HSE Management Standards and burnout dimensions among rehabilitation professionals.

BACKGROUND: The Health & Safety Executive Indicator Tool (HSE-IT) is a standard-based questionnaire commonly used to assess work-related stress in organizations. Although the HSE-IT validity has been well documented and significant relationships have been observed between its scales and several work-related outcomes, to date there is no evidence concerning the relationships between the HSE-IT and burnout among healthcare workers. AIMS: To investigate the relationships between the HSE-IT subscales and burnout dimensions as measured by the Maslach Burnout Inventory (MBI) in a sample of Italian rehabilitation professionals employed in healthcare institutions. METHODS: An anonymous cross-sectional questionnaire was administered to a sample of Italian rehabilitation professionals including physical therapists, occupational therapists, psychiatric rehabilitation technicians and developmental psychomotor therapists. Associations between the HSE-IT and the MBI were analysed with multiple linear regression models. RESULTS: A total of 432 rehabilitation professionals completed the questionnaire and 14% of them showed high levels of burnout risk. Significant differences in the HSE-IT scores were found between workers at high risk of burnout and workers at low risk of burnout. Hierarchical regressions showed an association between the HSE-IT scales and the MBI factors: emotional exhaustion was associated with 'demands' and 'role', and both depersonalization and personal accomplishment were associated with 'control' and 'role'. CONCLUSIONS: This preliminary study showed the HSE-IT subscales are sensitive to burnout risk as measured by the MBI. The association found between the HSE-IT 'demands', 'role' and 'control' subscales and the MBI dimensions is significant but small. These findings might inform targeted burnout prevention.

Design and fabrication of a hybrid alginate hydrogel/poly(ε-caprolactone) mold for auricular cartilage reconstruction.

The aim of this study was to design and manufacture an easily assembled cartilage implant model for auricular reconstruction. First, the printing accuracy and mechanical properties of 3D-printed poly-ε-caprolactone (PCL) scaffolds with varying porosities were determined to assess overall material properties. Next, the applicability of alginate as cell carrier for the cartilage implant model was determined. Using the optimal outcomes of both experiments (in terms of (bio)mechanical properties, cell survival, neocartilage formation, and printing accuracy), a hybrid auricular implant model was developed. PCL scaffolds with 600 µm distances between strands exhibited the best mechanical properties and most optimal printing quality for further exploration. In alginate, chondrocytes displayed high cell survival (~83% after 21 days) and produced cartilage-like matrix in vitro. Alginate beads cultured in proliferation medium exhibited slightly higher compressive moduli (6 kPa) compared to beads cultured in chondrogenic medium (3.5 kPa, p > .05). The final auricular mold could be printed with 300 µm pores and high fidelity, and the injected chondrocytes survived the culture period of 21 days. The presented hybrid auricular mold appears to be an adequate model for cartilage tissue engineering and may provide a novel approach to auricular cartilage regeneration for facial reconstruction. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1711-1721, 2019.

Hyperendorphinemia in obesity is not related to the affective state.

In seventy-two patients affected by hyperphagic obesity and forty age-matched, normal weight volunteers we performed a psychological assessment, through various mental tests, and evaluated the beta-endorphin (B-Ep), ACTH and cortisol circulating levels, in basal condition and following an overnight short dexamethasone suppression test (DST). The hormones were measured by radioimmunoassay either directly in the serum (cortisol) and the plasma (ACTH), or after affinity gel column chromatography (B-Ep). In obese subjects B-Ep levels in basal conditions were four times greater than in normal weight controls and showed significantly less reduction after DST. ACTH and cortisol levels, in contrast, were in the normal range and were suppressed following dexamethasone as was also true in the control group. Psychological evaluation on M.M.P.I. (Minnesota Multiphasic Personality Inventory) revealed a trend toward hypochondria, depression, hysterias, psychoasthenia and schizophrenia. However, no significant correlation has been found between M.M.P.I. clinical scale scores and circulating levels of B-Ep and cortisol either in basal conditions or after DST. In conclusion, these data do not support the hypothesis that abnormalities of the hypothalamus-pituitary-adrenal axis in hyperphagic obesity are related to affective disorders.

