Mental health issues and psychological risk factors among Paraguayan healthcare workers during the COVID-19 pandemic.

BACKGROUND: There is an increasing concern regarding the mental health of healthcare workers during the COVID-19 pandemic. AIMS: This study aimed to assess the psychological impact of the COVID-19 exposure among Paraguayan healthcare workers. METHODS: A cross-sectional descriptive study has been carried out in five hospitals of Paraguay. Demographic and occupational exposure to COVID-19 were collected through a short questionnaire. Mental health status was assessed with the GAD-7, the PHQ-9, and the PCL-C. Logistic regression was used to determine psychological risk factors. RESULTS: 432 participants were surveyed. 218 (50.46%) were physicians. The prevalence of symptoms of anxiety, depression and PTSD was 48.15, 41.90, and 5.79%, respectively. There were no significant differences in anxiety (128 [29.63%] vs. 80 [18.52%]; p = 0.3303), depression (102 [23.61%] vs. 79 [18.29%]; p = 0.6703), or PTSD (14 [3.24%] vs. 11 [2.55%]; p = 0.8074) between frontline versus second-line workers. Main risk factors associated with psychological distress included work experience <5 years for depression and a COVID-19 positive diagnosis or having family/friends with a COVID-19 positive diagnosis for PTSD. CONCLUSIONS: Paraguayan healthcare workers reported high prevalence of anxiety, depression, and a low prevalence of PTSD. A positive diagnosis of COVID-19 and work experience <5 years are important psychological risk factors.

Increasing reactivity by incorporating π-acceptor ligands into coordinatively unsaturated thiolate-ligated iron(II) complexes.

Reported herein is the structural, spectroscopic, redox, and reactivity properties of a series of iron complexes containing both a π-donating thiolate, and π-accepting N-heterocycles in the coordination sphere, in which we systematically vary the substituents on the N-heterocycle, the size of the N-heterocycle, and the linker between the imine nitrogen and tertiary amine nitrogen. In contrast to our primary amine/thiolate-ligated Fe(II) complex, [FeII(SMe2N4(tren))]+ (1), the Fe(II) complexes reported herein are intensely colored, allowing us to visually monitor reactivity. Ferrous complexes with R = H substituents in the 6-position of the pyridines, [FeII(SMe2N4(6-H-DPPN)]+ (6) and [FeII(SMe2N4(6-H-DPEN))(MeOH)]+ (8-MeOH) are shown to readily bind neutral ligands, and all of the Fe(II) complexes are shown to bind anionic ligands regardless of steric congestion. This reactivity is in contrast to 1 and is attributed to an increased metal ion Lewis acidity assessed via aniodic redox potentials, Ep,a, caused by the π-acid ligands. Thermodynamic parameters (ΔH, ΔS) for neutral ligand binding were obtained from T-dependent equilibrium constants. All but the most sterically congested complex, [FeII(SMe2N4(6-Me-DPPN)]+ (5), react with O2. In contrast to our Mn(II)-analogues, dioxygen intermediates are not observed. Rates of formation of the final mono oxo-bridged products were assessed via kinetics and shown to be inversely dependent on redox potentials, Ep,a, consistent with a mechanism involving electron transfer.

How Metal Ion Lewis Acidity and Steric Properties Influence the Barrier to Dioxygen Binding, Peroxo O-O Bond Cleavage, and Reactivity.

Herein we quantitatively investigate how metal ion Lewis acidity and steric properties influence the kinetics and thermodynamics of dioxygen binding versus release from structurally analogous Mn-O2 complexes, as well as the barrier to Mn peroxo O-O bond cleavage, and the reactivity of Mn oxo intermediates. Previously we demonstrated that the steric and electronic properties of MnIII-OOR complexes containing N-heterocyclic (NAr) ligand scaffolds can have a dramatic influence on alkylperoxo O-O bond lengths and the barrier to alkylperoxo O-O bond cleavage. Herein, we examine the dioxygen reactivity of a new MnII complex containing a more electron-rich, less sterically demanding NAr ligand scaffold, and compare it with previously reported MnII complexes. Dioxygen binding is shown to be reversible with complexes containing the more electron-rich metal ions. The kinetic barrier to O2 binding and peroxo O-O bond cleavage is shown to correlate with redox potentials, as well as the steric properties of the supporting NAr ligands. The reaction landscape for the dioxygen chemistry of the more electron-rich complexes is shown to be relatively flat. A total of four intermediates, including a superoxo and peroxo species, are observed with the most electron-rich complex. Two new intermediates are shown to form following the peroxo, which are capable of cleaving strong X-H bonds. In the absence of a sacrificial H atom donor, solvent, or ligand, serves as a source of H atoms. With TEMPOH as sacrificial H atom donor, a deuterium isotope effect is observed (kH/kD = 3.5), implicating a hydrogen atom transfer (HAT) mechanism. With 1,4-cyclohexadiene, 0.5 equiv of benzene is produced prior to the formation of an EPR detected MnIIIMnIV bimetallic species, and 0.5 equiv after its formation.

