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Cuidando al profesorado: resultados de un programa a distancia de autocuidado para educadores de profesiones de la salud
Caring for faculty: Results of a self-care online program for health professions educators
Denisse Zúñigaa,
Autor para correspondencia
dzunigpa@uc.cl

Autor para correspondencia.
, Guadalupe Echeverríab,c, Pía Nitsched, Nuria Pedralsc, Attilio Rigottib,c, Marisol Sirhana, Klaus Puschela, Marcela Bitrana
a Centro de Educación Médica y Ciencias de la Salud, Facultad de Medicina, Pontifica Universidad Católica de Chile, Santiago, Chile
b Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
c Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
d Departamento de Psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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agotamiento emocional y en algunos pa&#237;ses como Chile prevaleci&#243; la sintomatolog&#237;a depresiva e ideaci&#243;n suicida<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a>&#46; Estos hallazgos no solo dan cuenta del perfil de los profesionales que enfrentaron la sobrecarga in&#233;dita propia del trabajo en primera l&#237;nea&#44; sino que&#44; adem&#225;s la combinaron con actividades docentes&#46; Dado que los contextos desafiantes y la sobrecarga al parecer no cesar&#225;n&#44; el enfrentamiento del desgaste profesional requiere la implementaci&#243;n y evaluaci&#243;n de iniciativas individuales e institucionales que promuevan h&#225;bitos saludables y el desarrollo de estrategias adaptativas para el manejo del estr&#233;s<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="p0010" class="elsevierStylePara elsevierViewall">El profesionalismo suele explicitar la responsabilidad que tienen los profesionales sobre su propia salud f&#237;sica y mental para el apropiado ejercicio de su profesi&#243;n<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a>&#46; Sin embargo&#44; a pesar de ser conocida la asociaci&#243;n entre faltas al profesionalismo y los problemas de salud derivados de la sobrecarga&#44; en la pr&#225;ctica&#44; aun son insuficientes las oportunidades para el desarrollo de una cultura de autocuidado&#46; Todav&#237;a pareciera prevalecer una aparente incompatibilidad entre la perspectiva de la excelencia profesional basada en el &#171;hacer bien&#187; y el &#171;bien estar&#187;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">Desde un enfoque educativo&#44; basado en la evidencia e intentando hacer propia la tarea de promover el autocuidado&#44; se realiz&#243; un diagn&#243;stico de prevalencia del desgaste profesional e indicadores de bienestar en estudiantes de Medicina chilenos<a class="elsevierStyleCrossRef" href="#bb0065"><span class="elsevierStyleSup">13</span></a>&#46; Posteriormente&#44; el dise&#241;o e implementaci&#243;n de un programa de promoci&#243;n del autocuidado que obtuvo resultados auspiciosos determin&#243; que el aprendizaje de estas estrategias formara parte de los contenidos m&#237;nimos de la carrera de Medicina de una de las instituciones participantes<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a>&#46; En esta experiencia educativa detectamos la necesidad que los profesores ten&#237;an por aprender a cultivar su propio bienestar&#46; Es as&#237; como parte del conocimiento adquirido se transfiri&#243; al dise&#241;o de una propuesta de autocuidado para el profesorado y se incluy&#243; como un curso m&#225;s del Diplomado en docencia&#46;</p><p id="p0020" class="elsevierStylePara elsevierViewall">Con el inter&#233;s de generar evidencia sobre la pertinencia de la iniciativa en el profesorado&#44; el presente estudio tiene por objetivo examinar los resultados de la intervenci&#243;n a trav&#233;s de la medici&#243;n de los indicadores de desgaste profesional y bienestar subjetivo de los participantes del programa en sus 2 primeras versiones&#46; Para cumplir con este objetivo se describir&#225; el dise&#241;o del programa y presentar&#225;n los resultados de la implementaci&#243;n&#46;</p><p id="p0025" class="elsevierStylePara elsevierViewall">Esperamos que los hallazgos de este art&#237;culo contribuyan&#44; por una parte&#44; a sensibilizar sobre la pertinencia y efecto multiplicador que tiene promover el autocuidado entre los profesores&#44; modelos responsables de formar a los futuros profesionales de la salud&#59; y por otra&#44; difundir estrategias educativas de autocuidado factibles de implementar y medir con instrumentos validados&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Material y m&#233;todos</span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Dise&#241;o del estudio</span><p id="p0030" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio cuantitativo que analiz&#243; los indicadores de desgaste profesional y bienestar subjetivo de los participantes del programa de autocuidado&#46; Un total de 148 participantes se inscribieron entre 2020 y 2021&#46;</p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Dise&#241;o del programa &#171;Bases cient&#237;ficas del bienestar y herramientas de autocuidado para profesionales de la salud&#187;</span><p id="p0035" class="elsevierStylePara elsevierViewall">El Programa de autocuidado corresponde al segundo curso de un total de 5 que ofrece el &#171;Diplomado de docencia universitaria para profesionales de la salud&#187; del Centro de Educaci&#243;n M&#233;dica y Ciencias de la Salud de la Pontificia Universidad Cat&#243;lica de Chile<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a>&#46; Se fundamenta en principios te&#243;ricos y evidencia emp&#237;rica sobre el bienestar formulado por referentes de la psicolog&#237;a y la medicina&#46; Bienestar psicol&#243;gico de Keyes y Ryff<a class="elsevierStyleCrossRef" href="#bb0085"><span class="elsevierStyleSup">17</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a>&#59; psicolog&#237;a positiva de Seligman<a class="elsevierStyleCrossRef" href="#bb0095"><span class="elsevierStyleSup">19</span></a>&#59; s&#237;ndrome de desgaste profesional seg&#250;n Maslach<a class="elsevierStyleCrossRef" href="#bb0100"><span