Áreas de mejora en el manejo clínico de la depresión: perspectiva de pacientes, familiares y profesionales / Areas for improvement in the management of depression: perspectives of patients, families and professionals

Introducción. Actualmente existe consenso en que la atención a la depresión requiere entender las experiencias, expectativas y preferencias de los pacientes e incorporar la visión de los profesionales implicados en su manejo. El objetivo de este estudio fue explorar y comparar las perspectivas de pacientes, familiares y profesionales respecto de las principales áreas de mejora de la práctica clínica de la depresión. Material y métodos. Se realizaron 4 grupos focales (2 con pacientes con depresión mayor, uno con familiares y uno con profesionales). Para la captación de los participantes se contó con la colaboración del Servizo Galego de Saúde y de la Federación de Asociaciones de Familiares y Personas con Enfermedad Mental. El contenido de las transcripciones se analizó temáticamente. Resultados. Se identificaron 5 temas principales y 18 subtemas: los retos diagnósticos, la necesidad de un abordaje integral, las mejoras en la coordinación y seguimiento, el establecimiento de un espacio y relación terapéutica adecuados y, por último, el impacto del estigma. Los pacientes, familiares y profesionales aportaron información parcialmente coincidente y complementaria sobre estos temas principales. Conclusiones. El manejo de la depresión es una labor compleja que requiere la puesta en marcha de medidas de diferente naturaleza. Incorporar las perspectivas de los principales agentes implicados es fundamental y se hace patente la necesidad de seguir trabajando en modelos de atención a la depresión que optimicen las experiencias de los pacientes y que tengan en cuenta sus preferencias y expectativas (AU)

Introduction. There is currently a consensus that depression care requires understanding the experiences, expectations, and preferences of patients, and incorporating the views of the professionals involved in its management. The aim of this study was to explore and compare the perspectives of patients, families, and health professionals on the main areas for improvement in the clinical practice of depression. Material and methods. Four focus groups were performed (2 with patients with major depression, one with family members, and one with professionals). Participants were recruited with the collaboration the Galician Health Service and the Federation of Associations of Relatives and Persons with Mental Disease. The content of the transcripts were analysed thematically. Results. Five themes and 18 sub-themes emerged, including, diagnostic challenges, the need for a comprehensive approach, improvements in the coordination and monitoring, the establishment of an adequate relationship and therapeutic space and, finally, the impact of stigma. Patients, families and professionals provided partially overlapping and complementary information on these main themes. Conclusions. The management of depression is a complex task, which requires the implementation of measures of a different nature. The incorporation of the perspectives of key stakeholders is essential and it is necessary to continue working on models of care for depression that optimise the experiences of patients, and take into account their preferences and expectations (AU)

[Areas for improvement in the management of depression: perspectives of patients, families and professionals]. / Áreas de mejora en el manejo clínico de la depresión: perspectiva de pacientes, familiares y profesionales.

INTRODUCTION: There is currently a consensus that depression care requires understanding the experiences, expectations, and preferences of patients, and incorporating the views of the professionals involved in its management. The aim of this study was to explore and compare the perspectives of patients, families, and health professionals on the main areas for improvement in the clinical practice of depression. MATERIAL AND METHODS: Four focus groups were performed (2 with patients with major depression, one with family members, and one with professionals). Participants were recruited with the collaboration the Galician Health Service and the Federation of Associations of Relatives and Persons with Mental Disease. The content of the transcripts were analysed thematically. RESULTS: Five themes and 18 sub-themes emerged, including, diagnostic challenges, the need for a comprehensive approach, improvements in the coordination and monitoring, the establishment of an adequate relationship and therapeutic space and, finally, the impact of stigma. Patients, families and professionals provided partially overlapping and complementary information on these main themes. CONCLUSIONS: The management of depression is a complex task, which requires the implementation of measures of a different nature. The incorporation of the perspectives of key stakeholders is essential and it is necessary to continue working on models of care for depression that optimise the experiences of patients, and take into account their preferences and expectations.

Management of obstructive salivary disorders by sialendoscopy: a systematic review.

