Evolución del síndrome de desgaste profesional, ansiedad y depresión en personal sanitario durante la pandemia de la COVID-19 / Evolution of burnout syndrome, anxiety and depression in healthcare personnel during the COVID-19 pandemic

Introducción. La pandemia de la COVID-19 ha producido un impacto en la esfera psicológica de los trabajadores sanitarios. El objetivo de este estudio es analizar la evolución del síndrome de desgaste profesional, la ansiedad y la depresión en el personal sanitario a lo largo de la pandemia de la COVID-19. Material y métodos. Estudio observacional de los profesionales sanitarios del Servicio de Neumología del Hospital Gregorio Marañón que ha prestado servicio entre diciembre de 2019 y enero de 2021. Se evaluó el síndrome de desgaste profesional mediante el cuestionario Maslach Burnout Inventory (MBI) y la ansiedad y depresión mediante los cuestionarios de Zung referido a diciembre de 2019 (situación basal), marzo de 2020 (primera ola) y enero de 2021 (tercera ola) en diferentes profesiones sanitarias. Resultados. Se incluyeron 62 participantes, de los cuales 15 (24,2%) eran varones. En cuanto a las profesiones sanitarias, 24 (38,7%) eran médicos, 22 eran diplomados universitarios de enfermería (DUE), 12 (19,4%) eran técnicos en cuidados auxiliares de enfermería (TCAE), y 4 (6,5%) eran otros profesionales. Se documentó un cambio significativo al alza del estrés emocional y de despersonalización y a la baja de realización personal tanto de forma global como estratificado por diferentes profesiones sanitarias excepto en otros profesionales. Se objetivó un aumento progresivo de la ansiedad, mientras que el aumento de la depresión no fue estadísticamente significativo. Conclusión. Durante la pandemia de la COVID-19, los profesionales sanitarios sufrieron un aumento progresivo del desgaste profesional y de la ansiedad. Es importante tener en cuenta la salud psicológica de los sanitarios (AU)

Introduction. The COVID-19 pandemic has impacted the psychological sphere of healthcare workers. The objective of this study is to analyze the evolution of burnout syndrome, anxiety and depression in healthcare personnel throughout the COVID-19 pandemic Material and methods. Observational study of the healthcare professionals of the Respiratory Department of Gregorio Marañón Hospital that worked between December 2019 and January 2021. Burnout syndrome was evaluated using the Maslach Burnout Inventory (MBI) questionnaire and anxiety and depression using the Zung questionnaires referred to December 2019 (baseline situation), March 2020 (first wave) and January 2021 (third wave) in different healthcare professions. Results. Sixty-two participants were included, of which 15 (24.2%) were male. Regarding the healthcare professions, 24 (38.7%) were doctors, 22 were nurses, 12 (19.4%) were technicians in auxiliary nursing care, and 4 (6, 5%) were other professionals. A significant upward change in emotional stress and depersonalization and a downward personal fulfillment were documented both globally and stratified by different healthcare professions except in other professionals. A progressive increase in anxiety was observed, meanwhile, the increase in depression was not statistically significant. Conclusion. During the COVID-19 pandemic, healthcare professionals suffered a progressive increase in burnout and anxiety. It is important to consider the psychological health of the healthcare personnel (AU)

[Proinflammatory state in obese children]. / Estado proinflamatorio en niños obesos.

INTRODUCTION: Obesity is a chronic disease that affects adults as well as children and is associated with insulin resistance, type 2 diabetes and cardiovascular disease. One of the reasons for the presence of low-grade inflammation in these patients could be that adipose tissue of the obese produces proin flammatory molecules that favor the development of atherosclerosis. OBJECTIVE: To determine serum levels of soluble CD40 ligand (sCD40L), monocyte chemoattractant protein 1 (MCP-1), interleukin 6 (IL-6), Tumor Necrosis Factor alpha (TNF-α) and high sensitivity CRP (hsCRP), in an obese chil dren population compared to a control group, also to analyze the correlation of these molecules with the anthropometric and metabolic variables. PATIENTS AND METHOD: A cross-sectional, observational study was carried out on 37 obese children, aged 8 to 12 years, and 20 children with normal weight. Serum levels of sCD40L, MCP-1, IL-6, TNF-α and hsCRP were determined. Data were expressed as the median and interquartil range and Spearman coefficient was used to investigate correlations between variables. RESULTS: Compared to the control group, obese children presented significantly higher values of sCD40L, MCP-1, IL-6, TNF-α, and hsCRP than control group. Body mass index and waist circumference correlated positively with sCD40L and MCP-1. CONCLUSION: Elevated levels of the studied molecules studied suggest the presence of low-grade inflammation associated with obesity in this population.

