The mediating effects of coping strategies on the relationship between secondary traumatic stress and burnout in professional caregivers in the UAE.

BACKGROUND: Professional caregivers dealing with traumatized victims or mental health clients are at increased risk for developing the same symptoms as persons who are exposed directly to the trauma. AIMS: This research was aimed at examining the relationship between secondary traumatic stress, burnout and coping strategies in 502 professional caregivers who work in schools, hospitals, charity institutes and welfare centers in the United Arab Emirates (UAE). A further aim was to test the mediating effect of coping on the relationship between burnout and secondary traumatic stress. METHODS: Measures used in this study were the Professional Quality of Life Questionnaire (ProQOL), The General Health Questionnaire (GHQ-28), The Maslach Burnout Inventory: Human Services Survey (MBI-HSS) and Endler and Parker's Coping Inventory. RESULTS: Task-focused coping, personal accomplishment and compassion satisfaction were negatively associated with secondary traumatic stress. Burnout, emotion-focused and distraction coping were positively related to secondary traumatic stress. Coping partially mediated the relationship between burnout and secondary traumatic stress. There were also significant gender differences in depersonalization and distraction coping. CONCLUSIONS: Efforts need to focus on improvement of caregivers' work environments, enhancing their coping skills and professional development.

Clostridium difficile-associated disease acquired in the cardiothoracic intensive care unit.

OBJECTIVES: To determine the prevalence, severity, and outcome associated with Clostridium difficile-associated disease (CDAD) acquired while in the cardiothoracic intensive care unit (CTICU). DESIGN: A 5-year retrospective study. SETTING: The CTICU. PARTICIPANTS: All CTICU patients with a positive C difficile stool toxin assay 48 hours after admission. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The results of all CTICU patients with a positive C difficile stool toxin assay were obtained from the Microbiology Department. Each patient's medical notes and charts then were reviewed in turn. A total of 27 of 5,199 (0.5%) CTICU patients acquired CDAD. The median age was 74 years (IQR 68-77), and 17 (63%) patients were male. There were 21 (78%) surgical patients; 13 (62%) were elective admissions. The most frequent diagnosis on admission was valvular heart disease (10 [37%] patients). Sixteen (59%) patients underwent coronary artery bypass graft (CABG) surgery and/or valvular heart surgery. The median interval between CTICU admission and CDAD diagnosis was 10 days (IQR 5-18). Previously identified risk factors for ICU-acquired CDAD included age >65 years (23), antibiotic use (26), and medical device requirements (27). At the time of diagnosis, 14 (52%) patients had moderate CDAD. After treatment initiation, 8 (30%) patients developed worsening CDAD. The 30-day in-hospital mortality rate for CTICU-acquired CDAD was 26% (7 patients). CONCLUSIONS: C difficile-associated disease rarely is acquired in the CTICU. Approximately one third of patients may experience disease progression, and just over a quarter may die within 30 days of diagnosis. The implementation of recommended severity definitions and treatment algorithms may reduce complication rates and merits prospective evaluation.

Mental health problems among internally displaced persons in Darfur.

War victims are regarded as one of the highest risk groups for mental disturbances. This study investigated the effects of the Darfur conflict on mental health of 430 internally displaced persons (IDPs) from three camps located around Fasher and Nyala towns. A stratified random sampling technique was used to select participants. Male participants represented 50.6% of the sample while female participants represented 49.4%. The Posttraumatic Stress Disorder Checklist and the General Health Questionnaire (GHQ-28) were used in addition to a questionnaire measuring demographic variables and living conditions. It was hypothesized that high prevalence of posttraumatic stress disorder (PTSD) symptoms and of nonpsychotic psychiatric symptoms will be evident. Results showed a high dissatisfaction rate (72%) with living conditions among IDPs. There was also high prevalence of PTSD (54%) and general distress (70%) among IDPs. Female participants showed more somatic symptoms than their male counterparts. Married participants were more distressed, anxious, and showed more social dysfunction, while single ones reported more avoidance symptoms. Significant differences related to date of displacement were found in PTSD and hyperarousal. The group of IDPs displaced in 2003 scored higher on these scales than those displaced in 2004 and 2005. There was also significant difference related to date of displacement in distress, somatic symptoms, depression, anxiety, and social dysfunction. IDPs displaced in 2003 scored higher on these scales. Results are discussed in light of the study hypotheses and previous findings. It is concluded that three factors might affect the dissatisfaction of IDPs with living conditions inside camps. These are: lack of employment, unsuitability of food items, and lack of security around camps. It was recommended that psychological support services should be among the prime relief services provided by aid agencies.