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Prevalence and impact of comorbid mental disorders in hospitalized patients with obstructive sleep apnea: a protocol for a nationwide retrospective study
- D. Nora, A. Freitas, L. Fernandes, A. R. Ferreira
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S720
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Introduction
Obstructive sleep apnea (OSA) is a common sleep disorder in the adult population, often associated with an increased prevalence of comorbid conditions such as obesity and diabetes, but also several mental disorders that have been independently associated with worse hospitalization outcomes in a variety of situations. However, and despite such associations, there is a relative dearth of studies exploring comorbid psychopathology beyond depression and anxiety, and no studies seem to address the impact of comorbid mental disorders on the hospitalization outcomes of patients with OSA.
ObjectivesThis study aims to characterize and compare mental comorbidities among hospitalization episodes of adult patients with and without OSA held in mainland Portugal, regardless of the primary cause of admission, and to analyze the impact of such comorbidities on hospitalization outcomes.
MethodsAn observational retrospective study will be conducted using an administrative database comprising de-identified routinely collected discharge data from all Portuguese mainland public hospitals. Inpatient episodes spanning from 2008 to 2015 will be categorized into two groups according to the presence of an OSA code (ICD-9-CM codes 780.51, 780.53, 780.57, 327.20 and 327.23). For both groups, mental disorders will be identified according to categories 650 to 670 of the Clinical Classifications Software (CCS) for ICD-9-CM. Descriptive, univariate, and multivariate analyses will be performed. Study reporting will comply with the RECORD statement guidelines.
ResultsOut of 6,072,538 sampled episodes, 57,301 have an OSA code. Prevalence of any comorbid mental disorder is 30.4% in the OSA group, and 19.3% in the non-OSA group. For both groups, sociodemographic, administrative, and clinical variables will be characterized and compared, as well as the prevalence of each mental disorder category, yearly hospitalization trends, and most common primary diagnoses. Hospitalization outcomes, including length of stay, in-hospital mortality, and readmissions, will be compared taking into consideration the presence of CCS categories of mental disorders.
ConclusionsWe expect to improve the understanding of the prevalence of mental comorbidities among hospitalized patients with OSA, including understudied mental disorders, and to elucidate their impact on relevant hospitalization outcomes, thus highlighting the need to recognize and treat this common association to achieve optimal outcomes.
Disclosure of InterestNone Declared
Clinical and Psychosocial Impact of Psychoeducational Groups for Psychosis
- F. B. F. Leitão, C. Cunha, J. Loureiro, A. Guedes, M. J. Ribeiro, C. Loureiro, J. Meira, P. Oliveira, J. R. Silva, P. M. Ferreira, A. M. Moreira
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S717-S718
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Introduction
Individuals with mental health disorders often lack access to appropriate care, including psychosocial rehabilitation programs, which are considered essential for their recovery. In 2019, as part of the intervention by the Community and Mental Health Service, at Hospital de Magalhães Lemos, we initiated a psychoeducational group for patients with psychotic spectrum disorders, with the purpose of providing our patients with comprehensive information about their condition and effective management strategies. Our 8-week program consisted of 16 sessions, including icebreaker activities, discussion of certain themes, sharing of experiences and practice of stress management techniques.
ObjectivesThe aim of this study was to assess and quantify the impact of our 2023 program.
MethodsOut of a total of 20 patients interviewed for our program in 2023, 16 began the program and 12 completed it. The program’s evaluation was based on several assessment tools, including a sociodemographic questionnaire, a knowledge assessment questionnaire, the Positive and Negative Syndrome Scale (PANSS), the Insight and Treatment Attitudes Questionnaire (ITAC), the World Health Organization Quality of Life (WHOQOL), and the Medication Adherence Rating Scale (MARS). We also created a health agenda to organize an individual plan of care.
ResultsOur findings indicated an improvement in insight and attitudes towards treatment by 8.6%, an enhancement in treatment adherence by 5%, and an increase in knowledge by 11.9%. In terms of quality of life, we observed a slight improvement in the psychological domain by 0.6% and in the social domain by 1.2%. Regarding the impact on psychotic symptomatology, there was an average decrease in 4 points in the negative subscale and in 3 points in the general psychopathology subscale, whereas the positive subscale remained unchanged. None of the patients required hospitalization during this period.
ConclusionsOur study revealed some improvement in nearly all the evaluated parameters. There was an improvement of the therapeutic relationship, which we believe has contributed to lower scores in the negative symptoms and general psychopathology subscale. As for the study limitations, we acknowledge that we will need to expand our sample through additional programs in the next years, to include it in early intervention psychosis programs and to re-evaluate our patients’ outcomes after a more extended follow-up period, particularly if they continue to participate in our monthly mutual support group. Additionally, we must consider potential study biases, including the subjectivity of PANSS evaluations and the influence of other confounding factors, such as changes in treatment regimens during the program.
Disclosure of InterestNone Declared
The impact of clinical context on the recognition of facial expressions
- C. De Sousa, S. Morgado, J. Ferreira, S. Tukaiev, R. Fonseca
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S114
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Introduction
Several authors have demonstrated the relevance of the therapist sensitivity to the affective expression of his client (Merten & Schwab, 2005; 150-158), as well as to his own emotional experience (Haynal-Raymond et al., 2005;142-148) in order to build a more effective therapeutic relationship, and results. An important source of information to decode the emotional expression hints is the face, and its expression (Ekman & Friesen, 1975; Russel & Fernández-Dolls, 1997;275-294). Despite common sense saying that context is relevant to understand the meaning of the emotional facial expression, the literature review shows inconsistent results.
