ABSTRACT
Resumen Este trabajo de revisión analiza el estado de los conocimientos sobre la Telepsiquiatría (TP) tras la crisis provocada por el COVID y la consiguiente necesidad de utilizar nuevas modalidades de atención. Se abordan seis aspectos inherentes a la TP: la satisfacción de los pacientes y del personal de salud mental, la fiabilidad diagnóstica, la eficacia de la intervención de la TP, la rentabilidad en términos de coste-oportunidad (o eficiencia) y los aspectos legales inherentes a la confidencialidad y la privacidad en particular y la actitud de los profesionales hacia la TP. La satisfacción con el TP es aceptable tanto entre los pacientes como entre los profesionales, siendo estos últimos los más reacios. La fiabilidad diagnóstica está demostrada, pero requiere de más estudios que confirmen esta fiabilidad en diferentes diagnósticos y entornos sanitarios. La eficacia de los tratamientos con TP no es inferior a la atención presencial, como se ha comprobado en psicoterapias específicas. Por último, hay que destacar que la actitud del psiquiatra es el elemento más decisivo que limita o facilita la implantación del TP. This review paper analyzes the state of knowledge on Telepsychiatry (TP) after the crisis caused by COVID and the resulting need to use new modalities of care. Six essential aspects of TP are addressed: patient’s and mental health staff satisfaction, diagnostic reliability, effectiveness of TP interventions, cost-effectiveness in terms of opportunity cost (or efficiency), legal aspects inherent to confidentiality and privacy in particular and the attitude of professionals towards TP. Satisfaction with TP is acceptable among both patients and professionals, the latter being the most reluctant. Diagnostic reliability has been demonstrated, but requires further studies to confirm this reliability in different diagnoses and healthcare settings. The efficacy of TP treatments is not inferior to face-to-face care, as has been proven in specific psychotherapies. Finally, it should be noted that the attitude of the psychiatrist is the most decisive element that limits or facilitates the implementation of TP.
ABSTRACT
OBJECTIVE: The increase in COVID-19 cases is generating fear and concern in society, which generates an emotional response that influences the adoption of health-related behaviors. The objective of the study is to design and validate the Scale of Worry for Contagion of COVID-19 (PRE-COVID-19). METHOD: The study had a descriptive cross-sectional design. The population were young people and adults who resided in the cities of Lima and Callao (Perú) during the declaration of the national health emergency due to the COVID-19 pandemic, during the period from March 16 to 27, 2020, who were recruited through a non-probability sample. The PRE-COVID-19, the WHO-Five Well-Being Index, the Generalized Anxiety Disorder Scale-2 and a single item were applied to measure the general perception of health. The scales were shared using a Google form through social networks. An internal consistency reliability analysis and structural equation models were performed, specifically confirmatory factor analysis. The recommendations of the Declaration of Helsinki and the principles that guide the ethical practice of online studies were followed. RESULTS: Eight hundred and sixteen young people and adults from Lima and Callao (200 men and 616 women; mean age 28.40, SD 7.10) participated. The results show a one-dimensional model with satisfactory goodness-of-fit indices: χ2 (9)=52.00; CFI=0.99; RMSEA=0.09 [0.07, 0.12]; WRMR=0.85. The λ of the model were higher than 0.50 and the reliability had an excellent value (ω=0.90). Likewise, the convergent and discriminant validity is evident between PRE-COVID-19 and measures of anxiety, well-being and self-reported health. CONCLUSION: The results indicate that the PRE-COVID-19 is a valid and reliable instrument to measure concern about the spread of COVID-19 and the emotional impact on people.
Subject(s)
COVID-19 , Adolescent , Adult , Anxiety , Cross-Sectional Studies , Female , Humans , Male , Pandemics , Peru , Psychometrics , Reproducibility of Results , SARS-CoV-2 , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To adapt the ICU Mobility Scale (IMS) to the area of intensive care units (ICU) in Spain and to evaluate the metric properties of the Spanish version of the IMS (IMS-Es). METHOD: Descriptive metric study developed in two phases. Phase 1, adaptation to Spanish of the IMS by a team of nurses and physiotherapists (translation, pilot, backtranslation and agreement). Phase 2, analysis of metric properties (convergent, divergent and predictive validity, interobserver reliability, sensitivity and minimum important difference) of the IMS-Es. Patient characteristics (Barthel, Charlson, BMI, sex), sedation/agitation level (RASS), ICU and hospital stays, survival, quality of life (SF-12), muscle weakness (MRC-SS) and mobility (IMS-Es) were recorded in the patients of the MOviPre national multicentre study. RESULTS: After obtaining the IMS-Es, it was implemented in 645 patients from 80 Spanish ICUs between April and June 2017. Convergent validity: moderate correlation between IMS-Es and MRC-SS (r=.389; P<.001) and significant comparison between groups with and without ICU-acquired weakness (P<.001). Divergent validity: no correlation between IMS-Es and BMI [r (95%CI): -.112 (-.232 to .011)], weight [r (95%CI): -.098 (-.219 to .026)], Charlson [r (95%CI): -.122 (-.242 to .001)] and Barthel [r(95%CI): -.037 (-.160 to .087)] and no differences between sexes (P=.587) or BMI categories (P=.412). Predictive validity: moderate and significant correlations with post-ICU hospital stay [r (95%CI): -.442 (-.502 to -.377)] and physical component of SF-12 (PCS) [r (95%CI): .318 (.063 to .534)]; patients without active mobilisation in ICU increased risk of hospital mortality [OR (95%CI): 3.769 (1.428 to 9.947)]. Interobserver reliability: very good concordance between nurses [CCI (95%CI): .987 (.983 to .990)] and nurse-physiotherapist [CCI (95%CI): .963 (.948 to .974)]. Sensitivity to change: small effect on discharge from ICU (d=.273) and moderate effect at 3months after hospital discharge (d=.709). Minimal important difference: 2-point difference cut-off point, 91.1% sensitivity and 100.0% specificity. CONCLUSIONS: The IMS-Es is useful, valid and reliable for implementation by ICU nurses and physiotherapists in assessing the mobility of critical patients.