Association Between Physical Activity and the Risk of Burnout in Health Care Workers: Systematic Review

BACKGROUND

Burnout is a multidimensional psychological syndrome that arises from chronic workplace stress. Health care workers (HCWs), who operate in physically and emotionally exhausting work contexts, constitute a vulnerable group. This, coupled with its subsequent impact on patients and public economic resources, makes burnout a significant public health concern. Various self-care practices have been suggested to have a positive effect on burnout among HCWs. Of these, physical activity stands out for its ability to combine psychological, physiological, and biochemical mechanisms. In fact, it promotes psychological detachment from work and increases self-efficacy by inhibiting neurotransmitters and neuromodulators, increasing endorphin levels, enhancing mitochondrial function, and attenuating the hypothalamic pituitary-adrenal axis response to stress.

OBJECTIVE

Our objective was to conduct a systematic review of the evidence on the association between physical activity and burnout among HCWs.

METHODS

We considered HCWs, physical activity, and burnout, framing them as population, exposure, and outcome, respectively. We searched APA PsycArticles, MEDLINE, and Scopus until July 2022. We extracted relevant data on study design, methods to measure exposure and outcome, and statistical approaches.

RESULTS

Our analysis encompassed 21 independent studies. Although 10% (2/21) of the studies explicitly focused on physical activity, the remaining investigations were exploratory in nature and examined various predictors, including physical activity. The most commonly used questionnaire was the Maslach Burnout Inventory. Owing to the heterogeneity in definitions and cutoffs used, the reported prevalence of burnout varied widely, ranging from 7% to 83%. Heterogeneity was also observed in the measurement tools used to assess physical activity, with objective measures rarely used. In total, 14% (3/21) of the studies used structured questionnaires to assess different types of exercise, whereas most studies (18/21, 86%) only recorded the attainment of a benchmark or reported the frequency, intensity, or duration of exercise. The reported prevalence of physically active HCWs ranged from 44% to 87%. The analyses, through a variety of inferential approaches, indicated that physical activity is often associated with a reduced risk of burnout, particularly in the domains of emotional exhaustion and depersonalization. Furthermore, we compiled and classified a list of factors associated with burnout.

CONCLUSIONS

Our comprehensive overview of studies investigating the association between physical activity and burnout in HCWs revealed significant heterogeneity in definitions, measurements, and analyses adopted in the literature. To address this issue, it is crucial to adopt a clear definition of physical activity and make thoughtful choices regarding measurement tools and methodologies for data analysis. Our considerations regarding the measurement of burnout and the comprehensive list of associated factors have the potential to improve future studies aimed at informing decision-makers, thus laying the foundation for more effective management measures to address burnout.

Change in Descriptive Kinematic Parameters of Patients with Patellofemoral Instability When Compared to Individuals with Healthy Knees-A 3D MRI In Vivo Analysis

BACKGROUND

Patellofemoral instability (PFI) leads to chronic knee pain, reduced performance and chondromalacia patellae with consecutive osteoarthritis. Therefore, determining the exact patellofemoral contact mechanism, as well as the factors leading to PFI, is of great importance. The present study compares in vivo patellofemoral kinematic parameters and the contact mechanism of volunteers with healthy knees and patients with low flexion patellofemoral instability (PFI). The study was performed with a high-resolution dynamic MRI.

MATERIAL/METHODS

In a prospective cohort study, the patellar shift, patella rotation and the patellofemoral cartilage contact areas (CCA) of 17 patients with low flexion PFI were analyzed and compared with 17 healthy volunteers, matched via the TEA distance and sex, in unloaded and loaded conditions. MRI scans were carried out for 0°, 15° and 30° knee flexion in a custom-designed knee loading device. To suppress motion artifacts, motion correction was performed using a moiré phase tracking system with a tracking marker attached to the patella. The patellofemoral kinematic parameters and the CCA was calculated on the basis of semi-automated cartilage and bone segmentation and registrations.

RESULTS

Patients with low flexion PFI showed a significant reduction in patellofemoral CCA for 0° (unloaded: p = 0.002, loaded: p = 0.004), 15° (unloaded: p = 0.014, loaded: p = 0.001) and 30° (unloaded: p = 0.008; loaded: p = 0.001) flexion compared to healthy subjects. Additionally, patients with PFI revealed a significantly increased patellar shift when compared to volunteers with healthy knees at 0° (unloaded: p = 0.033; loaded: p = 0.031), 15° (unloaded: p = 0.025; loaded: p = 0.014) and 30° flexion (unloaded: p = 0.030; loaded: p = 0.034) There were no significant differences for patella rotation between patients with PFI and the volunteers, except when, under load at 0° flexion, PFI patients showed increased patellar rotation (p = 0.005. The influence of quadriceps activation on the patellofemoral CCA is reduced in patients with low flexion PFI.

