195 results
Periods of low renal perfusion pressure are associated with acute kidney injury following paediatric cardiac surgery
- Jamie S. Penk, Katja M. Gist, Matthew Barhight, Karl Migally, Santiago Borasino, Wendy F. Torres, Siyuan Dong, Bradley S. Marino, Catherine D. Krawczeski
-
- Journal:
- Cardiology in the Young , First View
- Published online by Cambridge University Press:
- 16 May 2024, pp. 1-6
-
- Article
- Export citation
-
Introduction:
Acute kidney injury is associated with worse outcomes after cardiac surgery. The haemodynamic goals to ameliorate kidney injury are not clear. Low post-operative renal perfusion pressure has been associated with acute kidney injury in adults. Inadequate oxygen delivery may also cause kidney injury. This study evaluates pressure and oximetric haemodynamics after paediatric cardiac surgery and their association with acute kidney injury.
Materials and Methods:Retrospective case–control study at a children’s hospital. Patients were < 6 months of age who underwent a Society of Thoracic Surgery-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery categories ≥ 3. Low renal perfusion pressure was time and depth below several tested thresholds. The primary outcome was serum creatine-defined acute kidney injury in the first 7 days.
Results:Sixty-six patients (median age 8 days) were included. Acute kidney injury occurred in 36%. The time and depth of renal perfusion pressure < 42 mmHg in the first 24 hours was greater in acute kidney injury patients (94 versus 35 mmHg*minutes of low renal perfusion pressure/hour, p = 0.008). In the multivariable model, renal perfusion pressure < 42 mmHg was associated with acute kidney injury (aOR: 2.07, 95%CI: 1.25–3.82, p = 0.009). Mean arterial pressure, central venous pressure, and measures of inadequate oxygen delivery were not associated with acute kidney injury.
Conclusion:Periods of low renal perfusion pressure (<42 mmHg) in the first 24 post-operative hours are associated with acute kidney injury. Renal perfusion pressure is a potential modifiable target that may mitigate the impact of acute kidney injury after paediatric cardiac surgery.
Four-bar linkage reconfigurable robotic wheel: Design, kinematic analysis, and experimental validation for adaptive size modification
- X. Yamile Sandoval-Castro, Sergio Muñoz-Gonzalez, Mario A. Garcia-Murillo, Pedro D. Ferrusca-Monroy, Maxiamiano F. Ruiz-Torres
-
- Journal:
- Robotica , First View
- Published online by Cambridge University Press:
- 13 May 2024, pp. 1-15
-
- Article
- Export citation
-
This article presents the development of a robot capable of modifying its size through a wheel reconfiguration strategy. The reconfigurable wheel design is based on a four-bar retractable mechanism that achieves variation of the effective radius of the wheel. A reconfiguration index is introduced based on the number of retractable mechanisms that predicts the radius of configuration according to the number of mechanisms implemented in the wheel. The kinematics of the retractable mechanism is studied to determine the theoretical reconfiguration radius during the transformation process, it is also evaluated numerically with the help of the GeoGebra software, and it is validated experimentally by image analysis using the Tracker software. The transformation process of the robot is investigated through an analysis of forces that consider the wheel in contact with the obstacle, the calculation of the wheel torque and the height of the obstacle to be overcome are presented. On the other hand, the experimental validation of the robot reconfiguration process is presented through the percentage of success shown by the robot to overcome obstacles of 50, 75, 100 and 125 mm. In addition, measurements of energy consumption during the transformation process are reported. Reconfigurable wheels, capable of adapting their size, offer innovative solutions to various challenges across different applications such as robotic exploration and search and rescue missions to industrial settings. Some key issues that these wheels can address include terrain adaptability enhancing a robot’s mobility over uneven surfaces, or obstacles; enhanced robotic design; cost-effective design; space efficiency; and versatility in applications.
Performance of Low-Grade Calcined Clays as Supplementary Cementitious Material in Relation to their Geological Characteristics
- Oscar O. Vásquez-Torres, Francisco D. Cabrera-Poloche, Jorge I. Tobón
-
- Journal:
- Clays and Clay Minerals / Volume 70 / Issue 2 / April 2022
- Published online by Cambridge University Press:
- 01 January 2024, pp. 233-251
-
- Article
- Export citation
-
Calcined clays are used as a supplementary cementitious material (SCM) because, as hydrated aluminosilicates of the phyllosilicate group, they can be activated thermally, promoting dehydroxylation and structural disorder, i.e. making them reactive. The main effect of using calcined clay as an SCM is that CO2 emissions into the atmosphere are reduced by the reduction in the clinker/cement factor due to substitution of a proportion of clinker by calcined clay. Clays rich in kaolinite (1:1) group minerals offer most promise in terms of thermal activation. However, increased costs caused by demand for kaolinite from other industries means that type 2:1 calcined clays and mixtures of them have begun to be investigated as possible pozzolanic materials. The physical, chemical, and mineralogical characteristics that control the performance of these calcined clays as SCMs are still under discussion. Few in-depth studies of the behavior of these characteristics have been reported. The origin and geological history of raw materials, as well as their impact on the thermal activation and performance as SCM, are not well understood or, in some cases, have not been considered. The objective of the current work, therefore, was to study multicomponent clays from metamorphic rocks with low-grade kaolinite (<50%) from a tropical region of Colombia for possible use as SCMs. The clay deposit was identified by geological exploration techniques and classified in depth according to horizons of the weathering profile. The samples were extracted from the first 50 m of the deposit and characterized physically, chemically, and mineralogically; they were calcined at 650, 750, and 850°C; their degree of alteration was estimated by the Chemical Index of Alteration (CIA); and their performance as an SCM was evaluated by the Strength Activity Index (SAI) and Frattini test. As a main result, a relationship was found between the weathering profile of the deposit and the CIA of raw clays, which confirmed the high weathering and degree of alteration of the parent rock in the deposit (weathered rock and residual soil with a CIA > 80%). Furthermore, pozzolanic (physical and chemical) tests demonstrated the potential use of calcined clays from this deposit as SCMs, as well as their thermal activation at low temperature (≤750°C). In addition, the pozzolanic activity increased with the kaolinite/(muscovite+illite+vermiculite) ratio mainly, and, in turn, the thermal activation temperature increased with the mica and type 2:1 clay content.
