Design and implementation of the Professional Wellbeing Programme of the Medical Council of Uruguay.

Multiple studies have reported a high prevalence of mental health problems among male and female physicians. Although doctors are reluctant to seek professional help when suffering from a mental disorder, specialised services developed specifically to treat their mental health problems have reported promising results. The purpose of this article is to describe the design and implementation of the Professional Wellbeing Programme (Programa de Bienestar Profesional) of the Uruguayan Medical Council (Colegio Médico del Uruguay). The context, inputs, activities and some of the outputs are described according to a case study design. The main milestones in the implementation of the programme are also outlined, as well as the enabling elements, obstacles and main achievements. Emphasis will be placed on the importance of international collaboration to share experiences and models, how to design the care process to promote doctors' access to psychiatric and psychological care, the need for them to be flexible and dynamic in adapting to new and changing circumstances, such as the COVID-19 pandemic, and to work in parallel with the medical regulatory bodies. It is hoped that the experience described in this work may be of use to other Latin American institutions interested in developing mental health programmes for doctors.

Diseño e implementación del Programa de Bienestar Profesional del Colegio Médico del Uruguay

Son múltiples los estudios que informan de una alta prevalencia de problemas de salud mental en médicos y médicas. Aunque los médicos presentan resistencias a la hora de solicitar ayuda profesional cuando están aquejados de trastornos mentales, los servicios especializados desarrollados específicamente para tratar sus problemas de salud mental han reportado resultados prometedores. El propósito de este artículo es describir el diseno y la implementación del Programa de Bienestar Profesional del Colegio Médico del Uruguay. El contexto, los insumos, las actividades y algunos de los productos se describen de acuerdo con el diseno de un estudio de caso. También se sefñalan los principales hitos en la puesta en marcha del programa, así como los elementos facilitadores, los obstáculos y los principales logros. Se enfatizará la importancia de la colaboración internacional para compartir experiencias y modelos, cómo articular el proceso asistencial para fomentar el acceso de los médicos a la atención psiquiátrica y psicológica, la necesidad de que sean flexibles y dinámicos para adaptarse a circunstancias novedosas y cambiantes como la pandemia por COVID-19 y la necesidad de que vayan en paralelo con las exigencias de los organismos reguladores de la práctica médica. Se espera que la experiencia descrita en este trabajo pueda ser de utilidad a otros colectivos latinoamericanos interesados en desarrollar programas de salud mental para los médicos.

Multiple studies have reported a high prevalence of mental health problems among male and female physicians. Although doctors are reluctant to seek professional help when suffering from a mental disorder, specialized services developed specifically to treat their mental health problems have reported promising results. The purpose of this article is to describe the design and implementation of the Professional Wellbeing Programme (Programa de Bienestar Profesional) of the Uruguayan Medical Association (Colegio Médico del Uruguay). The context, inputs, activities and some of the outputs are described according to a case study design. The main milestones in the implementation of the programme are also outlined, as well as the enabling elements, obstacles and main achievements. Emphasis will be placed on the importance of international collaboration to share experiences and models, how to design the care process to promote doctors' access to psychiatric and psychological care, the need for them to be flexible and dynamic in adapting to new and changing circumstances, such as the COVID-19 pandemic, and to work in parallel with the medical regulatory bodies. It is hoped that the experience described in this work may be of use to other Latin American institutions interested in developing mental health programmes for doctors.

Inclusion of information technology-based assessments of health-related quality of life in routine oncology practice in Uruguay.

