Training-related Factors Research Articles

The impact of individual factors and training on intrapreneurship

Purpose This paper aims to review the latest management developments across the globe and pinpoint practical implications from cutting-edge research and case studies. Design/methodology/approach This briefing is prepared by an independent writer who adds their own impartial comments and places the articles in context. Findings The paper identifies both individual factors and training-related factors that foster the development of intrapreneurship within organizations. Originality/value The briefing saves busy executives, strategists, and researchers hours of reading time by selecting only the very best, most pertinent information and presenting it in a condensed and easy-to-digest format.

Current State of Factors Influencing the Development of Running Speed in the 100m Sprint for Non-Specialized University Students at Tan Trao University

This study provides a comprehensive analysis of the current state of factors influencing the development of running speed in the 100m sprint for non-specialized university students at Tan Trao University. The primary objective of this research is to identify and examine the key elements that contribute to the improvement of short-distance running speed among this student population. Through an extensive review of both domestic and international literature, the study encompasses 20 relevant publications from 2012 to 2024, establishing a robust foundation for understanding the current state of research and best practices in this domain. The findings reveal that the development of running speed is influenced by a multifaceted interplay of biomechanical, physiological, psychological, and training-related factors. Specifically, the study delves into the significance of proper running technique, muscle strength and power, aerobic and anaerobic fitness, energy system utilization, athlete motivation, goal-setting, and mental preparation. Additionally, the paper highlights the importance of implementing effective training programs that incorporate periodization, volume and intensity management, and evidence-based injury prevention strategies. The implications of this study are paramount, as it offers valuable insights for coaches, physical education instructors, and sports science professionals working with non-specialized university students. The findings can inform the design and implementation of comprehensive training programs aimed at enhancing the speed capabilities of this population, while also prioritizing injury prevention and overall athletic development.

Determinants of menstrual dysfunction in the female athlete triad: A cross-sectional study in Italian athletes.

BackgroundIn 1992 the American College of Sports Medicine first described the Female Athlete Triad. The Triad is a metabolic injury involving three distinct clinical traits: low energy availability, with possible eating disorder, low bone mineral density and menstrual dysfunction (MD). Although the estimated prevalence of the Triad is low (1.2 %), single factors are common in female athletes, at all competitive levels and ages. Even though the Triad was described over two decades ago, the interrelation of the three diagnostics components is still debated: additional evidence is required to improve the multidisciplinary treatment approach for this complex condition. MD is one of the first signs of energy impairment. The present study aims at investigating MD determinants and predictors in female athletes, to allow an early diagnosis of the Triad and to implement adequate preventive strategies. Materials and methodsAn original structured questionnaire was composed to detect the presence of MD risk factors. Included participants were active female athletes within reproductive age range (15–40 years old). Anthropometric parameters and training-related factors, possibly affecting the regularity of the menstrual cycle, were investigated. ResultsRespondents were 288 female athletes. Among them, 73.3 % were under 25 years of age; 6.6 % resulted underweight; 30.6 % reported to follow a meal plan/diet and 13.9 % declared to be a smoker. Lean sports were practiced by 30.6 % of responders. Body-weight congruence was detected in in 79.9 % of participants, whereas overestimation of body image was found in 16.3 % of athletes. Irregular menstrual cycle, a possible MD predictor, was present in 33.0 % of athletes, with 41.1 % practicing some lean sport (p = 0.007). Also, overestimation of body image suggested an increased risk of menstrual irregularity (p = 0.001). BMI <18.5 or BMI >30 could also act as risk factor, although significance was not fully obtained (p = 0.053). Overall, practice of lean sports and overestimation of body image appeared good determinants of increased menstrual irregularity (AOR 2.02 and 3.83, respectively). ConclusionsMenstrual irregularity in female athletes can be considered an early predictor of MD: risk is further increased in athletes of lean sports and reporting an overestimation of self-perceived body image. Screenings and awareness programs should specifically address female athletes, because of their vulnerable-group profile. In order to define a standardized at-risk profile for Triad onset and sequelae likelihood, evaluation of menstrual regularity should especially be considered, in conjunction with the assessment of other indicators of energy availability (e.g. TEE, lean and fat mass, BMC). Testing for sport-derived stress and disordered eating attitudes is also recommended. Preventive strategy should involve the proactive engagement of sport clubs and periodic competitive sport medical assessment.

