La psicología militar en la prevención de salud mental durante la pandemia por SARS-Cov-2 / Military psychology in mental health prevention in Spain during the SARS-Cov-2 Pandemic

La literatura científica señala que las situaciones de emergencias y desastres tienen un impacto más elevado para la salud mental que para la salud física. No había razones para pensar que la pandemia por COVID-19 y la situación de estado de alarma fueran a impactar menos que epidemias anteriores. Por ello, la psicología militar debía aportar algunas de sus capacidades para reducir el impacto de la emergencia en la salud mental de una parte de la población. MÉTODO: Se realizaron búsquedas bibliográficas en PubMed, PsycINFO y EBSCOhost de cara a analizar el impacto de la pandemia por COVID-19 en la salud mental. Además, se describen algunas de las diferentes actuaciones que ha llevado a cabo la psicología militar en todo el territorio nacional, durante la mencionada crisis sanitaria. RESULTADOS: Se observa un impacto psicológico negativo del COVID-19 en países como China, Argelia, Irán, India, Italia, España, Reino Unido o Alemania. La psicología militar realizó al menos 15000 actuaciones, aunque no todas se concretaron en intervenciones psicológicas y solo unas 8000 se pudieron contabilizar formalmente. El 40% de las personas atendidas recibieron al menos una intervención psicológica (13% en formato individual y 27% en sesión grupal para intervinientes). De las actuaciones individuales contabilizadas, aproximadamente el 18% derivó en intervención psicológica. En las intervenciones individuales se observaron síntomas de salud mental negativos, así como patrones de resiliencia para gestionar el estrés. Las actuaciones se llevaron a cabo con: Trabajadores y usuarios de residencias de mayores y centros de personas vulnerables; hospitalizados y familiares de hospitalizados y fallecidos por COVID-19; militares intervinientes en la emergencia; familiares de militares; trabajadores civiles del Ministerio de Defensa; militares en situación de retiro; y viudas de militares. CONCLUSIONES: Según la literatura científica, la emergencia sanitaria ha tenido un impacto negativo en la salud mental. Sin embargo, pese a los síntomas negativos, los individuos también demuestran patrones de resiliencia bien establecidos

Scientific community indicates that emergency and disaster situations have a higher impact on mental health than on physical health. There was no reason to believe that outbreak COVID-19 and state of alarm were going to impact less than previous epidemics. For this reason, military psychology needed to contribute with some of its capabilities to reduce the impact of the emergency on the mental health of part of the population. METHOD: Bibliographic searches in PubMed, PsycINFO and EBSCOhost were performed for analyze the impact of the COVID-19 pandemic on mental health. In addition, some of the actions that military psychology has carried out throughout the Nation are described. RESULTS: A negative psychological impact of COVID-19 was observed in countries such as China, Algeria, Iran, India, Italy, Spain, United Kingdom or Germany. Military psychology carried out at least 15,000 actions, although not all of them resulted in psychological interventions and about half of them were formally accounted. Approximately 40% of the people received at least one psychological intervention (13% in individual format and 27% in group session for participants). Of the individual actions recorded, about 18% needed psychological first aid. Negative symptoms but also positive resilience patterns were observed in people. Actions were done in different contexts: Workers and users of nursing homes and centers for vulnerable people; hospitalized and hospitalized's relatives and deceased by COVID-19; military personnel as first workers; military relatives; civil workers from the Ministry of Defense; retired military personnel; and military widows. CONCLUSIONS: According to the scientific literature, this outbreak has had a negative impact on mental health. However, despite negative symptoms, people also presented resilience patterns

Evaluación de la conciliación de la medicación en una Unidad de Traumatología / Evaluation of medication reconcilliation in a Trauma Unit

Introducción: El objetivo del estudio fue evaluar la tasa de discrepancias en la conciliación de la medicación realizada al ingreso de los pacientes en una Unidad de Traumatología, identificando los posibles factores de riesgo asociados a los errores de conciliación. Material y métodos: Se trata de un estudio observacional transversal realizado en un hospital de tercer nivel durante el periodo comprendido entre el 1 de mayo y el 16 de julio del 2012, en el que se elaboró un listado del tratamiento domiciliario del paciente contrastándose con la historia farmacoterapéutica recogida al ingreso en dicha unidad, para identificar los errores de conciliación. Estos se clasificaron en función del tipo y la relevancia de la discrepancia. Se realizó un análisis estadístico por regresión logística, utilizando como variable dependiente la existencia de discrepancias. Resultados: Ciento sesenta y cuatro pacientes fueron incluidos en el estudio, hallándose errores de conciliación en el 48,8%, de las cuales el 14,4% fueron considerados muy relevantes. De los pacientes ingresados de forma urgente, el 66,7% presentó discrepancias frente al 44,8% en pacientes programados. En total, se identificaron 153 errores de conciliación, siendo el tipo más frecuente el de omisión de algún medicamento (72%). Se detectó que por cada fármaco añadido al tratamiento domiciliario habitual el riesgo de presentar discrepancias aumenta en un 33%. Conclusión: Este estudio pone en evidencia la falta de exhaustividad en la recogida de la historia farmacoterapéutica de los pacientes al ingreso en la Unidad de Traumatología (AU)

