Hostigamiento laboral y síndrome de burnout en personal sanitario en un hospital de referencia

Objetivo: Evaluar la asociación entre la exposición a hostigamiento laboral y la presencia de síndrome de burnout en el personal sanitario de un hospital de referencia peruano. Materiales y métodos: Estudio transversal, analítico. Se incluyó a médicos internistas, cirujanos, enfermeras, residentes, internos de medicina y técnicos de enfermería de los departamentos de Medicina y Cirugía del Hospital Nacional Hipólito Unanue en Lima, Perú. Se usaron los cuestionarios Maslach Burnout Inventory-Human Services Survey (MBI-HSS) y Negative Acts Questionnaire-Revised (NAQ-R) para la detección de burnout y hostigamiento, respectivamente. Adicionalmente, se evaluó la asociación con la edad, género, ocupación, estado civil, lugar de trabajo, conformidad con salario, carga familiar, actividad física, hábitos nocivos, vacaciones, afiliación religiosa, número de trabajos, remuneración mensual, tiempo de trabajo, horas laborales por semana, número de pacientes atendidos por día, guardias semanales y horas de descanso. El análisis multivariado se realizó mediante el uso de un modelo de regresión logística múltiple, para lo cual se utilizó como variable respuesta la presencia o no de burnout. Resultados: Se incluyeron a 206 participantes. De ellos, 22 (10,7 %) presentaron burnout y 27 (14 %), hostigamiento moderado a elevado. En el análisis bivariado, la edad (OR 0,94; IC 95 % 0,89-0,99; p = 0,02), el estado civil casados y convivientes (OR 2,85; IC 95 % 1,01-8,06; p = 0,04) y el hostigamiento (OR 5,20; IC 95 % 1,92-14,09; p = 0,009) se asociaron a la presencia de burnout. En el análisis multivariado, el único predictor significativo de burnout fue el hostigamiento laboral. La presencia de un hostigamiento moderado a elevado se asoció a un OR de 4,00 (IC 95 % 1,4-11,3; p = 0,009) comparado con bajos niveles de hostigamiento. Conclusiones: Es importante identificar a trabajadores de la salud con hostigamiento laboral por su fuerte asociación con el síndrome de burnout. Se considera indispensable la realización de una investigación complementaria que permita entender y abordar la problemática del hostigamiento laboral y su influencia en el desarrollo de burnout, así como estudios que permitan evaluar intervenciones destinadas a prevenir tanto el hostigamiento laboral como el burnout.

Objective: To determine the association between workplace harassment and burnout syndrome among healthcare personnel of a Peruvian referral hospital. Materials and methods: An analytical cross-sectional study which included internists, surgeons, nurses, residents, interns and nursing technicians from the Medicine and Surgery departments of Hospital Nacional Hipólito Unanue in Lima, Peru. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Negative Acts Questionnaire-Revised (NAQ-R) were used for the assessment of burnout and harassment, respectively. Additionally, the association with age, gender, occupation, marital status, workplace, salary satisfaction, family burden, physical activity, harmful habits, vacations, religious affiliation, number of jobs, monthly remuneration, job tenure, working hours per week, number of patients seen per day, weekly shifts and rest hours was evaluated. A multivariate analysis was conducted using a multiple logistic regression model and the presence or absence of burnout as an outcome variable. Results: The study consisted of 206 participants, out of whom 22 (10.7 %) suffered burnout and 27 (14 %) moderate to severe harassment. In the bivariate analysis, age (OR 0.94; 95 % CI 0.89-0.99; p = 0.02), marital status such as married and cohabiting (OR 2.85; 95 % CI 1.01-8.06; p = 0.04) and harassment (OR 5.20; 95 % CI 1.92-14.09; p = 0.009) were associated with burnout. In the multivariate analysis, the only significant predictor of burnout was workplace harassment. Moderate to severe harassment was associated with OR 4.00 (95 % CI 1.4-11.3; p = 0.009) compared to mild harassment. Conclusions: It is important to identify health workers suffering workplace harassment due to its strong association with burnout syndrome. It is essential to carry out further research to understand and address the problem of workplace harassment and its influence on the development of burnout, as well as studies to evaluate interventions aimed at preventing both workplace harassment and burnout.

