Les noves tecnologies de reproducció i els reptes a la maternitat / paternitat

Noves tecnologies reproductives (NTR) és el nom general donat a les múltiples tècniques creades i desenvolupades en els últims trenta anys en el terreny de la medicina reproductiva. Aquestes tècniques s'adrecen a les diverses fases del procés reproductiu, des de la concepció fins al naixement. Les NTR constitueixen instruments poderosos de visualització i control dels fetus i de les dones que els gesten, creen nous subjectes d'intervenció mèdica i afecten el nucli de la concepció occidental sobre la reproducció i les relacions de parentiu. Així, per exemple, tècniques com l'amniocentesi o els sistemes d'ultrasons introdueixen nocions de qualitat i de viabilitat del fetus en les eleccions reproductives de les persones i modifiquen substancialment conceptes com el de paternitat/maternitat responsable. La fecundació in vitro, adreçada al moment de la concepció, ha generat tot un discurs al voltant de la infertilitat i la necessitat de reproducció biològica de les parelles. En definitiva, les NTR mobilitzen, qüestionen i creen representacions, conceptes, valors i discursos polítics al voltant de la reproducció i de la paternitat/maternitat i constitueixen així un terreny d'estudi per a les ciències socials poc explorat fins ara dins el context de la sociologia feta al nostre país.Bajo el nombre de «Nuevas tecnologías reproductivas» (NTR) se recogen las múltiples técnicas creadas y desarrolladas en los últimos treinta años en el terreno de la medicina reproductiva. Estas técnicas se dirigen a las distintas fases del proceso reproductivo, desde la concepción hasta el nacimiento. Las NTR constituyen instrumentos poderosos de visualización y control de los fetos y de las mujeres que los gestan, crean nuevos sujetos de intervención médica y afectan al núcleo mismo de la concepción prevalente en Occidente sobre reproducción y parentesco. Así, por ejemplo, técnicas tales como la amniocentesis o los sistemas de ultrasonidos introducen nociones de calidad y viabilidad de los fetos en las elecciones reproductivas de las personas, al mismo tiempo que modifican sustancialmente nociones como las de paternidad responsable. La fecundación in vitro, dirigida al momento de la concepción, ha generado multitud de discursos alrededor de la infertilidad y la «necesidad» de reproducción biológica de las parejas (en especial de las mujeres). En definitiva, las NTR mobilizan, cuestionan y crean representaciones, conceptos, valores y discursos políticos alrededor de la reproducción y la paternidad, constituyendo así un terreno de estudio para las ciencias sociales poco explorado hasta el momento en el contexto de la sociología hecha en nuestro país.New Reproductive Technologies (NRT) is the general name given to the multiple technological devices created and developed in the last thirty years in the area of reproductive medicine. They address different aspects of the reproductive process —from conception to birth. These technologies present continuities with some other technologies of reproductive control, but also introduce novelties which have the potential for challenging our understanding of reproduction, motherhood, parenthood and family. The need for the NRT and especially for In Vitro Fertilisation (IVF) has been created through complex discursive devices. In this article we will be looking at some elements of how IVF has been legitimised, and how this process has involved (and carries as a consequence) the creation and typification of new subjects (the infertile, among others), of a disease (infertility) and of a need (the need for a biological child)

IMC applied to JC Charmant Events business plan

Treballs Finals del Grau de d'Administració i Direcció d'Empreses, Facultat d'Economia i Empresa, Universitat de Barcelona, Curs: 2014-2015 , Tutor: Claudio Cruz CázaresEl treball fi de grau que es presenta a continuació neix del desig de constituir un pla d’empresa sobre una empresa d’esdeveniments, anomenada JC Charmant Events amb una companya d’universitat. L’empresa ofereix tot tipus de serveis; corporatius, d’esports, socials i de moda. En el meu cas, es farà èmfasis en els esdeveniments socials i de moda que són els que em creen més interès. Després d’haver estat estudiant un any sencer a Estats Units i haver realitzat l’assignatura de comunicacions integrades de marketing, vaig adonar-me que era una tècnica que no s’utilitzava a Espanya. Doncs, al pensar que és una eina de treball eficient i eficaç vaig voler comprovar en el treball si es podria utilitzar com a eina de promoció de la meva possible empresa i veure si es econòmicament viable. En aquesta tesis doncs espero poder crear una empresa rentable i que generi beneficis i comprovar si el pla promocional que considero adequat es pot aplicar i és econòmicament factible. Ressaltar, que vull especialitzar-me en tot el món de la comunicació de l’empresa, i és per això que de totes les tècniques promocionals que aquesta tècnica ofereix, jo m’he centrat en la offline, les relacions públiques i la responsabilitat social corporativa; que es on penso que puc aportar més valor

