Validez convergente y discriminante del síndrome de quemarse por el trabajo en maestros mexicanos

Objetivo: explorar la validez convergente y discriminante del maslach burnout Inventory human services survey (MBI-HSS) y del Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo (CESQT) en población mexicana. Método: Se evaluaron 483 profesores de 100 escuelas de educación básica (primarias y secundarias) de la Ciudad de México. Se utilizó el CESQT validado en México por Gil-Monte, Unda y Sandoval (2009) y el MBI-HSS validado en población mexicana por Placencia et al. (2013), ambos son escalas likert que presentaron una confiabilidad aceptable. En el análisis de datos se realizó una matriz multirasgo-multimétodo (MRMM), que es un enfoque desarrollado por Campbell y Fiske (1959) para analizar la validez convergente y divergente. Resultados: En la MRMM se presentaron correlaciones significativas, positivas y diferentes a cero entre los mismos rasgos medidos por diferente método, Ilusión por el trabajo y realización personal (r=0,40**) desgaste psíquico y cansancio emocional (r=0,87**), e Indolencia y Despersonalización (r=0,52**) lo cual supone validez convergente, además, se pueden observar que todas las Alfas de Cronbach son aceptables salvo la de Despersonalización (subescala del MBI). El MBI-HSS presenta recurrentemente Alfas de Cronbach inferiores a 70 % en la subescala de despersonalización, en especial en población no angloparlante. Conclusión: Conforme a los resultados del presente estudio y las dificultades psicométricas presentadas por el MBI-HSS, se concluye que el CESQT es el instrumento recomendado para la evaluación del Burnout en población mexicana.

Objective: to explore the convergent and discriminant validity of the maslach burnout inventory human services survey (MBI-HSS) and the Spanish Burnout Inventory (SBI) in Mexican population. Method: 483 teachers from 100 basic education schools (primary and secondary) were evaluated in Mexico City. The mexican validated SBI by Gil-Monte, Unda and Sandoval (2009) and MBI-HSS validated in Mexican population by Placencia et al. (2013) were implemented, both are Likert scales that showed acceptable reliability. In the data analysis, a Multi-treat-Multi-method matrix (MTMM) was performed, which is an approach developed by Campbell and Fiske (1959) to analyze convergent and divergent validity. Results: MTMM showed significant positive and non-zero correlations between the same traits measured by different method, enthusiasm toward the job and personal accomplishment (r = 0,40 **) psychic exhaustion and emotional exhaustion (r = 0,87 **), and indolence and depersonalization (r = 0,52 **) which supposes convergent validity, in addition, it can be observed that all cronbach's alphas are acceptable except for depersonalization (subscale of MBI). The MBI-HSS recurrently presents cronbach's alphas lower than 0,70 on the depersonalization subscale, especially in non-English-speaking population. Conclusion: According to the results of this study and the psychometric difficulties presented by the MBI-HSS, the SBI is the recommended instrument for the evaluation of Burnout in the Mexican population.

Platelet VPS16B is dependent on VPS33B expression, as determined in two siblings with arthrogryposis, renal dysfunction, and cholestasis syndrome.

BACKGROUND: Platelet α-granule biogenesis in precursor megakaryocytes is critically dependent on VPS33B and VPS16B, as demonstrated by the platelet α-granule deficiency seen in the rare multisystem disorder arthrogryposis, renal dysfunction, and cholestasis (ARC) syndrome associated with biallelic pathogenic variants in VPS33B and VIPAS39 (encoding VPS16B). VPS33B and VPS16B are ubiquitously expressed proteins that are known to interact and play key roles in protein sorting and trafficking between subcellular locations. However, there remain significant gaps in our knowledge of the nature of these interactions in primary cells from patients with ARC syndrome. OBJECTIVES: To use primary cells from patients with ARC syndrome to better understand the interactions and roles of VPS33B and VPS16B in platelets and precursor megakaryocytes. PATIENTS/METHODS: The proband and his male sibling were clinically suspected to have ARC syndrome. Confirmatory genetic testing and platelet phenotyping, including electron microscopy and protein expression analysis, was performed with consent in a research setting. RESULTS: We describe the first case of ARC syndrome identified in Costa Rica, associated with a novel homozygous nonsense VPS33B variant that is linked with loss of expression of both VPS33B and VPS16B in platelets. CONCLUSION: These results indicate that stable expression of VPS16B in platelets, their precursor megakaryocytes, and other cells is dependent on VPS33B. We suggest that systematic evaluation of primary cells from patients with a range of VPS33B and VIPAS39 variants would help to elucidate the interactions and functions of these proteins.

