Food fortification with vitamin D in Portugal

publishersversionpublishe

Contributo para o estudo da influência do stress na resposta imunitária à vacina contra a gripe em profissionais de saúde

Resumo: Os profissionais de saúde podem estar expostos a vários factores indutores de stress crónico nomeadamente de natureza profissional destacando-se, entre os seus possíveis efeitos, a diminuição da resposta de anticorpos após administração de vacinas, entre as quais, a vacina contra a gripe. Uma vez que os trabalhadores da saúde estão expostos a factores indutores de stress e, simultaneamente, a agentes biológicos cujos efeitos poderão ser prevenidos pela vacinação, é pertinente estudar a influência do stress na resposta imunitária à vacina contra a gripe em enfermeiros. Constituíram objectivos deste trabalho: (1) estudar a associação entre a presença de stress crónico em enfermeiros hospitalares e a “insuficiente” resposta imunitária à vacina contra a gripe, avaliada um mês após a vacinação (T1); (2) estudar a associação entre a presença de stress crónico em enfermeiros hospitalares e a redução dos títulos de anticorpos dirigidos às hemaglutininas seis meses após a vacinação (T6) e (3) identificar algumas características das unidades de internamento e do trabalho dos participantes que possam estar associadas à presença de stress crónico e estudar a sua possível associação com a resposta imunitária à vacina contra a gripe. Realizou-se um estudo caso-controlo incorporado num estudo de coortes e a amostra em estudo foi constituída por 136 enfermeiros saudáveis (83,8% sexo feminino; média de idades de 33anos) de um hospital universitário. Realizaram-se entrevistas individuais e aplicaram-se as versões portuguesas dos questionários The General Health Questionnaire (GHQ12) e Maslach Burnout Inventory – Human Services Survey (MBI-HSS) para determinação da presença de stress crónico pelo método da triangulação, no início do estudo (T0) e realizou-se a recolha de dados relativos à caracterização de elementos de trabalho nas unidades de internamento. Foi administrada a vacina contra a gripe e determinou-se os títulos de anticorpos dirigidos às hemaglutininas de cada estirpe componentes da vacina contra a gripe utilizada em 2007, antes da vacinação, um mês e seis meses após a vacinação. Não se encontrou associação, ao nível de significância de 5%, entre a presença de stress e a “insuficiente” resposta à vacina contra a gripe, avaliada pela taxa de indivíduos que apresentaram um aumento, ao fim de um mês, inferior a quatro vezes os títulos de anticorpos antes da vacinação. No entanto, encontrou-se uma maior proporção de indivíduos com stress no grupo de participantes em que ocorreu uma diminuição do título de anticorpos dirigidos à hemaglutinina AH1 (ac AH1) em T6, quando comparado com o respectivo grupo controlo. A diferença entre grupos foi estatisticamente significativa, quando se avaliou a presença de stress pelo método da triangulação usando a entrevista (p=0,006), pelo método da triangulação usando o GHQ12 (p=0,045) e ainda usando a combinação dos três critérios (p=0,001). Após análise multivariada, verificou-se que a associação entre a presença de XXVI stress e a redução dos ac AH1 em T6 manteve significado estatístico (respectivamente, p= 0,010, p= 0,042 e p=0,002) e apresentou odds ratio ajustados, em função de cada um dos métodos de avaliação da presença de stress, de 3,643, de 2,733 e de 5,223. A quantidade de trabalho percepcionada como sobrecarga constituiu o factor indutor de stress mais vezes referido (58,8% da amostra e 61,8% dos enfermeiros de unidades de internamento), seguida dos conflitos entre profissionais. O contacto com o sofrimento e a morte de doentes foram identificados em quarto lugar pela amostra, mas em segundo pelos enfermeiros de unidades de internamento. Nesses, verificou-se uma associação positiva entre trabalhar em Serviços onde o número de doentes falecidos foi muito elevado e a presença de stress, medido pelo método da triangulação usando a entrevista (p=0,039), usando o GHQ12 (p=0,019), usando a escala de exaustão emocional do MBI-HSS (p=0,012) e