Concepción didáctica del proceso formativo interdisciplinar de la habilidad diagnosticar enfermedades para residentes de Dermatología / Didactic Concept of the Interdisciplinary Formation Process of the Diagnostic Ability of Dermatology Residents

Fundamento: El estudio teórico, el diagnóstico realizado y la experiencia de los investigadores, posibilitan formular como problema de la presente investigación: limitaciones en el desarrollo de la habilidad diagnosticar enfermedades dermatológicas en los residentes de la especialidad de Dermatología del Hospital General Provincial Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila. Objetivo: Elaborar una concepción didáctica del proceso de formación interdisciplinar de la habilidad diagnosticar enfermedades dermatológicas en los residentes de la especialidad de Dermatología, a partir de la caracterización del estado actual de esta habilidad. Metodología: Se realizó una investigación educativa con un componente descriptivo en el Hospital General Provincial Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila, en los cursos escolares desde 2016 al 2020. La población de estudio fueron los 16 residentes de 1.er año que matricularon la especialidad de Dermatología en el período de estudio. Se emplearon métodos del nivel teórico y empírico. Resultados: La caracterización realizada reveló limitaciones en el desarrollo de la habilidad diagnosticar enfermedades dermatológicas en los laboratorios de Anatomía Patológica, Microbiología y Parasitología Médica, por los residentes (100 %). La concepción didáctica del proceso de formación interdisciplinar de la habilidad diagnosticar orienta el proceso desde las actividades docentes-atencionales y prácticas de laboratorio en una consecutividad lógica y sistematización desde las diferentes formas de enseñanza y tipologías de clase. Integra la interdisciplinariedad y la utilización del método investigativo establecido en las ideas rectoras. Conclusiones: La concepción didáctica como aporte de la investigación resuelve la contradicción dialéctica entre la aplicación del método clínico y los procedimientos en la práctica de laboratorio que se da en ese proceso formativo y constituye un soporte didáctico que respalda las actividades prácticas en los laboratorios para cumplir con los objetivos del Plan de estudio de la especialidad.

Background: The theoretical study, the diagnosis conducted and the experience of the researchers make possible to formulate the problem of the present research: limitations in the development of the ability to diagnose dermatological diseases in residents of the Specialty of Dermatology of the General Provincial Teaching Hospital "Dr. Antonio Luaces Iraola" of Ciego de Avila. Objective: To elaborate a didactic conception of the interdisciplinary training process of the ability to diagnose dermatological diseases in residents of the specialty of Dermatology, based on the characterization of the current state of that ability. Methodology: An educational research with a descriptive component was conducted at the Provincial General Teaching Hospital "Dr. Antonio Luaces Iraola" of Ciego de Avila, in the 2016-2020 school years. The study population consisted of the 16 first-year dermatology residents who enrolled in the specialty during the study period. Results: The characterization conducted showed limitations in the development of the ability to diagnose dermatological diseases in anatomic pathology laboratories, Microbiology and Medical Parasitology, by residents (100%). The didactic conception of the interdisciplinary training process of diagnostic ability focuses on teaching and learning activities and laboratory practices in a logical consecutiveness and systematization from the different forms of teaching and class typologies. It integrates the interdisciplinary and the use of the research method that is established in the guiding ideas. Conclusions: The didactic conception, as a research contribution, resolves the dialectic contradiction between the application of the clinical method and the procedures in laboratory practice that occurs in this formative process which is a didactic support that backs up the practical activities in the laboratories in order to achieve the objectives of the study plan of the specialty.

Occupational exposure level and requirements for radiation protection of nuclear medical staff / 中华劳动卫生职业病杂志

With the rapid development of nuclear medicine, the number of nuclear medical staff has increased a lot in the past few years in China. Close-range operations, such as preparation and injections of radiopharmaceuticals, are usually carried out in nuclear medicine department. And the use of unsealed radionuclides may also create internal exposure risk. So, occupational exposure of nuclear medical staff is a main issue of occupational health management in China. In this paper, the occupational exposure level and requirements for radiation protection of nuclear medical staff are introduced to provide references for the related work that radiological health technical institutions carry out.

