Experiencias del equipo de salud en la aplicación del contacto piel con piel / Experiences of the Health Team in the Application of Skin-To- Skin Contact

Introducción: La Organización Panamericana de la Salud refiere que a nivel mundial pocos son los países que aplican el contacto piel con piel cuando lo realizan es por un tiempo inadecuado a pesar de los múltiples beneficios para la madre y el recién nacido. Objetivo: Describir la aplicación del contacto piel con piel desde la experiencia del equipo de salud en un centro materno infantil del sector público en Perú. Métodos: Investigación cualitativa con diseño descriptivo, de tipo estudio de caso, en una muestra no probabilística de 10 integrantes del equipo de salud, elegidos por conveniencia y determinado por saturación y redundancia. Los datos se recolectaron a través de la entrevista semiestructurada en línea. La información se procesó de manera manual, mediante el análisis de contenido temático. Resultados: Se obtuvieron tres categorías: a) aplicación del contacto piel con piel en la atención inmediata del recién nacido, b) estrategias implementadas para la aplicación del contacto piel con piel y c) barreras afrontadas por el equipo de salud para aplicar el contacto piel con piel. Conclusiones: Desde la experiencia del personal de salud, es posible aplicar el contacto pial a piel previa capacitación y sensibilización al equipo de salud, y acondicionamiento del ambiente, a fin de implementarlo como política del establecimiento de salud(AU)

Introduction: The Pan American Health Organization reports that few countries worldwide apply skin-to-skin contact and when they use it is during an inadequate amount of time despite the multiple benefits for the mother and the newborn. Objective: To describe the application of skin-to-skin contact from the experience of the health team in a public maternal and child center in Peru. Methods: A qualitative research with a descriptive design, case study, was carried out in a non-probabilistic sample of 10 members of the health team, chosen by convenience and determined by saturation and redundancy. Data were collected through semi-structured online interviews. The information was processed manually, through thematic content analysis. Results: Three categories were obtained: a) application of skin-to-skin contact in the immediate care of the newborn, b) strategies implemented for the application of skin-to-skin contact, and c) barriers faced by the health team to apply skin-to-skin contact. Conclusions: From the experience of health personnel, it is possible to apply skin-to-skin contact after training and sensitization to the health team and conditioning of the environment, in order to implement it as a policy of the health facility(AU)

Bovine lactoferrin for the prevention of COVID-19 infection in health care personnel: a double-blinded randomized clinical trial (LF-COVID).

Lactoferrin (LF) has in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to determine the effect of bovine lactoferrin (bLF) in the prevention of SARS-CoV-2 infection in health care personnel. A randomized, double-blinded, placebo-controlled clinical trial was conducted in two tertiary hospitals that provide care to patients with SARS-CoV-2 infection in Lima, Peru. Daily supplementation with 600 mg of enteral bLF versus placebo for 90 days was compared. Participants were weekly screened for symptoms suggestive of SARS-CoV-2 infection and molecular testing was performed on suspected episodes. A serological test was obtained from all participants at the end of the intervention. The main outcome included symptomatic and asymptomatic cases. A sub-analysis explored the time to symptomatic infection. Secondary outcomes were the severity, frequency, and duration of symptomatic infection. The study was prematurely cancelled due to the availability of vaccines against SARS-CoV-2 in Peru. 209 participants were enrolled and randomized, 104 received bLF and 105 placebo. SARS-CoV-2 infection occurred in 11 (10.6%) participants assigned to bLF and in 9 (8.6%) participants assigned to placebo without significant differences (Incidence Rate Ratio = 1.23, 95%CI 0.51-3.06, p-value = 0.64). There was no significant effect of bLF on time to symptomatic infection (Hazard Ratio = 1.61, 95%CI 0.62-4.19, p-value = 0.3). There were no significant differences in secondary outcomes. A significant effect of bLF in preventing SARS-CoV-2 infection was not proven. Further studies are needed to assess the effect of bLF supplementation on SARS-CoV-2 infection.Clinical trial registration ClinicalTrials.gov Identifier: NCT04526821, https://clinicaltrials.gov/ct2/show/NCT04526821?term=LACTOFERRIN&cond=COVID-19&cntry=PE&city=Lima&draw=2&rank=1 .

Use of the Maslach Burnout Inventory Among Public Health Care Professionals: Protocol for a Scoping Review.

