Prader-Willi syndrome in a large sample from Spain: general features, obesity and regular use of psychotropic medication.

BACKGROUND: Prader-Willi syndrome (PWS), a genetically determined disorder, the most frequent cause of early onset obesity, is associated with physical and cognitive dysfunctions and behavioural disturbances; these disturbances are frequently treated with psychotropic medication. The aim of this cross-sectional study was to describe the characteristics of the first large national sample of persons with PWS in Spain and analyse the relationships of those characteristics with key demographic and clinical factors, particularly with obesity and the regular use of psychotropic medication. METHODS: Participants were recruited among all members of the Spanish Prader-Willi Association who agreed to take part in the study and fulfilled its inclusion criteria. Family and patient demographic features, family size and birth order, intelligence quotient (IQ), anthropometric measures, lifestyle habits, behavioural disturbances (with the Aberrant Behavior Checklist) and clinical data, as well as use of psychotropic drugs and their side effects (with the UKU scale), were collected in genetically confirmed cases of PWS. Bivariate and logistic regression analyses were used for determining the associations of demographic and clinical factors with both obesity and the regular use of psychotropic medication. RESULTS: The cohort included 177 participants (aged 6-48 years), that is, 90 (50.8%) males and 87 (49.2%) females. Behavioural disturbances were present in a range of 75% to 93% of participants; psychotropic medication was prescribed to 81 (45.8%) of them. Number of siblings showed a direct correlation with IQ, especially among males, and inappropriate speech was more intense in only-child females. Obesity was, in parallel, strongly associated with ascending age and with not being currently under growth hormone (GH) treatment. Participants taking any psychotropic medication were characterised by more frequent age ≥30 years, high level of hyperactivity and a psychiatric diagnosis. CONCLUSIONS: Characterisation of persons with PWS in Spain confirms their physical and behavioural phenotype and supports the long-term application of GH therapy and the rational use of psychotropic medication.

Estudio FOTOTRANS: estudio multicéntrico sobre la validez del Fototest en condiciones de práctica clínica / FOTOTRANS Study. Multicentre study on the validity of Fototest under clinical practice conditions

Objetivo: El Fototest es un test breve, fácil, aplicable a analfabetos y no influido por el nivel educativo. El objetivo de este estudio es evaluar su validez para deterioro cognitivo (DC) y demencia (DEM) en condiciones de práctica clínica habitual. Material y métodos: Estudio transversal multicéntrico y naturalístico realizado en consultas de neurología general. Se incluyó a sujetos mayores de 60 años con diagnóstico previamente establecido de no deterioro cognitivo (NoDC), deterioro cognitivo sin demencia (DCsD) o demencia (DEM). La validez discriminativa se evaluó mediante el área bajo la curva ROC (aROC), sensibilidad (S), especificidad (E) y cocientes de probabilidad. Se calcularon correlaciones parciales ajustadas por edad, sexo y nivel educativo con Eurotest, fluidez verbal semántica (FVS) y el estadio GDS para evaluar la validez concurrente y de constructo.Resultados: Diecinueve neurólogos incluyeron a un total de 589 sujetos: 361 NoDC, 106 DCsD y 122 DEM. La validez discriminativa es mejor para DEM (aROC 0,94±0,02) que para DC (0,86±0,02). Para DEM el mejor punto de corte es 26/27 (S=0,88 [IC del 95%, 0,93-0,97], E=0,87 [IC del 95%, 0,84-0,90]), y para DC, 28/29 (S=0,71 [IC del 95%, 0,65-0,77], E=0,84 [IC del 95%, 0,80-0,88]). El Fototest muestra una alta y significativa correlación con el Eurotest (r=0,70±0,02), la FVS (r=0,68±0,02) y el estadio GDS (r=-0,77±0,02). Conclusión: El Fototest muestra una adecuada validez para DC y DEM, en consultas generales de neurología de un extenso y variado ámbito geográfico (AU)

