La aplicación del saber médico. Hipertensión y daño cognitivo

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Introduction: High blood pressure (HBP) is the leading cause of death from cardiovascular disease. Despite the advances, the percentage of undiagnosed and untreated hypertensive patients is 58.4%. The evaluation of cognitive damage in HBP focuses on preventing stroke, while functional damage is ignored. This inadequate management may be multifactorial. The objective was to analyze the opinions that doctors have about the relationship between high blood pressure and cognitive damage. Methodology: Observational, descriptive, cross-sectional study developed in the period between August 2020 and August 2023. Analysis of data obtained from a self-administered, anonymous and voluntary questionnaire. Revealing information on the professional profile, knowledge of HBP, its link with cognitive impairment (CD), diagnosis and treatment. Results: 222 professionals were included, 215 (96.8%) agree with the existence of a link between HBP and other cardiovascular risk factors in CD, and 218 (98.1%) acknowledge assisting patients at risk of suffering from CD. The CD evaluation is carried out in selected cases by 132 (59.4%) participants and 59 (26.7%) always do it. Of those who perform evaluation, 103 (54%) use the Mini Mental State Examination (MMSE), 10 (5.2%) use the Montreal Cognitive Assessment (MoCA) and 9 (4.7%) use the Clock Drawing Test. Regarding the decrease in blood pressure in elderly patients and the link with risk of CD: 54 (24.3%) do not recognize risk and 65 (29.2%) recognize a moderate-high risk. In reference to the implication of the treatment of cardiovascular disease and CD: 217 (97.7%) recognized a beneficial effect. Discussion: Given the recognition of the link between HBP and CD, it would be expected that CD would be investigated in the vast majority, however only 26.7% always evaluate it. There is no consensus on the method, the MMSE being the most used, with a low application of the MoCA test and/or Clock Drawing Test, the latter being the ones that evaluate executive function, mostly altered in CD linked to HBP. Although the treatment of cardiovascular disease is recognized as beneficial with respect to CD, the control of HBP in older adults is considered risky. A diagnosis is made of a situation where a disparity is evident between what one recognizes as knowing and what one claims to do. Conclusions: The role of vascular disease in functional brain damage is recognized, considering it necessary to know the cognitive status of patients, however there is a low application of screening tests that evaluate executive function. In this context, a gap between medical knowledge and practice is shown.

Introdução: A hipertensão arterial (HA) é a principal causa de morte por doenças cardiovasculares. Apesar dos avanços, o percentual de hipertensos não diagnosticados e não tratados é de 58,4%. A avaliação do dano cognitivo na hipertensão concentra-se na prevenção do acidente vascular cerebral, enquanto o dano funcional é ignorado. Esse manejo inadequado pode ser multifatorial. É objetivo fue analisar a opinião dos médicos sobre a relação entre hipertensão arterial e danos cognitivos. Metodologia: Estudo observacional, descritivo, transversal desenvolvido no período entre agosto de 2020 e agosto de 2023. Análise de dados obtidos a partir de questionário autoaplicável, anônimo e voluntário. Revelar informações sobre o perfil profissional, conhecimento sobre a HA, sua ligação com o comprometimento cognitivo (DC), diagnóstico e tratamento. Resultados: Foram incluídos 222 profissionais, 215 (96,8%) concordam com a existência de ligação entre hipertensão e outros fatores de risco cardiovascular na DC e 218 (98,1%) reconhecem ajudar pacientes com risco de sofrer de D.C. A avaliação da DC é realizada em casos selecionados por 132 (59,4%) participantes e 59 (26,7%) a fazem sempre. Dos que realizam avaliação, 103 (54%) utilizam o Mini Exame do Estado Mental (MEEM), 10 (5,2%) utilizam a Avaliação Cognitiva de Montreal (MoCA) e 9 (4,7%) utilizam o Clock Drawing Test. Em relação à diminuição da pressão arterial em pacientes idosos e a ligação com o risco de DC: 54 (24,3%) não reconhecem risco e 65 (29,2%) reconhecem risco moderado-alto. Em referência à implicação do tratamento de doenças cardiovasculares e DC: 217 (97,7%) reconheceram o efeito benéfico. Discussão: Dado o reconhecimento da ligação entre hipertensão e DC, seria de esperar que a DC fosse investigada na grande maioria, no entanto apenas 26,7% sempre a avaliam. Não há consenso sobre o método, sendo o MEEM o mais utilizado, com baixa aplicação do teste MoCA e/ou Clock Drawing Test, sendo estes últimos os que avaliam a função executiva, majoritariamente alterada nos DC vinculados à HA. Embora o tratamento das doenças cardiovasculares seja reconhecido como benéfico em relação à DC, o controle da HA em idosos é considerado arriscado. É feito um diagnóstico de uma situação em que é evidente uma disparidade entre o que se reconhece como saber e o que se afirma fazer. Conclusões: O papel da doença vascular no dano cerebral funcional é reconhecido, considerando-se necessário conhecer o estado cognitivo dos pacientes, porém há baixa aplicação de testes de triagem que avaliam a função executiva. Nesse contexto, evidencia-se uma lacuna entre o conhecimento e a prática médica.

Empatía con el paciente en médicos especialistas que trabajan en un Hospital de Cuenca (Ecuador) / Empathy with the Patient in Medical Specialists Working in a Hospital in Cuenca ­ Ecuador / Empatia com o paciente em médicos especialistas que trabalham em um hospital em Cuenca, Equador

ntroducción: la empatía es uno de los componentes de la estructura de la humanización en la atención de los pacientes. Los médicos especialistas deben tener mucha empatía. El objetivo del artículo es des-cribir los índices de empatía en médicos que trabajan en un hospital de alta complejidad y explorar si existen diferencias entre las especialidades estudiadas. Métodos: se accedió a una muestra por conve-niencia de 237 médicos que representa el 53.55 % del total poblacional (n = 443). La empatía se midió con la Escala de Empatía para Profesionales de la Salud (hp), junto con análisis factorial confirmatorio y análisis multigrupo (para examinar la invarianza del modelo entre los sexos) y análisis de confia-bilidad (α de Cronbach, coeficiente de correlación intraclase y ω de McDonald). Resultados: la espe-cialidad de pediatría tuvo los mayores índices de empatía general y en las dimensiones "cuidado con compasión" y "caminando en los zapatos del paciente", no así en la dimensión "toma de perspectiva", donde es semejante a las especialidades de anestesiología, medicina crítica y terapia intensiva, y gine-cología. Conclusión: los valores de la empatía y los valores en las subescalas "cuidado con compasión" y "caminando en los zapatos del paciente" fueron (en valores absolutos, pero no estadísticos) mayores en la especialidad de pediatría. En la subescala "toma de perspectiva", las especialidades de pediatría, anestesiología, cirugía y clínica se observaron puntuaciones prácticamente iguales. Se requieren otros estudios que permita arribar a una explicación que permita entender por qué algunas especialidades tienen valores de empatía mayores que otras

