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Introduction: The operating room (OR) is a high-cost and high-revenue area in a hospital comprising extremely complex process steps to treat patients. The perioperative process quality can be optimized through an efficiency-oriented central OR management based on performance indices. However, during the COVID-19 pandemic with the corresponding OR restrictions, there was a significant nation- and worldwide decline in the performance, which may have a lasting impact. Therefore, we proposed the hypothesis that COVID-19 pandemic-related OR restrictions could reduce operative performance in the long term., Methods: A retrospective, descriptive analysis of perioperative processing times was conducted exemplarily at the University Hospital Ulm using a pre-post design, examining the corresponding second quarters of 2019 to 2022. In total, n = 18,489 operations with n = 314,313 individual time intervals were analyzed. The statistical analyses included the Kruskal-Wallis test adjusted for multiple testing, and the significance level was set at p < 0.01., Results: The results revealed not only a significant decrease in the case volume by 31% (2020) and 23% (2021) during the COVID-19 crisis years, but also significant time delays in various process steps; e.g. the median patient's OR occupancy time (column time) rose from 65 min (2019) to 87 min (2020) and remained elevated (72 min in 2021 and 74 min in 2022, respectively). Even in 2022, beyond the pandemic, the net anaesthesia time was permanently enhanced by 9 min per case. Furthermore, both, the incision-to-closure time and surgeon attachment time were each significantly prolonged by 7 additional minutes, and the time from the end of anaesthesia to the release of the next patient was extended by 4 min. Selected standardized index operations showed only a trend towards these changes, even with a decrease in the incision-to-closure time over time., Conclusion: Overall, long-term changes were found in essential perioperative process times even after retraction of the COVID-19 restrictions, indicating some processual "slow down" after the Covid-19-induced "shut down". Further analyses are needed to determine the appropriate targeted control measures to improve processing times and increase the process quality., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction : Burnout and depression both occur with chronic work-related stress, and cognitive deficits have been found when symptom severity results in work disability. Less is known about cognitive deficits associated with milder symptoms among active workers, and few studies have examined whether cognitive deficits predict persistent burnout and depression symptoms. The goal of this study was to examine the association of information processing speed and executive function performance to burnout and depression symptoms at baseline and 12-month follow-up in a sample of actively working individuals (N = 372). Method : The design was prospective with laboratory cognitive data at baseline, and burnout and depressive symptoms assessed at baseline and monthly follow-ups. Information processing speed and executive functions were assessed in a task-switching paradigm, including single-task reaction time (RT), switching costs, and mixing costs. Burnout was assessed with the Exhaustion subscale of the Oldenburg Burnout Inventory and depression with the Patient Health Questionnaire-9. Results : Slower RT was modestly associated with higher levels of burnout symptoms both cross-sectionally and prospectively, but switching costs and mixing costs were not associated with burnout symptoms. None of the cognitive measures were associated with depression symptoms cross-sectionally or prospectively. Conclusions : Despite statistically significant findings of slowed RT in acute exhaustion-related burnout, the proportion of variance accounted for in the models was small and did not predict clinically significant levels of distress. The absence of statistically significant findings for depression symptoms suggests the cognitive profile associated with the exhaustion dimension of burnout may be distinct from that of depression, which reflects a more heterogeneous symptomatology. Our data suggest the clinical impact of burnout symptoms on actively working individuals is marginal; nonetheless, it is important to screen and intervene on burnout and depression symptoms in the workplace because they can lead to other forms of work impairment.

