Breaking the Stigma in Mental Health Nursing through High-Fidelity Simulation Training.

The social stigma toward individuals with mental health problems is habitual among nursing students, which can lead to poor quality of health care services for patients with mental illnesses. The purpose of the present study was to learn about nursing students' perceptions of providing care to patients with severe mental disorders before and after participating in a simulated student clinical case. A descriptive qualitative study was conducted through 39 interviews. The difficulties expected by the students and their perceptions about patients were explored before the simulation training. Their perceptions about the use of clinical simulation for learning about the adequate management of these patients were analyzed afterwards. Results: Before the simulation training, the students assessed the case as being complicated, expressed their lack of specific training, and felt fear and insecurity, thus reproducing the stigma towards mental health patients. After this training, they positively valued the usefulness of the clinical simulation for gaining confidence and overcoming the stigma. Discussion: The use of high-fidelity simulation offers nursing students the opportunity to approach patients with mental health conditions, overcoming their fears and normalizing mental disorders. Simulation training allows nursing students to analyze the reasoning of clinical judgment and to detect the influence of previous prejudices about mental illness in their clinical decision. This study was not registered.

Utilidad del lavado broncoalveolar para la detección microbiológica, y factores asociados, en receptores de trasplante de precursores hematopoyéticos: estudio de cohorte retrospectivo

Introducción: Las opacidades pulmonares en receptores de trasplante de precursores hematopoyéticos (TPH) representan un desafío diagnóstico y son una causa de morbimortalidad. Existen grandes discrepancias con respecto a la sensibilidad diagnóstica del lavado broncoalveolar (LBA), sus complicaciones, y los factores asociados a la identificación microbiológica. Objetivo: Conocer la utilidad del estudio microbiológico del LBA en el diagnóstico, modificación de la conducta médica y estimar las complicaciones y mortalidad asociada al procedimiento, en receptores de TPH con opacidades pulmonares. Pacientes y Métodos: Estudio de cohorte, retrospectivo, en adultos receptores de TPH a los que se les realizó una broncoscopía con LBA por presentar opacidades pulmonares, en el Hospital Italiano de Buenos Aires entre el 01/01/2011 y el 31/12/2020. Resultados: De los 189 procedimientos analizados, en 79 se logró un hallazgo microbiológico (41,8%) y 122 permitieron modificar la conducta médica (64,6%). En 11 casos se observaron complicaciones graves dentro de las 12 horas (5,8%) de efectuado el LBA. La mortalidad intrahospitalaria fue de 16,8% (N = 21/125). El valor de neutrófilos en sangre previo al LBA (p = 0,037) y la presencia de nódulos pulmonares como lesión tomográfica predominante (p = 0,029) se asociaron independientemente al hallazgo microbiològico global. Conclusiones: Nuestra investigación apoya la realización del LBA como herramienta diagnóstica en pacientes que reciben un TPH y presentan opacidades pulmonares.

Background: Lung opacities are a cause of morbimortality in bone marrow transplant patients, and represent a diagnostic challenge. There are large discrepancies regarding the diagnostic sensitivity of bronchoalveolar lavage (BAL), its complications, and the factors associated with microbiological detection. Aim: To know the usefulness of the microbiological study of BAL in the diagnosis, in the modification in medical behavior and to estimate the complications and associated mortality of this diagnostic procedure in patients transplanted with hematopoietic progenitor cells with pulmonary opacities. Methods: Retrospective cohort study in bone marrow transplant adult patients who underwent bronchoscopy with BAL due to lung opacities at Hospital Italiano de Buenos Aires between 01/01/2011 and 12/31/2020. Results: Of the 189 BAL analyzed, 79 presented a microbiological detection (41.8%) and 122 allowed to modify the medical behavior (64.6%). Severe complications were observed within 12 hours after the procedure in11 cases (5.8%). In-hospital mortality was 16,8% (N = 21/125). The value of blood neutrophils prior to bronchoalveolar lavage (p = 0.037) and the presence of pulmonary nodules as the predominant tomographic lesion (p = 0.029) were independently associated with global microbiological detection. Conclusion: Our research supports the performance of BAL as a diagnostic tool in bone marrow transplant patients with lung opacities.

