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INTRODUCTION: Smoking is a stroke risk factor but the most efficient way to promote cessation is unknown. The smoking behavior in patients during the first 2 years post-stroke is studied comparing brief advice and intensive behavioral counseling interventions, taking into consideration biological, psychological, and social factors. METHODS: Randomized clinical trial of 196 stroke patients, stratified by the presence or not of an insular cortex lesion, with two levels of smoking cessation intervention. RESULTS: The study retention rate was 85.2%. Abstinence point prevalence at three months after stroke was 50% in the brief advice group and 51.7% in the intensive behavioral counseling group (p = .82) and at 24 months, 48.3% in the brief group and 47.5% in the intensive group (p = .92). Most relapses occurred in the first weeks. After 3 months the curves separated with fewer events in the intensive group and at 24 months the Hazard Ratio was 0.91 (95% CI = 0.61 to 1.37; p = .67). Twenty-four months after stroke, patients with an insular lesion were more likely to be abstinent (OR 3.60, 95% CI = 1.27 to 10.14), as were those who lived with a partner (OR 2.31, 95% CI = 1.17 to 4.55) and those who were less dependent (OR 0.84, 95% CI = 0.73 to 0.97). CONCLUSIONS: A high percentage of patients gave up smoking in both intervention groups with no significant differences between the two. The effect of the insular lesion on smoking cessation, which is early and continued after two years, is particularly notable. IMPLICATIONS: This two-year clinical trial compares for the first time the efficacy of two different intensities of smoking cessation intervention in stroke patients, taking into consideration the effect of the insula. Good results are obtained both in the short and medium-term in people with stroke, especially when this is accompanied by an insular cortex lesion, but there is no evidence that better results are obtained with longer, more time-intensive, and possibly more costly follow-ups obtain better results than are obtained with briefer interventions.
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Cese del Hábito de Fumar , Terapia Conductista , Consejo , Humanos , Corteza Insular , FumarRESUMEN
On 16 September 2016, the World Health Organization confirmed a Rift Valley fever (RVF) outbreak in Niger. Epidemiological surveillance was reinforced among the French Armed Forces deployed in Niger and bordering countries: Chad, Mali and Burkina Faso. On 26 October, a probable case of RVF was reported in a service member sampled in Mali 3 weeks earlier. At the time the result was reported, the patient was on vacation on Martinique. An epidemiological investigation was conducted to confirm this case and identify other cases. Finally, the case was not confirmed, but three suspected cases of RVF were confirmed using serological and molecular testing. RVF viral RNA was detectable in whole blood for 57 and 67 days after onset of symptoms for two cases, although it was absent from plasma and serum. At the time of diagnosis, these cases had already returned from Mali to Europe. The infectivity of other arboviruses in whole blood has already been highlighted. That RVF virus has been detected in whole blood that long after the onset of symptoms (67 days) raises the question of its potential prolonged infectivity. Because of exposure to tropical infectious diseases during deployment, military populations could import emerging pathogens to Europe.
