Can the Second and Fourth Finger (2D: 4D) Ratio Guide Physicians in Choosing Internal Medicine or Surgical Branch? / ¿Puede la proporción del Segundo y Cuarto Dedo (2D: 4D) Guiar a los Médicos en la Elección de Medicina Interna o Rama Quirúrgica?

SUMMARY: This study investigates the relationship between the second and fourth finger ratio (2D:4D), physicians' propensity to choose an internal or surgical branch, and sex differences. On a voluntary basis, 177 physicians working in Elazig, 122 men and 55 women were enrolled in the study. Their hands were measured for 2D and 4D lengths, and the 2D:4D ratio was computed. In female doctors, the left hand's 2D:4D ratio is 1.01, compared to the right hand's 1.00. Male doctors' right 2D:4D ratio is 0.99, while their left 2D:4D ratio is 1.00. Male physicians' 2D:4D ratios were different from those of men in the general population, whereas female physicians' 2D:4D ratios were comparable to those of women in the general population. As a result, this study was the first to examine the relationship between the ratio of the second and fourth fingers (2D:4D), physicians' tendency to choose an internal medicine or surgical branch, and sex differences. While the 2D:4D ratio was higher than 0.98 in all physicians, it was low in women who disliked their profession and branch. Since there aren't many studies on this subject, data from in-depth studies that will be conducted in the future will help physicians who choose internal medicine and surgery make more informed decisions.

Este estudio investiga la relación entre la proporción de los dedos segundo y cuarto (2D:4D), la propensión de los médicos a elegir una rama interna o quirúrgica y las diferencias de género. De forma voluntaria, se inscribieron en el estudio 177 médicos que trabajaban en Elazig, 122 hombres y 55 mujeres. Sus manos se midieron en longitudes 2D y 4D, y se calculó la relación 2D:4D. En las médicos mujeres, la relación 2D:4D de la mano izquierda es 1,01, en comparación con 1,00 de la mano derecha. La relación 2D:4D derecha de los médicos hombres fue 0,99, mientras que la relación 2D:4D izquierda fye 1,00. Las proporciones 2D:4D de los médicos hombres fueron diferentes de las de los hombres en la población general, mientras que las proporciones 2D:4D de las mujeres médicas fueron comparables a las de las mujeres en la población general. Como resultado, este estudio fue el primero en examinar la relación entre la proporción del segundo y cuarto dedo (2D:4D), la tendencia de los médicos a elegir una rama de medicina interna o quirúrgica y las diferencias de sexo. Mientras que la relación 2D:4D fue superior a 0,98 en todos los médicos, fue baja en las mujeres que no les gustaba su profesión y rama. Dado que no hay muchos estudios sobre este tema, los datos de estudios en profundidad que se realizarán en el futuro ayudarán a los médicos que eligen medicina interna y cirugía a tomar decisiones más informadas.

Human embryology science: which theoretical information do clinical embryologists need to know more about? A survey / Ciencia de la embriología humana: ¿Qué información teórica necesitan saber más los embriólogos clínicos? Una encuesta

SUMMARY: For the past decades, it has been apparent that assisted reproductive technologies along with clinical embryology have both propounded themselves triumphantly in the field of medicine. Although high-tech equipment and staff skills are crucial to the success of these breakthrough implementations, the pivot of these practices is updated, knowledgeable and competent technicians who excel in the field of human embryology. Crucially, the advancement of clinical embryology and its related fields depends on the meticulous training of clinical embryologists in practical skills as well as theoretical knowledge. Unfortunately, most aspects of reproductive medicine have no obligatory assembled curriculum. A lot more emphasis has been put on the clinical aspect of these sciences and training than its theoretical counterpart. Consequently, clinical embryologists continue to face difficulty in unifying the needed theoretical knowledge in these fields. Not only that, but they also struggle to shed a light on the advanced knowledge required to stand out as professionals. This study aimed to explore which theoretical information in the science of human embryology that embryologists need to know thoroughly about. The survey was conducted online (July 2021).

RESUMEN: Durante las últimas décadas, ha sido evidente que las tecnologías de reproducción asistida junto con la embriología clínica han demostrado un éxito importante en el area de la medicina. Si bien los equipos de alta tecnología y las habilidades del personal son cruciales para el éxito de estas implementaciones, el eje de estas prácticas son los técnicos actualizados, competentes y expertos en el campo de la embriología humana. Fundamentalmente, el avance de la embriología clínica y sus campos relacionados dependen de la formación meticulosa de los embriólogos clínicos en las habilidades prácticas y los conocimientos teóricos. Desafortunadamente, la mayoría de los aspectos de la medicina reproductiva no cuenta con un plan de estudios obligatorio. El énfasis se ha concentrado en el aspecto clínico y en el entrenamiento de estas ciencias más que en la contraparte teórica. En consecuencia, los embriólogos clínicos continúan enfrentando dificultades para unificar el conocimiento teórico necesario en estos campos. Este estudio tuvo como objetivo explorar qué información teórica importante en la ciencia de la embriología humana requieren los embriólogos. La encuesta de este trabajo se realizó en línea (julio de 2021).

Uso del pódcast como herramienta educativa en una residencia de Cirugía General en tiempos de COVID-19 / Use of podcasts as educational tool in a residency program in general surgery in the time of COVID-19 pandemic

RESUMEN Antecedentes: la pandemia de COVID-19 alteró la formación de los residentes de cirugía, disminuyendo sus oportunidades de aprendizaje. La lectura y análisis de trabajos científicos a través de pódcast podrían ser una opción para atenuar ese problema. Objetivo: evaluar la aceptación por parte de los residentes de Cirugía del uso de pódcast como una nueva herramienta educativa. Material y métodos: estudio exploratorio, analítico y longitudinal, realizado desde mayo hasta diciembre de 2020. Cada semana, un residente fue el encargado de leer, analizar y confeccionar una presentación grabada en forma de pódcast sobre un artículo seleccionado por médicos de planta. Se evaluó la experiencia de los residentes mediante un cuestionario tipo Likert diseñado por los investigadores. Resultados: se realizaron 37 pódcast, que se reprodujeron 2091 veces. El 100% de los residentes informó que esta herramienta fomentó la discusión académica entre pares, el 88% que le generó preguntas de investigación y el 43% que lo inspiró a una revisión bibliográfica. Conclusión: la lectura y análisis de trabajos a través de pódcast es bien aceptada y puede ser una herramienta adicional para el aprendizaje en épocas atípicas.

