Effectiveness and feasibility of a mindful leadership course for medical specialists: a pilot study

BACKGROUND

Medical specialists experience high levels of stress. This has an impact on their well-being, but also on quality of their leadership. In the current mixed method study, the feasibility and effectiveness of a course Mindful Leadership on burnout, well-being and leadership skills of medical specialists were evaluated.

METHODS

This is a non-randomized controlled pre-post evaluation using self-report questionnaires administered at 3 months before (control period), start and end of the training (intervention period). Burn-out symptoms, well-being and leadership skills were assessed with self-report questionnaires. Semi-structured interviews were used to qualitatively evaluate barriers and facilitators for completion of the course.

RESULTS

From September 2014 to June 2016, 52 medical specialists participated in the study. Of these, 48 (92%) completed the course. Compared to the control period, the intervention period resulted in greater reductions of depersonalization (mean difference = - 1.2, p = 0.06), worry (mean difference = - 4.3, p = 0.04) and negative work-home interference (mean difference = - 0.2, p = 0.03), and greater improvements of mindfulness (mean difference = 0.5, p = 0.04), life satisfaction (mean difference = 0.4, p = 0.01) and self-reported ethical leadership (mean difference = 0.1, p = 0.02). Effect sizes were generally small to medium (0.3 to 0.6) and large for life satisfaction (0.8). Appreciation of course elements was a major facilitator and the difficulty of finding time a major barrier for participating.

CONCLUSIONS

A 'Mindful Leadership' course was feasible and not only effective in reducing burnout symptoms and improving well-being, but also appeared to have potential for improving leadership skills. Mindful leadership courses could be a valuable part of ongoing professional development programs for medical specialists.

Male hormonal contraception: a double-blind, placebo-controlled study

BACKGROUND

This study was performed to assess spermatogenesis suppression and safety of a new combination of an etonogestrel (ENG) implant combined with testosterone undecanoate (TU) injections for male contraception. This is the first large placebo-controlled study for male hormonal contraception.

DESIGN AND STUDY SUBJECTS

In this double-blind, multicenter study, we randomly assigned 354 healthy men to receive either a low- or high-release ENG implant sc combined with im TU injections (750 mg every 10 or 12 wk or 1000 mg every 12 wk) or placebo implant and injections. Treatment duration was 42 or 44 wk and posttreatment follow-up at least 24 wk.

RESULTS

Overall, spermatogenesis was suppressed to 1 million/ml or less at wk 16 in 89% of men, with approximately 94% in two high-release ENG groups. Suppression was maintained up to the end of the treatment period in 91% of men. For all men who completed the treatment period, 3% never achieved 1 million/ml or less. Median recovery time to a sperm concentration above 20 million/ml was 15 wk (mean 17 wk, 95% confidence interval 16-18 wk). Treatment was well tolerated. As compared with the placebo group, more men in the active treatment groups reported adverse events such as weight gain, mood changes, acne, sweating, or libido change. For both spermatogenesis suppression and safety, differences were small between the active treatment groups.

CONCLUSIONS

The combination of an ENG implant with TU injections is a well-tolerated male hormonal method, providing effective and reversible suppression of spermatogenesis. Although the results are good, there is still room for improvement, possibly by adjusting the dose regimen or changing the mode of application.

Determinants of the rate and extent of spermatogenic suppression during hormonal male contraception: an integrated analysis

CONTEXT

Male hormonal contraceptive methods require effective suppression of sperm output.

OBJECTIVE

The objective of the study was to define the covariables that influence the rate and extent of suppression of spermatogenesis to a level shown in previous World Health Organization-sponsored studies to be sufficient for contraceptive purposes (< or =1 million/ml).

DESIGN

This was an integrated analysis of all published male hormonal contraceptive studies of at least 3 months' treatment duration.

SETTING

Deidentified individual subject data were provided by investigators of 30 studies published between 1990 and 2006.

