Academic burnout in psychology and health-allied sciences: the BENDiT-EU program for students and staff in higher education.

Studying at university involves demanding academic and clinical training requirements for students from Psychology and other health-allied fields, potentially having severe physical and mental health implications. Existing training programs for addressing burnout have focused thus far on specific areas (e.g., stress management, physical exercise, mindfulness meditation, etc.) with promising outcomes. However, no comprehensive programs have been developed to train students and staff in the early identification of burnout signs and characteristics as well as in self-assessing personal needs and habits (i.e., primary prevention), or in identifying community resources and evidence-based strategies to overcome burnout (i.e., secondary prevention). This paper describes the content development, refinement, and piloting process of the BENDiT-EU program as part of a European collaborative to address academic burnout for health-allied students. Piloting results showed that participants viewed the program positively and provided helpful suggestions for content improvement and training delivery. Future research directions should target experimental investigations of the program's effectiveness and the longitudinal interaction of burnout with other variables (e.g., resilience).

Neuroendocrine Parathyroid Tumors: Quality of Life in Patients with Primary Hyperparathyroidism.

Tumors of the parathyroid glands, when associated with PTH (parathyroid hormone) excess, display a large area of complications; in addition to the classical clinical picture of primary hyperparathyroidism (PHP), a complex panel of other symptoms/signs can be identified, including memory and cognitive impairment, chronic asthenia/fatigue, reduced muscle functionality, depressive mood, non-specific bone pain, and loss of sleep quality. The perception of quality of life (QoL) can be supplementarily enhanced by their progressive onset, which makes many patients not be fully aware of them. Their improvement was reported very early after parathyroidectomy (PTx), yet the level of statistical evidence does not qualify these non-classical elements as standalone indications for PTx. Our objective is introducing an up-to-date on QoL scores with regards to the patients diagnosed with PHP, particularly taking into consideration PHP management from baseline to post-operatory outcome, including in cases with multiple endocrine neoplasia. This is a narrative review of literature. We revised full-length papers published in English through PubMed research conducted between January 2018 and May 2023 by using the key words "quality of life" and "primary hyperparathyroidism". We particularly looked at data on self-reported QoL (through questionnaires). We excluded from the search the studies focused on non-PTH related hypercalcemia, secondary, and/or renal/tertiary hyperparathyroidism, and vitamin D supplementation. Overall, we identified 76 papers and selected for the final analysis 16 original studies on QoL and PHP (a total of 1327 subjects diagnosed with syndromic and non-syndromic PHP). The studies with the largest number of individuals were of 92, 104, 110, 134, 159, as well as 191. A few cohorts (n = 5) were of small size (between 20 and 40 patients in each of them). Concerning the study design, except for 2 papers, all the mentioned studies provided longitudinal information, particularly the timeframe from baseline (before PTx) and after surgery. The post-operatory follow-up was of 3-6 months, but mostly between 1 and 3 years (maximum a decade of surveillance). The age of the patients varies between medians of 56, 62, 64, and 68 years. Most frequent questionnaires were SF-36, PHPQoL, and PAS. Despite not being unanimously similar, an overall reduced score of QoL in patients with PHP versus controls was registered, as well as general improvement following PTx. Variations of QoL results might have a multifactorial background from different comorbidities, studied populations, technical aspects of collecting the data, etc. QoL scores in PHP represents a complex heterogeneous picture, from their correlation with clinical features and lab assays (e.g., the level of serum calcium), the associated comorbidities (such as multiple endocrine neoplasia syndromes), up to the assessment of the QoL improvement after parathyroidectomy (PTx). While current studies do not unanimously agree on each QoL domain, the assessment of QoL might represent a supplementary argument to consider when deciding for PTx, especially in asymptomatic cases and in patients who do not fit into well-known categories of surgery candidates, according to current guidelines, thus assessing QoL in PHP is part of a current research gap. QoL evaluation in PHP remains an open issue, towards which awareness should be cultivated by both endocrinologists and surgeons. The introduction of a routine evaluation of the QoL scores in patients, as well as the selection of the most appropriate questionnaire(s), represents an open chapter thus awareness in mandatory.

