Factors Associated With Poor Sleep Quality Among Primary Healthcare Workers During the SARS-CoV-2 Pandemic.

INTRODUCTION: Sleep is one of the most important activities for health and the processes related to the central nervous system. Healthcare workers commonly present alterations in the sleep-wake cycle due to complex work schedules because 24-hour attention to the population is required in public health institutions. The increase in care needs caused by the COVID-19 pandemic caused changes in work schedules; as in Mexico, the number of patients requiring consultation in all public health units increased. Chronic partial sleep deprivation (< 7 hours of sleep in the 24-hour cycle) is the most frequent sleep alteration in Mexican health workers. However, it has not been explored whether work modifications due to the pandemic had an impact on the sleep quality of workers. OBJECTIVE: We aimed to describe the prevalence of poor sleep quality and the associated factors in workers (clinical and non-clinical) of a primary care medical unit. MATERIAL AND METHODS: We conducted an analytical and cross-sectional study during November and December 2022. We used the following tools for studying clinical and non-clinical staff working at a family medicine primary care unit: Pittsburgh Sleep Quality Index, Hamilton Anxiety Scale, Beck Depression Inventory, Maslach Burnout Inventory, and Graffar-Méndez-Castellanos socioeconomic level scale, as well as a data collection sheet and a survey of workers' knowledge, attitudes, fears, and needs regarding COVID-19. RESULTS: A total of 233 workers were surveyed. The prevalence of poor sleep quality was 56.7%. A higher score on the Beck Depression Inventory (OR: 1.21, CI 95%: 1.13-1.29), being a doctor (OR: 3.48, CI 95%: 1.5-8.01), and frequent alcohol consumption (OR: 2.4, CI 95%: 1.13-5.2) were identified as risk factors for poor sleep quality. A lower score in the depersonalization dimension of the Maslach Burnout Inventory (OR: 0.5, CI 95%: 0.26-0.99) was identified as a protective factor for poor sleep quality. CONCLUSIONS: During the pandemic, the stress of health workers increased due to work alterations that were necessary to treat the greatest number of patients, so their quality of sleep decreased. Unfortunately, the mental health of healthcare workers is often under-assessed in many institutions. Thus, it is relevant to identify risk factors for alterations (especially those of sleep), since by identifying the target population, comprehensive interventions can be carried out, which can reduce the prevalence of burnout, anxiety, and depression, but if not addressed, the alterations can lead to inadequate care for users of health units.

Mental Disorders Among Healthcare Workers During the Coronavirus Pandemic.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a disease that has become a regular part of care by health services. In the beginning, health services faced immense pressure due to new disease exposure, irregular schedules, and high work stress for healthcare workers. Unfortunately, their mental health was not adequately safeguarded, and there are few healthcare units that screen staff for depression and anxiety. OBJECTIVE: The objective of this study is to describe the prevalence and factors associated with anxiety and depression diagnoses among healthcare workers during the coronavirus pandemic. MATERIALS AND METHODS: A cross-sectional study was conducted in which depression (Beck questionnaire) and anxiety (Hamilton questionnaire) were investigated in health staff, after providing informed consent. This study was carried out during November and December 2022. All workers in all areas of a first-level unit were invited to participate in this research, so no sample calculation or sampling technique was required. Statistical analysis was performed using X2 and Student's t-test. RESULTS: Among the 232 workers surveyed, the prevalence of mild anxiety, severe anxiety, and certain levels of depression was 42.1%, 33.5%, and 18.9%, respectively. The study revealed that smoking is associated with a higher risk of anxiety diagnosis (OR=4; CI95%=1.3-12.7). A higher score on the Hamilton Anxiety Scale (OR=1.07; CI95%=1.04-1.11) as well as not being permanent staff (OR=3.34; CI95%=1.2-9.3) was found associated with depression diagnosis. CONCLUSION: The SARS-CoV-2 pandemic increased the stress and pressure on healthcare workers. Thus, early detection, timely treatment, and effective prevention measures are necessary for safeguarding health status and the provision of healthcare services.