ABSTRACT Background: COVID-19 pandemic altered the training of residents in surgery, reducing their opportunities to learn. Reading and analyzing scientific paper via podcasts could be an option to mitigate such problem. Objective: The aim of this study is to evaluate residents in surgery acceptance of the use of podcasts as a new educational tool. Material and methods: We conducted a longitudinal, analytical and exploratory study between May and December 2020. Each week, a resident was in charge of reading, analyzing and preparing a recorded presentation in the format of a podcast of an article selected by a staff physician. The residents' experience was assessed by means of a Likert-type questionnaire designed by the investigators. Results: A total of 37 podcasts were recorded with a total number of plays of 2091. All the residents reported that this tool encouraged the academic peer discussion, 88% responded that it generated research questions and 43% agreed that listening to the podcasts served as inspiration to perform a bibliographic search. Conclusion: Reading and analyzing scientific papers via podcasts is well accepted and could be an additional tool for learning in atypical times.

Percepção de cuidados desproporcionais entre médicos seniores, médicos residentes, enfermeiros e técnicos de enfermagem em um centro de terapia intensiva / Perception of disproportionate care among staff physicians, training physicians, nurses, and practical nurses in an intensive care unit

Introdução: O aumento progressivo de medidas avançadas para manutenção da vida em pacientes com pouca expectativa de sobrevida gera percepção de cuidado desproporcional. Objetivamos averiguar a prevalência de cuidado desproporcional em equipe médica e enfermagem que atuam na Unidade de Terapia Intensiva (UTI) em um hospital público do Brasil.Métodos: Estudo transversal envolvendo equipe médica e enfermagem em uma UTI multidisciplinar de 34 leitos de um hospital terciário no sul do Brasil de janeiro a julho de 2019. Ao total 151 profissionais responderam a um questionário eletrônico anônimo.Resultados: A taxa de resposta foi de 49,5%. Cento e dezoito (78,1%) profissionais identificaram cuidado desproporcional no ambiente de trabalho. Enfermeiros e técnicos de enfermagem receberam menos treinamento formal em comunicação de fim de vida do que médicos (10,6% versus 57,6%, p < 0,001). Vinte e nove (28,1%) enfermeiros e técnicos de enfermagem e 4 (0,08%) médicos responderam que não havia discussão sobre terminalidade na UTI (p = 0,006). Quarenta e três (89,5%) médicos afirmaram que havia colaboração entre equipe médica e equipe de enfermagem, ao passo que 58 (56,3%) enfermeiros e técnicos de enfermagem discordaram da assertiva (p < 0,001).Conclusão: Este é o primeiro estudo sobre percepção de cuidado desproporcional conduzido na América Latina, envolvendo residentes e técnicos de enfermagem e um centro de alta complexidade do sistema público de saúde. A vasta maioria dos profissionais percebe a existência de cuidado desproporcional em sua prática diária, independentemente da classe profissional.

Introduction: The increased use of life-sustaining measures in patients with poor long- and middle-term expected survival concerns health care providers regarding disproportionate care. The objective of this study was to report the prevalence of perceived inappropriate care among intensive care unit (ICU) staff physicians, training physicians, nurses, and practical nurses in a Brazilian public hospital.Methods: We conducted a cross-sectional study with the medical and nursing team of a 34-bed multidisciplinary ICU of a tertiary teaching hospital in Southern Brazil from January to July 2019. A total of 151 professionals completed an anonymous electronic survey. Results: The response rate was 49.5%. One hundred and eighteen (78.1%) respondents reported disproportionate care in the work environment. Nurses and practical nurses were less likely to receive formal training on end-of-life communication compared to physicians (10.6% vs. 57.6%, p < 0.001). Twenty-nine (28.1%) nurses and practical nurses vs. 4 (0.08%) physicians claimed that there were no palliative care deliberations in the ICU (p = 0.006). Of 48 senior and junior physicians, 43 (89.5%) believed that collaboration between physicians and nurses was good, whereas 58 out of 103 (56.3%) nurses and practical nurses disagreed (p < 0.001).Conclusion: This is the first survey on the perception of inappropriate care conducted in Latin America. The study included junior physicians and practical nurses working in a high-complexity medical center associated with the Brazilian public health system. Most health care providers perceived disproportionate care in their daily practice, regardless of their professional class.

Prevalencia de síndrome de burnout en anestesiología y cirugía ortopédica en un centro en Chile / Burnout prevalence in anesthesiology and orthopedic surgery in a center in Chile

Resumen Objetivo: Evaluar el agotamiento emocional o cansancio emocional, realización personal y despersonalización en el quehacer de los médicos del Servicio de Traumatología y Pabellón Central del Hospital Hernán Henríquez Aravena (HHHA) y Departamento de Cirugía de la Universidad de La Frontera, Temuco, Chile. Materiales y Método: Corte transversal. 48 sujetos: 10 residentes de traumatología y 8 de anestesiología, 12 anestesiólogos y 18 traumatólogos académicos asistenciales. Se aplicó bajo consentimiento informado: Inventario de Maslash (MBI). Análisis: tendencia central, porcentaje, así como t de student y coeficientes de alfa de Cronbach. Resultados: La prevalencia global del síndrome de burnout es 97%, por dimensiones, cansancio emocional mostró una prevalencia del 100%; baja realización personal en el trabajo 100% y despersonalización 91,6%. Para traumatología: cansancio emocional mostró prevalencia 100%; baja realización personal en el trabajo 100%, y despersonalización 82%. Para anestesiología: cansancio emocional mostró prevalencia 75%; baja realización personal en el trabajo 30% y despersonalización 30%. Existen diferencias significativas en cansancio emocional siendo mayor en género femenino y en quienes duermen menos de 7 h. El coeficiente de alpha de Cronbach del MBI fue de 0,7. Conclusión: Tanto residentes como académicos asistenciales de traumatología y anestesiología mostraron un elevado cansancio emocional que coexiste con una baja realización personal en el trabajo y alta despersonalización. En Chile, las políticas de protección están principalmente enfocadas en la Seguridad y Salud Ocupacional con la gestión de los riesgos, pero no se observan políticas de protección al estrés y salud mental que involucren contención y apoyo a la labor terapéutica de los profesionales de la medicina.

