[Impacto psicosocial de la COVID-19 en los profesionales de los Servicios de Vigilancia Epidemiológica de Cataluña.] / Psychosocial impact of COVID-19 on the professionals of the Epidemiological Surveillance Services of Catalonia.

OBJECTIVE: Healthcare professionals were subjected to very demanding working conditions during the COVID-19 pandemic. The aim of this paper was to assess the level of risk of suffering a psychosocial disorder in the professionals of the Epidemiological Surveillance Services of Catalonia (EVS) during the sixth wave of the COVID-19 pandemic. METHODS: An epidemiological study of prevalence was carried out in SVE workers in Catalonia. The information was collected through a questionnaire of sociodemographic and occupational data and the Goldberg General Health Questionnaire (GHQ-28) from January to March 2022. A score equal to or greater than 7 on the GHQ-28 was considered positive and indicated a risk of suffering some disorder. The dependent variables were the score and positivity of the GHQ-28 test. The relationship between the GHQ-28 score and the rest of the independent variables of the study was studied with the Odds Ratio (OR) and its 95% confidence intervals (IC). RESULTS: The mean age of the population studied was 37 years (SD=±11.4) and 75% were women. 53.8% of the participants presented a positive result in the GHQ-28. The participants with the highest psychosocial risk were workers with a history of psychological problems (OR 2.8; IC95% 1.2-6.7). The risk was also higher in women (OR 1.8; IC95% 0.8-4.1), participants with health professions (OR 1.2: IC95% 0.6-2.5), those who were taking pharmacological treatment (OR 2.4; IC95% 0.6-9.7) or those who were undergoing psychological therapy (OR 1.5; IC95% 0.6-3.6) at the time of data collection and workers who did not had a perception of work support and recognition from their work teams (OR 1.8; IC95% 0.9-3.8), although some differences were not statistically significant. CONCLUSIONS: The professionals of the SVE professionals presented, during the sixth pandemic wave, a high risk of psychosocial disorder. As measures to be adopted, and with the aim of reducing psychosocial risk among its professionals, it is recommended to introduce organizational changes in surveillance services to prevent psychosocial disorders among its professionals.

OBJECTIVE: Los profesionales sanitarios estuvieron sometidos durante la pandemia de la COVID-19 a condiciones laborales muy exigentes. El objetivo de este artículo fue evaluar el nivel de riesgo de padecer algún trastorno psicosocial por parte de los profesionales de los Servicios de Vigilancia Epidemiológica de Cataluña (SVE) durante la sexta ola pandémica de la COVID-19. METHODS: Se realizó un estudio epidemiológico de prevalencia en trabajadores/as de los SVE de Cataluña. La información se recogió mediante un cuestionario de datos sociodemográficos, laborales y el Cuestionario de Salud General de Goldberg (GHQ-28) de enero a marzo de 2022. Una puntuación igual o mayor de 7 en el GHQ-28 se consideró positiva e indicaba riesgo de padecer algún trastorno. Las variables dependientes fueron la puntuación y la positividad del test GHQ-28. La relación entre la puntuación del GHQ-28 con el resto de las variables independientes del estudio se estudió con la Odds Ratio (OR) y sus intervalos de confianza (IC) del 95%. RESULTS: La edad media de la población estudiada fue de 37 años (DE=±11,4) y el 75% eran mujeres. El 53,8% de los participantes presentaron un resultado positivo en el GHQ-28. Los participantes con mayor riesgo psicosocial fueron los trabajadores con antecedentes de problemas psicológicos (OR 2,8; IC95% 1,2-6,7). El riesgo también fue superior en las mujeres (OR 1,8; IC95% 0,8-4,1), los participantes con profesiones sanitarias (OR 1,2: IC95% 0,6-2,5), los que estaban tomando tratamiento farmacológico (OR 2,4; IC95% 0,6-9,7) o los que estaban realizando terapia psicológica (OR 1,5; IC95% 0,6-3,6) en el momento de la recogida de datos y los trabajadores que no tuvieron una percepción de apoyo y reconocimiento laboral por parte de sus equipos de trabajo (OR 1,8; IC95% 0,9-3,8), aunque algunas diferencias no fueron estadísticamente significativas. CONCLUSIONS: Los profesionales de los SVE presentaron, durante la sexta ola pandémica, un elevado riesgo de trastorno psicosocial. Como medidas a adoptar, y con el objetivo de reducir el riesgo psicosocial entre sus profesionales, se recomienda introducir cambios organizativos en los servicios de vigilancia para prevenir los trastornos psicosociales entre sus profesionales.

