Achieving sustainability on the ground poses a challenge in decoding globally defined goals, such as sustainable development goals, and aligning them with local perspectives and realities. This decoding necessitates the understanding of the multifaceted dimensions of the sustainability challenges in a given context, including their underlying causes. In case studies from Brazilian drylands, we illustrate how an enhanced multiscale participatory method, combined with systems thinking tools, can shed light on systemic structures that currently entrench unsustainable development trajectories. This method offers insights into co-designing potential pathways toward sustainable futures and unlocking transformative capacities of the local population.

Translating United Nations global sustainable development goals (SDGs) into actions that address local realities and aspirations is an urgent challenge. It requires new thinking and approaches that foster the discussion about the main challenges to implementing the SDGs at multiple levels. This paper presents a novel multiscale participatory approach that combines the popular Three Horizons diagram with the formalism of causal loop diagrams in systems thinking. We present results from six multi-stakeholder dialogues held across drylands in Brazil with a focus on desired futures aligned with SDGs. Focusing on identifying the root causes and systemic structures of unsustainability, participants identified lock-ins, leverage points, and interventions for how these could be changed. The core lock-ins are the discontinuity of public policies, and the historical land and power concentration reinforced by the current expansion of large-scale agricultural, mining, and energy projects. The proposed interventions are structural and – if implemented – would contribute to achieving SDGs in an integrated manner. The unique approach developed in this study can provide leverage as it bridges the inclusivity of participatory visioning with the change potential of systems thinking tools to tackle root causes and unleash societal transformations.

We are not achieving SDGs. Understanding root causes of unsustainability is critical to move toward sustainable and just futures.

Electroanatomic mapping (EAM) has been shown to be an alternative procedure to fluoroscopy for the implantation of conduction system pacing (His-bundle pacing [HBP] and left bundle branch pacing [LBBP]) in patients with severe bradyarrhythmias, mainly those vulnerable to ionizing radiation. However, the evidence of its beneficial and harmful effects has not been assessed in a systematic review (SR).

An SR of the available scientific literature was conducted on the safety, effectiveness, and cost-effectiveness of implantation of the HBP and LBBP using EAM system versus fluoroscopy in patients with bradycardia with an indication for pacing therapy. Cochrane methodology and PRISMA statement for reporting were followed. A partial economic evaluation was carried out to compare the costs of both pacemaker implantation strategies from the perspective of the Spanish National Health System. A budget impact analysis was also conducted with a five-year horizon.

Seven comparative observational studies (N=259) analyzing the use of EAM versus fluoroscopy were selected. Statistically significant differences were observed in total fluoroscopy time: −9.87 minutes (95% confidence interval [CI]: −14.20, −5.53; p<0.01; I2=95%; k=7; n=231); His-lead fluoroscopic time: −8.08 minutes (95% CI: −10.36, −5.81; p<0.01; I2=0%; k=2; n=50); and His-lead radiation dose: −17.21 mGy (95% CI: −24.08, −10.34; p<0.01; k=1; n=20). No differences in total radiation dose, procedural success, immediate procedure-related complications, electrode revision, or device infection were found. The use of EAM represents an increase of EUR1,397.81 (USD1,513.88) per patient and a net budget impact of EUR1.63 million (USD1.77 million).

No differences between EAM and fluoroscopy in terms of procedure success and safety were found. Therefore, EAM is a valuable alternative for patients who should not be exposed to ionizing radiation. The inclusion of EAM systems, for the indication under study, in routine clinical practice would mean an increase in costs for the Spanish National Health System.

The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.

The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.

About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15–20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.

The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

The coronavirus disease 2019 (COVID-19) has serious physiological and psychological consequences. The long-term (>12 weeks post-infection) impact of COVID-19 on mental health, specifically in older adults, is unclear. We longitudinally assessed the association of COVID-19 with depression symptomatology in community-dwelling older adults with metabolic syndrome within the framework of the PREDIMED-Plus cohort.

Participants (n = 5486) aged 55–75 years were included in this longitudinal cohort. COVID-19 status (positive/negative) determined by tests (e.g. polymerase chain reaction severe acute respiratory syndrome coronavirus 2, IgG) was confirmed via event adjudication (410 cases). Pre- and post-COVID-19 depressive symptomatology was ascertained from annual assessments conducted using a validated 21-item Spanish Beck Depression Inventory-II (BDI-II). Multivariable linear and logistic regression models assessed the association between COVID-19 and depression symptomatology.