pela combinação dos três métodos (p=0,014). Verificou-se também uma associação positiva entre a presença de stress, identificada pelo método da triangulação usando a escala de exaustão emocional do MBI-HSS, e o trabalho em serviços de internamento onde a percentagem de doentes idosos (p=0,025) e a taxa de letalidade (p=0,036) foram elevadas. Contudo, não se encontrou associação entre a exposição muito frequente ao sofrimento e à morte de doentes e a redução do título de ac AH1 em T6. Possivelmente, a exposição a esse factor indutor de stress, apesar de estar relacionada com a presença de stress nos enfermeiros de serviços de internamento, não foi suficientemente intenso para, por si só, estar associada à redução do título de ac AH1 em T6. A associação encontrada entre a presença de stress crónico e a redução do título de anticorpos AH1 em T6 vem apoiar a resposta à questão de investigação inicialmente colocada de que o stress poderá influenciar negativamente a manutenção dos títulos de anticorpos, mesmo em indivíduos adultos não idosos. Assim, o risco de um enfermeiro com stress apresentar redução do título de anticorpos dirigidos à hemaglutinina da estirpe AH1N1 – A/Solomon Islands/3/2006 ao fim dos seis meses do estudo, foi 3,6, 2,7 ou 5,2 vezes superior ao de um enfermeiro sem stress, consoante o critério de stress ter sido determinado, respectivamente, pelo método da triangulação usando a entrevista, pelo método da triangulação utilizando o GHQ12 ou pela combinação dos três critérios. Summary: Health workers may be exposed to various factors causing chronic stress namely those related directly to their activity, in particular the decrease in the capacity of the response of antibodies after the administration of the vaccines, amongst others the Influenza vaccine. Since health workers are exposed to factors causing stress and at the same time biological agents, whose effects may be prevented through vaccination, it is important to study the influence of stress in the immunity response to the Influenza vaccine on nurses. The aims of this study are: (1) to examine the relation between chronic stress in hospital nurses and the “insufficient” immunity response to the Influenza vaccine, assessed at one month after vaccination (T1); (2) to examine the relation between chronic stress in hospital nurses and the decrease of the hemagglutinin titles of antibodies six months after vaccination (T6); (3) to identify some characteristics of internment units and the work of the participants that may be related to the presence of chronic stress and to study its possible relation with the immunity response to the Influenza vaccine. A control-case study, integrated in a coortes study, was carried out and the sample under analysis consisted of 136 healthy nurses (83,8% female; average age 33 years old) from a university hospital. Several individual interviews were conducted and the portuguese versions of General Health Questionnaire (GHQ12) and Maslach Burnout Inventory – Human Services Survey (MBI-HSS) was applied in order to determine the presence of chronic stress, using the triangulation method at the beginning of the study (T0). Data concerning the particular features of the internment units was collected. The Influenza vaccine was administered and the titles of hemagglutinin antibodies of each strain composing the Influenza vaccine used in 2007, before vaccination, and a month and six months after vaccination, were determined. There was no statistically relevant (5%) relation between stress and the “insufficient” immune response to the Influenza vaccine, according to the rate of individuals that showed, after a month, a level of antibodies concentration lower than four times the level prior to the vaccination. Nevertheless, there was a greater number of individuals with stress in the group of participants in which there was a decrease of the hemagglutinin titles of antibodies AH1 (ac AH1) in T6, when compared to the control group under study. The difference between groups was statistically relevant when assessing the presence of stress by triangulation method using the interview (p=0,006), by