Aim: To assess levels of burnout, including emotional exhaustion, personal accomplishment and depersonalization, in the daily work of academic doctors in the Orthopedic Surgery Service and Central Surgery Service of the Hospital Hernán Henríquez Aravena (HHHA) and Surgery Department in the Universidad de La Frontera, Temuco, Chile. Materials and Method: Cross-sectional study. 48 subjects participated: 10 residents in orthopedic surgery, 8 residents in anesthesiology, 12 academic anesthesiologists and 18 academic orthopedic surgeons. Instruments applied under informed consent: Maslach Burnout Inventory (MBI). Analysis: Measures of central tendency and percentage, independent sample t-tests. Cronbach's alpha coefficients of the MBI. Results: The overall prevalence of burnout syndrome is 97%, whereas by dimensions, emotional exhaustion showed a prevalence of 100%, low personal accomplishment at work 100% and depersonalization 91.6%. For orthopedic surgery by dimensions: emotional exhaustion showed a prevalence of 100%, low personal accomplishment at work 100% and depersonalization 82%. For anesthesiology: emotional exhaustion showed a prevalence of 75%, low personal accomplishment at work 30% and depersonalization 30%. Only gender and hours of sleep showed significant differences in emotional exhaustion, with higher scores for women and those who slept less than 7 hours. 0.7 Cronbach's alpha of the MBI. Conclusión: There is excessive emotional fatigue, low job felt accomplishment and depersonalization in orthopedic surgery residents and academic. In anesthesiology, emotional high exhaustion coexists with low personal accomplishment values and depersonalization high. In Chile, protection policies are mainly focused on Occupational Safety and Health with risk management, but there are no stress protection and mental health policies involving containment and support for the therapeutic work of medical professionals.

Evaluation of moral intelligence of healthcare professionals via the "Survey for Measuring Moral Intelligence in the Provision of Healthcare Services" / Evaluación de la inteligencia moral de profesionales de la salud a través de la "Encuesta para medir la inteligencia moral en la prestación de servicios de salud" / Avaliação da inteligência moral de professionais de saúde via "Levantamento para Medir a Inteligência Moral na Provisão de Serviços de Cuidados à Saúde"

Abstract: Moral intelligence -through which an individual makes mental evaluation before taking action about a decision- is important in individual-centered healthcare. Using Lawshe Method, we designed the "Survey for Measuring Moral Intelligence in the Provision of Healthcare Services" with "equality", "empathy", "moral intelligence", "justice", "tolerance", "self-control", and "politeness" dimensions (α=.966). Age of the population (physicians and nurses) was 36.44±9.52, consisting 517 (65.5%) women, 538 married participants, 653 employed in public hospitals, and 352 had work experience of 8 hours/day. Using dimensions of this survey as skills is expected to ensure due diligence about rights and dignity in healthcare services.

Resumen: La inteligencia moral, mediante la cual un individuo realiza una evaluación mental antes de tomar medidas sobre una decisión, es importante en la atención médica centrada en el individuo. Usando el método Lawshe, diseñamos la "Encuesta para medir la inteligencia moral en la provisión de servicios de salud" con dimensiones de "igualdad", "empatía", "inteligencia moral", "justicia", "tolerancia", "autocontrol" y "cortesía" (α=.966). La edad de la población (médicos y enfermeras) era de 36.44±9.52, que consistía en 517 (65,5%) mujeres, 538 participantes casados, 653 empleados en hospitales públicos y 352 tenían una experiencia laboral de 8 horas/día. Se espera que el uso de las dimensiones de esta encuesta como habilidades garantice la debida diligencia sobre los derechos y la dignidad en los servicios de atención médica.

Resumo: Inteligência moral -através da qual um individuo faz uma avaliação mental antes de agir frente a uma decisão- é importante em cuidados à saúde centrados na pessoa. Usando o Método Lawshe, nós elaboramos o "Levantamento para Medir a Inteligência Moral na Provisão de Serviços de Cuidados à Saúde" com as dimensões "igualdade", "empatia", "inteligência moral", "justiça", "tolerância", "autocontrole" e "polidez (α=.966). A idade da população (médicos e enfermeiras) foi 36.44±9.52 anos, consistindo de 517 (65.5%) mulheres, 538 participantes casados, 653 empregados em hospitais públicos e 352 tinham experiência de trabalho 8 horas/dia. Usando dimensões deste levantamento como habilidades, espera-se que garanta a devida presteza sobre direitos e dignidade em serviços de cuidados à saúde.

Percepción de la atención de salud de personas transgénero en profesionales médicos y médicas del norte de Chile / Perception of transgender health care among physicians in northern Chile

RESUMEN La demanda de atención de salud en personas transgénero está creciendo. Existe escasa información del conocimiento de los médicos sobre el trato en la atención sanitaria de estas personas y sus necesidades. Se realizó una encuesta a médicos (as) en Chile sobre su oportunidad de atención a estas personas, su conocimiento sobre las normativas de trato a esta población y percepción sobre acceso a tratamientos de readecuación sexual. De 123 encuestados, edad promedio 41 años, 56% había atendido a alguna persona transgénero, 4,3% manifestó rechazo u odio en esa atención, 84% nunca tuvo alguna formación respecto al tema en su formación universitaria, 96% se mostró interesado en recibir información respecto al tema, 77% desconoce la existencia de normativas de trato a estas personas, 18% rechaza gasto de salud en apoyo a su proceso de readecuación sexual, 14% no usaría el nombre social en el trato con estos pacientes y 10% hospitalizaría a un paciente transgénero según su sexo biológico y no según su sexo sentido. Los médicos en Chile reciben escasa formación respecto al trato y las necesidades de salud de la población transgénero, pero están interesados en que se les entregue información respecto al tema. La mayoría están a favor de que personas transgéneros tengan la oportunidad de recibir apoyo médico en la atención sanitaria pública, en su proceso de reasignación de sexo hormonal y/o quirúrgica.

ABSTRACT The demand for health care in transgender people is growing. There is poor information on physician knowledge about the treatment of these people and their needs. A survey was conducted to physician in Chile about their opportunity to care for these people, their knowledge about the rules of treatment of this population, and their perception of access to sexual rehabilitation treatments. 123 respondents, average age 41 years, 56% had attended some transgender people, 4.3% expressed rejection or hatred in that attention, 84% never had any training on the subject in their university education, 96% were interested in receiving information on the subject, 77% are unaware of the existence of treatment regulations for these people, 18% reject health spending in support of their sexual rehabilitation process, 14% would not use the social name in dealing with these patients and 10% would hospitalize a transgender patient according to their biological sex and not according to their felt sex. Physician in Chile receive poor training regarding the treatment and health needs of the transgender population, but are interested in being given information on the subject. The majority are in favor of transgender people having the opportunity to receive medical support in public health care, in their process of reassignment of hormonal and / or surgical sex.

