Assessing Loneliness and Other Types of Emotional Distress among Practicing Physicians

Introduction. Loneliness has been linked to clinician burnout and other types of emotional distress. Research assessing the prevalence of loneliness among physicians is growing. Little is known, however, about how loneliness relates to other types of emotional distress among practicing physicians. The objectives of the study were to determine the prevalence of loneliness, and to explore the relationship between loneliness, burnout, depressive symptoms, and suicidal ideation among active member physicians of the Medical Society of Sedgwick County (MSSC). Methods. The study involved a convenience sample of 197 practicing physicians who were active members of the MSSC. The 3-item University of California, Los Angeles Loneliness Scale, the Abbreviated Maslach Burnout Inventory, and 2-item Primary Care Evaluation of Mental Disorders Patient Health Questionnaire were used to measure prevalence of loneliness, manifestations of burnout, and symptoms of depression, respectively. Results. Using an email survey, 442 practicing physicians received an invitation to participate; 197 (44%) completed the survey. The prevalence of loneliness was 43%. Loneliness prevalence was associated positively with age (p = 0.017) and more likely in those who reported manifestations of burnout (p < 0.01) or screened positive for depression (p < 0.01). Depression (OR = 2.24; 95% CI, 0.97-5.19) and emotional exhaustion (OR = 1.05; 95% CI, 0.39-2.84) were significantly associated with loneliness, including when adjusted for participants’ sex, age, and duty hours. Conclusion. Loneliness is prevalent among active member physicians of the Medical Society of Sedgwick County. Given that loneliness is associated with burnout and other emotional distress, there is an important need to understand its implications better

A critical evaluation of labour migrancy and practices of remittances: the case of Ghanaian workers in the informal economy in Johannesburg

ABSTRACT The research was inspired by further studies conducted on remittances indicating that; voluntary migrants worldwide remit generously to their families back home (Adams Jnr. 2006; Mazzucato et al., 2004a; Pendleton et al., 2006; Shady, 2004; Stark, 1991) with little attention paid to Ghanaians involved in labour migrancy in South Africa. This report explored remittance practices by Ghanaian labour migrants involved in the informal economy in Johannesburg and also investigated factors that motivated migrants from Ghana to send money and/or goods back home. The study objectives included identifying channels used to remit, frequency of remittance, different forms of remittances and also investigated the living conditions and nature of work of migrants. Finally, it established why these migrants chose to come to South Africa. A snowball sample was employed to gather data from 20 Ghanaian migrants involved in labour migrancy in the informal economy in Johannesburg. These respondents work at these various places: Parktown, Berea, Yeoville, and Braamfontein and engaged in such work as hairdressing, waiting, tailoring/clothing designing, hairdressing, Internet café operating, welding, barbering, Carpentry, shoe and bag repairing. It therefore appeared that most of these respondents got employed through social networks. Even though it was not the focus of the study, of the total population, 5 females were interviewed to explore their remittance practices compared to their male counterparts. Semi-structured interviews were used to address the research objectives. Though the research revealed two motivating factors namely; economic and social that influenced respondents to sent money to family members, economic factor emerged as the common factor among these migrants. Specific reasons for remitting among the migrants were also categorised as altruism, pure self-interest or “enlightened self-interest”. Further, the survey revealed two channels that were used by these migrants to remit family members back home. These were formal and informal channels. Under the formal channels were specialised money transfer institutions (Standard Bank, Rennies) and then sea freight services. The study saw that majority (75%) of the respondents (all the 5 female migrants inclusive) used the formal channel to transfer money or goods whereas a handful (25%) of the respondents reported to remit through personal contacts which falls under the informal channel. In terms of frequency of remittance, two trends were identified and these were regular and occasional. Migrants who remitted once, twice in every quarter or four months were categorised under regular remitters and among were the 5 female migrants interviewed, while occasional remitters were seen as those who sent money and goods once in 6 months or a year. All respondents reported to have remitted due to economic downturn in Ghana. The data collected highlighted all respondents came to South Africa for jobs that would offer better opportunities because of an impression they (migrants) had on South Africa’s economy

Patient Perception of Medical Learners and Medical Education during Clinical Consultation at a Family Medicine Residency