Encuesta de satisfacción de padres de pacientes y equipo médico sobre el consentimiento informado en un hospital pediátrico de la Ciudad de Buenos Aires / Satisfaction survey of parents and medical staff regarding informed consent in a pediatric hospital in the city of Buenos Aires

El consentimiento informado es un proceso en el que un paciente libre y bien informado o sus representantes autorizan o no un procedimiento médico. Objetivos: El objetivo del estudio fue explorar el grado de satisfacción de padres de pacientes y profesionales con respecto al CI implementado en diferentes áreas del hospital. Métodos: Estudio observacional y descriptivo mediante encuesta anónima, a médicos y padres de pacientes atendidos en el hospital entre enero y julio de 2018. Resultados: Se obtuvieron 158 respuestas de profesionales y 139 de padres. Para el 50% de los padres el CI es un proceso para mejorar la calidad. El 81% de ellos consideró que recibió la información, la comprendieron y pudieron aclarar dudas. El 89% recibió la información del médico y el 59% en el lugar adecuado. De los profesionales, 57% consideró al CI como un proceso de información para mejorar la calidad. El 3% estimó que los padres comprenden la información siempre, el 66% consideró que el CI contiene la información suficiente y 13% le entregó una copia a la familia. Conclusiones: El grado de satisfacción de los padres en relación al CI es alto mientras que el de los profesionales es moderado. Hay que continuar trabajando en el proceso de comunicación entre ambos grupos (AU)

Informed consent is a process based on which a free and wellinformed patient or his/her representatives decide whether or not to authorize a medical procedure. Objectives: The aim of the study was to explore the degree of satisfaction of parents of patients and professionals regarding the IC implemented in different areas of the hospital. Methods: Observational and descriptive study using an anonymous survey of physicians and parents of patients treated at the hospital between January and July 2018. Results: the survey was responded by 158 physicians and 139 parents. Overall, 50% of the parents considered that the IC is part of a quality improvement process; 81% of them found they received adequate information, understood it, and were able to clarify doubts. Eighty-nine percent received the information from the physician and 59% in the appropriate area. Of the professionals, 57% considered the IC to be an information process to improve quality; 3% felt that parents always understand the information; 66% felt that the IC contains sufficient information; and 13% gave the family a copy. Conclusions: A degree of satisfaction with the IC was found in parents while it was moderate among physicians. It is necessary to continue working on the communication process between both groups (AU)

Investigation on the current situation of safety protection of medical staffs for the prevention and treatment of infectious diseases in medical institutions in Jiangsu Province / 中华劳动卫生职业病杂志

Objective: To investigate the current situation of safety protection of medical staffs in medical institutions in Jiangsu Province, and to provide scientific basis for strengthening the safety protection of infectious diseases and protecting the occupational health of medical staffs. Methods: From September to October 2020, 1274 medical staffs in 43 medical and health institutions were randomly selected as the subjects. The self-made questionnaire for infectious disease prevention and protection was used to analyze the pre-job training and exposure to occupational harmful factors of the respondents. The influencing factors of using protective equipment and occupational injury were analyzed by binary logistic regression. Results: A total of 1216 valid questionnaires were collected with effective recovery of 95.4%. There were 312 males (25.7%) and 904 females (74.3%) , with an average age of (35.8±9.2) years and average working years of (13.6±9.9) years. Among them, 1143 (94.0%) had participated in pre-job training, 535 (44.0%) thought they were exposed to occupational harmful factors of infectious disease prevention, 1082 (89.0%) used protective equipment in daily operation, and 462 (38.0%) had occupational injury. According to binary logistic regression analysis, the utilization rates of protective equipment for medical staffs in Centers for Disease Control and Prevention (OR=2.473, 95%CI: 1.327-4.607, P=0.004) , 30-39 years old (OR=1.586, 95%CI: 1.038-2.426, P=0.033) , 40-49 years old (OR=2.257, 95%CI: 1.243-4.098, P=0.007) , 50 years old and above (OR=5.879, 95% CI: 1.755-19.692, P=0.004) and pre-job training (OR=2.580, 95%CI: 1.301-5.116, P=0.007) were higher than their respective control groups. And medical staffs with graduate degree or above (OR=0.342, 95%CI: 0.167~0.699, P=0.003) had lower utilization rate of protective equipment. Female (OR=1.902, 95%CI: 1.364-2.654, P<0.001) , 30-39 years old (OR=1.589, 95%CI: 1.157-2.181, P=0.004) , bachelor degree (OR=2.070, 95%CI: 1.419-3.021, P<0.001) , exposure to occupational harmful factors (OR=2.753, 95%CI: 2.086-3.634, P<0.001) were the risk factors for occupational injury of medical staffs. Centers for Disease Control and Prevention (OR=0.129, 95%CI: 0.086-0.194, P<0.001) and wearing protective equipment according to regulations (OR=0.597, 95%CI: 0.431-0.827, P=0.002) were the protective factors for occupational injury of medical staffs. Conclusion: At present, the occupational injury rate of medical staffs in Jiangsu Province is high due to various factors in the prevention and control of infectious diseases. It is necessary to pay attention to occupational safety protection, strengthen pre-job training and actively advocate "standard prevention", so as to reduce the exposure risk of harmful factors and promote occupational health of medical staffs.