Objective: Fototest is a short simple test, applicable to illiterate subjects and not influenced by educational level. The purpose of this study is to assess its validity for cognitive impairment (CI) and dementia (DEM) under routine clinical practice conditions. Material and methods: A cross-sectional, multicentre and naturalistic study conducted in General Neurology clinics. The subjects were, over 60 years old, with a previously established diagnosis of no cognitive impairment (NoCI), cognitive impairment without dementia (CInoDEM), or dementia (DEM). The discriminant validity was assessed using the area under the ROC curve (AUC), sensitivity (Sn), specificity (Sp), and probability coefficients. Partial correlations were calculated, adjusted for age, sex and education level with Eurotest, verbal fluency test (VFT) and Global Deterioration Scale (GDS) score to evaluate the concurrent and construct validity.Results: Nineteen neurologists included a total of 589 subjects: 361 NoCI, 106 CINoDEM and 122 DEM. The discriminant value was better for DEM (AUC 0.94±0.02) than for CI (0.86±0.02). For DEM the best cut-off point was 26/27 (Sn=0.88 [95% CI, 0.93-0.97], Sp=0.87 [95% CI, 0.84-0.90]); and for CI, 28/29 (Sn=0.71 [95% CI, 0.65-0.77], Sp=0.84 [95% CI, 0.80-0.88]). Fototest showed a high and significant correlation with Eurotest (r=0.70±0.02), VFT (r=0.68±0.02) and the GDS score (r=-0.77±0.02).Conclusion: The Fototest showed adequate validity for CI and DEM in general Neurology clinics in an extensive and wide geographical area (AU)

[FOTOTRANS study: multicentre study on the validity of Fototest under clinical practice conditions]. / Estudio FOTOTRANS: estudio multicéntrico sobre la validez del Fototest en condiciones de práctica clínica.

OBJECTIVE: Fototest is a short simple test, applicable to illiterate subjects and not influenced by educational level. The purpose of this study is to assess its validity for cognitive impairment (CI) and dementia (DEM) under routine clinical practice conditions. MATERIAL AND METHODS: A cross-sectional, multicentre and naturalistic study conducted in General Neurology clinics. The subjects were, over 60 years old, with a previously established diagnosis of no cognitive impairment (NoCI), cognitive impairment without dementia (CInoDEM), or dementia (DEM). The discriminant validity was assessed using the area under the ROC curve (AUC), sensitivity (Sn), specificity (Sp), and probability coefficients. Partial correlations were calculated, adjusted for age, sex and education level with Eurotest, verbal fluency test (VFT) and Global Deterioration Scale (GDS) score to evaluate the concurrent and construct validity. RESULTS: Nineteen neurologists included a total of 589 subjects: 361 NoCI, 106 CINoDEM and 122 DEM. The discriminant value was better for DEM (AUC 0.94 ± 0.02) than for CI (0.86 ± 0.02). For DEM the best cut-off point was 26/27 (Sn=0.88 [95% CI, 0.93-0.97], Sp=0.87 [95% CI, 0.84-0.90]); and for CI, 28/29 (Sn=0.71 [95% CI, 0.65-0.77], Sp=0.84 [95% CI, 0.80-0.88]). Fototest showed a high and significant correlation with Eurotest (r=0.70 ± 0.02), VFT (r=0.68 ± 0.02) and the GDS score (r=-0.77 ± 0.02). CONCLUSION: The Fototest showed adequate validity for CI and DEM in general Neurology clinics in an extensive and wide geographical area.

Normative and reliability study of Fototest.

INTRODUCTION: The Fototest is a brief cognitive test suitable for illiterate persons, and valid and accurate for detecting cognitive impairment or dementia. Our aim was to conclude the development of this instrument carrying out a normative and reliability study. METHOD: The normative study was performed on a convenience sample of 223 healthy volunteers aged between 20 and 85 years. The test-retest reliability was assessed through a repeated-measures cross-sectional design on a sample of 50 subjects with no cognitive impairment; the inter-rater reliability was determined by the blind assessment of 10 test applications performed by 30 independent observers; in both instances, reliability was expressed as intra-class correlation coefficient. Internal consistency was analysed by Cronbach's alpha coefficient. RESULTS: The results on the Fototest are normally distributed and are not influenced by gender or educational level but they do vary with age. The test-retest reliability of the Fototest was 0.89 (95% CI: 0.81-0.93); the inter-rater reliability, 0.98 (95% CI: 0.96-0.99); and the internal consistency, 0.94. CONCLUSIONS: The Fototest is free from educational influence and shows appropriate test-retest and inter-rater reliabilities, as well as a high internal consistency. Therefore, it is a suitable psychometric instrument to be used in the follow-up of patients with cognitive impairment or dementia, especially in contexts where evaluators are not the same on different occasions, or with patients of low educational level.

