Compassion fatigue and anxiety in critical care emergency nurses: In between efficiency and humanity.

OBJECTIVES: To determine the emotional impact of permanent proximity to trauma and death in the Emergency and ICU's nurses establishing prevalence of Compassionate Fatigue (burnout and Secondary Traumatic Stress) and anxiety. Analyze its relationship with sociodemographic, training, workplace and psychological variables. METHODS: Descriptive, cross-sectional and multicentre study. The validated ProQOL v. IV and STAI scales and an ad-hoc questionnaire with the variables of the second objective were used in 710 nurses from nine highly complex hospitals in Catalonia (Spain). RESULTS: In both units, the prevalence of professionals affected with high scores of burnout was higher than 20%, on Secondary Traumatic Stress was 30% and, 12% on anxiety. Each subscale was significantly associated with the intention to leave units and the career. 97% of participants stated that they needed to be trained in emotional management. CONCLUSION: The prevalence of burnout and Secondary Traumatic Stress were higher in our study than those offered in the reference literature in emergency and ICU nurses. The prevalence of each construct was individually related to the desire to leave work units and career. This fact, together with the participants' desire to be better trained in emotional management exposes the need to establish educational plans, as well as institutional measures to prevent and support nurses for Compassion Fatigue.

Epidemiology of tuberculosis in the Americas: the Stop TB strategy and the millennium development goals.

BACKGROUND: Tuberculosis (TB), a preventable and curable disease, remains a major public health threat in the poorest regions of the Americas. The DOTS strategy was implemented to control TB in the region in 1993, and the new Stop TB strategy, emphasizing high-quality DOTS expansion, in 2006. OBJECTIVES: To describe TB epidemiology in the region of the Americas from 1994 to 2005 and to analyze the progress made towards and prospects for achieving Goal 6 of the Millennium Development Goals (MDGs) by 2015. METHODS: TB incidence, mortality and prevalence rates as well as DOTS coverage and DOTS treatment success rates were collated from the World Health Organization (WHO) databases from 1994 to 2005. RESULTS: DOTS coverage and DOTS treatment success rates rose steadily from 1994 to 2005, with 88% of the population covered under DOTS by 2005, and an 80% success rate by the end of 2004. The TB incidence, prevalence and mortality rates have also decreased steadily from 1994 to date, but differ with respect to the various scenarios. CONCLUSIONS: With the exception of some countries, further reduction in TB incidence, prevalence and deaths by 2015 is possible. Widespread implementation of DOTS should continue in order to meet WHO targets and attain the MDGs.

[Pulmonary symptomatic tuberculosis' diagnostic delay study]. / Estudio del retraso diagnóstico de la tuberculosis pulmonar sintomática.

OBJECTIVE: To study symptomatic pulmonary tuberculosis (PTB) diagnostic delay. PATIENTS AND METHODS: Prospective study of new symptomatic PTB cases (aged > or = 15 years) by structured interview with the patients and their families. The main variables analyzed were patient's delay (PD), doctor's delay (DD), diagnostic process delay (DPD), health care system delay (HCSD) and total delay between the onset of symptoms and start of treatment (TD). Univariate and multivariate statistical analyses were performed for each component of delay. RESULTS: Two hundred eighty-seven patients were studied. The mean delays in days standard deviations were TD 81.8 77.3; PD 43.3 55.7; DD 28.4 59.6; DPD 10.0 17.7, and HCSD 38.5 62.5. CONCLUSIONS: Patients are responsible for 50% of excess delay in diagnosing symptomatic PTB. Patients in the health care system experienced diagnostic delays over 60 days in 18.5% of cases, doctors being responsible for 75% of the diagnostic delay attributable to the system.

[Evaluation of the information provided by the system of compulsory notification of diseases]. / Evaluación de la información que proporciona el sistema de declaración obligatoria de enfermedades.

