Exposure to moral stressors and associated outcomes in healthcare workers: prevalence, correlates, and impact on job attrition.

Introduction: Healthcare workers (HCWs) often experience morally challenging situations in their workplaces that may contribute to job turnover and compromised well-being. This study aimed to characterize the nature and frequency of moral stressors experienced by HCWs during the COVID-19 pandemic, examine their influence on psychosocial-spiritual factors, and capture the impact of such factors and related moral stressors on HCWs' self-reported job attrition intentions.Methods: A sample of 1204 Canadian HCWs were included in the analysis through a web-based survey platform whereby work-related factors (e.g. years spent working as HCW, providing care to COVID-19 patients), moral distress (captured by MMD-HP), moral injury (captured by MIOS), mental health symptomatology, and job turnover due to moral distress were assessed.Results: Moral stressors with the highest reported frequency and distress ratings included patient care requirements that exceeded the capacity HCWs felt safe/comfortable managing, reported lack of resource availability, and belief that administration was not addressing issues that compromised patient care. Participants who considered leaving their jobs (44%; N = 517) demonstrated greater moral distress and injury scores. Logistic regression highlighted burnout (AOR = 1.59; p < .001), moral distress (AOR = 1.83; p < .001), and moral injury due to trust violation (AOR = 1.30; p = .022) as significant predictors of the intention to leave one's job.Conclusion: While it is impossible to fully eliminate moral stressors from healthcare, especially during exceptional and critical scenarios like a global pandemic, it is crucial to recognize the detrimental impacts on HCWs. This underscores the urgent need for additional research to identify protective factors that can mitigate the impact of these stressors.

This study explored the nature of moral stressors encountered by health care workers, along with impacts on moral injury and intentions to leave their jobs.Morally distressing encounters were common, with the most prevalent and distressing experiences being organizational or team-based in nature.Findings revealed that severity of moral injury, particularly related to trust violation or betrayal, was a key factor influencing healthcare workers' intentions to leave their jobs.

Condiciones laborales e indicadores de salud mental en profesionales de la medicina y enfermería en Chile durante la pandemia por COVID-19 / Working conditions and mental health indicators in medical and nursing professionals in Chile during the COVID-19 pandemic

Antecedentes: La salud mental del personal sanitario fue afectada por la pandemia de SARS-CoV-2 y sus consecuencias asociadas, entre ellas, el cambio en las condiciones laborales. Objetivos: Analizar la relación entre indicadores de salud mental y factores socio-laborales. Materiales y métodos: Los instrumentos PHQ-9, GAD-7 e ISI-3 fueron aplicados a 90 trabajadores sanitarios. Resultados: El personal de enfermería reportó mayor sintomatología depresiva, ansiosa y de insomnio. A su vez, manifestaron mayores indicadores de depresión en interacción con el cambio en la jornada laboral (F (1,86) = 3.83, p= 0.05, η² parcial= 0.04) y turno de trabajo (F (1,86) = 6.80, p= 0.01, η² parcial = 0.07); mayor sintomatología ansiosa en interacción con cambio de jornada (F (1,86) = 5.83, p= 0.02, η² parcial= 0.06) y turno de trabajo (F (1,86) = 9.26, p= 0.003, η² parcial = 0.10). Asimismo, más indicadores de insomnio en interacción con pertenecer a la primera línea (F (1,86) = 4.96, p = 0.04, η² parcial= 0.05) y cambios en la jornada laboral (F (1,86) = 3.88, p = 0.05, η² parcial= 0.04). Conclusión: El personal de enfermería resultó más afectado por los cambios en las condiciones laborales, teniendo mayor sintomatología ansiosa, depresiva e insomnio (AU)

Background: The mental health of health personnel was affected by the SARS-CoV-2 pandemic and its associated consequences, including the change in working conditions. Aims: To analyze the relationship between mental health indicators and socio-occupational factors. Materials and methods: The PHQ-9, GAD-7, and ISI-3 were applied to 90 health workers. Results: Nursing staff reported greater depressive, anxiety, and insomnia symptomatology. In turn, they manifested greater indicators of depression in interaction with the change in workday (F (1,86) = 3.83, p= 0.05, partial η² = 0.04) and work shift (F (1,86) = 6.80, p= 0. 01, partial η² = 0.07); greater anxious symptomatology in interaction with change in workday (F (1,86) = 5.83, p= 0.02, partial η² = 0.06) and work shift (F (1,86) = 9.26, p= 0.003, partial η² = 0.10). Additionally, more indicators of insomnia in interaction with being on the front line (F (1,86) = 4.96, p = 0.04, partial η²= 0.05) and changes in working hours (F (1,86) = 3.88, p = 0.05, partial η²= 0.04). Conclusion: The nursing staff was more affected by changes in working conditions, having more symptoms of anxiety, depression, and insomnia (AU)

Segurança dos profissionais de saúde que atuaram na linha de frente da pandemia por covid-19 no Brasil / Safety of health professionals who worked in the front line of the COVID-19 pandemic in Brazil / Seguridad de los profesionales de la salud que actuaron en primera línea de la pandemia de COVID-19 en Brasil

Resumo Objetivou-se avaliar a segurança dos profissionais de saúde que atuaram no combate à pandemia de covid-19 em 2020 nos serviços de saúde brasileiros. Realizou-se inquérito on line, conduzido entre junho e setembro de 2020, com profissionais de saúde de instituições públicas e privadas brasileiras, com base no questionário Health workers exposure risk assessment and management in the context of COVID-19 virus, da Organização Mundial de Saúde, sendo analisados 2.832 registros. Raça/cor e categoria profissional foram variáveis relacionadas ao aumento de casos de covid-19 dentre os profissionais. Os que se autodeclararam não brancos, técnicos e auxiliares de enfermagem tiveram chance maior de resultado positivo, indicando maior suscetibilidade à infecção relacionada ao nível socioeconômico e/ou categoria profissional e papel desempenhado no cuidado ao paciente. As variáveis estrutura das unidades de saúde, localização, teste e disponibilidade de equipamentos de proteção individual relacionaram-se ao grau de risco de contrair a doença. Ressalta-se a importância da garantia de insumos e equipamentos aos profissionais de saúde, sobretudo em um contexto pandêmico e entre aqueles com baixo nível socioeconômico que atuam na linha de frente. Riscos em situações de emergência e escassez devem ser prospectivamente monitorados, ajustando-se às iniciativas no tocante à segurança do paciente.

Abstract The objective of this study was to evaluate the safety of health professionals who worked in the fight against the COVID-19 pandemic in 2020 in Brazilian health services. An online survey was conducted between June and September 2020, with health professionals from Brazilian public and private institutions, based on the Health workers exposure risk assessment and management in the context of COVID-19 virus, from the World Health Organization, and 2,832 records were analyzed. Race/color and professional category were variables related to the increase of covid-19 cases among professionals. Those who self-declared themselves non-white, technical and nursing assistants had a higher chance of positive results, indicating a higher susceptibility to infection related to socioeconomic level and/or professional category and a role played in patient care. The variables structure of the health units, location, test and availability of personal protective equipment were related to the degree of risk of contracting the disease. The importance of ensuring inputs and equipment to health professionals is highlighted, especially in a pandemic context and among those with low socioeconomic level who work on the front line. Risks in emergency and scarcity situations should be prospectively monitored, adjusting to patient safety initiatives.

