Risk management of radioiodine treatment in differentiated thyroid cancer.

INTRODUCTION: Patient safety is paramount in providing quality healthcare and constitutes a global concern for healthcare systems. Radioiodine treatment to patients with well-differentiated thyroid cancer is not without risks. The aim of this study is to identify, evaluate and mitigate the risks associated with this procedure. MATERIALS AND METHODS: A single-centre descriptive study was conducted in which risk management was carried out by establishing a risk map using FMEA methodology. RESULTS: Based on the process map 6 sub-processes and 23 failure modes in the three phases of the treatment process were analysed. According to risk priority number (RPN), the sub-process with the highest risk was administrative management (RPN 82), followed by treatment per se and post-treatment imaging (both with RPN 70). An overall process RPN of 300 (156 pre-treatment, 74 treatment and 70 post-treatment) was obtained. Failures directly related to the patient pose a high risk. The implementation of verification systems, performing tasks earlier and providing quality medical information are the most relevant preventive measures to be implemented. CONCLUSIONS: The application of the FMEA methodology in the risk management for radioiodine treatment is a valuable tool for improving the quality and safety of this process. The risk map has been able to identify failures at different stages, assess their causes and effects, prioritise the risks identified and implement preventive and corrective measures that can be monitored, ensuring the effectiveness of the actions taken.

Female ophthalmologists' perception of occupational hazards during pregnancy.

OBJECTIVE: Woman ophthalmologists of childbearing age are exposed to different types of occupational risks which can be harmful to pregnancy and to the development of the fetus. The objective of this paper is to analyze the perception of these risks during pregnancy. METHODS: We designed a survey which was answered by 42 ophthalmologists who had been working during pregnancy. We report the perception of global and specific risk according to the type of agent. RESULTS: 38.1% of the ophthalmologists perceive that the overall risk of working during pregnancy is high, and 35.7% consider it moderate. Regarding specific risk, the most relevant agents are the ergonomic and psychosocial ones. Physical agents are considered the least important. CONCLUSIONS: Although most of the surveyed ophthalmologists perceived the occupational risk as high or moderate, only 19% of them took time off work due to this reason. The most important agents were ergonomic and psychosocial.

Risk factors for hypoglycaemia in non-critical hospitalised diabetic patients.

OBJECTIVE: To determine the risk factors for hypoglycaemia in patients with diabetes on general hospital wards based on a systematic review of the literature since 2013 and meta-analysis. METHODS: Systematic review of the literature focused on the conceptual and methodological aspects of the PRISMA Declaration. The search carried out in Pub Med, Web of Science, Medline, Scielo, Lilacs, OVID, grey literature and Google Academic focused on risk factors for hypoglycaemia in patients with diabetes on general hospital wards. The CASPe (Critical Appraisal Skills Programme Spanish) tool was applied for quality control. RESULTS: From 805 references, 70 potentially eligible articles were identified for review of abstracts and full text. Finally, according to inclusion and exclusion criteria, seven studies with 554,601 patients of Asian, European and North American ethnicity were selected. A meta-analysis performed using the random effects model found an association between the presence of hypoglycaemia and: the use of insulin (OR 2.89 [95% CI: 1.8-4.5]); the use of long-acting insulin (OR 2.27 [95% CI: 1.8-2.8]) or fast-acting insulin (OR 1.4 [95% CI: 1.18-1.85]); nasogastric tube feeding (OR 1.75 [95% CI: 1.33-2.3]); chronic kidney disease (OR 1.65 [95% CI: 1.14-2.38]); congestive heart failure (OR 1.36 [95% CI: 1.10-1.68]); and elevated levels of glycosylated haemoglobin (OR 1.59 [95% CI: 1.32-1.91]). CONCLUSION: The factors associated with the risk of hypoglycaemia in non-critically ill hospitalised patients with type 2 diabetes were: use of any insulin; nasogastric tube feeding; elevated glycosylated haemoglobin levels; history of congestive heart failure; and chronic kidney disease.

Survival and its relationship with the type of peritoneal solute transfer rate, in patients with chronic kidney disease incident on peritoneal dialysis therapy in RTS Colombia between the years 2007-2017.

