Prioritizing Patient Experiences in the Management of Diabetes and Its Complications: An Endocrine Society Position Statement

Diabetes can be an arduous journey both for people with diabetes (PWD) and their caregivers. While the journey of every person with diabetes is unique, common themes emerge in managing this disease. To date, the experiences of PWD have not been fully considered to successfully implement the recommended standards of diabetes care in practice. It is critical for health-care providers (HCPs) to recognize perspectives of PWD to achieve optimal health outcomes. Further, existing tools are available to facilitate patient-centered care but are often underused. This statement summarizes findings from multistakeholder expert roundtable discussions hosted by the Endocrine Society that aimed to identify existing gaps in the management of diabetes and its complications and to identify tools needed to empower HCPs and PWD to address their many challenges. The roundtables included delegates from professional societies, governmental organizations, patient advocacy organizations, and social enterprises committed to making life better for PWD. Each section begins with a clinical scenario that serves as a framework to achieve desired health outcomes and includes a discussion of resources for HCPs to deliver patient-centered care in clinical practice. As diabetes management evolves, achieving this goal will also require the development of new tools to help guide HCPs in supporting PWD, as well as concrete strategies for the efficient uptake of these tools in clinical practice to minimize provider burden. Importantly, coordination among various stakeholders including PWD, HCPs, caregivers, policymakers, and payers is critical at all stages of the patient journey.

Emotional exhaustion and fear of COVID-19 in geriatric facilities during the COVID-19 pandemic

OBJECTIVE

Since the onset of the COVID-19 pandemic, healthcare workers, especially those employed in hospital settings, have been exposed to a variety of stressors in the workplace. The aim of this study was to explore the Emotional Exhaustion (EE) of workers in geriatric facilities during the COVID-19 crisis. We accordingly sought to investigate the short-term impact of the COVID-19 pandemic in terms of the EE experienced by workers in geriatric facilities, and to examine the manner in which psychosocial conditions and fear of COVID-19 in the workplace have affected EE.

METHODS

Surveys were administered in the midst of the COVID-19 crisis (October to December 2020). The study included 118 French healthcare workers with a mean age of 35.61 ± 0.73 recruited in geriatric facilities. We assessed EE, psychosocial conditions (e.g., demands at work, health and well-being, etc.) and fear of COVID-19 in the workplace.

RESULTS

The analysis yielded two main outcomes. First, 34.75% workers (41) reported severe levels of EE. Second, demands at work and the fear of COVD-19 increased EE. Health and well-being were, however, demonstrated to protect against EE.

DISCUSSION

Furthermore, fear of COVID-19 was shown to contribute significantly to EE healthcare workers in geriatric facilities. It is likely that Covid-19 indirectly contributes to EE by influencing demands at work.

Heart and Head: Profiles and Predictors of Self-Assessed Cognitive and Affective Empathy in a Sample of Medical and Health Professional Students

For medical and health professions, students learning to respond to others' distress with well-regulated empathy is an important developmental skill linked to positive health outcomes and professionalism. Our study aimed to investigate the sociodemographic, psychological, and psychosocial differences between medical (MS) and health professional (HPS) students and their empathic abilities, since both populations share common stressors, namely, dealing with suffering people. Additionally, we were interested in assessing the psychological and psychosocial predictors of empathy of MS compared to HPS. One hundred thirty MS and 86 HPS were administered the Patient Health Questionnaire-9, Interpersonal Reactivity Index, Integrative Hope Scale, and UCLA Loneliness Scale. The two groups showed differences in their contextual characteristics, with the HPS group having larger families, lower parents' education levels, and lower family income compared to the MS group. In both groups, ~15% of students reported previous contact for psychological problems. A higher proportion of HPS (23.3%) reported depressive symptoms than MS (10%), and female HPS reported more intense feelings of loneliness than other subgroups of students. No differences were found between the two groups in self-assessed cognitive and affective empathy. In both groups, women showed greater affective scores than men and, at the same time, seemed to be particularly prone to personal distress. The cognitive empathic dimension of “perspective taking” was predicted by young age (OR, 612; 95% CI, 1.395–15.242) and the overall socioeconomic status (OR, 3.175; 95% CI, 1.154–8.734) of the HPS. Self-assessed affective competence was predicted by female gender (OR, 3.112; 95% CI, 1.328–7.288), depressive symptomatology (OR, 2.777; 95% CI, 1.004–7.681), higher mother's level of education (OR, 2.764; 95% CI, 1.147–6.659), and feeling of hope related to social relationships (OR, 1.367; 95% CI, 1.152–1.622). Risk factors for poor self-assessed affective emphatic skills were previous contact for psychological problems (OR, 3.263; 95% CI, 1.238–8.601) and feelings of loneliness (OR, 1.18; 95% CI, 1.09–1.276). Our findings emphasize the need to test psychosocial models to better understand empathic skills.