COVID-19 in older adults was associated with higher post-COVID-19 BDI-II scores measured at a median (interquartile range) of 29 (15–40) weeks post-infection [fully adjusted β = 0.65 points, 95% confidence interval (CI) 0.15–1.15; p = 0.011]. This association was particularly prominent in women (β = 1.38 points, 95% CI 0.44–2.33, p = 0.004). COVID-19 was associated with 62% increased odds of elevated depression risk (BDI-II ≥ 14) post-COVID-19 when adjusted for confounders (odds ratio; 95% CI 1.13–2.30, p = 0.008).

COVID-19 was associated with long-term depression risk in older adults with overweight/obesity and metabolic syndrome, particularly in women. Thus, long-term evaluations of the impact of COVID-19 on mental health and preventive public health initiatives are warranted in older adults.

To study the respiratory patterns and the hemodynamic variations related to postural changes in inpatients with coronavirus disease (COVID-19).

This report is a prospective study in a cohort of inpatients admitted with COVID-19. We recruited 10 patients admitted to the hospital with moderate or severe COVID-19 who showed improvement in oxygen saturation with prone positioning. We performed cardiorespiratory polygraphy and hemodynamic evaluations by thoracic electrical bioimpedance.

We observed a median minimum oxygen saturation of 85.00% (IQR: 7.00) in the supine position versus 91.00% (IQR: 8.00) (P = 0.173) in the prone position. The airflow restriction in the supine position was 2.70% (IQR: 6.55) versus 1.55% (IQR: 2.80) (P = 0.383) in the prone position. A total of 36.4% of patients were classified as having a normo-hemodynamic state in the supine position, whereas 54.5% were classified in this group in the prone position (P = 0.668). A decrease in vascular resistance was observed in the prone position (18.2% of vasoconstriction) compared to the supine position (36.4% of vasoconstriction) (P = 0.871).

This brief report describes the effects of prone positioning on respiratory and hemodynamic variables in 10 patients with moderate or severe COVID-19.

This study aimed to determine the long-term mortality (one-year follow-up) associated with patients transferred by Emergency Medical Services (EMS), and to reveal the determinants (causes and risk factors).

This was a multicenter, prospective, observational, controlled, ambulance-based study of adult patients transferred by ambulance to emergency departments (EDs) from October 2019 through July 2021 for any cause. A total of six Advanced Life Support (ALS) units, 38 Basic Life Support (BLS) units, and five hospitals from Spain were included. Physiological, biochemical, demographic, and reasons for transfer variables were collected. A longitudinal analysis was performed to determine the factors associated to long-term mortality (any cause).

The final cohort included 1,406 patients. The one-year mortality rate was 21.6% (n = 304). Mortality over the first two days reached 5.2% of all the patients; between Day 2 and Day 30, reached 5.3%; and between Day 31 and Day 365, reached 11.1%. Low Glasgow values, elevated lactate levels, elevated blood urea nitrogen (BUN) levels, low oxygen saturation, high respiratory rate, as well as being old and suffering from circulatory diseases and neurological diseases were risk factors for long-term mortality.

The quick identification of patients at risk of long-term worsening could provide an opportunity to customize care through specific follow-up.

The consequences for the COVID-19 pandemic in the newborns of affected mothers remains unknown. Previous clinical experiences with other infections during pregnancy lead to considered pregnant women and their offspring especially vulnerable for SARS-COV-2. That is, the underlying physiopathological changes caused by the infection (e.g. storm of cytokines, micro-coagulation in placenta or vertical transmission) could clearly compromise fetal neurodevelopment.

To analyze the impact of maternal SARS-COV-2 infection during pregnancy in early neurodevelopment of infants gestated during the COVID-19 pandemic period compared to those gestated immediately prior (2017-2021).

212 pregnant women (14% infected) were followed throughout their pregnancy and postpartum, including newborn development. SARS-COV-2 infection was serologically confirmed during pregnancy. The Brazelton Neonatal Assessment Scale (NBAS) was administered at 6 weeks old by a trained neonatologist to evaluate neurological, social and behavioral aspects of newborn’s functioning. Differences in NBAS scores between cases and controls were tested by ANOVAs. All the analysis were adjusted for maternal age, sociodemographic status, anxious-depressive symptomatology, infant’s sex and gestational age at birth and NBAS, and for the period of gestation (previous or during COVID-19 pandemic).

