Burnout prevalence in intensive care nurses in Argentina. / Prevalencia de burnout entre las enfermeras de cuidados intensivos en Argentina.

PURPOSE: Burnout syndrome among intensive care professionals has been widely documented internationally. Few studies address the incidence and prevalence in Latin America. And there are no validated studies about the situation in Argentina. Our goal was to determine burnout prevalence among intensive care nurses in Argentina and related risk factors. MATERIALS AND METHODS: Online self-administered survey evaluating demographic variables and the Maslach Burnout Inventory in 486 critical care nurses between June and September 2016. RESULTS: A percentage of 84.4 of participants show moderate or high levels of burnout syndrome (95% CI 80.8 to 87.4). No significant association was found between burnout and gender, age, years of practice, academic degree, role or multiplicity of jobs. There was no statistical difference in burnout prevalence among different types of populations of care (neonatal, paediatric or adult care). Nurse to patient ratios of 1:3 or higher was found to be a statistically significant risk factor for emotional exhaustion and depersonalization sub-scales (P=.002 and .0039, respectively). CONCLUSION: More than 80% of nurses caring for critically ill patients in Argentina show moderate or high levels of burnout syndrome and this is related to a high nurse:patient ratio (1:3 or higher).

Histo-FISH protocol to detect bacterial compositions and biofilms formation in vivo.

The study of biofilm function in vivo in various niches of the gastrointestinal tract (GIT) is rather limited. It is more frequently used in in vitro approaches, as an alternative to the studies focused on formation mechanisms and function of biofilms, which do not represent the actual in vivo complexity of microbial structures. Additionally, in vitro tests can sometimes lead to unreliable results. The goal of this study was to develop a simple approach to detect bacterial populations, particularly Lactobacillus and Bifidobacterium in biofilms, in vivo by the fluorescent in situ hybridisation (FISH) method. We standardised a new Histo-FISH method based on specific fluorochrome labelling probes which are able to detect Lactobacillus spp. and Bifidobacterium spp. within biofilms on the mucosal surface of the GIT embedded in paraffin in histological slices. This method is also suitable for visualisation of bacterial populations in the GIT internal content. Depending on the labelling probes, the Histo-FISH method has the potential to detect other probiotic strains or pathogenic bacteria. This original approach permits us to analyse bacterial colonisation processes as well as biofilm formation in stomach and caecum of BALB/c and germ-free mice.

Interaction of substance use and risks to sexual health in the Slovak army: general, sociocultural and individual behaviour patterns.

This paper offers an overview about the application of the newly designed WHO/UNAIDS Rapid Assessment and Response Guide (SEX-RAR) for research on interaction between psychoactive substance use and sexual risks in the very specific environment during mandatory military service in the Slovak Republic. Presented results outline general, specific (sociocultural) and individual behaviour patterns concerning interaction of substance (alcohol) use and sexual behaviour, as well as proposed recommendations for intervention activities.

Possible precipitants of psychiatric hospitalization in patients with major depression: results from the Jerusalem Collaborative Depression Project.

In spite of substantial advances in the treatment of major depression by pharmacotherapy and other means, a significant number of depressed patients require hospitalization. In the context of the Jerusalem Collaborative Depression Project, possible precipitants of psychiatric hospitalization were sought in a cohort of patients (n = 107) who were admitted to hospitals in the Jerusalem area during a 14-month period because of a depressive episode. The patients fulfilled DSM III-R criteria for major depression, single or recurrent; bipolar 1 disorder, depressed or mixed; bipolar 2, depressed. The cohort encompassed more than two thirds of potential subjects admitted during this period with the ICD-9 equivalents of the specified diagnoses (as reported to the Israel Ministry of Health National Psychiatric Case Register) and were similar to the entire potential population in terms of their diagnostic breakdown. The patients underwent extensive socio-demographic and clinical evaluation that included detailed documentation of treatment received prior to hospitalization. Notwithstanding the absence of a comparison group of depressed patients who were not hospitalized, a number of potential precipitants were identified. These included older age (55.2% > 60 years, 20.6% > 70 years), immigration to Israel during the preceding 5 years (34.7%), concomitant physical illness (60%) which was associated with moderate to severe disability in 41% and poor quality of antidepressant pharmacotherapy prior to hospitalisation (only 24.3% received an adequate trial of antidepressant medication). Further evaluation of these and other potential factors could facilitate targeting of patient groups at particular risk for hospitalization and reduce the need for it.

