Aprendizagem baseada em projeto e a formação médica: relato de experiência introduzindo questões para o debate interprofissional / Project-based learning and medical education: experience report introducing issues for interprofessional debate / El aprendizaje basado en proyecto y la formación médica: informe de experiencia que introduce cuestiones para el debate interprofesional

A aprendizagem baseada em projeto orientada pelos fundamentos da educação interprofissional é um modelo que pode contribuir para a formação de relacionamentos interpessoais, criatividade, empatia e colaboração na educação médica, por meio de uma colaboração mútua com profissionais de saúde da rede. Muito se fala da efetividade desse método no campo do ensino e aprendizagem médica, mas há a necessidade de incluir a importância do desenvolvimento de habilidades interprofissionais, com equipes colaborativas, em ações extensionistas, diante das necessidades locais no contexto da atenção primária, pensando na melhoria dos resultados de saúde. O objetivo deste trabalho é apresentar um relato de experiência de aprendizagem baseada em projeto de estudantes de Medicina no contexto da Estratégia Saúde da Família. Participaram deste trabalho estudantes do Módulo Integração Ensino, Serviço e Comunidade da Faculdade de Medicina da Universidade Federal dos Vales do Jequitinhonha e Mucuri que executaram, em colaboração com uma equipe interprofissional o projeto sobre a saúde do homem. Como resultado da análise qualitativa do feedback entre os integrantes, observaram-se mudanças no comportamento dos estudantes, com melhorias na comunicação, empatia e nas relações interpessoais, por meio do trabalho colaborativo com a equipe interprofissional. Esta experiência poderá ser adaptada para implementar o ensino e aprendizagem no projeto pedagógico orientado pela educação interprofissional na atenção primária.

Project-based learning guided by the fundamentals of interprofessional education is a model that can contribute to the formation of interpersonal relationships, creativity, empathy and collaboration within medical education, through mutual collaboration with health professionals in the health network. Much has been said about the effectiveness of this method in medical teaching and learning, but there is a need to include the importance of developing interprofessional skills, with collaborative teams, within extension actions, in view of local needs in the context of primary care, thinking about the improved health outcomes. The objective of this work was to present a report of a project-based learning experience of medical students in Family Health Strategy. Students from the Teaching, Service and Community Integration Module of the Faculty of Medicine of Universidade Federal dos Vales do Jequitinhonha e Mucuri participated in this work, executing in collaboration with an interprofessional team a project about men's health. As a result of the qualitative analysis of the feedback among the members, changes in student behavior were observed with improvements in communication, empathy and interpersonal relationships through collaborative work with the interprofessional team. This experience can be adapted to implement teaching and learning in the pedagogical project guided by interprofessional education in primary care.

El aprendizaje basado en proyectos y guiado por los fundamentos de la educación interprofesional es un modelo que puede contribuir a la formación de relaciones interpersonales, creatividad, empatía y colaboración dentro de la educación médica, a través de la colaboración mutua con los profesionales de la salud en la red de salud. Mucho se habla de la efectividad de este método dentro de la enseñanza y el aprendizaje médico, pero es necesario incluir la importancia del desarrollo de habilidades interprofesionales, con equipos colaborativos, dentro de las acciones de extensión, frente a las necesidades locales en el contexto de la atención primaria, pensando sobre los mejores resultados de salud. El objetivo de este trabajo es presentar un informe de experiencia de aprendizaje basado en proyectos de estudiantes de medicina en la Estrategia de Salud Familiar. Participaron en este trabajo estudiantes del Módulo Integración Enseñanza, Servicio y Comunidad de la Facultad de Medicina de la Universidade Federal dos Vales do Jequitinhonha e Mucuri que ejecutaron en colaboración con un equipo interprofesional el proyecto sobre la salud del hombre. Como resultado del análisis cualitativo de la retroalimentación entre los integrantes, se observaron cambios en el comportamiento de los estudiantes con mejoras en la comunicación, la empatía y las relaciones interpersonales a través del trabajo colaborativo con el equipo interprofesional. Esta experiencia puede adaptarse para implementar la enseñanza y el aprendizaje en el proyecto pedagógico guiado por la educación interprofesional en atención primaria.

A experiência de profissionais da saúde de um Centro de Saúde Escola do estado de São Paulo na pandemia da Covid-19 / The experience of health professionals from the Centro de Saúde Escola in the state of São Paulo during the Covid-19 pandemic

Em 2020, a Atenção Primária à Saúde do Sistema Único de Saúde cumpriu função de protagonista no combate à Covid-19 como primeiro acesso aos serviços de saúde, que foi considerada Emergência de Saúde Pública e doença pandêmica, exigindo desses serviços e dos profissionais uma reorganização, com fortalecimento do trabalho em equipe para garantir cuidado integral e de qualidade à população. Objetivo: compreender a experiência de profissionais da saúde da Atenção Primária na pandemia. Métodos: estudo qualitativo na abordagem compreensiva, decorrente de projeto maior e aprovado com o Parecer Consubstanciado. Coleta de dados: entre agosto de 2021 e fevereiro de 2022, por entrevistas individuais, síncronas, pela plataforma Google Meet; gravadas pela própria plataforma, transcritas e analisadas segundo referencial metodológico de Bardin, vertente temática. Das unidades de significação originaram categorias e temas propostos. Resultados: cinco categorias: reorganização do processo de trabalho da unidade de saúde; sentimentos demonstrados por profissionais e população; conflito população-profissionais da saúde na adesão à vacinação influenciada pela mídia; indicadores do processo de trabalho durante a pandemia; e (des)conhecimento. Três temas foram identificados: Processo de trabalho da equipe multidisciplinar da unidade de saúde durante a pandemia de 2020 e 2021; Enfrentamento/sentimento dos profissionais e pacientes; Mídia influenciando comportamento da população. Considerações finais: as contribuições do estudo corroboram para desenvolver alternativas para melhorar o cuidado ao paciente; proporcionar condições de apoio aos profissionais, tornando-se necessário que a unidade de saúde forneça suporte psicológico aos profissionais e que os gestores considerem as vivências dos trabalhadores para fortalecer o trabalho em equipe.