Hyperendorphinemia in obesity and relationships to affective state.

Eight obese patients (exceeding ideal body weight by 50% or more) with no endocrinological or metabolic disorders and 8 healthy, age-matched, normal-weight volunteers were submitted to an overnight short dexamethasone (DXM) suppression test and to a psychological assessment through various psychometric scales. Plasma B-Endorphin (B-EP), B-Lipotropin (B-LPH), ACTH and cortisol concentrations were evaluated in basal conditions, as well as 9 and 17 hours after late night administration of 1 mg DXM in both groups. All hormones were measured by radioimmunoassay, either directly in the plasma (ACTH and cortisol) or after silicic acid extraction and Sephadex G-75 column chromatography (B-LPH and B-EP). In obese patients, plasma B-EP levels in basal conditions were three times higher than in normal weight controls and remained unaltered by DXM suppression. ACTH and B-LPH, in contrast, were within the normal range and were significantly reduced by DXM. In 3 of the 8 patients, plasma cortisol concentrations at 17 hours post-DXM were greater than 50 ng/ml indicating an early escape from the suppression. Psychometric evaluations revealed a prevalence of depressive personality in obese patients. These data indicate an hypersecretion of B-EP in obese patients, which is only partially dependent on hypothalamic control.

Rorschach findings for patients with pseudoseizures.

This study used the Rorschach test to investigate the possible differences between a carefully selected group of 16 patients with pseudoseizures, defined as spontaneous behavior resembling partial complex epilepsy and with or without tonic clonic generalization, and a group of 12 epileptic patients with partial complex seizures. Analysis of the structural data of protocols does not support a significant difference in the Rorschach findings between the two groups.

[Neuroendocrine changes and affective disorders in patients with hyperphagic obesity]. / Alterazioni neuroendocrine e disordini dell'affettività nei pazienti con obesità iperfagica.

Circulating levels of cortisol and beta-endorphin were evaluated in basal condition and following dexamethasone administration in 20 healthy subjects and in 60 subjects suffering from hyperphagic obesity. Moreover, mental tests were administered to these subjects in order to evaluate the affective state. Our data showed that in obese patients B-Ep plasma levels were significantly higher than those of the control group, while cortisol plasma levels were similar in the two groups. Dexamethasone administration decreased cortisol plasma levels in normal and obese subjects, while did not modify B-Ep plasma levels in obese subjects. However, after dexamethasone administration 16.6% of the obese subjects did not show a complete decrease of cortisol level. This group of subjects obtained the highest scores for depression and hypochondria to MMPI.

Personality variables and compliance with insulin therapy in Type 2 diabetic subjects.

Forty-five diabetic patients were studied to evaluate adaptation and coping strategies. The authors have also analysed personality traits mainly to study different behaviour in compliance conduct. The results revealed an important psychological dimension made up of difficulties in accepting insulin immediately, in fear of addiction and doubts about the therapy. On the basis of these results the sample was then divided into two subgroups, which were then tested and compared with the Adjective Check List. The subgroup that showed more fear, insecurity and initial resistance towards insulin therapy appeared to be more rigid and seemingly conforming. These people also revealed personality aspects compatible with the presence of passive-aggressive and avoidant traits.

Electrophysiological (CNV) analysis of personality traits under stress.

Contingent negative variation (CNV) recordings were performed in 55 healthy volunteers under stress condition (experimentally induced pain). A total of 20 subjects were included in the control group (no painful administration). In the tested group (n = 35) the painful stimulus was delivered before S1, between S2 and S1, and before S2. In the control group there were no changes in CNV parameters. Conversely, among the tested group a positive correlation was found between CNV values (whenever the painful stimulus was administered before S1 as well as before S2) and the highest scores in the State Trait Anxiety Inventory X 2 test. In addition, all individuals displayed the appearance of a positive deflection with a latency of about 300 ms from S2 when the experimental stress was given before S2. Furthermore, the postimperative negative variation (PINV) appeared in 13 out of 35 subjects. There was a strong correlation between the latter electrophysiological phenomenon and the Nowlis test. Our findings suggest that CNV study is useful for the investigation of personality traits in human beings under stress conditions.