The Work-life Check-ins randomized controlled trial: A leader-based adaptive, semi-structured burnout intervention in primary care clinics.

BACKGROUND: Burnout in primary care undermines worker well-being and patient care. Many factors contribute to burnout, including high workloads, emotional stress, and unsupportive supervisors. Formative evidence suggests that burnout might be reduced if clinic leaders hold quarterly and brief (∼30 min) one-on-one check-ins with team members to acknowledge and address work-life stressors (e.g., schedules, workflow breakdowns, time off requests). This paper describes the intervention protocol for a randomized controlled trial (RCT) designed to evaluate the effectiveness and process of the check-ins in reducing burnout among primary care professionals. METHODS: Two-arm RCT conducted at 12 primary care clinics of a healthcare system in the Pacific Northwest. Six clinics received an adaptive design, semi-structured intervention, including predefined training modules with evidence-based tactics to reduce burnout through the check-ins, followed by clinic-specific feedback sessions prior to offering and conducting quarterly leader-employee check-ins. Six clinics were randomized as waitlist controls. Burnout was measured using the Maslach Burnout Inventory (MBI) at baseline and at the 12-month follow-up. Secondary outcomes include organizational constraints, psychological safety, and supervisor support. Multilevel modeling and qualitative methods were applied to evaluate the effects and process of the intervention. CONCLUSION: By focusing on modifiable work-life factors such as stressors and supervisor support, the check-ins intervention aims to reduce burnout rates among primary care professionals. Findings from this trial will shed light on the conditions upon which check-ins might reduce burnout. Results will also inform policies and interventions aimed at improving mental health and well-being in primary care settings. CLINICALTRIALS: gov: ID NCT05436548.

Safety Responsiveness and Psychological Distress Among Health Care Workers During COVID-19 (2020-2022) in the Pacific Northwest.

Objectives. The COVID-19 pandemic imposed unprecedented safety challenges on health care facilities. This study examined whether health care workers who deemed a better safety response to the pandemic by their units or employers experienced lower psychological distress. Methods. Patient care workers at a health care system in the Pacific Northwest were surveyed every 6 to 8 months from May 2020 to May 2022 (n = 3468). Psychological distress was measured with the Well-being Index (range: -2 to 7 points). Safety response was scored on the basis of participants' ratings (on a 1-5 scale) of equipment sufficiency and responsiveness to safety concerns by their health care system and unit. Results. Adjusted multilevel regressions showed an inverse association between safety responsiveness and psychological distress at the individual level (b = -0.54; 95% confidence interval [CI] = -0.67, -0.41) and the unit level (b = -0.73; 95% CI = -1.46, -0.01). The cross-level interaction was also statistically significant (b = -0.46; 95% CI = -0.87, -0.05). Conclusions. Health care workers who deemed a better response to safety challenges reported lower psychological distress. This study highlights the need for continued efforts to ensure adequate safety resources. (Am J Public Health. 2024;114(S2):S204-S212. https://doi.org/10.2105/AJPH.2024.307582).

Promise and Perils of Leader-Employee Check-ins in Reducing Emotional Exhaustion in Primary Care Clinics: Quasi-Experimental and Qualitative Evidence.

OBJECTIVE: To analyze the role of short (<30 minutes) and frequent (quarterly) check-ins between clinic leaders and employees in reducing emotional exhaustion. METHODS: Three interrelated studies were conducted: a 3-year repeated cross-sectional survey at 10 primary care clinics (n=505; we compared emotional exhaustion, perceived stress, and values alignment among employees of a clinic where check-ins were conducted vs 9 control clinics); interviews with leaders and employees (n=10) regarding the check-ins process and experiences; and interviews with leaders and employees (n=10) after replicating the check-ins at a new clinic. RESULTS: Outcomes were similar at baseline. After a year, emotional exhaustion was lower at the check-ins compared with control clinics (standardized mean difference, d, -0.71 [P<.05]). After 2 years, emotional exhaustion remained lower at the check-ins clinic, but this difference was not significant. The check-ins were associated with an increment in values alignment (2018 vs 2017, d=0.59 [P<.05]; 2019 vs 2017, d=0.76 [P<.05]). There were no differences for perceived job stress. Interviews indicated that work-life challenges were discussed in the check-ins. However, employees need confidentiality and to feel safe to do so. The replication suggested that the check-ins are feasible to implement even amid turbulent times. CONCLUSION: Periodic check-ins wherein leaders acknowledge and address work-life stressors might be a practical tactic to reduce emotional exhaustion in primary care clinics.

