Clima organizacional en el personal de enfermería en una unidad de cuidados intensivos / Organizational environment in nursing staff in an intensive care unit

Introducción: el sistema organizacional genera un determinado clima de trabajo que repercute en las motivaciones de los miembros de la organización y en su comportamiento, por lo que al evaluar el clima organizacional se mide la forma como es percibida la organización. Objetivo: identificar el clima organizacional en el personal de enfermería de la unidad de cuidados intensivos (UCI) del Hospital de Especialidades (HE) No. 14 del Instituto Mexicano del Seguro Social (IMSS), en Veracruz, México. Metodología: estudio observacional, descriptivo y transversal, en el que participaron 49 enfermeras de los turnos matutino, vespertino y nocturno de la UCI del HE No. 14. Durante junio y julio de 2019, se aplicó el instrumento Clima Organizacional de Litwin y Stringer, que contiene 53 ítems en sus 9 dimensiones. Resultados: el nivel promedio global del clima organizacional en la UCI fue de 26.4, lo que lleva a categorizarlo como bueno. Las dimensiones: recompensa, estándares y conflicto obtuvieron una puntuación de 23.5 a 24.8, que se traduce como un promedio regular del clima organizacional. Conclusiones: hay un clima organizacional bueno en el personal de enfermería. El componente que influye de manera positiva es la dimensión cooperación, ya que el trabajador empatiza con sus compañeros de servicio. La dimensión conflicto influye de manera negativa, pues abarca la falta de motivación del personal para realizar su trabajo.

Introduction: Organizational systems generate certain workplace environment that affects the staff members' motivation and their behavior, which is why assessing the organizational environment allows to measure the staff perception on the organization. Objective: To identify the organizational environment of the nursing staff at the Specialty Hospital (SH) No. 14 intensive care unit (ICU) of the National Institute for Social Security (Instituto Mexicano del Seguro Social), in Veracruz, Mexico. Methods: Observational, descriptive, and cross-sectional study, which included 49 nurses from the morning, afternoon and night shifts of the aforementioned ICU. During June and July 2019, it was administered the instrument Organizational Climate by Litwin and Stringer, which contains 53 items in its 9 dimensions. Results: The global average level of the organizational environment in the ICU was 26.4, which leads to categorize it as good. The dimensions reward, standards and conflict obtained a range from 23.5 to 24.8, i.e., a regular average of the organizational environment. Conclusions: There is an organizational environment classified as good in the nursing staff. The component that has a positive influence is the cooperation dimension, since the worker empathizes with his fellow employees. The conflict dimension has a negative influence, given that it includes the lack of motivation of the staff to carry out their work.

Epidemias en los márgenes: la peste bubónica (1903-1905) y el covid-19 en el sur andino peruano / Epidemics on the Margins: The Bubonic Plague (1903­1905) and covid-19 Epidemics in the Peruvian South Andean Region / Epidemias marginais: a peste bubônica (1903-1905) e covid-19 no sul andino peruano

Introducción: la epidemia de covid-19 ha dejado en evidencia una serie de problemas de desigualdad en el acceso a la salud pública en Perú, especialmente en las provincias alejadas de la capital, donde se observa precariedad tanto en infraestructura como en personal sanitario. Este artículo analiza cómo el Gobierno y la población han hecho frente a epidemias en el sur de Perú, usando como casos de estudio el covid-19 y la peste bubónica ocurrida en 1903 y 1905, con el fin de entender continuidades en el manejo de la crisis epidémica y su respuesta a ellas. Desarrollo: se estudia la epidemia de la peste bubónica en las ciudades de Arequipa y Mollendo en 1903 y 1905 y el covid-19, con un enfoque en el funcionamiento del sistema de salud local y nacional, en la infraestructura sanitaria disponible para enfrentar epidemias y, finalmente, en las respuestas sociales de la población respecto al escepticismo de las medidas impuestas por las autoridades y al incremento de la automedicación. Conclusiones: la epidemia del covid-19 en el sur de Perú presenta importantes similitudes con la epidemia de peste bubónica que afectó a la región a inicios del siglo xx: desorden de responsabilidades, falta de previsión para hacer frente a enfermedades epidémicas, infraestructura precaria y una población con alto grado de desconfianza frente a las recomendaciones de las autoridades civiles y sanitarias