Litiasis renal en niños / Renal lithiasis in children

Resumen Justificación y objetivo: La litiasis renal se debe a la precipitación de cristales por un desequilibrio en la orina entre sustancias promotoras y las sustancias inhibitorias. Es una patología con una prevalencia entre 2-10% en la población pediátrica, con una incidencia que ha aumentado en los últimos 25 años; razón por la cual este estudio pretende conocer la prevalencia, las manifestaciones clínicas y metabólicas de la litiasis renal en la población pediátrica del Hospital Nacional de Niños de Costa Rica. Métodos: Es un estudio retrospectivo, descriptivo y observacional, mediante la revisión de expedientes de pacientes menores a 18 años con el diagnóstico de litiasis renal, atendidos en el Hospital Nacional de Niños, en el periodo comprendido entre enero del año 2000 al 2018. Resultados: Se incluyeron un total de 106 pacientes. El 57,5% hombres, la edad promedio al diagnóstico de 6,6 ± 3,8 años; la frecuencia de casos se ha incrementado en 5,5 veces en los últimos 5 años. Factores de riesgo detectados: anormalidades del tracto urinario 22,6% y antecedentes familiares de litiasis 17,9%. El análisis metabólico mostró un gasto urinario bajo en el 74,3%, hiperfosfaturia en un 43,2%, hipomagnesuria 39,2% e hipercalciuria 37,8%. Etiologías determinadas: metabólica 54,7%, malformaciones de las vías urinarias 16% e idiopática en un 30,9%. La litotricia intracorpórea se aplicó en un 61,2%. La recidiva se observó en el 28,5% de los casos, se encontró relación entre la incidencia de recidiva con el tamaño del lito (p = 0,001) y el tratamiento quirúrgico. (p = 0,010). Conclusiones: Existe un aumento en la frecuencia de casos de litiasis pediátrica con una etiología multifactorial en el Hospital Nacional de Niños de Costa Rica.

Abstract Background and aim: Renal lithiasis is due to the precipitation of crystals due to an imbalance in the urine between promoter substances and inhibitory substances. It is a pathology with a prevalence between 2-10% in the pediatric population, with an incidence that is increasing in the last 25 years, because of that, this study pretend to know the prevalence, the clinical and metabolic, manifestation of the renal lithiasis in the pediatric population. Methods: It is a retrospective, descriptive and observational study, by reviewing records of patients under 18 years of age with a diagnosis of renal lithiasis, treated at the Hospital Nacional de Niños, in the period of 2000 to 2018. Results: A total of 106 patients were included, 57,5% men, the average age at diagnosis of 6,6+- 3,8 years, the frequency of cases has increased 5,5 times in the last 5 years. Risk factors detected: urinary trac abnormalities 22,6% and family history of nephrolithiasis 17,9%. The metabolic analysis showed a low urinary flow rate in 74,3%, hyperphosphaturia in 43,2%, hypomagnesuria 39,2% and hypercalciuria 37,8%. Etiologies determined: metabolic 54,7%, malformations of the urinary trac 16% and idiopathic in 30,9%. Intracorporeal lithotripsy was applied in 61,2%. Recurrence was observe in 28,5 % of cases, a relationship was found between the incidence of recurrence with the size of litho (p= 0.001) and surgical treatment (p= 0.01). Conclusions: There is a significant increase in the incidence of pediatric lithiasis cases with a multifactorial etiology.

Confirmatory factorial analysis of the Maslach Burnout Inventory - Human Services Survey in health professionals in emergency services.

OBJECTIVE: to confirm the factorial validity of the Maslach Burnout Inventory - Human Services Survey version in a sample of health professionals from the emergency services. METHOD: a quantitative, exploratory, descriptive and analytical study. Two hundred and eighty-two health professionals participated in the study. For data collection, a sociodemographic questionnaire and the Maslach Burnout Inventory were used. The psychometric sensitivity for the MBI-HSS items was estimated by measures of central tendency, variability and the distribution shape. Internal consistency was estimated using Cronbach's alpha coefficient and the adequacy of the sample was verified using the Kaiser-Meyer-Olkin (KMO) index. As indexes for assessing the quality of fit of the model, the chi-square ratio by the degrees of freedom (χ2/DoF), the comparative fit index (CFI), the goodness of fit index (GFI), the Tucker Lewis index (TLI) and the root mean square error of approximation (RMSEA) were considered. To test data fit, the maximum likelihood method was used. RESULTS: the three-factor structure of the Maslach Burnout Inventory was confirmed. Items 9, 12, 15 and 16 had a factorial weight below what was considered appropriate and were removed from the model. The second order hierarchical model with the aforementioned modifications presented an adequate adjustment to the data and can be considered the best and most parsimonious model tested according to the information theory indexes. The internal consistency of the instrument's factors was recalculated considering the exclusion of the items and the three factors were considered adequate. CONCLUSION: the results obtained show that the Maslach Burnout Inventory is a reliable and factorially valid instrument for measuring the burnout syndrome in emergency service professionals in Brazil.

