Association between Presenteeism, Associated Factors, and Outcomes among Intern Physicians in Public Hospitals during the COVID-19 Pandemic: A Cross-Sectional Study.

Background and Objectives: Presenteeism, when employees continue to work despite being sick, may have increased among intern physicians during the COVID-19 pandemic due to the necessity of performing unfamiliar tasks. This study aimed to investigate the prevalence of presenteeism among intern physicians (IPs) in Thailand, its associated factors, and outcomes. Material and Methods: A total of 254 IPs participated in this cross-sectional study conducted from June to July 2022. Participants completed a nationwide online questionnaire including demographics, financial status, underlying diseases, hospital location and affiliation, department, resource problems, manpower shortage, workload intensity, presenteeism, and its outcomes. IPs were recruited via various social media platforms. Statistical analysis was performed using multivariable zero-inflated Poisson regression and multivariable linear regression. Results: The average age of IPs was 25.5 years (SD 1.9), and 57.5% were female. The majority of IPs reported dealing with resource problems (74.8%), insufficient manpower (94.9%), and intense workload (83.5%). Presenteeism was prevalent among 63.8% of IPs, with the most common of the diseases being allergic rhinitis (31.3%). IPs with underlying diseases had an increased rate of presenteeism (adjusted odds ratio (aOR) 2.50, 95% confidence interval (CI) 1.33-4.55). IPs working in community hospitals during their rotations exhibited a lower rate of presenteeism (aOR 0.39, 95% CI 0.16-0.94) compared to other departments within general or regional hospitals. The IPs frequently exposed to insufficient manpower had an increased rate of presenteeism (aOR 4.35, 95% CI 1.02-20.00) compared to those not exposed. Additionally, IPs with presenteeism had more exhaustion (ß 1.40, 95% CI 0.33 to 2.46), lower perceived well-being (ß -0.65, 95% CI -1.26 to -0.03), and job satisfaction (ß -0.33, 95% CI -0.63 to -0.03). Conclusions: During COVID-19, intern physicians in Thailand often exhibit presenteeism due to physical conditions, resource scarcity, and personnel shortages, impacting exhaustion, well-being, and job satisfaction. Recommendations include assessing healthcare workforces, allocating resources more effectively, enforcing policies to promote responsible use of sick leave, and implementing sick leave systems.

Burnout and Quality of Work Life among Physicians during Internships in Public Hospitals in Thailand.

Physicians are exposed to occupational stress and burnout, which have been identified as contributing to a decrease in the quality of work life (QWL). Thailand's medical education program, consisting of a six-year curriculum with government tuition support followed by three years of internships, provides the context for this investigation. This study aimed to assess the QWL among intern physicians (IPs) in public hospitals and investigated the association between burnout and QWL. A cross-sectional study was conducted among 241 IPs in public hospitals in Thailand utilizing an online self-administered questionnaire. The questionnaire included a Thai version of a 25-item QWL scale and the Maslach Burnout Inventory-Human Services Survey for Medical Personnel. Data analysis was performed using multivariable logistic regression. A significant proportion of IPs experienced low to moderate QWL (72.6%), with low levels of home-work interface (39.4%) and employee engagement (38.6%). In the exploratory model, after adjusting for sex and age, IPs with high depersonalization and low personal accomplishment demonstrated an association with low QWL (adjusted OR, aOR 2.08, 95% CI 1.01 to 4.31; aOR 2.74, 95% CI 1.40 to 5.39). Healthcare organizations should regularly assess intern physicians' QWL and burnout, prioritizing interventions; ensure reasonable work hours, schedule adjustments, and open communication; and develop support systems for cost-effective interventions. Further research on the dynamic relationship between burnout and QWL is crucial for targeted and culturally sensitive interventions.

Factors affecting the work ability of nursing personnel with post-COVID infection.

Post-COVID infection have raised concerns regarding their impact on nursing personnel's work ability. This study aimed to assess the relationship between post-COVID infection and work ability among nursing personnel. A retrospective observational study from December 2022 to January 2023 involved 609 nursing personnel with a history of COVID-19 infection at a tertiary hospital. An online questionnaire measured post-COVID infection, personal and working factors, and the Work Ability Index (WAI). Long COVID was defined as the continuation or development of new symptoms 1 month post COVID-19 infection. Of 609 personnel, 586 showed post-COVID symptoms (fatigue, cough, difficulty breathing, etc.), with 73.72% in the short COVID group and 26.28% in the long COVID group. A significant association was found between WAI and post-COVID infection (aOR: 3.64, 95% CI 1.59-8.30), with the short COVID group had a significantly higher WAI than the long COVID group (mean difference 2.25, 95% CI 1.44-3.05). The factors related to work ability in the long COVID group were chronic diseases, work limitation, low job control (P < 0.05). Post-COVID infection, especially long COVID, adversely affect nursing personnel's work ability. Enhancing job control and addressing work limitations are crucial for supporting their return to work.

Exploring the adverse effect of fine particulate matter (PM2.5) on wildland firefighters' pulmonary function and DNA damage.