In 2020, Primary Health Care (PHC) of the Sistema Único de Saúde (SUS) played a leading role in the fight against Covid-19 as the first access to health services. Covid-19 was considered a Public Health Emergency and a pandemic disease, which required all services and health professionals to reorganize and strengthen teamwork to ensure comprehensive and quality care for the population. Objective: to understand the experience of health professionals working in Primary Care in the Covid-19 pandemic. Methods: qualitative study with a comprehensive approach, resulting from a larger project approved with Embodied Opinion number 4,731,629. Data collection: took place from August 2021 to February 2022, through individual interviews, synchronous, through the Google Meet platform. These were recorded by the platform itself, transcribed and analyzed according to Bardin's Content Analysis methodological framework, thematic approach. From the units of meaning originated the proposed categories and themes. Results: five categories: reorganization of the health unit's work process; feelings shown by professionals and population; conflict population-health professionals in adherence to vaccination influenced by the media; Indicators of the work process during the pandemic and (lack of) knowledge. Three themes were identified: The work process of the health unit's multidisciplinary team during the 2020 and 2021 pandemic; The coping/feeling of professionals and patients; Media influencing population behavior. The study's contributions support the development of alternatives to improve patient care; provide support conditions for professionals. Final considerations: the study's contributions support the development of alternatives to improve patient care; provide support conditions for professionals, making it necessary for the health unit to provide psychological support to professionals and for managers to consider the experiences of workers to strengthen teamwork.

BRIEF COUNSELING ON PHYSICAL ACTIVITY IN UNIFIED HEALTH SYSTEM: A POSSIBILITY FOR ALL HEALTH PROFESSIONALS / BREVE ASESORAMIENTO SOBRE ACTIVIDAD FÍSICA EN EL SISTEMA ÚNICO DE SALUD: UNA POSIBILIDAD PARA TODOS LOS PROFESIONALES DE LA SALUD / ACONSELHAMENTO BREVE SOBRE ATIVIDADE FÍSICA NO SISTEMA ÚNICO DE SAÚDE: UMA POSSIBILIDADE PARA TODOS OS PROFISSIONAIS DE SAÚDE

Based on an infographic on physical activity (PA) counseling proposed for the international context, the aim of this essay was to adapt it to the reality of the Brazilian Unified Health System (SUS). Justifications are presented for the provision of brief counseling in Primary Health Care and strategies on 'how to counsel', based on: respect for the uniqueness of individuals and their possibilities; recognition of opportunities and barriers; (re)understanding the intersectoral PA network; and considering popular health education. Digital health strategies and the training of health professionals are highlighted as some of the challenges. In conclusion, it is argued that there is potential to expand access to PA through brief counseling.

Con referencia a una infografía que sugiere estrategias para el asesoramiento sobre actividad física (AF), se elaboró este ensayo con el objetivo de reflexionar sobre ella y adaptarla a la realidad de la atención primaria de salud (APS) del Sistema Único de Salud (SUS). Se presentan justificaciones para el asesoramiento breve en APS y estrategias sobre 'cómo aconsejar', basadas en: Respeto por la singularidad de las personas y sus posibilidades; Reconocimiento de oportunidades y barreras; (Re)conocimiento de basadas red intersectorial para la promoción del PS; y Educación popular para la salud. Así como los retos que se plantean, con énfasis en las estrategias de salud digital y la educación y formación de los profesionales de la salud. En conclusión, se argumenta que existe la posibilidad de ampliar el acceso a la PS a través de un asesoramiento breve em la APS.

Tomando como base um infográfico de aconselhamento sobre a Atividade física (AF) proposto para o contexto internacional, o objetivo deste ensaio foi adaptá-lo para a realidade do Sistema Único de Saúde (SUS). São apresentadas justificativas para a oferta do aconselhamento breve na Atenção Primária à Saúde e das estratégias sobre 'como aconselhar', a partir do: Respeito à singularidade das pessoas e suas possibilidades; Reconhecimento das oportunidades e barreiras; (Re)conhecimento da rede intersetorial de AF; e Considerar a educação popular em saúde. As estratégias de saúde digital e a formação e treinamento dos profissionais de saúde são apontados como alguns desafios. Em conclusão, defende-se que há potencial para a ampliação de acesso à AF por meio do aconselhamento breve.

Drivers and barriers of seasonal influenza vaccination 2015/16 & 2019/20 to 2022/23 - a survey on why most Norwegians don't get the flu vaccine.