Our aim was to assess the effectiveness and safety of sialendoscopy as a diagnostic and therapeutic technique in the management of obstructive salivary disorders. We searched the following databases: MEDLINE, EMBASE, ISI Web of Knowledge, The Cochrane Library, and the National Health Service Centre for Reviews and Dissemination (up to April 2014). References from the studies included and from review articles were scanned. A study was eligible for inclusion if it was a fully published peer-reviewed report with original data, if participants included adult patients with obstructive disease of the major salivary glands, if the outcome variables gave information about the success rates of the procedure in terms of freedom from symptoms and absence of residual obstruction, and if the paper was published in English, French, Italian, Portuguese, or Spanish. The data were extracted and summarised in tables of evidence. We report weighted pooled proportions, 95% CI, and test results for heterogeneity. The weighted pooled proportion of success rates of the obstruction's resolution was 76% (95% CI 71 to 82) for 40 studies involving 2654 patients undergoing sialendoscopy alone, and 91% (95% CI 88 to 94) for the 23 studies and 1480 procedures made with sialendoscopy and a combined surgical approach. In general, few complications were reported and the rate of sialadenectomy was low (4.6%). This systematic review suggests that sialendoscopy is effective and safe for the diagnosis and treatment of patients with obstructive salivary gland disease.

Satisfacción y utilidad percibidas por pacientes y familiares acerca de la información sobre prevención de suicidio / Perceived satisfaction and usefulness of suicide prevention information for patients and relatives

Objetivo: Evaluar la satisfacción de personas con conducta suicida y de sus familiares con la información incluida en la «Guía de práctica clínica de prevención y tratamiento de la conducta suicida». Método: Los participantes fueron reclutados a través de un programa de prevención de suicidio (Programa de intervención intensiva en conducta suicida [PII]) y de una Asociación (Federación de Asociaciones de Familiares y Personas con enfermedad mental de Galicia [FEAFES]). Se diseñó un cuestionario ad hoc para conocer el grado de satisfacción y utilidad percibidas con la información incluida en la guía. Resultados: La muestra estuvo formada por 57 pacientes con ideación o conducta suicidas y 52 familiares. Los pacientes puntuaron significativamente más bajo que los familiares en las 2 dimensiones: formato y utilidad; sin embargo, no se encontraron diferencias significativas entre ambos grupos en el nivel de satisfacción general. Las variables sociodemográficas no influyeron en los resultados. Tampoco se encontraron diferencias entre pacientes con y sin antecedentes de conducta suicida. Conclusiones: En general, tanto pacientes como familiares mostraron un alto nivel de satisfacción con el documento. Los participantes destacaron la atención primaria como el ámbito más adecuado para la difusión de este tipo de información. Suministrar información de estas características a pacientes con ideación y/o conducta suicida podría actuar como herramienta preventivo-educativa (AU)

Objective: To assess the satisfaction of persons with suicidal behaviour and their relatives using patient information material included in the Clinical Practice Guidelines on Prevention and Treatment of Suicidal Behaviour. Method: The sample was made up of 57 patients with suicidal ideation or behaviour, and 52 relatives. The participants were recruited through a suicide prevention programme (Programa de intervención intensiva en conducta suicida [PII] - Suicidal Behaviour IntensiveIntervention Programme) and a family association (Federación de Asociaciones de Familiares y Personas con enfermedad mental de Galicia [FEAFES] - Galician Federation of Associations of Relatives and Persons with mental diseases). An ad-hoc questionnaire was designed to ascertain the degree of perceived satisfaction and usefulness of using the information included in the guidelines. Results: The descriptive data of the sample is presented, along with an exploratory factorial analysis of the questionnaire that yielded two dimensions, i.e., format and usefulness. Patients scored significantly lower than the relatives in two dimensions; nevertheless, no significant differences were found between the two groups in the level of general satisfaction. The sociodemographic variables did not influence the results. Similarly, no differences were observed between patients with and without history of suicidal behaviour. Participants stressed that Primary Care was the setting best suited for dissemination of this type of information. Conclusions: In general, both patients and relatives displayed a high level of satisfaction with the patient information material assessed. Furnishing information of this type to patients with suicidal ideation and/or behaviour could act as a preventive-educational tool (AU)

[Perceived satisfaction and usefulness of suicide prevention information for patients and relatives]. / Satisfacción y utilidad percibidas por pacientes y familiares acerca de la información sobre prevención de suicidio.

