Social Experiences and Health Needs of Patients with Severe Mental Illness and their Caregivers during the first year of the COVID-19 pandemic in Spain.

BACKGROUND: The strict isolation measures for the population imposed by the health authorities caused a prolonged disruption of informal social support networks. Both this new social situation and the decrease in accessibility to health care have generated new needs in people with severe mental illness (SMI) and their caregivers. OBJECTIVES: This study provides insight into life experiences and health needs of a population with SMI during the first year of the COVID-19 pandemic in Spain. METHODS: Qualitative design using semi-structured dyadic interviews, conducted from January through December 2022. A purposive sampling of patients with SMI and their caregivers was carried out through key informants in rural and urban localities in southern Spain. Verbatims were identified and classified by triangulation after the evaluation of the interview transcripts. The codes were defined through content analysis using the NVivo software. RESULTS: Semi-structured dyadic interviews (21), identifying three main categories: 1. Social isolation: increased, causing greater personal vulnerability, exacerbation of psychiatric symptoms and exhaustion in caregivers. 2. Accessibility to Health Services: decreased with fewer face-to-face consultations, with difficulty in managing urgent situations and telephone attention in decompensated and disabled patients. 3. Continuity of healthcare: decreased with distrust in health professionals due to lack of communication between primary care and the hospital. CONCLUSION: COVID-19 confinement exacerbated loneliness and worse health self-perception in SMI people. Greater formal social support was required. GPs role is key to avoiding delays in appointments and lack of coordination between primary and specialised care.

Quality of life and medical care for SMI people got worse in controlled confinement during COVID-19 pandemic.Caregiving burden and isolation were common, especially in rural areas and in populations at social risk.SMI people requested an improvement in medical care accessibility, continuity, and more social resources.

Executive summary: Guidelines for the diagnosis and treatment of septic arthritis in adults and children, developed by the GEIO (SEIMC), SEIP and SECOT.

Infection of a native joint, commonly referred to as septic arthritis, is a medical emergency because of the risk of joint destruction and subsequent sequelae. Its diagnosis requires a high level of suspicion. These guidelines for the diagnosis and treatment of septic arthritis in children and adults are intended for use by any physician caring for patients with suspected or confirmed septic arthritis. They have been developed by a multidisciplinary panel with representatives from the Bone and Joint Infections Study Group (GEIO) belonging to the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Paediatric Infections (SEIP) and the Spanish Society of Orthopaedic Surgery and Traumatology (SECOT), and two rheumatologists. The recommendations are based on evidence derived from a systematic literature review and, failing that, on the opinion of the experts who prepared these guidelines. A detailed description of the background, methods, summary of evidence, the rationale supporting each recommendation, and gaps in knowledge can be found online in the complete document.

Patients with severe mental illness and their carers' expectations for GPs' communication skills: a qualitative approach in Spain.

BACKGROUND: Effective communication with GPs (General Practitioners) enables higher rates of patient satisfaction and adherence to treatment plans. People with severe mental illness (SMI) and their caregivers present unique characteristics that present difficulties in the GP-carer-patient communication process. AIM: To explore the expectations of patients with SMI and their caregivers regarding GPs' communication skills in primary care consultations. DESIGN & SETTING: Face-to-face interviews, using focus group methodology, which were undertaken in southern Spain. METHOD: Forty-two participants took part in 21 paired semi-structured interviews with an average duration of 19±7.2 minutes. Information was audio-recorded and transcribed verbatim. Qualitative content analysis was undertaken, obtaining a codification in categories by means of triangulation. RESULTS: Four themes emerged from the analysis. Theme 1 was interviewer communication characteristics. The ability of GPs to use a language that was colloquial and adapted to each person was perceived as a determinant of the quality of care provided. An empathetic attitude, low reactivity, and efficient time management were the most valued communication skills. Theme 2 was telemedicine: telephone consultation and video consultation. The telephone consultation was perceived as a useful tool to care for people with SMI. Video consultation was valued as a requirement in isolated rural areas. Theme 3 was the role of the caregiver during the clinical interview. The caregiver was considered by the patients as an ally who improves the clinical interview. Theme 4 was the perceived barriers and facilitators during the clinical interview. The continuity of care, defined by a low turnover of GPs, determined the quality perceived by those who required care. CONCLUSION: Themes emerging from this study have suggested that people with SMI require an inclusive, collaborative, and personalised approach in the care they receive from the public health system. Improved communication between GPs and patients with SMI is an essential requirement for quality medical care.