Interactions between home, work, and sleep among firefighters.

BACKGROUND: Firefighters endure large occupational burdens and generally operate under conditions of chronic sleep deficiency and circadian disruption due to long shifts, plus interrupted sleep due to emergency calls during the night. A typical shift for firefighters is 24-h on/48-h off, and firefighters are expected to use time-off to recover from any sleep debt, while balancing social, family, and home responsibilities. This qualitative study sets out to assess family dynamics and how firefighters prioritize sleep and recovery at home based on relationship or family status, as well as a fire department's current shift schedule. METHODS: Focus groups were conducted via convenience sampling in Portland, OR, with full-time firefighters, battalion chiefs, and their spouses. Grounded theory, using NVivo 12 Plus, was used to code transcripts to reveal reoccurring concepts and themes. RESULTS: Major themes centered around the increase of nonemergent calls contributing to compassion fatigue. Spouses can help improve the sleep of firefighters by creating opportunities for recuperative sleep at home. However, spouses also conveyed underlying tones of "resentment" relating to their firefighter being unavailable for emotional and instrumental support. While married firefighters discussed choosing family and home obligations over reducing sleep debt to maintain relationships, single and divorced firefighters spoke of fewer conflicts impeding their ability to prioritize sleep at home. CONCLUSIONS: These results improve our understanding of how firefighters prioritize sleep at home based on family dynamics and can inform future decision-making for fire departments in addressing concerns related to work-family conflict, sleep loss, and compassion fatigue among their members.

Use of Champions Identified by Social Network Analysis to Reduce Health Care Worker Patient-Assist Injuries.

BACKGROUND: Safe patient handling and mobility (SPHM) programs recommend having champions, but have not indicated how to identify them and have confined their role to peer-based activities, limiting their ability to influence control measures. METHODS: In a pilot program conducted at a community access hospital in Oregon, researchers applied social network analysis (SNA) of safety advice to identify champion candidates. Candidates were invited to complete mobility, communication, and quality improvement (QI) training modules to become champions. Champions' roles included peer-based instruction and participation in QI quarterly meetings with hospital leaders. The program process was evaluated through weekly e-mail check-ins and documentation of quarterly meetings. Outcomes were evaluated with a pre-post design, observing 12-month changes in self-reported leading indicators and Good Catch reports, as well as trends in patient-assist injuries (2011-2019). RESULTS: SNA identified six candidates, four of whom became champions. Champions completed 48 weekly logs. The quarterly meetings concerned unitwide SPHM training, equipment storage, and onboarding. Results showed significant improvements in equipment use, safety participation, and safety compliance, particularly among workers who would seek SPHM advice from champions or recently hired workers. Compared with the prior year, the Good Catch monthly entries increased from 11.69 to 28.81. The average annual incidence rate of patient-assist injuries dropped from 13.01 for the six years before the program to 3.7 per 100 full-time equivalents (FTE) for the two years after. CONCLUSION: A program with SNA-identified and QI-trained champions improved safety outcomes after one year. Better-designed evaluations are needed to establish the replicability and long-term impact of this program.

Employee Experiences with a Newly Adopted Paid Parental Leave Policy: Equity Considerations for Policy Implementation.

Purpose: Paid parental leave (PPL) policies offer immense opportunity to enhance health equity by providing financial stability to workers and promoting the health of families in the United States. Working in partnership with a local county government, which recently adopted a paid leave policy, we engaged in a qualitative substudy to enhance our understanding of how workers perceived and experienced the policy across levels of the socioecological framework. Methods: Working in partnership with Multnomah County, a large public-sector employer in Portland, OR that recently adopted a PPL policy, we collected qualitative data through focus groups with employees. Data were transcribed, coded, and analyzed thematically. Results: We conducted seven focus groups with county employees (N=35) in the fall of 2017. Three major themes emerged from the focus group data: intersectional inequities, disparities by department, and uneven benefits. Conclusions: Our findings highlight the inequities of experience with the PPL policy across employees at individual, organization, and environmental levels. These findings offer insight and guidance for entities considering the adoption and implementation of such policies to consider concrete steps to enhance equity of access and experience.

Caring for the elderly at work and home: Can a randomized organizational intervention improve psychological health?

