Organización y división del trabajo: riesgos para trabajadores de servicios de salud en empresas venezolanas / Organization and division of labor: risks for health services workers in Venezuelan companies

Los modos de producción generan formas de organización y división del trabajo que puede ocasionar la aparición de riesgos psicosociales como la fatiga o el estrés laboral. El objetivo del presente estudio fue, evaluar los factores de riesgo psicosociales, la fatiga y el estrés laboral en profesionales integrantes de Servicios de Seguridad y Salud en el Trabajo, en cuatro empresas venezolanas en el 2020. Estudio de campo, descriptivo, de corte transversal. Participaron 39 trabajadores (muestra censal), 25,6% inspectores, 20,6% enfermeras y 20,6% personal médico. Se usó el cuestionario SUSESO/ISTAS21 versión breve, el cuestionario de Estrés Laboral OIT-OMS, el cuestionario de Síntomas Subjetivos de Fatiga y el cuestionario de Problemas Psicosomáticos. Resultados: Solo el 51% son del sexo masculino, promedio de edad de 35±8,7con antigüedad de 6±4,5años. Todos están bajo el tipo de contratación tercerizada (outsourcing). Resultó un trabajo de alta demanda, pero con alto control (trabajo activo). Niveles de riesgo medio (45%) vinculado al Apoyo Social y Calidad de liderazgo y nivel de riesgo alto (40%) en Compensaciones y Doble presencia. El trabajo es fatigante para el 30,7% y el estresor con mayor puntaje fue la Influencia del Líder. Concluyéndose que en estos servicios hay un número importante de profesionales femeninos, adultos jóvenes, con antigüedad laboral, expuestos a diferentes factores de riesgo psicosociales con importante influencia del líder, generadores de fatiga laboral. Recomendándose la revisión del tipo de contratación, la compensación dineraria, así como evaluaciones periódicas sobre el clima laboral(AU)

The modes of production generate forms of organization and division of labor that can cause the appearance of psychosocial risks such as fatigue or work stress. The objective of this study was to evaluate psychosocial risk factors, fatigue and work stress in professionals who are members of Occupational Health and Safety Services, in four Venezuelan companies in 2020. Descriptive, crosssectional field study. 39 workers (census sample) participated, 25.6% inspectors, 20.6% nurses and 20.6% medical personnel. The SUSESO/ISTAS21 short version questionnaire, the OIT-WHO Work Stress questionnaire, the Subjective Symptoms of Fatigue questionnaire and the Psychosomatic Problems questionnaire were used. Results: Only 51% were male, mean age 35 ± 8.7 with seniority age of 6 ± 4.5 years. All are under the outsourcing type of hiring. It turned out to be a high demand job, but with highly controlled (active work). Medium risk levels (45%) linked to Social Support and Leadership Quality, and high risk level (40%) in Compensations and Double presence. The work is tiring for 30.7% and the stressor with the highest score was the Influence of the Leader. It was concluded that in these services there are a significant number of female professionals, young adults, with seniority, exposed to different psychosocial risk factors with Important Leader Influence, generators of work fatigue. Recommending the review of the type of contract, the monetary compensation, as well as periodic evaluations of the work environment(AU)

Towards the understanding of cytoskeleton fluidisation-solidification regulation.

The understanding of the self-regulation of the mechanical properties in non-sarcomeric cells, such as lung cells or cells during tissue development, remains an open research problem with many unresolved issues. Their behaviour is far from the image of the traditionally studied sarcomeric cells, since the crosstalk between the signalling pathways and the complexity of the mechanical properties creates an intriguing mechano-chemical coupling. In these situations, the inelastic effects dominate the cytoskeletal structure showing phenomena like fluidisation and subsequent solidification. Here, we proposes the inelastic contractile unit framework as an attempt to reconciles these effects. The model comprises a mechanical description of the nonlinear elasticity of the cytoskeleton incorporated into a continuum-mechanics framework using the eighth-chains model. In order to address the inelastic effect, we incorporate the dynamic of crosslinks, considering the [Formula: see text]-actinin and the active stress induced by the myosin molecular motors. Finally, we introduce a hypothesis that links the ability to fluidise and re-solidify as a consequence of the interaction between the active stress and the gelation state defined by the crosslinks. We validate the model with data obtained from experiments of drug-induced relaxation reported in the literature.

