Males and females with first episode psychosis present distinct profiles of social cognition and metacognition

Deficits in social cognition and metacognition impact the course of psychosis. Sex differences in social cognition and metacognition could explain heterogeneity in psychosis. 174 (58 females) patients with first-episode psychosis completed a clinical, neuropsychological, social cognitive, and metacognitive assessment. Subsequent latent profile analysis split by sex yielded two clusters common to both sexes (a Homogeneous group, 53% and 79.3%, and an Indecisive group, 18.3% and 8.6% of males and females, respectively), a specific male profile characterized by presenting jumping to conclusions (28.7%) and a specific female profile characterized by cognitive biases (12.1%). Males and females in the homogeneous profile seem to have a more benign course of illness. Males with jumping to conclusions had more clinical symptoms and more neuropsychological deficits. Females with cognitive biases were younger and had lower self-esteem. These results suggest that males and females may benefit from specific targeted treatment and highlights the need to consider sex when planning interventionsDF has been supported by Marsden (E2987-3648) administered by the Royal Society of New Zealand, by grant 2017 SGR 622 (GRBIO) administrated by the Departament d'Economia i Coneixement de la Generalitat de Catalunya (Spain) and by Ministerio de Ciencia e Innovación (Spain) [PID2019-104830RB-I00/ DOI (AEI): 10.13039/501100011033]Peer ReviewedAutors: M. Ferrer-Quintero, D. Fernández, R. López-Carrilero, I. Birulés, A. Barajas, E. Lorente-Rovira, A. Luengo, L. Díaz-Cutraro, M. Verdaguer, H. García-Mieres, A. Gutiérrez-Zotes, E. Grasa, E. Sousa, E. Huerta-Ramos, T. Pélaez, M. L. Barrigón, J. Gómez-Benito, F. González-Higueras, I. Ruiz-Delgado, J. Cid, S. Moritz, J. Sevilla-Llewellyn-Jones, Spanish Metacognition Group & S. OchoaPostprint (published version

Heterogeneity in response to MCT and psychoeducation: a feasibility study using latent class mixed models in first-episode psychosis

Metacognitive training (MCT) is an effective treatment for psychosis. Longitudinal trajectories of treatment response are unknown but could point to strategies to maximize treatment efficacy during the first episodes. This work aims to explore the possible benefit of using latent class mixed models (LCMMs) to understand how treatment response differs between metacognitive training and psychoeducation. We conducted LCMMs in 28 patients that received MCT and 34 patients that received psychoeducation. We found that MCT is effective in improving cognitive insight in all patients but that these effects wane at follow-up. In contrast, psychoeducation does not improve cognitive insight, and may increase self-certainty in a group of patients. These results suggest that LCMMs are valuable tools that can aid in treatment prescription and in predicting response to specific treatments.Daniel Fernández has been supported by grant 2017 SGR 622 (GRBIO) administrated by the Departament d’Economia i Coneixement de la Generalitat de Catalunya (Spain) and by the Ministerio de Ciencia e Innovación (Spain) [PID2019-104830RB-I00/ DOI (AEI): 10.13039/501100011033]; and CIBER, Consorcio Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Ministerio de Ciencia e InnovaciónPostprint (published version

Persons with first episode psychosis have distinct profiles of social cognition and metacognition