The Effects of COVID-19 on the Emotional and Social Stability, Motivation and Attitudes of Gifted and Non-Gifted Children in Greece.

Gifted children exhibit advanced cognitive abilities, usually beyond their emotional development, which puts them at higher risk of the negative consequences of isolation. This study investigates the effects of distance learning and home confinement on the emotional and social stability, motivation, and attitudes of gifted and non-gifted children in Greece. Our study includes two subsets, from before (September 2017 to March 2020) and after the outbreak of the COVID-19 pandemic (April 2020 to March 2022). The analysis indicated that home confinement and distance learning caused children to create a stronger attachment with their parents, and it increased the involvement of parents in their child's school experience. Non-gifted children displayed high levels of certain attitudes (perfectionism, desire for acceptance, and condescending behavior) and demonstrated elevated motivation. Gifted children in the pre-COVID-19 period had already displayed increased levels of condescending attitude, which is assumed to be the result of already existing expectations from their parents. The pandemic further increased this attitude, as a result of the higher expectations of their parents. Overall, the study highlighted the importance of children to have more than one support system and the need for them to strengthen their self-image.

Depression: A Contributing Factor to the Clinical Course in Myasthenia Gravis Patients.

Background and Objectives: The association between myasthenia gravis (MG) and depression is intricate and characterized by bidirectional causality. In this regard, MG can be a contributing factor to depression and, conversely, depression may worsen the symptoms of MG. This study aimed to identify any differences in the progression of the disease among patients with MG who were also diagnosed with depression as compared to those without depression. Our hypothesis focused on the theory that patients with more severe MG symptoms may have a higher likelihood of suffering depression at the same time. Materials and Methods: One hundred twenty-two male and female patients (N = 122) aged over 18 with a confirmed diagnosis of autoimmune MG who were admitted to the Neurology II department of Myasthenia Gravis, Clinical Institute Fundeni in Bucharest between January 2019 and December 2020, were included in the study. Patients were assessed at baseline and after six months. The psychiatric assessment of the patients included the Hamilton Depression Rating Scale-17 items (HAM-D), and neurological status was determined with two outcome measures: Quantitative Myasthenia Gravis (QMG) and Myasthenia Gravis Activities of Daily Life (MG-ADL). The patients were divided into two distinct groups as follows: group MG w/dep, which comprised 49 MG patients diagnosed with depressive disorder who were also currently receiving antidepressant medication, and group MG w/o dep, which consisted of 73 patients who did not have depression. Results: In our study, 40.16% of the myasthenia gravis (MG) patients exhibited a comorbid diagnosis of depression. Among the MG patients receiving antidepressant treatment, baseline assessments revealed a mean MG-ADL score of 7.73 (SD = 5.05), an average QMG score of 18.40 (SD = 8.61), and a mean Ham-D score of 21.53 (SD = 7.49). After a six-month period, a statistically significant decrease was observed in the MG-ADL (2.92, SD = 1.82), QMG (7.15, SD = 4.46), and Ham-D scores (11.16, SD = 7.49) (p < 0.0001). These results suggest a significant correlation between MG severity and elevated HAM-D depression scores. Regarding the MG treatment in the group with depression, at baseline, the mean dose of oral corticosteroids was 45.10 mg (SD = 16.60). Regarding the treatment with pyridostigmine, patients with depression and undergoing antidepressant treatment remained with an increased need for pyridostigmine, 144.49 mg (SD = 51.84), compared to those in the group without depression, 107.67 mg (SD = 55.64, p < 0.001). Conclusions: Our investigation confirms that the occurrence of depressive symptoms is significantly widespread among individuals diagnosed with MG. Disease severity, along with younger age and higher doses of cortisone, is a significant factor associated with depression in patients with MG. Substantial reductions in MG-ADL and QMG scores were observed within each group after six months, highlighting the effectiveness of MG management. The findings suggest that addressing depressive symptoms in MG patients, in addition to standard MG management, can lead to improved clinical outcomes.

Altered states, alkaloids, and catatonia: Monoaminoxidase inhibitors and their role in the history of psychopharmacology.

