Felicidad, calidad de vida y bienestar en personas con trastorno mental grave

Ante las escasas investigaciones sobre calidad de vida y felicidad, específicamente en personas con trastorno mental grave, y debido al interés creciente sobre la salud mental, esta investigación pretende conocer la percepción de calidad de vida de las personas con trastorno mental grave (TMG), además del significado de felicidad, a través de sus opiniones, creencias y experiencias, con el fin de fomentar la recuperación de su autonomía y autodeterminación personal, en relación a su enfermedad e intervenciones terapéuticas. Objetivos: O 1. Describir las variables sociodemográficas, clínicas y calidad de vida relacionada con la salud (CVRS) de las personas con trastorno mental grave de la muestra de la USMC de La Laguna O 2. Explorar las diferencias entre las categorías del trastorno mental grave (trastornos psicóticos, trastornos afectivos y trastornos de personalidad) y el resto de las variables del cuestionario C-VS-PCVRS-TMG O 3. Analizar las puntuaciones obtenidas en las dimensiones de calidad de vida, según las láminas COOP/WONCA, y su asociación con el resto de las variables sociodemográficas y clínicas O 4. Describir la prevalencia de las etiquetas diagnósticas de enfermería de NANDA-I y las intervenciones de enfermería NIC más frecuentes y analizar su asociación con el resto de las variables sociodemográficas, clínicas y de CVRS O 5. Analizar las diferencias y/o asociaciones entre las variables sociodemográficas y clínicas O 6. Relacionar las puntuaciones sobre la percepción de calidad de vida en las láminas COOP/WONCA y el estado de felicidad o infelicidad referida por el grupo de personas que realizaron las entrevistas de la investigación cualitativa O 7. Describir el significado de felicidad de las personas entrevistadas con trastorno mental grave de la USMC de La Laguna Material y método: Investigación mixta. En la investigación de enfoque cuantitativo se utilizó un método observacional, descriptivo y transversal, a través del Cuestionario de Valoración de la Salud y Percepción de Calidad de Vida Relacionada con la Salud de las personas con Trastorno Mental grave (C-VS-PCVRS-TMG) elaborado para esta investigación y las viñetas COOP/WONCA cuyas puntuaciones se recogen en los 10 últimos ítems del cuestionario (Lizán y Reig, 1999; Serrano-Gallardo et al., 2009). Se selecciona como población de estudio a los usuarios de la Unidad de Salud Mental de La Laguna, en la isla de Tenerife, que acuden para seguimiento a las consultas de enfermería, con una muestra resultante de 132 participantes, elegidos de manera intencional y por conveniencia, aceptando participar de manera voluntaria, con la firma previa del consentimiento informado. Los resultados fueron analizados con apoyo del paquete estadístico SPSS. Dentro de la investigación cualitativa, partiendo de una perspectiva de análisis constructivista y fenomenológico interpretativo, se realizó una entrevista estructurada ad hoc, para la que se seleccionaron a los participantes a través de un muestreo intencional y por conveniencia. Los datos se recogieron a través de diferentes métodos: un grupo focal de 5 personas, entrevistas individuales a 16 personas y observaciones recogidas en el diario de campo, lo que proporciona datos paralelos y permite realizar la triangulación. Las entrevistas se grabaron en audio, fueron transcritas verbatim, codificadas y analizadas con el apoyo del programa N-vivo. Resultados: Se realiza un análisis descriptivo de las variables sociodemográficas, de los datos clínicos y de las puntuaciones de calidad de vida, según las láminas COOP/WONCA, así como de su relación con los tipos de TMG. Asimismo, se realizó un análisis bivariado de asociaciones y relaciones entre los tipos de TMG, las puntuaciones de CVRS de las viñetas COOP/WONCA, los diagnósticos de enfermería de NANDA-I y las intervenciones de enfermería NIC y el resto de variables. Se establecen nueve categorías con sus respectivas subcategorías de los resultados obtenidos en las entrevistas a los 21 participantes sobre el significado de felicidad, las categorías obtenidas fueron: 1. “Concepto”; 2. “Experiencias relacionadas con la felicidad”; 3. “Eventos biográficos significativos; 4. “Estrategias para alcanzar la felicidad”; 5. “Sociedad”, 6. “Salud y felicidad”; 7. “Significado de la enfermedad”; 8. “Rechazo social”; 9. “Servicios de salud mental y estigma”. Dentro de las subcategorías obtenidas se establecieron tres dimensiones: la dimensión personal, la dimensión interpersonal-relacional y la dimensión temporal. Conclusiones: La percepción de CVRS es mejor en el grupo de personas que tienen trastornos psicóticos, además los diagnósticos de enfermería NANDA-I más asignados en este grupo son: deterioro de la interacción social, déficit de las actividades recreativas, aislamiento social y riesgo de confusión aguda (sustituida por trastorno de los procesos de pensamiento); junto a la intervención de enfermería NIC administración de medicación intramuscular, y de manera exclusiva, el manejo de las alucinaciones y de las ideas delirantes. Mientras que en el grupo de personas con trastornos afectivos las etiquetas NANDA-I más prevalentes son: ansiedad, afrontamiento ineficaz y labilidad emocional; con las siguientes intervenciones de enfermería NIC: apoyo emocional, desarrollo de un programa, potenciación de la autoestima y técnica de relajación. Por otro lado, las personas mayores, las polimedicadas y las que presentan pluripatologías perciben una peor calidad de vida global, sin embargo, la calidad de vida no mejora en función del sexo, nivel de estudios o el tipo de trabajo desempeñado. Las personas entrevistadas que refieren ser felices califican mejor su calidad de vida global. La felicidad incluye tres dimensiones: la dimensión personal, la dimensión interpersonal-relacional y la dimensión temporal

