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Being compassionate and empathic while making rational decisions is expected from healthcare workers across different contexts. But the daily challenges that these workers face, aggravated by the recent COVID-19 crisis, can give rise to compassion and decision fatigue, which affects not only their ability to meet these expectations but has a significant negative impact on their wellbeing. Hence, it is vital to identify factors associated to their exhaustion. Here, we sought to describe levels of compassion and decision fatigue during the pandemic, and to identify factors related to these forms of exhaustion. We collected data using self-reported questionnaires to measure compassion fatigue, decision fatigue, and grit in five intervals from April to November, 2020 (N = 856). Our results showed a negative correlation between grit and compassion and decision fatigue. We also found that under the circumstances studied grit tends to be higher in technicians, nurses, other professionals (psychologists, social workers), and workers at the Emergency Room (ER), and lower in general practitioners. Compassion fatigue tend to be higher for technicians, whereas decision fatigue was lower for specialists, general practitioners, and technicians, and higher for those working at private hospitals.
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Esgotamento Profissional , COVID-19 , Fadiga de Compaixão , Humanos , Fadiga de Compaixão/epidemiologia , COVID-19/epidemiologia , Pandemias , Esgotamento Profissional/epidemiologia , Empatia , Colômbia/epidemiologia , Pessoal de Saúde , Inquéritos e Questionários , Satisfação no Emprego , Qualidade de VidaRESUMO
Introduction: For young adults, the first year of higher education represents a transition period into adulthood associated with an increased risk of developing depression, anxiety, and stress, contributing to deteriorating physical and mental health. The present study aimed to analyze the relationship between depressive symptoms and social capital and lifestyles among Colombian university students. Methods: In 2020, a longitudinal repeated measures study was conducted on first year students at Universidad de los Andes in Bogota, Colombia. The study was conceptualized and approved by the university before the COVID-19 pandemic appeared. Each student completed a self-administered questionnaire including questions on sociodemographic characteristics, depressive symptoms, perceived stress, social capital, and lifestyles. The study's pilot was conducted in November 2019, and the two measurement points were in January 2020 (wave 1, before the COVID-19 pandemic was declared) and in August 2020 (wave 2, during the COVID-19 pandemic). A binary logistic regression analysis was performed to assess the relationship between depressive symptoms, perceived stress, social capital, and lifestyles. Findings: A total of 609 first year students (response rate = 58.11%) participated in wave 1, and 42% of the participants showed signs of clinically relevant depressive symptoms. In wave 2, despite the difficulties encountered in collecting data due to the COVID-19 pandemic, 216 students from wave 1 participated (35.47%). An increase in a sedentary lifestyle was observed (31.49%). We found that cognitive and behavioral social capital levels decreased by 12.03 and 24.54%, respectively. In addition, we observed a 6.5% increase in students with clinically relevant depressive symptoms compared to wave 1. A low level of behavioral [OR: 1.88; 95% CI (1.16, 3.04)] social capital was associated with clinically relevant depressive symptoms. Conclusion: The health of university students continues to be a public health concern. The study suggests that social capital may play an important role in preventing depressive symptoms. Therefore, universities should put effort into programs that bring students together and promote the creation of social capital.
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COVID-19 , Capital Social , Adulto , COVID-19/epidemiologia , Colômbia/epidemiologia , Depressão/psicologia , Humanos , Estilo de Vida , Saúde Mental , Pandemias , Estudantes/psicologia , Universidades , Adulto JovemRESUMO
Abstract In recent months, rare cases of thrombosis at unusual sites associated with thrombocytopenia, occurring within a typical risk window (i.e., 4-28 days) after receiving SARS CoV2 vaccines, have been reported. Healthcare professionals should be prepared to detect these cases on time. The Expert Panel of the Knowledge Management and Transfer Network conducted a free search of the related literature. With the available information and the clinical expertise of the working group, we formulated, reviewed, and endorsed recommendations for the timely suspicion, diagnosis (case definitions, the use of initial laboratory and imaging tests, specific tests), and management of these thrombotic conditions. This document is considered a living document that will be updated as new evidence emerges, and recommendations may change over time.
