Parental Burnout Around the Globe: a 42-Country Study.
Ontology highlight
ABSTRACT: Supplementary information
The online version contains supplementary material available at 10.1007/s42761-020-00028-4.
SUBMITTER: Roskam I
PROVIDER: S-EPMC7970748 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Alternative models of cardiac rehabilitation (CR) delivery, such as home or community-based programs, have been developed to overcome underutilization. However, their availability and characteristics have never been assessed globally. In this cross-sectional study, a piloted survey was administered online to CR programs globally. CR was available in 111/203 (54.7%) countries globally; data were collected in 93 (83.8% country response rate). 1082 surveys (32.1% program response rate) were initiated. Globally, 85 (76.6%) countries with CR offered supervised programs, and 51 (45.9%; or 25.1% of all countries) offered some alternative model. Thirty-eight (34.2%) countries with CR offered home-based programs, with 106 (63.9%) programs offering some form of electronic CR (eCR). Twenty-five (22.5%) countries with CR offered community-based programs. Where available, programs served a mean of 21.4% ± 22.8% of their patients in home-based programs. The median dose for home-based CR was 3 sessions (Q25-Q75 = 1.0⁻4.0) and for community-based programs was 20 (Q25⁻Q75 = 9.6⁻36.0). Seventy-eight (47.0%) respondents did not perceive they had sufficient capacity to meet demand in their home-based program, for reasons including funding and insufficient staff. Where alternative CR models are offered, capacity is insufficient half the time. Home-based CR dose is insufficient to achieve health benefits. Allocation to program model should be evidence-based.
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Project description:BackgroundCardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region.MethodsIn this cross-sectional study, a piloted survey was administered online to CR programs globally. Cardiac associations and local champions facilitated program identification. Quality (benchmark of ≥ 75% of programs in a given country meeting each of 20 indicators) was ranked. Results were compared by WHO region using generalized linear mixed models.Findings111/203 (54.7%) countries in the world offer CR; data were collected in 93 (83.8%; N = 1082 surveys, 32.1% program response rate). The most commonly-accepted indications were: myocardial infarction (n = 832, 97.4%), percutaneous coronary intervention (n = 820, 96.1%; 0.10), and coronary artery bypass surgery (n = 817, 95.8%). Most programs were led by physicians (n = 680; 69.1%). The most common CR providers (mean = 5.9 ± 2.8/program) were: nurses (n = 816, 88.1%; low in Africa, p < 0.001), dietitians (n = 739, 80.2%), and physiotherapists (n = 733, 79.3%). The most commonly-offered core components (mean = 8.7 ± 1.9 program) were: initial assessment (n = 939, 98.8%; most commonly for hypertension, tobacco, and physical inactivity), risk factor management (n = 928, 98.2%), patient education (n = 895, 96.9%), and exercise (n = 898, 94.3%; lower in Western Pacific, p < 0.01). All regions met ≥ 16/20 quality indicators, but quality was < 75% for tobacco cessation and return-to-work counseling (lower in Americas, p = < 0.05).InterpretationThis first-ever survey of CR around the globe suggests CR quality is high. However, there is significant regional variation, which could impact patient outcomes.
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Project description:BackgroundRadon is the primary source of environmental radiation exposure posing a significant human health risk in cold countries. In Canada, most provinces have revised building codes by 2017, requiring construction solutions to avoid radon in all new buildings. While various construction solutions and remediation techniques have been proposed and evaluated, the question about the best method that would effectively reduce radon in a variety of contexts remained unanswered. Radon practitioners, officials of radon control programs, and businesses offering radon testing and mitigation services, builders, property managers, homeowners and residents also have similar queries.ObjectiveThis paper systematically reviewed both experimental and observational studies (S) with radon interventions (I) used globally in residential houses (P) compared to other residential or model houses (C) to evaluate relative mitigation effectiveness (O) that could guide selecting the best radon reduction strategy for residential buildings.MethodsTwo researchers searched fifteen academic bibliographic and grey literature databases for radon intervention studies conducted around the world, with particular emphasis on areas of North America and Europe published from 1990 to 2018.Interventions in residential and model houses were included, but studies piloted purely in the lab were excluded; the PRISMA checklist was used to synthesize data; Cochrane and Hamilton tools were used to evaluate study quality.ResultsStudies around the globe have investigated a variety of construction solutions, radon mitigation and remediation systems with different levels of effectiveness. In most cases, sub-slab or sump depressurization system (SSDS) with active ventilation technique was found more effective in achieving a significant and sustained radon reduction than the passive methods such as sealing, membrane, block and beam, simple ventilation, or filtration. The choice of an optimal strategy largely depends on the factors related to the initial radon level, routes of entry, building design and age, as well as other geologic, atmospheric, and climatic conditions.ConclusionAlthough an active SSDS is the best mitigation systems, at places, it needs to be combined with another system and installed by a trained radon professional considering the pertinent factors to ensure radon level continues to remain below the action level. This study did not conduct any economic evaluation of the mitigation measures. Future review with studies on the implementation of new building codes will provide updated evidence.RecommendationFor the practical implementation of radon mitigation, training of the construction industry, information provision for residents, the establishment of public funds, incorporation of radon-prone areas in the land utilization maps, and enacting building codes deemed essential.