An atlas- and data-driven approach to initializing reaction-diffusion systems in computer cardiac electrophysiology.

The cardiac electrophysiology (EP) problem is governed by a nonlinear anisotropic reaction-diffusion system with a very rapidly varying reaction term associated with the transmembrane cell current. The nonlinearity associated with the cell models requires a stabilization process before any simulation is performed. More importantly, when used in a 3-dimensional (3D) anatomy, it is not sufficient to perform this stabilization on the basis of isolated cells only, since the coupling of the different cells through the tissue greatly modulates the dynamics of the system. Therefore, stabilization of the system must be performed on the entire 3D model. This work develops a novel procedure for the initialization of reaction-diffusion systems for numerical simulations of cardiac EP from steady-state conditions. We exploit surface point correspondence to establish volumetric point correspondence. Upon introduction of a new 3D anatomy with surface point correspondence, a prediction of the cell model steady states is derived from the set of earlier biophysical simulations. We show that the prediction error is typically less than 10% for all model variables, with most variables showing even greater accuracy. When initializing simulations with the predicted model states, it is demonstrated that simulation times can be cut by at least two-thirds and potentially more, which saves hours or days of high-performance computing. Overall, these results increase the clinical applicability of detailed computational EP studies on personalized anatomies.

Calidad metodológica de las evaluaciones económicas completas, publicadas en revistas médicas cubanas (1999-2014) / Methodological quality of complete economic evaluations published in Cuban medical journals from 1999 to 2014

Objetivo: determinar la calidad metodológica de las evaluaciones económicas completas publicadas en revistas médicas cubanas. Métodos: estudio observacional, descriptivo y transversal en 21 artículos, declarados por su autores como evaluaciones económicas completas, publicados entre 1999 y 2014 en 47 revistas médicas cubanas reconocidas por el Ministerio de Ciencia, Tecnología y Medio Ambiente. A todos se les aplicó una guía de evaluación que incluyó: año de publicación, revista, objetivo, problema, opciones, horizonte temporal, perspectiva, costo, efectos sobre la salud y cálculo de las razones costo/efectividad. Resultados: los artículos se concentraron en ocho revistas. La mayor cantidad está en la Revista Cubana de Farmacia. Le siguieron en importancia la Revista Cubana de Salud Pública y MEDISAN. Ninguno de los aspectos estaba correctamente tratado en más de 80 por ciento de los trabajos revisados. Los resultados más desfavorables estaban en la declaración de la perspectiva, presente en menos de 20 por ciento de los trabajos y el análisis de sensibilidad en menos de 30 por ciento. Menos de la mitad de los trabajos abordaron adecuadamente la presentación del problema de investigación, los objetivos, el horizonte temporal, los costos y la razón costo efectividad incremental. No se encontró ningún artículo en los últimos tres años. Conclusiones: son escasas las evaluaciones económicas publicadas. La mayoría tiene limitaciones metodológicas. Se observa insuficiente desarrollo de esta temática en el país y apunta hacia la importancia de continuar insistiendo en la divulgación de los aspectos metodológicos básicos de estas evaluaciones tanto para investigadores como para revisores y editores de revistas científicas(AU)

Objective: to determine the methodical quality of complete economic evaluations published in Cuban medical journals from 1999 to 2014. Methods: observational, descriptive and cross-sectional study of articles classified by their authors as complete economic evaluations and published from 1999 to 2014 in 47 Cuban medical journals authorized by the Ministry of Science, Technology and Environment. The applied evaluation guide included year of publication, journal, objective, problem, options, time frame, prospects, cost, health effects and estimation of the cost/effectiveness ratio. Results: twenty one papers were found, but in the last three years no paper has been published. These papers were mainly published in eight journals, being the first Revista Cubana de Farmacia, followed by Revista Cubana de Salud Publica and MEDISAN. None of the aspects was correctly addressed in over 80 percent of revised papers. The worst results were found in statement of perspective present in less than 20 percent of papers in addition to sensitivity analysis in less than 30 percent of them. Almost 50 of papers adequately dealt with the submission of research problems, objectives, time frame, costs and the incremental cost/effectiveness ratio. Conclusions: published economic evaluations are still scanty and most of them exhibit methodological faults. There is insufficient development in this area nationwide, which points to the importance of insisting once again on the dissemination of the basic methodological aspects of these evaluations aimed at researchers who act as reviewers and as editors of scientific journals(AU)