Risk factors analysis and intervention of blood-borne occupational exposure in medical staff / 中华劳动卫生职业病杂志

Objective: To analyze the risk factors of blood-borne occupational exposure among medical staff and explore the relevant intervention measures. Methods: In June 2020, the data of blood-borne occupational exposure and related factors reported by medical staff in a grade Ⅲ, Grade A general hospital from 2011 to 2019 were analyzed by retrospective investigation. Results: Among 431 cases of blood-borne occupational exposure, 69.37% were nurses. It mainly occurred in medical staff with 0-4 years of service, accounting for 63.57%; The main place of occupational exposure was in the ward 47.56%; Sharp instrument injury was the main occupational exposure route 91.65%. Occupational exposure department was mainly surgery department 17.87%; The main source of exposure was hepatitis B virus (HBV) 37.12%, followed by treponema pallidum 20.19%. Statistical analysis results show that: Exposure sites (χ(2)=43.585, P<0.01) , exposure sources (χ(2)=22.693, P<0.01) , treatment methods after exposure (χ(2)=18.866, P<0.01) , Flushing (χ(2)=31.963, P<0.01) and disinfection (χ(2)=14.216, P<0.01) were significantly different. Conclusion: The effective measures to reduce blood-borne occupational exposure are to strengthen occupational protection training of medical staff, standardize operation procedures, strengthen supervision of key groups and departments, improve reporting, monitoring and follow-up systems to realize informatization, and do a good job in risk control.

Help-seeking efficacy and the intention of social assistance among medical care personnel during the major public health events / 中华劳动卫生职业病杂志

Objective: To explore the help seeking efficacy and social assistance willingness of medical staff during major public health events, so as to provide basis for improving the psychological resources and service quality of medical staff and further optimizing the prevention and treatment policies. Methods: In February 2020, a convenient sampling method was used to conduct an online questionnaire survey on medical staff in Henan Province, and a total of 2136 questionnaires were collected. Among them, there were 1940 valid questionnaires, and the effective recovery rate was 90.82%. The questionnaire of help seeking efficacy and willingness to social assistance under epidemic situation was used to investigate the help seeking efficacy and willingness of medical staff. The frequency and rate (%) were used to analyze the overall situation of medical staff's help seeking efficacy and social assistance willingness. The differences among different demographic variables were tested by χ(2) test. Results: Among the 1940 medical and nursing staff, 18.81% (365/1940) did not know how to obtain appropriate psychological assistance. Compared with the low age group, the medical staff in the high age group had the ability of information query, the ability to occupy knowledge resources, the ability to distinguish rumors and facts and the sense of efficacy of obtaining appropriate medical help, and the difference was statistically significant (P<0.05) . The willingness of medical and nursing staff to actively cooperate with the government, maintain social stability and volunteer work were 99.43% (1929/1940) , 98.81% (1917/1940) and 97.11% (1884/1940) . Conclusion: The medical staff had a higher sense of help seeking efficacy and willingness to social assistance. It is necessary to further strengthen the resource support of psychological, social and humanistic care for medical staff.

A cross-sectional investigation and analysis of early treatment of partial-thickness burn wounds by professional burn medical staff in China / 中华烧伤杂志

