Burnout dimension profiles among healthcare workers in Indonesia.

Background: Besides biological impact, COVID-19 also poses a threat to psychological wellbeing and the quality of life. Healthcare workers, especially those assuming a front-line post, are at a higher risk of being affected, both physically and psychologically. This study aims to analyse variables potentially associated with burnout and psychological distress among healthcare workers with various health center stratifications, where we commenced a nationwide survey to establish the baseline data. Method: An analytic observational study with a cross-sectional design was conducted on the 11th - September 18, 2020. Participants were enrolled from healthcare institutions represented by epicenter of the COVID-19 pandemic in Indonesia, which were Java, Sumatra, Bali, and were asked questionnaires, including the Depression, Anxiety and Stress Scale 21 (DASS-21), Maslach Burnout Inventory (MBI), Somatic Symptom Scale 8 (SSS-8), also Well-Being Index (WBI). A linear mixed effect model was used to analyse how three dimensions of burnout vary across occupations. Results: A total of 3629 healthcare workers were analysed in this study. Burnout syndrome was found in 37.5% of healthcare workers. The prevalence of burnout among medical personnel, nurses, and midwives was 44.6%, 33.5%, and 36.2%, respectively. The prevalence of burnout in healthcare workers was most common in Java (38.4%) and healthcare workers who work in the hospital (28.6%). Based on the burnout dimensions, 48.2% of healthcare workers experienced moderate to high emotional exhaustion, 51.8% moderate to high depersonalization, and 96.9% high personal accomplishment. The R 2 values was 0.33,0.28,0.27 for emotional exhaustion, depersonalization and personal accomplishment model. Calculated power of the emotional exhaustion and depersonalization model was 100% for both midwife and nurse variable. Meanwhile, the power of the personal accomplishment model was 100% for midwife and 94.7% for nurse variable. Conclusion: The extent of the three burnout dimensions is pervasive in all occupational levels and the place of work (hospital/community health center).

Cardiac Performance by Echocardiography, Cardiovascular Biomarker, Kidney Function, and Venous Oxygen Saturation as Mortality Predictors of Septic Shock.

BACKGROUND: cardiac function in patients with septic shock at the cellular level can be assessed by measuring troponin I and NT Pro BNP levels. Venous oxygen saturation is measured to evaluate oxygen delivery and uptake by organ tissue. Our study may provide greater knowledge and understanding on pathophysiology of cardiovascular disorder in patients with septic shock. This study aimed to evaluate the roles of echocardiography, cardiovascular biomarkers, venous oxygen saturation and renal function as predictors of mortality rate in patients with septic shock. METHODS: this is a prospective cohort study in patients with infections, hypotension (MAP < 65 mmHg) and serum lactate level of > 2 mmol/L. On the first and fifth days, septic patients underwent echocardiography and blood tests. Statistical analysis used in our study included t-test or Mann-Whitney test for numeric data and chi-square test for nominal data of two-variable groups; while for multivariate analysis, we used Cox Regression model. RESULTS: on 10 days of observation, we found 64 (58%) patients died and 47 (42%) patients survived. The mean age of patients was 48 (SD 18) years. Patients with abnormal left ventricular ejection fraction (LVEF) had 1.6 times greater risk of mortality than those with normal LVEF (RR 1.6; p = 0.034). Patients with abnormal troponin I level showed higher risk of mortality as many as 1.6 times (RR: 1.6; p = 0.004). Patients with impaired renal function had 1.5 times risk of mortality (RR 1.5; p = 0.024). Patients with abnormal troponin I level and/or impaired renal function showed increased mortality risk; however, those with normal troponin I level and impaired renal function also showed increased mortality risk. Multivariate analysis revealed that left ventricular ejection fraction and troponin I level may serve as predictors of mortality in patients with septic shock. (HR 1.99; 95% CI: 1.099  ̶  3.956 ; p = 0.047 and HR: 1.83 ; 95%CI: 1.049  ̶ 3,215 ; p = 0.043). CONCLUSION: left ventricular ejection fraction and biomarkers such as troponin I level are predictors of mortality in septic shock patients.

Injury, disability and quality of life after the 2009 earthquake in Padang, Indonesia: a prospective cohort study of adult survivors.

BACKGROUND: On 30 September 2009, a 7.6 magnitude earthquake severely hit the coast of Padang city in West Sumatra, Indonesia leaving about 1,117 people dead and injuring another 3,515. Health consequences such as physical injury, co-morbidity, disability and quality of life over time are seldom reported among survivors after earthquakes. OBJECTIVES: To investigate the associations between injury, disability and quality of life amongst adult survivors in Padang city after the 2009 earthquake. DESIGN/METHODS: A prospective cohort study was conducted to compare adult injured (184) and adult non-injured (93) subjects over a 6-month period. Data on physical injury, co-morbidities, disability and quality of life were collected through interviews and measured quantitatively in three phases, i.e. at baseline, end of 3 and 6 months. RESULTS: Disability scores were consistently and significantly higher among injured subjects compared to non-injured, even when adjusted for co-morbidities (i.e. acute symptoms and chronic diseases). The highest disability score amongst injured subjects was attributed to 'feeling discomfort/pain'. Quality of life attribute (QLA) scores, were significantly lower amongst injured people as compared to those non-injured even when adjusted for co-morbidities. The lowest QLA item score amongst the injured was 'pain, depression and anxiety'. Significant and consistent negative correlations were found between disability and QLA scores in both the injured and non-injured groups. CONCLUSION: Physical injury is significantly correlated with both higher disability and lower quality of life, while disability has significant negative correlation with quality of life. The findings suggest that, through disability, injury may contribute to decreased quality of life. It is therefore recommended to promptly and adequately treat injuries after disasters to prevent any potential for disability and hence restore quality of life.

