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1.
Mol Psychiatry ; 2020 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-33288872

RESUMO

Studies of posttraumatic stress disorder (PTSD) report volume abnormalities in multiple regions of the cerebral cortex. However, findings for many regions, particularly regions outside commonly studied emotion-related prefrontal, insular, and limbic regions, are inconsistent and tentative. Also, few studies address the possibility that PTSD abnormalities may be confounded by comorbid depression. A mega-analysis investigating all cortical regions in a large sample of PTSD and control subjects can potentially provide new insight into these issues. Given this perspective, our group aggregated regional volumes data of 68 cortical regions across both hemispheres from 1379 PTSD patients to 2192 controls without PTSD after data were processed by 32 international laboratories using ENIGMA standardized procedures. We examined whether regional cortical volumes were different in PTSD vs. controls, were associated with posttraumatic stress symptom (PTSS) severity, or were affected by comorbid depression. Volumes of left and right lateral orbitofrontal gyri (LOFG), left superior temporal gyrus, and right insular, lingual and superior parietal gyri were significantly smaller, on average, in PTSD patients than controls (standardized coefficients = -0.111 to -0.068, FDR corrected P values < 0.039) and were significantly negatively correlated with PTSS severity. After adjusting for depression symptoms, the PTSD findings in left and right LOFG remained significant. These findings indicate that cortical volumes in PTSD patients are smaller in prefrontal regulatory regions, as well as in broader emotion and sensory processing cortical regions.

2.
Hum Brain Mapp ; 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33155747

RESUMO

In a previous study, we investigated the resting-state fMRI effective connectivity (EC) between the bed nucleus of the stria terminalis (BNST) and the laterobasal (LB), centromedial (CM), and superficial (SF) amygdala. We found strong negative EC from all amygdala nuclei to the BNST, while the BNST showed positive EC to the amygdala. However, the validity of these findings remains unclear, since a reproduction in different samples has not been done. Moreover, the association of EC with measures of anxiety offers deeper insight, due to the known role of the BNST and amygdala in fear and anxiety. Here, we aimed to reproduce our previous results in three additional samples. We used spectral Dynamic Causal Modeling to estimate the EC between the BNST, the LB, CM, and SF, and its association with two measures of self-reported anxiety. Our results revealed consistency over samples with regard to the negative EC from the amygdala nuclei to the BNST, while the positive EC from BNST to the amygdala was also found, but weaker and more heterogenic. Moreover, we found the BNST-BNST EC showing a positive and the CM-BNST EC, showing a negative association with anxiety. Our study suggests a reproducible pattern of negative EC from the amygdala to the BNST along with weaker positive EC from the BNST to the amygdala. Moreover, less BNST self-inhibition and more inhibitory influence from the CM to the BNST seems to be a pattern of EC that is related to higher anxiety.

3.
Hum Brain Mapp ; 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32596977

RESUMO

The ENIGMA group on Generalized Anxiety Disorder (ENIGMA-Anxiety/GAD) is part of a broader effort to investigate anxiety disorders using imaging and genetic data across multiple sites worldwide. The group is actively conducting a mega-analysis of a large number of brain structural scans. In this process, the group was confronted with many methodological challenges related to study planning and implementation, between-country transfer of subject-level data, quality control of a considerable amount of imaging data, and choices related to statistical methods and efficient use of resources. This report summarizes the background information and rationale for the various methodological decisions, as well as the approach taken to implement them. The goal is to document the approach and help guide other research groups working with large brain imaging data sets as they develop their own analytic pipelines for mega-analyses.

