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Suicide is a leading cause of preventable death worldwide. Evidence supports the impact of providing active contact for individuals who have attempted suicide. The current systematic review and meta-analyses aim to investigate the effects of suicide prevention strategies implemented through remote and synchronous technology-based interventions.
Systematic review, narrative synthesis and meta-analysis.
Electronic databases (PubMed, PsycINFO, Scopus and Web of Science) and grey literature sources (ClinicalTrials.gov and Google Scholar) were searched until December 2024.
Eligible articles assessed suicide prevention interventions for participants over 12 years with prior suicidal behaviour. Eligible study designs included randomised controlled trials and non-randomised clinical trials published in English or Spanish.
Screening, selection process, data extraction and risk of bias assessment were performed independently by two reviewers. Data on suicide-related factors and adherence to treatment were extracted. Meta-analyses were conducted to determine effect sizes (Hedges’ g) for suicidal ideation, risk ratios (RR) for suicide attempts and Peto odds ratios (OR) for suicide. Heterogeneity was assessed using the Cochrane’s Q test, tau2 statistic and I2 value. Publication bias was investigated employing funnel plots and Egger’s test.
A total of 28 studies, comprising 10 015 participants in the intervention group and 10 726 in the comparison group, were included in the systematic review and meta-analyses. Synchronous remote-based interventions were effective in preventing repeated suicide attempts at 1 month (RR 0.73, 95% CI 0.62 to 0.85, I2=0.0%, Q=0.70, tau2=0.00), 6 months (RR 0.56, 95% CI 0.34 to 0.95, I2=85.4%, Q=54.92, tau2=0.36) and 12 months (RR 0.68, 95% CI 0.49 to 0.96, I2=87.6%, Q=72.63, tau2=0.27). Additionally, these interventions were associated with a reduction in suicide-related deaths at 18 months (Peto OR 0.18, 95% CI 0.08 to 0.44, I2=0.0%, Q=0.03, tau2=0.00). Effects on suicidal ideation were not statistically significant at any time point (Hedges’ g –0.07 to –0.28, I2=0.0 to 69.3%, Q=1.16 to 7.38, tau2=0.00 to 0.14).
Synchronous remote-based interventions demonstrate a potential benefit in preventing suicide attempts and deaths by suicide and may serve as an adjunct to usual treatment; however, the effect on suicidal ideation appears limited. The observed heterogeneity warrants caution when interpreting these findings. Future research should prioritise methodological enhancements to improve the quality and consistency of evidence, as well as investigate the mediating processes underlying their effectiveness in reducing suicidal behaviour.
CRD42021275044.
To evaluate how insurance influences the risk of a dementia diagnosis among a large, diverse cohort of US civilian adults with traumatic brain injury (TBI) over a 22-year period.
This is a retrospective cohort study involving individuals diagnosed with TBI.
The study used the Merative MarketScan Research Database, specifically drawing from the Commercial Claims and Encounters, Medicare Supplemental and Medicaid databases, from 2000 to 2022 in the USA. These databases provide comprehensive insights into healthcare services received by enrollees, including inpatient and outpatient services, outpatient prescription claims, clinical utilisation records and healthcare expenditures.
267 473 adults aged 55 and older who were diagnosed with a TBI between 1 January 2000 and 31 December 2022. Individuals with unknown TBI severity and dementia claims 2 years preceding TBI were excluded. TBI and dementia diagnoses were identified using International Classification of Disease 9th and 10th editions codes from inpatient and outpatient admission records.
None.
We compared the incidence of all-cause dementia across different insurance types to assess potential disparities in diagnosis following TBI. Cox proportional hazards models, with age as the time scale, were used to study the association between insurance type and dementia diagnosis following a TBI. Models were adjusted for key demographic variables, medical comorbidities and psychiatric conditions to account for potential confounding.
Of the 267 473 individuals with TBI, 12.7% were diagnosed with dementia over a mean follow-up period of 40 months (SD of 42 months). Dementia incidence differed significantly by insurance type, with 18.2% for Medicaid recipients, 17.3% for Medicare beneficiaries and only 2.3% among individuals with commercial insurance. The adjusted HR for dementia was notably higher among individuals enrolled on Medicaid (HR 2.9, 95% CI: 2.8 to 3.1) and Medicare (HR 2.1, 95% CI: 2.0 to 2.2), when compared with those with commercial insurance.
Individuals with TBI covered by Medicaid and Medicare are significantly more likely to be diagnosed with dementia, with a 2.9-fold and 2.1-fold increase risk, respectively, compared with those with commercial insurance. Addressing insurance-related disparities in dementia diagnosis is crucial for building a more equitable healthcare system. It is essential that individuals with TBI cases, regardless of their insurance type, have access to comprehensive care and preventive interventions to achieve the best possible long-term outcomes.
