94 results
Quenched worst-case scenario for root deletion in targeted cutting of random recursive trees
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- Laura Eslava, Sergio I. López, Marco L. Ortiz
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- Journal of Applied Probability , First View
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- 03 September 2024, pp. 1-17
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We propose a method for cutting down a random recursive tree that focuses on its higher-degree vertices. Enumerate the vertices of a random recursive tree of size n according to the decreasing order of their degrees; namely, let $(v^{(i)})_{i=1}^{n}$ be such that $\deg(v^{(1)}) \geq \cdots \geq \deg (v^{(n)})$. The targeted vertex-cutting process is performed by sequentially removing vertices $v^{(1)}, v^{(2)}, \ldots, v^{(n)}$ and keeping only the subtree containing the root after each removal. The algorithm ends when the root is picked to be removed. The total number of steps for this procedure, $K_n$, is upper bounded by $Z_{\geq D}$, which denotes the number of vertices that have degree at least as large as the degree of the root. We prove that $\ln Z_{\geq D}$ grows as $\ln n$ asymptotically and obtain its limiting behavior in probability. Moreover, we obtain that the kth moment of $\ln Z_{\geq D}$ is proportional to $(\!\ln n)^k$. As a consequence, we obtain that the first-order growth of $K_n$ is upper bounded by $n^{1-\ln 2}$, which is substantially smaller than the required number of removals if, instead, the vertices were selected uniformly at random.
Suicidality and social cognition: the association between hypomentalizing and suicide lethality
- J. Andreo-Jover, K. March, E. Fernández-Jiménez, J. Fernandez Fernandez, A. Garcia Fernandez, M. P. Lopez Peña, M. Ruiz Veguilla, B. Crespo Facorro, N. Garrido Torres, A. Cebria, I. Grande, N. Roberto, W. Ayad-Ahmed, A. Pemau Gurumeta, A. Garcia Ramos, M. Diaz-Marsa, M. F. Bravo-Ortiz, A. Palao-Tarrero, V. Perez-Sola
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S183
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Introduction
Suicide attempts (SA) leading to highly lethal consequences have been associated with heightened suicide planning (Barker et al., 2022), along with deficits in social cognition (Levi-Belz et al., 2022). Hypomentalizing, characterized by excessive uncertainty regarding mental states, may contribute to heightened social withdrawal and an increased risk of SA (Nestor & Sutherland, 2022). Although certain studies have identified a connection between hypomentalizing profiles and self-harm (Badoud et al., 2015), research into the lethality of SA remains limited.
ObjectivesThis study aimed to explore the association between hypomentalizing and SA lethality.
MethodsOur study encompassed a cohort of 1,371 patients who committed a SA. We conducted assessments of mentalizing using the RFQ-8 instrument, and evaluations of suicidal ideation and behavior employing the CSRSS questionnaire. Demographic and clinical characteristics were compared using the T-student and Chi-square tests. To investigate the relationship between hypomentalizing and the SA lethality, we employed logistic regression models.
ResultsDescriptive date are presented in Table 1. Our results show that hypomentalizing do not predict a higher SA lethality. Additionally, hypomentalizing increased the risk of SA planning (p≤0.001, B=-0.182), and SA planning predicted a higher SA lethality (see Table 2).
Table 1. Means Comparison for low and high lethality (N=1371)
Low lethality N=539 High lethality N=832 p value Effect size Age, mean (SD) 38.65 (15.65) 41.91 (15.37) ≤0.001 -0.209a Female sex, N (%) 392 (72.7) 571 (68.6) 0.116 0.044b Educational years, mean (SD) 12.45 (2.99) 12.43 (3.41) 0.890 0.0076a Employed, N (%) 220 (41.2) 332 (40) 0.692 0.012b Suicide Ideation, N (%) 475 (88.1) 742 (89.2) 0.541 0.016b Suicide Planning, N (%) 159 (39.2) 400 (58.1) ≤0.001 0.183b Number of attempts, mean (SD) 3.28 (5.48) 3.63 (5.74) 0.269 -0.169a RFQ, mean (SD) 4.68 (1.27) 4.56 (1.32) 0.087 0.095a Table 2. Logistic regression analyses for high SA lethality (N=1371).
Univariate analysis Multivariate analysis OR p value OR p value Age 1.014 (1.007-1.021) ≤0.001 1.014 (1.005-1.022) 0.001 Female sex 0.820 (0.646-1.042) 0.105 Educational years 0.998 (0.965-1.031) 0.890 Employed 0.952 (0.763-1.187) 0.660 Suicide ideation 1.111 (0.790-1.562) 0.545 Suicide planning 2.150 (1.674-2.761) ≤0.001 2.183 (1.697-2.808) ≤0.001 Number SA 1.012 (0.990-1.034) 0.277 RFQ 0.929 (0.854-1.011) 0.088 ConclusionsWhile the association between hypomentalizing and high SA lethality was not significant, a discernible trend toward such relationship can be noted. Further studies examining the moderating effects of planning in the association between hypomentalizing and SA lethality are required.
Disclosure of InterestNone Declared
The deaths of invisible people. A literature review
- M. I. Santana Ortiz, N. Molina Pérez, J. Pereira López
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S787
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Introduction
Suicide is a serious public health problem. Each year it is estimated that it causes almost one million deaths worldwide, much more than those caused by war or homicide. These deaths are also devastating, affecting not only the person who commits them, but also his or her environment (family, friends, professionals involved, etc.) and society as a whole. The risk and protective factors for suicide are well known in the literature, which gives rise to the estimation of possible high-risk groups according to their characteristics, especially when risk factors are added, protective factors are reduced, and unfavorable life circumstances are present. Among these groups with greater vulnerability to suicidal behavior are homeless people with severe mental disorders, who are unfortunately little visible in society and in the investigation.
