Prevalencia del síndrome de agotamiento profesional (burnout) y variables asociadas en médicos especialistas / Prevalence of Burnout Syndrome and Associated Variables in Mexican Medical Specialists

RESUMEN Objetivo: Determinar la prevalencia del síndrome de agotamiento profesional (burnout) y las variables asociadas en médicos especialistas. Métodos: Estudio observacional, descriptivo y transversal, mediante censo de médicos especialistas de 3 hospitales regionales (n = 540), ficha de identificación y Maslach Burnout Inventory-Human Services Survey autoaplicado. Se realizaron estadísticas descriptivas y el análisis inferencial con SPSS 15.0 y Epi-infoV6.1. Resultados: Un 90,0% de los especialistas estudiados respondieron. Se detectó burnout en el 45,9%. Hubo diferencias significativas en las variables: ser mujer; la edad <40 arios; no tener pareja estable o llevar menos de 15 años con ella; que la pareja trabaje; no tener hijos; especialidad clínica; menos de 10 años de antigüedad profesional y en el puesto actual de trabajo, y laborar jornada acumulada. Correlación negativa: burnout con agotamiento emocional y con despersonalización. Positiva con la falta de realización personal en el trabajo. Conclusiones: El burnout es frecuente (45,9%) entre los médicos especialistas. Los niveles medios de las subescalas se encuentran cerca de la normalidad. La afección por el agotamiento emocional y la despersonalización se comportan inversamente proporcionales con la puntuación total del síndrome, y directamente proporcionales con la falta de realización personal en el trabajo con burnout.

ABSTRACT Objective: To determine the prevalence of burnout syndrome and the associated variables in medical specialists in Mexico. Methods: Observational, descriptive and cross-sectional study, by means of a census of 540 medical specialists from three Regional Hospitals. Using their identification card and self-administered Maslach Burnout Inventory-Human Services questionnaire, descriptive statistics and inferential analysis were performed using SPSS 15.0 and Epi-infoV6.1. Results: There was a 90.0% response in the specialists studied. Burnout was detected in 45.9%. There were significant differences in variables: being female; under 40 years of age; without a stable partner, and less than 15 years together; a working couple; childless; clinical specialty; less than 10 years of professional and current employment, and accumulated work day. A negative correlation was found in burnout with emotional exhaustion, and with depersonalisation. It was positive with a lack of personal fulfilment at work. Conclusions: Burnout is common (45.9%) in specialist physicians. The average levels of the subscales are close to normal. Emotional exhaustion and depersonalisation behave inversely proportional to the total score of the syndrome, and directly proportional to the lack of personal fulfilment in the work with burnout.

[Considerations concerning medical knowledge inherited in Mexico from 19th century: the diabetes mellitus case]. / Consideraciones sobre el saber médico heredado en México del siglo XIX: el caso de la diabetes mellitus.

In Mexico, as in the entire Western world, during the 19th century and the beginnings of the 20th century, medical knowledge developed in a remarkable way and the case of diabetes mellitus was not the exception. This situation, which arose on the basis of the antique paradigm, and which in turn was overthrown by the positivism as the emergent paradigm (with its clinical and anatomical, as well as physiopathological and etiopathological viewpoints), was reflected during the 19th the century through its actors and the communications that opened the access of Mexican medicine to the modernity.

En México, como en el mundo occidental, durante el siglo XIX y principios del XX, el conocimiento médico presentó un desarrollo notable y el caso de la diabetes mellitus no es la excepción. Esta situación, originada desde el paradigma antiguo, superado por el paradigma moderno emergente, con sus miradas anatomoclínica, fisiopatológica y etiopatogénica, se refleja en el México decimonónico a través de sus actores y de las comunicaciones que inauguran la entrada de la medicina mexicana a la modernidad.

Descriptive, Longitudinal Study Results Applied to Statistical Models to Assess the Impact of Early Microbiological Cultures on the Economic Burden of Treatment for Infected Diabetic Foot Ulcers at a Mexican Public Health Facility.

