Guía de práctica clínica para el diagnóstico y manejo inicial de artritis reumatoide en el Seguro Social del Perú (EsSalud) / Clinical Practice Guideline for the diagnosis and initial management of Rheumatoid Arthritis in the Social Security of Peru (EsSalud)

La Artritis Reumatoide (AR) tiene adversas consecuencias en la salud su diagnóstico temprano y manejo óptimo requiere recomendaciones basadas en evidencia de alta calidad adaptadas a cada sistema de salud. Objetivo: Proveer recomendaciones clínicas basadas en evidencia para el diagnóstico y manejo inicial de la AR. Material y Métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 10 preguntas clínicas a ser respondidas por la presente GPC. Se realizaron búsquedas sistemáticas de la evidencia publicada en PubMed y CENTRAL entre diciembre 2017 a julio 2019 (revisiones sistemáticas y ­cuando fue considerado pertinente­ estudios primarios). Se seleccionó la evidencia de mayor calidad para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE) y en reuniones de trabajo periódicas, el GEG usó dicha metodología para revisar la evidencia y formular las recomendaciones, los puntos de buena práctica clínica y los flujogramas. Finalmente, la GPC fue aprobada con Resolución N° 132 ­ IETSI ­ ESSALUD ­ 2019. Resultados: La presente GPC abordó 10 preguntas clínicas, divididas en dos temas: diagnóstico y manejo. En base a dichas preguntas se formularon 16 recomendaciones (5 fuertes y 11 condicionales), 45 puntos de buena práctica clínica, y 3 flujogramas. Conclusión: El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el diagnóstico y manejo inicial de la AR en EsSalud.

Rheumatoid arthritis (RA) has adverse health consequences its early diagnosis and optimal management requires high quality evidence-based recommendations tailored to each health system. Objective: To provide evidence-based clinical recommendations for the diagnosis and initial management of RA. Material and Methods: A guideline development group (GDG) was formed that included medical specialists and methodologists. The GEG formulated 10 clinical questions to be answered by this CPG. Systematic searches of the evidence published in PubMed and CENTRAL were performed between December 2017 and July 2019 (systematic reviews and -when considered relevant- primary studies). The highest quality evidence was selected to answer each of the clinical questions posed. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, and in periodic working meetings, the GEG used this methodology to review the evidence and formulate the recommendations, good clinical practice points, and flowcharts. Finally, the CPG was approved by Resolution No. 132 - IETSI - ESSALUD - 2019. Results: This CPG addressed 10 clinical questions, divided into two topics: diagnosis and management. Based on these questions, 16 recommendations (5 strong and 11 conditional), 45 points of good clinical practice, and 3 flowcharts were formulated. Conclusion: This article summarizes the methodology and evidence-based conclusions of the CPG for the diagnosis and initial management of RA in EsSalud.

Group Cognitive Behavioral Therapy and Attention Bias Modification for Childhood Anxiety Disorders: A Factorial Randomized Trial of Efficacy.

BACKGROUND: The objective of this study is to assess group differences in symptom reduction between individuals receiving group cognitive behavioral therapy (G-CBT) and attention bias modification (ABM) compared to their respective control interventions, control therapy (CT), and attention control training (ACT), in a 2 × 2 factorial design. METHODS: A total of 310 treatment-naive children (7-11 years of age) were assessed for eligibility and 79 children with generalized, separation or social anxiety disorder were randomized and received G-CBT (n = 42) or CT (n = 37). Within each psychotherapy group, participants were again randomized to ABM (n = 38) or ACT (n = 41) in a 2 × 2 factorial design resulting in four groups: G-CBT + ABM (n = 21), G-CBT + ACT (n = 21), CT + ABM (n = 17), and CT + ACT (n = 20). Primary outcomes were responder designation as defined by Clinical Global Impression-Improvement (CGI-I) scale (≤2) and change on the Pediatric Anxiety Rating Scale (PARS). RESULTS: There were significant improvements of symptoms in all groups. No differences in response rates or mean differences in PARS scores were found among groups: G-CBT + ABM group (23.8% response; 3.9 points, 95% confidence interval [CI] -0.3 to 8.1), G-CBT + ACT (42.9% response; 5.6 points, 95% CI 2.2-9.0), CT + ABM (47.1% response; 4.8 points 95% CI 1.08-8.57), and CT + ACT (30% response; 0.8 points, 95% CI -3.0 to 4.7). No evidence or synergic or antagonistic effects were found, but the combination of G-CBT and ABM was found to increase dropout rate. CONCLUSIONS: We found no effect of G-CBT or ABM beyond the effects of comparison groups. Results reveal no benefit from combining G-CBT and ABM for anxiety disorders in children and suggest potential deleterious effects of the combination on treatment acceptability.