Resumen El objetivo de este estudio fue evaluar la seguridad de los profesionales de la salud que actuaron en la lucha contra la pandemia de COVID-19 en 2020 en los servicios de salud brasileños. Entre junio y septiembre de 2020 se realizó una encuesta en línea con profesionales de la salud de instituciones públicas y privadas brasileñas, basada en la evaluación y gestión del riesgo de exposición de los trabajadores de la salud en el contexto del virus COVID-19, de la Organización Mundial de la Salud, y se analizaron 2.832 registros. Raza/color y categoría profesional fueron variables relacionadas con el aumento de casos de COVID-19 entre profesionales. Los que se autodeclararon no blancos, técnicos y auxiliares de enfermería tuvieron una mayor probabilidad de resultados positivos, lo que indica una mayor susceptibilidad a la infección relacionada con el nivel socioeconómico y/o categoría profesional y un papel desempeñado en la atención al paciente. Las variables estructura de las unidades de salud, ubicación, prueba y disponibilidad de equipo de protección personal se relacionaron con el grado de riesgo de contraer la enfermedad. Se destaca la importancia de garantizar insumos y equipos a los profesionales de la salud, especialmente en un contexto pandémico y entre aquellos con bajo nivel socioeconómico que trabajan en primera línea. Los riesgos en situaciones de emergencia y escasez deben ser monitoreados prospectivamente, ajustándose a las iniciativas de seguridad del paciente.

On the path to recovery: traumatic stress research during the COVID-19 pandemic 2021-2023.

This Special Issue of the European Journal of Psychotraumatology (EJPT) presents 51 articles published between 2021 and 2023 and follows the Special Issue on pandemic-related traumatic stress research published in 2021 (O'Donnell, M. L., & Greene, T. [2021]. Understanding the mental health impacts of COVID-19 through a trauma lens. European Journal of Psychotraumatology, 12(1), 1982502). Research on traumatic stress during the pandemic has cast the spotlight on vulnerable populations and groups, notably front-line healthcare workers; people faced with major losses including the deaths of loved ones; those who personally survived debilitating and often life-threatening viral infection; and students who were isolated and experienced profound delays in their education, relationships, and emerging independence. The papers in this collection underscore the associations between COVID-19 related stressors and a plethora of adverse mental health sequelae, including posttraumatic stress reactions, and draw attention to the ubiquity of grief and moral injury and their wide-ranging and detrimental impact. Currently, there is a paucity of evidence on interventions to enhance resources, self-efficacy, and hope for affected groups and individuals through societal, organisational, and healthcare systems; however early research on the prevention of COVID-related traumatic stress disorders provides a basis for both hope and preparedness for the future.

Stressors and traumatic events occurring due to the COVID-19 pandemic are associated with a wide range of mental health problems, including posttraumatic stress reactions, especially among vulnerable groups (e.g., front-line healthcare workers, individuals who faced major losses such as the deaths of loved ones, those who survived debilitating and often life-threatening infection).Loss and moral injury are common and potentially debilitating features of the pandemic.Societal, organisational, and healthcare system interventions to enhance resources, efficacy, and hope for affected groups and individuals are still in the early stages, although preliminary research on the prevention of COVID-related traumatic stress disorders is promising.

Sindrome de burnout, estado nutricional y conducta alimentaria en trabajadores de la salud / Burnout syndrome, nutritional status and eating behavior in health workers

Introducción: El síndrome de Burnout o agotamiento profesional aparece como una respuesta al estrés crónico en eltrabajo, con secuelas negativas a nivel individual y general. Objetivo: Determinar la presencia del síndrome de bur-nout, estado nutricional y conducta alimentaria en los traba-jadores de la salud. Materiales y Métodos: Estudio transversal, descriptivo y observacional. Para identificar la presencia del síndrome de Burnout se aplicó el cuestionario Maslach Burnout Inventory.La evaluación del estado nutricional se realizó por medio dela toma de datos antropométricos y la conducta alimentaria se identificó con el cuestionario semi-cuantitativo de frecuen-cia de consumo de alimentos. Resultados: La muestra de investigación estuvo constituida por 142 mujeres y 91 varones que representaron el60,9% y 39,1% respectivamente. La conducta alimentaria secaracterizó por un consumo insuficiente de lácteos, hortalizas,frutas, carnes, panes y cereales. Con respecto a las caracte-rísticas antropométricas relacionadas al estado nutricional seencontró que el mayor porcentaje de investigados presentanuna prevalencia de exceso de peso del 78% y un riesgo car-diovascular del 91%. En las 3 subescalas que valora la pre-sencia del síndrome de burnout se pudo observar que tantoen los componentes de cansancio emocional y despersonali-zación son bajos, reflejando un 60,9% y 53,6% respectiva-mente. Mientras que la dimensión de realización personal esalta, evidenciando un 63,1%.Conclusiones: En la población de estudio no existen indicios de presencia de síndrome de burnout, sin embargo, un menor porcentaje de trabajadores de la salud presentan can-sancio emocional (19,3%), despersonalización (25,8%) ybaja realización personal (19,7%). Por lo cual se recomienda, buscar estrategias para reducir la carga administrativa y disminuir el nivel de agotamiento laboral en quienes lo padeceny prevenirlo en aquellos que presenten factores de riesgo (AU)

Introduction: Burnout syndrome or professional exhaustion appears as a response to chronic stress at work, withnegative consequences at an individual and general level. Objective: Determine the presence of burnout syndrome, nutritional status and eating behavior in health workers. Materials and methods: Cross-sectional, descriptive and observational study. To identify the presence of Burnout syndrome, the Maslach Burnout Inventory questionnaire was applied. To assess the nutritional status, anthropometric datawere taken and eating behavior was identified with the semi-quantitative questionnaire on frequency of food consumption. Results: The research sample consisted of 142 womenand 91 men who represented 60.9% and 39.1% respectively. The eating behavior was characterized by an insufficient con-sumption of dairy products, vegetables, fruits, meats, breadsand cereals. Regarding the anthropometric characteristics re-lated to nutritional status, it was found that the highest per-centage of those investigated had a prevalence of excessweight of 78% and a cardiovascular risk of 91%. In the 3 sub-scales that assess the presence of burnout syndrome, it wasobserved that both the emotional exhaustion and deperson-alization components are low, reflecting 60.9% and 53.6%respectively. While the dimension of personal fulfillment ishigh, evidencing 63.1%.Conclusions: In the study population there are no indica-tions of the presence of burnout syndrome, however, a lowerpercentage of health workers present emotional exhaustion(19.3%), depersonalization (25.8%) and low personal fulfillment (19.7%). Therefore, it is recommended to seek strategies to reduce the administrative burden and reduce the levelof job burnout in those who suffer from it and prevent it inthose who present risk factors (AU)

Principales secuelas de SARS-CoV-2 en trabajadores de la salud en Baja California, México / Principal sequels of sars-cov-2 in health workers in Baja California, Mexico

