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Olds A, Tompkins A, Erkmen CP. History and Current Status of Well-being Among Organizations (Impact of Wellness on a Section, Division, Institution and Profession, ACGME Requirements, Policies). Thorac Surg Clin 2024; 34:249-259. [PMID: 38944452 DOI: 10.1016/j.thorsurg.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
The authors provide an overview of cultural adjustments and policy changes to support wellness in medicine. Subsequently, the data around wellness in cardiothoracic surgery, as well as policies and interventions that have been put into place to address wellness concerns in cardiothoracic surgery is discussed. The authors focus on both trainees and attendings and provide both a list of actions to address deficits in wellness management in the field, as well as resources available to promote well-being among cardiothoracic surgeons.
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Affiliation(s)
- Anna Olds
- Department of Surgery, University of Southern California, 1520 San Pablo Street, Suite 4300, Los Angeles, CA 90033, USA.
| | - Anastasiia Tompkins
- Center for Asian Health, Lewis Katz School of Medicine at Temple University, 3401 N. Broad Street, Suite 501, Philadelphia, PA, USA
| | - Cherie P Erkmen
- Department of Thoracic Medicine and Surgery, Temple University Hospital, 3401 N. Broad Street, Suite 501, Philadelphia, PA 19140, USA
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Quigley DD, Slaughter ME, Qureshi N, Hays RD. Associations of Primary Care Provider Burnout with Quality Improvement, Patient Experience Measurement, Clinic Culture, and Job Satisfaction. J Gen Intern Med 2024; 39:1567-1574. [PMID: 38273070 PMCID: PMC11255139 DOI: 10.1007/s11606-024-08633-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/12/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Burnout among providers negatively impacts patient care experiences and safety. Providers at Federally Qualified Health Centers (FQHC) are at high risk for burnout due to high patient volumes; inadequate staffing; and balancing the demands of patients, families, and team members. OBJECTIVE Examine associations of provider burnout with their perspectives on quality improvement (QI), patient experience measurement, clinic culture, and job satisfaction. DESIGN We conducted a cross-sectional provider survey about their perspectives including the single-item burnout measure. We fit separate regression models, controlling for provider type, gender, being multilingual, and fixed effects for clinic predicting outcome measures from burnout. PARTICIPANTS Seventy-four providers from 44 clinics in large, urban FQHC (52% response rate; n = 174). MAIN MEASURES Survey included a single-item, self-defined burnout measure adapted from the Physician Worklife Survey, and measures from the RAND AMA Study survey, Heath Tracking Physician survey, TransforMed Clinician and Staff Questionnaire, Physician Worklife Survey, Minimizing Errors Maximizing Outcomes survey, and surveys by Friedberg et al. 31 and Walling et al. 32 RESULTS: Thirty percent of providers reported burnout. Providers in clinics with more facilitative leadership reported not being burned out (compared to those reporting burnout; p-values < 0.05). More pressures related to patient care and lower job satisfaction were associated with burnout (p-values < 0.05). CONCLUSIONS Creating provider-team relationships and environments where providers have the time and space necessary to discuss changes to improve care, ideas are shared, leadership supports QI, and QI is monitored and discussed were related to not being burned out. Reducing time pressures and improving support needed for providers to address the high-need levels of FQHC patients can also decrease burnout. Such leadership and support to improving care may be a separate protective factor against burnout. Research is needed to further examine which aspects of leadership drive down burnout and increase provider involvement in change efforts and improving care.
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Affiliation(s)
- Denise D Quigley
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | | | - Nabeel Qureshi
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Ron D Hays
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Weinzimmer L, Hippler S. New insights into physician burnout and turnover intent: a validated measure of physician fortitude. BMC Health Serv Res 2024; 24:748. [PMID: 38890733 PMCID: PMC11186125 DOI: 10.1186/s12913-024-11186-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Given the increasing prevalence of the physician burnout, this study provides new insights into the antecedents driving burnout and turnover intent. By introducing the concept of physician fortitude, we develop a valid and statistically-reliable measure that increases our understanding of these issues. METHODS A two-sample design was employed. Using a sample of 909 physicians, Advanced Practice Providers (APPs) and healthcare leaders, exploratory factor analysis was employed to create a 12-item fortitude scale. In the second study, using a sample of 212 of practicing physicians, APPs and healthcare leaders, bivariate and tetrachoric correlations, and ordinary least square regression modeling were able to establish reliability and validity. RESULTS The fortitude scale shows sufficient reliability. Moreover, we found significant support for convergent and criterion-related validity. Fortitude was significantly related to all three subdimensions of burnout, including emotional exhaustion (r = -.62, p < .01), depersonalization (r = -.70, p < .01) and personal accomplishment (r = .65, p < .01), and turnover intent (r = -.55, p < .01). Moreover, the fortitude measure explained more variance in all three subdimensions of burnout and turnover intent compared to common measures, including grit, hardiness, mental toughness and resilience (p < .01). CONCLUSIONS Results from this study empirically demonstrate that fortitude is significantly related to burnout, and turnover intent. This new fortitude measure adds a new perspective to assist in the development of more effective interventions. Opportunities for future research are discussed.
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Affiliation(s)
- Laurence Weinzimmer
- Caterpillar Inc. Endowed Professor of Management, Bradley University, Peoria, IL, USA.
| | - Stephen Hippler
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
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Downs N, Davidson J, Haddad A, Zisook S. Learning from Health Care Counselors' Perspectives on Health Care Worker Distress: A Qualitative Analysis. HCA HEALTHCARE JOURNAL OF MEDICINE 2024; 5:285-296. [PMID: 39015588 PMCID: PMC11249175 DOI: 10.36518/2689-0216.1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Background Health care provider stress and emotional distress were well documented long before the COVID-19 pandemic, and there is growing data suggesting these have increased in response to the pandemic. The goal of this study was to take advantage of the unique experiences of licensed mental health (MH) clinicians working with health care trainees and clinicians before and during the pandemic to identify how this crisis affected both ongoing as well as new sources of stress. The Healer Education, Assessment and Referral Program (HEAR) provides MH screening, support, and MH referrals to ~19 000 health care students, trainees, staff, and faculty. Since its inception in 2009, the program has been staffed by 4 licensed counseling professionals who have worked both before and since the COVID-19 pandemic. Methods Qualitative data obtained from semi-structured, 1-hour interviews and a follow-up 1-hour focus group with 4 HEAR counselors was analyzed using reflexive thematic analysis. Results Several preexisting stressors were amplified during the pandemic: financial concerns; long work hours; exposure to the suffering of illness, death, and dying; bullying; discordant values and moral distress; social inequities; individuals' lack of adaptive coping; and individuals' self-concept as a victim. New stressors included: health care demand greater than the workforce numbers and resources; caretaking for ill family/friends; homeschooling of children; social isolation; experiencing the COVID-19 crisis as a war, fire, or storm; fear of personal illness and death, especially before vaccines; and hopes of a cure with vaccines; followed by perceived opportunities for improvement in leadership response to staff concerns. Conclusion Authentically responding to staff concerns/ideas, a patient and provider-centered health care culture, grief education and support, and attention to actionable stressors affecting providers' well-being are indicated to meet the amplified and new stressors triggered by the COVID-19 pandemic and sequelae.