PARTICIPANTS

A total of 1756 healthy men (by physical, blood, and semen exam) aged 18-51 yr of predominantly Caucasian (two thirds) or Asian (one third) descent were studied. This represents about 85% of all the published data.

INTERVENTION(S)

Men were treated with different preparations of testosterone, with or without various progestins.

MAIN OUTCOME MEASURE

Semen analysis was the main measure.

RESULTS

Progestin coadministration increased both the rate and extent of suppression. Caucasian men suppressed sperm output faster initially but ultimately to a less complete extent than did non-Caucasians. Younger age and lower initial blood testosterone or sperm concentration were also associated with faster suppression, but the independent effect sizes for age and baseline testicular function were relatively small.

CONCLUSION

Male hormonal contraceptives can be practically applied to a wide range of men but require coadministration of an androgen with a second agent (i.e. progestin) for earlier and more complete suppression of sperm output. Whereas considerable progress has been made toward defining clinically effective combinations, further optimization of androgen-progestin treatment regimens is still required.

Feasibility study for the centralized measurement of sperm concentration

Despite several efforts to standardize methods of semen analysis, sperm count is known to be subject to large interlaboratory differences. This is especially a problem in multicentre clinical trial settings and protocols for the preparation of semen for centralized assessment of sperm concentration are suggested here. The stability of semen has been tested after fixation with formalin at different dilutions and at different temperatures for different sperm concentrations. Sperm concentrations in formalin-fixed semen (at dilutions 1 + 0.5 to 1 + 19) were stable (<20% difference from original) at all concentrations (0.1 x 10(6)/mL to 100 x 10(6)/mL) for at least 5 days at room temperature and 4 degrees C. Prolonged stability up to 5 weeks at 4 degrees C was demonstrated for the lower dilutions (1 + 0.5 and 1 + 1). Freezing of fixed semen samples was unacceptable. These results illustrate that centralized assessment of sperm concentrations is feasible.

A multicentre study investigating subcutaneous etonogestrel implants with injectable testosterone decanoate as a potential long-acting male contraceptive

BACKGROUND

The combination of etonogestrel implants with injectable testosterone decanoate was investigated as a potential male contraceptive.

METHODS

One hundred and thirty subjects were randomly assigned to three treatment groups, all receiving two etonogestrel rods (204 mg etonogestrel) and 400 mg testosterone decanoate either every 4 weeks (group I, n = 42), or every 6 weeks (group II, n = 51) or 600 mg testosterone decanoate every 6 weeks (group III, n = 37) for a treatment period of 48 weeks.

RESULTS

One hundred and ten men completed 48 weeks of treatment. Sperm concentrations of <1 x 10(6)/ml were achieved in 90% (group I), 82% (group II) and 89% (group III) of subjects by week 24. Suppression was slower in group II, which also demonstrated more frequent escape from gonadotrophin suppression than groups I and III. Peak testosterone concentrations remained in the normal range throughout in all groups. Mean trough testosterone concentrations were initially subphysiological but increased into the normal range during treatment. Mean haemoglobin levels increased in group I, and a non-significant increase in weight and decline in high-density lipoprotein cholesterol was observed in all groups. Fourteen subjects discontinued treatment due to adverse events.

CONCLUSIONS

Subcutaneous etonogestrel implants in combination with injectable testosterone decanoate resulted in profound suppression of spermatogenesis that could be maintained for up to 1 year. Efficacy of suppression was less in group II, probably due to inadequate testosterone dosage. This combination has potential as a long-acting male hormonal contraceptive.

