Promoting psychological well-being in preschool children: study protocol for a randomized controlled trial of a mindfulness- and yoga-based socio-emotional learning intervention.

BACKGROUND: Mental health issues in youths have cascading negative effects on school outcomes, professional life, and physical health. Psychological well-being (P-WB) is an important protective factor against mental illness. Preliminary research suggests that mindfulness- and yoga-based socio-emotional learning (SEL) interventions can each have a positive impact on preschoolers P-WB. The objective of this trial is to rigorously evaluate the effect of a 24-week combined mindfulness- and yoga- based SEL intervention in preschool children from a French socio-economically disadvantaged area. METHODS: The P-WB promotion intervention is compared to a wait-list control condition in a cluster randomized controlled trial (RCT). Sixty-four pre-Kindergarten classrooms are randomized to the intervention or control group. Primary outcomes measure self-management capacity and core P-WB components: connection, insight, engagement, and positive relationship. Secondary outcomes include measures of mental health, executive functioning, and school performance. Primary and secondary outcomes are assessed through teacher questionnaires, standardized observations of children in school context, and experimental tasks and by collecting results of the national evaluation at first grade. All children-level outcomes are evaluated at pre-intervention, at the end of the intervention, and 1 year later (follow-up analysis), to the exception of school performance which is evaluated at follow-up only. Intention-to-treat analyses, accounting for clustering within classes, will adopt a random effects linear regression model to examine outcomes for the intervention versus control children. DISCUSSION: This is the first trial to rigorously evaluate a combined mindfulness- and yoga-based P-WB promotion intervention, and the first RCT evaluating a SEL curriculum in French schools. Results may have key implications for P-WB promotion in preschool children. TRIAL REGISTRATION: https://www.drks.de/ DRKS00028623. Retrospectively registered on 30 May 2022.

Primer consenso cubano sobre el uso de terapia convencional y biológica en pacientes con artritis reumatoide / First Cuban consensus on the use of conventional and biological therapy in patients with rheumatoid arthritis

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Introduction: The development of recommendations for the treatment of rheumatoid arthritis (RA) in the Cuban context may be one of the ways to achieve better control of this disease. Objective: To reach a consensus and update relevant aspects of conventional and biological RA modifier therapy in Cuba. Methods: 18 specialists from 8 Cuban provinces, experts in RA care, were summoned, according to the years of dedication to the specialty, the conferences on this topic and their publications. The first meeting took place in March 2016 in the provincial hospital of Villa Clara, Cuba, with the participation of all the experts. A review of the literature on conventional and biological therapy previously collected by the participants was developed, and two teams were formed: the first would address everything related to conventional therapy in RA (HRCT) and the other, biological therapy in RA (TBAR). Three questionnaires related to the use of corticosteroids, HRCT and TBAR, were prepared, answered by the participants via email. In a second meeting, held in October 2016 in Havana, the analysis of all the responses provided was carried out. Questions with a response of 90% or more votes were considered as recommendations. Results: The questionnaires were answered by 95% of the participants. 9 recommendations and 1 algorithm were established. The recommendations are as follows: methotrexate is the drug of choice in the treatment of RA after diagnosis; The administration of another conventional drug (DMARDc) (azathioprine, salazosulfapyridine, antimalarials and leflunomide) is recommended in patients with a diagnosis of active RA in whom methotrexate is contraindicated or there is a failure in response - consider the administration of low doses of prednisone or equivalent (<7.5 mg/d) associated with DMARDc in patients with active moderate to severe RA, for the shortest possible time; perform serological control including tests for hepatitis B and C viruses and screening for HIV in all patients diagnosed with RA before starting treatment with DMARDc and biologics; in patients in remission or, at least, with a DAS-28 below 3.2, consideration should be given to withdrawing one of the DMARDs or reducing, to the minimum possible expression, the dose of both disease modifiers; if methotrexate fails, tocilizumab in combination with methotrexate or as monotherapy will be indicated. Conclusions: Aspects related to conventional therapy with methotrexate, azathioprine, salazosulfapyridine, antimalarials and leflunomide were agreed. The value of early diagnosis and immediate initiation of DMARDc therapy and the use of glucocorticoids was analyzed. Treatment with tocilizumab, the only biological available in Cuba against RA, will be administered when there is a failure in the response to conventional therapy and combinations between these drugs. It is recommended to hold educational conferences through the mass media aimed at patientshttp(AU)

