22 results on '"Khireddine-Medouni, Imane"'
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2. Characteristics of persons who died by suicide in prison in France: 2017–2018
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Vanhaesebrouck, Alexis, Tostivint, Amélie, Lefèvre, Thomas, Melchior, Maria, Khireddine-Medouni, Imane, and Chee, Christine Chan
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- 2022
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3. Harmonized definition of occupational burnout : A systematic review, semantic analysis, and Delphi consensus in 29 countries
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Canu, Irina Guseva, Marca, Sandy Carla, Dell'Oro, Francesca, Balázs, Ádám, Bergamaschi, Enrico, Besse, Christine, Bianchi, Renzo, Bislimovska, Jovanka, Bjelajac, Adrijana Koscec, Bugge, Merete, Busneag, Carmen Iliana, Çağlayan, Çiğdem, Cernițanu, Mariana, Pereira, Cristiana Costa, Hafner, Nataša Dernovšček, Droz, Nadia, Eglite, Maija, Godderis, Lode, Gündel, Harald, Hakanen, Jari J, Iordache, Raluca Maria, Khireddine-Medouni, Imane, Kiran, Sibel, Larese-Filon, Francesca, Lazor-Blanchet, Catherine, Légeron, Patrick, Loney, Tom, Majery, Nicole, Merisalu, Eda, Mehlum, Ingrid Sivesind, Michaud, Laurent, Mijakoski, Dragan, Minov, Jordan, Modenese, Alberto, Molan, Marija, van der Molen, Henk, Nena, Evangelia, Nolimal, Dusan, Otelea, Marina, Pletea, Elisabeta, Pranjic, Nurka, Rebergen, David, Reste, Jelena, Schernhammer, Eva, and Wahlen, Anny
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- 2021
4. Suicide among agricultural, forestry, and fishery workers: a systematic literature review and meta-analysis
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Klingelschmidt, Justine, Milner, Allison, Khireddine-Medouni, Imane, Witt, Katrina, Alexopoulos, Evangelos C, Toivanen, Susanna, LaMontagne, Anthony D, Chastang, Jean-François, and Niedhammer, Isabelle
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- 2018
5. Impact de la COVID-19 sur la santé mentale aux urgences et chez SOS Médecins, France, 2020-21
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Forgeot, Cécile, primary, Pontais, Isabelle, additional, Khireddine-Medouni, Imane, additional, Du Roscoät, Enguerrand, additional, Fouillet, Anne, additional, Bauchet, Emmanuelle, additional, and Caserio-Schonemann, Céline, additional
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- 2022
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6. Additional file 1 of Characteristics of persons who died by suicide in prison in France: 2017���2018
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Vanhaesebrouck, Alexis, Tostivint, Am��lie, Lef��vre, Thomas, Melchior, Maria, Khireddine-Medouni, Imane, and Chee, Christine Chan
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Additional file 1: Health questionnaire of the study in English and in French.
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- 2022
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7. Additional file 3 of Characteristics of persons who died by suicide in prison in France: 2017���2018
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Vanhaesebrouck, Alexis, Tostivint, Am��lie, Lef��vre, Thomas, Melchior, Maria, Khireddine-Medouni, Imane, and Chee, Christine Chan
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Additional file 3: Tables 2 and 3 Ligature points and ligature for cases deceased by hanging/self-strangulation.
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- 2022
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8. Additional file 2 of Characteristics of persons who died by suicide in prison in France: 2017���2018
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Vanhaesebrouck, Alexis, Tostivint, Am��lie, Lef��vre, Thomas, Melchior, Maria, Khireddine-Medouni, Imane, and Chee, Christine Chan
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Additional file 2: Table 1 Sociodemographic, penal characteristics and circumstances of suicide of cases according to the collection of health data.
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- 2022
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9. Additional file 4 of Characteristics of persons who died by suicide in prison in France: 2017���2018
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Vanhaesebrouck, Alexis, Tostivint, Am��lie, Lef��vre, Thomas, Melchior, Maria, Khireddine-Medouni, Imane, and Chee, Christine Chan
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Additional file 4: Table 4 Suicide incidence rates according to some characteristics of the prisoners.