Non-alcoholic fatty liver disease (NAFLD) as a neglected metabolic companion of psychiatric disorders: common pathways and future approaches

Background: Non-alcoholic fatty liver disease (NAFLD) is characterized by hepatic steatosis in over 5% of the parenchyma in the absence of excessive alcohol consumption. It is more prevalent in patients with diverse mental disorders, being part of the comorbidity driving loss of life expectancy and quality of life, yet remains a neglected entity. NAFLD can progress to non-alcoholic steatohepatitis (NASH) and increases the risk for cirrhosis and hepatic carcinoma. Both NAFLD and mental disorders share pathophysiological pathways, and also present a complex, bidirectional relationship with the metabolic syndrome (MetS) and related cardiometabolic diseases. Main text: This review compares the demographic data on NAFLD and NASH among the global population and the psychiatric population, finding differences that suggest a higher incidence of this disease among the latter. It also analyzes the link between NAFLD and psychiatric disorders, looking into common pathophysiological pathways, such as metabolic, genetic, and lifestyle factors. Finally, possible treatments, tailored approaches, and future research directions are suggested. Conclusion: NAFLD is part of a complex system of mental and non-communicable somatic disorders with a common pathogenesis, based on shared lifestyle and environmental risks, mediated by dysregulation of inflammation, oxidative stress pathways, and mitochondrial function. The recognition of the prevalent comorbidity between NAFLD and mental disorders is required to inform clinical practice and develop novel interventions to prevent and treat these complex and interacting disorders

Vickybot, a Chatbot for Anxiety-Depressive Symptoms and Work-Related Burnout in Primary Care and Health Care Professionals: Development, Feasibility, and Potential Effectiveness Studies

