Assessment of visuospatial functions in post-Covid 19 patients: Beyond the traditional paradigm.

Several studies indicate that some cognitive changes occur after COVID-19. Visuospatial alterations have been reported in 24-40 %. These alterations may be useful as early biomarkers of neurodegenerative disease. Thus, we can emphasize the importance of visuospatial processes in cognition through quantitative and qualitative analysis of performance on the Clock Test (CDT) and the Rey-Osterrieth Complex Figure (FCRO). Our objective was to describe the performance of post COVID 19 patients in visuospatial tests, with different degrees of respiratory impairment and to perform a qualitative analysis of the performance to check its relationship with alterations in attention and executive functions. This will allow highlighting the executive component of the performance of the CDT and ROCF and differentiate patients with possible cognitive impairment. 77 patients with SARS-CoV-2 infection were evaluated (3 months post-infection) with a complete neuropsychological battery and MRI. Overall, there is a significant difference between FCRO and CDT, with FCRO having only 9 % change and CDT having 51.9 % change. Regarding the correlations observed between groups (VM Inv, VM non I and non hospitalized) the highest correlations were observed between Boston with FCRO copy (r=0.497; p=0.001) and with FCRO memory (r=0.429; p=0.001). Comparing the performance between groups by severity, significant differences were observed only in the TMT A (13.706 p=0.001) and B (9.583 p=0.008) tests and in the phonological fluency letter A (13.445 p=0.001), we observed that the group of non-hospitalized patients had a better performance. Neuropsychological deficits often have a direct impact on daily life by affecting the ability to learn and adapt. Thus, a useful strategy for the neuropsychological characterization of post-COVID-19 patients is the qualitative analysis of visuospatial abilities in conjunction with executive functions that cannot be analyzed in isolation.

SARS-CoV-2's brain impact: revealing cortical and cerebellar differences via cluster analysis in COVID-19 recovered patients.

BACKGROUND: COVID-19 is a disease known for its neurological involvement. SARS-CoV-2 infection triggers neuroinflammation, which could significantly contribute to the development of long-term neurological symptoms and structural alterations in the gray matter. However, the existence of a consistent pattern of cerebral atrophy remains uncertain. OBJECTIVE: Our study aimed to identify patterns of brain involvement in recovered COVID-19 patients and explore potential relationships with clinical variables during hospitalization. METHODOLOGY: In this study, we included 39 recovered patients and 39 controls from a pre-pandemic database to ensure their non-exposure to the virus. We obtained clinical data of the patients during hospitalization, and 3 months later; in addition we obtained T1-weighted magnetic resonance images and performed standard screening cognitive tests. RESULTS: We identified two groups of recovered patients based on a cluster analysis of the significant cortical thickness differences between patients and controls. Group 1 displayed significant cortical thickness differences in specific cerebral regions, while Group 2 exhibited significant differences in the cerebellum, though neither group showed cognitive deterioration at the group level. Notably, Group 1 showed a tendency of higher D-dimer values during hospitalization compared to Group 2, prior to p-value correction. CONCLUSION: This data-driven division into two groups based on the brain structural differences, and the possible link to D-dimer values may provide insights into the underlying mechanisms of SARS-COV-2 neurological disruption and its impact on the brain during and after recovery from the disease.

Violence and Clinical Learning Environments in Medical Residencies.

INTRODUCTION: The objective of this study was to describe and analyze residents' perceptions of characteristics on the expansive/restrictive continuum of their clinical learning environment. METHODS: We conducted a quantitative, descriptive and cross-sectional study. A self-administered questionnaire was designed, programmed and applied to residents at the Faculty of Medicine of the National Autonomous University of Mexico. The instrument was structured in eight sections, and for this article, Section 3, which referred to clinical environments and violence was considered. The questionnaire had an 85% response rate, with 12,612 residents from 113 medical units and 78 specialties participating. The reliability and internal consistency measured with alpha omega obtained a value of ω 0.835 (CI; 0.828-0.843). RESULTS: Unpleasant, competitive, tense and conflictive contexts were related to restrictive environments. Sexual orientation influenced the perception of intolerance in the clinical setting with respect to discriminatory comments, such that for gender minorities, the environment was experienced as exclusionary. First-year residents perceived environments as more aggressive, a perception that tended to decrease in later years of residency. DISCUSSION: Abuses in power relations, rigid hierarchical positions and offensive clinical interactions may foster restrictive environments. In such settings, the reproduction of socio-culturally learned violence is feasible; however, asymmetrical relationships may be deconstructed and transformed.