The aim of this study was to evaluate the effects of a high-capillarity dressing on chronic wound healing, using hyperspectral imaging to assess biophysical parameters. This quasi-experimental pilot study involved eight adults with chronic ulcers treated with the high-capillarity dressing for 4 weeks. Primary outcomes included pH, temperature, and oxygen saturation, measured using hyperspectral imaging, along with wound area assessed with ImageJ. Secondary outcomes included quality of life, evaluated using the EQ-5D-5L and Wound QoL-17 scales. Data were collected at baseline, 7, 14, and 21 days, and analysed using SPSS. Results showed a significant reduction in lesion size (p < 0.05) and pain (p < 0.001) following treatment. Biophysical assessments revealed a significant decrease in pH (p = 0.004), but no significant changes were observed in other parameters (oxygen saturation, NIR, TWI, TLI). A significant correlation was found between oxygen saturation and pH (p < 0.005). The results suggest that the high-capillarity dressing improves chronic wound healing by reducing lesion size, promoting pH acidification, and improving superficial oxygenation. Additionally, the dressing controlled edema and eliminated infection signs without antibiotics, suggesting its potential in optimising the wound healing environment. These findings highlight the need for further research into the clinical application of this dressing in chronic wound management.
Introducción. Las relaciones durante la infancia/adolescencia son fundamentales para la construcción psíquica. La familia y el colegio son inicialmente los medios de socialización donde la calidad de la experiencia relacional predetermina un modelo futuro. Las dificultades en el ámbito relacional tienen una repercusión en la salud mental de los menores. Existe un incremento de las conductas conflictivas e inhibidas en el alumnado, al igual que un aumento en prevalencia de trastornos psiquiátricos, siendo necesaria una evaluación de los recursos. Metodología. Este estudio cuasi-experimental unicéntrico, pre-post sin grupo control, tipo longitudinal de carácter prospectivo tiene como objeto evaluar los cambios en el desempeño del rol de padres y las habilidades de interacción social y resiliencia personal de la población atendida en la Unidad Terapéutica Educativa de Ortuella, desde una perspectiva enfermera, durante un curso escolar. La prueba Kolmogorov-Smirnov o Shapiro-Wilk determinará si la distribución de la variable es normal. Se utilizará la t de Student para muestras pareadas o Wilcoxon cuando la distribución de la variable no fuese normal y McNemar para comparación de proporciones, con un intervalo de confianza del 95%, considerándose significativo una p<0.05. Utilidad práctica. Los resultados permitirán comprobar si la permanencia de un curso escolar en la Unidad Terapéutica Educativa se relaciona con una mejora de las variables a estudio.
ABSTRACT
Introduction. Relationships during childhood/adolescence are fundamental for the psyche construction. The family and the school are the initial means of socialization and it is there where the quality of the relational experience predetermines a future model. Difficulties in the relational sphere have an impact on the mental health of minors. There is an increase in conflictive and inhibited behaviors in students, as well as an increase in the prevalence of psychiatric disorders, making an evaluation of resources necessary. Methodology. This unicentric quasi-experimental study, pre-post without control group, longitudinal type of prospective nature, aims to evaluate the changes in the performance of the parental role and the social interaction skills and personal resilience of the population served in the Educational Therapeutic Unit of Ortuella, from a nursing perspective, during a school year. The Kolmogorov-Smirnov or Shapiro-Wilk test will determine whether the distribution of the variable is normal. Student's t test will be used for paired samples or Wilcoxon when the distribution of the variable is not normal and McNemar for comparison of proportions, with a confidence interval of 95%, with p<0.05 being considered significant. Utility in practice. The results will allow us to verify whether the permanence of a school year in the Educational Therapeutic Unit is related to an improvement in the variables under study.
Objetivo. Analizar factores relacionados con la conducta suicida en pacientes con enfermedad mental para orientar la prevención y cuidados de salud mental especializados. Material y métodos. Estudio descriptivo transversal de una muestra de 44 pacientes hospitalizados por conducta suicida en psiquiatría. Durante 12 meses se registraron variables sociodemográficas y clínicas, se aplicaron la escala Columbia de cribado del riesgo suicida, la de Desesperanza de Beck, la de Impulsividad de Plutchik y el Inventario de Razones para Vivir. Se usó estadística descriptiva e inferencial para una significación estadística de p<0,05. Resultados. El 84% (n=37) presentó ideación suicida, el 63,3% (n=28) tentativa y el 2,3% (n=1) suicidio consumado. Realizaron más intentos previos las mujeres (60%/n=15) que los hombres (38%/n=7). La intoxicación medicamentosa fue el método más utilizado por ambos sexos seguido de autolesiones por mujeres (p<0,05) y precipitación por hombres (p<0,05). La depresión, trastorno más prevalente, se asoció a la edad y al medio rural (p<0,05). El trastorno de ansiedad fue el más predictivo para la intención/plan y tentativas suicidas (p<0,05). El 80% (n=16) de los intentos padecía enfermedad médica (p<0,05). Se evidenció la relación inversa entre las creencias de supervivencia/afrontamiento y la conducta suicida. Discusión. La conducta suicida supone más del 20% de los ingresos de una unidad psiquiátrica. No es posible determinar un perfil único de riesgo, se han evidenciado diferencias según el espectro suicida. Todos los factores relacionados deben ser valorados.