Efecto del tinnitus sobre la calidad de vida y sus factores asociados en pacientes adultos / Effects of Tinnitus on the Quality of Life and its Associated Factors in Adult Patients

Introducción: El tinnitus es una condición de alta prevalencia que puede afectar la calidad de vida. Objetivos: Evaluar la calidad de vida y sus factores asociados en pacientes adultos con tinnitus. Métodos: Estudio analítico transversal. La población incluida fueron pacientes adultos con síntoma de tinnitus, atendidos en el servicio de otorrinolaringología en un hospital de referencia en Lima, Perú. El efecto del tinnitus sobre la calidad de vida fue medida mediante el cuestionario Tinnitus Handicap Inventory. Resultados: Se incluyeron 151 pacientes con tinnitus; 31,2 por ciento fueron varones y la media de edad fue 66 años, 17,2 por ciento y 23,1 por ciento de pacientes con tinnitus tuvieron antecedentes de trastornos depresivos y desórdenes de ansiedad, respectivamente; 85,4 por ciento y 62,2 por ciento de pacientes con tinnitus presentaron hipoacusia y cefalea, respectivamente. El Tinnitus Handicap Inventory tuvo una mediana de 26 (rango intercuartil: 8-50), un valor mínimo de 0 y un valor máximo de 100. De los pacientes, 101 (66,8 por ciento) tuvieron una discapacidad leve a moderada debido al tinnitus y 50 (33 por ciento) discapacidad moderada a severa. En el análisis multivariado se encontró que la ansiedad (OR = 2,59; IC 95 por ciento 1,14-5,9; p = 0,02), hipoacusia (OR = 12,9; IC 95 por ciento 1,65-102,1; p= 0,01) y cefalea (OR = 2,61; IC 95 por ciento 1,18-5,8; p = 0,01) se asociaron con discapacidad moderada a severa debido al tinnitus. Conclusiones: Los pacientes adultos con tinnitus frecuentemente tuvieron una afectación moderada a severa de su calidad de vida. Los factores asociados a discapacidad moderada a severa debido a tinnitus fueron la ansiedad, cefalea e hipoacusia(AU)

Introduction: Tinnitus is a highly prevalent condition that can affect the quality of life of patients. Objective: To assess the quality of life and its associated factors in adult patients with tinnitus. Methods: Cross-sectional and analytical study carried out with a population that included adult patients with tinnitus symptoms attended in the otorhinolaryngology service of a reference hospital in Lima, Peru. The effect of tinnitus on quality of life was measured using the Tinnitus Handicap Inventory. Results: The study included 151 patients with tinnitus: 31.2 percent were male and the mean age was 66 years, while 17.2 percent and 23.1 percent of patients with tinnitus had a history of depressive disorders and anxiety disorders, respectively. Of tinnitus patients, 85.4 percent and 62.2 percent had hearing loss and headache, respectively. The Tinnitus Handicap Inventory showed a median value of 26 (interquartile: 8-50), a minimum value of 0, and a maximum value of 100. Of the patients, 101 (66.8 percent) had mild to moderate disability due to tinnitus, while 50 (33 percent) had moderate to severe disability. In multivariate analysis, anxiety (OR=2.59; 95 percent CI: 1.14-5.9; P= 0.02), hearing loss (OR= 12.9; 95 percent CI: 1.65-102.1; P= 0.01) and headache (OR= 2.61; 95 percent CI 1.18-5.8; p= 0.01) were found to be associated with moderate to severe disability due to tinnitus. Conclusions: Adult patients with tinnitus frequently had moderate to severe impairment of their quality of life. Factors associated with moderate to severe disability due to tinnitus were anxiety, headache, and hearing loss(AU)

[Comparison of prognostic scoring systems in the prediction of mortality and complications from sepsis]. / Comparación de sistemas de puntaje pronóstico en la predicción de mortalidad y complicaciones en sepsis.