Resumen En meses recientes se han reportado casos raros de trombocitopenia y trombosis en sitios inusuales, que ocurren dentro de una ventana de riesgo típica ( por ejemplo de 4 a 28 días) luego de recibir vacunas de SARS CoV 2. Los profesionales de la salud deben estar preparados para detectar estos casos a tiempo. Un panel de expertos y una red de transferencia de conocimiento realizó una búsqueda libre de literatura seleccionada. Con la información disponible y la experticia clínica del grupo de trabajo revisamos y dimos recomendaciones para la sospecha temprana, el diagnostico (definición de caso, el uso de pruebas de laboratorio especificas y de imágenes diagnósticas) para le manejo de estas condiciones tromboticas. Este documento es considerado un documento vivo que debe ser actualizado a medida que surja nueva evidencia y las recomendaciones vayan cambiando con el tiempo
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El maltrato, la amenaza, el acoso, la discriminación y la violencia de género en la educación médica son fenómenos generalizados mundialmente y altamente prevalentes. Los comportamientos inapropiados hacia los estudiantes de medicina han sido reconocidos como una amenaza pues interfieren en la construcción de la identidad profesional, el bienestar estudiantil y éxito académico contri-buyendo al agotamiento físico, el desgaste emocional, y el abuso de alcohol y otras sustancias psicoactivas. El impacto negativo de un ambiente jerárquico donde las relaciones de poder pueden tornarse abusivas cambia el enfoque empático y altruista que se espera de un profesional de la salud y perpetúa el maltrato por generaciones. En facultades de medicina de Latinoamérica, la prevalencia de conductas inapropiadas en estudiantes de pregrado y posgrado varía de 17 a 100%, con una importante participación de profesores y residentes como perpetradores del maltrato. Es responsabilidad de los líderes en educación médica enfocar sus esfuerzos pedagó-gicos en formar profesionales humanizados, empáticos y felices en modelos de enseñanza que promuevan la dignidad y los derechos de los estudiantes. La profesión médica debe asumir un papel de liderazgo condenando las conductas inapropiadas y aportando un enfoque de tolerancia cero para todas las formas de intimidación y acoso en el lugar de aprendizaje y de trabajo, así como fomentar la igualdad de oportunidades en la fuerza laboral médica.
Harassment, threatening behaviours, discrimination, and gender-based violence in medical education are global and widespread phe-nomena. Inappropriate behaviours towards medical students have been recognised as a threat to medical education. They interfere with the construction of professional identity, student well-being, and academic success, contributing to physical exhaustion, emotional burnout, and alcohol abuse. The negative impact of a hierarchical environment where abusive power-drive relationships can modify the empathic and altruistic approach expected from a health professional as perpetuates abuse for generations. In Latin American medical schools, the prevalence of inappropriate behaviour in undergraduate and graduate students ranges from 17 to 100%, with professors and residents as perpetrators of misconduct. Focus in medical schools must be based on training empathetic health professionals that embrace the rights of students and human dignity. The medical profession must take a leadership role in condemning inappropriate behaviour and bringing a zero-tolerance approach to all forms of bullying and harassment in hospitals and learning environments, as well as promoting equal opportunity in the medical workforce.