Introduction: Empathy is one of the components of the structure of humanization in patient care. Medical specialists must have high levels of empathy. Objective: The aim of this paper is to describe the levels of empathy in doctors working in a highly complex hospital and to explore whether there are differ-ences between the specialties studied. Methods: A convenience sample of 237 physicians representing 53.55% of the total population (n = 443) was accessed. Empathy was measured using the Empathy Scale for Health Professionals (hp). Confirmatory factor analysis and multigroup analysis were performed to examine the invariance of the model between the sexes and reliability analyzes (Cronbach's α, intraclass correlation coefficient and McDonald's ω). Results: The specialty of pediatrics had the highest levels in general empathy and in the Compassionate Care and Walking in Patient Shoes subscales, but not in the Perspective Taking subescale where it presents levels similar to the specialties of anesthesiology, critical medicine and intensive care. and gynecology. Conclusions: The empathy values and the values in the compassionate care and "Walking in the patient's shoes" subscales were (in absolute values, but not sta-tistically) higher in the Pediatrics specialty. In the subscale Perspective Taking, Pediatrics, Anesthesiology, Surgery, and Clinic, practically the same scores were observed. Other studies are required to arrive at an explanation that allows us to understand why some specialties have higher empathy values than others.

Introdução: a empatia é um dos componentes da estrutura de humanização no atendimento ao paciente. Os médicos especialistas devem ter altos níveis de empatia. Objetivo: o objetivo deste artigo é descre-ver os níveis de empatia em médicos que trabalham em um hospital de alta complexidade e explorar se há diferenças entre as especialidades estudadas. Materiais e métodos: foi acessada uma amostra de conveniência de 237 médicos, representando 53,55% da população total (n = 443). A empatia foi medida usando a Escala de Empatia para Profissionais de Saúde. A análise fatorial confirmatória e a análise mul-tigrupo foram realizadas (para examinar a invariância do modelo entre os sexos) e a análise de confia-bilidade (α de Cronbach, coeficiente de correlação intraclasse e ω de McDonald). Resultados: a pediatria apresentou os níveis mais altos de empatia geral e nas dimensões "cuidado compassivo" e "estar no lugar do paciente", mas não na dimensão "tomada de perspectiva", em que os níveis foram semelhantes aos da anestesiologia, da medicina crítica e da terapia intensiva, e da ginecologia. Conclusões: os valores de empatia e os valores das subescalas "cuidado compassivo" e "estar no lugar do paciente" foram (em valo-res absolutos, mas não estatisticamente) mais altos na especialidade de pediatria. Na subescala "tomada de perspectiva", as especialidades de pediatria, anestesiologia, cirurgia e clínica tiveram pontuações quase iguais. São necessários mais estudos para explicar por que algumas especialidades têm valores de empatia mais altos do que outras

Síndrome de burnout en pandemia y satisfacción laboral en médicos serumistas de Ayacucho / Pandemic burnout and job satisfaction among doctors from Ayacucho engaged in the SERUMS program

RESUMEN Objetivo: Evaluar la asociación entre el síndrome de burnout (SB) y la satisfacción laboral (SL) en los médicos serumistas de Ayacucho en el contexto de la pandemia por la COVID-19. Materiales y métodos: Estudio observacional, transversal, que usó un modelo crudo y ajustado para evaluar la asociación entre el SB, valorado por medio del cuestionario Maslach Burnout Inventory (MBI), y la SL, por medio del cuestionario de satisfacción S20/23. Las asociaciones se presentaron como razón de prevalencia (RP) con sus respectivos intervalos de confianza al 95 % (IC al 95 %). Resultados: De los 70 médicos serumistas, se encontró que el 77,14 % tenía entre 18-33 años, el 52,86 % eran hombres, el 51,43 % tenía menos de un año de experiencia laboral y el 88,57 % laboró en un centro de salud del Ministerio de Salud (Minsa). La prevalencia del SB fue de 45,71 %. La prevalencia del SB con insatisfacción fue del 30 %; con satisfacción, 32,86 %, y los indiferentes, 37,14 %. En el análisis crudo encontramos significancia estadística entre el SB y la SL (RP = 13,5; IC del 95 %:3,08-59,24), y en el análisis ajustado por sexo, estado civil y tiempo de experiencia laboral, la asociación entre el SB y la SL permaneció estadísticamente significativa (RP = 14,15; IC del 95 %: 3,02-66,32). Conclusiones: El SB se asocia a la SL de manera negativa, encontrando uno de cada dos médicos con SB. Además, se sugiere que existe mayor probabilidad de insatisfacción laboral en el personal con SB. Ello da a entender que podría usarse como indicador en diferentes áreas de la gestión y ser un punto a evaluar en la toma de decisiones en las directivas de salud. La solución de estos problemas contribuiría a mejorar las condiciones laborales actuales y, por ende, el sistema de salud.

ABSTRACT Objective: To determine the association between psychosocial work factors and symptoms of anxiety or depression among healthcare personnel in the Intensive Care Unit (ICU) at Hospital Regional Eleazar Guzmán Barrón in Nuevo Chimbote. Materials and methods: An observational, cross-sectional study was conducted, using both crude and adjusted models, to determine the association between burnout syndrome (BS), evaluated through the Maslach Burnout Inventory (MBI), and job satisfaction (JS), assessed via the Job Satisfaction Questionnaire S20/23. The associations were expressed as prevalence ratios (PR) with their respective 95 % confidence intervals (95 % CI). Results: Out of the 70 doctors engaged in the SERUMS program, 77.14 % were aged between 18 and 33 years, 52.86 % were males, 51.43 % had less than one year work experience and 88.57 % worked at a health center of the Ministry of Health. The prevalence of BS was 45.71 %. The prevalence of JS was as follows: dissatisfaction 30 %, satisfaction 32.86 % and indifference 37.14 %. In the crude analysis, a statistically significant association between BS and JS was found (PR = 13.5; 95 % CI: 3.08 59.24) and in the analysis adjusted for sex, marital status and length of work experience, the association between BS and JS remained statistically significant (PR = 14.15; 95 % CI: 3.02 66.32). Conclusions: BS is negatively associated with JS, with one in two doctors experiencing BS. Moreover, there appears to be a higher likelihood of job dissatisfaction among personnel with BS. This suggests that BS could serve as an indicator in different management areas and be considered in health management decision-making. Solving these issues could contribute to improving current working conditions and, therefore, the healthcare system.