Bloodstream infection burden among cancer clinic patients with PICC Lines: A prospective, observational study
- Jessica Bethlahmy, Hiroki Saito, Bardia Bahadori, Thomas Tjoa, Shereen Nourollahi, Mohamad Alsharif, Justin Chang, Linda Armendariz, Vincent Torres, Sandra Masson, Edward Nelson, Richard Van Etten, Syma Rashid, Raheeb Saavedra, Raveena D. Singh, Shruti Gohil
-
- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, p. s49
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Background: Oncology patients are at high risk for bloodstream infection (BSI) due to immunosuppression and frequent use of central venous catheters. Surveillance in this population is largely relegated to inpatient settings and limited data are available describing community burden. We evaluated rates of BSI, clinic or emergency department (ED) visits, and hospitalizations in a large cohort of oncology outpatients with peripherally inserted central catheters (PICCs). Methods: In this prospective, observational study, we followed a convenience sample of adults (age>18) with PICCs at a large academic outpatient oncology clinic for 35 months between July 2015 and November 2018. We assessed demographics, malignancy type, PICC insertion and removal dates, history of prior PICC, and line duration. Outcomes included BSI events (defined as >1 positive blood cultures or >2 positive blood cultures if coagulase-negative Staphylococcus), ED visits (without hospitalization), and unplanned hospitalizations (excluding scheduled chemotherapy hospitalizations). We used χ2 analyses to compare the frequency of categorical outcomes, and we used unpaired t tests to assess differences in means of continuous variable in hematologic versus solid-tumor malignancy patients. We used generalized linear mixed-effects models to assess differences in BSI (clustered by patient) separately for gram-positive and gram-negative BSI outcomes. Results: Among 478 patients with 658 unique PICC lines and 64,190 line days, 271 patients (413 lines) had hematologic malignancy and 207 patients (232 lines) had solid-tumor malignancy. Cohort characteristics and outcomes stratified by malignancy type are shown in Table 1. Compared to those with hematologic malignancy, solid-tumor patients were older, had 47% fewer clinic visits, and had 32% lower frequency of prior PICC lines. Overall, there were 75 BSI events (12%; 1.2 per 1,000 catheter days). We detected no significant difference in BSI rates when comparing solid-tumor versus hematologic malignancies (P = 0.20); BSIs with gram-positive pathogen were 69% higher in patients with solid tumors. Gram-negative BSIs were 41% higher in patients with hematologic malignancy. Solid-tumor malignancy was associated with 4.5-fold higher odds of developing BSI with gram-positive pathogen (OR, 4.48; 95% CI, 1.60–12.60; P = .005) compared to those with hematologic malignancy, after adjusting for age, sex, history of prior PICC, and line duration. Differences in gram-negative BSI were not significant on multivariate analysis. Conclusions: The burden of all-cause BSIs in cancer clinic adults with PICC lines was 12% or 1.2 per 1,000 catheter days, as high as nationally reported inpatient BSI rates. Higher risk of gram-positive BSIs in solid-tumor patients suggests the need for targeted infection prevention activities in this population, such as improvements in central-line monitoring, outpatient care, and maintenance of lines and/or dressings, as well as chlorhexidine bathing to reduce skin bioburden.
Disclosures: None
Assessment of executive functions through a virtual reality task in euthymic patients with bipolar disorder and influence in psychosocial functioning
- J. Andreu Martínez, D. Beltrán Cristancho, P. Navalón, P. Sierra San Miguel, A. García Blanco, A. Chicchi Glioli, S. Cervera Torres, M. Alcañiz Raya, Y. Cañada Pérez
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S700
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Previous research has shown that neurocognitive deficits, especially deficits in executive functions, may persist during euthymia in in patients with bipolar disorder (BD) and that those are associated with an impairment of psychosocial functioning. The assessment of executive functions (EFs) is normally carried out using laboratory tests. Novel methodologies such as virtual reality (VR) allow the creation of immersive environments, to evaluate executive performance with greater potential for ecological validity than evaluations with standard tasks.
ObjectivesThe objectives of this project are to evaluate executive performance in euthymic patients with BD with a novel virtual reality task compared to standard computerized tasks, and to find predictors of functioning associated with cognitive performance.
