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      Síndrome de Burnout en médicos/as y enfermeros/as ecuatorianos durante la pandemia de COVID-19 Translated title: Burnout syndrome among Ecuadorian medical doctors and nurses during COVID-19 pandemic


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          RESUMEN. Objetivo: Determinar la ocurrencia e intensidad de Síndrome de Burnout (SB) en médicos y enfermeros/as ecuatorianos/as durante la pandemia del COVID-19. Material y métodos: Estudio observacional de corte transversal. Participaron 224 médicos/as y enfermeros/as de establecimientos de la red integral de salud ecuatoriana, a quienes se administró el Inventario de Burnout de Maslach. Se analizaron los datos a través de modelos de regresión lineal usando R. Resultados: Más del 90% del personal médico y de enfermería presento SB moderado-severo, el cual se asoció de manera estadísticamente significativa a función (médico vs. enfermera/o), edad y género. El personal médico es afectado con mayor frecuencia que el personal de enfermería, tanto a nivel global como en las subescalas de agotamiento emocional y despersonalización. Conclusión: Durante la pandemia de COVID-19 más del 90% del personal médico y de enfermería presentó SB moderado a severo, siendo el personal médico el afectado con más frecuencia.

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          ABSTRACT Objective: To determine the occurrence and intensity of Burnout Syndrome (SB) in Ecuadorian doctors and nurses during the COVID-19 pandemic. Materials and methods: Observational cross-sectional study. 224 physicians and nurses from establishments of the Ecuadorian comprehensive health network participated. Participants were administered the Maslach Burnout Inventory. Data were analyzed through linear regression models using R. Results: More than 90% of the medical and nursing staff presented moderate-severe SB, which was statistically significantly associated with function (doctor vs. nurse), age and gender. Medical personnel were affected more frequently than nursing personnel, both globally and on the emotional exhaustion and depersonalization subscales. Conclusions: During the COVID-19 pandemine more than 90% of the medical and nursing personnel presented moderate to severe SB, with the medical staff being the most frequently affected.

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          Online mental health services in China during the COVID-19 outbreak

          At the start of 2020, the 2019 coronavirus disease (COVID-19), originating from Wuhan in Hubei province, started to spread throughout China. As a result of the rapidly increasing numbers of confirmed cases and deaths, both medical staff and the public have been experiencing psychological problems, including anxiety, depression, and stress.1, 2 Since January, 2020, the National Health Commission of China have published several guideline documents, starting with the notification of principles for emergency psychological crisis intervention for the COVID-19 epidemic on January 26, then the notice on establishing psychological assistance hotlines for the epidemic on February 2, and most recently, guidelines for psychological assistance hotlines during the COVID-19 epidemic on February 7. 3 During the severe acute respiratory syndrome epidemic in 2003, internet services and smartphones were not widely available. Therefore, few online mental health services were provided for those in need. 4 The popularisation of internet services and smartphones, and the emergence of fifth generation (5G) mobile networks, have enabled mental health professionals and health authorities to provide online mental health services during the COVID-19 outbreak. Fast transmission of the virus between people hinders traditional face-to-face psychological interventions. By contrast, provision of online mental health services is safe. To date, several types of online mental health services have been implemented widely for those in need during the outbreak in China. Firstly, as of Feb 8, 2020, 72 online mental health surveys associated with the COVID-19 outbreak could be searched for via the WeChat-based survey programme Questionnaire Star, which target different populations, including medical staff (23 of the surveys), patients with COVID-19 (one survey), students (18 surveys), the general population (nine surveys), and mixed populations (21 surveys); in Hubei province (five surveys), other provinces (15 surveys), all provinces, municipalities, and autonomous regions (36 surveys), and unspecified areas of China (16 surveys). One such multicentre survey involving 1563 medical staff, with our centre at Nanfang Hospital, Southern Medical University (Guangzhou, China) as one of the study sites, found the prevalence of depression (defined as a total score of ≥5 in the Patient Health Questionnaire-9) to be 50·7%, of anxiety (defined as a total score of ≥5 in the Generalized Anxiety Disorder-7) to be 44·7%, of insomnia to be 36·1% (defined as a total score of ≥8 in the Insomnia Severity Index), and of stress-related symptoms (defined as a total score of ≥9 in the Impact of Events Scale-Revised) to be 73·4%. These findings are important in enabling health authorities to allocate health resources and develop appropriate treatments for medical staff who have mental health problems. Secondly, online mental health education with communication programmes, such as WeChat, Weibo, and TikTok, has been widely used during the outbreak for medical staff and the public. In addition, several books on COVID-19 prevention, control, and mental health education have been swiftly published and free electronic copies have been provided for the public. As of February 8, 29 books associated with COVID-19 have been published, 11 (37·9%) of which are on mental health, including the “Guidelines for public psychological self-help and counselling of 2019-nCoV pneumonia”, published by the Chinese Association for Mental Health. Finally, online psychological counselling services (eg, WeChat-based resources) have been widely established by mental health professionals in medical institutions, universities, and academic societies throughout all 31 provinces, municipalities, and autonomous regions in mainland China, which provide free 24-h services on all days of the week. Online psychological self-help intervention systems, including online cognitive behavioural therapy for depression, anxiety, and insomnia (eg, on WeChat), have also been developed. In addition, several artificial intelligence (AI) programmes have been put in use as interventions for psychological crises during the epidemic. For example, individuals at risk of suicide can be recognised by the AI programme Tree Holes Rescue, 5 by monitoring and analysing messages posted on Weibo, and alerting designated volunteers to act accordingly. In general, online mental health services being used for the COVID-19 epidemic are facilitating the development of Chinese public emergency interventions, and eventually could improve the quality and effectiveness of emergency interventions.
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            Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore

            Background: In response to the coronavirus 2019 (COVID-19) pandemic, Singapore raised its Disease Outbreak Response System Condition alert to “orange,” the second highest level. Between 19 February and 13 March 2020, confirmed cases rose from 84 to 200 (34.2 per 1 000 000 population), with an increase in patients in critical condition from 4 to 11 (5.5%) and no reported deaths in Singapore (1). Understanding the psychological impact of the COVID-19 outbreak among health care workers is crucial in guiding policies and interventions to maintain their psychological well-being. Objective: We examined the psychological distress, depression, anxiety, and stress experienced by health care workers in Singapore in the midst of the outbreak, and compared these between medically and non–medically trained hospital personnel. Methods and Findings: From 19 February to 13 March 2020, health care workers from 2 major tertiary institutions in Singapore who were caring for patients with COVID-19 were invited to participate with a self-administered questionnaire. In addition to information on demographic characteristics and medical history (Table 1), the questionnaire included the validated Depression, Anxiety, and Stress Scales (DASS-21) and the Impact of Events Scale–Revised (IES-R) instrument (2, 3). Health care workers included “medical” (physicians, nurses) and “nonmedical” personnel (allied health professionals, pharmacists, technicians, administrators, clerical staff, and maintenance workers). The primary outcome was the prevalence of depression, stress, anxiety, and posttraumatic stress disorder (PTSD) among all health care workers (Table 2). Secondary outcomes were comparison of the prevalence of depression, anxiety, stress, and PTSD, and mean DASS-21 and IES-R scores between medical and nonmedical health care workers. The Pearson χ2 test and Student t test were used to compare categorical and continuous outcomes, respectively, between the 2 groups. Multivariable regression was used to adjust for the a priori defined confounders of age, sex, ethnicity, marital status, presence of comorbid conditions, and survey completion date. Table 1. Participant Characteristics at Baseline Table 2. Prevalence of Depression, Anxiety, Stress, and PTSD and Mean DASS-21 and IES-R Scores in Medical and Nonmedical Health Care Personnel (N = 470) Of 500 invited health care workers, 470 (94%) participated in the study; baseline characteristics are shown in Table 1. Sixty-eight (14.5%) participants screened positive for anxiety, 42 (8.9%) for depression, 31 (6.6%) for stress, and 36 (7.7%) for clinical concern of PTSD. The prevalence of anxiety was higher among nonmedical health care workers than medical personnel (20.7% versus 10.8%; adjusted prevalence ratio, 1.85 [95% CI, 1.15 to 2.99]; P = 0.011), after adjustment for age, sex, ethnicity, marital status, survey completion date, and presence of comorbid conditions. Similarly, higher mean DASS-21 anxiety and stress subscale scores and higher IES-R total and subscale scores were observed in nonmedical health care workers (Table 2). Discussion: Overall mean DASS-21 and IES-R scores among health care workers were lower than those in the published literature from previous disease outbreaks, such as the severe acute respiratory syndrome (SARS). A previous study in Singapore found higher IES scores among physicians and nurses during the SARS outbreak, and an almost 3 times higher prevalence of PTSD, than those in our study (4). This could be attributed to increased mental preparedness and stringent infection control measures after Singapore's SARS experience. Of note, nonmedical health care workers had higher prevalence of anxiety even after adjustment for possible confounders. Our findings are consistent with those of a recent COVID-19 study demonstrating that frontline nurses had significantly lower vicarious traumatization scores than non–frontline nurses and the general public (5). Reasons for this may include reduced accessibility to formal psychological support, less first-hand medical information on the outbreak, less intensive training on personal protective equipment and infection control measures. As the pandemic continues, important clinical and policy strategies are needed to support health care workers. Our study identified a vulnerable group susceptible to psychological distress. Educational interventions should target nonmedical health care workers to ensure understanding and use of infectious control measures. Psychological support could include counseling services and development of support systems among colleagues. Our study has limitations. First, data obtained from self-reported questionnaires were not verified with medical records. Second, the study did not assess socioeconomic status, which may be helpful in evaluating associations of outcomes and tailoring specific interventions. Finally, the study was performed early in the outbreak and only in Singapore, which may limit the generalizability of the findings. Follow-up studies could help assess for progression or even a potential rebound effect of psychological manifestations once the imminent threat of COVID-19 subsides. In conclusion, our study highlights that nonmedical health care personnel are at highest risk for psychological distress during the COVID-19 outbreak. Early psychological interventions targeting this vulnerable group may be beneficial.
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              Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis

              Physician burnout has reached epidemic levels, as documented in national studies of both physicians in training and practising physicians. The consequences are negative effects on patient care, professionalism, physicians' own care and safety, and the viability of health-care systems. A more complete understanding than at present of the quality and outcomes of the literature on approaches to prevent and reduce burnout is necessary.

                Author and article information

                Revista de la Asociación Española de Especialistas en Medicina del Trabajo
                Rev Asoc Esp Espec Med Trab
                Asociación Española de Especialistas en Medicina del Trabajo (Madrid, Madrid, Spain )
                : 29
                : 4
                : 330-339
                [4] Santa Ana orgnameCentro de Salud Rural “Puerto Santa Ana” Ecuador
                [6] Riobamba Chimborazo orgnameEscuela Superior Politécnica de Chimborazo orgdiv1Escuela de Medicina Ecuador
                [1] Chapintza orgnameCentro de Salud Rural “Chapintza” Ecuador
                [5] Valencia Valencia orgnameUniversitat de Valencia orgdiv1Departamento de Farmacia y Tecnología Farmacéutica y Parasitología Spain
                [2] Ambato Tungurahua orgnameUniversidad Técnica de Ambato orgdiv1Consultorio Jurídico Integral Gratuito Ecuador
                [3] Riobamba Chimborazo orgnameEscuela Superior Politécnica de Chimborazo orgdiv1Escuela de Medicina Ecuador
                S1132-62552020000400330 S1132-6255(20)02900400330

                This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 36, Pages: 10

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                Textos Originales

                Burnout Syndrome,COVID-19,Síndrome de Burnout,personal de salud,health personnel


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