Programa de intervención para abordar el estigma asociativo en familiares de personas con enfermedad mental

Treball Final de Màster Universitari en Rehabilitació Psicosocial en Salut Mental Comunitària. Codi: SAX014. Curs acadèmic: 2020-2021Associative stigma is a phenomenon where loss of value, prejudice and discrimination exercised by society, are transmitted to the family environment by having to live the stigma attributed to the diagnosis. This study proposes the creation of a specific intervention program on associative stigma, aimed for family members and caregivers of people with a mental disorder. Relatives of patients will be recruited to maintain a follow-up program at the Mental Health Center of the Parc Taulí Hospital in Sabadell (Spain). For the evaluation of the program, scales will be applied that measure attribution, level of caregiver overload and anxiety symptoms, before and after the program. The recruited relatives will be subjected to both individual and group sessions where psychoeducational content on mental disorders and specific content on associative stigma will be offered. After completing the program, it is expected that the level of attribution of stigma, overload and anxiety, will significantly decrease in relatives and caregivers of patients with mental disorders. There are currently few studies that deepen into this subject. That is why it is useful and interesting since relatives can suffer consequences of stigma. This constitutes a fundamental pillar in the prognosis of those who suffer from mental disorder.El estigma asociativo es un fenómeno donde la devaluación, los prejuicios y la discriminación que ejerce la sociedad, se transmite al entorno familiar al tener que convivir con el estigma atribuido al diagnóstico. El presente trabajo propone la creación de un programa específico de intervención sobre el estigma asociativo, destinado a familiares y cuidadores de personas con un trastorno mental. Para ello se reclutarán familias de pacientes que mantengan seguimiento en el Centro de Salud Mental del Hospital Parc Taulí de Sabadell (España). Para la evaluación del programa, se aplicarán unas escalas que miden la atribución, el nivel de sobrecarga del cuidador y la presencia de síntomas de ansiedad, antes y después de realizado el programa. Las familias reclutadas serán sometidas a sesiones individuales y grupales donde se ofrecerá contenido psicoeducativo de los trastornos mentales y contenido especifico sobre el estigma asociativo. Se espera que tras finalizar el programa, disminuya significativamente la percepción del estigma asociativo representado en la disminución del nivel de atribución de estigma, del nivel de sobrecarga y de ansiedad en los participantes. En la actualidad son pocos los estudios que profundizan sobre el estigma en las familias y es por ello que resulta de utilidad e interés, ya que las familias pueden sufrir secuelas del estigma y constituyen un pilar fundamental en el pronóstico de quien sufre el trastorno mental

Tres experiencias sobre clases invertidas para promover el compromiso por el aprendizaje. Percepciones de estudiantes universitarios

This article presents the results of three flipped classroom experiences carried out with university students, with the aim of promoting students' commitment to learning and, at the same time, knowing their assessments of the proposal. The study, conducted in 2017, involved 124 subjects enrolled in various professorships at the Universidad Nacional de Río Cuarto. Each experience was developed using Facebook as a virtual platform. For data collection, a questionnaire of open and closed questions was used, administered at the end of each experience. Among the results, the participation dynamics, interest and autonomy were highlighted as indicators of the commitment perceived by the students towards the new teaching-learning modality. Likewise, the students remarked that the proposal was interesting, suggesting more inverted classes and extrapolating them to other subjects.El artículo presenta los resultados de tres experiencias del modelo de clase invertida llevadas a cabo con estudiantes universitarios, con el objetivo de promover el compromiso de los alumnos con el aprendizaje y, a su vez, de conocer sus valoraciones respecto a la propuesta. Del estudio, realizado en 2017, participaron 124 sujetos inscriptos en diversos profesorados de la Universidad Nacional de Río Cuarto. Cada experiencia se desarrolló usando Facebook como plataforma virtual. Para la recolección de datos se usó un cuestionario de preguntas abiertas y cerradas, administrado al finalizar cada experiencia. Entre los resultados se destaca la dinámica de participación, el interés y la autonomía como indicadores del compromiso percibido por los estudiantes hacia la nueva modalidad de enseñanza-aprendizaje. Asimismo, los alumnos remarcaron como interesante la propuesta, al sugerir más clases invertidas y que se extrapolen a otras materias

Antibodies from patients with rheumatoid arthritis target citrullinated histone 4 contained in neutrophils extracellular traps.

