Learning from Health Care Counselors' Perspectives on Health Care Worker Distress: A Qualitative Analysis.

Background: Health care provider stress and emotional distress were well documented long before the COVID-19 pandemic, and there is growing data suggesting these have increased in response to the pandemic. The goal of this study was to take advantage of the unique experiences of licensed mental health (MH) clinicians working with health care trainees and clinicians before and during the pandemic to identify how this crisis affected both ongoing as well as new sources of stress. The Healer Education, Assessment and Referral Program (HEAR) provides MH screening, support, and MH referrals to ~19 000 health care students, trainees, staff, and faculty. Since its inception in 2009, the program has been staffed by 4 licensed counseling professionals who have worked both before and since the COVID-19 pandemic. Methods: Qualitative data obtained from semi-structured, 1-hour interviews and a follow-up 1-hour focus group with 4 HEAR counselors was analyzed using reflexive thematic analysis. Results: Several preexisting stressors were amplified during the pandemic: financial concerns; long work hours; exposure to the suffering of illness, death, and dying; bullying; discordant values and moral distress; social inequities; individuals' lack of adaptive coping; and individuals' self-concept as a victim. New stressors included: health care demand greater than the workforce numbers and resources; caretaking for ill family/friends; homeschooling of children; social isolation; experiencing the COVID-19 crisis as a war, fire, or storm; fear of personal illness and death, especially before vaccines; and hopes of a cure with vaccines; followed by perceived opportunities for improvement in leadership response to staff concerns. Conclusion: Authentically responding to staff concerns/ideas, a patient and provider-centered health care culture, grief education and support, and attention to actionable stressors affecting providers' well-being are indicated to meet the amplified and new stressors triggered by the COVID-19 pandemic and sequelae.

The Association of Psychotherapy With Burnout, Depression, and Measures of Well-Being in Residents and Fellows: A Pilot Study.

PURPOSE: Resident physicians experience high rates of burnout and depression but rarely prioritize their well-being or seek mental health care. The Accreditation Council for Graduate Medical Education mandated that training programs prioritize resident wellness and emotional and mental health to ensure readily available and accessible mental health care. To help meet that requirement and circumvent barriers to accessing care, the University of California San Diego Healer Education Assessment & Referral (HEAR) Program offers residents and fellows short-term therapy for coping with challenges that threaten their well-being. This report describes the results of a pilot study designed to evaluate the feasibility and effectiveness of the HEAR Program's resident therapy program. METHOD: The cohort included residents and fellows who completed at least 1 postbaseline assessment from January to May 2022. Measures of fulfillment, burnout, self-compassion, quality of life, depression, and suicidal ideation were assessed and compared before and up to 12 weeks after enrollment. RESULTS: Of the 39 residents who consented to participation, 30 completed at least 1 postbaseline assessment. Most outcomes improved after therapy, with significant increases in fulfillment (mean [SE] coefficient, 0.24 [0.08]; z score, 2.86; P = .004), self-compassion (mean [SE] coefficient, 0.37 [0.07]; z score, 5.72; P < .001), and quality of life ( P < .001) and significant reductions in burnout (Stanford burnout scale: mean [SE] coefficient, -0.27 [0.07]; z score, -4.01; P < .001; single-item burnout scale: mean [SE] coefficient, -0.34 [0.08]; z score, -4.37; P < .001) and depression severity (mean [SE] coefficient, -1.08 [0.25]; z score, -4.36; P < .001). CONCLUSIONS: This pilot study noted improvements in fulfillment, compassion, quality of life, and function, as well as reductions in burnout and depression severity, among resident physicians. Future studies in larger cohorts are needed to validate these findings and inform further optimization of this program.

Pedestrian crash frequency: Unpacking the effects of contributing factors and racial disparities.

In this paper, we unpack the magnitude effects of the determinants of pedestrian crashes using a multivariate analysis approach. We consider four sets of exogenous factors that characterize residential neighborhoods as well as potentially affect pedestrian crashes and the racial composition of such crashes: (1) crash risk exposure (CE) attributes, (2) cultural variables, (3) built environment (BE) features, and (4) sociodemographic (SD) factors. Our investigation uses pedestrian crash and related data from the City of Houston, Texas, which we analyze at the spatial Census Block Group (CBG) level. Our results indicate that social resistance considerations (that is, minorities resisting norms as they are perceived as being set by the majority group), density of transit stops, and road design considerations (in particular in and around areas with high land-use diversity) are the three strongest determinants of pedestrian crashes, particularly in CBGs with a majority of the resident population being Black. The findings of this study can enable policymakers and planners to develop more effective countermeasures and interventions to contain the growing number of pedestrian crashes in recent years, as well as racial disparities in pedestrian crashes. Importantly, transportation safety engineers need to work with social scientists and engage with community leaders to build trust before leaping into implementing planning countermeasures and interventions. Issues of social resistance, in particular, need to be kept in mind.