Confirmatory factorial analysis of the Maslach Burnout Inventory - Human Services Survey in health professionals in emergency services / Análise fatorial confirmatória do Maslach Burnout Inventory - Human Services Survey em profissionais de saúde dos serviços de emergência / Análisis factorial confirmatorio del Maslach Burnout Inventory - Human Services Survey en profesionales de la salud de los servicios de emergencia

Objective: to confirm the factorial validity of the Maslach Burnout Inventory - Human Services Survey version in a sample of health professionals from the emergency services. Method: a quantitative, exploratory, descriptive and analytical study. Two hundred and eighty-two health professionals participated in the study. For data collection, a sociodemographic questionnaire and the Maslach Burnout Inventory were used. The psychometric sensitivity for the MBI-HSS items was estimated by measures of central tendency, variability and the distribution shape. Internal consistency was estimated using Cronbach's alpha coefficient and the adequacy of the sample was verified using the Kaiser-Meyer-Olkin (KMO) index. As indexes for assessing the quality of fit of the model, the chi-square ratio by the degrees of freedom (χ2/DoF), the comparative fit index (CFI), the goodness of fit index (GFI), the Tucker Lewis index (TLI) and the root mean square error of approximation (RMSEA) were considered. To test data fit, the maximum likelihood method was used. Results: the three-factor structure of the Maslach Burnout Inventory was confirmed. Items 9, 12, 15 and 16 had a factorial weight below what was considered appropriate and were removed from the model. The second order hierarchical model with the aforementioned modifications presented an adequate adjustment to the data and can be considered the best and most parsimonious model tested according to the information theory indexes. The internal consistency of the instrument's factors was recalculated considering the exclusion of the items and the three factors were considered adequate. Conclusion: the results obtained show that the Maslach Burnout Inventory is a reliable and factorially valid instrument for measuring the burnout syndrome in emergency service professionals in Brazil.

Objetivo: confirmar a validade fatorial do Maslach Bunout Inventory - versão Human Services Survey numa amostra de profissionais da saúde dos serviços de emergência. Método: estudo de abordagem quantitativa, exploratório, descritivo e analítico. Participaram do estudo 282 profissionais de saúde. Utilizou-se para a coleta de dados, um questionário sociodemográfico e o Maslach Burnout Inventory. A sensibilidade psicométrica dos itens do Maslach Bunout Inventory - versão Human Services Survey foi estimada pelas medidas de tendência central, variabilidade e forma da distribuição. A consistência interna foi estimada por meio do Coeficiente alfa de Cronbach e a adequação da amostra verificada por meio do índice de Kaiser-Meyer-Olkin (KMO). Como índices para a avaliação da qualidade de ajustamento do modelo foram considerados a razão de qui-quadrado pelos graus de liberdade (χ2 /gl), comparative fit index (CFI), goodness of fit index (GFI), índice de Tucker Lewis (TLI) e root mean square error of aproximation (RMSEA). Para testar o ajustamento dos dados utilizou-se o método de máxima verossimilhança. Resultados: confirmou-se a estrutura trifatorial do Maslach Burnout Inventory. Os itens 9, 12, 15 e 16 apresentaram peso fatorial abaixo do considerado adequado e foram removidos do modelo. O modelo hierárquico de segunda ordem, com as modificações mencionadas, apresentou ajustamento adequado aos dados e pôde ser considerado o melhor e mais parcimonioso modelo testado de acordo com os índices da teoria da informação. A consistência interna dos fatores do instrumento foi recalculada considerando-se a exclusão dos itens e foi considerada adequada nos três os fatores. Conclusão: os resultados obtidos mostram que o Maslach Burnout Inventory é um instrumento confiável e fatorialmente válido para medir a síndrome de o burnout em profissionais dos serviços de emergência no Brasil.

