[Analysis of budgetary impact of COVID-19 vaccination in Latin AmericaAnálise do impacto orçamentário da vacinação contra a COVID-19 na América Latina]. / Análisis de impacto presupuestal de la vacunación contra COVID-19 en América Latina.

Objective: To estimate the budgetary impact of COVID-19 vaccination in six Latin American countries: Argentina, Brazil, Chile, Colombia, Mexico, and Peru, during the 2021-2022 biennium. Methods: Vaccines from Sinopharm (BBIBP-CorV), Janssen (JNJ-78436735), Gamaleya Institute (Gam-COVID-Vac), Sinovac (CoronaVac), CanSino (Convidecia), AstraZeneca (Vaxzevria), Moderna (mRNA-1273), and Pfizer (BNT162b2) were evaluated, according to their availability in each country. The health system perspective was adopted, so that only direct health care costs were included. The time horizon adopted took into account the implementation times of each vaccination plan, excluding children under 16 years of age and pregnant persons. The following costs were included: cost of vaccination/vaccine administration and costs of hospitalization (general isolation, stepdown care, and intensive care). Two vaccination scenarios were compared: 1) population wanting to be vaccinated (according to national surveys); and 2) population that should be vaccinated (total population susceptible to vaccination). The aggregate costs for each vaccination scenario were compared with the no-vaccination scenario. Deterministic and probabilistic sensitivity analyses were also performed. Results: The different COVID-19 vaccination regimens available in Latin America generate potential savings ranging from USD 100 million to USD 1.5 billion per country for the 2021-2022 biennium, assuming that the vaccination plan proposed for each country is fully implemented. Conclusions: COVID-19 vaccination is a strategy that not only reduces morbidity and mortality in Latin America, but also generates potential savings for health systems in the region.

Objetivo: Estimar o impacto orçamentário da vacinação contra a COVID-19 em seis países da América Latina: Argentina, Brasil, Chile, Colômbia, México e Peru, no período 2021-2022. Métodos: Foram avaliadas as vacinas da Sinopharm (BBIBP-CorV), Janssen (JNJ-78436735), Instituto Gamaleya (Gam-COVID-Vac), Sinovac (CoronaVac), CanSino (Convidecia), AstraZeneca (Vaxzevria), Moderna (mRNA-1273) e Pfizer (BNT162b2), conforme a disponibilidade para cada país. Adotou-se a perspectiva do sistema de saúde, de forma que só foram incluídos custos médicos diretos. O horizonte temporal foi adotado levando em consideração os tempos de implementação de cada plano de vacinação, excluindo crianças menores de 16 anos e gestantes. Foram incluídos os seguintes custos: custos de vacinação e aplicação, custos gerais de hospitalização, isolamento, e cuidados intermediários e intensivos. Compararam-se dois cenários de vacinação: 1) população disposta a se vacinar (com base em pesquisas nacionais) e 2) população que deveria ser vacinada (total elegível de vacinação). Os custos agregados para cada cenário de vacinação foram comparados com o cenário de não vacinação. Além disso, foram realizadas análises de sensibilidade determinísticas e probabilísticas. Resultados: Os diferentes esquemas de vacinação contra a COVID-19 disponíveis na América Latina geram economias potenciais entre 100 milhões e 1,5 bilhão de dólares por país para o período 2021-2022, considerando a implementação completa do plano de vacinação previsto em cada país. Conclusões: A vacinação contra a COVID-19 é uma estratégia que, além de reduzir a morbidade e a mortalidade na América Latina, gera economias potenciais para os sistemas de saúde da região.

Fixed-bed reactor packed with pumice-supported TiO2 for the treatment of polluted water by solar-driven photocatalytic oxidation.

A bench-scale tubular photo-reactor was built to evaluate the solar-driven TiO2-based photocatalytic degradation of synthetic polluted water samples. The reactor was designed as a compound-parabolic-collector and operated in batch mode using TiO2 P25 immobilized on a bed of pumice. The immobilization of TiO2 on pumice was carried out using a facile dip impregnation method followed by heat treatment. The obtained material was characterized by SEM, EDS, XRD, and nitrogen adsorption. It was possible to impregnate up to 68.5 mg of TiO2 per gram of pumice stones of 8-14 mm. Conversions of up to 35-40 and 62-69%, after 4 h of treatment and UV doses of 20.8 ± 3.5 kJ L-1, were achieved when the catalyst was used immobilized on pumice stone and in the form of a suspension, respectively. The stability and reusability of the catalyst-coated support was tested through a series of consecutive photocatalytic experiments. After four consecutive runs, the immobilized catalyst showed a decrease in its photoactivity leading to removal levels of 23%.

