Aspectos éticos de la asistencia personal, una visión desde el Trabajo Social / Ethical Aspects of Personal Assistance, a View from Social Work

El propósito de este estudio es, desde la óptica del Trabajo Social, identificar los principales problemas éticos que se le presentan a las profesionales de la asistencia personal al desarrollar sus funciones de ayuda o apoyo a las personas con discapacidad, así como detectar si las profesionales consideran necesaria una mayor formación ética. Para ello, se optó por un procedimiento mixto mediante la aplicación de dos cuestionarios ad hoc. El primero, de preguntas abiertas, se dirigió a 31 profesionales en activo de la asistencia personal en España en la fase de recogida de información. El segundo, de preguntas cerradas o respuesta breve, se dirigió a 52 profesionales con experiencia previa en dicha figura profesional. Mediante el análisis de su discurso se corroboró la necesidad de afrontar diferentes conflictos y problemas éticos durante la prestación del servicio de asistencia personal en distintos ámbitos y situaciones. Podemos concluir que la formación ética de las profesionales es insuficiente para el desarrollo de sus funciones en condiciones de calidad y respecto a la dignidad y la autonomía personal de las personas usuarias. (AU)

The purpose of this study is, from the point of view of Social Work, to identify the main ethical problems that personal assistance professionals face when developing their functions of helping or supporting people with disabilities, as well as detecting whether professionals consider that greater ethical training is necessary. To do this, a mixed method was chosen through the application of two ad hoc questionnaires. The first, with open questions, was addressed to 31 active personal assistance professionals in Spain in the information collection phase. The second, with closed questions or short answers, was addressed to 52 professionals with previous experience in said professional figure. Through the analysis of their speech, the need to face different conflicts and ethical problems during the provision of the personal assistance service in different areas and situations was corroborated. We can conclude that the ethical training of professionals is insufficient for the development of their functions in quality conditions and with respect to the dignity and personal autonomy of the users. (AU)

A longitudinal and multidesign epidemiological study to analyze the effect of the volcanic eruption of Tajogaite volcano (La Palma, Canary Islands). The ASHES study protocol.

INTRODUCTION: Volcanic eruptions emit gases and particulate matter into the atmosphere which, if inhaled, can have an impact on health. The eruption of the volcano situated in the Cumbre Vieja Nature Reserve (La Palma, Canary Islands, Spain) affords a unique opportunity to study the effect of such a phenomenon on health. The aim of the proposed study is to assess the short-, medium- and long-term respiratory health effects of exposure to volcanic emissions from the eruption in three different population groups. METHODS: We propose to undertake a multidesign study: an ambispective cohort study to analyze the effect of the eruption on the general population, the highly exposed population, and the childhood population; and a pre-post quasi-experimental study on subjects with previously diagnosed respiratory diseases. The information will be collected using a personal interview, biologic specimens, air pollution data, data from medical records, respiratory tests and imaging tests. The study has an envisaged follow-up of five years, to run from the date of initial recruitment, with annual data-collection. This study has been approved by the Santa Cruz de Tenerife Provincial Research Ethics Committee (Canary Island Health Service) on March 10, 2022. CONCLUSIONS: This study will make it possible to advance our knowledge of the effect a volcano eruption has on population health, both short- and long-term, and to assess the potential respiratory injury attributable to volcanic eruptions. It may serve as a model for future studies of new volcanic eruptions in the coming years.

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

Objetivo: Estimar el coste hospitalario de una muestra de casos atendidos en siete hospitales del Sistema Nacional de Salud de diferentes ciudades españolas. Método: Estudio basado en 78 casos de enfermedad profesional reconocida por la Seguridad Social, atendidos en centros hospitalarios de Badalona, Barcelona, Ferrol, Gijón, Girona, Madrid y Vigo entre 2017 y 2019. Resultados: La actividad asistencial generada en estos hospitales para atender estos procesos supuso un coste total para el Sistema Nacional de Salud de 282.927 €. Conclusiones: Urge mejorar la coordinación entre los dos sistemas públicos de salud: la asistencia sanitaria de la Seguridad Social y el Sistema Nacional de Salud. (AU)

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. (AU)

Risk Factors of Mortality in Hospitalized Patients With COVID-19 Applying a Machine Learning Algorithm.