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Affiliation(s)
- Nancy Downs
- University of California, San Diego, San Diego, CA
| | | | - Angela Haddad
- University of Guadalajara University Health Sciences Centre, Guadalajara, Jalisco,
Mexico
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Hadar PN, Gallani S, Moura L. Enhancing Value and Well-Being: The Basket of Motivators Framework for Aligning Neurology Clinical Practices With Performance Outcomes. Neurol Clin Pract 2024; 14:e200280. [PMID: 38586238 PMCID: PMC10997214 DOI: 10.1212/cpj.0000000000200280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/16/2024] [Indexed: 04/09/2024]
Abstract
Purpose of Review Physician burnout, which is prevalent in neurology, has accelerated in recent years. While multifactorial, a major contributing factor to burnout is a payment model that rewards volume over quality, leaving physicians overburdened and unfulfilled. The aim of this review was to investigate ways of reducing burnout while improving quality-based outcomes in a value-based health care model. Recent Findings Burnout affects researchers, educators, clinicians, and administrators in all fields and tracks, but neurologists experience some of the worst burnout rates among specialties. Transitioning to a value-based health care model, which rewards quality and outcomes over volume, may contribute to reversing the burnout trend. However, this requires that physicians feel valued in the workplace in ways corresponding to their preferences. We propose to stratify neurologists using the "basket of motivators" framework, which operates multiple individual-based and team-based motivators including balance among work responsibilities, work-life balance, institutional pride, self-actualization at work, work environment, and finances. By tailoring individual-based and team-based financial and nonfinancial incentives, neurologists are empowered to work at the top of their license to provide high-impact clinical care while combating the most prominent causes of burnout. Summary To address the neurologist burnout epidemic, a transition to value-based health care is needed that rewards quality-based performance outcomes through both individual-based and team-based approaches that apply financial and nonfinancial incentives. Understanding the underlying motivations behind neurologists' drives to work can inform tailored incentives that allow neurologists to provide value to their patients and feel valued by their organizations.
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Affiliation(s)
- Peter N Hadar
- Department of Neurology (PNH, LM), Massachusetts General Hospital; and Accounting and Management Unit (SG), Harvard Business School, Boston, MA
| | - Susanna Gallani
- Department of Neurology (PNH, LM), Massachusetts General Hospital; and Accounting and Management Unit (SG), Harvard Business School, Boston, MA
| | - Lidia Moura
- Department of Neurology (PNH, LM), Massachusetts General Hospital; and Accounting and Management Unit (SG), Harvard Business School, Boston, MA
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Lusk JB, Manandhar P, Thomas LE, O'Brien EC. Association between characteristics of employing healthcare facilities and healthcare worker infection rates and psychosocial experiences during the COVID-19 pandemic. BMC Health Serv Res 2024; 24:659. [PMID: 38783301 PMCID: PMC11119393 DOI: 10.1186/s12913-024-11109-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Healthcare facility characteristics, such as ownership, size, and location, have been associated with patient outcomes. However, it is not known whether the outcomes of healthcare workers are associated with the characteristics of their employing healthcare facilities, particularly during the COVID-19 pandemic. METHODS This was an analysis of a nationwide registry of healthcare workers (the Healthcare Worker Exposure Response and Outcomes (HERO) registry). Participants were surveyed on their personal, employment, and medical characteristics, as well as our primary study outcomes of COVID-19 infection, access to personal protective equipment, and burnout. Participants from healthcare sites with at least ten respondents were included, and these sites were linked to American Hospital Association data to extract information about sites, including number of beds, teaching status, urban/rural location, and for-profit status. Generalized estimating equations were used to estimate linear regression models for the unadjusted and adjusted associations between healthcare facility characteristics and outcomes. RESULTS A total of 8,941 healthcare workers from 97 clinical sites were included in the study. After adjustment for participant demographics, healthcare role, and medical comorbidities, facility for-profit status was associated with greater odds of COVID-19 diagnosis (aOR 1.76, 95% CI 1.02-3.03, p = .042). Micropolitan location was associated with decreased odds of COVID-19 infection after adjustment (aOR = 0.42, 95% CI 0.24, 0.71, p = .002. For-profit facility status was associated with decreased odds of burnout after adjustment (aOR = 0.53, 95% CI 0.29-0.98), p = .044). CONCLUSIONS For-profit status of employing healthcare facilities was associated with greater odds of COVID-19 diagnosis but decreased odds of burnout after adjustment for demographics, healthcare role, and medical comorbidities. Future research to understand the relationship between facility ownership status and healthcare outcomes is needed to promote wellbeing in the healthcare workforce. TRIAL REGISTRATION The registry was prospectively registered: ClinicalTrials.gov Identifier (trial registration number) NCT04342806, submitted April 8, 2020.
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Affiliation(s)
- Jay B Lusk
- Department of Neurology, Duke University, DUMC 3710, Durham, NC, USA.
- Department of Population Health Sciences, Duke University, Durham, NC, USA.
| | | | - Laine E Thomas
- Duke University Clinical Research Institute, Durham, NC, USA
| | - Emily C O'Brien
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke University Clinical Research Institute, Durham, NC, USA
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Stryker SD, Hargraves D, Velasquez V, Gottschlich M, Cafferty P, Vale D, Schlaudecker J, Pallerla H, Rich M. The Community Primary Care Champions Fellowship: a mixed methods evaluation of an interprofessional fellowship for physician assistants and physicians. BMC MEDICAL EDUCATION 2024; 24:556. [PMID: 38773571 PMCID: PMC11110310 DOI: 10.1186/s12909-024-05559-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/15/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND Primary care in the US faces challenges with clinician recruitment, retention, and burnout, with further workforce shortages predicted in the next decade. Team-based care can be protective against clinician burnout, and opportunities for interprofessional education (IPE) on professional development and leadership could encourage primary care transformation. Despite an increasingly important role in the primary care workforce, IPE initiatives training physician assistants (PAs) alongside physicians are rare. We describe the design, curriculum, and outcomes from an interprofessional primary care transformation fellowship for community-based primary care physicians and PAs. METHODS The Community Primary Care Champions (CPCC) Fellowship was a one-year, part-time fellowship which trained nine PAs, fourteen physicians, and a behavioralist with at least two years of post-graduate clinical experience in six content pillars: quality improvement (QI), wellness and burnout, mental health, social determinants of health, medical education, and substance use disorders. The fellowship included a recurring schedule of monthly activities in self-study, lectures, mentoring, and community expert evening discussions. Evaluation of the fellowship included pre, post, and one-year follow-up self-assessments of knowledge, attitudes, and confidence in the six content areas, pre- and post- wellness surveys, lecture and discussion evaluations, and midpoint and exit focus groups. RESULTS Fellows showed significant improvement in 24 of 28 self-assessment items across all content areas post-fellowship, and in 16 of 18 items one-year post-fellowship. They demonstrated reductions in emotional exhaustion and depersonalization post-fellowship and increased confidence in working in interprofessional teams post-fellowship which persisted on one-year follow-up assessments. All fellows completed QI projects and four presented their work at national conferences. Focus group data showed that fellows experienced collaborative, meaningful professional development that was relevant to their clinical work. They appreciated the flexible format and inclusion of interprofessional community experts in evening discussions. CONCLUSIONS The CPCC fellowship fostered an interprofessional community of practice that provided an effective IPE experience for physicians and PAs. The learning activities, and particularly the community expert discussions, allowed for a flexible, relevant experience, resulting in personal and professional growth along with increased confidence working within interprofessional teams.
