Treating postpartum affective and/or anxiety disorders in a mother-baby day hospital: preliminary results.

INTRODUCTION: Women experiencing perinatal mental-health illness have unique needs. The present study analyzes preliminary data about the effectiveness of MBDH in treating postpartum women with affective and anxiety disorders. METHODS: We analysed 33 mothers with affective and/or anxiety disorders treated at the MBDH with their babies between March 2018 and December 2019. All women were assessed at admission, discharge and three months after discharge. Outcomes included symptoms of depression (EPDS) and anxiety (STAI-S), mother-infant bonding (PBQ) and functional impairment (HoNOs). We also assessed the clinical significance of changes in patients' scores on these scales and patient satisfaction. RESULTS: At discharge, no patients still met the full criteria for the main diagnosis. Between admission and discharge, symptoms of depression and anxiety, mother-infant bonding, functional impairment and autonomy in caring for babies improved significantly. These gains were maintained at three months follow-up. Patient satisfaction was high. CONCLUSIONS: These preliminary results suggest that multidisciplinary intervention for postpartum women with affective or anxiety disorders at the MBDH improves maternal psychopathology, mother-infant bonding and mothers' ability to care for their babies. MBDHs are a promising approach for delivering specialised perinatal mental-health care for mother-baby dyads.

Mother-baby day hospital (MBDH) could be an adequate device for women with perinatal mental disordersMultidisciplinary intervention is effective for treating postpartum anxiety and depressive disorders.Interventions at MBHD improve mother-infant bonding and mothers' ability to care for their babies.Further research is needed to assess the effectiveness at long term not only on maternal health also on child neurodevelopment.

Use of Systemic Acquired Resistance and Whitefly Optical Barriers to Reduce Tomato Yellow Leaf Curl Disease Damage to Tomato Crops.

Epidemics of tomato yellow leaf curl disease (TYLCD) caused by tomato yellow leaf curl-like begomoviruses (genus Begomovirus, family Geminiviridae) severely damage open field and protected tomato crops worldwide. Intensive application of insecticides against the whitefly vector Bemisia tabaci is generally used as control strategy to reduce TYLCD impact. This practice, however, is frequently ineffective and has a negative impact on the environment and human health. TYLCD-resistant varieties are commercially available, but cultivation of susceptible traditional tasting ones is also requested if possible. For susceptible tomatoes, here we show that using whitefly optical barriers by means of UV-blocking plastics in protected crops can contribute to reducing TYLCD damage and increasing commercial fruit yield. Moreover, induction of systemic acquired resistance by application of the elicitor of plant defense acibenzolar-S-methyl was effective to reduce yield losses when viral pressure was moderate. Interestingly, combining both practices in protected tomato crops can result in a significant TYLCD control. Therefore, these control practices are proposed to be used commercially as management alternatives to include in integrated management of TYLCD.

¿Como é o sofrimento de adolescentes diagnosticados de transtorno comportamental? Estudar da Teoria Fundamentada / How is the suffering of adolescents diagnosed with behavioral disorders? A Grounded Theory Study

Objective:to determine how suffering is inadolescents with CD and to understand its meaning for these adolescents. Method:A groundedtheory study was developed with 15 adolescents diagnosed with CD attended at children and juvenile psychiatry units in Vizcaya (Spain). 25 in-depth interviews that were analyzed following the constant comparative method of Strauss and Corbin were performed through the software NVivo version 9 for qualitative analysis. Results:The central category "FeelingSick" identifies the substantive theory generated that expresses how and what is the meaning of suffering for adolescents with CD. This suffering precedes CD and unfolds into five main categories: Absence of childhood; Complex parental relationships; Signs of suffering; Awareness of suffering and; Softeningthe suffering. Final Considerations:The early approach to CD is recommended for the identification of suffering in children before they become adolescents through interventions in the family, school and health care