BACKGROUND: Previous research has shown that the inclusion of patient-reported outcomes measures in the patient's visit to the oncologists might improve the quality of global health care. The aim of the study was to assess the feasibility, acceptance, and utility perceived by patients and oncologists of health-related quality of life (HRQL) assessments obtained prior to clinical visits, and to evaluate if this has an impact on patient's well-being in a sample of Spanish-speaking patients from Uruguay. METHODS: Patients assisted regularly in the Oncology Clinic were randomized into two groups: an intervention group that completed a set of questionnaires (European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and Hospital Anxiety and Depression Scale using a touch screen device and a control group that did not respond to these questionnaires. At 2 months, the responses of all the participants to the Functional Assessment of Cancer Therapy-General (FACT-G) were collected over a telephone to determine whether there were differences in the HRQL between the intervention and control groups. The graphed scores of the intervention group were included in the clinical history of the patient during consultation. Patients and physicians completed the questionnaires on the usefulness of these measurements. RESULTS: In total, 58 patients participated in this study: 36 in the intervention group and 22 in the control group; 65% of the participants were female, and median age was 59 years (18-79). Regarding patients, 97% found the questionnaires easy to complete and thought that they included important questions. As for oncologists, 68.8% used the information and 87.5% found it useful for the consultation. There were no significant differences in the FACT-G scores between the intervention and control groups. CONCLUSIONS: The routine HRQL assessments using an electronic device prior to the consultations were positively valued by almost all patients and physicians. This could significantly contribute to a better understanding of the patient's overall problems during consultation. These results confirm the benefits of integrating the patient's self-reported quality of life outcomes into consultations.

Evaluation of a rehabilitation program from the perspective of children with disabilities and their caregivers in Uruguay.

PURPOSE: The aim of the study was to evaluate the Assessment and Orientation Treatment Program for children and adolescents with disabilities treated at the Center Teletón Uruguay from the perspective of the patients and their parents based on several patient reported outcome measures: health related quality of life (HRQOL), treatment satisfaction, family impact, and emotional distress. METHODS: The sample consisted of all the 126 dyads of children/adolescents with ages ranging from 2 to 18 years and their primary caregivers who entered the program from April to October 2012. A set of instruments were filled out by children and parents before and six months after the program. T test for paired samples for continuous variables and McNemar's test for categorical variables were used to assess changes pre and post intervention. RESULTS: There was a high prevalence of depression and anxiety in the caregivers. In the second evaluation, improvements that were statistically significant only for the caregivers were observed in the HRQOL of children, adolescents and caregivers. CONCLUSIONS: The patient reported outcome measures used were effective in detecting changes in several areas of the quality of life of children observed by their caregivers and in their own quality of life after the intervention.

Design and implementation of the Professional Wellbeing Programme of the Medical Council Association of Uruguay. / Diseño e implementación del Programa de Bienestar Profesional del Colegio Médico del Uruguay.

Multiple studies have reported a high prevalence of mental health problems among male and female physicians. Although doctors are reluctant to seek professional help when suffering from a mental disorder, specialised services developed specifically to treat their mental health problems have reported promising results. The purpose of this article is to describe the design and implementation of the Professional Wellbeing Programme (Programa de Bienestar Profesional) of the Uruguayan Medical Association (Colegio Médico del Uruguay). The context, inputs, activities and some of the outputs are described according to a case study design. The main milestones in the implementation of the programme are also outlined, as well as the enabling elements, obstacles and main achievements. Emphasis will be placed on the importance of international collaboration to share experiences and models, how to design the care process to promote doctors' access to psychiatric and psychological care, the need for them to be flexible and dynamic in adapting to new and changing circumstances, such as the COVID-19 pandemic, and to work in parallel with the medical regulatory bodies. It is hoped that the experience described in this work may be of use to other Latin American institutions interested in developing mental health programmes for doctors.

A Tale of Two Countries: Innovation and Collaboration Aimed at Changing the Culture of Medicine in Uruguay.

This is a case study of a program to address professionalism at the Universidad de la República in Uruguay. We describe a five-year ongoing international collaboration. Relevant characteristics of the context, the program components, activities, and results were analyzed. The expected outcomes were to introduce standards of professional practices in the curricula of medical students and residents and the implementation of a program that might lead to a significant change in the culture of medicine in the University. Traditional didactics, interactive theater, and professional development workshops, issues such as teamwork and communication, professional behavior, and the culture of medicine, and physician wellness were addressed. A total of 359 faculty members, general practitioners, stakeholders, and other healthcare professionals (nurses, psychologists, social workers) participated in the intervention. The process led to specific achievements including new content in the curricula, the use of educational innovations to address issues of professionalism, a growing institutional culture of accountability, and the establishment of new rules and regulations. The strategies and interventions followed in the case of Uruguay can serve as a model to other developing countries to promote physician professionalism, wellness, and joy.

Report of the procedure of voluntary interruption of pregnancy at a university hospital in Uruguay.