Objetivo: confirmar la validez factorial del Maslach Bunout Inventory - versión Human Services Survey en una muestra de profesionales de la salud de los servicios de emergencia. Método: estudio cuantitativo, exploratorio, descriptivo y analítico. Participaron en el estudio 282 profesionales de la salud. Para la recopilación de datos, se utilizó un cuestionario sociodemográfico y el Maslach Burnout Inventory . La sensibilidad psicométrica de los ítems del Maslach Bunout Inventory - versión Human Services Survey se estimó mediante medidas de tendencia central, variabilidad y forma de distribución. La consistencia interna se estimó usando el Coeficiente alfa de Cronbach y la adecuación de la muestra se verificó usando el índice de Kaiser-Meyer-Olkin (KMO). Como índices para evaluar la calidad de ajuste del modelo fueron considerados la razón chi-cuadrado para los grados de libertad (χ 2 /gl), comparative fit index (CFI), goodness of fit index (GFI), índice de Tucker Lewis (TLI) y root mean square error of aproximation (RMSEA). Para probar el ajuste de los datos, se utilizó el método de máxima verosimilitud. Resultados: se confirmó la estructura de tres factores del Maslach Burnout Inventory . Los ítems 9, 12, 15 y 16 presentaron un peso factorial por debajo de lo que se consideraba adecuado y se eliminaron del modelo. El modelo jerárquico de segundo orden, con las modificaciones antes mencionadas, presentó un ajuste adecuado a los datos y puede considerarse el mejor y más parsimonioso modelo probado de acuerdo con los índices de teoría de la información. La consistencia interna de los factores del instrumento se recalculó ponderando la exclusión de los ítems y se consideró adecuada en los tres factores. Conclusión: los resultados obtenidos muestran que el Maslach Burnout Inventory es un instrumento confiable y factorialmente válido para medir el síndrome de burnout en los profesionales de los servicios de emergencia en Brasil.

Seroprevalence of toxoplasmosis in pregnant women and its associated factors among hospital and community populations in Lambayeque, Peru.

INTRODUCTION: Toxoplasmosis is a zoonosis caused by Toxoplasma gondii. This study investigated the prevalence and factors associated with toxoplasmosis among pregnant women. METHODS: We followed an analytical observational study. From July 2016 to June 2017, 218 pregnant women were selected. The infection was detected through serological dosage of anti-T.gondii Immunoglobulin(Ig) M and IgG antibodies. RESULTS: The seroprevalence was 35.8%; the factors associated with infection were consumption of non-drinking water, residence in an urban area, and threatened abortion during the current pregnancy. CONCLUSIONS: The seroprevalence of toxoplasmosis among pregnant women is high. The risk factors are dependent on environmental determinants.

Epilepsia refractaria con convulsiones febriles plus en niños con mutaciones de la subunidad alfa de canales de sodio (SCN1A): un reporte de caso / Refractory epilepsy with febrile seizures in a child with sodium channel alpha subunit mutation (SCN1A): A case report

RESUMEN Se presenta caso de una niña de 10 años con cuadro de epilepsia mioclónica juvenil severa en la infancia, que a los 6 meses de edad debutó con crisis tónico-clónicas generalizadas (TCG) luego de la administración de una dosis de vacuna DPT, con posteriores crisis TCG, mioclónicas y múltiples episodios de estado epiléptico refractarios a fármacos antiepilépticos (FAE) de primera y segunda línea durante los primeros 5 años. Las crisis se asociaron a retraso global en el desarrollo luego del primer episodio. Durante la evolución se realizaron estudios que incluyen resonancia magnética cerebral que fue normal y tomografía por emisión de positrones (PET-CT) que evidenció alteraciones en el metabolismo en región temporal izquierda, además de estudios para inmunodeficiencias y trombofilias sin alteraciones. Los electroencefalogramas iniciales fueron normales, pero video electroencefalograma de 12 horas mostró actividad irritativa en la región central con diseminación bilateral. Los estudios genéticos identificaron una mutación en el marco de lectura de tipo "frameshift" del gen SCN1A mediante secuenciación de la región codificante. Luego de los primeros años de vida, la paciente presenta, atípicamente, remisión progresiva de las crisis con posterior desmonte de FAE y mejoría del neuro-desarrollo en el proceso interdisciplinario de rehabilitación.

SUMMARY We report the case of a 10-year-old female with a history of severe myoclonic epilepsy of infancy who presents with generalized tonic-clonic (GTC) seizures at 6 months of age after administration of a DPT vaccine, who then begins to present frequent and severe GTC seizures, myoclonic seizures and multiple refractory status epilepticus poorly controlled with first and second line anti-epileptic drugs (AEDs). This was accompanied by development delay. Studies performed on the patient included brain MRI which was normal, immunodeficiency and trombophilic studies which were normal and electroencephalographs: studies (EEG) that were at first mostly normal. The most significant findings were seen during a 12-hour video-EEG which reported epileptogenic activity in central region with bilateral dissemination and a PET-CT that showed metabolism alterations in the left temporal region. Due to this presentation a channelopathy was suspected and a coding region sequentiation study was performed which identified a frameshift mutation of the SCN1A gene confirming the diagnosis. Atipically, after 5 years the patient begins to present a favorable evolution with significant seizure remission even allowing the progressive weaning of AEDs and a remarkable stalemate of developmental delay after interdisciplinary rehabilitation process was started.

