A Clinical Trial Comparing Smoking Cessation Interventions at Two Levels of Intensity in Stroke Patients, Stratified by the Presence of Insular Cortex Lesions.

INTRODUCTION: Smoking is a stroke risk factor but the most efficient way to promote cessation is unknown. The smoking behavior in patients during the first 2 years post-stroke is studied comparing brief advice and intensive behavioral counseling interventions, taking into consideration biological, psychological, and social factors. METHODS: Randomized clinical trial of 196 stroke patients, stratified by the presence or not of an insular cortex lesion, with two levels of smoking cessation intervention. RESULTS: The study retention rate was 85.2%. Abstinence point prevalence at three months after stroke was 50% in the brief advice group and 51.7% in the intensive behavioral counseling group (p = .82) and at 24 months, 48.3% in the brief group and 47.5% in the intensive group (p = .92). Most relapses occurred in the first weeks. After 3 months the curves separated with fewer events in the intensive group and at 24 months the Hazard Ratio was 0.91 (95% CI = 0.61 to 1.37; p = .67). Twenty-four months after stroke, patients with an insular lesion were more likely to be abstinent (OR 3.60, 95% CI = 1.27 to 10.14), as were those who lived with a partner (OR 2.31, 95% CI = 1.17 to 4.55) and those who were less dependent (OR 0.84, 95% CI = 0.73 to 0.97). CONCLUSIONS: A high percentage of patients gave up smoking in both intervention groups with no significant differences between the two. The effect of the insular lesion on smoking cessation, which is early and continued after two years, is particularly notable. IMPLICATIONS: This two-year clinical trial compares for the first time the efficacy of two different intensities of smoking cessation intervention in stroke patients, taking into consideration the effect of the insula. Good results are obtained both in the short and medium-term in people with stroke, especially when this is accompanied by an insular cortex lesion, but there is no evidence that better results are obtained with longer, more time-intensive, and possibly more costly follow-ups obtain better results than are obtained with briefer interventions.

Doege-Potter syndrome in a facial solitary fibrous tumor: Diagnose and clinical management discussion.

Doege-Potter syndrome is a rare hypoglycemic paraneoplastic disorder. This case describes that severe and symptomatic hypoglycemia can occasionally be due to a rare malignant neoplasm, and the differential diagnosis of malignancy should not be overlooked in this setting.

Dispositional Optimism, Burnout and Their Relationship with Self-Reported Health Status among Nurses Working in Long-Term Healthcare Centers.

The mental health of nurses working in long-term healthcare centers is affected by the care they provide to older people with major chronic diseases and comorbidity and this in turn affects the quality of that care. The aim of the study was to investigate dispositional optimism, burnout and self-reported health among nurses working in long-term healthcare centers. A descriptive, cross-sectional survey design was used. Survey questionnaires were distributed in 11 long-term health care centers (n = 156) in Catalonia (Spain). The instruments used were LOT-R (dispositional optimism), MBI (burnout) and EuroQol EQ-5D (self-reported health). Bivariate analyses and multivariate linear regression models were used. Self-reported health correlated directly with dispositional optimism and inversely with emotional exhaustion and cynicism. Better perceived health was independently associated with greater dispositional optimism and social support, lower levels of emotional exhaustion level and the absence of burnout. Dispositional optimism in nurses is associated with a greater perception of health and low levels of emotional exhaustion.

Biological and Psychological Factors Associated With Smoking Abstinence Six Years Post-Stroke.

