Work Hours Research Articles

Quality of life among physicians in Egypy and its influencing factors: a cross-sectional study

Doctors have an essential role in healthcare service, and their quality of life (QoL) is crucial for their professional satisfaction and overall well-being. This study assessed the QoL among physicians and explored the influencing factors that affect it. This cross-sectional study was carried out using a self-administered Internet survey. The survey was focused on physicians employed at various hospitals and clinics in Egypt. Data on participants' demographics, work-related factors, and QoL were collected using WHOQOL-BREF. WHOQOL-BREF questionnaire measures a participant's perception of their life quality across various domains, including general health, physical well-being, psychological health, social relationships, and the environment. The scores for each domain are calculated based on participants' responses to specific items, with higher scores indicating a better QoL. The QoL scores were 3.57±1.02 for the general health domain, 12.93±2.49 for physical domain, 12.29±2.67 for psychological domain, 12.87±3.20 for social domain, and 11.00±2.58 for environmental domain. The overall QoL score was 3.64±0.835. The findings indicate a moderate QoL among the participating physicians. The physicians' QoL domains were affected by age, sex, education level, marital status, chronic disease, smoking, speciality, working hours per week, extra working hours, and work experience.

Streamlining outpatient prepectoral breast reconstruction: The role of polyurethane oxygen-enriched bra cups from pandemic innovation to standardized cost analysis

Background: The COVID-19 pandemic necessitated a reassessment of healthcare delivery, emphasizing on strategies to reduce hospital visits without compromising patient care. In response, plastic surgery units explored innovative approaches to ensure high-quality care and enhanced protection for vulnerable groups, such as oncologic patients undergoing mastectomy and breast reconstruction. This study evaluates the implementation of a polyurethane-polyester bra cup enriched with oxygen to diminish the need for postoperative outpatient visits. Methods: Patients who underwent mastectomy and prepectoral breast reconstruction between February 2020 and March 2021 were selected. A novel postoperative management protocol with a polyurethane-polyester bra cup was adopted, and a cost-benefit analysis evaluated the economic impact of integrating this medical device into postoperative care. Results: The polyurethane-polyester bra cup wound dressing significantly reduced the frequency of outpatient visits, enhancing patient autonomy in postoperative care. Patients reported high satisfaction levels, particularly appreciating the ability to manage the device independently, which contributed to the substantial reduction of hospital accesses. Economic analysis revealed that the devices’ utilized resulted in a notable reduction of 333.5 working hours, translating to a financial saving, ranging between €9990 and €40,020 for nursing and medical staff, respectively. The device cost was established at €20 per unit, demonstrating an effective cost-saving strategy in postoperative care. Conclusions: The adoption of polyurethane-polyester bra cup in postsurgical care for mastectomy patients undergoing implant-based prepectoral breast reconstruction proved to be a strategic measure in reducing hospital visits and maintaining high levels of patient satisfaction.

Characteristics of hospital pediatricians and obstetricians/gynecologists working long hours in Tokushima, Japan: A cross-sectional study

Background This study aimed to determine the actual working conditions, including working hours and desired future working styles of hospital pediatricians and obstetricians/gynecologists (OB/GYNs) in Tokushima Prefecture. Method This cross-sectional study used a self-administered questionnaire. Pediatricians and OB/GYNs (n = 96) working at 14 hospitals in Tokushima Prefecture were surveyed. The questionnaire included items related to working hours, working status, number of medical institutions, task-shifting/task-sharing status, and preferred work style. Factors associated with work hours were analyzed. Results Approximately 40% and 10% of pediatricians and OB/GYNs worked ≥60 h/week and ≥80 h/week, respectively. Their weekly working hours were significantly positively associated with the number of nights and holidays worked and concurrent medical facilities they worked at. Multiple regression models showed that weekly working hours were significantly associated with working at night and day-off duties and the number of working medical institutions being worked at concurrently. Pediatricians and OB/GYNs who worked ≥60 h/week were not implementing a “multiple attending physician system” or “on-call system,” and task-shifting/task-sharing was inadequate. A significantly higher proportion of physicians who worked long hours (≥60 h/week or ≥80 h/week) wanted to reduce the number of night and day-off duties and work hours compared with those who did not. Conclusions The results of this study suggest that many pediatricians and OB/GYNs work long hours, and it is essential to improve their work environment, including task-shifting/task-sharing. Further enhanced recruitment and retention of hospital pediatricians and OB/GYNs is required. A detailed and large-scale study of pediatricians and OB/GYNs’ working environments is essential in the future.

