Consequences of the COVID-19 pandemic on the mental health of medical students202.

Several studies have shown an increased prevalence of anxiety, depression and suicidal ideation in the general population in relation to the COVID-19 pandemic.

Worldwide prevalence of inadequate work ability among hospital nursing personnel: A systematic review and meta-analysis.

PURPOSE: To estimate the worldwide pooled prevalence of inadequate work ability among hospital nursing personnel using the Work Ability Index (WAI). DESIGN: Systematic review and meta-analysis. METHODS: A systematic search was conducted on Medline/PubMed, Scopus, Web of Science, Scielo, PsychInfo, CINAHL, Nursing and Allied Health, LILACS, and Google Scholar from inception to July 2021 to identify observational studies on work ability among hospital nursing personnel using the WAI. Two researchers independently completed the study selection, quality assessments, and data extraction on the prevalence of inadequate work ability that was pooled using the random effects model. Finally, subgroup analyses were performed to explore sources of heterogeneity. FINDINGS: A total of 42 studies were included, consisting of 24,728 subjects worldwide from 14 countries. Of these, 35 studies were included in the meta-analytical analyses. The worldwide pooled prevalence of inadequate work ability among hospital nursing personnel was 24.7% (95% CI = 20.2%-29.4%). High levels of heterogeneity were detected in all studies. Prevalence was higher in studies where samples were composed of nurses and nursing assistive personnel (26.8%; 95% CI = 22.4%-31.5%) than in those of nurses alone (22.2%; 95% CI = 13.1%-32.9%) and in studies where the sample was over 40 (28.1%; 95% CI = 19.5%-37.5%) than in those with a sample under that age (22.4%; 95% CI = 15.8%-29.7%). CONCLUSIONS: Almost one in four members of hospital nursing staff in the world has inadequate work ability and therefore are at risk of several negative outcomes during their working life. These prevalence data correspond to the pre-pandemic period, so new studies should also be especially useful in quantifying the impact of the COVID-19 pandemic on work ability in the hospital nursing workforce. CLINICAL RELEVANCE: The above findings justify the launch of initiatives that include annual assessment for the early identification of inadequate work ability, offering the possibility of anticipated corrective measures. Nursing workforce older than 40 years and those belonging to the professional category of nursing assistive personnel should be priority target groups for screening and intervention to improve work ability.

Work Ability Index: Psychometric Testing in Aeronautical Industry Workers.

Background: The Work Ability Index (WAI) is an instrument that measures work ability. The wide dispersion of the WAI internationally has led to its adaptation for use in different countries. This study aimed to evaluate the psychometric properties of the Spanish version of the WAI. Methods: A methodological design was used over an opportunistic sample of 233 workers in the aeronautical industry in Spain. Reliability was evaluated through internal consistency. Factorial validity, known groups, and convergent validity were tested. Results: The Cronbach's alpha and item-total correlation indicated an adequate internal consistency. The confirmatory factor analysis, performed to evaluate the factorial validity, found adequate fit indices for a two-factor solution with a high correlation between the factors. Factor 1, "Subjectively estimated work ability and resources", was composed of 3 subscales and factor 2, "Ill-health-related", of 2 subscales. Subscales 4 and 6 had loading in both factors. Workers under 45 years of age obtained higher significant scores than older ones. Convergent validity was also evidenced since WAI was highly correlated with self-assessment of health status. Conclusions: The Spanish version of the WAI has shown evidence of reliability and validity in this study, supporting its use in individual and collective health surveillance by occupational health professionals. The factorial solution that was found has previously been reported in another international context. However, further research is needed to resolve the discrepancies detected in the role of some subscales between other national and international studies.

Eleven New Species of the Genus Tarzetta (Tarzettaceae, Pezizales) from Mexico.

