Perception of personal protective equipment availability and mental health outcomes in workers from two national hospitals during the COVID-19 pandemic.

Background: During the first wave of the pandemic, a constant concern of healthcare workers, who are more vulnerable to contagion, is their personal safety. This is directly related to the availability of adequate PPE, which led to a perception of dissatisfaction and inequality with government responses. We aim t o determines whether perception of adequate PPE availability is associated with depressive, anxiety, and stress symptoms in different types of healthcare workers. Methods: Analytical cross-sectional study surveyed clinical and non-clinical healthcare workers in two third-level hospitals in Lima, Peru. An online self-survey assessed the perception of adequate PPE availability, using a Likert scale question, which was then dichotomized for the analysis. In addition, we assessed the depressive, anxiety, and stress symptoms using validated questionnaires. Results: 563 participants were included. In general, there is no association between perception of PPE availability and three mental health outcomes. However, in the subgroup analysis, physicians with better perception of PPE availability had less moderate-severe outcomes in mental health; in contrast, nurses had higher moderate-severe outcomes. The type of profession in healthcare workers may modify the effect of this association. Conclusion: The association between perception of PPE availability and mental health outcomes is complex in healthcare workers from two third-level hospitals. This association can vary according to the type of work.

Guía de práctica clínica para el tamizaje y manejo del episodio depresivo leve en el primer nivel de atención del Seguro Social del Perú (EsSalud) / Clinical practice guideline for the screening and management of the mild depressive episode at the first level of care for the Peruvian Social Security (EsSalud)

El presente artículo resume la guía de práctica clínica (GPC) para el tamizaje y el manejo del episodio depresivo leve en el primer nivel de atención en el Seguro Social del Perú (EsSalud). Para el desarrollo de esta GPC, se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas clínicos y metodólogos, el cual formuló 06 preguntas clínicas. Para responder cada pregunta se realizó búsquedas sistemáticas en PubMed y en repositorios de GPC, y se seleccionó la evidencia pertinente. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones periódicas, el GEG usó la metodología GRADE para revisar la evidencia y emitir las recomendaciones. Se emitieron siete recomendaciones (tres fuertes y cuatro condicionales), 28 puntos de buena práctica clínica, y dos flujogramas.

This paper summarizes the clinical practice guide (CPG) for the screening and management of mild depressive episode at the first level of care in the Social Security of Peru (EsSalud). A guideline development group (GDG) was established for develop this CPG, which included clinical and methodology specialists, who formulated 06 clinical questions. Systematic searches were conducted in Pubmed and GPC repositories to answer each question, and relevant evidence was selected. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GDG used the GRADE methodology for reviewing the evidence and for developing recommendations. At the end, this CPG formulated 07 recommendations (03 strong and 04 conditional), 28 points of good clinical practice, and 02 flow charts were formulated.

[Major depression in pregnant women served by the National Materno-Perinatal Institute in Lima, Peru]. / Depresión mayor en embarazadas atendidas en el Instituto Nacional Materno Perinatal de Lima, Perú

OBJECTIVES: To determine the prevalence of major depression during pregnancy and to define the sociodemographic and obstetric characteristics of pregnant women with major depression treated by the outpatient clinic at a hospital in Lima, Peru. METHODS: A descriptive, cross-sectional study with simple association. The analysis consisted of 222 pregnant women 16-42 years of age with low obstetric risk who had visited the outpatient services of the Obstetrics Department at the National Materno-Perinatal Institute in Lima, Peru, from 2 June-28 November 2006. Each pregnant woman was given the Edinburgh Depression Scale and a questionnaire on sociodemographic and obstetric data. The relationship between the study variables was determined by the presence of major depression revealed through either chi2 or Z tests, depending on variable type. RESULTS: Of the 222 pregnant women studied, 89 (40.1%) had major depression. Fewer married women tended to be depressed; those with unplanned pregnancies and pregnancy complications were more often depressed than their peers. Age, number of children, gestational stage, educational level, history of abortion/miscarriage, consumption of alcohol or other drugs, lack of family support, and perceived marital, family, or financial problems were not found to influence depression frequency. CONCLUSIONS: The prevalence of major depression among pregnant women was very high. Special attention should be given to women with unplanned pregnancies and those experiencing complications during pregnancy, so that an early diagnosis can be made and appropriate treatment offered.

Depresión mayor en embarazadas atendidas en el Instituto Nacional Materno Perinatal de Lima, Perú / Major depression in pregnant women served by the National Materno-Perinatal Institute in Lima, Peru