Monoamine oxidases are mitochondrial enzymes that catalyze the oxidative deamination of biogenic amines (adrenaline, noradrenaline, serotonin, and dopamine), causing their inactivation and subsequently playing a fundamental role in the homeostasis of various neurotransmitters. As the regulation of these effects was deemed important in clinical practice, numerous modulators of these enzymes were tested for various clinical effects. The purpose of this paper is to present a few historical landmarks regarding monoaminoxidase inhibitors and their usefulness as psychopharmacological agents. We will be focusing on banisterine, iproniazid, selegiline, rasagiline, tranylcypromine, moclobemide, and their role in the history of psychopharmacology. An almost unknown fact is that harmine, an MAO-A alkaloid, was used as early as the latter half of the 1920s in Bucharest, to reduce catatonic symptoms in schizophrenia, thus ushering the dawn of psychopharmacology era which started with chlorpromazine in the 1950s.

Somatic Symptoms and Sleep Disorders: A Literature Review of Their Relationship, Comorbidities and Treatment.

This study aimed to investigate the relationship between somatic symptom disorder (SSD) and sleep disorders, following three research questions: (1) How are these disorders correlated? (2) What are the comorbidities reported in these patients? and (3) What are the most effective pharmacological and non-pharmacological treatments for both conditions? PubMed, Scopus, OVID, Medline, and ProQuest databases were searched for relevant articles published between 1957-2020. Search terms included "somatic symptoms disorder", "sleep disorders", "insomnia", "somatoform", "somatization", "therapeutic", "psychotherapy", and alternative, formerly used terms for SSD. Forty papers were finally included in the study. Prevalence of insomnia in SSD patients ranged between 20.4-48%, with this being strongly correlated to somatic symptoms and psychosocial disability. The most relevant comorbidities were generalized anxiety disorder, depression, fatigue, negative mood, substance use, orthorexia, alexithymia, anorexia, weight loss, poor eating habits, and acute stress disorder. Patients receiving antidepressant therapy reported significant improvements in insomnia and somatic symptoms. In terms of non-pharmacological interventions, cognitive-behavioral therapy (CBT) showed improvements in sleep outcomes, while the Specialized Treatment for Severe Bodily Distress Syndromes (STreSS) may represent an additional promising option. Future research could include other medical and psychosocial variables to complete the picture of the relationship between sleep disorders and somatic symptoms.

The Impact of Self-Efficacy, Optimism, Resilience and Perceived Stress on Academic Performance and Its Subjective Evaluation: A Cross-Sectional Study.

This study aimed to highlight the contribution of self-efficacy, optimism, resilience and perceived stress on academic performance (GPA) at medical undergraduate students. Additionally, we investigated the relationship established between abovementioned variables, gender and position in the academic cycle and the factors associated with satisfaction regarding own academic results. 118 students (25 men, 93 women, mean age 22.863, SD = 1.763) participated in the study. They were administered the General Self-Efficacy Scale (G-SES), the Revised Life Orientation test (LOT-R), the Brief Resilience Scale (BRS) and the Perceived Stress Scale (PSS). t, Wilcoxon-Mann-Whitney, chi-square tests, and linear regressions were performed, in order to test the strength of the hypothesized associations. Data analysis demonstrates a significant association between low optimism, low resilience, high perceived stress and poor academic performance. Even though preclinical students displayed greater perceived stress, it negatively correlated to GPA only in clinical students, this indicating a possible accumulation of stress-related effects. No gender differences were met for the studied variables. Students in clinical cycle were significantly less satisfied about their own performance. These results indicate solid associations between psychosocial variables and academic performance, and differences in the subjective evaluation of own performance, suggesting key points to address, when designing interventions against academic stress.

Psychological Variables Associated with HPV Vaccination Intent in Romanian Academic Settings.