Presencia de egresados y egresadas de la Universidad Nacional del Sur en el sistema de residencias médicas de Bahía Blanca / Presence of graduates from the National University of the Sur in the medical residency system of Bahía Blanca

Introducción: La atracción, captación y retención son determinantes de una distribución equitativa de profesionales de la salud. Objetivo: describir las decisiones de formación de posgrado de egresados/as de medicina de la Universidad Nacional del Sur (UNS), y su impacto en el sistema de residencias médicas de Bahía Blanca durante el año 2023. Resultados: el 79,63% de quienes egresaron de esta universidad decidieron realizar una residencia médica, y el 51,12 % adjudicó en especialidades del Primer Nivel de Atención con una adjudicación en pediatría menor a la media nacional. La carrera de medicina local cubrió el 39,24 % de las vacantes de Bahía Blanca, y el 38% de sus graduados/as decidió formarse en otras ciudades. Ocho residencias de la ciudad quedaron sin ingresantes en el 2023. Conclusión: existe una gran proporción de egresados/as de la UNS que eligen especialidades de APS. Hay una baja adjudicación en Pediatría que contrasta con la elección de Medicina Familiar, a diferencia de las elecciones a nivel nacional. En términos generales hay un déficit en la atracción y captación de egresados/as de la UNS por parte del sistema de salud local, lo cual demanda a los sectores docentes y asistenciales nuevas estrategias para captar y atraer profesionales en área prioritarias (AU)

Introduction: Attraction, recruitment and retention are determinants of an equitable distribution of healthcare professionals. Objective: to describe the postgraduate training decisions of medical graduates from the National University of the South (UNS), and their impact on the Bahía Blanca medical residency system during the year 2023. Results: 79.63% of Those who graduated from this university decided to carry out medical residency, and 51.12% were awarded in First Level Care specialties with a pediatric award lower than the national average. The local medical career covered 39.24% of the vacancies in Bahía Blanca, and 38% of its graduates decided to train in other cities. Eight residences in the city were left without entrants in 2023. Conclusion: there is a large proportion of UNS graduates who choose APS specialties. There is a low allocation in Pediatrics that contrasts with the choice of Family Medicine, unlike the elections at the national level. In general terms, there is a deficit in the attraction and recruitment of UNS graduates by the local health system, which demands new strategies from the teaching and healthcare sectors to attract and attract professionals in priority areas (AU)

Cooperación entre médicos del departamento de emergencias y dermatólogos por telemedicina / Cooperation between emergency department physicians and dermatologists via telemedicine

Las intercurrencias dermatológicas agudas son un motivo de consulta frecuente a las centrales de emergencias, y generalmente los médicos de atención primaria se ocupan del primer nivel de atención. Puede ser necesaria una interconsulta con expertos, aunque no siempre estén disponibles. Ante la necesidad de facilitar dicha interacción a distancia, en Julio 2022 se implementó una herramienta de teledermatología en un hospital de alta complejidad en Buenos Aires, Argentina. Este servicio se limitó a días hábiles con horario restringido, permitiendo la comunicación entre médicos del departamento de emergencias y dermatólogos, a través de WhatsApp institucional. El dermatólogo podía verificar datos de salud relacionados al paciente (ej: comorbilidades y medicación crónica) mediante revisión de la historia clínica electrónica, para decidir sobre un plan de acción. Se evaluó la perspectiva de los usuarios a través de un formulario electrónico tras 3 meses de implementación. Los resultados evidenciaron que la mayoría (85%) de los profesionales conocía la herramienta, y el 57% la había usado al menos una vez. Se obtuvo una mediana de 9 puntos (de una escala de Likert del 1 al 10) sobre la recomendación hacia otro profesional. El teletriage dermatológico resultó beneficioso y fue aceptado, tanto por médicos de guardia como por especialistas. Ante las demoras en la atención ambulatoria, ha resultado una alternativa útil para evitar derivaciones innecesarias y/o acelerar aquellas que verdaderamente lo ameritan. Sin embargo, representa una forma de comunicación informal desde el punto de vista de almacenamiento de datos. Será necesario reflexionar sobre estos tópicos pendientes de esta experiencia asistencial como legalidad, seguridad y confidencialidad (AU)

Acute skin conditions are a frequent reason for consultation in emergency departments, and primary care physicians generally handle them. They might require referrals to experts, who are not always readily available. Recognizing the need to facilitate such interactions remotely, a teledermatology triage tool was implemented in July 2022 at a high-complexity hospital in Buenos Aires, Argentina. The service was limited to business days with restricted hours, enabling communication between emergency department physicians and dermatologists through institutional WhatsApp. Dermatologists could access patient-related health data (e.g., comorbidities and chronic medication) through the electronic medical record to determine an appropriate course of action. The perspective of users was evaluated through an electronic questionnaire after three months of application. Results showed that most professionals were aware of the tool (85%), and 57% used it at least once. The median rating for recommending the tool to other professionals was 9 points (on a Likert scale from 1 to 10). Dermatological teletriage proved beneficial and was well-received by emergency physicians and specialists. In the face of delays in outpatient care, it has been a useful alternative to avoid unnecessary referrals and expedite those that are warranted. However, it represents an informal method of communication with regard to data storage. It will be necessary to rethink on improvements in pending topics such as legal limitations, security, and confidentiality of this healthcare experience (AU)

Percepción de médicos especialistas sobre la usabilidad de una aplicación móvil de dengue en zonas rurales: un estudio cualitativo / Perception of medical specialists on the usability of a dengue mobile application in rural areas: a qualitative study

RESUMEN Introducción. Las aplicaciones móviles representan una alternativa prometedora para brindar soporte en la gestión de pacientes con dengue. Sin embargo, se desconoce la usabilidad de estas herramientas en el Perú. Objetivo. Evaluar la usabilidad y las recomendaciones de uso de la aplicación Dengue ONQOY en la gestión de pacientes con dengue en zonas rurales de Perú. Métodos. Se realizó un estudio cualitativo que incluyó entrevistas semiestructuradas a 8 expertos en el tratamiento del dengue, los datos fueron codificados mediante el programa Atlas. Ti. Fueron evaluadas tres categorías: (1) usabilidad informativa, (2) usabilidad de diseño y (3) recomendaciones para su mejoramiento. Resultados. Se destacaron tres aspectos clave: (1) la aplicación es percibida como valiosa para los médicos de primer nivel en áreas periféricas con poca experiencia en dengue debido a su enfoque personalizado y valor académico; (2) se destacó su facilidad de uso y practicidad, aunque se señaló la limitación de la conectividad en algunas áreas; y, (3) se recomendó la inclusión de diagnósticos diferenciales, factores de riesgo adicionales, referencias actualizadas, guías de hidratación y dosis de medicamentos para mejorar la aplicación. Conclusión. Dengue ONQOY fue considerado altamente utilizable por médicos que atienden casos de dengue en el primer nivel de atención en Perú. A pesar de las limitaciones relacionadas con la conectividad y las posibles mejoras en su diseño, su desarrollo e implementación ofrecen una alternativa prometedora para el manejo de pacientes con Dengue en el país.

