[Self-perception of smoking cessation skills among Cardiology residents in Argentina]. / Autopercepción de las habilidades para la cesación del tabaquismo entre los residentes de cardiología en Argentina.

Objective: To evaluate the self-perception of cardiology residents in Argentina regarding their abilities to help their patients stop smoking, as well as their opinions about their knowledge and skills in this area. Materials and methods: A cross-sectional study was carried out using secondary data from a study carried out in five Latin American countries and Spain, focusing on the information provided by cardiology residents in Argentina. Discrete variables were expressed as median and interquartile range, and categorical variables were expressed as percentages, and were analyzed using the chi-square test or Fisher's exact test, depending on the relative frequency of the expected values. Results: 447 residents participated; 87.5% routinely provided brief advice to quit smoking, and 11.6% used validated questionnaires to assess the degree of addiction. Furthermore, 32.1% stated that they prescribed pharmacological treatment, but 53.1% were only familiar with a single drug. When asked about their self-perception of getting their patients to stop smoking, the median response was 5 (scale from 1 to 10); only 13.7% responded with a score of 8 or more. Conclusions: The present study suggests that cardiology residents in Argentina recognize the importance of carrying out smoking cessation interventions, but a high proportion of them do not feel qualified to do so.

Comparación de la violencia y agresiones sufridas por el personal de salud durante la pandemia de COVID-19 en Argentina y el resto de Latinoamérica / Comparison of violence and aggressions suffered by health personnel during the COVID-19 pandemic in Argentina and the rest of Latin America

RESUMEN Objetivos. Explorar la frecuencia e impacto de la violencia contra los trabajadores de salud de Argentina y compararlo con el resto de sus pares de Latinoamérica en el contexto de la pandemia por COVID-19. Materiales y métodos. Estudio de corte transversal a través de una encuesta electrónica al personal médico y no médico de Latinoamérica que desempeño tareas asistenciales desde marzo de 2020. Se utilizó una regresión de Poisson para estimar las Razones de Prevalencia crudas (RP) y ajustadas (RPa) con sus respectivos intervalos de confianza al 95%. Resultados. Un total de 3544 participantes de 19 países respondieron la encuesta; 1992 (56,0%) residían en Argentina. Entre los mismos, el 62,9% padeció al menos un hecho de violencia: 97,7% refirió violencia verbal y 11,8% violencia física. El 41,5% de los agredidos padecieron situaciones de violencia al menos una vez por semana. El personal de salud de Argentina vivenció más frecuentemente violencia que los de otros países (62,9% vs. 54,6%, p<0,001), siendo estos eventos más habituales y estresantes (p<0,05). Además, refirieron más frecuentemente haber considerado cambiar sus tareas asistenciales y/o deseos de abandonar su profesión (p<0,001). En la regresión de Poisson, los participantes de Argentina tuvieron una prevalencia de violencia mayor que los trabajadores de salud de la región (14,6%; p<0,001). Conclusiones. Existió una elevada prevalencia de violencia contra el personal de salud de Argentina durante la pandemia por COVID-19. Estos hechos tuvieron un alto impacto negativo entre quienes los padecieron. Nuestros datos sugieren que, esto podría haber sido más frecuente en Argentina respecto de otras regiones del continente.

ABSTRACT Objectives. To explore the frequency and impact of violence against healthcare workers in Argentina and to compare it with the rest of their Latin American peers during the COVID-19 pandemic. Materials and methods. A cross-sectional study was conducted by applying an electronic survey on Latin American medical and non-medical personnel who carried out health care tasks since March 2020. We used Poisson regression to estimate crude (PR) and adjusted (aPR) Prevalence Ratios with their respective 95% confidence intervals. Results. A total of 3544 participants from 19 countries answered the survey; 1992 (56.0%) resided in Argentina. Of these, 62.9% experienced at least one act of violence; 97.7% reported verbal violence and 11.8% physical violence. Of those who were assaulted, 41.5% experienced violence at least once a week. Health personnel from Argentina experienced violence more frequently than those from other countries (62.9% vs. 54.6%, p<0.001), and these events were more frequent and stressful (p<0.05). In addition, Argentinean health personnel reported having considered changing their healthcare tasks and/or desired to leave their profession more frequently (p<0.001). In the Poisson regression, we found that participants from Argentina had a higher prevalence of violence than health workers from the region (14.6%; p<0.001). Conclusions. There was a high prevalence of violence against health personnel in Argentina during the COVID-19 pandemic. These events had a strong negative impact on those who suffered them. Our data suggest that violence against health personnel may have been more frequent in Argentina than in other regions of the continent.