Infection plays a critical role in health care and impacts the cost of the treatment of diabetic foot ulcers (DFU). To examine the cost reduction associated with the multidisciplinary treatment of infected DFU (IDFU) by obtaining early (ie, within 48 hours of admission) microbiological culture results, a descriptive, longitudinal study was conducted. Data were collected prospectively from patient medical charts of a cohort of 67 patients (mean age, 56.14 ± 12.3 years; mean duration of diabetes, 14.95 ± 8 years) with IDFU treated at a Mexican public health facility from January 1 to April 30, 2010. Information included demographic data (age, gender, marital status, time elapsed since first diagnosis of diabetes mellitus type 2 [DM2]), and the following clinical records: Wagner classification, bacterium type, antimicrobial resistance, length of hospital stay, and the antibiotic schedule utilized, as well as number and type of laboratory tests, medications, intravenous therapy, surgical and supportive treatment, type and number of specialists, and clinical outcome. Microcosting was used to calculate the unit cost of each medical treatment element. Using the Monte Carlo and Markov predictive simulation economical models, cost reduction associated with early identification of the specific microorganism through bacterial culture in IDFU was estimated. Based on the statistical results, differences between real and estimated costs when including early microbiological culture were identified and the number and type of most common species of infectious bacteria were detected. The total cost observed in the patient cohort was $502 438.04 USD, mean cost per patient was $7177.69 ± $5043.51 USD, and 72.75% of the total cost was associated with the hospital stay length. The cost of the entire treatment including antibiotics was $359 196.16 USD; based on the simulation of early microbiological culture, the model results showed cost could be reduced by 10% to 25% (in this study, the cost could be as low as $304 624.63 USD). The use of early microbiological cultures on IDFU to determine the appropriate antibiotic can reduce treatment costs by >30% if hospital stay is part of the consideration.

Intento de suicidio en adolescentes mexicanos: perspectiva desde el consenso cultural / Suicide Attempts in Mexican Teenagers: a Cultural Consensus Theory Perspective

El suicidio es un problema de salud pública mundial y los adolescentes son los que presentan con mayor frecuencia esta problemática. El estudio realizado identifica la estructura semántica del dominio cultural, el promedio de conocimiento y el grado de consenso cultural que sobre el suicidio tienen adolescentes con tentativa suicida. El trabajo es un estudio cualitativo mediante la técnica de listas libres. Participaron 29 adolescentes (13 a 18 años). Las listas libres fueron sobre: las causas; los signos y los síntomas; lo que siente, piensa y hace un adolescente antes de cometer suicidio y las estrategias de prevención de éste. Los resultados muestran para cada pregunta un único modelo semántico en el dominio cultural. En lo estructural se identifican los problemas familiares como la causa del intento suicida; la depresión y la tristeza son síntomas previos al intento suicida. La tristeza y la soledad, salir del problema y suicidarse es lo que considera que siente, piensa y hace un adolescente previo al intento de suicidio. Como estrategias de prevención, se identifican le ponga más atención y hablar con él. Los resultados ponderan la importancia de la familia para los programas de prevención de las conductas suicidas en adolescentes.

The suicide is a problem of public world health and the adolescents are those who present with more frequency this problem. Nevertheless, the studies of the suicide phenomenon from a cultural perspective are limited. Cultural research in suicidology is important to develop the understanding of the meanings of suicidal behavior in different contexts. The cultural consensus theory would contribute to the cultural perspective of the knowledge of suicidal behaviors in terms of its internal elements and their functioning (emic) and this theory allows knowing if there exists a knowledge shared by a social group regarding an issue and allows to recognize its organization. The aim of this study was to identify the semantic structure of the cultural domain, as well as the average of knowledge and the degree of cultural consensus regarding suicide among adolescent suicide attempters. It was a qualitative study, using the free-listing technique, with a non-random sample made up of 29 adolescents between the ages of 13 and 18 years. The free lists were on: the causes; the signs and the symptoms; what he/she feels, thinks and does before attempting suicide and the strategies of suicide prevention at adolescence. The results showed for every question a single semantic model in the cultural domain suicide attempt. In such structure, the family problems were identified as the cause of suicidal attempt; the depression and the sadness were symptoms before suicidal attempt. The sadness, the loneliness and the angerwere what an adolescent feels before the suicide attempt. Furthermore, to get out of the problem and to end his/her life were what an adolescent thinks before attempting suicide and to commit suicide was what an adolescent does before to suicide attempt. To pay more attention, to talk with the adolescent, to improve the communication with the parents and to attend a psychotherapy were identified as strategies for suicide prevention. The results highlight the importance of the family of suicide prevention programs for adolescents based on cultural knowledge.