class="elsevierStyleSup">20</span></a>&#59; autocompasi&#243;n propuesta por Neff<a class="elsevierStyleCrossRef" href="#bb0105"><span class="elsevierStyleSup">21</span></a>&#59; atenci&#243;n plena de Gilbert<a class="elsevierStyleCrossRef" href="#bb0110"><span class="elsevierStyleSup">22</span></a>&#44; as&#237; como su aplicaci&#243;n en la pr&#225;ctica m&#233;dica formulada por Epstein<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a>&#44; fueron los principales modelos que inspiraron el dise&#241;o del programa&#46;</p><p id="p0040" class="elsevierStylePara elsevierViewall">El programa tiene como prop&#243;sito que los participantes adquieran conocimientos acerca de los factores de riesgo del s&#237;ndrome de desgaste profesional&#44; los modelos de bienestar y algunas pr&#225;cticas de autocuidado basadas en mindfulness&#44; autorregulaci&#243;n y escritura reflexiva&#46; Los contenidos se organizaron en 5 m&#243;dulos&#58; el primero revisa la evidencia sobre la prevalencia del s&#237;ndrome de desgaste profesional en el &#225;rea de la salud&#44; sus factores de riesgo y prevenci&#243;n y algunos modelos cient&#237;ficos del bienestar&#46; El segundo y tercero&#44; dan cuenta de las estrategias desadaptativas y adaptativas de emociones y pensamientos&#46; Los &#250;ltimos 2 m&#243;dulos abordan el cultivo de relaciones positivas hacia uno mismo y los dem&#225;s&#44; y h&#225;bitos saludables &#40;<a class="elsevierStyleCrossRef" href="#f0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><p id="p0045" class="elsevierStylePara elsevierViewall">La intervenci&#243;n tiene una duraci&#243;n de 5 semanas y se gestiona a trav&#233;s de la plataforma Moodle&#46; La modalidad a distancia es preferentemente asincr&#243;nica&#44; 2 sesiones sincr&#243;nicas est&#225;n destinadas a la introducci&#243;n y cierre del curso&#46; Las estrategias de ense&#241;anza-aprendizaje privilegian y promueven el estudio independiente&#44; la autoobservaci&#243;n y reflexi&#243;n&#44; la autorregulaci&#243;n y el autoconocimiento&#46; Los m&#233;todos de ense&#241;anza-aprendizaje incluyen&#58; revisi&#243;n de video-clases de expertos&#44; lectura de art&#237;culos cient&#237;ficos para la profundizaci&#243;n de los contenidos&#44; pr&#225;cticas de atenci&#243;n plena y escritura reflexiva&#46; Los aprendizajes son evaluados a trav&#233;s de preguntas breves de contenido al final de las video-clases y controles de aseguramiento de la lectura&#46; La parte experiencial incluye escritura de reflexiones sobre las actividades de observaci&#243;n de las propias emociones&#44; pensamientos y h&#225;bitos de vida saludable&#46; Cada participante recibe retroalimentaci&#243;n de sus reflexiones escritas&#46;</p><p id="p0050" class="elsevierStylePara elsevierViewall">Tanto la versi&#243;n 2020 y 2021 cont&#243; con 6 tutores&#44; mismos autores que dise&#241;aron el programa&#46; Cada tutor ten&#237;a conocimientos previos en ciencias del bienestar y formaci&#243;n en diversas pr&#225;cticas de atenci&#243;n plena&#46; Adicionalmente&#44; se capacitaron en pr&#225;cticas de atenci&#243;n plena y autocompasi&#243;n basadas en el modelo de Kristin Neff&#46; Cada tutor estuvo a cargo de la revisi&#243;n y retroalimentaci&#243;n individual de los textos reflexivos de 11 a 12 participantes&#46;</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0085">Instrumentos y procedimiento</span><p id="p0055" class="elsevierStylePara elsevierViewall">Cinco cuestionarios de autoreporte validados en espa&#241;ol fueron respondidos por los participantes a trav&#233;s de un formulario electr&#243;nico al inicio &#40;t1&#41; y al t&#233;rmino del programa &#40;t2&#41;&#46; Las repuestas derivaron a una base de datos independiente a la que solo accedi&#243; la investigadora responsable del proyecto&#46; Cada participante recibi&#243; un mail personal con el informe de los resultados que obtuvo en cada medici&#243;n&#46;</p><p id="p0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">S&#237;ndrome de desgaste profesional</span> fue evaluado con el Maslach <span class="elsevierStyleItalic">Burnout Inventory-Human Services Survey</span> &#40;MBI-HSS&#59; Maslach&#44; 1986&#41;&#46; Veintid&#243;s &#237;tems consultan sobre la frecuencia con la que se experimentan las emociones en determinadas situaciones propuestas&#46; El MBI-HSS se responde utilizando una escala Likert &#40;1 &#61; nunca a 7 &#61; diariamente&#41;&#46; El inventario informa de 3 subescalas&#58; agotamiento emocional&#44; despersonalizaci&#243;n y realizaci&#243;n personal&#46; Tambi&#233;n clasifica el s&#237;ndrome de desgaste profesional en 3 niveles&#58; alto&#44; moderado y bajo que se determinan a trav&#233;s de puntos de corte definidos para cada subescala&#46; Para el presente estudio&#44; el MBI-HSS se analizar&#225; como variable continua&#44; tomando en cuenta la puntuaci&#243;n obtenida en cada subescala<a class="elsevierStyleCrossRef" href="#bb0100"><span class="elsevierStyleSup">20</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="p0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Bienestar Psicosocial</span> se examin&#243; con el cuestionario <span class="elsevierStyleItalic">Mental Health Continuum Short-Form</span> &#40;MHC-SF&#59; Keyes&#44; 2008&#41;&#46; Contiene 14 &#237;tems que consultan sobre cu&#225;n a menudo se sienten las personas en el &#250;ltimo mes&#46; Las opciones de respuesta corresponden a una escala Likert &#40;0 &#61; nunca a 6 &#61; diariamente&#41;&#46; El MHC-SF tiene como prop&#243;sito evaluar la salud mental subjetiva en sus componentes&#58; emocional&#44; psicol&#243;gico y social&#46; Tambi&#233;n pueden categorizar los resultados en 3 niveles de salud mental&#58; floreciente&#44; moderado y languideciente&#46; El MHC-SF ser&#225; analizado como variable continua&#44; utilizando el puntaje por componente y total<a class="elsevierStyleCrossRef" href="#bb0085"><span class="elsevierStyleSup">17</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="p0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Afectividad</span> o <span