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Burnout components, perceived stress and hair cortisol in healthcare professionals during the second wave of COVID 19 pandemic

Name: Αlpha¹ Rigor Record — Burnout components, perceived stress and hair cortisol in healthcare professionals during the second wave of COVID 19 pandemic
Item: Burnout components, perceived stress and hair cortisol in healthcare professionals during the second wave of COVID 19 pandemic
Rating: 39
Author: Αlpha¹

Fortuna F, Gonzalez D, Fritzler A, Ibar C, Nenda G, D'Isa E, Otero P, Jamardo J, Calvo M, Funez F, Minotti F, Filipuzzi L, Canellas N, Casciaro S, Jacobsen D, Azzara S, Iglesias S, Gutierrez G, Aranda C, Berg G, Fabre B.

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Αlpha¹ Rigor Review — 1★ (Critical), 1 critical, 0 high issues for “Burnout components, perceived stress and hair cortisol in healthcare professionals during the second wave of COVID 19 pandemic”

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Αlpha¹ Editorial

This rigor review was examined and confirmed by Αlpha¹ Editorial · August 5, 2026

Αlpha¹ Rigor Review

Rigor Reviewed

1 / 5

Critical — a demonstrable failure

Observational Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

IntegritySerious integrity concern−1★
IntegrityIntegrity concern ×2−1★
ClaimsOverstated claim−0.5★
ReportingKey resources not met−0.5★
ReportingData & code availability not met−0.5★
ReportingStudy design partially met−0.25★
ReportingBiological variables partially met−0.25★
ReportingStatistical analysis partially met−0.25★
ReportingReporting transparency partially met−0.25★
CitationsUnresolved reference−0.25★

A demonstrable critical failure caps the rating at the minimum, regardless of the deductions above.

Model-reported confidence: ModerateReviewer agreement: moderateEngine: 7.15.0Source: full text

Not verified in this report

No data or code availability links were detected to verify.

Problems surfaced9 types

Data and code not shared
Internal contradictions in the reported numbers
Key resources not identified
Statistical reporting gaps (tests, assumptions, effect sizes)
Biological variables underreported (sex, age, strain)
Conclusions overstated beyond the evidence
Reporting/transparency gaps
Study-design details incomplete (controls, blinding, power)
References not resolvable to a published paper

This Αlpha¹ Rigor Review uses AI Rigor Reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

Critical findings

• internal_contradiction (high, corroborated): The mediation analysis reports an indirect effect b = 0.0325 with a 95% CI of 0.054–0.0596, which does not contain the point estimate. This is impossible and suggests a typo or calculation error.

This published cross-sectional study of burnout, perceived stress, and hair cortisol in 496 healthcare workers is well motivated and has exemplary ethics reporting (named committees, written consent, Declaration of Helsinki). It falls short of current reporting and rigor standards in several respects: the mediation analysis contains a statistically impossible confidence interval, no power analysis or outlier handling is reported, assay reagents and software versions are not identified, the data-availability statement is vague, and STROBE, systematic limitations, and funding/COI elements are missing.

Three independent reviewer runs were synthesized with a copyedit pass and specialized verification (citation, statistics, integrity, claim audit). The statistics component recomputed 13 tests reported with test statistics/df or effect+CI and all 13 were consistent — this is not a blanket validation of the paper's statistics, and everything not recomputed remains unverified; the mediation CI error is an internal-consistency finding, not a recomputation. The study is not preregistered, and no reproducibility (data/code link) check was available. Reviewers diverged on biological variables (warn vs fail) and reporting transparency (warn vs fail); the synthesized statuses follow the checklist rules applied to the merged evidence.

7 major claims checked against the paper's own evidence: 1 not fully backed by the presented evidence (unsupported or overstated).

Recomputed 13 tests: 13 consistent, 0 inconsistent; 13 via agent-written checks.

3 integrity concerns flagged (1 high).

