A Change of Paradigm in the Management of Acute Psychiatric Episodes? A Retrospective Cohort Study on Trajectories of Use of Clinical Resources After the Implementation of Intensive Home-Treatment.

Intensive home treatment (IHT) has shown to be a feasible alternative to hospitalization for the management of acute psychiatric episodes, but there are no real-world studies assessing if patients with a first IHT use it again for the management of their recurrences. The objectives of this retrospective cohort study were to map the use ofacute treatment resources after the implementation of IHT in our territory through the establishment of trajectories of management, and to disentangle if there are profiles of patients who fit better each trajectory. We included the first 1000 episodes admitted to IHT, of which we selected those that corresponded to the first IHT of a patient (index admission). Trajectories after the index admission were: (T-A) absence of use of acute resources, (T-B) only IHT, and (T-C) at least one hospitalization. Follow-up ranged from 6 months to 6 years. We calculated the frequency of each trajectory and performed univariate analyses searching for associations between trajectory and clinical factors. Among those patients with psychiatric history (N = 659), 66.2% followedT-A, 11.2% T-B, and 22.6% T-C. The probability of following T-C was higher for patients with a psychotic disorder (pBonf = 0.018) and with previous hospitalizations (pBonf < 0.0001). Among those patients without psychiatric history (N = 168), 82.7% followed T-A, 6.6% T-B, and 10.7% T-C. The probability of following T-B was higher for those with a higher severity at the index admission (pBonf = 0.028). This study shows that some -or even all- recurrences of some subjects were successfully managed with IHT, providing real-world evidence for its use in acute psychiatric conditions.

Streptococcus suis Research Update: Serotype Prevalence and Antimicrobial Resistance Distribution in Swine Isolates Recovered in Spain from 2020 to 2022.

This study aimed to update the Streptococcus suis serotype distribution in Spain by analysing 302 clinical isolates recovered from diseased pigs between 2020 and 2022. The main objectives were to identify prevalent serotypes, differentiate specific serotypes 1, 14, 2, and 1/2, investigate specific genotypic and phenotypic antimicrobial resistance features, and explore associations between resistance genes and phenotypic resistances. Serotypes 9 (21.2%), 1 (16.2%), 2 (15.6%), 3 (6%), and 7 (5.6%) were the most prevalent, whereas serotypes 14 and 1/2 corresponded with 4.3% and 0.7% of all isolates. Antimicrobial resistance genes, including tet(O), erm(B), lnu(B), lsa(E), tet(M), and mef(A/E), were analysed, which were present in 85.8%, 65.2%, 7%, 7%, 6.3%, and 1% of the samples, respectively. Susceptibility testing for 18 antimicrobials revealed high resistance levels, particularly for clindamycin (88.4%), chlortetracycline (89.4%), and sulfadimethoxine (94.4%). Notably, seven significant associations (p < 0.0001) were detected, correlating specific antimicrobial resistance genes to the observed phenotypic resistance. These findings contribute to understanding the S. suis serotype distribution and its antibiotic resistance profiles in Spain, offering valuable insights for veterinary and public health efforts in managing S. suis-associated infections.

Is intensive home-treatment a real alternative to classical hospitalization for managing acute psychiatric processes? Insights from clinical practice / ¿Es la hospitalización domiciliaria una alternativa real a la hospitalización clásica para el tratamiento de los procesos psiquiátricos agudos? Reflexiones desde la práctica clínica

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Anatomical Site, Typing, Virulence Gene Profiling, Antimicrobial Susceptibility and Resistance Genes of Streptococcus suis Isolates Recovered from Pigs in Spain.

A set of 207 Streptococcus suis isolates were collected from ten autonomous communities from Spain in 2019 to 2020 from pigs with meningitis, pneumonic lungs, arthritic joints or other swollen viscera, to a lesser extent. Thirteen capsular types were detected being the most prevalent serotype 2 (21.7%), followed by serotypes 1 (21.3%), 9 (19.3%) and 3 (6.3%). Serotypes 2 and 9 were recovered mainly from the central nervous system (CNS), while serotype 1 was isolated mostly from swollen joints and serotype 3 from the lungs. Twenty-five isolates (12.1%) could not be typed. The most prevalent pathotype was epf + mrp + sly + luxS (49 isolates, 23.8%), and it was related mainly to serotypes 1 and 2. Serotypes 1-3 and 9 were significantly associated with anatomical sites of isolation and virulence factors, serotype 9 (CNS) and serotypes 3 and 9 (lungs) being associated with virulence profiles without the epf gene. S. suis isolates showed globally high antimicrobial resistances, but ampicillin followed by spectinomycin and tiamulin resulted in the highest activities, while the greatest resistances were detected for sulphadimethoxine, tetracyclines, neomycin, clindamycin and macrolides. A total of 87.4% isolates were positive to the tetO gene, 62.4% to the ermB gene and 25.2% to the fexA gene, while 14.6% were positive to all three genes simultaneously. A significative association between isolate resistances to tetracyclines and macrolides and the resistance genes tested was established, except for phenicol resistance and the fexA gene. A set of 14 multiresistance patterns were obtained according to the number of antimicrobials to which the isolates were resistant, the resistances to 12 or more agents being the most prevalent ones. A remarkable amount of multiresistance profiles could be seen among the S. suis serotype 9 isolates.