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- 2022
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10. Enjeux de la contention mécanique dans les services d’urgence
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Khireddine-Medouni, Imane and Gourevitch, Raphaël
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- 2021
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11. Harmonized definition of occupational burnout. A systematic review, semantic analysis, and Delphi consensus in 29 countries
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Guseva Canu, Irina, Marca, Sandy Carla, Dell’Oro, Francesca, Balázs, Ádám, Bergamaschi, Enrico, Besse, Christine, Bianchi, Renzo, Bislimovska, Jovanka, Koscec Bjelajac, Adrijana, Bugge, Merete, Busneag, Carmen Iliana, Çağlayan, Çiğdem, Cernițanu, Mariana, Costa Pereira, Cristiana, Dernovšček Hafner, Nataša, Droz, Nadia, Eglite, Maija, Godderis, Lode, Gündel, Harald, Hakanen, Jari J., Iordache, Raluca Maria, Khireddine-Medouni, Imane, Kiran, Sibel, Larese-Filon, Francesca, and Lazor-Blanchet, Catherine
- Abstract
Background: A consensual definition of occupational burnout is currently lacking. We aimed to harmonize the definition of occupational burnout as a health outcome in medical research and to reach a consensus on this definition within the Network on the Coordination and Harmonisation of European Occupational Cohorts (OMEGA-NET). Methods: First, we performed a systematic review in MEDLINE, PsycINFO and EMBASE (January 1990 to August 2018) and a semantic analysis of the available definitions. We used the definitions of burnout and burnout-related concepts from the Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) to formulate a consistent harmonized definition of the concept. Second, we sought to obtain consensus on the proposed definition using the Delphi technique. Results: We identified 88 unique definitions of burnout and assigned each of them to one of the 11 original definitions. The semantic analysis yielded a semantic proposal, formulated in accordance with SNOMED-CT as follows: “In a worker, occupational burnout or occupational physical AND emotional exhaustion state is an exhaustion due to prolonged exposure to work-related problems”. A panel of 50 experts (researchers and healthcare professionals with an interest for occupational burnout) reached consensus on this proposal at the second round of the Delphi, with 82% of experts agreeing on it. Conclusion: This study resulted in a harmonized definition of occupational burnout approved by experts from 29 countries within the OMEGA-NET. Future research should address the reproducibility of the Delphi consensus in a larger panel of experts, representing more countries, and examine the practicability of the definition.
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- 2020
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12. Harmonized definition of occupational burnout: A systematic review, semantic analysis, and Delphi consensus in 29 countries
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Guseva Canu, Irina, primary, Marca, Sandy Carla, additional, Dell'Oro, Francesca, additional, Balázs, Ádám, additional, Bergamaschi, Enrico, additional, Besse, Christine, additional, Bianchi, Renzo, additional, Bislimovska, Jovanka, additional, Koscec Bjelajac, Adrijana, additional, Bugge, Merete, additional, Busneag, Carmen Iliana, additional, Çağlayan, Çiğdem, additional, Cernițanu, Mariana, additional, Costa Pereira, Cristiana, additional, Dernovšček Hafner, Nataša, additional, Droz, Nadia, additional, Eglite, Maija, additional, Godderis, Lode, additional, Gündel, Harald, additional, Hakanen, Jari J, additional, Iordache, Raluca Maria, additional, Khireddine-Medouni, Imane, additional, Kiran, Sibel, additional, Larese-Filon, Francesca, additional, Lazor-Blanchet, Catherine, additional, Légeron, Patrick, additional, Loney, Tom, additional, Majery, Nicole, additional, Merisalu, Eda, additional, Mehlum, Ingrid Sivesind, additional, Michaud, Laurent, additional, Mijakoski, Dragan, additional, Minov, Jordan, additional, Modenese, Alberto, additional, Molan, Marija, additional, van der Molen, Henk, additional, Nena, Evangelia, additional, Nolimal, Dusan, additional, Otelea, Marina, additional, Pletea, Elisabeta, additional, Pranjic, Nurka, additional, Rebergen, David, additional, Reste, Jelena, additional, Schernhammer, Eva, additional, and Wahlen, Anny, additional