In order to assess activities of epidemiological surveillance resulting from the statutory notification system, a total of 17,394 notification records of eight infectious diseases (brucellosis, bacillary dysentery, typhoid fever, viral hepatitis, meningococcal infection, rickettsioses other than exanthematous typhus, pulmonary tuberculosis, and tuberculosis of other organs) together with 10,503 epidemiological surveys submitted to the "Servei Territorial de Salut Pública" of the province of Barcelona between 1982 and 1986 were reviewed. In notification records, data to locate physicians were the most commonly found (between 92.6% and 99.4% according to disease), whereas in epidemiological surveys, clinical and analytical data were the most frequently encountered. The inclusion of data of epidemiological interest ranged from 3.6 to 68.6%. In order to improve efficacy of the statutory notification system a proposal is made to reduce the extension of epidemiological surveys in terms of requesting only necessary data to establish appropriate measures in each case.

[The knowledge of the obligatory reporting of diseases among health professionals]. / El conocimiento de la notificación de las enfermedades de declaración obligatoria en profesionales sanitarios.

In order to assess what different health care workers (mainly physicians and nursing staff) know about the reporting of communicable diseases, with special emphasis on diseases that must be urgently reported, four groups were interviewed about this health information system (91 persons, who took part in different Public Health Seminars during the periods 1989-90 and 1990-91). The total mean score was 16.6 +/- 5.2, in a quantitative scale ranging from 0 to 27 points. Cholera was the communicable disease with the highest percentage of correct answers concerning the knowledge of its reporting (100% in two groups), while typhus was the disease with the lowest percentage (23%). The diversity of the results within the study groups suggests that it is necessary to insist on a continuous training on epidemiological surveillance and communicable diseases within Public Health activities in Catalonia.

The value of the autopsy in a rural hospital of Haiti.

We conducted a retrospective study of the autopsies performed during a 28-month period in the Department of Medicine of the Hôpital Albert Schweitzer in Haiti. We found that of 77 autopsies, the main clinical diagnosis was not confirmed at autopsy in 15 patients (19.5%). The results obtained at autopsy would have changed the treatment in 19 patients (24.7%) and the new therapeutical regimens could have had a significant impact on the outcome in six patients (7.8%). Important new information was also gained from the macroscopical examination only. The authors stress the value of the post-mortem examination in areas with limited resources.

[Epidemiology of tobacco use in health-science students]. / Epidemiología del tabaquismo en los estudiantes de ciencias de la salud.

The characteristics of tobacco use by students of the Division of Health Sciences of the University of Barcelona have been studied. During the 1988-1989 school year, 382 students were individually interviewed about their use of tobacco by means of a questionnaire routinely used by the Department of Health and Social Security of the Generalitat of Catolonia (Spain), with pertinent modifications for this specific group. These interviews were performed by appropriately trained personnel. Information was also gathered on the influence of university-level studies on smoking habits, the effect of advertising and the efficacy of antitobacco programs and campaigns carried out by the government. The study sample was drawn from lists supplied by the registrars' offices, by means of a random sampling by school (Medicine, Pharmacy, Psychology, Odontology and Nursing). The prevalence of tobacco use was 40.8% (29.8% daily smokers and 11% occasional smokers). These results are similar to those described in the literature, although these values are somewhat higher than those in more developed countries with a longer tradition of resistance to the use of tobacco. It is important to note that studying health sciences does not appear to be a major influence on the student's habits, but that the social and cultural environment is the factor which weighs the most in this respect. In conclusion, to reduce the prevalence of tobacco use in this important group, educational programs must be begun at the pre-university level (secondary school) and changes should be made in the curricula of the health professional so that areas related to tobacco use are more motivational for students.

[An approach to the study of excess weight in health professionals using observational data]. / Aproximación al estudio del exceso de peso en profesionales sanitarios mediante datos observacionales.

