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Cuba is a paradigmatic case where the term and concept of the peasantry remains of lived importance. Cuban peasants had a significant role in the past as they did return to the political agenda after the Revolution with particular emphasis under Raul Castro’s administration. However, the Cuban case has not been significantly explored from a long-term perspective that connects the old debates and dimensions of land reforms under developmentalist states to the new agrarian questions in the global era. Based on secondary sources, semi-structured interviews and updated data on land structures, this article explores the long-term process of land reform in Cuba.
The current study aimed to analyse the prospective association between perceived work demand and changes in eating behaviours in schoolteachers.
This was a prospective cohort study with self-reported information obtained on the Demand Control Support Questionnaire and eating behaviours at baseline and after a 2-year follow-up. The analyses were performed using mixed-effects models adjusted for the main confounders.
The setting consisted of elementary and secondary schools located in a large city in southern Brazil.
The participants were 502 schoolteachers (65·9 % females, median age of 42·7 years [interquartile range 34·2, 49·4]).
A total of 39·2 % of the schoolteachers were classified at baseline with job strain, 28·9 % with passive job, 12·2 % with active job and 19·7 % with low-strain job. In the fully adjusted models, compared with teachers who reported low-strain job, those with higher levels of job strain were more likely to reduce (coefficient = 0·064; 95 % CI 0·018, 0·109) and less likely to increase (coefficient = −0·066; 95 % CI −0·115, −0·016) their frequency of fruit consumption regardless of sociodemographic, lifestyle, health conditions and social support at work.
Job strain plays a relevant role in the frequency of fruit consumption over time in schoolteachers. The balance between demand and control at work must be considered in strategies for promoting healthy eating despite perceived social support.
Emotional disorders are highly prevalent in primary care. We aimed to determine whether a transdiagnostic psychological therapy plus treatment-as-usual (TAU) is more efficacious than TAU alone in primary care adult patients.
A randomized, two-arm, single-blind clinical trial was conducted in 22 primary care centres in Spain. A total of 1061 adult patients with emotional disorders were enrolled. The transdiagnostic protocol (n = 527) consisted of seven 90-min sessions (8–10 patients) delivered over a 12–14-week period. TAU (n = 534) consisted of regular consultations with a general practitioner. Primary outcome measures were self-reported symptoms of anxiety, depression, and somatizations. Secondary outcome measures were functioning and quality of life. Patients were assessed at baseline, post-treatment, and at 3, 6, and 12 months. Intention-to-treat and per-protocol analyses were performed.
Post-treatment primary outcomes were significantly better in the transdiagnostic group compared to TAU (anxiety: p < 0.001; Morris's d = −0.65; depression: p < 0.001; d = −0.58, and somatic symptoms: p < 0.001; d = −0.40). These effects were sustained at the 12-month follow-up (anxiety: p < 0.001; d = −0.44; depression: p < 0.001; d = −0.36 and somatic symptoms: p < 0.001; d = −0.32). The transdiagnostic group also had significantly better outcomes on functioning (d = 0.16–0.33) and quality of life domains (d = 0.24–0.42), with sustained improvement at the 12-month follow-up in functioning (d = 0.25–0.39) and quality of life (d = 0.58–0.72). Reliable recovery rates showed large between-group effect sizes (d > 0.80) in favour of the transdiagnostic group after treatment and at the 12-month follow-up.
Adding a brief transdiagnostic psychological intervention to TAU may significantly improve outcomes in emotional disorders treated in primary care.
Data on short-term peripheral intravenous catheter–related bloodstream infections per 1,000 peripheral venous catheter days (PIVCR BSIs per 1,000 PVC days) rates from Latin America are not available, so they have not been thoroughly studied.
International Nosocomial Infection Control Consortium (INICC) members conducted a prospective, surveillance study on PIVCR BSIs from January 2010 to March 2018 in 100 intensive care units (ICUs) among 41 hospitals, in 26 cities of 9 countries in Latin America (Argentina, Brazil, Colombia, Costa Rica, Dominican-Republic, Ecuador, Mexico, Panama, and Venezuela). The Centers for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) definitions were applied, and INICC methodology and INICC Surveillance Online System software were used.
In total, 10,120 ICU patients were followed for 40,078 bed days and 38,262 PVC days. In addition, 79 PIVCR BSIs were identified, with a rate of 2.06 per 1,000 PVC days (95% confidence interval [CI], 1.635–2.257). The average length of stay (ALOS) of patients without a PIVCR BSI was 3.95 days, and the ALOS was 5.29 days for patients with a PIVCR BSI. The crude extra ALOS was 1.34 days (RR, 1.33; 95% CI, 1.0975–1.6351; P = .040).