Introduction: The covid-19 epidemic has revealed a series of inequality problems in the access to public health services in Peru, especially in provinces far from the capital where precariousness in both infra-structure and sanitary personnel is observed. In this study, we analyzed how the population and author-ities in southern Peru faced epidemics, using covid-19 epidemic and bubonic plague in 1903 and 1905 as case studies to understand continuities in the management of epidemic crises and social response to them. Development: We studied the bubonic plague epidemic in the cities of Arequipa and Mollendo in 1903 and 1905 as well as the covid-19 epidemic, focusing on the functioning of local and national health systems, health infrastructure available to face epidemics, and finally, the social response of the population, paying particular attention to the skepticism of the population toward measures imposed by the authorities and increase in self-medication. Conclusions: The covid-19 epidemic in southern Peru pres-ents important similarities with the bubonic plague epidemic that affected the region at the beginning of the 20th century, including a disorder of responsibilities, lack of foresight to face epidemic diseases, insufficient infrastructure, and a population with a high degree of distrust in the recommendations given by the civil and health authorities

Introdução: a epidemia de covid-19 expôs uma série de problemas de desigualdade no acesso à saúde pública no Peru, especialmente nas províncias distantes da capital onde há precariedade tanto de infraestrutura quanto de pessoal de saúde. Este artigo analisa como o governo e a população têm enfren-tado epidemias no sul do Peru, utilizando o covid-19 e a peste bubônica ocorrida em 1903 e 1905 como estudos de caso, a fim de compreender as continuidades na gestão da crise epidêmica e suas respostas. Desenvolvimento: são estudadas as epidemias de peste bubônica nas cidades de Arequipa e Mollendo em 1903 e 1905 e a covid-19, enfocando no funcionamento do sistema de saúde local e nacional, a infraes-trutura de saúde disponível para enfrentar as epidemias e, por fim, as respostas da população, com particular atenção para o ceticismo em relação às medidas impostas pelas autoridades e ao aumento da automedicação. Conclusões: a epidemia de covid-19 no sul do Peru apresenta semelhanças importantes com a epidemia de peste bubônica que afetou a região no início do século XX: desordem de responsabili-dades, falta de previsão para enfrentar as doenças epidêmicas, infraestrutura precária e uma população com alto grau de desconfiança em relação às recomendações das autoridades civis e sanitárias

Pharmaceuticals in a Mediterranean Basin: The influence of temporal and hydrological patterns in environmental risk assessment.

Occurrence of pharmaceuticals in the aquatic environment is nowadays a well-established issue that has become a matter of both scientific and public concern. Tons of different classes of pharmaceuticals find their way to the environment at variable degrees, after their use and excretion through wastewater and sewage treatment systems. The main goal of this study was to correlate the dynamics and the environmental risk of pharmaceuticals with different temporal and hydrological patterns, at the Guadiana Basin (South of Portugal). Water samples were collected bimonthly during 2017 (classified as a drought year) and 2018 (post-drought year) in: Zebro, Álamos and Amieira (intermittent hydrological streams), and Lucefécit (perennial hydrological stream). The pharmaceuticals quantified in higher concentrations, out of 27 investigated, were diclofenac (up to 4806 ng L-1), ibuprofen (3161 ng L-1), hydrochlorothiazide (2726 ng L-1) and carbamazepine (3223 ng L-1). Zebro and Álamos presented the highest contamination by this group of environmental hazardous substances, which may be correlated with the presence of wastewater treatment plants upstream the sampling point of each stream. Furthermore, the highest concentrations occurred mainly during the dry period (2017), when the flow was nearly inexistent in Zebro, and in Álamos after the first heavy rainfalls. In specific periods, the high concentrations of pharmaceuticals detected may induce risk for the organisms of lowest trophic levels, damaging the balance of the ecosystems at these streams. The risk quotient optimised approach (RQf) integrating exposure, toxicity and persistence factors, ranks the pharmaceuticals investigated in terms of risk for the aquatic ecosystems as follows: diclofenac, ibuprofen and carbamazepine (high risk), clarithromycin (moderate risk), acetaminophen, ofloxacin and bezafibrate (endurable risk), and hydrochlorothiazide (negligible risk).

