Social care staff shortages are having a detrimental impact across the health and care system. There are reports of care homes closing, stopping nursing services and not admitting new residents because of challenges with staff shortages. To develop an explanatory framework of strategies used to attract, recruit, and retain registered nurses and care workers working in care homes. Explain how and why strategies work, for whom, the conditions needed and the costs involved. A realist synthesis approach was used. In step 1, strategies were identified and initial programme theories developed using data from stakeholder consultations (n = 10), theory gleaning interviews with registered nurses and care workers (n = 13), and evidence retrieved from scoping literature searches (n = 50). Strategies (and initial programme theories) prioritised by sector stakeholders focused on staff recruitment and retention, and were taken forward for testing/refinement. Step 2 involved searching academic databases and social care websites for evidence. Step 3 involved screening and selecting records relevant to the prioritised initial programme theories. Relevant data were extracted and analysed to identify context-mechanism-outcome configurations. To assess rigour, the appropriateness of research methods, and the plausibility/transparency of grey literature were assessed. Step 4 involved testing and refining the programme theories, with programme theories sense checked/refined by sector stakeholders. Existing and established theories were used to help further explain the programme theories and develop an overarching explanatory framework. During step 1, strategies used to attract, recruit, and retain registered nurses and care workers were identified and initial programme theories developed (n = 22). Ten strategies and initial programme theories were prioritised for testing/refining and were focused on recruitment and retention: staff recognition, flexible working, career development, salary package, early investment, induction, continuous feedback, caring community, effective interviewing and listening to all staff. From the focused literature searches, 153 papers were included and data from these were used to test and refine the prioritised strategies and initial programme theories, and throughout the process collated into five final theories: effective interviewing, career development, reward and recognition, promoting work-life balance and caring conversations. These strategies do not operate independently; they interact and work together. Effective interviewing sets accurate expectations, and loyalty starts to develop through setting an accurate 'psychological contract' which is fulfilled over time. Opportunities for career development, rewarding and recognising staff, providing flexible working options and supporting staff with caring conversations help staff to feel listened to, respected and valued, which in turn, develops job satisfaction. Supportive leaders and a sense of inclusion and fairness are needed for these strategies to work. These strategies provide staff with positive experiences, and these are reciprocated through employee commitment and loyalty. Supporting staff through providing caring conversations and opportunities for career development also help staff feel empowered. This is the first realist synthesis in this field. The findings provide practical strategies for improving staff recruitment and retention. Stakeholder consultations did not include the views of staff who had left care work. Understanding how to attract new staff to the social care workforce remains an important research gap. This study is registered as PROSPERO CRD42021261112. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR131016) and is published in full in Health and Social Care Delivery Research; Vol. 14, No. 21. See the NIHR Funding and Awards website for further award information. We worked on understanding strategies which can help with attracting, recruiting, and retaining registered nurses and care workers in care homes. In the first step we interviewed registered nurses and care workers, talked to stakeholders (e.g. care home managers), and took insights from relevant research papers. The information was used to identify 22 practical strategies, and develop rough ideas around why the strategies work, for which staff, the conditions needed, and the costs involved. Registered nurses, care workers and wider sector stakeholders prioritised 10 strategies focused on staff recruitment and retention (and not on attracting new staff): staff recognition, flexible working, career development, salary package, early investment, induction, continuous feedback, caring community, effective interviewing and listening to all staff. These were taken forward for further testing and developing. In steps 2–4, we searched online library databases and social care websites for relevant papers (n = 153) and information from these papers was used to build on the rough ideas developed during step 1. Stakeholders helped with refining the final findings. The 10 prioritised strategies were combined into 5: effective job interviews, providing opportunities for career development, rewarding and recognising staff, promoting work–life balance, and caring conversations. The strategies interact and work together. The way staff are recruited is important for retaining staff. Setting accurate expectations during the job interview stage avoids creating false impressions, and this helps with developing staff commitment. Providing staff with career development opportunities, rewards and recognition, flexible working options, and caring conversations helps staff feel listened to, respected, and valued, and this creates job satisfaction. Giving staff opportunities for career development and supporting staff with caring conversations also helps with building staff confidence. Overall, providing staff with positive experiences means staff will also respond positively in return in terms of being committed and loyal to the employer. Supportive leaders and a sense of inclusion and fairness are needed for these strategies to work well. This research has described ways of improving staff recruitment and retention, understanding how to attract new staff remains an important research gap.
