562 research outputs found
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
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