Physical activity, musculoskeletal disorders, burnout, and work engagement: a cross-sectional study on Italian white-collar employees.

Introduction: Both mental and physical health of office workers had a positive relationship with their work engagement, with the latter relationship being driven by the association of a healthy diet and physical activity (PA). This observational study aimed to investigate the associations between PA levels, musculoskeletal disorders (MSDs), burnout, and work engagement, in a sample of white-collar employees. Methods: A total of 615 workers (age 42.2 ± 9.5 years) successfully completed an online questionnaire comprising work-related information and standardized questionnaires on PA, MSDs, burnout and work engagement. Results: 36.9% of the participants did not meet the PA guidelines, 19.0% adhered to them, and 44.1% exceeded them. A significant portion of participants reported suffering from MSDs, primarily neck/shoulder and/or low back/hip pain. Those exceeding PA guidelines had fewer MSDs compared to non-compliant participants and exhibited better mental health and work engagement. Compliance with PA guidelines was associated with a 38% reduced risk of emotional exhaustion, with an even greater reduction of 47% among those surpassing the guidelines. Discussion: PA could exert a positive effect on physical and mental health of employees, but only if performed above a certain amount. The study supports the need to identify workplaces as suitable for health-focused interventions and lifestyle changes.

Implementing an oral health policy in long-term care facilities for older adults in Flanders, Belgium: The Oral Health Care Track.

BACKGROUND: The oral health of care-dependent older people living in residential care facilities is generally suboptimal. To facilitate adequate daily oral care and timely referral to a dental professional, studies emphasise the need for sustainable, structured oral healthcare policies in aged care organisations. The effect of such interventions is often limited or uncertain owing to a lack of understanding of how effective the integration and implementation of the policy has been within the facilities. This study reports on the development of a method to adequately implement an oral healthcare policy in long-term care organisations for older adults. MATERIALS AND METHODS: An intervention mapping protocol was used to develop a theory- and practise-based methodology. This step-by-step approach combined findings from a literature review, experiences from earlier projects and behaviour change theories in a multilevel programme. RESULTS: Intervention mapping yielded a systematic programme for implementing an oral healthcare policy in aged care organisations. The Oral Health Care Track or "De Mondzorglijn" comprises seven phases, each subdivided into several tasks. The programme's implementation is guided by oral healthcare coaches. CONCLUSION: By using intervention mapping, it was possible to combine behaviour change theories, information derived from needs assessment and earlier experiences into a comprehensive programme to improve the oral health and quality of life of older residents in residential care facilities. Further research is needed to evaluate the use of coaches in the implementation of the Oral Health Care Track.

Parental perspectives on oral health-related quality of life in children and adolescents with autism spectrum disorder: A systematic review.

BACKGROUND: Children with autism spectrum disorder (ASD) face unique challenges related to oral health, which can negatively impact their day-to-day lives, significantly compromising their overall quality of life. Primary caregivers of children with ASD have a critical role in delivering and seeking oral health care. Hence, it is vital to study their perspective towards their children's oral health and its impact on their quality of life. AIM: To explore the parental perception of oral health-related quality of life in children with autism. METHODS: A systematic electronic and manual search was conducted in Medline (via PubMed), Embase, Google Scholar, Scopus, and LILACS of articles published from January 2003 to May 2023 using appropriate MeSH terms, keywords, and other terms. A four-phase study selection process was followed according to PRISMA guidelines, and data extraction and synthesis were performed using an extraction form. The selected studies were critically appraised using the QATSDD and Crombie's assessment tool. The inter-reviewer agreement was assessed using the kappa with a linear weighting coefficient. RESULTS: Out of the 885 results, 15 studies were included in the review after the two selection phases, and the study characteristics were summarized in tabular form. Study quality varied considerably, and out of a total possible QATSDD score of 42, scores for the individual studies ranged from 14 to 40. The risk of bias for the seven criteria was found to be low. CONCLUSION: The parental perception of the OHRQoL in children with ASD is poor, and the most significant perceived impact is on the child's functional and social well-being aspects. Parental-Caregiver Perception Questionnaire was the most commonly used. The most frequent symptoms include bad breath, food lodgment, mouth breathing and night grinding. The familial impact and influence on the OHRQoL of siblings were also studied.

Development and validation of a self-regulation scale within the German version of the Early Development Instrument.