Estado proinflamatorio en niños obesos / Proinflammatory state in obese children

INTRODUCCIÓN: La presencia de un estado de inflamación de bajo grado en niños obesos, se debería, entre otros factores, a que el tejido adiposo de los obesos produce moléculas proinflamatorias que contribuyen al desarrollo de aterosclerosis. OBJETIVO: Determinar en una población de niños obesos los niveles séricos de ligando CD-40 soluble (sCD40L), proteína quimioatractante de monocitos 1 (MCP-1), interleuquina 6 (IL-6), Factor de Necrosis tumoral a (TNF-a) y Proteína C Reactiva ultrasensible (PCR-us), comparados con un grupo control y analizar la correlación de estas moléculas con las variables antropométricas y metabólicas. PACIENTES Y MÉTODO: Estudio transversal de 37 niños obesos de 8 a 12 años y 20 niños con peso normal. A todos los pacientes se les realizó una historia clínica consignando edad, peso, talla, IMC, circunferencia de cintura, estadios de Tanner y antecedentes familiares. Se determinaron los niveles séricos de sCD40L, MCP-1, IL-6, TNF-a y PCR-us mediante ELISA, PCR-us por quimioluminiscencia, glucemia, insulina plasmática, perfil lipídico y se calculó el índice HOMA. Los datos se expresaron como la mediana y rango intercuartil y se utilizó el coeficiente de Spearman para investigar las correlaciones entre variables. RESULTADOS: Los niños obesos presentaron valores significativamente mayores de sCD40L, MCP-1, IL-6, TNF-a, PCR-us que los niños controles. El índice de masa corporal y la circunferencia de cintura se correlacionaron positivamente con sCD40L y MCP-1. CONCLUSIÓN: Los niveles elevados de las moléculas estudiadas sugieren la presencia de inflamación de bajo grado asociada a obesidad en esta población.

INTRODUCTION: Obesity is a chronic disease that affects adults as well as children and is associated with insulin resistance, type 2 diabetes and cardiovascular disease. One of the reasons for the presence of low-grade inflammation in these patients could be that adipose tissue of the obese produces proin flammatory molecules that favor the development of atherosclerosis. OBJECTIVE: To determine serum levels of soluble CD40 ligand (sCD40L), monocyte chemoattractant protein 1 (MCP-1), interleukin 6 (IL-6), Tumor Necrosis Factor alpha (TNF-Α) and high sensitivity CRP (hsCRP), in an obese chil dren population compared to a control group, also to analyze the correlation of these molecules with the anthropometric and metabolic variables. PATIENTS AND METHOD: A cross-sectional, observational study was carried out on 37 obese children, aged 8 to 12 years, and 20 children with normal weight. Serum levels of sCD40L, MCP-1, IL-6, TNF-Α and hsCRP were determined. Data were expressed as the median and interquartil range and Spearman coefficient was used to investigate correlations between variables. RESULTS: Compared to the control group, obese children presented significantly higher values of sCD40L, MCP-1, IL-6, TNF-Α, and hsCRP than control group. Body mass index and waist circumference correlated positively with sCD40L and MCP-1. CONCLUSION: Elevated levels of the studied molecules studied suggest the presence of low-grade inflammation associated with obesity in this population.

