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BMC Public Health Mar 2017Practitioners and decision makers in the medical and insurance systems need knowledge on the relationship between work exposures and burnout. Many burnout studies -... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Practitioners and decision makers in the medical and insurance systems need knowledge on the relationship between work exposures and burnout. Many burnout studies - original as well as reviews - restricted their analyses to emotional exhaustion or did not report results on cynicism, personal accomplishment or global burnout. To meet this need we carried out this review and meta-analyses with the aim to provide systematically graded evidence for associations between working conditions and near-future development of burnout symptoms.
METHODS
A wide range of work exposure factors was screened. Inclusion criteria were: 1) Study performed in Europe, North America, Australia and New Zealand 1990-2013. 2) Prospective or comparable case control design. 3) Assessments of exposure (work) and outcome at baseline and at least once again during follow up 1-5 years later. Twenty-five articles met the predefined relevance and quality criteria. The GRADE-system with its 4-grade evidence scale was used.
RESULTS
Most of the 25 studies focused emotional exhaustion, fewer cynicism and still fewer personal accomplishment. Moderately strong evidence (grade 3) was concluded for the association between job control and reduced emotional exhaustion and between low workplace support and increased emotional exhaustion. Limited evidence (grade 2) was found for the associations between workplace justice, demands, high work load, low reward, low supervisor support, low co-worker support, job insecurity and change in emotional exhaustion. Cynicism was associated with most of these work factors. Reduced personal accomplishment was only associated with low reward. There were few prospective studies with sufficient quality on adverse chemical, biological and physical factors and burnout.
CONCLUSION
While high levels of job support and workplace justice were protective for emotional exhaustion, high demands, low job control, high work load, low reward and job insecurity increased the risk for developing exhaustion. Our approach with a wide range of work exposure factors analysed in relation to the separate dimensions of burnout expanded the knowledge of associations, evidence as well as research needs. The potential of organizational interventions is illustrated by the findings that burnout symptoms are strongly influenced by structural factors such as job demands, support and the possibility to exert control.
Topics: Achievement; Adult; Australia; Burnout, Professional; Case-Control Studies; Europe; Female; Humans; Male; Mental Fatigue; New Zealand; North America; Occupational Exposure; Organizational Culture; Prospective Studies; Reward; Social Justice; Surveys and Questionnaires; Workload; Workplace
PubMed: 28302088
DOI: 10.1186/s12889-017-4153-7 -
Journal of Clinical Medicine Feb 2019The purpose of this systematic review is to analyze and summarize the current knowledge regarding the use of yoga to manage and prevent stress and burnout in healthcare... (Review)
Review
The purpose of this systematic review is to analyze and summarize the current knowledge regarding the use of yoga to manage and prevent stress and burnout in healthcare workers. In February 2017, a literature search was conducted using the databases Medline (PubMed) and Scopus. Studies that addressed this topic were included. Eleven articles met the inclusion criteria. Seven studies were clinical trials that analyzed yoga interventions and evaluated effectiveness by gauging stress levels, sleep quality and quality of life. A study on Chinese nurses showed statistical improvement in stress levels following a six-month yoga program (χ2 = 16.449; < 0.001). A population of medical students showed improvement in self-regulation values after an 11-week yoga program (from 3.49 to 3.58; = 0.04) and in self-compassion values (from 2.88 to 3.25; = 0.04). Four of the included articles were observational studies: They described the factors that cause stress in the work environment and highlighted that healthcare workers believe it is possible to benefit from improved physical, emotional and mental health related to yoga activity. According to the literature, yoga appears to be effective in the management of stress in healthcare workers, but it is necessary to implement methodologically relevant studies to attribute significance to such evidence.
PubMed: 30813641
DOI: 10.3390/jcm8030284 -
The American Journal of Occupational... 2014We describe the results of a systematic review of the literature on occupational therapy-related interventions for people with Parkinson's disease (PD). Three broad... (Review)
Review
We describe the results of a systematic review of the literature on occupational therapy-related interventions for people with Parkinson's disease (PD). Three broad categories of intervention emerged: (1) exercise or physical activity; (2) environmental cues, stimuli, and objects; and (3) self-management and cognitive-behavioral strategies. Moderate to strong evidence exists for task-specific benefits of targeted physical activity training on motor performance, postural stability, and balance. Low to moderate evidence indicates that more complex, multimodal activity training supports improvement in functional movement activities. The evidence is moderate that the use of external supports during functional mobility or other movement activities has positive effects on motor control. In addition, moderate evidence is available that individualized interventions focused on promoting participant wellness initiatives and personal control by means of cognitive-behavioral strategies can improve targeted areas of quality of life. The implications for practice, education, and research are discussed.