Histone deimination regulates gene function and contributes to antimicrobial response, allowing the formation of neutrophil extracellular traps (NETs). Deiminated proteins are target of anti-citrullinated peptides antibodies (ACPA) in rheumatoid arthritis (RA). OBJECTIVE: The objective of this paper is to test the hypothesis that RA sera react with deiminated histones contained in NETs. METHODS: Neutrophils from peripheral blood were stimulated with A23187 and acid treated; NETosis was induced by phorbol myristate acetate, and NET proteins were isolated. Sera were tested by immunoblot on acid extracted proteins from neutrophils and from NETs, and by ELISA on deiminated histone H4 or H4-derived peptides. Bands reactive with RA sera were excised from gels, digested with trypsin and subjected to matrix-assisted laser desorption/ionisation time of flight (MALDI-TOF) analysis, before and after derivatisation to detect citrullinated peptides. RESULTS: RA sera reacted with a deiminated antigen of 11 KDa from activated neutrophils, recognised also by anti-H4 and antideiminated H4 antibodies. A similar reactivity was observed with NET proteins. The antigen from neutrophils or NETs was identified as citrullinated H4 by MALDI-TOF analysis. By ELISA, RA sera bound in vitro citrullinated H4. Citrullinated H4 14-34 and 31-50 peptides detected antibodies in 67% and 63% of RA sera and in less than 5% of controls; antibody titre was correlated with anti-CCP2. CONCLUSIONS: Citrullinated H4 from activated neutrophils and NETs is a target of antibodies in RA, and synthetic citrullinated H4-derived peptides are a new substrate for ACPA detection. As NETosis can generate antigens for ACPA, these data suggest a novel connection between innate and adaptive immunity in RA

Positive end expiratory pressure in acute hypoxemic respiratory failure due to community acquired pneumonia: Do we need a personalized approach?

Background. Acute respiratory failure (ARF) is a life-threatening complication in patients with community acquired pneumonia (CAP). The use of non-invasive ventilation is controversial. With this prospective, observational study we aimed to describe a protocol to assess whether a patient with moderate-to-severe hypoxemic ARF secondary to CAP benefits, in clinical and laboratoristic terms, from the application of a positive end expiratory pressure (PEEP) + oxygen vs oxygen alone. Methods. Patients who benefit from PEEP application (PEEP-responders) were defined as those with partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) increase > 20% and/or reduction of respiratory distress during PEEP + oxygen therapy compared to oxygen therapy alone. Clinical characteristics and outcomes were compared between PEEP-responders and PEEP-non responders. Results. Out of 41 patients, 27 (66%) benefit from PEEP application (PEEPresponders), the best response was obtained with a PEEP of 10 cmH2O in 13 patients, 7.5 cmH2O in eight and 5 cmH2O in six. PEEP-responders were less likely to present comorbidities compared to PEEP-non responders. No differences between groups were found in regards to endotracheal intubation criteria fullfillment, intensive care unit admission and in-hospital mortality, while PEEP-responders had a shorter length of hospital stay. Discussion. The application of a protocol to evaluate PEEP responsiveness might be useful in patients with moderate-to-severe hypoxemic ARF due to CAP in order to personalize and maximize the effectiveness of therapy, and prevent the inappropriate PEEP use. PEEP responsiveness does not seem to be associated with better outcomes, with the exception of a shorter length of hospital stay

Noninvasive ventilation weaning in acute hypercapnic respiratory failure due to COPD exacerbation : A real-life observational study

