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The Interdisciplinary Network for Dementia Using Current Technology, INDUCT, is a Marie Sklodowska Curie funded International Training Network that aims to develop a multi-disciplinary, inter-sectorial educational research framework for Europe to improve technology and care for people with dementia, and to provide the evidence to show how technology can improve the lives of people with dementia. Within INDUCT (2016-2020) 15 Early Stage Researchers worked on projects in the areas of Technology to support every day life; technology to promote meaningful activities; and health care technology.
Three transversal objectives were adopted by INDUCT: 1) To determine the practical, cognitive and social factors needed to make technology more useable for people with dementia; 2) To evaluate the effectiveness of specific contemporary technology; and 3) To trace facilitators and barriers for implementation of technology in dementia care.
The main recommendations resulting from the research projects are integrated in a web-based digital Best Practice Guidance on Human Interaction with Technology in Dementia which will be presented at the congress. The recommendations are meant to be helpful for different target groups, i.e. people with dementia, their formal and informal carers, policy makers, designers and researchers, who can easily select the for them relevant recommendations in the Best Practice Guidance by means of a selection tool. The main aim of the Best Practice Guidance is to improve the development, usage and implementation of technology for people with dementia in the three mentioned technology areas.
This Best Practice Guidance is the result of the intensive collaborative partnership of INDUCT with academic and non-academic partners as well as the involvement of representatives of the different target groups throughout the INDUCT project.
Acknowledgements: The research presented was carried out within the Marie Sklodowska Curie International Training Network (ITN) action, H2020-MSCA-ITN-2015, grant agreement number 676265.
Darwin's frogs Rhinoderma darwinii and Rhinoderma rufum are the only known species of amphibians in which males brood their offspring in their vocal sacs. We propose these frogs as flagship species for the conservation of the Austral temperate forests of Chile and Argentina. This recommendation forms part of the vision of the Binational Conservation Strategy for Darwin's Frogs, which was launched in 2018. The strategy is a conservation initiative led by the IUCN SSC Amphibian Specialist Group, which in 2017 convened 30 governmental, non-profit and private organizations from Chile, Argentina and elsewhere. Darwin's frogs are iconic examples of the global amphibian conservation crisis: R. rufum is categorized as Critically Endangered (Possibly Extinct) on the IUCN Red List, and R. darwinii as Endangered. Here we articulate the conservation planning process that led to the development of the conservation strategy for these species and present its main findings and recommendations. Using an evidence-based approach, the Binational Conservation Strategy for Darwin's Frogs contains a comprehensive status review of Rhinoderma spp., including critical threat analyses, and proposes 39 prioritized conservation actions. Its goal is that by 2028, key information gaps on Rhinoderma spp. will be filled, the main threats to these species will be reduced, and financial, legal and societal support will have been achieved. The strategy is a multi-disciplinary, transnational endeavour aimed at ensuring the long-term viability of these unique frogs and their particular habitat.
OBJECTIVES/GOALS: The goal of this project was to a) evaluate the first five years of Miami CTSI’s Pilot Translational and Clinical Studies Program using outcome measures that quantify research productivity augmented by the CTSA Common Metrics; and b) use the results to shape future program management. METHODS/STUDY POPULATION: Pilot Program applicant and awardee demographic data were collected during the first 5-year cycle of the Miami CTSI grant. Projects were categorized into the translation spectrum based on type of research using published guidelines. Research productivity from funded pilot projects were tracked annually using internal institutional grant award databases and external databases such as PubMed and NIH Reporter. CTSA Common Metrics were tracked using the Results Based Accountability framework. Relative Citation Ratio (RCR), NIH percentile and translation impact of pilot project publications were determined using the iCite tool (NIH Office of Portfolio Analysis). RESULTS/ANTICIPATED RESULTS: The Miami CTSI’s Pilot Award Program demonstrated notable success in its first five years. Of the twenty-two projects that were funded during that time period, 45% led to follow-on funding for a total of $17.2M—a strong return on investment of 15:1. Further, 77% of awardees had at least one publication. A total of four patents and 43 publications resulted directly from the funded projects. The mean RCR for all publications was 2.7, weighted RCR was 99.87, and nine papers were been cited by clinical documents. Overall, 63% of the projects were classified as T1/T2 (pre-clinical/clinical research) and 37% as T3/T4 (post-clinical translational research/public health). DISCUSSION/SIGNIFICANCE OF IMPACT: Miami CTSI’s Pilot Award Program demonstrated success in scholarly output, follow on funding, and scientific impact. These results will serve as benchmarks going forward and will allow the CTSI to leverage program strengths in collaborating with other institutional internal award mechanisms.