The aim of this study was to evaluate (1) the female medical students' knowledge about HPV infection; (2) the associations between the HPV vaccination intent and coping strategies, health locus of control (HLOC), and sense of coherence; and (3) the specific differences between preclinical and clinical students in terms of the vaccination intent. Participants included 1243 female medicine students (mean age = 21.526, SD = 2.007), who completed The Multidimensional Health Locus of Control (MHLC)-Form A, the Brief COPE Scale, the Sense of Coherence Scale (SOC-13), and two questionnaires measuring the knowledge about the HPV infection and the HPV vaccination intent. Results show a good knowledge about HPV, which progressively increased during the study cycles. Still, the main contributors to vaccination intent are represented by coping strategies and health locus of control. Refusal of vaccination is associated to behavioral disengagement and the use of religion, precontemplation and contemplation to denial, and preparation to planning, positive reframing, and the powerful others component of HLOC. Sense of coherence did not predict vaccination intent. In clinical years, active coping outweighs HLOC in making the decision to get vaccinated. These results could be helpful in designing personalized strategies for addressing vaccine hesitancy in academic communities.

Psychopharmacological Treatment, Intraocular Pressure and the Risk of Glaucoma: A Review of Literature.

Through the years, the available psychopharmacological treatments have expanded with numerous new drugs. Besides weight gain, gastro-intestinal problems or Parkinson-like symptoms, ocular adverse effects of psychiatric drugs have been reported. These adverse effects are not common, but can be dangerous for the patient. This review summarises the current knowledge on the risk of raised intraocular pressure and glaucoma entailed by psychopharmacological treatment. Also, it provides updated data for clinicians involved in the treatment of patients with glaucoma or glaucoma risk factors. For this purpose, we performed an extensive literature search in the PubMed database using specific terms. Selective serotonin and noradrenaline reuptake inhibitors are the best evidenced as having no association with glaucoma. Antipsychotics, and especially first generation, seem to have no correlation with an increased intraocular pressure and therefore possibly with a risk of glaucoma, although a special attention should be paid when using ziprasidone. Tricyclic antidepressants, benzodiazepines and topiramate should be avoided in patients diagnosed with glaucoma or at risk. Clinicians should be aware of the possible psychotropic drug induced glaucoma and monitor at risk patients closely in order to prevent this condition. Irrespective of the psychopharmacological regimen taken into consideration, the glaucoma patient should be under the strict supervision of the ophthalmologist.

Meaning in Life, Subjective Well-Being, Happiness and Coping at Physicians Attending Balint Groups: A Cross-Sectional Study.

This study aimed to measure the scores of well-being, subjective happiness, sense of meaning, and coping in Romanian physicians and the potential impact on them of systematically attending Balint groups. Eighty participants (33 men, 47 women, mean age 38.90, SD 9.73) were included in the study. From them, 43 had systematically attended a Balint group in the last two years, while the others represented the controls. All participants were administered the Meaning of Life Questionnaire, the Job-related Affective Well-being Scale, the Brief COPE Scale, and the Subjective Happiness Scale. t-tests and MANOVA were used to compare the group scores and the impact of Balint training on the study variables. Results showed that Balintian participants had a lower use of denial and self-blame and were more oriented towards the seeking of emotional and instrumental support. They also reported higher scores in high pleasurable-low arousal emotions, positive emotions, and in the perception of the presence of meaning. Still, when considering other additional predictors (gender, age), the distinct impact of Balint training remained limited to the preference for certain coping mechanisms. These results could stimulate the use of Balint groups as a tool for the physician's formation programs.

Going on a vision quest in the pandemic context: the linkage between a learning organization, internal marketing and burnout in Ophthalmology physicians.

The Romanian health care system faced a long line of chaotic reformations that proved to be less patient oriented and more expensive, leading to an increased level of burnout in physicians. The phenomenon of burnout occurs more and more often in the pandemic context, even in ophthalmology services. Among psychological and occupational factors that may cause burnout, there are also organizational factors that may decrease the burnout levels. The aim of this paper was to bring more insight into the prevention of burnout in ophthalmology physicians by applying strategies related to the organizational factors, namely, learning organization and internal marketing, in sustainable manner. We elaborated the conceptual framework on a thorough literature review and concluded that a learning organization has a positive impact on the implementation of internal marketing practices, internal marketing practices decrease the level of burnout, if appropriately applied, as well as, a learning organization has the power to decrease the level of burnout in ophthalmology physicians.