Subjects with first-episode psychosis experience substantial deficits in social cognition and metacognition. Although previous studies have investigated the role of profiles of individuals in social cognition and metacognition in chronic schizophrenia, profiling subjects with first-episode psychosis in both domains remains to be investigated. We used latent profile analysis to derive profiles of the abilities in 174 persons with first-episode psychosis using the Beck’s Cognitive Insight Scale, the Faces Test, the Hinting Task, the Internal, Personal and Situational Attributions Questionnaire, and the Beads Task. Participants received a clinical assessment and a neuropsychological assessment. The best-fitting model was selected according to the Bayesian information criterion (BIC). We assessed the importance of the variables via a classification tree (CART). We derived three clusters with distinct profiles. The first profile (33.3%) comprised individuals with low social cognition. The second profile (60.9%) comprised individuals that had more proneness to present jumping to conclusions. The third profile (5.7%) presented a heterogeneous profile of metacognitive deficits. Persons with lower social cognition presented worse clinical and neuropsychological features than cluster 2 and cluster 3. Cluster 3 presented significantly worst functioning. Our results suggest that individuals with FEP present distinct profiles that concur with specific clinical, neuropsychological, and functional challenges. Each subgroup may benefit from different interventionsPeer ReviewedArticle signat per 22 articles: "M. Ferrer-Quintero, D. Fernández, R. López-Carrilero, I. Birulés, A. Barajas, E. Lorente-Rovira, L. Díaz-Cutraro, M. Verdaguer, H. García-Mieres, J. Sevilla-Llewellyn-Jones, A. Gutiérrez-Zotes, E. Grasa, E. Pousa, E. Huerta-Ramos, T. Pélaez, M. L. Barrigón, F. González-Higueras, I. Ruiz-Delgado, J. Cid, S. Moritz, Spanish Metacognition Group & S. Ochoa"Postprint (published version

The impact of city-wide deployment of Wolbachia-carrying mosquitoes on arboviral disease incidence in Medellín and Bello, Colombia: study protocol for an interrupted time-series analysis and a test-negative design study.

Background: Dengue, chikungunya and Zika are viral infections transmitted by Aedes aegypti mosquitoes, and present major public health challenges in tropical regions. Traditional vector control methods have been ineffective at halting disease transmission. The World Mosquito Program has developed a novel approach to arbovirus control using Ae. aegypti stably transfected with the Wolbachia bacterium, which have significantly reduced ability to transmit dengue, Zika and chikungunya in laboratory experiments. Field releases in eight countries have demonstrated Wolbachia establishment in local Ae. aegypti populations. Methods: We describe a pragmatic approach to measuring the epidemiological impact of city-wide Wolbachia deployments in Bello and Medellín, Colombia. First, an interrupted time-series analysis will compare the incidence of dengue, chikungunya and Zika case notifications before and after Wolbachia releases, across the two municipalities. Second, a prospective case-control study using a test-negative design will be conducted in one quadrant of Medellín. Three of the six contiguous release zones in the case-control area were allocated to receive the first Wolbachia deployments in the city and three to be treated last, approximating a parallel two-arm trial for the >12-month period during which Wolbachia exposure remains discordant. Allocation, although non-random, aimed to maximise balance between arms in historical dengue incidence and demographics. Arboviral disease cases and arbovirus-negative controls will be enrolled concurrently from febrile patients presenting to primary care, with case/control status classified retrospectively following laboratory diagnostic testing. Intervention effect is estimated from an aggregate odds ratio comparing Wolbachia-exposure odds among test-positive cases versus test-negative controls. Discussion: The study findings will add to an accumulating body of evidence from global field sites on the efficacy of the Wolbachia method in reducing arboviral disease incidence, and can inform decisions on wider public health implementation of this intervention in the Americas and beyond. Trial registration: ClinicalTrials.gov: NCT03631719. Registered on 15 August 2018

Elaboración de recursos hipermedia para la asignatura Evaluación en Contextos Clínicos, y aplicación en el aula de la metodología Assessment while studying, repetición espaciada con aprendizaje asociativo