A multicenter phase IIb study of a novel combination of intramuscular androgen (testosterone decanoate) and oral progestogen (etonogestrel) for male hormonal contraception

The effect of a novel combination of oral etonogestrel (ENG) and im testosterone decanoate (TD) on suppression of gonadotropins and spermatogenesis as a potential lead for male contraception was investigated. Healthy male volunteers were randomized into two groups receiving 300 microg ENG daily and 400 mg TD every 4 (n = 55) or 6 (n = 57) wk for 48 wk. At wk 48, all men except one in the 6-wk group suppressed sperm concentration to less than 1 million/ml. Faster suppression occurred in the 4-wk group. Gonadotropins were suppressed in both groups and most consistently in the 4-wk group. During treatment, trough testosterone levels increased into the normal range in the 4-wk group but remained just below normal in the 6-wk group. All peak levels were within the normal range. After treatment cessation, recovery of sperm counts and gonadotropins to normal levels occurred in both groups. Minor effects on weight and cholesterol were noted. Fourteen subjects withdrew because of an adverse event with those possibly related to the study medication reported more frequently in the 6-wk group (nine vs. one). In conclusion, the combination of 300 microg ENG with 400 mg TD every 4 wk was superior in terms of efficacy, hormone profiles, and safety. This represents a promising approach to male hormonal contraception.

Assessment of exposure to solvents among hairdressers: reliability of a classification scheme and questionnaire

OBJECTIVES

To assess the reliability of a classification scheme and interview questions to be used for retrospective expose assessment in a study on reproductive disorders among hairdressers. Based on the presence of an air cleaning device (yes or no) and setting waves (yes or no), this scheme divides hairdressers into groups with potentially high and low exposure to solvents. The reliability of this and other schemes was assessed. Also; the reliability of self reports on other job characteristics was evaluated.

METHODS

The monitored hairdressers were interviewed one or two years after measurements were performed. Based on the interview information, hairdressers were classified into exposure groups according to the original and other classification schemes. Measured ethanol concentrations were compared between the classified exposure groups. Furthermore, the interview answers were compared with the registered information one to two years ago.

RESULTS

Using self reports, the original scheme resulted in mean ethanol concentrations (used as indicator variable) of 11.8 and 7.4 mg/m3 for the high and low exposure groups, respectively. The resolution was slightly less than for the original classification based on observations (15.0 and 7.1 mg/m3). Surprisingly, the self reported presence of any ventilation device resulted in more contrast in mean exposure concentration between the groups (17.4 and 7.5 mg/m3, respectively). Hairdressers reported validly on salon characteristics such as the type of salon, the number of hairdressers that worked in the salon, and the presence of ventilation devices, but could not make a distinction between different kinds of ventilation devices. The numbers of customers and tasks performed were largely overreported, but most variables correlated significantly with the information registered during the measurements.

CONCLUSION

The self reported presence of any ventilation device is most predictive for the level of exposure to ethanol in the hairdressing salon. Questionnaire data on work characteristics should be treated with caution.

Reproductive disorders among hairdressers

To evaluate whether hairdressers have an increased risk of reproductive disorders, we conducted a historical cohort study in the Netherlands. Because exposure to reproduction toxic agents in hair salons may have changed over time, we studied two specific periods: conceptions in 1986-1988 and in 1991-1993. We ascertained 9,000 hairdressers and, as a comparison group, 9,000 clothing salesclerks from their respective trade associations. All were of reproductive age in the defined study periods. Frequency matching on 5-year age groups ensured comparability with regard to age. All women were approached by mail to complete a short, self-administered questionnaire on reproductive history, including questions on time-to-pregnancy, spontaneous abortion, livebirths, and congenital malformations. In the analyses, we used random effect models to account for correlated outcomes (multiple pregnancies per woman). The results show that hairdressers who conceived in 1986-1988 had an increased risk of prolonged time-to-pregnancy of more than 12 months [odds ratio (OR) = 1.5; 95% confidence interval (CI) = 0.8-1.6], spontaneous abortion (OR = 1.6; 95% CI = 1.0-2.4), and a low-birthweight infant (OR = 1.5; 95% CI = 0.7-3.1). In both periods, more major malformations occurred among children of hairdressers, but numbers were small. These results indicate an increase in reproductive risks for hairdressers in earlier years that now seems to be disappearing.

