Introduction. Medical specialty residents have become a high-risk population for mental health disorders, mainly due to long working days, limited time for rest and recreation, problems inherent in ...the work environment, and substance use. Since all these factors not only alter the training of future specialists, but also the care they provide for people, the study of an intervention in this population is of interest to the health system and human resource training in the health sector. Objective. To evaluate the mental health status, prevalence of work exhaustion and associated psychosocial and work factors in medical residents in the Guadalajara Metropolitan Area. Method. This was a cross-sectional, observational, descriptive, and comparative study, in which, through a digitized survey on the Google Forms platform, the GHQ-28, ASSIST, and Maslach Burnout Inventory scales were administered to medical specialty residents from various health institutions in the Guadalajara Metropolitan Area. Results. The total sample comprised 306 residents, representing 11.23% of the total residents in the Guadalajara Metropolitan Area (2,724). Female physicians had a higher percentage of participation with 61.4% (n = 188), with male physicians accounting for 38.6% (n = 118). The average age was 28.9 years and 84.9% (n = 260) were pursuing a clinical specialty, and 15.1% (n = 46) a surgical one p < 05. On average, they worked 74.1 hours per week, whereas in surgical specialties they worked another 10 hours (82.63 + or - 23.40 vs. 72.67 + or - 19.76, p = .002). 72.5% (n = 222) showed a high risk of developing burnout. 9.2% (n = 28) obtained scores compatible with severe depression, which was related to a higher number of hours worked per week and heavier alcohol consumption than residents without depression, 21.24% (n = 65) of respondents frequently thought about dropping out, 22.5% (n = 69) felt dissatisfied with their work, while 14.05% (n= 43) of the residents had recently noticed that they had had frequent thoughts of taking their own lives. Discussion and conclusion. The higher number of hours worked per week, surgical specialties, and the presence of workplace harassment were recognized as psychosocial and occupational factors associated with mental health problems in resident physicians, such as depression, thoughts of death, burnout, and psychoactive substance use. In a country like Mexico, where medical residents are a crucial pillar of the public health system, it is necessary to ensure their well-being, and seek to improve the working and academic conditions of medical residencies to ensure that this is reflected in the quality and safety of patient care. Keywords: Mental health, medical residents, depression, substance use, suicide risk, burnout, medical specialties. Introduccion. Los residentes de especialidades medicas se han convertido en una poblacion de alto riesgo para padecer alteraciones de la salud mental, principalmente por la extension de las jornadas laborales, tiempo limitado para su descanso y recreacion, los problemas propios del ambiente laboral o el consumo de sustancias. Todos estos factores alteran no solo la formacion de futuros especialistas, sino la atencion que brindan a las personas, por lo que el estudio e intervencion en esta poblacion es de interes para el sistema de salud y la formacion de recursos humanos en salud. Objetivo. Evaluar el estado de salud mental, la prevalence de desgaste laboral y los factores psicosociales y laborales asociados en medicos residentes de la Zona Metropolitana de Guadalajara. Metodo. Se trato de un estudio transversal, observacional, descriptivo y comparativo, en el cual, por medio de una encuesta digitalizada en la plataforma de Google Forms, se aplicaron las escalas GHQ-28, ASSIST y el Inventario de Burnout de Maslach a los residentes de especialidades medicas de diferentes instituciones de salud en la zona metropolitana de Guadalajara. Resultados. La muestra total fue de 306 residentes, lo que represento el 11.23% del total de residentes de la zona metropolitana de Guadalajara (2,724). Las medicas tuvieron un mayor porcentaje de participacion con el 61.4% (n = 188), y los medicos 38.6% (n = 118). La edad promedio fue de 28.9 anos y el 84.9% (n = 260) realizaba una especialidad clinica, el 15.1% (n = 46) una quirurgica p < 05. En promedio trabajaban, 74.1 horas por semana, mientras que en las especialidades quirurgicas trabajaban 10 horas mas (82.63 + or - 23.40 vs. 72.67 + or - 19.76, p = .002). El 72.5% (n = 222) presentaron alto riesgo de presentar burnout. El 9.2% (n = 28) presentaron puntuaciones compatibles con depresion grave, lo cual se relaciono con mayor cantidad de horas trabajadas por semana y un mayor consumo de alcohol que los residentes sin depresion; el 21.24% (n = 65) de los encuestados pensaban frecuentemente en renunciar, el 22.5% (n = 69) no sentian satisfaccion por su trabajo; y el 14.05% (n = 43) de los residentes habian notado ultimamente que la idea de quitarse la vida venia repetidamente a su cabeza. Discusion y conclusion. El mayor numero de horas laboradas a la semana se manifestaba las especialidades quirurgicas y la presencia de acoso laboral se reconocieron como factores psicosociales y laborales asociados a los problemas de salud mental en medicos residentes. Entre estos estaban la depresion, los pensamientos de muerte, el burnout y el consumo de sustancias psicoactivas. En un pais como Mexico, en el que los medicos residentes son un pilar fundamental para el funcionamiento del sistema de salud publico, es necesario asegurar su bienestar, procurando la mejora en las condiciones laborales y academicas de las residencias medicas, a fin de que se reflejen en la calidad y seguridad en la atencion de sus pacientes. Palabras clave: Salud mental, residentes medicos, depresion, consumo de sustancias, riesgo suicida, burnout, especialidades medicas.