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Comfort index and environmental variables are indicators of thermal stress conditions inside a livestock facility.The environmental conditions of ten different constructive typologies of swine-production facilities with natural ventilation were characterized in a tropical country (Antioquia, Colombia). Temperature and humidity index (THI), enthalpy (H), animal surface temperature (ST), light intensity, and noise level were measured and computed for each typology, which were located at heights above sea levels between 8:00-23:00. Data was analyzed as a function of each typology, geographical altitude, and time of the day. It was employed descriptive statistics, analysis of variance, and contour maps to analyze the data. It was found that more than 80% of the typologies presented moderate or critical stress conditions associated with the construction typology, not suitable THI and light intensity values, especially in warm and mild-mild climates. Showing high special variability inside the facilities. New typological designs and bioclimatic conditioning for swine facilities need to be studied to be implemented in these climatic conditions.(AU)
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Animais , Suínos/metabolismo , Suínos/fisiologia , Resposta ao Choque Térmico/efeitos da radiaçãoRESUMO
Comfort index and environmental variables are indicators of thermal stress conditions inside a livestock facility.The environmental conditions of ten different constructive typologies of swine-production facilities with natural ventilation were characterized in a tropical country (Antioquia, Colombia). Temperature and humidity index (THI), enthalpy (H), animal surface temperature (ST), light intensity, and noise level were measured and computed for each typology, which were located at heights above sea levels between 8:00-23:00. Data was analyzed as a function of each typology, geographical altitude, and time of the day. It was employed descriptive statistics, analysis of variance, and contour maps to analyze the data. It was found that more than 80% of the typologies presented moderate or critical stress conditions associated with the construction typology, not suitable THI and light intensity values, especially in warm and mild-mild climates. Showing high special variability inside the facilities. New typological designs and bioclimatic conditioning for swine facilities need to be studied to be implemented in these climatic conditions.
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Animais , Resposta ao Choque Térmico/efeitos da radiação , Suínos/fisiologia , Suínos/metabolismoRESUMO
Objetivo Generar una aproximación a las terapias no farmacológicas que disminuyan el dolor durante la realización de la cistoscopia. Métodos Se realizó una búsqueda de la literatura para identificar artículos relevantes con respecto al tópico, utilizando como palabras clave: cistoscopia, dolor, terapia no farmacológica en cistoscopia y terapias alternativas. La búsqueda se hizo a través de Medline y Embase. Se realizó una revisión narrativa. Resultados Aunque la cistoscopia flexible aumenta la tolerancia, especialmente en pacientes masculinos, el dolor sigue siendo inevitable durante la misma. Se han estudiado diferentes intervenciones no farmacológicas orientadas a disminuir el dolor y la ansiedad durante la cistoscopia, entre las que se encuentran: escuchar música, tomar la mano del paciente, ver el procedimiento en tiempo real, el aumento de la presión hidrostática, insuflación con aire y la hipnosis. Conclusión Esas intervenciones podrían ser usadas como adyuvantes en la disminución del dolor y la ansiedad durante la cistoscopia, principalmente la masculina. Sin embargo, se requieren más estudios que comprueben su uso clínico apropiado.
Objective To generate an approach to non-pharmacological therapies that reduce pain during cystoscopy. Methods We searched the literature to identify relevant articles regarding the topic, using as keywords: cystoscopy, pain, non-pharmacological therapy in cystoscopy and alternative therapies. The search was made through Medline and Embase. A narrative review was made. Results Although flexible cystoscopy increases tolerance, especially in male patients, pain remains unavoidable during it. Different non-pharmacological interventions aimed at reducing pain and anxiety during cystoscopy have been studied, among which are: listening to music, taking the patient's hand, seeing the procedure in real time, increasing hydrostatic pressure, insufflation with air and hypnosis. Conclusion These interventions could be used as adjuvants in the reduction of pain and anxiety during cystoscopy, mainly male. However, more studies are required to prove their appropriate clinical use.