Sleep analysis of hospital and out-of-hospital emergency professionals.

INTRODUCTION: Sleep deprivation is associated with poorer cognitive functioning and a greater risk of serious diseases. Herein, we analyzed differences in the quality of sleep and excessive daytime sleepiness between hospital emergency services and out-of-hospital emergencies services, and investigated its association with sociodemographic and labor variables. METHOD: This is a cross-sectional observational study carried out between April 2019 and February 2020, including healthcare professionals from different emergency departments, who were evaluated through the following instruments: "Pittsburgh Sleep Quality Index" and "Epworth Sleepiness Scale". RESULTS: Four-hundred and four healthcare professionals were included (mean age 40.4 ± 11.1 years), predominantly women (61.4%) from hospital emergency departments (62.6%). A total of 65.3% of the workers had poor sleep quality and 27.7% had excessive sleepiness. Women had poorer sleep quality (p = 0.022) and higher sleepiness (p = 0.010) than men. Hospital emergency workers presented 2-fold increased risk of poor sleep quality (OR = 1.93, p = 0.003) and sleepiness (OR = 1.93, p = 0.009) than out-of-hospital emergency workers. The more optimistic were less likely to have poor sleep quality (OR = 0.73, p = 0.01) or sleepiness (OR = 0.70, p = 0.002). Nurses, emergency medical technicians and nursing assistants also had a higher risk of poor sleep quality compared to physicians (OR = 1.60; p = 0.043). CONCLUSIONS: Emergency healthcare professionals working in hospital emergency departments had a two-times higher risk of poor sleep quality and sleepiness than out-of-hospital emergency healthcare professionals.

Efecto de la inactivación de las órdenes múltiples para solicitud de estudios complementarios en una central de emergencias.

Introducción. La plantilla de órdenes múltiples es una herramienta informática que podría producir consecuencias inadvertidas pese a sus innumerables beneficios. Nos propusimos explorar el efecto de su inactivación sobre las solicitudes de estudios complementarios y los costos asociados. Métodos. Corte transversal en la Central de Emergencias de Adultos del Hospital Italiano de Buenos Aires, que incluyó muestra consecutiva de consultas pre-intervención (Enero-Febrero 2020) y post-intervención (2021). Mediante el uso de bases secundarias, las variables incluidas fueron los débitos administrativos y sus respectivos precios de facturación. Resultados. Hubo 27.671 consultas en 2020 con una mediana de valor total de 474$, y 20.819 con 1.639$ en 2021. Tras el análisis restringido al área de consultorios de moderada complejidad (excluyendo consultas por COVID-19), se encontró: una disminución en la mediana del número de prácticas por consulta (mediana de 11 vs 10, p=0,001), una disminución en la solicitud de al menos una práctica de laboratorio (45% versus 39%, p=0,001), sin encontrar cambios significativos en costos globales (mediana 1.419$ vs 1.081$; p=0,122) ni en costos específicos de laboratorio (mediana 1.071$ vs 1.089$, p=0,710). Conclusión. Pese a la inflación interanual, se logró una reducción significativa en el número de prácticas y se mantuvieron los costos globales por consulta. Estos hallazgos demuestran la efectividad de la intervención, pero serán necesarias medidas educativas que apunten al recordatorio de los potenciales daños en la sobreutilización, y los costos sanitarios de los estudios innecesarios.

Impact of the COVID-19 pandemic on stress and sleep in emergency room professionals.

