Prevalencia del síndrome de burnouten profesionales de la salud durante la pandemia de COVID-19 en una clínica privada de Chile / Frequency of burnout syndrome among health care workers during COVID-19 pandemic

BACKGROUND: COVID-19 pandemic increased the prevalence of burnout syndrome. AIM: To describe the prevalence of burnout syndrome in health care workers of a private clinic in the Metropolitan Region of Chile. MATERIAL AND METHODS: Cross-sectional study, the study population were health care workers of a private clinic. An online version of Maslach Burnout Inventory-Human Service Survey was applied during June 2020. Variables such as age, sex, marital status, number of children, service, occupation, and night shift were studied. RESULTS: We collected 846 responses. A 36% (95% confidence intervals (CI) [32,8-39,2]) prevalence of high levels of burnout syndrome was found. Thirty one percent (95% CI [28,1-34,3]) of the respondents had high levels of emotional exhaustion (AE), 33% (95%CI [29,8-36,2]) had low personal fulfillment (RP) and 30% (95%CI [26,6-32,7]) had high levels of depersonalization (DP). CONCLUSIONS: Healthcare workers showed concerning levels of burnout syndrome. It is recommended to pay special attention to high levels of emotional exhaustion in nursing and night shift staff. Institutions should develop and apply prevention and emotional support strategies in health personnel.

Distribución de la COVID-19 y tuberculosis en la Región Metropolitana de Chile: diferentes enfermedades, similares desigualdades / Distribution of COVID-19 and tuberculosis in the Metropolitan Region of Chile: differents diseases, similar inequalities

Background: Poor living conditions promote the spread of communicable diseases. It happened with Tuberculosis (TB) and is happening with COVID-19. Due to its dynamic nature, this group of diseases must be studied in the context of the social determinants of health. Aim: To describe the epidemiological behavior of COVID-19 in response to the control strategies implemented by the Chilean Ministry of Health and its similarities with the socio-economic distribution of TB in the Metropolitan Region (MR) of Chile. Material and Methods: The 2018 Tuberculosis rates and average income of districts belonging to the MR were described, as well as the incidence rates of COVID-19. A Pearson correlation analysis was applied between the rates of both diseases, to assess similarities in the epidemiological distribution patterns. Results: The RM accounts for over 50% of the total national cases of COVID-19. After the implementation of selective quarantines, only four districts in the RM managed to control the outbreak (those with the highest incomes). In the rest, a clear increase in cases was observed. The districts with the highest increase in cases were the most disadvantaged, and those with the highest TB rates during 2018, with a correlation coefficient of 0.6. Conclusions: Control policies cannot deepen health inequalities. If vulnerable groups, as well as the factors that determine their health, are not properly identified, the consequences of the current pandemic could be even more devastating.

Caracterización socio-epidemiológica y evolución de la tuberculosis en la Región Metropolitana de Chile, 2005 a 2018 / Socio-epidemiological caracterization and evolution of tuberculosis in the Metropolitan Region of Chile, 2005 to 2018

Resumen Introducción: El Programa chileno de Control y Eliminación de Tuberculosis (PROCET) ha permitido reducir la mortalidad por esta enfermedad en 78%, entre los años 2004 y 2013. No obstante, luego de décadas de resultados exitosos, a partir del 2000 ocurrió un enlentecimiento en la reducción de incidencia y desde el 2014, un aumento de ésta. Objetivos: Describir la evolución socio-epidemiológica de los casos de tuberculosis (TBC), desde 2005 al 2018, estratificando según país de origen, en Servicios de Salud de la Región Metropolitana (RM). Métodos: Estudio transversal con componente ecológico. Se consideraron las variables: edad, sexo, localización de la TBC, confirmación bacteriológica, co-infección con VIH, privación de libertad, país de procedencia y efectividad de la terapia anti-tuberculosis. Resultados: Se notificaron 7.507 casos, de los cuales 75,1% fue de localización pulmonar y 65,4% bacteriológicamente demostrado. Un 19,0% de los casos pertenecieron a personas no nacidas en Chile, con un aumento de esta proporción en los últimos seis años. Las tasas de incidencia, descendientes en la primera mitad del período, exhibieron un alza a partir del 2012, alejándolas del umbral de eliminación. Se observó en 74,3% éxito en la terapia y 13,4% de muerte en los casos evaluados. Conclusiones: En los últimos años, la incidencia de TBC en la RM aumentó. Los nuevos grupos vulnerables, especialmente los migrantes, requieren con urgencia, que se implementen y refuercen estrategias como la educación, pesquisa activa y acciones de control de TBC.

Abstract Background: The Chilean Program for the Control and Elimination of Tuberculosis (PROCET) has reduced mortality from this disease by 78% between 2004 and 2013. However, after decades of successful results, starting in 2000 there was a slowdown in the reduction of incidence and since 2014, an increase in it. Aim: To describe the socio-epidemiological evolution of tuberculosis (TB) cases treated at health clinics in the Metropolitan Region (MR) of Chile from 2005 to 2018, stratifying by country of origin. Methods: Cross-sectional study with ecological components, including analyses of age, sex, TB localization, bacteriological confirmation of diagnosis, co-infection with HIV, incarceration, country of origin, and effectiveness of tuberculosis treatment. Results: A total of 7,507 TB cases were recorded during the study period; 75.1% of cases were pulmonary tuberculosis, and 65.4% were bacteriologically confirmed. Overall, 19.0% of cases involved persons born outside of Chile, with the proportion of cases in foreign-born persons increasing over the past 6 years. Incidence decreased during the first half of the study period but then began to increase after 2012, moving the country away from the threshold of elimination. A total of 74.3% of cases were treated successfully, and 13.4% expired. Conclusion: In recent years, TB incidence has increased in the MR of Chile, possibly attributable to growing populations of vulnerable groups such as immigrants. This finding suggests an urgent need to implement and reinforce strategies such as education, an active screening model and more efficient contact tracing to prevent the spread of TB.