MethodsThis is a cross sectional study in which 46 euthymic patients with BD treated at La Fe University and Polytechnic Hospital were assessed with a battery of standard computerized tasks (ST) (TMT/Stroop,/Go-No-Go/TOL/DOT) and with the Cooking Task virtual reality task. The Cooking Task presents 4 tasks of increasing difficulty in which you must cook food in a specific time. It records total time to complete the task, whether food is cooled or burned, the simultaneous use of two fires, the proper use of seasonings and the time to set the table.
Functioning was assessed with the Functioning Assessment Short Test (FAST) that evaluates the overall functioning of patients with a mental illness in 6 subscales.
Correlation analyses between cognitive performance variables and clinical variables were done. Multiple linear regression was performed with the FAST score as a dependent variable and cognitive performance variables and relevant clinical variables to executive functioning (months of euthymia, age, and number of total episodes) were included as independent variables.
ResultsA worse psychosocial functioning was significantly associated with a worse performance in standard tasks (TMTA, TMTB, STROOP, and TOL) and cooking task (total time spent on task 2, burning time and total time spent on task 3, and total time spent on task 4). In the regression analysis, the correct simultaneous use of the two fires was the best predictor of a better psychosocial functioning in BD patient. This implies the preserved ability of planning and performing dual tasks.
ConclusionsOur findings suggest that euthymic patients with BD present deficits in executive functions related with a worse psychosocial functioning. Among the tasks, the cooking task may have a greater sensitivity than standards task to predict real functioning. This in an opportunity to design virtual applications for diagnostic and therapeutic purposes.
Disclosure of InterestNone Declared
Does intensive home treatment change treatment trajectories of psychiatric disorders?
- A. Martín-Blanco, A. González-Fernández, A. Farré, S. Vieira, P. Alvaro, C. Isern, D. Giménez, C. Torres, V. de la Cruz, C. Martín, N. Moll, O. Castro, M. Sagué-Vilavella
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S167-S168
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Intensive home treatment (IHT) for people experiencing a mental health crisis has been progressively established in many western countries as an alternative to in-ward admission. But is this a real alternative? We previously reported that patients treated in our IHT unit only differ from those voluntarily admitted to hospital in suicidal risk and severe behaviour disorders (not in other factors such as clinical severity) (Martín-Blanco et al., Rev Psiquiatr Salud Ment 2022;15:213-5). Now we are interested in disentangle if those patients who used to require inward management can be successfully treated at home.
ObjectivesTo describe subsequent treatment trajectories of the first 1000 admissions to our IHT unit and to compare clinical characteristics among the different groups of trajectories.
MethodsRetrospective cohort study. Subsequent treatment trajectories were collected from December 2016 to October 2022 and classified: absence, hospital, IHT, and mixed (hospital and IHT). Statistical significance was tested by means of ANOVA or Kruskal-Wallis test for quantitative variables (corrected for multiple comparisons) and chi-square tests for qualitative variables.
ResultsTables 1 shows the characteristics of the whole sample. Of the 1000 IHT admissions, 12.1% needed subsequent hospital admission(s), 12.7% IHT admission(s), and 9.3% mixed admission(s). There were no differences among these groups in median severity at IHT admission, but there were differences in the number of previous admissions (p=0.0001): the group with no subsequent admissions had less previous admissions than the other groups (pBonf<0.0001), and the group with subsequent IHT admissions had less than the group with mixed admissions (pBonf=0.0123). There were differences between groups regarding distribution of diagnoses (p<0.0001) (Fig. 1). When considering subsequent admissions by diagnosis, there were differences in severity at IHT admission (p=0.0068) and in number of previous hospitalizations (p<0.0001) (Fig. 2).
Table 1. Clinical characteristics of the whole sample (N=1000) mean SD Age (years) 47.07 17.02 CGI-s at admission * 5 4-5 N % Sex (female) 548 54.8% Psychotic disorders 463 46.3% Affective disorder 257 25.7% Bipolar disorder 128 12.8% Other disorders 152 15.2% Hospital admission in the previous 5 years 313 31.3% CGI-s: clinical global impression - severity. * median and IQR
Image:
Image 2:
ConclusionsPatients that used to require inward management can now be treated at home when suffering an acute episode. Therefore, IHT has changed treatment trajectories for some patients with psychiatric disorders.
Disclosure of InterestNone Declared
Comorbid Obsessive-Compulsive Symptoms in Schizophrenia - Diagnostic and Treatment Challenges
- J. A. Leal, J. C. Moura, T. C. Rocha, J. F. Cunha, S. P. Torres, D. Seabra, I. M. Lopes, M. E. Carneiro, S. M. Esteves, R. Cajão, G. Lima
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1061
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
The comorbidity between Schizophrenia and Obsessive-Compulsive Symptoms represents almost 25% of schizophrenic patients and it is believed that almost 12% match the diagnostic criteria for Obsessive-Compulsive Disorder. Some second-generation antipsychotics may worsen or even induce those symptoms, which makes the treatment of this patients a difficult challenge.
ObjectivesTo assess the link between Schizophrenia and Obsessive-Compulsive Symptoms, to discuss the diagnostic challenges and treatment options. To present a clinical case report of a schizophrenic patient with Obsessive-Compulsive Symptoms, which improved with proper treatment.
MethodsWe performed a non-systematic review of the existent literature with the keywords “Schizophrenia” and “Obsessive-Compulsive Symptoms”. Description of a clinical case report.