INTRODUCTION: In some studies, the peritoneal solute transfer rate (PSTR) through the peritoneal membrane has been related to an increased risk of mortality. It has been observed in the literature that those patients with rapid diffusion of solutes through the peritoneal membrane (high/fast transfer) and probably those with high average transfer characterized by the Peritoneal Equilibrium Test (PET) are associated with higher mortality compared to those patients who have a slow transfer rate. However, some authors have not documented this fact. In the present study, we want to evaluate the (etiological) relationship between the characteristics of peritoneal membrane transfer and mortality and survival of the technique in an incident population on peritoneal dialysis in RTS Colombia during the years 2007-2017 using a competing risk model. MATERIALS AND METHODS: A retrospective cohort study was carried out at RTS Colombia in the period between 2007 and 2017. In total, there were 8170 incident patients older than 18 years, who had a Peritoneal Equilibration Test (PET) between 28 and 180 days from the start of therapy. Demographic, clinical, and laboratory variables were evaluated. The (etiological) relationship between the type of peritoneal solute transfer rate at the start of therapy and overall mortality and technique survival were analyzed using a competing risk model (cause-specific proportional hazard model described by Royston-Lambert). RESULTS: Patients were classified into four categories based on the PET result: Slow/Low transfer (16.0%), low average (35.4%), high average (32.9%), and High/Fast transfer (15.7%). During follow-up, with a median of 730 days, 3025 (37.02%) patients died, 1079 (13.2%) were transferred to hemodialysis and 661 (8.1%) were transplanted. In the analysis of competing risks, adjusted for age, sex, presence of DM, HTA, body mass index, residual function, albumin, hemoglobin, phosphorus, and modality of PD at the start of therapy, we found cause-specific HR (HRce) for high/fast transfer was 1.13 (95% CI 0.98-1.30) p = 0.078, high average 1.08 (95% CI 0.96-1.22) p = 0.195, low average 1.09 (95% CI 0.96-1.22) p = 0.156 compared to the low/slow transfer rate. For technique survival, cause-specific HR for high/rapid transfer of 1.22 (95% CI 0.98-1.52) p = 0.66, high average HR was 1.10 (95% CI 0.91-1.33) p = 0.296, low average HR of 1.03 (95% CI 0.85-1.24) p = 0.733 compared with the low/slow transfer rate, adjusted for age, sex, DM, HTA, BMI, residual renal function, albumin, phosphorus, hemoglobin, and PD modality at start of therapy. Non-significant differences. CONCLUSIONS: When evaluating the etiological relationship between the type of peritoneal solute transfer rate and overall mortality and survival of the technique using a competing risk model, we found no etiological relationship between the characteristics of peritoneal membrane transfer according to the classification given by Twardowski assessed at the start of peritoneal dialysis therapy and overall mortality or technique survival in adjusted models. The analysis will then be made from the prognostic model with the purpose of predicting the risk of mortality and survival of the technique using the risk subdistribution model (Fine & Gray).

Vivencias y estrategias comunitarias de manejo del riesgo dentro de las prácticas chemsex: un estudio cualitativo / Community experiences and strategies of risk management within chemsex practices: a qualitative study

Resumen El auge en el estudio del uso sexualizado de drogas entre hombres gais, bisexuales u otros hombres que tienen sexo con hombres (HSH), conocido como chemsex, ha generado una multiplicidad de datos que contribuyen a su problematización en tanto cuestión de salud pública a través del vínculo con el VIH y las adicciones. El estudio de estas prácticas, desde un paradigma biomédico, se ha centrado en el riesgo y ha contribuido a su reducción como fenómeno único y cuantificable. Este estudio tiene como objetivo explorar la vivencia del riesgo en el transcurso de las prácticas, para conocer qué estrategias de manejo emplean frente a éste y de qué manera son generadas. Se realizaron entrevistas semiestructuradas a cinco practicantes de chemsex en el Área Metropolitana de Barcelona y, posteriormente se aplicó un análisis temático. Los hallazgos muestran cómo estos hombres detectan, asumen y enfrentan los riesgos presentes en estas prácticas, donde toman relevancia el tipo de relaciones que allí se dan y el círculo social del que disponen. Este estudio destaca también la creación de estrategias basadas en la experiencia y cómo la transmisión de estos saberes entre participantes facilita la toma de decisiones y el manejo del riesgo.

Abstract The rise in the study of sexualised drug use among gay, bisexual and other men who have sex with men (MSM), known as chemsex, has generated a multiplicity of data that contribute to its problematisation as a public health issue through the link with HIV and addictions. The study of these practices, from a biomedical paradigm, has focused on risk and has contributed to its reduction as a unique and quantifiable phenomenon. This study aims to explore the experience of risk in the course of the practices, to find out what management strategies they employ in the face of risk and how they are generated. Semi-structured interviews were conducted with five chemsex practitioners in the Metropolitan Area of Barcelona and, subsequently, a thematic analysis was applied. The findings show how these men detect, assume and confront the risks present in these practices, where the type of relationships that take place and the social circle available to them are relevant. This study also highlights the creation of strategies based on experience and how the transmission of this knowledge among participants facilitates decision-making and risk management.

[Health and well-being of healthcare workers: employment and working conditions beyond the pandemic]. / Salud y bienestar del personal sanitario: condiciones de empleo y de trabajo más allá de la pandemia. Informe SESPAS 2024.

Healthcare workers are people who work in health activities, whether or not they have direct contact with citizens. Currently, around 1.3 million people (70% women) work in healthcare activities in Spain. This represents around 10% of the active population, having increased by 33% since 2008, especially the number of women, which has doubled. Healthcare organizations, especially hospitals, are extremely complex workplaces, with precarious working and employment conditions, especially in more hierarchical occupations, exposing healthcare workers to numerous occupational hazards, mainly from ergonomic and psychosocial conditions. These causes frequent musculoskeletal and mental disorders, highlighting burnout, which is estimated at 40% in some services such as intensive care units. This high morbidity is reflected in a high frequency of absences due to illness, around 9% after the pandemic. The pandemic, and its consequences in the last three years, has put extreme pressure on the health system and has clearly shown its deficiencies in relation to working and employment conditions. The hundreds of occupational health professionals, technicians and healthcare workers, who are part of the structures of health organizations, constitute very valuable resources to increase the resilience of the NHS. We recommend the strengthening in resources and institutionally of the occupational health services of health centers and the creation of an Observatory of working, employment and health conditions in the National Health Service, as an instrument for monitoring changes and proposing solutions.