A Reinforcement Learning Model Equipped with Sensors for Generating Perception Patterns: Implementation of a Simulated Air Navigation System Using ADS-B (Automatic Dependent Surveillance-Broadcast) Technology.

Over the last few decades, a number of reinforcement learning techniques have emerged, and different reinforcement learning-based applications have proliferated. However, such techniques tend to specialize in a particular field. This is an obstacle to their generalization and extrapolation to other areas. Besides, neither the reward-punishment (r-p) learning process nor the convergence of results is fast and efficient enough. To address these obstacles, this research proposes a general reinforcement learning model. This model is independent of input and output types and based on general bioinspired principles that help to speed up the learning process. The model is composed of a perception module based on sensors whose specific perceptions are mapped as perception patterns. In this manner, similar perceptions (even if perceived at different positions in the environment) are accounted for by the same perception pattern. Additionally, the model includes a procedure that statistically associates perception-action pattern pairs depending on the positive or negative results output by executing the respective action in response to a particular perception during the learning process. To do this, the model is fitted with a mechanism that reacts positively or negatively to particular sensory stimuli in order to rate results. The model is supplemented by an action module that can be configured depending on the maneuverability of each specific agent. The model has been applied in the air navigation domain, a field with strong safety restrictions, which led us to implement a simulated system equipped with the proposed model. Accordingly, the perception sensors were based on Automatic Dependent Surveillance-Broadcast (ADS-B) technology, which is described in this paper. The results were quite satisfactory, and it outperformed traditional methods existing in the literature with respect to learning reliability and efficiency.

Water-soluble Fe(II)-H2O complex with a weak O-H bond transfers a hydrogen atom via an observable monomeric Fe(III)-OH.

Understanding the metal ion properties that favor O-H bond formation versus cleavage should facilitate the development of catalysts tailored to promote a specific reaction, e.g., C-H activation or H2O oxidation. The first step in H2O oxidation involves the endothermic cleavage of a strong O-H bond (BDFE = 122.7 kcal/mol), promoted by binding the H2O to a metal ion, and by coupling electron transfer to proton transfer (PCET). This study focuses on details regarding how a metal ion's electronic structure and ligand environment can tune the energetics of M(HO-H) bond cleavage. The synthesis and characterization of an Fe(II)-H2O complex, 1, that undergoes PCET in H2O to afford a rare example of a monomeric Fe(III)-OH, 7, is described. High-spin 7 is also reproducibly generated via the addition of H2O to {[Fe(III)(O(Me2)N4(tren))]2-(µ-O)}(2+) (8). The O-H bond BDFE of Fe(II)-H2O (1) (68.6 kcal/mol) is calculated using linear fits to its Pourbaix diagram and shown to be 54.1 kcal/mol less than that of H2O and 10.9 kcal/mol less than that of [Fe(II)(H2O)6](2+). The O-H bond of 1 is noticeably weaker than the majority of reported M(n+)(HxO-H) (M = Mn, Fe; n+ = 2+, 3+; x = 0, 1) complexes. Consistent with their relative BDFEs, Fe(II)-H2O (1) is found to donate a H atom to TEMPO(•), whereas the majority of previously reported M(n+)-O(H) complexes, including [Mn(III)(S(Me2)N4(tren))(OH)](+) (2), have been shown to abstract H atoms from TEMPOH. Factors responsible for the weaker O-H bond of 1, such as differences in the electron-donating properties of the ligand, metal ion Lewis acidity, and electronic structure, are discussed.

Direct O2 mediated oxidation of a Ni(II)N3O structural model complex for the active site of nickel acireductone dioxygenase (Ni-ARD): characterization, biomimetic reactivity, and enzymatic implications.

