Work Engagement and Burnout in a Private Healthcare Unit in Greece.

Work engagement represents a positive work-related state of mind characterized by three dimensions: Vigor (high levels of energy and mental resilience during work), Dedication (strong involvement in one's work), and Absorption (complete-joyous immersion in one's tasks). This study aimed to investigate work engagement and burnout in health professionals in a private healthcare unit in Greece. A cross-sectional study was conducted with a sample of 151 professionals, including doctors, nurses, administrative staff, and other health professionals involved in this setting. The study duration was four months (January-April 2022). The questionnaire covered sociodemographic and work-related information, along with the Utrecht Work Engagement Scale and the Maslach Burnout Inventory. Regarding the subdimensions of the Utrecht Work Engagement Scale, participants demonstrated a moderate score in Absorption and medium to high scores in Vigor and Dedication. In terms of burnout, they showed a low score in Depersonalization, a medium score in Emotional Exhaustion, and a high score in Personal Accomplishment. Those with nonpermanent employment contracts scored higher in all dimensions of burnout compared to those with permanent employment contracts. Vigor, Dedication, and Absorption correlated negatively with Emotional Exhaustion and Depersonalization and positively with Personal Accomplishment. Vigor negatively predicted Emotional Exhaustion, Depersonalization, and Personal Accomplishment. In conclusion, healthcare professionals in the private healthcare sector in Greece demonstrate moderate work engagement and experience moderate burnout. There are differences in work engagement and burnout based on sociodemographic and work-related characteristics. Promoting work engagement (especially the dimension of Vigor) is essential to preventing and addressing burnout among healthcare professionals.

Evolución de pacientes con ELA bajo seguimiento neumológico y comparación de dos áreas asistenciales en una provincia española / Evolution under respiratory follow-up of patients with ALS and comparison of two healthcare areas in a Spanish province

Introducción: Describir las características de pacientes con Esclerosis Lateral Amiotrófica (ELA) remitidos para valoración respiratoria, determinando si existen factores diferenciales en el manejo clínico y su evolución en dos áreas asistenciales. Métodos: Análisis retrospectivo (seguimiento de 16 años) de pacientes con ELA atendidos en dos Servicios de Neumología en la misma provincia. Se analizan características demográficas, tipo de ELA, clase de adaptación a la ventilación domiciliaria (VMD), modalidad ventilatoria, uso de asistencia mecánica para la tos e indicación de gastrostomía, comparando supervivencia. El Área Sanitaria de Talavera de la Reina cuenta con acreditación de Unidad de Ventilación Domiciliaria Especializada, siendo de Unidad Básica en el Área de Toledo. Resultados: Se analizaron 97 pacientes (60 en Toledo). La edad media fue de 63,3 años y el 60,8% varones. Inicio espinal en el 55,7% y bulbar 35,1%. Se inició VMD en el 88% de los pacientes, siendo programada en el 80%. Indicación de tos asistida mecánica en un 35,1% y en el 51,5% de los pacientes se realizó gastrostomía. La supervivencia media global fue de 32,3 meses, desde el inicio de la VMD de 26,2 meses y 17,1 meses desde la realización de gastrostomía. Los datos de supervivencia fueron similares comparando ambas áreas asistenciales. Conclusiones: Los pacientes con ELA atendidos en dos áreas asistenciales, con criterios clínicos similares, pero con estrategias diferenciadas según los recursos disponibles, presentaron una supervivencia global similar, así como tras el inicio de la VMD y la realización de gastrostomía y con un resultado equiparable al de centros de referencia.(AU)