class="elsevierStyleItalic">Positive and Negative Affect Scale</span> &#40;PANAS&#59; Watson&#44; Clarck y Tellegen&#44; 1988&#41; en su versi&#243;n breve&#44; tiene como prop&#243;sito identificar la afectividad positiva &#40;AP&#41; y negativa &#40;AN&#41; asociada a sentimientos y emociones habituales&#46; Cada subescala del PANAS&#44; AP y AN&#44; contiene 10 &#237;tems&#46; El formato de respuesta es tipo Likert &#40;1 &#61; muy leve o nada en absoluto a 5 &#61; extremadamente&#41;&#46; Se obtiene una puntuaci&#243;n global para cada subescala y la raz&#243;n entre ambas &#40;AP&#47;AN&#41;<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="p0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Vitalidad Subjetiva</span> evaluada con la <span class="elsevierStyleItalic">Subjective Vitality Scale</span> &#40;SVS&#59; Ryan y Frederick&#44; 1997&#41; mide el grado en que las 7 afirmaciones presentadas son consideradas verdaderas&#46; Las respuestas se recogen en una escala tipo Likert &#40;1 &#61; no es verdad a 7 &#61; verdadero&#41;&#46; Los resultados se expresan en un puntaje global que da cuenta del grado de viveza y energ&#237;a de los sentimientos subjetivos<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="p0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Atenci&#243;n Plena</span> o <span class="elsevierStyleItalic">Mindful Attention Awareness Scale</span> &#40;MAAS&#59; Brown &#38; Bryan&#44; 2003&#41; es un cuestionario de 14 &#237;tems que mediante una escala likert &#40;1 &#61; casi nunca a 6 &#61; casi siempre&#41; permite identificar la frecuencia del estado de atenci&#243;n plena de sensaciones&#44; emociones y pensamientos en la vida cotidiana&#46; La puntuaci&#243;n obtenida en el MAAS corresponde a un promedio general de atenci&#243;n plena disposicional<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a>&#46;</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0090">An&#225;lisis estad&#237;stico</span><p id="p0085" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis de los resultados se realiz&#243; una caracterizaci&#243;n de los participantes&#44; el an&#225;lisis de confiabilidad de los instrumentos y la comparaci&#243;n de medias de la medici&#243;n en t1 y t2&#46; Los descriptivos se reportaron en n&#250;mero y porcentaje&#59; mientras que los indicadores del s&#237;ndrome de desgaste profesional y los relacionados al bienestar subjetivo se expresaron como variables continuas&#46; Los resultados por indicador se expresaron a trav&#233;s de los estad&#237;grafos media&#44; desviaci&#243;n est&#225;ndar y diferencia de medias&#46;</p><p id="p0090" class="elsevierStylePara elsevierViewall">Luego&#44; se analiz&#243; el nivel de confiabilidad de los instrumentos a partir de las pruebas Alfa de Cronbach y Omega de McDonald con base en las 148 mediciones disponibles en t1&#46; Se complement&#243; con Omega de McDonald porque ofrece una mayor precisi&#243;n en el c&#225;lculo del coeficiente<a class="elsevierStyleCrossRef" href="#bb0145"><span class="elsevierStyleSup">29</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0150"><span class="elsevierStyleSup">30</span></a>&#46; El procedimiento concluye con la comparaci&#243;n de medias de t1 y t2 para el grupo total&#44; y separados por sexo&#44; cohorte y profesi&#243;n&#46; Se incluye el an&#225;lisis de t1 y t2 por separado&#46;</p><p id="p0095" class="elsevierStylePara elsevierViewall">Para la comparaci&#243;n de medias se utiliz&#243; el test W de Wilcoxon&#46; El an&#225;lisis se complement&#243; con las pruebas Shapiro-Wilks para el contraste de normalidad de la distribuci&#243;n en muestras pareadas y U de Mann-Whitney en el caso de muestras independientes<a class="elsevierStyleCrossRef" href="#bb0150"><span class="elsevierStyleSup">30</span></a>&#46; Se consideraron significativos valores de p <span class="elsevierStyleUnderline">&#60;</span> 0&#44;05&#46; El an&#225;lisis estad&#237;stico del estudio se realiz&#243; con los programas Microsoft Excel &#40;2023&#41;&#44; v&#46;16&#46;71 y <span class="elsevierStyleItalic">The Jamovi Project</span> &#40;2022&#41;&#44; v&#46;2&#46;3&#46;21&#46;0&#44; disponible en&#58; <a href="https://www.jamovi.org">https&#58;&#47;&#47;www&#46;jamovi&#46;org</a>&#46;</p></span></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0095">Resultados</span><p id="p0100" class="elsevierStylePara elsevierViewall">Ciento veinte participantes &#40;81&#44;1&#37;&#41; de 148 inscritos en el programa contaron con mediciones en los 2 tiempos y aceptaron participar en el estudio &#40;52&#44;5&#37; mujeres&#59; 72&#44;5&#37; profesionales de medicina&#59; y 55&#44;8&#37; participantes cohorte 2021&#41; &#40;<a class="elsevierStyleCrossRef" href="#t0005">tabla 1</a>&#41;&#46; El 90&#37; de los participantes realiza docencia de pregrado y&#47;o posgrado&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0100">Confiabilidad de los instrumentos</span><p id="p0105" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#t0010">tabla 2</a> muestra los resultados de confiabilidad de cada instrumento y sus escalas&#46; Todos los instrumentos obtuvieron coeficientes de confiabilidad entre el rango 0&#44;8 y 0&#44;9 que califica de muy bueno&#44; excepto la subescala despersonalizaci&#243;n del Inventario de S&#237;ndrome de Desgaste Profesional &#40;MBI-HSS&#41;&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0105">Cambio en los indicadores de desgaste profesional y bienestar subjetivo</span><p id="p0110" class="elsevierStylePara elsevierViewall">El desgaste profesional y el bienestar subjetivo de los participantes cambi&#243; favorablemente al t&#233;rmino del programa &#40;t2&#41; &#40;valor p &#60; 0&#44;01&#41;&#46; Disminuyeron los indicadores agotamiento emocional&#44; despersonalizaci&#243;n y afectividad negativa&#59; y aumentaron los indicadores realizaci&#243;n personal&#44; bienestar psicosocial en cada subescala y total&#44; afectividad positiva&#44; vitalidad y atenci&#243;n plena &#40;<a class="elsevierStyleCrossRef" href="#t0015">tabla 3</a>&#41;&#46; Agotamiento emocional y bienestar psicosocial total cambiaron