Effectiveness of a multimodal training programme to improve general practitioners' burnout, job satisfaction and psychological well-being

BACKGROUND

The changes in the models of care for mental disorders towards a community focus and deinstitutionalisation might have risen General practitioners' (GPs) workload, increasing their mental health concerns and the need for solutions. Pragmatic research into improving GPs' work-related health and psychological well-being is limited by focusing mainly on stressors and through not providing systematic attention to the development of positive mental health via interventions that develop psychological resources and capacities. The aim of this study was twofold: a) to determine the effectiveness of an intensive multimodal training programme for GPs designed to improve their management of mental-health patients; and b) to ascertain if the program could be also useful to improve the GPs management of their own burnout, job satisfaction and psychological well-being.

METHOD

Eighteen GPs constituted a control group that underwent the routine clinical Mental health support programme for primary care. An experimental group (N = 20) additionally received a Multimodal training programme (MTP) with an Integrated Brief Systemic Therapy (IBST) approach. Through questionnaires and a clinical interview, level of burnout, professional satisfaction, psychopathological state and various indicators of the quality of administrative and healthcare management were analysed at baseline and 10 months after the programme.

RESULTS

In relation to government of mental-health patients indicators, on the one hand MTP group showed statistically significant improvements in certain administrative health parameters, but on the other it did not improve opinions and attitudes towards mental illness. Regarding GPs management of their own burnout, job satisfaction and psychological well-being assessments, the MTP presented better scores on global psychopathological state and better evolution of satisfaction at work; psychopharmacology use dropped in both groups; in contrast, the MTP did not improve burnout levels.

CONCLUSIONS

Findings of this preliminary study are promising for the MTP (with an IBST approach) practice in primary care. More research evidence is required from larger samples and randomized controlled trials to support both the hypothetical adoption of MTP (with an IBST approach) as a part of a continuing professional-training programme for GPs' management of mental-health patients and its positive effects on work-related health factors.

[Minor cutaneous ambulatory surgery and cryotherapy. Comparative study between a dermatologist and family physicians]

INTRODUCTION

Lack of diagnostic skill in cutaneous surgery may lead to erroneous and potentially detrimental therapies. This study compares the diagnosis and treatment in cutaneous surgery, including cryotherapy, between a dermatologist and family physicians.

METHODS

It is an observational, prospective study on a random sample of patients that consulted the dermatologist for candidate lesions. Each lesion was independently evaluated by a dermatologist and a family physician, both of whom assigned the clinical diagnosis and therapeutic advice. Concordance for diagnosis, recommended treatment and indication for cryotherapy was calculated by Cohen's kappa coefficient.

RESULTS

Six hundred forty-six lesions were evaluated. Global kappa indexes were 0.69 (95 % CI, 0.65-0.73) for diagnostic concordance, 0.62 (95 % CI, 0.56-0.67) for recommended treatment and 0.73 (95 % CI, 0.67-0.78) for indication of cryotherapy. Diagnostic concordance was significantly better for melanocytic nevus, achrocordon and for lesions with multiple and monomorphous presentation, and worse for isolated pigmented lesions. For recommended treatment concordance was better for multiple and monomorphous lesions and worse for skin cancer and seborrheic keratosis. For indication of cryotherapy concordance was worse for skin cancer, melanocytic nevus, acrochordon and seborrheic keratosis. Family physicians made an erroneous indication for cryotherapy in 5.88 % of cases, including 3 non melanoma skin cancers.

CONCLUSIONS

Concordance between dermatologists and family physicians for minor cutaneous surgery is generally good. Family physicians should be more careful in evaluating solitary pigmented lesions and patients at risk for skin cancer.

Psychometric evaluation of the Spanish version of CONNECT: a measure of continuity of care in mental health services

This article provides the results of the psychometric testing of the Spanish version of CONNECT(-S), a measure of continuity of care in mental health services. CONNECT-S is a multidimensional measure designed for use with seriously mentally ill respondents. Consisting of 12 scales and one single-item indicator, it addresses qualities of interaction in current relationships between mental health service providers and consumers in five conceptual domains: (1) practitioner knowledge of their clients, (2) creating flexibility, (3) practitioner availability, (4) practitioner co-ordination, and (5) smoothing transitions. One-hundred-and-fifty participants took part in the study. Participants were recruited from mental health outpatient clinics in both the Puerto Rican (n = 109) and the San Antonio (n = 41) samples. Internal consistency for scales in a combined site estimate ranged from 0.68 to 0.96. Test-retest reliability ranged from fair to substantial in all but one scale. Concurrent validity hypotheses based on a priori predictions were mostly supported. The Spanish translation and adaptation of CONNECT-S provided sound psychometric results across both sites. CONNECT-S addresses the gap in measurement of continuity of care for the two largest US Latino subgroups, Mexican Americans and Puerto Ricans; and provides an encouraging starting point for a measure that is both relevant and culturally sensitive.