OBJECTIVE: To describe the constitution and operation of a voluntary interruption of pregnancy team of a university hospital, from the outlook of the mental health team. METHODS: In this case study, the following aspects were analyzed: 1) historical background; 2) implementation of Law 18,897 of October 22, 2012; and 3) functioning of the program at the Hospital de Clínicas of the Facultad de Medicina (Universidad de la República, Uruguay), taking into account three dimensions: structure, process, and results. RESULTS: Between December 2012 and November 2013, a total of 6,676 voluntary interruptions of pregnancy were reported in Uruguay; out of these, 80 were conducted at the Hospital de Clínicas. The patients' demographic data agreed with those reported at the national level: Of the total patients, 81.0% were aged over 19 years; 6.2% decided to continue with the pregnancy; and only 70.0% attended the subsequent control and received advice on contraception. CONCLUSIONS: In its implementation year in Uruguay, we can assess the experience as positive from the point of view of women's health. Our experience as a mental health team at the Hospital de Clínicas, inserted into the multidisciplinary voluntary interruption of pregnancy team, is in the process of assessment and reformulation of practices. OBJETIVO: Describir la conformación y funcionamiento de un equipo de interrupción voluntaria del embarazo de un hospital universitario, desde la mirada del equipo de salud mental. MÉTODOS: En este estudio de caso, se analizan los siguientes aspectos: 1) antecedentes históricos; 2) implementación de la Ley 18.897 de 22 de octubre de 2012; y 3) funcionamiento del programa en el Hospital de Clínicas de la Facultad de Medicina (Universidad de la República, Uruguay), teniendo en cuenta tres dimensiones (estructura, proceso y resultados). RESULTADOS: Entre diciembre de 2012 y noviembre de 2013, se reportaron en Uruguay un total de 6.676 interrupciones voluntarias del embarazo; de ellas, 80 se llevaron a cabo en el Hospital de Clínicas. Los datos sociodemográficos de las pacientes concordaron con los reportados a nivel nacional: 81,0% de las pacientes que consultaron era mayores de 19 años; 6,2% decidieron continuar con el embarazo; solo 70,0% concurrieron al control posterior y recibieron asesoramiento sobre anticoncepción. CONCLUSIONES: Al año de su implementación, en Uruguay, podemos evaluar la experiencia como positiva desde el punto de vista de la salud de las mujeres. Nuestra experiencia como equipo de salud mental en el Hospital de Clínicas, inserto dentro del equipo multidisciplinario de interrupción voluntaria del embarazo, se encuentra en pleno proceso de evaluación y reformulación de prácticas.

[Evaluation of the Charing Cross Venous Ulcer Questionnaire in patients with chronic venous ulcers in Uruguay]. / Adaptación y evaluación inicial del Charing Cross Venous Ulcer Questionnaire en pacientes con úlceras venosas crónicas en Uruguay.

BACKGROUND: Chronic venous ulcers (CVU) represent a frequent condition, with difficult therapeutic approaches, that impact on patients’ quality of life, and generate an economic burden to patients and health systems. AIM: To perform the cultural adaptation and initial evaluation of the Charing Cross Venous Ulcer Questionnaire (CCVUQ) for Uruguay, and to study the health-related quality of life (HRQL) of patients with CVU. MATERIAL AND METHODS: The translated and culturally adapted version of the CCVUQ was applied to a convenience sample of 50 patients. In addition, the PROMIS Global Health Survey was included in the assessment. RESULTS: Both questionnaires showed good internal consistency (Cronbach alfa > 0.70). A statistically significant association was observed between the CCVUQ total scores, its subscales and both dimensions of the PROMIS: Global Physical (GPH) and Global Mental Health (GMH) (rho ≥ 0.40). The CCVUQ mean score was 54.9 ± 42 points while GPH and GMH mean scores were 37.9 ± 29 points, and 43.1 ± 35.1 points respectively. Simple linear regression showed that patients with higher income reported better emotional well-being, while in younger patients, ulcers had a higher impact on Emotional Status and Cosmetics. CONCLUSIONS: The translated and adapted version of the CCVUQ was easy to comprehend and apply, showing good psychometric properties. When used in association with the PROMIS Global Health Measure it provides complementary information. HRQL was severely affected in the study sample.

