Bipolar symptoms, somatic burden and functioning in older-age bipolar disorder: A replication study from the global aging & geriatric experiments in bipolar disorder database (GAGE-BD) project.

OBJECTIVES: The Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) project pools archival datasets on older age bipolar disorder (OABD). An initial Wave 1 (W1; n = 1369) analysis found both manic and depressive symptoms reduced among older patients. To replicate this finding, we gathered an independent Wave 2 (W2; n = 1232, mean ± standard deviation age 47.2 ± 13.5, 65% women, 49% aged over 50) dataset. DESIGN/METHODS: Using mixed models with random effects for cohort, we examined associations between BD symptoms, somatic burden and age and the contribution of these to functioning in W2 and the combined W1 + W2 sample (n = 2601). RESULTS: Compared to W1, the W2 sample was younger (p < 0.001), less educated (p < 0.001), more symptomatic (p < 0.001), lower functioning (p < 0.001) and had fewer somatic conditions (p < 0.001). In the full W2, older individuals had reduced manic symptom severity, but age was not associated with depression severity. Age was not associated with functioning in W2. More severe BD symptoms (mania p ≤ 0.001, depression p ≤ 0.001) were associated with worse functioning. Older age was significantly associated with higher somatic burden in the W2 and the W1 + W2 samples, but this burden was not associated with poorer functioning. CONCLUSIONS: In a large, independent sample, older age was associated with less severe mania and more somatic burden (consistent with previous findings), but there was no association of depression with age (different from previous findings). Similar to previous findings, worse BD symptom severity was associated with worse functioning, emphasizing the need for symptom relief in OABD to promote better functioning.

Spanish validation of the Empirically Developed Clinical Staging Model (EmDe-5) for patients with bipolar disorder.

INTRODUCTION: Bipolar disorder (BD) has been reconceptualised as a progressive disorder that develops from mild to severe presentations. An empirical staging model - the Empirically Developed Clinical Staging Model for BD (EmDe-5) - was developed in a previous study. This study aims to further validate that model using a larger and more representative Spanish sample. MATERIAL AND METHODS: 183 BD outpatients were recruited at 11 sites in Spain. Assessment included clinical characteristics of the BD (number of hospitalisations, number of suicide attempts, comorbid personality disorders), physical health (BMI, metabolic syndrome, number of physical illnesses), cognition (SCIP), functioning (permanently disabled due to BD, FAST), and quality of life (SF-36). The CGI-S, VAS-S, and psychopharmacological treatment pattern were used as external validators. RESULTS: Ten patients (51.5%) were classified as stage 1, 33 (18%) as stage 2, 93 (508%) as stage 3, 37 (202%) as stage 4, and 10 (55%) as stage 5. All profilers, other than number of suicide attempts (p=0.311) and comorbid personality disorder (p=0.061), exhibited worse scores from stage 1 to 5. As expected, VAS-S and CGI-S scores were worse in the later stages. Regarding treatment, early stages (1-2) were associated with the use of one to three drugs while late stages (4-5) were associated with four or more drugs (p=0.002). CONCLUSIONS: We confirm the EmDe-5 staging model's construct validity. The ease of obtaining the profilers, together with the operational criteria provided to quantify them, will facilitate the use of the EmDe-5 staging model in daily clinical practice.

Cognitive impairment and consumption of mental healthcare resources in outpatients with bipolar disorder.

Cognitive dysfunction is a major predictor of functional outcomes, and loss of occupational functioning is usually linked with a higher cost of illness. However, the association between cognitive impairment and consumption of health resources has not been studied in bipolar disorder to date. This study aims to examine this relationship. This is an observational, retrospective study of a representative sample of euthymic outpatients between 18 and 55 years, fulfilling DSM 5 criteria for bipolar disorder and recruited at a catchment area in Spain. Cognitive performance was screened with the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S), and several variables of health resources consumption during the previous year were registered. A total of 72 patients were assessed. Cognitive impairment according to the SCIP-S was significantly associated with the number of scheduled clinical appointments (p < 0.005) and hospital admissions (p < 0.04) but not with other health resources consumption variables. These results need to be interpreted with caution given that neither a control group nor a comprehensive, objective neuropsychological battery were used. However, despite these limitations, this study shows that in euthymic outpatients with bipolar disorder, those with suspected cognitive impairment had consumed a higher number of health resources over the previous year. These preliminary results may foster similar studies on the relationship between mental healthcare resource use and cognitive dysfunction in bipolar disorder and other psychiatric disorders.