Introducción: La pandemia por COVID-19, impactó en la vida de los trabajadores de la salud por su elevado riesgo de contagio. Objetivo: El objetivo fue describir las principales secuelas secundarias a la infección por SARS-CoV-2 en trabajadores de la salud. Material y Métodos: Estudio retrospectivo en los expedientes clínicos y Nuevo Sistema de Subsidios y Ayudas de los trabajadores de la salud que fueron valuados por una secuela secundaria a la COVID-19 adscritos al Órgano de Operación Administrativa Desconcentrada de Baja California del Instituto Mexicano del Seguro Social de marzo 2020 a diciembre 2021. Resultados: Se valuaron 41 secuelas: 36,56 % presentaron secuela neuromuscular y 29,26 % pulmonares. Predominaron: el sexo femenino, el personal médico y de enfermería. Conclusiones: Es necesario identificar oportunamente aquellas secuelas asociadas al SARS-CoV-2, para brindar una atención especial a los pacientes vulnerables y otorgar un seguimiento que mejore su calidad de vida. (AU)

Introduction: The COVID-19 pandemic impacted the lives of health workers due to its high risk of contagion. Objetives: The objective was to describe the principal sequels secondary to SARS-CoV-2 in healthcare workers. Material and methods: Retrospective study of clinical records and the Nuevo Sistema de Subsidios y Ayudas of health workers who were valued for a secondary sequel to COVID-19 assigned to the Órgano de Operación Administrativa Desconcentrada de Baja California of the Instituto Mexicano del Seguro Social, from March 2020 to December 2021. Results: 41 sequelae were valuated, 36,56 % presented neuromuscular sequelae and 29,26 % pulmonary sequelae. Predominated: the female sex, the medical and nursing staff. Conclusions: It is necessary to timely identify those sequelae associated with SARS-CoV-2, to provide special care to vulnerable patients and follow-up that improve their quality of life. (AU)

Evaluation of Lactobacillus Coryniformis K8 Consumption by Health Care Workers Exposed to COVID-19 (LactoCor2 Project): Protocol for a Randomized Controlled Trial.

BACKGROUND: Lactobacillus coryniformis K8 CECT5711 has immune-modulating properties, enhances the immune response to viral antigens leading to the production of specific antibodies, and has anti-inflammatory activity, which may help to prevent uncontrolled inflammatory processes leading to respiratory and other organ failures. OBJECTIVE: The purpose of this study is to evaluate the effect of the consumption of a probiotic strain on the incidence and severity of COVID-19 in health personnel who carry out their professional work among patients with infection or suspected infection by SARS-CoV-2. METHODS: This is a double-blind randomized clinical trial in which the experimental group will receive a capsule of L coryniformis K8 per day (3×109 colony former units/day), and the control group will receive a daily placebo capsule consisting of maltodextrin. A sample size of 314 volunteers was calculated. Volunteers must meet the following inclusion criteria: older than 20 years and active health personnel caring for patients with COVID-19, including all professionals such as medical doctors, nurses, and caretakers at the 2 referral hospitals that treat patients with COVID-19. The main outcome of the clinical trial will be the incidence of symptomatic infection by SARS-CoV-2 in personnel who care for patients with suspected or confirmed COVID-19. RESULTS: The study had to be extended to the 2 referral hospitals that treat patients with COVID-19 in the province of Granada (Andalusia, Spain); Hospital San Cecilio and Hospital Virgen de las Nieves. A total of 255 individuals met the inclusion criteria and were randomly assigned to one of the 2 groups. CONCLUSIONS: The results of this randomized controlled trial will provide valuable information regarding the administration of L coryniformis K8 against COVID-19, including whether there are fewer infectious processes due to this virus or, in case of occurrence, whether the disease is milder in participants taking the probiotic strain. TRIAL REGISTRATION: ClinicalTrials.gov NCT04366180; http://www.clinicaltrials.gov/ct2/show/NCT04366180. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/37857.

Behind COVID-19 pandemic backstage: anxiety and healthcare workers.

BACKGROUND: COVID- 19 disease causes serious anxiety in healthcare workers. OBJECTIVE: This study was carried out to determine the relationship between the anxiety level of epidemic diseases and occupational satisfaction. METHOD: The "Disease Anxiety Scale," which consists of four subgroups and a total of 18 questions, and the "Vocational Satisfaction Scale," which consists of two subgroups and 20 questions, were utilized to investigate the relationship between epidemic disease anxiety and occupational satisfaction. The statistical analysis was performed using the SPSS 26.0 program. RESULTS: A total of 395 nurses were included in the study. The mean age of the participants was 33, and 63% were women. About 35.4% of the participants had deaths due to the COVID-19 pandemic in their family or close environment. It was determined that 83% of the nurses have a pandemic disease anxiety. Occupational satisfaction and epidemic anxiety level (p = 0.005, r = 0.560), pandemic (p = 0.01, r = 0.525), economic (p = 0.001, r = -0.473), quarantine (p = 0.003, r = -0.503), and social life (p = 0.003, r = -0.507) were found to be negatively correlated. There was no significant difference between job satisfaction (t = 0.286, p = 0.08) and epidemic anxiety (t = 1.312, p = 0.06) in terms of gender. CONCLUSION: Most health-care professionals experience serious anxiety, especially during the pandemic period.

ANTECEDENTES: La enfermedad de COVID- 19 causa ansiedad grave en los trabajadores de la salud. OBJETIVO: Determinar la relación entre el nivel de ansiedad de las enfermedades durante ña epidemia de COVID-19 y la satisfacción laboral. MÉTODO: Se utilizaron la Escala de Ansiedad por Enfermedad, que consta de cuatro subgrupos y un total de 18 preguntas, y la Escala de Satisfacción Vocacional, que consta de dos subgrupos y 20 preguntas, para investigar la relación entre la ansiedad por enfermedad epidémica y la satisfacción laboral. El análisis estadístico se realizó mediante el programa SPSS 26.0. RESULTADOS: La edad media de los participantes fue de 33 años y el 63% eran mujeres. El 35.4% de los participantes tuvieron muertes a causa de la pandemia de COVID-19 en su familia o entorno cercano. Se determinó que el 83% de los profesionales de enfermería tienen ansiedad por enfermedad pandémica. se Se encontraron correlacionados negativamente nivel de satisfacción laboral y ansiedad epidémica (p = 0.005, r = 0.560), pandemia (p = 0.01, r = 0.525), económica (p = 0.001, r = −0.473), cuarentena (p = 0.003, r = −0.503) y vida social (p = 0.003, r = −0.507). No hubo diferencia significativa entre la satisfacción laboral (t = 0.286, p = 0.08) y la ansiedad epidémica (t = 1.312, p = 0.06) en cuanto al sexo. CONCLUSIONES: La mayoría de los profesionales de la salud experimentan una ansiedad grave, en especial durante el período de pandemia.