BACKGROUND: This study aimed to explore the reasons adults in the general population, influenza risk groups (RGs) and health care workers (HCWs) in Norway give for their vaccination choices and whether these reasons vary between groups or over time in order to further improve influenza vaccination coverage. METHODS: Respondents of a nationally representative telephone survey conducted by Statistics Norway were asked "What was the most important reason why you did/did not get vaccinated?". The question on influenza non-vaccination was included in 2016 and in 2020 to 2023 and the question on influenza vaccination in 2021 to 2023. RESULTS: The study included 9 705 individuals aged 18-79 years. Influenza vaccination coverage in the RGs increased from 20.6% in 2016 to 63.1% in 2022, before a reduction to 58.3% in 2023. Common reasons for non-vaccination were similar in all groups. The most cited reasons were "no need" for the vaccine and "no specific reason", followed by "not recommended/offered the vaccine", "worry about side effects" and "vaccine refusal". The most frequent reasons for vaccination among the general population and RGs were protection against influenza and belonging to a RG, while the most frequent responses among HCWs were being offered the vaccine at work/work in health care, followed by a desire for protection against influenza. Receiving a vaccine recommendation from a health professional was mentioned in all groups. We also observed that the proportion reporting "no need" for the vaccine decreased over time, especially among HCWs, and that the proportions reporting vaccine refusal and worry about side effects as reasons for non-vaccination were temporarily reduced during the COVID-19 pandemic. CONCLUSIONS: The general population and RGs cite protection against influenza as their primary incentive for vaccination, while HCWs mainly refer to their professional role or workplace vaccination. For non-vaccination we see a similar pattern in all groups, with "no need" and "no specific reason" as the main reasons. Of note, worry about side effects and vaccine refusal is as frequent among HCWs as in other groups. Continued efforts to maintain and increase vaccine confidence are needed.

Burnout syndrome among health care professionals in the context of the COVID-19 pandemic.

Introduction: Burnout syndrome, a mental illness caused by stressful work conditions, is prevalent among health professionals. In addition to existing risk factors, the COVID-19 pandemic introduced new ones, such as fear of infection and concern about the availability of personal protective equipment. Objectives: This study's purpose was to verify the prevalence and correlates of burnout syndrome among health professionals in the context of the pandemic. Methods: This quantitative study was conducted between April and June 2021 using the Google Forms platform. A semi-structured questionnaire and the Questionário para la Evaluación del Syndrome de Quemarse por el Trabajo were applied. Results: A total of 93 health professionals participated. Those who fought on the frontline against COVID-19 were younger and had less professional experience, longer work hours, daily contact with a greater number of patients, lower scores in the disillusionment dimension, and higher scores in the emotional exhaustion dimension. Significant correlations were found between age and disillusionment, emotional exhaustion, and indolence. Less professional experience was also correlated with psychological distress. Conclusions: Age and length of experience were significantly associated with burnout, given that younger and less experienced professionals generally worked on the frontline against COVID-19.

Introdução: A síndrome de burnout é uma doença psíquica ocasionada por situações desgastantes de trabalho, sendo prevalente entre os profissionais de saúde. Além dos fatores de risco já existentes para o seu desenvolvimento, a pandemia de covid-19 apresentou novos fatores de risco, como o medo de adquirir a doença e a preocupação com a disponibilidade de equipamentos de proteção individual. Objetivos: Verificar a prevalência da síndrome de burnout em profissionais de saúde no contexto da covid-19 e suas correlações. Métodos: Trata-se de um estudo quantitativo, realizado em 2021 por meio da plataforma Google Forms. Foram utilizados um questionário semiestruturado e o Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo. Resultados: Participaram da pesquisa 93 profissionais de saúde. Os profissionais que participaram do enfrentamento à covid-19 possuíam menor idade, menor tempo de atuação profissional, maior carga horária semanal de trabalho, contato com maior número de pacientes diariamente, menor pontuação na dimensão ilusão pelo trabalho e maior pontuação na dimensão desgaste psíquico. Correlações significantes foram encontradas entre idade e ilusão pelo trabalho, desgaste psíquico e indolência. Além disso, menor tempo de atuação profissional foi correlacionado com desgaste psíquico. Conclusões: A idade e o tempo de atuação foram as variáveis que apresentaram significância nos testes estatísticos realizados, em que profissionais mais jovens e com menor tempo de atuação estavam em maioria no enfrentamento à covid-19, além de estarem associados ao burnout, corroborando para que fossem os profissionais mais susceptíveis a desenvolver a síndrome de burnout.

Protective strategies against occupational stress among health professionals during the COVID-19 pandemic.

The purpose of this study was to investigate which protective strategies against occupational stress were developed for health professionals during the COVID-19 pandemic. This was an integrative literature review conducted in 2021. The Medical Literature Analysis and Retrieval System Online and the Latin American and Caribbean Literature in Health Sciences databases were searched using the Boolean operator AND and the controlled vocabularies "health professionals" AND "occupational stress" AND "COVID-19", both in English and Portuguese. After applying the inclusion criteria and reading the selected articles, a final sample of 24 articles was obtained. Protective strategies against occupational stress developed by institutions included psychological support, support from managers and team leaders, provision of personal protective equipment, appropriate schedules and workload, and training. As for the strategies developed by health professionals themselves, these included resilience, peer support, and self-care. Several protective strategies during the pandemic were observed, but institutions still need to develop and/or improve practices to offer better psychological conditions to health professionals in general.