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Fiebre/etiología , Fiebre del Valle del Rift/diagnóstico , Virus de la Fiebre del Valle del Rift/aislamiento & purificación , Adulto , Animales , Anticuerpos Antivirales/sangre , Estudios Transversales , Culex/virología , Brotes de Enfermedades , Europa (Continente)/epidemiología , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Masculino , Malí/epidemiología , Personal Militar , ARN Viral/sangre , ARN Viral/genética , ARN Viral/aislamiento & purificación , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Fiebre del Valle del Rift/sangre , Fiebre del Valle del Rift/epidemiología , Fiebre del Valle del Rift/transmisión , Virus de la Fiebre del Valle del Rift/genética , Vigilancia de Guardia , Estudios Seroepidemiológicos , ZoonosisRESUMEN
Introduction: Tobacco use is a public health problem causing high morbidity and mortality, including stroke. This study evaluates predictive factors of smoking cessation in the long term after stroke. Methods: We followed a cohort of 110 consecutive smokers with stroke for up to 6 years. Sociodemographic variables, stroke severity, insular involvement, stage of change in smoking habit before stroke and disruption of addiction variable (smoking cessation, absence of relapses, having stopped smoking without difficulties and not having had urge) were evaluated. Results: Twenty patients died during follow-up and two patients were lost leaving a final cohort of 88 patients. The prevalence of smoking cessation in the remaining population was 65.9% post-stroke, 54.9% at 3-6 months, 40.9% at 1 year and 37.5% at 6 years. Prevalence was significantly higher in patients with insular involvement during the first year of follow-up, but not at 6 years. Disruption immediately after stroke (OR = 10.1; 95% CI = 2.5 to 40.1) and intention to change before having the stroke (OR = 4.8; 95% CI = 1.0 to 23.0) were predictors of abstinence at 6 years after adjusting for age, sex and stroke severity at baseline. When tobacco abstinence at the 1 year follow-up was included in the model, this factor was the best predictor of tobacco abstinence at 1 year (OR = 10.5; 95% CI = 2.2 to 49.4). Conclusions: Intention of change, having the disruption criteria, and abstinence 1 year after stroke were predictors of abstinence at 6 years. An insular lesion in the acute phase of stroke does not determine the tobacco use status at 6 years. Implications: This study is the first prospective investigation with a cohort of stroke patients to examine the long-term influence of biological and psychological factors on smoking cessation. Tobacco abstinence 1 year after stroke was the strongest predictor of abstinence at 6 years of follow-up. The effect of the insular cortex lesion on tobacco cessation, which had been relevant during the first year, no longer had an influence over the longer period studied here.
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Cese del Hábito de Fumar/psicología , Fumar/psicología , Fumar/terapia , Accidente Cerebrovascular/psicología , Accidente Cerebrovascular/terapia , Dispositivos para Dejar de Fumar Tabaco/tendencias , Anciano , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Cese del Hábito de Fumar/métodos , Factores de TiempoRESUMEN
BACKGROUND: We aimed to study anxiety, depression and quality of life in smokers after stroke by sex. METHODS: A longitudinal prospective study with a 24-month follow-up of acute stroke patients who were previously active smokers. Anxiety and depression were evaluated with the Hospital Anxiety and Depression scale, and quality of life was evaluated with the EQ-5D questionnaire. RESULTS: One hundred and eighty patients participated (79.4% men); their mean age was 57.6 years. Anxiety was most prevalent at 3 months (18.9% in men and 40.5% in women) and depression at 12 months (17.9% in men and 27% in women). The worst perceived health occurred at 24 months (EQ-VAS 67.5 in men and 65.1 in women), which was associated with depression (p < 0.001) and Rankin Scale was worse in men (p < 0.001) and depression in women (p < 0.001). Continued tobacco use was associated with worse perceived health at 3 months in men (p = 0.034) and at 12 months in both sexes. Predictor variables of worse perceived health at 24 months remaining at 3 and 12 months were tobacco use in men and neurological damage in women. CONCLUSION: Differences by sex are observed in the prevalence of anxiety and depression and associated factors and in the predictive factors of perceived health.
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INTRODUCTION: Meloidae are distributed in temperate and arid regions but are also common in subtropical and tropical savannahs. These insects contain cantharidin, a vesicant substance that can cause poisoning by ingestion and dermatitis by direct contact. MATERIAL AND METHODS: We describe recurrent Meloidae-related dermatitis outbreaks and their health impact by analyzing medical consultation records and meteorological data. RESULTS: Between 2015 and 2019, dermatitis outbreaks took place at a French military base at the end of the rainy season, from July to August, with 100 cases reported in 2015, 74 in 2017, 100 in 2018, and 36 in 2019. In 2017, the incidence rate was 4.4% for the base's population. Initial medical consultations represented 31.5% of total medical care activity. Meloidae were identified as Cyaneolytta fryi. CONCLUSIONS: These outbreaks of burn-like lesions, although clinically benign, can place a considerable burden on the medical activity of health care facilities. The diagnosis of Meloidae dermatitis is exclusively anamnestic and clinical and requires reported contact with the insect. The treatment protocol is that of standard burn care, and the best preventive measure is to avoid bright white lights. Military personnel, foreign workers, and travelers venturing into the Sahel should be warned of the risks associated with these beetles.
