Individual factors as predictors of secondary traumatic stress and burnout in forensic inpatient staff.

WHAT IS KNOWN ON THE SUBJECT: Secondary traumatic stress (STS) is the indirect traumatisation of a person through the stress of helping or knowing about other's trauma. Burnout is gradual exhaustion in response to long-term work-related stress. Both have negative psychological, physiological and/or organisational consequences; however, the existing research in forensic health care professionals (FHCPs) is limited. One study explored STS in FCHPs and found that lower psychological flexibility (ability to adapt) was a predictor of greater STS. Existing research on burnout in FHCPs suggests that individual differences, such as the ways in which we cope (talking to people vs. using substances), may predict burnout levels. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Prevalence findings add to the recent evidence base, which also found moderate levels of burnout. However, this study is the first to find high levels of secondary traumatic stress in FHCPs. Similar to existing literature, the study's findings suggest that FHCP's with lower levels of psychological flexibility and more maladaptive coping strategies may experience greater STS and burnout symptoms, while staff who use more adaptive coping strategies may experience less burn-out. Unexpectedly, staff who reported a more anxious attachment style were burnt-out; however, there are limitations to this finding. WHAT ARE THE IMPLICATIONS FOR PRACTICE: Policies and practices in forensic settings should reflect the risk of STS and burnout. Practices or interventions should enhance adaptive coping strategies and psychological flexibility, such as Resilience Enhancement Programmes or Acceptance and Commitment Therapy (ACT). ABSTRACT: INTRODUCTION: Secondary traumatic stress (STS) and burnout literature in inpatient forensic health care professionals (FHCPs) is limited, despite the psychological, physiological and organisational consequences. AIMS: This study aimed to further this limited evidence base, investigating predictors of STS and burnout in FHCPs. METHOD: 98 healthcare professionals working in two UK forensic inpatient settings completed measures assessing: burnout, STS, psychological flexibility, coping style, attachment style and a demographic questionnaire recording length of service and the sex of staff. RESULTS: Results indicated high STS and moderate burnout levels. The main predictors of STS and burnout were poorer psychological flexibility and greater maladaptive coping styles, whereas lower burnout was predicted by greater adaptive coping styles and an anxious attachment style. DISCUSSION: This study has contributed towards a limited evidence base and indicates poorer psychological flexibility and greater maladaptive coping may be risk factors for STS and burnout in FHCPs, whereas greater maladaptive coping may be a protective factor. IMPLICATION FOR PRACTICE: The findings suggest that interventions such as Acceptance and Commitment Therapy (ACT) and coping skills interventions, may offer protective benefits to inpatient forensic healthcare professionals.

Antimicrobial susceptibility of Canadian isolates of Helicobacter pylori in Northeastern Ontario.

BACKGROUND: Helicobacter pylori plays a significant role in gastritis and ulcers. It is a carcinogen as defined by the WHO, and infection can result in adenocarcinomas and mucosa-associated lymphoid tissue lymphomas. In Canada, rates of antimicrobial resistance are relatively unknown, with very few studies conducted in the past 15 years. OBJECTIVE: To examine rates of resistance in Sudbury, Ontario, compare antimicrobial susceptibility methods and attempt to determine the molecular basis of antibiotic resistance. METHODS: Patients attending scheduled visits at Health Sciences North (Sudbury, Ontario) provided gastric biopsy samples on a volunteer basis. In total, 20 H pylori isolates were collected, and antimicrobial susceptibility testing (on amoxicillin, tetracycline, metronidazole, ciprofloxacin, levofloxacin and clarithromycin) was conducted using disk diffusion and E-test methods. Subsequently, genomic DNA from these isolates was sequenced to detect mutations associated with antimicrobial resistance. RESULTS: Sixty-five percent of the isolates were found to be resistant to at least one of the listed antibiotics according to E-test. Three isolates were found to be resistant to ≥3 of the above-mentioned antibiotics. Notably, 25% of the isolates were found to be resistant to both metronidazole and clarithromycin, two antibiotics that are normally prescribed as part of first-line regimens in the treatment of H pylori infections in Canada and most of the world. Among the resistant strains, the sequences of 23S ribosomal RNA and gyrA, which are linked to clarithromycin and ciprofloxacin/levofloxacin resistance, respectively, revealed the presence of known point mutations associated with antimicrobial resistance. CONCLUSIONS: In general, resistance to metronidazole, ciprofloxacin/levofloxacin and clarithromycin has increased since the studies in the early 2000s. These results suggest that surveillance programs of H pylori antibiotic resistance may need to be revisited or improved to prevent antimicrobial therapy failure.

HISTORIQUE: L'Helicobacter pylori contribue énormément à la gastrite et aux ulcères. L'OMS le définit comme un cancérigène, et l'infection peut provoquer l'apparition d'adénocarcinomes et de lymphomes de tissus lymphoïdes associés aux muqueuses. Au Canada, on connaît relativement peu les taux de résistance antimicrobienne, car très peu d'études ont été réalisées sur le sujet depuis 15 ans. OBJECTIF: Examiner les taux de résistance à Sudbury, en Ontario, comparer les méthodes de susceptibilité antimicrobienne et tenter de déterminer le fondement biologique de la résistance antibiotique. MÉTHODOLOGIE: Les patients qui allaient à un rendez-vous prévu au Health Sciences North de Sudbury ont remis les résultats de biopsies gastriques sur une base volontaire. Au total, 20 isolats de H pylori ont été recueillis, et les tests de susceptibilité antimicrobienne (à l'amoxicilline, à la tétracycline, au métronidazole, à la ciprofloxacine, à la lévofloxacine et à la clarithromycine) ont été effectués au moyen de la diffusion sur disque et de l'essai E. L'ADN génomique de ces isolats a ensuite été séquencé pour déceler les mutations associées à la résistance antimicrobienne. RÉSULTATS: Selon l'essai E, 65 % des isolats étaient résistants à au moins un des antibiotiques énumérés. Notamment, 25 % des isolats étaient résistants à la fois au métronidazole et à la clarithromycine, tous deux normalement prescrits en première ligne pour traiter les infections à H pylori au Canada et dans la plupart des régions du monde. Parmi les souches résistantes, les séquences d'ARN ribosomique 23S et de gyrA, qui sont liées à la résistance à la clarithromycine et à la ciprofloxacine-lévofloxacine, respectivement, révélaient la présence de mutations de points connus associés à une résistance antimicrobienne. CONCLUSIONS: En général, la résistance au métronidazole, à la ciprofloxacine-lévofloxacine et à la clarithromycine a augmenté depuis les études réalisées au début des années 2000. D'après ces résultats, il faudra peut-être revoir ou améliorer les programmes de surveillance de l'antibiorésistance au H pylori pour prévenir l'échec du traitement antimicrobien.