Adaptación y evaluación inicial del Charing Cross Venous Ulcer Questionnaire en pacientes con úlceras venosas crónicas en Uruguay / Evaluation of the Charing Cross Venous Ulcer Questionnaire in patients with chronic venous ulcers in Uruguay

Background: Chronic venous ulcers (CVU) represent a frequent condition, with difficult therapeutic approaches, that impact on patients’ quality of life, and generate an economic burden to patients and health systems. Aim: To perform the cultural adaptation and initial evaluation of the Charing Cross Venous Ulcer Questionnaire (CCVUQ) for Uruguay, and to study the health-related quality of life (HRQL) of patients with CVU. Material and Methods: The translated and culturally adapted version of the CCVUQ was applied to a convenience sample of 50 patients. In addition, the PROMIS Global Health Survey was included in the assessment. Results: Both questionnaires showed good internal consistency (Cronbach alfa > 0.70). A statistically significant association was observed between the CCVUQ total scores, its subscales and both dimensions of the PROMIS: Global Physical (GPH) and Global Mental Health (GMH) (rho ≥ 0.40). The CCVUQ mean score was 54.9 ± 42 points while GPH and GMH mean scores were 37.9 ± 29 points, and 43.1 ± 35.1 points respectively. Simple linear regression showed that patients with higher income reported better emotional well-being, while in younger patients, ulcers had a higher impact on Emotional Status and Cosmetics. Conclusions: The translated and adapted version of the CCVUQ was easy to comprehend and apply, showing good psychometric properties. When used in association with the PROMIS Global Health Measure it provides complementary information. HRQL was severely affected in the study sample.

Case report of a computer-assisted psychotherapy of a patient with ALS.

This case describes a psychotherapy intervention in a patient in advanced stages of ALS. The inability for verbal communication at these stages necessitated the inclusion of a computational system to favor augmentative and alternative communication (AAC) to provide psychological care. The association of this device and software with ongoing psychotherapy acted in a synergistic manner. AAC devices made it possible to maintain patient-therapist communication and provided material support for psychotherapy despite severe speech limitations. This bimodal protocol of intervention resulted in better symptom control, improved communication with the team and family, reduction of psychological distress, promotion of autonomy, dignity, and self-esteem. The novelty of this communication is to report how the regular psychological care could be adapted to the patient circumstances using a computer device. Clinical trials will be required to evaluate the effectiveness of this mode of psychotherapy for the general population of ALS patients.

Cuestionario sobre calidad de vida pediátrica (PedsQL) versión 4.0: fase inicial de la adaptación transcultural para Uruguay / Questionnaire on pediatric quality of life (PedsQl) 4.0 version: initial phase of transcultural adaptation for Uruguay

Objetivo: el propósito de este trabajo es presentar la primera fase de la adaptación lingüística y transcultural del Cuestionario de Calidad de Vida Pediátrica (PedsQL) versión 4.0 para Uruguay. Método: para la adaptación lingüística y cultural de versiones no validadas en español se siguió el procedimiento: traducción anterógrada desde el idioma original al español traducción retrógrada nuevamente al idioma original con una conciliación de las versiones y nueva traducción al español. Las versiones ya validadas para Argentina fueron revisadas y cotejadas con el original en inglés y se realizaron adaptaciones para Uruguay. Para estudiar la validez de contenido, la aplicabilidad y comprensibilidad se realizó testeo mediante una metodología cualitativa en una muestra de niños portadores de enfermedades crónicas y sus padres. Se obtuvo consentimiento informado en ambos casos y se realizó una entrevista estructurada. Se registró las características sociodemográficas y condiciones de aplicación. Se envió reportes del procedimiento y las conclusiones de las adaptaciones realizadas a los autores y responsables del cuestionario, las que fueron aprobadas. Resultados: considerando el análisis cualitativo, las escalas genéricas del PedsQL y las escalas específicas: Módulo de Impacto Familiar y Escala de Síntomas Gastrointestinales resultaron fáciles de aplicar y presentaron una aceptable comprensión. El Módulo Genérico de Satisfacción del Cuidado de la Salud mostró dificultades en la comprensión por lo que se requiere una revisión de la versión traducida y una nueva evaluación antes de su aplicación en estudios clínicos. Conclusiones: de acuerdo a lo analizado hasta el momento podemos afirmar que el Cuestionario PedsQL versión 4.0, así como el Módulo de Impacto Familiar y la Escala de Síntomas Gastrointestinales, cumplen con los requisitos básicos para su evaluación psicométrica en nuestra población.