Objective: To assess the current situation of early treatment of partial-thickness burn wounds by professional burn medical staff in China, and to further promote the standardized early clinical treatment of partial-thickness burn wounds. Methods: A cross-sectional investigation was conducted. From November 2020 to February 2021, the self-designed questionnaire for the early treatment of partial-thickness burn wounds was published through the "questionnaire star" website and shared through WeChat to conduct a convenient sampling survey of domestic medical staff engaged in burn specialty who met the inclusion criteria. The number, region, and grade of the affiliated hospital, the age, gender, occupation, and seniority of the respondents were recorded. The respondents were divided into physician group and nurse group, senior group and junior group, eastern region group and non-eastern region group, primary and secondary hospital group and tertiary hospital group. Then the seniority, grade of the affiliated hospital, region of the affiliated hospital of the respondents in physician group and nurse group, conventional treatment of partial-thickness burn blisters, reasons for retaining vesicular skin, reasons for removing vesicular skin, and the conventional selection and optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage of respondents in each of all the groups were recorded. Data were statistically analyzed with chi-square test. Results: The survey covered 31 provinces, municipalities, and autonomous regions in China (except for Hong Kong, Macau, and Taiwan regions). A total of 979 questionnaires were recovered, which were all valid. The 979 respondents came from 449 hospitals across the country, including 203 hospitals in the eastern region, 116 hospitals in the western region, 99 hospitals in the central region, and 31 hospitals in the northeast region, 348 tertiary hospitals, 79 secondary hospitals, and 22 primary hospitals. The age of the respondents was (39±10) years. There were 543 males and 436 females, 656 physicians and 323 nurses, 473 juniors and 506 seniors, 460 in the eastern regions and 519 in the non-eastern regions, 818 in tertiary hospitals and 161 in primary and secondary hospitals. There were statistically significant differences in the composition of different seniority in the respondents between physician group and nurse group (χ2=44.32, P<0.01), while there were no statistically significant differences in grade or region of the affiliated hospital of the respondents between physician group and nurse group (P>0.05). There were no statistically significant differences in the conventional treatment of partial-thickness burn blisters among respondents between different occupational groups, seniority groups, and region of the affiliated hospital groups (P>0.05).The respondents in different grade of the affiliated hospital groups differed significantly in the conventional treatment of partial-thickness burn blisters (χ2=6.24, P<0.05). Compared with respondents in nurse group, larger percentage of respondents in physician group chose to retain vesicular skin for protecting the wounds and providing a moist environment, and alleviating the pain of dressing change (with χ2 values of 21.22 and 19.96, respectively, P values below 0.01), and smaller percentage of respondents in physician group chose to retain vesicular skin for prevention of wound infection (χ2=23.55, P<0.01). The reasons for retaining vesicular skin of respondents between physician group and nurse group were similar in accelerating wound healing, alleviating pigmentation and scar hyperplasia post wound healing (P>0.05). Compared with respondents in junior group, larger percentage of respondents in senior group chose to retain vesicular skin for protecting the wounds and providing a moist environment and alleviating the pain of dressing change (with χ2 values of 10.36 and 4.60, respectively, P<0.05 or P<0.01), and smaller percentage of respondents in senior group chose to retain vesicular skin for prevention of wound infection (χ2=8.20, P<0.01). The reasons for retaining vesicular skin of respondents in senior group and junior group were similar in accelerating wound healing, alleviating pigmentation and scar hyperplasia post wound healing (P>0.05). The 5 reasons for the respondents between eastern region group and non-eastern region group, primary and secondary hospital group and tertiary hospital group chose to retain vesicular skin were all similar (P>0.05). Compared with those in physician group, significantly higher percentage of respondents in nurse group were in favor of the following 6 reasons for removing the vesicular skin, including convenience for using more ideal dressings to protect the wounds, prevention of wound infection, facilitating the effect of topical drugs on the wounds, the likely rupture of blisters and wound contamination, accelerating wound healing, and alleviating pigmentation and scar hyperplasia post wound healing (with χ2 values of 4.35, 25.59, 11.83, 16.76, 46.31, and 17.54, respectively, P<0.05 or P<0.01). Compared with respondents in senior group, larger percentage of respondents in junior group chose to remove vesicular skin for the reasons such as the likely blister rupture and wound contamination, preventing wound infection, accelerating wound healing, and alleviating pigmentation and scar hyperplasia post wound healing (with χ2 values of 17.25, 18.63, 14.83, and 10.23, respectively, P values below 0.01). Compared with respondents in non-eastern region group, larger percentage of respondents in eastern region group chose to remove vesicular skin for preventing wound infection and the likely rupture of blisters and wound contamination (with χ2 values of 9.30 and 8.65, respectively, P values below 0.01). The 6 reasons for the respondents between tertiary hospital group and primary and secondary hospital group choose to remove vesicular skin were similar (P>0.05). Compared with respondents in physician group, larger percentage of respondents in nurse group chose to use moisturizing materials for partial-thickness burn wounds in the early stage (χ2=6.18, P<0.05), and smaller percentage of respondents in nurse group chose other topical drugs or dressings (χ2=5.20, P<0.05). Compared with respondents in junior group, larger percentage of respondents in senior group chose to use moisturizing materials and other topical drugs or dressings for partial-thickness burn wounds in the early stage (with χ2 values of 4.97 and 21.80, respectively, P<0.05 or P<0.01). Compared with respondents in non-eastern region group, larger percentage of respondents in eastern region group chose to use topical antimicrobial drugs for partial-thickness burn wounds in the early stage (χ2=4.09, P<0.05), and smaller percentage of respondents in eastern region group chose to use other topical drugs or dressings for the partial-thickness burn wounds in the early stage (χ2=5.63, P<0.05). Compared with respondents in primary and secondary hospital group, larger percentage of respondents in tertiary hospital group chose to use biological dressings for partial-thickness burn wounds in the early stage (χ2=9.38, P<0.01). The optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage varied significantly among the respondents between different occupational groups and seniority groups (with χ2 values of 39.58 and 19.93, respectively, P values below 0.01). There were no statistically significant differences between eastern and non-eastern region groups, tertiary hospital group and primary and secondary hospital groups in optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage (P>0.05). Conclusions: The conventional treatment measures of partial-thickness burn blisters and reasons for preserving blister skin by professional burn medical staff in China are relatively consistent, but there are great differences in the selection of reasons for removing blister skin, the conventional selection and optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage. Therefore, it is urgent to establish a clinical treatment standard for partial-thickness burn wounds.

