Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Directional Effects in Cultural Identity: A Family Systems Approach for Immigrant Latinx Families

Although there is a substantial body of work focusing on the processes underlying cultural identity in general, less is known regarding how these processes might operate within the context of Latinx families. Moreover, among the limited research that has included the adolescent and caregiver cultural identity, most of the research has primarily focused on how caregivers influence their adolescent's cultural identity. In the present study, the directional pathways between recently immigrated adolescents' and caregivers' ethnic and U.S. identity belonging were examined using data from a longitudinal study of acculturation and identity development among recently arrived Latinx immigrant families. The sample consisted of 302 primary caregivers (M  = 41.09, SD = 7.13 at baseline; 67.5% mothers) and their adolescents (M  = 14.51, SD = 0.88 at baseline; 46.7% female). The results indicated that caregivers' ethnic identity belonging significantly predicted adolescents' ethnic identity belonging over time. At the same time, adolescents' ethnic identity negatively predicted caregivers' ethnic identity belonging over time, whereas adolescents' U.S. identity belonging positively predicted caregivers' later ethnic identity belonging. The findings indicate that immigrant caregivers may retain their native culture to direct and respond to their children's changing cultural identifications

Examining the Temporal Order of Ethnic Identity and Perceived Discrimination Among Hispanic Immigrant Adolescents

Ethnic identity formation is a central developmental task that can become challenging when adolescents face a salient stressor, such as ethnic discrimination. Although ethnic identity and experiences with ethnic discrimination are thought to be associated, the temporal order of these constructs is unclear. In the current study, we examined (a) the rejection-identification model and (b) the identification-attribution model in a longitudinal, cross-lagged model among 302 Hispanic immigrant adolescents (Mage = 14.51, SD = .88 at baseline; 46.7% female) living in Miami (n = 152) and Los Angeles (n = 150). Results support the identification-attribution model such that adolescents who reported higher levels of ethnic identity exploration reported higher levels of perceived discrimination 1 year later. Conversely, adolescents who reported higher levels of ethnic identity belonging reported less subsequent perceived discrimination. Findings suggest that ethnic identity formation may affect the recognition of ethnic discrimination among Hispanic immigrant adolescents

Latino parent acculturation stress: Longitudinal effects on family functioning and youth emotional and behavioral health

Latino parents can experience acculturation stressors, and according to the Family Stress Model (FSM), parent stress can influence youth mental health and substance use by negatively affecting family functioning. To understand how acculturation stressors come together and unfold over time to influence youth mental health and substance use outcomes, the current study investigated the trajectory of a latent parent acculturation stress factor and its influence on youth mental health and substance use via parent-and youth-reported family functioning. Data came from a 6-wave, school-based survey with 302 recent (<5 years) immigrant Latino parents (74% mothers, Mage = 41.09 years) and their adolescents (47% female, Mage = 14.51 years). Parents' reports of discrimination, negative context of reception, and acculturative stress loaded onto a latent factor of acculturation stress at each of the first 4 time points. Earlier levels of and increases in parent acculturation stress predicted worse youth-reported family functioning. Additionally, earlier levels of parent acculturation stress predicted worse parent-reported family functioning and increases in parent acculturation stress predicted better parent-reported family functioning. While youth-reported positive family functioning predicted higher self-esteem, lower symptoms of depression, and lower aggressive and rule-breaking behavior in youth, parent-reported family positive functioning predicted lower youth alcohol and cigarette use. Findings highlight the need for Latino youth preventive interventions to target parent acculturation stress and family functioning. (PsycINFO Database Recor

Alcohol initiation among recently immigrated Hispanic adolescents: Roles of acculturation and sociocultural stress

There is a growing recognition for the need for research to explore the unique and interactive effects of acculturation and sociocultural stress on alcohol initiation. Building on this research agenda, the current study sought to explore the independent and interactive effects of acculturation (i.e., heritage and U.S. cultural practices and identification) and sociocultural stress (i.e., perceived discrimination, perceived context of reception, and bicultural stress) on alcohol initiation among recently immigrated Hispanic adolescents. Data were taken from a 6-wave longitudinal study with 302 recently immigrated Hispanic adolescents (53% boys; Mage = 14.51 years at baseline; range = 14-17 years) and their families. Discrete-time survival models indicated that none of the acculturation indicators directly predicted alcohol initiation. Sociocultural stress-and specifically, bicultural stress-predicted alcohol initiation. There were significant interactions between acculturation and sociocultural stress in predicting alcohol initiation. Further research considering multiple components of acculturation and sociocultural stressors is needed to broaden our understanding of the potential role of sociocultural processes in alcohol initiation among Hispanic youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