Aim: the purpose of this investigation is to show the first stage of the linguistic and cultural adaptation of the HRQL Pediatric Questionnaire PedsQL version 4.0, for Uruguay. Method: for the linguistic and cultural adaptation of versions not validated in Spanish, this procedure was followed: forward translation from the source language to Spanish, backward translation to the source language with a reconciliation of the versions and a new translation to Spanish. The versions already validated for Argentina were revised, they were compared with the original in English and adaptations for Uruguay were made. To study the content validity, the applicability and comprehension of the questionnaire the testing was done through a qualitative methodology in a sample of children with chronic illnesses and parents. The informed consent was obtained in both cases and a structured interview was done. The sociodemographic characteristics and the conditions of application were registered. Reports of the procedure and the conclusions of the adaptations done were sent to the authors and responsibles of the questionnaire, which were approved. Results: considering the qualitative analysis the generic scales of the Peds QL and the specific ones: Family Impact Module and Gastrointestinal Symptoms Scale adapted to Uruguay were easy to apply and showed an acceptable comprehension. The Generic Module of Healthcare Satisfaction showed difficulties in the comprehension so a revision of the translated version and a new evaluation before its application in clinical studies are required.

Determinants of quality of life in patients with cancer.

BACKGROUND: Because health-related quality of life (QOL) is an important outcome in cancer management, the authors sought to better understand its determinants. To address this subject, they analyzed QOL, as measured with the Functional Assessment of Cancer Therapy-General questionnaire (FACT-G), Spanish Version 4, and depicted the complex relations among physical, psychological, social, and cultural factors, including spirituality. METHODS: A cross-sectional study design was used with a sample of 309 patients with cancer. The influence of several possible determinants was first studied by univariate regression analysis. Variables showing an association were included in a forward stepwise multivariate regression model. RESULTS: Five regression models were studied, for the FACT-G total score and its four subscales. Five variables explained 32.1% of the variance of the FACT-G total score: tumor stage, spiritual well-being, income, mood disorders, and mode of questionnaire administration. The type and relevance of the explanatory variables differed among the various dimensions of QOL. CONCLUSIONS: The authors underlined the entwining of biologic, psychosocial, and spiritual factors as determinants of the QOL of patients with cancer, thus supporting the multidimensional definition and modeling of the construct.

Evaluation of the Functional Assessment of Cancer Therapy-General (FACT-G) Spanish Version 4 in South America: classic psychometric and item response theory analyses.

BACKGROUND: The FACT-G has gone through many validation studies. However, little research has been conducted in South American Spanish speaking patients. The present study aimed to evaluate the FACT-G Spanish Version 4 in Uruguayan cancer patients. METHODS: The data analyzed were collected from 309 patients, with various tumor sites, at different stages of disease and receiving different treatments. RESULTS: Reliability was evaluated using Cronbach's coefficient alpha and showed high internal consistency for each of the subscales and its total scale (range =.78 -.91) of the FACT-G. The FACT-G total score also showed significant mean differences among known groups (performance status, in vs. outpatients) when tested by ANOVA and t-test. When the tumor stage (Local and Regional vs. Metastatic disease) was used as a clinical anchor, the FACT-G total score, the Physical Well-being (PWB), and Functional Well-being (FWB) subscale scores showed mean differences, ranging from 5 to 10 points in a scale from 0-108 (effect sizes = 0.30-0.60). Item response theory (IRT)-based evaluation using mean square fit statistics (.60-1.4) criteria showed that only two items misfit: "Estoy satisfecho(a) con mi vida sexual" (I am satisfied with my sex life) and "Estoy satisfecho(a) de cómo estoy enfrentando mi enfermedad" (I am satisfied with how I am coping with my illness). CONCLUSION: The results indicated that, using both traditional and IRT approaches, the Spanish FACT-G has good reliability and validity to be used as a QOL instrument among Uruguayan cancer patients.