Migraine can impair productivity, work performance, and daily functioning in working-age adults. While higher Central Sensitization Inventory (CSI) scores have been observed in migraine chronicity, work-related stress, and musculoskeletal pain are also common among desk-based workers and may play a role in exacerbating migraine symptoms. However, these factors have rarely been studied together in this population. This cross-sectional study aimed to compare central sensitization, work-related stress, and musculoskeletal pain symptoms in desk-based workers with and without migraine, to examine the relationships among them, and to identify the determinants of central sensitization in individuals with migraine. This cross-sectional study included 228 desk-based workers: a control group (CG) without migraine (n = 84), episodic migraine (EM) (n = 74), and chronic migraine (CM) (n = 70). Participants completed the CSI, General Work Stress Scale (GWSS), Nordic Musculoskeletal Questionnaire (NMQ), Migraine Disability Assessment (MIDAS), and Headache Impact Test-6 (HIT-6). Group comparisons were performed using ANOVA or Kruskal-Wallis tests. Spearman coefficients were used in correlation analyses. Multiple linear regression was applied to identify factors associated with CSI. Both migraine groups scored higher on the CSI compared to the CG (p < 0.001), with CM showing the highest CSI scores. This difference remained significant after adjusting for confounders. GWSS scores were also higher in both migraine groups than the CG (p < 0.001) and remained significant after adjustment. NMQ;3-items were significantly higher in the migraine groups compared to the CG (p ≤ 0.005), independent of confounders. In the migraine groups, higher CSI scores showed a positive correlation with GWSS, MIDAS, HIT-6, and NMQ. In multiple linear regression analysis, GWSS (β = 0.380), number of painful body regions during the past 12 months (β = 0.382), MIDAS (β = 0.230), and the number of headache days per month (β = 0.170) were identified as variables independently associated with CSI scores (all p < 0.05). Desk-based workers with migraine had higher central sensitization, greater work-related stress, and more widespread musculoskeletal pain symptoms compared to those without migraine. In desk-based workers with migraine, central sensitization was more pronounced in CM than EM, suggesting a potential role in migraine chronicity. These findings support multifaceted management strategies for desk-based workers with migraine, including headache-stress management, musculoskeletal rehabilitation, and Sustainable Development Goal-3, "to ensure healthy lives and promote well-being for all ages." NCT07554664 (registration date: 21.04.2026).
Occupational fatigue is a complex and widespread issue among healthcare workers, yet its heterogeneous manifestations remain inadequately studied. This study aimed to identify distinct fatigue profiles and examine the multifaceted determinants that differentiate these profiles. A cross-sectional survey was conducted among 734 healthcare workers. The assessment was conducted using the newly developed Healthcare Worker Occupational Fatigue Scale that has undergone reliability and validity tests. Latent profile analysis was used to identify occupational fatigue subgroups, and multiple logistic regression analysis was conducted to explore the influencing factors of each subgroup. Latent profile analysis identified four distinguishable occupational fatigue subgroups: the compensated group (17.97%), the prodromal-symptomatic group (35.29%), the decompensated diffuse group (37.87%), and the systemic crisis group (8.86%). Multivariate logistic regression analysis revealed that perceived workload, department affiliation, number of night shifts per month, low intention to stay, noisy environment, commuting time, and individual-level factors, including gender and health status, were significant risk factors for occupational fatigue. Occupational fatigue among healthcare workers exhibits substantial heterogeneity and can be categorized into four distinct profiles, with multiple contributing factors. It is necessary to adopt hierarchical and personalized intervention strategies based on precise subgroup characteristics, such as systematically reducing the workload and optimizing the acoustic environment for the severe fatigue group, in order to effectively alleviate the occupational fatigue of healthcare workers.