4.
Mol Psychiatry ; 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31857689

RESUMO

A growing number of studies have examined alterations in white matter organization in people with posttraumatic stress disorder (PTSD) using diffusion MRI (dMRI), but the results have been mixed which may be partially due to relatively small sample sizes among studies. Altered structural connectivity may be both a neurobiological vulnerability for, and a result of, PTSD. In an effort to find reliable effects, we present a multi-cohort analysis of dMRI metrics across 3047 individuals from 28 cohorts currently participating in the PGC-ENIGMA PTSD working group (a joint partnership between the Psychiatric Genomics Consortium and the Enhancing NeuroImaging Genetics through Meta-Analysis consortium). Comparing regional white matter metrics across the full brain in 1426 individuals with PTSD and 1621 controls (2174 males/873 females) between ages 18-83, 92% of whom were trauma-exposed, we report associations between PTSD and disrupted white matter organization measured by lower fractional anisotropy (FA) in the tapetum region of the corpus callosum (Cohen's d = -0.11, p = 0.0055). The tapetum connects the left and right hippocampus, for which structure and function have been consistently implicated in PTSD. Results were consistent even after accounting for the effects of multiple potentially confounding variables: childhood trauma exposure, comorbid depression, history of traumatic brain injury, current alcohol abuse or dependence, and current use of psychotropic medications. Our results show that PTSD may be associated with alterations in the broader hippocampal network.

5.
Hum Brain Mapp ; 40(9): 2723-2735, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-30829454

RESUMO

The bed nucleus of the stria terminalis (BNST) and the laterobasal nucleus (LB), centromedial nucleus (CM), and superficial nucleus (SF) of the amygdala form an interconnected dynamical system, whose combined activity mediates a variety of behavioral and autonomic responses in reaction to homeostatic challenges. Although previous research provided deeper insight into the structural and functional connections between these nuclei, studies investigating their resting-state functional magnetic resonance imaging (fMRI) connectivity were solely based on undirected connectivity measures. Here, we used high-quality data of 391 subjects from the Human Connectome Project to estimate the effective connectivity (EC) between the BNST, the LB, CM, and SF through spectral dynamic causal modeling, the relation of the EC estimates with age and sex as well as their stability over time. Our results reveal a time-stable asymmetric EC structure with positive EC between all amygdala nuclei, which strongly inhibited the BNST while the BNST exerted positive influence onto all amygdala nuclei. Simulation of the impulse response of the estimated system showed that this EC structure shapes partially antagonistic (out of phase) activity flow between the BNST and amygdala nuclei. Moreover, the BNST-LB and BNST-CM EC parameters were less negative in males. In conclusion, our data points toward partially separated information processing between BNST and amygdala nuclei in the resting-state.


Assuntos
Tonsila do Cerebelo/fisiologia , Conectoma/métodos , Rede Nervosa/fisiologia , Núcleos Septais/fisiologia , Adulto , Tonsila do Cerebelo/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Rede Nervosa/diagnóstico por imagem , Núcleos Septais/diagnóstico por imagem , Adulto Jovem
6.
Neuroimage Clin ; 22: 101735, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30878610

RESUMO

Anticipation of potentially threatening social situations is a key process in social anxiety disorder (SAD). In other anxiety disorders, recent research of neural correlates of anticipation of temporally unpredictable threat suggests a temporally dissociable involvement of amygdala and bed nucleus of the stria terminalis (BNST) with phasic amygdala responses and sustained BNST activation. However, the temporal profile of amygdala and BNST responses during temporal unpredictability of threat has not been investigated in patients suffering from SAD. We used functional magnetic resonance imaging (fMRI) to investigate neural activation in the central nucleus of the amygdala (CeA) and the BNST during anticipation of temporally unpredictable aversive (video camera observation) relative to neutral (no camera observation) events in SAD patients compared to healthy controls (HC). For the analysis of fMRI data, we applied two regressors (phasic/sustained) within the same model to detect temporally dissociable brain responses. The aversive condition induced increased anxiety in patients compared to HC. SAD patients compared to HC showed increased phasic activation in the CeA and the BNST for anticipation of aversive relative to neutral events. SAD patients as well as HC showed sustained activity alterations in the BNST for aversive relative to neutral anticipation. No differential activity during sustained threat anticipation in SAD patients compared to HC was found. Taken together, our study reveals both CeA and BNST involvement during threat anticipation in SAD patients. The present results point towards potentially SAD-specific threat processing marked by elevated phasic but not sustained CeA and BNST responses when compared to HC.