Topics: Activities of Daily Living; Cognitive Behavioral Therapy; Cues; Evidence-Based Medicine; Exercise Therapy; Humans; Motor Skills; Occupational Therapy; Parkinson Disease; Postural Balance; Self Care; Walking
PubMed: 24367954
DOI: 10.5014/ajot.2014.008706 -
Occupational and Environmental Medicine Jan 2016The burden of disabling musculoskeletal pain and injuries (musculoskeletal disorders, MSDs) arising from work-related causes in many workplaces remains substantial.... (Review)
Review
The burden of disabling musculoskeletal pain and injuries (musculoskeletal disorders, MSDs) arising from work-related causes in many workplaces remains substantial. There is little consensus on the most appropriate interventions for MSDs. Our objective was to update a systematic review of workplace-based interventions for preventing and managing upper extremity MSD (UEMSD). We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis. 6 electronic databases were searched (January 2008 until April 2013 inclusive) yielding 9909 non-duplicate references. 26 high-quality and medium-quality studies relevant to our research question were combined with 35 from the original review to synthesise the evidence on 30 different intervention categories. There was strong evidence for one intervention category, resistance training, leading to the recommendation: Implementing a workplace-based resistance training exercise programme can help prevent and manage UEMSD and symptoms. The synthesis also revealed moderate evidence for stretching programmes, mouse use feedback and forearm supports in preventing UEMSD or symptoms. There was also moderate evidence for no benefit for EMG biofeedback, job stress management training, and office workstation adjustment for UEMSD and symptoms. Messages are proposed for both these and other intervention categories.
Topics: Ergonomics; Exercise Therapy; Humans; Musculoskeletal Diseases; Occupational Diseases; Occupational Health Services; Outcome Assessment, Health Care; Upper Extremity; Work; Workplace
PubMed: 26552695
DOI: 10.1136/oemed-2015-102992 -
Journal of Rehabilitation Medicine May 2008This article reviewed the literature to clarify the physiological effects and benefits of, and misconceptions about, stretches used to reduce musculoskeletal disorders. (Review)
Review
OBJECTIVE
This article reviewed the literature to clarify the physiological effects and benefits of, and misconceptions about, stretches used to reduce musculoskeletal disorders.
METHODS
Nine databases were reviewed to identify studies exploring the effectiveness of stretching to prevent work-related musculoskeletal disorders. Included studies were reviewed and their methodological quality was assessed using the PEDro scale.
RESULTS
The physiological effects of stretches may contribute to reducing discomfort and pain. However, if other measures are not in place to remediate their causes, stretches may suppress awareness of risks, resulting in more debilitating injuries. If inadequately performed, stretches may also cause or aggravate injuries. Careful analysis and stretching program design are required before implementing stretches. Seven studies evaluating the effectiveness of stretching to prevent musculoskeletal disorders in different occupations were identified and reviewed.
CONCLUSION
The studies provided mixed findings, but demonstrated some beneficial effect of stretching in preventing work-related musculoskeletal disorders. However, due to the relatively low methodological quality of the studies available in the literature, future studies are necessary for a definite response. Future studies should minimize threats to internal and external validity, have control groups, use appropriate follow-up periods, and present a more detailed description of the interventions and worker population.
Topics: Cumulative Trauma Disorders; Follow-Up Studies; Humans; Muscle Contraction; Muscle Stretching Exercises; Musculoskeletal Diseases; Occupational Diseases; Pain; Pain Management; Range of Motion, Articular; Reminder Systems; Software; Treatment Outcome
PubMed: 18461255
DOI: 10.2340/16501977-0204 -
Clinical Microbiology and Infection :... May 2023Post-acute COVID-19 syndrome (PACS) is a well-recognized, complex, systemic disease which is associated with substantial morbidity. There is a paucity of established... (Review)
Review
A systematic review of trials currently investigating therapeutic modalities for post-acute COVID-19 syndrome and registered on WHO International Clinical Trials Platform.
BACKGROUND
Post-acute COVID-19 syndrome (PACS) is a well-recognized, complex, systemic disease which is associated with substantial morbidity. There is a paucity of established interventions for the treatment of patients with this syndrome.
OBJECTIVES
To systematically review registered trials currently investigating therapeutic modalities for PACS.
DATA SOURCES
A search was conducted up to the 16 September, 2022, using the COVID-19 section of the WHO Internal Clinical Trials Registry Platform.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS
Interventional clinical trials of any sample size examining any therapeutic modality targeting persistent symptoms among individuals after diagnosis with COVID-19.
METHODS
Data on trial characteristics and intervention characteristics were collected and summarized.