Estudio normativo y de fiabilidad del fototest / Normative and reliability study of fototest

Introducción: El Fototest es un test cognitivo breve aplicable a analfabetos, válido y útil para la detección de deterioro cognitivo y demencia. Nuestro objetivo es completar el proceso de desarrollo del instrumento llevando a cabo un estudio normativo y de fiabilidad. Métodos: El estudio normativo se realizó en una muestra de conveniencia de 223 sujetos voluntarios sanos entre 20 y 85 años. La fiabilidad test-retest (Ftr) se evaluó mediante un diseño transversal de medidas repetidas en una muestra de 50 sujetos sin deterioro cognitivo; la fiabilidad interobservador (Fio) se determinó mediante la evaluación a ciegas de 10 aplicaciones del test por 30 observadores independientes; en ambos casos se utilizó el coeficiente de correlación intraclase. La evaluación de la consistencia interna (CI) se llevó a cabo mediante el coeficiente alfa de Cronbach. Resultados: Los resultados del Fototest se distribuyen normalmente y no están influenciados por el sexo ni el nivel educativo, pero sí por la edad. La Ftr del Fototest es 0,89 (IC 95%: 0,81-0,93), la Fio es de 0,98 (IC 95%: 0,96-0,99) y 0,94 la CI. Conclusiones: El Fototest está libre de influencias educativas y tiene una adecuada fiabilidad, tanto Ftr como Fio, y una alta consistencia interna, por tanto, es un instrumento adecuado para ser usado en el seguimiento de pacientes con deterioro cognitivo y demencia sobre todo en entornos en que cambien los evaluadores, en especial en poblaciones con bajo nivel educativo (AU)

Introduction: The Fototest is a brief cognitive test suitable for illiterate persons, and valid and accurate for detecting cognitive impairment or dementia. Our aim was to conclude the development of this instrument carrying out a normative and reliability study.Method: The normative study was performed on a convenience sample of 223 healthy volunteers aged between 20 and 85 years. The test-retest reliability was assessed through a repeated-measures cross-sectional design on a sample of 50 subjects with no cognitive impairment; the inter-rater reliability was determined by the blind assessment of 10 test applications performed by 30 independent observers; in both instances, reliability was expressed as intra-class correlation coefficient. Internal consistency was analysed by Cronbach's alpha coefficient.Results: The results on the Fototest are normally distributed and are not influenced by gender or educational level but they do vary with age. The test-retest reliability of the Fototest was 0.89 (95% CI: 0.81-0.93); the inter-rater reliability, 0.98 (95% CI: 0.96-0.99); and the internal consistency, 0.94. Conclusions: The Fototest is free from educational influence and shows appropriate test-retest and inter-rater reliabilities, as well as a high internal consistency. Therefore, it is a suitable psychometric instrument to be used in the follow-up of patients with cognitive impairment or dementia, especially in contexts where evaluators are not the same on different occasions, or with patients of low educational level (AU)

Seguridad de inmunoterapia con veneno de himenópteros en pauta agrupada. Perspectiva de enfermería / Safety of hymenopteran venoms immunotherapy in a cluster schedule. A nursing perspective

Fundamento. La gravedad inherente a la hipersensibilidadIgE mediada a veneno de himenópteros impone la necesidadde alcanzar, en el menor plazo de tiempo posible, ladosis de mantenimiento en la inmunoterapia con venenos.El objetivo del presente trabajo es valorar la seguridad deuna pauta agrupada (cluster) de inmunoterapia subcutáneacon veneno de himenópteros, que reduce de 12 a 3 semanasel tiempo necesario para llegar a la dosis de mantenimiento.Material y métodos. El estudio fue realizado en 30 pacientes,24 varones y 6 mujeres con una media de edad de 46,06años, que habían sido diagnosticados de hipersensibilidada veneno de himenópteros y se les había indicado tratamientocon inmunoterapia. Los pacientes recibieron inmunoterapiafrente a veneno de himenópteros Pharmalgen®(ALK Abelló), 13 fueron de Apis mellífera, 12 de Véspula spp,y 5 de Polistes spp, con una pauta agrupada que consistióen: día 1 (4μg + 6μg), día 8 (10μg + 30μg) y día 15 (40μg +60μg). Se valoraron las reacciones ocurridas durante la fasede inicio entre abril de 2005 y febrero de 2008.Resultados. De los 30 pacientes vacunados 2 presentaronreacción local exagerada, otros síntomas inespecíficos endos ocasiones y 2 más reacción sistémica. Uno tras administrarla dosis de 40μg, presentó reacción sistémica grado III,y el otro tras recibir la dosis de 60 μg, presentó una reacciónsistémica grado II. Ambos pasaron a una pauta convencionalde administración de inmunoterapia y tuvieron nuevasreacciones de grado III por lo que se les mantiene la inmunoterapiacon premedicación con antihistamínicos orales.Discusión. El estudio confirma que la pauta utilizada es seguracon una baja incidencia de reacciones adversas, 1,67%presentó reacción local exagerada, 1,11% tuvo reaccióninespecífica y 1,11% reacción sistémica(AU)

