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

Facilitators and barriers to modifying dietary and hygiene behaviours as adjuvant treatment in patients with depression in primary care: A qualitative study.

Background: Major depression is a highly prevalent condition. Its pathogenesis is related to a wide variety of biological and psychosocial factors and among these is factors related to lifestyle. Lifestyle-based interventions seem to be appropriate strategies as coadjutant treatment. The objective of this study is to explore and identify expectations and experiences of both patients and healthcare professionals that can point to the main barriers and facilitators with regard to the promotion of healthy dietary and hygiene behaviours in patients suffering from major depression. Methods: A qualitative design was used to collect information from a wide range of purposefully and theoretically guided samples of depressed patients and health professionals from Primary Care (PC). Both in-depth interviews and discussion groups were used. A standardized protocol was designed to guide the interviews and groups, including the preparation of a topic list to be addressed, with previously tested, open suggestions that could be of interest. A thematic analysis was performed from grounded theory in order to explore, develop and define until saturation the emergent categories of analysis derived from the individual interview and group data. Results: Both patients as well as PC professionals noted a series of central aspects with respect to the implementation of a programme for the acquisition of healthy dietary and hygiene habits for depressive patients, which may be organized around ‘personal’, ‘programmatic’, and ‘transversal’ aspects. As for the personal aspects, categories regarding ‘patient history’, and ‘disposition’ were found; the programmatic aspects included categories such as ‘presentation and monitoring’, and modification of ‘cognitive’ and ‘behavioural’ habits; whereas the transversal aspects comprised the possibilities of ‘social support’ and defining categories of ‘objectives’. Conclusion: The implementation of intervention programmes that combine dietary and hygiene-related factors in patients with depression is complex, given the nature of the disorder itself, and its symptoms such as apathy and feelings of guilt or incompetence. Key issues exist for the success of the intervention, such as the simplicity of guidelines, tailoring through motivational interviewing, prolonged and intense monitoring throughout the different stages of the disorder, and the provision of adequate feedback and social support. PC could be an appropriate level in which to implement these interventions

Mindfulness and Symptoms of Depression and Anxiety in the General Population: The Mediating Roles of Worry, Rumination, Reappraisal and Suppression

The present study examined the effects of mindfulness on depression and anxiety, both direct and indirect through the mediation of four mechanisms of emotional regulation: worry, rumination, reappraisal and suppression. Path analysis was applied to data collected from an international and non-clinical sample of 1151 adults, including both meditators and non-meditators, who completed an online questionnaire battery. Our results show that mindfulness are related to lower levels of depression and anxiety both directly and indirectly. Suppression, reappraisal, worry and rumination all acted as significant mediators of the relationship between mindfulness and depression. A similar picture emerged for the relationship between mindfulness and anxiety, with the difference that suppression was not a mediator. Our data also revealed that the estimated number of hours of mindfulness meditation practice did not affect depression or anxiety directly but did reduce these indirectly by increasing mindfulness. Worry and rumination proved to be the most potent mediating variables. Altogether, our results confirm that emotional regulation plays a significant mediating role between mindfulness and symptoms of depression and anxiety in the general population and suggest that meditation focusing on reducing worry and rumination may be especially useful in reducing the risk of developing clinical depression

Nutritional Potential of Weeds on Suburban Farms in Santiago de Cuba

Context: Although weed species have traditionally been considered a problem, today, they are a resource in need of preservation. Objective: To determine the food potential of weed vegetation on suburban farms in Santiago de Cuba Methods: An ethnobotanical study was conducted in communities adjacent to various farms. The botanical composition, percentage of species with a food potential, and their most frequently used organs, food types, and most favored species for animal nutrition, were determined. Results: A total of 22 weed species with food potential were identified, family Poaceae being the most commonly found, and Bothriochloa pertusa (L.) A. Camus, was the most dominating species. Together with Megathyrsus maximus (Jacq.) Sim. & Jac., their reference percentage was 100%. The most commonly used organ of weed was the leaves (77.27%), especially in animal nutrition (63.63%). Eight species are used in human nutrition, of which Pithecellobium dulce (Roxb.) Benth and Chrysophyllum oliviforme L. are consumed as scarce fruits. Conclusions: The grass studied has a potential for use as human and animal nutrition

Potencialidades de la vegetación arvense existente en fincas de la agricultura suburbana de Santiago de Cuba para la alimentación

