How Identity Impacts Bystander Responses to Workplace Mistreatment
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PROVIDER: S-EPMC11341270 | biostudies-literature | 2023 Jul
REPOSITORIES: biostudies-literature
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Project description:ImportanceReducing physician occupational distress requires understanding workplace mistreatment, its relationship to occupational well-being, and how mistreatment differentially impacts physicians of diverse identities.ObjectivesTo assess the prevalence and sources of mistreatment among physicians and associations between mistreatment, occupational well-being, and physicians' perceptions of protective workplace systems.Design, setting, and participantsThis survey study was administered in September and October 2020 to physicians at a large academic medical center. Statistical analysis was performed from May 2021 to February 2022.Main outcomes and measuresPrimary measures were the Professional Fulfillment Index, a measure of intent to leave, and the Mistreatment, Protection, and Respect Measure (MPR). Main outcomes were the prevalence and sources of mistreatment. Secondary outcomes were the associations of mistreatment and perceptions of protective workplace systems with occupational well-being.ResultsOf 1909 medical staff invited, 1505 (78.8%) completed the survey. Among respondents, 735 (48.8%) were women, 627 (47.1%) were men, and 143 (9.5%) did not share gender identity or chose "other"; 12 (0.8%) identified as African American or Black, 392 (26%) as Asian, 10 (0.7%) as multiracial, 736 (48.9%) as White, 63 (4.2%) as other, and 292 (19.4%) did not share race or ethnicity. Of the 1397 respondents who answered mistreatment questions, 327 (23.4%) reported experiencing mistreatment in the last 12 months. Patients and visitors were the most common source of mistreatment, reported by 232 physicians (16.6%). Women were more than twice as likely as men to experience mistreatment (31% [224 women] vs 15% [92 men]). On a scale of 0 to 10, mistreatment was associated with a 1.13 point increase in burnout (95% CI, 0.89 to 1.36), a 0.99-point decrease in professional fulfillment (95% CI, -1.24 to -0.73), and 129% higher odds of moderate or greater intent to leave (odds ratio, 2.29; 95% CI, 1.75 to 2.99). When compared with a perception that protective workplace systems are in place "to a very great extent," a perception that there are no protective workplace systems was associated with a 2.41-point increase in burnout (95% CI, 1.80 to 3.02), a 2.81-point lower professional fulfillment score (95% CI, -3.44 to -2.18), and 711% higher odds of intending to leave (odds ratio, 8.11; 95% CI, 3.67 to 18.35).Conclusions and relevanceThis survey study found that mistreatment was common among physicians, varied by gender, and was associated with occupational distress. Patients and visitors were the most frequent source, and perceptions of protective workplace systems were associated with better occupational well-being. These findings suggest that health care organizations should prioritize reducing workplace mistreatment.
| S-EPMC9077480 | biostudies-literature
Project description:ImportanceMistreatment is a common experience among medical students, with various negative consequences of such perceived mistreatment reported. However, few large-scale studies have investigated the association between perceived mistreatment and the formation of medical students' professional identities.ObjectiveTo investigate medical students' perceived mistreatment during medical school and its association with professional identity.Design, setting, and participantsThis repeated cross-sectional study included medical students graduating between 2019 and 2022 at 135 medical schools in China. Analyses were performed from July 25, 2023, to May 15, 2024.ExposureThe China Medical Student Survey includes 5 items designed to measure students' perceived experiences of mistreatment.Main outcomes and measuresProfessional identity was measured using a validated 7-item scale adapted from the Macleod Clark Professional Identity Scale. Multivariate linear regression was used to determine the association between perceived mistreatment and medical students' professional identity.ResultsA total of 94 153 students (53 819 female [57.2%]; 83 548 Han ethnicity [88.7%]) were analyzed, representing 67.2% of the medical graduates enrolled in all responding medical schools. Most medical students reported having experienced at least 1 mistreatment incident (79 554 students [84.5%]). Medical students reported being required to perform personal service (57 455 students [61.0%]), experiencing mistreatment by patients (67 439 students [71.6%]), being publicly humiliated (24 348 students [25.9%]), being unjustly treated (35 926 students [38.2%]), and experiencing deliberate harassment (46 082 students [48.9%]). A negative association and saturation effect (where effect size plateaus after moderate exposure of mistreatment) were found between the degree of mistreatment and medical students' professional identity scores. Compared with students who had not reported mistreatment, students who reported single (β, -0.30; 95% CI, -0.33 to -0.28; P < .001), moderate (β, -0.66; 95% CI, -0.69 to -0.63; P < .001), and high (β, -0.62; 95% CI, -0.65 to -0.58; P < .001) frequency of mistreatment were more likely to have lower professional identity scores; this association persisted but was attenuated after adjusting for students' sociodemographic characteristics and was consistent across all the types of mistreatment.Conclusions and relevanceIn this national, repeated cross-sectional study, a high prevalence of mistreatment among medical students in China and a negative association between perceived mistreatment and medical students' professional identity was found. Further research is needed to ensure that medical schools offer supportive and respectful learning environments.