Objective: The aim of this study was to assess the prevalence of pharmacological neuroenhancement in 4 occupations and to investigate its association with psychosocial working conditions and mental health., Methods: In the study on "Neuroenhancement Behaviour in the Context of Stressful Workload - empirical Studies on Employees", 4166 employed physicians, advertising experts, publishers and software developers were surveyed with computer-assisted personal interviews. Lifetime, 12 months and 4 weeks prevalence rates with corresponding confidence intervals were calculated. The association of neuroenhancement with psychosocial working conditions and mental health were estimated in Poisson regression models., Results: The lifetime prevalence of pharmacological neuroenhancement was 8.4%, the 12 months prevalence 2.9% and the 4 weeks prevalence 1.3%. Advertising experts and female software developers showed elevated prevalence rates for neuroenhancement. Psychosocial working conditions, such as support from colleagues, role clarity, emotional demands and job insecurity were associated with neuroenhancement in men. Burnout and depressive symptoms were related to an increase in neuroenhancement., Conclusions: Compared to samples from the general population or the overall working population, the estimated prevalence rates among the investigated occupations were slightly elevated. Burnout and depressive symptoms might operate as potential risk factors or consequences of pharmacological neuroenhancement., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Burnout and depression pose significant threats to emotional and occupational functioning; however, questions exist over how these 2 conditions are associated with each other over time, and how these are related to underlying job stressors. The job demands-resources model provides a useful framework for understanding how job demands and job resources may lead to burnout, but questions remain about their distinct association with depression symptoms. The current study examined these questions in a sample of 402 nursing workers. The Exhaustion subscale of the Oldenburg Burnout Inventory, the Patient Health Questionnaire-9 depression assessment, and items reflecting job demands and job resources from the Copenhagen Psychosocial Questionnaire were assessed at baseline; additionally, Oldenburg Burnout Inventory Exhaustion and Patient Health Questionnaire-9 depression were assessed over 12 monthly follow-ups. Linear mixed models assessed longitudinal bidirectional associations between burnout and depression in both concurrent and lagged models. Longitudinal models found bidirectional relationships between burnout and depression symptoms over time, with relatively stronger associations for concurrent models relative to lagged models. Job demands and job resources each predicted unique variance in burnout and depression symptoms over time. Results provide evidence that burnout and depression symptoms change in the same direction, in tandem, rather than one condition having a distinctly stronger temporal association over the other. Results also indicate that both job demands and job resources are associated with depression symptoms independent from their association with burnout symptoms. Our results highlight the importance of considering burnout symptoms, depression symptoms, and job stressors concurrently in evaluating worker mental health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Aim: Do the amount of workload, strain and the association between both differ between employed physician and other employees subject to social security contributions? This is investigated in this present study by comparing two representative samples., Methods: Psycho-social working conditions were by assessed computer-assisted personal interviews and supplemented by questions about burnout and depressive symptoms. The associations were investigated by linear regression analysis including moderating effects due to differences between occupations., Results: The score for depressive symptoms was lower among male and female physicians than in the comparison groups. Moreover, male physician had higher scores for burnout. Quantitative demands and job insecurity were associated with an increase of scores for burnout and depressive symptoms. Higher quality of leadership, role clarity, and decision latitude contributed to a decrease of both scores. Additional effects were found for hours worked per week (females) and number of night shifts (males). The moderating effect of occupational group was detected for quantitative demands and decision latitude., Conclusion: The associations of working conditions with mental health indicators are similar in the compared groups. There is a higher workload and higher level of burnout among physicians but there is no indication for more depressive symptoms., Competing Interests: Die Autoren geben an, dass kein Interessenskonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

OBJECTIVESince 2007, a continuous neurosurgery emergency service has been available in the International Security Assistance Force (ISAF) field hospital in Mazar-e-Sharif (MeS), Afghanistan. The object of this study was to assess the number and range of surgical procedures performed on the spine in the period from 2007 to 2014.METHODSThis is a retrospective analysis of the annual neurosurgical caseload statistics from July 2007 to October 2014 (92 months). The distribution of surgical urgency (emergency, delayed urgency, or elective), patient origin (ISAF, Afghan National Army, or civilian population), and underlying causes of diseases and injuries (penetrating injury, blunt injury/fracture, or degenerative disease) was analyzed. The range and pattern of diagnoses in the neurosurgical outpatient department from 2012 and 2013 were also evaluated.RESULTSA total of 341 patients underwent neurosurgical operations in the period from July 2007 to October 2014. One hundred eighty-eight (55.1%) of the 341 procedures were performed on the spine, and the majority of these surgeries were performed for degenerative diseases (127/188; 67.6%). The proportion of spinal fractures and penetrating injuries (61/188; 32.4%) increased over the study period. These spinal trauma diagnoses accounted for 80% of the cases in which patients had to undergo operations within 12 hours of presentation (n = 70 cases). Spinal surgeries were performed as an emergency in 19.8% of cases, whereas 17.3% of surgeries had delayed urgency and 62.9% were elective procedures. Of the 1026 outpatient consultations documented, 82% were related to spinal issues.CONCLUSIONSCompared to the published numbers of cases from neurosurgery units in the rest of the ISAF area, the field hospital in MeS had a considerably lower number of operations. In addition, MeS had the highest rates of both elective neurosurgical operations and Afghan civilian patients. In comparison with the field hospital in MeS, none of the other ISAF field hospitals showed such a strong concentration of degenerative spinal conditions in their surgical spectrum. Nevertheless, the changing pattern of spine-related diagnoses and surgical therapies in the current conflict represents a challenge for future training and material planning in comparable missions.

