Background The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers. Aims In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes. Method From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country. Results A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries. Conclusions This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.

Objective In the fight against coronavirus disease-2019 (COVID-19), vaccination is vital in achieving herd immunity, with many Asian countries starting to vaccinate frontline workers. However, expedited vaccine development has led to hesitancy amongst the general population. We evaluated the willingness of healthcare workers to receive COVID-19 vaccine. Methods From 12 th to 21 st December 2020, we recruited 1720 healthcare workers from six countries, including China, India, Indonesia, Singapore, Vietnam and Bhutan. The self-administrated survey collected information on willingness to vaccinate, perception of COVID-19, vaccine concerns, COVID-19 risk profile, stigma, pro-socialness scale, and trust in health authorities. Results More than 95% of healthcare workers were willing to vaccinate. These participants were more likely to perceive the pandemic as severe, considered the vaccine safe, had less financial concerns, less stigmatization to the vaccine, increased pro-socialness mindset, and trust in health authorities. In multivariable analysis, high perceived risk index of the pandemic, lower physical harm index of vaccine, and high pro-socialness index were independent predictors. Conclusions Majority of healthcare workers in Asia are willing to receive COVID-19 vaccination. The perceived susceptibility, potential low risk of harm from the vaccine and pro-socialness are main drivers. These encouraging findings may help formulate vaccination strategies in other countries.

Background As the COVID-19 pandemic evolves, challenges in frontline work continue to impose a significant psychological impact on nurses. However, there is a lack of data on how nurses fared compared to other health care workers in the Asia-Pacific region. Objective This study aims to investigate (1) the psychological outcome characteristics of nurses in different Asia-Pacific countries and (2) psychological differences between nurses, doctors, and nonmedical health care workers. Methods Exploratory data analysis and visualization were conducted on the data collected through surveys. A machine learning modeling approach was adopted to further discern the key psychological characteristics differentiating nurses from other health care workers. Decision tree–based machine learning models (Light Gradient Boosting Machine, GradientBoost, and RandomForest) were built to predict whether a set of psychological distress characteristics (ie, depression, anxiety, stress, intrusion, avoidance, and hyperarousal) belong to a nurse. Shapley Additive Explanation (SHAP) values were extracted to identify the prominent characteristics of each of these models. The common prominent characteristic among these models is akin to the most distinctive psychological characteristic that differentiates nurses from other health care workers. Results Nurses had relatively higher percentages of having normal or unchanged psychological distress symptoms relative to other health care workers (n=233-260 [86.0%-95.9%] vs n=187-199 [74.8%-91.7%]). Among those without psychological symptoms, nurses constituted a higher proportion than doctors and nonmedical health care workers (n=194 [40.2%], n=142 [29.5%], and n=146 [30.3%], respectively). Nurses in Vietnam showed the highest level of depression, stress, intrusion, avoidance, and hyperarousal symptoms compared to those in Singapore, Malaysia, and Indonesia. Nurses in Singapore had the highest level of anxiety. In addition, nurses had the lowest level of stress, which is the most distinctive psychological outcome characteristic derived from machine learning models, compared to other health care workers. Data for India were excluded from the analysis due to the differing psychological response pattern observed in nurses in India. A large number of female nurses emigrating from South India could not have psychologically coped well without the support from family members while living alone in other states. Conclusions Nurses were least psychologically affected compared to doctors and other health care workers. Different contexts, cultures, and points in the pandemic curve may have contributed to differing patterns of psychological outcomes amongst nurses in various Asia-Pacific countries. It is important that all health care workers practice self-care and render peer support to bolster psychological resilience for effective coping. In addition, this study also demonstrated the potential use of decision tree–based machine learning models and SHAP value plots in identifying contributing factors of sophisticated problems in the health care industry.