Older Adult Patients in the Emergency Department: Which Patients should be Selected for a Different Approach?

BACKGROUND: While multidimensional and interdisciplinary assessment of older adult patients improves their short-term outcomes after evaluation in the emergency department (ED), this assessment is time-consuming and ill-suited for the busy environment. Thus, identifying patients who will benefit from this strategy is challenging. Therefore, this study aimed to identify older adult patients suitable for a different ED approach as well as independent variables associated with poor short-term clinical outcomes. METHODS: We included all patients ≥65 years attending 52 EDs in Spain over 7 days. Sociodemographic, comorbidity, and baseline functional status data were collected. The outcomes were 30-day mortality, re-presentation, hospital readmission, and the composite of all outcomes. RESULTS: During the study among 96,014 patients evaluated in the ED, we included 23,338 patients ≥65 years-mean age, 78.4±8.1 years; 12,626 (54.1%) women. During follow-up, 5,776 patients (24.75%) had poor outcomes after evaluation in the ED: 1,140 (4.88%) died, 4,640 (20.51) returned to the ED, and 1,739 (7.69%) were readmitted 30 days after discharge following the index visit. A model including male sex, age ≥75 years, arrival by ambulance, Charlson Comorbidity Index ≥3, and functional impairment had a C-index of 0.81 (95% confidence interval, 0.80-0.82) for 30-day mortality. CONCLUSION: Male sex, age ≥75 years, arrival by ambulance, functional impairment, or severe comorbidity are features of patients who could benefit from approaches in the ED different from the common triage to improve the poor short-term outcomes of this population.

Soledad y fragilidad en personas mayores que viven en comunidad: Una revisión integrativa / Loneliness and frailty in community-dwelling older adults: An integrative review

CONTEXTO: Se proyecta un aumento del 6% en la población mundial de personas mayores para el 2050, generando desafíos sociales significativos, especialmente el crecimiento de la soledad en la vejez. Este fenómeno está estrechamente vinculado a problemas de salud notables, incluido el síndrome de fragilidad. OBJETIVO: Esta revisión de literatura tiene como objetivo proporcionar una comprensión actualizada de la relación entre fragilidad y soledad en adultos mayores que residen en la comunidad. METODOLOGÍA: Utilizando una revisión integradora, se recopilaron sistemáticamente artículos originales de las bases de datos de PubMed, Web of Science y CINAHL. RESULTADOS: Una revisión de 475 artículos publicados entre 2018 y 2022 identificó 17 estudios que cumplían con los criterios de inclusión y exclusión especificados. CONCLUSIÓN: Los hallazgos revelan sólida evidencia científica que respalda una asociación sustancial entre la soledad y la fragilidad en adultos mayores que viven en la comunidad. A pesar de la consistencia en la evidencia, persisten variaciones en los enfoques conceptuales y las metodologías de medición en los estudios revisados.

CONTEXT: The global elderly population is projected to increase 6% by 2050, posing significant social challenges, particularly the escalating prevalence of loneliness in old age. This phenomenon is closely linked to notable health issues, including the frailty syndrome. OBJECTIVE: This literature review aims to provide an updated understanding of the relationship between frailty and loneliness among older adults residing in the community. Methodology: Employing an integrative review, original articles were systematically gathered from PubMed, Web of Science, and CINAHL databases. RESULTS: A review of 475 articles published between 2018 and 2022 identified 17 studies meeting specified inclusion and exclusion criteria. CONCLUSION: Findings reveal robust scientific evidence supporting a substantial association between loneliness and frailty among older adults in community settings. Despite consistent evidence, variations persist in conceptual approaches and measurement methodologies across reviewed studies.

