IntroductionSince the beginning of the modern psychiatry the acute units have established a “locked door” policy. Some studies show that this condition may increase patient’s discomfort and affect ...the perception of health quality of care (Boyer L, 2009, Eur Psychiatry Dec;24(8):540-9). Lately, several European countries such as Germany, Switzerland and Spain are starting to implement the “open-door” policy but its impact on patient’s satisfaction is still unknown (Hochstrasser, L, Frontiers in Psychiatry, 9(57). https://doi.org/10.3389/fpsyt.2018.00057) .ObjectivesTo help characterize the advantages of the “open-door” policy implemented in an acute inpatient psychiatric unit in order to assess the patient’s view of it.MethodsThis is a descriptive observational study carried out at an inpatient psychiatric unit. Data were collected after the implementation of the open door policy on June 2019, assessing the patient satisfaction of 31 subjects who completed the SATISPSY-22 scale at the time of discharge. Results are described using the average and its standard deviation.ResultsResults show scores in all items above 50 points, being the care team and the quality of care the most valued ones with 82 and 79 points respectively. The overall score is above 65 points (Fig. 1).Image:ConclusionsIn line with previous studies, our data suggests that the main impact of the “open-door” policy implementation is on patients’ perception of the care, being Quality of care and satisfaction with the Staff the items with highest scores. This could be explained by patients trusting more in the Care team, which would help enhance the therapeutic relationship improving therapeutic adherence, treatment adequacy and the outcome. Nevertheless, the Feeling related to hospitalisation was found to be the item with the lowest score. This could mean strategies should focus on improving patient’s insight regarding their clinical state and their need to be admitted. Our study supports the hypothesis that open-door policy in acute psychiatric units is seen positively by patients and that further research should be carried.Disclosure of InterestNone Declared
Telomeres are nucleoprotein structures that protect the ends of eukaryote chromosomes. Shorter telomere length (TL) is associated with some age-related human disorders, but its relationship with ...obesity or adiposity parameters remains unclear.
The aim of this study was to assess the relationship between TL and changes in adiposity indices after a 5-year nutritional intervention.
TL was measured by quantitative real-time PCR in 521 subjects (55-80 years, 55% women). Participants were randomly selected from the PREDIMED-NAVARRA centre after they completed a 5-year intervention programme. Anthropometric parameters were directly measured by trained personnel at baseline and on a yearly basis thereafter. TL at baseline and changes in TL after a 5-year intervention were assessed.
Higher baseline TL significantly predicted a greater decrease in body weight (B=-1.09 kg, 95% confidence interval (CI): -2.01 to -0.16), body mass index (BMI) (B=-0.47 kg m(-2), 95% CI: -0.83 to -0.11), waist circumference (B=-1.15 cm, 95% CI: -2.28 to -0.01) and waist to height ratio (B=-0.008, 95% CI: -0.010 to -0.001) in multiple-adjusted models. In addition, changes in TL during the 5-year intervention were inversely associated with changes in the four anthropometric variables. The reduction in adiposity indices during the intervention, associated with increasing TL, was even higher among subjects with the longest telomeres at baseline. Logistic regression analysis showed that the risk of remaining obese after 5 years was lower in those participants who initially had the longest telomeres and increased their TL after intervention (odds ratio=0.27, 95% CI: 0.03-2.03).
Our research suggests that TL is inversely associated with changes in obesity parameters. The assessment of TL can provide further insights for biological pathways leading to adiposity. We show for the first time an improvement of obesity indices when an increase in TL is observed after a 5-year Mediterranean diet intervention.
Response to Letter to the Editor Clinical Nutrition Marti, A.; Fernández de la Puente, M.; Canudas, S. ...
Clinical nutrition (Edinburgh, Scotland),
April 2024, 2024-04-00, 20240401, Letnik:
43, Številka:
4
Journal Article
Aims. Our goal is to study the chemical composition of the outflows of active galactic nuclei and starburst galaxies. Methods. We obtained high-resolution interferometric observations of HCN and ...HCO+J = 1 → 0 and J = 2 → 1 of the ultra-luminous infrared galaxy Mrk 231 with the IRAM Plateau de Bure Interferometer. We also use previously published observations of HCN and HCO+J = 1 → 0 and J = 3 → 2, and HNC J = 1 → 0 in the same source. Results. In the line wings of the HCN, HCO+, and HNC emission, we find that these three molecular species exhibit features at distinct velocities which differ between the species. The features are not consistent with emission lines of other molecular species. Through radiative transfer modelling of the HCN and HCO+ outflow emission we find an average abundance ratio X(HCN) /X(HCO+) ≳ 1000. Assuming a clumpy outflow, modelling of the HCN and HCO+ emission produces strongly inconsistent outflow masses. Conclusions. Both the anti-correlated outflow features of HCN and HCO+ and the different outflow masses calculated from the radiative transfer models of the HCN and HCO+ emission suggest that the outflow is chemically differentiated. The separation between HCN and HCO+ could be an indicator of shock fronts present in the outflow, since the HCN/HCO+ ratio is expected to be elevated in shocked regions. Our result shows that studies of the chemistry in large-scale galactic outflows can be used to better understand the physical properties of these outflows and their effects on the interstellar medium in the galaxy.
The top quark is a fundamental constituent of the Standard Model (SM). The properties of this quark are accurately predicted by this theory, except for its mass, which remains a fundamental parameter ...of the SM. With the advent of the Large Hadron Collider (LHC), many million of top-antitop quark pairs are available for study. With such statistics, the physics of the top quark has entered the precision era. In this note, the most recent experimental results by ATLAS concerning the top quark mass are reported.