Psychopathological Symptoms and Psychological Wellbeing in Mexican Undergraduate Students.

College life involves a process of adaptation to changes that have an impact on the psycho-emotional development of students. Successful adaptation to this stage involves the balance between managing personal resources and potential stressors that generate distress. This epidemiological descriptive and transversal study estimates the prevalence of psychopathological symptomatology and psychological well-being among 516 college students, 378 (73.26%) women and 138 (26.74%) men, ages between 17 and 24, from the city of Monterrey in Mexico. It describes the relationship between psychopathological symptomatology and psychological well-being, and explores gender differences. For data collection, two measures were used: The Symptom Checklist Revised and the Scale of Psychological Well-being. Statistical analyses used were t test for independent samples, Pearson's r and regression analysis with the Statistical Package for the Social Sciences (SPSS v21.0). Statistical analyses showed that the prevalence of psychopathological symptoms was 10-13%, being Aggression the highest. The dimension of psychological well-being with the lowest scores was Environmental Mastery. Participants with a higher level of psychological well-being had a lower level of psychopathological symptoms, which shows the importance of early identification and prevention. Gender differences were found on some subscales of the psychopathological symptomatology and of the psychological well-being measures. This study provides a basis for future research and development of resources to promote the psychological well-being and quality of life of university students.

Extracurricular activities and group belonging as a protective factor in adolescence / Actividades extraescolares y pertenencia al grupo como factor protector en la adolescencia

In the transition into adulthood, family and school play a critical role protecting the adolescent from engaging in behaviors that could cause mental health problems. Nevertheless, there are other social groups and structured activities that have shown to act as an educational activity and as a protective factor as well. The aim of this study was to investigate the relationship between belonging to different types of social groups and the positive and negative mental health indicators of Mexican adolescents. Participants were 840 Mexican adolescents ranging between 12 and 17 years old. Results indicated that belonging to artistic and scout groups reported a statistically significant correlation with higher levels of emotional intelligence. Belonging to sport and artistic groups reported a statistically significant correlation with higher levels of resilience. No statistically significant results were found on anxiety, depression, and/or disruptive behaviors. Further research is needed, especially investigating possible predictive and moderating variables

En la transición a la vida adulta, la familia y la escuela juegan un papel protector decisivo para proteger al adolescente de comportamientos que podrían acarrearle problemas de salud mental. No obstante, hay otros grupos sociales y actividades estructuradas que han funcionado como actividades educativas además de como factores protectores. El objetivo de este trabajo ha sido investigar la relación entre la pertenencia a diferentes tipos de grupos sociales y los indicadores positivos y negativos de salud mental de adolescentes mexicanos. Los participantes eran 840 adolescentes mexicanos de edades comprendidas entre los 12 y los 17 años. Los resultados indican que la pertenencia a grupos artísticos y scouts correlacionaba significativamente con elevados niveles de inteligencia emocional. Pertenecer a grupos deportivos y artísticos correlacionaba significativamente con elevados niveles de resiliencia. No se dieron resultados estadísticamente significativos en ansiedad, depresión o conductas problemáticas. Se necesita continuar investigando, sobre todo en las posibles variables predictoras y moderadoras

Preventing childhood anxiety and depression: Testing the effectiveness of a schoolbased program in Mexico

A growing number of school-aged children experience or are at risk for a myriad of psychological and behavioral problems such as anxiety and depression that interfere with their interpersonal relationships, school performance, and potential to become productive citizens –hence the importance of school prevention. This study assessed the effectiveness of the Spanish version of the FRIENDS for Life program [AMISTAD para siempre], a social and emotional program that uses cognitive-behavioral techniques to prevent anxiety and depression. Eight schools from a northern city in Mexico were randomly selected and assigned to either an intervention or standard curriculum instruction. Fifteen teachers implemented the intervention, and 16 served as control. Participants were 1,030 fourth and fifth grade students (ages 8-13). The impact of the program was evaluated immediately after the intervention and after 6 months. The program showed a positive effect by reducing symptoms and risk for depression and increasing the proactive coping skills of the overall sample. Suggestions for further research and implications for practice are offered (AU)