[Adiposity percentage relationship with hormone receptors immunoreactive score in breast cancer mexican women]. / Porcentaje de adiposidad y su relación con el índice de inmunorreactividad de los receptores hormonales en mujeres mexicanas con cáncer de mama.

INTRODUCTION: Adipose tissue is an important estrogen resource and they are involved in breast cancer development. OBJECTIVE: To establish the relationship between adiposity percentage and the estrogen and progesterone receptors immunoreactive score in Mexican women with breast cancer. METHODS: This is a transversal and analytical study. We identified breast cancer women with cancer histologic diagnosis. We calculated: adiposity percentage and immunoreactive score. We performed correlation analysis between adiposity percentage, body mass index, diabetes mellitus and arterial hypertension, with estrogen and progesterone receptors in breast cancer samples. We perform logistic regression and Odds Ratio estimations. RESULTS: We studied 43 patients with breast cancer and we observed association between adiposity percentage and estrogen and progesterone immnunoreactive score (rP 0.470; p 0.003 and rP 0.328; p 0.042, respectively). The most important risk factor in breast cancer positive to estrogen receptors was obesity (OR 19.1, IC95% 2.1 a 169.1, p 0.008), and previous obesity in breast cancer positive to progesterone receptors (OR 20.7, IC95% 2.3 a 185.9, p 0.007). DISCUSSION: Adiposity percentage is an important risk factor to develop breast cancer positive to hormone receptors related with the risk of breast cancer positive to hormonal receptors.

Introducción: El tejido adiposo es una importante fuente de estrógenos, los cuales se encuentran implicados en el desarrollo de cáncer de mama. Objetivo: Establecer la relación entre el porcentaje de adiposidad y el índice de inmunorreactividad de los receptores a estrógenos y a progesterona en mujeres mexicanas con cáncer de mama. Métodos: Estudio transversal analítico en pacientes con cáncer de mama confirmado con estudio histopatológico. Se estimó el % de adiposidad, y el índice de inmunorreactividad. Se realizó el análisis de correlación entre el porcentaje de adiposidad, el IMC, la presencia de DM2 e hipertensión arterial con la expresión de receptores a estrógeno y progesterona y regresión logística con cálculo de Odds Ratio. Resultados: Se estudiaron 43 pacientes con cáncer de mama y se observó asociación entre el porcentaje de adiposidad y el índice de inmunoreactividad para los RE y RP (rP 0,470; p 0,003 y rP 0,328; p 0,042 respectivamente). El factor de riesgo más importante en cáncer positivo a receptores estrogénicos fue la obesidad (OR 19,1, IC 95% 2,1 a 169,1, p 0,008) y obesidad previa en cáncer positivo a receptores a progesterona (OR 20,7, IC 95% 2,3 a 185,9, p 0,007). Conclusión: El porcentaje de adiposidad es un factor de riesgo importante para desarrollar cáncer de mama positivo a receptores hormonales.

[Analgesic efficacy of the incisional infiltration of ropivacaine vs ropivacaine with dexamethasone in the elective laparoscopic cholecystectomy]. / Eficacia analgésica de la infiltración incisional de ropivacaína vs ropivacaína con dexametasona en la colecistectomía laparoscópica electiva.

BACKGROUND: Incisional pain is the main obstacle for elective laparoscopic cholecystectomy as an outpatient. We evaluated the analgesic efficacy of local infiltration of ropivacaine with dexamethasone (Rop/Dx), compared with ropivacaine (Rop) alone, during the first 24 hours postoperative of this surgery. Our hypothesis is that incisional pain intensity will be lower in patients of the group Rop/Dx. METHODS: In a randomized, controlled, double-blind trial clinical, 80 patients were divided into two groups. Group Rop (n= 40) received pre and post-incisional infiltration with 150 mg of ropivacaine in 8 mL of 0.9% saline, while group Rop/Dx (n= 40) received 150 mg of ropivacaine with 8 mg of dexamethasone in 6 mL of 0.9% saline. The intensity of pain at rest and movement was assessed at 2, 4, 8, 12 and 24 hours postoperatively by a numerical rating scale of 11 points. RESULTS: Incisional pain scores in group Rop/Dx were significantly lower, compared to the group Rop, at 12 hours (p= 0.05) and 24 hours (p= 0.01) at rest and at 12 hours (p= 0.04) and 24 hours (p= 0.01) during movement postoperatively. CONCLUSIONS: We found initial evidence that ropivacaine with dexamethasone for local infiltration decreased incisional pain intensity after 12 hours post-elective laparoscopic cholecystectomy with a good safety profile.