Quality of life and mental health in multiple sclerosis patients during the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic had a profound impact on mental health symptoms and quality of life (QoL) in the general population due to necessary public health restrictions such as social distancing. The psychosocial effect of the pandemic on vulnerable groups such as people living with Multiple Sclerosis (PwMS) has been scarcely explored in countries with additional socioeconomical burdens such as access to healthcare disparities METHODS: A questionnaire exploring sociodemographic variables, quality of life, mental health determinants and sleep quality was applied to 92 PwMS to explore changes prior and during the pandemic regarding these domains RESULTS: 58.8% of the subjects were female, median age was 37.1 (± 8.5) years and relapsing-remitting MS was the predominant clinical subtype (83.5%). Unemployment rate significantly increased during the pandemic (12.3% vs 27.8%; p= 0.001). Only 46.4% received medical follow-up care during the pandemic. QoL was affected predominantly due to limitations in instrumented activities of daily life (IADL). Neuropsychiatric symptoms, requiring healthcare during the pandemic, anxiety prior to the pandemic and restricted IADL were predictors of MS-related physical impact worsening, while decreased physical/emotional wellbeing selfcare, neuropsychiatric symptoms, bad sleep quality, anxiety prior to the pandemic and restricted non-instrumental ADL predicted aggravation of MS-related psychological impact measured by the MSIS-29. Curiously, specific items regarding anxiety were more prevalent prior to the pandemic (anxious mood; p=0.02, helplessness; p=0.01), sleep problems; p=0.001 and cardiovascular symptoms; p=0.001, nevertheless, stability was observed for most items. Importantly, 77.3% of PwMS reported at least one neuropsychiatric symptom CONCLUSION: The deleterious effects of the COVID-19 pandemic on psychosocial wellbeing in PwMS, QoL and mental health outcomes are frequently overseen in vulnerable populations such as PwMS. Albeit the limitations of this study, our results may help implement policies that prevent negative outcomes on psychosocial wellbeing due to public health measures (e.g., social distancing) in MS and other neurological diseases that inexorably need constant follow-up.

Intimate Partner Violence in Persons With Parkinson's Disease.

Recent studies have reported that older adults with cognitive or physical disabilities are at risk to suffer intimate partner violence. This article investigates the intimate partner violence among caregivers and persons with Parkinson's disease (PD). We used qualitative methods to investigate whether the presence of violence was related to the type of couple relationship before the disease onset. We used a survey, in-depth interviews, and focus groups in 20 dyads of caregivers and patients. Twelve (60%) persons with PD and nine (45%) caregivers reported receiving violence. Considering their relationships previous to disease onset, we describe three typologies of violence in PD: (a) disease and history of violence, (b) disease as a buffer of violence, and (c) the burden of disease as an inductor of violence. Previous relationships and the couple's biographical trajectories influence the types of violence and its nature. This study is relevant as it considers time as a crucial factor in both the violence and suffering of PD and its caregiving.

