A comparison of univariate and meta-analytic structural equation modeling approaches to reliability generalization applied to the Maslach Burnout Inventory.

Introduction: Reliability is a property of tests scores that varies from sample to sample. One way of generalizing reliability of a test is to perform a meta-analysis on some reliability estimator. In 2011, a reliability generalization meta-analysis on the Maslach Burnout Inventory (MBI) was conducted, concluding that average alpha values for the MBI dimensions ranged from 0.71 to 0.88. In the present study, we aimed to update the average reliability values of the MBI by conducting a literature search from 2010 until now and comparing to statistical procedures of meta-analysis: the Univariate approach, that were used in the previous study, and a novel meta-analytic approach based on structural equation modeling. Method: An estimation of average reliability was done based on 69 independent primary reliability coefficients for the Univariate approach. The average reliability was based on 9 independent studies in the case of the Meta-analytic Structural Equation Modeling (MASEM) approach. Given that MASEM has the additional capability of testing the internal structure of a test, we also fitted several models. Results: The data was well-suited to the bifactor model, revealing the dominance of the general factor over the domain-specific ones. Acceptable overall alpha and omega coefficients were achieved for the two of the MBI dimensions, having depersonalization reliability estimates below recommendations. Discussion: In general, the MBI can be viewed as a highly interconnected three-factor scale, being its appropriate for research purposes.

The Roles of Protocols and Protocolization in Improving Outcome From Severe Traumatic Brain Injury.

BACKGROUND AND OBJECTIVES: Our Phase-I parallel-cohort study suggested that managing severe traumatic brain injury (sTBI) in the absence of intracranial pressure (ICP) monitoring using an ad hoc Imaging and Clinical Examination (ICE) treatment protocol was associated with superior outcome vs nonprotocolized management but could not differentiate the influence of protocolization from that of the specific protocol. Phase II investigates whether adopting the Consensus REVised Imaging and Clinical Examination (CREVICE) protocol improved outcome directly or indirectly via protocolization. METHODS: We performed a Phase-II sequential parallel-cohort study examining adoption of the CREVICE protocol from no protocol vs a previous protocol in patients with sTBI older than 13 years presenting ≤24 hours after injury. Primary outcome was prespecified 6-month recovery. The study was done mostly at public South American centers managing sTBI without ICP monitoring. Fourteen Phase-I nonprotocol centers and 5 Phase-I protocol centers adopted CREVICE. Data were analyzed using generalized estimating equation regression adjusting for demographic imbalances. RESULTS: A total of 501 patients (86% male, mean age 35.4 years) enrolled; 81% had 6 months of follow-up. Adopting CREVICE from no protocol was associated with significantly superior results for overall 6-month extended Glasgow Outcome Score (GOSE) (protocol effect = 0.53 [0.11, 0.95], P = .013), mortality (36% vs 21%, HR = 0.59 [0.46, 0.76], P < .001), and orientation (Galveston Orientation and Amnesia Test discharge protocol effect = 10.9 [6.0, 15.8], P < .001, 6-month protocol effect = 11.4 [4.1, 18.6], P < .005). Adopting CREVICE from ICE was associated with significant benefits to GOSE (protocol effect = 0.51 [0.04, 0.98], P = .033), 6-month mortality (25% vs 18%, HR = 0.55 [0.39, 0.77], P < .001), and orientation (Galveston Orientation and Amnesia Test 6-month protocol effect = 9.2 [3.6, 14.7], P = .004). Comparing both groups using CREVICE, those who had used ICE previously had significantly better GOSE (protocol effect = 1.15 [0.09, 2.20], P = .033). CONCLUSION: Centers managing adult sTBI without ICP monitoring should strongly consider protocolization through adopting/adapting the CREVICE protocol. Protocolization is indirectly supported at sTBI centers regardless of resource availability.

Testing the Impact of Protocolized Care of Patients With Severe Traumatic Brain Injury Without Intracranial Pressure Monitoring: The Imaging and Clinical Examination Protocol.