ObjectivesThe main goal of this study was to evaluate the impact of clinical context over the perception of the emotional facial expression.
MethodsThis study followed a within-subjects design, and its sample consisted of 60 clinical psychologists. 21 combinations of prototypical expression images with mixed emotional signals, and clinical information texts were presented to the participants. Then their judgement on the type of emotion displayed was requested. The presentation of the text-image pairs was randomized between three conditions: consistent, and non-consistent, and neutral.
ResultsThe results suggest that emotions are more easily recognized in the presence of a concordant context than a non-concordant or neutral one, and that the greater the similarity between the facial expression of the image presented and the face prototypically associated with the context, the greater the influence of the context.
However, In the recognition of mixed emotional signs, there was greater recognition of signs of anger in the facial expression, as a non-dominant emotion, when in the presence of the neutral story than of the story that agreed with the dominant emotion (sadness). There was also greater recognition of sadness, as a non-dominant emotion, in the presence of a story in agreement with fear than in the presence of a neutral story. There was also a statistically significant increase in the attribution of anger to images in which it is not present and whose dominant emotion is fear, when associated with a context of aggression vs. a neutral context.
It was also found that there was a significant decrease in the attribution of fear to the sadness-anger image (25%-75%) in the presence of the aggression context compared to the neutral and panic contexts.There was also a statistically significant decrease in the attribution of sadness to an image of fear in the neutral context compared to the other contexts (panic and aggression).
ConclusionsIn conclusion, our study have shown an impact of context over overvaluation or the undervaluation of the emotional facial expression as well as either with prototypical expressions or the mixed emotional signals when referring to sadness, fear, and anger. Thus, mental health clinicians should consider the influence of these contexts.
Disclosure of InterestNone Declared
Understanding the Occurrence of Psychiatric Disorders in Epilepsy in Brazil: An Epidemiological Investigation
- L. Bardini Goulart, A. Roloff Krüger, G. Moreno Xavier, G. Fiorio Grando, J. Michelon, L. F. Alves Nascimento, J. Adames, A. T. Konzen, G. Pereira Bernd, C. Fontes Augusto, H. Wolmeister, I. Fachinetto Thoen, Y. de França, P. H. Filipin Von Muhlen, F. J. Carvalho da Costa, V. Kayser, P. H. Paesi Dutra, R. Rahal de Albuquerque, T. Garcia Furtado, G. Macelaro, A. C. Castelo, H. Vieira Rodrigues, E. Rockenbach Fidélis, D. Crusius, E. Guidugli, M. F. Valentim de Paula, Y. Marques Loureiro, E. Paiva Borsa, L. de Paula e Souza, G. Ferreira Cruz
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S98
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Introduction
Epilepsy is one of the most common serious brain illness, with symptoms influenced by multiple risk factors and a strong genetic predisposition, rather than having a single expression and cause¹. Neuropsychiatric symptoms in epilepsy can encompass manifestations such as mood alterations, anxiety, sleep disturbances, psychosis, and behavioral disorders. While the motor and sensory manifestations of epileptic seizures are widely recognized, neuropsychiatric symptoms accompanying epilepsy are often underestimated. Therefore, it is essential to understand the most prevalent epidemiological profile of these patients to improve the diagnosis and management of these symptoms.
ObjectivesOur goal was to evaluate the neuropsychiatric behavior of epilepsy patients in Brazilian over the past 3 years through hospitalization data in order to outline an epidemiological and behavioral profile.
MethodsA cross-sectional, descriptive, retrospective, and quantitative study was conducted on hospitalizations of individuals simultaneously diagnosed with epilepsy, schizotypal and delusional disorders, and mood disorders in all five regions of Brazil (South, Southeast, Midwest, North, and Northeast) between February 2020 and December 2022. Data from January 2020 were not available. The data used were collected through the Department of Health Informatics of the Brazilian Unified Health System (DATASUS) in the “Hospital Information System of SUS” section, gathering information regarding the nature of care, age range, gender, and ethnicity of the patients.
ResultsThe analysis covers the years 2020 to 2022, totaling 503,045 hospitalizations. In 2022, the highest number of cases occurred (≈ 37.55%), followed by 2021 (≈ 33.62%) and 2020 (≈ 28.81%). Urgent hospitalizations represented ≈ 90.85% of the total. The most affected age group was 30 to 39 years old (≈ 18.30%). Men were more affected than women (≈ 52.03% and ≈ 47.96%, respectively), and Caucasians accounted for ≈ 36.07% of the hospitalizations. The average length of stay was 19.1 days, and the mortality rate was 1.4%.
ConclusionsThus, there is a gradual and annual increase in the number of hospitalizations during the observed period. While there is a minimal disparity between the affected genders, it is evident that the profile of male, caucasian, and adult patients is the most prevalent. Moreover, the predominantly urgent nature of hospitalizations points to an alarming scenario regarding this issue. From the analysis of the data obtained in the study, there is a clear need for interventions capable of reducing the prevalence of hospitalizations for neuropsychiatric symptoms in epilepsy patients in Brazil.
Disclosure of InterestNone Declared
Comparing the characteristcs of hospitalized patients admitted in involuntary or voluntary treatment after first episode psychosis
- F. Leitão, S. A. Pinho, S. Sousa, J. Loureiro, C. Cunha, J. R. Silva, G. França, N. Oliveira, P. M. Ferreira, A. M. Moreira
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S313
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Introduction
Individuals experiencing psychotic symptoms often lack insight into their conditions, especially in first psychotic episodes. According to the Portuguese Mental Health Law, involuntary hospitalization may be necessary in cases of severe mental disorder, involving a threat to the patient or his/her legal assets, when there is a refusal of the necessary treatment.
