Aplicabilidad del reintegro ocupacional de trabajadores con síndrome post-COVID-19

ECLIPSE: a French Study Concerning the Diagnosis of Paroxysmal Nocturnal Hemoglobinuria (PNH)

To determine the major presenting features of the most frequent leukemias and to describe the period from the first symptoms to the final diagnosis, we analyzed the records of 1,004 consecutive patients with acute (AL) and chronic (CL) leukemias diagnosed between 2004 and 2009. In 24% of AL and 63% of CL, the diagnosis was made incidentally. In contrast to the frequency of the symptoms, their spectrum did not differ from historical studies, and fatigue and weakness were the most frequent symptoms observed [with the exception of acute promyelocytic leukemia (APL) where bleeding predominated]. More profound cytopenia was found in AL compared to CL. The median time from the first symptoms to final diagnosis was 3 weeks in AL and 4 weeks in CL. APL had the shortest time to a definitive diagnosis (2 weeks); however, a very short duration of symptoms was also observed in CML (3 weeks). This study is the largest series reported to date on symptoms in leukemia patients at the time of diagnosis, and the first such report that reflects on clinical practice in the new millennium.

Dear Editor, HIV infection, the same as other chronic diseases, is associated with psychiatric symptoms.[1] A profound psychological distress is made after the diagnosis of infection, and several psychiatric disorders including AIDS phobia, bereavement and grief, anxiety and depression were shown as a reaction to the infection.[2] Associating the infection to the stigmatized and illegal behaviors by the family, friends, and others, especially in the developing countries, as well as the nature of the infection that is frustrating and incurable, both affect the patients enormously.[3] A lack in investigations on the psychiatric symptomatology of HIV infection in our country, which surely affects the patient’s compliance and management process, convinced us to assess the frequency and severity of psychiatric symptoms in those living with HIV in Razavi Khorasan Province, northeast of Iran. From the 320 cases of HIV infection, documented in the Health Center of Razavi Khorasan Province, Mashhad, Iran, up to 2006, all above 15 years old with an ongoing management (n=61), were included in the study. Others were not accessible because of death, migration and non-cooperation. Demographic characteristics, clinical and laboratory findings were defined according to their management files. Symptom Checklist 90-Revised (SCL-90-R) with sensitivity and specificity of 80.9% and 92.7% in a national study,[4] was filled out by a clinical psychologist. The 90 items in the questionnaire were scored on a five-point Likert scale (0-4), indicating the rate of occurrence of the symptom during the time reference. The response rate was 82% (50/61). Respondents were 21-51 (35.9 ± 7.1) years old, 90% male, 74% married at least once, 52% unemployed, 46% with utmost 5 years education, 80% IUDs, 84% with a history of imprisonment, 30% AIDS patients, 66% HCV-Ab positive, and 12% HBs-Ag positive. The checklist-derived scores were: Overall score 145.1±61.2 (42-305); GSI (Global Severity Index, average score of the 90 items) 1.6±0.68 (0.47-3.4), PST (Positive Symptoms Total, the number of items scored above zero) 60.9±16.9 (15-90), and PSDI (Positive Symptom Distress Index, the average score of the items scored above zero) 2.3±0.53 (1.2-3.4). The GSI is suggested to be the best single indicator of the current level of the disorder. Those with a GSI above 1 were considered to have psychiatric symptoms (79.6%). With the cut-off point of 0.7, defined in another study in Iran,[8] symptom prevalence was 85.7%. Severity of psychiatric symptoms according to the GSI index was low (1-1.99) in 46.9%, moderate (2-2.99) in 30.6%, and severe (≥3) in 2% of cases. Another study in Iran showed the frequency of psychiatric symptoms as high as 93.2%, among HIV-infected individuals using SRQ-24 test.[5] Although no study was found comparing these symptoms between HIV infected individuals and general population in Iran, frequency of these symptoms seems to be considerably higher, regarding to the results of population based studies.[6] In other countries, psychiatric symptoms were also highly frequent among HIV-infected individuals.[1][7] The scores and symptom distress indices (PSDI) of each symptom and the related frequency was shown in Table 1. Except phobic anxiety with a 28 % frequency, others had a considerable frequency, ranging from 67-86%. Depression, obsessive compulsive and interpersonal sensitivity were the subscales with the highest frequency. Depression and anxiety were also the most frequent psychiatric symptoms in the other studies.[8][9] However, there is evidence that only symptomatic HIV disease, not HIV infection itself, increases the risk of major depression.[9] Table 1 Scores and symptom distress indices, and frequency of each subscale in the SCL-90-R In this study, HIV-positive cases were mostly male, middle-aged, low-educated and unemployed individuals. Low socio-economical status was reported in some studies to have significant association with psychological symptoms in HIV infection.[8] In addition, high prevalence of psychiatric disorders among prisoners and drug users has been showen in several studies. Furthermore, it was demonstrated that drug abuse could exacerbate the severity of mental distress in HIV-positive patients.[10] This could be another important factor that explains the considerable frequency of the symptoms among participants in our study with a prominent history of prison and injective drug use. The high frequency of psychiatric symptoms, shown in this study, necessitates a precise attention to this aspect of HIV infection for an effective management of the HIV positive individuals.

