Actitudes de los médicos de un hospital pediátrico de tercer nivel ante la muerte / Attitudes of physicians in a tertiary care children's hospital in the face of death

Introducción. La muerte involucra, para los médicos, un análisis complejo que determina su actitud hacia el paciente, principalmente los comportamientos en situaciones de diagnóstico, tratamiento y la relación médico-paciente. Objetivos. 1) Describir las actitudes del personal médico de un hospital pediátrico ante la muerte. 2) Explorar si existen factores asociados a esas actitudes. Población y métodos. Estudio transversal, por encuesta. Se invitó a los médicos de un hospital pediátrico de tercer nivel de la Ciudad Autónoma de Buenos Aires, Argentina, a completar el Cuestionario de actitud ante la muerte (CAM). Se investigaron variables sociodemográficas, categoría profesional y área laboral, haber presenciado la muerte de pacientes, autopercepción de actitud positiva ante la muerte y actitud ante la muerte según CAM. Resultados. Entre el 01 de junio de 2021 y el 01 de junio de 2022 se incluyeron 362 participantes, con edad media de 39,88 (± 11,56) años y experiencia médica asistencial de 14,06 (± 11,97) años. Presentaron actitud positiva 35 (9,67 %). Encontramos significancia estadística para mayor probabilidad de actitud positiva en edad ≥ 40 años (p = 0,02, IC95 % 1,1-3,9), experiencia médica asistencial ≥ 14 años (p = 0,042, IC95 % 1-4,1), creencia religiosa (p = 0,003, IC95 % 1,4-10,5), práctica religiosa activa (p <0,001, IC95 % 1,6-6,9) y autopercepción positiva ante la muerte (p = 0,002, IC95 % 1,7-30,8). Conclusiones. El 9,67 % de los encuestados presentó actitud positiva ante la muerte. Los factores asociados a ella fueron edad ≥ 40 años, experiencia médica asistencial ≥ 14 años, creencia religiosa, práctica religiosa activa y la autopercepción personal de actitud positiva ante la muerte.

Introduction. For physicians, death involves an intricate analysis that determines their attitude towards the patient. Objectives. 1) To describe the attitudes towards death among medical staff working at a children's hospital. 2) To explore factors associated with such attitudes. Population and methods. Cross-sectional, survey study. The physicians working at a tertiary care children's hospital completed the Questionnaire of attitudes towards death (QAD). Sociodemographic variables, professional category, work setting, having witnessed the death of patients, self-perception of a positive attitude towards death, and attitude towards death according to the QAD were studied. Results. Between June 1st, 2021 and June 1st, 2022, 362 participants were included; mean age: 39.88 years (± 11.56), health care experience: 14.06 years (± 11.97). A positive attitude was observed in 35 (9.67%). A statistical significance was observed for a greater probability of a positive attitude among those who were ≥ 40 years old (p = 0.02, 95% CI: 1.1­3.9), had health care experience for ≥ 14 years (p = 0.042, 95% CI: 1­4.1), had a religious belief (p = 0.003, 95% CI: 1.4­10.5), actively practiced their religion (p < 0.001, 95% CI: 1.6­6.9), and had a positive self-perception in the face of death (p = 0.002, 95% CI: 1.7­30.8). Conclusions. A positive attitude towards death was observed in 9.67% of surveyed participants. Associated factors were age ≥ 40 years, health care experience for ≥ 14 years, religious belief, active religious practice, and self-perception of a positive attitude towards death.

Attitudes of physicians in a tertiary care children's hospital in the face of death. / Actitudes de los médicos de un hospital pediátrico de tercer nivel ante la muerte.