ABSTRACT Introduction. Mobile applications represent a promising alternative for providing support in the management of Dengue patients. However, the usability of these tools in Peru is unknown. Objectives. To evaluate the usability and usage recommendations of the Dengue ONQOY application in managing Dengue patients in rural areas of Peru. Methods. A qualitative study was conducted, which included semi-structured interviews with 8 experts in Dengue management. Data were coded using Atlas. Ti software. Three categories were assessed: (1) informative usability (2) design usability, and (3) recommendations for improvement. Results. Three key aspects were highlighted. (1) The application is perceived as valuable for first- level doctors in peripheral areas with limited Dengue experience due to its personalized approach and academic value. (2) Its ease of use and practicality were emphasized, although connectivity limitations in some areas were noted. (3) Recommendations for improvement included the inclusion of differential diagnoses, additional risk factors, updated references, hydration guidelines, and medication dosages. Conclusions. Dengue ONQOY is considered highly usable by doctors treating Dengue cases at the primary care level in Peru. Despite connectivity limitations and potential design improvements, its development and implementation offer a promising alternative for managing Dengue patients in the country in this field.

Actitudes hacia la investigación en médicos residentes de un hospital pediátrico público

Introducción: La investigación es un proceso intencional de construcción de nuevos conocimientos e ideas, que impulsan la trasformación de la sociedad. Los profesionales de la salud deben desarrollar actitudes positivas hacia la investigación, toda vez que esto mejora su desempeño profesional y, por ende, la calidad de atención al paciente. Objetivo: Identificar las actitudes hacia la investigación en médicos residentes de un hospital pediátrico público. Métodos: Estudio descriptivo transversal; se incluyeron 200 médicos residentes. Se aplicó el instrumento "Escala de actitudes hacia la investigación (EACIN)", de 39 ítems. Se empleó la prueba t de Student para muestras independientes para determinar la diferencia de los puntajes de las actitudes de investigación y las variables sexo, tipo de especialidad y experiencia laboral; mientras que para la variable horas de trabajo semanal, se empleó la prueba U de Mann-Whitney. Resultados: El 58,5 % fue de sexo femenino; el 25 % (48) mostró una actitud afectiva positiva; el 98 % (196) una actitud cognitiva positiva; el 94 % (188) una actitud conductual positiva. En general, el 96 % (192) tuvo una actitud positiva y el 4 % (8) neutral. El puntaje obtenido por los médicos residentes que realizaban especialidades quirúrgicas fue mayor que el quienes realizaban especialidades clínicas (115,69 ± 6,02 vs. 113,29 ± 5,93; p= 0,012). Conclusiones: La mayor parte de los médicos residentes presentan actitudes positivas hacia la investigación, lo cual podría ser beneficioso para implementar programas de capacitación y actividades relacionadas con la investigación en el hospital.

Introduction: Research is an intentional process of constructing new knowledge and ideas, promoting the transformation of society. Health professionals must develop positive attitudes towards research since this will improve their professional performance and therefore improve the quality of patient care. Objective: Identify the attitudes towards research in resident doctors of a public pediatric hospital. Methods: The study was descriptive cross-sectional; 200 resident doctors were included. The "Research Attitudes Scale (EACIN)" of 39 items was applied. The T-Student test for independent samples was used to determine the difference in the scores of research attitudes, and the variables sex, type of specialty and work experience, while the Mann Whitney U test was used for the weekly work hours variable. Results: 58.5% were female, 25% (48) showed a positive affective attitude, 98% (196) a positive cognitive attitude, 94% (188) a positive behavioral attitude. In general, 96% (192) had a positive attitude and 4% (8) had a neutral attitude. The score obtained by resident physicians who performed surgical specialties was higher than that of those who performed clinical specialties (115.69 ± 6.02 versus 113.29 ± 5.93; p= 0.012). Conclusions: Most resident doctors have positive attitudes towards research, which could be beneficial to implement training programs and/or activities related to research in the hospital.

Bibliometric analysis of research related to medical humanistic care based / 中国医学伦理学

ObjectiveBy analyzing the research related to medical humanistic care， the aim is to understand its research status and development trends， and provide theoretical and data support for research in this field. MethodsThe relevant literature in the China National Knowledge Infrastructure （CNKI） database were systematically searched. Excel 2019 was used to analyze the situation of annual publication volume， journal distribution， and other content of the literature. CiteSpace software was used to visually analyze the knowledge graph related to authors and keywords. ResultsA total of 825 articles were included in the study and the overall number of articles showed an upward trend since 2000. The research hotspots included humanistic care， medical humanities， nursing education， etc. It was found by analyzing that there were three problems in the research of humanistic care in medicine：the research focus is mainly on the need for medical staff to provide patients with more humanistic care， and there is relatively little research on the humanistic care of medical staff themselves；The types of journals are scattered， and the funding support is insufficient；No medical education collaborative research model has been formed. ConclusionMedical humanistic care is the essence of the professional spirit of physicians and an important indicator in testing the effectiveness of medical humanistic education. In the future， the research on medical humanistic care should strengthen multi-dimensional humanistic care to effectively protect the rights and interests of medical staff， pay more attention to the combination of theoretical research and clinical practice， exploit the instrumental value of narrative medicine， increase support efforts from fund， and improve top-level design.

The 2024-2028 Philippine Academy of Family Physicians, Inc. Research Agenda

@#<p style="text-align: justify;" data-mce-style="text-align: justify;">Research agenda are identified following the process of research priority setting which generally serves to guide resource allocation, address the identified needs of the stakeholders, and reinforce the link between research and actions and policies. The 2023-2028 PAFP Research Agenda was developed in three (3) phases - preparation, implementation and dissemination. An online survey was sent to the general membership through the regions, chapters and training institutions to determine priority research topics based on the National Unified Health Research Agenda and World Organization of Family Doctors (NUHRA and WONCA) research themes. Responses were collated and categorized in the appropriate research themes through an iterative process. A research agenda setting workshop was held with participants from the different stakeholders, which was facilitated by members of the working committee on research agenda and grants. Research themes and research questions were generated and compiled. There were forty-four (44) sub themes generated which align with the research themes of the 2023-2028 NUHRA and with the goal of the universal healthcare act. Majority of these sub themes fall under the themes, disease management and health systems strengthening towards UHC and support information generation on topic areas that are pertinent to the PAFP’s organizational missions - use of clinical pathways and clinical practice guidelines, continuous quality improvement, Patient-centered, Family-focused and Community-oriented approach to care, patient education and counseling, primary care models, family and community practice, family medicine in basic medical education and the role of a Family Physician in UHC.</p>

Transition from an in-person to a telemedicine diabetic retinopathy screening program