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Humanos , Terapias Complementares , Cistoscopia , Dor , Insuflação , Pressão Hidrostática , HipnoseRESUMO
INTRODUCTION: The purpose of this study was to determine the effectiveness and harms of periprostatic block compared with other interventions in patients with clinically suspected prostate cancer who underwent transrectal biopsy to diminish pain. MATERIAL AND METHODS: We included only clinical trials which involved male adults older than 18 years-old suspected of having prostate cancer. The intervention performed was a periprostatic block and the comparators were topical anesthetics, sedatives, placebo/no intervention or combined therapies. The primary outcome was perianal or perineal pain and serious adverse effects (SAE). Literature search was conducted in MEDLINE, EMBASE, LILACS, CENTRAL and non-published literature from inception to March 2019. We performed a network meta-analysis in R. RESULTS: We included 43 studies in the meta-analysis. Thirteen studies compared periprostatic block vs. placebo/no intervention (the most frequent). Most of the studies had an unclear risk of bias for selection, performance and detection bias and low risk for attrition, reporting and other bias. Periprostatic block (lidocaine) + intrarectal gel (lidocaine + prilocaine) vs. periprostatic block (lidocaine) showed an RR -0.9 (95%CI - 1.9 to 0.074); intrarectal gel (lidocaine) vs. periprostatic block (lidocaine) had a RR 0.77 (95%CI 0.14 to 1.4); placebo/no intervention vs. periprostatic block (lidocaine) + intrarectal gel (lidocaine+prilocaine) RR 3 (95%CI 1.9 to 4); intrarectal gel (lidocaine) versus periprostatic block (lidocaine) + intrarectal gel (lidocaine + prilocaine) RR 1.7 (95%CI 0.64 to 2.7). CONCLUSIONS: The blockage of the periprostatic plexus in the performance of a transrectal ultrasound-guided prostatic biopsy, alone or in combination with intrarectal analgesia or sedation, is an effective method to reduce pain.
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AIM: This cross-sectional case-control study was designed to determine the association of the salivary concentration of CD9/CD81 exosome-related tetraspanins with the periodontal clinical status. MATERIALS AND METHODS: Saliva samples from 104 periodontitis patients and 45 healthy controls were collected. Periodontal status was assessed based on full-mouth clinico-radiographical data, and salivary concentration of the analytes was calculated by ELISA. The association between the biomarkers with disease status was analysed using multivariate binary logistic regression models. RESULTS: Significantly decreased salivary levels of CD9 and CD81 exosomes were detected in periodontitis patients in comparison with healthy controls. Also, negative significant correlations between salivary concentrations of CD9/CD81 exosomes regarding clinical measurements were observed. Likewise, a significant downward trend of the concentration of these two biomarkers concerning the stage and grade of disease could be identified. Logistic regression analyses revealed a strong/independent association for decreased salivary concentration of CD81 exosomes regarding disease status. Confounding and interaction effects between age and salivary concentration of CD9 exosomes were also noted. CONCLUSION: Reduced salivary concentration of CD9/CD81 exosomes might be of significance in the context of periodontal disease pathogenesis.
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Exossomos , Estudos de Casos e Controles , Estudos Transversais , Humanos , Saliva , Tetraspanina 28 , TetraspaninasRESUMO
Objetivo: Caracterizar los pacientes con displasia de cadera atendidos en el Hospital Infantil Universitario de la ciudad de Manizales (Caldas, Colombia) entre los años 2004 y 2011. Materiales y métodos: Estudio de corte trasversal. Se estudiaron 198 pacientes pediátricos. Se tomaron variables asociadas a esta patología y se revisaron historias clínicas. Resultados: Se encontró que la cadera izquierda, presentó una proporción de 35,6%; hiperlaxos 31,9%, 3,1% embarazo gemelar, pliegues asimétricos 61,6% en la cadera luxada. Maniobra de Ortolani negativa en 47,1%,maniobra de Barlow negativa en 53,3% teniendo en cuenta que las maniobras se realizan antes de los 3 meses. Edad promedio de diagnóstico 16,56 meses, género femenino 75,6% de los casos, por cesárea el 33,5%, madres primigestantes 53,8%, antecedentes familiares de displasia del desarrollo de la cadera 20,9% de los casos, parto en presentación podálica 29,7%. El 71,2% son de área urbana, 98,2% de raza mestiza. Se encontró relación significativa entre las variables asociadas a DDC, cargar al niño envuelto, procedencia urbana, historia familiar de DDC, uso de caminadores y variables propias de la DDC como afectación en ambas caderas, hiperlaxitud ligamentosa, maniobra de Ortolani negativa y presencia de parálisis cerebral como condición especial de cadera paralitica y no como factor de riesgo. Conclusión: Este estudio concuerda con otros ya realizados, lo que podría indicar que la DDC en Caldas se presenta en pacientes cuyos perfiles se asocian a factores de riesgo señalados por varios autores en otras investigaciones...