First evidence of a general disease ("d") factor, a common factor underlying physical and mental illness.

Children's mental health, including their well-being, is a major public health concern, as the burden of related disorders may last throughout one's life. Although epidemiological mental health surveillance systems for children and adolescents have been implemented in several countries, they are sorely lacking in France. This study aims to describe the first step of the implementation of a novel surveillance system in France called Enabee (Etude nationale sur le bien-être des enfants), which focuses on the issue of mental health in children. The system aims to (1) describe the temporal trends in the population-based prevalence of the main mental health disorders and well-being in children aged 3 to 11 years, (2) explore their major determinants, and (3) assess mental health care use by this population. To do this, Enabee will rely on results from a recurrent national cross-sectional homonymous study. This paper presents the protocol for the first edition of this study (called Enabee 2022), as well as initial results regarding participation. Enabee 2022 is a national cross-sectional study that was implemented in French schools in 2022. It used a probabilistic, multistage, stratified, and balanced sampling plan as follows: first, schools were randomly drawn and stratified according to the type of school. Up to 4 classes per school were then randomly drawn, and finally, all the pupils within each class were selected. The study covered children from preschool and kindergarten (aged 3 to 6 years, US grading system) to fifth grade (aged 6 to 11 years). Children from first to fifth grades provided a self-assessment of their mental health using 2 validated self-administered questionnaires: the Dominic Interactive (DI) and the KINDL. Parents and teachers completed a web-based questionnaire, including the Strengths and Difficulties Questionnaire. Parents also answered additional questions about their parenting attitudes; their own mental health; known social, economic, and environmental determinants of mental health in children; and their child's life habits. Health, education, and family stakeholders were involved in designing and implementing the study as part of a large consultation group. Data were collected from May 2, 2022, to July 31, 2022, in 399 schools across metropolitan France. Teachers completed questionnaires for 5721 pupils in preschool and kindergarten and for 15,263 pupils from first to fifth grades. Parents completed questionnaires for 3785 children in preschool and kindergarten and for 9227 children from first to fifth grades. Finally, 15,206 children from first to fifth grades completed the self-administered questionnaire. Enabee 2022 constitutes the first milestone in the development of a novel national epidemiological surveillance system, paving the way for improved children's mental health policies in France.

BackgroundPrevalences of multimorbidity vary between European studies and several methods and definitions are used. In this study we examine the prevalence of multimorbidity in relation to age, gender and educational attainment and the association between physical and mental health conditions and educational attainment in a Danish population.MethodsA cross-sectional design was used to study the prevalence of multimorbidity, defined as two or more chronic conditions, and of comorbid physical and mental health conditions across age groups and educational attainment levels among 1,397,173 individuals aged 16 years and older who lived in the Capital Region of Denmark on January 1st, 2012. After calculating prevalence, odds ratios for multimorbidity and mental health conditions were derived from logistic regression on gender, age, age squared, education and number of physical conditions (only for odds ratios for mental health conditions). Odds ratios for having multimorbidity and mental health conditions for each variable were adjusted for all other variables.ResultsMultimorbidity prevalence was 21.6%. Half of the population aged 65 and above had multimorbidity, and prevalence was inversely related to educational attainment: 26.9% (95% CI, 26.8–26.9) among those with lower secondary education versus 13.5% (95% CI, 13.5–13.6) among people with postgraduate education. Adjusted odds ratios for multimorbidity were 0.50 (95% CI, 0.49–0.51) for people with postgraduate education, compared to people with lower secondary education. Among all population members, 4.9% (95% CI, 4.9–4.9) had both a physical and a mental health condition, a proportion that increased to 22.6% of people with multimorbidity. Physical and mental health comorbidity was more prevalent in women (6.33%; 95% CI, 6.3–6.4) than men (3.34%; 95% CI, 3.3–3.4) and approximately 50 times more prevalent among older persons than younger ones. Physical and mental health comorbidity was also twice as prevalent among people with lower secondary education than among those with postgraduate education. The presence of a mental health condition was strongly associated with the number of physical conditions; those with five or more physical conditions had an adjusted odds ratio for a mental health condition of 3.93 (95% CI, 3.8–4.1), compared to those with no physical conditions.ConclusionMultimorbidity prevalence and patterns in the Danish population are comparable to those of other European populations. The high prevalence of mental and physical health conditions highlights the need to ensure that healthcare systems deliver care that takes physical and mental comorbidity into account. Further, the higher prevalence of multimorbidity among persons with low educational attainment emphasizes the importance of having a health care system providing care that is beneficial to all regardless of socioeconomic status.