Conocimiento y conciencia de los médicos sobre la osteonecrosis relacionada con bifosfonatos / Knowledge and awareness of physicians about bisphosphonate-related osteonecrosis of the jaws

Objetivo: Determinar el conocimiento y la conciencia que tienen los médicos sobre la osteonecrosis relacionada con bifosfonatos. Material y métodos: Se realizó un estudio transversal, en el cual se encuestó a médicos generales y especialistas con la finalidad de identificar el nivel de conocimientos y conciencia que tienen sobre el tema. Resultados: Se entrevistó a un total de 475 médicos generales y especialistas, de los cuales 210 (44.2%) mencionaron prescribir bifosfonatos, de este grupo 58.1% no envía a los pacientes con el odontólogo para eliminar factores de riesgo, a pesar de que 61.8% de los mismos mencionó conocer las reacciones adversas; 36 médicos (17.4%) han visto a algún paciente con osteonecrosis por bifosfonatos. El 37% de los médicos que prescriben medicamentos consideran que no es necesario remitir a los pacientes al odontólogo. Conclusiones: La prescripción de bifosfonatos en la práctica médica va en aumento, los médicos deben tener el conocimiento adecuado sobre las reacciones adversas de estos medicamentos para así poder referir oportunamente al odontólogo, educar al paciente y poder prevenir complicaciones como la osteonecrosis relacionada con bifosfonatos (AU)

Objectives : To evaluate the knowledge and awareness of physicians about bisphosphonate-related osteonecrosis of the jaws. Material and methods: A cross-sectional survey was carried out among general practitioners and specialized physicians to determine their knowledge and awareness of bisphosphonate-related osteonecrosis of the jaws. Results: Of the 475 interviewed general practitioners and specialized physicians, 210 (44.2%) claimed to prescribe bisphosphonates. A total of 58.1% of these physicians did not refer their patients to the dentist for the elimination of risk factors, despite the fact that 61.8% of them reported knowledge of the adverse reactions of these drugs. Thirty-six physicians (17.4%) had seen some patient with bisphosphonate-related osteonecrosis of the jaws. A total of 37% of the physicians that prescribed drugs considered it not necessary to refer patients to the dentist. Conclusions: Bisphosphonate prescription is increasingly common in medical practice, and physicians must have adequate knowledge of the adverse reactions of these drugs in order to ensure opportune patient referral to the dentist, educate their patients, and avoid complications such as bisphosphonate-related osteonecrosis of the jaws (AU)

Idosos vivendo com HIV/aids: a percepção de usuários e profissionais da Atenção Primária à Saúde / Elderly people living with HIV/aids: the perception of users and professionals of Primary Health Care

Considerando a rápida transição demográfica e epidemiológica que se tem vivenciado no Brasil e, sendo a Atenção Primária a porta de entrada preferencial aos serviços de saúde, esta pesquisa possui como objetivo geral avaliar, o cuidado de pessoas idosas vivendo com HIV/Aids no âmbito da Atenção Primária à Saúde. Estudo qualitativo, com abordagem metodológica do tipo estudo de caso, desenvolvido nas seguintes etapas: conhecimento do cuidado às pessoas idosas vivendo com HIV/Aids a partir da percepção dos enfermeiros da Atenção Primária à Saúde; identificação dos desafios para o cuidado a estas pessoas na percepção dos profissionais da Atenção Primária à Saúde; percepção de pessoas idosas que vivem com HIV/Aids sobre o seu tratamento; análise sobre a influência da acessibilidade geográfica dos serviços públicos de saúde no tratamento das pessoas idosas vivendo com HIV/Aids. A pesquisa foi realizada no município de Itaboraí, no estado do Rio de Janeiro. A coleta dos dados foi realizada por meio da entrevista semiestruturada com os profissionais no mês de novembro de 2019 a janeiro de 2020 e a entrevista com os idosos que vivem com HIV/Aids, devido à pandemia COVID-19, foi realizada entre o mês de setembro de 2020 a fevereiro de 2021. Ao conhecer o cuidado a partir da percepção dos enfermeiros emergiram as seguintes unidades de análise: 1- O cuidado integral visto essencialmente como acolhimento; 2- Para os enfermeiros a participação da equipe multiprofissional e a capacitação profissional conferem garantias do cuidado; 3- O cuidado integral é caracterizado pelos atributos essenciais da Atenção Primária à Saúde. Na identificação dos desafios para o cuidado aos idosos vivendo com HIV/Aids na percepção dos profissionais da Atenção Primária à Saúde o corpus foi desenvolvido com o discurso dos 56 profissionais (24 médicos e 32 enfermeiros) e na descrição do tratamento na percepção dos idosos que vivem com HIV/Aids, o corpus foi constituído com textos oriundos dos discursos de 15 usuários. Os dados foram organizados e processados com auxílio do software Iramuteq, analisados por meio da Classificação Hierárquica Descendente, análise de similitude e nuvem de palavras. Emergiram 10 classes nos discursos dos profissionais e 6 classes nos discursos dos usuários. O georreferenciamento foi realizado através do Google Earth e Google Maps. A percepção dos enfermeiros sobre o cuidado ainda é voltada para a dimensão técnica, sendo os aspectos biopsicossociais menoconsiderados como parte do trabalho junto à população. Na percepção dos profissionais da Atenção Primária o cuidado a essas pessoas apresenta como principais desafios o sigilo, estigma da doença, vínculo, manutenção de equipe multidisciplinar para apoio, educação permanente dos profissionais, acesso e a integralidade da assistência. Foi identificado que a distância entre a residência do idoso e o Serviço de Atenção Especializada chega a ser 30 vezes superior que a distância entre o usuário e a Unidade de Atenção Primária à Saúde. A necessidade de fortalecer serviços de Atenção Primária foi notária, tendo em vista que, como ordenadora da Rede de Atenção à Saúde, seu papel não ficou bem delineado, com grande fragilidade na integralidade da assistência e na própria resolubilidade da APS. Apesar do modelo de atenção fragmentado, longe do ideal recomendado pelas literaturas, os idosos sentem-se satisfeitos com o tratamento recebido para o HIV/aids, referindo vínculo e humanização no cuidado à sua saúde, independentemente da acessibilidade geográfica dos serviços de saúde.

