Art Interventions to Mitigate Burnout in Health Care Professionals: A Systematic Review.

Burnout in the medical workforce is a growing global concern. Visual arts-based interventions can be a novel way to mitigate burnout and bolster resilience in medicine. Improving tolerance of ambiguity and uncertainty has been associated with decreased rates of burnout in clinicians. No known systematic review exists summarizing the evidence behind the use of visual arts-based interventions to mitigate burnout in clinicians. The authors conducted a systematic literature review of PubMed, EMBASE, and CINAHL in November 2022 using the terms: art, medicine, burnout, and uncertainty. The authors review the evidence for the effects of visual arts-based interventions on clinician burnout. The search identified 58 articles, of which 26 met study inclusion criteria and were assessed by 2 reviewers. These studies reported mixed methods assessments of changes in burnout, empathy, and stress. Overall, visual arts-based interventions promoted empathy, connectedness, and tolerance of ambiguity and had positive effects on burnout; however, some results were mixed. Visual arts-based interventions to mitigate burnout show promise, and additional research should focus on feasibility and longer-term outcomes.

Altered social trajectories and risks of violence among young Syrian women seeking refuge in Turkey: a qualitative study.

BACKGROUND: There is limited evidence regarding the ways in which displacement disrupts social norms, expectations and trajectories for adolescent girls and young women and the resulting impacts on their risks of violence. This knowledge gap is especially marked with regards to Syrian adolescent girls and young women seeking refuge in Turkey. We explored risks of gender-based violence against Syrian adolescent girls and young women in Turkey and examined how these risks were shaped by their displacement. METHODS: Data were collected in August 2016 in Izmir, Turkey through five sex-specific focus group discussions with Syrian adolescents and young people (aged 15-25 years) and two mixed gender focus group discussions with Syrian adults (18 years and older). Group discussions covered the issues facing Syrian adolescents and young women in Turkey, and how these were influenced by their displacement. Discussions in Arabic were audio-recorded, transcribed and translated into English. Data were coded inductively, and analysed thematically. RESULTS: Syrian adolescent girls and young women expressed an increased sense of vulnerability to violence since their displacement. Due to financial strains and limited educational opportunities, they were often encouraged by parents to work or marry, both of which they perceived to increase the risks of violence. In contrast, some adults suggested that marriage could protect adolescent girls and young women from risks of violence associated with working. Being alone outside the home was viewed as risky by all participants due to pervasive sexual, verbal and physical harassment, aggression, and even kidnapping attempts. To limit these risks, many parents reported keeping adolescent girls and young women at home, or ensuring that they were accompanied by male relatives when in public. CONCLUSIONS: Syrian adolescent girls and young women face multiple risks of violence following displacement related to altered social trajectories. Some family-based strategies to protect young women from violence could reinforce restrictive gender norms and increase risks of violence. Interventions to address violence should include providing safe spaces, access to education and safe transport for young women, and financial support for families as well as community-based interventions to address the daily risks of sexual harassment in public spaces.

Human-Centered Design as an Approach for Place-Based Innovation in Public Health: A Case Study from Oakland, California.

PURPOSE: This case study provides a high-level overview of the human-centered design (HCD) or "design thinking" process and its relevance to public health. DESCRIPTION: The Best Babies Zone (BBZ) initiative is a multi-year project aimed at reducing inequities in infant mortality rates. In 2012, BBZ launched pilot programs in three US cities: Cincinnati, Ohio; New Orleans, Louisiana; and Oakland, California. The Alameda County Public Health Department (ACPHD), the lead for the Oakland BBZ site, identified HCD as a promising approach for addressing the social and economic conditions that are important drivers of health inequities. HCD is a process for creating innovative products, services, and strategies that prioritizes the needs of the intended population. ACPHD partnered with the Gobee Group (a social innovation design consultancy) to develop the Design Sprint. The Design Sprint was a 12-week pilot in which 14 professionals from nine organizations used the HCD process to develop concepts for stimulating a vibrant local economy in the Oakland Best Babies Zone. ASSESSMENT: Thirty- to sixty-minute semi-structured interviews were conducted with all 14 individuals involved in the Design Sprint. With the exception of one interview, the interviews were audio-recorded, transcribed, and inductively coded to identify themes. CONCLUSION: Our experience suggests that HCD can: enhance community engagement; expedite the timeframe for challenge identification, program design, and implementation; and create innovative programs that address complex challenges.

Solutions that stick: activating cross-disciplinary collaboration in a graduate-level public health innovations course at the University of California, Berkeley.