Introduction: Risk stratification of patients with COVID-19 can be fundamental to support clinical decision-making and optimize resources. The objective of our study is to identify among the routinely tested clinical and analytical parameters those that would allow us to determine patients with the highest risk of dying from COVID-19. Material and methods: We carried out a retrospective cohort multicentric study by consecutively, including hospitalized patients with COVID-19 admitted in any of the 11 hospitals in the healthcare network of HM Hospitals-Spain. We collected the clinical, demographic, analytical, and radiological data from the patient's medical records.To assess each of the biomarkers' predictive impact and measure the statistical significance of the variables involved in the analysis, we applied a random forest with a permutation method. We used the similarity measure induced by a previously classification model and adjusted the k-groups clustering algorithm based on the energy distance to stratify patients into a high and low-risk group. Finally, we adjusted two optimal classification trees to have a schematic representation of the cut-off points. Results: We included 1246 patients (average age of 65.36 years, 62% males). During the study one hundred sixty-eight patients (13%) died. High values of age, D-Dimer, White Blood Cell, Na, CRP, and creatinine represent the factors that identify high-risk patients who would die. Conclusions: Age seems to be the primary predictor of mortality in patients with SARS-CoV-2 infection, while the impact of acute phase reactants and blood cellularity is also highly relevant.

Introducción: La estratificación del riesgo de los pacientes con COVID-19 puede ser fundamental para apoyar la toma de decisiones clínicas y optimizar los recursos. El objetivo de nuestro estudio es identificar, entre los parámetros clínicos y analíticos probados de forma rutinaria, aquellos que nos permitirían determinar a los pacientes con mayor riesgo de morir por COVID-19. Material y métodos: Se realizó un estudio multicéntrico de cohorte retrospectiva de forma consecutiva, incluyendo pacientes hospitalizados con COVID-19 ingresados en cualquiera de los 11 hospitales de la red sanitaria de HM Hospitales-España.Los datos clínicos, demográficos, analíticos y radiológicos se recopilaron de las historias clínicas de los pacientes.Para evaluar el impacto predictivo de cada uno de los biomarcadores y medir la significación estadística de las variables involucradas en el análisis, se aplicó un bosque aleatorio con un método de permutación. Utilizamos la medida de similitud inducida por un modelo de clasificación previo, y ajustamos el algoritmo de agrupación de grupos k en función de la distancia de energía para estratificar a los pacientes en un grupo de alto y bajo riesgo. Finalmente, ajustamos 2 árboles de clasificación óptimos para tener una representación esquemática de los puntos de corte. Resultados: Se incluyeron 1.246 pacientes (edad promedio de 65,36 años, 62% varones). Durante el estudio murieron 168 pacientes (13%). Los factores que identifican a los pacientes de alto riesgo de mortalidad son los valores elevados de edad, dímero D, glóbulos blancos, Na, PCR y creatinina. Conclusiones: La edad parece ser el principal predictor de mortalidad en pacientes con infección por SARS-CoV-2, mientras que el impacto de los reactantes de fase aguda y la celularidad sanguínea también es muy relevante.

[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.

Psychometric properties of the Maslach Burnout Inventory - Human Services in Social Work professionals in Spain.