ABSTRACT
Objective. To analyze factors related to suicidal behavior in patients with mental illness to guide prevention and specialized mental health care. Methodology. A descriptive cross-sectional study carried out in a sample of 44 inpatients at a psychiatric unit who attempted suicide. Sociodemographic and clinical variables were registered during 12 months. The scales applied were the Columbia-Suicide Severity Rating Scale (C-SSRS), Beck Hopelessness Scale, Plutchik’s Impulsivity Scale and the Reasons for Living Inventory. A descriptive and inferential statistic has been applied for a statistical significance of p<0,05. Results. 84% (n=37) had suicidal thinking, 63,3% (n=28) attempted suicide and 2,3% (n=1) committed suicide. More women (60%; n=15) than men (38%; n=7) attempted suicide. Medication overdose was the main suicidal approach by both sexes followed by self-harm by women (p<0,05) and deliberate fall by men (p<0,05). Depression, the most prevalent disorder, was associated with age and rural environment (p<0,05). Anxiety had the highest predictive value of suicidal attempt (p<0,05). 80% (n=16) of those who attempted suicide suffered from a medical illness (p<0,05). There is evidence of inverse relationship between the survival and coping beliefs and the suicidal behaviour. Discussion. Suicidal behaviour surpasses 20% of the admissions at a psychiatric unit. It is not possible to determine a specific risk profile as differences according to the suicidal spectrum have been acknowledged. Every possible cause must be evaluated.
La histeroscopia es un procedimiento con finalidad terapéutica y de diagnóstico, permitiendo una visión directa de la cavidad uterina. Es relativamente sencillo pero no exento de complicaciones. La solución más comúnmente utilizada para la distensión es glicina 1.5% debi-do a su baja viscosidad, bajo costo, transparencia y compatibilidad con electrocirugía. Una de las complicaciones más temidas durante la cirugía histeroscópica es hemodilución por absorción de medios de distensión. Presentamos el caso de una mujer de 64 años, con ab-sorción excesiva de glicina durante una histeroscopia. Destacamos la importancia de una vigilancia continua y una comunicación efectiva entre el equipo quirúrgico: ginecólogo, anestesiólogo y equipo de enfermería. Sin duda, esto nos permite identificar los factores de riesgo que pueden prevenir la absorción intraoperatoria de estos fluidos, así como establecer un diagnóstico temprano y aplicar un tratamiento oportuno y eficaz para minimizar complicaciones.
La histeroscopia es un procedimiento con finalidad terapéutica y de diagnóstico, permitiendo una visión directa de la cavidad uterina. Es relativamente sencillo pero no exento de complicaciones. La solución más comúnmente utilizada para la distensión es glicina 1.5% debi-do a su baja viscosidad, bajo costo, transparencia y compatibilidad con electrocirugía. Una de las complicaciones más temidas durante la cirugía histeroscópica es hemodilución por absorción de medios de distensión. Presentamos el caso de una mujer de 64 años, con ab-sorción excesiva de glicina durante una histeroscopia. Destacamos la importancia de una vigilancia continua y una comunicación efectiva entre el equipo quirúrgico: ginecólogo, anestesiólogo y equipo de enfermería. Sin duda, esto nos permite identificar los factores de riesgo que pueden prevenir la absorción intraoperatoria de estos fluidos, así como establecer un diagnóstico temprano y aplicar un tratamiento oportuno y eficaz para minimizar complicaciones.
Objetivo principal: El objetivo perseguido en esta investigación es estudiar la relevancia y características de la administración oral de fármacos, y sus implicaciones para los cuidados de enfermería, buscando aumentar la seguridad y efectividad de la misma. Metodología: Realizamos un estudio descriptivo en un servicio de medicina interna, concretamente de 194 episodios de ingreso correspondientes al año 2014. A continuación, se analizaron los principios activos y formas farmacéuticas más empleados por vía oral, revisando en la evidencia científica cuáles de ellos requerían recomendaciones especiales para garantizar la seguridad y eficacia en su administración. Resultados principales: La mayoría de los principios activos empleados poseen recomendaciones especiales, y se cometen errores e interacciones significativas como consecuencia de no aplicarlas. Conclusión principal: La administración de medicamentos oral entraña una serie de características, en la que los cuidados de enfermería, permiten al profesional garantizar que un proceso interdisciplinario como el tratamiento farmacológico, conduzca a una administración personalizada, segura y eficaz.
Rev Enferm;41(3): 210-216, mar. 2018. graf. [Artículo]
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