ObjectivesThe aim of this paper is to review the current state of the question of suicide in homeless people with severe mental disorders.
MethodsReview of the international scientific literature on the issue published in the last twenty years.
ResultsThe few studies available conclude the higher prevalence of suicidal behavior in homeless people with severe mental disorders compared to the general population, which has not been translated into the development of specific care and prevention plans and programs.
ConclusionsIt is considered essential to expand investigation in this field, which will be very useful to lay the foundations for the development of guidelines, plans and specific programs, and to know the evidence about them.
Disclosure of InterestNone Declared
“They say I’m crazy, but I’ve lived through hell.”
- N. Molina Pérez, J. Pereira López, M. I. Santana Ortiz, P. Rivero Rodríguez, A. R. N. Del Rosario, M. M. Grimal, V. Acosta Pérez
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S524
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Introduction
Migration has been present in the evolution of human beings throughout history. Economic inequalities give rise to a permanent flow of people trying to improve their lives. In addition, there are people who are forced to seek asylum or refuge due to wars or political violence. Therefore, the migratory flow, gives rise to a clinical scenario in which, the arrival of immigrant people demands an adaptation of the psychiatric paradigm.
ObjectivesThe objective of this paper is to review the international scientific literature published on the impact of the migration process on mental health.
MethodsWe propose a review of the international scientific literature published in recent years on psychiatry and migration.
We present the case of a 27-year-old male, diagnosed with paranoid schizophrenia, who arrived in the Canary Islands after a 2-year migration process from his country of origin (Senegal).
ResultsThe limits between normality and pathology of certain types of behavior vary from one culture to another.
In the case of a patient with a mental disorder who has undergone a migration process, an approach based on the cultural formulation of the case should be made, taking into account the process of adaptation to the culture of the host country, as well as the impact of the culture of origin on the patient’s interpretation of his or her psychopathology.
ConclusionsCulture can influence the acceptance or rejection of a diagnosis and treatment, affecting the course of the disease and recovery.
Therefore, understanding the cultural context in which the disease is experienced is essential for a good diagnostic evaluation and effective clinical management.
Disclosure of InterestN. Molina Pérez: None Declared, J. Pereira López: None Declared, M. I. Santana Ortiz: None Declared, P. Rivero Rodríguez: None Declared, A. R. Del Rosario Grant / Research support from: Jansen Pharmaceuticals, Inc., Consultant of: Jansen Pharmaceuticals, Inc.; Lundbeck, Inc., Employee of: Universidad de Las Palmas de Gran Canaria, Speakers bureau of: Jansen Pharmaceuticals, Inc.; Lundbeck, Inc.; Otsuka Pharmaceutical Co.; Pfizer Inc.; Esteve Pharmaceuticals, S.A.; AstraZeneca Pharmaceuticals LP.; Angelini Pharma S.L.U.; Laboratorios Farmacéuticos ROVI SA., M. Grimal: None Declared, V. Acosta Pérez: None Declared
Treatment Interruptions and Mortality Among Puerto Rican Women With Gynecologic Cancers in Puerto Rico After Hurricanes Irma and María: A Retrospective Cohort Study
- Fabiola A. Rivera-Gastón, Sharee Umpierre-Catinchi, Jeslie M. Ramos-Cartagena, Karen J. Ortiz-Ortiz, Carlos R. Torres-Cintrón, Sandra I. García-Camacho, William A. Calo, Guillermo Tortolero-Luna, Liz M. Martínez-Ocasio, Ana P. Ortiz
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- Disaster Medicine and Public Health Preparedness / Volume 18 / 2024
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- 21 May 2024, e105
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Objective:
Cancer patients are among the most vulnerable populations during and after a disaster. We evaluated the impact of treatment interruption on the survival of women with gynecologic cancer in Puerto Rico following Hurricanes Irma and María.
Methods:A retrospective cohort study among a clinic-based sample of women with gynecological cancer diagnosed between January 2016 and September 2017 (n = 112) was done. Women were followed from their diagnosis until December 2019, to assess vital status. Kaplan-Meier survival curves and Cox proportional hazards models were performed.
Results:Mean age was 56 (± 12.3) years; corpus uteri (58.9%) was the most common gynecologic cancer. Predominant treatments were surgery (91.1%) and chemotherapy (44.6%). Overall, 75.9% were receiving treatment before the hurricanes, 16.1% experienced treatment interruptions, and 8.9% died during the follow-up period. Factors associated with treatment interruption in bivariate analysis included younger age (≤55 years), having regional/distant disease, and receiving > 1 cancer treatment (P < 0.05). Crude analysis revealed an increased risk of death among women with treatment interruption (HR: 3.88, 95% CI: 1.09-13.77), persisting after adjusting for age and cancer stage (HR: 2.49, 95% CI: 0.69-9.01).
Conclusions:Findings underscore the detrimental impact of treatment interruption on cancer survival in the aftermath of hurricanes, emphasizing the need for emergency response plans for this vulnerable population.
