ABSTRACT
Objetivo Evaluar el riesgo de Burnout en los profesionales sanitarios del Hospital Universitario de Huesca, 50 años después de su inauguración, investigar las variables relacionadas con la motivación laboral de los sanitarios del hospital y valorar los factores predisponentes y protectores del riesgo de Burnout. Material y métodos Estudio observacional, analítico, prospectivo, unicéntrico mediante cuestionario, de todos los profesionales sanitarios que trabajaban en el Hospital San Jorge de Huesca, de septiembre de 2017 a abril de 2019 (n=209). Resultados La edad media fue de 42,86 años. El 72,2% eran mujeres. Un 12,4% presentaba riesgo moderado de Burnout. Existía un 12,4% de cansancio emocional alto, un 36,8% de despersonalización alta y un 44,5% de realización personal baja. El Burnout se asoció estadísticamente significativo a la categoría profesional (p=0,010), trayectoria profesional (p=0,026), horas de trabajo a la semana (p=0,036), elección de la misma profesión (p=0,001) y recomendación a la descendencia (p<0,001). Conclusiones Una décima parte de la muestra presentaba riesgo moderado de Burnout. Casi la mitad de los sanitarios constataban alto grado de satisfacción con el ámbito de trabajo y la mayoría expresaba un uso adecuado de las estrategias de bienestar y alto grado de autonomía, reconocimiento y satisfacción en el trabajo (AU)Objective
To evaluate the risk of Burnout in the health professionals of the Huesca University Hospital, 50 years after its inauguration, to investigate the variables related to the work motivation of the hospital health personnel and to assess the predisposing and protective factors of the risk of Burnout. Material and methods An observational, analytical, prospective and unicentric study was conducted from September 2017 to April 2019, evaluating all the health professionals who worked at the Hospital San Jorge de Huesca (n=209). Results The mean age was 42.86 years. 72.2% were women. 12.4% had moderate risk of burnout. There was 12.4% of high emotional exhaustion, 36.8% of high depersonalization and 44.5% of low personal accomplishment. Burnout was statistically significant associated with the professional category (P=.010), work experience (P=.026), hours of work per week (P=.036), choice of the same profession (P=.001) and recommendation to the offspring (P<.001). Conclusions One tenth of the sample had a moderate risk of burnout. Almost half of the health workers confirmed a high degree of satisfaction with the work environment and the majority expressed an adequate use of well-being strategies and a high degree of autonomy, recognition and satisfaction at work (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Burnout, Psychological/epidemiology , Health Personnel , Hospitals, University , Prospective Studies , Spain/epidemiologyABSTRACT
OBJECTIVE: To evaluate the risk of Burnout in the health professionals of the Huesca University Hospital, 50 years after its inauguration, to investigate the variables related to the work motivation of the hospital health personnel and to assess the predisposing and protective factors of the risk of Burnout. MATERIAL AND METHODS: An observational, analytical, prospective and unicentric study was conducted from September 2017 to April 2019, evaluating all the health professionals who worked at the Hospital San Jorge de Huesca (n=209). RESULTS: The mean age was 42.86 years. 72.2% were women. 12.4% had moderate risk of burnout. There was 12.4% of high emotional exhaustion, 36.8% of high depersonalization and 44.5% of low personal accomplishment. Burnout was statistically significant associated with the professional category (P=.010), work experience (P=.026), hours of work per week (P=.036), choice of the same profession (P=.001) and recommendation to the offspring (P<.001). CONCLUSIONS: One tenth of the sample had a moderate risk of burnout. Almost half of the health workers confirmed a high degree of satisfaction with the work environment and the majority expressed an adequate use of well-being strategies and a high degree of autonomy, recognition and satisfaction at work.
ABSTRACT
BACKGROUND: Recently, the notion that smoking may adversely affect Crohn's disease (CD) outcomes has been challenged by the suggestion that the widespread use of immunosuppressants and anti-TNF drugs might offset the adverse effects of tobacco. AIM: To reassess the influence of tobacco smoking on disease phenotype and complications on a time-dependent analysis, taking into account the different therapeutic interventions. METHODS: We designed a retrospective cohort study of 3224 patients with Crohn's disease. The data were collected from the Spanish national inflammatory bowel disease registry (ENEIDA), including information regarding demographics, clinical characteristics, disease complications, therapeutic interventions and smoking status. Patients were classified as nonsmokers, smokers and former smokers, according to their present and past smoking habits. RESULTS: In the univariate analysis, smokers had more strictures (22.6% vs. 19.3%, P < 0.05) and less colonic involvement (7.2% vs. 10.9%, P < 0.05), and were more frequently under treatment with steroids (91.6% vs. 85.8%, P < 0.05), immunosuppressants (73.5% vs. 63.6% P < 0.05) or anti-TNF drugs (31.4% vs. 25.1%, P < 0.05) than nonsmokers. In the time-dependent multivariate analysis, smokers were found to have a significantly decreased survival free of stricturing disease (HR: 1.5, CI 95% 1.18-1.90) or perianal complications (HR: 1.50, CI 95% 1.01-1.46), and had a higher risk for requiring thiopurine therapy (HR: 1.20, CI 95% 1.05-1.30). CONCLUSION: These results suggest that, despite the widespread use of immunosuppressants and anti-TNF drugs, smokers with Crohn's disease still have a more severe disease course, with increased therapeutic requirements when compared with nonsmokers.