Neoliberalismo, violencia política y salud mental en Perú (1990-2006) / Neoliberalism, Political Violence and Mental Health in Peru (1990-2006) / Neoliberalismo, violência política e saúde mental no Peru (1990-2006)

Resumen Introducción: el presente artículo examina los factores que han ocasionado el precario estado de la salud mental en Perú, donde casi el 90 % de pacientes con síntomas asociados con problemas mentales no reciben tratamiento. Desarrollo: se analiza el programa neoliberal de salud implementado durante el gobierno de Alberto Fujimori (1990-2000). Posteriormente, se estudia cómo esta política pública afectó al programa de salud mental y al estado de la salud de la población. Finalmente, se examinan diversos diagnósticos sobre la salud mental posterior al retorno a la democracia en el año 2000, desde una perspectiva de los derechos humanos. Esta investigación finaliza el año 2006, momento en que el gobierno presentó un nuevo Plan Nacional de Salud Mental. Conclusiones: la falta de acceso a un tratamiento adecuado a nivel nacional ha sido consecuencia directa del reducido gasto del Estado en materia de salud, en especial hacia las enfermedades no transmisibles y de salud mental. Las políticas neoliberales de salud implementadas durante el gobierno de Alberto Fujimori redujeron el rol del Estado como garante del acceso universal a los servicios de salud, y situaron a la salud mental en un lugar marginal dentro de la salud pública. El retorno a la democracia en el año 2000, el informe final de la Comisión de la Verdad y Reconciliación (2003) y el llamado de organismos internacionales, Iglesias Católicas y Evangélicas, junto con ONG, presionaron al gobierno para situar a la salud mental como parte importante de la agenda de pública de salud.

Abstract Objective: This paper examines the elements that have caused the precarious state of mental health in Peru, where almost 90 % of patients with symptoms associated with mental disorders do not receive treatment. Development: The article analyzes the neoliberal health program implemented during the government of Alberto Fujimori (1990-2000). Subsequently, it studies how this public policy affected the mental health program and the health status of the population. Finally, it examines several diagnoses on mental health after the return of democracy in the year 2000 from a human rights perspective. This research ended in 2006 when the government presented a new National Mental Health Plan. Conclusions: The lack of access to adequate treatment at the national level has been a direct consequence of the reduced state expenditure on health, especially towards non-transmissible diseases and mental health. The neoliberal health policies implemented during the government of Alberto Fujimori reduced the role of the State as guarantor of universal access to health services and placed mental health in a marginal place within public health. The return to democracy in 2000, the final report of the Truth and Reconciliation Commission (2003), and the call of international organizations, Catholic and Evangelical Churches, together with NGOS, pressed to the government to situate mental health as a relevant part of public health agenda.

Resumo Objetivo: o presente artigo examina os fatores que têm ocasionado o precário estado da saúde mental no Peru, onde quase o 90 % de pacientes com sintomas associados com problemas mentais não recebem tratamento. Desenvolvimento: se analisa o programa neoliberal de saúde implementado durante o governo de Alberto Fujimori (1990-2000). Posteriormente estuda-se como esta política pública afetou ao programa de saúde mental e ao estado de saúde da população. Finalmente se examinam diversos diagnósticos sobre a saúde mental posterior ao retorno da democracia no ano 2000 desde uma perspectiva dos direitos humanos. Esta pesquisa finaliza no ano 2006, momento em que o governo apresentou um novo Plano Nacional de Saúde Mental. Conclusões: a falta de acesso a um tratamento adequado no nível nacional tem sido consequência direta do reduzido gasto do Estado em matéria de saúde, em especial para as doenças não transmissíveis e de saúde mental. As políticas neoliberais de saúde implementadas durante o governo de Alberto Fujimori reduziram o rol do Estado como garante do acesso universal aos serviços de saúde, e situaram à saúde mental em um lugar marginal dentro da saúde pública. O retorno à democracia no ano 2000, o informe final da Comissão da Verdade e Reconciliação (2003), e o chamado de organismos internacionais, Igrejas Católicas e Evangélicas, junto com ONGs pressionaram ao governo para situar à saúde mental como parte importante da agenda pública de saúde.

Assessment of the environmental impact of an abandoned mine using an integrative approach: A case-study of the "Las Musas" mine (Extremadura, Spain).