425 Anifrolumab for the treatment of refractory cutaneous lupus erythematosus in patients: interim analysis of real-world outcomes
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- Oluwadamilola Oke, Rochelle L. Castillo, Kimberly B. Hashemi, Ahmad Rajeh, Laura I. Ortiz-López, Karla M. Santiago-Soltero, Neda Shahriari, Avery H. LaChance, Katharina S. Shaw, Ruth Ann Vleugels
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- Journal:
- Journal of Clinical and Translational Science / Volume 8 / Issue s1 / April 2024
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- 03 April 2024, pp. 126-127
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OBJECTIVES/GOALS: * Patients with skin of color (SOC) are disproportionately affected by systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE). In this study, we aim to address this disparity and characterize the real-world efficacy and tolerability of anifrolumab in CLE patients using validated disease activity instruments. METHODS/STUDY POPULATION: This single-center, prospective observational cohort study includes SLE patients with severe or refractory CLE who have received ≥ 1 dose of anifrolumab. Cutaneous disease activity is assessed periodically at 2, 6, 9, 12, and 18 months using the Cutaneous Lupus Disease Area and Severity Index (CLASI). Adverse events and concurrent treatments are also routinely evaluated. To date, 22 patients have been enrolled, with 6-month follow-up data available for 15. At the time of anifrolumab initiation, 95% of participants had discoid LE (DLE), 60% had mucosal DLE, and 13% had subacute CLE. Nine patients identified as SOC, two as White, and four did not report race/ethnicity. RESULTS/ANTICIPATED RESULTS: A Friedman test showed statistically significant changes over time in CLASI activity score (CLASI-A) (χ2(2) =20, p<0.0001) (Figure 1) and CLASI damage score (CLASI-D) (χ2(2) =9.5789, p=0.0083) (Figure. To estimate effect sizes, we employed linear mixed models, which demonstrated statistically significant reductions in the CLASI-A score from baseline by an average of 14 points at 2 months (p<0.001) and 18 points at 6 months (p<0.001); notably, a reduction in CLASI-A of 4 is considered clinically meaningful. At 2 months, 20% of patients experienced a 50% or more reduction in CLASI, which increased to 60% of patients at 6 months. Patients on systemic corticosteroids could taper off. Adverse events were minimal and did not lead to treatment discontinuation. Fig. 1:[blob:https://acts.slayte.com/045319b4-7272-4351-a771-78ba9ee57f5c] Fig. 2:[blob:https://acts.slayte.com/67df7653-0cd8-4e8e-a3e1-d5c565b19dce] DISCUSSION/SIGNIFICANCE: As SOC patients with CLE have significant potential for permanent pigmentary alternations, early treatment is imperative. Effective treatments for refractory CLE are elusive. Our study represents the largest single-center cohort of CLE patients treated with anifrolumab and suggests that it is a promising therapeutic option for patients with SOC.
A proof-of concept randomized controlled trial to show that the antidepressant effect of psilocybin does not require a psychedelic experience: study protocol
- M. I. Husain, D. M. Blumberger, D. J. Castle, S. M. Kloiber, A. Ortiz, J. D. Rosenblat, B. H. Mulsant
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S557
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Introduction
During the last decade there has been a resurgence of interest on the use of psychedelics as novel treatments for mental disorders, including treatment-resistant depression (TRD). Psilocybin, the chemical component of “magic mushrooms”, has been administered with psychotherapy in randomized clinical trials (RCTs) showing large and sustained antidepressant effects. As the use of psilocybin expands, it is becoming more important to understand whether psilocybin’s psychedelic effects are required for psilocybin’s antidepressant effects. Psilocybin’s psychedelic effects are known to be dependent on serotonin 2A receptor (5-HT2AR) activation. Given the safety concerns associated with psilocybin’s psychedelic effects, all studies have used it in conjunction with at least 12 hours of intensive psychotherapy. This makes psilocybin-assisted psychotherapy (PAP) highly resource intensive and impedes scalability given limited resources and access to trained therapists in most jurisdictions. Studies in healthy volunteers have shown that psilocybin’s psychedelic effects are blocked by 5-HT2AR antagonists like risperidone and ketanserin. In a pre-clinical study using a mouse model of depression, administration of ketanserin followed by psilocybin had the same antidepressant effect as psilocybin alone. We propose to conduct the first study to test in humans whether the antidepressant effects of psilocybin are attenuated by 5-HT2AR blockade from risperidone.
ObjectivesAim 1: To evaluate the feasibility and tolerability of administering psilocybin with risperidone in adults with TRD by evaluating recruitment, retention, tolerability, and safety.
Aim 2: To evaluate psychedelic effects (measured with the 5-Dimensional Altered States of Consciousness Rating Scale) in the three groups.
Aim 3: To evaluate antidepressant effects (measured with the Montgomery Asberg Depression Rating Scale; MADRS) in the three groups. .
MethodsA three-arm, 4-week, double blind, proof-of-concept RCT for patients with a DSM-5 major depressive episode that has failed to respond to at least two adequate trials of antidepressants. Participants will be randomized to: 1) psilocybin 25 mg plus risperidone 1 mg; 2) psilocybin 25 mg plus placebo; 3) placebo plus risperidone 1 mg. All participants will receive 12 hours of manualized psychotherapy.
ResultsEthics approval for the proposed study has been obtained. We will present preliminary feasibility data at the meeting in March.
ConclusionsIf the study demonstrates that psilocybin’s psychedelic effects are not necessary for psilocybin’s antidepressant effects, the combination of psilocybin and a 5-HT2AR antagonist, such as risperidone, could increase acceptability and access to the use of psilocybin to treat MDD and related conditions.