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Paralisia Cerebral , Recém-Nascido , Lesões do Quadril/congênito , Fatores de RiscoRESUMO
Apresentamos um relato de caso no qual o diagnóstico de ausência congênita do pericárdio (ACP) foi, inicialmente, suspeito na análise ecocardiográfica bidimensional, devido à presença do ápice posterior deslocado na janela das quatro câmaras na direção da linha axilar média. Posteriormente, o diagnóstico foi confirmado por um raio-x do tórax, ressonância magnética e tomografia computadorizada do tórax.
We report a case in which the diagnosis of congenital absence of the pericardium (ACP) was initially suspected in two-dimensional echocardiographic analysis due to the presence of the apex later moved in the window of the four chambers in the direction of the midaxillary line. Subsequently, the diagnosis was confirmed by a chest x-ray, magnetic resonance imaging and computed tomography.
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Humanos , Masculino , Adulto , Cardiopatias Congênitas/complicações , Ecocardiografia/métodos , Pericárdio , Taquicardia/complicaçõesRESUMO
El objetivo de esta investigación fue determinar la calidad de vida de los pacientes con lupus eritema-toso sistémico (LES) en la consulta externa del Hospital de la Misericordia en el segundo semestre de 2006 y su frecuencia con el nivel de actividad de la enfermedad, escolaridad, régimen de salud y nivel socioeconómico. Estudio descriptivo de corte transversal. Se escogieron 20 pacientes de 6 a 18 años, con diagnóstico de LES que asistieron a la consulta en el Hospital de la Misericordia en el segundo semestre de 2006, con aceptación del consentimiento informado. Se aplicó el instrumento (CHAQ) de calidad de vida diligenciado por los padres de los pacientes menores de 12 años. Se analizó por medio de tablas de frecuencia y se calcularon medidas de tendencia central y dispersión, identificando un grupo de 40 pacientes con LES de los cuales 20 cumplían con los criterios de inclusión. De ellos, el 76 % tenían buena calidad de vida en el momento del estudio; el 72% con actividad de la enfermedad se encuentran en este grupo. La totalidad de los que no tienen buena calidad de vida están en la adolescencia. La mayoría afiliados al régimen subsidiado en estrato dos. A pesar de ser una enfermedad con alta morbimortalidad, casi todos se encontraron con una adecuada calidad de vida. Este trabajo genera nuevos interrogantes sobre la relación entre la actividad de la enfermedad y calidad de vida, puesto que es una limitación importante.
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Criança , Qualidade de Vida , Lúpus Eritematoso Sistêmico , PediatriaRESUMO
Macrophages and dendritic cells are involved in the immune response to Mycobacterium tuberculosis (Mtb). Such a response, although extensively studied using animal models and cells from human blood, has not been characterized in cells from pulmonary hilar lymph nodes (PHLN). We characterized populations of myeloid APC from PHLN and determined their expression of CCR2, CCR5, CCR7, CD40, CD54, CD80, and CD86 as well as the cytokine/chemokine microenvironment before and after purified protein derivative (PPD) and mannosilated lipoarabinomannan (ManLAM) stimulation. Results show that there are at least three APC populations in PHLN, defined as CD14highHLA-DRlow/-, CD14dimHLA-DRdim, and CD14-HLA-DRhigh/dendritic cells (DC), with the largest number represented by CD14dimHLA-DRdim cells (where dim indicates intermediate levels). CD14-HLA-DRhigh/DC expressed higher levels of costimulatory molecules and lower levels of CCR2 and CCR5, but all cell populations showed similar CCR7 levels. PPD and ManLAM specifically down-regulated CCR2 expression but not that of CCR5 and CCR7, and such down-regulation was observed on all APC populations. Mtb Ag did not affect the expression of costimulatory molecules. PPD but not ManLAM specifically induced MCP-1/CCL2 production, which was likely associated with the induction of IFN-gamma because this cytokine was highly induced by PPD. We characterized, for the first time, different APC from human PHLN and show that Mtb Ag exert fine and specific regulation of molecules closely associated with the immune response to Mtb infection. Because knowledge of this response in secondary lymphoid tissues is still poorly understood in humans, such studies are necessary and important for a better understanding of lymphoid cell microenvironment and migrating capacities and their role in the immunopathogenesis of tuberculosis.