The burnout syndrome has traditionally been identified in the service sector professions, among which is Social Work. In order to determine this syndrome, different measuring instruments have emerged, including the Maslach Burnout Inventory. The main objective of this study was to evaluate the psychometric properties of this instrument and to find evidence of its validity (corroborating the original factorial structure and its convergent validity) and reliability (internal consistency). The Spanish adapted version of the Maslach Burnout Inventory was used. Four hundred social workers participated, randomly divided into two samples of 200 individuals (Sample 1: M = 43.06, SD = 9.04 and Sample 2: M = 40.89, SD = 8.78). We carried out principal components exploratory factor analysis with Varimax rotation. The results identified a factorial structure with four factors (Emotional Exhaustion, Depersonalization, Personal Realization, and Interpersonal Psychological Stress) (χ2 /df = 1.73, CFI = 0.929, NNFI = 0.859, SRMR = 0.069, RMSEA = 0.061), different from that of the original questionnaire, which indicated three dimensions. The data also show a high internal consistency (α = 0.882). The four factors were directly and moderately associated with each other (r between 0.328 and 0.534). In conclusion, this study provides new data of a valid and reliable tool for evaluating professional burnout or exhaustion.

Prevalencia del burnout en el Sistema de Servicios Sociales: estudio transversal en servicios sociales comunitarios / Prevalence of burnout in the Social Services System: cross-sectional study in community social services

Objetivo principal: evaluar la prevalencia del síndrome de burnout en las trabajadoras sociales que ejercen su actividad laboral en los servicios sociales comunitarios. Metodología: diseño de enfoque descriptivo y transversal, utilizando el cuestionario Maslach Burnout Inventory. Dicho cuestionario mide tres dimensiones relacionadas con el burnout: Agotamiento emocional, Despersonalización y Realización personal. La recogida de datos se realizó a través de una aplicación de encuestas, entre trabajadoras sociales colegiadas. Resultados: participaron 209 trabajadoras sociales, de las cuales el 92,8% son mujeres y un 7,2% hombres; sus edades están comprendidas entre los 23 y los 64 años. Los datos de prevalencia arrojan unos resultados elevados en los factores que componen el constructo de burnout, especialmente en la dimensión de Agotamiento Emocional. Conclusiones: el síndrome de burnout se encuentra presente en un porcentaje elevado de trabajadoras sociales del Sistema de Servicios Sociales. (AU)

Objective: to assess the prevalence of burnout syndrome in the professional group of social workers who perform their work in the community social services. Methods: a descriptive and cross-sectional design was proposed, using as the main instrument the Maslach Burnout Inventory. This inventory measures three dimensions related to burnout: Emotional Exhaustion, Depersonalization, and Personal Accomplishment. Data collection was carried out through a survey among the social workers registered. Results: 209 social workers participated in the study, of which 92.8% of the population under study are women and 7.2% are men; their ages ranging between 23 and 64 years. The study prevalence data yields high results in the factors that make up the burnout construct, especially in the Emotional Exhaustion dimension. Conclusions: burnout syndrome is present in a high percentage of social workers in the social services system. (AU)

Identificación y reconocimiento de enfermedades profesionales en siete hospitales públicos de España / Identification and recognition of occupational diseases in seven public hospitals in Spain

Antecedentes: La infra-notificación y reconocimiento de enfermedad profesional (EP) es un problema secular en España y demás países europeos. El proyecto de Carga de la Enfermedad Profesional en España (CEPS) pretende contribuir a resolver este problema. Objetivo: Describir el proceso de identificación y reconocimiento de EP en siete hospitales españoles entre 2017 y 2019. Material y Métodos: En los siete hospitales que participan en el estudio se creó una unidad de patología laboral (UPL) la cual estimulaba en los servicios asistenciales la identificación de posibles EP atendidas en el hospital. Los pacientes confirmados por la UPL fueron acompañados en el proceso de reconocimiento. Resultados: En este periodo fueron derivados 308 casos, y en 154 (62%) se confirmó la sospecha EP. De éstos, 78 (65%) han sido reconocidos. La tasa de confirmación (casos confirmados/ derivados) varió según hospitales (de un 25% en el Badalona Serveis Assistencials a un 100% en el Hospital Universitario Fundación Jiménez Díaz) y grupos de diagnósticos (de un 13% para trastornos musculoesqueléticos a un 100% para patologías varias). La tasa de reconocimiento (casos confirmados/casos reconocidos) varió según centro, diagnóstico, sexo y edad, siendo más alta en mujeres, con ≥ 55 años y diagnosticados con patologías varias (oculares, infecciosas, mentales, entre otras). Conclusión: Las UPL contribuyen significativamente en el proceso de identificación y reconocimiento de EP, lo que los pacientes posiblemente no hubieran obtenido de otra forma (AU)