O objetivo deste estudo é investigar as estratégias de proteção ao estresse ocupacional em profissionais de saúde na pandemia de covid-19. Trata-se de uma revisão integrativa da literatura realizada nas bases de dados Medical Literature Analysis and Retrieval System Online e Literatura Latino-Americana e do Caribe em Ciências da Saúde em 2021. Utilizou-se o operador booleano AND e vocabulários controlados, a citar: profissionais de saúde AND estresse ocupacional AND COVID-19 e suas respectivas equivalências com termos em inglês. Após a aplicação dos critérios de inclusão e leitura do material, obteve-se uma amostra final de 24 artigos. Suporte psicológico, apoio de gestores e líderes das equipes, disponibilidade de equipamentos de proteção individuais, cronogramas e carga horária apropriados e treinamentos foram estratégias de proteção ao estresse ocupacional organizadas pelas instituições. Quanto à resiliência, o apoio entre pares e os cuidados pessoais foram estratégias criadas pelos profissionais de saúde. Evidenciou-se o uso de diversas estratégias no cenário pandêmico, porém ainda se torna necessário que as instituições elaborem e/ou aprimorem suas práticas de modo a oferecer melhores condições psicológicas aos profissionais de saúde.

Musculoskeletal disorders, associated factors, and literature review for intervention according to gender.

Introduction: The relationship of risk factors with musculoskeletal disorders and their intervention is a topic of interest, given their prevalence among workers. Thus, analyzing risk factors from approaches such as the gender perspective may be an alternative. Objectives: To analyze risk factors in a health entity with a high prevalence of musculoskeletal disorders in upper limbs and to describe possible intervention measures according to scientific evidence, from a gender perspective. Methods: This is an analytical study. A questionnaire was applied to 93 workers on demographic aspects, presence of factors related to the environment, the task, and the organization, extra-work activities related to musculoskeletal disorders in the upper limbs. Chi-square was used to identify significant relationships between the sex variable and individual, occupational, and non-occupational factors, corroborated by Fisher's test and prevalence ratio. According to the associations identified, a literature review was carried out to establish possible strategies. Results: Significant relationships were found between the sex variable and task-related factors such as the presence of repetitive or sudden movements (p < 0.05), supporting postulates of labor segregation. According to the literature consulted, the effectiveness of activities such as physical preparation and adaptation of the workplace under professional guidance, training activities, and breaks is discussed. It is important to review organizational factors. Conclusions: By identifying significant relationships between the sex variable and task-related factors, the present study contributes to the postulate of labor segregation, in terms of concentration of female labor in activities with particular working conditions. Regarding literature and actions, it is important to generate more studies from this perspective.

Introducción: La relación de factores de riesgo con desordenes musculoesqueléticos y su intervención es tema de interés, dada su prevalencia entre trabajadores. Así, analizar los factores de riesgo desde enfoques como la perspectiva de género puede ser una alternativa. Objetivos: Analizar factores de riesgo en una entidad sanitaria con alta prevalencia de desordenes musculoesqueléticos en miembros superiores y describir posibles medidas de intervención según evidencia científica, desde la perspectiva de género. Métodos: Éste es un estudio de tipo analítico. Se aplicó un cuestionario a 93 trabajadores sobre aspectos demográficos, presencia de factores relacionados con ambiente, tarea y organización, y actividades extralaborales vinculadas con desórdenes musculoesqueléticos en miembros superiores. Mediante chi cuadrado, se realizó la identificación de relaciones significativas entre la variable sexo y factores individuales, intralaborales y extralaborales, corroboradas por prueba de Fisher y razón de prevalencias. Según las asociaciones identificadas, se efectuó revisión de literatura para establecer posibles estrategias. Resultados: Se encontraron relaciones significativas entre la variable sexo y factores de la tarea como la presencia de movimientos repetitivos o súbitos (p < 0,05), apoyando postulados de segregación laboral. Según la bibliografia consultada, se discute la eficacia de actividades como preparación física y adecuación del puesto de trabajo bajo orientación profesional, actividades de capacitación y pausas. Es importante revisar factores organizacionales. Conclusiones: Al identificarse relaciones significativas entre la variable sexo y factores de la tarea, se aporta al postulado de segregación laboral en cuanto a concentración de mano de obra femenina en actividades con condiciones de trabajo particulares. Sobre la literatura y las acciones, es importante generar más estudios desde esta perspectiva.

The impact of workplace violence on the mental health of health care workers during the COVID-19 pandemic.

Introduction: The COVID-19 pandemic introduced a new set ofwork-related stressors for health care workers. Objectives: This study aimed to investigate the associations between exposure to violence and common mental disorders among health care workers in emergency care settings during COVID-19 in the city of São Paulo, Brazil. Methods: We randomly selected two emergency care units. The 12-item General Health Questionnaire was used to assess common mental disorders among emergency health care workers (n = 100). We examined the relationships between common mental disorders and COVID-19 pandemic-related variables, including availability of personal protective equipment, exposure to violence, discrimination, harassment, and confidence in the workplace to handle the pandemic. We used multivariate Poisson regression with robust variance to estimate prevalence ratios for common mental disorders. Results: Overall, 50% (95%CI 39.8-60.1) of participants had a common mental disorder. In addition, 71% reported being victims of at least one type of violence during the COVID-19 pandemic. Higher risks ofcommon mental disorders were found among those who reported lacking personal protective equipment, being victims of discrimination, violence, or harassment, and reporting less confidence in the workplace to handle the pandemic. Participants exposed to two types of violence and three types of violence had higher prevalence ratios, with prevalence ratios of 2.28 (95%CI 1.23-4.21) and 3.14 (95%CI 1.62-6.08), respectively. Conclusions: Promoting access to personal protective equipment, addressing mistreatment of health workers as well as promoting their well-being at work, and building confidence in the workplace to deal with the pandemic are critical.

