Effectiveness of a universal personalized intervention for the prevention of anxiety disorders: Protocol of a randomized controlled trial (the prevANS project).

Background: To date, all preventive anxiety disorders interventions are one-fit-all and none of them are based on individual level and risk profile. The aim of this project is to design, develop and evaluate an online personalized intervention based on a risk algorithm for the universal prevention of anxiety disorders in the general population. Methods: A randomized controlled trial (RCT) with two parallel arms (prevANS vs usual care) and 1-year follow-up including 2000 participants without anxiety disorders from Spain and Portugal will be conducted.The prevANS intervention will be self-guided and can be implemented from the prevANS web or from the participants' Smartphone (through an App). The prevANS intervention will have different intensities depending on the risk level of the population, evaluated from the risk algorithm for anxiety: predictA. Both low and moderate-high risk participants will receive information on their level and profile (risk factors) of anxiety disorders, will have access to stress management tools and psychoeducational information periodically. In addition, participants with a moderate-high risk of anxiety disorders will also have access to cognitive-behavioral training (problem-solving, decision-making, communication skills, and working with thoughts). The control group will not receive any intervention, but they will fill out the same questionnaires as the intervention group.Assessments will be completed at baseline, 6 and 12-month follow-up. The primary outcome is the cumulative incidence of anxiety disorders. Secondary outcomes include depressive and anxiety symptoms, risk probability of anxiety disorders (predictA algorithm) and depression (predictD algorithm), improvement in physical and mental quality of life, and acceptability and satisfaction with the intervention. In addition, cost-effectiveness and cost-utility analyses will also be carried out from two perspectives, societal and health system, and analyses of mediators and moderators will also be performed. Discussion: To the best of our knowledge, prevANS study will be the first to evaluate the effectiveness and cost-effectiveness of a personalized online intervention based on a risk predictive algorithm for the universal prevention of anxiety disorders. Trial registration: ClinicalTrials.gov: NCT05682365.

Comparison of the prognostic value of AJCC cancer staging system 7th and 8th editions for differentiated thyroid cancer.

BACKGROUND: In the last American Joint Committee on Cancer/Tumor, Node, Metastasis (AJCC/TNM) 8th edition (TNM8), several changes were introduced to this risk stratification system to improve the prognosis of differentiated thyroid cancer (DTC). AIM: To validate the impact of TNM8 vs. TNM 7th edition (TNM7) in DTC in terms of predictive value in two hospitals from Buenos Aires, Argentina. METHODS: Retrospective study of DTC patients from two institutions. Reclassification from TNM7 to TNM8, disease-specific survival (DSS), and final clinical outcomes at the end of follow-up (recurrent/persistent structural disease) (median 5 years) were analyzed. The proportion of variation explained (PVE) was used to compare the predictive capability of DSS of both classification systems. RESULTS: Reclassification of 245 patients, aged (mean ± SD) 55 ± 15.36 years, 91% women, to TNM8 from TNM7 showed: 82% vs 57% stage I (SI), 10% vs 8.5% SII, 5% vs 22% SIII, 3% vs 12% SIV (p < 0.01). Forty percent of the population was downstaged with TNM8. Ten-year DSS rates for SI, SII, SIII and SIV in TNM7 were 100, 100, 100 and 74%, respectively and in TNM8: 97.6, 100, 100 and 37.5%, respectively. Out of 4 disease-specific deaths in SIV TNM7, one was subclassified to SI TNM8, corresponding to a 53-year-old patient with structural persistence. PVE for TNM8 (29%) was more than twice that of TNM7 (13%). CONCLUSION: In this Argentinian DTC patients sample, it was confirmed that the new TNM8 classification is more accurate in predicting survival attributable to cancer than its previous version.

Mechanisms of energy dissipation and relationship with tissue composition in human meniscus.