Report the prevalence of depression, resilience, and risk factors among healthcare workers (HCW) during Co-vid-19.
This is an observational cross-sectional study derived from the ongoing ...international, prospective multicentric study "The COVID-19 HEalth caRe wOrk-Ers Study" (HEROES). A convenience sample of 2 127 HCW was obtained from Chiapas and Jalisco between May 19th and July 24th 2020. Depression was assessed using the Patient Health Questionnaire, resilience with the Brief Resilience Scale and a Covid risk scale was developed. Model-adjusted prevalence ratios (PRs) and an additive interaction model were performed.
Moderate-severe depression was found in 16.6% of HCW. Those from Jalisco, physicians, in hospitals, with chronic illness and mental health history were more depressed. The interaction between resilience and risk showed that, compared to those with no risk and medium/high resilience, HCW at risk with medium/high resilience had a 2.38 PR for depression while those at risk and low resilience had a PR of 5.83.
This evidence points the need to develop strategies to enhance resilience and reduce the risk in HCW.
Despite the increasing use of comprehensive rehabilitation models for people with severe mental illness (SMI), there are still limitations to their implementation and replicability in a consensual ...way, particularly in Latin American countries. The REINTEGRA program aims to be a standardized model of comprehensive rehabilitation focused on psychosocial and cognitive improvement through a set of interventions on different areas of people's functionality, with the goal of reintegrating people with SMI into the labour market. In this paper we summarize the protocol for its subsequent implementation in a mental health institution in Mexico.
The protocol is based on a quasi-experimental, prospective longitudinal study, with a pragmatic or naturalistic control group. It will be carried out in three phases. Phase 1 consists of a series of interventions focused on psychosocial improvement; Phase 2 focuses on cognitive and behavioral improvement treatments; and Phase 3 targets psychosocial recovery through rehabilitation and reintegration into the labour market. The overall procedure will be monitored with standarized evaluations at different stages of the program.
This study presents a model of integral rehabilitation of people with SMI. At the moment, one of the obstacles to overcome is the organization and procedural control of the different actors needed for its implementation (nurses, psychologists, doctors, companies, institutions, etc.). REINTEGRA will be the first comprehensive rehabilitation model that includes systematized procedures for job reinsertion for people with SMI in Mexico, which aims to be a standardized tool of easy adaptation and the replicability for other mental health centers and institutions.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Background
Charles Bonnet Syndrome (CBS) is a rare clinical entity that is classically composed of visual hallucinations in the context of an altered optic pathway with preservation of ...reality judgment. This case aims to present the association of visual hallucinations with complex alterations of the nervous structures adjacent to the visual pathway and an atypical clinical presentation, thus explaining the possible mechanisms involved in the generation of these symptoms.
Case presentation
A 43-year-old man presents seeking care due to visual hallucinations with partial preservation of reality judgment and symptoms compatible with a major depressive disorder, including irritability and diminished hygiene habits. He has a history of complete gradual loss of vision and hyposmia. Due to poor treatment response during hospitalization, an MRI was obtained, which showed a frontal tumor lesion with meningioma characteristics adjacent to the olfactory groove and compression of the optic chiasm. He underwent surgical resection of the lesion, which remitted the psychotic symptoms, but preserving the visual limitation and depressive symptoms.
