Efficacy of Existing Interventions for Health Care Provider Stress & Implications for Low-Resource Health Care Settings: A Systematic Review

Introduction: There is a demand for interventions that may help providers cope with inevitably high levels of stress, but there is a paucity of data on the efficacy/feasibility of interventions for provider stress/burnout—particularly in low-resource settings. This study examined existing interventions and their effectiveness in combatting stress and burnout among providers. Methods: The traditional format of a systematic review was employed utilizing PubMed, PsycInfo, and SCOPUS to examine stress and burnout interventions offered to health care providers. Primary outcomes of stress/burnout were analyzed through the use of validated resilience scores. This study initially identified 1,720 records; twelve studies were included in the final review (6 RCT, 6 Observational). Results: Mindfulness-Based Stress Reductions (MBSR) and modified versions of MBSR proved effective in mitigating burnout among healthcare providers. Interventions involving work-hour adjustments and “Balint-type” discussion sessions demonstrated modest results with downward trends in burnout joined by a decrease in other secondary measurements like emotional exhaustion. Interventions focused on protected sleep periods, communication skills training combined with stress management, and online courses did not demonstrate statistically significant reductions in burnout or depression. Conclusion: Some of the mindfulness-based and focused educational interventions analyzed in this review show promise in the sustainable reduction in stress/burnout among physicians and nurses. This review also supports the need for and the potential benefits of long-term follow-up measures regarding healthcare provider stress/burnout interventions in order to develop feasible programs that may help low-resource setting providers that experience burnout in its most extreme form

A holistic approach to facility protection from adventitious agents – A case study

The Eli Lilly biologics manufacturing facility in Kinsale, Ireland has been operational since 2010 with a 100% cell culture contamination control success rate. The presentation will review the holistic approach to facility protection from adventitious agents that underpins this success including: The risk assessment approach to points of entry and management via detectability and control measures The approach to personnel training that considers human factors, increased vigilance and event simulations following strategies that are used in chemical synthesis process safety The presentation will then focus on control of adventitious virus. The talk will briefly comment on the early warning measures via use of an in process qPCR assay and then move on to place significant emphasis on the application of High Temperature Short Term (HTST) treatment for culture media. The Proof of Concept studies showing applicability to certain media classes and challenges for others will be discussed and then a case study showing detailed laboratory support studies for a number of products will be presented. Finally the challenges of application to clinical and commercial products will be discussed

The effect of a home-based strength training program on type 2 diabetes risk in obese Latino boys

This paper is designed to determine the effects of a home-based strength training (HBST) intervention on insulin sensitivity (SI), compensatory acute insulin response and β-cell function, body composition measures, and maximum strength in obese Latino boys. A total of 26 obese Latino males aged between 14 and 18 years were randomized to either a twice-weekly (n=15) or a control group (C; n=15) for 16 weeks. HBST for 16 weeks, composed of two 1-h sessions per week. Outcome measures were assessed pre-and post-intervention/control condition and included SI, acute insulin response to glucose (AIR) and disposition index (DI), fasting glucose, 2-h glucose, body composition using waist-hip circumferences, body mass index (BMI), dual energy X-ray absorptiometry (DEXA) scan, blood pressure, and strength by 1-repetition maximum. A repeated measures GLM was used to assess differences in changes in outcome measures, between the C and the HBST groups. There were no significant overall intervention effects on any of the outcome variables (p<0.05). These results suggest that an HBST does not improve SI, maximal strength or decrease adiposity in obese Latino boys

Indiana Emergency Medical Services Needs Assessment: Workforce and Training Issues

