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Kaimen Rigor review

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

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.

DOI: 10.1038/s41598-024-79925-8
Record issued: 2026-08-05
Engine: 7.15.0
Exported: 2026-09-20

Prepared by Alpha1. This document is confidential: it is intended for the recipient it was shared with and must not be redistributed. The live record at alpha1science.com/verify/49120a40-7a71-4c2f-bf26-7641b62b983b is authoritative.

Kaimen Rigor review

Kaimen 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.

Biggest issues1 demonstrable

01Internal contradictions in the reported numbersdemonstrable
highArithmeticreviewer-assessedFull detail
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.
“indirect effect: b = 0.0325, SE = 0.0138, CI = 0.054–0.0596, p = 0.019”
Results
02Key resources not identified
highDisclosurereviewer-assessedFull detail
The analytical method (cortisol assay) and statistical software are inadequately identified, lacking details such as kit name, version, or lot numbers.
“cortisol was extracted and then measured using an automated chemiluminescent method (Immulite 2000 autoanalyzer, Siemens, LA, USA).”
Methods
03Data and code not shared
highDisclosurereviewer-assessedFull detail
The data availability statement is vague ('available on reasonable request') with no platform or timeline, and no code is shared.
“The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.”
Data availability
04Internal contradictions in the reported numbers
mediumArithmeticreviewer-assessedFull detail
The mediation indirect effect is reported as b = 0.0325 with 95% CI 0.054–0.0596; a point estimate must lie within its confidence interval, so the CI is impossible (likely a typo for 0.0054–0.0596).
“indirect effect: b = 0.0325, SE = 0.0138, CI = 0.054–0.0596, p = 0.019”
Results
05Conclusion reaches beyond the evidence
mediumOverreachreviewer-assessedFull detail
Depersonalization may be a critical pathway through which physiological stress manifests as negative psychological experiences.
“depersonalization may be a critical pathway through which physiological stress manifests as negative psychological experiences”
Discussion

Findings by category

101ArithmeticNumerical inconsistencies 202OverreachOverstated conclusions 03AuthenticityNone found 604DisclosureReporting gaps 105AvailabilityBroken references and links · partly checked 106CopyeditCopyediting

This Kaimen Rigor review uses Kaimen 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.

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.

Numerical inconsistencies

1 finding · worst high

Values that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.

Internal contradictions in the reported numbersAssessed

Recomputed 11 tests: 11 consistent, 0 inconsistent; 11 via agent-written checks.

Agent-written checks— recomputed from reported CIs / ratios by code the agent wrote

CONSISTENTreported p = .005 · recomputed p = .004Reviewer 1
Two-tailed p for Pearson r=0.129, n=496 (Table 2)
How we recomputed it: pR(0.129,496)
CONSISTENTreported p < .001 · recomputed p = <.001Reviewer 1
Two-tailed p for Pearson r=0.269, n=496 (Table 2)
How we recomputed it: pR(0.269,496)
CONSISTENTreported p < .001 · recomputed p = <.001Reviewer 1
Two-tailed p for Pearson r=0.228, n=496 (Table 2)
How we recomputed it: pR(0.228,496)
CONSISTENTreported p < .001 · recomputed p = <.001Reviewer 1
Two-tailed p for Pearson r=0.183, n=496 (Table 2)
How we recomputed it: pR(0.183,496)
CONSISTENTreported p = .026 · recomputed p = .023Reviewer 1
Two-tailed p for Pearson r=0.102, n=496 (Table 2)
How we recomputed it: pR(0.102,496)
CONSISTENTreported p = .024 · recomputed p = .024Reviewers 1, 2, 3
p for OR 1.258 from 95% CI 1.030–1.536 (logistic regression)
How we recomputed it: pCI(1.258,1.030,1.536,1)
CONSISTENTreported p = .025 · recomputed p = .025Reviewer 1
p for OR 0.894 from 95% CI 0.810–0.986 (logistic regression)
How we recomputed it: pCI(0.894,0.810,0.986,1)
CONSISTENTreported p = .001 · recomputed p = .001Reviewer 1
p for OR 0.954 from 95% CI 0.926–0.981 (logistic regression)
How we recomputed it: pCI(0.954,0.926,0.981,1)
CONSISTENTreported p = .019 · recomputed p = .019Reviewer 1
Two-sided p for mediation indirect effect z=0.0325/0.0138
How we recomputed it: pZ(0.0325/0.0138)
CONSISTENTreported p < .001 · recomputed p = <.001Reviewer 2
Correlation between age and hair cortisol (above median group): r = -0.236, p < 0.0001, N=496
How we recomputed it: pR(-0.236, 496)
CONSISTENTreported p < .001 · recomputed p = <.001Reviewer 3
Correlation between hair cortisol and age (r=-0.236, n=496)
How we recomputed it: pR(-0.236, 496)