ObjectivesThe aim of our study was to characterize patients admitted involuntarily for first psychotic episode and to compare them with the patients undergoing inpatient voluntary treatment.
MethodsOut of a total of 87 patients diagnosed with first psychotic episode, hospitalized between 2020 and 2022 in our service, at Hospital Magalhães Lemos, 65 were included in the study. Exclusion criteria included patients from other residential areas. 40 patients were admitted under involuntary treatment, whereas 25 were hospitalized voluntarily. For both groups, we calculated the duration of untreated psychosis, the prevalence of psychoactive substance abuse, the type of treatment provided and the number of re-hospitalizations.
ResultsPatients in involuntary treatment had longer duration of untreated psychosis (71 vs 38 weeks). Among these patients, 53% had comorbid psychoactive substance abuse, in contrast with only 36% of voluntarily treated patients. Upon discharge, 58% of patients in involuntary treatment were prescribed depot antipsychotic medication, whereas only 12% of the ones in voluntary treatment. Out of 40 patients admitted involuntarily, 11 were re-hospitalized, but only 4 of the 25 patients in voluntary treatment (28 vs 16%).
ConclusionsPatients in involuntary treatment probably suffered from more severe disease, as seen for the higher duration of untreated psychosis and frequent comorbid substance abuse. Injectable medication was the preferred choice at the time of discharge for this group. Additionally, they experienced higher rates of re-hospitalizations. Recent changes in Portuguese Mental Health Law, that aims to safeguard the rights and responsibilities of individuals with mental health care needs, motivated this study.
Disclosure of InterestNone Declared
Mental and Behavioral Disorders Associated with the Use of Psychoactive Substances and Alcohol: An Epidemiological Analysis in Southern Brazil
- L. Bardini, A. Roloff Krüger, G. Moreno Xavier, G. Fiorio Grando, J. Michelon, L. F. Alves Nascimento, J. Adames, A. T. Konzen, G. Pereira Bernd, C. Fontes Augusto, H. Wolmeister, I. Fachinetto Thoen, Y. de França, P. H. Filipin Von Muhlen, F. J. Carvalho da Costa, V. Kayser, P. H. Paesi Dutra, R. Rahal de Albuquerque, T. Garcia Furtado, G. Macelaro, A. C. Castelo, H. Vieira Rodrigues, E. Rockenbach Fidélis, D. Crusius, E. Guidugli, M. F. Valentim de Paula, Y. Marques Loureiro, E. Paiva Borsa, L. de Paula e Souza, G. Ferreira Cruz
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S831
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Introduction
Neuropsychiatric disorders are the leading cause of disability worldwide, as seen in cases such as depression, anxiety, bipolar mood disorder and schizophrenia, which can be developed or exacerbated by the use of psychoactive substances. Most mental disorders have an early onset, often leading to early and/or permanent disability, increasing the need and cost of healthcare. Therefore, it is necessary to improve the identification of the epidemiological profile of these cases in the South of Brazil in order to enhance the diagnosis and reduce the costs associated with managing these disorders.
ObjectivesThe present study aimed to analyze statistical data regarding hospitalizations related to mental disorders caused by the use of psychoactive substances and alcohol in the southern region of Brazil, highlighting the pathological scenario and identifying the most prevalent profiles of these disorders in this region.
MethodsA cross-sectional, descriptive, retrospective, and quantitative study was conducted on hospitalizations of individuals diagnosed with mental and behavioral disorders due to the use of psychoactive substances and alcohol in the states of the Southern region of Brazil (Paraná, Santa Catarina, and Rio Grande do Sul) between February 2020 and December 2022. Data of January 2020 were not available. The data used were collected through the Department of Health Informatics of the Brazilian Unified Health System (DATASUS) in the “Hospital Information System of SUS” section, gathering information regarding the nature of the care, age range, gender, and ethnicity of the patients.
ResultsThe study covers the years 2020 to 2022, indicating a total of 81,608 hospitalizations, with the year 2022 having the highest number of cases (≈ 37.13%), followed by 2021 (≈ 33.30%) and 2020 (≈ 29.55%). The states with the highest number of hospitalizations were Rio Grande do Sul (≈ 54.90%), Paraná (≈ 29.29%), and Santa Catarina (≈ 15.79%). Urgent hospitalizations accounted for ≈ 87.29% of the total. The most affected age group was 30 to 39 years old (≈ 25.61%). Men were more affected than women (≈ 81.70% and ≈ 18.28%, respectively). Caucasians accounted for ≈ 64.29% of the hospitalizations. The average length of stay was 20.8 days, and the mortality rate was 0.32%.
ConclusionsThere is a clear increase in the number of hospitalizations related to mental disorders caused by the use of psychoactive substances in the period from 2020 to 2022 in the southern region of Brazil, with the highest number of cases in the state of Rio Grande do Sul. The most affected population consisted of Caucasian men aged 30 to 39 years old. Furthermore, these results may be related to the increasing trend of psychoactive substance use among the Brazilian population and also the COVID-19 pandemic, which led to a period of underreporting due to social isolation.
