Gender differences in adolescents with suicidal behaviour: Personality and psychopathology / Diferencias de género en adolescentes con conducta suicida: Personalidad y psicopatología

This study evaluates the relationship between gender, personality, psychopathology and suicidal behaviour among adolescents. For this purpose, across-sectional study with adolescent inpatients (N = 92) displaying suicidal behaviour was designed. Sociodemographic characteristics and datarelated to suicidal behaviour were collected. In addition, personality and clinical severity were assessed by administering the Millon Adolescent Clinical Inventory (MACI). Results revealed that the most prevalent personality dimensions for both genders were Introversive, Self-demeaning, Doleful,Oppositional, Borderline tendency and Inhibited. However, men scored higher in Inhibited (p = 0.02, Cohen’s d = 0.45) and women in Egotistic(p = 0.03, Cohen’s d = 0.40). Concerning clinical severity of syndromes, women scored higher in Delinquent Predisposition (p = 0.04, Cohen’sd = 0.45) and men in Anxious Feelings (p = 0.02, Cohen’s d = 0.51), Depressive Affect (p = 0.04, Cohen’s d = 0.41) and Suicidal Tendency (p= 0.03, Cohen’s d = 0.37), with men reporting more frequently Childhood Abuse (p < 0.001, Cohen’s d= 0.70). Results highlight the importanceof universal interventions to promote a change in attitudes towards seeking psychological help, specially in men, and the need to designeffective tailored treatments to acquire emotional management skills for both genders. (AU)

Este estudio evalúa la relación entre el género, lapersonalidad, la psicopatología y la conducta suicida entre los adolescentes. Para ello, se diseñó un estudio transversal con adolescentes hospitalizados (N = 92) que presentaban conductas suicidas. Se recogieron características sociodemográficas y datos relacionados con la conductasuicida. Además, se evaluó la personalidad y la gravedad clínica mediante la administración del Inventario Clínico de Adolescentes de Millon (MACI).Los resultados revelaron que las dimensiones de personalidad más prevalentes para ambos géneros fueron Introversivo, Auto-punitivo, Pesimista,Oposicionista, Tendencia límite e Inhibido. Sin embargo, los hombres puntuaron más alto en Inhibido (p = 0,02, d de Cohen = 0,45) y las mujeresen Egocéntrica (p = 0,03, d de Cohen = 0,40). En cuanto a la gravedad clínica de los síndromes, las mujeres puntuaron más alto en PredisposiciónDelictiva (p = 0,04, d de Cohen = 0,45) y los hombres en Sentimientos Ansiosos (p = 0,02, d de Cohen = 0. 51), Afecto Depresivo (p = 0,04, dde Cohen = 0,41) y Tendencia Suicida (p = 0,03, d de Cohen = 0,37), y los hombres informaron con mayor frecuencia de Abuso en la Infancia(p < 0,001, d de Cohen = 0,70). Los resultados ponen de manifiesto la importancia de las intervenciones universales para promover un cambiode actitud hacia la búsqueda de ayuda psicológica, especialmente en los hombres, y la necesidad de diseñar tratamientos eficaces a medidapara adquirir habilidades de gestión emocional para ambos géneros. (AU)

El proceso de divulgación de la donación y el trasplante del siglo XXI: experiencia en redes sociales de «Coordinación Sectorial de Trasplantes de Sevilla-Huelva» / The donation and transplant divulgation process of 21st century: Social media experience from «Coordinación Sectorial de Trasplantes de Sevilla-Huelva»

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Intensivista o coordinador de trasplantes: tanto monta monta tanto / Intensivist or transplant coordinator: It makes no difference

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Análisis de pacientes con diabetes tipo 2 en un centro de salud urbano. Estudio DESENROQUE / Analysis of patients with type 2 diabetes in an urban Primary Healthcare centre. DESENROQUE Study

OBJETIVOS: Analizar el estado de salud de los pacientes con diabetes tipo 2 (DM2) en un centro de salud urbano y valorar el seguimiento realizado por parte de los profesionales sanitarios. Analizar las terapias farmacológicas en pacientes con DM2, así como valorar la individualización atendiendo a sus comorbilidades. MATERIAL Y MÉTODOS: Análisis descriptivo y transversal de pacientes con DM2. De un total de 920 pacientes se obtuvo una muestra aleatorizada y simple de 460 individuos, de los cuales se recogieron los parámetros relacionados con las comorbilidades asociadas y el tratamiento integral de la DM2. RESULTADOS: Nos encontramos ante una muestra de 460 pacientes (42,4% mujeres) con una edad media de 67,1 años (DE=13,07). El valor medio de su última HbA1c fue 6,75% (DE=1,24). El 83,7% cumplía con los objetivos individualizados propuestos de HbA1c atendiendo a su edad y comorbilidades. El 65,43% de los pacientes contaba con un seguimiento subóptimo por parte de los profesionales sanitarios. Con respecto a la adecuación del tratamiento, el 19,8% contaba con asociaciones farmacológicas no recomendadas o fármacos aplicados fuera de ficha técnica. El 74,3% contaba con un tratamiento integral de la DM2 mejorable. CONCLUSIONES: Aunque el 83,7% de los pacientes presentaba un buen control de la HbA1c, el tratamiento es glucocéntrico y mejorable en un alto porcentaje de los pacientes (74,3%). Dado que la terapia debe ajustarse a las necesidades de cada paciente, y siendo el IMC un factor determinante para la selección del tratamiento, llama la atención que en el 44,13% de los pacientes no esté registrado en su historia clínica