NBAS social interactive dimension was significantly decreased in those infants exposed to prenatal SARS-COV-2 (F=4.248, p=.043), particularly when the infection occurred before the week 20 of gestation. Gestation during COVID-19 pandemic did not alter NBAS subscales.

SARS-COV-2 infection during pregnancy seems to be associated with lower NBAS scores on social dimension in 6 weeks old exposed newborns.

No significant relationships.

Cultural differences influence understanding and therapeutic adherence of migrant patients, therefore it is very important to acquire cultural competence.

The objective of this paper is to study, from the following case, the effect of cultural competence in approach to psychosis in migrant patients.

A bibliographic search was performed from different database (Pubmed, TripDatabase) about the influence of culture on psychosis and its resolution. A 25-year-old Moroccan man who came to Spain two years ago fleeing his country and suffered violence in different countries until he arrived. He lived on the street until they offered him a sheltered house with other Moroccans. He felt lack of acceptance and loss of his roots. In this context, he developed a first psychotic episode in which he described “the presence of a devil”.

He distrusted antipsychotic treatment and believed “that devil” was still inside him, being convinced that he needed a Muslim healer to expel him. We followed up with the patient and a cultural mediator, better understanding his cultural reality, uprooting and traumas, and he could feel understood and trust us. During the process, he decided to go to the Muslim healer who performed a symbolic rite for which he felt he “expelled the devil”, while accepting antipsychotics. With all this, the psychotic symptoms and their acculturation process improved.

It is very important that psychiatrists have cultural competence to understand the context of migrant patients, and to be able to provide them with the best treatment.

No significant relationships.

Levetirazetam is an antiepileptic drug with psychiatric adverse reactions. It includes psychosis, paranoia or hallucinations. The frequency is less than 1%.

To describe a case of Psychosis produced by Levetirazetam

Retrospective review of clinical records and complementary test, including psychiatry, electrophysiology and neurology. Diagnosis schales such as Salamanca Questionnaire were used as suport.

A 42-year-old woman diagnosed with tuberous sclerosis and undergoing treatment with levetirazetam acudes to the emergency department for behavioral disorders. She has presented an episode of aggression against a relative threatening him with a kitchen knife. The family reports that since the change in antiepilepticus 1 month ago, the patient has presented strange behaviors. Te Patient is conscious, uncooperative. Barely Approachable. Suspicious of her surroundings, with psychomotor restlessness, self-reference ideas and sparse speech. Auditory hallucinations seem to be present, as well as depressed and irritable mood. Psychic and somatic anxiety is found.

Levetirazetam is discontinued, being replaced by valproic acid. Risperidone is started at a 3 mg dose. Treatment is well tolerated, and clinical stability is achived. Cluster A personality traits are found. Complementary test Blood and Urine simples, Imaging tests (CT and MRI), electroencephalogram and Electrocardiogram show no alterations

Levetirazetam can cause psychiatric adverse effects. it is important to make a proper diagnosis before a first psychotic outbreak in later life. Drugs that can produce psychiatric side effects should be identified and patients should be inform.

No significant relationships.

Psychotic symptoms are not exclusive to schizophrenia, they can be due to paranoid development and can be treated differently.

The objective of this paper is to study, from the following case, the effect of psychotherapeutic treatment in patients with paranoid development.

A bibliographic search was performed from different database (Pubmed, TripDatabase) about psychological intervention for the improvement of paranoid symptoms. 20-year-old man, born into a family with marital problems, without difficulties in psychomotor development, socialization or academic performance, who began with behavioral alterations from the age of 5 that he had begun to suffer abuse from his father, showing aggressiveness towards other children and progressively worsening over the years: consuming cannabis, isolating himself, listening to protective voices and distrusting of people, to whom he responded aggressively believing that they wanted to harm him.

Initially, he was treated with antipsychotics that were later suspended when acute psychotic symptoms were ruled out, diagnosing a paranoid development secondary to trauma, for which he had felt fear and defenselessness, and had learned to be alert and respond aggressively to everything he considered threatening, showing anger that he did not know how to express. During therapy, abstinence to drugs was worked on, therapeutic link, mentalization-based therapy, emotions, narrative techniques, trauma and systemic family therapy.

