Mental Health in Healthcare Workers Post-COVID-19: A Latin American Review and Insights into Personalized Management Strategies.

Over the COVID-19 pandemic, the impact of enduring mental health on healthcare workers has become increasingly evident. This review focuses on post-pandemic mental health challenges faced by healthcare personnel in Latin America. This highlights the persistent burden on healthcare workers, especially women, which is exacerbated by economic disparities, inadequacies in the healthcare system, and ongoing occupational stressors. Our literature review, utilizing databases such as PubMed, Scopus, and Google Scholar, scrutinized the mental health status of healthcare professionals in the region after the pandemic's peak. The analysis indicated sustained levels of psychological distress, with frontline workers and women continuing to be affected disproportionately. These findings emphasize the urgent need for personalized interventions to effectively address the complex mental health challenges in this context. This review advocates strategic interventions, including tailored psychological support, innovative diagnostics, and technological solutions, integrated into patient-centered care models. Such approaches aim to enhance the mental resilience and overall well-being of healthcare professionals across Latin America in the post-COVID era.

The impact of illegitimate tasks on burnout syndrome in a healthcare system: A cross-sectional study.

Background: Burnout syndrome, characterized by physical, mental, and emotional exhaustion due to continuous exposure to high-stress work conditions, has been increasingly recognized as a serious occupational phenomenon, especially amongst healthcare professionals. Recent studies indicate that illegitimate tasks-activities unrelated to one's role are a significant factor contributing to burnout. However, given the variability of work environments across regions, these findings may not apply universally. Objective: To investigate the behavior of the relationship between burnout and illegitimate tasks among healthcare professionals in Guayaquil, Ecuador. Methods: We conducted a survey of 562 healthcare professionals, including physicians, nurses, and medical/nursing interns, employing the Copenhagen Burnout Inventory and Bern Illegitimate Task Scale. Regression models were developed to predict burnout levels based on multiple factors, including demographic characteristics, professional roles, and perceptions of illegitimate tasks. Results: We revealed a statistically significant positive correlation between burnout and illegitimate tasks, with correlation coefficients ranging from 0.320 to 0.588, with higher levels of illegitimate tasks leading to increased burnout. Interestingly, we also found that age and length of service were negatively correlated with burnout, suggesting that these factors may serve as protective elements against burnout. Conclusions: Illegitimate tasks had an impact on burnout amongst healthcare professionals and emphasized the need for organizational strategies aimed at better task management to mitigate burnout risk.

Unveiling motives for dentistry studies: psychometric validation of a comprehensive questionnaire among aspiring dental students.

OBJECTIVE: The aim of this study is to develop and validate a questionnaire for dental students in Ecuador to assess their reasons to study dentistry. MATERIALS AND METHODS: A 25-item questionnaire was developed by the authors based on similar studies and a qualitative study. The questionnaire had five theoretical factors: economic, professional, vocational, social and academic reasons for study. In the first two samples, exploratory factor analysis was performed to identify the structure, and the models obtained were compared with confirmatory factor analysis in the third sample. RESULTS: Three samples were used, sample A with 201 participants, sample B with 623 participants, and sample C with 596 participants. Two-thirds of the participants were female and almost one-third were from coast region. The EFA applied in sample A resulted in a five-factor model with 18 items; in contrast, a three-factor model was obtained from sample B. According to the CFA in sample C, the best model was explained by three factors: labor, vocational and academic reasons. Considering two items to cross-load in labor and vocational factors, which are theoretically justified. CONCLUSION: This study presents a 12-item questionnaire that assesses labor, vocational and academic reasons for studying dentistry in an Ecuadorian population.

Waist Circumference as a Risk Factor for Non-Alcoholic Fatty Liver Disease in Older Adults in Guayaquil, Ecuador.