The mortality rate in patients without PIVCR BSI was 3.67%, and this rate was 6.33% in patients with a PIVCR BSI. The crude extra mortality was 1.70 times higher. The microorganism profile showed 48.5% gram-positive bacteria (coagulase-negative Staphylococci 25.7%) and 48.5% gram-negative bacteria: Acinetobacter spp, Escherichia coli, and Klebsiella spp (8.5% each one), Pseudomonas aeruginosa (5.7%), and Candida spp (2.8%). The resistances of Pseudomonas aeruginosa were 0% to amikacin and 50% to meropenem. The resistance of Acinetobacter baumanii to amikacin was 0%, and the resistance of coagulase-negative Staphylococcus to oxacillin was 75%.
Our PIVCR BSI rates were higher than rates from more economically developed countries and were similar to those of countries with limited resources.
We present the rare case of lipomatous atrial septal hypertrophy associated with adrenocorticotropin hormone therapy in an infant with West syndrome, highlighting their relatively benign nature and good prognosis in children, and the relevance of the differential diagnosis with more dangerous cardiac masses in order to avoid aggressive diagnostic and therapeutic interventions.
The Monitoring Studies (MS) program, the approach developed by RedETS to generate postlaunch real-world evidence (RWE), is intended to complement and enhance the conventional health technology assessment process to support health policy decision making in Spain, besides informing other interested stakeholders, including clinicians and patients. The MS program is focused on specific uncertainties about the real effect, safety, costs, and routine use of new and insufficiently assessed relevant medical devices carefully selected to ensure the value of the additional research needed, by means of structured, controlled, participative, and transparent procedures. However, despite a clear political commitment and economic support from national and regional health authorities, several difficulties were identified along the development and implementation of the first wave of MS, delaying its execution and final reporting. Resolution of these difficulties at the regional and national levels and a greater collaborative impulse in the European Union, given the availability of an appropriate methodological framework already provided by EUnetHTA, might provide a faster and more efficient comparative RWE of improved quality and reliability at the national and international levels.
Current clinical practice is based on guidelines and local protocols that are informed by clinical evidence. This means that clinical variability is reduced, but can lead to inefficient clinical decision-making and can increase medical errors, decreasing patient's safety. The aim of the EXCON project is to investigate the innovative concept of Intelligent Clinical History (ICH), and to develop functional prototypes of high added-value in healthcare services.
The innovative EXCON project will take advantage of recent advances in technologies for coding, structuring and semantizing medical information. Thanks to this new structuring, the EXCON platform will be developed. The final users will be health professionals and other decision-makers. Doctors, nurses, epidemiologists and information specialists will be involved in the development and subsequent validation of the platform.
The EXCON platform identifies profiles of patients with a high probability of ischemic heart disease. In the sample analyzed (n = 4,700), 17 percent of patients were admitted to a cardiology unit with suspected coronary heart disease. Of the patients admitted, 53.7 percent did not have ischemic heart disease at discharge. If we apply the algorithm developed by the EXCON project, 24.8 percent of patients would not have been admitted and did not have ischemic heart disease.
In coming decades, patient management will be impacted by the application of new advanced data analytics tools. This will allow for safer and more efficient clinical management, decrease variability in clinical practice, and improve equity. That is why the development and assessment of these technologies is necessary.
Telomere integrity is influenced by oxidative stress. Also, inflammation-related factors, including nutritional factors, could modulate telomere integrity. The relationship between a posteriori-derived dietary patterns and telomere length (TL) has been scarcely investigated. Thus, our objective was to examine the association between empirically derived dietary patterns ascertained through principal component analysis (PCA) and TL in an older adult Spanish population. A total of 886 older adults (>55 years old; 645 males and 241 females) from the Seguimiento Universidad de Navarra (SUN) cohort were included in the study. TL was measured by monochrome multiplex real-time quantitative PCR. Age-adjusted TL was used for all analyses. Dietary patterns were identified by PCA based on thirty predefined candidate food groups collected from a validated 136-food items frequency questionnaire. Generalised linear models were fitted to obtain β-coefficients and their 95 % CI evaluating differences in TL between each of the four upper quintiles of adherence to dietary patterns and the lowest quintile. Sensitivity analyses by rerunning all multiple linear models under different stratifications were performed to evaluate the robustness of our results. Two major dietary patterns were empirically identified, Western dietary pattern (WDP) and Mediterranean dietary pattern (MDP). After adjustment for potential confounders, longer TL was found among subjects in the highest quintile of MDP (β = 0·064; 95 % CI 0·004, 0·123). The WDP showed no significant association with TL. In conclusion, higher adherence to a posteriori-derived MDP was independently associated with longer telomeres in an older adult Spanish population of the SUN project.
