Tag: 9/10/23

Categories : Medical Industry Mental HealthTags : Leave a comment

Rollout of Coaching Programme Reduces Burnout in Medical Residents

On By ModernMedia
Photo by SJ Objio on Unsplash

Researchers found that a national level programme to reduce burnout levels, which disproportionately affects women, was even more successful than its pilot programme two years prior. They published their findings in the journal JAMA Network Open.

“We did a pilot programme in 2021 to see if it would work and it did,” said study co-author Tyra Fainstad, MD, associate professor at the University of Colorado School of Medicine. “Then we expanded it to 26 graduate medical institutions in 19 states. There were 1017 participants. We saw significant improvement in every wellbeing outcome we assessed including all three subscales involved in burnout.”

Burnout within the health care community is a national epidemic disproportionally affecting women. Last year, the US Surgeon General declared it a `crisis’ deserving ‘bold, fundamental change’ though little was known about scalable, effective solutions to the problem.

Women are hit harder by burnout for reasons that include bias and sexism at work, pay disparities as well as a disproportionate burden of home management and child/elder care, the researchers said.

Fainstad and co-author Adrienne Mann, MD, both faculty in the CU Department of Medicine, created the web-based Better Together Physician Coaching Program at CU Anschutz with the goal of reducing that burnout. Then they replicated it to a national level and published their findings.

While the pilot programme saw improvements in `imposter syndrome’ (feeling as if you ‘don’t really belong in the job’) and self-compassion, the expanded national study also showed significant improvements in outcomes across the board including moral injury and flourishing, offering actual evidence that the program works.

“Physician trainees who received online group coaching over four months had substantial reductions in multiple dimensions of professional distress (burnout, moral injury and imposter syndrome) and improvements in well-being (self-compassion and flourishing),” said Mann.

Mann and Fainstad are both certified life coaches. Better Together is owned and operated by the University of Colorado. It’s not a business, they said, and they don’t personally profit financially from it. The program is available to any heath care institution, school of medicine, department, or residency program wishing to meaningfully support the wellbeing of their clinicians and trainees.

Better Together is web-based. Participants take part in two videoconferencing coaching calls per week where up to five people can be coached live on any topic with an unlimited audience. Calls are recorded for later listening on a private podcast.

Participants can also access unlimited, anonymous written coaching in a forum by submitting a narrative reflection and receive a coach’s response published to Better Together’s secure, members-only website. There are also weekly self-study sessions using videos and worksheets. They focus on topics pertinent to the physician lifestyle such as goal setting, cultivating a growth mindset, receiving critical feedback, imposter syndrome and perfectionism.

The researchers use the Maslach Burnout Inventory (MBI) to measure their work. The MBI has three subscales: emotional exhaustion (EE) or feeling emotionally exhausted from work; Depersonalisation (DP), detached and impersonal treatment of patients; Professional accomplishment (PA), beliefs around competence and success at work.

The EE score is a key construct in health care related burnout. A one point increase in the EE scale has been associated with a 7% increase in suicidal ideation and a 5-6% increase in major medical errors.

The researchers said a reduced mean EE score among those that took part in the training and an increased EE score in those that did not.

“From what we see in this study, coaching helps in every aspect of burnout,” Fainstad said. “The multi-modal nature of our program is unique. You can interact in many ways. That partially explains the powerful impact -that and the group nature of our coaching.”

Mann said the majority are watching others being coached and share in the experience.

“That is deeply connecting. They try to see themselves in someone else’s story,” she said. “When someone is on a view screen you have compassion and empathy for them and, by extension, learn to practice compassion and empathy for yourself.”

While few strategies to address burnout have shown much overall effect, Fainstad said this study demonstrates that group coaching works.

“We’re now showing that we have an actual evidence-based answer to burnout,” she said.

Fainstad and Mann said burnout is a product of the current, often toxic, medical culture pervading every aspect of the profession.

“Culture is a belief system,” Fainstad said. “And while structural changes are absolutely necessary to fix our medical system, working with individuals who have been harmed along the way will be imperative to healing.”

Mann suggested a step towards healing the culture would be making coaching programs like Better Together accessible to everyone – not necessarily mandatory but at least made available by institutions.