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Affiliation(s)
- Shanna D Stryker
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML0582, Medical Sciences Building 4453C, Cincinnati, OH, 45267, USA.
| | - Daniel Hargraves
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML0582, Medical Sciences Building 4453C, Cincinnati, OH, 45267, USA
| | - Veronica Velasquez
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML0582, Medical Sciences Building 4453C, Cincinnati, OH, 45267, USA
| | - Melissa Gottschlich
- Department of Physician Assistant Studies, Mount St. Joseph University, Cincinnati, OH, USA
| | - Patrick Cafferty
- Department of Physician Assistant Studies, Mount St. Joseph University, Cincinnati, OH, USA
| | - Darla Vale
- Department of Physician Assistant Studies, Mount St. Joseph University, Cincinnati, OH, USA
| | - Jeff Schlaudecker
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML0582, Medical Sciences Building 4453C, Cincinnati, OH, 45267, USA
| | - Harini Pallerla
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML0582, Medical Sciences Building 4453C, Cincinnati, OH, 45267, USA
| | - Megan Rich
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML0582, Medical Sciences Building 4453C, Cincinnati, OH, 45267, USA
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Wang J, Leung L, Jackson N, McClean M, Rose D, Lee ML, Stockdale SE. The association between population health management tools and clinician burnout in the United States VA primary care patient-centered medical home. BMC PRIMARY CARE 2024; 25:164. [PMID: 38750457 PMCID: PMC11094957 DOI: 10.1186/s12875-024-02410-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/26/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Technological burden and medical complexity are significant drivers of clinician burnout. Electronic health record(EHR)-based population health management tools can be used to identify high-risk patient populations and implement prophylactic health practices. Their impact on clinician burnout, however, is not well understood. Our objective was to assess the relationship between ratings of EHR-based population health management tools and clinician burnout. METHODS We conducted cross-sectional analyses of 2018 national Veterans Health Administration(VA) primary care personnel survey, administered as an online survey to all VA primary care personnel (n = 4257, response rate = 17.7%), using bivariate and multivariate logistic regressions. Our analytical sample included providers (medical doctors, nurse practitioners, physicians' assistants) and nurses (registered nurses, licensed practical nurses). The outcomes included two items measuring high burnout. Primary predictors included importance ratings of 10 population health management tools (eg. VA risk prediction algorithm, recent hospitalizations and emergency department visits, etc.). RESULTS High ratings of 9 tools were associated with lower odds of high burnout, independent of covariates including VA tenure, team role, gender, ethnicity, staffing, and training. For example, clinicians who rated the risk prediction algorithm as important were less likely to report high burnout levels than those who did not use or did not know about the tool (OR 0.73; CI 0.61-0.87), and they were less likely to report frequent burnout (once per week or more) (OR 0.71; CI 0.60-0.84). CONCLUSIONS Burned-out clinicians may not consider the EHR-based tools important and may not be using them to perform care management. Tools that create additional technological burden may need adaptation to become more accessible, more intuitive, and less burdensome to use. Finding ways to improve the use of tools that streamline the work of population health management and/or result in less workload due to patients with poorly managed chronic conditions may alleviate burnout. More research is needed to understand the causal directional of the association between burnout and ratings of population health management tools.
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Affiliation(s)
- Jane Wang
- Department of Medicine, Stanford University, Stanford, USA
| | - Lucinda Leung
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Avenue, North Hills, CA, 91343, USA
| | - Nicholas Jackson
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Avenue, North Hills, CA, 91343, USA
| | - Michael McClean
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Avenue, North Hills, CA, 91343, USA
| | - Danielle Rose
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Avenue, North Hills, CA, 91343, USA
| | - Martin L Lee
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Avenue, North Hills, CA, 91343, USA
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, USA
| | - Susan E Stockdale
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Avenue, North Hills, CA, 91343, USA.
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, USA.
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Pillado E, Li RD, Chia MC, Eng JS, DiLosa K, Grafmuller L, Conway A, Escobar GA, Shaw P, Sheahan MG, Bilimoria KY, Hu YY, Coleman DM. Reported pain at work is a risk factor for vascular surgery trainee burnout. J Vasc Surg 2024; 79:1217-1223. [PMID: 38215953 DOI: 10.1016/j.jvs.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Work-related pain is a known risk factor for vascular surgeon burnout. It risks early attrition from our workforce and is a recognized threat to the specialty. Our study aimed to understand whether work-related pain similarly contributed to vascular surgery trainee well-being. METHODS A confidential, voluntary survey was administered after the 2022 Vascular Surgery In-Service Examination to trainees in all Accreditation Council for Graduate Medical Education-accredited vascular surgery programs. Burnout was measured by a modified, abbreviated Maslach Burnout Inventory; pain after a full day of work was measured using a 10-point Likert scale and then dichotomized as "no to mild pain" (0-2) vs "moderate to severe pain" (3-9). Univariable analyses and multivariable regression assessed associations of pain with well-being indicators (eg, burnout, thoughts of attrition, and thoughts of career change). Pain management strategies were included as additional covariables in our study. RESULTS We included 527 trainees who completed the survey (82.2% response rate); 38% reported moderate to severe pain after a full day of work, of whom 73.6% reported using ergonomic adjustments and 67.0% used over-the-counter medications. Significantly more women reported moderate to severe pain than men (44.3% vs 34.5%; P < .01). After adjusting for gender, training level, race/ethnicity, mistreatment, and dissatisfaction with operative autonomy, moderate-to-severe pain (odds ratio, 2.52; 95% confidence interval, 1.48-4.26) and using physiotherapy as pain management (odds ratio, 3.06; 95% confidence interval, 1.02-9.14) were risk factors for burnout. Moderate to severe pain was not a risk factor for thoughts of attrition or career change after adjustment. CONCLUSIONS Physical pain is prevalent among vascular surgery trainees and represents a risk factor for trainee burnout. Programs should consider mitigating this occupational hazard by offering ergonomic education and adjuncts, such as posture awareness and microbreaks during surgery, early and throughout training.
