Factor Structure and Measurement Invariance of the Spanish Burnout Inventory Among Professionals Across 17 Countries and Regions.

Studies on the prevalence of burnout in professionals in service organizations who work in direct contact with the clients or users of the organization have concluded that burnout is a serious health disorder that has increased due to the COVID-19 pandemic. A significant advantage of the Spanish Burnout Inventory (SBI) over other instruments is that it provides a broader conceptualization of burnout by including feelings of guilt as a dimension of burnout to explain its development. However, the measurement invariance of the SBI across countries has not been investigated. The purpose of this study was to test the measurement invariance of the SBI among professionals across 17 countries and regions in Europe, Latin America, and Asia, and in different languages. All the countries showed a good fit to the four-factor model, except the Indian sample, which was excluded from the measurement invariance study. Using the alignment method, it was possible to verify the scalar measurement invariance of the four SBI factors across 15 countries and one Spanish region (16 samples). The comparison of estimated latent means indicates that France is the country with the lowest scores on the Enthusiasm factor and the highest scores on the negative factors (Exhaustion, Indolence, and Guilt). In contrast, the Andean countries, Colombia, Peru, and Ecuador, show the highest latent means on the Enthusiasm factor and the lowest means on the negative factors. These results support the validity of the SBI in the countries and regions in Europe and Latin America included in this study.

Epidemiological characteristics and serotype distribution of culture-confirmed pediatric pneumococcal pneumonia before and after PCV 10 introduction, a multicenter study in Bogota, Colombia, 2008-2019.

BACKGROUND: Pneumococcal conjugate vaccines (PCVs) have decreased pneumonia in children. Colombia introduced mass vaccination with PCV10 in 2012. METHODS: Cases of pneumococcal pneumonia from 10 hospitals were included. Two periods were compared: pre-PCV10: 2008-2011 and post-PCV10: 2014-2019. The objective was to compare epidemiological and clinical characteristics before and after PCV10 vaccination. RESULTS: A total of 370 cases were included. Serotypes 1 (15, 11.2%) and 14 (33, 24.6%) were the most frequent in the pre-PCV10 period, with only 4 (3%) cases of serotype 19A and 1 case (0.7%) serotype 3. From the pre-PCV10 period to the post-PCV10 period, cases of serotypes 1 (6, 3.1%) and 14 (1, 7.8%) decreased, while cases of serotypes 19A (58, 30.2%), serotype 3 (32, 16.7%) and 6A (7, 3.6%) increased (p < 0.001); complicated pneumonia (CP) increased significantly (13.4% to 31.8%) (p < 0.001); hospitalizations increased from 8 (5.5-15) to 12 (7-22) days (p < 0.001); and the frequency of PICU admission increased from 32.8% to 51.6% (p = 0.001). The use of ampicillin-sulbactam (0.7% to 24%) and ceftriaxone/clindamycin (0.7% to 5.7%) increased in the post-PCV10 period. The duration of empirical antibiotic treatment was 7 (4-11) days in the pre-PCV10 period and increased to 10 (6-17) days (p < 0.001) in the post-PCV10 period. Lethality showed a slight nonsignificant increase (7.5% vs. 9.9%; p = 0.57) in the post-PCV10 period. CONCLUSIONS: PCV10 significantly decreased cases of serotypes 1 and 14, with an increase in cases of serotypes 19A, 3 and 6A, which were the predominant serotypes and had greater severity (e.g., admission to the PICU, CP and more resistance, with an increase in the use of broad-spectrum antibiotics and longer hospitalization) and subsequently included in PCV13. Current data support national and regional evidence on the importance of replacing PCV10 with a higher valence that includes 19A, such as PCV13, with the aim of reducing circulation, particularly of this serotype.

Low-Intensity, High-Frequency Grazing Positively Affects Defoliating Behavior, Nutrient Intake and Blood Indicators of Nutrition and Stress in Sheep.