System Responsiveness to the Psychosocial and Mental Health Needs of Children in Ethiopian Primary Schools: The Case of Gondar City, Northwest Ethiopia Needs

Background: Ethiopia is the second most populous nation in Africa with children and adolescents constituting more than 40% of the population. Evidence shows the onset of significant degrees of mental illnesses is detectable in this age range. For such early identification to be made there should be a system responding to those needs. Objective: The objective of this study was to explore the extent to which the education system is responsive to the psychosocial and mental health needs of children in primary schools through putting appropriate professionals in place, raising teachers' awareness and putting in place viable policies and guidelines. Methods: An exploratory qualitative study was conducted in public and private primary schools in Gondar city Data was collected through focus group discussions from seventeen participants drawn from both schools and key informant interviews with two experts from the zonal Department of Education. A thematic qualitative data analysis was employed. Themes were identified with the help of the Nvivo 12 plus software. Results: We found teachers' mental health awareness is very low with parameters such as magnitude, case identification and support. There is an exception in terms of causal attributions of mental illness that matches with scientific literature. Psychosocial support and mental health resources are not available and schools do not provide capacity building mental health trainings for teachers which might help them to identify, handle and make referrals of mental health cases. We also found the Ethiopian education policy and other guidelines do not address the issue of mental health at primary school level. Conclusion: The Ethiopian education system is not responsive to the psychosocial and mental health needs of children in primary schools. Implications: Arresting minor impairments before they become major disabilities is vital. Investing in childhood mental health enables a healthy and productive society to be cultivated. The Ethiopian education system should therefore respond to the psychosocial and mental health needs of children in primary schools.

Organizational types in relation to exposure at work and sickness - a repeated cross-sectional study within public dentistry

Objective: Organizations and state agencies that provide dental care continuously face various and novel demands related to the need for dental care. However, rearrangements of work tasks by reducing the number of tasks performed by dental personnel might make the work more monotonous, repetitive, and static within an organization. The aim of this study is to compare how two dental work organizations, with different staffing and clinic size, are perceived by dental personnel focusing on physical and psychosocial conditions, leadership, work ability and presenteeism in 2012 and 2014.Material and Methods: This repeated cross-sectional study included personnel from the Public Dental Service in Sweden. There were 282 dentists, dental hygienists, and dental nurses who answered a questionnaire 2012 and 299 in 2014.Results and conclusion: In 2012, nine per cent of medium clinics reported poor leadership compared with 27% in 2014. For large clinics, 17% perceived poor leadership in 2012 compared with 31% in 2014. A higher proportion of the employees reported presenteeism due to high physical load (43%) and high psychosocial load (21%) in 2014 compared with 31% and 13% in 2012. These results indicate the need for work place interventions promoting health among dental employees.

Psychosocial Conditions and Resilience Status of Street Children in Jimma Town

Background

Traditional research and practices focused on an investigation of risk factors to handle psychosocial problems street children faced while surviving on the street. However, more recently, attention has been given to how knowledge can be developed in the area to devise interventions that reflect the promotion of resilience as a means of achieving positive outcomes for the children. The purpose of this study was to explore the psychosocial conditions and resilience status of street children in Jimma Town.

Methods

Explanatory sequential research design was employed. Out of 246 teenager street children, 137 were selected using simple random sampling. Questionnaire, interview guide and FGD probes were used in data collection. Mean and standard deviation, multiple regression analysis and Man Whitney U T-test were used to analyze quantitative data; while discourse analysis was used to analyze qualitative data.

Results

The result of multiple regression analysis indicated that anxiety significantly predicted resilience status, b=.623, t (109) =8.418, p<.001. Anxiety also explained a significant proportion of the variance in resilience status, R2=.388, F (112) = 70.86, p <.001. Further, the result revealed that street children had slow growing resilience status in which boys were more resilient than girls.

Conclusion

Street children in Jimma Town faced various psychosocial challenges and had low resilience status. Thus, Jimma Town Women and Children Affairs Office ought to work to build resilience status of street children, in collaboration with different stakeholders in and around the town.

Understanding the impact of a syndemic on the use of pre-exposure prophylaxis in a community-based sample of behaviorally PrEP-eligible BMSM in the United States

HIV Pre-Exposure Prophylaxis (PrEP) has shown great promise in reducing HIV transmission among affected populations; however, PrEP uptake among Black men who have sex with men (BMSM) has stalled. This study compares BMSM using PrEP and BMSM at risk for HIV not using PrEP based on differences in behavior, psychosocial conditions and the presence of a syndemic (n = 1,411). BMSM reporting PrEP use were significantly more likely to report three of five HIV risk behaviors and three of four psychosocial conditions. Odds of reporting PrEP use increased as the number of psychosocial conditions increased such that BMSM with three psychosocial conditions (AOR = 5.65, 95% CI: 3.17, 10.08) and four conditions (AOR = 18.34, 95% CI: 5.01, 67.20) demonstrated significantly greater odds of PrEP use compared to BMSM reporting one or less conditions. While BMSM at greatest risk are using PrEP, strategies are still needed for men at varying risk levels.

