious conditions of this ongoing pandemic.
According to the results in your research, healthcare workers suffered increased anxiety from fear of contracting the virus and transmitting it to loved ones, lack of testing, had limited protective equipment as well as very few guidance on properly donning personal protective equipment and having to reuse them caused significant distress. It was stated in a similar study that nurses signed up to care for patients, however, being faced with this disease has brought many fears for the nurses and their families (Rolle, 2020). Additionally, it was also conveyed in your research that nurses were redeployed back into the workforce, and graduation was fast-tracked for medical students. This is in congruence with Nagesh & Chakraborty (2020) study stating that health departments and ministries reached out to retired medical staff and those who spend more time in research, to return to clinical work and tide...
Dear editor,
This response is concerning your article exploring “Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the Uk”, published in 2020. The study is both informative and intriguing as it provided thorough information on what healthcare workers experienced during the pandemic. It is interesting to me because I am a nursing student who will be on the frontlines one day and possibly face similar circumstances like this. I empathize with healthcare workers who had to withstand the atrocious conditions of this ongoing pandemic.
According to the results in your research, healthcare workers suffered increased anxiety from fear of contracting the virus and transmitting it to loved ones, lack of testing, had limited protective equipment as well as very few guidance on properly donning personal protective equipment and having to reuse them caused significant distress. It was stated in a similar study that nurses signed up to care for patients, however, being faced with this disease has brought many fears for the nurses and their families (Rolle, 2020). Additionally, it was also conveyed in your research that nurses were redeployed back into the workforce, and graduation was fast-tracked for medical students. This is in congruence with Nagesh & Chakraborty (2020) study stating that health departments and ministries reached out to retired medical staff and those who spend more time in research, to return to clinical work and tide over the mounting pressures on the health system. This vividly reveals how the pandemic placed a serious strain on the healthcare system from staff being infected, exposed, and as a result having to be quarantined. The remaining staff faced longer working hours and strained patient to nurse ratios which caused significant burnout and additional stress. To fill this gap of staff shortage, additional help had to be brought in.
As I conclude, I commend your efforts for obtaining data from three sources such as UK healthcare review policy, mass media, and social media, and from interviews with participants as you stated in the methodology. The collection of data from multiple sources provides a more accurate depiction of the perceptions and experience of healthcare workers. I also commend you for highlighting the positive outcomes of the healthcare workers in such chaotic events to conclude your study such as healthcare workers having a healthy supportive work environment as well as learning to cope and work under this pressure. It was also great timing to capture the views of health personnel and, this expanded my knowledge on the various circumstances healthcare workers face, especially during a pandemic.
References
Rolle, R. (2020, September 23). Crisis Taking Heavy Toll on Nurses. The Tribune. http://www.tribune242.com/news/2020/sep/24/crisis-taking-heavy-toll-nurses/
Nagesh, S., & Chakraborty, S. (2020). Saving the frontline health workforce amidst the COVID-19 crisis: Challenges and recommendations. Journal of Global Health, 10(1), 1–4. https://doi.org/10.7189/jogh.10.010345
Dear Editor,
This response is in relation to your article Women and substance use in Delhi India published on November 19th ,2017. Your article piqued my interest, because I am a female and also, a nursing student. The prevalence and effects of substance abuse amongst women is extremely important as it relates to the women’s health, reproductive health, mental health, sexual transmitted infections and childbearing.
I agree that drug use among the female population is often stigmatized because it goes against female gender roles. The belief that women are only seen as nurturers, partners and mothers still exist today. Many cannot see beyond the soft femininity of women & gender roles that have been shaped by society from the beginning of time. According to, Hentchel et al (2019) men are characterized as more agentic than women, taking charge and being in control, and women are characterized as more communal than men, being attuned to others and building relationships.
There are many factors that contribute to substance use in women. I understand the correlation made between substance use and socioeconomic demographics such as education, employment and financial income. Aside from socioeconomic demographics, abuse factors such as trauma and abusive relationships contribute to substance abuse. As stated in your article drug use pushes women into a chaotic lifestyle. According to Harvard Heath(2010) women face tougher challenges and tend to progress more...
Dear Editor,
This response is in relation to your article Women and substance use in Delhi India published on November 19th ,2017. Your article piqued my interest, because I am a female and also, a nursing student. The prevalence and effects of substance abuse amongst women is extremely important as it relates to the women’s health, reproductive health, mental health, sexual transmitted infections and childbearing.
I agree that drug use among the female population is often stigmatized because it goes against female gender roles. The belief that women are only seen as nurturers, partners and mothers still exist today. Many cannot see beyond the soft femininity of women & gender roles that have been shaped by society from the beginning of time. According to, Hentchel et al (2019) men are characterized as more agentic than women, taking charge and being in control, and women are characterized as more communal than men, being attuned to others and building relationships.
There are many factors that contribute to substance use in women. I understand the correlation made between substance use and socioeconomic demographics such as education, employment and financial income. Aside from socioeconomic demographics, abuse factors such as trauma and abusive relationships contribute to substance abuse. As stated in your article drug use pushes women into a chaotic lifestyle. According to Harvard Heath(2010) women face tougher challenges and tend to progress more quickly from using an addictive substance to dependence which is a phenomenon known as telescoping.Some women are reduced to becoming addicted, sex workers, contracting sexually transmitted disease and ruining interpersonal relationship with family members. Substance abuse also, effects childbearing and reproductivity in women. According to, the National Institute of Drug Abuse (NIDA) (2020) substance use can increase the likelihood of infertility and early onset of menopause. Moreover, substance use during pregnancy can also, affect the developing featus.