[One homeless person out of ten suffers from cognitive disorders: What do we know about these impairments? A systematic review of homeless people's cognition]. / Une personne SDF sur 10 souffre de troubles cognitifs : que sait-on de ces troubles ? Une revue de littérature sur la cognition des personnes SDF.

OBJECTIVES: Homelessness is associated with several issues (psychiatric and neurological disorders, neurodevelopmental difficulties, malnutrition…) which are also risk factors for cognitive disorders. However, little is known about the relationship between the cognition of homeless people and these eventual explicative etiologies. The aim of this work is to complete the results of Depp et al. about cognition in homelessness by proposing a systematic review of the neuropsychological disorders of homeless people associated with an analysis of the etiologies likely to explain these disorders. METHODS: We followed the PRISMA recommendations to build up this work. We analyzed the abstracts of 385 papers found on databases PSYCINFO and PubMed. Twenty-two studies have been selected for respecting our criteria (at least one valid neuropsychological test ; general group of homeless people and not a sub-group of this population ; study published in English). The prevalence quality has been evaluated through the criteria of Loney et al. Cognitive scores and etiological factors have been compared between studies. RESULTS: The 22 studies represent only nine countries. More than half of them are considered as having a poor prevalence quality. In total, 4,256 participants have been evaluated. Their mean age was around 40 years, and 85 % of the participants were men. The results show a prevalence of cognitive disorders (MMSE) in 8.77 % of the sample. The mean IQ was 87.47 and the premorbid IQ 94.59. We also notice possible disorders affecting the episodic memory and the executive functions. Mean scores for short-term memory, speech and visuo-spatial functions are relatively low. None of the studies evaluated the praxia, the gnosia or the social cognition. The heterogeneity of studies and the lack of data did not allow us to give general conclusions about the etiology of these disorders. However, we see that around 40 % of the time subjects had histories of brain injuries and 89 % of childhood trauma. Intellectual disability is found in 49 % of the sample of a single study. Also, 70 % of the homeless population have been diagnosed with substance-related disorders and 65 % with psychiatric disorders. It appears that the only factors correlated with cognitive disorders would be the history of brain injuries and childhood traumas. CONCLUSIONS: We confirm that homeless people often suffer from cognitive difficulties, and some of these difficulties (memory, executive functioning) are severe. Yet the etiology of these disorders remain relatively unknown: even if we observe a high prevalence of psychiatric, substance-related, neurodevelopmental and neurological issues by the homeless population, only a few of them (brain injury history and childhood trauma) seem to be correlated with cognition in homelessness. The potential explicative factors have been too rarely explored to bring a powerful explanation of cognitive disorders in homeless people. Further research needs to be done in order to give a more precise neuropsychological profile of the homeless population and to better understand what the disorders are rooted in. Last but not least, all this research and knowledge should be applied more to the care of homeless people by providing neuropsychological assessment and rehabilitation and by training the team to detect cognitive disorders and to support the person with a cognitive disability.

Inhibition of PKC-dependent extracellular Ca2+ entry contributes to the depression of contractile activity in long-term pressure-overloaded endothelium-denuded rat aortas

