Common somatic symptoms, causal attributions of somatic symptoms and psychiatric morbidity in a cross-sectional community study in Santiago, Chile

<p>Abstract</p> <p>Background</p> <p>It has been suggested that individuals from non-western countries tend to deny or mask psychological symptoms of common mental disorders and to present with somatic symptoms. The aim of the present paper was to investigate the association between common mental disorders and somatic symptoms in a representative sample of the general population of Santiago, Chile</p> <p>Findings</p> <p>This was a cross-sectional study of a stratified random sample of 3807 subjects living in private households in Santiago, Chile. Psychiatric disorders were assessed with the revised Clinical Interview Schedule. We found a strong association between the presence of somatic symptoms and psychiatric disorders (odds ratio 3.20, [95% confidence interval 2.52 - 4.05]). In addition, subjects who attributed their somatic symptoms to psychological or mixed psychological/physical causes were more likely to be cases compared to subjects who made physical attributions only (odds ratios 7.10 [95% CI 4.49-11.25] and 9.27 [6.00-14.34] respectively.</p> <p>Conclusions</p> <p>The study confirms previous observations from more selected samples that subjects of Hispanic origin are generally aware of the link between somatic symptoms and psychological ill-health and do not hide or "mask" their psychological symptoms.</p

Antidepressant Drugs for Chronic Urological Pelvic Pain: An Evidence-Based Review

The use of antidepressant drugs for the management of chronic pelvic pain has been supported in the past. This study aimed to evaluate the available evidence for the efficacy and acceptability of antidepressant drugs in the management of urological chronic pelvic pain. Studies were selected through a comprehensive literature search. We included all types of study designs due to the limited evidence. Studies were classified into levels of evidence according to their design. Ten studies were included with a total of 360 patients. Amitriptyline, sertraline, duloxetine, nortriptyline, and citalopram are the antidepressants that have been reported in the literature. Only four randomized controlled trials (RCTs) were identified (two for amitriptyline and two for sertraline) with mixed results. We conclude that the use of antidepressants for the management of chronic urological pelvic pain is not adequately supported by methodologically sound RCTs. From the existing studies amitriptyline may be effective in interstitial cystitis but publication bias should be considered as an alternative explanation. All drugs were generally well tolerated with no serious events reported

Towards a brief definition of burnout syndrome by subtypes: Development of the "Burnout Clinical Subtypes Questionnaire" (BCSQ-12)

<p>Abstract</p> <p>Background</p> <p>Burnout has traditionally been described by means of the dimensions of exhaustion, cynicism and lack of eficacy from the "Maslach Burnout Inventory-General Survey" (MBI-GS). The "Burnout Clinical Subtype Questionnaire" (BCSQ-12), comprising the dimensions of overload, lack of development and neglect, is proposed as a brief means of identifying the different ways this disorder is manifested. The aim of the study is to test the construct and criterial validity of the BCSQ-12.</p> <p>Method</p> <p>A cross-sectional design was used on a multi-occupational sample of randomly selected university employees (n = 826). An exploratory factor analysis (EFA) was performed on half of the sample using the maximum likelihood (ML) method with varimax orthogonal rotation, while confirmatory factor analysis (CFA) was performed on the other half by means of the ML method. ROC curve analysis was preformed in order to assess the discriminatory capacity of BCSQ-12 when compared to MBI-GS. Cut-off points were proposed for the BCSQ-12 that optimized sensitivity and specificity. Multivariate binary logistic regression models were used to estimate effect size as an odds ratio (OR) adjusted for sociodemographic and occupational variables. Contrasts for sex and occupation were made using Mann-Whitney U and Kruskall-Wallis tests on the dimensions of both models.</p> <p>Results</p> <p>EFA offered a solution containing 3 factors with eigenvalues > 1, explaining 73.22% of variance. CFA presented the following indices: χ²= 112.04 (p < 0.001), χ²/gl = 2.44, GFI = 0.958, AGFI = 0.929, RMSEA = 0.059, SRMR = 0.057, NFI = 0.958, NNFI = 0.963, IFI = 0.975, CFI = 0.974. The area under the ROC curve for 'overload' with respect to the 'exhaustion' was = 0.75 (95% CI = 0.71-0.79); it was = 0.80 (95% CI = 0.76-0.86) for 'lack of development' with respect to 'cynicism' and = 0.74 (95% CI = 0.70-0.78) for 'neglect' with respect to 'inefficacy'. The presence of 'overload' increased the likelihood of suffering from 'exhaustion' (OR = 5.25; 95% IC = 3.62-7.60); 'lack of development' increased the likelihood from 'cynicism' (OR = 6.77; 95% CI = 4.79-9.57); 'neglect' increased the likelihood from 'inefficacy' (OR = 5.21; 95% CI = 3.57-7.60). No differences were found with regard to sex, but there were differences depending on occupation.</p> <p>Conclusions</p> <p>Our results support the validity of the definition of burnout proposed in the BSCQ-12 through the brief differentiation of clinical subtypes.</p