Introdução: A pandemia de covid-19 trouxe uma nova gama de estressores relacionados ao trabalho para os profissionais de saúde. Objetivos: Este estudo examina as associações entre a exposição à violência e os transtornos mentais comuns entre os profissionais de saúde durante as situações de emergência na pandemia de covid-19 em São Paulo, Brasil. Métodos: Selecionamos aleatoriamente dois serviços de emergência. O Questionário Geral de Saúde 12 foi utilizado para avaliar os transtornos mentais comuns entre os trabalhadores de saúde de urgência (n = 100). Investigamos as relações entre transtornos mentais comuns e variáveis relacionadas com a pandemia: disponibilidade de equipamento de proteção pessoal, exposição à violência/discriminação/assédio e nível de confiança no local de trabalho para lidar com a pandemia. Realizamos uma regressão multivariada de Poisson com uma variação robusta para estimar as razões de prevalência para transtornos mentais comuns. Resultados: Entre os participantes, 50% (intervalo de confiança de 95% [IC95%] 39,8-60,1) apresentaram transtornos mentais comuns e 71% relataram ter sido vítimas de pelo menos um tipo de violência durante a pandemia de covid-19. Foi encontrado maior risco de transtornos mentais comuns entre aqueles que reportaram falta de equipamento de proteção pessoal, sendo vítimas de discriminação, violência ou assédio; e que reportaram menor confiança no local de trabalho para lidar com a pandemia. Os participantes expostos a dois tipos e a três tipos de violência apresentaram razão de prevalência 2,28 (IC95% 1,23-4,21) e razão de prevalência 3,14 (IC95% 1,62-6,08) mais elevados, respectivamente. Os resultados indicam domínios que podem ser cruciais para mitigar os transtornos mentais comuns entre os trabalhadores da saúde. Conclusões: É crucial promover o acesso a equipamento de proteção pessoal, combater os maus tratos e promover o bem-estar e confiança no local de trabalho para lidar com a pandemia.

Study of Patients' Privacy during the COVID-19 Pandemic in Iranian Health Care Settings.

Background: Patient's privacy protection is a challenging ethical issue. The complex situation of the COVID-19 pandemic was a probable predictor of breaching confidentiality. This study aimed to assess the viewpoints of COVID-19-confirmed patients, who were hospitalized, and their healthcare providers about the compliance of different aspects of patient's privacy. Methods: This cross-sectional study included 3433 COVID-19-confirmed patients who were hospitalized in Kerman, between 2020 and 2021, and about 1228 related physicians, nurses, and paraclinical staff. Two separate validated researcher-made questionnaires were developed, each including subscales for physical, informational, and spatial privacy, as well as a satisfaction rate of privacy protection. The data were analyzed using SPSS software version 26, with independent samples t test, Mann-Whitney-U, Kruskal Wallis, and Multiple Linear Regression tests at a 95% confidence interval. Results: The mean percentages of the patients' privacy scores in physical, spatial, and informational areas were significantly lower (P<0.001) than the average of the medical staff's scores in all three areas (Difference: 10.27%, 14.83%, and 4.91%, respectively). Physical and spatial privacy scores could be predicted based on the participants' classification, patients or medical staff, and sex. The mean patients' satisfaction score was 9.25% lower than the medical staff's (P<0.001). Moreover, only academic hospitals showed a statistically significant difference between the patient's satisfaction with privacy protection and medical staff's viewpoints (P<0.001). Conclusion: Although this study indicated the benefits of protecting patients' privacy in the healthcare setting, patients' privacy scores and satisfaction were lower than their healthcare providers. The pandemic conditions might have been an obstacle to preserving patients' rights. These findings demonstrated the importance of sensitizing healthcare providers to manage these ethical challenges in a complicated critical state such as the COVID-19 pandemic.

[Prevalence and underdiagnosis of burn out syndrome in critical services in the context of the COVID-19 pandemic] / Prevalencia y subdiagnóstico del síndrome de burn out en servicios criticos en el contexto de la pandemia COVID-19.

Introduction: The importance of knowing the impact of work on people's health has increased after the COVID-19 pandemic. Burn Out (BO) syndrome arises from the tension emerging from the conflictive interaction between the worker and his or her employment. The objective was to describe the prevalence and frequency of diagnosis of BO in the health human resources of critical services of the Bahía Blanca Municipal Hospital in the context of the COVID-19 pandemic.Methods: Descriptive, cross-sectional study. The study population was the medical and nursing staff of the Intensive Care (IT), Emergency Medicine (SMU) and Clinic services who worked with COVID-19 during 2021. The Maslach Burnout Inventory (MBI) questionnaire was used and complementary closed questions to identify, among these cases, those that were diagnosed and treated by the institution.Results: Of the 219 workers, 55.3% (121/219) were nurses. In the SMU, 25% (24/96) of respondents had BO, followed by 20.4% (11/54) in Clinic and 8.7% (6/69) in IT (p value=0.004). Only 5.5% (12/219) of the total were diagnosed with BO by the institution and of this group, two people (0.9%) had previously consulted for characteristic symptoms.Discussion: A high prevalence of BO and a marked underdiagnosis were evident at the institutional level during the pandemic. Although the IT Service had the highest demand for attention, it was the one that presented the lowest BO values in relation to other services.