According to Harvard Heath(2010), women develop medical or social consequences of addiction faster than men and often find it harder to quit using addictive substances, and are more susceptible to relapse. Therefore, additional interventions and assistance should be implemented to maintain rehabilitation and all aspects of health among women who battle with substance abuse. These implementations are not only specific to women in India but women worldwide.
References
Hentschel, T., Heilman, M., & Peus, C. (2019). The Multiple Dimensions of Gender Stereotypes:
A Current Look at Men’s and Women’s Characterizations of Others and Themselves. Front. Psychol. https://doi.org/https://doi.org/10.3389/fpsyg.2019.00011
National Institute of Drug Abuse. (2020). Substance Use in Women Research Report Summary. https://www.drugabuse.gov/publications/research-reports/substance-use-in....
Sharma, V., Sarna, A., Tun, W., Saraswati, L., Thior, I., Madan, I., & Luchters, S. (2017).
Women and substance use: a qualitative study on sexual and reproductive health of women who use drugs in Delhi, India, 1-8. https://doi.org/http://dx.doi.org/10.1136/bmjopen-2017-018530
Havard Mental Health Letter. (2010). Addiction In Women. https://www.health.harvard.edu/newsletter_article/addiction-in-women
Dear Editor,
The sentiments shared in the article Contamination and washing of cloth masks and risk of infection among hospital health workers in Vietnam: a post hoc analysis of a randomised controlled trial raises important concerns relating to health care today.
The world’s health care industry continues to grapple with the effects of the COVID 19 pandemic. Globally, this pandemic has created a significant shortage in Personal Protective Equipment (PPE). As it stands, the wearing of cloth masks during this pandemic in a hospital setting has ignited significant concerns. According to Bayona and Infantado (2020), “there is no direct evidence on the effects of cloth mask in preventing COVID-19 pandemic among health care workers …” (p. 2). Coupled with the aforementioned fact, many health care workers are further compromising their health, as well as the health of others when they improperly decontaminate these masks. I share similar sentiments with you on the basis that if hospitals have to utilize cloth masks then they should bear the burden of decontaminating them. Moreover, I strongly believe that policies need to be implemented and enforced when the use of cloth masks are required in the hospital. These polices should include the mandatory utilization of the facility’s laundry services and the wearing of cloth masks as stipulated by the institutional guidelines.
The World Health Organizations (WHO) recently disseminated their recommendations regardi...
Dear Editor,
The sentiments shared in the article Contamination and washing of cloth masks and risk of infection among hospital health workers in Vietnam: a post hoc analysis of a randomised controlled trial raises important concerns relating to health care today.
The world’s health care industry continues to grapple with the effects of the COVID 19 pandemic. Globally, this pandemic has created a significant shortage in Personal Protective Equipment (PPE). As it stands, the wearing of cloth masks during this pandemic in a hospital setting has ignited significant concerns. According to Bayona and Infantado (2020), “there is no direct evidence on the effects of cloth mask in preventing COVID-19 pandemic among health care workers …” (p. 2). Coupled with the aforementioned fact, many health care workers are further compromising their health, as well as the health of others when they improperly decontaminate these masks. I share similar sentiments with you on the basis that if hospitals have to utilize cloth masks then they should bear the burden of decontaminating them. Moreover, I strongly believe that policies need to be implemented and enforced when the use of cloth masks are required in the hospital. These polices should include the mandatory utilization of the facility’s laundry services and the wearing of cloth masks as stipulated by the institutional guidelines.
The World Health Organizations (WHO) recently disseminated their recommendations regarding the construction and maintenance of cloth masks. WHO stipulates that cloth masks should have three layers. Moreover, WHO recommended that for each layer a different material should be used. The WHO also states that washing methods will vary depending on the type of materials used (WHO, 2020). It is imperative that health care institutions follow the necessary guidelines in order to decrease the likelihood of transmission and spreading of infection among health care workers utilizing cloth masks. Your article was very informative and it raises awareness regarding the concerns associated with the use and decontamination of cloth masks. In the near future, I am anticipating further research regarding this topic, particularly utilizing larger sample sizes.
References
World Health Organization. (2020). Advice on the use of masks in the context of COVID-19. https://apps.who.int/iris/bitstream/handle/10665/332293/WHO-2019-nCov-IP...
Bayona, H. H. G. & Infantado, M. A. J. (2020). Are cloth masks effective in preventing COVID-19 infections? https://www.researchgate.net/publication/343432092_Are_cloth_masks_effec...
Thank you for your response and interest in our study!
You refer to the studies by Tidemalm et al (1) and Beckman et al (2), both very interesting and important studies who comment on risk factors for suicide in the long term.
Tidemalm et al. (1) investigate suicide risk in suicide attempters with a specific focus on psychiatric disorders. We refer repeatedly to this study and make similar findings in regard to diagnoses, though our scope of investigated risk factors was wider. Further, the diagnoses in Tidemalm et al:s study was assessed in psychiatric in-patient care, while in ours at a medical emergency unit. Their finding that health care efforts are of high importance in the first two years following the suicide attempt is in line with our finding that a large portion (53%) of individuals died within the first five years, though we did not analyse risk factors after two years specifically.