Gerenciamento do protocolo de prevenção de lesão por pressão: construção de painel de bordo informatizado / Management of the pressure injury prevention protocol: construction of a computerized dashboard / Gestión del protocolo de prevención de lesiones por presión: construcción de panel informatizado

Objetivo: Relatar a construção e implantação de painel de bordo, desenvolvido por enfermeiros e profissionais da tecnologia da informação, para gerenciamento do Protocolo de Prevenção de Lesão por Pressão. Métodos: Trata-se de um relato de experiência sobre a construção e implantação de painel de bordo informatizado para gerenciamento de protocolo em um hospital privado universitário, localizado no interior do estado de São Paulo. Resultados: A construção do painel de bordo foi dividida nas seguintes etapas: revisão e atualização do protocolo, construção do modelo eletrônico e implementação. A divulgação foi realizada pela Comissão de Prevenção de Lesão por Pressão. Conclusão: O painel de bordo possibilitou a visualização rápida e em tempo real dos riscos dos pacientes, intervenções propostas e efetividade das medidas de prevenção, além de promover a integração e empoderamento dos profissionais na gestão do cuidado. (AU)

Objective: To report the construction and implementation of a dashboard, developed by nurses and information technology professionals, to manage the Pressure Injury Prevention Protocol. Methods: This is an experience report on the construction and implementation of a computerized dashboard for protocol management in a private university hospital, located in the interior of the state of São Paulo. Results: The construction of the dashboard was divided into the following steps: review and update of the protocol, construction of the electronic model and implementation. The Pressure Injury Prevention Commission disclosed the tool. Conclusion: The dashboard enabled the quick and real-time visualization of patient risks, proposed interventions and effectiveness of prevention measures, in addition to promoting the integration and empowerment of professionals in the management of care. (AU)

Objetivo: Informar la construcción e implementación de un panel, desarrollado por enfermeras y profesionales de tecnologías de la información, para gestionar el Protocolo de Prevención de Lesiones por Presión. Métodos: Se trata de un informe de experiencia sobre la construcción e implementación de un panel computarizado para la gestión del protocolo en un hospital universitario privado, en el interior del estado de São Paulo. Resultados: La construcción del panel se dividió en los siguientes pasos: revisión y actualización del protocolo, construcción del modelo electrónico e implementación. La divulgación fue realizada por la Comisión de Prevención de Lesiones por Presión. Conclusión: El panel permitió la visualización rápida y en tiempo real de los riesgos del paciente, las intervenciones propuestas y la efectividad de las medidas de prevención, además de promover la integración y el empoderamiento de los profesionales en la gestión del cuidado. (AU)

Current perspectives on the use of artificial intelligence in critical patient safety.

Intensive Care Units (ICUs) have undergone enhancements in patient safety, and artificial intelligence (AI) emerges as a disruptive technology offering novel opportunities. While the published evidence is limited and presents methodological issues, certain areas show promise, such as decision support systems, detection of adverse events, and prescription error identification. The application of AI in safety may pursue predictive or diagnostic objectives. Implementing AI-based systems necessitates procedures to ensure secure assistance, addressing challenges including trust in such systems, biases, data quality, scalability, and ethical and confidentiality considerations. The development and application of AI demand thorough testing, encompassing retrospective data assessments, real-time validation with prospective cohorts, and efficacy demonstration in clinical trials. Algorithmic transparency and explainability are essential, with active involvement of clinical professionals being crucial in the implementation process.

Software educativo para la asignatura Estratificación de Riesgos Medioambientales

Se realizó una investigación relacionada con la innovación tecnológica, en la Facultad de Enfermería-Tecnología de la Salud de Santiago de Cuba, durante el curso escolar 2019-2020, con el objetivo de diseñar un software educativo para la asignatura Estratificación de Riesgos Medioambientales, dirigido a los estudiantes de técnico medio en Vigilancia y Lucha Antivectorial. Se utilizaron los métodos teóricos: análisis-síntesis, histórico-lógico, modelación, sistémico-estructural e inductivo-deductivo; y empíricos: observación y análisis documental. La muestra fue de 44 estudiantes y 6 profesores escogidos al azar. Se concluye que el software propuesto es factible, pertinente y necesario como medio de enseñanza; proporciona información actualizada, su navegación es fácil y amena, y permite la autoevaluación de los estudiantes al interactuar con él mismo, lo que contribuye a mejorar el trabajo independiente.

An investigation related to the technological innovation was carried out in the Health Nursing-Technology Faculty from Santiago de Cuba, during the school course 2019-2020, aimed at designing an educational software for the subject Stratification of Environmental Risks, directed to medium technician students in Surveillance and Vector Control. The theoretical methods used were: analysis-synthesis, historical-logical, modelation, systemic-structural and inductive-deductive; and the empiric methods were: observation and documental analysis. The sample had 44 students and 6 professors chosen at random. It was concluded that the proposed software is feasible, pertinent and necessary as teaching aid; provides up-to-date information, it is easy and interesting to surf internet, and allows the self-appraisal of students in the interaction with themselves, what contributes to improve the independent work.

