Burnout in residents during the first wave of the COVID-19 pandemic: a systematic review and meta-analysis

IntroductionThe high prevalence of burnout in resident physicians is expected to have increased as a result of the expansion of the pandemic. We conducted a systematic review with a meta-analysis of studies conducted during the first wave of the COVID-19 pandemic on burnout in residents and potential associated risk factors.MethodsThe search was done in the Web of Science, MEDLINE, Scopus, and Lillac databases (April 2020–October 2021) using a priori protocol based on the PRISMA guidelines. The Newcastle Ottawa Scale was used to assess the risk of bias in the included studies. We estimated the pooled prevalence (95% CI) of burnout and the prevalence ratio (95% CI) of each risk factor associated.ResultsWe included 23 studies from 451 potential initial articles and those written in the English language; all of the collected studies were cross-sectional with anonymous online surveys, involving 4,998 responders (34%), of which 53.2% were female responders, 51% were R1-2, and 71% were in direct contact with COVID-19 patients. Eighty-seven percent presented a low-to-moderate risk of bias. Publication bias was not shown. The estimated pooled prevalence of burnout was 40% (95% CI = 0.26 – 0.57). Burnout was associated with psychiatry history (PR = 4.60, 95% CI = 1.06 – 20.06). There were no differences by gender, civil status, children in-charge, year of residency, or time exposure to COVID-19.DiscussionThe overall prevalence of burnout in residents during the first wave of the pandemic was in line with the results described in this collective before the pandemic. The presence of a psychiatry history was a potential burnout risk factor, suggesting a high vulnerability during the peak of the stress period and the need to implement mental health surveillance for this subgroup

Vigilancia epidemiológica de la Legionelosis en España, años 2019 y 2020. informe de la Red Nacional de Vigilancia Epidemiológica

[ES] Legionelosis es una enfermedad de origen ambiental que se transmite al ser humano a través de aerosoles de agua contaminada con la bacteria Legionella pneumophila. La relevancia de esta enfermedad, desde el punto de vista de la salud pública, viene dada por su frecuente presentación en forma de brotes. En 2019 se notificaron 1.579 casos y 1.543 fueron autóctonos (TI=3,28 por 100.000 habitantes). La vigilancia de casos asociados a viajes del ECDC (ELDSNet), notificó 97 casos en viajeros de otros países. En 2020 se notificaron 1.365 casos y 1.354 fueron autóctonos (TI=2,86). Ese año los casos asociados a viajar a España fueron 22. La incidencia en 2020 fue un 13% menor que la registrada en 2019. Este descenso se produjo después de tres años de un aumento mantenido. El descenso se observó, tanto en los casos con antecedente de viaje como en los que no lo tuvieron y se relacionó con los cambios en la movilidad y en los debidos al propio sistema de vigilancia durante la pandemia de COVID-19. El patrón de presentación de la enfermedad no varió con respecto a años anteriores, el 70% de los casos se dieron en hombres y la incidencia aumentó con la edad en ambos sexos. La letalidad se estimó en el 5,5% para ambos años. Se notificaron 58 brotes (246 casos y 13 defunciones). En el 52% de los brotes sólo se registraron 2 casos. [EN] Legionellosis is a disease of environmental origin that is transmitted to humans through aerosols of water contaminated with the bacterium Legionella pneumophila. The relevance of this disease, from the point of view of public health, is given by its frequent presentation as outbreaks. In 2019, 1579 cases were reported and 1543 were autochthonous (TI=3.28 per 100,000 inhabitants). The surveillance of cases associated to travel (ELDSNet) reported 97 cases in foreign travellers who visited Spain. In 2020, 1365 cases were reported and 1354 were autochthonous (TI=2.86). That year the cases associated to travel to Spain were 22. The incidence in 2020 was 13% lower than in 2019. This decrease occurred after three years of a sustained increase. The decrease was observed, both in cases with a travel history and in those that did not and was related to changes in mobility and those which affected the surveillance system itself during the COVID-19 pandemic. The pattern of presentation of the disease did not vary with respect to previous years, 70% of the cases occurred in men and the incidence increased with age in both sexes. The case fatality ratio was estimated at 5.5% for both years. 58 outbreaks (246 cases and 13 deaths) were reported. Only 2 cases occurred in the 52% of outbreaks.N

Incidence of depression in patients with hepatitis C treated with direct-acting antivirals

