Staging models in eating disorders: A systematic scoping review of the literature.

Eating Disorders (ED) are characterized by low remission rates, treatment drop-out, and residual symptoms. To improve assessment and treatment of ED, the staging approach has been proposed. This systematic scoping review is aimed at mapping the existing staging models that explicitly propose stages of the progression of ED. A systematic search of PubMed, PsycINFO, Scopus was conducted with the terms staging, anorexia nervosa, bulimia nervosa, binge-eating disorders, eating disorders. Eleven studies met inclusion criteria presenting nine ED staging models, mostly for anorexia nervosa. Three were empirically tested, one of which was through an objective measure specifically developed to differentiate between stages. Most staging models featured early stages in which the exacerbation of EDs unfolds and acute phases are followed by chronic stages. Intermediate stages were not limited to acute stages, but also residual phases, remission, relapse, and recovery. The criteria for stage differentiation encompassed behavioral, psychological, cognitive, and physical features including body mass index and illness duration. One study recommended stage-oriented interventions. The current review underscores the need to empirically test the available staging models and to develop and test new proposals of staging models for other ED populations. The inclusion of criteria based on medical features and biomarkers is recommended. Staging models can potentially guide assessment and interventions in daily clinical settings.

Perineal ultrasound evaluation of urethral mobility after the TVT-O procedure.

AIMS: The aim of study was to assess, by means of perineal ultrasound (US), women treated with the trans-obturator suburethral sling procedure for urinary stress incontinence (USI). METHODS: Twelve women with USI and urethral hypermobility were enrolled. Static and dynamic perineal US of urethral mobility was performed before and after tension-free vaginal tape opturator (TVT-O) procedure: US parameters evaluated were pubis-urethra distance and inclination angle of the urethral axis. RESULTS: The Valsalva stress US evaluation showed a return to normal range of the pubic urethral distance in all cases (p = 0.0001); also a correction of the angle of inclination of the urethral axis occurred in all patients (p < 0.0001). CONCLUSIONS: Our results propose the use of perineal US for patients with USI as an additional diagnostic tool and a means for postsurgical follow-up.

Expression of p16 in abnormal pap-tests as an indicator of CIN2+ lesions: a possible role in the low grade ASC/US and L/SIL (Ig) cytologic lesions for screening prevention of uterine cervical tumours.

The aim of this study was to assess the validity of protein p16 expression as an indicator of progression in lesions as ASC-US and L-SIL. For this purpose, we examined 246 cytological samples (91 ASC-US, 60 L-SIL, 36 ASC-H, 59 H-SIL) of which 151 were conventional Pap-tests (CC) and 95 in liquid based cytology (LBC) with colposcopic and histology follow-up. The results showed that in the positive p16 Pap-tests a 59% PPV vs CIN2+ in all cytologic diagnoses compared to 43% in cytologic reading alone. 96% of HG cytologic lesions were positive for p16, and the data showed good correlation between positivity for p16 in the cytologic preparations and the presence of CIN2+ lesions in the histologic test (chi-square for trend p < 0.0001). The sensitivity, specificity and NPV were 93%, 52% and 91%, respectively, in all cytologic diagnostic categories. P16 was positive in 46% of ASC-US and 53% of L-SIL. The PPV vs expressed CIN2+ was higher than that observed in cytologic reading (48% vs 26%, and 31% vs 20%, respectively). The sensitivity was 83%, the specificity 67% and 54%, respectively, and the VNP was 92% and 93%. It is possible to design algorithms for colposcopic follow-up that can reduce the need to obtain a follow-up. The future application of this test may allow the creation of a bio-molecular automated pap test.

[Medical assessment of occupational disability (preparation of a list of occupational diseases with the colaboration of scientific societies)]. / La valoración médica de la incapacidad para el trabajo (elaboración del listado de enfermedades con la colaboración de las sociedades científicas).

INTRODUCTION: Amongst the financial benefits given by the Social Security Service, that of disability benefit is one of the most important. To determine the right to obtain this and the amount due, it is necessary to have administrative certification of the existence of this disability, the cause of it and the degree (partial, total, absolute or great disability). Therefore medical assessment is essential. DEVELOPMENT: The medical assessors of the Disability Tribunals of the Instituto Nacional de la Seguridad Social are responsible for medical assessment. It is necessary for these doctors to understand all types of disorders and useful for them to have methodology at their disposal for each of the different disorders. Also, lack of official criteria for evaluation, due to the variety of situations which may arise, make unification difficult. We aim to devise criteria for evaluation of the diagnosis, by means of the tests and investigations necessary, their evaluation and the symptoms of each disorder which may cause problems (deficiencies) in the individual person, when carrying out his work (determining which tests and investigations allow this to be shown). Neurology is one of the specialities which offers the greatest difficulty to nonspecialists. This is due to the evaluation of complementary tests used and the subjectivity of some defects. In this paper, we aim to report these difficulties in order to promote collaboration between medical assessors and Neurology specialists.

La valoración médica de la incapacidad para el trabajo(elaboración del listado de enfermedadescon la colaboración de las sociedades científicas) / Medical assessment of occupational disability (preparation of a list of professional diseases with the collaboration of the scientific societies)

Introducción. Dentro de las prestaciones económicas del sistema de Seguridad Social, la prestación por incapacidad laboral es una de las de mayor significado. Para poder resolver el derecho a su percepción y la cuantía de la misma, es necesaria la calificación administrativa de la existencia de dicha incapacidad, la contingencia productora y el grado (parcial, total, absoluta o gran invalidez).Para todo ello, es preceptiva la valoración médica. Desarrollo. Los médicos evaluadores de los equipos de valoración de incapacidades encuadrados en el Instituto Nacional de la Seguridad Social son quienes realizan la valoración médica. Es necesario que estos facultativos sepan manejarse con todo tipo de enfermedades y es conveniente que dispongan de una metodología para cada una de las diferentes materias. Por otro lado, la inexistencia de criterios oficiales de valoración, debido a las numerosas situaciones que pueden producirse, dificulta su unificación. Se pretende elaborar los criterios de valoración del diagnóstico, a través de la determinación de las pruebas y exploraciones necesarias, así como de su valoración, y las manifestaciones de cada enfermedad, que pueden producir dificultades (deficiencias) en el individuo, para la realización de las tareas de su trabajo (determinando las pruebas y exploraciones que permitan su objetivación). La Neurología es una de las especialidades que presentan mayores dificultades para los no especialistas. La valoración de las pruebas complementarias utilizadas y la subjetividad de algunas de las deficiencias es la causa de ello. Conclusión. En esta comunicación, se pretende transmitir estas dificultades con el fin de solicitar la colaboración entre médicos evaluadores y especialistas en Neurología (AU)