Evaluation of the Community Support Programme applied at the Intensive Psychiatric Rehabilitation Unit at the Parc Sanitari Sant Joan de Déu, Sant Boi

Introduction

Our hospital has chosen a model that goes beyond long-term hospital inpatient care to a community support for people with severe and persisting mental illnesses. This programme is called Community Support Programme (CSP) and focuses mainly on connecting patients who are being discharged from long-term hospitalization to a community based rehabilitation service.

Objectives

To evaluate the effectiveness of the CSP among people with severe and persisting mental illness, as a method to support the positive outcomes and reduce the use of hospital resources after a discharge.

Methods

This is a retrospect, observational descriptive study. We reviewed 55 cases between 2017 and May of 2021. We analyzed demographic information, diagnosis, duration of stay in the CSP, number of hospitalizations before and after the program, number of emergency visits before and after this program and what kind of community rehabilitation services are connected after the discharge.

Results

We found 58,2% male and 41,8% female. The main diagnoses were schizophrenia; schizoaffective and bipolar disorder. Before the CSP 85.4% of the patients had been hospitalized, and 76% had attended in a psychiatric emergency unit. After the discharge 36,36% required hospitalization, and 40% visited the psychiatric emergencies units. 54,54% of patients didn’t require hospital resources after their discharge from CSP.

Conclusions

The results suggest that the CSP helps to avoid hospitalization, reduce the use of hospital resources and drop outs. It helps the transition from hospitalization to a community based rehabilitation service.

Disclosure

No significant relationships.

Towards a European health research and innovation cloud (HRIC)

The European Union (EU) initiative on the Digital Transformation of Health and Care (Digicare) aims to provide the conditions necessary for building a secure, flexible, and decentralized digital health infrastructure. Creating a European Health Research and Innovation Cloud (HRIC) within this environment should enable data sharing and analysis for health research across the EU, in compliance with data protection legislation while preserving the full trust of the participants. Such a HRIC should learn from and build on existing data infrastructures, integrate best practices, and focus on the concrete needs of the community in terms of technologies, governance, management, regulation, and ethics requirements. Here, we describe the vision and expected benefits of digital data sharing in health research activities and present a roadmap that fosters the opportunities while answering the challenges of implementing a HRIC. For this, we put forward five specific recommendations and action points to ensure that a European HRIC: i) is built on established standards and guidelines, providing cloud technologies through an open and decentralized infrastructure; ii) is developed and certified to the highest standards of interoperability and data security that can be trusted by all stakeholders; iii) is supported by a robust ethical and legal framework that is compliant with the EU General Data Protection Regulation (GDPR); iv) establishes a proper environment for the training of new generations of data and medical scientists; and v) stimulates research and innovation in transnational collaborations through public and private initiatives and partnerships funded by the EU through Horizon 2020 and Horizon Europe.

Human newborn natural killer cell responses to activation by monoclonal antibodies. Effect of culture with herpes simplex virus

Deficient responses by NK cells may contribute to the susceptibility of human newborns to severe HSV infections. Furthermore, HSV disseminates widely during neonatal infection and may also infect and interfere with the function of blood mononuclear cells (MNC). To determine whether the function of newborn NK cells would be affected by contact with HSV, and whether newborn NK cells might be permissive for HSV replication, newborn MNC were cultured with HSV in vitro for 3 days. Before culture, the intracellular calcium mobilization in newborn NK cells induced by mAb to CD2 and CD16 did not differ from that of adult NK cells. This result argues against immaturity of an early NK cell activation event in human newborns. After culture with HSV the Ca2+ flux response was unaffected by lysis of K562 targets by newborn NK cells and NK-dependent suppression of HSV replication in fibroblasts were preserved or increased. Incorporation of thymidine by NKH-1 cells following stimulation with PHA and IL-2 was not suppressed. NK cells recovered from these cultures did not contain infectious HSV and synthesis of HSV-specific proteins was not detected by immunoprecipitation although HSV genome was detected by DNA hybridization. Our results extend the in vitro model stimulation systems in which newborn NK cells respond positively to include triggering through the CD2 Ag, cross-linking of cell surface CD 16 Ag and response to a pathogen, HSV.

