Factors associated with healthcare professionals' intent to stay in hospital: a comparison across five occupational categories

Objectives To identify factors associated with intent to stay in hospital among five different categories of healthcare professionals using an adapted version of the conceptual model of intent to stay (CMIS). Design A cross-sectional survey targeting Lausanne University Hospital employees performed in the fall of 2011. Multigroup structural equation modeling was used to test the adapted CMIS model among professional groups. Measures Satisfaction, self-fulfillment, workload, working conditions, burnout, overall job satisfaction, institutional identification and intent to stay. Participants Surveys of 3364 respondents: 494 physicians, 1228 nurses, 509 laboratory technicians, 935 administrative staff and 198 psycho-social workers. Results For all professional categories, self-fulfillment increased intent to stay (all β > 0.14, P 0.22, P < 0.05). Some factors were associated with specific professional categories: workload was associated with nurses' intent to stay (β = −0.15), and physicians' institutional identification mitigated the effect of burnout on intent to stay (β = −0.15 and β = 0.19). Conclusion Respondents' intent to stay in a position depended both on global and profession-specific factors. The identification of these factors may help in mapping interventions and retention plans at both a hospital level and professional groups' leve

An instrumental variable approach under dependent censoring

This paper considers the problem of inferring the causal effect of a variable $Z$ on a dependently censored survival time $T$. We allow for unobserved confounding variables, such that the error term of the regression model for $T$ is correlated with the confounded variable $Z$. Moreover, $T$ is subject to dependent censoring. This means that $T$ is right censored by a censoring time $C$, which is dependent on $T$ (even after conditioning out the effects of the measured covariates). A control function approach, relying on an instrumental variable, is leveraged to tackle the confounding issue. Further, it is assumed that $T$ and $C$ follow a joint regression model with bivariate Gaussian error terms and an unspecified covariance matrix such that the dependent censoring can be handled in a flexible manner. Conditions under which the model is identifiable are given, a two-step estimation procedure is proposed, and it is shown that the resulting estimator is consistent and asymptotically normal. Simulations are used to confirm the validity and finite-sample performance of the estimation procedure. Finally, the proposed method is used to estimate the causal effect of job training programs on unemployment duration

Character process model for semen volume in AI rams: evaluation of correlation structures for long and short-term environmental effects

The objective of this study was to build a character process model taking into account serial correlations for the analysis of repeated measurements of semen volume in AI rams. For each ram, measurements were repeated within and across years. Therefore, we considered a model including three environmental effects: the long-term environmental effect, which is a random year* subject effect, the short-term environmental effect, which is a random within year subject* collection effect, and the classical measurement error. We used a four-step approach to build the model. The first step explored graphically the serial correlations. The second step compared four models with different correlation structures for the short-term environmental effect. We selected fixed effects in the third step. In the fourth step, we compared four correlation structures for the long-term environmental effect. The model, which fitted best the data, used a spatial power correlation structure for the short-term environmental effect and a first order autoregressive process for the long-term environmental effect. The heritability estimate was 0.27 (0.04), the within year repeatability decreased from 0.56 to 0.44 and the repeatability across years decreased from 0.43 to 0.37

Genetic and environmental effects on semen traits in Lacaune and Manech tête rousse AI rams (Open Access publication)

Data from 51 107 and 11 839 ejaculates collected on rams of the "Lacaune" and "Manech tête rousse" breeds, respectively, were analysed to determine environmental and genetic factors affecting semen production traits (ejaculate volume, semen concentration, number of spermatozoa and motility) in young (≤1 year) and adult (≥2 years) rams. Fixed effects and variance components were estimated using multiple trait animal models within each breed. For all traits, the main environmental effects identified were year, season, number of ejaculations, daily variation, interval from previous to current collection and age. Heritability estimates were moderate for volume, concentration and number of spermatozoa (0.12 to 0.33) and lower for motility (0.02 to 0.14). Genetic correlations between ages differed from 1 for all traits (0.14 to 0.90), indicating that semen characteristics corresponded to different traits in young and adult rams. Genetic and phenotypic correlations among traits within age category were globally similar for the different breeds and categories of animals

Mise en évidence de transporteurs de la résistance pléiotropique dans la muqueuse olfactive et leur implication dans la réponse aux odorants chez les rongeurs

