The impact of community care: Burden and quality of life of the informal caregivers of patients with severe mental disorder.

This study analyzes the dimensions and consequences of the burden of caregivers of patients with SMD (Severe Mental Disorder) and the repercussions that this role has on their quality of life and health in the physical, psychic and social spheres. This is a descriptive cross-sectional study and inferential observational study which explores caregivers of patients with SMD admitted to Psychiatry Day Hospital (Huesca, Spain). The technique of consecutive cases was used as a technique for sampling and sample selection. An individualized interview was arranged, where sociodemographic data were collected and scales and instruments were administered. 52 caregivers met the inclusion criteria. The female sex predominates (67%), being the patient's mother (48%). The average age of caregivers is 60 years old. Almost 60% of the sample presents intense burden and alterations of general mental health, 77% reveal anxiety and depression, and 46% little social support. Burden is associated with hospitalization within the last year, anxiety, or total social support received. It is appreciated how the diagnosis of a chronic disease constitutes an important challenge for the patient and their family, due to the burden of the disease and the impact of the new routines imposed by the continuous treatment.

La virtualidad al servicio del encuentro con el otro y una conexión posibilitadora de cambios. La historia de Carola / Virtuality at the service of the encounter with the other and a connection that enables changes. Carola's story

En un contexto de pandemia, se presenta el relato clínico de una paciente, cuyo tratamiento fue llevado a cabo mediante sesiones online. A partir del mismo, se analizarán los efectos de la virtualidad en un tratamiento psicoanalítico, donde el motivo de consulta que consistía en la manifestación de conductas agresivas por parte de la niña, pudieron ser trabajadas a través del juego instrumentalizado mediante el uso de los videojuegos, desplegándose una virtualidad potenciada. Finalmente, se reflexionará sobre las mutaciones que la clínica actual ha sufrido como resultado de la situación sanitaria mundial, proponiendo imaginar si la presencialidad podría haber generado o posibilitado una dirección a la cura distinta a la sostenida en la virtualidad(AU)

Descripción: In a pandemic context, the clinical report of a patient is presented, whose reatment was carried out through online sessions. From the same, the effects of virtuality in a sychoanalytic treatment will be analyzed, where the reason for consultation that consisted of the manifestation of aggressive behaviors on the part of the girl, could be worked through the instrumentalized game through the use of video games, unfolding an enhanced virtuality. Finally, it will reflect on the mutations that the current clinic has suffered as a result of the global health situation, proposing to imagine if the presence could have generated or made possible a direction to the cure other than that sustained in virtuality(AU)

Carlos de la Torre y Huerta. Paradigma del quehacer científico cubano / Carlos de la Torre y Huerta. Paradigma of Cuban scientific activity

RESUMEN La dimensión científica educativa constituye uno de los aportes más sólidos de la obra de Carlos de la Torre y Huerta. Su extensa obra investigativa se nutre de las asignaturas que impartió en la Universidad de la Habana entre las que se desatacan Paleontología, Arqueología, Antropología, Zoología, Geología, Biología y Entomología. Estos estudios favorecieron el descubrimiento de la gran riqueza existente en el país, destacándose una trayectoria ejemplar cuyos cimientos se insertan en la malacología. El descubrimiento de las Polymitas lo llevan a describir una diversidad de subespecies que lo insertan en el escenario internacional aclamado como un referente de obligatoria consulta para los especialistas. La divulgación sistemática de su obra lo conducen a la formación de una escuela cubana de naturalistas en la que los discípulos marcaron impronta en el quehacer científico nacional al apropiarse de las herramientas que le permiten hacer ciencia utilizando medios de enseñanza, imágenes proyectadas, láminas, dibujos y ejemplares autóctonos del país (AU).

ABSTRACT The educational scientific dimension is one of the strongest contributions of the work of Carlos de la Torre and Huerta. His extensive research work draws on the subjects he taught at the University of Havana, including Paleontology, Archeology, Anthropology, Zoology, Geology, Biology and Entomology. These studies favored the discovery of the great wealth existing in the country, highlighting an exemplary trajectory whose foundations are inserted in malacology. The discovery of the Polymites leads him to describe a diversity of subspecies that insert him in the acclaimed international scenario as a mandatory reference for specialists. The systematic dissemination of his work lead him to the formation of a Cuban school of naturalists in which the disciples marked imprint on the national scientific work by appropriating the tools that allow him to do science using teaching means, projected images, prints, drawings and native copies of the country (AU).