Assuntos
Tonsila do Cerebelo/diagnóstico por imagem , Antecipação Psicológica/fisiologia , Fobia Social/diagnóstico por imagem , Estimulação Luminosa/métodos , Núcleos Septais/diagnóstico por imagem , Comportamento Social , Adulto , Tonsila do Cerebelo/metabolismo , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Fobia Social/metabolismo , Fobia Social/psicologia , Núcleos Septais/metabolismo , Fatores de Tempo , Adulto Jovem
7.
Sci Rep ; 9(1): 2415, 2019 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-30787382

RESUMO

Despite considerable effort, the neural correlates of altered threat-related processing in panic disorder (PD) remain inconclusive. Mental imagery of disorder-specific situations proved to be a powerful tool to investigate dysfunctional threat processing in anxiety disorders. The current functional magnetic resonance imaging (fMRI) study aimed at investigating brain activation in PD patients during disorder-related script-driven imagery. Seventeen PD patients and seventeen healthy controls (HC) were exposed to newly developed disorder-related and neutral narrative scripts while brain activation was measured with fMRI. Participants were encouraged to imagine the narrative scripts as vividly as possible and they rated their script-induced emotional states after the scanning session. PD patients rated disorder-related scripts as more arousing, unpleasant and anxiety-inducing as compared to HC. Patients relative to HC showed elevated activity in the right amygdala and the brainstem as well as decreased activity in the rostral anterior cingulate cortex, and the medial and lateral prefrontal cortex to disorder-related vs. neutral scripts. The results suggest altered amygdala/ brainstem and prefrontal cortex engagement and point towards the recruitment of brain networks with opposed activation patterns in PD patients during script-driven imagery.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Encéfalo/fisiopatologia , Medo/fisiologia , Transtorno de Pânico/fisiopatologia , Adulto , Tonsila do Cerebelo/diagnóstico por imagem , Tonsila do Cerebelo/fisiopatologia , Transtornos de Ansiedade/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico , Emoções/fisiologia , Medo/psicologia , Feminino , Giro do Cíngulo/diagnóstico por imagem , Giro do Cíngulo/fisiopatologia , Humanos , Imagens, Psicoterapia/métodos , Imaginação/fisiologia , Imagem por Ressonância Magnética , Masculino , Transtorno de Pânico/diagnóstico por imagem , Projetos Piloto , Córtex Pré-Frontal/diagnóstico por imagem , Córtex Pré-Frontal/fisiopatologia , Inquéritos e Questionários
8.
J Appl Psychol ; 104(2): 293-302, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30221952

RESUMO

The ability to detect differences between groups partially impacts how useful a group-level variable will be for subsequent analyses. Direct consensus and referent-shift consensus group-level constructs are often measured by aggregating group member responses to multi-item scales. We show that current measurement validation practice for these group-level constructs may not be optimized with respect to differentiating groups. More specifically, a 10-year review of multilevel articles in top journals reveals that multilevel measurement validation primarily relies on procedures designed for individual-level constructs. These procedures likely miss important information about how well each specific scale item differentiates between groups. We propose that group-level measurement validation be augmented with information about each scale item's ability to differentiate groups. Using previously published datasets, we demonstrate how ICC(1) estimates for each item of a scale provide unique information and can produce group-level scales with higher ICC(1) values that enhance predictive validity. We recommend that researchers supplement conventional measurement validation information with information about item-level ICC(1) values when developing or modifying scales to assess group-level constructs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Interpretação Estatística de Dados , Conjuntos de Dados como Assunto , Emprego , Processos Grupais , Análise Multinível/normas , Psicometria/normas , Adulto , Humanos , Análise Multinível/métodos , Psicometria/métodos , Reprodutibilidade dos Testes
9.
Proc Natl Acad Sci U S A ; 115(36): E8538-E8546, 2018 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-30127024

