Effectiveness of structural-strategic family therapy in the treatment of adolescents with mental health problems and their families

Mental health problems during adolescence constitute a major public health concern today for both families and stakeholders. Accordingly, different family-based interventions have emerged as an effective treatment for adolescents with certain disorders. Specifically, there is evidence of the effectiveness of concrete approaches of systemic family therapy on the symptoms of adolescents and family functioning in general. However, few studies have examined the effectiveness of other relevant approaches, such as structural and strategic family therapy, incorporating parent–child or parental dyadic measurement. The purpose of this study was to test the effectiveness of a structural–strategic family therapy with adolescents involved in mental health services and their families. For this purpose, 41 parents and adolescents who participated in this treatment were interviewed at pre-test and post-test, providing information on adolescent behavior problems, parental sense of competence, parental practices, parenting alliance, and family functioning. Regardless of participants’ gender, adolescents exhibited fewer internalizing and externalizing problems after the treatment. Parents reported higher family cohesion, higher satisfaction and perceived efficacy as a parent, and healthier parental practices (less authoritarian and permissive practices, as well as more authoritative ones). An interaction effect between parenting alliance and gender was found, with more favorable results for the mothers. In conclusion, this paper provides evidence of the usefulness of structural–strategic family therapy for improving family, dyadic, and individual facets in families with adolescents exhibiting mental health problems

Políticas públicas sobre discapacidad en España. Hacia una perspectiva basada en los derechos

Social policies on disability in Spain present a notable evolution from the middle of the 20th century, with a growth and clear stabilization from the 70s. This movement can be understood in parallel with the evolution of the conceptualizations on disability, from an archaic model based on charity and characterized by the invisibility, to the current approaches that focus on the phenomenon as a question of rights and not discrimination. At the same time, since the 60s the first representative associations of persons with disability were created in Spain. These entities have been characterized by their increasing active participation in the design and management of resources and services derived from the successive advances on social policies related to disability. This article, using as reference the evolution of the concept of disability, revises the principal achievements of social services orientated to the support and promotion of persons with disability, and its relation to the organizations that represent them.Las políticas sociales en el sector de la discapacidad en España, presentan una evolución notable desde mediados del siglo XX, con un crecimiento y estabilización clara a partir de los años 70. Este movimiento se puede explicar en paralelo a la evolución de las conceptualizaciones sobre la discapacidad, desde un modelo arcaico basado en la caridad y caracterizado por la invisibilidad, hasta los planteamientos actuales que enfocan el fenómeno de la discapacidad como una cuestión de derechos y no discriminación. En paralelo, desde que en la década de los 60 se crearan en nuestro país las primeras asociaciones representativas de las personas con discapacidad, éstas se han distinguido por su participación crecientemente activa en el diseño y gestión de los recursos y servicios derivados de los sucesivos avances en las políticas sociales sobre discapacidad. El presenta artículo, utilizando como referencia permanente la evolución del concepto de discapacidad, repasa los principales hitos de desarrollo de los servicios sociales orientados al apoyo y promoción de las personas con discapacidad, y su relación con las organizaciones que las representan

Impacto de la pandemia COVID-19 en la salud física y mental de pacientes con enfermedades crónicas