Reporting

Eight Dimensions2 pass · 4 warn · 2 fail

The introduction cites multiple prior studies (e.g., meta-analyses, the authors' own first-wave study) and establishes a logical link between pandemic stressors, chronic stress, burnout, and hair cortisol as a biomarker. Limitations of prior research (e.g., lack of biomarker assessment) are addressed by including hair cortisol and expanding to multiple hospitals.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 80% conf

The introduction establishes the study's rationale through prior literature on COVID-19-related stress and burnout and clearly states the aim and novelty.

Evidence

direct quote[Introduction, paragraph 4]

“Several studies have documented increased levels of chronic stress, and burnout among healthcare professionals”

direct quote[Introduction, final paragraph]

“The novelty of this study remains in revisiting the healthcare worker population from the university hospital initially examined during the first wave of COVID-19, while also expanding the research to include two additional frontline hospitals.”

absence[Introduction]

No explicit limitations of prior research are addressed.

PASSReviewer 2· 90% conf

The scientific premise is well-established, citing prior work on pandemic stress, burnout, and hair cortisol, with a clear rationale for the study.

Evidence

paraphrase[Introduction, paragraph 6]

“In this regard, we conducted a study during the initial COVID-19 wave in 2020, in which we discovered that 40% of healthcare workers exhibited altered hair cortisol levels, a biomarker of chronic stress.”

direct quote[Introduction, final paragraph]

“Accordingly, the aim of this study was to evaluate chronic stress and burnout in a new cohort of healthcare workers from three different hospitals as well as measuring hair cortisol levels as a stress biomarker during the second wave of COVID-19 in 2021.”

paraphrase[Discussion, paragraph 1]

“The authors note that their prior study lacked a biomarker assessment, and the current study addresses this by including hair cortisol.”

PASSReviewer 3· 85% conf

The paper establishes a clear scientific premise by citing prior research on stress, burnout, and hair cortisol, and provides a logical rationale for the study. However, it does not explicitly address limitations of prior work.

Evidence

direct quote[Introduction, paragraph 5]

“For this reason, assessment of mental health and psychological burden in health workers is essential in order to mitigate its negative consequences, such as reduced productivity, increased absenteeism, and higher turnover rates”

direct quote[Introduction, last paragraph]

“the aim of this study was to evaluate chronic stress and burnout in a new cohort of healthcare workers from three different hospitals as well as measuring hair cortisol levels as a stress biomarker during the second wave of COVID-19 in 2021.”

absence[Introduction]

Limitations of prior research are not explicitly addressed.

The study is cross-sectional, with pre-specified exclusion criteria (glucocorticoid use, HPA axis alterations, etc.). However, no power analysis or sample size justification is provided, and outlier handling is not mentioned. These omissions reduce the methodological rigor for an observational study.

Sub-criteria

controlsN/A

power analysisNOT REPORTED

blinding levelsN/A

outlier handlingNOT REPORTED

randomization unitN/A

inclusion exclusionADEQUATE

randomization methodN/A

replicate distinctionN/A

independent replicationNOT REPORTED

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 65% conf

The cross-sectional design is clearly described and inclusion/exclusion criteria are pre-specified, but no sample-size/power calculation and no outlier-handling description are provided.

Evidence

direct quote[Materials and methods, paragraph 1]

“The study employed a cross-sectional observational design.”

direct quote[Materials and methods, paragraph 1]

absence[Statistical analyses]

No power analysis or outlier handling is reported.

WARNReviewer 2· 80% conf

The study design is observational, with clear inclusion/exclusion criteria, but lacks a priori power analysis and outlier handling protocol.

Evidence

direct quote[Materials and Methods, paragraph 1]

absence[Materials and Methods (Statistical analyses)]

No a priori power analysis is reported.

absence[Materials and Methods]

Outlier handling is not described.

WARNReviewer 3· 80% conf

The study design is an observational cross-sectional study. Inclusion and exclusion criteria are reported, but no power analysis or outlier handling is described.

Evidence

direct quote[Materials and methods, paragraph 1]

“Individuals undergoing treatment with glucocorticoids or psychotropic drugs, those with hypothalamic-pituitary-adrenal (HPA) axis alterations, or a history of mental health disorders were excluded from the study. Moreover, individuals with less than 3 cm hair length on the posterior vertex were also excluded.”

absence[Materials and methods]

No power analysis is reported.

absence[Materials and methods]

No outlier handling is described.