Disclosure of InterestNone Declared
Workplace mental health resilience: usability and impact study of a mental health coping mobile app on a corporate setting
- R. Maçorano, F. Canais, M. Ribas, M. Parreira, H. A. Ferreira
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S553
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Introduction
Mental health resilience is crucial to professional wellbeing and productivity, being that 57% of company employees are reporting burnout. Additionally, early-stage preventive mental health interventions are not common, and typically employees only have access to mid-stage professional care.
ObjectivesThe aim of this project is to provide employees with a preventive self-coping tool, enabling open and inclusive care. Specifically, the aim is to assess the receptivity, usability and impact of the usage of a mobile app that provides coping strategies based on positive psychology and a burnout-risk screening.
MethodsA mobile app was used with the purpose of being accessible to everyone, independently of their financial capacity. The app also promotes inclusiveness, by aggregating several approaches and methods for mental health coping, which are recommended given the needs of each user. The app was released to a large Portuguese company with 700 employees, in which employees could download it voluntarily.
ResultsAfter 7 months, the results showed 37% receptivity rate, 24% improvement on anxiety levels, 36% improvement on workplace wellbeing, 23% increase on mental health self-coping skills, and 21% improvement on burnout-risk levels. These metrics were acquired via app’s back-end, self-reporting, and our model for burnout-risk screening.
ConclusionsFirst results showcase the positive impact of adding such a mobile solution to the employees’ mental healthcare. Next steps will be conducting a longer study, adding control groups and productivity assessment.
Disclosure of InterestNone Declared
Epidemiological analysis of hospitalizations for Schizophrenia, Schizotypal Disorders and Delirium in Rio Grande do Sul over the last 5 years
- L. Bardini, A. Roloff Krüger, G. Moreno Xavier, G. Fiorio Grando, J. Michelon, L. F. Alves Nascimento, J. Adames, A. T. Konzen, G. Pereira Bernd, C. Fontes Augusto, H. Wolmeister, I. Fachinetto Thoen, Y. de França, P. H. Filipin Von Muhlen, F. J. Carvalho da Costa, V. Kayser, P. H. Paesi Dutra, R. Rahal de Albuquerque, T. Garcia Furtado, G. Macelaro, A. C. Castelo, H. Vieira Rodrigues, E. Rockenbach Fidélis, D. Crusius, E. Guidugli, M. F. Valentim de Paula, Y. Marques Loureiro, E. Paiva Borsa, L. de Paula e Souza, G. Ferreira Cruz
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S390-S391
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Introduction
In recent years, mental health has gained prominence in public health, prompting thorough investigations into psychiatric condition trends. This study conducts a comprehensive epidemiological analysis of hospitalizations for Schizophrenia, Schizotypal, and Delirium Disorders in Rio Grande do Sul (RS) over the past five years. By revealing these patterns, it enhances our understanding of regional mental health dynamics and offers insights for intervention strategies, resource planning, and improved mental healthcare. The ultimate goal is to advance more effective and accessible mental healthcare in RS and beyond.
ObjectivesThis study aims to analyze the prevalence and epidemiological profile of hospitalizations due to psychiatric disorders to assist in the diagnosis and outcome of affected patients.
MethodsA cross-sectional, descriptive, retrospective, and quantitative study was conducted regarding hospitalizations for Schizophrenia, Schizotypal Disorders, and Delirium in the state of RS between January 2018 and November 2022. Data were collected from the Department of Informatics of the Brazilian Unified Health System (DATASUS) in the “Hospital Information System of SUS” section, focusing on the nature of care, age group, gender, and ethnicity of the patients. The information was aggregated over the five-year period based on the four mentioned descriptors and subsequently analyzed to establish a profile of hospitalizations during that period.
ResultsThe analysis spans from 2018 to 2022, encompassing a total of 28,345 hospitalizations. In 2019, there was the highest number of cases (22.21%), followed by 2018 (21.08%). Urgent care admissions constituted 85.34% of the total. The age group most affected was 35 to 39 years (11.8%). Men were more affected than women (60.18%), and the majority of hospitalizations were among the Caucasian ethnicity (75.12%). The average length of stay was 23.7 days, and the mortality rate stood at 0.26%.
ConclusionsThe increasing trend in hospitalizations, peaking in 2019, highlights the need for preventive measures. Urgent admissions (85.34%) underscore the demand for accessible mental health resources. Men in the 35 to 39 age group are disproportionately affected, suggesting specific risk factors. The predominance of Caucasian ethnicity emphasizes the need for culturally sensitive care. A longer average length of stay (23.7 days) underscores treatment complexity, while a low mortality rate (0.26%) signals effective medical care. In essence, these findings inform tailored mental health policies to enhance service quality and prioritize patient-centered approaches.
Disclosure of InterestNone Declared
Insights into Early Onset Dementia: a protocol for an 8-year nationwide retrospective study using administrative data
- B. F. Pinto, A. R. Ferreira, M. Gonçalves Pinho, A. Freitas, L. Fernandes
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S719-S720
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Introduction
Early-onset dementia (EOD) is defined as any type of dementia with an onset before the age of 65. Despite its profound impact on patients and their families, EOD has garnered less attention when compared to late-onset dementia (LOD), often resulting in its underestimation. In comparison to LOD, EOD commonly manifests with atypical and heterogeneous symptoms, encompassing mainly non-memory problems, ranging from language and executive impairments to behavioral-led dysfunction. Despite the importance of accurate data to organize appropriate healthcare, evidence regarding EOD patients in Portugal is lacking.