Introduction: The aim of this study was to assess the rate of discrepancies in medication reconciliation on admission patients in a trauma unit, and identifying potential risk factors associated with these discrepancies. Material and methods: A cross-sectional, observational study was carried out to identify reconciliation errors in a tertiary hospital during the period from May 1 to July 16 of 2012. Medication history of the patient was compared with home medication data collected on admission, to identify reconciliation errors. These were classified according to the type and severity of the discrepancies. Statistical analysis by logistic regression was performed, using the presence of discrepancies as dependent variable. Results: The study included 164 patients, and reconciliation errors were found in 48.8%, of which 14.4% were considered highly relevant. Around two-thirds (66.7%) of the patients admitted to the emergency department showed unjustified discrepancies compared to 44.8% in scheduled patients. In total, 153 reconciliation errors were identified, being omitted drug the most frequent type of discrepancie (72%). The risk of discrepancies increases by 33% for each drug added to the usual home treatment. Conclusion: This study demonstrates the lack of quality in home medication recording in patients admitted to the trauma unit (AU)

Secreted frizzled-related protein 1 regulates adipose tissue expansion and is dysregulated in severe obesity.

AIM: The Wnt/ß-catenin signaling network offers potential targets to diagnose and uncouple obesity from its metabolic complications. In this study, we investigate the role of the Wnt antagonist, secreted frizzled-related protein 1 (SFRP1), in promoting adipogenesis in vitro and adipose tissue expansion in vivo. METHODS: We use a combination of human and murine, in vivo and in vitro models of adipogenesis, adipose tissue expansion and obesity-related metabolic syndrome to profile the involvement of SFRP1. RESULTS: SFRP1 is expressed in both murine and human mature adipocytes. The expression of SFRP1 is induced during in vitro adipogenesis, and SFRP1 is preferentially expressed in mature adipocytes in human adipose tissue. Constitutive ectopic expression of SFRP1 is proadipogenic and inhibits the Wnt/ß-catenin signaling pathway. In vivo endogenous levels of adipose SFRP1 are regulated in line with proadipogenic states. However, in longitudinal studies of high-fat-diet-fed mice, we observed a dynamic temporal but biphasic regulation of endogenous SFRP1. In agreement with this profile, we observed that SFRP1 expression in human tissues peaks in patients with mild obesity and gradually falls in morbidly obese subjects. CONCLUSIONS: Our results suggest that SFRP1 is an endogenous modulator of Wnt/ß-catenin signaling and participates in the paracrine regulation of human adipogenesis. The reduced adipose expression of SFRP1 in morbid obesity and its knock-on effect to prevent further adipose tissue expansion may contribute to the development of metabolic complications in these individuals.

Thyroid hormone responsive Spot 14 increases during differentiation of human adipocytes and its expression is down-regulated in obese subjects.

CONTEXT: Very limited information is available regarding the function of human thyroid hormone responsive Spot 14 (human S14, hS14) in adipogenesis and human adiposity. OBJECTIVE: To evaluate hS14 levels during differentiation of human pre-adipocytes, in human fat depots and isolated fat cells. DESIGN: This was a cross-sectional study. SUBJECTS: A total of 161 omental (OM) and 87 subcutaneous (SC) adipose tissue samples obtained during elective surgical procedures from a population who varied widely in terms of obesity. MEASUREMENTS: hS14 gene expression and protein levels during adipogenesis were assessed by RT-PCR, western blot, and using an automated confocal imaging approach. RESULTS: hS14 gene expression levels were decreased in OM adipose tissue from overweight (-42.0%) and obese subjects (-56.5%) compared with lean subjects (P<0.05 and P<0.0001, respectively). hS14 mRNA (but not hS14-related) was inversely associated with obesity measures such as body mass index (P=0.001), percent fat mass (P=0.001), waist-to-hip ratio (P=0.020), and systolic blood pressure (P=0.031). hS14 gene expression and protein levels were up-regulated at the early stages of differentiation of human pre-adipocytes as well as for 3T3-L1 cells. That observation was most prominent in those individual cells exhibiting the more marked differentiation features. hS14 gene expression levels increased by approximately 45 000-fold in mature adipocytes. Increased hS14 levels were also found in stromal-vascular cells/pre-adipocytes (3.8-fold, P<0.05) and in adipose tissue samples (1.9-fold, P<0.0001) from SC compared with OM fat depots. CONCLUSIONS: These results suggest that hS14 is involved in human adipogenesis, but inversely related to obesity and OM fat accumulation.