This systematic review examines the effectiveness and cost-effectiveness of behavioural health integration into primary healthcare in the management of depression and unhealthy alcohol use in low- and middle-income countries. Following PRISMA guidelines, this review included research that studied patients aged ≥18 years with unhealthy alcohol use and/or depression of any clinical severity. An exploration of the models of integration was used to characterise a typology of behavioural health integration specific for low- and middle-income countries.
Fifty-eight articles met inclusion criteria. Studies evidenced increased effectiveness of integrated care over treatment as usual for both conditions. The economic evaluations found increased direct health costs but cost-effective estimates. The included studies used six distinct behavioural health integration models.
Behavioural health integration may yield improved health outcomes, although it may require additional resources. The proposed typology can assist decision-makers to advance the implementation of integrated models.
Improving adherence in mental patients, growing up insight and reducing stigmatization.
Giving simple and clear messages to families and patients for learning about symptoms and the management of daily difficulties.
Three were the main pillars of our work: patients’ opinion, professional knowledge and families contributions. First, patients were questioned about “What is for you mental illness?” “May you explain your illness?” and the answers were completed with a collage/picture. Those opinions were evaluated by the group and the therapist. We already made reunions with a mental patients association and family groups to expose their opinions and daily life difficulties.
Analyzing drawing-collage characteristics, medical histories and reflections from patients and families, we achieved an individual management for patients. Families could expose doubts and suggestions about patients care. We offered a multidisciplinary management to develop insight and adherence.
“The other shore of mental illness” is a book with a psicoeducative propose about useful concepts of mental illness. It emerges from the professional need to approach to the other shore, families and patients’ opinions and feelings.
Drawing has been used as worktherapy, becoming a benefit for diagnosis and evolution in mental illness. In this book we used them as a means in the improvement of insight and adherence.
The work with families, patients and caregivers let therapists to attend the real difficulties in their daily lives.
The book would be not only a vehicle to reduce stigma, but also a reflection on avoiding discriminatory politicals in mental patients assistance.
Sexuality is a crucial area of human life. A proper examination to assess and detect problems in this field, it seems imperative to intervene when transsexual patients. Therefore accurately known, the sexual practices of these patients, allows us to work directly on possible alterations in the functioning of sexual life during the therapeutic process.
Describe patterns of sexual behavior in patients diagnosed with transsexualism
Gender and Identity Disorder Unit (GIDU)
Selected by consecutive sampling, 200 transsexuals treated at GIDU Malaga, aged between 20 and 40 years and who agreed to participate in the study. Comprising 142 transgender male-to-woman (MtW) and 58 women-to-man (WtM).
Was conducted through a heterocompleted questionnaire that included questions about sexuality, personality traits and demographic characteristics. These were filled in the consultation and were anonymous.
11.6% of MtW transsexuals have never had sex. 26.8% of the MtW and 29% of WtM are more than 3 months without masturbating. 54.1% of the MtW avoid having sex due to the rejection of his genitals, lack of sexual desire and previous traumatic experience. Transgender respondents had secondary education, stable jobs and they were single.