Prevalence of diabetes mellitus in Spanish primary care setting and its association with cardiovascular risk factors and cardiovascular diseases. SIMETAP-DM study. / Prevalencia de diabetes mellitus en el ámbito de la atención primaria española y su asociación con factores de riesgo cardiovascular y enfermedades cardiovasculares. Estudio SIMETAP-DM.

INTRODUCTION: The aims of this study were to determine the age- and sex-adjusted prevalence rates of DM, type-1 DM (T1DM), and type-2 DM (T2DM), and to compare the relationship with cardiovascular risk factors, cardiovascular diseases, chronic kidney disease, and metabolic diseases between populations with and without DM. METHODS: SIMETAP-DM is a cross-sectional observational study conducted in a Primary Care setting with a random population-based sample of 10,579 adults. Response rate: 66%. The diagnoses of DM, T1DM and T2DM were based on clinical and biochemical criteria and/or the checking of these diagnoses in the medical records. The crude and age- and sex-adjusted (standardised for Spanish population) prevalence rates were calculated. RESULTS: The crude prevalence rates of T1DM, T2DM, and DM were 0.87% (95% confidence interval [95% CI]: 0.67-1.13), 14.7% (95% CI: 13.9-15.6), and 15.6% (95% CI: 14.7-16.5), respectively. The age- and sex-adjusted prevalence rates of T1DM, T2DM, and DM were 1.0% (1.3% for men and 0.7% for women), 11.5% (13.6% for men and 9.7% for women), and 12.5% (14.9% for men and 10.5% for women), respectively. The prevalence of DM in the population≥70 years was double (30.3% [95% CI: 28.0-32.7]) that of the population between 40 and 69 years (15.3% [95% CI: 14.1-16.5]). Hypertension, peripheral arterial disease, increased waist-to-height ratio, albuminuria, coronary heart disease, atherogenic dyslipidaemia and hypercholesterolaemia were associated with DM. CONCLUSIONS: In a Spanish primary care setting, the age-adjusted prevalences of T1DM, T2DM and DM in the adult population were 1.0, 11.5, and 12.5%, respectively. One-third (33%) of the population over 70 years had DM.

Prevalence of erectile dysfunction in Spanish primary care setting and its association with cardiovascular risk factors and cardiovascular diseases. SIMETAP-ED study.

INTRODUCTION: Few studies conducted in primary care setting report about age-adjusted prevalence rates of erectile dysfunction (ED). Aims of SIMETAP-ED study were to determine crude and age-adjusted prevalence rates of ED diagnosis, to compare these rates with other similar studies, and to compare prevalence rates of cardiovascular risk factors (CVRF), cardiovascular diseases (CVD), metabolic diseases and chronic kidney disease (CKD) between populations with and without ED. METHODS: Cross-sectional observational study conducted in primary care setting. Population-based random sample: 2934 adult men. Response rate: 66%. A clinical interview was conducted to diagnose ED using a question derived from ED definition. The medical records of patients were reviewed to identify their CVRF and diseases associated with ED. The age-adjustments were standardized to Spanish population. RESULTS: The prevalence rates of metabolic diseases, CVD, CVRF, and CKD in population with ED were higher than population without ED, highlighting the CVD. The crude prevalence of ED was 17.2% (95% confidence interval: 15.8-18.6). The age-adjusted prevalence rates of ED were 0.71% in men under 40 years, 12.4% in men over 18 years, 10.8% in men aged 40-69 years, 18.9% in men over 40 years, and 48.6% in men over 70 years. CONCLUSIONS: SIMETAP-ED study showed association of ED with metabolic diseases, CKD, CVRF, and highlighting CVD. The age-adjusted prevalence of ED was 12.4% in adult men, 19% in men over 40 years, and almost 50% in men over 70 years.

Definition of a cell surface signature for human cardiac progenitor cells after comprehensive comparative transcriptomic and proteomic characterization.

