José Manuel Pérez-Mármol

Association between burnout and cortisol secretion, perceived stress, and psychopathology in palliative care unit health professionals.

ABSTRACTObjective:A high incidence of burnout has been reported in health professionals working in palliative care units. Our present study aims to determine whether there are differences in the secretion of salivary cortisol between palliative care unit health professionals with and without burnout, and to elucidate whether there is a relationship between burnout syndrome and perceived stress and psychopathological status in this population. METHOD A total of 69 health professionals who met the inclusion criteria participated in our study, including physicians, nurses, and nursing assistants. Some 58 were women (M = 29.65 years, SD = 8.64) and 11 men (M = 35.67 years, SD = 11.90). The level of daily cortisol was registered in six measurements taken over the course of a workday. Burnout syndrome was evaluated with the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), the level of perceived stress was measured using the Perceived Stress Scale, and psychopathological status was gauged using the SCL-90-R Symptoms Inventory. RESULTS There were statistically significant differences in secretion of cortisol in professionals with high scores on a single subscale of the MBI-HSS [F(3.5) = 2.48, p < 0.03]. This effect was observed 15-30 minutes after waking up (p < 0.01) and at bedtime (p < 0.06). Moreover, the professionals with burnout showed higher scores on the psychopathology and stress subscales than professionals without it. SIGNIFICANCE OF RESULTS A higher score in any dimension of the burnout syndrome in palliative care unit health professionals seems to be related to several physiological and psychological parameters. These findings may be relevant for further development of our understanding of the relationship between levels of burnout and cortisol secretion in the health workers in these units.

Functional rehabilitation of upper limb apraxia in poststroke patients: study protocol for a randomized controlled trial

BackgroundUpper limb apraxia is a common disorder associated with stroke that can reduce patients’ independence levels in activities of daily living and increase levels of disability. Traditional rehabilitation programs designed to promote the recovery of upper limb function have mainly focused on restorative or compensatory approaches. However, no previous studies have been completed that evaluate a combined intervention method approach, where patients concurrently receive cognitive training and learn compensatory strategies for enhancing daily living activities.Methods/DesignThis study will use a two-arm, assessor-blinded, parallel, randomized controlled trial design, involving 40 patients who present a left- or right-sided unilateral vascular lesion poststroke and a clinical diagnosis of upper limb apraxia. Participants will be randomized to either a combined functional rehabilitation or a traditional health education group. The experimental group will receive an 8-week combined functional program at home, including physical and occupational therapy focused on restorative and compensatory techniques for upper limb apraxia, 3 days per week in 30-min intervention periods. The control group will receive a conventional health education program once a month over 8 weeks, based on improving awareness of physical and functional limitations and facilitating the adaptation of patients to the home. Study outcomes will be assessed immediately postintervention and at the 2-month follow-up. The primary outcome measure will be basic activities of daily living skills as assessed with the Barthel Index. Secondary outcome measures will include the following: 1) the Lawton and Brody Instrumental Activities of Daily Living Scale, 2) the Observation and Scoring of ADL-Activities, 3) the De Renzi Test for Ideational Apraxia, 4) the De Renzi Test for Ideomotor Apraxia, 5) Recognition of Gestures, 6) the Test of Upper Limb Apraxia (TULIA), and 7) the Quality of Life Scale For Stroke (ECVI-38).DiscussionThis trial is expected to clarify the effectiveness of a combined functional rehabilitation approach compared to a conservative intervention for improving upper limb movement and function in poststroke patients.Trial registrationClinical Trial Gov number NCT02199093. The protocol registration was received 23 July 2014. Participant enrollment began on 1 May 2014. The trial is expected to be completed in March 2016.

Effectiveness of two home ergonomic programs in reducing pain and enhancing quality of life in informal caregivers of post-stroke patients: A pilot randomized controlled clinical trial

BACKGROUND Informal caregivers of post-stroke patients usually undergo high levels of pain and stress and have a reduced quality of life. OBJECTIVE To evaluate the effectiveness of two home ergonomic interventions aimed at reducing pain intensity and perceived stress and enhancing the quality of life in informal caregivers of chronic post-stroke patients. METHODS A randomized single-blind controlled clinical trial was conducted, with a sample of 33 informal caregivers of patients with stroke. Three groups were included: one received postural hygiene training and kinesiotherapy, for 12 weeks, two days a week, one hour per session; another received adaptation of the home environment, and the third was a control group. Pain intensity, stress level and general quality of life were evaluated at three-time points: pre-intervention, post-intervention, and after a follow-up period of three months. RESULTS Neck pain decreased in the two experimental groups, and increased in the control group. Pain in the shoulders and knees was alleviated in the group that received postural hygiene and kinesiotherapy. In addition, regarding quality of life, this group obtained an improvement in the physical health dimension, while the home adaptation group reported improved social relationships. CONCLUSIONS These results suggest that 12 weeks of training in postural hygiene, combined with kinesiotherapy, and home adaptations can reduce pain and improve several aspects of the quality of life of this population. CLINICALTRIALS. GOV ID NCT03284580.