Considering the rapid demographic and epidemiological transition that has been experienced in Brazil and, since Primary Care is the preferred gateway to health services, this research has the general objective of evaluating the care of elderly people living with HIV/AIDS within the scope of Primary Health Care. Qualitative study, with a case study methodological approach, developed in the following stages: knowledge of care for elderly people living with HIV/AIDS from the perception of nurses in Primary Health Care; identification of challenges for the care of these people in the perception of Primary Health Care professionals; perception of elderly people living with HIV/AIDS about their treatment; analysis of the influence of geographic accessibility of public health services in the treatment of elderly people living with HIV/AIDS. The research was carried out in the municipality of Itaboraí, in the state of Rio de Janeiro. Data collection was carried out through a semi-structured interview with professionals from November 2019 to January 2020 and the interview with the elderly living with HIV/AIDS, due to the COVID-19 pandemic, was carried out between the month of September 2020 to February 2021. When knowing care from the nurses' perception, the following units of analysis emerged: 1- Comprehensive care seen essentially as embracement; 2- For nurses, the participation of the multidisciplinary team and professional training provide guarantees of care; 3- Comprehensive care is characterized by the essential attributes of Primary Health Care. In identifying the challenges for the care of elderly people living with HIV/AIDS in the perception of Primary Health Care professionals, the corpus was developed with the speech of 56 professionals (24 doctors and 32 nurses) and in the description of the treatment in the perception of the elderly living with HIV/AIDS, the corpus was constituted with texts from the speeches of 15 users. Data were organized and processed using the Iramuteq software, analyzed using Descending Hierarchical Classification, similarity analysis and word cloud. 10 classes emerged in the professionals' discourses and 6 classes in the users' discourses. Georeferencing was performed using Google Earth and Google Maps. Nurses' perception of care is still focused on the technical dimension, with biopsychosocial aspects being less considered as part of working with the population. In the perception of Primary Care professionals, care for these people presents as main challenges confidentiality, stigma of the disease, bonding, maintenance of a multidisciplinary team for support, permanent education of professionals, access and comprehensive care. It was identified that the distance between the elderly person's residence and the Specialized Care Service is up to 30 times greater than the distance between the user and the Primary Health Care Unit. The need to strengthen Primary Care services was evident, taking into account given that, as coordinator of the Health Care Network, her role was not well defined, with great fragility in the integrality of care and in the very solvability of Primary Health Care. Despite the fragmented care model, far from the ideal recommended by the literature, the elderly feel satisfied with the treatment received for HIV/AIDS, referring to bonding and humanization in their health care, regardless of the geographic accessibility of health services.

Muerte Súbita en Epilepsia (SUDEP): Encuesta a familiares de pacientes con epilepsia y a profesionales de la salud / Sudden unexpected death in epilepsy (SUDEP): Epilepsy Family and Survey health professionals

Sudden unexpected death in epilepsy (SUDEP), definida como la muerte brusca, inesperada, con o sin testigos, no traumática ni por ahogo, que ocurre en circunstancias benignas, en un individuo con epilepsia, con o sin evidencias de crisis, pero sin estado epiléptico. En general, afecta sobre todo a pacientes con epilepsia refractaria. La incidencia es de 4-7/1000 pacientes al año. En nuestra región, no contamos con muchos datos epidemiológicos de SUDEP, lo cual es un desafío a investigar, ya que sabemos que el 85% de los pacientes con epilepsia viven en países en desarrollo. Es muy importante que los pacientes y/o familiares conozcan sobre SUDEP, ya que ayuda a lograr mejor lo objetivos de tratamiento, promueve mejor el reporte médico-paciente, disminuye ansiedad, filtra la información inadecuada y creencias inapropiadas. Pero es necesario preguntarles a ellos, cuanto saben de SUDEP, cómo, que y cuando recibir esta información. Existen países y culturas donde está vedado hablar de SUDEP. Tampoco conocemos cómo los médicos manejamos el tema, cuando decirlo, que contar y cómo hacerlo. Por otro lado, hay controversias entre los epileptólogos, en qué momento tratar la temática. Por este motivo, se realiza una encuesta a pacientes con epilepsia y/o familiares, además de especialistas médicos. El objetivo es evaluar si los colegas especialistas están hablando del tema y por otro lado constatar los conocimientos de SUDEP en los pacientes y/o familiares. Los resultados de la encuesta, arrojan que la mayoría de los médicos no habla del tema y la mayor parte de los familiares de pacientes con epilepsia desea conocer la temática al inicio de la enfermedad, contada por el médico. Gran número de ellos se ha informado por redes sociales y creen que es prevenible.

Sudden unexpected death in epilepsy (SUDEP), is defined as sudden, unexpected death, with or without witnesses, neither traumatic nor by choking, occurring in benign circumstances in an individual with epilepsy, with or without evidence of crisis, but without epileptic status. In general, it mainly affects patients with refractory epilepsy. The incidence is 4-7/1000 patients per year. In our region, we do not have much epidemiological data about SUDEP, which is a challenge to investigate, as we know that 85% of epilepsy patients live in developing countries. It is important to ask patients and/or family members how much do they know about SUDEP and how as well as when to receive this information. It is important that parents and/or family members know about SUDEP, as it helps to better achieve treat ment goals, better promotes doctor-patient reporting, decreases anxiety, filters inadequate information and inappropriate beliefs. There are countries and cultures where it is forbidden to talk about SUDEP. We also do not know how doctors handle the subject, when to talk about it, what to tell and how to do it. On the other hand, there are controversies among epileptologists at which point to deal with this subject. For this reason, a survey is conducted on parents of children with epilepsy and/or family members, as well as medical specialists. The objective is to be able to evaluate how specialist colleagues are talking about the topic and on the other hand evaluate some parameters of SUDEP in parents and/or family members. Most doctors do not talk about it and most relatives of epilepsy patients want to know the topic of the onset of the disease form their doctor. Large numbers of them have gathered information on SUDEP through social networks and believe it is preventable.

Development and validation of a scale to measure the gross anatomy preparedness of medical graduates / Desarrollo y validación de una escala para medir la preparación anatómica general de los graduados médicos

SUMMARY: Postgraduate refresher courses may address deficiencies in the gross anatomy preparedness of medical graduates. However, the literature does not offer a method to identify such deficiencies. Our aim is to develop and validate a scale to measure the gross anatomy preparedness of medical graduates. First, we defined gross anatomy preparedness (the construct) as "the benchmark of personal ability in gross anatomy against the standard required for clinical practice." Next, we conducted a literature search for extant items related to our definition. To develop our scale, we grouped the items under three headings: proficiency, preference, and pertinence. Finally, we constructed item-specific response anchors to "Likertize" the items. We recruited experts to validate the content and conducted cognitive interviews to validate the response process. To evaluate the internal structure and reliability of the scale, we invited a purposive sample of 120 surgery residents to complete the scale and explored the results of the pilot test using data reduction and reliability analysis. A total of 77 surgery residents completed the scale. Varimax-rotated principal components analysis revealed three components with eigenvalues greater than one, and the components explained 64 % of the total variance. The rotated solution was consistent with the original structure of the questionnaire. The components, which represented the proficiency, preference, and pertinence item sets, explained 25 %, 23 %, and 16 %, respectively, of the total variance. Cronbach's α coefficients for the item sets were 0.72, 0.71, and 0.61, respectively. We developed and validated a scale to measure the gross anatomy preparedness of medical graduates. In addition, we offer conceptual guidelines to help users interpret the results of the scale. Outcome data are required to substantiate the predictive validity of the scale.