Prevalencia de Sars-CoV-2 en los profesionales sanitarios de un servicio hospitalario de pediatría / Prevalence of SARS-CoV-2 in health professionals of a hospital pediatric service

La enfermedad por SARS-CoV-2 (COVID-19), declarada pandemia mundial en marzo de 2020, ha afectado a millones de personas en todo el mundo, siendo los profesionales sanitarios uno de los colectivos más expuestos. El objetivo del presente estudio es analizar la prevalencia de la infección por SARS-CoV-2 en los profesionales sanitarios de un área determinada de un hospital terciario durante la primera ola de la pandemia COVID-19 en España. Material y métodos: Se realizó un estudio observacional de tipo transversal, mediante la autocumplimentación de una encuesta voluntaria y anónima por parte de los profesionales sanitarios de los servicios de Pediatría y Maternidad del Hospital Clínico Universitario de Valladolid (HCUV). La encuesta recogió información del período comprendido entre el 10 de marzo y 15 de junio de 2020. Resultado: Participaron en el estudio 177 profesionales de los 231 trabajadores totales en plantilla lo que supuso una participación del 76,6%. Fueron diagnosticadas 37 personas de infección por SARS-CoV-2: 25 personas mediante técnica de Reacción en Cadena de la Polimerasa con Transcriptasa Inversa (RT-PCR) y 12 mediante pruebas serológicas (ELISA). La prevalencia global de infección por SARS-CoV-2 fue de 20,9% y requirieron ingreso hospitalario 3 personas. Conclusión: La prevalencia de infección por SARS-CoV-2 durante la primera ola de la pandemia en el personal sanitario del Servicio de Pediatría y Maternidad del HCUV fue superior a la declarada por la Red de Vigilancia Epidemiológica de Castilla y León. Uno de cada 5 profesionales de la salud del presente estudio ha tenido la infección por SARS-CoV-2. (AU)

SARS-CoV-2 disease (COVID-19), declared a global pandemic in March 2020, has affected millions of people worldwide, with healthcare professionals being one of the most exposed groups. The aim of this study was to analyze the prevalence of SARS-CoV-2 infection in healthcare professionals in a specific area of a tertiary hospital during the first wave of the COVID-19 pandemic in Spain. Material and methods: A transversal observational study was carried out by means of a voluntary and anonymous self-completion survey by healthcare professionals from the Pediatrics and Maternity services of the Hospital Clínico Universitario de Valladolid (HCUV). The survey collected information from the period between 10 March and 15 June 2020. Results: 177 professionals of the 231 total staff participated in the study, which meant a participation rate of 76.6%. SARS-CoV-2 infection was diagnosed by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) in 25 persons and by serological tests (ELISA) in 12 persons. The overall prevalence of SARS-CoV-2 infection was 20.9% and 3 persons required hospital admission. Conclusion: The prevalence of SARS-CoV-2 infection during the first wave of the pandemic among healthcare personnel in the Pediatrics and Maternity Department of the HCUV was higher than that reported by the Epidemiological Surveillance Network of Castilla y León. One in 5 healthcare professionals in the present study had been infected with SARS-CoV-2. (AU)

Estudio de reactogenicidad en las vacunas mRNA frente a la COVID-19 / Reactogenicity Study of mRNA Vaccines Against COVID-19

Objetivo: Comparar la reactogenicidad entre los tipos de vacuna RNAm Commirnaty® (Pfizer) y Spikevax® (Moderna) frente a la COVID-19 en población sanitaria.Métodos: Estudio de prevalencia de los efectos adversos a corto plazo y sus consecuencias tras la administración de la primera y segunda dosis en profesionales y estudiantes de una institución sanitaria. Se administró un cuestionario de síntomas y sus consecuencias a los 7 días de la vacunación. Se calculó la prevalencia e intervalo de confianza del 95% (IC95%). Las diferencias entre vacunas se cuantificaron mediante las odds ratio (OR) e IC95%.Resultados: Completaron el cuestionario 1924 y 1170 sanitarios (tasas de respuesta 62.2% y 39.1%) tras la primera y la segunda dosis, respectivamente, de la vacuna Commirnaty®, y 410 (56.0%) y 107 (15.0%), de Spikevax®. Después de la primera dosis de Comirnaty® un 67,4% presentó algún efecto adverso, y un 76,1% para Spikevax® (OR 1,5 IC95% 1,2-1,9). En general mujeres y jóvenes mostraron mayor reactogenicidad y diferencias entre vacunas. Las consecuencias de los efectos adversos fueron más frecuentes para Spikevax®. La reactogenicidad fue superior tras la segunda dosis que tras la primera, para las dos vacunas (Comirnaty® 67,4% vs. 75,6%; Spikevax® 76,1% vs. 87,9%).Conclusiones: La mayor reactogenicidad y sus consecuencias, para la primera y segunda dosis de la vacuna Spikevax® respecto a Comirnaty®, y de la segunda dosis respecto a la primera dosis de ambas vacunas, aporta conocimiento útil para la planificación de campañas de vacunación frente a la COVID-19 en el entorno sanitario. (AU)

Objective: To compare the reactogenicity between the types of mRNA Commirnaty® (Pfiz-er) and Spikevax® (Moderna) vaccines against COVID-19 in a healthcare population.Methods: Cross sectional study of short-term adverse effects and their consequences (sick leave, limitations of daily life, etc.) after the administration of the first and second doses of both vaccines in professionals and students of a health institution. A questionnaire on symptoms and their consequences was administered seven days after each vaccination dose. The prevalence and 95% confidence interval (95%CI) were calculated. Differences be-tween vaccines were quantified using the odds ratio (OR) and its 95%CI.Results: The questionnaire was completed by 1924 and 1170 healthcare providers (re-sponse rates 62.2% and 39.1%) after the first and second doses, respectively, of the Com-mirnaty® vaccine, and 410 (56.0%) and 107 (15.0%) of Spikevax®. After the first dose of Comirnaty®, 67.4% presented some adverse effect, and 76.1% for Spikevax® (OR 1.5 95%CI 1.2-1.9). In general, women and young people showed greater reactogenicity and differences between vaccines. Consequences of adverse effects were more frequent for Spikevax®. The reactogenicity was higher after the second than the first dose, for both vaccines (Comirnaty®: 67.4% vs. 75.6%; Spikevax®: 76.1% vs. 87.9%Conclusions: The greater reactogenicity and its consequences, for the first and second dose of the Spikevax® vaccine compared to Comirnaty®, and of the second dose com-pared to the first dose of both vaccines, provides useful knowledge for planning vaccination against COVID-19 campaigns in healthcare settings (AU)

Ética de los sentimientos, desarrollo de capacidades, memoria histórica y reconciliación: la fragilidad del personal de salud en el conflicto armado colombiano / Ètica dels sentiments, desenvolupament de capacitats, memòria històrica i reconciliació: la fragilitat del personal de salut al conflicte armat colombià / Ethics of feelings, capacity building, historical memory, and reconciliation: the fragility of health personnel in the Colombian armed conflict