Objective: The aim of the study was to present first representative data on burnout measured as exhaustion in German employees., Methods: Data were taken from the Study on Mental Health at Work (n = 4058). Computer-assisted personal interviews were conducted in 2011 to 2012. Multiple linear regression models were estimated to investigate the association between work-related and personal variables and burnout., Results: Severe burnout was detected in nearly 3% of employees. Job demands were associated with higher burnout scores, more resources with lower scores. Independent of personal factors, higher quantitative demands (men: regression coefficient [β] = 0.19; 95% confidence interval [CI], 0.16 to 0.23; women: β = 0.24; 95% CI, 0.20 to 0.27) was identified as the strongest predictor of burnout measured as exhaustion. The model explained 28% to 33% of the total variance., Conclusions: Quantitative demands seem to be important risk factors for burnout independent of critical life events and general self-efficacy.

Background: Job related factors have been associated with higher risk for developing depression, but past studies lacked full consideration of individual factors such as personality and coping. We sought to evaluate associations of personality, coping, job characteristics, and burnout with 12-month trajectories of depressive symptoms among nursing workers., Methods: Cohort of nursing workers (N = 281) in a private hospital system, with baseline assessments of personality, job characteristics, and coping. Burnout and depression were measured at baseline and during monthly follow-ups. Linear mixed modeling was used to examine contributions to between- and within-individual variation in monthly depressive symptoms., Results: Personality trait of negative affectivity accounted for 36% of between-individual variation in depressive symptoms over 12 months, while job characteristics and coping explained an additional 5% and 8% of this variation, respectively. Exhaustion dimension of burnout was associated with between-individual variation in depressive symptoms (fixed effect β coefficient 2.44, p < 0.001), but not with within-individual variation in symptoms. Disengagement dimension of burnout was not associated with between-individual variation in depressive symptoms, but contributed to within-individual variation in depressive symptoms over time (fixed effect β coefficient 0.52, p = 0.01)., Limitations: Participants were nursing workers within a single hospital system. Participants who were excluded due to missing baseline data were more likely of non-white race, which may also limit the generalizability of our results. We used latent variables to represent certain job and coping characteristics, which may make our results less comparable with other studies examining the role of these factors in work-associated depression., Conclusions: Future interventions to prevent depression in healthcare workers should consider multiple job and individual factors. Potential components include strategies to manage negative affectivity and reduce avoidant coping, such as cognitive reframing and mindfulness-based techniques, and organizational approaches to address burnout through augmentation of job resources., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Burnout is a syndrome occurring mainly in individuals with long-term stressful work. The main complaints are emotional exhaustion and reduced performance. Burnout also largely overlaps with depression. Both are characterized by increased incidence of infections due to dysregulation of the immune system, overexpression of pro-inflammatory cytokines and cognitive deficits, particularly related to executive functions. To distinguish between burnout and depression already at the pre-clinical stage, the present double-blinded study compared immunological and cognitive parameters in seventy-six employees from emotionally demanding occupations who were post-hoc subdivided into two groups scoring low (EE-) and high (EE+) in emotional exhaustion and low (DE-) and high (DE+) in depression. Immunological parameters were measured from blood samples. Executive functions were studied by analyzing event-related brain potentials (ERPs) and performance during a task switching paradigm. Psychosocial job parameters were measured with standardized questionnaires. Burnout and mild to moderate depression largely overlapped. However, several subjects showed burnout without depressive