Cognitive biases are associated with clinical and functional variables in psychosis: A comparison across schizophrenia, early psychosis and healthy individuals

Objective: We investigated the presence of cognitive biases in people with a recent-onset psychosis (ROP), schizophrenia and healthy adolescents and explored potential associations between these biases and psychopathology.MethodsThree groups were studied: schizophrenia (N=63), ROP (N=43) and healthy adolescents (N=45). Cognitive biases were assessed with the Cognitive Biases Questionnaire for Psychosis (CBQ). Positive, negative and depressive symptoms were assessed with the PANSS and Calgary Depression Scale (ROP; schizophrenia) and with the CAPE-42 (healthy adolescents). Cannabis use was registered. The association between CBQ and psychopathology scales was tested with multiple linear regression analyses.ResultsPeople with schizophrenia reported more cognitive biases (46.1±9.0) than ROP (40±5.9), without statistically significant differences when compared to healthy adolescents (43.7±7.3). Cognitive biases were significantly associated with positive symptoms in both healthy adolescents (Standardized β=0.365, p=0.018) and people with psychotic disorders (β=0.258, p=0.011). Cognitive biases were significantly associated with depressive symptoms in healthy adolescents (β=0.359, p=0.019) but in patients with psychotic disorders a significant interaction between schizophrenia diagnosis and CBQ was found (β=1.804, p=0.011), which suggests that the pattern differs between ROP and schizophrenia groups (positive association only found in the schizophrenia group). Concerning CBQ domains, jumping to conclusions was associated with positive and depressive symptoms in people with schizophrenia and with cannabis use in ROP individuals. Dichotomous thinking was associated with positive and depressive symptoms in all groups.ConclusionsCognitive biases contribute to the expression of positive and depressive symptoms in both people with psychotic disorders and healthy individuals. (AU)

Objetivo: Investigamos la presencia de sesgos cognitivos en personas con psicosis de reciente comienzo (ROP), esquizofrenia y adolescentes sanos, y exploramos las asociaciones potenciales entre estos sesgos y la psicopatología.MétodosSe estudiaron tres grupos: esquizofrenia (N=63), ROP (N=43) y adolescentes sanos (N=45). Los sesgos cognitivos se evaluaron utilizando Cognitive Biases Questionnaire for Psychosis (CBQ). Los síntomas positivos, negativos y depresivos se evaluaron utilizando las escalas PANSS and Calgary Depression Scale (ROP; esquizofrenia) y CAPE-42 (adolescentes sanos). Se registró el consumo de cannabis. La asociación entre CBQ y las escalas de psicopatología se probó utilizando un análisis de regresión lineal múltiple.ResultadosLas personas esquizofrénicas reportaron más sesgos cognitivos (46,1±9) que las personas con ROP (40±5,9), sin diferencias estadísticamente significativas en la comparación con los adolescentes sanos (43,7±7,3). Los sesgos cognitivos se asociaron significativamente a los síntomas positivos, tanto en adolescentes sanos (β=0,365 estandarizada; p=0,018) como en personas con trastornos psicóticos (β=0,258; p=0,011). Los sesgos cognitivos se asociaron significativamente a síntomas depresivos en adolescentes sanos (β=0,359; p=0,019), pero en pacientes con trastornos psicóticos se encontró una interacción significativa entre diagnóstico de esquizofrenia y CBQ (β=1,804; p=0,011), lo cual sugiere que el patrón difiere entre los grupos de ROP y esquizofrenia (solo se encontró asociación positiva en el grupo de esquizofrenia). En cuanto a los dominios de CBQ, el adoptar conclusiones se asoció a síntomas positivos y depresivos en las personas esquizofrénicas y que consumen cannabis en los individuos con ROP. El pensamiento dicótomo se asoció a síntomas positivos y depresivos en todos los grupos. (AU)

Cognitive biases are associated with clinical and functional variables in psychosis: A comparison across schizophrenia, early psychosis and healthy individuals.