A new biomimetic model complex of the active site of acireductone dioxygenase (ARD) was synthesized and crystallographically characterized ([Ni(ii)(N-(ethyl-N'Me2)(Py)(2-t-ButPhOH))(OTf)]-1). 1 displays carbon-carbon oxidative cleavage activity in the presence of O2 towards the substrate 2-hydroxyacetophenone. This reactivity was monitored via UV-Visible and NMR spectroscopy. We postulate that the reactivity of 1 with O2 leads to the formation of a putative Ni(III)-superoxo transient species resulting from the direct activation of O2via the nickel center during the oxidative reaction. This proposed intermediate and reaction mechanism were studied in detail using DFT calculations. 1 and its substrate bound derivatives display reactivity toward mild outer sphere oxidants, suggesting ease of access to high valent Ni coordination complexes, consistent with our calculations. If confirmed, the direct activation of O2 at a nickel center could have implications for the mechanism of action of ARD and other nickel-based dioxygenases and their respective non-traditional, enzymatic moonlighting functions, as well as contribute to a general understanding of direct oxidation of nickel(II) coordination complexes by O2.

Delivering Multidisciplinary Rehabilitation Care in Parkinson's Disease: An International Consensus Statement.

BACKGROUND: Parkinson's disease (PD) is a complex neurodegenerative disorder impacting everyday function and quality of life. Rehabilitation plays a crucial role in improving symptoms, function, and quality of life and reducing disability, particularly given the lack of disease-modifying agents and limitations of medications and surgical therapies. However, rehabilitative care is under-recognized and under-utilized in PD and often only utilized in later disease stages, despite research and guidelines demonstrating its positive effects. Currently, there is a lack of consensus regarding fundamental topics related to rehabilitative services in PD. OBJECTIVE: The goal of the international Parkinson's Foundation Rehabilitation Medicine Task Force was to develop a consensus statement regarding the incorporation of rehabilitation in PD care. METHODS: The Task Force, comprised of international multidisciplinary experts in PD and rehabilitation and people directly affected by PD, met virtually to discuss topics such as rehabilitative services, existing therapy guidelines and rehabilitation literature in PD, and gaps and needs. A systematic, interactive, and iterative process was used to develop consensus-based statements on core components of PD rehabilitation and discipline-specific interventions. RESULTS: The expert-based consensus statement outlines key tenets of rehabilitative care including its multidisciplinary approach and discipline-specific guidance for occupational therapy, physical therapy, speech language pathology/therapy, and psychology/neuropsychology across all PD stages. CONCLUSIONS: Rehabilitative interventions should be an essential component in the comprehensive treatment of PD, from diagnosis to advanced disease. Greater education and awareness of the benefits of rehabilitative services for people with PD and their care partners, and further evidence-based and scientific study are encouraged.

Isolation and characterization of a dihydroxo-bridged iron(III,III)(µ-OH)2 diamond core derived from dioxygen.

Dioxygen addition to coordinatively unsaturated [Fe(II)(O(Me2)N4(6-Me-DPEN))](PF6) (1) is shown to afford a complex containing a dihydroxo-bridged Fe(III)2(µ-OH)2 diamond core, [Fe(III)(O(Me2)N4(6-Me-DPEN))]2(µ-OH)2(PF6)2·(CH3CH2CN)2 (2). The diamond core of 2 resembles the oxidized methane monooxygenase (MMOox) resting state, as well as the active site product formed following H-atom abstraction from Tyr-OH by ribonucleotide reductase (RNR). The Fe-OH bond lengths of 2 are comparable with those of the MMOHox suggesting that MMOHox contains a Fe(III)2(µ-OH)2 as opposed to Fe(III)2(µ-OH)(µ-OH2) diamond core as had been suggested. Isotopic labeling experiments with (18)O2 and CD3CN indicate that the oxygen and proton of the µ-OH bridges of 2 are derived from dioxygen and acetonitrile. Deuterium incorporation (from CD3CN) suggests that an unobserved intermediate capable of abstracting a H-atom from CH3CN forms en route to 2. Given the high C-H bond dissociation energy (BDE = 97 kcal/mol) of acetonitrile, this indicates that this intermediate is a potent oxidant, possibly a high-valent iron oxo. Consistent with this, iodosylbenzene (PhIO) also reacts with 1 in CD3CN to afford the deuterated Fe(III)2(µ-OD)2 derivative of 2. Intermediates are not spectroscopically observed in either reaction (O2 and PhIO) even at low-temperatures (-80 °C), indicating that this intermediate has a very short lifetime, likely due to its highly reactive nature. Hydroxo-bridged 2 was found to stoichiometrically abstract hydrogen atoms from 9,10-dihydroanthracene (C-H BDE = 76 kcal/mol) at ambient temperatures.