Health care workers face numerous occupational stressors that place them at heightened risk for burnout and poor mental health. Internet-delivered interventions have shown promise in reducing stress and related symptoms, yet adherence is often low, and users do not complete programs. Abbreviated interventions may help address engagement barriers such as high workload, limited time, and varying user preferences. There is a need to evaluate brief, accessible formats of internet-delivered programs for this population. This study aimed to examine the initial outcomes, usability, and acceptability of a 4-week abbreviated internet-delivered stress recovery intervention for health care workers. Specifically, it evaluated changes in stress recovery, perceived stress, depression and anxiety symptoms, and psychological well-being. The study also sought to understand participants' experiences with the brief format to determine whether it meets their needs. This single-arm pre-post study examined a 4-week abbreviated version of the online guided cognitive behavioral therapy-based stress recovery program FOREST among self-enrolled health care workers recruited through professional networks (N=52; mean age 39.31, SD 11.31 years; 49/52, 94.2% women). Outcomes included stress recovery (the Recovery Experience Questionnaire), perceived stress (the Perceived Stress Scale-4), depression and anxiety symptoms (the Patient Health Questionnaire-4), psychological well-being (the World Health Organization Well-being Index), and usability and acceptability ratings. We found that after the abbreviated version of the FOREST intervention participants showed moderate improvements in stress recovery (d=0.54, 95% CI 0.25-0.83); reductions in stress (d=-0.43, 95% CI -0.72 to -0.14), anxiety and depression symptoms (d=-0.51, 95% CI -0.80 to -0.22); and increase in psychological well-being (d=0.39, 95% CI 0.08-0.70). The majority (37/52, 71.2%) accessed all 6 modules. Users reported high satisfaction with the abbreviated program. While preliminary and limited by the pre-post design, these findings indicate that abbreviated internet-based stress recovery programs are a promising and practical tool for supporting the mental health of health care workers. Future research should examine the long-term effects, compare the abbreviated and standard versions, and explore implementation in routine practice.
In the gig economy, the influence of algorithmic management pressure on gig workers' well-being has drawn increasing attention in both theoretical and practical contexts. Grounded in the conservation of resources theory, the study aims to explore the mechanisms linking algorithmic management pressure to three dimensions of gig workers' well-being, with a particular focus on the mediating role of avoidance job crafting. We conducted a three-wave survey with 321 ride-hailing drivers using an anonymous, structured questionnaire that measured algorithmic management pressure, avoidance job crafting, and well-being. We analyzed the data by using SPSS 26.0 and Mplus 8.30. Results show that algorithmic management pressure does not consistently undermine well-being outcomes. Specifically, by eliciting gig workers' avoidance job crafting, algorithmic management pressure exhibits a temporally positive relationship with aspects of their life well-being and workplace well-being. However, the hypothesis regarding the indirect effect of the pressure on psychological well-being through avoidance job crafting is not supported. Theoretical and practical implications are discussed.
To investigate variations in post-operative cataract surgery instructions among eye health workers in Tanzania and identify areas requiring standardization. A cross-sectional survey was conducted among 142 eye health workers across all health workers providing cataract surgery or post-operative care in Tanzania. The survey assessed counselling practices, timing recommendations for resuming 23 daily activities, medication prescription patterns, and follow-up protocols. Variation indices (VI) were calculated to quantify the degree of disagreement among providers using the formula: VI = 1 - (modal frequency/total responses). Variation was classified as low (VI < 0.40), moderate (0.40-0.60), high (0.60-0.70), or very high (> 0.70). Survey respondents included ophthalmology residents (28%), consultant ophthalmologists (22%), ophthalmic nursing officers (17%), assistant medical officers (13%), and optometrists (12.0%). Only 30%of providers routinely provide written post-operative instructions to patients. Substantial variations existed across most activities examined: watching television (VI = 0.775), computer use (VI = 0.761), smartphone use (VI = 0.754), bending for prayers (VI = 0.725), and sexual activity (VI = 0.690). Recommendations for activity resumption ranged from Day 1 to 6 weeks post-operatively (a 41-day span) for most activities. Good consensus existed only for phone use (59.2% allow Day 1, VI = 0.323) and eating normal diet (48.6% allow Day 1, VI = 0.434). Provision of written instructions varied significantly by professional designation (χ²=28.85, p = 0.0013), but activity recommendations showed no significant correlation with designation, years of experience, or surgical volume. The modal number of follow-up visits was 4 (32.4%), with the last visit most commonly scheduled at 8 weeks (30.3%). Substantial variations in post-operative cataract surgery instructions reflect the absence of evidence-based guidelines rather than individual provider factors. The critical deficit in written instruction provision (only 30%) and wide variation in activity restrictions have significant implications for patient compliance, quality of life, and economic productivity. Development of standardized, evidence-based, culturally appropriate guidelines is urgently needed for Tanzania and similar settings in sub-Saharan Africa.