ResultsWe present the case report of a male, 21 years old, single, diagnosed with Schizophrenia. In the past year, he was admitted twice in a psychiatric ward for persecutory and mystic delusions, which lead him to erratic behaviour. Since his adolescence he manifested repeated washing and compulsive cleaning associated with the fear of being contaminated with multiple diseases. Those compulsions worsened when he started being treated with antipsychotics. However, with therapeutic adjustments and with the introduction of an antidepressant we were able to control those symptoms.
ConclusionsSome antipsychotics may induce or even aggravate Obsessive-Compulsive Symptoms in psychotic patients. It is of extreme relevance to differentiate those symptoms as comorbid in Schizophrenia or if they existed prior to the first positive symptoms, since they can be representative of an Obsessive-Compulsive Disorder. Understanding this diagnostic and treatment complexity enables us to be more familiar with the development of Obsessive-Compulsive Symptoms in schizophrenic patients.
Disclosure of InterestNone Declared
Effects of cognitive rehabilitation interventions on non-central nervous system cancer survivors: A meta-analysis
- A. F. Oliveira, J. D. Reis, I. M. Santos, A. Torres
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S116-S117
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Cancer treatments can have a detrimental impact on cancer survivors’ cognitive function. Cognitive rehabilitation is considered the first-line intervention to address cognitive difficulties of cancer survivors. Nevertheless, its efficacy remains unclear.
ObjectivesThis meta-analysis aimed to understand the effects of cognitive rehabilitation in non-central system (non-CNS) cancer survivors, through the assessment of the overall efficacy on subjective cognitive outcomes.
MethodsThis meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. An electronic search on the databases PubMed, Scopus, and Web of Science was conducted in May 2021, considering the past 15 years, by two independent authors. Studies were eligible if they included cancer survivors (excluding CNS cancers) who were exposed to cognitive rehabilitation interventions, in which the subjective cognitive effects were measured through self-report questionnaires. The quality of studies was assessed using the Cochrane Risk of Bias Tool for Randomized Trials. The effect size was the standardized mean difference in the cognitive assessment, between baseline and post-intervention. Statistical heterogeneity was assessed using I2 Statistic. Publication bias was evaluated with Egger’s test. P<0.05 was considered statistically significant. The meta-analysis was performed using R software.
ResultsAmong 14 studies, with 1115 cancer survivors, one study included a pediatric population, other young adult survivors, and the remaining adult population. The most used scale for measuring cognitive changes was the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) and, as recommended, the Perceived Cognitive Impairments (PCI) subscale was used as the primary measure of subjective cognitive function. Results indicated beneficial effects following cognitive rehabilitation, with an overall standard mean difference between pre- and post-treatment of 3.4447, with CI95% [1.5543; 5.3350], p-value<0.0004. The subgroup analysis between the measures of cognitive outcomes showed that the heterogeneity is Group=Other 0.00% (I2) and for the Group=FACT-Cog PCI is 86% (I2). Analyzing the FACT-Cog PCI, the CI95% [-2.93; 6.43] includes 0, meaning that the overall effect in this subgroup is non-significant. The meta-analysis does not demonstrate publication bias (p-value of the Egger test=0.3220).
ConclusionsImprovement of cognitive function in non-CNS survivors throughout cognitive rehabilitation appears to be effective. The findings of this meta-analysis can help inform clinical practice and assist practitioners in recommending and developing interventions of cognitive rehabilitation and deciding how to evaluate them. Further research is required to strengthen this evidence.
Disclosure of InterestNone Declared
Autism spectrum disorders - gender differences and the diagnosis dilemma
- J. D. C. Moura, J. Leal, J. F. Cunha, D. Seabra, S. Torres, T. Rocha, I. Lopes, B. Barata
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S726
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by social and communication deficits and restricted and repetitive or stereotyped behaviours. The prevalence of ASD has been thought to be higher in men, which may reflect aspects of the own aetiology of the disorder. Still, it may also be associated with misdiagnosis or missed diagnosis of females with autism due to specific phenotypic traits.
ObjectivesTo explore the differences between sex/gender in autism’s clinical presentation.
MethodsNon-systematic literature review using the most relevant papers found on PubMed and Google Scholar using the following keywords: “autism spectrum disorder”, “gender differences”, and “autistic women”.
ResultsAutistic women seem to have a “camouflage” phenomenon, characterized by a high level of functioning, less unusual play or restricted interests, better socio-emotional reciprocity and coping behaviours. Therefore, women with ASD commonly have an anteriority of multiple diagnoses, which delays their access to the support and care they need.
ConclusionsProfessionals must be aware of the sex/gender clinical differences to prevent the misdiagnosis or missed diagnosis of females with autism. Moreover, the current clinical criteria used to diagnose ASD may underserve the female population and deserve to be reviewed.
Disclosure of InterestNone Declared
Life stress and Bipolar Disorder: regarding a clinical case
- T. Coelho Rocha, J. F. Cunha, S. Torres, J. Alves Leal, J. Carvalho Moura, D. Seabra, I. Monteiro Lopes, A. Lopes, G. Lima
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S712
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Research on life stress in bipolar disorder largely fails to account for the possibility of a dynamic relationship between psychosocial stress and episode initiation. The kindling hypothesis states that over the course of recurrent affective disorders, there is a weakening temporal relationship between major life stress and episode initiation that could reflect either a progressive sensitization or progressive autonomy to life stress.
