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1 gün önce -

Leadership wishing to reduce burnout and increase fulfilment among employees should increase levels of organisational support and consideration and expand supports to employees seeking treatment for depression and anxiety.
Individual factors such as personal mental health symptoms, including depression and anxiety, are also related to burnout among HCW (Denning et al., 2021). Depression and suicidality have been longstanding problems in the medical community, and discrimination in medical licensing and hospital privileges for physicians who seek mental health treatment have perpetuated the problem (Center et al., 2003). While multiple programs have been created to reduce the rates of depression and suicide among physicians and physicians in training, rollout to nurses has lagged behind (Davidson et al., 2008), potentially increasing disparities between these groups. Moreover, anxiety is one of the most common psychiatric conditions encountered in HCW, with young nurses being the most vulnerable (Tiete et al., 202. Further, a study on Chinese HCW demonstrated a positive association between anxiety symptoms with burnout and emotional exhaustion (Ding et al., 2014). Occupational stresses further contribute to anxiety in HCW, contributing to a positive feedback loop (Ding et al., 2014).
Distributions of outcomes. Distribution of outcome (Burnout and Fulfilment) scores at each timepoint (survey) of the study period. Only participants who completed at least any 4 surveys are included, though the results are qualitatively equivalent when all participants are included.
Estimates of interaction effect between nursing occupation and organisational structure on fulfilment. Each line represents level of fulfilment for nurses only and doctors only at one standard deviation above, below and at the mean of organisational structure as measured at baseline.
Standardised effect estimates and three standard deviation confidence intervals from the nested sequence of longitudinal regression models of burnout and fulfilment. Effects of dummy indicators for categorical predictors are unadjusted, effects of continuous predictors are multiplied (equivalent to having divided the predictors) by twice the standard deviations of the predictors, and distributions of random effects are represented by twice their standard deviations.
Another strong and reliable predictor of increased burnout and reduced fulfilment was depression symptoms. Anxiety also showed a clear relationship to increased burnout and decreased fulfilment in longitudinal analyses, but this relationship was weaker than that observed with depression. Even prior to the pandemic, healthcare workers, especially nurses, were at increased risk of developing mental health symptoms including depression and anxiety, and these findings are consistent with previous studies finding a strong relationship between psychological symptoms and work attitudes (Peterson et al., 2008). Consequently, healthcare systems would be wise to expand their offerings of mental health services to their employees. Such interventions can and should take varying forms so as to appeal and apply to the most individuals. The introduction of legislation like the Dr. Lorna Breen Health Care Provider Protection Act is also a promising start in providing funding and national support for efforts to improve mental health resources for healthcare workers. In the meantime, common workplace interventions include expansions of employee assistance programs to include more providers and allow for longer treatment, flexible scheduling to allow time for treatment, online trainings focusing on psychoeducation and online individual counselling programs.
There were also some weaknesses of this study to be considered in generalising the results and informing future study designs. Most notably, this sample was drawn from one geographic region and participants were mostly white American women. Additional studies in other healthcare systems and

2 günler önce -

Indoor air pollution (IAP) and environmental tobacco smoke (ETS) are associated with lower respiratory tract illness (LRTI) or wheezing in children. However, the effect of the timing of these exposures, specifically antenatal versus postnatal, and of alternate fuel sources such as the increasingly used volatile organic compounds have not been well studied. We longitudinally investigated the effect of antenatal or postnatal IAP and ETS on LRTI or wheezing prevalence and severity in African infants.
Mother and infant pairs enrolled over a 3-year period in a birth cohort study in two centres in Paarl, South Africa, were followed for the first year of life for LRTI or wheezing illness. We measured exposure to IAP (particulate matter, nitrogen dioxide, sulphur dioxide, carbon monoxide, and volatile organic compounds benzene and toluene) using devices placed in homes, antenatally and postnatally. We measured ETS longitudinally by maternal self-report and by urine cotinine measures. Study staff trained in recognition of LRTI or wheeze documented all episodes, which were categorised according to WHO case definition criteria. We used multivariate logistic and Poisson regressions to explore associations.
Antenatal exposures were the predominant risk factors associated with LRTI or wheezing illness. Toluene was a novel exposure associated with severe LRTI. Urgent and effective interventions focusing on antenatal environmental factors are required, including smoking cessation programmes targeting women of childbearing age pre-conception and pregnant women.
Bill & Melinda Gates Foundation, Discovery Foundation, South African Thoracic Society AstraZeneca Respiratory Fellowship, Medical Research Council South Africa, National Research Foundation South Africa, and CIDRI Clinical Fellowship.
Lower respiratory tract illness (LRTI), principally pneumonia, remains the leading cause of under-5 mortality in low-income and middle-income countries (LMICs), with a very high burden of disease in LMIC settings including Africa.1 Wheezing illness is common in young children and asthma is the most common non-communicable disease in African children.2 Indoor air pollution (IAP) and environmental tobacco smoke (ETS) exposure have been strongly associated with the development of childhood respiratory illness, but little data are available on the effect of the timing of exposures on child respiratory health.3, 4
Antenatally, in-utero tobacco smoke exposure has been shown to affect lung growth and predispose to development of LRTI or wheezing disorders.5 Potential mechanisms include the toxic effects of the numerous chemicals found in tobacco smoke on the developing respiratory system,6 suppression of fetal breathing or direct genotoxicity,7 the effects of nicotine on lung collagen deposition,6 and impaired immune function from imbalances in T-helper-1 and T-helper-2 cell responses.8 Although its role is less clear, antenatal IAP exposure is postulated to affect lung development through an interplay of maternal and placenta-fetal factors including oxidative stress resulting in placental insufficiency with decreased transport of oxygen and nutrients to the developing fetus.9 Postnatal IAP or ETS exposure might disrupt pulmonary defences leading to epithelial inflammation and affect microbial colonisation and systemic inflammation, particularly if the alveolar capillary membrane is breached.3 Most studies have focused on the association of postnatal IAP exposure on child respiratory health;10 separating the effects of antenatal versus postnatal exposure is difficult, with few studies able to delineate this.9, 11
In this African birth cohort study, in which exposures were objectively and longitudinally measured antenatally and postnatally, LRTI or wheezing was common and associated with antenatal rather than postnatal exposure to ETS or to IAP. Antenatal exposure to toluene, a volatile organic compound, was identified as a novel exposure associated with LRTI, h

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