Non-alcoholic liver steatosis is currently considered an epidemic. It involves a broad spectrum of liver diseases, in which older adults constitute a susceptible group. The aim of this study is to identify the role of waist circumference as a risk factor for non-alcoholic fatty liver disease. METHODS: A cross-sectional study was carried out in 99 older adults who regularly attended five gerontological centers in the city of Guayaquil, Ecuador. The variables studied were age, gender, independent life, access to complete meals, waist circumference, and NAFLD diagnosed by ultrasound. RESULTS: A significant relationship exists between waist circumference, body mass index, and fat mass percentage. However, only age and waist circumference were significant in the multivariate logistic regression model. Our results suggest that in the presence of waist circumference, body mass index loses its significance and age may be a protective factor due to adipose tissue loss and redistribution. CONCLUSION: Anthropometric measurements such as waist circumference can be used as complement indicators of NAFLD.

Attitudes toward depression among Ecuadorian physicians using the Spanish-validated version of the Revised Depression Attitude Questionnaire (R-DAQ).

PURPOSE: Depression is inadequately recognized and managed, and physicians' attitudes toward this condition and its treatment may play a part in this. This study aimed to assess Ecuadorian physicians' attitudes toward depression. METHODS: This was a cross-sectional study conducted using the validated Revised Depression Attitude Questionnaire (R-DAQ). The questionnaire was delivered to Ecuadorian physicians, and the response rate was 88.8%. RESULTS: 76.4% of participants had never received previous training in depression, and 52.1% of them indicated neutral or limited professional confidence when dealing with depressed patients. More than two-thirds of the participants reported an optimistic attitude toward the generalist perspective of depression. CONCLUSION: Overall, physicians in Ecuador's healthcare settings were optimistic and held positive attitudes toward patients with depression. However, a lack of confidence in the management of depression and a need for ongoing training were found, especially among medical professionals who are not in daily contact with patients with depression.

Impact of biosecurity measures, social pressure and bullying on attitudes, perceptions, and job satisfaction levels among healthcare workers during the COVID-19 pandemic: a cross-sectional survey.

INTRODUCTION: The extent and nature of social pressure and bullying towards healthcare workers (HCWs) during the COVID-19 remains unclear. The following study identifies the effect of social pressure and bullying directed towards HCWs when using biosecurity measures during the COVID-19 pandemic; further, the impact on perceptions, attitudes and job satisfaction level is also explored. METHODOLOGY: We conducted a cross-sectional survey-based study among 684 Ecuadorian HCWs. The survey consisted of 38 questions related to the frequency, attitudes, and perceptions of biosecurity measures during the COVID-19 pandemic. Exploratory factor analysis was performed to assess the validity of the questionnaire. Associations between variables were analysed using χ2 and Fisher's exact test. Using SPSS V.25, qualitative and quantitative data were analysed. RESULTS: Of the 684 participants, 175 (25.59%) experienced or felt bullying or social pressure during the COVID-19 pandemic associated with the use of biosecurity measures. Of these, 40.6% believed it was due to an imbalance of power in the workplace. The perception that HCWs wearing personal protective equipment resulting in bullying was noted in 12% of the respondents. Job satisfaction was positive among 73% of the respondents. Gender (female) and type of institution (public) were noted to contribute towards job satisfaction and bullying experiences. CONCLUSION: Exposure to social bullying and pressure due to the use of biosecurity measures during the COVID-19 pandemic may result in reduced job satisfaction and thoughts about quitting work.

Does the SDMQ-9 Predict Changes in HbA1c Levels? An Ecuadorian Cohort.

Background and Objectives: Diabetes mellitus affects 422 million people around the world, positioning it as a major health problem. According to the WHO(World Health Organization), 90% corresponds to type 2. The shared-decision making (SDM) is a method used to facilitate patient control, medication, maintenance, and assessment of health status according to their priorities and preferences. With the application of SDM in patients with diabetes, it is expected there will be an increase in treatment adherence and a reduction in HbA1c levels. The aim of this study is to determine the predictors of the change in HbA1c. Material and Methods: A sample of 76 participants attending as endocrinology outpatients was obtained. Data collected within the sample included: sex, age, educational level, body mass index, and the level of SDM using the SDMQ-9. In addition, HbA1c levels were measured twice: at baseline and three months after the first measurement. Results: The linear regression indicates that the level of SDM is a significant predictor of the change in HbA1c, specifically in men. However, the direction of the relationship was a somewhat opposite trend than we expected. Higher levels of SDM imply an increase in HbA1c rather than a reduction. Conclusions: Contrary to the literature, our results shows that elevated levels of perceived SDM may be associated with worse diabetic control. However, more investigation is needed as these results are not generalizable, due to the specific population used and the sample size. Furthermore, to better understand the effect of SDM on the change in HbA1c in patients with poorly controlled diabetes.