Pulsed magnetic field increases the effect of ultraviolet C radiation and thermal shock in aged yeasts / El campo magnético pulsado aumenta el efecto de la radiación ultravioleta C y el choque térmico en levaduras envejecidas

The study of the effects of the magnetic field (MF) on living matter continues to be a dilemma. Until now, the interaction mechanisms of MF with living matter that explain the observed phenomena are unknown. Despite the existing literature and the multiple effects described to date, there are few published articles that study the combined effect of MF with other physical agents during the cellular aging process. In this sense, the aim of this work is to study whether low frequency and intensity pulsed and sinusoidal MF exposure produce alterations in the cell killing effect of ultraviolet C (UVC) radiation and thermal shock during the chronological aging of S. cerevisiae. Yeast cells were exposed to 2.45 mT (50 Hz) sinusoidal MF and 1.5 mT (25 Hz) pulsed MF, during 40 days of aging, in combination with UVC radiation (50 J/m2) and/or thermal shock (52°C). Cell survival was evaluated by clonogenic assay. The exposure of yeast to pulsed MF produces an acceleration of aging, which is not observed in cells exposed to sinusoidal MF. The pulsed MF modifies the cellular response to damaging agents only in aged S. cerevisiae cells. In this sense, the pulsed MF applied increases the damage induced by UVC radiation and by thermal shock. In contrast, the sinusoidal MF used has no effect.(AU)

Patient, clinician, and performance-based measures provide different information about clinical symptoms in patients with severe knee osteoarthritis presenting with depressive symptoms: a cross-sectional study.

BACKGROUND AND PURPOSE: Clinical status of subjects with knee osteoarthritis (KOA) is influenced by a complex interaction of several biopsychosocial factors. The use of patient-reported measures (PROM) is considered the gold standard for their evaluation. However, considering that 1 in 5 subjects with KOA present with depressive symptoms, it is necessary to analyse how this psychological domain may influence the subjective perception of PROM. The objective was to study the impact that depressive symptoms have on functional outcome assessments, according to the degree of objectivity of diverse outcome measures. METHODS: Cross-sectional study. Subjects with severe KOA, verified with clinical and radiological symptoms, were assessed with patient-reported (Oxford Knee Score), clinician-reported (knee range of motion), and performance-based (Timed up and go test) measures. The existence of depressive symptoms was assessed with the Yesavage scale, and participants were classified for having no-, mild- or severe-symptoms. Linear correlations (r) and one-way analysis of variance compared groups (95% CI). RESULTS: 244 participants were analysed, of which 75 (30.7%) had depressive symptoms. These symptoms had an inverse moderate association with Oxford Knee Score (r = -0.387). However, the correlation with the Timed up and go test was low (r = 0.176), while there was no correlation with knee ROM (r = -0.087). CONCLUSIONS: This study supports that patient-reported questionnaires may offer biased information on the clinical status of patients with severe knee osteoarthritis who present with depressive symptoms. Consideration of such symptoms may be critical to ensure data collected to accurately reflect patients' capacities and perceptions.

Maize plant expresses SWEET transporters differently when interacting with Trichoderma asperellum and Fusarium verticillioides, two fungi with different lifestyles.

Most Trichoderma species are beneficial fungi that promote plant growth and resistance, while Fusarium genera cause several crop damages. During the plant-fungi interaction there is a competition for sugars in both lifestyles. Here we analyzed the plant growth promotion and biocontrol activity of T. asperellum against F. verticillioides and the effect of both fungi on the expression of the maize diffusional sugar transporters, the SWEETs. The biocontrol activity was done in two ways, the first was by observing the growth capacity of both fungus in a dual culture. The second one by analyzing the infection symptoms, the chlorophyl content and the transcript levels of defense genes determined by qPCR in plants with different developmental stages primed with T. asperellum conidia and challenged with F. verticillioides. In a dual culture, T. asperellum showed antagonist activity against F. verticillioides. In the primed plants a delay in the infection disease was observed, they sustained chlorophyll content even after the infection, and displayed upregulated defense-related genes. Additionally, the T. asperellum primed plants had longer stems than the nonprimed plants. SWEETs transcript levels were analyzed by qPCR in plants primed with either fungus. Both fungi affect the transcript levels of several maize sugar transporters differently. T. asperellum increases the expression of six SWEETs on leaves and two at the roots and causes a higher exudation of sucrose, glucose, and fructose at the roots. On the contrary, F. verticillioides reduces the expression of the SWEETs on the leaves, and more severely when a more aggressive strain is in the plant. Our results suggest that the plant is able to recognize the lifestyle of the fungi and respond accordingly by changing the expression of several genes, including the SWEETs, to establish a new sugar flux.