Objetivo: determinar cómo es sufrimiento en los adolescentes con TC y comprender su significado para estos adolescentes. Metodo:Se llevó a caboun estudio de Teoría Fundamentada, con 15 adolescentes diagnosticados de TC atendidos en unidades de psiquiatría infanto-juvenil de Vizcaya (España). Se realizaron 25 entrevistas en profundidad que fueron analizadas siguiendo el método comparativo constante de Strauss y Corbin utilizando el programa NVivo versión 9 para el análisis cualitativo. Resultado: Lacategoría central "Pasarlo Mal" identifica la teoría sustantiva generada que expresa cómo es y cuál es el significado del sufrimiento para los adolescentes con TC. Este sufrimiento es anterior al TC y se desdobla en cinco categorías principales: Infancia ausente; Relaciones parentales complejas; Señales del sufrimiento; Concienciación del sufrimiento y; Suavizar el sufrimiento. Considerações finales:Por tanto, se recomienda el abordaje temprano del TC mediante la identificación de sufrimiento en los niños y niñas antes de llegar a ser adolescentes, a través de intervenciones en la familia, en la escuela, y en la atención de salud.

Mother-infant bonding in the postpartum period: assessment of the impact of pre-delivery factors in a clinical sample.

This study aims to examine the extent to which a variety of pre-delivery factors (demographic, reproductive, psychological, psychiatric, and psychopathological) predict disturbances in mother-infant bonding (MIB) in the postpartum period. Two hundred fifty-one pregnant women enrolled at a public perinatal psychiatric service were assessed between the first and second trimester of pregnancy and at 6-7 weeks after delivery. During pregnancy, the psychological risk factors were assessed with the Vulnerable Personality Style Questionnaire, the Marital Adjustment Scale, the Early Trauma Inventory, and the General Health Questionnaire. To detect psychopathology, the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory were used. At the postpartum evaluation, MIB was measured by the Postpartum Bonding Questionnaire. The results of the final regression model showed that emotional abuse in childhood, family psychiatric history, previous psychiatric hospitalization, and anxiety during pregnancy were significant predictors of MIB disturbances in postpartum, explaining 10.7% of the variance. The evaluation of women's risk factors in pregnancy is important in order to prevent MIB disturbances and thus to ensure the welfare of mothers and their babies.

Determination of diuron, terbuthylazine, and terbutryn in wastewater and soil by micellar liquid chromatography.

An analytical method for the quantification of the herbicides and algaecides diuron, terbuthylazine, and terbutryn in wastewater and soil by micellar liquid chromatography was developed. The sample preparation was expedited to reduce the number of intermediate steps and the use of chemicals. The analytes in soils were recovered by ultrasonication in the mobile phase. The obtained supernatant and the water samples were directly injected, thus avoiding intermediate steps. The chromatographic behavior of the analytes, depending on the surfactant and alcohol was studied, in order to optimize the chromatographic run, by a chemometrical approach. The herbicides were resolved in <16 min using a C18 column and a mobile phase of 0.07 M sodium dodecyl sulfate/6% 1-pentanol phosphate buffered at pH 3, running under isocratic mode at 1 mL/min. The detection absorbance wavelength was set to 240 nm. The method was successfully validated in terms of selectivity, detection limit (0.06 mg/L in water and 0.3 mg/kg in soil), quantitation range (0.2-2 mg/L in water and 1-10 mg/kg in soil), trueness (-6.1 to +5.0%), precision (<9.4%), and ruggedness (<8.3%). The procedure was reliable, practical, easy-to-handle, available, short-time and ecofriendly and useful for routine analysis. Its applicability to real samples was evaluated by analyzing several wastewater, decorative reservoir, and soil samples from agricultural and urban sources.

Normal gray and white matter volume after weight restoration in adolescents with anorexia nervosa.