BACKGROUND: Most patients with severe traumatic brain injury (sTBI) in low- or-middle-income countries and surprisingly many in high-income countries are managed without intracranial pressure (ICP) monitoring. The impact of the first published protocol (Imaging and Clinical Examination [ICE] protocol) is untested against nonprotocol management. OBJECTIVE: To determine whether patients treated in intensive care units (ICUs) using the ICE protocol have lower mortality and better neurobehavioral functioning than those treated in ICUs using no protocol. METHODS: This study involved nineteen mostly public South American hospitals. This is a prospective cohort study, enrolling patients older than 13 years with sTBI presenting within 24 h of injury (January 2014-July 2015) with 6-mo postinjury follow-up. Five hospitals treated all sTBI cases using the ICE protocol; 14 used no protocol. Primary outcome was prespecified composite of mortality, orientation, functional outcome, and neuropsychological measures. RESULTS: A total of 414 patients (89% male, mean age 34.8 years) enrolled; 81% had 6 months of follow-up. All participants included in composite outcome analysis: average percentile (SD) = 46.8 (24.0) nonprotocol, 56.9 (24.5) protocol. Generalized estimating equation (GEE) used to account for center effects (confounder-adjusted difference [95% CI] = 12.2 [4.6, 19.8], P = .002). Kaplan-Meier 6-month mortality (95% CI) = 36% (30%, 43%) nonprotocol, 25% (19%, 31%) protocol (GEE and confounder-adjusted hazard ratio [95% CI] = .69 [.43, 1.10], P = .118). Six-month Extended Glasgow Outcome Scale for 332 participants: average Extended Glasgow Outcome Scale score (SD) = 3.6 (2.6) nonprotocol, 4.7 (2.8) protocol (GEE and confounder-adjusted and lost to follow-up-adjusted difference [95% CI] = 1.36 [.55, 2.17], P = .001). CONCLUSION: ICUs managing patients with sTBI using the ICE protocol had better functional outcome than those not using a protocol. ICUs treating patients with sTBI without ICP monitoring should consider protocolization. The ICE protocol, tested here and previously, is 1 option.

Predictors of burnout of health professionals in the departments of maternity and gynaecology, and its association with personality factors: A multicentre study.

AIMS AND OBJECTIVES: To analyse the prevalence, levels and phases of burnout syndrome in midwives and obstetrics and gynaecology nurses, and to evaluate the relationship between burnout and sociodemographic, occupational and psychological factors. BACKGROUND: Burnout syndrome is a major problem in occupational health, characterised by feelings of exhaustion, depersonalisation and a low sense of personal achievement that appears after long-term occupational stress. Recent research has found that burnout harms the physical and mental well-being of workers, and jeopardises the quality of care provided. The association between burnout and a risk profile in maternity wards has not previously been investigated but it deserves special attention since it is a highly stressful area to work in. DESIGN: A cross-sectional survey design was selected. METHODS: A total of 150 nurses and midwives at 18 hospitals participated in this study. The data were collected using the Maslach Burnout Inventory, NEO Personality Inventory and the Educational-Clinical Questionnaire: Anxiety and Depression. This study adhered to the STROBE guideline. RESULTS: 17% of participants presented high levels of emotional exhaustion, 16.6% high depersonalisation and 55.1% a sense of low personal accomplishment. The sociodemographic and occupational variables related to burnout were gender, marital status and work shift. The three dimensions of the syndrome, emotional exhaustion, depersonalisation and personal accomplishment were predicted by depression, neuroticism, agreeableness and openness. CONCLUSIONS: One third of the sample presented high levels of burnout, which was most strongly experienced as feelings of low personal accomplishment. Furthermore, personality factors play an important role in the development of burnout syndrome. RELEVANCE TO CLINICAL PRACTICE: Managers and policy makers should promote strategies to reduce burnout. To prevent the syndrome, personality factors should be taken into account, for the early identification of a profile of professionals most at risk of developing burnout.

Study of the Predictive Validity of the Burnout Granada Questionnaire in Police Officers.

Professionals with burnout have negative physical and psychological effects, with adverse consequences in their workplace. Burnout mainly affects assisting professions; amongst them, police work is one of the professions at risk of suffering from this syndrome. The aim of this research is to study the adequacy of the Maslach Burnout Inventory and Granada Burnout Questionnaire instruments to measure burnout in police officers through the study of the reliability and validity (concurrent and predictive) of these instruments. A cross-sectional study was carried out. The sample was composed of 1884 police officers, mostly men (85.4%), with an average age of 35.04 (SD = 8.30). The Maslach Burnout Inventory and Granada Burnout Questionnaire were used to measure burnout. The results obtained in this study support the adequacy of both instruments for measuring burnout. The correlation coefficients between the dimensions are significant, with a medium-high magnitude. Participants with burnout had significantly higher scores in emotional exhaustion and depersonalization and lower scores in personal accomplishment in both instruments. The area under the curve estimated for the Granada Burnout Questionnaire provided evidence of the predictive validity of the instrument. The police profession needs validated and sensitive tools to identify police changes in the dimensions of burnout. The Granada Burnout Questionnaire instrument correctly classifies burnout in police professionals.

