Burnout-related complaints are increasing, and general practitioners are frequently consulted for work-related concerns. However, knowledge regarding clinical management practices for burnout and the psychosocial and contextual determinants that shape these practices remains limited. This study aims to address this gap through an exploratory sequential mixed-methods design. The study will be conducted in two phases. Phase 1 will consist of semi-structured interviews incorporating video-based clinical vignettes to explore management practices and their underlying determinants. Phase 2 will build on these findings to develop a questionnaire aimed at generalizing the qualitative results to a larger sample, testing new hypotheses derived from the qualitative material, and statistically assessing the effects of psychosocial and contextual determinants on medical practices. The originality of this protocol lies in the integration of complementary theoretical models and in the use of video-based clinical vignettes to investigate medical practices and their determinants in a contextualized manner. From an ecologically informed and sustainable research perspective, these videos may also be repurposed for professional training in burnout management and for future interventional studies. Finally, the findings of this project may inform public and policy discussions and contribute to improving clinical management practices and support recommendations regarding burnout management. This study was registered on ClinicalTrials.gov (Identifier: NCT06811181, registered on 2025-02-06).
In chronic disease management, perceived effectiveness of patient-physician interaction may be associated with health literacy, patient adherence, and clinical processes. This study was conducted to examine the relationships of health literacy and patient adherence with the perceived effectiveness of patient-physician interactions among individuals with chronic diseases registered with family physicians. This cross-sectional study was conducted in 12 Family Health Centers in Türkiye between June 23 and July 13, 2026. 422 adult patients with at least one chronic disease were included using stratified and convenience sampling. Data were collected using a sociodemographic/clinical form, the European Health Literacy Scale Short Form, the Patient Compliance Scale, and the Perceived Effectiveness of Patient-Physician Interactions Scale. Descriptive statistics, Mann-Whitney U, Kruskal-Wallis, and two-step Multiple Linear Regression were used in the analyses. The median age of the participants was 48.0, and 55.5
How primary care physicians (PCPs) cognitively approach the diagnostic process of spondyloarthritis (SpA) remains poorly documented. This study aims to analyze their clinical reasoning, decision-making, and potential cognitive and gender biases in identifying axial (axSpA) and peripheral (pSpA) forms. We designed a qualitative study using online structured electronic questionnaire with 46 PCPs from the Spanish National Health System. Four cases-based simulations were presented: a male/female patient (1) 30-year-old with one-year low back pain (axSpA) and (2) 25-year-old with three-month left knee pain and left ankle pain (pSpA). Case information was provided sequentially. Following each section, participants supported their clinical reasoning and diagnostic decisions. Responses were analyzed alongside identified differential diagnoses and potential cognitive and gender biases. In the clinical case assessments, axSpA was correctly diagnosed in 11 out of 12 participants for the female case and in 7 out of 10 for the male case. In contrast, none of the participants correctly diagnosed the pSpA cases, regardless of patient sex. Distinct diagnostic reasoning patterns emerged based on the patient’s sex. In axSpA female cases, pain was initially interpreted as functional by 6 out of 12 participants, compared to 3 out of 10 in male cases. This gender bias was reflected in a tendency to attribute young women’s symptoms to psychological or nonspecific causes, in the clinicians’ perceived absence of overt red flags. Patterns consistent with anchoring bias were identified in diagnostic assessment, including persistence of initial interpretations even after objective inflammatory markers were reported, despite these tests often not having been initially requested by the participants. In pSpA cases, diagnostic reasoning showed patterns consistent with availability bias, with interpretations that appeared to be shaped by familiarity with sex —and age— related conditions. In women, pSpA was frequently misclassified as juvenile arthritis or vague inflammatory syndromes. In men, diagnoses emphasized contextual risk factors —such as sexual history or occupational strain— leading to misclassification as reactive arthritis or mechanical disorders. Findings indicate that diagnostic reasoning for spondyloarthritis in primary care may be shaped not only by clinical evidence but also by implicit biases related to patients’ sex, age and contextual factors. Addressing these influences requires targeted educational strategies that foster reflective, evidence-based diagnostic practices and integrate a gender-sensitive approach into clinical judgment.
Nocturia is associated with poor sleep quality, but its relationship with subjective sleep dissatisfaction remains insufficiently understood. In primary care, sleep-related complaints are common, and nocturia may be overlooked as a contributor to sleep dissatisfaction. This study examined the association between nocturia and sleep dissatisfaction and explored age-related differences using explainable machine learning. We conducted a community-based cross-sectional postal survey in 2022 among 10,000 randomly selected residents of Tsukuba City, Japan, aged 45–89 years. A total of 2,148 participants were analyzed. Multivariable logistic regression was used to assess the association between nocturia and sleep dissatisfaction after adjustment for demographic, lifestyle, psychological, and clinical factors. An eXtreme Gradient Boosting (XGBoost) model combined with SHapley Additive exPlanations (SHAP) was used to evaluate the direction and relative magnitude of each variable’s contribution and explore age-related heterogeneity. The prevalence of nocturia increased from 8.3
Antiretroviral (ARV) resistance poses a major challenge for HIV patient management in Cameroon, with resistance prevalence reaching 15