Introducción: La importancia del conocimiento del impacto del trabajo en la salud de las personas se ha acrecentado tras la pandemia por COVID-19. El síndrome de Burn Out (BO) nace de la tensión emergente de la interacción conflictiva entre el trabajador y su empleo. El objetivo fue describir la prevalencia y frecuencia de diagnóstico del BO en el recurso humano en salud de servicios críticos del Hospital Municipal de Bahía Blanca en el contexto de la pandemia COVID-19. Métodos: Estudio descriptivo, de corte transversal. La población de estudio fue el personal médico y de enfermería de los servicios de Terapia intensiva (TI), Médico de Urgencias (SMU) y Clínica que trabajaron con COVID-19 durante el 2021. Se empleó el cuestionario Maslach Burnout Inventory (MBI) y preguntas cerradas complementarias para identificar, entre estos casos, aquellos que fueron diagnosticados y tratados por la institución. Resultados: De los 219 trabajadores, el 55,3% (121/219) fueron enfermeros. En el SMU el 25% (24/96) de encuestados tenía BO, seguido por un 20,4% (11/54) en Clínica y un 8.7% (6/69) en TI (valor p=0.004). Sólo el 5,5% (12/219) del total fue diagnosticado con BO por la institución y de este grupo, dos personas (0,9%) habían consultado previamente por síntomas característicos. Discusión: Se evidenció una elevada prevalencia de BO y un marcado sub-diagnóstico a nivel institucional durante la pandemia. A pesar de que el Servicio de TI tuvo la mayor demanda de atención, fue el que presentó los valores más bajos de BO en relación a otros servicios.

Burnout amongst chiropractic faculty, practitioners, and trainees: a scoping review.

OBJECTIVE: The purpose of this scoping review was to summarize the literature pertaining to burnout and chiropractic. METHODS: A literature review was performed in accordance with Preferred Reporting of Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). A literature review was performed by combining the term "chiropractic" with terms relevant to professional burnout (e.g., "work-related stress," "emotional exhaustion"). We included all publications addressing burnout within the chiropractic profession, including all study designs in only peer-reviewed literature. RESULTS: Our search yielded 126 citations and 10 met the inclusion criteria. The studies identified consisted of eight surveys and two narrative reviews published from 2011 to 2024. Six of the studies utilized the Maslach Burnout Inventory to assess burnout. Chiropractic students reported greater burnout than the general population. Factors reported to increase burnout risk include higher workload, insurance mandates, and physical demands of daily practice. Factors reported to be protective against burnout included longer duration in clinical practice and philosophy-based practices. CONCLUSIONS: Research on burnout within the chiropractic profession is limited and may not be generalizable. However, the reported factors contributing to burnout are well-documented. Future research should be conducted to improve understanding of the prevalence and causes of burnout in chiropractic.

Contraception used by people assigned female at birth with spinal cord injury.

OBJECTIVE: There is limited data on contraception used by people assigned female at birth with spinal cord injury (SCI). Pregnancy in people with SCI can be medically complex, therefore access to contraception to prevent unplanned pregnancies is imperative. This study aimed to assess the availability of contraception from health care providers (HCPs) to people with SCI and contraception methods used. METHODS: An online international questionnaire was distributed. Demographic data and reproductive histories were recorded. 780 responses were received from participants in 33 different countries. Most participants lived in North America and self-identified as white. 75% had a traumatic SCI. Most SCIs were at cervical and thoracic levels and ASIA-A and ASIA-B. Descriptive and chi square statistics were used. RESULTS: The recruitment rate was 85.4% and completion rate was 73.8%. 93.6% of participants reported ever having been sexually active, while 60.7% reported sexual activity over the past year. Of people who were injured under the age of 50 and who have been sexually active, 63.6% were offered birth control by a HCP. Condoms were used by 44.5% of participants, withdrawal by 20.1%, the combined oral contraceptive pill by 28.4% and intra-uterine device by 20.1% of respondents. CONCLUSIONS: This is the largest known study on SCI and contraception. Most people with SCI are sexually active. The withdrawal method and no contraception are used by many individuals, which may increase the risk of unplanned pregnancy. Increased use of highly effective contraception in this population may be achieved through HCP-initiated conversations about sexual health. OBJECTIF: Les données sont limitées en ce qui concerne la contraception utilisée par les personnes de sexe féminin assigné à la naissance atteinte de lésions médullaires (LM). La prise en charge de la grossesse en contexte de LM peut s'avérer complexe; il est donc primordial que les personnes atteintes aient accès à la contraception pour éviter une grossesse non planifiée. Cette étude visait à évaluer l'offre contraceptive des prestataires de soins et les méthodes contraceptives utilisées chez les personnes atteintes d'une LM. MéTHODES: Un questionnaire en ligne a été distribué à des personnes de partout dans le monde. Les données démographiques et les antécédents reproductifs ont été recueillis. Au total, 780 réponses de participantes provenant de 33 pays ont été reçues. La plupart vivaient en Amérique du Nord et s'identifiaient comme Blanches. De ces participantes, 75 % ont indiqué avoir une LM traumatique. Les LM étaient généralement cervicaux ou thoraciques et de grades A ou B sur l'échelle de l'ASIA. L'analyse des données repose sur les statistiques descriptives et le test du chi carré. RéSULTATS: Le taux de recrutement s'élevait à 85,4 % et le taux de questionnaires remplis à 73,8 %. Parmi les participantes, 93,6 % ont déclaré avoir déjà été sexuellement actives et 60,7 % ont déclaré avoir eu des activités sexuelles dans la dernière année. Chez les personnes sexuellement actives ayant contracté une LM avant 50 ans, 63,6 % se sont fait offrir un contraceptif par un prestataire de soins. Dans l'ensemble, 44,5 % des participantes ont utilisé le condom; 20,1 %, la méthode du retrait; 28,4 %, la contraception orale combinée; et 20,1 %, le dispositif intra-utérin. CONCLUSIONS: Cette étude sur les LM et la contraception est la plus vaste à ce jour. La plupart des personnes atteintes d'une LM sont sexuellement actives. Bon nombre d'entre elles utilisent la méthode du retrait ou n'utilisent aucune méthode contraceptive; des facteurs qui peuvent augmenter le risque de grossesse non planifiée. Il serait sans doute possible d'augmenter l'utilisation de méthodes contraceptives hautement efficaces dans cette population au moyen de conversations sur la santé sexuelle amorcées par le prestataire de soins.