Although job stress models suggest that changing the work social environment to increase job resources improves psychological health, many intervention studies have weak designs and overlook influences of family caregiving demands. We tested the effects of an organizational intervention designed to increase supervisor social support for work and nonwork roles, and job control in a results-oriented work environment on the stress and psychological distress of health care employees who care for the elderly, while simultaneously considering their own family caregiving responsibilities. Using a group-randomized organizational field trial with an intent-to-treat design, 420 caregivers in 15 intervention extended-care nursing facilities were compared with 511 caregivers in 15 control facilities at 4 measurement times: preintervention and 6, 12, and 18 months. There were no main intervention effects showing improvements in stress and psychological distress when comparing intervention with control sites. Moderation analyses indicate that the intervention was more effective in reducing stress and psychological distress for caregivers who were also caring for other family members off the job (those with elders and those "sandwiched" with both child and elder caregiving responsibilities) compared with employees without caregiving demands. These findings extend previous studies by showing that the effect of organizational interventions designed to increase job resources to improve psychological health varies according to differences in nonwork caregiving demands. This research suggests that caregivers, especially those with "double-duty" elder caregiving at home and work and "triple-duty" responsibilities, including child care, may benefit from interventions designed to increase work-nonwork social support and job control. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Social Network Analysis of peer-specific safety support and ergonomic behaviors: An application to safe patient handling.

This study applied Social Network Analysis (SNA) to test whether advice-seeking interactions among peers about safe patient handling correlate with a higher frequency of equipment use. Patient-care workers (n=38) at a community hospital in Oregon nominated peers they would consult for advice regarding safe patient handling. Results show a positive correlation between identifying more peers for safe patient handling advice and using equipment more frequently. Moreover, nurses with more reciprocal advice seeking nominations used safe patient handling equipment more frequently. However, employees who would be more consulted about safe patient handling by their peers did not use equipment more frequently than nurses with fewer nominations. Despite the small sample size, the magnitude of the adjusted regressions coefficients ranged between 3 to 4 standard deviations. These results suggest that having more or reciprocal sources of peer-based support may trigger ergonomic related behaviors such as frequent utilization of equipment.

Effects of a Flexibility/Support Intervention on Work Performance: Evidence From the Work, Family, and Health Network.

PURPOSE: To estimate the effects of a workplace initiative to reduce work-family conflict on employee performance. DESIGN: A group-randomized multisite controlled experimental study with longitudinal follow-up. SETTING: An information technology firm. PARTICIPANTS: Employees randomized to the intervention (n = 348) and control condition (n = 345). INTERVENTION: An intervention, "Start. Transform. Achieve. Results." to enhance employees' control over their work time, to increase supervisors' support for this change, and to increase employees' and supervisors' focus on results. METHODS: We estimated the effect of the intervention on 9 self-reported employee performance measures using a difference-in-differences approach with generalized linear mixed models. Performance measures included actual and expected hours worked, absenteeism, and presenteeism. RESULTS: This study found little evidence that an intervention targeting work-family conflict affected employee performance. The only significant effect of the intervention was an approximately 1-hour reduction in expected work hours. After Bonferroni correction, the intervention effect is marginally insignificant at 6 months and marginally significant at 12 and 18 months. CONCLUSION: The intervention reduced expected working time by 1 hour per week; effects on most other employee self-reported performance measures were statistically insignificant. When coupled with the other positive wellness and firm outcomes, this intervention may be useful for improving employee perceptions of increased access to personal time or personal wellness without sacrificing performance. The null effects on performance provide countervailing evidence to recent negative press on work-family and flex work initiatives.

Precarious schedules linked with workplace aggression in a high-risk occupation.

INTRODUCTION: Night work and prolonged work hours increase the risk for workplace aggression, however, the risk related to precarious schedules remains unknown. METHODS: Cross-sectional study among Parole Probation Officers (PPOs) (n = 35). A precarious schedules index was created including the following indicators (a) experiencing one or more unexpected shifts during the last 4 weeks; (b) having minimal control over work hours; and (c) shifts notifications of less than a week. Generalized Poisson Regressions estimated the association between precarious schedules and self-reported client-based aggressive incidents (verbal, threating, property, or physical) during the last 12 months. RESULTS: Workplace aggression was highly prevalent (94.3%). PPOs who experienced precarious schedules (74.3% prevalence) had an adjusted rate of workplace aggression 1.55 times greater than PPOs without precarious schedules (IRR = 1.55, 95% CI 1.25, 1.97, P < 0.001). CONCLUSIONS: Precarious schedules were associated with workplace aggression. Further research ought to examine whether improving schedule predictability may reduce client-based aggression.