RESUMO

Traditional theories of sensorimotor learning posit that animals use sensory error signals to find the optimal motor command in the face of Gaussian sensory and motor noise. However, most such theories cannot explain common behavioral observations, for example, that smaller sensory errors are more readily corrected than larger errors and large abrupt (but not gradually introduced) errors lead to weak learning. Here, we propose a theory of sensorimotor learning that explains these observations. The theory posits that the animal controls an entire probability distribution of motor commands rather than trying to produce a single optimal command and that learning arises via Bayesian inference when new sensory information becomes available. We test this theory using data from a songbird, the Bengalese finch, that is adapting the pitch (fundamental frequency) of its song following perturbations of auditory feedback using miniature headphones. We observe the distribution of the sung pitches to have long, non-Gaussian tails, which, within our theory, explains the observed dynamics of learning. Further, the theory makes surprising predictions about the dynamics of the shape of the pitch distribution, which we confirm experimentally.


Assuntos
Aprendizagem/fisiologia , Modelos Biológicos , Aves Canoras/fisiologia , Vocalização Animal/fisiologia , Animais
10.
Brain Cogn ; 125: 142-148, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29990704

RESUMO

Previous studies have reported cerebellar activations during error and reward processing. The present study investigated if the cerebellum differentially processes feedback depending on changes in response strategy during reversal learning, as is conceivable given its internal models for movement and thought. Negative relative to positive feedback in an fMRI-based reversal learning task was hypothesized to be associated with increased cerebellar activations. Moreover, increased activations were expected for negative feedback followed by a change in response strategy compared to negative feedback not followed by such a change, and for first positive feedback after compared to final negative feedback before a change, due to updating of internal models. As predicted, activation in lobules VI and VIIa/Crus I was increased for negative relative to positive feedback, and for final negative feedback before a change in response strategy relative to negative feedback not associated with a change. Moreover, activation was increased for first positive feedback after relative to final negative feedback before a change. These findings are consistent with updating of cerebellar internal models to accommodate new behavioral strategies. Recruitment of posterior regions in reversal learning is in line with the cerebellar functional topography, with posterior regions involved in complex motor and cognitive functions.


Assuntos
Cerebelo/fisiologia , Cognição/fisiologia , Retroalimentação Psicológica/fisiologia , Reversão de Aprendizagem/fisiologia , Adulto , Mapeamento Encefálico , Cerebelo/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Recompensa , Adulto Jovem
11.
Neuroimage ; 178: 660-667, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29864521

RESUMO

The spatio-temporal neural basis of earliest differentiation between emotional and neutral facial expressions is a matter of debate. The present study used concurrent electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) in order to investigate the 'when' and 'where' of earliest prioritization of emotional over neutral expressions. We measured event-related potentials (ERPs) and blood oxygen dependent (BOLD) signal changes in response to facial expressions of varying emotional intensity and different valence categories. Facial expressions were presented superimposed by two horizontal bars and participants engaged in a focal bars task (low load, high load), in order to manipulate the availability of attentional resources during face perception. EEG data revealed the earliest expression effects in the P1 range (76-128 ms) as a parametric function of stimulus arousal independent of load conditions. Conventional fMRI data analysis also demonstrated significant modulations as a function of stimulus arousal, independent of load, in amygdala, superior temporal sulcus, fusiform gyrus and lateral occipital cortex. Correspondingly, EEG-informed fMRI analysis revealed a significant positive correlation between single-trial P1 amplitudes and BOLD responses in amygdala and lateral posterior occipital cortex. Our results are in line with the hypothesis of the amygdala as fast responding relevance detector and corresponding effects in early visual face processing areas across facial expressions and load conditions.