The intensity and frequency of grazing affect the defoliating strategy of ruminants, their daily nutrient intake, thus nutrition and physiological status. Italian ryegrass (Lolium multiflorum Lam.) pastures were grazed by sheep either under a low-intensity/high-frequency grazing strategy (Rotatinuous stocking; RN) with nominal pre- and post-grazing sward heights of 18 and 11 cm, respectively, or under a high-intensity/low-frequency strategy (traditional rotational stocking; RT) with nominal pre- and post-grazing sward heights of 25 and 5 cm, respectively. Treatments were arranged under a complete randomized design and evaluated over two periods, in different years. In 2017, the aim was to depict the type of bites that sheep perform during the grazing-down and associate them to the grazing management strategy according to their relative contribution to the diet ingested. In 2018 we estimated the total nutrient intake and evaluated blood indicators of the nutritional status and immune response to stress of sheep. The bite types accounting the most for the diet ingested by RN sheep were those performed on the "top stratum" of plants with around 20, 15, and 25 cm, whereas the type of bites accounting the most for the diet of RT sheep were those performed on "grazed plants" with around 10, 5, and ≤ 3 cm. In 2018, the RN sheep increased by 18% the total organic matter (OM) intake and by 20-25% the intake of soluble nutrients (i.e., crude protein, total soluble sugars, crude fat), digestible OM and of metabolizable energy, and had 17.5, 18, and 6.1% greater blood concentration of glucose, urea nitrogen (BUN) and albumin, respectively, but 17% lower blood neutrophil-to-lymphocyte (N:L) ratio. Sheep grazing vegetative Italian ryegrass pastures under the low-intensity/high-frequency grazing strategy (RN) ingested a diet of better quality from bites allocated on the top stratum of plants, had greater intake of soluble nutrients and blood parameters positively associated with nutritional status and immune response to stress.

Influence of Burnout and Feelings of Guilt on Depression and Health in Anesthesiologists.

BACKGROUND AND OBJECTIVE: The WHO has included burnout as an occupational phenomenon in the ICD-11. According to the WHO, burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. The study aimed to evaluate the influence of feelings of guilt and burnout on health in Polish anesthesiologists. Alcohol and tobacco intake, psychosomatic disorders, and depression were assessed. METHODS: The study had a non-randomized cross-sectional character. The sample consisted of 372 Polish anesthesiologists. Burnout was measured by the Spanish burnout inventory. RESULTS: Post hoc analysis for burnout consequences: depression (F(5,366) = 17.51, p < 0.001, ηp2 = 0.193), psychosomatic disorders (F(5,366) = 13.11, p < 0.001, ηp2 = 0.152), and tobacco intake (F(5,366) = 6.23, p < 0.001, ηp2 = 0.078), showed significant differences between burnout with and without the highest levels of feelings of guilt. All the instruments applied were reliable. CONCLUSIONS: Depression, psychosomatic disorders, and alcohol and tobacco intake are suspected to be consequences of the highest guilt levels related to burnout, i.e., Profile 2 according to the burnout model of Gil-Monte. Participation in prevention programs is recommended for these cases.

Patterns of storage, use, and disposal of opioids among cancer outpatients.

PURPOSE: Improper storage, use, and disposal of prescribed opioids can lead to diversion or accidental poisoning. Our objective was to determine the patterns of storage, utilization, and disposal of opioids among cancer outpatients. PATIENTS AND METHODS: We surveyed 300 adult cancer outpatients receiving opioids in our supportive care center and collected information regarding opioid use, storage, and disposal, along with scores on the CAGE (cut down, annoyed, guilty, eye-opener) alcoholism screening questionnaire. Unsafe use was defined as sharing or losing opioids; unsafe storage was defined as storing opioids in plain sight. RESULTS: The median age was 57 years. CAGE was positive in 58 of 300 patients (19%), and 26 (9%) had a history of illicit drug use. Fifty-six (19%) stored opioids in plain sight, 208 (69%) kept opioids hidden but unlocked, and only 28 (9%) locked their opioids. CAGE-positive patients (p = .007) and those with a history of illicit drug use (p = .0002) or smoking (p = .03) were more likely to lock their opioids. Seventy-eight (26%) reported unsafe use by sharing (9%) or losing (17%) their opioids. Patients who were never married or single (odds ratio: 2.92; 95% confidence interval: 1.48-5.77; p = .006), were CAGE positive (40% vs. 21%; p = .003), or had a history of illicit drug use (42% vs. 23%; p = .031) were more likely to use opioids unsafely. Overall, 223 of 300 patients (74%) were unaware of proper opioid disposal methods, and 138 (46%) had unused opioids at home. CONCLUSION: A large proportion of cancer patients improperly and unsafely use, store, and dispose of opioids, highlighting the need for establishment of easily accessed patient education and drug take-back programs.