A Multicentre Study of Burnout Prevalence and Related Psychological Variables in Medical Area Hospital Nurses.

BACKGROUND: Nursing burnout is an important problem that affects nurses' wellness, the quality of care and the health institutions. Study aims were to estimate levels of burnout; to determine the phase of burnout experienced by nurses in the medical area; to analyse the relationship between burnout and personality and psychological factors. METHODS: Quantitative, cross-sectional, multicentre study. Hospitals from eight cities were included. The study sample was n = 301 nurses, working in the medical area of hospitals in the Andalusian Health Service during the second semester of 2017. Sociodemographic, occupational and personality variables were studied using the Revised NEO Personality Inventory together with the Educational-Clinical Questionnaire: Anxiety and Depression, and burnout was measured by the Maslach Burnout Inventory. RESULTS: Almost 40% of the nurses presented high levels of burnout. The three burnouts (emotional exhaustion, depersonalisation and personal accomplishment) presented statistically significant correlations with the personality factors of neuroticism, extraversion, openness, agreeableness and conscientiousness, and also with the scores recorded for anxiety and depression. Multiple linear regression models showed agreeableness and depression to be statistically significant predictors of all dimensions of the syndrome. CONCLUSION: Hospital nurses working in the medical area in Andalusia experience high levels of burnout.

The Outcome of Severe Traumatic Brain Injury in Latin America.

BACKGROUND: Traumatic brain injury (TBI) disproportionately affects lower- and middle-income countries (LMIC). The factors influencing outcomes in LMIC have not been examined as rigorously as in higher-income countries. METHODS: This study was conducted to examine clinical and demographic factors influencing TBI outcomes in Latin American LMIC. Data were prospectively collected during a randomized trial of intracranial pressure monitoring in severe TBI and a companion observational study. Participants were aged ≥13 years and admitted to study hospitals with Glasgow Coma Scale score ≤8. The primary outcome was Glasgow Outcome Scale, Extended (GOS-E) score at 6 months. Predictors were analyzed using a multivariable proportional odds model created by forward stepwise selection. RESULTS: A total of 550 patients were identified. Six-month outcomes were available for 88%, of whom 37% had died and 44% had achieved a GOS-E score of 5-8. In multivariable proportional odds modeling, higher Glasgow Coma Scale motor score (odds ratio [OR], 1.41 per point; 95% confidence interval [CI], 1.23-1.61) and epidural hematoma (OR, 1.83; 95% CI, 1.17-2.86) were significant predictors of higher GOS-E score, whereas advanced age (OR, 0.65 per 10 years; 95% CI, 0.57-0.73) and cisternal effacement (P < 0.001) were associated with lower GOS-E score. Study site (P < 0.001) and race (P = 0.004) significantly predicted outcome, outweighing clinical variables such as hypotension and pupillary examination. CONCLUSIONS: Mortality from severe TBI is high in Latin American LMIC, although the rate of favorable recovery is similar to that of high-income countries. Demographic factors such as race and study site played an outsized role in predicting outcome; further research is required to understand these associations.

[Not Available]. / Estudio del impacto del índice de masa corporal pretrasplante sobre el pronto funcionamiento del injerto renal.

Introducción: la obesidad y el sobrepeso presentan efectos adversos sobre la salud, lo que contribuye a la aparición de enfermedades metabólicas y cardiovasculares que ponen en peligro la integridad del injerto.Objetivo: investigar la influencia del IMC pretrasplante renal sobre el funcionamiento del injerto renal al año de trasplante mediante el estudio de cuatro métodos distintos de medir la filtración glomerular.Material y métodos: en este trabajo se ha seguido a 1.336 pacientes de ambos sexos trasplantados renales; se les realizaron mediciones pretrasplante y postrasplante de parámetros bioquímicos, mediciones antropométricas y función renal mediante medidas de filtrado glomerular.Resultados: a mayor índice de masa corporal pretrasplante se produce una disminución del filtrado glomerular medido por cuatro métodos distintos, así como mayor porcentaje de rechazos.Conclusiones: un IMC elevado pretrasplante contribuye a la disfunción del injerto, a una disminución del filtrado glomerular y a complicaciones del injerto en el primer año postrasplante.