The diagnosis of insomnia rests on self-report of difficulty initiating or maintaining sleep. However, subjective reports may be unreliable, and possibly may vary by the method of inquiry. We investigated this possibility by comparing within-individual response to direct versus indirect time queries after overnight polysomnography. We obtained self-reported sleep-wake times via morning questionnaires in 879 consecutive adult diagnostic polysomnograms. Responses were compared within subjects (direct versus indirect query) and across groups defined by apnea-hypopnea index and by self-reported insomnia symptoms in pre-sleep questionnaires. Direct queries required a time duration response, while indirect queries required clock times from which we calculated time durations. Direct and indirect queries of sleep latency were the same in only 41% of cases, and total sleep time queries matched in only 5.4%. For both latency and total sleep, the most common discrepancy involved the indirect value being larger than the direct response. The discrepancy between direct and indirect queries was not related to objective sleep metrics. The degree of discrepancy was not related to the presence of insomnia symptoms, although patients reporting insomnia symptoms showed underestimation of total sleep duration by direct response. Self-reported sleep latency and total sleep time are often internally inconsistent when comparing direct and indirect survey queries of each measure. These discrepancies represent substantive challenges to effective clinical practice, particularly when diagnosis and management depends on self-reported sleep patterns, as with insomnia. Although self-reported sleep-wake times remains fundamental to clinical practice, objective measures provide clinically relevant adjunctive information.

The interaction between income and mental health conditions for subsequent physical health conditions: a nationwide Danish cohort study from 2000 to 2021.

Symptoms of gastroesophageal reflux disease (GERD) are the primary risk factor for Barrett's esophagus (BE). However, the significance of age at symptom onset is unknown. We examined the effects of multiple dimensions of GERD exposure on BE risk and whether these associations are modified by other risk factors for BE. Data were from a cross-sectional study of 683 Veterans Affairs patients undergoing an elective esophagogastroduodenoscopy (EGD) or a study EGD concurrently with colonoscopy from primary care clinics. We compared 236 patients with both endoscopically suspected and histologically confirmed BE to 447 primary-care patients ("primary-care controls") without endoscopically suspected BE on their study EGD. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariate logistic regression. Age at onset <30 years of frequent (at least weekly) GERD symptoms was associated with highest risk of BE (OR=15.1, 95% CI 7.91-28.8), and risk increased linearly with earlier age at onset of symptoms (P-trend=0.001). This association was independent of cumulative GERD symptom duration. People with early onset GERD symptoms who reported ever using proton pump inhibitors were at especially high risk of BE (OR=31.1, 95% CI 13.9-69.7). In people with frequent GERD symptoms, BE risk was almost 80% lower among Helicobacter pylori-positive patients (OR=2.60, 95% CI 1.26-5.40) than those negative for H. pylori (OR=8.24, 95% CI 5.00-13.6). Risk of BE increased linearly with earlier age at onset of frequent GERD symptoms. Age at symptom onset may help practitioners decide which patients with GERD symptoms to refer for endoscopic screening for BE.