BACKGROUND: Burnout syndrome is a chronic response to stressors in the workplace. It is characterized by emotional exhaustion and physical and mental burnout and may lead to high employee turnover, work absenteeism, and increased occupational accidents. Most studies use the Maslach Burnout Inventory (MBI) to identify burnout and implement preventive actions and treatments. OBJECTIVE: This study presents a scoping review protocol to identify and map studies that used MBI to assess burnout syndrome in health care professionals working in public health services. METHODS: This scoping review protocol follows the Joanna Briggs Institute reviewers' manual, and this protocol consists of 6 stages: identifying the research question, identifying relevant studies, study selection, data extraction and coding, analysis and interpretation of results, and consultation with stakeholders. We will conduct searches in Embase, LILACS, PubMed/MEDLINE, PsycINFO, Scopus, Web of Science databases, and gray literature. The main research question is as follows: how is MBI used to identify burnout syndrome in health care professionals working in public health services? Inclusion criteria will comprise qualitative and quantitative studies using MBI to identify burnout syndrome in health care professionals working in public health services and no restrictions in language and publication dates. Data will be extracted using a spreadsheet adapted from the Joanna Briggs Institute model. Quantitative and qualitative data will be analyzed using descriptive statistics and thematic analysis, respectively. The consultation with stakeholders will be essential for increasing the knowledge about MBI, identifying new evidence, and developing future strategies to guide public policies preventing burnout syndrome in health care professionals working in public services. RESULTS: This protocol will guide a scoping review to identify and map studies that used MBI to identify burnout syndrome in health care professionals working in public health services. The results of this review may be useful to public health care professionals, managers, policymakers, and the general population because these findings will help understand the validated, translated, and adapted versions of MBI and domains, number of items, Likert scales, and cutoff points or the latent profile analysis most used in the literature. Furthermore, possible research gaps may be identified to guide future studies. All information regarding the stages of the scoping review favor its transparency and allow it to be methodologically replicated according to the principles of open science, thereby reducing the risk of bias and data duplication. CONCLUSIONS: This study may reveal the multiplicity of scales described in the literature and the different forms of assessing burnout syndrome in health care professionals. This study may help to standardize the assessment of burnout syndrome in health care professionals working in public health services and contribute to the discussion and knowledge dissemination about burnout syndrome and mental health in this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42338.

Percepciones y experiencias de los profesionales de la salud sobre la aplicación de la norma de manejo y tratamiento de la anemia en menores de tres años durante la pandemia de la COVID-19 / Perceptions and experiences of healthcare professionals on the guideline of management and treatment of anemia among children under 3 years of age during the COVID-19 pandemic

RESUMEN Objetivos. Comprender las percepciones y experiencias de los profesionales de la salud sobre la aplicación de la directiva para el manejo y tratamiento de anemia en niños menores de tres años, durante la pandemia de la COVID-19 en Lima Metropolitana, año 2020. Materiales y métodos. Estudio de diseño fenomenológico. Se realizaron entrevistas semiestructuradas individuales a profesionales de salud: médicos, enfermeras y nutricionistas que trabajaban en el primer nivel de atención en el Ministerio de Salud de Lima, Perú. Las entrevistas se llevaron a cabo en forma virtual. Todos laboraban en forma presencial en servicios de atención a niños menores de tres años. El análisis de datos fue temático, para las codificaciones se utilizó el software NVivo. Resultados. Se realizaron 33 entrevistas a profesionales de la salud, entre noviembre de 2020 a enero de 2021. Surgieron cuatro temas emergentes sobre la norma: su factibilidad, imperfecciones percibidas, los desafíos para implementarla y las perspectivas de mejora. Los profesionales entrevistados percibieron que la norma era factible de ejecutarla, pero presentaba vacíos en las indicaciones que deberían estar más explícitos los aspectos del manejo y tratamiento de la anemia. A pesar de ello dieron a conocer sus desafíos y expectativas de mejora. Conclusiones. Los encuestados percibieron que fue factible utilizar la norma y destacaron sus experiencias para lograr superar las dificultades pese a encontrar vacíos en la normativa para el manejo y tratamiento de la anemia.

ABSTRACT Objective. To understand the perceptions and experiences of healthcare professionals on the application of the guideline for the management and treatment of anemia in children under 3 years old, during the COVID-19 pandemic, in metropolitan Lima, 2020. Materials and methods. Phenomenological design. Individual semi-structured interviews were conducted with healthcare professionals: physicians, nurses and nutritionists working at the first level of care in the Ministry of Health in Lima, Peru. The interviews were conducted virtually with the participants, all of whom worked face-to-face in services providing care to children under 3 years old. Data analysis was thematic and NVivo software was used for coding. Results. A total of 33 interviews with healthcare professionals were conducted between November 2020 and January 2021. Four themes emerged about the guideline: its feasibility, perceived imperfections, challenges in implementing it, and prospects for improvement. The health professionals interviewed perceived the guideline to be feasible to implement, but there were gaps in the indications that should have been more explicit. Nevertheless, they expressed their challenges and expectations for improvement. Conclusions. Healthcare professionals perceived that it was feasible to use the guideline and emphasized their experiences overcoming perceived difficulties and weaknesses in the guidelines for anemia management and treatment.

Olhar profissional no atendimento em saúde às pessoas privadas de liberdade: revisão integrativa / The professional perspective on health care for people deprived of their liberty: an integrative review / Mirada profesional sobre el cuidado de la salud de las personas privadas de libertad: revisión integradora

Resumo O sistema carcerário pode ser marcado por um conjunto de fatores que dificultam a ressocialização do indivíduo e o acesso integral à saúde, revelando questões que afetam a assistência e dificultam a atuação dos profissionais de saúde. Para tanto, buscou-se neste texto descrever a visão de profissionais das diversas áreas da saúde a respeito do atendimento às pessoas privadas de liberdade por meio da leitura de artigos. A revisão integrativa foi construída com base em pesquisa nas bases de dados Medline, via PubMed, e Literatura Latino-Americana e do Caribe em Ciências em Saúde, por meio dos descritores education, medical, health personnel e prisoners, selecionando artigos publicados nos últimos dez anos. Após a etapa de exclusão, foram lidas na íntegra 68 referências, resultando em 13 estudos selecionados. Definiram-se três categorias com base na identificação dos temas mais frequentes nas publicações: estigma, barreiras no atendimento e saúde mental. Conclui-se que ainda existem lacunas importantes para a formação adequada voltada ao atendimento das pessoas privadas de liberdade, uma vez que estigmas e barreiras do sistema prejudicam a saúde mental desse grupo vulnerável no âmbito de acesso integral à saúde.