Background: Under-reporting and recognition of occupational disease (OD) is a secular problem in Spain and other European countries. The burden of occupational disease in Spain project (CEPS) aims to contribute. Objective: To describe the process of identification and recognition of OD in seven Spanish between 2017 and 2020. Material and Methods: In the seven hospitals that participate in the study an occupational pathology unit (OPU) was created. The OPU encouraged the healthcare services to identify possible OD treated in the hospital. The patients confirmed by the OPU were accompanied in the recognition process. Results: 308 cases were referred in this period and 154 OD was confirmed (62%). Of these, 78 have been recognized (65%). The confirmation rate (confirmed/ referred cases) varied according to hospitals (from 25% at the Badalona Serveis Assistencials to 100% at the Hospital Universitario Fundación Jiménez Díaz) and diagnosis groups (from 13% for musculoskeletal disorders to 100% for various pathologies). The recognition rate (confirmed/ recognized cases) varied according to hospitals, diagnosis, sex and age, being higher in women, aged ≥ 55 years and diagnosed with various pathologies (ocular, infectious, mental, among others). Conclusion: OPU contribute significantly in the process of identification and recognition of OD, which the patients might not have obtained otherwise (AU)

Síndrome de burnout en el Sistema de Salud: el caso de las trabajadoras sociales sanitarias / Burnout syndrome in the Health System: the case of social health workers

OBJETIVO: El objetivo general de esta investigación es medir la prevalencia del síndrome de burnout en el colectivo profesional de trabajadoras sociales sanitarias que ejercen su actividad laboral en los diferentes servicios y centros del Servicio Público de Salud de Galicia (España). MÉTODO: Se ha planteado un diseño de enfoque cuantitativo-analítico y transversal, utilizando como instrumento principal el cuestionario Maslach Burnout Inventory, versión Human Services Suvey. Dicho cuestionario mide tres dimensiones relacionadas con el burnout: Agotamiento emocional, Despersonalización y Realización personal. La recogida de datos se realizó a través de una aplicación de encuestas entre las trabajadoras sociales colegiadas en el Colegio Oficial de Trabajo Social de Galicia. RESULTADOS: El 86,2% de la población objeto de estudio son mujeres y un 13,8% hombres, y sus edades están comprendidas entre los 23 y los 63 años. Los datos de prevalencia del estudio arrojan unos resultados elevados, especialmente en la dimensión de Agotamiento Emocional donde más de la mitad de la población objeto de estudio presenta una puntuación considerada alta. CONCLUSIÓN: Al igual que otros colectivos profesionales que ejercen su actividad laboral en el sistema de salud, como es el caso de Enfermería y Medicina, las trabajadoras sociales sanitarias presentan índices elevados de burnout, siendo el Agotamiento Emocional la dimensión más afectada

OBJECTIVE: The general goal of this research is to measure the prevalence of the burnout syndrome in the professional group of social health workers who perform their work in the diverse services and centers of the Public Health Service of Galicia (Spain). METHOD: A quantitative-analytical and cross-sectional design was proposed, using as the main instrument the Maslach Burnout Inventory, Human Services Survey version. This inventory measures three dimensions related to burnout: Emotional Exhaustion, Depersonalization, and Personal Fulfillment. Data collection was carried out through a survey among the social workers registered in the Official Association of Social Work of Galicia. RESULTS: 86.2% of the population under study are women and 13.8% are men; their ages range between 23 and 63 years. The study prevalence data yields high scores, especially in the Emotional Exhaustion dimension, where more than half of the population under study obtained a high score. CONCLUSION: Like other professional groups that perform their work in the health system, as is the case of Nursing and Medicine, social health workers present high rates of burnout, with Emotional Exhaustion being the most affected dimension