Objetivo: analizar la forma en que los sentimientos y la recuperación de la memoria colectiva, posibilitan la disminución de la fragilidad social y política de los integrantes de la Misión Médica, haciendo factible nuevas maneras de participación, mediante el desarrollo de capacidades deliberativas desde la perspectiva bioética. Metodología: estudio exploratorio con enfoque cualitativo, que toma en cuenta la subjetividad e intersubjetividad de los participantes. Con fuentes de información heterogénea: grupos focales, entrevistas semiestructuradas y cartillas de campo, se constituyó un marco de factores relevantes, que permitieron procesar la información, mediante relaciones y categorizaciones conceptuales,para su posterior triangulación. Resultados: los sentimientos con mayor impacto ético en Misión Médica: incertidumbre, inseguridad ante el trabajo, ansiedad por los hechos de violencia, tristeza, temor, miedo e impotencia; producen efectos emocionales relacionados con el principio de maleficencia. La resiliencia, ha impedido realizar ejercicios de memoria colectiva, a causa del negacionismo y temor a recordar los hechos más significativos, esto les ha impedido el acceso a los mecanismos de Justicia Restaurativa. La ausencia de capacidades para afrontar la situación compromete la autonomía individual, la salud laboral y genera carencias legales no resueltas. Conclusiones: los sentimientos colectivos en el ámbito público del personal sanitario prevalecen sobre los sentimientos individuales basados en vivencias, que afectan la capacidad de deliberación, esto implica promover ejercicios de memoria colectiva, sobre los hechos del conflicto, mediante el desarrollo de capacidades que fortalezcan la legitima defensade su autonomía y el desarrollo de un ejercicio profesional beneficiente, ante situaciones limítrofes de confrontación.(AU)

Objectiu: analitzar la manera com els sentiments i la recuperació de la memòria col·lectiva, possibiliten la disminució de la fragilitat social i política dels integrants de la Missió Mèdica, fent factible noves maneres de participació, mitjançant el desenvolupament de capacitats deliberatives des de la perspectiva bioètica. Metodologia: estudi exploratori amb enfocament qualitatiu, que té en compte la subjectivitat i la intersubjectivitat dels participants. Amb fonts d'informació heterogènia: grups focals, entrevistes semiestructurades i cartilles de camp, es va constituir un marc de factors rellevants, que van permetre processar la informació, mitjançant relacions i categoritzacions conceptuals, per triangular-les posteriorment. Resultats: els sentiments amb més impacte ètic a Missió Mèdica: incertesa, inseguretat davant la feina, ansietat pels fets de violència, tristesa, temor, por i impotència; produeixen efectes emocionals relacionats amb el principi de maleficència. La resiliència, ha impedit fer exercicis de memòria col·lectiva, a causa del negacionisme i temor de recordar els fets més significatius, això els ha impedit l'accés als mecanismes de Justícia Restaurativa. L'absència de capacitats per fer fronta la situació compromet l'autonomia individual, la salut laboral i genera mancances legals no resoltes. Conclusions: els sentiments col·lectius en l'àmbit públic del personal sanitari prevalen sobre els sentiments individuals basats en vivències, que afecten la capacitat de deliberació, això implica promoure exercicis de memòria col·lectiva, sobre els fets del conflicte, mitjançant el desenvolupament de capacitats que enforteixin la legítima defensa de la seva autonomia i el desenvolupament d'un exercici professional beneficient, davant de situacions limítrofes de confrontació.(AU)

Objective: to analyze the way in which feelings and the recovery of collective memory make it possible to reduce the social and political fragility of the members of the Medical Mission, making new ways of participation feasible, through the development ofdeliberative capacities from a bioethical perspective. Methodology: exploratory study with qualitative approach, which considers the subjectivity and intersubjectivity of the participants. With heterogeneous sources of information: focus groups, semi-structured interviews and field primers, a framework of relevant factors was constituted, which allowed processing the information, through conceptual relationships and categorizations, for its subsequent triangulation. Results: the feelings with the greatest ethical impact in Mission Medical: uncertainty, insecurity at work, anxiety due to acts of violence, sadness, fear, fear, and impotence; produce emotional effects related to the principle of maleficence. Resilience has prevented them from carrying out collective memory exercises, due to denial and fear of remembering the most significant events, which has prevented them from accessing Restorative Justice mechanisms. The absence of capacities to face the situation compromises individual autonomy, occupational health and generates unresolved legal shortcomings. Conclusions: collective feelings in the public sphere of health personnel prevail over individual feelings based on experiences, which affect the capacity for deliberation, this implies promoting exercises of historical memory on the facts of the conflict, through the development of capacities that strengthen the legitimate defense of their autonomy and the development of a beneficial professional exercise, in the face of borderline situations of confrontation.(AU)

Mortalidad de médicos por COVID-19 de acuerdo con su especialidad en la primera y segunda ola de la pandemia en el Perú

Introducción : El COVID-19 es una enfermedad infecciosa, declarada pandemia por la OMS en marzo 2020. Ha causado millones de muertes, incluidos médicos en el mundo. El objetivo fue determinar las características de la mortalidad de médicos por COVID-19 y la tasa de mortalidad específica por especialidad durante la pandemia del COVID-19 en el Perú. Material y métodos: Estudio descriptivo que evalúo la totalidad de médicos fallecidos reportados por el Colegio Médico del Perú hasta noviembre 2021 y que cumplieron con tener su certificado de defunción. Se definió tres grupos: médicos especialistas con alto (EMACC) y bajo contacto (EMBCC) con pacientes COVID-19 y médicos sin especialidad. Resultados: La edad >60 años y tener el sexo masculino en los EMACC mostraron un p=0,003 y 0,016 respectivamente. El 69,4% de médicos fallecieron en Lima y donde más fallecieron fue Hospital Rebagliati Martins (21%). La mayor tasa de mortalidad específica por especialidad (TME) fue 29,7 y 25,0 en epidemiología y administración de salud respectivamente. En la ciudad de Lima, fallecieron 69,4% de médicos, principalmente el grupo de EMBCC. Conclusión: Los médicos varones y >60 años son los que murieron con mayor frecuencia, sobre todo en la ciudad de Lima y en el grupo de EMACC. Las mayores tasas de mortalidad por el COVID-19 ha sido en el grupo de EMBCC.

Introduction: COVID-19 is an infectious disease declared a pandemic by the WHO in March 2020. It has caused millions of deaths, including among doctors in the world. The objective was to determine the characteristics of physician mortality from COVID-19 and the specific mortality rate by specialty during the COVID-19 pandemic in Peru. Material and methods: Descriptive study that evaluated all deceased physicians reported by the Medical College of Peru until November 2021 and who complied with having their death certificate. Three groups were defined: specialist physicians with high (EMACC) and low (EMBCC) contact with COVID-19 patients and physicians without a specialty. Results: Age >60 years and males in the EMACC showed p=0.003 and 0.016, respectively. 69.4% of doctors died in Lima, and most died at Rebagliati Martins Hospital (21%). The highest specialty-specific mortality rate was 29.7 and 25.0 in epidemiology and health administration, respectively. In Lima, 69.4% of physicians died, mainly in the EMBCC group. Conclusion: Male physicians >60 years old are the ones who die more frequently, especially in the city of Lima and in the EMACC group. The highest mortality rates from COVID-19 were in the EMBCC group.