Abstract The imprisonment system can be marked by a set of factors that hinder the re-socialization of the individual and the integral access to health, revealing issues that affect the assistance and hinder the performance of health professionals. Therefore, this text aims to describe the vision of professionals from different areas of health regarding the care of people deprived of liberty through the reading of articles. The integrative review was built based on a search in the Medline, PubMed, and Latin American and Caribbean Literature in Health Sciences databases, using the descriptors 'education', 'medical', 'health personnel', and 'prisoners', selecting articles published in the last ten years. After the exclusion step, 68 references were read in full, resulting in 13 selected studies. Three categories were defined based on the identification of the most frequent themes in the publications: stigma, barriers to care, and mental health. It is concluded that there are still important gaps in the adequate training for the care of people deprived of liberty, since stigmas and barriers in the system hinder the mental health of this vulnerable group in the scope of integral access to health.

Resumen El sistema penitenciario puede estar marcado por un conjunto de factores que dificultan la resocialización del individuo y el acceso integral en salud, revelando problemáticas que afectan la atención y dificultan el trabajo de los profesionales de la salud. Por lo tanto, este texto buscó describir la mirada de profesionales de las diferentes áreas de la salud sobre la atención a las personas privadas de libertad a través de la lectura de artículos. La revisión integradora fue construida a partir de la investigación en las bases de datos Medline, vía PubMed y Literatura Lationamericana y del Caribe en Ciencias de la Salud, a través de los descriptores education, medical, health personnel y prisoners, seleccionando artículos publicados en los últimos diez años. Trás la etapa de exclusión, se leyeron 68 referencias en su totalidad, lo que resultó en 13 estudios seleccionados. Se definieron tres categorías a partir de la identificación de los temas más frecuentes en las publicaciones: estigma, barreras al cuidado y salud mental. Se concluye que aún existen importantes vacíos para una adecuada formación dirigida a la atención de las personas privadas de libertad, ya que los estigmas y barreras del sistema perjudican la salud mental de este grupo vulnerable en el contexto del pleno acceso a la salud.

Perfil dos trabalhadores da Atenção Primária à Saúde e proteção de riscos ocupacionais na pandemia da Covid-19 no Brasil / Profile of Primary Health Care workers and occupational risk protection in the Covid-19 pandemic in Brazil / Perfil de los trabajadores de la Atención Primaria de Salud y protección de riesgos laborales en la pandemia de Covid-19 en Brasil

Resumo Este artigo teve como objetivo caracterizar o perfil dos trabalhadores da Atenção Primária à Saúde e analisar as medidas de proteção de riscos ocupacionais em dois estados brasileiros durante a pandemia da Covid-19. Trata-se de estudo quantitativo do tipo survey, com amostra aleatória de 259 profissionais de saúde da Atenção Primária dos estados de Mato Grosso do Sul e São Paulo no período inicial da pandemia. A maioria dos participantes era do sexo feminino (85,3%), profissionais de enfermagem (40,6%) com idade média de 39,1 anos (dp ± 9,5) e do estado de São Paulo (73%). Utilizaram-se análise descritiva e teste exato de Fisher. Quanto às medidas de proteção de risco ocupacional no trabalho, verificou-se que a imunização antecipada contra influenza teve maior frequência no Mato Grosso do Sul (93,8%), porém 47,7% não tiveram acesso aos testes de Covid-19 neste estado e 24,3% em São Paulo. Os profissionais de nível superior tiveram mais acesso à máscara N95/PFF2 (10,2%) em comparação aos auxiliares e técnicos, com 6,5% e 7,8%, respectivamente. Observaram-se possíveis diferenças nas gestões municipais dos respectivos estados, que parecem não ofertar o acesso equânime de profissionais da Atenção Primária à Saúde a proteção, imunizantes e testes para detecção de SARS-CoV-2.

Abstract This article aimed to characterize the profile of Primary Health Care workers and analyze occupational risk protection measures in two Brazilian states during the Covid-19 pandemic. This is a quantitative survey study, with a random sample of 259 primary care health professionals from the states of Mato Grosso do Sul and São Paulo during the initial period of the pandemic. Most of the participants were female (85.3%), nursing professionals (40.6%) with a mean age of 39.1 years (SD ± 9.5), and from the state of São Paulo (73%). Descriptive analysis and Fisher's exact test were used. As for occupational risk protection measures at work, it was found that early immunization against influenza had the highest frequency in Mato Grosso do Sul (93.8%), but 47.7% did not have access to Covid-19 testing in this state and 24.3% in São Paulo. Higher-level professionals had more access to the N95/PFF2 mask (10.2%) compared to assistants and technicians, with 6.5% and 7.8%, respectively. Possible differences were observed in the municipal administrations of the respective states, which do not seem to provide equitable access for Primary Health Care workers to protection, immunizers, and testing for SARS-CoV-2.

