Burnout Among Surgeons in the UK During the COVID-19 Pandemic: A Cohort Study.

BACKGROUND: Surgeon burnout has implications for patient safety and workforce sustainability. The aim of this study was to establish the prevalence of burnout among surgeons in the UK during the COVID-19 pandemic. METHODS: This cross-sectional online survey was set in the UK National Health Service and involved 601 surgeons across the UK of all specialities and grades. Participants completed the Maslach Burnout Inventory and a bespoke questionnaire. Outcome measures included emotional exhaustion, depersonalisation and low personal accomplishment, as measured by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). RESULTS: A total of 142 surgeons reported having contracted COVID-19. Burnout prevalence was particularly high in the emotional exhaustion (57%) and depersonalisation (50%) domains, while lower on the low personal accomplishment domain (15%). Burnout prevalence was unrelated to COVID-19 status; however, the greater the perceived impact of COVID-19 on work, the higher the prevalence of emotional exhaustion and depersonalisation. Degree of worry about contracting COVID-19 oneself and degree of worry about family and friends contacting COVID-19 was positively associated with prevalence on all three burnout domains. Across all three domains, burnout prevalence was exceptionally high in the Core Trainee 1-2 and Specialty Trainee 1-2 grades. CONCLUSIONS: These findings highlight potential undesirable implications for patient safety arising from surgeon burnout. Moreover, there is a need for ongoing monitoring in addition to an enhanced focus on mental health self-care in surgeon training and the provision of accessible and confidential support for practising surgeons.

Cross-sectional associations between domain-specific sitting time and other lifestyle health behaviours: the Stormont study.

BACKGROUND: There is a dearth of literature on how different domains of sitting time relate to other health behaviours. Therefore, this study aimed to explore these associations in a sample of office workers. METHODS: 7170 Northern Irish Civil Servants completed an online survey which included information on workday and non-workday sitting time in five domains (travel, work, TV, computer-use, leisure-time), physical activity, fruit and vegetable intake, alcohol consumption and cigarette smoking. An unhealthy behaviour score was calculated by summing the number of health behaviours which did not meet the current guidelines. Multinomial regressions examined associations between unhealthy behaviour score and each domain of sitting time. RESULTS: ≥7 hours sitting at work and ≥2 hours TV viewing on a workday both more than doubled the odds of partaking in ≥3 unhealthy behaviours [Odds ratio, OR = 2.03, 95% CI, (1.59-2.61); OR = 2.19 (1.71-2.80)] and ≥3 hours of TV viewing on a non-workday nearly tripled the odds [OR = 2.96 (2.32-3.77)]. CONCLUSIONS: High sitting time at work and TV viewing on a workday and non-workday are associated with increased odds of partaking in multiple unhealthy behaviours. Interventions need to focus on these domains and public health policy should consider sitting time as an important health behaviour.

Nurses' perceived work performance and health during presenteeism: Cross-sectional associations with personal and organisational factors.

AIM: To determine personal and organisational factors associated with work performance and illness outcomes during presenteeism in a cohort of nurses. BACKGROUND: Presenteeism is prevalent in nursing populations. It is known to be associated with impaired health and performance loss. Knowledge about the factors associated with presenteeism may help foster better health and performance in this group. METHODS: A survey (N = 270) was conducted in a population of nurses working with older adults. Hierarchical multiple regression was used to explore factors associated with performance loss and illness outcomes during presenteeism. RESULTS: Work performance and illness outcomes were often reported as poor during presenteeism. Less negative illness perceptions and work engagement were associated with better work performance and illness outcomes. Older age and manager support were also associated with better work performance. Non-organisational causes of illness were associated with better illness outcomes. CONCLUSION: Performance levels and illness outcomes during presenteeism are associated with a combination of illness-related, individual, attitudinal and organisational factors. IMPLICATIONS FOR NURSING MANAGEMENT: Fostering engagement, support, good relationships and a hazard-free environment may improve performance and health during presenteeism.

Effort-reward imbalance and burnout among humanitarian aid workers.

This study sought to examine stress-related working conditions-defined in terms of effort-reward imbalance (ERI)-and their association with burnout among a large, international sample of humanitarian aid workers. Descriptive statistics were applied to cross-sectional survey data (N=1,980) to profile ERI and burnout and Pearson's χ2 tests were used to characterise associated socio- and occupational-demographic factors. Associations between ERI and burnout were established using binary logistic regression to generate odds ratios and 95 per cent confidence intervals adjusted for potential confounding variables. For high emotional exhaustion, the prevalence rate was 36 per cent for women and 27 per cent for men, whereas the proportions for high depersonalisation and low personal achievement were 9 and 10 per cent and 47 and 31 per cent, respectively. Intermediate and high ERI was associated with significantly increased odds of high emotional exhaustion; the findings were mixed for depersonalisation and personal achievement.

