ABSTRACT
Anxiety disorders affect up to 50% of individuals with autism spectrum disorder (ASD) and are significantly impairing to the person affected, as well as to their loved ones. Cognitive-behavioral therapy (CBT) has been established as the gold-standard treatment for anxiety disorders among typically developing youth and adults, and demonstrates similar efficacy among youth with high-functioning autism (HFA). Many CBT interventions utilize a "full-package" treatment approach to treat co-occurring anxiety in youth with ASD. However, these service delivery systems are often therapist-intensive, costly, and impractical, thereby compromising full engagement and treatment adherence. This paper describes the design, rationale, and methodology of a study examining stepped-care CBT for youth with HFA and co-occurring anxiety - a clinical trial examining the efficacy of low-intensity, parent-led CBT as the first line of treatment and utilizing a more intensive, therapist-led intervention for nonresponders. The study will evaluate the potential benefits of stepped-care and parent-led therapist-assisted interventions, predictors of treatment response, and the economic value of using a stepped-care model. Implications for practice will be discussed.
Subject(s)
Humans , Adolescent , Adult , Autistic Disorder , Autism Spectrum Disorder , Anxiety/therapy , Anxiety Disorders/therapy , Parents , Treatment Outcome , CognitionABSTRACT
RESUMEN: Introducción: La Reforma de Salud del 2005 estableció la mediación como un procedimiento obligatorio para la justicia civil, con el objeto de evitar la judicialización de la salud. Esta investigación ahonda en las características de las mediaciones odontológicas del sistema público de salud en Chile. Material y Método: Estudio transversal, de mediaciones generadas por atenciones odontológicas otorgadas en el sistema público de salud entre los años 2005 y 2015 informadas por Unidad de Mediación del Consejo de Defensa del Estado (CDE). Resultados: No se dispone de anterior al año 2010 por falta de registro. Por tanto, solo fue factible analizar desde 2010 al 2015. Se registran 127 mediaciones ingresadas odontológicas, el 61% reclamantes son mujeres. 60,6% proviene de la atención secundaria. 83,4% (106 casos) el reclamo es contra el establecimiento y el tratante. Sólo el 22% logra acuerdo. De estos, el 10% solo requiere explicaciones y solo el 28,5% solicita indemnización. Conclusiones: Una mejor relación profesional-paciente disminuye el riesgo de judicialización, así como una mejor difusión del procedimiento de mediación aumentaría tasa de acuerdos.
ABSTRACT: Introduction: The 2005 Health Reform established mediation as a mandatory procedure for civil justice, in order to avoid prosecution of health. This research delves into the characteristics of the dental mediations of the Chilean public health system. Material and method: Cross-sectional study of mediations generated by dental care granted in the public health system between 2005 and 2015, reported by the Mediation Unit of the State Defense Council (CDE). Results: Not available prior to 2010 due to the lack of registration. Therefore, an analysis was only feasible from 2010 to 2015. There are 127 dentistry mediations registered, 61% of the claimants are women. 60.6% come from secondary care. 83.4% (106 cases) the claim is against the establishment and the practitioner. Only 22% achieve agreement. Of these, 10% only require explanations and only 28.5% ask for compensation. Conclusions: A better professional-patient relationship reduces the risk of prosecution, and a better dissemination of the mediation procedure would increase agreement rate.
Subject(s)
Humans , Male , Female , Public Health , Public Health Dentistry , Dental Care , Negotiating , Compensation and Redress , Health's Judicialization , Cross-Sectional StudiesABSTRACT
Objective: a study was conducted to evaluate two sources of omega-3 (n-3) fatty acid enrichment, namely a trout by-product meal (TBPM) and tuna fish oil (TFO), as potential sources for egg yolk n-3 enrichment. Methods: Seventy-27 week old commercial layers were assigned to each of seven dietary treatments, as follows. Group 1: control; group 2: 5% TBPM; group 3: 10% TBPM; group 4: 15% TBPM; group 5: 20% TBPM; group 6: 2% TFO; and group 7: 3% TFO. The experimental diets were fed for 28 days. Results: no effect on production parameters was caused by the experimental diets. All diets containing TBPM or TFO significantly (p<0.05) increased n-3 egg yolk fatty acid content. Dietary levels of 5-20% TBPM increased egg yolk n-3 content between 1.97 and 3.54 times compared with control eggs. TFO levels of 2% and 3% increased the n-3 egg yolk content 3.37 and 4.13 times, respectively, compared with control eggs. The n-6/n-3 ratio in egg yolk lipids was significantly (p<0.05) decreased by the experimental diets. The n-6/n-3 ratio in control eggs was 16.79 compared with ratios ranging from 4.34 to 8.11 in enriched eggs. Conclusions: the results showed that both TBPM and TFO are good sources of n-3 fatty acid enrichment in eggs. Further studies are required in order to determine the effects of TBPM and TFO inclusion on the organoleptic quality of eggs.