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Escarabajos , Dermatitis , Animales , Malí , Cantaridina/uso terapéutico , Brotes de EnfermedadesRESUMEN
Doege-Potter syndrome is a rare hypoglycemic paraneoplastic disorder. This case describes that severe and symptomatic hypoglycemia can occasionally be due to a rare malignant neoplasm, and the differential diagnosis of malignancy should not be overlooked in this setting.
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The mental health of nurses working in long-term healthcare centers is affected by the care they provide to older people with major chronic diseases and comorbidity and this in turn affects the quality of that care. The aim of the study was to investigate dispositional optimism, burnout and self-reported health among nurses working in long-term healthcare centers. A descriptive, cross-sectional survey design was used. Survey questionnaires were distributed in 11 long-term health care centers (n = 156) in Catalonia (Spain). The instruments used were LOT-R (dispositional optimism), MBI (burnout) and EuroQol EQ-5D (self-reported health). Bivariate analyses and multivariate linear regression models were used. Self-reported health correlated directly with dispositional optimism and inversely with emotional exhaustion and cynicism. Better perceived health was independently associated with greater dispositional optimism and social support, lower levels of emotional exhaustion level and the absence of burnout. Dispositional optimism in nurses is associated with a greater perception of health and low levels of emotional exhaustion.
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Agotamiento Profesional , Enfermeras y Enfermeros , Autoinforme , Anciano , Anciano de 80 o más Años , Agotamiento Profesional/epidemiología , Estudios Transversales , Femenino , Estado de Salud , Humanos , Masculino , Enfermeras y Enfermeros/psicología , Casas de Salud , España/epidemiología , Encuestas y CuestionariosRESUMEN
BACKGROUND: Burnout syndrome is related to cultural and individual factors. The aim of this study was to compare the frequency of burnout and the scores for its three components with the perceptions and the demographic and professional characteristics of the workers. METHODS: Burnout syndrome was studied in 11,530 Hispanic Americans and Spanish healthcare professionals (51% male, mean age 41.7 years). The Maslach Burnout Inventory and a previously drawn up questionnaire were administered online from the Intramed website from December 2006 to September 2007. Associations were tested using multiple logistic regression. RESULTS: The frequency of burnout in professionals resident in Spain was 14.9%, in Argentina 14.4%, and in Uruguay 7.9% whereas professionals in Mexico, Ecuador, Peru, Columbia, Uruguay, Guatemala and El Salvador presented frequencies of burnout of between 2.5% and 5.9%. By professions, doctors had a prevalence of burnout of 12.1%, nurses 7.2%, and dentists, psychologists and nutritionists of <6%. Amongst doctors, burnout predominated amongst doctors working in emergency departments (17%) and internal medicine departments (15.5%) whereas anaesthetists and dermatologists had the lowest prevalence (5% and 5.3%, respectively). Older age (OR=0.96), having children (OR=0.93), the perception of feeling valued (OR=0.53), optimism (OR=0.80), job satisfaction (OR=0.80), and satisfaction with salary (OR=0.91) are variables which protect against burnout. CONCLUSIONS: The expression of burnout varies among nations and professions. Age (older age), having children, the perception of feeling valued, optimism, job satisfaction and satisfaction with salary are protective variables of burnout.
