Relación entre apoyo en duelo y el síndrome de burnout en profesionales y técnicos de la salud infantil / Relationship between grief support and burnout syndrome in professionals and technicians of pediatric health

Conocer la presencia de Burnout y de apoyo en duelo de profesionales de la salud en unidades de oncología y cuidados intensivos pediátricos de hospitales públicos chilenos. Sujetos y Método: Diseño trasversal de tipo descriptivo correlacional. Auto aplicación de los instrumentos Maslach Burnout Inventory y Grief Support Health Care Scale en 210 profesionales y técnicos. Para el análisis de comparación de medias se usó la prueba de t-student y para la comparación entre las variables, las correlaciones de Pearson y Spearman, considerando un nivel de significancia del 5%. Resultados: El 4% de los participantes presentaron Burnout y el 71%, estaba en riesgo de padecerlo. El 52% presentó alto nivel de percepción de apoyo en duelo, en especial en mujeres y personal de oncología. Al correlacionar el apoyo en duelo y el Burnout, los datos sugirieron que tanto el reconocimiento del vínculo como de la pérdida tras la muerte de un paciente, disminuye la despersonalización del profesional y mejora su realización personal. Conclusión: Los profesionales de unidades de alta complejidad pediátrica presentan alto riesgo de padecer Burnout, por un mayor cansancio emocional y baja realización personal. Sin embargo, una mayor percepción de reconocimiento y apoyo en sus duelos, es un factor que puede disminuir dicho riesgo. Por lo que se requiere de programas de intervención continua dentro de las unidades, con estrategias concretas de acompañamiento, trabajo en equipo y rituales de duelo.

Detect the presence of Burnout and bereavement support of health professionals in oncology and pediatric intensive care units in Chilean public hospitals. Subjects and Method: Transversal design of descriptive correlational type. Auto-evaluation using the Maslach Burnout Inventory and Grief Support Health Care Scale instruments in 210 professionals and technicians. For the analysis of a means comparison, the t-student test was used and for the comparison between the variables, the correlations of Pearson and Spearman were used, considering a level of significance of 5%. Results: 4% of the participants presented with Burnout and 71% were at risk of suffering it. 52% had a high level of perception of bereavement support, especially in women and oncology personnel. When correlating support in bereavement and Burnout, the data suggests that both the recognition of the bond, as well as the loss after death of a patient, helps decrease the depersonalization of the professional and improves their personal fulfillment. Conclusion: Professionals in areas of high pediatric complexity are at high risk of Burnout, due to greater emotional exhaustion and low personal accomplishment. However, a greater perception of recognition and support in their bereavement is a factor that can reduce that risk. Therefore, continuous intervention programs are required within these units, with concrete strategies for accompaniment, teamwork and mourning rituals.

Caracterización del desarrollo psicomotor de niños y niñas con cáncer / Psychomotor development characterization of children with cancer

Antecedentes: El desarrollo psicomotor (DPSM) es una condicionante social de la salud, por lo que sus alteraciones pueden perpetuar otras desigualdades hasta la adultez. Los menores con cáncer se ven expuestos a una serie de factores que pueden poner en riesgo su DPSM. Metodología: Se evalúa el DPSM de 35 niños y niñas con cáncer de 0 a 5 años de dos hospitales, con los test EEDP y TEPSI, estandarizados para población chilena. Se excluyen los niños/as con características o patologías de base que pudiesen explicar el retraso del desarrollo psicomotor (tumores cerebrales, discapacidad visual, síndrome de Down o hemiparesia.). Las evaluaciones se realizan en período ambulatorio estando los niños y niñas en buenas condiciones generales, sin infecciones activas y con parámetros hematológicos estables. Es decir, en igualdad de condiciones de salud, salvo por el diagnóstico oncológico de base. Resultados: El promedio nacional de rezago es 5,5 por ciento, el de riesgo 5,64 y el retraso alcanza un 1,3 por ciento. Sumando las tres categorías alcanza un 12,44 por ciento. Los niños/as evaluados arrojan un 28,52 por ciento, 14,29 por ciento y 2,86 por ciento respectivamente, con un total de 45,67 por ciento, es decir 3,67 veces más alteraciones del DPSM que los niños sin cáncer. Conclusiones: Los niños y niñas con cáncer evaluados presentan más alteraciones del DPSM que aquellos que no tuvieron cáncer antes de los 5 años de edad. Existen iniciativas ya implementadas desde el 2007 por el Sistema de Protección Integral de la infancia para prevenir e intervenir las alteraciones del DPSM, pero parecen no se suficientes para esta población específica.

