Burnout status of healthcare workers in the world during the peak period of the COVID-19 pandemic

During the COVID-19 pandemic, healthcare workers have a high workload and have been exposed to various psychosocial stressors. This study aimed to evaluate health workers during the COVID-19 pandemic in the world. The method used in this research is qualitative with a literature review approach. The data sources in this study were taken from the Scopus database using the keywords “health workers,” “burnout,” AND “coronavirus” from the time range of 2020 to April 25, 2022. From the determination of the time range, 150 documents emerged. This study revealed that the Pearson correlation between total burnout scale scores on healthcare workers, professionals, exhaustion, mental, stress, personal, depression, symptoms, emergency, system, job, and impact indicated that overall burnout scores were associated with depression and anxiety. Stress symptoms had correlation values ranging from 0.84 to 0.73. Job burnout had a significant relationship with exhaustion at 0.89; depression r = 0.73), impacting a score of 0.66. At the same time, the fulfillment of professional and interpersonal disengagement showed a Pearson correlation between the total burnout scale scores on health workers, professionals, exhaustion, mental, stress, personal, depression, symptoms, emergency, system, job, and impact. Overall, the participants in health care workers worldwide experienced high levels of psychological distress. We also found that health workers dealing with COVID-19 pandemic patients were more likely to experience depression, stress, and burnout than health staff who were not personally involved in medical work. Furthermore, this study will be a follow-up study using the Work Ability Index (WAI) to measure work ability and work satisfaction

Situation report on COVID-19

With concerns of a simultaneous COVID-19 and influenza pandemic in the winter of 2022, preparations were being made for the upcoming tightening of inpatient and outpatient care. The mRNA vaccine, which was expected to be the trump card to converge the pandemic of COVID-19, has been shown high efficacy comparable to natural immunity by inducing humoral and cellular immunity. m-RNA vaccination has shown strong efficacy in preventing exacerbation. However, in the early stages of the COVID-19 epidemic, severe respiratory failure was seen in unvaccinated groups of 40s and 50s, and sometimes even in the group of 30s, severe pathology requiring intensive care management and high-level ventilator management had been essential for the treatments. As a result, the medical field has quickly tightened up and has been dealing with the situation with a sense of crisis. With repeated mutation, it is becoming increasingly understood that vaccination alone is not enough to converge the pandemic. In addition, the infectivity of the virus has increased greatly, and even if patients are promptly isolated from the first symptomatic patient, a high percentage of patients in the same space will be infected, making it extremely difficult to control infection in hospitals and elderly care facilities. Given these current conditions, it will be extremely difficult to control pandemics worldwide. However, as the rate of severe illness and mortality declines, a shift to category 5 infectious diseases is being discussed. There have been multiple evidence for the efficacy of universal masks from the early stages of the COVID-19 epidemic until recently. A recent report showed that in areas where the mask wearing requirement was discontinued, there was an increase of 44.9 cases per 1,000 people infected in the following 15 weeks to people in schools that continued to wear masks, which resulted corresponds to about 30% of all new infection cases that occurred in the targeted areas for this study during this period. It is very important to continue to be aware of the need to prevent the spread of infection by wearing masks and taking precautions against droplet infection on an individual basis for those who are symptomatic. After that, new items such as partitions and vinyl curtains have been introduced, as well as new eating habits. There have been scattered outbreaks of various infectious diseases, especially influenza every year, but we have never requested such many infection control measures for frontline healthcare workers and staff. Probably in the future, it will be necessary to review the infection control measures in order to recreate the mid to long-term plan that has been taken at the Infection Control Department, at the University of Tokushima Hospital. The three important items to prevent COVID-19 infection are : ⑴ how to detect symptomatic patients as soon as possible, ⑵ aerosol generation techniques and wearing the N95 during cough symptom treatment, and ⑶ thorough health observation prior to admission. However, these items were of fundamental importance in preventing outbreaks of many respiratory infections, including tuberculosis, even before the COVID-19 epidemic. Based on our experience with cluster interventions in medical care insurance facilities and my own hospital, It is safe to consider that this new type of coronavirus infection is a category 5 infection that is no longer overly feared, although it is a pathogen that can be transmitted at high rates if certain conditions are met. If a patient in the same room has COVID-19 and an aerosol generating procedure is performed, there is a high rate of infection in the same room. In facilities where cooperation is difficult to obtain because of dementia and so on, preventing clusters is even more difficult. However, patients with adaptions for hospitalization should be accepted by many medical institutions as class 5 infectious diseases. If patients with non-adaption for hospitalization should be observed at each facility with the infection control measures. And then the situation should be landed back to normal as soon as possible. It must be important to fully share practical knowledge and infection control techniques that have been cultivated through know how among administrative agencies, health centers, and medical facilities

