Beyond burnout I: Doctors health services and unmet need.

OBJECTIVES: Doctors' mental health has received renewed attention given the epidemic of burnout, high suicide rates and the recent pressures of the COVID-19 pandemic. Internationally, various service designs and primary prevention initiatives have been trialled to address these needs. Systemic barriers such as stigma as well as individual characteristics of doctors have historically prevented access to mental health services. This paper outlines the Australian service context from which a new publicly funded doctors' mental health programme emerged. METHODS: A narrative review of current services and a description of the challenges is outlined. RESULTS: A picture of urgency and unmet needs emerged with particular challenges, such as the need for privacy. CONCLUSIONS: Doctors' mental health is an urgent priority with direct impacts on patient safety and care. The complex context and the unmet need suggest the focus must go far beyond burnout and has prompted the establishment of a new service model designed to complement existing services in the Australian context, to be described in a sister paper.

Beyond burnout II: A case series of doctors seen in a new publicly funded doctors' mental health service.

OBJECTIVE: Doctors' mental health has received increased focus recently and has been met with a variety of systemic responses. A Professional Support Unit (PSU) in a public hospital was established to address service gaps. This paper aims to describe the care of doctors referred to this service. METHODS: Participants in the first four cases were referred to the PSU and assessed by the first author. RESULTS: The cases revealed: (i) variety of referral sources, symptom presentations and backgrounds of doctors referred to a dedicated doctors' health service; and (ii) the person-centred, multi-modal treatments and adjunctive services required. CONCLUSION: Doctors' mental health is an urgent priority, with direct impacts on patient safety and care. The mix of patients presented here suggest difficulties beyond burnout and highlight the workings of a new service model designed to complement existing services in the Australian context.

Post-traumatic stress disorder in doctors: Origins, approach and Eye Movement Desensitisation and Reprocessing therapy.

OBJECTIVES: Navigating a high-stakes clinical environment, medical doctors tend to consider trauma and adverse workplace events as 'part of their job'. This often leads to delays in help-seeking in doctors who develop acute traumatic stress symptoms (ATSS), post-traumatic stress disorder (PTSD) and their comorbidities. This article outlines the prevalence of acute traumatic stress and PTSD in this population and summarises the emerging evidence base for Eye Movement Desensitisation and Reprocessing (EMDR) early-intervention protocols of this population. CONCLUSION: Doctors have higher prevalence rates of ATSS and PTSD than the general public. Eye Movement Desensitisation and Reprocessing therapy's early-intervention protocols for recent, prolonged and ongoing traumatic stress have the potential to be a widely acceptable, timely and cost-effective intervention for doctors and other healthcare workers (HCWs), as highlighted in the emerging evidence base, which has grown considerably in response to the impact of the COVID pandemic on HCWs' mental health. These evidence-based interventions could potentially be routinely offered to doctors and other HCWs within 1 month of an adverse workplace experience to reduce ATSS, PTSD and other comorbidities.

Transforming the journey together: Baseline findings from a longitudinal, co-designed study on psychiatry trainee experiences of training and wellbeing.

OBJECTIVE: Junior doctors have high rates of burnout resulting in downstream impacts on patient care. The aim of this study is to capture cross-sectional data on a cohort of psychiatry trainees. These data will be used to inform a wider project investigating psychiatry trainee mental health and wellbeing. METHOD: This paper reports on the 2019 baseline data of psychiatry trainees enrolled in a formal education course at the University of Sydney, Australia. The data were collected with an online survey using a range of validated mental health and wellbeing scales. This descriptive study involved psychiatry trainees as co-designers. RESULTS: Our research findings are in keeping with the existing literature on the poor mental health and wellbeing of doctors with significantly higher levels of anxiety and exhaustion found in female trainees and carers. Despite this, the cohort had high scores on the flourishing scale. CONCLUSIONS: Concern around the wellbeing of junior doctors in Australia appears justified. We need to move beyond focussing on individual action to systems-based approaches to improving wellbeing and ongoing sustainability of the psychiatry trainee workforce in NSW.

Systematic training in master swimmer athletes increases serum insulin growth factor-1 and decreases myostatin and irisin levels.