Medicolegal aspects of documentation and the electronic health record / Aspectos medicolegales de la documentación y la historia clínica electrónica

Introduction: The busiest times in the hospital are often met by the greatest challenges in complete and comprehensive documentation of the patient care event. The near complete transition to the Electronic Health Record (EHR) was to be the solution to a host of provider documentation concerns. It is clear the EHR provides reliability, reproducibility, integration, evidence based decision-making, multidisciplinary contribution across the entire healthcare spectrum.Methods: The use of a consensus of expert opinion supplemented by focused literature review allows a balanced evidence based presentation of data. Results: Documentation is not a perfect tool however, as issues with efficiency, reliability, use of shortcut maneuvers and potential for increased medico-legal risk have been raised. The solution is attention to documentation detail, and creation of systems that facilitate excellence. The focus on electronic documentation systems should include continual evaluation, ongoing improvement, involvement of a multidisciplinary patient care team and vendor receptiveness to in EHR development and operations. Conclusion: The most effective use of the EHR as a risk management tool requires documentation knowledge, targeted analysis, product improvement and co-development of clinical-commercial resource.(AU)

Introducción: Los momentos de mayor actividad en el hospital a menudo se enfrentan con los mayores desafíos en cuanto a la documentación completa y exhaustiva del evento de atención al paciente. La transición casi completa a la historia clínica electrónica (HCE) iba a ser la solución a una serie de preocupaciones sobre la documentación de los proveedores. Está claro que la HCE proporciona confiabilidad, reproducibilidad, integración, toma de decisiones basada en la evidencia y contribución multidisciplinaria en todo el espectro de la atención médica.Métodos: El uso de un consenso de opinión de expertos complementado con una revisión de la literatura enfocada permite una presentación equilibrada de los datos basada en la evidencia.Resultados: La documentación no es una herramienta perfecta, ya que se han planteado problemas de eficiencia, confiabilidad, uso de maniobras abreviadas y la posibilidad de un mayor riesgo medicolegal. La solución es la atención al detalle de la documentación y la creación de sistemas que faciliten la excelencia. El enfoque en los sistemas de documentación electrónica debe incluir evaluación continua, mejora continua, participación de un equipo multidisciplinario de atención al paciente y receptividad de los proveedores en el desarrollo y las operaciones de la HCE. Conclusión: El uso más eficaz de la HCE como herramienta de gestión de riesgos requiere conocimiento de la documentación, análisis específicos, mejora del producto y desarrollo conjunto de recursos clínico-comerciales.(AU)

Ideas to use CHATGPT in the Prevention of Occupational Risks / Ideas para usar CHATGPT en Prevención de Riesgos Laborales

In this work, some ideas are presented to use ChatGPT in PRL such as: analyze the history of accidents and risks, supervise real -time job security, provide detailed information on the use of hazardous equipment, make risk simulations, among others . The article highlights the benefits of ChatGPT, such as its accessibility, consistency, efficiency, flexibility, customization and ability to identify patterns and trends. However, some limitations and challenges are also mentioned, such as the need for human supervision, precise data dependence and ethical and privacy concerns. The article concludes that ChatGPT can be a valuable tool for the prevention of occupational hazards, but must be used in combination with other techniques and tools for effective risk prevention. In addition, the importance of considering the social and ethical impacts of technology and of promoting diversity and competition in the artificial intelligence market stands out.

En este trabajo, se presentan ideas para utilizar CHATGPT en PRL como pueden ser: analizar el historial de accidentes y riesgos, supervisar la seguridad laboral en tiempo real, proporcionar información detallada sobre el uso de equipos peligrosos, realizar simulaciones de riesgos, entre otras. El artículo destaca los beneficios de CHATGPT, como su accesibilidad, consistencia, eficiencia, flexibilidad, personalización y capacidad para identificar patrones y tendencias. Sin embargo, también se mencionan algunas limitaciones y desafíos, como la necesidad de supervisión humana, la dependencia de datos precisos y las preocupaciones éticas y de privacidad. El artículo concluye que CHATGPT puede ser una herramienta valiosa para la prevención de riesgos laborales, pero debe ser utilizada en combinación con otras técnicas y herramientas para una prevención efectiva de riesgos. Además, se destaca la importancia de considerar los impactos sociales y éticos de la tecnología y de fomentar la diversidad y la competencia en el mercado de la inteligencia artificial.

Medicolegal aspects of documentation and the electronic health record.

INTRODUCTION: The busiest times in the hospital are often met by the greatest challenges in complete and comprehensive documentation of the patient care event. The near complete transition to the Electronic Health Record (EHR) was to be the solution to a host of provider documentation concerns. It is clear the EHR provides reliability, reproducibility, integration, evidence based decision-making, multidisciplinary contribution across the entire healthcare spectrum. METHODS: The use of a consensus of expert opinion supplemented by focused literature review allows a balanced evidence based presentation of data. RESULTS: Documentation is not a perfect tool however, as issues with efficiency, reliability, use of shortcut maneuvers and potential for increased medico-legal risk have been raised. The solution is attention to documentation detail, and creation of systems that facilitate excellence. The focus on electronic documentation systems should include continual evaluation, ongoing improvement, involvement of a multidisciplinary patient care team and vendor receptiveness to in EHR development and operations. CONCLUSION: The most effective use of the EHR as a risk management tool requires documentation knowledge, targeted analysis, product improvement and co-development of clinical-commercial resource.