OBJECTIVE: The human meniscus is essential in maintaining proper knee joint function. The meniscus absorbs shock, distributes loads, and stabilizes the knee joint to prevent the onset of osteoarthritis. The extent of its shock-absorbing role can be estimated by measuring the energy dissipated by the meniscus during cyclic mechanical loading. METHODS: Samples were prepared from the central and horn regions of medial and lateral human menisci from 8 donors (both knees for total of 16 samples). Cyclic compression tests at several compression strains and frequencies yielded the energy dissipated per tissue volume. A GEE regression model was used to investigate the effects of compression, meniscal side and region, and water content on energy dissipation in order to account for repeated measures within samples. RESULTS: Energy dissipation by the meniscus increased with compressive strain from ∼0.1 kJ/m3 (at 10% strain) to ∼10 kJ/m3 (at 20% strain) and decreased with loading frequency. Samples from the anterior region provided the largest energy dissipation when compared to central and posterior samples (P < 0.05). Water content for the 16 meniscal tissues was 77.9 (C.I. 72.0-83.8%) of the total tissue mass. A negative correlation was found between energy dissipation and water content (P < 0.05). CONCLUSION: The extent of energy dissipated by the meniscus is inversely related to loading frequency and meniscal water content.

Calidad asistencial de la psicología clínica en el Servicio Andaluz de Salud evaluada por los facultativos / Quality of care of Clinical Psychology in the Andalusian Health Service as assessed by professionals

Objetivo: evaluación de la calidad asistencial de los servicios de psicología clínica en el Servicio Andaluz de Salud (SAS) desde la perspectiva de los/as facultativos/as. Método: investigación descriptiva; se elaboró un cuestionario de 39 ítems que evalúa diferentes dimensiones de la calidad asistencial (prevención, accesibilidad, idoneidad de intervenciones de evaluación y tratamiento, seguridad, y coordinación); han participado 83 facultativos/as especialistas de psicología clínica del SAS, lo que supone un 32’17% de la población de referencia en el momento de la recogida de datos.Resultados:la calidad asistencial actual de las prestaciones de psicología clínica en el SAS, partiendo de una ratio de 3,05 facultativos por cada100.000 habitantes, es deficiente, sobre todo en las variables de prevención, intensidad de las intervenciones de tratamiento y seguridad, y especialmente preocupante en los dispositivos del segundo nivel asistencial.Conclusiones: es urgente aumentar el número de profesionales especialistas en psicología clínica por cada 100.000 habitantes para reducir el riesgo que supone para los usuarios la deficiente intensidad con que se practican los tratamientos psicológicos; asimismo, es necesario establecer estándares de la carga de trabajo de los psicólogos clínicos para poder ofrecer una calidad asistencial adecuada, e integrar indicadores medibles de calidad en los sistemas de información de salud mental (AU)

Objective: Evaluation of healthcare quality of clinical psychology services in the Andalusian Health Service (SAS) from the perspective of the facultative. Method: Descriptive research. For data collection, a 39-item questionnaire was developed that assesses various dimensions of quality (prevention, accessibility, suitability of evaluation and treatment interventions, safety, and care coordination). A sample of 83 clinical psychologists responded to the questionnaire, representing 32.17% of the reference population, 258 facultative who, at the time of data collection make up the SAS staff. Results: The current quality of care of clinical psychology services in the SAS, based on a ratio of 3.05 clinical psychologists per 100,000 inhabitants, is deficient, especially in the dimensions of prevention, intensity of treatment interventions, and safety, and worrisome in the 2nd level of care. Conclusions: It is urgent to increase the ratio of clinical psychologists/100,000 inhabitants to reduce the risk posed for users by the deficient intensity with which psychological treatments are currently practiced. It is necessary to esta-blish standards for the workload of clinical psychologists in order to offer an adequate quality of care, and to integrate measurable indicators of quality in mental health information systems (AU)

Psychometric characteristics of Spanish adaptation of a Test for Bulimia (BULIT).

INTRODUCTION: The high prevalence of bulimia nervosa among eating disorders and limited repertoire of assessment tools available for these disorders in Spanish have resulted in special interest regarding the adaptation of a specific instrument such as the Bulimia Test (BULIT). METHODOLOGY: A total of 119 outpatients, most of them women (97.5%) seen in a community mental health center, were assessed with the Spanish adaptation of the Bulimia Test (BULIT) and by Eating Attitudes Test (EAT-40). Reliability (internal consistency and temporal reliability) and validity (convergent and discriminant) were studied. RESULTS: Cronbach's alpha coefficient (alpha: 0.93) shows high internal consistency while the temporal reliability is supported by the high correlation observed (r=0.83) between applications conducted in an interval of 8-10 weeks. In relationship with convergent validity, moderate correlations were observed with the global score on EAT (r=0.38) and substantial correlation with the EAT Bulimia subscale (r=0.69). By using an 88 cutoff on the BULIT, the test properly classified 90% of the bulimic subjects and 100% of those without eating disorder. CONCLUSIONS: The results firmly supported the reliability and validity of this Spanish adaptation, stressing its utility as a screening device to detect current or incipient cases of bulimia and to assess severity of bulimic symptoms.