Cambios en la vida de las personas tras el diagnóstico de trastorno mental: significado e impacto

Objetivo: conocer el significado del diagnóstico del trastorno mental y el impacto en sus vidas, además de valorar si la presencia de cualquier enfermedad es un indicador de infeli-cidad. Metodología: estudio cualitativo fenomenológico, con muestreo por conveniencia e intencional, a un grupo focal y 16 entrevistas individuales, grabadas en audio, transcritas verbatim, codificadas y analizadas en el programa N-vivo. Resultados: la enfermedad física y mental puede producir infelicidad, si bien a veces no es causa de infelicidad. El significado de la enfermedad para algunos no supuso nada y para otros cambios importantes en sus vidas. Conclusiones: la enfermedad provoca cambios en la vida de las personas, no solo los esperados, como pueden ser las rupturas, pérdidas laborales, el estigma, etc., sino, además, cambios positivos, tales como el crecimiento personal.Objective: To find out the meaning of the diagnosis of mental disorder and the impact on their lives, as well as to assess whether the presence of any illness is an indicator of unhap-piness. Methodology: Qualitative phenomenological study, with convenience and intentional sampling, a focus group and 16 individual interviews, audio-recorded, transcribed verbatim, coded and analysed in the N-vivo programme. Results: Physical and mental illness can pro-duce unhappiness, although sometimes it is not a cause of unhappiness. The meaning of the illness for some meant nothing and for others major changes in their lives. Conclusions: Illness brings about changes in people’s lives, not only the expected ones, such as break-ups, job losses, stigma, etc., but also positive changes, such as personal growth

Precisamos de receitas para sermos felizes?

Objetivo: Conocer las estrategias de las personas con trastorno mental grave (TMG) para ser felices. Método: Estudio cualitativo fenomenológico, con muestreo por conveniencia e intencional. Se elaboró una entrevista, de la cual 3 preguntas estaban relacionadas con las estrategias empleadas y deseadas para alcanzar la felicidad. Se realizó un grupo de focal constituido por 5 personas y 16 entrevistas individuales a personas con TMG. Las entrevistas se grabaron en audio, fueron transcritas verbatim, codificadas y analizadas con el apoyo del programa N-vivo. Resultados: Todos los participantes identifican sus estrategias para ser felices. Al analizarlas encontramos que la aceptación, el optimismo, la espiritualidad, la recuperación, la normalidad, sentirse funcionales, el apoyo y las relaciones, la realización de actividades, tanto compartidas como individuales, tener las necesidades básicas cubiertas y algunas más, forman parte de las habilidades o tácticas que les permite alcanzar la felicidad. Si bien estas estrategias no parecen diferentes a las de cualquier persona, sí encontramos el deseo de la ausencia del estigma sobre la enfermedad mental y la protección contra el rechazo. Conclusiones: La felicidad se puede alcanzar de variadas y personales maneras, e independientemente de la enfermedad que te acompañe.Aim: To find out the strategies of people with severe mental disorders (SMD) to be happy. Method: Qualitative phenomenological study, with convenience and purposive sampling. An interview was developed, of which 3 questions were related to the strategies used and desired to achieve happiness. A focus group of 5 people and 16 individual interviews were conducted with people with TMG. The interviews were audio-recorded, transcribed verbatim, coded and analysed with the support of N-vivo software. Results: All participants identify their strategies for being happy. When analysed, we found that acceptance, optimism, spirituality, recovery, normality, feeling functional, support and relationships, doing activities, both shared and individual, having basic needs met and some more, are part of the skills or tactics that allow them to achieve happiness. While these strategies do not seem different from those of anyone else, we do find a desire for the absence of stigma about mental illness and protection from rejection. Conclusions: Happiness can be achieved in various and personal ways, and regardless of the disease that accompanies you.Objetivo: Conhecer as estratégias de pessoas com transtorno mental grave (TMG) para serem felizes. Método: Estudo fenomenológico qualitativo, com amostragem por conveniência e intencional. Foi elaborada uma entrevista, da qual 3 questões estavam relacionadas às estratégias utilizadas e desejadas para alcançar a felicidade. Foi realizado um focus group composto por 5 pessoas e 16 entrevistas individuais com pessoas com SMI. As entrevistas foram gravadas em áudio, transcritas na íntegra, codificadas e analisadas com o apoio do programa N-vivo. Resultados: Todos os participantes identificam suas estratégias para ser feliz. Ao analisá-los, constatamos que aceitação, otimismo, espiritualidade, recuperação, normalidade, sentir-se funcional, apoio e relacionamento, realizar atividades, tanto compartilhadas como individuais, ter necessidades básicas atendidas e mais algumas, fazem parte das habilidades ou táticas que permitem eles para alcançar a felicidade. Embora essas estratégias não pareçam diferentes das de qualquer outra pessoa, encontramos o desejo de ausência de estigma sobre doença mental e proteção contra rejeição. Conclusões: A felicidade pode ser alcançada de várias formas e pessoais, e independentemente da doença que o acompanha

