A Computational Platform to Support the Detection, Follow-up, and Epidemiological Surveillance of Mental Health and Substance Use Disorders: Protocol for a Development and Evaluation Study.

BACKGROUND: According to the World Health Organization, approximately 15% of the global population is affected by mental health or substance use disorders. These conditions contribute significantly to the global disease burden, which has worsened because of the direct and indirect effects of COVID-19. In Mexico, a quarter of the population between the ages of 18 and 65 years who reside in urban areas present a mental health condition. The presence of a mental or substance abuse disorder is behind a significant percentage of suicidal behaviors in Mexico, where only 1 in 5 of those who have these disorders receive any treatment. OBJECTIVE: This study aims to develop, deploy, and evaluate a computational platform to support the early detection and intervention of mental and substance use disorders in secondary and high schools as well as primary care units. The platform also aims to facilitate monitoring, treatment, and epidemiological surveillance ultimately helping specialized health units at the secondary level of care. METHODS: The development and evaluation of the proposed computational platform will run during 3 stages. In stage 1, the identification of the functional and user requirements and the implementation of the modules to support the screening, follow-up, treatment, and epidemiological surveillance will be performed. In stage 2, the initial deployment of the screening module will be carried out in a set of secondary and high schools, as well as the deployment of the modules to support the follow-up, treatment, and epidemiological surveillance processes in primary and secondary care health units. In parallel, during stage 2, patient applications to support early interventions and continuous monitoring will also be developed. Finally, during stage 3, the deployment of the complete platform will be performed jointly with a quantitative and qualitative evaluation. RESULTS: The screening process has started, and 6 schools have been currently enrolled. As of February 2023, a total of 1501 students have undergone screening, and the referral of those students presenting a risk in mental health or substance use to primary care units has also started. The development, deployment, and evaluation of all the modules of the proposed platform are expected to be completed by late 2024. CONCLUSIONS: The expected results of this study are to impact a better integration between the different levels of health care, from early detection to follow-up and epidemiological surveillance of mental and substance use disorders contributing to reducing the gap in the attention to these problems in the community. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44607.

ANALYSIS OF MENTAL HEALTH IN PATIENTS, WHO HAVE HAD SARS COV-2 AT THE PRIMARY LEVEL OF HEALTH CARE.

OBJECTIVE: The aim of the study was to evaluate retrospectively the mental state of patients, who have had COVID - 19 at the primary level of health care according to medical documentation. PATIENTS AND METHODS: Materials and methods: 70 outpatient charts of patients aged from 31 to 80 years who have had laboratory-confirmed SARS CoV-2 and received primary health care, were processed. Conducted: assessment for the presence and determination of the severity of depression based on the scale of PHQ 9; screening for post-traumatic stress disorder (PTSD) (Breslau et al., 1999). CONCLUSION: Results and conclusions: patients, who have had SARS CoV-2, the moderate severity of depressive syndrome prevailed. The risk of forming of PTSD is most presented in patients who have had severe SARS CoV-2, who had inpatient treatment and combined with low quality of life (QOL) at outpatient treatment as well. The increase of anxiety was found in individuals after outpatient and inpatient treatment, and it was accompanied with low QOL. Patients with complaints about cognitive impairment prevailed after inpatient treatment, and determined their QOL as low, especially in men in 100%. Sleep disturbances were detected in 90.3% of patients with complicated course of SARS CoV-2 during inpatient treatment with low QOL. Tachycardia was detected in 61.7% of patients in group 1 and in 52.2% in group 2, that could be a symptom of increased anxiety and PTSD, but it requires differential diagnosis with cardiac pathology.