Environmental factors regulate soil microbial attributes and their response to drought in rangeland ecosystems.

In ecosystems, soil microbial variables characterization are used to determine soil biological health and the response of soils to environmental stress. Although there are strong associations between plants and soil microorganisms, they may respond asynchronously to environmental factors and severe droughts. We aimed to: I) evaluate the special variation of soil microbiome such as microbial biomass carbon (MBC) and nitrogen (MBN), soil basal respiration (SBR) and microbial indexes in eight rangeland sites located across an aridity gradient (distributed from arid to mesic climates); II) analyze the relative importance of main environmental factors (climate, soils, and plants) and their relationships with microbial variables in the rangelands; and III) assess the effect of drought on microbial and plant variables in field-based manipulative experiments. First, we found significant changes of microbial variables along a precipitation and temperature gradient. The responses of MBC and MBN were strongly dependent on soil pH, soil nitrogen (N), soil organic carbon (SOC), C:N ratio and vegetation cover. In contrast, SBR was influenced by the aridity index (AI), the mean annual precipitation (MAP), the soil pH and vegetation cover. MBC, MBN and SBR were negatively related with soil pH compared to the other factors (C, N, C:N, vegetation cover, MAP and AI) that had a positive relationship. Second, we found a stronger soil microbial variables response to drought in arid sites compared to humid rangelands. Third, the responses of MBC, MBN, and SBR to drought showed positive relationships with vegetation cover and aboveground biomass, but with different regression slopes, this suggest that plant and microbial communities responded differently to drought. The results from this study improve our understanding about the microbial response to drought in different rangelands, and may facilitate the development of predictive models on responses of soil microorganisms in carbon cycle under global change scenarios.

Characterization and dioxygen reactivity of a new series of coordinatively unsaturated thiolate-ligated manganese(II) complexes.

The synthesis, structural, and spectroscopic characterization of four new coordinatively unsaturated mononuclear thiolate-ligated manganese(II) complexes ([Mn(II)(S(Me2)N(4)(6-Me-DPEN))](BF(4)) (1), [Mn(II)(S(Me2)N(4)(6-Me-DPPN))](BPh(4))·MeCN (3), [Mn(II)(S(Me2)N(4)(2-QuinoPN))](PF(6))·MeCN·Et(2)O (4), and [Mn(II)(S(Me2)N(4)(6-H-DPEN)(MeOH)](BPh(4)) (5)) is described, along with their magnetic, redox, and reactivity properties. These complexes are structurally related to recently reported [Mn(II)(S(Me2)N(4)(2-QuinoEN))](PF(6)) (2) (Coggins, M. K.; Kovacs, J. A. J. Am. Chem. Soc.2011, 133, 12470). Dioxygen addition to complexes 1-5 is shown to result in the formation of five new rare examples of Mn(III) dimers containing a single, unsupported oxo bridge: [Mn(III)(S(Me2)N(4)(6-Me-DPEN)](2)-(µ-O)(BF(4))(2)·2MeOH (6), [Mn(III)(S(Me2)N(4)(QuinoEN)](2)-(µ-O)(PF(6))(2)·Et(2)O (7), [Mn(III)(S(Me2)N(4)(6-Me-DPPN)](2)-(µ-O)(BPh(4))(2) (8), [Mn(III)(S(Me2)N(4)(QuinoPN)](2)-(µ-O)(BPh(4))(2) (9), and [Mn(III)(S(Me2)N(4)(6-H-DPEN)](2)-(µ-O)(PF(6))(2)·2MeCN (10). Labeling studies show that the oxo atom is derived from (18)O(2). Ligand modifications, involving either the insertion of a methylene into the backbone or the placement of an ortho substituent on the N-heterocyclic amine, are shown to noticeably modulate the magnetic and reactivity properties. Fits to solid-state magnetic susceptibility data show that the Mn(III) ions of µ-oxo dimers 6-10 are moderately antiferromagnetically coupled, with coupling constants (2J) that fall within the expected range. Metastable intermediates, which ultimately convert to µ-oxo bridged 6 and 7, are observed in low-temperature reactions between 1 and 2 and dioxygen. Complexes 3-5, on the other hand, do not form observable intermediates, thus illustrating the effect that relatively minor ligand modifications have upon the stability of metastable dioxygen-derived species.