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- 2020
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13. Le suicide chez les travailleurs du secteur agriculture, sylviculture et pêche: une revue systématique de la littérature et méta-analyse
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Klingelschmidt, Justine, Milner, Allison, Khireddine-Medouni, Imane, Witt, Katrina, Alexopoulos, Evangelos C, Toivanen, Susanna, LaMontagne, Anthony D, Chastang, Jean-François, Niedhammer, Isabelle, Klingelschmidt, Justine, Milner, Allison, Khireddine-Medouni, Imane, Witt, Katrina, Alexopoulos, Evangelos C, Toivanen, Susanna, LaMontagne, Anthony D, Chastang, Jean-François, and Niedhammer, Isabelle
- Abstract
ObjectifsLes objectifs de l’étude étaient de quantifier le risque de suicide des travailleurs de l’agriculture, de la sylviculture et de la pêche via une revue systématique de la littérature et une méta-analyse et d’étudier les éventuelles variations de risque au sein de cette population selon ses caractéristiques professionnelles et sociodémographiques. Jusqu’à présent, le suicide au sein de cette population n’avait jamais fait l’objet d’une revue systématique de la littérature et/ou d’une méta-analyse.MéthodesUne revue systématique de la littérature sur la période 1995–2016 et une méta-analyse à partir de la base de données MEDLINE via le moteur de recherche Pubmed ont été réalisées conformément aux recommandations PRISMA. La méta-analyse a permis de calculer une estimation poolée de la taille d’effet du risque de suicide au sein de la population d’intérêt. Des analyses par sous-groupes ont ensuite été …
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- 2019
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14. Response to letter to the editor from Dr Rahman Shiri : The challenging topic of suicide across occupational groups
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Niedhammer, Isabelle, Milner, Allison, Witt, Katrina, Klingelschmidt, Justine, Khireddine-Medouni, Imane, Alexopoulos, Evangelos C., Toivanen, Susanna, Chastang, Jean-Francois, LaMontagne, Anthony D., Niedhammer, Isabelle, Milner, Allison, Witt, Katrina, Klingelschmidt, Justine, Khireddine-Medouni, Imane, Alexopoulos, Evangelos C., Toivanen, Susanna, Chastang, Jean-Francois, and LaMontagne, Anthony D.
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- 2018
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15. Response to letter to the editor from Dr Rahman Shiri: The challenging topic of suicide across occupational groups
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Niedhammer, Isabelle, primary, Milner, Allison, additional, Witt, Katrina, additional, Klingelschmidt, Justine, additional, Khireddine-Medouni, Imane, additional, Alexopoulos, Evangelos C, additional, Toivanen, Susanna, additional, Chastang, Jean-François, additional, and LaMontagne, Anthony D, additional
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- 2017
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16. Suicide among agricultural, forestry, and fishery workers: a systematic literature review and meta-analysis
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Klingelschmidt, Justine, primary, Milner, Allison, additional, Khireddine-Medouni, Imane, additional, Witt, Katrina, additional, Alexopoulos, Evangelos C, additional, Toivanen, Susanna, additional, LaMontagne, Anthony D, additional, Chastang, Jean-François, additional, and Niedhammer, Isabelle, additional
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- 2017
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17. Augmentation des taux de prévalence de la souffrance psychique en lien avec le travail chez les salariés actifs en France entre 2007 et 2012, à partir du programme MCP
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Khireddine-Medouni, Imane, primary, Lemaître, Audrey, additional, Homère, Julie, additional, Plaine, Julie, additional, Garras, Loïc, additional, Riol, Marie-Christine, additional, and Valenty, Madeleine, additional
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- 2016
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18. Suicide among agricultural, forestry, and fishery workers.
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Shiri, Rahman, Niedhammer, Isabelle, Milner, Allison, Witt, Katrina, Klingelschmidt, Justine, Khireddine-Medouni, Imane, Alexopoulos, Evangelos C., Toivanen, Susanna, Chastang, Jean-François, and LaMontagne, Anthony D.