Comparación del riesgo nutricional alto por tres variantes del puntaje NUTrICen pacientes críticos ventilados / High nutritional risk by three variants of NUTRIC score in critically ventilated patients

Introducción: las variantes del puntaje NUTRIC con o sin biomarcadores inflamatorios, modificada sin interleucina-6 (IL-6) (NUTRICm), conproteína C reactiva (PCR) en lugar de IL-6, dicotómica (NUTRICpcr1) o en terciles (NUTRICpcr2), se propusieron para evaluar el riesgo nutricional(RN) en pacientes críticos. Sin embargo, la valoración del RN alto podría no ser uniforme entre dichos puntajes.Objetivos: comparar la valoración del RN alto por NUTRICm y las dos variantes del NUTRICpcr.Material y métodos: análisis de una cohorte prospectiva de pacientes ventilados previa al COVID-19. El acuerdo se analizó mediante la prueba deKappa y la discriminación de la mortalidad por regresión logística. La proporción de pacientes de RN alto se comparó con la prueba Chi-cuadrado.Resultados: se analizaron 550 pacientes. Mediana (RIQ) de edad y APACHE II: 44 (28-58) años y 17 (12-22) puntos, patología traumática predo-minante (38,2 %) y mortalidad en Unidad de Cuidados Intensivos (UCI) del 32,5 %. La concordancia fue alta entre NUTRICm y NUTRICpcr1 (Kappa= 0,81) y menor entre NUTRICm y NUTRICpcr2 (Kappa = 0,60). El AUCROC (IC 95 %) del NUTRICm, NUTRICpcr1 y NUTRICpcr2 para discriminarmortalidad fue de 0,695 (0,495-0,591), 0,693 (0,495-0,591) y 0,685 (0,495-0,591), respectivamente. El RN alto mostró diferencias significa-tivas entre NUTRICm y NUTRICpcr1 (19,8 % vs. 14,4 %, p 0,0243), y fue mayor entre NUTRICm y NUTRICpcr2 (19,8 vs. 9,8 %, p < 0,0001).Conclusión: las tres variantes del NUTRIC estudiadas discriminan la mortalidad en forma similar. Sin embargo, el NUTRICm, sin biomarcadorinflamatorio, clasifica más pacientes como de RN alto.(AU)

Introduction: variants of the NUTRIC score with or without inflammatory biomarkers, modified without interleukin 6 (IL-6) (NUTRICm), withC-reactive protein (CRP) instead of IL-6, dichotomous (NUTRICpcr1) or in tertiles (NUTRICpcr2), were proposed to assess nutritional risk (NR) incritical patients. However, the assessment of the high NR might not be uniform between these scores.Objectives: to compare the assessment of the high NR by NUTRICm and the two variants of the NUTRICpcr.Material and methods: analysis of a prospective cohort of patients ventilated prior to COVID-19. Agreement was analyzed using the Kappa testand mortality discrimination by logistic regression. The proportion of patients with high NR was compared with the Chi-square test.Results: five hundred and fifty patients were analyzed. Median (IQR) age and APACHE II: 44 (28-58) years and 17 (12-22) points, predominanttraumatic pathology (38.2 %) and Intensive Care Unit (ICU) mortality of 32.5 %. The concordance was high between NUTRICm and NUTRICpcr1(Kappa = 0.81) and lower between NUTRICm and NUTRICpcr2 (Kappa = 0.60). The AUCROC (95 % CI) of NUTRICm, NUTRICpcr1 and NUTRI-Cpcr2 to discriminate mortality was 0.695 (0.495-0.591), 0.693 (0.495-0.591) and 0.685 (0.495-0.591), respectively. The tall NB showedsignificant differences between NUTRICm and NUTRICpcr1 (19.8 % vs 14.4 %, p 0.0243), being greater between NUTRICm and NUTRICpcr2(19.8 vs 9.8 %, p < 0.0001).Conclusion: the three NUTRIC variants studied discriminate mortality in a similar way. However, the NUTRICm, without an inflammatory biomarker,classifies more patients as high nutritional risk.(AU)

Equipos de protección personal en odontología antes y después de la COVID-19

El uso de equipamientos de protección personal durante los tratamientos odontológicos garantiza la salud de profesionales y pacientes. Este trabajo tiene como propósito analizar, en la literatura científica, el conocimiento de estudiantes y profesionales de odontología sobre el uso de equipos de protección personal, antes y después de la pandemia COVID-19. Para ello se realizó una revisión integrativa en las bases de datos: Scielo, Pubmed, BVS y Web of Science, incluyendo artículos publicados entre agosto del 2010 y agosto del 2022. Fueron seleccionados 14 artículos, disponibles íntegramente en las bases de datos seleccionadas. Se excluyeron tesis, artículos de revisión, duplicados y aquellos donde la metodología no respondía al objetivo propuesto. En los 14 artículos seleccionados, el método para obtención de datos fue el cuestionario. Los estudios fueron realizados en Brasil, Yemen, Cuba, México, Líbano, Turquía, India, Londres, y Colombia. Seis estudios se realizaron antes de la pandemia y 8 de ellos después de su inicio. Todas las investigaciones evaluaban conocimientos, actitudes, prácticas y factores relacionados con el uso de equipos de protección personal. Se concluye que el uso de equipos de protección personal antes de la pandemia ya era una práctica esencial para garantizar la seguridad de profesionales, estudiantes y pacientes durante los procedimientos odontológicos; con la pandemia de COVID-19 nuevos protocolos fueron establecidos y con ellos nuevos equipamientos como el uso del protector facial y la mascarilla N95.