Duration of euthymia and predominant polarity in bipolar disorder.

BACKGROUND: The concept of Predominant Polarity (PP) provides relevant information for clinical practice and has been widely described as course specifier for Bipolar Disorder (BD), however it has not been incorporated in DSM-5 yet. A descriptive study was conducted to identify clinical patterns associated with PP in outpatients attending a Mental Health Unit. METHODS: Clinical and socio-demographic characteristics were assessed from a sample of 118 euthymic outpatients fulfilling DSM 5 criteria for BDI or II recruited at a catchment area. According to their PP, patients were divided into three subgroups: depressive (DPP; 39.0%), manic (MPP; 32.2%) or indeterminate (IPP; 28.8%). Subgroups of PP were compared regarding a comprehensive set of demographic and clinical features. RESULTS: PP subgroups significantly differed in duration of euthymia, measured in months since the last episode (p < 0.04), with MMP patients showing longer periods (42.4 months) than those with DPP and IPP (18.6 and 18.1 months, respectively). Moreover, history of seasonal pattern was significantly higher in the DPP group compared with the PPM group (p < 0.001). There were no significant correlations between PP and type of last episode, length of illness, number of previous admissions, history of psychotic symptoms, or number of suicide attempts. LIMITATIONS: Cross sectional design, relatively modest sample size. CONCLUSIONS: Our study showed similar results to previous literature regarding distribution of predominant polarity. The association found between PP and duration of euthymia represents a novel finding which awaits confirmation and adds further support to the usefulness of PP in clinical practice.

Grading the potential safety risk of medications used in hospital care.

OBJECTIVE: The aim of this study was to stratify medications used in hospital  care according to their potential risk. METHOD: The RAND/UCLA Appropriateness Method was used. Anatomical Therapeutic Chemical subgroups were classified according to their potential risk. A literature search, bulletins, and alerts issued by patient safety organizations were used to identify the potential safety risk of  these subgroups. Nine experts in patient/medication safety were selected to score the subgroups for their appropriateness in the classification. Two evaluation rounds were conducted: the first by email and the second by a  panel meeting. RESULTS: A total of 298 Anatomical Therapeutic Chemical subgroups were  evaluated. They were classified into three scenarios (low, medium, and high  risk). In the first round, 266 subgroups were classified as appropriate to the  assigned scenario, 32 were classified as uncertain, and none were classified as  inappropriate. In the second round, all subgroups were classified as appropriate.  The most frequent subgroups in the low-risk scenario belonged to  group A "Alimentary tract and metabolism" (44%); the most frequent in the  medium-risk scenario belonged to group J "Antiinfectives for systemic use"  (32%); and the most frequent in the high-risk scenario belonged to group L  "Antineoplastic and immunomodulating agents" (29%) and group N "Nervous  system" (26%). CONCLUSIONS: Based on the RAND/UCLA appropriateness method, Anatomical  Therapeutic Chemical subgroups used in hospital care were classified according  to their potential risk (low, medium, or high). These lists can be incorporated  into a risk-scoring tool for future patient/medication safety studies.