Context: Although weeds species have traditionally been seen as a problem, in light of present day knowledge, they have become a valuable resource worthy of preserving. Objetive: To determine the nutritional potential of weed vegetation existing on suburban agriculture farms in Santiago de Cuba. Method: An etnobotanic study was done in communities near several farms. The botanical composition, percentage of species with a nutritional potential, and most commonly organs used, destination, and most benefitted animal species were determined. Results: A number of 22 weed species with a nutritional potential were identified. Family Poaceae was the kind with the highest variety of species, and Bothriochloa pertusa (L.) A. Camus was the most dominating species, which along with Megathyrsus maximus (Jacq.) Sim. & Jac. Showed 100% reference percentage. Out of 77.27% of the weed vegetation, the most commonly used organ was the leaves, and 63.63% was used for animal nutrition. Eight species were used for human nutrition, including Pithecellobium dulce (Roxb.) Benth and Chrysophyllum oliviforme L., which are consumed as low presence fruit.Contexto: Si bien es cierto que las especies arvenses han sido vistas tradicionalmente como un problema, a la luz de los conocimientos actuales se han convertido en un recurso a conservar. Objetivo: Determinar las potencialidades de la vegetación arvense existente en fincas de la agricultura suburbana de Santiago de Cuba para la alimentación. Métodos: Se desarrolló un estudio etnobotánico en comunidades cercanas a diferentes fincas. Se determinó composición botánica, porcentajes de especies con potencialidades para la alimentación así como órganos más utilizados, tipo de alimentación a la que se destinan y para la alimentación animal las especies más favorecidas. Resultados: Se contabilizaron 22 especies arvenses con potencialidades para la alimentación siendo la familia Poaceae la de mayor riqueza de especies y Bothriochloa pertusa (L.) A. Camus la especie más dominante. Esta junto a Megathyrsus maximus (Jacq.) Sim. & Jac. tuvieron un porcentaje de referencia igual al 100 %. Del 77,27 % de la flora arvense el órgano más utilizado son las hojas y el 63,63 % se destinan a la alimentación animal. Ocho especies se destinan a la alimentación humana de las cuales Pithecellobium dulce (Roxb.) Benth y Chrysophyllum oliviforme L. se consumen como frutales de baja presencia. Conclusiones: La flora arvense estudiada posee potencialidades para ser utilizada en la alimentación animal y humana

Relación entre actividad física, gravedad clínica y perfil sociodemográfico en pacientes con Depresión Mayor

El ejercicio físico está demostrando en los últimos años ser una buena estrategia antidepresiva complementaria para muchos pacientes. La asociación entre el grado de actividad física y las características clínicas y sociodemográficas en la Depresión aún no se ha estudiado suficientemente en muestras amplias y representativas de pacientes. Hacerlo es importante para obtener información que posibilite mejorar el diseño de programas destinados a promover el ejercicio físico en estos pacientes. Se reclutaron 3374 pacientes con Depresión Mayor en tratamiento, que acudieron a consulta psiquiátrica por primera vez en Centros de Salud Mental distribuidos por toda España. Fueron clasificados en tres grupos de acuerdo con el nivel de actividad física semanal que declararon. En este estudio comparamos el grupo que comunicó mayor actividad física (n = 1033; 30.6%) con el que menos (n = 858; 25.4%). Los pacientes más activos tenían menor gravedad clínica de acuerdo con la puntuación en la escala Montgomery-Asberg Depression Rating Scale (MADRS). Además eran más jóvenes, con mejor nivel educativo y de empleo, menor aislamiento social y menor consumo de tabaco. Sin embargo, cuando todas estas variables fueron controladas, la diferencia en la puntuación en la MADRS seguía siendo estadísticamente significativa. De lo anterior deducimos que los pacientes depresivos con más edad o dificultades socioeconómicas tienden a hacer menos ejercicio espontáneamente, por lo que probablemente necesiten un apoyo especial al recomendárselo.Physical activity is showing in recent years to be a good antidepressant complementary strategy for many patients. The association between the degree of physical activity and clinical and sociodemographic characteristics in depression has still not been studied sufficiently in large and representative patient samples. Doing so is important to improve the design of programs that promote physical activity in depressive patients. 3374 patients with Major Depression who first came to psychiatric consultation in mental health centres in Spain were recruited. They were classified into three groups according to the level of weekly physical activity declared. In this study we compared the most physical activity declared group (n = 1033; 30.6%) with less physical activity declared group (n = 858; 25.4%). Most physically active patients had lower clinical depression severity according to the Montgomery-Asberg Depression Rating Scale (MADRS) scale. They were also younger, with higher education level and employment status; do not tend to live alone and less tobacco use. However, when all these variables were controlled, differences in MADRS Scores between groups remain statistically significant. Older and with socioeconomic difficulties depressive patients tend to do less physical activity, for this reason, it is probably that they need a particular support to recommend do exercise.A atividade física mostra nos últimos anos uma boa estratégia de antidepressivos complementares para muitos pacientes. A associação entre o grau de atividade física e as características clínicas e sociodemográcas na Depressão ainda não foi sucientemente estudada em amostras grandes e representativas de pacientes. Fazer isso é importante para obter informa- ções que permitam melhorar o design de programas destinados a promover a atividade física nesses pacientes. Registramos 3374 pacientes com maior depressão no tratamento, que participaram de consultas psiquiátricas pela primeira vez em centros de saúde mental distribuídos em toda a Espanha. Eles foram classicados em três grupos de acordo com o nível de atividade física semanal que relataram. Neste estudo, comparamos o grupo que relatou a maior atividade física (n = 1033, 30,6%) com o mínimo (n = 858, 25,4%). Os pacientes mais ativos tiveram menor gravidade clínica de acordo com a pontuação na Escala de Avaliação de Depressão de Montgomery-Asberg (MADRS). Eles também eram mais jovens, com melhores níveis educacionais e de emprego, menos isolamento social e menor consumo de tabaco. No entanto, quando todas essas variáveis foram controladas, a diferença no índice MADRS permaneceu estatisticamente signicante. A partir do acima, deduzimos que os pacientes deprimidos mais velhos ou as diculdades socioeconômicas tendem a uma atividade física espontaneamente menor, então eles provavelmente precisam de apoio especial ao recomendá-lo