AIMS AND OBJECTIVES: To analyze stress levels, sleep quality, sleepiness and chronotypes on emergency room (ER) professionals before and during the COVID-19. BACKGROUND: ER healthcare professionals are exposed to high stress levels, and they often present with poor sleep quality. DESIGN: Observational study conducted into two different phases (before the COVID-19 and during the first wave of the COVID-19). METHOD: Physicians, nurses and nursing assistants working in the ER were included. Stress, sleep quality, daytime sleepiness and chronotypes were assessed by the Stress Factors and Manifestations Scale (SFMS), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Horne and Österberg Morningness-Eveningness questionnaire, respectively. The first phase of the study was performed between December 2019 and February 2020, and the second between April and June 2020. The STROBE checklist was used to report the present study. RESULTS: In total, 189 ER professionals in the pre-COVID-19 phase and 171 (of the initial 189) during COVID-19 were included. The proportion of workers with a morning circadian rhythm increased during the COVID-19, and stress levels were significantly higher during COVID-19 compared to the previous phase (38.34 ± 10.74 vs. 49.97 ± 15.81). ER professionals with poor sleep quality presented higher stress in the pre-COVID-19 phase (40.60 ± 10.71 vs. 32.22 ± 8.19) and during COVID-19 (55.27 ± 15.75 vs. 39.66 ± 9.75). Similarly, workers with excessive sleepiness had higher stress in the pre-COVID-19 phase (42.06 ± 10.95 vs. 36.64 ± 10.24) and during COVID-19 (54.67 ± 18.10 vs. 48.44 ± 14.75). Positive associations were also found between the SFMS and the PSQI, as well as with the ESS in both phases of the study. CONCLUSIONS: Emergency room professionals had increased stress levels during the COVID-19 pandemic. Stress was particularly higher in those with poor sleep quality or with excessive daytime sleepiness. RELEVANCE TO CLINICAL PRACTICE: These results should aim to impulse the implementation of measures to improve the working conditions of ER professionals.

Effect of computerized physician order entry inactivation to order complementary studies in an emergency department / [Efecto de la inactivación de las órdenes múltiples para solicitud de estudios complementarios en una central de emergencias.]

Introduction: The computerized provider order entry (CPOE) is a computing tool that could lead to unintended consequences despite its myriad benefits. We aimed to explore the effect of its inactivation on requests for complementary studies and the associated costs. Methods: Cross sectional study at the Emergency Department of Hospital Italiano de Buenos Aires, which included a consecutive sample of pre-intervention (January-February 2020) and post-intervention (2021) consultations. Using secondary bases, the variables included were administrative debits and their respective billing prices. Results: There were 27,671 consultations in 2020 with a total median value of $474, and 20,819 with $1,639 in 2021. After the analysis restricted to the area of ​​moderately complex clinics (excluding COVID-19 consultations), the following was found: a decrease in the median number of practices per consultation (median of 11 vs. 10, p=0.001), a decrease in the request for at least one laboratory practice (45% vs. 39%, p=0.001), without finding significant changes in global costs (median $1,419 vs. $1,081; p=0.122) or in specific laboratory costs (median $1,071 vs. $1,089, p=0.710). Conclusion: Despite inflation, a significant reduction in the number of practices was achieved and overall costs per consultation were maintained. These findings demonstrate the effectiveness of the intervention, but an educational intervention aimed at reminding the potential harm of overuse and the health costs of unnecessary studies will be necessary.

Introducción: La plantilla de órdenes múltiples es una herramienta informática que podría producir consecuencias inadvertidas pese a sus innumerables beneficios. Nos propusimos explorar el efecto de su inactivación sobre las solicitudes de estudios complementarios y los costos asociados. Métodos: Corte transversal en la Central de Emergencias de Adultos del Hospital Italiano de Buenos Aires, que incluyó muestra consecutiva de consultas pre-intervención (Enero-Febrero 2020) y post-intervención (2021). Mediante el uso de bases secundarias, las variables incluidas fueron los débitos administrativos y sus respectivos precios de facturación. Resultados: Hubo 27.671 consultas en 2020 con una mediana de valor total de 474$, y 20.819 con 1.639$ en 2021. Tras el análisis restringido al área de consultorios de moderada complejidad (excluyendo consultas por COVID-19), se encontró: una disminución en la mediana del número de prácticas por consulta (mediana de 11 vs 10, p=0,001), una disminución en la solicitud de al menos una práctica de laboratorio (45% versus 39%, p=0,001), sin encontrar cambios significativos en costos globales (mediana 1.419$ vs 1.081$; p=0,122) ni en costos específicos de laboratorio (mediana 1.071$ vs 1.089$, p=0,710). Conclusión: Pese a la inflación interanual, se logró una reducción significativa en el número de prácticas y se mantuvieron los costos globales por consulta. Estos hallazgos demuestran la efectividad de la intervención, pero serán necesarias medidas educativas que apunten al recordatorio de los potenciales daños en la sobreutilización, y los costos sanitarios de los estudios innecesarios.

