2,5-Dimethylfuran as a Validated Biomarker of Smoking Status.

INTRODUCTION: Exposure biomarkers are required in tobacco use studies to accurately assess smoking status since self-reporting usually results in misclassification estimates. This study uses breath analysis and assesses some volatile organic compounds (VOCs) as potential biomarkers of tobacco smoke exposure. METHODS: Forced-expiratory breath samples were obtained from 377 volunteers (174 smokers and 203 nonsmokers). Exhaled breath levels of different VOCs previously related to tobacco smoke were evaluated. The toluene-to-benzene ratio was evaluated as this ratio has been found to be different in atmospheric samples and tobacco smoke emissions. Finally, breath analyses from 64 patients attending a clinical practice were evaluated and the results were compared to their self-reporting status. RESULTS: Univariate analysis shows that all compounds evaluated gave significant differences (p < .001). Receiver operating characteristic (ROC) curves suggest that xylenes and toluene are not able to accurately determine smoking status, and benzene and the T/B ratio present potential utility in certain conditions. The highest discriminant capacity was obtained for 2,5-dimethylfuran (AUC = 0.982, 95% confidence interval [CI]: 0.969-0.995), with a cut-off value of 0.016 ppbv (sensibility = 0.965, specificity = 0.896). Drinking coffee was the only confounding parameter that can give low breath levels for this compound. The evaluation of the results obtained from the patients attending a clinical practice showed that 8% of people who claim to be nonsmokers hid their real smoking status. CONCLUSIONS: The results obtained confirm that the determination of 2,5-dimethylfuran in breath samples is a good and simpler alternative to conventional blood or urine tests for assessing smoking status. IMPLICATIONS: Analysis of 2,5-dimethylfuran in breath samples results in a simple and fast method for the determination of the smoking status of a person. This methodology presents multiple advantages as it is neither invasive nor embarrassing for patients attending clinical practices. Moreover, analysis of biomarkers in breath samples is simpler and faster than using conventional methods based on urine or blood analysis.

[Influence of personal, professional and cross-national factors in burnout syndrome in Hispanic Americans and Spanish health workers (2007)]. / Influencia de factores personales, profesionales y transnacionales en el síndrome de burnout en personal sanitario hispanoamericano y Español (2007).

BACKGROUND: Burnout syndrome is related to cultural and individual factors. The aim of this study was to compare the frequency of burnout and the scores for its three components with the perceptions and the demographic and professional characteristics of the workers. METHODS: Burnout syndrome was studied in 11,530 Hispanic Americans and Spanish healthcare professionals (51% male, mean age 41.7 years). The Maslach Burnout Inventory and a previously drawn up questionnaire were administered online from the Intramed website from December 2006 to September 2007. Associations were tested using multiple logistic regression. RESULTS: The frequency of burnout in professionals resident in Spain was 14.9%, in Argentina 14.4%, and in Uruguay 7.9% whereas professionals in Mexico, Ecuador, Peru, Columbia, Uruguay, Guatemala and El Salvador presented frequencies of burnout of between 2.5% and 5.9%. By professions, doctors had a prevalence of burnout of 12.1%, nurses 7.2%, and dentists, psychologists and nutritionists of <6%. Amongst doctors, burnout predominated amongst doctors working in emergency departments (17%) and internal medicine departments (15.5%) whereas anaesthetists and dermatologists had the lowest prevalence (5% and 5.3%, respectively). Older age (OR=0.96), having children (OR=0.93), the perception of feeling valued (OR=0.53), optimism (OR=0.80), job satisfaction (OR=0.80), and satisfaction with salary (OR=0.91) are variables which protect against burnout. CONCLUSIONS: The expression of burnout varies among nations and professions. Age (older age), having children, the perception of feeling valued, optimism, job satisfaction and satisfaction with salary are protective variables of burnout.

Influencia de factores personales, profesionales y transnacionales en el Síndrome de Burnout en personal sanitario hispanoamericano y español (2007) / Influence of personal, professional and cross-national factors in Burnout Syndrome in Hispanic Americans and Spanish health workers (2007)