symptoms. Higher levels of the pro-inflammatory cytokines IL-6 and IL-12 were correlated with burnout severity and depressive symptoms in male individuals. In the switch task a trend for lower performance in the EE+ vs. EE- group and no difference between DE+ and DE- groups were found. In the ERPs, however, differences were observed which distinguished between subclinical burnout and depression: the terminal contingent negative variation (CNV), indicating preparatory activity and the P3b, related to allocation of cognitive resources were generally reduced in EE+ vs. EE-, whereas no differences were found in the DE+ vs. DE- groups. The frontal P3a was selectively reduced in switch trials in the EE+ vs. EE- group and showed only a trend in DE+ vs. DE-, indicating impairment of executive control in subclinical burnout. Taken together, the results unveil specific immunological changes and declines in brain functions in employees with subclinical burnout that are not apparent in persons with moderate depression. Hence, the combination of immunological, behavioral and ERP methods renders a promising method for distinguishing both syndromes and for improving an early diagnosis of burnout before a clinical stage is reached., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Burnout is a pattern of complaints in individuals with emotionally demanding jobs that is often seen as a precursor of depression. One often reported symptom of burnout is cognitive decline. To analyze cognitive control and to differentiate between subclinical burnout and mild to moderate depression a double-blinded study was conducted that investigates changes in the processing of performance errors and feedback in a task switching paradigm. Fifty-one of 76 employees from emotionally demanding jobs showed a sufficient number of errors to be included in the analysis. The sample was subdivided into groups with low (EE-) and high (EE+) emotional exhaustion and no (DE-) and mild to moderate depression (DE+). The behavioral data did not significantly differ between the groups. In contrast, in the EE+ group, the error negativity (Ne/ERN) was enhanced while the error positivity (Pe) did not differ between the EE+ and EE- groups. After negative feedback the feedback-related negativity (FRN) was enhanced, while the subsequent positivity (FRP) was reduced in EE+ relative to EE-. None of these effects were observed in the DE+ vs. DE-. These results suggest an upregulation of error and negative feedback processing, while the later processing of negative feedback was attenuated in employees with subclinical burnout but not in mild to moderate depression., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Aims: The Study on Mental Health at Work (S-MGA) generates the first nationwide representative survey enabling the exploration of the relationship between working conditions, mental health and functioning. This paper describes the study design, sampling procedures and data collection, and presents a summary of the sample characteristics., Methods: S-MGA is a representative study of German employees aged 31-60 years subject to social security contributions. The sample was drawn from the employment register based on a two-stage cluster sampling procedure. Firstly, 206 municipalities were randomly selected from a pool of 12,227 municipalities in Germany. Secondly, 13,590 addresses were drawn from the selected municipalities for the purpose of conducting 4500 face-to-face interviews. The questionnaire covers psychosocial working and employment conditions, measures of mental health, work ability and functioning. Data from personal interviews were combined with employment histories from register data. Descriptive statistics of socio-demographic characteristics and logistic regressions analyses were used for comparing population, gross sample and respondents., Results: In total, 4511 face-to-face interviews were conducted. A test for sampling bias revealed that individuals in older cohorts participated more often, while individuals with an unknown educational level, residing in major cities or with a non-German ethnic background were slightly underrepresented., Conclusions: There is no indication of major deviations in characteristics between the basic population and the sample of respondents. Hence, S-MGA provides representative data for research on work and health, designed as a cohort study with plans to rerun the survey 5 years after the first assessment.