Validating and automating learning of cardiometabolic polygenic risk scores from direct-to-consumer genetic and phenotypic data: implications for scaling precision health research.

INTRODUCTION: A major challenge to enabling precision health at a global scale is the bias between those who enroll in state sponsored genomic research and those suffering from chronic disease. More than 30 million people have been genotyped by direct-to-consumer (DTC) companies such as 23andMe, Ancestry DNA, and MyHeritage, providing a potential mechanism for democratizing access to medical interventions and thus catalyzing improvements in patient outcomes as the cost of data acquisition drops. However, much of these data are sequestered in the initial provider network, without the ability for the scientific community to either access or validate. Here, we present a novel geno-pheno platform that integrates heterogeneous data sources and applies learnings to common chronic disease conditions including Type 2 diabetes (T2D) and hypertension. METHODS: We collected genotyped data from a novel DTC platform where participants upload their genotype data files and were invited to answer general health questionnaires regarding cardiometabolic traits over a period of 6 months. Quality control, imputation, and genome-wide association studies were performed on this dataset, and polygenic risk scores were built in a case-control setting using the BASIL algorithm. RESULTS: We collected data on N = 4,550 (389 cases / 4,161 controls) who reported being affected or previously affected for T2D and N = 4,528 (1,027 cases / 3,501 controls) for hypertension. We identified 164 out of 272 variants showing identical effect direction to previously reported genome-significant findings in Europeans. Performance metric of the PRS models was AUC = 0.68, which is comparable to previously published PRS models obtained with larger datasets including clinical biomarkers. DISCUSSION: DTC platforms have the potential of inverting research models of genome sequencing and phenotypic data acquisition. Quality control (QC) mechanisms proved to successfully enable traditional GWAS and PRS analyses. The direct participation of individuals has shown the potential to generate rich datasets enabling the creation of PRS cardiometabolic models. More importantly, federated learning of PRS from reuse of DTC data provides a mechanism for scaling precision health care delivery beyond the small number of countries who can afford to finance these efforts directly. CONCLUSIONS: The genetics of T2D and hypertension have been studied extensively in controlled datasets, and various polygenic risk scores (PRS) have been developed. We developed predictive tools for both phenotypes trained with heterogeneous genotypic and phenotypic data generated outside of the clinical environment and show that our methods can recapitulate prior findings with fidelity. From these observations, we conclude that it is possible to leverage DTC genetic repositories to identify individuals at risk of debilitating diseases based on their unique genetic landscape so that informed, timely clinical interventions can be incorporated.

The stigma of mental health professionals towards users with a mental disorder.

Individuals with mental disorders are labeled in such a way that it leads to stigmatization. This generates a disadvantage as regards to the rest of the members of the society, limiting their participation as active members within it and at the same time being deleterious to their way of life. Mental health professionals are not safe from internalizing these stereotypes and prejudices assumed from their environment, thereby showing stigmatizing attitudes and behaviors towards the users in the different mental health resources.

[Prevalence of burnout in healthcare workers during the COVID-19 pandemic and associated factors. A cross-sectional study]. / Prevalencia de síndrome de burnout en personal de salud durante la pandemia de COVID-19 y factores asociados. Estudio de corte transversal.