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Affiliation(s)
- Eric Pillado
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Ruojia Debbie Li
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Matthew C Chia
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Kathryn DiLosa
- Division of Vascular Surgery, Department of Surgery, University of California, Davis, Sacramento, CA
| | - Leanne Grafmuller
- Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, NY
| | - Allan Conway
- Division of Vascular Surgery Lenox Hill Hospital, Department of Surgery, Northwell Health, New York, NY
| | - Guillermo A Escobar
- Division of Vascular Surgery, Department of Surgery, Emory University, Atlanta, GA
| | - Palma Shaw
- Division of Vascular Surgery, Upstate Medical University, Syracuse, NY
| | - Malachi G Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Dawn M Coleman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC.
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Zok A, Matecka M, Bienkowski A, Ciesla M. Reduce stress and the risk of burnout by using yoga techniques. Pilot study. Front Public Health 2024; 12:1370399. [PMID: 38699423 PMCID: PMC11064875 DOI: 10.3389/fpubh.2024.1370399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/01/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction This article examines the effectiveness of yoga in managing stress, with a particular focus on work-related stress. Yoga combines physical postures, breath control, and meditation, and has gained recognition for its potential to relieve stress. Purpose This study aimed to investigate the motivating factors behind individuals adopting yoga exercises and to assess the effects of regular yoga practice, with a particular focus on age-related differences. Additionally, we aimed to compare participants' expectations with the actual results of their yoga practice. Methods To achieve this, we conducted a comprehensive survey using an online form, which was completed by 520 yoga practitioners. Participants were surveyed about their motivation, the effects they experienced, and the type of yoga they practiced. Results The results showed that the most common motivation for individuals practicing yoga was stress reduction. Additionally, the analysis of the effects of regular yoga practice demonstrated a significant reduction in stress levels, with experienced practitioners reporting lower stress levels compared to beginners. In conclusion, the study suggests that regular yoga practice can be an effective way to reduce stress levels. Conclusion Dynamic forms of yoga, which incorporate fluid movements and synchronized breathing techniques, are highly effective approaches to stress management and relief. These findings highlight the value of yoga as a tool for individuals of all ages seeking stress relief and overall well-being. Another advantage of yoga practice is its affordability and lack of negative side effects.
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Affiliation(s)
- Agnieszka Zok
- Department of Philosophy of Medicine and Bioethics, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Matecka
- Department of Occupational Therapy, Poznan University of Medical Sciences, Poznań, Poland
| | - Artur Bienkowski
- Department of Philosophy of Medicine and Bioethics, Poznan University of Medical Sciences, Poznan, Poland
| | - Magdalena Ciesla
- Department of Philosophy of Medicine and Bioethics, Poznan University of Medical Sciences, Poznan, Poland
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Meredith LS, Ahluwalia S, Chen PG, Dong L, Farmer CM, Bouskill KE, Dalton S, Qureshi N, Blagg T, Timmins G, Schulson LB, Huilgol SS, Han B, Williamson S, Watson P, Schnurr PP, Martineau M, Davis K, Cassells A, Tobin JN, Gidengil C. Testing an Intervention to Improve Health Care Worker Well-Being During the COVID-19 Pandemic: A Cluster Randomized Clinical Trial. JAMA Netw Open 2024; 7:e244192. [PMID: 38687482 PMCID: PMC11061774 DOI: 10.1001/jamanetworkopen.2024.4192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/26/2024] [Indexed: 05/02/2024] Open
Abstract
Importance Stress First Aid is an evidence-informed peer-to-peer support intervention to mitigate the effect of the COVID-19 pandemic on the well-being of health care workers (HCWs). Objective To evaluate the effectiveness of a tailored peer-to-peer support intervention compared with usual care to support HCWs' well-being at hospitals and federally qualified health centers (FQHCs) during the COVID-19 pandemic. Design, Setting, and Participants This cluster randomized clinical trial comprised 3 cohorts of HCWs who were enrolled from March 2021 through July 2022 at 28 hospitals and FQHCs in the US. Participating sites were matched as pairs by type, size, and COVID-19 burden and then randomized to the intervention arm or usual care arm (any programs already in place to support HCW well-being). The HCWs were surveyed before and after peer-to-peer support intervention implementation. Intention-to-treat (ITT) analysis was used to evaluate the intervention's effect on outcomes, including general psychological distress and posttraumatic stress disorder (PTSD). Intervention The peer-to-peer support intervention was delivered to HCWs by site champions who received training and subsequently trained the HCWs at their site. Recipients of the intervention were taught to respond to their own and their peers' stress reactions. Main Outcomes and Measures Primary outcomes were general psychological distress and PTSD. General psychological distress was measured with the Kessler 6 instrument, and PTSD was measured with the PTSD Checklist. Results A total of 28 hospitals and FQHCs with 2077 HCWs participated. Both preintervention and postintervention surveys were completed by 2077 HCWs, for an overall response rate of 28% (41% at FQHCs and 26% at hospitals). A total of 862 individuals (696 females [80.7%]) were from sites that were randomly assigned to the intervention arm; the baseline mean (SD) psychological distress score was 5.86 (5.70) and the baseline mean (SD) PTSD score was 16.11 (16.07). A total of 1215 individuals (947 females [78.2%]) were from sites assigned to the usual care arm; the baseline mean (SD) psychological distress score was 5.98 (5.62) and the baseline mean (SD) PTSD score was 16.40 (16.43). Adherence to the intervention was 70% for FQHCs and 32% for hospitals. The ITT analyses revealed no overall treatment effect for psychological distress score (0.238 [95% CI, -0.310 to 0.785] points) or PTSD symptom score (0.189 [95% CI, -1.068 to 1.446] points). Post hoc analyses examined the heterogeneity of treatment effect by age group with consistent age effects observed across primary outcomes (psychological distress and PTSD). Among HCWs in FQHCs, there were significant and clinically meaningful treatment effects for HCWs 30 years or younger: a more than 4-point reduction for psychological distress (-4.552 [95% CI, -8.067 to -1.037]) and a nearly 7-point reduction for PTSD symptom scores (-6.771 [95% CI, -13.224 to -0.318]). Conclusions and Relevance This trial found that this peer-to-peer support intervention did not improve well-being outcomes for HCWs overall but had a protective effect against general psychological distress and PTSD in HCWs aged 30 years or younger in FQHCs, which had higher intervention adherence. Incorporating this peer-to-peer support intervention into medical training, with ongoing support over time, may yield beneficial results in both standard care and during public health crises. Trial Registration ClinicalTrials.gov Identifier: NCT04723576.