Objetivo: Estratificar los medicamentos utilizados en el ámbito hospitalario según el riesgo de provocar daño al paciente.Método: Se utilizó la metodología RAND/UCLA para clasificar los subgrupos terapéuticos del código Anatómica, Terapéutica, Química según el  riesgo de provocar daño al paciente. Para ello se realizó una revisión de la  evidencia disponible en publicaciones, boletines y alertas de organismos de  seguridad del paciente. A continuación se seleccionaron nueve expertos en  seguridad del paciente/medicamento para evaluar la clasificación de los  subgrupos terapéuticos: una primera ronda de evaluación por vía telemática y  una segunda ronda en una reunión presencial en la que se presentaron y  discutieron los resultados de la primera.Resultados: Se evaluaron 298 subgrupos terapéuticos. Se clasificaron en tres  escenarios (riesgo bajo, medio y alto). En la primera ronda se clasificaron 266  subgrupos como adecuados al escenario asignado, 32 subgrupos fueron  clasificados como inciertos y ninguno fue clasificado como inapropiado. En la  segunda ronda, todos los subgrupos fueron clasificados como adecuados. Los  subgrupos más frecuentes en el escenario de riesgo bajo pertenecieron al Grupo  A: "Tracto alimentario y metabolismo" (44%), en el de riesgo medio al Grupo J:  "Antiinfecciosos para uso sistémico" (32%), y en el de riesgo alto al Grupo L:  "Agentes antineoplásicos e inmunomoduladores" (29%) y al Grupo N: "Sistema  nervioso" (26%).Conclusiones: La metodología RAND/UCLA ha permitido estratificar los  subgrupos utilizados en el ámbito hospitalario según el riesgo potencial de  provocar daño al paciente. Esta estratificación puede servir como herramienta  para futuros estudios de seguridad en la utilización de medicamentos.

Failure mode and effects analysis applied to the administration of liquid medication by oral syringes.

OBJECTIVE: To carry out a Failure Mode and Effects Analysis (FMEA) to the use of oral syringes. METHODS: A multidisciplinary team was assembled within the Safety Committee.  The stages of oral administration process of liquid  medication were analysed, identifying the most critical and establishing the  potential modes of failure that can cause errors. The impact associated with  each mode of failure was calculated using the Risk Priority Number (RPN).  Preventive actions were proposed. RESULTS: Five failure modes were identified, all classified as high risk (RPN>  100). Seven of the eight preventive actions were implemented. CONCLUSIONS: The FMEA methodology was a useful tool. It has allowed to know  the risks, analyse the causes that cause them, their effects on patient safety and  the measures to reduce them.

Objetivo: Realizar un análisis modal de fallos y efectos (AMFE) aplicado a la utilización de jeringas orales.Métodos: Un grupo multidisciplinar dentro del Comité de Seguridad analizó las etapas en la administración oral de los medicamentos líquidos, identificándose las más críticas y estableciendo modos potenciales de fallo que podrían producir un error. El riesgo asociado a cada modo de fallo se calculó  utilizando el número de prioridad de riesgo (NPR). Se sugirieron acciones preventivas.Resultados: Se identificaron cinco modos de fallo, todos clasificados de alto  riesgo (NPR>100). Siete de las ocho recomendaciones fueron implementadas.Conclusiones: La aplicación de la metodología AMFE ha sido una herramienta muy útil que ha permitido conocer los riesgos, analizar las causas que los pueden provocar y saber los efectos que tienen en la seguridad del paciente; todo ello con el fin de implantar acciones para  reducirlos.

Prediction of alkaline earth elements in bone remains by near infrared spectroscopy.

An innovative methodological approach has been developed for the prediction of the mineral element composition of bone remains. It is based on the use of Fourier Transform Near Infrared (FT-NIR) diffuse reflectance measurements. The method permits a fast, cheap and green analytical way, to understand post-mortem degradation of bones caused by the environment conditions on different skeletal parts and to select the best preserved bone samples. Samples, from the Late Roman Necropolis of Virgen de la Misericordia street and En Gil street located in Valencia (Spain), were employed to test the proposed approach being determined calcium, magnesium and strontium in bone remains and sediments. Coefficients of determination obtained between predicted values and reference ones for Ca, Mg and Sr were 90.4, 97.3 and 97.4, with residual predictive deviation of 3.2, 5.3 and 2.3, respectively, and relative root mean square error of prediction between 10% and 37%. Results obtained evidenced that NIR spectra combined with statistical analysis can help to predict bone mineral profiles suitable to evaluate bone diagenesis.

Comparison of pharmacokinetics of marbofloxacin after subcutaneous administration of various multiple-dose regimens to water buffalo calves (Bubalus bubalis).