We examined the contractile responsiveness of rat thoracic aortas under pressure overload after long-term suprarenal abdominal aortic coarctation (lt-Srac). Endothelium-dependent angiotensin II (ANG II) type 2 receptor (AT2R)-mediated depression of contractions to ANG II has been reported in short-term (1 week) pressure-overloaded rat aortas. Contractility was evaluated in the aortic rings of rats subjected to lt-Srac or sham surgery (Sham) for 8 weeks. ANG I and II levels and AT2R protein expression in the aortas of lt-Srac and Sham rats were also evaluated. lt-Srac attenuated the contractions of ANG II and phenylephrine in the aortas in an endothelium-independent manner. However, lt-Srac did not influence the transient contractions induced in endothelium-denuded aortic rings by ANG II, phenylephrine, or caffeine in Ca2+-free medium or the subsequent tonic constrictions induced by the addition of Ca2+ in the absence of agonists. Thus, the contractions induced by Ca2+ release from intracellular stores and Ca2+ influx through stored-operated channels were not inhibited in the aortas of lt-Srac rats. Potassium-elicited contractions in endothelium-denuded aortic rings of lt-Srac rats remained unaltered compared with control tissues. Consequently, the contractile depression observed in aortic tissues of lt-Srac rats cannot be explained by direct inhibition of voltage-operated Ca2+ channels. Interestingly, 12-O-tetradecanoylphorbol-13-acetate-induced contractions in endothelium-denuded aortic rings of lt-Srac rats were depressed in the presence but not in the absence of extracellular Ca2+. Neither levels of angiotensins nor of AT2R were modified in the aortas after lt-Srac. The results suggest that, in rat thoracic aortas, lt-Srac selectively inhibited protein kinase C-mediated activation of contraction that is dependent on extracellular Ca2+ entry.

Epilepsias benignas de la infancia: dificultades académicas y alteraciones comportamentales / Benign childhood epilepsies: academic difficulties and behavioural disorder

Introducción. Se han publicado artículos en los que se muestra que los pacientes pueden presentar trastornos del comportamiento y dificultad para el aprendizaje en las epilepsias benignas de la infancia (EBI). Objetivos. Hacer una revisión de los pacientes con diagnóstico de EBI en nuestro hospital e identificar si presentan dichas alteraciones. Pacientes y métodos. Revisión retrospectiva de las historias clínicas de los pacientes con diagnóstico de EBI. Se realizó electroencefalograma (EEG) o video-EEG-poligrafía de sueño a todos los pacientes. Para la valoración intelectual se utilizaron los tests de inteligencia para niños de Wechsler. Resultados. Se recogieron 102 pacientes con diagnóstico de EBI. El 51,6% de los pacientes con epilepsia rolándica mostraba una atención dispersa y el 16,2% evidenciaba un temperamento impulsivo. En el grupo con síndrome de Panayiotopoulos, un 30,3% mostraba una atención dispersa y un 27,3% presentaba un temperamento impulsivo. Se llevó a cabo una valoración psicométrica en 43 pacientes. El valor del cociente intelectual total medio fue de 95 (rango: 55-126). En los tres grupos el rendimiento escolar fue bueno en aproximadamente la mitad, regular en cerca del 30% y malo en alrededor del 15%. En el grupo con epilepsia rolándica se encontró relación entre paroxismos frontales (p = 0,039) y occipitales (p = 0,004) en el EEG y un peor rendimiento escolar. En este grupo, los niños con conductas calificadas como dispersa, impulsiva o hiperactiva mostraban con más frecuencia paroxismos izquierdos (p = 0,030). Conclusiones. Las EBI son entidades con buen pronóstico, pero parecen asociar trastornos del aprendizaje y conductuales. Sería conveniente realizar estudios neuropsicológicos a estos pacientes para detectar tales alteracione (AU)

Introduction. Some papers published in the literature have shown that patients can present behavioural disorders and learning difficulties in benign childhood epilepsies (BCE). Aims. To review the patients diagnosed with BCE in our hospital and to determine whether they present such disorders. Patients and methods. The study consisted in a retrospective review of the medical records of patients diagnosed with BCE. An electroencephalogram (EEG) or video-EEG-polygraph recordings were performed on all patients during sleep. The Wechsler Intelligence Scale for Children was used to evaluate intelligence. Results. Data were collected for 102 patients diagnosed with BCE. Dispersed attention was observed in 51.6% of the patients with rolandic epilepsy and 16.2% displayed an impulsive temperament. In the group of patients with Panayiotopoulos syndrome, 30.3% displayed dispersed attention and 27.3% presented an impulsive temperament. A psychometric evaluation was carried out in 43 patients. The overall mean intelligence quotient was 95 (range: 55-126). In the three groups, academic achievement was good in approximately half the sample, regular in about 30% and poor in around 15%. In the group with rolandic epilepsy, the EEG showed a relation between frontal (p = 0.039) and occipital paroxysms (p = 0.004) and poorer academic achievement. In this group, the children with behaviours classed as dispersed, impulsive or hyperactive showed left-side paroxysms more frequently (p = 0.030). Conclusions. BCE are conditions with a good prognosis, but seem to be associated to learning and behavioural disorders. Neuropsychological studies should be conducted on these patients to detect these disorders (AU)