ObjectivesTo explore the concept of the Kindling model applied to bipolar disorder and to present a clinical case of a bipolar patient whose latter mood episodes were caused by adverse life events.
MethodsWe performed a non-systematic literature review using the most relevant papers found on the database PubMed with the keywords “kindling effect”, “allostatic load”, “bipolar disorder” and “prevention”. Description of the clinical case report.
ResultsThe phenomenon of kindling was first discovered by Goddard in 1967 who described it in epilepsy. Later, Post applied it to the bipolar disorder, arguing that the initial episodes of both unipolar and bipolar affective disorders are often precipitated by psychosocial stressors, but after multiple recurrences, not only do precipitated episodes continue to occur, but so do spontaneous ones as well. We present the case report of a 62 years old woman, divorced, diagnosed with type 1 bipolar disorder since she was 20 years old. She always have had poor adherence to her medication and follow-up with Psychiatry consultation, with a non-containing sociofamily environment that does not promote clinical stability. Over the time, her admissions on the Psychiatry ward were more frequent and precipitated by adverse life events, mainly caused by the deteriorated relationship with her children.
ConclusionsThe kindling model clarifies aspects of the longitudinal course of episode development, recurrence, and progression to spontaneity, as well as further conceptual and theoretical rationales for intervention in order to prevent illness progression.
Disclosure of InterestNone Declared
Psychopathological symptoms as clinical phenotypes in suicide attempters: relation in terms of suicidal ideation, suicidal related behaviors and medical damage of the attempt
- D. Saiz-Gonzalez, P. Diaz-Carracedo, A. Pemau, W. Ayad-Ahmed, F.-R. Veronica, M. Navas Tejedor, A. de la Torre-Luque, M. Diaz-Marsa
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S560-S561
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Suicide behaviour is a complex and multifactor concept that includes different risk factors. According with literature a dimensional concept of illness could help to understand this complexity and clarify clinical aspects of suicide risk.
ObjectivesThe aim of this study is to identify different profiles of symptoms in a sample of suicide attempters and the relationship between this profiles and suicide behaviour in terms of outcome: presence and intensity of suicidal ideation, presence and number of attempts and severity of the medical damage in the current attempt.
Methods634 patients were recruited at the psychiatry emergency of eight public general hospitals in Spain between November 2020 until February 2022 in the SURVIVE protocol. The patients were assessed in 15 days using a battery of clinical tools that includes Brief Symptom Inventory, a sociodemographic interview, Mini Clinical Interview and C-SSRS, ACSS and BIS-11 scales. Latent profile analysis was applied to obtain profile symptoms. Logistic and multivariant regression was used to obtain data about outcome.
ResultsThree clinical profiles of psychiatric symptoms were described in suicide attempters (p < 0.01): high symptoms (HS) (45.02%), moderate symptoms (MS) (42.5 %) and low symptoms (LS) (12.48%). Significant differences were found between classes in four symptom domains (Figure 1): anxiety, obsessive-compulsive, sensitivity, and somatization (p < 0.01). Participants of the HS class showed higher values in relation with the BSI summary indexes, and more diagnoses, higher levels of suicidal ideation and suicidal related behaviour as well as higher acquired capability for suicide. Participants of the LS class were more likely to be women, older and unemployed and was related, according the analysis, with severe medical damage when compared with other groups (P< 0.01).
Image:
ConclusionsAccording with the predictive model the study suggests different symptom-frequency clusters related with suicide attempt outcomes. Suicide ideation presence and intensity is related with HS class and acquired capability of suicide. Suicide ideation intensity is also related with number of diagnosis and number of previous attempts. Suicide behaviours presence is associated with being student and number with HS profile. Both presence and number were related with number of diagnosis as well as number of previous attempts (the higher all these clinical factors, the more intense of ideation in the last month). Finally, the severity of medical damage was related with LS profile and unemployed/retired work status. The dimensional symptom profile could be useful to predict suicide attempt outcome. Further study is needed to clarify this relation.
Disclosure of InterestNone Declared
Predictors of adherence to electronic self-monitoring in patients with bipolar disorder: a contactless study using Growth Mixture Models
- A. Ortiz, C. Park, C. Gonzalez-Torres, M. Alda, D. Blumberger, I. Husain, M. Sanches, B. H. Mulsant
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S504-S505
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Several studies have reported on the feasibility and impact of e-monitoring using computers, or smartphones, in patients with mental disorders, including Bipolar Disorder (BD). Despite some promising early results, concerns have been raised about the motivation and ability of patients with BD to adhere to e-monitoring, in particular when they are depressed or manic. While studies on e-monitoring have examined the role of demographic factors, such as age, gender, or socioeconomic status and use of health apps, to our knowledge, no study has examined clinical characteristics that might impact adherence with e-monitoring of patients with BD.
ObjectivesWe analyzed adherence to e-monitoring in patients with BD who participated in an ongoing e-monitoring study and evaluated whether demographic and clinical factors would predict adherence.
MethodsEighty-seven participants with BD in different phases of the illness were included. Patterns of adherence for wearable use, daily and weekly self-rating scales over 15 months were analyzed to identify adherence trajectories using growth mixture models (GMM). Multinomial logistic regression models and Multiple Component Analyses were fitted to compute the effects of predictors on GMM classes.