Introduction. Experience in treating patients under supervisionof faculty is an important factor in medical education at all levels.However, unpleasant patient experiences with a medical learnerduring clinical consultation can damage the relationship betweenthe medical learner, physician supervisor, and patient. A goal of thisstudy was to examine patient experiences and preferences regardingmedical learners during clinical consultation at a family medicineresidency clinic. Another goal was to determine factors relating topatients’ experiences and preferences regarding medical learners. Methods. This cross-sectional study relied on patients completinga survey designed from extant questionnaires to measure patients’experiences and preferences relating to interactions with medicallearners at a family medicine clinic. Data were collected from 216patients between December 2016 and August 2017. We correlatedpatients’ feelings, overall experiences with medical learners and theimportance of medical education. Results. There was a 93% participation rate. The patients rated theiroverall experiences with medical learners as 3.8 on a 5-point scale,suggesting positive experiences. Eighty-eight percent prefer not morethan three medical learners to be involved in their care during clinicalconsultation. Patients’ overall experiences with medical learnersparticipating in medical care correlated with their preferences regardingmedical learners’ involvement in their treatment (r[209] = .524;p = 0.01). Patients’ perception of medical learners participating inmedical care correlated with the importance of medical education(r[209] = .878; p = 0.01). Conclusions. The results showed that most patients have positiveexperiences with medical learners and are generally in favor ofmedical education.Kans J Med 2018;11(4):102-105

Potential of immunomodulatory agents as adjunct host-directed therapies for multidrug-resistant tuberculosis

Treatment of multidrug-resistant tuberculosis (MDR-TB) is extremely challenging due to the virulence of the etiologic strains of Mycobacterium tuberculosis (M. tb), the aberrant host immune responses and the diminishing treatment options with TB drugs. New treatment regimens incorporating therapeutics targeting both M. tb and host factors are urgently needed to improve the clinical management outcomes of MDR-TB. Host-directed therapies (HDT) could avert destructive tuberculous lung pathology, facilitate eradication of M. tb, improve survival and prevent long-term functional disability. In this review we (1) discuss the use of HDT for cancer and other infections, drawing parallels and the precedent they set for MDR-TB treatment, (2) highlight preclinical studies of pharmacological agents commonly used in clinical practice which have HDT potential, and (3) outline developments in cellular therapy to promote clinically beneficial immunomodulation to improve treatment outcomes in patients with pulmonary MDR-TB. The use of HDTs as adjuncts to MDR-TB therapy requires urgent evaluation

Why Patients Miss Scheduled Outpatient Appointments at Urban Academic Residency Clinics: A Qualitative Evaluation

Introduction Missed outpatient appointments are a common problem for academic residency clinics, and reducing their rate improves office efficiency, income, and resident education. Identifying specific reasons why some patients miss outpatient appointments may provide insight into developing targeted approaches to reducing their rates. This study sought to find reasons associated with patients’ missed appointments at two family medicine residency clinics. Methods The study utilized a qualitative research design involving patients at two urban, university-affiliated family medicine residency outpatient clinics. Twenty-five randomly selected patients who were dismissed from the clinics for missing three or more scheduled appointments during a five-year span (July 2012 to July 2017) were interviewed over the phone about reasons they did not keep their scheduled clinic appointments. The authors, individually and as a group, used an immersion-crystalization approach to analyze the content of the interviews. Results Responses from 25 participants (21 females and four males) are presented. Fifty-two percent of patients were Caucasian, 32% Black, 12% Hispanic, and 4% Asian. Five themes emerged from the data analysis as major reasons the patients missed their scheduled outpatient appointments: forgetfulness, transportation issues, personal health issues, family and employer obligations, and other issues, such as anticipated long clinic wait times, bad weather, and financial problems. Conclusions The findings showed there are several logistical, situational, and clinical reasons for patients’ missed scheduled outpatient appointments

Assessing Work-Related Burnout and Job Satisfaction among Obstetrics and Gynecology Residency Program Coordinators

Introduction. This study explored the prevalence of and the relationshipbetween job satisfaction and burnout among obstetrics andgynecology residency program coordinators.Methods.xThis cross-sectional study involved members of theAmerican Program Managers of Obstetrics and Gynecology. TheCopenhagen Burnout Inventory and Spector’s Job SatisfactionSurvey were used to measure the participants’ burnout and job satisfactionrates respectively. Data were collected between August 2017and December 2017. The authors used Fisher’s exact tests, Spearman’sr correlations, and multiple linear regression to analyze thedata.Results. There was an 83% (171/207) response rate. Thirteenpercent of the coordinators reported high, 70% moderate, and 17%low job satisfaction scores. Thirty-nine percent of the coordinatorsreported high, 25% moderate, and 36% slight work-related burnoutrates. Correlation coefficient showed a significantly negative relationshipbetween job satisfaction and work-rated burnout, (rs[169] =-0.402, p < 0.01). Regression analysis showed co-workers (β = -0.47)and supervision (β = -0.16) domains of the job satisfaction scale weresignificant predictors of work-related burnout (R = 0.55; F[5, 195] =11.05; p < .001).Conclusions. The findings highlight the importance of job satisfactionfactors, such as support from coworkers and supervisors, indealing with work-related burnout among residency coordinators.Kans J Med 2019;12(1):11-16

Burnout and Quality of Life among Active Member Physicians of the Medical Society of Sedgwick County