Beckman et al. (2) make important conclusions of the long-term risk of suicide, though they investigate a somewhat different type of sample; self-harming young people (i.e. not specifically suicide attempters) admitted to in-patient care. We did not investigate self-harm defined more broadly and it is beyond the scope of our study to comment on the risk factors for suicide associated with this.
Thank you once again for your comments!
Kind regards,
Sara Probert-Lindström, Jonas Berge, Åsa Westrin, Agneta Öjeha...
Thank you for your response and interest in our study!
You refer to the studies by Tidemalm et al (1) and Beckman et al (2), both very interesting and important studies who comment on risk factors for suicide in the long term.
Tidemalm et al. (1) investigate suicide risk in suicide attempters with a specific focus on psychiatric disorders. We refer repeatedly to this study and make similar findings in regard to diagnoses, though our scope of investigated risk factors was wider. Further, the diagnoses in Tidemalm et al:s study was assessed in psychiatric in-patient care, while in ours at a medical emergency unit. Their finding that health care efforts are of high importance in the first two years following the suicide attempt is in line with our finding that a large portion (53%) of individuals died within the first five years, though we did not analyse risk factors after two years specifically.
Beckman et al. (2) make important conclusions of the long-term risk of suicide, though they investigate a somewhat different type of sample; self-harming young people (i.e. not specifically suicide attempters) admitted to in-patient care. We did not investigate self-harm defined more broadly and it is beyond the scope of our study to comment on the risk factors for suicide associated with this.
Thank you once again for your comments!
Kind regards,
Sara Probert-Lindström, Jonas Berge, Åsa Westrin, Agneta Öjehagen and Katarina Skogman Pavulans
References.
1. Tidemalm D, Långström N, Lichtenstein P, Runeson B. Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up. BMJ. 2008 Nov 18;337:a2205.
2. Beckman K, Mittendorfer-Rutz E, Lichtenstein P, Larsson H, Almqvist C, Runeson B, Dahlin M. Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort. Psychol Med. 2016 Dec;46(16):3397-3405.
This response is in relation to the article discussing Factors associated with mental health outcomes across healthcare settings in Oman during COVID-19: frontline versus non-frontline healthcare workers, published on October 10, 2020. After reading the article, truly this is an intriguing and very timely article. The results from this indicates that frontline healthcare workers are more likely to experience anxiety, stress and sleep problems as compared with non-frontline healthcare workers. However, the results also presented that both frontline and non-frontline healthcare workers showed no significant differences in depression status. In addition, this study emphasized and seemed to be congruent with other studies in suggesting that the Covid-19 pandemic has increased the rate of depressive symptoms, anxiety and insomnia among healthcare workers. Research studies like Tan, B.Y.Q., Chew, N.W.S, Lee G.K.H., et al. (2020) which also discovered that the primary outcome of the impact of Covid-19 was the prevalence of depression, stress, and anxiety among healthcare workers.
Furthermore, while being faced with the Covid-19 pandemic, there were various social limitations that were put into place including travel restrictions, quarantine, and curfews etc. These social restrictions and the fear of contracting Covid-19 was very stressful for me as a nursing student. I cannot imagine how this pandemic has impacted the mental health of frontline and non-frontline healthcar...
This response is in relation to the article discussing Factors associated with mental health outcomes across healthcare settings in Oman during COVID-19: frontline versus non-frontline healthcare workers, published on October 10, 2020. After reading the article, truly this is an intriguing and very timely article. The results from this indicates that frontline healthcare workers are more likely to experience anxiety, stress and sleep problems as compared with non-frontline healthcare workers. However, the results also presented that both frontline and non-frontline healthcare workers showed no significant differences in depression status. In addition, this study emphasized and seemed to be congruent with other studies in suggesting that the Covid-19 pandemic has increased the rate of depressive symptoms, anxiety and insomnia among healthcare workers. Research studies like Tan, B.Y.Q., Chew, N.W.S, Lee G.K.H., et al. (2020) which also discovered that the primary outcome of the impact of Covid-19 was the prevalence of depression, stress, and anxiety among healthcare workers.
Furthermore, while being faced with the Covid-19 pandemic, there were various social limitations that were put into place including travel restrictions, quarantine, and curfews etc. These social restrictions and the fear of contracting Covid-19 was very stressful for me as a nursing student. I cannot imagine how this pandemic has impacted the mental health of frontline and non-frontline healthcare workers. Moreover, from this article I understood that although it is important to control the spread of and treat Covid-19, it is also important to make the mental healthcare of frontline healthcare workers priority. I strongly agree with this stance.
This was quite a timely research study that gave insight on the factors associated with mental health outcomes of Covid-19 of frontline versus non-frontline healthcare workers.
In addition, immediate implementation of special interventions to promote mental health of both frontline and non-frontline health care workers exposed to COVID-19 should be considered.
Reference
Tan, B.Y.Q., Chew, N.W.S., Lee, G.K.H., et al. (2020) Psychological impact of the COVID-19 pandemic on health care workers in Singapore. Annals of International Medicine. 173(4), 317-320. https://doi.org/10.7326/M20-1083
Conflict of Interest:
None declared.