Impacto psicosocial de la COVID-19 en los profesionales de los Servicios de Vigilancia Epidemiológica de Cataluña / Psychosocial impact of COVID-19 on the professionals of the Epidemiological Surveillance Services of Catalonia

Fundamentos: Los profesionales sanitarios estuvieron sometidos durante la pandemia de la COVID-19 a condiciones laborales muy exigentes. El objetivo de este artículo fue evaluar el nivel de riesgo de padecer algún trastorno psicosocial por parte de los profesionales de los Servicios de Vigilancia Epidemiológica de Cataluña (SVE) durante la sexta ola pandémica de la COVID-19. Métodos: Se realizó un estudio epidemiológico de prevalencia en trabajadores/as de los SVE de Cataluña. La información se recogió mediante un cuestionario de datos sociodemográficos, laborales y elCuestionario de Salud General de Goldberg (GHQ-28) de enero a marzo de 2022. Una puntuación igual o mayor de 7 en el GHQ-28 se consideró positiva e indicaba riesgo de padecer algún trastorno. Las variables dependientes fueron la puntuación y la positividad del test GHQ-28. La relación entre la puntuación del GHQ-28 con el resto de las variables independientes del estudio se estudió con laOdds Ratio (OR) y sus intervalos de confianza (IC) del 95%. Resultados: La edad media de la población estudiada fue de 37 años (DE=±11,4) y el 75% eran mujeres. El 53,8% de los participantes presentaron un resultado positivo en el GHQ-28. Los participantes con mayor riesgo psicosocial fueron los trabajadores con antecedentes de problemas psicológicos (OR 2,8; IC95% 1,2-6,7). El riesgo también fue superior en las mujeres (OR 1,8; IC95% 0,8-4,1), los participantes con profesiones sanitarias (OR 1,2: IC95% 0,6-2,5), los que estaban tomando tratamiento farmacológico (OR 2,4; IC95% 0,6-9,7) o los que estaban realizando terapia psicológica (OR 1,5; IC95% 0,6-3,6) en el momento de la recogida de datos y los trabajadores que no tuvieron una percepción de apoyo y reconocimiento laboral por parte de sus equipos de trabajo (OR 1,8; IC95% 0,9-3,8), aunque algunas diferencias no fueron estadísticamente significativas...(AU)

Background: Healthcare professionals were subjected to very demanding working conditions during the COVID-19 pandemic. The aim of this paper was to assess the level of risk of suffering a psychosocial disorder in the professionals of the Epidemiological Surveillance Services of Catalonia (EVS) during the sixth wave of the COVID-19 pandemic. Methods: An epidemiological study of prevalence was carried out in SVE workers in Catalonia. The information was collected through a questionnaire of sociodemographic and occupational data and the Goldberg General Health Questionnaire (GHQ-28) from January to March 2022. A score equal to or greater than 7 on the GHQ-28 was considered positive and indicated a risk of suffering some disorder. The dependent variables were the score and positivity of the GHQ-28 test. The relationship between the GHQ-28 score and the rest of the independent variables of the study was studied with the Odds Ratio (OR) and its 95% confidence intervals (IC). Results: The mean age of the population studied was 37 years (SD=±11.4) and 75% were women. 53.8% of the participants presented a positive result in the GHQ-28. The participants with the highest psychosocial risk were workers with a history of psychological problems (OR 2.8; IC95% 1.2-6.7). The risk was also higher in women (OR 1.8; IC95% 0.8-4.1), participants with health professions (OR 1.2: IC95% 0.6-2.5), those who were taking pharmacological treatment (OR 2.4; IC95% 0.6-9.7) or those who were undergoing psychological therapy (OR 1.5; IC95% 0.6-3.6) at the time of data collection and workers who did not had a perception of work support and recognition from their work teams (OR 1.8; IC95% 0.9-3.8), although some differences were not statistically significant. Conclusions: The professionals of the SVE professionals presented, during the sixth pandemic wave, a high risk of psychosocialdisorder...(AU)

Lichen planus of the esophagus: a case report.