The mine abandonment is generally associated with the release of potentially toxic metals into the environment, which may depend on metals speciation, soil properties and climate conditions. The goal of the present work was to assess the environmental impact of the abandoned Pb-Zn mine "Las Musas" (Spain) using an integrative approach. The impact on soils and surface waters was performed using: chemical parameters, quantification of potentially toxic metals (Cd, Cu, Pb and Zn), and ecotoxicological responses using lethal and sub-lethal bioassays with organisms' representative of different trophic level ((soil: Eisenia fetida (mortality and reproduction test); Latuca sativa and Lollium perenne (seedling emergence); and water: Vibrio fischeri (luminescence inhibition), Daphnia magna (immobility and reproduction test), Thamnocephalus platyurus (mortality), Pseudokirchneriella subcapitata (growth inhibition)). The results showed soils with neutral to slight alkaline pH (7.64-8.18), low electric conductivity (125-953 µS/cm) and low organic matter levels (0.20-1.85%). For most of the soil samples, Pb was the only metal which surpassed the limit proposed by the Canadian soil quality guidelines, with values ranging from 42.2 to 181.4 mg/kg. The ecotoxicological results showed that the soils with the highest levels of Pb induced a decrease on E. fetida reproduction and on L. sativa germination, indicating negative impacts on the habitat function. The analysis of the surface waters showed levels of Zn surpassing the legal limit adopted from the Water Framework Directive (37.0 to 69.0 µg/L). The ecotoxicological results highlight the importance of bioassays that evaluate the behavior of species, when assessing the risk of mining areas with non-acid soils and waters with high nutrients/organic matter concentrations and low concentrations of potentially toxic metals. The results indicated a moderate environmental risk from potentially toxic metals, at the areas analyzed around the Azuaga mine.

Organic wastes as soil amendments - Effects assessment towards soil invertebrates.

Using organic wastes, as soil amendments, is an important alternative to landfilling with benefits to soil structure, water retention, soil nutrient and organic matter concentrations. However, this practice should be monitored for its environmental risk due to the frequent presence, of noxious substances to soil organisms. To evaluate the potential of eight organic wastes with different origins, as soil amendments, reproduction tests with four soil invertebrate species (Folsomia candida, Enchytraeus crypticus, Hypoaspis aculeifer, Eisenia fetida) were performed using gradients of soil-waste mixtures. Results obtained demonstrated that contaminant concentrations required by current legislation might not be a protective measure for the soil ecosystem, as they do not properly translate the potential toxicity of wastes to soil invertebrates. Some wastes with contaminant loadings below thresholds showed higher toxicity than wastes with contaminants concentrations above legal limits. Also, test organism reproduction was differently sensitive to the selected wastes, which highlights the need to account for different organism sensitivities and routes of exposure when evaluating the toxicity of such complex mixtures. Finally this study shows that when combining chemical and ecotoxicological data, it is possible to postulate on potential sources of toxicity, contributing to better waste management practices and safer soil organic amendment products.

Ecotoxicological assessment of the potential impact on soil porewater, surface and groundwater from the use of organic wastes as soil amendments.

This study aimed to assess the potential impact on soil porewater, surface and groundwater from the beneficial application of organic wastes to soil, using their eluates and acute bioassays with aquatic organisms and plants: luminescence inhibition of Vibrio fischeri (15 and 30 min), Daphnia magna immobilization (48 h), Thamnocephalus platyurus survival (24 h), and seed germination of Lolium perenne (7 d) and Lactuca sativa (5 d). Some organic wastes' eluates promoted high toxic responses, but that toxicity could not be predicted by their chemical characterization, which is compulsory by regulatory documents. In fact, when organisms were exposed to the water-extractable chemical compounds of the organic wastes, the toxic responses were more connected to the degree of stabilization of the organic wastes, or to the treatment used to achieve that stabilization, than to their contaminant load. That is why the environmental risk assessment of the use of organic wastes as soil amendments should integrate bioassays with eluates, in order to correctly evaluate the effects of the most bioavailable fraction of all the chemical compounds, which can be difficult to predict from the characterization required in regulatory documents. According to our results, some rapid and standardized acute bioassays can be suggested to integrate a Tier 1 ecotoxicological evaluation of organic wastes with potential to be land applied, namely luminescence inhibition of V. fischeri, D. magna immobilization, and the germination of L. perenne and L. sativa.

