Spanish validation of the Stigma of Occupational Stress Scale for Doctors (SOSS-D) and factors associated with physician burnout.

OBJECTIVES: The aim of this study was to investigate the psychometric properties of the Spanish version of the Stigma of Occupational Stress Scale for Doctors (SOSS-D) and the factors associated with Physician Burnout in Paraguay. METHODS: Participants included 747 Paraguayan healthcare workers, aged 24-77 years old, of both sexes. SOSS-D was translated into Spanish and validated through an exploratory and confirmatory factor analysis. Participants were also scored with the Oldenburg Burnout Inventory (OLBI), the CAGE questionnaire, and the stigma subscale of the Perceived Barriers to Psychological Treatment (PBPT) measure. RESULTS: Three factors had a raw eigenvalue greater than 1, and explained 61.7% of total variance. The confirmatory analysis confirmed that the scale is three-dimensional. The model adjustment was good, according to all fit indices. OLBI results indicate clinically significant disengagement in 85.9% and clinically significant exhaustion in 91.6% of participants. Of the 747 participants, 57.6% reported alcoholic beverage consumption and among those, 19.3% had problematic alcohol consumption according to the CAGE questionnaire. The correlation between SOSS-D and the stigma subscale of the PBPT was statistically significant (r = 0.245, p < 0.001). CONCLUSIONS: The Spanish version of the SOSS-D was found to have good psychometric properties and adequately reproduces the three-dimensional model of the original English version.

Photochemical two-electron reduction of a dinuclear ruthenium complex containing a bent tetraazatetrapyridopentacene bridging ligand: pushing up the LUMO for storing more energy.

The synthesis and characterization of a ditopic bridging ligand, 9,12,21,22-tetraazatetrapyrido[3,2-a:2',3'-c:3″2″-m:2''',3'''-o]pentaphene (tatppα) and its dinuclear ruthenium complex, [(phen)(2)Ru(tatppα)Ru(phen)(2)][PF(6)](4) (1(4+)), are described. The tatppα ligand is structurally very similar to 9,10,20,33-tetraazatetrapyrido[3,2-a:2',3'-c:3″,2″-l:2''',3'''-n]pentacene (tatppß), except that, instead of a linear tetraazapentacene backbone, tatppα has an ortho (or α) substitution pattern about the central benzene ring, leading to a 120° bend. Complex 1(4+) shows tatppα-based reductions at -0.73 and -1.14 V vs Ag/AgCl/saturated KCl and has an absorption spectrum showing the typical Ru(II) dπ → phen-like π* metal-to-ligand charge-transfer transition centered at ∼450 nm. In acetonitrile, visible-light irradiation of 1(4+) in the presence of triethylamine leads to two sequential changes in the absorption spectra, which are assigned to the formation of the one- and two-electron-reduced species, with the electrons stored on the tatppα ligand. These assignments were made by comparison of the spectral changes observed in 1(4+) upon stoichiometric chemical reduction with cobaltocene and by spectroelectrochemical analysis. Significantly, DFT calculations are very predictive of the optical and reductive behavior of the tatppα complex relative to the tatppß complexes and show that modeling is a useful tool for ligand design. The chemical reactivity and differential reflectance spectroelectrochemical data reveal that the reductions are accompanied by radical dimerization of the tatppα ligand to species such as σ-{1}(2)(6+), which is only slowly reversible upon exposure to air and may limit the complexe's 1(4+) utility for driving photochemical H(2) production.

Angiocentric nasal T/natural killer cell lymphoma: a single centre study of prognostic factors in 108 patients.

Angiocentric T cell/natural killer (NK) nasal lymphoma remains a rare clinical presentation in North America and Europe but is more common in Asia and Latin America. We have reviewed 108 cases of angiocentric T/NK cell lymphoma of the nasal cavity with a view to establishing prognostic factors. Most patients were high or high intermediate clinical risk and had additional poor prognostic factors such as bulky disease, high levels of beta 2 microglobulin, advanced stage and multiple extranodal involvement. At 8 years, overall survival was 82%, 90% and 84% for low-intermediate, high-intermediate and high clinical, respectively. Disease free survival was very similar: 79%, 83% and 80%, respectively. Multivariate analysis did not identify any factor influencing overall survival and disease-free survival. There was no evidence that the international prognostic index (IPI) was applicable in these patients and it appears that angiocentric T/NK cell lymphoma is an independent prognostic factor itself.

Interferon as maintenance therapy in refractory malignant lymphoma.

Patients with refractory malignant lymphoma (RML) have a poor prognosis when treated with conventional chemotherapy, as less than 20% remain alive and free of disease after 5 years. The use of myeloablative chemotherapy followed by BMT has improved the complete remission (CR) rate. Nevertheless, relapse rates remain unchanged, and only a few patients remain alive and free of disease for more than 3 years. For this reason, we began a prospective randomized clinical trial to determine if IFN-alpha2B (5.0 MU three times a week for 1 year) can improve the prognosis in RML. Ninety-six patients with high or high-intermediate clinical risk RML and in CR after intensive chemotherapy were randomly assigned to receive or not to receive IFN as maintenance therapy. A median follow-up of 48.1 months, the time to treatment failure and survival were similar in both groups. Toxicity secondary to IFN administration was mild, and all patients received the planned doses of IFN. We conclude that IFN is not recommended at this dose and schedule as maintenance therapy in patients with RML who achieve CR. Different therapeutic approaches may be developed to improve outcomes for these patients.

High Dose Chemotherapy in the Treatment of Poor Prognosis Malignant Lymphoma.

UNLABELLED: The aim of the present study was to evaluate an intensive chemotherapy regimen in patients with poor prognosis malignant lymphoma. Sixty previously untreated patients with malignant lymphoma of high- or high-intermediate risk were treated with an intensive regimen. Patients received increasing doses of cyclophosphamide 1000 mg/m(2), and epirubicin 120 mg/m(2), in an CEOP-Bleo regimen with granulocyte-macrophage colony stimulating factor as hematological support. Moreover the high clinical risk patients had more adverse prognostic factors such as bulky disease, elevated levels of beta 2 microglobulin and multiple extranodal sites of involvement at diagnosis. Complete response was achieved in 49 out of 60 patients (81%) (95% confidence interval 63% to 89%). With a median follow-up of 43.6 months (ranged 31 to 61 months), only five patients have relapsed. Thus, at 5-years 72% of the patients remain in first complete response and 74% of the patients are alive free of disease. TOXICITY: severe granulocytopenia was observed in the 46% of the chemotherapy cycles; infection-related granulocytopenia was observed in 17%, but no fatality due therapy was observed. Granulocyte recovery was faster and delay on treatment was minimal (3.4 days). No thrombocytopenia, severe mucositis or cardiac abnormalities were observed. The CEOP-Bleo regimen with increasing doses of cyclophosphamide and epirubicin is an useful and well tolerated regimen for the treatment of poor prognosis malignant lymphoma.