Estudio piloto en cuidadores de pacientes con enfermedades neurológicas, sobre el significado y conocimiento de cuidados paliativos / Estudo piloto em cuidadores de pacientes com enfermidades neurológicas, sobre o significado e conhecimento de cuidados paliativos / Pilot study with caregivers attending patients with neurologic diseases, about the meaning and knowledge of palliative care

Objetivo. Describir el significado que atribuyen cuidadores a los cuidados paliativos (CPS), así como su preferencia respecto a informar al paciente y su satisfacción con el papel de cuidador. Metodología. Estudio descriptivo transversal, muestra intencional de 40 cuidadores de enfermos neurológicos con necesidad de CPS. Se aplicó un cuestionario de conocimientos sobre el tema y sobrecarga. Se realizó análisis descriptivo-comparativo con un intervalo de confianza de 95 por ciento (p mayor 0.05). Resultados. Pacientes: 52,6 por ciento hombres, edad promedio de 57,9 por ciento años, tiempo de enfermedad: 5 años, 2 hijos en promedio. Cuidadores: 77,5 mujeres, 25,0 por ciento cónyuges. Edad promedio: 49.3 años, proporcionan 18,5 horas de cuidado diario, 62,5 por ciento tenía estudios de secundaria o superiores, 40 por ciento son cuidadores únicos, 16,7 por ciento no cuenta con redes de apoyo y 42,5 por ciento presenta sobrecarga alta. Un 70 por ciento no tenía información previa sobre CPS. Significado: 50 por ciento mencionó "dar ayuda" (física o emocional), 20 por ciento"mejorar la calidad de vida". El 87,5 por ciento desearía ser informado con detalle si ellos fueran los pacientes, 86,1 por ciento quisiera ser informado por el médico y 62,5 por ciento se mostró a favor de que se le informara con detalle a su familiar. Conclusiones. Es importante difundir los CPS en cuidadores y estimular el derecho de los pacientes a recibir información sobre el pronóstico de su enfermedad.

Aim. To describe the meaning attributed to palliative care (PC) by caregivers, as well as their preference with respect to informing the patient and their satisfaction in their caring role. Methodology: Study descriptive transversal, sample intended of 40 caregivers of neurologic patients needing PC. A questionnaire about knowledge of the topic and their burnout status was applied. A descriptive-comparative analysis was carried out with 95 percent (p higher 0.05) confidence interval. Results: Patients: 52.6 percent men, average age 57.9 years, duration of disease: 5 years, average of 2 children. Caregivers: 77.5 percent women, 25.0 percent married, average age: 49.3 years, daily caring 18.5 hours, 62.5 percent with high School or university studies, 40 percent alone as caregivers, 16.7 percent do not count with support nets and 42.5 percent present high burn out status. Of them 70 percent did not have previous information about PC. Meaning: 50 percent mentioned "to give help" (physical or emotional), 20 percent "to enhance quality of life". 87.5 percent would like to be informed with detail if they were the patients, 86.1 percent would like to be informed by the physician and 62.5 percent were in favor to inform with detail to their family member. Conclusions: It is important to disseminate PC to caregivers and to stimulate the right of patients to receive information about the prognosis of their disease.

Objetivo. Descrever o significado que atribuem cuidadores aos cuidados paliativos (CPS), assim como sua preferência com respeito a informar ao paciente e sua satisfação com o papel de cuidador. Metodologia. Estudo descritivo transversal, amostra intencional de 40 cuidadores de enfermos neurológicos com necessidade de CPS. Aplicou-se um questionário de conhecimentos sobre o tema e sobrecarga. Realizou-se análise descritivo-comparativa com um intervalo de confiança de 95 por cento (p superior 0.05). Resultados. Pacientes: 52,6 por cento homens, idade média de 57,9 anos, tempo de enfermidade: 5 anos, 2 filhos em média. Cuidadores: 77,5 por cento mulheres, 25,0 por cento cônjuges. Idade média: 49.3 anos, proporcionam 18,5 horas de cuidado diário, 62,5 por cento tinham estudos secundários ou superiores, 40 por cento são cuidadores únicos, 16,7 por cento não contam com redes de apoio e 42,5 por cento apresentam sobrecarga alta. 70 por cento não tinham informação prévia sobre CPS. Significado: 50 por cento mencionaram "dar ajuda" (física ou emocional), 20 por cento "melhorar a qualidade de vida". 87,5 por cento desejariam ser informados com detalhe se eles fossem pacientes, 86,1 por cento quiseram ser informados pelo médico e 62,5 por cento se mostraram a favor de que fossem informados com detalhes um seu familiar. Conclusões. É importante difundir os CPS em cuidadores e estimular o direito dos pacientes em receber informação sobre o prognóstico de sua enfermidade.