RESUMEN: Los cursos de actualización de posgrado pueden abordar las deficiencias en la preparación de la anatomía macroscópica de los graduados médicos. Sin embargo, la literatura no ofrece un método para identificar tales deficiencias. Nuestro objetivo fue desarrollar y validar una escala para medir la preparación anatómica general de los graduados médicos. Primero, definimos la preparación para la anatomía macroscópica (el constructo) como "el punto de referencia de la capacidad personal en anatomía macroscópica frente al estándar requerido para la práctica clínica". A continuación, realizamos una búsqueda bibliográfica de elementos existentes relacionados con nuestra definición. Para desarrollar nuestra escala, agrupamos los ítems bajo tres encabezados: competencia, preferencia y pertinencia. Finalmente, construimos anclas de respuesta específicas del ítem para "dar me gusta" a los ítems. Reclutamos expertos para validar el contenido y realizamos entrevistas cognitivas para validar el proceso de respuesta. Para evaluar la estructura interna y la confiabilidad de la escala, invitamos a una muestra intencional de 120 residentes de cirugía a completar la escala y exploramos los resultados de la prueba piloto utilizando la reducción de datos y el análisis de confiabilidad. Un total de 77 residentes de cirugía completaron la escala. El análisis de componentes principales rotados con Varimax reveló tres componentes con valores propios mayores que uno, y los componentes explicaron el 64 % de la varianza total. La solución rotada fue consistente con la estructura original del cuestionario. Los componentes, que representaban los conjuntos de ítems de competencia, preferencia y pertinencia, explicaban el 25 %, el 23 % y el 16 %, respectivamente, de la varianza total. Los coeficientes de Cronbach para los conjuntos de elementos fueron 0,72, 0,71 y 0,61, respectivamente. Desarrollamos y validamos una escala para medir la preparación anatómica general de los graduados médicos. Además, ofrecemos pautas conceptuales para ayudar a los usuarios a interpretar los resultados de la escala. Se requieren datos de resultados para corroborar la validez predictiva de la escala.

Prevalência de burnout entre médicos atuantes em terapia intensiva: uma revisão sistemática / Prevalence of burnout among intensive care physicians: a systematic review

RESUMO Objetivo: Realizar uma revisão sistemática para sumarizar o conhecimento relativo à prevalência de burnout entre médicos atuantes na unidade de terapia intensiva. Métodos: Conduzimos uma revisão sistemática nas bases de dados MEDLINE e PubMed® (última atualização em 4 de fevereiro de 2019), com o objetivo de resumir a evidência a respeito de burnout entre médicos atuantes em unidades de terapia intensiva. Incluímos todos os estudos que relatavam burnout em trabalhadores na unidade de terapia intensiva, segundo o Inventário de Burnout de Maslach e, a seguir, triamos os estudos quanto a dados relativos a burnout especificamente em médicos atuantes na unidade de terapia intensiva. Resultados: Encontramos 31 estudos que descreviam burnout em membros da equipe da unidade de terapia intensiva e incluíam diferentes perfis de profissionais de saúde. Dentre estes, cinco estudos se focalizavam apenas em médicos, e 12 outros investigavam burnout em uma mescla de profissionais atuantes na unidade de terapia intensiva, mas forneciam dados à parte relativos aos médicos. A prevalência de burnout teve grande variação entre os estudos (variando entre 18% e 49%), porém diversas discrepâncias metodológicas, dentre elas os critérios de corte para definição de burnout e variabilidade da escala de Likert, impediram uma análise agrupada significativa. Conclusão: A prevalência da síndrome de burnout entre médicos atuantes na unidade de terapia intensiva é relativamente alta, porém heterogeneidades metodológicas significantes exigem precauções na interpretação de nossos resultados. Os níveis mais baixos de burnout relatados parecem mais elevados do que os identificados em estudos que investigaram uma mescla de profissionais da unidade de terapia intensiva. Há uma necessidade urgente de consenso que recomende o uso consistente do Inventário de Burnout de Maslach para triar a presença de burnout a fim de fornecer dados precisos a respeito de burnout entre médicos atuantes na unidade de terapia intensiva.

Abstract Objective: We performed a systematic review to summarize the knowledge regarding the prevalence of burnout among intensive care unit physicians. Methods: We conducted a systematic review of the MEDLINE and PubMed® databases (last update 04.02.2019) with the goal of summarizing the evidence on burnout among intensive care unit physicians. We included all studies reporting burnout in intensive care unit personnel according to the Maslach Burnout Inventory questionnaire and then screened studies for data on burnout among intensive care unit physician specifically. Results: We found 31 studies describing burnout in intensive care unit staff and including different healthcare profiles. Among these, 5 studies focused on physicians only, and 12 others investigated burnout in mixed intensive care unit personnel but provided separate data on physicians. The prevalence of burnout varied greatly across studies (range 18% - 49%), but several methodological discrepancies, among them cut-off criteria for defining burnout and variability in the Likert scale, precluded a meaningful pooled analysis. Conclusion: The prevalence of burnout syndrome among intensive care unit physicians is relatively high, but significant methodological heterogeneities warrant caution being used in interpreting our results. The lower reported levels of burnout seem higher than those found in studies investigating mixed intensive care unit personnel. There is an urgent need for consensus recommending a consistent use of the Maslach Burnout Inventory test to screen burnout, in order to provide precise figures on burnout in intensive care unit physicians.

Síndrome de burnout e engajamento em profissionais de saúde: um estudo transversal / Burnout syndrome and engagement among critical care providers: a cross-sectional study

RESUMO Objetivo: Avaliar a frequência de síndrome de burnout grave em profissionais de terapia intensiva e correlacioná-la com o engajamento com o trabalho. Métodos: Foi distribuído um questionário autoaplicável que incluía o Inventário de Burnout de Maslach, a Escala de Depressão Ansiedade e Estresse e o questionário Gallup. Todas as análises foram estratificadas por local de trabalho (unidade de terapia intensiva ou unidade semi-intensiva) e por grupo profissional (enfermeiros versus médicos versus fisioterapeutas). Resultados: Entre fevereiro de 2017 e junho de 2017, 206 dos 325 profissionais convidados (63,4%) responderam aos questionários. Destes, 55 eram médicos (26,7%), 88 eram fisioterapeutas (42,7%) e 63 eram enfermeiros (30,6%). A frequência de burnout grave foi de 34,3% (27,9 - 41,4%), e não se identificaram diferenças entre os grupos profissionais ou locais de trabalho. A frequência de casos graves ou muito graves de depressão, ansiedade ou estresse foi de 12,9%, 11,4% e 10,5%, respectivamente. O escore mediano (intervalo interquartil) observado pelo questionário Gallup foi 41 (34 - 48), e não se observaram diferenças entre os grupos profissionais ou locais de trabalho. Houve correlação negativa entre burnout e engajamento com o trabalho (r = -0,148; p = 0,035). Conclusão: A frequência de burnout grave foi elevada entre os profissionais de saúde que trabalham na unidade de terapia intensiva e na unidade semi-intensiva. Existe uma correlação negativa entre burnout e engajamento com o trabalho.