BASIS: Overweight is a public health problem in Catalonia as well. Quetelet's body mass index (BMI) is the most commonly used measurement in epidemiology for obesity quantification. This study was designed to assess its prevalence among the Catalonian health professionals. MATERIAL AND METHODS: We used a self-evaluated anonymous questionnaire which was filled up by 176 health professionals (75 men, 101 women) attending several training programmes in public health. More than 90% of the were between 25 and 38 years of age. RESULTS: Overweight prevalence (BMI > or = ) was of 15% (10% - 10% - 20%), significantly greatest among men (29%) than among women (5%). In both cases, it was mainly mild overweight. CONCLUSIONS: Overweight prevalence is highest among male health professionals, although globally, it is lower than in the general adult population of Catalonia for similar age groups.

Fatiga por compasión y ansiedad en enfermeras de cuidados críticos y emergencias. Entre eficiencia y humanidad / Compassion fatigue and anxiety in critical care emergency nurses: In between efficiency and humanity

Objetivos: Determinar el impacto emocional de la proximidad al trauma y la muerte en enfermeras de urgencias y de UCI mediante las prevalencias de fatiga de compasión (burnout y estrés traumático secundario) y ansiedad. Analizar su relación con variables de tipo sociodemográfico, formativas, laborales y psicológicas. Método: Estudio descriptivo, transversal y multicéntrico. Se utilizaron las escalas validadas ProQOL v.IV y STAI y un cuestionario ad-hoc con las variables del segundo objetivo, en 710 enfermeras de nueve hospitales de alta complejidad de Cataluña (España). Resultados: En ambas unidades, la proporción de profesionales afectados en alto grado de burnout fue superior al 20%, al 30% en estrés traumático secundario y al 12% en ansiedad. Cada subescala se asoció con la intención de abandonar la unidad y la profesión. El 97% de participantes manifestaron que era necesario recibir formación en gestión emocional. Conclusiones: Las prevalencias de burnout y de estrés traumático secundario fueron superiores en nuestro estudio respecto a la literatura de referencia en las enfermeras de urgencias y en las de UCI. La prevalencia de cada constructo se relacionó individualmente con el deseo de abandono de las enfermeras de sus unidades y de su profesión. Este hecho, junto al deseo de recibir formación de los participantes, expone la necesidad de establecer planes formativos, así como medidas institucionales de prevención y apoyo para la fatiga por compasión.(AU)

Objectives: To determine the emotional impact of permanent proximity to trauma and death in the Emergency and ICU's nurses establishing prevalence of Compassionate Fatigue (burnout and secondary traumatic stress) and anxiety. Analyze its relationship with sociodemographic, training, workplace and psychological variables. Methods: Descriptive, cross-sectional and multicentre study. The validated ProQOL v.IV and STAI scales and an ad-hoc questionnaire with the variables of the second objective were used in 710 nurses from nine highly complex hospitals in Catalonia (Spain). Results: In both units, the prevalence of professionals affected with high scores of burnout was higher than 20%, on secondary traumatic stress was 30%, and 12% on anxiety. Each subscale was significantly associated with the intention to leave units and the career. 97% of participants stated that they needed to be trained in emotional management. Conclusion: The prevalence of burnout and secondary traumatic stress were higher in our study than those offered in the reference literature in emergency and ICU nurses. The prevalence of each construct was individually related to the desire to leave work units and career. This fact, together with the participants’ desire to be better trained in emotional management exposes the need to establish educational plans, as well as institutional measures to prevent and support nurses for Compassion Fatigue.(AU)

[The opinion of the users as opportunity for improvement in primary health care]. / La opinión de los usuarios como oportunidad de mejora en atención primaria.