Subject(s)
Crohn Disease/physiopathology , Immunologic Factors/therapeutic use , Immunosuppressive Agents/therapeutic use , Smoking/adverse effects , Adult , Anti-Inflammatory Agents/therapeutic use , Cohort Studies , Crohn Disease/drug therapy , Disease Progression , Female , Humans , Male , Middle Aged , Registries , Retrospective Studies , Risk , Severity of Illness Index , Spain , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
FUNDAMENTO Y OBJETIVO. Estudiar las características demográficas y clínicas de los pacientes diagnosticados de enfermedad celiaca en La Rioja. MATERIAL Y MÉTODOS. Estudio descriptivo de carácter retrospectivo de pacientes diagnosticados de enfermedad celiaca desde enero hasta diciembre de 2006. Se registraron sus características demográficas, las manifestaciones clínicas, las pruebas complementarias que certificaron el diagnóstico, su respuesta al tratamiento y sus complicaciones. RESULTADOS. En este estudio se han incluido 179 pacientes celiacos riojanos, teniendo en cuenta el modelo iceberg en nuestra población. Este dato supone la quinta parte de los pacientes celiacos que hipotéticamente existen en nuestra comunidad. Existen dos picos de máxima incidencia en el diagnóstico: en la infancia (50,3%) y entre la tercera y la cuarta décadas de la vida (14,5%), siendo diagnosticados el 40,8% de los pacientes antes de los 6 años de edad. Las manifestaciones digestivas más típicas fueron la diarrea y la pérdida de peso (72,3 y 52,3%, respectivamente) y las manifestaciones extradigestivas más frecuentes fueron la ferritina baja (57,1%) junto con la anemia ferropénica (36,8%) seguidas de la hipertransaminasemia (34,6%). En la población celiaca riojana se encontró evidencia de enfermedad celiaca en un 10% de familiares de primer grado. La antigliadina fue el marcador serológico más solicitado tanto para diagnóstico (72,6%) como para seguimiento (98,1%). La biopsia, que es la prueba diagnóstica principal, se realizó en el 82,6% de los pacientes. En todos los pacientes se pautó tratamiento con dieta sin gluten, mientras que el tratamiento con hierro (39,6%) fue el tratamiento coadyuvante más utilizado. CONCLUSIONES. La enfermedad celiaca es una patología infradiagnosticada en la población riojana, pero se ha observado un incremento en su diagnóstico en los últimos años (AU)
OBJECTIVE. To study the demographic and clinical characteristicsof patients diagnosed of celiac disease in La Rioja.PATIENTS AND METHODS. Descriptive, retrospectivestudy on patients suffering celiac disease from January 2006to December 2006. Their demographic characteristics, clinicalmanifestations, and complementary tests that certifiedtheir diagnosis, as well as response to treatment and theircomplications were recorded.RESULTS. A total of 179 celiac patients from La Rioja wereincluded in this study. Considering the iceberg model inour population, this information accounted for one-fifth ofthe hypothetically existing celiac patients in our community.There are two maximum peaks in the incidence of thediagnosis: childhood (50.3%) and between the third andfourth decades of the life (14.5%), 40.8% of the patientsbeing diagnosed before 6 years of age.The most frequent typical digestive manifestations werediarrhea and weight loss (72.3% and 52.3%, respectively).The most frequent extradigestive manifestations were low ferritin(57.1%) and ferropenic anemia (36.8%) followed byhypertransaminasemia (34.6%). Evidence of celiac diseasewas found in 10% of first degree relatives in the La Rioja celiacpopulation. Antigliadin was the serological marker requestedmost, both for diagnosis (72.6%) and for follow-upstudy (98.1%). Biopsy, which is the main diagnostic test, wasperformed in 82.6% of the patients. All patients were treatedwith gluten-free diet, treatment with iron (39.6%) being thecoadjuvant treatment used most.CONCLUSIONS. Celiac disease is an underdiagnosed diseasein the La Rioja population. However an increase in itsdiagnosis has been observed in recent years (AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Celiac Disease/epidemiology , Glutens/adverse effects , Celiac Disease/complications , Celiac Disease/diet therapy , Celiac Disease/diagnosis , Socioeconomic Factors , Epidemiology, Descriptive , Spain/epidemiology , Diarrhea/etiology , Age DistributionABSTRACT