Seroprevalence of toxoplasmosis in pregnant women and its associated factors among hospital and community populations in Lambayeque, Peru

Abstract INTRODUCTION Toxoplasmosis is a zoonosis caused by Toxoplasma gondii. This study investigated the prevalence and factors associated with toxoplasmosis among pregnant women. METHODS We followed an analytical observational study. From July 2016 to June 2017, 218 pregnant women were selected. The infection was detected through serological dosage of anti-T.gondii Immunoglobulin(Ig) M and IgG antibodies. RESULTS The seroprevalence was 35.8%; the factors associated with infection were consumption of non-drinking water, residence in an urban area, and threatened abortion during the current pregnancy. CONCLUSIONS The seroprevalence of toxoplasmosis among pregnant women is high. The risk factors are dependent on environmental determinants.

Sobrevida en trasplante renal en el Hospital Nacional de Niños / Survival of kidney transplant at the National Children's Hospital

Resumen Objetivo: conocer la sobrevida del programa de trasplante renal en el Hospital Nacional de Niños, de enero 1978 a enero 2016. Métodos: estudio retrospectivo y descriptivo, en niños que recibieron un trasplante renal. Se recopiló la información de los expedientes clínicos. Se incluyeron pacientes menores de edad que tuvieran un injerto viable por al menos tres meses, pacientes con expediente pasivo completo y que brindaran el consentimiento informado. Resultados: se recopiló un total de 152 pacientes, y se incluyeron 143 en el estudio, ya que 9fueron excluidos. El 51 % (n= 73) fueron mujeres. Se realizó 167 trasplantes renales, el 63,5 % (n=105) fue de injertos provenientes de donante vivo relacionado. La sobrevida al primer año fue del 100 %, el 95 % a los 10 años y el 61% a los 20 años del trasplante. En cuanto a la sobrevida del injerto, se encontró una sobrevida al primer año del 95 %, del 76 % a los 3 años y del 73 % a los 5 años después del trasplante, con una incidencia de rechazo agudo del 28,7 %. Conclusión: el trasplante renal en niños es un procedimiento muy complejo donde la sobrevida depende de múltiples factores ambientales y adquiridos; sin embargo, sí es posible que centros pediátricos como el nuestro puedan llegar a alcanzar porcentajes de sobrevida acordes a los de centros de países desarrollados.

Abstract Objective: to know the survival of the renal transplant program at the National Children's Hospital, from January 1978 to January 2016. Methods: retrospective and descriptive study in children who received a kidney transplant. The information was compiled from the clinical files. We included children who had a viable graft for at least three months, patients with a complete passive file and who provided informed consent. Results: A total of 152 patients were collected, and 143 were included in the study, since 9 were excluded. 51% (n = 73) were women. A total of 167 kidney transplants were performed, 63.5% (n = 105) were grafts from a related living donor. Survival at the first year was 100%, 95% at 10 years and 61% at 20 years after transplantation. Regarding the survival of the graft, a survival rate of 95% was found in the first year, 76% at 3 years and 73% at 5 years after transplantation, with an incidence of acute rejection of 28.7%. Conclusions: Kidney transplantation in children is a very complex procedure where survival depends on multiple environmental factors and / or acquired, however it is possible that pediatric centers like ours can reach survival rates according to centers in developed countries.

Abordaje del niño con hipercalcemia: reporte de 3 casos / Approach to the child with hypercalcemia: report of 3 cases

La hipercalcemia en niños es un trastorno electrolítico raro. Su presentación clínica es variable, al igual que su etiología. En esta publicación se abordan los casos de tres niños con hipercalcemia. Primeramente, un neonato de 24 días con irritabilidad, pobre succión y nefrocalcinosis. El segundo caso es de un niño de 1 año de edad con estenosis pulmonar, falla para progresar, retraso en el desarrollo psicomotor, fascies de duende y nefrocalcinosis. Por último, se presenta una niña de 11 años, con cuadro de dolor abdominal, polidipsia, náuseas, vómitos, lesiones líticas en huesos largos y anemia. Las causas determinadas para cada caso fueron, respectivamente: acidosis tubular distal, síndrome de Williams y leucemia linfocítica aguda. Para el abordaje del niño con hipercalcemia se muestran dos esquemas de diagnóstico realizados con fundamento en los hallazgos clínicos, laboratorios y gabinete. La terapeútica en estos niños debe basarse en el aumento de la excreción renal de calcio (hidratación, diuréticos), reducción de la absorción a nivel intestinal(restricción nutricional de calcio y vitamina D, glucocorticoides), inhibición de la resorción ósea (bifosfonatos, glucocorticoides), redistribución del calcio y, sobre todo, la prontitud con la que se instaure una terapia eficaz, ya que esta tendrá un impacto a largo plazo sobre su salud y calidad de vida...