Perceptions and knowledge of telemedicine in Ecuadorian practicing physicians: an instrument adaptation, validation and translation from English to Spanish.

BACKGROUND: During the COVID-19 pandemic, multiple countries have taken measures, such as isolation and quarantine, to prevent person-to-person spread of disease. These actions forced many physicians to adopt new techniques, such as telemedicine, to continue patient care, which has proven to be useful in continued care for those with non-COVID-19 pathologies. Various factors, such as security, confidentiality, cost-effectiveness, comfort, and the risk of malpractice, influence the perception of telemedicine among medical practitioners. The aim of this study was to adapt an existing instrument and validate it into a new Spanish version. The instrument is about the perceptions and knowledge of telemedicine in healthcare professionals. METHODS: The original questionnaire surveyed 6 domains with 40 questions, and each question was measured with a five-point Likert scale ranging from very high [5] to very low [1]. The survey was translated to Spanish using machine translation. The translation was reviewed independently, and then, a consensus was achieved regarding minor changes in the syntax of the survey to facilitate understanding. After expert feedback and questionnaire review, the research team members proposed reducing the instrument to 13 items in 4 domains due to the similarity of some questions. The sample was divided into 2randomly selected groups. Eligibility criteria included physicians providing private or public services with active medical/clinical practice. RESULTS: In total, 382 surveys were collected and separated into two random samples, S1 and S2 (198 and 184, respectively). In exploratory factor analysis (EFA), the 13 items were grouped into four theoretical domains, and item 7 presented cross loading between factors and was removed. Confirmatory factor analysis was performed to assess the scale reliability and interscale associations; three models were tested. Global Cronbach's alpha for internal consistency was 0.76 for the EFA. The goodness of fit measures root mean square error of approximation and comparative fit index were 0.009 and 0.999, respectively, for the best model. CONCLUSIONS: The translated instrument was clear, with adequate internal consistency, readability, and appropriate for application in the physician setting. This validated questionnaire made it possible to evaluate physicians' knowledge of telemedicine to increase its use, especially during the COVID-19 pandemic.

Psychometric Properties of the Bern Illegitimate Tasks Scale - Spanish Version.

In recent years, a new factor for work stress has been studied along with stress as an offense to self-theory. Illegitimate tasks refer to assignments that are unnecessary or are not related to the employee's role. Because of this, the Bern Illegitimate Tasks Scale was developed, which measures illegitimate tasks in terms of unreasonable tasks and unnecessary tasks. There are no studies in Latin America on illegitimate tasks, so the purpose of this research is to translate and validate the Bern Illegitimate Tasks Scale. The study was performed with a sample of nursing staff from a hospital in Guayaquil, Ecuador. Written informed consent was obtained from each of the participants. The reliability of the questionnaire was evaluated and its structural validity was verified by exploratory factor analysis and confirmatory factor analysis. The internal consistency of the whole scale, measured by Cronbach's alpha, was 0.857. Moreover, the unnecessary and unreasonable subscales measure were 0.846 and 0.841, respectively. The exploratory factor analysis supported a two-factor model that explained 73.96% of the variance. Additionally, the confirmatory factor analysis showed good indexes of fit (GFI = 0.915, CFI = 0.955, TLI = 0.933, SRMR = 0.084, and RMSEA = 0.087). The Spanish version of the Bern Illegitimate Tasks Scale presents good psychometric properties and can be applied to nurses in the Ecuadorian population.