highinternal contradiction
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.
“indirect effect: b = 0.0325, SE = 0.0138, CI = 0.054–0.0596, p = 0.019”
Results
mediuminternal contradiction
The mediation indirect effect is reported as b = 0.0325 with 95% CI 0.054–0.0596; a point estimate must lie within its confidence interval, so the CI is impossible (likely a typo for 0.0054–0.0596).
“indirect effect: b = 0.0325, SE = 0.0138, CI = 0.054–0.0596, p = 0.019”
Results
lowinternal contradiction
Table 2 shows a significant correlation between hair cortisol and burnout (r=0.129, p=0.005), but the text states that burnout was not associated with hair cortisol in the logistic regression? The text does not mention this correlation, but it appears in the table.
“Hair cortisol | r = 0.129 p = 0.005”
Table 2

Overstated conclusions

2 findings · worst medium

Conclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.

Conclusions overstated beyond the evidenceAssessed
Conclusions only partially backed by the presented evidenceAssessed

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

overstatedReviewer 1
Depersonalization may be a critical pathway through which physiological stress manifests as negative psychological experiences.
Cross-sectional data cannot establish a causal pathway; the word 'pathway' implies a causal chain not supported by the design.
Evidence: The mediation analysis is cross-sectional and cannot support causal pathway language.
“depersonalization may be a critical pathway through which physiological stress manifests as negative psychological experiences”
Discussion
partialReviewers 1, 2, 3
Binary logistic regression revealed associations between burnout and perceived stress, and age.
Odds ratios with CIs are reported, but the presentation lists three ORs for two named predictors, leaving the mapping ambiguous.
Evidence: Three odds ratios are reported: OR 1.258 [IC1.030-1.536], OR 0.894 [IC0.810-0.986], OR 0.954 [IC0.926-0.981], with p=0.024, p=0.025, p=0.001.
“Binary logistic regression revealed associations between burnout and perceived stress, and age.”
Results
partialReviewers 1, 2, 3
Mediation analysis showed depersonalization as a mediating variable in the relationship between hair cortisol concentration and emotional exhaustion.
The mediation analysis is reported, but the internally inconsistent confidence interval undermines the reliability of the specific estimate.
Evidence: indirect effect: b = 0.0325, SE = 0.0138, CI = 0.054–0.0596, p = 0.019.
“Finally, mediation analysis showed depersonalization as a mediating variable in the relationship between hair cortisol concentration and emotional exhaustion.”
Results
supportedReviewers 1, 2
10% of the population exhibited hair cortisol levels above 128 pg/mg.
This is a direct result reported in the Results section, albeit without an exact numerator.
Evidence: Within the cohort of volunteers, 10% of the population showed hair cortisol levels greater than 128 pg/mg of hair.
“Notably, 10% of the population exhibited hair cortisol levels above 128 pg/mg.”
Abstract
supportedReviewers 1, 2, 3
Associations were found between high hair cortisol levels and age, workload, emotional exhaustion, and depersonalization.
Correlation coefficients and p-values are reported for these associations.
Evidence: Among individuals with hair cortisol levels above the median, associations with age, workload, emotional exhaustion, and depersonalization (r=-0.236, p<0.0001; r=0.204, p=0.006; r=0.185, p=0.006; r=0.172, p=0.010).
“Associations were found between high hair cortisol levels and age, workload, emotional exhaustion, and depersonalization.”
Results
supportedReviewers 1, 2, 3
Burnout, identified in 11% of participants, correlated with higher perceived stress and lower social support.
The reported group comparisons support this claim.
Evidence: Individuals with burnout reported higher perceived stress score and lower social support score (p=0.013; p=0.007).
“burnout, identified in 11% of participants, correlated with higher perceived stress and lower social support.”
Results
supportedReviewer 2
This study highlights the complex relationships between stress, cortisol levels, and burnout.
The study finds associations and mediation, supporting the claim of complex relationships.
Evidence: Conclusion: 'In summary, this study emphasizes the persistent mental health challenges faced by healthcare workers, particularly in the realms of stress. It sheds light on the intricate interplay between psychological factors, cortisol levels, and burnout.'
“It sheds light on the intricate interplay between psychological factors, cortisol levels, and burnout.”
Conclusion

Data authenticity concerns

None found

An adversarial read for patterns associated with data that may not be genuine: results that look too clean, implausibly large effects, duplicated data or images, and methods that do not match the results reported.