Introduction. The medical literature suggests disturbingly high ratesof burnout among US physicians. The objective of this study was todetermine the rates of burnout, other forms of distress, and overallquality of life among physicians in Sedgwick County.Methods.xThe study involved a convenience sample of 197 physicianswho were active member physicians of the Medical Society of SedgwickCounty (MSSC). Between July and August 2018, we surveyed872 physicians who were active members of the MSSC. The surveyassessed manifestations of burnout, symptoms of depression and suicidalideation, fatigue, and quality of life. The authors used standarddescriptive summary statistics, Mann-Whitney U test/independentsamples t-Test, Fisher’s exact test, and correlations to analyze thedata.Results. The participation rate was 44.6%, with 49.5% of therespondents reporting manifestations of burnout. Although 85% ofthe participants rated their overall quality of life as good/very good,45% screened positive for depression, 5% had thoughts of suicideduring the past year, and 44% reported excessive fatigue during thepast week. Those with manifestations of burnout were 2.13 (100%vs 46.9%, p < 0.01) times more likely to report thoughts of suicidalideation, 2.43 (72.6% vs 30.4%; p < 0.001) times more likely to screenpositive for depression, and 1.89 (67.5% vs 35.8%; p < 0.001) timesmore likely to have high degrees of fatigue. All of the participants whohad suicidal ideation reported manifestations of burnout.Conclusions. Burnout was prevalent among active member physiciansof the MSSC. Burnout among the participants was associatedwith symptoms of depression, fatigue, suicidal ideation, and intentionof leaving the medical profession via early retirement and/or careerchange. Kans J Med 2019;12(2):33-39

Short versus long chain polyelectrolyte multilayers: a direct comparison of self-assembly and structural properties

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG geförderten) Allianz- bzw. Nationallizenz frei zugänglich.This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively.Successful layer-by-layer (LbL) growth of short chain (∼30 repeat units per chain) poly(sodium styrene sulfonate) (PSS)–poly(diallyl dimethylammonium chloride) (PDADMAC) multilayers is presented for the first time and compared with the growth of equivalent long chain polyelectrolyte multilayers (PEMs). A detailed study performed by quartz crystal microbalance with dissipation (QCM-D) is carried out and three main processes are identified: (i) initial mass uptake, (ii) adsorption–desorption during layer equilibration and (iii) desorption during rinsing. In contrast to the high stability and strong layer increment of high molecular weight (HMW) PEMs, layer degradation characterizes low molecular weight (LMW) multilayers. In particular, two different instability phenomena are observed: a constant decrease of sensed mass during equilibration after PDADMAC adsorption, and a strong mass loss by salt-free rinsing after PSS adsorption. Yet, an increase of salt concentration leads to much stronger layer growth. First, when the rinsing medium is changed from pure water to 0.1 M NaCl, the mass loss during rinsing is reduced, irrespective of molecular weight. Second, an increase in salt concentration in the LMW PE solutions causes a larger increment during the initial adsorption step, with no effect on the rinsing. Finally, the mechanical properties of the two systems are extracted from the measured frequency and dissipation shifts, as they offer a deeper insight into the multilayer structures depending on chain length and outermost layer. The paper enriches the field of PE assembly by presenting the use of very short PE chains to form multilayers and elucidates the role of preparation conditions to overcome the limitation of layer stability.DFG, SPP 1369, Polymer-Festkörper-Kontakte: Grenzflächen und Interphase

Mycobacterium tuberculosis proteins involved in cell wall lipid biosynthesis improve BCG vaccine efficacy in a murine TB model

OBJECTIVES: Advances in tuberculosis (TB) vaccine development are urgently required to enhance global disease management. We evaluated the potential of Mycobacterium tuberculosis (M. tb)-derived protein antigens Rv0447c, Rv2957 and Rv2958c to boost BCG vaccine efficacy in the presence or absence of glucopyranosyl lipid adjuvant formulated in a stable emulsion (GLA-SE) adjuvant. METHODS: Mice received the BCG vaccine, followed by Rv0447c, Rv2957 and Rv2958c protein boosting with or without GLA-SE adjuvant 3 and 6 weeks later. Immune responses were examined at given time points. 9 weeks post vaccination, mice were aerosol-challenged with M. tb, and sacrificed at 6 and 12 weeks to assess bacterial burden. RESULTS: Vaccination of mice with BCG and M. tb proteins in the presence of GLA-SE adjuvant triggered strong IFN-γ and IL-2 production by splenocytes; more TNF-α was produced without GLA-SE addition. Antibody responses to all three antigens did not differ, with or without GLA-SE adjuvant. Protein boosting without GLA-SE adjuvant resulted in vaccinated animals having better control of pulmonary M. tb load at 6 and 12 weeks post aerosol infection, while animals receiving the protein boost with GLA-SE adjuvant exhibited more bacteria in the lungs. CONCLUSIONS: Our data provides evidence for developing Rv2958c, Rv2957 and Rv0447c in a heterologous prime-boost vaccination strategy with BCG