Assessment of depression, anxiety and stress levels in the Ecuadorian general population during social isolation due to the COVID-19 outbreak: a cross-sectional study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a global pandemic with serious consequences that have led to the implementation of unprecedented social isolation measures. At the early stages of the pandemic, Ecuador was one of the most affected countries in Latin America. The objective of this study was to assess the levels of depression, anxiety and stress in the Ecuadorian general population during the social isolation period due to COVID-19. METHODS: A web-based survey consisting of 31 short-answer and multiple-choice questions was administered to the general population from April 22-May 3, 2020. Mental health status was assessed through the Depression, Anxiety and Stress Scale-21 Items (DASS-21) questionnaire. Ordinal logistic analyses were used to identify potential risk factors associated with the severity of mental health issues. RESULTS: A total of 626 individuals were included. Most of them were females (60.5%), and their mean age was 29.6 ± 11.7 years. Approximately 17.7% of the respondents had moderate to very severe levels of depression, 30.7% had similar levels of anxiety, and 14.2% experienced stress. Female sex, younger age, student status, and having a relative diagnosed with COVID-19 were associated with significantly higher levels of depression, anxiety and stress. Ordinal regression models showed that being a student was a risk factor for having more severe levels of depression (OR = 3.67; 95% CI = 2.56-5.26, p: 0.0001), anxiety (OR= 1.86; 95% CI= 1.35-2.55, p: 0.0001), and stress (OR = 2.17; 95% CI= 1.47-3.19, p: 0.0001). Having a relative with COVID-19 was also found to be a risk factor only for depression (OR= 1.70; 95% CI= 1.03-2.80, p: 0.036) and anxiety (OR = 2.17; 95% CI= 1.35-3.47, p: 0.001). Additionally, male sex,  older age, and having more children were found to be protective factors for the three conditions. CONCLUSIONS: Our findings suggest that social isolation due to the COVID-19 outbreak has impacted the mental health of the general population in Ecuador. We identified potential risk and protective factors that could serve as a foundation from which to develop psychological strategies to safeguard the mental health of our population during the current pandemic.

Relation between serum uric acid levels with the degree of coronary artery disease: A prospective study from Ecuador / Relación entre los niveles séricos de ácido úrico y el grado de enfermedad arterial coronaria: un estudio prospectivo en Ecuador

To analyze the relationship between serum levels of uric acid and the severity of coronary disease. Methods: This observational, descriptive and cross-sectional study included 77 patients previously selected using inclusion criteria, from September 2014 to May 2015. It was conducted in a third level regional hospital from Guayaquil, Ecuador. Patients enrolled in this study were older than 30 years with coronary disease undergoing coronary angiography, without prior diagnosis of any other condition that could influence in serum uric acid values. Results: (1) Direct relation between serum uric acid levels and the severity of coronary disease, with a 0.600 Spearman correlation coefficient (p < 0.001); (2) other variables such as hypertension and medical history did not have an influence on the study's results; (3) serum uric acid levels didn't show difference among the different groups (p>0.05). Conclusions: Based on the results, it was possible to conclude that there is a relation between serum uric acid level and the severity of coronary artery disease; this relation was independent of clinical diagnosis and hypertension. According to this, serum uric acid levels can be taken as a practical and inexpensive parameter related to the severity of coronary artery disease. As a primary preventive intervention, we recommend maintaining levels within normal parameters in patients with cardiovascular risk

Objetivo: Analizar la relación entre los niveles séricos de ácido úrico y la severidad de la enfermedad coronaria. Métodos: Este estudio observacional, descriptivo y transversal incluyó 77 pacientes previamente seleccionados mediante criterios de inclusión, desde septiembre de 2014 a mayo de 2015. Se realizó en un hospital regional de tercer nivel de Guayaquil, Ecuador. Los pacientes incluidos en este estudio eran mayores de treinta años, con enfermedad coronaria sometidos a angiografía coronaria, sin diagnóstico previo de ninguna otra condición que pudiera influir en los valores de ácido úrico sérico. Resultados: 1) Relación directa entre los niveles séricos de ácido úrico y la gravedad de la enfermedad coronaria, con un coeficiente de correlación de Spearman de 0.600 (p < 0.001); 2) Otras variables como la hipertensión y el historial médico no influyeron en los resultados del estudio; 3) Los niveles séricos de ácido úrico no mostraron variabilidad entre los diferentes grupos (p > 0.05). Conclusiones: de acuerdo con los resultados, fue posible concluir que existe una relación entre el nivel sérico de ácido úrico y la severidad de la enfermedad coronaria; esta relación fue independiente del diagnóstico clínico y la hipertensión. De acuerdo con esto, los niveles séricos de ácido úrico se pueden tomar como un parámetro práctico y económico relacionado con la gravedad de la enfermedad arterial coronaria. Como intervención preventiva primaria, recomendamos mantener los niveles dentro de los parámetros normales en pacientes con riesgo cardiovascular

Spanish validation endorsement of SDM-Q-9, a new approach.