Estudio del impacto del índice de masa corporal pretrasplante sobre el pronto funcionamiento del injerto renal / Studying the impact of body mass index on pretransplant early renal graft function

Introducción: la obesidad y el sobrepeso presentan efectos adversos sobre la salud, lo que contribuye a la aparición de enfermedades metabólicas y cardiovasculares que ponen en peligro la integridad del injerto. Objetivo: investigar la influencia del IMC pretrasplante renal sobre el funcionamiento del injerto renal al año de trasplante mediante el estudio de cuatro métodos distintos de medir la filtración glomerular. Material y métodos: en este trabajo se ha seguido a 1.336 pacientes de ambos sexos trasplantados renales; se les realizaron mediciones pretrasplante y postrasplante de parámetros bioquímicos, mediciones antropométricas y función renal mediante medidas de filtrado glomerular. Resultados: a mayor índice de masa corporal pretrasplante se produce una disminución del filtrado glomerular medido por cuatro métodos distintos, así como mayor porcentaje de rechazos. Conclusiones: un IMC elevado pretrasplante contribuye a la disfunción del injerto, a una disminución del filtrado glomerular y a complicaciones del injerto en el primer año postrasplante (AU)

Introduction: Obesity and overweight have adverse health effects contributing to the presence of oxidative metabolic and cardiovascular diseases that threaten the integrity of the graft. Objective: To investigate the influence of body mass index on pre transplant graft function one year after transplant by studying four different methods of measuring the glomerular filtration rate. Material and methods: The sample consisted of 1336 kidney transplant patients of both sexes, measurements were performed pre transplant and post transplant of biochemical parameters, anthropometric measurements and kidney function by glomerular filtration steps. Results: When an increased body mass index pretransplant occurs, there is a decrease in glomerular filtration rate measured by four different methods and greater percentage of rejections. Conclusions: A high body mass index pretransplant contributes to graft dysfunction, a decrease in glomerular filtration rate and graft complications in the first year after transplant (AU)

UK Views toward Breastfeeding in Public: An Analysis of the Public's Response to the Claridge's Incident.

BACKGROUND: The embarrassment that UK mothers experience when breastfeeding in public has often been cited as a key factor in the decision of the mother to discontinue breastfeeding. There is convincing evidence that many UK residents are not comfortable with women breastfeeding in public; however, little is known about the underlying reasons for this discomfort. OBJECTIVE: This study aimed to assess views on breastfeeding in public in the United Kingdom and to understand why some UK residents object to this practice. METHODS: The comments sections of news media websites and parenting forums were systematically identified and reviewed for statements made in response to an incident widely reported in the British press: a woman was asked to cover up while breastfeeding in public at Claridge's, a London luxury hotel. Of these, 805 comments (73 108 words) met the inclusion criteria and were thematically analyzed. RESULTS: The majority of commenters were supportive of "discreet" breastfeeding in public, but a significant portion felt that breastfeeding in public is always inappropriate. Sexualization of the breast was mainly evoked as something others may experience while viewing a breastfeeding mother, rather than to reflect the commenters' own views. Common justifications cited against breastfeeding in public were onlookers' embarrassment (not knowing where to look) and disgust (at bodily fluids and/or functions). CONCLUSION: Campaigns portraying breastfeeding in public as normal and desirable with a focus on human milk as food rather than a bodily fluid may improve societal acceptance of breastfeeding in public.

Prevalence and risk factors of Burnout syndrome among spanish police officers / Prevalencia y factores de riesgo del síndrome de burnout en policías españoles

Background: Police work is currently one of the most stressful occupations. High levels of stress can culminate in suffering the burnout syndrome. This syndrome is characterised by emotional exhaustion, depersonalisation and low personal accomplishment. Police officers, despite being a risk group, have been investigated less than other professional groups. The objectives of the current work are to estimate the prevalence of burnout syndrome in police officers, to present a classification of the syndrome and to identify some risk factors (socio-demographic, personality, and work-related). Method: A cross-sectional study was carried out with 747 national police officers from Andalucía (Spain). Results: The prevalence of burnout is high. Furthermore, individual differences, and in particular, personality factors, are important to explain the development of burnout. Conclusions: Police officers are a risk group and, therefore, actions aimed at reducing the levels of burnout among these professionals should be developed (AU)