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SUICIDAL behavior ,PSYCHOLOGY of agricultural laborers ,INDUSTRIAL hygiene - Published
- 2018
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19. Harmonized definition of occupational burnout: A systematic review, semantic analysis, and Delphi consensus in 29 countries
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Merette Bugge, Laurent Michaud, Francesca Dell'Oro, Jovanka Karadzinska Bislimovska, Nadia Droz, Dragan Mijakoski, Carmen Iliana Busneag, Sandy Carla Marca, Adrijana Košćec Bjelajac, Nataša Dernovšček Hafner, Maija Eglite, Henk F. van der Molen, Irina Guseva Canu, Eda Merisalu, Francesca Larese-Filon, Catherine Lazor-Blanchet, Sibel Kiran, Dusan Nolimal, Jordan Minov, Patrick Légeron, Ádám Balázs, Harald Gündel, David S Rebergen, Christine Besse, Marina Otelea, I. Khireddine-Medouni, Jari Hakanen, Tom Loney, Raluca Maria Iordache, Elisabeta Pletea, Nicole Majery, Eva S. Schernhammer, Jelena Reste, Cristiana Pereira, Renzo Bianchi, Enrico Bergamaschi, Alberto Modenese, Marija Molan, Ingrid Sivesind Mehlum, Çiğdem Çağlayan, Anny Wahlen, Evangelia Nena, Nurka Pranjić, Lode Godderis, Mariana Cernițanu, Guseva Canu, Irina, Marca, Sandy Carla, Dell'Oro, Francesca, Balázs, Ádám, Bergamaschi, Enrico, Besse, Christine, Bianchi, Renzo, Bislimovska, Jovanka, Koscec Bjelajac, Adrijana, Bugge, Merete, Busneag, Carmen Iliana, Çağlayan, Çiğdem, Cernițanu, Mariana, Costa Pereira, Cristiana, Dernovšček Hafner, Nataša, Droz, Nadia, Eglite, Maija, Godderis, Lode, Gündel, Harald, Hakanen, Jari J, Iordache, Raluca Maria, Khireddine-Medouni, Imane, Kiran, Sibel, Larese-Filon, Francesca, Lazor-Blanchet, Catherine, Légeron, Patrick, Loney, Tom, Majery, Nicole, Merisalu, Eda, Mehlum, Ingrid Sivesind, Michaud, Laurent, Mijakoski, Dragan, Minov, Jordan, Modenese, Alberto, Molan, Marija, van der Molen, Henk, Nena, Evangelia, Nolimal, Dusan, Otelea, Marina, Pletea, Elisabeta, Pranjic, Nurka, Rebergen, David, Reste, Jelena, Schernhammer, Eva, Wahlen, Anny, Public and occupational health, APH - Societal Participation & Health, Coronel Institute of Occupational Health, and APH - Quality of Care
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Epidemiology ,Exhaustion ,Job stress ,Occupational health ,Applied psychology ,semantic analysi ,PsycINFO ,Review ,Burnout ,Burnout, Psychological ,Delphi consensus ,epidemiology ,exhaustion ,job stress ,occupational burnout ,occupational health ,semantic analysis ,systematic review ,Occupational safety and health ,Occupational burnout ,Delphi Consensus ,Semantic Analysis ,Systematized Nomenclature of Medicine ,job stre ,Humans ,Emotional exhaustion ,Burnout, Professional ,computer.programming_language ,Delphi consensu ,Ar e Saúde Ocupacional ,Public Health, Environmental and Occupational Health ,Semantic analysis (knowledge representation) ,Public aspects of medicine ,RA1-1270 ,Psychology ,computer ,Delphi - Abstract
Objective: A consensual definition of occupational burnout is currently lacking. We aimed to harmonize the definition of occupational burnout as a health outcome in medical research and reach a consensus on this definition within the Network on the Coordination and Harmonisation of European Occupational Cohorts (OMEGA-NET). Methods: First, we performed a systematic review in MEDLINE, PsycINFO and Embase (January 1990 to August 2018) and a semantic analysis of the available definitions. We used the definitions of burnout and burnout-related concepts from the Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) to formulate a consistent harmonized definition of the concept. Second, we sought to obtain the Delphi consensus on the proposed definition. Results: We identified 88 unique definitions of burnout and assigned each of them to 1 of the 11 original definitions. The semantic analysis yielded a first proposal, further reformulated according to SNOMED-CT and the panelists` comments as follows: "In a worker, occupational burnout or occupational physical AND emotional exhaustion state is an exhaustion due to prolonged exposure to work-related problems". A panel of 50 experts (researchers and healthcare professionals with an interest for occupational burnout) reached consensus on this proposal at the second round of the Delphi, with 82% of experts agreeing on it. Conclusion: This study resulted in a harmonized definition of occupational burnout approved by experts from 29 countries within OMEGA-NET. Future research should address the reproducibility of the Delphi consensus in a larger panel of experts, representing more countries, and examine the practicability of the definition. This study was supported by the University of Lausanne and European Cooperation in Science and Technology, Action CA 16216 "Network on the Coordination and Harmonisation of European Occupational Cohorts” (OMEGA-NET). info:eu-repo/semantics/publishedVersion
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- 2021
20. Implementation of a Novel Epidemiological Surveillance System for Children's Mental Health and Well-Being in France: Protocol for the National "Enabee" Cross-Sectional Study.
