[Occupational stress in health care personnel]. / Estrés ocupacional en personal de salud.

BACKGROUND: Occupational stress results from the interaction of multiple risk factors, such as the physical environment, biological function disturbances, work content and organization and diverse psychosocial components. AIM: To study the frequency of symptoms and the main sources of job stress, perceived by professional and non professional health care workers and to compare gender differences. SUBJECTS AND METHODS: A group of specially designed, self-administered, questionnaires adapted by the main author and independently validated, were applied. The results of two symptoms, one work satisfaction, and one job stress scales are reported. RESULTS: One hundred sixteen women and 89 men were studied, 143 are professionals and 62 non professionals (clerical and nurse auxiliaries). Forty percent had symptoms of job stress and 82 subjects were defined as "probable cases", according to the ratings on the symptom scales. There were significant differences in the frequency of symptoms between professionals and non professionals (34.3 and 69.2% respectively). The main differences in symptoms, sources of job stress and dissatisfaction were more closely associated to the occupational level than to gender. CONCLUSIONS: A high frequency of job stress symptoms was observed in this sample of health care workers and the risk of occupational stress varies more with the occupational level than with gender.

[Sepsis in children with malignant neoplasia, equipped with a Broviac-type venous catheter]. / Sepsi in bambini affetti da neoplasia maligna portatori di catetere venoso centrale tipo Broviac.

Indwelling central venous catheters obviate many problems in the care of children with malignancies, but they also are a well-known source of infection. We are reviewed the history of 584 Broviac catheters inserted from January 1984 to December 1991, in 475 children with cancer in order to assess the etiology of bacteremias, their association with neutropenia and their relationship with the presence of the catheters. The overall duration-time of the catheters, employed for blood tests, drug and blood infusions and parenteral nutrition, was 1-835 days (median 263, mean 186). Total catheter courses was 108.678 days. In this period 226 episodes of sepsis were observed in 180 patients: 157 in neutropenic patients and 69 in non neutropenic. Catheter related bacteremias were diagnosed in 65/226 episodes (29%): 23 (35%) were observed in neutropenic patients and 42 (65%) in non neutropenic (P < 0.005). Gram-positive pathogens were isolated in 28/65 (43%) episodes, Gram-negatives in 15/65 (23%), fungi in 9/65 (14%), and the remaining 13 (20%) were polymicrobial. In the last years we observed an increase of catheter related bacteremias due to Gram-negative rods no change was observed in pathogens causing catheters unrelated bacteremias. The high incidence of catheters related bacteremias in non neutropenic, non hospitalized patients, stress on the home-care of the catheters; a high level of suspicion of Gram-negative infections should be maintained in cancer patients with an indwelling central venous catheters.