Prevalencia de síndrome de burnout en anestesiología y cirugía ortopédica en un centro en Chile / Burnout prevalence in anesthesiology and orthopedic surgery in a center in Chile

Resumen Objetivo: Evaluar el agotamiento emocional o cansancio emocional, realización personal y despersonalización en el quehacer de los médicos del Servicio de Traumatología y Pabellón Central del Hospital Hernán Henríquez Aravena (HHHA) y Departamento de Cirugía de la Universidad de La Frontera, Temuco, Chile. Materiales y Método: Corte transversal. 48 sujetos: 10 residentes de traumatología y 8 de anestesiología, 12 anestesiólogos y 18 traumatólogos académicos asistenciales. Se aplicó bajo consentimiento informado: Inventario de Maslash (MBI). Análisis: tendencia central, porcentaje, así como t de student y coeficientes de alfa de Cronbach. Resultados: La prevalencia global del síndrome de burnout es 97%, por dimensiones, cansancio emocional mostró una prevalencia del 100%; baja realización personal en el trabajo 100% y despersonalización 91,6%. Para traumatología: cansancio emocional mostró prevalencia 100%; baja realización personal en el trabajo 100%, y despersonalización 82%. Para anestesiología: cansancio emocional mostró prevalencia 75%; baja realización personal en el trabajo 30% y despersonalización 30%. Existen diferencias significativas en cansancio emocional siendo mayor en género femenino y en quienes duermen menos de 7 h. El coeficiente de alpha de Cronbach del MBI fue de 0,7. Conclusión: Tanto residentes como académicos asistenciales de traumatología y anestesiología mostraron un elevado cansancio emocional que coexiste con una baja realización personal en el trabajo y alta despersonalización. En Chile, las políticas de protección están principalmente enfocadas en la Seguridad y Salud Ocupacional con la gestión de los riesgos, pero no se observan políticas de protección al estrés y salud mental que involucren contención y apoyo a la labor terapéutica de los profesionales de la medicina.

Aim: To assess levels of burnout, including emotional exhaustion, personal accomplishment and depersonalization, in the daily work of academic doctors in the Orthopedic Surgery Service and Central Surgery Service of the Hospital Hernán Henríquez Aravena (HHHA) and Surgery Department in the Universidad de La Frontera, Temuco, Chile. Materials and Method: Cross-sectional study. 48 subjects participated: 10 residents in orthopedic surgery, 8 residents in anesthesiology, 12 academic anesthesiologists and 18 academic orthopedic surgeons. Instruments applied under informed consent: Maslach Burnout Inventory (MBI). Analysis: Measures of central tendency and percentage, independent sample t-tests. Cronbach's alpha coefficients of the MBI. Results: The overall prevalence of burnout syndrome is 97%, whereas by dimensions, emotional exhaustion showed a prevalence of 100%, low personal accomplishment at work 100% and depersonalization 91.6%. For orthopedic surgery by dimensions: emotional exhaustion showed a prevalence of 100%, low personal accomplishment at work 100% and depersonalization 82%. For anesthesiology: emotional exhaustion showed a prevalence of 75%, low personal accomplishment at work 30% and depersonalization 30%. Only gender and hours of sleep showed significant differences in emotional exhaustion, with higher scores for women and those who slept less than 7 hours. 0.7 Cronbach's alpha of the MBI. Conclusión: There is excessive emotional fatigue, low job felt accomplishment and depersonalization in orthopedic surgery residents and academic. In anesthesiology, emotional high exhaustion coexists with low personal accomplishment values and depersonalization high. In Chile, protection policies are mainly focused on Occupational Safety and Health with risk management, but there are no stress protection and mental health policies involving containment and support for the therapeutic work of medical professionals.

Feasibility of a Brief Online Mindfulness and Compassion-Based Intervention to Promote Mental Health Among University Students During the COVID-19 Pandemic.

Objectives: The COVID-19 pandemic constitutes a global mental health challenge that has disrupted the lives of millions of people, with a considerable effect on university students. The aim of this study was to assess the feasibility of a brief online Mindfulness and Compassion-based Intervention to promote mental health among first year university students during COVID-19 home confinement. Methods: Participants (n=66) were first-year psychology students from a university in Spain with no prior meditation experience. Intervention lasted for 16 days and was designed ad-hoc. Using a pre-post within-subjects design, feasibility was assessed in five domains (acceptability, satisfaction, implementation, practicality, and limited efficacy testing). Participants completed both baseline and post-intervention assessments of perceived stress, anxiety, and self-compassion. Results: The intervention showed to be feasible in all domains evaluated. It was implemented as planned with constrained resources, and limited efficacy testing showed promising results. After the intervention, stress and anxiety levels decreased significantly (p<0.001, Hedges's g=0.5146; p<0.001, Hedges's g=0.6068, respectively) whereas self-compassion levels were augmented significantly (p<0.001, Hedges's g=0.6968). Conclusions: Our findings suggest that a brief online mindfulness and compassion intervention may be a feasible way of promoting mental health among university students during COVID-19 lockdown. Further studies are required to address the limitations of the present study. We conclude that online interventions may constitute a promising pathway to buffer the mental health burden derived from the COVID-19 pandemic.