Comparison of violence and aggressions suffered by health personnel during the COVID-19 pandemic in Argentina and the rest of Latin America. / Comparación de la violencia y agresiones sufridas por el personal de salud durante la pandemia de COVID-19 en Argentina y el resto de Latinoamérica.

OBJECTIVES.: Motivation for the study. The COVID-19 pandemic has caused profound repercussions at different socio-environmental levels. Its impact on violence against healthcare team workers in Argentina has not been well documented. Main findings. The present study evidenced high rates of aggression, particularly verbal aggression. In addition, almost half of the participants reported having suffered these events on a weekly basis. All participants who experienced violence reported having experienced post-event symptoms, and up to one-third reported having considered changing their profession after these acts. Implications. It is imperative to take action to prevent acts of violence against health personnel, or to mitigate its impact on the victims. . To explore the frequency and impact of violence against healthcare workers in Argentina and to compare it with the rest of their Latin American peers during the COVID-19 pandemic. MATERIALS AND METHODS.: A cross-sectional study was conducted by applying an electronic survey on Latin American medical and non-medical personnel who carried out health care tasks since March 2020. We used Poisson regression to estimate crude (PR) and adjusted (aPR) Prevalence Ratios with their respective 95% confidence intervals. RESULTS.: A total of 3544 participants from 19 countries answered the survey; 1992 (56.0%) resided in Argentina. Of these, 62.9% experienced at least one act of violence; 97.7% reported verbal violence and 11.8% physical violence. Of those who were assaulted, 41.5% experienced violence at least once a week. Health personnel from Argentina experienced violence more frequently than those from other countries (62.9% vs. 54.6%, p<0.001), and these events were more frequent and stressful (p<0.05). In addition, Argentinean health personnel reported having considered changing their healthcare tasks and/or desired to leave their profession more frequently (p<0.001). In the Poisson regression, we found that participants from Argentina had a higher prevalence of violence than health workers from the region (14.6%; p<0.001). CONCLUSIONS.: There was a high prevalence of violence against health personnel in Argentina during the COVID-19 pandemic. These events had a strong negative impact on those who suffered them. Our data suggest that violence against health personnel may have been more frequent in Argentina than in other regions of the continent.

OBJETIVOS.: Explorar la frecuencia e impacto de la violencia contra los trabajadores de salud de Argentina y compararlo con el resto de sus pares de Latinoamérica en el contexto de la pandemia por COVID-19. MATERIALES Y MÉTODOS.: Estudio de corte transversal a través de una encuesta electrónica al personal médico y no médico de Latinoamérica que desempeño tareas asistenciales desde marzo de 2020. Se utilizó una regresión de Poisson para estimar las Razones de Prevalencia crudas (RP) y ajustadas (RPa) con sus respectivos intervalos de confianza al 95%. RESULTADOS.: Un total de 3544 participantes de 19 países respondieron la encuesta; 1992 (56,0%) residían en Argentina. Entre los mismos, el 62,9% padeció al menos un hecho de violencia: 97,7% refirió violencia verbal y 11,8% violencia física. El 41,5% de los agredidos padecieron situaciones de violencia al menos una vez por semana. El personal de salud de Argentina vivenció más frecuentemente violencia que los de otros países (62,9% vs. 54,6%, p<0,001), siendo estos eventos más habituales y estresantes (p<0,05). Además, refirieron más frecuentemente haber considerado cambiar sus tareas asistenciales y/o deseos de abandonar su profesión (p<0,001). En la regresión de Poisson, los participantes de Argentina tuvieron una prevalencia de violencia mayor que los trabajadores de salud de la región (14,6%; p<0,001). CONCLUSIONES.: Existió una elevada prevalencia de violencia contra el personal de salud de Argentina durante la pandemia por COVID-19. Estos hechos tuvieron un alto impacto negativo entre quienes los padecieron. Nuestros datos sugieren que, esto podría haber sido más frecuente en Argentina respecto de otras regiones del continente.