BACKGROUND: Early childhood self-regulation (SR) is key for many health- and education-related outcomes across the life span. Kindergarten age is a crucial period for SR development, and within this developmental window, potential SR difficulties can still be compensated for (e.g., through interventions). However, efficient measurement of SR through brief, comprehensive, and easy-to-use instruments that identify SR difficulties are scarce. To address this need, we used items of an internationally applied kindergarten teacher questionnaire-the Early Development Instrument (EDI) - to develop and validate a specific SR measurement scale. METHODS: The psychometric evaluation and validation of the selected SR-items was performed in data collected with the German version of the EDI (GEDI), in two independent data sets - (a) the development dataset, with 191 children, and b) the validation dataset, with 184 children. Both included three- to six-year-old children and contained retest and interrater reliability data. First, three independent raters-based on theory-selected items eligible to form a SR scale from the two SR-relevant GEDI domains "social competence" and "emotional maturity". Second, exploratory and confirmatory factor analysis using structural equation modeling examined the item structure across both data sets. This resulted in a defined SR scale, of which internal consistency, test-retest and interrater reliability, cross-validation, and concurrent validity using correlation and descriptive agreements (Bland-Altman (BA) plots) with an existing validated SR-measuring instrument (the Kindergarten Behavioral Scales) were assessed. RESULTS: Confirmatory factor analysis across both data sets yielded the best fit indices with 13 of the GEDI 20 items initially deemed eligible for SR measurement, and a three-factor structure: a) behavioral response inhibition, b) cognitive inhibition, c) selective or focused attention (RMSEA: 0.019, CFI: 0.998). Psychometric evaluation of the resulting 13-item-GEDI-SR scale revealed good internal consistency (0.92), test-retest and interrater reliability (0.85 and 0.71, respectively), validity testing yielded stability across populations and good concurrent validity with the Kindergarten Behavioral Scales (Pearson correlation coefficient: mean 0.72, range 0.61 to 0.84). CONCLUSIONS: The GEDI contains 13 items suitable to assess SR, either as part of regular EDI developmental monitoring or as a valid stand-alone scale. This short 13-item (G)EDI-SR scale may allow early detection of children with SR difficulties in the kindergarten setting in future and could be the basis for public health intervention planning. To attain this goal, future research should establish appropriate reference values using a representative standardization sample.

Altered self-reported resting state mediates the effects of Mindfulness-Based Stress Reduction on mental health: a longitudinal path model analysis within a community-based randomized trial with 6-months follow-up.

Background: A large body of randomized controlled trials (RCTs) has shown that mindfulness-based interventions are effective for improving mental health, but research is lacking in regards to the mechanisms of change. We aimed to investigate the mediating effects of self-reported altered resting state of Mindfulness-Based Stress Reduction (MBSR) on mental health, when provided as a universal intervention in a real-life context. Methods: Autoregressive path models with three time points of measurement, and contemporaneous and constant b paths were used in an RCT. The RCT took place in all five geographical regions of Denmark and included 110 schools and 191 schoolteachers. The schools were randomized 1:1 in each geographical region to intervention or a wait-list control group. The intervention was the standardized MBSR. Data were collected at baseline and after 3 and 6 months. The outcomes were perceived stress, measured by Cohen's Perceived Stress Scale (PSS), symptoms of anxiety and depression, measured by Hopkins Symptom Check List-5 (SCL-5), and well-being measured by WHO-5 Well-being Index (WHO-5). The mediator was resting state measured by the Amsterdam Resting State Questionnaire (ARSQ). Results: Statistically significant mediated effects of altered ARSQ-subscales scores for Discontinuity of Mind, Planning, and Comfort were found for the MBSR effect on all outcomes; PSS, SCL-5 and WHO-5. Furthermore, statistically significant mediated effects of altered sleepiness subscale score of the effects on PSS and SCL-5 of MBSR were found. No statistically significant mediating effects of the subscales Theory of Mind, Self and Somatic Awareness for the MBSR intervention effect were found. Conclusion: The results support that the MBSR program can alter self-reported resting state, towards less mind wandering and more comfort, measured by the ARSQ, and that this may explain some of the mechanisms regarding the effectiveness of MBSR on mental health at 6 months, when provided as a universal intervention. The study provides insight into an active ingredient of how MBSR may improve mental health and well-being. It supports the suggestions that mindfulness meditation may be a sustainable way of training the mental health.Clinical trial registration:ClinicalTrials.gov, identifier NCT03886363.