Ethnic differences in social network help-seeking strategies among Latino and Euro-Aamerican dementia caregivers

This research explores the help-seeking behavior of Euro-American and Latino caregivers who provide homecare assistance to an older adult with dementia. A community sample of 89 caregiver-care recipient pairs (39 Latino and 50 Euro-American) was interviewed. Descriptive, bivariate, and multivariate analyses were conducted to examine ethnic differences in use of an informal social network for help with caregiving tasks. Caregiver experiences that may impact help-seeking behaviors such as perceived availability of support network, satisfaction with support received and caregiver distress were also considered. Latino caregivers reported less help-seeking than did the Euro-American caregivers. Overall, ethnicity accounted for 16% of the variation in help-seeking behaviors. Ethnicity accounted for a significant portion of the variation in most of the help-seeking characteristics examined even after adjusting for socioeconomic variables. In the multivariate model, the effects of ethnicity on help-seeking persisted, while the effects of other likely predictors did not. The size of social network may not be synonymous with the seeking of support by caregivers. Likewise, higher levels of distress among Latino caregivers did not result in increased help-seeking behaviors. There remains a need to identity what other factors may contribute to the cultural variability in caregivers' use of informal support.

Successful use of tissue plasminogen activator in catheter-related intracardiac thrombus of a premature infant

The incidence of clinically apparent neonatal thrombosis is about 0.1 to 0.2% in the neonatal intensive care unit (NICU). The optimal treatment modalities for neonates with thromboses are not known. We report on our experience with recombinant tissue type plasminogen activator (rt-PA) in a premature infant with an intracardiac thrombus.

Culture and schizophrenia: a cross-ethnic growth curve analysis

This study examined the longitudinal trajectory of a sociocentric construct among African-Americans, Latinos, and nonminorities. Participants were 163 individuals diagnosed with schizophrenia who were admitted to community-based psychosocial programs. Previous research had established empathy and social competence as sociocentric cultural mediators of a benign symptom profile for ethnic minorities. Data on sociocentric indicators were collected every 6 months for over 3 years. Growth curve methodology was used to examine the empathy and social competence outcomes over time and across ethnic groups. The results revealed a dynamic course for both sociocentric mediators. However, the dynamic growth curve for empathy was related to ethnicity; for social competence it was not. Empathy levels for African-Americans decreased and then attenuated, whereas empathy levels for Latinos decreased over the entire study. Nonminorities showed very little change overall. The nature of sociocentric phenomena is dynamic and complex. These qualities can apparently be cultivated or diminished over time.

Theory and computer simulation for the equation of state of additive hard-disk fluid mixtures

A procedure previously developed by the authors to obtain the equation of state for a mixture of additive hard spheres on the basis of a pure fluid equation of state is applied here to a binary mixture of additive hard disks in two dimensions. The equation of state depends on two parameters which are determined from the second and third virial coefficients for the mixture, which are known exactly. Results are compared with Monte Carlo calculations which are also reported. The agreement between theory and simulation is very good. For the fourth and fifth virial coefficients of the mixture, the equation of state gives results which are also in close agreement with exact numerical values reported in the literature.

The cultural relevance of community support programs

The research and practice literature was examined to determine whether community support programs are responsive to ethnocultural issues and to derive strategies for developing culturally relevant programming. Great variation exists across cultures in family practices, conceptions of mental illness, stigma attributed to mental illness, and expectations of the provider system. Ethnic minority cultures are typically centered on the family, whereas Western European cultures are characterized as more individualistic and as valuing independence. Research shows that some rehabilitation approaches based on Western models may produce adverse effects when used with patients from ethnic minority groups. Interventions that incorporate family networks and use group modalities are considered culturally congruent. Clients from sociocentric cultures may have strong support networks and display prosocial behaviors that can be tapped in the rehabilitation process. Community support programs should incorporate cultural factors into psychosocial assessments, train staff to conduct ethnographic interviews, and use focus groups to gain an understanding of the cultures of clients they serve.