ABSTRACT Purpose: Timely screening and treatment are essential for preventing diabetic retinopathy blindness. Improving screening workflows can reduce waiting times for specialist evaluation and thus enhance patient outcomes. This study assessed different screening approaches in a Brazilian public healthcare setting. Methods: This retrospective study evaluated a telemedicine-based diabetic retinopathy screening implemented during the COVID-19 pandemic and compared it with in-person strategies. The evaluation was conducted from the perspective of a specialized referral center in an urban area of Central-West Brazil. In the telemedicine approach, a trained technician would capture retinal images by using a handheld camera. These images were sent to specialists for remote evaluation. Patient variables, including age, gender, duration of diabetes diagnosis, diabetes treatment, comorbidities, and waiting time, were analyzed and compared. Results: In total, 437 patients with diabetes mellitus were included in the study (mean age: 62.5 ± 11.0 years, female: 61.7%, mean diabetes duration: 15.3 ± 9.7 years, insulin users: 67.8%). In the in-person assessment group, the average waiting time between primary care referral and specialist evaluation was 292.3 ± 213.9 days, and the referral rate was 73.29%. In the telemedicine group, the average waiting time was 158.8 ± 192.4 days, and the referral rate was 29.38%. The telemedicine approach significantly reduced the waiting time (p<0.001) and significantly lowered the referral rate (p<0.001). Conclusion: The telemedicine approach significantly reduced the waiting time for specialist evaluation in a real-world setting. Employing portable retinal cameras may address the burden of diabetic retinopathy, especially in resource-limited settings.

O aborto legal em casos de gravidez decorrente de violência sexual: percepções e vivências de médicas e médicos obstetras / Legal abortion in cases of sexual violence pregnancy: perceptions and experiences of obstetricians / El aborto legal en casos de embarazo resultante de violencia sexual: percepciones y experiencias de médicas y médicos obstetras

Resumo: Este estudo objetivou analisar as percepções de obstetras e residentes de ginecologia-obstetrícia, atuantes numa maternidade escola federal, sobre o aborto legal em casos de gravidez decorrente de violência sexual, desvelando suas motivações, resistências e sentimentos, e identificando suas experiências com o tema. A primeira etapa correspondeu ao preenchimento de um questionário autoaplicável. Os critérios de seleção foram: obstetras vinculados ao centro obstétrico; diretor da divisão médica; e residentes do programa de ginecologia-obstetrícia da instituição. Obtiveram-se 36 questionários respondidos. A segunda etapa correspondeu à realização de uma entrevista, tendo sido utilizado o critério de amostragem por saturação e foram entrevistados seis médicos. As entrevistas foram analisadas pelo método de análise de conteúdo, na modalidade temática. Os questionários retrataram que todos os participantes já haviam prestado assistência a mulheres em situação de violência sexual e que a maioria já havia participado da realização de um aborto legal. As entrevistas evidenciaram os dilemas enfrentados pelos profissionais na assistência a esses casos e a escassez da formação profissional em relação à temática. A palavra da mulher foi tida ora como objeto de suspeição em relação à veracidade do estupro, ora como capaz de suscitar afetação das profissionais em suas escutas, o que possibilitou que essas se aproximassem das vítimas e ofertassem uma assistência mais humanizada. Os resultados apontaram para a importância da temática ser abordada nos campos da saúde e da formação para além do enfoque técnico-científico, visando produzir novas estratégias de cuidado.

Abstract: This study aimed to analyze the perceptions of obstetricians and gynecology-obstetrics residents at a federal school maternity hospital regarding legal abortion in cases of sexual violence pregnancy, understand their motivations, strengths, and feelings, and identify their experience with this topic. The first stage consisted of answering a self-administered questionnaire. The selection criteria were: obstetricians linked to the obstetric center, director of the medical division, and residents of the institution's obstetrics-gynecology program. In total, 36 questionnaires were answered and returned. The second stage corresponded to an interview using a saturation sampling criterion. Six physicians were interviewed. The interviews were evaluated using a thematic content analysis. The questionnaires showed that all participants had already provided care to women in situations of sexual violence and that most of them had already participated in a legal abortion procedure in these cases. The interviews highlighted the dilemmas faced by professionals in providing care to these women and the lack of professional training to handle these cases. The speeches of women were sometimes seen as an object of suspicion regarding the veracity of sexual violence, and sometimes as an object that caused professionals to feel emotionally affected while listening to them, allowing professionals to approach the victims and offer more humanized care. The results pointed to the importance of addressing this topic in the areas of health and providing training beyond the technical-scientific focus in order to support the development of new care strategies.

Resumen: El estudio tuvo como objetivo analizar las percepciones de obstetras y residentes de gineco-obstetricia de una maternidad escolar federal sobre el aborto legal en casos de embarazo resultante de violencia sexual, revelar sus motivaciones, resistencias y sentimientos, e identificar sus experiencias con el tema. La primera etapa consistió en completar un cuestionario autoadministrado. Los criterios de selección fueron los siguientes: obstetras vinculados al centro obstétrico; director de la división médica; y residentes del programa de gineco-obstetricia de la institución. Se obtuvieron 36 cuestionarios cumplimentados. La segunda etapa consistió en una entrevista, utilizando un criterio de muestreo por saturación. Se entrevistó a 6 médicos. Las entrevistas se analizaron mediante el método de análisis de contenido, en la modalidad temática. Los cuestionarios mostraron que todos los participantes ya habían brindado asistencia a mujeres en situación de violencia sexual y que la mayoría ya había participado en la realización de un aborto legal en estos casos. Las entrevistas pusieron de manifiesto los dilemas que enfrentan los profesionales en la asistencia a estos casos y la escasa formación profesional con relación al tema. La palabra de la mujer fue vista a veces como objeto de sospecha con respecto a la veracidad de la violación, y a veces como un objeto capaz de suscitar la afectación de las profesionales en sus escuchas, lo que les permitió acercarse a las víctimas y ofrecer una asistencia más humanizada. Los resultados señalaron la importancia de que la temática sea abordada en los campos de la salud y de la formación más allá del enfoque técnico-científico, con el objetivo de producir nuevas estrategias de cuidado.