La responsabilidad jurídica del médico, conceptos que se debaten entre dos ciencias / The Physician's Legal Responsibility, Debatable Concepts between two Sciences

La exigencia de responsabilidad jurídica a los profesionales de la salud ha experimentado, a pesar de su antigüedad, un auge en las sociedades contemporáneas. En el artículo se reflexiona sobre conceptos médicos y jurídicos que permitan clarificar los presupuestos de intervención del Derecho en el ámbito de la Medicina, en función de la determinación de la responsabilidad médica jurídicamente relevante(AU)

In spite of being demanded since long ago, legal responsibility from health professionals has experienced a boom in contemporary societies. This article reflects on medical and legal concepts that make it possible to clarify the assumptions for involving law in the field of medicine, based on the determination of legally relevant medical responsibility(AU)

Síntomas de ansiedad y depresión en personal de salud que trabaja con enfermos de COVID-19 / Anxiety and depression symptoms in health personnel who work with COVID-19 patients

El personal de salud pública que se enfrenta a la COVID-19, está expuesto a múltiples riesgos entre ellos los trastornos psicológicos. El objetivo de este estudio fue determinar la presencia de síntomas asociados a ansiedad y depresión en personal de salud que trabaja con enfermos de la COVID-19. Se realizó un estudio descriptivo de corte transversal en el que participaron 61 profesionales y técnicos de atención sanitaria, que trabajaban directamente con pacientes con COVID-19, a los cuales se les consultó acerca de la presencia de síntomas asociados a la depresión y ansiedad, sus principales preocupaciones y el tiempo de trabajo continuo para evitar la aparición de síntomas psicológicos. El 64,1% de los participantes relató nerviosismo y 59,2% cansancio, para el 90,16% la principal preocupación fue el fallecimiento del paciente y el 60,66% de los participantes indicó que el período ideal, de atención continua de pacientes COVID-19, para evitar la aparición de síntomas psicológicos era de 7 días. Nuestros resultados sugieren que es necesario elaborar estrategias de trabajo para disminuir la aparición de síntomas asociados al deterioro de la salud mental de los profesionales de la salud que atienden pacientes COVID-19

Public health personnel facing COVID-19 are exposed to multiple risks including psychological disorders. The goal of this study was to determine the presence of symptoms associated with anxiety and depression in health personnel working with COVID-19 patients. A descriptive cross-sectional study involving 61 health care professionals and technicians was conducted, working directly with COVID-19 patients, who were consulted about the presence of symptoms associated with depression and anxiety, their main concerns and ongoing working time to avoid the onset of psychological symptoms. 64.1% of participants reported nervousness and 59.2% tiredness, for 90.16% the main concern was the patient's death and 60.66% of participants indicated that the ideal period, of continuous care of COVID-19 patients, to prevent the onset of psychological symptoms was 7 days. Our results suggest that work strategies need to be developed to decrease the onset of symptoms associated with deteriorating mental health of health professionals caring for COVID-19 patients

An investigation on the cognition of neonatal pain assessment and analgesia management among medical staff in the neonatal intensive care unit / 中国当代儿科杂志