Introduction: Tobacco use is a public health problem causing high morbidity and mortality, including stroke. This study evaluates predictive factors of smoking cessation in the long term after stroke. Methods: We followed a cohort of 110 consecutive smokers with stroke for up to 6 years. Sociodemographic variables, stroke severity, insular involvement, stage of change in smoking habit before stroke and disruption of addiction variable (smoking cessation, absence of relapses, having stopped smoking without difficulties and not having had urge) were evaluated. Results: Twenty patients died during follow-up and two patients were lost leaving a final cohort of 88 patients. The prevalence of smoking cessation in the remaining population was 65.9% post-stroke, 54.9% at 3-6 months, 40.9% at 1 year and 37.5% at 6 years. Prevalence was significantly higher in patients with insular involvement during the first year of follow-up, but not at 6 years. Disruption immediately after stroke (OR = 10.1; 95% CI = 2.5 to 40.1) and intention to change before having the stroke (OR = 4.8; 95% CI = 1.0 to 23.0) were predictors of abstinence at 6 years after adjusting for age, sex and stroke severity at baseline. When tobacco abstinence at the 1 year follow-up was included in the model, this factor was the best predictor of tobacco abstinence at 1 year (OR = 10.5; 95% CI = 2.2 to 49.4). Conclusions: Intention of change, having the disruption criteria, and abstinence 1 year after stroke were predictors of abstinence at 6 years. An insular lesion in the acute phase of stroke does not determine the tobacco use status at 6 years. Implications: This study is the first prospective investigation with a cohort of stroke patients to examine the long-term influence of biological and psychological factors on smoking cessation. Tobacco abstinence 1 year after stroke was the strongest predictor of abstinence at 6 years of follow-up. The effect of the insular cortex lesion on tobacco cessation, which had been relevant during the first year, no longer had an influence over the longer period studied here.

Síndrome de burnout en los profesionales de medicina hispanoamericanos / Burnout syndrome in Spanish-American doctors

Se observaron diferencias en la intensidad de las dimensiones del burnout y de los factores asociados según las naciones de ejercicio de la medicina, pero los factores vinculados con el nivel alto de las dimensiones fueron comunes para los médicos de todas las naciones

Síndrome de burnout en los profesionales de medicina hispanoamericanos / Burnout syndrome in Spanish-American doctors

Se observaron diferencias en la intensidad de las dimensiones del burnout y de los factores asociados según las naciones de ejercicio de la medicina, pero los factores vinculados con el nivel alto de las dimensiones fueron comunes para los médicos de todas las naciones (AU)

[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.

La satisfacción de los pacientes hospitalizados como indicador de la calidad asistencial / Satisfaction among hospitalized patients as an indicator of quality of care

Objetivos. Estudiar la satisfacción general de los pacientes hospitalizados y su satisfacción con los cuidados de enfermería durante su estancia hospitalaria. Método. El diseño del presente estudio es observacional, descriptivo y prospectivo, desarrollado en el Hospital Universitario Dr. Josep Trueta de Girona en la unidad de neurología medicoquirúrgica. La satisfacción de los pacientes se ha valorado con las escalas de satisfacción SGEM, CEP y LOPPS 12. Resultados. Se han estudiado 150 pacientes con patología neurológica médica y quirúrgica, que han expresado altos niveles de satisfacción. Entre los aspectos peor valorados destacan la información, el espacio físico y la hostelería. No se ha hallado asociación entre ninguna variable sociodemográfica y la satisfacción de los pacientes. Los más dependientes valoraron más la calidad de los cuidados recibidos, los pacientes con estudios universitarios apreciaron más los consejos y los que presentaron alguna complicación valoraron más la asistencia técnica. Tampoco se observan diferencias significativas entre las puntuaciones de satisfacción realizadas en la hospitalización con las realizadas ya en el domicilio. Conclusiones. Se destaca la necesidad de mejorar la comunicación y la información con los pacientes hospitalizados

Objective. To study general satisfaction among hospitalized patients and to evaluate their satisfaction with nursing care both during their hospital stay and after discharge. Method. We performed an observational, descriptive, prospective study at the Josep Trueta Hospital in Girona (Spain). Patient satisfaction was evaluated through the SGEM, CEP and LOPSS 12 scales. Results. We studied 150 patients with medical and surgical neurological diseases. A high level of satisfaction was expressed. Among the least valued aspects were physical space, catering, and the quality of information. No association was found between any of the sociodemographic variables and patient satisfaction. The most highly valued aspects were the quality of the care received (among the most dependent patients), the advice given (among patients who were university graduates), and technical procedures (among patients with complications). No significant differences were observed between satisfaction scores during hospitalization and scores measured after discharge. Conclusions. We highlight the need to improve communication with inpatients and the information given to them

[Anxiety and depression levels in medical inpatients and their relation to the severity of illness]. / Niveles de ansiedad y depresión en enfermos hospitalizados y su relación con la gravedad de la enfermedad.