Work-related stress in a humanitarian context: a qualitative investigation.

There is a paucity of research on the subjective stress-related experiences of humanitarian aid workers. Most evaluations of stress among these individuals focus on trauma and related conditions or adopt a quantitative approach. This interview-based study explored how 58 humanitarian aid workers employed by a United Nations-aligned organisation perceived the transactional stress process. The thematic analysis revealed eight main topics of interest: an emergency culture was found where most employees felt compelled to offer an immediate response to humanitarian needs; employees identified strongly with humanitarian goals and reported a high level of engagement; the rewards of humanitarian work were perceived as motivating and meaningful; constant change and urgent demands resulted in work overload; and managing work-life boundaries and receiving positive support from colleagues and managers helped to buffer perceived stress, work overload, and negative health outcomes. The practical implications of the results are discussed and suggestions made in the light of current research and stress theory.

Descriptive epidemiology of domain-specific sitting in working adults: the Stormont Study.

BACKGROUND: Given links between sedentary behaviour and unfavourable health outcomes, there is a need to understand the influence of socio-demographic factors on sedentary behaviour to inform effective interventions. This study examined domain-specific sitting times reported across socio-demographic groups of office workers. METHODS: The analyses are cross-sectional and based on a survey conducted within the Stormont Study, which is tracking employees in the Northern Ireland Civil Service. Participants self-reported their daily sitting times across multiple domains (work, TV, travel, PC use and leisure) on workdays and non-workdays, along with their physical activity and socio-demographic variables (sex, age, marital status, BMI, educational attainment and work pattern). Total and domain-specific sitting on workdays and non-workdays were compared across socio-demographic groups using multivariate analyses of covariance. RESULTS: Completed responses were obtained from 4436 participants. For the whole sample, total daily sitting times were higher on workdays in comparison to non-workdays (625 ± 168 versus 469 ± 210 min/day, P < 0.001). On workdays and non-workdays, higher sitting times were reported by individuals aged 18-29 years, obese individuals, full-time workers and single/divorced/widowed individuals (P < 0.001). CONCLUSIONS: Interventions are needed to combat the high levels of sedentary behaviour observed in office workers, particularly among the highlighted demographic groups. Interventions should target workplace and leisure-time sitting.

Work engagement and its association with occupational sitting time: results from the Stormont study.

BACKGROUND: Evidence suggests that poor health outcomes and poor work-related health outcomes such as sickness presenteeism are associated with excessive sitting at work. Studies have yet to investigate the relationship between work engagement and occupational sitting. Work engagement is considered to be an important predictor of work-related well-being. We investigated the relationship between and self-reported work engagement and high occupational sitting time in Northern Ireland Civil Service (NICS) office-based workers. METHOD: A cohort of 4436 NICS office-workers (1945 men and 2491 women) completed a questionnaire measuring work engagement and occupational sitting time. Logistic regression analyses were used to test the associations between work engagement and occupational sitting times. RESULTS: Compared to women, men reported lower mean occupational sitting time (385.7 minutes/day; s.d. = 1.9; versus 362.4 minutes/day; s.d. =2.5; p < .0001). After adjusting for confounding variables, men with high work engagement of vigor (OR = 0.49, 95% CI 0.34-0.98) and dedication (OR 0.68 95% CI 0.47-0.98) were less likely to have prolonged sitting time. Women with high work engagement of vigor (OR = 0.62, 95% CI 0.45-0.84) were also less likely to have prolonged occupational sitting times. In contrast, women with high absorption (OR = 1.29, 95% CI 1.01-1.65) were more likely to have prolonged sitting times. CONCLUSIONS: Being actively engaged in one's work is associated with lower occupational sitting times for men (vigor and dedication) and to a limited extent for women (vigor only). This suggests that interventions such as introducing sit-stand workstations to reduce sitting times, may be beneficial for work engagement.

"I'm pulling through because of you": injured workers' perspective of workplace factors supporting return to work under the Saskatchewan Workers' Compensation Board scheme.