La asistencia personal como nuevo derecho de ciudadanía: una mirada desde el ámbito de los profesionales de la salud / Personal assistance as a new citizens' right: seen from the health professionals' sphere / Assistência pessoal como novo direito de cidadania: um olhar do campo dos profissionais de saúde

OBJETIVO: El objetivo principal de esta investigación es conocer la figura del asistente personal para personas con discapacidad. Asimismo, se pretende exponer la importancia de los cuidados y el acompañamiento profesionalizado frente a los cuidados familiares. MÉTODO: Abordaje de investigación mixto consistente en la revisión de bases de datos oficiales, así como la realización de entrevistas semiestructuradas a 11 profesionales de la enfermería pertenecientes al Servicio Público de Salud de Galicia (España). RESULTADOS: Los resultados apuntan a que la figura del asistente personal continúa sin ser mayoritaria en la prestación de servicios para personas con discapacidad. El personal de enfermería entrevistado considera que las funciones de asistencia personal deben enfocarse hacia una clara profesionalización por sus características específicas. CONCLUSIONES: Los resultados de este estudio, constituyen un marco propio para la reflexión sobre la intervención y acompañamiento en personas con discapacidad. Sin duda, es necesario el trabajo interdisciplinar dentro de un abordaje conjunto de profesionales con formación sanitaria y social

OBJECTIVE: The main objective of this research is to familiarize ourselves with the figure of the personal assistant for disabled people. It also seeks to reveal the importance of professionalized care and accompaniment compared with family care. METHODS: Joint research consisting of the review of official databases, as well as the performance of semi-structured interviews with 11 professional nurses belonging to the Public Health Service of Galicia (Spain). RESULTS: The results suggest that the figure of the personal assistant is still not predominant in the provision of services for people with disabilities. The interviewed nursing staff considered that the functions of personal assistance should be clearly professionalized due to their specific characteristics. CONCLUSIONS: The results of this study constitute a framework for reflection on intervention and support for people with disabilities. No doubt, interdisciplinary work is necessary within a joint approach of professionals with health and social training

OBJETIVO: O objetivo principal desta pesquisa é conhecer a figura do assistente pessoal para pessoas com deficiência. Da mesma forma, pretende-se expor a importância do cuidado e o acompanhamento profissionalizado versus cuidado familiar. MÉTODO: Abordagem de pesquisa mista composta pela revisão de bases de dados oficiais, bem como entrevistas semiestruturadas a 11 profissionais de enfermagem pertencentes ao Serviço de Saúde Pública da Galiza (Espanha). RESULTADOS: Os resultados sugerem que a figura do assistente pessoal continua sem ser uma maioria na prestação de serviços para pessoas com deficiência. A equipe de enfermagem entrevistada considera que as funções de assistência pessoal devem estar focadas em uma profissionalização clara devido às suas características específicas. CONCLUSÕES: Os resultados deste estudo constituem um marco adequado para a reflexão sobre a intervenção e acompanhamento de pessoas com deficiência. Sem dúvida, o trabalho interdisciplinar é necessário dentro de uma abordagem conjunta de profissionais com formação em saúde e social

Contenido pulmonar de amianto en trabajadores de los astilleros de Ferrol / Asbestos pulmonary content in workers of Ferrol shipyards, Spain

