Síndrome de fatiga crónica en una adolescente de 15 años

Fatigue and lack of energy are frequent symptoms in children and adolescents. A diagnosis of chronic fatigue syndrome should be considered in children and adolescents who complain of chronic fatigue associated with other symptoms without a demonstrable physical cause. Lack of knowledge about this syndrome and late diagnosis may have a negative impact on the normal development of affected children and adolescents. Treatment should be based on a rehabilitation program with cognitive behavioral therapy and a gradual increase in activities

IS THERE A CORTICAL BLOOD FLOW REDISTRIBUTION PATTERN RELATED WITH PERSEVERATIVE ERROR IN SCHIZOPHRENIA?

Background: We studied relative cortical blood flow (relCBF) patterns associated to correct performance (CP) and perseverative error (PE) during Wisconsin Card Sorting Test (WCST) execution, in controls and patients with schizophrenia. Subjects and methods: relCBF (regional cortical blood flow (rCBF) / whole cortex blood flow) of 10 well defined cortical regions was measured in 18 patients with schizophrenia and 13 healthy controls by a Technetium – 99 – HMPAO – SPECT, at rest and while they performed WCST. Results: Patients made significantly more PE than controls during WCST performance. In patients, we found a significant correlation between PE and relCBF in right occipital cortex. In controls, we found a significant correlation between CP and relCBF of several cortical regions during WCST execution: left orbitofrontal cortex and left global frontal cortex positively and parietal bilateral cortex negatively. PE was inversely correlated with relCBF in left temporal cortex. Conclusions: Successful WCST performance is associated to a high left frontal activity in controls but not in patients. The severity of PE during WCST performance is associated to a low left frontal-temporal activity in controls and to a high right parietal-occipital activity in schizophrenia. This may represent a cortical activity redistribution pattern related to perseveration in schizophrenia

Automatic mental processes, automatic actions and behaviours in game transfer phenomena: an empirical self-report study using online forum data

Previous studies have demonstrated that the playing of videogames can have both intended and unintended effects. The purpose of this study was to investigate the influence of videogames on players’ mental processes and behaviours in day-to-day settings. A total of 1,023 self-reports from 762 gamers collected from online videogame forums were classified, quantified, described and explained. The data include automatic thoughts, sensations and impulses, automatic mental replays of the game in real life, and voluntary/involuntary behaviours with videogame content. Many gamers reported that they had responded – at least sometimes – to real life stimuli as if they were still playing videogames. This included overreactions, avoidances, and involuntary movements of limbs. These experiences lasted relatively short periods of time but in a minority of players were recurrent. The gamers' experiences appeared to be enhanced by virtual embodiment, repetitive manipulation of game controls, and their gaming habits. However, similar phenomena may also occur when doing other non-gaming activities. The implications of these game transfer experiences are discussed

Growth and puberty in a 2-year open-label study of lisdexamfetamine dimesylate in children and adolescents with attention-deficit/hyperactivity disorder

Background: Stimulant medications for the treatment of attention-deficit/hyperactivity disorder have a history of safe and effective use; however, concerns exist that they may adversely affect growth trajectories in children and adolescents. Objective: The objective of this study was to evaluate the longer-term effects of lisdexamfetamine dimesylate on weight, height, body mass index and pubertal development in children and adolescents with attention-deficit/hyperactivity disorder. Methods: Children and adolescents aged 6–17 years with attention-deficit/hyperactivity disorder took open-label lisdexamfetamine dimesylate (30, 50 or 70 mg/day) in this open-label 2-year safety and efficacy study. Safety evaluations included treatment-emergent adverse events, measurement of weight, height and body mass index, and selfreported pubertal status using Tanner staging. Results: The safety analysis population comprised all enrolled participants (N = 314) and 191 (60.8%) completed the study. Weight decrease was reported as a treatmentemergent adverse event in 63 participants (20.1%) and two participants (0.6%) discontinued the study as a result of treatment-emergent adverse events of weight decrease