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Agotamiento Profesional/epidemiología , Agotamiento Profesional/psicología , Características Culturales , Personal de Salud , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/psicología , Personalidad , Adulto , Estudios Transversales , Femenino , Humanos , América Latina , Masculino , Prevalencia , España , Encuestas y CuestionariosRESUMEN
BACKGROUND AND OBJECTIVE: Anxiety and depression are common among medical inpatients. While their relation to the severity of illness is often discussed, the feeling of such severity by the patient and his/her prospects of improvement can be influenced by anxiety and depression. PATIENTS AND METHOD: Patients admitted in an internal medicine ward. Sociodemographic characteristics, State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale (HAD), Beck Depression Inventory (BDI), APACHE II, illness severity and reversibility self-evaluation were recorded. The HAD cut-off for anxiety or depression was 10. RESULTS: We included 260 admissions: 66.2% men, mean age 64.1 years. Anxiety was detected in 39.8% of women and 21.5% of men (p = 0.003); 31.8% of women and 16.3% of men had depression (p = 0.006). Anxious and depressive subjects did not score high in APACHE. Anxious patients had a worse knowledge of the medical diagnosis. Depressive patients were older, had a lower educational level and a greater physical impairment. Patients with a higher perception of severity displayed higher scores both on anxiety and depression scales. Patients with lower illness reversibility self-evaluation had more anxiety and depression, and more illness severity as well. CONCLUSIONS: The prevalence of anxiety and depression in hospitalized medical patients is high, occurs mainly in women, and no relation to illness severity is observed. Anxiety and depression are associated with both illness perception of greater severity and less improvement.
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Ansiedad , Actitud Frente a la Salud , Depresión , Pacientes Internos/psicología , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/epidemiología , Depresión/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Multiple symmetric lipomatosis (MSL) is characterised by nonencapsulated localised lipomatous accumules (type I) or diffused (type II). There is a high incidence in Mediterranean males with high alcohol intake. The biochemical blood alterations described are similar to those related to alcoholism or chronic hepatopathy. The disease can be associated with demyelinating peripheric or autonomic neuropathy and in MSL type I with mediastinal findings of 5 patients suffering from MSL type I, comparing them with the cases in the literature and insisting on the participation of alcoholism (early onset, important amount, and long-term habit) in the etiology of MSL and its contribution to the developing of neuropathy and abnormalities of lipidic metabolism.
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Alcoholismo/complicaciones , Lipomatosis Simétrica Múltiple/diagnóstico , Anciano , Alcoholismo/patología , Humanos , Lipomatosis Simétrica Múltiple/etiología , Lipomatosis Simétrica Múltiple/patología , Masculino , Persona de Mediana EdadRESUMEN
The purpose of this study was to analyse the relationship between perceived quality of life and levels of burnout among healthcare personnel. A sample of 1095 participants (nurses, physicians, nursing assistants and orderlies) from five hospitals in the province of Girona (Spain) were studied (78% women, mean age=36.6 years, SD=8.8) using the 36-item short-form health questionnaire (SF-36) and the Maslach Burnout Inventory. The results showed that health-related quality of life reported by this sample of healthcare personnel was lower than the reference population values, especially in those SF-36 dimensions that comprise the mental component. In comparing the dimensions of the SF-36 by profession, we found that physicians had better perceived health in the dimensions of the physical component than nurses and other professionals (P< 0.01). No statistical differences were observed between profession and the dimensions of the mental component (P>0.05). Moreover, perceived health was worse among those that reported a high level on any of the components of burnout. These results should be taken account when designing a burnout prevention programme in the workplace.
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Agotamiento Profesional/psicología , Personal de Salud/psicología , Calidad de Vida/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , EspañaRESUMEN
Se observaron diferencias en la intensidad de las dimensiones del burnout y de los factores asociados según las naciones de ejercicio de la medicina, pero los factores vinculados con el nivel alto de las dimensiones fueron comunes para los médicos de todas las naciones