Background. The inherent seriousness of IgE mediated hypersensitivityto hymenopteran venoms makes it necessary toreach, in the shortest period of time, the maintenance dosein immunotherapy with poisons. The aim of this article is toevaluate the safety of a cluster schedule of subcutaneous Hymenopteranvenoms immunotherapy, which reduces the timeneeded to reach the maintenance dose from 12 to 3 weeks.Material and methods. Thirty patients, 24 men and 6 womenwith an average age of 46.06 years, who had beendiagnosed with hypersensitivity to the poison of hymenopteransand for whom immunotherapy had been prescribedparticipated in the study. The patients received Pharmalgen® (ALK Abelló) immunotherapy against hymenopteranvenoms, 13 Apis mellífera, 12 Véspula spp, and 5 Polistes spp,with a cluster schedule that consisted of: day 1 (4μg + 6μg),day 8 (10μg + 30μg) and day 15 (40μg + 60μg). The reactionsoccurring during the starting phase between April 2005 andFebruary 2008 were evaluated.Results. Of the 30 vaccinated patients 2 presented an exaggeratedlocal reaction, there were other non-specific symptomson two occasions, and another 2 presented systemicreaction. One following administration of the dose of 40μgpresented a grade III systemic reaction, and the other afterreceiving the dose of 60μg presented a grade II systemicreaction. Both passed to a conventional model of immunotherapyadministration and had new grade III reactions, andwere therefore kept on immunotherapy with premedicationwith oral antihistamines.Discussion. The study confirms that the model employedis safe with a low incidence of adverse reactions, 1.67%presented an exaggerated local reaction, 1.11% had an nonspecificreaction and 1.11% a systemic reaction(AU)

[Safety of hymenopteran venoms immunotherapy in a cluster schedule. A nursing perspective]. / Seguridad de inmunoterapia con veneno de himenópteros en pauta agrupada. Perspectiva de enfermería.

BACKGROUND: The inherent seriousness of IgE mediated hypersensitivity to hymenopteran venoms makes it necessary to reach, in the shortest period of time, the maintenance dose in immunotherapy with poisons. The aim of this article is to evaluate the safety of a cluster schedule of subcutaneous hymenopteran venom immunotherapy, which reduces the time needed to reach the maintenance dose from 12 to 3 weeks. MATERIAL AND METHODS: Thirty patients, 24 men and 6 women with an average age of 46.06 years, who had been diagnosed with hypersensitivity to the poison of hymenopterans and for whom immunotherapy had been prescribed participated in the study. The patients received Pharmalgen (ALK Abelló) immunotherapy against hymenopteran venoms, 13 Apis mellífera, 12 Véspula spp, and 5 Polistes spp, with a cluster schedule that consisted of: day 1 (4 microg + 6 microg), day 8 (10 microg + 30 microg) and day 15 (40 microg + 60 microg). The reactions occurring during the starting phase between April 2005 and February 2008 were evaluated. RESULTS: Of the 30 vaccinated patients 2 presented an exaggerated local reaction, there were other non-specific symptoms on two occasions, and another 2 presented systemic reaction. One following administration of the dose of 40 microg presented a grade III systemic reaction, and the other after receiving the dose of 60 microg presented a grade II systemic reaction. Both passed to a conventional model of immunotherapy administration and had new grade III reactions, and were therefore kept on immunotherapy with premedication with oral antihistamines. DISCUSSION: The study confirms that the model employed is safe with a low incidence of adverse reactions, 1.67% presented an exaggerated local reaction, 1.11% had an non-specific reaction and 1.11% a systemic reaction.

Nombres de personas: una prueba de fluidez verbal sin influencias socioeducativas / Names of persons: a verbal fluency test without socioeducational influences