Calidad metodológica de las evaluaciones económicas completas, publicadas en revistas médicas cubanas (1999-2014) / Methodological quality of complete economic evaluations published in Cuban medical journals from 1999 to 2014

Objetivo: determinar la calidad metodológica de las evaluaciones económicas completas publicadas en revistas médicas cubanas. Métodos: estudio observacional, descriptivo y transversal en 21 artículos, declarados por su autores como evaluaciones económicas completas, publicados entre 1999 y 2014 en 47 revistas médicas cubanas reconocidas por el Ministerio de Ciencia, Tecnología y Medio Ambiente. A todos se les aplicó una guía de evaluación que incluyó: año de publicación, revista, objetivo, problema, opciones, horizonte temporal, perspectiva, costo, efectos sobre la salud y cálculo de las razones costo/efectividad. Resultados: los artículos se concentraron en ocho revistas. La mayor cantidad está en la Revista Cubana de Farmacia. Le siguieron en importancia la Revista Cubana de Salud Pública y MEDISAN. Ninguno de los aspectos estaba correctamente tratado en más de 80 por ciento de los trabajos revisados. Los resultados más desfavorables estaban en la declaración de la perspectiva, presente en menos de 20 por ciento de los trabajos y el análisis de sensibilidad en menos de 30 por ciento. Menos de la mitad de los trabajos abordaron adecuadamente la presentación del problema de investigación, los objetivos, el horizonte temporal, los costos y la razón costo efectividad incremental. No se encontró ningún artículo en los últimos tres años. Conclusiones: son escasas las evaluaciones económicas publicadas. La mayoría tiene limitaciones metodológicas. Se observa insuficiente desarrollo de esta temática en el país y apunta hacia la importancia de continuar insistiendo en la divulgación de los aspectos metodológicos básicos de estas evaluaciones tanto para investigadores como para revisores y editores de revistas científicas(AU)

Objective: to determine the methodical quality of complete economic evaluations published in Cuban medical journals from 1999 to 2014. Methods: observational, descriptive and cross-sectional study of articles classified by their authors as complete economic evaluations and published from 1999 to 2014 in 47 Cuban medical journals authorized by the Ministry of Science, Technology and Environment. The applied evaluation guide included year of publication, journal, objective, problem, options, time frame, prospects, cost, health effects and estimation of the cost/effectiveness ratio. Results: twenty one papers were found, but in the last three years no paper has been published. These papers were mainly published in eight journals, being the first Revista Cubana de Farmacia, followed by Revista Cubana de Salud Publica and MEDISAN. None of the aspects was correctly addressed in over 80 percent of revised papers. The worst results were found in statement of perspective present in less than 20 percent of papers in addition to sensitivity analysis in less than 30 percent of them. Almost 50 of papers adequately dealt with the submission of research problems, objectives, time frame, costs and the incremental cost/effectiveness ratio. Conclusions: published economic evaluations are still scanty and most of them exhibit methodological faults. There is insufficient development in this area nationwide, which points to the importance of insisting once again on the dissemination of the basic methodological aspects of these evaluations aimed at researchers who act as reviewers and as editors of scientific journals(AU)

In silico simulations of experimental protocols for cardiac modeling.

A mathematical model of the AP involves the sum of different transmembrane ionic currents and the balance of intracellular ionic concentrations. To each ionic current corresponds an equation involving several effects. There are a number of model parameters that must be identified using specific experimental protocols in which the effects are considered as independent. However, when the model complexity grows, the interaction between effects becomes increasingly important. Therefore, model parameters identified considering the different effects as independent might be misleading. In this work, a novel methodology consisting in performing in silico simulations of the experimental protocol and then comparing experimental and simulated outcomes is proposed for parameter model identification and validation. The potential of the methodology is demonstrated by validating voltage-dependent L-type calcium current (ICaL) inactivation in recently proposed human ventricular AP models with different formulations. Our results show large differences between ICaL inactivation as calculated from the model equation and ICaL inactivation from the in silico simulations due to the interaction between effects and/or to the experimental protocol. Our results suggest that, when proposing any new model formulation, consistency between such formulation and the corresponding experimental data that is aimed at being reproduced needs to be first verified considering all involved factors.

