Not All Demands Are Exhausted for Healthcare Workers. A Cross-Lagged Study on the Buffering Effect of Leadership Resources

This study investigated the cross-lagged effects of a three job demands on exhaustion and buffering function of leadership resources among Polish healthcare workers. Job demands include quantitative and two emotional (related to engaging in the patient’s personal problems and related to hiding emotions) demands, while leadership resources include quality of leadership and trust in management. The study was conducted in two waves (both of them in COVID-19 pandemic), with a one-year interval between the measurements. Data were collected among 1251 healthcare workers. A moderated regression analysis showed that quantitative demands and demands for hiding emotions (T1 but not emotionally engagement in the patient’s personal problems) were related to high exhaustion (T2). Both leadership resources (T1) diminished the negative impact of quantitative (not emotional) demands on exhaustion, but the buffering effect of trust was stronger. Furthermore, the two leadership resources interact with each other and together neutralize the effects of quantitative demands. Specifically, the lowest level of exhaustion was observed in those healthcare workers who had high levels of both resources, measured one year before. The implications for theory and research on the effects of different job demands on exhaustion in pandemic are discussed.

Trinity Review: Integrating registered reports with ethics and research funding reviews

One major source of high exhaustion for researchers is the redundant paperwork of three different documents (research papers, applications for ethics review, and applications for research grants) for the same research plan. These similar documents are submitted to three different organizations, each with its own format, and independently peer-reviewed three times. This is a wasteful and redundant process for researchers. Here, we propose a trinity review that integrates scientific, ethics, and research funding reviews. In our proposed trinity review system, scientific and ethics reviews are undertaken concurrently for a pre-experimental research protocol. When the protocol is accepted in principle through these review processes, a funding review will occur, and researchers will conduct their studies. After experiments or surveys, the scientific review will be conducted for a completed version of the paper including results and discussions (i.e., the full paper) again, and the full paper will be published after it has passed the second review. This paper provides a detailed explanation of the operation of the trinity review system and discusses the positive impacts and solutions to difficulties in its implementation.

High Exhaustion in Geriatric Healthcare Professionals During the COVID-19 Second Lockdown

Background: In a previous study, we assessed burnout in geriatric healthcare workers during the first lockdown that lasted from March to May 2020 in France, in response to the COVID-19 crisis. Objective: We carried out a follow-up study to assess burnout in the same population during the second lockdown that was implemented at the end of October 2020. Methods: We used an online survey to assess burnout in terms of exhaustion and disengagement in a sample of 58 geriatric healthcare workers. Results: We found higher levels of exhaustion, disengagement, and burnout among geriatric healthcare workers during the second than during the first lockdown. We also found high levels of exhaustion but moderate disengagement and burnout during the second lockdown. Conclusion: The increased exhaustion, disengagement, and burnout during the second lockdown can be attributed to the increased workload in geriatric facilities throughout this crisis and during the second lockdown due to shortage in staff and increased number of shifts and allocated duties. The high levels of exhaustion reported among geriatric healthcare workers during the second lockdown can reflect their physical fatigue, as well as their feelings of being emotionally overextended and exhausted by their workload.

High exhaustion in geriatric healthcare professionals during the Covid-19 second lockdown (Preprint)

BACKGROUND In a previous study, we assessed burnout in geriatric healthcare workers during the first lockdown that lasted from March to May 2020 in France, in response to the Covid-19 crisis. OBJECTIVE We carried out a follow-up study to assess burnout in the same population during the second lockdown that was implemented at the end of October 2020. METHODS We carried out an online study to assess burnout in the geriatric healthcare workers. RESULTS We found higher levels of exhaustion, disengagement, and burnout among geriatric healthcare workers during the second than during the first lockdown. We also found high levels of exhaustion but moderate disengagement and burnout during the second lockdown. CONCLUSIONS The increased exhaustion, disengagement, and burnout during the second lockdown can be attributed to the increased workload in geriatric facilities throughout this crisis and during the second lockdown due to shortage in staff and increased number of shifts and allocated duties. The high levels of exhaustion reported among geriatric healthcare workers during the second lockdown can reflect their physical fatigue, as well as their feelings of being emotionally overextended and exhausted by their workload.

