Referral to treatment of absent employees diagnosed with burnout in the Netherlands

Background

Despite large amounts of research on determinants of burnout, research on its treatment is scarce. In the Netherlands, occupational physicians (OPs) can officially diagnose burnout and have to offer return-to-work (RTW) guidance to employees on sick leave, which includes referral to treatment. This research aimed to explore 1) characteristics of treatment for burnout and 2) how employee-, complaint- and employer characteristics relate to referral to treatment by the OP and to employee RTW expectation.

Methods

All 212 employees (45% male, 42.5 years of age, 35% high educated) diagnosed with burnout at one occupational health service during February-June 2020 were included. Register data (gender, age (years), education, organization size) and self-reported data collected online (living situation; Burnout Assessment Tool (BAT) score; cause of absence mainly work-related (0/1); treatment (0/1); on waiting list (0/1); type of treatment; treatment focused on RTW (0/1); employee RTW expectation high (0/1)) were tested with Chi2, ANOVA and logistic regression analyses.

Results

Of all employees, 75.9% (n = 161) were referred to treatment by their OP, of which 25.5% (n = 41) were currently on a waiting list. The majority received treatment from a nurse practitioner (51.7%) or psychologist (23.3%) These practitioners focused on RTW less often (51.6%-60.7%) than the other practitioners (81.5-100%) (p = 0.042). Multivariate tests showed age to relate to referral to treatment (OR 0.956; 95% CI 0.928-0.986) and BAT score to employee RTW expectation (OR 0.635; 95% CI 0.407-0.991).

Conclusions

OPs referred three quarters of the employees on sick leave with burnout to treatment. Referral by OPs related only to younger age and employee RTW expectation only to BAT score. The practitioners that were referred to most often, focused less on RTW. As burnout is a work-related syndrome, these findings suggest room for improving the treatment's focus on (returning to) work.

Key messages

OPs referred 75.9% of the burned out employees on sick leave to treatment, particularly younger employees. The practitioners that were referred to most often, focused less on RTW.

DNA identification of species of the Anopheles maculipennis complex and first record of An. daciae in Belgium

The present study aimed at identifying the members of the Anopheles maculipennis complex (Diptera: Culicidae) occurring in Belgium. Therefore, the second internal transcribed spacer of nuclear ribosomal DNA (ITS2) and the mitochondrial cytochrome oxidase subunit I (COI) loci were sequenced in 175 and 111 specimens, respectively, collected between 2007 and 2019. In parallel, the suitability of two species-diagnostic PCR-RFLP assays was tested. The identified specimens included: An. maculipennis s.s. (N = 105), An. daciae (N = 62), An. atroparvus (N = 6) and An. messeae (N = 2). Each species was characterized by unique ITS2 haplotypes, whereas COI only supported the monophyly of An. atroparvus, a historical malaria vector in Belgium. Species identification results were further supported by unique PCR-RFLP banding patterns. We report for the first time An. daciae in Belgium, where it was found to co-occur with An. maculipennis s.s. The latter was the most prevalent in the collection studied (60%) and appears to have the widest distribution in Belgium. As in other studies, An. daciae and An. messeae appeared the most closely related species, up to the point that their species status remains debatable, while their ecological differences, including vector competences, need further study.

Closed intramedullary tibial nailing using the Marchetti-Vicenzi nail

We present the results of using the Marchetti-Vicenzi nail in the management of 41 closed and 16 type I-III open tibial fractures in 56 patients. The treatment goals were to achieve stability and fracture alignment allowing early functional treatment of the knee and ankle by immediate partial or full weight-bearing. Early callus formation and rapid mobilisation were obtained in 84% of the patients. The mean time to clinical union was 9.8 weeks (radiological union 28.4 weeks) for closed fractures and also 9.8 weeks for open fractures (radiological union 28.7 weeks). No late rotational deformities were observed. We argue that intramedullary nailing with a Marchetti-Vicenzi nail is a quick and excellent method of treating selected closed and open tibial fractures.