Integración de solar térmica en redes de distrito : predicción de la producción

CIES2020 - XVII Congresso Ibérico e XIII Congresso Ibero-americano de Energia SolarRESUMEN: El presente trabajo describe un algoritmo de cálculo de predicción de producción de plantas solares térmicas para su uso integrado en un sistema de control de redes de distrito (GIRTER). Inicialmente se describe brevemente la estrategia global con el fin de poder integrar el aporte de la producción solar, como un elemento que resta carga al sistema. A partir de la estimación de un horizonte de predicción dependiente de las inercias de la red de distrito, se obtiene una predicción horaria de temperatura y radiación horizontal de una base de datos externa que son empleadas para determinar la demanda asociada a los edificios de la red de distrito así como a la producción de la instalación solar. A continuación se describe el algoritmo desarrollado basado en la ecuación de Bliss indicando el procedimiento de cálculo de los diferentes términos. Finalmente se muestra su validación comparando los resultados que da GIRTER con los de una simulación realizada en TRNSYS®. El proyecto GIRTER ha sido realizado dentro de la convocatoria RETOS 2016.ABSTRACT: The present work describes an algorithm for calculating the prediction of the production of solar thermal plants for its integrated use in a district network control system (GIRTER). Initially, the global strategy is briefly described in order to be able to integrate the contribution of solar production, as an element that reduces the burden on the system. From the estimation of a prediction horizon dependent on the inertias of the district network, an hourly prediction of temperature and horizontal radiation is obtained from an external database that are used to determine the demand associated with the buildings of the network of district, as well as the production of the solar installation. The following describes the algorithm developed based on the Bliss equation, indicating the procedure for calculating the different terms. Finally, its validation is shown by comparing the results that GIRTER gives with those of a simulation carried out in TRNSYS®. The GIRTER project has been carried out within the RETOS 2016 call.info:eu-repo/semantics/publishedVersio

The management of ADHD in children and adolescents: bringing evidence to the clinic: perspective from the European ADHD Guidelines Group (EAGG)

ADHD is the most common neurodevelopmental disorder presenting to child and adolescent mental health, paediatric, and primary care services. Timely and effective interventions to address core ADHD symptoms and co-occurring problems are a high priority for healthcare and society more widely. While much research has reported on the benefits and adverse effects of different interventions for ADHD, these individual research reports and the reviews, meta-analyses and guidelines summarizing their findings are sometimes inconsistent and difficult to interpret. We have summarized the current evidence and identified several methodological issues and gaps in the current evidence that we believe are important for clinicians to consider when evaluating the evidence and making treatment decisions. These include understanding potential impact of bias such as inadequate blinding and selection bias on study outcomes; the relative lack of high-quality data comparing different treatments and assessing long-term effectiveness, adverse effects and safety for both pharmacological and non-pharmacological treatments; and the problems associated with observational studies, including those based on large national registries and comparing treatments with each other. We highlight key similarities across current international clinical guidelines and discuss the reasons for divergence where these occur. We discuss the integration of these different perspective into a framework for person/family-centered evidence-based practice approach to care that aims to achieve optimal outcomes that prioritize individual strengths and impairments, as well as the personal treatment targets of children and their families. Finally, we consider how access to care for this common and impairing disorder can be improved in different healthcare systems

Validación de la versión en español de la escala de evaluación del trastorno por déficit de atención e hiperactividad (ADHD-RS-IV.es) en una muestra española

Objetivos El objetivo de este estudio es validar la versión en castellano del ADHD-RS-IV (ADHD-RS-IV.es) en una muestra española. Métodos A partir de una muestra total de 652 niños y adolescentes (rango edad: 6-17 años; media [DE] = 11,14 [3,27] años), se incluyó a 518 pacientes con TDAH (criterios DSM-IV-TR) y a 134 controles sanos. Para la evaluación de la estructura factorial, la validez y la fiabilidad de la escala se realizó un análisis factorial confirmatorio (CFA) mediante structural equation modeling en una matriz de correlaciones policóricas, y usando el método de máxima verosimilitud para la estimación. Se calcularon la validez discriminante y su valor predictivo mediante curvas receiver operating characteristics. Resultados La escala en castellano mostró una consistencia interna elevada, tanto para la escala total como para sus subescalas. El coeficiente alfa de Cronbach era 0,94 para la escala total y ≥ 0,90 para las subescalas. Los valores alfa ordinales eran 0,95 para la escala total y ≥ 0,90 para las subescalas. El análisis CFA mostró un modelo de 2 factores (inatención e hiperactividad/impulsividad) intercorrelacionados. La escala ofrece buen poder discriminante (AUC = 0,97). Conclusiones La versión española del ADHD-RS-IV (ADHD-RS-IV.es) mostró una estructura bifactorial consistente con los modelos del DSM-IV-TR y DSM-5, y con el modelo propuesto por el autor de la escala original. Además, posee un alto poder discriminante, lo que lo convierte en un instrumento válido y fiable para medir la presencia y severidad de síntomas de TDAH en la población española.Objectives The purpose of this study is to validate a Spanish-language version of the 18-item ADHD Rating Scale-IV (ADHD-RS-IV.es) in a Spanish sample. Methods From a total sample of 652 children and adolescents aged 6 to 17 years (mean age was 11.14 ± 3.27), we included 518 who met the DSM-IV-TR criteria for ADHD and 134 healthy controls. To evaluate the factorial structure, validity, and reliability of the scale, we performed a confirmatory factor analysis (CFA) using structural equation modelling on a polychoric correlation matrix and maximum likelihood estimation. The scale's discriminant validity and predictive value were estimated using ROC (receiver operating characteristics) curve analysis. Results Both the full scale and the subscales of the Spanish-language version of the ADHD-RS-IV showed good internal consistency. Cronbach's alpha was 0.94 for the full scale and ≥ 0.90 for the subscales, and ordinal alpha was 0.95 and ≥ 0.90, respectively. CFA showed that a two-factor model (inattention and hyperactivity/impulsivity) provided the best fit for the data. ADHD-RS-IV.es offered good discriminant ability to distinguish between patients with ADHD and controls (AUC = 0.97). Conclusions The two-factor structure of the Spanish-language version of the ADHD-RS-IV (ADHD-RS-IV.es) is consistent with those of the DSM-IV-TR and DSM-5 as well as with the model proposed by the author of the original scale. Furthermore, it has good discriminant ability. ADHD-RS-IV.es is therefore a valid and reliable tool for determining presence and severity of ADHD symptoms in the Spanish population