Resumen Este artículo tuvo como objetivo caracterizar el perfil de los trabajadores de la Atención Primaria de Salud y analizar las medidas de protección contra riesgos laborales en dos estados brasileños durante la pandemia de Covid-19. Se trata de un estudio cuantitativo de tipo survey, con una muestra aleatoria de 259 profesionales de salud de Atención Primaria provenientes de los estados de Mato Grosso do Sul y São Paulo en el período inicial de la pandemia. La mayoría de los participantes eran mujeres (85,3%), profesionales de enfermería (40,6%) con una edad media de 39,1 años (desviación estándar ± 9,5) y del estado de São Paulo (73%). Se utilizaron el análisis descriptivo y la prueba exacta de Fisher. En cuanto a las medidas de protección contra riesgos laborales en el trabajo, se constató que la inmunización temprana contra la influenza fue más frecuente en Mato Grosso do Sul (93,8%), pero el 47,7% no tuvo acceso a las pruebas de Covid-19 en ese estado y el 24,3% en São Paulo. Los profesionales de la educación superior tuvieron más acceso a la mascarilla N95/PFF2 (10,2 %) en comparación con los auxiliares y técnicos, con un 6,5 % y un 7,8%, respectivamente. Se observaron posibles diferencias en las administraciones municipales de los respectivos estados, que parecen no ofrecer un acceso equitativo a los profesionales de la Atención Primaria de Salud a la protección, inmunizaciones y pruebas para detección del SARS-CoV-2.

Infection and mortality of nursing personnel in Brazil from COVID-19: A cross-sectional study.

BACKGROUND: Health care personnel (HCP) worldwide are at-risk for contracting the novel Coronavirus disease (COVID-19). Among health care personnel, nurses are at a particularly high risk due to the physical proximity and duration of time spent providing direct care. Documenting accurate rates of COVID-19 infection and deaths among nurses worldwide has been problematic, and many countries such as the USA have no systematic mechanism for collecting this information. Brazil is unique in that it prioritized the implementation of a dedicated database, the Nursing Observatory to collect accurate and timely data regarding COVID-19 and Brazilian nursing personnel. OBJECTIVES: The aim of this study was to analyze COVID-19 infections and deaths among nurses registered in the centralized and dedicated Brazilian database called the Nursing Observatory. DESIGN: A cross-sectional study using secondary data from the Brazilian Nursing Observatory was conducted. PARTICIPANTS: Data are reported for two occupational categories: professional Nurse and technical nurse by country regions. All cases or deaths of professional Nurse and technical nurse registered between the 12th and 31st epidemiological weeks of 2020 were included. METHODS: From a unique numerical identification, the appropriate records of nursing personnel affected by COVID-19 were entered by the Technical Responsible Nurse for each service, according to the condition regarding COVID-19. All suspected, confirmed or unconfirmed infections were considered "cases", and all confirmed or unconfirmed deceased as "deaths". Cases and deaths were analyzed according to the variables: 1. region of the country where the case occurred, 2. nursing category and 3. epidemiological week. Universal protocols for collecting and cleaning data were used throughout the country. Infection and mortality rates (per 100,000) were obtained from the relationship between deaths registered and the population of nursing personnel by category and region. RESULTS: Nursing personnel in the Northern, Northeast and Southeast Regions of Brazil had the highest number of COVID-19 infections and deaths overall with an ascending curve occurring mainly after Epidemiological Week 19. COVID-19 infections and deaths spread later to the Midwest and Southern regions also showing an ascending curve, although the total numbers were less. CONCLUSIONS: All occupational categories of nursing personnel showed higher than expected rates of infection and death. Inequalities and a lack of adequate healthcare resources, hospital beds and Personal Protective Equipment varied by region in Brazil. The politicization of COVID-19 and the lack of a coherent national pandemic plan is a factor to be taken into account. Tweetable abstract: This cross-sectional study shows the evolution of cases and deaths of Brazilian nursing personnel over the first months of the COVID-19 pandemic.

Incidence and Related Factors of Infidelity among Medical Doctors and Nurses.

Although there is a large body of research addressing infidelity, no study, to our knowledge, has specifically addressed infidelity in doctors and nurses and the correlation with work hours, schedule and other variables. This research aimed to know the incidence of and factors related to infidelity among doctors and nurses. A descriptive study was carried out, studying the association of certain variables. In total, 367 volunteer participants completed an online survey. Of them, 21% either have or have had an unfaithful relationship. The majority (81.7%) were doctors. Men were 4.3 times more unfaithful than women, with these differences being statistically significant (OR = 4.37, p < 0.001). Of the participants involved in an unfaithful relationship within the work area, the majority were men. Likewise, those who reported having had sex in the doctor's room on duty were also men, with these differences being statistically significant (OR = 12.81, p < 0.01). The night emergency schedule was 60% more frequent in unfaithful people, and these differences were statistically significant (OR = 12.43, p < 0.01). There is a significant rate of infidelity in doctors and nurses. Men are more likely to be unfaithful than women are, and people who work nighttime emergencies are more likely to be unfaithful.