A model for gain of function in superoxide dismutase.

Studies have found that mutant, misfolded superoxide dismutase [Cu-Zn] (SOD1) can convert wild type SOD1 (wtSOD1) in a prion-like fashion, and that misfolded wtSOD1 can be propagated by release and uptake of protein aggregates. In developing a prion-like mechanism for this propagation of SOD1 misfolding we have previously shown how enervation of the SOD1 electrostatic loop (ESL), caused by the formation of transient non-obligate SOD1 oligomers, can lead to an experimentally observed gain of interaction (GOI) that results in the formation of SOD1 amyloid-like filaments. It has also been shown that freedom of ESL motion is essential to catalytic function. This work investigates the possibility that restricting ESL mobility might not only compromise superoxide catalytic activity but also serve to promote the peroxidase activity of SOD1, thus implicating the formation of SOD1 oligomers in both protein misfolding and in protein oxidation.

Protein dynamics of [Cu-Zn] superoxide dismutase (SOD1): How protein motions at the global and local levels impact the reactivity of SOD1.

This work explores the pivotal role that protein mobility plays in facilitating the catalytic activity of Copper-Zinc superoxide dismutase (SOD1). Through both localized active site distortions and correlated domain movement, these motions enable the enzyme to adopt the conformations necessary to achieve both substrate delivery and efficient catalytic transformation. Structural and computational studies of a biomimetic model complex are used to probe the localized interactions between substrate and secondary sphere residues that play a role in guiding substrate to the active site, as well as facilitating the conformational changes necessary for substrate turnover. Normal mode analysis (NMA) of SOD1 demonstrates how collective domain motion influences key residues of the electrostatic loop (ESL), guiding substrate to the active site and facilitating the delivery of the conserved water network necessary for proton transfer.

Evaluation of an Interdisciplinary Screening Program for People With Parkinson Disease and Movement Disorders.

OBJECTIVE: To describe the characteristics of people with Parkinson disease and movement disorders (PDMDs) referred by neurologist to a physiatrist-led interdisciplinary rehabilitation screening program. DESIGN: Retrospective data analysis of electronic health records (EMRs). SETTING: Outpatient PDMD neurology clinic and an interdisciplinary rehabilitation hospital's PDMD screening program. PARTICIPANTS: People with PDMDs referred by neurologists to the interdisciplinary rehabilitation screening program from 2009-2017 (n=934), with early referrals from 2009-2015 (n=449) and recently referred from 2015-2017 (n=485), and patients who had new interdisciplinary rehabilitation screening program evaluations from 2015-2017 (n=183). INTERVENTION: Participation in the physiatrist-led PDMD screening clinic. MAIN OUTCOME MEASURES: Demographics, disease-related features, timed Up and Go, conversational voice volume, recommended therapy services, and number of therapies completed 90 days following interdisciplinary rehabilitation screening program. RESULTS: People referred from the neurologists to the interdisciplinary rehabilitation screening program from 2009-2017 were 72±12.9 years old, male (56%), white (65%), and with 1 or more comorbidities (62%). Compared with early referrals from 2009-2015, more recently referred participants from 2015-2017 were younger (P<.001) and earlier in disease duration (P=.036). The interdisciplinary rehabilitation screening program participants from 2015-2017 had mean timed Up and Go time of 15.4±10.1 seconds and a mean conversational voice volume of 68.98±4.7 dB. CONCLUSIONS: The interdisciplinary rehabilitation screening program was sustained with increased number of referrals over time, occurring earlier in the disease in more recent years. Key strategies used to sustain the program over time include development of a unique referral order set for the neurologists, implementation of a comprehensive screen tool in the rehabilitation hospital EMR, and centralized communication through social workers at both facilities.

A family of structural and functional models for the active site of a unique dioxygenase: Acireductone dioxygenase (ARD).