Disclosure of InterestNone Declared
Sociodemographic and clinical characteristics of the population with a first psychotic episode attended in the mental health services of area 5 of Madrid (Spain)
- J. Garde González, P. Herrero Ortega, A. Oliva Lozano, I. I. Louzao Rojas, M. P. Vidal-Villegas, A. Muñoz-Sanjosé, M. P. Sánchez-Castro, G. Lahera, S. Sánchez Quílez, M. F. Bravo-Ortiz, O. B. O. A.-M. Group
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S443
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Introduction
Risk of functional impairment and progression to chronic illness in people with a first episode of psychosis (FEP) has motivated early intervention programs, showing promising results. Defining the characteristics of people with FEP at local level enables the clinicians to adjust interventional models to the reality of the population. The area 5 of Madrid (Spain) is referred to La Paz University Hospital and it serves a catchment area of roughly 527,000 people.
ObjectivesWe aim to identify sociodemographic and clinical characteristics of patients in the area 5 of Madrid (Spain) who meet the criteria of FEP.
MethodsA descriptive retrospective study including 179 people (age range 18-40 years) who were attended in mental health services of La Paz University Hospital (area 5 of Madrid, Spain), between January 2019 and May 2020, having suffered a psychotic episode in the last five years.
ResultsThe average age of people with FEP was 29.32 years, with a higher proportion of men (62%). The mean duration of untreated psychosis (DUP) was 3.64 months and 47% of patients consume cannabis. We found disparities in DUP among the different districts in the area and we also observed differences depending on the district for inclusion in rehabilitation programs or psychotherapy. The following averages were obtained for the aggregate sample: 1.01 hospitalization/year, 1.42 emergency room visits/year, 1.81 years of illness and a mean dosage equivalent to olanzapine 6.75 mg/day. The incidence of psychosis in our area has been 7.01 cases per 100000 inhabitants/year.
ConclusionsThe incidence of psychosis has been as expected according to data recorded at previous studies in Spain. The results obtained in our sample have included a lower DUP and a higher use of cannabis than those described in the literature. We have also found differences when observing the inclusion of patients in different treatments (psychotherapy, rehabilitation), which may be related to the differences in the DUP by districts. Further exploration in this field is needed to draw causal conclusions.
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
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S504-S505
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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
Associations between peripheral inflammation and clinical phenotypes of bipolar depression in a lower-middle income country
- Brett D.M. Jones, Urbee Mahmood, John Hodsoll, Imran B. Chaudhry, Ameer B. Khoso, Mohammed O. Husain, Abigail Ortiz, Nusrat Husain, Benoit H. Mulsant, Allan H. Young, Muhammad I. Husain
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- CNS Spectrums / Volume 28 / Issue 6 / December 2023
- Published online by Cambridge University Press:
- 10 May 2023, pp. 710-718
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Objective
There has been increased interest in repurposing anti-inflammatories for the treatment of bipolar depression. Evidence from high-income countries suggests that these agents may work best for specific depressive symptoms in a subset of patients with biochemical evidence of inflammation but data from lower-middle income countries (LMICs) is scarce. This secondary analysis explored the relationship between pretreatment inflammatory markers and specific depressive symptoms, clinical measures, and demographic variables in participants with bipolar depression in Pakistan.
MethodsThe current study is a cross-sectional secondary analysis of a randomized controlled trial of two anti-inflammatory medications (minocycline and celecoxib) for bipolar depression (n = 266). A series of logistic and linear regression models were completed to assess the relationship between C-reactive protein (CRP) (CRP > or < 3 mg/L and log10CRP) and clinical and demographic features of interest and symptoms of depression. Baseline clinical trial data was used to extract clinical and demographic features and symptoms of depression were assessed using the 24-item Hamilton Depression Rating Scale.
ResultsThe prevalence of low-grade inflammation (CRP > 3 mg/L) in the sample was 70.9%. After adjusting for baseline body mass index, socioeconomic status, age, gender, symptoms related to anhedonia, fatigue, and motor retardation were most associated with low-grade inflammation.
ConclusionsBipolar disorder (BD) patients from LMICs may experience higher rates of peripheral inflammation than have been reported in Western populations with BD. Future trials of repurposed anti-inflammatory agents that enrich for participants with these symptom profiles may inform the development of personalized treatment for bipolar depression in LMICs.
COVID-19 after two years: trajectories of different components of mental health in the Spanish population
- I. Bayes-Marin, M. Cabello-Toscano, G. Cattaneo, J. Solana-Sánchez, D. Fernández, C. Portellano-Ortiz, J. M. Tormos, A. Pascual-Leone, D. Bartrés-Faz
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 32 / 2023
- Published online by Cambridge University Press:
- 17 April 2023, e19
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Our study aimed to (1) identify trajectories on different mental health components during a two-year follow-up of the COVID-19 pandemic and contextualise them according to pandemic periods; (2) investigate the associations between mental health trajectories and several exposures, and determine whether there were differences among the different mental health outcomes regarding these associations.
MethodsWe included 5535 healthy individuals, aged 40–65 years old, from the Barcelona Brain Health Initiative (BBHI). Growth mixture models (GMM) were fitted to classify individuals into different trajectories for three mental health-related outcomes (psychological distress, personal growth and loneliness). Moreover, we fitted a multinomial regression model for each outcome considering class membership as the independent variable to assess the association with the predictors.