Translation and Cross-Cultural Adaptation of English Version of Kiddy-KINDL to Filipino Language in Assessing the Children\u27s Health-Related Quality of Life (CHRQoL)

Background: Children\u27s health-related quality of life (CHRQoL) involves a child\u27s aim, expectations, standards, or concerns regarding overall health and its domains. The Kiddy-KINDL questionnaire is a tool to measure CHRQoL from information directly derived from children. It has been translated to various languages, except Filipino. This study would provide Filipino healthcare professionals with another functional tool for pediatric evaluation. Objective: To translate the English version of Kiddy-KINDL to Filipino and to determine its validity, test-retest reliability, and internal consistency of the Kiddy-KINDL in assessing the children\u27s health-related quality of life (CHRQoL). Methods: The study involved 3 Phases: Translation, Pilot Testing, and Reliability Phase. The English version of Kiddy-KINDL was cross-culturally adapted and translated into Filipino through a forward and backward translation process. Face validity was performed with 40 participants during the pilot testing phase. Test-retest reliability testing was performed with a total of 116 pairs of children, ages four to six, and their guardian living in Metropolitan Manila. Results: In phases 1 and 2, there were a total of 5 versions before the final Filipino version was considered acceptable. In phase 3, the test-retest reliability score of each dimension ranged from 0.18 to 0.98. The total reliability scores were 0.77 and 0.98 for adults and children, respectively. The internal consistency score was found to be acceptable in both questionnaires. Conclusion: The Filipino-translated Kiddy-KINDL has acceptable face validity results, test-retest reliability, and internal consistency scores

Trajectories of Cultural Stressors and Effects on Mental Health and Substance Use Among Hispanic Immigrant Adolescents

PURPOSE: We sought to determine the extent to which initial levels and over-time trajectories of cultural stressors (discrimination, negative context of reception, and bicultural stress) predicted well-being, internalizing symptoms, conduct problems, and health risk behaviors among recently immigrated Hispanic adolescents. Addressing this research objective involved creating a latent factor for cultural stressors, establishing invariance for this factor over time, estimating a growth curve for this factor over time, and examining the effects of initial levels (intercepts) and trajectories (slopes) of cultural stressors on adolescent outcomes. METHODS: A sample of 302 recently immigrated Hispanic adolescents in Miami (Mdn 1 year in the US at baseline) and Los Angeles (Mdn 3 years in the US at baseline) was recruited from public schools and assessed 6 times over a 3-year period. RESULTS: Perceived discrimination, context of reception, and bicultural stress loaded onto a latent factor at each of the first five timepoints. A growth curve conducted on this factor over the first five timepoints significantly predicted lower self-esteem and optimism, more depressive symptoms, greater aggressive behavior and rule breaking, and increased likelihood of drunkenness and marijuana use. CONCLUSIONS: The present results may be important in designing interventions for Hispanic immigrant children and adolescents, including those within the current wave of unaccompanied child migrants. Results indicate targeting cultural stressors in interventions may have potential to improve well-being and decrease externalizing behaviors and substance use within this population

Long-term safety and efficacy of eculizumab in generalized myasthenia gravis

Introduction: Eculizumab is effective and well tolerated in patients with antiacetylcholine receptor antibody-positive refractory generalized myasthenia gravis (gMG; REGAIN; NCT01997229). We report an interim analysis of an open-label extension of REGAIN, evaluating eculizumab's long-term safety and efficacy. Methods: Eculizumab (1,200 mg every 2 weeks for 22.7 months [median]) was administered to 117 patients. Results: The safety profile of eculizumab was consistent with REGAIN; no cases of meningococcal infection were reported during the interim analysis period. Myasthenia gravis exacerbation rate was reduced by 75% from the year before REGAIN (P < 0.0001). Improvements with eculizumab in activities of daily living, muscle strength, functional ability, and quality of life in REGAIN were maintained through 3 years; 56% of patients achieved minimal manifestations or pharmacological remission. Patients who had received placebo during REGAIN experienced rapid and sustained improvements during open-label eculizumab (P < 0.0001). Discussion: These findings provide evidence for the long-term safety and sustained efficacy of eculizumab for refractory gMG. Muscle Nerve 2019