Emotional distress and occupational burnout in health care professionals serving HIV-infected patients: A comparison with oncology and internal medicine services.

BACKGROUND: The present paper examines the levels of emotional distress and professional burnout among health care professionals working with HIV patients in two different settings, Infectious Disease (ID) Units and a Haemophilia (H) Unit, and compares them with those of professionals working in Oncology (O) or General Internal Medicine (IM) Units, all at public hospitals. METHODS: Cross-sectional anonymous survey assessing their psychological condition, occupational stress, work and social adjustment, and providing information about stressors, supports and coping methods, using the General Health Questionnaire, the Maslach Burnout Inventory, the Modified Social Adjustment Scale, and other self-administered instruments. RESULTS: Perceived stress was higher in both O and IM, and the number of stressful circumstances was especially higher in O. No significant differences in psychological morbidity were found among the groups, with these exceptions: a better status among the H staff, who also showed less overall burnout; emotional exhaustion was lower in both ID and H than in the two other groups; the ID staff showed less personal accomplishment. Using a multiple regression model, a series of variables - including work adjustment, social/leisure adjustment, and having chosen to work in their position - was able to predict outcome. CONCLUSIONS: Our results highlight the presence of substantial levels of emotional distress and work-related difficulties in a significant number of health care workers. The mental health services could play an important role in conducting further research in this field and in providing practical help to deal with staff's difficulties.

Psychiatric consultation and post-traumatic stress disorder in burned patients.

We report a prospective study of 65 burned inpatients referred for psychiatric consultation. All of the subjects in the sample were evaluated by a structured questionnaire and clinical interview. Reasons for referral were: suicide attempt by burning (n = 7), substance dependence (n = 8) and behaviour disturbed by coping difficulties (n = 50). The diagnoses were adjustment disorder (n = 40), alcohol dependence (n = 7), opiate dependence (n = 2), dementia (n = 3), depressive disorder (n = 5), schizophrenia (n = 1), delirium (n = 1) and post-traumatic stress disorder (n = 5). Patients with post-traumatic stress disorder (PTSD) were specifically and carefully evaluated. There were no significant differences between patients with PTSD and adjustment disorder for severity and type of burn injuries. We conclude that PTSD is apt to be missed by the medical staff of burn units.

[Severe and mild forms of nemaline myopathy: a report of three cases]. / Miopatía nemalínica: forma congénita neonatal y moderada a propósito de tres observaciones.

Three new cases of two different forms of congenital nemaline myopathy are reported. Two of them represent a severe neonatal form. These cases were presented as a floppy infant syndrome. Although neither of them needed intensive care, they had feeding difficulties and one needed a feeding-tube for a period of time. Both of the patients showed a very severe motor delay and neither could manage to walk independently. During their lives, they suffered from repeated pneumonias, which was the cause of death in both cases before the age of two years. The mild congenital type represents a more benign form. Although hypotonic and weak, the patient managed to walk independently before two years of age. The weakness was spread all over, but was focused in the face, extensors of the neck and axial muscles. At 9 years of age, the patient has not experienced any respiratory trouble. The CK (creatine kinase) test were normal in all patients, but the EMG (electromyogram) showed different electromyographic patterns. The rods were in subsarcolemic positions, cytoplasmic positions or in both positions.

[Magnetic resonance++ with gadolinium in Sturge Weber syndrome]. / Resonancia magnética con gadolinium en el síndrome de Sturge Weber.

We report four patients with Sturge Weber syndrome in which the pial angioma was visualized better with Gd-DOTA enhanced MR imaging. MR alone demonstrated thickened cortex with diminished convolutions, abnormal white matter and prominent subependymal veins. However, Gd-DOTA enhanced MR imaging improved the visualization of the angioma, localizing and demonstrating the extent of the malformation in Sturge Weber syndrome. We believe that this is the procedure of choice to recognize the extent of the intracranial involvement and which would help to select those patients that would benefit from surgical treatment.