Desflurane reduces the febrile response to administration of interleukin-2

BACKGROUND

Intraoperative fever is relatively rare considering how often pyrogenic causes are likely to be present and how common fever is postoperatively. This low incidence suggests that general anesthesia per se inhibits the normal response to pyrogenic stimulation. The authors therefore tested the hypothesis that desflurane-induced anesthesia produces a dose-dependent inhibition of the febrile response.

METHODS

Eight volunteers were studied, each on 3 study days. Each was given an intravenous injection of 50,000 IU/ kg of interleukin-2 (elapsed time, 0 h), followed 2 h later by 100,000 IU/kg. One hour after the second dose, the volunteers were assigned randomly to three doses of desflurane to induce anesthesia: (1) 0.0 minimum alveolar concentration (MAC; control), (2) 0.6 MAC, and (3) 1.0 MAC. Anesthesia continued for 5 h. Core temperatures were recorded from the tympanic membrane. Thermoregulatory vasoconstriction was evaluated using forearm-minus-fingertip skin temperature gradients; shivering was evaluated with electromyography. Integrated and peak temperatures during anesthesia were compared with repeated-measures analysis of variance and Scheffé's F tests.

RESULTS

Values are presented as mean +/- SD. Desflurane reduced the integrated (area under the curve) febrile response to pyrogen, from 7.7 +/- 2.0 degrees C x h on the control day to 2.1 +/- 2.3 degrees C x h during 0.6 MAC and to -1.4 +/- 3.1 degrees C x h during 1.0 MAC desflurane-induced anesthesia. Peak core temperature (elapsed time, 5-8 h) decreased in a dose-dependent fashion: 38.6 +/- 0.5 degrees C on the control day, 37.7 +/- 0.7 degrees C during 0.6 MAC and 37.2 +/- 1.0 degrees C during 1.0 MAC desflurane anesthesia. Rising core temperature was always associated with fingertip vasoconstriction and often with shivering.

CONCLUSIONS

Desflurane-induced anesthesia produced a dose-dependent decrease in integrated and peak core temperatures after administration of pyrogen, with 1.0 MAC essentially obliterating fever. Anesthetic-induced inhibition of the pyrogenic response is therefore one reason that fever is an inconsistent clinical response to inflammation during surgery.

Post-operative effects of tramadol administered at wound closure

The aim of this prospective, randomized and double-blind study was to assess the effects of a high dose of the analgesic tramadol administered at the conclusion of surgery on extubation time, sedation, and post-anaesthetic shivering. Forty adult patients, ASA physical status I or II, underwent laparoscopic surgery of about 1 h duration and received a standardized anaesthesia that was maintained with isoflurane in O2/N2O. Tramadol 3 mg kg-1 (n = 20) was administered intravenously at the beginning of wound closure, and was compared with saline (n = 20). Post-anaesthetic shivering did not occur in any patient who received tramadol, whereas it occurred in 60% of the control group (P < 0.001). There were no adverse effects on time to extubation and sedation, and discharge-ready time was shorter in the tramadol group (P < 0.05 compared with control). Pain scores in the post-anaesthesia care unit (PACU) were statistically not different between the two groups, but significantly more supplemental medication was administered in the control group to treat shivering and/or pain. In conclusion, administration of a high dose of tramadol at the end of surgery prevents post-anaesthetic shivering without prolongation of extubation time, and shortens the PACU/discharge-ready time.

Technical note: the use of arterialized arm veins in infrainguinal bypass

In order to augment the vein donation area of arm veins for infrainguinal bypass, we performed an arteriovenous AV fistula prior to the revascularization procedure. This technique was used in 5 patients. The diameter enlargement of the vein obtained by this technique enabled us to construct completely autologous grafts with gratifying results.

[A case of lycanthropy with deadly violence]

After a short historical review of the contemporary medical literature, the authors analyze a new and original observation of lycanthropy. He is a 28 years old man, imprisoned for deadly violence, who has been showing, for many years, the belief of being transformed into a werewolf during depersonalization episodes when he presents a lycanthropic behaviour. Our observation is closer to hysteria and mythomania on an antisocial personality, although it seems difficult to place the mental pathology of this alcoholic recidivist delinquent into a nosographical frame.