Examining the Overlap between Autism Spectrum Disorder and 22q11.2 Deletion Syndrome.

22q11.2 deletion syndrome (22q11.2DS) is a genomic disorder reported to associate with autism spectrum disorders (ASDs) in 15-50% of cases; however, others suggest that individuals with 22q11.2DS present psychiatric or behavioral features associated with ASDs, but do not meet full criteria for ASD diagnoses. Such wide variability in findings may arise in part due to methodological differences across studies. Our study sought to determine whether individuals with 22q11.2DS meet strict ASD diagnostic criteria using research-based guidelines from the Collaborative Programs of Excellence in Autism (CPEA), which required a gathering of information from three sources: the Autism Diagnostic Interview-Revised (ADI-R), the Autism Diagnostic Observational Schedule (ADOS), and a clinician's best-estimate diagnosis. Our study examined a cohort of children, adolescents, and young adults (n = 56) with 22q11.2DS, who were ascertained irrespective of parents' behavioral or developmental concerns, and found that 17.9% (n = 10) of the participants met CPEA criteria for an ASD diagnosis, and that a majority showed some level of social-communication impairment or the presence of repetitive behaviors. We conclude that strictly defined ASDs occur in a substantial proportion of individuals with 22q11.2DS, and recommend that all individuals with 22q11.2DS be screened for ASDs during early childhood.

The effect of hypocalcemia in early childhood on autism-related social and communication skills in patients with 22q11 deletion syndrome.

22q11 deletion syndrome (22qDS), also known as DiGeorge syndrome, is a copy number variant disorder that has a diverse clinical presentation including hypocalcaemia, learning disabilities, and psychiatric disorders. Many patients with 22q11DS present with signs that overlap with autism spectrum disorder (ASD) yet the possible physiological mechanisms that link 22q11DS with ASD are unknown. We hypothesized that early childhood hypocalcemia influences the neurobehavioral phenotype of 22q11DS. Drawing on a longitudinal cohort of 22q11DS patients, we abstracted albumin-adjusted serum calcium levels from 151 participants ranging in age from newborn to 19.5 years (mean 2.5 years). We then examined a subset of 20 infants and toddlers from this group for the association between the lowest calcium level on record and scores on the Communication and Symbolic Behavior Scales-Developmental Profile Infant-Toddler Checklist (CSBS-DP ITC). The mean (SD) age at calcium testing was 6.2 (8.5) months, whereas the mean (SD) age at the CSBS-DP ITC assessment was 14.7 (3.8) months. Lower calcium was associated with significantly greater impairment in the CSBS-DP ITC Social (p < 0.05), Speech (p < 0.01), and Symbolic domains (p < 0.05), in regression models adjusted for sex, age at blood draw, and age at the psychological assessment. Nevertheless, these findings are limited by the small sample size of children with combined data on calcium and CSBS-DP ITC, and hence will require replication in a larger cohort with longitudinal assessments. Considering the role of calcium regulation in neurodevelopment and neuroplasticity, low calcium during early brain development could be a risk factor for adverse neurobehavioral outcomes.

Judgments of Monkey's (Macaca mulatta) Facial Expressions by Humans: Does Housing Condition "Affect" Countenance?

The ability to interpret facial expressions of others is one of the more important abilities possessed by humans. However, is it possible for humans to accurately interpret the facial expressions of another species of primate, namely rhesus monkeys (Macaca mulatta)? We investigated this possibility by taking digital photos of four rhesus monkeys housed either singly or socially and allowing thirty-one participants to judge these photographs as representing either a happy, sad, or neutral monkey. Results indicated that the photographs of monkeys that were socially housed were more likely to be rated as happy or neutral than were photographs of singly housed monkeys. We suggest that these results imply important parallels between the perception of human and nonhuman primate facial expressions as well as introduce a potential new method for assessing nonhuman primate well-being.

Asymmetries in postural control and locomotion in chimpanzees (Pan troglodytes).

Posture and locomotion are two of the most primitive and basic motor manifestations of an organism's behavior. Although the restrictions they impose on other motor functions are evident, few studies have considered the possibility of asymmetries in these behaviors in human and nonhuman primates, and how they might impact other asymmetries at higher functional levels. The aim of the current study was to explore in a group of 10 chimpanzees at the Madrid Zoo-Aquarium the degree of asymmetry in four behaviors related to locomotion (walking, ascending, descending, and brachiating) and four behaviors associated with posture (sitting, lying, hanging, and changing postures). Few subjects showed individual preferences, but significant trends in the group for some of the behaviors were found, including right-hand use when initiating quadruped walking, and left-hand use when descending and hanging. Some significant correlations also emerged: a negative one between walking and descending, and a positive one between walking and brachiating and between sitting and changing postures. No correlations were found between locomotor and postural modes. Although we cannot make generalizations on the population level at this time, these findings highlight the importance of considering postural and locomotion factors when studying motor asymmetries in primates.