Background: Many people attending primary care (PC) have anxiety-depressive symptoms and work-related burnout compounded by a lack of resources to meet their needs. The COVID-19 pandemic has exacerbated this problem, and digital tools have been proposed as a solution. Objective: We aimed to present the development, feasibility, and potential effectiveness of Vickybot, a chatbot aimed at screening, monitoring, and reducing anxiety-depressive symptoms and work-related burnout, and detecting suicide risk in patients from PC and health care workers. Methods: Healthy controls (HCs) tested Vickybot for reliability. For the simulation study, HCs used Vickybot for 2 weeks to simulate different clinical situations. For feasibility and effectiveness study, people consulting PC or health care workers with mental health problems used Vickybot for 1 month. Self-assessments for anxiety (Generalized Anxiety Disorder 7-item) and depression (Patient Health Questionnaire-9) symptoms and work-related burnout (based on the Maslach Burnout Inventory) were administered at baseline and every 2 weeks. Feasibility was determined from both subjective and objective user-engagement indicators (UEIs). Potential effectiveness was measured using paired 2-tailed t tests or Wilcoxon signed-rank test for changes in self-assessment scores. Results: Overall, 40 HCs tested Vickybot simultaneously, and the data were reliably transmitted and registered. For simulation, 17 HCs (n=13, 76{\%} female; mean age 36.5, SD 9.7 years) received 98.8{\%} of the expected modules. Suicidal alerts were received correctly. For the feasibility and potential effectiveness study, 34 patients (15 from PC and 19 health care workers; 76{\%} [26/34] female; mean age 35.3, SD 10.1 years) completed the first self-assessments, with 100{\%} (34/34) presenting anxiety symptoms, 94{\%} (32/34) depressive symptoms, and 65{\%} (22/34) work-related burnout. In addition, 27{\%} (9/34) of patients completed the second self-assessment after 2 weeks of use. No significant differences were found between the first and second self-assessments for anxiety (t8=1.000; P=.34) or depressive (t8=0.40; P=.70) symptoms. However, work-related burnout scores were moderately reduced (z=−2.07, P=.04, r=0.32). There was a nonsignificant trend toward a greater reduction in anxiety-depressive symptoms and work-related burnout with greater use of the chatbot. Furthermore, 9{\%} (3/34) of patients activated the suicide alert, and the research team promptly intervened with successful outcomes. Vickybot showed high subjective UEI (acceptability, usability, and satisfaction), but low objective UEI (completion, adherence, compliance, and engagement). Vickybot was moderately feasible. Conclusions: The chatbot was useful in screening for the presence and severity of anxiety and depressive symptoms, and for detecting suicidal risk. Potential effectiveness was shown to reduce work-related burnout but not anxiety or depressive symptoms. Subjective perceptions of use contrasted with low objective-use metrics. Our results are promising but suggest the need to adapt and enhance the smartphone-based solution to improve engagement. A consensus on how to report UEIs and validate digital solutions, particularly for chatbots, is required.We are grateful to all participants. GA is supported by a Rio Hortega 2021 grant (CM21/00017) from the Spanish Ministry of Health financed by the Instituto de Salud Carlos III (ISCIII) and cofinanced by Fondo Social Europe Plus. MS was supported by a grant from the Baszucki Brain Research Fund. AM is supported by the Agència de Gestió d’Ajudes Universitàries I de Investigació—PANDÈMIES 2020 grant (PI047003) from the Generalitat de Catalunya. IG thanks the support of the Spanish Ministry of Science and Innovation (PI19/00954) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdirección General de Evaluación y el Fondos Europeos de la Unión Europea (FEDER, Fondo Social Europe, Next Generation European Union or Plan de Recuperación Transformación y Resiliencia_PRTR); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); and the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), CERCA Programme or Generalitat de Catalunya as well as the Fundació Clínic per la Recerca Biomèdica (Pons Bartran 2022-FRCB_PB1_2022). AHY’s independent research was funded by the National Institute for Health Research Biomedical Research Centre in South London and Maudsley National Health Service Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the National Health Service, National Institute for Health and Care Research, or Department of Health. JR is supported by a Miguel Servet II contract (CPII19/00009), funded by ISCIII and cofunded by the European Social Fund “Investing in your future.” CT has been supported through a “Miguel Servet” postdoctoral contract (CPI14/00175) and a Miguel Servet II contract (CPII19/00018) and thanks the support of the Spanish Ministry of Innovation and Science (PI17/01066 and PI20/00344), funded by the Instituto de Salud Carlos III and cofinanced by the European Union (FEDER) “Una manera de hacer Europa.” AMA thanks the support of the Spanish Ministry of Science and Innovation (PI18/00789, PI21/00787) integrated into the Plan Nacional de I+D+I and cofinanced by ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER); the ISCIII; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365); the CERCA Programme; and the Departament de Salut de la Generalitat de Catalunya for the Pla estratègic de recerca I innovació en salut (PERIS) grant SLT006/17/00177. AM thanks the support of the Spanish Ministry of Science and Innovation (PI19/00672) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdirección General de Evaluación and the FEDER. GF is supported by a fellowship from “La Caixa” Foundation (ID 100010434)—fellowship code—LCF/BQ/DR21/11880019. SA has been supported by a Sara Borrell contract (CD20/00177), funded by ISCIII and founded by the European Social Fund “Investing in your future.” EV thanks the support of the Spanish Ministry of Science, Innovation and Universities (PI15/00283, PI18/00805, PI19/00394, PI21/00787, and CPII19/00009) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdirección General de Evaluación and the FEDER; the ISCIII; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), and the CERCA Programme or Generalitat de Catalunya. We would like to thank the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357. DHM´s research was supported by Juan Rodés JR18/00021 granted by the ISCIII. The PRESTO project has been funded by Fundació Clínic per a la Recerca Biomèdica through the Pons Bartran 2020 grant (PI046549). The development of a version of the digital solution adapted to health workers is funded by the Spanish Foundation for Psychiatry and Mental Health, Spanish Psychiatric Society, and Spanish Society of Biological Psychiatry (PI046813). The enhancement of the digital solution with Natural Language Processing techniques in a chatbot user-interface in collaboration with the text mining technologies in the health domain of the Barcelona Supercomputing Center is funded by the Agència de Gestió d’Ajudes Universitàries I de Investigació—PANDÈMIES 2020 grant (PI047003), from La Generalitat de Catalunya.Peer Reviewed"Article signat per 50 autors/es: Gerard Anmella; Miriam Sanabra; Mireia Primé-Tous; Xavier Segú; Myriam Cavero; Ivette Morilla; Iria Grande; Victoria Ruiz; Ariadna Mas; Inés Martín-Villalba; Alejandro Caballo; Julia-Parisad Esteva; Arturo Rodríguez-Rey; Flavia Piazza; Francisco José Valdesoiro; Claudia Rodriguez-Torrella; Marta Espinosa; Giulia Virgili; Carlota Sorroche; Alicia Ruiz; Aleix Solanes; Joaquim Radua; María Antonieta Also; Elisenda Sant; Sandra Murgui; Mireia Sans-Corrales; Allan H Young; Victor Vicens; Jordi Blanch; Elsa Caballeria; Hugo López-Pelayo; Clara López; Victoria Olivé; Laura Pujol ; Sebastiana Quesada; Brisa Solé; Carla Torrent; Anabel Martínez-Aran; Joana Guarch; Ricard Navinés; Andrea Murru; Giovanna Fico; Michele de Prisco; Vicenzo Oliva; Silvia Amoretti ; Casimiro Pio-Carrino; María Fernández-Canseco; Marta Villegas; Eduard Vieta; Diego Hidalgo-Mazzei"Postprint (published version