Dimensión subjetiva de los procesos de trabajo en profesionales de salud en contexto de pandemia: un estudio exploratorio a partir del análisis de dispositivos de Apoyo a los Equipos de Salud en un municipio del Área Metropolitana de Buenos Aires (AMBA)

Resumen: Objetivo: caracterizar la dimensión subjetiva de los procesos de trabajo en el primer nivel de atención en contexto de pandemia, a través de la descripción y análisis de los discursos de los y las trabajadores/as producidos en el marco del dispositivo de Apoyo a los Equipos de Salud implementado en un municipio del área metropolitana de Buenos Aires. Metodología: investigación cualitativa, exploratoria y descriptiva. Estudio de caso único centrado en observación participante en 10 reuniones en centros de salud del Municipio de Tigre, durante los meses de abril y mayo de 2020. La sistematización del material se realizó siguiendo técnicas de análisis de contenido y generación de categorías. Resultados: el análisis permitió identificar cinco categorías emergentes: a) cambios en los escenarios de trabajo, b) emociones y actitudes frente a la tarea, c) vínculos al interior de los equipos, d) vínculos con las autoridades y e) vínculos con la comunidad. Discusión: la dimensión subjetiva contenida en las vivencias relatadas está caracterizada por sensaciones de incertidumbre, miedos, tensiones en la relación entre compañeros/as, con las instancias jerárquicas y con la población asistida, pero también por búsquedas activas de alternativas, apoyo entre compañeros/as, participación, motivación en los sentidos del trabajo, cuidados mutuos y acercamiento a la comunidad. De este modo se hacen visibles aspectos que preexistían a la situación de pandemia y aspectos que el contexto introduce. Finalmente, se arriba a algunas reflexiones sobre las implicancias de la inclusión de este dispositivo en el proceso de trabajo de equipos de salud durante la pandemia.

Abstract: Objective: characterize the subjective dimension of the work processes at the first level of care in the context of a pandemic, through the description and analysis of the speeches of the workers produced within the framework of the Health Team Support device implemented in a municipality in the metropolitan area of Buenos Aires. Methodology: qualitative, exploratory and descriptive research. Single case study focused on participant observation in 10 meetings in health centers of the Municipality of Tigre, during the months of April and May 2020. The systematization of the material was carried out following techniques of content analysis and category generation. Results: the analysis identified five emerging categories: a) changes in work settings, b) emotions and attitudes towards the task, c) ties within teams, d) ties with authorities, and e) ties with the community. Discussion: the subjective dimension contained in the experiences reported are characterized by feelings of uncertainty, fears, tensions in the relationship between colleagues, with hierarchical instances and with the assisted population, but also by active searches for alternatives, support among colleagues, participation, motivation in the sense of work, mutual care and approach to the community. In this way, aspects that pre-existed the pandemic situation and aspects that the context introduce are made visible. Finally, we come up with some reflections on the implications of the inclusion of this device in the work process of health teams during the pandemic.

Resumo: Objetivo: caracterizar a dimensão subjetiva dos processos de trabalho em primeiro nível de atenção em contexto de pandemia, por meio da descrição e análise das falas dos trabalhadores produzidos no âmbito do dispositivo de Apoio à Equipe de Saúde implantado em município da região metropolitana de Buenos Aires. Metodologia: pesquisa qualitativa, exploratória e descritiva. Estudo de caso único com foco na observação participante em 10 encontros em centros de saúde do Município de Tigre, durante os meses de abril e maio de 2020. A sistematização do material foi realizada seguindo técnicas de análise de conteúdo e geração de categorias. Resultados: a análise identificou cinco categorias emergentes: a) mudanças nos ambientes de trabalho, b) emoções e atitudes em relação à tarefa, c) vínculos dentro das equipes, d) vínculos com autoridades e e) vínculos com a comunidade. Discussão: a dimensão subjetiva contida nas vivências relatadas é caracterizada por sentimentos de incerteza, medos, tensões na relação entre colegas, com instâncias hierárquicas e com a população assistida, mas também por buscas ativas de alternativas, apoio entre colegas, participação, motivação no sentido de trabalho, cuidado mútuo e aproximação com a comunidade. Desta forma, tornam-se visíveis os aspectos prévios à situação pandémica e os que o contexto introduz. Por fim, são feitas algumas reflexões sobre as implicações da inclusão desse dispositivo no processo de trabalho das equipes de saúde durante a pandemia.