During the evolution of SARS-CoV-2, new genetic variants emerged that differed in virulence, infectivity, and clinical manifestations. The WHO classifies them for epidemiological monitoring as variants of concern (VOC) and variants of interest (VOI). In particular, the Delta and Omicron variants showed different frequencies of respiratory symptoms and severity of the disease. As the pandemic progressed, the number of reports of dermatological symptoms increased, which in some cases appeared earlier than the classic signs of COVID-19. Further study of skin manifestations may contribute to improving diagnostics and epidemiological surveillance. Objective — to summarize data on the nature of skin manifestations of COVID-19 and circulating variants of the SARS-CoV-2 virus, as well as to evaluate skin manifestations as potential markers for early detection of infection and their role in the epidemiological surveillance system. Materials and methods. Bibliosemantic and analytical approaches were used. The information base was publications from the scientometric databases PubMed, Scopus, and Web of Science, which included the results of meta-analyses, reviews, original studies, and clinical observations on skin manifestations of COVID-19. The search was carried out using the following keywords: «COVID-19», «SARS-CoV-2», «skin manifestation», «early symptoms», «surveillance», «rash», «cutaneous signs». Results and discussion. During the circulation of the Alpha and Beta variants, the prevalence of skin manifestations remained stable, and among them the most frequent were maculopapular, urticarial and vesicular rashes, as well as vascular-type lesions. According to reviews and case registries, some dermatological symptoms preceded respiratory ones and varied depending on the severity of the disease — feathery changes were observed in mild cases, and retiform purpura — mainly in hospitalized patients. During the Delta wave, the frequency and duration of skin manifestations, including skin burning and acral rash, were higher compared to the Omicron period, with skin burning being the most diagnostically significant symptom. Monitoring skin manifestations of COVID-19 may be a valuable tool to support diagnosis and track changes in the interaction between the virus and herd immunity. In a number of cases, skin manifestations of COVID-19, particularly in the pediatric population, were the first or only clinical signs of infection, highlighting the potential of dermatological examination as a means of early clinical detection of the disease. In conditions of limited access to in-person consultations during quarantine measures, telemedicine technologies provided effective remote diagnosis of dermatological symptoms. Integrating dermatological monitoring, including using telemedicine, into the epidemiological surveillance system may contribute to the timely detection of COVID-19 cases. Conclusions. Skin manifestations of COVID-19 may serve as additional diagnostic markers, especially in cases of limited access to testing. Their frequency and nature vary depending on the SARS-CoV-2 variant. The evolution of the virus is accompanied by a transformation of dermatological symptoms, which requires dermatologists to be aware of typical clinical patterns. The integration of dermatologists into the epidemiological surveillance system can contribute to the timely detection of cases and the containment of the spread of infection. Detection of skin signs may also improve clinical management and prognosis of COVID-19.

Prior studies have identified associations between specific health conditions and occupational impairments in the U.S. military, but little is known about the relative magnitude of impairments associated with different mental and physical health conditions among military service members. The goal of this study is to comparatively assess occupational impairment associated with mental and physical conditions among active duty military service members. Data on 11,055 U.S. active duty service members were from the Department of Defense 2015 Health Related Behaviors Survey, an anonymous online health survey. Items assessed common mental and physical health conditions. Absenteeism was assessed as number of lost work days and presenteeism was assessed as number of work days with impaired functioning in the past 30 days. This research was approved by the RAND Human Subjects Protections Committee. Back pain (23%) and anxiety (14%) were the most prevalent conditions in the sample. Mental health conditions (anxiety, depression, and PTSD) were associated with more absentee and presentee days than physical conditions. Adjusting for physical health conditions, anxiety, depression, and PTSD showed robust associations with both absenteeism and presenteeism. Common mental health conditions such as anxiety, depression, and PTSD showed robust associations with absenteeism and presenteeism among active duty U.S. military service members. Efforts to rigorously evaluate and improve existing military screening programs and reduce barriers to accessing and engaging in mental healthcare may help to reduce work absenteeism and presenteeism among active duty service members.

Background: Tobacco use disorders associated with most psychiatric and respiratory disorders smoking ultimately destroy a person's life, rehabilitation and smoke cessation program can save the person's life.Aim Of The Work: assessment of rehabilitation and smoking cessation program and to evaluate the improvement of the patients after following the rehabilitation program.Patients And Methods: This is interventional study was carried on 120 patients collected from the private psychiatric clinicsas a convenience sample selection 120 are tobacco use disorder and had psychiatric disorder.Results: After one year of actual rehabilitation and smoking cessation program show improvement in clinical picture of patients Conclusion: Smoking cessation is associated with improved quality of life compared with continuing to smoke Recomendation: strict regulation should be adopted to prevent mal usage of smoking that lead to dependence and abuse also recommend that future policies should encourage further research into adverse health effects of smoking and the benefits of rehabilitation and smoking cessation.