Assuntos
Mapeamento Encefálico/métodos , Encéfalo/fisiologia , Emoções/fisiologia , Expressão Facial , Percepção Visual/fisiologia , Eletroencefalografia/métodos , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Estimulação Luminosa , Processamento de Sinais Assistido por Computador , Adulto Jovem
12.
Neuroimage ; 166: 110-116, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29107120

RESUMO

An influential framework suggests that the central nucleus of the amygdala (CeA) is involved in phasic responses to threat, while the bed nucleus of the stria terminalis (BNST) mediates sustained anxiety. However, this model has been questioned, proposing that the role of the BNST is not limited to sustained threat contexts. Rather, amygdala and BNST also seem to work in concert in the processing of discrete and briefly presented threat-related stimuli, likely dependent on inter-individual differences in anxiety. A direct test of this assumption with sufficient experimental power is missing in human research and the degree to which individual differences in trait anxiety moderate phasic responses and functional connectivity of amygdala and BNST during threat processing remains unclear. The current event-related functional magnetic resonance imaging (fMRI) study investigated activation and connectivity of amygdala and BNST, as well as modulating effects of trait anxiety, during processing of briefly presented threat-related relative to neutral standardized pictures in 93 psychiatrically healthy individuals. Both amygdala and BNST activation was increased during presentation of threat-related relative to neutral pictures. Furthermore, functional connectivity between BNST and amygdala in response to threat was positively associated with trait anxiety. These findings suggest that amygdala and BNST form a functional unit during phasic threat processing whereby their connectivity is shaped by inter-individual differences in trait anxiety.


Assuntos
Tonsila do Cerebelo/fisiologia , Ansiedade/fisiopatologia , Conectoma/métodos , Medo/fisiologia , Personalidade/fisiologia , Núcleos Septais/fisiologia , Adulto , Tonsila do Cerebelo/diagnóstico por imagem , Ansiedade/diagnóstico por imagem , Feminino , Humanos , Individualidade , Imagem por Ressonância Magnética , Masculino , Núcleos Septais/diagnóstico por imagem , Adulto Jovem
13.
J Appl Psychol ; 102(3): 375-388, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28125258

RESUMO

Starting with initiatives dating back to the mid-1800s, we provide a high-level review of the key trends and developments in the application of applied psychology to the field of occupational safety. Factory laws, basic worker compensation, and research on accident proneness comprised much of the early work. Thus, early research and practice very much focused on the individual worker, the design of their work, and their basic protection. Gradually and over time, the focus began to navigate further into the organizational context. One of the early efforts to broaden beyond the individual worker was a significant focus on safety-related training during the middle of the 20th century. Toward the latter years of the 20th century and continuing the move from the individual worker to the broader organizational context, there was a significant increase in leadership and organizational climate (safety climate) research. Ultimately, this resulted in the development of a multilevel model of safety culture/climate. After discussing these trends, we identify key conclusions and opportunities for future research. (PsycINFO Database Record


Assuntos
Saúde do Trabalhador , Cultura Organizacional , Psicologia Industrial , Pesquisa , Segurança , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Saúde do Trabalhador/história , Psicologia Industrial/história , Pesquisa/história , Segurança/história
14.
IEEE Trans Neural Syst Rehabil Eng ; 24(12): 1333-1341, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-26600161

RESUMO

The amplitude of the surface EMG (sEMG) is commonly estimated by rectification or other nonlinear transformations, followed by smoothing (low-pass linear filtering). Although computationally efficient, this approach leads to an estimation accuracy with a limited theoretical signal-to-noise ratio (SNR). Since sEMG amplitude is one of the most relevant features for myoelectric control, its estimate has become one of the limiting factors for the performance of myoelectric control applications, such as powered prostheses. In this study, we present a recursive nonlinear estimator of sEMG amplitude based on Bayesian filtering. Furthermore, we validate the advantage of the proposed Bayesian filter over the conventional linear filters through an online simultaneous and proportional control (SPC) task, performed by eight able-bodied subjects and three below-elbow limb deficient subjects. The results demonstrated that the proposed Bayesian filter provides significantly more accurate SPC, particularly for the patients, when compared with conventional linear filters. This result presents a major step toward accurate prosthetic control for advanced multi-function prostheses.