During ageing, anabolic status is essential to prevent the decrease in quantity and quality of skeletal muscle mass (SMM). Exercise modulates endocrine markers of muscle status. We studied the differences of endocrine markers for muscle status in 62 non-sarcopenic Mexican swimmer adults aged 30-70 y/o, allocated into two groups: the systematic training (ST) group including master athletes with a physical activity level (PAL) >1.6, and the non-systematic training group (NST) composed by subjects with a PAL <1.5. Body composition, diet, biochemical and endocrine markers were analyzed. The ST group showed lower myostatin (MSTN) and irisin (IRI) levels, two strong regulators of SMM. The insulin growth factor-1 (IGF-1) was higher in the ST. This is consistent with most of the evidence in young athletes and resistance training programs, where IGF-1 and IRI seem to play a crucial role in maintaining anabolic status in master athletes.

[An Early Obesity Prevention Program: HaViSa UC (2009-2019)]. / Un programa de prevención temprana de la obesidad: "HaViSa UC" (2009-2019).

INTRODUCTION: Prevention is the definitive solution to the serious nutritional epidemiological pro blem of children in our country and the world, obesity. OBJECTIVE: To describe the results of an obesi ty prevention program for infants and preschoolers, ten years after its implementation. SUBJECTS AND METHODS: Retrospective, and quasi-experimental study of the overweight and obesity prevalence, in children attending three nursery and preschool centers located at the Universidad Católica de Chile, since the implementation of a multidimensional program for early promotion of healthy lifestyle habits (HaViSa-UC) between 2009 and 2019. This study obtained ethical approval. Annual records of anthropometric assessment (WHO 2006) were analyzed using Minitab 17 software. The actions applied by the HaViSa-UC program were the assessment of nutritional status and communication with parents, delivery of healthy food, promotion of an active lifestyle, and education to encourage such healthy habits. RESULTS: The annual mean was 319 subjects, 14% younger than two years old, and 49.5% were girls. In March 2009 (baseline), 32.6% had overweight and 8.6% obesity; both figures decreased reaching 23.8% and 4.7% respectively, in March 2019. Normal weight increased from 56.9 to 67.4% and malnutrition presented no increase. In the same period, zW/H dropped from 0.84 ± 0.94 to 0.55 ± 0.87 (p: 0.00), and zH/A increased from -0.36 ± 0.87 to -0.32 ± 0.90 (p > 0.05). Con clusion: Since the implementation of the HaViSa-UC Program, the frequency of obesity decreased by 45.4% and overweight by 27.2% in this sample of infants and preschoolers, remaining stable after 10 years.

Un programa de prevención temprana de la obesidad: "HaViSa UC" (2009-2019) / An Early Obesity Prevention Program: HaViSa UC (2009-2019)

Resumen: Introducción: La prevención es la solución definitiva al grave problema epidemiológico nutricional de la niñez en nuestro país y el mundo, que es la obesidad. Objetivo: Describir los resultados de un programa de prevención de la obesidad en lactantes y preescolares, a diez años de su inicio. Sujetos y Método: Estudio retrospectivo, cuasi experimental, de la prevalencia de sobrepeso y obesidad, en niños y niñas asistentes a las salas-cuna y jardines infantiles de la Universidad Católica de Chile, desde la implementación en 2009 de un programa de promoción precoz de hábitos de vida saludable en alimentación y actividad física (HaViSa-UC), hasta 2019. Se obtuvo aprobación ética y se analizaron los registros anuales de las evaluaciones antropométricas (referencia OMS 2006), de cada mes de marzo, en los centros de tres campus universitarios, utilizando el programa Minitab 17. Las acciones implementadas por el HaViSa-UC fueron: evaluación del estado nutricional y comunicación con los padres, entrega de una alimentación saludable, promoción de un hábito activo de vida y educa ción para favorecer hábitos saludables de vida. Resultados: El promedio anual fue de 319 asistentes, 14% menores de dos años y 49,5% niñas. En marzo 2009 se detectó 32,6% de sobrepeso y 8,6% de obesidad, cifras que disminuyeron y se estabilizaron, alcanzando en marzo de 2019 a 23,8% y 4,7% respectivamente. Los eutróficos aumentaron desde 56,9% a 67,4%, sin aumentar el bajo peso. En el mismo período, zP/T bajó desde 0,84 ± 0,94 a 0,55 ± 0,87 (p = 0,00), y zT/E aumentó desde -0,36 ± 0,87 a -0,32 ± 0,90 (p > 0,05). Conclusión: Desde la implementación del programa HaViSa, en esta muestra de lactantes y preescolares la frecuencia de obesidad bajó en 45,4% y el sobrepeso en 27%, con estabilidad al cabo de diez años.

