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Glenn procedure is performed for patients with cyanotic CHD and univentricular physiology and has a survival rate above 90%.
To evaluate the risk factors associated with a poor outcome after Glenn procedure.
The data for this retrospective analysis were collected from a regional Brazilian registry of congenital heart surgeries (ASSIST initiative) from 2014 to 2019. Data from 97 patients who underwent the Glenn procedure were considered. The primary outcomes were prolonged mechanical ventilation (>24 hours post-operatively) or in-hospital death, alone and combined.
The overall in-hospital mortality was 13.4% (n = 13). Prolonged mechanical ventilation occurred in 52% (n = 51) of the patients. Our analysis found that risk factors for death or prolonged post-operative mechanical ventilation were cardiopulmonary bypass duration and post-operative lactate, whereas weight-for-age z-score and age at surgery were risk factors for prolonged mechanical ventilation. Cardiopulmonary bypass duration increased (adjusted odds ratio: 1.02; 95 % CI: 1.01, 1.03) and age at surgery decreased (adjusted odds ratio: 0.96; 95 % CI: 0.93, 0.99) the odds of the combined outcome.
Age at surgery, post-operative lactate, and low-weight-for-age z-score are associated with prolonged mechanical ventilation and death following the Glenn procedure.
“Rite of passage” is an etnographic concept developed by VanGennep that defines the vital transition of an individual between two different status. It is divided in three stages: separation, liminal/threshold and aggregation. Turner described the liminal phase, and the terms of “communitas” and “liminoid” (structure of a rite without religious/spiritual elements). One widely-known Rite of Passage is the initiation of the shamans.
Study the elements of a rite of passage present in Psychiatric Trainning.
• Field study (observational, descriptive, non-experimental).
• Preliminary Sample=10trainees (5man+5women); last year of Psychiatric Trainning.
• “ad hoc” semi-structured interview (21items subdivided in open questions). 10interviews (average duration=75mins). Permanent register:digital recorder.
• Summary and analysis of the answers. Review of the literature.
- Psychiatric Trainning shared the elements and tri-phasic structure of VanGennep's “rite of passage” concept
- Trainees saw themselves as more empathic(7/10) and humanistic(8/10) than other specialties colleagues. Stigma towards mental illness(8/10) and fear of suicide(9/10) were also considered as their distinctives.
- The collective behaved as a communitas(10/10)
- No spiritual elements(0/10): liminoid process
- Resemblances of the ancestral shamans' Initiation: Despite bloody practices were over, suffering was also present(7/10), but was seen as necessary(6/10) and well tolerated(7/10).
- Trainees felt that they grew spiritual and mentally(7/10) during the trainning years
Results suggest that Psychiatric Trainning has stable phenomena that:
• are compatible with the Rite of Passage schema
• Are considered exclusive of Psychiatry by trainees
• Have not been systematically studied as a whole, which could help to improve the training.
The studies about the comorbidity of major depressive disorder (MDD) and bipolar disorder (BD) have increased in the last years. The comorbidity with Axis I psychiatric disorders complicates the diagnosis, prognosis and treatment.
To analyze the prevalence of affective disorders associated with another Axis I psychiatric disorders to treat correctly from the beginning of the diagnosis and to improve the course of the disorder and the quality of life of these patients
The subjects who participated in the study were diagnosed of bipolar I disorder, bipolar II disorder and MDD, according to DSM-IV-TR criteria. The sample (n = 114) was divided into three groups: MDD (n = 58), BD (n = 31) and a control group of healthy subjects (n = 25). The diagnosis and stability were assessed using the MINI International Neuropsyquiatric Interview and the Hamilton Depression Rating Scale (HDRS).
BD had a significantly association with risk of suicide (38%), anxiety disorder (3.3%) and social phobia (12.9%). It was also reported a significant association between MDD and risk of suicide (71%), manic/hypomanic episodes (25.9%), anxiety disorder (37.9%), social phobia (25.9%) and generalized anxiety disorder (37.9%).
It is necessary for clinical practice an integrative model which takes into account the comorbidity of affective disorders to improve the response to treatment and the prognosis of these mental disorders
Recent epidemiological studies suggest that the prevalence of bipolar disorder might be misdiagnosed initially as unipolar depression due to the difficulty to detect episodes of hypomania. The Hypomania Checklist (HCL-32), validated in Spanish, is a self-report questionnaire with 32 hypomania items designed to screen for hypomanic episodes.
To examine the prevalence of hypomania in patients with unipolar depression. Corroborate the efficacy of the HCL-32 to detect symptoms of hypomania.
The presence of hypomanic symptoms was assessed by the HCL-32 in a sample of 128 subjects diagnosed with bipolar I disorder (n = 30), bipolar II disorder (n = 1), unipolar depression (n = 57), and anxiety disorder (n = 15) according to DSM-IV-TR criteria. A control group of healthy subjects was selected (n = 25).
