Las personas con trastorno mental grave en un programa de alojamiento supervisado por un Equipo Comunitario Asertivo / People with severe mental disorders in a housing program supervised by an Assertive Community Team

El objetivo de este trabajo es evaluar la actitud y satisfacción de 182 pacientes con trastorno mental grave alojados en pisos y residencias supervisadas, sus redes sociales, las necesidades de atención y los cambios clínicos. Se recogieron datos sociodemográficos y clínicos. Se aplicaron los cuestionarios de Actitudes del Usuario (CAU), de Red Social (CURES) y la Escala ENAR-CPB de Valoración de los Niveles de Atención Residencial, con repetición a los dos años. El 86% refirieron mejoría en su vida, 77% en su enfermedad y 50% en sus relaciones sociales. Se observó una reducción significativa en las necesidades de atención a los dos años. Un 86% no tuvo ingresos hospitalarios, frente al 99% del año previo. En general, encontramos una buena aceptación de los alojamientos, con mejoría en las relaciones sociales, la estabilidad clínica y hospitalizaciones. Gracias al tratamiento asertivo comunitario, la mayoría consideraba que había habido una mejoría en su enfermedad y en sus vidas. (AU)

The aim of this work was to evaluate the attitude and satisfaction of 182 patients with severe mental disorder in supervised accommodation, their social networks, their care needs and clinical changes. Sociodemographic and clinical data were collected. The User Attitudes Questionnaire (CAU), the Social Network Questionnaire (CURES) and the Scale of Assessment of the Levels of Residential Attention for people with Severe Mental Disorder (ENAR-CPB) were administered with repetition at two years. 86% of them reported improvement in their life, 77% in their illness, and 50% in their social relationships. There was a significant reduction in care needs at two years. 86% of the participants did not have hospital admissions, compared to 99% the previous year. In general, we found a good acceptance of the accommodations, as well as an improvement in their social relationships, clinical stability, and hospitalizations. Thanks to the assertive community treatment, the majority considered that there was an improvement both in their disease and in their lives. (AU)

Decreased Consumption of Added Fructose Reduces Waist Circumference and Blood Glucose Concentration in Patients with Overweight and Obesity. The DISFRUTE Study: A Randomised Trial in Primary Care.

The relationship between fructose intake and insulin resistance remains controversial. Our purpose was to determine whether a reduction in dietary fructose is effective in decreasing insulin resistance (HOMA2-IR). This field trial was conducted on 438 adults with overweight and obese status, without diabetes. A total of 121 patients in a low fructose diet (LFD) group and 118 in a standard diet (SD) group completed the 24-week study. Both diets were prescribed with 30-40% of energy intake restriction. There were no between-group differences in HOMA2-IR. However, larger decreases were seen in the LFD group in waist circumference (-7.0 vs. -4.8 = -2.2 cms, 95% CI: -3.7, -0.7) and fasting blood glucose -0.25 vs. -0.11 = -0.14 mmol/L, 95% CI: -0.028, -0.02). The percentage of reduction in calorie intake was similar. Only were differences observed in the % energy intake for some nutrients: total fructose (-2 vs. -0.6 = -1.4, 95% CI: -2.6, -0.3), MUFA (-1.7 vs. -0.4 = -1.3, 95% CI: -2.4, -0.2), protein (5.1 vs. 3.6 = 1.4, 95% CI: 0.1, 2.7). The decrease in fructose consumption originated mainly from the reduction in added fructose (-2.8 vs. -1.9 = -0.9, 95% CI: -1.6, -0.03). These results were corroborated after multivariate adjustments. The low fructose diet did not reduce insulin resistance. However, it reduced waist circumference and fasting blood glucose concentration, which suggests a decrease in hepatic insulin resistance.

Efectividad de una estrategia de apoyo individualizado al empleo para personas con trastornos mentales graves / Effectiveness of individual supported employment for people with severe mental disorders

Objetivo: Valorar la efectividad de una estrategia de apoyo individualizado al empleo (IPS) en personas con enfermedad mental grave en la isla de Tenerife (España). Método: Pacientes de los Servicios de Salud Mental Comunitaria con trastornos mentales graves fueron asignados a dos grupos de forma aleatorizada. En uno de ellos se aplicó el método IPS (n=124) y en el grupo control (n=75) se asesoró en la manera habitual de búsqueda de empleo. Los pacientes fueron seguidos una media de 3,4 años y se analizó cuántos trabajaron al menos un día, el tiempo trabajado, los salarios, el número de contratos y el número de admisiones hospitalarias. Se usaron métodos estadísticos no paramétricos en la comparación de resultados (U de Mann-Whitney). Resultados: Los pacientes asignados al grupo IPS trabajaron al menos un día el 99%, frente al 75% del grupo control; trabajaron de media 30,1 semanas/año vs. 7,4; el salario mensual fue de 777,9 euros vs. 599,9 euros; el número de contratos por persona fue de 3,89 vs. 4,85, y los ingresos hospitalarios fueron 0,19 vs. 2,1. Conclusión: La estrategia IPS es efectiva en la integración laboral de personas con enfermedad mental grave, logrando que trabajen más tiempo, tengan mayor salario y menos ingresos hospitalarios, en un contexto social de alto desempleo

Objective: To assess the effectiveness of an individual placement and support (IPS) strategy in people with severe mental disorders in Tenerife Island (Spain). Methods: Patients of Community Mental Health Services with severe mental disorders were randomly assigned to two groups. One of them received IPS (n=124), and the control group (n=75) was advised in the usual job search. Patients were followed up for an average of 3.4 years and an analysis was made of how many patients worked at least one day, working hours, wages, the number of contracts and the number of hospital admissions. Non-parametric methods were used to compare the results (Mann-Whitney U test). Results: The percentage of patients who worked at least one day was 99% in the IPS group compared with 75% in the control group; they worked on average 30.1 weeks per year vs 7.4; the monthly salary was Euros 777.9 vs Euros 599.9; the number of contracts per person was 3.89 vs 4.85, and hospital admissions were 0.19 vs 2.1. Conclusions: The IPS strategy is effective for the labour integration of people with severe mental illness getting them to work longer, have higher wages and fewer hospital admissions

[Effectiveness of individual supported employment for people with severe mental disorders]. / Efectividad de una estrategia de apoyo individualizado al empleo para personas con trastornos mentales graves.