OBJECTIVES@#To investigate the current status of the cognition of neonatal pain assessment and analgesia management among medical staff in the neonatal intensive care unit (NICU).@*METHODS@#A self-made scale was developed according to "Expert consensus on neonatal pain assessment and analgesia management (2020 edition)" and was used to distribute questionnaires to the medical staff in the NICU from the member units of Jiangsu Province Medical Quality Control Centre of Neonatal Department to evaluate their levels of understanding the basic knowledge, assessment, and management of neonatal pain.@*RESULTS@#A total of 957 questionnaires (from 383 doctors and 574 nurses) were collected. Doctors and nurses had mean correct rates of 38% and 39% respectively in answering the questions on the basic knowledge of neonatal pain. They had median correct rates of 0% and 50% respectively in answering the questions on neonatal pain assessment, and mean correct rates of 73% and 68% respectively in answering on analgesia management. Compared with those who did not receive the training on neonatal pain, the medical staff who received such training had significantly higher correct rates in answering the questions on the basic knowledge of neonatal pain and neonatal pain assessment (@*CONCLUSIONS@#The medical staff in the NICU have insufficient cognition of neonatal pain, and thus it is necessary to carry out the special training on neonatal pain, focusing on the promotion and practical application of "Expert consensus on neonatal pain assessment and analgesia management (2020 edition)", in order to improve the level of neonatal pain assessment and analgesia management among medical staff in the NICU.

Psychological and behavior status of minor children of medical staff during the COVID-19 epidemic in Hubei province / 浙江大学学报·医学版

OBJECTIVE@#To investigate the psychological and behavior status of minor children of medical staff in Hubei province during the coronavirus disease 2019 (COVID-19) epidemic.@*METHODS@#A cross-sectional questionnaire survey was conducted through WeChat from March 13 to 15, 2020, which included a general data questionnaire and Conners parental assessment questionnaire (PSQ). The questionnaires received from outside of Hubei province were excluded through IP address, and the questionnaires with answer time 0.05) between children with parents as medical staff and those without. In 6-0.05).@*CONCLUSIONS@#s During COVID-19 epidemic period, the psychological and behavior status of minor children of Hubei medical staff with different ages shows differences with those without parents as medical staff, particularly in 6-<10 years and 10 to 16 year groups. It is necessary to pay attention to the psychological and behavioral status of children of medical staff in these age groups.

Influential factors for insomnia in medical staff in the national medical aid team for Hubei Province during the outbreak of coronavirus disease 2019 / 中南大学学报(医学版)

OBJECTIVES@#To investigate the insomnia status and relevant factors for the medical staff in the medical aid team for Hubei Province during the outbreak of coronavirus disease 2019.@*METHODS@#A convenient sampling survey was conducted among 1 056 medical staff in the national medical team of Hubei Province by using the Insomnia Severity Index (ISI) and the Regulatory Emotional Self-Efficacy (RES).@*RESULTS@#The incidence from moderate to severe insomnia was 35.14%, and the total self-efficacy of emotion regulation was 3.60±0.91. Univariate analysis showed that the incidence of insomnia in female medical workers in Hubei Province was higher than that of male medical workers, which was increased with the elongation of work time and frequency. In addition, insomnia was associated with age, perceived ambient exposure and infection, and RES scores. Stepwise regression analysis showed that the occurrence of insomnia was mainly related to gender, perceived peripheral exposure, infection, and RES scores.@*CONCLUSIONS@#Insomnia is very common among medical workers in Hubei Province during the COVID-19 epidemic. Insomnia is related to the medical work status, the gender and their own emotional management and regulation in the epidemic area.

Mental health status of medical staff in the epidemic period of coronavirus disease 2019 / 中南大学学报(医学版)

OBJECTIVES@#To explore the psychological status of medical staff in the epidemic period of coronavirus disease 2019 (COVID-19), and to analyze its influential factors.@*METHODS@#A total of 373 medical staff from Xiangya Hospital and the Second Xiangya Hospital of Central South University were enrolled for this study. The General Sociological Data Questionnaire, Symptom Check-List 90 (SCL-90), and self-designed public opinion response questionnaire were used to assess general sociological data, mental health scores, and ability to respond to COVID-19 related public opinion information of medical staff. The mental health scores of medical staff with different general sociological data and public opinion information coping abilities were compared. Influential factors of mental health were analyzed.@*RESULTS@#The average score of 10 factors in SCL-90 of 373 medical staff was less than 2 points. 14.21% medical staff had one or more factor scores more than two points, including 11.26% with terror symptoms, 7.77% with compulsive symptoms, and 5.63% with anxiety. The main sources of COVID-19 information for medical staff included WeChat, microblog, Jinri toutiao, TV and radio. 66.22% medical staff regularly verified information about COVID-19 through official websites or formal channels. A great deal of COVID-19 information in WeChat could make medical staff nervous (34.05%), anxious (30.29%), and insecure (29.22%). 68.63% medical staff sometimes were worried about getting infected because they knew information about COVID-19. Different departments of medical staff, getting cough or having a fever recently, and the degree of fear of infection had an impact on the SCL-90 score of medical staff, the differences were all statistically significant (all <0.05). Stepwise regression analysis showed that the impact of COVID-19 information on their life in WeChat, getting cough or having a fever recently, insomnia-early caused by COVID-19 information in WeChat, different departments, and the degree of fear of infection COVID-19 were the influential factors for the mental health of medical staff (all <0.05).@*CONCLUSIONS@#During the epidemic of COVID-19, medical staff suffered from psychological problems to various degrees. It is necessary to establish a psychological assistance platform and guide the direction of public opinion correctly to promote the mental health of medical staff.