triangulation method using the GHQ12 (p=0,045) and by the combination of the three criteria (p=0,001). After multivariate analysis, it was verified that the XXVIII relation between the presence of stress and the reduction of the ac AH1 in T6 was statistically relevant (respectively, p= 0,010, p= 0,042 and p=0,002) and the odds ratio were, according to each of the methods used to assess the presence of stress, 3,643, 2,733 and 5,223. Overwork was the most emphasised stress-causing factor (58,8% of the sample and 61,8% of the nurses working in the Internment Units), followed by conflicts arousing among co-workers. Witnessing the suffering and death of patients was ranked as the fourth cause of stress, but the second by the nurses of the internment units. The former revealed a positive connection between working in the services, where there was a high rate of deaths, and the presence of stress, when assessing the presence of stress by triangulation method using the interview (p=0,039), the GHQ12 (p=0,019), the MBI-HSS emotional exhaustion scale (p=0,012) and by the combination of the three criteria (p=0,014).There was also a connection between the presence of stress, identified by the method of triangulation using the MBI-HSS emotional exhaustion scale, and working in the internment units, where the percentage of elderly people (p=0,025) and the mortality rate (p=0,036) were high. However, there was no connection between frequent exposure to suffering and death in patients and the reduction of ac AH1 titles, in T6. Although one can establish a connection between stress in nurses working in the internment units and the aforementioned stress-causing factor, the exposure to that factor was not, per se, intense enough to reduce the ac AH1 title in T6. The relation found between the presence of chronic stress and the reduction of AH1 antibodies titles in T6, corroborates the hypothesis that stress can negatively influence the title of antibodies, even in non-elderly adults. Thus, and according to the criteria used to define stress, by the triangulation method using the interview, by the triangulation method using the GHQ12 or the combination of the three criteria respectively, the risk of a nurse suffering from stress showing a reduction in the title of hemagglutinin antibodies for the strain AH1N1 – A/Solomon Islands/3/2006 six-month after Influenza vaccine was 3,6, 2,7 or 5,2 times greater than on a nurse suffering from no stress at all. Résumé: Les professionnels de la santé peuvent être exposés à différents facteurs inducteurs de stress chronique de nature professionnelle. On remarque, parmi les effets possibles, une baisse de la réponse des anticorps après l´administration de vaccins, comme en particulier, le vaccin de la grippe. Lorsque les professionnels de la santé ont été exposés à des facteurs inducteurs de stress, et de manière simultanée, à des agents biologiques dont les effets pourront être prévenus par la vaccination, il est pertinent d´étudier l´influence du stress dans la réponse immunitaire au vaccin de la grippe chez les infirmiers. Ils ont constitué des objectifs d´études et de discussion : (1) étudier l´association entre la présence de stress chronique chez les infirmiers, en milieu hospitalier, et la “insuffisant” réponse immunitaire au vaccin de la grippe, vérifiée à un mois après la vaccination (T1); (2) étudier l´association entre la présence de stress chronique chez les infirmiers, en milieu hospitalier, et la réduction de la teneur des anticorps dirigé à la hémaglutinina six mois après la vaccination (T6) (3) identifier certaines caractéristiques des unités d´internement, et étudier les aspects du travail des participants, qui puissent être associée à la présence de stress chronique et étudier sa possible association avec la réponse immunitaire au vaccin de la grippe. Une étude cas-contrôle incorporée dans une étude de groupe a été réalisée et un échantillon, pour étude, a été constitué par 136 infirmiers sains (83,8% de sexe féminin, âge moyen 33 ans) travaillant dans un hôpital universitaire. Des entretiens individuels ont été réalisés et les versions portugaises des questionnaires de General Health Questionnaire (GHQ12) et Maslach Burnout Inventory- Human Service Survey (MBI-HSS) ont été utilisés pour déterminer la présence de stress chronique grâce à la méthode de triangulation, au début de l´étude (T0) et un relevé de données relatives à la caractérisation d´éléments de travail dans les unités d´internement a été fait. Le vaccin de la grippe a été administré et les teneurs en anticorps dirigés aux hémaglutininas de chaque composant du vaccin de la grippe pour 2007 ont été déterminés, avant la vaccination et un mois et six mois après. On n´a pas trouvé d´association, à un niveau significatif de au moins 5%, entre la présence de stress et la “insuffisant” réponse au vaccin de la grippe, évaluée par le taux d´individus qui ont présenté une augmentation, à la fin du mois, inférieur à quatre fois la teneur des anticorps par rapport à avant la vaccination. Cependant , on a trouvé une plus grande proportion d´individus victimes de stress dans le groupe des participants où il y a eu une baisse de la teneur des anticorps dirigé à la hémaglutinina AH1 (ac AH1) en T6, après comparaison avec le respectif groupe de contrôle. La différence entre les groupes a été statistiquement significative lorsqu´on a vérifié la présence de stress grâce à la méthode de triangulation, en utilisant l´entretien (p=0,006), par la méthode de triangulation en utilisant le GHQ12 (p=0,045) et en utilisant aussi la combinaison des trois critères (p=0,001). Après une analyse XXX multivariée, on a vérifié que l´association entre la présence de stress et la réduction des ac AH1 en T6 a conservé un signifié statistique (respectivement, p=0,010, p=0,042 et p=0,002) et a présenté des odds ratio ajustés, en fonction de chacune des méthodes de vérification de la présence de stress de 3,643, de 2,733 et de 5,223. La quantité de travail perçue comme une surcharge constitue le facteur inducteur de stress le plus souvent cité (58,8% de l´échantillon et 61,8% des infirmiers des unités d´internement), suivi par les conflits entre professionnels. Le contact avec la souffrance et la mort des patients a été placé en quatrième position par l´échantillon, mais en deuxième position par les infirmiers des unités d´internement. Dans ces cas, on a vérifié une association évidente entre le fait de travailler dans des services où le nombre de patients décédés a été très élevé et la présence de stress, identifiée par la méthode de triangulation, en utilisant l´entretien (p=0,039), le GHQ12 (p=0,019), l´échelle de fatigue émotionnelle du MBI-HSS (p=0,012) et en utilisant aussi la combinaison des trois critères (p=0,014). On a aussi vérifié une association positive entre la présence de stress, identifiée par la méthode de triangulation, en utilisant l´échelle de fatigue émotionnelle du MBI-HSS et le travail dans des services d´internement où le pourcentage de malade âgés (p=0,025) et le taux de mortalité ont été élevés (p=0,036). Malgré tout, on n´a pas trouvé d´association entre l´exposition très fréquente à la souffrance et à la mort des patients et la réduction de la teneur de ac AH1 en T6. Probablement l´exposition à ce facteur inducteur de stress, bien qu´elle soit liée à la présence de stress chez les infirmiers des services d´internement, n´a pas été suffisamment intense pour, en elle-même, être associée à la réduction de la teneur ac AH1 enT6. L´association trouvée entre la présence de stress chronique et la réduction de la teneur des anticorps AH1 en T6 vient renforcer l´hypothèse que le stress pourra influencer négativement la manutention des teneurs en anticorps même chez les individus adultes jeunes. Donc le risque qu´un infirmier stressé présente une réduction de la teneur en anticorps dirigés à la hémaglutinina de le composant AH1N1-A/Solomon Island/3/2006 à la fin des six mois d´études a été 3,6, 2,7 ou 5,2 fois supérieure à celui d´un infirmier sans stress, après avoir déterminé le critère de stress, respectivement par la méthode de triangulation utilisant l´entretien, par la méthode de triangulation utilisant le GHQ12 ou par la combinaison des trois critères

Low back pain among hospital nursing assistants

publishersversionpublishe

a systematic review

Publisher Copyright: © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.Objectives: Active duty Navy military personnel are prone to vitamin D deficiency due to an occupational environment detrimental to sunlight exposure. The main objective of this systematic review is to provide a worldwide overview of vitamin D status in this population. Methods: The Condition, Context, Population (CoCoPop) mnemonic was used to define the inclusion criteria (vitamin D status; all contexts; active duty Navy military personnel). Studies with recruits or veterans were excluded. Scopus, Web of Science and PubMed/Medline databases were searched from inception to 30 June 2022. Joanna Briggs Institute and Downs & Black checklists were used for quality assessment and data were synthesised in narrative and tabular formats. Results: Thirteen studies published between 1975 and 2022 and conducted in northern hemisphere Navies, including mainly young and male service members, were included. The prevalence of vitamin D deficiency was globally reported as significant. Nine studies included a total of 305 male submariners who performed 30-92 days submarine patrol and reported the effect of sunlight deprivation in the decrease of vitamin D levels. Conclusions: This new systematic review underlines the high prevalence of vitamin D deficiency in the Navy, especially in submariners, and the need to implement measures to prevent vitamin D deficiency. Serum 25(OH)D data available and the heterogeneity of the studies limited a pooled analysis. Most studies included only submariners, which may limit generalisability to all active duty Navy military personnel. Further research on this topic should be promoted. PROSPERO registration number: CRD42022287057.publishersversionpublishe

job tenure as a potential protective factor

Funding Information: The authors would like to thank Patricia Soares, PhD, from the Portuguese School of Public Health, Lisbon, Portugal, for her assistance in planning and reviewing the statistical analysis of the study and for her contribution to the manuscript scientific writing. Funding Information: The article processing fee has been supported by Lundbeck Portugal. Publisher Copyright: Copyright © 2022 Antao, Sacadura-Leite, Correia and Figueira.Burnout is an impactful occupational health phenomenon to which doctors and nurses have been more exposed during the COVID-19 pandemic. The objectives of this study were to measure the dimensions of burnout—emotional exhaustion, depersonalization and personal accomplishment—in a hospital healthcare population after the second COVID-19 wave and to study their association with sociodemographic variables and previous COVID-19 infection. We invited 112 healthcare professionals (doctors and nurses) who attended the occupational health department of a tertiary hospital in March–July 2021. Emotional exhaustion, depersonalization and personal accomplishment were measured by the Maslach Burnout Inventory. Linear-regression analyses were conducted to explore relationships between burnout dimensions and sociodemographic variables. Differences between groups according to previous COVID-19 infection were verified using the t-test and when appropriate the Mann–Whitney test (for continuous variables), the chi-square test and when appropriate the Fisher exact test (for categorical variables). We surveyed 106 subjects (95% response rate). High emotional exhaustion and depersonalization were reported by 33.0 and 18.4% of participants, respectively; 21.4% reported low personal accomplishment. Job tenure was associated with depersonalization and personal accomplishment. For each 1-year increase in job tenure, depersonalization decreases 0.14 (95% CI [−0.23, −0.04]) and personal accomplishment increases 0.16 (95% CI [0.06, 0.25]). Gender was associated with emotional exhaustion (being male increases emotional exhaustion 5.62-fold [95% CI: 1.33; 9.92]). The prevalence of high emotional exhaustion, high depersonalization and low personal accomplishment after the second COVID-19 wave was relevant and should not be overlooked. Our findings suggest that job tenure may play a protective role in healthcare workers’ burnout.publishersversionpublishe

the incomplete process of an action research in the hospital

Health professionals are at high risk for developing burnout symptoms. Directed at reducing the organizational variables affecting professionals’ burnout, an action research was developed in a specific sector of a large hospital, with 59 doctors, 66 nurses, and 42 ancilliary professionals. Researchers conducted 11 interviews, one focus group, and 20 h of in loco observation. Professionals report demotivation and the need to address the emotional part of their job. Nonetheless, the hierarchy blocked the proposed intervention possibilities. Organizational factors are unequivocally relevant, particularly in complex settings with emotionally charged interactions, and the direct hierarchy is pivotal for facilitating organizational change.publishersversionpublishe