Neuropsicología de la percepción y la expresión facial de emociones: Estudios con niños y primates no humanos / Neuropsychology of perception and facial expression of emotions: Studies with children and non human primates

Este estudio revisa diferentes investigaciones sobre la neuropsicología de la percepción y la expresión facial de emociones en niños y en primates no humanos. Se parte de las teorías neodarwinianas sobre el origen de la emoción, que presuponen la existencia de circuitos cerebrales específicos para la expresión y comprensión del afecto y consideran que estos comportamientos son innatos y filogenéticamente determinados . A partir de la literatura examinada, las conclusiones principales que pueden extraerse son las siguientes: (1) A lo largo del primer año de vida los niños manifiestan capacidades básicas para reconocer emociones. Entre otros correlatos neurobiológicos, se ha observado que este proceso se corresponde con una mayor actividad del hemisferio cerebral derecho, frente al izquierdo. (2) En primates no humanos, y desde distintas aproximaciones experimentales, se ha encontrado un patrón similar al de nuestra especie en tareas de reconocimiento y discriminación de expresiones faciales de emociones.(3) Los lactantes expresan emociones con acciones musculares similares a las descritas en adultos. La mayoría de los autores señalan que el hemisferio cerebral derecho muestra una mayor implicación que el izquierdo, también en el caso de la expresión emocional y para todas las emociones estudiadas. No obstante desde algunas investigaciones se concluye que el hemisferio izquierdo es el dominante en el caso de la expresión de emociones positivas y el hemisferio derecho sólo en las negativas. (4) Los estudios sobre expresión facial en primates no humanos indican que existe una asimetría facial que se manifiesta en una mayor intensidad de la expresión en la mitad izquierda de la cara y, de manera correspondiente, en una mayor implicación del hemisferio cerebral derecho. Se concluye esta revisión considerando que la existencia de semejanzas anatómicas y funcionales entre adultos, niños y primates no humanos justifica el interés por los estudios de ontogenia y filogenia para conocer mejor las bases neurobiológicas que subyacen a la conducta emocional (AU)

Human assessment of chimpanzee facial asymmetry.

In this study, facial asymmetry in chimpanzees was assessed using a technique that has traditionally been implemented in human studies. Image composites made of each half of chimpanzees' facial expressions were presented to humans with and without chimpanzee experience. The group of subjects with chimpanzee experience considered composites made of the left side of the chimpanzee faces as the most emotionally intense for the emotional categories of play, silent bared-teeth, scream face, and a neutral category. On the other hand, left-left composites were not consistently judged by subjects with and without chimpanzee experience as the most similar to the whole original face, which might be explained as the result of an attentional bias in the human observers towards the right side of the chimpanzee expressions. Furthermore, responses given by subjects with and without chimpanzee experience were highly correlated, which indicates that the two groups of humans perceived the chimpanzee facial expressions in a similar fashion. The finding of left-sided asymmetries in these chimpanzees' facial expressions suggests a right hemisphere asymmetry in the production of emotions in this species and it is consistent with results reported in human and other nonhuman primates.

Asymmetry in facial expression of emotions by chimpanzees.

Asymmetries in human facial expressions have long been documented and traditionally interpreted as evidence of brain laterality in emotional behavior. Recent findings in nonhuman primates suggest that this hemispheric specialization for emotional behavior may have precursors in primate evolution. In this study, we present the first data collected on our closest living relative, the chimpanzee. Objective measures (hemimouth length and area) and subjective measures (human judgements of chimeric stimuli) indicate that chimpanzees' facial expressions are asymmetric, with a greater involvement of the left side of the face in the production of emotional responses. No effect of expression type (positive versus negative) on facial asymmetry was found. Thus, chimpanzees, like humans and some other nonhuman primates, show a right hemisphere specialization for facial expression of emotions.

Functional asymmetry of emotions in primates: new findings in chimpanzees.

In the past 15 years, there have been a number of studies conducted on asymmetries in the perception and production of facial expressions in human and non-human primates as a means of inferring hemispheric specialization for emotions. We review these studies to assess continuity and discontinuity between species in these emotional processes. We further present new data on asymmetries in the production of facial expressions in a sample of captive chimpanzees. Objective measures (hemimouth length and area) and subjective measures (human judgement's of chimeric stimuli) indicate that chimpanzees' facial expressions are asymmetric, with a greater involvement of the left side of the face (right hemisphere) in the production of emotional responses. Left hemimouth was bigger than the right in the facial expressions of pant-hooting, play, and silent bared-teeth (p < 0.05) and it extended laterally more than the right in the categories of pant-hooting, silent bared-teeth, and scream face (p < 0.05). Human judges also reported that the left side of the faces was emotionally more intense in the case of the play and silent bared-teeth categories (p < 0.01). Thus, chimpanzees, like humans and some other non-human primates, show a right hemisphere specialization for facial expression of emotions, which suggests that this functional asymmetry is homologous in all these species.