We present our recent experience with a 6-month-old infant with a personal history of short bowel syndrome that presented with fever, cyanosis, and cardiogenic shock secondary to severe pulmonary hypertension and right ventricular failure without pulmonary thromboembolism. He did not present signs of toxin-mediated disease or Kawasaki disease. He was finally diagnosed with SARS-CoV-2 infection. If this presentation is confirmed in future research, the severe cardiovascular impairment in children with COVID-19 could be also attributable to the primary pulmonary infection, not only to a multisystem inflammatory syndrome but also in children without heart disease.
OBJECTIVES/GOALS: Parents’ empathy toward their children affects their parenting, which can in turn impact child outcomes. Although parental empathy is theoretically distinct from trait empathy, current literature relies on largely self-report measures of parents’ trait empathy. Thus, the current study evaluated new analog assessments of parental empathy. METHODS/STUDY POPULATION: One parental empathy analog measure (Empathy Measure for Parents Analog Task, Emotion Script; EMPAT-ES) was created based on parents’ responses to open ended prompts describing scenarios that elicit different emotions (e.g., happy, mad, sad, scared) in children. These responses were used to create short scripts. A second analog task (EMPAT, Emotion Audio) was created using 20 sec audio clips of children expressing the different emotions wherein participants respond with how they feel hearing the emotions and separately, how they believe the child feels. After an initial pilot, both versions of the EMPAT-E were administered to 120 families enrolled in a prospective longitudinal study. Parents completed self-report measures of trait empathy and parental empathy, as well as the EMPAT-ES and EMPAT-EA analog tasks. RESULTS/ANTICIPATED RESULTS: Internal consistency of both the EMPAT-ES and EMPAT-EA tasks are expected to be robust, demonstrating the reliability of these novel assessments of parental empathy. Results are also expected to demonstrate the construct and convergent validity of both analog tasks. These new measures of parental empathy are expected to be significantly associated with measures of trait empathy. Specifically, parents’ responses indicating how they believe the child feels in the analog are expected to be strongly related to their reported emotion recognition abilities and responses indicating how analog items made parents feel are expected to be related to parents’ empathic concern. Finally, parents’ responses to the analog tasks are anticipated to be strongly associated with parents’ self-reported parental empathy. DISCUSSION/SIGNIFICANCE OF IMPACT: Valid, novel assessments of parental empathy can impact the parenting literature as well as community intervention and prevention efforts with parents. Such analog tasks can bolster parenting research but they may also be translated to the community setting as a training tool wherein parents are taught new skills that promote more positive parenting.
Brain-derived neurotrophic factor (BDNF) is involved in neurogenesis and in the protection against oxidative damage and neuronal apoptosis. After exercise, there is an increased expression of this myokine, especially in skeletal muscle and brain. Low BDNF levels have been described in neurodegenerative diseases. Alcoholics show both muscle atrophy and brain atrophy. Thus, this study was performed in order to analyze serum BDNF levels among alcoholics and their associations with brain atrophy and muscle strength.
Serum BDNF values were determined to 82 male alcoholics and 27 age-matched controls, and compared with handgrip strength, with the presence of brain atrophy, assessed by computed tomography, and with the intensity of alcoholism and liver function derangement.
BDNF levels and handgrip strength were significantly lower among patients. Handgrip strength was correlated with BDNF values, both in the whole population and in alcoholics, especially in patients over 59 years of age. BDNF was poorly related to liver dysfunction but showed no relationship with brain atrophy or age.
Chronic alcoholics show decreased BDNF serum levels that are related to muscle function impairment rather than to age, brain atrophy, liver dysfunction, or the amount of ethanol consumed.
To know prevalence of depression in Spanish nursing home(NH) by analysing the clinical profile of residents from RESYDEM study (Identification of patients with cognitive deterioration and dementia in NH).
A multicentral, transversal, observational study was carried out in April 2005. 71 geriatrician from 54 NH representing the Spanish state participated. Depression was analysed in patient´s history and determined by NPI of Cummings, NH version.
1037 residents were randomized, 1020 were used by clinical data analysis. 941 were used to determine depression prevalence. Median age 83,4yo, 66.6% were women, 70.9% with basic educational level, 57.4% widows, 25.7% single, 41.5% had some degree of functional deterioration, 22.1% had delirium. In 26.4% were documented Stroke(17,9% TIA). 61.7% had dementia.
