Efecto de la capacidad visoespacial en el rendimiento académico de estudiantes de anatomía médica

Visuospatial ability is associated with clinical skills in medical education, as it predicts the academic performance of anatomy students. Objective: To determine whether visuospatial processing generates changes in the teaching of medical anatomy and predicts academic performance in that subject. Methods: 140 students were evaluated at the beginning of the semester and before final exams with the Rey Complex Figure Test (CRFT).  Student's t-tests were performed to contrast pre- and post-test differences, Cohen's d to measure effect size, and linear regression to evaluate prediction with final grades. Results: Mean age 20.22 years (SD=1.12), mean grade point average 4.96 (SD=1.20). Seventy percent of the students passed the course. The t-test reports significant differences of TFCR (Memory recall: t=-17.383; p<0.001; Delayed recall: t=-16.547, p<0.001) with a medium effect size (d=0.59 and d=0.56), respectively. The scores obtained in the post-test on the TFCR deferred recall task explained up to 90% of the students' academic performance. Conclusions: The instrument's deferred memory predicted academic performance and anatomy learning improved students' visuospatial function performance.La capacidad visoespacial se asocia con habilidades clínicas en la educación médica, ya que predice el desempeño académico de los estudiantes de anatomía. Objetivo: Determinar si el procesamiento visoespacial genera cambios en la enseñanza de la anatomía médica y predice el desempeño académico en esa asignatura. Método: 140 estudiantes evaluados al inicio de semestre y antes de exámenes finales con el Test de la Figura Compleja de Rey.  Se realizaron análisis t de Student para contrastar las diferencias pre y pos-test, d de Cohen para medir el tamaño de efecto y regresión lineal para evaluar la predicción con las notas finales. Resultados: Edad promedio 20.22 años (DE=1.12), media de calificaciones 4.96 (DE=1.20). El 70% de los estudiantes aprobó la asignatura. La prueba t reporta diferencias significativas del TFCR (Evocación de Memoria: t=-17.383; p<0.001; Evocación diferida: t=-16.547, p<0.001) con un tamaño del efecto mediano (d=0.59 y d=0.56), respectivamente. Las puntuaciones obtenidas en el post-test en la tarea de memoria diferida del TFCR, explicaron hasta en un 90% el desempeño académico de los estudiantes. Conclusiones: La memoria diferida del instrumento predijo el rendimiento académico y el aprendizaje de anatomía mejoró el desempeño en la función visoespacial de los estudiantes

Effectiveness of deep brain stimulation on refractory aggression in pediatric patients with autism and severe intellectual disability: meta-analytic review

Some patients with autism and severe intellectual disability may experience uncontrolled aggression, causing serious injury or harm to others, and the therapeutic ineffectiveness of traditional pharmacological and behavioral treatment may aggravate symptoms. Deep brain stimulation (DBS) has been tested in patients with little evidence in children and adolescents. Therefore, we analyzed the efficacy and safety of DBS in refractory aggression in pediatric subjects with autism (ASD) and severe intelligence deficit (ID).Methods A meta-analytic review of Web of Science (WOS) and Scopus articles, following Prisma criteria. A total of 555 articles were identified, but after applying the inclusion criteria, only 18 were analyzed. The review of the registries and the extraction of information was performed by 2 independent groups, to reduce the evaluator's bias. For the description of the results, pediatric patients with ASD or ID present in each registry, with an application of specialized scales (Overt aggression scale, OAS, and THE modified version of the OAS, MOAS) pre and post-DBS, with a clinical follow-up of at least 12 months, were considered valid. Clinical improvement was calculated using tests of aggressiveness. In each registry with available data and then pooling the means of all patients in the OAS and MOAS, the effect size of DBS (overall and per study) was estimated. Finally, the adapted NOS scale was applied to rate the studies' quality and level of bias.Results In the studies analyzed, 65/100 were pediatric patients, with a mean age of 16.8 years. Most of the studies were conducted in South America and Europe. In all teams, aggressive behavior was intractable, but only 9 groups (53/65) applied specialized scales to measure aggressiveness, and of these, only 51 subjects had a follow-up of at least 12 months. Thus, in 48/51 a clinical improvement of patients was estimated (94.2%), with a considerable overall effect size (OAS: d = 4.32; MOAS: d = 1.46). However, adverse effects and complications were found in 13/65 subjects undergoing DBS. The brain target with the most evidence and the fewest side effects was the posteromedial hypothalamic nuclei (pHypN). Finally, applying the adapted NOS scale, quality, and bias, only 9 studies show the best indicators.Conclusion An optimal level of efficacy was found in only half of the publications. This is mainly due to design errors and irrelevant information in the reports. We believe that DBS in intractable aggressiveness in children and adolescents with ASD and severe ID can be safe and effective if working groups apply rigorous criteria for patient selection, interdisciplinary assessments, objective scales for aggressiveness, and known surgical targets