OBJECTIVE: The aim of this study was to determine whether treated, weight-stabilized adolescents with anorexia nervosa (AN) present brain volume differences in comparison with healthy controls. METHOD: Thirty-five adolescents with weight-recovered AN and 17 healthy controls were assessed by means of psychopathology scales and magnetic resonance imaging. Axial three-dimensional T1-weighted images were obtained in a 1.5 Tesla scanner and analyzed using optimized voxel-based morphometry (VBM). RESULTS: There were no significant differences between controls and weight-stabilized AN patients with regard to global volumes of either gray or white brain matter, or in the regional VBM study. Differences were not significant between patients with psychopharmacological treatment and without, between those with amenorrhea and without, as well as between patients with restrictive versus purgative AN. DISCUSSION: The present findings reveal no global or regional gray or white matter abnormalities in this sample of adolescents following weight restoration.

Proton magnetic resonance spectroscopy in pediatric obsessive-compulsive disorder: longitudinal study before and after treatment.

Abnormalities in neurochemical compounds in obsessive-compulsive disorder (OCD) may help increase our knowledge of neurobiological abnormalities in the fronto-subcortical circuits. The aims of this exploratory study were to identify with in vivo magnetic resonance spectroscopy ((1)H-MRS) the possible alterations in neurometabolites in a group of drug naïve children and adolescents with OCD in comparison with a control group and to determine whether there was any effect of treatment on the metabolite levels. Eleven OCD children and adolescents (age range 9-17 years; 6 male, 5 female) and twelve healthy subjects with similar age, sex and estimated intellectual quotient were studied. Proton magnetic resonance spectroscopy at 1.5 T was used. We placed 3 voxels, one bilaterally located involving anterior cingulate-medial frontal regions, and one in each striatal region involving the caudate and putaminal regions. Concentrations of creatine (Cr), myo-inositol (mI), total Cho (glycerophosphocholine+phosphocholine), total NAA (N-acetyl aspartate+N-acetyl aspartylglutamate), and total Glx (glutamate+glutamine) were calculated. We found significantly lower concentrations of total Cho in left striatum in OCD patients compared with healthy subjects. The difference in Cho concentrations in left striatum between the two groups did not change over time and persisted at follow-up assessment. Like the control subjects, OCD patients undergoing pharmacological treatment and clinical recovery showed no significant changes in neurometabolic activity between the first and second evaluations.

Contención verbal: prevención primaria de la hostilidad / Verbal containment: primary prevention of hostility

En este trabajo se describe el síndrome Ira-Hostilidad-Agresividad (IHA),que se produce con frecuencia en el entorno hospitalario, sobre todo en las áreas de salud mental y psiquiatría. Se pretende mostrar una realidad a la que se enfrentan las enfermeras asistenciales y proporcionar información para que la valoración enfermera permita identificar precozmente el síndrome, así como algunas claves para la intervención enfermera que incluyen las recomendaciones del National Institute for Clinical Excellence (NICE) y que permitirán garantizar, tanto la seguridad de las personas a las que se atiende como la propia seguridad y la del entorno. Se identifican los componentes de la respuesta humana: emoción, cognición y actuación, muchas veces automatizada y reactiva, pero que requiere ser analizada, desmenuzada y entrenada para que el autocontrol sea exquisito a la hora de afrontar el cuidado de personas con estas conductas. Actuar desde el momento en que se identifica la reacción emocional más primitiva, ayudará a que la escalada sea menor y a que la contención verbal sea efectiva. La actitud de los profesionales se considera el elemento fundamental para dominar la contención verbal con competencia; sin ella, los conocimientos sobran y las habilidades no se desarrollarán (AU)