Prior hospitalization and age as predictors of mental health resource utilization in Israel.

A two-part demand model based on data from a psychiatric case registry was estimated in order to search for predictors of hospital-based psychiatric care utilization. Using only age as an independent variable, explanation of future resource utilization is considerably weaker than when number of cumulative days of psychiatric hospital-based service use during the previous five years is also included. Only a small marginal gain is achieved by also adding diagnoses. Prospective remuneration by capitating sick funds according to age and past hospital-based service utilization records is recommended to avoid the twin pitfalls of cream-skimming and a distorted allocation of resources for psychiatric services.

Ambulatory mental health treatment under universal coverage: policy insights from Israel.

Untested assumptions concerning ambulatory treatment have shaped mental health policies for decades. Three opinions prevail: (1) all use is alike; (2) any use leads to high use; and (3) all high use is discretionary and therefore excessive. These assumptions were tested, using data from a nationwide survey of ambulatory utilizers in Israel, a country that has universal coverage. The findings, based on detailed clinical and treatment records, challenge all three assumptions. Moreover, they document a diversity of clinical needs while also verifying substantial variations in the type, frequency, and duration of treatment provided to meet those needs. In brief, Israeli data do not confirm continuing concerns by policy makers about uncontrollable use of services with expanded mental health coverage. Special policy limitations on mental health treatment should be reconsidered in light of empirical evidence from a system without the restrictions that exist in the United States.

Physical illness among all discharged psychiatric inpatients in a national case register.

Previous studies have found that although psychiatric patients tend to have more physical illness than the rest of the population, it frequently goes unrecognized and untreated in psychiatric settings. This study investigated rates of reported physical illness among hospitalized psychiatric patients in preparation for national reform in mental health services. Data from the Israeli National Psychiatric Case Registry were analyzed on reported physical illness among all 38,714 psychiatric discharges during 1989-1991. Physical illness was reported for 10.62% of patients under age 25, 14.04% of patients 25 to 44, 34.27% of patients 45 to 65, and 61.26% of patients 65 and older. Rates differed among hospitals. Reported physical illness was considerably lower than expected as compared with other studies. Underdiagnosis is suggested as a possible explanation. Study results were used to add differential payment for physical comorbidity under the new National Health Insurance Law. Other corrective measures are discussed.

[Patterns of service utilization of mental health outpatients].

In light of the forthcoming implementation of national health reform, it is important to review and analyze data regarding the degree and pattern of outpatient, mental-health service utilization in Israel. The main questions this study addressed were: to identify the main groups of users of mental health care, and to determine the utilization patterns of these groups (by length, frequency, and type of treatment) and the profession of the caregivers. This study is based on the findings of the national survey of all adult users of ambulatory mental health services in 1 week in May 1986, and of a 1-week survey in 1994 of similar data from 7 mental health clinics. When patients were grouped into 2 main clinical categories according to the severity of their psychopathology (psychotic, major affective and organic disorders, vs. neurotic, adjustment and personality disorders) they showed different patterns of service utilization. The pattern of the first group was associated with the severity of the psychopathology, whereas the pattern of utilization of the second group was also associated with sociodemographic factors, which may reflect awareness of psychological problems and readiness to turn to mental health services. These factors may also affect the willingness of the caregiver to treat them.

Reported comorbidity of mental disorders with substance abuse among psychiatric inpatients in Israel.