How to Handle Concomitant Asymptomatic Prosthetic Joints During an Episode of Hematogenous Periprosthetic Joint Infection, a Multicenter Analysis

[Background] Prosthetic joints are at risk of becoming infected during an episode of bacteremia, especially during Staphylocococcus aureus bacteremia. However, it is unclear how often asymptomatic periprosthetic joint infection (PJI) occurs, and whether additional diagnostics should be considered.[Methods] In this multicenter study, we retrospectively analyzed a cohort of patients with a late acute (hematogenous) PJI between 2005–2015 who had concomitant prosthetic joints in situ. Patients without at least 1 year of follow-up were excluded.[Results] We included 91 patients with a hematogenous PJI and 108 concomitant prosthetic joints. The incident PJI was most frequently caused by Staphylococcus aureus (43%), followed by streptococci (26%) and Gram-negative rods (18%). Of 108 concomitant prosthetic joints, 13 were symptomatic, of which 10 were subsequently diagnosed as a second PJI. Of the 95 asymptomatic prosthetic joints, 1 PJI developed during the follow-up period and was classified as a “missed” PJI at the time of bacteremia with S. aureus (1.1%). Infected prosthetic joints were younger than the noninfected ones in 67% of cases, and prosthetic knees were affected more often than prosthetic hips (78%).[Conclusions] During an episode of hematogenous PJI, concomitant asymptomatic prosthetic joints have a very low risk of being infected, and additional diagnostic work-up for these joints is not necessary.Peer reviewe

Osteosynthesis-associated infection of the lower limbs by multidrug-resistant and extensively drug-resistant Gram-negative bacteria: a multicentre cohort study

Purpose: The purpose of this study was the clinical and therapeutic assessment of lower-limb osteosynthesis-associated infection (OAI) by multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria (GNB), which have been poorly studied to date. Methods: A prospective multicentre observational study was conducted on behalf of ESGIAI (the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Implant-Associated Infections). Factors associated with remission of the infection were evaluated by multivariate and Cox regression analysis for a 24-month follow-up period. Results: Patients (n=57) had a history of trauma (87.7 %), tumour resection (7 %) and other bone lesions (5.3 %). Pathogens included Escherichia coli (n=16), Pseudomonas aeruginosa (n=14; XDR 50 %), Klebsiella spp. (n=7), Enterobacter spp. (n=9), Acinetobacter spp. (n=5), Proteus mirabilis (n=3), Serratia marcescens (n=2) and Stenotrophomonas maltophilia (n=1). The prevalence of ESBL (extended-spectrum β-lactamase), fluoroquinolone and carbapenem resistance were 71.9 %, 59.6 % and 17.5 % respectively. Most patients (n=37; 64.9 %) were treated with a combination including carbapenems (n=32) and colistin (n=11) for a mean of 63.3 d. Implant retention with debridement occurred in early OAI (66.7 %), whereas the infected device was removed in late OAI (70.4 %) (p=0.008). OAI remission was achieved in 29 cases (50.9 %). The type of surgery, antimicrobial resistance and duration of treatment did not significantly influence the outcome. Independent predictors of the failure to eradicate OAI were age &gt;60 years (hazard ratio, HR, of 3.875; 95 % confidence interval, CI95 %, of 1.540–9.752; p=0.004) and multiple surgeries for OAI (HR of 2.822; CI95 % of 1.144–6.963; p=0.024). Conclusions: Only half of the MDR/XDR GNB OAI cases treated by antimicrobials and surgery had a successful outcome. Advanced age and multiple surgeries hampered the eradication of OAI. Optimal therapeutic options remain a challenge.</p

Melancholic versus non-melancholic depression: differences on cognitive function. A longitudinal study protocol

<p>Abstract</p> <p>Background</p> <p>Cognitive dysfunction is common among depressed patients. However, the pattern and magnitude of impairment during episodes of major depressive disorder (MDD) through to clinical remission remains unclear. Heterogeneity of depressive patients and the lack of longitudinal studies may account for contradictory results in previous research.</p> <p>Methods/Design</p> <p>This longitudinal study will analyze cognitive differences between CORE-defined melancholic depressed patients (n = 60) and non-melancholic depressed patients (n = 60). A comprehensive clinical and cognitive assessment will be performed at admission and after 6 months. Cognitive dysfunction in both groups will be longitudinally compared, and the persistence of cognitive impairment after clinical remission will be determined.</p> <p>Discussion</p> <p>The study of neuropsychological dysfunction and the cognitive changes through the different phases of depression arise a wide variety of difficulties. Several confounding variables must be controlled to determine if the presence of depression could be considered the only factor accounting for group differences.</p

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements