Psychological intervention in women victims of childhood sexual abuse: a randomized controlled clinical trial comparing EMDR psychotherapy and trauma-focused cognitive behavioral therapy.

Introduction: Childhood sexual abuse persists as a painful societal reality, necessitating responses from institutions and healthcare professionals to prevent and address its severe long-term consequences in victims. This study implements an intervention comprising two psychotherapeutic approaches recommended by the WHO and international clinical guidelines for addressing short-, medium-, and long-term posttraumatic symptomatology: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR). Both approaches are adapted from group formats for implementation in small online groups via Zoom. Methods: The impact of both therapeutic approaches on trauma improvement was assessed in a sample of 19 women who were victims of childhood sexual abuse through a Randomized Clinical Trial comparing EMDR Psychotherapy and Trauma-Focused Cognitive Behavioral Therapy after a baseline period. Intra and inter comparison were made using statistics appropriate to the sample. Results: Both therapeutic approaches significantly reduced symptomatology across various evaluated variables, suggesting their efficacy in improving the quality of life for these individuals. Following CBT-FT treatment, patients exhibited enhanced emotional regulation, reduced reexperiencing, and avoidance. The EMDR group, utilizing the G-TEP group protocol, significantly improved dissociation, along with other crucial clinical variables and the perception of quality of life. Discussion: Although the limitations of this study must be taken into account due to the size of the sample and the lack of long-term follow-up, the results align with existing scientific literature, underscoring the benefits of trauma-focused psychological treatments. The online group format appears promising for enhancing the accessibility of psychological treatment for these women. Furthermore, the differential outcomes of each treatment support recent research advocating for the inclusion of both approaches for individuals with trauma-related symptomatology. Ethics and dissemination: The study has been approved by the Ethics Committee of the Valencian International University (VIU) (Valencia, Spain) (Ref. CEID2021_07). The results will be submitted for publication in peer-reviewed journals and disseminated to the scientific community. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT04813224, identifier NCT04813224.

Kairos study protocol: a multidisciplinary approach to the study of school timing and its effects on health, well-being and students' performance.

Recent evidence from chronobiology, chssronomedicine and chronopsychology shows that the organisation of social time (e.g., school schedules) generally does not respect biological time. This raises concerns about the impact of the constant mismatch between students' social and internal body clocks on their health, well-being and academic performance. The present paper describes a protocol used to investigate the problem of (de) synchronisation of biological times (chronotypes) in childhood and youth in relation to school times. It studies the effects of student chronotype vs. school schedule matches/mismatches on health behaviours (e.g., how many hours students sleep, when they sleep, eat, do physical activity, spend time outdoors in daylight) and learning (verbal expression, spatial structuring, operations) and whether alert-fatigue levels mediate this effect alignments/misalignments on learning (verbal expression, spatial structuring, operations) and their mediation by alert-fatigue levels. The novelty of our protocol lies in its multidisciplinary and mixed methodology approach to a relevant and complex issue. It draws on up-to-date knowledge from the areas of biology, medicine, psychology, pedagogy and sociology. The methods employed include a varied repertoire of techniques from hormonal analysis (cortisol and melatonin), continuous activity and light monitoring, self-registration of food intake, sleep timings, exercise and exposure to screens, alongside with systematic application of cognitive performance tests (e.g., memory, reasoning, calculation, attention) and self-reported well-being. This comprehensive and interdisciplinary protocol should support evidence-based education policy measures related to school time organisation. Appropriate and healthier school timetables will contribute to social change, healthier students and with more efficient learning. The results of studies using a similar methodology in other countries would ensure replication and comparability of results and contribute to knowledge to support policy making.

Psychological Intervention in Women Victims of Childhood Sexual Abuse: An Open Study-Protocol of a Randomized Controlled Clinical Trial Comparing EMDR Psychotherapy and Trauma-Based Cognitive Therapy.