Identification and Characterization of VDAC Family in Maize.

The voltage-dependent anion channel (VDAC) is the most abundant protein in the outer mitochondrial membrane (OMM) of all eukaryotes, having an important role in the communication between mitochondria and cytosol. The plant VDAC family consists of a wide variety of members that may participate in cell responses to several environmental stresses. However, there is no experimental information about the members comprising the maize VDAC (ZmVDAC) family. In this study, the ZmVDAC family was identified, and described, and its gene transcription profile was explored during the first six days of germination and under different biotic stress stimuli. Nine members were proposed as bona fide VDAC genes with a high potential to code functional VDAC proteins. Each member of the ZmVDAC family was characterized in silico, and nomenclature was proposed according to phylogenetic relationships. Transcript levels in coleoptiles showed a different pattern of expression for each ZmVDAC gene, suggesting specific roles for each one during seedling development. This expression profile changed under Fusarium verticillioides infection and salicylic acid, methyl jasmonate, and gibberellic acid treatments, suggesting no redundancy for the nine ZmVDAC genes and, thus, probably specific and diverse functions according to plant needs and environmental conditions. Nevertheless, ZmVDAC4b was significantly upregulated upon biotic stress signals, suggesting this gene's potential role during the biotic stress response.

Effectiveness of using a chatbot to promote adherence to home physiotherapy after total knee replacement, rationale and design of a randomized clinical trial.

BACKGROUND: Rehabilitation is essential to optimize outcomes after surgical procedures in musculoskeletal disorders. However, adherence to rehabilitation continues to be an important barrier, since compliance with the programs is not always as desired, which may have a negative impact on clinical results. METHODS: Randomized controlled trial aimed at to determining the effectiveness of using a virtual assistant (i.e., chatbot) to promote adherence to home rehabilitation. Overall, seventy patients under 75, undergoing total knee replacement, who have a personal smartphone and are familiar with its use, will be assigned into the control (standard care) or the experimental (standard care plus virtual assistant) group. Adherence (primary outcome) will be assessed three months after surgery. The WOMAC questionnaire, knee pain and system usability scale will be also outcomes of interest at three months and one year. Overall, an analysis of variance will look for possible time, group and time*group interactions. DISCUSSION: The expected result is to determine whether the use of a chatbot that interacts with the patient can increase adherence to post-surgical home physiotherapy, and result in better clinical results (functional and pain) than standard care. TRIAL REGISTRATION: clinicaltrials.gov id. NCT05363137.

Qualitative study on the use of emergency services by people with serious mental disorder in Spain.

BACKGROUND: The population with severe mental disorders (SMD) is a frequent user of emergency services. Situations of psychiatric decompensation can have devastating consequence and can cause problems in getting urgent medical care. The objective was to study the experiences and needs of these patients and their caregivers regarding the demand for emergency care in Spain. METHODS: Qualitative methodology involving patients with SMD and their informal caregivers. Purposive sampling by key informants in urban and rural areas. Paired interviews were carried out until data saturation. A discourse analysis was conducted, obtaining a codification in categories by means of triangulation. RESULTS: Forty-two participants in twenty-one paired interviews (19 ± 7.2 min as mean duration). Three categories were identified. 1º Reasons for urgent care: poor self-care and lack of social support, as well as difficulties in accessibility and continuity of care in other healthcare settings. 2º Urgent care provision: trust in the healthcare professional and the information patients receive from the healthcare system is crucial, telephone assistance can be a very useful resource. 3º Satisfaction with the urgent care received: they request priority care without delays and in areas separated from the other patients, as well as the genuine interest of the professional who attends them. CONCLUSIONS: The request for urgent care in patients with SMD depends on different psychosocial determinants and not only on the severity of the symptoms. There is a demand for care that is differentiated from the other patients in the emergency department. The increase in social networks and alternative systems of care would avoid overuse of the emergency departments.