Cost and Return on Investment of a Work-Family Intervention in the Extended Care Industry: Evidence From the Work, Family, and Health Network.

OBJECTIVE: To estimate the cost and return on investment (ROI) of an intervention targeting work-family conflict (WFC) in the extended care industry. METHODS: Costs to deliver the intervention during a group-randomized controlled trial were estimated, and data on organizational costs-presenteeism, health care costs, voluntary termination, and sick time-were collected from interviews and administrative data. Generalized linear models were used to estimate the intervention's impact on organizational costs. Combined, these results produced ROI estimates. A cluster-robust confidence interval (CI) was estimated around the ROI estimate. RESULTS: The per-participant cost of the intervention was $767. The ROI was -1.54 (95% CI: -4.31 to 2.18). The intervention was associated with a $668 reduction in health care costs (P < 0.05). CONCLUSIONS: This paper builds upon and expands prior ROI estimation methods to a new setting.

Nurses' but not supervisors' safety practices are linked with job satisfaction.

AIMS: To test the associations of safety practices as reported by nurses and their respective unit supervisors with job satisfaction. BACKGROUND: Psychosocial workplace factors are associated with job satisfaction; however, it is unknown whether nurses and supervisors accounts of safety practices are differentially linked to this outcome. METHODS: Cross-sectional study design including nurses (n = 1052) nested in 94 units in two hospitals in Boston (MA, USA). Safety practices refer to the identification and control of occupational hazards at the unit. Safety practices were measured aggregating nurses' responses per unit, and supervisory levels. Individual's job satisfaction for each nurse was the response variable. RESULTS: Supervisors assessed safety practices more favourably than their unit nursing staff. Adjusted random intercept logistic regressions showed that the odds of higher job satisfaction were higher for nurses at units with better safety practices (OR: 1.67, 95% CI: 1.04, 2.68) compared with nurses at units that averaged lower safety practices. Supervisors' reports of safety practices were not correlated with the job satisfaction of their staff. CONCLUSIONS: Adequate safety practices might be a relevant managerial role that enhances job satisfaction among nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing supervisors should calibrate their safety assessments with their nursing staff to improve nurses' job satisfaction.

The hidden costs of informal work: lack of social protection and subjective well-being in Colombia.

OBJECTIVES: To examine the association between informal work and subjective well-being in Colombia. METHODS: Repeated cross-sectional study based on data from three nationally representative surveys of 1997, 2005 and 2011 (n = 4485). Life satisfaction was measured with a Likert scale ranging from 1 to 10 points. Informal work was defined as paid work without pension/unemployment contributions. Individual-level pooled Generalized Estimating Equation (GEE) models were used to assess the association between informal work and life satisfaction. Propensity Score Matching (PSM) was applied to address potential selection into informal work. RESULTS: Informal work increased from 52 % in 1997 to 68 % in 2011. Informal workers averaged significantly lower life satisfaction than formal (GEE: b = -0.14, 95 % CI -0.26, -0.01, p < 0.05). These results were confirmed in PSM models that controlled for selection by measured confounders (PSM: b = -0.15, 95 % CI -0.23, -0.03, p < 0.05). CONCLUSIONS: Informal workers who are not covered by social security systems had lower subjective well-being than workers in the formal economy. Results suggest that recent increases in informal work may also translate into reduced subjective well-being.

Integrating worksite health protection and health promotion: A conceptual model for intervention and research.

There is increasing recognition of the value added by integrating traditionally separate efforts to protect and promote worker safety and health. This paper presents an innovative conceptual model to guide research on determinants of worker safety and health and to inform the design, implementation and evaluation of integrated approaches to promoting and protecting worker health. This model is rooted in multiple theories and the premise that the conditions of work are important determinants of individual safety and health outcomes and behaviors, and outcomes important to enterprises such as absence and turnover. Integrated policies, programs and practices simultaneously address multiple conditions of work, including the physical work environment and the organization of work (e.g., psychosocial factors, job tasks and demands). Findings from two recent studies conducted in Boston and Minnesota (2009-2015) illustrate the application of this model to guide social epidemiological research. This paper focuses particular attention on the relationships of the conditions of work to worker health-related behaviors, musculoskeletal symptoms, and occupational injury; and to the design of integrated interventions in response to specific settings and conditions of work of small and medium size manufacturing businesses, based on a systematic assessment of priorities, needs, and resources within an organization. This model provides an organizing framework for both research and practice by specifying the causal pathways through which work may influence health outcomes, and for designing and testing interventions to improve worker safety and health that are meaningful for workers and employers, and responsive to that setting's conditions of work.