Fundamento: La aparición del síndrome de burnout se relaciona con factores ambientales, culturales y personales. Los objetivos de este estudio son comparar la prevalencia de burnout entre profesionales sanitarios de países de habla hispana y explorar su asociación con las características sociodemográficas y profesionales de los trabajadores y con sus percepciones. Métodos: Se ha estudiado el síndrome de burnout en 11.530 profesionales de la salud de habla hispana (51% varones, edad media de 41,7 años). Se utilizó el Maslach Burnout Inventory y un cuestionario de elaboración propia vía online desde el portal sanitario Intramed El período de estudio fue desde diciembre del 2006 hasta septiembre del 2007. Las asociaciones entre variables se estudiaron mediante pruebas de regresión logística. Resultados: La prevalencia de burnout en los profesionales residentes en España fue de 14,9%, del 14,4% en Argentina, y del 7,9% en Uruguay. Los profesionales de México, Ecuador, Perú, Colombia, Guatemala y El Salvador presentaron prevalencias entre 2,5% y 5,9%. Por profesiones, Medicina tuvo una pre- valencia del 12,1%, Enfermería del 7,2%, y Odontología, Psicología y Nutrición tuvieron cifras inferiores al 6%. Entre los médicos el burnout predominaba en los que trabajaban en urgencias (17%) e internistas (15,5%), mientras que anestesistas y dermatólogos tuvieron las prevalencias más bajas (5% y 5,3% respectivamente). Fueron variables protectoras la mayor edad (OR=0,96), tener hijos (OR=0,93), la percepción de sentirse valorado (OR=0,53), el optimismo (OR=0,80), la satisfacción profesional (OR=0,80) y la valoración económica (OR=0,91). Conclusiones: La prevalencia del burnout es mayor en España y Argentina y los profesionales que más lo padecen son los médicos. La edad, tener hijos, la percepción de sentirse valorado, el optimismo, la satisfacción laboral y la valoración económica, son variables protectoras de burnout (AU)

Background: Burnout syndrome is related to cultural and individual factors. The aim of this study was to compare the frequency of burnout and the scores for its three components with the perceptions and the demographic and professional characteristics of the workers. Methods: Burnout syndrome was studied in 11,530 Hispanic Americans and Spanish healthcare professionals (51% male, mean age 41.7 years). The Maslach Burnout Inventory and a previously drawn up questionnaire were administered online from the Intramed website from December 2006 to September 2007. Associations were tested using multiple logistic regression. Results: The frequency of burnout in professionals resident in Spain was 14.9%, in Argentina 14.4%, and in Uruguay 7.9% whereas professionals in Mexico, Ecuador, Peru, Columbia, Uruguay, Guatemala and El Salvador presented frequencies of burnout of between 2.5% and 5.9%. By professions, doctors had a prevalence of burnout of 12.1%, nurses 7.2%, and dentists, psychologists and nutritionists of <6%. Amongst doctors, burnout predominated amongst doctors working in emergency departments (17%) and internal medicine departments (15.5%) whereas anaesthetists and dermatologists had the lowest prevalence (5% and 5.3%, respectively). Older age (OR=0.96), having children (OR=0.93), the perception of feeling valued (OR=0.53), optimism (OR=0.80), job satisfaction (OR=0.80), and satisfaction with salary (OR=0.91) are variables which protect against burnout. Conclusions The expression of burnout varies among nations and professions. Age (older age), having children, the perception of feeling valued, optimism, job satisfaction and satisfaction with salary are protective variables of burnout (AU)

Calidad de vida relacionada con la salud y consumo de tabaco / Health related quality of life and tobacco consumption

La calidad de vida relacionada con la salud se ha descrito como un concepto multidimensionalque incluye la identificación de síntomas, el estado funcional, la percepción debienestar psicológico y la percepción general de salud. En el caso de la adicción al consumode tabaco, la preocupación por la salud actual o futura es uno de los motivos másinformados para dejar de fumar. En el presente estudio se analiza la relación entre la percepciónde la calidad de vida relacionada con la salud y la etapa de cambio en el abandonodel consumo de tabaco propuesta desde el modelo transteórico a fin de mejorar lasestrategias de intervención comunitaria y clínica para la cesación tabáquica. Se ha administradoel cuestionario SF-36 a una muestra formada por 201 fumadores y exfumadores.Los datos obtenidos indican peor salud física percibida en las etapas de cambio más próximasal abandono de tabaco y una peor salud mental percibida en las etapas con tabaquismoactivo. Se comparan los resultados con los observados en otras poblaciones y sediscuten las implicaciones a nivel de tratamiento y prevención del tabaquismo

Health-related quality of life (HRQL) has been described as a multidimensional conceptthat includes symptoms identification, functional condition, psychological wellbeing perceptionand general health perception. In the case of nicotine addiction, the concern aboutcurrent or future health is one of the most reported reasons for smoking cessation. Themain goal of this research is to investigate the relationship between HRQL perception andtobacco cessation stage formulated by the Tran theoretical model, with the aim to improvecommunity and clinical interventions. SF-36 questionnaire has been administered to asample of 201 smokers and ex-smokers. Results show worse perceived physical health instages of change closer to smoking cessation and worse perceived mental health in stagesof change with active tobacco habit. Results are compared with previous studies, whileimplications for tobacco consumption and prevention are discussed

El optimismo de los profesionales sanitarios y su relación con la calidad de vida, el burnout y el clima organizacional / Optimism in health workers and its relationship with quality of life, burnout syndrome, and organizational environment