ResultsFor the outcomes studied we identified three latent trajectories, differentiating two major trends, a large proportion of participants was classified into ‘resilient’ trajectories, and a smaller proportion into ‘chronic-worsening’ trajectories. For the former, we observed a lower susceptibility to the changes, whereas, for the latter, we noticed greater heterogeneity and susceptibility to different periods of the pandemic. From the multinomial regression models, we found global and cognitive health, and coping strategies as common protective factors among the studied mental health components. Nevertheless, some differences were found regarding the risk factors. Living alone was only significant for those classified into ‘chronic’ trajectories of loneliness, but not for the other outcomes. Similarly, secondary or higher education was only a risk factor for the ‘worsening’ trajectory of personal growth. Finally, smoking and sleeping problems were risk factors which were associated with the ‘chronic’ trajectory of psychological distress.
ConclusionsOur results support heterogeneity in reactions to the pandemic and the need to study different mental health-related components over a longer follow-up period, as each one evolves differently depending on the pandemic period. In addition, the understanding of modifiable protective and risk factors associated with these trajectories would allow the characterisation of these segments of the population to create targeted interventions.
Burden of infectious disease studies in Europe and the United Kingdom: a review of methodological design choices
- Periklis Charalampous, Juanita A. Haagsma, Lea S. Jakobsen, Vanessa Gorasso, Isabel Noguer, Alicia Padron-Monedero, Rodrigo Sarmiento, João Vasco Santos, Scott A. McDonald, Dietrich Plass, Grant M. A. Wyper, Ricardo Assunção, Elena von der Lippe, Balázs Ádám, Ala'a AlKerwi, Jalal Arabloo, Ana Lúcia Baltazar, Boris Bikbov, Maria Borrell-Pages, Iris Brus, Genc Burazeri, Serafeim C. Chaintoutis, José Chen-Xu, Nino Chkhaberidze, Seila Cilovic-Lagarija, Barbara Corso, Sarah Cuschieri, Carlotta Di Bari, Keren Dopelt, Mary Economou, Theophilus I. Emeto, Peter Fantke, Florian Fischer, Alberto Freitas, Juan Manuel García-González, Federica Gazzelloni, Mika Gissler, Artemis Gkitakou, Hakan Gulmez, Sezgin Gunes, Sebastian Haller, Romana Haneef, Cesar A. Hincapié, Paul Hynds, Jane Idavain, Milena Ilic, Irena Ilic, Gaetano Isola, Zubair Kabir, Maria Kamusheva, Pavel Kolkhir, Naime Meriç Konar, Polychronis Kostoulas, Mukhtar Kulimbet, Carlo La Vecchia, Paolo Lauriola, Miriam Levi, Marjeta Majer, Enkeleint A. Mechili, Lorenzo Monasta, Stefania Mondello, Javier Muñoz Laguna, Evangelia Nena, Edmond S. W. Ng, Paul Nguewa, Vikram Niranjan, Iskra Alexandra Nola, Rónán O'Caoimh, Marija Obradović, Elena Pallari, Mariana Peyroteo, Vera Pinheiro, Nurka Pranjic, Miguel Reina Ortiz, Silvia Riva, Cornelia Melinda Adi Santoso, Milena Santric Milicevic, Tugce Schmitt, Niko Speybroeck, Maximilian Sprügel, Paschalis Steiropoulos, Aleksandar Stevanovic, Lau Caspar Thygesen, Fimka Tozija, Brigid Unim, Hilal Bektaş Uysal, Orsolya Varga, Milena Vasic, Rafael José Vieira, Vahit Yigit, Brecht Devleesschauwer, Sara M. Pires
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- Epidemiology & Infection / Volume 151 / 2023
- Published online by Cambridge University Press:
- 09 January 2023, e19
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This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and grey literature were searched for articles reporting the assessment of DALY and its components. We considered studies in which researchers performed DALY calculations using primary epidemiological data input sources. We screened 3053 studies of which 2948 were excluded and 105 studies met our inclusion criteria. Of these studies, 22 were multi-country and 83 were single-country studies, of which 46 were from the Netherlands. Food- and water-borne diseases were the most frequently studied infectious diseases. Between 2015 and 2022, the number of burden of infectious disease studies was 1.6 times higher compared to that published between 2000 and 2014. Almost all studies (97%) estimated DALYs based on the incidence- and pathogen-based approach and without social weighting functions; however, there was less methodological consensus with regards to the disability weights and life tables that were applied. The number of burden of infectious disease studies undertaken across Europe has increased over time. Development and use of guidelines will promote performing burden of infectious disease studies and facilitate comparability of the results.
Mental health service requirements after hospitalization due to COVID-19: a 1- year follow-up study
- J. Andreo Jover, M.P. Vidal-Villegas, R. Mediavilla, I. Louzao Rojas, S. Cebolla Lorenzo, E. Fernández Jiménez, A. Muñoz-Sanjosé, M.F. Bravo-Ortiz, G. Martinez-Ales, C. Bayón-Pérez
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S381
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Introduction
Long-term COVID-19 effects has been recently described as persistent and prolonged symptoms after an acute and severe SARS-COV-2 (1). An important concern is that the sequelae of severe COVID-19 may suppose a substantial outpatient 's burden for the specialized services in reopening pandemic phase (2).
ObjectivesTo describe the frequency of mental health service use in COVID-19 hospitalized patients after discharge and to estimate the costs associated to the post- discharge consultations.
MethodsWe used a 1-year follow-up cohort of 1455 COVID-19 inpatients hospitalized in La Paz University Hospital of Madrid, Spain between March 16th and April 15th, 2020. Data were retrieved from Psychiatry Service (PS) electronic health records and we described the frequency of mental health reason for consultation. We used information published by the Madrid health Office to estimate the cost of initial and following appointments.