Background: We aim to describe the characteristics of patients with Amyotrophic Lateral Sclerosis (ALS) referred for respiratory assessment, and whether there are differential factors in the evolution of patients according to two different healthcare areas. Methods: Retrospective analysis of patients with ALS in two Pulmonology services at the same province in Spain (16-year follow-up). We analysed demographic variables, ALS subtype, Home Mechanical Ventilation (HMV) modality and way of adaptation, use of mechanical assisted cough and gastrostomy indication, comparing survival. In the Health Area of Talavera there is a Specialized Unit of HMV according to accreditation by Spanish Respiratory Society, with a Basic Unit in the Toledo Area. Results: A total of 97 patients were analysed (60 in Toledo). The mean age was 63,3 years and 60,8% were male. The form of onset was spinal: 55,7% and bulbar: 35,1%. HMV was started in 88% of the patients, programmed in 80% of them. The use of mechanical assisted cough reached 35,1% of the patients and up to 51,5% of them underwent gastrostomy. Median survival was 32,3 months, being 26,2 months from the start of HMV and 17,1 months after gastrostomy. When comparing the two areas survival data were similar. Conclusions: Patients with ALS assisted in two healthcare areas at the same province, with similar clinical criteria, but with differentiated strategies according to the available resources, present a similar overall survival, as well as after the start of HMV and the performance of gastrostomy and with a similar outcome compared with reference units.(AU)

Temporal variation in bacterial community profile on patients' bedsheets in a primary healthcare unit.

Fabrics serve as fomites in spreading nosocomial infections. As a patient is in close contact with bedsheets, it is important to assess the seasonal variation in bacterial diversity on these in healthcare units. The study was conducted to characterise the bacterial diversity on patients' bedsheets across 7 months in a primary healthcare unit. Polyester-cotton blend fabric was stitched on bedsheets, and temporal dynamics of bacterial communities was assessed from May to November 2019. qPCR and amplicon sequencing of 16S rRNA gene was performed for profiling of bacterial community. Results revealed the dominance of Bacillota followed by Pseudomonadota, and Actinomycetota. A seasonal variation was observed in the bacterial load, with maximum values in June. This indicates the impact of environmental conditions on bacterial abundance and composition on fabrics in healthcare unit. The presence of priority pathogens on the patient bedsheets is a human health concern reiterating the need for season-specific laundering protocol.

An evaluation of excellence in primary healthcare units after the introduction of a performance management innovation in two regional states of Ethiopia: a facility based comparative study.

BACKGROUND: The Ethiopian Ministry of Health strives to achieve universal health coverage (UHC) through increasing the number of its high-performing primary healthcare units. Although the Ethiopian health system is managed within a decentralized political system, the Ministry of Health works towards institutionalizing performance management innovations and organizational cultures that increase the excellence of primary healthcare entities. To date, there has been little evidence gathered on the factors influencing the excellence of primary healthcare units in Ethiopia. Therefore, the aim of this study was to assess and compare how the introduction of performance management and organizational culture innovations through project support affect the excellence of primary healthcare units in Ethiopia. METHODS: A facility-based comparative study was conducted in USAID Transform: Primary Health Care project supported and non-supported primary healthcare units located in the Oromia and Southern Nations Nationalities and Peoples' (SNNP) regions of Ethiopia. Quantitative data were collected from randomly selected health workers using interviewer-administered questionnaires. In addition, primary healthcare unit excellence measurements were extracted from routine health information databases over eight quarters. The data were analyzed using the Statistical Package for Social Science (SPSS IBM v 20) research software package. Results were presented in frequency tables and graphs. After checking the data for homogeneous distribution, a paired sample t-test for equal variances, otherwise known as the Mann-Whitney U test was analyzed to claim statistically significant difference at P < 0.05. RESULTS: Out of 368 invited health workers, 364 participated in this study, (a response rate of 98.9%). Slightly higher than two-thirds of participants were enrolled from the Jimma Zone of Oromia Region. Orientations on performance management standards were provided to 101 (68.2%) and 45 (48.3%) health workers from project-supported and non-supported facilities, respectively. The mean perceived organizational culture score with [± Standard Deviation (SD)] was 3.72 ± 0.75 among project-supported health workers and 3.385 ± 0.75 among non-supported health workers, respectively. An independent sample t-test showed statistically significant differences, where project-supported health workers had higher mean scores on perceived organizational culture than their non-supported counterparts, with t = 433, df = 362, P = 0.001. The mean baseline primary healthcare unit excellence score was 63.2% and 50.5% for project-supported and non-supported health facilities, respectively. The end line excellence scores increased to 93.3% for project-supported and 79.1% for non-supported facilities. The end line overall primary healthcare units' mean rank excellence scores were 257.67 for the project supported and 105.66 for non-project supported facilities. This result of a non-parametric test, i.e. the Mann-Whitney U test revealed that project-supported facilities were higher and had a positive statistically significant difference (U = 2,728, z = -13.78, P = 0.001). CONCLUSIONS: The findings of this study underscore a direct relationship between implementing performance management innovations and enhancing organizational cultures for excellence at primary healthcare units. Project-supported primary healthcare units had higher organizational culture and excellence scores than their counterpart non-supported facilities. Therefore, achieving UHC through excellence in primary healthcare facilities requires scaling up of performance management innovation interventions.