INTRODUCTION: Most victims of sexual abuse have symptoms that may lead to post-traumatic stress disorder. This study aims to offer evidence-based psychological treatment to women who have been sexually abused earlier in life and currently have sequelae from that trauma. With this treatment, each of the women in the study will hopefully improve their overall quality of life and, more specifically, it is expected that post-traumatic stress symptoms will decrease, as found in recent studies, as well as strengthening their security, confidence, and coping with the situations they have experienced. METHODS AND ANALYSIS: The effect of two therapeutic approaches focused on the improvement of trauma will be evaluated in a sample of 30-50 women victims of childhood sexual abuse, with a randomized clinical trial comparing EMDR psychotherapy and trauma-focused cognitive behavioral therapy. According to the literature reviewed, both approaches will considerably improve self-esteem when the appropriate number of sessions are conducted, significantly reducing general psychiatric symptoms and depression. Furthermore, the effects are sustained over time. It should be noted that this study will be carried out comparing both therapies, analyzing both the differential benefit of each and the cumulative effect of receiving both treatments and in which order. It is also intended to demonstrate that implementing the protocols presented in this study will help improve the quality of life of the women who benefit from them, and after this study, it will be possible to replicate this program in other people with the same problems. Each of the therapeutic benefits of each of them will be analyzed, and clinical and logistical guidance will be provided to implement both, including a session-by-session protocol.

Prevalence of Anxiety Symptoms and Associated Clinical and Sociodemographic Factors in Mexican Adults Seeking Psychological Support for Grief During the COVID-19 Pandemic: A Cross-Sectional Study.

The COVID-19 pandemic is one of the greatest challenges in modern history, with more than four million confirmed deaths worldwide. To date, evidence regarding the psychological impact of the COVID-19 pandemic on grievers is scarce for developing countries such as Mexico. This study aimed to assess the levels of anxiety and associated concerns in a sample of Mexican adults bereaved during the COVID-19 outbreak. A cross-sectional study was conducted through the Duelo COVID (COVID Grief) platform, which is a self-guided online treatment. A total of 5,224 participants reported their anxiety, depression, sleep quality, avoidance, and arousal, prolonged grief symptoms, and medication consumption. Independent sample Mann-Whitney U-tests, chi-square tests, and Kruskal-Wallis tests, as well as multinomial logistic regression, were conducted. Results indicated that 90.4% of the participants reported clinical levels of anxiety, depression, and sleep affectations. The people who lost someone during the last 5 months scored higher in normal grief symptoms compared to the people whose loss was 6 months ago or more, and 9.8% of individuals reported the use of prescription medication, with anxiolytics and antidepressants being the most common. Females, younger respondents, unemployed people with a lower educational level, and participants who disclosed a recent suicide attempt were among those who reported medication consumption. Sleep problems were more frequent in older participants.

Use of EHRs in a Tertiary Hospital During COVID-19 Pandemic: A Multi-Purpose Approach Based on Standards.

This work aims to describe how EHRs have been used to meet the needs of healthcare providers and researchers in a 1,300-beds tertiary Hospital during COVID-19 pandemic. For this purpose, essential clinical concepts were identified and standardized with LOINC and SNOMED CT. After that, these concepts were implemented in EHR systems and based on them, data tools, such as clinical alerts, dynamic patient lists and a clinical follow-up dashboard, were developed for healthcare support. In addition, these data were incorporated into standardized repositories and COVID-19 databases to improve clinical research on this new disease. In conclusion, standardized EHRs allowed implementation of useful multi- purpose data resources in a major Hospital in the course of the pandemic.

A Self-Applied Multi-Component Psychological Online Intervention Based on UX, for the Prevention of Complicated Grief Disorder in the Mexican Population During the COVID-19 Outbreak: Protocol of a Randomized Clinical Trial.

Background: COVID-19 has taken many lives worldwide and due to this, millions of persons are in grief. When the grief process lasts longer than 6 months, the person is in risk of developing Complicated Grief Disorder (CGD). The CGD is related to serious health consequences. To reduce the probability of developing CGD a preventive intervention could be applied. In developing countries like Mexico, the psychological services are scarce, self-applied interventions could provide support to solve this problem and reduce the health impact even after the pandemic has already finished. Aims: To design and implement a self-applied intervention composed of 12 modules focused on the decrease of the risk of developing CGD, and increasing the life quality, and as a secondary objective to reduce the symptomatology of anxiety, depression, and increase of sleep quality. The Intervention Duelo COVID (Grief COVID) follows the principles of User Experience (UX) and is designed according to the needs and desires of a sample of the objective participants, to increase the adherence to the self-applied intervention, considered one of the main weaknesses of online interventions. Methods: A Randomized Controlled Trial will be conducted from the 22nd of December of 2020 to the first of June 2021. The participants will be assigned to an intervention with elements of Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Mindfulness and Positive Psychology. The control group will be a wait-list condition, that will receive the intervention 1.5-2 months after the pre-measurement were taken. The Power Size Calculation conducted through G*Power indicated the need for a total of 42 participants, which will be divided by 21 participants in each group. The platform will be delivered through responsive design assuring with this that the intervention will adapt to the screen size of cellphones, tablets, and computers. Ethics and Dissemination: The study counts with the approval of the Research Ethics Committee of the Autonomous University of Ciudad Juárez, México, and it is registered in Clinical Trials (NCT04638842). The article is sent and registered in clinical trials before the recruitment started. The results will be reported in future conferences, scientific publications, and media.

