Enhanced Stress Resilience Training in Surgeons: Iterative Adaptation and Biopsychosocial Effects in 2 Small Randomized Trials.

OBJECTIVE: To determine the effects of ESRT (an iteratively adapted and tailored MBI) on perceived stress, executive cognitive function, psychosocial well-being (ie, burnout, mindfulness), and pro-inflammatory gene expression in surgical (ESRT-1) and mixed specialty (ESRT-2) PGY-1 volunteers. SUMMARY OF BACKGROUND AND DATA: Tailored MBIs have proven beneficial in multiple high-stress and high-performance populations. In surgeons, tailored MBIs have been shown to be feasible and potentially beneficial, but whether mindfulness-based cognitive training can improve perceived stress, executive function, well-being or physiological distress in surgical and nonsurgical trainees is unknown. METHODS: In 2 small single-institution randomized clinical trials, ESRT, a tailored mindfulness-based cognitive training program, was administered and iteratively adapted for first-year surgical (ESRT-1, 8 weekly, 2-hour classes, n = 44) and mixed specialty (ESRT-2, 6 weekly, 90-minute classes, n = 45) resident trainees. Primary and secondary outcomes were, respectively, perceived stress and executive function. Other prespecified outcomes were burnout (assessed via Maslach Burnout Inventory), mindfulness (assessed via Cognitive Affective Mindfulness Scale - Revised), and pro-inflammatory gene expression (assessed through the leukocyte transcriptome profile "conserved transcriptional response to adversity"). RESULTS: Neither version of ESRT appeared to affect perceived stress. Higher executive function and mindfulness scores were seen in ESRT-1, and lower emotional exhaustion and depersonalization scores in ESRT-2, at pre-/postintervention and/or 50-week follow-up (ESRT-1) or at 32-week follow-up (ESRT-2), compared to controls. Pooled analysis of both trials found ESRT-treated participants had reduced pro-inflammatory RNA expression compared to controls. CONCLUSIONS: This pilot work suggests ESRT can variably benefit executive function, burnout, and physiologic distress in PGY-1 trainees, with potential for tailoring to optimize effects.

Using spinal activity-related osseous change in order to explore patterns of occupational stress in a Greek Contemporary Skeletal Collection.

Even though the relationship between occupational stress and entheseal changes has been extensively examined in modern skeletal series, less attention has been given in examining degenerative and plastic osseous change along the spine in relation to different professions. This paper attempts this investigation and is the first that explores the level of physical activity in female housekeepers of The Athens Collection. A sample of 65 adult skeletons up to 50 years old and 1653 vertebrae are examined for Degenerative Joint Diseases (including Schmorl's nodes) and spinal facet remodeling. The above sample is divided in three occupational groups: male laborers, male non-laborers and female housekeepers, based on biomechanical and socio-cultural criteria. Males in the labor group present the highest percentage in Schmorl's nodes (13.1%) and osteophytes, whilst housekeepers exhibit the highest rate in spinal facet remodeling (45.8%). As expected, male laborers actually do present a more intense physical activity than those of the non-labor one, while this study confirmed that housekeepers do comprise a physically stressed occupational group. Spinal facet remodeling and Schmorl's nodes seem to be the least affected indicators by the factor of age, and thus are cautiously proposed as markers of physical activity in modern reference collections. Our study supports the significance of examining the current markers and especially spinal facet remodeling, in a modern skeletal collection with documented occupations and hopes to encourage more researchers to further explore the potential merit of exploring occupational stress through spinal plastic and degenerative change in identified skeletal collections.