OBJECTIVES: To determine those aspects of Primary Care Center (PCC) that displeases more the clients/users, to investigate its determinants, and to apply the intervention or corresponding interventions. DESIGN: Results evaluation oriented. Detection of dissatisfaction reasons through cross observational study from survey self-fulfilled on 200 individuals selected through random cluster sampling. A continuous improvement group was implemented in order to the factors causing detected problems and their possible solutions were analyzed. LOCATION: Rambla PCC, Sant Feliu de Llobregat. Catalonian Health Institute. PARTICIPANTS AND CONTEXT: Users/clients of the PCC who were in the waiting room. Improvement Group: Professionals of Sant Feliu Primary Care Team and Baix Llobregat Nord Primary Care Service. INTERVENTIONS: Reorganization of the family doctors' agendas and reduction of bureaucratic tasks in the physicians' offices. PRINCIPAL MEASUREMENTS: Respondents socio-demographic data, and reasons for their dissatisfaction. Determinants of the problem were analyzed. The principal cause of discomfort was the delay of previous appointment. RESULTS: Among reasons for discomfort expressed by the users, the most frequent was lag time with 16% (95% CI, 10.9-21.1). This complaint referred both to wait for obtaining visit and to be in the waiting room before being visited. As determinants of delay there were identified a high number of patients, visits duplicity, bureaucratic visits, high number of urgent visits and an insufficient previous appointment visits. CONCLUSIONS: Patient's opinions help us to know how public health services are accomplishing their expectations. Process improvement is indispensable in order to provide a quality product, but it must be endowed with resources adequacy to population needs.

An outbreak of Brucella melitensis infection by airborne transmission among laboratory workers.

An outbreak of acute brucellosis infection was detected among the employees of a biologicals manufacturing laboratory located in Girona, Spain. The first cases appeared six weeks after a vaccine with attenuated Brucella melitensis, Rev-1 had been produced for one week. A clinical and epidemiologic investigation conducted among the 164 employees found 22 patients with clinical symptoms and positive serology, and six patients detected by serology only (attack rate: 17.1 per cent). Blood cultures were obtained from two patients and Brucella melitensis was isolated. Employees working in areas with open windows above the laboratory air extracting system had an attack rate of 39.5 per cent, substantially higher than those working in other locations. When vaccine was manufactured again, an electric oven reaching 300 degrees C had been installed in the air extracting system just before its exit to the exterior. Appropriate culture medium plates were exposed to the laboratory air before and after passing through the oven. Brucellae were isolated from the plates exposed to the air before passing through the oven but not after doing so.

[Evolution of adolescent fertility and its association with evolution of income in the Spanish provinces during the period 1975-1985]. / Evolución de la fecundidad adolescente y su asociación con la evolución de la renta en las provincias Españolas en el periodo 1975-1985.

BACKGROUND: Fertility rates in women under 21, during the period 1975-1985 in Spain, have analyzed, as well as their association with the evolution of the socioeconomic indicators in order to study the distribution and associated factors to adolescent maternity in our environment. METHODS: The fertility rates have been elaborated from the Official Demographic Statistics. The socioeconomic indicators have been obtained from the Statistics Year Book of the National Institute of Statistics and from other complementary sources. The method of weighted linear regression has been used to analyze the association between the indicators and the rates at the provincial level. RESULTS: The fertility rates have decreased a 16% in mothers from 15 to 19 years old in Spain, between 1975 and 1985. The highest accumulated rates belong to the Communities of Canarias (42.8 births by 1000 women of 15 to 19, Galicia (38.1) Murcia (33.7) and Andalucía (30.3). In the regression analysis, the income evolution shows an association with the fertility evolution in the group from 15 to 19 years old, and this association remains when we take into account unemployment, index of provincial development and birth rate, which allows to explain a 49% of the variance. Fertility of adolescent under 15 is only associated with the income evolution, with a determination coefficient of 0.29. CONCLUSIONS: Results indicate that early maternity has decreased in Spain, although there are geographical differences, which cam, in some measure, be related with social-economic factors.

[Factors conditioning absenteeism among primary care physicians]. / Factores condicionantes del absentismo laboral entre los médicos de atención primaria.