The COVID-19 pandemic generated an overload of the health system and mental, emotional, and physical exhaustion of workers. Previous studies have reported elevated levels of burnout syndrome in healthcare workers. The objective of the study was to estimate the prevalence and associated factors of burnout syndrome in healthcare workers. A cross-sectional study was conducted through the administration of an email survey during the second wave of COVID-19 cases. Burnout was evaluated using the Maslach Burnout Inventory questionnaire. The prevalence of burnout was estimated and the associated factors were analyzed using multivariate logistic regression analysis. The 84% of the participants completed the survey (N = 133), 106 were physicians (80%), 11 administrators (8%), 9 respiratory physiologists (7%), and 7 nurses (5%). 62% were women. The prevalence of burnout was 38% (95% CI 30-47%) and it was different according to the occupation (p = < 0.001). Physicians and respiratory kinesiologists presented the highest values with a prevalence of 40% and 89% respectively. In the multivariate analysis, the variables that were independently associated with the burnout syndrome were: being a physician (OR = 8.9; 95% CI: 1.1-71; p: 0.041) and being a respiratory kinesiologist (OR = 137.5; 95% CI: 2-262; p 0.001). The prevalence of burnout syndrome in healthcare workers during the COVID-19 pandemic was high. Mainly in respiratory kinesiologists and physicians.

La pandemia de COVID-19 generó globalmente una sobrecarga del sistema de salud y agotamiento mental, emocional y físico del personal. Estudios previos han reportado niveles elevados del síndrome de burnout en el personal de salud. El objetivo del estudio fue estimar la prevalencia y los factores asociados del síndrome de burnout en el personal de salud. Se realizó un estudio de corte transversal a través de la administración de una encuesta por correo electrónico durante la segunda ola de casos de COVID-19. El burnout fue evaluado mediante el cuestionario de Maslach Burnout Inventory. Se estimó la prevalencia de burnout y se analizaron los factores asociados mediantes un análisis de regresión logística multivariado. El 84% de los participantes completo la encuesta (n 133), 106 fueron médicos (80%), 11 administrativos (8%), 9 kinesiólogos respiratorios (7%) y 7 enfermeros (5%). El 62% fueron mujeres. La prevalencia de burnout fue de 38% (IC 95% 30-47%) y fue diferente según la ocupación (p < 0.001). Los médicos y los kinesiólogos respiratorios presentaron los valores más altos con una prevalencia del 40% y 89% respectivamente. En el análisis multivariado las variables que se asociaron en forma independiente al síndrome de burnout fueron: ser Médico (OR = 8.9; IC 95%: 1.1-71; p: 0.041) y ser Kinesiólogo respiratorio (OR = 137.5; IC 95%: 2-262; p 0.001). La prevalencia de síndrome de burnout en personal de salud durante la pandemia de COVID-19 fue elevada. Principalmente en los kinesiólogos respiratorios y los médicos.

El estigma de los profesionales de salud mental hacia los usuarios con trastorno mental / The stigma of mental health professionals towards users with a mental disorder

Introducción: Las personas con trastornos mentales padecen el etiquetado que provoca el estigma y este a su vez les genera una desventaja con el resto de los componentes de una sociedad, limitando su participación como ciudadanos activos en la misma y mermando su calidad de vida. Los profesionales no están a salvo de interiorizar estos estereotipos y prejuicios asumidos por su entorno reflejándose en sus actitudes y comportamientos hacia los usuarios en los diferentes servicios de salud mental.Metodología: El diseño empleado en este estudio para conocer el estigma de los profesionales de salud mental es un estudio cuantitativo, analizando el nivel de estigma que presentan los profesionales mediante el cuestionario de Atribución-27 (AQ27). La muestra resultó de 59 profesionales.Resultados: Los resultados obtenidos ponen de manifiesto la existencia de actitudes y comportamientos estigmatizadores por parte de los profesionales analizados. Dentro de los datos sociodemográficos de la muestra cabe destacar que el mayor nivel de formación de los profesionales disminuye las actitudes y comportamientos relacionados con el estigma.Conclusiones: Se ha podido constatar la existencia de diferentes factores del estigma como son la ayuda, la coacción, la piedad y la evitación que afectan a los profesionales de la salud mental. (AU)