CONCLUSION

Patients with PFI showed different patellofemoral kinematics at low flexion angles in both unloaded and loaded conditions compared to volunteers with healthy knees. Increased patellar shifts and decreased patellofemoral CCAs were observed in low flexion angles. The influence of the quadriceps muscle is diminished in patients with low flexion PFI. Therefore, the goal of patellofemoral stabilizing therapy should be to restore a physiologic contact mechanism and improve patellofemoral congruity for low flexion angles.

Association between Physical Fitness Index and Psychological Symptoms in Chinese Children and Adolescents

The aim of this study was to determine the relationship between different physical fitness indices (PFIs) and psychological symptoms and each dimension (emotional symptoms, behavioral symptoms, social adaptation difficulties) of Chinese children and adolescents. Methods: A total of 7199 children and adolescents aged 13−18 in Jiangxi Province, China, were tested for grip strength, standing long jump, sit-ups, sit and reach, repeated straddling, 50 m run, 20 m shuttle run test (20 m SRT) items. The physical fitness indicators were standardized, converted to Z score and added up to obtain the PFI, and the self-assessment of the psychological section of the multidimensional sub-health questionnaire of adolescents (MSQA) to test the psychological symptoms, using the chi-square test to determine the psychological symptoms of different types of children and adolescents and binary logistic regression analysis to determine the association between psychological symptoms and different PFI grades. Results: The higher the PFI of Chinese children and adolescents, the lower the detection rate of psychological symptoms, emotional symptoms and social adaptation difficulties, from 25.0% to 18.4%, 31.3% to 25.7% and 20.1% to 14.4%, respectively. These results were statistically significant (χ2 = 14.073, 9.332, 12.183, p < 0.05). Taking the high-grade PFI as a reference, binary logistic regression analysis was performed. Generally, compared with the high-grade PFI, children and adolescents with a low-grade PFI (OR = 1.476, 95% CI: 1.200−1.814) or medium-grade PFI (OR = 1.195, 95% CI: 1.010−1.413) had a higher risk of psychological symptoms (p < 0.05). Conclusions: The lower the PFI of Chinese children and adolescents, the higher the detection rate of psychological symptoms, showing a negative correlation. In the future, measures should be taken to improve the physical fitness level of children and adolescents in order to reduce the incidence of psychological symptoms and promote the healthy development of children and adolescents.

Examining the viewing pattern of Web-delivered personalized feedback interventions aimed at reducing alcohol-related risky sexual behavior among young adults

OBJECTIVE

The present study examined young adults' completion of the Web-based intervention content in a randomized trial that tested two Personalized Feedback Interventions (PFIs) for alcohol use and risky sex behavior (RSB).

METHOD

Data are from a study that evaluated efficacy of two Web-delivered PFIs (combined PFI and integrated PFI) among 269 sexually active young adults between the ages of 18 and 25. We described the view patterns of the Web-based intervention and examined if baseline sociodemographic and alcohol- and sex-related behavioral factors were associated with the completion of PFI.

RESULTS

Many participants viewed the intervention more than one time, and the majority finished all intervention pages in at least one session. Older participants and participants who drink more frequently prior to or during sex were more likely to complete.

CONCLUSIONS

Most participants, especially the young adults who were at higher risk, utilized the intervention contents as intended.

Extending the platinum-free interval: The impact of omitting 2nd line platinum chemotherapy in intermediate platinum-sensitive ovarian cancer

OBJECTIVES

Patients with epithelial ovarian cancer (EOC) recurring between 6 and 12 months after primary platinum chemotherapy have worse prognosis than those recurring in >12 months. Artificially prolonging the platinum-free interval (PFI) with cytotoxic chemotherapy was tested in MITO-8 with poor outcomes. This study aimed to determine the impact of using non-platinum or targeted therapy in 2nd line treatment of EOC patients recurring 6-12 months after completion of primary platinum-based chemotherapy.

METHODS

A multi-institutional retrospective review of 177 patients with recurrent EOC and PFI of 6-12 months following primary chemotherapy was performed comparing platinum versus non-platinum chemotherapy or targeted therapy for 2nd line treatment. PFI1 was defined as the date of last chemotherapy to date of recurrence. PFS2/3 were defined as start of 2nd or 3rd line chemotherapy to start of subsequent line.