OBJETIVOS: Determinar la prevalencia de depresión mayor durante el embarazo y establecer las características sociodemográficas y obstétricas de las mujeres embarazadas con depresión mayor atendidas en la consulta externa de un hospital de Lima, Perú. MÉTODOS: Estudio descriptivo transversal de asociación simple. Se analizaron 222 gestantes de 16 a 42 años con bajo riesgo obstétrico que acudieron a la consulta externa del Departamento de Obstetricia del Instituto Nacional Materno Perinatal de Lima, Perú, entre el 2 de junio y el 28 de noviembre de 2006. A cada embarazada se le aplicó la escala de depresión de Edimburgo y un cuestionario sobre datos sociodemográficos y obstétricos. Se determinó la relación entre las variables de estudio según la presencia de depresión mayor mediante las pruebas de la χ2 y de la Z, según el tipo de variable. RESULTADOS: De las 222 gestantes estudiadas, 89 (40,1 por ciento) presentaron depresión mayor. Las mujeres casadas tendían a deprimirse menos; las que no planificaron su embarazo y que presentaron complicaciones durante su gestación tendieron a deprimirse más que sus pares. No se encontró que la edad, el número de hijos, la edad gestacional, el nivel educacional, los antecedentes de aborto, el consumo de alcohol u otras sustancias, la falta de apoyo familiar y la percepción de tener problemas de pareja, familiares, económicos o personales influyeran en la frecuencia de depresión. CONCLUSIONES: La prevalencia de depresión mayor en las gestantes estudiadas fue muy elevada. Se debe prestar especial atención a las mujeres que manifiestan tener un embarazo no planificado y las que sufren complicaciones durante su embarazo, a fin de llegar a diagnósticos tempranos y aplicar tratamientos oportunos.

OBJECTIVES: To determine the prevalence of major depression during pregnancy and to define the sociodemographic and obstetric characteristics of pregnant women with major depression treated by the outpatient clinic at a hospital in Lima, Peru. METHODS: A descriptive, cross-sectional study with simple association. The analysis consisted of 222 pregnant women 16-42 years of age with low obstetric risk who had visited the outpatient services of the Obstetrics Department at the National Materno-Perinatal Institute in Lima, Peru, from 2 June-28 November 2006. Each pregnant woman was given the Edinburgh Depression Scale and a questionnaire on sociodemographic and obstetric data. The relationship between the study variables was determined by the presence of major depression revealed through either χ2 or Z tests, depending on variable type. RESULTS: Of the 222 pregnant women studied, 89 (40.1 percent) had major depression. Fewer married women tended to be depressed; those with unplanned pregnancies and pregnancy complications were more often depressed than their peers. Age, number of children, gestational stage, educational level, history of abortion/miscarriage, consumption of alcohol or other drugs, lack of family support, and perceived marital, family, or financial problems were not found to influence depression frequency. CONCLUSIONS: The prevalence of major depression among pregnant women was very high. Special attention should be given to women with unplanned pregnancies and those experiencing complications during pregnancy, so that an early diagnosis can be made and appropriate treatment offered.

Manifestaciones neuropsiquiátricas en accidentes cerebrovasculares / Neuropsychiatric manifestations in cerebrovascular diseases

Introducción: Los accidentes cerebrovasculares puede producir manifestaciones neuro-psiquiátricas, la presente revisión intenta mostrar los avances y conceptos agregados hasta la fecha que ayudan al diagnóstico, tratamiento y la investigación. Método: Se revisó la bibliografía publicada en cuatro bases electrónicas (Medline, EBSCO, ProQuest, Ovid) usando términos relacionados con manifestaciones neuropsiquiátricas en el accidente cerebrovascular. Discusión: Esta revisión muestra que los accidentes cerebrovasculares pueden producir una serie de manifestaciones neuropsiquiátricas como depresión, manía, apatía, ansiedad, psicosis, etc. Recientemente se ha propuesto el término de Desorden de Expresión Emocional Involuntaria que pretende homogenizar criterios para el llanto y risa patológica, labilidad emocional o afectiva, emocionalismo, incontinencia emocional, emociones o afectos patológicos, y descontrol emocional, términos usados para describir una misma patología. Asimismo, el termino Deterioro Cognitivo Vascular ha sido propuesto para englobar el amplio espectro de cambios cognitivos y conductuales asociados a accidentes cerebrovasculares sin demencia. Además, se brinda especial atención al estudio e instrumentalización de las funciones ejecutivas, teoría de la mente y empatia, conceptos que describen habilidades propiamente humanas, que también se ven deterioradas. Conclusión: Los síntomas neuropsi-quiátricos obstaculizan el proceso de rehabilitación, deterioran el nivel de vida del paciente, creando institucionalización y agregando mayor carga emocional y economía a los responsables del paciente.

Background: Neuropsychiatric manifestations could occur following a cerebrovascular disease, the present review shows the advantages and update concepts which helps to the diagnostic, treatment and research. Method: we searched four electronic database (Medline, EBSCO, ProQuest, Ovid) using the terms in relation with neuropsychiatric manifestations in cerebrovascular disease. Discussion: The present review shows the different neuropsychiatric manifestations which could be occur following Cerebrovascular Lesions, like depression, mania, apathy, anxiety, psychosis, etc. Recently the term of Involuntary Emotional Expression Disorder has been proposed to unifying terms like pathological laughing and crying, pathological weeping, emotional or affective lability, emotionalism, emotional incontinence, pathologic emotionality or affect, and emotional dyscontrol, terms which are used to describe the same pathology. Also, the term vascular cognitive impairment has been proposed to include the broad spectrum of cognitive and behavioural changes associated with cerebrovascular lesions without dementia. In addition, there are special attention to the study and instrumentalization of the executive functions, theory of mind and empathy, concepts that describe abilities properly human, which also are deteriorated. Conclusions: The neuropsychiatric symptoms cause significant problems in the rehabilitation process, deterioration in patient's quality of life, creating institutionalization and adding greater emotional and economy load to the people in charge of the patient's care.