The genus Tarzetta is distributed mainly in temperate forests and establishes ectomycorrhizal associations with angiosperms and gymnosperms. Studies on this genus are scarce in México. A visual, morphological, and molecular (ITS-LSU) description of T. americupularis, T. cupressicola, T. davidii, T. durangensis, T. mesophila, T. mexicana, T. miquihuanensis, T. poblana, T. pseudobronca, T. texcocana, and T. victoriana was carried out in this work, associated with Abies, Quercus, and Pinus. The results of SEM showed an ornamented ascospores formation by Mexican Taxa; furthermore, the results showed that T. catinus and T. cupularis are only distributed in Europe and are not associated with any American host.

Compassionate use of esketamine intranasal in patients with severe major depressive disorder resistant to the treatment.

BACKGROUND: Treatment-resistant depression (TRD) is defined as the failure of at least two antidepressants in adequate doses and timing during a major depressive episode. Esketamine intranasal (ESK-IN) has been approved by the Food and Drug Administration and the European Medicines Agency for the treatment of TRD in combination with other antidepressants. AIMS: To assess the effectiveness and tolerability of a sample of TRD patients who received treatment with ESK-IN as part of the compassionate use program. METHODS: A retrospective, observational study was carried out on patients with a diagnosis of TRD enrolled in the early access program of ESK-IN in nine centers. Effectiveness was assessed with the Montgomery-Asberg depression rating scale (MADRS) at four time points: baseline, 28, 90, and 180 days of treatment. RESULTS: The sample included 71 patients (70% women) with a mean baseline MADRS score of 38.27 ± 5.9 and total or partial work disability rates of 85%. ESK-IN treatment was associated with a statistically and clinically significant reduction in the severity of depressive symptoms at all time points assessed. The presence of side effects was common but the majority were mild in severity and resolved after the observation period. Those patients who received psychotherapy in combination with ESK-IN showed a significantly lower MADRS score at 90 and 180 days than those patients who did not undergo psychotherapy. CONCLUSION: ESK-IN has proven to be effective and safe in a clinical sample of patients with severe TRD. To optimize clinical outcomes, the pharmacological treatment for TRD should always be integrated into a comprehensive therapeutic plan that encompasses strategies such as psychotherapy, social support, and family interventions.

Cigarette smoking and risk of suicide in bipolar disorder: a systematic review.

Objective: Bipolar disorder (BD) is a highly prevalent, chronic and recurrent mental illness. The smoking rates in patients with BD are much higher than those of the general population, and BD is associated with an increased risk of suicide. An association between smoking and suicidal behavior has been found in the general population, this systematic review examines whether there is evidence of an association between smoking and suicide behavior in patients with BD. Method: A database search was carried out in Medline, Embase, The Cochrane Library, Scopus, and Web of Science, updated until December 31st, 2021, according to the 2020 PRISMA guidelines. We identified prospective and retrospective studies that included patients diagnosed with BD types I, II, and not otherwise specified, and in which smoking and suicidal behavior were correlated. Articles that focused exclusively on other mental disorders were excluded. The Ottawa-Newcastle scale was used to assess the methodological quality of the included articles. Results: Fifteen articles (n = 7,395) met all the inclusion criteria. In nine of these articles, the authors found an association between smoking and suicidal behavior in BD, while in the remaining six articles, this association was not found. A great deal of variability was observed between articles, particularly in the measurement of suicidal behavior and tobacco consumption. The risk of bias, as assessed by the NOS, was high for most of the included articles, except for two papers, whose risk was low. Conclusion: It was not possible to establish a clear relationship between tobacco use and the risk of suicide in BD patients due to the heterogeneity of the articles included in this systematic review, which had different sample sizes and methodological issues. However, both conditions are highly prevalent and have a negative impact on the prognosis of BD. Therefore, a systematic approach is needed, based on accurate measurement of a patient's smoking habits and their risk of suicidal behavior, in order to establish an appropriate therapeutic plan. Additional information: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors and was registered on PROSPERO with the CRD42022301570 on January 21th 2022.

New Ascomycetes from the Mexican Tropical Montane Cloud Forest.

