European Journal of Health Research

Anatomical variations of the frontal sinus drainage pathway according to the IFAC classification: frequency and interobserver agreement in a Paraguayan population

Rodrigo González, Juan Santacruz, Enrique Pérez Girala, Carlos Mena Canata — Tue, 24 Mar 2026 00:00:00 +0000

Objective: To determine the frequency of anatomical variations of the frontal sinus drainage pathway (FSDP) according to the International Frontal Sinus Anatomy Classification (IFAC) and to assess interobserver agreement in a Paraguayan population.

Methods: An observational, descriptive, analytical, cross-sectional study was conducted in 203 patients (406 FSDPs) with paranasal sinus computed tomography. Two otolaryngologists independently classified frontal-ethmoidal cells following the IFAC system. Frequencies, 95 % confidence intervals (CI95 %), and interobserver agreement were analyzed using Cohen’s κ, PABAK, and Gwet’s AC1, with clustering adjustment for paired sides per patient.

Results: Mean age was 37.3 ± 16.3 years; 54.7 % were female. The most frequent cells were agger nasi (95.1 %), suprabullar (85.2 %), and supra-agger nasi (50.3 %). Less frequent variants included frontal suprabullar (18.7 %) and frontal supra-agger nasi (17.5 %). No significant differences were found by sex, age group, or laterality (p > 0.05). Overall interobserver agreement was moderate-to-good (κ = 0.693; 95 % CI 0.64–0.74), with high consistency confirmed by PABAK (0.74) and Gwet’s AC1 (0.77).

Conclusion: The most frequently identified anatomical variations of the frontal sinus drainage pathway according to the IFAC classification were the agger nasi cell (95.1%), the suprabullar cell (85.2%), and the supra-agger nasi cell (50.3%). Application of the IFAC classification demonstrated moderate to good interobserver agreement (κ = 0.693), confirmed by the PABAK and AC1 indices, supporting its reproducibility and usefulness for anatomical assessment of the frontal recess in clinical practice and endoscopic surgical planning.

Burnout syndrome among workers referred to an occupational health unit

Jesica Pardos, Meritxell Soler Saña, Montserrat Puiggené Vallverdú — Fri, 23 Jan 2026 00:00:00 +0000

Background: Burnout syndrome is an occupational phenomenon that affects the health and well-being of workers. However, its frequency in populations referred to specialized occupational health units in specific territorial contexts is poorly documented.

Objective: To estimate the frequency of suspected burnout syndrome and to explore its association with sociodemographic, occupational, and lifestyle variables in workers referred from Primary Care to the occupational health unit of Lleida, Alt Pirineu, and Aran during 2024.

Methodology: A cross-sectional observational study was conducted among 51 workers referred from Primary Care to the occupational health unit in Lleida, Alt Pirineu, and Aran in 2024. Sociodemographic data were collected, and the Maslach Burnout Inventory – General Survey (MBI-GS) was administered. The main outcome was MBI-GS positivity. Odds Ratios (OR) with 95% confidence intervals were calculated to explore the association between positivity and the independent variables.

Main results: Nineteen of the 51 workers (37.3%) presented positive results, indicating suspected burnout in this referred population. Most of the associations analyzed were not statistically significant. Workers aged 26 to 45 years showed a lower risk of positivity.

Conclusion: In this specific sample of workers referred to the occupational health unit, suspected burnout was a frequent occurrence. The findings should be interpreted with caution due to the small sample size and the selected nature of the population; therefore, the results are considered exploratory.

Structural changes in respiratory emergency demand in Chile (2017–2024): a retrospective Bayesian time-series analysis

Eric Comincini Cantillo, Jorge Homero Wilches Visbal — Wed, 18 Mar 2026 00:00:00 +0000

Objective: to identify structural changes in respiratory emergency demand in Chile between 2017 and 2024 using a Bayesian time-series framework incorporating annual seasonality, day-of-week effects, and smooth change points, stratified by level of care.

Materials and Methods: An ecological time-series study was conducted using official administrative records of 33,597,638 respiratory emergency visits in Chile from January 1, 2017, to December 31, 2024. Daily counts were stratified by care level: primary care emergency services (APS) and hospital emergency departments. Bayesian negative binomial regression models were fitted incorporating Fourier-based annual seasonality, day-of-week effects, and two a priori structural change points with smooth transitions aligned to key COVID-19 epidemiological milestones. Structural effects were summarized using multiplicative ratios and 90% credible intervals, and compared with classical methods including CUSUM, moving averages with Z-score thresholds, and deterministic segmentation.

Results: Of the 33,597,638 visits recorded, 24,617,474 occurred in primary care and 8,980,164 in hospital emergency departments. The series exhibited marked annual seasonality and two structural transitions consistent with the early and later pandemic phases. Both care levels showed multiplicative ratios below unity at the first change point and above unity at the second. The Bayesian approach demonstrated shorter detection latency than classical methods in retrospective comparison.

Conclusions: Respiratory emergency demand in Chile between 2017 and 2024 displayed structural changes clearly distinguishable from seasonal variation, with distinct patterns across care levels. Bayesian time-series modeling enabled more precise characterization of demand transitions, supporting its use as an analytical tool for health system surveillance in high-variability contexts.