Pandemia da COVID-19: repercussões no quotidiano da família de profissionais de saúde atuantes em unidades emergenciais / The COVID-19 pandemic: repercussions on the daily life of health professionals working in emergency units / Pandemia del COVID-19: repercusiones en el cotidiano familiar de profesionales sanitarios actuantes en unidades de urgencia

Objetivo: compreender as repercussões da pandemia da COVID-19 no quotidiano de familiares de profissionais de saúde atuantes em unidades de emergência. Métodos: estudo descritivo-exploratório de abordagem qualitativa, realizado com 18 familiares de profissionais de saúde atuantes em duas unidades de emergência localizadas no Sul do Brasil. Os dados foram coletados de setembro a novembro de 2020, mediante entrevistas telefônicas audiogravadas, posteriormente transcritas na íntegra. A análise foi realizada à luz da sociologia compreensiva. Resultados: as repercussões negativas da pandemia no quotidiano dos familiares foram marcadas pelo medo da atuação profissional na linha de frente e pela possibilidade de o familiar se contaminar, levando, por conseguinte, o vírus para os demais membros da família. Porém, paradoxalmente, houve repercussões positivas, como a união dos membros da família e maior aproximação da religiosidade/espiritualidade. Considerações finais e implicações para a prática: identifica-se como relevante o desenvolvimento de estratégias de comunicação para oferecer suporte emocional, promover encorajamento, reconhecimento das forças do sistema familiar e, se necessário, educação para que se diminuam as consequências negativas, como o estigma e as desavenças decorrentes dessa experiência

Objective: to understand the repercussions of the pandemic of COVID-19 in the daily lives of family members of health professionals working in emergency units. Methods: this is a qualitative descriptive-exploratory study conducted with 18 family members of health professionals working in two emergency units located in the South of Brazil. Data was collected from September to November 2020, through audio-recorded telephone interviews, later transcribed in full. The analysis was conducted in the light of the comprehensive sociology. Results: the negative repercussions of the pandemic in the daily life of family members were marked by the fear of professional performance in the front line and the possibility of the family member getting infected, thus taking the virus to the other members of the family. However, paradoxically, there were positive repercussions, such as the union of the family members and greater closeness to religiosity/spirituality. Final considerations and implications for the practice: the development of communication strategies to offer emotional support, promote encouragement, recognition of the family system's strengths and, if necessary, education to diminish the negative consequences, such as stigma and disagreements arising from this experience, is identified as relevant

Objetivo: comprender las repercusiones de la pandemia del COVID-19 en la vida cotidiana de los familiares de los profesionales sanitarios que laboran en las unidades de urgencia. Métodos: estudio descriptivo-exploratorio con abordaje cualitativo, realizado con 18 familiares de profesionales sanitarios que laboran en dos unidades de urgencias ubicadas en el sur de Brasil. Los datos fueron recolectados entre septiembre y noviembre de 2020, a partir de entrevistas telefónicas grabadas en audio, posteriormente transcritas íntegramente. El análisis se llevó a cabo a la luz de la sociología comprensiva. Resultados: las repercusiones negativas de la pandemia en la vida cotidiana de los familiares estuvieron marcadas por el miedo a la actividad profesional en primera línea y por la posibilidad de que el familiar se contagie, llevando el virus al resto de familiares. Sin embargo, paradójicamente, hubo repercusiones positivas, como la unión de los miembros de la familia y un acercamiento más próximo a la religiosidad / espiritualidad. Consideraciones finales e implicaciones para la práctica: se identifica como relevante el desarrollo de estrategias de comunicación para ofrecer apoyo emocional, promover el estímulo, el reconocimiento de las fortalezas del grupo familiar y, si es necesario, la educación para reducir las consecuencias negativas, como el estigma y los desacuerdos resultantes de esa experiencia

Inmunización en personal de salud / Immunization in health care workers

Resumen Justificación: la inmunoprofilaxis del personal sanitario conlleva múltiples propósitos que engloban tanto la protección de los pacientes como de los funcionarios mismos, y redunda en un claro beneficio para el empleador. En particular, la protección de pacientes inmunocomprometidos y con bajo potencial de desarrollar respuestas vacunales efectivas es de suma importancia. Programas de inmunización sistemática del personal de salud pueden reducir el riesgo de enfermedad, minimizar el impacto de accidentes laborales con materiales infecciosos y mantener la fuerza de trabajo indemne en los centros médicos durante los brotes estacionales de algunas infecciones. Objetivos: concatenar los esquemas de vacunación recomendados actualmente para los funcionarios que laboran en centros de salud y ofrecer una guía adaptada a la realidad epidemiológica nacional. Métodos: se efectuó una revisión no sistemática de bibliografía médica publicada en Internet entre 1990 y 2018, concerniente a vacunación de empleados sanitarios. De igual manera, se compararon los respectivos esquemas de inmunización vigentes en América y Europa. Conclusiones: la trasmisión de enfermedades infecciosas en los centros sanitarios es un problema de salud pública frecuentemente no reconocido, pero sustancial, que pone en riesgo tanto a los usuarios como al personal de estas instituciones. La inmunización de los trabajadores sanitarios es una estrategia fundamental para prevenir y contener la diseminación de agentes infecciosos a nivel hospitalario. Esta medida puede crear "inmunidad de rebaño" para proteger a pacientes y funcionarios que no se hayan vacunado o no puedan generar inmunidad suficiente contra determinados patógenos. Además, la vacunación de los empleados de salud constituye un punto de referencia para motivar las inmunizaciones en los demás segmentos de la población.