Caracterización del gen mecA de Staphylococcus aureus resistentes a meticilina aislados de tres grupos poblacionales de la ciudad de Medellín / Characterization of mecA gene of methicillin-resistant Staphylococcus aureus Isolated from three population groups in Medellín

Introducción: Staphylococcus aureus resistente a la meticilina (SARM) es responsable de infecciones intrahospitalarias, las que constituyen una importante causa de morbilidad y mortalidad en nuestro medio, por lo cual la rápida identificación y tipificación molecular de la resistencia como el complejo SSCmec es esencial para entender la epidemiología de la infección. Objetivo: Caracterizar fenotípicamente la resistencia a meticilina y genotípicamente el casete cromosomal SSCmec en cepas de S. aureus aislados de individuos de la ciudad de Medellín mediante PCR múltiple. Materiales y métodos: A 41 aislamientos (hospitalarios y de la comunidad) de S. aureus se les estableció la resistencia a cefoxitin mediante la técnica de Kirby-Bauer y la concentración inhibitoria mínima para oxacilina. Mediante PCR convencional se les confirmó la presencia del gen mecA. Para la tipificación del complejo SSCmec se utilizó PCR múltiple para amplificar 6 loci diferentes de este gen. Resultados: A todos los aislamientos se les confirmó resistencia a meticilina y la presencia del gen mecA, de los cuales 17 fueron clasificados como SSC mec I, 1 como SSC mec II, 21 como SSC mecIV; dos aislamientos no fue posible clasificarlos. Conclusiones: Con el uso de esta técnica clasificamos el 95% de los aislamientos del estudio, encontrando una mayor prevalencia de los SSCmec I y IV. La implementación de esta técnica permite una fácil caracterización de los aislamientos SARM y un apropiado manejo de la información de los integrantes de los comités de infecciones hospitalarios, lo cual podría impactar positivamente en el tratamiento a los pacientes y el control de enfermedades infecciosas intrahospitalarias.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is involved in nosocomial infections, representing an important cause of morbidity and mortality. The rapid identification and molecular classification of resistance, such as the SSCmec complex, is essential to understanding the epidemiology of infection. Objective: To phenotypically characterize methicillin resistance and to genotype the SSCmec complex in S. aureus isolates collected from a cohort of patients from Medellín, Colombia. Materials and Methods: Cefoxtin resistance was evaluated in 41 S. aureus isolates, using the Kirby-Bauer method and determining the minimal bactericidal concentration of oxacillin. To confirm the presence of the mecA gene, conventional PCR was performed. The classification of the SSCmec complex was carried out by multiple PCR, amplifying 6 different loci in this gene. Results: Methicillin resistance and the presence of the mecA gene were confirmed in all isolates. A total of 17 were classified as SSCmec I, one as SSCmec II, and 21 SSCmec IV (only two isolates were not classified). Conclusions: Using this method, it was possible to classify 95% of the studied isolates, with a higher prevalence of SSCmec I and IV. The implementation of this technique allows the characterization of MRSA isolates and an appropriate management of the information by the members of the Hospital Infection Committee. Altogether, this method may have a positive impact on the treatment of patients with MRSA infections.

Evaluation of male COPD patients' health status by proxies.