Impact of on-call shifts on working memory and the role of burnout, sleep, and mental well-being in trainee physicians

ABSTRACT Background Optimal cognitive functions, including working memory (WM), are crucial to enable trainee physicians to perform and excel in their clinical practice. Several risk factors, including on-call shifts, poor mental health, burnout, and sleep problems, can impair clinical practice in trainee physicians, potentially through cognitive impairment; however, these associations have not been fully explored. Objective This study investigated the effect of on-call shifts on WM among trainee physicians and its association with burnout, depression, anxiety, affect, and sleep. Materials and methods This cross-sectional study involved 83 trainee physicians (45% male). We measured demographic and training-related factors including on-call shifts and working hours. We also assessed depressive symptoms (PHQ-9), both state and trait anxiety (STAI total score), burnout (OLBI total score), positive and negative affect scores (PANAS), and sleep disturbances (PSQI total score). WM was evaluated using spatial working memory (SWM) strategy scores that reflected performance and total error counts. Results Trainee physicians with more on-calls per month had significantly worse depressive symptoms, burnout scores, and sleep, as well as more negative affect. While controlling for covariates, being on-call more times per month was significantly associated with worse WM. Worse depressive symptoms and burnout scores were also significantly associated with impaired WM. Conclusion Working more on-call shifts is associated with compromised WM. Trainee physicians who experienced more depressive symptoms and burnout had worse WM.

Hispanic worker attitudes toward pig euthanasia on U.S. farms.

On-farm pig euthanasia considers aspects of animal welfare and industry economics. Guidelines are available about the euthanasia process, but the agricultural workforce is highly diverse and guidelines do not consider cultural barriers. Euthanasia requires the ability to identify compromised pigs, technical skills, and willingness to euthanize pigs. In addition, timely euthanasia is part of the Common Swine Industry Audit (CSIA) and, thus, can lead to failed audits if not performed as required by the audit standards. The United States (US) swine industry employs a high percentage of Latin American workers, some US residents/citizens, and others through non-immigrant North American Free Trade Agreement (NAFTA) visas. These workers vary in their level of education and swine industry experience. Proper training of this workforce and identification of the barriers associated with performing timely euthanasia are critical to promote improved welfare practices. The objectives of this study were to: (1) develop a survey instrument to identify Hispanic caretaker attitudes toward pig euthanasia, (2) assess and describe swine caretakers' attitudes toward pig euthanasia using the developed survey instrument, and (3) determine the demographic and psychological barriers associated with performing pig euthanasia. Participants (n = 163) were surveyed from 16 farms across the State of Iowa. The on-farm survey was administered for two days in a period of 60 min per day. The results for demographics and the swine management survey data indicated that employees with less time working on the farm showed less knowledge of the CSIA, lower perceived ability to identify compromised pigs that needed to be euthanized, lower willingness to pecrform euthanasia on their own, and preferred not to have the responsibility of telling others when to euthanize pigs (p < 0.001). Secondary traumatic stress and transgressions were significantly correlated scales, associated with burnout, betrayals, and worker satisfaction (p = 0.022). Furthermore, individuals identifying as female had higher secondary traumatic stress scores (p = 0.026) and lower compassion satisfaction scores (p = 0.015). This data suggest that there are demographic, psychometric, and training-related factors correlated with Hispanic caretakers' feelings about pig euthanasia. The results of this study could be used to further improve and develop targeted training programs for Hispanic caretakers for early identification of compromised pigs and timely euthanasia, which could benefit human well-being, animal welfare, and the swine industry audit performance.

Factors associated with non-specific low back pain in field hockey: A cross-sectional study of Premier and Division One players.