The paper reports sex (88.5% female), age (mean 42 ± 11 years), and BMI (median 20 kg/m²). However, health status beyond exclusion criteria is not reported, and race/ethnicity and comorbidities are absent. The study includes both sexes, so sex-justification is not applicable.

Sub-criteria

demographicsINADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthINADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 60% conf

Sex and age/BMI are reported, but health status and full demographics (race/ethnicity, comorbidities) are not provided.

Evidence

direct quote[Table 1]

“Gender % (n) | F:88.5 (439) M: 11.5 (57)”

paraphrase[Table 1]

“Age (years, mean ± SD) | 42 ± 11 | BMI (Kg/m 2 ) | 20 (12–50)”

direct quote[Materials and methods, Epidemiological data and psychological tests]

“All participants were requested to complete an epidemiological sheet: providing information on: age, sex, weight, height, family, medication, hair dye usage, shampoo usage, any cosmetic hair treatment, smoking habits, profession, workplace, and pre-existing pathologies.”

WARNReviewer 2· 70% conf

Sex and age/BMI are reported, but health status, ethnicity, and comorbidities are not fully described, and single-sex justification is not applicable.

Evidence

paraphrase[Table 1]

“Gender % (n) | F:88.5 (439) M: 11.5 (57) | Age (years, mean ± SD) | 42 ± 11”

absence[Results, Table 1]

Health status beyond exclusion criteria is not reported.

absence[Results, Table 1]

Race/ethnicity and comorbidities are not reported.

FAILReviewer 3· 70% conf

Sex is reported, but age/weight/health status is only partially reported (only age and BMI), and demographics lack race/ethnicity and comorbidities. This results in a fail.

Evidence

direct quote[Results, Table 1]

“Gender % (n) | F:88.5 (439) M: 11.5 (57)”

direct quote[Results, Table 1]

“Age (years, mean ± SD) | 42 ± 11”

absence[Results, Table 1]

Race/ethnicity and health status are not reported.

The paper explicitly names three hospital ethics committees that approved the study, reports that all participants provided written informed consent, and states adherence to the Declaration of Helsinki. All applicable sub-criteria are reported adequately.

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

Named ethics committees approved the study, written informed consent was obtained, and compliance with the Declaration of Helsinki is stated.

Evidence

direct quote[Materials and methods, paragraph 1]

“The study was prior approved by the Ethics Committee of the “Hospital de Clinicas”, the Ethics Committee of the “Hospital Argerich”, and the Ethics Committee of the “Hospital Durand”.”

direct quote[Materials and methods, paragraph 1]

“Participants did not receive any form of compensation for their involvement in the study, and all provided former written informed consent.”

direct quote[Materials and methods, paragraph 1]

“All methods were carried out in accordance with the Declaration of Helsinki.”

PASSReviewer 2· 90% conf

Ethical approval from three named ethics committees, informed consent, and adherence to the Declaration of Helsinki are clearly stated.

Evidence

direct quote[Materials and Methods, paragraph 1]

“all provided former written informed consent.”

direct quote[Materials and Methods, paragraph 1]

“All methods were carried out in accordance with the Declaration of Helsinki.”

PASSReviewer 3· 95% conf

The study reports approval from three named ethics committees and written informed consent. Compliance with Declaration of Helsinki is stated.

Evidence

direct quote[Materials and methods, paragraph 1]

paraphrase[Materials and methods, paragraph 1]

“all provided former written informed consent. All methods were carried out in accordance with the Declaration of Helsinki.”

The cortisol measurement is described only as 'automated chemiluminescent method (Immulite 2000 autoanalyzer, Siemens, LA, USA)' without specifying the assay kit or extraction protocol. Statistical software (SPSS) is mentioned without version. These are the only applicable resources; both are inadequately reported.

Sub-criteria

mycoplasma testingN/A

reagents identifiedINADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedINADEQUATE

Per reviewer (3) — the votes behind the verdict

FAILReviewer 1· 70% conf

The cortisol assay and statistical software are identified only generically; no reagent kit, catalog/lot, or software version is given, and no other key resources are used.