Knowledge of and Attitudes Toward Hearing Loss Among Primary Care Physicians in the Public Health Sector of Mauritius

Abstract Introduction Primary care physicians are essential first points of contact for patients with hearing loss. Thus, knowledge of hearing loss and related aspects is essential to ensure the optimal management of individuals with suspected hearing loss. Objective This study aimed to determine the knowledge of and attitudes toward hearing loss among primary care physicians in the public health sector in Mauritius. Methods In this cross-sectional descriptive cohort study, 320 primary care physicians completed an online questionnaire adapted from previous questionnaires on knowledge of and attitudes toward hearing loss. Responses were analyzed using descriptive statistics and cross-sectional analyses. Results Primary care physicians showed limited knowledge of hearing loss in areas such as early identification and intervention, professionals responsible for hearing assessments, and hearing tests used for assessing hearing sensitivity. However, the responses also showed positive attitudes toward hearing loss. Significant associations between knowledge of and attitudes toward hearing loss were obtained regarding the type of physician, length of practice, and department posted in. Ear, nose, and throat specialists, as well as pediatricians, demonstrated significantly higher scores for both knowledge of and positive attitudes toward hearing loss. Conclusions The findings highlight a strong need for ongoing medical education to spread awareness about hearing loss among primary care physicians in the public health sector of Mauritius.

Knowledge, attitude, and practice (KAP) study of Egyptian physicians towards HIV infection: a multicentre study

Introduction: In Egypt, there is a paucity of new data regarding awareness of HIV/AIDS among physicians. This study aimed to assess the level of awareness, attitude, practice, and knowledge of a sample of Egyptian physicians regarding HIV regarding natural history, epidemiology, and virology, method of transmission, clinical manifestations, diagnosis, prevention, and management.Methodology: Sixty-eight Egyptian physicians were enrolled in an observational analytic multicenter cross-sectional KAP study in Egyptian tertiary health care facilities covering different localities, including New Valley University, Assiut University, South Valley University, Helwan University, Alexandria University, Aswan University, and Al-Azhar University.Results: The attitude of physicians towards the privacy of persons living with HIV, was the one with the highest percentage 85.3%. On the other hand, respondents think that only 25% of physicians do not stigmatize HIV patients. Moreover, only 25% of the study group do not stigmatize persons living with HIV. The highest proportion of favorable practice was 39.7% and the lowest was 17.6%. With regard to their knowledge about HIV, the lowest proportion of correct answers to a question was 4.4%, and the highest proportion was 92.6%. Most of the enrolled physicians were found to have a moderate knowledge score, 49/68 (72%). There was a significant difference between different specialties regarding knowledge scores.Conclusions: There are some knowledge gaps among a sample of Egyptian physicians with regard to HIV/AIDS. In addition, Egyptian physicians may have a moderate degree of undesirable attitude and practice toward HIV/AIDS

Mental health of Brazilian physicians: a nationwide cross-sectional study to investigate factors associated with the prevalence of suicide plans and attempts

Objective: To report on suicide plans and attempts among Brazilian physicians and to investigate the associated risk factors. Methods: From January 2018 to January 2019, a nationwide online survey was conducted among Brazilian physicians using the Tool for Assessment of Suicide Risk and the Satisfaction with Life Scale. Multivariate exploratory associations of demographic, psychological, and work-related factors were performed on reports of suicide plans and attempts. Results: Of the 4,148 participants, 1,946 (53.5%) were male, 2,527 (60.9%) were 30 to 60 years old, 2,675 (64.5%) had two to four jobs, and 1,725 (41.6%) worked 40 to 60 hours a week. The overall prevalence of suicide plans was 8.8% (n=364), and suicide attempts were reported by 3.2% (n=133) of participants. Daily emotional exhaustion (ORadj = 7.857; 95%CI 2.282-27.051, p = 0.002), weekly emotional exhaustion (ORadj = 7.953; 95%CI 2.403-26.324, p = 0.001), daily frustration at work (ORadj = 3.093; 95%CI 1.711-5.588, p < 0.001), and bisexuality (ORadj = 5.083; 95%CI 2.544-10.158, p < 0.001) were significantly associated with higher odds of suicide. Extremely dissatisfied physicians reported suicide plans and attempts in 38.3% of cases, whereas extremely satisfied physicians reported suicide plans and attempts in only 2.8% of cases (p < 0.001). Conclusion: Brazilian physicians with a history of suicide plans and attempts express emotional exhaustion and frustration at work. There is an urgent need for actions to promote professional safeguards and resilience.

Compreensão de médicas sobre gênero e a influência na formação acadêmica: um estudo qualitativo / How women physicians understand gender and its influence on academic training: a qualitative study

RESUMO Introdução: A "feminização" da medicina é uma tendência nacional e mundial. Cada vez mais mulheres têm escolhido essa área como profissão, mudando a demografia médica brasileira e internacional. No entanto, ainda há algumas barreiras na formação e atuação em medicina, como a manutenção de estereótipos de gênero, o que pode ser observado na sub-representação de mulheres em áreas cirúrgicas. Ademais, desigualdade salarial, assédio, machismo, preconceito e discriminação de gênero são outros desafios enfrentados pelas médicas. Objetivo: O artigo analisou a compreensão de mulheres médicas sobre as relações de gênero e a possível influência na sua formação acadêmica. Método: Consistiu em um estudo qualitativo, sendo realizadas entrevistas semiestruturadas, no período de novembro a dezembro de 2022, com 13 médicas que atuam profissionalmente no município de Marabá, no Pará. A amostra foi obtida por meio do método bola de neve, e, para a abordagem dos dados, utilizou-se a análise temática de conteúdo proposta por Laurence Bardin. Resultado: As entrevistas apontaram uma diversidade de compreensões acerca do conceito de gênero e demonstraram, de variadas formas, a interferência das relações de gênero na formação médica. As participantes narraram situações misóginas e machistas vivenciadas por elas, as quais, em sua maioria, evidenciavam a minimização das qualificações profissionais das mulheres. Além disso, o assédio foi algo bem evidenciado pelas colaboradoras, nove das 13 entrevistadas relataram episódios que envolviam comentários sobre aparência, convites, favores e contatos físicos, principalmente provenientes de professores e preceptores. Também foi pontuado que os estereótipos relacionados à escolha da especialidade são evidentes no meio médico, pois observam-se a predominância de mulheres em áreas da clínica médica, como dermatologia e pediatria, e o afastamento das especialidades cirúrgicas. Conclusão: Por meio dos relatos das participantes, foi observado o que médicas compreendem sobre o conceito de gênero, e revelou-se um contraste entre as suas percepções. Ademais, este trabalho abordou como, do ponto de vista de médicas, o gênero influencia na formação acadêmica das mais variadas formas, sendo retratada a qualidade de situações apresentadas pelas entrevistadas que evidenciam essa interferência.