Peritoneal ultrafiltration in older adult patients with advanced heart failure.

Advanced heart failure (HF) with congestive symptoms refractory to diuretic treatment worsens the patient's prognosis and quality of life. Peritoneal ultrafiltration (PUF) attempts to improve symptoms and reduce HF-related events. This study analyzes the impact of PUF on older adult patients with significant comorbidity and advanced HF. Eighteen patients with advanced HF attended to in the Internal Medicine HF Unit of the Lucus Augusti University Hospital of Lugo, Spain, who started PUF between 2014 and 2021 were analyzed. The number of admissions and instances in which diuretic rescue treatment was used in the year before and after starting PUF were compared. The evolution of renal function, complications secondary to the technique, and survival were also analyzed. The median age was 80 (SD 5.8) years and 72.2% were men. Comparing the year after starting PUF to the year before starting PUF, hospital admissions due to HF (4 vs 20, p = 0.01) and the use of intravenous diuretic rescue treatment declined (4 vs 118, p < 0.001). There was no significant deterioration in renal function during the first year of follow-up or major complications associated with the technique. Survival was 72% at 1 year. In older adult patients with comorbidity, advanced HF, and refractory congestive symptoms, PUF reduced hospital admissions and the use of intravenous diuretic rescue treatment, without major complications.

Pulsed magnetic field increases the effect of ultraviolet C radiation and thermal shock in aged yeasts.

The study of the effects of the magnetic field (MF) on living matter continues to be a dilemma. Until now, the interaction mechanisms of MF with living matter that explain the observed phenomena are unknown. Despite the existing literature and the multiple effects described to date, there are few published articles that study the combined effect of MF with other physical agents during the cellular aging process. In this sense, the aim of this work is to study whether low frequency and intensity pulsed and sinusoidal MF exposure produce alterations in the cell killing effect of ultraviolet C (UVC) radiation and thermal shock during the chronological aging of S. cerevisiae. Yeast cells were exposed to 2.45 mT (50 Hz) sinusoidal MF and 1.5 mT (25 Hz) pulsed MF, during 40 days of aging, in combination with UVC radiation (50 J/m2) and/or thermal shock (52°C). Cell survival was evaluated by clonogenic assay. The exposure of yeast to pulsed MF produces an acceleration of aging, which is not observed in cells exposed to sinusoidal MF. The pulsed MF modifies the cellular response to damaging agents only in aged S. cerevisiae cells. In this sense, the pulsed MF applied increases the damage induced by UVC radiation and by thermal shock. In contrast, the sinusoidal MF used has no effect.

Cutibacterium spp. Infections after Instrumented Spine Surgery Have a Good Prognosis Regardless of Rifampin Use: A Cross-Sectional Study.

Infection after spinal instrumentation (IASI) by Cutibacterium spp. is being more frequently reported. The aim of this study was to analyse the incidence, risk factors, clinical characteristics, and outcome of a Cutibacterium spp. IASI (CG) compared with non-Cutibacterium IASI (NCG) infections, with an additional focus on the role of rifampin in the treatment. All patients from a multicentre, retrospective, observational study with a confirmed IASI between January 2010 and December 2016 were divided into two groups: (CG and NCG) IASI. Baseline, medical, surgical, infection treatment, and follow-up data were compared for both groups. In total, 411 patients were included: 27 CG and 384 NCG. The CG patients were significantly younger. They had a longer median time to diagnosis (23 vs. 13 days) (p = 0.025), although 55.6% debuted within the first month after surgery. Cutibacterium patients were more likely to have the implant removed (29.6% vs. 12.8%; p = 0.014) and received shorter antibiotic regimens (p = 0.014). In 33% of Cutibacterium cases, rifampin was added to the baseline therapy. None of the 27 infections resulted in treatment failure during follow-up regardless of rifampin use. Cutibacterium spp. is associated with a younger age and may cause both early and late IASIs. In our experience, the use of rifampin to improve the outcome in the treatment of a Cutibacterium spp. IASI is not relevant since, in our series, none of the cases had therapeutic failure regardless of the use of rifampin.