The Trend of Health Service Utilization and Challenges Faced During the COVID-19 Pandemic at Primary Units in Addis Ababa: A Mixed-Methods Study.

INTRODUCTION: The COVID-19 pandemic has imposed an extraordinary challenge to the health and socio-economic facet of nations globally. Health facilities have encountered tremendous challenges to contain service delivery at all levels. This study aims to assess the trend of health service utilization and challenges faced during the COVID-19 pandemic at primary units in Addis Ababa, Ethiopia. METHOD: A multi-facility-based cross-sectional study was conducted in Addis Ababa between 1 and 30 of August 2020. A mixed-methods design was employed, and both quantitative and qualitative data were collected at 5 health centers. Facilities were selected randomly from 5 sub-cities while interviewees were recruited purposively. A structured questionnaire was used to collect quantitative data from the HMIS units of each facility. Qualitative data was collected using a semi-structured key-informant interview guide. Quantitative data were analyzed using Microsoft Excel, and a 10-month time-series trend was generated. For the qualitative data, qualitative data analysis (QDA-minor) software was used. RESULTS: Time-series comparison of the pre-COVID-19 era loads with the COVID-19 period showed that there was an extensive disparity in the service delivery capacity of the health facilities. A huge drop in inpatient flow of some units such as PICT, VCT, FP services, and most sub-units of the OPDs has been recorded following the COVID-19 outbreak. The key-informant interview also revealed that such challenges, as fear of infection and stigma, poor infrastructure, challenges related to human resources, and challenges related to the supply of prevention and treatment inputs were prominently encountered at the health centers. CONCLUSION: The COVID-19 wave has negatively impacted many service delivery points in the study settings. The presence of weak infrastructure, lack of PPEs, fear of the infection and stigma, and staff workload have been mentioned as the predominant challenges faced during the outbreak. Health authorities should arrange multifaceted supports to ensure uninterrupted service delivery at primary healthcare units.

An overview of the mental and physical health status and post-migration psychosocial stressors of refugee toddlers and preschoolers.

PURPOSE: Although thousands of refugee children are being born in resettlement areas, few studies have described the mental and physical status in early childhood. We aimed to study the mental, physical status, and post-migration psychosocial stressors of refugee toddlers and preschoolers. DESIGN AND METHODS: The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood was used to assess psychiatric disorders, parent-child relational context, physical health conditions, psychosocial and environmental stressors, and developmental competencies of children who were evaluated at the clinic site. This study was a retrospective examination of these health records. Seventy participants were divided into two groups: children born during resettlement in Turkey and children born in Syria. The Syria group consisted of 33 participants aged 66.73 ± 13.05 months. The Turkey group consisted of 37 participants aged 38.78 ± 16.82 months. FINDINGS: In both groups, children suffered from a wide range of mental and physical disorders and a variety of psychosocial stressors. Monthly income and resettlement time in the Turkey group were more statistically significant (χ2 = 10.611, p = 0.014; χ2 = 5.976, p = 0.050). Also in the Turkey group, parents and siblings had significantly more mental health problems (χ2 = 4.39, p = 0.04; χ2 = 5.38, p = 0.02). PRACTICE IMPLICATIONS: Child and adolescent mental health workers need to be aware of the specific needs of this particular age group of refugees. Social, economic, and policy efforts are needed to improve the living conditions of refugee children.