Chiang Mai encounters severe pollution during the wildfire season. Wildland firefighters encounter various hazards while engaged in fire suppression operations, which encompass significant exposure to elevated concentrations of air pollutants resulting from combustion, especially particulate matter. The adverse effects of wildfire smoke on respiratory health are a significant concern. The objective of this study was to examine the potential adverse effects of PM2.5 exposure on the respiratory function and DNA damage of wildland firefighters. This prospective cohort study conducted in Chiang Mai from January to May 2022 planned to evaluate the health status of wildland firefighters during the pre-peak, peak, and post-peak ambient air pollution seasons. The measurement of PM2.5 was done at every forest fire station, as well as utilizing data from the Pollution Control Department. Participants received general health examinations, spirometry evaluations, and blood tests for DNA damage analysis. Pair t-tests and multiple regression models were used to examine the connection between pulmonary function parameters (FVC, FEV1) and PM2.5 concentration, with a significance level of P < 0.05. Thirty-three peak-season and twenty-one post-peak-season participants were enrolled. Four pre-peak-season wildland firefighters had FVC and FEV1 declines of > 15%. Multiple regression analysis showed a negative association between PM2.5 exposure and FVC% predicted (- 2.81%, 95% CI - 5.27 to - 0.34%, P = 0.027) and a marginally significant negative correlation with FVC (- 114.38 ml, 95% CI - 230.36 to 1.59 ml, P = 0.053). The remaining pulmonary measures showed a statistically insignificant decline. There were no significant changes in DNA damage detected. Wildland firefighters suffered a significant decline in pulmonary function associated with PM2.5 exposure. Spirometry is crucial for monitoring and promptly identifying respiratory issues that occur during wildfire seasons. Further research is recommended to explore DNA damage alterations and their potential association with PM2.5.

Outcomes of the Initial Phase of an Adult Living vs Deceased Donor Liver Transplantation Program in a Low-Volume Transplant Center: Integration of Hepatobiliary and Transplant Surgery.

BACKGROUND: The development of living donor liver transplantation (LDLT) is clinically challenging, especially in a low-volume transplant program. We evaluated the short-term outcomes of LDLT and deceased donor liver transplantation (DDLT) to demonstrate the feasibility of performing LDLT in a low-volume transplant and/or high-volume complex hepatobiliary surgery program during the initial phase. MATERIAL AND METHODS: We conducted a retrospective study of LDLT and DDLT in Chiang Mai University Hospital from October 2014 to April 2020. Postoperative complications and 1-year survival were compared between the 2 groups. RESULTS: Forty patients who underwent LT in our hospital were analyzed. There were 20 LDLT patients and 20 DDLT patients. The operative time and hospital stay were significantly longer in the LDLT group than in the DDLT group. The incidence of complications in both groups was comparable, except for biliary complications, which were higher in the LDLT group. Bile leakage, found in 3 patients (15%), is the most common complication in a donor. The 1-year survival rates of both groups were also comparable. CONCLUSION: Even during the initial phase of the low-volume transplant program, LDLT and DDLT had comparable perioperative outcomes. Surgical expertise in complex hepatobiliary surgery is necessary to facilitate effective LDLT, potentially increasing case volumes and promoting program sustainability.

Dynamic of anti-spike receptor binding domain (RBD) levels and short-term adverse events following a heterologous booster dose of BNT162b2 after two doses of CoronaVac in Thai health care workers.

BACKGROUND: CoronaVac was administered as the primary COVID-19 vaccine for Thai health care workers (HCWs) in early 2021 in response to the epidemic of new variants. This study aimed to evaluate the dynamic of humoral immune response as well as the short-term side effects resulting from the booster dose of BNT162b2 following completion of a CoronaVac double-dose in Thai HCWs. METHODS: This study was conducted at a teaching hospital in Northern Thailand during August and September 2021. The participants were 50 HCWs who were vaccinated with 2 doses of CoronaVac and were scheduled to receive a booster dose of BNT162b2. Anti-SARS-CoV-2 IgG antibodies levels and short-term side effects were assessed. The anti-RBD level was determined using Architect SARS-CoV-2 IgG II Quant (Abbott). RESULT: Of the 50 participants, 37 were female. The median age was 33.0 years old. The average time between the second CoronaVac shot and the BNT162b2 booster shot was 81.7 days (SD = 25.0). The median anti-SARS-CoV-2 IgG antibody level on booster vaccination date, as well as day 14, and day 28 after the booster were 335.5 AU/ml, 31,613.5 AU/ml, and 20,311.9 AU/ml, respectively. Fourteen days after the booster, 94% of participants had anti-SARS-CoV-2 IgG antibody levels higher than 50.0 AU/ml. Being female, higher log anti-SARS-CoV-2 IgG antibodies prior to booster vaccination, and longer interval between the second shot and the booster shot were found to be significantly associated with higher levels of anti-SARS-CoV-2 IgG antibodies at both day 14 and day 28 after the booster. There were no reports of serious adverse events. CONCLUSION: A booster dose of BNT162B2 promoted a high level of anti-SARS-CoV-2 IgG antibodies among HCWs who received 2 doses of CoronaVac. The time between the second CoronaVac shot and the booster shot should be at least three months. There were no severe adverse effects observed.