# data[].attributes.body
For my first source being “Radiologists battling insomnia, depression and anxiety amid pandemic, but a few factors appear protective” by Marty Stempniak, the main point would be that radiologists are experiencing mental health challenges like depression, insomnia, and anxiety during the Covid-19 pandemic with certain factors increasing the risk, with the article stating “Radiologists working in private practice, in a high COVID-19 density area, managing patients with COVID-19 and with past medical history seemed to be the most at risk and should be closely monitored. Access to medical education via webinar or e-learning should be emphasized.” (Stempniak). Now as for sentences I would like to paraphrase from this article, they would be "All told, 1,515 radiologists took the anonymous survey, administered between April 10 to 19. Emailed to members of five separate medical societies, the respondents included residents and board-certified rads from academia, nonteaching public hospitals and private practices"(Stempniak). The conducted survey including a total of 1,515 radiologists was sent to members of different medical societies, which included residents and board-certifiec radiologists from various types of hospitals and practices, (Stempniak).

For my second source included being “Shift Work and Mental Health Among Radiologic Technologists” by Marilyn Sachett, the main point here is that the study found significant research between working during weekends and depression amongst radiologic technologists, who also reported that mental health issueas had a significant impact within their job preformance. We can find this within the article when it states "Purpose To determine the relationships between mental health (depression and anxiety) and engaging in shift work, working weekend shifts, and taking call for radiologic technologists, and to identify coping strategies used to manage depression and anxiety" (Sackett). Now, a sentence I would paraphrase would be "Most radiologic technologists in this study experienced mild symptoms of depression (62, 35.8%) and anxiety (57, 32.9%). Nearly half of the participants indicated that their depression and anxiety made it difficult for them to perform their jobs effectively, and about one-third of the participants believed those symptoms were intensified by shift work" (Sackett). The study showed that many radiologic technologists had mild depression with statistics saying it was a (35.8%) and anxiety (32.9$). Almost hald said these issues made work harder, and a third felt shift work worsened their symptoms, (Sackett).

Moving onto my third source being “Depression and Anxiety Symptoms Tied to Radiologic Technology Weekend Shift Work” by Marilyn Sackett, the main point being that shift work among radiologic technologists is associated with mental health disorders like depression and anxiety. We can see this when it states "Survey instruments were used to measure depression and anxiety levels among a sample of radiologic technologists who are members of Advanced Health Education Center educational programs" (Sackett). A sentence I would paraphrase would be "Engaging in shift work is associated with mental health disorders and these workers are at a higher risk for adverse health outcomes, such as stroke, obesity, G.I. symptoms and various types of cancer. Health care workers experience elevated stress levels from exposure to emotional and traumatic situations which affect mental health" (Sackett). Working in shifts can lead to mental health issues, and these employers are more than likely to struggle with things like strokes, obesity, stomach issues, and different cancers. The stress from dealing with intense emotional and traumatic situations in healthcare can impact their mental well-being, (Sackett).

Continuing with my last source which is “The Impact of the Covid-19 Pandemic on the Mental Health and Work Morale of Radiographers within a Conventional X-Ray Department” by Yasin, B, the main point being how shift work can impact the mental health and job performance of radiologic technologists. We can find this when the article states "There is a plethora of literature that has described the negative impact of the COVID-19 pandemic on the mental health of healthcare staff worldwide" (Sackett). Now, as for a sentence I would paraphrase, it would be "Little is known about the impact of COVID-19 on UK radiographers' mental health and wellbeing. This paper will broadly describe the effect the first wave of the COVID-19 pandemic had on the mental health and well-being of diagnostic radiographers in an NHS (National Health Service) Trust in the UK" (Sackett). The article aims to comprehensively detail the repercussions of the initial Covid-19 surge on the psychological health and welfare of diagnostic radiographers within a particular NHS Trust in Britain, (Sackett).

# data[].attributes.body
https://radiologybusiness.com/topics/healthcare-management/leadership/radiologists-insomnia-depression-anxiety-pandemic

For this first source, I feel as if it is a good fit for this topic because it continues the conversation carrying the fact that borh radiologists and radiographers bare the relationships between socio-demographic characteristics and occupational stress. Not onlt that but it inlcudes data that is crucial for this work, it helps it be a much more reliable source and as well much more creditable. I feel like this could be added into the sources I already have included but not remove one or take place of another source. This source yet still supports the same point im trying to make within this work process. Although, this source talks about the same struggles with data included, it is not meant to be for a counterargument as I would like to keep it stable.

Now as for the second added source, I would like to replace this source with another that doesnt inlcude an author only because it makes this much more creditable and it allows me to search for many other different trypes of work by the same author that being Marty Stempniak. What this source does it help shed light to the pandemic part of my assignment as I included the fact that Covid-19 took a toll on these professionals lifes, its good to have more research in order to fully fulfill that piece of topic. This again is not for a counterargument as I stated I would like to keep this stable to my liking if possible.

# data[].attributes.attachment_link.readable_text
Philippe Gorce, , Krystyna Kowalczuk, , Nicola Mucci, , and Izabella Uchmanowicz, Academic Editor

Abstract

The COVID-19 pandemic has heightened stress levels, potentially affecting the occupational wellbeing of radiographers and radiologists. Our study aimed to assess occupational stress levels within the radiology department and identify contributing factors. A cross-sectional survey was conducted between September and November 2022, with participants comprising radiographers and radiologists affiliated with the Hungarian Society of Radiographers and the Hungarian Society of Radiologists. The online survey collected socio-demographic and COVID-19 data, and the participants completed an effort-reward imbalance questionnaire. The analysis of 406 responses revealed significantly higher effort-reward imbalance (ERI) levels among the radiologists compared to the radiographers ( p < 0.05). The healthcare professionals with over 30 years of experience exhibited significantly lower ERI levels than those with 1-9 years, 10-19 years, or 20-29 years of experience ( p < 0.05). Additionally, the individuals aged 31-40 demonstrated higher ERI levels compared to their counterparts aged 19-30, 41-50, and over 51 ( p < 0.05). The respondents cohabiting with a spouse/partner reported significantly higher stress levels than their single colleagues ( p < 0.05), while the dog owners exhibited significantly lower ERI levels ( p < 0.05). Elevated occupational stress highlights specific groups requiring targeted interventions to reduce stress and mitigate burnout among radiologists and radiographers.

