El tratamiento psicológico del insomnio durante la infancia: Una revisión paraguas

El insomnio es un problema muy frecuente en niños y adolescentes y está relacionado con numerosos resultados negativos. La evidencia sobre las intervenciones psicológicas efectivas en el tratamiento del insomnio infantil ha ido en aumento, pero carece de una síntesis exhaustiva de los hallazgos. Por ello, realizamos una revisión sistemática de revisiones sistemáticas y meta-análisis sobre la efectividad de las intervenciones psicológicas en el tratamiento del insomnio infantil. Se realizaron búsquedas en la base de datos PsycINFO, hasta julio de 2022, mediante una combinación de palabras clave. Los datos fueron extraídos de forma independiente por las dos autoras y se presentó una síntesis de los resultados. La calidad metodológica fue evaluada de forma independiente por las dos autoras, utilizando AMSTAR-2. Se incluyeron cuatro artículos que informaron, en general, sobre la efectividad de las intervenciones psicológicas para disminuir los síntomas de insomnio durante la infancia y adolescencia, tanto a corto como a largo plazo. Las revisiones incluidas fueron calificadas con una calidad metodológica baja, lo que debilita la evidencia de los resultados reportados. Se encontró que actualmente la Terapia Cognitivo Conductual es la intervención psicológica más basada en la evidencia y la más efectiva, independientemente del formato de tratamiento. Se necesitan realizar más ensayos clínicos aleatorios de alta calidadThe psychological treatment of insomnia during childhood: An umbrella review. Insomnia is a very common problem in children and adolescents and is associated with numerous negative outcomes. Evidence for effective psychological interventions in the treatment of childhood insomnia has been increasing, but lacks a comprehensive synthesis of findings. Therefore, we conducted a systematic review of systematic reviews and meta-analyses on the effectiveness of psychological interventions in the treatment of childhood insomnia. We searched the PsycINFO database, until July 2022, using a combination of keywords. Data were extracted independently by the two authors and a synthesis of the results was presented. Methodological quality was assessed independently by the two authors using AMSTAR-2. Four articles were included that reported, in general, on the effectiveness of psychological interventions to decrease insomnia symptoms during childhood and adolescence, both in the short and long term. The included reviews were rated with low methodological quality, which weakens the evidence for the reported results. CBT was currently found to be the most evidence-based and effective psychological intervention, regardless of treatment format. More high-quality randomized clinical trials are neede

El cuestionario general de salud (GHQ-28) en pacientes con fibromialgia: propiedades psicométricas y adecuación

ResumenLa fibromialgia es un síndrome que incluye síntomas como dolor generalizado musculoesquelético, problemas emocionales y cognitivos, así como dificultades de adaptación. El Cuestionario General de Salud (GHQ-28) ha sido ampliamente usado, aunque apenas existen datos sobre su utilización en pacientes de fibromialgia. Se han estudiado 301 pacientes de esta patología, analizándose la bondad del cuestionario y su estructura y obteniéndose altos niveles en ansiedad (=1.5), disfunción social (=1.56) y síntomas somáticos del GHQ-28 ( .67). La fiabilidad es adecuada (α de Cronbach = .94). La estructura factorial analizada de cuatro factores se ajusta a la propuesta por los autores del cuestionario. Se concluye que el GHQ-28ha sido útil para explorar la sintomatología psicológica en los pacientes de fibromialgia.AbstractFibromyalgia is a syndrome that involves multiple symptoms, including widespread musculoskeletal pain, emotional and cognitive problems, and adjustment difficulties. The General Health Questionnaire (GHQ-28) has been widely used, even if little data exist on its use in patients with fibromyalgia. A sample of 301 patients with fibromyalgia was studied, analyzing the goodness of the questionnaire andX its structure. High anxiety levels (= 1.5), social dysfunction (= 1.56) and somatic symptoms of GHQ-28 (= 1.67) were obtained. The reliability is adequate (Cronbach's α = .94) and the factor structure of four factors analyzed conforms to that proposed by the authors of the questionnaire. The conclusion is that GHQ-28 has been useful to explore the psychological symptoms in patients with fibromyalgia