Introduction: Individuals with mental disorders are labeled in such a way that it leads to stigmatization. This generates a disadvantage as regards to the rest of the members of the society, limiting their participation as active members within it and at the same time being deleterious to their way of life. Mental health professionals are not safe from internalizing these stereotypes and prejudices assumed from their environment, thereby showing stigmatizing attitudes and behaviors towards the users in the different mental health resources.Methodology: The design used in this study to determine the stigma of mental health professionals is a quantitative study, which was used to analyze the level of stigma presented by professionals using the Attribution Questionnaire-27 (AQ27). The sample consisted of 59 professionals.Results: The results obtained showed the existence of stigmatizing attitudes and behaviors by the professionals analyzed. Within the sociodemographic data of the sample, it should be noted that the higher level of education of the professionals decreased the attitudes and behaviors associated to stigma. Conclusions: It was possible to confirm the existence of differentstigma factors such as helping, coercion, pity and avoidancethat affect mental health professionals. (AU)

Can CPOE Based on Electronic Order Sets Cause Unintended Consequences (Expensive and Unnecessary Tests) at the Emergency Department?

Computerized Provider Order Entry (CPOE) systems may cause unintended consequences. This study aimed to describe the on-going system for CPOE order sets, and to explore an economic evaluation at the Emergency Department. First, we developed a costs dashboard which showed us the significant and excessive use of medical tests per consultation. We identified the top 10 most widely used and most expensive tests. Additionally we noticed that the labs seemed to continually increase. Then, we found that 27% of the consultations have at least one item of laboratory practice between January and February 2020, and this represents more than 80% of the consultation costs. Health care spending has reached epic proportions globally. We think that it is time to rethink effective strategies. Maybe it is time to deactivate/remove electronic order sets (EOSs) and the functionality to develop and create their own "private" order sets, in order to eliminate waste and inefficiencies.

Adaptation of the Highly Sensitive Person Scale (HSP) and Psychometric Properties of Reduced Versions of the Highly Sensitive Person Scale (R-HSP Scale) in Spanish Nursing Students.

Sensory processing sensitivity (SPS) can be defined as a personality characteristic that includes the individual characteristics of sensitivity towards endogenous and exogenous stimuli. The differences in environmental sensitivity can play a crucial role in the academic context of health professionals, thus defining it as an area of research that must be addressed. The reduced scale for highly sensitive people (HSP) is a short (16 items) and adapted version of the original scale for highly sensitive people (HSP). This study aims to analyze the psychometric properties of reduced versions of the Highly Sensitive Person Scale (r-HSP Scale) in Spanish nursing students. Once the questionnaire was translated, its psychometric characteristics were analyzed. The Spanish version of the r-HSP scale was administered to 284 university students enrolled in the Nursing Degree. The results from the factorial analysis confirmed the structure of sensitiveness of six factors in our sample. This structure included the following dimensions: (1) Instability, (2) Surroundings, (3) Interaction with others, (4) Sensoperception, (5) Sensitivity, and (6) Insecurity. Additionally, the Cronbach's α values indicated that the Spanish version of the r-HSP scale had an adequate reliability (α = 0.702). The r-HSP scale is defined as a reliable, valid, and agile replica of the original structure of sensitivity in Spanish university students.

Changes in Protonation Sites of 3-Styryl Derivatives of 7-(dialkylamino)-aza-coumarin Dyes Induced by Cucurbit[7]uril.

The incorporation of a guest, with different basic sites, into an organized system (host), such as macrocycles, could stabilize, detect, or promote the formation of a certain protomer. In this context, this work aimed to study the influence of cucurbit[7]uril (CB7) on dyes such as 7-(dimethylamino)-aza-coumarins, which have more than one basic site along their molecular structure. For this, three 3-styryl derivatives of 7-(dialkylamino)-aza-coumarin dyes (SAC1-3) were synthesized and characterized by NMR, ESI-HRMS and IR. The spectral behaviour of the SACs in the absence and presence of CB7 was studied. The results showed large shifts in the UV-vis spectrum in acid medium: a hypsochromic shift of ≈5400 cm-1 (SAC1-2) and ≈3500 cm-1 (SAC3) in the absence of CB7 and a bathochromic shift of ≈4500 cm-1 (SAC1-3) in the presence of CB7. The new absorptions at long and short wavelengths were assigned to the corresponding protomers by computational calculations at the density functional theory (DFT) level. Additionally, the binding mode was corroborated by molecular dynamics simulations. Findings revealed that in the presence of CB7 the heterocyclic nitrogen was preferably protonated instead of the dialkylamino group. Namely, CB7 induces a change in the protonation preference at the basic sites of the SACs, as consequence of the molecular recognition by the macrocycle.