| S-EPMC11549658 | biostudies-literature
Project description:BackgroundWorkplace gender-based mistreatment (GBM) refers to negative or harmful behaviors directed towards employees. In healthcare settings, this can lead to job dissatisfaction and underperformance and potentially compromise patient outcomes. The aim of this study was to examine workplace GBM among European anesthesiologists and produce the first European Gender-based Mistreatment Rank in Anesthesiology.MethodsWe conducted a secondary analysis from a worldwide cross-sectional survey database consisting of a 46-item questionnaire exploring, among other outcomes, gender bias attributable to workplace attitudes. The survey completion rate was 80.8%. All respondents were selected from European countries. Associations between mistreatment and the remaining variables were analyzed using univariate and multivariate logistic regression analyses. A generalized linear mixed model was then used to quantify the impact of mistreatment in each European country. Statistical significance was set at P < 0.05.ResultsThis study included 5,795 respondents from 43 European countries. The independent predictors of GBM were as follows: female gender, younger age, perceiving gender as a disadvantage for leadership, and perceiving gender as a disadvantage for research. The full model was statistically significant, indicating an ability to distinguish between those who experienced GBM and those who did not (P < 0.001). Thus, 26 European countries were ranked based on the prevalence of mistreatment, with Italy showing the best performance (lowest prevalence).ConclusionsThe aim of our study was to provide preliminary insight into GBM in anesthesiology in Europe, function as a key benchmark for gender equity, and chart the evolution of disparities over time.
| S-EPMC10834715 | biostudies-literature
Project description:Spillover occurs when one environmentally sustainable behavior leads to another, often initiated by a behavior change intervention. A number of studies have investigated positive and negative spillover effects, but empirical evidence is mixed, showing evidence for both positive and negative spillover effects, and lack of spillover altogether. Environmental identity has been identified as an influential factor for spillover effects. Building on identity process theory the current framework proposes that positive, negative, and a lack of spillover are determined by perceived threat of initial behavior and identity process mechanisms evaluating the behavior. It is proposed, that an environmental behavior change intervention may threaten one's existing identities, leading to either (a) integration, (b) compartmentalization, or (c) conflict between one's environmental identity and non-environmental identities. Initial evidence for the proposed framework is based on a field intervention which included a meat reduction programme in a canteen of a medium size private sector company. Semi-structured interviews and an explorative visualization method that aimed at assessing identity change were implemented with thirteen employees (i.e., intervention participants) before and after the intervention. The qualitative data was analyzed by using thematic analysis via NVivo12. Results of the visualization task and interview method provided initial evidence of direct and indirect positive contextual spillover effects, with comparatively less evidence a lack of spillover and a relative absence of reported negative spillover. This paper provides a novel theoretical approach, centered on identity process theory to enhance understanding of positive spillover, negative spillover, and the lack of spillover.