Keywords: occupational stress, radiographer, radiologist, Effort-Reward Imbalance, ERI, COVID-19

1. Introduction

Healthcare institution employees are constantly exposed to stress during everyday patient care, which can stem from various sources. These include factors such as long working hours, high workloads, inadequate rewards, exposure to traumatic events, and caring for critically ill patients [ 1, 2, 3]. Occupational stress can have adverse effects on the mental and physical health of healthcare workers, causing psychological distress which may lead to anxiety, depression, burnout, or other mental illnesses [ 1, 2, 3, 4].

The COVID-19 pandemic that occurred at the end of 2019 had a significant impact on the physical and mental health of society as a whole, particularly affecting healthcare workers. Mental health refers to an individual's emotional, psychological, and social wellbeing, encompassing how a person feels, thinks, manages stress, relates to others, and makes decisions. The pandemic caused a great deal of stress and anxiety as well as triggering feelings of isolation, depression, and grief in people [ 5, 6].

The uncertainty caused by the pandemic brought about significant fear and panic. When fear and anxiety persist, it takes time for the resulting high stress levels to subside. The increasing number of COVID-19 cases, limited resources, and overwhelmed healthcare infrastructure further worsened the inherently stressful situation of healthcare systems [ 7, 8].

It is worth considering that, as a result of all these factors, healthcare workers are more likely to experience burnout and psychological anxiety. Numerous studies have addressed, among other things, the mental health status of healthcare workers during the COVID period, as well as the occupational stress levels of nurses combating coronavirus [ 1, 2, 3, 6, 7].

We must remember the radiographers handling imaging modalities and the radiologist specialists interpreting imaging materials who also work on the front lines. Their work makes the proper diagnosis of patients infected with coronavirus possible [ 9].

Healthcare professionals employ various coping strategies to manage occupational stress. Many prioritize self-care, incorporating regular exercise, sufficient sleep, and healthy dietary habits to enhance their overall wellbeing. Seeking social support plays a crucial role, as sharing experiences and concerns with colleagues or friends can provide emotional relief [ 8]. Mindfulness and relaxation techniques, such as meditation or deep-breathing exercises, are commonly used to alleviate stress and promote mental wellbeing. Additionally, time management skills help healthcare professionals organize their tasks efficiently, reducing feelings of being overwhelmed. Lastly, ongoing professional development and training can empower healthcare workers, enhancing their skills and confidence in handling challenging situations, ultimately mitigating stress [ 10, 11].

The presence of animals can significantly contribute to stress coping strategies by providing companionship and emotional support. Interacting with animals, such as pets, has been shown to reduce stress hormones and promote calmness, emphasizing their therapeutic role in enhancing mental wellbeing [ 12, 13, 14].

The international literature has reported that radiographers were not recognized as frontline healthcare personnel. Due to the pandemic, radiology departments became overwhelmed, leading to significant psychological stress among the staff [ 8, 15].

Our study sought to evaluate the occupational stress experienced by radiographers and radiologists within a radiology department amid the COVID-19 pandemic, with a specific focus on discerning the underlying factors of said stress. Notably, our investigation included an examination of the impact of pet ownership on the respondents' occupational stress levels.

2. Materials and Methods

Our cross-sectional study was conducted through purposeful, non-random sampling from September 2022 to October 2022. The online survey was distributed to all registered email addresses in the Hungarian Society of Radiographers and the Hungarian Society of Radiologists database. Additionally, we sent the questionnaire to all county hospitals' radiology departments and shared it through the most popular social media platform (Facebook). The participants were informed about the questionnaire's content in the first phase of the survey. The questionnaire was completed anonymously, and the participants could interrupt the process at any stage. The respondents confirmed their intention to participate by accepting the content of the consent statement.

During our survey, we included the internationally validated Hungarian version of the effort-reward imbalance questionnaire and a self-designed questionnaire. The latter comprised socio-demographic questions alongside inquiries specific to the COVID-19 virus situation.

In our research, we formulated closed questions regarding socio-demographic characteristics, in line with those found in the international literature, supplemented with questions specific to the pandemic and the occupation of the participants.

Our questions covered the following areas: gender, age, family characteristics (marital status, presence of children, questions related to pets), workplace characteristics (occupation, nature of the current workplace, willingness to take on shifts, weekly working hours, second job).

We formulated questions regarding whether the respondent had ever had a positive COVID-19 test, whether they had been in quarantine, whether they had received training on specific precautions, whether they had examined a patient with COVID-19 during their work, whether there had been a COVID-19 infection in their family, among close friends or colleagues, and their opinion on how the COVID-19 pandemic had influenced societal esteem of healthcare workers, specifically radiographers and radiologists.

The effort-reward imbalance questionnaire consists of three dimensions: efforts at work, workplace rewards, and overcommitment. The abbreviated instrument included fifteen statements, with three about the effort dimension, six about the reward dimension, and an additional six about overcommitment. The statements related to effort and reward specifically assessed stress-inducing factors associated with one's workplace or job. At the same time, those in the overcommitment category demonstrated individual characteristics appearing in work-related situations for the respondents [ 16].