Concepções e contribuições de trabalhadores de saúde sobre ambiente de trabalho saudável / Concepciones y contribuciones de trabajadores de la salud sobre ambientes de trabajo saludables / Health workers' conceptions and contributions regarding healthy work environments

Objetivo: discutir concepções e contribuições de trabalhadores de uma instituição hospitalar, acerca de ambientes de trabalho saudáveis. Método: estudo exploratório descritivo, de abordagem qualitativa, que entrevistou 21 trabalhadores do Serviço de Saúde Ocupacional e Segurança do Trabalho e da Comissão Interna de Prevenção de Acidentes de um hospital público de grande porte da região Norte do país. Os dados foram analisados pela Análise de Conteúdo Focal apoiada por recursos do software ATLAS.ti, 9.0. Resultados: quatro categorias foram geradas: condições necessárias: materiais e pessoal; desafios a superar: gestão, reconhecimento, desgaste e acolhimento; sugestões e ferramentas; concepções para um ambiente de trabalho saudável. As contribuições apreendidas na análise indicam componentes que se referem ao bem-estar ao trabalhar, efetiva proteção e controle de riscos, e relações interpessoais positivas. Considerações finais: os trabalhadores de saúde expressam fragilidades e necessidades que podem contribuir para a compreensão, intervenções e melhorias dos ambientes do trabalho.

Objetivo: debatir concepciones y contribuciones de trabajadores de una institución hospitalaria sobre ambientes de trabajo saludables. Método: estudio cualitativo en el que se entrevistó a 21 trabajadores del Servicio de Seguridad y Salud en el Trabajo y de la Comisión Interna de Prevención de Accidentes de un hospital público de gran porte de la región norte del país. Los datos se analizaron mediante análisis de contenido focal compatible con características del software ATLAS.ti, 9.0. Resultados: se generaron cuatro categorías: Condiciones necesarias: materiales y personal; Retos a superar: gestión, reconocimiento, desgaste y aceptación; Sugerencias y herramientas; y (Concepciones) para ambientes de trabajo saludables. Los aportes derivados del análisis señalan componentes que se refieren al bienestar en el trabajo, protección y control de riesgos efectivos, y relaciones interpersonales positivas. Consideraciones finales: los trabajadores de la salud expresan debilidades y necesidades que pueden contribuir a la comprensión, intervenciones y mejoras en los ambientes de trabajo.

Objective to discuss conceptions and contributions of hospital workers about healthy work environments. Method: a qualitative study that interviewed 21 workers from the Occupational Health and Safety Service and the Internal Accident Prevention Commission from a large-sized public hospital in the northern region of the country. The data were analyzed by means of Focal Content Analysis supported by ATLAS.ti, 9.0 software features. Results: four categories were generated: Necessary conditions: materials and personnel; Challenges to overcome: management, recognition, attrition and acceptance; Suggestions and tools; and (Conceptions) for healthy working environments. The contributions seized in the analysis indicate components that refer to well-being at work, effective protection and risk control, and positive interpersonal relationships. Final considerations: health workers express weaknesses and needs that can contribute to understanding, interventions and improvements in work environments.

Conflito distributivo: análise do Programa de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB) em duas capitais nordestinas / Conflicto distributivo: análisis del Programa de Mejora del Acceso y Calidad de la Atención Básica (PMAQ-AB) en dos capitales del nordeste de Brasil / Distributive conflict: analysis of the Program for Improving Access and Quality of Primary Care (PMAQ-AB) in two Brazilian northeastern capitals

Este artigo analisa a execução do PMAQ-AB a partir de sua contextualização em um cenário político nacional de profundas transformações, desde o reformismo fraco que promoveu lenta extensão de direitos até o contrarreformismo forte da restauração neoliberal. Para debater os elementos relacionados ao trabalho e às disputas pela distribuição dos recursos públicos, foi realizado estudo de caso com trabalhadores, gestores e conselheiros de saúde em duas capitais do nordeste brasileiro. Os resultados evidenciam o acirramento do conflito distributivo e o resultado desfavorável aos trabalhadores no contexto pós-golpe parlamentar de 2016. As dinâmicas locais expõem processos de contração salarial e individualização das relações de trabalho e a reafirmação da meritocracia como justificativa ideológica da precarização. A isso, trabalhadores se contrapõem pela reafirmação de sua condição coletiva de classe, em favor de benefícios derivados do PMAQ, como recomposição salarial para todos.(AU)

Este artículo analiza la realización del PMAQ-AB a partir de su contextualización en un escenario político nacional de profundas transformaciones, desde el reformismo débil que promovió una lenta extensión de derechos contra el reformismo fuerte de la restauración neoliberal. Para discutir los elementos relacionados al trabajo y a las disputas por la distribución en los recursos públicos se realizó un estudio de caso con trabajadores, gestores y consejeros de salud en dos capitales del nordeste brasileño. Los resultados ponen en evidencia el recrudecimiento del conflicto distributivo y el resultado desfavorable para los trabajadores en el contexto post-golpe parlamentario de 2016. Las dinámicas locales exponen procesos de contracción salarial e individualización de las relaciones de trabajo y la reafirmación de la meritocracia como justificativa ideológica de la precarización. A eso se contraponen los trabajadores por medio de la reafirmación de su condición colectiva de clase, en favor del beneficio derivado del PMAQ con la recomposición salarial para todos.(AU)

This article analyzes the implementation of the Program for Improving Access and Quality of Primary Care (PMAQ-AB) in the context of a national political scenario of deep transformations, from the weak reformism that promoted slow extension of rights to the strong counter-reformism of neoliberal restoration. It is a case study with health workers, managers, and counselors in two capital cities in northeastern Brazil, discussing matters of work and distributive disputes of public resources. Results show the intensification of these conflicts in health and the unfavorable outcome for workers after the parliamentary coup in 2016 political context. Local dynamics expose the wage contraction and individualization of labor relations and the reassertion of meritocracy as an ideological ground for precariousness. Workers oppose this, reaffirming their collective class condition, favoring the benefit derived from PMAQ for fully regaining their group wages.(AU)

Moral injury and mental health among health-care workers during the COVID-19 pandemic: meta-analysis.

Background: During the COVID-19 pandemic, health-care workers (HCWs) may have been confronted with situations that may culminate in moral injury (MI). MI is the psychological distress that may result from perpetrating or witnessing actions that violate one's moral codes. Literature suggests that MI can be associated with mental health problems.Objective: We aimed to meta-analytically review the literature to investigate whether MI is associated with symptoms of posttraumatic stress disorder (PTSD), anxiety, depression, burnout, and suicidal ideation among active HCWs during the COVID-19 pandemic.Method: We searched eight databases for studies conducted after the onset of the COVID-19 pandemic up to 18 July 2023, and performed random-effects meta-analyses to examine the relationship between MI and various mental health outcomes.Results: We retrieved 33 studies from 13 countries, representing 31,849 individuals, and pooled 79 effect sizes. We found a positive association between MI and all investigated mental health problems (rs = .30-.41, all ps < .0001). Between-studies heterogeneity was significant. A higher percentage of nurses in the samples was associated with a stronger relationship between MI and depressive and anxiety symptoms. Samples with a higher percentage of HCWs providing direct care to patients with COVID-19 exhibited a smaller effect between MI and depressive and anxiety symptoms. We observed a stronger effect between MI and PTSD symptoms in US samples compared to non-US samples.Conclusion: We found that higher MI is moderately associated with symptoms of PTSD, anxiety, depression, burnout, and suicidal ideation among HCWs during the COVID-19 pandemic. Our findings carry limitations due to the array of MI scales employed, several of which were not specifically designed for HCWs, but underscore the need to mitigate the effect of potentially morally injurious events on the mental health of HCWs.