Circulating IL-18 concentration is associated with insulin sensitivity and glucose tolerance through increased fat-free mass.

AIMS/HYPOTHESIS: Knowledge of the factors which simultaneously contribute to insulin-resistance-related inflammation may contribute to early therapeutic targeting. IL-18 has recently been described as one of the factors which, in addition to insulin resistance, may also contribute to atherosclerosis. However, the source of IL-18 is not well characterised. MATERIALS AND METHODS: We aimed to study body composition (bioelectric impedance), glucose tolerance (OGTT) and insulin sensitivity (minimal model method) in relation to serum IL-18 (ELISA) concentration in 144 otherwise healthy men aged 51.9+/-12.5 years. RESULTS: In contrast to previous observations in women, circulating IL-18 was not significantly associated with BMI (r=0.12, p=0.1) or WHR (r=0.08, p=0.3). IL-18 was also not associated with absolute or percent fat mass (bioelectric impedance, p>0.20) but, interestingly, it was significantly linked to fat-free mass (p=0.03). Serum IL-18 increased with each quartile of fat-free mass, corresponding to values of < or = 64.2; >64.2 to < or = 71.6; >71.6 to < or = 80.9; and > or = 80.9 kg (ANOVA, p<0.0001). IL-18 was more closely associated with postload glucose during an OGTT (p=0.04) rather than with fasting glucose (p=0.1). HbA1c (p=0.03), HDL-cholesterol (p=0.04) and serum triglycerides (p=0.03) and parameters of systemic inflammation (C-reactive protein, p=0.02) were also significantly associated with circulating IL-18. Insulin sensitivity (minimal model analysis) was linked to circulating IL-18 (p=0.01). In a multiple linear regression analysis this relationship remained significant after controlling for BMI, age and glucose tolerance status. In another model, both fat-free mass and insulin sensitivity contributed to 10% of IL-18 variance. CONCLUSIONS/INTERPRETATION: Fat mass does not seem to influence circulating IL-18, as initially proposed. In contrast, the fat-free mass compartment (a well-known confounder in the evaluation of insulin sensitivity) may significantly contribute to the relationship between IL-18 and insulin action.

Smoking, fat mass and activation of the tumor necrosis factor-alpha pathway.

OBJECTIVE: Obesity may be associated with increased markers of inflammation that could be triggered by metabolic, physical, infectious or environmental processes. As smoking significantly increases cytokine production, we aimed to study how smoking influences the relationship between fat mass and soluble tumor necrosis factor-alpha (TNF-alpha) receptors 1 and 2 (sTNFR1 and sTNFR2). DESIGN: Cross-sectional, clinical observational study. SUBJECTS: A total of 133 healthy men (age: 27-53 y, body mass index (BMI): 24-30.2 kg/m(2)), 80 of whom were never-smokers and 53 smokers, matched for age, BMI and waist-to-hip ratio. MEASUREMENTS: Circulating soluble fractions of the TNF-alpha receptors sTNFR1 and sTNFR2 were measured to study their relationship with fat mass (bioelectric impedance). RESULTS: Smokers had significantly lower fat mass, lower fasting glucose, insulin and leptin concentrations than nonsmokers. Despite lower fat mass and insulin, smokers showed significantly increased circulating sTNFR2 levels (3.7+/-0.8 vs 3.4+/-0.7 ng/ml, P=0.03). The slopes of the relationships between sTNFR1 and fat mass, and between sTNFR2 and fat mass, were significantly steeper in smokers than in nonsmokers. In a stepwise multiple linear regression analysis, both fat mass (P<0.00001) and smoking (P=0.025) independently contributed to 13% of sTNFR1 variance and to 4% of sTNFR2 variance (P=0.03). CONCLUSION: Both fat mass and smoking are related to increased activity of the TNF-alpha axis.