OBJECTIVES: To determine the health status of patients with type 2 diabetes (T2D) in an urban Primary Healthcare centre, and to assess the follow-up carried out by health professionals. To analyse the pharmacological treatment in patients with T2D, as well as to assess the individualisation according to their comorbidities. MATERIAL AND METHODS: Descriptive and cross-sectional analysis conducted on patients with DM2. Out of a total of 920 patients, a randomised and simple sample of 460 individuals was obtained, from which the parameters related to associated comorbidities and the integral treatment of T2D were collected. RESULTS: The study included 460 patients (42.4% women) with a mean age of 67.1 years (SD=13.07). The mean value of their last HbA1c was 6.75% (SD=1.24). The large majority (83.7%) fulfilled the proposed individualised HbA1c objectives according to their age and comorbidities. Approximately two-thirds (65.43%) of patients had a suboptimal follow-up by health professionals. As regards the suitability of the treatment, 19.8% had non-recommended pharmacological combinations or drugs applied outside the indications of the data sheet. A comprehensive T2D treatment that could be improved was observed in 74.3%. CONCLUSIONS: Although 83.7% of patients had good control of HbA1c, the treatment is centred on blood glucose and improvable in a high percentage of patients (74.3%). Given that the therapy must be adjusted to the needs of each patient, and since the BMI (body mass index) is a determining factor for the selection of treatment, it is striking that it is not recorded in the clinical histories of 44.13% of the patients

[Analysis of patients with type 2 diabetes in an urban Primary Healthcare centre. DESENROQUE Study]. / Análisis de pacientes con diabetes tipo 2 en un centro de salud urbano. Estudio DESENROQUE.

OBJECTIVES: To determine the health status of patients with type 2 diabetes (T2D) in an urban Primary Healthcare centre, and to assess the follow-up carried out by health professionals. To analyse the pharmacological treatment in patients with T2D, as well as to assess the individualisation according to their comorbidities. MATERIAL AND METHODS: Descriptive and cross-sectional analysis conducted on patients with DM2. Out of a total of 920 patients, a randomised and simple sample of 460 individuals was obtained, from which the parameters related to associated comorbidities and the integral treatment of T2D were collected. RESULTS: The study included 460 patients (42.4% women) with a mean age of 67.1 years (SD=13.07). The mean value of their last HbA1c was 6.75% (SD=1.24). The large majority (83.7%) fulfilled the proposed individualised HbA1c objectives according to their age and comorbidities. Approximately two-thirds (65.43%) of patients had a suboptimal follow-up by health professionals. As regards the suitability of the treatment, 19.8% had non-recommended pharmacological combinations or drugs applied outside the indications of the data sheet. A comprehensive T2D treatment that could be improved was observed in 74.3%. CONCLUSIONS: Although 83.7% of patients had good control of HbA1c, the treatment is centred on blood glucose and improvable in a high percentage of patients (74.3%). Given that the therapy must be adjusted to the needs of each patient, and since the BMI (body mass index) is a determining factor for the selection of treatment, it is striking that it is not recorded in the clinical histories of 44.13% of the patients.

Personality traits, theory of mind and their relationship with multiple suicide attempts in a sample of first episode psychosis patients: One-year follow-up study.

BACKGROUND: High rates of suicidal behaviour (SB) have been found in first episode psychosis (FEP) patients. It has been suggested that the presence of multiple suicide attempts (mSA) increases the risk of later SA and the risk of eventual death by suicide. OBJECTIVE: Our main objective was to study the baseline factors associated with the presence of mSA during the first year after FEP. In addition, a second aim was to find out whether there were any differences between single and multiple suicide attempters in the timing of the first SA after FEP. METHOD: A total of 65 FEP patients were evaluated. The presence of SAs were recorded at two different times after FEP. Bivariate and multivariate analyses were performed to explore the relationship between SA with sociodemographic and clinical variables. RESULTS: Multiple linear regression showed that mSA was associated with the presence of increased symptom severity (B = 0.35; t = 3.67; p < 0.01) and errors in first-order false-belief task (B = 0.48; t = 2.11; p = 0.04). There were significant differences in the timing of first SA after FEP between multiple and single suicide attempters. CONCLUSIONS: Theory of mind impairments along with more severe symptoms during the first contact with mental health services for psychotic symptoms appeared to be important predictors of mSA. On the other hand, multiple suicide attempters tend to make a first SA after FEP earlier than single suicide attempters. These results could contribute to the implementation of preventive suicidal programs, however they must be confirmed by additional research.