| S-EPMC6405690 | biostudies-literature
Project description:Although workplace discrimination and mistreatment (WDM) has recently drawn widespread media attention, our understanding of the prevalence of these phenomena remains limited. In the current study, we generated national prevalence estimates of WDM from a community-based cohort of employed black and white men and women aged ≥48 years. Measures of WDM in the current job were obtained by computer-assisted telephone interview (2011-2013) involving dichotomous responses (yes or no) to five questions and deriving a composite measure of discrimination (yes to at least one). Prevalence estimates and age- and region-adjusted prevalence ratios were derived with use of SUDAAN software to account for the complex sample design. Analyses were stratified by race and sex subgroups. This sample represents over 40 million U.S. workers aged ≥48 years. The prevalence of workplace discrimination ranged from a high of 25% for black women to a low of 11% for white men. Blacks reported a 60% higher rate of discrimination compared to whites; women reported a 53% higher prevalence of discrimination, compared with men. The prevalence of workplace mistreatment ranged from 13% for black women to 8% for white men. Women reported a 52% higher prevalence of mistreatment compared to men, while differences by race were not significant. Mistreatment was 4-8 times more prevalent among those reporting discrimination than among those reporting none. Subgroup differences in mistreatment were confined to the wage-employed. Findings suggest that middle age and older wage-employed blacks and women experience the highest prevalence of WDM; moreover, discrimination is strongly associated with mistreatment. This study contributes to our understanding of at-risk segments of the U.S. labor market and the need for targeted interventions to reduce WDM.
| S-EPMC6612926 | biostudies-literature
Project description:BackgroundWork environment is rapidly evolving, unfortunately, it is also becoming increasingly hostile for workers due mostly to common psychosocial hazards. This situation is posing significant challenges for organisations to protect the psychological well-being of their workers. Hence, this review aims to map studies to understand the influence of psychosocial safety climate (PSC) on workplace mistreatment and mental health of workers.MethodsThe guidelines outlined by Arksey and O'Malley were adopted for this review. PubMed, Scopus, Web of Science, JSTOR, Google and Google Scholar were searched for relevant papers. Only peer-reviewed studies that measured PSC using PSC-12, PSC-8 or PSC-4 were included in this review.ResultsThirty-eight studies met the inclusion criteria. This review found that PSC has a negative association with workplace mistreatment such as bullying, harassment, violence, discrimination and abuse. Further, PSC has a positive association with psychological well-being, personal resilience and hope. Low level organisational PSC also promotes psychological distress, stress, depression, cognitive weariness and emotional exhaustion. The buffering effect of PSC is well-established. Moreover, PSC mediates the association between health-centric leadership and workers' psychological health problems. The inverse relationship between PSC and depressive symptoms was stronger for females than males.ConclusionOrganisations should prioritise training and development of supervisors to enhance their supportive skills, encourage respectful behaviour, encourage the use of resources promote open and bottom-up communication and provide guidance on conflict resolution. By promoting a high PSC context, organisations can create a culture that discourages mistreatment, leading to increased employee well-being, job satisfaction, and productivity.
| S-EPMC11003102 | biostudies-literature
Project description:The immunogenic clonal-fraction threshold in heterogeneous solid-tumor required to induce effective bystander-killing of non-immunogenic subclones is unknown. Pancreatic cancer poses crucial challenges for immune therapeutic interventions due to low mutational-burden and consequent lack of neoantigens. Here, we designed a model to incorporate artificial-neoantigens into genes-of -interest in cancer-cells and to test their potential to actuate bystander-killing. By precisely controlling a neoantigen's abundance in the tumor, we studied the impact of neoantigen frequency on immune-response and immune-escape. Our results showed single, strong, widely-expressed neoantigen could lead to robust antitumor response when over 80% of cancer cells express the neoantigen. Further, immunological assays demonstrated T-cell responses against non-target self-antigen on KRAS-oncoprotein, when we inoculated animals with a high frequency of tumor-cells expressing test-neoantigen. Using nanoparticle-based gene-therapy, we successfully altered tumor-microenvironment by perturbing interleukin-12 and interleukin-10 gene-expression. The subsequent microenvironment-remodeling reduced the neoantigen frequency threshold at which bioluminescent signal intensity for tumor-burden decreased 1.5-log-fold, marking robust tumor-growth inhibition, from 83% to 29%. Our results thus suggest bystander killing is inefficient in immunologically-cold tumors like pancreatic-cancer and requires high neoantigen abundance. However, bystander killing mediated antitumor response can be rescued by adjuvant-immune therapy.