To determine the extent to which various factors are associated with greater or lesser odds of reporting non-specific low back pain (NS-LBP) in field hockey. To meet the objective of the study, a cross-sectional study design was used with a purposive sampling strategy. A total of 194 responses (~18% of those accessible) from Premier and Division One players within the UK were received using a UK-based online survey. Data collected included information on NS-LBP, participant characteristics, injury history, training related factors, and work and personal factors. The overall and category-specific prevalence of NS-LBP was calculated. Univariable and multivariable logistic regression was used in conjunction with clinical value to identify associations. The overall prevalence of NS-LBP was 44.0%, with this varying from 23.5 to 70.0% for categories with responses of "yes" and "no" to experiencing NS-LBP. A total of ten individual factors associated with a greater odds ratio (OR) of reporting NS-LBP (OR = 1.43-7.39) were identified in Premier and Division One players. Five individual factors were associated with reduced odds (OR = 0.11-0.60) of reporting NS-LBP. Seven factors (age, stature, playing position, playing internationally, performing a drag flick, low back stiffness/tightness and occupational factors) were deemed particularly pertinent to those working in field hockey given the magnitude of association and clinical value to clinicians. Clinicians working in field hockey can consider the key risk factors identified in this study that are associated with NS-LBP when assessing injury risk, movement screening approaches, and overall athlete management.

Barriers to delivery of culturally competent care among nurses: A multi-center cross-sectional study in a resource-limited setting

BackgroundIn a growing multicultural society like Ghana, the cultural competence (CC) of nurses is imperative. Despite the importance of CC within the healthcare environment, factors that hinder nurses’ ability to render culturally competent care (CCC) to patients in the clinical unit have not been adequately explored. PurposeTo examine the barriers nurses encounter in the delivery of CCC across two regions of Ghana. MethodsFrom October to December 2022, an institutional-based cross-sectional study in eight hospitals involving nurses was conducted in the Western and Ashanti regions. A probability sampling method was employed to select 759 participants. Data was entered into a spreadsheet and exported to S.P.S.S version 23. Binary and multivariable logistic regressions were used to establish the associations between dependent and independent variables. The odds ratio with a 95 % confidence interval was computed. Outcome variables with a P-value < 0.05 were deemed statistically significant. ResultsThe majority of the respondents were females (61.4 %; n = 466). The three-factor structure of the instrument was validated using an exploratory factor analysis. The study revealed that barriers that hindered nurses were the lack of CCC policies (β = 0.150, 95 % CI = 0.120, 0.180), nurse staffing-related factors (β = 0.120, 95 %; CI = 0.090, 0.150), and the lack of training related factors (β = 0.084, 95 % CI = 0.054, 0.114). Nurses’ age, marital status, and experience were significant at a p-value of < 0.05. ConclusionThe lack of culturally appropriate policies, lack of training-related factors, and nurse staffing-related challenges hindered respondents’ efforts to render CCC. Interventions aimed at improving CCC should target these barriers.

A categorization of factors affecting quality of design documentation in Tanzanian construction projects

Purpose The design documents are products of a process that aims to provide sufficient details to enable the contractor to efficiently implement the project at a realistic cost. Accordingly, it is expected that these design documents must be of high quality to engender the attainment of the desired project objectives. The purpose of this study is to analyze the factors that affect the quality of design documentation in construction projects in the context of a developing country. Design/methodology/approach This study used a descriptive research design involving professionals from firms offering services in areas of design and documentation, mainly architectural, quantity surveying and engineering. A total of 80 out of 84 questionnaires were received and analyzed using IBM SPSS Statistics Version 25, and a factor analysis approach was used to categorize the factors into smaller five groups. Findings The factors were subsequently categorized according to size, time, staff, quality and training-related factors. Collectively, large size of the project, inadequate supervision of junior design staff, low professional fees, procurement process and system, failure to adopt quality management systems and allocation or assigning of staff to more than one project at the same time have high influence (component loading of 700) in respective groups. Research limitations/implications The reliance on data to analyze the factors of design documents in construction projects in developing economies context, using a Tanzanian exemplar, is considered a limitation. Developing countries with similar economic characteristics, procurement systems and cultural setup could benefit from the results of this study. Practical implications The study of factors affecting quality of design and documents in construction projects serves as a guide for built environment firms in Tanzania in conducting effective business and ensuring quality design documents, hence improved project performance. Understanding the nature of relationship between the design and construction teams as well as the impact of design documents on project performance is of great importance for the design teams of future projects and other decision-makers to pay attention when preparing design and related documents, especially during design stage of construction projects in developing countries. Originality/value The study contributes the knowledge by providing useful insights on the subject through a categorization of the factors affecting the quality of design documentation and exploring the nature of relationship between the design and construction teams in construction projects within a previously unexplored Tanzanian context focusing on a traditional procurement system for future improvement of project delivery, hence project success.

