Factores estresores y síndrome de Burnout en enfermeras de cuidados intensivos en dos hospitales de EsSalud nivel III-2 Lima Metropolitana

Estudios de Europa determinan la prevalencia de Burnout en enfermeras entre 10-30%, en Perú afecta al 11%, con gran repercusión en la salud física y mental; siendo las unidades de cuidados intensivos un área de alta presión laboral y carga psico-emocional. Objetivo: determinar los factores estresores asociados al síndrome de Burnout en enfermeras de UCI de hospitales de EsSalud nivel III-2, Lima-Metropolitana. Metodología: estudio cuantitativo, diseño descriptivo correlacional, considerando una población de 114 enfermeras de UCI, se utilizó dos instrumentos: Inventario de Burnout de Maslach y cuestionado de Respuesta Emocional al Estrest laboral. Los datos se recolectaron en agosto/2014, fueron analizados en paquete estadístico SPSS v.21 usando estadística descriptiva para las univariables y chi2 de Pearson para las bivariables. Resultados: el 60% de enfermeras presenta factores estresores en nivel medio y 22% nivel alto, destacándose en el análisis por factores “presión y exigencia” y “organizativos y relaciones humanas” con nivel medio y “ambientales” nivel alto. Respecto al síndrome de Burnout, el 7% estaba quemado y 84% tenía tendencia a desarrollarlo. La correlación de variables mostró que los factores estresores están asociados con el síndrome de Burnout. Conclusiones: existe relación entre las variables, siendo necesario implementar mejoras acorde con las recomendaciones internacionales

La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia. Departamento de Cundinamarca.

Árbol de Problemas donde se evidencian las causas del problema (sus raíces), el problema central (el tallo) y efectos y consecuencias del problema (las hojas). Matriz Formulación de preguntas circulares, reflexivas y estratégicasEl siguiente documento tiene como finalidad reflexionar frente a diferentes situaciones que vive nuestro país en medio del conflicto armado y como desde nuestro rol como futuros psicólogos es importante intervenir y potenciar habilidades psicosociales en los individuos y comunidades afectadas. A través de 4 actividades se desarrolla el presente trabajo donde inicialmente se realiza una aproximación al enfoque narrativo y el análisis de relatos, realizado por cada integrante del grupo 4 basándose en las lecturas de relatos de vida. Seguidamente de forma colaborativa se realizaron retroalimentaciones donde se escogió un solo caso para ampliar su reflexión “José Ignacio”. Se implementaron preguntas circulares, reflexivas y estratégicas del caso escogido “José Ignacio” con el fin de establecer un acercamiento psicosocial donde se conozcan detalles de los sucesos vividos por el individuo, generando una sensibilización en aras de mejorar su estado físico y emocional y así mismo lo refleje en la comunidad donde se encuentra inmerso actualmente. También se trabajó sobre el caso de las comunidades de Cacarica, analizando la afectación de esta población y proponiendo desde la psicología estrategias que potencien y empoderen a la comunidad frente a los eventos traumáticos vividos en medio del conflicto armado. Finalmente se presenta el informe analítico y reflexivo del trabajo realizado en la fase anterior “foto voz”, que permitió un acercamiento a las diferentes comunidades.The following document aims to reflect on different situations that our country is experiencing in the midst of the armed conflict and as from our role as future psychologists it is important to intervene and enhance psychosocial skills in the affected individuals and communities. Through 4 activities the present work is developed where initially an approximation to the narrative approach and the analysis of stories is carried out, carried out by each member based on the readings of life stories. Then, in a collaborative way, feedback was done where only one case was chosen to broaden its reflection. Circular, reflexive and strategic questions of the chosen case "José Ignacio" were implemented in order to establish a psychosocial approach where details of the events lived by the individual are known. We also worked on the case of the communities of Cacarica, analyzing the impact of this population and proposing strategies from psychology that empower and empower the community against the traumatic events experienced in the midst of the armed conflict. Finally, the analytical and reflective report of the work carried out in the previous phase "foto voz", which allowed an approach to the different communities, is presented. Keyword: Victims, Violence, Psychosocial strategies, Intervention, community

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