Stresse crónico e a imunidade à vacina contra a gripe em profissionais de saúde

A B S T R A C T - Introduction: Chronic stress can influence immune response to vaccines. Healthcare workersare exposed to stressors and biological hazards, the health effects of which may be preventedthrough vaccination.Objectives: This study aims to evaluate the association between stress in nurses and: (1)insufficient response to influenza vaccine, assessed one month after vaccination (T1); (2)the drop in haemagglutination-inhibition (HAI) antibodies (ab) six months after vaccination(T6).Methods: A nested case–control study was carried out with 136 healthy hospital nurses.Individual interviews, the General Health Questionnaire (GHQ12) and Maslach Burnout Inventory(MBI-HSS) were applied in order to determine the presence of stress, using the triangulationmethod at the beginning of the study (T0). Influenza vaccine was administered and titresof HAI above each strain composing influenza vaccine before vaccination (T0), at T1and T6were assessed.Results: There was no statistically relevant (5%) relationship between stress and the insuffi-cient immune response to the vaccine at T1. Nevertheless, there was an association betweenstress and the drop in HAI ab AH1at T6, when we assessed stress by the triangulation methodusing an interview (p = 0.006), GHQ12(p = 0.045) and combination of criteria (p = 0.001), evenafter multivariate analysis (respectively, p = 0.01, p < 0.05 and p = 0.002). The odds ratios were,respectively, 3.64, 2.73 and 5.22.Conclusions: The association we found, between chronic stress and the drop in HAI ab atT6, corroborates the hypothesis that stress can negatively influence immune response.Therefore, it seems reasonable to consider this issue when we implement vaccinationprogrammes for healthcare workers.R E S U M O - Introdução: O stresse crónico pode influenciar a resposta imunitária à vacinação. Os profissionais de saúde estão expostos a stressores de natureza profissional e ainda a agentes biológicos cujos efeitos poderão ser prevenidos pela vacinação. Objetivos: Estudar a associação entre a presença de stresse e (1) a “insuficiente” resposta imunitária à vacina contra a gripe, avaliada um mês após a vacinação (T1); (2) a redução dos títulos de anticorpos dirigidos às hemaglutininas (HAI) seis meses após a vacinação (T6). Métodos: Realizou-se um estudo caso-controlo incorporado num estudo de coortes com a participação de 136 enfermeiros hospitalares saudáveis. Realizaram-se entrevistas individuais e aplicaram-se os questionários The General Health Questionnaire (GHQ12) e Maslach Burnout Inventory (MBI-HSS) para determinação da presença de stresse crónico pelo método da triangulação, no início do estudo (T0). Foi administrada a vacina contra a gripe e determinou-se os títulos de HAI dirigidos a cada estirpe componentes da vacina contra a gripe, antes da vacinação(T0), em T1 e em T6. Resultados: Não se encontrou associação significativa (5%) entre a presença de stress e a “insuficiente” resposta à vacina contra a gripe em T1. Contudo, encontrou-se uma associação entre a presença de stress e a diminuição do título de HAI dirigidos à estirpe A(H1N1) em T6 quando se avaliou a presença de stresse pelo método da triangulação usando a entrevista (p=0,006), o GHQ12 (p=0,045) e a combinação dos três critérios (p=0,001), que se manteve após análise multivariada (respetivamente p=0,01, p<0.05 e p=0.002). Os odds ratio ajustados foram de 3,64, de 2,73 e de 5,22. Conclusões: A associação encontrada entre a presença de stresse crónico e a redução do título de HAI em T6 vem apoiar a hipótese de que o stresse poderá influenciar negativamente a manutenção dos títulos de anticorpos, mesmo em indivíduos adultos não idosos. Assim, parece razoável considerar este aspeto quando se pretende implementar programas de vacinação dirigidos a profissionais de saúde.info:eu-repo/semantics/publishedVersio