Uso de agentes hipolipemiantes y cumplimiento de metas terapéuticas en pacientes de alto riesgo cardiovascular en la República Argentina / Use of Lipid-Lowering Agents and Therapeutic Goal Achievement in Cardiovascular High-Risk Patients in Argentina

RESUMEN Introducción: Uno de los pilares fundamentales para la reducción del riesgo cardiovascular en pacientes en prevención secundaria es el correcto manejo del tratamiento hipolipemiante. Las estatinas en altas dosis, el ezetimibe, y más recientemente los inhibidores de PCSK9 (iPCSK9) son las principales herramientas farmacológicas con las que contamos para que estos pacientes cumplan metas terapéuticas de colesterol LDL (C-LDL). A pesar de la contundente evidencia a favor de estas terapéuticas, existe una gran subutilización de las mismas a nivel mundial, con bajos niveles de adherencia e inercia terapéutica. En Argentina existe escasa evidencia sobre la calidad del tratamiento hipolipemiante, y qué porcentaje de pacientes en prevención secundaria se encuentran con un perfil lipídico controlado acorde a guías nacionales e internacionales. Material y métodos: Diseñamos un estudio de corte transversal en pacientes en prevención secundaria de eventos cardiovasculares incluidos de forma prospectiva, consecutiva y multicéntrica en hospitales de la República Argentina que poseen sistema de Residencia Médica afiliados al Consejo Argentino de Residentes de Cardiología (CONAREC). Se realizó la recolección de datos durante los meses de marzo a agosto del año 2020. Se relevó el tratamiento hipolipemiante que recibían, los motivos detrás de la no utilización de estatinas en dosis adecuadas, y los valores de perfil lipídico en caso de contar con un registro en los últimos 6 meses previos a la inclusión. Resultados: Se incluyeron 1000 pacientes consecutivos de 24 centros, correspondientes a 11 provincias. Un 85,9% se encontraba bajo tratamiento con estatinas; un 4,8%, con ezetimibe; un 2,4% con fibratos; y un 13%, sin tratamiento. De aquellos pacientes en tratamiento con estatinas, un 67% recibía estatinas en altas dosis (58% del total de pacientes). Un total de 509 pacientes presentaban medición del C-LDL dentro de los últimos 6 meses. El valor promedio de C-LDL fue de 94 (90,6-97,8) mg/dL; el de C-LDL, 41 (40,7-42,6) mg/dL; y el de triglicéridos, 151 (142,9-159,8) mg/dL. Un 30% se encontraba con valores por debajo del corte de 70 mg/dL. Un 16% se encontraba con valores por debajo de 55 mg/dL. Un 37% de los pacientes presentaba C-LDL >100 mg/dL. Conclusiones: En este estudio multicéntrico de pacientes en prevención secundaria desarrollado en la República Argentina, poco más de la mitad presentaba tratamiento con estatinas en altas dosis, con una escasa utilización de ezetimibe. El subtratamiento se reflejó en los valores de C-LDL, con más de dos tercios de los pacientes fuera de rango terapéutico y, por lo tanto, lejos de las recomendaciones de las guías clínicas.

ABSTRACT Background: The correct management of lipid-lowering treatment is one of the key factors for the reduction of cardiovascular risk in secondary prevention patients. High-dose statins, ezetimibe, and more recently PCSK9 inhibitors (PCSK9i) are the main tools available to meet LDL cholesterol (LDL-C) therapeutic goals in these patients. Despite the overwhelming evidence in their favor, these therapies are greatly underutilized worldwide, with low levels of adherence and therapeutic inertia. In Argentina, there is scarce evidence on the quality of lipid-lowering treatment and the rate of patients in secondary prevention with a controlled lipid profile according to national and international guidelines. Methods: A prospective, multicenter, cross-sectional study including consecutive patients in secondary prevention for cardiovascular events from hospitals of Argentina with a Medical Residency system affiliated to CONAREC, was carried out from March to August 2020. Data was collected on the lipid-lowering treatment received, the reasons behind the non-use of statins in adequate doses and the lipid profile levels in case of having a record from the last 6 months prior to inclusion. Results: Among 1000 consecutive patients included from 24 centers corresponding to 11 provinces, 85.9% was treated with statins, 4.8% with ezetimibe, 2.4% with fibrates, and 13% was without treatment. In the case of patients treated with statin therapy, 67% was receiving high-dose statins (58% of the total number of patients). A total of 509 patients presented LDL-C assessment within the last 6 months. Mean LDL-C was 94 (90.6-97.8) mg/dl, HDL cholesterol 41 (40.7-42.6) mg/dl, and triglycerides 151 (142.9-159.8) mg/dl. In 30% of cases, LDL-C was below the cut-off value of 70 mg/dl and in 16% below 55 mg/ dl. In 37% of patients, LDL-C was >100 mg/dl. Conclusions: In this multicenter secondary prevention study performed in Argentina, just over half of the patients presented high-dose statin treatment, with scarce use of ezetimibe. Undertreatment was reflected in LDL-C values, with more than two-thirds of patients outside the therapeutic range, and therefore far from clinical guideline recommendations.