Fundamento y objetivo: Desde hace unos años se está llevando a cabo el estudio de los trabajadores expuestos a amianto en los astilleros de Ferrol con la finalidad de llegar al diagnóstico de las enfermedades derivadas de la exposición. El objetivo del presente estudio fue conocer el contenido pulmonar de amianto en esta población. Material y método Se obtuvieron muestras pulmonares necrópsicas correspondientes a individuos que habían trabajado en los astilleros de Ferrol. En la mayoría de los casos se analizaron muestras de los 2 pulmones. Tras eliminar la materia orgánica pulmonar con hipoclorito sódico, el residuo inorgánico fue analizado mediante microscopia óptica. Los resultados se expresaron como cuerpos de amianto (CA) por gramo de tejido seco. Se consideraron niveles causantes de enfermedad aquellos que superaron los 1.000 CA/g. Resultados Se estudiaron 30 pacientes varones, con una edad media de 67 años (extremos 56-89 años). Veintiséis sujetos eran fumadores o ex fumadores, mientras que 4 no habían fumado. Todos tenían una enfermedad pulmonar, pleural o peritoneal relacionada con la exposición a amianto (16 cáncer de pulmón, 6 mesotelioma, 25 enfermedad pleural benigna). Solo en 6 de los 16 casos de cáncer de pulmón existía asbestosis concomitante. La mediana (intervalo) de CA observados fue de 6.171 (249-4.660.059) CA/g. El 97% de individuos presentaron valores superiores a los 1.000 CA/g. Se encontró correlación entre los CA y la edad del sujeto (r=0,5676; p=0,0011).Conclusiones Los trabajadores de los astilleros de Ferrol analizados tienen valores pulmonares de amianto elevados. Se debe aumentar la sospecha clínica del amianto como factor potencialmente causante de enfermedad pulmonar en este colectivo (AU)

Background and objective: In the last years, a study is being conducted about exposure to asbestos among shipyards workers in order to know the diagnosis of the diseases associated with the exposure. Our goal was to know the asbestos pulmonary contents in this population. Material and methods: We obtained autopsy pulmonary samples from individuals who had worked in Ferrol shipyards. We analyzed samples from both lungs in most cases. After removing the lung organic matter with sodium hypochlorite, the inorganic residue was analyzed with optic microscopy. Results were expressed as asbestos bodies (AB) per gram of dry tissue. We considered as disease causative levels those above 1,000 AB/g. Results: We studied 30 males, with a mean age of 67 years (r: 56-89 years). Twenty-six were smokers or former smokers, and 4 had never smoked. All had a lung, pleural or peritoneal disease related to asbestos exposure (16 lung cancer, 6 mesothelioma, 25 benign pleural disease). Only in 6 out of the 16 lung cancercases there was coexisting asbestosis. The median (interval) of AB was 6,171 (249-4,660,059) AB/g. Ninety-seven per cent of individuals had levels above 1,000 AB/g. There was a correlation between A Band age (r = .5676; P = .0011).Conclusions: Workers from Ferrol shipyards who were analyzed had increased pulmonary levels of asbestos. It is essential to raise clinical suspicion of asbestos as a factor that can potentially cause lungdisease in this group (AU)

[Asbestos pulmonary content in workers of Ferrol shipyards, Spain]. / Contenido pulmonar de amianto en trabajadores de los astilleros de Ferrol.

BACKGROUND AND OBJECTIVE: In the last years, a study is being conducted about exposure to asbestos among shipyards workers in order to know the diagnosis of the diseases associated with the exposure. Our goal was to know the asbestos pulmonary contents in this population. MATERIAL AND METHODS: We obtained autopsy pulmonary samples from individuals who had worked in Ferrol shipyards. We analyzed samples from both lungs in most cases. After removing the lung organic matter with sodium hypochlorite, the inorganic residue was analyzed with optic microscopy. Results were expressed as asbestos bodies (AB) per gram of dry tissue. We considered as disease causative levels those above 1,000 AB/g. RESULTS: We studied 30 males, with a mean age of 67 years (r: 56-89 years). Twenty-six were smokers or former smokers, and 4 had never smoked. All had a lung, pleural or peritoneal disease related to asbestos exposure (16 lung cancer, 6 mesothelioma, 25 benign pleural disease). Only in 6 out of the 16 lung cancer cases there was coexisting asbestosis. The median (interval) of AB was 6,171 (249-4,660,059) AB/g. Ninety-seven per cent of individuals had levels above 1,000 AB/g. There was a correlation between AB and age (r=.5676; P=.0011). CONCLUSIONS: Workers from Ferrol shipyards who were analyzed had increased pulmonary levels of asbestos. It is essential to raise clinical suspicion of asbestos as a factor that can potentially cause lung disease in this group.