Unravelling potential severe psychiatric repercussions on healthcare professionals during the COVID-19 crisis

The coronavirus disease 2019 (COVID-19) outbreak is putting healthcare professionals, especially those in the frontline, under extreme pressures, with a high risk of experiencing physical exhaustion, psychological disturbances, stigmatization, insomnia, depression and anxiety. We report the case of a general practitioner, without relevant somatic or psychiatric history that experienced a 'brief reactive psychosis (298.8)' under stressful circumstances derived from COVID-19. She presented with delusional ideas of catastrophe regarding the current pandemic situation, delusions of self-reference, surveillance and persecution, with high affective and behavioural involvement. Physical examination and all further additional investigations did not reveal any secondary causes. She was administered olanzapine 10 mg with significant psychopathological improvement being later discharged with indications to maintain the treatment. To our knowledge this is the first reported case of severe mental illness in a healthcare professional without previous psychiatric history due to COVID-19 outbreak. Around 85% of patients presenting a brief psychotic disorder will develop a potentially disabling serious psychotic illness in the long-term. This case represents the potentially serious mental health consequences on healthcare professionals throughout the COVID-19 crisis and emphasizes the need to implement urgent measures to maintain staff mental health during the current pandemic

Tratamiento de aguas industriales residuales mediante destilación fría sólido líquido