Checked — nothing surfaced.

Reporting gaps

6 findings · worst high

Required detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.

Data and code not sharedAssessed
Key resources not identifiedAssessed
Statistical reporting gaps (tests, assumptions, effect sizes)Assessed
Biological variables underreported (sex, age, strain)Assessed
Reporting/transparency gapsAssessed
Study-design details incomplete (controls, blinding, power)Assessed

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

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

Introduction ¶4

“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.”

Introduction

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.”

“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.”

Introduction

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

“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”

Introduction ¶5

“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.”

Introduction

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

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

Methods ¶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

Methods ¶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

“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.”

Methods ¶1

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

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

Table 1

paraphrase[Table 1]

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

“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.”

Methods

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

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

Table 1

“Age (years, mean ± SD) | 42 ± 11”

Table 1

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

“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”.”

Methods ¶1

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

Methods ¶1

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

Methods ¶1

PASSReviewer 2· 90% conf

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

Evidence

Methods ¶1

“all provided former written informed consent.”

Methods ¶1

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

Methods ¶1

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

Methods ¶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

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

Methods

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

Methods

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

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

Methods

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

Methods

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

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

Methods

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

Methods

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

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

Methods

“r =-0.236, p < 0.0001”

Results

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

Results

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

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

Methods

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

Results ¶1

“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]”

Results

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

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

Methods

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

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

Data availability

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

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

Data availability

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

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

Data availability

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

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

Discussion

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

“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”

Methods

absence[Materials and methods]

No reporting guideline is mentioned.

absence[Declarations section]

No funding or COI statement.

Broken references and links

1 finding · worst low

References checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.

References not resolvable to a published paperRecomputed

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

UNRESOLVED10.1016/s1473-3099(20
Informe Exceso de mortalidad en Argentina. Años 2020–2021
Cited DOI does not resolve to any Crossref record.
NO DOI
Durante la pandemia el sistema de salud argentino aumentó en más del
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Análisis de la situación del personal de salud afectado por COVID-19
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
Physiological biomarkers of chronic stress: a systematic review
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
NO DOI
The social support inventory (SSI): a brief scale to assess perceived adequacy of social support
No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).

Copyediting

1 finding · worst low

Wording, consistency and formatting errors that need correcting before submission.