Asegurar el conocimiento del estudiante más allá de la evaluación supone uno de los retos en el ámbito académico. La metodología que se presenta se basa en el uso de medios audiovisuales, la competición y un modelo de examinarse mientras se estudia. En relación con el objetivo general, se elaboraron un total de 2 vídeos relacionados con la evaluación psicológica y la intervención en concreto en dos diagnósticos hasta ahora no incluidos en los videos de proyectos anteriores como son 1) El primer Episodio Psicótico y 2) Los Trastornos de Personalidad, en concreto el Trastorno Límite de la Personalidad. Además, en estos videos, por primera vez se han incluido diferentes modalidades de intervención, como el Modelo Psicoeducativo para los casos de Primeros Episodios Psicóticos y la Terapia Basada en la Mentalización para los Trastornos de Personalidad. En relación con los objetivos específicos, se aplicaron los recursos en la clase y se trabajó con los vídeos y los audios aplicando un modelo de repetición espaciada con aprendizaje asociativo.Depto. de Personalidad, Evaluación y Psicología ClínicaFac. de PsicologíaFALSEsubmitte

Clinical guideline for diagnosis and surgical treatment of obstructive sleep apnea syndrome in patients from two to eight years old

Introduction and objective: The adenotonsillar hypertrophy is the fundamental cause of childhood obstructive sleep apnea syndrome (OSAS), a frequent pathology that can cause a series of important complications. In certain circumstances, it can be diagnosed without the need of complex tests and treated effectively, with adenotonsillectomy being the choice; since, with the current resources, assuming all the recommendations of the main guidelines are impractical, the number of children that would require referral for diagnostic polysomnography (PSG) and adenotonsillectomy would exceed our capacity. Limiting the guidelines to available means would significantly ignore the health repercussions of childhood OSA, making it difficult to recognize children at risk, as well as being able to offer adequate treatment. Our objective is to establish the recommendations based on the best available scientific evidence to increase, in an efficient way, the diagnosis of pediatric OSAS and to establish the adequate surgical recomendation as well as the safety in the perioperative procedure. Sections: Review of the bibliography of national and international guidelines on the management of childhood OSAS and assessment of own experience derived from clinical practice and prospective follow-up studies of operated patients. Summary of the evidence on childhood OSAS. Resolution of disagreements between scientific evidence and current clinical practice with proposals to minimize them. Recommendations for the diagnostic procedure and the surgical procedure. Perioperative management scheme and post-surgical follow-up. Conclusions: The application of the suggested changes regarding the management of children with suspected OSAS will allow: 1) greater prominence in the process of Primary and Secondary Care provided by general pediatricians to consider adenotonsillectomy; 2) the widespread use of specific questionnaires for the detection of OSAS, nocturnal oximetry and video recording during sleep as assessment tools; and 3) greater availability of complex sleep studies (PSG) to meet international standards for certain conditions.Introducción y objetivo: La hipertrofia adenoamigdalar es la causa fundamental del SAOS infantil, patología frecuente que puede causar complicaciones importantes. En determinadas circunstancias, puede ser diagnosticado sin necesidad de pruebas complejas y tratado eficazmente, siendo de elección la adenoamigdalectomía, ya que, con los recursos actuales, asumir todas las recomendaciones de las principales guías resulta impracticable, pues el número de niños que requerirían derivación para polisomnografía (PSG) diagnóstica y adenoamigdalectomía superarían nuestra capacidad. Nuestro objetivo es establecer las recomendaciones basadas en la mejor evidencia científica disponible para incrementar, de manera eficiente, el diagnóstico del SAOS pediátrico, adecuar la indicación quirúrgica así como la seguridad en el procedimiento perioperatorio./nSecciones: Revisión de bibliografía de guías nacionales e internacionales de manejo de SAOS infantil y valoración de experiencia propia derivada de práctica clínica y estudios prospectivos de seguimiento de pacientes intervenidos. Síntesis de la evidencia sobre el SAOS infantil. Recomendaciones para el procedimiento diagnóstico y el procedimiento quirúrgico. Resolución de discordancias entre la evidencia científica y la práctica clínica actual con propuestas para minimizarlas./nConclusiones: La aplicación de los cambios sugeridos permitirá: 1) mayor protagonismo en el proceso de la Atención Primaria y Secundaria proporcionada por los pediatras generales para la consideración de adenoamigdalectomía; 2) el uso generalizado de cuestionarios específicos para la detección de SAOS, de la oximetría nocturna y de la videograbación durante el sueño como herramientas de evaluación; y 3)  mayor disponibilidad de estudios de sueño complejos (PSG) para cumplir con los estándares internacionales para ciertas condiciones

Large-scale releases and establishment of wMel Wolbachia in Aedes aegypti mosquitoes throughout the Cities of Bello, Medellín and Itagüí, Colombia.