Assuntos
Algoritmos , Membros Artificiais , Eletromiografia/métodos , Retroalimentação Fisiológica/fisiologia , Contração Muscular/fisiologia , Reconhecimento Automatizado de Padrão/métodos , Teorema de Bayes , Humanos , Dinâmica não Linear , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Processamento de Sinais Assistido por Computador
15.
Infect Control Hosp Epidemiol ; 36(12): 1444-50, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26383964

RESUMO

The Hawthorne Effect is a prevalent observer effect that causes behavioral changes among participants of epidemiological studies or infection control interventions. The purpose of the review is to describe the origins of the Hawthorne Effect, to understand the term in relation to current scientific literature, to describe characteristics of the Hawthorne effect, and to discuss methods to quantify and overcome limitations associated with the Hawthorne Effect.


Assuntos
Modificador do Efeito Epidemiológico , Comportamentos Relacionados com a Saúde , Controle de Infecções/métodos , Sujeitos da Pesquisa/psicologia , Viés , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/transmissão , Desinfecção das Mãos , Humanos , Estudos Observacionais como Assunto
16.
BMC Health Serv Res ; 15: 6, 2015 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-25608564

RESUMO

BACKGROUND: The failure rates for implementing complex innovations in healthcare organizations are high. Estimates range from 30% to 90% depending on the scope of the organizational change involved, the definition of failure, and the criteria to judge it. The innovation implementation framework offers a promising approach to examine the organizational factors that determine effective implementation. To date, the utility of this framework in a healthcare setting has been limited to qualitative studies and/or group level analyses. Therefore, the goal of this study was to quantitatively examine this framework among individual participants in the National Cancer Institute's Community Clinical Oncology Program using structural equation modeling. METHODS: We examined the innovation implementation framework using structural equation modeling (SEM) among 481 physician participants in the National Cancer Institute's Community Clinical Oncology Program (CCOP). The data sources included the CCOP Annual Progress Reports, surveys of CCOP physician participants and administrators, and the American Medical Association Physician Masterfile. RESULTS: Overall the final model fit well. Our results demonstrated that not only did perceptions of implementation climate have a statistically significant direct effect on implementation effectiveness, but physicians' perceptions of implementation climate also mediated the relationship between organizational implementation policies and practices (IPP) and enrollment (p <0.05). In addition, physician factors such as CCOP PI status, age, radiological oncologists, and non-oncologist specialists significantly influenced enrollment as well as CCOP organizational size and structure, which had indirect effects on implementation effectiveness through IPP and implementation climate. CONCLUSIONS: Overall, our results quantitatively confirmed the main relationship postulated in the innovation implementation framework between IPP, implementation climate, and implementation effectiveness among individual physicians. This finding is important, as although the model has been discussed within healthcare organizations before, the studies have been predominately qualitative in nature and/or at the organizational level. In addition, our findings have practical applications. Managers looking to increase implementation effectiveness of an innovation should focus on creating an environment that physicians perceive as encouraging implementation. In addition, managers should consider instituting specific organizational IPP aimed at increasing positive perceptions of implementation climate. For example, IPP should include specific expectations, support, and rewards for innovation use.


Assuntos
Eficiência Organizacional/estatística & dados numéricos , Eficiência Organizacional/normas , National Cancer Institute (U.S.)/estatística & dados numéricos , National Cancer Institute (U.S.)/normas , Serviço Hospitalar de Oncologia/estatística & dados numéricos , Serviço Hospitalar de Oncologia/normas , Médicos/psicologia , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Interpretação Estatística de Dados , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Inovação Organizacional , Pesquisa Qualitativa , Estados Unidos
17.
J Appl Psychol ; 100(3): 846-62, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25365728

