背景:卫生和护理人员(HCW)面临着SARS-CoV-2大流行的双重负担:作为受公共卫生紧急情况影响的社会成员,以及经历了对感染和感染他人的恐惧的HWC,污名,暴力,增加的工作负载,实践范围的变化,在其他人中。了解COVID-19大流行和其他国际关注的突发公共卫生事件(PHEIC)对HCW的短期和长期影响以及应对这些影响的相关干预措施,我们设计并进行了实时系统综述(LSR)。
方法:我们回顾了从MEDLINE-PubMed检索到的文献,Embase,Scopus,LILACS,世界卫生组织COVID-19数据库,ClinicalTrials.org和国际劳工组织数据库,从2000年1月到2021年12月出版。我们纳入了定量观察研究,实验研究,准实验,混合方法或定性研究;解决心理问题,身体健康、福祉和生活质量。审查针对的是HCW;以及干预措施和暴露,在COVID-19大流行或其他PHEIC期间实施。为了评估纳入研究的偏倚风险,我们使用了约翰娜·布里格斯研究所(JBI)的关键评估工具。使用meta汇总对数据进行定性合成,并进行meta分析以估计某些结局的汇总患病率。
结果:纳入综述的1013项研究主要是定量研究,横截面,具有中等偏差/质量风险,至少解决以下问题之一:心理健康问题,暴力,身体健康和福祉,和生活质量。此外,旨在解决PHEIC对HCW的短期和长期影响的干预措施,包括在审查中,虽然稀缺,主要是行为和个人导向,旨在通过制定个人干预措施来改善心理健康。有人指出,缺乏解决组织或系统瓶颈的干预措施。
结论:PHEIC影响了HCW的身心健康,对心理健康的影响最大。影响PHEIC错综复杂。审查揭示了医疗和护理服务交付的后果,随着计划外缺勤率的增加,服务中断和职业营业额破坏了对PHEIC的响应能力,特别挑战卫生系统的韧性。
BACKGROUND: Health and care workers (HCW) faced the double burden of the SARS-CoV-2 pandemic: as members of a society affected by a public health emergency and as HWC who experienced fear of becoming infected and of infecting others, stigma, violence, increased workloads, changes in scope of practice, among others. To understand the short and long-term impacts in terms of the COVID-19 pandemic and other public health emergencies of international concern (PHEICs) on HCW and relevant interventions to address them, we designed and conducted a living systematic review (LSR).
METHODS: We reviewed literature retrieved from MEDLINE-PubMed, Embase, SCOPUS, LILACS, the World Health Organization COVID-19 database, the ClinicalTrials.org and the ILO database, published from January 2000 until December 2021. We included quantitative observational studies, experimental studies, quasi-experimental, mixed methods or qualitative studies; addressing mental, physical health and well-being and quality of life. The review targeted HCW; and interventions and exposures, implemented during the COVID-19 pandemic or other PHEICs. To assess the risk of bias of included studies, we used the Johanna Briggs Institute (JBI) Critical Appraisal Tools. Data were qualitatively synthetized using meta-aggregation and meta-analysis was performed to estimate pooled prevalence of some of the outcomes.
RESULTS: The 1013 studies included in the review were mainly quantitative research, cross-sectional, with medium risk of bias/quality, addressing at least one of the following: mental health issue, violence, physical health and well-being, and quality of life. Additionally, interventions to address short- and long-term impact of PHEICs on HCW included in the review, although scarce, were mainly behavioral and individual oriented, aimed at improving mental health through the development of individual interventions. A lack of interventions addressing organizational or systemic bottlenecks was noted.
CONCLUSIONS: PHEICs impacted the mental and physical health of HCW with the greatest toll on mental health. The impact PHEICs are intricate and complex. The review revealed the consequences for health and care service delivery, with increased unplanned absenteeism, service disruption and occupation turnover that subvert the capacity to answer to the PHEICs, specifically challenging the resilience of health systems.