OBJECTIVE: To assess the satisfaction of persons with suicidal behaviour and their relatives using patient information material included in the Clinical Practice Guidelines on Prevention and Treatment of Suicidal Behaviour. METHOD: The sample was made up of 57 patients with suicidal ideation or behaviour, and 52 relatives. The participants were recruited through a suicide prevention programme (Programa de intervención intensiva en conducta suicida [PII] - Suicidal Behaviour Intensive Intervention Programme) and a family association (Federación de Asociaciones de Familiares y Personas con enfermedad mental de Galicia [FEAFES] - Galician Federation of Associations of Relatives and Persons with mental diseases). An ad-hoc questionnaire was designed to ascertain the degree of perceived satisfaction and usefulness of using the information included in the guidelines. RESULTS: The descriptive data of the sample is presented, along with an exploratory factorial analysis of the questionnaire that yielded two dimensions, i.e., format and usefulness. Patients scored significantly lower than the relatives in two dimensions; nevertheless, no significant differences were found between the two groups in the level of general satisfaction. The socio-demographic variables did not influence the results. Similarly, no differences were observed between patients with and without history of suicidal behaviour. Participants stressed that Primary Care was the setting best suited for dissemination of this type of information. CONCLUSIONS: In general, both patients and relatives displayed a high level of satisfaction with the patient information material assessed. Furnishing information of this type to patients with suicidal ideation and/or behaviour could act as a preventive-educational tool.

Preliminary genetic linkage map of Miscanthus sinensis with RAPD markers.

We have used an "offspring cross" mapping strategy in combination with the random amplified polymorphic DNA (RAPD) assay to construct the first genetic map of the species Miscanthus sinensis (2 n = 2 x = 38). This map is based on an outbred population of 89 individuals resulting from the cross between two genotypes from a previously designed cross. Consequently, both parents are fullsibs. The same proportion of bi-parental markers (heterozygotic in both parents) and pseudo-testcross markers (heterozygotic in one parent and null in the other), mono-parental markers, have been obtained. A total of 383 RAPD markers were analysed within the 89 F1 plants. Out of these markers, 257 were mapped into 28 linkage groups which spanned a total map length of around 1,074.5 cM with an average density of 4.2 cM per marker. Out of 257 mapped markers, 62 were inherited from F1.1 (P1), 63 from F1.7 (P7) and 132 were bi-parental markers. The contribution to the map was equal from both parents. This map provides a useful tool for genetic analyses of agronomically interesting characters in M. sinensis such as flowering, yield, plant height, stem diameter and mineral constitution. The offspring cross mapping strategy is proposed to obtain a higher efficiency in developing integrated maps including both parents.

Effect of streptozotocin-induced diabetes mellitus on serotonin measures of peripheral tissues in rats.

The present study was conducted to examine whether experimental diabetes (streptozotocin-induced) promotes changes in serotonin (5HT) measures of peripheral tissue. Platelet-free plasma 5HT, tryptophan and 5-hydroxyindolacetic acid (5HIAA), whole blood 5HT and renal, liver, intestinal and lung 5HT and 5HIAA levels were measured in rats of four experimental groups: control, diabetic, diabetic+insulin and non-diabetic+insulin. Several serotonin measures were unaltered in all four experimental groups, i.e. plasma, liver and lung 5HT and 5HIAA levels. Whole blood 5HT levels descended about 50% in diabetic rats, then recovered their proper levels after 1 week of insulin therapy. Diabetic animals had a significantly greater intestinal 5HT concentration (+50% versus control), while intestinal 5HIAA levels did not achieve statistical significance despite a -26% decrement in their value. Both renal 5HT and 5HIAA levels were decreased in diabetic animals and recovered with insulin therapy. Peripheral tissue 5HT measures were not varied by insulin administration to non-diabetic animals. The results are consistent with a 5HT release, which is diminished in enterochromaffin cells and enhanced in platelet concomitantly to a minor platelet 5HT uptake, for explaining alterations of plasma/blood 5HT measures in experimental diabetes, and with a diminished synthesis of 5HT for explaining renal changes.

Platelet serotonin transport is altered in streptozotocin-induced diabetic rats.