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Motreff Y, Marillier M, Saoudi A, Verdot C, Seconda L, Pognon D, Khireddine-Medouni I, Richard JB, Kovess-Masfety V, Delorme R, Decio V, Perrine AL, El Haddad M, Gallay A, Monnier-Besnard S, and Regnault N
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- Humans, France epidemiology, Child, Cross-Sectional Studies, Child, Preschool, Male, Female, Mental Disorders epidemiology, Population Surveillance methods, Surveys and Questionnaires, Mental Health statistics & numerical data
- Abstract
Background: Children's mental health, including their well-being, is a major public health concern, as the burden of related disorders may last throughout one's life. Although epidemiological mental health surveillance systems for children and adolescents have been implemented in several countries, they are sorely lacking in France., Objective: This study aims to describe the first step of the implementation of a novel surveillance system in France called Enabee (Etude nationale sur le bien-être des enfants), which focuses on the issue of mental health in children. The system aims to (1) describe the temporal trends in the population-based prevalence of the main mental health disorders and well-being in children aged 3 to 11 years, (2) explore their major determinants, and (3) assess mental health care use by this population. To do this, Enabee will rely on results from a recurrent national cross-sectional homonymous study. This paper presents the protocol for the first edition of this study (called Enabee 2022), as well as initial results regarding participation., Methods: Enabee 2022 is a national cross-sectional study that was implemented in French schools in 2022. It used a probabilistic, multistage, stratified, and balanced sampling plan as follows: first, schools were randomly drawn and stratified according to the type of school. Up to 4 classes per school were then randomly drawn, and finally, all the pupils within each class were selected. The study covered children from preschool and kindergarten (aged 3 to 6 years, US grading system) to fifth grade (aged 6 to 11 years). Children from first to fifth grades provided a self-assessment of their mental health using 2 validated self-administered questionnaires: the Dominic Interactive (DI) and the KINDL. Parents and teachers completed a web-based questionnaire, including the Strengths and Difficulties Questionnaire. Parents also answered additional questions about their parenting attitudes; their own mental health; known social, economic, and environmental determinants of mental health in children; and their child's life habits. Health, education, and family stakeholders were involved in designing and implementing the study as part of a large consultation group., Results: Data were collected from May 2, 2022, to July 31, 2022, in 399 schools across metropolitan France. Teachers completed questionnaires for 5721 pupils in preschool and kindergarten and for 15,263 pupils from first to fifth grades. Parents completed questionnaires for 3785 children in preschool and kindergarten and for 9227 children from first to fifth grades. Finally, 15,206 children from first to fifth grades completed the self-administered questionnaire., Conclusions: Enabee 2022 constitutes the first milestone in the development of a novel national epidemiological surveillance system, paving the way for improved children's mental health policies in France., (©Yvon Motreff, Maude Marillier, Abdessattar Saoudi, Charlotte Verdot, Louise Seconda, Damien Pognon, Imane Khireddine-Medouni, Jean-Baptiste Richard, Viviane Kovess-Masfety, Richard Delorme, Valentina Decio, Anne-Laure Perrine, Maria El Haddad, Anne Gallay, Stéphanie Monnier-Besnard, Nolwenn Regnault, Enabee Study Group. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 13.08.2024.)
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- 2024
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21. Harmonized definition of occupational burnout: A systematic review, semantic analysis, and Delphi consensus in 29 countries.