Effectiveness of a fine motor skills rehabilitation program on upper limb disability, manual dexterity, pinch strength, range of fingers motion, performance in activities of daily living, functional independency, and general self-efficacy in hand osteoarthritis: A randomized clinical trial

Study Design: A randomized clinical trial. Introduction: Rehabilitation treatments for improving fine motor skills (FMS) in hand osteoarthritis (HOA) have not been well explored yet. Purpose of the Study: To assess the effectiveness of a rehabilitation program on upper limb disability, independence of activities of daily living (ADLs), fine motor abilities, functional independency, and general self‐efficacy in older adults with HOA. Methods: About 45 adults (74‐86 years) with HOA were assigned to an experimental group for completing an FMS intervention or a control group receiving conventional occupational therapy. Both interventions were performed 3 times/wk, 45 minutes each session, during 8 weeks. Upper limb disability, performance in ADLs, pinch strength, manual dexterity, range of fingers motion, functional independency, and general self‐efficacy were assessed at baseline, immediately after treatment, and after 2 months of follow‐up. Results: FMS group showed significant improvements with a small effect size on manual dexterity (P ≤ .034; d ≥ 0.48) and a moderate‐high effect on range of index (P ≤ .018; d ≥ 0.58) and thumb (P ≤ .027; d ≥ 0.39) motion. The control group showed a significant worse range of motion over time in some joints at the index (P ≤ .037; d ≥ 0.36) finger and thumb (P ≤ .017; d ≥ 0.55). Conclusions: A rehabilitation intervention for FMS may improve manual dexterity and range of fingers motion in HOA, but its effects on upper limb disability, performance in ADLs, pinch strength, functionality, and self‐efficacy remain uncertain. Specific interventions of the hand are needed to prevent a worsening in range of finger motion. Level of Evidence: 1b.

Adherencia al tratamiento en pacientes con lupus eritematoso sistémico

BACKGROUND AND OBJECTIVE Non-adherence to treatment is usually a clinical problem in patients with systemic lupus erythematosus (SLE). Increasing the knowledge of predictors of treatment adherence can be meaningful in the clinical setting. The main objective of the present study was to analyse the influence of sociodemographic, clinical and psychological variables on the degree of treatment adherence in a sample of Spanish women with SLE. PATIENTS AND METHOD This is an observational-transversal study. All participants were evaluated for the degree of treatment adherence, their clinical status, psychopathological manifestations, the level of perceived stress and self-efficacy. The sample was divided into two groups (adherent vs non-adherent). The factors associated with a lack of adherence in this sample were analysed by means of logistic regression. RESULTS This study comprises 72 women with SLE (average age=36.72±12.2 years). Almost 64% of patients with SLE were non-adherent to treatment. The results showed that a low educational level, being unemployed, living with a partner and alcohol abuse were associated with low treatment adherence. There were significant mean differences between groups in psychopathological subscales of somatisation, obsession-compulsion and general psychopathological indices. There were also mean differences between groups for the level of perceived stress. The use of non-steroidal anti-inflammatory drugs, suffering arthrosis and scoring higher in dimensions of psychopathology were significant predictors of treatment adherence, explaining between 35% and 47% of its variability. CONCLUSIONS Including the clinical and psychopathological manifestations as important aspects in the clinical reasoning of health professionals could improve the adherence to treatment of patients with SLE.