In preparation for shifting of care from psychiatric hospital to the community, the prevalence of substance abuse comorbidity among discharged psychiatric patients was studied. Such patients are not usually treated by substance abuse programs or mental health clinics. Data from the Israeli National Psychiatric Case Registry were analyzed on reported substance abuse among all 53,379 psychiatric discharges during 1989-92. The Registry consists of data that physicians are mandated to report on all patients. The authors found that reported substance abuse comorbidity was 13.2% for males and 3.6% for females. Patients with a diagnosis of personality disorder had the most reported substance abuse. Reported drug abuse for males increased with age until age 45, and alcohol abuse until age 65. Drug and alcohol abuse by females is the highest for the patients under age 24 and declines with an increase in age. The results were almost identical for each of the four years studied. The results suggest that developing special outpatient facilities to serve this group will be impractical because of the small numbers. Ways of serving these patients in existing community mental health centers are discussed.

Patterns of use and changes in diagnosis during first admission. National Case Register Study.

The goal of this study was to describe patterns of diagnosis and to explore the extent to which diagnosis changes during first-in-life psychiatric admissions. All 2,998 first admissions to Israeli psychiatric wards in 1989 were studied. Diagnosis did not change in at least 60% of the cases. Diagnoses in order of stability were: mental retardation (84%), substance abuse (82%), organic conditions (77.5%), neurotic (75%), schizophrenia (74%), personality disorders (73%), affective (68%), childhood (55%), paranoid (45%) and V-codes (22%). There was less change in diagnosis for patients over 45 (37.5%), than for patients aged 19-44 (43.2%) and 15-18 (57.8%). Diagnoses assigned at admission to first hospitalization are not likely to change during that hospitalization.

Predicting revolving-door patients in a 9-year national sample.

We attempted to predict revolving door (RD) patterns of admission (four or more admissions with less than 2.5 years between consecutive admissions) in a random sample of 10% of all first admissions to psychiatric hospitals and psychiatric wards of general hospitals in Israel from 1983 to 1990 with follow-up into 1993. This included 4570 hospitalizations of 2220 patients. Data were extracted from the National Psychiatric Case Registry of the Ministry of Health. Almost 59% of the sample had only one admission, 41% had two or more, 23% had three or more, and 14% had four or more admissions. Patients with four or more admissions were all RD patients. They had an average of 200 days between admissions. The average number of admissions for RD patients was 6.17, and the average number of years between the first admission and the last admission was 3.28 years. Using discriminant analysis we correctly predicted 73.9% of the non-RD group (about chance level since 80% of the cases were non-RD) and 71.2% of the RD group (considerably better than chance, only 12.0% of the sample were RD). The main predictors of RD in descending order were not being married at the time of first hospitalization, unemployment and more severe initial diagnosis. The minor predictors were older age, more education and longer first admission. Substance abuse, patients ability to care for their affairs, voluntary status of first admission and suicide attempts did not predict RD.(ABSTRACT TRUNCATED AT 250 WORDS)

Does affordability affect mental health utilization? A United States-Israel comparison of older adults.

The affordability of treatment is considered a major influence on the utilization of mental health services, a premise empirically examined in this research. Utilization patterns in the U.S. are compared with Israel, a country where access to treatment is not influenced by costs and their coverage. The focus is primarily on older adults, whose consistently low use of ambulatory services (in U.S.) has been attributed to financial barriers. The finding challenge the affordability-utilization assumption: (1) older Israeli ambulatory use is lower than in the U.S.; (2) Israel elders have the lowest rates of all adult groups, the same pattern as in the U.S.; (3) older Israelis have a substantially higher inpatient rate than younger Israelis (< 65), a pattern dissimilar from the U.S. These findings have important implications for policymakers who attempt to address underserved groups by reducing financial barriers. Israeli data provide compelling evidence that affordability may be less relevant to mental health than to other health services. A more promising research focus is on those organizational, professional and other structural factors which shape the system and influence how, where, and to whom treatment is provided.

Changes in diagnosis in a 9-year national longitudinal sample.