The use of personal protective equipment during dental treatments guarantees the professionals and patients' health. This researcher's purpose is to analyze in scientific literature the dental students and professionals' knowledge regarding the use of personal protective equipment, before and after the COVID-19 pandemic. An integrative review was carried out in the databases: Scielo, Pubmed, BVS and Web of Science, including articles published between August 2010 and August 2022. 14 articles were selected, available in full in the selected databases. Theses, review articles, duplicates and those where the methodology did not respond to the proposed objective were excluded. In the 14 selected articles, the method for obtaining data was the questionnaire. The studies were carried out in Brazil, Yemen, Cuba, Mexico, Lebanon, Turkey, India, London, and Colombia. Six studies were carried out before the pandemic and 8 of them after its start. All researches evaluated knowledge, attitudes, practices and factors related to the use of personal protective equipment. It is concluded that the use of personal protective equipment before the pandemic was already an essential practice to guarantee the safety of professionals, students and patients during dental procedures; with the COVID-19 pandemic, new protocols were established and with them new equipment such as the use of the face shield and the N95 mask.

Psychosocial risks and their consequences on health and job satisfaction among Spanish police officers / Riesgos psicosociales y sus consecuencias sobre la salud y la satisfacción laboral en policías españoles

Fundamento. La vida laboral del policía es estresante dada la exposición al riesgo y a la violencia en el trabajo. Según el Modelo de Demandas y Recursos laborales (DRL), las condiciones de trabajo de los policías pueden influir en la salud y la satisfacción laboral. Los objetivos de esta investigación fueron evaluar los factores psicosociales en el trabajo en una muestra de policías municipales de la Comunidad Valenciana (España), identificar la prevalencia de riesgos psicosociales y sus consecuencias, y analizar la influencia de los factores psicosociales (recursos y demandas) en el trabajo sobre la satisfacción laboral y la salud. Material y método. Se utilizó la Batería UNIPSICO para evaluar la prevalencia y la distribución de policías (n=103) en los diferentes niveles de riesgo y consecuencias. La influencia de los factores psicosociales (recursos y demandas) en el trabajo sobre los trastornos psicosomáticos y la satisfacción laboral se examinó mediante un análisis de regresión por pasos. Resultados. Se obtuvieron valores moderados de riesgo psicosocial en todas las variables para toda la muestra. Para las consecuencias de los riesgos psicosociales también se obtuvieron niveles moderados de trastornos psicosomáticos y satisfacción laboral. Los niveles de estrés percibidos y los estresores organizacionales tienen un efecto negativo sobre la salud y la satisfacción laboral. Conclusión. Para facilitar condiciones positivas para la salud y el bienestar de los policías, se requiere un compromiso real para la evaluación de riesgos psicosociales en las organizaciones policiales locales y para la adopción de medidas de prevención e intervención, donde se detecten factores de riesgo psicosocial. (AU)

Background. Police officers are exposed to risk and violence, which makes their work highly stressful. According to the Job Demand-Resource model, the working conditions of police officers may affect their health and job satisfaction. The aims of this research were to evaluate the psychosocial factors at work in a sample of municipal police officers from the Valencian Community (Spain) to identify the prevalence of psychosocial risks and their consequences and analyse the influence of psychosocial factors (resource and demands) at work on job satisfaction and health. Methods. The Unidad de Investigación Psicosocial de la Conducta Organizacional (UNIPSICO) battery was used to evaluate the prevalence and distribution of different levels of risk and their consequences in police officers (n=103). The influence of psychosocial factors (resource and demands) at work on psychosomatic disorders and job satisfaction was examined using stepwise regression analysis. Results. All considered variables showed moderate levels of psychosocial risk for the whole sample. As for the consequences of psychosocial risks, moderate levels of psychosomatic disorders and job satisfaction were also observed. Perceived stress levels and organizational stressors have a negative effect on health and job satisfaction. Conclusions. To create positive conditions for the health and well-being of police officers, real commitment is required when evaluating psychosocial risks in local police organizations and the establishment of prevention and intervention measures where psychosocial risk factors are detected. (AU)

[High nutritional risk by three variants of NUTRIC score in critically ventilated patients]. / Comparación del riesgo nutricional alto por tres variantes del puntaje NUTRIC en pacientes críticos ventilados.

Introduction: Introduction: variants of the NUTRIC score with or without inflammatory biomarkers, modified without interleukin 6 (IL-6) (NUTRICm), with C-reactive protein (CRP) instead of IL-6, dichotomous (NUTRICpcr1) or in tertiles (NUTRICpcr2), were proposed to assess nutritional risk (NR) in critical patients. However, the assessment of the high NR might not be uniform between these scores. Objectives: to compare the assessment of the high NR by NUTRICm and the two variants of the NUTRICpcr. Material and methods: analysis of a prospective cohort of patients ventilated prior to COVID-19. Agreement was analyzed using the Kappa test and mortality discrimination by logistic regression. The proportion of patients with high NR was compared with the Chi-square test. Results: five hundred and fifty patients were analyzed. Median (IQR) age and APACHE II: 44 (28-58) years and 17 (12-22) points, predominant traumatic pathology (38.2 %) and Intensive Care Unit (ICU) mortality of 32.5 %. The concordance was high between NUTRICm and NUTRICpcr1 (Kappa = 0.81) and lower between NUTRICm and NUTRICpcr2 (Kappa = 0.60). The AUCROC (95 % CI) of NUTRICm, NUTRICpcr1 and NUTRICpcr2 to discriminate mortality was 0.695 (0.495-0.591), 0.693 (0.495-0.591) and 0.685 (0.495-0.591), respectively. The tall NB showed significant differences between NUTRICm and NUTRICpcr1 (19.8 % vs 14.4 %, p 0.0243), being greater between NUTRICm and NUTRICpcr2 (19.8 vs 9.8 %, p < 0.0001). Conclusion: the three NUTRIC variants studied discriminate mortality in a similar way. However, the NUTRICm, without an inflammatory biomarker, classifies more patients as high nutritional risk.