ResultsOur sample consisted of 1,455 patients admitted with a COVID-19 diagnosis between March 16th and April 15th, 2020, and then discharged. Roughly half of them were men (776, 53%), 238 (16%) had a prior history of mental health problems, and 44 (3%) died. 193 participants (13%) visited the mental health department after being discharged. The total cost was estimated in 103,581 USD, of which two-thirds corresponded to patients with prior history of mental health problems.
ConclusionsOur results indicate that the mental health burden of severe COVID-19 inpatient s after discharge was substantial during the first year of follow-up. This generate important economic impact to mental health providers and society at large.
DisclosureNo significant relationships.
Differences in physical activity in subjects with psychosis versus a control group
- A.L. Montejo, B. Buch, M.J. López, M.T. Arias, M.D. Corrales, E. Dominguez, C. Matos, B. Cortés, Y. Santana, I. Valrriberas, J. Matías, T. Prieto, M. Gómez-Marcos, L. García-Ortiz, J.M. Acosta
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S763
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Introduction
Psychiatric illnesses are related with a reduced life expectancy and an increase of mortality rates (around 60%) mainly associated with cardiovascular diseases [1]. The high prevalence of obesity, metabolic syndrome, diabetes mellitus and tobacco use among these patients undoubtelly predispose to the impairment in physical health and mortaility increase. Regular physical activity in the general population is associated with a decrease in cardiovascular risk but litle is know about iss influence in some chronic and severe mental disorders like schizophrenia [2].
ObjectivesTo quantify the physical activity performed by a sample of subjects with psychosis, borth males and female, compared to a control group.
MethodsA sample composed of 141 patients with schizoprenia was compared to 103 healthy subjects as a control group. The International Physical Activity Questionnaire - Short Form (IPAQ) scale was applied to all participants. The time (minutes) of physical activity performed in a week (METs) was collected by each participant [3].
ResultsThe differences in the total physical activity Mets for the patients with schizophrenia were highly significant (p = 0.001), showing a lower degree of physical activity compared to the control group. A higher and significant percentage of sedentary lifestyle among the psychiatric group (64.5%), compared to 35.5% in the control group was found.
ConclusionsThe group of pateints with Schizophrenia showed a significant higher sedentary lifestile including less physical activity. This finding could be highly related with a higher risk of cardiovascular disease and deterioration of the physical health.
DisclosureNo significant relationships.
Characterisation of age and polarity at onset in bipolar disorder
- Janos L. Kalman, Loes M. Olde Loohuis, Annabel Vreeker, Andrew McQuillin, Eli A. Stahl, Douglas Ruderfer, Maria Grigoroiu-Serbanescu, Georgia Panagiotaropoulou, Stephan Ripke, Tim B. Bigdeli, Frederike Stein, Tina Meller, Susanne Meinert, Helena Pelin, Fabian Streit, Sergi Papiol, Mark J. Adams, Rolf Adolfsson, Kristina Adorjan, Ingrid Agartz, Sofie R. Aminoff, Heike Anderson-Schmidt, Ole A. Andreassen, Raffaella Ardau, Jean-Michel Aubry, Ceylan Balaban, Nicholas Bass, Bernhard T. Baune, Frank Bellivier, Antoni Benabarre, Susanne Bengesser, Wade H Berrettini, Marco P. Boks, Evelyn J. Bromet, Katharina Brosch, Monika Budde, William Byerley, Pablo Cervantes, Catina Chillotti, Sven Cichon, Scott R. Clark, Ashley L. Comes, Aiden Corvin, William Coryell, Nick Craddock, David W. Craig, Paul E. Croarkin, Cristiana Cruceanu, Piotr M. Czerski, Nina Dalkner, Udo Dannlowski, Franziska Degenhardt, Maria Del Zompo, J. Raymond DePaulo, Srdjan Djurovic, Howard J. Edenberg, Mariam Al Eissa, Torbjørn Elvsåshagen, Bruno Etain, Ayman H. Fanous, Frederike Fellendorf, Alessia Fiorentino, Andreas J. Forstner, Mark A. Frye, Janice M. Fullerton, Katrin Gade, Julie Garnham, Elliot Gershon, Michael Gill, Fernando S. Goes, Katherine Gordon-Smith, Paul Grof, Jose Guzman-Parra, Tim Hahn, Roland Hasler, Maria Heilbronner, Urs Heilbronner, Stephane Jamain, Esther Jimenez, Ian Jones, Lisa Jones, Lina Jonsson, Rene S. Kahn, John R. Kelsoe, James L. Kennedy, Tilo Kircher, George Kirov, Sarah Kittel-Schneider, Farah Klöhn-Saghatolislam, James A. Knowles, Thorsten M. Kranz, Trine Vik Lagerberg, Mikael Landen, William B. Lawson, Marion Leboyer, Qingqin S. Li, Mario Maj, Dolores Malaspina, Mirko Manchia, Fermin Mayoral, Susan L. McElroy, Melvin G. McInnis, Andrew M. McIntosh, Helena Medeiros, Ingrid Melle, Vihra Milanova, Philip B. Mitchell, Palmiero Monteleone, Alessio Maria Monteleone, Markus M. Nöthen, Tomas Novak, John I. Nurnberger, Niamh O'Brien, Kevin S. O'Connell, Claire O'Donovan, Michael C. O'Donovan, Nils Opel, Abigail Ortiz, Michael J. Owen, Erik Pålsson, Carlos Pato, Michele T. Pato, Joanna Pawlak, Julia-Katharina Pfarr, Claudia Pisanu, James B. Potash, Mark H Rapaport, Daniela Reich-Erkelenz, Andreas Reif, Eva Reininghaus, Jonathan Repple, Hélène Richard-Lepouriel, Marcella Rietschel, Kai Ringwald, Gloria Roberts, Guy Rouleau, Sabrina Schaupp, William A Scheftner, Simon Schmitt, Peter R. Schofield, K. Oliver Schubert, Eva C. Schulte, Barbara Schweizer, Fanny Senner, Giovanni Severino, Sally Sharp, Claire Slaney, Olav B. Smeland, Janet L. Sobell, Alessio Squassina, Pavla Stopkova, John Strauss, Alfonso Tortorella, Gustavo Turecki, Joanna Twarowska-Hauser, Marin Veldic, Eduard Vieta, John B. Vincent, Wei Xu, Clement C. Zai, Peter P. Zandi, Psychiatric Genomics Consortium (PGC) Bipolar Disorder Working Group, International Consortium on Lithium Genetics (ConLiGen), Colombia-US Cross Disorder Collaboration in Psychiatric Genetics, Arianna Di Florio, Jordan W. Smoller, Joanna M. Biernacka, Francis J. McMahon, Martin Alda, Bertram Müller-Myhsok, Nikolaos Koutsouleris, Peter Falkai, Nelson B. Freimer, Till F.M. Andlauer, Thomas G. Schulze, Roel A. Ophoff