A new conceptualization of the nurse-patient relationship construct as caring interaction.

The journey through the history of nursing, and its philosophical and political influences of the moment, contextualizes the interest that arose about the nurse-patient relationship after World War II. The concept has always been defined as a relationship but, from a phenomenological approach based on a historical, philosophical, psychological and sociological cosmology, it is possible to re-conceptualize it as 'caring interaction'. Under the vision of aesthetics and sociopoetics, the object of nursing care is the most delicate, vulnerable and unrepeatable raw material: the person, whose feelings and reciprocity, which must be considered. In addition, it involves the adoption of the socio-critical paradigm, as it considers the importance of actively involving the person, not just patient anymore, or their family in the nursing cares, optimizing the reciprocity inherent to this interactivity. In short, our philosophical and epistemological approach to the concept of nurse-patient relationship proposes a new conceptualization of it as a caring interaction.

[Abordaje y atención a la cronicidad con tecnologías digitales en las políticas sanitarias en España]. / Approach and attention to chronicity with digital technologies in health policies in Spain.

OBJECTIVE: From the healthcare policies that support Public Health strategies, technology implementation in healthcare is an innovative element to address chronicity. Its introduction is not uniform across Spain, despite of the existence of digital strategic implementation and national chronicity plans. The aim of this paper was to explore the current deployment of autonomic strategies for chronicity and the implementation of digital tools for telemonitoring and user support. METHODS: A descriptive cross-sectional study was conducted through documental review of autonomous strategies in digital health and chronicity care, available until 2020. Consequently, a consultation was carried out to eighteen experts addressing autonomic availability, benefits and barriers to healthcare digitalization. RESULTS: The expert consultation revealed that, in fifteen autonomous communities, the use and the enhancement of digital technologies were addressed and in nine the focus was on promoting digital transformation. Eleven communities are working on updates, fourteen have health-related digital applications, thirteen allow users checking their test results, ten allow them to carry out administrative procedures, nine deliver patient support resources, and three provide telematic communication channels. 38.89% of the consulted refered not knowing about the existence of any follow-up and monitoring programs in their community. The 60% identified a gap in digital competencies among citizens and the lack of resources, as main barriers to implementation. CONCLUSIONS: There exists disparity in the update of strategies to address chronicity and the introduction of digital technologies. Many of them are currently updating, which is an opportunity to provide efficient responses that incorporate digital tools.

OBJECTIVE: La implementación de tecnologías digitales supone un elemento innovador para el abordaje de la cronicidad, como parte de las estrategias de Salud Pública. Su implantación es variable a nivel autonómico, pese a existir un plan nacional. Este trabajo pretendió conocer el despliegue de las estrategias autonómicas sobre cronicidad, así como de la implementación de opciones de telemonitorización y apoyo al usuario. METHODS: Se realizó un estudio descriptivo transversal mediante revisión documental de las estrategias autonómicas de salud digital y abordaje de la cronicidad disponibles hasta 2020. Se realizó una posterior consulta a dieciocho personas expertas sobre disponibilidad autonómica, beneficios y barreras a la digitalización de la atención sanitaria. RESULTS: La consulta a personas expertas reveló que quince comunidades autónomas abordaron el uso y la potenciación de tecnologías digitales y nueve trabajaron en favorecer la trasformación digital. Once comunidades trabajan en actualizaciones, catorce tienen aplicaciones digitales de salud, trece permiten a los ciudadanos consultar resultados de pruebas, diez permiten trámites administrativos, nueve ofrecen recursos de apoyo al paciente y tres disponen de canales telemáticos de comunicación. El 38,89% de los consultados refirió no conocer los programas de seguimiento y monitorización en su comunidad. El 60% identificó a la falta de competencias digitales de la ciudadanía y a la falta de recursos como barreras de su implantación. CONCLUSIONS: Existe disparidad en la actualización de estrategias para el abordaje de la cronicidad y la implantación de tecnologías digitales. Muchas de ellas se están actualizando, lo que supone una oportunidad para dar respuestas eficientes que incorporen las herramientas digitales.

Lung Cancer Screening in People With COPD: The Pamplona-IELCAP Experience.