[Domestic violence in patients and caregivers dyads in neurological diseases]. / Violencia doméstica en díadas paciente-cuidador de enfermedades neurológicas.

INTRODUCTION: Patients with neurological diseases are susceptible to abuse and neglect. Studies on violence in this context have mainly focused on abuse perpetrated by a caregiver to the patient directionally. In this study we describe violence in dyads of caregivers and patients with neurological disorders according to frequency, directionality, and type of relation. METHODS: One-hundred-and-eighty-five caregiver-patient dyads were assessed by means of the National Survey of Violence Against Women (NSVAW) guidelines and the Zarit and Pfeiffer questionnaires. Bivariate analysis and Spearman correlation tests were performed. RESULTS: Violence was reported by 32.5% of caregivers and 33.5% of patients. In both groups, psychological abuse was the most common. Mutual violence (54.5%) is the most common type of abuse and the caregiver reported as having more violent behavior is the intimate partner. Epilepsy was the neurological disorder where violence was more prevalent (47.6%). CONCLUSIONS: The prevalence of violence in our sample is higher than the one for the general population of 21%, as reported by the NSVAW. Clinical neurologists and healthcare services are key elements for the detection of abuse in this context.

Expectativas laborales y empleabilidad en enfermería y psicología / Job Prospects and Employability in Nursing and Psychology / Expectativas laborais e empregabilidade em enfermagem e psicologia

Objetivo: describir la empleabilidad de los estudiantes de las carreras de enfermería y psicología respecto a la búsqueda, obtención y expectativas de un trabajo. Materiales y métodos: estudio descriptivo, transversal, en estudiantes universitarios de la Universidad Autónoma del Estado de Morelos (UAEM, Cuernavaca, México), de las carreras de Enfermería y Psicología; el universo muestral fue de 1060 estudiantes, se obtuvo una muestra intencional de 297 estudiantes, 126 de Enfermería y 171 de Psicología; las variables estudiadas fueron: mercado de trabajo, futuro laboral, valoración de un empleo, aportación a la empresa u organización, perfil de trabajo ideal y variables sociodemográficas. Se elaboró una encuesta para medir la variable dependiente. Resultados: se observa un mayor predominio de mujeres (74,7%); el 20,9% de los graduados trabajan actualmente, de los cuales 18,1% son psicólogos/as y 24,3% enfermeros/as (71% mujeres). En lo referente a la valoración de un empleo, aportación a la empresa u organización y perfil de trabajo ideal, los estudiantes de la carrera de Enfermería muestran mejores puntajes que los de Psicología. Conclusión: la empleabilidad es un constructo complejo, la formación profesional debe valorar en qué medida su perfil de egreso permite satisfacer las demandas del mercado laboral, que está sujeto a condiciones precarias de empleo, factores culturales, habilidades mostradas y potencial del factor humano.

Objective: Describe the employability of students majoring in nursing and psychology with respect to their job expectations and success in finding work. Materials and Methods: This is a descriptive, cross-sectional study conducted among nursing and psychology students at the Autonomous University of the State of Morelos (UAEM) in Cuernavaca, Mexico. The sampling universe was comprised of 1,060 students, and a purposive sample of 297 students was obtained: 126 who are majoring in nursing and 171 in psychology. The variables studied include the job market, employment future, job appreciation, contribution to the company or organization, ideal job profile and socio-demographic variables. A survey was developed to measure the dependent variable. Results: A higher prevalence of women (74.7%) was observed; 20.9% of the graduates are currently employed; 18.1% of those who are working are psychologists and 24.3% are nurses (71% women). As for job appreciation, contribution to the company or organization and ideal job profile, the students majoring in nursing had better scores than those majoring in psychology. Conclusion: Employability is a complex construct. Professional training should assess to what extent the graduate's profile coincides with the demands of the job market, which is subject to precarious employment conditions, cultural factors, demonstrated skills and the potential of the human factor.