The participants completing the questionnaire were required to indicate on a 5-point Likert scale how characteristic each statement was for their work concerning efforts and rewards. In the overcommitment dimension, responses were given on a 4-point Likert scale: (0) Not at all characteristic, (1) Not characteristic, (2) Characteristic, and (3) Very characteristic [ 16].

The effort scale has a minimum score of 3 and a maximum score of 15. The higher the score on the effort scale, the higher the perceived effort. The reward scale ranges from 6 to 30, where a lower score indicates better rewards. The overcommitment scoring ranges from 6 to 24, with a higher score indicating greater overcommitment by the worker [ 16].

The ratio of efforts to rewards on the respective scales gives a suitable indicator for measuring occupational stress. This variable, the effort-reward imbalance (ERI), in our case, quantifies the ratio of invested efforts to the rewards received in the daily work of radiographers and radiologists. If ER > 1, the respondent puts in more effort than the rewards received [ 16].

2.1. Statistical Analysis

We conducted descriptive statistics for the sample description (mean, standard deviation) during our research. For comparing the variances in the samples, we applied an F-test. In the case of a normal distribution, we used a two-sample T-test, analysis of variance (ANOVA) for group categories, post hoc analysis for within-group differences, and non-parametric distributions. We performed Mann-Whitney U and Kruskal-Wallis tests at a 95% confidence level ( p < 0.05).

The statistical analysis of the incoming data was carried out using the Statistical Software Package for Social Sciences (SPSS) version 23.0. The graphs and tables were created using Microsoft Excel 2021.

2.2. Ethics

We conducted our research with the professional and ethical approval of the Medical Research Council (BMEÜ/253-1/2022/EKU).

3. Results

Our research analyzed responses from radiographers and radiologists with work experience exceeding one year, actively involved in patient care during the COVID-19 pandemic. After data cleaning, 406 sets of feedback were included in the analysis.

3.1. Socio-Demographic Results

The average age of the sample was 40.9 ± 11.2 (21-67). In terms of gender, the majority of the participants were female ( n = 324; 79.8%). Those working as radiographers constituted over two-thirds of the total sample ( n = 287, 70.7%). Regarding age distribution, there was a roughly equal distribution among those aged 19-30 ( n = 93; 22.9%), 31-40 ( n = 106; 26.1%), 41-50 ( n = 97; 23.9%), and those aged 51 or older ( n = 110; 27.1%). Regarding marital status, over half of the respondents lived with their spouse/partner ( n = 268; 66.0%), while less than 10% were divorced ( n = 37; 9.1%), and fewer than a quarter were single ( n = 87; 21.4%). Almost half of the respondents had not had children ( n = 164; 40.4%) up to their completion of the questionnaire. ().

Regarding the nature of the main job of the radiologists and radiographers, most worked in state healthcare ( n = 368; 90.6%). Slightly over 30% of the respondents had a second job ( n = 129, 31.8%). The sample predominantly comprised healthcare workers with 1-9 years of experience ( n = 159; 39.2%). Following this group were those with over 30 years of professional experience ( n = 115; 28.3%). Those with 10-19 years ( n = 72, 17.7%) and 20-29 years ( n = 60; 14.8%) of experience in healthcare showed a similar distribution. Most respondents worked 40 h per week ( n = 313; 77.1%). Two-thirds of the sample ( n = 271; 66.7%) participated in on-call duties during their work, with those taking on more than three on-call shifts per month being the majority ( n = 217; 53.4%). ().

The number of pet owners ( n = 217; 53.4%) and those without pets ( n = 189; 46.6%) was almost evenly distributed among the respondents. Ninety individuals (22.2%) had only a dog, and forty-four individuals (10.8%) owned both a dog and a cat. Most of the dog owners ( n = 44, 32.83%) took their dogs for a walk once a day ().

3.2. Sample Characteristics Related to COVID-19

Most of the respondents ( n = 370; 91.1%) had examined a patient with COVID-19 during their work, but only slightly more than half of the sample reported having had a coronavirus infection ( n = 226; 55.7%). Most of them ( n = 342; 84.2%) mentioned that there had been cases of coronavirus illness among their family, friends, and colleagues as well ().

We asked questions regarding the training healthcare workers received for adequate protection against coronavirus. The majority read informational materials ( n = 145; 35.7%), but many also prepared through e-learning ( n = 91; 22.4%) or workplace simulations ( n = 72; 17.7%) for the fight against coronavirus. Some reported receiving no specific highlighted training for the virus ( n = 89; 22%). ().

Regarding societal esteem of radiographers and radiologists, in both cases, more than half of the sample ( n = 231, 56.9%; n = 222, 54.7%) believed that it had not changed due to the pandemic.

3.3. The Results of the Effort-Reward Imbalance Questionnaire

The descriptive statistics of the effort-reward imbalance questionnaire, the reliability values indicated using Cronbach's alpha for its scales, and the overall stress score for the entire sample are summarized in .

3.4. The Relationship between Socio-Demographic Characteristics and Occupational Stress

The occupational stress score of the radiologists (0.87 ± 0.41) was significantly higher than that of the radiographers (0.49 ± 0.23) ( p < 0.001).

The respondents with a side job had a significantly higher stress score (0.70 ± 0.39) than their counterparts working only their main job (0.56 ± 0.30) ( p < 0.001).

The occupational stress score of those with more than 30 years of experience in the profession (0.50 ± 0.24) was significantly lower than that of the colleagues with 1-9 years (0.61 ± 0.30), 10-19 years (0.70 ± 0.41), and 20-29 years (0.65 ± 0.44) of experience ( p = 0.006; p = 0.001; p = 0.007).

The stress score of the individuals living alone (0.48 ± 0.22) was significantly lower than that of the respondents who were divorced (0.67 ± 0.32) or living with a spouse or partner (0.64 ± 0.37) ( p = 0.004; p = 0.001).

Pet ownership alone was not a significant factor in the occupational stress scores ( p = 0.374). However, analyzing groups of respondents with pets revealed a significant relationship between pet type and stress score changes ( p = 0.006). The respondents with only cats (0.72 ± 0.39) had significantly higher stress scores than those with dogs (0.51 ± 0.22). Furthermore, the respondents without pets (0.62 ± 0.34) had significantly higher stress scores than the dog owners ( p = 0.012) but significantly lower stress scores than the cat owners ( p = 0.042).

(All the results can be seen in ).

3.5. The Relationship between COVID-19 Characteristics and Occupational Stress

The respondents' occupational stress scores were not significantly influenced by whether the respondent had already had a COVID-19 infection ( p = 0.826), and the examination of a COVID-19-infected patient also did not have a significant impact ( p = 0.484).

However, the occupational stress scores of the respondents were significantly higher for those who had experienced COVID-19 infections within their family, among close friends, and colleagues (0.63 ± 0.35) compared to those for whom COVID-19 had occurred only among colleagues (0.47 ± 0.22) ( p = 0.04). (All the results can be seen in ).

4. Discussion

Elevated occupational stress is a common phenomenon in various professions, which can significantly impact the physical and mental health of employees and their workplace performance [ 1, 2, 3, 4, 5, 6, 7, 8]. During public health emergencies, such as the COVID-19 pandemic, healthcare workers are exposed to even higher stress levels, exacerbated by increased risk of infection, heavier workloads, and a lack of social support [ 1, 2, 3, 4, 6, 7].

Birgit et al. also highlighted the role of one's occupation in ERI, where healthcare professionals typically experienced a more significant imbalance in their effort-reward compared to physicians [ 17].

Our study results confirmed that the nature of one's occupation is a significant factor in occupational stress; however, in our case, the radiologists showed a higher effort-reward imbalance than the radiographers. Our survey aligns with the findings of the study conducted by Nguyen Van et al. [ 18], who found that in some cases there is more perceived reward than perceived effort in the observed workplace.

For years, professionals researching this field believed financial rewards to be the most effective way to motivate employees and boost morale. There are other ways to reward employees beyond financial compensation. Some of these include recognition and praise from their superiors, providing opportunities for their development, and taking on meaningful projects [ 19, 20].

Msaouel et al. [ 19] demonstrated that the 31-40 age group had a significantly higher effort-reward imbalance than their younger or older colleagues. This is consistent with our study results, as we also found that the age group between 31 and 40 years of age exhibits a significantly higher stress level than the younger and older age groups.

Based on Nguyen Van et al.'s research [ 18], female healthcare workers are more likely to report a lower ER ratio. The survey identified higher effort and overcommitment among men, but they received lower rewards than women. Our survey does not exhibit this trend. In terms of gender, no significant difference was observed in the dimensions of effort, rewards, or overcommitment.

Yubonpunt and colleagues [ 21] found that employees living with their partners showed higher coping scores, indicating that they handled stress more effectively than their single counterparts. This could be explained by viewing their partners as a secure zone providing emotional support. Their research revealed that healthcare workers with children had lower stress levels and higher coping scores compared to their childless counterparts.

Ali et al. [ 22] investigated the main stressors and coping strategies of frontline nursing staff during the COVID-19 pandemic in Alabama. Their results showed that single nurses and those without children had significantly higher stress levels than their counterparts in relationships.

However, some studies have found the opposite and identified living with a spouse or partner and having children as a source of concern and stress [ 22, 23].

Among respondents with children, higher stress levels may have been observed because, during quarantine, online education could impose a significant burden on parents in terms of its undertaking and the placement of children. This could be particularly true for healthcare workers, given the nature of their work, which often did not allow for remote work. In cases where both parents were healthcare professionals, the arrangement and supervision of young children may have been even more complicated.

Hossain et al. [ 23] examined the relationship between COVID-19 and stress based on marital status. It was found that the stress levels of doctors and healthcare workers were significantly higher than those of teachers, engineers, or researchers. Furthermore, the highest stress levels and severe anxiety were measurable among married individuals, while singles exhibited mild stress levels and moderate anxiety [ 23].

Our present study found that the stress levels of single respondents were significantly lower than those living with a spouse or partner. Additionally, there was no significant connection between the respondents' stress levels and whether they had children, indicating that having children was not interpreted as a protective factor or a significant stressor. These results align with Hossain's findings [ 23], and our study may support the assumption that individuals in a marital relationship may have had increased concerns regarding their daily livelihood and protecting their family members from infection.

According to our survey, the number of years spent in healthcare showed a significant relationship with occupational stress. The respondents working in healthcare for over 30 years exhibited the lowest stress levels in the examined sample. This might be attributed to the wealth of work experience accumulated over the years, which could have assisted them in coping with the challenges posed by the pandemic.

Mainly during the first wave, radiographers in England reported on protocols that changed daily, sometimes hourly, which was one of the causes of the anxiety felt by many. The rapidly changing information primarily focused on the use of personal protective equipment [ 24].

Foley et al. [ 15] also surveyed the training received by radiographers about the pandemic, reporting similar results to our study. In their case, the most common form of education was practical training, received by 28% of the workers. This was followed by nearly 20% of respondents who read publications or materials related to COVID-19. It is evident that various forms of training were employed in both Hungary and Ireland to prepare and inform radiographers about combating COVID-19.

Pets are an integral part of the daily lives of pet owners. During the COVID-19 pandemic, the number of household pets exponentially increased worldwide, although the reasons for this growth are not yet fully understood [ 25]. We observed that the respondents without pets had a significantly higher stress level than the individuals with dogs; however, their stress level was significantly lower than that of cat owners. Additionally, those who only owned cats reported significantly higher stress than those who owned dogs. Based on our results, pet ownership alone does not constitute an apparent predictive factor for the stress levels of healthcare workers. However, the type of pet may be an influencing factor. Understanding the impact of pets on human mental health and wellbeing, especially during the pandemic, when we lived isolated lives for an extended period of time, is crucial for determining whether animals can be incorporated into preventive or restorative interventions to promote mental health and reduce stress levels.

The aim of Grajfoner et al.'s [ 25] research was to explore how pets affected the mental health of their owners during the COVID-19 pandemic. Their results showed that the respondents with pets enjoyed significantly better mental health than those without animals. This is because pet owners felt that they coped better with adverse situations and experienced much more positive emotions during the quarantine.

Exercise is an essential tool in treating and preventing various physical illnesses. Additionally, it has long been recognized that regular physical activity comes with benefits in alleviating depressive and anxious symptoms [ 26, 27].

The media plays a role in maintaining connections among people and promoting emotional stability, which, as previous studies have pointed out, is crucial because family support plays a vital role in the stress management of healthcare workers [ 28]. Additionally, numerous pages and groups were formed on social platforms where videos, various materials on mental health, or relaxation exercises were shared. All of this could have assisted those going through depressive phases due to various aspects of the pandemic. The critical role of the media lies in providing people with credible information and striving to keep them connected during these challenging times [ 28, 29].

Evanoff et al. [ 30] emphasized that organizational and societal support, clear communication, and a sense of control were protective factors for mental health during the pandemic.

Training programs that enhance employees' resilience can improve burnout rates and other wellbeing outcomes, but organizational-level interventions that reduce perceived job demands or increase resources are generally more effective [ 4, 5, 6, 8].

Windarwati et al. [ 31] found that 97.9% of respondents evaluated that their workplace rewarded them for their work. The most significant stress-inducing factor for them was the daily use of personal protective equipment. The three most commonly used coping strategies by healthcare workers were adopting positive behavioral patterns to maintain self-motivation, reading information about COVID-19 prevention and the prevention of its spread, and following and adhering to appropriate and recommended self-defense tools and measures. Additionally, their study highlighted family support as a significant factor in the motivation of these healthcare workers in the battle against the pandemic, as seen in several previous surveys.

Our study did not explore the stressors related to individual protective equipment or address issues concerning the availability of protective equipment. However, these can be a noteworthy aspect of factors influencing occupational stress, as healthcare workers must use individual protective equipment daily to protect themselves, each other, and their patients. Using such equipment could cause discomfort, such as unwanted skin reactions, difficulty in breathing, heat stress, dizziness, and nausea.

Lewis et al. [ 32] surveyed South African radiographers' experiences of COVID-19. Their results also confirm that radiographers reported feeling sad, fearful, confused, stressed, frightened, anxious, and overwhelmed. The constant fluctuation of these emotions, akin to a rollercoaster, took a toll on them mentally and physically. The mental health of radiographers was further compromised by the inability to see their families and friends, causing anxiety about the risk of infecting them.

We need to mention that machine learning in radiology can alleviate the burden on radiologists and radiographers by automating routine tasks, allowing them to focus on more complex analyses and patient interactions. This can potentially reduce occupational stress by streamlining workflows, enhancing efficiency, and improving overall job satisfaction in the medical imaging field [ 33, 34].

5. Conclusions

The critical role of radiographers and radiologists in service delivery is not widely understood among healthcare workers. Therefore, it is crucial to emphasize a more significant promotion of the radiography profession.

Based on our findings, we discovered that factors such as profession, family status, presence of a side job, number of years spent in healthcare, type of household pet, and occurrence of coronavirus infection can significantly affect the levels of occupational stress experienced by radiologists and radiographers. With these findings in mind, targeted protective interventions can be implemented for this group of affiliated health professionals in order to minimize the chronic effects of workplace stress on individuals.

6. Limitations

As a limitation of this research, our results are indicative, considering that our survey was based on cross-sectional sampling, thus reflecting a specific condition. Using exclusively close-ended questions is also a limitation of our study. Another limitation could lie in the time constraints and stressful situations arising from the burden caused by the pandemic, which may have negatively influenced health professionals' willingness to respond.

Acknowledgments

We sincerely thank every radiologist and radiographer who, despite the challenges, was willing to complete our survey.

Funding Statement

This research received no external funding.

Author Contributions

Conceptualization, D.S. and M.P.C.; methodology, D.S.; statistics O.K.; formal analysis, L.F. and K.D.; investigation, K.D. and M.P.C.; resources, D.S. and Á.K.; writing-original draft preparation, D.S., B.R. and A.P.; writing-review and editing, M.P.C. and Á.K.; supervision, M.P.C.; project administration, O.K. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

We conducted our research with the professional and ethical approval of the Medical Research Council (BMEÜ/253-1/2022/EKU). This study was conducted in accordance with the Declaration of Helsinki. The ethical permission was issued on the 1st of July 2022.

Informed Consent Statement

Informed consent was obtained from all the subjects involved in the study.

Data Availability Statement

Data are contained within the article.

Conflicts of Interest

The authors declare no conflicts of interest.