“There are other coaching programs in this space but this one is rigorously evidence-based. We studied it,” Mann said. “There are no downsides. It helps in all aspects of burnout.”

Source: University of Colorado Anschutz Medical Campus

Categories : VaccinesTags : Leave a comment

Vaccine Acceptance is Sometimes Influenced in Unexpected Ways

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Using simulations, researchers at Vanderbilt University have uncovered new insights into vaccine hesitancy have shown that external factors such as vaccine mandates and availability have varied and sometimes contradictory influences on people’s willingness to get vaccinated. The research was published in the journal PLOS Global Public Health, and the simulations are available to be reviewed on GitHub.

Building on a new mathematical model that represents vaccine hesitancy as a belief that can influence whether parents vaccinate their children, Nicole Creanza, assistant professor of biological sciences, and postdoctoral scholar Kerri-Ann Anderson extended their work to include the effect of external factors that affect vaccine availability, such as vaccine mandates and vaccine inaccessibility.

“Instead of modelling vaccine mandates and inaccessibility as a physical driver or barrier to vaccination, respectively, we considered their effects from a cultural perspective,” Anderson said. “We model the effects of these external factors by considering how beliefs interact with them to shape vaccination behaviours. Our data shows that a vaccine mandate has a lesser consequence on a person’s motivation to vaccinate if they already had very positive feelings about vaccines.”

The findings also demonstrate that when large groups trust vaccines, they usually get vaccinated. But if there aren’t enough vaccines, even those who trust them might not get them. In addition, when vaccine mandates are in place, it can seem like everyone is getting vaccinated. But more people than researchers expected might still be unsure about vaccines and not get them.

“We hope that our research emphasises how important it is to not generalise populations based on a single characteristic or assume populations behave similarly or beliefs have similar influences across varying circumstances,” Anderson said.

“This research provides a better understanding of how public health policies could interact with cultural dynamics to bring about unexpected outcomes,” Creanza said. The research was funded by the John Templeton Foundation, and both researchers are members of the Evolutionary Studies Initiative.

Next, Creanza and Anderson aim to make a model to explore how people respond when a new vaccine (eg for COVID), is introduced. When a novel vaccine is initially introduced, people tend to exhibit more unpredictable behaviour, even those who have confidence in established vaccines, Creanza said.

Source: Vanderbilt University

Categories : COVID Pain ManagementTags : Leave a comment

Does COVID Infection or Vaccination Worsen Migraines?

On By ModernMedia
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Headaches are a frequent complaint of those with a COVID infection, or have received a COVID vaccination, and it is thought that it may subsequently increase the frequency of migraines. To put this to the test, an observational study published in the European Journal of Neurology investigated the effects on migraine frequency of having had either been infected with COVID or having received a COVID vaccination.

Among 550 adults who had received migraine-related care at a Spanish headache clinic, 44.9% (247) reported COVID at least once and 83.3% (458) had been vaccinated; 61 patients (24.7%) reported migraine worsening since COVID and 52 (11.4%) since vaccination.

In participants who perceived that their migraines worsened, those who had been infected were 2.5-times more likely to be concerned about migraine worsening and patients who had been vaccinated were 17.3-times more likely to have this concern.

When investigators examined patients’ e-diary information, they observed no significant difference in headache frequency one month before and after infection or vaccination, even when comparing patients with and without self-reported migraine worsening.

“In the case of COVID-19, we reported previously that indeed headache is a frequent and disabling symptom of the infection; yet, it may not necessarily be linked to an increase in migraine frequency,” the authors wrote. “In light of our results, we believe that clinicians should deliver to patients a more reassuring message that COVID-19 and COVID-19 vaccines may marginally affect migraine course and that probably the impact of the infection and vaccines is less than the individual rhythmicity to have attacks. This information may help minimise their worry.”

Source: Wiley

Categories : Gastrointestinal Metabolic DisordersTags : Leave a comment

For Weight Loss, the Side Effects of GLP-1 Agonists can be Hard to Stomach

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GLP-1 agonists are being lauded as game-changers in the fight against obesity, but GLP-1 agonist drugs like semaglutide may come with a heightened risk of severe gastrointestinal problems, according to new research published in JAMA.