Detection and evaluation of SARS-CoV-2 nucleic acid contamination in corona virus disease 19 ward surroundings and the surface of medical staff's protective equipment / 北京大学学报(医学版)

OBJECTIVE@#To determine the environmental contamination degree of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in corona virus disease 2019 (COVID-19) wards, to offer gui-dance for the infection control and to improve safety practices for medical staff, by sampling and detecting SARS-CoV-2 nucleic acid from the air of hospital wards, the high-frequency contact surfaces in the contaminated area and the surfaces of medical staff's protective equipment in a COVID-19 designated hospital in Wuhan, China.@*METHODS@#From March 11 to March 19, 2020, we collected air samples from the clean area, the buffer room and the contaminated area respectively in the COVID-19 wards using a portable bioaerosol concentrator WA-15. And sterile premoistened swabs were used to sample the high-frequency contacted surfaces in the contaminated area and the surfaces of medical staff's protective equipment including outermost gloves, tracheotomy operator's positive pressure respiratory protective hood and isolation clothing. The SARS-CoV-2 nucleic acid of the samples were detected by real-time fluorescence quantitative PCR. During the isolation medical observation period, those medical staff who worked in the COVID-19 wards were detected for SARS-CoV-2 nucleic acid with oropharyngeal swabs, IgM and IgG antibody in the sera, and chest CT scans to confirm the infection status of COVID-19.@*RESULTS@#No SARS-CoV-2 nucleic acid was detected in the tested samples, including the 90 air samples from the COVID-19 wards including clean area, buffer room and contaminated area, the 38 high-frequency contact surfaces samples of the contaminated area and 16 surface samples of medical staff's protective equipment including outermost gloves and isolation clothing. Moreover, detection of SARS-CoV-2 nucleic acid by oropharyngeal swabs and IgM, IgG antibodies in the sera of all the health-care workers who participated in the treatment for COVID-19 were all negative. Besides, no chest CT scan images of medical staff exhibited COVID-19 lung presentations.@*CONCLUSION@#Good ventilation conditions, strict disinfection of environmental facilities in hospital wards, guidance for correct habits in patients, and strict hand hygiene during medical staff are important to reduce the formation of viral aerosols, cut down the aerosol load, and avoid cross-infection in isolation wards. In the face of infectious diseases that were not fully mastered but ma-naged as class A, it is safe for medical personnel to be equipped at a high level.

Intensivists' Direct Management without Residents May Improve the Survival Rate Compared to High-Intensity Intensivist Staffing in Academic Intensive Care Units: Retrospective and Crossover Study Design

Chinese Society of Allergy and Chinese Society of Otorhinolaryngology-Head and Neck Surgery Guideline for Chronic Rhinosinusitis

The current document is based on a consensus reached by a panel of experts from the Chinese Society of Allergy and the Chinese Society of Otorhinolaryngology-Head and Neck Surgery, Rhinology Group. Chronic rhinosinusitis (CRS) affects approximately 8% of Chinese adults. The inflammatory and remodeling mechanisms of CRS in the Chinese population differ from those observed in the populations of European descent. Recently, precision medicine has been used to treat inflammation by targeting key biomarkers that are involved in the process. However, there are no CRS guidelines or a consensus available from China that can be shared with the international academia. The guidelines presented in this paper cover the epidemiology, economic burden, genetics and epigenetics, mechanisms, phenotypes and endotypes, diagnosis and differential diagnosis, management, and the current status of CRS in China. These guidelines—with a focus on China—will improve the abilities of clinical and medical staff during the treatment of CRS. Additionally, they will help international agencies in improving the verification of CRS endotypes, mapping of eosinophilic shifts, the identification of suitable biomarkers for endotyping, and predicting responses to therapies. In conclusion, these guidelines will help select therapies, such as pharmacotherapy, surgical approaches and innovative biotherapeutics, which are tailored to each of the individual CRS endotypes.

