Experiencias del uso del portafolio para residentes de la Clínica Universidad de Navarra / Experiences about the University Clinic of Navarra portfolio in medical education

Introducción: En el año 2008 se implantó el portafolio electrónico para residentes en la Clínica Universidad de Navarra. Materiales y métodos: Hemos recabado los datos mediante una herramienta informática para conocer su cumplimiento online. Resultados: El cumplimiento es universal en los aspectos asistenciales, pero bajo en investigación y profesionalismo, sobre todo en los R1. La mitad registra las entrevistas con el tutor, mientras que éste sólo firma la mitad de las entrevistas. Conclusiones: Tras tres años de experiencia, el cumplimiento del portafolio por el residente se puede considerar alto, y algo menor el del tuto (AU)

Introduction: In 2008, the residents of the University Clinic of Navarra began to use a new electronic portfolio. Materials and methods: In order to know their fulfillment, we have collected the data by an online tool. Results: The total of trainees fulfilled the clinical sections, but the data about professionalism and research were less performed, particularly by the R1's. Half of the residents fulfilled the interviews with the trainers, and these ones signed only half of these interviews. Conclusions: After three years, the portfolio accomplishment by the residents could be considered high, and a little lower by the trainers (AU)

Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort.

CONTEXT: Adherence to the Mediterranean dietary pattern (MDP) is thought to reduce inflammatory, vascular, and metabolic processes that may be involved in the risk of clinical depression. OBJECTIVE: To assess the association between adherence to the MDP and the incidence of clinical depression. DESIGN: Prospective study that uses a validated 136-item food frequency questionnaire to assess adherence to the MDP. The MDP score positively weighted the consumption of vegetables, fruit and nuts, cereal, legumes, and fish; the monounsaturated- to saturated-fatty-acids ratio; and moderate alcohol consumption, whereas meat or meat products and whole-fat dairy were negatively weighted. SETTING: A dynamic cohort of university graduates (Seguimiento Universidad de Navarra/University of Navarra Follow-up [SUN] Project). PARTICIPANTS: A total of 10 094 initially healthy Spanish participants from the SUN Project participated in the study. Recruitment began on December 21, 1999, and is ongoing. MAIN OUTCOME MEASURE: Participants were classified as having incident depression if they were free of depression and antidepressant medication at baseline and reported a physician-made diagnosis of clinical depression and/or antidepressant medication use during follow-up. RESULTS: After a median follow-up of 4.4 years, 480 new cases of depression were identified. The multiple adjusted hazard ratios (95% confidence intervals) of depression for the 4 upper successive categories of adherence to the MDP (taking the category of lowest adherence as reference) were 0.74 (0.57-0.98), 0.66 (0.50-0.86), 0.49 (0.36-0.67), and 0.58 (0.44-0.77) (P for trend <.001). Inverse dose-response relationships were found for fruit and nuts, the monounsaturated- to saturated-fatty-acids ratio, and legumes. CONCLUSIONS: Our results suggest a potential protective role of the MDP with regard to the prevention of depressive disorders; additional longitudinal studies and trials are needed to confirm these findings.

Validity of a self-reported diagnosis of depression among participants in a cohort study using the Structured Clinical Interview for DSM-IV (SCID-I).

BACKGROUND: Depression assessment in population studies is usually based on depressive symptoms scales. However, the use of scales could lead to the choice of an arbitrary cut-off point depending on the sample characteristics and on the patient diagnosis. Thus, the use of a medical diagnosis of depression could be a more appropriate approach. OBJECTIVE: To validate a self-reported physician diagnosis of depression using the Structured Clinical Interview for DSM-IV (SCID-I) as Gold Standard and to assess the factors associated to a valid self-reported diagnosis. METHODS: The SUN Project is a cohort study based on university graduates followed-up through postal questionnaires. The response to the question included in the questionnaire: Have you ever been diagnosed of depression by a physician? was compared to that obtained through the SCID-I applied by a psychiatrist or a clinical psychologist. The percentages of confirmed depression and non-depression were assessed for the overall sample and according to several characteristics. Logistic regression models were fitted to ascertain the association between different factors and a correct classification regarding depression status. RESULTS: The percentage of confirmed depression was 74.2%; 95% confidence interval (95% CI) = 63.3-85.1. Out of 42 participants who did not report a depression diagnosis in the questionnaire, 34 were free of the disease (%confirmed non-depression = 81.1%; 95% CI = 69.1-92.9). The probability of being a true positive was higher among ex-smokers and non-smokers and among those overweight or obese but the differences were not statistically significant. CONCLUSION: The validity of a self-reported diagnosis of depression in the SUN cohort is adequate. Thus, this question about depression diagnosis could be used in further investigations regarding this disease in this graduate cohort study.

