Burnout subtypes and their clinical implications: A theoretical proposal for specific therapeutic approaches

Abstract: Burnout is associated with a poor perception of health status, psychosomatic disorders and physical illness. The aim of this study is to construct a comprehensive theoretical proposal for a therapeutic intervention that is sensitive to the different clinical manifestations of this state. In order to do this, the frenetic, under-challenged and worn-out subtypes of burnout are presented in a systematic manner, together with the interventions that may provide suitable management for each subtype. Said clinical profiles may represent different stages in the progression of burnout, and have specific dysfunctional mechanisms that require a choice of adjusted intervention strategies according to the characteristics of each particular case. Finally, the degree of dedication to work and its clinical repercussions are put forward as a hypothesis to explain the progressive impairment caused by burnout, and as a target on which primary, secondary and tertiary prevention strategies could be founded.Resumen: Subtipos de burnout e implicaciones clínicas: Una propuesta teórica basada en abordajes terapéuticos específicos. El burnout se asocia con un peor estatus de salud percibida, trastornos psicosomáticos y enfermedades físicas. El objetivo del presente trabajo es articular una propuesta teórica comprehensiva de intervención terapéutica sensible a las diferen­tes manifestaciones clínicas de dicho estado. Para ello, se presentan de forma sistemática los subtipos de burnout frenético, sin-desafíos y desgastado, así como las intervenciones que pueden proporcionar un adecuado manejo de cada subtipo. Dichos perfiles clínicos parecen representar momentos diferentes en la progresión del burnout, con mecanismos disfuncionales especí­ficos, que obligan a optar por estrategias de intervención ajustadas a las características de cada caso en particular. Finalmente, se propone el grado de dedicación en el trabajo, y sus repercusiones clínicas, como hipótesis para explicar la progresiva erosión que supone el burnout, y como eje sobre el que fundamentar las estrategias de prevención primaria, secundaria y terciaria.Abstract: Burnout is associated with a poor perception of health status, psychosomatic disorders and physical illness. The aim of this study is to construct a comprehensive theoretical proposal for a therapeutic intervention that is sensitive to the different clinical manifestations of this state. In order to do this, the frenetic, under-challenged and worn-out subtypes of burnout are presented in a systematic manner, together with the interventions that may provide suitable management for each subtype. Said clinical profiles may represent different stages in the progression of burnout, and have specific dysfunctional mechanisms that require a choice of adjusted intervention strategies according to the characteristics of each particular case. Finally, the degree of dedication to work and its clinical repercussions are put forward as a hypothesis to explain the progressive impairment caused by burnout, and as a target on which primary, secondary and tertiary prevention strategies could be founded.Resumen: Subtipos de burnout e implicaciones clínicas: Una propuesta teórica basada en abordajes terapéuticos específicos. El burnout se asocia con un peor estatus de salud percibida, trastornos psicosomáticos y enfermedades físicas. El objetivo del presente trabajo es articular una propuesta teórica comprehensiva de intervención terapéutica sensible a las diferen­tes manifestaciones clínicas de dicho estado. Para ello, se presentan de forma sistemática los subtipos de burnout frenético, sin-desafíos y desgastado, así como las intervenciones que pueden proporcionar un adecuado manejo de cada subtipo. Dichos perfiles clínicos parecen representar momentos diferentes en la progresión del burnout, con mecanismos disfuncionales especí­ficos, que obligan a optar por estrategias de intervención ajustadas a las características de cada caso en particular. Finalmente, se propone el grado de dedicación en el trabajo, y sus repercusiones clínicas, como hipótesis para explicar la progresiva erosión que supone el burnout, y como eje sobre el que fundamentar las estrategias de prevención primaria, secundaria y terciaria

Exercise in colon cancer modulation: an experimental approach

Carcinogenesis is a complex process best characterized as an accumulation of alterations in genes regulating cellular homeostasis. The whole process can be divided into three main stages: initiation, promotion, and progression. It has been observed that moderate and regular physical activity (PA) may prevent cancer, mainly colon cancer (CC), up to 50% in humans. The evidence that PA protects against colon cancer is convincing. Also, PA probably protects against postmenopausal breast cancer and cancer of the endometrium. On the other hand, exhaustive exercise increases free radical DNA oxidative damage, inflammation and depresses immune function, events also related to the increased risk for cancer development. Nevertheless, the mechanisms involved in both PA effects remain largely unknown and poorly studied. Understanding the mechanisms that link PA with cancer is useful to identify plausible mechanisms and associations between PA and cancer; to provide evidence for implementing interventions on clinical and public-health levels; to define exercise prescription for people without and with cancer; and to identify new clues to cancer biology, which might help in designing other cancer prevention and treatment modalities. Because of the complexity and heterogeneity of activity in people, animal models for carcinogenesis and PA present the opportunity to study the amounts and types of PA and biomarkers that influence carcinogenesis in controlled environments. Epithelial cell proliferation and aberrant crypt foci (ACF) have been used for early detection of factors that influence colorectal carcinogenesis in rats and can be induced by the colon carcinogen dimethyl-hydrazine (DMH). This interesting animal-tumor model is possible a useful approach for studying the influence of exercise during the initiation and post initiation period, and has already contributed to the current understanding of colon carcinogenesis and PA relationship