Background: Psychomotor development (PD) is known to be a social determinant of health which means that a development delay or disorder can perpetuate other inequalities into adulthood. Children with cancer are exposed to a number of factors that may jeopardize their PD. Methodology: All eligible children with cancer under 5 years were evaluated in two hospitals of Santiago, with a total n° of 35. Children with underlying conditions that may explain a developmental delay were excluded (brain tumors, visually impaired, Down Syndrome). Evaluations were performed on outpatient period, in good general conditions, meaning in equal terms than children in the general population, except for the cancer. Results: The average national lag is 5.5 percent, the risk 5.64 and the retardation reaches 1.3 percent. Adding the three categories of delay, it reaches a 12.44 percent. Children evaluated presented 28.52 percent, 14.29 percent and 2.86 percent respectively, with a total of 45.67 percent that means 3.67 times more developmental delays than children without cancer. Conclusions: Children with cancer have more PD disorders than those who did not have cancer before age 5. There are initiatives already implemented since 2007 by the System of Integral Protection of Children, with protocols to prevent and attend PD disorders, but seem to be insufficient for this specific population.

Frecuencia de tuberculosis pulmonar y extrapulmonar en un hospital de referencia de la provincia de Córdoba, 1991-2003 / [Frequency of pulmonary and extrapulmonary tuberculosis in a reference hospital in Córdoba province, 1991-2003]

Tuberculosis continues to be a serious problem of public health causing nearly three million deaths per year all over the world. Despite technologic improvements in the diagnostic methods, it is not possible to control the disease in the absence of surveillance and treatment follow-up programs supervising the ending of treatments, and definitive cure of patients. The frequency of pulmonary and extrapulmonary tuberculosis, and simultaneous pulmonary and extrapulmonary tuberculosis localization among patients assisted at Tránsito Cáceres de Allende Hospital during thirteen years (1991-2003), was determined. The benefit of inoculating the specimens on Stonebrink medium for the best recuperation of Mycobacterium bovis was herein observed, and the contribution of Ziehl Neelsen staining in extrapulmonary materials was tested as well. Out of 790 cases of tuberculosis diagnosed, 723 were pulmonary, and 48 were extrapulmonary localization (pleural 31, renal 7, ganglionar 5, meningeal 2, genital 1, pericardial 1 and digestive 1), and 19 patients presented both, pulmonary and extrapulmonary tuberculosis. Out of the 723 pulmonary cases, 9 were caused by M. bovis. All M. bovis isolates grew on Stonebrink medium, and only one grew also on Lowenstein Jensen. Smear microscopy using Ziehl Neelsen staining resulted positive in 4 extrapulmonary specimens.

Prevalencia de micobacteriosis y de tuberculosis en pacientes de un hospital de referencia de la provincia de Córdoba / Prevalence of mycobacteriosis and tuberculosis in a reference hospital, Cordoba province

Las micobacterias ambientales (MA) constituyen un importante grupo de especies bacterianas que se encuentran en el medio ambiente, pueden colonizar y ocasionalmente producir enfermedad enel hombre. En este trabajo se investigó la frecuencia de casos de micobacteriosis en relación con los de tuberculosis durante un período de diez años (1.991-2.000). Se estudiaron 16.700 muestras de 9.300 pacientes adultos de ambos sexos asistidos en el Hospital Regional de Tuberculosis de la Provincia de Córdoba, por consulta espontánea. Los aislamientos se realizaron por cultivo en los medios de Lowenstein Jensen y Stonebrink. Las colonias de bacilos ácidoalcohol resistentes (BAAR) se identificaron por pruebas bioquímicas y moleculares. El total de casos diagnosticados fue de 716, de los cuales 684 (95,5%) correspondieron a al complejo Mycobacterium tuberculosis y a micobacterias ambientales 32 (4,5%). Los casos de micobacteriosis se definieron por reiterados aislamientos con desarrollo representativo de una micobacteria ambiental, sospecha clínica y radiológica. De los 32 casos de micobacteriosis, el 75% del total correspondió aMycobacterium avium-intracellulare,15,6% a Mycobacterium fortuitum, 3,1% a Mycobacterium kansasii y 6,3% a Mycobacterium chelonae.Los casos de tuberculosis fueron 94,5% de localización pulmonar y 5,5% extrapulmonar.