ABSTRACT Introduction: The "feminization" of medicine is a national and worldwide phenomenon. Women have been increasingly choosing this field as a profession, changing the demographics of Brazilian and international medicine. However, there are still some barriers in medical education and practice, such as perpetual gender stereotypes, which can be observed in the underrepresentation of women in surgical fields. Furthermore, wage inequality, harassment, sexism, prejudice, and gender discrimination are other challenges faced by female physicians. Objective: The article analyzed the understanding of female physicians regarding gender relations and their potential influence on their academic formation. Method: This is a qualitative study that involved semi-structured interviews that were conducted from November to December 2022 with thirteen female physicians practicing professionally in the city of Marabá, in the state of Pará. The sample was obtained using the snowball method and the Thematic Content Analysis proposed by Laurence Bardin was used to process the data. Result: The interviews pointed to a diversity of understandings about the concept of gender and demonstrated, in various regards, the interference of gender relations in medical education. The participants narrated misogynistic and sexist situations they had experienced, most of which evidenced the belittling of women's professional qualifications. Additionally, harassment was clearly evident among the contributors, as nine out of the thirteen interviewees reported episodes involving comments about their appearance, invitations, favors, and physical contact, mainly from professors and preceptors. It was also noted that stereotypes related to specialty choice are evident in the medical field, as there is a predominance of women in clinical areas such as dermatology and pediatrics and a distancing from surgical specialties. Conclusion: The participants' reports revealed the physicians' understanding of the concept of gender, with contrasting views. In addition, this work addressed how, from the perspective of female physicians, gender influences academic training in various aspects, depicting the quality of situations presented by the interviewees that highlight this interference.

Physician's perceptions regarding the pharmaceutical industry: a Brazilian national study

OBJECTIVE: The objective of this study was to investigate the newly graduated physicians' attitudes and perceptions regarding the medical relationship with the pharmaceutical industry and identify the sociodemographic patterns related to such thinking. METHODS: A structured questionnaire was administered to 4,601 participants selected from a pool of 16,323 physicians who were registered with one of the 27 Regional Medical Councils of Brazil in 2015. Answers were analyzed using two stratification variables: type of medical school (public vs. private) and the sex of the respondents. RESULTS: Out of the participants, 61.8% believed that industry funding could support medical conferences and education, and 48.4% felt that small gifts and conference travel funding were acceptable. Conversely, 64.7% disagreed with industry-sponsored social events. Views on whether pharmaceutical representatives' visits influenced prescriptions were divided. Statistically significant differences were observed between genders and medical school types, with men and private school graduates being more accepting of certain industry interactions. CONCLUSION: The study highlights the nuanced attitudes of new doctors toward industry relationships, indicating the need for clearer ethical guidelines and education in medical schools to align practice with evolving societal values.

Fractional anisotropy in degenerative cervical stenosis surgery prognostic: a systematic review / Anisotropia fracionada no prognóstico de cirurgia de estenose cervical degenerativa: revisão sistemática / Anisotropía fraccional en el pronóstico de cirugía de la estenosis cervical degenerativa: revisión sistemática

ABSTRACT: Cervical spondylotic myelopathy (CSM) is a common disease with an increased anticipated burden to health systems worldwide. Methods to predict outcomes in these patients are needed so physicians can provide more effective care. Fractional anisotropy (FA) analysis is a promising technique used to quantify how preserved the diffusion is in neural pathways. A systematic review and meta-analysis were performed using the PRISMA guidelines. Full articles available online were searched for correlation coefficients between FA values and mJOA scores. Average FA values, preoperative mJOA, and postoperative mJOA scores were gathered to perform a correlation analysis. A total of 5 articles presented correlations between FA and mJOA change and were included in the correlation meta-analysis. Correlation coefficients varied from -0.42 and 0.55. The number of patients in each study varied from 15 to 95. The Random effects model resulted in a non-significant correlation coefficient of 0.1315 (95% CI: -0.2575 to 0.4839; p= 0.5124). Spearman's correlation analysis was significant for preoperative vs postoperative mJOA (r = 0.79, p = 0.02), while preoperative FA did not correlate significantly with preoperative or postoperative mJOA. At this point, the data available in the literature is insufficient to determine a real correlation between FA and mJOA scores. More studies are necessary for a better understanding of this matter. Level of Evidence III; Study Review.

RESUMO: A mielopatia espondilótica cervical (CSM, pelas suas siglas em inglês) é uma doença comum com elevados gastos para os sistemas de saúde em todo o mundo. Métodos para prever resultados nesses pacientes são necessários para que a atenção médica seja mais eficaz. A análise de anisotropia fracionada (FA) é uma técnica promissora usada para quantificar a preservação da difusão nas vias neurais. Uma revisão sistemática e meta-análise foi realizada usando as diretrizes PRISMA. Artigos completos disponíveis online foram avaliados em busca de coeficientes de correlação entre valores de FA e escores de mJOA. Valores médios de FA, escores de mJOA pré-operatórios e pós-operatórios foram coletados para realizar uma análise de correlação. Um total de 5 artigos apresentaram correlações entre alteração de FA e mJOA e foram incluídos na meta-análise de correlação. Os coeficientes de correlação variaram entre -0,42 e 0,55. O número de pacientes em cada estudo variou de 15 a 95. O modelo de efeitos aleatórios resultou em um coeficiente de correlação não significativo de 0,1315 (95% CI: -0,2575 a 0,4839; p= 0,5124). A análise de correlação de Spearman foi significativa para mJOA pré-operatório vs. pós-operatório (r = 0,79, p = 0,02), enquanto a FA pré-operatório não apresentou correlação significativa com o mJOA pré-operatório ou pós-operatório. Os dados disponíveis na literatura neste momento são insuficientes para determinar uma correlação real entre os escores FA e mJOA. Mais estudos são necessários para uma melhor compreensão deste assunto. Nível de Evidência III; Revisão de Estudos.

RESUMEN: La mielopatía cervical espondilótica (CSM, por sus siglas en inglés) es una enfermedad común con una mayor carga anticipada para los sistemas de salud en todo el mundo. Se necesitan métodos para predecir los resultados en estos pacientes para que los médicos puedan brindar una atención más eficaz. El análisis de anisotropía fraccional (FA) es una técnica prometedora que se utiliza para cuantificar cuán preservada está la difusión en las vías neurales. Se realizó una revisión sistemática y un metanálisis utilizando las pautas PRISMA. Se buscaron artículos completos disponibles en línea para encontrar coeficientes de correlación entre los valores de FA y las puntuaciones de mJOA. Se recopilaron los valores promedio de FA, mJOA preoperatorios y mJOA postoperatorios para realizar un análisis de correlación. Un total de 5 artículos presentaron correlaciones entre el cambio de FA y mJOA y se incluyeron en el metanálisis de correlación. Los coeficientes de correlación variaron entre -0,42 y 0,55. El número de pacientes en cada estudio varió de 15 a 95. El modelo de efectos aleatorios resultó en un coeficiente de correlación no significativo de 0,1315 (IC 95%: -0,2575 a 0,4839; p= 0,5124). El análisis de correlación de Spearman fue significativo para la mJOA preoperatoria frente a la posoperatoria (r = 0,79, p = 0,02), mientras que la FA preoperatoria no presentó una correlación significativa con la mJOA preoperatoria o posoperatoria. Los datos disponibles en la literatura en este momento son insuficientes para determinar una correlación real entre las puntuaciones de FA y mJOA. Son necesarios más estudios para una mejor comprensión de este asunto. Nivel de Evidencia III; Revisión de Estudios.

