Preparando el escenario para dejar de fumar en el paciente con Trastorno Bipolar: intervención breve en la práctica clínica

Tobacco consumption is the main preventable factor of mortality in smokers with bipolar disorder (BD), and any possible solutions are often blocked by prejudices over desire, and the possibilities and risks for these patients in giving up tobacco consumption. Adults with BD were recruited at 8 Mental Health Centres. Smokers were evaluated before and after a brief intervention based on the 3 A’s and classified into a ‘Stage of Change’ (SOC) and their ‘Readiness to Change’ (RTC). A multiple linear regression was used to analyze the progression in their RTC and the independent effect of different variables (pharmacological treatment, history of psychotic symptoms, current anxiety symptoms, willingness, self-perceived capacity to quit smoking and subjective perception of cognitive functioning). Of 212 stable patients diagnosed with BD, current smokers (n=101; 47.6%) were included in the intervention phase, and 80.2% completed it. At baseline, 75.2% were considering the idea of giving up smoking and, after the brief intervention, 30.9% of the patients progressed in their SOC. A significant increase in the level of RTC was observed (53.3 vs 59.3, P=0.019). Perception of cognitive performance (β=- 0.35;P=0.002), the degree of willing to quit (β=0.32;P=0.008), selfperceived capacity to quit tobacco smoking (β=-0.30;P=0.012), the patient’s age (β=-0.72;P=0.004), the age of onset of smoking (β=0.48;P=0.022) and years as a smoker (β=0.48;P=0.025) were all factors that significantly influenced the chances of improving after the short intervention. Smokers with BD consider the idea of quitting and a brief intervention developed in the every day mental health care setting improves the level of readiness. The neurocognitive dysfunction associated with BD may limit patients’ readiness to quit smoking.El consumo de tabaco es el principal factor prevenible de mortalidad en pacientes con trastorno bipolar (TB), y las posibles soluciones se encuentran bloqueadas por prejuicios acerca del deseo, posibilidades y riesgos al dejar el consumo de tabaco en estos pacientes. En 8 Centros de Salud Mental se reclutaron consecutivamente pacientes con TB. Los fumadores fueron evaluados antes y después de una intervención breve basada en las 3 As y clasificados según los “estadios de cambio” (EC) y su “disposición para el cambio” (DC). Mediante una regresión lineal múltiple se analizó la evolución del DC y su efecto sobre otras variables independientes (tratamiento farmacológico, historias de síntomas psicóticos, presencia de síntomas de ansiedad, deseo de abandono, capacidad auto-percibida y la percepción subjetiva de funcionamiento cognitivo). Se incluyeron 212 pacientes con TB estabilizados, los fumadores activos (n=101; 47.6%) pasaron a la fase de intervención, y un 80.2% la completaron. Basalmente, 75.2% consideraban la idea de dejar de fumar, después de la intervención breve, el 30.9% de los pacientes progresó en su EC. Se observó un incremento significativo del nivel de DC (53.3 vs 59.3, P=0.019). La autopercepción del rendimiento cognitivo (β=-0.35;P=0.002), el deseo de abandono (β=0.32;P=0.008), la autopercepción de la capacidad para dejar de fumar (β=-0.30;P=0.012), la edad del paciente (β=-0.72;P=0.004), la edad de inicio del tabaquismo (β=0.48;P=0.022) y los años fumando (β=0.48;P=0.025) fueron los factores que influyeron significativamente en la posibilidad de cambio tras la intervención breve. Los fumadores con TB consideran la idea de dejar de fumar y una intervención breve desarrollada en el marco de la atención a la salud mental diaria, mejoraría el nivel de preparación. La disfunción neurocognitiva asociada con el TB podría limitar la disposición de los pacientes a dejar de fumar

Facilitators and Barriers of Medication Adherence Based on Beliefs of Persons with Bipolar Disorder: A Qualitative Study

One of the big challenges in treating individuals with bipolar disorder (BD) is nonadherence to medication. This is the principal factor associated with a worse prognosis or outcome of the disease. This study aimed to explore and analyze the individual perceptions that people with BD have about the positive and negative aspects when taking medication. A descriptive and interpretative study was carried out using the qualitative research paradigm with the use of the analytical technique of discourse analysis, extracting the data through the completion of focus groups. Participants’ speech was digitally audio-recorded in digital format. In order to complete the codification of the participants’ speech content, we relied on the qualitative data analysis (using the QRS NVivo 10 computer software). Thirty-six participants diagnosed with bipolar disorder took part in our study. In the participants’ speech concerning the main barriers to pharmacological treatment, three key topics were identified. Perceived facilitators were summarized in four factors. The main facilitators regarding the use of pharmacological treatment in individuals with BD were the ones related with the perceived need for treatment in the acute phase, the recognition of the illness, the shared clinical decision, and the causal biological attribution in the chronic phase. In terms of perceived barriers, social control was identified in both phases, adverse effects in the acute phase, and the absence of effective treatment in the chronic state