Clinical Validity of Subjective Clinical Prognosis in First Episode Psychosis Schizophrenia Patients: An Analysis of Data from the European First Episode Schizophrenia Trial (EUFEST) Study.

PURPOSE: This study examined the validity of subjective clinical prognosis (SCP), a commonly used clinical tool, in first episode psychosis patients included in the European First Episode Schizophrenia Trial (EUFEST) study. PATIENTS AND METHODS: The study comprised 455 patients from the EUFEST trial (mean age 25.92, SD=5.45; 188 (41.31%) women, 267 (58.69%) men). SCP was classified into three mutually exclusive groups: "good prognosis" (GP) (n=265), "average prognosis" (AP) (n=131), and "poor prognosis" (PP) (n=59). The validity of the SCP was assessed by investigating the differences between the SCP groups and completer or responder status of the patients, during 1 year of the trial. RESULTS: The proportion of completers was significantly higher in the GP group (64.4%) compared to the AP group (25.6%) (OR=1.62, 95% CI=1.062-2.476, p<0.031) and the PP group (10%) (OR=2.17, 95% CI=1.226-3.853, p<0.009) throughout the whole duration of the trial. In what concerns responsiveness, a significantly higher number of responders were registered in the GP group compared to the AP and the PP groups in the first three months of treatment, but this outcome did not persist afterwards. CONCLUSION: In terms of its predictive value at first episode schizophrenic patients, SCP seems to be reliable for treatment completion, but has a limited utility in what concerns responsiveness to treatment. This finding suggests the necessity of creating a prediction model potentially including, besides SCP, other measurement-based variables.

Factors Associated with Burnout in Medical Academia: An Exploratory Analysis of Romanian and Moldavian Physicians.

This study aimed to assess the extent of burnout in Romanian and Moldavian academic physicians and to determine the predictive value of emotional intelligence (EI), coping strategies, work motivation (WM), perceived organizational support (POS), and the socio-demographic characteristics of burnout. Two hundred physicians (40% men, 60% women, mean age = 43.02, SD = 9.91) participated in the study. They were administered the Maslach Burnout Inventory-General Survey, Brief COPE Scale, Multidimensional Work Motivation Scale, Schutte's Self-Report Emotional Intelligence Test, and Perceived Organizational Support Scale. Mann-Whitney U tests were used to assess the significance of intercountry differences, while hierarchical regressions were performed to investigate the predictive value of the independent variables on burnout. Moldavian participants had significantly lower scores in burnout and amotivation (p < 0.001) and higher scores in EI, POS, and WM (p < 0.001). The main burnout predictors were amotivation (ß = 0.388, p < 0.001) and low POS (ß = -0.313, p< 0.001) in Moldavian respondents, and WM (intrinsic: ß = -0.620, p < 0.001; extrinsic: ß = 0.406, p < 0.001) in Romanian participants. Moldavian respondents displayed better adjustment to academic stress. The distribution of burnout predictors suggests better sensitivity of respondents to organizational interventions in Moldova and to individual therapy in Romania. This data could serve to better tailor Public Health interventions addressing burnout in the academic environment.

The impact of Balint work on alexithymia, perceived stress, perceived social support and burnout among physicians working in palliative care: a longitudinal study.