favorablemente en <span class="elsevierStyleUnderline">&#62;</span><span class="elsevierStyleHsp" style=""></span>6 puntos&#46;</p><elsevierMultimedia ident="t0015"></elsevierMultimedia><p id="p0115" class="elsevierStylePara elsevierViewall">No se encontraron diferencias en t1cuando se analizaron los indicadores por sexo&#44; cohorte y profesi&#243;n&#46; Cuando se realiz&#243; el mismo an&#225;lisis en t2&#44; se encontraron algunas diferencias dependientes de sexo y profesi&#243;n&#46; Las diferencias por sexo favorecieron a hombres en agotamiento emocional &#40;hombres 15&#44;9 &#177; 8&#44;3 vs&#46; mujeres 20&#44;5 &#177; 10&#44;9&#59; valor p &#61; 0&#44;036&#41; y afectividad positiva &#40;hombres 42&#44;5 &#177; 5&#44;8 vs&#46; mujeres 40 &#177; 6&#44;2&#59; valor p &#61; 0&#44;031&#41;&#46; Otra diferencia detectada es que afectividad positiva depende de profesi&#243;n y favorece a medicina &#40;medicina 42&#44;1 &#177; 5&#44;7 vs&#46; otras profesiones 39&#44;1 &#177; 6&#44;8&#59; valor p &#61; 0&#44;039&#41;&#46; Para terminar&#44; en t2 no se encontraron diferencias por cohorte &#40;datos no mostrados&#41;&#46;</p></span><span id="s0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0110">Cambio en los indicadores de degaste profesional y bienestar subjetivo separados por sexo&#44; cohorte y profesi&#243;n</span><p id="p0120" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#t0020">tabla 4</a>&#44; se analiz&#243; el cambio posprograma separado por hombres y mujeres&#46; En los hombres cambiaron favorablemente todos los indicadores asociados a desgaste profesional y bienestar subjetivo &#40;valor p &#60; 0&#44;05&#41;&#46; Los indicadores de las mujeres tambi&#233;n cambiaron &#40;valor p &#60; 0&#44;02&#41;&#44; excepto las subescalas despersonalizaci&#243;n y realizaci&#243;n personal&#46;</p><elsevierMultimedia ident="t0020"></elsevierMultimedia><p id="p0125" class="elsevierStylePara elsevierViewall">Al analizar el cambio separado por cohorte&#44; se advierte que 2020 y 2021 tienen en com&#250;n cambios favorables en la mayor&#237;a de los indicadores &#40;valor p &#60; 0&#44;05&#41;&#44; excepto en 3 casos&#46; En 2020 realizaci&#243;n personal no cambia&#44; en 2021 la afectividad positiva cambia desfavorablemente &#40;valor p &#60; 0&#44;001&#41;&#59; y en ambas cohortes&#44; despersonalizaci&#243;n no mostr&#243; cambios&#46; &#40;<a class="elsevierStyleCrossRef" href="#t0025">tabla 5</a>&#41;&#46; Finalmente&#44; el an&#225;lisis seg&#250;n profesi&#243;n mostr&#243; que al t&#233;rmino del programa los profesionales de medicina cambiaron favorablemente en todos los indicadores &#40;valor p &#60; 0&#44;004&#41;&#46; Las otras profesiones cambiaron favorablemente a excepci&#243;n de las subescalas despersonalizaci&#243;n y realizaci&#243;n personal &#40;datos no mostrados&#41;&#46;</p><elsevierMultimedia ident="t0025"></elsevierMultimedia></span></span><span id="s0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0115">Discusi&#243;n</span><p id="p0130" class="elsevierStylePara elsevierViewall">El dise&#241;o del programa a distancia &#171;Bases cient&#237;ficas del bienestar y herramientas de autocuidado para profesionales de la salud&#187; de 5 semanas de duraci&#243;n y modalidad asincr&#243;nica tuvo un efecto favorable en los participantes&#46; Al finalizar el programa&#44; el grupo total cambi&#243; en todas las variables analizadas&#46; Disminuyeron los indicadores asociados al &#171;malestar&#187;&#58; agotamiento emocional&#44; despersonalizaci&#243;n y afectividad negativa&#59; y por otra&#44; mejoraron los indicadores asociados al bienestar subjetivo&#58; realizaci&#243;n personal&#44; capacidad de atenci&#243;n plena&#44; bienestar psicosocial&#44; afectividad positiva y vitalidad&#46; De todas las variables&#44; agotamiento emocional y bienestar psicosocial total mostraron mayor diferencia postintervenci&#243;n&#46;</p><p id="p0135" class="elsevierStylePara elsevierViewall">Al inicio del programa&#44; los resultados no mostraron diferencias al compararse por cohorte&#44; sexo o profesi&#243;n de los participantes&#46; El mismo an&#225;lisis realizado post intervenci&#243;n mostr&#243; que la mayor&#237;a de las variables mantuvo su efecto&#44; y se encontraron algunas diferencias en despersonalizaci&#243;n&#44; realizaci&#243;n personal y afectividad positiva&#46; El programa no tuvo efecto en despersonalizaci&#243;n ni en realizaci&#243;n personal de las mujeres&#46; Lo mismo ocurri&#243; con las otras profesiones cuando se les compar&#243; con medicina&#46; Al separar ambas cohortes se perdi&#243; el efecto de despersonalizaci&#243;n y el grupo de 2021 disminuy&#243; la puntuaci&#243;n en afectividad positiva&#46; En suma&#44; el programa de autocuidado contribuy&#243; m&#225;s en fortalecer los indicadores de bienestar subjetivo&#46; Agotamiento emocional fue el &#250;nico indicador de &#171;malestar&#187; que mantuvo su impacto independiente de sexo&#44; cohorte y profesi&#243;n&#46;</p><p id="p0140" class="elsevierStylePara elsevierViewall">No es desconocido que el alcance de las intervenciones basadas en atenci&#243;n plena incidan m&#225;s en indicadores de bienestar subjetivo que en los de &#171;malestar&#187;<a class="elsevierStyleCrossRef" href="#bb0155"><span class="elsevierStyleSup">31</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a>&#46; Resultados favorables en atenci&#243;n plena y bienestar psicosocial tambi&#233;n se han reportado en intervenciones con estudiantes<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a>&#46; Mejores resultados en atenci&#243;n plena se relacionan con una mayor conciencia de las propias emociones y aumento en el repertorio emocional para responder a los estresores&#46; Por lo tanto&#44; la atenci&#243;n plena resultaria ser un factor protector de la salud mental que contribuye en el desarrollo de la autorregulaci&#243;n&#44; as&#237; lo confirman intervenciones que al mejorar en atenci&#243;n plena a la vez disminuyen en agotamiento emocional<a class="elsevierStyleCrossRef" href="#bb0155"><span