Impact of Predialysis Psychosocial Conditions on Kidney Transplant Recipient Survival: Evidence Using Propensity Score Matching

Background:

An increased number of end-stage renal disease patients suffer psychosocial conditions and may experience delayed access to transplantation due to listing restrictions. However, it remains to be shown whether preexisting psychosocial conditions confer an independent risk factor of poor posttransplant outcomes.

Objective:

We addressed this gap in knowledge by conducting a retrospective cohort study to investigate an independent association between the risk of death after transplant and having a diagnosis of psychosocial conditions 1 year prior to starting dialysis.

Methods:

All cases of adult deceased-donor kidney transplantation performed in Ontario, Canada, between April 1, 2002, and March 31, 2013, were used. Propensity score matching was applied to adjust for potential endogenous bias of using predialysis psychosocial status to predict posttransplant mortality. Survival analysis techniques, including Kaplan-Meier curves and Cox proportional hazards modeling, were also used.

Results:

Our results indicate a 49.4% (hazard ratio [HR] = 1.494 [95% confidence interval (CI) = 1.168-1.913]) increased relative risk of posttransplant death to be associated with predialysis psychosocial conditions, when other factors are held constant. The effect is significant (P = .001) and is independent of other known predictors of death including advanced age.

Conclusions:

Findings from this study offered strong support for the development of psychosocial evaluation to screen candidates prior to transplant listing and early interventions for transplant candidates with psychosocial concerns.

The importance of individual predictors and psychosocial working conditions in assessing the work ability index of people with low vision

Purpose. This investigation aimed to clarify the importance of individual predictors and psychosocial working conditions in estimating the work ability index (WAI) of people with impaired vision. Materials and methods. This study utilized a quantitative cross-sectional design involving 450 respondents who had low vision with visual acuity in the range of 0.05-0.3 and a control group of 150 respondents with visual acuity in the range of 0.5-0.3. The investigation was conducted using the standardized instruments of the Copenhagen psychosocial questionnaire (COPSOQ) and the WAI. Results. The average WAI score of the respondents with low vision was 30.1 ± 4.1 and that of the control group was 34.7 ± 3.4. Results indicated a positive COPSOQ/WAI correlation in the following domains: work importance; career prospects; rewards/feedback; role and definition; quality of management; social support; job satisfaction; health condition. Negative correlations were indicated in the following domains: quantitative, cognitive and emotional demands; exhaustion; stress. Conclusions. The WAI of people with low vision is both positively and negatively impacted via different intensities associated with complex correlations, including: gender; age; profession; stress propensity; quantitative, qualitative and emotional demands of work; specificity of work, professional education; presence of stressors.

The Reciprocal Effect of Psychosocial Aspects on Nurses' Working Conditions

Objectives: Psychosocial work risks are most often considered in the context of occupational stress. The aim of this article is to evaluate the correlations between different aspects of nurses' psychosocial working conditions.

Materials and Methods: The study was conducted using the questionnaire: Psychosocial aspects of work. A total of 789 nurses working in inpatient health care facilities in Bialystok were included in the study. Correlation analysis was performed by determining Spearman's correlation coefficient.

Results: Correlations between the primary scales, such as job demands, control, social support, well-being, and expectations of changes, were evaluated. The weakest correlation was shown between the assessment of job demands and other work aspects. The strongest correlation was found between the ability to control and social support. Perception of the need for changes was influenced by the assessment of job demands, components of the control scale and, most of all, the scale of social support. A strong correlation was found between physical and psychological well-being and support from superiors and coworkers.

Conclusions:

The state of well-being had no effects on nurses' assessment of the demands they were faced with. Nurses' well-being depended only on social support provided by their superiors and colleagues, the sense of being able to have an effect on the performed work, minimal conflicts, and absence of overload.

Management should enable adequate working conditions in order to ensure nurses' physical and psychological well-being, as both these aspects were closely correlated.

Poor social support, lack of a sense of control over one's work, conflicts, and work overload were factors that promoted nurses' expectations of changes.

Occupational Safety and Health Conditions Aboard Small- and Medium-Size Fishing Vessels: Differences among Age Groups

Although marine fishing is one of the most hazardous occupations, research on the occupational safety and health (OSH) conditions aboard marine fishing vessels is scarce. For instance, little is known about the working conditions of vulnerable groups such as young and aging fishermen. The objective of the current paper is to study the OSH conditions of young and aging fishermen compared to middle-aged fishermen in the small- and medium-size (SM) marine fishing sector. A cross-sectional study was designed, and 686 fishermen working aboard SM fishing vessels were interviewed to collect information about their safety and health. The associations of physical and psychosocial work conditions with safety and health outcomes, e.g., injuries, illnesses and job satisfaction, are presented. The results of the current study can be utilized in the design of effective accident prevention and OSH training programs for the three age groups and in the regulation of working conditions aboard fishing vessels.