Conclusions
The presence of visual hallucinations, without other psychotic features as delusions, is a focus of attention for basic structural pathologies in the central nervous system. Affection at any level of the visual pathway can cause CBS. When finding atypical symptoms, a more in-depth evaluation should be made to allow optimization of the diagnosis and treatment.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
One of the proposed mechanisms for the development of diabetic nephropathy (DN) is the increase of end products of advanced glycosylation (AGEs), which bind to its receptor (RAGE), favoring nephron ...cellular damage. An isoform of this receptor is soluble RAGE (sRAGE), which can antagonize AGE-altered intracellular signaling. It has known that green tea extract (GTE) increases the expression of sRAGE, but it is unknown whether this could improve kidney function. The objective of this study was to evaluate the effect of the administration of GTE on the concentrations of sRAGE, renal function, and metabolic profile in patients with type 2 diabetes mellitus (T2DM) and DN. A randomized, double-blinded, placebo-controlled clinical trial was carried out in 39 patients who received GTE (400 mg every 12 h) or placebo for 3 months. sRAGE levels, renal function, and metabolic parameters were determined before and after the intervention. In the GTE group, there were statistically significant increase on sRAGE (320.55 ± 157.63 pg/mL vs. 357.59 ± 144.99 pg/mL;
= .04) and glomerular filtration rate (GFR; 66.44 ± 15.17 mL/min/1.73 m
vs. 71.70 ± 19.33 mL/min/1.73 m
;
= .04), and a statistically significant decrease in fasting serum glucose (7.62 ± 3.00 mmol/L vs. 5.86 ± 1.36 mmol/L;
≤ .01) and triacylglycerols (1.91 ± 0.76 mmol/L vs. 1.58 ± 0.69;
= .02). Administration of GTE increases the serum concentration of sRAGE and the GFR and decreases the concentration of fasting serum glucose and triacylglycerols. The study was registered in ClinicalTrials.gov with the identifier NCT03622762.
Access to mental health care is a worldwide public health challenge. In Mexico, an unacceptably high percentage of the population with mental disorders does not receive the necessary treatment, which ...is mainly due to the lack of access to mental health care. The community mental health care model was created and has been implemented to improve this situation. In order to properly plan and implement this model a precise situational diagnosis of the mental health care network is required, thus this is a first approach to evaluate the community mental health networks in the state of Jalisco.
Two components from the EvaRedCom-TMS instrument were used including a general description and accessibility of the community mental health care network. A geographic and economic accessibility evaluation was carried out for the different regions of the state ranging from scattered rural to urban communities using information gathered from health institutions, telephone interviews and computer applications.
Jalisco's community mental health network includes a total of 31 centers and 0.64 mental health workers for every 10,000 inhabitants > 15 years of age. The mean transportation cost required to access mental health care was 16.25 USD per visit. The time needed to reach the closest mental health center in 7 of the 13 analyzed regions was more than 30 min and the mean time required to reach a prolonged stay center was 172.7 min with transportation cost (taxi, private and public transport) of 22.3 USD. Some marginalized regions in the state have a mean 114 min required to reach the closest mental health care center and 386 min to reach a prolonged stay center.
This first approach to evaluate the mental health networks in Mexico showed that there are multiple barriers to access its care including an unfavorable number of human resources, long distances, and high costs. The identification of Jalisco's mental health network deficiencies is the first step towards establishing a properly planned community mental health care model within the country.
Background: People diagnosed with substance use disorders (SUDs) are at risk for impairment of brain function and structure. However, physicians still do not have any clinical biomarker of brain ...impairment that helps diagnose or treat these patients when needed. The most common method to study these patients is the classical electroencephalographic (EEG) analyses of absolute and relative powers, but this has limited individual clinical applicability. Other non-classical measures such as frequency band ratios and entropy show promise in these patients. Therefore, there is a need to expand the use of quantitative (q)EEG beyond classical measures in clinical populations. Our aim is to assess a group of classical and non-classical qEEG measures in a population with SUDs. Methods: We selected 56 non-medicated and drug-free adult patients (30 males) diagnosed with SUDs and admitted to Rehabilitation Clinics. According to qualitative EEG findings, patients were divided into four groups. We estimated the absolute and relative powers and calculated the entropy, and the alpha/(delta + theta) ratio. Results: Our findings showed a significant variability of absolute and relative powers among patients with SUDs. We also observed a decrease in the EEG-based entropy index and alpha/(theta + delta) ratio, mainly in posterior regions, in the patients with abnormal qualitative EEG. Conclusions: Our findings support the view that the power spectrum is not a reliable biomarker on an individual level. Thus, we suggest shifting the approach from the power spectrum toward other potential methods and designs that may offer greater clinical possibilities.