ObjectivesThe primary aims of this study include identifying the causes for hospitalization in EOD patients, diagnosed with dementia either as a primary or secondary diagnosis, and comparing them with inpatients aged 65 and older (LOD). Additionally, the study aims to analyze key hospitalization outcomes for both groups, including length of stay, in-hospital mortality, and readmissions. As a secondary aim, this study seeks to describe subtypes of EOD.
MethodsA retrospective observational study will be conducted following the RECORD statement. Data will be retrieved from an administrative database that gathers de-identified routinely collected hospitalization data from all Portuguese mainland public hospitals. Hospitalization episodes of inpatients younger than 65 years old, with a primary or secondary diagnosis of dementia (ascertained by ICD-9-CM codes 290.0-290.4, 294.0-294.2, 331.0, 331.1, and 331.82), will be extracted. Comparison patients will be selected by propensity score-matching from inpatients over 65 years with a dementia ICD-9-CM code (in any position), matched for Charlson Comorbidity Index (CCI).
ResultsDescriptive and analytical statistics will be conducted to describe and characterize both group of inpatients. Variables such as age at admission, sex, place of residence, causes and type of admission, psychiatric comorbidities, length of stay (LoS), destination after discharge, readmissions, in-hospital mortality and hospital charges will be analyzed.
ConclusionsWith this nationwide analysis of EOD hospitalizations, we aim to reveal critical aspects of this condition, including common causes of admission, diagnostic features and health outcomes, allowing for appropriate medical interventions and support tailored to the specific needs of this clinical group.
Disclosure of InterestNone Declared
Energetic particle tracing in optimized quasi-symmetric stellarator equilibria
- P.A. Figueiredo, R. Jorge, J. Ferreira, P. Rodrigues
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- Journal of Plasma Physics / Volume 90 / Issue 2 / April 2024
- Published online by Cambridge University Press:
- 05 April 2024, 905900207
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Recent developments in the design of magnetic confinement fusion devices have allowed the construction of exceptionally optimized stellarator configurations. The near-axis expansion in particular has been proven to enable the construction of magnetic configurations with good confinement properties while taking only a fraction of the usual computation time to generate optimized magnetic equilibria. However, not much is known about the overall features of fast-particle orbits computed in such analytical, yet simplified, equilibria when compared with those originating from accurate equilibrium solutions. This work aims to assess and demonstrate the potential of the near-axis expansion to provide accurate information on particle orbits and to compute loss fractions in moderate to high aspect ratios. The configurations used here are all scaled to fusion-relevant parameters and approximate quasi-symmetry to various degrees. This allows us to understand how deviations from quasi-symmetry affect particle orbits and what are their effects on the estimation of the loss fraction. Guiding-centre trajectories of fusion-born alpha particles are traced using gyronimo and SIMPLE codes under the NEAT framework, showing good numerical agreement. Discrepancies between near-axis and magnetohydrodynamic fields have minor effects on passing particles but significant effects on trapped particles, especially in quasi-helically symmetric magnetic fields. Effective expressions were found for estimating orbit widths and passing–trapped separatrix in quasi-symmetric near-axis fields. Loss fractions agree in the prompt losses regime but diverge afterwards.
An integrative taxonomy study reveals a rare new species of the genus Creptotrema (Trematoda: Allocreadiidae) in an endangered frog in South America
- E.P. Alcantara, M.B. Ebert, C. Ferreira-Silva, L.R. Forti, D.H. Morais, G. Pérez-Ponce de León, R. J. Silva
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- Journal of Helminthology / Volume 98 / 2024
- Published online by Cambridge University Press:
- 11 March 2024, e23
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During an ecological study with a near-endangered anuran in Brazil, the Schmidt’s Spinythumb frog, Crossodactylus schmidti Gallardo, 1961, we were given a chance to analyze the gastrointestinal tract of a few individuals for parasites. In this paper, we describe a new species of an allocreadiid trematode of the genus Creptotrema Travassos, Artigas & Pereira, 1928, which possesses a unique trait among allocreadiids (i.e., a bivalve shell-like muscular structure at the opening of the ventral sucker); the new species represents the fourth species of allocreadiid trematode parasitizing amphibians. Besides, the new species is distinguished from other congeners by the combination of characters such as the body size, ventral sucker size, cirrus-sac size, and by having small eggs. DNA sequences through the 28S rDNA and COI mtDNA further corroborated the distinction of the new species. Phylogenetic analyses placed the newly generated sequences in a monophyletic clade together with all other sequenced species of Creptotrema. Genetic divergences between the new species and other Creptotrema spp. varied from 2.0 to 4.2% for 28S rDNA, and 15.1 to 16.8% for COI mtDNA, providing robust validation for the recognition of the new species. Even though allocreadiids are mainly parasites of freshwater fishes, our results confirm anurans as hosts of trematodes of this family. Additionally, we propose the reallocation of Auriculostoma ocloya Liquin, Gilardoni, Cremonte, Saravia, Cristóbal & Davies, 2022 to the genus Creptotrema. This study increases the known diversity of allocreadiids and contributes to our understanding of their evolutionary relationships, host–parasite relationships, and biogeographic history.