Objetivo: descrever a empregabilidade dos estudantes dos cursos de enfermagem e psicologia a respeito da procura, obtenção e expectativas de trabalho. Materiais e métodos: estudo descritivo, transversal, em estudantes universitários da Universidade Autônoma do Estado de Morelos (UAEM, Cuernavaca, México), dos cursos de enfermagem e psicologia. O universo da amostra foi de 1.060 estudantes; obteve-se uma amostra intencional de 297 estudantes, 126 de enfermagem e 171 de psicologia; as variáveis estudadas foram: mercado de trabalho, futuro laboral, valorização de um emprego, contribuição para a empresa ou organização, perfil de trabalho ideal e variáveis sociodemográficas. Elaborou-se uma enquete para medir a variável dependente. Resultados: observa-se um maior predomínio de mulheres (74,7%); 20,9% dos formados trabalham atualmente, dos quais 18,1% são psicólogos/as e 24,3% enfermeiros/as (71% mulheres). Quanto à valorização de um emprego, contribuição para a empresa ou organização e perfil de trabalho ideal, os estudantes do curso de enfermagem mostram melhores pontuações do que os de psicologia. Conclusão: a empregabilidade é um constructo complexo; a formação profissional deve valorizar em que medida seu perfil de egresso permite satisfazer as demandas do mercado laboral, que está sujeito a condições precárias de emprego, fatores culturais, habilidades mostradas e potencial do fator humano.

Compromiso organizacional en profesionales de la salud. Revisión bibliográfica / Study on Organizational Commitment in Health Professionals

Resumen

Existe un aumento importante en las investigaciones sobre Compromiso Organizacional (CO) y este interés se debe en gran parte a que se reconoce que tiene un impacto no sólo para determinar la permanencia de los empleados, sino porque los empleados comprometidos contribuyen a alcanzar los objetivos organizacionales y llevan a mayores niveles de eficiencia. En el campo de la salud, el CO, como constructo teórico y como variable empírica, ha sido poco estudiado, para su estudio se han basado en modelos con distintos enfoques, tratando de determinar las relaciones existentes, antes que definir con precisión su naturaleza para los profesionales de la salud. En nuestro país, es un tema que sólo recientemente ha empezado a generar cierto interés en los investigadores de la psicología social, de las organizaciones y la administración, siendo un grupo al cual no se le ha prestado atención desde esta perspectiva de investigación. La presente revisión busca dar un panorama general del estudio de este constructo en profesionales de la salud y propone alternativas para su medición haciendo énfasis en variables relacionadas con la salud psicológica de los profesionales de la salud que no se han descrito consistentemente, como son; variables personales: tipo de profesión, personalidad resistente, riesgos psicosociales en el trabajo (fatiga por compasión, conflicto trabajo-familia y acoso psicológico) y factores organizacionales (contrato psicológico, apoyo percibido, satisfacción laboral) en el mantenimiento del CO y permanencia de los empleados en la organización.

Summary

There is a significant increase in research on Organizational Commitment (OC) and this interest is driven in large part because it is recognized the impact OC has not only for determining employees’ permanence but also because committed employees contribute to achieving organizational goals and lead to higher levels of efficiency. In the health field, the OC, as a theoretical construct and empirical variable has been little studied and their work have been based on models with different approaches, trying to determine existing relationships before precisely defining its nature for health professionals. In our country, is a subject that has only recently begun to generate some interest in social psychology researchers, organizations and administration, as a group to which no attention has been given from the research perspective. This review aims to give a general overview of the study of this construct in health care professionals and proposes alternatives for their measurement with emphasis on variables related to psychological health of health professionals which have not been consistently described, such as; Personal Variables (type of profession, resisting personality), psychosocial risks at work (compassion fatigue, work-family conflict and psychological harassment) and organizational factors (psychological contract, perceived support, job satisfaction) in the maintenance of OC and permanence of employees in the organization.