Personalized antimicrobial therapy in critical and elderly patients.

OBJECTIVE: Personalized therapy in the treatment of infections is essential to  ensure optimization of antimicrobial drug levels. This strategy, together with an  understanding of the activity of these drugs, decreases the risk of bacterial  resistance and improves the drugs' safety profile. Alternative  outes of administration, such as inhalation, and the information provided by  pharmacokinetic models, are essential given the limitation of antimicrobial  activity allowed by the new antimicrobials. METHOD: A non-systematic review of the literature is presented as a way of  tackling and finding solutions to the problem. A search for high-quality articles  on the research topic was conducted. Results: A total of 370 articles were  detected, which were subjected to a further selection to discard low quality  papers by a team of five clinical pharmacists and an intensivist. Finally, 153  articles were included in the review. CONCLUSIONS: The geriatric and the critical care patient population require the  administration of antimicrobials with close monitoring. The routes of  administration recommended for the first group are discouraged for the  second. The inhaled route often results in high plasma concentrations in  patients with respiratory infections. Pharmacokinetic models are a valuable tool  in the treatment of geriatric patients, who are often excluded  from clinical trials.

OBJETIVO: La terapia personalizada en el tratamiento de las infecciones es esencial para garantizar la optimización de los niveles de fármaco  lcanzados en el paciente tratado. Adicionalmente, esta estrategia, juntamente  con el conocimiento de la actividad antimicrobiana de estos fármacos,  isminuye la posibilidad de desarrollar resistencias bacterianas y mejora el perfil  de seguridad de estos fármacos. Las terapias por vías alternativas, como  la inhalada, y el soporte de la información facilitada por modelos  farmacocinéticos son esenciales debido a la limitación de la actividad aportada  por los nuevos antimicrobianos.Método: Se presenta una revisión no sistemática de la literatura como medida  de orientación de la problemática y soluciones a lo expuesto  anteriormente. Se ha efectuado una búsqueda de artículos de alta calidad  sobre el tópico planteado. RESULTADOS: Se detectaron 231 artículos que sufrieron una selección posterior,  en base a la calidad de los trabajos valorada por un equipo de cinco farmacéuticos clínicos y un médico intensivista. Finalmente, se incluyeron 153 artículos que soportan la revisión que se ha desarrollado. CONCLUSIONES: La población geriátrica y la integrada por pacientes críticos presenta la necesidad de utilización de los antimicrobianos con una  estrecha monitorización. Vías de administración recomendadas en la primera,  están desaconsejadas en la segunda. La vía inhalada es una vía que suele  relacionarse con elevadas concentraciones en pacientes con infecciones  respiratorias. Los modelos farmacocinéticos son un soporte de gran valor para poblaciones como la geriátrica debido a que es mayoritariamente excluida de los ensayos clínicos.

Terapia antimicrobiana personalizada en pacientes críticos y en edad avanzada / Personalized antimicrobial therapy in critical and elderly patients

Objetivo: La terapia personalizada en el tratamiento de las infecciones esesencial para garantizar la optimización de los niveles de fármaco alcanzadosen el paciente tratado. Adicionalmente, esta estrategia, juntamente con el conocimiento de la actividad antimicrobiana de estos fármacos, disminuye la posibilidad de desarrollar resistencias bacterianas y mejora el perfil de seguridad deestos fármacos. Las terapias por vías alternativas, como la inhalada, y el soportede la información facilitada por modelos farmacocinéticos son esencialesdebido a la limitación de la actividad aportada por los nuevos antimicrobianos.Método: Se presenta una revisión no sistemática de la literatura comomedida de orientación de la problemática y soluciones a lo expuesto anteriormente. Se ha efectuado una búsqueda de artículos de alta calidadsobre el tópico planteado.Resultados: Se detectaron 231 artículos que sufrieron una selecciónposterior, en base a la calidad de los trabajos valorada por un equipode cinco farmacéuticos clínicos y un médico intensivista. Finalmente, seincluyeron 153 artículos que soportan la revisión que se ha desarrollado.Conclusiones: La población geriátrica y la integrada por pacientes críticospresenta la necesidad de utilización de los antimicrobianos con una estrechamonitorización. Vías de administración recomendadas en la primera, estándesaconsejadas en la segunda. La vía inhalada es una vía que suele relacionarse con elevadas concentraciones en pacientes con infecciones respiratorias. Los modelos farmacocinéticos son un soporte de gran valor parapoblaciones como la geriátrica debido a que es mayoritariamente excluidade los ensayos clínicos. (AU)