It is vital that we explore the sex lives of transsexual patients. This information must be integrated in a systematic and rigorous evaluation process. According to the results presented, the hyposexuality would be the most significant feature that describes sexuality for this population.
Fiction films offer unexplored opportunities of rehabilitation for schizophrenia and other psychoses. Schizophrenia produces deficits y distortions in the perception and comprehension of reality, also expressed in the perception and comprehension of films. After a year of an “ad hoc” experience, the following technique was developed:
1) Selecting a fiction film for its narrative, affective, cognitive and social cognitive content
2) Briefly presenting of the film to a group of 8-16 patients with diverse psychosis.
3) Screening of the film to the patients and the therapeutic team.
4) Summarizing of the plot by a patient. Group correcting of distortions and deficits caused by problems of attention and working memory, as well as positive, negative, affective and social cognitive symptoms (emotional perception, theory of mind, attributive style)
5) Selecting 1-2 sequences by each patient, and group commenting using the same technique.
6) Field recording of all the commentaries obtained.
7) Second screening of the film two days after, repeating points 2 to 6.
8) Comparing both field records.
An experimental study using this technique is presented. 8 patients with schizophrenia and other psychoses watched 4 fiction films (“The 39 Steps”, “Charade”, “M”, “The General”). The differences founded in both viewings by two external evaluators (using CGI and analogical scales of the main variables) are presented and commented. An evaluation of the perceived usefulness and satisfaction of the participants was included.
Cocaine consumption can induce transient psychotic symptoms, expressed as paranoia or hallucinations. Cocaine induced psychosis (CIP) is common but not developed in all cases.
To describe the Risk Factors for developing cocaine-induced psychosis in cocaine dependent patients, according DSM-IV-TR criteria.
This is the first European study about the relationship of CIP with consumption pattern variables and personality disorders, we evaluated 220 cocaine dependents over 18 years, 80'5% males, mean age 33.9 years (SD = 7.6). Patients were recluted from an outpatient clinic department and subsequently systematically evaluated using SCID I and SCID II interviews for comorbidity disorders, and a clinical-based systematic psychotic symptoms form.
A high proportion of cocaine dependent patients reported psychotic symptoms (51.8%) under influence of cocaine. The most frequent reported psychotic symptoms were paranoid beliefs and suspiciousness (42.4%). After a logistic regression analysis we found that a model consisted of high cocaine consumption (mean of 12.01 grams per week), cannabis dependence history and to use intranasal or smoked rout of administration had a sensitivity of 63.2% and a specificity of 70.2%.
We conclude that is relevant to evaluate CIP in patients consuming high amounts of cocaine, with cannabis dependence history and who do not use intranasal rout. It could be useful for preventing consequences or risks of psychotic states for themselves or others.
Drug substance abuse has been related with chronic insomnia and other sleep disorders that are thought to interfere in detoxification treatment and relapse induction. These disorders can persist after drug detoxification.
To describe sleep disorders refered by drug dependents patients in an inpatient detoxification unit.
We prospectively studied drug dependents patients admitted to our Detoxification Unit from January 2005 to March 2009. The first night, patients were asked to complete an 11-item questionnaire measure designed to assess the relationship between sleep disorders and drug use. Responses ranged from 1 to 7. The questionnaire measured the following:
a) insomnia before hospitalization;
b) patients’ beliefs about the relationship between insomnia and drug use;
c) insomnia in previous detoxifications;
d) patients’ worry about insomnia;
e) treatment of sleep disorder with benzodiazepines.
The study sample included 150 patients (75.3% men). 39% of the patients suffered from alcohol abuse, 34.67% from cocaine abuse, 22.67% from opiod abuse, 21% from cannabis abuse, 18% from benzodiazepine abuse, and 12.67% of patients were polydrug users.Lifetime prevalence of sleep disorders was 68.1%. 64% had suffered insomnia the months previous to detoxification. 80.1% of patients’ refered sleep disorders in relationship with substance abuse. 69.4% were worried about insomnia during detoxification. 75.4% of patients took benzodiazepines without prescription.