Calidad en la atención del servicio de odontología en población sin seguridad social / Quality of Dental Services in People with no Social Security

Resumen Objetivo: Evaluar la calidad de la atención odontológica en población sin seguridad social, en unidades de atención primaria. Material y métodos: Estudio observacional, descriptivo, exploratorio y transversal que evaluó la calidad de la atención a través de la estructura, los procesos y resultados, incluyó la revisión de 86 expedientes clínicos, siete consultorios, 168 usuarios y 43 odontólogos, los instrumentos utilizados fueron tres listas de cotejo y un cuestionario. Resultados: El índice total de la calidad fue de 69.73%, para las dimensiones de estructura, proceso y resultado fue de 72.9%, 54.61% y 81.6% respectivamente. Hay carencias de insumos, instrumental, déficit de unidades dentales y excedente de odontólogos, e incumplimiento técnico- normativo. Conclusiones: La evaluación integral de la calidad en la atención odontológica a través de medir la estructura, los procesos y resultados, permite identificar áreas de oportunidad y tomar decisiones basadas en evidencias científicas.

Abstract Objective: Assess the quality of dental care among population with no social security treated in primary care units. Material and methods: An observational, descriptive, exploratory, and cross-sectional study was conducted to assess, through structure, process and results. Also, 86 clinical records, seven (7) medical offices, 168 users and 43 dentists were reviewed. Three checklists and a questionnaire were the tools used. Results: The total quality index was that of 69.73, while for structure, process and the result was 72.9%, 54.61 and 81.6 respectively. There is a lack of supplies, instruments, dental units and surplus of dentists, as well as technical and regulatory non-compliance. Conclusions: Comprehensive evaluation of quality of dental care through measuring the structure, processes, and results, enables to identify areas of opportunity and scientific evidence-based decision making.

Evaluation of Anomalies and Neurodevelopment in Children Exposed to ZIKV during Pregnancy.

Zika virus (ZIKV) infection in pregnancy is associated with birth and developmental alterations in infants. In this study, clinical records of 47 infants whose mothers had Zika during pregnancy or clinical manifestations compatible with Zika were reviewed. A description of the infants' anomalies was established, and a neurodevelopmental assessment was performed on 18 infants, using the Evaluation of Infant Development (EDI for its initialism in Spanish) and DDST-II (Denver Developmental Screening Test II) tests. From his sample, 74.5% of the infants evaluated had major anomalies and 51.9% had minor anomalies. The incidence of major anomalies, related to trimester of pregnancy, was 84.2% for the first trimester, 77.8% for the second trimester, and 37.5% in the third trimester. A similar trend was observed in the frequency of infants without anomalies and was less evident in the incidence of minor anomalies (p = 0.016). Through neurodevelopmental assessments, EDI identified 27.8% of infants as having normal development, while 55.5% of affected infants had developmental delay, and 16.7% were at risk for developmental delay. The DDSST-II showed that 77.7% infants had delay in the gross motor and language area, 88.8% in the fine-adaptative motor area, and 72.2% in the personal-social area. In this work, children of mothers with ZIKV infection during pregnancy may have major or minor anomalies regardless of the trimester of pregnancy in which the infection occurred. The neurodevelopmental assessment shows that ZIKV can cause a developmental delay in infants with the fine-adaptative motor area being the most affected.

Place of residence and social marginalization as prognostic factors for prostate cancer survival in Veracruz, Mexico. / Lugar de residencia y grado de marginación como factores pronóstico de supervivencia al cáncer de próstata en Veracruz, México.

OBJECTIVES: To determine if the place of residence and the level of social marginalization are associated with prostate cancer survival. MATERIALS AND METHODS: All patients diagnosed with prostate cancer (PC) in the period from 2013 to 2017 in a tertiary healthcare hospital in Veracruz, Mexico were included. Patients resided in rural and urban areas. Variables were collected according to clinical-epidemiological and histopathological characteristics. The Kaplan Meier method and the Log Rank test were used to measure survival. Prognostic factors were determined by calculating the adjusted hazard ratio (HRa) in a multivariate analysis using the Cox proportional risk method. RESULTS: A total of 186 PC cases were analyzed. Overall, after 5 years, 48.3% of the patients survived. Men living in urban areas had a higher probability of survival than those living in rural areas (HRa 1.67, 95% CI 1.16-2.41). Similarly, people living in areas classified as low- marginalization zones had a higher probability of survival than those living in areas with a high level of social marginalization (HRa 2.32, 95% CI 1.47-3.66). CONCLUSIONS: To reside in a rural place was identified as a negative prognostic factor for the survival of patients with PC regardless of other sociodemographic and clinical variables; patients living in high-marginalization places had an unfavorable survival prognosis.