OBJECTIVES: To use a previously derived methodology to estimate cost-effectiveness thresholds (CETs) based on per capita health expenditures (pcHE) and life expectancy at birth (LE), and update ...empirically derived CETs for 194 countries. METHODS: We developed a conceptual framework to assess how the selection of a particular CET will affect the rate of increase of pcHE. When the cumulative effect of the new interventions has added one year of life to population LE, the pcHE will have increased at a ratio ("i") which can be quantified as: i=1+CET/pcHE*(LE+1), assuming that the mean cost-effectiveness of new interventions is equal to CET. This allows the definition of CETs based on a target increase in expenditures. The expected rate of increase in pcHE, according to countries' LE and income level, was estimated using WorldBank data to empirically derive the country-level indicative CETs that new interventions should not exceed in order to keep the increase in expenditures at the expected rate. RESULTS:The expected increase in pcHE was between 7.8% and 10.5% (low and high-income countries respectively) for each one-year increase in LE (an achievement that countries typically attain in 4-6 years). In order not to promote increases beyond this trend, CETs should be in a range between 5-8 pcHE per life-year and 7-11 pcHE per QALY/DALY In 91.6% of the countries the estimated CETs were below one GDP per capita per life-year and in 80.0% were below one GDP per QALY/DALY. In none, CETs were above two GPD per capita. CETs per life-year ranged between 0.53-0.90,0.45-0.71, 0.37-0.62 and 0.36-0.50 GDP in Brazil, Mexico, Peru and Bolivia respectively (0.62-1.05, 0.52-0.83,0.43-0.72 and 0.42-0.58 per QALY). CONCLUSIONS: Our results show lower CETs than those promoted in the past by the WHO, and suggest that the adoption of higher thresholds would drive increases in pcHE beyond the current trend.
Aim of the study was to describe characteristics and outcomes of Hartmann's procedure (HP) and subsequent intestinal restoration.
Retrospective study including all patients who underwent HP over a ...period of 16 consecutive years. We propose a classification and regression tree for a more accurate view of the relationship between the variables related to intestinal restoration and their weighting in the decision to reverse HP.
533 patients were included. Overall morbidity rate of HP was 53.5% and mortality 21.0%. Overall morbidity of the intestinal continuity reconstruction was 47.3% and mortality 0.9%. Patients with a benign disease, aged under 69 years and with low comorbidity, had an 84.4% probability of undergoing intestinal reconstruction.
HP is associated with high morbidity and mortality. Restoration of intestinal continuity involves minor, but frequent, morbidity and a low mortality rate. Age and comorbidities can decrease, and even override, the decision to reverse HP.
•Hartmann's procedure is still associated with high morbidity and mortality rates.•The most frequent cause of death along the follow-up period after a Hartmann's procedure was unrelated to the process.•Restoration of intestinal continuity involves minor, but frequent, morbidity and a low mortality rate.•Over recent years a trend to perform less Hartmann's procedure and more intestinal continuity restorations can be observed.•Patients under 69 years with low comorbidity and benign disease had the highest probability of intestinal reconstruction.
OBJECTIVES: To develop a value framework and a visual tool to inform the "evidence-to-decision making" process to be applied in Health Technology Assessment (HTA). METHODS: We performed a review of ...the literature to identify the main dimensions used in other frameworks. After an initial selection of dimensions and methods we validated them with a panel of twenty HTA researchers. Selected dimensions were weighted through a Delphi method with nine HTA senior researchers. Also a traffic light based colored scale was developed. The final framework was piloted in 24 rapid HTAs. RESULTS: The three dimensions included were: quality of the evidence; magnitude of net benefit (considering both benefits and adverse effects); and economic and organizational aspects (cost-effectiveness or expected budgetary impact). To classify the domain of evidence we used GRADE. The net benefit was classified as major, considerable, minor and marginal/null/uncertain, similarly to the German HTA agency (IQWiG). Finally, the domain of cost-effectiveness and budgetary impact were defined by consensus of experts taking into account the GDP per capita, catastrophic health expenditures and health budget characteristics in Argentina; and categorized as reasonable, uncertain and unreasonable. The final colored scale had five categories to summarize the assessment and as a decision aid: two poles suggesting positive or negative recommendations; and three intermediate categories where additional information is recommended before making the coverage decision During the pilot we found the framework friendly and easy to understand. From 24 HTAs, one was categorized as positive, eight as negative, and 15 with varying degrees of intermediate results (10 more favorable, 2 uncertain; and 3 less favorable). CONCLUSIONS: Developing and piloting a value framework and a user friendly tool to facilitate evidence informed deliberative process was feasible in Argentina. Further validation and follow-up are recommended to assess its applicability with decision makers.
Abstract Controversy exists about the role of parent psychopathology in persistence and severity of attention deficit hyperactivity disorder (ADHD) symptoms in their children. Here we aimed to ...analyse the potential association between the severity of ADHD symptoms in children and the presence of psychiatric and ADHD symptoms in their biological parents. Seventy-three triads of children and their parents who were in active treatment for their diagnosed ADHD were evaluated in our Child and Adolescent Mental Health Centers. The mental health of the parents was also assessed. The general psychopathology of the parents was evaluated using the Symptom Checklist-90-R (SCL-90-R), and symptoms of hyperactivity were examined using the Adult ADHD Self-Report Scale (ASRS v.1.1). The severity of symptoms in children was assessed using the ADHD Rating Scale-IV (ADHD-RS-IV). Variables that could have affected the clinical development of ADHD such as sex, evolution time, age, academic level and the presence of comorbidities were controlled. The severity of the symptoms in children with ADHD was significantly related to the psychiatric history of their mother, the younger age of the child and the presence of a comorbid conduct disorder in the child. We discussed the importance of screening for parental psychopathology in clinical practice.
PDF