[Dealing with assisted suicide-knowledge, attitudes and experiences of members of the German Association for Palliative Medicine]. / Umgang mit assistiertem Suizid ­ Kenntnisse, Einstellungen und Erfahrungen von Mitgliedern der Deutschen Gesellschaft für Palliativmedizin.

BACKGROUND: In February 2020, the Federal Constitutional Court declared § 217 of the German Criminal Code void. Ever since, assisted suicide services have been legal in Germany. This study aims to describe the knowledge, attitudes and experiences of members of the German Association for Palliative Medicine (DGP) regarding assisted suicide. METHODS: Online survey with members of the DGP from July to September 2023 using Qualtrics®. The study group developed the questionnaire based on current literature; it was adapted following an initial application among young physicians and an interprofessional panel of experts with consensus voting. Data was analysed using descriptive and explorative statistics. RESULTS: 991 DGP-members (18%) participated, of which physicians made up 57.0% (n = 545/957) and nurses 23.4% (n = 224/957). Of the participants, 197/851 (23.1%) incorrectly stated that assisted suicide is prohibited by professional code, 430/914 (47.1%) rejected a restriction of palliative care teams to suicide prevention measures, and 766/930 (82.4%) rejected personal involvement in assisted suicide regardless of a patient's health status. For patients in palliative situations, 473/926 (51.1%) could imagine participating in assisted suicide, and 71% wanted new legislation regulating assisted suicide. CONCLUSION: There are gaps in the knowledge of the participating members of the DGP regarding the legal and professional status of assisted suicide. Further educational work is needed in this regard. The participants can more easily imagine assisted suicide for people in palliative disease trajectories. As in surveys of members of other medical societies, the attitudes of more experienced staff are reflected. Compared to younger healthcare professionals, they have a more restrictive attitude towards the concept of assisted suicide.

Implications of genetic attributions for addiction among addiction professionals.

Given increasing emphasis on understanding the role of genes in the etiology of addictive disorders, the present study aimed to investigate the implications of genetic explanations of addiction for attitudes and beliefs about patients among addiction treatment providers. Participants were recruited from addiction-related professional organizations. The sample included professionals with medical backgrounds (n = 153) and with nonmedical backgrounds (n = 232). They viewed a description of a fictitious patient with either alcohol use disorder or gambling disorder, which was experimentally varied to indicate the presence or absence of a genetic cause. They completed measures of their genetic attributions for the patient's symptoms as well as their attitudes and beliefs about the patient. The presence of a genetic explanation increased genetic attribution ratings but did not significantly affect other measured variables. However, participants' genetic attributions for the patient's symptoms were associated with significantly lower ascriptions of blame to the patient and greater belief in the effectiveness of medication, but also with reduced confidence in the effectiveness of psychotherapy and with pessimism about the patient's prognosis. Geneticized, biomedical conceptualizations of addiction may have implications for treatment providers' attitudes toward patients.

Post COVID-19 syndrome among 5248 healthcare workers in England: longitudinal findings from NHS CHECK.