Objetivos El objetivo de esta tesis doctoral es analizar la prevalencia y los niveles actuales de ansiedad, angustia, estrés y depresión así como los factores relacionados en pacientes con afecciones crónicas durante la pandemia COVID-19. Asimismo, se pretenden analizar los parámetros clínicos de seguimiento habitual de dichos pacientes en centros sanitarios de Atención Primaria del Servicio Andaluz de Salud. Metodología Los dos primeros estudios sobre niveles y prevalencia de ansiedad, angustia, estrés y depresión se basan en dos revisiones sistemáticas y meta-análisis. Para el tercer estudio se realizó un estudio longitudinal prospectivo en centros de atención primaria del Servicio Andaluz de Salud. Los datos se registraron antes de la pandemia (T1), durante la declaración del estado de emergencia (T2) y en la fase de transición (T3). Resultados En el estudio realizado en pacientes diabéticos, la prevalencia de ansiedad fue del 23% (IC 95% = 19–28) para pacientes con DM1 y del 20% (IC 95% = 6–40) en pacientes con DM2. Para la angustia fue del 41 % (95% IC = 24–60) en DM1 y para los pacientes con DM2 del 36% (95% IC = 2–84). Para el estrés, la prevalencia fue del 79% (IC 95% = 49–98) en pacientes con DM1. El segundo estudio analizó la depresión encontrando una prevalencia para pacientes diabéticos del 17% (95% CI = 7–31) al 33% (95% CI = 16–51), en pacientes con obesidad del 48% (95% CI = 26–71) y en pacientes con hipertensión del 18% (95% CI = 13–24). Los factores relacionados con la depresión fueron sexo femenino, estar soltero, parámetros clínicos de diabetes alterados, cambios en los comportamientos de autocuidado, reducción de la actividad física y tiempo de sueño, así como miedo al contagio. El tercer artículo tras analizar variables clínicas de seguimiento habitual informa que durante la declaración del estado de emergencia así como en las sucesivas olas de contagio hubo mejoras significativas en IMC, niveles totales de colesterol y HDL durante el inicio de la pandemia. El índice de Barthel, Pfeiffer, la presión arterial, triglicéridos y LDL empeoraron en T2 y los efectos negativos se mantuvieron en T3. En comparación con los valores prepandémicos, los niveles de HbA1c mejoraron en T3 pero los niveles de HDL empeoraron. Conclusiones Las revisiones sistemáticas y meta-análisis que se han llevado a cabo en esta tesis doctoral muestran que los pacientes con enfermedades crónicas han visto mermada su salud mental, ya que en pacientes diabéticos se observa un aumento significativo de los niveles de ansiedad, angustia y estrés. Por otro lado, se observa que la prevalencia de depresión en pacientes diabéticos, obesos e hipertensos aumentó. Los estudios revisados muestran como factores asociados a un mayor nivel de depresión, el sexo femenino, estar soltero, parámetros clínicos de diabetes alterados, cambios en los comportamientos de autocuidado, reducción de la actividad física y tiempo de sueño, así como miedo al contagio. Por otro lado, en base a los resultados obtenidos en el trabajo empírico a nivel de atención primaria en pacientes crónicos se encuentra una mayor dificultad para la realización de las actividades de la vida diaria así como un empeoramiento en su evaluación cognitiva. Además, a corto plazo durante el confinamiento y las diferentes olas solo se evidencian reduciones en IMC, niveles totales de colesterol y HDL, por lo que los cambios fueron positivos. Sin embargo, la presión arterial, triglicéridos y LDL empeoraron, manteniendo los efectos negativos durante la fase de transición. En comparación con los valores prepandémicos, los niveles de HbA1c mejoraron a largo plazo durante la etapa de transición, pero los niveles de HDL empeoraron.Objective The objective of this doctoral thesis is to analyse the prevalence and current levels of anxiety, distress, stress and depression as well as related factors in patients with chronic conditions during the COVID-19 pandemic. Also, this thesis aims to analyse the clinical parameters of the usual follow-up of these patients in Primary Care health Centres of the Andalusian Health Service. Methodology The first two studies about the levels and prevalence of anxiety, distress, stress and depression were based on two systematic reviews and meta-analyses. For the third study, a prospective longitudinal study was carried out in primary care centres of the Andalusian Health Service. The data was recorded before the pandemic (T1), during the declaration of the state of emergency (T2) and in the transition phase (T3). Results In the study carried out in diabetic patients, the prevalence of anxiety was 23% (95% CI = 19–28) for patients with DM1 and 20% (95% CI = 6–40) in patients with DM2. For distress it was 41% (95% CI = 24–60) in DM1 and for patients with DM2 it was 36% (95% CI = 2–84). For stress, the prevalence was 79% (95% CI = 49–98) in patients with DM1. The second study analysed depression, finding a prevalence for diabetic patients of 17% (95% CI = 7–31) to 33% (95% CI = 16–51), in patients with obesity of 48% (95% CI = 26). –71), and in patients with hypertension of 18% (95% CI = 13–24). The factors related to depression were female sex, being single, altered clinical parameters of diabetes, changes in self-care behaviours, reduction in physical activity and sleep time, as well as fear of contagion. The third article, after analysing routine follow-up clinical variables, reported that during the declaration of the state of emergency as well as in the successive waves of contagion, there were significant improvements in BMI, total cholesterol and HDL levels during the beginning of the pandemic. The Barthel and Pfeiffer index, blood pressure, triglycerides and LDL worsened in T2 and the negative effects were maintained in T3. Compared to pre-pandemic values, HbA1c levels improved in T3 but HDL levels worsened. Conclusions The systematic reviews and meta-analyses done in this doctoral thesis showed that patients with chronic diseases have seen their mental health diminished, since a significant increase in levels of anxiety, distress and stress was observed in diabetic patients. On the other hand, it was observed that the prevalence of depression in diabetic, obese and hypertensive patients increased. The studies reviewed showed that factors associated with a higher level of depression include female sex, being single, altered clinical parameters of diabetes, changes in self-care behaviours, reduction in physical activity and sleep time, as well as fear of contagion. On the other hand, based on the results obtained in the empirical study at the primary care level in chronic patients, greater difficulty was found in carrying out activities of daily living as well as a worsening in their cognitive evaluation. Furthermore, in the short term during confinement and the different waves, only reductions in BMI, total cholesterol and HDL levels were evident, so the changes were positive. However, blood pressure, triglycerides and LDL worsened, maintaining the negative effects during the transition phase. Compared to pre-pandemic values, HbA1c levels improved in the long term during the transition phase, but HDL levels worsened