An overview of Indonesian doctors in combating COVID-19

Background: Indonesia's COVID-19 pandemic is putting a strain on the ability of health systems around the world to adapt and maintain sustainable performance. Indonesia has had more than four million cases of the disease and more than 141 thousand deaths in Indonesia. The hospital, along with other healthcare facilities, contributes to providing comprehensive individual health care in outpatient, inpatient, and emergency settings. Changes in facilities for patient accommodation, and acquisition of personal protective equipment (PPE) are all going through substantial changes. As doctors and health workers continue to work on this case every day while out in the field, many of their colleagues become ill and some die as a result. The aim of the study was intended to provide an overview of the conditions faced by doctors in Indonesia in dealing with COVID-19.Methods: The researchers surveyed the situation of 270 Indonesian doctors and specialists working during the COVID-19 pandemic. The questionnaires adapted from the WHO risk assessment tool for healthcare workers were translated into Bahasa Indonesia and distributed from April 2021 to May 2021 using a retrospective study.Results: Most respondents were female (61.5%) with an average age of 27.7. Forty respondents (14.8%) had a history of COVID-19.Conclusions: Based on compliance with using PPE and compliance with washing hands, doctors in Indonesia had a low risk of contracting COVID-19 from the healthcare facility environment. Even so, a correlation was found between the history of COVID-19 and happiness at work

Targeting platelet-derived growth factor as a therapeutic approach in pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a progressive and lethal lung disease characterized by the proliferation of fibroblasts and deposition of extracellular matrix. Since the prognosis of IPF is still poor, novel therapeutic modalities are strongly required. For this reason, to find molecular target for therapy of IPF is of much importance. The recent understanding of pathogenesis in IPF indicates the critical role of alveolar epithelial type II cells (AECII) and fibroblasts. Although the detailed mechanisms involved in IPF is still unclear, various profibrotic mediators which are produced by the injured AECII are thought to play a role in the progression of pulmonary fibrosis via stimulating fibroblasts. Among them, platelet-derived growth factor (PDGF) is one of critical growth factors by stimulating the proliferation and migration of fibroblasts. In this review, we discuss the role of PDGF in pulmonary fibrosis and the possibility as a therapeutic target for IPF

SARS ノ キソ ト リンショウ : インナイ カンセン タイサク オ チュウシン ニ

The outbreak of severe acute respiratory syndrome （SARS） affected more than ８０００ patients and caused ７７４ deaths in the world. A novel coronavirus was identified as the causative agent and named as SARS-coronavirus. Infected persons initially show the full-like symptoms such as fever, chill, myalgia and malaise, and subsequently respiratory symptoms including cough and dyspnea occur. In some patients, a watery diarrhea also appears. About １０ to ２０％ of patients requires the admission and mechanical ventilation. The mortality rate was as high as １０％. On the other hand, nasocomial transmission was a prominent feature of SARS. Transmission of SARS mainly occures through large droplets and direct contact. However, the evidence for airbone transmission in SARS was also reported. To prevent nasocomial transmission, a proper use of personal protective equipment （PPE） including N９５ respirator, gloves, gown and face shield in addition to standard precaution. Here we review basic and clinical aspects of SARS, and present SARS infection control in Tokushima University Hospital

Clinical Significance of Carbapenem-Tolerant Pseudomonas aeruginosa Isolated in the Respiratory Tract

We often come across difficult to treat infections—even after administering appropriate antibiotics according to the minimal inhibitory concentration of the causative bacteria. Antibiotic tolerance has recently started to garner attention as a crucial mechanism of refractory infections. However, few studies have reported the correlation between clinical outcomes and antibiotic tolerance. This study aims to clarify the effect of antibiotic tolerance on clinical outcomes of respiratory tract infection caused by Pseudomonas aeuginosa (P. aeruginosa). We examined a total of 63 strains isolated from sputum samples of different patients and conducted a retrospective survey with the medical records of 37 patients with imipenem-sensitive P. aeruginosa infections. Among them, we selected 15 patients with respiratory infections, and they were divided into high-tolerance minimal bactericidal concentration for adherent bacteria (MBCAD)/minimal inhibitory concentration for adherent bacteria (MICAD) ≥ 32 (n = 9) group and low-tolerance MBCAD/MICAD ≤ 16 (n = 6) group for further investigations. The findings indicated that the high-tolerance group consisted of many cases requiring hospitalization. Chest computed tomography findings showed that the disease was more extensive in the high-tolerance group compared to the low-tolerance group. Regarding the bacterial phenotypic characterization, the high-tolerance group significantly upregulated the production of the virulence factors compared to the low-tolerance group. Our study provided evidence that carbapenem tolerance level is a potent prognostic marker of P. aeruginosa infections, and carbapenem tolerance could be a potential target for new antimicrobial agents to inhibit the progression of persistent P. aeruginosa infections