Adult cardiac progenitor/stem cells (CPC/CSC) are multipotent resident populations involved in cardiac homeostasis and heart repair. Assisted by complementary RNAseq analysis, we defined the fraction of the CPC proteome associable with specific functions by comparison with human bone marrow mesenchymal stem cells (MSC), the reference population for cell therapy, and human dermal fibroblasts (HDF), as a distant reference. Label-free proteomic analysis identified 526 proteins expressed differentially in CPC. iTRAQ analysis confirmed differential expression of a substantial proportion of those proteins in CPC relative to MSC, and systems biology analysis defined a clear overrepresentation of several categories related to enhanced angiogenic potential. The CPC plasma membrane compartment comprised 1,595 proteins, including a minimal signature of 167 proteins preferentially or exclusively expressed by CPC. CDH5 (VE-cadherin),  OX2G (OX-2 membrane glycoprotein; CD200), GPR4 (G protein-coupled receptor 4), CACNG7 (calcium voltage-gated channel auxiliary subunit gamma 7) and F11R (F11 receptor; junctional adhesion molecule A; JAM-A; CD321) were selected for validation. Their differential expression was confirmed both in expanded CPC batches and in early stages of isolation, particularly when compared against cardiac fibroblasts. Among them, GPR4 demonstrated the highest discrimination capacity between all cell lineages analyzed.

The moderating role of age and gender differences in the relation between subjective well-being, psychopathology and substance use in Uruguayan adolescents / O papel moderador das diferenças de idade e gênero na relação entre bem-estar subjetivo, psicopatologia e uso de substâncias em adolescentes uruguaios / Le rôle modérateur des différences d'âge et de sexe dans le rappot entre le bien-être subjectif, la psychopathologie et la consommation de substances chez les adolescents Uruguayens / El papel moderador de las diferencias de edad y género en la relación entre bienestar psicológico subjetivo, psicopatología y consumo de sustancias entre adolescentes uruguayos

The aim of this study is to explore the Subjective well-being (SWB) of school-going adolescents in Uruguay (N= 325; Mage= 14.67; SD= 1.62). We investigate age- and gender-specific relationships between psychopathology and substance use on the one hand, and subjective well-being on the other hand. Multivariate linear regression analyses, indicated five significant predictors of SWB: three psychopathology factors (depression-anxiety, social anxiety and dissocial behaviour), and age displayed a negative association, while one psychopathology factor (resilience) showed a positive association. When extending the multivariate linear regression analysis with interaction effects, significant interactions appeared regarding gender and resilience and age and substance use. Our study focuses on the necessity to have evidence-based results in order to plan appropriate preventive interventions with adolescents.

O objetivo deste estudo é explorar o bem-estar subjetivo (BES) de adolescentes que frequentam o ensino médio no Uruguai (N = 325; M idade = 14,67; DP = 1,62). Pesquisamos as relações específicas de idade e sexo entre psicopatologia e uso de substâncias, por um lado, e bem-estar subjetivo, por outro. Análises de regressão linear multivariada indicaram cinco preditores significativos de BES: três fatores psicopatológicos (depressão-ansiedade, ansiedade social e comportamento dissocial) e idade apresentaram associação negativa, ao passo que um fator psicopatológico (resiliência) apresentou associação positiva. Ao estender a análise de regressão linear multivariada com efeitos de interação, surgiram interações significativas em relação a gênero e resiliência e idade e uso de substâncias. Este estudo está centrado da necessidade de obter resultados baseados em evidências para planejar intervenções preventivas adequadas com adolescentes.

Le but de cette recherche est d'explorer le bien-être subjectif (BES) des adolescents étudiants du secondaire en Uruguay (N = 325, M être = 14,67, SD = 1,62). Nous étudions les rapports spécifiques entre l'âge et le sexe entre la psychopathologie et l'usage de substances, d'une part, et le bien-être subjectif, d'autre part. Les analyses de régression linéaire multivariée ont indiqué cinq prédicteurs significatifs de BES: trois facteurs psychopathologiques (dépression-anxiété, anxiété sociale et comportement anti social) et l'âge ont montré une association négative, tandis qu'un facteur psychopathologique (résilience) présentait une association positive. Après extension de l'analyse de régression linéaire multivariée avec des effets d'interaction, des interactions significatives sont apparues concernant le genre et la résilience et l'âge et la consommation de substances. Notre recherche met l'accent sur la nécessité d'obtenir des résultats fondés sur des données appuyés empiriquement afin de planifier des interventions préventives appropriées auprès des adolescents.