Objective: Personalized therapy in the treatment of infections is essentialto ensure optimization of antimicrobial drug levels. This strategy, togetherwith an understanding of the activity of these drugs, decreases the risk ofbacterial resistance and improves the drugs’ safety profile. Alternative routes of administration, such as inhalation, and the information provided bypharmacokinetic models, are essential given the limitation of antimicrobialactivity allowed by the new antimicrobials.Method: A non-systematic review of the literature is presented as a wayof tackling and finding solutions to the problem. A search for high-qualityarticles on the research topic was conducted.Results: A total of 370 articles were detected, which were subjected toa further selection to discard low quality papers by a team of five clinicalpharmacists and an intensivist. Finally, 153 articles were included in thereview.Conclusions: The geriatric and the critical care patient populationrequire the administration of antimicrobials with close monitoring. The routes of administration recommended for the first group are discouraged forthe second. The inhaled route often results in high plasma concentrationsin patients with respiratory infections. Pharmacokinetic models are a valuable tool in the treatment of geriatric patients, who are often excluded fromclinical trials. (AU)

El sufrimiento existencial en el paciente oncológico en estadio avanzado: dimensiones y ejes vertebradores para la intervención psicológica / Existential Suffering of the Oncologic Patient in an Advanced Stage: Dimensions and Vertebral Axes for a Psychological Intervention / Sofrimento existencial no paciente oncológico em estágio avançado: dimensões e eixos vertebrais para intervenção psicológica

Resumen El alivio del sufrimiento existencial en los pacientes oncológicos en estadio avanzado es un objetivo terapéutico de primer orden. En el presente trabajo se sugieren una serie de ejes sobre los cuales podría pivotar la intervención psicoterapéutica, con el fin de propiciar: 1) la experiencia de que a pesar del "ya" de la situación límite, la vida "todavía" tiene sentido; 2) experiencias emocionales positivas que promuevan el bienestar y la calidad de vida; 3) el afrontamiento de la experiencia de enfermedad grave y de muerte esperada más o menos inminente, mediante el desarrollo de una actitud serena, reconciliada con la vida e integradora con uno mismo y con los demás, a la par que abierta a la trascendencia.

Abstract The relief of existential suffering in the patients with adavanced cancer is a first-order therapeutic goal. The present work suggests some axis on which psychotherapeutic intervention could be developed, in order to facilitate in these patients: 1) The experience of: In spite of the "existing" limited situation, one's life "still" has meaning, 2) Positive emotional experiences that promote well-being and quality of life, and 3) Face the serious illness that will cause one's almost imminent death, through the development of a serene, reconciled attitude with life and integrating with oneself and the others.

Resumo O alívio do sofrimento existencial em pacientes oncológicos em estágio avançado é um objetivo terapêutico de primeira ordem. No presente trabalho, sugerimos uma série de eixos nos quais a intervenção psicoterapêutica poderia girar, a fim de promover: 1) a experiência de que, apesar do "já" da situação limite, a vida "ainda" faz sentido; 2) experiências emocionais positivas, que promovam bem-estar e qualidade de vida; 3) enfrentar a experiência de doença grave e morte esperada mais ou menos iminente, através do desenvolvimento de uma atitude serena, conciliada com a vida e integrando-se consigo mesmo e com os outros, ao mesmo tempo que aberta à transcendência.

Molecular Time Sharing through Dynamic Pulsing in Single Cells.

