Incontinencia urinaria en trabajadoras de la salud como factor predisponente de presentismo en Chile: estudio exploratorio de método mixto / Urinary incontinence in health workers as a predisposing factor for presenteeism in Chile: A mixed-methods exploratory study

Introducción La incontinencia urinaria impacta de forma negativa la calidad de vida de quienes la padecen y puede perjudicar las actividades laborales, siendo causante de presentismo en las profesionales de salud. Esto puede implicar la disminución en la calidad de la atención y seguridad de la/el paciente. El objetivo del presente estudio es explorar la autopercepción de las trabajadoras de salud que padecen incontinencia urinaria como factor predisponente de presentismo. Métodos Estudio mixto de carácter exploratorio-descriptivo. La muestra fue seleccionada de forma no probabilística e intencionada por criterio y conveniencia con un tamaño de 14 voluntarias, considerando la saturación de la información. Para el proceso y análisis de datos temáticos se consideraron los criterios de confiabilidad definidos por Guba. Resultados Muestra con edad media de 38,9 + 7,1 años y un puntaje de SPS-6 medio de 15,8 + 3,5 puntos, mostrando mayor alteración en la dimensión de evitar la desconcentración. Las narrativas presentes en el caso estudiado aportaron información relevante de cómo la incontinencia urinaria afecta el desempeño laboral de las trabajadoras de salud a través de la interrupción en su jornada, disminución en la calidad de la atención clínica, como también el aumento de su ansiedad respecto a su entorno. Conclusiones Dado que la incontinencia urinaria y el presentismo son experiencias subjetivas y multidimensionales, al igual que el efecto negativo en el desempeño laboral, se recomienda un estudio que permita identificar variables predictoras y las pérdidas económicas asociadas a esta condición. Con ello se buscaría establecer mejoras en el ambiente laboral, así como en el autocuidado de funcionarias, procurando mayores beneficios y mejores niveles de eficiencia en la organización.

Introduction Urinary incontinence negatively impacts the quality of life and can harm work activities, causing presenteeism in health professionals and decreasing the quality of care and patient safety. The objective of this study is to explore the self-perception of health workers who suffer from urinary incontinence as a predisposing factor for presenteeism. Methods Mixed study of an exploratory-descriptive nature. The sample was selected in a non-probabilistic and intentional way by criterion and convenience with a size of 14 volunteers, considering the saturation of the information. Reliability criteria defined by Guba for the process and analysis of thematic data were considered. Results The sample had a mean age of 38.9 + 7.1 years and a mean SPS-6 score of 15.8 + 3.5 points, showing alteration in the dimension of avoiding deconcentration. The narratives in the case study provide relevant information on how urinary incontinence affects the work performance of health workers through the interruption in their day, decreases the quality of clinical care, and increases their anxiety regarding their environment. Conclusions Urinary incontinence and presenteeism are subjective, and multidimensional experiences affect work performance. Therefore, further studies are recommended to identify predictor variables and the economic losses associated with this condition to establish improvements in the work environment and the self-care of female employees seeking greater benefits and better levels of efficiency in the organization

Urinary incontinence in health workers as a predisposing factor for presenteeism in Chile: A mixed-methods exploratory study. / Incontinencia urinaria en trabajadoras de la salud como factor predisponente de presentismo en Chile: estudio exploratorio de método mixto.

Introduction: Urinary incontinence negatively impacts the quality of life and can harm work activities, causing presenteeism in health professionals and decreasing the quality of care and patient safety. The objective of this study is to explore the self-perception of health workers who suffer from urinary incontinence as a predisposing factor for presenteeism. Methods: Mixed study of an exploratory-descriptive nature. The sample was selected in a non-probabilistic and intentional way by criterion and convenience with a size of 14 volunteers, considering the saturation of the information. Reliability criteria defined by Guba for the process and analysis of thematic data were considered. Results: The sample had a mean age of 38.9 + 7.1 years and a mean SPS-6 score of 15.8 + 3.5 points, showing alteration in the dimension of avoiding deconcentration. The narratives in the case study provide relevant information on how urinary incontinence affects the work performance of health workers through the interruption in their day, decreases the quality of clinical care, and increases their anxiety regarding their environment. Conclusions: Urinary incontinence and presenteeism are subjective, and multidimensional experiences affect work performance. Therefore, further studies are recommended to identify predictor variables and the economic losses associated with this condition to establish improvements in the work environment and the self-care of female employees seeking greater benefits and better levels of efficiency in the organization.