El objetivo de este estudio es explorar el bienestar psicológico subjetivo (BPS) de adolescentes uruguayos que van al colegio (N = 325, M edad = 14,67, SD = 1,62). Por un lado, investigamos las relaciones específicas, por edad y género, entre la psicopatología y el uso de sustancias, y por otro lado, el bienestar psicológico subjetivo. Los análisis de regresión lineal multivariante indicaron cinco predictores significativos de BS: tres factores psicopatológicos (depresión-ansiedad, ansiedad social y comportamiento disocial) y la edad, mostraron una asociación negativa, mientras que un factor psicopatológico (resiliencia) mostró una asociación positiva. Al extender el análisis de regresión lineal multivariante con efectos de interacción, aparecieron interacciones significativas con respecto al género, la resiliencia, la edad y el uso de sustancias. Este estudio se enfoca en la necesidad de lograr resultados basados en evidencias para planificar intervenciones preventivas apropiadas para adolescentes.

Ziel dieser Studie ist es, das subjektive Wohlbefinden (SWB) schulpflichtiger Jugendlicher in Uruguay zu untersuchen (N = 325; Mage = 14,67; SD = 1,62). Wir untersuchen alters- und geschlechtsspezifische Zusammenhänge zwischen Psychopathologie und Substanzgebrauch einerseits und subjektivem Wohlbefinden andererseits. Multivariate lineare Regressionsanalysen ergaben fünf signifikante SWB Prädiktoren: drei psychopathologische Faktoren (Depressionsangst, soziale Angst und dissoziales Verhalten) und Alter ergaben eine negative Assoziation und nur ein psychopathologischer Faktor (Resilienz) ergab eine positive Assoziation. Bei der Erweiterung der multivariaten linearen Regressionsanalyse mit Interaktionseffekte ergaben sich signifikante Wechselwirkungen hinsichtlich Geschlechtes und Resilienz sowie Alter und Substanzkonsum. Unsere Studie konzentriert sich auf die Notwendigkeit evidenzbasierter Ergebnisse um geeignete präventive Maßnahmen für Jugendliche zu planen.

Population and methodology of the SIMETAP study: Prevalence of cardiovascular risk factors, cardiovascular diseases, and related metabolic diseases. / Población y metodología del estudio SIMETAP: Prevalencia de factores de riesgo cardiovascular, enfermedades cardiovasculares y enfermedades metabólicas relacionadas.

The prevention of cardiovascular disease is based on the detection and control of cardiovascular risk factors (CVRF). In Spain there are important geographical differences both in the prevalence and in the level of control of the CVRF. In the last decade there has been an improvement in the control of hypertension and dyslipidaemia, but a worsening of cardio-metabolic risk factors related to obesity and diabetes. The SIMETAP study is a cross-sectional descriptive, observational study being conducted in 64 Primary Care Centres located at the Community of Madrid. The main objective is to determine the prevalence rates of CVRF, cardiovascular diseases, and metabolic diseases related to cardiovascular risk. A report is presented on the baseline characteristics of the population, the study methodology, and the definitions of the parameters and diseases under study. A total of 6,631 study subjects were selected using a population-based random sample. The anthropometric variables, lifestyles, blood pressure, biochemical parameters, and pharmacological treatments were determined. The highest crude prevalences were detected in smoking, physical inactivity, obesity, prediabetes, diabetes, hypertension, dyslipidaemias, and metabolic syndrome. A detailed analysis needs to be performed on the prevalence rates, stratified by age groups, and prevalence rates adjusted for age and sex to assess the true epidemiological dimension of these CVRF and diseases.

Cell senescence abrogates the therapeutic potential of human mesenchymal stem cells in the lethal endotoxemia model.