Background: Research demonstrates sustained return to work (RTW) by individuals on medical leave is influenced by personal and job resources and job demands. Relatively few studies have been conducted in the workers' compensation context that is known to have longer absence durations for RTW. Aims: This study sought to illuminate workers' experience as they returned to work following a work injury that was either psychological in nature or involved more than 50 days of disability, with a focus on the co-worker, supervisor, and employer actions that supported their return. Methods: Workers in Saskatchewan, Canada, with a work-related psychological or musculoskeletal injury, subsequent disability, and who returned to work in the last three years, were invited to complete an online survey comprising of free-text questions. Thematic analysis was used to explore participants' experiences. Results: Responses from 93 individuals were analysed. These revealed that persistent pain, emotional distress, and loss of normal abilities were present during and beyond returning to work. Almost two-thirds indicated that the supervisors' and co-workers' support was critical to a sustained return to work: their needs were recognized and they received autonomy and support to manage work demands. By contrast, one-third indicated that the support they expected and needed from supervisors and employers was lacking. Conclusions: Workers returning to work lacked personal resources but co-workers' and supervisors' support helped improve confidence in their ability to RTW. Supervisors and employers should acknowledge workers' experiences and offer support and autonomy. Likewise, workers can expect challenges when returning to work and may benefit from cultivating supportive relationships with co-workers and supervisors.

Acceptance of repeat worksite HIV voluntary counselling and testing in a rural South African factory.

In response to the human immunodeficiency virus (HIV) pandemic, many employers in sub-Saharan Africa have introduced voluntary counselling and testing (VCT) for HIV. To assess the factors that predict repeat VCT attendance at 12-month follow-up we analysed data from a nurse-administered questionnaire that was distributed to factory workers in a rural South African factory. Employees were offered VCT for HIV in 2009 and again 12 months later. Odds ratios examined factors associated with attendance at follow-up. Totally, 2138 employees accepted VCT at initial assessment and 406 attended at follow-up. After controlling for socio-demographic factors (age, gender, marital status and education), elevated blood glucose was associated with increased likelihood of attendance at follow-up; positive HIV status was a key risk factor for non-attendance at follow-up. This study underscores the importance of determining those groups at risk of non-attendance at employer-provided repeat VCT clinics; differences between employee groups might usefully inform targeted promotional activities to encourage attendance.

A systematic review of dentists' psychological wellbeing during the COVID-19 pandemic.

Background The COVID-19 pandemic presented significant challenges to healthcare workers worldwide, including the effect on the psychological wellbeing of dentists.Aims To evaluate the impact of the early phases of the pandemic on the psychological health, long-term wellbeing and clinical service provision of dentists, as well as the identification of the key risk and protective factors for adverse mental health outcomes (MHOs) in this group.Methods A systematic review of cross-sectional studies (n = 53) from public and private dentistry sectors was employed to delineate the risk and protective factors for adverse MHOs.Results Self-reports from these studies (1 December 2019 to 31 December 2021), involving 45,671 dentists worldwide were analysed. Study findings were classified according to their psychological impact (as risk or protective factors), categorised as 'operational' or 'organisational' and subdivided into 'psychosocial', 'occupational', 'sociodemographic' and 'environmental' elements. A GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) certainty of evidence score was calculated for all the identified factors.Conclusions This review confirmed the negative impact of the pandemic on the MHOs of dentists worldwide. Pivotal risk factors included fear of infection, transmission to families, lack of personal protective equipment and possible direct contact with infected patients. Enhanced infection control protocols, individual resilience and organisational support were identified as important protective factors.

Mental wellbeing and psychosocial working conditions of autistic veterinary surgeons in the UK.

BACKGROUND: Certain autistic characteristics (such as hyper-focus and attention to detail) are valued by veterinary surgeons and autistic adults may disproportionately self-select into the profession. Links between mental wellbeing and retention in the veterinary profession highlight an imperative to profile autistic veterinary surgeons' mental wellbeing and identify protective factors. The psychosocial work environment may represent one such protective factor. We aimed to assess autistic veterinary surgeons' mental wellbeing, the extent to which their psychosocial working conditions achieved UK government management standards and links between these. METHODS: Eighty-five autistic veterinary surgeons completed the Warwick-Edinburgh Mental Wellbeing Scale and the Health and Safety Executive's Management Standards Indicator Tool. Descriptive comparisons were drawn with normative data; correlation and linear regression analyses examined relations between mental wellbeing and psychosocial working conditions. RESULTS: Mental wellbeing and psychosocial work environment quality were markedly below veterinary surgeon and general workforce norms. Psychosocial working conditions accounted for 44% of the unique variance in mental wellbeing, with 'control' and 'role' making a significant contribution. LIMITATION: This exploratory study involved a small self-selecting sample, raising the possibility of response bias. CONCLUSION: Work design centred on the enhancement of control and role clarity would likely support mental wellbeing in this population.