Abstract Background: Immune prophylaxis in health care personnel induces multiple positive effects that include protection for patients, as well as for employees and results with a clear benefit for the employers. Especially in immunological compromised patient groups and individuals who present a diminished potential to develop immunity to vaccination, contagion prevention is of highest importance. Systematic immunization programs can help to lower disease risks, minimize impact of occupational accidents related to handling of contagious materials and maintain the intactness of workforce in medical centers during periods of seasonal infection outbreaks. Objectives: this article resumes the present recommended schemes for vaccination of health care personnel and concludes them in a guideline adapted to the country´s epidemiologic reality. Methods: a non-systematic revision of medical literature related to immunization of health care personnel, published online between 1990 and 2018, was realized. In the same manner, a comparison of active vaccination schemes existing in Europe and the United States of America has been executed. Conclusion: the transmission of infectious diseases in health care installations represents a frequently ignored problem which substantially elevates the infection risk of patients as well as of health care personnel. The vaccination of health care personnel represents the easiest to imply and most effective strategy to inhibit this kind of transmission of infectious diseases. As well, this measure can create a "herd immunity" protecting patients and health care personnel who are not vaccinated or in conditions where they can not develop sufficient immunity against infectious agents. Furthermore, the immunization of the health care workers represents a reference and an example of motivation to other parts of the population.

Mumps outbreak with high complication rates among residents in a university teaching hospital.

According to the US Advisory Committee on Immunization Practices recommendations, only health care personnel (HCP) with adequate evidence of immunity should be exposed to patients with a suspected diagnosis of mumps. Here we report a hospital-outbreak scenario among medical residents with no previous vaccination record against mumps who had a high rate of complications. We also describe the importance and impact of full and proper vaccination, as well as isolation, of HCP in stopping the outbreak and, finally, review opportunities for improving the safety of HCP.

Transtornos mentais comuns em trabalhadores da Atenção Básica à Saúde / Common mental disorders in primary health care workers

Resumo Introdução: os trabalhadores da saúde podem ser acometidos por doenças relacionadas ao trabalho. A literatura registra que os transtornos mentais constituem importante fator de adoecimento entre esses trabalhadores. Objetivo: avaliar a prevalência de transtornos mentais comuns (TMC) e os fatores sociodemográficos, de estilo de vida e de trabalho, associados à sua ocorrência entre trabalhadores da Atenção Básica à Saúde. Métodos: estudo exploratório, de corte transversal, com amostra estratificada proporcional de trabalhadores das Unidades Básicas de Saúde, Unidades de Saúde da Família, equipe de Vigilância Epidemiológica e Núcleo de Apoio à Saúde da Família (Nasf). Resultados: a prevalência global de TMC foi de 22,9%; entre os trabalhadores do Nasf atingiu 31,6%. Observou-se associação positiva e estatisticamente significante (p≤0,05) entre TMC e sexo feminino, qualidade de vida regular/ruim/muito ruim, estado de saúde regular/ruim/muito ruim, pressão do tempo, insatisfação com o trabalho e elevadas demandas psicológicas. Discussão: devem ser priorizadas ações sobre os aspectos relacionados ao gênero, ao estado de saúde, qualidade de vida e, especialmente, sobre os aspectos da organização do trabalho, como a pressão do tempo, satisfação no trabalho e demanda psicológica envolvida.

Abstract Introduction: health care workers may be exposed to work-related diseases. The literature reports that mental disorders are important causes of illness among these workers. Objective: to evaluate the prevalence of Common Mental Disorders (CMD) and sociodemographic, lifestyle and working life factors associated with CMD occurrence among Primary Health Care Services workers. Methods: exploratory, cross-sectional study with a proportional stratified sample of workers from Primary Health Units, Family Health Units, Epidemiological Surveillance Team and Support Center for Family Health (NASF). Mental health was assessed by the Self-Reporting Questionnaire (SRQ-20) and the psychosocial aspects of work by the Job Content Questionnaire (JCQ). Results: the global CMD prevalence was 22.9%; among workers from NASF it reached 31.6%. Positive association, statistically significant (p≤0.05), was observed between CMD and women, regular/bad/very bad quality of life, regular/bad/very bad health status, time pressure, dissatisfaction with work and high psychological demands. Discussion: actions related to gender, health status, quality of life and especially to work organization aspects, such as time pressure, psychological demands and job satisfaction should be prioritized.

