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

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

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

Preocupación por el bienestar de residentes, un tema presente en la Conferencia Latinoamericana en Educación de Residentes (LACRE) 2017 / Concern for residents' wellbeing, an issue discussed at the latin american conference on resident education (LACRE) 2017

At the end of May 2017, the third version of the Latin American Conference on Resident Education, LACRE, was held in Chile; it convened 433 people from 14 regional countries. Chronic stress and emotional exhaustion of residents was one of the topics discussed. Reports from different countries documented that about half of residents suffer from burnout. This is, they are emotionally drained, indifferent towards their patients and with a sense of low personal fulfillment at work. This article describes the contributions presented in LACRE about interventions or institutional programs designed to reduce burnout and promote self-care of residents. The relevance of these initiatives is discussed in the current global context, considering the available evidence on the effectiveness of interventions to promote well-being among residents. International experts are making renewed and eloquent calls to medical educators and organizations to get involved in the solution of the erosion of resident wellbeing during the residence.

Transtorno do espectro autista: onde estamos e para onde vamos / Autism spectrum disorders: where we are and where we are going / Trastorno de espectro autista: dónde estamos y hacia dónde vamos

A ampliação do conhecimento científico sobre o autismo pode ser identificado pelo aumento na produção de pesquisas sobre este transtorno nas últimas décadas, implicando atualizações recentes em sua classificação, compreensão e intervenção. O objetivo deste artigo é apresentar uma revisão da literatura sobre o autismo, apontando como os avanços investigativos recentes têm lançado luz sobre a compreensão do transtorno. Relata historicamente como os critérios para o diagnóstico nos manuais médicos de classificação foram aprimorados, complementados e suplantados com base em evidências até o atual DSM-5. É realizada uma revisão das contribuições teóricas e empíricas que impulsionaram essas mudanças para sintetizar o que tem sido considerado como aspectos centrais desse transtorno como espectro dimensional. Problematiza o aumento do número de diagnósticos a partir dos dados epidemiológicos atuais, destacando o que as pesquisas multidisciplinares têm identificado como fatores etiológicos e prognósticos para a vida adulta. Por fim, revisa brevemente o panorama dos principais programas e modelos de intervenção baseados em evidências para pessoas com autismo nas áreas da saúde e educação, para então apontar os atuais desafios neste contexto.

The diffusion of scientific knowledge about autism can be explained trough the increasing number of researches on this disorder in the last decades, implying in recent updates in its classification, understanding and intervention. The purpose of this paper is to present a literature review on autism highlighting how the recent investigative advances that have shed light on the understanding ofthe disorder. It reports historically how the first diagnostic criteria were being improved, supplemented and supplanted in the medical classification manuals, based on research until DSM-5. A review of empirical researches that drove these changes is performed to synthesize what has been considered as core aspects of this disorder as a dimensional spectrum. Discusses the increasing number of diagnoses, emphasizing the points that the multidisciplinary research has identified as possible causes, and the knowledge about the development expectations for adulthood. Finally, it reviews the landscape of the main programs and intervention models for people with autism in health and education fields, to point out to the current challenges and those to be addressedin the future

El propósito de este artículo es presentar una revisión de la literatura sobre el autismo señalando los avances recientes de investigación resultantes que han arrojado luz sobre la comprensión del trastorno. Informa históricamente como los criterios para este diagnóstico en la clasificación de los manuales de medicina se están siendo avanzados, complementados y suplantados con base en la investigación por la corriente del DSM-5. Se realiza una revisión de las investigaciones empíricas que impulsó a estos cambios para sintetizar lo que se ha considerado como aspectos centrales de este trastorno como un espectro dimensional. Se analiza el creciente número de diagnósticos, enfatizando o que las investigaciones multidisciplinares han identificado como posibles causas, y lo que se sabe acerca de las expectativas de desarrollo para la edad adulta. Por último, revisa el panorama de los principales programas y modelos de intervención para las personas con autismo en las áreas de salud y educación, para apuntar a los retos actuales en este contexto y aquellos que se abordarán en el futuro.

comparison of anxiety and depression rate between medical staff of infertility centers and obstetrics and gynecology centers of Yazd, Shiraz, Isfahan and Kerman hospitals