This paper describes the Rage-Hostility-Aggressiveness (RHA) syndrome, which usually occurs in the hospital setting, mainly in the areas of mental health and psychiatry. The aim is to demonstrate a reality faced by care delivery nurses and to provide information enabling the nurse to make an early identification of the syndrome. The paper also presents some clues for the nursing intervention that include the recommendations issued by the National Institute for Clinical Excellence (NICE) and which will ensure the safety of the individuals cared by the nursing professional as well as his or her own safety and the safety of their surroundings. The components of human response identified are: emotion, cognition and actions, which are more often than not automatic and reactive. Actions in particular must be analysed in detail and trained for self-control in order for it to be effective when confronting the care of people displaying these behaviours. Taking action from the very first time the most primitive emotional reaction is identified will help the inadequate escalating behaviour to be less intense and will make verbal containment more effective. The attitude of professional is considered to be the most fundamental element to gain control over verbal containment with competence, as without it, knowledge serves no purpose and skills are not developed (AU)

A voxel-based morphometric MRI study of stabilized obsessive-compulsive adolescent patients.

BACKGROUND: The aim of this study was to determine whether treated stabilized adolescents with obsessive-compulsive disorder (OCD) present brain structure differences in comparison with healthy control subjects. METHODS: Twenty-seven adolescents with already-treated OCD and 27 healthy controls matched by age, sex and estimated intellectual level were assessed by means of psychopathological scales and magnetic resonance imaging (MRI). Axial three-dimensional T1-weighted images were obtained in a 1.5 T scanner and analyzed using optimized voxel-based morphometry (VBM). RESULTS: Compared with controls, stabilized patients with OCD did not present any statistical differences in the whole brain. However, a small volume correction analysis yielded significant results that survived correction for multiple comparisons, showing decreased white matter (WM) volume in a small area of the parietal cortex (t=3.39, p=0.045 FWE (family wise error)-corrected) of OCD patients in comparison with healthy controls. There was no significant correlation between decreased WM volume in the parietal cortex and obsessive-compulsive symptomatology. CONCLUSION: There were no global significant differences in either gray matter (GM) or WM. Small differences were found between adolescent patients with stabilized OCD and healthy controls as regards in WM volume in right parietal areas. The parietal lobe may play a role in the pathophysiology of OCD, even in clinically stabilized patients.

Comparison between young siblings and offspring of subjects with schizophrenia: clinical and neuropsychological characteristics.

INTRODUCTION: High rates of psychopathology and worse performance in cognitive areas have been described in high risk (HR) first degree relatives of subjects with schizophrenia. The present study aimed to examine clinical and neuropsychological characteristics in two different groups of first degree relatives of patients with schizophrenia - one of siblings (HRs), and one of offspring (HRo) - and compare them with healthy controls (HC). METHODS: Participants were 30 HRo, 26 HRs and 33 HC, all aged between 7 and 16 years. Clinical and neuropsychological assessments were completed by all participants. RESULTS: No significant differences were observed between HR groups in DSM-IV diagnoses. The most prevalent diagnosis in both HR samples was attention deficit/hyperactivity disorder (ADHD) followed by oppositional defiant disorder and generalized anxiety disorder. Both HR groups obtained worse scores than HC on prodromal symptoms, premorbid adjustment and behavioral problem scales. In cognitive areas, HRo performed worse than HC on most WISC-IV index scores, logical memory, visual memory and perceptual organization, whereas HRs only performed worse in WISC-IV indexes, logical memory and perceptual organization. Most of these differences remained stable after controlling for ADHD. The comparison between HRo and HRs showed significant differences in prodromal symptoms and working memory after controlling for ADHD. CONCLUSION: Similar abnormalities in HRo and HRs were found in relation to clinical and neuropsychological variables. Subtle differences were found between HR groups with HRo showing difficulties in more clinical and neuropsychological areas than HRs and HC. This suggests that, the specific kind of family relationship should to be taken into account in future HR research.

Approaches for understanding and predicting drug interactions in human immunodeficiency virus-infected patients.