Nationwide evaluation of the advanced clinical practitioner role in England: a cross-sectional survey.

BACKGROUND AND STUDY OBJECTIVE: In response to growing pressures on healthcare systems, the advanced clinical practice (ACP) role has been implemented widely in the UK and internationally. In England, ACP is a level of practice applicable across various healthcare professions, who exercise a level of autonomy across four domains, referred to as the four pillars of practice (education, leadership, research and clinical practice). A national framework for ACP was established in 2017 to ensure consistency across the ACP role, however current ACP governance, education and support is yet to be evaluated. This study aimed to analyse data from a national survey of the ACP role to inform the development and improvement of policies relating to ACP in the National Health Service (NHS) in England. DESIGN: A cross-sectional survey with free-text comments. SETTING: The survey was distributed across primary and secondary levels of care to three distinct groups in England, including individual ACPs, NHS provider organisations and Trusts and primary care settings. PARTICIPANTS: A total of 4365 surveys were returned, from ACP staff (n=4013), NHS provider organisations and Trusts (n=166) and primary care organisations (n=186). RESULTS: Considerable variation was found in role titles, scope of practice, job descriptions and educational backgrounds of ACPs. Differing approaches to governance were noted, which led to inconsistent ACP frameworks in some organisations. A further challenge highlighted included committing time to work across the four pillars of advanced practice, particularly the research pillar. ACPs called for improvements in supervision and continuing professional development alongside further support in navigating career pathways. CONCLUSIONS: A standardised approach may support ACP workforce development in England and enable ACPs to work across the four pillars of practice. Due to the wide uptake of ACP roles internationally, this study has relevance across professions for global healthcare workforce transformation.

Effort-Reward Imbalance and Job Strain: A Composite Indicator Approach.

The Job Demand-Control-Support (JDC-S) and Effort-Reward Imbalance (ERI) models dominate psychosocial work environment research and practice, with their independent and collective contributions to employee health having been extensively demonstrated. Psychosocial risk assessment in the humanitarian aid sector is in its infancy, and there is a need to identify appropriate psychosocial work environment models to inform approaches to assessment. The aim of this study is to examine the efficacy of these models separately and in combination to identify psychological distress in humanitarian aid workers. Cross-sectional survey data were obtained from 283 humanitarian aid workers. Logistic regression analyses investigated the separate and combined ability of the models to identify psychological distress. More than half of the participant sample reported psychological distress, and one third reported high ERI and high job strain. When tested separately, each model was associated with a significantly elevated likelihood of psychological distress. When tested in combination, the two models offered a superior estimation of the likelihood of psychological distress than achieved by one model in isolation. Psychosocial risk assessment in the humanitarian aid sector encompassing the characteristics of both these leading psychosocial work environment models captures the breadth of relevant generic psychosocial work characteristics. These initial findings require corroboration through longitudinal research involving sector-representative samples.

Move-It: A Cluster-Randomised Digital Worksite Exercise Intervention in China: Outcome and Process Evaluation.

We evaluate the outcomes and processes of a video and web-based worksite exercise intervention for sedentary office workers in China, in a 2-arm cluster-randomised wait-list control trial (n = 282: intervention (INT) n = 196 and wait-list control (WLC) n = 86). Eligible clusters were two sites of a major organisation in China randomly allocated to each group (INT: Guangzhou; WLC: Beijing); eligible participants were site employees (n = 690). A theoretically informed digital workplace intervention (Move-It) involving a 10 min Qigong exercise session (video demonstration via website) was delivered twice a day at set break times during the working day for 12 consecutive weeks. Individual-level outcomes were assessed. Participants' physical activity increased significantly from baseline to post-intervention similarly in both the intervention and the control group. There was a significantly smaller increase in weekday sitting hours in intervention than controls (by 4.66 h/week), and work performance increased only in the control group. Process evaluation (including six focus groups) was conducted using the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework. The intervention had wide reach and was successfully marketed to all employees with good uptake. The participatory approach increased perceived organisational support and enhanced adoption. The intervention was implemented broadly as planned. Qigong worksite exercise intervention can be successfully delivered to sedentary office workers in China using video and web-based platforms. It may increase physical activity and does not adversely affect perceived work performance. The study highlights the complexity of conducting health promotion research in real-world organisational settings.

UK Postal Delivery Workers' Occupational Sun Safety: Using Behavior Change Theories to Identify Intervention Pathways.