Introducción. Las tareas de fluidez verbal semántica(FVS) se emplean ampliamente por su facilidad, brevedad yutilidad diagnóstica (UD), pero tienen el inconveniente deestar muy influidas por variables socioeducativas. Nuestroobjetivo es evaluar la posible influencia de estas variables enla tarea de fluidez «nombres de personas» (FVS-np).Métodos. Estudio transversal en 226 pacientes neurológicosclasificados en demencia (criterios DSM-IV), deteriorocognitivo sin demencia (criterios GENCyD-SEN) y no deteriorocognitivo a los que se aplicó una prueba de FVS-np yla prueba clásica de fluidez verbal «nombres de animales»(FVS-an). Se evaluó la UD de sus resultados para demencia ydeterioro cognitivo mediante el cálculo y comparación delárea bajo la curva ROC (aROC); asimismo se evaluó la influenciaen los resultados de las variables socioeducativas ydel estado cognitivo mediante un estudio de regresión linealmúltiple.Resultados. No hay diferencia significativa entre la UDde la FVS-np y FVS-an para demencia (0,88 ± 0,02 [aROC ±error estándar, ee] frente a 0,90 ± 0,02, respectivamente) nipara deterioro cognitivo (0,88 ± 0,02 frente a 0,87 ± 0,02).Los resultados de la FVS-an están asociados a la edad, el sexo,el nivel educativo y el estado cognitivo del sujeto, encambio los de la FVS-np sólo dependen del estado cognitivo.Discusión. La tarea de FVS-np tiene las mismas ventajasy UD que la FVS-an, pero disfruta de la ventaja adicional deno estar influenciada por variables socioeducativas, no precisandoajustes ni correcciones de puntuación. Esta independenciala hace especialmente apta para su uso en poblacionesmulticulturales y con bajo nivel educativo (AU)

Introduction. Semantic verbal fluency (SVF) tasksare widely used because of their simplicity, brevity anddiagnostic accuracy (DA). However, they have the disadvantageof being greatly influenced by socioeducationalvariables. Our objective is to assess the possible influenceof these variables on the fluency test «names of persons» (SVF-np).Methods. Cross-sectional study in 226 neurologypatients classified in dementia (DSM-IV criteria), cognitiveimpairment without dementia (GENCyD-SEN criteria)and non-cognitive impairment who responded to aSVF-np test and to the classical test of verbal fluency,«names of animals» (SVF-an), evaluating the DA of theirresults for both dementia and cognitive impairment bycalculating and comparing the area under the ROC curve(aROC). In addition, the influence of the socioeducationalvariables and cognitive state on the results was assessedthrough multiple linear regression analysis.Results. There were no significant differences betweenthe DA of the SVF-np and SVF-an for dementia(0.88 ± 0.02 [aROC ± SD] vs. 0.90 ± 0.02, respectively) orfor cognitive impairment (0.88±0.02 vs. 0.87±0.02). Thescores of the SVF-an task were associated with age, sex,educational level and cognitive status of the subject. Onthe contrary, those of the SVF-np task only dependedon the cognitive status.Discussion. The SVF-np task has the same advantagesand DA as the SVF-an, but it has the additional advantageof not being influenced by socioeducational variables andnot requiring score adjustments or corrections. This independencemakes it especially appropriate for use inmulticultural populations and persons with low educationallevel (AU)

[Names of persons: a verbal fluency test without socioeducational influences]. / Nombres de personas: una prueba de fluidez verbal sin influencias socioeducativas.

INTRODUCTION: Semantic verbal fluency (SVF) tasks are widely used because of their simplicity, brevity and diagnostic accuracy (DA). However, they have the disadvantage of being greatly influenced by socioeducational variables. Our objective is to assess the possible influence of these variables on the fluency test "names of persons" (SVF-np). METHODS: Cross-sectional study in 226 neurology patients classified in dementia (DSM-IV criteria), cognitive impairment without dementia (GENCyD-SEN criteria) and non-cognitive impairment who responded to a SVF-np test and to the classical test of verbal fluency "names of animals" (SVF-an), evaluating the DA of their results for both dementia and cognitive impairment by calculating and comparing the area under the ROC curve (aROC). In addition, the influence of the socioeducational variables and cognitive state on the results was assessed through multiple linear regression analysis. RESULTS: There were no significant differences between the DA of the SVF-np and SVF-an for dementia (0.88 +/- 0.02 [aROC +/- SD] vs. 0.90 +/- 0.02, respectively) or for cognitive impairment (0.88 +/- 0.02 vs. 0.87 +/- 0.02). The scores of the SVF-an task were associated with age, sex, gender, educational level and cognitive status of the subject. On the contrary, those of the SVF-np task only depended on the cognitive status. DISCUSSION: The SVF-np task has the same advantages and DA as the SVF-an, but it has the additional advantage of not being influenced by socioeducational variables and not requiring score adjustments or corrections. This independence makes it especially appropriate for use in multicultural populations and those persons with low educational level.