Evaluación de una intervención en línea para prevenir la violencia en población juvenil y adolescente: Resultados preliminares sobre su efectividad con profesionales de la salud / Evaluation of an online intervention evaluation to prevent violence in youths and adolescents: Preliminary results on its effectiveness with health professionals

El Modelo de Intervención Interactiva, denominado "Sin Violencia es Mejor", se deriva de la investigación psicosocial desarrollada en el Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz. Este trabajo tiene como fin evaluar la adquisición y consolidación de conocimientos, y la modificación de actitudes asociadas con la violencia en participantes de esta intervención en línea. La convocatoria fue abierta para personal de salud de todo el país. Participaron 132 prestadores de servicios de salud, a quienes se les aplicó un pre y post test mediante un cuestionario construido ad hoc para evaluar conocimientos sobre violencia y actitudes de intolerancia. Se analizaron las diferencias pre-post en todos los reactivos individualmente y por dimensión, y se reagruparon los reactivos para contar con tres dimensiones de mayor consistencia: 1. Conocimientos generales sobre la violencia (alpha=.50), 2. Tipos y efectos de la violencia (alpha=.63), 3. Actitudes de intolerancia (alpha=.58). Se encontraron diferencias significativas para la primera (t(131)=4.1, p<.000) y segunda dimensión (t(131)=6.6, p<.0001), pero no en la última, en la que, si bien hubo cambio, no alcanzó significancia estadística. Lo anterior apunta a un aumento en el conocimiento sobre los elementos que permiten reconocer un acto violento. Esto es significativo porque indica que, luego de la intervención, los participantes pueden reconocer si viven o ejercen violencia. El aumento del conocimiento de los participantes es consistente con la evaluación que éstos hicieron de los recursos de la intervención en línea, en términos de la relevancia y utilidad de la información. Aunque las actitudes suelen ser estables, pueden ser modificadas, ya sea por decisión propia o mediante una intervención externa. Los resultados indican que tras la intervención se observan menores niveles de intolerancia a la igualdad entre hombres y mujeres, si bien requiere profundizarse y mejorarse esta dimensión.

The Interactive Intervention Model, called "It is Better Without Violence", derives from psychosocial research carried out at the National Institute of Psychiatry Ramón de la Fuente Muñiz. The objective of this article is to evaluate the acquisition and consolidation of the knowledge, and the modification of the attitudes associated with violence in participants of this online intervention. The convening was open to health personnel from all over the country. One hundred and thirty-two health services providers participated. These were submitted to an ad hoc questionnaire to evaluate their knowledge on violence and intolerant attitudes, before and after the intervention. Pre- and post-intervention differences for all the items were analyzed individually and by dimension, and they were regrouped to render three dimensions with a higher consistency: 1. Overall knowledge about violence (α =.50), 2. Violence types and effects (α=.63), 3. Intolerant attitudes towards difference (α=.58). Significant differences were found for the first (t(131)=4.1, p<.000) and second (t(131)=6.6, p<.0001, dimensions, but not so for the last where the change did not reach statistical significance. This points out to an increase in the knowledge of the elements which allow for the recognition of a violent act. This is important because it indicates that, after the intervention, participants are able to identify if they suffer or exert violence. The increase in the knowledge of participants is consistent with their evaluation of the resources of the online intervention in terms of the relevance and usefulness of the information. Even though attitudes tend to be stable and harder to modify, lower levels of intolerance were observed after the intervention. Given that this dimension is associated with possible discrimination practices towards the "different ones" and these are associated with the exertion of violence, reviewing the intervention content and the instrument itself is proposed in order to achieve changes.

Prompt control of an outbreak caused by extended-spectrum ß-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit.

OBJECTIVES: To assess the effectiveness of a set of multidisciplinary interventions aimed at limiting patient-to-patient transmission of extended-spectrum ß-lactamase-producing Klebsiella pneumoniae (ESBL-KP) during a neonatal intensive care unit (NICU) outbreak, and to identify risk factors associated with ESBL-KP colonization and disease in this setting. STUDY DESIGN: A 61-infant cohort present in the NICU during an outbreak of ESBL-KP from April 26, 2011, to May 16, 2011, was studied. Clinical characteristics were compared in infected/colonized infants and unaffected infants. A multidisciplinary team formulated an outbreak control plan that included (1) staff reeducation on recommended infection prevention measures; (2) auditing of hand hygiene and environmental services practices; (3) contact precautions; (4) cohorting of infants and staff; (5) alleviation of overcrowding; and (6) frequent NICU-wide screening cultures. Neither closure of the NICU nor culturing of health care personnel was instituted. RESULTS: Eleven infants in this level III NICU were infected/colonized with ESBL-KP. The index case was an 18-day-old infant born at 25 weeks' gestation who developed septicemia from ESBL-KP. Two other infants in the same room developed sepsis from ESBL-KP within 48 hours; both expired. Implementation of various infection prevention strategies resulted in prompt control of the outbreak within 3 weeks. The ESBL-KP isolates presented a single clone that was distinct from ESBL-KP identified previously in other units. Being housed in the same room as the index infant was the only risk factor identified by logistic regression analysis (P = .002). CONCLUSION: This outbreak of ESBL-KP affected 11 infants and was associated with 2 deaths. Prompt control with eradication of the infecting strain from the NICU was achieved with multidisciplinary interventions based on standard infection prevention practices.