Thematic analysis and natural language processing of job-related problems prior to physician suicide in 2003-2018.

INTRODUCTION: Although previous studies have consistently demonstrated that physicians are more likely than non-physicians to experience work-related stressors prior to suicide, the specific nature of these stressors remains unknown. The current study aimed to better characterize job-related problems prior to physician suicide. METHODS: The study utilized a mixed methods approach combining thematic analysis and natural language processing to develop themes representing death investigation narratives of 200 physician suicides with implicated job problems in the National Violent Death Reporting System database between 2003 and 2018. RESULTS: Through thematic analysis, six overarching themes were identified: incapacity to work due to deterioration of physical health, substance use jeopardizing employment, interaction between mental health and work-related issues, relationship conflict affecting work, legal problems leading to work-related stress, and increased financial stress. Natural language processing analysis confirmed five of these themes and elucidated important subthemes. CONCLUSIONS: This is the first known study that integrated thematic analysis and natural language processing to characterize work-related stressors preceding physician suicide. The findings highlight the importance of bolstering systemic support for physicians experiencing job problems associated with their physical and mental health, substance use, relationships, legal matters, and finances in suicide prevention efforts.

A análise time line da Escala de Avaliação Comportamental Neonatal de Brazelton em bebês a termo e prematuros / Time line analysis of the neonatal behavioral assessment scale in term and preterm infants

Desenvolve o sistema de análise time line para descrever e quantificar a seqüência temporal da Escala de Avaliação Comportamental Neonatal de Brazelton (NBAS). Verificar a forma como a NBAS é administrada pelo examinador, os manejos requeridos pelos bebês e os seus efeitos nos escore do desempenho. Os Ss são 73 bebês a termo saudáveis e bebês prematuros divididos em: saudáveis (N=46), doentes (N=75), neurológicos (N=28) e pequenos para a idade gestacional (N=45), nascidos em um hospital de Providence, EUA. Examina os bebês a termo na 40 e 44 semanas de idade gestacional e os bebês pré-termos na 36, 40 e 44 semanas com idade corrigida para prematuridade. Administra a NBAS no decorrer do registro de atividades cárdio-respiratórias (ECG) e do choro, utilizando gravações em vídeo cassete acoplado a computador. A análise dos dados mostra as diferenças de desempenho e escore na NBAS entre os bebês a termo e os prematuros. Os bebês neurológicos apresentam desorganização relativa à atenção social, ao desempenho motor e reflexos, seguidos pelos pré-termos doentes e os pequenos para a idade gestacional. Através da aplicação da ANOVA verifica o efeito Tempo e a interação Grupo/Tempo, observando mudanças com o passar do tempo. Encontra correlações entre o time line e os escores da NBAS, constatando que a análise permite detectar sutilezas no desempenho de bebês prematuros durante a avaliação NBAS (AU)

Identificação, descrição e análise da situação de alimentação de bebês com fissuras labio-palatais, através da observação dos comportamentos das atendentes de um hospital de reabilitação de lesões labio-palatais

Estuda os comportamentos de atendentes do Hospital de Pesquisa e Reabilitação de Lesões Labio-Palatais da USP, em situação de rotina alimentar, através da observação direta. São Ss 20 atendentes dos períodos da manhã, da tarde, da noite, e 27 bebês internados no berç rio do hospital. As etapas que fazem parte do trabalho são: observação de comportamento através de vídeo-tape; treinamento de observadores; consulta às atendentes e registro através de categorias comportamentais. As observações ocorrem durante o horário de refeição dos bebês e registram a posição que a atendente alimenta o bebê, o manuseio do instrumento bico/colher, a quantidade de alimento ingerido, o tempo de duração da alimentação; a presença ou ausência de restrição dos membros superiores; incidentes durante ou após a alimentação, como escape nasal, engasgo, regorgito e vômito. Os resultados evidenciam que as atendentes adotam, preferencialmente, posições pouco inclinadas para alimentar os bebês, assim como fazem mais uso da sequência de apoiar a colher no labio inferior, “despejar” a comida na boca e passar a colher em movimento semi-circular para retirar o excesso de alimento da boca do bebê. Mostram também que o tempo médio de duração de cada alimentação é muito inferior ao reportado em literatura, e que, freqüentemente, as atendentes alimentam o bebê com restrição nos 2 membros superiores. Verifica que as atendentes são capazes de identificar problemas na situação de trabalho e que consideram a situação de alimentação como mais uma das rotinas a cumprir no hospital. Observa que há necessidade de se oferecer um treinamento às atendentes, para melhor adequa -las a esta importante tarefa para o desenvolvimento e a saúde dos bebês (AU)