"Nacer en determinado lugar te condiciona". Salud, derecho a la ciudad, crisis y participación en un barrio reubicado / "Being born in a certain place conditions you". Health, right to the city, crisis and participation in a relocated neighborhood

Resumen Este artículo analiza, en el marco de una relocalización de asentamientos, la participación y las tácticas de los/as habitantes de Barrio Nuevo y médicos/as de un Centro de Salud de La Plata (Argentina) ante la crisis acontecida a partir de la aplicación de políticas de austeridad.El supuesto del que partimos es que la participación comunitaria y en el campo de la salud (entendida en un sentido holístico) posibilita identificar e incidir en los condicionantes sociales, como el derecho a la ciudad, para favorecer transformaciones de la situación de salud del territorio. Para ello, indagaremos la crisis, las políticas actuales y los modos de participación. En particular, desarrollaremos la experiencia de un Análisis de Situación de Salud (ASIS) en el barrio y analizaremos la relación entre derecho a la salud y derecho a la ciudad.Se empleó una metodología etnográfica. Se realizaron observaciones participantes, entrevistas en profundidad, un taller de salud y se participó en el ASIS.Concluimos que hay una relación dialéctica entre derecho a la ciudad y a la salud y ésta es una construcción colectiva. Toda participación barrial fortalece las intervenciones en salud. Ello es indispensable en contextos de crisis para luchar por derechos vulnerados.

Abstract The present paper analyzes, in the context of a settlements' relocation, the participation and tactics developed by the Barrio Nuevo inhabitants and doctors of a Health Centre in La Plata (Argentina), to face the crisis that is taking place in the country from the application of austerity policies. Our assumption is that community participation and in health issues (understood in a holistic sense) makes it possible to identify and intervene in social conditions, such as the right to the city, to produce changes in the health situation of the territory. For this, we will investigate the crisis, the current public policies and the modes of participation. Specifically, we will develop the experience of a Health Situation Analysis (ASIS) held in the territory and we will analyze the relationship between the right to health and the right to the city.The methodology used is ethnography. We carried out participant observations, in-depth interviews, a health workshop and participated in the ASIS.We conclude that there is a dialectical relationship between the right to the city and to health and this is a collective construction. All community participation strengthens health interventions. This is essential in crisis contexts to fight for violated rights.

Soporte social en usuarios de los servicios de salud en una institucion de segundo nivel / Suporte social para usuários de serviços de saúde em uma instituição de atençao secundária / Social support for health service users at a secondary-care institution

RESUMEN Objetivo: describir el nivel del soporte social percibido por los usuarios de los servicios de salud de segundo nivel. Método: estudio descriptivo, con una muestra de 287 usuarios de los servicios de salud del estado de Durango, México, aplicando la Escala de Soporte Social de Salud, utilizando en programa SPSS para el análisis de resultados. Resultados: se encontró que el usuario de la consulta externa del hospital, percibe mayor soporte social por parte del personal de enfermería en comparación con el médico y trabajo social, presentando una media de (M=10.70, 10.19, 9.58) respectivamente; con una diferencia significativa de p<0.05. Conclusión: es el personal de enfermería el que brinda mayor soporte social a los usuarios de los servicios de salud, resolviendo cada una de las dudas que se les presenten y permitiéndoles expresar sus sentimientos.

RESUMO Objetivo: Descrever o nível de suporte social percebido por usuários de serviços de atenção secundária. Método: Estudo descritivo com uma amostra de 287 usuários de serviços de saúde do estado de Durango, México, aplicando a Escala de Suporte Social de Saúde, e utilizando o programa SPSS para a análise de resultados. Resultados: Os usuários ambulatoriais do hospital perceberam maior suporte por parte da equipe de enfermagem quando comparado aos médicos e assistentes sociais, com uma média de M=10,70, 10,19, e 9,58, respectivamente; e com uma diferença significativa de p<0,05. Conclusão: A equipe de enfermagem fornece mais suporte social aos usuários dos serviços de saúde, respondendo às perguntas que são feitas e permitindo aos pacientes que expressem seus sentimentos.

ABSTRACT Objective: To describe the level of social support perceived by users of a second-level health service. Method: This was a descriptive study with 287 users of health services in the state of Durango, Mexico, using the Social Support Scale in Health to collect data and SPSS software to analyze the results. Results: The outpatients perceived more social support from nursing staff than from physicians and social workers, with a mean of 10.70, 10.19, 9.58, respectively; with a p<0.05 significant difference. Conclusion: Nursing professionals provide health service users with the greatest social support, answering their questions and allowing them to express their feelings.