INTRODUCTION: The Global Initiative for Obstructive Lung Disease (GOLD) recommends lung cancer screening for patients with Chronic Obstructive Pulmonary Disease (COPD), but data is lacking regarding results of screening in this high-risk population. The main goal of the present work is to explore if lung cancer screening with Low Dose Chest Tomography (LDCT) in people with COPD, allows lung cancer (LC) diagnosis in early stages with survival compatible with curative state. METHODS: This is a post hoc exploratory analysis. Pamplona International Early Lung Cancer Action Program (P-IELCAP) participants with a GOLD defined obstructive pattern (post bronchodilator FEV1/FVC<0.70) were selected for analysis. The characteristics of those who developed LC and their survival are described. A Cox proportional analysis explored the factors associated with LC diagnosis. RESULTS: Eight hundred and sixty-five patients (77% male, 93% in spirometric GOLD stage 1+2) were followed for 102±63 months. LC prevalence was 2.6% at baseline, with an annual LC diagnosis rate of 0.68%. Early-stage tumors predominated (74%) with a median survival (25-75th percentiles) of 139 (76-185) months. Cumulative tobacco exposure, FEV1%, and emphysema were the main predictors of an LC diagnosis. Eight (11%) patients with COPD had a second LC, most of them in early stage (92%), and 6 (8%) had recurrence. Median survival (25-75th percentiles) in these patients was 168 (108-191) months. CONCLUSIONS: Lung cancer screening of selected high-risk participants with COPD allowed the LC diagnosis in early stages with survival compatible with curative state.

Night Work and Breast Cancer Risk in Nurses: Multifactorial Risk Analysis.

Night work has been highlighted by the International Agency for Research on Cancer (IARC) as a likely carcinogenic factor for humans, associated with breast cancer and professions that require continuity of work. Knowing the impact that short and long-term night work has on the nurses' collective seems a priority, therefore, this study aims to analyse the relationship between night work and the development of breast cancer risk factors in nurses. For this, a cross-sectional study through an online questionnaire on breast cancer risk variables and working life was designed. The study was conducted in Spain and the sample consisted of 966 nurses, of whom 502 were healthy participants and 56 were breast cancer patients. These two groups were compared in the analyses. A descriptive analysis was performed, and the relationship was tested using χ2 independence test and OR calculation. The CHAID (Chi Square Automatic Interaction Detection) data mining method allowed for the creation of a segmentation tree for the main risk variables. The most significant risk variables related to working life have been the number of years worked, nights worked throughout life, and years working more than 3 nights per month. Exceeding 16 years of work has been significant for women and men. When the time worked is less than 16 years, the number of cases increases if there is a family history of cancer and if there have been more than 500 nights of work. High-intensity night work seems more harmful at an early age. The accumulation of years and nights worked increase the risk of breast cancer when factors such as sleep disturbance, physical stress, or family responsibilities come together.

Anxiety Effect on Communication Skills in Nursing Supervisors: An Observational Study.

Communication represents an essential skill in nurse managers' performance of everyday activities to ensure a good coordination of the team, since it focuses on the transmission of information in an understandable way. At the same time, anxiety is an emotion that can be caused by demanding and stressful work environments, such as those of nurse managers. The aim of the present study was to analyze the impact of anxiety management on nurse managers' communication skills. The sample comprised 90 nursing supervisors from hospitals in Madrid, Spain; 77.8% were women, and 22.2% were men, with an average of 10.9 years of experience as nursing supervisors. The instruments used for analysis were the Sixteen Personality Factor Questionnaire: version five (16PF5) and State Trait Anxiety Inventory (STAI) questionnaires, validated for the Spanish population. The results showed that emotional stability was negatively affected by anxiety (r = -0.43; p = 0.001), while apprehension was positively affected (r = 0.382; p = 0.000). Nursing supervisors, as managers, were found to possess a series of personality factors and skills to manage stress and communication situations that prevent them from being influenced by social pressure and the opinion of others.

Corrigendum to "Effectiveness of a bio-catalytic agent used in the bioremediation of crude oil-polluted seawater" [Heliyon 7 (4), (April 2021) Article e06926].

[This corrects the article DOI: 10.1016/j.heliyon.2021.e06926.].

Sense of coherence, engagement, and work environment as precursors of psychological distress among non-health workers during the COVID-19 pandemic in Spain.