The most recent British Thoracic Society/Intensive Care Society (BTS/ICS) guidelines on the use of noninvasive ventilation (NIV) in acute hypercapnic respiratory failure (AHRF) suggest to maximize NIV use in the first 24 hours and to perform a slow tapering. However, a limited number of studies evaluated the phase of NIV weaning. The aim of this study is to describe the NIV weaning protocol used in AHRF due to acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), patients' characteristics, clinical course, and outcomes in a real-life intermediate respiratory care unit (IRCU) setting. We performed a retrospective study on adult patients hospitalized at the IRCU of San Gerardo Hospital, Monza, Italy, from January 2015 to April 2017 with a diagnosis of AHRF due to COPD exacerbation. The NIV weaning protocol used in our institution consists of the interruption of one of the three daily NIV sessions at the time, starting from the morning session and finishing with the night session. The 51 patients who started weaning were divided into three groups: 20 (39%) patients (median age 80 yrs, 65% males) who completed the protocol and were discharged home without NIV (Completed Group), 20 (39%) did not complete it because they were adapted to domiciliary ventilation (Chronic NIV Group), and 11 (22%) interrupted weaning ex abrupto mainly due to NIV intolerance (Failed Group). Completed Group patients were older, had a higher burden of comorbidities, but a lower severity of COPD compared to Chronic NIV Group. Failed Group patients experienced higher frequency of delirium after NIV discontinuation. None of the patients who completed weaning had AHRF relapse during hospitalization. While other NIV weaning methods have been previously described, our study is the first to describe a protocol that implies the interruption of a ventilation session at the time. The application of a weaning protocol may prevent AHRF relapse in the early stages of NIV interruption and in elderly frail patients

Coaching through technology: a systematic review into efficacy and effectiveness for the ageing population

Background: Despite the evidence on the positive role of self-management, the adoption ofhealth coaching strategies for older people is still limited. To address these gaps, recent efforts havebeen made in the ICT sector in order to develop systems for delivering coaching and overcomingbarriers relating to scarcity of resources. The aim of this review is to examine the efficacy of personalhealth coaching systems for older adults using digital virtual agents.Methods: A systematic reviewof the literature was conducted in December 2019 analyzing manuscripts from four databases overthe last 10 years. Nine papers were included.Results: Despite the low number of studies, there wasevidence that technology-integrated interventions can deliver benefits for health over usual care.However, the review raises important questions about how to maintain benefits and permanence ofbehavior change produced by short-term interventions.Conclusion: These systems offer a potentialtool to reduce costs, minimize therapist burden and training, and expand the range of clients who canbenefit from them. It is desirable that in the future the number of studies will grow, considering otheraspects such as the role of the virtual coaches’ characteristics, social-presence, empathy, usability,and health literac

Benzodeazaoxaflavins as Sirtuin Inhibitors with Antiproliferative Properties in Cancer Stem Cells

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Serological and genetic evidence for altered complement system functionality in systemic lupus erythematosus: Findings of the GAPAID consortium

Systemic lupus erythematosus is a chronic autoimmune disease with multifactorial ethiopathogenesis. The complement system is involved in both the early and late stages of disease development and organ damage. To better understand autoantibody mediated complement consumption we examined ex vivo immune complex formation on autoantigen arrays. We recruited patients with SLE (n = 211), with other systemic autoimmune diseases (n = 65) and non-autoimmune control subjects (n = 149). Standard clinical and laboratory data were collected and serum complement levels were determined. The genotype of SNP rs1143679 in the ITGAM gene was also determined. Ex vivo formation of immune complexes, with respect to IgM, IgG, complement C4 and C3 binding, was examined using a functional immunoassay on autoantigen microarray comprising nucleic acids, proteins and lipids. Complement consumption of nucleic acids increased upon binding of IgM and IgG even when serum complement levels were decreased due to consumption in SLE patients. A negative correlation between serum complement levels and ex vivo complement deposition on nucleic acid autoantigens is demonstrated. On the contrary, complement deposition on tested protein and lipid autoantigens showed positive correlation with C4 levels. Genetic analysis revealed that the non-synonymous variant rs1143679 in complement receptor type 3 is associated with an increased production of anti-dsDNA IgG antibodies. Notwithstanding, homozygous carriers of the previously reported susceptible allele (AA) had lower levels of dsDNA specific IgM among SLE patients. Both the non-synonymous variant rs1143679 and the high ratio of nucleic acid specific IgG/IgM were associated with multiple organ involvement. In summary, secondary complement deficiency in SLE does not impair opsonization of nucleic-acid-containing autoantigens but does affect other antigens and potentially other complement dependent processes. Dysfunction of the receptor recognizing complement opsonized immune complexes promotes the development of classswitched autoantibodies targeting nucleic acids

Use of a high sensitive nanofluidic array for the detection of rare copies of BCR-ABL1 transcript in patients with Philadelphia-positiveacute lymphoblastic leukemia in complete responseIlaria

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