Social frailty, a state of vulnerability to social risk factors, has been linked to adverse physical, psychological, and cognitive outcomes. However, evidence on its role in the progression of multimorbidity across these domains is limited. This study examined social frailty in relation to transitions from a healthy state to physical, psychological, and cognitive conditions and to multimorbidity. In this multi-cohort study across 24 countries in the USA, Europe, and Asia, middle-aged and older individuals with no preexisting physical, psychological, or cognitive conditions were included. Social frailty, assessed through baseline questionnaires, was defined across four domains: general resources, social behaviors, social resources, and basic social needs. Physical, psychological, and cognitive conditions were ascertained at baseline and reassessed four times during a mean follow-up of 7years. Multi-state models and the group-based multi-trajectory model were used to examine the role of social frailty in the development of physical, psychological, and cognitive conditions and their progression to multimorbidity. Among the 7119 participants (mean age, 59.6years [SD 8.5]; 3575 [50.2%] women), 778 (10.9%) were socially frail at baseline. During 49,648 person-years at risk, 2981 (41.9%) individuals progressed from a healthy state to one physical, psychological, or cognitive condition, and 1592 (22.4%) progressed to multimorbidity. Compared with socially robust participants, those with social frailty had a higher risk of progressing to any of these conditions (hazard ratio, 1.30; 95% CI, 1.17-1.44) and to multimorbidity (2.10, 1.67-2.65). Four outcome trajectories were identified, including "stably no physical, psychological or cognitive conditions" (48.0%), "increased physical conditions" (16.4%), "increased physical and psychological conditions" (8.7%), and "increased physical and cognitive conditions" (26.9%). Social frailty was associated with more than a twofold increase in risk for the latter three trajectories (odds ratios 2.34, 1.76-3.09, 2.27, 1.63-3.15 and 2.69, 2.11-3.44, respectively). The strongest associations were observed for frailty in the domains of general resources and basic social needs. Social frailty is associated with faster transitions from a healthy state to physical, psychological, and cognitive conditions and further progression to multimorbidity. Early identification and interventions to address social frailty may help improve health in middle-aged and older adults.

Mental and physical health conditions are a major topic of concern in autistic adults, but studies rarely consider their overlap. Therefore, this study assessed physical health conditions and mental health conditions in autistic adults in the Netherlands and potential associations between them. Using questionnaires, we compared autistic (n = 327) and non-autistic (n = 274) adults (30–90 years) on mental health conditions, physical health conditions, and health-related quality of life. Autistic adults reported lower health-related quality of life than non-autistic adults. Logistic regressions indicated significantly higher rates of all mental health conditions reported by autistic adults, most common being mood (45%), anxiety (22%), and personality disorders (21%), with odds ratios ranging from six to 34. Regarding physical health conditions, autistic adults reported significantly higher rates of bowel conditions (27%), allergies (48%), and hypothyroid conditions (6%), with odds ratios ranging from two to four. Psychometric network analysis of autism and the most frequently occurring mental health conditions and physical health conditions highlighted autism as a central node, followed by mood and personality disorders, bowel and respiratory conditions, and allergies. Mental health conditions were tightly clustered, indicating high comorbidity. While no single condition connected physical and mental health in particular, we found several links between the two. These findings emphasize the need for improved healthcare and broader societal changes to enhance the well-being of autistic individuals.Lay Autistic adults often face a range of physical and mental health conditions, but the relationship between these two types of health issues is not well understood. Our study looked at how often physical and mental health conditions in autistic adults occurred. We also studied the connections between these conditions, using a method called psychometric network analysis. We surveyed 327 autistic and 274 non-autistic adults, aged 30–90 years, about potential health conditions they faced and the perception of the quality of their health, also known as health-related quality of life. We found that autistic adults had a lower health-related quality of life and reported higher rates of all mental health conditions. Mood (45%), anxiety (22%), and personality disorders (21%) were most common. Autistic adults were between six and 34 times more likely to have these mental health conditions compared to non-autistic adults. In terms of physical health, autistic adults reported higher rates of bowel conditions (27%), allergies (48%), hypothyroid conditions (6%), and less robustly of strokes (CVA/TIAs; 3%), and rheumatic conditions (31%)— and a two- to four-times higher risk than non-autistic adults. Using psychometric network analysis, we found that mental health conditions in autistic adults are closely linked, showing how complex their health challenges are. While there was no single condition that connected physical and mental health in particular, we found several links between the two. These findings emphasize the need for improved healthcare and broader societal changes to enhance the well-being of autistic individuals.

Mental Disorders and Service Use Among Welfare and Disability Program Participants in Fee-for-Service Medicaid