High levels of psychosocial distress among Australian frontline healthcare workers during the COVID-19 pandemic: a cross- sectional survey

Background The coronavirus disease 2019(COVID-19)pandemic has had a profound and prolonged impact on healthcare services and healthcare workers.Aims The Australian COVID-19 Frontline Healthcare Workers Study aimed to investigate the severity and prevalence of mental health issues,as well as the social,workplace and financial disruptions experienced by Australian healthcare workers during the COVID-19 pandemic.Methods A nationwide,voluntary,anonymous,single timepoint,online survey was conducted between 27 August and 23 October 2020.Individuals self-identifying as frontline healthcare workers in secondary or primary care were invited to participate.Participants were recruited through health organisations,professional associations or colleges,universities,government contacts and national media.Demographics,home and work situation,health and psychological well-being data were collected.Results A total of 9518 survey responses were received;of the 9518 participants,7846(82.4%)participants reported complete data.With regard to age,4110(52.4%)participants were younger than 40 years;6344(80.9%)participants were women.Participants were nurses(n=3088,39.4%),doctors(n=2436,31.1%),allied health staff(n=1314,16.7%)or in other roles(n=523,6.7%).In addition,1250(15.9%)participants worked in primary care.Objectively measured mental health symptoms were common:mild to severe anxiety(n=4694,59.8%),moderate to severe burnout(n=5458,70.9%)and mild to severe depression(n=4495,57.3%).Participants were highly resilient(mean(SD)=3.2(0.66)).Predictors for worse outcomes on all scales included female gender;younger age;pre-existing psychiatric condition;experiencing relationship problems;nursing,allied health or other roles;frontline area;being worried about being blamed by colleagues and working with patients with COVID-19.Conclusions The COVID-19 pandemic is associated with significant mental health symptoms in frontline healthcare workers.Crisis preparedness together with policies and practices addressing psychological well-being are needed.

Quantitative hepatitis B surface antigen in predicting recurrence of hepatitis B-related hepatocellular carcinoma after liver transplantation

Aim:Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) for chronic hepatitis B (CHB) can be associated with reappearance of hepatitis B surface antigen (HBsAg). The current study determined the significance of HBsAg qualitatively and quantitatively using a highly sensitive assay in recurrent HCC after transplantation. Methods:Consecutive patients with HBV-related HCC with LT were included. Oral nucleos(t)ide analogues without hepatitis B immune globulin were used as hepatitis B virus (HBV) prophylaxis. Quantitative HBsAg levels were performed at time of transplant, at 1 month, 3 and 6 months post transplant using a highly sensitive (hs)-HBsAg assay. Results:One hundred and fourteen patients were included, with a median follow-up of 80 months, with 24 cases of HCC recurrence, and a cumulative rate of 20.7% at 5 years. There was significant correlation between time of tumor recurrence and time of HBsAg reappearance (r = 0.551,P = 0.027). Early HCC recurrence was associated with higher median level of hs-HBsAg at the time of transplant (72.85vs. 69.70 IU/mL,P = 0.018). Using a hs-HBsAg cut-off level of 0.0005 IU/mL, patients with levels above this threshold at 3 and 6 months were associated with higher rate of early HCC recurrence (28.6%vs. 3.0% and 26.9%vs. 2.9% respectively, bothP =0.0006). There was no significant difference in HCC recurrence between positive and negative HBsAg using the conventional qualitative HBsAg assay. Conclusion:Serum hs-HBsAg levels of≥ 0.0005 IU/mL at 3 to 6 months after LT is associated with higher rates of early HCC recurrence, and may be useful as an early tumor marker.