The tropical montane cloud forest is the most diverse and threatened vegetation type in Mexico. In the last decade, the number of described Ascomycetes species has notably increased, reaching more than 1300 species. This study describes six new species based on their molecular and morphological characteristics. Our results suggest that Mexico has the highest number of described species in the Neotropics. However, many other Mexican lineages still need to be described.

Novelties in Macrofungi of the Tropical Montane Cloud Forest in Mexico.

The tropical montane cloud forest in Mexico is the most diverse and threatened ecosystem. Mexican macrofungi numbers more than 1408 species. This study described four new species of Agaricomycetes (Bondarzewia, Gymnopilus, Serpula, Sparassis) based on molecular and morphological characteristics. Our results support that Mexico is among the most biodiverse countries in terms of macrofungi in the Neotropics.

Five New Species of Aureoboletus and Chalciporus (Boletaceae, Boletales) and Their Ethnomycological Aspects.

Among Boletales, the family Boletaceae has the highest diversity worldwide. Additionally, this fungal group has great ecological relevance because it not only includes mainly ectomycorrhizal but also saprotrophic species. Furthermore, some species are used as food and have sociocultural and economic importance worldwide. In Mexico, the Boletaceae family boasts a substantial number of species, yet our understanding of these species remains far from comprehensive. In this work, by using macro- and micromorphological and phylogenetic analyses of DNA sequences from multi-gene analyses based on ITS, nrLSU, rpb1, rpb2, and tef1, we report five new species belonging to the genera Aureoboletus and Chalciporus: A. ayuukii and A. elvirae from a Quercus scytophylla forest, A. readii from a mixed forest, C. perezsilvae from cloud forest, and C. piedracanteadensis from both a mixed coniferous forest and a Quercus-Pinus forest. In Mexico, four species of Aureoboletus are used as a food source, and in this work, we add another one, A. readii, which is traditionally consumed by members of the Tlahuica-Pjiekakjoo culture, who are located in the central part of the country. This work contributes to our knowledge of two genera of Boletaceae in a geographical area that is scarcely studied, and thus, our understanding of its biocultural relevance is enriched.

Elaphomycescastilloi (Elaphomycetaceae, Ascomycota) and Entolomasecotioides (Entolomataceae, Basidiomycota), two new sequestrate fungi from tropical montane cloud forest from south Mexico.

Two new species of sequestrate fungi are described from south Mexico based on morphological and molecular evidences. Here we describe Elaphomycescastilloi characterized by the yellowish mycelial mat, dull blue gleba and ascospores of 9.7-11.5 µm; Entolomasecotioides is characterized by the secotioid basidiomata, sulcate, pale cream pileus, and basidiospores of 7-13 × 5-9 µm. Both species grow in montane cloud forest under Quercus sp. in the state of Chiapas, Mexico. Descriptions, photographs, and multilocus phylogeny for both species are presented.

Broadening the Knowledge of Mexican Boletes: Addition of a New Genus, Seven New Species, and Three New Combinations.

Boletes are one of the most common groups of fungi in temperate, subtropical, and tropical ecosystems. In Mexico, the northern region has mainly been explored in terms of bolete diversity. This study describes a new genus and seven new species based on macromorphological, micromorphological, molecular, phylogenetic, and ecological data. Garcileccinum gen. nov. is typified with G. salmonicolor based on multigene phylogenetic analysis of nrLSU, RPB2, and TEF1, and it is closely related to Leccinum and Leccinellum. Garcileccinum viscosum and G. violaceotinctum are new combinations. Boletellus minimatenebris (ITS, nrLSU, and RPB2), Cacaoporus mexicanus (RPB2 and ATP6), Leccinum oaxacanum, Leccinum juarenzense (nrLSU, RPB2, and TEF1), Tylopilus pseudoleucomycelinus (nrLSU and RPB2), and Xerocomus hygrophanus (ITS, nrLSU, and RPB2) are described as new species. Boletus neoregius is reclassified as Pulchroboletus neoregius comb. nov. based on morphological and multigene phylogenetic analysis (ITS and nrLSU), and its geographic distribution is extended to Central Mexico, since the species was only known from Costa Rica. Furthermore, T. leucomycelinus is a new record from Mexico. This study contributes to increasing our knowledge of boletes and expands the diversity found in Mexican forests.

