Work-Related Stress Questionnaire: confirmatory factor analysis for construct validation by the PHRASI study.

OBJECTIVE: The purpose of this study is to validate the 13-item version of the Work-Related Stress Questionnaire (WRSQ) on a representative sample of Italian public health residents. MATERIALS AND METHODS: The WRSQ was administered as part of the Public Health Residents' Anonymous Survey in Italy (PHRASI) from 14 June to 26 July 2022. Collinearity between each questionnaire item was assessed with Kendall's τ statistic. The latent factors identified associating similar items based on the authors' observations were workplace, job demand, support and unpleasant workplace. Goodness-of-fit was assessed with confirmatory factor analysis calculating: Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), Standardized Root-Mean-Residual (SRMR). Cronbach's alpha (α) and Omega McDonald (ω) were calculated to evaluate the reliability of the questionnaire. R 4.2.2 was used to perform the analyses. RESULTS: 379 Public Health residents (58% women) responded to the questionnaire. No significant collinearity was found between the items (τ range -0.31 to 0.49). Confirmatory Factor Analysis showed CFI = 0.975, TLI = 0.967, RMSEA = 0.041 and SRMR = 0.051. Internal consistency of the WRSQ Total Score was α = 0.80 and ω = 0.85. CONCLUSIONS: Although validated in a sectorial subpopulation of healthcare workers, the WRSQ proved to be an excellent tool for assessing work-related stress. Unpleasant workplace latent factors showed lower factor loading and internal consistency than others. This could be due to the fact that topics investigated with unpleasant workplace items (e.g., abuse and discrimination) are experienced on a less regular basis than the ones assessed through the other items.

Splenic trauma following colonoscopy.

A case of splenic trauma after colonoscopy is reported. After description of their experience, the Authors report a review of the literature and some considerations about clinical diagnosis and surgical or medical therapy for this pathology.

Prosthetic replacement of the tricuspid valve: biological or mechanical?

BACKGROUND: Incidence of tricuspid prosthesis replacement was 1.9% of all valvular operations performed between June 6, 1966 and April 18, 1996. Many series report similar figures, but institutional experience is limited and the consensus on treatment modalities is lacking. METHODS: One hundred tricuspid operations were performed on 83 patients (46 female). A primary operation was performed in 64 cases, 13 patients had one previous operation, 4 patients had two previous operations, and 2 patients had three previous operations. Seventeen patients required a tricuspid prosthetic valve rereplacement. There were 2 emergent and 17 urgent operations. The New York Heart Association class was IV in 13 patients (mean pulmonary artery pressure, 41 mm Hg), III in 66 patients (mean pressure, 38 mm Hg), and II in 21 patients. The most frequent operation was simultaneous replacement of the mitral and tricuspid valve (41 patients). Seventy biological and 30 mechanical prostheses were used. Total follow-up time was 613 years, mean 7.4 years (median 4.2 years), with a maximum of 27.8 years, and was 92% complete. RESULTS: Operative mortality was 24%. Survival was 0.54 (0.48 to 0.59, n = 39) at 5 years, 0.38 (0.32 to 0.44, n = 27) at 10 years, 0.31 (0.25 to 0.36, n = 19) at 15 years, 0.29 (0.23 to 0.34, n = 11) at 20 years, and 0.17 (0.098 to 0.26, n = 3) at 25 years. Early mortality was increased from higher New York Heart Association class (hazard ratio = 2.2), congenital disease (hazard ratio = 6.9), and valvuloplasty failure (hazard ratio = 4.3). The constant risk phase (4%/patient-year) after 2 years was enhanced by older operative age (hazard ratio = 1.4). Prosthetic type had no independent effect. Biological prostheses were at risk for 300 years and had a reoperation incidence of 4.7%/ patient-year (14 events); mechanical prosthesis were at risk for 137 years with a rate of 2.2%/patient-year (3 events) (p = 0.21). Three valve thromboses were observed in old-design mechanical prosthesis. Bioprosthetic degeneration showed a steeper rate after 7 years. CONCLUSIONS: This study does not show a clear superiority of biological versus mechanical prostheses. In the long run survival with mechanical prostheses could be superior, given the high rate of bioprosthetic degeneration after 7 years.