Depression has been associated with hepatitis C, as well as with its treatment with proinflammatory cytokines (i.e., interferon). The new direct-acting antiviral agents (DAAs) have minimal adverse effects and high potency, with a direct inhibitory effect on non-structural viral proteins. We studied the incidence and associated factors of depression in a real-life prospective cohort of chronic hepatitis C patients treated with the new DAAs. The sample was recruited from a cohort of 91 patients with hepatitis C, of both sexes, with advanced level of fibrosis and no HIV coinfection, consecutively enrolled during a 6-month period for DAA treatment; those euthymic at baseline (n=54) were selected. All were evaluated through the depression module of the Patient Health Questionnaire (PHQ-9-DSM-IV), at three time points: baseline, 4 weeks, and end-of-treatment. The cumulative incidence (95%CI) of major depression and any depressive disorder during DAA treatment was 13% (6.4-24.4) and 46.3% (33.7-59.4), respectively. No differences were observed between those patients with and without cirrhosis or ribavirin treatment (p > 0.05). Risk factors for incident major depression during DAA treatment included family depression (relative risk 9.1 [1.62-51.1]), substance use disorder (11.0 [1.7-73.5]), and baseline PHQ-9 score (2.1 [1.1-3.1]). The findings of this study highlight the importance of screening for new depression among patients receiving new DAAs, and identify potential associated risk factors

High S100B Levels Predict Antidepressant Response in Patients With Major Depression Even When Considering Inflammatory and Metabolic Markers

Background: The relationship between antidepressant response and glial, inflammatory, and metabolic markers is poorly understood in depression. This study assessed the ability of biological markers to predict antidepressant response in major depressive disorder (MDD). Methods: We included 31 MDD outpatients treated with escitalopram or sertraline for 8 consecutive weeks. The Montgomery-Åsberg Depression Rating Scale (MADRS) was administered at baseline and at week 4 and 8 of treatment. Concomitantly, blood samples were collected for the determination of serum S100B, C-reactive protein (CRP), and high-density lipoprotein cholesterol (HDL)-C levels. Treatment response was defined as ≥50% improvement in the MADRS score from baseline to either week 4 or 8. Variables associated with treatment response were included in a linear regression model as predictors of treatment response. Results: Twenty-seven patients (87%) completed 8 weeks of treatment; 74% and 63% were responders at week 4 and 8, respectively. High S100B and low HDL-C levels at baseline were associated with better treatment response at both time points. Low CRP levels were correlated with better response at week 4. Multivariate analysis showed that high baseline S100B levels and low baseline HDL-C levels were good predictors of treatment response at week 4 (R2 = 0.457, P =. 001), while S100B was at week 8 (R2 = 0.239, P =. 011). Importantly, baseline S100B and HDL-C levels were not associated with depression severity and did not change over time with clinical improvement. Conclusions: Serum S100B levels appear to be a useful biomarker of antidepressant response in MDD even when considering inflammatory and metabolic markers. © 2022 The Author(s) 2022

Brain volumes in alcohol use disorder : Do females and males differ? A whole-brain magnetic resonance imaging mega-analysis

Emerging evidence suggests distinct neurobiological correlates of alcohol use disorder (AUD) between sexes, which however remain largely unexplored. This work from ENIGMA Addiction Working Group aimed to characterize the sex differences in gray matter (GM) and white matter (WM) correlates of AUD using a whole-brain, voxelbased, multi-tissue mega-analytic approach, thereby extending our recent surfacebased region of interest findings on a nearly matching sample using a complementary methodological approach. T1-weighted magnetic resonance imaging (MRI) data from 653 people with AUD and 326 controls was analyzed using voxel-based morphometry. The effects of group, sex, group-by-sex, and substance use severity in AUD on brain volumes were assessed using General Linear Models. Individuals with AUD relative to controls had lower GM volume in striatal, thalamic, cerebellar, and widespread cortical clusters. Group-by-sex effects were found in cerebellar GM and WM volumes, which were more affected by AUD in females than males. Smaller groupby- sex effects were also found in frontotemporal WM tracts, which were more affected in AUD females, and in temporo-occipital and midcingulate GM volumes, which were more affected in AUD males. AUD females but not males showed a negative association between monthly drinks and precentral GM volume. Our results suggest that AUD is associated with both shared and distinct widespread effects on GM and WM volumes in females and males. This evidence advances our previous region of interest knowledge, supporting the usefulness of adopting an exploratory perspective and the need to include sex as a relevant moderator variable in AUD