Footnotes

Disclaimer/Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

References

# data[].attributes.attachment_link.title
Occupational Stress Levels among Radiologists and Radiographers in Hungary during the COVID-19 Era

# data[].attributes.attachment_link.description
The COVID-19 pandemic has heightened stress levels, potentially affecting the occupational wellbeing of radiographers and radiologists. Our study aimed to assess occupational stress levels within the radiology department and identify contributing factors. ...

# data[].attributes.body
For this assignment I chose the article called The impact of the Covid-19 pandemic on the mental health and work morale of radiographers within a conventional X-ray department by B. Yasin, N. Barlow, and R. Milner. The reason i chose this article is because I believe it is important to understand how the pandemic has affected healthcare professionals, including of course radiographers. What this article does, is provide an insight into the challenges that they have faced and how it has also impacted their mental health and work morale. This article compares to the first article I have chosen called Shift Work and Mental Health Among Radiologic Technologists because they both focus on the mental health of radiologic technologists, but in this case, they explore different aspects. This article bases on the impact of the Covid-19 pandemic, while the second article looks at the topic including their shift work and its effects on their mental health. They both provide a comprehensive understanding of the various challenges faced by radiologic technologists, in different contexts.

Bushra Yasin, is a student at the University of California, Los Angels (UCLA) who is in the department of Pathology and Laboratory Medicine. What this author typically writes about are things surrounding the medical field, for example their article called Patient Safety in the Clinical Laboratory A Longitudinal Analysis of Specimen Identification Errors. This author has skills and expertise in things like Microbial Molecular Biology, Molecular/General Microbiology and many more.

I believe that this article will argue how Covid-19 pandemic has had a significant impact on the mental health and work morale of radiographers in the X-ray department. This article shows evidence and examples that help support the argument. In this article the author is sharing research and providing data on how this has impacted the workers. This is more about providing insights into the effects rather than debunking a claim or presenting a new perspective.

sciencedirect.com/science/article/pii/S107881742100047X

I didn't add the libraries link because it may not allow you to access the article, but in the libraries article, it takes you to this website including the whole article.

# data[].attributes.body
For this assignment I chose the article called Shift Work and Mental Health Among Radiologic Technologists by Marilyn Sackett, Kevin R. Clark, and Tammy L. Webster. I chose this article because it acts as a super useful write-up for understanding the unique challenges faced by radiologic technologists, especially with the difficult/odd hours they work. This article sheds light on the mental health impacts of their shift work, which is something important for their overall well-being. Having authors with backgrounds in the field, they offer some credible insights and strategies in order to manage those challenges.

Marilyn Sackett, is the founder and president of Advanced Health Education Center, created the program in order to help and encourage more leadership, she spent more than 50 years as a radiologic technologist, and holds the belief that leadership advances medical imaging. She is a current faculty member of a radiography program and a department chair at Madison College's School of Health Sciences in Wisconsin, also working towards her doctoral degree in Organizational Leadership.

This article could argue the impact that shift work does to the mental health of radiologic technologists. The author here is sharing research findings and exploring how the irregular hours in the healthcare department can affect the overall well-being of the professionals.

https://eds.p.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&sid=69d1c4dd-47b4-48f4-ae86-7c7573f8457c%40redis

# data[].attributes.body
What career I am currently in school for or am switching associates for is to be a Rad Tech (Radiologic Technologist). I would describe this as both a career and a labor of love, because its something I am truly passionate about but am also doing for the pay. I love helping people and I consider myself to have people skills, in a way of good with talking face to face, I feel like that could be put into this as well in order to get a high demanding/paying job like this one. I believe that in someones career or job passion plays a huge role, you cant go to a job you hate every morning if its that you don't have the passion for it, it would simply ruin your mental stability. Having passion for your career/job allows for a good money making opportunity, and for a healthier lifestyle while in the working industry. I do believe that passion shoud affect ones compensation, reason being that getting full payment for something you aren't doing at a 100% isn't fair to the owner, the person gaining from the work, and you for the skills you may portray.

# data[].attributes.body
In Simone Stolzoff's New York Times Opinion Piece called "Please Don't Call My Job a Calling" he articulates a critical perspective on the modern glorification of work as a calling. He Stolzoff, says that this mindset can blur personal boundaries that may eventually lead to overwork, as individuals may at times feel both intertwined and compelled with their personal identity towards their profession. I believe that his main thesis is advocating for a healthier work-life, where ones job is an important aspect of their identity. The main point being that we shouldn't confuse our jobs with our callings because it could lead to overwork and burnout. On page 2, Stolzoff states "But the rhetoric that a job is a passion or a “labor of love” obfuscates the reality that a job is
an economic contract. The assumption that it isn’t sets up the conditions for exploitation" (Stolzoff, 5). Here Stolzoff is indicating that when we view a job as a passion or a "labor of love", it can his the fact that a job is truly an economic transaction. When we romanticize work too much, it can lead to unfair treatment and taking advantage of workers. On page 2, Stolzoff states "Teaching is a calling,” tweeted Mayor Eric Adams of New York City a few weeks ago. “You don’t do it for the money, you do it because you believe in the kids that come into your classrooms” (Stolzoff, 8). In the article, the idea is being challenged that any job (in this case teaching) should be seen as a calling or done purely out of belief in the work. The tweet made by Mayor Eric Adams is aligned with the viewpoint that Stolzoff is critiquing. He argues that this can be overlooked in a aspect of a job and it creates conditions for exploitation. I can say that I do agree with Stolzoff's thesis because it is important to recognize the potential negative consequences of both viewing work as a calling and the potential for exploitation. I do find the evidence that Stolzoff uses effective. Why? Because he includes personal stories or references to studies about both work and well-being.