Utilidad de los marcadores biológicos en la detección precoz y prevención del síndrome de burnout

Burnout is associated with a worse health self-perception and greater physical and psychiatric comorbidity. The objective of this review is to summarize in a systematic way the main biomarkers associated with the burnout syndrome: cardiovascular (blood pressure, heart rate and variability of heart rate); sleep-related (quality,fragmentation, and sleep latency); associated with the hypothalamic-pituitary-adrenal axis and the sympathetic-adrenal-medullary axis (cortisol, salivary IgA, lysozime, a-amylase and chromogranin-A); related to the immune system (natural killer cells and mononuclear antibodies CD57 and CD16), and related to inflammation (TNF-a, IL-4 interleukins, fibrinogen, reactive C protein). In the next years, some of these biomarkers, mainly those related to the immune system and inflammation could become useful keys for the early detection and monitorization of this disorder.El burnout se asocia a una peor autopercepción de la salud, así como a una gran comorbilidad somática y psicológica. El objetivo de esta revisión es presentar de forma sistemática los principales biomarcadores asociados al burnout: cardiovasculares (tensión arterial, frecuencia cardiaca y variabilidad de la frecuencia cardiaca); losrelacionados con el sueño (calidad, fragmentación, latencia y horas de sueño); losrelacionados con los ejes hipotálamo-hipófiso-suprarrenal y simpático-médulo-suprarrenal (cortisol, IgA, lisozima, a-amilasa y cromogranina A salival);relacionados con el sistema inmunitario (células naturales asesinas y anticuerpos mononucleares CD57 y CD16), ylosrelacionados con la inflamación (TNF-a, interleuquinas IL-4, fibrinógeno, proteína c-reactiva). Es probable que en los próximos años algunos de estos biomarcadores, sobre todo los relacionados con el sistema inmune y con la inflamación, resulten de gran utilidad para la detección precoz y monitorización del tratamiento en este trastorno.

Effects of mindfulness-based interventions on biomarkers in healthy and cancer populations: a systematic review

Background: Only a small number of articles have investigated the relationship between mindfulness-based interventions (MBIs) and biomarkers. The aim of this systematic review was to study the effect of MBIs on specific biomarkers (cytokines, neuropeptides and C-reactive protein (CRP)) in both healthy subjects and cancer patients. Methods: A search was conducted using PubMed, EMBASE, PsycINFO and the Cochrane library between 1980 and September 2016. Results: A total of 13 studies with 1110 participants were included. In the healthy population, MBIs had no effect on cytokines, but were found to increase the levels of the neuropeptide insulin-like growth factor 1 (IGF-1). With respect to neuropeptide Y, despite the absence of post-intervention differences, MBIs may enhance recovery from stress. With regard to CRP, MBIs could be effective in lower Body Mass Index (BMI) individuals. In cancer patients, MBIs seem to have some effect on cytokine levels, although it was not possible to determine which specific cytokines were affected. One possibility is that MBIs might aid recovery of the immune system, increasing the production of interleukin (IL)-4 and decreasing interferon gamma (IFN-gamma). Conclusions: MBIs may be involved in changes from a depressive/carcinogenic profile to a more normalized one. However, given the complexity and different contexts of the immune system, and the fact that this investigation is still in its preliminary stage, additional randomized controlled trials are needed to further establish the impact of MBI programmes on biomarkers in both clinical and non-clinical populations.Instituto de Salud Carlos III of the Spanish Ministry of Economy and CompetitivenessNetwork for Prevention and Health Promotion in primary Care from the Instituto de Salud Carlos III of the Ministry of Economy and Competitiveness (Spain)European Union ERDF fundsAragon Hlth Sci Inst IACS, Zaragoza, SpainShowa Univ, Dept Psychiat, Sch Med, Tokyo, JapanPrimary Care Prevent & Hlth Promot Res Network RE, Barcelona, SpainUniv Zaragoza, Miguel Servet Univ Hosp, Dept Psychiat, Zaragoza, SpainUniv Zaragoza, Fac Social & Human Sci, Dept Psychol & Sociol, Teruel, SpainFed Univ Sao Paulo UNIFESP, Dept Prevent Med, Mente Aberta Brazilian Ctr Mindfulness & Hlth Pro, Sao Paulo, BrazilHosp Israelita Albert Einstein, Sao Paulo, BrazilUniv Zaragoza, Fac Hlth Sci & Sports, Huesca, SpainUniv Balearic Isl, Res Inst Hlth Sci IUNICS, Palma De Mallorca, SpainFed Univ Sao Paulo UNIFESP, Dept Prevent Med, Mente Aberta Brazilian Ctr Mindfulness & Hlth Pro, Sao Paulo, BrazilInstituto de Salud Carlos III of the Spanish Ministry of Economy and Competitiveness: PI13/01637Network for Prevention and Health Promotion in primary Care from the Instituto de Salud Carlos III of the Ministry of Economy and Competitiveness (Spain): RD12/0005Web of Scienc