Stresse crónico e a imunidade à vacina contra a gripe em profissionais de saúde

A B S T R A C T - Introduction: Chronic stress can influence immune response to vaccines. Healthcare workersare exposed to stressors and biological hazards, the health effects of which may be preventedthrough vaccination.Objectives: This study aims to evaluate the association between stress in nurses and: (1)insufficient response to influenza vaccine, assessed one month after vaccination (T1); (2)the drop in haemagglutination-inhibition (HAI) antibodies (ab) six months after vaccination(T6).Methods: A nested case–control study was carried out with 136 healthy hospital nurses.Individual interviews, the General Health Questionnaire (GHQ12) and Maslach Burnout Inventory(MBI-HSS) were applied in order to determine the presence of stress, using the triangulationmethod at the beginning of the study (T0). Influenza vaccine was administered and titresof HAI above each strain composing influenza vaccine before vaccination (T0), at T1and T6were assessed.Results: There was no statistically relevant (5%) relationship between stress and the insuffi-cient immune response to the vaccine at T1. Nevertheless, there was an association betweenstress and the drop in HAI ab AH1at T6, when we assessed stress by the triangulation methodusing an interview (p = 0.006), GHQ12(p = 0.045) and combination of criteria (p = 0.001), evenafter multivariate analysis (respectively, p = 0.01, p < 0.05 and p = 0.002). The odds ratios were,respectively, 3.64, 2.73 and 5.22.Conclusions: The association we found, between chronic stress and the drop in HAI ab atT6, corroborates the hypothesis that stress can negatively influence immune response.Therefore, it seems reasonable to consider this issue when we implement vaccinationprogrammes for healthcare workers.R E S U M O - Introdução: O stresse crónico pode influenciar a resposta imunitária à vacinação. Os profissionais de saúde estão expostos a stressores de natureza profissional e ainda a agentes biológicos cujos efeitos poderão ser prevenidos pela vacinação. Objetivos: Estudar a associação entre a presença de stresse e (1) a “insuficiente” resposta imunitária à vacina contra a gripe, avaliada um mês após a vacinação (T1); (2) a redução dos títulos de anticorpos dirigidos às hemaglutininas (HAI) seis meses após a vacinação (T6). Métodos: Realizou-se um estudo caso-controlo incorporado num estudo de coortes com a participação de 136 enfermeiros hospitalares saudáveis. Realizaram-se entrevistas individuais e aplicaram-se os questionários The General Health Questionnaire (GHQ12) e Maslach Burnout Inventory (MBI-HSS) para determinação da presença de stresse crónico pelo método da triangulação, no início do estudo (T0). Foi administrada a vacina contra a gripe e determinou-se os títulos de HAI dirigidos a cada estirpe componentes da vacina contra a gripe, antes da vacinação(T0), em T1 e em T6. Resultados: Não se encontrou associação significativa (5%) entre a presença de stress e a “insuficiente” resposta à vacina contra a gripe em T1. Contudo, encontrou-se uma associação entre a presença de stress e a diminuição do título de HAI dirigidos à estirpe A(H1N1) em T6 quando se avaliou a presença de stresse pelo método da triangulação usando a entrevista (p=0,006), o GHQ12 (p=0,045) e a combinação dos três critérios (p=0,001), que se manteve após análise multivariada (respetivamente p=0,01, p<0.05 e p=0.002). Os odds ratio ajustados foram de 3,64, de 2,73 e de 5,22. Conclusões: A associação encontrada entre a presença de stresse crónico e a redução do título de HAI em T6 vem apoiar a hipótese de que o stresse poderá influenciar negativamente a manutenção dos títulos de anticorpos, mesmo em indivíduos adultos não idosos. Assim, parece razoável considerar este aspeto quando se pretende implementar programas de vacinação dirigidos a profissionais de saúde.info:eu-repo/semantics/publishedVersio

a contribution to improving quality and patient safety

PMID: 25034870 Scopus ID: 84904271100 WOS: 000339571900001publishersversionpublishe

a systematic review of literature

publishersversionepub_ahead_of_prin