class="elsevierStyleSup">31</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="p0145" class="elsevierStylePara elsevierViewall">Al analizar el cambio&#44; despersonalizaci&#243;n y realizaci&#243;n personal&#44; 2 de los 3 indicadores del Inventario de Maslach &#40;MBI&#41;&#44; perdieron su efecto&#46; Despersonalizaci&#243;n&#44; adem&#225;s&#44; fue de todas las variables la que obtuvo el coeficiente de confiabilidad m&#225;s bajo &#40;aun cuando en rango razonable&#41;&#46; Estos hallazgos y&#44; en contraste&#44; que agotamiento emocional mantuviera su efecto independiente de los an&#225;lisis coinciden con resultados previos<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a>&#46; Por otra parte&#44; que el programa no impactara en despersonalizaci&#243;n ni realizaci&#243;n personal de las mujeres y el mismo resultado se obtuviera en el an&#225;lisis separado por profesi&#243;n puede explicarse porque otras profesiones &#40;odontolog&#237;a&#44; enfermer&#237;a y otras de la salud&#41; estuvo compuesta mayoritariamente por mujeres&#46;</p><p id="p0200" class="elsevierStylePara elsevierViewall">Los cambios reportados en este estudio hacen sentido desde las actividades educativas implementadas&#46; Al inicio del programa fue com&#250;n recibir reflexiones escritas de los participantes sobre la escasa atenci&#243;n que daban a las emociones y a su respuesta fisiol&#243;gica&#46; Asimismo&#44; fueron recurrentes pensamientos negativos de preocupaci&#243;n por la incertidumbre&#44; el contagio o muerte de seres queridos&#44; y rumiaci&#243;n por la sensaci&#243;n de incumpliendo en los distintos roles&#46; Como consecuencia&#44; y a pesar del alto sentido de compromiso y responsabilidad profesional para enfrentar la sobrecarga&#44; los participantes experimentaron&#58; trastorno del sue&#241;o&#44; conflictos en las relaciones laborales o familiares&#44; consumo de alimentos poco saludables&#44; disminuci&#243;n de la actividad f&#237;sica y aumento de la ansiedad&#44; cansancio&#44; autocr&#237;tica y culpa&#46; El acompa&#241;amiento y la retroalimentaci&#243;n de tutores orientados a la promoci&#243;n de pr&#225;cticas de atenci&#243;n plena y reflexi&#243;n guiada sobre el efecto de las emociones positivas&#44; la regulaci&#243;n de la rumiaci&#243;n y trampas del pensamiento&#44; el cultivo de una relaci&#243;n saludable con uno mismo &#160;menos autocr&#237;tica y m&#225;s compasiva&#44; parecieron ser el coraz&#243;n de la intervenci&#243;n&#46;</p><p id="p0150" class="elsevierStylePara elsevierViewall">&#161;Cuidemos al cuidador&#33; Promover el autocuidado requiere mayor reflexi&#243;n y acci&#243;n por parte de las instituciones&#46; A&#250;n controlada la crisis sanitaria&#44; el fen&#243;meno de la sobrecarga y multiplicidad de roles est&#225; muy lejos de acabar<a class="elsevierStyleCrossRefs" href="#bb0005"><span class="elsevierStyleSup">1&#8211;3</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a>&#46; Profesores y estudiantes buscan el balance entre la demanda de infinitas identidades posibles de desplegar en lo profesional y personal&#46; Balance que se tensiona entre el mandato por pr&#225;cticas de excelencia y el habitus &#40;manera de ser&#41; que orienta las pr&#225;cticas y las creencias sobre esas pr&#225;cticas<a class="elsevierStyleCrossRef" href="#bb0170"><span class="elsevierStyleSup">34</span></a>&#46; No fue sorpresa en esta experiencia entonces&#44; encontrarse con participantes que cumplieron sus compromisos del diplomado&#44; y las actividades docentes y las asistenciales&#46; Un fuerte involucramiento profesional y alta motivaci&#243;n en la formaci&#243;n continua no son suficientes para proteger del desgaste&#46; Pr&#225;cticas saludables para enfrentar el estr&#233;s compartidas entre estudiantes&#44; profesores&#44; equipos de trabajo y la instituci&#243;n promueven el bienestar&#44; fortalecen el sentido de comunidad y la capacidad de adaptaci&#243;n al cambio&#44; reconocidas caracter&#237;sticas de personas e instituciones resilientes<a class="elsevierStyleCrossRef" href="#bb0186"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="p0155" class="elsevierStylePara elsevierViewall">Durante el periodo en que se realiz&#243; el estudio es sabido que las mujeres&#44; por desigualdades que a&#250;n persisten&#44; fueron m&#225;s presionadas a ajustarse a roles tradicionales de g&#233;nero y recibieron menos apoyo<a class="elsevierStyleCrossRef" href="#bb0187"><span class="elsevierStyleSup">36</span></a>&#46; No es de extra&#241;ar que fueran las principales encargadas de adaptar el nuevo funcionamiento del hogar durante el confinamiento&#44; y m&#225;s desafiadas a conjugar las responsabilidades profesionales y acad&#233;micas con las de madre y educadora de hijos peque&#241;os&#44; jefa de hogar o cuidadora<a class="elsevierStyleCrossRefs" href="#bb0188"><span class="elsevierStyleSup">37&#44;38</span></a>&#46; Escapa a este estudio establecer si las demandas asociadas a ser mujer se relacionaron con la falta de efecto en despersonalizaci&#243;n y realizaci&#243;n personal&#46; Sin embargo&#44; autoeficacia y enfrentamiento del estr&#233;s forman parte del constructo del MBI<a class="elsevierStyleCrossRef" href="#bb0190"><span class="elsevierStyleSup">39</span></a>&#46; Su expresi&#243;n en las mujeres merece&#44; al menos&#44; ser explorada en mayor profundidad&#46;</p><p id="p0160" class="elsevierStylePara elsevierViewall">Es fundamental que las instituciones formadoras pongan mayor atenci&#243;n al estr&#233;s y sobrecarga a la que pueden estar expuestos los acad&#233;micos&#44; sus desencadenantes y enfrentamiento&#46; En este rumbo&#44; es fundamental que personas e instituciones est&#233;n dispuestas a aprender y dialogar respecto del estr&#233;s&#44; sus desencadenantes y enfrentamiento a trav&#233;s de estrategias nuevas y m&#225;s saludables&#46; De no conseguir cierto balance entre sobrecarga y autocuidado&#44; a la vuelta de la esquina esperan nuevos retos&#44; p&#233;rdida de motivaci&#243;n por la actividad docente&#44; deserci&#243;n o migraci&#243;n por opciones profesionales m&#225;s atractivas que impliquen