Sleep disorders in patients with drug abuse are frequent. A high prevalence of patients having worries about insomnia during the detoxification treatment and believing in a relationship between their sleep disorders and the drug abuse was found.
The neurodevelopmental hypothesis defends the existance of factors that would cause an early impairment on the normal brain development. The neurodegenerative hypothesis proposes the existance of later and progressive pathological phenomena, responsible of the appearance of clinical manifestations and changes on neuroimaging. Both hypotheses would be complementary. Neurodevelopment is completed during adolescence. Within this period, these deficts on executive functions would become apparent, reflecting a neurodevelopmental impairment. Glutamate is the main excitatory neurotransmitter, present throughout the normal postnatal brain development and maduration. In schizophrenic patients and unaffected relatives, a glutamatergic hypofunction has been found and so, an alteration of the dopaminergic mesocortical limbic and nigrostriatal pathways.
Usage of molecules that are capable of reversing the glutamatergic hypofunction would be potentially benefitial for either positive or negative symptomathology in schizophrenia.
We have performed a review of several clinical trials (on humans and animals) using glutamatergic drugs alone and combined with neuroleptics to diminish behavioural disturbances related to NMDA blockage.
Usage of glycine binding site agonists (glycine, D- cicloserine, D-serine) has been proposed. D-serine is effective both as monotherapy and combined with neuroleptics. D-cicloserine is not effective on negative symptoms. Usage of high doses of oral glycine (30–60 mg a day) on its own has not shown any clinical change but there is an improvement on negative and positive symptoms if combined with neuroleptics.
Nowadays, there is no glutamatergic agonist used in schizophrenia treatment. Out of the three previously mentioned drugs, only D-serine has shown some efficacy.
This project will work closely with existing service partners involved in street level services and focus on testing and evaluating three approaches for street level interventions for youth who are homeless and who have severe or moderate mentally illness. Youth will be asked to choose their preferred service approach:
Housing First related initiatives focused on interventions designed to move youth to appropriate and available housing and ongoing housing supports.
Treatment First initiatives to provide Mental Health/Addiction supports and treatment solutions, and; Simultaneous attention to both Housing and Treatment Together
Our primary objective is to understand the service delivery preferences of homeless youth and understand the outcomes of these choices. Our research questions include:
1. Which approaches to service are chosen by youth?
2. What are the differences and similarities between groups choosing each approach?
3. What are the critical ingredients needed to effectively implement services for homeless youth from the perspectives of youth, families and service providers?
Focus groups with staff and family members will occur to assist in understanding the nature of each of service approach, changes that evolve within services, & facilitators and barriers to service delivery. This work will be important in determining which approach is chosen by youth and why. Evaluating the outcomes with each choice will provide valuable information about outcomes for the service options chosen by youth. This assist in better identifying weaknesses in the services offered and inform further development of treatment options that youth will accept.
Fiction films offer unexplored support for rehabilitation in patients with schizophrenia and other psychoses. Schizophrenia produces deficits and distortions in perception and understanding of reality, also expressed in the perception and comprehension of films. After two years of experience “ad hoc” we have designed an experimental case-control study in order to study the effectiveness of the proposed technique compared with conventional “cinema-forum”
20 patients treated at the Psychiatric Day Hospital in Puerta de Hierro Hospital (Majadahonda) will participate in the study. Initially, the researcher will collect information on socio-demographic and clinical data of all participants, as well as a written informed consent. There will be an initial assessment using the following instruments:
- SCIP (schizophrenia cognitive screening)
- Scale GEOPTE (social cognition in schizophrenia)
- Social Functioning Scale (SOFAS, PSP)
- Scale of disease awareness
- IPDE (TP)
- Hamilton Scale (anxiety-depression)
The material used will be the 12 chapters of the first season of TV series “The Sopranos” by David Chase (2004). Specific techniques of cognitive and affective work are compared against a “cinema-forum”. For the evaluation of the effectiveness of the proposed technique, it will be used a measurement tool designed specifically for the activity, which includes:
1. 60 item-Scale, specific on each chapter, evaluating:
Natural polyamines (putrescine, spermidine and spermine) are low molecular weight highly protonated aliphatic molecules that physiologically modulate NMDA, AMPA/kainate glutamatergic receptors and limbic dopaminergic neurotransmission. Previous studies had demonstrated that polyamine metabolism might be disrupted in schizophrenia, what could potentially be linked to glutamatergic dysfunction. In particular, polyamine levels in blood and fibroblast cultures from patients with schizophrenia had previously been found to be higher than in healthy controls. Indeed, a significant positive correlation between blood polyamine levels and severity of illness may exist.