RESULTS
After screening 17 125 trials, 388 trials, from 42 countries, were eligible. In total, we had 406 interventions, of which 368 were mono-therapeutic strategies, whereas 38 were intervention combinations. Among 824 primary outcomes identified, there were >300 different outcomes. Rehabilitation was the most employed class of intervention in 169 trials. We encountered 76 trials examining the pharmacological agents of various classes, with the most common agent being colchicine. Complementary and alternative medicine encompassed 64 trials exploring traditional Chinese medicine, Ayurveda, homeopathic medications, naturopathic medications, vitamins, dietary supplements, and botanicals. Psychotherapeutic and educational interventions were also employed in 12 and 4 trials, respectively. Other interventions, including transcranial direct current stimulation, transcutaneous auricular vagus nerve stimulation, general electrical stimulation, cranial electrotherapy stimulation, various stem cell interventions, and oxygen therapy interventions, were also employed.
CONCLUSION
We identified 388 registered trials, with a high degree of heterogeneity, exploring 144 unique mono-therapeutic interventions for PACS. Most studies target general alleviation of symptoms. There is a need for further high-quality and methodologically robust PACS treatment trials to be conducted with standardization of outcomes while following WHO's recommendation for uniform evaluation and treatment.
Topics: Humans; COVID-19; SARS-CoV-2; Post-Acute COVID-19 Syndrome; Transcranial Direct Current Stimulation; World Health Organization
PubMed: 36642173
DOI: 10.1016/j.cmi.2023.01.007 -
International Journal of Environmental... May 2020Musculoskeletal diseases and pain (MSDs) are prevalent among dental professionals. They cause a growing inability to work and premature leaving of the occupation. Thus,...
Musculoskeletal diseases and pain (MSDs) are prevalent among dental professionals. They cause a growing inability to work and premature leaving of the occupation. Thus, the objective of this review was to summarize the evidence of ergonomic interventions for the prevention of MSDs among dental professionals. This review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was carried out in May 2018, with an update in April 2019. Scientific databases such as MEDLINE, CINAHL, PubMed and Web of Science as well as reference lists of the included studies were used. Relevant data were extracted from the studies and summarized. The quality assessment was performed using a validated standardized instrument. Eleven studies were included in this review, of which four are of high quality. Eight studies focused on setting prevention strategies. Of those, in five studies, magnification loupes or prismatic spectacles were the subject of ergonomic interventions. Further subjects were the dental chair ( = 2) and dental instruments ( = 1). Three studies evaluated ergonomic training. In all studies, the ergonomic interventions had positive effects on the study outcome. Several ergonomic interventions to prevent MSDs among dental professionals were found to exert a positive effect on the prevalence of MSDs or working posture. This systematic review adds current evidence for the use of prismatic spectacles in order to prevent MSDs among dental professionals. Further intervention studies about the role of ergonomics for the prevention of MSDs among dental professionals are warranted.
Topics: Dentists; Ergonomics; Humans; Musculoskeletal Diseases; Occupational Diseases; Pain; Posture
PubMed: 32429439
DOI: 10.3390/ijerph17103482 -
Open Forum Infectious Diseases Feb 2023Peripherally inserted central catheters (PICCs) and midlines are commonly used devices for reliable vascular access. Infection and thrombosis are the main adverse...
BACKGROUND
Peripherally inserted central catheters (PICCs) and midlines are commonly used devices for reliable vascular access. Infection and thrombosis are the main adverse effects of these catheters. We aimed to evaluate the relative risk of complications from midlines and PICCs.
METHODS
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies. The primary outcomes were catheter-related bloodstream infection (CRBSI) and thrombosis. Secondary outcomes evaluated included mortality, failure to complete therapy, catheter occlusion, phlebitis, and catheter fracture. The certainty of evidence was assessed using the GRADE approach.
RESULTS
Of 8368 citations identified, 20 studies met the eligibility criteria, including 1 RCT and 19 observational studies. Midline use was associated with fewer patients with CRBSI compared with PICCs (odds ratio [OR], 0.24; 95% CI, 0.15-0.38). This association was not observed when we evaluated risk per catheter. No significant association was found between catheters when evaluating risk of localized thrombosis and pulmonary embolism. A subgroup analysis based on location of thrombosis showed higher rates of superficial venous thrombosis in patients using midlines (OR, 2.30; 95% CI, 1.48-3.57). We did not identify any significant difference between midlines and PICCs for the secondary outcomes.
CONCLUSIONS
Our findings suggest that patients who use midlines might experience fewer CRBSIs than those who use PICCs. However, the use of midline catheters was associated with greater risk of superficial vein thrombosis. These findings can help guide future cost-benefit analyses and direct comparative RCTs to further characterize the efficacy and risks of PICCs vs midline catheters.
PubMed: 36751645
DOI: 10.1093/ofid/ofad024 -
BMC Cancer Feb 2015Sinonasal cancer (SNC) has been related to occupational exposures, but the relative risk associated to specific jobs and/or carcinogen exposures other than wood and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Sinonasal cancer (SNC) has been related to occupational exposures, but the relative risk associated to specific jobs and/or carcinogen exposures other than wood and leather dust is generally based on small or inadequate sample sizes and the range of observed estimates is large. This paper is aimed at investigating such relationship through a systematic review of the literature followed by a meta-analysis of studies meeting specific inclusion criteria.