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Affiliation(s)
| | | | | | - Lu Dong
- RAND Corporation, Santa Monica, California
| | | | | | | | | | - Tara Blagg
- RAND Corporation, Santa Monica, California
| | | | - Lucy B. Schulson
- Section of General Internal Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts
- RAND Corporation, Boston, Massachusetts
| | | | - Bing Han
- Department of Research & Evaluation, Southern California Kaiser Permanente, Pasadena
| | | | | | - Paula P. Schnurr
- National Center for PTSD, White River Junction, Vermont
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | | | | | | | - Jonathan N. Tobin
- Clinical Directors Network, New York, New York
- The Rockefeller University Center for Clinical and Translational Science, New York, New York
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Giusti EM, Ferrario MM, Veronesi G, D'Amato A, Gianfagna F, Iacoviello L. Perceived work stressors and the transition to burnout among nurses in response to the pandemic: implications for healthcare organizations. Scand J Work Environ Health 2024; 50:158-167. [PMID: 38477898 PMCID: PMC11014740 DOI: 10.5271/sjweh.4148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES This study aimed to assess the associations of pre-pandemic perceived work stressors and work satisfaction among nurses, including nurse assistants, with burnout profiles and their transitions in response to the pandemic. METHODS Three hundred and thirty-seven nurses working in an Italian University hospital participated in a longitudinal study including a survey in August 2019 investigating perceived work stressors (assessed using the HSE Indicator Tool), work satisfaction (Work Satisfaction Scale), and burnout (Maslach Burnout Inventory), and a second survey in December 2020 assessing burnout. Using latent transition analysis, we identified burnout profiles and then estimated the associations between work stressors and satisfaction on profiles and transitions. RESULTS We identified three pre-pandemic profiles, namely engaged (67%), ineffective (15%), and burnout (18%); and three pandemic profiles, namely engaged (37%), exhausted (51%), and severe burnout (12%). The severe burnout profile consisted of 70% nurses classified in the burnout profile before the pandemic. Overall, work stressors and satisfaction were associated with both pre-pandemic and pandemic burnout profiles. Among nurses not in the burnout profile prior to COVID-19, pre-pandemic hostile relationships increased [odds ratio (OR) 1.19, 95% confidence interval (CI) 1.05-1.34] and work satisfaction decreased (OR 0.82, 95% CI 0.68-0.98) the probability to transition to exhausted. Moreover, work satisfaction (OR 0.54, 95% CI 0.32-0.91) and participation in work organization (OR 0.69, 95% CI 0.51-0.93) protected from transitioning to severe burnout. The association between peer support and the transition to exhausted needs further investigation. CONCLUSIONS Pre-pandemic work stressors and satisfaction were associated with pandemic burnout and burnout transitions. To enhance preparedness for future crises, healthcare managers should carefully assess and tackle work-related constraints affecting nurses.
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Affiliation(s)
| | - Marco Mario Ferrario
- EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
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13
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Puyat JH, Pott K, Leclerc A, Song A, Choi YN, Chan K, Bernard C, Rodney P. Online Modules to Alleviate Burnout and Related Symptoms Among Interdisciplinary Staff in Long-Term Care: A Pre-post Feasibility Study. Am J Hosp Palliat Care 2024; 41:329-339. [PMID: 37163580 PMCID: PMC10802091 DOI: 10.1177/10499091231174448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND The rising trend of providing palliative care to residents in Canadian long-term care facilities places additional demands on care staff, increasing their risk of burnout. Interventions and strategies to alleviate burnout are needed to reduce its impact on quality of patient care and overall functioning of healthcare organizations. AIM To examine the feasibility of implementing online modules with the primary goal of determining recruitment and retention rates, completion time and satisfaction with the modules. A secondary goal was to describe changes in burnout and related symptoms associated with completing the modules. SETTING This single-arm, nonrandomized feasibility study was conducted in five long-term care sites of a publicly-funded healthcare organization in Vancouver, British Columbia, Canada. Eligible participants were clinical staff who worked at least 1 day per month. RESULTS A total of 103 study participants consented to participate, 31 (30.1%) of whom were lost to follow-up. Of the remaining 72 participants, 64 (88.9%) completed the modules and all questionnaires. Most participants completed the modules in an hour (89%) and found them easy to understand (98%), engaging (84%), and useful (89%). Mean scores on burnout and secondary traumatic stress decreased by .9 (95% CI: .1-1.8; d = .3) and 1.4 (95% CI: .4-2.4; d = .4), respectively; mean scores on compassion satisfaction were virtually unchanged. CONCLUSIONS Modules that teach strategies to reduce burnout among staff in long-term care are feasible to deliver and have the potential to reduce burnout and related symptoms. Randomized controlled trials are needed to assess effectiveness and longer-term impact.
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Affiliation(s)
- Joseph H. Puyat
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
| | - Karen Pott
- Providence Health Care, Vancouver, BC, Canada
- Health Sciences Association of British Columbia, Vancouver, BC, Canada
| | - Anne Leclerc
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
- Providence Health Care, Vancouver, BC, Canada
| | - Annes Song
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
- Providence Health Care, Vancouver, BC, Canada
| | - You Na Choi
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
| | - Kit Chan
- Providence Health Care, Vancouver, BC, Canada
- Health Sciences Association of British Columbia, Vancouver, BC, Canada
| | - Chris Bernard
- Providence Health Care, Vancouver, BC, Canada
- Canadian Association for Spiritual Care, Toronto, ON, Canada
| | - Patricia Rodney
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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14
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Kaltenegger HC, Marques MD, Becker L, Rohleder N, Nowak D, Wright BJ, Weigl M. Prospective associations of technostress at work, burnout symptoms, hair cortisol, and chronic low-grade inflammation. Brain Behav Immun 2024; 117:320-329. [PMID: 38307447 DOI: 10.1016/j.bbi.2024.01.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Working conditions in the age of digitalization harbor risks for chronic stress and burnout. However, real-world investigations into biological effects of technostress, that is stress in the context of digital technology use, are sparse. This study prospectively assessed associations between technostress, general work stress, burnout symptoms, hair cortisol, and chronic low-grade inflammation. METHODS Hospital employees (N = 238, 182 females, Mage = 28.5 years) participated in a prospective cohort study with two follow-ups six months apart (T2, T3). Participants answered standardized questionnaires on general job strain (job demand-control ratio), technostressors (work interruptions, multitasking, information overload), burnout symptoms (exhaustion, mental distance), and relevant confounders. Moreover, they provided capillary blood samples for C-reactive protein (CRP) and hair strands for hair cortisol concentration (HCC) analysis. Structural equation modelling was performed. RESULTS The factorial structure of survey measures was confirmed. Burnout symptoms (MT2 = 2.17, MT3 = 2.33) and HCC (MT2 = 4.79, MT3 = 9.56; pg/mg) increased over time, CRP did not (MT2 = 1.15, MT3 = 1.21; mg/L). Adjusted path models showed that technostress was negatively associated with HCC (β = -0.16, p =.003), but not with burnout and CRP. General work stress in contrast, was not significantly associated with burnout, HCC or CRP. Furthermore, there were reciprocal effects of CRP on HCC (β = 0.28, p =.001) and of HCC on CRP (β = -0.10, p ≤.001). Associations were robust in additional analyses including further confounders. CONCLUSION This is the first study on prospective effects of technostress on employees' endocrine and inflammatory systems. Results suggest differential effects of technostress on the hypothalamic-pituitary-adrenocortical axis activity. Given its key role for long-term health, the findings have important implications for occupational health and safety in digitalized work environments.