Abstract: Introduction: Prevention is the definitive solution to the serious nutritional epidemiological pro blem of children in our country and the world, obesity. Objective: To describe the results of an obesi ty prevention program for infants and preschoolers, ten years after its implementation. Subjects and Methods: Retrospective, and quasi-experimental study of the overweight and obesity prevalence, in children attending three nursery and preschool centers located at the Universidad Católica de Chile, since the implementation of a multidimensional program for early promotion of healthy lifestyle habits (HaViSa-UC) between 2009 and 2019. This study obtained ethical approval. Annual records of anthropometric assessment (WHO 2006) were analyzed using Minitab 17 software. The actions applied by the HaViSa-UC program were the assessment of nutritional status and communication with parents, delivery of healthy food, promotion of an active lifestyle, and education to encourage such healthy habits. Results: The annual mean was 319 subjects, 14% younger than two years old, and 49.5% were girls. In March 2009 (baseline), 32.6% had overweight and 8.6% obesity; both figures decreased reaching 23.8% and 4.7% respectively, in March 2019. Normal weight increased from 56.9 to 67.4% and malnutrition presented no increase. In the same period, zW/H dropped from 0.84 ± 0.94 to 0.55 ± 0.87 (p: 0.00), and zH/A increased from -0.36 ± 0.87 to -0.32 ± 0.90 (p > 0.05). Con clusion: Since the implementation of the HaViSa-UC Program, the frequency of obesity decreased by 45.4% and overweight by 27.2% in this sample of infants and preschoolers, remaining stable after 10 years.

Cytotoxic Lesions of the Corpus Callosum Caused by Thermogenic Dietary Supplements.

Consumption of over-the-counter dietary supplements to reduce body weight is common among the population. Thermogenics are herbal combinations that claim to produce a fat-burning process through an increase in the cellular metabolic rate and greater cellular energy consumption, having a high risk for patients developing toxic leukoencephalopathy. We present a series of 6 patients with acute neurologic symptoms and MR imaging showing restricted diffusion and decreased apparent diffusion coefficient values (mean value, 400 mm2/s × 10-6) in the entire corpus callosum compatible with a cytotoxic lesion of the corpus callosum. Although patients responded favorably to the product discontinuation with rapid recovery of neurologic symptoms, there was a more prolonged resolution on imaging alterations. Because of the widespread availability and unregulated nature of thermogenic dietary supplements, physicians must be aware of the clinical and radiologic characteristics of these potential complications of their use.

Marcación de nódulos pulmonares con lipiodol bajo tomografía computada: experiencia local y correlación anatomopatológica / Marking of pulmonary nodules with lipiodol by computerized tomography: local experience and anatomopathological correlation

El objetivo de este estudio es la descripción de la novedosa y poco invasiva técnica de marcación de pequeños nódulos pulmonares con lipiodol, guiado con TAC para su posterior resección por cirugía videotoracoscópica con apoyo radioscópico. Se trata de un estudio retrospectivo que incluye 51 pacientes consecutivos en un tiempo comprendido entre junio del 2012 a septiembre del 2017, obteniendo el diagnóstico final mediante la correlación anatomopatológica, representando los procesos malignos el 81% y los benignos el 19%. Mediante esta técnica se lograron identificar y extraer con éxito el 100% de los nódulos marcados, demostrándose la efectividad y seguridad del procedimiento por las mínimas complicaciones relacionadas.

The purpose of this study is describing a novel and minimally invasive technique of CT-guided marking of small pulmonary nodules with lipiodol prior to resection by videothoracoscopic surgery with radioscopic support. This is a retrospective study that includes 51 consecutive patients between June 2012 and September 2017, with the final diagnosis confirmed by pathology. Malignant nodules represented 81% of the cases with the remaining 19% being benign nodules. Through this technique, 100% of the marked nodules were successfully identified and extracted with few procedure related complications and no adverse clinical outcome, demonstrating the effectiveness and safety of the procedure.