menos desgaste<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0189"><span class="elsevierStyleSup">38</span></a>&#46;</p><p id="p0165" class="elsevierStylePara elsevierViewall">El estudio presenta limitaciones&#58; a&#41; los an&#225;lisis aqu&#237; presentados solo muestran el efecto del cambio inmediatamente despu&#233;s de terminado el programa&#44; nada es posible concluir sobre la permanencia del cambio en el tiempo y b&#41; el estudio&#44; aun cuando incluy&#243; 2 versiones del programa&#44; requiere replicaci&#243;n&#59; por un lado&#44; para evaluar el efecto que tiene la intervenci&#243;n bajo condiciones contextuales diferentes y&#44; por otra&#44; para profundizar en el an&#225;lisis del alcance que las estrategias propuestas tienen para las mujeres&#46; Dicho esto&#44; los resultados obtenidos en esta acotada experiencia educativa para responder al objetivo del estudio nos parecieron s&#243;lidos considerando los niveles de confiabilidad del que gozaron los instrumentos y la inclusi&#243;n de pruebas de ajuste que aseguraron su precisi&#243;n&#46; Si bien el hallazgo se obtuvo en un contexto in&#233;dito&#44; constituye evidencia sobre iniciativas de autocuidado factibles y formales para docentes de la salud<a class="elsevierStyleCrossRefs" href="#bb0005"><span class="elsevierStyleSup">1&#8211;3&#44;8&#44;33</span></a>&#46;</p><p id="p0170" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el programa de autocuidado basado en un dise&#241;o de educaci&#243;n a distancia y de 5 semanas de duraci&#243;n tuvo un efecto positivo en los profesionales de la salud que realizan actividades docentes&#46; El efecto positivo se observ&#243; particularmente en la disminuci&#243;n del agotamiento emocional y el aumento del bienestar subjetivo expresado en mayor atenci&#243;n plena&#44; bienestar psicosocial y vitalidad&#46; Cursos a distancia acotados que promuevan el aprendizaje de estrategias de autocuidado basados en atenci&#243;n plena y estrategias de autorregulaci&#243;n&#44; pueden formar parte de programas de educaci&#243;n continua para profesionales de la salud&#46;</p></span><span id="s0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0120">Responsabilidades &#233;ticas</span><p id="p0175" class="elsevierStylePara elsevierViewall">Estudio autorizado por el Comit&#233; de &#201;tica de la Escuela de Medicina UC &#40;ID&#35;180809007&#44; sesi&#243;n 7&#47;2019&#41;&#46; La informaci&#243;n que forma parte de esta publicaci&#243;n cuenta con el consentimiento de los participantes para que fuera usada con fines de investigaci&#243;n y publicaci&#243;n&#46;</p></span><span id="s0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0125">Financiaci&#243;n</span><p id="p0185" class="elsevierStylePara elsevierViewall">Proyecto financiado por el Fondo Nacional de Desarrollo Cient&#237;fico y Tecnol&#243;gico&#44; Proyecto FONDECYT&#35;1190232&#46;</p></span><span id="s0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0130">Conflicto de intereses</span><p id="p0190" class="elsevierStylePara elsevierViewall">Los autores declaran no tener conflictos de intereses&#46;</p></span><span id="s0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0135">Agradecimientos</span><p id="p0195" class="elsevierStylePara elsevierViewall">Nuestra gratitud a cada participante que form&#243; parte de esta experiencia y acept&#243; compartirla con la comunidad de educaci&#243;n en salud&#46; El contexto de implementaci&#243;n del programa fue in&#233;dito&#44; transformando este proyecto en una experiencia valiosa para el equipo docente&#46; Aprendimos y resonamos juntos a trav&#233;s de la reflexi&#243;n sobre la educaci&#243;n del autocuidado en uno de los momentos m&#225;s desafiantes de nuestras vidas y de la humanidad&#46;</p></span></span>"
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    "resumen" => array:2 [
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        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Introducci&#243;n</span><p id="sp0075" class="elsevierStyleSimplePara elsevierViewall">existe evidencia sobre el desgaste profesional experimentado por el profesorado del &#225;rea de la salud producto de la sobrecarga que implica la combinaci&#243;n de los roles acad&#233;mico&#44; investigador y asistencial&#46; Es mandatorio generar conocimiento sobre iniciativas que promuevan su autocuidado a nivel individual e institucional&#46; El objetivo del estudio es examinar a trav&#233;s de indicadores de desgaste profesional y bienestar subjetivo la implementaci&#243;n del programa &#171;Bases cient&#237;ficas del bienestar y herramientas de autocuidado para profesionales de la salud&#187;&#46;</p></span> <span id="as0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Material y m&#233;todos</span><p id="sp0080" class="elsevierStyleSimplePara elsevierViewall">se evalu&#243; el s&#237;ndrome de desgaste profesional&#44; atenci&#243;n plena&#44; bienestar psicosocial&#44; vitalidad y afectividad de 120 participantes de 2 cohortes&#46; El estudio cuantitativo compar&#243; las mediciones en 2 tiempos&#46; El cambio se analiz&#243; mediante las pruebas de Wilcoxon y Mann-Whitney&#46; Cronbach y McDonald se utilizaron para evaluar la confiabilidad de los instrumentos&#46;</p></span> <span id="as0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Resultados</span><p id="sp0085" class="elsevierStyleSimplePara elsevierViewall">se implement&#243; un programa de 5 semanas que incluy&#243; actividades individuales preferentemente asincr&#243;nicas&#44; retroalimentaci&#243;n y evaluaci&#243;n sumativa&#46; Seis tutores recibieron entrenamiento en bienestar y autocompasi&#243;n&#46; Los indicadores de bienestar y desgaste profesional cambiaron favorablemente al t&#233;rmino del programa &#40;valor p &#60; 0&#44;01&#41;&#46; El cambio se mantuvo al analizar los indicadores separados por sexo&#44; cohorte y carrera&#44; excepto en despersonalizaci&#243;n&#44; realizaci&#243;n personal y afectividad positiva&#46; Los instrumentos alcanzaron una confiabilidad <span class="elsevierStyleUnderline">&#62;</span>&#8239;0&#44;7&#46;</p></span> <span id="as0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Conclusi&#243;n</span><p id="sp0090" class="elsevierStyleSimplePara elsevierViewall">el programa de autocuidado fue efectivo para reducir el agotamiento emocional y promover las estrategias que mejoran la atenci&#243;n plena y la autorregulaci&#243;n&#46; Cursos a distancia acotados que promuevan el aprendizaje de estrategias de autocuidado podr&#237;an formar parte de programas de desarrollo de las competencias docentes para profesionales de la salud&#46;</p></span>"