El gran consumo de agua que se produce en todo proceso industrial y su posterior desecho, no siempre admitido en la Estación Depuradora de Aguas Residuales (EDAR), por alto contenido en Demanda Química de Oxígeno (DQO), hace que se replantee y busquen nuevas soluciones. La alternativa a la destilación por calor, generalmente acompañada con sistemas de vacío, filtrado, controles complicados; es la ofrecida por la destilación fría sólido líquido, que permite concentrar un fluido mediante técnicas de frio, en combinación con regulación hidráulica. Se ofrece así menor consumo energético, menor inversión y una instalación sencilla. Con este procedimiento físico, se consigue separar el agua contenida en el efluente, en forma de hielo por un lado y el concentrado por otro. La aplicación a las aguas residuales, procedentes de industrias de lavado u otras, ha sido uno de los logros de esta técnica, al ver que el agua retirada en forma de hielo estaba libre de impurezas y a la vez se obtenía el concentrado deseado. El reciclado del agua es otra de las ventajas. En el desarrollo del artículo se muestra esquemáticamente el proceso tecnológico de la destilación sólido líquido, con valores experimentales, y datos tanto cualitativos como cuantitativos.Postprint (published version

Real-world Implementation of a Smartphone-Based Psychoeducation Program for Bipolar Disorder: Observational Ecological Study

Background: SIMPLe is an internet-delivered self-management mobile app for bipolar disorder (BD) designed to combine technology with evidence-based interventions and facilitate access to psychoeducational content. The SIMPLe app was launched to the real world to make it available worldwide within the context of BD treatment. Objective: The main aims of this study are as follows: to describe app use, engagement, and retention rates based on server data; to identify patterns of user retention over the first 6-month follow-up of use; and to explore potential factors contributing to discontinuation of app use. Methods: This was an observational ecological study in which we pooled available data from a real-world implementation of the SIMPLe app. Participation was open on the project website, and the data-collection sources were a web-based questionnaire on clinical data and treatment history administered at inclusion and at 6 months, subjective data gathered through continuous app use, and the use patterns captured by the app server. Characteristics and engagement of regular users, occasional users, and no users were compared using 2-tailed t tests or analysis of variance or their nonparametric equivalent. Survival analysis and risk functions were applied to regular users' data to examine and compare use and user retention. In addition, a user evaluation analysis was performed based on satisfaction, perceived usefulness, and reasons to discontinue app use. Results: We included 503 participants with data collected between 2016 and 2018, of whom 77.5% (n=390) used the app. Among the app users, 44.4% (173/390) completed the follow-up assessment, and data from these participants were used in our analyses. Engagement declined gradually over the first 6 months of use. The probability of retention of the regular users after 1 month of app use was 67.4% (263/390; 95% CI 62.7%-72.4%). Age (P=.002), time passed since illness onset (P<.001), and years since diagnosis of BD (P=.048) correlate with retention duration. In addition, participants who had been diagnosed with BD for longer used the app on more days (mean 97.73, SD 69.15 days; P=.002) than those who had had a more recent onset (mean 66.49, SD 66.18 days; P=.002) or those who had been diagnosed more recently (mean 73.45, SD 66 days; P=.01). Conclusions: The user retention rate of the app decreased rapidly after each month until reaching only one-third of the users at 6 months. There exists a strong association between age and app engagement of individuals with BD. Other variables such as years lived with BD, diagnosis of an anxiety disorder, and taking antipsychotics seem relevant as well. Understanding these associations can help in the definition of the most suitable user profiles for predicting trends of engagement, optimization of app prescription, and management

A 12-month prospective study on the time to hospitalization and clinical management of a cohort of bipolar type I and schizoaffective bipolar patients

Background: Schizoaffective disorder, bipolar type (SAD) and bipolar disorder I (BD) present a large clinical overlap. In a 1-year follow-up, we aimed to evaluate days to hospitalization (DTH) and predictors of relapse in a SAD-BD cohort of patients. Methods: A 1-year, prospective, naturalistic cohort study considering DTH as primary outcome and incidence of direct and indirect measures of psychopathological compensation as secondary outcomes. Kaplan-Meyer survival analysis with Log-rank Mantel-Cox test compared BD/SAD subgroups as to DTH. After bivariate analyses, Cox regression was performed to assess covariates possibly associated with DTH in diagnostic subgroups. Results: Of 836 screened patients, 437 were finally included (SAD = 105; BD = 332). Relapse rates in the SAD sample was n = 26 (24.8%) vs. n = 41 (12.3%) in the BD sample (p = 0.002). Mean ± SD DTH were 312.16 ± 10.6 (SAD) vs. 337.62 ± 4.4 (BD) days (p = 0.002). Patients with relapses showed more frequent suicide acts, violent behaviors, and changes in pharmacological treatments (all p 0.0005). Conclusions: SAD patients relapse earlier with higher hospitalization rates and violent behavior during psychotic episodes whereas bipolar patients have more suicide attempts. Psychiatric/psychological follow-up visits may delay hospitalizations by closely monitoring symptoms of self- and hetero-aggression