Esophageal lichen planus (ELP) is an inflammatory disorder that affects the skin, cutaneous appendages and mucous membranes. The esophageal involvement is rare. We present the case of a 70-year-old woman with years of dysphagia and a history of erosive lichen planus involving the vulva, vagina, gingiva, and skin, who was eventually diagnosed with esophageal lichen planus. The patient's condition was refractory and progressed to the development of intraepithelial squamous neoplasia. We reviewed the literature on this condition.

A case report of gastrointestinal histoplasmosis in a patient treated with infliximab.

Histoplasmosis is an endemic mycosis in some areas of North and South America. This disease is usually asymptomatic, but it can result in severe and disseminated infection involving gastrointestinal tract, especially in immunocompromised individuals. We report a case of a 33-years-old Ecuadorian male treated with infliximab who developed disseminated histoplasmosis with gastrointestinal affection. Due to the non-specific presentation of gastrointestinal histoplasmosis, the diagnosis is often delayed and it causes poor outcomes. It is important to consider this diagnosis in immunocompromised patients with compatible symptoms, like patients on TNF inhibitors.

Significant decrease in the prevalence of hepatitis C infection after the introduction of direct acting antivirals.

BACKGROUND AND AIM: Accurate information on the epidemiology of hepatitis C and B infection is mandatory to establish a national/regional plan. We aim to update the prevalence of hepatitis C and B infection in Catalonia using point-of-care tests to analyze the risk factors related and to implement a linkage-to-care circuit. METHODS: This is a community-based study. A random list of adult individuals was retrieved from censuses of primary care centers. Point-of-care tests for anti-hepatitis C virus (HCV) and HBV surface antigen (HBsAg) and a questionnaire for risk factor assessment were performed. Positive results were validated and a circuit for linkage-to-care was established. RESULTS: A total of 3328 individuals were included. The anti-HCV and HBsAg overall prevalence were lower than expected [1.02%, 95% confidence interval (CI) 0.65-1.39; and 0.52%, 95% CI 0.26-0.77, respectively]. Anti-HCV positive subjects were mostly (88%) autochthonous. The prevalence increased with age; only 12% were under age 40. The associated risk factors were drug use, blood transfusion, relative with HCV, and diabetes. Notably, the prevalence of active infection was only 0.49% (95% CI 0.23-0.74), 40% less than previously reported, reflecting the impact of direct acting antiviral therapy. Differently, HBsAg positive subjects were mostly foreign migrants (53%) with no other risk factors. Despite the implementation of a linkage-to-care circuit, one third of HBsAg positive subjects were lost. CONCLUSIONS: The prevalence of HCV infection was lower than previously reported, showing a strong impact of direct acting antiviral therapy in the last years. Because of hepatitis B universal vaccination, HBV infection in Catalonia is mainly associated with migrant population. Linkage-to-care in patients with hepatitis B was challenging and warrants additional efforts.

Autoantibodies to cytoplasmic rods and rings in patients with hepatitis C virus infection treated with direct-acting antivirals: The role of prior treatment with interferon plus ribavirin / Autoanticuerpos citoplasmáticos contra bastones (Rods) y anillos (Rings) en pacientes infectados por el virus de la hepatitis C tratados con antivirales de acción directa: el papel de un tratamiento anterior con interferón y ribavirina