Regarding the close and continuous interaction of infertility staff with hopeless infertile couples and in the contrary the atmosphere of happiness especially in obstetric wards make a sense that considering anxiety and depression it would be a difference between these two wards. The objective of this study is the comparison of the rate of depression and anxiety between the two wards of infertility and obstetrics and gynecology. This study is a descriptive-correlation study based on cross-sectional method. 199 individuals who were the staff of infertility and obstetrics and gynecology wards in four provinces enrolled in this study through stratified sampling. Data collection was done by demographic questionnaire, Spiel Berger and Beck depression inventory tests. Data were analyzed by SPSS software using ANOVA test. The result showed the rate of anxiety in obstetrics and gynecology staff of Isfahan center [54.69 +/- 13.58] and depression rate had increased level in infertility staff of Shiraz center [14.94 +/- 10.87]. Overall, there was significant correlation between anxiety, depression and work place [p=0.047, 0.008 respectively]. According to ANOVA test, the mean value of anxiety level was higher in the staff of four obstetrics and gynecology centers and one infertility center. As long as we know that infertile couples have little chance for success rate and obstetrics and gynecology wards patients have little risk of failure in treatment, it could be mentioned that the anxiety and depression in the staff are not correlated with the client illness

Características del empleo y bienestar subjetivo en médicos de la Región Metropolitana / Characteristics of employment and wellbeing among physicians working in Santiago, Chile

Background: Profound changes have been observed in medical practice during the last thirty years. This may be understood as a result of the influence of economic variables in health services management, among other probable causes. At the same time, doctors' work has been diversified, and a tendency to work in several paid jobs simultaneously has been observed. Aim: To describe the characteristics of employment in a representative sample of Chilean physicians. Material and Methods: A probabilistic sample of 414 physicians residing in Metropolitan Santiago answered a survey about their number and type of jobs and completed the BIS UMED questionnaire that measures the subjective wellbeing of physicians. Results: Forty percent of surveyed physicians had three or more jobs (36.3% of men and 47.5% of women). There was a significant inverse association between the number of jobs, general wellbeing and facing medicine from a new perspective. Conclusions: The number of jobs is inversely related to the general wellbeing of physicians.

A clínica na carne: subjetividade, corpo e transe em psicoterapia / The clinic in the flesh: subjectivity, body, and trance in psychotherapy / La clínica en la carne: subjetividad, cuerpo y trance en psicoterapia

Este trabalho busca, numa perspectiva da subjetividade, uma compreensão sobre a experiência de mundo do sujeito em termos de corpo e transe em psicoterapia. Partindo de dois casos clínicos, busca transcender dicotomias comuns no pensamento psicológico (como mente-corpo, indivíduo-social, real-imaginário), chegando a uma noção complexa dessa experiência que envolve a produção de sentidos, imagens, enredos simbólicos, personagens, relações e crenças que habitam o espaço vivido onde o corpo ocupa um lugar central. Em ambos os casos, o transe é concebido como uma forma de acesso a esse mundo simbólico que também proporciona às pacientes a possibilidade da mudança. O trabalho é concluído destacando os processos de imaginação e memória vividos ligados a determinadas partes do corpo e as possibilidades terapêuticas proporcionadas pelo transe, quando este é considerado em termos da experiência de mundo do sujeito...

This paper seeks to understand the subject's world in terms of body and psychotherapy trance from a subjectivity perspective. Two clinical cases are presented in an endeavor to go beyond common dichotomies found in psychological thought (such as mind-body, individual-social, realimaginary) and reach more complex perspectives that involve producing feelings, images, symbolic themes, characters, relationships, and beliefs that inhabit life experiences in which the body is central. In both cases trance was used as a way to access these symbolic worlds that can help patients change. The conclusion highlights imagination and memory processes experienced in connection with certain parts of the body and the therapeutic possibilities enabled by trance that takes the subject's life experience into consideration...

El presente trabajo pretende, en una perspectiva de subjetividad, una comprensión sobre la experiencia de mundo del sujeto en términos de cuerpo y trance en la psicoterapía. Partiendo de dos casos clínicos, pretende trascender dicotomías comunes en el pensamiento psicológico (como mente-cuerpo, individuo-social, real-imaginario) llegando a una noción compleja de esa experiencia que envuelve la producción de sentidos, imágenes, enredos simbólicos, personajes, relaciones y creencias que habitan el espacio vivido donde el cuerpo ocupa un lugar central. En ambos casos, el trance es concebido como una forma de acceso a ese mundo simbólico que también proporciona a las pacientes la posibilidad de cambio. El trabajo es concluido destacando los procesos de imaginación y memoria vividos vinculados a determinadas partes del cuerpo y las posibilidades terapéuticas proporcionadas por el trance, cuando éste es considerado en términos de experiencia de mundo del sujeto...