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- Journal:
- The British Journal of Psychiatry / Volume 219 / Issue 6 / December 2021
- Published online by Cambridge University Press:
- 25 August 2021, pp. 659-669
- Print publication:
- December 2021
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Background
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
AimsTo examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
MethodGenome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
ResultsEarlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
ConclusionsAAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
Higher illness burden is associated with reduced heart rate variability in bipolar disorder
- A. Ortiz, I. Husain, P. Moorti, M. Alda, M. Sanches, B. Mulsant
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, pp. S76-S77
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Introduction
Bipolar disorder (BD) is associated with premature death and ischemic heart disease is the main cause of excess mortality. The predictive power of heart rate variability (HRV) for mortality has been confirmed in patients with or without cardiovascular disease. While several studies have analyzed the association between HRV and BD, their results are incongruent; and none has analyzed the effect of the clinical factors characterizing illness burden on HRV.
ObjectivesTo assess the association between HRV and the following factors characterizing illness burden: illness duration, number and type of previous episode(s), duration of the most severe depressive or hypomanic/manic episode, severity of episodes, co-morbid psychiatric disorders, family history of BD or suicide, and duration and polarity of current episode in participants experiencing one.
MethodsWe used a wearable device in 53 BD participants to assess the association between HRV using 4 measures (RMSSD, SDANN, SDNN and RR Triangular Index) and the abovementioned clinical factors characterizing illness burden. For each of the 4 HRV measures we ran 11 models, one for each burden of illness clinical factor as an independent variable.
ResultsLonger illness duration, higher number of depressive episodes, and family history of suicide were negatively correlated with HRV; in the 14 participants experiencing a depressive episode, the MADRS score was negatively correlated with HRV
ConclusionsOur study analyzed the association between burden of illness and HRV in BD, while controlling for functional cardiovascular status, age, sex, BMI, education, and treatment. Our results showed that high illness burden is associated with reduced HRV.
DisclosureNo significant relationships.
Mineralization of bagged pruning waste in agrosystem on the subtropical coast of Andalusia (Spain)
- M. P. Reyes-Martín, M. L. Martínez-Cartas, I. Ortiz-Bernad, L. M. San-Emeterio, E. Fernández-Ondoño
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- Journal:
- The Journal of Agricultural Science / Volume 158 / Issue 8-9 / November 2020
- Published online by Cambridge University Press:
- 18 March 2021, pp. 634-645
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Spreading of pruning waste over the soil surface may increase soil organic carbon, thus improving soil physical properties and serving as a source of nutrients and energy for microbial populations. The aim of this study was to test the effect of the environmental conditions and the biochemical composition of pruning waste from avocado, cherimoya, mango and gardens on their decomposition process in a Mediterranean subtropical climate. Bagged pruning and garden waste were placed on the ground at a distance of 1 m around the trunk of the three trees from each crop. The concentrations in C, N, lignin, cellulose, hemicellulose, other extracts and ash were determined at the beginning of the experiment (T0), after six (T6) and 24 (T24) months in the field. Initially, significant differences were detected for all types of waste, especially in lignin, hemicellulose, cellulose and other extracts. No significant differences were found in the N content and the C content in mango pruning waste was significantly lower than that in avocado. The greatest weight loss recorded at T24 (63.2%) was related to the lower content in lignin, cellulose and other extracts. Weight losses and C concentrations showed negative correlations with lignin content. Despite the intense decomposition of all the waste, between 55 and 36.8% of the original weights were recorded at the end of the experiment. Recalcitrant C could be the result of the lignin concentrating in the case of the garden waste applied to the different crops.
Ten - Policy Analysis in the Health Sector in Colombia
- Edited by Pablo Sanabria-Pulido, Nadia Rubaii
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- Policy Analysis in Colombia
- Published by:
- Bristol University Press
- Published online:
- 10 March 2021
- Print publication:
- 30 September 2020, pp 169-186
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Summary
Introduction
In 1993, Colombia overhauled its health system, transitioning from a national health system to a social health insurance system. This change represented important improvements in the way healthcare was provided as it expanded healthcare coverage, enhanced private sector participation, increased the flow of resources to the system and improved quality of healthcare in high-end urban hospitals (Giedion and Uribe, 2009; Vecino-Ortiz et al, 2018). Nonetheless, the reform came at a cost. It placed a focus on healthcare at the expense of essential public health functions (Jaramillo Pérez, 1999, p. 100; Rigoli and Dussault, 2003; Yepes, 2010; Vecino-Ortiz et al, 2018).