Introducción: La incontinencia urinaria impacta de forma negativa la calidad de vida de quienes la padecen y puede perjudicar las actividades laborales, siendo causante de presentismo en las profesionales de salud. Esto puede implicar la disminución en la calidad de la atención y seguridad de la/el paciente. El objetivo del presente estudio es explorar la autopercepción de las trabajadoras de salud que padecen incontinencia urinaria como factor predisponente de presentismo. Métodos: Estudio mixto de carácter exploratorio-descriptivo. La muestra fue seleccionada de forma no probabilística e intencionada por criterio y conveniencia con un tamaño de 14 voluntarias, considerando la saturación de la información. Para el proceso y análisis de datos temáticos se consideraron los criterios de confiabilidad definidos por Guba. Resultados: Muestra con edad media de 38,9 + 7,1 años y un puntaje de SPS-6 medio de 15,8 + 3,5 puntos, mostrando mayor alteración en la dimensión de evitar la desconcentración. Las narrativas presentes en el caso estudiado aportaron información relevante de cómo la incontinencia urinaria afecta el desempeño laboral de las trabajadoras de salud a través de la interrupción en su jornada, disminución en la calidad de la atención clínica, como también el aumento de su ansiedad respecto a su entorno. Conclusiones: Dado que la incontinencia urinaria y el presentismo son experiencias subjetivas y multidimensionales, al igual que el efecto negativo en el desempeño laboral, se recomienda un estudio que permita identificar variables predictoras y las pérdidas económicas asociadas a esta condición. Con ello se buscaría establecer mejoras en el ambiente laboral, así como en el autocuidado de funcionarias, procurando mayores beneficios y mejores niveles de eficiencia en la organización.

Impact of COVID-19 pandemic outbreak on mental health of the hospital front-line healthcare workers in Chile: a difference-in-differences approach.

BACKGROUND: Most of the evidence about impact of COVID-19 pandemic on the mental health of healthcare workers (HCWs) comes from symptom questionnaires. It is important to evaluate main mental health diagnoses in hospital front-line HCW's during the early acute phase of the COVID-19 pandemic in Chile. METHODS: An individual-level cross-sectional study using administrative data was conducted. A Difference-in-Difference (DiD) approach was used to estimate the impact of the COVID-19 pandemic on sick leave rates of depression, anxiety and acute stress reaction among hospital front-line HCW's in comparison with other private insured workers. RESULTS: DiD estimates showed a significant reduction of depression (17%), anxiety (8%) and acute stress reaction (8%) sick leave rate, in the front-line HCWs during the COVID-19 pandemic. Reduction of the three mental disorders sick leave rates was higher in men than women. Except for depression, front-line HCW's from the Santiago region's sick leave rates of anxiety and acute stress reaction decreased more than other regions'. CONCLUSION: Opposite to our hypothesis the results suggests a remarkable resilience level and compromise of front-line HCW's. To address threats to the mental health of HCW's is key to promotes programs for their psychological well-being and safety.

Prevalencia de riesgo de apnea obstructiva del sueño en población adulta chilena / Prevalence of risk of obstructive sleep apnea in Chilean adult population

