The effects of occupational and mental stress among home care rehabilitation professionals working during the COVID-19 pandemic: An exploratory qualitative study.

Home care rehabilitation professionals (hcRPs) provide health services for clients with a broad range of medical conditions. During the COVID-19 pandemic, home care rehabilitation professionals experienced exacerbations of pre-existing work-related stressors, increased risk of transmission of the COVID-19 virus, reduced resource availability, greater workloads, and staffing shortages. The primary aim of this study was to examine the experience and impact of occupational and mental stress on hcRPs working during the COVID-19 pandemic. Semi-structured interviews were conducted with 24 hcRPs working in Ontario, Canada during the COVID-19 pandemic. Inductive thematic analysis was used to interpret and organize the data into conceptualized themes. Interview data was organized into three themes: (a) unique challenges of a home care rehabilitation professional, (b) COVID-19 exacerbations of home care occupational and mental stress, and (c) personal and workplace coping strategies. Many participants reported reducing their hours or taking on adjunctive roles in different clinical settings outside of home care due to work-related stress exacerbated by the COVID-19 pandemic. With a focus on the effects of COVID-19 on the practice of home care, this study provides a unique perspective on the challenges experienced by hcRPs during an emergent and evolving global public health concern. The exploratory nature of this research works towards providing a framework of factors to be addressed when creating sustainable healthcare interventions, as well as recommendations to support hcRPs to benefit both the community and health-care providers.

Brief Report: The Rise of Online Betting in Ontario.

In this paper we examine the nature of calls for the Ontario Problem Gambling Helpline from June 2021 to Jan 2023 to determine if the increased marketing of online and sports gambling has changed the nature of calls to the helpline. An interrupted time series model comparing the monthly calls before and after the expansion of online gambling and advertising (April 2023), found a significant effect. Calls related to the other games examined did not have a significant interrupted time series effect of from the expansion and advertising of online gambling. The results of this analysis clearly indicate an association between the expansion of legalized gambling and gambling advertising with the number of people who call the helpline for problem related to online gambling.

Changing Default Fluoroscopy Equipment Settings Decreases Entrance Skin Dose in Patients.

PURPOSE: Proper fluoroscopic education and protocols may reduce the patient radiation dose but few prospective studies in urology have been performed. Using optically stimulated luminescent dosimeters we tested whether fluoroscopy time and/or entrance skin dose would decrease after educational and radiation reduction protocols. MATERIALS AND METHODS: At default manufacturer settings fluoroscopy time and entrance skin dose were prospectively measured using optically stimulated luminescent dosimeters in patients undergoing ureteroscopy, retrograde pyelogram/stent or percutaneous nephrolithotomy with access for stone disease. A validated radiation safety competency test was administered to urology faculty and residents before and after web based, hands-on fluoroscopy training. Default fluoroscopy settings were changed from continuous to intermittent pulse rate and from standard to half-dose output. Fluoroscopy time and entrance skin dose were then measured again. RESULTS: The cohorts of 44 pre-protocol and 50 post-protocol patients with stones were similarly matched. The change in mean fluoroscopy time and entrance skin dose from pre-protocol to post-protocol was -0.6 minutes and -11.6 mGy (33%) for percutaneous nephrolithotomy (p = 0.62 and <0.001), 0.5 minutes and -0.1 mGy (34%) for ureteroscopy (p = 0.42 and 0.31), and 0.1 minute and -0.1 mGy (29%) for retrograde pyelogram/stent (p = 0.85 and 0.49, respectively). Urologist post-training test scores increased 30% from pretraining scores (p = 0.1). CONCLUSIONS: Radiation safety training protocols improved clinical knowledge but did not significantly alter fluoroscopy time. Changing equipment default settings to intermittent pulse rate (12 frames per second) and half-dose lowered the entrance skin dose by 30% across all endourology patients but most significantly during percutaneous nephrolithotomy. To limit patient radiation exposure fluoroscopy default settings should be decreased before all endourology procedures and image equipment manufacturers should consider lowering standard default renal settings.

Determining Organ Doses from CT with Direct Measurements in Postmortem Subjects: Part 1--Methodology and Validation.

PURPOSE: To develop a methodology that allows direct measurement of organ doses from computed tomographic (CT) examinations of postmortem subjects. MATERIALS AND METHODS: In this institutional review board approved study, the x-ray linear attenuation coefficients of various tissues were calculated from the mean CT numbers of images that were obtained in eight embalmed adult female cadavers and compared with the corresponding linear attenuation coefficients calculated from CT images obtained in eight living patients that were body mass index (BMI)-matched. Dosimetry was performed in three of the cadavers by accessing organs of interest and affixing partially sealed vinyl tubes inside them. Optically stimulated luminescent dosimeters (OSLDs) were inserted into the tubes and positioned within the organs of interest and on the skin. OSLDs were read with an InLight MicroStar (Landauer, Glenwood, Ill) reader, and readings were corrected for energy and scatter response. Fifteen tubes containing dosimeters were used, and imaging was repeated twice in each cadaver, for a total of five standard clinical protocols. Average dosimetry values were used for analysis. RESULTS: Differences in linear attenuation coefficients between living and embalmed cadaveric tissues were within 3% for the tissues investigated. Measured organ doses for a chest-abdomen-pelvis CT protocol were less than 32 mGy for all organs measured. Organs that were completely irradiated during a given examination received similar doses, whereas organs that were partially irradiated displayed a large variation in measured organ dose. CONCLUSION: The anatomic and radiation attenuation characteristics of cadavers are comparable to those of living human tissue. This methodology allows direct measurement of organ doses from clinical CT examinations.

Determining Organ Doses from CT with Direct Measurements in Postmortem Subjects: Part 2--Correlations with Patient-specific Parameters.

PURPOSE: To generate empirical sets of equations that can be used to calculate patient-specific organ doses resulting from a group of computed tomographic (CT) studies by using data from direct dose measurements performed within a human body. MATERIALS AND METHODS: Organ dose measurements were obtained in eight postmortem female subjects. A chest-abdomen-pelvis protocol was used for this study. The relationships among measured organ doses, body mass index, effective diameter (D(eff)), and volume CT dose index (CTDI(vol)) were investigated. Organ dose equations were developed by means of linear regression from organ dose data, with CTDI(vol) and D(eff) as variables, by using Pearson correlation coefficients and P values to determine correlation strength of fit. Measured organ doses were compared with corresponding size-specific dose estimates (SSDEs). RESULTS: The central-section D(eff) presented similar correlations with organ doses to those from D(eff) measured at specific organ locations. The strongest correlations were observed between the central-section D(eff) and CTDI(vol)-normalized organ doses (R(2): 0.478-0.941). The average of measured organ doses for each subject resulted in an average difference of only 5% from SSDE-calculated doses; however, individual organ doses differed from +31% to -61% from the calculated SSDE. CONCLUSION: The organ dose equations developed represent a method for organ dose estimation from direct organ dose measurements that can estimate organ doses more accurately than the calculated SSDE, which provides a less-specific patient dose estimate.