Studied are changes in diagnosis in a random sample of 10% of all first admissions to psychiatric hospitals and psychiatric wards of general hospitals in Israel from 1983 to 1990 with follow-up evaluation to 1991. This included 4,570 hospitalizations of 2,220 patients. Data were extracted from the National Psychiatric Case Registry of the Ministry of Health. Almost 59% of the sample had one admission, 18% had two, 9% had three, and 14% had four or more. From the first admission to the last discharge (a mean of 2.15 years), 59.2% of the patients' diagnoses did not change. In 89.46% of the cases in which the diagnosis changed, the changes took place during the first admission. Diagnostic change differed between diagnostic groups. In descending order of stability in diagnosis from the first admission to the last discharge were neurotic and personality disorder (73.6%), mental retardation (73.5%), schizophrenia (73.0%), organic conditions (70.6%), affective disorders (66.2%), substance abuse (65.6%), childhood disorders (60%), paranoid disorder (43.6%), other nonorganic psychosis (30.3%), and V-codes (25.0%). The average level of diagnostic agreement between the first admission and the last discharge was a kappa of .52. The average length of stay for patients whose diagnosis became more severe was considerably longer than for patients whose diagnosis became less severe or did not change in level of severity. Older age was related to less change in diagnosis. For patients aged less than 18 years, diagnosis changed in 46.7% of the cases, for patients aged 19 to 44, 31.2%, and for patients older than 45, 27.8%.

Interviewing prepubertal children about suicidal ideation and behavior.

OBJECTIVE: Much of the literature on assessment of suicidal children has focused on identifying risk factors associated with suicidal ideation and behavior in this population. Unique problems encountered in interviewing prepubertal children about suicidal ideation and behavior are examined in this paper. METHOD: Observations of problems encountered in interviewing prepubertal children about suicidal ideation and behavior were gleaned in the context of interviews of children admitted to a child psychiatry inpatient unit and interviews of the parents of these children. RESULTS: Unique problems include difficulties in assessment of suicidal intent, impact of cognitive development, particularly of the concept of death, interaction between current emotional state and memory of previous suicidal episodes, characteristics of play associated with suicidal states, effects of parents' attitudes toward assessment on information gathering, and the impact of certain risk factors on cognition and behavior during the interview. CONCLUSION: Interviewing children about suicidal ideation and behavior necessitates that the clinician attend to multiple elements of the interview simultaneously. These interviews are further complicated by the stressful thoughts and feelings that can be raised in both clinician and child in reaction to exploring the child's suicidal ideation and behavior. Additional research is needed to refine the process of reliable interviewing of children about suicidal ideation and behavior and to develop instruments both to quantitate the different elements of these interviews and to guide the clinicians conducting them.

[Psychiatric hospitalization trends and predicted needs].

This study attempts to predict the need up to 1995 for psychiatric beds in Israel, based on the trends of psychiatric hospitalization during 1986-1990. Additional need created by the recent large waves of immigrants to Israel are taken into account. Analysis was separate for chronic in-patients, (continuous stay of 1 year or more) and for acute in-patients (stay of less than 1 year). The data were drawn from the National Psychiatric Case Register. Among acute in-patients, the admission rate of immigrants was higher than that of the veteran population, thus counterbalancing the trend to a decrease in admissions among the latter. It is assumed therefore that the present rate of 0.4 acute patients/1000 population will not change. However, an additional 300 new beds will be needed due to increase in the general population. With regard to chronic in-patients, a continuous decrease of about 50 chronic in-patients per year has been observed. Assuming 700,000 new immigrants will have arrived in Israel between 1990-1995, and that the proportion of patients admitted who remain in continuous hospitalization is larger among new immigrants than among the veteran Israeli population (10% vs. 6%), the beds expected to be vacated by chronic patients will be filled by new immigrant patients. The expected rate of chronic in-patients will nevertheless decrease from the present rate of 1.0/1000. to 0.8/1000 by 1995.

Psychiatric hospitalization of immigrants to Israel from the former USSR: assessment of demand in future waves of immigration.