Evidence

direct quote[Materials and methods, Hair sample collection and hair cortisol measurement]

“Each sample was weighed, and cortisol was extracted and then measured using an automated chemiluminescent method (Immulite 2000 autoanalyzer, Siemens, LA, USA).”

direct quote[Materials and methods, Statistical analyses]

“a mediation analysis was performed using Hayes PRO- CESS macro in SPSS statistical software”

FAILReviewer 2· 80% conf

The analytical method (cortisol assay) and statistical software are inadequately identified, lacking details such as kit name, version, or lot numbers.

Evidence

direct quote[Materials and Methods, Hair sample collection]

“cortisol was extracted and then measured using an automated chemiluminescent method (Immulite 2000 autoanalyzer, Siemens, LA, USA).”

direct quote[Materials and Methods, Statistical analyses]

“mediation analysis was performed using Hayes PRO- CESS macro in SPSS statistical software”

FAILReviewer 3· 75% conf

The cortisol assay reagents are not identified, and the statistical software is named but without version. No other biological resources are used. This results in a fail.

Evidence

direct quote[Materials and methods, Hair sample collection]

“cortisol was extracted and then measured using an automated chemiluminescent method (Immulite 2000 autoanalyzer, Siemens, LA, USA)”

direct quote[Materials and methods, Statistical analyses]

“mediation analysis was performed using Hayes PRO- CESS macro in SPSS statistical software”

The paper names Pearson, Spearman, t-test, Mann-Whitney, Kruskal-Wallis, logistic regression, and mediation. Normality tests are mentioned but no explicit assumptions verification. Effect sizes with CIs are reported for logistic regression. Software is identified as SPSS but no version. Data are presented as mean±SD or median (range) in tables, without individual data points.

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationINADEQUATE

software identifiedINADEQUATE

assumptions verifiedINADEQUATE

mathematical plausibilityPASS

Per reviewer (3) — the votes behind the verdict

FAILReviewer 1· 75% conf

Statistical tests are named and many effect sizes with confidence intervals are reported, but the mediation analysis reports an impossible confidence interval that excludes the point estimate, and some p-values are printed only as thresholds.

Evidence

direct quote[Materials and methods, Statistical analyses]

“Initially, we assessed the distribution of variables using normality tests (kurtosis and skewness).”

direct quote[Results, Stress and hair cortisol concentration]

“r =-0.236, p < 0.0001”

direct quote[Results, Analysis of mediation]

“indirect effect: b = 0.0325, SE = 0.0138, CI = 0.054–0.0596, p = 0.019”

WARNReviewer 2· 70% conf

Statistical tests are named, but assumption verification is incomplete, exact p-values are not always reported, effect sizes lack CIs for correlations, and software version is missing.

Evidence

direct quote[Materials and Methods, Statistical analyses]

“we assessed the distribution of variables using normality tests (kurtosis and skewness).”

direct quote[Results, paragraph 1 (Stress and hair cortisol)]

“r = 0.204, p = 0.006; r = 0.185, p = 0.006; r = 0.172, p = 0.010”

direct quote[Results, Burnout and hair cortisol]

“OR: 1.258 [IC1.030-1.536]; p = 0.025 OR: 0.894 [IC0.810-0.986]; p = 0.001 OR: 0.954 [IC0.926-0.981]”

WARNReviewer 3· 80% conf

Statistical tests are named and exact p-values are provided, but assumptions are not verified, software version is missing, and data presentation lacks individual points. This yields a warn.

Evidence

direct quote[Materials and methods, Statistical analyses]

“Pearson test (for parametrically distributed data) or the Spearman test (for non-parametrically distributed data) were employed to evaluate correlations between variables.”

paraphrase[Results, Burnout and hair cortisol concentration]

“binary logistic regression analysis revealed associations between burnout, perceived stress, and age (p = 0.024, OR: 1.258 [IC1.030-1.536]; p = 0.025 OR: 0.894 [IC0.810-0.986]; p = 0.001 OR: 0.954 [IC0.926-0.981])”

paraphrase[Results, Table 1 and Table 2]

“Data are presented as mean±SD or median (range) in tables, without individual data points.”