Estudio de prevalencia del Síndrome de Quemarse por el Trabajo (SQT) y su asociación con sobrecarga y autoeficacia en maestros de primaria de la ciudad de México / Study on the prevalence of the Burnout Syndrome (BS) and its association with overload and self efficiency in elementary school teachers of Mexico city

El objetivo de este estudio fue identificar la prevalencia del Síndromede Quemarse por el Trabajo (SQT en adelante) en una muestra de 698 maestros mexicanos. Y su asociación con variables de Sobrecarga y Autoeficacia laboral. Se utilizó el Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo para Profesionales de la Educación (CESQT-PE). La prevalencia se analizó siguiendo el procedimiento de los puntos de referencia de la escala de frecuencia de respuesta. Se encontró que el 3 por ciento de los participantes presentaba baja Ilusión por el trabajo, 37.4 por ciento puntuaciones altas en Desgaste psíquico, 4.70 por ciento altos niveles de Indolencia, y, para Culpa 9.70 por ciento. Los hombres presentaron niveles más bajos en Ilusión por el trabajo y Desgaste psíquico que las mujeres. Considerando la edad, los niveles más elevados del SQT se dieron entre los 41 y 50 años. En cuanto a la asociación con Sobrecarga se encontró una correlación negativa con Ilusión por el trabajo (-0.15); y, con Desgaste psíquico, (0.56), Indolencia (0.36) y Culpa (0.29) una correlación positiva. En cuanto a la variable de Autoeficacia, una correlación positiva con Ilusión por el trabajo (0.25) y negativa con Desgaste psíquico (-0.25), Indolencia(-0.24) y Culpa (-0.19). Se concluye sobre la necesidad de intervenir para prevenir el deterioro de la salud de los docentes.

The aim of this study was to identify the prevalence of the burnout syndrome in a sample of 698 Mexican teachers and its association with labor overload and self-efficiency. The questionnaire for theevaluation of the burnout syndrome for education professionals was used. The prevalence was analyzed by the procedure of reference points of the response scale. It was found that a 3 percent of the participants showed low enthusiasm at work; a 37.40 percent scored high in psychological exhaustion; 4.70 percent high levels of indolence, and a 9.70 percent for guilt. Men displayed lower levels of enthusiasm at work and lower psychological exhaustion than women. Regarding age, the highest levels of burnout occurred between the ages of 41 and 50 years. With regard to association with overload, a negative correlation with enthusiasm (- 0.15) was found and a positive one with psychological exhaustion, (0.56), indolence (0.36) and guilt (0.29). With regard to the self-efficiency variable, a positive correlation with enthusiasm (0.25) and a negative one with psychological exhaustion (-0.25), indolence (-0.24) and guilt (-0.19) were found. It was concluded on the need to take action to prevent impairment of teachers’ health.

Validez factorial del <> (CESQT) en una muestra de maestros mexicanos / Factorial validity of the <> (CESQT) in a sample of Mexican teachers