OBJECTIVES: The objectives of this study were to examine post COVID-19 syndrome (PCS) among healthcare workers (HCWs) in England and explore risk factors for the condition. METHODS: Data were collected by National Health Service (NHS) CHECK, a longitudinal study exploring HCWs' mental and physical well-being during and after the COVID-19 pandemic. NHS CHECK collected data at four timepoints: the baseline survey between April 2020 and January 2021, and then three follow-up surveys at approximately 6, 12 and 32 months post baseline. PCS data were collected at 12 and 32 months, while risk factor data were from baseline. HCWs were asked what COVID-19 symptoms they experienced and for how long and were classified as having PCS if they had any symptom for ≥12 weeks. Multilevel regressions were used to examine risk factors for PCS. RESULTS: This study included 5248 HCWs. While 33.6% (n=1730) reported prolonged COVID-19 symptoms consistent with PCS, only 7.4% (n=385) reported a formal diagnosis of PCS. Fatigue, difficult concentrating, insomnia and anxiety or depression were the most common PCS symptoms. Baseline risk factors for reporting PCS included screening for common mental disorders, direct contact with COVID-19 patients, pre-existing respiratory illnesses, female sex and older age. CONCLUSIONS: While a third of HCWs reported prolonged COVID-19 symptoms consistent with PCS, a smaller percentage reported a formal diagnosis of the condition. We replicate findings that direct contact with COVID-19 patients, older age, female sex, pre-existing respiratory illness and symptoms of common mental disorders are associated with increased risk of PCS.

The right care in the right place: a scoping review of digital health education and training for rural healthcare workers.

BACKGROUND: Digital health offers unprecedented opportunities to enhance health service delivery across vast geographic regions. However, these benefits can only be realized with effective capabilities and clinical leadership of the rural healthcare workforce. Little is known about how rural healthcare workers acquire skills in digital health, how digital health education or training programs are evaluated and the barriers and enablers for high quality digital health education and training. OBJECTIVE: To conduct a scoping review to identify and synthesize existing evidence on digital health education and training of the rural healthcare workforce. INCLUSION CRITERIA: Sources that reported digital health and education or training in the healthcare workforce in any healthcare setting outside metropolitan areas. METHODS: We searched for published and unpublished studies written in English in the last decade to August 2023. The databases searched were PubMed, Embase, Scopus, CINAHL and Education Resources Information Centre. We also searched the grey literature (Google, Google Scholar), conducted citation searching and stakeholder engagement. The JBI Scoping Review methodology and PRISMA guidelines for scoping reviews were used. RESULTS: Five articles met the eligibility criteria. Two case studies, one feasibility study, one micro-credential and one fellowship were described. The mode of delivery was commonly modular online learning. Only one article described an evaluation, and findings showed the train-the-trainer model was technically and pedagogically feasible and well received. A limited number of barriers and enablers for high quality education or training of the rural healthcare workforce were reported across macro (legal, regulatory, economic), meso (local health service and community) and micro (day-to-day practice) levels. CONCLUSIONS: Upskilling rural healthcare workers in digital health appears rare. Current best practice points to flexible, blended training programs that are suitably embedded with interdisciplinary and collaborative rural healthcare improvement initiatives. Future work to advance the field could define rural health informatician career pathways, address concurrent rural workforce issues, and conduct training implementation evaluations. REVIEW REGISTRATION NUMBER: Open Science Framework: https://doi.org/10.17605/OSF.IO/N2RMX .

What clinicians could consider in providing group interventions for people with cognitive impairments: a scoping review.

This study identified evidence and considerations for allied health clinicians in providing group interventions for people with cognitive impairment. A scoping review was conducted by searching the MEDLINE (Ovid), CINHAL (EBSCOhost), Scopus (Elsevier), Embase (Ovid) and TROVE databases from 2016. Articles of any study design in which group interventions were performed by an allied health professional with participants with cognitive impairment were included. Data on physical, cognitive, psychological, and quality of life measures were extracted from the selected articles. Standardised mean changes (SMC) were calculated. Ten articles were included in the study. No article directly compared group interventions versus one-to-one interventions. The results of the meta-analysis showed significant improvements after the intervention in the physical (SMC = 0.42, P = 0.013), cognitive (SMC = 0.43, P = 0.005), psychological (SMC = 0.14, P = 0.005), and quality of life domains (SMC = 0.28, P = 0.002). This review identified considerations for clinicians when developing group interventions for people with cognitive impairments, including specific participant criteria, increasing support, modifications to intervention difficulty, and environmental considerations. Group intervention for people with cognitive impairments demonstrated moderate effectiveness in improving physical and cognitive domains and a small effect in improving psychological and quality of life domains. Specific considerations are recommended when clinicians provide group interventions for people with cognitive impairments.

Factors associated with health personnel-chaplain interactions in the hospital setting: a cross-sectional survey study.

Health personnel may seek chaplain support to discuss stressors related to complex patient cases, difficult team dynamics, and personal issues. In this survey study of 1376 healthcare interprofessional clinicians, participants reported interacting with chaplains most frequently over patient-related stressors in the prior 12 months. Factors associated with chaplain interactions to discuss all three stressors included: reporting chaplains provide spiritual support to health personnel, more years of service, seeking professional help to deal with stressors, and higher levels of secondary traumatic stress. Being a registered nurse (RN) and working in a critical care specialty were associated with increased odds of interactions with a chaplain to discuss patient-related stressors while identifying as Catholic or Protestant was associated with chaplain interactions to discuss team-related and personal stressors. Chaplains should tailor interventions to promote health personnel's spiritual well-being based on patient-related, team-related, and personal stressors. Healthcare institutions which do not employ chaplains should advocate for this resource. Leaders in healthcare settings with chaplains should promote increased staff awareness that chaplains are available to support wellbeing by discussing patient, team, or personal stressors.