Introducción: En Chile la apnea obstructiva del sueño (AOS) es una enfermedad crónica insuficientemente reconocida, que probablemente emerge bajo condiciones epidemiológicas apropiadas. Nuestro objetivo fue estimar su prevalencia en nuestra población adulta. Pacientes y Métodos: A través de la 2ᵃ Encuesta Nacional de Salud (ENS) 2010, estimamos la prevalencia de riesgo de AOS en población ≥ 18 años de edad. Derivada del STOP-Bang Questionnaire construimos una regla de predicción clínica-RPC: ronquido habitual, somnolencia diurna, pausas respiratorias nocturnas, hipertensión arterial, IMC > 35 kg/m2, edad > 50 años, circunferencia cervical ≥ 43 cm (hombres) y ≥ 41 cm (mujeres), sexo: hombre. Según el puntaje total, el riesgo de los sujetos se clasificó como: Bajo (< 3), Medio (3-4) y Alto (≥ 5). Para obtener prevalencia e intervalos de confianza al 95%, usamos el módulo para muestras complejas del Software SPSS (v22). Resultados: Obtuvimos 5.069 registros, edad promedio: 48 ± 18 años, 60% mujeres. Una submuestra de 4.234 cumplió los criterios de la RPC. La muestra expandida (representando 11.279.865 personas) arrojó los siguientes resultados: riesgo Bajo 60,7% (CI 95%, 58-63,4), Medio 31,1% (28,7-33,6) y Alto 8,2% (7-9,5). Riesgo en hombres: Bajo 45,8% (41,7-49,9), Medio 41,1% (37,3-45,1), Alto 13,1% (11-15,5). Riesgo en mujeres: Bajo 74,6% (71,6-77,4), Medio 21,8% (19,4-24,4), Alto 3,6% (2,5-5,1). Observamos un incremento del riesgo Alto de AOS desde 0,3% (0-1,8) en el grupo etario de 18-24 años, a 22,9% (18,4-28,2) en las personas mayores de 65 años. Los hombres con la mayor prevalencia de Alto riesgo de AOS provenían de 7 de las 15 Regiones de Chile: Araucanía (24%), Aysén (21,3%), Coquimbo (18%), Maule (17,8%), Bio-Bío (17%), Arica (16,2%) y O'Higgins (15,7%). Conclusiones: La AOS es una condición prevalente en la población chilena, es mayor en hombres que en mujeres y se observó que el riesgo Alto tiende a aumentar con la edad.

Introduction: Obstructive sleep apnea (OSA) is a neglected chronic disease probably emerging under appropriate epidemiological conditions in Chile. Our goal was to estimate the prevalence of OSA risk in adult population. Patients and Methods: From the 2nd Chilean Health Survey 2010 (NHS), we estimate the prevalence of risk of OSA in population ≥ 18 years, as a derived proxy from STOPBang Questionnaire. A clinical prediction rule-CPR: habitual snoring, daytime sleepiness, nocturnal breathing pauses, blood hypertension, BMI > 35 kg/m2, age > 50 y.o., neck circumference ≥ 43 cm (men) and ≥ 41 cm (women) and male, was constructed. According to the total score subjects were classified as: Low (< 3), Medium (3-4), and High Risk (≥ 5). SPSS Software (v22) modules for complex survey was used to obtain population prevalence and 95% confidence intervals. Results: 5,069 records were obtained, mean age 48 ± 18 years, 60% women. A subsample of 4,234 fulfil the criteria per the CPR. The expanded sample (representing 11,279,865 persons), yielded the following results: Low risk 60.7% (CI 95%, 58-63.4), Medium 31.1% (28.7-33.6) and High 8.2% (7-9.5). Men with Low risk 45.8% (41.7-49.9), Medium 41.1% (37.3-45.1), High 13.1% (11-15.5). Women with Low risk 74.6% (71.6-77.4), Medium 21.8% (19.4-24.4), High 3.6% (2.5-5.1). We observed an increasing trend in High risk of OSA from 0.3% (0-1.8) in 18-24 years old group to a 22.9% (18.4-28.2) in people aged > 65 years old. Men with the highest prevalence of High risk OSA are in 7 of the 15 Regions: Araucanía (24%), Aysén (21.3%), Coquimbo (18%), Maule (17.8%), Bio-Bio (17%), Arica (16,2%) and O'Higgins (15.7%). Conclusion: OSA is a prevalent condition in Chilean Population, is higher in men than in women and a positive age trend of high risk OSA was observed.

Effect of in-home and community-based services on the functional status of elderly in the long-term care insurance system in Japan.