Since the term burnout began to be used in the mid 1970's to refer to the process of deterioration in the care and professional attention given to users of human service organizations (public service, volunteer, medical, human social service, educational organizations, etc.), a variety of instruments have been developed to measure this phenomenon. A review of the literature makes it possible to conclude that among these measurement instruments the Maslach Burnout Inventory (MBI) has been used with the greatest frequency to measure the burnout syndrome, regardless of the occupational characteristics of the sample or the source of the burnout. While the most commonly employed burnout measure has been the MBI, researchers have been troubled by some of the psychometric limitations of this scale: a number of authors have suggested that a three-factor structure might not be appropriate; some items are not associated with their factors; Cronbach's alpha values are low for the Depersonalization subscale; different versions of the instrument evaluate the same phenomenon, etc. Other instruments used to evaluate burnout (for example Burnout Measure) do not satisfactorily operationalize the definition of the syndrome. The deficiencies in the instruments used for evaluating burnout have led to the development of the <> (CESQT) (Spanish Burnout Inventory). The theoretical model underlying the CESQT is based on the concept that burnout is a response to chronic job stress that stems from problematic interpersonal work relationships, and it develops in those individuals who work with people, quite frequently in service sector professionals who are in direct contact with the end-users. It is characterized by cognitive deterioration (loss of enthusiasm toward the job), emotional deterioration, and attitudes and behaviours of indifference, indolence, withdrawal and sometimes, abusive attitudes toward the client. In some cases, feelings of guilt appear. The psychometric model of the CESQT contains twenty items distributed in four dimensions such as: 1. enthusiasm toward the job (five items), defined as the individual's desire to achieve goals at work because it is a source of personal pleasure; 2. psychological exhaustion (four items), defined as the appearance of emotional and physical exhaustion due to the fact that at work s/he must deal daily with people who present or cause problems; 3. indolence (six items), defined as the appearance of negative attitudes of indifference and cynicism toward the organization's clients; 4. guilt (five items), defined as the appearance of feelings of guilt for negative attitudes developed on the job, especially toward the people with whom s/he establishes work relationships. The purpose of this study is the validation of the CESQT in Mexican primary education teachers. A four factor model, like that of the original model presented, was hypothesized. Materials and method The sample consisted of 698 primary education public school teachers in the area of Iztapalapa of the Federal District (Iztapalapa, Mexico). With regard to gender, 133 (19.10%) were men and 541 (77.50%) women. In the remaining 24 questionnaires (3.40%) gender was not identified. The mean age was 42.49 years. The <> was applied, using the version for professionals working in education (CESQT-PE). This instrument contains 20 items distributed into four dimensions called: enthusiasm toward the job (5 items) (α=.76), psychological exhaustion (4 items) (α=.82), indolence (6 items) (α=.73), and guilt (5 items) (α=.79). Low scores on Enthusiasm toward the job, together with high scores on psychological exhaustion and indolence, as well as on guilt, indicate high levels of burnout. The questionnaire was applied in 51 schools. Results The <> was high for all the items, with values superior to .40. All of the items contributed to increasing the internal consistency of the subscales they were part of. All of the subscales presented Cronbach's alpha values superior to .70. The factorial model obtained an adequate data fit for the sample: Chi²(164) = 481.01 (p<.001), AGFI = .91, RMSEA=.055, NNFI = .91, CFI = .92, and ECVI(.60-6.16) = .86. The results confirmed the hypothesis formulated. All of the factorial loadings were significant with high values, superior to .50. All of the relationships between the dimensions of the CESQT were significant for p< .001. The subscales of the CESQT presented values of skewness and kurtosis within the range of normality, with the exception of Enthusiasm toward the job, which presented asymmetry values outside the range ± 1, although the values were not extreme (S = -1 .71, K=3.96). Discusión The purpose of the study was to analyze the psychometric quality of the CESQT and its subscales in Mexican teachers, in order to evaluate the transnational validity of the instrument. The <> values obtained for the items are relatively high, which indicates that each of the dimensions of the CESQT-PE can be considered as a lineal function of the items that make it up. Therefore, all of the items make it possible to adequately predict the score of the scale and distinguish between individuals with high vs. low scores in the respective subscales. The results confirmed the hypothesized factorial structure. The four-factor structure fit the model according to all the fit indices considered, except the Chi-square test, which is an index that depends on sample size and finds a poor model fit with large samples. Based on the results obtained, it can be concluded that the factorial model adequately reproduces the theoretical model of the CESQT. The final scale is made up of four dimensions that evaluate the cognitive impairment (lack of enthusiasm about the job), emotional and physical deterioration (Psychological exhaustion), and attitudinal deterioration (Indolence), of the individual, together with the appearance of guilt feelings. These results confirm the results obtained in Spain, Chile and Portugal, and in Mexico with a sample of doctors. The Cronbach's alpha values obtained indicate that the internal consistency is good for the four subscales, and for the entire CESQT-PE scale. The skewness and kurtosis values were also good for the subscales, as values inferior to ±1 were obtained, except for the Enthusiasm toward the job subscale. The values obtained for the percentiles recommend using the 90th percentile instead of the 66th to draw conclusions about the individuals with high levels of burnout. The results of the study contribute to the psychometric validation of the theoretical model with four dimensions originating from the questionnaire, and to the transnational validation of the instrument. These results also make it possible to conclude that the CESQT, in its version for education professionals (CESQT-PE), is a reliable and valid instrument for evaluating burnout in Mexico. A slight deficiency of the instrument in this study has to do with the skweness value obtained for the Enthusiasm toward the job subscale, although further studies are necessary before conclusions can be drawn about possible modifications.