RESULTS

Of 177 patients, the majority of patients were Caucasian, had serous histology, and underwent primary cytoreductive surgery. Median PFI1 was 8.2 months (95% CI 8-9 months). Second line platinum was omitted in 28% of patients. Bevacizumab was used in 2nd line in 16% of patients; 19% received other targeted therapies. Median PFS2 for platinum chemotherapy was longer than non-platinum (7.1 vs 3 months, p = 0.0114). Median PFS2 was significantly longer for platinum vs. targeted therapy (7.1 vs. 3 months p = 0.0431). Median OS for platinum in 2nd line vs. no platinum was 43.6 vs. 37.6 months (p = 0.0174).

CONCLUSIONS

Use of non-platinum chemotherapy and even targeted therapy to prolong PFI in patients with EOC recurring between 6 and 12 months leads to worse survival.

Effect of Paenibacillus cellulase pretreatment for fiber surface

Refining is the major process of paper formation. This study focuses on the impact of a specific enzyme (Paenibacillus cellulase) for fibers on the surfaces, the roughness and height of the fibers are also investigated. Effects of enzyme dosages and the mechanical refining action (PFI revolution) on fiber physical properties were also analyzed. The fibers were observed by scanning electron microscopy (SEM), their roughness and height were analyzed by Atomic force microscopy (AFM). Results show that the Paenibacillus cellulase pretreatment increased the drainability of both kinds of pulp at the same level of refining energy. In other words, enzymatic treatment on pulp refining consumed less refining revolutions to reach the same drainability compared to the untreated pulp. Although the viscosity of both kinds of pulp was degraded with the enzymatic treatment, the physical properties of paper had no significantly negative influence on them. The results indicated the treatment with cellulase swelled the fibers in the absence of refining, and there were better fibrillation on the fibers treated with cellulase after refining. Furthermore, the statistical analysis of AFM suggested that both kinds of pulp treated with low cellulase dosage with PFI refining had higher roughness.

In vitro experimental models for examining the skeletal muscle cell biology of exercise: the possibilities, challenges and future developments

Exercise provides a cornerstone in the prevention and treatment of several chronic diseases. The use of in vivo exercise models alone cannot fully establish the skeletal muscle-specific mechanisms involved in such health-promoting effects. As such, models that replicate exercise-like effects in vitro provide useful tools to allow investigations that are not otherwise possible in vivo. In this review, we provide an overview of experimental models currently used to induce exercise-like effects in skeletal muscle in vitro. In particular, the appropriateness of electrical pulse stimulation and several pharmacological compounds to resemble exercise, as well as important technical considerations, are addressed. Each model covered herein provides a useful tool to investigate different aspects of exercise with a level of abstraction not possible in vivo. That said, none of these models are perfect under all circumstances, and the choice of model (and terminology) used should be informed by the specific research question whilst accounting for the several inherent limitations of each model. Further work is required to develop and optimise the current experimental models used, such as combination with complementary techniques during treatment, and thereby improve their overall utility and impact within muscle biology research.

Perinephric and Sinus Fat Invasion in Stage pT3a Tumors Managed by Partial Nephrectomy

INTRODUCTION

We evaluated the influence of perinephric fat invasion (PFI) compared with sinus fat invasion (SFI) on disease-free survival (DFS) and cancer-specific survival (CSS) after partial nephrectomy (PN) for stage pT3a renal cell carcinoma (RCC).

MATERIALS AND METHODS

Data were recorded from the consecutive records of patients who had undergone underwent PN for cT1-T2 RCC from 2007 to 2016. Of these patients, 143 had stage pT3a with SFI or PFI found on final pathologic examination. The demographic, perioperative, and pathologic variables were reviewed. DFS and CSS analyses were performed. The factors predicting disease progression in this population were assessed.

RESULTS

After a median follow-up period of 28 months (range 15-41 months), 19 patients (13.3%) had developed recurrence, including 5 local and 14 distant metastases, with 11 cancer-specific deaths (7.7%). No differences were found in DFS (5 years, 60.9% vs. 55.3%; log-rank P = .7) or CSS (5 years, 81% vs. 74.2%; log-rank P = .8) between the SFI and PFI groups. For the pT3a fat invasion population, the 2- and 5-year DFS and CSS rates were 83.6% and 58.6% and 93.6% and 78%, respectively. SFI (P = .5) and positive surgical margins (P = .1) did not predict for progression. On multivariate Cox regression, increased tumor size (hazard ratio, 1.5; 95% confidence interval, 1.1-1.9; P < .01) and higher tumor grade (hazard ratio, 3.6; 95% confidence interval, 1.1-4.6; P = .04) were independent predictors of disease progression in the pT3a fat invasion population.

CONCLUSION

In our series of patients with pT3a RCC after PN, SFI compared with PFI was not associated with an increased risk of progression or cancer-specific death.