Parámetros de inmunidad natural como marcadores biológicos de la depresión / Parameters of natural immunity as biological markers of depression

IntroducciÓn: Durante la depresión se producen cambios en la respuesta inmunitaria natural. Conocer mejor estas alteraciones en el laboratorio podría ayudarnos como complemento en el diagnóstico clínico de la depresión. El objetivo fue seleccionar qué parámetros inmunitarios pueden ser más útiles como marcadores biológicos de la depresión. Sujetos y método: Hemos estudiado distintos parámetros inmunitarios de 42 pacientes deprimidos durante la fase aguda y después de la respuesta al tratamiento, y los comparamos con un grupo de 20 controles sanos. Los parámetros estudiados fueron: recuento de monocitos y de células natural killer (NK), expresión de moléculas de superficie monocitaria HLA-II, CD14, y CD16, producción de citocinas monocitarias (IL-1ß, IL-6, y TNF-alfa), actividad oxidativa e índice de fagocitosis monocitarios, y actividad citotóxica de células NK. Resultados: En los pacientes deprimidos se produjo un aumento de monocitos CD16+, células NK, capacidad oxidativa monocitaria y producción de las citocinas estudiadas (IL-1ß, IL-6 y TNF-alfa), y un descenso de la expresión de HLA-II y del índice de fagocitosis monocitario. De estos parámetros, el índice de fagocitosis (especificidad del 90%; valor predictivo negativo del 99%) y, en menor medida, la producción de TNF-alfa (especificidad del 85%; valor predictivo negativo del 98,9%) fueron los que más podrían ayudar en el diagnóstico clínico de la depresión. Conclusiones: Los resultados indican que el índice de fagocitosis y la producción de TNF-alfa podrían ser marcadores biológicos útiles en la depresión, tanto para el diagnóstico como para el seguimiento evolutivo

Introduction: Immune function is altered in adult patients with depression. Laboratory assessment of these alterations could aid clinical diagnosis of depression. Objectives: To assess which immune parameters are the most reliable biological markers of depression. Subjects and method: We studied immune function in 42 depressed patients during the acute depressive phase and after treatment response, and compared it to that of 20 healthy controls. The following immune parameters were evaluated: monocyte and natural killer (NK) cell count; monocyte surface molecule expression (HLA-II, CD14, and CD16); monocyte cytokine proinflammatory production (interleukin [IL]-1ß, IL-6, and tumor necrosis factor [TNF]-alpha); respiratory burst capacity and monocyte phagocytic index; and NK cytotoxic activity. Results: Depressed patients showed an increase of CD16+ monocytes, NK cell count, respiratory burst activity, and monocyte cytokine production (IL-1ß, IL-6, and TNF-alpha). Depressed patients also showed a decrease in HLA-II molecule expression and phagocytic index. The monocyte phagocytic index (specificity = 90%, and negative predictive value = 99%), and to a lesser extent, TNF-alpha production (specificity = 90%, and negative predictive value = 99%) could be the most reliable immune parameters in the clinical diagnosis of depression. Conclusions: Our results suggest that the monocyte phagocytic index and TNF-alpha production are reliable biological markers of depression

Lymphocyte subsets and lymphokine production in patients with melancholic versus nonmelancholic depression.

Several studies have reported immune changes during depression, but the results have not been fully consistent. Some of these changes could be related to the presence of melancholic features. A total of 42 depressed patients (melancholic [MEL] and nonmelancholic [non-MEL]) and 20 healthy controls participated in the study. We detected a higher CD4+ lymphocyte subset in MEL patients than in controls during the depressive state, which disappeared after clinical remission. We also found an increase in interleukin-2 (IL-2) production both in MEL and non-MEL patients, but these values did not differ from control values after clinical remission. Some of these changes may be related to the melancholic characteristics of depression.

Monocytic parameters in patients with dysthymia versus major depression.

BACKGROUND: The studies on monocytic function during depression are controversial. A better knowledge of affective disorders may improve the differential diagnosis of depression subtypes. Our goals are to examine if there are differences in monocytic function in patients with major depression and dysthymia. METHOD: Twenty-two depressed patients (12 dysthymia and 10 major depression) and 15 healthy controls participated in the study. We analyzed monocyte count, monocyte subsets (CD14+, CD16+, and HLA class-II+), respiratory burst activity, phagocytic index and the interleukin (IL)-1beta, IL-6 and tumor necrosis factor (TNFalpha) production. RESULTS: Depressed patients showed elevated IL-1beta (P<0.05) and IL-6 (P<0.01), elevated monocytic respiratory burst activity (P<0.01); and reduced surface molecule expression HLA class-II and phagocytosis (P<0.01) compared with controls. We found no differences in any monocytic parameters between dysthymia and major depression. LIMITATIONS: The small sample size and the short wash-out reduce the reliability of the results. CONCLUSIONS: Major depression and dysthymia show similar signs of both monocytic activation and suppression. These alterations may be due to the depressive syndrome and not to the characteristics of depression subtypes studied.