Dehydroepiandosterone induction of increased resistance to vancomycin in Staphylococcus aureus clinical isolates (MSSA, MRSA).

AIMS: To investigate whether dehydroepiandosterone (DHEA), an androgen present throughout life, alters the response of Staphylococcus aureus clinical isolates to vancomycin. METHODS AND RESULTS: DHEA in physiologically relevant concentrations (0.1, 0.5, 1.0 and 5.0 micromol l(-1)) was tested for its effect on methicillin-sensitive S. aureus (MSSA, n = 53) and methicillin-resistant S. aureus (MRSA, n = 73) response to vancomycin using standard protocols. Mutant selection was determined by serial transfer of selected isolates (n = 5). DHEA-mediated at least a fourfold increase in vancomycin MIC for 42% of MSSA and 21% of MRSA. For five of the isolates (0.1 and 0.5 micromol l(-1) DHEA) the MIC was increased to levels (8 microg ml(-1)) defined as vancomycin-intermediate resistance. CONCLUSION: Resistance was detected only in the presence of DHEA, and was not related to altered generation time, indicating induction of phenotypic resistance. SIGNIFICANCE AND IMPACT OF THE STUDY: These findings require further investigation to determine what role DHEA plays in clinical vancomycin treatment failure that has been reported in the absence of vancomycin genotypic resistance or heteroresistance.

Metodología de investigación en tartamudez / No disponible

Los clínicos quieren que los investigadores les ofrezcan herramientas claras para tomar decisiones sobre evaluación e intervención en tartamudez. Por su parte los investigadores se quejan del poco interés de los que trabajan en la práctica por los resultados de sus estudios. ¿Dónde está la razón de tanto alejamiento?, ¿por qué es tan profundo el abismo que separa a clínicos e investigadores? Tal vez porque la etiología de la tartamudez sigue siendo, en gran medida, una incógnita; tal vez porque los estudios que tratan de testar los resultados que obtienen los tratamientos siguen teniendo grandes lagunas metodológicas. Este es el tema que abordamos en este artículo dedicado a la metodología de trabajo en tartamudez. Nuestro objetivo es ofrecer al lector una descripción detallada del “state of the art” de la metodología de investigación en disfemia, para que los clínicos sepan a qué atenerse cuando revisan los resultados de los trabajos científicos. La revisión, lo reconocemos de antemano, quiere ser crítica, describiremos diseños pero haciendo énfasis en sus limitaciones tratando desde la crítica de proponer soluciones nuevas para futuros investigadores del campo. Plantearemos por separado los dos tipos de estudios clave: a) los causales que buscan aportar datos sobre la naturaleza del trastorno, y b) los dedicados a establecer la eficacia de los tratamientos (AU)

Clinicians want researchers to provide them with clear decisionmaking tools for evaluation and intervention in stuttering. At the same time, researchers complain about the lack of interest that practitioners have in research issues. Why is there so great a gulf between clinicians and researchers? Perhaps because the origin of stuttering is still not well understood; perhaps because the studies aimed at testing the efficacy of treatments still have serious methodological deficiencies. This is the subject of this paper. The main goal of this work is to describe the current status of methodologies used to study stuttering, with the goal of offering clinicians with the knowledge required to analyse and evaluate the results of scientific studies on this topic. We will critically review the different research designs used, seeking to show their strengths and limitations, and sometimes proposing new solutions to future researchers in the field. Two types of studies will be described: a) causal studies about the nature of the disorder, and b) studies aimed at establishing the efficacy of treatments (AU)

Social functioning scale: new contributions concerning its psychometric characteristics in a Spanish adaptation.