Prevalencia de síndrome de burnout en personal de salud durante la pandemia de COVID-19 y factores asociados. Estudio de corte transversal / Prevalence of burnout in healthcare workers during the COVID-19 pandemic and associated factors. A cross-sectional study

Resumen La pandemia de COVID-19 generó globalmente una sobrecarga del sistema de salud y agotamiento mental, emocional y físico del personal. Estudios previos han reportado niveles elevados del síndrome de burnout en el personal de salud. El objetivo del estudio fue estimar la prevalencia y los factores asociados del síndrome de burnout en el personal de salud. Se realizó un estudio de corte transversal a través de la administración de una encuesta por correo electrónico durante la segunda ola de casos de COVID-19. El burnout fue evaluado mediante el cuestionario de Maslach Burnout Inventory. Se estimó la prevalencia de burnout y se analizaron los factores asociados mediantes un análisis de regresión logística multivariado. El 84% de los participantes completo la encuesta (n 133), 106 fueron médicos (80%), 11 administrativos (8%), 9 kinesiólogos respiratorios (7%) y 7 enfermeros (5%). El 62% fueron mujeres. La prevalencia de burnout fue de 38% (IC 95% 30-47%) y fue diferente según la ocupación (p < 0.001). Los médicos y los kinesiólogos respiratorios presenta ron los valores más altos con una prevalencia del 40% y 89% respectivamente. En el análisis multivariado las variables que se asociaron en forma independiente al síndrome de burnout fueron: ser Médico (OR = 8.9; IC 95%: 1.1-71; p: 0.041) y ser Kinesiólogo respiratorio (OR = 137.5; IC 95%: 2-262; p 0.001). La prevalencia de síndrome de burnout en personal de salud durante la pandemia de COVID-19 fue elevada. Principalmente en los kinesiólogos respiratorios y los médicos.

Abstract The COVID-19 pandemic generated an overload of the health system and mental, emotional, and physical exhaustion of workers. Previous studies have reported elevated levels of burnout syndrome in healthcare workers. The objective of the study was to estimate the prevalence and as sociated factors of burnout syndrome in healthcare workers. A cross-sectional study was conducted through the administration of an email survey during the second wave of COVID-19 cases. Burnout was evaluated using the Maslach Burnout Inventory questionnaire. The prevalence of burnout was estimated and the associated factors were analyzed using multivariate logistic regression analysis. The 84% of the participants completed the survey (N = 133), 106 were physicians (80%), 11 administrators (8%), 9 respiratory physiologists (7%), and 7 nurses (5%). 62% were women. The prevalence of burnout was 38% (95% CI 30-47%) and it was different according to the occupation (p = < 0.001). Physicians and respiratory kinesiologists presented the highest values with a prevalence of 40% and 89% respectively. In the multivariate analysis, the variables that were independently as sociated with the burnout syndrome were: being a physician (OR = 8.9; 95% CI: 1.1-71; p: 0.041) and being a respiratory kinesiologist (OR = 137.5; 95% CI: 2-262; p 0.001). The prevalence of burnout syndrome in healthcare workers during the COVID-19 pandemic was high. Mainly in respiratory kinesiologists and physicians.

Stress in Emergency Healthcare Professionals: The Stress Factors and Manifestations Scale.