Molecular detection of SARS-CoV-2 from indoor air samples in environmental monitoring needs adequate temporal coverage and infectivity assessment.

The relevance of airborne exposure to SARS-CoV-2 in indoor environments is a matter of research and debate, with special importance for healthcare low-risk settings. Experimental approaches to the bioaerosol sampling are neither standardized nor optimized yet, leading in some cases to limited representativity of the temporal and spatial variability of viral presence in aerosols. Airborne viral viability moreover needs to be assessed. A study has been conducted collecting five 24-h PM10 samples in a COVID-19 geriatric ward in late June 2020, and detecting E and RdRp genes by RT-qPCR with a Ct between 36 and 39. The viral RNA detection at Ct = 36 was related to the maximal numerosity of infected patients hosted in the ward. Lacking a direct infectivity assessment for the collected samples an experimental model has been defined, by seeding twelve nasopharyngeal swab extracts from COVID-19 positive patients on Vero E6 cells; only the four extracts with a viral load above E+10 viral copies (approximately Ct<24) have been able to establish a persistent infection in vitro. Therefore, the cytopathic effect, a key feature of residual infectivity, could be considered unlikely for the environmental PM10 samples showing amplification of viral RNA at Ct = 36 or higher. A standardization of airborne SARS-CoV-2 long-term monitoring and of environmental infectivity assessment is urgently needed.

Survey on the employment intention in primary healthcare unit of medical undergraduates and analysis of corresponding learning and psychological influencing factors / 中华医学教育探索杂志

Objective:To investigate the relationship between medical students' employment intention in primary healthcare unit and their learning and psychological state through a questionnaire survey among clinical undergraduates.Methods:A cross-sectional survey was conducted among 821 graduates of a Medical University in 2017 to investigate their employment intention, learning and psychological status and employment plan. The learning and psychological status was evaluated by a self-designed questionnaire. Independent-sample t test, variance analysis and multiple linear regression analysis were used to examine the relevant factors affecting medical students' employment intention in primary healthcare by SPSS 21.0 version. Results:A total of 810 questionnaires were distributed and 753 questionnaires were included in the analysis. The employment intention of working in primary healthcare units of medical students was (4.61±2.24). Students in the advanced class had lower willingness to work in primary healthcare unit (the group of students with higher entrance examination scores) ( P<0.05), and students with higher learning pressure and greater pressure of doctor-patient relationship were more reluctant to work in primary healthcare units ( P<0.05). In terms of the employment plan, students who focus on their professional counterparts are more willing to work in primary healthcare unit, while those who pay more attention to salary are less willing to work in primary healthcare unit ( P<0.05). Conclusion:Improving the incentive policies for working in primary healthcare unit, actively relieving psychological pressure of medical students, and increasing the training of doctor-patient communication can have a positive effect on improving the willingness of medical students to have an employment intention in primary healthcare unit.

Estimation of urine volume in municipal sewage originating from patients receiving antibiotics at a private clinic in Crete, Greece.

This study presents an estimation of the urine volume in the wastewater from a real, private clinic in Crete, Greece, during a seven-month period (01/06/2018 to 31/12/2018). Separate estimates were obtained for the volume of urine belonging to patients receiving antibiotics. It was found that the clinic disposed into the local municipal sewage network on the average 3,263 L/month of urine, from which 1,331 L/month (40.8%) belonged to patients receiving antibiotics. According to the pharmacy department of the private clinic, during the period of the study, the most frequently administered groups of antibiotics were on the average 779 g/month cephalosporins (68.1%), 108 g/month fluoroquinolones (9.5%) and others (11.2%), with various active substances including cefuroxime, ciprofloxacin, metronidazole and doxycycline. These active substances act like pollutants when disposed via the municipal sewer network into the environment.