ResultsAdherence rates were 79.5% for the wearable; 78.5% for weekly self-ratings; and 74.6% for daily self-ratings. GMM identified three latent class subgroups: (i) participants with good adherence with the protocol; (ii) participants with partial adherence; (iii) participants with poor adherence. Women, participants with a history of suicide attempt, and those with a history of inpatient admission were more likely to belong to the group with good adherence.
ConclusionsParticipants with higher illness burden (e.g., history of admission to hospital, history of suicide attempts) have higher adherence rates to e-monitoring. This is important because our findings debunk myths around illness burden as an obstacle to adhere to e-monitoring studies. Participants might have seen e-monitoring as a tool for better documenting symptom change and better managing their illness, thus motivating their engagement.
Disclosure of InterestNone Declared
School-based socio-emotional learning programs to prevent depression, anxiety and suicide among adolescents: a global cost-effectiveness analysis
- Y. Y. Lee, S. Skeen, G. J. Melendez-Torres, C. A. Laurenzi, M. van Ommeren, A. Fleischmann, C. Servili, C. Mihalopoulos, D. Chisholm
-
- Journal:
- Epidemiology and Psychiatric Sciences / Volume 32 / 2023
- Published online by Cambridge University Press:
- 12 July 2023, e46
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Aims
Preventing the occurrence of depression/anxiety and suicide during adolescence can lead to substantive health gains over the course of an individual person’s life. This study set out to identify the expected population-level costs and health impacts of implementing universal and indicated school-based socio-emotional learning (SEL) programs in different country contexts.
MethodsA Markov model was developed to examine the effectiveness of delivering universal and indicated school-based SEL programs to prevent the onset of depression/anxiety and suicide deaths among adolescents. Intervention health impacts were measured in healthy life years gained (HLYGs) over a 100-year time horizon. Country-specific intervention costs were calculated and denominated in 2017 international dollars (2017 I$) under a health systems perspective. Cost-effectiveness findings were subsequently expressed in terms of I$ per HLYG. Analyses were conducted on a group of 20 countries from different regions and income levels, with final results aggregated and presented by country income group – that is, low and lower middle income countries (LLMICs) and upper middle and high-income countries (UMHICs). Uncertainty and sensitivity analyses were conducted to test model assumptions.
ResultsImplementation costs ranged from an annual per capita investment of I$0.10 in LLMICs to I$0.16 in UMHICs for the universal SEL program and I$0.06 in LLMICs to I$0.09 in UMHICs for the indicated SEL program. The universal SEL program generated 100 HLYGs per 1 million population compared to 5 for the indicated SEL program in LLMICs. The cost per HLYG was I$958 in LLMICS and I$2,006 in UMHICs for the universal SEL program and I$11,123 in LLMICs and I$18,473 in UMHICs for the indicated SEL program. Cost-effectiveness findings were highly sensitive to variations around input parameter values involving the intervention effect sizes and the disability weight used to estimate HLYGs.
ConclusionsThe results of this analysis suggest that universal and indicated SEL programs require a low level of investment (in the range of I$0.05 to I$0.20 per head of population) but that universal SEL programs produce significantly greater health benefits at a population level and therefore better value for money (e.g., less than I$1,000 per HLYG in LLMICs). Despite producing fewer population-level health benefits, the implementation of indicated SEL programs may be justified as a means of reducing population inequalities that affect high-risk populations who would benefit from a more tailored intervention approach.
Aversion to carbon dioxide stunning in pigs: effect of carbon dioxide concentration and halothane genotype
- A Velarde, J Cruz, M Gispert, D Carrión, JL Ruiz de la Torre, A Diestre, X Manteca
-
- Journal:
- Animal Welfare / Volume 16 / Issue 4 / November 2007
- Published online by Cambridge University Press:
- 11 January 2023, pp. 513-522
-
- Article
- Export citation
-
Aversion to the dip-lift stunning system and to the inhalation of 70 and 90% carbon dioxide was assessed in 18 halothane-free (NN) and 14 heterozygous halothane (Nn) slaughter weight pigs using aversion learning techniques and behavioural studies in an experimental slaughterhouse. Pigs were subjected to the treatments individually. When the dip lift system contained atmospheric air, the proportion of pigs that entered the crate voluntarily increased on subsequent days, indicating that pigs habituate to the stunning system. Based on the number of attempted retreats, for the first descent into the well with atmospheric air, Nn pigs were more reactive than NN pigs. On repeating the descent, Nn pigs showed greater habituation to the procedure. When the pit contained (either 70 or 90%) carbon dioxide, the time taken to enter the crate and the incidence of pigs that attempted to retreat increased on subsequent days, indicating aversion to the carbon dioxide concentrations. The aversion was higher when the stunning system contained 90 as opposed to 70% carbon dioxide due possibly to increased irritation of the nasal mucosal membranes and more severe hyperventilation. Conversely, a decrease in the concentration of carbon dioxide increased the time to loss of posture and, therefore, lengthened the perception of the aversive stimulus till the animal lost consciousness. These results suggest that stunning with carbon dioxide is not free from pain or distress. The degree of aversion depends on the carbon dioxide concentration. Therefore, if higher concentrations of carbon dioxide are recommended for rapid induction of anaesthesia, it needs to be assumed that this may be more aversive to pigs.