Antecedentes: el dolor incisional es el principal obstáculo para la colecistectomía laparoscópica electiva ambulatoria. Objetivo: evaluar la eficacia analgésica de la infiltración local de ropivacaína con dexametasona (Rop/Dx) en comparación con ropivacaína (Rop) sola, durante las primeras 24 horas del postoperatorio de esta cirugía. Material y métodos: ensayo clínico aleatorizado, controlado y doble ciego, efectuado en 80 pacientes que para fines de estudio se dividieron en dos grupos. El grupo Rop (n= 40) recibió infiltración pre y post-incisional con 150 mg de ropivacaína en 8 mL de solución salina 0.9%, mientras que el grupo Rop/Dx (n= 40) recibió 150 mg de ropivacaína con 8 mg de dexametasona en 6 mL de solución salina 0.9%. La intensidad del dolor durante el reposo y el movimiento se evaluó a las 2, 4, 8, 12 y 24 horas del postoperatorio con una escala de clasificación numérica de 11 puntos. La hipótesis es que la intensidad del dolor incisional será menor en los pacientes del grupo Rop/Dx. Resultados: las puntuaciones del dolor incisional en el grupo Rop/Dx fueron significativamente menores, comparadas con el grupo Rop, a las 12 horas (p= 0.05) y 24 horas (p= 0.01) durante el reposo y a las 12 horas (p= 0.04) y 24 horas (p= 0.01) durante el movimiento postoperatorio. Conclusiones: la evidencia inicial es que la ropivacaína con dexametasona, por infiltración local, disminuye la intensidad del dolor incisional a partir de las 12 horas post-colecistectomía laparoscópica electiva con un buen perfil de seguridad.

Simultaneous blood pressure measurement in both arms in hypertensive and nonhypertensive adult patients.

BACKGROUND: When blood pressure (BP) is taken for the first time, it should be measured in both arms; follow-up measurements should be taken in the arm with the highest BP. However, in clinical practice, this recommendation is rarely followed. OBJECTIVE: Identify the degree of differences in BP between the right and the left arm in individuals with normal and high BP. METHODS: We measured BP in 111 hypertensive and 80 normotensive patients in both arms at the same time using identical Omron HEM 725 CIC automatic sphygmomanometers. The devices were then switched to the other arm and another set of readings was taken. The absolute and relative difference in BP between arms was calculated from the average of these two readings. We categorized differences as at least 5, at least 10, and at least 20 mmHg for systolic blood pressure/diastolic blood pressure (SBP/DBP). RESULTS: The BP was higher in the right arm, with no statistical significance. The relative differences were also not significant: SBP 1.1±7.1 and DBP 0.21±5.0. However, the absolute differences were significant at an individual level, with a systolic difference of 5.4±4.8 mmHg and a diastolic difference of 3.9 ±3.2 mmHg. The percentages of absolute SBP/DBP differences more than 5 mmHg (21.4%/20.4%) and more than 10 mmHg (15.7%/4.7%) were considerable. The range of arm differences was clinically significant; in hypertensives, the SBP/DBP was -13.2 to +15/-9.2 to +9.6 mmHg and in nonhypertensives it was -12.9 to +15.6/-9.7 to +10.1 mmHg. CONCLUSION: Although on average there was no clinically significant relative difference between arms, absolute differences at an individual level were often clinically significant. Failure to determine interarm BP differences will lead to erroneous clinical decisions.

[Cognitive anthropology applied to the study of the causes of arterial hypertension in Guadalajara, Jalisco, México]. / La antropología cognitiva aplicada al estudio de las causas de la hipertensión arterial en Guadalajara, Jalisco. México.

BACKGROUND: In medical anthropology, culture is shared knowledge and it can be used to study cultural consensus for development of preventive and control actions in chronic diseases such as high blood pressure. The aim of this study was to characterize the semantic structure and level of cultural consensus regarding the causes of arterial hypertension in persons >15 years of age belonging to families of laborers from "Colonia Fabrica de Atemajac." METHODS: Using a propositive sample of 36 persons >15 year of age of both genders and divided into three age groups, we conducted an anthropological study. A structured questionnaire and semi-structured interviews were applied in order to obtain the semantic model and cultural consensus regarding the causes of arterial hypertension. RESULTS: The semantic structure of the model links the causes of arterial hypertension to emotions and certain risk conditions that vary in relation to their arrangement as elements of related semantics nuclei according to age group. CONCLUSIONS: Our results show evidence of one semantic model in regard to the causes of arterial hypertension and different from the biomedical cognitive pattern. These types of models must be taken into account for establishing cultural comprehensive health policies.