La résistance pléiotropique (MDR) est une propriété de certaines cellules relative à la capacité de rejeter ou d évacuer une très large variété de substances potentiellement toxiques. Les pompes à l origine de ce rejet sont des protéines membranaires appartenant à la superfamille ABC (ATP-Binding Cassette). Deux membres de cette famille ABC confèrent la propriété de résistance pléiotropique, P-gp (P-glycoprotein) et MRP1 (Multidrug Resistance-associated Protein). Nous avons mené une étude fonctionnelle sur l activité de ces deux transporteurs dans la muqueuse olfactive à la fois chez le rat et la souris. Nous avons employé le test fluorométrique à la calcéine-AM sur des tranches coronales de la muqueuse olfactive incubées en présence d inhibiteurs spécifiques des transporteurs de la résistance pléiotropique, vérapamil et cyclosporine A comme inhibiteurs de Pgp ainsi que probénécide et MK571 comme inhibiteurs de MRP1. Chacun de ces quatre inhibiteurs provoque une augmentation significative de l intensité de la fluorescence.Afin de savoir si les transporteurs de la résistance pléiotropique peuvent être impliqués dans la réponse olfactive nous avons examiné les réponses évoquées par des odorants seuls ou mélangés à l aide d enregistrements d électro-olfactogrammes (EOG). En présence des deux inhibiteurs de MRP1, l amplitude maximale des EOG est significativement réduite pour chaque stimulus odorant testé, tandis que les inhibiteurs de Pgp n ont qu un effet modéré ou nul. L expression des gènes codant pour Pgp et MRP1 dans l épithélium olfactif ont ensuite été confirmées par RT-PCR. L ensemble de ces résultats suggère que les transporteurs MRP1 et Pgp sont présents et fonctionnels dans l épithélium olfactif principal des rongeurs et sont impliqués dans la réponse aux odorants. Leur fonction précise dans l olfaction reste à éluciderMultidrug resistance (MDR) is a property of various cells associated with the capacity to reject or efflux a wide range of potentially harmful substances out of the cell. Pumps that effect such efflux are membrane proteins and belong to the ATP- binding cassette (ABC) superfamily. Among the members of the ABC family two are conferring MDR, P-glycoprotein (Pgp) and the multidrug resistance-associated protein (MRP1). In this study we investigated the functional activity of MDR transporters in olfactory mucosa of two species, rat and mouse. We used the fluorometric calcein-AM uptake assay on olfactory mucosal slices incubated with specific inhibitors of the MDR-transporters, verapamil and cyclosporin A as Pgp-inhibitors, and probenecid and MK571 as MRP-inhibitors. All four inhibitors caused significant increases in fluorescence intensities. To test if MDR transporters may be involved in the olfactory response we examined odorant evoked responses to single and mixed odorants by means of electro-olfactograms recordings (EOG). In the presence of the two MRP inhibitors, maximum EOG amplitudes were significantly reduced for all odorants tested, while Pgp inhibitors had only a moderate or no effect. Expression of Pgp and MRP1 encoding genes in the olfactory epithelium was further confirmed by RT-PCR. The results together suggest that MRP and Pgp transporters are present and functional in the main olfactory epithelium of rodents and are implicated in the olfactory response. The precise functional role in olfaction remains to be elucidated.DIJON-BU Doc.électronique (212319901) / SudocSudocFranceF

Mass sperm motility is associated with fertility in sheep

The study was to focus on the relationship between wave motion (mass sperm motility, measured by a mass sperm motility score, manually assessed by artificial insemination (AI) center operators) and fertility in male sheep. A dataset of 711,562 artificial inseminations performed in seven breeds by five French AI centers during the 2001–2005 time period was used for the analysis. Factors influencing the outcome of the insemination, which is a binary response observed at lambing of either success (1) or failure (0), were studied using a joint model within each breed and AI center (eight separate analyses). The joint model is a multivariate model where all information related to the female, the male and the insemination process were included to improve the estimation of the factor effects. Results were consistent for all analyses. The male factors affecting AI results were the age of the ram and the mass motility. After correction for the other factors of variation, the lambing rate increased quasi linearly from three to more than ten points with the mass sperm motility score depending on the breed and the AI center. The consistency of the relationship for all breeds indicated that mass sperm motility is predictive of the fertility resulting when sperm are used from a specific ejaculate. Nonetheless, predictability could be improved if an objective measurement of mass sperm motility were available as a substitute for the subjective scoring currently in use in AI centers