Siriwardhana et al. examined the association between frailty and disability in rural community-dwelling older adults, aged ≥ 60 years, in Sri Lanka (1). About 15.2% were frail and 48.5% were prefrail. The prevalence of ≥1 instrumental activities of daily living (IADL) limitations was 84.4% among frail adults. 38.7% of frail adults reported ≥1 basic activities of daily living (BADL) limitations. In addition, 58.3% reported both ≥1 physical and cognitive IADL limitations. Furthermore, the odds of being frail for having no IADL limitations significantly decreased. I have some concerns about their study.
The same authors described the prevalence and associated sociodemographic factors of frailty and pre-frailty (2). They found a strong association of frailty and pre-frailty with aging. In addition, longest-held occupation had a strong association with frailty, and education level was strongly associated with pre-frailty. Furthermore, prevalence of frailty was relatively lower in high-income and upper middle-income countries, compared with prevalence in Sri Lanka. The same authors also evaluated the association of frailty status with overall and domain-specific quality of life (QoL) (3). The estimated reduction in the total quality of life (QoL) score was 7.3% for those frail and 2.1% for those with pre-frail. These reductions could be explained by 'health' and 'independence, control over life and freedom' QoL domains. I suppose that aging, ethnicit...
Siriwardhana et al. examined the association between frailty and disability in rural community-dwelling older adults, aged ≥ 60 years, in Sri Lanka (1). About 15.2% were frail and 48.5% were prefrail. The prevalence of ≥1 instrumental activities of daily living (IADL) limitations was 84.4% among frail adults. 38.7% of frail adults reported ≥1 basic activities of daily living (BADL) limitations. In addition, 58.3% reported both ≥1 physical and cognitive IADL limitations. Furthermore, the odds of being frail for having no IADL limitations significantly decreased. I have some concerns about their study.
The same authors described the prevalence and associated sociodemographic factors of frailty and pre-frailty (2). They found a strong association of frailty and pre-frailty with aging. In addition, longest-held occupation had a strong association with frailty, and education level was strongly associated with pre-frailty. Furthermore, prevalence of frailty was relatively lower in high-income and upper middle-income countries, compared with prevalence in Sri Lanka. The same authors also evaluated the association of frailty status with overall and domain-specific quality of life (QoL) (3). The estimated reduction in the total quality of life (QoL) score was 7.3% for those frail and 2.1% for those with pre-frail. These reductions could be explained by 'health' and 'independence, control over life and freedom' QoL domains. I suppose that aging, ethnicity and socioeconomic status should be considered for evaluating the relationship between frailty, disability and QoL.
Kojima conducted a meta-analysis to examine the association between baseline frailty status and subsequent risk of developing or worsening ADL and IADL disabilities among community-dwelling older people (4). Overall, frail/prefrail older people were more likely to develop or worsen disabilities, presenting increased pooled odds ratios for ADL and IADL, although there existed high heterogeneity. By summing-up data of prospective high-quality studies, risk estimation might become more stable.
References
1. Siriwardhana DD, Weerasinghe MC, Rait G, Scholes S, Walters KR. Association between frailty and disability among rural community-dwelling older adults in Sri Lanka: a cross-sectional study. BMJ Open. 2020 Mar 29;10(3):e034189.
2. Siriwardhana DD, Weerasinghe MC, Rait G, Falcaro M, Scholes S, Walters KR. Prevalence of frailty in rural community-dwelling older adults in Kegalle district of Sri Lanka: a population-based cross-sectional study. BMJ Open. 2019 Jan 25;9(1):e026314.
3. Siriwardhana DD, Weerasinghe MC, Rait G, Scholes S, Walters KR. The association between frailty and quality of life among rural community-dwelling older adults in Kegalle district of Sri Lanka: a cross-sectional study. Qual Life Res. 2019 Aug;28(8):2057-2068.
4. Kojima G. Frailty as a predictor of disabilities among community-dwelling older people: a systematic review and meta-analysis. Disabil Rehabil. 2017 Sep;39(19):1897-1908.
The survey reported by Dost et al [1] across 40 UK medical schools provides a thorough and valuable insight into medical students’ perceptions of the move to online teaching consequent upon the Covid 19 pandemic. Most respondents (75.99%; n=1842) felt that “online teaching had not successfully replaced the clinical teaching they had received via direct patient contact”. The authors conclude that clinical skills remain “ a pertinent barrier” to effective online teaching of medical students. [1] In anticipation of the challenges posed by the current pandemic to undergraduate medical education, Rose has asserted that “medical schools will need to be nimble and flexible in their response”.[2]
Our initial experience of employing the Microsoft Hololens 2 for teaching of Final Year medical students indicates that certain of the “direct patient contact” elements can be provided remotely. Having a bedside clinician (wearing the Hololens) share a rendered mixed reality with remote students may also enable a degree of vertical or horizontal integration that would be difficult in the setting of a traditional bedside ward round. For instance, an image of a schematic depicting the Mallampati Classification for predicting difficulty with management of the upper airway can be “pinned” adjacent to the mouth of the person whose airway is being evaluated. Although our experience with mixed reality in this setting is limited, preliminary student and teacher feedback is positive. We...
