Monitoreo serológico y psicológico en personal de salud durante el comienzo de la pandemia COVID-19 / Serological and psychological monitoring of healthcare workers during the start of the COVID-19 pandemic

Introducción: el personal de salud (PdS) es esencial en la lucha contra el COVID-19. Al inicio de la pandemia, el riesgo de adquirir la enfermedad en este grupo era desconocido. Buscamos estimar incidencia y prevalencia de anticuerpos anti-SARS-CoV-2, y prevalencia de burnout en una cohorte de PdS durante la pandemia COVID-19, así como valorar la prevalencia de burnout y depresión en la cohorte. Materiales y métodos: cohorte prospectiva conformada por médicos que atendían pacientes COVID-19 desde marzo de 2020 hasta enero de 2021, en un hospital de alta complejidad de la ciudad de Buenos Aires. Se evaluó IgM e IgG anti-SARS-CoV-2 quincenalmente durante 3 meses, así como la presencia de síntomas compatibles y factores asociados a la exposición. Se remitió a participantes con alteraciones de la esfera psíquica a contacto con el equipo de salud mental del hospital. Resultados: se incluyeron 52 participantes; de ellos, 31 eran mujeres; mediana de edad 32 años (rango 25-58). La mediana de horas semanales de trabajo autoinformadas fue 48 (IIC [intervalo intercuartil] 40-69,5). Inicialmente todos fueron PCR SARS-CoV-2 negativos en hisopado nasal; 11 (21,50% IC 95%; 9,62-32,53%) tuvieron COVID-19 sintomático con anticuerpos positivos. Los factores con mayor asociación a riesgo de COVID-19 fueron anosmia/disgeusia OR 403,33 (IC 95%; 47,60-3417,02), fiebre OR 172,53 (IC 95%; 28,82-1032,65), mialgias OR 41,97 (IC 95%; 8,08-217,84), conviviente con COVID-19 OR 28,17 (IC 95%; 5,67-179,97). Cerca del 40% presentaba alteraciones en las escalas de medición de burnout o depresión. Discusión: la incidencia hallada coincide con las cifras informadas acerca de personal de salud en la etapa inicial de la pandemia en la Argentina. Otro aspecto similar fue una mayoría de infecciones de curso leve, sin ningún paciente hospitalizado. No obstante, se halló una elevada incidencia de alteraciones de la esfera psíquica, tanto al comienzo como al final del seguimiento. Conclusiones: la incidencia de positivización de anticuerpos anti-SARS-CoV-2 fue cercana al 20%. No evidenciamos infecciones presintomáticas o asintomáticas. En cambio, la prevalencia de burnout y depresión fue elevada. La salud mental es un componente del personal de salud que debe ser priorizado en situaciones futuras de impacto similar. (AU)

Introduction: healthcare personnel are essential in the response against COVID-19. At the beginning of the pandemic the risk of acquiring the disease in this group was unknown. We sought to estimate incidence and prevalence of anti SARS-CoV-2 antibodies, as well as burnout prevalence in a cohort of healthcare staff during the pandemic, as well as assessing the prevalence of burnout and depression in this group. Materials and methods: prospective cohort formed by physicians tending to COVID-19 patients from march 2020 to january 2021 in a high-complexity hospital in the city of Buenos Aires. We evaluated anti SARS-CoV-2 IgM and IgG each 15 days for 3 months as well as the presence of compatible symptoms and factors associated to exposition to the virus. Patients showing signs of burnout and/or depression were referred to proper care by the mental health team in the hospital. Results: we included 52 patients, 31 women, median age was 32 years (range 25 - 58). Median amount of self-reported hours worked each week was 48 (IQR 40 - 69.5). Initially all participants had a negative COVID-19 PCR nasopharyngeal swab; 11 (21.50% CI95% 9.62 - 32.53%) had symptomatic COVID-19 with positive antibodies. Factors showing stronger association with testing positive were anosmia/dysgeusia OR 403.33 (CI95% 47.60-3417.02), fever OR 172.53 (CI95% 28.82 - 1032.65), myalgia OR 41.97 (CI95% 8.08 - 217.84), cohabitation with confirmed COVID-19 case OR 28.17 (CI95% 5.67 - 179.97). Near 40% showed alterations in burnout or depression scales. Discussion: the incidence rate we found was like reported values in the initial stages of the pandemic in Argentina. Another similarity was that all cases were mild; no hospitalization was required for any participant. We found an elevated incidence of alterations in the psychic sphere, both at the beginning and end of the follow up period. Conclusions:the incidence of positive SARS-CoV-2 antibodies was around 20%. No pre or asymptomatic cases were identified. Burnout and depression incidence was high. Mental health is a component that should never be overlooked in similar situations to come. (AU)