Factores de riesgo cardiovascular en niños con diabetes tipo 1 y su relación con el control de la glucemia / Cardiovascular risk factors in children with type 1 diabetes and their relationship with the glycemic control

Diabetics have an increased risk of cardiovascular disease (CVD). The objective of this work was to evaluate the cardiovascular risk factors in infant-juvenile type 1 diabetics and their association with the degree of glycemic control. A total of 52 patients, aged 5-15 years, were studied and compared with 37 control subjects. The degree of glycemic control, lipid profile, plasma fibrinogen, microalbuminuria and blood pressure were investigated. The patients were grouped in diabetics with good glycemic control [DGGC, glycosilated hemoglobin (HbA1c) < 8%] and poor glycemic control [DPGC, HA1c > or = 8%]. Diabetic patients presented incremented values of total cholesterol (4.1 +/- 0.9 vs. 3.1 +/- 0.7 mmol/l, p = 0.0008), LDL-cholesterol (2.4 +/- 0.9 vs. 1.7 +/- 0.7 mmol/l, p = 0.0001), HDL-cholesterol (1.2 +/- 0.3 vs. 1.0 +/- 0.2 mmol/l, p = 0.0002), with respect to control group. Eighty three per cent of diabetics showed a poor glycemic control. There were not significant differences in lipid profile between DGGC and DPGC, excepting HDL-cholesterol which was higher in DPGC group (p = 0.007). Plasma fibrinogen levels were similar in diabetics and controls, but they were higher in DPGC than in DGGC (265 +/- 46 vs. 229 +/- 22 mg/dl, p = 0.02). Three patients with microalbuminuria and none with hypertension were detected. In these patients the most pronounced risk factors for CVD were dyslipidemia and hyperglycemia, which justify the need for the early detection of these factors as well as strict metabolic control.

Factores de riesgo cardiovascular en niños con diabetes tipo 1 y su relación con el control de la glucemia / Cardiovascular risk factors in children with type 1 diabetes and their relationship with the glycemic control

Diabetics have an increased risk of cardiovascular disease (CVD). The objective of this work was to evaluate the cardiovascular risk factors in infant-juvenile type 1 diabetics and their association with the degree of glycemic control. A total of 52 patients, aged 5-15 years, were studied and compared with 37 control subjects. The degree of glycemic control, lipid profile, plasma fibrinogen, microalbuminuria and blood pressure were investigated. The patients were grouped in diabetics with good glycemic control [DGGC, glycosilated hemoglobin (HbA1c) < 8%] and poor glycemic control [DPGC, HA1c > or = 8%]. Diabetic patients presented incremented values of total cholesterol (4.1 +/- 0.9 vs. 3.1 +/- 0.7 mmol/l, p = 0.0008), LDL-cholesterol (2.4 +/- 0.9 vs. 1.7 +/- 0.7 mmol/l, p = 0.0001), HDL-cholesterol (1.2 +/- 0.3 vs. 1.0 +/- 0.2 mmol/l, p = 0.0002), with respect to control group. Eighty three per cent of diabetics showed a poor glycemic control. There were not significant differences in lipid profile between DGGC and DPGC, excepting HDL-cholesterol which was higher in DPGC group (p = 0.007). Plasma fibrinogen levels were similar in diabetics and controls, but they were higher in DPGC than in DGGC (265 +/- 46 vs. 229 +/- 22 mg/dl, p = 0.02). Three patients with microalbuminuria and none with hypertension were detected. In these patients the most pronounced risk factors for CVD were dyslipidemia and hyperglycemia, which justify the need for the early detection of these factors as well as strict metabolic control.(AU)

[Factors related to treatment adherence in schizophrenic patients]. / Factores relacionados con la adherencia al tratamiento en pacientes esquizofrénicos.

BACKGROUND: The percentage of lack of adherence in schizophrenia is estimated in 50%. Non-compliance cause higher rates of relapses, rehospitalizations, suicide, homicide and violent behaviour among schizophrenic patients. The aim of this study was to find several factors related to adherence in schizophrenia. MATERIAL AND METHODS: 40 schizophrenic patients were assessed with a protocol which examined sociodemographic, clinical and therapeutical variables, scales in order to evaluate insight (Birchwood), drug attitude (Drug Attitude Inventory), psychopathology (BPRS) and side effects (UKU). Variables of outcome and overall functioning (GAS) in the previous year were also included. RESULTS: Multiple regression analysis revealed that BPRS thought disorder subscale and UKU neurologic side effects subscale predicted 24% of the variance of adherence. Adherence is related to insight and attitude to medication too. An adequate adherence was related to better overall functioning, less psychopathology and fewer hospitalizations during the year prior to the study.