"Mesmo que a gente seja a mão que cuida": médicas negras e racismo estrutural no contexto da atenção primária à saúde / "Even if we are the caring hand": Black doctors and structural racism in the context of primary health care

Resumo Trata-se de estudo sobre o racismo estrutural na formação e na ocupação de trabalhadoras e trabalhadores negros atuando na atenção primária à saúde (APS) no município do Rio de Janeiro, a partir da experiência de médicas negras. Realizou-se um estudo qualitativo, utilizando grupo focal, conduzido em novembro de 2022. Utilizou-se o interacionismo simbólico como referência para a interpretação relacionada às situações que compõem as experiências/vivências a partir do racismo. Os achados foram reunidos em dois eixos: manifestação do racismo estrutural e institucional no âmbito do SUS; e como o racismo atravessa os processos de trabalho em saúde e suas repercussões. Os resultados revelam uma continuidade das implicações do racismo desde a formação de médicas negras até o trabalho na APS, tornando-se um obstáculo na reorganização do processo de trabalho na perspectiva territorial de atenção à saúde. As participantes identificam o racismo institucional e estrutural na negligência da gestão, na violência do território e na vacância de médicos nas equipes desses territórios, limitando a oferta de um cuidado adequado. É necessário desvelar e aprofundar a compreensão do caráter estrutural do racismo da organização do trabalho em saúde, tendo como imagem-objetivo a saúde como direito.

Abstract This study scrutinizes structural racism's influence on the training and work of Black professionals in primary health care (PHC) in Rio de Janeiro, particularly focusing on the experiences of Black female physicians. Employing a qualitative approach via a Focus Group, conducted in November 2022, we adopted symbolic interactionism to interpret racism-related experiences. Our findings encompass two primary dimensions: the manifestation of structural and institutional racism within the Unified Health System (SUS), and how racism permeates health work processes and consequences. Results highlight enduring impacts, spanning education to PHC roles, hindering healthcare process recalibration. Participants identify institutional and structural racism, from managerial neglect to territorial violence and physician scarcity, constraining comprehensive care. It is crucial to unveil and grasp racism's structural essence within healthcare, aligned with the vision of health as a fundamental right.

Síntomas de Burnout entre médicos y enfermeros antes, durante y después de atender pacientes con COVID-19 / Burnout symptoms among physicians and nurses before, during and after COVID-19 care / Sintomas de burnout entre médicos e enfermeiros antes, durante e depois do cuidado de pacientes com COVID-19

Objetivo: este estudio evaluó síntomas de Burnout entre médicos y enfermeros antes, durante y después de la atención provista a pacientes con la enfermedad COVID-19. Método: estudio comparativo y transversal realizado en la unidad de Atención Respiratoria de un hospital público de nivel terciario. Se empleó el Inventario de Burnout Maslach. Resultados: se distribuyeron 280 encuestas entre los tres períodos: antes (n=80), durante (n=105) y después (n=95) de la atención a pacientes con COVID-19; se obtuvieron 172 encuestas respondidas. Las tasas de respuesta fueron 57,5%, 64,8% y 61,1%, respectivamente. Los valores de prevalencia de Burnout grave fueron 30,4%, 63,2% y 34,5% antes, durante y después de la atención a pacientes por la enfermedad del coronavirus 2019 (p<0,001). Los síntomas de agotamiento emocional (p<0,001) y despersonalización (p=0,002) fueron más prevalentes entre los enfermeros que entre los médicos. El Síndrome de Burnout grave fue más prevalente en las mujeres, los enfermeros y el personal del turno noche. Conclusión: la elevada prevalencia de Burnout se duplicó en el primer pico de internaciones y regresó a niveles previos a la pandemia un mes después de finalizada la atención a pacientes por la enfermedad del coronavirus 2019. El Síndrome de Burnout varió por sexo, turno de trabajo y ocupación, y los enfermeros representaron los grupos más vulnerables. Es necesario enfocarse en estrategias de evaluación y mitigación tempranas para asistir a los enfermeros, no solo durante la crisis sino permanentemente.

Objective: this study evaluated burnout symptoms among physicians and nurses before, during and after COVID-19 care. Method: a cross-sectional comparative study in the Pulmonary Care unit of a tertiary-level public hospital. The Maslach Burnout Inventory was used. Results: 280 surveys were distributed across three periods: before (n=80), during (n=105) and after (n=95) COVID-19 care; 172 surveys were returned. The response rates were 57.5%, 64.8% and 61.1%, respectively. The prevalence of severe burnout was 30.4%, 63.2% and 34.5% before, during and after COVID-19 care (p<0.001). Emotional exhaustion (p<0.001) and depersonalization (p=0.002) symptoms were more prevalent among nurses than among physicians. Severe burnout was more prevalent in women, nurses and night shift staff. Conclusion: the high prevalence of burnout doubled in the first peak of hospital admissions and returned to pre-pandemic levels one month after COVID-19 care ended. Burnout varied by gender, shift and occupation, with nurses among the most vulnerable groups. Focus on early assessment and mitigation strategies are required to support nurses not only during crisis but permanently.

Objetivo: este estudo avaliou os sintomas de burnout entre médicos e enfermeiros antes, durante e após o cuidado dos pacientes contaminados com o COVID-19. Método: estudo transversal comparativo realizado na unidade de Atenção Pulmonar de um hospital público de nível terciário. Foi utilizado o Inventário de Burnout de Maslach. Resultados: 280 formulários de pesquisa foram distribuídos em três períodos: antes (n=80), durante (n=105) e após (n=95) os cuidados dos pacientes contaminados com COVID-19; 172 formulários foram respondidos. As taxas de resposta foram de 57,5%, 64,8% e 61,1%, respectivamente. A prevalência de burnout grave foi de 30,4%, 63,2% e 34,5% antes, durante e após o atendimento dos pacientes (p<0,001). Os sintomas de exaustão emocional (p<0,001) e despersonalização (p=0,002) foram mais prevalentes entre os enfermeiros do que entre os médicos. O burnout grave foi mais prevalente em mulheres, enfermeiros e funcionários do turno da noite. Conclusão: a alta prevalência de burnout dobrou no primeiro pico de internações hospitalares e voltou aos níveis pré-pandemia um mês após o término dos cuidados dos pacientes contaminados com COVID-19. O burnout variou de acordo com o sexo, turno e profissão, encontrando-se os enfermeiros entre os grupos mais vulneráveis. O foco na avaliação precoce e nas estratégias de mitigação é necessário para apoiar os enfermeiros não apenas durante a crise, mas de forma permanente.