Quality of life and psychological health after mild traumatic brain injury in older people: Three- and six-month follow up.

OBJECTIVES: Examine quality of life (QoL) and psychological health after mild traumatic brain injury (mTBI) in older people (65+ years) at 3- and 6-month follow-up and explore which injury factors predicted QoL. METHODS: mTBI patients were compared to trauma comparison (TC) and community comparison (CC) groups. QoL and psychological health were measured at both timepoints. After accounting for 3-month psychological health, injury severity, neuroimaging, and 3-month neuropsychological performance were assessed as predictors of 6-month QoL. RESULTS: Overall 3-month QoL was lower for mTBI (Cohen's d = 0.938) and TC (Cohen's d = 0.485) groups compared to CCs, but by 6 months only mTBI patients continued to report poorer overall QoL (Cohen's d = 0.577) and physical QoL (Cohen's d = 0.656). Despite group differences, QoL for most (~92%) was within normative limits. 3-month psychological health predicted QoL 6-months postinjury (ß = -.377, 95% CI -.614, -.140) but other proposed risk factors (GCS <15, neuroimaging, 3-month neuropsychological performance) did not uniquely predict QoL. CONCLUSIONS: Older adults following mTBI reported lower QoL up to 6-months postinjury compared to non-injured peers, indicating that mTBI patients were particularly susceptible to ongoing differences in QoL 6-months postinjury.

Undiagnosed prediabetes in Mexican adolescents under poverty in contexts affected by collective violence: A clinical comparison among health services users and hidden population.

Introduction: The epidemiological pattern of prediabetes in adolescents is understudied. In Mexico, adolescents are exposed to social adversity conditions, including poverty and violence. Therefore, understanding their clinical profiles and how the social determinants of health impose barriers to access to health services is important to address detection, in those who, by their vulnerability, remain a hidden population. Aim: This study aimed to describe undiagnosed prediabetes in Mexican adolescents under poverty in violent contexts and to compare the clinical features among health services users and hidden population. Methods: This cross-sectional study included 371 adolescents from difficult access locations in violent contexts. Poverty, lack of health services access, and perceived vulnerability were determined in all samples. Endocrine markers (BMI, HOMA-IR, HbA1c, and cortisol) were measured in those with high violence perception. Results: A total of 61.7% of the adolescents had a suburban grid and urban cluster residence, and 77.7-85.7% of them belonged to locations where 35-50% of their population lived below the poverty line. In total, 40-75% had a lack of 10-20% access to health services, and 18.8% had a high perceived vulnerability due to collective violence and were screened. Overall, 61.9% of respondents were newly diagnosed with prediabetes and showed the worst HbA1c (p = 0.001) compared to the health services subsample, which showed the highest BMI (p = 0.031) and insulin resistance (p = 0.025). Conclusion: There is a prediabetes hidden population living in violent contexts under poverty. These social determinants promote poor outcomes in perceived vulnerability and endocrine response and represent barriers to access to health services.

Factores de riesgo psicosociales impacto del control y recompensa desde la percepción de residentes médicos

Objetivo: Analizar la percepción de los residentes a factores de riesgos psicosociales a los que se enfrentan a lo largo de su formación académica relacionados con los dominios de control y recompensas del trabajo. Materiales y métodos: Estudio cualitativo con metodología fenomenológica, que utilizó la entrevista a profundidad como técnica de obtención de los datos a partir de los elementos contemplados en la Batería de Instrumentos para la Evaluación de Factores de Riesgo Psicosocial del Ministerio de Protección Social de Colombia. Se entrevistó a 42 residentes de 8 especialidades médicas en Barranquilla. El análisis de la información obtenida se interpretó a partir de la teoría sociológica de Schütz. Resultados: Se observó relación de la carga de trabajo, tiempo y organización con el poco reconocimiento al esfuerzo. Además, existe poco apego con las instituciones y no hay vínculo profesional y emocional estable debido a la baja percepción de autorrealización en el ejercicio de su trabajo. Conclusiones: Los dominios "control" y "recompensas" se conjeturan como problemáticas frecuentes en el ámbito de las residencias médicas. Si no hay control de las funciones, participación en la toma de decisiones y en el funcionamiento de la institución, y si existen pocas oportunidades de demostrar el dominio en las responsabilidades adquiridas, la percepción de bienestar se ve implicada.