Introduction. Medical specialty residents have become a high-risk population for mental health disorders, mainly due to long working days, limited time for rest and recreation, problems inherent in ...the work environment, and substance use. Since all these factors not only alter the training of future specialists, but also the care they provide for people, the study of an intervention in this population is of interest to the health system and human resource training in the health sector. Objective. To evaluate the mental health status, prevalence of work exhaustion and associated psychosocial and work factors in medical residents in the Guadalajara Metropolitan Area. Method. This was a cross-sectional, observational, descriptive, and comparative study, in which, through a digitized survey on the Google Forms platform, the GHQ-28, ASSIST, and Maslach Burnout Inventory scales were administered to medical specialty residents from various health institutions in the Guadalajara Metropolitan Area. Results. The total sample comprised 306 residents, representing 11.23% of the total residents in the Guadalajara Metropolitan Area (2,724). Female physicians had a higher percentage of participation with 61.4% (n = 188), with male physicians accounting for 38.6% (n = 118). The average age was 28.9 years and 84.9% (n = 260) were pursuing a clinical specialty, and 15.1% (n = 46) a surgical one p ˂ 05. On average, they worked 74.1 hours per week, whereas in surgical specialties they worked another 10 hours (82.63 ± 23.40 vs. 72.67 ± 19.76, p = .002). 72.5% (n = 222) showed a high risk of developing burnout. 9.2% (n = 28) obtained scores compatible with severe depression, which was related to a higher number of hours worked per week and heavier alcohol consumption than residents without depression, 21.24% (n = 65) of respondents frequently thought about dropping out, 22.5% (n = 69) felt dissatisfied with their work, while 14.05% (n = 43) of the residents had recently noticed that they had had frequent thoughts of taking their own lives. Discussion and conclusion. The higher number of hours worked per week, surgical specialties, and the presence of workplace harassment were recognized as psychosocial and occupational factors associated with mental health problems in resident physicians, such as depression, thoughts of death, burnout, and psychoactive substance use. In a country like Mexico, where medical residents are a crucial pillar of the public health system, it is necessary to ensure their well-being, and seek to improve the working and academic conditions of medical residencies to ensure that this is reflected in the quality and safety of patient care.
Introducción. Los residentes de especialidades médicas se han convertido en una población de alto riesgo para padecer alteraciones de la salud mental, principalmente por la extensión de las jornadas laborales, tiempo limitado para su descanso y recreación, los problemas propios del ambiente laboral o el consumo de sustancias. Todos estos factores alteran no solo la formación de futuros especialistas, sino la atención que brindan a las personas, por lo que el estudio e intervención en esta población es de interés para el sistema de salud y la formación de recursos humanos en salud. Objetivo. Evaluar el estado de salud mental, la prevalencia de desgaste laboral y los factores psicosociales y laborales asociados en médicos residentes de la Zona Metropolitana de Guadalajara. Método. Se trató de un estudio transversal, observacional, descriptivo y comparativo, en el cual, por medio de una encuesta digitalizada en la plataforma de Google Forms, se aplicaron las escalas GHQ-28, ASSIST y el Inventario de Burnout de Maslach a los residentes de especialidades médicas de diferentes instituciones de salud en la zona metropolitana de Guadalajara. Resultados. La muestra total fue de 306 residentes, lo que representó el 11.23% del total de residentes de la zona metropolitana de Guadalajara (2,724). Las médicas tuvieron un mayor porcentaje de participación con el 61.4% (n = 188), y los médicos 38.6% (n = 118). La edad promedio fue de 28.9 años y el 84.9% (n = 260) realizaba una especialidad clínica, el 15.1% (n = 46) una quirúrgica p ˂ 05. En promedio trabajaban, 74.1 horas por semana, mientras que en las especialidades quirúrgicas trabajaban 10 horas más (82.63 ± 23.40 vs. 72.67 ± 19.76, p = .002). El 72.5% (n = 222) presentaron alto riesgo de presentar burnout. El 9.2% (n = 28) presentaron puntuaciones compatibles con depresión grave, lo cual se relacionó con mayor cantidad de horas trabajadas por semana y un mayor consumo de alcohol que los residentes sin depresión; el 21.24% (n = 65) de los encuestados pensaban frecuentemente en renunciar, el 22.5% (n = 69) no sentían satisfacción por su trabajo; y el 14.05% (n = 43) de los residentes habían notado últimamente que la idea de quitarse la vida venía repetidamente a su cabeza. Discusión y conclusión. El mayor número de horas laboradas a la semana se manifestaba las especialidades quirúrgicas y la presencia de acoso laboral se reconocieron como factores psicosociales y laborales asociados a los problemas de salud mental en médicos residentes. Entre éstos estaban la depresión, los pensamientos de muerte, el burnout y el consumo de sustancias psicoactivas. En un país como México, en el que los médicos residentes son un pilar fundamental para el funcionamiento del sistema de salud público, es necesario asegurar su bienestar, procurando la mejora en las condiciones laborales y académicas de las residencias médicas, a fin de que se reflejen en la calidad y seguridad en la atención de sus pacientes.
