El papel del Hospital Universitario de Navarra y su liderazgo en el Plan de Contingencia de hospitales de la red pública y privada de Navarra en relación con la enfermedad por COVID-19 / The role of the University Hospital of Navarra and its leadership in the Plan of Public network hospital contingency and private company of Navarra in relation to the COVID-19 disease

Los modelos de atención se modificaron y adaptaron de forma constante en respuesta al diferente carácter de cada ola (diferente perfil de pacientes, integrar atención no COVID-19,necesidad e impacto posterior de la vacunación, protección del paciente vulnerable e inmunodeprimido...), y también a las incorporación de las herramientas disponibles (mayor disponibilidad de equipos de protección individual, disponibilidad de test diagnósticos y optimización del tiempo de resultado, mayor evidencia en tratamientos, incremento de la posibilidadde proveer soporte respiratorio, gestión de información y predicción de escenarios, posibilidad de integrar la asistencia con otros niveles: atención primaria, hospitales privados, atención sociosanitaria, etc.(AU)

[The professional in emergency care: aggressiveness and burnout]. / El profesional en urgencias y emergencias: agresividad y burnout.

Violence against professionals and the syndrome of burnout, or the professional exhaustion of health personnel, has acquired enormous significance in recent years, especially in emergency care. Only a small proportion of the aggressions against the health personnel come to light, but there is a great volume of submerged violent incidents that are not recorded anywhere. Protocols and registers of aggressions have been created in different autonomous communities to make precise data available so that more suitable and opportune decisions can be taken. The aggressions suffered by the workers fall within a wide range of risks that affect the safety and health of health workers, who are already subjected to high stress that lead to high levels of professional exhaustion (burnout). On the other hand, "burnt-out professionals", with their attitudes at work, increase the risk of aggressions against themselves and against their colleagues. The priorities of the health authorities include not only offering a quality service to all the users of the health system, but also ensuring that every health professional can work in optimum working conditions, with suitable levels of satisfaction, motivation and safety.

Dermatoglyphic anomalies and neurocognitive deficits in sibling pairs discordant for schizophrenia spectrum disorders.

The neurodevelopmental hypothesis of schizophrenia suggests that adverse genetic loading in conjunction with environmental factors early in fetal life causes a disruption of neural development, decades before the symptomatic manifestation of the disease. Neurocognitive deficits have been observed early on the course of schizophrenia, and their association with an early developmental brain lesion has been postulated. Dermatoglyphics have been analyzed in schizophrenia as markers of prenatal brain injury because of their early fetal ontogenesis and susceptibility to the same environmental factors that can also affect cerebral development. The aim of our study was to conduct a comparative examination of neurocognitive functions and dermatoglyphic variables in 89 sibling pairs discordant for schizophrenia spectrum disorders. Therefore, we investigated the association between these two markers to explore the prenatal origin of cognitive deficits in schizophrenia. The affected siblings were significantly impaired on all the cognitive variables assessed (Wisconsin Card Sorting Test, Trail Making Test and Continuous Performance Test) and had a greater number of dermatoglyphic anomalies. These results suggest the influence of intrauterine environmental factors in the siblings affected with schizophrenia. However, we did not detect a significant association between these two vulnerability markers in the schizophrenic patients, suggesting the role of genetic or late environmental factors in the origin of the neurocognitive deficits found in these patients.

Duration of untreated psychotic illness: the role of premorbid social support networks.

BACKGROUND: A lengthy delay often exists between the onset of psychotic symptoms and the start of appropriate treatment. However, the causes of this long delay remain poorly understood, and there is a need to search for the factors involved in such a delay in order to reduce the time of untreated psychosis. This study aimed at examining the influence of premorbid social networks on the duration of untreated psychotic illness. METHOD: One hundred subjects with a first episode of schizophrenia or related psychotic disorders never treated with antipsychotics made up the study sample. Social support was assessed by means of the Sturtees's social support scale that comprises two subscales measuring close and diffuse social support. Duration of untreated illness was assessed according to three definitions: duration of untreated unspecific symptoms, duration of untreated psychotic symptoms, and duration of untreated continuous psychotic symptoms. We also examined the effect of putative confounding factors such as gender, residence (urban-rural), age at illness onset, years of education, and parental socio-economic status. RESULTS: Correlational analysis showed that poor diffuse social support, but not poor close social support, predicted long duration of untreated illness according to the three definitions; this association being mainly due to poor work/academic support. Logistic regression analysis confirmed such an association, but it was limited to duration of continuous psychotic symptoms (unadjusted OR=3.44, 95% CI=1.51-7.83); this association persisted after adjusting for the confounding variables (adjusted OR=3.39, 95% CI=1.39-8.29). We also found that subjects with low socio-economic status were depending on the definition of duration of untreated illness considered, between 2.7 and 4.3 times more likely to present with a long duration of untreated illness. CONCLUSION: Both poor diffuse social support and a low socio-economic status seem to be relevant factors of a prolonged duration of untreated psychosis.

New evidence of association between COMT gene and prefrontal neurocognitive function in healthy individuals from sibling pairs discordant for psychosis.

OBJECTIVE: Using a sample of sibling pairs discordant for psychosis, the authors attempted to replicate the findings of previous studies suggesting that the functional genetic polymorphism Val158Met in the catechol O-methyltransferase (COMT) gene influences prefrontal cognitive function and increases the risk for schizophrenia. METHOD: Eighty-nine sibling pairs discordant for psychosis were genotyped for this polymorphism and were assessed with the Wisconsin Card Sorting Test, a measure of prefrontal function. Additionally, the preferential transmission of alleles for this polymorphism was analyzed in a sample of 89 nuclear families in order to examine the genetic association. RESULTS: In the healthy siblings, a linear relationship was seen in which performance on the Wisconsin Card Sorting Test was associated in an allele dosage fashion with COMT genotype (i.e., fewer perseverative errors with higher number of methionine alleles). However, this association was not observed in patients. Furthermore, no evidence of genetic association with psychosis was detected. CONCLUSIONS: These results seem to confirm the role of COMT genotype in the modulation of executive functions related to frontal lobe function in healthy individuals but not in schizophrenia patients.

Interleukin-1beta (IL-1beta) gene and increased risk for the depressive symptom-dimension in schizophrenia spectrum disorders.

Interleukin-1beta (IL-1beta), as well as other cytokines, has been classically implicated in the pathophysiology of major psychiatric disorders such as schizophrenia and major depression, and recent studies have implicated the IL-1beta gene and schizophrenia. Nevertheless, new approaches to this complex phenotype are necessary to clarify the risk conferred by this gene, either to the disorder or to its clinical manifestations. The aim of the present study was to explore the effect of a genetic polymorphism of the promoter region of the IL-1beta gene, in schizophrenia defined with: (i) a categorical diagnosis and (ii) a multidimensional symptom approach. We studied 356 individuals from 89 nuclear families consisting of one affected individual and the unaffected father, mother, and sib, in a family-based association study design. We find a trend for biased transmission of allele 2 from heterozygous parents to affected offspring, categorically defined (P = 0.07). This tendency was not observed in the healthy offspring. Using a multidimensional symptom approach to the diagnosis, the association was confirmed in psychotic patients showing the depressive symptom-dimension (P = 0.02).