De la estadística también se sale: Uso de escape room para la docencia en las asignaturas de metodología de investigación

Memoria ID-074 Ayudas de la Universidad de Salamanca para la innovación docente, curso 2020-2021

Mutations in TP53 and JAK2 are independent prognostic biomarkers in B-cell precursor acute lymphoblastic leukaemia

[EN]Background: In B-cell precursor acute lymphoblastic leukaemia (B-ALL), the identification of additional genetic alterations associated with poor prognosis is still of importance. We determined the frequency and prognostic impact of somatic mutations in children and adult cases with B-ALL treated with Spanish PETHEMA and SEHOP protocols. Methods: Mutational status of hotspot regions of TP53, JAK2, PAX5, LEF1, CRLF2 and IL7R genes was determined by next-generation deep sequencing in 340 B-ALL patients (211 children and 129 adults). The associations between mutation status and clinicopathological features at the time of diagnosis, treatment outcome and survival were assessed. Univariate and multivariate survival analyses were performed to identify independent prognostic factors associated with overall survival (OS), event-free survival (EFS) and relapse rate (RR). Results: A mutation rate of 12.4% was identified. The frequency of adult mutations was higher (20.2% vs 7.6%, P=0.001). TP53 was the most frequently mutated gene (4.1%), followed by JAK2 (3.8%), CRLF2 (2.9%), PAX5 (2.4%), LEF1 (0.6%) and IL7R (0.3%). All mutations were observed in B-ALL without ETV6-RUNX1 (P=0.047) or BCR-ABL1 fusions (P<0.0001). In children, TP53mut was associated with lower OS (5-year OS: 50% vs 86%, P=0.002) and EFS rates (5-year EFS: 50% vs 78.3%, P=0.009) and higher RR (5-year RR: 33.3% vs 18.6% P=0.037), and was independently associated with higher RR (hazard ratio (HR)=4.5; P=0.04). In adults, TP53mut was associated with a lower OS (5-year OS: 0% vs 43.3%, P=0.019) and a higher RR (5-year RR: 100% vs 61.4%, P=0.029), whereas JAK2mut was associated with a lower EFS (5-year EFS: 0% vs 30.6%, P=0.035) and a higher RR (5-year RR: 100% vs 60.4%, P=0.002). TP53mut was an independent risk factor for shorter OS (HR=2.3; P=0.035) and, together with JAK2mut, also were independent markers of poor prognosis for RR (TP53mut: HR=5.9; P=0.027 and JAK2mut: HR=5.6; P=0.036). Conclusions: TP53mut and JAK2mut are potential biomarkers associated with poor prognosis in B-ALL patients.European Commision (EC). Funding FP7/SP1/HEALTH. Project Code: 30624

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Variables psicológicas implicadas en la actitud e iniciativa emprendedora (II): personalidad, cognición y emoción

El proyecto titulado: Variables implicadas en la actitud e iniciativa emprendedora (II): personalidad, cognición y emoción, es la continuidad de otro presentado en la convocatoria anterior (2016-2017) cuyo objetivo era evaluar variables psicológicas en la actitud emprendedora de los estudiantes universitarios de la Universidad Complutense de Madrid (UCM). Este segundo proyecto ha tenido por objetivo principal ampliar la evaluación a otras facultades y áreas de conocimiento de nuestra universidad a fin de obtener el mapa y perfil de la iniciativa emprendedora del universitario UCM