Farm workers experience some of the highest chronic pesticide exposures worldwide, yet potential links with key cardiovascular risk factors remain underexplored. This systematic review focuses specifically on associations between occupational pesticide exposure and hypertension or obesity in farm-exposed adult populations, highlighting two major, modifiable cardiovascular risk factors in a high-risk group. MEDLINE was systematically searched for observational studies of hypertension and/or obesity among adults with farm-related pesticide exposure. Using the PECOS framework, two reviewers independently screened records and extracted data on study design, population, exposure assessment, outcomes, and main findings. Of 355 records, 14 studies met inclusion criteria (10 cross-sectional, 2 case-control, 2 cohort). Most assessed general pesticide use (n = 9), with fewer examining specific pesticide groups, chemical classes, or active ingredients (each n = 4). Obesity was positively associated with organophosphates (n = 3), atrazine (n = 1), and general pesticide exposure (n = 5), while two studies reported inverse associations; no other active ingredient showed consistent effects. General pesticide exposure was associated with hypertension in three studies, but overall evidence for blood pressure was heterogeneous. Occupational exposure to organophosphates, atrazine, and general pesticide use may increase obesity risk among farm workers, suggesting a potential contribution to cardiovascular disease, whereas associations with hypertension remain uncertain. Interpretation is constrained by limited, heterogeneous data and by a predominant focus on compounds now restricted or banned in many high-income settings. Future longitudinal studies should apply standardized, quantitative exposure assessment and evaluate currently used pesticides and mixtures in diverse agricultural contexts.
Mask-Associated Dry Eye disease (MADE) has been linked to facemask wear predominantly because of the upward flow of expired air towards the eyes. Taping the rim of the mask to the nasal bridge has been proposed to reduce MADE. This study compared dry eye disease rates following short-term face mask wear with or without taping the nasal bridge among health workers in National Hospital Abuja. This was a cross-over randomized clinical trial conducted between February and July 2024 at National Hospital Abuja. It involved 77 health workers recruited according to their work environments (Open = 38 and Restricted = 39) using a stratified sampling method. Participants completed a modified MADE Questionnaire to assess MADE risk factors and symptoms. Dry eye symptom scores, Schirmer's test values, Tear Break-Up Time (TBUT), and Oxford ocular surface staining scores were measured before and after six hours of facemask wear, with and without nasal bridge taping, on two separate days. Participants were randomized into group A or B corresponding to facemask wear without taping or with taping on the 1st day. MADE was defined as presence of dry eye symptoms plus an abnormal TBUT, Schirmer's or Oxford corneal staining score post-facemask wear. Descriptive statistics, paired T-test, ANOVA, binary logistic regression and crossover analysis were used to analyze data using SPSS version 26, with statistical significance set at p < 0.05. The mean age of participants was 32.40 ± 9.14 years, with a male to female ratio of 1:2.21. There was a statistically significant difference in all outcome variables pre and post facemask wear with and without taping at the nasal bridge (p < 0.05). TBUT and Oxford scores showed greater improvement post-taped mask wear when compared with mask wear without taping (7.40 ± 2.24 s vs. 5.63 ± 1.82 s; and 0.23 ± 0.43 vs. 0.51 ± 0.70; p < 0.001). MADE developed in 14.3% of participants after facemask wear without taping, versus 3.9% with taping. Working in open environments was identified as a predictor of MADE in the non-taping group (OR: 0.111, p = 0.019). Crossover analysis showed significant carry-over effects in outcome variables. Short-term facemask wear can result in dry eye disease and taping facemasks at the nasal bridge can reduce these effects. Retrospectively registered with the Pan African Clinical Trial Registry (https://pactr.samrc.ac.za/) on August 1, 2025 PACTR202508721722676.