The survey reported by Dost et al [1] across 40 UK medical schools provides a thorough and valuable insight into medical students’ perceptions of the move to online teaching consequent upon the Covid 19 pandemic. Most respondents (75.99%; n=1842) felt that “online teaching had not successfully replaced the clinical teaching they had received via direct patient contact”. The authors conclude that clinical skills remain “ a pertinent barrier” to effective online teaching of medical students. [1] In anticipation of the challenges posed by the current pandemic to undergraduate medical education, Rose has asserted that “medical schools will need to be nimble and flexible in their response”.[2]
Our initial experience of employing the Microsoft Hololens 2 for teaching of Final Year medical students indicates that certain of the “direct patient contact” elements can be provided remotely. Having a bedside clinician (wearing the Hololens) share a rendered mixed reality with remote students may also enable a degree of vertical or horizontal integration that would be difficult in the setting of a traditional bedside ward round. For instance, an image of a schematic depicting the Mallampati Classification for predicting difficulty with management of the upper airway can be “pinned” adjacent to the mouth of the person whose airway is being evaluated. Although our experience with mixed reality in this setting is limited, preliminary student and teacher feedback is positive. We believe that various forms of mixed reality teaching may have a role in clinical education, in particular when access to “face to face” patient encounters is limited.
References.
1. Dost S, Hossain A, Shehab M, et al. Perceptions of medical students towards online teaching during the COVID-19 pandemic: a national cross-sectional survey of 2721 UK medical students. BMJ Open 2020;10:e042378. doi:10.1136/ bmjopen-2020-042378.
2. Rose S. Medical Student Education in the Time of COVID-19. JAMA 2020; 323(21):2131-2.
This study is a useful addition to the far wider literature regarding the stalling in life expectancy observed in places around the world. May I recommend several avenues of further investigation to the authors and/or others seeking to explore this area.
My own published and unpublished research indicates that the output area classification of social groups gives far greater insight into health behaviours than deprivation [1,2]. Hence the observation in this study that areas of similar deprivation show different life expectancies. Deprivation is merely a crude pointer to social group. In an unpublished study of hospital admission via A&E the role of deprivation completely disappeared after adjusting for social group.
Further research into the role of influenza rates on the expression of excess winter mortality is relevant [3]. This study is about to be published and shows curious spatio-temporal differences between UK local authorities and between countries.
In a series of papers to be published in the Journal of Health Care Finance I have demonstrated an important role for population density in the transmission of infections and this adds a further layer of complexity to the spatio-temporal patterns. Preliminary investigation is available as a multi-series preprint which covered the spread of Covid-19 [4]. Issues relating to population density are profoundly important.
As a final area of interest I have been investigating strange patterns i...
This study is a useful addition to the far wider literature regarding the stalling in life expectancy observed in places around the world. May I recommend several avenues of further investigation to the authors and/or others seeking to explore this area.
My own published and unpublished research indicates that the output area classification of social groups gives far greater insight into health behaviours than deprivation [1,2]. Hence the observation in this study that areas of similar deprivation show different life expectancies. Deprivation is merely a crude pointer to social group. In an unpublished study of hospital admission via A&E the role of deprivation completely disappeared after adjusting for social group.
Further research into the role of influenza rates on the expression of excess winter mortality is relevant [3]. This study is about to be published and shows curious spatio-temporal differences between UK local authorities and between countries.
In a series of papers to be published in the Journal of Health Care Finance I have demonstrated an important role for population density in the transmission of infections and this adds a further layer of complexity to the spatio-temporal patterns. Preliminary investigation is available as a multi-series preprint which covered the spread of Covid-19 [4]. Issues relating to population density are profoundly important.
As a final area of interest I have been investigating strange patterns in deaths, which are observed around the world, and which are associated with unexplained patterns of higher medical admissions [See references in 5-10]. These patterns can only be described as shift up and down in deaths which behave in an identical way to an infectious outbreak. These patterns have a profound effect on UK local authority trends in deaths. Sickness absence in NHS workers follows the same patterns.
Hopefully these suggested avenues will yield further clarity.
References
1. Beeknoo N, Jones R. Using Social Groups to Locate Areas with High Emergency Department Attendance, Subsequent Inpatient Admission and Need for Critical Care. Journal of Advances in Medicine and Medical Research 2016; 18(6): 1-23. http://www.sciencedomain.org/abstract/16693
2. Beeknoo N, Jones R. Using social groups to locate areas of high utilization of critical care. Brit J Healthcare Management 2016; 22(11): 551-560.
3. Jones R. Excess winter mortality (EWM) and stalling international improvements in life expectancy and mortality rates. BJHCM 2020; (in press)
5. Jones R. Recurring outbreaks of an infection apparently targeting immune function, and consequent unprecedented growth in medical admission and costs in the United Kingdom: A review. Brit J Med and Medical Research 2015; 6(8): 735-770. doi: 10.9734/BJMMR/2015/14845
6. Jones R. A presumed infectious event in England and Wales during 2014 and 2015 leading to higher deaths in those with
neurological and other disorders. Journal of Neuroinfectious Diseases 2016; 7(1): 1000213 doi: 10.4172/2314-7326.1000213
7. Jones R. A reduction in acute thrombotic admissions during a period of unexplained increased deaths and medical admissions in the UK.