In order to test potential differences in blood polyamine levels between drug-free schizophrenia in-patients (n = 12), and healthy controls (n = 26, blood donors), spermidine (spd), spermine (spm), and spermidine/spermine index (spd/spm) were determined using HPLC after dansylation.
No significant differences were found between groups (t = 0,974; df = 36; P = 0,337 for spd, t = l0, 52; df = 36; P = 0,959 for Spm, and, t = 0, 662; df = 36; P = 0,512 for spd/spm).
Though we couldn’t replicate previous findings suggesting disturbances in blood polyamine levels in schizophrenia, this issue may be a promising target. Future research should take into account possible factors such as sex, nutritional state, and stress.
To describe the physical health profile of patients with drug use disorders who were included in the study of adaptation-validation of the Addiction Severity Index 6th version (ASI-6) into Spanish.
Multicentre, observational, longitudinal, prospective study. A total of 194 substance dependent/abuser individuals were included. Assessments were made with the Spanish ASI-6.
Men were 79.9%, mean ages were 41.08 (SD 11.64), 42.3% were single and 87.6% were acute patients. The severity score in the Physical Health area was 44.32 (SD 9.51). The most prevalent diseases were: 25.3% hepatitis, 11.9% had high blood pressure, 8.2% cirrhosis or hepatic disease, 6.7% epilepsy or convulsions and 5.7% tuberculoses. No statistically significant differences were found according to gender. Acute patients had statistically significant higher proportion of pregnant woman (2.3% vs. 0% p< 0.05) and lower proportion of diabetes (3.5% vs. 12.5% p= 0.05).
Patients with drug use disorders have a mild-moderate severity of physical health. Physical health is not influenced by gender, but it is by the clinical state.
A growing interest in the potential role of polyamines in stress, mood disorders and suicidal behavior has recently emerged. In particular, the expression of polyamine's rate-limiting catabolic enzyme (SAT-1, Spermidine/spermine N1-acetyltransferase-1) may be reduced in ventral prefrontal cortex and posterior cyngulate gyrus of patients who committed suicide. However, there is some controversy regarding the involvement of potential cis-acting loci controlling SAT-1 gene expression (rs6526342 or rs17286006) in suicidal behavior. Moreover, a significant association between SAT-1 rs1960264 SNP and anxiety disorders has been found in a male caucasian spanish sample.
In order to test the potential association of SAT-1 -1415T/C SNP (rs1960264) with suicidal behavior, genotype frequencies for that SNP were compared between 193 suicidal attempters (126 female and 67 male) and 650 non-suicidal patients (314 female and 336 male) from an in-patient sample.
We could not find a significant difference in the distribution of the genotypes for rs1960264 SNP between suicide attempters versus non-suicidal individuals (Linear-by-Linear association X2 = 0,203; df = 1; P = 0,652, females; Linear-by-Linear association X2 = 0,000; df = 1; P = 0,990, males). Neither could we demonstrate a relationship between rs1960264 genotype and past history of suicidal attempts (Linear-by-Linear association X2 = 2,966 ; df = 1; P = 0,085, females; Linear-by-Linear association X2 = 1,171; df = 1; P = 0,279, males).