The discriminative capacity was analyzed by the ROC curve. The AUC was 0.65 which did not indicate a good capacity. The sensitivity (S), specificity (E) and prevalence (P) of hypomania in unipolar patients for the following cut-off points were :14: S = 81.6%,95%CI(69.8, 93.5); E = 30.1%,95%CI(19.7,40.6); P = 74.1%; 15: S = 77.6%,95%CI(64.9,90.3); E = 37.4%,95%CI(26.3,48.4); P = 67.2%; 16: S = 59.2%,95%CI(44.4,73.9); E = 55.4%,95%CI(44.1,74.0); P = 51.7%; 17: S = 55.1%,95%CI(40.2,70.1); E = 57.8%,95%CI(46.6,69.1); P = 48.3%.
The HCL-32 has a high sensitivity but a low specificity as screening instrument. This might explain the high proportion of hypomania found in this study. The difference with previous studies is that our sample was heterogeneous, unstable and serious. This suggests that the HCL-32 is not valid for any psychiatric sample. Future research should develop more specific instruments with better external validity.
Public hospital systems have struggled to identify ways of cutting costs while improving quality of mental health treatment, even more since the economic downturn.
To compare mental health care expenditures and quality in two large sites, Boston and Madrid, and to analyze the amount of the expenditure corresponding to pharmacy, ER, outpatient and inpatient care.
Data are mental health electronic records from three hospitals in Madrid (n=31,183 person-years) and in Boston(n=8,805). Adequacy of care was measured as four or more visits within the last year. Unadjusted comparisons of variables were conducted using t-tests. Multivariate generalized linear regression models were computed with log link and residual variance proportional to mean squared, adjusting for covariates. Results were also adjusted for World Bank Purchasing Power Parity and converted to U.S. dollars.
The annual average treatment expenditure is $4,874 in Boston and $2,693 in Madrid . Boston patients had a bigger percentage of use (13,6% vs 5,3%) and greater annual expenditure ($25,175 vs $15,470) for inpatient services (p<0,05). Conversely, Madrid patients used and spent more on outpatient treatments (87% vs 84%;$1,670 vs $1,378;p<0,05). Being in the Boston site, having a bipolar, psychotic or alcohol disorder was a significant positive predictor of total expenditure. Adequacy of care was bigger in Boston (32,8% vs 23,1%)
Emphasis on outpatient care appears to reduce inpatient stays and global expenditures. An earlier recognition due to a more open access to treatments in Spain may help decreasing costs. Bipolar, psychotic and alcohol disorders imply bigger costs.
Prior studies have identified that individuals with comorbid substance use disorder and mental health disorder are at a greater risk of benzodiazepine abuse compared to individuals that present with mental health disorder without an accompanying substance use disorder. These studies were conducted in predominantly white populations, and little is known if the same associations are seen in safety net health care networks. Also, the literature is mixed as to whether or not psychiatrists’ prescription of benzodiazepines places individuals at undue risk of benzodiazepine abuse.
We use 2013–2015 electronic health record data from a Boston healthcare system. Patients with benzodiazapene abuse were identified if they had received treatment under the ICD-9 code 304.1. Benzodiazepine abuse was compared between patients with only mental illness and patients with existing comorbid substance and mental health disorder, in unadjusted comparisons and adjusted regression models. Covariates in regression models were used to identify subgroups at higher risk of benzodiazepine abuse.
Individuals with benzodiazepine abuse had higher rates of emergency room and inpatient use than patients with other mental health and/or substance use disorders. Those with comorbid substance and mental disorder were significantly more likely than individuals with mental or substance use disorder alone to abuse benzodiazepines (P < .01). Among those with benzodiazepine abuse, 93.3% were diagnosed with a mental illness, 75.6% were diagnosed with a substance use disorder (other than benzodiazepine), and 64.4% had comorbid anxiety disorder and substance use disorder. These analyses suggest that patients with benzodiazepine abuse have complex presentations and intensive service use.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Some inconsistent evidence indicates experiences of trauma and the presence of symptoms of PTSD are associated with increased risk of cardiovascular diseases. This relation has rarely been explored with community samples including participants with PTSD symptoms or who fulfill criteria for PTSD disorders.
We identify those with a high number of PTSD symptoms and those fulfilling criteria for PTSD are more likely to have CVD than those without a PTSD syndrome or diagnosis. We examine rates of mental health access for those with PTSD and CVD.
We use Collaborative Psychiatric Epidemiology Surveys (CPES) to examine differences in trauma/PTSD prevalence and the association of prior trauma exposure and PTSD diagnoses with CVD (n = 13,286). CIDI was used to make psychiatric diagnoses and medical data was acquired regarding onset and severity of CVD.
Individuals with prior exposure to trauma and PTSD diagnoses had twice the likelihood of developing a cardiovascular disease as those without trauma exposure [OR = 1.77, 95% CI (1.0, 2.94)]. Having a PTSD diagnosis is a significant predictor of having a CVD for individuals who experienced a traumatic event.