OBJECTIVES: To find whether the variables age, gender, speciality, training and type of contract of primary care doctors, as well as the size of their patient lists and the sort of centre where they work, affect their absenteeism, as measured by time off work sick. DESIGN: An observational, crossover study. SETTING: Nou Barris, sub-division of Barcelona City, primary care (PC) district during 1994. PARTICIPANTS: Doctors. MEASUREMENTS AND MAIN RESULTS: In the PC district there were 121 doctors, counting PC teams (PC), traditional system (TS) and specialists. Bivariant epidemiological and statistical techniques were used to verify the relationships between variables. Alpha risk was 5%. 40% of the District's doctors had some time off sick during the year. There were 79 occasions of time off (74 were for short-term sickness and 5 for maternity). Total days lost were 2,477, an average of 31.35. Time off work was related to the age of the doctors and the number of patients attending. Centres where the reform had been implemented had very few cases of time off. CONCLUSIONS: Cases of time off work for sickness among primary care doctors are mainly concentrated in the non-reformed network. It would be useful to study ways of increasing these doctors' motivation.

[Assessment of an interventional study on iodine deficiency in Burkina Faso, 1990-1993. Direction de la Santé de la Famille (Burkina Faso)]. / Valoración de un estudio de intervención sobre el déficit de yodo en Burkina Faso, 1990-1993. Direction de la Santé de la Famille (Burkina Faso).

OBJECTIVES: To find how the urinary parameters of iodine excretion evolved in a community with deficiencies, after administering iodine orally and IM in two provinces in Burkina Faso; to recommend a national strategy to tackle iodine deficits. Design. A longitudinal survey before and after the iodine was given (12 months). Descriptive analysis of the data. SETTING: Provinces of Namentenga and Passoré in Burkina Faso. PARTICIPANTS: The general population of the two provinces who satisfied age-sex criteria: males from 0 to 25, females from 0-45. Randomised two-stage sampling. 423 people in all took part (210 in Namentenga and 213 in Passoré). INTERVENTIONS: The administration of 1 ml of iodised oil (Lipiodol) orally in Namentenga and IM in Passoré. MEASUREMENTS AND MAIN RESULTS: The urinary parameters of micrograms of iodine per gr. of Creatinine, and micrograms of iodine per dl of urine, were used. Figures for normalisation of the urinary parameters 12 months after iodisation was significantly higher in Passoré province, where iodine was administered IM. CONCLUSIONS: The intramuscular pathway has more longlasting effects, but the characteristics of Burkina Faso's health system and the feasibility of a medium or long-term intervention make it advisable that iodine supplements be administered orally.

[Diagnosis of maternal and infant health in Palestine]. / Diagnóstico de salud maternoinfantil en Palestina.

OBJECTIVE: To describe the health situation of the target population (women between 15 and 45 and children from 0 to 3), living in the towns on the West Bank in which the 12 dispensaries of the Palestine NGO Health Services Council were located, in order to plan a programme of support activities for that NGO. DESIGN: Crossover survey. Descriptive analysis of the data. SETTING: 12 towns in the 5 districts of the West Bank (Palestine) between May and July 1994. PARTICIPANTS: Women of a fertile age (15 to 45) and children between 0 and 3 living in the towns where the 12 dispensaries of the NGO Health Services Council were located. MEASUREMENTS AND MAIN RESULTS: Social, demographic and health variables of the population group involved, the availability of primary care services and the pattern of health service use were studied. Worthy of mention were the average fertility of fertile women of 4.55 deliveries (CI 95%, 4.30-4.80), the use of family planning methods by 61% of the women surveyed, the low indices of mother and infant malnutrition, and the frequency of episodes of acute respiratory infections and diarrhoea in the under-3s. The availability of health services in these communities is wide. The non-governmental and private Palestinian services were preferred for antenatal control, whereas the Israeli government services were preferred for deliveries, as these services had more resources. CONCLUSIONS: The findings were typical of an intermediately developed society, similar to neighbouring countries. The multiplicity of health services available and their lack of coordination could make the application of a unitary health policy in the area difficult.