| S-EPMC7475277 | biostudies-literature
Project description:Epidemiological evidence suggests that chronic infections impair immune responses to unrelated pathogens and vaccines. The underlying mechanisms, however, are unclear and distinguishing effects on priming versus development of immunological memory has been challenging. We investigated whether bystander chronic infections impact differentiation of memory CD8(+) T cells, the hallmark of protective immunity against intracellular pathogens. Chronic bystander infections impaired development of memory CD8(+) T cells in several mouse models and humans. These effects were independent of initial priming and were associated with chronic inflammatory signatures. Chronic inflammation negatively impacted the number of bystander CD8(+) T cells and their memory development. Distinct underlying mechanisms of altered survival and differentiation were revealed with the latter regulated by the transcription factors T-bet and Blimp-1. Thus, exposure to prolonged bystander inflammation impairs the effector to memory transition. These data have relevance for immunity and vaccination during persisting infections and chronic inflammation.
| S-EPMC4114317 | biostudies-literature
Project description:ObjectivesThis study investigated effects of workers' cultural and personal characteristics on the relationship between workplace mistreatment and health problems in both South Korea and EU Countries.MethodsData were obtained from nationally representative interview surveys: the third Korean Working Conditions Survey (KWCS) in 2011 (50,032 participants) and fifth European Working Conditions Survey (EWCS) in 2010 (41,302 participants). The Pressure-State-Response model was adapted to explore differences in the relationship between mistreatment and health problems according to country, and logistic regression analysis was used after stratification of moderating factors. Workplace mistreatment, such as discrimination, violence, harassment, and self-reported health problems, were assessed by gender and educational level.ResultsAmong KWCS participants, there were 4,321 victims (14.70%) of workplace mistreatment; among EWCS participants, there were 5,927 victims (17.89%). There was a significant positive association between workplace mistreatment and self-reported health problems. A stronger association was found among workers with higher educational levels in Korea (2- to 4-fold higher odds for mental and physical health problems), but there was no significant difference by education level in workers of EU Countries. Female Koreans who worked alone had a higher risk of health problems related to workplace mistreatment than other gender compositions in the workplace (the OR for psychological symptoms reached 6.631). In contrast, the gender composition of the work place did not significantly affect EU workers.ConclusionsWorkplace mistreatment is significantly associated with physical and mental health problems, especially among workers with higher educational levels and females who work alone in Korea.
| S-EPMC6706210 | biostudies-literature
Project description:Neurotropic viruses are the most common cause of infectious encephalitis and highly target neurons for infection. Our understanding of the intrinsic capacity of neuronal innate immune responses to mediate protective antiviral responses remains incomplete. Here, we evaluated the role of intercellular crosstalk in mediating intrinsic neuronal immunity and its contribution to limiting viral infection. We found that in the absence of viral antagonism, neurons transcriptionally induce robust interferon signaling and can effectively signal to uninfected bystander neurons. Yet, in two-dimensional cultures, this dynamic response did not restrict viral spread. Interestingly, this differed in the context of viral infection in three-dimensional forebrain organoids with complex neuronal subtypes and cellular organization, where we observed protective capacity. We showed antiviral crosstalk between infected neurons and bystander neural progenitors is mediated by type I interferon signaling. Using spatial transcriptomics, we then uncovered regions containing bystander neural progenitors that expressed distinct antiviral genes, revealing critical underpinnings of protective antiviral responses among neuronal subtypes. These findings underscore the importance of interneuronal communication in protective antiviral immunity in the brain and implicate key contributions to protective antiviral signaling.
| S-EPMC11881317 | biostudies-literature