The probability of developing a CVD was higher when patients had prior diagnosis of substance abuse [OR = 1.36, 95% CI (1.11, 1.65)] or mental health disorders [OR = 1.43, 95% CI (1.10, 1.87) for depression; OR = 1.33, 95% CI (1.04, 1.69) for anxiety]. Men were almost twice as likely as women to be diagnosed with a CVD [OR = 1.67, 95% CI (1.37, 2.00)].
Exposure to trauma and the presence of PTSD symptoms are significantly associated with CVD.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The use of valid and practical screening scales might ease the burden for greatly needed universal testing for mental health, substance use and dual disorders, but do they work well with all populations? Do they miss correct identification of certain groups?
To understand discrepancies in diagnostic prediction using the AC-OK screen in conjunction with other standardized assessment scales.
Two hundred and twenty-six Latino participants were recruited from primary care and community clinics in Madrid, Barcelona and Boston and assessed with standardized mental health and substance abuse measures including the AC-OK screen and with a Computerized adaptive test for mental health (CAT-MH). A measure of frequency of discrepancies and an adjusted and unadjusted comparison of results and demographic characteristics or respondents were made for mental health, substance abuse or for discrepancies in both categories.
35.4% of cases were discrepant in mental health (AC-OK-Mental Health vs. Patient Health Questionnaire-9, Generalized Anxiety Disorder 7 or PTSD Checklist) and 14.2% in substance abuse (AC-OK-substance abuse vs. drug abuse screening test or Alcohol use disorders identification test). When CAT-MH scale was incorporated, discrepant results were found in 24.3% and 14.2%, respectively. No association was found between substance abuse discrepancies and patient demographics. In logit regressions being from Barcelona, of younger age and male were significant predictors of discrepancies.
Discrepancies were observed in the diagnostic prediction, with differences detected for site and sociodemographic characteristics of participants suggesting the importance of testing screeners for site and population differences. Evidence for the misclassification of young males is discussed. Caution is warranted in the implementation of screeners for at risk populations.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
An electrochemical impedance spectroscopy (EIS) corrosion study of API X70 steel was carried out in synthetic seawater with different rotation speeds using a rotating cylinder electrode (RCE) to control the hydrodynamic conditions at room temperature, atmospheric pressure and 24 h of exposure time. A superficial analysis through a scanning electron microscope (SEM) was used to analyze the corrosion type. The rotation speed used was 0 rpm (static condition), 1000, 3000 and 5000 rpm (turbulent flow). The results show that the turbulent flow conditions affect directly the corrosion rate (CR) of the steel, because all values of the CR under turbulent flow conditions are higher than the CR values at static conditions. In addition, it is important to point out that at turbulent flow conditions, the CR increased as the rotation speed also increased. The morphology of the corrosion in all experiments was localized corrosion.
This article makes the first systematic attempt to analyse quantitatively the evolution of Spanish housing markets from 1904 to 1934, a period of dramatic changes in housing demand as a consequence of substantial income and demographic growth. In order to do so, we collect a new database on houses sold and their prices using data from the Registrar's Yearbooks. Furthermore, we construct a new hedonic index of real housing prices for Spain and its provinces. To our surprise, we found that real housing prices rose slightly over the entire period and, hence, that housing supply responded effectively to new demand for housing.
We conducted an epidemiological, observational cohort study to determine the incidence and complications of acute otitis media (AOM) in children aged <6 years. Data on physician-diagnosed AOM were collected from retrospective review of medical charts for the year preceding enrolment and then prospectively in the year following enrolment. The study included 5776 children in Germany, Italy, Spain, Sweden, and the UK. AOM incidence was 256/1000 person-years [95% confidence interval (CI) 243–270] in the prospective study period. Incidence was lowest in Italy (195, 95% CI 171–222) and highest in Spain (328, 95% CI 296–363). Complications were documented in <1% of episodes. Spontaneous tympanic membrane perforation was documented in 7% of episodes. Both retrospective and prospective study results were similar and show the high incidence during childhood in these five European countries. Differences by country may reflect true differences and differences in social structure and diagnostic procedures.
Recently, the usage of optical fiber coils has increased significantly, especially in the design of physic and chemical sensors. Therefore, it is important to test the theoretical current models developed to predict the power loss throughout optical fiber. In this paper a pioneer and popular model, the Marcuse model of power loss, was studied and evaluated for optical fiber coils of small radii. Power attenuation in a bent fiber data was collected using an Optical Time Domain Reflectometer (OTDR), and it was compared to the theoretical predictions of the Marcuse model. It was observed that the model predicts correctly the attenuation behavior for usual curvature radii, however, it fails to predict accurately the attenuation behavior for small curvature radii, underestimating considerably the actual power loss. Also, it has been observed that at small radii the power loss parameter 2α and the mode propagation constant of the wave guide β stop being constants and become functions of the optical path, particularly of the number of loops in the coil. It is possible that new mechanisms of light leaking are present, due to the extreme distortion of the modes configuration into the fiber at small radii. Those mechanisms cannot be described by a model that considers a power loss parameter 2α, and more specifically the mode propagation constant of the wave guide (β) as constants. Then it is important to develop other models where the previous parameters can be considered as functions of the optical path.