Factores psicosociales, estrés psicológico y burnout en enfermería: un modelo de trayectorias / Psychosocial factors, psychological stress, and burnout in nursing: a model of trajectories / Fatores psicossociais, estresse psicológico e burnout em enfermagem: um modelo de trajetórias

Resumen Introducción: El personal de enfermería se enfrenta cotidianamente a diferentes eventos asociados al estrés, factores psicosociales y otros mecanismos que afectan su salud mental. Objetivo: Evaluar la correlación entre la demanda psicológica, el control laboral, el apoyo social, el estrés psicológico, y las dimensiones del Síndrome de Burnout (ilusión por el trabajo, desgaste psíquico, indolencia y culpa), en un modelo de trayectorias en enfermeras mexicanas. Metodología: Estudio transversal, observacional, analítico, conducido en 357 profesionales de enfermería de Morelos, México, seleccionados por conveniencia. Los datos fueron colectados empleando tres cuestionarios, la Escala de Estrés Percibido, el Cuestionario del Contenido del Trabajo y el Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo. Los programas SPSS 19 y LISREL 8.3 fueron empleados para el procesamiento y modelaje de los datos. Resultados: En el modelo de trayectorias, se especificó como variable mediadora de los factores psicosociales y de las dimensiones del Síndrome de Quemarse por el Trabajo (SQT), al estrés psicológico. Los índices de ajuste fueron aceptables. Se encontraron altos niveles de apoyo social, control laboral e ilusión por el trabajo; grados moderados de demanda psicológica y estrés psicológico; y bajos niveles de desgaste psíquico, indolencia y culpa. Conclusión: Implicaciones para la disciplina, se propone implementar estrategias de intervención efectivas para mantener en el personal de enfermería bajos niveles de demandas psicológicas, altos niveles de control laboral, altos niveles de apoyo social, y niveles moderados de estrés, para prevenir, el SQT.

Abstract Introduction: Nurses frequently face different events associated with stress, psychosocial factors, and other issues which have impacts on their mental health. Objective: To assess the correlation between psychological demand, work control, social support, psychological stress, and burnout dimensions (illusion for the activity, psychic wear, indolence, guilt), within a model of trajectories among Mexican nurses. Methodology: This is a transversal, observational, and analytical study conducted on a convenience sample of 357 nursing professionals from the state of Morelos, Mexico. Data were gathered using three questionnaires, the Perceived Stress Scale, the Job Content Questionnaire, y el Maslach Burnout Inventory. SPSS 19 and LISREL 8.3 were used to process and model the data. Results: Psychological Stress was specified as the mediating variable of the psychosocial factors and dimensions of burnout within the model of trajectories. Adjustment indexes were acceptable. High levels of social support, work control, and illusion for the activity were found. Moderate degrees of psychological demand and psychological stress were found. Low levels of psychic wear, indolence, and guilt were found. Conclusion: It is recommended to implement effective intervention strategies to maintain nursing personnel within low levels of psychological demand, high levels of work control, high levels of social support, and moderate levels of stress, all these in order to prevent the Syndrome of Burnout.

Resumo Introdução: O pessoal de enfermagem se enfrenta cotidianamente a diferentes eventos associados ao estresse, fatores psicossociais e outros mecanismos que afetam sua saúde mental. Objetivo: Avaliar a correlação entre a demanda psicológica, o controle laboral, o apoio social, o estresse psicológico, e as dimensões e da Síndrome de Burnout (ilusão pelo trabalho, desgaste psíquico, indolência e culpa), em um modelo de trajetórias em enfermeiras mexicanas. Metodologia: Estudo transversal, observacional, analítico, conduzido em 357 profissionais de enfermagem de Morelos, México, selecionados por conveniência. Os dados foram coletados empregando três questionários, a Escala de Estresse Percebido, o Questionário do Conteúdo do Trabalho e o Questionário para a Avaliação da Síndrome de Burnout no Trabalho. Os programas SPSS 19 e LISREL 8.3 foram empregados para o processamento e modelagem dos dados. Resultados: No modelo de trajetórias, especificou-se como variável mediadora dos fatores psicossociais e das dimensões da Síndrome de Burnout no Trabalho (SQT), ao estresse psicológico. Os índices de ajuste foram aceitáveis. Encontraram-se altos níveis de apoio social, controle laboral e ilusão pelo trabalho; graus moderados de demanda psicológica e estresse psicológico; e baixos níveis de desgaste psíquico, indolência e culpa. Conclusão: Implicações para a disciplina, propõe-se implementar estratégias de intervenção efetivas para manter no pessoal de enfermagem baixos níveis de demandas psicológicas, altos níveis de controle laboral, altos níveis de apoio social, e níveis moderados de estresse, para prevenir, o SQT.