Sex Differences and Trends in Prevalence of Anxiety, Depression and Vital Exhaustion in Russia / Siberia from 1994 To 2017

Purpose: To determine gender differences in trends of anxiety, depression and vital exhaustion levels in an open population aged 25-64 years over long-term period - 23 years in Russia / Siberia (Novosibirsk). Methods: Within the framework of the screening in 1994-95 under the WHO MONICA-psychosocial (MOPSY) program (n = 1527, 43% males, mean age 44.85 ± 0.4 years), in 2003-2005 under the international project HAPIEE (n=1650, 34,9% males, mean age 54,25±0,2 years), in 2013-2016 (n=975, 43,8% males, mean age 34,5±0,4 years) and 2016-2017 гг.( n=663, 41,3% years 51,95±0,32 years) within the framework of the budgetary theme No. АААА-А17-117112850280-2, random representative samples of men and women in one of districts in Novosibirsk were examined. Anxiety traits studied by means of the Spielberger test. Depression and vital exhaustion assessed by MOPSY questionnaires. Results: 2/3 of the female population aged 25-64 years had high level of anxiety traits in 1994. It was highest in the younger age groups. High anxiety was found in less than half of the surveyed men, increasing with age. The maximum values of anxiety were noted in 2003-2005 in both genders. The decrease in the incidence of high anxiety which began in 2013-2016, remained only in the female part of the population aged 35-64y but in men the prevalence of anxiety returned to the levels of 1994. Depression occurred in more than half of the female population in 1994. The overall prevalence among men was less than 30%. At the same time, the frequency of major D in women was 4-fold higher compared with men (p <0.001). Trends in prevalence in 2017 were mixed: a reduction in moderate levels and an increase in major depression in the youngest and oldest age groups. The prevalence of high vital exhaustion in 1994 was 14.6% and 31% in men and women 25-64 years, respectively (p <0.001). An increase in high exhaustion from younger to older age groups was noted in both sexes. The downward trend in exhaustion in 2017 persisted only among women. At that moment for the first time men began to report high exhaustion more often than women over 23-year of follow-up (16.9% and 15.6% for men and women 35-64y, respectively; n.s.). Conclusion: The prevalence of affective states is higher in females in general population. Long-term trends in decreasing the prevalence of anxiety, depression and vital exhaustion were not sustainable and returned to levels of 1994.

Immune Cytolytic Activity for Comprehensive Understanding of Immune Landscape in Hepatocellular Carcinoma

Cytolytic activity score (CYT), defined by granzyme A and perforin expression, is a useful marker for underlying immunity. We hypothesized that CYT-high hepatocellular carcinomas (HCCs) have stronger immunogenicity and favorable tumor microenvironments, which would result in better clinical outcomes, using the cancer genome atlas (TCGA) cohort with 371 patients with HCC. We found CYT-high HCCs were associated with higher expressions of the apolipoprotein B mRNA editing enzyme catalytic polypeptide-like 3 (APOBEC3), well-known mutagenic enzymes. Further, higher numbers of anti-cancer immune cells, such as CD8+ T cells and M1 macrophages, were infiltrated in CYT-high HCCs. Major T cell exhaustion markers were expressed significantly higher in CYT-high HCCs, likely as a negative feedback loop. Additionally, CYT-high HCCs strongly enriched gene sets related with enhanced immune activity. With strong immunity, patients with CYT-high HCCs had significantly longer disease-specific survival (DSS) and overall survival (OS) (p = 0.03 and <0.01). Furthermore, when the OS is stratified by exhaustion marker expressions, the CYT-high/exhaustion-low group had the best and CYT-low/exhaustion-high groups had the worst OS. Lastly, high CYT was an independent protective factor for prognosis. In conclusion, CYT-high HCCs were associated with enhanced immunity and better survival. Our findings suggest that proper identification of tumor-immune microenvironments could stratify the patients for appropriate treatments.

Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians

Objectives The study sought to determine whether objective measures of electronic health record (EHR) use—related to time, volume of work, and proficiency—are associated with either or both components of clinician burnout: exhaustion and cynicism. Materials and Methods We combined Maslach Burnout Inventory survey measures (94% response rate; 122 of 130 clinicians) with objective, vendor-defined EHR use measures from log files (time after hours on clinic days; time on nonclinic days; message volume; composite measures of efficiency and proficiency). Data were collected in early 2018 from all primary care clinics of a large, urban, academic medical center. Multivariate regression models measured the association between each burnout component and each EHR use measure. Results One-third (34%) of clinicians had high cynicism and 51% had high emotional exhaustion. Clinicians in the top 2 quartiles of EHR time after hours on scheduled clinic days (those above the sample median of 68 minutes per clinical full-time equivalent per week) had 4.78 (95% confidence interval [CI], 1.1-20.1; P = .04) and 12.52 (95% CI, 2.6-61; P = .002) greater odds of high exhaustion. Clinicians in the top quartile of message volume (&gt;307 messages per clinical full-time equivalent per week) had 6.17 greater odds of high exhaustion (95% CI, 1.1-41; P = .04). No measures were associated with high cynicism. Discussion EHRs have been cited as a contributor to clinician burnout, and self-reported data suggest a relationship between EHR use and burnout. As organizations increasingly rely on objective, vendor-defined EHR measures to design and evaluate interventions to reduce burnout, our findings point to the measures that should be targeted. Conclusions Two specific EHR use measures were associated with exhaustion.

Experience of Stress Assessed by Text Messages and Its Association with Objective Workload—A Longitudinal Study

Exploring stress trajectories in detail and over a long time may give valuable information in terms of both understanding and practice. We followed a group of primary health care employees in a randomized controlled trial. The objective was to describe their experience of stress, explore the intra-individual variability and examine the association between the experience of stress and the objective workload. Weekly text messages with a single item stress question were distributed in two time series: 12 weeks at the beginning of the trial and 26 weeks after the 6-month follow up. Aggregated objective data about workload were collected from their administration office and related to stress levels. There was a seasonal variation, with higher stress during the fall than in spring and summer. The analysis comparing high and low stress subgroups showed that the stress trajectory of a high-stress subgroup was different from that of a low-stress subgroup. Individuals with high exhaustion scores had higher odds of belonging to a subgroup of individuals with high intra-individual variability in stress experience. The objective workload was measured in two ways and was strongly associated with the stress experience. We found that the lower the productivity, the higher the feeling of stress.

Synthesis of a Fluorescent Whitening Molecule and its Application to Wool Fibres

Aim and Objective: Reactive dye molecules are commonly employed to dye or modify colour characteristics of wool fibres. Yellowness of wool fibres poses a challenge and here, we report synthesis of a reactive fluorescent molecule and its application to wool fibres to reduce yellowness of the wool fibre and improve its colour features. Material and Methods: The new molecule was based upon 7-amino-4-methylcoumarin (AMC) and 2,4,6- trichloro-1,3,5-triazine (TZT). The synthesis involved a two-step chemical reaction, initiated by the nucleophilic substitution of a chloro group on the triazine ring with the hydroxyl group of 4-hydroxybenzenesulfonic acid. The substitution of 2nd chloro group at triazine ring with the amino group of 7-amino-4-methylcoumarin resulted in a novel molecule with a monofunctional reactive chloro group (AMC-MCT molecule). Results: The new molecule was applied to the wool fibres using exhaust dyeing method. This exhibited a high exhaustion value; however low fixation and total efficiency values were observed for the new molecule. The resultant wool fibres exhibited fluorescence which shows that aminocoumarin fluorophore retained its fluorescence when incorporated in the new molecule. An assessment of the molecule for yellowness index in a controlled exposure to UV radiation suggested an improvement in whiteness of wool fibre. Conclusion: A novel aminocoumarin based fluorescent whitening molecule 2 has been synthesised and applied to the wool fibres. The new molecule continued to exhibit fluorescence after its application to the wool fibres. These results will encourage researchers to explore further possibilities for reactive whitening agent for wool fibres.