The influence of balance, physical disability, strength, mechanosensitivity and spinal mobility on physical activity at home, work and leisure time in women with fibromyalgia

Background: Fibromyalgia syndrome is a chronic disease consisting of widespread pain, fatigue, sleep disturbances, and cognitive impairments, among other symptoms, which affect daily physical activity. However, the influence of functional status on physical activity involved in leisure, household and work activities has not been researched previously. The main objective was to evaluate balance, strength, spinal mobility, mechanosensitivity and function levels as related factors of physical activity in female with fibromyalgia. Methods: Thirty‐four patients with Fibromyalgia and 22 matched controls were included in a cross‐sectional study. Dynamic and static balance, general and daily activities disability, lumbosacral mechanosensitivity, spinal range of motion, lower limb strength, physical activity in leisure, household and work activities were registered. We tested for differences between groups by using independent sample t‐tests. The influence of demographics, symptoms and physical outcomes on physical activity was statistically analyzed using bivariate and multivariate regression analyses. Findings: There was a significant association between leisure‐time physical activity scores and age (r = 0.564), spinal flexion (r = 0.512), spinal extension (r = 0.421) and the total range of spinal inclination (r = 0.533). Fifty‐eight percent of the variance of leisure‐time physical activity was explained by age and range of spinal flexion‐extension. Similarly, functional mobility was associated with physical activity at home and work scores (r = 0.459), explaining 21% of its variance. Interpretation: A higher time spent in leisure, household and work activities was related to higher age, spinal range of motion and lower functional mobility in women with Fibromyalgia. Rehabilitation intervention programs should promote physical activity at home, work and leisure time. HighlightsWomen with fibromyalgia showed impaired balance, strength and mechanosensitivity.Fibromyalgia sample had higher disability and activities dependence than controls.Work physical activity was related to the impaired dynamic balance in this sample.Leisure physical activity was associated with age and range of spinal inclination.

Burnout y funciones ejecutivas en personal sanitario de Cuidados Paliativos: influencia del desgaste profesional sobre la toma de decisiones

BACKGROUND Health professionals show a high prevalence of burnout syndrome. This syndrome could be involved in the alteration of higher cognitive functions in the clinical setting. The aim of this study is to evaluate whether burnout is related to the executive functions of inhibition, working memory, decision-making, and cognitive flexibility in palliative care health professionals. METHOD Degree of burnout was evaluated in seventy-seven health professionals from palliative care units by the Maslach Burnout Inventory (MBI-HSS), while executive functions were evaluated by Stroop test (inhibition), Letter-Number Sequencing (working memory), Iowa Gambling Task (decision-making) and Trail Making Test (cognitive flexibility). The total sample was classified in relation to both degree of burnout (low, medium, high) in each subscale of MBI-HSS (emotional exhaustion, depersonalization, and reduced personal accomplishment), and the number of dimensions altered (high levels in none, one or more than one). RESULTS Burnout syndrome was present in 54.5% of palliative care health professionals, 15.6% of them with more than one dimension altered; these professionals showed significantly lower scores than professionals without burnout in the Stroop test, the Letter-Number Sequencing and the Iowa Gambling Task. Higher levels of emotional exhaustion and depersonalization were associated with significantly lower scores in the Iowa Gambling Task for assessing decision-making. CONCLUSIONS The results showed that palliative care health professionals with a higher level of burnout have an alteration of inhibition, working memory and decision-making. These executive functions can be relevant in the clinical setting since they could be related to the cognitive thinking required for correct clinical reasoning by health professionals.Fundamento. Los profesionales sanitarios presentan una alta prevalencia del sindrome de burnout . Este sindrome podria implicar la afectacion de funciones cognitivas superiores en el ambito clinico. El objetivo ha sido evaluar si el burnout esta relacionado con las funciones ejecutivas de inhibicion, memoria de trabajo, toma de decisiones y flexibilidad cognitiva en el personal sanitario de Cuidados Paliativos. Material y metodos. Se ha evaluado el burnout en setenta y siete profesionales sanitarios de Cuidados Paliativos mediante el Maslach Burnout Inventory (MBI-HSS) y las funciones ejecutivas mediante el test Stroop (inhibicion), test de letras y numeros (memoria de trabajo), Iowa Gambling Task (toma de decisiones) y Trail Making Test (flexibilidad). Los profesionales fueron clasificados en funcion tanto de su nivel de burnout (bajo, medio, alto) para cada dimension del MBI-HSS (cansancio emocional, despersonalizacion y baja realizacion personal), como del numero de dimensiones de burnout alteradas (con niveles altos en ninguna, una o mas de una). Resultados. El 54,5% del personal sanitario presento burnout, un 15,6% con mas de una dimension alterada; estos profesionales obtuvieron puntuaciones significativamente mas bajas que los sanitarios sin burnout en los test Stroop, letras y numeros e Iowa Gambling Task . Niveles mas altos de cansancio emocional y despersonalizacion se relacionaron con puntuaciones significativamente mas bajas en el Iowa Gambling Task (toma de decisiones). Conclusiones. Los resultados mostraron que el personal sanitario de Cuidados Paliativos con alto burnout tiene un peor funcionamiento en inhibicion, memoria de trabajo y toma de decisiones. Estas funciones ejecutivas pueden ser relevantes en el ambito clinico, ya que estan relacionadas con el procesamiento cognitivo necesario para un adecuado razonamiento clinico del profesional sanitario.