BACKGROUND: The interrelationship between the sense of coherence, work environment, work engagement, and psychological distress have particular interest in non-health workers who carried out essential activities during the COVID-19 pandemic. OBJECTIVE: To assess the effects of the COVID-19 on the physical and mental health of non-health workers. DESIGN: Observational descriptive cross-sectional study. DATA SOURCES: 1089 questionnaires have been analysed. Engagement (UWES-9), sense of coherence (SOC-13), mental health (Goldberg GHQ-12), demographic data, perception of health and stress and work environment were assessed. RESULTS: At low levels of engagement, the percentage of distress is higher (77.9%). Low levels of sense of coherence correspond to the highest percentages of distress (86.3%). The 94.1% believe it necessary for professionals and volunteers involved in COVID-19 to receive psychological support. Low comprehensibility is mediated by the perception of stress; if the perception is low, comprehensibility is modulated by the level of significance; if it is low, it generates 95.9% of distress. CONCLUSION: The interrelationship between the sense of coherence, work environment, work engagement, and psychological distress have particular interest in non-health workers who carried out essential activities during the COVID-19 pandemic. Almost all respondents believed that professionals and volunteers involved in COVID-19 should receive psychological support. This may be an indicator of the effect of the COVID-19 pandemic on workers' mental health.

Communication and humanization of care: Effects over burnout on nurses.

BACKGROUND: Healthcare professionals may have certain psychological characteristics which contribute to increasing the quality of their professional performance. OBJECTIVE: Study the effect that humanization of care and communication have on the burnout syndrome in nursing personal. METHODS: The sample included a total of 330 Spanish nurses. Analytical instruments used were the Health Professional's Humanization Scale (HUMAS), Communication Styles Inventory Revised (CSI-R) and Brief Burnout Questionnaire Revised (CBB-R). RESULTS: Two broad nursing profiles could be differentiated by their level of humanization (those with scores over the mean and those with scores below it in optimistic disposition, openness to sociability, emotional understanding, self-efficacy, and affection), where the largest group had the high scores. A communication repertoire based on verbal aggressiveness impacted indirectly on the effect of humanization on burnout, mainly in the personal impact component. We observed the relation of humanization profiles in nursing staff with the job dissatisfaction and burnout components. Besides that, some communication styles, verbal aggressiveness and questioningness, have an indirect effect on the relationship between humanization profiles and job dissatisfaction. CONCLUSIONS: The results on the relationship between communication styles and burnout, and the mediator effect of communication styles on the relationship between humanization of care and burnout in nursing personnel are discussed.

[Impact of SARS-CoV-2 (Covid-19) on the mental health of healthcare professionals: a systematic review.] / Impacto del SARS-CoV-2 (Covid-19) en la salud mental de los profesionales sanitarios: una revisión sistemática.

BACKGROUND: In times of this global pandemic situation, population's mental health is compromised, especially in those groups that are at the forefront of defence against the virus such as healthcare professionals. The objective of this study was to analyze the impact of the SARS-CoV-2 outbreak on healthcare professionals' mental health. METHODS: A systematic review was carried out following the PRISMA format in Pubmed, Scopus, Web of Science, CINAHL, PsycINFO and ScienceDirect electronic databases between January and May 2020. Methodological quality was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tools for non-randomized studies. RESULTS: A total of 13 studies were included in this review. Professionals' mental health and mental functions were compromised, being especially affected those professionals on the front line of battle against the virus. However, these stats were below the general population data. Although there is wide variability of results, medium-high levels of anxiety (26,5%-44,6%), depression (8,1%-25%), concern and insomnia are detected (23,6%-38%). Paradoxically, stress levels were below expectations (3,8%-68,3%). CONCLUSIONS: The mental well-being of health professionals working on the front line is compromised in times of pandemic by presenting medium-high levels of anxiety, depression, nervousness and insomnia, and, to a lesser extent, stress.