BACKGROUND AND OBJECTIVE: Anxiety and depression are common among medical inpatients. While their relation to the severity of illness is often discussed, the feeling of such severity by the patient and his/her prospects of improvement can be influenced by anxiety and depression. PATIENTS AND METHOD: Patients admitted in an internal medicine ward. Sociodemographic characteristics, State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale (HAD), Beck Depression Inventory (BDI), APACHE II, illness severity and reversibility self-evaluation were recorded. The HAD cut-off for anxiety or depression was 10. RESULTS: We included 260 admissions: 66.2% men, mean age 64.1 years. Anxiety was detected in 39.8% of women and 21.5% of men (p = 0.003); 31.8% of women and 16.3% of men had depression (p = 0.006). Anxious and depressive subjects did not score high in APACHE. Anxious patients had a worse knowledge of the medical diagnosis. Depressive patients were older, had a lower educational level and a greater physical impairment. Patients with a higher perception of severity displayed higher scores both on anxiety and depression scales. Patients with lower illness reversibility self-evaluation had more anxiety and depression, and more illness severity as well. CONCLUSIONS: The prevalence of anxiety and depression in hospitalized medical patients is high, occurs mainly in women, and no relation to illness severity is observed. Anxiety and depression are associated with both illness perception of greater severity and less improvement.

Niveles de ansiedad y depresión en enfermos hospitalizados y su relación con la gravedad de la enfermedad / Anxiety and depression levels in medical in patients and their relation to the severity of illness

FUNDAMENTO Y OBJETIVO: La ansiedad y la depresión son frecuentes en enfermos hospitalizados. Su relación con la gravedad de la enfermedad es objeto de discusión. La sensación de gravedad del enfermo y sus perspectivas de mejoría pueden estar influidas por la ansiedad y la depresión. PACIENTES Y MÉTODO: Pacientes ingresados en un servicio de medicina interna. Se recogieron variables sociodemográficas, las puntuaciones en el State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale (HAD), Beck Depression Inventory (BDI), APACHE II, así como autoevaluación de gravedad y reversibilidad de la enfermedad. Los pacientes fueron clasificados como ansiosos o deprimidos si puntuaban 10 o más en el HAD.RESULTADOS: Se estudiaron 260 ingresos, con una edad media de 64,1 años, un 66,2 por ciento eran varones. La ansiedad estaba presente en el 39,8 por ciento de las mujeres y 21,5 por ciento de los varones (p = 0,003) y la depresión en el 31,8 por ciento de las mujeres y 16,3 por ciento de los varones (p = 0,006). Los pacientes con ansiedad y depresión no estaban más graves según el índice APACHE. Los pacientes con ansiedad tenían peor conocimiento del diagnóstico médico, y los deprimidos, más edad, menor escolarización y más deterioro físico. Los pacientes con sensación de mayor gravedad presentaban valores más altos de ansiedad y depresión en todos los cuestionarios, pero no mayor gravedad por APACHE, siendo la ansiedad por HAD el mejor predictor. Los pacientes con autoevaluación de menor reversibilidad de su enfermedad tenían más ansiedad y depresión, y se hallaban más graves, siendo el APACHE y la depresión mediante BDI los mejores predictores. CONCLUSIONES: La prevalencia de ansiedad y depresión en enfermos hospitalizados es alta, especialmente en mujeres, sin guardar relación con la gravedad de la enfermedad, y se asocia a una percepción subjetiva del enfermo de mayor gravedad y menor mejoría (AU)