Bone marrow-derived mesenchymal stem cells transplantation produces a tissue recovery in hydrocephalic mice

In congenital hydrocephalus, cerebrospinal fluid accumulation is associated to ischemia/hypoxia, metabolic impairment, neuronal damage and astrocytic reaction, which cause significant mortality and life-long neurological complications. Currently, there are no effective therapies for congenital hydrocephalus. Bone marrow-derived mesenchymal stem cells (BM-MSC) are considered as a potential therapeutic tool for neurodegenerative diseases due to their ability for migrating and producing neuroprotector factors when they are transplanted. The aim of this research was to study the ability of BM-MSC to reach the degenerated regions and to detect their neuroprotector effects, using an animal model of congenital hydrocephalus, the hyh mouse. Fluorescent BM-MSC were analyzed by flow-cytometry and multilineage cell differentiation. BM-MSC were brain-ventricle injected into hyh mice. Wild-type and saline-injected hyh mice were used as controls. Inmunohistochemical, RT-PCR and High Resolution Magic Angle Spinning spectroscopy (HRMAS) analyses were carried out. After administration, integrated BM-MSC were identified inside the periventricular astrocyte reaction. They were detected producing glial-derived neuroprotector factor (GDNF), neural growth factor (NGF), and brain-derived neuroprotector factor (BDNF). Tissue recovery was detected with a reduction of apoptotic cells in the periventricular walls and of the levels of glutamate, glutamine, taurine, and creatine, all of them markers of tissue damage in hydrocephalus.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech. ISCIII PI15/00619 y FEDE

Long-time effects of an experimental therapy with mesenchymal stem cells in congenital hydrocephalus