Evaluación de la fiabilidad del EUROTEST / Reliability assessment of the EUROTEST

Introducción. El EUROTEST es un instrumento válido y útil para la detección de deterioro cognitivo y demencia. Nuestro objetivo fue evaluar la fiabilidad test-retest (FTR) y la fiabilidad interobservador (FIO) de este instrumento. Métodos. La FTR se evaluó mediante un diseño transversal de medidas repetidas en una muestra de 30 sujetos sin deterioro cognitivo; la FIO se determinó mediante la evaluación a ciegas de 10 aplicaciones del test por 20 observadores independientes; en ambos casos se utilizó el coeficiente de correlación intraclase y los resultados se compararon con los obtenidos con las mismas muestras y los mismos procedimientos por el Test de Fluidez Verbal semántica (TFVs). Resultados. No hay diferencia significativa en las características de los sujetos de este estudio y las de estudios previos del EUROTEST. La FTR del EUROTEST (0,94 [IC 95%: 0,87-0,97]) fue significativamente superior a la del TFVs (0,51 [IC 95 %: 0,17-0,74]); no hubo diferencia significativa, en cambio, entre la FIO del EUROTEST (0,91 [IC 95 %: 0,82- 0,97]) y la del TFVs (0,96 [IC 95%: 0,91-0,99]). Conclusiones. El EUROTEST tiene altas FTR y FIO; por tanto, es un instrumento adecuado para seguir evolutivamente a sujetos con demencia y evaluar su respuesta al tratamiento

Introduction. The EUROTEST is a valid and useful instrument for detecting cognitive impairment and dementia. Our aim was to assess the test-retest reliability (TRTR) and the inter-rater reliability (IRR) of this instrument. Methods. We assessed the TRTR by means of a cross-sectional repeated measures design in 30 subjects with no cognitive impairment. The IRR was determined through the blind assessment of 10 test administrations by 20 independent observers. In both instances we calculated the intra-class correlation coefficient and we compared those coefficients with the ones of the semantic Verbal Fluency Test (sVFT) obtained with the same samples and procedures. Results. There were not significant differences concerning the characteristics of the subjects included in this study and those of previous studies on the EUROTEST. The EUROTEST showed a significantly higher TRTR (0.94 [95% CI: 0.87-0.97]) than the sVFT (0.51 [95% CI: 0.17- 0.74]), but there was not significant difference in IRR between the EUROTEST (0.91 [95% CI: 0.82-0.97]) and the sVFT (0.96 [95% CI: 0.91-0.99]). Conclusions. The EUROTEST shows high TRTR and IRR; therefore, this instrument is appropriate for the longitudinal assessment of subjects with dementia and their response to treatment

[Reliability assessment of the EUROTEST]. / Evaluación de la fiabilidad del EUROTEST.

INTRODUCTION: The EUROTEST is a valid and useful instrument for detecting cognitive impairment and dementia. Our aim was to assess the test-retest reliability (TRTR) and the inter-rater reliability (IRR) of this instrument. METHODS: We assessed the TRTR by means of a cross-sectional repeated measures design in 30 subjects with no cognitive impairment. The IRR was determined through the blind assessment of 10 test administrations by 20 independent observers. In both instances we calculated the intra-class correlation coefficient and we compared those coefficients with the ones of the semantic Verbal Fluency Test (sVFT) obtained with the same samples and procedures. RESULTS: There were not significant differences concerning the characteristics of the subjects included in this study and those of previous studies on the EUROTEST. The EUROTEST showed a significantly higher TRTR (0.94 [95% CI: 0.87-0.97]) than the sVFT (0.51 [95% CI: 0.17- 0.74]), but there was not significant difference in IRR between the EUROTEST (0.91 [95% CI: 0.82-0.97]) and the sVFT (0.96 [95% CI: 0.91-0.99]). CONCLUSIONS: The EUROTEST shows high TRTR and IRR; therefore, this instrument is appropriate for the longitudinal assessment of subjects with dementia and their response to treatment.

Formación continuada y continuidad en la habilitación / Continuing training and continuity in training

No disponible

Cannabis-induced psychosis: a cross-sectional comparison with acute schizophrenia.

OBJECTIVE: The existence of cannabis-induced psychosis (CP) remains controversial, partly because of methodological problems. We hypothesize that acute schizophrenia (AS) and CP can have distinct demographic, premorbid and clinical features. METHOD: We compared 26 patients with CP to 35 with AS, after their cannabis-consumption status was confirmed by repeated urine screens. Patients with CP were assessed after at least 1 week but not more than 1 month of abstinence. Symptoms were evaluated with the Present State Examination (PSE). RESULTS: In group CP, male gender, expansive mood and ideation, derealization/depersonalization, visual hallucinations, and disturbances of sensorium were more frequent than in group AS. Premorbid schizoid personality traits were more frequently associated to AS and antisocial personality traits to CP. CONCLUSION: The continuous heavy use of cannabis can induce a psychotic disorder distinct from AS. These two clinical entities share some features but they differ in others.