Acute acalculous cholecystitis is a very rare clinical presentation of Q fever. We report the case of a 38-year-old man who presented with fever associated with elevation of liver enzyme levels and thickening of the gallbladder wall on abdominal ultrasonography and who was initially diagnosed with acute acalculous cholecystitis. Due to the persistence of fever and transaminase elevation despite antibiotic treatment, a liver biopsy was performed. Characteristic "doughnut" epithelioid granulomas were observed, suggesting a diagnosis of granulomatous hepatitis caused by Q fever, which was confirmed by serological methods. Treatment with doxycycline was commenced and the patient subsequently showed rapid clinical improvement, with disappearance of fever and normalization of liver enzyme levels. We review 8 cases of acute cholecystitis associated with Q fever published in the literature and stress the importance of liver biopsy in the etiological diagnosis of patients with prolonged fever and abnormal liver function tests.
Subject(s)
Acalculous Cholecystitis/etiology , Q Fever/complications , Acalculous Cholecystitis/diagnosis , Adult , Humans , Male , Q Fever/diagnosisABSTRACT
La colecistitis aguda alitiásica es una forma infrecuente depresentación de la fiebre Q. Se expone el caso clínico de unpaciente varón de 38 años con un síndrome febril asociado aalteraciones en las pruebas de función hepática y un engrosamientode la pared vesicular en la ecografía abdominal,que permitió establecer un diagnóstico inicial de colecistitisalitiásica. La falta de respuesta al tratamiento habitual, juntocon la persistencia de la fiebre e hipertransaminasemia,motivó la realización de una biopsia hepática que mostró lapresencia de granulomas de células epitelioides «en rosquilla» típicos de la hepatitis granulomatosa por fiebre Q. Eldiagnóstico se confirmó posteriormente mediante serología.El tratamiento con doxiciclina fue altamente efectivo, conrápida desaparición de la fiebre y normalización de laspruebas de función hepática.Además, se realiza una revisión de los 8 casos de colecistitisaguda asociada a fiebre Q descritos en la bibliografía y sesubraya el papel de la biopsia hepática en el diagnósticoetiológico de los cuadros de fiebre prolongada asociada a alteracionesen el perfil hepático
Acute acalculous cholecystitis is a very rare clinical presentationof Q fever. We report the case of a 38-year-old manwho presented with fever associated with elevation of liverenzyme levels and thickening of the gallbladder wall on abdominalultrasonography and who was initially diagnosedwith acute acalculous cholecystitis. Due to the persistence offever and transaminase elevation despite antibiotic treatment,a liver biopsy was performed. Characteristic «doughnut epithelioid granulomas were observed, suggesting adiagnosis of granulomatous hepatitis caused by Q fever,which was confirmed by serological methods. Treatmentwith doxycycline was commenced and the patient subsequentlyshowed rapid clinical improvement, with disappearanceof fever and normalization of liver enzyme levels.We review 8 cases of acute cholecystitis associated with Q feverpublished in the literature and stress the importance ofliver biopsy in the etiological diagnosis of patients with prolongedfever and abnormal liver function tests
Subject(s)
Male , Humans , Acalculous Cholecystitis/etiology , Q Fever/complications , Acalculous Cholecystitis/diagnosis , Q Fever/diagnosisABSTRACT
Ménétrier's disease is an infrequent clinical entity characterized by thickening of the gastric folds secondary to hyperplasia of the foveolar mucosa cells, frequently associated with loss of enteric proteins and hypoalbuminemia. Its etiology is unknown, although in the last few years it has been related to Helicobacter pylori infection. We present the case of a 38-year-old man with protein-losing gastroenteropathy caused by Ménétrier's disease, in whom eradication of H. pylori infection was followed by symptom improvement and resolution of hypoalbuminemia. In agreement with the criteria of other authors, we investigate the presence of H. pylori infection in all patients with Ménétrier's disease. When positive, the first-line treatment consists of eradication therapy.