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Affiliation(s)
- Helena C Kaltenegger
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.
| | - Mathew D Marques
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Linda Becker
- Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Humanwissenschaftliche Fakultät, Vinzenz Pallotti University gGmbH, Vallendar, Germany
| | - Nicolas Rohleder
- Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Bradley J Wright
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
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15
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Anderson AR, LaPenna J, Willis D, Simpson K, Chang AH. Imposter phenomenon in physical therapists: A cross-sectional observational study. Health Sci Rep 2024; 7:e1953. [PMID: 38440262 PMCID: PMC10910609 DOI: 10.1002/hsr2.1953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/06/2024] Open
Abstract
Background and Aims Imposter phenomenon (IP), or perceived fraudulence, describes an ongoing fear of exposure as a fraud or imposter, despite objective successes and accomplishments. Although there is a growing interest of IP in medicine, IP in the physical therapy profession has been minimally examined. We aimed to determine the prevalence and predictors of IP among licensed physical therapists in the United States. Methods This cross-sectional observational study utilized an online survey to assess levels of IP using the Clance Imposter Phenomenon Scale. We assessed degrees of emotional exhaustion and job satisfaction and collected professional and demographic information. A multivariable logistic regression model examined factors associated with IP presence. Results The mean IP score was 60.3 (SD: 15.1, range: 19-95). Fifty-five respondents (10.7%) had low IP, 196 (38.1%) moderate, 215 (41.8%) frequent, and 48 (9.3%) intense IP. The prevalence of IP, defined as frequent or intense IP, was 51.2%. Having manager/supervisor experience (odds ratio [OR] = 0.55, 95% confidence interval [CI] = 0.34-0.90) was associated with a reduced odds of IP presence. Holding a bachelor's or master's degree (vs. Doctor of Physical Therapy (DPT); OR = 2.31, 95% CI = 1.07-5.00), a history of or current mental health diagnosis (OR = 2.77, 95% CI = 1.69-4.54), and emotional exhaustion (moderate vs. low: OR = 5.37, 95% CI = 2.11-13.69; high vs. low: OR = 14.13, 95% CI = 5.56-35.89) were each associated with an increased odds of IP presence. Conclusions IP is highly prevalent among licensed physical therapists. Seasoned clinicians with managerial roles seemed to be less susceptible to IP, whereas those with mental health diagnoses, emotional exhaustion, and those without a DPT degree may be more susceptible. Given its high prevalence and potential negative impact on burnout and career advancement, it is crucial to increase IP awareness and provide education on management strategies.
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Affiliation(s)
- Alexandra R. Anderson
- Department of Physical Therapy and Human Movement Sciences, Northwestern UniversityFeinberg School of MedicineChicagoIllinoisUSA
| | - Jamie LaPenna
- Department of Physical TherapyLoyola University Medical CenterBurr RidgeIllinoisUSA
| | - Dustin Willis
- Department of Physical Therapy, West Coast UniversityCenter for Graduate StudiesLos AngelesCaliforniaUSA
| | | | - Alison H. Chang
- Department of Physical Therapy and Human Movement Sciences, Northwestern UniversityFeinberg School of MedicineChicagoIllinoisUSA
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Bentulila Y, Lev Shalem L, Cohen B, Adler L. Physical work environment and burnout among primary care physicians in Israel: a cross-sectional study. BMC PRIMARY CARE 2024; 25:74. [PMID: 38418978 PMCID: PMC10900697 DOI: 10.1186/s12875-024-02310-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Physician burnout remains a prevalent issue globally, negatively affecting work satisfaction and patient care. However, exploration of the physical work environments of physicians, a potential influencing factor for burnout, remains scarce. The physical work environment is everything that surrounds the physician, including the doctor's office, the clinic, the clinic's building, the waiting, and staff rooms. The aims of this study were to describe aspects of the physical work environment of primary care physicians (PCPs) and to explore the association between the physical work environment and burnout. METHODS In this cross-sectional study, we emailed questionnaires to an online community of PCPs in Israel in October 2021. We asked physicians about their satisfaction with their physical work environment, evaluated elements of the work environment, and assessed burnout status (with the Shirom-Melamed Burnout Measure, SMBM). We used the Chi-square and Mann-Witney tests to compare categorical and continuous variables and used logistic regression for the final model. RESULTS Two hundred twenty-one PCPs answered the questionnaire (27.6% response rate). Over a third (35.7%) of respondents reported high burnout. PCPs who were satisfied with their general physical environment had lower burnout rates than those who were unsatisfied (28.1% vs. 47.8%, p-value < 0.001). We found positive correlations between general satisfaction with the physical work environment and the scores achieved for the doctor's office, the clinic, the clinic's building, and the waiting room. In the multivariate analysis, high satisfaction with the general physical work environment was associated with decreased odds for burnout (OR-0.50, 95% CI 0.25-0.99, p-value-0.048). CONCLUSION The doctor's office, the clinic, the clinic's building, and the waiting room affected general satisfaction from the physical work environment. High satisfaction with the physical work environment reduced burnout rates. Future studies are needed to determine whether PCPs and managers should invest in the physical work environment to decrease burnout and increase satisfaction.
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Affiliation(s)
- Yaara Bentulila
- Health Division, Maccabi HealthCare Services, Tel Aviv-Jaffa, Israel
| | - Liat Lev Shalem
- Health Division, Maccabi HealthCare Services, Tel Aviv-Jaffa, Israel
| | - Bar Cohen
- Health Division, Maccabi HealthCare Services, Tel Aviv-Jaffa, Israel
| | - Limor Adler
- Health Division, Maccabi HealthCare Services, Tel Aviv-Jaffa, Israel.
- Faculty of Medicine, Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel.