Conocimiento de médicos de 2 hospitales peruanos sobre la relación entre enfermedad periodontal y alteraciones sistémicas / Knowledge of physicians, from 2 peruvian hospitals on the relationship between periodontal and systemic diseases

Objetivo: Determinar el nivel de conocimiento sobre la enfermedad periodontal y su relación con la diabetes mellitus, la gestación y las enfermedades cardiovasculares, en médicos de 2 hospitales peruanos. Material y método El presente estudio, transversal y descriptivo, se desarrolló entre abril y mayo de 2014 e incluyó un total de 77 médicos, 39 del Hospital Belén de Trujillo y 38 del Víctor Lazarte Echegaray (Trujillo, Perú), a quienes se les aplicó un cuestionario, sometido previamente a validación por expertos y análisis de confiabilidad (Alfa de Cronbach = 0,605). Resultados El nivel de conocimiento sobre la enfermedad periodontal y su relación con la diabetes mellitus, la gestación y las enfermedades cardiovasculares fue bueno en un 57,1 por ciento y regular en un 41,6 por ciento de los médicos evaluados. No se encontraron diferencias con respecto a la especialidad médica (p = 0,348) ni al tiempo de ejercicio profesional (p = 0,403). Conclusión Los resultados permiten concluir que el nivel de conocimiento sobre la enfermedad periodontal y su relación con la diabetes mellitus, la gestación y las enfermedades cardiovasculares fue bueno en el 57,1 por ciento de los médicos de los hospitales Belén y Víctor Lazarte Echegaray de Trujillo, Perú, 2014.

Objective: To determine the level of knowledge of physicians from two Peruvian hospitals on the relationship between periodontal and systemic diseases. Methods This cross-sectional and descriptive study was conducted between April and May 2014 and included a total of 77 physicians, 39 from Hospital Belen de Trujillo and 38 from Hospital Victor Lazarte Echegaray (Trujillo, Peru). They were given a questionnaire that was previously submitted for validation by experts and reliability analysis (Cronbach's alpha = 0.605). Results The level of knowledge on periodontal disease and its relationship with diabetes mellitus, cardiovascular disease and pregnancy was good in 57.1 percent and moderate in 41.6 percent of physicians who responded. No differences were found as regards medical specialty (P = .348) or professional experience (P = .403). Conclusion The results suggest that the level of knowledge on periodontal disease and its relationship with diabetes mellitus, cardiovascular disease and pregnancy was good in 57.1 percent of physicians from Victor Lazarte Echegaray and Belen hospitals in Trujillo, Peru, in 2014.

Idosos em Unidades de Terapia Intensiva na perspectiva de médicos em hospital brasileiro / Old people in Intensive Care Units

O ritmo intenso do envelhecimento populacional no Brasil tem levado a questionamentos sobre o impacto das mudanças demográficas em diferentes âmbitos da Seguridade Social, dentre os quais destacamos a área da saúde e, mais especificamente, as Unidades de Terapia Intensiva. Os avanços representados pelos princípios do Sistema Único de Saúde, a criação do Estatuto do Idoso e a preocupação com os direitos humanos tornam urgentes reflexões sobre o que se coloca como desafio no atendimento médico à população idosa em UTI. Médicos intensivistas têm sua atuação marcada, dentre outros fatores, pelos sentidos que atribuem à fase da vida e a visão que têm de seus pacientes idosos. Esta pesquisa teve por objetivo compreender quais os sentidos que médicos que atuam em UTI atribuem a velho/velhice/envelhecimento e suas relações com as práticas de assistência prestada aos pacientes idosos. Trata-se de pesquisa qualitativa, realizada por meio de observação participante de reuniões de equipes que atuam em UTI de um hospital escola na cidade de São Paulo, e de entrevistas com médicos que compõem estas equipes. Os dados foram analisados sob a ótica Construcionista. Os resultados apontam para a existência de uma polissemia relacionada à velhice, incluindo sentidos que podem produzir práticas idadistas quando não há uma postura reflexiva dos profissionais a respeito do tema, ou quando conflitos decorrentes da complexidade que envolve o atendimento hospitalar em diferentes contextos econômicos...