Postpartum Relapse in Patients with Bipolar Disorder

Pregnancy and postpartum are vital times of greater vulnerability to suffer a decompensation of bipolar disorder (BD). Methods: A systematic literature search was performed on public electronic medical databases, following PRISMA guidelines. Studies were included if they reported postpartum relapse in patients diagnosed with BD according to Diagnosis Statistical Manual (DSM) or International Classification Disease (ICD) criteria. Results: Sixteen articles describing 6064 deliveries of 3977 women were included in the quantitative analyses. The overall risk of postpartum relapse was 36.77%. The methodology of the studies, the diagnostic criteria, the discrimination between BD type I and II, and the origin of the sample were very heterogeneous. Conclusions: the rate of postpartum bipolar relapse is very high, as it is considered to be a critical period. It is especially important to detect decompensation in this period and to evaluate mood-stabilizing treatment, given the high risk of relapse concentrated in a short period.Spanish Ministry of Health through the Carlos III Health Institute (Health Research Projects of the Strategic Action in Health) PI21/0125

Cigarette smoking and risk of suicide in bipolar disorder: a systematic review

Objective: Bipolar disorder (BD) is a highly prevalent, chronic and recurrent mental illness. The smoking rates in patients with BD are much higher than those of the general population, and BD is associated with an increased risk of suicide. An association between smoking and suicidal behavior has been found in the general population, this systematic review examines whether there is evidence of an association between smoking and suicide behavior in patients with BD. Method: A database search was carried out in Medline, Embase, The Cochrane Library, Scopus, and Web of Science, updated until December 31st, 2021, according to the 2020 PRISMA guidelines. We identified prospective and retrospective studies that included patients diagnosed with BD types I, II, and not otherwise specified, and in which smoking and suicidal behavior were correlated. Articles that focused exclusively on other mental disorders were excluded. The Ottawa-Newcastle scale was used to assess the methodological quality of the included articles. Results: Fifteen articles (n = 7,395) met all the inclusion criteria. In nine of these articles, the authors found an association between smoking and suicidal behavior in BD, while in the remaining six articles, this association was not found. A great deal of variability was observed between articles, particularly in the measurement of suicidal behavior and tobacco consumption. The risk of bias, as assessed by the NOS, was high for most of the included articles, except for two papers, whose risk was low. Conclusion: It was not possible to establish a clear relationship between tobacco use and the risk of suicide in BD patients due to the heterogeneity of the articles included in this systematic review, which had different sample sizes and methodological issues. However, both conditions are highly prevalent and have a negative impact on the prognosis of BD. Therefore, a systematic approach is needed, based on accurate measurement of a patient’s smoking habits and their risk of suicidal behavior, in order to establish an appropriate therapeutic plan. Additional information: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors and was registered on PROSPERO with the CRD42022301570 on January 21th 2022

Biological Role of Nutrients, Food and Dietary Patterns in the Prevention and Clinical Management of Major Depressive Disorder

Major Depressive Disorder (MDD) is a growing disabling condition affecting around 280 million people worldwide. This complex entity is the result of the interplay between biological, psychological, and sociocultural factors, and compelling evidence suggests that MDD can be considered a disease that occurs as a consequence of an evolutionary mismatch and unhealthy lifestyle habits. In this context, diet is one of the core pillars of health, influencing multiple biological processes in the brain and the entire body. It seems that there is a bidirectional relationship between MDD and malnutrition, and depressed individuals often lack certain critical nutrients along with an aberrant dietary pattern. Thus, dietary interventions are one of the most promising tools to explore in the field of MDD, as there are a specific group of nutrients (i.e., omega 3, vitamins, polyphenols, and caffeine), foods (fish, nuts, seeds fruits, vegetables, coffee/tea, and fermented products) or dietary supplements (such as S-adenosylmethionine, acetyl carnitine, creatine, amino acids, etc.), which are being currently studied. Likewise, the entire nutritional context and the dietary pattern seem to be another potential area of study, and some strategies such as the Mediterranean diet have demonstrated some relevant benefits in patients with MDD; although, further efforts are still needed. In the present work, we will explore the state-of-the-art diet in the prevention and clinical support of MDD, focusing on the biological properties of its main nutrients, foods, and dietary patterns and their possible implications for these patients.Fondo de Investigacion de la Seguridad Social, Instituto de Salud Carlos III PI18/01726 PI19/00766Programa de Actividades de I+D de la Comunidad de Madrid en Biomedicina B2017/BMD3804 B2020/MITICAD-C

Chronic obstructive pulmonary disease in severe mental illness: A timely diagnosis to advance the process of quitting smoking

