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ImportanceThe COVID-19 pandemic has affected clinician health and retention.ObjectiveTo describe trends in burnout from 2019 through 2021 with associated mitigating and aggravating factors.Design, Setting, and ParticipantsCross-sectional surveys were sent to physicians and advanced practice clinicians throughout 120 large US health care organizations between February 2019 and December 2021. From 56 090 surveys, there were 20 627 respondents.ExposuresWork conditions and COVID-19.Main Outcomes and MeasuresSurveys measured time pressure, chaos, work control, teamwork, electronic health record use, values alignment, satisfaction, burnout, intent to leave, and in 2021, feeling valued. Multivariate regressions controlling for gender, race and ethnicity, years in practice, and role determined burnout, satisfaction, and intent-to-leave correlates.ResultsOf the 20 627 respondents (median response rate, 58% [IQR, 34%-86%; difference, 52%]), 67% were physicians, 51% female, and 66% White. Burnout was 45% in 2019, 40% to 45% in early 2020, 50% in late 2020, and 60% in late 2021. Intent to leave increased from 24% in 2019 to more than 40% as job satisfaction decreased. Higher burnout was seen in chaotic workplaces (odds ratio [OR], 1.51; 95% CI, 1.38-1.66; P < .001) and with low work control (OR, 2.10; 95% CI, 1.91-2.30; P < .001). Higher burnout was associated with poor teamwork (OR, 2.08; 95% CI, 1.78-2.43; P < .001), while feeling valued was associated with lower burnout (OR, 0.22; 95% CI, 0.18-0.27; P < .001). In time trends, burnout was consistently higher with chaos and poor work control. For example, in the fourth quarter of 2021 burnout was 36% (95% CI, 31%-42%) in calm environments vs 78% (95% CI, 73%-84%) if chaotic (absolute difference, 42%; 95% CI, 34%-49%; P < .001), and 39% (95% CI, 33%-44%) with good work control vs 75% (95% CI, 69%-81%) if poor (absolute difference, 36%; 95% CI, 27%-44%; P < .001). Good teamwork was associated with lower burnout rates (49%; 95% CI, 44%-54%) vs poor teamwork (88%; 95% CI, 80%-97%; absolute difference, 39%; 95% CI, 29%-48%; P < .001), as was feeling valued (37%; 95% CI, 31%-44%) vs not feeling valued (69%; 95% CI, 63%-74%; absolute difference, 32%; 95% CI, 22%-39%; P < .001).Conclusions and RelevanceResults of this survey study show that in 2020 through 2021, burnout and intent to leave gradually increased, rose sharply in late 2021, and varied by chaos, work control, teamwork, and feeling valued. Monitoring these variables could provide mechanisms for worker protection.

This study highlighted the magnitude of these preventable conditions among older adults and disabled persons and the burden on the Medicare system. These results can help target public education and preparedness activities for extreme weather events.

Every organ in the body is made up of cells that originated as stem cells, which are then differentiated (changed) into different forms.Stem cells have special ability to become more than one type of cell in the body and also to keep dividing and multiplying without limits. The more potent a stem cell is, the more types of cells it can become. The most potent stem cells are embryonic stem cells, which are found in the very early stages of pregnancy or can be made outside the body using in vitro fertilization. Adult stem cells, which are present throughout life, are less potent but still very important for maintaining overall health. Adult stem cells were first found in bone marrow but now are thought to be present in almost every organ in the body. These adult stem cells also include neonatal stem cells that are found in the umbilical cord and placenta. Finally, induced pluripotent stem cells are adult cells that are reprogrammed in a laboratory to revert back to a stem cell that is similar to an embryonic stem cell.

Human papillomavirus (HPV) is a virus that affects both men and women.Human papillomavirus is considered a sexually transmitted infection that can be passed on by skin, mouth, and genital contact. It is very common worldwide, and most people have been exposed and infected at some point in their lives. There is no treatment for the infection itself; in most cases, the body clears the virus on its own. However, there are vaccines available to prevent HPV infection (3 available worldwide; 1 currently used in the United States). In the United States, the HPV vaccine is currently recommended for all girls and women and all boys and men aged 9 to 26 years. Since the introduction of the HPV vaccine, the rates of infection have decreased in recent years. HPV and CancerAlthough HPV infection is common and generally causes no symptoms, it is a unique health concern because it is one of very few infections that can, over time, lead to cancer. There are many different types (strains) of HPV; most are not linked to cancer. Noncancer strains of HPV can cause genital warts. The cancer strains of HPV can cause several different types of cancer, but most people with these HPV strains will never develop any kind of HPV-associated cancer.In women, HPV can lead to cervical cancer, the fourth most common type of cancer in women worldwide. Nearly all cases of cervical cancer are caused by HPV. In men, it can lead to cancer of the penis. In both men and women, HPV can cause oral cancer as well as anal cancer. Unlike with cervical cancer, not all cases of penile, anal, or oral cancers are due to HPV. Screening for HPV and HPV-Related CancersThe US Preventive Services Task Force recommends routine screening of women for cervical cancer and/or cervical HPV infection via Papanicolaou testing ("Pap smears") along with HPV co-testing when appropriate. This screening test has been a major public health victory in the United States, as rates of and deaths due to cervical cancer have drastically decreased with its routine implementation.For oral, anal, and penile cancers, screening is sometimes done in higher-risk populations. However, there is no official current recommendation for screening for either HPV infection or cancerous/precancerous lesions in these areas in the absence of symptoms. Emerging Concerns About Oral HPV Infections and CancerOral HPV infection refers to HPV found in the mouth or throat. It is much less common than genital HPV infection and generally does not cause any symptoms. However, recent data have shown that oral cancers are now the most common type of HPVassociated cancers in the United States, more common than cervical cancer. Among these cases of HPV-positive oral cancers, men are affected about 4 times as often as women. In recent years, the proportion of oral cancers that are HPV positive (as opposed to HPV negative, which are generally linked to tobacco and alcohol use), has been increasing for unclear reasons. Data on transmission are still limited, but oral HPV infection appears to be linked at least in part ...