ESTRÉS DE ROL, IMPLICACIÓN CON EL TRABAJO Y BURNOUT EN SOLDADOS PROFESIONALES ESPAÑOLES

Este estudio analiza la relación entre el estrés de rol y el burnout y el papel modulador de la implicación con el trabajo en una muestra de 779 soldados profesionales del ejército español. Los resultados encontrados muestran que el conflicto, la ambigüedad de rol y las dos dimensiones de la implicación con el trabajo se relacionan significativamente y en la dirección esperada con los tres síntomas del burnout. Además, la identificación psicológica con el trabajo reduce el burnout, mientras que, al contrario, los sentimientos de deber-obligación lo potencian. Sin embargo, en contra de lo esperado, la implicación con el trabajo no es una variable moduladora de la relación entre el estrés de rol y el burnout

¿Es Posible el Uso de la Postpartum Depression Screening Scale Short Form en la Depresión Antenatal?

El objetivo fue analizar la validez de la Escala de Depresión Posparto, forma abreviada (PDSS-SF) en la detección de los síntomas de depresión prenatal mediante el uso del cuestionario Patient Health Questionnaire-9 (PHQ-9) como gold standard. La muestra del presente estudio estuvo conformada por 449 gestantes reclutadas en el Hospital Clínico San Carlos de Madrid (España). Se utilizó un análisis de curva ROC. Los resultados indican que el área bajo la curva ROC para la depresión menor, moderada y severa fue .86, p < .001, .95, p < .001, y .99, p < .001, respectivamente. La sensibilidad y especificidad fueron .70 y .81 para la depresión menor con un punto de corte de 11, .85 y .88 para depresión moderada con un punto de corte de 14 y 1 y .99 con un punto de corte de 23 para depresión severa. Los resultados de PDSS-SF proporcionan una buena consistencia interna y muestran combinaciones satisfactorias de sensibilidad y especificidad. La PDSS-SF es una herramienta precisa para evaluar la depresión prenatal

Circulating neutrophil counts and mortality in septic shock

Producción CientíficaPolynuclear neutrophils can play dual roles in sepsis: on the one hand they mediate major antimicrobial activities and on the other hand they can contribute to the development of multiple organ failure [1]. Nonetheless, in spite of the importance of these cells in sepsis, the influence of the circulating neutrophil count (CNC) on the prognosis of septic patients with this pathology has not been properly evaluated. We analyzed the association between CNC and outcome in two cohorts of patients with diagnostic criteria of septic shock (SS) [2]: the first was recruited in the context of a single center study (EXPRESS study, discovery cohort, n = 195; Table 1), and the second in the context of a multi-centric study (GRECIA study, validation cohort, n = 194; Table 2). Written informed consent was obtained from each patient or their legal representative. The two studies were approved by the Research Ethics Committee of the Hospital Clínico Universitario, Valladolid, Spain (for the EXPRESS study) and Hospital Universitario Río Hortega, Valladolid, Spain (coordinating center for the GRECIA study).Instituto de Salud Carlos III (grant PI 10/01362)Junta de Castilla y León (grant BOCYL-D-26072010

Nosocomial Vs. Community-Acquired Infective Endocarditis in Spain: Location, Trends, Clinical Presentation, Etiology, and Survival in the 21st Century

Major changes have occurred in the epidemiology and etiology of infective endocarditis (IE). Nevertheless, the differences between nosocomial infective endocarditis (NIE) and community-acquired infective endocarditis (CIE) have not been addressed in a population-based study. We conducted a retrospective, nationwide, temporal trend study from 1997 to 2014 analyzing the epidemiology, clinical, geographical, meteorological characteristics of patients diagnosed with IE in Spain, to distinguish NIE from CIE. Among 25,952 patients with IE (62.2 ± 18·6 years; 65.9% men), 45.9% had NIE. The incidence of IE increased from 2.83 to 3.73 due to the NIE incidence increment with a decline in CIE. Patients with NIE were older (63.8 years vs. 60.8 years, p < 0·001), presented a higher Charlson index (1.22 vs. 1.03, p < 0.001), a greater history of implanted cardiac devices (8.7% vs. 4.6%, p < 0.001), and higher mortality (31.5% vs. 21.7%, p < 0.001). The most frequent microorganism for both NIE and CIE was Staphylococcus (p < 0.001), and the North reported a higher incidence (p < 0.001). Risk factors of mortality for NIE were age, Charlson index, hemodialysis, shock, heart failure, and stroke. Risk factors for CIE included female sex, renal disease, and cardiac-device carriers. The etiology of IE shifted from community origins to mostly nosocomial-associated infections. Higher morbidity, mortality, and poorer outcomes are associated with NIE.This research received no external funding. The authors thank Consejería de Educación, Junta de Castilla y León, Spain (reference: VA161G18), for covering the publication charges of this article.S