Designing their study for the side effects rather than the efficacy of the drugs, the researchers found that GLP-1 agonists are associated with an increased risk of serious medical conditions including gastroparesis (stomach paralysis), pancreatitis and bowel obstruction.

While previous studies highlighted some of these risks in patients with diabetes, this study from the University of British Columbia is the first large, population-level study to examine adverse gastrointestinal events in non-diabetic patients using the drugs specifically for weight loss.

“Given the wide use of these drugs, these adverse events, although rare, must be considered by patients thinking about using them for weight loss,” said first author Mohit Sodhi, a graduate of UBC’s experimental medicine program and fourth year UBC medical student studying the adverse events of commonly prescribed medications. “The risk calculus will differ depending on whether a patient is using these drugs for diabetes, obesity or just general weight loss. People who are otherwise healthy may be less willing to accept these potentially serious adverse events.”

GLP-1 agonists have exploded in popularity over the past decade as an off-label weight-loss tool, reaching approximately 40 million prescriptions in the US in 2022.

It was only in 2021 that some forms of the medications were approved as a treatment for obesity. However, randomised clinical trials examining the efficacy of the medications for weight loss were not designed to capture rare gastrointestinal events due to their small sample sizes and short follow-up periods.

“There have been anecdotal reports of some patients using these drugs for weight loss and then presenting with repeated episodes of nausea and vomiting secondary to a condition referred to as gastroparesis,” said senior author Dr Mahyar Etminan, an epidemiologist and associate professor in the department of ophthalmology and visual sciences at the UBC faculty of medicine. “But until now, there hasn’t been any data from large epidemiologic studies.”

To help fill this knowledge gap, UBC researchers examined health insurance claim records for approximately 16 million US patients and looked at people prescribed either semaglutide or liraglutide, two main GLP-1 agonists, between 2006 and 2020. They included patients with a recent history of obesity, and excluded those with diabetes or who had been prescribed another antidiabetic drug.

The researchers analysed the records to see how many patients developed one of four gastrointestinal conditions, and compared that rate to patients using another weight-loss drug, bupropion-naltrexone. Compared to bupropion-naltrexone, GLP-1 agonists were associated with a:

  • 9.09 times higher risk of pancreatitis, which can cause severe abdominal pain and, in some cases, require hospitalisation and surgery.
  • 4.22 times higher risk of bowel obstruction, resulting in symptoms like cramping, bloating, nausea and vomiting. Depending on the severity, surgery may be required.
  • 3.67 times higher risk of gastroparesis, limiting the passage of food from the stomach to the small intestine and results in symptoms like vomiting, nausea and abdominal pain.

Additionally, the study found a non-significant higher incidence of biliary disease.

The researchers say that although the events are rare, with millions around the world using the drugs, it could still lead to hundreds of thousands of people experiencing these conditions.

“These drugs are becoming increasingly accessible, and it is concerning that, in some cases, people can simply go online and order these kinds of medications when they may not have a full understanding of what could potentially happen. This goes directly against the mantra of informed consent,” said Sodhi.

In the meantime, the researchers hope that regulatory agencies and drug makers will consider updating the warning labels for their products, which currently don’t include the risk of gastroparesis.

“This is critical information for patients to know so they can seek timely medical attention and avoid serious consequences,” said Sodhi.

Source: University of British Columbia

Categories : Environmental EffectsTags : 2 Comments

Opinion Piece: The Harsh Reality of South Africa’s Ongoing Sewage Crisis and its Undeniable Link to Drinking Water Quality

On By ModernMedia
Photo by Hush Naidoo Jade Photography on Unsplash

By Gerhart Britz, Director at Sanitech

South Africa’s sewage crisis has dire consequences for public health, waterways, and ecosystems. Outdated and poorly maintained wastewater infrastructure due to insufficient investment is one factor that results in poor waste management. The strain of rapid urbanisation with inadequate sanitation facilities in informal settlements and the exacerbating impact of climate change through increased rainfall events are also factors that contribute to poor waste management. Despite these challenges, there is room for optimism. Collaborative efforts between government and the private sector have the potential to address this dire situation, bringing forward practical, affordable solutions that hold the promise of a cleaner, healthier future for all communities.