Since 2011 we have taught a public health innovations course at the University of California, Berkeley. Students gain skills in systematic innovation, or human-centered design, while working in small interdisciplinary teams on domestic and global health projects with client organizations. To support acquisition of meaningful problem-solving skills, we structured the course so that the majority of learning happens in scenarios that do not involve faculty. Taken by students representing 26 graduate programs (as diverse as epidemiology, city planning, and mechanical engineering), it is one of the 10 highest-rated courses offered by the School of Public Health. We present the blueprints for our course with the hope that other institutions whose students could benefit will borrow from our model.

Effect of soy isolate protein and resistance exercises on muscle performance and bone health of osteopenic/osteoporotic post-menopausal women.

There are contradictory reports regarding the effect of soy protein isolate on bone health in menopause. The main objective of this study was to assess the influence of soy isolate protein intake and resistance exercises on isokinetic muscle strength, endurance, power, and bone health parameters in osteopenic/osteoporotic postmenopausal women. Sixty osteoporotic sedentary women (mean age 54.55 years) were randomly assigned to three groups: soy isolate protein (Group A), soy + exercise group (Group B), and control group (Group C). Group B performed supervised progressive resistance exercises 4 times/week for 12 weeks. Muscle performance was measured by isokinetic dynamometry, and bone health was measured by ultrasound densitometry. Analysis of variance showed significant bone and muscle strength gains (p < .05) both in Group A and B, with the improvements more pronounced in Group B. Significant muscle performance changes, after intervention, were evident and bone strength increases may parallel changes in muscle strength.

Concurrent validity of the non-exercise based VO2max prediction equation using percentage body fat as a variable in asian Indian adults.

BACKGROUND: Aerobic capacity (VO2max) is highly dependent upon body composition of an individual and body composition varies with ethnicity. The purpose of this study was to check the concurrent validity of the non-exercise prediction equation developed by Jackson and colleagues (1990) using percentage body fat as a variable in Asian Indian adults. METHODS: One hundred twenty college-aged participants (60 male, 60 female, mean age 22.02 ± 2.29 yrs) successfully completed a maximal graded exercise test (GXT) on a motorized treadmill to assess VO2max. VO2max was then estimated by the non-exercise prediction equation developed by Jackson and colleagues (1990) using percentage body fat. Percentage body fat was calculated by three different models (Sandhu et al's fat mass equation, Durnin-womersley's 4 site percentage body fat and Jackson & Pollock's 4 site percentage body fat) and was used in the above equation. The results of VO2max obtained using "gold standard" treadmill methods were then compared with the three results of VO2max obtained by Jackson et al's equation (using three different models to calculate percentage body fat) and it was determined which equation is best suited to determine percentage body fat and in turn VO2 max for Indian population. RESULTS: Jackson et al's prediction equation overpredicts VO2max in Asian Indian subjects who have a lower VO2max (33.41 ± 14.39 ml/kg/min) than those reported in other age matched populations. percentage body fats calculated by the three equations were significantly different and the correlation coefficient (r) between VO2max calculated by Jackson and colleagues (1990) using Sandhu et al's equation for percentage body fat with VO2 max calculated using treadmill (gold standard) (r = .817) was found slightly more significantly correlated than the other two equations and was not statistically different from the measured value. CONCLUSIONS: This study proves that VO2max equation using Sandhu et al's model for percentage body fat yields more accurate results than other studied equations in healthy college-aged participants in India.

Effects of eight-week supplementation of Ashwagandha on cardiorespiratory endurance in elite Indian cyclists.

BACKGROUND: Cycling is an endurance sport relying mainly on aerobic capacity to provide fuel during long-duration cycling events. Athletes are constantly searching for new methods to improve this capacity through various nutritional and ergogenic aids.s PURPOSE: The aim of the study was to find out the effect of Ashwagandha on the cardiorespiratory endurance capacity, that is, aerobic capacity of elite Indian cyclists. MATERIALS AND METHODS: Forty elite (elite here refers to the participation of the athlete in at least state-level events) Indian cyclists were chosen randomly and were equally divided into experimental and placebo groups. The experimental group received 500 mg capsules of aqueous roots of Ashwagandha twice daily for eight weeks, whereas the placebo group received starch capsules. OUTCOME MEASURES: The baseline treadmill test for the cyclists were performed to measure their aerobic capacity in terms of maximal aerobic capacity (VO(2) max), metabolic equivalent, respiratory exchange ratio (RER), and total time for the athlete to reach his exhaustion stage. After eight weeks of supplementation, the treadmill test was again performed and results were obtained. RESULTS: There was significant improvement in the experimental group in all parameters, whereas the placebo group did not show any change with respect to their baseline parameters. There was significant improvement in the experimental group in all parameters, namely, VO(2) max (t = 5.356; P < 0.001), METS (t = 4.483; P < 0.001), and time for exhaustion on treadmill (t = 4.813; P < 0.001) in comparison to the placebo group which did not show any change with respect to their baseline parameters. CONCLUSION: Ashwagandha improved the cardiorespiratory endurance of the elite athletes.