Two new species of Trichoglossum (Geoglossaceae, Ascomycota) from south Mexico.

Two new species of Trichoglossum are described from south Mexico based on morphological and molecular evidence. Trichoglossumcaespitosum is characterized by the caespitose ascomata, rough and coiled paraphyses and the ascospores with 9-11 septa. Trichoglossumtropicale is characterized by the capitate ascomata, clavate and straight paraphyses and the ascospores with 10-12 septa. Both species grow in the tropical forests of the Yucatán peninsula. Here we provide descriptions and photographs for these species, together with a phylogenetic analyses based on the DNA sequences of nuc rDNA (ITS region and 28S gene) and a comparative table for the species known for America.

Hemiaustroboletus, a new genus in the subfamily Austroboletoideae (Boletaceae, Boletales).

The present study describes Hemiaustroboletus gen. nov. in the subfamily Austroboletoideae (Boletaceae). Hemiaustroboletus is supported by morphological and molecular data using LSU and RPB2 regions. Additionally, its geographic distribution and intraspecific variation were inferred using ITS sequences. The genus is characterised by pileate-stipitate basidiomata; purple, brown, reddish-brown, orange-brown to dark brown vinaceous pileus; whitish or lilac to vinaceous context and a subclavate stipe. Microscopically, it is characterised by ornamented, slightly verrucose, cracked to perforated brown basidiospores. Two species are described within the genus, Hemiaustroboletusvinaceobrunneus sp. nov. and H.vinaceus sp. nov. Hemiaustroboletusvinaceus sp. nov. is morphologically similar to Austroboletusgracilis, which suggests they may have been confused in the past. This study presents the phylogenetic placement, microscopic structures, detailed morphological descriptions and illustrations of both new species.

[Case detection and follow-up of an outbreak of COVID-19 in repatriated workers: A case series study.] / Detección y segui-miento de casos de un brote de covid-19 en trabajadores repatriados: Un estudio de serie de casos.

OBJECTIVE: The mobility of workers to other countries in a globalized work world has posed an added risk in the current pandemy of COVID-19 and can carry with it an increased risk of spread and transmission of the disease. The collaboration of the Occupational Health Units of the companies and the Health Authorities has been fundamental in the investigation of COVID-19 outbreaks secondary to international travel of workers on mission. The objective of this study was to describe the process of detection and follow-up of cases in an outbreak of COVID-19 in repatriated workers after a six-month mission in a factory of aircraft components in Poland. METHODS: A case series study was conducted. Data on sociodemographic, epidemiological and clinical course variables of the cases were collected by telephone clinical interview. Descriptive statistics were used to summarize the data. RESULTS: The outbreak involved 20 workers who shared the workplace and made the repatriation trip together. The outbreak investigation was initiated after detecting that a worker presented symptoms compatible with COVID-19 during the 4 days prior to the return trip, which was later confirmed by PCR. During follow-up, 40% (n=8) of the workers were considered cases confirmed by PCR. Of these, only 62.5% (n=5) presented symptoms. Fifty percent (n=4) had fever, 25% (n=2) had cough, respiratory distress, general malaise, and diarrhea, and 12.5% (n=1) had anosmia, ageusia, and conjunctivitis. All of them underwent home isolation with outpatient telephone follow-up. At the end of the follow-up, all were asymptomatic and returned to work. The mean close contact was 1.85 per case within the group (SD=3.13), with a range of 0-11, occurring primarily during attendance at extra work social events that were limited to members of the workers' own group and/or during the return flight. The health authorities were informed through established channels so that they could proceed with the detection and tracking of close contacts with people outside the group of workers that occurred during the flight and after arrival to Spain. CONCLUSIONS: Early detection of potential cases of COVID-19 with transmission capacity by the Occupational Health and Safety Departments of the companies, in collaboration with the Health Authorities, is essential for more efficient case and contact management of imported cases of COVID-19.