Impact of work hours on sleep quality: a non-linear and gendered disparity

Impact of work hours on sleep quality: a non-linear and gendered disparity

Animal spirits at play? Firm sentiments and labour demand during the COVID‐19 pandemic

Economists have long theorized that sentiments, or spontaneous beliefs that are unjustified by economic fundamentals, are a driver of economic behaviours. In this study, I explore whether such sentiments influenced firms’ behaviours following the outbreak of COVID‐19. Using a sample of Italian firms, I observe that in the immediate aftermath of the outbreak, firms’ expectations about post‐COVID economic recovery largely reflected beliefs unexplained by their COVID‐related experiences. I then show that these beliefs were associated with firms’ labour market behaviours. Firms that displayed more pessimistic beliefs were more likely to implement cost‐cutting labour market measures, such as dismissing employees and reducing work hours.

Effects of the Interaction Between Time-on-Task and Task Load on Response Lapses

To investigate the interaction effects of prolonged working periods and different task loads on response lapses, focusing on the mechanisms of delayed responses and error lapses. Professionals such as pilots, truck drivers, and nurses often face extended work hours and fluctuating task loads. While these factors individually affect performance, their interaction and its impact on response lapses remain unclear. Twenty participants completed the Uchida–Kraepelin (U–K) Psychological Test and a dual-task version with functional near-infrared spectroscopy. Independent variables were time-on-task and task load. Dependent variables included measures of fatigue, arousal, workload, task performance (delayed and error rates), and brain functional connectivity. Both time-on-task and task load significantly affected cerebral connectivity, response lapses, workload (frustration level), fatigue, and arousal. Arousal levels significantly decreased and reaction times increased after 60 min of work. Cognitive resource regulation became challenging after 90 min under high task load levels. A decline in the connection between the prefrontal and occipital cortex during high-load tasks was observed. The findings provide insight into the mechanisms of response lapses under different task load levels and can inform strategies to mitigate these lapses during extended work periods. This study’s findings can be applied to improve work schedules and fatigue management in industries like aviation, transportation, and healthcare, helping reduce response lapses and errors during extended work periods under high task load conditions.

A Predictive Score for Bullying-Related Burnout in Healthcare Professionals: Implications for Organizational Interventions in Indonesia

Introduction: Workplace bullying is a pervasive issue with detrimental effects on the mental health and well-being of healthcare professionals. This study aimed to develop and validate a predictive score for bullying-related burnout among healthcare professionals in Indonesia and explore its implications for organizational interventions. Methods: A cross-sectional study was conducted involving 785 healthcare professionals from various hospitals in Indonesia. Data were collected using self-reported questionnaires, including the Indonesian versions of the Negative Acts Questionnaire-Revised (NAQ-R), the Copenhagen Burnout Inventory (CBI), and the Workplace Bullying Scale (WBS). Sociodemographic and work-related factors were also assessed. Multiple linear regression analysis was used to develop the predictive score, and its performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results: The prevalence of workplace bullying was 32.1%, with verbal bullying being the most common type. Burnout was significantly associated with bullying experiences (p<0.001). The final predictive score included age, gender, profession, years of experience, work hours per week, perceived social support, and exposure to different types of bullying. The score demonstrated good predictive accuracy (AUC=0.88, 95% CI: 0.84-0.90) for identifying individuals at high risk of burnout. Conclusion: This study provides a validated predictive score for bullying-related burnout in Indonesian healthcare professionals. The score can be used to identify high-risk individuals and guide targeted organizational interventions to prevent and mitigate the negative consequences of workplace bullying.