Objective: To analyze the perception of residents to psychosocial risk factors they face throughout their academic training related to the domains of control and work rewards. Materials and Methods: Qualitative study with phenomenological methodology, which used in-depth interview as a technique to obtain data from the elements contemplated in the Battery of Instruments for the Evaluation of Psychosocial Risk Factors of the Ministry of Social Protection of Colombia. Forty-two residents from 8 medical specialties in Barranquilla were interviewed. The analysis of the information obtained was interpreted based on Schütz's sociological theory. Results: A relationship was observed between workload, time and organization, with little recognition of effort. In addition, there is little attachment to the institutions and there is no stable professional and emotional bond due to the low perception of self-fulfillment in the exercise of their work. Conclusions: The control and reward domains are conjectured as frequent problems in the field of medical residencies. If there is no control of the functions, participation in decision making and in the functioning of the institution, and if there are few opportunities to demonstrate mastery in the acquired responsibilities, the perception of well-being is implicated.

Training student volunteers as community resource navigators to address patients' social needs: A curriculum toolkit.

Introduction: Few resources are available to train students to provide patients assistance for obtaining needed community-based services. This toolkit outlines a curriculum to train student volunteers to become "community resource navigators" to serve patients via telephone at partner health sites. Methods: University students co-designed the Help Desk navigator program and training for volunteer navigators as part of an academic-community partnership with a local Federally Qualified Health Center (FQHC). The multi-modal curricula consisted of five components: didactic instruction on social determinants of health and program logistics, mock patient calls and documentation, observation of experienced navigator interaction with patients, supervised calls with real patients, and homework assignments. In 2020, training materials were adapted for virtual delivery due to the COVID-19 pandemic. Trainees completed a survey after completion to provide qualitative feedback on the training and preparedness. Results: The training was offered for the first cohort of 11 student volunteer navigators in 2019, revised and then offered for 13 undergraduate and nursing students over 6 weeks in 2020. In the training evaluation, trainees described the new knowledge and skills gained from the training, the long-term benefits toward their educational and professional career goals, and helpful interactive delivery of the training. Trainees also highlighted areas for improvement, including more time learning about community resources and practicing challenging patient conversations. Conclusions: Our peer-to-peer, multi-modal training prepares student volunteers to become community resource navigators. Student, eager for meaningful clinical experiences, are an untapped resource that can help patients with their social needs.

Addressing Health Disparities Across the Cancer Continuum-a Los Angeles Approach to Achieving Equity.

Introduction: Different models have been developed to address inequities across the cancer care continuum. However, there remains a scarcity of best practices on understanding and responding to the burden of cancer in a defined catchment area.As such, the National Cancer Institute (NCI) recently provided a framework to maximize the impact on cancer burden, including a greater focus on community outreach and engagement. In this paper, we describe how Cedars Sinai Cancer (CSC), a health system that serves one of the most diverse counties in the US, implemented the framework to define its catchment area, characterize its population, identify high risk priority groups, and make decisions to address health disparities. Methods: We provide a review of the methods used to assess socio-ecological levels of influence. Data were reviewed from numerous national, statewide, and county sources and supplemented by locally administered questionnaires, heat maps, and community profile summaries to gain more localized snapshots of cancer disparities in Los Angeles County. Lastly, feedback was solicited from external peer groups, community stakeholders, and key decision-makers, and the proposed catchment area was aligned with the State's Cancer Plan and the NCI Catchment Area and Community Outreach and Engagement Mandate. Results: The selected CSC catchment area meets NCI criteria and has potential to demonstrate impact both at the population level and within specialty populations. As a result, strategies are being developed to organize community outreach and engagement, as well as research across basic, clinical, and population sciences to guide cancer control and prevention efforts. Discussion: To maintain a high level of cultural inclusion and sensitivity, multiple layers of data are needed to understand localized pictures of cancer disparities and underlying causes. Community engagement remains essential to implementing policy, best practice, and translational science for broader impact. Impact: The clinical and translation work conducted at any cancer center requires an understanding of the determinants of health that contribute to the differences in cancer incidence and mortality among different groups. The NCI-aligned approach that we highlight is critical to support the design of future cancer control strategies that address and possibly reduce local health inequities.

Development, testing, and implementation of a new procedure to assess the clinical added benefit of pharmaceuticals.