OBJETIVO: Ante una situación de pandemia mundial, la salud mental de la población se ve comprometida, especialmente en los colectivos que están en primera línea de defensa contra el virus como son los profesionales sanitarios. El objetivo de este estudio fue analizar el impacto en la salud mental de los profesionales sanitarios que prestan atención a pacientes durante el brote de SARS-CoV-2. METODOS: Se realizó una revisión sistemática siguiendo el formato PRISMA en las bases de datos electrónicas Pubmed, Scopus, Web of Science, CINAHL, PsycINFO y ScienceDirect entre los meses de enero y mayo de 2020. Se evaluó la calidad metodológica a partir de las herramientas de evaluación crítica para estudios no randomizados del Joanna Briggs Institute (JBI). RESULTADOS: Un total de 13 estudios fueron incluidos en esta revisión. La salud mental de los profesionales sanitarios se vio comprometida ante la pandemia de SARS-CoV-2 en el ejercicio de sus funciones, siendo especialmente afectados los profesionales que se encontraban en la primera línea de batalla contra el virus, pero con valores por debajo de los de la población general. Aunque existió una amplia variabilidad de resultados, se observaron niveles medio-altos de ansiedad (26,5%-44,6%), depresión (8,1%-25%), preocupación e insomnio (23,6%-38%), y, paradójicamente, niveles de estrés por debajo de lo esperado (3,8%-68,3%). CONCLUSIONES: La salud mental de los profesionales sanitarios que trabajan en primera línea de batalla se ve comprometida en tiempos de pandemia presentando niveles medio-altos de ansiedad, depresión, preocupación e insomnio, y, en menor medida, estrés.

Effect of Anxiety on Empathy: An Observational Study Among Nurses.

Empathy, defined as an emotional ability to put oneself in the place of others, read their state of mind, and think how they are feeling, is an essential pillar of nursing care. On the other hand, anxiety is a frequent emotion that can be generated in stressful work environments, like nurses developing their activity. The aim of the present study is to explore the value of empathy and anxiety personal traits in staff nurses. The sample was comprised of 197 staff nurses from tertiary level hospitals from Madrid, Spain, where 79.2% were women and 20.8% were men in the present study. The instrument used for analysis was the Spanish adaptation of the 16PF5 questionnaire. The results showed the following measurements to warmth (5.58), lively (5.25), socially bold (5.6), privacy (5.82), open to change (5.62), self-reliance (6.12), and anxiety (6.38). Furthermore, anxiety affects positively to warmth (t: 2.66; p > 0.0001) and lively (t = 2.36; p < 0.05), but in a negative way to social bold (t = -3.17; p < 0.001) or open to change (t = -5.81; p < 0.0001). However, it was not seen to have any effect over privacy (t = 1.96; p = 0.052) and self-reliance (t = 1.19; p = 0.234). Finally, it is recommended that healthcare professionals reinforce their personal competencies to strengthen their skills to manage anxiety and improve their empathy competencies.

A Cross-Sectional Study of Empathy and Emotion Management: Key to a Work Environment for Humanized Care in Nursing.

INTRODUCTION: At the present time, technological advances have increased the technification of healthcare services, in which high priority is given to efficiency and results achieved, leading healthcare personnel to prioritize administrative and procedural aspects to the detriment of humanization of care and the work environment. OBJECTIVE: This study was intended to continue progress in research on the work environment based on the humanization construct by analyzing the explanatory value of emotional intelligence and empathy in nursing personnel. MATERIALS AND METHODS: The study was quantitative, observational, and cross-sectional. The sample was made up of 338 Spanish nurses with a mean age of 32.20 (SD = 7.54; range 22-56). The instruments employed for analysis were the Healthcare Professional Humanization Scale (HUMAS), Brief Emotional Intelligence Inventory for Adults, and Basic Empathy Scale (BES). RESULTS: Mood and stress management-both emotional intelligence components-and cognitive empathy explained over half (51%) of the variability found in humanization of care in a sample of nurses. Furthermore, the mediation models proposed emphasized the mediating role of cognitive empathy in stress management and improvement in mood and its relationship to humanization. CONCLUSION: It is recommended that healthcare professionals reinforce their personal competencies in order to tend to the needs of their patients empathetically and improve emotional competencies for coping successfully with potentially stressful situations.

Shared Decision-Making in Chronic Patients with Polypharmacy: An Interventional Study for Assessing Medication Appropriateness.