Although we did not find a link between rs1960264 genotype and suicidal behavior, SAT-1 may be an interesting target to investigate the biology of this phenotype. Future studies should take into account other genetic polymorphisms at SAT-1, and definitively evaluate whether or not rs6526342 and rs1960264 have any functional implications.
To identify the differences in the ASI-6 scores according to main substance of consumption among patients with drug use disorder who were included at the study of adaptation-validation of the Addiction Severity Index 6th version (ASI-6) into Spanish.
Multicentre, observational, longitudinal, prospective study. 186 substance dependent/abuser individuals were included. Assessments were made with the Spanish ASI-6.
Main substance of consumption: 57% alcohol, 19.9% cocaine and 19.4% opiates. Men were 77.4% vs. 81.1% vs. 83.3% (p n.s.), mean ages were 47.12 (SD 10.18) vs. 32.62 (SD 8.20) vs. 36.47 (SD 8.04) years (p< 0.001), and 25.5% vs. 64.9% vs. 55.6% were single (p< 0.001). The greatest severity was found in the Alcohol area in the case of alcohol users (56.86) and in the Family/Social Partner Problems area in the case of cocaine and the opiate users (50.43 and 51.22). Alcohol users had statistically significant greater severity than the other two groups in the Alcohol area (56.86 vs. 49.38 vs. 45.17, p< 0.001) and tended to have lower severity in the Legal area than cocaine users (46.78 vs. 48.43, p 0.079).
Cocaine users were the youngest and used to be single. The ASI-6 only differentiated in the severity of the Alcohol area. Further studies including a higher proportion of cocaine and opiate users are needed.
The Attention Deficit Disorder and Hyperactivity (ADDH) is now, a frequent diagnosis in Paediatrics Psychiatry. This real neurobiological syndrome has a variable incidence (3-12%), an early beginning (before 7 years) and an important permanency in adult age (15-20% keep diagnosis and 65% residual symptoms). It represents a risk factor for posterior psychiatric diseases, antisocial behaviour and relation problems. This makes the early diagnosis and treatment necessary. The 70-90% of the patients responds to simpatico mimetic treatment and the methylphenidate is the most used. Patients must carry out the clinical criteria and nowadays there is not any recognized helpful test for the diagnoses except the clinical one. The medium latency auditory evoked response (MLAER) appears 10-70 ms after the cochlear receptor activation and it has cortical and subcortical generators.
We studied MLAER in ADDH: their morphology, changes with treatment and relation between morphology changes and clinical response to treatment.
Patients (53) had ADDH clinical criteria, methylphenidate treatment chosed, not comorbidity neither hearing loss. First phase without treatment and second with it where we did MLAER and tronco-encephalic auditory evoked response during wakefulness and sleep.
Without treatment 76% responses were asymmetric (51% of them with a specific type). The rest 23% were normal. With treatment 63% changed the morphology and 70% had a good response to treatment. Only 11% of patients without alterations had a good clinical development.
An ADDH diagnosis has different physiopathologic mechanism. The MLAER in ADDH could predict the treatment response.
Studies on the enhancing effects of nicotine on performance are usually pharmacological challenges using deprived male smokers. However, gender may be a factor that influences nicotine/smoking effects upon information processing. We investigated gender differences in contingent negative variation (CNV) amplitude in non-deprived dependent smokers performing a go-no go reaction time paradigm. Female smokers did not differ from female non-smokers in both early and late CNV, whereas male smokers presented greater early and late CNV compared to male non-smokers and an alteration in inhibiting processes responsible for CNV development in the no go condition. Consistent with the evidence of gender differences in nicotine/smoking sensitivity, these preliminary results emphasize the need for taking into account gender in psychophysiological research of nicotine/smoking effects.