OBJECTIVES: The reimbursement process for innovative health technologies in Hungary lacks any formalized assessment of clinical added benefit (CAB). The aim of this research is to present the development, retrospective testing, and implementation of a local assessment framework for determining the CAB of cancer treatments at the Department of Health Technology Assessment of the National Institute of Pharmacy and Nutrition in Hungary. METHODS: The assessment framework was drafted after screening existing methods and a retrospective comparison of local reimbursement dossiers to that of German and French methods. The Magnitude of Clinical Benefit Scale of the European Society for Medical Oncology was chosen to rate the extent of CAB in oncology, as part of a conclusion complemented by the assessment of endpoint relevance and the quality of evidence. Several rounds of retrospective assessments have been conducted involving all clinical assessors, iterated with semistructured discussions to consolidate divergence between assessors. External stakeholders were consulted to provide feedback on the framework. RESULTS: Retrospective assessments resulted in average more than 75 percent concordance between assessors on each element of the conclusion. Input from ten stakeholders was also incorporated; stakeholders were generally supportive, and they mostly commented on the concept, the elements of the framework, and its implementation. CONCLUSIONS: The procedure is suitable for routine use in the decision-making process to describe the CAB of antineoplastic technologies in Hungary. Further extension of the framework is required to cover more disease areas for structured and comparable conclusions on CAB of innovative health technologies.

Conjunto mínimo de datos: su utilidad en cirugía / Mínimum data set and it utility in surgery

Resumen Los sistemas de información sanitaria son fundamentales para el conocimiento y análisis del estado de salud individual y colectivo, así como para la evaluación de las funciones de los sistemas de salud; basados en el desarrollo de las historias clínicas, los expedientes clínicos permiten el acceso a dicha información. El Conjunto Mínimo de Datos (CMD), es un conjunto esencial de elementos potencialmente disponibles sobre entidades específicas, constituye un extracto de información administrativa, clínica y quirúrgica estandarizados, recogidos a partir del informe de alta o la historia clínica, siendo un paso preliminar en la gestión de información sobre enfermedades, que se traduce en la mejora de la calidad de la atención y el control de las enfermedades, así como en la posibilidad para emprender investigaciones. El objetivo de este manuscrito fue generar un documento de estudio referente al uso del CMD en cirugía, que consideró los mecanismos de aplicación, sus fortalezas y debilidades.

Health information systems are fundamental for the knowledge and analysis of the individual and collective health status, as well as for the evaluation of the functions of the health systems, based on the development of medical records, that allow access to information. The Minimum Data Set (CMD), is an essential set of elements potentially available on specific entities, constitutes an extract of standardized administrative, clinical, and surgical information, collected from the discharge report or the clinical history, being a preliminary step in disease information management that translates into improved quality of care and disease control, as well as the ability to undertake research. The aim of this manuscript was to generate a study document regarding the use of CMD in surgery, which considered the application mechanisms, as well as its strengths and weaknesses.

Latin American Agricultural Workers' Job Demands and Resources and the Association With Health Behaviors at Work and Overall Health.

In the present study, we describe the job demands and job resources (JD-R) experienced by agricultural workers in three Latin American countries and their relationship to proactive health behaviors at work and overall health. Following previous research on the JD-R model, we hypothesized that job demands (H1) would be negatively related to agricultural workers' self-reported overall health. On the other hand, we hypothesized that job resources (H2) would be positively related to agricultural workers' overall health. Furthermore, we hypothesized (H3) that workers' engagement in jobsite health promotion practices via their proactive health behaviors at work would partially mediate the relationship between workers' job resources and job demands and overall health. We also had a research question (R1) about whether there were differences by type of job held. The sample of workers who participated in this study (N = 1,861) worked in Mexico, Guatemala, and Nicaragua for one large agribusiness that produces sugar cane. They worked in two distinct areas: company administration and agricultural operations. We administered employee health and safety culture surveys using survey methods tailored to meet the needs of both types of workers. Stratified path analysis models were used to test study hypotheses. In general, we found support for hypotheses 1 and 2. For example, operations workers reported more physically demanding jobs and administrative workers reported more work-related stress. Regardless, the existence of high job demands was associated with poorer overall health amongst both types of workers. We found that workers in more health-supportive work environments perform more proactive health behaviors at work, regardless of their role within the organization. However, hypothesis 3 was not supported as proactive health behaviors at work was not associated with overall health. We discuss future research needs in terms of evaluating these hypotheses amongst workers employed by small- and medium-sized agribusinesses as well as those in the informal economy in Latin America. We also discuss important implications for agribusinesses seeking to develop health promotion programs that meet the needs of all workers.