Depresión en el personal sanitario femenino y el análisis de los factores de riesgos sociodemográficos y laborales / Depression in Female Healthcare Workers and Analysis of Socio-demographic and Work-related Risk Factors

Objetivo: Determinar la prevalencia de depresión en el personal sanitario femenino y analizar los factores de riesgo socio demográficos y laborales. Métodos: Estudio observacional, descriptivo y transversal, con 190 mujeres del Instituto Mexicano del Seguro Social, a quienes se les aplicó una ficha de identificación y el cuestionario clínico de diagnóstico para cuadros depresivos. Resultados: La tasa de respuesta fue del 86,0 %. El 52,2 % tenía más de 40 años de edad; el 61,0 %, pareja estable; el 75,3 %, hijos, y el 51,5 %, nivel de escolaridad mayor a 12 años. El 71,0 % mostró una antigüedad institucional mayor de 10 años y el 56,3% reveló una antigüedad en el puesto de actual menor a 10 años; predominaron el turno vespertino en el 52,1 %, la contratación de base en el 90,0 % y el no tener otro trabajo en el 8,6 %. Se detectó depresión en 18,9 %; 9,5 % presentó reacción de ansiedad; 8,4 %, depresión moderada, y 1,1 %, depresión severa. No hubo diferencias significativas en la variable socio-demográficas y laboral, a excepción de tener pareja estable, antigüedad institucional mayor de 10 años, trabajar solamente en la institución, tabaquismo y alcoholismo negativos. Conclusiones: La depresión presentó una prevalencia del 18,9 %. Los factores de riesgo fueron: ser trabajadora social, mayor de 40 años, con pareja estable y con menos de 15 años con ella, tener hijos, escolaridad mayor de 12 años, con más de 10 años de antigüedad institucional y en el puesto actual de trabajo, turno matutino, contratación de base y no tener otro trabajo aparte del institucional...

Objective: To determine the prevalence of depression in women healthcare workers and to Analyze the socio-demographic and work-related risk factors. Material and methods: This is an observational, descriptive, and transversal study. 190 female healthcare workers of the Mexican Social Security Institute were assessed by an identification form and a self-administered diagnostic clinical questionnaire of depressive symptoms. Results: The response rate was 86.0 %. All were women, 52.2 % were over 40 years old, 61.0 % had a steady partner, and 75.3 % reported having children. 51.5 % had more than 12 years of schooling 71.0 % had been at the institution over 10 years, and 56.3 % had been at their current position for less than 10 years. 52.1 % had the afternoon shift, 90.0 % were hired directly, and 8.6 % had no other job outside the institution. Depression was detected in 18.9 % of the women. 9.5 % had anxiety reactions, 8.4 % moderate depression, and 1.1 % severe depression. There were no significant differences according to socio-demographic and work-related variables, except for having a stable partner, being at the institution for more than 10 years, working only at the institution, and non-use of tobacco and alcohol. Conclusions: Depression showed a prevalence of 18.9 %. Risk factors were being a social worker, being more than 40 years old, having a stable partner for less than 15 years, having children, having over 12 years of schooling, working for more than 10 years at the institution in the current position, having the morning shift, being a direct hire employee, and not having another job outside the institution...

Calidad de vida laboral en trabajadores de la salud, Tamaulipas, México 2010 / Quality of work life among health workers, Tamaulipas, Mexico 2010

Objetivo: Determinar el grado de satisfacción con la calidad de vidalaboral en trabajadores del sector salud. Método y Materiales. Se realizó un estudio transversal analítico en una muestra aleatoria de372 trabajadores de la Secretaría de Salud del Estado de Tamaulipas, México, mediante un cuestionario para datos socio-laborales y un instrumento para medir Calidad de Vida en el Trabajo. Resultados: Grupo con edad productiva entre 25 y 55 años, una capacitación de 45% con licenciatura. El 26% cuenta con dos trabajos y el 10% reporta ausentismo laboral. Dos tercios tienen plaza laboral segura. Se muestran trabajadores insatisfechos con procesos de trabajo,baja motivación, poca satisfacción personal y seguridad laboral. Sinoportunidades de progreso por escalafón. Ven injusta su remuneración.Reportan problemas de salud relacionados con el trabajo, tienen mala administración del tiempo libre y laboral, no programan descanso ni recreación, lo que afecta su salud. Conclusiones: Este estudio constituye el primer intento para diagnosticar la satisfacción con la calidad de vida laboral en trabajadores de la saludpública en México. Las percepciones de éstos reflejan una realidad laboral que podría afectar las metas de la institución, la calidad de sus servicios y la posibilidad de manifestaciones de inconformidad en el futuro a menos que se detecten las causas de la insatisfacción y sean resueltas gradualmente.

Objective: To determine the satisfaction level with the quality of work life among employees from the health sector. Method and Materials: An analytic and cross-sectional study was conducted in asample of 372 workers from the Secretariat of Health in the State ofTamaulipas, Mexico. A questionnaire for social-labor data and an instrument for assessing the quality of work life were applied. Results: A group with a productive age from 25 to 55 years old in which 45% has bachelor’s degrees, 26% has two jobs, 10% shows jobabsenteeism and two thirds holds a permanent position. Employees are dissatisfied with work processes. Both their motivation and personal satisfaction as well as employment security are low. They also perceive a lack of career progress opportunities and think their salary is unfair. Employees report work-related health problems, due to the poor use of laboral and leisure time, and lack of breaks orrecreation. Conclusions: This study is the first attempt to diagnose the satisfaction in relation to the quality of work life among public health employees in Mexico. Their perceptions reflect a situation that could affect the goals of the institution, quality of service and possibility of future demonstrations of discontent, unless causes are solved gradually.