El <> (burnout) (en adelante SQT) ha sido definido como una respuesta al estrés laboral crónico al que están sometidos los profesionales de servicio que trabajan en contacto directo con humanos. En las investigaciones realizadas sobre el SQT, el instrumento para la medición que más se ha utilizado es el Maslach Burnout Inventory (MBI). Pero, este instrumento presenta insuficiencias psicométricas, y otros instrumentos de evaluación del SQT no operacionalizan de manera adecuada la definición del síndrome. Las insuficiencias en los instrumentos utilizados en la actualidad para la evaluación del SQT han llevado al desarrollo del <> (CESQT). El CESQT está formado por cuatro dimensiones denominadas: 1. Ilusión por el trabajo, definida como el deseo del individuo de alcanzar las metas laborales porque supone una fuente de placer personal. 2. Desgaste psíquico, definida como la aparición de agotamiento emocional y físico debido a que en el trabajo se tiene que tratar a diario con personas que presentan o causan problemas. 3. Indolencia, definida como la aparición de actitudes negativas de indiferencia y cinismo hacia los clientes de la organización. 4. Culpa, definida como la aparición de sentimientos de culpa por el comportamiento y las actitudes negativas desarrolladas en el trabajo, en especial hacia las personas con la que se establecen relaciones laborales. El objetivo de este estudio es la validación del CESQT en maestros mexicanos de educación básica. Se hipotetizó un modelo de cuatro factores como el del modelo original. Material y método La muestra la formaron 698 profesores de educación primaria de escuelas públicas. Según el género, 133 participantes fueron hombres (19.10%) y 541 mujeres (77.50%). En 24 cuestionarios (3.40%) no se respondió a la pregunta sobre el género. Asimismo, se aplicó el <>, en su versión para profesionales que trabajan en la educación (CESQT-PE). Es importante señalar que bajas puntuaciones en ilusión por el trabajo (cinco reactivos, (α=.76), junto a altas puntuaciones en desgaste psíquico (cuatro reactivos, (α=.82), indolencia (seis reactivos, α=.73) y en Culpa (cinco reactivos, α=.79) indican altos niveles del SQT. El cuestionario se aplicó en 51 escuelas. Resultados Para todos los reactivos la homogeneidad corregida fue alta, con valores superiores a .40. El modelo factorial obtuvo un ajuste adecuado a los datos para la muestra: Chi²(164) = 481.01 (p<.001), AGFI = .91, RMSEA=.055, NNFI = .91, CFI = .92 y ECVI(.60-6.16) = .86. Los resultados confirmaron la hipótesis formulada. Todas las cargas factoriales resultaron significativas con valores altos, superiores a .50. Discusión Los valores de homogeneidad corregida obtenidos para los reactivos son relativamente altos, lo que indica que cada una de las dimensiones del CESQT-PE se puede considerar como una función lineal de los reactivos que la componen. Los resultados han confirmado la estructura factorial hipotetizada. La estructura de cuatro factores ha alcanzado el ajuste del modelo a través de diversos índices de ajuste considerados. Todas las dimensiones presentan valores adecuados de consistencia interna. Los valores de asimetría también han sido buenos para las subescalas, excepto para la subescala de Ilusión por el trabajo que ha excedido ligeramente el criterio de ±1. Los resultados del estudio contribuyen a la validación psicométrica del modelo teórico de cuatro dimensiones origen del cuestionario, y a la validación transnacional del instrumento, y permiten concluir que el CESQT, en su versión para profesionales de la educación (CESQT-PE), resulta un instrumento fiable y válido para evaluar el SQT en México.

Manejo del niño febril / Handling of the febrile children

Introducción: La fiebre en el niño es uno de los principales motivos de consulta en pediatría. En ocasiones, el temor de los padres produce la conocida fobia febril, que conlleva al uso de los servicios de emergencias hospitalarios y a tratamientos inadecuados. Objetivo: Conocer la percepción, el conocimiento y el manejo que dan a la fiebre los padres o encargados de familia, de aquellos niños hospitalizados en el servicio de Infectología del Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera" de Costa Rica. Materiales y métodos: Se realizó un estudio prospectivo descriptivo, donde se entrevistan a los padres o encargados de los niños hospitalizados en el Servicio de SI-HNN, entre enero y abril de 2001. A los padres ó encargados que cumplían con los criterios de inclusión y exclusión, se les explicó el propósito del estudio y la dinámica del cuestinario. Resultados. Se recolectaron un total de 100 cuestinarios, donde se documentó que el 61 por ciento de los entrevistados consideran necesario el termómetro para hacer el diagnóstico de fiebre, el 43 por ciento define como fiebre toda temperatura > o igual 38 C. La complicación más temida en el 75 por ciento de los consultados es la convulsión. El 71 por ciento cuenta con algún tipo de tratamiento, en su hogar, para el manejo de la fiebre. Conclusión: Este estudio demuestra que muchos de los entrevistados no disponen de conocimiento adecuado acerca de la fiebre, sus implicaciones y manejo, lo que hace necesario promover información basada en la evidencia, que ayude a los padres, para que sepan cómo actuar correctamente ante la presencia de este importante y común síntoma. Descriptores: fiebre, padres, Costa Rica.