BACKGROUND: The Shared Decision Making (SDM) model allows the patient to be part of their own disease treatment and control. The translation to Spanish of a questionnaire that measures the patient perception of SDM will allow enlarging the range of its application. However, the essence of the questionnaire can be altered during its translation, which could curb the appreciation of the question and what the question originally asked for. The objective of this study is to evaluate the application of SDM-Q-9 in its psychometric properties, to a Spanish speaking population after its translation process. METHOD: The questionnaire was given to 76 outpatients who attended a medical control at the hospital. The informed consent process was developed before the patient underwent the physician's evaluation, and the SDM-Q-9 was applied when the patient finished the medical evaluation. The reliability of the questionnaire was evaluated and its structural validity was verified by the exploratory factor analysis (EFA) and the confirmatory factor analysis (CFA). RESULTS: The SDM-Q-9 presented reliability and validity according to the following indicators. The internal consistency, measured by Cronbach's alpha, was 0.839 for the whole scale. The EFA showed a bi-dimensional solution, but the CFA indicated that the model with best indices of fit was the one-dimensional solution, excluding the first item. The indices used where: CFI 0.953, RMSEA (IC) 0.076 (0.000-0.134) for model 2, and CFI 0.961, RMSEA 0.071 (0.000-0.132) for model 5 are better. CONCLUSION: The questionnaire adaptation to the Latin American Spanish language has displayed reliability and validity according to the Cronbach's alpha indicators.

Relation between serum uric acid levels with the degree of coronary artery disease: A prospective study from Ecuador.

To analyze the relationship between serum levels of uric acid and the severity of coronary disease. METHODS: This observational, descriptive and cross-sectional study included 77 patients previously selected using inclusion criteria, from September 2014 to May 2015. It was conducted in a third level regional hospital from Guayaquil, Ecuador. Patients enrolled in this study were older than 30 years with coronary disease undergoing coronary angiography, without prior diagnosis of any other condition that could influence in serum uric acid values. RESULTS: (1) Direct relation between serum uric acid levels and the severity of coronary disease, with a 0.600 Spearman correlation coefficient (p<0.001); (2) other variables such as hypertension and medical history did not have an influence on the study's results; (3) serum uric acid levels didn't show difference among the different groups (p˃0.05). CONCLUSIONS: Based on the results, it was possible to conclude that there is a relation between serum uric acid level and the severity of coronary artery disease; this relation was independent of clinical diagnosis and hypertension. According to this, serum uric acid levels can be taken as a practical and inexpensive parameter related to the severity of coronary artery disease. As a primary preventive intervention, we recommend maintaining levels within normal parameters in patients with cardiovascular risk.

Spanish Validation Of The Revised Depression Attitude Questionnaire (R-DAQ).

PURPOSE: The aim of the study was to develop and validate a Spanish version of the Revised Depression Attitude Questionnaire (R-DAQ). METHODS: The R-DAQ was used as a baseline for the study. It was translated and tested to ensure the instrument was appropriate for the target population. 537 Ecuadorian healthcare professionals completed the revised Spanish version of the R-DAQ (SR-DAQ). Statistical and exploratory factor analyses were performed to examine construct validity, internal consistency, readability and floor and ceiling effects. RESULTS: Three factors were obtained: "Professional confidence in depression care"; "Therapeutic optimism about depression"; and "Generalist perspective about depression occurrence, recognition, and management". The internal consistency of the SR-DAQ was determined by means of Cronbach's α coefficient, with values ranging between 0.61-0.8. The correlations with the English version reflected adequate validity. The model explained 39% of the variance. Subsequent analysis with a sample restricted to those who had received training in depression produced a model that explained 42% of the variance. CONCLUSION: The SR-DAQ meets the psychometric requirements for measuring depression attitude in a Spanish-speaking population and shows adequate internal consistency and validity.