The only applicable criterion is the data availability statement, which is inadequate because it lacks a concrete access mechanism (e.g., repository, data access committee). No code or other data are shared. This falls short of current standards for observational research.

Sub-criteria

code sharingNOT REPORTED

accession numbersN/A

repository depositNOT REPORTED

data availability statementINADEQUATE

Per reviewer (3) — the votes behind the verdict

FAILReviewer 1· 80% conf

Only a vague data-availability statement is provided ('available from the corresponding author on reasonable request') with no repository deposit, accession numbers, or code sharing.

Evidence

direct quote[Data availability section]

“The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.”

absence[Data availability section]

No public repository or accession number is provided.

FAILReviewer 2· 90% conf

The data availability statement is vague ('available on reasonable request') with no platform or timeline, and no code is shared.

Evidence

direct quote[Data Availability Statement]

“The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.”

FAILReviewer 3· 90% conf

The data availability statement is vague ('available on reasonable request'), and no repository deposit or code sharing is provided. This results in a fail.

Evidence

direct quote[Data availability]

“The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.”

absence[Data availability]

No repository deposit mentioned.

The methods section describes participant recruitment, exclusion criteria, hair sampling, cortisol measurement, and psychological instruments, though some details (e.g., cortisol extraction protocol) are omitted. All outcomes mentioned in methods are reported. Conclusions do not overclaim causality. However, no reporting guideline (e.g., STROBE) is referenced, limitations are not explicitly discussed, and no funding or conflict-of-interest statement is provided.

Sub-criteria

funding coiNOT REPORTED

trial registrationN/A

reporting guidelineNOT REPORTED

methods completenessINADEQUATE

all outcomes reportedADEQUATE

limitations discussedNOT REPORTED

conclusions proportionalADEQUATE

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 65% conf

Results include non-significant associations and conclusions are generally proportional, but no STROBE checklist, no formal limitations section, and no funding/COI statement are provided, and some methods are under-specified.

Evidence

direct quote[Discussion]

“In these two hospitals in Buenos Aires, we lack previous data on burnout during the first wave.”

absence[Declarations]

No funding or conflicts-of-interest statement is provided.

absence[Materials and methods]

No reporting guideline is referenced.

WARNReviewer 2· 70% conf

Methods are mostly complete, outcomes are reported, and conclusions are proportional, but no reporting guideline is followed, limitations are not discussed, and funding/COI are missing.

Evidence

absence[Materials and Methods]

No reporting guideline mentioned.

absence[Discussion]

No limitations section.

absence[Declarations]

No funding or COI statement.

FAILReviewer 3· 70% conf

Methods are partially described, no reporting guideline is mentioned, limitations are not fully discussed, and funding/COI are not reported. This yields a fail.

Evidence

direct quote[Materials and methods, Hair sample collection]

“Hair samples were obtained using scissors from the posterior vertex, as close to the scalp as possible. Each sample was weighed, and cortisol was extracted and then measured using an automated chemiluminescent method”

absence[Materials and methods]

No reporting guideline is mentioned.

absence[Declarations section]

No funding or COI statement.

16 copyedit issues flagged (1 major): mostly consistency, typo, clarity.

Checked 29 references by DOI: 24 verified — 1 DOI unresolved, 4 no DOI (shown, not verified).

Αlpha¹ Rigor Action ItemsFinal pass before journal submission

As published, the work is not fully robust

1.
CRITICALother
Address the corroborated integrity concern: internal_contradiction (high, corroborated): The mediation analysis reports an indirect effect b = 0.0325 with a 95% CI of 0.054–0.0596, which does not contain the point estimate. This is impossible and suggests a typo or calculation error.
Demonstrable critical failure — blocks the verdict from passing.

Full text (21,873 chars)Analyzed: Aug 5, 2026

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Burnout components, perceived stress and hair cortisol in healthcare professionals during the second wave of COVID 19 pandemic

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DOI

10.1038/s41598-024-79925-8

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Issued Aug 5, 2026Engine 7.15.0

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