Causal attributions of failure among post graduate medical residents in exit fellowship examination in Pakistan: A qualitative study.

Causal attributions are reasons given to certain events in life including failure and success. The objective of this qualitative study was to explore the attributions perceived as the cause of failure by post graduate residents, failing the final clinical exit examination of Fellowship of College of Physicians and Surgeons Pakistan (FCPS). This exploratory study was conducted from July 2021 to July 2022, at Jinnah Hospital, Lahore. Study population was selected by purposeful maximal variation sampling. A total of ten post graduate residents from four specialties, failing in FCPS part two clinical examination were included. After written informed consent, semi structured face to face, in depth interviews were conducted. Data saturation was achieved after eight interviews after which two more interviews were carried out. All interviews were recorded and transcribed verbatim. Thematic analysis of the data was done by synthesizing codes into categories and themes. A total of 17 attributions noted were grouped into five categories namely 'Inadequate exam preparation', 'Personal factors,' 'Exam related factors,' 'Training related factors and 'Luck'. Two main themes of External and Internal factors emerged from these. Common attributions were; lack of effort (8/10), inadequate knowledge (8/10), family commitments (7/10), luck (8/10) and examiner's attitude (5/10). Most of the residents attributed internal, unstable and controllable factors like inadequate knowledge and lack of effort. In addition, external uncontrollable factors of bad luck and harsh attitude of examiners were considered as contributory factors towards failure.

Clinical and ultrasound findings of ‘swimmer’s shoulder’ and its association with training history in elite Portuguese swimmers: a cross-sectional study

ABSTRACT Objectives To assess the prevalence of shoulder injuries and ultrasound findings in elite Portuguese swimmers and their association with symptoms and personal or training-related factors. Methods This cross-sectional study was conducted at the Portuguese Open and Youth Swimming National Championships between 27 and 30th July 2022. Each athlete entered details regarding personal and training history into a questionnaire and underwent a physical and ultrasound shoulder examination. Results A total of 102 swimmers out of 662 Portuguese athletes were included in the study. Shoulder pain experienced during the previous season was reported by 42% of the athletes. A high prevalence of shoulder structural abnormalities was noted, specifically supraspinatus tendinosis (91%), tears (29%), and subacromial bursitis (29%). Specific training for injury prevention was associated with higher rates of infraspinatus tendinosis (p = 0.047), and supraspinatus tears were linked to greater swimming distances per week (p < 0.001) and practice (p < 0.001), more years of practice (p = 0.018), shoulder pain at the time of evaluation (p = 0.023), a higher number of missed competitions (p = 0.041), and shoulder injections (p = 0.009). Subacromial bursitis was associated with shoulder pain at the time of evaluation (p = 0.002) and during the previous season (p < 0.001), missed competitions (p < 0.001), and requirement for physical therapy (p = 0.006). Conclusions A high prevalence of shoulder morphological changes was found in surveyed swimmers and there were several associations with training load, regardless of individual characteristics of each athlete. It is essential to understand the true impact of current injury prevention programs and to develop effective measures to protect swimmers’ health.

Experiences of Nursing Students in Practicing Blood Transfusion

Healthcare professionals need to know about blood transfusion. The purpose of this study is to determine the experiences of nursing students on blood transfusion and their opinions on the influencing factors. In this qualitative study, the sample of the study consisted of 12 second, third, and fourth-year nursing students who were continuing their education at a state university. In the study, data were collected by conducting in-depth interviews via a semi-structured interview form. In the study, the data were coded under two themes including nursing students’ experiences with blood transfusion (three sub-themes: level of theoretical knowledge about transfusion, fear of making mistakes, and inadequate practice) and the factors affecting these experiences (four sub-themes: factors related to patients’ relatives, factors related to patients, factors related to the practice and training related factors). As a result of the study, nursing students were observed to have different fears regarding blood transfusion. In the education of nurses, it is recommended to organize training on this subject for nursing educators and manager nurses.