Subject(s)
Anti-Ulcer Agents/therapeutic use , Gastritis, Hypertrophic/drug therapy , Helicobacter Infections/drug therapy , Helicobacter pylori/isolation & purification , Adult , Gastric Mucosa/microbiology , Gastritis, Hypertrophic/etiology , Helicobacter Infections/complications , Humans , Male , Protein-Losing Enteropathies/etiology , Treatment OutcomeABSTRACT
El síndrome de distensión visceral es el diagnóstico más frecuente en nuestro medio en pacientes ancianos que acuden a Urgencias por presentar dolor abdominal agudo (DAA). La oclusión intestinal representa el 59,6 por ciento de estos pacientes y el carcinoma colorrectal es la primera causa (46,6 por ciento) en la población de edad avanzada. Objetivos: Una exhaustiva revisión de la bibliografía nos ha llevado a verificar la escasez de trabajos que hacen referencia a la sensibilidad de la historia clínica en el proceso diagnóstico del dolor abdominal agudo en el anciano en general y en la oclusión intestinal por carcinoma colorrectal en particular, siendo éste el objetivo fundamental de nuestro estudio. Métodos: Cirujanos, gastroenterólogos y expertos en Medicina de Urgencia elaboramos un cuestionario especialmente diseñado para evaluar la semiología del DAA y que aplicamos a pacientes de edad igual o mayor a 65 años que acudían a Urgencias por este motivo. Resultados: Una historia clínica y examen físico efectuados con rigor es capaz de predecir con acierto el diagnóstico en más de la mitad de los casos de los pacientes ancianos que acuden a Urgencias presentando una oclusión intestinal por carcinoma colorrectal. Este porcentaje se eleva al 75 por ciento cuando sumamos la aportación de las pruebas complementarias rutinarias. Conclusiones: La historia clínica, aún con las limitaciones que comporta en este grupo de edad, constituye el documento principal del proceso diagnóstico en el DAA (AU)
Subject(s)
Aged , Female , Male , Humans , Intestinal Obstruction/etiology , Colorectal Neoplasms/diagnosis , Clinical Protocols , Abdomen, Acute/etiology , Medical History Taking/standards , Data Collection/standardsSubject(s)
Burns, Chemical/etiology , Caustics/adverse effects , Esophagus/injuries , Stomach/injuries , Algorithms , Burns, Chemical/pathology , Burns, Chemical/therapy , Carcinoma, Squamous Cell/chemically induced , Constriction, Pathologic/chemically induced , Constriction, Pathologic/therapy , Emergencies , Esophageal Stenosis/chemically induced , Esophageal Stenosis/therapy , Esophagoscopy , Esophagus/pathology , Gastroscopy , Humans , Necrosis , Stomach/pathology , Stomach Diseases/chemically induced , Stomach Diseases/therapyABSTRACT
El empleo de diversas dietas alimenticias como terapéutica en Gastroenterología ha originado durante muchos años numerosos tópicos, escasamente fundamentados en bases científicas que permitan avalar ciertas conductas terapéuticas. En este artículo se valora de forma crítica sus posibilidades como tratamientos primarios o bien como simples complementos terapéuticos (AU)
Subject(s)
Humans , Diet/methods , Gastrointestinal Diseases/diet therapy , Nutritional Physiological Phenomena , Gastrointestinal Diseases/therapySubject(s)
Diverticulum/complications , Gastrointestinal Hemorrhage/etiology , Jejunal Diseases/complications , Aged , Female , Humans , MaleABSTRACT
BACKGROUND: During upper digestive endoscopy arterial desaturations occur which may favour cardiopulmonary complications; therefore, monitoring and oxygen administration to risk patients is recommended. The aim of this study was to evaluate desaturations occurring during endoscopy and whether there are differences between patients with or without prior obstructive respiratory pathology. METHODS: A total of 119 consecutive patients undergoing upper digestive endoscopy were studied. The clinical history and simple spirometry were obtained before endoscopy; during endoscopy, a continuous monitoring of oxygen saturation and heart rate with pulse oximetry. RESULTS: Forty-six patients (38.7%) had oxygen saturations lower than 90% (Group I). Patients were significantly older and FEV-1, FVC, FEF 25-75, and FEV-1/FVC significantly lower among patients in Group I than among the 73 patients (61.3%) with no oxygen desaturation (Group II). A Tiffenau index lower than 70% was not a good predictor for oxygen desaturation during endoscopy. CONCLUSIONS: Pulse-oximetry monitoring during upper digestive endoscopy is recommended and particularly in patients with obstructive respiratory conditions and/or advanced age.