Prevalência e fatores associados ao risco de quedas em idosos adscritos a uma Unidade Básica de Saúde do município de Natal, RN, Brasil / Prevalence and factors associated with the risk of falls among the elderly registered in a primary healthcare unit of the city of Natal in the state of Rio Grande do Norte, Brazil

Resumo O objetivo deste artigo foi analisar a prevalência e os fatores associados a quedas em idosos adscritos a uma Unidade Básica de Saúde (UBS), no município de Natal/RN. Estudo transversal realizado com 280 idosos cujos dados foram coletados nas dependências da UBS. A associação entre os desfechos “queda” e “queda recorrente” e as variáveis independentes foi verificada mediante análise bivariada e regressão de Poisson, com cálculo das respectivas razões de prevalências. Prevaleceram os idosos do gênero feminino (68,2%), com média de idade de 71,6 anos (± 6,7), alfabetizados (54,6%), não aposentados (73,5%) e sedentários (87,1%). Registraram queda 53,6% dos idosos, porém 27,8% caíram duas ou mais vezes. O modelo preditivo de queda incluiu o gênero feminino (RP = 1,81), presença de doenças osteoarticulares (RP = 1,71) e comprometimento do equilíbrio (RP = 0,88), enquanto a mobilidade funcional (RP = 0,94), medo de cair (RP = 1,21) e déficit de equilíbrio (RP = 0,80) compuseram o modelo final de quedas recorrentes. Encontrou-se maior prevalência de episódio único de queda e os fatores associados incluíram variáveis sociodemográficas, de saúde e performance física. Por outro lado, associaram-se a ocorrência de duas ou mais quedas apenas as variáveis de performance física.

Abstract The scope of the study was to analyze the prevalence and factors associated with falls among the elderly registered in a Primary Healthcare Unit (PHU) in Natal, State of Rio Grande do Norte. It involved a cross-sectional study conducted with 280 elderly individuals with data collected at the primary healthcare unit. The association between falls, recurrent falls and independent variables was assessed using bivariate analysis and Poisson regression with calculation of their respective prevalence ratios. It involved predominantly elderly females (68.2%) with mean age of 71.6 years (± 6.7), literate (54.6%), non-retired (73.5%) and sedentary (87.1%). 53.6% of the elderly recorded falls and 27.8% fell twice or more. The predictive model of falls included the female gender (PR= 1.81), osteoarticular diseases (PR = 1.71) and balance impairment (PR = 0.88), while functional mobility (PR = 0.94), fear of falling (PR = 1.21) and balance deficit disorders (PR = 0.80) constituted the definitive model of recurrent falls. A higher prevalence of single fall episodes was found and the associated factors included sociodemographic, health and physical performance variables. On the other hand, the occurrence of two or more falls were only associated with physical performance variables.

Realidade sociopolítica, ambiental e de saúde de famílias pertencentes a uma comunidade vulnerável / The social-political-environmental and health reality of families belonging to a vulnerable community

OBJETIVO: Conhecer a percepção de lideranças, profissionais de saúde e usuários acerca da cidadania e melhoria das condições de saúde de famílias pertencentes a uma comunidade vulnerável. MÉTODO: Estudo exploratório, de caráter qualitativo, orientado pela teoria fundamentada nos dados. Os dados foram coletados entre julho e dezembro de 2009, mediante entrevistas com quatro lideranças comunitárias de saúde, oito profissionais de uma equipe de saúde da família e doze usuários da saúde. RESULTADOS: A codificação dos dados resultou nas categorias: Compreendendo as Condições sociais, as Condições políticas, as Condições ambientais e as Condições de saúde de famílias de uma comunidade vulnerável. CONCLUSÕES: Se por um lado as políticas de seguridade social e de saúde possibilitaram a redução da pobreza e das desigualdades locais, por outro lado, não garantem a necessária expansão da cidadania e nem mesmo a melhoria das condições de saúde.

The scope of this paper is to ascertain the perception of community leadership, health professionals and users regarding citizenship status and the enhancement of the healthcare conditions of families belonging to a vulnerable community. This is an exploratory study of a qualitative nature, guided by theory based on data. Data were collected between July and December 2009, by means of interviews with four community health leaders, a team of eight family health team professionals and twelve health users. The codification of the data resulted in the following categories: Understanding the social conditions, the political conditions, the environmental conditions and the health conditions of families in a vulnerable community. The conclusions reached were, that if on the one hand the social security and health policies made it possible to reduce poverty and local inequalities, on the other hand they do not ensure the requisite enhancement of citizenship or even the improvement of health conditions.