Socioeconomic inequalities in general and psychological health among adolescents: a cross-sectional study in senior high schools in Greece

<p>Abstract</p> <p>Background</p> <p>Socioeconomic health inequalities in adolescence are not consistently reported. This may be due to the measurement of self-reported general health, which probably fails to fully capture the psychological dimension of health, and the reliance on traditional socio-economic indicators, such as parental education or occupational status. The present study aimed at investigating this issue using simple questions to assess both the physical and psychological dimension of health and a broader set of socioeconomic indicators than previously used.</p> <p>Methods</p> <p>This was a cross-sectional survey of 5614 adolescents aged 16-18 years-old from 25 senior high schools in Greece. Self-reported general and psychological health were both measured by means of a simple Likert-type question. We assessed the following socio-economic variables: parents' education, parents' employment status, a subjective assessment of the financial difficulties experienced by the family and adolescents' own academic performance as a measure of the personal social position in the school setting.</p> <p>Results</p> <p>One out of ten (10%) and one out of three (32%) adolescents did not enjoy good general and psychological health respectively. For both health variables robust associations were found in adolescents who reported more financial difficulties in the family and had worse academic performance. The latter was associated with psychological health in a more linear way. Father's unemployment showed a non-significant trend for an association with worse psychological health in girls only.</p> <p>Conclusions</p> <p>Socioeconomic inequalities exist in this period of life but are more easily demonstrated with more subjective socioeconomic indicators, especially for the psychological dimension of health.</p

Health related quality of life in patients with anogenital warts

<p>Abstract</p> <p>Introduction</p> <p>The health-related quality-of-life (HRQoL) instruments are an important tool for the evaluation of medical outcomes. Sexually transmitted diseases (STDs) influence the patients' life. We aimed to evaluate the HRQoL in patients with anogenital warts at the time of and 1 month after the diagnosis.</p> <p>Materials and methods</p> <p>We used the short-form (SF)-36 questionnaire to compare the HRQoL of 91 patients with anogenital warts to 53 control subjects with the same socioeconomic characteristics.</p> <p>Results</p> <p>There was no statistical difference in the overall HRQoL measurement between the anogenital wart patients and controls. However, there was an improvement in the scales of vitality (65.22 ± 15.70 vs. 69.04 ± 14.11, respectively; p < 0.05) and mental health (65.00 ± 20.09 vs. 69.43 ± 18.08, respectively; p < 0.05) in anogenital warts patients between the time of diagnosis and 1 month later. Furthermore, there was a significant deterioration in the scale of social functioning (73.47 ± 22.18 vs. 72.89 ± 19.28, respectively; p < 0.05). The small sample size is a limitation of our study.</p> <p>Conclusions</p> <p>HRQoL does not appear to be influenced in anogenital wart patients, as measured by the generic instrument SF-36. It is therefore important to develop specific instruments for the measurement of HRQoL in this group of patients.</p

Translation to success of surgical innovation

Contemporary thoracic and cardiovascular surgery uses extensive equipment and devices to enable its performance. As the specialties develop and new frontiers are crossed, the technology needs to advance in a parallel fashion. Strokes of genius or problem-solving brain-storming may generate great ideas, but the metamorphosis of an idea into a physical functioning tool requires a lot more than just a thinking process. A modern surgical device is the end-point of a sophisticated, complicated and potentially treacherous route, which incorporates new skills and knowledge acquisition. Processes including technology transfer, commercialisation, corporate and product development, intellectual property and regulatory routes all play pivotal roles in this voyage. Many good ideas may fall by the wayside for a multitude of reasons as they may not be marketable or may be badly marketed. In this article, we attempt to illuminate the components required in the process of surgical innovation, which we believe must remain in the remit of the modern-day thoracic and cardiovascular surgeo