Antecedentes: el trabajo policial es uno de los más estresantes actualmente. Sufrir altos niveles de estrés puede provocar el desarrollo del síndrome de burnout. Este síndrome se caracteriza por cansancio emocional, despersonalización y baja realización personal. La policía, a pesar de ser un grupo de riesgo, ha sido menos investigada que otros colectivos profesionales. Los objetivos del presente trabajo son estimar la prevalencia del burnout en policías, presentar una clasificación del síndrome e identificar algunos factores de riesgo (sociodemográficos, de personalidad y laborales). Método: se realizó un estudio transversal con 747 policías nacionales de Andalucía. Resultados: la prevalencia del burnout es alta. Además, las diferencias individuales, especialmente, los factores de personalidad son importantes en la explicación del burnout. Conclusiones: los policías son un colectivo de riesgo y por esta razón se deberían desarrollar acciones para reducir los niveles de burnout en estos profesionales (AU)

Prevalence and risk factors of burnout syndrome among Spanish police officers.

BACKGROUND: Police work is currently one of the most stressful occupations. High levels of stress can culminate in suffering the burnout syndrome. This syndrome is characterised by emotional exhaustion, depersonalisation and low personal accomplishment. Police officers, despite being a risk group, have been investigated less than other professional groups. The objectives of the current work are to estimate the prevalence of burnout syndrome in police officers, to present a classification of the syndrome and to identify some risk factors (socio-demographic, personality, and work-related). METHOD: A cross-sectional study was carried out with 747 national police officers from Andalucía (Spain). RESULTS: The prevalence of burnout is high. Furthermore, individual differences, and in particular, personality factors, are important to explain the development of burnout. CONCLUSIONS: Police officers are a risk group and, therefore, actions aimed at reducing the levels of burnout among these professionals should be developed.

Efecto de la posición del bisel de la aguja en el acceso a la fístula arteriovenosa interna / Effect of the position of the bevel of the needle on access to the internal arteriovenous fistula

Introducción: La fístula arterio venosa, es hoy día el acceso vascular de elección en los pacientes con insuficiencia renal crónica terminal en tratamiento renal sustitutivo. Sin embargo, con el tiempo y tras punciones repetidas, las fístulas llegan a deteriorarse y desarrollar una serie de complicaciones como pueden ser: aneurismas, trombosis, estenosis e infecciones. Objetivos: Este trabajo pretende evaluar dos métodos de punción, mediante la posición del bisel dela aguja, hacia arriba o hacia abajo con el objetivo de comparar el sangrado durante la punción del acceso vascular y posteriormente, las complicaciones a la hora de canalizar el acceso vascular y determinar si la posición del bisel influye en el tiempo de hemostasia. Metodología: La muestra esta formada por 100enfermos que realizan diálisis periódicamente, con edades comprendidas entre 24 y 72. El promedio de la duración de la sesión fue de 4 horas, se observaron variables como: problemas al acceder a la fístula, sangrado a la punción y durante la diálisis, sangrado de la fístula tras hemostasia, dosis de heparina al comienzo y final de diálisis y dosis de heparina total. Resultados: La posición del bisel hacia abajo reduce los sangrados de la zona de punción, facilita la punción en la zona de acceso a la fístula y minimiza el sangrado a la punción (AU)

Introduction: The arterio venous fistula, is today the vascular access of choice in patients with Chronic Kidney Disease in terminal renal replacement therapy. However, over the time and after repeated punctures, fistulas tend to deteriorate and develop a number of complications such as: neurysms, thrombosis, stenosis and infections. Objectives: This study intends to evaluate two methods of puncture, by the position of the bevel of the needle, upwards or downwards with the following objective: To compare the bleeding at the site of the vascular access, and determine whether the position of the bevel influences at the time of haemostasis after haemodialysis. Methodology: The sample was composed of 100patients in haemodialysis programme, aged between24 and 72. The average duration of dialysis session was 4 hours. We studied variables such as difficulties accessing fistula, bleeding at the puncture, bleeding during the dialysis and later, bleeding from fistula after haemostasis, heparin dosage at the beginning and end of dialysis and total dose of heparin. Results: The bevel’s position down reduces bleeding from the puncture area, facilitates puncture in the area of access to the fistula and minimizes bleeding at the puncture site (AU)

La ceguera y otras enfermedades oculares en las novelas de Galdós / The blindness and other oculars illness in Galdo´s literature

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