A contribution towards the risk assessment of soils from the São Domingos Mine (Portugal): chemical, microbial and ecotoxicological indicators.

This study is a contribution towards a risk assessment of the São Domingos Mine area (Portugal), integrating information from: soil physicochemical characteristics, pseudo-total and bioavailable trace elements (As, Cd, Cr, Cu, Ni, Pb and Zn), ecotoxicological evaluation, and microbial indicators. The bioassays using soil eluates (seed germination, luminescent inhibition of Vibrio fischeri and Daphnia magna immobilization) confirmed the soil toxicity categorization obtained with the bioassays using soil (plant growth tests, Eisenia fetida mortality and avoidance behaviour). However, the soil identified as the most toxic using bioassays, was different from the expected when considering the results from pseudo-total and effective bioavailable trace elements. Taking in consideration the observations, it is highly recommended to complement the results from environmental chemistry with results from bioassays, in order to provide a more complete and relevant information on the bioavailability of contaminants and to characterize the risk of contaminated soils.

Assessment of anthropogenic sources of water pollution using multivariate statistical techniques: a case study of the Alqueva's reservoir, Portugal.

Multivariate statistical techniques were applied to evaluate spatial/temporal variations, and to interpret water quality data set obtained at Alqueva reservoir (south of Portugal). The water quality was monitored at nine different sites, along the water line, over a period of 18 months (from January 2006 to May 2007) using 26 water quality parameters. The cluster analysis allowed the formation of five different similarity groups between sampling sites, reflecting differences on the water quality at different locations of the Alqueva reservoir system. The PCA/FA identified six varifactors, which were responsible for 64% of total variance in water quality data set. The principal parameters, which explained the variability of quality water, were total phosphorus, oxidability, iron, parameters that at high concentrations indicate pollution from anthropogenic sources, and herbicides indicative of an intensive agricultural activity. The spatial analysis showed that the water quality was worse in the north of the reservoir.

Assessment of water quality in the Alqueva Reservoir (Portugal) using bioassays.

BACKGROUND, AIM, AND SCOPE: Alqueva Reservoir is the biggest artificial freshwater reservoir in Europe and is an important water supply for human and agricultural consumption in the Alentejo region (Portugal). Pollution can impair environmental and human health status, and to assure water quality and ecological balance, it is crucial to frequently monitor water supplies. In this study, we used an ecotoxicological test battery to identify the potential toxicity of water from this reservoir. MATERIALS AND METHODS: Water samples from the Alqueva aquatic system were collected bimonthly in 2006 from 11 different water points within the reservoir. Several bioassays were carried out: a 72-h growth test with Pseudokirchneriella subcapitata, a 6-day growth test with Chironomus riparius larvae, and the luminescence inhibition test with Vibrio fischeri (Microtox(R)). RESULTS AND DISCUSSION: Algae growth was significantly inhibited in several sampling points and periods throughout the year, mainly due to the presence of pesticides. Although in some sampling points pesticide concentrations (single and sum) were still below the maximum permissible concentrations, water samples showed high toxicities to algae, especially during the summer months. In addition, several sampling points showed pesticide concentrations above the permissible level which can pose a significant risk to humans and the environment. Chironomids showed less sensitivity to the water samples, possibly due to the low concentrations of insecticides present. V. fischeri showed no sensitivity when exposed to all the water samples collected throughout the year of 2006. CONCLUSIONS: Standardized laboratory bioassays can be useful tools to assess water quality from aquatic systems and can valuably complement chemical analysis evaluation. The results obtained in this study demonstrated that the most sensitive species used in this test battery was the microalgae P. subcapitata. The growth of C. riparius was less affected, which is probably due to the fact that low insecticide concentrations were measured and, furthermore, since this species lives in the sediment and not in the water column and is, therefore, usually more resistant to pollutants. RECOMMENDATIONS AND PERSPECTIVES: On its own, chemical analysis is not enough to derive conclusions on the water quality and/or status, which can be valuably complemented by laboratory bioassays. Single chemical, maximum permissible values, and the sum of pesticide concentrations do not take into account possible patterns of synergism, antagonism, dose level dependencies, or even the dominance of several chemicals within a mixture. In addition, several species from different levels in trophic chains are recommended due to differences in species' sensitivities to chemical compounds that are present.