OBJETIVO: La movilidad de los trabajadores a otros países en un mundo laboral globalizado, ha supuesto un riesgo añadido en el contexto actual de la pandemia de COVID-19 y puede llevar consigo un riesgo mayor de propagación y transmisión de la enfermedad. La colaboración de las Unidades de Salud Laboral de las empresas y las Autoridades Sanitarias ha sido fundamental en la investigación de brotes de COVID-19 secundarios a viajes internacionales de trabajadores en misión. El objetivo de este estudio fue describir el proceso de detección y seguimiento de casos en un brote de COVID-19 en trabajadores repatriados tras una misión de seis meses en una fábrica de elementos aeronáuticos en Polonia. METODOS: Se realizó un estudio de serie de casos. Se recogieron datos relativos a variables sociodemográficas, epidemiológicas y relativas al curso clínico de los casos mediante entrevista clínica telefónica. Se utilizó la estadística descriptiva para resumir los datos. RESULTADOS: El brote implicó a 20 trabajadores que compartían lugar de trabajo y realizaron el viaje de retorno juntos. La investigación del brote se inició tras detectar que un trabajador presentó sintomatología compatible con COVID-19 durante los 4 días previos al viaje de regreso, que posteriormente fue confirmado con PCR. Durante el seguimiento, el 40% (n=8) de los trabajadores fueron considerados casos confirmados con PCR. De ellos, únicamente el 62,5% (n=5) presentó sintomatología. El 50% (n=4) presentó fiebre, mientras que el 25% (n=2) presentó tos, dificultad respiratoria, malestar general y diarrea, y el 12,5% (n=1) presentó anosmia, ageusia y conjuntivitis. Todos realizaron aislamiento domiciliario con seguimiento ambulatorio telefónico y estaban asintomáticos al final del seguimiento causando alta laboral. Los casos presentaron una media de 1,85 (DE=3,13) contactos estrechos dentro del grupo con un rango de 0-11, principalmente ocurridos durante la asistencia a eventos sociales extralaborales que se limitaban a los miembros del propio grupo y/o durante el viaje de avión de regreso. Las autoridades sanitarias fueron informadas a través de los cauces establecidos para que procedieran a la detección y seguimiento de los contactos estrechos con personas externas al grupo de trabajadores sucedidos durante el vuelo y tras la llegada a España. CONCLUSIONES: La detección precoz de los casos de COVID-19 con capacidad de transmisión a través de los servicios de prevención de las empresas, en colaboración con las Autoridades Sanitarias, es fundamental para el manejo de casos y contactos más eficiente ante la eventual aparición de casos importados de COVID-19.

Revision of the genus Restingomyces, including two new species from Mexico.

To document sequestrate fungal diversity in American tropical regions, we performed a series of field surveys in southeastern Mexico and discovered two new species in the phalloid genus Restingomyces (Trappeaceae, Phallales). Here, we describe them based on morphological and phylogenetic analyses of mitochondrial adenosine triphosphatase (ATPase) subunit 6 and nuc 28S rDNA. Restingomyces guzmanianus is characterized by the brownish peridium, yellowish brown gleba, and ellipsoid basidiospores, whereas R. yaaxtax is characterized by the white peridium, pale green gleba, and small ellipsoid basidiospores. Both species occur in medium-statured tropical dry forest. The original diagnosis of the genus Restingomyces is emended to include these novel species. Illustrations are provided.

Users' Perception of Violence and Conflicts With Professionals in Primary Care Centers Before and During COVID-19. A Qualitative Study.