Consenso cultural sobre el intento de suicidio en adolescentes / Consenso cultural sobre tentativa de suicídio em adolescentes / Cultural consensus regarding suicide attempts in adolescents

Este estudio buscó identificar la estructura semántica del dominio cultural, el promedio de conocimiento y el grado de consenso cultural manifestado por los adolescentes sobre el intento de suicidio. Fue un estudio cualitativo de listas libres, con un muestreo propositivo no aleatorizado de 27 adolescentes entre 13 y 18 años. Los resultados evidenciaron un solo modelo semántico. En lo estructural se identificó el problema familiar como una causa importante del intento suicida; las categorías depresión y tristeza se consideraron como signos y síntomas previos a esta tentativa y no como causas. Como estrategias de prevención, se consideró recibir información mediante pláticas o establecer conversaciones sobre los problemas. Este modelo permite proponer estrategias de prevención que privilegien el núcleo familiar.

The objective of this study was to identify the semantic structure of the cultural domain, as well as the average knowledge and degree of cultural consensus among adolescents regarding suicide attempts. It was a qualitative study, using the free-listing technique, with a non-random sample made up of 27 adolescents between the ages of 13 and 18. The results showed a single semantic model. in such structure, family problems were identified as an important cause of suicide attempts, while depression and sadness were identified as signs and symptoms prior to the attempt, rather than as causes. Information talks and conversations about problems were suggested as prevention strategies. This model makes it possible to propose prevention strategies that prioritize the family nucleus.

Este estudo buscou identificar a estrutura semântica do domínio cultural, o nível de conhecimento e o grau de consenso cultural manifestado pelos adolescentes acerca da tentativa de suicídio. Foi um estudo qualitativo com listas livres e uma amostra propositiva, não aleatória, com 27 adolescentes entre 13 e 18 anos. Os resultados evidenciaram somente um modelo semântico. No estrutural identificou-se o problema familiar como uma causa importante para as tentativas de suicídio; enquanto que as categorias depressão e tristeza foram consideradas não como causas, mas como signos e sintomas prévios a esta tentativa. Como estratégias de prevenção foram consideradas a recepção da informação mediante diálogos livres ou mediante conversações sobre os problemas. Esse modelo permite propor estratégias de prevenção que privilegiem o núcleo familiar.

Esperanza de vida en la población usuaria del IMSS. como indicador de la acción de la seguridad social / Life expectancy in an IMSS user population as an indicator of social security action

Se construyó una tabla de vida para la población usuaria del Instituo Mexicano del Seguro Social, Delegación Jalisco, con el fin de conocer la esperanza de vida (EV) en esa población, sus diferencias en cuanto a grupo etáreo, sexo y variaciones de tendencia. Fue utilizado el método abreviado de Reed y Merrel, con datos obtenidos de los certificados de defunción de 1996. Se calculó una EV al nacer de 76.36 años para hombres y 79.7 para mujeres, cifras superiores a la nacional (70.8 años) y a la de Jalisco (72.17 años). Es notable una mejoría en la EV general, hay un cambio positivo de 3.31 puntos respecto al año de 1983. Concluimos que nuestra población está al borde de una transición demográfica consumada, con un incremento del grupo de 20 a 64 años, y que se requiere adoptar los servicios a la nueva estructura de salud poblacional. Por ello, el equipo de salud deberá estrechar su labor participativa con la población, teniendo a la seguridad social como base de la promoción y cuidado de la salud

Luxación congénita de cadera y estacionalidad / Luxation coxae congenita and the seasons

En el presente trabajo, se analizan los datos concernientes a la incidencia de luxación congénita de cadera en el Hospital de Gineco-Obstetricia de la Unidad Médica Oblatos del Instituto Mexicano del Seguro Social en la ciudad de Guadalajara, Jalismo, México, correspondientes a un año. De acuerdo con los resultados, se obtiene una correlación inversa entre la temperatura y el número de casos, ambos estadísticamente significativos, demostrándose la estacionalidad de la luxación congénita de cadera