Degeneración quística de la cicatriz uterina anterior, riesgo de rotura uterina y revisión de la literatura / Cystic degeneration of a prior uterine scar, risk of uterine rupture and literature review

Objetivo: Valorar si el adelgazamiento del segmento uterino inferior puede aumentar el riesgo de complicaciones obstétricas. Y determinar cuál es el método de elección para su correcta medición. Material y método: Revisión bibliográfica de la literatura y exposición de un caso clínico. Resultados, caso clínico: Presentamos el caso de una gestante con una degeneración quística de la cicatriz uterina que durante la gestación se resuelve: se produce el parto a término y sin complicaciones obstétricas ni neonatales. Comentario, discusión y revisión de la literatura: La ecografía se valora como una técnica fácil, reproducible y con una metodología ya definida a la hora de valorar una cicatriz anterior. Aun así, no disponemos de una técnica estandarizada para la medición del segmento uterino inferior. La mayoría de los autores y algunas sociedadesestán de acuerdo en que faltan estudios homogéneos y un punto de corte definitivo. A pesar de los estudios publicados, no hay datos que indiquen que la dehiscencia de la cicatriz uterina requiere reparación para su adecuada cicatrización. Conclusiones: El mejor método diagnóstico es la histerosonografía. La medición del segmento uterino inferior en el tercer trimestre podría ser útil para decidir la vía de parto. No se puede determinar un punto de corte para predecir el riesgo de rotura uterina o dehiscencia de cicatriz uterina. Se requieren más estudios para establecer una técnica adecuada y un punto de corte mediante el cual se pueda clasificar a las pacientes y tomar decisiones respecto a la vía de parto. El punto de corte más definido en los estudios para el segmento uterino inferior es 3.5-3.2. El factor más importante de las pruebas de imagen es valorar si son capaces o no de predecir las complicaciones obstétricas que pueden suceder, el riesgo de afectación materna o fetal y la opción de la vía vaginal. Faltan estudios para tomar decisiones clínicas conforme a estos resultados

Objective: To assess whether thinning of the lower uterine segment may increase the risk of obstetric complications and to determine the most effective method to study its correct measurement. Material and method: Literature review and case report. Results case report: We present the case of a pregnant woman with cystic degeneration of a uterine scar during pregnancy. The delivery occurred at term with no obstetric or neonatal complications. Comment, discussion and literature review: Ultrasound is considered an easy-to-use and reproducible technique with a well-defined methodology to assess a prior caesarean scar. Nevertheless, there is still no standardised technique to measure the lower uterine segment. Although most authors and some societies are in agreement, there is a lack of homogeneous studies and a definitive cut-off value. Despite published studies, there are no data to suggest that uterine scar dehiscence requires repair for proper healing. Conclusions: The most effective diagnostic method is hysterosonography. Measurement of the lower uterine segment in the third trimester could be useful to decide the route of delivery. A cut-off cannot be determined to predict the risk of uterine rupture or uterine scar dehiscence. Further studies are required to establish an adequate technique and a cut-off value to classify patients and aid decision-making on the route of delivery. The most clearly defined cut-off for the lower uterine segment is 3.5-3.2. The most important factor in imaging tests is to evaluate whether they are able to predict the obstetric complications that may occur, the risk of maternal or foetal compromise and the option of vaginal delivery. There are no studies on clinical decision-making according to these results

The patient-body relationship and the "lived experience" of a facial burn injury: a phenomenological inquiry of early psychosocial adjustment.

