Radiaciones ionizantes en trabajadores sanitarios: función tiroidea y niveles de riesgo de exposición laboral / Ionizing radiation in healthcare workers: thyroid function and risk levels of occupational exposure

Introducción: Uno de los sectores donde más se emplean las radiaciones ionizantes es el sanitario. Existen evidencias que sugieren que la exposición a radiaciones ionizantes podría relacionarse con alteraciones en las hormonas tiroideas. Objetivos: Analizar la posible asociación de alteraciones de hormonas tiroideas con la exposición a radiaciones ionizantes en trabajadores sanitarios según la clasificación actual con mayor probabilidad de riesgo (PER A) y menor probabilidad de riesgo (PER B), y la influencia de otros factores asociados, así como, valorar las dosimetrías personales en función de la exposición laboral en distintas zonas de trabajo según el nivel de riesgo. Material y Métodos: Estudio retrospectivo comparativo de valores de TSH, T3 y T4 en trabajadores expuestos (PER A y/o PER B) y un grupo control. Finalmente, se realizó una comparación de valores de dosimetrías personales respecto a zonas de trabajo con distintos niveles de exposición. Resultados: se halla un ligero aumento de los valores de TSH en los trabajadores PER B (2,6 ± 1,4) y PER A (2,7 ± 1,3), frente a no PER (2,4 ± 1,5) sin alcanzar significación estadística. Se ha encontrado diferencia estadísticamente significativa en las dosis quinquenales individuales de los trabajadores en relación a los niveles de exposición laboral con valores de 0,1 ± 0,3 en la zona de exposición baja y de 0,9 ± 1,4 en la zona de exposición media/alta. Conclusiones: Se evidencia la relación entre exposición laboral a radiaciones ionizantes y los valores individuales dosimétricos en trabajadores sanitarios expuestos, por lo que parece conveniente considerar también las zonas de trabajo de cara a las medidas preventivas realizadas en los trabajos con riesgo de exposición a radiaciones ionizantes. (AU)

Introduction: One of the sectors with the highest rates of use of ionizing radiations is the healthcare system. There is some evidence to suggest that exposure to ionizing radiations could be associated with alterations in thyroid hormone levels. Objectives: To analyze a possible association between the levels of thyroid hormones and the occupational exposure to ionizing radiation in healthcare workers according to the current classification of PER A (with more probability of risk of exposure) and PER B (with less probability of risk of exposure), plus the influence of other factors. To analyze the values of personal dosimeters according to the occupational exposure in the different areas of work and level of risk. Material and Methods: Retrospective comparative study of TSH, T3 and T4 in exposed healthcare workers (PER A and PER B) and control group, working from 2014 to 2019. Levels of personal dosimeters were compared in the areas classified according to the level of risk of exposure. Results: No statistically significant relationship was found between the levels of thyroid hormones and the occupational exposure to radiation in PER A, PER B, though higher levels of TSH were found in the exposed groups PER B (2,6 ± 1,4) and PER A (2,7 ± 1,3) compared to TSH levels in the control group (2,4 ± 1,5). There is a statistically significant difference between the individual five-year dose of healthcare workers and the levels of occupational exposure, with values in the areas classified according to the level of exposure with values of 0,1 ± 0,3 in the low exposure area and 0,9 ± 1,4 in the medium/high exposure area. Conclusions: There is a relationship between occupational exposure to ionizing radiations and the individual dosimetric values, thus areas of work should be considered when designing preventive measures in healthcare workers exposed to ionizing radiations. (AU)

[Approximation to the cost of occupational diseases treated in seven hospitals in Spain]. / Aproximación al coste de enfermedades profesionales atendidas en siete hospitales en España.

OBJECTIVE: To estimate the hospital cost of a sample of cases treated in seven hospitals of the National Health System in several Spanish cities. METHOD: Study based on 78 cases of occupational disease recognized by the social security, and previously treated in hospitals in Badalona, Barcelona, Ferrol, Gijón, Girona, Madrid and Vigo between 2017 and 2019. RESULTS: The healthcare activity generated by these hospitals to attend these processes involved a total cost of 282,927€. CONCLUSIONS: It is urgent to improve the coordination between the two public health systems, the social security health care system and the National Health System.