Duration of untreated illness and bipolar disorder: time for a new definition? Results from a cross-sectional study

Background: We primarily aimed to explore the associations between duration of untreated illness (DUI), treatment response, and functioning in a cohort of patients with bipolar disorder (BD). Methods: 261 participants with BD were recruited. DUI was defined as months from the first affective episode to the start of a mood-stabilizer. The functioning assessment short test (FAST) scores and treatment response scores for lithium, valproate, or lamotrigine according to the Alda Scale Total Score (TS) were compared between patients with short (<24 months) or long DUI. Differences in FAST scores among good (GR; TS≥7), poor (PR; TS=2-6), or non-responders (NR; TS<2) to each mood-stabilizer were analyzed. Linear regression was computed using the FAST global score as the dependent variable. Results: DUI and FAST scores showed no statistically significant correlation. Patients with a longer DUI showed poorer response to lithium (Z=-3.196; p<0.001), but not to valproate or lamotrigine. Response to lithium (β=-1.814; p<0.001), number of hospitalizations (β=0.237; p<0.001), and illness duration (β=0.160; p=0.028) were associated with FAST total scores. GR to lithium was associated with better global functioning compared to PR or NR [H=27.631; p<0.001]. Limitations: The retrospective design could expose our data to a recall bias. Also, only few patients were on valproate or lamotrigine treatment. Conclusions: Poor functioning in BD could be the result of multiple affective relapses, rather than a direct effect of DUI. A timely diagnosis with subsequent effective prophylactic treatment, such as lithium, may prevent poor functional outcomes in real-world patients with BD

Affective temperaments mediate aggressive dimensions in bipolar disorders: A cluster analysis from a large, cross-sectional, international study

Background: Affective temperaments show potential for aggressive behavior (AB) preventive strategies in bipolar disorder (BD). We aim to define intra-diagnostic subgroups of patients with BD based on homogeneous behaviors related to AB. Subsequently, to assess whether affective temperament dimensions may contribute to the presence and severity of AB. Methods: Patients with BD were recruited. AB was evaluated through the modified overt aggression scale (MOAS); affective temperaments were assessed with the TEMPS-A. A cluster analysis was conducted based on TEMPS-A and MOAS scores. Stepwise backward logistic regression models were used to identify the predictive factors of cluster membership. Results: 799 patients with BD were enrolled. Three clusters were determined: non-aggressive (55.5 %), self-aggressive (18 %), and hetero-aggressive (26.5 %). Depressive, irritable, and anxious temperament scores significantly increased from the non-aggressive (lower) to the self-aggressive (intermediate) and the hetero-aggressive group (highest). A positive history of a suicide attempt (B = 5.131; OR = 169.2, 95 % CI 75.9; 377) and rapid cycling (B = -0.97; OR = 0.40, 95 % CI 0.17; 0.95) predicted self-aggressive cluster membership. Atypical antipsychotics (B = 1.19; OR = 3.28, 95 % CI 2.13; 5.06) or SNRI treatment (B = 1.09; OR = 3, 95 % CI 1.57; 5.71), psychotic symptoms (B = 0.73; OR = 2.09, 95 % CI 1.34; 3.26), and history of a suicide attempt (B = -1.56; OR = 0.20, 95 % CI 0.11; 0.38) predicted hetero-aggressive cluster membership. Limitations: Recall bias might have affected the recollection of AB. Conclusions: Clinical factors orientate the prevention of different ABs in BD. Affective temperaments might play a role in preventing AB since patients with more pronounced affective temperaments might have an increased risk of showing AB, in particular hetero-AB