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Guseva Canu I, Marca SC, Dell'Oro F, Balázs Á, Bergamaschi E, Besse C, Bianchi R, Bislimovska J, Koscec Bjelajac A, Bugge M, Busneag CI, Çağlayan Ç, Cernițanu M, Costa Pereira C, Dernovšček Hafner N, Droz N, Eglite M, Godderis L, Gündel H, Hakanen JJ, Iordache RM, Khireddine-Medouni I, Kiran S, Larese-Filon F, Lazor-Blanchet C, Légeron P, Loney T, Majery N, Merisalu E, Mehlum IS, Michaud L, Mijakoski D, Minov J, Modenese A, Molan M, van der Molen H, Nena E, Nolimal D, Otelea M, Pletea E, Pranjic N, Rebergen D, Reste J, Schernhammer E, and Wahlen A
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- Consensus, Delphi Technique, Humans, Reproducibility of Results, Semantics, Surveys and Questionnaires, Burnout, Professional
- Abstract
Objective A consensual definition of occupational burnout is currently lacking. We aimed to harmonize the definition of occupational burnout as a health outcome in medical research and reach a consensus on this definition within the Network on the Coordination and Harmonisation of European Occupational Cohorts (OMEGA-NET). Methods First, we performed a systematic review in MEDLINE, PsycINFO and Embase (January 1990 to August 2018) and a semantic analysis of the available definitions. We used the definitions of burnout and burnout-related concepts from the Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) to formulate a consistent harmonized definition of the concept. Second, we sought to obtain the Delphi consensus on the proposed definition. Results We identified 88 unique definitions of burnout and assigned each of them to 1 of the 11 original definitions. The semantic analysis yielded a first proposal, further reformulated according to SNOMED-CT and the panelists` comments as follows: "In a worker, occupational burnout or occupational physical AND emotional exhaustion state is an exhaustion due to prolonged exposure to work-related problems". A panel of 50 experts (researchers and healthcare professionals with an interest for occupational burnout) reached consensus on this proposal at the second round of the Delphi, with 82% of experts agreeing on it. Conclusion This study resulted in a harmonized definition of occupational burnout approved by experts from 29 countries within OMEGA-NET. Future research should address the reproducibility of the Delphi consensus in a larger panel of experts, representing more countries, and examine the practicability of the definition.
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- 2021
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22. Response to letter to the editor from Dr Rahman Shiri: The challenging topic of suicide across occupational groups.
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Niedhammer I, Milner A, Witt K, Klingelschmidt J, Khireddine-Medouni I, Alexopoulos EC, Toivanen S, Chastang JF, and LaMontagne AD
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- Australia, Europe, Humans, Japan, Male, Prospective Studies, Suicide
- Abstract
We thank Dr Rahman Shiri (1) for his careful reading of our systematic review and meta-analysis on suicide among agricultural, forestry, and fishery workers (2). Our paper had the objective of providing a pooled effect size of suicide for this occupational group. Suicide is a crucial issue in public and occupational health. Suicide has a multifactorial etiology and recent systematic reviews and meta-analyses have pointed out the role of occupational exposures, mainly psychosocial work stressors, as risk factors for suicide (3, 4). Suicide is a very rare event in the general population and still more seldom in the working population. Indeed, unemployed and economically inactive people have a higher risk of suicide compared to employed people (5, 6). However, the total number of suicides is greater in the employed population than among the economically inactive or unemployed (6). Shiri's letter (1) questioned several aspects of our review and meta-analysis. One comment related to the single reference database used in our review and a suggestion that our review could not be considered to be systematic. The review was based on Medline because our main interest was in quantitative epidemiologic studies. This is the largest database for biomedical literature and we would argue the most pertinent. Furthermore, we checked the reference lists of the most recent papers and literature reviews, and Shiri did not report any paper that was missing. No review, whether searching one or more databases, can expect to be totally exhaustive. There may always be missing studies, especially if we consider grey literature. Thus we assert that our review was systematic, while acknowledging that it may not be perfectly comprehensive. Shiri suggested an absence of quality assessment of the studies included in our meta-analysis. First, quality was considered in the context of our comments in the discussion section. Second, as suggested by Rothman et al (7), quality assessment was replaced by regression analyses of the effect of each quality item (study characteristics, ie, study design, effect measure, reference group, and adjustment). Third, because most studies included in this review were based on objective data (census, administrative, or register data), they were free of many of the sources of bias that exist in studies where information on exposure and outcome must be collected from participants. Consequently, many of the items related to quality were not pertinent, such as response and follow-up rates, coverage and representativeness of the sample, selection, etc. Contrary to what Shiri suggested, all study designs can be informative in this topic because all of them are able to provide an unbiased estimate of the effect size. In addition, the prospective and case-control studies may have shortcomings. For example, we excluded five studies including three prospective