The reform also worked under the expectation that formal sector participation would increase within ten years, and that competition among private insurers would work as in any competitive market (Ruiz, 2018). Some of these assumptions proved to be incorrect and the accumulation of unaddressed market failures, persistently high numbers of informal workers, and a generous plan of benefits led to an imbalance between health system revenues and costs (Gaviria et al, 2006; Calderon-Mejia and Marinescu, 2012; Peñaloza et al, 2012; Vecino-Ortiz et al, 2018), placing the system at a high financial risk.
Both successes and challenges of the health system combined with increasing technical capacity in public sector institutions led the health sector to start approaching the policy process in a more formal fashion through policy analysis, to better inform policy options.
In this chapter, we discuss the development of policy analysis studies in the Colombian health sector since the health reform in 1993, and the heterogeneity of such development across different health sector institutions in the country. The chapter assesses how policy analysis in the health sector evolved over time, highlighting the divergent development in national-level and local-level institutions (Collins, 2005).
To develop the chapter, we conducted document reviews and six interviews with current and former high level officials from the Ministry of Health/Ministry of Social Protection (a merger between the Ministry of Health and Ministry of Labor between 2002 and 2011) and its related agencies.
Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries
- D. Wasserman, G. Apter, C. Baeken, S. Bailey, J. Balazs, C. Bec, P. Bienkowski, J. Bobes, M. F. Bravo Ortiz, H. Brunn, Ö. Bôke, N. Camilleri, B. Carpiniello, J. Chihai, E. Chkonia, P. Courtet, D. Cozman, M. David, G. Dom, A. Esanu, P. Falkai, W. Flannery, K. Gasparyan, G. Gerlinger, P. Gorwood, O. Gudmundsson, C. Hanon, A. Heinz, M. J. Heitor Dos Santos, A. Hedlund, F. Ismayilov, N. Ismayilov, E. T. Isometsä, L. Izakova, A. Kleinberg, T. Kurimay, S. Klæbo Reitan, D. Lecic-Tosevski, A. Lehmets, N. Lindberg, K. A. Lundblad, G. Lynch, C. Maddock, U.F. Malt, L. Martin, I. Martynikhin, N. O. Maruta, F. Matthys, R. Mazaliauskiene, G. Mihajlovic, A. Mihaljevic Peles, V. Miklavic, P. Mohr, M. Munarriz Ferrandis, M. Musalek, N. Neznanov, G. Ostorharics-Horvath, I. Pajević, A. Popova, P. Pregelj, E. Prinsen, C. Rados, A. Roig, M. Rojnic Kuzman, J. Samochowiec, N. Sartorius, Y. Savenko, O. Skugarevsky, E. Slodecki, A. Soghoyan, D. S. Stone, R. Taylor-East, E. Terauds, C. Tsopelas, C. Tudose, S. Tyano, P. Vallon, R. J. Van der Gaag, P. Varandas, L. Vavrusova, P. Voloshyn, J. Wancata, J. Wise, Z. Zemishlany, F. Öncü, S. Vahip
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- Journal:
- European Psychiatry / Volume 63 / Issue 1 / 2020
- Published online by Cambridge University Press:
- 24 August 2020, e82
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Background.
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
Methods.The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
Results.We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
Conclusions.We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
Cocoa-rich chocolate and body composition in postmenopausal women: a randomised clinical trial
- Irene A. Garcia-Yu, Luis Garcia-Ortiz, Manuel A. Gomez-Marcos, Emiliano Rodriguez-Sanchez, Cristina Lugones-Sanchez, Jose A. Maderuelo-Fernandez, Jose I. Recio-Rodriguez
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- Journal:
- British Journal of Nutrition / Volume 125 / Issue 5 / 14 March 2021
- Published online by Cambridge University Press:
- 04 August 2020, pp. 548-556
- Print publication:
- 14 March 2021
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During menopause, women undergo a series of physiological changes that include a redistribution of fat tissue. This study was designed to investigate the effect of adding 10 g of cocoa-rich chocolate to the habitual diet of postmenopausal women daily on body composition. We conducted a 6-month, two-arm randomised, controlled trial. Postmenopausal women (57·2 (sd 3·6) years, n 132) were recruited in primary care clinics. Participants in the control group (CG) did not receive any intervention. Those of the intervention group (IG) received 10 g daily of 99 % cocoa chocolate in addition to their habitual diet for 6 months. This quantity comprises 247 kJ (59 kcal) and 65·4 mg of polyphenols. The primary outcomes were the between-group differences in body composition variables, measured by impendancemetry at the end of the study. The main effect of the intervention showed a favourable reduction in the IG with respect to the CG in body fat mass (–0·63 kg (95 % CI –1·15, –0·11), P = 0·019; Cohen’s d = –0·450) and body fat percentage (–0·79 % (95 % CI –1·31, –0·26), P = 0·004; Cohen’s d = –0·539). A non-significant decrease was also observed in BMI (–0·20 kg/m2 (95 % CI –0·44, 0·03), P = 0·092; Cohen’s d = –0·345). Both the body fat mass and the body fat percentage showed a decrease in the IG for the three body segments analysed (trunk, arms and legs). Daily addition of 10 g of cocoa-rich chocolate to the habitual diet of postmenopausal women reduces their body fat mass and body fat percentage without modifying their weight.