An affine micro-sphere-based constitutive model, accounting for junctional sliding, can capture F-actin network mechanics.

Actin filaments are a major component of the cytoskeleton and play a crucial role in cell mechanotransduction. F-actin networks can be reconstituted in vitro and their mechanical behaviour has been studied experimentally. Constitutive models that assume an idealised network structure, in combination with a non-affine network deformation, have been successful in capturing the elastic response of the network. In this study, an affine network deformation is assumed, in which we propose an alternative 3D finite strain constitutive model. The model makes use of a micro-sphere to calculate the strain energy density of the network, which is represented as a continuous distribution of filament orientations in space. By incorporating a simplified sliding mechanism at the filament-to-filament junctions, premature filament locking, inherent to affine network deformation, could be avoided. The model could successfully fit experimental shear data for a specific cross-linked F-actin network, demonstrating the potential of the novel model.

Dominant frequency and organization index maps in a realistic three-dimensional computational model of atrial fibrillation.

AIMS: To study, using simulation, the spectral characteristics of different patterns of atrial fibrillation (AF) at high spatial resolution. Dominant frequency (DF) and organization index (OI) maps have been used to approximate the location of the focal source of high frequency during AF events. METHODS AND RESULTS: A realistic three-dimensional model of the human atria that includes fibre orientation, electrophysiological heterogeneity, and anisotropy was implemented. The cellular model was modified to simulate electrical remodelling. More than 43 000 electrograms were calculated on the surface, and were processed to reconstitute the DF and OI maps. Atrial fibrillation episodes were triggered by a source of transitory and of continuous activity (both with a cycle length of 130 ms) in five different locations. The maps obtained during the AF events triggered by transitory foci did not show areas with high DF or OI values. When continuous foci were applied, the DF maps show ample zones with high values in the atrium where the focus was applied; while OI maps display smaller areas with high values, always within the areas of high DF and, in three of five locations, this high-value area was located at the site of focus application and at the nearby area. In the other two locations, the area presenting the highest OI values is small and located at the site of focus application, which allowed its precise localization. CONCLUSION: Organization index maps provide a better approximation than DF maps for the localization of ectopic sources of high frequency and continuous activity during episodes of simulated AF in remodelled tissue.

Análisis de eficiencia relativa en el control del Aedes aegypti del municipio Camagüey / Analysis of relative efficiency in the Aedes aegypti control in Camagüey municipality

Fundamento: es posible identificar instituciones que utilizan de manera efectiva los recursos productivos puestos a su disposición, así como también se puede identificar aquellas unidades ineficientes mediante el análisis envolvente de datos. El Centro de Medicina y Complejidad de la provincia de Camagüey, junto a la Dirección Provincial de Salud y la Dirección Provincial de la lucha contra vectores, trabajan en un proyecto conjunto para la recolección, análisis y procesamiento de datos. Objetivo: realizar un análisis de eficiencia relativa del control del Aedes aegypti del municipio Camagüey, que se pueda incorporar de forma sistemática al sistema creado. Método: se realizó un análisis de eficiencia relativa a las nueve áreas de salud del municipio de Camagüey vinculadas al control del vector del Dengue, correspondiente al mes de julio del año 2010. Se utilizó la técnica de análisis envolvente, en particular el modelo Constant returns to scale, input oriented model in envelopment form. Se empleó el software Ri para su resolución. Para la selección de las variables a introducir en el modelo, se evaluó el aporte de cada una con la técnica estadística de componentes principales, para lo que se utilizó el programa SPSS 18. Resultados: se seleccionaron como entradas o gastos: gasolina, diesel, insecticida, cantidad de hombres involucrados; como salidas o producciones, cantidad de viviendas visitadas, muestras de adultos y de larvas realizadas, y cantidad de depósitos inspeccionados. Se mostró la eficiencia relativa de cada institución, así como las que pueden servir como puntos de referencia a las no eficientes. Se mostró también un sumario de los objetivos para mejorar la eficiencia a lograr en las entradas y en las salidas. Conclusiones: se identificaron áreas que operan con deficiencias productivas. Se puede introducir el modelo Análisis envolvente de datos de forma sistemática con los códigos abiertos del R.