Influencia de factores sociodemográficos, laborales y de estilo de vida sobre los niveles de burnout en personal sanitario de cuidados paliativos

BACKGROUND Palliative care health professionals have reported high levels of burnout. An understanding of factors associated with this syndrome in this population could foster new prevention and intervention strategies. The objectives were to evaluate the levels of burnout in each of its dimensions in a sample of palliative care health professionals and to analyze the relationship between levels of burnout and sociodemographic, occupational and lifestyle characteristics in this sample. METHODS The total sample was composed of 92 palliative care health professionals. Sociodemographic, occupational and lifestyle characteristics were registered. The levels of burnout syndrome were evaluated by the Maslach Burnout Inventory - Human Services Survey (MBI-HSS). The total sample was divided into three groups, depending on the level of burnout (non-burnout group, burnout group meeting one criterion, and burnout group meeting two or three criteria). Comparisons were performed amongst groups for all characteristics evaluated. RESULTS The non-burnout professionals were significantly older and slept more than the professionals with more than one altered dimension; in addition, they had greater job seniority in the unit than those with a single altered dimension and did physical exercise more frequently than either of the burnout groups. CONCLUSION The younger professionals, with more job seniority in the units of palliative care, and less hours of sleep and physical activity showed higher levels of burnout. Therefore, these factors should be considered for enhancing prevention and intervention strategies for these health professionals.Fundamento. El personal sanitario de cuidados paliativos ha mostrado niveles altos de burnout. El conocimiento de los factores asociados a este podria utilizarse para el diseno de estrategias de intervencion sobre estos profesionales. Los objetivos de este estudio son evaluar los niveles de burnout y analizar la posible relacion entre estos y diversos factores sociodemograficos, laborales y de estilos de vida en una muestra de personal sanitario que trabaja en unidades de cuidados paliativos. Material y metodos. La muestra estuvo compuesta por 92 profesionales sanitarios de cuidados paliativos. Se registraron las caracteristicas sociodemograficas, laborales y de estilos de vida. Ademas, se evaluo el sindrome de burnout mediante el Maslach Burnout Inventory – Human Services Survey (MBI-HSS). La muestra fue dividida en funcion de su nivel de burnout en tres grupos (grupo sin burnout, grupo con una dimension alterada del MBI-HSS y grupo con dos o tres dimensiones alteradas). Se realizo una comparacion entre grupos para las caracteristicas evaluadas. Resultados. Los profesionales sin bornout eran significativamente mayores y dormian mas que los profesionales con mas de una dimension alterada; ademas, poseian mayor antiguedad en la unidad que aquellos con una unica dimension alterada, y realizaban ejercicio fisico mas frecuentemente que cualquiera de los grupos con burnout. Conclusiones. Los profesionales sanitarios mas jovenes, con mas antiguedad en la unidad de cuidados paliativos, que dormian menos horas y que realizaban menos ejercicio fisico presentaron niveles mayores de burnout. Estos factores deberian tenerse en cuenta para el desarrollo de nuevas estrategias de prevencion y tratamiento de este sindrome en el personal de estas unidades.

Evaluation of Functional Status Associated with Overweight in Adults with Cerebral Palsy.

Purpose: The aim of this study was to describe the motor disability level of ambulatory adults with overweight and cerebral palsy (CP) and to investigate the functional factors associated with weight gain in this population. Design: Cross-sectional study. Methods: Thirty adults with CP were classified according to their body mass index (BMI). Mobility, physical disability, functional independence, gait and balance, gross motor function, and maximum walking speed were assessed to evaluate their physical status. The influence of demographic and functional factors on BMI was analyzed using bivariate and multivariate regression analyses. Findings: Multiple regression analyses showed that age (p = .012) and lower cardiorespiratory function/lower walking distance (p = .048) were significantly associated with higher BMI. Other functional outcomes were not associated with BMI. Conclusions: Greater age and reduced walking distance related to cardiorespiratory function seem to be the main factors associated with BMI. Clinical Relevance: Cardiorespiratory rehabilitation is recommended in conjunction with nutritional nursing interventions.