Effects on cigarette consumption of a work-family supportive organisational intervention: 6-month results from the work, family and health network study.

BACKGROUND: Observational studies have linked work-family issues with cigarette consumption. This study examined the 6-month effects on cigarette consumption of a work-family supportive organisational intervention among nursing home workers. METHODS: Group randomised controlled trial where 30 nursing homes across New England states were randomly assigned to either usual practice or to a 4-month intervention aimed at reducing work-family conflict via increased schedule control and family supportive supervisory behaviours (FSSB). Cigarette consumption was based on self-reported number of cigarettes per week, measured at the individual level. RESULTS: A total of 1524 direct-care workers were enrolled in the trial. Cigarette consumption was prevalent in 30% of the sample, consuming an average of 77 cigarettes/week. Smokers at intervention sites reduced cigarette consumption by 7.12 cigarettes, while no reduction was observed among smokers at usual practice sites (b=-7.12, 95% CI -13.83 to -0.40, p<0.05) (d=-0.15). The majority of smokers were US-born White nursing assistants, and among this subgroup, the reduction in cigarette consumption was stronger (b=-12.77, 95% CI -22.31 to -3.22, p<0.05) (d=-0.27). Although the intervention prevented a decline in FSSB (d=0.08), effects on cigarette consumption were not mediated by FSSB. CONCLUSIONS: Cigarette consumption was reduced among smokers at organisations where a work-family supportive intervention was implemented. This effect, however, was not explained by specific targets of the intervention, but other psychosocial pathways related to the work-family interface. TRIAL REGISTRATION NUMBER: NCT02050204; results.

Obesity trends by industry of employment in the United States, 2004 to 2011.

BACKGROUND: Obesity is associated with increased morbidity, occupational injuries, and premature mortality. Obesity also disproportionately affects blacks and socioeconomically disadvantaged workers. However, few studies have evaluated national trends of obesity by employment industry overall and especially by race. METHODS: To investigate national trends of obesity by employment industry overall and by race, we estimated the age-standardized obesity prevalence from 2004 to 2011. We used direct age-standardization with the 2000 US Census population as the standard among 136,923 adults in the US National Health Interview Survey. We also estimated prevalence ratios (PRs) for obesity in black women and men compared to their white counterparts for each employment industry using adjusted Poisson regression models with robust variance. RESULTS: Obesity prevalence increased for men and women over the study period across all employment industry categories, and the healthcare industry had the highest overall age-standardized prevalence (30 %). Black women had a significantly higher obesity prevalence than white women across all employment industry categories, ranging from 33 % (95 % confidence interval (CI): 1.16,1.52) in Professional/Management to 74 % in Education (95 % CI: 1.56,1.93). Obesity prevalence was higher among black than white men for Healthcare (PR = 1.39 [1.15,1.69]), Education (PR = 1.39 [1.17,1.67]), Public Administration (PR = 1.34 [1.20,1.49]), and Manufacturing (PR = 1.19 [1.11,1.27]). Differences in obesity prevalence by race were generally widest in professional/management occupations. CONCLUSIONS: Obesity trends varied substantially overall as well as within and between race-gender groups across employment industries. These findings demonstrate the need for further investigation of racial and sociocultural disparities in the work-obesity relationship to employ strategies designed to address these disparities while improving health among all US workers. Further research and interventions among workers in industries with an increasing or high prevalence of obesity should be prioritized.

Schedule Control and Nursing Home Quality: Exploratory Evidence of a Psychosocial Predictor of Resident Care.

AIM: To examine whether nursing homes' quality of care was predicted by schedule control (workers' ability to decide work hours), independently of other staffing characteristics. METHOD: Prospective ecological study of 30 nursing homes in New England. Schedule control was self-reported via survey in 2011-2012 (N = 1,045). Quality measures included the prevalence of decline in activities of daily living, residents' weight loss, and pressure ulcers, indicators systematically linked with staffing characteristics. Outcomes data for 2012 were retrieved from Medicare.gov. RESULTS: Robust Linear Regressions showed that higher schedule control predicted lower prevalence of pressure ulcers (ß = -0.51, p < .05). This association was independent of staff mix, staffing ratios, job satisfaction, and turnover intentions. CONCLUSION: Higher schedule control might enhance the planning and delivery of strategies to prevent or cure pressure ulcers. Further research is needed to identify potential causal mechanisms by which schedule control could improve quality of care.