Background: it is possible to identify institutions that use effectively, productive resources placed at their disposal, as well as to identify those inefficient units using data enveloping analysis. The Medicine and Complexity Center of Camagüey province, along with the Provincial Health Office and the Provincial Office of the fight against vectors, work in a joint project for the collection, analysis and data processing. Objective: to perform an analysis of relative efficiency of Aedes aegypti control in Camagüey municipality, which may be incorporated systematically into the created system. Method: an analysis of relative efficiency to nine health areas in Camagüey municipality related to the control of Dengue's vector was performed on July, 2010. The enveloping analysis technique, in particular the model constant returns to scale, input oriented model in envelopment form was used. The Ri software for its resolution was employed. Variables were assessed by its contribution of each with the statistical technique of main components; the 18 SPSS program was used. Results: selected income or expenditure: gasoline, diesel, insecticide, and number of men involved; as outputs or productions: amount of visited homes, samples of adults and larvae was carried out, and inspected deposits amount. The relative efficiency of each institution was showed, as well as the ones may serve as points of reference to the no efficient ones. A summary of the objectives to improve efficiency regarding income or expenditure also was expressed. Conclusions: the areas that operate with productive deficiencies were identified. Data enveloping analysis model may be inserted systematically with Ri open codes.

A human ventricular cell model for investigation of cardiac arrhythmias under hyperkalaemic conditions.

In this study, several modifications were introduced to a recently proposed human ventricular action potential (AP) model so as to render it suitable for the study of ventricular arrhythmias. These modifications were driven by new sets of experimental data available from the literature and the analysis of several well-established cellular arrhythmic risk biomarkers, namely AP duration at 90 per cent repolarization (APD(90)), AP triangulation, calcium dynamics, restitution properties, APD(90) adaptation to abrupt heart rate changes, and rate dependence of intracellular sodium and calcium concentrations. The proposed methodology represents a novel framework for the development of cardiac cell models. Five stimulation protocols were applied to the original model and the ventricular AP model developed here to compute the described arrhythmic risk biomarkers. In addition, those models were tested in a one-dimensional fibre in which hyperkalaemia was simulated by increasing the extracellular potassium concentration, [K(+)](o). The effective refractory period (ERP), conduction velocity (CV) and the occurrence of APD alternans were investigated. Results show that modifications improved model behaviour as verified by: (i) AP triangulation well within experimental limits (the difference between APD at 50 and 90 per cent repolarization being 78.1 ms); (ii) APD(90) rate adaptation dynamics characterized by fast and slow time constants within physiological ranges (10.1 and 105.9 s); and (iii) maximum S1S2 restitution slope in accordance with experimental data (S(S1S2)=1.0). In simulated tissues under hyperkalaemic conditions, APD(90) progressively shortened with the degree of hyperkalaemia, whereas ERP increased once a threshold in [K(+)](o) was reached ([K(+)](o)≈6 mM). CV decreased with [K(+)](o), and conduction was blocked for [K(+)](o)>10.4 mM. APD(90) alternans were observed for [K(+)](o)>9.8 mM. Those results adequately reproduce experimental observations. This study demonstrated the value of basing the development of AP models on the computation of arrhythmic risk biomarkers, as opposed to joining together independently derived ion channel descriptions to produce a whole-cell AP model, with the new framework providing a better picture of the model performance under a variety of stimulation conditions. On top of replicating experimental data at single-cell level, the model developed here was able to predict the occurrence of APD(90) alternans and areas of conduction block associated with high [K(+)](o) in tissue, which is of relevance for the investigation of the arrhythmogenic substrate in ischaemic hearts.

Quantification of restitution dispersion from the dynamic changes of the T-wave peak to end, measured at the surface ECG.