Introduction. For physicians, death involves an intricate analysis that determines their attitude towards the patient. Objectives. 1) To describe the attitudes towards death among medical staff working at a children's hospital. 2) To explore factors associated with such attitudes. Population and methods. Cross-sectional, survey study. The physicians working at a tertiary care children's hospital completed the Questionnaire of attitudes towards death (QAD). Sociodemographic variables, professional category, work setting, having witnessed the death of patients, self-perception of a positive attitude towards death, and attitude towards death according to the QAD were studied. Results. Between June 1st, 2021 and June 1st, 2022, 362 participants were included; mean age: 39.88 years (± 11.56), health care experience: 14.06 years (± 11.97). A positive attitude was observed in 35 (9.67%). A statistical significance was observed for a greater probability of a positive attitude among those who were ≥ 40 years old (p = 0.02, 95% CI: 1.1-3.9), had health care experience for ≥ 14 years (p = 0.042, 95% CI: 1-4.1), had a religious belief (p = 0.003, 95% CI: 1.4-10.5), actively practiced their religion (p < 0.001, 95% CI: 1.6-6.9), and had a positive self-perception in the face of death (p = 0.002, 95% CI: 1.7-30.8). Conclusions. A positive attitude towards death was observed in 9.67% of surveyed participants.Associated factors were age ≥ 40 years, health care experience for ≥ 14 years, religious belief, active religious practice, and self-perception of a positive attitude towards death.

Introducción. La muerte involucra, para los médicos, un análisis complejo que determina su actitud hacia el paciente, principalmente los comportamientos en situaciones de diagnóstico, tratamiento y la relación médico-paciente. Objetivos. 1) Describir las actitudes del personal médico de un hospital pediátrico ante la muerte. 2) Explorar si existen factores asociados a esas actitudes. Población y métodos. Estudio transversal, por encuesta. Se invitó a los médicos de un hospital pediátrico de tercer nivel de la Ciudad Autónoma de Buenos Aires, Argentina, a completar el Cuestionario de actitud ante la muerte (CAM). Se investigaron variables sociodemográficas, categoría profesional y área laboral, haber presenciado la muerte de pacientes, autopercepción de actitud positiva ante la muerte y actitud ante la muerte según CAM. Resultados. Entre el 01 de junio de 2021 y el 01 de junio de 2022 se incluyeron 362 participantes, con edad media de 39,88 (± 11,56) años y experiencia médica asistencial de 14,06 (± 11,97) años. Presentaron actitud positiva 35 (9,67 %). Encontramos significancia estadística para mayor probabilidad de actitud positiva en edad ≥ 40 años (p = 0,02, IC95 % 1,1-3,9), experiencia médica asistencial ≥ 14 años (p = 0,042, IC95 % 1-4,1), creencia religiosa (p = 0,003, IC95 % 1,4-10,5), práctica religiosa activa (p <0,001, IC95 % 1,6-6,9) y autopercepción positiva ante la muerte (p = 0,002, IC95 % 1,7-30,8). Conclusiones. El 9,67 % de los encuestados presentó actitud positiva ante la muerte. Los factores asociados a ella fueron edad ≥ 40 años, experiencia médica asistencial ≥ 14 años, creencia religiosa, práctica religiosa activa y la autopercepción personal de actitud positiva ante la muerte.

Coevolutionary cycling of host sociality and pathogen virulence in contact networks.

Infectious diseases may place strong selection on the social organization of animals. Conversely, the structure of social systems can influence the evolutionary trajectories of pathogens. While much attention has focused on the evolution of host sociality or pathogen virulence separately, few studies have looked at their coevolution. Here we use an agent-based simulation to explore host-pathogen coevolution in social contact networks. Our results indicate that under certain conditions, both host sociality and pathogen virulence exhibit continuous cycling. The way pathogens move through the network (e.g., their interhost transmission and probability of superinfection) and the structure of the network can influence the existence and form of cycling.

The evolution of restraint in bacterial biofilms under nontransitive competition.

Theoretical and empirical evidence indicates that competing species can coexist if dispersal, migration, and competitive interactions occur over relatively small spatial scales. In particular, spatial structure appears to be critical to certain communities with nontransitive competition. A typical nontransitive system involves three competing species that satisfy a relationship similar to the children's game of rock-paper-scissors. Although the ecological dynamics of nontransitive systems in spatially structured communities have received some attention, fewer studies have incorporated evolutionary change. Here we investigate evolution within toxic bacterial biofilms using an agent-based simulation that represents a nontransitive community containing three populations of Escherichia coli. In structured, nontransitive communities, strains evolve that do not maximize their competitive ability: They do not reduce their probability of death to a minimum or increase their toxicity to a maximum. That is, types evolve that exercise restraint. We show that nontransitivity and spatial structure (in the form of localized interactions) are both necessary for the evolution of restraint in these biofilms.