OBJECTIVE: To assess the effectiveness of an individual placement and support (IPS) strategy in people with severe mental disorders in Tenerife Island (Spain). METHODS: Patients of Community Mental Health Services with severe mental disorders were randomly assigned to two groups. One of them received IPS (n=124), and the control group (n=75) was advised in the usual job search. Patients were followed up for an average of 3.4 years and an analysis was made of how many patients worked at least one day, working hours, wages, the number of contracts and the number of hospital admissions. Non-parametric methods were used to compare the results (Mann-Whitney U test). RESULTS: The percentage of patients who worked at least one day was 99% in the IPS group compared with 75% in the control group; they worked on average 30.1 weeks per year vs 7.4; the monthly salary was € 777.9 vs € 599.9; the number of contracts per person was 3.89 vs 4.85, and hospital admissions were 0.19 vs 2.1. CONCLUSIONS: The IPS strategy is effective for the labour integration of people with severe mental illness getting them to work longer, have higher wages and fewer hospital admissions.

Effectiveness of a low-fructose and/or low-sucrose diet in decreasing insulin resistance (DISFRUTE study): study protocol for a randomized controlled trial.

BACKGROUND: Research published to date on the relationship between insulin resistance (IR) and fructose consumption is scarce, has used different methods, and has yielded sometimes contradictory results. This study aims to determine whether a low-fructose and/or low-sucrose diet supervised by a physician or nurse decreases IR compared to a standard diet. METHODS/DESIGN: This field trial is located at primary care centers. The participants are adults aged 29 to 66 years, with a Body mass Index (BMI) between 29 and 40.99 kg/m2 and without diabetes. To date, 245 participants have been assigned randomly to the low-fructose diet intervention group (LFDI) at health centers in the western health service zone of Tenerife island, and 245 to the standard-diet control group (SDC) at health centers in the eastern health service zone. Recruitment is opportunistic and is carried out by physicians and nurses at participating health centers. Initially (baseline), and after 24 weeks of intervention, dietary records, physical activity, waist circumference, BMI, blood pressure, fasting blood glucose and insulin concentrations (HOMA2-IR) and lipid profile are recorded; blood glucose and insulin and lipid profile are also recorded 2 h after a 75-g glucose overload. After 48 weeks (24 weeks after the intervention), fasting blood samples are again obtained and a physical examination is performed. All tests and measures are repeated and recorded except dietary records, physical activity and oral glucose overload. Low-fructose diets are designed by calculating free and total (free + fructose associated with sucrose) fructose contents in standard diets, and removing foods with a fructose content in the highest quartile for the amounts in the standard diet. Participants in both groups are prescribed a diet that contains 30 to 40% less than the participant's energy requirements. The primary endpoint is change in HOMA2-IR between baseline and week 24, and other outcomes are change in HDL-cholesterol, LDL-cholesterol, triglycerides , waist circumference to height ratio and BMI. The secondary endpoint is change in HOMA2-IR between week 24 and week 48 together with the outcomes noted above. Comparisons between groups for variables used to indicate IR levels are done with a Student's t test for unpaired variables or the Mann-Whitney U test if the distribution is not normal. Multivariate regression models will be used to control for confounding factors not accounted for in the study design, and for independent prognostic factors. DISCUSSION: If the dietary intervention being tested, i.e., a diet low in fructose/sucrose, is able to reduce IR, the results - if translated into regular clinical practice - could provide a hitherto unavailable tool to prevent type-2 diabetes mellitus. TRIAL REGISTRATION: ISRCTN, ID: ISRCTN41579277 . Registered retrospectively on 15 November 2016.

Community study on a parasuicidal population: Clinical identification of repetition risk

Background and Objectives: The greatest predictor of eventual suicide isparasuicide. The aim of this research was to identify the clinical features that can identifypeople with high parasuicide purpose among a parasuicidal population.Methods: A total of 48 persons who had commited a parasuicide episode 2-6 yearsafter, were interviewed and classified according Research Diagnostic Criteria. During theinterviews, socio-demographic data and psychopathological features were picked upthrough several scales. Scores on Beck Depression Inventory (BDI), Beck Anxiety Inventory(BAI), Beck Hopelessness Scale (BHS) and The Plutchick Impulsivity Scale (PI)were measured. These persons were then followed-up for two years.Results: At follow-up, eight persons (16,7%) had repeated at least one parasuicide act.On comparison of repeaters and no repeaters, a higher significant differences in the finalvalues reported in BHS was found but not significative differences were founded in theBAI, BHS or PI scores or in the proportion of the different mental illness (accordingRDC). An interesting finding is that in the repeaters group the average value in the IP scaletended to be lower than in the non-repeaters, although not significant.A high percentage (72.8%) related the existence of negative vital events with their suicideattempt, more often, relationship problems with the spouse (42.8%), with their parents(17.1%) or the breakdown of an interpersonal relationship (14.2%) (..) (AU)