Depression appears in 31.4% of elderly institutionalized with the only diagnosis of depression or independent of others. There were no significant differences in age groups. However, was most frequent in women. 95.7% of patients with diagnosis of dementia had at least one drug for depression. Most used anti-depressants were trazadone (23%), citalopram (20.9%), sertraline (15.8%), fluoxetine (10.1%). No tricyclical anti-depressant reached 1% of consumption.
Depression affects practically one in three institutionalized elderly in Spain
Institutionalized elderly with depression are largely treated with ISRS. It is believed that the use of trazadone is linked with the effects on sleep and anxiety.
The high prevalence of depression, its overlapping with other processes and the comorbility of residents requires a careful search and approach in NH which implies a challenge for professionals in order to treat it.
Despite of the evidence of high psychopathological disorders in patients with ATSCI, few data are available on their psychiatric morbidity prior to the injury.
Identify psychiatric morbidity pre-post ATSCI in a sample of patients admitted in the Spinal Injuries Unit of the Vall d’ Hebron University Hospital in Barcelona (Spain).
Material and methods
54 patients with ATSCI patients were admitted between 1st. October 2009 and 1st. October 2010. SPSS (version 16.1) was used to analyze the data.
Seventy-six percent of the inpatients with ATSCI (41 cases) were evaluated by the psychiatrist and constitute the study sample. Twenty-seven (66%) were male and 14 (33%) female. The average age of the sample was 41 years with younger males (p < 0.05).
Reasons for ATSCI in males were traffic accident (26%), accidental falls and sports accidents (both 18.5%). In women were suicidal attempt by precipitation, fall accident (28.6% both) and traffic accident (21.4%).
41% of men versus 14% of women had a history of substance misuse (p < 0.01) while 64% of women versus the 14.8% of males had a prior psychiatric disorder (p < 0.01). 72.5% of men with ATSCI caused by traffic accident had used substances prior to the accident, those association was not found for women.
91% of patients underwent psychopharmacological intervention.
ATSCI patients exhibit high psychiatric morbidity and require specialized assessment. The high incidence of substance use associated with road traffic injuries suggests the need to identify risk groups in order to establish effective preventive measures.
Self-perceived health is a well-recognised predictor of later health outcomes and mortality, but its relationship to incident dementia has been scarcely explored.
To analyze self- perceived health as a risk factor for dementia and Alzheimer disease (AD) in a population- based survey of the elderly (NEDICES) Study.
Participants were evaluated at baseline (1994-1995) with a standardized questionnaire that included subjective and objective (chronic disorders) health status and screening questions for depression and neurologic disorders. At follow-up (a median of 3.2 years later in 1997-1998) an analogous protocol and neurological assessment were performed.
Of 5,278 participants evaluated at baseline there were 306 prevalent dementia cases, and 161 incident dementia cases were identified among 3,891 individuals assessed at follow-up (D: 115).
Cox hazard ratio analyses showed that age, stroke and illiteracy were independent risk factors for dementia and AD. Aggregation of vascular risk factors was related to a higher risk of both dementia and AD. Good (and very good) versus less than good (fair, bad and very bad) self-perceived health was an independent risk factor for dementia (CI 95% 1.13- 2.16; p= .006) and AD (CI 95% 1.02- 2.18; p= .038) after adjusting by age, sex education and vascular risk factors.
Self-perceived health increased the risk for incident dementia and AD in the NEDICES cohort as it was previously described in the United Kindom MRC- CFA Study of dementia incidence. Global health measurements (self-perceived health, quality of life) needs farther studies as risk for dementia and AD.
Along last years psychiatric literature has shown an increased interest about Borderline Personality Disorder (BPD) diagnosis. Nevertheless, few studies in large samples has been developed in our country. This study is a part of a main research: Personality Disorders in Andalusian Community. Diagnostic evolution and its link with use of health services.
• To study BPD diagnosis in Andalusian inpatients throughout the last 10 years.
• To establish a predictive model analyzing the BPD diagnostic evolution.
The information has been obtained from the Basic Information Minimum Set: A record of admissions (with clinical and demographic variables) registered in the Andalusian population. We made an observational naturalistic study about the number of inpatients with BPD diagnosis, and an analytical study (Linear Regression) to determine the trend marked in the last years about evolution in the diagnosis of inpatients with Personality Disorders (PD).
The number of total psychiatric admissions was 99444 (64968 inpatients): 10755 records had a Personality Disorder (PD) diagnosis.The number of patients with BPD diagnosis has increased from 75 in 1995 to 340 in 2004 (11,8% to 26,13% over percentage of PD). the linear regression had a thread of 0,95, with a determination coefficient of 91,6% (standard error 0,34), with statistical significance (p = 0,00), establishing a prediction linear model about the increase of inpatients with BPD diagnosis.