Time to a Negative SARS-CoV-2 PCR Predicts Delayed Return to Work After Medical Leave in COVID-19 Infected Health Care Workers.

OBJECTIVE: To investigate whether HCWs return to work (RTW) after COVID-19 was associated with time to a negative viral detection test. METHODS: To evaluate the association of RTW with an undetectable RT-PCR adjusting for different factors. RESULTS: Three hundred seventy-five HCWs who required medical leave for COVID-19 at a hospital in Madrid. Multivariable analyses confirmed the association of delayed RTW with interval to negative PCR (ORadj 1.12, 95% CI 1.08, 1.17) as well as age, sex, and nursing staff and clinical support services compared to physicians. A predictive model based on those variables is proposed, which had an area under the receiver operating curve of 0.82. CONCLUSIONS: Delayed RTW was associated with longer interval to a negative RT-PCR after symptom onset, adjusting for occupational category, age, and sex.

Serological study of healthcare workers in four different hospitals in Madrid (Spain) with no previous history of COVID-19.

OBJECTIVES: Healthcare workers (HCWs) have been one of the most severely affected groups during the COVID-19 pandemic, though few studies have sought to determine the rate of undiagnosed cases among this population. In this study, we aim to determine the rate of undetected infection in HCWs, a potential source of nosocomial infection. METHODS: Serological screening for IgG and IgM antibodies against SARS-CoV-2 was carried out among HCWs from four different hospitals in Madrid, Spain, from 6 April to 25 April 2020; HCWs with a previous diagnosis of infection based on real-time reverse transcriptase-PCR assay performed after presenting compatible symptoms were excluded. Prevalence of IgG and IgM antibodies was calculated among HCWs to obtain the rate of COVID-19 presence of antibodies in each hospital. RESULTS: Of the 7121 HCWs studied, 6344 (89.09%) had not been previously diagnosed with COVID-19. A total of 5995 HCWs finally participated in the study, resulting in a participation rate of 94.49%. A positive IgM or IgG test against COVID-19 was revealed in 16.21% of the HCWs studied (n=972). CONCLUSION: This study reveals the importance of early detection of SARS-CoV-2 infection among HCWs to prevent nosocomial infection and exposure of patients, visitors and workers and the spread of COVID-19 in the overall community.

Síndrome de burnout en médicos residentes de los hospitales del área sureste de la Comunidad de Madrid / Burnout syndrome in internal medical residents in the southeast area's hospitals of Madrid

El Síndrome de Burnout se reconoce como un problema global importante entre los trabajadores de atención médica, produciendo agotamiento, despersonalización y baja realización personal en los trabajadores. Objetivo: determinar la prevalencia del síndrome de Burnout entre los médicos residentes de diversas especialidades y evaluar los factores asociados. Material y Métodos: estudio observacional transversal. Se utilizaron el cuestionario del Inventario de Burnout de Maslach y un cuestionario sociodemográfico para evaluar los factores asociados en médicos internos residentes de hospitales del área sureste de Madrid. Participaron 119 residentes en el estudio. Resultados: encontramos una prevalencia de Burnout en los residentes encuestados de 29,4%. El único factor que se ha visto asociado a una mayor prevalencia de Burnout fue ser mujer. No se encontraron factores asociados a las dimensiones cansancio emocional ni realización personal, sin embargo sí se encontraron factores asociados a la dimensión despersonalización, así se vio que tener personas a cargo es un riesgo y estar en los últimos años de residencia es un factor de protección para desarrollar mayor grado de despersonalización. Conclusión: la prevalencia de agotamiento en los médicos residentes está de acuerdo con estudios anteriores. La identificación temprana de los factores de riesgo es fundamental para desarrollar soluciones e intervenciones que podrían mejorar la condición laboral de los médicos residentes