Introduction: The cytoplasmic rods-rings (RR) pattern is found in hepatitis C (HCV) patients treated with interferon-ribavirin when studied with ANA-IIF. Ribavirin aggregates/induces antigenic changes in IMPDH-2, an enzyme necessary for ribavirin action. Patients and method: Prospective search for anti-RR autoantibodies (HEp-2, INOVA) in patients treated with direct-acting antivirals (DAAs) from October 2015 to June 2017. HCV-negative patients from up to June 2016 acted as controls. Anti-RR was analyzed at baseline and, mainly, during treatment and follow-up. The Chi-square test, Student's t-test and a logistic regression analysis were performed. Results: Between October 2015 and June 2016, 1258 men and 2389 women who were HCV-negative and 137 men and 112 women who were HCV-positive patients were studied. Approximately 22.9% of HCV-negative and 13.2% of HCV-positive were ANA-IIF-positive (p<0.05). Three HCV-negative (0.08%) and 23 (9.2%) HCV-positive patients had anti-RR (p<0.001). A total of 122 patients received DAAs; 30 received DAA+RBV; 46 pre-treated with IFN-RBV received DAA; 31 pre-treated with IFN-RBV received DAA+RBV; 16 received IFNpeg-RBV; and 24 received IFN-RBV-DAA. None of the 122 DAA-treated patients showed anti-RR; anti-RR were identified in 14.8% of those treated with DAA-RBV; in 25.9% of those pre-treated with IFN-RBV receiving DAA; in 22.2% of IFN-RBV-pre-treated patients who received DAA+RBV; in 7.4% of those treated with IFNpeg-RBV and in 29.6% of those treated with IFNpeg-RBV-DAA. The multivariate analysis showed significant associations between anti-RR and "Exposure to IFN" and "Time of exposure to RBV". Conclusions: Anti-RR autoantibodies were detected only in patients with current or past treatments with RBV, even in cases in which only DAAs were later administered

Introducción: La investigación de ANA-IFI en pacientes con hepatitis C tratados con interferón-ribavirina ha detectado un patrón citoplasmático en bastones y anillos. La ribavirina agregaría e induciría cambios antigénicos en la IMPDH-2, enzima imprescindible para su acción. Pacientes y método: Investigar las tasas de anti-RR (HEp-2, INOVA) en pacientes tratados con antivirales de acción directa (AAD) entre octubre-2015 y junio-2017. Como controles se han utilizado los pacientes VHC-negativo habidos hasta junio-2016. Los anti-RR se analizaron antes del tratamiento y, mayoritariamente, durante y después del mismo. Se han utilizado las pruebas Chi-cuadrado, T de Student y de regresión logística. Resultados: Entre octubre-2015 y junio-2016 hubo 1.258 varones y 2.389 mujeres VHC-negativo y 137 varones y 112 mujeres VHC-positivo. El 22,9% de los VHC-negativo y el 13,2% de los VHC-positivo fueron ANA-IFI-positivo (p<0,05). Tres pacientes (0,08%) VHC-negativo y 23 (9,2%) VHC-positivo fueron anti-RR+ (p<0,001). Ciento veintidós pacientes recibieron AAD; 30, AAD+RBV; 46 pretratados con IFN-RBV recibieron AAD; 31, pretratados con IFN-RBV, recibieron AAD+RBV; 16 IFNpeg-RBV; 24 IFN-RBV-AAD. Ningún paciente con AAD mostró anti-RR; tuvieron anti-RR el 14,8% de los tratados con AAD+RBV; 25,9% de los pretratados con IFN-RBV que recibieron AAD; 22,2% de los pretratados con IFN-RBV que recibieron AAD+RBV; 7,4% de los tratados con IFNpeg-RBV; el 29,6% de los tratados con IFNpeg-RBV-AAD. El análisis multivariante asoció significativamente la presencia de anti-RR con «Exposición al IFN» y «Tiempo de exposición a ribavirina». Conclusiones: Los autoanticuerpos anti-RR solo se han detectado en pacientes tratados con ribavirina, incluso cuando después se utilizaron solamente AAD

Autoantibodies to cytoplasmic rods and rings in patients with hepatitis C virus infection treated with direct-acting antivirals: The role of prior treatment with interferon plus ribavirin.