Working from home and mental well-being at different stages of the COVID-19 pandemic.

This paper analyses the relationship between working from home (WFH) and mental well-being at different stages during the first two critical years of the COVID-19 pandemic, when governments repeatedly imposed lockdowns and enacted WFH mandates to contain the spread of the virus. Using data from a representative survey conducted at four different time periods in 2020 (first lockdown, subsequent gradual reopening), 2021 (further lockdown) and 2022 (restrictions widely lifted) in the 27 EU member states, it examines the changing role of several mediators over time: work-family conflict, family-work conflict, stability, resilience, isolation, the importance of different support networks, workload, physical risk of contracting COVID-19 at work and housing conditions. For the first lockdown, it also differentiates by previous WFH experience, in terms of WFH novices and experienced WFH workers. It likewise differentiates by gender, in order to take the potential gendered nature of COVID-19 measures into account. The results point to several important mediators: for those who work from home, less family-work conflict and isolation, but greater stability, resilience, network support from family and friends, and superior housing conditions were associated with better mental well-being. The relevance of mediators was specific to certain stages of the pandemic. Stability was the most important mediator during the first lockdown. Work-family conflict and family-work conflict were only relevant during the first lockdown, while resilience and isolation mattered especially towards the end of the pandemic. Unlike established WFH workers, WFH novices had an advantage during the first lockdown, benefiting from lower family-work conflict and more helpful networks of family and friends. Our results differ by gender: for females who undertook WFH, important mediators were work-family conflict and family-work conflict. Both were related to adjustments they had to make in work and non-work hours in response to the enforced closure of schools and childcare facilities. For males who undertook WFH, support from networks of family and friends was an important mediator during the first lockdown.

Financial strain and resilience: a qualitative exploration of parental perspectives on caring for children with sickle cell disease in Ghana.

In Ghana, nearly one in four (25%) of the population are sickle cell disease carriers. Furthermore, 2% of all babies born (20 for every 1000 live births) has sickle cell disease. However, little is known about how parents negotiate the financial challenges facing parents of a child with sickle cell disease. This study explores the financial difficulties of parents and children living with sickle cell disease. The study adopted a qualitative approach. Twenty-seven parents were purposively selected from a sickle cell clinic in Accra, Ghana. Data collection was through an in-depth, face-to-face interview, using an interview guide based on the research objectives, and analyzed using thematic analysis. The findings showed that parents faced multiple financial difficulties (both direct and indirect) as they met the direct cost of medications, routine laboratory investigations, and hospital admissions. The National Health Insurance scheme does not wholly cover these costs. Families also describe more indirect costs, such as those associated with maintaining their child's well-being alongside those connected to their caring responsibilities, including the impact of giving up work and reducing working hours. Findings highlight the most pressing challenge, including the lack of access to financial support and a more general lack of understanding of the difficulties they faced on the part of policymakers. Supporting sickle cell parents' financial needs would improve their emotional and social well-being, enabling them to be more effective family carers.

Influence of Blood Sampling Service Process Reengineering on Medical Services Supply: Quasi-Experimental Study.