Mindfulness, perceived stress, and subjective well-being: a correlational study in primary care health professionals

Background: Primary health care professionals (PHPs) usually report high levels of distress and burnout symptoms related to job strain. Mindfulness, defined as non-judgmental-present-moment awareness, seems to be a moderator in the causal association between life stressors and well-being. This study aimed to verify correlations among self-reported mindfulness, perceived stress (PS), and subjective well-being (SW) in Brazilian PHPs. Methods: We performed a correlational cross-sectional study in a purposive sample of Brazilian PHPs (physicians, nurses, nursing assistants, and community health workers), working in community-oriented primary care programs (known locally as 'Family Health Programs'). We used validated self-reporting instruments: the Mindful Attention Awareness Scale (MAAS), the Perceived Stress Scale (PSS), and the Subjective Well-being Scale (SWS). We performed a multivariate analysis of variance (MANOVA), through regression coefficients (beta) in relation to the professional category (nursing assistant), in addition to the length of time in the same job (under than 6 months) that had indicated the lowest level of PS. Results: participants (n = 450) comprised community health workers (65.8 %), nursing assistants (18 %), registered nurses (10.0 %), and doctors (family physicians) (6.0 %); 94 % were female and 83.1 % had worked in the same position for more than one year. MANOVA regression analysis showed differences across professional categories and length of time in the same job position in relation to mindfulness, PS, and SW. Nurses demonstrated lower levels of mindfulness, higher PS, and SW negative affect, as well as lower SW positive affect. Being at work for 1 year or longer showed a clear association with higher PS and lower SW positive affect, and no significance with mindfulness levels. Pearson's coefficient values indicated strong negative correlations between mindfulness and PS, and medium correlations between mindfulness and SW. Conclusion: In this study, there were clear correlations between mindfulness, PS, and SW across different primary care professional categories and time in the same job position, suggesting specific vulnerabilities that should be addressed through the development of staff awareness, stress prevention, and well-being interventions

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Eating disorders in weight-related therapy (EDIT): protocol for a systematic review with individual participant data meta-analysis of eating disorder risk in behavioural weight management

The Eating Disorders In weight-related Therapy (EDIT) Collaboration brings together data from randomised controlled trials of behavioural weight management interventions to identify individual participant risk factors and intervention strategies that contribute to eating disorder risk. We present a protocol for a systematic review and individual participant data (IPD) meta-analysis which aims to identify participants at risk of developing eating disorders, or related symptoms, during or after weight management interventions conducted in adolescents or adults with overweight or obesity. We systematically searched four databases up to March 2022 and clinical trials registries to May 2022 to identify randomised controlled trials of weight management interventions conducted in adolescents or adults with overweight or obesity that measured eating disorder risk at pre- and post-intervention or follow-up. Authors from eligible trials have been invited to share their deidentified IPD. Two IPD meta-analyses will be conducted. The first IPD meta-analysis aims to examine participant level factors associated with a change in eating disorder scores during and following a weight management intervention. To do this we will examine baseline variables that predict change in eating disorder risk within intervention arms. The second IPD meta-analysis aims to assess whether there are participant level factors that predict whether participation in an intervention is more or less likely than no intervention to lead to a change in eating disorder risk. To do this, we will examine if there are differences in predictors of eating disorder risk between intervention and no-treatment control arms. The primary outcome will be a standardised mean difference in global eating disorder score from baseline to immediately post-intervention and at 6- and 12- months follow-up. Identifying participant level risk factors predicting eating disorder risk will inform screening and monitoring protocols to allow early identification and intervention for those at risk