Objectives. Proper use of personal protective equipment (PPE) is essential for worker safety, but many employees fail to use it correctly due to limited knowledge, negative attitudes and low perceived control. This study assessed the effectiveness of a health belief model (HBM)-based educational intervention on PPE use among factory workers in Yasuj. Methods. This quasi-experimental study (2022-2023) randomly assigned 109 workers were to experimental (n = 56) and control (n = 53) groups. The intervention included six 60-min in-person sessions delivered by a researcher and an occupational health expert. Data were collected via an HBM-based questionnaire before and 2 months after the intervention. Statistical analyses included paired t tests, independent t tests and χ2 tests using SPSS version 27. Results. Pre-intervention assessments showed no significant differences between groups (p > 0.05). Post intervention, the experimental group demonstrated significant improvements in all HBM constructs - knowledge, attitudes, perceived susceptibility and severity, perceived benefits and barriers, self-efficacy, guidance for action - as well as PPE-related behavior (p = 0.001). Conclusion. HBM-based educational interventions effectively enhance PPE usage by improving knowledge, shaping positive attitudes and addressing perceived barriers and benefits. These findings support structured educational programs as a key strategy for promoting workplace health and safety.
Urinary 8-hydroxy-2´-deoxyguanosine (8-OHdG), a biomarker for oxidative DNA damage, is commonly used to assess the repair of reactive oxygen species (ROS) induced DNA damage. This study developed predictive models to quantify 8-OHdG concentrations in urine samples based on demographic and exposure-related variables from metal workers (21.27 ng/ml) and controls (12.63 ng/ml) using ELISA and machine learning algorithms. Three models; Random Forest Regressor (RFR), Support Vector Machine Regressor (SVMR), and Gradient Boosting Regressor (GBR) were evaluated for their predictive performance using metrics like Mean Squared Error (MSE), Root Mean Squared Error (RMSE), R-squared (R2), Mean Absolute Error (MAE), and classification metrics including Accuracy, Precision, Recall, and F1 Score. The RFR emerged as the best regression model with an MSE of 1.35, RMSE of 1.16, R2 of 0.92, and precision of 0.89 where feature importance analysis indicated exposure and age as key predictors. The SVMR showed slightly lower performance (MSE = 1.54, R2 = 0.91, precision = 0.83). GBR had reduced regression performance (MSE = 1.66, RMSE = 1.29, R2 = 0.90) but achieved superior classification metrics all at 0.89. Overall, RFR provided the most accurate predictions, while GBR excelled in balancing classification performance. These findings indicated the efficiency of machine learning in quantifying oxidative stress biomarkers.
Health professionals are often confronted with new workplace risks that go beyond physical risks to include psychosocial risks. Moroccan healthcare professionals often experience burnout. Understanding the impact of burnout is essential for creating a healthy work environment in healthcare institutions. This study aimed to systematically analyze: 1) the prevalence of burnout among Moroccan health care professionals. 2) the factors associated with burnout in the same population. A systematic review of articles published in PubMed, Scopus, Science Direct, Web of Science, Medline, and ProQuest databases was conducted using keywords up to July 2024. This review included studies that used the Maslach Burnout Inventory (MBI) to evaluate burnout among Moroccan healthcare professionals in three domains: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment. A total of 14 studies assessing burnout in 4382 Moroccan healthcare professionals were included. The average prevalence of burnout was 73.36%. The burnout prevalence for the three domains ranged from 29 % to 85.71% for high emotional exhaustion (EE), 17% to 79.70% for high depersonalization (DP), and 6% to 85.90% for low personal accomplishment (PA). Young age, female sex, single status, low job satisfaction, poor organization, poor communication, and work conflict were identified as risk factors for burnout. The identification of factors associated with burnout syndrome can help prioritize areas of intervention to prevent it. This will guarantee the work-life quality for health professionals in Morocco.
The commitment of health personnel in initiatives for improving their working conditions is recognised as a key condition for the success and the sustainability of such initiatives. Healthcare organisations are faced with the challenge of deploying strategies needed to mobilise this commitment. The objective of this article is to present the results of a qualitative evaluation of a bottom-up co-construction project aimed at engaging oncology staff in four Québec healthcare organisations in a process of transformation and improvement of their working environment. As part of our constructivist approach, we utilised a qualitative method, which involved conducting one-on-one interviews and gathering documentary data, including survey results, to assess the development and implementation of an intervention across four oncology units. We conducted one-on-one interviews from January 26, 2023 to March 5, 2023 with 17 workers from different categories. We collected documentary data that cover the pre-implementation activities, the co-construction workshops, and the intervention implementation. All collected data were coded and analysed using QDA Miner 6.0, and our findings were validated iteratively throughout the project, involving regular interaction with participants. Fourteen areas of vulnerability emerged across the four dimensions studied, and six were targeted by workers as priorities: emotional exhaustion; role conflict; ability to learn; leadership; team cohesion; and communication. Interventions developed to address the prioritised areas included: co-development workshops; training sessions aimed at enhancing workers' control over their working environment; team connectivity through professional and social activities; staffing and workload reviews; support from a psychosocial professional; and coaching. According to workers, most improvements occurred in two targeted areas, team cohesion and communication, even in the units where these issues were not prioritised at first. Participants pinpointed some factors that facilitated the implementation of the intervention and its impact (engagement, organisational support, the bottom-up approach) and others that created constraints (staff shortages, conflicting priorities, level of commitment). This exploratory work offers insightful perspectives on how a bottom-up co-construction approach can serve as a lever to engage workers to improve their work experience. It may inspire other healthcare organisations, both in oncology and in other fields of activity.