Intususcepción eecocólica e invaginación del ciego en un canino: reporte de caso / Cecocolic intusuusception and invagination of the cecum in a dog: case report

Se expone el caso de un perro mestizo de Fox Terrier que presentaba diarrea sanguinolenta que no mejoró al tratamiento inicial; se detectó a la palpación una masa a nivel del colon, que se confirmó con un estudio radiográfico de tránsito intestinal; también, se diagnosticó un megacolon. Se decidió realizar una laparotomía exploratoria donde se encontró una intususcepción cecocólica y la invaginación del ciego, el procedimiento quirúrgico realizado consistió en hacer tiflectomia y enteroanastomosis término-terminal; luego de este procedimiento, el paciente se recuperó completamente del cuadro intestinal que presentaba.

A case is presented of a mestizo Fox Terrier dog than presented diarrhea with blood and the initial treatment didn't achieved any improve; with palpation it was determinate a mass to the colon, which was confirmed after performing the routine clinical testing and radiographic studies of intestinal transit; also, megacolon is diagnosed. Exploratory laparotomy was performed at it was found cecocolic intussusepction and the cecum invagination, the surgical procedure developed was typhlectomy and of end-to-end intestinal anastomoses; after the procedure, the patient was completely recovered to the intestinal disease.

[Glycosylated hemoglobin (HbA1) in pregnancy]. / Hemoglobina glicosilada (HbA1) en el embarazo.

The life style, genetic predisposition and metabolic changes occurring during pregnancy can modify the percent value of glycated hemoglobins (HbA1 and HbA1c). In addition, research papers from different laboratories in the world have reported contradictory results on this respect. The purpose of this trial was to know the percent value of HbA1 in healthy women, during the different trimesters of pregnancy. 206 pregnant (E) healthy women who came over for prenatal control to UMF No 80 IMSS in Morelia, Michoacan with no previous history of Diabetes mellitus or Essential Hypertension were classified by trimesters of pregnancy (1T, 2T, 3T) and chronological age (I, 18-24; 11, 25-30; III, 31-35 years). Their chronological and gestational ages, weight, height, body mass index and parity were recorded. % HbA1 (ion exchange chromatography) was determined on each patient. Control group was formed by 187 non pregnant healthy women (NE) chosen with same criterion that pregnant women. % HbA1 was lower in E during pregnancy (7.11 +/- 1.53 vs 7.78 +/- 1.12%, p < 0.0001) than NE group. % HbA1 in E group was lower in the 1T and 2T than in the 3T (p < 0.001), same situation was observed in 18 to 24 (group I) and 25 to 30 (group II) years old. In the other hand, in E from group II on the 2T the weeks of gestation were correlated with % HbA1 (r = 0.72, p < 0.05). This results show a diminished HbA1 percent in E group with a lower values in the 1T and 2T. Moreover, these results will allow us to know HbA1 appearance in diabetic pregnant women and to evaluate the degree of metabolic control.

[Distribution of adipose tissue and insulin serum levels in women with gestational diabetes]. / La distribución del tejido adiposo y los niveles séricos de insulina en la mujer obesa que desarrolla diabetes mellitus gestacional.

Obesity has been mentioned as a major risk factor to develop gestational diabetes mellitus (GDM). In this work the main purpose was to compare the distribution of body fat tissue and insulin serum levels in obese women suffering GDM. Twenty obese pregnant patients, ten with GDM and ten non-diabetic control subjects were selected. To define the body fat distribution the following anthropometric indexes were performed: subscapular/triceps skinfold index (STI) during pregnancy (24-28 weeks) and STI plus waist/hip ratio (WHR) in postpartum (6 weeks). The two obese groups were evaluated through an oral glucose tolerance test, taking blood at 0, 60, 120 and 180 minutes; after centrifugation glucose serum levels were measured immediately by the glucose oxidase technique and the rest of the sample was kept frozen at -20 degrees C until insulin determinations by radioimmunoassay. The ten patients with GDM presented upper body fat, segment distribution, while among those without GDM, only six had this last feature and four were found with lower body fat segment distribution (p < 0.047). Insulin serum levels in GDM group were higher than in women without GDM (p < 0.01). The STI during and after pregnancy correlated positively (r = 0.77, p < 0.00003) and also with WHR (r = 0.61, p < 0.0001). There was correlation between STI and WHR both measured in postpartum (r = 0.52, p < 0.0007).