The intense pace of population aging in Brazil has led to questions about the impact of demographic changes on different aspects of Social Security, among which we highlight the area of health and, more specifically, the Intensive Care Units (ICU). The advances represented by the principles of the Unified Health System (SUS), the creation of the Elderly Statute and the concerns for Human Rights, have sped up reflections on what it is a challenge in the medical care to old people population in the ICU. Intensive care physicians have marked their performance, among other factors, by the meanings they attribute to this stage of life and by the vision they have of their elderly patients. This research aimed to explain which are the meanings attributed by that physicians working in ICUs to old/old people/aging, and their relationship to practical assistance provided to elderly patients. This is a qualitative research, resulting from the participatory observations of teams working at ICU in a university hospital in São Paulo, and from interviews with the physicians who take part in these teams. Data have been analyzed from the constructionist perspective. The results signalize to the existence of an age-related polysemy, including meanings that may produce ageist practices when there is a lack of reflexive posture of professionals about the subject, or when conflicts arising from the complexity that involves inpatient care in different economic contexts are imposed to...

Conhecimento do médico hospitalar referente à higiene e as manifestações bucais de pacientes internados / Hospital physicians' knowledge of oral hygiene and oral manifestations in hospitalized patients

Objetivo: Avaliar através de questionário o conhecimento de médicoshospitalares referente à saúde bucal de pacientes internados. Métodos: Inicialmente os autores se dirigiam aos hospitais e pediam para os profissionais envolvidos preencherem um questionário semiestruturado.No total foram entrevistados 100 médicos, em seis hospitais, que atuam na rede pública e privada. O questionário foi composto por 12 questões que envolviam o ambiente hospitalar de atendimento; a área de atuação do médico; a unidade hospitalar que trabalha; a participação do cirurgião-dentista (CD) no ambientehospitalar; o conhecimento do médico referente à saúde bucal e aodiagnóstico das manifestações orais.Resultados: 52% dos médicos afirmaram não existir um controle deinfecção bucal, inclusive na unidade de terapia intensiva (UTI); 45% relataram nunca ter solicitado a presença do cirurgião dentista na equipe de saúde; cerca de 93% desconheciam a forma adequada de diagnosticar a doença periodontal; e 84% da doença cárie. Sobre as questões relacionadas à higiene bucal todos os profissionaisdesconheciam técnicas e instrumentos relacionados à higiene bucal. Destaca-se nas respostas que os médicos hospitalares, na sua grande maioria, acreditam que uma unidade hospitalar de odontologia poderia diminuir o tempo de internação dos pacientes. Conclusão: Há deficiência no conhecimento dos médicos hospitalares frente ao controle do biofilme oral dos pacientes hospitalizados, mas não omissão frente às questões que envolvem o foco de infecção odontogênica...

Objective: To evaluate hospital physiciansÆ knowledge of the oralhealth of hospitalized patients by means of a questionnaire-based survey.Methods: Physicians working at hospitals were invited to fill out a semistructured questionnaire. One hundred physicians from six public andprivate hospitals were interviewed. The questionnaire contained 12 questions addressing the hospital care facilities, the physicianÆs area of expertise, the hospital unit where he/she worked, the dentistÆs role in the hospital environment, and the physicianÆs knowledge of oral health and diagnosis of oral manifestations. Results: Among the interviewed physicians, 52% stated that there was no control of oral infections in the hospital were they worked, including the intensive care unit (ICU); 45% reported never asking for a dentist in the health care team; approximately 93% and 84% did not know the correct manner for diagnosing periodontal disease and dental caries,respectively. Regarding the questions relative to oral hygiene, none of the physicians knew about oral hygiene instruments and techniques. Among the answers, it should be highlighted that most physicians believed that a hospital dental unit could reduce the hospitalization time of patients.Conclusion: Under the conditions of this study, it may be concluded that the hospital physicians do not know how to control oral biofilm in hospitalized patients, but they are aware of the issues involving infections of odontogenic origin...