[Relapse in schizophrenia: an exploratory study of the joint conceptions of patients, parents and caregivers]. / Regards croisés sur les signes précoces de rechute des sujets schizophrènes.

INTRODUCTION: The question of the course of schizophrenia relapses, is of considerable interest in different clinical and social areas such as prognosis, quality of life, therapeutic relationship, psychoeducation, rehabilitation and so on. The more the schizophrenic relapses, the higher the level of handicap. Although there is a widespread agreement that it is essential to detect early signs of relapses in order to prevent them, there still remain theoretical and methodological difficulties in identifying these signs because they are personal, heterogeneous and not always specific to psychosis. That is why the notion of "relapse signature" seems relevant by taking into account differentiated and personal assessment of early signs of relapse. This implies the consideration of the different visions of relapse given by patients, parents and caregivers. OBJECTIVE: We propose a qualitative study of the joint appraisal of patients, patients' parents and medical staff. The aim of this study is to regroup the expertises in order to further our understanding of the early signs of relapse. We assume that patients and parents are able to describe signs that are not considered as pathological symptoms, but refer to a personal manner of initiating the relapse process. This should then help in designing early intervention and provide reinforced therapeutic alliance and more positive responses to psychoeducation programs. METHOD: We have interviewed 30 subjects divided in three groups: 10 schizophrenic patients, 10 caregivers (including physicians, psychologists and nurses) and 10 parents of schizophrenics. The patients met the following criteria: patients with a diagnosis of schizophrenia (DSM IV criteria), under neuroleptic treatment, and stabilized. The mean duration of illness was 15 years. The patients as well as caregivers were recruited in two external hospital structures. All the subjects gave their written consent for this study and its methods. We did not recruit parents who were not living with their schizophrenic child or who did not see or have frequent contact with him or her for this study. We conducted a semistructured interview and analysed the transcripts of the narratives provided by our three groups on the definition of relapse and early signs of relapse. Recorded interviews were processed using the Alceste Method, a computer program of textual analysis that identifies the word patterns most frequently used by the subjects. Alceste creates classes of words using a hierarchical descending classification. The description of each class is presented in the form of a word list (with the value of the word's Chi(2) association in this class). We assessed the awareness of problems using the 8-Q. RESULTS: The three groups described relapses as a distressed, even traumatic experience. This experience is shared by the patients' siblings who sometimes mention violent situations and difficulties at home. The analysis showed that each group uses a compartmentalized universe of speech. This raises the question of the communication and the sharing of information between the different groups. Parents who didn't live the relapse of their children and the caregivers gave prepsychotic or psychotic symptoms of relapse. Conversely, parents who had lived relapse(s) of their children gave nonspecific and very personalized signs of relapse (e.g., "When she relapses, our daughter eats much more cheese than usually"). The patients with a low level of awareness of his/her problem were able to describe early signs of relapse. They described mood and sleep disturbances. This is an unexpected result and calls for a debate on the need or not to have good insight in order to follow a psychoeducation program. CONCLUSION: This study insists on the complementarity of different conceptions of all persons involved in schizophrenic relapse in order to identify as accurately as possible the "relapse signature" of patients. According to us, and in order to promote suitable subjective data to increase insight, compliance and therapeutic alliance, psychoeducation programs should rely on these personal criteria rather than propose systematic programs. Then the relapse signature could be the first step to the appropriation of the course of illness and control of psychotic symptoms by schizophrenic patients.