Safety and immunogenicity of sequential administration of PCV13 followed by PPSV23 in pneumococcal vaccine-naïve adults aged ≥ 65 years : Comparison of booster effects based on intervals of 0.5 and 1.0 year

Objective: An open-label study was conducted to compare the safety and immunogenicity of a　sequential administration of 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) between an interval of 0.5 (0.5-y) and 1 year (1.0-y) in adults aged ≥ 65 years. Methods: Pneumococcal vaccine-naïve adults aged ≥ 65 years (n = 129) received a sequential administration with an interval of 0.5-y or 1.0-y or received a single administration of PPSV23 (single PPSV23). We evaluated the immunogenicity before and 1 month after each vaccination and at 0.5-y intervals for 2 years. The primary endpoint was the increase in geometric mean fold rises (GMFRs) of immunoglobulin G (IgG) or opsonophagocytic activity (OPA) for eight common serotypes one month after one dose of PPSV23. The secondary endpoint was the safety profile for one dose of PPSV23. Results: One month after administration of PPSV23, the GMFRs of IgG considerably increased for five of eight serotypes in the 1.0-y interval group, whereas the GMFRs of IgG considerably increased for two serotypes in the 0.5-y interval group. Furthermore, GMFRs of OPA markedly increased for all eight serotypes in the 1.0-y interval group, while GMFRs of OPA markedly increased for four serotypes in the 0.5-y interval group. At 2 years after initial vaccination, GMFRs of IgG or OPA were higher for all serotypes, except for serotype 3, than those in the single PPSV23 group irrespective of intervals. No significant difference was found in the frequencies of local reactions of all grades between the two intervals. Conclusions: The 1.0-y interval provided better booster effects induced by PPSV23 than those of the 0.5-y interval in a sequential administration in pneumococcal vaccine-naïve adults aged ≥ 65 years. No difference was found in the safety profile between both intervals

ガン チリョウヤク ト フクサヨウ

In Japan, about one-half of population suffers from cancer in their lives, and one-third will die of it. Currently, we have three strategies in the treatment of cancer, i.e., surgical treatment, radiotherapy, and chemotherapy（drug therapy）. Most conventional chemotherapeutic drugs work by impairing cell division, resulting in apototic cell death. However, these drugs have potent side-effects including nausea and vomiting, diarrhea and constipation, anemia, hair loss, hemorrhage, immunosupression and myelosuppression, and secondary neoplasms due to disrupt normal cell growth. Some specific anti-cancer drugs are associated with organ-specific toxicities including cardiovascular disease（e.g., doxorubicin）and lung disease（e.g., bleomycin）. In addition, anti-cancer drugs are applied to patients with maximum tolerated dose（MTD）, side-effects are intolerable to the patients in most cases. In order to improve these unpleasant symptoms, some drugs are approved to cope with the side-effects of chemotherapy（synthetic G-CSF for neutropenia, ５-HT３ inhibitors to block one or more of the signals that cause nausea and vomiting）though, medical staffs should pay attention to these sign of side effects. By the way, recent advances in molecular biology have identified numerous genes and proteins involved in malignant transformation as targets of anticancer therapy. Many moleculartargeted agents are now applied at the bedside. Successful developments of trastuzumab in treating breast cancer, imatinib in chronic myeloid leukemia（CML）and gastrointestinal stromal tumors（ GISTs）, gefitinib and erlotinib in non-small cell lung cancer, sunitinib in GISTs and renal cell carcinoma（RCC）, sorafenib in RCC, and bevacizumab in colorectal cancer, have validated the concept of molecular targeting and raised expectations of patients and oncologists alike. These drugs have high selectivity for tumor cells, provide effective treatment, and produce fewer side effects than are seen with conventional anticancer agents. However, unexpected untoward results may occur during treatment. Special attention will be required