Supervisors' support for nurses' meal breaks and mental health.

Meal breaks promote occupational health and safety; however, less is known about supervisors' support for nurses' meal breaks. In this study, the researchers tested whether the frequency of meal breaks was positively related to supervisors' support of nurses' meal breaks, and whether more frequent meal breaks were associated with less psychological distress. This study is based on a cross-sectional survey of 1,595 hospital nurses working on 85 units supervised by nursing directors. Specific meal-break support was measured at the nursing director level; frequency of meal breaks and psychological distress were measured at the individual nurse level. Multilevel adjusted models showed a positive association between supervisors' support for meal breaks and the frequency of nurses' meal breaks (ß=.16, p<.001). Moreover, nurses who took meal breaks more frequently reported lower psychological distress (ß=-.09, p<.05). Meal breaks might be daily opportunities to promote mental health and fatigue recovery and provide downtime.

Occupational injury among hospital patient-care workers: what is the association with workplace verbal abuse?

OBJECTIVE: To test the association between workplace abuse exposure and injury risk among hospital workers. We hypothesized that exposed workers would have higher injury rates than unexposed workers. METHODS: Survey of direct-care workers (n = 1,497) in two hospitals. Exposure to workplace abuse was assessed through self-report; occupational injury reports were extracted from employee records. We tested associations between non-physical workplace violence and injury using log-binomial regression and multilevel modeling. RESULTS: Adjusted prevalence ratio (PR) for injury associated with being yelled at was 1.52 (95% CI 1.19, 1.95); for experiencing hostile/offensive gestures 1.43 (1.11, 1.82); and for being sworn at 1.41 (1.09, 1.81). In analyses by injury subtypes, musculoskeletal injuries were more strongly associated with abuse than were acute traumatic injuries. Associations operated on group and individual levels and were most consistently associated with abuse perpetrated by patients. CONCLUSION: Exposure to workplace abuse may be a risk factor for injuries among hospital workers.

Prevalencia de alteraciones de la creatina-fosfoquinasa (CPK) sérica en pacientes que toman estatinas / Prevalence of abnormalities of creatine phosphokinase (CPK) levels in patients taking statins

El uso de estatinas para combatir la dislipidemia se asocia con un espectro de síntomas musculares que van desde mialgias con o sin aumento de la creatina-fosfoquinasa (CPK), hasta rabdomiólisis fatal. Objetivo: determinar la prevalencia de la elevación de la CPK en pacientes que toman estatinas y determinar los posibles factores de riesgo asociados al aumento de la CPK en estos pacientes. Métodos: estudio observacional de corte transversal en el que se evaluaron las alteraciones de la CPK en una población de 503 pacientes con tratamiento con estatinas para el control de la dislipidemia, y que asisten al Laboratorio Clínico Hematológico en Medellín, Colombia por razones diferentes a la medición de la CPK. Mediante un cuestionario aplicado a los pacientes se obtuvieron los datos demográficos, los antecedentes personales y el tipo de estatina utilizada. Resultados: 56 (11,1 por ciento) pacientes presentaron aumento de la CPK por encima del rango de referencia normal; 7 pacientes (1,4 por ciento) tenían un aumento dos veces por encima del valor superior normal, y de ellos 3 (0,6 por ciento) tenían un aumento tres veces por encima del valor superior normal. Se encontró asociación significativa entre niveles altos de la CPK con el sexo masculino y con el uso de inhibidores selectivos de la recaptación de serotonina (ISRS). No se encontró asociación con otros factores de riesgo previamente descritos en otros estudios como son el ejercicio, el consumo de alcohol, el hipotiroidismo y la dosis de estatinas, entre otros. En cuanto a síntomas musculares, el 28,4 por ciento relató dolor muscular con el uso de estatinas, 26 por ciento cansancio y 15,9 por ciento debilidad muscular. Conclusión: los hallazgos de este estudio demuestran que el aumento asintomático de la CPK en pacientes que toman estatinas para la reducción por ciento del colesterol, es mayor al previamente reportado y confirma que el sexo masculino y el uso de fármacos tipo ISRS se relacionan con un aumento de la CPK. También se encontró que el porcentaje de pacientes con síntomas musculares, especialmente dolor y cansancio, es mucho mayor a lo reportado en la literatura mundial. Desde el punto de vista clínico se desconocen las repercusiones que pueda tener el aumento asintomático de la CPK, lo que requeriría estudios de seguimiento a largo plazo.