Ozonoterapia en el dolor crónico osteoarticular

Introducción: El dolor crónico es una de las causas más frecuentes de consulta médica en el mundo, las de causa osteomioarticular son las más frecuentes. Esto genera un gran consumo de medicamentos, muchos de los cuales producen efectos adversos que comprometen la calidad de vida de los pacientes. Objetivos: Obtener información sobre la efectividad de la ozonoterapia en el dolor crónico osteoarticular. Método: Se realizó una revisión bibliográfica de los artículos publicados en los últimos 15 años sobre esta temática. A través del buscador Google Académico, se revisaron documentos de carácter académico como artículos, tesis, libros, patentes, documentos relativos a congresos y resúmenes de diferentes bases de datos, como son Web of Science, MEDLINE, SciELO, pubmed, todas ellas ajustadas al ámbito biomédico. En primer lugar, se realizó una búsqueda general, y en función de lo que se vio que era más relevante con respecto al tema, se realizaron posteriormente nuevas búsquedas con términos más concretos, en los idiomas español e inglés. No se aplicó ninguna restricción de ámbito geográfico, edad, ni campo de investigación. Se encontraron 750 resultados iniciales, de los cuales se seleccionaron un total de 36. Conclusiones: Se concluye que hay artículos sobre la ozonoterapia, que respaldan su uso como una herramienta terapéutica efectiva y económica en el tratamiento del dolor crónico osteomioarticular, con mayor evidencia en el tratamiento del dolor por enfermedades del disco intervertebral.

Introduction: Chronic pain is one of the most frequent causes of medical consultation in the world, those osteoarticular causes are the most frequent. This generates a large consumption of drugs, many of which produce adverse effects that compromise the quality of life of patients. Objectives: To obtain information on the effectiveness of ozone therapy in chronic osteoarticular pain. Method: A bibliographic review of the articles published in the last 15 years on this subject was carried out. Using the Google Scholar search engine, academic documents such as articles, theses, books, patents, conference papers and abstracts from different databases, such as Web of Science, MEDLINE, SciELO, PubMed, all of them adjusted to the biomedical field, were reviewed. First, a general search was carried out, and depending on what was seen to be most relevant to the topic, new searches were subsequently carried out with more specific terms, in Spanish and English. No restriction of geographic scope, age, or field of research was applied. A total of 750 initial results were found, of which a total of 36 were selected. Conclusions: It is concluded that there are articles on ozone therapy, which support its use as an effective and economical therapeutic tool in the treatment of chronic osteoarticular pain, with greater evidence in the treatment of pain due to intervertebral disc disease.

Genomic DNA damage induced by co-exposure to DNA damaging agents and pulsed magnetic field.

PURPOSE: Many articles describe the effects of extremely low-frequency magnetic fields (MFs) on DNA damage induction. However, the mechanism of MF interaction with living matter is not yet known with certainty. Some works suggest that MF could induce an increase in the efficacy of reactive oxygen species (ROS) production. This work investigates whether pulsed MF exposure produces alterations in genomic DNA damage induced by co-exposure to DNA damaging agents (bleomycin and methyl methanesulfonate (MMS)). MATERIALS AND METHODS: Genomic DNA, prepared from S. cerevisiae cultures, was exposed to pulsed MF (1.5 mT peak, 25 Hz) and MMS (0-1%) (15-60 min), and to MF and bleomycin (0-0.6 IU/mL) (24-72 h). The damage induced to DNA was evaluated by electrophoresis and image analysis. RESULTS: Pulsed MF induced an increment in the level of DNA damage produced by MMS and bleomycin in all groups at the exposure conditions assayed. CONCLUSIONS: Pulsed MF could modulate the cytotoxic action of MMS and bleomycin. The observed effect could be the result of a multifactorial process influenced by the type of agent that damages DNA, the dose, and the duration of the exposure to the pulsed MF.