[Hiperfrequency in mental health hospital emergencies: case-control study.] / Hiperfrecuentación en Urgencias Hospitalarias de Salud Mental: Estudio caso-control.

OBJECTIVE: To ensure the efficiency of the operation of the Emergency Department, specific mental health studies are needed. The purpose of the study was to identify and quantify the sociodemographic, clinical and organizational factors associated with the hyperfrequency of hospital Mental Health emergency departments in the three central areas of Asturias. METHODS: A retrospective case-control study was carried out. A total of 110 hyperfrequenters were recorded in 2017, based on a definition of five or more visits to the emergency department. The control group was composed of 170 subjects who attended on one occasion. In addition to descriptive analysis, Chi-square and ANOVA tests were used to identify differences between the two groups. A multivariate study was also carried out using binomial logistic regression. RESULTS: Hyperfrequent users were more likely to be young adult (30-44 years old), single, living with their family of origin, and with no jobs. The most prevalent diagnoses for these users were "Personality and Behavior Disorder" (F60-69) and "Schizophrenia, Schizotypal Disorders and Delusional Disorders" (F20-29). The most frequent reason for consultation was "anxiety/depression/somatization symptoms". The destination of the most frequent emergency was "Continue follow-up at scheduled appointments" and most consultations were made in the morning and on weekdays. CONCLUSIONS: Hyperfrequent users continue to demand attention despite being assigned one or more devices. Knowing their needs would help to improve healthcare and use resources more efficiently and effectively.

OBJETIVO: Para garantizar la eficiencia del funcionamiento del Servicio de Urgencias es necesario realizar estudios específicos de Salud Mental. El propósito del estudio fue identificar y cuantificar los factores sociodemográficos, clínicos y organizativos asociados con la hiperfrecuentación de las Urgencias Hospitalarias del Servicio de Salud Mental de las tres áreas sanitarias centrales de Asturias. METODOS: Se realizó un estudio retrospectivo de tipo casos-controles. Se registraron 110 hiperfrecuentadores en el año 2017, basándonos en una definición de cinco o más visitas al servicio de Urgencias. El grupo control lo compusieron 170 sujetos que acudieron en una sola ocasión. Además del análisis descriptivo, se utilizaron las pruebas Chi cuadrado y ANOVA para identificar diferencias entre ambos grupos. También se realizó un estudio multivariado mediante regresión logística binomial. RESULTADOS: Los usuarios hiperfrecuentadores eran más probablemente adultos jóvenes (30-44 años), solteros, convivientes con la familia de origen e inactivos laboralmente. Los diagnósticos más prevalentes para estos usuarios eran: "Trastorno de la personalidad y el comportamiento" (F60-69) y "Esquizofrenia, trastornos esquizotípicos y trastornos delirantes" (F20-29). El motivo de consulta más frecuente era "Síntomas de ansiedad/depresión/somatizaciones". El destino de la urgencia más frecuente fue "Continuar seguimiento en citas programadas" y la mayor parte de las consultas se realizaron en horario de mañana y en días laborables. CONCLUSIONES: Los usuarios hiperfrecuentadores continúan demandando atención a pesar de tener asignados uno o varios dispositivos de la red de salud mental. Conocer sus necesidades ayudaría a mejorar la atención sanitaria y a utilizar los recursos de manera más eficiente y eficaz.

Quasi-spherical focal spot in two-photon scanning microscopy by three-ring apodization.

We present a beam-shaping technique for two-photon excitation (TPE) fluorescence microscopy. We show that by inserting a properly designed three-ring pupil filter in the illumination beam of the microscope, the effective optical sectioning capacity of such a system improves so that the point spread function gets a quasi-spherical shape. Such an improvement, which allows the acquisition of 3D images with isotropic quality, is obtained at the expense of only a small increase of the overall energy in the axial sidelobes. The performance of this technique is illustrated with a scanning TPE microscopy experiment in which the image of small beads is obtained. We demonstrate an effective narrowing of 12.5% in the axial extent of the point spread function, while keeping the 82% of the spot-fluorescence efficiency.

Quasi-isotropic 3-D resolution in two-photon scanning microscopy.

One of the main challenges in three-dimensional microscopy is to overcome the lack of isotropy of the spatial resolution, which results from the axially-elongated shape of the point spread function. Such anisotropy gives rise to images in which significant axially-oriented structures of the sample are not resolved. In this paper we achieve an important improvement in z resolution in two-photon excitation microscopy through spatial modulation of the incident beam. Specifically, we demonstrate that the design and implementation of a simple shaded ring performs quasi-isotropic threedimensional imaging and that the corresponding loss in luminosity can be easily compensated by most available femtosecond lasers. The outcome looks particularly relevant to nano-fabrication and optical manipulation.

Optical-sectioning improvement in two-color excitation scanning microscopy.

We present a new beam-shaping technique for two-color excitation fluorescence microscopy. We show that by simply inserting a properly designed shaded-ring filter in the illumination beam of smaller wavelength, it is possible to improve the effective optical sectioning capacity of such microscopes by 23%. Such an improvement is obtained at the expense of only a very small increasing of the overall energy in the point-spread-function sidelobes. The performance of this technique is illustrated by a numerical imaging simulation.