Burnout en médicos: aproximaciones teóricas y algunos diagnósticos diferenciales / Burnout in doctors: theoretical approaches and some differential diagnoses

En las últimas tres décadas muchos autores e investigadores han hecho sus aportes al Síndrome de Burnout o agotamiento profesional, principalmente en médicos por ser esta una de las poblaciones más afectadas. Es necesario diferenciar el Burnout de otros conceptos que se pueden solapar con él, como depresión, estrés e insatisfacción laboral, reconociendo que este síndrome puede provocar el suficiente deterioro físico y mental en el personal de salud hasta el punto de poder interferir gravemente en su trabajo cotidiano y ocasionar, en consecuencia, importantes daños a la salud de sus pacientes. Por lo que es de vital importancia hacer conciencia de la necesidad de prevención en los aspectos que se pueden corregir o de la identificación del proceso de Burnout una vez instaurado.

In last the three decades many authors and investigators have made their contributions to the Syndrome of Burnout or professional exhaustion, mainly in doctors, being this one of the affected populations. It is necessary to differentiate the Burnout from other concepts that can be overlapped with it like depression, stress and labor dissatisfaction, recognizing that this syndrome can cause the sufficient physical and mental deterioration in the health personnel to the point of being able to interfere seriously in their daily work and to cause, consequently, important damages the health of their patients. This is why it is of vital importance to make conscience of the necessity of prevention in the aspects that can be corrected or of the identification of the process of Burnout once restored.

El estrés laboral y el síndrome de Burnout en el cuerpo médico: una perspectiva ergonómica y clínica: revisión / Job stress and Burnout syndrome of physicians: a clinical and ergonomic perspective: review

Hoy los fenómenos globalizadores con una suerte compleja de red interaccional, mediatizan los instrumentos de cultura de los países, generando nuevas expectativas y nuevos valores en el inconsciente colectivo. La celeridad del cambio, exige rápidas adaptaciones, con costo social, biológico y psicológico para las personas de todos los niveles ocupacionales (Estrés) que puede llegar a determinar no sólo trastornos en la esfera mental, sino también en lo físico, determinando la aparición o agravación de enfermedades bien definidas, como la diabetes, dislipidemias, hipertensión arterial, etc (Distres o Carga Alostatica) y la consecuente incapacidad laboral temporal o permanente. Hoy numerosas encuestas mundiales dan cuenta que entre un 38 y un 45 por ciento de los trabajadores perciben su trabajo como estresante; en este contexto los profesionales de la salud se encuentran en una tremenda dualidad de rol; el rol del salvador y el rol de victima. Así, en medio de este conflicto, surge el Síndrome de Burnout que afecta, en mayor o menor grado, a un 70 por ciento de los médicos. El Burn-out tiene importantes consecuencias tanto en la salud de los profesionales que la sufren, como en la calidad de la atención que pueden prestar a sus paciente. Se le han atribuido el desarrollo de cambios conductuales, la aparición de hábitos de vida no saludables y de actitudes defensivas y el aumento del absentismo laboral.

Implantaçäo de prontuário eletrônico em um hospital de grande porte: estudo de caso / Implantation of electronic records in a large hospital: a case study

Analisa um caso de implantaçäo de prontuário eletrônico em um hospital brasileiro privado e de grande porte, que presta assistência de alta complexidade. Relata que a pesquisa exploratória serviu-se de uma metodologia qualitativa, que investigou o primeiro ano de funcionamento do prontuário eletrônico e os respectivos antecedentes e se centrou nas percepçöes expressas, através de entrevistas, por profissionais de nível superior que atuam no referido hospital (implantadores, usuários administrativos e usuários clínicos). Enfatiza que o objetivo foi entender as mudanças decorrentes da implantaçäo do prontuário eletrônico no hospital e examinar resistências. Fornece uma perspectiva histórica do processo de informatizaçäo hospitalar e do desenvolvimento de sistemas de prontuário eletrônico.

Teaching medical ethics in Basra: perspective of students and graduates

The University of Basra Medical College introduced a course on medical ethics for undergraduate students in 1994. We explored the opinions of 54 graduates and 52 final-year medical students about the benefits they perceive they gained from the course and its relevance to their training or practice. About 31% of students and 34% of graduates thought the course was practically and theoretically useful. Over 80% of graduates and students thought the course was either very relevant or relevant to some extent to the practice of medicine. When asked to recall the important ethical issues taught in the course, 52% of graduates and 44% of students listed patient-doctor relationship. Confidentiality, physician liability and ethical issues concerning recent medical innovations were listed by few respondents. Only 6% of both graduates and students were able to list the four principles of medical ethics as described by Raanan. The self-learning component of the course should be developed to strengthen ethical reasoning and judgment in decision-making