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Células Apresentadoras de Antígenos/imunologia , Antígenos de Bactérias/imunologia , Quimiocina CCL2/metabolismo , Pulmão/imunologia , Linfócitos/imunologia , Receptores CCR2/metabolismo , Adulto , Apresentação de Antígeno , Células Apresentadoras de Antígenos/efeitos dos fármacos , Antígenos de Bactérias/farmacologia , Quimiocina CCL2/análise , Quimiocinas/metabolismo , Criança , Células Dendríticas/efeitos dos fármacos , Células Dendríticas/imunologia , Citometria de Fluxo , Humanos , Lipopolissacarídeos/imunologia , Lipopolissacarídeos/farmacologia , Linfonodos/imunologia , Linfócitos/efeitos dos fármacos , Macrófagos/imunologia , Masculino , Monócitos/imunologia , Receptores CCR2/análise , Receptores de Quimiocinas/metabolismo , Tuberculina/imunologia , Tuberculina/farmacologiaRESUMO
Macrophages play an important role during Mycobacterium tuberculosis (MTB) infection. In humans most of the studies on MTB-macrophage interactions have been performed using circulating monocytes and monocyte-derived macrophages. However, little research has been performed on this interaction using tissue macrophages. Herein, we used human splenic macrophages to characterize particular responses to MTB infection. Based on morphological, biochemical, and immunological markers, splenic adherent cells exhibit characteristics of tissue macrophages. They were able to efficiently phagocytose both live and heat-killed (h-k) MTB H37Rv. Upon infection with live, but not h-k MTB, an increase in secreted TNF-alpha was elicited. Splenic macrophages produced high basal levels of IL-10; however, infection with live or h-k MTB resulted in decrease IL-10 secretion. Both IL-12p40 and IL-12p70 basal levels were also decreased upon infection with live or h-k MTB; however, while the reduction for IL-12p40 levels was observed at earlier time points (4h) for both live and h-k MTB, infection with live MTB, but not h-k MTB, resulted in a time-dependent secretion of IL-12p40 at 24 and 48h after infection. IL-12p70 levels were completely reduced upon infection by either live or h-k MTB. These results support that human splenic macrophages may represent a potential useful model to study MTB-macrophage interactions in vitro.
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Macrófagos/microbiologia , Modelos Biológicos , Mycobacterium tuberculosis/imunologia , Baço/microbiologia , Tuberculose/imunologia , Antígenos CD/metabolismo , Adesão Celular , Citocinas/biossíntese , Antígenos HLA-DR/metabolismo , Humanos , Macrófagos/imunologia , Fagocitose/imunologia , Baço/imunologiaRESUMO
The majority of knowledge about the role of cytokines and chemokines in controlling Mycobacterium tuberculosis infection mainly derives from animal models. In humans, this knowledge is still mainly limited to the blood compartment or accessible lymphoid organs, such as tonsils. Here, we studied cytokine and chemokine production and their modulation by M. tuberculosis antigens in mononuclear cells from human blood, spleen and hilar lung lymph nodes. Results show that the kinetics and magnitude of cytokine and chemokine production varied according to the tissue of cell origin. Mycobacterium tuberculosis antigens enhanced cytokine and chemokine production in blood, but the enhancement was restricted in spleen and hilar lung lymph node cells. We show, for the first time in humans, differences in cytokine and chemokine microenvironments according to lymphoid tissues, and suggest that these differences may affect the way cells respond to M. tuberculosis infection.