We report the synthesis and biomimetic activity of a family of model complexes with relevance to acireductone dioxygenase (ARD), an enzyme that displays dual function based on metal identity found in the methionine salvage pathway (MSP). Three complexes with related structural motifs were synthesized and characterized derived from phenolate, and pyridine N4O Schiff-base ligands. They display pseudo-octahedral Ni(II)-N4O ligand coordination with water at the sixth site, in close alignment to the structure in the resting state of ARD. The three featured complexes exhibit carbon­carbon bond cleavage activation of lithium acetylacetonate, which was used as a model enzyme substrate. Computationally derived mechanistic routes for the observed reactivity consistent with experimental conditions are herein proposed. The mechanism suggests the possibility of Ni(II)-substrate interactions, followed by oxygen insertion. These results constitute only the third functional model system of ARD, in an attempt to further advance biomimetic contributions to the ongoing debate of ARD's unique metal mediated, regioselective oxidative cleavage.

Using Implementation Frameworks to Provide Proactive Physical Therapy for People With Parkinson Disease: Case Report.

BACKGROUND AND PURPOSE: European clinical practice guidelines recommend physical therapy for people with Parkinson disease (PD) soon after diagnosis to provide education, physical activity advice, and individualized interventions when needed. However, therapy is frequently not used until after gait and balance problems occur. The purpose of this administrative case study is to present the application of a proactive physical therapy (PAPT) approach at 1 rehabilitation center using implementation frameworks to support the (1) implementation process, (2) determinants of implementation success, and (3) implementation evaluation. CASE DESCRIPTION: The PAPT program targeted people with PD before the onset of significant mobility dysfunction. It was initiated in 1 outpatient neurological rehabilitation center. The program used shared decision-making to promote long-term maintenance of independent exercise. The Knowledge-to-Action Framework was used by champions to plan implementation processes. Implementation barriers were addressed using the Consolidated Framework for Implementation Research. The program was evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework with mixed methods. OUTCOMES: In the program's first year, 38 people were referred, 28 were evaluated, and 20 participated in the 6-month program evaluation. Following PAPT, the number of participants reporting regular participation in aerobic, strengthening, and flexibility exercise approximately doubled, while those engaging in balance activities increased from 1 to 8. They reported a median of 140 minutes of aerobic exercise per week. Implementation barriers included location, insurance coverage, and difficulty scheduling long-term follow-up visits. Participants reported physical and emotional benefits of the program. DISCUSSION: Implementation frameworks assisted with the implementation and evaluation of a PAPT delivery model that helped people with PD to increase and maintain independent exercise participation.

Outcomes of Inpatient Rehabilitation in Patients With Simultaneous Bilateral Total Knee Arthroplasty.

BACKGROUND: The number of total knee arthroplasty (TKA) procedures performed in the United States is increasing each year, and the number of bilateral TKA procedures has also increased during the past 2 decades. However, few studies in the literature have investigated the rehabilitation outcomes of patients who undergo bilateral TKA. This study was performed to provide information on the benefits and role of inpatient rehabilitation for patients after bilateral TKA. OBJECTIVE: To investigate the functional outcomes, complications, and transfer rates of patients in the inpatient rehabilitation setting who undergo simultaneous bilateral TKA. DESIGN: Retrospective cohort study. SETTING: Freestanding inpatient rehabilitation hospital. PATIENTS: Ninety-four patients admitted to an inpatient rehabilitation hospital after simultaneous bilateral TKA from 2008-2013. METHODS: Retrospective chart review of demographic, clinical, and functional data for patients admitted to inpatient rehabilitation after simultaneous bilateral TKA. MAIN OUTCOME MEASURES: Length of stay, admission and discharge Functional Independence Measure (FIM), and FIM efficiency. RESULTS: The study included 27 male (28.7%) and 67 female (71.3%) patients aged 42.0-86.9 years, with a mean of 65.6 ± 10.2 years. Mean length of time between surgery and admission to inpatient rehabilitation was 4.5 ± 3.3 days. Mean length of stay in rehabilitation was 11.7 ± 4.2 days. Mean admission and discharge FIM scores were 87.3 ± 11.7 and 113.4 ± 4.8, respectively, with a mean FIM gain of 26.1 ± 10.5. The mean FIM efficiency was 2.33 ± 0.84. Eight patients required transfer to an acute care hospital. Complications leading to transfer to acute care facilities included sepsis, cardiac arrhythmias, knee dislocation, and suspected small bowel obstruction. Eighty-eight patients were discharged home, 4 patients were discharged to skilled nursing facilities, and 2 patients were transferred to an acute care hospital and did not return to the inpatient rehabilitation hospital. CONCLUSIONS: After undergoing simultaneous bilateral TKA, patients demonstrate functional gains when admitted to inpatient rehabilitation facilities based on FIM gains and FIM efficiency scores; 8.5% of patients in this cohort required transfer to an acute care facility as a result of complications during inpatient rehabilitation, and 93.6% of patients were discharged home.