Potentially inappropriate medications are associated with polypharmacy and polypathology. Some interventions such as pharmacotherapy reviews have been designed to reduce the prescribing of inappropriate medications. The objective of this study is to evaluate how effective a decision-making support tool is for determining medication appropriateness in patients with one or more chronic diseases (hypertension, dyslipidaemia, and/or diabetes) and polypharmacy in the primary care setting. For this, a quasi-experimental study (randomised, controlled and multicentre) has been developed. The study compares an intervention group, which assesses medication appropriateness by applying a decision support tool, with a control group that follows the usual clinical practice. The intervention included a decision support tool in paper format, where participants were informed about polypharmacy, inappropriate medications, associated problems and available alternatives, as well as shared decision-making. This is an informative guide aimed at helping patients with decision-making by providing them with information about the secondary risks associated with inappropriate medications in their treatment, according to the Beers and START/STOPP criteria. The outcome measure was the proportion of medication appropriateness. The proportion of patients who confirmed medication appropriateness after six months of follow-up is greater in the intervention group (32.5%) than in the control group (27.9%) p = 0.008. The probability of medication appropriateness, which was calculated by the proportion of drugs withdrawn or replaced according to the STOPP/Beers criteria and those initiated according to the START criteria, was 2.8 times higher in the intervention group than in the control group (OR = 2.8; 95% CI 1.3-6.1) p = 0.008. In patients with good adherence to the treatment, the percentage of appropriateness was 62.1% in the shared decision-making group versus 37.9% in the control group (p = 0.005). The use of a decision-making support tool in patients with potentially inappropriate medications increases the percentage of medication appropriateness when compared to the usual clinical practice.

[Anxiety in nurse midwives and non-specialist nurses in the Madrid health service (Spain)]. / Ansiedad en matronas y enfermeras no especialistas de hospitales del servicio madrileño de salud.

OBJECTIVE: We analyzed state anxiety and trait anxiety in a population of nurses specialising in gynecology and obstetrics (nurse midwives) and a group of generalist nurses. METHODS: Cross-sectional descriptive study using the State-Trait Anxiety Inventory questionnaire (STAI), administered to a group of non-specialist nurses (n=96) and nurse midwives (n=63) who practice in the Madrid Health Service of Spain. RESULTS: State anxiety was similar in generalist nurses and in midwives (5,01±1,62 and 5,17±1,75, respectively). Levels of trait anxiety were lower in nurse midwives (3,46±1,58) than in the non-specialist group (4,36±2,84), with the latter presenting higher levels of habitual anxiety as a personality trait (p=0,013). CONCLUSION: Nurse midwives may adapt better to the stress derived from their work than generalist nurses. This could be attributed to the greater training and safety that specialties provide for the development of nursing care functions.

OBJETIVO: El objetivo de este estudio es analizar los valores de la ansiedad estado y ansiedad rasgo en un grupo de enfermeras especialistas en ginecología y obstetricia (matronas) con respecto enfermeras asistenciales no especialistas. MÉTODOS: Se realizó un estudio descriptivo transversal, utilizando el cuestionario de ansiedad estado-rasgo (State-Trait Anxiety Inventory STAI), en un grupo de enfermeras no especialistas (n=96) y matronas (n=63) que desarrollan su actividad asistencial en hospitales del Servicio Madrileño de Salud en España. RESULTADOS: La ansiedad estado fue similar en las enfermeras no especialistas (5,01±1,62) y en las matronas (5,17±1,75). La ansiedad rasgo fue menor en las matronas (3,46±1,58) que en el grupo de enfermeras no especialistas (4,36±2,84), presentando éstas últimas mayores niveles de ansiedad habitual como rasgo de personalidad (p=0,013). CONCLUSIONES: Las matronas pueden presentar una mejor adaptación al estrés derivado de su trabajo que las enfermeras no especialistas, pudiendo estar relacionado con la posible mayor seguridad en el desarrollo de las funciones asistenciales en enfermería.

The Development and Validation of the Healthcare Professional Humanization Scale (HUMAS) for Nursing.

INTRODUCTION: The approach and use of the term "humanization" is very much present in healthcare. However, instruments for measuring the concept of the humanization of care are yet to be designed and developed. OBJECTIVE: The main objective of this study was to evaluate and validate the Healthcare Professional Humanization Scale (HUMAS) for nursing professionals. METHOD: The sample was made up of 338 adults, who were nurses working at health centers and hospitals, and aged between 22 and 56. RESULTS: The results of the analyses confirm that the Healthcare Professional Humanization Scale (HUMAS) has an adequate construct validity and reliability, and defines the humanization of care as a multidimensional construct, made up of five factors: Affection, Self-efficacy, Emotional understanding, Optimistic disposition and Sociability. CONCLUSIONS: The new HUMAS scale may be an easily administered and coded instrument for approaching the humanization of care, not only in research, but also in practice.