# data[].attributes.body
Some myths about Asian Americans would be...

1. Myth: All Asian Americans are the same.

Reality: Asian Americans come from diverse countries, cultures, and backgrounds, each with their own unique identities and experiences.

2. Myth: Asian Americans are all good at math and science.

Reality: While there are certainly many Asian Americans who excel in these fields, it's important to recognize that individuals have different strengths and interests, just like anyone else.

3. Myth: Asian Americans are all quiet and submissive.

Reality: Asian Americans, like people from any other cultural background, exhibit a wide range of personalities, behaviors, and communication styles. It's important not to generalize or stereotype.

4. Myth: Asian Americans are all recent immigrants.

Reality: Many Asian Americans have deep roots in the United States, with families that have been here for multiple generations. They are just as American as anyone else.

5. Myth: Asian Americans are all successful and wealthy.

Reality: While there are certainly successful Asian Americans, it's important to recognize that individuals within the community have different socioeconomic backgrounds, just like any other group.

Remember, it's essential to challenge these myths and embrace the diversity and individuality within the Asian American community.

In her essays, Hong addresses and challenges these perceptions by sharing personals stories and experiences that defy the stereotypes. She provides a nuanced understanding of Asian American identity and highlights the complexities and diversity within the community. Hong also critiques the harmful effects of these stereotypes and emphasizes the importance of representation and accurate portrayals in media and society. Through her writing, she aims to combat these perceptions by promoting empathy, understanding, and the recognition of Asian Americans as individuals with their own unique stories and contributions.

# data[].attributes.body
I believe Hong chose to start her book with a personal story that portrays her in a complex light because it adds depth and authenticity to her writing. By sharing her vulnerabilities and flaws, she invites readers to explore the complexities of her experiences and emotions. It also challenges traditional notions of perfection and allows for a more nuanced understanding of identity and the human experience.

As a reader, the effect of this opening is that it immediately draws me in and makes me feel connected to the author. It creates a sense of intimacy and honesty, which makes me more invested in the essays and eager to explore the themes and ideas that Hong presents. It also sets the tone for a thought-provoking and introspective reading experience.

I really appreciate the raw honesty and vulnerability in the first chapter. It surprised me how the author was willing to share personal stories that challenge societal expectations and explore complex emotions. It made me feel more connected to the author and eager to continue reading.

# data[].attributes.body
In this novel called There There by Tommy Orange, storytelling serves as a vital thread that weaved together the diverse experiences on the chapters and their Native American heritage. The novel explores how storytelling functions as a means of preserving culture, reclaiming history, and finding healing in the face of intergenerational trauma. Both storytelling and power are very much intricately connected in a way (in this novel).Through the storytelling, characters reclaim their agency, challenge dominant narratives, and assert their own truths. Storytelling becomes a means of preserving cultural memory, as it allows for the transmission of all history, traditions, and of course collective experiences across generations. It has the ability to empower both individuals and communities to confront historical trauma, reclaim their identities, and forge a path towards healing and resilience. In this particular way, storytelling serves as a very powerful tool for both collective and personal empowerment. Now, while reading this novel, I would say that Opal Viola Victoria Bear Shield is particularly intriguing to me. She has the ability to embody both the strength and the resilience of Native American women, and her journey to preserve cultural traditions and find solace in her community is very much captivating. Opal's personal story highlights the importance of ancestral roots and the power of community in navigating the complexities of identity.

# data[].attributes.body
Five things that make this character unique and their initial Impressions.

Calvin Johnson:
1. Calvin's complex backstory adds depth to his character.
2. He serves as a mentor figure to the younger characters in the book.
3. Calvin's Native American heritage plays a significant role in shaping his identity.
4. His resilience in the face of adversity sets him apart.
5. Calvin's journey of self-discovery and personal growth is a central theme in the story.

Calvin Johnson in "There There" by Tommy Orange initially comes across as a wise and experienced mentor, providing guidance and support to the younger characters in the book.

Octavio Gomez (Calvin's brother):
1. Octavio's passion for traditional Native American dance showcases his cultural pride.
2. His struggle with addiction and the journey of recovery adds depth to his character.
3. Octavio's complex relationships with his family members bring emotional complexity to the story.
4. His determination to find his place in the world and reconcile his past makes him a compelling character.
5. Octavio's transformation throughout the book highlights themes of redemption and personal growth.

Octavio Gomez's initial impression in "There There" by Tommy Orange is that of a complex character who wrestles with addiction but also showcases cultural pride through his passion for traditional Native American dance.

Daniel Gonzales (Octavio's cousin):
1. Daniel's artistic talent and passion for art make him stand out.
2. His exploration of identity and cultural heritage adds depth to his character.
3. Daniel's journey of self-discovery and finding his place in the world is compelling.
4. His complex relationships with family and friends contribute to the story's emotional depth.
5. Daniel's resilience and determination in the face of adversity make him a memorable character.

Daniel Gonzales's initial impression in "There There" by Tommy Orange is that of an artistic and introspective character, exploring questions of identity and cultural heritage. He brings depth to the story through his passion for art and his journey of self-discovery.

For me, I would say that for the rest of these characters I would want or hope for them to continue their personal journeys, face challenges, and find resolutions. I wouldn't want only that but for them to experience personal growth within themselves, self-realization, and perhaps even come together in unexpected ways.

# data[].attributes.body
Starting a new novel like There There by Tommy Orange I feel is very cool. I really have enjoyed the first few pages of this novel as I believe that it has a powerful story to it. I really enjoy the rich storytelling, diverse perspectives, and the way this novel sheds light on Native American experience.

Something that I would say I would consider to be challenging as aspects for There There would be the raw and honest portrayal of difficult themes and experiences. I feel it can be emotionally intense at times, but that's what makes it impactful.