Psychological impact of COVID-19 pandemic among healthcare workers in Paraguay: A descriptive and preliminary study

ABSTRACT Introduction: Healthcare workers exposed to SARS-CoV-2 are vulnerable to psychological distress. Methodology: A descriptive cross-sectional study was carried out in 5 tertiary hospitals in the Central, San Pedro and Caaguazú Departments of Paraguay during the COVID-19 pandemic from April to June 2020. The pilot study included 125 healthcare workers as participants, 25 for each hospital. Demographic data and occupational exposure data were collected with an ad-hoc questionnaire. Symptoms of depression and anxiety were evaluated employing the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder scale-7. The prevalence of post-traumatic stress was determined using the Post-Traumatic Stress Disorder Check List-C. Results: Of the 125 participants, 68 (54.8%) were doctors, 37 (29.8) nurses, 7 (5.6%) biochemists, 3 (2.4%) obstetricians, and 9 (7.3%) other healthcare workers. Most participants were females (86 (68.8%)), with an average age of 33.8 years (SD ± 7.4), single (71 (56.8%)), with a postgraduate educational level (83 (66.4%)), and reporting a junior level of work experience (52 (41.6%)). A total of 71 (57.3%) were classified as high-risk healthcare workers after exposure to SARS-CoV-2. 61 (48.8%) of participants presented symptoms of depression, and 68 (54.4%) presented symptoms of anxiety. A small group reported symptoms of post-traumatic stress (9 (7.2%)). Conclusion: Healthcare workers in Paraguay reported a significant prevalence of depressive and anxious symptoms during the COVID-19 pandemic. These findings lend support to the idea that healthcare workers are vulnerable to psychological distress and that they may require specific mental health interventions.

RESUMEN Introducción: los trabajadores de la salud expuestos al SARS-CoV-2 son vulnerables a la angustia psicológica. Metodología: se realizó un estudio descriptivo transversal en 5 hospitales de tercer nivel de los Departamentos Central, San Pedro y Caaguazú de Paraguay durante la pandemia de COVID-19, de abril a junio de 2020. El estudio piloto incluyó a 125 trabajadores de la salud, 25 de cada hospital. Los datos demográficos y sobre la exposición ocupacional se recopilaron con un cuestionario ad-hoc. Los síntomas de depresión y ansiedad se evaluaron empleando la escala Patient Health Questionnaire-9 y la escala Generalized Anxiety Disorder scale-7. La prevalencia de estrés postraumático fue determinada usando la escala Post-Traumatic Stress Disorder Check List-C. Resultados: de los 125 participantes, 68 (54,8%) eran médicos, 37 (29,8) enfermeros, 7 (5,6%) bioquímicos, 3 (2,4%) obstetras y 9 (7,3%) otros trabajadores de la salud. La mayoría de los participantes eran mujeres (86 (68,8%)), con una edad media de 33,8 años (DE ± 7,4), solteros (71 (56,8%)), con un nivel de estudios de posgrado (83 (66,4%)), y reportaban un nivel junior de experiencia laboral (52 (41,6%)). Un total de 71 (57,3%) fueron clasificados como trabajadores de la salud de alto riesgo después de la exposición al SARS-CoV-2. 61 (48,8%) de los participantes presentaron síntomas de depresión y 68 (54,4%) presentaron síntomas de ansiedad. Conclusión: los trabajadores de la salud en Paraguay reportaron una prevalencia significativa de síntomas depresivos y ansiosos durante la pandemia de COVID-19. Estos hallazgos apoyan la idea de que los trabajadores de la salud son vulnerables a la angustia psicológica y que pueden requerir intervenciones específicas de salud mental.