Objetivo: Conocer la autoevaluación del grado de optimismo de los trabajadores sanitarios hospitalarios, y su relación con la calidad de vida relacionada con la salud, el síndrome del desgaste profesional y el clima organizacional de la empresa. Pacientes y método: Estudio observacional transversal descriptivo en una muestra de 1.086 trabajadores sanitarios hospitalarios. Se cuantificó el grado de optimismo mediante una escala analógica visual de 0 (nada optimista) a 10 (totalmente optimista) con las respuestas a la pregunta "¿se considera una persona optimista?". La puntuación de optimismo se codificó como nivel de optimismo inferior (NoI) para valores de 0 a 5; nivel de optimismo medio (NoM), entre 6 y 8, y nivel superior (NoS), para los valores 9 y 10. Se estudió el clima organizacional de la empresa, el desgaste profesional (Maslach Burnout Inventory) y la calidad de vida relacionada con la salud (SF-36). Resultados: La mediana de optimismo fue 7 con un percentil 25 de 6 y un percentil 75 de 8. Un 19,2% se clasificó como NoI y un 18%, como NoS. Las personas con un mayor nivel de optimismo tuvieron mayores puntuaciones en calidad de vida en todas las dimensiones del SF-36, menor desgaste profesional y una mejor percepción del clima organizacional. Conclusiones: La autovaloración de los trabajadores sanitarios tuvo una tendencia hacia los valores altos de optimismo. Se observaron mejores resultados en las tres escalas medidas a mayor nivel de optimismo. El optimismo debe ser una variable a controlar en los estudios de valoración de la salud percibida y de desgaste profesional

Objectives: To identify self-reported levels of optimism in hospital health workers and to study its relationship with health-related quality of life, burnout syndrome, and the hospital's organizational environment. Patients and method: We performed an observational, descriptive, cross-sectional study in a sample of 1,086 hospital health workers. The level of optimism was quantified through a visual analog scale from 0 (not at all optimistic) to 10 (totally optimistic) in which the workers responded to the question "Do you consider yourself to be an optimistic person?" The optimism score was codified so that levels from 0 to 5 were considered to indicate a low level of optimism, values from 6 to 8 to indicate medium levels of optimism, and scores of 9 and 10 to indicate a high level of optimism. The relationship between optimism and the hospital's organizational environment, burnout syndrome (Maslach Burnout Inventory), and health-related quality of life (SF-36 health questionnaire) was studied. Results: The median level of optimism was 7 with a 25th percentile of 6 and 75th percentile of 8. A total of 19.2% were classified as having a low level of optimism and 18% as having a high level of optimism. High levels of optimism corresponded to better quality of life in all aspects of the SF-36, lower levels of occupational burnout and a more favorable perception of the organizational environment. Conclusions: The health workers' self-evaluation tended toward high scores for optimism. Better results were found in the three scales measured when optimism was higher. Optimism is a factor that should be taken into account in studies evaluating perceived health and occupational burnout

Desgaste profesional en el personal sanitario y su relación con los factores personales y ambientales / Burnout syndrome in health workers and relationship with personal and environmental factors

Objetivos: Entre los profesionales sanitarios se han hallado altos índices de desgaste profesional. Nuestro objetivo fue estudiar la prevalencia del síndrome de desgaste profesional en los trabajadores sanitarios hospitalarios, y valorar su relación con los factores personales y ambientales. Métodos: Un total de 2.290 trabajadores sanitarios de 5 hospitales de Girona fueron invitados a participar. Se les administró un cuestionario de elaboración propia, una encuesta del clima organizacional, y el Maslach Burnout Inventory, que incluye tres dimensiones: cansancio emocional, despersonalización y baja realización personal. Resultados: Contestaron la encuesta 1.095 trabajadores (con un 47,8% de participación). Un 41,6% presentó un alto nivel de cansancio emocional, sobre todo los médicos y el personal de enfermería; un 23% tuvo un alto nivel de despersonalización, sobre todo los médicos, y un 27,9% tuvo una baja realización personal, en especial los técnicos y los médicos. Mediante un análisis de regresión logística múltiple, se asoció un alto nivel de cansancio emocional al consumo de tranquilizantes o antidepresivos con asiduidad, mientras que el optimismo y la satisfacción profesional mostraron una asociación inversa. Los años de profesión, el optimismo, valorar como útil el trabajo y percibir que se es valorado por los demás se asociaron inversamente con un alto nivel de despersonalización. La baja realización personal se asoció inversamente con el optimismo, la valoración de la utilidad del trabajo y el equipo de trabajo. Conclusiones: A partir de los resultados obtenidos, recomendamos mejorar el clima organizacional y potenciar el optimismo y la autoestima individual, para disminuir el desgaste profesional en los hospitales