Wording or formatting errors that need correctingAssessed

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

MAJORconsistencyResults, Mediation analysis
“CI = 0.054–0.0596”
→ The confidence interval does not contain the reported indirect effect (b = 0.0325). Verify the numbers; likely a typo.
The CI must contain the point estimate; this appears to be an error.
MINORtypoMaterials and methods, paragraph 1
“all provided former written informed consent”
→ all provided formal written informed consent
former should be formal
MINORclarityMaterials and methods, Statistical analyses
“Hayes PRO- CESS macro in SPSS statistical software”
→ Hayes PROCESS macro in SPSS statistical software
Remove unintended space in PROCESS
MINORconsistencyResults, Burnout and hair cortisol concentration
“OR: 1.258 [IC1.030-1.536]”
→ OR: 1.258 [CI 1.030–1.536]
IC (intervalo de confianza) should be CI for English consistency
MINORotherResults, Stress and hair cortisol concentration
“Table presents significant associations identified in the entire studied population”
→ Table 2 presents significant associations identified in the entire studied population
Missing table number
MINORotherResults, Analysis of mediation
“as shown in Fig. .”
→ as shown in Fig. 1.
Missing figure number
MINORgrammarDiscussion
“overall well-being in health workers practitioners, who are often affected”
→ overall well-being in healthcare practitioners, who are often affected
Redundant and malformed phrase in the Discussion
MINORgrammarDiscussion
“during the second wave of COVID-19 pandemic”
→ during the second wave of the COVID-19 pandemic
Missing definite article
MINORclarityResults, Binary logistic regression
“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], respectively)”
→ Clarify which variable corresponds to each OR and p-value, e.g., 'perceived stress (OR=1.258, p=0.024), age (OR=0.894, p=0.025), and [third variable] (OR=0.954, p=0.001)'.
The text is ambiguous; it is unclear which OR belongs to which predictor.
MINORconsistencyTable 2
“Variable | Burnout | Emotional exhaustion | Personal achievement | Depersonalization | Hair cortisol | r = 0.129 p = 0.005 | NS | NS”
→ The table header structure is confusing. Consider separating the correlation rows clearly.
The table could be more readable.
MINORtypoMaterials and Methods, Statistical analyses
“Hayes PRO- CESS macro”
→ Remove extra space: 'Hayes PROCESS macro'.
Minor formatting issue.
MINORconsistencyResults, Burnout and hair cortisol concentration
“r =-0.236”
→ r = -0.236
Missing space before the equals sign.
MINORpunctuationResults, Burnout and hair cortisol concentration
“IC1.030-1.536”
→ IC 1.030-1.536
Missing space after 'IC'.
MINORconsistencyMaterials and methods, Statistical analyses
“Hayes PRO- CESS macro”
→ Hayes PROCESS macro
Extra space in macro name.
MINORpunctuationMaterials and methods, Burnout
“Maslach Burnout Inventory - Human Services Survey (MBI - HSS)”
→ Maslach Burnout Inventory-Human Services Survey (MBI-HSS)
Inconsistent use of dashes.
MINORconsistencyResults, Burnout and hair cortisol concentration
“p = 0.024, OR: 1.258 [IC1.030-1.536]; p = 0.025 OR: 0.894 [IC0.810-0.986]”
→ Add consistent spacing around p values and ORs, e.g. 'p = 0.024, OR: 1.258 [IC 1.030-1.536]; p = 0.025, OR: 0.894 [IC 0.810-0.986]'
Missing comma after some p values and missing space in IC intervals.

Kaimen 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

RigorReviewer 1

RigorReviewer 2

RigorReviewer 3

RigorPre-Submission Reviewer

CopyeditAgent Scribe

CitationsCitation Integrity

StatisticsStatistics Consistency

PreregistrationDeterministic check· no model (rule-based)

The star rating is the report’s one-glance summary. Every paper starts at 5★ and loses stars for the concrete problems the review finds — so a rating is never a vague average, it’s a running total you can read line by line under “How this rating was calculated.”

How stars are deducted

Reporting — 8 dimensionseach dimension that fully fails−½★
each dimension partially met−¼★
Statistics · Integrity · Claimseach serious problem−1★
each medium problem−½★
Citationseach retracted or unverifiable reference−¼★
Copyeditonly when the manuscript needs a full edit−½★

The rating never drops below 1★, and a demonstrable critical failure (an impossible statistic, a proven ethics violation) caps it at 1★ on its own — so the stars can never look healthy when the verdict is CRITICAL.

The rating draws on a panel of agents. Three independent Kaimen Rigor reviewers grade the eight dimensions below across several independent passes (the shown verdict is their majority vote — steadier than any single run), isolate the paper’s major claims and check its own evidence backs them, and flag integrity concerns. Alongside them, a citation agent resolves every reference against Crossref, OpenAlex, and Retraction Watch; a statistics agent recomputes reported tests; and rule-based checks verify that declared data/code links actually resolve. Full text is required — an abstract-only submission is not analyzed.

The eight reporting dimensions

Scientific PremisePrior work, rationale, and how it addresses gaps.

Study Design & RigorRandomization, blinding, power, controls, replication.

Biological VariablesSex, age, species/strain, housing, demographics.

Ethical ApprovalsIRB/IACUC approval, informed consent, regulatory compliance.

Key ResourcesAntibodies, cell lines, organisms, software — identified with persistent IDs.

Statistical ReportingNamed tests, exact p-values, effect sizes, plausible summary stats.

Data & Code AvailabilityAvailability statements, repositories, accession numbers, shared code.

Reporting TransparencyMethods, registration, guidelines, outcomes, limitations, funding/COI.

Graded against NIH, MDAR, ARRIVE 2.0, CONSORT, EQUATOR, and RRID guidelines. A dimension that doesn’t apply to the study type is skipped, never penalized.

This Kaimen Rigor review is model-assisted and is not a substitute for formal expert review. It complements human evaluation by surfacing potential methodological concerns — verify each finding against the source.

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

DOI

10.1038/s41598-024-79925-8

Record issued

2026-08-05

Engine

7.15.0

Exported

2026-09-20