Prevalence and factors associated with subjective cognitive complaints in Latin American health workers during the COVID-19 pandemic

Introducción y objetivos: Se ha observado un incremento de alteraciones emocionales y quejas sobre el rendimiento cognitivo en el personal sanitario latinoamericano durante la pandemia de SARS-CoV-2; lo cual puede afectar a las capacidades de atención y aumentar los niveles de estrés y burnout de estos profesionales. El objetivo es analizar las quejas cognitivas subjetivas (QCS) y los factores asociados en el personal sanitario durante la pandemia de COVID-19 en 5 países de América Latina. Métodos: Estudio transversal multicéntrico que incluyó a 3.738 profesionales de Colombia, Chile, Argentina, Ecuador, Bolivia y Perú. Se utilizó la Escala de Trastorno de Ansiedad Generalizada (GAD-7) y el Patient Health Questionnaire (PHQ-9) para valorar la depresión y el Mini-Z para evaluar el burnout. Para las QCS se usó un ítem sobre preocupaciones cognitivas en atención y memoria. Resultados: Se observó una prevalencia de queja cognitiva del 69,2%. Los factores asociados con un mayor riesgo de QCS fueron las puntuaciones en GAD-7, PHQ y Mini-Z, además de ser parte del personal de salud del Ecuador. Conclusiones: La prevalencia de QCS en el personal sanitario es alta y está modulada por estados emocionales y estrés.Background and objectives: An increase in emotional disturbances and complaints about cognitive performance has been observed in Latin American healthcare workers during the SARS-CoV-2 pandemic, which can affect attention capacity and increase the levels of stress and burnout of these professionals. The objective was to analyse subjective cognitive complaints (SCC) and associated factors in health personnel during the COVID-19 pandemic in five Latin American countries. Methods: Multicentre cross-sectional study, which included 3,738 professionals from Colombia, Chile, Argentina, Ecuador, Bolivia, and Peru. The Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9) was used to assess depression, and the Mini-Z to assess Burnout. For the SCC, an item on cognitive concerns in attention and memory was used. Results: The prevalence of cognitive complaints was 69.2%. The factors associated with a higher risk of SCC were the scores in the GAD-7, PHQ and Mini-Z, in addition to being part of the Ecuadorian health personnel. Conclusions: There is a high prevalence of SCC in health personnel, which is modulated by emotional states and stress

Psychological Impact of COVID-19 on Health Workers During the Second Year of the Pandemic in Latin America: Cross-Sectional Survey Study

