Descrição dos fatores de risco para recaída em pacientes com diagnóstico de transtorno mental

Objective: The objective of this paper is to describe the population served in mental health institutionsfor mental illness relapse, and the process of identifying risk factors in relapsing patientsdiagnosed with severe mental illness. To this end a descriptive exploratory multicenter, multistageepidemiological study was carried out in mental health institutions of the Order of San Juan deDios Hospital (OHSJD) with hospitalized relapsing patients with a diagnosis of severe mentaldisorder. This study comes from a working network of Psychology professionals in the OHSJDnationwide. Materials and methods: The population sample was of 1005 patients diagnosed withsevere mental disorders, who had presented relapse during the last year. First, the characterizationof the general population was conducted; then, it was narrowed down to the centers, taking intoaccount similarities and differences found according to the clinical and demographic variables.Results: Major risk factors for relapse found in patients diagnosed with severe mental disorderswere: having between 38 and 58 years of age, being female, single, graduates, unemployed, witha prevalence of bipolar affective disorder diagnosis, number of hospitalizations between 2 and10, number of drugs at the time of leaving hospital 2 to 6, with severe difficulties relating withothers and difficulties in adherence to treatment. The need for a caregiver was also found, as wellas a limited number of received psychological interventions. How the system of beliefs affects thedisease and the poor adherence to treatment was identified. Conclusions: These results indicatethe requirement of a design of team intervention strategies, ranging from the assessment team(home), definition of therapeutic action plans (for) and the posthospitalizacion (egress) following.There is a poor support network and limited adherence to comprehensive treatment.Objetivo: El objetivo del presente artículo es socializar los resultados de la investigación realizadarespecto a la descripción de la población atendida en instituciones de salud mental que tienenrecaídas por enfermedad mental, así como el proceso de identificación de los factores de riesgoen pacientes diagnosticados con trastorno mental severo que presentan recaídas. Para este finse realizó un estudio descriptivo exploratorio multicéntrico, multietápico y epidemiológico enpacientes hospitalizados en las instituciones de salud mental de la Orden Hospitalaria San Juande Dios (OHSJD) que presentan recaídas con diagnóstico de trastorno mental severo. Este estudiosurge a partir de un trabajo en red de los profesionales de psicología de la OHSJD a nivelnacional. Materiales y métodos: La muestra poblacional fue de 1005 pacientes con diagnósticosde trastornos mentales severos que hubieran presentando recaídas durante el ultimo año. Enel estudio, se realizó en primera instancia la caracterización de la población en general y luegopor centros, teniendo en cuenta similitudes y diferencias encontradas de acuerdo a las variablesclínicas y sociodemográficas. Resultados: Los factores de riesgo importantes para recaídas en pacientesdiagnosticados con trastornos mentales severos encontrados fueron: la edad entre los 38y los 58 años, sexo femenino, solteras, bachilleres, desempleadas, con prevalencia del diagnósticode trastorno afectivo bipolar, número de ingresos entre 2 y 10, número de medicamentos a suegreso 2 a 6, con dificultades severas en la relación con los otros, con dificultades en la adherenciaal tratamiento. Además, se encontró que estos pacientes requieren de un cuidador y que elnúmero de intervenciones psicológicas recibidas son limitadas, y se identificó cómo el sistema decreencias influye frente a la enfermedad y en la pobre adherencia al tratamiento. Conclusiones:Estos resultados señalan que se requiere del diseño de estrategias de intervención en equipo terapéutico, que van desde la evaluación en equipo (inicio), definición de planes de acción terapéutica(durante) y el seguimiento posthospitalizacion (egreso). Existe una pobre red de apoyo y limitadaadherencia al tratamiento integral.Objetivo: O objetivo do presente artigo é socializar os resultados da pesquisa realizada em relação àdescrição da população atendida em instituições de saúde mental que têm recaídas por enfermidademental, assim como o processo de identificação dos fatores de risco em pacientes diagnosticadoscom transtorno mental severo que apresentam recaídas. Para esta finalidade realizou-se um estudodescritivo exploratório multicêntrico, multietápico e epidemiológico em pacientes hospitalizadosnas instituições de saúde mental da Ordem Hospitalaria San Juan de Dios (OHSJD) que apresentamrecaídas com diagnóstico de transtorno mental severo. Este estudo surge a partir de umtrabalho em rede dos profissionais de psicologia da OHSJD no nível nacional. Materiais e métodos:A amostra populacional foi de 1005 pacientes com diagnósticos de transtornos mentais severos,que tivessem apresentado recaídas durante o último ano. No estudo, realizou-se em primeira instânciaa caracterização da população em geral e depois por centros, tendo em conta similitudes e diferenças encontradas de acordo às variáveis clínicas e sociodemográficas. Resultados: Os fatoresde risco importantes para recaídas em pacientes diagnosticados com transtornos mentais severosencontrados foram: a idade entre os 38 e 58 anos, sexo feminino, solteiras, bacharéis, desempregadas,com prevalência do diagnóstico de transtorno afetivo bipolar, número de ingressos entre 2e 10, número de medicamentos no seu egresso 2 a 6, com dificuldades severas na relação com osoutros, com dificuldades na aderência ao tratamento. Além disso, encontrou-se que estes pacientesrequerem de um cuidador e que o número de intervenções psicológicas recebidas é limitado,e se identificou como o sistema de crenças influi à frente da enfermidade e na pobre aderênciaao tratamento. Conclusões: Estes resultados assinalam que se requere o desenho de estratégiasde intervenção em equipe terapêutica que vão desde a avaliação em equipe (inicio), definição deplanos de ação terapêutica (durante) e o seguimento após hospitalização (egresso). Existe umapobre rede de apoio e limitada aderência ao tratamento integral

Photon pair-state preparation with tailored spectral properties by spontaneous four-wave mixing in photonic-crystal fiber

We study theoretically the generation of photon pairs by spontaneous four-wave mixing (SFWM) in photonic crystal optical fiber. We show that it is possible to engineer two-photon states with specific spectral correlation (``entanglement'') properties suitable for quantum information processing applications. We focus on the case exhibiting no spectral correlations in the two-photon component of the state, which we call factorability, and which allows heralding of single-photon pure-state wave packets without the need for spectral post filtering. We show that spontaneous four wave mixing exhibits a remarkable flexibility, permitting a wider class of two-photon states, including ultra-broadband, highly-anticorrelated states.Comment: 17 pages, 7 figures, submitte

Tailored photon-pair generation in optical fibers

We experimentally control the spectral structure of photon pairs created via spontaneous four-wave mixing in microstructured fibers. By fabricating fibers with designed dispersion, one can manipulate the photons' wavelengths, joint spectrum, and, thus, entanglement. As an example, we produce photon-pairs with no spectral correlations, allowing direct heralding of single photons in pure-state wave packets without filtering. We achieve an experimental purity of $85.9\pm1.6$, while theoretical analysis and preliminary tests suggest 94.5% purity is possible with a much longer fiber

Wses Guidelines For Management Of Clostridium Difficile Infection In Surgical Patients

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.1

2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy.

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI

A pandemic recap : lessons we have learned

On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.Non peer reviewe

2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias

Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.Peer reviewe