Impacto clínico de la introducción de la ultrasonografía endoscópica (USE) alta en un hospital de área / No disponible

Objetivos: Evaluar el impacto de la introducción de la ecoendoscopia en la práctica clínica. Métodos: Se analizaron todas las exploraciones realizadas en los primeros 18 meses de implantación de la técnica. Se valoró la concordancia mediante técnicas radiológicas o piezas quirúrgicas en los casos en los que fue posible. Resultados: Se realizaron 277 exploraciones. Sólo se han registrado 2 complicaciones y en ambos casos fue en relación con la sedación. La demanda fue en aumento, alcanzando 70 exploraciones/ 100.000 habitantes. Las indicaciones principales fueron procesos biliares (34,3%) y pancreáticos. No se encontró patología alguna en el 10% de los casos. 29 presentaban coledocolitiasis (93% confirmadas y tratadas endoscópicamente). Se diagnosticaron 19 pancreatitis crónicas (sólo el 15,78% fueron diagnosticadas por tomografía computarizada). Se evaluaron 32 pacientes con pancreatitis aguda idiopática: en 20 de ellos se visualizó microlitiasis (80% fueron colecistectomizados y permanecen asintomáticos tras una media de seguimiento de 21,5 meses), 2 casos de coledocolitiasis, 1 con pancreatitis crónica y 9 casos permanecieron sin filiar la etiología. Hemos realizado 56 punciones: 39 muestras de páncreas en 33 pacientes (fueron diagnósticas en el 81,1%, siendo los diagnósticos más frecuentes el adenocarcinoma y el cistoadenoma seroso), 13 adenopatías y 4 masas abdominales. Conclusiones: La ecoendoscopia es una técnica con una demanda creciente, presenta escasos riesgos y conlleva una mejor toma de decisiones en un importante número de pacientes con enfermedades diversas. Por lo tanto, su inclusión en la práctica clínica rutinaria ha de ser considerado(AU)

Objectives: Evaluation of the impact of EUS in clinical practice. Methods: All exploration performed during the first 18 months of implementation of the technique were analyzed. Agreement was assessed by radiographic techniques or surgical specimens in those cases allowed. Results: 277 exploration were performed. There have been only 2 complications and they were related to sedation in both cases. The demand increased gradually, reaching 70 scans per 100,000 inhabitants. Main indications were bile (34.3%) and pancreatic processes. No pathology was found in 10% of cases; 29 cases had choledocholithiasis (93% confirmed and treated endoscopically). Chronic pancreatitis was diagnosed in 19 cases (only 15.78% of the cases were diagnosed by computed tomography). 32 patients with idiopathic acute pancreatitis were evaluated: 20 of them had evidence of microlithiasis (80% cholecystectomized and asymptomatic after a mean follow-up of 21.5 months), two cases of choledocholithiasis, 1 with chronic pancreatitis and 9 cases remained free of filial etiology. We performed 56 punctures: 39 samples of pancreas in 33 patients (81.1% of the samples were diagnostic; adenocarcinoma and serous cystadenoma were the most common diagnoses), 13 enlarged nodes and 4 abdominal masses. Conclusions: EUS is a growing demand technique that has low risks and leads to better decision-making in a significant number of patients with different diseases. Therefore, its inclusion in routine clinical practice must be considered(AU)

Disfunciones ováricas en la mujer / No disponible

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Síndrome del déficit androgenico del anciano o andropausia / No disponible

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Drug resistance among Mycobacterium tuberculosis strains in immigrants: is there a real threat everywhere?

A study was performed to determine the impact of drug resistance in tuberculosis among immigrant patients in Madrid, Spain. During the period 1995-2001, the relative proportion of isolates from immigrant patients increased from 4.4% to 24.2%. No differences between immigrants and Spanish-born patients were detected for resistance to any first-line anti-tuberculous drug. More studies are required to determine the actual incidence of resistant tuberculosis in immigrants.