Action potential duration restitution (APDR) curves present spatial variations due to the electrophysiological heterogeneities present in the heart. Enhanced spatial APDR dispersion in ventricle has been suggested as an arrhythmic risk marker. In this study, we propose a method to noninvasively quantify dispersion of APDR slopes at tissue level by making only use of the surface electrocardiogram (ECG). The proposed estimate accounts for rate normalized differences in the steady-state T-wave peak to T-wave end interval (T(pe)). A methodology is developed for its computation, which includes compensation for the T(pe) memory lag after heart-rate (HR) changes. The capability of the proposed estimate to reflect APDR dispersion is assessed using a combination of ECG signal processing, and computational modeling and simulation. Specifically, ECG recordings of control subjects undergoing a tilt test trial are used to measure that estimate, while its capability to provide a quantification of APDR dispersion at tissue level is assessed by using a 2-D ventricular tissue simulation. From this simulation, APDR dispersion, denoted as ∆α(SIM), is calculated, and pseudo-ECGs are derived. Estimates of APDR dispersion measured from the pseudo-ECGs show to correlate with ∆α(SIM), being the mean relative error below 5%. A comparison of the ECG estimates obtained from tilt test recordings and the ∆α(SIM) values measured in silico simulations at tissue level show that differences between them are below 20 % , which is within physiological variability limits. Our results provide evidence that the proposed estimate is a noninvasive measurement of APDR dispersion in ventricle. Additional results from this study confirm that T(pe) adapts to HR changes much faster than the QT interval.

Aspectos metodológicos críticos en las evaluaciones económicas de salud en el contexto cubano / Critical methodological aspects of the health economic assessments in the Cuban setting

Diversos factores participan como determinantes en el aumento sostenido de los costos de atención de la salud, lo que ha obligado a los gobiernos de todos los países del mundo a priorizar la asignación de los recursos disponibles entre diversas opciones de gasto en salud. Ante esta situación es de suma importancia lograr una mayor eficiencia en la aplicación de los recursos existentes. En este artículo se presentan los pasos básicos para la realización de evaluaciones económicas en salud, escasas aún en Cuba, con el objetivo de contribuir a su mejor comprensión. Se profundiza en dos de las acciones específicas de este tipo de estudio: la identificación de opciones de comparación y el análisis de resultados. A pesar del paso de avance dado en el campo metodológico con la Guía de Evaluación Económica en Salud cubana todavía se debe insistir en el rigor metodológico de este tipo de estudios

A number of factors are involved as determinants in the sustained increase of health care costs, all of which has forced the governments worldwide to prioritize the allocation of the available resources among several health expenditure choices. In the face of this situation, it is extremely important to achieve higher efficiency in the use of existing resources. This paper presented the basic steps to make health economic assessments, still very limited in Cuba, in order to contribute to a better understanding. It delved into two specific actions of this type of study, that is, identification of comparison options and analysis of results. Despite the step forward represented by the Cuban Health Economic Assessment Guideline in the methodological field, it is necessary to insist on the methodological rigor that this type of studies must have

Aspectos metodológicos críticos en las evaluaciones económicas de salud en el contexto cubano / Critical methodological aspects of the health economic assessments in the Cuban setting

Diversos factores participan como determinantes en el aumento sostenido de los costos de atención de la salud, lo que ha obligado a los gobiernos de todos los países del mundo a priorizar la asignación de los recursos disponibles entre diversas opciones de gasto en salud. Ante esta situación es de suma importancia lograr una mayor eficiencia en la aplicación de los recursos existentes. En este artículo se presentan los pasos básicos para la realización de evaluaciones económicas en salud, escasas aún en Cuba, con el objetivo de contribuir a su mejor comprensión. Se profundiza en dos de las acciones específicas de este tipo de estudio: la identificación de opciones de comparación y el análisis de resultados. A pesar del paso de avance dado en el campo metodológico con la Guía de Evaluación Económica en Salud cubana todavía se debe insistir en el rigor metodológico de este tipo de estudios(AU)

A number of factors are involved as determinants in the sustained increase of health care costs, all of which has forced the governments worldwide to prioritize the allocation of the available resources among several health expenditure choices. In the face of this situation, it is extremely important to achieve higher efficiency in the use of existing resources. This paper presented the basic steps to make health economic assessments, still very limited in Cuba, in order to contribute to a better understanding. It delved into two specific actions of this type of study, that is, identification of comparison options and analysis of results. Despite the step forward represented by the Cuban Health Economic Assessment Guideline in the methodological field, it is necessary to insist on the methodological rigor that this type of studies must have(AU)