Trust in medical organizations predicts pandemic (H1N1) 2009 vaccination behavior and perceived efficacy of protection measures in the Swiss public

Following the recent avian influenza and pandemic (H1N1) 2009 outbreaks, public trust in medical and political authorities is emerging as a new predictor of compliance with officially recommended protection measures. In a two-wave longitudinal survey of adults in French-speaking Switzerland, trust in medical organizations longitudinally predicted actual vaccination status 6months later, during the pandemic (H1N1) 2009 vaccination campaign. No other variables explained significant amounts of variance. Trust in medical organizations also predicted perceived efficacy of officially recommended protection measures (getting vaccinated, washing hands, wearing a mask, sneezing into the elbow), as did beliefs about health issues (perceived vulnerability to disease, threat perceptions). These findings show that in the case of emerging infectious diseases, actual behavior and perceived efficacy of protection measures may have different antecedents. Moreover, they suggest that public trust is a crucial determinant of vaccination behavior and underscore the practical importance of managing trust in disease prevention campaign

Brief survey on current Swiss hospitals satisfaction practices & Literature review on international large-scale initiatives evaluating inpatient satisfaction

The ANQ (Swiss National Association for Quality Development in Hospitals and Clinics) has been conducting annual satisfaction surveys for inpatients in acute care settings since 2011. Within a few years, similar surveys were developed and implemented in other settings, for parents of hospitalized children in acute hospitals, adult inpatients in rehabilitation and in psychiatric clinics. The implementation of patient surveys is a mandatory component of the National Measurement Plan to promote and maintain the quality of care in Swiss hospitals. The ANQ surveys are very brief and actually carried out once every two years during one to three months. The findings are used for monitoring temporal changes, for benchmarking among providers and are published in a transparent way to inform the public. However, the usefulness of these results for quality improvement in hospitals is somewhat limited because the selected questions are of a general nature and not suitable to identify precisely potential areas for improvement, a near real-time analysis is not possible and the limited collection period reduces the sample size for small hospital sites. Therefore, hospitals and clinics who would like to monitor and improve patient care have to carry out their own surveys. The purpose of this brief survey among Swiss hospitals and clinics was to make an inventory of existing satisfaction/care experiences surveys, to find out which instruments are used, which methods are applied, and how the findings of the surveys are used to improve inpatient care

Evidence for decline in the incidence of cystic fibrosis: a 35-year observational study in Brittany, France

<p>Abstract</p> <p>Background</p> <p>Cystic fibrosis (CF) is an autosomal recessive disorder whose incidence has long been estimated as 1/2500 live births in Caucasians. Expanding implementation of newborn screening (NBS) programs now allows a better monitoring of the disease incidence, what is essential to make reliable predictions for disease management. This study assessed time trends in the birth incidence of CF over a long period (35 years: 1975-2009) in an area where CF is frequent (Brittany, France) and where NBS has been implemented for more than 20 years.</p> <p>Methods</p> <p>This study enrolled CF patients born in Brittany between January 1^st1975 and December 31^st2009 (n = 483). Time trends in incidence were examined using Poisson regression and mainly expressed using the average percent change (APC).</p> <p>Results</p> <p>The average number of patients born each year declined from 18.6 in the late 1970's (period 1975-79) to 11.6 nowadays (period 2005-09). The corresponding incidence rates dropped from 1/1983 to 1/3268, which represented a decline close to 40% between these two periods (APC = -39.3%, 95% CI = -55.8% to -16.7%, p = 0.0020). A clear breakpoint in incidence rate was observed at the end of the 1980's (p < 0.0001). However, the incidence rate has remained quite stable since that time (annual APC = -1.0%, 95% CI = -3.0% to 1.1%, p = 0.3516).</p> <p>Conclusions</p> <p>This study provides an accurate picture of the evolution of the incidence of a genetic disease over a long period and highlights how it is influenced by the health policies implemented. We observed a 40% drop in incidence in our area which seems consecutive to the availability of prenatal diagnosis.</p