[Estimate of HIV-1 infection prevalence in pregnant women and effectiveness of zidovudine administered during pregnancy in the prevention of vertical transmission]

BACKGROUND

Despite the proven efficacy of zidovudine (ZDV) for reducing perinatal transmission of HIV-1, questions remain about its implementation and effectiveness in routine practice. The aims of this study were to assess the impact of ZDV administered during pregnancy in preventing perinatal HIV-1 transmission, and to determine the proportion of early identification of maternal HIV-1 infection over time.

PATIENTS AND METHODS

We prospectively followed from birth a cohort of children born between 1/1/1987 and 31/10/1997 to HIV-1-infected mothers. Infant infection status was assessed by follow-up beyond 18 months or HIV-PCR up to 3 months of age.

RESULTS

229 mothers and 248 infants were identified in the cohort. ZDV was administered during pregnancy as monotherapy to 34 mothers for a mean of 4.7 (3.1) months prior to delivery. There were no differences in baseline characteristics between the treated and untreated groups. Mean (SD) CD4 cell count was 465 (261) cells x 10(6)/l. Factors associated with transmission were a more prolonged time of rupture of obstetric membranes (median 6 vs 1.04 hours; p = 0.023) and ZDV treatment. Among the ZDV-treated mothers only one child was infected (2.9%), whereas 37 children born to 212 untreated women became infected. (OR: 0.14; 95% CI: 0.07-0.92). The estimated prevalence of HIV-1 in pregnant women in our area is about 0.39% (95% CI: 0.34-0.45). From 1987 to 1991, 9.7% of infected women were nor identified at the perinatal period, as compared to 2.5% in the last 5 years of the study period (p = 0.034).

CONCLUSIONS

In this study, the estimated prevalence of HIV-1 infection is high. ZDV during pregnancy is significantly associated with a decrease in perinatal transmission in our setting. The awareness of an effective treatment might have contributed to the increased identification of HIV-infected mothers prior to delivery observed over time in our cohort of children born to HIV-infected mothers.

Cross-ethnic symptom differences in schizophrenia: the influence of culture and minority status

The two objectives of this tri-ethnic study were (1) to test competing hypotheses from the minority status and ethnic culture perspectives in examining cross-ethnic symptom differences in schizophrenia and (2) to test cultural mediators of the symptom differences. Analyses were done on samples of minority (African-American and Latino) and nonminority (white) groups. Hypothesized cross-ethnic symptom differences were tested, and indicators of sociocentricity were examined as cultural mediators of symptom differences. The sample consisted of 184 individuals (51.6% white, 32.6% African-American, 15.8% Latino, 75% male) diagnosed with schizophrenia in an outpatient, urban setting. Symptom variables were obtained from the Brief Psychiatric Rating Scale and the Quality of Life Scale. Two sociocentric indicators (empathy and social competence) were used to differentiate minority from nonminority groups. Multiple regression was used to test the mediational influence of the sociocentric indicators on the symptom differences. After controlling for social class, significant differences were found in eight symptom variables. These showed the nonminority group to be consistently more symptomatic than the ethnic minority groups, findings which supported the ethnic culture hypothesis. Sociocentric indicators were found to be significant mediators of the cross-ethnic symptom differences. This study supported the ethnic culture hypothesis, which predicted lower symptoms for the ethnic minority groups, and showed that sociocentric variables strongly mediated the more benign symptom profile for the ethnic minority groups. The study indicates that culture should be more fully integrated into current biopsychosocial models of schizophrenia.

[Meconium aspiration syndrome with severe hypoxemia. Treatment with a pulmonary vasodilator (tolarzoline) (author's transl)]

Three patients with Meconium Aspiration Syndrome (S.A.M.) and severe hypoxemia are reported. From the first hours of life they needed mechanical ventilation, showing no improvement in PaO2 in spite of usual respiratory support measures. In one case, pulmonary hypertension and ductal right to left shunt through ductus arteriosus and foramen ovale was objetivated by cardiac catheterization. Following intravenous prefusion of a pulmonary vasodilator (Tolazoline) patients showed a clinical amelioration and a definite increase in PaO2. Results and evolution with the use of this drug are commented.