FC32: Neuropsychiatric symptoms: Disentangling the role of unmet needs using the Camberwell Assessment of Need for the Elderly (CANE) interview
- Ana Rita Ferreira, Mário R. Simões, Lia Fernandes
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- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, p. 95
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Objective:
As the world’s population ages, the number of people with dementia is expected to increase. In addition to progressive cognitive and functional deterioration, dementia comprises neuropsychiatric symptoms (NPS). NPS present significant management challenges based on their high frequency and disruptive nature. Against the prevailing guidelines, their treatment is often over-reliant on psychotropic drugs and other restrictive care approaches, frequently without a thorough assessment of underlying and potentially modifiable causes, such as over- and under-stimulating environments, untreated medical illnesses, drug interactions, or unidentified unmet needs. Consistent with the latter, the unmet needs model proposes that these neuropsychiatric phenomena are needs-driven and constitute indicators of identifiable unmet physical, psychological, emotional, or social needs. Despite this backdrop, few studies have investigated this association using standardized and replicable measures. In this context, the present study aims to put the unmet needs model into a practical context in order to disentangle the contribution of the unmet needs, assessed with the Camberwell Assessment of Need for the Elderly (CANE), to the presence of NPS.
Methods:A cross-sectional study was conducted. Participants were assessed with validated, accessible, and replicable measures, including the CANE interview and the Neuropsychiatric Inventory (NPI). Other variables collected included residents’ demographic characteristics, cognitive and functional impairment, and daily medication. Multivariate models were used to explore potential risk factors for NPS.
Results:Residents from four nursing homes entered the study. Results found that those with unmet needs assessed using CANE and those taking hypnotic/sedative medications had a higher risk of presenting at least one NPS, even after adjusting for other demographic and clinical-functional covariates.
Conclusion:Built on the main finding that unmet needs assessed with CANE can independently contribute to explaining the presence of NPS, a working model is proposed to find solutions for these symptoms based on uncovering unmet needs. The CANE, as a practical, low-cost, yet clinically relevant assessment of met and unmet needs may be used to signal need areas that can be useful for formulation and intervention purposes and may offer the first step towards individually-tailored non- pharmacological interventions for NPS.
Legislation of euthanasia in Portugal: The psychiatrist’s role
- Lia Fernandes, Rui Barranha, Ana R. Ferreira
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- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, pp. 53-54
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The Netherlands (2001) and Belgium (2002) were pioneer countries in euthanasia legislation, and it has been progressively implemented in Luxembourg (2009), Colombia (2015), Canada (2016), the state of Victoria in Australia (2017), and New Zealand (2021). After these, the most recent approvals of euthanasia-related legislation were Spain's Organic Law (2021), and recently, in December 2022, euthanasia and physician-assisted suicide were approved by the Portuguese parliament, following four years of discussion.
In this context, an increasing number of countries are currently regulating or considering the inclusion of euthanasia as a healthcare service, which places an urgent need to define the health professionals' and particularly psychiatrists' roles and participation in this process. Currently, these assessments are limited by the lack of scientific precision in the methods used to determine patients' decision-making capacity, conditioning this process to psychiatrists' personal beliefs.
This presentation will provide a comprehensive overview of Portuguese legislation, highlighting the psychiatrists' involvement.
A Comparison of the Adsorption of Cesium on Zeolite Minerals vs Vermiculite
- D. R. Ferreira, G. D. Phillips, B. Baruah
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- Journal:
- Clays and Clay Minerals / Volume 69 / Issue 6 / December 2021
- Published online by Cambridge University Press:
- 01 January 2024, pp. 663-671
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Radiocesium was deposited on the soils of Fukushima Prefecture in Japan after the meltdown of the Fukushima Daiichi Nuclear Power Plant in 2011. The radiocesium bound to 2:1 clay minerals, such as vermiculite, common in the soil of that region and became non-exchangeable due to the strong affinity of these clay minerals for the Cs+ adsorbed. The current study generated adsorption envelopes for Cs+ on three zeolite minerals: zeolite Y, ZSM-5, and ferrierite. Two of these (ZSM-5 and ferrierite) caused monovalent cations to adsorb via a strong inner-sphere mechanism. A comparison of Cs+ adsorption on these zeolites to Na+ adsorption on the same zeolites showed that Cs+ adsorbs much more strongly than Na+, which is explained by its atomic properties. Despite the inner-sphere adsorption of Cs+ on ZSM-5 and ferrierite, the affinity of vermiculite for Cs+ is even stronger. An adsorption envelope for Cs+ on vermiculite failed to show a low-pH adsorption edge even at a pH of 1.01, with adsorption remaining at ~65% of the maximum even at this low pH. The adsorption envelopes for Cs+ on ZSM-5 and ferrierite minerals did show low-pH adsorption edges centered at pH 3.5 and 3.0, respectively, where Cs+ adsorption dropped to zero. The greater affinity of vermiculite for Cs+, even when compared with that for two zeolite minerals known to have significant affinities for monovalent ions, highlights the difficulty in removing Cs+ from contaminated Fukushima soils.
An Electron Paramagnetic Resonance Spectroscopy Investigation of the Retention Mechanisms of Mn and Cu in the Nanopore Channels of Three Zeolite Minerals
- Daniel R. Ferreira, Cristian P. Schulthess, James E. Amonette, Eric D. Walter
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- Journal:
- Clays and Clay Minerals / Volume 60 / Issue 6 / December 2012
- Published online by Cambridge University Press:
- 01 January 2024, pp. 588-598
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The adsorption mechanisms of divalent cations in zeolite nanopore channels can vary as a function of their pore dimensions. The nanopore inner-sphere enhancement (NISE) theory predicts that ions may dehydrate inside small nanopore channels in order to adsorb more closely to the mineral surface if the nanopore channel is sufficiently small. The results of an electron paramagnetic resonance (EPR) spectroscopy study of Mn and Cu adsorption on the zeolite minerals zeolite Y (large nanopores), ZSM-5 (intermediate nanopores), and mordenite (small nanopores) are presented. The Cu and Mn cations both adsorbed via an outer-sphere mechanism on zeolite Y based on the similarity between the adsorbed spectra and the aqueous spectra. Conversely, Mn and Cu adsorbed via an inner-sphere mechanism on mordenite based on spectrum asymmetry and peak broadening of the adsorbed spectra. However, Mn adsorbed via an outer-sphere mechanism on ZSM-5, whereas Cu adsorbed on ZSM-5 shows a high degree of surface interaction that indicates that it is adsorbed closer to the mineral surface. Evidence of dehydration and immobility was more readily evident in the spectrum of mordenite than in that of ZSM-5, indicating that Cu was not as close to the surface on ZSM-5 as it was when adsorbed on mordenite. Divalent Mn cations are strongly hydrated and are held strongly only in zeolites with small nanopore channels. Divalent Cu cations are also strongly hydrated, but can dehydrate more easily, presumably due to the Jahn-Teller effect, and are held strongly in zeolites with medium-sized nanopore channels or smaller.