OBJECTIVES: Physicians working with palliative patients have a substantial risk of emotional exhaustion because of their daily confrontation with suffering and death. Common concerns include alexithymia, high stress, low perceived social support and a greater burnout risk. This longitudinal study aimed to evaluate the effectiveness of Balint training in preventing the development of these symptoms in these medical professionals. MATERIAL AND METHODS: The design of the study was longitudinal. A group of 69 physicians working with palliative patients from 5 county hospitals in Romania (33 men, 36 women) participated in the study. Out of them, 31 joined and systematically attended a local Balint group whereas the others did not participate in such a group, either during the study or previously. They were given, both at the beginning (2015) and at the end of the study (2017), 4 psychometric instruments assessing alexithymia (Bagby's Toronto Alexithymia Scale), perceived stress (Cohen and Williamson's Perceived Stress Scale), social support (Duke-UNC Functional Social Support Questionnaire) and burnout (Maslach Burnout Inventory). A split-plot ANOVA analysis was used for evaluating the significance of Balint groups participation, with gender and age considered as auxiliary variables. RESULTS: In the study group, Balint training significantly improved the scores of global burnout (F(1, 64) = 25.104, p < 0.0001), 2 of its components (emotional exhaustion (F(1, 64) = 18.390, p < 0.0001) and depersonalization (F(1, 64) = 10.957, p < 0.002), alexithymia (F(1, 64) = 3.461, p < 0.0001) and perceived social support (F(1, 64) = 57.883, p < 0.0001), but not the scores of perceived stress and low personal accomplishment. Gender had an additional contribution in decreasing alexithymia (F(1, 64) = 7.436, p < 0.009) and increasing perceived social support (F(1, 64) = 15.426, p < 0.0001), with higher effects in men. CONCLUSIONS: This study points to the potential usefulness of Balint training in addressing alexithymia and burnout, and in improving perceived social support among physicians working with palliative patients. As the Balint method is easily understood and does not require special investments, it could represent a cost-effective instrument of addressing job-related psychological risks. Int J Occup Med Environ Health. 2019;32(1):53-63.

Difficulties in histopathology diagnosis and treatment of depressive disorder of breast cancer in male - clinical case presentation.

Breast cancer is less common among men than among women (about 1 in 100) and it is considered a rare disease but the evolution is significantly influenced by depression and distress. We present the case of a 63-year-old patient that was diagnosed in another Clinic with squamous skin carcinoma, but, after complete resection in our Hospital, it was proven to be breast cancer. At diagnosis, computed tomography (CT) scan showed local disease. Adjuvant treatment, consisting in chemotherapy and radiotherapy, was administered. At the beginning of hormonal therapy, the patient had a new CT scan that showed liver and bone metastases. The patient started palliative hormonal treatment with bisphosphonates. The aim of the study was to highlight both the importance of early diagnosis and treatment and the aggressiveness of male breast cancer compared with female. Depressive disorder and social distress worsens the prognosis and quality of life. Male with breast cancer has identity difficulties, body image disturbances and secondary distress.

Investigating the dimensions of learning organizations questionnaire (DLOQ) in a Romanian private ophthalmology organization.

Private ophthalmology organizations are knowledge-based institutions that need to adapt to changes from both external and internal environments. To ease the organization's survival, a learning process is required at different levels: individual, team, group, and to the organization itself, triggering a learning organization (LO) transformation. The aim of this research was to assess the relevance and efficiency of the Dimensions of the Learning Organization Questionnaire (DLOQ) in a private ophthalmology organization from Bucharest, Romania. The DLOQ was translated from English into Romanian and administered to 113 nurses and physicians working in the private ophthalmology organization. The DLOQ includes the following dimensions: Continuous learning, Dialogue and inquiry, Team learning and collaboration, Embedded systems, Empowerment, Systems connections and Strategic Leadership. Data was analyzed using central tendency indicators, such as the mean and standard deviation for quantitative variables, as well as the frequency, for qualitative variables. To be able to determine the comparison between the DLOQ dimensions' scores and the professions of the respondents, several Mann-Whitney U tests were performed. The DLOQ's internal consistency and its measurement validity were assessed using the Cronbach's alpha coefficient values and the Confirmatory Factor Analysis, respectively. The findings of the DLOQ implementation revealed that it is generally suitable to be used in the ophthalmology context. However, among the DLOQ dimensions, the Strategic Leadership dimension had to be removed, due to cultural and socio-demographic factors. No significant variations across professions and dimensions were registered. Although the DLOQ was developed for company settings, this study demonstrated that it could be successfully applied in health care as well. The DLOQ dimensions may provide valuable insights and understanding regarding the objective where further efforts should be directed. Also, through appropriate care management strategies, this instrument may contribute to the strengthening of the health care system, and particularly to the implementation of LO orientation in other medical specialties.