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        "resumen" => "<span id="as0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Introduction</span><p id="sp0095" class="elsevierStyleSimplePara elsevierViewall">There is evidence of burnout experienced by faculty due to the overload involved in combining the academic and research roles and the practice with patients&#46; It is interesting to generate knowledge on initiatives that favor learning individual and institutional self-care strategies&#46; The study aims to examine the implementation of the program &#34;Scientific Basis of Well-Being and Self-Care Tools for Health Professionals&#34; through burnout and well-being indicators&#46;</p></span> <span id="as0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Material and methods</span><p id="sp0100" class="elsevierStyleSimplePara elsevierViewall">One hundred twenty participants from two cohorts completed questionnaires&#46; Burnout&#44; Mindfulness&#44; Psychosocial Well-being&#44; Vitality&#44; and Affectivity indicators were measured&#46; The quantitative study compared the measurements in two moments&#46; Change t1-t2 was analyzed with W Wilcoxon-test and U Mann-Whitney-test&#46; Cronbach&#39;s and McDonald&#39;s tests were used to analyze the instruments&#8217; reliability&#46;</p></span> <span id="as0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Results</span><p id="sp0105" class="elsevierStyleSimplePara elsevierViewall">A five-week online program was implemented in the Moodle platform&#46; Asynchronous individual activities and learning assessments were incorporated&#46; Six tutors were trained in well-being and self-compassion&#46; Levels of wellbeing and burnout changed post-program favorably &#40;p-value &#60; 0&#46;01&#41;&#46; The change is maintained when analyzing the variables separated by sex&#44; profession&#44; and cohort&#44; except the depersonalization&#44; personal accomplishment&#44; and positive affectivity variables&#46; Questionnaires achieved reliability &#62; 0&#46;7&#46;</p></span> <span id="as0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Conclusion</span><p id="sp0110" class="elsevierStyleSimplePara elsevierViewall">A five-week self-care online program effectively reduced emotional exhaustion and promoted strategies that enhanced dispositional mindfulness and self-regulation&#46; Short online courses that encourage learning self-care strategies could be part of programs that develop teaching competencies in health professionals&#46;</p></span>"
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                  \t\t\t\t">Total inscritos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">148&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Agotamiento emocional&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">24&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;10&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;10&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">-6&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0005">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Despersonalizaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;009<a class="elsevierStyleCrossRef" href="#tf0010">&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Realizaci&#243;n personal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">0&#44;008<a class="elsevierStyleCrossRef" href="#tf0010">&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Bienestar Psicosocial</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Emocional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0005">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">49&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">55&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;9&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">variable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#240;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">valor p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">t2</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#240;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">valor p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Desgaste Profesional</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Agotamiento Emocional&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0015">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0015">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Despersonalizaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Realizaci&#243;n personal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Bienestar Psicosocial</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Emocional&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">0&#44;003<a class="elsevierStyleCrossRef" href="#tf0020">&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">11&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">12&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002<a class="elsevierStyleCrossRef" href="#tf0020">&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Social&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">14&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">17&#44;4 &#40;4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">3&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0015">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">17&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0015">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Psicol&#243;gico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">24&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">25&#44;7 &#40;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">2&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">0&#44;004<a class="elsevierStyleCrossRef" href="#tf0020">&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">23&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0015">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">50&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;10&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">56&#44;0 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0015">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">49&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">55&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0015">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="12" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Afectividad</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Afectividad positiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">38&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#40;6&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">42&#44;5 &#40;5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0015">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">37&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;7&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">40&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;6&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">3&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0015">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Afectividad negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">23&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;1 &#40;5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-4&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001<a class="elsevierStyleCrossRef" href="#tf0015">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">21&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;7&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-4&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Agotamiento emocional&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;10&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0025">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">-7&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0025">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Despersonalizaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#44;9 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">-0&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Realizaci&#243;n personal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;017<a class="elsevierStyleCrossRef" href="#tf0030">&#8270;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Bienestar Psicosocial</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Emocional&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;048<a class="elsevierStyleCrossRef" href="#tf0030">&#8270;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0025">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Social&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0025">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0025">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Psicol&#243;gico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">24&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;3&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">25&#44;4 &#40;3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;010<a class="elsevierStyleCrossRef" href="#tf0030">&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">23&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">25&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;4&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0025">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">50&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;8&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">55&#44;6 &#40;8&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0025">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;11&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">56&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;9&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">6&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0025">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="12" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Afectividad</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Afectividad positiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">37&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;6&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">41&#44;0 &#40;5&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0025">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">37&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;10&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">30&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;13&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">-3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0025">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Afectividad negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">-3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0025">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">24&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">-4&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0025">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Raz&#243;n AP&#47;AN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0025">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">2&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tf0025">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Vitalidad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">32&#44;9 &#40;5&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tf0025">&#8270;&#8270;&#8270;</a>&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 15751813
Idioma original: Español
DOI:10.1016/j.edumed.2023.100871
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