The extension of working life has become a key policy agenda in Western societies. Studies have shown that purpose and competence development are important factors for the extension of working life. Hence, this article provides a theoretical and critical lens for understanding older workers' perceptions of meaningful competence development. It is based on qualitative fieldwork conducted with older workers and their managers in Denmark, with Hartmut Rosa's theory of acceleration, alienation, and resonance as its analytical standpoint. We demonstrate that current labor market dynamics and paradigms of accelerating, continuous competence development risk alienating older workers and shortening their working lives instead of extending them. Furthermore, these dynamics disregard that later working lives are already full of competences, experience, and wisdom. Therefore, we encourage meaningful competence development that blossoms in slow, informal, and mutual encounters and a different logic to counterbalance the current push for acceleration and growth, as older workers can mediate and enable resonance in the workplace. We apply Donna Haraway and Ursula K. Le Guin's theories of swords and carrier bags to problematize dominant stories promoting self-development and a competence orientation for the sake of competition and discuss alternative stories of later working lives that recognize the importance in caring, storing, creating, and sustaining relations. In sum, we contribute with a story that emphasizes the value in consolidating, employing, and nurturing existing skills and relationships in the workplace and recommend a broader repertoire of being in later working life.
There is scarcity of evidence on the changes over time of adherence to oral HIV pre-exposure prophylaxis (PrEP) among female sex workers. Therefore, we assessed the changes of adherence to PrEP over 12 months and influencing factors for suboptimal adherence and explored strategies to optimize adherence to oral PrEP among female sex workers in Tanzania. Convergence analysis was conducted involving 313 respondent driven sampled participants in the city of Tanga. Adherence was assessed at months 1, 6, and 12. In month 12 we conducted 26 in-depth interviews in parallel with quantitative interviews. A modified Poisson regression and thematic analysis was conducted for quantitative and qualitative data respectively. The prevalence of suboptimal adherence at month 1 was 19.5% (95% CI 14.1-26.3), with a significant increase to 91.8% (95% CI 87-94.9) at month 6 and 94.7% (95% CI 90.3-97.1) at month 12. Sub-optimal adherence was influenced by: Medical and medication related barriers, mobility and travel, limited access and availability of PrEP pills, lifestyle-related factors, inadequate PrEP knowledge and low perceived benefits of PrEP, non-disclosure PrEP use and, low perceived HIV risk. Participants recommended modifying PrEP dosing, introducing multiple dosing options at the PrEP care clinic, enhancing counselling sessions, and ensuring continuous availability of PrEP pills. The prevalence of suboptimal PrEP adherence is high among female sex workers in Tanzania. The study underscores the need for implementation research on the introduction of multiple dosing modalities, coupled with improved availability and accessible PrEP services and tailored counselling programs.
Mamás del Río is a community-based intervention that, since 2015, has strengthened maternal and child health in the Peruvian Amazon by empowering community health workers. In July 2024, a leadership workshop was conducted with 24 Indigenous community health workers, employing participatory and intercultural methodologies. The workshop was structured in three stages: 1) participatory diagnosis, 2) capacity building, and (3) strategic planning. As a result, key challenges were identified, and an action plan was developed focusing on partnership development, economic sustainability, and organizational strengthening of the Asociación de Agentes Comunitarios de Salud Intercultural de Loreto. This experience highlights the potential of community empowerment in rural settings and underscores the fundamental role of community health workers in Amazonian health systems.