Environmental mycobacteria (EM) constitute an important group of bacteria species found in the environment. They can colonize and occasionally produce disease in man. Sixteen thousand three hundred samples from 9300 adult symptomatic patients from the Hospital Regional of Tuberculosis in Cordoba were bacteriolocally investigated. The isolations were performed by culture on Lowenstein Jensen and Stonebrink culture media. The colonies of acid fast bacilli (AFB) were identified by biochemical and molecular tests. Among 716 culture positive cases, 684 (95.5%) were due to Mycobacterium tuberculosis complex and 32 to environmental mycobacteria.Serial samples allowed the confirmation of the etiologicalagent in culture and correlated with consistent clinical and radiological abnormalities. Seventy-five percente of these patients were affected by M. avium complex, 15.6% by M. fortuitum, 3.1% Mycobacterium kansasii and 6.3% Mycobacterium chelonae. Among tuberculosis cases, 94.5% and 5.5% had pulmonary and extrapulmonary disease respectively.

Endocarditis infecciosa: morbimortalidad en Chile: resultados del estudio cooperativo nacional de endocarditis infecciosa, ECNEI, 1998-2002 / Mortality and complications of infective endocarditis in Chile: results of the national cooperative study of infective endocarditis, 1998-2002

Infective endocarditis is a severe condition, with a mortality that fluctuates between 16 and 25 percent in the Metropolitan area of Chile. Aim: To perform a prospective assessment of clinical and microbiological features of patients with infective endocarditis in Chile. Material and methods: Collaborative study of regional hospitals in the whole country and teaching hospitals in Santiago. Patients with a possible or definitive infective endocarditis, according to Duke's criteria, were included in the protocol and a structured data entry form was completed. Results: Three hundred twenty one patients (65 percent male, mean age 49ñ16.5 years) were studied. According Duke's criteria, 89 percent had a definitive and 11 percent a possible endocarditis. The subacute form occurred in 64 percent of patients. The most frequent predisposing cardiopathies were rheumatic in 25 percent, prosthetic valves in 15 percent and congenital in 13 percent. There was no evidence of cardiopathy in 20 percent. Twenty percent of patients were on hemodialysis, 11 percent were diabetic and only one patient abused intravenous drugs. The most frequent complication was cardiac failure in 59 percent of cases, followed by renal failure in 32 percent and embolism in 28 percent. The most frequent causing organism was coagulase positive Staphylococcus in 35 percent. Blood cultures were negative in 28 percent of cases from the metropolitan region, in 56 percent of cases from the north and 38 percent of cases from the south. Echocardiographic diagnosis was done in 92 percent of cases. Aortic valve was involved in 42 percent and mitral valve in 29 percent. Successful antimicrobial treatment was achieved in 59 percent of patients. Thirty five percent of patients were subjected to surgical procedures with a 78 percent survival. Overall mortality was 29 percent. Univariate analysis identified sepsis, an age over 60 years and the presence of cardiac or renal failure as prognostic indicators of mortality. On multivariate analysis, the identified prognostic indicators were the presence of sepsis, renal failure, mitroaortic involvement associated to combined surgery and failure of antimicrobial treatment not associated to surgery. Conclusions: Subacute form is the most common presentation of infective endocarditis and rheumatic valve disease is the most common underlying cardiac lesion. The most frequent causing agent is coagulase positive Staphylococcus...

Endocarditis infecciosa: factores pronósticos de mortalidad en 131 casos / Infectious endocarditis: prognostic factors of mortality in 131 cases

We followed during their hospital stay, 129 patients aged 14 to 74 years old, who had 131 episodes of infective endocarditis. Clinical assessment, echocardiography and microbiological study was done to all patients. Surgical indications were those derived from complications. Thirty three patients died during hospital stay (25.2 percent). There were no differences between survivors and deceased patients in the lapse between onset of symptoms and hospital admission, presence of fever, dyspnea or heart murmurs. Skin and mucosal septic manifestations occured with higher frequency in deceased patients (57.1 and 24.3 percent respectively). Blood cultures were positive in 55 percent in survivors and 48 percent in those who died. The most frequent infecting organisms were staphilococci and streptococci. Vegetations were found with greater frequency in aortic position in both groups of patients. Deceased patients had a higher frequency of cardiac failure (84 and 65 percent respectively) and embolic episodes (77 and 46 percent respectively) than survivors. Antimicrobial treatment was successfull in 94 percent of survivors and 15 percent of those who died. Forty percent of survivors and 54 percent of deceased patients were subjected to surgical procedures. The most important predictor of hospital mortality in this series of patients with infective endocarditis was antimicrobial treatment failure