The Black Panther, Masculinity Barriers to Medical Care, and Colorectal Cancer Screening Intention Among Unscreened American Indian/Alaska Native, Black, and White Men.

Objective: To determine if masculinity barriers to medical care and the death from colorectal cancer (CRC) of actor Chadwick Boseman (The Black Panther) influenced CRC early-detection screening intent among unscreened American Indian/Alaska Native (AIAN) and Non-Hispanic-Black (Black) men compared with Non-Hispanic-White (White) men. Methods: Using a consumer-panel, we surveyed U.S. men aged 18-75 years (N = 895) using the 24-item Masculinity Barriers to Medical Care (MBMC) scale. We calculated the median score to create binary exposures to evaluate associations with CRC screening intent and conducted multivariable logistic regression to evaluate independent associations stratified by race/ethnicity. Results: Overall, Black respondents were most likely to have a high MBMC score (55%) compared to White (44%) and AIAN (51%) men (p = 0.043). AIAN men were least likely to report CRC screening intent (51.1%) compared with Black (68%) and White men (64%) (p < 0.001). Black men who reported the recent death of Chadwick Boseman increased their awareness of CRC were more likely (78%) to report intention to screen for CRC compared to those who did not (56%) (p < 0.001). Black men who exhibited more masculinity-related barriers to care were more likely to intend to screen for CRC (OR: 1.76, 95% CI: 0.98-3.16) than their counterparts, as were Black men who reported no impact of Boseman's death on their CRC awareness (aOR: 2.96, 95% CI: 1.13-7.67). Conversely, among AIAN men, those who exhibited more masculinity-related barriers to care were less likely to have CRC screening intent (aOR: 0.47, 95% CI: 0.27-0.82) compared with their counterparts. Conclusions: Masculinity barriers to medical care play a significant role in intention to screen for CRC. While Black men were most likely to state that The Black Panther's death increased their awareness of CRC, it did not appear to modify the role of masculine barriers in CRC screening intention as expected. Further research is warranted to better understand how masculine barriers combined with celebrity-driven health-promotion interventions influence the uptake of early-detection screening for CRC. Impact: Our study provides formative data to develop behavioral interventions focused on improving CRC screening completion among diverse men.

Association between intergenerational solidarity involving elders and mental health of Indigenous people living off reserve.

BACKGROUND: Indigenous elders play an important role in transmitting knowledge, values and practices, hence fostering identity-building through intergenerational solidarity. We aimed to verify the association between intergenerational solidarity involving Indigenous elders and mental health of Indigenous people living off reserve. METHODS: We carried secondary analyses of data for a subsample from the cross-sectional 2012 Aboriginal Peoples Survey (total sample: n = 28,410 Indigenous persons aged ≥6 years old living off reserve; subsample: n = 13,020 aged 18-44 years old). Controlling for age as well as material and social deprivation, we used logistic regressions to verify the association between intergenerational solidarity (proxied as time spent with an elder and potential of turning to an elder or grandparent for support in times of need) and mental health (perceived mental health, mood disorders, anxiety, suicidal thoughts and attempts). RESULTS: About 39 and 9% of the respondents respectively reported having spent time with an elder and would have turned to an elder or grandparent for support in times of need. Women who would not turn to an elder or grandparent for support in times of need were more likely to report fair or poor perceived mental health (OR = 1.69, p = 0.03). Men not spending time with an elder were more likely to experience mood disorders (OR = 1.66, p = 0.004). Women who would not turn to an elder or grandparent for support in times of need were more likely to experience anxiety disorders (OR = 1.57, p = 0.04). Women not spending time with an elder or who would not turn to an elder or grandparent for support in times of need were respectively more likely to have suicidal thoughts (OR = 1.62, p = 0.04) or to have attempted suicide (OR = 3.38, p = 0.04). CONCLUSION: Intergenerational solidarity is associated with better mental health outcomes of Indigenous people living off reserve. These results could guide policies and practices that aim to enhance mental health and wellness in Indigenous populations.