and case-control studies in the sensibility analysis because the group of interest was defined on the basis of the exposure to chemicals (pesticides) rather than job title. Our choice to retain the least adjusted models was justified because aggregated data were used for the meta-analysis. Therefore, unless all included studies adjusted for the same covariates measured in the same way, adjusted estimates cannot be meaningfully provided in an aggregate data meta-analysis. In addition, as the objective was above all descriptive and not etiological or explanatory, and as it is the norm in the exploration of social inequalities in health (8), the results from the least (gender- and age-) adjusted models were in line with the objective. Indeed, including more adjustment variables could lead to overadjustment as they may be intermediate variables on the causal pathways between occupation and suicide. Our strategy was in line with previous meta-analyses on similar topics (9-11). Consequently, we would argue that our results are not likely to be largely due to confounding, contrary to the comment by Shiri. Indeed, the study of the contribution of underlying factors in explaining social inequalities in health outcomes is a fully-fledged topic of research (12-15), but this is relevant research to conduct after demonstrating that inequalities exist between social or occupational groups. Several of Shiri's comments were about statistical aspects of our analyses. First, it was suggested that we did not correctly extract the confidence intervals for the estimates of several studies. We disagree. We used the STATA metan suite of commands using log-transformed effect sizes and standard errors. Our figure 1 and the values of effect sizes and confidence intervals were provided by STATA, this explains why there may be small differences in these values compared with the results published in some studies. Using log-transformed effect sizes and confidence intervals, the analysis provided the same results. Second, our subgroup comparison was based on subsamples that were independent. As not all studies provided information for these subgroups, each subgroup was treated as a unit of analysis. This strategy allows the use of all relevant subgroups and comparisons between them (16). Third, we were also criticized for the use of random-effects models. Random-effects models are generally more plausible for meta-analysis based on studies from the published literature, because the fixed-effect model assumed that the entire corpus of literature has been obtained, ie, that every study has been or ever will be written on the topic has been included, which is an implausible assumption. We also assumed differences in effect size between studies and between subgroups, and the use of random-effects models was consistent with such an assumption. However, random-effects models produce wider confidence intervals compared to fixed-effect models (16). These models are thus more conservative, making our results all the more robust. One of Shiri's comments related to the reference group used in the studies for the comparison of agricultural, forestry, and fishery workers. Although we reported that the studies using a specific occupational group as reference group provided a higher effect size than the studies using other reference groups, we did not explicitly recognize and state in the paper that the results for Japan were based on two studies using a specific occupational group as reference; we concede that this may explain why we found a much more elevated effect size for Japan. Shiri's results (1) allow to conclude that the difference between Japan and the other geographic areas could be explained by the choice of reference group-we are grateful to him for raising this point. However, we would note that the effect size of suicide was still elevated and significant for agricultural, forestry, and fishery workers even after this change in the reference group for these two studies. Nevertheless, the choice of the optimal reference group is not obvious. If we consider the general population as the reference group, as unemployed people and economically inactive people (including people who may not be working due to illness or disability) are part of it and have a higher risk of suicide than employed people, the effect size provided by the nine studies using the general population as the reference is likely to be underestimated, which may contribute to an underestimation of the observed effect size of suicide among agricultural, forestry, and fishery workers in our study. The comparison was made in our paper with the other occupational groups (ie, the working population except the group of interest) as the reference, which was used by nine other studies, but this did not allow to determine the exact rank of the group of interest in the occupational hierarchy. Another relevant choice would have been to retain the group with the lowest suicide risk (for example, the high-skilled occupational group) as the reference, which would have led to a much higher effect size of suicide for agricultural, forestry, and fishery workers. To conclude, as statistical power in detecting differences between subgroups may be low in subgroup analyses and meta-regression, the absence of significant results according to subgroups found in our results cannot be interpreted as evidence that the effect size is the same across subgroups. Consequently, our meta-analysis reporting a significant excess of risk of suicide among agricultural, forestry, and fishery workers may also be a good incentive for more research among this group of workers to (i) confirm this observed excess of risk using differing methodological approaches to meta-analysis and (ii) explore the potential differences within this group and the underlying factors that may explain this excess of risk. 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