We conducted the first meta-analysis of moral injury and mental health among healthcare workers.Moral injury is moderately associated with symptoms of PTSD, depression, anxiety, burnout, and suicidal ideation.There was a stronger association between MI and anxiety and depressive symptoms for samples with more nurses.

Superexploração da força de trabalho na saúde em um contexto de pandemia de Covid-19 no Brasil / Superexploitation of the health workforce in the context of the COVID-19 pandemic in Brazil / Sobreexplotación de la fuerza de trabajo de salud en el contexto de la pandemia de COVID-19 en Brasil

Resumo O capitalismo, na sua etapa de dominância do capital fictício, acentuado pelas dimensões de sua crise pandêmica, econômica e ecológica, tem intensificado a superexploração da força de trabalho no mundo e, particularmente, no Brasil. Nessa perspectiva, o presente artigo tem como objetivo analisar as manifestações da superexploração da força de trabalho entre trabalhadores(as) da saúde em um contexto de pandemia de Covid-19 no Brasil. O artigo está estruturado em quatro partes. A primeira discute as dimensões do valor da força de trabalho. A segunda aborda os mecanismos de superexploração da força de trabalho. A seção seguinte discorre acerca das manifestações da superexploração entre os(as) trabalhadores(as) da saúde, nos últimos anos. E a parte final apresenta dados de como tem ocorrido ou acontecido a superexploração no cenário da pandemia de Covid-19 no Brasil. Atualmente, em um cenário de pandemia de Covid-19, observa-se um percentual significativo de profissionais da saúde com sobrecarga de trabalho, com jornadas para além das 40 horas semanais, alguns tendo que recorrer a mais de um vínculo de trabalho para poder sobreviver. Tais manifestações representam as péssimas condições de trabalho dessa categoria de trabalhadores, além de contribuir para o adoecimento e o elevado número de acidentes de trabalho.

Abstract Capitalism, in its stage of dominance of fictitious capital, accentuated by the dimensions of its pandemic, economic and ecological crisis, has intensified the superexploitation of the labor force in the world and, particularly, in Brazil. In this perspective, this article aims to analyze the manifestations of the superexploitation of the workforce among health workers in the context of the COVID-19 pandemic in Brazil. The article is structured in four parts. The first discusses the dimensions of the value of labor power. The second deals with the mechanisms of superexploitation of the workforce. The following section discusses the manifestations of superexploitation among health workers in recent years. And the final part presents data on how superexploitation has occurred in the scenario of the COVID-19 pandemic in Brazil. Currently, in the COVID-19 pandemic scenario, there is a significant percentage of health professionals with work overload, with working hours beyond 40 hours per week, some having to resort to more than one employment relationship to survive. Such manifestations represent the terrible working conditions of this category of workers, in addition to contributing to illness and the high number of accidents at work.

Resumen El capitalismo, en su etapa de dominación del capital ficticio, acentuado por las dimensiones de su crisis pandémica, económica y ecológica, ha intensificado la sobreexplotación de la fuerza de trabajo en el mundo y, particularmente, en Brasil. Desde esta perspectiva, este artículo tiene como objetivo analizar las manifestaciones de sobreexplotación de la fuerza de trabajo entre los trabajadores y trabajadoras de la salud en un contexto de pandemia de COVID-19 en Brasil. El artículo está estructurado en cuatro partes. La primera discute las dimensiones del valor de la fuerza de trabajo. La segunda aborda los mecanismos de sobreexplotación de la mano de obra. En la siguiente sección se analizan las manifestaciones de la sobreexplotación entre los trabajadores y trabajadoras de la salud en los últimos años. Y la parte final presenta datos sobre cómo se ha producido u ocurrió la sobreexplotación en el contexto de la pandemia de COVID-19 en Brasil. Actualmente, en un escenario de la pandemia del COVID-19, existe un porcentaje importante de profesionales de la salud con sobrecarga laboral, trabajando más de 40 horas a la semana, teniendo algunos que recurrir a más de un empleo para poder subsistir. Tales manifestaciones representan las malas condiciones de trabajo de esta categoría de trabajadores, además de contribuir a la enfermedad y al elevado número de accidentes de trabajo.

Face mask and protective eyewear-associated headache among healthcare workers during the COVID-19 pandemic.

OBJECTIVE: The objective of this study was to investigate the prevalence, clinical features, and factors related to personal protective-associated headaches. METHODS: We conducted a cross-sectional study among healthcare workers using an online questionnaire. RESULTS: We surveyed 305 participants. The N95 face-mask was the most used device by 93%. Of 305 respondents, 206 experienced headaches while wearing protective equipment; 36.06% suffered from a headache disorder before the pandemic. The prevalence of de novo headache was 39.01%. Gender, age, or exposure to coronavirus disease were not determining factors to develop headache. Headache intensity was higher in front-line healthcare workers and was correlated (r = 0.728) with the time wearing protective equipment. The more days per month the participants wore personal protective equipment the shorter the time to headache onset after donning equipment. CONCLUSION: Our study confirms the relationship between frequent and prolonged use of protection devices with headaches and reaffirms the implication of external pressure as a primary mechanism.

OBJETIVO: Investigar la prevalencia, las características clínicas y los factores relacionados con las cefaleas asociadas al equipo de protección personal. MÉTODOS: Realizamos un estudio transversal entre trabajadores de la salud por medio de un cuestionario en línea. RESULTADOS: Encuestamos a 305 participantes. La mascarilla N95 fue el dispositivo más utilizado opor 93%. Del total de encuestados, 206 experimentaron cefalea mientras usaban el equipo de protección; el 36.06% padecía algun trastorno cefalálgico antes del inicio de la pandemia. La prevalencia de cefalea de novo fue del 39.01%. El género, la edad o la exposición a la enfermedad por coronavirus no fueron factores determinantes para desarrollar cefalea. La cefalea fue de mayor intensidad en los trabajadores de primera línea y se correlacionó (r = 0.728) con el tiempo que se uso el equipo de protección personal. Mientras más días por mes los participantes usaron el equipo de protección personal menor fue el tiempo de inicio de la cefalea tras la colocación del equipo cada vez. CONCLUSIONES: Nuestro estudio confirma la asociación del uso frecuente y prolongado de dispositivos de protección con el desarrollo de cefalea y reafirma la implicación de la compresión externa como mecanismo primario.