Neurodevelopment in offspring of hairdressers

The hypothesis that intrauterine exposure to hairdressers' chemicals adversely affects neurodevelopment of the offspring was investigated. Neurodevelopmental characteristics were analysed using a historical cohort study of reproductive disorders among hairdressers in The Netherlands. Because exposure in hair salons to agents toxic to reproductive processes might have changed over time, two specific study periods were examined: from 1986 to 1988 and from 1991 to 1993. Nine thousand hairdressers and 9000 clothing sales clerks (referent group) who were in the reproductive age in the defined study periods were selected by the trade association for service jobs. Frequency matching assured comparability with regard to age. All women were invited by mail to complete a short self-administered questionnaire on their reproductive history, including questions on the ages of their child at the times of the first words, first sentences, and first steps, and the occurrence of seizures during fever. The results showed that in 1986 to 1988 more children of hairdressers started speaking their first words after 15 months and their first sentences after 24 months. For 1991 to 1993 no increased risks of these outcomes were found. Seizures during fever had occurred more often among children of hairdressers in 1986 to 1988, and in 1991 to 1993, especially when women had been working until maternity leave. Although the quality of the data in this explorative study requires careful interpretation, the consistent results seem to indicate adverse effects on neurodevelopment among offspring of hairdressers in the earlier years (1986 to 1988). In the later years the effect seemed to be disappearing. However, these findings should be confirmed in more detailed studies.

Reproductive disorders due to chemical exposure among hairdressers

The evidence for reproductive disorders due to chemical exposure among hairdressers was evaluated. To this end, a literature study was conducted on Medline for the years 1985-1993. Reproductive disorders in humans were described for solvents such as ethanol and dichloromethane found mainly in hair sprays. Reproductive effects of several dye formulations, ethylene glycol ethers, nitrosamines, formaldehyde, hexachlorophene, and phthalic esters cannot be excluded, but few human data on low concentrations of these agents were available. Associations with menstrual disorders and spontaneous abortions were found in epidemiologic studies focused on hairdressers. Other studies showed inconsistent results, probably due to methodological shortcomings (misclassification of exposure, small sample sizes). It is concluded that there is little evidence for reproductive disorders among hairdressers to date. Limited availability of human data and unknown effects of chemical mixtures call for future research focused on human reproductive risks among hairdressers with emphasis on exposure assessment in the hairdressing salon.

Menstrual disorders and month of birth

Menstrual characteristics in a population of 23,227 women who participated in a breast cancer screening programme were considered with respect to month of birth. High and low risk months of birth were defined according to the seasonal preovulatory overripeness ovopathy (SPrOO) hypothesis. Positive associations were found in 11 out of the 14 relations studied. The results were significant for early menarche (< or = 11 years), long menstrual cycles (> or = 5 weeks), menorrhagia (> or = 7 days and profuse blood loss), and early (< or = 40 years) or late (> or = 56 years) menopause. The results not only confirm the birth excess of these women in specific months, as has been found by others. They apparently agree with the SPrOO hypothesis and with a transgenerational concept of familial subfecundability along matrilineal lines and hence, familial clustering of pathological progeny, independent of Mendelian rules.

[Menstruation pattern and month of birth]

By using the Nijmegen data base on breast cancer we attempted to determine whether a relationship exists between menstrual pattern and month of birth and if so, if its agreed with the hypothesis of Seasonal Preovulatory Overripening Ovopathy (SPrOO). On the basis of the birth curve of women who participated in the Nijmegen breast cancer screening programme (1975) risk months for SPrOO and reference months were defined. We found that more women born in a risk month had an early menarche (< or = 11 years), a long menstrual cycle (> or = 5 weeks; QI: 20-25 kg/m2), menorrhagia, and an early (35-40 years) or late (> or = 56 years) menopause age. This relationship was in line with the predictions according to the SPrOO hypothesis. In all, a positive (but not always significant) relationship appeared to exist in 12 of the 15 associations studied. We conclude that there is a relationship between menstrual pattern and month of birth, which can be explained by the SPrOO hypothesis.