Introducción: Introducción: las variantes del puntaje NUTRIC con o sin biomarcadores inflamatorios, modificada sin interleucina-6 (IL-6) (NUTRICm), con proteína C reactiva (PCR) en lugar de IL-6, dicotómica (NUTRICpcr1) o en terciles (NUTRICpcr2), se propusieron para evaluar el riesgo nutricional (RN) en pacientes críticos. Sin embargo, la valoración del RN alto podría no ser uniforme entre dichos puntajes.. Objetivos: comparar la valoración del RN alto por NUTRICm y las dos variantes del NUTRICpcr. Material y métodos: análisis de una cohorte prospectiva de pacientes ventilados previa al COVID-19. El acuerdo se analizó mediante la prueba de Kappa y la discriminación de la mortalidad por regresión logística. La proporción de pacientes de RN alto se comparó con la prueba Chi-cuadrado. Resultados: se analizaron 550 pacientes. Mediana (RIQ) de edad y APACHE II: 44 (28-58) años y 17 (12-22) puntos, patología traumática predominante (38,2 %) y mortalidad en Unidad de Cuidados Intensivos (UCI) del 32,5 %. La concordancia fue alta entre NUTRICm y NUTRICpcr1 (Kappa = 0,81) y menor entre NUTRICm y NUTRICpcr2 (Kappa = 0,60). El AUCROC (IC 95 %) del NUTRICm, NUTRICpcr1 y NUTRICpcr2 para discriminar mortalidad fue de 0,695 (0,495-0,591), 0,693 (0,495-0,591) y 0,685 (0,495-0,591), respectivamente. El RN alto mostró diferencias significativas entre NUTRICm y NUTRICpcr1 (19,8 % vs. 14,4 %, p 0,0243), y fue mayor entre NUTRICm y NUTRICpcr2 (19,8 vs. 9,8 %, p < 0,0001). Conclusión: las tres variantes del NUTRIC estudiadas discriminan la mortalidad en forma similar. Sin embargo, el NUTRICm, sin biomarcador inflamatorio, clasifica más pacientes como de RN alto.

Factores psicosociales laborales y sintomatología ansiosa y depresiva en cuidados intensivos de un hospital público de Nuevo Chimbote / Psychosocial work factors and anxiety and depression symptoms in the intensive care unit of a public hospital in Nuevo Chimbote

RESUMEN Objetivo: Determinar la asociación entre factores psicosociales laborales y la presencia de sintomatología de ansiedad o depresión en el personal de salud de la Unidad de Cuidados Intensivos (UCI) del Hospital Regional Eleazar Guzmán Barrón de Nuevo Chimbote. Materiales y métodos: El método fue cuantitativo, observacional, no experimental, de corte transversal y descriptivo-correlacional. La población estuvo conformada por los 70 trabajadores de la UCI del hospital; la muestra fue censal. La técnica empleada fue la aplicación de la encuesta. Los instrumentos fueron el Cuestionario de factores psicosociales en el trabajo aplicados a trabajadores peruanos, validado con un alfa de Cronbach de 0,9; la escala de ansiedad de Lima (EAL-20), validada con un alfa de Cronbach de 0,89, y la escala de psicopatología depresiva (EPD-6), validada con un alfa de Cronbach de 0,7359. Para la recopilación, procesamiento y análisis de datos se utilizó el programa SPSS, versión 26, y se aplicó estadística descriptiva, mientras que para la asociación de variables se empleó la prueba ji al cuadrado. Resultados: El factor psicosocial laboral más bajo fue el papel laboral y desarrollo de la carrera (57,10 %), donde el personal de enfermería fue el más afectado (27,10 %). El factor psicosocial laboral más alto fue la remuneración del rendimiento (40,00 %), donde el personal técnico de enfermería fue el más afectado (30,00 %). Conclusiones: Las condiciones laborales, la carga de trabajo, las exigencias laborales, el contenido y las características de la tarea fueron las dimensiones laborales que se asociaron a la aparición de la sintomatología de ansiedad; asimismo, el contenido y las características de la tarea, las exigencias y el papel laboral y desarrollo de la tarea fueron las dimensiones que se asociaron a la aparición de síntomas de depresión.