ABSTRACT Objective: To evaluate the frequency of severe burnout syndrome among critical care providers and to correlate it with work engagement. Methods: A self-administered survey including the Maslach Burnout Inventory, Depression Anxiety and Stress Scales, and Gallup questionnaire was distributed. All analyses were stratified by setting (intensive care unit or step-down unit) and by professional group (nurses versus physicians versus physiotherapists). Results: Between February 2017 and June 2017, 206 out of 325 invited professionals (63.4%) answered the questionnaires. Of these, 55 were physicians (26.7%), 88 were physiotherapists (42.7%) and 63 were nurses (30.6%). The frequency of severe burnout was 34.3% (27.9 - 41.4%), and no difference was found between professional groups or settings. The frequency of severe or very severe cases of depression, anxiety or stress was 12.9%, 11.4% and 10.5%, respectively. The median (interquartile range) score observed on the Gallup questionnaire was 41 (34 - 48), and no differences were found between professional groups or settings. There was a negative correlation between burnout and work engagement (r = -0.148; p = 0.035). Conclusion: There is a high frequency of severe burnout among critical care providers working in the intensive care unit and step-down unit. There was a negative correlation between burnout and work engagement.

Desarrollo de un instrumento para evaluar la complejidad física de pacientes con secuela de quemaduras: Consenso e-Delphi / Development of an instrument to evaluate the physical complexity of patients with burn sequelae: e-Delphi Consensus

INTRODUCCION: En la literatura existen escalas de valoración de cicatrices, basadas en la observación de características físicas de una porción de ellas, pero ninguna se refiere al nivel de compromiso físico que la secuela produce en el paciente desde el punto de vista del tratante o evaluador. OBJETIVO: Identificar en forma consensuada, elementos determinantes de la complejidad física del paciente con cicatrices e injertos producto de una o más quemaduras. MATERIAL Y MÉTODOS: Quince profesionales médicos, kinesiólogos y terapeutas ocupacionales, que cumplieron diferentes requisitos de selección, participaron en un consenso e-Delphi, para operacionalizar el constructo "complejidad física de un paciente con secuela de quemaduras", constituido por tres rondas de encuestas anónimas, con retroalimentación, cuyos resultados se evaluaron mediante análisis de frecuencia, considerando como aceptable una concordancia de 80% y más. RESULTADOS: Como componentes de la complejidad física del paciente con secuela de quemaduras, se identificaron las dimensiones: localización, edad, etapa de evolución de los injertos, etapa de evolución de las cicatrices, tipo de cicatrices, tipo de injertos, grado de retracción en las secuelas y tipo de deformidad. Cada dimensión, con sus respectivos ítems. CONCLUSION: El consenso fue alcanzado en una variedad de dimensiones y sus ítems específicos para identificar los principales componentes involucrados en la complejidad física del paciente con secuela de quemaduras, lo que permite incluir esta información en una escala, cuya validación biométrica podría favorecer el pronóstico de la evolución de la secuela de quemaduras, orientar la rehabilitación, mejorar la gestión administrativa y calidad de vida del paciente.

INTRODUCTION: In literature there are scales for scar assessment, based on the observation of physical characteristics of each patient´s scar but none refer to the level of physical compromise that the sequelae produces in the patient from the point of view of the treating physician or evaluator. OBJECTIVE: To identify, by consensus, elements that determining the physical complexity of patients with scars and skin grafts resulting from one or more burns.MATERIALS AND METHODS: A total of 15 health care professionals physicians, physiotherapist and occupational therapists, who met different selection requirements, participated in an e-Delphi consensus, to operationalize the construct of "physical complexity of a patient with burn sequelae". The e-Delphi panel consisted of three rounds of anonymous surveys, with feedback, and the results were evaluated by frequency analysis. An 80% or more of concordance was considered as acceptable.RESULTS: The following dimensions were identified as components of physical complexity in patients with burn sequelae; location, age, stage of skin graft progress, type of scar, type of skin graft, retraction degree of sequelae and type of deformity. Each dimension with its respective items.CONCLUSION: The consensus was reached on a variety of dimensions and their specific items to identify the main components involved in the physical complexity in patients with burn sequelae. The biometric validation of this information include on a scale could report regarding the prognosis the burn sequelae, guide rehabilitation therapy, improve the management administration and the quality of life of patient with burn sequelae.

What patients consider to be a good doctor, and what doctors consider to be a good patient / Cómo definen los pacientes a un buen médico, y cómo definen los médicos a un buen paciente

ABSTRACT Background: From a patient's point of view, an 'ideal' doctor could be defined as one having personal qualities for interpersonal relationships, technical skills and good intentions. However, doctors' opinions about what it means to be a 'good' patient have not been systematically investigated. Aim: To explore how patients define the characteristics of a 'good' and a 'bad' doctor, and how doctors define a 'good' and a 'bad' patient. Material and Methods: We surveyed a cohort of 107 consecutive patients attending a community teaching hospital in February 2019, who were asked to define the desirable characteristics of a good/bad doctor. Additionally, a cohort of 115 physicians working at the same hospital was asked to define the desirable characteristics of a good/bad patient. Responses were subjected to content analysis. Simultaneously, an algorithm in Python was used to automatically categorize responses throughout text-mining. Results: The predominant patients' perspective alluded to desirable personal qualities more importantly than proficiency in knowledge and technical skills. Doctors would be satisfied if patients manifested positive personality characteristics, were prone to avoid decisional and personal conflicts, had a high adherence to treatment, and trusted the doctor. The text-mining algorithm was accurate to classify individuals' opinions. Conclusions: Ideally, fusing the skills of the scientist to the reflective capabilities of the medical humanist will fulfill the archetype of what patients consider to be a 'good' doctor. Doctors' preferences reveal a "paternalistic" style, and his/her opinions should be managed carefully to avoid stigmatizing certain patients' behaviors.