Human newborn natural killer cell responses to activation by monoclonal antibodies. Effect of culture with herpes simplex virus

Deficient responses by NK cells may contribute to the susceptibility of human newborns to severe HSV infections. Furthermore, HSV disseminates widely during neonatal infection and may also infect and interfere with the function of blood mononuclear cells (MNC). To determine whether the function of newborn NK cells would be affected by contact with HSV, and whether newborn NK cells might be permissive for HSV replication, newborn MNC were cultured with HSV in vitro for 3 days. Before culture, the intracellular calcium mobilization in newborn NK cells induced by mAb to CD2 and CD16 did not differ from that of adult NK cells. This result argues against immaturity of an early NK cell activation event in human newborns. After culture with HSV the Ca2+ flux response was unaffected by lysis of K562 targets by newborn NK cells and NK-dependent suppression of HSV replication in fibroblasts were preserved or increased. Incorporation of thymidine by NKH-1 cells following stimulation with PHA and IL-2 was not suppressed. NK cells recovered from these cultures did not contain infectious HSV and synthesis of HSV-specific proteins was not detected by immunoprecipitation although HSV genome was detected by DNA hybridization. Our results extend the in vitro model stimulation systems in which newborn NK cells respond positively to include triggering through the CD2 Ag, cross-linking of cell surface CD 16 Ag and response to a pathogen, HSV.

Non-productive infection of human newborn blood mononuclear cells with herpes simplex virus: effect on T cell activation, IL-2 production and proliferation

Proliferative responses by T cells from newborn cord blood stimulated with PHA or CD3 were reduced following infection with live (but not killed) herpes simplex virus in vitro although activation (measured by calcium flux) and IL-2 production were unaffected. The impairment of proliferation was not reversed by exogenous IL-2, phosphonoacetic acid, indomethacin or anti-alpha or anti-gamma interferon antibodies. HSV DNA was detected by hybridization in DNA extracted from unseparated MNC and from subsets sorted for CD3+ and for HLA DR+ expression. HSV DNA replication was not detected by thymidine uptake and only small amounts of virus were recovered in an infectious centre assay, suggesting that infection was non-permissive. Nevertheless, in-vitro synthesis of a limited range of HSV proteins including ICP4 was detected by metabolic labelling.

Specific lysis of varicella zoster virus-infected B lymphoblasts by human T cells

Epstein-Barr virus-transformed human B cells expressed cell surface varicella-zoster virus (VZV) antigens after superinfection with VZV although they did not form infectious centers in a plaque assay. The VZV-superinfected cells were lysed by autologous VZV-stimulated T-cell lines and their derivative clones. The effector cells were specific for VZV and an HLA DR antigen and were T4+. The specificity of lysis of Epstein-Barr virus-transformed, VZV-superinfected targets by prestimulated mononuclear cells in this system contrasted with the unrestricted lysis seen when the targets were VZV-infected fibroblasts.

Serum pseudocholinesterase activity during experimental fattening

The exact role of serum pseudocholinesterase (PSCE) is not known. Its main role probably consists in the degradation of butyril-choline, an intermediate of lipid metabolism. Decreased values have been described in liver cirrhosis as an index of diminished proteosynthetic function. An increased activity of this enzyme was reported in obesity, diabetes mellitus, nephrosis, hyperthyroidism and in hyperlipemic subjects without obesity. A significant correlation was found between serum cholesterol, triglycerides and PSCE, as an expression of lipid metabolism. In view of assessing the possible change of this enzyme during fattening, the authors investigated PSCE activity during fattening in pigs (the same breed). The results indicate a statistically significant increase of PSCE during fattening, from 30.4 +/- 1.7 to 43.6 +/- 1.7 (p less than 0.001). These results together with those reported in a previous paper concerning blood lipids and cholesterol, show a positive correlation between these parameters and PSCE during fattening in pigs, which might be due to an adaptative increase of the hepatic synthesis of this enzyme in response to the increased lipid metabolism.