RESUMO

To deliver high-quality, reliable, and consistent services safely, organizations develop professional standards. Despite the communication and reinforcement of these standards, they are often not followed consistently. Although previous research suggests that high job demands are associated with declines in compliance over lengthy intervals, we hypothesized-drawing on theoretical arguments focused on fatigue and depletion-that the impact of job demands on routine compliance with professional standards might accumulate much more quickly. To test this hypothesis, we studied a problem that represents one of the most significant compliance challenges in health care today: hand hygiene. Using longitudinal field observations of over 4,157 caregivers working in 35 different hospitals and experiencing more than 13.7 million hand hygiene opportunities, we found that hand hygiene compliance rates dropped by a regression-estimated 8.7 percentage points on average from the beginning to the end of a typical 12-hr work shift. This decline in compliance was magnified by increased work intensity. Further, longer breaks between work shifts increased subsequent compliance rates, and such benefits were greater for individuals when they had ended their preceding shift with a lower compliance rate. In addition, (a) the decline in compliance over the course of a work shift and (b) the improvement in compliance following a longer break increased as individuals accumulated more total work hours the preceding week. The implications of these findings for patient safety and job design are discussed.


Assuntos
Fidelidade a Diretrizes/normas , Higiene das Mãos/normas , Pessoal de Saúde/normas , Local de Trabalho/normas , Adulto , Fidelidade a Diretrizes/estatística & dados numéricos , Higiene das Mãos/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Humanos , Fatores de Tempo , Local de Trabalho/estatística & dados numéricos
18.
Psychol Sci ; 22(12): 1494-9, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22075239

RESUMO

Diseases often spread in hospitals because health care professionals fail to wash their hands. Research suggests that to increase health and safety behaviors, it is important to highlight the personal consequences for the actor. However, because people (and health care professionals in particular) tend to be overconfident about personal immunity, the most effective messages about hand hygiene may be those that highlight its consequences for other people. In two field experiments in a hospital, we compared the effectiveness of signs about hand hygiene that emphasized personal safety ("Hand hygiene prevents you from catching diseases") or patient safety ("Hand hygiene prevents patients from catching diseases"). We assessed hand hygiene by measuring the amount of soap and hand-sanitizing gel used from dispensers (Experiment 1) and conducting covert, independent observations of health care professionals' hand-hygiene behaviors (Experiment 2). Results showed that changing a single word in messages motivated meaningful changes in behavior: The hand hygiene of health care professionals increased significantly when they were reminded of the implications for patients but not when they were reminded of the implications for themselves.


Assuntos
Desinfecção das Mãos , Pessoal de Saúde/psicologia , Hospitais , Motivação , Humanos , Controle de Infecções , Segurança do Paciente , Estados Unidos
19.
J Appl Psychol ; 96(1): 71-94, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21171732

RESUMO

In this article, we develop and meta-analytically test the relationship between job demands and resources and burnout, engagement, and safety outcomes in the workplace. In a meta-analysis of 203 independent samples (N = 186,440), we found support for a health impairment process and for a motivational process as mechanisms through which job demands and resources relate to safety outcomes. In particular, we found that job demands such as risks and hazards and complexity impair employees' health and positively relate to burnout. Likewise, we found support for job resources such as knowledge, autonomy, and a supportive environment motivating employees and positively relating to engagement. Job demands were found to hinder an employee with a negative relationship to engagement, whereas job resources were found to negatively relate to burnout. Finally, we found that burnout was negatively related to working safely but that engagement motivated employees and was positively related to working safely. Across industries, risks and hazards was the most consistent job demand and a supportive environment was the most consistent job resource in terms of explaining variance in burnout, engagement, and safety outcomes. The type of job demand that explained the most variance differed by industry, whereas a supportive environment remained consistent in explaining the most variance in all industries.


Assuntos
Esgotamento Profissional/psicologia , Segurança , Local de Trabalho , Acidentes de Trabalho/psicologia , Acidentes de Trabalho/estatística & dados numéricos , Esgotamento Profissional/epidemiologia , Humanos , Indústrias/normas , Indústrias/estatística & dados numéricos , Fatores de Risco , Segurança/estatística & dados numéricos , Gestão da Segurança/normas , Gestão da Segurança/estatística & dados numéricos , Recursos Humanos , Local de Trabalho/psicologia , Local de Trabalho/normas , Local de Trabalho/estatística & dados numéricos
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