BACKGROUND: Throughout development and into adulthood, a person's face is the central focus for interpersonal communication, providing an important insight into one's identity, age, sociocultural background, and emotional state. The face facilitates important social, including nonverbal, communication. Therefore, sustaining a severe burn, and in particular a facial burn, is a devastating and traumatizing injury. Burn survivors may encounter unique psychosocial problems and experience higher rates of psychosocial maladjustment, although there may be a number of potentially mediating factors. OBJECTIVES: The purpose of this phenomenological study was to examine the early recovery experience of patients with a facial burn. In particular, this study focused on how the injury impacted on the participants' relationship with their own body and the challenges of early psychosocial adjustment within the first 4 months of sustaining the injury. METHODS: In 2011, six adult participants encompassing two females and four males ranging from 29 to 55 years of age with superficial to deep dermal facial burns (with background burns of 0.8%-55% total body surface area) were recruited from a severe burn injury unit in Australia for participation in a Burns Modified Adult Attachment Interview. Narrative data were analyzed thematically and informed by Colaizzi's method of data analysis. RESULTS: Three overarching themes emerged: relationship to self/other, coping, and meaning-making. Themes identified related to how the experience affected the participants' sense of relationship with their own bodies and with others, as well as other challenges of early psychosocial adjustment. All participants indicated that they had experienced some early changes in their relationship with their body following their burn injury. CONCLUSION: These findings highlight the struggle burn survivors experienced with postburn adjustment, but expressed altruism and optimism around their recovery. Past trauma was observed to be a significant finding in this sample. Understanding the "lived experience" supports the way clinical and family systems can foster positive adjustment and coping. Consequently, multidisciplinary burn teams and health care professionals need to understand the principles of trauma-informed care and translate these into practice in the treatment of this group of patients.

Ongoing ethical issues concerning authorship in biomedical journals: an integrative review.

Health professionals publishing within the field of health sciences continue to experience issues concerning appropriate authorship, which have clinical, ethical, and academic implications. This integrative review sought to explore the key issues concerning authorship from a bioethical standpoint, aiming to explore the key features of the authorship debate. Studies were identified through an electronic search, using the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases of peer-reviewed research, published between 2009 and 2014, limited to English language research, with search terms developed to reflect the current issues of authorship. From among the 279 papers identified, 20 research papers met the inclusion criteria. Findings were compiled and then arranged to identify themes and relationships. The review incorporated a wide range of authorship issues encompassing equal-credited authors, honorary (guest/gift) and ghost authorship, perception/experiences of authorship, and guidelines/policies. This review suggests that the International Committee of Medical Journal Editors' (ICMJE) recommended guidelines for authorship are not reflected in current authorship practices within the domain of health sciences in both low-and high-impact-factor journals. This devaluing of the true importance of authorship has the potential to affect the validity of authorship, diminish the real contributions of the true authors, and negatively affect patient care.

Adenosis poliquística esclerosante de la glándula parótida / Sclerosing polycystic adenosis of the parotid gland

La adenosis poliquística esclerosante de la parótida (APEP) es una enfermedad infrecuente, caracterizada por elementos histológicos inflamatorios reactivos de las glándulas salivales, pero la presencia de displasia y atiplas hace también posible pensar se trate de un pseudotumor o una neoplasia. La APEP posee además semejanzas histopatológicas con la enfermedad fibroquística de la mama y comparten receptores de progesterona y estrógenos en las células ductales. La edad promedio de ocurrencia de esta patología es de 44,5 años y generalmente afecta las glándulas salivares mayores. Presentamos aquí el caso clínico de una mujer de 25 años de edad que el año 2002 consultó por un aumento de volumen de la parótida derecha, de larga data. Después de estudios diagnósticos y tratamientos fue intervenida quirúrgicamente y el análisis histopatológico sugirió el diagnóstico APEP.

Sclerosing polycystic adenosis (SPA) of the parotid gland is a rare disease characterized histologically by a reactive inflammation of the salivary glands, although the presence of displasia and atypia raise the possibility that SPA might represent a neoplastic lesion. SPA bears histopathological resemblance to fibrocystic disease of the breast, and both glands show progesterone and oestrogen receptors in the ductal cells. The mean age of occurrence is 44.5 year-old, and it mostly affects major salivary glands. We report the case of a 25-years-old woman, who in 2002 presented with increased volume in the right parotid gland. After medical studies and several surgical treatments, the histopathological study revealed it to be SPA.

[Endoluminal stent-graft placement for acute dissection of the descending aorta complicated with rupture. Report of one case]. / Tratamiento endoluminal de disección aguda complicada en aorta descendente. Comunicación de un caso.