Análisis de impacto presupuestal de la vacunación contra COVID-19 en América Latina / Analysis of budgetary impact of COVID-19 vaccination in Latin America / Análise do impacto orçamentário da vacinação contra a COVID-19 na América Latina

RESUMEN Objetivo. Estimar el impacto presupuestal de la vacunación contra COVID-19 en seis países de América Latina: Argentina, Brasil, Chile, Colombia, México y Perú, durante el periodo 2021-2022. Métodos. Se evaluaron las vacunas de Sinopharm (BBIBP-CorV), Janssen (JNJ-78436735), Instituto de Gamaleya (Gam-COVID-Vac), Sinovac (CoronaVac), CanSino (Convidecia), AstraZeneca (Vaxzevria), Moderna (mRNA-1273) y Pfizer (BNT162b2), según disponibilidad para cada país. Se adoptó la perspectiva del sistema de salud, de manera que solo se incluyeron costos médicos directos. El horizonte temporal se adoptó teniendo en cuenta los tiempos de implementación de cada plan de vacunación, excluyendo menores de 16 años y gestantes. Se incluyeron los siguientes costos: costo de la vacunación y aplicación, costos de la hospitalización general aislamiento, cuidado intermedio e intensivo. Se compararon dos escenarios de vacunación: 1) Población que desea vacunarse (según las encuestas nacionales) y 2) Población que debería vacunarse (total susceptible de vacunación). Los costos agregados para cada escenario de vacunación se compararon con el escenario de no vacunación. Adicionalmente, se realizaron análisis de sensibilidad determinísticos y probabilísticos. Resultados. Los diferentes esquemas de vacunación contra COVID-19 disponibles en América Latina generan ahorros potenciales que oscilan entre USD 100 y USD 1 500 millones de dólares por país para el período 2021-2022, asumiendo que se logra implementar en su totalidad el plan de vacunación previsto en cada país. Conclusiones. La vacunación contra COVID-19 es una estrategia que además de reducir la morbilidad y mortalidad para Latinoamérica, genera ahorros potenciales para los sistemas de salud en la región.

ABSTRACT Objective. To estimate the budgetary impact of COVID-19 vaccination in six Latin American countries: Argentina, Brazil, Chile, Colombia, Mexico, and Peru, during the 2021-2022 biennium. Methods. Vaccines from Sinopharm (BBIBP-CorV), Janssen (JNJ-78436735), Gamaleya Institute (Gam-COVID-Vac), Sinovac (CoronaVac), CanSino (Convidecia), AstraZeneca (Vaxzevria), Moderna (mRNA-1273), and Pfizer (BNT162b2) were evaluated, according to their availability in each country. The health system perspective was adopted, so that only direct health care costs were included. The time horizon adopted took into account the implementation times of each vaccination plan, excluding children under 16 years of age and pregnant persons. The following costs were included: cost of vaccination/vaccine administration and costs of hospitalization (general isolation, stepdown care, and intensive care). Two vaccination scenarios were compared: 1) population wanting to be vaccinated (according to national surveys); and 2) population that should be vaccinated (total population susceptible to vaccination). The aggregate costs for each vaccination scenario were compared with the no-vaccination scenario. Deterministic and probabilistic sensitivity analyses were also performed. Results. The different COVID-19 vaccination regimens available in Latin America generate potential savings ranging from USD 100 million to USD 1.5 billion per country for the 2021-2022 biennium, assuming that the vaccination plan proposed for each country is fully implemented. Conclusions. COVID-19 vaccination is a strategy that not only reduces morbidity and mortality in Latin America, but also generates potential savings for health systems in the region.

RESUMO Objetivo. Estimar o impacto orçamentário da vacinação contra a COVID-19 em seis países da América Latina: Argentina, Brasil, Chile, Colômbia, México e Peru, no período 2021-2022. Métodos. Foram avaliadas as vacinas da Sinopharm (BBIBP-CorV), Janssen (JNJ-78436735), Instituto Gamaleya (Gam-COVID-Vac), Sinovac (CoronaVac), CanSino (Convidecia), AstraZeneca (Vaxzevria), Moderna (mRNA-1273) e Pfizer (BNT162b2), conforme a disponibilidade para cada país. Adotou-se a perspectiva do sistema de saúde, de forma que só foram incluídos custos médicos diretos. O horizonte temporal foi adotado levando em consideração os tempos de implementação de cada plano de vacinação, excluindo crianças menores de 16 anos e gestantes. Foram incluídos os seguintes custos: custos de vacinação e aplicação, custos gerais de hospitalização, isolamento, e cuidados intermediários e intensivos. Compararam-se dois cenários de vacinação: 1) população disposta a se vacinar (com base em pesquisas nacionais) e 2) população que deveria ser vacinada (total elegível de vacinação). Os custos agregados para cada cenário de vacinação foram comparados com o cenário de não vacinação. Além disso, foram realizadas análises de sensibilidade determinísticas e probabilísticas. Resultados. Os diferentes esquemas de vacinação contra a COVID-19 disponíveis na América Latina geram economias potenciais entre 100 milhões e 1,5 bilhão de dólares por país para o período 2021-2022, considerando a implementação completa do plano de vacinação previsto em cada país. Conclusões. A vacinação contra a COVID-19 é uma estratégia que, além de reduzir a morbidade e a mortalidade na América Latina, gera economias potenciais para os sistemas de saúde da região.