El Psicólogo en el Primer Nivel de Atención de Salud: desafíos para Uruguay

Resumen: En Uruguay cada vez más se reconoce la importancia del profesional psicólogo en el Primer Nivel de Atención (PNA). En la actualidad se transita una oportunidad única ya que el Plan Nacional de Salud Mental 2020-2027 (PNSM) recientemente aprobado, plantea su incorporación en forma expresa. El presente artículo analiza el rol del psicólogo en el PNA, realiza un recorrido internacional seleccionando algunos países en los que se muestran diversos modos de incorporación de los psicólogos en este rol. Se aborda a continuación cuál es la situación del psicólogo en el PNA en Uruguay. Por último, se plantean algunos de los desafíos que implica renovar el trabajo tradicional del psicólogo clínico, e incorporar las competencias y prácticas profesionales características del PNA.

Abstract: In Uruguay, the importance of the professional psychologist in the First Level of Health Care (PNA) is increasingly recognized, and currently there is a unique opportunity since the recently approved National Mental Health Plan 2020-2027 (PNSM), raises its incorporation expressly. This article analyzes the role of the psychologist in PNA, makes an international review selecting some countries in which the various ways in which psychologists have been incorporated into this role are shown. The situation of the psychologist in the PNA in Uruguay is discussed below. Finally, some of the challenges faced are raised, which implies renewing the traditional role of the clinical psychologist, and incorporating the competencies and professional practices characteristic of the PNA.

Resumo: No Uruguai, a importância do psicólogo profissional no Primeiro Nível de Atenção de Saúde (PNA) é cada vez mais reconhecida, e atualmente existe uma oportunidade única desde o recém-aprovado Plano Nacional de Saúde Mental 2020-2027 (PNSM), levanta expressamente a sua incorporação. Este artigo faz análise do papel do psicólogo na PNA, faz uma revisão internacional selecionando alguns países nos quais são mostradas as diversas formas pelas quais os psicólogos foram incorporados a essa função. A seguir se discute a situação do psicólogo na PNA do Uruguai. Por fim, são apresentados alguns dos desafios que implica a renovação do papel tradicional do psicólogo clínico e incorporar as competências e práticas profissionais próprias da PNA.

Developing and using a dengue patient care guideline for patients admitted from households to primary care units and the district hospital: A community participatory approach in Southern Thailand.

BACKGROUND: Dengue has been an important health issue in southern Thailand. However, this area has only a surveillance-prevention system, without step-by-step guidelines on dengue treatment for patients admitted from households to primary care units (PCUs) and district hospitals. Therefore, this study were to develop and use a dengue patient care guideline (DPCG), and to evaluate knowledge, attitude, practice (KAP) of dengue patient care. METHODS: 26 health care providers (13 nurses, and 13 public health officials) from eight PCUs and the district hospital developed the DPCG. The study design was based on the community participatory action research that integrated the Iowa model involving the following steps: preparation, guideline development, use and monitoring, evaluation and conclusion, and referring technology. We assessed the improvement between before and after using the DPCG regarding the participants' KAP on patient care and preparedness of equipment. McNamara's test was used to compare the changing results before and after using the DPCG. Qualitative data collection was performed in two meeting discussions with six open-end items. Using a thematic analysis technique, we extracted conclusions and suggested solutions. RESULTS: The guideline included four steps for patients' care provision at households, PCUs, outpatient departments, emergency rooms, and inpatient departments. After using the DPCG in 39 dengue patients of which 30 patients were admitted to the inpatient department1 and two patients were referred to the tertiary care hospital without mortality. The overall participants' knowledge and attitude, two of six aspects of patients' care, and three of eight types of equipment management were significantly improved (p < 0.05). Eleven themes were evaluated which were associated with the quantitative data. CONCLUSION: The DPCG instructed dengue patient's care for health care providers from households to the PCUs and district hospital. All participants improved KAP, and equipment management. Step-by-step of DPCG use and participation of all stakeholders are needed.

Condições de saúde mental e qualidade de vida de taxistas / Mental health conditions and quality of life of taxi drivers / Condiciones de la salud mental en la calidad de vida de taxistas

Objetivos: Avaliar a influência das condições de saúde mental na qualidade de vida (QV) dos taxistas. Métodos: Estudo de corte transversal realizado com 133 taxistas associados ao Sindicato dos Condutores Autônomos de Jequié/BA. Para avaliar a qualidade de vida foi utilizado o questionário Whoqol-Bref e o questionário SRQ20 para as condições de saúde. Para as análises estatísticas foi utilizado o teste de Mann Whitney, adotando nível de confiança de 5% (p<0,05). A pesquisa teve aprovação do Comitê de Ética em Pesquisa sob o n° 333.535. Resultados: A prevalência da suspeição de transtorno mental comum foi de 25,6% e houve diferença estatisticamente significante entre todos os domínios da qualidade de vida. Conclusão: Os indivíduos que apresentaram algum tipo de transtorno mental comum apresentaram pior percepção de QV. Assim conclui-se que as condições de saúde mental influenciam na qualidade de vida dos taxistas