Delta variant of SARS-CoV-2: characteristics and implications for public health in Colombia / Variante delta del SARS-CoV-2: características e implicaciones para la salud pública en Colombia

Abstract The SARS-CoV-2 Delta variant has become one of the greatest public health challenges worldwide since, after being first identified in India in December 2020, it has spread rapidly, affecting mainly countries with low vaccination rates and those that have relaxed the public health and social measures implemented to control the COVID-19 pandemic. The Delta variant has a higher replication capacity and is associated with viral loads up to 1 260 times higher than those of infections caused by the original strain, which may be associated with an increased likelihood of hospitalization, ICU admission, need for oxygen therapy, pneumonia, or even death. Fully vaccinated individuals have almost similar protection against both Delta and Alpha variants. Given the impact of Delta in countries where it is the dominant variant, it is necessary for all countries to develop systematic action plans focused on implementing strict public health and social measures in the context of the COVID-19 pandemic and on increasing vaccination coverage. Bearing this in mind, the objective of this reflection paper is to describe the main characteristics of the Delta variant, its impact on the dynamics of the pandemic in some of the countries where it has been detected, the effectiveness of vaccines against this variant, and its implications for public health in Colombia.

Resumen La variante delta del SARS-CoV-2 se ha convertido en uno de los mayores desafíos en salud pública a nivel mundial, ya que, luego de su identificación en la India en diciembre de 2020, se ha extendido de manera rápida, afectando principalmente a los países con bajas tasas de vacunación, y aquellos que han flexibilizado las medidas de salud pública establecidas para controlar la pandemia por COVID-19. La variante delta tiene una mayor capacidad de replicación y se asocia con cargas virales hasta 1 260 veces más altas en comparación con las de infecciones causadas por la cepa original, lo cual puede estar asociado a mayores probabilidades de hospitalización, ingreso a UCI, necesidad de oxigenoterapia, neumonía, o incluso muerte. Las personas con vacunación completa tienen una protección casi similar contra las variantes delta y alfa. Dado el impacto de delta en los países afectados en los que es la variante dominante, es necesario que todos los países desarrollen planes de acción sistemáticos enfocados en implementar estrictas medidas de salud pública y sociales en el contexto de la pandemia por COVID-19, y aumentar la cobertura de vacunación. Teniendo en cuenta lo anterior, el objetivo de esta reflexión es describir las principales características de la variante delta, su impacto en la dinámica de la pandemia en algunos de los países en que ha sido detectada, la efectividad de las vacunas contra esta variante, y sus implicaciones para la salud pública en Colombia.

Burnout syndrome and associated factors among dentists working in hospitals of the Ministry of Health in the Lima Metropolitan Area, Peru / Síndrome de burnouty factores asociados en odontólogos que trabajan en hospitales del Ministerio de Salud de Lima Metropolitana, Perú

Abstract Introduction: Worldwide, burnout syndrome is becoming increasingly frequent among dentists, so it is necessary to identify its possible causes. Objective: To describe the prevalence of burnout syndrome and the factors associated with its development among dentists working in hospitals of the Ministry of Health (MINSA) in the Lima Metropolitan Area, Peru. Materials and methods: Analytical cross-sectional study carried out between December 2019 and January 2020 in 105 dentists working in the 11 MINSA hospitals in the Lima Metropolitan Area. The Maslach Burnout Inventory instrument was used to measure burnout. Factors such as sex, age, marital status, type of shift, years of experience as a dentist, whether they performed any other dentistry-related work activity, and hours of physical activity and leisure per day were evaluated. Crude and adjusted prevalence ratios (PR) were obtained to analyze the association between the presence of the syndrome and the factors. Results: The prevalence of burnout syndrome was 28.57%. Emotional exhaustion, depersonalization and personal accomplishment levels were high in 90.47%, 98.09% and 35.23% of the participants, respectively. The presence of the syndrome was 47% lower in women (aPR=0.53, p=0.044) compared to men, and 70% lower in those who reported having worked as dentists between 11 and 20 years (aPR=0.30, p=0.017), compared to those with less than 11 years of work experience as dentists. Conclusions: Almost one third of the participants had burnout syndrome. In addition, the majority of dentists showed high levels of emotional exhaustion and depersonalization. Being a woman and having 11 to 20 years of work experience as dentists were protective factors for burnout syndrome.