BackgroundThe wMel strain of Wolbachia has been successfully introduced into Aedes aegypti mosquitoes and has been shown to reduce the transmission of dengue and other Aedes-borne viruses. Here we report the entomological results from phased, large-scale releases of Wolbachia infected Ae. aegypti mosquitoes throughout three contiguous cities located in the Aburrá Valley, Colombia.Methodology/principal findingsLocal wMel Wolbachia-infected Ae. aegypti mosquitoes were generated and then released in an initial release pilot area in 2015-2016, which resulted in the establishment of Wolbachia in the local mosquito populations. Subsequent large-scale releases, mainly involving vehicle-based releases of adult mosquitoes along publicly accessible roads and streets, were undertaken across 29 comunas throughout Bello, Medellín and Itagüí Colombia between 2017-2022. In 9 comunas these were supplemented by egg releases that were undertaken by staff or community members. By the most recent monitoring, Wolbachia was found to be stable and established at consistent levels in local mosquito populations (>60% prevalence) in the majority (67%) of areas.ConclusionThese results, from the largest contiguous releases of wMel Wolbachia mosquitoes to date, highlight the operational feasibility of implementing the method in large urban settings. Based on results from previous studies, we expect that Wolbachia establishment will be sustained long term. Ongoing monitoring will confirm Wolbachia persistence in local mosquito populations and track its establishment in the remaining areas

Reduced dengue incidence following city-wide wMel Wolbachia mosquito releases throughout three Colombian cities: Interrupted time series analysis and a prospective case-control study.

BackgroundThe introduction of Wolbachia (wMel strain) into Aedes aegypti mosquitoes reduces their capacity to transmit dengue and other arboviruses. Randomised and non-randomised studies in multiple countries have shown significant reductions in dengue incidence following field releases of wMel-infected Ae. aegypti. We report the public health outcomes from phased, large-scale releases of wMel-Ae. aegypti mosquitoes throughout three contiguous cities in the Aburrá Valley, Colombia.Methodology/principal findingsFollowing pilot releases in 2015-2016, staged city-wide wMel-Ae. aegypti deployments were undertaken in the cities of Bello, Medellín and Itagüí (3.3 million people) between October 2016 and April 2022. The impact of the Wolbachia intervention on dengue incidence was evaluated in two parallel studies. A quasi-experimental study using interrupted time series analysis showed notified dengue case incidence was reduced by 95% in Bello and Medellín and 97% in Itagüí, following establishment of wMel at ≥60% prevalence, compared to the pre-intervention period and after adjusting for seasonal trends. A concurrent clinic-based case-control study with a test-negative design was unable to attain the target sample size of 63 enrolled virologically-confirmed dengue (VCD) cases between May 2019 and December 2021, consistent with low dengue incidence throughout the Aburrá Valley following wMel deployments. Nevertheless, VCD incidence was 45% lower (OR 0.55 [95% CI 0.25, 1.17]) and combined VCD/presumptive dengue incidence was 47% lower (OR 0.53 [95% CI 0.30, 0.93]) among participants resident in wMel-treated versus untreated neighbourhoods.Conclusions/significanceStable introduction of wMel into local Ae. aegypti populations was associated with a significant and sustained reduction in dengue incidence across three Colombian cities. These results from the largest contiguous Wolbachia releases to-date demonstrate the real-world effectiveness of the method across large urban populations and, alongside previously published results, support the reproducibility of this effectiveness across different ecological settings.Trial registrationNCT03631719