MIB-1 (KI-67) proliferation index and cyclin-dependent kinase inhibitor p27(Kip1) protein expression in nephroblastoma.

PURPOSE: A number of studies have indicated that the tumor proliferation marker MIB-1 and cell cycle inhibitor p27(Kip1) expression are of prognostic importance in a variety of cancers. The present study was performed to evaluate the prognostic value of these molecules in Wilms' tumors. EXPERIMENTAL DESIGN: MIB-1 and p27(Kip1) expressions were investigated by the means of immunohistochemical analysis of 62 Wilms' tumor. Patients were preoperatively treated by chemotherapeutic agents and had a mean follow-up of 5.7 years. RESULTS: MIB-1 and p27(Kip1) were expressed in normal kidney tissues and in the three main components of Wilms' tumor, i.e., the blastemal, epithelial, and stromal cells. In Wilms' tumors, the percentage of MIB-1-positive cells in the blastema ranged between 0 and 42% (mean, 9.4%) and in the epithelial component between 0 and 53% (mean, 19.9%), with a significant difference (P < 0.01). The percentage of blastemal p27(Kip1)-positive cells ranged between 3 and 85% (mean, 55.1%) and for the epithelial component between 1 and 87% (mean, 59%). There was a significant inverse relationship between blastemal MIB-1 and p27(Kip1) expression in Wilms' tumor. Univariate analysis showed that blastemal MIB-1 and p27(Kip1) expression were indicative for clinical progression and tumor-specific survival. In a multivariate analysis, blastemal MIB-1 and p27(Kip1) protein expression proved to be an independent prognostic for clinical progression besides stage. CONCLUSIONS: It was concluded that both MIB-1-based proliferative activity and p27(Kip1) protein expression in the blastema have prognostic impact in Wilms' tumor.

Expression and prognostic value Of CD44 isoforms in nephroblastoma (Wilms tumor).

PURPOSE: CD44 is a group of transmembranous glycoproteins formed by alternative splicing of a single messenger RNA. An abnormal pattern of CD44 expression has been demonstrated in several human malignancies. We evaluate the prognostic value of standard CD44 (CD44s) and some of its isoforms in treating clinical Wilms tumor. MATERIALS AND METHODS: The immunohistochemical expression of CD44 isoforms was studied in paraffin material of 61 clinical Wilms tumors. Patients were treated preoperatively with chemotherapy and mean followup was 5.7 years. RESULTS: Generally CD44s, CD44v5 and CD44v10 were expressed in normal kidney tissues and at variable levels in the 3 cell types of Wilms tumor (blastemal, epithelial and stromal). No CD44v6 expression was found neither in normal kidney or in tumor tissue. CD44s, CD44v5 and CD44v10 epithelial expression gradually decreased from stage T1 to T3. By contrast the percentage of CD44 positive cells in the blastemal component significantly increased from T1 to T3. CD44 immunoreactive blastema cells were found in 62%, 44% and 41% for CD44s, CD44v5 and CD44v10, respectively. Blastemal expression of CD44s and CD44v5 statistically significantly correlated with clinicopathological stage. Univariate and multivariate analyses showed that blastemal CD44v5 expression was indicative of poor prognosis. CONCLUSIONS: Increased expression of CD44v5 in the blastemal part of Wilms tumor correlated with tumor stage, clinical progression and tumor related death. Therefore, blastemal CD44v5 expression may be of value in identifying patients with a high propensity for distant metastases. These patients might benefit from adjuvant chemotherapy and/or radiotherapy.

What proportion of episodes of gonorrhoea and chlamydia becomes symptomatic?

The effectiveness of syndromic treatment as an STD control strategy depends on the proportion of episodes which become symptomatic; few studies have measured this directly. We estimated these proportions for gonorrhoea (NG) and chlamydia (CT), synthesizing data on the point prevalence of self-reported discharge and dysuria among infected cases in rural Uganda, the durations of symptoms, incubation period and asymptomatic episodes, and the effect of treatment on symptom duration. Estimated proportions of episodes that become symptomatic were 45% for males with NG, 11% for males with CT, 14% for females with NG and 6% for females with CT. This was on average 1.5-fold higher than symptom prevalence at cross-section among infected cases in this population. Estimates were sensitive to assumptions on the relative durations of asymptomatic and symptomatic episodes, but were invariably inconsistent with previous direct estimates based on a US cohort study. These results show that the probability of recognizing symptoms in NG and CT episodes varies between settings. In populations with low treatment rates like Uganda, these probabilities can be very low. Here, health education should have priority in STD management programmes.