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Bryant VE, Sorna MJ, Dana A, Leon KG, Guastello AD, Sambuco N, Huxhold A, Allen B, Cuffe SP, Mathews CA, Dale LP. Protective and risk factors associated with substance use coping among healthcare workers during the COVID-19 pandemic. Front Psychol 2023; 14:1228517. [PMID: 38173849 PMCID: PMC10761529 DOI: 10.3389/fpsyg.2023.1228517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Background Healthcare workers (HCWs) experienced high levels of stress and mental health consequences associated with the COVID-19 pandemic, which may have contributed to unhealthy coping behaviors, such as substance use coping (SUC). This study aimed to understand the extent of and predictors of SUC. Methods The sample consisted of 263 HCWs in North Central Florida. Univariable and multivariable logistic regression analyses investigated whether moral injury and other work risk factors, protective factors, and clinically relevant symptoms (i.e., work exhaustion, interpersonal disengagement, depression, anxiety, and/or PTSD) were associated with likelihood of SUC. Results Clinically relevant levels of interpersonal disengagement and anxiety increased the likelihood of SUC. Mediational analyses found that interpersonal disengagement and anxiety explained 54.3% of the relationship between Self Moral Injury and SUC and explained 80.4% of the relationship between professional fulfillment and SUC. Conclusion Healthcare supervisors should be aware that providers who are experiencing moral injury and less professional fulfillment may be experiencing significant interpersonal disengagement and anxiety, which could lead to SUC. Future studies should examine the effects of implementing targeted prevention and treatment interventions, along with longitudinal outcomes related to SUC behaviors.
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Affiliation(s)
- Vaughn E. Bryant
- Department of Psychiatry, College of Medicine – Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Michael J. Sorna
- Department of Psychiatry, College of Medicine – Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Audrey Dana
- Department of Psychology, University of North Florida, Jacksonville, FL, United States
| | - Kalie G. Leon
- Department of Psychology, University of North Florida, Jacksonville, FL, United States
| | - Andrea D. Guastello
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Nicola Sambuco
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Ashley Huxhold
- Department of Psychiatry, College of Medicine – Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Brandon Allen
- Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Steven P. Cuffe
- Department of Psychiatry, College of Medicine – Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Carol A. Mathews
- Department of Psychiatry, Center for OCD, Anxiety and Related Disorders, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Lourdes P. Dale
- Department of Psychiatry, College of Medicine – Jacksonville, University of Florida, Jacksonville, FL, United States
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18
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Olson LE, Bredella MA, Levy AS, Mehta DH. Well-being grants in an academic medical center: A case example. J Clin Transl Sci 2023; 7:e206. [PMID: 37900355 PMCID: PMC10603360 DOI: 10.1017/cts.2023.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/31/2023] [Accepted: 08/15/2023] [Indexed: 10/31/2023] Open
Abstract
Academic medical centers (AMCs) rely on engaged and motivated faculty for their success. Significant burnout among clinical and research faculty has resulted in career disengagement and turnover. As such, AMCs must be vested in cultivating faculty engagement and well-being through novel initiatives that support faculty. The Well-Being Education Grants program was established by the Office for Well-Being within the Center for Faculty Development at Massachusetts General Hospital to provide the impetus many faculty needed to dedicate time to their well-being, demonstrating that investments in multi-component interventions around faculty well-being require resources and funding.
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Affiliation(s)
- Lauren E. Olson
- Center for Faculty Development, Massachusetts General Hospital, Boston, MA, USA
| | | | - Anne S. Levy
- Center for Faculty Development, Massachusetts General Hospital, Boston, MA, USA
| | - Darshan H. Mehta
- Center for Faculty Development, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Hudson MF, Oostdyk AM, Simmons VM, Martin JC. Considering context in area-level socioeconomic status, cancer treatment initiation, and survival. JNCI Cancer Spectr 2023; 7:pkad078. [PMID: 37850333 PMCID: PMC10582689 DOI: 10.1093/jncics/pkad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Matthew F Hudson
- Department of Medicine, Prisma Health Cancer Institute, Greenville, SC, USA
| | - Alicia M Oostdyk
- Department of Medicine, Prisma Health Cancer Institute, Greenville, SC, USA
| | - Virginia M Simmons
- Department of Medicine, Prisma Health Cancer Institute, Greenville, SC, USA
| | - Julie C Martin
- Department of Medicine, Prisma Health Cancer Institute, Greenville, SC, USA
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Schmidt M, Seifried-Dübon T, Göbel J, Degen L, Werners B, Grot M, Rind E, Pieper C, Jöckel KH, Minder K, Rieger MA, Weltermann B. 180° view on general practitioners' leadership skills: practice-level comparisons of leader and staff assessments using data from the cluster-randomised controlled IMPROVE job study. BMJ Open 2023; 13:e066298. [PMID: 37500272 PMCID: PMC10387622 DOI: 10.1136/bmjopen-2022-066298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVES Strong primary care leaders are needed to assure high quality services for patient populations. This study analysed general practitioners' (GP) leadership skills comparing practice-level self and staff assessments based on the full range of leadership model and the leader-member exchange (LMX). SETTING The questionnaire survey was conducted among German general practice leaders and their staff participating in the IMPROVEjob trial. PARTICIPANTS The study population comprised 60 German general practices with 366 participants: 84 GP practice leaders and 282 employees (28 physicians and 254 practice assistants). PRIMARY AND SECONDARY OUTCOME MEASURES Leadership skills of the practice leaders were measured using the Integrative Leadership Questionnaire (German Fragebogen für integrative Führung) and the LMX-7 questionnaire. Leaders rated themselves and practice staff rated their leaders. The data was analysed by paired mean comparisons on the practice level. RESULTS For most leadership dimensions, practice leaders rated themselves higher than their employees rated them. Differences were found for transformational leadership (p<0.001, d=0.41), especially for the dimensions 'innovation' (p<0.001, d=0.69) and 'individuality focus' (p<0.001, d=0.50). For transactional leadership, the dimension 'goal setting' differed significantly (p<0.01, d=0.30) but not the other dimensions. Scores for negative leadership were low and showed no differences between leaders and employees. Interestingly, employed physicians' rated their practice leaders higher on the two transformational ('performance development', 'providing a vision') and all transactional dimensions. The LMX-7 scale showed high quality relationships between leaders and employees. CONCLUSIONS This 180° analysis of GPs' leadership skills with self and employee ratings indicated good relationships. There is a potential to improve leadership regarding goal-setting, innovation and focusing on individual team members. These results allow for the development of targeted interventions. TRIAL REGISTRATION NUMBER German Clinical Trials Register, DRKS00012677. Registered 16 October 2019.