Operational impact of decreased turnaround times for Candida auris screening tests in a tertiary academic medical center
- Sebastian Arenas, Samira Patel, Spencer O. Seely, Paola P. Pagan, Prem R. Warde, Labu J. Tamrakar, Dipen J. Parekh, Tanira Ferreira, Yi Zhou, Hayley B. Gershengorn, Bhavarth S. Shukla
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue 1 / 2023
- Published online by Cambridge University Press:
- 18 October 2023, e176
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Objective:
Assess turnaround time (TAT) and cost-benefit of on-site C. auris screening and its impact on length of stay (LOS) and costs compared to reference laboratories.
Design:Before-and-after retrospective cohort study.
Setting:Large-tertiary medical center.
Methods:We validated an on-site polymerase chain reaction-based testing platform for C. auris and retrospectively reviewed hospitalized adults who screened negative before and after platform implementation. We constructed multivariable models to assess the association of screening negative with hospital LOS/cost in the pre and postimplementation periods. We adjusted for confounders such as demographics and indwelling device use, and compared TATs for all samples tested.
Results:The sensitivity and specificity of the testing platform were 100% and 98.11%, respectively, compared to send-out testing. The clinical cohort included 287 adults in the pre and 1,266 postimplementation period. The TAT was reduced by more than 2 days (3 (interquartile range (IQR): 2.0, 7.0) vs 0.42 (IQR: 0.24, 0.81), p < 0.001). Median LOS was significantly lower in the postimplementation period; however, this was no longer evident after adjustment. In relation to total cost, the time period had an effect of $6,965 (95% CI: −$481, $14,412); p = 0.067) on reducing the cost. The median adjusted total cost per patient was $7,045 (IQR: $3,805, $13,924) less in the post vs the preimplementation period.
Conclusions:Our assessment did not find a statistically significant change in LOS, nevertheless, on-site testing was not cost-prohibitive for the institution. The value of on-site testing may be supported if an institutional C. auris reduction strategy emphasizes faster TATs.
Translocation as a tool for the conservation of the jaguar Panthera onca: a case study in the Brazilian Atlantic Forest
- Fernando C.C. Azevedo, Pedro H. Nobre, Giovanne A. Ferreira, Ronaldo Morato, Rogério C. de Paula, Paulo R. Amaral, Eduardo Eizirik, Caroline C. Sartor, Artur Andriolo
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The success of translocation as a management tool is based on reversing the factors that led to a population becoming threatened or locally extinct. We assessed whether translocating a jaguar Panthera onca into the surroundings of a protected area in the Brazilian Atlantic Forest with a resident jaguar population was effective. We captured a male jaguar in an urban area where there were no substantiated previous records of jaguars. In the capture area only one predation event had been recorded, when the jaguar killed several chickens a few days before capture. After capture we translocated the jaguar to a forested area 240 km from the capture site, adjacent to the Rio Doce State Park. To investigate whether the potential geographical origin of the individual was any nearby fragment of the Atlantic Forest or nearby fragments of the Cerrado ecoregion, we genotyped it for 12 microsatellite loci and compared the results to a database developed previously. We fitted the jaguar with a GPS/VHF collar from which we recovered 2.5 months of data. Post-release monitoring with camera traps indicated the jaguar established residence within the region of the Park and we recorded no events of predation on livestock. The genetic analysis indicated that the jaguar resembled individuals from the Inner Atlantic Forest, Cerrado and Amazon. Translocation was an important tool for avoiding potentially negative interactions between the jaguar and local people, and may have benefitted the jaguar population at the release site.
Psychiatric role in physician-assisted death requests – a study protocol for a literature review
- R. Barranha, A. R. Ferreira, E. Gonçalves, L. Fernandes
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1038
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Introduction
The prospect of a medium-term approval of physician-assisted death in Portugal raises relevant ethical and deontological issues that need to be addressed, namely the framework of psychiatric assessments in this process. Such assessments are undermined by the lack of scientific precision in the methods used to determine decision-making capacity, making it possible for the final decision to be affected by psychiatrists’ personal beliefs. As such, outlining scientific evidence and legislation pieces defining the psychiatrists’ role and scope is of utmost importance to frame this debate.
ObjectivesTo synthetize the accumulated evidence worldwide regarding the psychiatrists’ involvement in the global process of physician-assisted death requests by reviewing scientific literature, published protocols, official reports and international promulgated or amended legislation related to hasten death practices.