Objetivo: se realizó un estudio para evaluar dos potenciales fuentes de enriquecimiento de ácidos grasos omega-3 (n-3) en yema de huevo: ensilaje de vísceras de trucha (TBPM) y aceite de atún (TFO). Métodos: un total de 70 gallinas de postura de 27 semanas se asignaron a siete tratamientos dietarios, así: grupo 1: control; grupo 2: 5% TBPM; grupo 3: 10% TBPM; grupo 4: 15% TBPM; grupo 5: 20% TBPM; grupo 6: 2% TFO y grupo 7: 3% TFO. Las dietas experimentales se suministraron durante 28 días. Resultados: no se encontraron efectos sobre los parámetros productivos a causa de las dietas experimentales, pero todas las dietas suplementadas con TBPM o TFO causaron un aumento significativo (p<0.05) en el contenido de n-3 de la yema. La suplementación de 5-20% de TBPM causó un incremento de n-3 de 1.97 a 3.54 veces, comparado con el contenido de n-3 de los huevos control. La suplementación de 2% y 3% de TFO incrementó en contenido de n-3 en 3.37 y 4.13 veces, respectivamente. La relación n-6/n-3 en los lípidos de la yema aumentó significativamente en las dietas experimentales siendo esta relación de 16.79 en los huevos control y de 4.34-8.11 en los huevos de gallinas suplementadas con las fuentes de n-3. Conclusiones: los resultados del presente estudio demuestran que tanto el TBPM como el TFO constituyen fuentes apropiadas de enriquecimiento de huevos con ácidos grasos n-3. Se requieren más estudios para determinar los efectos de estas materias primas en la calidad organoléptica del huevo.
Objetivo: Foi realizado um estudo para avaliar duas fontes potenciais de enriquecimento de ômega-3 (n-3) na gema de ovo: silagem de vísceras de truta (TBPM) e óleo de atum (TFO). Métodos: Um total de 70 galinhas poedeiras de 27 semanas, foram atribuídas a sete tratamentos dietéticos: grupo 1: controle, grupo 2: 5%TBPM, grupo 3: 10% TBPM, grupo 4: 15% TBPM, grupo 5: 20% TBPM, grupo 6: 2% TFO e grupo 7: TFO 3%. As dietas experimentais foram subministradas durante 28 dias. Resultados: Não foram encontradas diferencias nos parâmetros de produção por causa das dietas experimentais, mas todas as dietas suplementadas com TFO ou TBPM causaram um aumento significativo (p<0.05) no conteúdo de n-3 da gema. A suplementação de 5-20% de TBPM causou um aumento de n-3 de 1.97 a 3.54 vezes, em comparação com o conteúdo de n-3 do controle. A suplementação de 2% e 3% de TFO aumentou o conteúdo de n-3 em 3.37 e 4.13 vezes, respectivamente. A relação n-6/n-3 nos lipídios da gema aumentou significativamente nas dietas experimentais, sendo esta relação de 16.79 nos ovos do controle e de 4.43 a 8.11 em ovos de galinha suplementados com fontes de n-3. Conclusões: Os resultados deste estudo demonstram que o TFO e o TBPM são fontes apropriadas de enriquecimento de ovos com n-3 ácidos graxos. Mais estudos são necessários para determinar os efeitos dessas matérias primas na qualidade organoléptica do ovo.