Background: Workplace violence is a social problem of special interest in both intervention and research. Among the sectors that most perceive this type of violence, health care professionals stand out. The most common type of violence for this professional group is the one perpetrated by the users or patients themselves. It has been reported that one out of every four acts of violence in the workplace occurs in the healthcare setting. Within the health sector, the Mental Health, Emergency and Primary Care services have been widely reported as being among the most vulnerable, with Primary Care being the least addressed of the three. Although the available literature is extensive, there are hardly any studies that explore from a qualitative perspective what are the sources of conflict in this sector from the perspective of the users, the most common being to work with professionals. Objective: The aim of this study is to examine those aspects derived from the organization, the professionals or the users of Primary Care that, from the users' point of view, cause violent situations and how they think these could be avoided. Method: The sample consisted of 80 users of the Primary Care services of the Health Service of Murcia. For data collection, a qualitative study was conducted through 10 focus groups and a subsequent thematic analysis of the data. Results: The results have allowed us to identify that, from an organizational point of view, the uncertainty in waiting times, the need to adapt the telematic or telephone appointment to the different types of users, or the management of emergencies in Primary Care are the aspects that cause most conflicts between users and professionals. In this sense, suggested improvements are aimed at providing information in the mobile application updated on the opening hours or maintaining the telephone appointment for those who need or request it, among many others. As for the professionals, users point out that the medical staff is perceived as distant and sometimes does not provide enough information on the health status of users. Another professional group widely addressed in the focus groups was the administrative staff, being described as lacking in communication skills, assertiveness, or empathy. Users recognize the existence of a demanding/aggressive profile among users, who makes instrumental use of violence to achieve privileges over users in general. We have also identified the profile of the user who makes use of Primary Care as a way of socializing or managing conflicts of a socioemotional nature. As proposals for this thematic block, users suggest group therapies, the use of audiovisual material complementary to the information provided by professionals or community interventions in psychoeducation. Conclusion: This study allows to explore conflicts between users and professionals from the Primary Care patients' perspective. Our results are complementary to the available evidence that has used the professional's approach to study the phenomenon of workplace violence. The identification of sources of conflict and the assessment and contribution of users on possible ways of improvement can serve as a basis for the design of prevention and intervention plans to improve the work environment in Primary Care centers.

Improving the university teaching-learning process with ECO methodology: Teachers' perceptions.

This study presents the results of research focused on university teachers' perceptions of the implementation of ECO (Explore, Create, and Offer) methodology. Through teachers´ responses, the objective was to learn about the impact ECO has on both teaching and learning. The sample consists of 22 teachers from four academic fields; they implemented ECO methodology during the 2018-19 academic year with 1,350 undergraduate students and 175 Master's-level students. The participating teachers belong to five universities: Universidad de Sevilla (Spain), Universitat de Barcelona (Spain), Universidade de Vigo (Spain), Universidad de Las Palmas de Gran Canaria (Spain) and Universidad Nacional de La Plata (Argentina). An exploratory and descriptive study was carried out, and the data were gathered from an online survey filled in by the teachers. Twenty-eight cases were obtained, one for each course that was involved in the project. The mean values were analysed by running a Kruskal-Wallis H test and ER2 for the effect size. In addition, the thematic analysis method was used to analyse the teachers' perceptions while representing their opinions faithfully. The results showed that ECO methodology has a very positive effect on the personal development of the teachers. ECO is a methodology that comes to have revolutionary effects, improving the relationship between teachers and students, who strengthen their commitment to their own learning. It is also an excellent means for connecting students with the social and professional world outside of academia.

Obesity and Depression: Its Prevalence and Influence as a Prognostic Factor: A Systematic Review.