Clinical associate students’ perceptions of factors that influence their developing professional identity: a qualitative study

BackgroundNew cadres of clinicians, known as clinical associates, physician assistants, or clinical officers have evolved globally within many health systems to broaden access to care by increasing human resources. The training of clinical associates started in 2009 in South Africa, entailing the attainment of knowledge, clinical skills, and attitude competencies. Less formal educational attention has been focused on the process of developing personal and professional identities.MethodThis study utilized a qualitative interpretivist approach to explore professional identity development. A convenient sample of 42 clinical associate students at the University of Witwatersrand in Johannesburg were interviewed using focus groups to explore their perceptions of factors that influenced their professional identity formation. A semi-structured interview guide was used in six focus group discussions, involving 22 first-year and 20 third-year students. The transcriptions from the focus group audio recordings were thematically analyzed.ResultsThe multi-dimensional and complex factors that were identified were organized into three overarching themes, identified as individual factors which derive from personal needs and aspirations, training-related factors consisting of influences from the academic platforms, and lastly, student perceptions of the collective identity of the clinical associate profession influenced their developing professional identity.ConclusionThe newness of the identity of the profession in South Africa has contributed to dissonance in student identities. The study recognizes an opportunity for strengthening the identity of the clinical associate profession in South Africa through improving educational platforms to limit barriers to identity development and effectively enhancing the role and integration of the profession in the healthcare system. This can be achieved by increasing stakeholder advocacy, communities of practice, inter-professional education, and the visibility of role models.

Fitness Trainers' Educational Qualification and Experience and Its Association with Their Trainees' Musculoskeletal Pain: A Cross-Sectional Study.

This is a cross-sectional study that examined the association between fitness trainers’ educational qualifications and experience, and the risk of their trainees’ musculoskeletal pain. The study included 1177 trainees (aged 15–60 years) from 74 fitness centers in Bangladesh. Data were collected by using the Nordic musculoskeletal questionnaire, including potential confounders such as demographic factors (e.g., age, occupation), and training-related factors (e.g., workout knowledge, overweight lifting). Multiple logistic regression was performed for a binary outcome (pain—yes or no), and a generalized linear model was fitted for the ordinal outcome (pain—sites of the body). The trainers’ lower experience (no or ≤1 year) was associated with higher odds of their trainees’ musculoskeletal pain (OR: 2.53, 95% CI: 1.18–5.44) compared to trainers with >5 years of experience; however, no association was found between the trainers’ education and the risk of their trainees’ musculoskeletal pain, after controlling for potential confounders. Similarly, the trainees trained by trainers with lower experience had more than two-time the risk of having pain in different sites (IRR: 2.04, 95% CI: 1.50–2.79). The trainers’ experience may play a pivotal role in the trainees’ musculoskeletal pain. Further study is warranted in this regard.

Risk factors for not finishing an ultramarathon: 4-year study in 23,996 race starters, SAFER XXI.

Limited data support prerace medical screening to identify risk factors for not finishing an endurance running race. The aim of the study was to determine risk factors associated with not finishing an ultramarathon. A prospective, cross-sectional study of Two Oceans ultramarathon (56 km) race starters who completed a prerace medical screening questionnaire. Race day environmental conditions were recorded on race day. Univariate analyses of risk factors associated with the did-not-finish (DNF) included race day factors and prerace medical screening history. Risk factors for DNF amongst 23,996 starters during the 56 km race included older age and females (P<0.0001). After adjusting for age and sex, the following were significant univariate risk factors: fewer years of running (P<0.0001), less previous race experience (P<0.0001), less training/racing per week (P=0.0002), lower average weekly training distance (P=0.0016), slower race vs. training speed (P<0.0001), lack of allergies (P=0.0100) and average wet-bulb globe temperature (P<0.0001). Females, older age, training-related factors (less training/racing, average weekly training distance, race vs. training speed) and average wet-bulb temperature, were risk factors for not finishing an ultramarathon. The results may not only assist runners and coaches in race preparation, but also have clinical implications for the medical planning prior to races.