| S-EPMC6538966 | biostudies-literature
Project description:Studies have investigated the effects of heat and temperature variability (TV) on mortality. However, few assessed whether TV modifies the heat-mortality association. Data on daily temperature and mortality in the warm season were collected from 717 locations across 36 countries. TV was calculated as the standard deviation of the average of the same and previous days' minimum and maximum temperatures. We used location-specific quasi-Poisson regression models with an interaction term between the cross-basis term for mean temperature and quartiles of TV to obtain heat-mortality associations under each quartile of TV, and then pooled estimates at the country, regional, and global levels. Results show the increased risk in heat-related mortality with increments in TV, accounting for 0.70% (95% confidence interval [CI]: -0.33 to 1.69), 1.34% (95% CI: -0.14 to 2.73), 1.99% (95% CI: 0.29-3.57), and 2.73% (95% CI: 0.76-4.50) of total deaths for Q1-Q4 (first quartile-fourth quartile) of TV. The modification effects of TV varied geographically. Central Europe had the highest attributable fractions (AFs), corresponding to 7.68% (95% CI: 5.25-9.89) of total deaths for Q4 of TV, while the lowest AFs were observed in North America, with the values for Q4 of 1.74% (95% CI: -0.09 to 3.39). TV had a significant modification effect on the heat-mortality association, causing a higher heat-related mortality burden with increments of TV. Implementing targeted strategies against heat exposure and fluctuant temperatures simultaneously would benefit public health.
| S-EPMC8942841 | biostudies-literature
Project description:ObjectiveBurnout among physicians in public hospital has become a major public health issue in most Western countries. Qualitative literature has underlined the importance of interpersonal and group aspects in this context. Yet, no qualitative study has ever explicitly explored workplace direct environment's association with physicians' burnout. This study aimed to fill this gap.MethodsThis qualitative study used the five-stage inductive process to analyse the structure of lived experience (IPSE) approach and was conducted in French hospitals. We interviewed 45 participants - 16 with a lived experience of burnout and 29 of their colleagues - 19 women/26 men, (13 radiologists, 12 gastroenterologists, 10 gastrointestinal surgeons and 10 residents) from February 2018 to April 2019. Data analysis followed the IPSE analytic procedure and was conducted in two stages: three individual researchers carried out independent work and the group collectively pooled data.ResultsThree axes of experience were identified: (i) the loss of meaning, that is being a doctor, no longer has any meaning in the actual context of public hospitals; (ii) "the tower of Babel", the impossibility of dialogue with both management and colleagues; and (iii) physicians' daily interactions: too many conflicts, too much pressure and not enough recognition.ConclusionPhysicians in this study described being exposed to a deleterious atmosphere, experiencing both emotional abuse and structural violence within the workplace. They considered that such an environment could contribute to the development of burnout. Further research is necessary to assess this hypothesis.
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Project description:So far, the conceptualization and measurement of parental burnout have been deduced from those of job burnout. As a result, it is unclear whether current measures of parental burnout constitute the best representation of the parental burnout construct/syndrome: the possibility cannot be excluded that some dimensions ought to be added, which would change the structure and definition of parental burnout. In this study, the conceptualization and measurement of parental burnout were approached using an inductive method, in which the parental burnout phenomenon was (re)constructed based solely on the testimonies of burned-out parents. Items extracted from their testimonies were presented to a sample of French-speaking and English-speaking parents (N = 901) and submitted to factor analyses. An identifiable parental burnout syndrome including four dimensions was found (exhaustion in one's parental role, contrast with previous parental self, feelings of being fed up with one's parental role and emotional distancing from one's children). The resulting instrument, the Parental Burnout Assessment (PBA) presents good validity. Factorial invariance across gender and languages was also found. Finally, the results of this study replicate previous findings that psychological traits of the parents, parenting factors, and family functioning account for more variance in parental burnout than sociodemographic factors.
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