Criterios de retorno al trabajo y determinación del valor de vulnerabilidad por Covid-19 / Criteria for returning to work and determination of the vulnerability value for Covid-19

Resumen: Objetivo: Establecer criterios médicos de retorno al trabajo en personal con riesgo de complicaciones por Covid-19. Material y métodos. Se realizó una revisión sistemática para identificar las condiciones y las características clínicas que influyen en el riesgo de desarrollar Covid-19 grave. Resultados: Se ha demostrado incremento del riesgo en obesidad, edad >60 años, diabetes mellitus, hipertensión arterial, enfermedad pulmonar obstructiva crónica, enfermedad cardiovascular, enfermedad renal crónica y cáncer. Solamente en diabetes se ha estudiado si el control previo influye. Se proponen condiciones específicas y el nivel de riesgo epidemiológico para el retorno al trabajo. Conclusiones: El retorno laboral de estos grupos debe priorizarse buscando favorecer el control de la enfermedad, identificando el estado de salud que incrementa el riesgo y protegiendo el derecho al trabajo. Se presentan recomendaciones para guiar la reincorporación al trabajo.

Abstract: Objective: To establish medical criteria for return to work to people with increased risk of severe illness from Covid-19. Materials and methods. We performed a systematic review to identify the conditions and clinical characteristics that influence the risk of developing severe Covid-19. Results: Increased risk has been shown in obesity, age >60 years old, diabetes mellitus, arterial hypertension, chronic obstructive pulmonary disease, cardiovascular disease, chronic kidney disease and cancer. Only in diabetes it has been studied whether prior control influences. Specific medical conditions and epidemiological risk level for return to work are proposed. Conclusions: Return to work of vulnerable groups should be prioritized, seeking to promote disease control, identifying health conditions that increase risk, and protecting the right to work. We present recommendations to guide the return to work.

Criterios de retorno al trabajo y determinación del valor de vulnerabilidad por Covid-19.

Objetivo. Establecer criterios médicos de retorno al trabajo en personal con riesgo de complicaciones por Covid-19. Material y métodos. Se realizó una revisión sistemática para identificar las condiciones y las características clínicas que influyen en el riesgo de desarrollar Covid-19 grave. Resultados. Se ha demostrado incremento del riesgo en obesidad, edad >60 años, diabetes mellitus, hipertensión arterial, enfermedad pulmonar obstructiva crónica, enfermedad cardiovascular, enfermedad renal crónica y cáncer. Solamente en diabetes se ha estudiado si el control previo influye. Se proponen condiciones específicas y el nivel de riesgo epidemiológico para el retorno al trabajo. Conclusiones. El retorno laboral de estos grupos debe priorizarse buscando favorecer el control de la enfermedad, identificando el estado de salud que incrementa el riesgo y protegiendo el derecho al trabajo. Se presentan recomendaciones para guiar la reincorporación al trabajo.

[Occupational asthma related to wheat. Presentation of one case]. / Asma laboral por trigo. Presentación de un caso.

Allergy to wheat proteins is the most common type of occupational asthma caused by cereals. Its incidence based on international reports is about 1-2.4/1000 cases among workers per year. In Mexico there is an underdiagnosis of occupational asthma > 99%. During the period 2009-2012 we recorded 5 cases of occupational asthma, 40% of them caused by cereals. This is the case of a 38 year old male, baker for 24 years exposed to wheat flour. In his workplace he used to wear surgical mask and there are no exhaust fans. He initiated 10 years ago with sneezing, itching, hyaline rhinorrhea and nasal obstruction. The following year he presented mild to moderate dyspnea, chest tightness, cough and wheezing during working hours, which improved during his days off. Pulmonary function tests were confirmatory of asthma, with negative skin prick tests to aeroallergens. Specific bronchial challenge was performed with wheat flour resulting positive with a decrease in VEF1 greater than 20%. Pharmacological treatment was provided and was sent to occupational medicine service for evaluation. The case was qualified as an occupational disease with a permanent partial disability of 25%, receiving a financial compensation. He returned to work in the same company but in a different area without wheat flour exposure. The diagnosis of occupational asthma is mainly clinical, according to Brooks¥ criteria, and a bronchial positive challenge test will confirms the diagnosis.

Burnout and patient care in junior doctors in Mexico City.

BACKGROUND: Burnout is known to occur in public service workers leading to a reduction in effectiveness at work. AIM: To estimate the prevalence of burnout in junior doctors and its impact on patient care. METHODS: A cross-sectional study of junior doctors at three hospitals in Mexico City was conducted. Measures used included the Maslach Burnout Inventory (MBI), measuring depersonalization (DP), emotional exhaustion (EE) and personal achievement (PA), a questionnaire about patient care practices and attitudes and one on sociodemographic characteristics. Logistic regression analysis was used to assess the association between burnout and suspected risk factors. RESULTS: A total of 312 junior doctors participated (response rate 65%). In total, 57% were male and the average age was 28. Average scores in MBI subscales were EE: 18.2, DP: 6.9 and PA: 37.6. Burnout prevalence was 40% (126). Junior doctors with burnout were more likely to report suboptimal patient care practices occurring monthly (OR 5.5; 95% CI 2.7-11.2) and weekly (OR 5.2; 95% CI 1.6-16.3). The logistic regression model for burnout included shifts lasting >12 h, current depression, former major depression, first- or second-year junior doctors, male gender and single status. CONCLUSIONS: Burnout was most strongly associated with shifts >12 h and with both current and previous depression. Reported suboptimal patient care was also associated with working shifts of >or=12 h. Burnout may be adversely affecting junior doctors' health and their patients' care.

[Efficacy and impact of polymerase chain reaction in the diagnosis of extrapulmonary tuberculosis]. / Eficacia e impacto de la prueba de la reacción en cadena de la polimerasa en el diagnóstico de tuberculosis extrapulmonar.

OBJECTIVE: To evaluate the efficacy of PCR in the diagnosis of extrapulmonary tuberculosis (TB) and its impact in the management of patients in a tertiary-care center in Mexico City. METHOD: We conducted a retrospective study based on 40 clinical charts of patients to whom nested PCR was performed for the diagnosis of TB from June 1999 to December 2000. We reviewed the medical notes of 10 days before and 10 days after the PCR study to analyze its impact in the management of the patient. Also, we reviewed the rest of the chart to decide if the patient suffered from TB or not (gold standard). The categories of diagnosis were definitive case of TB, probable TB and no TB. We calculated the sensitivity, specificity, and predictive values. RESULTS: The PCR was positive in 45% of the cases. The sensitivity of PCR to diagnosis TB was 50%, specificity 59%, and the positive and negative predictive value were 35% and 72%, respectively. If just spinal fluid was included, the sensitivity and the negative predictive value increased to 75% and 63%, respectively. The PCR had an impact in the management of 13% of the patients. CONCLUSIONS: The PCR for the diagnosis of extrapulmonary TB has limited efficacy, which improves when the test is done in spinal fluid samples. The impact of the result of PCR in the clinical management of the patients was poor.