Introduction: Bone marrow-derived mesenchymal stem cells (BM-MSC) are a potential therapeutic tool due to their ability for migrating and producing neuroprotector factors when they are transplanted in other neurodegenerative diseases. Moreover, some investigations have shown that BM-MSC are able to modulate astrocyte activation and neuroprotector factor production. The aim of this study was to evaluate the long-time effects of a BM-MSC experimental therapy in the hyh mouse model of congenital hydrocephalus. Methods: BM-MSC were characterized in vitro and then transplanted into the ventricles of young hydrocephalic hyh mice, before they develop the severe hydrocephalus. Non-hydrocephalic normal mice (wt) and hydrocephalic hyh mice sham-injected (sterile saline serum) were used as controls. Samples were studied by analyzing and comparing mRNA, protein level expressions and immunoreaction related with the progression and severity of hydrocephalus. Results: Fourteen days after transplantation, hydrocephalic hyh mice with BM-MSC showed lower ventriculomegaly. In these animals, BM-MSC were found undifferentiated and spread into the periventricular astrocyte reaction. There, BM-MSC were detected producing several neuroprotector factors (BDNF, GDNF, NGF, VEGF), in the same way as reactive astrocytes. Total neocortical levels of NGF, TGF-β and VEGF were found increased in hydrocephalic hyh mice transplanted with BM-MSC. Furthermore, astrocytes showed increased expressions of aquaporin-4 (water channel protein) and Slit-2 (neuroprotective and anti-inflammatory molecule). Conclusions: BM-MSC seem to lead to recovery of the severe neurodegenerative conditions associated to congenital hydrocephalus mediated by reactive astrocytes.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech. PI15/0619 (ISCIII/FEDER

Estilos relacionales en Terapia Familiar: Necesidades de apoyo para el proceso de intervención

Desde el convencimiento de que es necesario contar con prácticas basadas en la evidencia, este trabajo pretende contribuir al conocimiento acerca de cómo procesos de terapia familiar pueden actuar en beneficio de menores con problemas psicológicos específicos. Concretamente, se presentan datos sobre sus necesidades de apoyo e intervención (N = 69), examinando las características de ajuste psicológico de los menores, así como del perfil psicosocial de sus familias

Development of a soot radiation model for diesel flames

[EN] This paper describes a radiation model for diesel sprays that can predict the heat losses based on spray characteristics to the spray plume due to radiation. The model is based on three sub-models: spray model, soot model and radiation model. The spray model is a one-dimensional model that simulates the axial and radial distribution of a fuel spray for each instant. The soot model is a one-dimensional tool, which is based on formation and oxidation processes calculating the axial and radial soot concentration profile for each instant. The output results of the two sub-models are used as input information for the radiation model, which obtains the radiation heat transfer values for a diesel flame. The experimental measurements used to adjust the different constants and to validate the sub-models were performed in a high-pressure high-temperature vessel using three different optical techniques: Schlieren, to obtain spray penetration, Diffused Back-Illumination technique (DBI) for the soot concentration and the 2-color method for calculating the soot temperature and concentration. The radiant fraction shows values from 0.11% to 0.43% with respect to the total energy of the fuel depending on the operating condition. Taking into account the different assumptions taken for modeling the spray radiation, these results are consistent with those obtained in the literature, in which the radiation was characterized under similar conditions.The authors acknowledge FEDER and Spanish Ministerio de Economía y Competitividad for partially supporting this research through TRANCO project (TRA2017-87694-R).López, JJ.; García-Oliver, JM.; García Martínez, A.; Villalta-Lara, D. (2019). Development of a soot radiation model for diesel flames. Applied Thermal Engineering. 157:1-10. https://doi.org/10.1016/j.applthermaleng.2019.04.120S11015

Assessment on the consequences of injection strategies on combustion process and particle size distributions in Euro VI medium-duty diesel engine