Organização dos cuidados pelo método de enfermeiro de família por área geográfica / Organization of care by family nurse method by geographical area

O presente trabalho de projecto insere-se no âmbito do Mestrado de Gestão das Organizações,Ramo Gestão de Unidades de Saúde, em consonância com um projecto pessoal e profissional de enfermeira de família numa Unidade de Saúde Familiar (USF). A sua concretização tornou-sepossível pela mobilização de conhecimentos, atitudes e acções adquiridas ao longo do mestrado. Este trabalho de projecto tem como finalidade a organização dos cuidados pelo método de enfermeiro de família por área geográfica, implícita à estruturação de novas políticas de saúde em Portugal, nomeadamente a reorganização dos Cuidados de Saúde Primários (CSP) considerados a base de todo o sistema de saúde. Na criação da USF, os enfermeiros assumem a importância de implementar e promover o enfermeiro de família, cujo alvo e foco da sua prática é a família, ao longo de todo o ciclo vital. Assim, procedeu-se à análise de situação de forma a obter uma análise integral e identificação de problemas e causas através da análise SWOT e diagrama de causa e efeito de Ishikaswa. De seguida foram planificadas, concretizadas e aprovadas acções e documentos de apoio à organização dos cuidados pelo método de enfermeiro de família por área geográfica. Das acções realizadas foram aprovadas em Conselho Geral da USF a definição da área geográfica de influência da USF; identificação do enfermeiro de família/gestor de caso; elaboração de um horário modelo do enfermeiro de família; construção de um manual para a qualidade dos registos de enfermagem; plano de acompanhamento interno; organigrama da USF e diagnóstico de necessidades formativas. Constituem propostas a serem sujeitas a aprovação pelo Conselho Geral da USF e/ou pelo Conselho Clínico do Agrupamento de Centros de Saúde (ACES) os indicadores e metas a contratualizar relativas ao enfermeiro de família; manual de articulação e o regulamento interno. Projecta-se a abertura da unidade de saúde objecto do estudo para Janeiro de 2012 pelo que, só será possível a avaliação das mesmas após o início do seu funcionamento. No entanto temos presente que, um projecto pode ser flexível e susceptível a mudanças e reformulações e que, as actividades concretizadas e aprovadas poderão em qualquer momento serem sujeitas a ajustes e modificações.

This project is inserted in the scope of a masters in organizational management, healthcare unit management branch, in conjunction with a personal and professional project of family nurses in a USF (Family Healthcare Unit). This project became possible thanks to the mobilization of knowledge, performance and actions acquired throughout the masters. The purpose of this project is the organization of nursing care by the method of family by geographic area, inherent to the structuring of new healthcare policies in Portugal, namely the reorganization of primary healthcare considered the basis of the entire healthcare system. In creating a USF, the nurses assume the importance of implementing and promoting the family nurses, who have as target and focus of their practice the family during its entire life cycle. Therefore, an analysis of the situation was performed, in order to attain a complete analysis and identification of the problems and causes using the SWOT analysis and Ishikaswa cause and effect diagram. Thus, actions and documents supporting organization of nursing care by the method of family by geographic area were planned, performed and approved. The following actions performed were approved by the USF General Counsel: the definition of the geographical area of USF's influence; the identification of the family nurse/case manager; the elaboration of a template schedule for the family nurse; the creation of a manual for improving the quality of the nurse's records; the creation of an internal supervision plan; the creation of a USF's organization chart and diagnostics of formative necessities. The proposals still being submitted to approval by the USF General Counsel and/or by the ACES's (Health Center Group) Clinical Counsel are the indicators and goals to be employed regarding a family nurse; the structuring manual and internal regulation. The opening of a healthcare unit as a study subject is envisioned for January 2012. Therefore, it will only be possible to asses it after it begins functioning. However, we are aware that a project might be flexible and susceptible to changes and reformulations, and that the activities performed and approved may at any time be subjected to adjustments and modifications.