Sarcoma de Monte de Venus: una presentación infrecuente / Testicular germ-cell tumor in two siblings: a propos of a new case

Los sarcomas de partes blandas son raros. Tan sólo representan el 0,7 por ciento de los tumores malignos en el adulto, y el 1-3 por ciento de los tumores de vulva. Embriológicamente derivan del mesenquima primitivo y pueden asentar en cualquier parte del organismo.Existe gran variedad de tipos histológicos con más de 30 subtipos, siendo difícil la distinción entre ellos.A propósito de un caso de sarcoma en el Monte de Venus tratado en nuestro servicio realizamos una revisión de la bibliografía existente (AU)

[Visuo-perceptual processing in patients with schizophrenia treated with typical or atypical antipsychotics]. / Procesamiento visuo-perceptivo en los pacientes con esquizofrenia tratados con antipsicóticos típicos y los tratados con atípicos.

OBJECTIVE: This is a pilot study exploring the possible association between a particular antipsychotic (AP) medication regime and both clinical and visuo-perceptual features. SUBJECTS AND METHOD: A series of 32 patients (25 males; mean age+/- SD = 28.1+/- 5.1 years, range 20-39) suffering from schizophrenia for at least two years (mean+/- SD duration of illness = 6.0+/- 3.6 years), and maintained on the same antipsychotic medication for at least one year, were divided into four groups according to their maintenance medication. Their assessment included the Positive and Negative Syndrome Scale (PANSS), the Rey's Complex Figure test (visual perception and memory), and Leff's BELS scale (skills of daily living). RESULTS: There were not significant differences in demographic features or daily living skills. The patients on oral classical APs scored significantly higher on the disorganization factor than those on clozapine. In general, patients on atypical APs did better on the visual perception and memory tasks, with those on fluphenazine decanoate being the poorest. In the whole series of the 32 patients, the copy time increased with age, with higher scores on the negative and the depressive factors, and with lower scores in visual memory. On multiple linear regression, only visual memory score and age remained significant. CONCLUSIONS: In spite of the small sample size, patients on atypical APs seem to be in a better condition, both in symptoms and in visuo-spatial abilities. Visual reproduction is influenced by both visual memory and age.

Marcadores tumorales procesos ginecológicos benignos / Tumor markers in benign gynecologic diseases

La determinación de marcadores tumorales se emplea como prueba complementaria en el diagnóstico de algunas neoplasias. Cifras muy elevadas se asocian casi invariablemente a neoplasias malignas. Presentamos el caso de una paciente en la que el conjunto de datos analíticos, sobre todo la importante elevación de marcadores tumorales, y exploratorios orientaron hacia un diagnóstico de malignidad que condujo a la realización de cirugía radical. Únicamente el estudio histopatológico diferido de toda la pieza demostró la benignidad del proceso. Tras el tratamiento los niveles de marcadores descendieron hasta su normalización. Se concluye que la presencia de marcadores tumorales muy elevados puede inducir a un diagnóstico erróneo de malignidad en el estudio de las masas ováricas (AU)

Procesamiento visuo-perceptivo en los pacientes con esquizofrenia tratados con antipsicóticos típicos y los tratados con atípicos / Visuo-perceptual processing in patients with schizophrenia treated with typical or atypical antipsychotics

Objetivo: Estudio piloto para explorar la posible asociación entre un régimen particular de medicación antipsicótica (AP) y las características clínicas y visuoperceptivas.Sujetos y método: Una serie de 32 pacientes (25 varones; edadñ DE = 28,1ñ 5,1 años, límites 20-39) con esquizofrenia desde hacía al menos dos años (promedioñ DE = 6,0ñ 3,6 años), y mantenidos con la misma medicación antipsicótica durante al menos un año, se dividieron en cuatro grupos según su medicación de mantenimiento. La evaluación incluía el empleo de la Escala de los Síndromes Positivo y Negativo (PANSS), la Figura Compleja de Rey, y la Escala BELS de Leff (habilidades de la vida diaria).Resultados: No hubo diferencias significativas en características demográficas ni en habilidades de la vida diaria. Los pacientes con APs clásicos por vía oral puntuaron significativamente más alto en el factor desorganizativo que quienes tomaban clozapina. En general, los pacientes con APs atípicos obtuvieron mejor resultado en las tareas de percepción y memoria visual (los peores fueron los de decanoato de flufenazina). En el conjunto de los 32 pacientes, el tiempo de copia aumenta con la edad, con puntuaciones más altas en los factores negativo y depresivo, y con más bajas en memoria visual. En la regresión lineal múltiple, sólo la puntuación en memoria visual y la edad siguen siendo significativas.Conclusiones: A pesar del pequeño tamaño de la muestra, los pacientes con APs atípicos parecen estar mejor, tanto en síntomas como en capacidades visuo-espaciales. La reproducción visual está influida por la memoria visual y por la edad (AU)

[Psychiatric morbidity associated to enuresis in children]. / Morbilidad psiquiátrica asociada a enuresis infantil.