Resumen Introducción. En el año de 2011 había en México 3 823 psiquiatras, con una tasa estimada de 3.4 por cada 100 mil habitantes. Es necesario mantener actualizada esta información para alcanzar ...los objetivos globales de atención a la salud mental. Objetivo. Estimar el número total de psiquiatras en México en 2016; determinar su distribución geográfica y comparar los resultados con los obtenidos en el año 2011. Método. Estudio comparativo y longitudinal. Se consultaron diversas fuentes para actualizar el número de psiquiatras en 2016 y conocer sus características sociodemográficas. Se compararon estas características con las encontradas en 2011. Resultados. Un total de 4 4 393 psiquiatras ejercen su especialidad en México en 2016. Sobre una población de 119 530 753 habitantes, se obtuvo una tasa de 3.68 psiquiatras por cada 100 000 habitantes. Existe una pobre distribución de estos especialistas en el país. Alrededor del 60% de todos los psiquiatras ejercen en las tres mayores ciudades de México. Discusión y conclusión. La tasa nacional de psiquiatras se incrementó en comparación con la obtenida en 2011, sigue siendo inferior a la recomendada por la Organización Mundial de la Salud (OMS). La distribución geográfica de los psiquiatras es inequitativa debido a la centralización y a factores económicos.
Introduction In 2011 we had 3823 psychiatrists in Mexico, with an estimated rate of 3.4 per 100 000 inhabitants. In order to achieve the global targets of mental health attention, it is important to ...update this information. Objective To estimate the total number of psychiatrists in Mexico in 2016; determine their geographic distribution and compare the results with the ones obtained in 2011. Method Longitudinal and comparative study. Diverse sources of information were consulted in order to update the number of psychiatrists in 2016 and to know their sociodemographic characteristics that were compared with the ones obtained in 2011. Results 4 393 psychiatrists practiced their specialty in Mexico in 2016. With a population of 119 530 753 inhabitants, we obtained a rate of 3.68 psychiatrists per 100 000 inhabitants. There's a poor distribution of these specialists in the country. Around 60% of all psychiatrists practice in the tree major cities of Mexico. Discussion and conclusion The national rate of psychiatrists increase in comparison with the one we found in 2011, it remains lower that the one recommended by the World Health Organization (WHO). Geographic distribution of the psychiatrists is inequitative because of centralization and economic factors. Key words: Mexico, psychiatrists, distribution, board certification. Introduccion En el ano de 2011 habia en Mexico 3823 psiquiatras, con una tasa estimada de 3.4 por cada 100 mil habitantes. Es necesario mantener actualizada esta informacion para alcanzar los objetivos globales de atencion a la salud mental. Objetivo Estimar el numero total de psiquiatras en Mexico en 2016; determinar su distribucion geografica y comparar los resultados con los obtenidos en el ano 2011. Metodo Estudio comparativo y longitudinal. Se consultaron diversas fuentes para actualizar el numero de psiquiatras en 2016 y conocer sus caracteristicas sociodemograficas. Se compararon estas caracteristicas con las encontradas en 2011. Resultados Un total de 4393 psiquiatras ejercen su especialidad en Mexico en 2016. Sobre una poblacion de 119 530 753 habitantes, se obtuvo una tasa de 3.68 psiquiatras por cada 100 000 habitantes. Existe una pobre distribucion de estos especialistas en el pais. Alrededor del 60% de todos los psiquiatras ejercen en las tres mayores ciudades de Mexico. Discusion y conclusion La tasa nacional de psiquiatras se incremento en comparacion con la obtenida en 2011, sigue siendo inferior a la recomendada por la Organizacion Mundial de la Salud (OMS). La distribucion geogrdfica de los psiquiatras es inequitativa debido a la centralizacion y a factores economicos. Palabras clave: Mexico, psiquiatras, distribucion, certificacion.