European Journal of Internal Medicine 2017; 46: e31-e33 doi: http://dx.doi.org/10.1016/j.ejim.2017.09.007
8. Jones R. Age-specific and year of birth changes in hospital admissions during a period of unexplained higher deaths in England. European Journal of Internal Medicine 45: 2-4. doi: http://dx.doi.org/10.1016/j.ejim.2017.09.039
9. Jones R. Periods of unexplained higher deaths and medical admissions have occurred previously – but were apparently ignored, misinterpreted or not investigated. European Journal of Internal Medicine 40: e18-e20. https://doi.org/10.1016/j.ejim.2017.11.004
Probert-Lindström et al. conducted a long-term prospective study to investigate the clinical risk factors of suicide among suicide attempters with special reference to follow-up period (1). Suicide and all-cause mortality were used as dependent variables. A diagnosis of psychosis at baseline represented the risk factor with the highest hazard ratio at >5 years of follow-up, followed by major depression and a history of suicide attempt. In addition, the severity of a suicide attempt showed a non-proportional association with the risk for suicide, and it was a relevant risk factor for suicide only within the first 5 years after an attempted suicide. The authors clarified that risk factors of suicide among suicide attempters differed according to the follow-up period, and I have two concerns about their study.
Tidemalm et al. conducted a follow-up study for 21-31 years to investigate the effect of coexistent psychiatric morbidity on risk of suicide after a suicide attempt (2). The adjusted HRs (95% CIs) of schizophrenia for completed suicide were 4.1 (3.5-4.8) in men and 3.5 (2.8-4.4) in women. In addition, the adjusted HRs (95% CIs) of bipolar/unipolar disorder for completed suicide were 3.5 (3.0-4.2) in men and 2.5 (2.1-3.0) in women. The increased risks for completed suicide were also found for other depressive disorder, anxiety disorder, alcohol misuse, drug misuse, and personality disorder. They pointed out that healthcare in the first two years after attempted...
Probert-Lindström et al. conducted a long-term prospective study to investigate the clinical risk factors of suicide among suicide attempters with special reference to follow-up period (1). Suicide and all-cause mortality were used as dependent variables. A diagnosis of psychosis at baseline represented the risk factor with the highest hazard ratio at >5 years of follow-up, followed by major depression and a history of suicide attempt. In addition, the severity of a suicide attempt showed a non-proportional association with the risk for suicide, and it was a relevant risk factor for suicide only within the first 5 years after an attempted suicide. The authors clarified that risk factors of suicide among suicide attempters differed according to the follow-up period, and I have two concerns about their study.
Tidemalm et al. conducted a follow-up study for 21-31 years to investigate the effect of coexistent psychiatric morbidity on risk of suicide after a suicide attempt (2). The adjusted HRs (95% CIs) of schizophrenia for completed suicide were 4.1 (3.5-4.8) in men and 3.5 (2.8-4.4) in women. In addition, the adjusted HRs (95% CIs) of bipolar/unipolar disorder for completed suicide were 3.5 (3.0-4.2) in men and 2.5 (2.1-3.0) in women. The increased risks for completed suicide were also found for other depressive disorder, anxiety disorder, alcohol misuse, drug misuse, and personality disorder. They pointed out that healthcare in the first two years after attempted suicide among patients with psychiatric morbidity was important to reduce the risk of suicide.
Beckman et al. estimated the risk of mental illness and suicide in adult who experienced self-harm in young adulthood with special reference to the follow-up period (3). They determined dependent variables as suicide, psychiatric hospitalization and psychotropic medication. Hazard ratio (HR) (95% confidence interval [CI]) of self-harm for subsequent suicide was 16.4 (12.9-20.9). Especially, HRs (95% CIs) of self-harm for subsequent psychiatric hospitalization and psychotropic medication in long-term follow-up were 6.3 (5.8-6.8) and 2.8 (2.7-3.0), respectively. Caution should be paid that the increased risk of suicide and psychotic disorders among self-harm patients in the young might be continued for more than 5 years, and continuous healthcare to prevent suicide and psychotic disorders is needed.
References
1. Probert-Lindström S, Berge J, Westrin Å, Öjehagen A, Skogman Pavulans K. Long-term risk factors for suicide in suicide attempters examined at a medical emergency in patient unit: results from a 32-year follow-up study. BMJ Open. 2020 Oct 31;10(10):e038794.
2. Tidemalm D, Långström N, Lichtenstein P, Runeson B. Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up. BMJ. 2008 Nov 18;337:a2205.
3. Beckman K, Mittendorfer-Rutz E, Lichtenstein P, Larsson H, Almqvist C, Runeson B, Dahlin M. Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort. Psychol Med. 2016 Dec;46(16):3397-3405.
Dear Editor,
Show MoreI write in response to your article discussing the perception and experience of healthcare workers during the Covid-19 pandemic. Firstly, I want to state that I found this article to be very intriguing, as I am a healthcare provider working on the frontline during the Covid-19 pandemic. The results of this study revealed that many healthcare workers’ concerns were geared toward the inadequate training, the shortage of personal protective equipment (PPE), inconsistency in guidelines, and prolonged testing of healthcare workers (HCWs). In addition, the results highlighted an increase in anxiety levels as persons fear contracting the virus and infecting their relatives.
Having been a healthcare provider working the frontline of the pandemic, I can relate to many of the negative factors stated in the study. In addition to inadequate training, prolonged results and the shortage of PPE’s, the mental impact and increased workload has also negatively affected the healthcare team. Furthermore, the article stated that some healthcare workers were relieved of their duties as a result of workers having to be quarantined. This is common in many facilities which leaves inadequate staff on the battlefield. Consequently, the shortage of staffing aids in work-related fatigue that also impacts mental health, thereby creating a crisis within a crisis. In another research, Mehdi et al. (2020) alluded to this by stating that in addition to the burnout and occupational...