OBJECTIVES: To compare the Mortality in Emergency Department Sepsis (MEDS), Sepsis-related Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE II), and Confusion, Urea, Respiratory rate, Blood pressure, 65 years of age and older (CURB-65) scoring systems for predicting mortality and complications in septic patients. MATERIALS AND METHODS: A prospective study of diagnostic test assessment was carried out. Scores were compared by analysis of receiver operating characteristic (ROC) curves corresponding to each score, with the development of death or complications as the dependent variable. RESULTS: There were 265 patients included in the analysis; 155 (58.4%) patients died and/or presented complications. The multivariate analysis revealed variables associated with mortality and complications were age, oliguria, mental health impairment, acute lung injury, and the use of inotropes. Analysis of ROC curves showed the area below the ROC curve was 0.74 (95% CI: 0.68-0.80) for SOFA, 0.73 (95% CI: 0.67-0.79) for MEDS, 0.73 (95% CI: 0.66-0.79) for APACHE II, and 0.67 (95% CI: 0.60-0.73) for CURB-65, the latter being significantly lower than the first three. CONCLUSIONS: The MEDS, SOFA, and APACHE II are adequate scoring systems for predicting mortality and complications in septic patients. It is essential to utilize these scoring systems in emergency medical assistance in hospitals in Peru.

Comparación de sistemas de puntaje pronóstico en la predicción de mortalidad y complicaciones en sepsis / Comparison of prognostic scoring systems in the prediction of mortality and complications from sepsis

Comparar los sistemas de puntaje MEDS (Mortality in Emergency Department Sepsis), SOFA (Sepsis-related Organ Failure Assessment), APACHE II (Acute Physiology and Chronic Health Evaluation) y CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, 65 years of age and older) para pronóstico de mortalidad y complicaciones en pacientes sépticos. Materiales y métodos. Se realizó un estudio prospectivo de evaluación de prueba diagnóstica. Se realizó la comparación de los puntajes mediante el análisis de las curvas ROC (receiver operating characteristic) correspondientes a cada uno de ellos, teniendo como variable dependiente el desarrollo de muerte o complicaciones. Resultados. 265 pacientes fueron incluidos en el análisis; 155 (58,4%) pacientes fallecieron y/o presentaron complicaciones. En el análisis multivariado se encontró como variables asociadas a mortalidad y complicaciones a la edad, oliguria, alteración del estado mental, daño pulmonar agudo y el uso de inotrópicos. Con respecto al análisis de las curvas ROC, el área bajo la curva ROC fue 0,74 (IC 95%: 0,68-0,80) para SOFA, 0,73 (IC 95%: 0,67-0,79) para MEDS, 0,73 (IC 95%: 0,66-0,79) para APACHE II, y 0,67 (IC 95%: 0,60-0,73) para CURB-65 siendo este último significativamente inferior a las tres primeras. Conclusiones. Los puntajes MEDS, SOFA y APACHE II son puntajes adecuados para predecir mortalidad y complicaciones en pacientes sépticos y deben considerarse su uso en la atención de emergencias en hospitales de Perú...

To compare the Mortality in Emergency Department Sepsis (MEDS), Sepsis-related Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE II), and Confusion, Urea, Respiratory rate, Blood pressure, 65 years of age and older (CURB-65) scoring systems for predicting mortality and complications in septic patients. Materials and methods. A prospective study of diagnostic test assessment was carried out. Scores were compared by analysis of receiver operating characteristic (ROC) curves corresponding to each score, with the development of death or complications as the dependent variable. Results. There were 265 patients included in the analysis; 155 (58.4%) patients died and/or presented complications. The multivariate analysis revealed variables associated with mortality and complications were age, oliguria, mental health impairment, acute lung injury, and the use of inotropes. Analysis of ROC curves showed the area below the ROC curve was 0.74 (95% CI: 0.68-0.80) for SOFA, 0.73 (95% CI: 0.67-0.79) for MEDS, 0.73 (95% CI: 0.66-0.79) for APACHE II, and 0.67 (95% CI: 0.60-0.73) for CURB-65, the latter being significantly lower than the first three. Conclusions. The MEDS, SOFA, and APACHE II are adequate scoring systems for predicting mortality and complications in septic patients. It is essential to utilize these scoring systems in emergency medical assistance in hospitals in Peru...