INTRODUCTION: Knowledge of drug interactions is vital to maximize antiretroviral efficacy and avoid drug-related toxicities. Treatment of co-morbidities has become a difficult task in HIV-infected individuals because pharmacokinetic and/or pharmacodynamic interactions are common when other medications are prescribed along with antiretroviral agents. AREAS COVERED: This article provides an update of the most relevant drug interactions that occur between antiretroviral agents and other drugs. The article additionally revisits how these drug interactions can be prevented from occurring as well as how they can be managed. EXPERT OPINION: Interactions between antiretrovirals and other drugs are frequent in clinical practice. The most common are those affecting drug metabolism due to induction or inhibition of the CYP450, leading to abnormal drug exposure. It is by this mechanism that most HIV protease inhibitors, non-nucleoside reverse transcriptase inhibitors and maraviroc often interact with other medications. In contrast, nucleoside reverse transcriptase inhibitors and some integrase inhibitors, which do not or only marginally affect CYP450, are relatively free of significant pharmacokinetic interactions, although nucleoside analogs might be involved in some pharmacodynamic interactions.

Relationship between clinical and neuropsychological characteristics in child and adolescent first degree relatives of subjects with schizophrenia.

INTRODUCTION: Studies have shown higher rates of psychopathology and cognitive difficulties among relatives of schizophrenia patients than among the general population. This study aimed to analyze the relationship between clinical and neuropsychological characteristics in children and adolescents at high genetic risk for schizophrenia. METHODS: Participants were 26 children and adolescent first-degree relatives of subjects diagnosed with schizophrenia (high-risk [HR] group) and 20 controls whose parents and siblings did not meet DSM-IV criteria for any psychotic disorder. These two groups were matched by age, sex and socio-economic status and clinical and neuropsychological assessments were completed by all participants. RESULTS: Among HR children 42.3% were diagnosed with one or more DSM-IV axis I psychiatric disorders. The most common diagnoses were attention deficit/hyperactivity disorder (ADHD) (34.6%) and generalized anxiety disorder (3.8%) There were significant differences between HR children and controls with respect to prodromal symptoms, behavioral problems and premorbid adjustment, as well as on the majority of intelligence subscales, working memory and logical memory. When differences between HR with ADD (HR-ADD), HR without ADD (HR-NADD) and controls were analyzed, significantly higher scores on clinical scales of prodromal symptoms, behavioral problems and premorbid adjustment were found in HR-ADD than in HR-NADD or controls. There were no significant differences in cognitive domains between HR-ADD and HR-NADD, but there were between HR-ADD and controls and between HR-NADD and controls on the Verbal Comprehension Index, Perceptual Reasoning Index, Working Memory Index and GAI. CONCLUSIONS: Compared to controls, HR children showed more clinical symptoms and cognitive abnormalities. HR children with ADD had worse clinical symptoms than did HR without ADD, although there were no differences in terms of cognitive abnormalities. Both HR groups seem to have similar deficits in neuropsychological performance.

Brain changes in children and adolescents with obsessive-compulsive disorder before and after treatment: a voxel-based morphometric MRI study.

The aim of this study is to determine whether children and adolescents with treatment-naïve obsessive-compulsive disorder (OCD) present brain structure differences in comparison with healthy subjects, and to evaluate brain changes after treatment and clinical improvement. Initial and 6 months' follow-up evaluations were performed in 15 children and adolescents (age range=9-17 years, mean=13.7, S.D.=2.5; 8 male, 7 female) with DSM-IV OCD and 15 healthy subjects matched for age, sex and estimated intellectual level. An evaluation with psychopathological scales and magnetic resonance imaging (MRI) was carried out at admission and after 6 months' follow-up. Axial three-dimensional T1-weighted images were obtained in a 1.5 T scanner and analysed using optimized voxel-based morphometry (VBM) and longitudinal VBM approaches. Compared with controls, OCD patients presented significantly less gray matter volume bilaterally in right and left parietal lobes and right parietal white matter (P=0.001 FWE corrected) at baseline evaluation. After 6 months of treatment, and with a clear clinical improvement, the differences between OCD patients and controls in the parietal lobes in gray and white matter were no longer statistically significant. During follow-up in the longitudinal study, an increase in gray matter volume in the right striatum of OCD patients was observed, though the difference was not statistically significant. Children and adolescents with untreated OCD present gray and white matter decreases in lateral parietal cortices, but this abnormality is reversible after clinical improvement.