The assessment of social functioning takes on special importance with the development of promising new types of psychosocial intervention for the treatment of schizophrenia. Nevertheless, there are still few satisfactorily reliable instruments for the assessment of social functioning that are reasonably applicable in terms of time. This scarcity is even more notable in the Spanish language. The aim of this study is to validate a Spanish version of the Social Functioning Scale (SFS) giving new data (test-retest stability and concurrent validity) on the psychometric characteristics of the scale. One hundred and fifty subjects with a diagnosis of functional psychosis according to the DSM-III-R (codes 295-298) criteria - 105 (70%) of them schizophrenic patients - in an outpatient regimen of the Community Mental Health Center were assessed using a Spanish version of the Social Functioning Scale. The reliability and validity of the scale were studied. Data on the reliability (internal consistency, item-total correlation, test-retest and informant/self-report reliability) and validity (of the construct, concurrent and the criterion group method) revealed a substantial fulfillment of the basic psychometric criteria. The results corroborate the favorable psychometric characteristics of the scales and support the worth of the instrument for the assessment of the social functioning of psychotic patients when there is reliable and feasible assessment of out-patients.

The Mannheim interview on social support psychometric characteristics of a Spanish version.

This study analysed the psychometric characteristics of a Spanish version of the Mannheim Interview on Social Support (MISS) with 82 mental health care centre outpatients. Moderate and high correlation coefficients were obtained on test-retest reliability for a 6 week interval. In addition, correlations with the Revised UCLA Loneliness Scale and the Perceived Social Support scale confirmed an acceptable concurrent validity.

[Behavior disorders and schizophrenia: a study using the SBS (Social Behavior Schedule) in the Ecija District]. / Problemas de conducta y esquizofrenia: estudio mediante el SBS (Social Behaviour Schedule) en el distrito de Ecija.

By the application of SBS (Social Behaviour Schedule) the frequency and severity of the behaviour problems of all schizophrenics patients treated by the Mental Health Center of the Ecija District is evaluated. In this way relevant information can be obtained in order to develop priority programs of psychosocial intervention.

[Some results obtained by population projections]. / Algunos resultados obtenidos en los pronosticos de poblacion.

PIP: Within the context of the "Study Program for the elaboration of a strategy concerning the economic and social development up to the year 2000" sponsored by the Central Planning Committee, some studies have been conducted in relation to the prospective demographic development of the Cuban population. A team of qualified experts of which the author is a member, have performed some population studies. Guided by the Statistics State Committee, it has put forward several papers concerning the demographic analysis and prognosis of the country. The paper presents a brief analysis of the current situation of demographic growth factors. Special emphasis is placed on a fecundity study, pointing out the rapid decrease observed in it during the last few years. Trends observed in Cuba have been compared with those occurring in other countries. On the basis of the current situation analysis, 5 hypotheses formulated by a team of experts are presented in order to make a 1st approach concerning what the future demographic development could be. The most general results obtained in the prognosis are presented. This extends to the year 2075 in order to analyze not only the closer prospective situation but also possible future trends. Brief comments are made on the situations that each hypothesis leads to, graphically illustrating their respective effects with regard to the volume and structure of the prospective population according to age. Some criteria are presented about the probable future trends in the demographic sphere, according to the current situation. It is concluded that these trends seem favorable for the socioeconomic development of the country but that it is necessary to perform similar studies in the coming years with the intention of making the additional assessments. (author's)^ieng

Los niveles de mortalidad en Cuba durante el siglo XX / Mortality levels in Cuba during the 20th century

Se plantea que para medir adecuadamente cómo se ha mantenido, durante el siglo XX la variable mortalidad, lo mejor sería contar con tablas de mortalidad para un buen número de años. De esta manera resultaría factible realizar estudios sobre la tendencia de esta variable en el país. La información que debe manejarse para ello a veces es fragmentaria o no existe. Se señala que en el presente documento se conjugan los resultados obtenidos en dos ensayos que abordan este tema. Partiendo de algunas tablas de mortalidad calculadas para Cuba en momentos aislados, se ha logrado- mediante la aplicación de técnicas de estimación demográfica- obtener primeramente tablas de mortalidad estimadas por sexo para los años calendarios terminados en cero y en cinco a partir del año 1900 y hasta 1950. Se destaca que el método permite, además, realizar una interpolación, dado el conocimiento de al menos dos tablas (AU)