Resumen Introducción. En el mundo, el síndrome de burnout es cada vez más frecuente en odontólogos, por lo que es necesario identificar sus posibles causas. Objetivo. Describir la prevalencia del síndrome de burnout y los factores asociados a su desarrollo en odontólogos que trabajan en hospitales del Ministerio de Salud (MINSA) de Lima Metropolitana, Perú. Materiales y métodos. Estudio transversal analítico realizado entre diciembre de 2019 y enero de 2020 en 105 odontólogos de los 11 hospitales del MINSA de Lima Metropolitana. Se usó el instrumento Maslach Burnout Inventory para medir el burnout. Se evaluaron factores como sexo, edad, estado civil, tipo de jornada laboral, años de ejercicio laboral, si realizaba otra actividad laboral relacionada y horas diarias de ejercicio físico y de ocio. Se obtuvieron razones de prevalencia (RP) crudas (c) y ajustadas (a) para analizar la asociación entre presencia del síndrome y los factores. Resultados. La prevalencia del síndrome de burnout fue de 28.57%. Los niveles de agotamiento emocional, despersonalización y realización personal fueron altos en 90.47%, 98.09% y 35.23% de los participantes, respectivamente. La presencia del síndrome fue 47.00% menor en las mujeres (RPa=0.53, p=0.044) en comparación con los hombres, y 70.00% menor en quienes reportaron tener entre 11 y 20 años de ejercicio laboral (RPa=0.30, p=0.017), comparado con aquellos con menos de 11 años de experiencia laboral. Conclusiones. Casi un tercio de los participantes tuvieron síndrome de burnout; además, la mayoría de los odontólogos presentó altos niveles de agotamiento emocional y despersonalización. Ser mujer y tener entre 11 y 20 años de ejercicio laboral se comportaron como factores protectores.

The perceived importance of prognostic aspects considered by physicians during work disability evaluation: a survey.

BACKGROUND: Assessing prognosis is challenging for many physicians in various medical fields. Research shows that physicians who perform disability assessments consider six areas when evaluating a prognosis: disease, treatment, course of the disease, external information, patient-related and physician-related aspects. We administered a questionnaire to evaluate how physicians rate the importance of these six prognosis areas during work disability evaluation and to explore what kind of support they would like during prognosis assessment. METHODS: Seventy-six physicians scored the importance of 23 prognostic aspects distributed over six prognosis areas. Participants scored the importance of each aspect both "in general" and from the perspective of a case vignette of a worker with a severe degenerative disease. The questionnaire also covered needs and suggestions for support during the evaluation of prognoses. RESULTS: Medical areas that are related to the disease, or the treatment or course of the disease, appeared important (scores of 7.0-9.0), with less differing opinions among participants (IQR 1.0-3.0). Corresponding verbatim remarks supported the importance of disease and treatment as prognostic aspects. In comparison, patient- and physician-related aspects scored somewhat lower, with more variability (range 4.0-8.0, with IQR 2.0-5.0 for patient- and physician-related considerations). Participants indicated a need for a tool or online database that includes prognostic aspects and prognostic evidence. CONCLUSIONS: Despite some variation in scores, the physicians rated all six prognosis areas as important for work disability evaluations. This study provides suggested aids to prognosis assessment, including an online support tool based on evidence-based medicine features.

Systematic Review and Meta-analysis of Outcome after Mild Traumatic Brain Injury in Older People.

OBJECTIVE: Older age is often identified as a risk factor for poor outcome from traumatic brain injury (TBI). However, this relates predominantly to mortality following moderate-severe TBI. It remains unclear whether increasing age exerts risk on the expected recovery from mild TBI (mTBI). In this systematic review of mTBI in older age (60+ years), a focus was to identify outcome through several domains - cognition, psychological health, and life participation. METHODS: Fourteen studies were identified for review, using PRISMA guidelines. Narrative synthesis is provided for all outcomes, from acute to long-term time points, and a meta-analysis was conducted for data investigating life participation. RESULTS: By 3-month follow-up, preliminary findings indicate that older adults continue to experience selective cognitive difficulties, but given the data it is possible these difficulties are due to generalised trauma or preexisting cognitive impairment. In contrast, there is stronger evidence across time points that older adults do not experience elevated levels of psychological distress following injury and endorse fewer psychological symptoms than younger adults. Meta-analysis, based on the Glasgow Outcome Scale at 6 months+ post-injury, indicates that a large proportion (67%; 95% CI 0.569, 0.761) of older adults can achieve good functional recovery, similar to younger adults. Nevertheless, individual studies using alternative life participation measures suggest more mixed rates of recovery. CONCLUSIONS: Although our initial review suggests some optimism in recovery from mTBI in older age, there is an urgent need for more investigations in this under-researched but growing demographic. This is critical for ensuring adequate health service provision, if needed.