Acute dissection of the aorta, although not common, has early and highly lethal complications. The type A dissection is treated with surgery. Patients with type B dissections are treated with surgery if they have complications like rupture, growth or visceral ischemia. Surgery, however, has complications such as spinal cord ischemia. Endovascular grafts have less mortality and complications. We report a 59 years old male patient with a type B dissection complicated with rupture. He was treated successfully with the placement of an endoluminal graft. He was discharged five days after the procedure in good conditions. After one year of follow up, the patient remains asymptomatic.

Mediterranean and Amerindian MHC class II alleles are associated with multiple sclerosis in Mexicans.

OBJECTIVES: Human leukocyte antigen (HLA)-DRB1, DQA1, DQB1 allele typing was performed in Mexicans Mestizos with multiple sclerosis (MS) to define the HLA class II alleles associated with the disease in this population. METHODS: Patients (n = 51) diagnosed according to the Poser criteria and a group of 173 unrelated healthy subjects were studied. PCR-SSOP and PCR-SSP were used for genotyping. RESULTS: Fifty five percent of the patients were females. The mean age at disease onset was 27 years. A relapsing-remitting disease was the most frequent type of MS (67%). A significant association of DRB1*0403 (OR = 5.68) with MS was shown. DRB1*0802 was also involved in susceptibility (OR = 2.41). An excess of DRB1*0802 homozygotes was observed in patients (P = 0.005), this genotype being in genetic equilibrium in controls. CONCLUSIONS: Two novel class II associations are described in Mexicans with MS: DRB1*0403 and DRB1*0802. Both alleles share with DRB1*1501, valine-86 and negatively charged amino acids, in the DRB1-anchoring motif of pocket 4.

Comparación de susceptibilidad de especies de shigella a antimicrobianos de uso habitual en el Hospital Regional de Temuco, Chile 1990-2001 / Shigella species susceptibility to commonly used antimicrobials in the Temuco Regional Hospital, Chile 1990-2001

Background: The permanent surveillance of antimicrobial susceptibility of Shigella sp in the Temuco Regional Hospital, allowed us to define the empirical use of antimicrobials in dysenteric syndrome. Aim: To study antimicrobial susceptibility of Shigella strains collected from 1997 to May 2001 and compare the results with those reported in 1990. Material and methods: Two hundred and seventeen Shigella strains, coming from stool cultures of pediatric patients, were studied. Results: In the period 1989-1990 Shigella flexneri was the main species isolated (83 percent) whereas, in the period 1997-2001, Shigella sonnei (55.8 percent) predominated. In the second period, an increase of antimicrobial resistance, as compared with the period 1989-1990, was observed for ampicillin (74.5 and 42 percent respectively), for cotrimoxazol (57.5 and 45 percent respectively) and tetracycline (64 and 8 percent respectively). Chloramphenicol resistance increased from 0 to 57.5 percent. In the second period no resistance to ciprofloxacin was detected. There was simultaneous resistance to four drugs in 30 percent of the strains, predominating multiresistance in S flexneri (52.1 percent). Conclusions: In the two periods studied, a significant increase was detected in the resistance of Shigella strains to antimicrobials

Resistencia de especies de shigella a antimicrobianos de uso habitual en el Hospital Regional Temuco, Chile / Resistance of the shigella species to regular antibiotics in the Regional Hospital of Temuco, Chile

El Hospital Regional de Temuco realiza vigilancia permanente de susceptibilidad a antimicrobianos en shigella detectándose desde 1996 resistencia progresiva a cloranfenicol, droga de elección en el tratamiento empírico frente a la sospecha de shigellosis. Se estudiaron 200 cepas de shigella aisladas de pacientes pediátricos que consultaron por diarrea entre julio 1997 y octubre 2000. La identificación bioquímica y serológica de las especies se realizó mediante metodología tradicional. La susceptibilidad a antimicrobianos de uso habitual, se midió mediante método de difusión en agar (Kirby-Bauer). Distribución por especies: shigella sonnei 64,5 por ciento y S. flexneri 35,5 por ciento. Se detectó 73 por ciento de resistencia a ampicilina, 56,5 por ciento a cloranfenicol, 45 por ciento a cotrimoxazol y 0 por ciento a ciprofloxacino. S. flexneri presentó resistencia y multirresistencia significativamente mayor. La resistencia limita las posibilidades terapéuticas, lo que incentiva a continuar con la vigilancia, para establecer normas de tratamiento y controlar la selección y diseminación de cepas multirresistentes