Effect of different cuff widths on the motor nerve conduction of the median nerve: an experimental study.

BACKGROUND: A bloodless operative field is considered mandatory for most surgical procedures on the upper and lower extremity. This is accomplished by using either an Esmarch bandage or a pneumatic tourniquet, but a number of complications are associated with both. Nerve palsy is one of the most frequently encountered complications of this procedure. Wider cuffs have been found to cause reduced risk of tourniquet induced injury to the underlying soft tissues than the narrower ones due to the fact that lower occlusion pressures are caused by the former. To address and investigate this question, conduction in the median nerve has been measured proximal to tourniquet as well as distal to the tourniquet. Parameters of nerve conduction measured are nerve conduction velocity, latency and amplitude. METHODS: Sphygmomanometer cuffs with widths 14 cm and 7 cm were applied to the upper extremities of 20 healthy, normotensive volunteers (9 males and 11 females with age ranging from 22 to 27). Systolic blood pressure was measured first and then the cuff was inflated to about 20-30 mm Hg above it and was kept inflated for 15 minutes. Recordings were done prior to, for the period of tourniquet inflation, and following release of the tourniquet. RESULTS: Nerve conduction was found to be more severely affected by the 14 cm cuff than the 7 cm cuff. CONCLUSION: Wider cuffs resulted in more severe changes in the nerve. This brings us to the conclusion that though lower inflation pressures are required for the occlusion of the blood supply using wider cuffs, the nerve conduction is more severely affected by the wider ones. Both electrophysiological changes and occlusion pressure should be kept in mind while choosing the width of the cuff.

An electromyographic analysis of shoulder muscle activation during push-up variations on stable and labile surfaces.

BACKGROUND: Numerous exercises are used to strengthen muscles around the shoulder joint including the push-up and the push-up plus. An important consideration is the addition of surface instability in the form of swiss ball for rehabilitation and strength. The justification for the use of the swiss ball is based on its potential for increasing muscular demand required to maintain postural stability and for improving joint proprioception. Evidence for this is lacking in literature. PURPOSE OF THE STUDY: To compare the myoelectric amplitude of shoulder muscles during push-ups on labile and stable surface. STUDY DESIGN: Same subject experimental study. MATERIALS AND METHODS: Thirty healthy male subjects in the age group 20-30 years with a mean height of 173.65 cm (+/- SD 2.56) and a mean weight of 69.9 kg (+/-SD 0.2) were taken. Surface electromyogram was recorded from triceps, pectoralis major, serratus anterior and upper trapezius while performing push-up and push-up plus exercises, both on labile and stable surface. RESULTS: Significant increase in muscle activity was observed in pectoralis major and triceps muscle (only during eccentric phase of elbow pushups), while serratus anterior and upper trapezius showed no change in activation level on swiss ball. CONCLUSION: The addition of a swiss ball is capable of influencing shoulder muscle activity during push-up variations, although the effect is task and muscle dependent.

Effects of strength training and jatamansi on reducing hand tremor amongst archers

To investigate and compare the effects of strength training (Shoulder girdle and respiratory muscles) and drug (Jatamansi) on reducing hand tremor in archers. Randomized experimental, different subject design. Institutional study done at Manipur Archery Association. Thera-band (Hygienic Corporation) and Nardostachys jatamansi (GMP Certified) were used as interventions. Pre & Post Hand Steadiness Score (Arm-Hand-Steadiness Tester on 4 mm hole) and Performance Test Scores (AAPHER Archery Test) was evaluated. 45 National Level Archers within age 16-28yrs were assigned into three groups: Group I (Medicine), Group II (Strength Training) and Group III (Control). Medicine was consumed for 4 weeks continuously 3 gm TDS and Thera-band strength training was given for 3 times weekly for 4 weeks. Main Outcome Measures: It was hypothesized that strength training is more effective in reducing hand tremors than medicinal or control groups. Arm-Hand-Steadiness: Numbers of Contact (NOC): On inter Group Comparison of the three Groups using One Way ANOVA, left and right arm showed significant differences (F = 5.64, p<0.05; F = 8.97, p<0.001) respectively and on Post Hoc Scheffe’s analysis, Group II showed maximum improvement. Total Contact Time (TCT): On inter Group comparison of the three Groups using One Way ANOVA, left and right arm showed significant differences (F = 12.50, p<0.001; F = 9.23, p<0.001) respectively and On Post Hoc Scheffe’s analysis, Group II showed maximum improvement. Archery Performance: On inter Group comparison of the three Groups using One Way ANOVA showed significant difference (F = 6.53, p<0.005) and on Post Hoc Scheffe’s analysis, Group II showed maximum improvement. Intervention of strength training and jatamansi may be effective for an archer however, strength training with thera-band and respiratory muscles conditioning intervention in combination increases steadiness and archery performance.