In the years 1970-1990 approximately half a million immigrants from the former USSR arrived in Israel. Experts predict that new waves of immigration are likely to happen. This paper presents an attempt to forecast the need for appropriate psychiatric services in future waves of immigration. The study compares hospitalization patterns of immigrants arriving in Israel between 1972-1980 with those arriving in 1990. The rates of admission were compared to the rates for Israelis in the specified periods and an estimate for the future need for psychiatric services was calculated. The central finding in this study was that former Soviet immigrants were admitted to psychiatric hospitals within the first year of their arrival at a higher rate than Israelis in the 1970s and in 1990. In the 1970s the admission rate for immigrants was 33 per 10,000, while the rate for Israelis was 20 per 10,000. In 1990 the admission rate for immigrants was 31 per 10,000, while the rate for Israelis was 20 per 10,000. The forecast for the next years is for 320 first admissions within a year after arrival for every 100,000 immigrants. Planning for new waves of immigrations from the former USSR should therefore include a serious consideration of the provision of appropriate psychiatric services.

A comparison of the mental health systems of New York State and Israel.

The article compares characteristics of the residential and non-residential mental health services in Israel and in New York State and considers their influences on extent of service utilization. The data is based on special surveys covering all patients seen in public mental health services in New York State and in Israel during one week in 1986. The results indicate similar overall residential prevalence rates in both systems (1.9 per 1,000 population). Israeli males aged 45-64 show much higher residential prevalence rates than males of this group in NYS. The Israeli non-residential rates are much lower, 3.5 per 1,000 as compared to 5.5 in NYS. These differences are seen in both sexes and across all age groups. Overall diagnostic distributions show a greater percentage of patients with major affective disorder in NYS and a somewhat greater percentage of patients with the diagnosis of schizophrenia in Israel. Three Service Dependency Levels (SDL) are defined and their distribution by loci of care are presented. A greater proportion of patients belong to the highest SDL (1) in Israel as compared to NYS. Both in New York State and in Israel, the development of public mental health services is generally oriented to a preference for the non-residential, community treatment model over the residential, institutional model. However, Israel is less advanced than New York in developing its non-residential psychiatric services, as reflected by the relative low rate of psychiatric referrals to community facilities and clinics. Analysis and explanation of these survey differences are presented.

Patterns and correlates of psychiatric hospitalization in a nationwide sample. II. Correlates of length of hospitalization and length of stay out of hospital.

A nationwide random sample of psychiatric patients (n = 832) admitted for hospitalization in Israel in 1980 was followed up until the end of 1984. A multivariate analysis was performed, where the dependent variables were: the cumulative length of all hospitalizations, the mean duration of hospitalization and the mean length of stay out of hospital. The independent variables were: age, sex, marital status, ethnic origin, diagnosis, and various indices of previous hospitalizations. For patients whose hospitalization in 1980 (index hospitalization) was the first in their life, older age and male gender predicted a low probability of readmission, and the diagnosis of schizophrenia a long cumulative stay. For patients whose index hospitalization was not the first in their life, the main variables predictive of long cumulative stay were: old age, being single, long duration and high frequency of previous hospitalizations. Patients tended to maintain the same relative length of inpatient stay and the same frequency of readmission from the beginning of their hospitalization history.

The epidemiology of involuntary psychiatric hospitalization in Israel.

The reasons for both voluntary and involuntary admissions of patients into psychiatric hospitals in Israel is discussed. An analysis is presented of the demographic and clinical features of those admitted during the period from 1983 to 1988.

Patterns and correlates of psychiatric hospitalization in a nationwide sample. I. Patterns of hospitalization with special reference to the "new chronic" patients.

A nationwide random sample of psychiatric patients (n = 832) admitted for hospitalization in Israel in 1980 was followed up until the end of 1984 regarding their hospitalization patterns. Information about hospitalizations as well as demographic and diagnostic data were obtained from the Israel Central Psychiatric Case Register. Two main contrasting patterns of hospitalization emerged. One pattern consisted of a single short hospitalization during the entire follow-up period. This pattern was found among more than 50% of those patients for whom this hospitalization was the first in their life. The second pattern characterized the patients who accumulated long periods of inpatient stay, that is, at least one year during the follow-up period. These are the "new chronic" patients (about 30% of the total sample). About one third of these "new chronic" patients (8.2% of the total sample) accumulated their long stay through one continuous hospitalization, thus resembling the "old chronic" patients; two-thirds accumulated their long stay over several hospitalizations. Each patient has a fairly constant pattern of hospitalization, regarding the length of stay in hospital and out of hospital.