Síntomas depresivos, ansiosos e insomnio, y posibles factores asociados en personal de salud, en un Hospital General en Suramérica, durante la pandemia por COVID-19 en 2020 / Depressive and anxious symptoms and insomnia, and possible associated factors in health workers, in a General Hospital in South America, during the COVID-19 pandemic in 2020

La pandemia por el nuevo coronavirus COVID- 19 ha tenido impacto en la salud mental del personal médico y de enfermería en todo el mundo. Objetivo: identificar la frecuencia de síntomas depresivos, ansiosos e insomnio y los factores posiblemente relacionados con estos desenlaces en el personal sanitario de un hospital de Suramérica durante el primer pico de la pandemia. Materiales y métodos: se aplicaron las escalas PHQ-9 para depresión, GAD- 7 para ansiedad, ISI - 7 para insomnio en 876 trabajadores de la salud del Hospital Pablo Tobón Uribe en la ciudad de Medellín. Resultados: de los 876 participantes (29,2% médicos, 21.2% profesionales de enfermería y 49,5% auxiliares de enfermería), 357 (40.8%) presentaron síntomas depresivos, 300 (34.2%) síntomas ansiosos y 317 (36.2%) insomnio. Se observaron síntomas de depresión, ansiedad e insomnio, con mayor frecuencia en quienes no tenían las necesidades básicas satisfechas y en quienes se sentían estigmatizados por ser personal de salud. Además, la depresión se presentó con más frecuencia en mujeres, la ansiedad en menores de 44 años y el insomnio en personas separadas. Conclusiones: la frecuencia de problemas de salud mental en el personal de salud es considerable. Estos hallazgos demuestran la necesidad de atención en la salud mental de los profesionales médicos y de enfermería durante la pandemia por COVID-19 y la búsqueda de estrategias para mitigar el riesgo en esta población.

Background: pandemic due to novel coronavirus COVID-19 has impacted on the mental health of health care workers all around the world. Material and Methods: this is a cross sectional study in which questionnaires PHQ-9 for depression, GAD-7 for anxiety, ISI-7 for insomnia were virtually and self administered by 876 health care workers laboring in hospital Pablo Tobón Uribe in Medellin city. Results: from 876 participants (29.2% physicians, 21.2% nurses and 49.5% technical nurses), 357 (40.8%) developed depressive symptoms, 300 (34.2%) anxious symptoms and 317 (36.2%) insomnia. Symptoms of depression, anxiety and insomnia were more frequently found in those who did not have basic needs satisfied and in those who felt stigmatized due to being health personal. Besides, depressive symptoms were more frequent in women, anxious symptoms in people younger than 44 years old and insomnia in divorced people. Conclusions: the frequency of mental health problems in health care workers is significant, these findings bring to light the needs for mental health attention in nurses and doctors during COVID-19 pandemic and the research of strategies to mitigate the risk on this population. Feeling stigmatized and not having basic needs satisfied were associated with symptoms of anxiety, depression and insomnia.

Sars-CoV-2 infection rate in employees of a medium and high complexity hospital / Velocidad de la infección con Sars-CoV-2, en funcionarios en un hospital de mediana y alta complejidad

Introduction: The coronavirus disease 2019 (COVID-19) was originally identified in the city of Wuhan, China, in December 2019. Current evidence indicates that the COVID-19-causing virus is transmitted person-to-person through direct contact and droplets. Objective: To estimate Sars-CoV-2 virus infection rate in hospital employees according to their job responsibilities. Materials and methods: Retrospective cohort study to detect Sars-CoV-2 infection in hospital employees, carried out between February 2020 and October 2021. The Kaplan Meier procedure was carried out to estimate the virus infection rate based on variables such as gender, age and job description. Results: There was a difference in infection rate between young and older adult age groups (Log Rank=18.6 gl=1 p=<0.0001). A significant difference was also found between young adult and older adult groups (Log Rank=10.6 gl=1 p=0.0011). Conclusions: The older adult group showed a higher infection rate than that observed in younger age groups. These findings highlight the occupational risk of Sars-CoV-2 infection in health workers, especially in older employees. Therefore, it is necessary to maintain safety measures in order to reduce infection risks.

Introducción: La enfermedad por coronavirus 2019 se identificó originalmente en la ciudad de Wuhan, China, en diciembre de 2019. La evidencia actual indica que el virus que causa la COVID-19 se transmite de persona a persona a través del contacto directo y gotitas. Objetivo: Estimar la tasa de infección por el virus Sars-CoV-2 en empleados de hospitales según sus responsabilidades laborales. Materiales y métodos: Estudio de cohorte retrospectivo para detectar infección por Sars-CoV-2 en empleados de hospitales, realizado entre febrero 2020 y octubre 2021. Se realizó el procedimiento de Kaplan Meier para estimar la tasa de infección del virus según género, edad y descripción del trabajo. Resultados: Hubo una diferencia en la tasa de infección entre los grupos de edad de adultos jóvenes y mayores (Log Rank=18,6 gl=1 p=<0,0001). Se encontró una diferencia significativa entre grupos de adultos jóvenes y adultos mayores (Log Rank=10.6 gl=1 p=0.0011). Conclusiones: Los adultos mayores presentaron una tasa de infección superior a la observada en grupos de edades más jóvenes. Se resalta el riesgo ocupacional de infección por Sars-CoV-2 en los trabajadores de la salud, especialmente en los empleados de mayor edad. Es necesario mantener las medidas de seguridad para reducir los riesgos de infección.

[Determinantes del puntaje PHQ 9 para síntomas depresivos mayores en trabajadores de la salud durante la pandemia de COVID-19 mediante técnicas de machine learning].

Introducción y objetivos: La pandemia por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) ha generado efectos psicológicos y sociales negativos en el personal de salud según se evidenció en la encuesta IMPPACTS-SAC20. Nuestro objetivo es determinar qué dominios del Patient Health Questionnaire (PHQ 9) tienen más influencia en el diagnóstico de depresión mayor e identificar subpoblaciones con elevada prevalencia de esta enfermedad. Métodos: Subanálisis de la encuesta IMPPACTS-SAC20. Se utilizaron técnicas de machine learning no supervisado para realizar un análisis factorial y generar subgrupos de casos similares en cuanto a su desempeño en el puntaje PHQ 9. Resultados: Se incluyeron 1,221 encuestados que respondieron el puntaje PHQ 9. El análisis factorial demostró la presencia de dos dimensiones principales (neurastenia y autopercepción negativa) que explican el 67.2% de la varianza del cuestionario (prueba KMO 0.911, Bartlett p < 0.001). La combinación de ambas dimensiones en un análisis jerárquico generó 9 clusters. Los grupos 5, 4, 2 y 1 explican el 93% de los casos de depresión mayor. Los grupos 5 y 4 presentaron valores más elevados de neurastenia, y los grupos 2 y 1 de autopercepción negativa. Los grupos 6, 7 y 8 en su conjunto presentaron una prevalencia de depresión mayor del 0.6%. Conclusión: La implementación de técnicas de machine learning detectó dos dimensiones dentro del puntaje PHQ 9, la neurastenia y la autopercepción negativa. Se evidenciaron subgrupos de alta prevalencia de depresión mayor, cuyas principales características clínicas fueron el sexo femenino, el consumo de alcohol, el tabaquismo y la intención suicida.