BACKGROUND: It is not always possible to collect information about health from patients, so information from proxies (relatives and others) is used to aid medical decision-making, but there has been no formal evaluation of the reliability of their reports. The aim of this study was to analyse the reliability and validity of the St. George's Respiratory Questionnaire (SGRQ) answered by proxies and to determine their accuracy as raters. METHODS: Stable symptomatic male COPD patients and relatives living in the same house independently completed the same version of the SGRQ. RESULTS: Forty-six male patients were studied; age 72.1+/-7.3 years, pre-bronchodilator FEV(1) 37.9+/-14.7% predicted, 30.4% on long-term oxygen therapy. Internal consistency (Cronbach's alpha) was over 0.73 for all domains and >0.9 for the total score. Their scores correlated with dyspnoea (r=0.30-0.45) and FEV(1) (r=0.4-0.61). The proxies could distinguish between levels of disease severity, but with a weaker discriminant power compared to patients. Seventy-two per cent of proxies over-reported the degree of the patient's overall health status impairment, especially at mild-moderate scores. Proxies showed weaker correlations at the more severe scores. CONCLUSIONS: The SGRQ was reliable and valid when administered to relatives of male COPD patients; however due to the systematic over-reporting of the level of the patient's health status impairment, caution should be applied whilst trying to use proxies as surrogates for male COPD patients.

Pancreatoduodenectomía con preservación de píloro: experiencia de 5 casos HSJD / Pancreatoduodenectomy whith pylorus preservation: experience of 5 cases HSJD

La pancreatoduodenectomía fue introducida por Kaush en 1912 y popularizada por Whipple en 1935. Su uso se ha incrementado en los últimos años y ha probado ser una opción en algunos pacientes bien seleccionados con cáncer periampular y de la cabeza del páncreas. La preservación del antro y del píloro es el resultado del esfuerzo para reducir las complicaciones asociadas con el procedimiento tradicional, reconstruyendo el tracto gastrointestinal en una forma más fisiológica. Su uso en pacientes con cáncer de la cabeza del páncreas es controversial. El propósito de este estudio es revisar en forma retrospectiva la evolución de 5 pacientes con cáncer de páncreas y periampular, a los que se les hizo una pancreatoduodenectomía con preservación de píloro en nuestro servicio en el primer cuatrimestre de 2003. Descriptores: Pancratoduodenectomía, periampular, Whipple, píloro

Chlamydia pneumoniae en valvulas aorticas de pacientes sometidos a reemplazo valvular / Chlamydia pneumoniae in aortic valves of patient undergoing valvular replacement

Diferentes estudios han demostrado relación entre la presencia de C. pneumoniae y patologías cardíacas como enfermedad coronaria, endocarditis y ateromatosis. En la actualidad hay muy pocas publicaciones que muestran la relación de este microorganismo y el daño valvular aórtico. El propósito de esta investigación fue determinar la presencia de C. pneumoniae en válvulas aórticas de pacientes sometidos a reemplazo valvular. La población estuvo conformada por 51 pacientes sometidos a reemplazo de la válvula aórtica. Para la detección del ADN de C. pneumoniae se utilizó la técnica de PCR anidada. Se analizaron otras variables: edad, sexo, patología anatómica macroscópica responsable de la disfunción valvular y diagnóstico clínico. El 84 por ciento de los pacientes tenían más de 40 años. El 68.6 por ciento fueron del sexo masculino. La prevalencia general de C. pneumoniae en válvulas aórticas file del 54.9 por ciento. La proporción de prevalencia fue mayor en el sexo femenino (62 por ciento). Se observó una mayor prevalencia de C. pneumoniae en el grupo de mayor edad. La patología más frecuente el engrosamiento de la válvula aórtica, con 31.4 por ciento. El diagnóstico clínico más frecuente en los pacientes con válvulas defectuosas con presencia de C. pneumoniae, fue insuficiencia aórtica, con 54 por ciento. Los resultados obtenidos concuerdan con lo reportado en la literatura mundial sobre este tema y proporcionan una base local sobre la prevalencia de este microorganismo en nuestro medio para posteriores estudios, en los cuales además de la búsqueda de su presencia, se obtendrá la verdadera relación de este microorganismo y sus posibles implicaciones en la fisiopatología del daño valvular