Postal delivery workers have substantial sun exposure. In the United Kingdom (UK) a high proportion of workers possesses a sun sensitive skin type. This population is at elevated risk for skin cancer, yet uptake of sun safety practices is low. Studies are needed to identify the underlying factors that contribute to the uptake of occupational sun safety practices that may be targeted during behavior change interventions. This study integrated the Theory of Planned Behavior (TPB) and the Transtheoretical Model's stages of change (SoC) as guiding frameworks to identify underlying beliefs that influence UK postal delivery workers' uptake of occupational sun safety practices. Thirty-four workers participated in semi-structured interviews that used the SoC to establish current receptiveness to and adoption of two sun safety practices (using sunscreen of at least sun protection factor (SPF) 30 on exposed skin and wearing a wide-brimmed hat when working outdoors in the summer). Beliefs underlying current practices were elicited in accordance with the TPB and stratified by the SoC. For sunscreen use and wearing a wide-brimmed hat, 64% and 3% of participants were in the action or maintenance SoC, respectively. Behavioral and control beliefs differed by SoC, with those in the earlier stages more likely than those in the latter stages to report negative attitudes to, and difficulty enacting, sun safety practices. Normative beliefs concerning the views of colleagues and employers towards sunscreen were relatively consistent across the SoC. This study highlights the need for tailored and targeted behavior change interventions. The SoC-stratified accounts of the influence of TPB components on behavior provide a basis for bespoke interventions that reflect inter-individual and inter-practice differences in their working mechanisms.

What Does a Single-Item Measure of Job Stressfulness Assess?

Single-item measures of global job stressfulness are increasingly used in occupational health research, yet their construct validity remains unexplored. This study used a qualitative approach to identify frames of reference that underlie self-ratings on such a measure. Data were collected from a convenience sample of 55 adults in full-time employment who completed a single-item measure inviting a rating of the extent to which their job is generally stressful. A cognitive interview schedule was used to explore the factors taken into account when providing a global rating, with thematic analysis applied to identify themes in the interview transcripts. The most common frames of reference were the presence of problematic psychosocial working conditions, particularly job demands. Health characteristics, predominantly poor psychological wellbeing, emerged as a further less dominant secondary theme. Almost half the sample cited four or more referents. In terms of the timeframe under consideration, most participants referred to a long timeframe such as their work in general, with some specifying their current job and, a few, recent weeks. These findings shed light on the frames of reference used to inform judgements on global job stressfulness elicited by a single-item measure and in doing so contribute to the evidence base to support the application of such measures in occupational health research and organisational psychosocial risk management activities.

Effort-Reward Imbalance and Heavy Alcohol Consumption Among Humanitarian Aid Workers.

OBJECTIVE: The purpose of the study was to explore the prevalence of heavy alcohol consumption and its association with stress-related working conditions-defined in terms of effort-reward imbalance (ERI)-among a large sample of humanitarian aid workers operating across four continents. Research has shown employee alcohol consumption has potential detrimental implications for health and work outcomes and is associated with exposure to work stressors. Research to identify links between stressful aspects of work and heavy alcohol consumption among humanitarian aid workers could usefully inform the design of sector-specific interventions concerned with the reduction of alcohol consumption. METHOD: Questionnaire data were obtained from 1,063 women and 917 men working in an international humanitarian agency. Logistic regression analyses were conducted separately for men and women (with different cutoff points to identify heavy drinking) to investigate the relationship between ERI and the risk of heavy alcohol consumption while controlling for a host of sociodemographic and occupational variables. RESULTS: The prevalence of heavy alcohol consumption among women (18%) was higher than the corresponding rate for men (10%). Results lent support for the effort-reward perspective among women only: intermediate and high ERI in women was associated with a tripling of risk for heavy alcohol consumption. CONCLUSIONS: Interventions to reduce ERI among female humanitarian aid workers might help to reduce heavy drinking within this population.

Psychosocial risk assessment in organizations: Concurrent validity of the brief version of the Management Standards Indicator Tool.

The Management Standards Indicator Tool (MSIT) is a 35-item self-report measure of the psychosocial work environment designed to assist organizations with psychosocial risk assessment. It is also used in work environment research. Edwards and Webster presented a 25-item version of the MSIT based on the deletion of items having a factor loading of < .65. Stress theory and research suggest that psychosocial hazard exposures may result in harm to the health of workers. Thus, using data collected from three UK organizations (N = 20,406) we compared the concurrent validity of the brief and full versions of the MSIT by exploring the strength of association between each version of the instrument and a measure of psychological wellbeing (GHQ-12 and Maslach Burnout Inventory). Analyses revealed that the brief instrument offered similar but not always equal validity to that of the full version. The results indicate that use of the brief instrument, which would be less disruptive for employees, would not elevate the risk of false negative or false positive findings in risk assessment.