OBJECTIVE: To determine pharmacokinetics of marbofloxacin in water buffalo calves (Bubalus bubalis) after multiple SC administrations and to assess differences in regimen efficacy. ANIMALS: 18 healthy buffalo calves. PROCEDURES: Calves (n = 6 calves/group) were assigned to receive marbofloxacin SC in the neck at 1 of 3 dosages (2 mg/kg, q 24 h for 6 days [regimen 1]; 4 mg/kg, q 48 h for 6 days [regimen 2]; and 4 mg/kg, q 24 h for 3 days [regimen 3]). Serum marbofloxacin concentrations were analyzed. Efficacy predictors were estimated on the basis of minimum inhibitory concentration and mutant prevention concentration reported for Pasteurella multocida and Mannheimia haemolytica. RESULTS: Mean ± SD area under the concentration-time curve was 5.92 ± 0.40 µg•h/mL for regimen 1, which differed significantly from that for regimens 2 (14.26 ± 0.92 µg•h/mL) and 3 (14.17 ± 0.51 µg•h/mL). Mean residence time and mean elimination half-life for regimen 2 (9.93 ± 0.20 hours and 8.77 ± 0.71 hours) both differed significantly from those for regimens 1 (721 ± 0.11 hours and 5.71 ± 0.38 hours) and 3 (759 ± 0.13 hours and 737 ± 1.19 hours). Values obtained from indices for P multocida and M haemolytica had an excessively wide range because of the various degrees of antimicrobial susceptibility (low, medium, and high) of the strains. CONCLUSIONS AND CLINICAL RELEVANCE: Regimen 3 had the most favorable indices, and it would be conducive for owner compliance and require less handling of animals.

[An experience of collaboration between primary health care and mental health care in La Ribera Department of Health (Valencia, Spain)]. / Experiencia de colaboración entre atención primaria y salud mental en el Departamento de Salud La Ribera, 7 años después.

Despite the high prevalence of mental health problems among patients attending primary care, diagnosis and treatment of these disorders remain inadequate. Sound training of primary care physicians in how to manage mental health problems is needed to reduce the health, economic and social impact associated with these disorders. Among other elements, there is a need for cooperation between primary care physicians and mental health services. Distinct models are available for such collaboration. In 2006, our health department started a collaboration between these two levels of heath care, using a liaison model. Delays until the first specialist visit were reduced and satisfaction among health professionals increased, although these results should be interpreted with caution. Evidence has recently accumulated on the usefulness of the collaborative model, but evaluation of this model and extrapolation of its results are complex. We intend to evaluate our model more thoroughly, similar to other projects in our environment.

Pharmacokinetic behaviour of enrofloxacin in greater rheas following a single-dose intramuscular administration.

The pharmacokinetic behaviour of enrofloxacin in greater rheas was investigated after intramuscular (IM) administration of 15 mg/kg. Plasma concentrations of enrofloxacin and its active metabolite, ciprofloxacin, were determined by high performance liquid chromatography. Enrofloxacin peak plasma concentration (C(max)=3.30+/-0.90 microg/mL) was reached at 24.17+/-9.17 min. The terminal half-life (t(1/2lambda)) and area under the curve (AUC) were 2.85+/-0.54 h and 4.18+/-0.69 microg h/mL, respectively. The AUC and C(max) for ciprofloxacin were 0.25+/-0.06 microg/mL and 0.66+/-0.16 microg h/mL, respectively. Taking into account the values obtained for the efficacy indices, an IM dose of 15 mg/kg of enrofloxacin would appear to be adequate for treating infections caused by highly susceptible bacteria (MIC(90)<0.03 microg/mL) in greater rheas.

Mäes de crianças com anomalia congênita: histórias de gestantes peruanas assistidas em situações especiais / Mothers of children with congenital malformation: histories of pregnant peruvian women assisted in special situations / Madres de niiios con malformación congénita: historias de mujeres peruanas embarazadas asistidas en situaciones especiales

Este artigo faz parte de um estudo de natureza qualitativa que tem por objeto investigar: a percepção de mães peruanas de crianças com anomalia congênita da assitência de saúde recebida na gestação. Como objetivo pretendemos: analisar a percepção das mães peruanas de crianças com anomalia congênita da assistência de saúde recebida na gestação. Os sujeitos foram mães de crianças com anomalia congênita que residem em Piura-Perú. O método utilizado foi a história de vida e a entrevista neste método é aberta, isto é, sem um roteiro determinado, na qual o sujeito fala livremente sobre um determinado período ou acontecimento em sua vida do qual participou, neste caso sobe a assistência recebida na gestação....