The mediating effects of coping strategies on the relationship between secondary traumatic stress and burnout in professional caregivers in the UAE.

BACKGROUND: Professional caregivers dealing with traumatized victims or mental health clients are at increased risk for developing the same symptoms as persons who are exposed directly to the trauma. AIMS: This research was aimed at examining the relationship between secondary traumatic stress, burnout and coping strategies in 502 professional caregivers who work in schools, hospitals, charity institutes and welfare centers in the United Arab Emirates (UAE). A further aim was to test the mediating effect of coping on the relationship between burnout and secondary traumatic stress. METHODS: Measures used in this study were the Professional Quality of Life Questionnaire (ProQOL), The General Health Questionnaire (GHQ-28), The Maslach Burnout Inventory: Human Services Survey (MBI-HSS) and Endler and Parker's Coping Inventory. RESULTS: Task-focused coping, personal accomplishment and compassion satisfaction were negatively associated with secondary traumatic stress. Burnout, emotion-focused and distraction coping were positively related to secondary traumatic stress. Coping partially mediated the relationship between burnout and secondary traumatic stress. There were also significant gender differences in depersonalization and distraction coping. CONCLUSIONS: Efforts need to focus on improvement of caregivers' work environments, enhancing their coping skills and professional development.

Clostridium difficile-associated disease acquired in the cardiothoracic intensive care unit.

OBJECTIVES: To determine the prevalence, severity, and outcome associated with Clostridium difficile-associated disease (CDAD) acquired while in the cardiothoracic intensive care unit (CTICU). DESIGN: A 5-year retrospective study. SETTING: The CTICU. PARTICIPANTS: All CTICU patients with a positive C difficile stool toxin assay 48 hours after admission. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The results of all CTICU patients with a positive C difficile stool toxin assay were obtained from the Microbiology Department. Each patient's medical notes and charts then were reviewed in turn. A total of 27 of 5,199 (0.5%) CTICU patients acquired CDAD. The median age was 74 years (IQR 68-77), and 17 (63%) patients were male. There were 21 (78%) surgical patients; 13 (62%) were elective admissions. The most frequent diagnosis on admission was valvular heart disease (10 [37%] patients). Sixteen (59%) patients underwent coronary artery bypass graft (CABG) surgery and/or valvular heart surgery. The median interval between CTICU admission and CDAD diagnosis was 10 days (IQR 5-18). Previously identified risk factors for ICU-acquired CDAD included age >65 years (23), antibiotic use (26), and medical device requirements (27). At the time of diagnosis, 14 (52%) patients had moderate CDAD. After treatment initiation, 8 (30%) patients developed worsening CDAD. The 30-day in-hospital mortality rate for CTICU-acquired CDAD was 26% (7 patients). CONCLUSIONS: C difficile-associated disease rarely is acquired in the CTICU. Approximately one third of patients may experience disease progression, and just over a quarter may die within 30 days of diagnosis. The implementation of recommended severity definitions and treatment algorithms may reduce complication rates and merits prospective evaluation.

A study of muscle tissue oxygenation and peripheral microcirculatory dysfunction in cirrhosis using near infrared spectroscopy.

BACKGROUND: The circulatory dysfunction associated with cirrhosis is well described. Reduced systemic vascular resistance and high cardiac output are the main features of the hyperdynamic state, but involvement of the peripheral microcirculation in this process is poorly understood. Near infrared spectroscopy (NIRS) has been used to assess muscle tissue oxygenation (StO(2)) in haemorrhagic and septic shock. Vascular occlusion testing (VOT) can produce dynamic changes in StO(2) which represent tissue oxygen extraction, delivery, and hence, surrogate markers of microvascular function. AIMS: We aimed to investigate dynamic StO(2) changes in the peripheral microcirculation of patients with cirrhosis. METHODS: Thirty-five subjects were examined (25 cirrhosis, 10 healthy volunteers) with an InSpectra 650 StO(2) monitor and 15 mm thenar probe. Brachial VOT was applied at systolic blood pressure +50 mmHg for 3 min, in triplicate. Dynamic StO(2) parameters are reported for baseline, downslope, upslope, area over ischaemic curve, overshoot, area under recovery curve and recovery time. RESULTS: Patients with cirrhosis demonstrated significantly larger post-occlusive hyperaemic variables compared with volunteers: overshoot (17 vs 15%, P=0.009), area under recovery curve (25.1 vs 16.3 %/min, P<0.001) and recovery time (3.0 vs 2.2 min, P<0.001). Magnitude of change was also seen to increase with disease stage as defined by Child-Pugh score. Serial VOT revealed microcirculatory ischaemic adaptation in volunteers, which was absent in cirrhosis. CONCLUSIONS: NIRS can identify dynamic changes in muscle tissue oxygenation in cirrhosis which are compatible with microcirculatory vasodilatation. Ischaemic adaptation was seen in controls but not in patients with cirrhosis. NIRS techniques offer a novel approach to the assessment of peripheral vascular dysfunction in cirrhosis.

Clostridium difficile infection and inflammatory bowel disease.

The importance of Clostridium difficile (C. difficile) infection amongst patients with inflammatory bowel disease (IBD) is increasingly being recognized. Recent studies have demonstrated a concerning trend towards increased rates of infection, morbidity, mortality and health costs, and guidelines now promote testing for C. difficile in IBD patients experiencing a relapse. This critical review focuses on the epidemiology, risk factors, pathogenesis, treatment options and outcomes associated with C. difficile infection in patients with IBD.

Mental health problems among internally displaced persons in Darfur.

War victims are regarded as one of the highest risk groups for mental disturbances. This study investigated the effects of the Darfur conflict on mental health of 430 internally displaced persons (IDPs) from three camps located around Fasher and Nyala towns. A stratified random sampling technique was used to select participants. Male participants represented 50.6% of the sample while female participants represented 49.4%. The Posttraumatic Stress Disorder Checklist and the General Health Questionnaire (GHQ-28) were used in addition to a questionnaire measuring demographic variables and living conditions. It was hypothesized that high prevalence of posttraumatic stress disorder (PTSD) symptoms and of nonpsychotic psychiatric symptoms will be evident. Results showed a high dissatisfaction rate (72%) with living conditions among IDPs. There was also high prevalence of PTSD (54%) and general distress (70%) among IDPs. Female participants showed more somatic symptoms than their male counterparts. Married participants were more distressed, anxious, and showed more social dysfunction, while single ones reported more avoidance symptoms. Significant differences related to date of displacement were found in PTSD and hyperarousal. The group of IDPs displaced in 2003 scored higher on these scales than those displaced in 2004 and 2005. There was also significant difference related to date of displacement in distress, somatic symptoms, depression, anxiety, and social dysfunction. IDPs displaced in 2003 scored higher on these scales. Results are discussed in light of the study hypotheses and previous findings. It is concluded that three factors might affect the dissatisfaction of IDPs with living conditions inside camps. These are: lack of employment, unsuitability of food items, and lack of security around camps. It was recommended that psychological support services should be among the prime relief services provided by aid agencies.

Clostridium difficile infection and liver disease.

The rates of the predominantly hospital acquired infection, Clostridium difficile, have increased throughout the world. Several risk factors and susceptible patient populations have been identified. Patients with pre-existing liver disease represent an important cohort; recent evidence suggests that Clostridium difficile infection (CDI) is associated with a worse outcome and increased health care costs. This review focuses on the epidemiology, risk factors, pathogenesis, treatment options and outcomes associated with CDI in patients with liver disease.