Comentario crítico de un estudio científico para una publicación / Critical comment to an original article for a publication

Objetivo: Diseñar un formato estandarizado para la elaboración de un comentario crítico sobre un artículo original.Metodología: Se realizó una revisión de las revistas más importantes del mundo iberoamericano y anglosajón que publican este tipo de artículo. Se llevó a cabo una revisión por expertos investigadores en investigación secundaria y se consultó a un panel de profesionales asistenciales para dar estructura y contenido a este formato de publicación.Estructura del Comentario Crítico: Se obtuvo un formato estandarizado con dos partes principales donde destacan, respectivamente: la descripción de la información más relevante del artículo original acorde a la lista de comprobación pertinente, y la evaluación de su calidad metodológica y el nivel de evidencia derivado -Clasificación GRADE-, debatiendo su validez interna y externa.Utilidad esperada: Este formato estandarizado pretende tener un valor pedagógico para el revisor como guía orientativa para facilitar la escritura de este tipo de publicación, y un valor de mejora en la comprensión y transferencia del conocimiento para el lector (AU)

Objectives: To design a standardized format so as to elaborate a critical comment about an original article.Methods: The most popular journals publishing this type of articles were reviewed. Spanish and English journals were included. A review was performed by secundary research experts and, also, an clinical panel was enquired to work out the content and structure of this publication format.Critical comment structure: A standardized format with two main parts was obtained. These parts were: the most relevant information from the original article according to a suitable checklist, and the methodological quality assessment and the evidence level -GRADE Classification-, discussing the internal and external validity.Expected utility: The standarized format aims to have a pedagogical value for the reviewers as an orientative guide for writing this kind of articles, and a value of improvement on reading comprehension and knowledge transference to clinical practice for the reader (AU)

A cross-sectional and follow-up voxel-based morphometric MRI study in adolescent anorexia nervosa.

The objective was to examine whether cerebral volumes are reduced, and in what regions, in adolescents with anorexia nervosa and to study changes after nutritional recovery. Twelve anorexia nervosa (DSM-IV) patients aged 11-17 consecutively admitted to an Eating Disorders Unit were assessed by means of psychopathological scales, neuropsychological battery and voxel-based morphometric (VBM) magnetic resonance imaging at admission and after 7 months' follow-up. Nine control subjects of similar age, gender and estimated intelligence level were also studied. The two groups showed differences in gray matter (F=22.2; p<0.001) and cerebrospinal fluid (CSF) (F=21.2; p<0.001) but not in white matter volumes. In anorexic patients, gray matter volume correlated negatively with the copy time from the Rey Complex Figure Test. In the regional VBM study several temporal and parietal gray matter regions were reduced. During follow-up there was a greater global increase in gray matter (F=10.7; p=0.004) and decrease in CSF (F=22.1; p=0.001) in anorexic patients. The increase in gray matter correlated with a decrease in cortisol (Spearman correlation=-0.73; p=0.017). At follow-up there were no differences in global gray matter (F=2.1; p=0.165), white matter (F=0.02, p=0.965) or CSF (F=1.8; p=0.113) volumes between both groups. There were still some smaller areas, in the right temporal and both supplementary motor area, showing differences between them in the regional VBM study. In conclusion, in adolescent anorexic patients gray matter is more affected than white matter and mainly involves the posterior regions of the brain. Overall gray matter alterations are reversible after nutritional recovery.

Cerebral activation in children and adolescents with obsessive-compulsive disorder before and after treatment: a functional MRI study.