Background: Healthcare workers are continuously exposed to a high level of stress, especially emergency department professionals. In the present research, we aimed to determine the internal consistency and validity of the Stress Factors and Manifestations Scale for in-hospital and out-of-hospital emergency workers. Methods: A quantitative, prospective, cross-sectional, and observational study including 269 emergency service professionals. Results: The scale was composed of 21 items, with a Cronbach's α value of 0.908. The hospital workers (38.4 ± 10.8 vs. 35.1 ± 9.9, p = 0.014) and women (39.3 ± 11.4 vs. 34.2 ± 8.6, p < 0.001) had higher levels of stress. The sensitivity, specificity, and predictive values of the scale were adequate. Conclusion: In the present study, including in-hospital and out-of-hospital emergency workers, the Stress Factors and Manifestations Scale presented appropriate usefulness, internal consistency, and validity, with optimal predictive ability. Higher levels of anxiety, female gender, being less optimistic, and working in hospital emergency departments were related to increased stress levels. Further studies are warranted to validate our results and potentially extend the Stress Factors and Manifestations Scale to other contexts.

Occupational Therapy in Severe Mental Disorder-A Self-Controlled Quasi-Experimental Study.

Severe mental disorder (SMD) produces a significant functional limitation that affects the performance of daily activities. The occupational therapist intervenes on this limitation by seeking greater autonomy of these patients through specific activities. This study aims to identify the main limitations of people with SMD and to examine whether an occupational intervention has any effect in helping to overcome or ameliorate these limitations. A quasi-experimental study including 103 participants was carried out. An evaluation using the World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire was performed before and after the intervention. Within the activity program, those with a higher attendance rating during cognitive stimulation, cooking workshop, therapeutic walks, relaxation, and creative activities were mainly men. Both patients and professionals indicated that Understanding and Communicating, Participation in Society, and Activities of Daily Living were the main perceived limitations. Upon discharge, patients and professionals reported positive outcomes. The intervention programs carried out by occupational therapy, along with the other aspects of the treatment that SMD patients received, played an important part in improving the performance and occupational interests of these patients.

Triggers of Agitation in Psychiatric Hospitalization Ward According to Professional Experience Questionnaire.

AIM: To create and analyze an instrument to assess the possible agitation triggers of hospitalized psychiatric patients. BACKGROUND: No tools exist for identifying according to a professional's experience. METHODS: Descriptive and cross-sectional study. The questionnaire of possible triggers of agitation behaviors of patients hospitalized in psychiatric wards according to professional experience (TAPE) was designed and analyzed. RESULTS: The questionnaire was provided to 156 mental health workers (76.9% women, average work experience: 10.15 ± 8 years, 46.8% were nurses specialized in mental health, and 21.2% psychiatrists). A good internal consistency was obtained, with a Cronbach α value of 0.791 in the initial test, and 0.892 in the retest. The factorial analysis found four factors: factor 1 "personnel", factor 2 "routines", factor 3 "norms-infrastructure", and factor 4 "clinic". Factor 1 obtained the highest value, with a mean of 4.16 ± 0.63, highlighting the item "lack of specialized personnel" (mean 4.38 ± 0.81). The specialized professionals provided higher scores to the items from the factors associated with the training of the personnel and routines (p = 0.017; p = 0.042). CONCLUSIONS: The TAPE questionnaire is useful for identifying the possible triggers that could lead to situations of agitation of hospitalized patients.

Romani Women and Health: The Need for a Cultural-Safety Based Approach.

The Romani are the main European ethnic minority. The Romani people's situation of social vulnerability and their difficulties accessing the health system make their health indicators worse than those of the non-Romani population. The present study will delve into health beliefs, and experiences with health services and professionals, through the perspectives of Romani women. In this qualitative study, 16 women of different ages were interviewed in a city located in the South of Spain. Four themes emerged from the analysis of the data: the construction of the identity of Romani women, difficulties in life, health and disease beliefs and barriers to accessing the health system. We conclude that every project for the improvement of the health of the Romani community must take into account the active participation of Romani women and must consider the principles of Cultural Safety, by delving into the intercultural training of health professionals and addressing the social determinants of health which affect the Romani collective.