Concepts of indirect calorimetry on metabolic disorders: a narrative review

Introdução: A calorimetria indireta continua sendo um padrão ouro na avaliação do gasto energético de repouso no campo clínico. Por meio de suas medições, é possível oferecer as necessidades energéticas de um paciente para maximizar os benefícios da terapia nutricional. No entanto, os conceitos e as bases metodológicas dos dados coletados podem ser dificultosos para serem interpretados pelos usuários na prática clínica. Objetivo: abordar os conceitos de gasto energético diário total e seus componentes, e, apresentar os aspectos metodológicos da calorimetria indireta que podem servir como guia no campo clínico. Método: Revisão bibliográfica narrativa, realizada pelas bases de dados eletrônicas Pubmed (US National Library of Medicine), SCOPUS e Scientific Electronic Library Online (SciELO). A pesquisa foi realizada no período entre 1905-2019, utilizando os seguintes identificadores em Descritores em Ciências da Saúde: Metabolismo Basal, Metabolismo Energético e Calorimetria Indireta. Foram selecionadas 55 pesquisas publicadas que apresentaram conteúdos relacionados aos objetivos deste estudo. Resultado: O gasto energético total diário (GETD) é composto por três componentes principais, tais como: atividade física (AF), efeito térmico dos alimentos (TEF) e taxa metabólica basal (TMB) e / ou gasto energético de repouso (GER). O GER é geralmente avaliado por calorimetria indireta, que também fornece informações sobre o coeficiente respiratório (CR) e oxidação de substratos, que pode variar de acordo com o metabolismo do paciente, como algum distúrbio metabólico, obesidade ou desnutrição. Portanto, o manejo adequado dos aspectos metodológicos da calorimetria indireta e sua posterior interpretação nos distúrbios metabólicos é fundamental para garantir a qualidade dos resultados. Conclusão: Os conceitos de gasto energético e as bases metodológicas da calorimetria indireta são relevantes para fornecer uma atenção individualizada aos pacientes com distúrbios metabólicos. As descrições desta revisão podem ser utilizadas como um guia prático, auxiliando a compreensão da aplicação correta da técnica de calorimetria indireta, em estudos relacionados ao gasto energético com ênfase nos distúrbios metabólicos.Introduction: Indirect calorimetry remains a gold standard in measuring resting energy expenditure in the clinical field. Through its measurements, it is possible to offers a patient’s energy needs to maximize nutritional therapy benefits. However, the concepts and methodological basis of collected data can be difficult to be interpreted by users in clinical practice. Objective: To address the concepts of total daily energy expenditure and its components and present the methodological aspects of indirect calorimetry that can guide the clinical field. Method: Narrative bibliographic review using the electronic Pubmed (US National Library of Medicine), SCOPUS, and Scientific Electronic Library Online (SCIELO) databases. The research was carried out in the period between 1905-2019, using the following identifiers in Health Sciences Descriptors: Basal Metabolism, Energy Metabolism and Indirect Calorimetry. We selected 55 researches published that presented contents related to the objectives of this study. Result: The total daily energy expenditure (TDEE) is comprised of three main components, such as physical activity (PA), thermic effect of food (TEF) and basal metabolic rate (BMR) and/or resting energy expenditure (REE). The REE is generally evaluated by indirect calorimetry, which also provides information on the respiratory coefficient (RQ) or oxidation of substrates. Its result varies depending on the existence of some metabolic disorders such as obesity or malnutrition. Therefore, the proper management of the methodological aspects of indirect calorimetry and its subsequent interpretation in metabolic disorders is essential to guarantee the results’ quality. Conclusion: Energy expenditure concepts and the methodological basis of indirect calorimetry are relevant to providing individualized attention to patients with metabolic disorders. This review can be used as a practical guide, helping to understand the correct application of the indirect calorimetry technique in studies related to energy expenditure with an emphasis on metabolic disorders

Sex and dependence related neuroanatomical differences in regular cannabis users: findings from the ENIGMA Addiction Working Group

Males and females show different patterns of cannabis use and related psychosocial outcomes. However, the neuroanatomical substrates underlying such differences are poorly understood. The aim of this study was to map sex differences in the neurobiology (as indexed by brain volumes) of dependent and recreational cannabis use. We compared the volume of a priori regions of interest (i.e., amygdala, hippocampus, nucleus accumbens, insula, orbitofrontal cortex (OFC), anterior cingulate cortex and cerebellum) between 129 regular cannabis users (of whom 70 were recreational users and 59 cannabis dependent) and 114 controls recruited from the ENIGMA Addiction Working Group, accounting for intracranial volume, age, IQ, and alcohol and tobacco use. Dependent cannabis users, particularly females, had (marginally significant) smaller volumes of the lateral OFC and cerebellar white matter than recreational users and controls. In dependent (but not recreational) cannabis users, there was a significant association between female sex and smaller volumes of the cerebellar white matter and OFC. Volume of the OFC was also predicted by monthly standard drinks. No significant effects emerged the other brain regions of interest. Our findings warrant future multimodal studies that examine if sex and cannabis dependence are specific key drivers of neurobiological alterations in cannabis users. This, in turn, could help to identify neural pathways specifically involved in vulnerable cannabis users (e.g., females with cannabis dependence) and inform individually tailored neurobiological targets for treatment