BACKGROUND: Structural and functional fronto-striatal abnormalities are involved in the pathophysiology of obsessive-compulsive disorder (OCD). The aims of the present study were: (a) to investigate possible regional brain dysfunction in premotor cortico-striatal activity in drug-naïve children and adolescents with OCD; (b) to correlate brain activation with severity of obsessive-compulsive symptomatology; and (c) to detect possible changes in brain activity after pharmacological treatment. METHOD: Twelve children and adolescents (age range 7-18 years; seven male, five female) with DSM-IV obsessive-compulsive disorder and twelve healthy subjects matched for age, sex and intellectual level were studied. Functional magnetic resonance imaging data were obtained during the performance of simple and complex sequences. RESULTS: Comparing the complex motor condition with the simple control condition, both patients and controls showed a pattern of cerebral activation involving the fronto-parietal cortex and basal ganglia. Compared with controls, OCD patients presented significantly higher brain activation bilaterally in the middle frontal gyrus. After 6 months of pharmacological treatment and with clear clinical improvement, activation in the left insula and left putamen decreased significantly. CONCLUSION: In a paediatric OCD sample that was treatment naïve and without another psychiatric disorder we showed hyperactivation of the circuits that mediate symptomatic expression of OCD. The cerebral activation decreases after treatment and clinical improvement.

Changes in cognitive dysfunction in children and adolescents with obsessive-compulsive disorder after treatment.

The majority of follow-up studies show stability of deficits after treatment in adults with obsessive-compulsive disorder (OCD), regardless of improvement in symptomatology, and this suggests a possibly chronic dysfunction of the dorsolateral-striatal circuit. To our knowledge, this is the first study to explore the evolution of cognitive dysfunction in children and adolescents with OCD after treatment. A neuropsychological battery designed for this study was administered to 29 OCD patients aged between 7 and 18 years before and after 6 months of naturalistic treatment, and to 22 healthy subjects of similar age, sex and intellectual level. In the first assessment, the OCD group performed worse on some tests of memory, speed of information processing and executive functions, this being similar to the cognitive dysfunction described in adult patients. After treatment the cognitive profile of the OCD group was normalized, and many of the significant differences present in the first assessment disappeared. Children and adolescents did not show the stability in cognitive dysfunction described in studies with adults. Six months of effective treatment normalized cognitive performance in young patients, who showed an important response to treatment.

La vivencia de la sujeción mecánica experimentada por el personal de enfermería de una unidad de psiquiatria infanto-juvenil / Mechanical restraints as experienced by nursing staff at a child and adolescent psychiatric unit

Introducción: La sujeción mecánica es una técnica ampliamente utilizada por las enfermeras en los hospitales bajo indicación médica. Su utilización en las unidades de adolescentes provoca situaciones de conflicto emocional e inconvenientes viviéndolo las enfermeras en primera persona. Hablar de sujeción es poco concreto; para entenderla es necesario explicar motivos, situaciones, expectativas profesionales, tipo de enfermos y problemáticas. Los menores que ingresan en una unidad psiquiátrica sienten gran frustración, manifestándola habitualmente a través de agresividad al darse cuenta que pasarán algunos días ingresados. Objetivo: Conocer la vivencia del equipo de enfermería de la unidad de psiquiatría infanto juvenil del Hospital de Basurto (Bilbao), respecto al fenómeno de la sujeción mecánica de adolescentes. Método: El enfoque teórico es la fenomenología. El diseño, descriptivo interpretativo, basado en metodología cualitativa. Resultados: Las categorías emergidas durante el estudio se agrupan en tres, cada una con varias subcategorías: (a) La intervención: la sujeción mecánica = las sensaciones corporales, los pensamientos y las actuaciones. (b) El cuestionamiento = la evaluación individual, la percepción del equipo, la autocrítica de la utilización, el uso de los criterios. (c) La utilidad de la técnica = la provocación del entorno, el refuerzo negativo, última alternativa. Existe un malestar generalizado como consecuencia de la utilización de la sujeción. Conclusiones: Unificar criterios es necesario para trabajar de manera cohesionada, tranquila y autocontrolada siendo la autocrítica una necesidad útil para emplear una técnica tan conflictiva y compleja de usar como real en su aplicación