Mesenchymal stem cells (MSCs) possess unique paracrine and immunosuppressive properties, which make them useful candidates for cellular therapy. Here, we address how cellular senescence influences the therapeutic potential of human MSCs (hMSCs). Senescence was induced in bone marrow-derived hMSC cultures with gamma irradiation. Control and senescent cells were tested for their immunoregulatory activity in vitro and in vivo, and an extensive molecular characterization of the phenotypic changes induced by senescence was performed. We also compared the gene expression profiles of senescent hMSCs with a collection of hMSCs used in an ongoing clinical study of Graft Versus Host disease (GVHD). Our results show that senescence induces extensive phenotypic changes in hMSCs and abrogates their protective activity in a murine model of LPS-induced lethal endotoxemia. Although senescent hMSCs retain an ability to regulate the inflammatory response on macrophages in vitro, and, in part retain their capacity to significantly inhibit lymphocyte proliferation, they have a severely impaired migratory capacity in response to proinflammatory signals, which is associated with an inhibition of the AP-1 pathway. Additionally, expression analysis identified PLEC, C8orf48, TRPC4, and ZNF14, as differentially regulated genes in senescent hMSCs that were similarly regulated in those hMSCs which failed to produce a therapeutic effect in a GVHD trial. All the observed phenotypic alterations were confirmed in replicative-senescent hMSCs. In conclusion, this study highlights important changes in the immunomodulatory phenotype of senescent hMSCs and provides candidate gene signatures which may be useful to evaluate the therapeutic potential of hMSCs used in future clinical studies.

[Research projects in mental health care speciality: mentoring and lived experiences]. / Tutorización y vivencias personales: investigación en la especialidad de salud mental.

The goal of the present study is to describe the methodology followed in the implementation of the mentoring research projects developed by the three residents of mental health during the 2009-10 academic years and present the results obtained and recognition. We designed eight targeted monthly tutorials and educational material complementing the methodological support. The development of the project followed an established pattern that allowed progressively advancing in the various phases. When completed the projects, the most relevant were selected for presentation at the XI National Meeting of Residents of Mental Health Nursing, and planned a public presentation of all projects. The main findings from the evaluation work were made for every resident of the experience and the quality of the tutorials. In his narrative are the positive enrichment achieved during the year of residency from the perspective of learning as well as relationship with mentors. In the individual assessment reflect relevant aspects of the authorization process as closeness, trust, resolving doubts, guidelines for intervention. The project presented at the national meeting took second award.

Filopodial protrusions induced by glycoprotein M6a exhibit high motility and aids synapse formation.

M6a is a neuronal membrane glycoprotein whose expression diminishes during chronic stress. M6a overexpression in rat primary hippocampal neurons induces the formation of filopodial protrusions that could be spine precursors. As the filopodium and spine motility has been associated with synaptogenesis, we analysed the motility of M6a-induced protrusions by time-lapse imaging. Our data demonstrate that the motile protrusions formed by the neurons overexpressing M6a were more abundant and moved faster than those formed in control cells. When different putative M6a phosphorylation sites were mutated, the neurons transfected with a mutant lacking intracellular phosphorylation sites bore filopodia, but these protrusions did not move as fast as those formed by cells overexpressing wild-type M6a. This suggests a role for M6a phosphorylation state in filopodium motility. Furthermore, we show that M6a-induced protrusions could be stabilized upon contact with presynaptic region. The motility of filopodia contacting or not neurites overexpressing synaptophysin was analysed. We show that the protrusions that apparently contacted synaptophysin-labeled cells exhibited less motility. The behavior of filopodia from M6a-overexpressing cells and control cells was alike. Thus, M6a-induced protrusions may be spine precursors that move to reach presynaptic membrane. We suggest that M6a is a key molecule for spine formation during development.

Comparison of neointimal hyperplasia with drug-eluting stents versus bare metal stents in patients undergoing intracoronary bone-marrow mononuclear cell transplantation following acute myocardial infarction.