BACKGROUND: Japan is setting the pace among aging societies of the world. In 2005, Japan became the country with the highest proportion of elderly persons in the world. To deal with the accelerated ageing population and with an increased demand for long-term care services, in April 2000 the Japanese government introduced a mandatory social Long-Term Care Insurance System (LTCI), making long-term care services a universal entitlement for elderly. Overseas literature suggests that the effectiveness of a home visiting program is uncertain in terms of preventing a decline in the functional status of elderly individuals. In Japan, many studies regarding factors associated with LTC service utilization have been conducted, however, limited evidence about the effect of LTC services on the progression of recipient disability is available. METHODS: Data were obtained from databases of the LTC insurer of City A. To examine the effect of in-home and community-based services on disability status of recipients, a survival analysis in a cohort of moderately disabled elderly people, was conducted. RESULTS: The mean age of participants was 81 years old, and females represented 69% of the participants. A decline or an improvement in functional status, was observed in 43% and 27% of the sample, respectively. After controlling for other variables, women had a significantly greater probability of improving their functional status during all phases of the observation period. The use of "one service" and the amount of services utilized (days/month), were marginally (p = < 0.10) associated with a greater probability of improving their functional status at 12 months into the observation period. CONCLUSIONS: The observed effects of in-home and community-based services on disability transition status were considered fairly modest and weak, in terms of their ability to improve or to prevent a decline in functional status. We suggest two mechanisms to explain these findings. First, disability transition as a measure of disability progression may not be specific enough to assess changes in functional status of LTCI recipients. Secondly, in-home and community-based services provided in City A, may be inappropriate in terms of intensity, duration or quality of care.

Social valuation of EQ-5D health states: the Chilean case.

BACKGROUND: Cost-effectiveness analysis has been recommended by many national agencies around the world as a valid methodology to improve resource allocation within the health-care system. If the preferences of the society are taken into account in such a decision-making process, it is generally recommended that these values should be elicited by using a generic health-related quality-of-life instrument, such as the EuroQol five-dimensional (EQ-5D) questionnaire. OBJECTIVES: To estimate a set of social values for EQ-5D questionnaire based on the time trade-off valuation technique for use in Chile. METHODS: A valuation questionnaire was applied to a probabilistic sample of 2000 individuals, aged 20 years or older, living in the Metropolitan region. The fieldwork took place during October to November 2008. Utility weights for 42 health states were calculated directly by the application of time trade-off. Several random effect and ordinary least-squares regression models were fitted to these valuations to predict the full set of 243 health states generated by the EQ-5D system. The best model was chosen by applying criteria of parsimony, goodness of fit, and prediction capacity. RESULTS: The selected regression model was robust and showed better predictive characteristics than others reported in similar studies conducted elsewhere. The chosen regression model showed a R(2) of 0.34, mean absolute error of 0.017, and high predictive capacity. CONCLUSIONS: This study provides an EQ-5D social value set for domestic use in Chile. Our results differ from those reported in other countries, justifying the need to perform local studies that adequately reflect societal health preferences.

Predictors of the highest long-term care expenditures in Japan.

BACKGROUND: In Japan, as the number of elderly covered by the Long-term Care Insurance (LTCI) system has increased, demand for long-term care services has increased substantially and consequently growing expenditures are threatening the sustainability of the system. Understanding the predictive factors associated with long-term care expenditures among the elderly would be useful in developing future strategies to ensure the sustainability of the system. We report a set of predictors of the highest long-term care expenditures in a cohort of elderly persons who received consecutive long-term care services during a year in a Japanese city. METHODS: Data were obtained from databases of the LTC insurer of City A in Japan. Binary logistic regression was used to examine the predictors of the highest long-term care expenditures. We used a simplified model that focused on the effects of disability status and type of services used, while controlling for several relevant factors. Goodness of fit, a multicollinearity test, and logistic regression diagnostics were carried out for the final model. RESULTS: The study cohort consisted of 862 current users of LTCI system in city A. After controlling for gender and income, age, increased utilization rate of benefits, decline in functional status, higher care needs level and institutional care were found to be associated with the highest LTCI expenditures. An increased utilization rate of benefits (OR = 24.2) was a strong main effect predictors of the high LTC expenditures. However, a significant interaction between institutional care and high care need level was found, providing evidence of the combined effect of the two covariates. CONCLUSIONS: Beyond to confirm that disability status of elderly persons is the main factor driving the demand of LTC services and consequently the expenditures, we showed that changes in utilization rate of benefits -a specific insurance factor- and the use of institutional care conditional on the high care level, were strongest predictors of the highest LTC expenditures. These findings could become crucial for tracking policies aimed at ensuring financial sustainability of LTCI from a public insurer perspective in Japan.