Coronavirus disease 2019 (COVID-19) is an infectious disease that was later declared a pandemic. During a pandemic, excessive workloads cause an increase in physical symptoms, such as tension-type headaches, in medical personnel. Tension-type headache (TTH) is associated with decreased sleep quality which will lead to excessive daytime sleepiness (EDS) and fatigue syndrome. This study aims to determine the relationship between TTH and sleep quality, EDS, and fatigue syndrome in medical personnel during the pandemic. This study is a cross-sectional study conducted on health workers at Sebelas Maret University Hospital, Surakarta, Indonesia in March–August 2020. The relationship between TTH and three other variables was analyzed using the Spearman correlation test. Multiple logistic regression analysis was used to calculate the odds ratio (OR) of headache associated with the covariate. The Kruskal-Wallis test was used to compare sleep quality, EDS, and fatigue syndrome in the TTH, non-TTH headache, and control groups. There were 120 respondents (mean age 30.93±12.48) in this study. The Spearman correlation test found a weak positive correlation between TTH and the three dependent variables. OR sleep quality, EDS, and fatigue syndrome with the incidence of TTH respectively 2.33 (95% CI=1.18–5.11, p<0.001); 2.52 (CI 95%=1.17–4.79, p=0.001), and 4.46 (95% CI=2.71–7.69, p<0.001). The Kruskal-Wallis test showed that the TTH group had poorer sleep quality and more frequent EDS and fatigue syndrome. There is a significant relationship between TTH and sleep quality, EDS, and fatigue syndrome in medical personnel during the pandemic. HUBUNGAN NYERI KEPALA TIPE TEGANG DENGAN KUALITAS TIDUR, RASA KANTUK BERLEBIHAN DI SIANG HARI, DAN SINDROM KELELAHAN PADA TENAGA MEDIS SELAMA COVID-19Coronavirus disease 2019 (COVID-19) merupakan penyakit menular yang kemudian dinyatakan sebagai pandemi. Selama pandemi, beban kerja yang berlebihan menyebabkan peningkatan gejala fisik, seperti nyeri kepala tipe tegang (tension-type headache) pada tenaga medis. Tension-type headache (TTH) dikaitkan dengan penurunan kualitas tidur yang akan menyebabkan rasa kantuk berlebihan di siang hari (excessive daytime sleepiness, EDS) dan sindrom kelelahan. Penelitian ini bertujuan mengetahui hubungan TTH dengan kualitas tidur, EDS, dan sindrom kelelahan pada tenaga medis selama pandemi. Penelitian ini merupakan studi potong lintang yang dilakukan pada petugas kesehatan di RS Universitas Sebelas Maret, Surakarta, Indonesia pada Maret–Agustus 2020. Hubungan antara TTH dan tiga variabel lainnya dianalisis menggunakan uji korelasi Spearman. Analisis regresi logistik ganda digunakan untuk menghitung odds ratio (OR) nyeri kepala yang terkait dengan kovariat. Uji Kruskal-Wallis digunakan untuk membandingkan kualitas tidur, EDS, dan sindrom kelelahan pada kelompok TTH, nyeri kepala non-TTH, dan kontrol. Terdapat 120 responden (rerata usia 30,93±12,48). Uji korelasi Spearman menemukan korelasi positif lemah antara TTH dan tiga variabel terikat. OR kualitas tidur, EDS, dan sindrom kelelahan dengan kejadian TTH secara berurutan 2,33 (IK 95%=1,18–5,11; p<0,001); 2,52 (IK95 %=1,17–4,79; p=0,001); dan 4,46 (IK 95%=2,71–7,69; p<0,001). Uji Kruskal-Wallis menunjukkan bahwa kelompok TTH memiliki kualitas tidur yang lebih buruk dan lebih sering mengalami EDS, serta sindrom kelelahan. Terdapat hubungan yang signifikan TTH dengan kualitas tidur, EDS, dan sindrom kelelahan pada tenaga medis selama pandemi.

Background Coronavirus disease 2019 (COVID-19) is a disease designated as a global pandemic by the WHO that can manifest clinically as neurological disorders that can occur in the acute phase or after the acute phase (long COVID-19), such as headache, myalgia, anosmia, and cognitive impairment. These neurological disorders as symptoms of long COVID-19 are presumably caused by hypercoagulable conditions characterized by an increase in D-dimer level. This study aims to determine the correlation of long COVID-19 neurological symptoms with hypercoagulable conditions and the role of D-dimer as a biomarker of long COVID-19 neurological symptoms. MethodsThis was a cross-sectional study involving 31 patients with long COVID-19 symptoms. Admitted long COVID-19 cases with recorded D-dimer levels and definitive outcomes were included consecutively. Long COVID-19 neurological symptoms were collected. D-dimer level was measured using immunofluorescence assay and reported in fibrinogen equivalent units (ìg/mL). The correlation between D-dimer levels and neurological clinical manifestations was assessed by using ordinal regression analysis. The p-value of <0.05 was considered statistically significant. ResultsThe mean age of the subjects was 38.81 ± 11.58 years and 18 (58.06%) were female. Long COVID neurological symptoms comprised myalgia, anosmia and cephalgia, and most subjects complained of myalgia (80.65%). On multivariable analysis, long-COVID-19 neurological symptoms were significantly correlated with D-dimer [odds ratio (OR) = 1.05; p=0.020]. ConclusionThe number of neurological long COVID symptoms were significantly correlated with level of D-Dimer. Ultimately, more clarity is needed on the neurological impact of COVID-19, its diagnosis, and its treatment.