Health care and societal costs of the management of children and adolescents with attention-deficit/hyperactivity disorder in Spain: a descriptive analysis

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition in childhood (5.3% to 7.1% worldwide prevalence), with substantial overall financial burden to children/adolescents, their families, and society. The aims of this study were to describe the clinical characteristics of children and adolescents with ADHD in Spain, estimate the associated direct/indirect costs of the disorder, and assess whether the characteristics and financial costs differed between children/adolescents adequately responding to currently available pharmacotherapies compared with children/adolescents for whom pharmacotherapies failed. Methods: This was a multicenter, cross-sectional, descriptive analysis conducted in 15 health units representative of the overall Spanish population. Data on demographic characteristics, socio-occupational status, social relationships, clinical variables of the disease, and pharmacological and non-pharmacological treatments received were collected in 321 children and adolescents with ADHD. Direct and indirect costs were estimated over one year from both a health care system and a societal perspective. Results: The estimated average cost of ADHD per year per child/adolescent was €5733 in 2012 prices; direct costs accounted for 60.2% of the total costs (€3450). Support from a psychologist/educational psychologist represented 45.2% of direct costs and 27.2% of total costs. Pharmacotherapy accounted for 25.8% of direct costs and 15.5% of total costs. Among indirect costs (€2283), 65.2% was due to caregiver expenses. The total annual costs were significantly higher for children/adolescents who responded poorly to pharmacological treatment (€7654 versus €5517; P = 0.024), the difference being mainly due to significantly higher direct costs, particularly with larger expenses for non-pharmacological treatment (P = 0.012). Conclusions: ADHD has a significant personal, familial, and financial impact on the Spanish health system and society. Successful pharmacological intervention was associated with lower overall expenses in the management of the disorde

Remote assessment of ADHD in children and adolescents: recommendations from the European ADHD Guidelines Group following the clinical experience during the COVID-19 pandemic

The COVID-19 pandemic led ADHD services to modify the clinical practice to reduce in-person contact as much as possible to minimise viral spread. This had far-reaching effects on day-to-day clinical practice as remote assessments were widely adopted. Despite the attenuation of the acute threat from COVID, many clinical services are retaining some remote practices. The lack of clear evidence-based guidance about the most appropriate way to conduct remote assessments meant that these changes were typically implemented in a localised, ad hoc, and un-coordinated way. Here, the European ADHD Guidelines Group (EAGG) discusses the strengths and weaknesses of remote assessment methods of children and adolescents with ADHD in a narrative review based on available data and expert opinions to highlight key recommendations for future studies and clinical practice. We conclude that going forward, despite remote working in clinical services functioning adequately during the pandemic, all required components of ADHD assessment should still be completed following national/international guidelines; however, the process may need adaptation. Social restrictions, including changes in education provision, can either mask or exacerbate features associated with ADHD and therefore assessment should carefully chart symptom profile and impairment prior to, as well as during an ongoing pandemic. While remote assessments are valuable in allowing clinical services to continue despite restrictions and may have benefits for routine care in the post-pandemic world, particular attention must be paid to those who may be at high risk but not be able to use/access remote technologies and prioritize these groups for conventional face-to-face assessments