Síndrome de quemarse por el trabajo (burnout) y sus consecuencias entre personal forense. Relación con vergüenza y culpa / Burnout and its consequences among forensic personnel. Relationship with shame and guilt

Background: The work of forensic personnel is a source of daily exposure to very stressful situations, and a potential risk for employee burnout. Objectives: The objective of the study was to analyze the prevalence of burnout and its consequences in a sample of 79 workers from the Institute of Legal Medicine (IML) of Valencia (Spain). Method: Data collection measurements used were the Spanish Burnout Inventory (SBI), and questionnaires to evaluate health and job satisfaction, as well as feelings of guilt and shame. Results: IML staff showed a moderate risk of professional burnout, with psychological exhaustion as the strongest predictor of health consequences. Regarding the role of emotions in burnout, the highest prevalence was found for guilt and shame, and both were associated with health problems. Conclusions: The IML staff requires labor plans and programs that take into account the high level of their job demands, in order to avoid the development of employee burnout. Keywords: burnout; forensic personnel; guilt; shame; job satisfaction; health problems.

Antecedentes: El trabajo del personal forense es una fuente de exposición diaria a situaciones muy estresantes y un potencial riesgo a presentar el Síndrome de Quemarse por el Trabajo (SQT). Objetivos: El objetivo del presente estudio fue analizar la prevalencia del SQT y sus consecuencias en una muestra de 79 trabajadores del Instituto de Medicina Legal (IML) de Valencia (España). Método: Para la recogida de información se aplicó el Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo (CESQT) y cuestionarios para evaluar la salud y satisfacción laboral, así como los sentimientos de culpa y vergüenza. Resultados: Se encontró al personal del IML en un riesgo moderado de SQT, siendo la variable desgaste psíquico la que predijo de manera más intensa las consecuencias para la salud. En referencia al papel de las emociones dentro del SQT, se encontraron las prevalencias más elevadas para culpa y vergüenza, asociándose con la aparición de problemas de salud. Conclusiones: El personal del IML requiere de planes y programas de trabajo que contemplen su alto nivel de demanda, para evitar la aparición del SQT. Palabras clave: síndrome de quemarse por el trabajo; personal forense; culpa; vergüenza; satisfacción laboral; problemas de salud.

Use of exome sequencing to determine the full profile of genetic variants in the fluoropyrimidine pathway in colorectal cancer patients affected by severe toxicity.

AIM: To identify genetic variants associated with capecitabine toxicity in fluoropyrimidine pathway genes using exome sequencing. PATIENTS & METHODS: Exomes from eight capecitabine-treated patients with severe adverse reactions (grade >2), among a population of 319, were sequenced (Ion Proton). SNPs in genes classified as potentially damaging (Sorting Intolerant from Tolerant and Polymorphism Phenotyping v2) were tested for association with toxicity in a validation cohort of 319 capecitabine-treated patients. RESULTS: A total of 17 nonsynonymous genetic variants were identified. Of these, five putative damaging SNPs in DPYD, ABCC4 and MTHFR were genotyped in the validation cohort. DPYD rs1801160 was associated with the risk of toxicity (p = 0.029) and MTHFR rs1801133 with delayed administration of chemotherapy due to toxicity (p = 0.047). CONCLUSION: Exome sequencing revealed two specific biomarkers of the risk of toxicity to capecitabine.

Identification of new SNPs associated with severe toxicity to capecitabine.

Predicting individual risk of chemotherapy-induced severe adverse reaction is a critical issue when selecting the best treatment for cancer patients. SNPs have been identified in genes involved in the pharmacodynamics of fluoropyrimidines, and guidelines even recommend genotyping some DPYD variants in order to estimate the risk of toxicity. However, the predictive value of this approach remains insufficient, thus limiting its clinical implementation. The aim of the present study was to identify new genetic variants by selecting a group of tag SNPs in genes associated with the pharmacodynamics of fluoropyrimidines (CDA, DPYD, ENOSF1, CES1, TYMS, SLC22A7, TYMP, and UMPS). For this purpose, 23 selected SNPs were genotyped on an OpenArray™ platform in a cohort of 301 colorectal cancer patients receiving capecitabine-based chemotherapy. Univariate and multivariate statistical analysis by logistic regression revealed 10 SNPs associated with severe adverse reactions to capecitabine (P<0.05): rs1048977, rs12726436, and rs2072671 in CDA; rs12119882 in DPYD; rs2853741 in TYMS; rs699517 in TYMS/ENOSF1; rs2270860 and rs4149178 in SLC22A7; and rs2279199 and rs4678145 in UMPS. Except for rs2072671, no association had previously been reported between these SNPs and the risk of capecitabine-induced toxicity. The use of tag SNPs to find new polymorphisms related to adverse reactions to capecitabine was successful. These new variants could increase the predictive power of currently available tests and thus prevent severe adverse reactions to capecitabine.