This is the author's version of a work that was accepted for publication in International Journal of Engine Research. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published as https://doi.org/10.1177/1468087419865652.[EN] Although there are already several works where the influence of injection parameters on exhaust emissions, and specifically on particulate matter emissions, in diesel engines has been evaluated, the diversity in the results that can be found in the literature indicates the need to carry out new experiments that can provide more information about the influence of these parameters on modern diesel engines. This study intends to be placed within this scientific framework, hence a parametric study was carried out based on the independent modification of the main injection timing and the injection pressure with respect to the nominal conditions of a new Euro VI direct injection diesel engine. Four steady-state operation points of the engine map were chosen: 25% load and 950 r/min, 50% load and 1500 r/min, 75% load and 2000 r/min and 100% load and 2200 r/min, where in each of these operation points, the variations of the injection parameters in the study on the combustion process and its consequent impact on the particle size distribution, including an analysis of the geometric mean diameter values, were evaluated. The results showed that the different injection strategies adopted, despite not significantly affecting the engine efficiency, did cause a significant impact on particle number emissions. At the low load operation, the size distribution showed a bimodal structure, and as the main injection timing was delayed and the injection pressure was decreased, the nucleation-mode particle concentration decreased, while the accumulation-mode particle concentration increased. In addition, at medium load, the nucleation-mode particle emission decreased considerably while the accumulation-mode particle emission increased, and this increase was much greater with the main injection timing delay and the injection pressure reduction. Similar behavior was observed at high load, but with a much more prominent pattern.The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This investigation has been funded by VOLVO Group Trucks Technology. The authors also acknowledge the Spanish economy and competitiveness ministry for partially supporting this research (HiReCo TRA2014-58870-R).Bermúdez, V.; García Martínez, A.; Villalta-Lara, D.; Soto, L. (2020). Assessment on the consequences of injection strategies on combustion process and particle size distributions in Euro VI medium-duty diesel engine. International Journal of Engine Research. 21(4):683-697. https://doi.org/10.1177/1468087419865652683697214Kemball-Cook, S., Yarwood, G., Johnson, J., Dornblaser, B., & Estes, M. (2015). Evaluating NOx emission inventories for regulatory air quality modeling using satellite and air quality model data. Atmospheric Environment, 117, 1-8. doi:10.1016/j.atmosenv.2015.07.002Paulin, L., & Hansel, N. (2016). Particulate air pollution and impaired lung function. F1000Research, 5, 201. doi:10.12688/f1000research.7108.1Hime, N., Marks, G., & Cowie, C. (2018). 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Particulate emissions from biodiesel vs diesel fuelled compression ignition engine. Renewable and Sustainable Energy Reviews, 15(6), 3278-3300. doi:10.1016/j.rser.2011.04.002Bai, J., & Qiao, X. (2015). Crankcase gaseous and particle emissions in common rail diesel engine. International Journal of Engine Research, 17(2), 179-192. doi:10.1177/1468087414563585Reijnders, J., Boot, M., & de Goey, P. (2018). Particle nucleation-accumulation mode trade-off: A second diesel dilemma? Journal of Aerosol Science, 124, 95-111. doi:10.1016/j.jaerosci.2018.06.013Bonatesta, F., Chiappetta, E., & La Rocca, A. (2014). Part-load particulate matter from a GDI engine and the connection with combustion characteristics. Applied Energy, 124, 366-376. doi:10.1016/j.apenergy.2014.03.030Desantes, J. M., Bermúdez, V., García, A., & Linares, W. G. (2011). A Comprehensive Study of Particle Size Distributions with the Use of PostInjection Strategies in DI Diesel Engines. 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A metabolite profile reveals the presence of neurodegenerative conditions according to severity of hydrocephalus

Introduction: In obstructive congenital hydrocephalus, cerebrospinal fluid accumulation is associated with high intracranial pressure (ICP), ischemia/hypoxia, metabolic impairment, neuronal damage and astrocytic reaction. The hyh mutant mice exhibit two different forms of hydrocephalus evolution: severe and moderate. A study was carried out in hyh mice to detect a metabolite profile that define the tissue response in each hydrocephalus form. Methods: Metabolites levels in brain cortex were analyzed with 1H High Resolution Magic Angle Spinning Nuclear Magnetic Resonance (1H HR-MAS) spectroscopy. The study was complemented with ICP recording and histopathological analysis. Results: Mice with severe hydrocephalus were found to have higher ICP and stronger astrocytic reaction. Several metabolites including glutamate and glutamine were found to correlate with the severity of hydrocephalus. The whole metabolite profile may be explained based in differential astrocyte reactions, neurodegenerative and ischemic conditions. The glutamate transporter EAAT2 and the metabolite taurine were found as key histopathological markers for the damaged parenchyma. Conclusions: Spectroscopy allowed the detection of a metabolite profile related to intracranial pressure and hydrocephalus severity, and therefore can be useful to monitor the efficacy of experimental therapies. Supported by Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech, and PI15/0619 (ISCIII/FEDER).Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech. Supported by Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech, and PI15/0619 (ISCIII/FEDER)