Tertiary hospitals in China are confronted with significant challenges due to limited spatial capacity and workforce constraints, leading to saturated allocation of medical resources and restricted growth in medical service provision. The incorporation of digital health into medical service process reengineering (MSPR) marks a pivotal transformation and restructuring of conventional health service delivery models. Specifically, the application of MSPR to blood sampling services processes reengineering (BSSPR) holds promise for substantially enhancing the efficiency and quality of medical services through streamlining and optimizing these procedures. However, the comprehensive impact of BSSPR has been infrequently quantified in existing research. This study aims to investigate the influence of BSSPR on the efficiency and quality of medical services and to elucidate the key informative technological support points underpinning BSSPR. Data were collected from both the new and old laboratory information systems from August 1, 2019, to December 31, 2021. A combination of statistical description, chi-square test, and t test was used to compare check-in time and waiting time of outpatients before and after the implementation of BSSPR. An interrupted time-series design was used to analyze the impact of BSSPR on medical service efficiency and quality, enabling the control of confounding variables, including changes in medical human resources and both long- and short-term temporal trends. BSSPR had an impact on the efficiency and quality of medical services. Notably, there was a significant increase in the number of patients receiving blood sampling services, with a daily service volume increase of ~150 individuals (P=.04). The average waiting time for patients decreased substantially from 29 (SD 36) to 11 (SD 11) minutes, indicating a marked improvement in patient experience. During the peak period, the number of patients receiving blood sampling services per working hour statistically increased from 9.56 to 16.77 (P<.001). The interrupted time-series model results demonstrated a reduction in patients' waiting time by an average of 26.1 (SD 3.8; 95% CI -33.64 to -18.57) minutes. Although there was an initial decline in the number of outpatients admitted following BSSPR implementation, an upward trend was observed over time (β=1.13, 95% CI 0.91-1.36). BSSPR implementation for outpatients not only reduced waiting time and improved patients' experience but also augmented the hospital's capacity to provide medical services. This study's findings offer valuable insights into the potential advantages of BSSPR and underscore the significance of harnessing digital technologies to optimize medical service processes. This research serves as a foundational basis and provides scientific support for the promotion and application of BSSPR in other health care contexts. By continuing to explore and refine the integration of digital technologies in health care, we can further enhance patient outcomes and elevate the overall quality of medical services.

Policies for sufficiency: factors influencing acceptance in the Swiss population

Adopting strategies for sufficiency is crucial to meeting climate and sustainability objectives. However, this requires a societal shift which depends on favorable framework conditions pertaining to infrastructure, incentives, regulations, and social and cultural values. Sufficiency policies are essential for influencing and creating such conditions and acceptance by the affected population are important. This article presents two related studies that investigated the acceptance levels of policies supporting sufficiency among the Swiss population and the factors influencing this acceptance. The first study involved a quantitative survey of 834 individuals to assess acceptance of ten policy measures at national and communal levels. The second study entailed interviews with 15 individuals with the same sociodemographic criteria as a critical subgroup identified in the quantitative survey, namely respondents with little environmental affinity, with a low or medium level of education, and from rural or semi-urban areas, and considered on an in-depth basis three of the ten policy measures: the real price of meat, the potential of reduced working hours, and the ban on fossil-fuel powered cars. We further discussed the obstacles and drivers associated with each of these measures with seven experts from relevant fields, leading to recommendations on increasing their acceptance. The findings show that sufficiency policy can gain public support if implemented equitably and seen as effective by the population. When implementing such measures, it is essential to consider fairness and evaluate compensation strategies. Avoiding consideration of sufficiency measures is not advisable and it is crucial to build on existing favorable assessments and counter misleading perceptions with specific arguments and positive framings.

Factors influencing medical students career intentions in Flanders, Estonia and Hungary: a multivariable analysis.

The career decisions of medical students are pivotal in shaping the future healthcare workforce. In many countries, the number of medical students who choose general practice (GP) as their career is insufficient to meet the needs of the healthcare system. The aim of this study was to describe the factors influencing medical students' career intentions and their preference for a career in GP. A cross-sectional study involving medical students from Flanders (Belgium), Estonia and Hungary. An online questionnaire was used to gather data. Multivariable logistic regression was conducted. Altogether 1601 medical students participated in this study. 18.5% of the participants were interested in GP. Factors related to medical students and the curriculum which predicted the interest in GP were being a woman, being a medical student from Flanders, being a 6th year medical student, coming from a rural area and having GP role models. Students preferring GP named the following factors as important: short and low intensity training program, having long-term and close relationship with patients, continuity of care, regular and flexible working hours and opportunities to achieve work-life balance. This study adds further evidence which characteristics and factors can predict medical students' interest in GP, having GP role models being the most important predictor. Further research into which qualities medical students value in their role models could give us better understanding on how we can support GPs to be better advocates for their specialty and thereby help increase interest in GP.