Objective: The objective of this study was to evaluate the influence of mental health conditions in the Quality of Life of taxi drivers. Methods: This is a cross-sectional study of 133 taxi drivers associated with the Union of Autonomous in Jequié-BA. To evaluate the Quality of Life were used the instrument Whoqol-Bref and to the mental health conditions, were used SRQ-20. For the statistical analysis were used the Mann Whitney test and a 95% confidence level (p< 0,05). The study was approved by the Research Ethics Committee under number 333.535. Results: The prevalence of mental health disorders was 25,6% and the results of the study have highlighted significant differences between the suspicion of common mental disorder with all areas of quality of life. Conclusion: Individuals who had some type of common mental disorders had a poorer perception of Quality of Life. Thus, it is concluded that mental health conditions influence the quality of life of taxi drivers

Objetive: Evaluar la influencia de las condiciones de salud mental en la calidad de vida de taxistas. Métodos: Estudio de corte transversal realizado con los taxistas asociados al Sindicato de Conductores Autónomos de Jequié-Ba. Para evaluar la calidad de vida se utilizó lo cuestionario Whoqol-Bref y lo cuestionario SRQ-20 para las condiciones de salud. Para las análisis estadísticas se utilizó el test de MannWhitney, adoptando nível de confianza de 5% (p< 0,05). La investigación fue aprobada por el Comité de Ética en Pesquisa con el número 333.535. Resultados: La prevalência de sospecha de trastorno mental comum fue de 25,6% y hubo diferencias estadísticamente significativas todos los dominios de la calidad de vida. Conclusión: Los taxistas que presentaran algún tipo de trastorno mental comum presentaran peor percepción de la calidad de vida. Por lo tanto, se concluye que las condiciones de salud mental influyen en la calidad de vida de los taxislas

Joint Health Status in Hemophilia Patients Using Hemophilia Joint Health Score and Pettersson Score / 임상소아혈액종양

BACKGROUND: Comprehensive clinical and radiologic follow-up is needed to preserve joint functions and quality of life in hemophilia using clinimetric tools such as Hemophilia joint health score (HJHS) or Pettersson score (PS). We investigated the joint health status evaluated using the tools in Korean hemophilia patients. METHODS: We reviewed retrospectively medical records to collect clinical parameters, HJHS and PS, who were followed up in Severance Hospital, Seoul, Korea. The correlation between HJHS and PS, and the effect of the prophylaxis for hemophilia on the outcomes measured with the scores were evaluated. The prophylaxis proportion (PP) was calculated as the proportion of prophylaxis duration to each patient's life time. RESULTS: Total of 28 patients with severe hemophilia were enrolled. Twelve patients (42.8%) were less than 20 years old. Total of 23 patients had experienced prophylaxis during their lives, and median PP was 39.7%. There was significant correlation between HJHS and PS (P 20 years old. CONCLUSION: HJHS and PS were positively correlated. Each score increased as the patient's age increased. The prophylaxis had protective effect on joint health. The prospective evaluation of HJHS and PS will be needed to prove the effect of proper management on the joint health status.

The effect of Health Inequality Factors on Health Level of the Rural Elderly

PURPOSE: This study aimed to analyze the relationships between the factors affecting health levels of the elderly in rural areas. METHODS: Subjects were 257 elderly people residing in rural areas of six cities and Gangwon Province. Data was collected through questionnaires (demographic and socioeconomic status, social resources, health behaviors, physical environment, psychological tendency and general health levels) and was analyzed by using multiple regression and Sobel test. RESULTS: The demographic and socioeconomic characteristics of the subjects exerted statistically significant influence on their social resources, health behaviors, physical environment, and psychological tendencies. The demographic and socioeconomic characteristics, social resources, health behaviors, physical environment, and psychological tendencies, in turn, exerted a statistically significant influence on the health level. The social resources had mediating effects on the relationship between income, one of the demographic and socioeconomic characteristics, and health level. The residential environments had mediating effects on the relationship between income and health level. The psychological tendency had mediating effects on the relationship between income and health level. CONCLUSION: This study suggests that income is an important factor affecting health level among rural elderly people. In addition, social resources, health behaviors, physical environment, and psychological tendencies among them also affect health level, so it is necessary to make strategies to improve these factors.