Antecedentes: Desde la perspectiva del paciente, un médico "ideal" podría definirse como aquel que tiene cualidades para las relaciones interpersonales, habilidades técnicas y buenas intenciones. Sin embargo, las opiniones de los médicos sobre lo que significa ser un "buen" paciente no se han investigado sistemáticamente. Objetivo: Explorar cómo los pacientes definen las características de un "buen" y "mal" médico, y cómo los médicos definen un "buen" y "mal" paciente. Material y Métodos: Encuestamos a una cohorte de 107 pacientes consecutivos que asistieron a un hospital comunitario en febrero de 2019, a quienes se les pidió que definieran las características deseables de un médico bueno/malo. Además, se pidió a una cohorte de 115 médicos que trabajaban en el mismo hospital que definieran las características deseables de un paciente bueno/malo. Las respuestas se sometieron a un análisis de contenido. Simultáneamente, se utilizó un algoritmo en Python para clasificar automáticamente las respuestas mediante minería de texto. Resultados: Los pacientes aludieron que las cualidades personales del médico eran más importantes que la competencia en conocimiento y las habilidades técnicas. Los médicos estarían satisfechos si los pacientes mostraran características positivas de personalidad, fueran propensos a evitar conflictos, tuvieran una alta adherencia al tratamiento y confiaran en el médico. El algoritmo de minería de texto clasificó las opiniones de los encuestados en forma precisa. Conclusiones: Idealmente, fusionar las habilidades del científico con las capacidades reflexivas del médico humanista cumplirá con el arquetipo de lo que los pacientes consideran un "buen" médico. Las preferencias de los médicos revelan un estilo "paternalista", y sus opiniones deben manejarse con cuidado para evitar estigmatizar los comportamientos de ciertos pacientes.

Síndrome de burnout entre profissionais de saúde nas unidades de terapia intensiva: um estudo transversal com base populacional / Burnout syndrome among healthcare professionals in intensive care units: a cross-sectional population-based study

RESUMO Objetivo: Avaliar a prevalência e os fatores associados com a síndrome de burnout em profissionais que atuam em unidade de terapia intensiva. Métodos: Estudo transversal com base populacional. Aplicou-se um questionário sociodemográfico, comportamental e ocupacional a 241 enfermeiros e médicos atuantes em 17 unidades de terapia intensiva públicas na cidade de São Luís (MA). Utilizou-se o Maslach Burnout Inventory-Human Services Survey (MBI-HSS) para identificar a síndrome, com base nos critérios de Maslach e Grunfeld. A taxa de prevalência foi estimada juntamente do intervalo de confiança de 95% para cada dimensão da síndrome. As associações foram estimadas pela razão de chance (odds ratio), por meio de análises de regressão logística múltipla (α = 5%). Resultados: A prevalência da síndrome de burnout foi de 0,41% (0,01 - 2,29) segundo Maslach e 36,9% (30,82 - 43,36) segundo Grunfeld. Os profissionais das unidades de atendimento pediátrico tiveram maior probabilidade de desenvolver exaustão emocional (OR = 3,16). Aqueles com idade superior a 35 anos tiveram menos propensão a desenvolver exaustão emocional (OR = 0,32) e despersonalização (OR = 0,06). Maior número de horas de trabalho em unidades de terapia intensiva associou-se com diminuição da realização pessoal (OR = 1,13). Dentre os enfermeiros, os homens foram mais propensos à diminuição da realização profissional, e a ausência da prática de atividades físicas regulares associou-se com mais exaustão emocional e menos despersonalização. Dentre os médicos, o trabalho nas unidades de terapia intensiva pediátrica e cardiológica os tornou menos propensos a perceberem menor realização pessoal, e os médicos sem pós-graduação em terapia intensiva tiveram maior chance de apresentar sentimento de falta de realização pessoal. Conclusão: Este estudo demonstrou baixa prevalência da síndrome de burnout. Para cada dimensão de burnout, a maioria dos profissionais demonstrou baixos níveis de exaustão emocional, despersonalização e sentimento de falta de realização pessoal. Enfermeiros e médicos apresentaram diferentes características associadas com a síndrome de burnout.

ABSTRACT Objective: To assess the prevalence of and factors associated with Burnout syndrome among intensive care unit professionals. Methods: In this cross-sectional population-based study, a questionnaire assessing sociodemographic, behavioral, and occupational data was administered to 241 nurses and physicians working in 17 public intensive care units in São Luis (MA), Brazil. The Maslach Burnout Inventory - Human Services Survey was used to identify Burnout syndrome based on Maslach's and Grunfeld's criteria. The prevalence of each dimension of the syndrome was estimated with a 95% confidence interval. Associations were estimated by the odds ratios via multiple logistic regression analyses (α = 5%). Results: The prevalence of Burnout syndrome was 0.41% (0.01 - 2.29) according to Maslach's criteria and 36.9% (30.82 - 43.36) according to Grunfeld's criteria. Infant intensive care unit professionals were more likely to develop emotional exhaustion than other intensive care professionals (OR = 3.16). Respondents over the age of 35 were less likely to develop emotional exhaustion (OR = 0.32) and depersonalization (OR = 0.06). Longer working hours in intensive care units were associated with a reduced sense of personal accomplishment (OR = 1.13). Among nurses, males had a lower sense of professional accomplishment, and not exercising regularly was associated with more emotional exhaustion and less depersonalization. Among physicians, working in infant and cardiology intensive care units made them less likely to have a reduced sense of personal accomplishment, and physicians without a postgraduate degree who worked in intensive care units had a higher chance of having a lower sense of personal accomplishment. Conclusion: This study demonstrated the low prevalence of Burnout syndrome. Most of the professionals reported low levels for each dimension of Burnout, including low levels of emotional exhaustion, low levels of depersonalization, and a lower likelihood of having a reduced sense of personal accomplishment. Nurses and physicians have different characteristics associated with Burnout syndrome.

Work Environment Evaluation Instrument (WEEI): development, validation, and association with burnout

Abstract Introduction Physician burnout is considered an epidemic. In 2019, 44% of U.S. physicians reported feeling burned out. The work environment is a central risk factor for this. The aim of this study is to develop and test an instrument to evaluate work environment factors in medical training courses. Method After focus groups, an initial pool of 14 items was generated and tested in a pilot study (n = 66). Face validity was verified, and small adjustments were made. The resulting version was administered to a sample of 115 psychiatry residents. Eleven items were selected based on the correlations between them, principal component analysis, and theoretical reasons, and then tested for internal and construct validity. Results The final version had high reliability (Cronbach's alpha = 0.898) and comprised three dimensions: relations with the institution; with colleagues; and with preceptors. Both total scores and dimensions correlated significantly with burnout scores (p < 0.01). Cutoffs defining the environment as healthy (>32 points); risky (23-31 points); or toxic (<22 points) were suggested and related to the risk of burnout. Conclusion Several authors have emphasized the importance of approaching institutional factors as an effective strategy for coping with the increased prevalence of burnout. This instrument should contribute to these efforts.