Objective and subjective evaluation of the use of protective clothing on the thermal strain and mental workload of nurses during the Covid-19 pandemic.

Nurses are among high-risk occupational groups during the outbreak of epidemics. Therefore, these people are required to use personal protective equipment (PPE). Previous studies have shown that the use of personal protective equipment can affect people's thermal strain and mental workload. The present study was conducted with the aim of objectively and subjectively evaluating the use of protective clothing on the thermal strain and mental workload of nurses during the covid-19 pandemic. This cross-sectional study was divided into two groups with a sample size of 300 people who were selected by systematic random method. In the first group, 120 people were objectively evaluated (use of protective clothing). In the second group, 180 people only completed the questionnaire of mental workload, feeling of heat and sweating and other information related to the type of clothing and the duration of its use, etc. Measurements were done in August and September of 2021 and in the morning shift of hospitals. Data were analyzed using SPSS version 21 software and chi-square, independent T-test and linear regression tests. The average age and average working hours per month of the participants in the study were 33.51±7.88 years, 187.91±35.37 hours, respectively. The results showed that the predicted average vote (PMV) index and the predicted percentage of dissatisfied (PPD), moisture felt on the skin surface, the feeling of desirability and pleasantness of the temperature, the weight of sweat and the humidity inside the clothes between the two groups of people using insulated clothes There is a significant difference between medicine and dressing (P < 0.05). There was a significant relationship between mental workload and type of clothing, average working hours per month. The use of medical isolation clothes causes a high heat load on nurses and can increase their mental workload. On the other hand, people using normal gowns suffer from a high mental workload due to the fear of disease due to the uncertainty of high-level protection. In addition, medical isolation clothes increase the humidity of the skin due to their impermeability, which causes skin complications.

Evaluation of Performance Improvement Rate of Plastic Production System Using ARENA: A Case Study of Phoenix Plastic Services

Production improvement has become essential to all industrial activity because of the fierce competition among today's production systems and organizations and the unquenchable customer demand. The shorter product life cycle has significantly increased the demand for prompt reactions to increase the productivity and efficiency of these industrial systems. This study examined the evaluation of performance improvement rate of plastic production system using ARENA. The report provided by the plastics industry was used in the study to analyze and assess the rate of performance improvement of the plastic manufacturing system. The location of the bottleneck was determined by the research following a thorough analysis of the plastic company's data, which included information on all manufacturing lines and procedures. The research employed Arena to assess and compute the rate of improvement in system performance while accounting for the material transporting process throughout the production line. The conveyor velocity maintains a lock at 75m/min, despite the company's report stating that the transports run at 30m/min. The optimized and unoptimized processes when obtained from a finished recycling process running for 1000 working hours, indicate that the conveyor process had 1045 and 1027 entity input and output, respectively, and the transporter process had 953 and 929 entities input and output respectively. The remaining number left when considering the number that enters the system with the number that leaves the system went to waste, resulting from the sorting and demagnetization process. The introduction of the conveyor brings 10.549% in the production rate and 50% decrease on expenses spent in labor. Through the conveyor system's speed control factor, which is an automated procedure, the system's percentage increment may be further raised. By raising the conveyor system's speed, more items will be produced. Conveyor system installation free up more space for additional production-related equipment, increasing products formed and the company's profit. The cost of purchasing and installing the conveyor will be covered by the excess profit.