Burnout Syndrome is recognized as an important global problem among health care workers, producing exhaustion as a result of emotional demands, depersonalization as a cynical, negative response to patient care and reduced achievement refers to the belief that you can no longer work effectively. All this leads to a major concern among doctors due to their high level of stress at work. Objective: determine the prevalence of Burnout Syndrome among internal medical residents of various specialties and evaluate the associated factors. Methods: cross-sectional observational study. The Maslach Burnout Inventory questionnaire and a sociodemographic questionnaire were used to evaluate the factors associated with the syndrome in internal medical residents the southeast area of Madrid. Burnout was defined as the association of high emotional exhaustion, depersonalization and low professional performance. From all 569 internal medical residents just 119 participated in the study. Results: the prevalence of Burnout in the internal medical residents surveyed was 29.4%. The only factor that showed association with a higher prevalence of Burnout was being a woman. No factors showed association with the dimensions emotional fatigue or personal fulfillment. However, having people in charge seems to be a risk factor and being in the last years of medical residence seems to be a risk protective factor for developing a higher degree of depersonalization. Conclusion: the prevalence of exhaustion in internal medical residents is in agreement with previous studies. The early identification of risk factors is essential to develop solutions and interventions that could improve the working condition of internal medical residents as preventive measures against Burnout Syndrome

Cost-effectiveness of different screening strategies (single or dual) for the diagnosis of tuberculosis infection in healthcare workers.

OBJECTIVE: To evaluate the cost-effectiveness of a dual strategy of tuberculin skin test (TST) and QuantiFERON-TB Gold (QFT-G) for screening of latent tuberculosis infection (LTBI) in healthcare workers (HCWs) and, as a secondary objective, to study relationships between TST results, QFT-G results, and sociodemographic factors. DESIGN: Cross-sectional prospective study. SETTING: University hospital in Madrid. PARTICIPANTS: A total of 103 HCWs. METHODS: QFT-G was requested for all positive TST results; QFT-G results were compared with TST results, and their relationships with sociodemographic factors were analyzed. A cost-effectiveness analysis was conducted for the dual strategy (TST/QFT-G) and for TST or QFT alone, taking into account the indication of and compliance with isoniazid, the risk of hepatotoxicity, and postexposure tuberculosis. RESULTS: Of all HCWs studied, 42.3% showed a positive result by QFT-G, and 49.5% had received bacille Calmette-Guérin (BCG) vaccination; no significant association was detected between BCG and QFT-G results. Increased TST was linked to higher positive QFT-G values (TST of 5-9.9 mm, 27.6%; TST of 15 mm or more, 56.5%; P=.03). The probability of positive QFT-G results was 1.04 times higher for each year of age (odds ratio, 1.04 [95% confidence interval, 1.01-1.09]; P=.0257). The incremental cost per active TB case prevented was lower for TST/QFT-G than for the other strategies studied (€14,211 per 1,000 HCWs). The number of people treated for LTBI per case of active TB prevented (number needed to treat) for TST/QFT-G was lower than for TST alone (17.2 vs 95.3 and 88.7 with the 5- and 10-mm cutoff value, respectively) or QFT-G alone (69.6). CONCLUSIONS: Dual strategy with TST/QFT-G is more cost-effective than TST or QFT-G alone for the diagnosis of LTBI in HCWs.

[Vitamin D and bone health: is there a need to review supplementation in osteoporosis risk population?]. / Vitamina D y salud ósea: 'es necesario revisar la administración de sus suplementos en poblaciones de riesgo de osteoporosis?

Vitamin D is an essential hormone for achieving an optimal bone physiology. There is no universal consensus nowadays on the definition of hypovitaminosis D and cut-off values have been refined in the last years. The aim of this review is to analyze vitamin D deficiency among osteoporosis risk populations, including elderly and postmenopausal women, in Spain and other countries. We also review vitamin D supplementation: current clinical guidelines, last clinical studies, safety, and prescription schemes.