Objectives: High rates of professional burnout syndrome have been found among health service professionals. Our objective was to study the prevalence of burnout syndrome in hospital health workers and to determine its relationship with personal and environmental factors. Methods: A total of 2290 health workers from five hospitals in the province of Girona (Spain) were invited to participate. Interviewees were given a specifically designed questionnaire, a questionnaire on organizational climate, and the Spanish version of the Maslach Burnout Inventory, which includes three scales: emotional exhaustion, depersonalization, and reduced personal accomplishment. Results: Responses were received from 1095 health workers (a response rate of 47.8%). A high level of emotional exhaustion was found in 41.6% of staff members, especially among doctors and nurses; a high level of depersonalization was found in 23%, mainly among doctors, and reduced personal accomplishment was found in 27.9%, mainly among technicians and doctors. Multiple logistic regression revealed that a high level of emotional exhaustion was associated with frequent consumption of tranquilizers or antidepressants, whereas optimism and job satisfaction showed an inverse association. The variables that were inversely associated with a high level of depersonalization were the number of years in the profession, optimism, evaluation of work as being useful and the perception of being valued by others. Reduced personal accomplishment was also inversely associated with optimism, satisfaction with the usefulness of one's work, and satisfaction with teamwork. Conclusions: In view of the results obtained, to reduce professional burnout in hospitals, optimism and a sense of self-worth among individuals should be encouraged and the organizational environment should be improved

Semi-intensive monitoring in acute stroke and long-term outcome.

BACKGROUND AND PURPOSE: Factors that determine the benefit of stroke units (SU) are unknown. The aim of our study was to analyze whether semi-intensive monitoring during the acute phase of stroke reduces mortality and dependency at long term. METHODS: We studied patients with an ischemic stroke or intracerebral hemorrhage, consecutively admitted to our SU within 24 h of symptoms onset. Based on bed availability, patients were allocated to either a conventional care stroke unit (C-SU, n = 209) or a semi-intensive stroke unit (SI-SU, n = 321) with continuous monitoring of cardiac, respiratory, metabolic and neurological functions during the first 72 h. Both groups were treated following the same medical and nursing protocols. Criteria for exclusion were patients with stupor/coma, previously dependent (Barthel score <85) and with TIA. Using logistic regression models, we analyzed the influence of semi-intensive care on mortality and dependency at one year. RESULTS: Baseline characteristics were similar between patients admitted to the SI-SU and the C-SU, except for a higher frequency of more severe stroke and intracerebral hemorrhage in the SI-SU. Twenty-six percent of patients in the SI-SU and 4% in the C-SU were randomized in acute clinical trials (p < 0.01), and 61% and 39% were seen by a neurologist in less than 6 h from the onset of symptoms (p < 0.01). At 1 year, mortality and combined mortality and dependency were not significantly different between the two groups. However, due to the presence of a significant interaction between the type of unit and stroke severity, the OR of mortality for SI-SU allocation was 0.19 (95% CI, 0.07-0.54) in patients with severe stroke (CSS < or =4), whereas it was 0.64 (95% CI, 0.37-1.11) in those with mild-to-moderate stroke. CONCLUSIONS: This study suggests that semi-intensive monitoring in a stroke unit reduces mortality at 1 year in patients with severe stroke, with no influence over dependency.

[Burnout syndrome in health workers and relationship with personal and environmental factors]. / Desgaste profesional en el personal sanitario y su relación con los factores personales y ambientales.

OBJECTIVES: High rates of professional burnout syndrome have been found among health service professionals. Our objective was to study the prevalence of burnout syndrome in hospital health workers and to determine its relationship with personal and environmental factors. METHODS: A total of 2290 health workers from five hospitals in the province of Girona (Spain) were invited to participate. Interviewees were given a specifically designed questionnaire, a questionnaire on organizational climate, and the Spanish version of the Maslach Burnout Inventory, which includes three scales: emotional exhaustion, depersonalization, and reduced personal accomplishment. RESULTS: Responses were received from 1095 health workers (a response rate of 47.8%). A high level of emotional exhaustion was found in 41.6% of staff members, especially among doctors and nurses; a high level of depersonalization was found in 23%, mainly among doctors, and reduced personal accomplishment was found in 27.9%, mainly among technicians and doctors. Multiple logistic regression revealed that a high level of emotional exhaustion was associated with frequent consumption of tranquilizers or antidepressants, whereas optimism and job satisfaction showed an inverse association. The variables that were inversely associated with a high level of depersonalization were the number of years in the profession, optimism, evaluation of work as being useful and the perception of being valued by others. Reduced personal accomplishment was also inversely associated with optimism, satisfaction with the usefulness of one's work, and satisfaction with teamwork. CONCLUSIONS: In view of the results obtained, to reduce professional burnout in hospitals, optimism and a sense of self-worth among individuals should be encouraged and the organizational environment should be improved.