Evolución de la coinfección por TB/VIH en la Región Metropolitana de Chile, 2005 a 2018 / Evolution of tuberculosis/HIV coinfection in Metropolitan Santiago, Chile from 2005 to 2018

Background: Tuberculosis (TB)/HIV coinfection has a high mortality rate. Aim: To describe socio-epidemiological characteristics of tuberculosis (TB)-HIV coinfection, and aspects associated with its prevalence, from 2005 to 2018. Material and Methods: Analysis of the registry of the tuberculosis control and elimination program of three public health services of metropolitan Santiago. The variables considered were: TB/HIV coinfection, age, sex, location of tuberculosis, bacteriological confirmation, incarceration, commune of residence, country of origin and effectiveness of the tuberculosis therapy. Results: We analyzed 7507 TB cases, of whom 12% corresponded to cases of coinfection. The number of coinfections doubled in the last 6 years. In 2018, 45% of coinfection cases occurred in migrants. Of the total cases evaluated, 53% were successfully treated and 28% died. Conclusions: The remarkable increase in TB/HIV coinfection, urgently demands new prevention and control strategies, aimed at the most vulnerable groups.

Epidemiología de las consultas respiratorias de adultos en Santiago de Chile desde 2003 a 2008 / Primary care consultations due to respiratory diseases in the period 2003-2008

Background: Respiratory diseases are the third cause of death, and the second cause of hospitalization among people aged 65 years or more in Chile. Aim: To analyze the distribution of consultations due to respiratory diseases among adults living in Metropolitan Santiago. Material and Methods: A daily registry of all consultations of patients older than 15 years old in seven public primary care centers, was carried out between January 2003 and December 2008. Consultations were classified as having non-respiratory or respiratory causes. The latter were broke down in upper or lower respiratory diseases, pneumonia, chronic obstructive pulmonary disease (COPD) and asthma. Results: A total of 1,170,941 consultations were registered and 19% were due to respiratory diseases. Of these, 46% were due to upper respiratory diseases, 31% due to lower respiratory diseases, 8% due to COPD, 6% due to pneumonia, 5% due to asthma and 4% due to other respiratory causes. Pneumonia and COPD were more frequent among consultants older than 65 years. Conclusions: Consultations due to respiratory diseases are approximately one fifth of all primary care consultations. Older people often have more chronic and severe diseases.

Epidemiología de las consultas pediátricas respiratorias en Santiago de Chile desde 1993 a 2009 / Epidemiology of pediatric respiratory consultations in Santiago de Chile, from 1993 to 2009

OBJETIVO: El presente trabajo se propone describir la metodología de análisis y la distribución global de las consultas de morbilidad -particularmente las de tipo respiratorio- en menores de 15 años de edad de la ciudad Santiago de Chile, Chile, con el objetivo de conocer sus diferencias según grupos etarios, su comportamiento estacional y su evolución a lo largo de los años. MÉTODOS: Se investigó la distribución de las consultas de morbilidad pediátrica (CP) -en especial las respiratorias- y su evolución en un período de 17 años. En siete centros centinela de Santiago de Chile se recolectó prospectivamente información diaria de todas las CP, agrupadas en infecciones no respiratorias e infecciones respiratorias agudas (IRA). RESULTADOS: Entre enero de 1993 y diciembre de 2009 se registraron 1 947 477 CP, de las cuales 1 188 029 (61,0%) fueron por causa respiratoria: 656 567 (33,7%) por enfermedad respiratoria aguda de vía aérea baja (IRAb), 418 932 (21,5%) por síndrome bronquial obstructivo (SBO) y 48 669 (2,5%) por neumonía. Neumonía y SBO fueron más frecuentes en menores de 5 años. Las IRAb, SBO y neumonía presentaron una significativa tendencia a la disminución durante el período observado. Las IRA constituyen la primera causa de CP en atención primaria de salud y el SBO es la primera causa específica de consulta pediátrica. CONCLUSIONES: Estos resultados enfatizan la necesidad de asignar o redestinar recursos en programas de promoción, educación, prevención y tratamiento de estas enfermedades, con la debida focalización que determina su variación estacional.

OBJECTIVE: This paper describes the analytical methodology and overall distribution of these consultations-particularly respiratory consultations-for children under 15 years of age in Santiago de Chile, Chile. The aim is to understand differences by age groups, as well as seasonal trends and trends over the years. METHODS: The research covered the distribution of consultations and their evolution over a period of 17 years. Information was collected on a daily basis from all pediatric consultations, grouped into nonrespiratory and acute respiratory categories, in seven sentinel centers of Santiago de Chile. RESULTS: Between January 1993 and December 2009, 1 947 477 cases of pediatric illnesses were recorded, of which 1 188 029 (61.0%) were for respiratory causes. Of those, 656 567 (33.7%) were for acute lower respiratory tract illnesses, 418 932 (21.5%) were for broncho-obstructive syndrome, and 48 669 (2.5%) were for pneumonia. Pneumonia and broncho-obstructive syndrome were more frequent in children under age 5. Lower respiratory tract illnesses, broncho-obstructive syndrome, and pneumonia showed a significant downward trend during the period observed. Lower respiratory tract illnesses are the leading cause of pediatric morbidity in primary health care, while broncho-obstructive syndrome is the leading specific reason for pediatric consultations. CONCLUSIONS: These results point to the need to allocate or reallocate resources for programs for promotion, education, prevention, and treatment of these illnesses with the targeting necessary to address seasonal variations.