A mail survey was conducted to assess issues related to the EMS workforce and EMS workforce training in Indiana. Responses were received from approximately 45% of individuals and EMS organization contacted. Major findings are: Evidence exists of a shortage of EMS personnel in Indiana due to high vacancy rates. This is particularly acute in volunteer organizations, which report the greatest difficulty in recruiting EMS personnel. Paid EMS personnel work on average significantly more than a standard 40 hour week, and high percentages of EMS personnel add a second job. Because excessive working hours have been linked to low quality healthcare, this may indicate potential problems with the quality of EMS care. Differences in training needs and training received in areas related to cardiac care indicate potential disparities in the quality of care for heart attacks between rural and urban areas. Contrary to the Indiana requirements for recertification, it appears that a significant proportion of Indiana EMS personnel and organizations are not using audits as a tool for ensuring quality and developing skills. A wide variety of training needs have been identified. While some clinical skill areas (basic and advanced life support) are needed, many of these areas are in important non-clinical areas, such as automobile extrication, foreign languages, safety, and incident management. The training environment, both in terms of initial and continuing training, is so varied that it cannot realistically be considered a “system.” In the abstract, EMS personnel prefer “hands-on” type training, but when presented with specific scenarios they indicate a greater affinity for locally-delivered mechanisms such as classroom courses at a local school or computer-based training. This probably reflects the tradeoff between time and utility, and is consistent with findings that time is the largest barrier to continuing education and the high percentage EMS personnel who hold second jobs. Self-assessment of preparedness levels by EMS personnel reveals that the EMS system in rural areas is likely to be less prepared and capable than in urban areas. Volunteer organizations rate themselves as less capable than paid organizations, although this is largely not reflected in self-assessments by volunteer EMS personnel

Physical activity counseling in overweight and obese primary care patients: Outcomes of the VA-STRIDE randomized controlled trial.

The purpose of this 2-arm randomized clinical trial was to evaluate the effectiveness of a 12-month, expert system-based, print-delivered physical activity intervention in a primary care Veteran population in Pittsburgh, Pennsylvania. Participants were not excluded for many health conditions that typically are exclusionary criteria in physical activity trials. The primary outcome measures were physical activity reported using the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire and an accelerometer-based activity assessment at baseline, 6, and 12 months. Of the 232 Veterans enrolled in the study, 208 (89.7%) were retained at the 6-month follow-up and 203 (87.5%) were retained at 12 months. Compared to the attention control, intervention participants had significantly increased odds of meeting the U.S. recommended guideline of ≥ 150 min/week of at least moderate-intensity physical activity at 12 months for the modified CHAMPS (odds ratio [OR] = 2.86; 95% CI: 1.03-7.96; p = 0.04) but not at 6 months (OR = 1.54; 95% CI: 0.56-4.23; p = 0.40). Based on accelerometer data, intervention participants had significantly increased odds of meeting ≥ 150 min/week of moderate-equivalent physical activity at 6 months (OR = 6.26; 95% CI: 1.26-31.22; p = 0.03) and borderline significantly increased odds at 12 months (OR = 4.73; 95% CI: 0.98-22.76; p = 0.053). An expert system physical activity counseling intervention can increase or sustain the proportion of Veterans in primary care meeting current recommendations for moderate-intensity physical activity. Trial Registration Clinical trials.gov identifier: NCT00731094 URL: http://www.clinicaltrials.gov/ct2/show/NCT00731094

Predictors of Long-term Exercise Maintenance among College Aged Adults: Role of Body Image Anxiety

Background and Purpose: Participation in regular exercise is low among young adults and is contributing to a rapid increase in obesity and chronic health conditions. Enhancing motivation is a key element in exercise initiation and maintenance. The current investigation considers factors relevant to the transtheoretical model (TTM), self-determination theory (SDT), self-efficacy (SE), and body image anxiety (BIA) in relation to college students’ motivation to exercise. Design and Main Outcome Measures: In this cross sectional study, lower division college students (N=614, 64% female, 36% male) completed an online survey of exercise behavior, motivation, SE and BIA. Results: BIA was related to both controlled extrinsic (external and introjected regulations) and autonomous extrinsic (integrated regulation) SDT motivational variables, as well as intrinsic motivation. Exercise maintenance was most strongly associated with integrated regulation, a “selfdetermined” motivational state, and SE. Conclusion: The current study provides support for the central tenet of SDT indicating that intrinsic and extrinsic motivation are not mutually exclusive constructs. Helping individuals with BIA develop a more intrinsic approach to exercise is integral for fostering long-term exercise maintenance. Thus, future research should focus on developing interventions that enhance integrated regulation and SE in order to promote exercise maintenance and reduce associated BIA

Microphotonic needle for minimally invasive endoscopic imaging with sub-cellular resolution