Impact of Teleworking Practices on Presenteeism: Insights from a Cross-Sectional Study of Japanese Teleworkers During COVID-19

Few studies have examined the relationship between teleworking practices and presenteeism. This study determined the association between teleworking practices and presenteeism among teleworkers in Japan. A cross-sectional online survey was administered to 2687 teleworkers from five companies in Japan, collecting data on demographic variables, teleworking practices, frequency and duration of teleworking, presenteeism, and various lifestyle- and health-related factors. A logistic regression analysis was performed. Teleworkers with full-time employment and less teleworking experience exhibited higher presenteeism rates. Key practices negatively associated with presenteeism included creating a dedicated workspace, chatting with colleagues, and setting daily work goals. Gender differences were significant: for men, additional practices, such as determining their work hours, were beneficial; while for women, chatting with colleagues was particularly important. A sensitivity analysis indicated that specific teleworking practices can mitigate presenteeism. Certain teleworking practices, such as creating a workspace, chatting with colleagues, and setting work goals, were associated with lower presenteeism among teleworkers. These findings highlight the need for organizations to support telework ergonomics, promote social interaction, and encourage goal setting to enhance teleworker productivity and health. Training for employees and supervisors to raise awareness of their own and their subordinates’ health while teleworking is advised.

Long Working Hours, Work-life Imbalance, and Poor Mental Health: A Cross-sectional Mediation Analysis Based on the Sixth Korean Working Conditions Survey, 2020-2021.

There has been growing concern about the negative mental health impact of long working hours and overwork. Our study examined how work-life imbalance (WLI) could be a mediator between working hours and poor mental well-being. We included 34,968 individuals from a nationwide cross-sectional survey in Korea. Self-reported working hours per week were collected, and mental health was assessed using the World Health Organization (WHO)-5 Well-Being Index. Counterfactual-based mediation models were employed to disentangle the total effects into a direct effect (work hour - poor mental health) and an indirect effect (work hour - WLI - poor mental health). Out of 34,968 participants, 52.6% worked 35-40 hours/week, 20.0% worked 41-48 hours/week, 11.7% worked 49-54 hours/week, and 15.6% worked ≥55 hours/week. The odds ratios (ORs) of the total impact of working hours on poor mental health were 1.08 (95% confidence interval [CI], 1.01-1.16) for 41-48 hours/week, 1.28 (95% CI, 1.17-1.39) for 49-54 hours/week, and 1.60 (95% CI, 1.48-1.74) for ≥55 hours/week in comparison to 35-40 hours/week. The ORs of the indirect effects were 1.04 (95% CI, 1.03-1.05) for 41-48 hours/week, 1.08 (95% CI, 1.07-1.09) for 49-54 hours/week, and 1.14 (95% CI, 1.12-1.16) for ≥55 hours/week, accounting for 51%, 31%, and 28% of the total effects, respectively. Our findings suggest that WLI can partially mediate the association of long working hours with mental health deterioration. Policy efforts are required to mitigate the adverse mental health effects of overwork.

Determining the effect levels of augmented decent work criteria in sustainable economic development with the fuzzy DEMATEL method

Creating decent work is among the priority issues for sustainable employment and development. This study aimed to determine the effect levels of the International Labour Organization (ILO) decent work criteria by augmenting nine indicators in the ILO manual to 12 criteria through a comprehensive literature review. Fuzzy DEMATEL, a multi-criteria decision-making method, has been preferred in this context. According to the analysis results of the study, the most heavily ranked criteria are ‘healthy workplace environment’, ‘decent working hours’ and ‘safe working conditions’ respectively, which contribute to the decent work concept. Further, ‘balance between work–family–personal life’ has been found the most affected criterion, while ‘education and training system’ has been the most affecting. Based on the findings, remedial and developing strategies are suggested on issues such as corporate culture, working hours regulation, safe working environment, subordinate–superior relations, social activities and regulations that take family life into account.

The Effect of After-Hours Resection on the Outcomes in Patients with High-Grade Gliomas.