To conclude, we need to pay attention to development of pathologies like this so as not to rush with antipsychotics, when it may be due to a development secondary to trauma that needs to be treated psychotherapeutically.

No significant relationships.

To examine the cross-sectional and longitudinal (2-year follow-up) associations between dietary diversity (DD) and depressive symptoms.

An energy-adjusted dietary diversity score (DDS) was assessed using a validated FFQ and was categorised into quartiles (Q). The variety in each food group was classified into four categories of diversity (C). Depressive symptoms were assessed with Beck Depression Inventory-II (Beck II) questionnaire and depression cases defined as physician-diagnosed or Beck II >= 18. Linear and logistic regression models were used.

Spanish older adults with metabolic syndrome (MetS).

A total of 6625 adults aged 55–75 years from the PREDIMED-Plus study with overweight or obesity and MetS.

Total DDS was inversely and statistically significantly associated with depression in the cross-sectional analysis conducted; OR Q4 v. Q1 = 0·76 (95 % CI (0·64, 0·90)). This was driven by high diversity compared to low diversity (C3 v. C1) of vegetables (OR = 0·75, 95 % CI (0·57, 0·93)), cereals (OR = 0·72 (95 % CI (0·56, 0·94)) and proteins (OR = 0·27, 95 % CI (0·11, 0·62)). In the longitudinal analysis, there was no significant association between the baseline DDS and changes in depressive symptoms after 2 years of follow-up, except for DD in vegetables C4 v. C1 = (β = 0·70, 95 % CI (0·05, 1·35)).

According to our results, DD is inversely associated with depressive symptoms, but eating more diverse does not seem to reduce the risk of future depression. Additional longitudinal studies (with longer follow-up) are needed to confirm these findings.

Levetirazetam is an antiepileptic drug with psychiatric adverse reactions. It includes psychosis, paranoia or hallucinations. The frequency is less than 1%.

To describe and study a case of Psychosis produced by Levetirazetam

Retrospective review of clinical records and complementary test, including psychiatry, electrophysiology and neurology. Diagnosis schales such as Salamanca Questionnaire were used as suport.

A 42-year-old woman diagnosed with tuberous sclerosis and undergoing treatment with levetirazetam acudes to the emergency department for behavioral disorders. She has presented an episode of aggression against a relative threatening him with a kitchen knife. The family reports that since the change in antiepilepticus 1 month ago, the patient has presented strange behaviors. Te Patient is conscious, uncooperative. Barely Approachable. Suspicious of her surroundings, with psychomotor restlessness, self-reference ideas and sparse speech. Auditory hallucinations seem to be present, as well as depressed and irritable mood. Psychic and somatic anxiety is found. Levetirazetam is discontinued, being replaced by valproic acid. Risperidone is started at a 3 mg dose. Treatment is well tolerated, and clinical stability is achived. Cluster A personality traits are found. Complementary test Blood and Urine simples, Imaging tests (CT and MRI), electroencephalogram and Electrocardiogram show no alterations

Levetirazetam can cause psychiatric adverse effects. it is important to make a proper diagnosis before a first psychotic outbreak in later life. Drugs that can produce psychiatric side effects should be identified and patients should be inform.

No significant relationships.

Relapse prevention is a key objetive for patients with a First Episode Psychosis (FEP) and the low adherence to antipsychotic (AP) treatment is the main reason for relapse after a FEP.

There are no clear recommendations about the early use of long-acting injectables (LAIs) in FEP. We review the impact on hospitalization rates of the early use (earlier than 1 year after the inclusion in our Early Intervention Service “Lehenak”) of LAI paliperidone in a FEP sample.

We evaluated in a naturalistic study a sample (N=384) of patients with a FEP. We carried out a mirror-design study to compare the numer of hospitalizations before and after the introduction of LAI paliperidone (1 and 3 monthly) in early users (<1 year) vs late users (>1 year).

A total of 384 FEP patients with LAI paliperidone were assessed.

There was no difference between the early and late introduction of LAI Paliperidone in the number of hospitalizations after treatament. There was a trend to present more previous hospitalizations and days in hospital in late users. This could support an earlier use of paliperidone LAI to prevent an excess of hospitalizations due to late introduction.

The presenting author has received honouraria for lectures or advisory boards from Janssen, Otsuka, Lundbeck and Angelini in the last five years.