AIMS: The objective of the study was to know the clinical and epidemiological features, including associated psychiatric morbidity, of the children seeking help for enuresis in a public child and adolescent mental health unit. SUBJECTS AND METHOD: Within an exploratory, retrospective, and observational study, we reviewed the clinical charts of all the children (N= 2,315) attending the unit during a five-year period (January 1992-December 1997), collecting information on gender, age, type of enuresis, associated psychiatric morbidity, and social and family characteristics. Both the enuresis and the associated psychiatric disorders were diagnosed according to the DSM-IV criteria. RESULTS: Enuresis was the reason for admission in 230 children (9.9%), whose mean (+/- SD) age was 9.0 (+/- 2.9) years (range: 5-18). The condition of single-parent family, the perception of economic difficulties, and a poor academic achievement were not associated to any type of enuresis. A 19.5 per cent of the patients with enuresis presented a co-morbid psychiatric disorder, which was significantly associated to both male gender in subjects younger than 9 and enuresis of the type secondary or mixed. DISCUSSION: Most children with enuresis referred for psychiatric consultation do not present an associated psychiatric disorder. Our results on children with enuresis, in a clinical sample, are similar to those of previous studies conducted in the general population. This may mean that these patients are sent to child psychiatry services for reasons of traditional health delivery uses rather than for their psychopathological characteristics.

Emotional distress and occupational burnout in health care professionals serving HIV-infected patients: A comparison with oncology and internal medicine services.

BACKGROUND: The present paper examines the levels of emotional distress and professional burnout among health care professionals working with HIV patients in two different settings, Infectious Disease (ID) Units and a Haemophilia (H) Unit, and compares them with those of professionals working in Oncology (O) or General Internal Medicine (IM) Units, all at public hospitals. METHODS: Cross-sectional anonymous survey assessing their psychological condition, occupational stress, work and social adjustment, and providing information about stressors, supports and coping methods, using the General Health Questionnaire, the Maslach Burnout Inventory, the Modified Social Adjustment Scale, and other self-administered instruments. RESULTS: Perceived stress was higher in both O and IM, and the number of stressful circumstances was especially higher in O. No significant differences in psychological morbidity were found among the groups, with these exceptions: a better status among the H staff, who also showed less overall burnout; emotional exhaustion was lower in both ID and H than in the two other groups; the ID staff showed less personal accomplishment. Using a multiple regression model, a series of variables - including work adjustment, social/leisure adjustment, and having chosen to work in their position - was able to predict outcome. CONCLUSIONS: Our results highlight the presence of substantial levels of emotional distress and work-related difficulties in a significant number of health care workers. The mental health services could play an important role in conducting further research in this field and in providing practical help to deal with staff's difficulties.

[Infant mortality and sudden infant death in Navarra between 1985 and 1996]. / Mortalidad infantil y mortalidad por muerte súbita infantil en Navarra 1985-1996.

OBJECTIVE: The objective of this study was to obtain an accurate register of the deaths of children less than one year of age in order to discover the real infant mortality (IM) rate in Navara and its trend during the period between 1985 and 1996, a well as to investigate the deaths by sudden infant death (SID) in the same period and their relationship to the prone position during sleep. PATIENTS AND METHODS: Infant mortality was determined by detailed examination of all certified deaths. Research into possible nonregistered deaths was also carried-out. The sources of information included the archives and registers of the pediatric and obstetric wards and pathology departments of all hospitals. Deaths codified as 798.0 (CIE9 infinity R) were included in the study as death by SID. To determine sleeping posture. In the second semester of 1996, a survey was carried out on a sample of 285 children of under 6 months of age. The survey's model is the same as that published previously. RESULTS: In the period of 1985 to 1992, IM was 12.33 per thousand live births. The SID rate was 1.30/1,000 live births. The prevalence of the prone position is unknown. In the period between 1993 and 1996, IM decreased to 5.84/1,000 live births and this decrease was proportional in both the neonatal and postneonatal components. The rate of SIM decreased to 0.44/1,000 live births. At the beginning of 1993, 86% of the children slept in the prone position, in 1994, 38% and in 1996, only 23%. CONCLUSIONS: Trustworthy data in Navarra shows a decrease in IM of more than 50% from 1993 on. The SID rate also decreased by 65%, coinciding with a massive drop in the use of the prone position during sleep.