Early Tracheostomy for Managing ICU Capacity During the COVID-19 Outbreak: A Propensity-Matched Cohort Study

10 p.Background: During the first wave of the COVID-19 pandemic, shortages of ventilators and ICU beds overwhelmed health care systems. Whether early tracheostomy reduces the duration of mechanical ventilation and ICU stay is controversial. Research question: Can failure-free day outcomes focused on ICU resources help to decide the optimal timing of tracheostomy in overburdened health care systems during viral epidemics? Study design and methods: This retrospective cohort study included consecutive patients with COVID-19 pneumonia who had undergone tracheostomy in 15 Spanish ICUs during the surge, when ICU occupancy modified clinician criteria to perform tracheostomy in Patients with COVID-19. We compared ventilator-free days at 28 and 60 days and ICU- and hospital bed-free days at 28 and 60 days in propensity score-matched cohorts who underwent tracheostomy at different timings (≤ 7 days, 8-10 days, and 11-14 days after intubation). Results: Of 1,939 patients admitted with COVID-19 pneumonia, 682 (35.2%) underwent tracheostomy, 382 (56%) within 14 days. Earlier tracheostomy was associated with more ventilator-free days at 28 days (≤ 7 days vs > 7 days [116 patients included in the analysis]: median, 9 days [interquartile range (IQR), 0-15 days] vs 3 days [IQR, 0-7 days]; difference between groups, 4.5 days; 95% CI, 2.3-6.7 days; 8-10 days vs > 10 days [222 patients analyzed]: 6 days [IQR, 0-10 days] vs 0 days [IQR, 0-6 days]; difference, 3.1 days; 95% CI, 1.7-4.5 days; 11-14 days vs > 14 days [318 patients analyzed]: 4 days [IQR, 0-9 days] vs 0 days [IQR, 0-2 days]; difference, 3 days; 95% CI, 2.1-3.9 days). Except hospital bed-free days at 28 days, all other end points were better with early tracheostomy. Interpretation: Optimal timing of tracheostomy may improve patient outcomes and may alleviate ICU capacity strain during the COVID-19 pandemic without increasing mortality. Tracheostomy within the first work on a ventilator in particular may improve ICU availability

Consumption of aspartame and other artificial sweeteners and risk of cancer in the Spanish multicase‐control study (MCC‐Spain)

Use of artificial sweeteners (AS) such as aspartame, cyclamate, saccharin and sucralose is widespread. We evaluated the association of use of aspartame and other AS with cancer. In total 1881 colorectal, 1510 breast, 972 prostate and 351 stomach cancer and 109 chronic lymphocytic leukaemia (CLL) cases and 3629 population controls from the Spanish Multicase-Control (MCC-Spain) study were recruited (2008-2013). The consumption of AS, from table-top sweeteners and artificially sweetened beverages, was assessed through a self-administered and validated food frequency questionnaire (FFQ). Sex-specific quartiles among controls were determined to compare moderate consumers ( third quartile) vs non consumers (reference category), distinguishing aspartame-containing products and other AS. Unconditional logistic regression models were used to estimate adjusted OR and 95%CI, and results were stratified by diabetes status. Overall, we found no associations between the consumption of aspartame or other AS and cancer. Among participants with diabetes, high consumption of other AS was associated with colorectal cancer (OR=1.58, 95% CI 1.05-2.41, P trend=.03) and stomach cancer (OR=2.27 [0.99-5.44], P trend=.06). High consumption of aspartame, was associated with stomach cancer (OR=2.04 [0.7-5.4], P trend=.05), while a lower risk was observed for breast cancer (OR=0.28 [0.08-0.83], P trend=.03). In some cancers, the number of cases in participants with diabetes were small and results should be interpreted cautiously. We did not find associations between use of AS and cancer, but found associations between high consumption of aspartame and other AS and different cancer types among participants with diabetes