The challenging scenario of beliefs and attitudes toward chronic low back pain among final year undergraduate students: A cross-sectional investigation

ObjectiveTo identify the beliefs and attitudes of students in four health courses about chronic low back pain (CLBP) management, and to investigate personal and undergraduate training-related factors associated with their beliefs. Methods: Cross-sectional study conducted with 173 Brazilian medicine, physiotherapy, nursing and pharmacy students. Participants provided information on age, personal experience with LPB, training or class on CLBP management, and contact with patients with CLBP, followed by their first therapeutic choices. HC-PAIRS (0–90) was applied to understand the beliefs and attitudes related to CLBP. We built a One-Way ANOVA with Tukey post hoc tests to compare the results among courses. We built multivariate linear regression models to investigate associated factors with HC-PAIRS score. Results: Mean HC-PAIRS for all participants was 49.8 (±10.2). Physiotherapy students presented more positive CLBP beliefs compared to medicine, pharmacy and nursing students. Only 41.67% of the responses about the first therapeutic choices were according to the main guidelines of care for CLBP. Total HC-PAIRS score was positive and significantly associated with being a student from medicine, nursing and pharmacy. Conclusion: Physiotherapy students had more positive beliefs about the association between pain and disability in those with CLBP. Still, the beliefs and attitudes of the majority of health students concerning CLBP are not yet in line with the current management framework.

Modelling the age‐related trajectory of performance in Para swimmers with physical, vision and intellectual impairment

This study is the first to provide information on the age-related trajectories of performance in Para swimmers with physical, vision and intellectual impairment. Race times from long-course swim meets between 2009 and 2019 were obtained for Para swimmers with an eligible impairment. A subset of 10661 times from 411 Para swimmers were included in linear mixed effects modelling to establish the relationship between age and performance expressed relative to personal best time and world record time. The main findings were: (a) age has the most noticeable influence on performance between the ages of 12-20years before performances stabilize and peak in the early to late twenties, (b) women have faster times relative to personal best and world record time than men during early adolescence and their performances stabilize, peak and decline at younger ages, and (c) Para swimmers from different sport classes show varying age-related trajectories in performance after maturation and when training-related factors are more likely to explain competitive swim performance. The results of this study can guide talent identification and development of Para swimmers at various stages of their career and help to inform decision-making on the allocation of sport class and sport class status in Para swimming classification.

Sex, But Not Age, Associates With Whole Muscle Carnosine Content Of Trained Men And Women

Carnosine is a dipeptide formed from the amino acids β-alanine and L-histidine, which contributes toward a number of essential processes in skeletal muscle metabolism. A number of modifiable (e.g., sex and age) and non-modifiable factors (e.g., training status) purportedly influence muscle carnosine content (MCarn), but little is known about the relative contribution of these factors. PURPOSE: To investigate the influence of modifiable and non-modifiable determinants of MCarn in a group of cycling-trained men and women. METHODS: 73 trained cyclists (54 men and 19 women, age 18 - 60) participated. Whole muscle MCarn was determined using high-performance liquid tomography, from a biopsy taken from m. vastus lateralis. All participants completed a self-report questionnaire of their current and previous training habits, and an exercise test battery (aerobic capacity testing, wingate test and a 4km time-trial). Body composition was assessed using the sum of 7 skinfolds. To describe relationships between MCarn and a range of demographic, performance and training-related factors, penalized regression in the form of LASSO (least absolute shrinkage and selection operator) analysis was completed. Models were generated using the glmnet package in R with associations described by regression coefficients and percentage inclusion in 10000 bootstrap samples. RESULTS: Sex (91% of models) and sum of skinfolds (69% of models), but not age (52% of models), training habits (13-30% of models), nor exercise test performance (4-45% of models), predicted MCarn. The LASSO model estimated women to have a median reduction of ~two units compared to men (-1.8, 95%CrI: -5.2 – 0)), while each 2SD increase in the sum of skinfolds resulted in an MCarn decrease of approximately 1 unit (-0.8; 95%CrI: -5.6 – 0). Repeating the model with men only identified no relevant associations (≤37% of models) on MCarn. CONCLUSION: Sex and body composition, but not age nor performance outcomes, had very small associations with whole muscle MCarn in a group of trained cyclists. These results imply that habitual training may reduce previously reported impacts of age on MCarn content (at least across the 4 decades investigated in this study). In contrast, women had lower MCarn content than men, even though their type and volume of training was similar.

Time Pressure Experienced by Internal Medicine Residents in an Educational Hospital in Saudi Arabia: A Qualitative Study

PurposeResidents suffer from high workload and extended working hours, which have several negative consequences on their mental health and patients' safety. Similarly, time pressure, which is also part of the clinical training of medical residents, may have adverse effects on their performance. The aim of this study was to explore internal medicine residents’ perceptions of time pressure sources in the workplace, its negative effects on them and their patients and finally what strategies they adopt to cope with them. MethodThis was a focus group qualitative study. Seventeen internal medicine residents from all four years of the residency training were recruited. A semi-structured interview approach was used, and data were analyzed using thematic analysis. ResultsParticipants perceived their work as stressful and very demanding. Four major themes emerged to explain the sources of time pressure in the workplace: patient-related factors; practice-related factors; training-related factors; and resident-related factors. In addition, two main themes arose to show the negative effects of time pressure on residents: the effects on residents' health and the effects on residents’ performance. Data also showed two main coping strategies, which can be summarized as: active adaptive coping and avoidant maladaptive coping. DiscussionThis in depth-qualitative study highlights the sources and consequences of perceived time pressure in clinical training of internal medicine residents. Residents feel this adverse working condition could have substantial adverse effects on their health and performance.

Incidence of Achilles tendinopathy and associated risk factors in recreational runners: A large prospective cohort study

ObjectivesTo determine the incidence of Achilles tendinopathy in a large group of recreational runners and to determine risk factors for developing AT. DesignObservational cohort study. MethodsRunners registering for running events (5–42 km) in the Netherlands were eligible for inclusion. Main inclusion criteria were: age ≥18 years, and registration ≥2 months before the running event. The digital baseline questionnaire obtained at registration consisted of demographics, training characteristics, previous participation in events, lifestyle and previous running-related injuries. All participants received 3 follow-up questionnaires up to 1 month after the running event with self-reported AT as primary outcome measure. To study the relationship between baseline variables and AT onset, multivariable logistic regression analyses were performed. ResultsIn total, 2378 runners were included, of which 1929 completed ≥1 follow-up questionnaire, and 100 (5.2%, 95%CI [4.2;6.2]) developed AT. Runners registered for a marathon (7.4%) had the highest incidence of AT. Risk factors for developing AT were use of a training schedule (odds ratio (OR) = 1.8 (95%Confidence Interval(CI)[1.1;3.0])), use of sport compression socks ((OR = 1.7, 95%CI[1.0;2.8]) and AT in the previous 12 months (OR = 6.3, 95%CI[3.9;10.0]). None of the demographic, lifestyle or training-related factors were associated with the onset of AT. ConclusionOne in twenty recreational runners develop AT. AT in the preceding 12 months is the strongest risk factor for having AT symptoms. Using a training schedule or sport compression socks increases the risk of developing AT and this should be discouraged in a comparable running population. Trial registration numberThe Netherlands Trial Register (ID number: NL5843).

Cardiac Remodeling in Middle-Aged Endurance Athletes and Recreationally Active Individuals: Challenges in Defining the “Athlete's Heart”

Chronic endurance exercise is known to elicit cardiac morphologic and functional adaptations collectively known as the “athlete's heart.” 1 Paterick T.E. Gordon T. Spiegel D. Echocardiography: profiling of the athlete's heart. J Am Soc Echocardiogr. 2014; 27: 940-948 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar Yet the extent to which exercise burden and other phenotypic factors dictate the extent of cardiac remodeling remains understudied. While there are significant data in younger, elite athletes, reference values for cardiac morphology in long-standing, middle-aged endurance athletes (EAs) performing high-volume exercise, particularly when compared with recreationally active adults (RECs) who perform recommended levels of physical activity, remain limited. We therefore evaluated cardiac structure and training-related factors associated with cardiac remodeling. We hypothesized that middle-aged EAs would have greater cardiac remodeling than RECs. We further hypothesized that a higher peak rate of oxygen consumption ( V ˙ O2peak) and greater weekly exercise hours would predict a larger left ventricular (LV) volume.