The impact of public versus private insurance on trauma patients.

BACKGROUND: The socioeconomic status has been associated with disparities in the incidence and mortality of traumatic injuries. However, there is a lack of studies on the level of health insurance with regard to various epidemiologic data of traumatic injuries, which this study opted to clarify. MATERIALS AND METHODS: All consecutive 6595 patients admitted to a level one trauma center in 2012 and 2013 were included in this retrospective cohort study. Patients were grouped according to their health insurance status (public versus private extended health care insurance) and compared with regard to several epidemiologic variables, that is, the type of injuries, inhospital outcome, and surgical procedures. RESULTS: Public insurance coverage was significantly more common than private insurance (75% versus 25%). Public insurance was associated with younger age, male sex, transfers to another hospital or mental institution, head concussions, head fractures, and increased mortality. Contrarily, patients with private insurance were more often associated with longer hospital stay, discharge to a rehabilitation clinic, fractures of the proximal humerus, and shoulder dislocations. However, there were no significant differences for the remaining majority of studied variables. CONCLUSIONS: In a trauma setting, the level of insurance does not seem to play a crucial role in most types of injuries and surgical procedures in a country with a high level of obligatory health care coverage. Nonetheless, it appears that publicly insured patients are more commonly younger, males, transferred to another hospital more often, more prone to head trauma, and subject to increased mortality, whereas privately insured patients show longer hospital stays, increased transfers to rehabilitation clinics, and more fractures of the proximal humerus.

Necessidades de saúde de idosos de uma Unidade de Saúde da Família* / Health care needs of the elderly at a Family Health Unit

O presente estudo propõe-se a caracterizar as necessidades de saúde entre idosos da área de abrangência de uma Unidade de Saúde da Família (USF). Trata-se de um estudo transversal, realizado com 301 idosos (65,3%) da população total da área. O instrumento de coleta de dados foi construído visando à avaliação multidimensional, que possibilita a identificação das necessidades de saúde no âmbito funcional, social, emocional e ambiental. Constatou-se, entre os entrevistados que 129 (42,9%) pertencem à faixa etária dos 60 a 69 anos; 186 (61,8%) são mulheres; 207 (68,1%) são analfabetos ou têm o primeiro grau incompleto; 111 (36,9%) vivem sem o companheiro; 149 (49,5%) não realizam qualquer atividade; 218 (72,4%) são considerados pobres ou muito pobres e 161 (53,5%) vivem apenas da aposentadoria. Em torno de um quarto deles, apresentam sintomatologia de depressão, cognição diminuída e graus de dependência diversos. Os idosos apresentam, ainda, 2,5 diagnósticos/idoso e fazem uso, em média, de 2,9 medicamentos/idoso. Os idosos apresentam necessidades de saúde complexas que demandam planejamento de ações em equipe interdisciplinar.

This paper aims to determine the health care needs of individuals aged 60 or more and who live in a Family Health Program area. This cross-sectional study has been carried out with 301 elderly (65,3%) of the total population in the area. The data collecting tool was built aiming at multidimensional evaluation that makes possible to identify the following health care needs: functional, social, emotional and environmental. Among the interviewed elderly, 129 (42,9%) are 60 to 69 years old; 186 (61,8%) are women; 207 (68,1%) are illiterate or have attended incomplete elementary school; 111 (36,9%) live without the partners; 149 (49,5%) do not carry out any activity; 218 (72,4%) are considered poor or very poor and 161 (53,3%) live just from their pension. About one fourth of them present depression symptoms, diminished cognition and various dependence degrees. They present 2.5 diagnoses and use an average 2.9 drugs/elderly. The elderly present intense and complex health care needs, which require planning actions with interdisciplinary teams. This is a great challenge to be faced.