OBJETIVOS: Determinar si el lugar de residencia y el grado de marginación se encuentran asociados a la supervivencia al cáncer de próstata. MATERIALES Y MÉTODOS: Se incluyeron a todos los pacientes diagnosticados con cáncer de próstata (CP) en el periodo 2013-2017 en un hospital de tercer nivel de atención de Veracruz, México. Los casos expuestos fueron los pacientes que habitualmente residían en zonas rurales, los no expuestos fueron los de zonas urbanas. Se recolectaron variables según características clínico epidemiológicas e histopatológicas. Para medir la supervivencia se utilizó el método de Kaplan Meier y la prueba de Log Rank. Los factores pronósticos fueron determinados calculando hazard ratio ajustado (HRa) en un análisis multivariado mediante el método de riesgos proporcionales de Cox. RESULTADOS: Se analizaron 186 casos de CP. La supervivencia global a 5 años fue de 48,3%. Los hombres que residían en zonas urbanas tuvieron una probabilidad de supervivencia mayor que quienes residían en zonas rurales (HRa 1,67; IC 95%: 1,16-2,41). Asimismo, las personas que vivían en lugares catalogados como zonas de baja marginación tuvieron una mayor probabilidad de supervivencia que quienes vivían en zonas de alta marginación (HRa 2,32; IC 95%: 1,47-3,66). CONCLUSIONES: El lugar de residencia rural se identificó como un factor de mal pronóstico para la supervivencia de pacientes con CP independientemente de otras variables sociodemográficas y clínicas; los pacientes que vivían en lugares con grados de marginación más elevados tuvieron un pronóstico desfavorable de supervivencia.

Lugar de residencia y grado de marginación como factores pronóstico de supervivencia al cáncer de próstata en Veracruz, México / Place of residence and social marginalization as prognostic factors for prostate cancer survival in Veracruz, Mexico

Resumen Objetivos: Determinar si el lugar de residencia y el grado de marginación se encuentran asociados a la supervivencia al cáncer de próstata. Materiales y métodos: Se incluyeron a todos los pacientes diagnosticados con cáncer de próstata (CP) en el periodo 2013-2017 en un hospital de tercer nivel de atención de Veracruz, México. Los casos expuestos fueron los pacientes que habitualmente residían en zonas rurales, los no expuestos fueron los de zonas urbanas. Se recolectaron variables según características clínico epidemiológicas e histopatológicas. Para medir la supervivencia se utilizó el método de Kaplan Meier y la prueba de Log Rank. Los factores pronósticos fueron determinados calculando hazard ratio ajustado (HRa) en un análisis multivariado mediante el método de riesgos proporcionales de Cox. Resultados: Se analizaron 186 casos de CP. La supervivencia global a 5 años fue de 48,3%. Los hombres que residían en zonas urbanas tuvieron una probabilidad de supervivencia mayor que quienes residían en zonas rurales (HRa 1,67; IC 95%: 1,16-2,41). Asimismo, las personas que vivían en lugares catalogados como zonas de baja marginación tuvieron una mayor probabilidad de supervivencia que quienes vivían en zonas de alta marginación (HRa 2,32; IC 95%: 1,47-3,66). Conclusiones: El lugar de residencia rural se identificó como un factor de mal pronóstico para la supervivencia de pacientes con CP independientemente de otras variables sociodemográficas y clínicas; los pacientes que vivían en lugares con grados de marginación más elevados tuvieron un pronóstico desfavorable de supervivencia.

ABSTRACT Objectives: To determine if the place of residence and the level of social marginalization are associated with prostate cancer survival. Materials and methods: All patients diagnosed with prostate cancer (PC) in the period from 2013 to 2017 in a tertiary healthcare hospital in Veracruz, Mexico were included. Patients resided in rural and urban areas. Variables were collected according to clinical-epidemiological and histopathological characteristics. The Kaplan Meier method and the Log Rank test were used to measure survival. Prognostic factors were determined by calculating the adjusted hazard ratio (HRa) in a multivariate analysis using the Cox proportional risk method. Results: A total of 186 PC cases were analyzed. Overall, after 5 years, 48.3% of the patients survived. Men living in urban areas had a higher probability of survival than those living in rural areas (HRa 1.67, 95% CI 1.16-2.41). Similarly, people living in areas classified as low- marginalization zones had a higher probability of survival than those living in areas with a high level of social marginalization (HRa 2.32, 95% CI 1.47-3.66). Conclusions: To reside in a rural place was identified as a negative prognostic factor for the survival of patients with PC regardless of other sociodemographic and clinical variables; patients living in high-marginalization places had an unfavorable survival prognosis.