This study receives founding by the Spanish Ministry of Economy, Industry, and Competitiveness, Instituto Carlos III (FIS PI16/00802).The authors would like to thank M. Osuna, M. Ayora, J. Caballero, P. Zurita, N. Novoa, J. Álvarez, J. Fernández, J. Redondo, M.S. López, I. Caro, F. Valdivia, C. Sádaba, R. Luque, and L. Padilla for their assistance. We also thank the altruistic and generous participation of all the patients in that project.Background. This study has two main objectives: to describe the prevalence of undetected chronic obstructive pulmonary disease (COPD) in a clinical sample of smokers with severe mental illness (SMI), and to assess the value of the Tobacco Intensive Motivational Estimated Risk tool, which informs smokers of their respiratory risk and uses brief text messages to reinforce intervention. Method. A multicenter, randomized, open-label, and active-controlled clinical trial, with a 12-month follow-up. Outpatients with schizophrenia (SZ) and bipolar disorder were randomized either to the experimental group—studied by spirometry and informed of their calculated lung age and degree of obstruction (if any)—or to the active control group, who followed the 5 A’s intervention. Results. The study sample consisted of 160 patients (71.9% SZ), 78.1% of whom completed the 12-month follow-up. Of the patients who completed the spirometry test, 23.9% showed evidence of COPD (77.8% in moderate or severe stages). TIMER was associated with a significant reduction in tobacco use at week 12 and in the long term, 21.9% of patients reduced consumption and 14.6% at least halved it. At week 48, six patients (7.3%) allocated to the experimental group achieved the seven-day smoking abstinence confirmed by CO (primary outcome in terms of efficacy), compared to three (3.8%) in the control group. Conclusion. In this clinical pilot trial, one in four outpatients with an SMI who smoked had undiagnosed COPD. An intensive intervention tool favors the early detection of COPD and maintains its efficacy to quit smoking, compared with the standard 5 A’s intervention.Spanish Ministry of Economy, Industry, and Competitiveness, Instituto Carlos III FIS PI16/0080

Marco de trabajo basado en BPM y Design Sprint para el proceso de control de suministros de producción en granja de la empresa Chimu Agropecuaria año 2021

La investigación permitió diseñar y aplicar un marco de trabajo a partir del análisis del método design sprint y BPM (Business Process Management) para la empresa Chimu Agropecuaria debido que no contaban con ninguna solución que les permita controlar su proceso de suministro para producción en las granjas de pollo. En el desarrollo del marco de trabajo se obtuvo la fase de comprensión y alineamiento estratégico que permitió comprender y capturar los requerimientos del negocio; en las fases de análisis y diseño de los procesos permitió realizar el análisis actual y así mismo proponer una solución para poder plasmarlo en diagramas de procesos (Proceso AS IS y Proceso TO BE); en la fase prototipar se obtuvo las diferentes vistas funcionales para la utilización dentro del ERP SAP, por último en la fase de validar se verifico la aprobación del prototipo por parte de los usuarios finales, además la evaluación de las fases del marco de trabajo por parte de juicio de expertos. Así mismo ha permitido que a partir de la aplicación del marco de trabajo se logró gestionar y optimizar las actividades que se desarrollan dentro del proceso de control de suministros de producción, que son recepcionados en las diferentes granjas de la empresa además de ser prioridad alta para la producción y el correcto abastecimiento de suministros claves como son el petróleo, gas a granel, pajilla (cáscara de arroz) y agua utilizados para la crianza de pollo. Además el marco de trabajo basado en design sprint y BPM ha permitido realizar el análisis del proceso para poder plasmarlo en un prototipo funcional que será desarrollado en SAP que es el actual ERP de la empresa, además utilizando la técnica de encuesta a los diferentes almaceneros nos ha permitido evaluar y comprobar el nivel de satisfacción del encuestado superando el 85% de aprobación generando un alto beneficio, reduciendo tiempos en el proceso, aumentando la productividad y generando valor para la empresa.The research allowed to design and apply a framework based on the analysis of the design sprint method and BPM (Business Process Management) for the company Chimu Agropecuaria because they did not have any solution that allows them to control their supply process for production on farms. of chicken. In the development of the framework, the phase of understanding and strategic alignment was obtained, which allowed understanding and capturing the business requirements; in the analysis and design phases of the processes, it allowed to carry out the current analysis and also to propose a solution to be able to translate it into process diagrams (AS IS Process and TO BE Process); in the prototyping phase, the different functional views were obtained for use within the SAP ERP, finally, in the validation phase, the approval of the prototype by the end users was verified, in addition to the evaluation of the phases of the framework by expert judgment. Likewise, it has allowed that from the application of the framework it was possible to manage and optimize the activities that are developed within the process of control of production supplies, which are received in the different farms of the company in addition to being a high priority for the production and correct supply of key supplies such as oil, bulk gas, straw (rice husks) and water used for raising chicken. In addition, the framework based on design sprint and BPM has allowed us to carry out the analysis of the process in order to translate it into a functional prototype that will be developed in SAP, which is the current ERP of the company, in addition to using the survey technique of the different storekeepers. It has allowed evaluating and verifying the level of satisfaction of the respondent, exceeding 85% approval, generating a high profit, reducing time in the process, increasing productivity and generating value for the company.Tesi

El Xoconochco: ¿Una provincia aislada del Imperio?

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