Introduction: The restraint is a technique widely used by nurses in hospitals under medical supervision. Its use in psychiatric units adolescent patients can result in emotionally conflictive. When referring to the restraint, it is necessary to explain motives, situations, professional expectations, type of patient and their specific problems. The minors who are admitted to a psychiatric unit in order to be mentally evaluated, experience great frustration, usually expressed through aggressive behaviour when they realise that they will have to spend a few days in hospital. Objectiv: To acknowledge the existence of the medical team of the psychiatric unit for children in Basurto Hospital (Bilbao), regarding the restrain for adolescents. Method: The phenomenology is the main theory which we focus on. The design is descriptive-interpretative, based on qualitative methodology. Results: The results of the study have been divided into three categories, which are in turn divided into its respective categories: (a) The restraint procedure = corporal sensations, thoughts and performances. (b) The questioning = individual assessment, the team’s observation, the view of its usage, the use of criteria. (c) The usage of the technique = the effects of the surroundings, the negative reinforcement, last alternative. There is a negative feeling surrounding the usage of the restraint; negative feelings due to unknown comments, and others as a result of the relevant cognitive assessment. Both of these have influenced the following decisions regarding the use of the technique. Conclusions: It is necessary to take into account all the criteria in order to work together as a team and to try and find the best method to use this technique (AU)

Frequent occurrence of recombinants in mixed infections of tomato yellow leaf curl disease-associated begomoviruses.

Begomoviruses are plant DNA viruses for which recombination plays a key role in driving evolution. However, little is known about how frequently begomovirus recombinants arise in mixed infected plants. To tackle this issue, co-infections of tomato with monopartite begomoviruses associated with the tomato yellow leaf curl disease, Tomato yellow leaf curl Sardinia virus and Tomato yellow leaf curl virus, have been studied as a model system. The frequency of recombinant genotypes in the progeny populations was evaluated at several times post inoculation. Recombinants constituted a significant proportion of the viral population. Interestingly, not all regions of the genome contributed equally to genetic exchange. In addition to the intergenic region, a known hot spot for recombination, a second hot spot region was found. Implication of secondary structure sequence features in cross-over sites is suggested, which might favor discontinuous DNA replication with the replication complex switching between homologous regions of DNA templates.

Neuropsychological performance in children and adolescents with obsessive-compulsive disorder and influence of clinical variables.

BACKGROUND: Several studies have found impairment in visual memory and visual organization in adults with obsessive-compulsive disorder (OCD), but little is known about the neuropsychological profile of children and adolescents with this disorder. The influence of clinical variables such as age, severity of obsessive-compulsive symptomatology, depressive symptomatology, and pharmacological treatment on cognitive performance in these patients has not been thoroughly studied. METHODS: A neuropsychological battery designed for this study was administered to 35 patients with DSM-IV-TR diagnosis of OCD without psychiatric comorbidity aged between 7 and 18 years and 35 gender- and age-matched healthy subjects. RESULTS: Children and adolescents with OCD performed significantly worse on verbal and visual memory and velocity. When depressive symptomatology was controlled, impairment in visual memory, visual organization, and velocity again was found, but impairment in verbal memory was not. Neuropsychological impairment was not related to age, obsessive-compulsive severity, and pharmacological treatment. CONCLUSIONS: Children and adolescents with OCD without psychiatric comorbidity with acute illness show impairment in visual memory, visual organization, and velocity, similar to adults. The influence of depressive symptomatology is important in cognitive performance. No relation was found between neuropsychology and age, severity of obsessive-compulsive symptomatology, or pharmacological treatment in this study.