Perfiles psicológicos del adolescente con conducta suicida / Psychological profiles of adolescents with suicidal behavior

La necesidad de prevenir muertes evitables y contener el impacto emocional que genera la conducta suicida requiere de estudios que permitan entender mejor el fenómeno, con el fin de incrementar la eficacia de las estrategias preventivas e interventivas. Clasificar la conducta suicida permitiría un mejor abordaje de esta problemática tan heterogénea, con influencias culturales, evolutivas y de género. Este trabajo pretende describir diferentes perfiles psicológicos prototípicos del adolescente con conducta suicida, a partir de una propuesta de clasificación ya existente que se amplía con otras variables clínicas de relevancia. Para ello, se diseñó un estudio transversal descriptivo-correlacional con pacientes de entre 8-17 años, visitados en Urgencias por conducta suicida entre noviembre del 2013 y diciembre del 2014. Los datos se obtuvieron a partir de entrevistas clínicas. La propuesta de clasificación mostró que los adolescentes del grupo I, el más prevalente (60%), se caracterizaron por presentar mayor prevalencia de rasgos desadaptativos de personalidad, trastorno de conducta, más ingresos hospitalarios y autolesiones y la mitad de ellos presentaron antecedentes de conducta suicida. Los del grupo II (30%), presentaron mayor prevalencia de trastornos del estado de ánimo. El grupo III (10%), mostró un alto porcentaje de tentativas autolíticas (>75%) respecto a otras conductas suicidas, identificando los conflictos relacionales como desencadenantes más frecuentes. La obtención de estos perfiles prototípicos y sus correspondientes características clínicas y psicopatológicas, permite sugerir diferentes procesos de tratamiento ajustados a cada uno de los procesos descritos

The need to prevent avoidable deaths and to contain the emotional impact of suicidal behavior requires studies to better understand the phenomenon and to increase the effectiveness of prevention and intervention strategies. Suicidal behavior has a very heterogeneus characterization, which is influenced by cultural, evolutionary, and gender features, and its classification could facilitate a better approach to this problem. This study was intended to describe the different prototypical psychological profiles of the adolescent with suicidal behavior, based on an existing classification proposal that is extended with other relevant clinical variables. A cross-sectional and descriptive design was employed in a sample of patients between 8-17 years old attended in a pediatric emergency unit between November 2013 and December 2014. Data was collected by means of semistructured interviews. The classification showed that adolescents in group I, the most prevalent (60%), were characterized by a higher prevalence of maladaptive personality traits, behavioral disorders, more mental health hospital admissions, self-harm behaviors, and half of them had a history of previous suicidal behavior. Those in group II (30%) had a higher prevalence of mood disorders. Group III (10%) showed a high percentage of autolysis attempts (>75%) when compared to other type of suicidal behavior, identifying relational conflicts as the most frequent triggers. To obtain these prototypic profiles and their corresponding clinical and psychopathological characteristics in the study sample suggests different treatments tailored to each specific profile

Pulsión y objeto en la transferencia narcisista. Presentación teórico-clínica / Drive and objetal in the narcissitic transference

El presente trabajo realiza un desarrollo teórico del concepto de transferencias narcisistas a través del análisis de la dinámica de la pulsión de meta inhibida y de la pulsión que busca su descarga en el objeto. Muestra cómo dichas pulsiones intervienen en el balance entre libido del yo, narcisista y libido de objeto. Describe cómo éstas intervienen en la elección y relación de objeto y cómo se traducen en la relación analítica expresándose por medio de la transferencia. Partiendo de postulados freudianos, se destaca la utilidad de plantear el concepto de transferencias narcisistas como herramienta teórica y clínica, basándose en los aportes de varios autores representativos: H.Kohut, B. Grunberger, J. Bergeret y O. Kernberg. Los conceptos teóricos que se describen se ilustran con un caso clínico de una paciente adulta en análisis (AU)

