Burnout syndrome and sleep quality in doctors

El Síndrome de Burnout es consecuencia del estrés crónico, caracterizándose por despersonalización, agotamiento emocional y sensación de pobre realización personal, teniendo manifestaciones psiciológicas y físicas, incluyendo variaciones en la calidad y patrón del sueño, considerada una función fisiológica primordial para conservar la integridad de la salud de los individuos.La presente investigación pretende determinar la presencia de Síndrome de Burnout en médicos de un hospital, a través de (MBI-HSS), y buscar su asociación a la calidad del sueño aplicando (PSQI). El diseño fue observacional, analítico, prospectivo, corte transversal. Se utilizó Chi-cuadrada (X2) para analizar la asociación entre las variables principales, con una significancia estadística de p< 0.05, el resto se expresó con estadística descriptiva a través de medidas de tendencia central para las variables cuantitativas; frecuencias y porcentajes para las variables cualitativas. Obteniendo prevalencia del Síndrome de Burnout en médicos no familiares del 66%. Mediana en la antigüedad laboral de 12 años, media en la edad de 44 años, y moda en el número de empleos de 2.  El 60.3% de los sujetos con mala calidad del sueño de categoría de médico no familiar y el 80% de las personas con Síndrome de Burnout tuvo una mala calidad del sueño, concluyendo que existe relación entre el Síndrome de Burnout y una mala calidad del sueño.Burnout Syndrome is a consequence of chronic stress, characterized by depersonalization, emotional exhaustion and a feeling of poor personal fulfillment, having psychological and physical manifestations, including variations in the quality and pattern of sleep, considered a primary physiological function to preserve the integrity of the body. health of individuals. The present investigation aims to determine the presence of Burnout Syndrome in doctors in a hospital, through (MBI-HSS), and seek its association with sleep quality by applying (PSQI). The design was observational, analytical, prospective, cross-sectional. Chi-square (X2) was used to analyze the association between the main variables, with a statistical significance of p < 0.05, the rest was expressed with descriptive statistics through measures of central tendency for the quantitative variables; frequencies and percentages for qualitative variables. Obtaining prevalence of Burnout Syndrome in non-family doctors of 66%. Median length of service of 12 years, mean age of 44 years, and mode of number of jobs of 2. 60.3% of subjects with poor sleep quality in the non-family doctor category and 80% of people with Burnout Syndrome had poor quality of sleep, concluding that there is a relationship between Burnout Syndrome and poor quality of sleep

Adherence to Therapeutics and Control of Blood Pressure in Patients with a Diagnosis of Arterial Hypertension

Introduccion: La Hipertensión Arterial Sistemica (HAS) es el trastorno cardiovascular mas frecuente del mundo afectando al 30% de la población (Organizacion Mundial de la Salud, 2023; Mancia et al., 2023), es factor predisponente para enfermedad cardiovascular, renal y demencia (Hidalgo, 2019; Canadian Cardiovascular Society, 2020; Pérez et al., 2021; Alvarez et al., 2022; Baffour et al., 2023), la inadecuada adherencia terapéutica dificulta el control de la HAS y aumenta la probabilidad de desarrollar complicaciones (Enriquez, 2022). Objetivo: analizar la asociación entre la adherencia terapéutica farmacológica y el control de la tensión arterial de los pacientes con Hipertensión Arterial Sistémica. Material y métodos: Estudio observacional, prospectivo, transversal. Se aplicó, la Escala de Adherencia a la Medicación de Morisky de 8 ítems (MMAS-8) a 236 pacientes con diagnistico de HAS, realizado del 01 de Marzo del 2023 al 30 de Septiembre del 2023. Proyecto de investigación apegado a la declaración de Helsinki y sus enmiendas, aprobado por el Comité de Local de Ética e Investigación (R-2023-1003-007). Se utilizó Chi-cuadrada (X2) para analizar la asociación entre las variables principales, con una significancia estadística de p< 0.05, mediante el programa SPSS versión 26. Resultados: asociación entre adherencia terapéutica farmacológica y el control de la tensión arterial por Chi2 con valor de P= 0.027.Introduction: Systemic Arterial Hypertension (HTA) is the most common cardiovascular disorder in the world, affecting 30% of the population (Organizacion Mundial de la Salud, 2023; Mancia et al., 2023), it is a predisposing factor for cardiovascular, kidney disease and dementia (Hidalgo, 2019; Canadian Cardiovascular Society, 2020; Pérez et al., 2021; Alvarez et al., 2022; Baffour et al., 2023), inadequate therapeutic adherence difficult the control of HTA and increases the probability of developing related complications (Enriquez, 2022). Objective: to analyze the association between pharmacological therapeutic adherence and blood pressure control in patients with Systemic Arterial Hypertension. Material and methods: Observational, prospective, cross-sectional study. The 8-item Morisky Medication Adherence Scale (MMAS-8) was applied to 236 patients with SAH diagnosis, carried out from March 1, 2023 to September 30, 2023. Research project was developed according to Helsinki declaration and its amendments, approved by the Local Ethics and Research Committee (R-2023-1003-007). Chi-square (X2) was used to analyze the association between the main variables, with a statistical significance of p < 0.05, using the SPSS 26 version program. Results: statistically significative association between pharmacological therapeutic adherence and blood pressure control by X2 with P value= 0.027

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Experiencias de agroforestería en México

Cuadernillo especializado en actividades de agroforestería y ciencias ligadas a la naturaleza,El presente trabajo es una colección de los Cuadernos de Divulgación Ambiental, que constituyen un acercamiento inicial a tópicos ambientales de nuestro tiempo, abordados con una visión amplia y considerando diferentes ópticas. Con rigor académico, pretenden contribuir al conocimiento y la difusión de situaciones y problemáticas socio-ambientales, así como al entendimiento de sus dilemas, retos y oportunidades.Secretaría de Medio Ambiente y Recursos Naturales (Semarnat