1. The number of inpatients with BPD diagnosis in Andalusia is increasing over last years.
2. The model predicts a growing of BPD diagnosis along next years.
Andalusia is the most highly populated (7,849,799 hab.) region of the Spanish State. It has all the sanitary domains under its own Health Service (Consejería de Salud), and it has undertaken a deep reorganization of the psychiatric services, establishing a new model based on the mental health communitarian alternative that is already completely implanted. Rates of readmission are a method to assess the quality of care and an important tool in the planning of services of mental health.
The aim of this study is to establish if readmission rates are influenced by Human Resources in Psychiatric Community Devices.
Part of FIS Project PI05/90061 ‘Patterns of General Hospital Psychiatric Units Overuse’.
MBDS is a system of hospital register that gathers all the discharges produced in the andalusian hospitals. It is totally trustworthy from 1995, and we have processed data up to 2004.
Our Data Set register 101234 hospital admissions of psychiatric patients.
The number of admissions from patients who enter three times or more throughout the year has been: 22.66%(1995); 24.66% (1996); 31.01%(1997); 30.72%(1998); 34.07%(1999); 35.35%(2000); 36.92%(2001); 32.93%(2002); 31.20%(2003) and 29.36%(2004).
On the other hand, it has been an increase in Mental Health Human Resources Rates: 24.23-100.000 inhab-(1998); 24.19 (1999); 26.01(2000); 28.04(2001); 29.83(2002); 29.16(2003); 29.34(2004) and 29.90(2005).
Increasing human resources in psychiatric community devices do not change revolving-door rates in general hospital acute psychiatric units in a community mental health system.
Adoption, twin and family studies suggest that suicide behavior is familial and heritable. Both completed and attempted suicide appear to be transmitted in a familial form. Genetics and environment influences had been detected in various studies. But suicidal behavior suggests to be inherited independently from the mental disorders usually associated with it. While traditional statistics emphasizes inference and estimations, data mining emphasizes the fulfillment of a task such as classification, estimation, or knowledge discovery.
The goal of this study was to determine in a large sample of suicide attempts which variables are associated with family history of attempted suicide.
In an emergency room, 539 adult suicide attempters were recruited. The two dichotomous dependent variables were family history of suicide attempt (10%) and of completed suicide (4%). Independent variables were 101 clinical variables explored with two data mining techniques: Random Forest and Forward Selection.
A model for family history of completed suicide could not be developed. A classificatory model for family history of attempted suicide included the use of alcohol in the intent and family history of completed suicide, provide a sensitivity of 78.4%, a specificity of 98.7% and accuracy of 96.6%.
A classificatory model for family history of completed suicide could not be developed using data mining techniques. But it suggested that the use of alcohol in the intent and family history of completed suicide may be associated with familial attempted suicide.
Determine the presence of neuropsychiatric symptoms (NPS), using the NPI-NH(Neuropsychiatric Inventory Nursing Home(NH) Version),in order to provide a multidimensional profile in behavioural symptoms in residents and to calculate its prevalence in Spanish NH.
From randomized population of RESYDEM study (Identification of patients with cognitive deterioration and dementia in NH) a multi-central, cross-sectional and observational study was carried out. 71 geriatrician from 54 NH representative the Spanish state participated.NPS was determinated by NPI Cummings NH version. This version includes upsets in sleep and feeding patterns.
992 residents were examined (Median age 83.4yo, 66.6% women, 91.8% received at least one type of treatment, 61.7% with dementia). 523 (52.7%) presented at least one type of NPS. In order of greatest frequency, the following were noted: alterations in sleep patterns (41.7%), depression/disphoria (31.4%), anxiety (31.2%), agitation/aggressiveness (29.6%), apathy/indifference (25.8%), delirious ideas (23.7%), irritability (22.4%), feeding/appetite upsets (18.5%), anomalous motor behaviour (15.3%), hallucinations (13.8%), desinhibition (11.1%), euphoria (4.4%).
35.9% of residents received benzodiapines, 26.7% antidepressants. Atypical neuroleptics were used in 15.8%, in contrast with 7.4% of the use of classic ones.
NPS ´s reached a high prevalence in NH and it is usual that more than one co-exists in the patients.
Alterations in sleep patterns, depression, anxiety, agitation/aggressiveness affect approximately one in three residents.
It is useful and recommendable to evaluate the 12 behavioural areas from the NH version of the NPI scale. This instrument was chosen as a sifting measure to establish neuropyschiatric symptomology in residences.