In cells, specific regulators often compete for limited amounts of a core enzymatic resource. It is typically assumed that competition leads to partitioning of core enzyme molecules among regulators at constant levels. Alternatively, however, different regulatory species could time share, or take turns utilizing, the core resource. Using quantitative time-lapse microscopy, we analyzed sigma factor activity dynamics, and their competition for RNA polymerase, in individual Bacillus subtilis cells under energy stress. Multiple alternative sigma factors were activated in ∼1-hr pulses in stochastic and repetitive fashion. Pairwise analysis revealed that two sigma factors rarely pulse simultaneously and that some pairs are anti-correlated, indicating that RNAP utilization alternates among different sigma factors. Mathematical modeling revealed how stochastic time-sharing dynamics can emerge from pulse-generating sigma factor regulatory circuits actively competing for RNAP. Time sharing provides a mechanism for cells to dynamically control the distribution of cell states within a population. Since core molecular components are limiting in many other systems, time sharing may represent a general mode of regulation.

Stochastic pulse regulation in bacterial stress response.

Gene regulatory circuits can use dynamic, and even stochastic, strategies to respond to environmental conditions. We examined activation of the general stress response mediated by the alternative sigma factor, σ(B), in individual Bacillus subtilis cells. We observed that energy stress activates σ(B) in discrete stochastic pulses, with increasing levels of stress leading to higher pulse frequencies. By perturbing and rewiring the endogenous system, we found that this behavior results from three key features of the σ(B) circuit: an ultrasensitive phosphorylation switch; stochasticity ("noise"), which activates that switch; and a mixed (positive and negative) transcriptional feedback, which can both amplify a pulse and switch it off. Together, these results show how prokaryotes encode signals using stochastic pulse frequency modulation through a compact regulatory architecture.

Repercusión de las ausencias no suplidas en el tamaño de los cupos y el salario de los médicos de familia / Repercussion of absences that are not covered on the size of lists and the salaries of family doctors

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Glutathione and homoglutathione play a critical role in the nodulation process of Medicago truncatula.

Legumes form a symbiotic interaction with bacteria of the Rhizobiaceae family to produce nitrogen-fixing root nodules under nitrogen-limiting conditions. This process involves the recognition of the bacterial Nod factors by the plant which mediates the entry of the bacteria into the root and nodule organogenesis. We have examined the importance of the low molecular weight thiols, glutathione (GSH) and homoglutathione (hGSH), during the nodulation process in the model legume Medicago truncatula. Using both buthionine sulfoximine, a specific inhibitor of GSH and hGSH synthesis, and transgenic roots expressing GSH synthetase and hGSH synthetase in an antisense orientation, we showed that deficiency in GSH and hGSH synthesis inhibited the formation of the root nodules. This inhibition was not correlated to a modification in the number of infection events or to a change in the expression of the Rhizobium sp.-induced peroxidase rip1, indicating that the low level of GSH or hGSH did not alter the first steps of the infection process. In contrast, a strong diminution in the number of nascent nodules and in the expression of the early nodulin genes, Mtenod12 and Mtenod40, were observed in GSH and hGSH-depleted plants. In conclusion, GSH and hGSH appear to be essential for proper development of the root nodules during the symbiotic interaction.

Influencia del status en hierro en la atención y rendimiento intelectual de un colectivo de adolescentes espanoles / Influence of iron status on attention and intellectual performance of a population of Spanish adolescents

Dietetic, hematologic and biochemical data were used to asses the iron status of a group of 64 adolescents (37 males and 27 females), aged 15 to 18 (mean age 15.94 +/- 0.76 years), who study in a High School in the comunidad Aut onoma de Madrid. All were asked to keep a dietary record during 5 days, one of which had to be a sunday. Iron intake was estimated using the Food Composition Tables of the Instituto de Nutrici on (1990). The hematologic survey determined hemoglobin hematocrit mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), serum iron and serum ferritin. These data were correlated with the scores obtained in the attention and school capability test (AT), that gave information about the verbal (V), reasoning (R) and calculus (C) capabilities. There is a positive correlation between MCV (r = 0.2705), MCH (r = 0.3370) ferritin (r = 0.3383) and attention. MCV (r = 0.2995), MCH (r = 0.3998), MCHC (r = 0.3134) and ferritin (r = 0.3970) were also correlated with the speed capability shown on the attention test and the hemoglobin level was correlated with the calculus capability (r = 0.2905). The students who obtained higher scores in the school capability test had also better blood parameter values. This was statistically significant for serum ferritin in males students and for hemoglobin and MCHC in female students. 19.6 per cent of the adolescents had ferritin levels lower than 12 ng/ml. Their intelligence test scores were lower to those who had serum ferritin > or = 12 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)