Objetivo: Estimar la prevalencia de las alteraciones psicológicas y los factores de riesgo asociados a la salud mental en el personal de salud de LA, durante el segundo ano˜ de pandemia del COVID-19. Método: Estudio transversal multicéntrico que incluyó una muestra total de 5.437 profesionales de la salud de Argentina, Bolivia, Chile, Colombia, Ecuador y Perú. Se utilizó el PHQ-9, el GAD-7 junto a un cuestionario demográfico breve. Se estimó la prevalencia de ansiedad y depresión a partir de los puntos de corte de los instrumentos. Se realizaron 2 regresiones logísticas multivariantes. Resultados: Se encontró una carga poblacional de ansiedad del 40,1% y de depresión del 62,2% en el personal sanitario de LA. En los profesionales de Argentina (OR = 1,374; p < 0,001), quienes trabajan en hospitales estatales (OR = 1,536; p < 0,003), de primera línea de atención de pacientes con COVID (OR = 1,848; p < 0,001), en los médicos generales (OR = 1,335; p < 0,001), especialistas (OR = 1,298; p < 0,001), se observó un mayor riesgo de sufrir trastornos mentales. A su vez, en las mujeres, el personal más joven y en los administrativos se identificó una mayor probabilidad para sufrir ansiedad y depresión. Conclusiones: La carga de trastornos mentales en el personal de salud de LA es alarmante. Es necesario servicios de apoyo psicológico, orientados a proporcionar medidas para que los profesionales desarrollen mecanismos de afrontamiento saludables que mitiguen el impacto de la pandemia en su bienestar, y faciliten el ajuste posterior a la crisis sanitaria.Introduction: The coronavirus pandemic continues to affect the mental health of healthcare personnel in Latin America (LA). Objective: To estimate the prevalence of psychological disturbances and associated risk factors for mental health in healthcare personnel in LA during the second year ofthe COVID19 pandemic. Method: This multicenter cross-sectional study included a total sample of 5437 healthcare professionals from Argentina, Bolivia, Chile, Colombia, Ecuador, and Peru. The PHQ-9, GAD-7, and a brief demographic questionnaire were used. The prevalence of anxiety and depression was estimated based on the cut-off points of the instruments. Two multivariate logistic regressions were performed. Results: A population burden of anxiety (40.1%) and depression (62.2%) was found in healthcare personnel in LA. Among professionals in Argentina (OR = 1.374; P<.001), those working in state hospitals (OR = 1.536; P<.003), frontline healthcare workers for COVID patients (OR = 1.848; P<.001), general practitioners (OR = 1.335; P<.001), and specialists (OR = 1.298; P<.001), a higher risk of experiencing mental disorders was observed. Among women, younger personnel, and administrative staff, a higher probability of experiencing anxiety and depression was identified. Conclusions: The burden of mental disorders on healthcare personnel in Latin America is alarming. Psychological support services are necessary, aimed at providing measures for professionals to develop healthy coping mechanisms that mitigate the impact of the pandemic on their well-being and facilitate post-crisis adjustment.Fil: Caldichoury, Nicole. Universidad de Los Lagos; ChileFil: García-Roncallo, Paola. Universidad de la Costa.; ColombiaFil: Saldías, Carol. Universidad San Sebastián; ChileFil: Zurita, Boris. Hospital de Omni; EcuadorFil: Castellanos, Cesar. Universidad de la Costa.; ColombiaFil: Herrera Pino, Jorge. University of Florida; Estados UnidosFil: Soto Añari, Marcio. Universidad Católica San Pablo; PerúFil: Porto, María F.. Universidad de Barcelona; EspañaFil: Quispe Rodríguez, Indalecio. Universidad Nacional de San Cristóbal Huamanga; PerúFil: Florez, Yuliana. Universidad de la Costa; ColombiaFil: Castillo Tamara, Edgar. Universidad del Sinú; ColombiaFil: Díaz, Maria Cecilia. Universidad del Sinú; ColombiaFil: Coronado López, Juancarlos. Universidad Católica de Temuco; ChileFil: Gaitan Quintero, Gustavo. No especifíca;Fil: Pabón Moreno, Alexander. Universidad Industrial Santander; ColombiaFil: Ocampo Barba, Ninoska. Universidad Autónoma Gabriel René Moreno.; BoliviaFil: Martínez Pérez, Juan. Universidad Ana G. Méndez; Puerto RicoFil: Gargiulo, Pascual Angel. Universidad Nacional de Cuyo; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza; ArgentinaFil: Quispe Ayala, Cesar. Universidad Nacional de Huancavelica; PerúFil: Camposano Córdova, Alvaro. Universidad Nacional de Huancavelica; PerúFil: Escorcia Villarreal, Jahaira. Universidad de la Costa; ColombiaFil: Ripoll Cordoba, Daniela. Universidad de la Costa; ColombiaFil: Camargo, Loida. Universidad de Cartagena; ColombiaFil: López, Norman. Universidad de la Costa; Colombi