Dear editor,
Show MoreThis response is concerning your article exploring “Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the Uk”, published in 2020. The study is both informative and intriguing as it provided thorough information on what healthcare workers experienced during the pandemic. It is interesting to me because I am a nursing student who will be on the frontlines one day and possibly face similar circumstances like this. I empathize with healthcare workers who had to withstand the atrocious conditions of this ongoing pandemic.
According to the results in your research, healthcare workers suffered increased anxiety from fear of contracting the virus and transmitting it to loved ones, lack of testing, had limited protective equipment as well as very few guidance on properly donning personal protective equipment and having to reuse them caused significant distress. It was stated in a similar study that nurses signed up to care for patients, however, being faced with this disease has brought many fears for the nurses and their families (Rolle, 2020). Additionally, it was also conveyed in your research that nurses were redeployed back into the workforce, and graduation was fast-tracked for medical students. This is in congruence with Nagesh & Chakraborty (2020) study stating that health departments and ministries reached out to retired medical staff and those who spend more time in research, to return to clinical work and tide...
Dear Editor,
Show MoreThis response is in relation to your article Women and substance use in Delhi India published on November 19th ,2017. Your article piqued my interest, because I am a female and also, a nursing student. The prevalence and effects of substance abuse amongst women is extremely important as it relates to the women’s health, reproductive health, mental health, sexual transmitted infections and childbearing.
I agree that drug use among the female population is often stigmatized because it goes against female gender roles. The belief that women are only seen as nurturers, partners and mothers still exist today. Many cannot see beyond the soft femininity of women & gender roles that have been shaped by society from the beginning of time. According to, Hentchel et al (2019) men are characterized as more agentic than women, taking charge and being in control, and women are characterized as more communal than men, being attuned to others and building relationships.
There are many factors that contribute to substance use in women. I understand the correlation made between substance use and socioeconomic demographics such as education, employment and financial income. Aside from socioeconomic demographics, abuse factors such as trauma and abusive relationships contribute to substance abuse. As stated in your article drug use pushes women into a chaotic lifestyle. According to Harvard Heath(2010) women face tougher challenges and tend to progress more...
Dear Editor,
Show MoreThe sentiments shared in the article Contamination and washing of cloth masks and risk of infection among hospital health workers in Vietnam: a post hoc analysis of a randomised controlled trial raises important concerns relating to health care today.
The world’s health care industry continues to grapple with the effects of the COVID 19 pandemic. Globally, this pandemic has created a significant shortage in Personal Protective Equipment (PPE). As it stands, the wearing of cloth masks during this pandemic in a hospital setting has ignited significant concerns. According to Bayona and Infantado (2020), “there is no direct evidence on the effects of cloth mask in preventing COVID-19 pandemic among health care workers …” (p. 2). Coupled with the aforementioned fact, many health care workers are further compromising their health, as well as the health of others when they improperly decontaminate these masks. I share similar sentiments with you on the basis that if hospitals have to utilize cloth masks then they should bear the burden of decontaminating them. Moreover, I strongly believe that policies need to be implemented and enforced when the use of cloth masks are required in the hospital. These polices should include the mandatory utilization of the facility’s laundry services and the wearing of cloth masks as stipulated by the institutional guidelines.
The World Health Organizations (WHO) recently disseminated their recommendations regardi...
Dear Professor Kawada,
Thank you for your response and interest in our study!
You refer to the studies by Tidemalm et al (1) and Beckman et al (2), both very interesting and important studies who comment on risk factors for suicide in the long term.
Tidemalm et al. (1) investigate suicide risk in suicide attempters with a specific focus on psychiatric disorders. We refer repeatedly to this study and make similar findings in regard to diagnoses, though our scope of investigated risk factors was wider. Further, the diagnoses in Tidemalm et al:s study was assessed in psychiatric in-patient care, while in ours at a medical emergency unit. Their finding that health care efforts are of high importance in the first two years following the suicide attempt is in line with our finding that a large portion (53%) of individuals died within the first five years, though we did not analyse risk factors after two years specifically.
Beckman et al. (2) make important conclusions of the long-term risk of suicide, though they investigate a somewhat different type of sample; self-harming young people (i.e. not specifically suicide attempters) admitted to in-patient care. We did not investigate self-harm defined more broadly and it is beyond the scope of our study to comment on the risk factors for suicide associated with this.
Thank you once again for your comments!
Kind regards,
Sara Probert-Lindström, Jonas Berge, Åsa Westrin, Agneta Öjeha...
Show MoreThis response is in relation to the article discussing Factors associated with mental health outcomes across healthcare settings in Oman during COVID-19: frontline versus non-frontline healthcare workers, published on October 10, 2020. After reading the article, truly this is an intriguing and very timely article. The results from this indicates that frontline healthcare workers are more likely to experience anxiety, stress and sleep problems as compared with non-frontline healthcare workers. However, the results also presented that both frontline and non-frontline healthcare workers showed no significant differences in depression status. In addition, this study emphasized and seemed to be congruent with other studies in suggesting that the Covid-19 pandemic has increased the rate of depressive symptoms, anxiety and insomnia among healthcare workers. Research studies like Tan, B.Y.Q., Chew, N.W.S, Lee G.K.H., et al. (2020) which also discovered that the primary outcome of the impact of Covid-19 was the prevalence of depression, stress, and anxiety among healthcare workers.