Quality management, a directive approach to patient safety. / Gestión de la calidad, un enfoque directivo para la seguridad del paciente.

Nowadays the implementation of effective quality management systems and external evaluation in healthcare is a necessity to ensure not only transparency in activities related to health but also access to health and patient safety. The key to correctly implementing a quality management system is support from the managers of health facilities, since it is managers who design and communicate to health professionals the strategies of action involved in quality management systems. This article focuses on nursing managers' approach to quality management through the implementation of cycles of continuous improvement, participation of improvement groups, monitoring systems and external evaluation quality models (EFQM, ISO). The implementation of a quality management system will enable preventable adverse effects to be minimized or eliminated, and promote patient safety and safe practice by health professionals.

Evaluación del tiempo de exposición de una resina Bulk-Fill en preparaciones profundas / Evaluation of the exposure time of a Bulk-Fill resin in deep preparations

RESUMEN Antecedentes: Las resinas compuestas tipo Bulk-Fill (BF) son usadas en piezas posteriores con preparaciones extensas y profundas. Uno de sus beneficios más resaltantes es que, puede ser utilizada en incrementos de 4 a 5 mm, disminuyendo el tiempo de trabajo clínico. Sin embargo, en dientes con tratamientos de conductos estas preparaciones podrían tener mayor profundidad. Objetivos: Determinar el tiempo de fotoactivación necesario para polimerizar una resina Bulk-Fill ubicada en zonas profundas. Material y Métodos: En el presente estudio experimental in vitro, se confeccionaron especímenes de resina compuesta Filtek One Bulk Fill (3M ESPE, St. Paul, EE.UU.) de 5x5x5 mm color A2 fotoactivado a una distancia/tiempo de 0 mm/10 s, 0 mm/20 s, 3 mm/10 s, 3 mm/20 s, 3 mm/30 s y 3 mm/40 s (n=5). La microdureza superficial se registró en la superficie y en la base de cada espécimen. Resultados: El mayor valor de microdureza se registró en el grupo BF 0 mm/20 s y BF 3 mm/40 s (p<0,05), seguido por los grupos BF 3 mm/20 s y BF 3 mm/30 s (p>0,05). Los menores valores de microdureza se encontraron en los grupos BF 0 mm/10 s y BF 3 mm/10 s. Conclusión : Se requiere de 40 s de fotoactivación para polimerizar una resina Bulk-Fill ubicada en zonas profundas, cuando la lámpara está a una distancia de 3 mm de la superficie de la resina.

ABSTRACT Background: Bulk-fill composite resins (BF) are used in posterior restorations with extensive and deep preparations. One of the most outstanding benefits is that it can be used in increments of 4 to 5 mm, reducing clinical working time. However, in teeth with root canal treatment, these preparations could be deeper. Objectives: To determine the photoactivation time necessary to polymerize a Bulk-Fill resin located in deep areas. Material and Methods: In the present experimental in vitro study, specimens of Filtek One Bulk Fill composite resin (3M ESPE, St. Paul, USA) of 5x5x5 mm color A2 photoactivated at a distance/time of 0 mm/10 s, 0 mm/20 s, 3 mm/10 s, 3 mm/20 s, 3 mm/30 s and 3 mm/40 s (n=5) were fabricated. Surface microhardness was recorded on the surface and at the base of each specimen. Results: The highest microhardness value was recorded in group BF 0 mm/20 s and BF 3 mm/40 s (p<0.05), followed by groups BF 3 mm/20 s and BF 3 mm/30 s (p>0.05). The lowest microhardness values were found in the BF 0 mm/10 s and BF 3 mm/10 s groups. Conclusion: It takes 40 s of photoactivation to polymerize a Bulk-Fill resin located in deep areas, when the lamp is 3 mm away from the resin surface.