Resilience and active coping style: Effects on the self-reported quality of life in cancer patients.

Objective This study aimed to assess the association between resilience, active coping styles and the self-perceived quality of life in cancer patients. Additionally, we evaluated the contribution brought to quality of life by demographic variables (age, gender, occupational status) and medical ones (tumour, node and metastasis [TNM] stage, time from diagnosis, number of treatment lines). Methods The study design was cross-sectional. One hundred and seventy-eight patients (94 males, 84 females; mean age 56.20, SD = 7.81) consecutively admitted to two specialty hospitals in Bucharest and displaying TNM cancer stages II-IV were administered the Brief COPE Questionnaire, the RS-14 Resilience Scale and the Rotterdam symptom checklist. Hierarchical regression was used to analyze the relationship between the study variables and the quality of life components (physical distress, psychological distress, and the ability to remain active). Results The quality of life scores were within the average limits, despite 87.6% of patients being in an advanced cancer stage. Both resilience and active coping scores were in the higher range (resilience mean = 78.10, SD = 13.31, 95%CI = 76.14-80.06; active coping mean = 18.33, SD = 4.39, 95%CI = 17.68-18.98). Resilience correlated significantly with all quality of life components (global: p < .001, physical distress: p < .04, psychological distress: p < .0005, activity level: p < .03), whereas active coping did it only indirectly, via resilience. Among other variables, occupational status and time from diagnosis correlated inversely to two of quality of life components, and TNM stage to all. Conclusions This study points out the importance of resilience in influencing the self-perception of quality of life in cancer patients. Considering that resilience can be improved through psychological intervention, our findings may be useful for the design, adjustment, and implementation of future psychotherapeutic protocols.

Burnout and Its Relationships with Alexithymia, Stress, and Social Support among Romanian Medical Students: A Cross-Sectional Study.

Medical school students often experience emotional difficulties when handling the challenges of their formation, occasionally leading to burnout. In this study, we measured the prevalence of burnout and its relationships with perceived stress, perceived social support, and alexithymia in medical students from the largest academic medical community in Romania. A cross-sectional survey was administered to a randomized sample of 299 preclinical medical students at the University of Medicine in Bucharest. Participants completed four standardized questionnaires. In addition to the assessment of burnout prevalence, stepwise backward regression was used to establish which variables had the highest correlation to burnout components. Further, t-tests were run to assess gender-related differences. Overall, burnout prevalence was 15.05%. Perceived stress was found to be the strongest predictor of emotional exhaustion and lack of accomplishment, while the strongest predictors of depersonalization were low perceived social support (in women) and alexithymia (in men). Women appear to be more vulnerable to two of the components of burnout (emotional exhaustion and low personal accomplishment) and associate higher perceived stress and alexithymia. These results suggest that interventions addressing academic burnout could benefit from being gender-specific, with focus on key elements, such as perceived stress and alexithymia.

Quality indicators for care of cancer patients in their last days of life: literature update and experts' evaluation.

BACKGROUND: Quality indicators (QIs) are needed to monitor and to improve palliative care. Care of patients in the last days of life is a discrete phase of palliative care and therefore specific QIs are needed. This study aimed to identify and evaluate current QIs against which to measure future care of patients in the last days of life. METHODS: To identify QIs for patients in the last days of life an update of the literature and national guidelines was conducted. Subsequently, an international panel of palliative care experts was asked to evaluate the identified QIs: how well they describe care and how applicable they are for care in the last days of life. Also additional QIs were asked. RESULTS: In total, 34 QIs for care in the last days were identified in the literature and guidelines. The experts (response rate 58%) agreed with seven QIs as being good descriptors and applicable: concerning a home visit for the family following a patient's death, the presence of a dedicated family room, limited patients receiving chemotherapy, limited need for pain control, gastrointestinal symptoms, and communication from professional to patient and family. The experts also suggested 18 additional topics for QIs for the last days of life. CONCLUSION: Currently no definite set of QIs exist to describe quality of care of patients in their last days of life. New QIs that are focused on care for patients in their last days of life, their relatives, as well as their professional caregivers are needed.