Work engagement, emotional exhaustion, and OCB-civic virtue among nurses: a multilevel analysis of emotional supervisor support

Introduction: This study investigates the moderating role of supervisor emotional support at the group level on the relationship between emotional exhaustion and work engagement with organizational citizenship behavior-civic virtue (OCB-civic virtue) at the individual level among nurses. Method: A cross-sectional study was carried out on 558 nurses nested in 36 working units from two hospitals in Algiers. A multilevel analysis using Hierarchical Linear Modeling was performed. Results: Results show that the positive effect of work engagement on OCB-civic virtue was moderated by supervisor emotional support at group level. The nurses emotional exhaustion and OCB-civic virtue negative relationship at the individual level is buffered by supervisor emotional support at group level. Discussion: In consequence, supervisor emotional support experienced by the team has an influence on the emotional exhaustion and work engagement OCB-civic virtue relationship

Anatomic-Clinical Presentation. Testicular Teratocarcinoma with Thoracic-Abdominal Adenopathy

peer reviewedThis case report of a young man with a testicular germ cell-teratoma tumor illustrates the necessity of a multidisciplinary sequential approach to ensure chance of cure. The outcome of patients with advanced germ cell tumor depends on the optimal clinical management. Residual masses are frequent, and their histology can be different than the initial one (i.e., only residual mature teratoma cells or necrosis-fibrosis). Therefore a second surgery on residual masses with curative intent, may be important to optimalize the treatment and follow up

Inequality in treatment use among elderly patients with acute myocardial infarction: USA, Belgium and Quebec

<p>Abstract</p> <p>Background</p> <p>Previous research has provided evidence that socioeconomic status has an impact on invasive treatments use after acute myocardial infarction. In this paper, we compare the socioeconomic inequality in the use of high-technology diagnosis and treatment after acute myocardial infarction between the US, Quebec and Belgium paying special attention to financial incentives and regulations as explanatory factors.</p> <p>Methods</p> <p>We examined hospital-discharge abstracts for all patients older than 65 who were admitted to hospitals during the 1993–1998 period in the US, Quebec and Belgium with a primary diagnosis of acute myocardial infarction. Patients' income data were imputed from the median incomes of their residential area. For each country, we compared the risk-adjusted probability of undergoing each procedure between socioeconomic categories measured by the patient's area median income.</p> <p>Results</p> <p>Our findings indicate that income-related inequality exists in the use of high-technology treatment and diagnosis techniques that is not justified by differences in patients' health characteristics. Those inequalities are largely explained, in the US and Quebec, by inequalities in distances to hospitals with on-site cardiac facilities. However, in both Belgium and the US, inequalities persist among patients admitted to hospitals with on-site cardiac facilities, rejecting the hospital location effect as the single explanation for inequalities. Meanwhile, inequality levels diverge across countries (higher in the US and in Belgium, extremely low in Quebec).</p> <p>Conclusion</p> <p>The findings support the hypothesis that income-related inequality in treatment for AMI exists and is likely to be affected by a country's system of health care.</p

Socialist government health policy reforms in Bolivia and Ecuador: the underrated potential of comprehensive primary health care to tackle the social determinants of health

Background: Selective vertical programs have prevailed over comprehensive primary health care in Latin America. In Bolivia and Ecuador, socialist governments intend to redirect health policy. We outline key features of both countries’ health systems after reform, explore their efforts to rebuild primary health care, identify and explain policy gaps, and offer considerations for improvement. Methods: Qualitative document analysis. Findings: Neoliberal reforms left Bolivia’s and Ecuador’s population in bad health, with limited access to a fragmented health system. Today, both countries focus their policy on household and community-based promotion and prevention. The negative effects on access to care of decentralization, dual employment, vertical programming, and targeting have been not received much attention. The neglect of health care services can be understood in the light of a particular, rigid interpretation of social medicine and social determinants, international policy pressures, reliance on external funding, and institutional inertia. Current policy choices preserve key elements of selective care and consolidate commodification. These reforms might not improve health and may worsen poverty. Conclusions: Health care can be considered as a social determinant in its own right. Primary care needs to be founded on an integrated model of family medicine, taking advantage of individual care as one of the ways to act on social determinants. It deserves a central place on the policy-makers’ priority list in Bolivia and Ecuador as elsewhere

Recurrence dynamics of breast cancer according to baseline body mass index

Background In cancer follow-up, in addition to the evaluation of survival probabilities, there is a fundamental need of assessing recurrence dynamics for optimal disease management. Although the time-dependent effect of the oestrogen receptor (ER) status of the tumour has already been described, so far no factor has proven to disentangle the multi-peak behaviour observed for breast cancer recurrences. Here, we aimed at investigating whether adiposity at diagnosis, reflected by increased patient's body mass index (BMI), could be associated with breast cancer recurrence patterns over time after primary cancer therapy. Methods We retrieved BMI from 734 of 777 patients with node-positive breast cancer from a phase III randomised clinical trial, which compared different chemotherapy regimens and had a median follow-up of 15.4 years. Cumulative incidence estimation as well as piecewise exponential models were carried out to estimate the distant recurrence dynamics, in all patients, as well as in subgroups based on the ER status, with the ER-positive group being further split according to the menopausal status. Results In patients with ER-negative breast cancer, time-dependent analyses revealed that the hazard of late relapses could mainly be attributed to the overweight and obese patients. Within the subgroup of premenopausal patients with ER-positive tumours, obesity was associated with an early high narrow peak of distant recurrences followed by another main peak after 5 years of follow-up. The risk for overweight patients was intermediate between obese and normal-weight patients. In the postmenopausal subgroup of patients with ER-positive tumours, the distant recurrence rate was significantly more elevated in the overweight patients compared to the other BMI categories, and a second late peak of recurrences was also observed for the obese patients. Conclusion These results demonstrate that the patient's BMI at diagnosis is associated with cancer recurrence dynamics. Patient adiposity should therefore be central to the exploration of late adjuvant treatment modalities