METHODS
Systematic search was made with PubMed, Google Scholar and Scopus engines using related keywords. Occupational exposures include wood and leather dust, formaldehyde, nickel and chromium compounds, textile industry, farming and construction. Meta-analysis of published studies after 1985 with a case-control or cohort design was performed, firstly using the fixed-effect model. Heterogeneity was assessed with the Q statistical test and quantified by the I(2) index. When the heterogeneity hypothesis appeared relevant, the random-effect model was chosen. Sources of heterogeneity were explored using subgroup analyses.
RESULTS
Out of 63 reviewed articles, 28 (11 cohort, 17 case-control) were used in the meta-analysis. Heterogeneity among studies was observed and random-effects models were used. Exposure to wood dust results associated with SNC (RRpooled = 5.91, 95% CI: 4.31-8.11 for the case-control studies and 1.61, 95% CI: 1.10-2.37 for the cohort studies), as well as to leather dust (11.89, 95% CI: 7.69-18.36). The strongest associations are with adenocarcinomas (29.43, 95% CI: 16.46-52.61 and 35.26, 95% CI: 20.62-60.28 respectively). An increased risk of SNC for exposures to formaldehyde (1.68, 95% CI: 1.37-2.06 for the case control and 1.09, 95% CI: 0.66-1.79 for the cohort studies), textile industry (2.03, 95% CI: 1.47-2.8), construction (1.62, 95% CI: 1.11-2.36) and nickel and chromium compounds (18.0, 95% CI: 14.55-22.27) was found. Subset analyses identified several sources of heterogeneity and an exposure-response relationship was suggested for wood dust (p = 0.001).
CONCLUSIONS
By confirming the strength of association between occupational exposure to causal carcinogens and SNC risk, our results may provide indications to the occupational etiology of SNC (not only wood and leather dusts). Future studies could be focused on specific occupational groups to confirm causative agents and to define appropriate preventive measures.
Topics: Agriculture; Dust; Formaldehyde; Humans; Metals, Heavy; Occupational Exposure; Odds Ratio; Paranasal Sinus Neoplasms; Publication Bias; Risk; Textile Industry
PubMed: 25885319
DOI: 10.1186/s12885-015-1042-2 -
International Journal of Chronic... 2017The association between occupational exposure and COPD reported previously has mostly been derived from studies relying on self-reported exposure to vapors, gases, dust,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The association between occupational exposure and COPD reported previously has mostly been derived from studies relying on self-reported exposure to vapors, gases, dust, or fumes (VGDF), which could be subjective and prone to biases. The aim of this study was to assess the strength of association between exposure and COPD from studies that derived exposure by job exposure matrices (JEMs).
METHODS
A systematic search of JEM-based occupational COPD studies published between 1980 and 2015 was conducted in PubMed and EMBASE, followed by meta-analysis. Meta-analysis was performed using a random-effects model, with results presented as a pooled effect estimate with 95% confidence intervals (CIs). The quality of study (risk of bias and confounding) was assessed by 13 RTI questionnaires. Heterogeneity between studies and its possible sources were assessed by Egger test and meta-regression, respectively.
RESULTS
In all, 61 studies were identified and 29 were included in the meta-analysis. Based on JEM-based studies, there was 22% (pooled odds ratio =1.22; 95% CI 1.18-1.27) increased risk of COPD among those exposed to airborne pollutants arising from occupation. Comparatively, higher risk estimates were obtained for general populations JEMs (based on expert consensus) than workplace-based JEM were derived using measured exposure data (1.26; 1.20-1.33 vs 1.14; 1.10-1.19). Higher risk estimates were also obtained for self-reported exposure to VGDF than JEMs-based exposure to VGDF (1.91; 1.72-2.13 vs 1.10; 1.06-1.24). Dusts, particularly biological dusts (1.33; 1.17-1.51), had the highest risk estimates for COPD. Although the majority of occupational COPD studies focus on dusty environments, no difference in risk estimates was found for the common forms of occupational airborne pollutants.
CONCLUSION
Our findings highlight the need to interpret previous studies with caution as self-reported exposure to VGDF may have overestimated the risk of occupational COPD.
Topics: Air Pollutants, Occupational; Bias; Dust; Female; Gases; Humans; Inhalation Exposure; Male; Occupational Diseases; Occupational Exposure; Occupational Health; Occupations; Odds Ratio; Pulmonary Disease, Chronic Obstructive; Risk Assessment; Risk Factors; Time Factors
PubMed: 28260879
DOI: 10.2147/COPD.S125980