Un número elevado de niños de edad escolar experimentan o corren el riesgo de experimentar una serie de problemas psicológicos y de comportamiento tales como la ansiedad y la depresión, las cuales interfieren en sus relaciones interpersonales, el desempeño académico y el potencial para convertirse en personas productivas. El presente estudio evalúa la eficacia de la versión en español del programa FRIENDS for Life [AMISTAD para siempre], que enseña habilidades sociales y emocionales utilizando técnicas cognitivas-conductuales para prevenir ansiedad y depresión. Ocho escuelas de una ciudad al norte de México fueron aleatoriamente seleccionadas y asignadas a un grupo de intervención o al grupo de currículo estándar. Quince educadoras implementaron el programa y 16 maestras siguieron con el currículo estándar. Los participantes fueron 1.030 niños, de 8 a 13 años de edad, de cuarto y quinto grado de primaria. El impacto del programa se evaluó inmediatamente después de la intervención, y a los seis meses. Los resultados muestran que el programa tuvo efectos positivos al reducir los síntomas y el riesgo de depresión e incrementar las estrategias de afrontamiento proactivas de aquellos que lo recibieron. Se ofrecen sugerencias sobre futuras investigaciones así como sobre sus implicaciones para la práctica (AU)

Psychosocial Interventions to Prevent Anxiety Disorders in School Settings from 1985-2007: A Meta-Anaysis

Childhood anxiety disorders are a salient concern because they are associated with deviant conduct, substance abuse, and depression later in life. This meta-analysis focuses on the efficacy of psychosocial interventions in preventing anxiety disorders in children. A search of several databases covering 1985- 2007 identified 19 peer-reviewed studies. Most of the studies were judged with "Low Risk of Bias". Results showed CBT to be the most effective psychosocial intervention (95% CI, 0.19 a 0.43), particularly when implemented at a selective prevention level (95% CI, 0.20 a 0.97). The protective factors to improve the most were positive future outlook (95% CI, 0.87 to 1.51) and self-esteem (95% CI, 0.87 a 1.51). Suggestions for further research and implications for practice are offered (AU)

Los trastornos de ansiedad en la infancia han sido un tema de preocupación ya que están asociados con la conducta desafiante, el abuso de sustancias y la depresión en edad adulta. El presente metaanálisis se enfoca en la eficacia de las intervenciones psicosociales para la prevención de los trastornos de ansiedad en la infancia. Se realizó una búsqueda en diferentes bases de datos cubriendo de 1985 al 2007 y se identificaron 19 estudios de investigación publicados en revistas con arbitraje. La mayoría de los estudios fueron juzgados con "bajo riesgo de sesgo". Los resultados del presente estudio muestran que la mejor intervención psicosocial es la cognitivo-conductual (95% IC, 0.19 a 0.43), particularmente cuando se implementa en el nivel de prevención selectivo (95% IC, 0.20 a 0.97). Los factores de protección que mostraron mayor mejora fueron el optimismo (95% IC, 0.87 a 1.51) y la autoestima (95% IC, 0.87 a 1.51). Se ofrecen sugerencias tanto para futuras investigaciones como para implicaciones en la práctica (AU)

Anxiety, Depression, and Coping Skills Among Mexican School Children: A Comparison of Students With and Without Learning Disabilities.

The purpose of this study was to compare severity and risk status for anxiety and depression with coping skills among 130 Mexican school children with learning disabilities (LD) and 130 school children without LD. This research is the first to explore the emotional difficulties of Mexican children with LD. Children completed the Spanish version of the Spence Children's Anxiety Scale and Children's Depression Inventory, and the Cuestionario de Afrontamiento (Coping Skills Questionnaire). Results indicated that a higher percentage of children with LD were at risk for anxiety (22.3% vs. 11.5%) and depression (32% vs. 18%). No statistically significant differences were found for coping skills. Results support the idea that there is an increased awareness of comorbid depression and anxiety among students with LD and a need to promote early identification and intervention in schools. Efforts should focus on better understanding the relationship between social-emotional difficulties and academic achievement and on developing effective interventions to support children with LD.