This paper deals with the theoretic study of the concept of narcissistic transference through the analysis of the dynamics of the goal inhibited drive as well as through the study of the drive that looks for discharge in the object. It shows how these drives mediate in the balance between the libido of the narcissistic ego and the libido of the object. The study describes how these drives mediate in the election of the object, and in the object relationship. Also, it shows how they manifest themselves in the transference. From the Freudian postulates, it outstands the concept of narcissistic transference as a basic tool, both theoretically as well as clinically, based on the contributions of a group of representative authors: H. Kohut, B. Grunberger, J. Bergeret and O. Kernberg. The theoretical concepts described are exemplified with a clinical case of an adult patient in analysis (AU)

Prevalencia de la depresión en pacientes con artritis reumatoide o espondilitis anquilosante / Prevalence of depression in patients with rheumatoid arthritis or ankylosing spondylitis

Objetivo: Estudiar la frecuencia de depresión en pacientes con artritis reumatoide y espondilitis anquilopoyética.Pacientes y métodos: Estudio transversal. Se estudiaron 164 pacientes con artritis reumatoide, 44 con espondilitis anquilopoyética y 143 controles vistos consecutivamente durante un año. Todos rellenaron los ítems del cuestionario Zung-Conde para el diagnóstico de la depresión, considerándose con depresión aquéllos cuya puntuación era mayor o igual a 48, normales si era menor o igual a 32 y como estado intermedio entre 33 y 47. Las medias de las puntuaciones en los tres grupos se compararon entre sí mediante el test de la t de Student.Resultados: En las artritis reumatoide, espondilitis anquilopoyética y grupo control, los resultados fueron, respectivamente: 19 por ciento, 32 por ciento y 59 por ciento normales; 43 por ciento, 50 por ciento, 35 por ciento en un estadio intermedio; 38 por ciento, 32 por ciento y 6 por ciento depresivos. La media de puntuación fue para la artritis reumatoide, espondilitis anquilopoyética y controles de 44ñ12,9 (rango 20-75); 39ñ9,6 (rango 20-59) y 31ñ9,5 (rango 20-61 ), respectivamente, con una p<0,001 para la artritis reumatoide y espondilitis anquilopoyética frente al grupo control.Conclusiones: Los pacientes con artritis reumatoide y espondilitis anquilopoyética padecen depresión con mayor frecuencia que la población general (AU)

Factors influencing the return to work of patients after hip replacement and rehabilitation.

OBJECTIVE: To determine the incidence of medical and sociocultural factors on the return to work of patients after hip replacement and rehabilitation treatment. DESIGN: Case review. Frequency and association of variables' analysis. SETTING: The rehabilitation unit of a general hospital in Oviedo (Spain). This setting is a part of an institutional referral center and is the only state-owned hospital that provides rehabilitation treatment for hospitalized patients from a rural and urban area of about 1,000,000 inhabitants. PATIENTS: 747 patients of both sexes, all of them working before receiving treatment, age range 18 to 64 years. MAIN OUTCOME MEASURES: Relationship of several variables: age, sex, habitat, level of education, type of work, underlying illness, walking ability, pain, and type of social security versus return to work. RESULTS: At discharge, 25% of patients return to work. There is a significant association (p < .001) between return to work and any of the following variables: underlying illness, kind of work, walking ability, habitat, and educational level. CONCLUSION: This physiopathology of symptoms and signs of the patients is not the unique indicator of whether a person will continue working after hip replacement and rehabilitation treatment. Extramedical factors, such as social status, kind of work, and cultural background, are very influential.

Diagnostic value of the blind brush in mechanically ventilated patients with nosocomial pneumonia.

OBJECTIVES: To check on the accuracy of a new protected blind brush (BB) inserted through an endotracheal tube to collect respiratory secretions to be used in the diagnosis of nosocomial pneumonia (NP) in ventilated patients. DESIGN: Prospective study of patients who had undergone both BB and plugged telescoping catheter via fiberoptic bronchoscopy (PTC-FB) sample collection sessions. SETTING: Intensive Care Unit of a referral-based University Hospital. PATIENTS: All patients (n = 37) mechanically ventilated for more than 3 days with clinical and radiological criteria of NP between July 1990 and March 1991. INTERVENTIONS: Randomized BB and PTC-FB sample collection sessions carried out less than 30 min apart. MEASUREMENTS AND MAIN RESULTS: The two sampling procedures resulted in similar findings with both cultures either negative or positive and identified the same organism and colonies in 31 patients (83.7%). Agreement was 90% when the patients with right or bilateral pulmonary infiltrates were grouped together and 100% when only the right field was considered. Complications arising from BB sampling were much lower than those from the conventional PTC-FB technique. CONCLUSIONS: Our results, pending confirmation by other prospective studies, indicate that BB sampling is useful in the diagnosis of NP in ventilated patients with radiological evidence of either right or bilateral pulmonary infiltrates and that it could stand in for PTC-FB in ICU settings where this procedure is not available.