ABSTRACT Objective: To determine the association between psychosocial work factors and anxiety or depression symptoms among health workers of the Intensive Care Unit (ICU) at Hospital Regional Eleazar Guzmán Barrón in Nuevo Chimbote. Materials and methods: The study used a quantitative, observational, non-experimental, cross-sectional and descriptivecorrelational research design. The population consisted of 70 workers of the hospital's ICU. A census sampling and survey technique were employed. The instruments were the following: Questionnaire on Psychosocial Work Factors Administered to Peruvian Workers, validated with a Cronbach's alpha coefficient of 0.9; Lima Anxiety Scale (EAL-20), validated with a Cronbach's alpha coefficient of 0.89; and Psychopathology Scale for Depressive Disorders (EPD-6), validated with a Cronbach's alpha coefficient of 0.7359. By applying descriptive statistics, IBM SPSS Statistics V26 was used for data collection, processing and analysis, and the chi-square test for the association of variables. Results: The lowest psychosocial work factor was work role and career development (57.10 %), with the nursing staff being the most affected one (27.10 %). The highest psychosocial work factor was performance-based remuneration (40.00 %), with the technical nursing staff being the most affected one (30.00 %). Conclusions: Working conditions, workload, work demands and content and characteristics of the task were the work dimensions associated with the occurrence of anxiety symptoms; likewise, content and characteristics of the task, work demands, and work role and career development were the dimensions associated with the occurrence of depression symptoms.

Ergonomic risks and musculoskeletal pain in hospital cleaning workers: Convergent Care Research with mixed methods / Riesgos ergonómicos y dolor musculoesquelético en trabajadores de limpieza hospitalaria: Investigación Convergente Asistencial con métodos mixtos / Riscos ergonômicos e dor musculoesquelética em trabalhadores de limpeza hospitalar: Pesquisa Convergente Assistencial com métodos mistos

Objective: to analyze exposure to ergonomic risks and the occurrence of musculoskeletal pain in workers in the Hospital Cleaning Service. Method: Convergent Care Research, with data production designed using mixed methods, implemented with 149 hospital cleaning workers. The methodological strategy of the convergent parallel project was employed, using observation, photographic records, questionnaires and convergence groups. The results were integrated through joint display. Data analysis with descriptive and inferential statistics and content analysis. Results: the mixing of data highlighted the multifactorial nature of exposure to ergonomic risks (uncomfortable work postures; repetitive movements; prolonged orthostatism; use of equipment not adapted to the psychophysiological needs of workers) and musculoskeletal pain in the population investigated. The latter was prevalent in the lumbar spine, ankles or feet, wrists or hands, thoracic spine and shoulders. The concept of ergonomic risk was expanded and was influenced by the psychosocial aspects of work. Conclusion: the workers investigated are exposed to modifiable multifactorial ergonomic risks related to musculoskeletal pain. It is possible to promote innovations and teaching-learning actions to minimize them, such as the continuing education program, collectively constructed with recommendations for improvements.

Objetivo: analizar la exposición a riesgos ergonómicos y la ocurrencia de dolor musculoesquelético en trabajadores del Servicio de Limpieza Hospitalaria. Método: investigación Convergente Asistencial, con producción de datos diseñada mediante métodos mixtos, realizada con 149 trabajadores de limpieza hospitalaria. Se utilizó la estrategia metodológica del proyecto paralelo convergente, basada en observación, registros fotográficos, cuestionarios y grupos de convergencia. Los resultados se integraron mediante joint display . Análisis de datos con estadística descriptiva e inferencial y análisis de contenido. Resultados: la combinación de datos puso de relieve la naturaleza multifactorial de la exposición a riesgos ergonómicos (posturas de trabajo incómodas; movimientos repetitivos; ortostatismo prolongado; uso de equipos no adaptados a las necesidades psicofisiológicas de los trabajadores) y al dolor musculoesquelético en la población investigada. Este último prevalecía en la columna lumbar, tobillos o pies, puños o manos, columna torácica y hombros. El concepto de riesgo ergonómico se amplió y estuvo influenciado por los aspectos psicosociales del trabajo. Conclusión: los trabajadores investigados están expuestos a riesgos ergonómicos multifactoriales modificables relacionados con el dolor musculoesquelético. Es posible promover innovaciones y acciones de enseñanza-aprendizaje para minimizarlos, como el programa de educación continua, construido colectivamente con recomendaciones de mejora.

Objetivo: analisar a exposição aos riscos ergonômicos e a ocorrência de dor musculoesquelética em trabalhadores do Serviço Hospitalar de Limpeza. Método: pesquisa Convergente Assistencial, sendo a produção de dados delineada com métodos mistos, realizada com 149 trabalhadores de limpeza hospitalar. Utilizou-se a estratégia metodológica do projeto paralelo convergente, baseada em observação, registros fotográficos, questionários e grupos de convergência. Os resultados foram integrados por meio de joint display . Análise de dados com estatística descritiva e inferencial e análise de conteúdo. Resultados: a mixagem dos dados evidenciou o caráter multifatorial da exposição aos riscos ergonômicos (posturas de trabalho desconfortáveis; movimentos repetitivos; ortostatismo prolongado; utilização de equipamentos não adaptados às necessidades psicofisiológicas dos trabalhadores) e à dor musculoesquelética na população investigada. Esta última foi prevalente na coluna lombar, tornozelos ou pés, punhos ou mãos, coluna torácica e ombros. O conceito de risco ergonômico foi ampliado e sofreu influência dos aspectos psicossociais do trabalho. Conclusão: os trabalhadores investigados estão expostos aos riscos ergonômicos multifatoriais modificáveis relacionados à dor musculoesquelética. É possível promover inovações e ações de ensino-aprendizagem para minimizá-los, como o programa de educação continuada, construído coletivamente com recomendações de melhorias.