OBJECTIVE: Depression and obesity are two conditions with great impact over global health. This is mainly due to their high prevalence and the morbidity and mortality associated to both. The main aim of the present systematic review is to study the association between obesity and depression and the prognostic implications derived from it. METHODS: A literature review was performed in the PUBMED database. 18 articles were found (9 cross-sectional studies, 6 longitudinal studies and 3 clinical trials), which were reviewed by critical reading after which a summary of the main conclusions was written. RESULTS: These selected articles confirmed that there is indeed a link between depression and obesity, although there are doubts as to the significance of this relationship. Depression is a risk factor for obesity, especially atypical depression and in African-American adolescent males. Obesity is a risk factor for depression, especially in women and for recurrent depressive disorder. The comorbidity between obesity and depression is a risk factor for a bad prognosis illness. CONCLUSION: The relationship between both disorders has been analysed in scientific literature, obtaining significant associations but also contradictory results. The most current data demonstrates that there is a relationship between both entities, although there is no unanimity when it comes to establishing the meaning of this association.

Features Associated With Depressive Predominant Polarity and Early Illness Onset in Patients With Bipolar Disorder.

Objective: The aim of this study is to determine the prevalence of three possible diagnostic specifiers, namely predominant polarity (PP) throughout illness, polarity of the first episode and early age at onset, in a sample of bipolar disorder (BD) patients and their association with important socio-demographic, clinical and course-of-illness variables. Methods: A retrospective and naturalistic study on 108 BD outpatients, who were classified according to the PP, polarity of the first episode and early age at onset (≤ 20 years) [vs. late (>20 years)] and were characterized by their demographics, clinical data, functionality and social support, among others features. After bivariate analyses, those variables showing certain association (P value < 0.25) with the three dependent variables were entered in logistic regression backward selection procedures to identify the variables independently associated with the PP, polarity of the first episode and early age at onset. Results: The sample consisted of 75 women ad 33 men, 74% with type I BD and 26% with type II. Around 70% had depressive PP, onset with a depressive episode and onset after age 20. Depressive PP was independently associated with depressive onset, higher score on the CGI severity scale and work disability. Onset with depressive episode was associated with type II BD, longer diagnostic delay and higher score on family disability. Early age at onset (≤ 20 years) was associate with younger age, longer diagnostic delay, presence of ever psychotic symptoms, current use of antipsychotic drugs and higher social support score. Conclusions: The results of this study show that BD patients with depressive PP, onset with depression and early age at onset may represent greater severity, because they are frequently associated with variables that worsen the prognosis. Our findings match up with the conclusions of two systematic reviews and we also include a disability factor (at family and work) that has not been previously reported. This work contributes to the use of polarity and age at onset in BD patients, as it can become a useful instrument in the prognostic and therapeutic applications.

Epidemiological and clinical variables related with the predominant polarity on bipolar disorder: A systematic review. / Factores asociados a la polaridad predominante en el trastorno bipolar: una revisión sistemática.

INTRODUCTION: Current classification of bipolar disorder (BD) in type i or type ii, however useful, may be insufficient to provide relevant clinical information in some patients. As a result, complementary classifications are being proposed, like the predominant polarity (PP) based, which is defined as a clear tendency in the patient to present relapses in the manic or depressive poles. METHODS: We carried out a search in PubMed and Web of Science databases, following the Preferred Items for Reporting of Systematic Reviews and Meta-Analyses -PRISMA- guidelines, to identify studies about BD reporting PP. The search is updated to June 2016. RESULTS: Initial search revealed 907 articles, of which 16 met inclusion criteria. Manic PP was found to be associated with manic onset, drug consumption prior to onset and a better response to atypical antipsychotics and mood stabilisers. Depressive PP showed an association with depressive onset, more relapses, prolonged acute episodes, a greater suicide risk and a later diagnosis of BD. Depressive PP was also associated with anxiety disorders, mixed symptoms, melancholic symptoms and a wider use of quetiapine and lamotrigine. LIMITATIONS: Few prospective studies. Variability in some results. CONCLUSION: PP may be useful as a supplement to current BD classifications. We have found consistent data on a great number of studies, but there is also contradictory information regarding PP. Further studies are needed, ideally of a prospective design and with a unified methodology.