The present work was conducted to examine whether experimental diabetes (streptozotocin-induced) promotes changes in mean platelet volume, and platelet serotonin (5HT) uptake and content. These variables were measured in from four experimental groups: control, diabetic, diabetic+insulin, and non-diabetic+insulin. Animals treated fifteen days before with streptozotocin had platelets with higher 5HT uptake affinity, 5HT content, and volume. The insulin therapy reestablished the control values of all of these three variables. Non-diabetic animals treated one week with insulin did not show any variations. The effects of in vitro application of insulin, hyperglycaemic incubation medium, and streptozotocin on platelet amine uptake and release were also examined. Only those platelets incubated with streptozotocin showed an altered platelet 5HT uptake. No changes were observed for spontaneous 5HT release. The results are consistent with: a) an increase of platelet uptake capacity, as a consequence of an increase in platelet turnover, for explaining alterations of intraplatelet 5HT contents in experimental diabetes; b) a non-direct effect of insulin and glucose levels on platelet 5HT uptake -for explaining its dysfunctions in experimental diabetes-; c) the contribution of alterations in platelet 5HT transport for explaining the higher incidence of vascular complications in diabetic patients; d) the suitability of platelet as a model for investigating neuronal 5HT reuptake.

Melatonin effect on serotonin uptake and release in rat platelets: diurnal variation in responsiveness.

UNLABELLED: The present study was conducted to examine whether melatonin impairs serotonin (5HT) release and uptake in rat platelets. Exposure of platelet-rich plasma samples (PRP) to melatonin induced a concentration-dependent inhibition of 5HT uptake and the value of IC50 was 1.3 x 10(-3) M. We have also investigated the melatonin effect on the kinetic parameters of platelet 5HT uptake. Transport capacity was inhibited (Vmax; CONTROL: 2.28 +/- 0.52, Melatonin: 0.74 +/- 0.13 pmol/10(7) platelet.min; p < 0.05) while the affinity of 5HT for its uptake carriers remained unaltered, thus indicating a non-competitive effect. Studies carried out to determine the existence of a differential morning (8:00h)-evening (21:00h) melatonin effect showed a higher platelet uptake sensitivity at 8:00h (two-way ANOVA, p < 0.001). Spontaneous 5HT release was not impared by the hormone and no daily variation in sensitivity was detected. The possible mechanism of action of melatonin on platelet transport is discussed, and the results support the suitability of the platelet model for studying sensitivity changes in target cells to the hormone.

Brain tryptophan uptake and sodium-potassium ATPase activity in long-term streptozotocin diabetic rats.

Serum, liver and brain tryptophan concentrations and brain Na+K(+)-ATPase activity were studied in streptozotocin diabetic rats after an acute tryptophan load. Results show that tryptophan administration in the experimental diabetic group produces a generalized fall in tryptophan uptake in all the brain regions studied, though it does not increase serum and hepatic tryptophan concentrations. These parameters are normalized in insulin-treated diabetic rats. With regard to Na+K(+)-ATPase, diabetic animals showed a diminished and unchanged activity; whereas, the other two experimental groups showed a gradual decrease and a negative correlation with brain tryptophan uptake.

Rat blood and brain amino acid pattern in short term experimental diabetes.

Some serum and brain amino acid variations occurring in animals with short term streptozotocin-diabetes (24 h) are studied in this work. Diabetic animals showed an increase in serum of the three branched-chain amino acids as well as an increase in free tryptophan, besides a decrease in total serum tryptophan and in the tryptophan/competitor amino acids ratio. In brain, the three branched-chain amino acids increased, but there were no variation in whole brain tryptophan. Nevertheless, by studying levels of tryptophan in different brain regions, an increase in medulla-pons was recorded. This circumstance could be explained by the increase in free serum tryptophan levels, in agreement with several authors who assign this reason for brain tryptophan.

Effects of short term experimental diabetes on brain serotonin metabolism.

Serotonin metabolism was studied in several brain regions of control and Streptozotocin-treated male Wistar rats. After induction of diabetes, the animals were killed at 24 hours. Concentrations of brain tryptophan show a generalized increase in all brain regions, being only significant in medulla-pons. Serotonin levels do not change, while 5-HIAA concentrations, as well as the ratio 5-HIAA/5-HT, show significant increases in medulla-pons and mid-brain.