The aims of this study were to assess the safety of drug-eluting stent (DES) use and to compare the incidence of in-stent restenosis (ISR) and neointimal hyperplasia formation according to the type of stent implanted (DES vs bare-metal stents [BMS]) in patients who underwent intracoronary bone marrow mononuclear cell transplantation after acute ST elevation myocardial infarction. Fifty-nine patients with successfully revascularized ST elevation myocardial infarction (37 using BMS and 22 using DES) underwent paired angiographic examinations at baseline and 6 to 9 months after the intracoronary injection of 91 million +/- 56 million autologous bone marrow mononuclear cells. A subgroup of 30 patients also underwent serial intravascular ultrasound examinations. Off-line angiographic assessment showed 4 cases of binary ISR, primarily in BMS (3 cases), and no major adverse cardiac events were associated with stent type (mean follow-up period 41 +/- 10 months). At follow-up, angiographic late luminal loss was significantly lower in patients with DES than in those patients with BMS (0.35 +/- 0.66 vs 0.71 +/- 0.38 mm, p = 0.011). Multivariate analysis identified the use of DES (beta = -0.32, 95% confidence interval [CI] -0.57 to -0.26, p = 0.03) and a smaller baseline reference vessel diameter (beta = 0.29, 95% CI 0.04 to 0.54, p = 0.02) as independent predictors of lower late loss. Moreover, intravascular ultrasound showed a significant reduction of in-stent neointimal hyperplasia formation related to DES use compared with BMS use (Delta neointimal hyperplasia volume 5.4 mm(3) [95% CI 2.7 to 28.1] vs 35.9 mm(3) [95% CI 22.0 to 43.6], p = 0.035). In conclusion, these findings suggest that the use of DES is safe and may prevent ISR and neointimal hyperplasia formation in patients who undergo intracoronary bone marrow mononuclear cell transplantation after a successfully revascularized ST elevation myocardial infarction.

Contemplating the bright future of stem cell therapy for cardiovascular disease.

Not long ago, it was assumed that mammalian hearts were so differentiated that regeneration of cardiac tissue was not possible, but now an increasing amount of information suggests that the intrinsic regenerative capacity of the heart can be encouraged by stimulating resident stem cells or transplanting extracardiac progenitor cells. In the future, cardiovascular stem cell therapy may be administered to all patients. Here, we review what has happened and look at where we are going.

Experimental models for cardiac regeneration.

Simple ex vivo or in vitro models are most useful for testing putative cell therapy protocols, as they allow quick and controlled screening of variants and possible improvements. We discuss here three different models: coculture of precursors of human bone marrow cells (BMCs) with mouse heart slices bearing a cryogenic lesion; coculture of human BMCs and rat cardiomyocytes separated by a porous membrane that allows passage of soluble substances but prevents migration of nuclear material; and injection of human BMCs in developing chick heart bearing burn lesions. Our results indicate that the damaged areas express specific genes such as MPC1 and SDF1, and that some human BMCs migrate and graft near the lesion, where they can originate cells with a cardiac phenotype that produce human cardiac proteins. The frequency of this transformation is, however, very low. Understanding the factors that determine and regulate nuclear reprogramming and transdifferentiation would be crucial to appraising the contribution of these phenomena to cardiac regeneration and, eventually, to modulating them with therapeutic intent.

Experimental and clinical regenerative capability of human bone marrow cells after myocardial infarction.

Bone marrow mononuclear cells (BMCs) from 20 patients with extensive reperfused myocardial infarction (MI) were used to assess their myocardial regenerative capability "in vitro" and their effect on postinfarction left ventricular (LV) remodeling. Human BMCs were labeled, seeded on top of cryoinjured mice heart slices, and cultured. BMCs showed tropism for and ability to graft into the damaged mouse cardiac tissue and, after 1 week, acquired a cardiomyocyte phenotype and expressed cardiac proteins, including connexin43. In the clinical trial, autologous BMCs (78+/-41x10(6) per patient) were intracoronarily transplanted 13.5+/-5.5 days after MI. There were no adverse effects on microvascular function or myocardial injury. No major cardiac events occurred up to 11+/-5 months. At 6 months, magnetic resonance showed a decrease in the end-systolic volume, improvement of regional and global LV function, and increased thickness of the infarcted wall, whereas coronary restenosis was only 15%. No changes were found in a nonrandomized contemporary control group. Thus, BMCs are capable of nesting into the damaged myocardium and acquire a cardiac cell phenotype in vitro as well as safely benefiting ventricular remodeling in vivo. Large-scale randomized trials are needed now to assess the clinical efficacy of this treatment.