Stress in wild-caught Eurasian otters (Lutra lutra): effects of a long-acting neuroleptic and time in captivity
- J Fernández-Morán, D Saavedra, JL Ruiz De La Torre, X Manteca-Vilanova
-
- Journal:
- Animal Welfare / Volume 13 / Issue 2 / May 2004
- Published online by Cambridge University Press:
- 11 January 2023, pp. 143-149
-
- Article
- Export citation
-
As part of a translocation project, 28 Eurasian otters (Lutra lutra) were captured from the wild and transported to the Barcelona Zoo for veterinary evaluation, quarantine and intraperitoneal implantation of telemetry devices. Eleven animals were injected with the long-acting neuroleptic (LAN) perphenazine enanthate at the time of capture and the remaining animals served as a control group. During their time in captivity, which averaged 23 days, all of the animals were bled three times. Haematological and biochemical parameters were evaluated, including red blood cell count (RBC), haemoglobin (Hb), white blood cell count (WBC), blood urea, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (AP), lactate dehydrogenase (LDH), creatine kinase (CK), albumin, and serum cortisol. No significant differences were found between treated and control otters except for monocyte count, which was higher in treated animals. Time after capture had an effect on many parameters. RBC and Hb decreased at first and then increased, while WBC and segmented neutrophils decreased over time. Most of the biochemical parameters considered to vary in relation to stress, including AST, ALT, CK, AP and LDH, decreased over time, suggesting that the stress responses of the animals decreased throughout the period of captivity. However, no significant change in serum cortisol levels was noted. The lack of effect of perphenazine treatment on haematological parameters should encourage further research on other stress indicators applicable to wild animals, such as behaviour or faecal cortisol concentration. Finally, the results obtained in this study suggest that, when captive conditions are adequate, keeping wild-caught animals in human care for a period of time prior to their release into the wild can be beneficial. However, further studies taking into account other welfare indicators would be useful.
Sphingolipids and acylcarnitines are altered in placentas from women with gestational diabetes mellitus
- Gabriela D. A. Pinto, Antonio Murgia, Carla Lai, Carolina S. Ferreira, Vanessa A. Goes, Deborah de A. B. Guimarães, Layla G. Ranquine, Desirée L. Reis, Claudio J. Struchiner, Julian L. Griffin, Graham J. Burton, Alexandre G. Torres, Tatiana El-Bacha
-
- Journal:
- British Journal of Nutrition / Volume 130 / Issue 6 / 28 September 2023
- Published online by Cambridge University Press:
- 21 December 2022, pp. 921-932
- Print publication:
- 28 September 2023
-
- Article
- Export citation
-
Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy and a severe threat to pregnant people and offspring health. The molecular origins of GDM, and in particular the placental responses, are not fully known. The present study aimed to perform a comprehensive characterisation of the lipid species in placentas from pregnancies complicated with GDM using high-resolution MS lipidomics, with a particular focus on sphingolipids and acylcarnitines in a semi-targeted approach. The results indicated that despite no major disruption in lipid metabolism, placentas from GDM pregnancies showed significant alterations in sphingolipids, mostly lower abundance of total ceramides. Additionally, very long-chain ceramides and sphingomyelins with twenty-four carbons were lower, and glucosylceramides with sixteen carbons were higher in placentas from GDM pregnancies. Semi-targeted lipidomics revealed the strong impact of GDM on the placental acylcarnitine profile, particularly lower contents of medium and long-chain fatty-acyl carnitine species. The lower contents of sphingolipids may affect the secretory function of the placenta, and lower contents of long-chain fatty acylcarnitines is suggestive of mitochondrial dysfunction. These alterations in placental lipid metabolism may have consequences for fetal growth and development.
20 years of experience with the Fontan procedure: characteristics and clinical outcomes of children in a tertiary referral hospital
- Jaiber A. Gutiérrez-Gil, Laura A. Torres-Canchala, Leidy D. Castro-Viáfara, Manuela Uribe-Mora, Juan F. Vélez-Moreno, Valentina Mejía-Quiñones, Walter Mosquera-Álvarez
-
- Journal:
- Cardiology in the Young / Volume 33 / Issue 8 / August 2023
- Published online by Cambridge University Press:
- 07 October 2022, pp. 1378-1382
-
- Article
- Export citation
-
Introduction:
Without participating in a contractile chamber, the Fontan procedure seeks to create a separation of oxygenated and deoxygenated blood in patients with univentricular heart, reducing the risks of long-term hypoxemia and improving their survival. This study describes the clinical outcomes of children undergoing the Fontan procedure between 2000 and 2020 in a tertiary referral hospital care centre in southwestern Colombia.
Materials and methods:A retrospective observational descriptive study. The 81 patients who underwent the Fontan procedure were included. Categorical variables were presented with percentages and continuous variables with measures of central tendency according to the distribution of the data evaluated through the Shapiro–Wilk test. Sociodemographic, clinical, surgical variables, complications, and mortality were described.
Results:Between 2000 and 2020, 81 patients underwent the Fontan procedure: 43 (53.1%) males and a median age of 5.3 years (interquartile range 4.3–6.6). The most common diagnosis was tricuspid atresia (49.4%). The median mean pulmonary arterial pressure was 12 mmHg (interquartile range 10–15), the Nakata index 272 mm2/m2 (interquartile range 204–327), and the McGoon index (interquartile range 1.86–2.3). Seventy-two (88.9%) patients underwent extracardiac Fontan and 44 (54.3%) patients underwent fenestration. The median hospitalisation days were 19 days. The main complication was coagulopathy (19.8%), mortality in the first month between 2000 and 2010 was 8.6%, and after 2010 was 1.2%.