Ultra-compact micro-optical elements for endoscopic instruments and miniaturized microscopes allow for non-invasive and non-destructive examination of microstructures and tissues. With sub-cellular level resolution such instruments could provide immediate diagnosis that is virtually consistent with a histologic diagnosis enabling for example to differentiate the boundaries between malignant and benign tissue. Such instruments are now being developed at a rapid rate||however, current manufacturing technologies limit the instruments to very large sizes, well beyond the sub-mm sizes required in order to ensure minimal tissue damage. We show here a platform based on planar microfabrication and soft lithography that overcomes the limitation of current optical elements enabling single cell resolution. We show the ability to resolve lithographic features that are as small as 2 mu m using probes with a cross section that is only 100 microns in size. We also show the ability to image individual activated neural cells in brain slices via our fabricated probe.8116Agências de fomento estrangeiras apoiaram essa pesquisa, mais informações acesse artig

An examination of objectively-measured sedentary behavior and mental well-being in adults across week days and weekends

BackgroundLimited research has explored the links between sedentary behaviour, mental health and quality of life. This study examines objectively measured sedentary behaviour and perceived mental health and quality of life across week days and weekends.Methods42 adults (19M, 23F; mean age 38yrs (range 18–67) & BMI 24.8kg/m2 (range 18.7–33.8) wore an activPAL monitor 24h/day for one week and completed the Hospital Anxiety and Depression Scale (HADS) and SF12 Health Survey. Average weekday and weekend day sitting time was computed. Differences between sitting (Group 1 = 10hrs/day) and components of the HADS and SF12 health survey were examined using an ANCOVA with a measure of physical activity (step count) included as a covariate.ResultsAverage sitting time on a weekday was 9hrs 29mins (range 5hrs 52mins to 12hrs 55mins) and 8hrs 59mins (range 4hrs, 07mins to 14hrs, 40mins) on a weekend day. There was a main effect (p 0.05). No main effects were found for weekend sitting (p > 0.05).ConclusionsWeekday sitting time below 8 hours/day is associated with better perceived mental health and quality of life

The Long-Term Conditions Questionnaire (LTCQ): Conceptual framework and item development

Purpose: To identify the main issues of importance when living with long-term conditions to refine a conceptual framework for informing the item development of a patient-reported outcome measure for long-term conditions. Methods: Semi-structured qualitative interviews (n=48) were conducted with people living with at least one long-term condition. Participants were recruited through primary care. The interviews were transcribed verbatim and analysed by thematic analysis. The analysis served to refine the conceptual framework, based on reviews of the literature and stakeholder consultations, for developing candidate items for a new measure for long-term conditions. Results: Three main organising concepts were identified ‘Impact of long-term conditions’, ‘Experience of services and support’ and ‘Self-care’. The findings helped to refine a conceptual framework leading to the development of 23 items that represent issues of importance in long-term conditions. The 23 candidate items formed the first draft of the measure, currently named the Long-Term Conditions Questionnaire (LTCQ). Conclusions: The aim of this study was to refine the conceptual framework and develop items for a patient-reported outcome measure for long-term conditions, including single and multiple morbidities, and physical and mental health conditions. Qualitative interviews identified the key themes for assessing outcomes in long-term conditions and these underpinned the development of the initial draft of the measure. These initial items will undergo cognitive testing to refine the items prior to further validation in a survey

Patterns of Sedentary Behaviour in Female Office Workers

Background: Prolonged sedentary behaviour is associated with poor health outcomes. Office workers often engage in excessive sedentary behaviour, however limited research reports on how this sedentary behaviour is accumulated. This study examines objectively measured patterns of prolonged sedentary behaviour in female office workers during weekdays and weekend days and across time of day. Methods: Full time female office workers from a Scottish University participated (N = 27 mean age 43.0 ± 11.5 yrs; BMI 25.8 ± 4.1 kg/m2). Participants wore an activPAL™ for 7 days and completed a diary of waking and working hours. Average week and weekend time sitting, standing and stepping was calculated and also expressed as a proportion of waking day. Average week and weekend daily step count and sit to stand transitions were calculated. Continuous bouts of sedentary behaviour were categorised as: 20–40, 40–60 and > 60 minutes and compared between week and weekend days and across time of day. Results: Average weekday sitting time and proportion was higher (P 0.05) on weekdays vs weekend days. The pattern of sedentary behaviour bouts was different between week and weekend days. Week days were dominated by a consistent pattern of shorter (20–40 mins) sedentary behaviour bouts. The longest continuous sedentary behaviour bouts occurred in the evening, particularly at weekends. Conclusions: In office workers the most prolonged sedentary behaviour occurred in the evening, particularly at weekends. Interventions need to target these highly saturated periods of sedentary behaviour