I believe that in this novel, we may be introduced to many upcoming things like more of the Native American experience, including identity, some cultural heritage, urban life, or maybe some impacts of historical trauma. These are some of the things that I believe will be introduced as we continue to read this novel.

# data[].attributes.body
While reading through the small chapters all the way towards the chapter called Louie, His Cousin & His Other Cousin I have noticed many things that I liked about the text. I really like the way that each chapter is a different story, meaning you can read starting from anywhere as long as its a new chapter, you wouldn't get lost or have to wonder what happened in the chapter before. The thing is, for me, I felt like the chapter before always tied up with the chapter leading into that one. I love how Cisneros writes and the words she chooses. It makes it so easy to understand her. I like how she explains how her house looks, its almost as if you can picture exactly how it would look, and how she defines her new friends Rachel and Lucy. One last thing I liked that was brought up from the chapter My Name, was how she included what name she would of rather introduced herself with instead of saying her actual name Esmeralda to Rachel and Lucy on page 15. It always ties back.

Something that has surprised me was how much I truly like reading this book. Why? is because its not that much of a challenging book. Anyone can understand it and I personally feel like I relate to her in some levels. Now, something from the book that has surprised me was the last chapter I read called Louie, His Cousin & His Other Cousin. Once the plot twist came out that Louie's cousin most likely stole the Cadillac on page 25, that blew my mind, and now I am very excited to continue to read The House on Mango Street.

Something I expect to happen in the rest of the book is, truly for Cisneros to continue the story in depth. Esmeralda might find out what her passion will be soon, and she might also go through some very big challenge along the way.

# data[].attributes.body
In the chapter "Hairs" when Esperanza describes her mother saying "Like little candy circles all curly and pretty" this similie is describing her feeling towards her mother in a positive way. She uses the word "Like" to give an example of what her mothers beautiful hair looks like to her in a more exaggerated way. She's comparing her mothers hair to little roses on the part before that statement. In the next paragraph Esperanza compares her mother's hair with the warm smell of bread before you bake it. I think this means that her mothers hair has a natural scent, like something you or someone has smelt before that is giving the smell of home and protection. By the looks of this, I can tell that Esperanza has good feelings towards her mother, comparing her to things that she Esperanza knows are suited for good. Now, while I was reading through the chapters and I came across this poem Esperanza made on chapter Born Bad located on page 60 saying "I want to be like the waves on the sea, like the clouds in the wind, one day i'll jump out of my skin". In this, Esperanza keeps on repeating the words "like" she is telling us that she wants to be like the waves and the clouds, meaning she wants to be free, and wants to feel alive. Here she is explaining herself and what she wants to do. Lastly, on chapter Born Bad located on page page 58  we get introduced to Guadalupe who Esperanza said was... "Pretty like my mother. Dark. Good to look at". Here Guadalupe is being compared to Esperanzas mother, and how we talked about earlier was a beautiful lady, full of life and warmth. This guys us an idea of how Guadalupe might be and or looks like considering the fact that Esperanza had lots of good things to say about her mother.

# data[].attributes.body
I have never been able to just sit down and enjoy a book to its full potential, I have not really had a moment where I can enjoy a book and its meaning. That is until I started reading Tragic City, I believe the reason I have enjoyed this book so far is because of its style. I like the poems, I feel like it gives things more meaning especially with such a sensitive topic like the Tulsa Race Massacre. I really enjoy the amount of metaphors that are added into this book, for example, "I've wandered where the chosen have been pushed hungry as a pack of black sheep", "Our stomachs growl like the lions they are" (Heard, page 16). I feel like this novel has so much potential and will help guid us and give us knowledge of things we may not have though where happening in this world. It has so much to offer.

Something that has challenged me during my reading process would most definitely be the hard vocabulary it uses. I feel like at times I get stuck and completely forget about what I have just read. Another things that has challenged me are the random spaces, I feel like the sentence is ending but then theres a space and under theres more to it, making the text a little confusing for my reading.

In the rest of the poems I expect that there will be more things involved, maybe the topic of racism, or maybe even violence. I also believe that some flash backs may be interpreted into the poems somehow. Whatever it is, I bet it will be exciting to learn about and or experience with the author.

# data[].attributes.body
While exploring the poems for the various writing styles Clemonce has, I noticed one thing in particular that he used throughout a poem, it was a piece of punctuation grammar that caught my attention as soon as I crossed paths with it. This is located on chapter 35 called Compartmentalizing @ The Refinery located on page 60. The piece of punctuation that I am talking about is called an Asterisk (*). This symbol is constantly used during the poem and I have a feeling Clemonce used this for the reason that this poem is very ungrammatical. There is no other symbol in this poem, no (.), (,), ect. This affects me in a positive way, because I am less intimidated by the text since it looks a little less serious, its almost as if the author is speaking his thoughts and I like that a lot, I really enjoy it. I feel as if it affects the poem by making it look like I said very ungrammatical, giving it the look of having errors, but it also affects it by giving it a different style of many that are added into this novel.

A word that I feel very unfamiliar with in this poem would be pigeonholing. I say I am very familiar with every other word and their meanings but this one is something I haven't heard from. Pigeonholing has many meanings by the look of it, some seem to refer to the place where pigeons are nested, that makes sense, and others to some very different meanings. I will choose one and go from there. Pigeonholing would mean categorizing or labeling someone or something based on limited or narrow characteristics. I understand the connection this words has with the book because in the poem it gives us various examples of how you don't define what pigeonholing is, for example "You don't define pigeonholing as a desk compartment in which letters are kept." (Chapter 35, page 60).