Conclusion:The Fontan procedure is a palliative surgery for children with complex heart disease. According to anatomical and physiological variables, the proper choice of patients determines the short- and long-term results.
Perceived stress and physiological consistency during mental stress exercises and controlled breathing
- D. Vasquez, E. Mejia-Mejia, R. Torres, D. Restrepo
-
- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S733-S734
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
The measurement of the physiological coherence, the order and the quality of the connection of complex systems such as the cardiac and the respiratory system, varies in situations of stress and relaxation.
ObjectivesWe aim to assess changes in physiological coherence and perception of stress during mental stress and directed breathing exercises.
MethodsRepeated-measures study in healthy adults without prior training in breathing techniques, aged between 18 and 65 years of both sexes who were evaluated in three situations: baseline, mental stress (Stroop test and successive subtractions), and directed breathing, during which were captured heart rate and respiratory signals to estimate physiological coherence and the participants rated the perceived stress at each moment.
Results34 participants were analyzed, 59% women, with a median age of 36 years (Rq = 13). During mental stress tasks, the median for physiological coherence was similar to baseline coherence but increased significantly with five minutes of directed breathing exercises (38% vs. 63% p <0.0001). The highest perception of stress was during successive subtractions (Me 7, Rq = 4) and the lowest during directed breathing exercises (Me 2 Rq = 3.0). The correlation was sought between physiological coherence and perception of stress during each of the four moments of the study. Basal (Rho Spearman -0.05, p 0.54); Stroop (Rho -0.17, p 0.03); successive subtractions (Rho 0.50, p 0.77); and directed breathing (Rho -0.28, p 0.09).
ConclusionsA correlation was found between physiological coherence and perception of stress during the Stroop test; however, no association was found.
DisclosureNo significant relationships.
Psychopathological networks in psychosis and changes over time: A long-term cohort study of first-episode psychosis
- G. Gil-Berrozpe, V. Peralta, A. Sánchez-Torres, L. Moreno-Izco, E. Garcia De Jalon, D. Peralta, L. Janda, M. Cuesta
-
- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S247
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
First-episode psychosis is a critical period for early interventions to reduce the risk of poor outcomes and relapse as much as possible. There are now many studies revealing the patterns of course in the short and medium terms, but uncertainties about the long-term outcomes of symptomatology remain to be ascertained.
ObjectivesFirst, we ascertained whether the structure of psychopathological symptoms, dimensions and domains of psychopathology remains invariant over time between first-episode psychosis and long-term follow-up. Second, we analysed the changes in the interrelationships of psychopathological symptoms, dimensions and domains of psychopathology between FEP and long-term follow-up at three levels.
MethodsWe performed network analysis to investigate first-episode and long-term stages of psychosis at three levels of analysis: micro, meso and macro. The sample was a cohort of 510 patients with first-episode psychoses from the SEGPEP study, who were reassessed at the long-term follow-up (n = 243). We used the Comprehensive Assessment of Symptoms and History (CASH) for their assessments.
ResultsOur results showed a similar pattern of clustering between first episodes and long-term follow-up in seven psychopathological dimensions at the micro level, 3 and 4 dimensions at the meso level, and one at the macro level. They also revealed significant differences between first-episode and long-term network structure and centrality measures at the three levels.
ConclusionsOur findings suggest that disorganization symptoms have more influence in long-term stabilized patients. The main results of the current study add evidence to the hierarchical, dimensional and longitudinal structuring of first-episode psychoses.
DisclosureNo significant relationships.
Sleep Disorders and Dual Disorders
- L. Fernandez Mayo, D. Baño Rodrigo, E. Barbero García, M. Agujetas Rodriguez, I. Falcón Torres, V. De Antonio Pérez, C. Medina Sanchez, M. Serrano García
-
- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S466
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
While it is well known that there is an interaction between sleep disorders and substance abuse, it is certainly more complex than was previously thought. The effects on sleep depend on the substance used, but it has been shown that both during use and in withdrawal periods consumers have various sleep problems, and basically more fragmented sleep. We know that sleep problems must be taken into account to prevent addiction relapses.
ObjectivesTo explain the different sleep disorders caused by substances such as alcohol and cannabis
MethodsAs an example of this, two cases are introduced: the first one, a 17-year-old boy, who is diagnosed with ADHD with daily cannabis use since the age of 14. As a result of reducing consumption, he presents an episode of sleep paralysis that he had not previously had. The second one is a 50-year-old man diagnosed with a personality disorder and with dependence on cannabis and alcohol for years. He currently has abstinence from alcohol for months and maintains daily cannabis use. However, he has long-standing sleep pattern disturbances and frequent depersonalization phenomena at night.
ResultsAlcohol at low doses has no clear effects on sleep architecture. At higher doses it decreases sleep latency, as well as awakenings. In chronic alcoholic patients, a decrease in deep slow sleep, and more fragmented sleep have been found. Cannabis withdrawal reduces sleep quality, increases latency, and produces strange dreams.
ConclusionsThere is a positive relationship both between having a substance use disorder and suffering from a sleep disorder.
DisclosureNo significant relationships.