A public health crisis: deadly waterborne diseases

South Africa’s persistent sewage crisis recently sparked a new cholera outbreak, primarily stemming from dysfunctional municipal sewage systems. Over 90% of the nation’s 824 treatment plants discharge untreated or partially treated sewage into our limited water resources. As of June 2023, the Department of Health had documented 1,045 suspected cholera cases across five provinces, with 197 cases confirmed by laboratory testing, directly linked to compromised water supply.

This crisis disproportionately impacts both urban and rural regions, where access to clean water and sanitation remains a pressing concern. Impoverished communities often rely on highly polluted water sources contaminated by sewage from overwhelmed treatment plants, further straining water purification efforts to meet safety standards. Recognising the intrinsic connection between drinking water quality and wastewater treatment is crucial, necessitating immediate attention and resolution.

However, a significant challenge faced by South African communities is the prohibitive cost of implementing waterborne sanitation solutions everywhere. With over four million latrines and roughly 50 million people lacking adequate sanitation, conventional waterborne systems are neither viable nor cost-effective comprehensive solutions.

South Africa’s water quality reports: red flags aplenty

The Blue Drop Report 2023, released in June 2023, paints a concerning picture of South Africa’s drinking water quality. While major cities maintain safe water, outlying areas face contamination and infrastructure challenges. Key statistics from the report reveal that the average Technical Site Assessment (TSA) score for water treatment systems is 69%, indicating partial functionality. About 15% of water supply systems are in poor or critical condition, with only 33% having Water Safety Plans, posing significant risks to water quality. Additionally, 50% of municipalities struggle with bad or poor microbiological water quality.

Wastewater and water wasting: two major risks

The 2023 Green Drop Report assesses wastewater treatment systems, showing a decline with an average score of 50%. Regional disparities persist, with Eastern Cape and Limpopo scoring lowest, while the Western Cape and Gauteng lead. The No Drop Report examines water losses, revealing a decline in overall performance in 2023, with an average score of 65%, which means that one-third of supplied water is wasted before it reaches consumers.

These reports collectively underline the urgent need to enhance drinking water quality in South Africa. Municipalities must focus on prioritising infrastructure maintenance and upgrades, implement risk-based water quality management, and strengthen compliance with standards. The Department of Water and Sanitation must offer more support to municipalities. Failing wastewater treatment facilities exacerbate drinking water purification, risking tap water safety and triggering further potential health and environmental crises. Therefore, they must take steps to safeguard water quality and address sewage infrastructure issues.

Rapid crisis intervention required

South Africa’s sewage crisis is a dire challenge that requires immediate action and innovative solutions. In recognising the inextricable link between sewage waste management and water quality, we must also acknowledge that this crisis cannot only be addressed by government without support from private sector industry leaders and experts. Portable water treatment package plants are available, along with small filtration and sterilisation systems for communities. Wastewater packaged treatment plants and solutions can help both alleviate immediate concerns and contribute to long-term sewage management strategies. Further neglecting the sewage problem and the critical maintenance of existing infrastructure will only deepen our water crisis. For this reason, the government needs to prioritise investment in sewage treatment infrastructure and implement practical, affordable solutions across all communities.

Mitigating South Africa’s sewage crisis

If municipal water supplies deteriorate further, sanitation specialists will be required to step in with a range of interventions. These extend from portable water treatment packaged plants to improve water quality at its source, to small-scale filtration and sterilisation systems designed for household use to ensure safe drinking water directly from the tap. From a contamination perspective, it is critical to reduce sewage entry into water courses, particularly in rural areas and informal settlements. This can be achieved through enhanced sanitation solutions, such as dry sanitation toilets, which are waste-contained alternatives to pit latrines.

From immediate relief to sustainable futures

Interventions will need to consider both immediate and long-term strategies. For short-term relief, containerised package plants can bolster sewage treatment facilities without the need for extensive infrastructure development, alleviating the strain on existing systems. Simultaneously, sanitation providers in the private sector can aid municipalities in implementing long-term solutions, including megalitre plans that feature efficiently packaged treatment plants. By adopting these smaller, cost-effective alternatives, it is possible to achieve the same capacity traditionally associated with larger concrete plants, in a fraction of the time to avert total system collapse and the impending health and economic catastrophes that would surely follow.