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Affiliation(s)
- Manuela Schmidt
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Tanja Seifried-Dübon
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Julian Göbel
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Lukas Degen
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Brigitte Werners
- Institute of Management, Operations Research, Ruhr University Bochum, Bochum, Germany
| | - Matthias Grot
- Institute of Management, Operations Research, Ruhr University Bochum, Bochum, Germany
| | - Esther Rind
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Tuebingen, Germany
| | - Claudia Pieper
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Karl-Heinz Jöckel
- Center for Clinical Trials, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Karen Minder
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Tuebingen, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
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Belay AA, Gasheya KA, Engdaw GT, Kabito GG, Tesfaye AH. Work-related burnout among public secondary school teachers is significantly influenced by the psychosocial work factors: a cross-sectional study from Ethiopia. Front Psychol 2023; 14:1215421. [PMID: 37465483 PMCID: PMC10351280 DOI: 10.3389/fpsyg.2023.1215421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/05/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction Work-related burnout (WRB) is the degree of physical and psychological fatigue and exhaustion perceived by individuals as related to their work. Even though the condition is widespread across various occupations, teachers inevitably experience high levels of burnout in their work, which can have long-term effects on their health and well-being. However, in developing countries such as Ethiopia, the lack of reliable data on psychosocial hazards, including work-related burnout, often encumbers officials from planning preventive measures. This study investigated the prevalence and contributing factors of work-related burnout among public secondary school teachers in Gondar City, northwestern Ethiopia. Methods An institution-based cross-sectional study was conducted from May to June 2022. A sample of 588 teachers was recruited using simple random sampling. Work-related burnout was assessed using a standardized seven-item Copenhagen Burnout Inventory (CBI). The data were collected through a self-administered questionnaire. The collected data were entered into EpiData and analyzed using SPSS. A multivariable logistic regression analysis was used to identify factors associated with work-related burnout. Results The overall response rate was 94.05% (N = 553). The majority of participants, 356 (64.4%), were male. The mean (±SD) age of the participants was 38.74 (±7.65) years. This study demonstrated that the prevalence of work-related burnout among school teachers in the past 12 months was 37.4% (n = 207). High job demands, job stress, job dissatisfaction, low role clarity, and student demotivation were found to be the psychosocial work factors that significantly influenced the prevalence of work-related burnout among school teachers. Conclusion This study highlights the high prevalence of work-related burnout among public secondary school teachers. Psychosocial work factors such as job demands, job stress, job satisfaction, role clarity, and student demotivation were significant factors influencing work-related burnout. To reduce the condition, it is recommended to take measures to cope with high job demands, improve stress management skills, promote job satisfaction strategies, clarify teachers' responsibilities, and use effective teaching practices to motivate students. In general, addressing psychosocial work factors needs to be central to efforts to prevent teacher burnout.
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Affiliation(s)
- Azanaw Asega Belay
- Department of Occupational Health and Safety, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Kassahun Ayele Gasheya
- Department of Occupational Health and Safety, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Garedew Tadege Engdaw
- Department of Environmental and Occupational Health and Safety, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Gebisa Guyasa Kabito
- Department of Environmental and Occupational Health and Safety, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Amensisa Hailu Tesfaye
- Department of Environmental and Occupational Health and Safety, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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22
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Fukushima H, Imai H, Miyakoshi C, Naito A, Otani K, Matsuishi K. The sustained psychological impact of coronavirus disease 2019 pandemic on hospital workers 2 years after the outbreak: a repeated cross-sectional study in Kobe. BMC Psychiatry 2023; 23:313. [PMID: 37143062 PMCID: PMC10157547 DOI: 10.1186/s12888-023-04788-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/14/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Healthcare workers who are exposed to coronavirus disease 2019 are psychologically distressed. This study aimed to evaluate the mental health outcomes of hospital workers 2 years after the outbreak of coronavirus disease 2019 and to identify changes in the stress of hospital workers and predicted risk factors. METHODS This survey was conducted 2 years after the initial evaluation performed under the first emergency declaration of the coronavirus disease 2019 pandemic among hospital workers at the same hospital in an ordinance-designated city in Japan from June to July 2022. Sociodemographic data, 19 stress-related question responses, the Impact of Event Scale-Revised, and the Maslach burnout inventory-general survey were collected. Multiple regression models were used to identify factors associated with each of the mental health outcomes 2 years after the coronavirus disease 2019 outbreak. RESULTS We received 719 valid responses. Between 2020 and 2022, hospital workers' anxiety about infection decreased, whereas their exhaustion and workload increased. Multiple regression analysis revealed that 2 years after the coronavirus disease 2019 outbreak, nurses and young people were at a higher risk of experiencing stress and burnout due to emotional exhaustion, respectively. CONCLUSIONS This is the first study to examine the long-term stress of hospital workers measured in Japan. Exhaustion and workload were worsened 2 years into the pandemic. Therefore, health and medical institutions should continuously monitor the physical and psychological health of staff members.
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Affiliation(s)
- Haruko Fukushima
- Department of Psychiatry, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - Hissei Imai
- Health Promotion and Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Ohashi Clinic, Kyoto, Japan
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Atsumi Naito
- Department of Psychiatry, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kyohei Otani
- Department of Psychiatry, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Kunitaka Matsuishi
- Department of Psychiatry, Kobe City Medical Center General Hospital, Kobe, Japan
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23
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Granja M, Correia S, Alves L. Access to General Practitioners during the second year of the COVID-19 pandemic in Portugal: a nationwide survey of doctors. BMC PRIMARY CARE 2023; 24:46. [PMID: 36782109 PMCID: PMC9924884 DOI: 10.1186/s12875-023-01994-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The Portuguese National Health System (NHS) provides universal coverage and near-free health care, but the population has high out-of-pocket expenses and unmet care needs. This suggests impaired accessibility, a key dimension of primary care. The COVID-19 pandemic has further affected access to health care. Understanding General Practitioners' (GP) experiences during the pandemic is necessary to reconfigure post-pandemic service delivery and to plan for future emergencies. This study aimed to assess accessibility to GPs, from their perspective, evaluating determinants of accessibility during the second pandemic year in Portugal. METHODS All GPs working in NHS Family Practices in continental Portugal were invited to participate in a survey in 2021. A structured online self-administered anonymous questionnaire was used. Accessibility was assessed through waiting times for consultations and remote contacts and provision of remote access. NHS standards were used to assess waiting times. Descriptive statistics were used to characterize the study sample. Associations between categorical variables were tested using the χ2 statistic and the Student t-test was used to compare means of continuous variables. RESULTS A total of 420 GPs were included (7% of the target population). Median weekly working hours was 49.0 h (interquartile range 42.0-56.8), although only 14% reported a contracted weekly schedule over 40 h. Access to in-person consultations and remote contacts was reported by most GPs to occur within NHS time standards. Younger GPs more often reported waiting times over these standards. Most GPs considered that they do not have enough time for non-urgent consultations or for remote contacts with patients. CONCLUSIONS Most GPs reported compliance with standards for waiting times for most in-person consultations and remote contacts, but they do so at the expense of work overload. A persistent excess of regular and unpaid working hours by GPs needs confirmation. If unpaid overtime is necessary to meet the regular demands of work, then workload and specific allocated tasks warrant review. Future research should focus on younger GPs, as they seem vulnerable to restricted accessibility. GPs' preferences for more in-person care than was feasible during the pandemic must be considered when planning for the post-pandemic reconfiguration of service delivery.
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Affiliation(s)
- Mónica Granja
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal.
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal.
| | - Sofia Correia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
| | - Luís Alves
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
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