This study presents a fast, lightweight computer vision framework that achieves high accuracy in verifying the correct use of goggles and N95 masks. For ergonomics practitioners, this model offers a computer vision tool for enhancing workplace safety compliance, that operates up to five times faster than benchmark models. The proposed algorithm enables automated PPE compliance checks at worksite entrances using consumer-grade computing hardware. Thus, reducing the burden of daily safety checks. This system can directly reduce preventable injuries through ensuring workers are properly protected by PPEs before starting work. Ensuring the proper usage of Personal Protective Equipment (PPE) is mandatory to minimize workplace injuries. U.S. Department of Labor reported that appropriate PPE usage reduces over 37% of occupational diseases and injuries. Previous research investigated RepVGG and ResNet50 for PPE compliance, but the highest accuracy reported is limited, about 80%. Another challenge of PPE compliance research is the tradeoff between large model size, with high inference times, and achieving satisfactory accuracy. Our study presents a novel lightweight computer vision framework for automated PPE compliance verification prior to worksite entry. The objective is to achieve 90% of classification accuracy with faster inference time than standard Vision Transformer, while allowing potential deployment on consumer-level computing hardware. Another objective is to identify the incorrect PPE wearing scenario with the spatial relationship awareness between workers and their equipment. The proposed method constructs a state space model layer for linear computation modeling and a spatial attention module to capture global spatial dependencies with positional encoding of an image. We utilized two public PPE compliance datasets, PPE-CLS and PPE-BQZEL, to evaluate the goggles and N95 mask compliance in manufacturing. The model achieved 0.91 and 0.94 accuracy on two datasets, respectively. This outperforms a standard Vision Transformer (ViT) which achieved 0.88 and 0.90, while operating up to 5 times faster. The framework's minimal size (2.8 M parameters) and linear inference scaling enable real-time performance without sacrificing accuracy. This work provides a fast, memory-efficient solution for automated safety supervision, which advances the artificial intelligence and machine learning applications for occupational health.
Burnout, a pervasive phenomenon among healthcare providers, has been linked to both clinicians' and patient safety. This study aimed to assess the association between burnout and patient safety. This cross-sectional study was conducted at Al Nahda General Hospital in Saudi Arabia from 2023 to 2024. A total of 399 healthcare providers (HCPs) completed an online survey. Burnout was measured using the Copenhagen Burnout Inventory (CBI). The primary outcomes were evaluating the prevalence of burnout among HCPs and measuring its association with Patient Safety Management Activities (PSMA). The secondary outcome was to identify potential risk factors affecting PSMA practice. Of the study group, 64.4% of HCPs aged 30 to 45 years, 61.2% were physicians, and 50.1% had over 10 years of experience. The prevalence of burnout among participants was 41%. HCPs under 30 years old exhibited a significantly lower prevalence of burnout compared to those aged 30-45 years (Prevalence ratio (PR) = 0.63, 95% CI: 0.46-0.86, P = 0.003). Work schedule played a significant role, with night-shift workers showing a higher burnout prevalence compared to those on morning shifts (PR = 1.38, 95% CI: 1.09-1.74, P = 0.007). Respondents experiencing burnout showed a significantly higher likelihood of being suboptimal in complying with infection control guidelines (Odds ratio (OR) = 3.78, 95% CI: 1.04-13.69, P = 0.04) and were less likely to be familiar with standard precautions for preventing the spread of infections (OR = 0.30, 95% CI: 0.11-0.82, P = 0.02) compared to those who were not experiencing burnout. HCPs burnout was significantly associated with higher moderate patient involvement in decision-making (OR = 9.69, 95% CI: 2.53-37.10, P = 0.001), speaking up about patient safety concerns within teams and departments (OR = 3.62, 95% CI: 1.18-11.07, P = 0.02), and documentation and record-keeping (OR = 5.17, 95% CI: 1.22-21.81, P = 0.03). Healthcare setting and depression were significant risk factors associated with reduced PSMA. HCPs burnout was prevalent among middle-aged staff (aged 30-45 years) and night shift workers. It is potentially associated with patient safety practices, including lapses in infection control, patient involvement, safe communication, and record documentation. Further research is required to include multiple centers and multi-pronged interventions to mitigate burnout and improve patient safety.