The "weekend effect" is the finding that patients presenting for medical care outside of regular working hours tend to have worse outcomes. There is a paucity of literature in the neuro-oncology space exploring this effect. We investigated the extent of resection and complication rates in patients undergoing after-hours high-grade glioma resection. A retrospective review was conducted on patients with high-grade glioma requiring emergent surgery between January 1, 2021, and March 31, 2023. After hours was defined as surgical resection on the weekend and/or evening (>50% of surgical time between 1630 and 0659). These patients were matched to patients undergoing resection during regular working hours. Groups were compared on the basis of the extent of resection, postoperative complications and 6-month mortality rate. A total of 38 patients were included in this study (19 after hours, 19 regular hours). There was no significant difference in age, sex, tumor grade and tumor size between the two groups (all p > 0.05). There was no significant difference in the extent of resection between the groups (p = 0.7442). There was no significant difference in the rate of intraoperative complications, postoperative complications, reoperation and death at 6 months between the groups (all p > 0.05). Estimated blood loss was significantly higher in the regular hours group (p = 0.0278). There was no significant difference in the total operative time (p = 0.0643) and length of stay (p = 0.0601). After-hours high-grade glioma surgery has similar outcomes to regular-hours surgery for lesions not requiring specialized functional mapping.

"Hit a bottleneck": a convergent mixed-methods approach to the Influencing factors and experience of fertility intention among mothers of childbearing age with two children in mainland China.

Fertility rates have been decreasing both worldwide and in China. Although current policies have been aimed at raising the birth rate in China, their overall effects have been unclear. Therefore, exploration of fertility intention and related influencing factors is crucial. This study used a convergent parallel mixed methods combining descriptive and cross-sectional designs with a framework analysis. Convenience sampling was used to select mothers of childbearing age with two children (n = 603), living in Guangdong Province, China. Participants completed an online questionnaire investigating sociodemographic characteristics, as well as determinants and attitudes regarding the third-child fertility intention. Correlation coefficients and multivariate regression analyses were used to present quantitative findings. Eleven interviews were conducted, and a framework analysis method was used for data analysis. The results for the qualitative and quantitative study components were analyzed separately and were subsequently integrated through side-by-side comparison and joint display. Attitudes toward fertility intention were negative, and the rate of fertility intention was 10.4% in Guangdong Province. In the quantitative component, women's age, perceived value of having a third child, and attitudes were found to be factors promoting the intention to have a third child, whereas monthly family income, grandparents' health status, and policy support were found to be factors hindering the intention to have a third child. Four major themes emerged regarding the perceptions and experiences regarding fertility intention in the qualitative component. After integrated analysis, younger age, knowledge regarding policy support, and access to childcare support were found to be factors significantly affecting the intentions of mothers with two children regarding having a third child. Fertility issues require continued attention. Our findings provide a reference for optimizing existing policies to increase fertility intentions. Providing policy support, such as public childcare support, flexible working hours for mothers, affordable childcare, and greater psychological support, would enable mothers to improve their parenting. In addition, increasing the dissemination of knowledge regarding policies is necessary to improve the level of public understanding and promote fertility intention.

Remote out-of-hours ultrasound live supervision in pediatrics - improvement of diagnostics and training.

Ultrasound (US) is the preferred imaging modality in pediatrics for diagnostic and therapeutic issues. The absence of radiation and the constant on-site accessibility make it the ideal tool for children. However, despite remarkable technical advances in resolution and applicability, many sophisticated medical questions still require profound expertise on the part of the examiner, thus often hampering fast decisions particularly outside regular working hours. This single-center study, at a university children's hospital evaluated the use of US during emergency service. A four-week documentation period was followed by a subsequent eight-week supervision period with live supervision availability on demand guided by a remote US expert. The demand for expert support, diagnosis, grading of urgency, duration and success of examination, and satisfaction of both examiners were analyzed. 108 patients (mean age 9.7 years) were included. In 38% of cases, US was supervised on demand with a definite diagnosis in 92.6% of cases (25/27). Image quality and technical performance were graded sufficient in 100% of cases. Supervised compared to non-supervised US examinations were prolonged (14.4 min vs. 7.1 min, p<0.001), were more prevalent within the first 24 h in the hospital (70% vs. 56.8%, p=0.06), and were classified more frequently as emergency (22.2% vs. 2.3%; p=0.015). All participants classified the availability of US supervision as decisively helpful. Remote live supervised pediatric US was feasible and effective. It combined timely, high-quality diagnostics even in the case of challenging medical questions with simultaneous US training.