INTRODUCTION: The cytoplasmic rods-rings (RR) pattern is found in hepatitis C (HCV) patients treated with interferon-ribavirin when studied with ANA-IIF. Ribavirin aggregates/induces antigenic changes in IMPDH-2, an enzyme necessary for ribavirin action. PATIENTS AND METHOD: Prospective search for anti-RR autoantibodies (HEp-2, INOVA) in patients treated with direct-acting antivirals (DAAs) from October 2015 to June 2017. HCV-negative patients from up to June 2016 acted as controls. Anti-RR was analyzed at baseline and, mainly, during treatment and follow-up. The Chi-square test, Student's t-test and a logistic regression analysis were performed. RESULTS: Between October 2015 and June 2016, 1258 men and 2389 women who were HCV-negative and 137 men and 112 women who were HCV-positive patients were studied. Approximately 22.9% of HCV-negative and 13.2% of HCV-positive were ANA-IIF-positive (p<0.05). Three HCV-negative (0.08%) and 23 (9.2%) HCV-positive patients had anti-RR (p<0.001). A total of 122 patients received DAAs; 30 received DAA+RBV; 46 pre-treated with IFN-RBV received DAA; 31 pre-treated with IFN-RBV received DAA+RBV; 16 received IFNpeg-RBV; and 24 received IFN-RBV-DAA. None of the 122 DAA-treated patients showed anti-RR; anti-RR were identified in 14.8% of those treated with DAA-RBV; in 25.9% of those pre-treated with IFN-RBV receiving DAA; in 22.2% of IFN-RBV-pre-treated patients who received DAA+RBV; in 7.4% of those treated with IFNpeg-RBV and in 29.6% of those treated with IFNpeg-RBV-DAA. The multivariate analysis showed significant associations between anti-RR and "Exposure to IFN" and "Time of exposure to RBV". CONCLUSIONS: Anti-RR autoantibodies were detected only in patients with current or past treatments with RBV, even in cases in which only DAAs were later administered.

Repercusiones en el cuidador de los enfermos crónicos domiciliarios / Repercussions on carers of the chronically ill at home

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Influencia de la comorbilidad trastorno distímico-trastorno de la personalidad en el tratamiento cognitivo-conductual en grupo para el trastorno distímico / Influence of comorbidity of dysthymia and personality disorders on cognitive-behavioural group therapy for dysthymia

Objetivo: En el presente estudio pretendemos analizar la influencia de la asociación trastorno distímico y trastorno de la personalidad en los resultados de la intervención cognitivo-conductual en grupo para el trastorno distímico. Metodología: La muestra consta de 71 pacientes. Se evalúa el estado clínico y la personalidad de estos mediante los siguientes tests psicométricos: PDQ-4, BDI, STAI-E, STAI-R y Mini-Mult. Se divide la muestra en dos grupos: presencia o no de trastorno de personalidad y se analizan las diferencias respecto la severidad incial de psicopatología presentada y respecto al cambio clínico tras el tratamiento psicológico entre estos dos grupos. Resultados: Respecto a la severidad inicial del trastorno distímico se encuentran diferencias estadísticamente significativas entre los dos grupos en las variables STAI-R, en las escalas de validez del Mini-Mult (f y K) y en las clínicas: desviación psicopática, paranoia, esquizofrenia y manía. No se encuentran diferencias en el nivel de severidad previo al tratamiento de la sintomatología depresiva, ni a través del BDI ni en la escala de depresión del Mini-Mult. No se detecta un efecto del tratamiento psicológico diferenciado para ambos grupos y no se obtienen diferencias pre y post tratamiento estadísticamente significativas para ninguna de las variables de estado psicopatológico, con excepción de la escala manía, en la que el grupo con trastorno de la personalidad aumenta la puntuación respecto el nivel inicial. Conclusión: En función de nuestros datos parece que los pacientes con trastorno de la personalidad presentan más psicopatología previa al tratamiento, pero no parece que la asociación trastorno distímico-trastorno de la personalidad tenga ninguna influencia específica en el beneficio clínico obtenido para el tratamiento psicológico en comparación con los sujetos sin trastorno de la personalidad asociado. Es decir, que el tratamiento psicológico es igual de efectivo para ambos grupos (AU)