Show MoreFurthermore, while being faced with the Covid-19 pandemic, there were various social limitations that were put into place including travel restrictions, quarantine, and curfews etc. These social restrictions and the fear of contracting Covid-19 was very stressful for me as a nursing student. I cannot imagine how this pandemic has impacted the mental health of frontline and non-frontline healthcar...
Siriwardhana et al. examined the association between frailty and disability in rural community-dwelling older adults, aged ≥ 60 years, in Sri Lanka (1). About 15.2% were frail and 48.5% were prefrail. The prevalence of ≥1 instrumental activities of daily living (IADL) limitations was 84.4% among frail adults. 38.7% of frail adults reported ≥1 basic activities of daily living (BADL) limitations. In addition, 58.3% reported both ≥1 physical and cognitive IADL limitations. Furthermore, the odds of being frail for having no IADL limitations significantly decreased. I have some concerns about their study.
The same authors described the prevalence and associated sociodemographic factors of frailty and pre-frailty (2). They found a strong association of frailty and pre-frailty with aging. In addition, longest-held occupation had a strong association with frailty, and education level was strongly associated with pre-frailty. Furthermore, prevalence of frailty was relatively lower in high-income and upper middle-income countries, compared with prevalence in Sri Lanka. The same authors also evaluated the association of frailty status with overall and domain-specific quality of life (QoL) (3). The estimated reduction in the total quality of life (QoL) score was 7.3% for those frail and 2.1% for those with pre-frail. These reductions could be explained by 'health' and 'independence, control over life and freedom' QoL domains. I suppose that aging, ethnicit...
Show MoreThe survey reported by Dost et al [1] across 40 UK medical schools provides a thorough and valuable insight into medical students’ perceptions of the move to online teaching consequent upon the Covid 19 pandemic. Most respondents (75.99%; n=1842) felt that “online teaching had not successfully replaced the clinical teaching they had received via direct patient contact”. The authors conclude that clinical skills remain “ a pertinent barrier” to effective online teaching of medical students. [1] In anticipation of the challenges posed by the current pandemic to undergraduate medical education, Rose has asserted that “medical schools will need to be nimble and flexible in their response”.[2]
Show MoreOur initial experience of employing the Microsoft Hololens 2 for teaching of Final Year medical students indicates that certain of the “direct patient contact” elements can be provided remotely. Having a bedside clinician (wearing the Hololens) share a rendered mixed reality with remote students may also enable a degree of vertical or horizontal integration that would be difficult in the setting of a traditional bedside ward round. For instance, an image of a schematic depicting the Mallampati Classification for predicting difficulty with management of the upper airway can be “pinned” adjacent to the mouth of the person whose airway is being evaluated. Although our experience with mixed reality in this setting is limited, preliminary student and teacher feedback is positive. We...
This study is a useful addition to the far wider literature regarding the stalling in life expectancy observed in places around the world. May I recommend several avenues of further investigation to the authors and/or others seeking to explore this area.
My own published and unpublished research indicates that the output area classification of social groups gives far greater insight into health behaviours than deprivation [1,2]. Hence the observation in this study that areas of similar deprivation show different life expectancies. Deprivation is merely a crude pointer to social group. In an unpublished study of hospital admission via A&E the role of deprivation completely disappeared after adjusting for social group.
Further research into the role of influenza rates on the expression of excess winter mortality is relevant [3]. This study is about to be published and shows curious spatio-temporal differences between UK local authorities and between countries.
In a series of papers to be published in the Journal of Health Care Finance I have demonstrated an important role for population density in the transmission of infections and this adds a further layer of complexity to the spatio-temporal patterns. Preliminary investigation is available as a multi-series preprint which covered the spread of Covid-19 [4]. Issues relating to population density are profoundly important.
As a final area of interest I have been investigating strange patterns i...
Show MoreProbert-Lindström et al. conducted a long-term prospective study to investigate the clinical risk factors of suicide among suicide attempters with special reference to follow-up period (1). Suicide and all-cause mortality were used as dependent variables. A diagnosis of psychosis at baseline represented the risk factor with the highest hazard ratio at >5 years of follow-up, followed by major depression and a history of suicide attempt. In addition, the severity of a suicide attempt showed a non-proportional association with the risk for suicide, and it was a relevant risk factor for suicide only within the first 5 years after an attempted suicide. The authors clarified that risk factors of suicide among suicide attempters differed according to the follow-up period, and I have two concerns about their study.
Tidemalm et al. conducted a follow-up study for 21-31 years to investigate the effect of coexistent psychiatric morbidity on risk of suicide after a suicide attempt (2). The adjusted HRs (95% CIs) of schizophrenia for completed suicide were 4.1 (3.5-4.8) in men and 3.5 (2.8-4.4) in women. In addition, the adjusted HRs (95% CIs) of bipolar/unipolar disorder for completed suicide were 3.5 (3.0-4.2) in men and 2.5 (2.1-3.0) in women. The increased risks for completed suicide were also found for other depressive disorder, anxiety disorder, alcohol misuse, drug misuse, and personality disorder. They pointed out that healthcare in the first two years after attempted...
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