OBJECTIVE: We investigated the presence of cognitive biases in people with a recent-onset psychosis (ROP), schizophrenia and healthy adolescents and explored potential associations between these biases and psychopathology. METHODS: Three groups were studied: schizophrenia (N=63), ROP (N=43) and healthy adolescents (N=45). Cognitive biases were assessed with the Cognitive Biases Questionnaire for Psychosis (CBQ). Positive, negative and depressive symptoms were assessed with the PANSS and Calgary Depression Scale (ROP; schizophrenia) and with the CAPE-42 (healthy adolescents). Cannabis use was registered. The association between CBQ and psychopathology scales was tested with multiple linear regression analyses. RESULTS: People with schizophrenia reported more cognitive biases (46.1±9.0) than ROP (40±5.9), without statistically significant differences when compared to healthy adolescents (43.7±7.3). Cognitive biases were significantly associated with positive symptoms in both healthy adolescents (Standardized ß=0.365, p=0.018) and people with psychotic disorders (ß=0.258, p=0.011). Cognitive biases were significantly associated with depressive symptoms in healthy adolescents (ß=0.359, p=0.019) but in patients with psychotic disorders a significant interaction between schizophrenia diagnosis and CBQ was found (ß=1.804, p=0.011), which suggests that the pattern differs between ROP and schizophrenia groups (positive association only found in the schizophrenia group). Concerning CBQ domains, jumping to conclusions was associated with positive and depressive symptoms in people with schizophrenia and with cannabis use in ROP individuals. Dichotomous thinking was associated with positive and depressive symptoms in all groups. CONCLUSIONS: Cognitive biases contribute to the expression of positive and depressive symptoms in both people with psychotic disorders and healthy individuals.

Candidate HPV genotypes not included in the 9-valent vaccine for prevention of CIN 2-3.

OBJECTIVES: To identify the prevalence of human papillomavirus genotypes - as a single infection or co-infection - not included in the 9-valent (9v) HPV vaccine among women with cervical intraepithelial neoplasia (CIN 2-3). METHODS: Retrospective study of 1700 women referred due to abnormal cytology to Sant Joan de Deu Hospital. We selected 849 patients with CIN 2 or CIN 3 diagnosis confirmed by biopsy. An HPV test, a second cytology, and colposcopy were performed on all patients.Those with abnormal colposcopy underwent cervical biopsy. Patients with abnormal cytology and normal colposcopy or transformation zone type 3 underwent endocervical curetage. Conization was performed if punch biopsy or endocervical curetage confirmed CIN 2-3 or if a CIN 1 lesion persisted (diagnosed by biopsy) over 2 years in patients over 25 years of age. Comparisons for qualitative variables were analyzed with the chi-squared test. Analysis of variance was used for comparisons involving more than two samples. RESULTS: HPV was detected in 746 of 849 patients (87.9%) and in 306 (41%) of those where more than one HPV genotype was present. The more frequent genotypes detected as single infection were: HPV-16 (267/849%-31.4%), HPV 31 (34/849-4%), HPV-33 (20/849%-2.4%), HPV-58 (17/849%-2%), HPV-51 (15/849%-1.8%), and HPV-53 (12/849%-1.4%). The more frequent genotypes isolated including multiple HPV infection were HPV-16 (427/849%-50.2%), HPV-31 (108/849%-12.7%), HPV-51 (79/849%-9.3%), HPV-33 (67/849%-7.8%), HPV-58 (67/849%-7.8%), and HPV-52 (59/849%-6.9%). In total, 78% of women diagnosed with CIN 2 or CIN 3 had an infection by a HPV genotype included in the 9v vaccine. Of the 849 women diagnosed with CIN 2 or CIN 3, 103 (12.1%) tested negative for HPV and 106 (12.4%) tested positive for low-risk HPV types. CONCLUSIONS: Inclusion of HPV-51, 53, 66, and 35 in a new vaccine may not be advisable as most are detected as coinfection with other high-risk genotypes that are already included in the current vaccines.

La interdisciplinariedad: una vía para la formación integral de los estudiantes de administración y economía de la salud / Interdisciplinarity: way for the integral formation of the administration students and economy of the health

Las condiciones históricas concretas que vive el mundo contemporáneo están marcadas de complejos procesos de cambios, transformaciones y reajustes sociales. Estos nuevos problemas y fenómenos científicos son irreducibles a una estricta posición disciplinaria, es un principio presente en la ciencia moderna lo que permite demostrar la necesidad de desarrollar un trabajo científico–metodológico interdisciplinario en el perfil de administración y economía del primer año en la disciplina de bioestadística e investigación en salud, que beneficiará la formación profesional con una visión interdisciplinaria de los estudiantes de este perfil. En este trabajo, se ilustra la definición de interdisciplinariedad abordadas por varios autores, los aspectos didácticos para establecer la interdisciplinariedad, así como las ventajas del trabajo científico-metodológico con enfoque interdisciplinario en el colectivo de año (AU)