Prolonged recovery from work following commuting accidents entails substantial personal, social, and economic costs; however, the social and health determinants of delayed recovery remain comparatively underexplored. Identifying factors associated with extended recovery is essential for informing prevention strategies and strengthening return-to-work policies. Administrative records from Mutual de Seguridad (Chile) were analyzed using a balanced sample of 10,940 commuting accidents (50% with recoveries of ≥ 90 days and 50% with recoveries of < 90 days). Prolonged recovery was defined as an absence of 90 days or more. A probit model was estimated, and average marginal effects (AMEs) were computed. The dataset was randomly divided into training (70%) and validation (30%) samples to assess model stability. The validation model confirmed the robustness of the estimated effects. A greater probability of prolonged recovery was observed among male workers (10%), individuals aged 45 years or older (12%), individuals with multiple diagnoses (20%), and cases classified as severe (59%). Situational factors were also relevant: Commuting accidents occurring between 18:00 and 24:00 h (6%) and during the Friday-Sunday period (5%) were associated with an increased likelihood of extended absence. In contrast, injuries classified as traumatic were associated with a lower probability of prolonged recovery (-43%). The findings underscore the importance of considering not only individual and clinical characteristics but also situational factors when designing prevention and return-to-work strategies for commuting-related injuries. Preventive policies should prioritize older workers, men, and late-day and late-week (Friday-Sunday) commuting contexts while recognizing that accident frequency does not necessarily coincide with the recovery burden. A commuting-specific perspective may strengthen occupational risk management and contribute to reducing prolonged work absence. La recuperación prolongada tras accidentes de trayecto genera importantes costos personales, sociales y económicos; no obstante, los determinantes sociales y de salud asociados a la ausencia laboral prolongada siguen siendo poco estudiados, especialmente en países de ingresos medios. Identificar los factores vinculados a recuperaciones prolongadas es clave para orientar estrategias de prevención y políticas de reintegro laboral desde una perspectiva de salud pública. MéTODOS: Se analizaron registros administrativos de Mutual de Seguridad (Chile), utilizando una muestra balanceada de 10.940 accidentes de trayecto (50% con ausencias ≥90 días y 50% con ausencias <90 días). La recuperación prolongada se definió como una ausencia laboral igual o superior a 90 días. Se estimó un modelo probit y se calcularon efectos marginales promedio (AMEs). Para evaluar la estabilidad del modelo, la base de datos se dividió aleatoriamente en una muestra de estimación (70%) y una de validación (30%). El modelo de validación confirmó la robustez de los resultados. Se observó una mayor probabilidad de recuperación prolongada entre hombres, personas de 45 años o más, trabajadores con múltiples diagnósticos y accidentes clasificados como severos. Asimismo, los accidentes ocurridos entre las 18:00 y las 24:00 horas y durante el período viernes–domingo se asociaron con una mayor probabilidad de ausencia prolongada. En contraste, las lesiones traumáticas se asociaron con una menor probabilidad de recuperación prolongada. Los resultados destacan la importancia de considerar no solo factores individuales y clínicos, sino también condiciones situacionales del accidente al diseñar estrategias de prevención y políticas de reintegro laboral. Desde una perspectiva de salud pública, las intervenciones preventivas deberían priorizar a trabajadores mayores, hombres y trayectos asociados con mayor carga de severidad, reconociendo que la frecuencia de los accidentes no siempre coincide con su impacto en términos de recuperación y carga social.
The November 2023/2024 national health budget cuts represent the largest reduction in public health expenditure in South Africa's post-apartheid history. This article critically examines the implications of these budget cuts within the context of the country's post-apartheid health system reforms and macroeconomic strategies. Specifically, it documents the historical evolution of fiscal policies and health expenditure across three distinct periods: the 2008 - 2013 period, which witnessed a counter-cyclical fiscal strategy that improved healthcare access and began addressing apartheid-era disparities; the years 2013 - 2023, marked by economic and political instability, culminating in a national debt crisis exacerbated by COVID-19, which eroded health system resilience under fiscal consolidation policies; and the post-November 2023/2024 period, which represents a distinct threat to two decades of progress in health equity and outcomes under further fiscal consolidation measures. The article discusses the impact of these austerity measures on healthcare workers and patient populations and the implementation of the National Health Insurance, while exploring the ethical and legal implications. It concludes by proposing recommendations for system-wide reforms to mitigate the negative effects of these budget cuts and prevent systemic collapse.