BackgroundHIV epidemic remains a major global health issue. Data from cost-effectiveness analyses base on CD4+ count and morbidity in patients with symptomatic and asymptomatic HIV infection. The approach adopted in these analyses includes many other factors, previously not investigated. Additionally, we evaluate the impact of sexual HIV transmission due to delayed cART on the cost-effectiveness of care.MethodsA lifetime Markov model (1-month cycle) was developed to estimate the cost per quality adjusted life years (QALY) for a 1- and 3-year delay in starting cART (as compared to starting immediately at linkage to care) lifetime costs, clinical outcomes and cost-effectiveness. Patients were categorized into having asymptomatic HIV, AIDS, Hodgkin’s Lymphoma, and non-AIDS defining condition. Mortality rates and utility values were obtained from published literature. The number of new infected persons was estimated on the basis of sexual orientation, the number of sexual partners per year, the number of sex acts per month, frequency of condom use and use of cART. For the input Test and Keep in Care (TAK) project cohort data were used. Costs of care, cART and potential life-years lost were based on estimated total costs and the difference in expected QALY gained between an HIV-positive and an average person in Polish population. Costs were based on real expenditures of the Ministry of Health, National Health Fund, available studies and experts’ opinion. Costs and effects were discounted at rates of 5% and 3.5%, respectively.ResultsInput data were available for 141 patients form TAK cohort. The estimated number of new HIV infections in low, medium and high risk transmission groups were 0.28, 0.61, 2.07 with 1 and 0.82, 1.80, 6.11 with a 3-year delay, respectively. This reflected QALY loss due to cART delay of 0.52, 1.13, 3.84 and 2.02, 4.43, 15.03 for a 1- and 3-year delay, respectively. If additional costs of treatment and potential life-years lost due to new HIV infections were not taken into account, initiating cART immediately at linkage to care was not cost-saving irrespective of cART delay. Otherwise, when additional costs and QALY lost due to new HIV infections were included, immediate cART initiation was cost-saving regardless of the chosen scenarios.ConclusionsIf new HIV infections are not taken into account, then starting cART immediately does not dominate comparing to delaying cART. When taking into account HIV transmission in cost–effectiveness analysis, immediate initiation of HIV treatment is a profitable decision from the public payer’s perspective.

Extended author information available on the last page of the article quality of life of males who transitioned to a widowed life. There has not been observed statistically significant change in terms of healthrelated quality of life between first and second wave of the survey among both widowed and divorced males and females.

AimsTo assess the prevalence of burnout and associated factors among healthcare workers (HCWs) working in a hospital admitting patients with COVID‐19.BackgroundBurnout among HCWs is related to age, gender and occupation. However, little is known about organisational factors associated with burnout during the COVID‐19 pandemic.DesignA cross‐sectional study of 1412 hospital HCWs (748 nurses) was carried out via online survey during the COVID‐19 pandemic between 4 and 19 January 2021.MethodsThe Maslach Burnout Inventory‐Human Services Survey, the Checklist Individual Strength questionnaire, the interRAI items covering mental health, the WHO questionnaire items assessing HCWs' preparedness and exposure to SARS‐CoV‐2 were used. Univariable and multivariable linear regression analyses were conducted to clarify factors associated with emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). This study adheres to the STROBE guidelines.ResultsBurnout prevalence varied from 10.0% to 22.0%. Most respondents (83.6%) reported low PA, 22.9% high EE and 18.7% high DP. Nurses and physicians had the highest levels of EE and DP. Staff exposed or uncertain if exposed to contaminated patients' body fluids and materials had higher levels of burnout. Preparedness (training) (b = 1.15; 95%CI 0.26 to 2.05) and adherence to infection prevention and control procedures (b = 1.57; 95%CI 0.67 to 2.47) were associated with higher PA, and accessibility of personal protective equipment (PPE) (b = −1.37; 95%CI ‐2.17 to −0.47) was related to lower EE. HCWs working in wards for patients with COVID‐19 reported lower EE (b = −1.39; 95%CI ‐2.45 to −0.32). HCWs who contracted COVID‐19 reported lower DP (b = −0.71, 95%CI ‐1.30 to −0.12).ConclusionsOrganisational factors such as better access to PPE, training, and adherence to infection prevention and control procedures were associated with a lower level of burnout.Relevance to clinical practiceHealthcare managers should promote strategies to reduce burnout among HCWs with regard to preparedness of all staff.

(1) Healthcare workers are exposed to increased risks of insomnia and aggression during the COVID-19 pandemic. The aim of the study was to assess insomnia, sleep disturbances, and aggression and identify the associated risk factors among healthcare workers during the COVID-19 pandemic. (2) A total of 264 healthcare workers participated in the study. The study was conducted with the diagnostic survey method, using the Buss–Perry Aggression Questionnaire, the Athens Insomnia Scale, the Pittsburgh Sleep Quality Index, and a self-administered questionnaire. (3) The vast majority of the respondents (81.06%) suffered from insomnia and had poor sleep quality (78.03%). Education (p = 0.038), marital status (p = 0.043), and working with patients suffering from COVID-19 (p = 0.024) were statistically significant contributors to insomnia. Age was found to significantly correlate with total aggression (r = −0.133 p = 0.031), verbal aggression (r = −0.138 p = 0.025), and anger (r = −0.151 p = 0.014). The analysis demonstrated statistically significant relationships between gender and physical aggression (p = 0.017), anger (p = 0.032), and hostility (p = 0.002). A statistically significant positive correlation between the quality of sleep as per the PSQI and all subscales of the BPAQ was found (p < 0.001). (4) A considerable proportion of HCWs experienced sleep disturbances during the outbreak, stressing the need to establish ways to reduce long-term adverse outcomes associated with chronic insomnia and mental health problems and adjust interventions under pandemic conditions.

The study explores the direct and indirect associations (i.e., through the extent of the level of loneliness and perceived social support) between internet use for instrumental purposes and the quality of life (QoL) among elderly females and males in Poland. Material and Methods:The analysis was based on 2001 face-to-face interviews performed among randomly selected individuals aged ≥65 years from the general population. The collected data was weighted to generalize the study sample for the reference population. The analysis was conducted using multiple linear regression models. The mediation effect was tested according to the Baron and Kenny approach. Results: The obtained results indicate that internet use for instrumental purposes is directly related to a better QoL of elderly Polish males. This positive effect among men also occurs indirectly, through the decrease in loneliness levels as well as the increase in social support scores. It has also been shown that among elderly females, the effect of internet use for instrumental purposes is not related to a better QoL, either directly or indirectly. Conclusions: Internet use for instrumental purposes seems to be important in enhancing a successful life among elderly male adults. However, these technologies are not associated with better QoL among females. Practitioners should be aware of these gender differences. The study adds to the previous studies by demonstrating that the feeling of loneliness and social support mediates the relationship between internet use for instrumental purposes and QoL among elderly males, whereas among elderly females this effect does not occur.