Impact of the COVID-19 pandemic on the mental health of the general population and health care workers.

The Health Sciences Foundation has assembled a multidisciplinary group around a series of questions about the impact of the COVID-19 pandemic on the mental health of the general population and specific groups within that population, particularly healthcare workers. In the general population, the most prevalent mental disorders have been anxiety, sleep disorders and affective disorders, primarily depression. There has been a considerable increase in suicidal behavior, especially in young women and men over 70 years of age. There has been an increase in alcohol abuse and nicotine, cannabis and cocaine use. In contrast, the use of synthetic stimulants during periods of confinement has decreased. With regard to non-substance addictions, gambling was very limited, pornography consumption increased significantly and there was an increase in compulsive shopping and the use of video games. Particularly vulnerable groups include adolescents and patients with autism spectrum disorders. Healthcare workers suffered an increase in depression, anxiety and post-traumatic stress, especially those who were exposed during the early stages of the pandemic. Female sex, being a nurse, proximity to patients with COVID-19, working in a rural environment and having previous psychiatric or organic illnesses were some of the most frequently repeated factors in various studies in this population group. The media have shown a good degree of knowledge about these problems and have dealt with them frequently and from the point of view of ethics, crisis situations, such as the one experienced, have triggered not only physical but also moral claudications.

Identification of components of health complexity on internal medicine units by means of the INTERMED method.

BACKGROUND: The INTERMED was developed for the early identification of biological, psychological, social and health system factors considered interacting in health complexity. This is defined as the interference with the achievement of expected or desired health and service use outcomes when patients are exposed to standard care. OBJECTIVE: The aim of this study was to test the INTERMED's ability to identify 'case' and 'care' complexity, identifying patients that would especially benefit from integrated care. METHODS: Observational longitudinal study of Internal medicine in patients in two National Health System hospitals in Spain using the INTERMED (patients scoring ≥ 21 were considered to be 'complex'); the Cumulative Illness Rating Scale (CIRS), a severity of illness assessment; and standard clinical variables. RESULTS: Six hundred and fifteen consecutives were included, and the prevalence of health complexity was 27.6%. The greatest differences between patients with and without health complexity were observed in the non-biological domains. Eighty-five per cent of patients with health complexity had non-biological items considered to require timely (immediately or soon) assistance or intervention compared to 30% of those without, nearly a threefold difference. Complex patients had a significantly higher number of medical diagnoses (p = 0.002) and number of psychiatric referrals (p = 0.041), but there were no differences in CIRS scores or lengths of stay. CONCLUSION: The INTERMED has the potential to identify a considerable subset of complex internal medicine inpatients for which timely corrective action related to non-biological risk factors not typically uncovered during standard medical evaluations would be considered beneficial.

High frequency of childhood ADHD history in women with fibromyalgia.

Fibromyalgia and ADHD share some clinical features, and a reduced dopamine function has been proposed for both disorders. Here we found, in a large sample of fibromyalgia female patients, a higher frequency of childhood ADHD antecedent when compared with healthy women. Our data suggest that Fibromyalgia and ADHD have some common etiopathological mechanism.

[Mortality in a cohort of intravenous drug users before the introduction of potent HIV therapy]. / Mortalidad en una cohorte de usuarios de drogas por vía intravenosa antes de la introducción de la terapia VIH potente.

BACKGROUND: The HIV/AIDS epidemics has contributed to an excess of morbidity and mortality in injecting drug users. The main goal of this study is to estimate incidence and factors associated with mortality from different causes among intravenous drug users. SUBJECTS AND METHODS: Prospective study of patients admitted to a detoxification unit between 1987 and 1990. At baseline they underwent interviews (drug injecting patterns) and venipuncture for HIV and other parameters including T-cell subsets. Viral status was determined for those who returned at least once. Cumulative incidence, overall and cause-specific mortality rates were calculated according to gender, HIV at admission and length of injecting drugs. RESULTS: 420 patients (334 men, 86 women), 69.6% HIV+, were admitted to treatment; the mean age of participants was 26 years and the mean duration of injecting drugs was 73 months. Three hundred and eighty seven patients were followed-up (92% of the initial cohort) for 2,029 persons-years and 101 deaths occurred. The overall mortality rate was 50/1000 persons-year (52/1000 for men and 40/1000 for women). The relative risk (RR) for death among women compared with men was 1.3 (95% CI = 0.8-2.2). The mortality rates for HIV+ was 60/1000 persons-year and 29/1000 persons-year for the seronegatives (RR: 2.1; 95% CI = 1.2-3.4). The HIV+ patients with CD4/microliter < or = 500 showed a threefold increase in mortality rates compared to HIV+ patients without immunosuppression (CI = 1.7-5.3). The cause-specific mortality rates were 27/1000 persons-year for HIV/AIDS, 15/1000 persons-year for drug overdose, 3/1000 persons-year for violence/trauma and 1/1000 persons-year for non-AIDS conditions. CONCLUSIONS: In this hospital cohort, HIV/AIDS and overdose have had a marked effect on mortality among intravenous drug users. Detoxification units may provide clinical services and extensive use of antiretroviral treatment for HIV infected drug users as a strategy to reduce the risk of death from AIDS.

[Rates of human immunodeficiency virus (HIV) infection in intravenous drug addicts from the Barcelona area, according to sex and age of drug consumption onset]. / Tasas de infección por el virus de la inmunodeficiencia humana (VIH) en drogadictos intravenosos del área de Barcelona, según sexo y edad de inicio en el consumo.

BACKGROUND: The differences in the rates of HIV infection in intravenous drug addicts according to the age of onset of drug consumption, sex and length of intake were evaluated. METHODS: The study sample was made up of 650 intravenous drug addicts (535 males and 115 females) admitted to a Hospital Detoxication Unit over 7 years (1987-1993). Of all these patients HIV serology and a questionnaire related to sociodemographic variables and drug consumption (age, sex, year of onset of intravenous drug intake, length of addiction and year of admission) were obtained. RESULTS: The rate of HIV infection for any length of addiction was higher in females than in males with this difference being significant for a length of addiction of less than 24 months (p = 0.03). The greater the age of onset in the use of intravenous drugs the lower the rate of HIV infection (p < 0.0001). In addiction times of less than 24 months the subjects who began drug consumption at an earlier age than the mean (19 years) presented significantly higher HIV infection rates (p = 0.04). CONCLUSIONS: Among the intravenous drug consumers in the area of Barcelona, Spain subgroups may be found: those who enter the consumption of intravenous drugs early and women, demonstrating high rates of HIV seroprevalence from the onset of their addiction.