MethodsPubMed, Scopus, Web of Science, PsycInfo and Google Scholar electronic bibliographic databases will be searched for eligible articles, as well as grey literature, using the following search terms: Psychiatry AND (Euthanasia OR (Suicide AND Assisted)). Official governments’ and countries health authorities’ websites will also be searched for relevant reports and legislation documents, as well as right-to-die organizations and akin associations. No language, date of publication, or geographical restrictions will be applied. The full text of potentially relevant results will be retrieved from the different sources for review after screening titles and abstracts. This two-stage process will be conducted independently by two researchers. Outcomes of interest will be the descriptions of psychiatric role in the process of physician-assisted death requests, assessment methods, and measurement techniques used.
ResultsGiven the fact that physician-assisted death is legalized only in a few jurisdictions, we believe the number of eligible results will be limited. Data will be extracted and a descriptive summary of the evidence will be provided. We anticipate finding a significant variability, but also to identify points of consensus. The findings will be published in a peer-review indexed journal and presented at national and international conferences.
ConclusionsTo our knowledge, this is the first review of both, scientific published literature, and international legislation on the role of psychiatrists in physician-assisted death requests. We hope to provide an international overview to frame the public debate by pinpointing the most consensual assessment methodology, allowing to design an optimized assessment protocol before the implementation of the law in Portugal.
Disclosure of InterestNone Declared
Trans person: discrimination and barriers associated with health care
- I. Ferreira, A. Valente, A. Morais, R. Lopes
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1132
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Introduction
Discrimination is seen as a behavioral response, caused by negative attitudes towards specific values of certain people, and can be considered an effective form of stigma.
The trans population has been the target of various forms of discrimination, not only through disrespect for their name and gender-appropriate pronouns, but also resorting to aggression, isolation, marginalization and consequent economic hardship. These experiences can negatively influence mental health (MH), namely a higher prevalence of substance use, depressive episodes, anxiety disorders and suicide attempts.
ObjectivesTo identify the impact of discrimination and to determine the barriers associated with healthcare for trans person.
MethodsThe P[I][C]OD methodology was used to prepare the research question: How does discrimination create barriers to health care for transgender people?. Research carried out through the EBSCOhost search engine, in the CINAHL Complete, MEDLINE Complete and Academic Search Complete databases, using the MeSH descriptors: “transgender”, “health”, “barriers” and “discrimination”, conjugated to the Boolean AND and OR, the search expression was obtained: (TI transgender OR AB transgerder) AND (TI discrimination OR AB discrimination) AND (TI health OR AB health) AND (TI barriers OR AB barriers). Inclusion criteria: studies published from 2018-2022; available in full text; English, Portuguese or Spanish languages. Sample of 6 articlesResults: Studies show that the trans person is often stigmatized, a victim of prejudice and discrimination in accessing health care, with an impact on MH. Barriers to accessing health care highlighted are: denial of care, lack of specialized services, lack of knowledge and support, failures in training and knowledge of guidelines by health professionals.
Prejudiced/insulting language and exclusion are episodes reported with high frequency. Denial and discouragement of exploration of gender identity are reported as episodes of indirect discrimination.
With regard to MH, the stress of gender minorities caused by stigma, prejudice and discrimination in health services creates a hostile and stressful social environment in the trans population, which causes MH problems.
ConclusionsPrescription and barriers lead trans person to avoid accessing care, with short and long-term adverse health warnings. The absence and/or lack of knowledge of health professionals contribute to this problem, making it crucial to invest in their academic training and continuous training, as well as in clinical practice guidelines and guidance, with the aim of training professionals.
It is necessary to acquire knowledge about the health of the trans person, particularly about the specific health needs and the creation of an inclusive environment between professionals and the person being cared for. Increased support, knowledge about issues related to the trans population and access to care improve MH.
Disclosure of InterestNone Declared
Being mindful of our insomnia can get us to sleep? - Mindfulness aproach to sleep disorders
- R. B. Cohen, I. M. Pereira, M. G. Marguilho, M. C. Sousa, B. V. Ferreira
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1104
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Introduction
Sleep disorders (e.g., insomnia) are extremely prevalent in our population and are intimately associated with distress and productivity impairment. It is estimated that between 40 to 60% of people suffering from a sleep disorder have an underlying psychiatric diagnosis.
Mindfulness, which is described as the quality or state of being self-conscious or aware of something, has shown to be a potential helpful therapy in insomnia.
ObjectivesTherefore, and due to the lack of new and effective treatment approaches, we did a non-systematic review of the positive impact of mindfulness in quality of sleep.
MethodsBibliographic research through PubMed, Web of Science and Springer Link.
ResultsThe mindfulness tools that may be linked to its therapeutic effects include the awareness state and conscious posture to respond when perceiving insomnia symptoms, as well as the modulation of sleep-related arousal courses. These can be primary when directly related to the inability to sleep, or secondary if considering the relationship with thoughts about sleep (such as the tendency to create bias in the attention and perception of sleep related thoughts).
Formerly, mindfulness-based cognitive therapy (MTPC) was designed for the treatment of chronic depression and has shown to be efficacious. It was hypothesized that interoceptive dysfunction in the insula, commonly observed in anxiety and depression, may respond to MTPC by the gained interoceptive awareness, which provides advantage to adapt to life challenges and ongoing adjustments.
ConclusionsBased on the currently available literature, mindfulness-based strategies may be a valuable treatment option in sleep disorders, especially for patients with concomitant mental illness. Therefore, it is necessary further research to standardize in terms of type of approach, duration, and outcome measures since it seems promising as an intervention for insomnia.
Disclosure of InterestNone Declared