Stressors in anaesthesiology: development and validation of a new questionnaire: A cross-sectional study of Portuguese anaesthesiologists

BACKGROUND: Stress in anaesthesiologists is a common and multifactorial problem related to patients, colleagues and organisations. The consequences of stress include depression, work-home conflicts and burnout. Reduction in stress can be achieved by reducing the number and magnitude of stressors or by increasing resilience strategies. OBJECTIVES: We have created the self-reporting 'Stress Questionnaire in Anaesthesiologists' (SQA), to qualify the sources of stress in anaesthesiologists' professional lives, and measure the level of associated stress. Our study aimed to develop and validate the SQA using exploratory and confirmatory factor analyses. Construct validity was assessed through correlations between SQA and negative psychological outcomes as well as by comparing perception of stress among different known groups. DESIGN: A questionnaire-based cross-sectional, correlational, observational study. SETTINGS: The study was conducted between January 2014 and December 2014, throughout different anaesthesia departments in Portuguese hospitals. Data collection was from a representative subset at one specific time point. PARTICIPANTS: A sample of 710 anaesthesia specialists and residents from Portugal. MAIN OUTCOME MEASURES: The primary outcome measure was to identify specific stressors in anaesthesiologists. Secondary outcome was the association between stressors and burnout, depression symptoms, anxiety, stress, rumination, satisfaction with life and functional impairment. RESULTS: The exploratory analysis showed the SQA is a tri-dimensional instrument and confirmatory analysis showed the tri-dimensional structure presented good model fit. The three dimensions of SQA correlated positively with other stress measures and burnout, but negatively with satisfaction with life. CONCLUSION: SQA is a well adjusted measure for assessing stressors in anaesthesia physicians and includes clinical, organisational and team stress factors. Results showed that the SQA is a robust and reliable instrument.info:eu-repo/semantics/publishedVersio

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

La vocation de la biophysique

The author begins by discussing the two main fundamental methods, i.e. integrism and reductionism, which are used for the interpretation of the physical world. But the main idea which dominates this paper is based on an analogy between Mendeleïev's periodic law which transcends inorganic matter, and the behaviour of living beings. It is suggested that, just as atomic masses were used to classify the species in the inanimate world, it would be valuable to codify the organic world in terms of maximal life-spans. A theory was recently worked out by the author to interpret this very general phenomenon on the basis of the concentrations of organic free radicals in the brain. This is strictly related to the presence of a more or less free electron, which itself explains the remarkable structure of the periodic system. Further, suggestions are made concerning other fundamental properties of living matter, such as senescence and cancer, and these are integrated with life-span in a unifying theory. It is mainly in these directions, based on a research of holistic properties of living matter, that a new way is opened up for the further evolution of biophysics itself.Duchesne Jules. La vocation de la biophysique. In: Bulletin de la Classe des sciences, tome 62, 1976. pp. 6-19

Éloge de Maurice, Henri, Léonard PIRENNE (30 mai 1912 -11 octobre 1978)

Duchesne Jules. Éloge de Maurice, Henri, Léonard PIRENNE (30 mai 1912 -11 octobre 1978) . In: Bulletin de la Classe des sciences, tome 65, 1979. pp. 570-573

De la tumeur maligne spontanée à la cancérogenèse virale

We compare in this paper the mechanism of the spontaneous malignant tumour, which was recently established by us, with that of viral cancerogenesis. The result is extremely positive, so that this new coordination brings a strong argument in favour of our theory, which therefore now includes two basic forms of cancer. It follows from this synthesis that the therapy which we proposed in the first case can quite naturally be extended to the second, which is in full agreement with recent experimental results.Duchesne Jules. De la tumeur maligne spontanée à la cancérogenèse virale. In: Bulletin de la Classe des sciences, tome 67, 1981. pp. 529-531

Chemistry and life

Duchesne Jules. Chemistry and life. In: Bulletin de la Classe des sciences, tome 68, 1982. pp. 626-635

Le système périodique des éléments et l'évolution des êtres vivants

Here are confronted two concepts which were radically separated until now. On the basis of the new mechanism proposed to explain the evolution of living beings, it is proved that there is a strong link between this and the well-known periodic system of chemical elements. This original synthesis is most important because it constitutes a strong argument in favour of the validity of the mechanism involved and at the same time demonstrates the determinism which is at the basis of evolution as well as the simplicity of the laws of the Universe. All this is therefore radically opposed to the role played by chance as held by the neo-darwinists.Duchesne Jules. Le système périodique des éléments et l'évolution des êtres vivants. In: Bulletin de la Classe des sciences, tome 68, 1982. pp. 636-641

What is the living state ?

The question of life whose end point is death is herein discussed under a new light based on our previous discoveries. This presentation is the result of the examination of the mechanisms which control ageing cells, on the one hand, and cancerous or anti-senescent cells, on the other hand. Starting from the comparative analysis which in itself leads to the definition of the living state, we develop rationally a method through which senescence would be slowed down and maximum longevity would consequently be increased.Duchesne Jules. What is the living state ?. In: Bulletin de la Classe des sciences, tome 66, 1980. pp. 300-306

Éloge de Archibald Vivian Hill (26 septembre 1886 -3 juin 1977)

Duchesne Jules. Éloge de Archibald Vivian Hill (26 septembre 1886 -3 juin 1977) . In: Bulletin de la Classe des sciences, tome 66, 1980. pp. 640-642

Hommage à Charles Manneback, Secrétaire Perpétuel Honoraire de l'Académie Royale de Belgique

Duchesne Jules. Hommage à Charles Manneback, Secrétaire Perpétuel Honoraire de l'Académie Royale de Belgique. In: Bulletin de la Classe des lettres et des sciences morales et politiques, tome 57, 1971. pp. 282-288