Isostrain among tourism employees in Tunisia during COVID-19 pandemic

Abstract Background Psychological and social factors related to work activity can improve or deteriorate the physical and mental health of employees. Since the COVID-19 pandemic, the psychological well-being of workers has been strongly affected. Particularly, jobs with isostrain characterized by high work demands and low work control, coupled with low social support, place employees at highest risk for poor mental health. We aimed to assess the factors associated with isostrain among employees in the tourism sector in Sousse. Methods A cross-sectional study was conducted between September and November 2020 among tourism workers belonging to 12 hotels and restaurants in Sousse, Tunisia, using a self-administered questionnaire. ‘Isostrain’ was assessed using the Karasek questionnaire. ‘Isostrain’ is a situation where there is a combination of ‘jobstrain’ (‘tension at work') and low social support (score below the median of the group). SPSS 20 software was used to analyze the data. Results A total of 226 workers were included. The mean age was 38.2 ± 9.6 years. The sex ratio was 2.7. The majority of employees (64.8%) were working at workplace during COVID-19 lockdown. The prevalence of isostrain was 5.4%. Isostrain was reported by 5.7% of women (p = 1). All workers older than 50 years did not have isostrain (p = 0.6). Moreover, isostrain was found among 6.6% of workers with less than 5 years of work experience (p = 0.4), 4.8% of married employees (p = 0.7), and 7.6% of employees with a university education (p = 0.53). Conclusions Isostrain can affect employees in the tourism sector. Social support should be promoted among workers to ensure good mental health. Key messages • Prevalence of isostrain in tourism sector of Sousse during COVID-19 pandemic is quite high. • Preventive strategies of mental health should be promoted at workplace in Tunisia.


Background:
Despite the growing awareness about nonprescription misuse of anxiolytics, there is not much evidence about people's behavior during the covid-19 lockdown when access to healthcare specialists was limited. Over the counter drug use has risen sharply in the past decades among college students and junior health care workers, yet, there are few studies reporting on the use of nonprescription medicine groups during the COVID-19 pandemic.

Methods:
A cross-sectional study among 163 second-year medical students of the Lithuanian University of Health Sciences was conducted in Kaunas, Lithuania with self-reported measures of anxiety and insomnia and comparing nonprescription medicine use for anxiety and insomnia before and during the covid-19 pandemic.

Results:
A near two-fold increase in the prevalence of anxiety and insomnia among Lithuanian medical students was reported during the covid-19 pandemic compared to before the onset of the pandemic (p < 0,001). The use of nonprescription medication increased during the pandemic (p < 0,001), in particular anxiolytics (p < 0,05). Once-weekly anxiolytic medication use increased from 8,0% before the pandemic to 14,7% during the pandemic. Regular nonprescription medicine use (2-3 times weekly) had more than tripled, from 2,4% to 9,2%. During the pandemic, almost a fifth of the respondents were increasingly searching for information on anxiolytic nonprescription medication online during the pandemic compared to before the pandemic.

Conclusions:
During the covid-19 pandemic, the prevalence of anxiety and insomnia increased among Lithuanian medical students, along with the practice of anxiolytic nonprescription medications. Lithuanian medical students increasingly practiced self-medication during the pandemic and found the information on nonprescription medication increasingly online, which offers opportunities for telemedicine.

Key messages:
During the covid-19 pandemic, the prevalence of anxiety and insomnia increased among Lithuanian medical students, along with the practice of anxiolytic nonprescription medications. During covid-19, Lithuanian medical students increasingly retrieved information on nonprescription medication online instead of consulting a pharmacist, offering opportunities for telemedicine. Cooperation among all the stakeholders involved as Church, travel agency, Regional Health Systems and Government Bodies has to be promoted for specific surveillance in religious MG events. hotels and restaurants in Sousse, Tunisia, using a selfadministered questionnaire. 'Isostrain' was assessed using the Karasek questionnaire. 'Isostrain' is a situation where there is a combination of 'jobstrain' ('tension at work') and low social support (score below the median of the group). SPSS 20 software was used to analyze the data.

Results:
A total of 226 workers were included. The mean age was 38.2 AE 9.6 years. The sex ratio was 2.7. The majority of employees (64.8%) were working at workplace during COVID-19 lockdown. The prevalence of isostrain was 5.4%. Isostrain was reported by 5.7% of women (p = 1). All workers older than 50 years did not have isostrain (p = 0.6). Moreover, isostrain was found among 6.6% of workers with less than 5 years of work experience (p = 0.4), 4.8% of married employees (p = 0.7), and 7.6% of employees with a university education (p = 0.53).

Conclusions:
Isostrain can affect employees in the tourism sector. Social support should be promoted among workers to ensure good mental health.

Background:
The COVID-19 pandemic caused a crisis in the Israeli healthcare system. The wave-like morbidity created an overload of epidemiological investigations, which led to delays and less than successful efforts to prevent infection. For this reason, Israel decided to mobilize the military for this purpose, creating a forced cooperation between the Ministry of Health (MOH) and the IDF, an expert in dealing with crises.

Aim:
To examine the implications of the forced encounter between the IDF and the healthcare system, including both tensions and cooperation efforts.

Methods:
Twenty in-depth interviews were carried out with MOH and IDF personnel in different roles at various levels towards the end of the second pandemic wave in Israel.

Findings:
The findings present a dual picture of cooperation and mutual respect, side by side with contradictions and conflicts. The feeling that the IDF came in to 'save the day' placed the healthcare people in an inferior position. Clearly, there was no explicit plan for division of authority. It was clear to the healthcare staff that they have the authority as the professionals, and to the IDF people that they have it as the 'saviors' brought in for this purpose. The healthcare people did see the potential of the military force mobilized for this purpose, but felt they were asked for their opinion only initially, when the military personnel had to study the system. As soon as they became familiar with it, they were no longer asked for advice, and control was given to the IDF. The findings also show that the MOH's qualitative professional approach often clashed with the IDF's action-based approach.

Conclusions:
The military was mobilized as a crisis expert in order to assist the healthcare system in managing said crisis, but in fact this

Background:
The PSIC study (Prospective Study of Intensivists and COVID-19) monitored the intensivists working in one of the two COVID-19 hub hospitals in Central Italy over 2 years from April 2020. This study showed how mental health varies in relation to the stressors posed by the different pandemic phases.

Methods:
In 4 surveys corresponding to the 4 pandemic waves, the intensivists were invited to indicate changes in work activity and measure their state of mental health using standardized questionnaires administered via SurveyMonkey.

Results:
During the pandemic there was a change in occupational stressors that led to insomnia, anxiety, depression, burnout, job dissatisfaction, unhappiness and intention to quit. The predominant stressors in the first wave were fear of unprotected exposure, distrust of safety measures, and compassion fatigue from having to inform relatives of the adverse outcome of treatment. In the second and third waves the workload, the monotony due to always following only one type of patient, the isolation, and the lack of time to meditate were the more relevant factors. The fourth wave added the stress deriving from interacting with anti-vax patients Conclusions: Specific prevention strategies have been developed and applied for each of the stress factors identified. Excessive workload and lack of time for meditation originated from lack of staff were remedied with extraordinary temporary hires. The management of compassion fatigue and relations with anti-vax people were addressed with specific policies and training. The monotony and isolation in COVID-19 wards can only be resolved through employee turnover in ordinary departments. Organizational and financial efforts are necessary to protect the health of intensivists during a pandemic.

Key messages:
Monitoring of critical care workers during the pandemic waves indicated the preventive measures necessary to ensure their mental health and quality of care. Protecting healthcare workers is a priority.