Incidence and risk factors of cisplatin-induced ototoxicity

Introduction and objectives: Cisplatin is one of the drugs with greater ototoxicity within clinical use. Hearing loss detection and therapeutic measures can be done in early stages by controlling the auditory thresholds of patients on treatment. With this paper we intend to assess the incidence and severity of hearing loss by cisplatin in our environment, identifying major risk factors./nMethods: The case study was conducted on a third level hospital by monitoring and recording the hearing loss by cisplatin among the first 100 patients who accepted the audiologic monitoring. Those patients were sent by the oncology department. Then a high frequency audiometry and the otoacoustic emissions was carried out on the patients to evaluate them./nResults: Essentially, we refer to a group which us made up of adults with an average age of 59 years old. Out of the 70 patients treated only with cisplatin, 27% experienced hearing loss. Among the remaining 30 patients who received radiotherapy in addition to cisplatin, hearing impairment at 53% was detected. Cisplatin ototoxic effects are dose-dependent and more intense with normal hearing. In our results, gender, age or the presence of previous hearing loss, were not statistically significant factors in vulnerability./nConclusions: the susceptibility variable to ototoxic damage on patients, the clinically insidious onset of hearing loss and its irreversibility, justify the need to monitor the cisplatin ototoxicity. Clinical data allow us to calculate the risk of an average population, although it does not help to predict what will happen to each patient.Introducción y objetivos: El cisplatino es uno de los fármacos de uso clínico con mayor ototoxicidad. Controlando los umbrales auditivos de los pacientes en tratamiento, podemos realizar una detección precoz de la hipoacusia y adoptar medidas terapéuticas. Con este trabajo pretendemos evaluar la incidencia y severidad de la hipoacusia por cisplatino en nuestro medio, identificando los principales factores de riesgo. /nMétodos: Monitorización y registro, en un hospital de tercer nivel, de la pérdida auditiva por cisplatino, en los primeros 100 pacientes enviados por oncología que aceptan el seguimiento audiológico, aplicando la audiometría de alta frecuencia y las otoemisiones acústicas./nResultados: Se trata de una población fundamentalmente adulta, con una edad media de 59 años. De los 70 pacientes tratados sólo con cisplatino un 27% manifestó la aparición o el incremento de su hipoacusia. En los 30 restantes, que además de cisplatino recibieron radioterapia, detectamos afectación auditiva en el 53%. Los efectos ototóxicos del cisplatino son dosis dependiente y más intensos con audición normal. En nuestros resultados, ni el género, ni la edad, ni la presencia de hipoacusia previa, fueron factores estadísticamente significativos en la vulnerabilidad./nConclusiones: La susceptibilidad variable al daño ototóxico, el inicio clínicamente insidioso y su irreversibilidad, justifican la conveniencia de monitorizar la ototoxicidad por cisplatino. Los datos clínicos nos permiten calcular el riesgo medio de una población, aunque no sirvan para predecir lo que le ocurrirá a un paciente en concreto

The overlooked immune state in candidemia: A risk factor for mortality

Producción CientíficaLymphopenia has been related to increased mortality in septic patients. Nonetheless, the impact of lymphocyte count on candidemia mortality and prognosis has not been addressed. We conducted a retrospective study, including all admitted patients with candidemia from 2007 to 2016. We examined lymphocyte counts during the first 5 days following the diagnosis of candidemia. Multivariable logistic regression analysis was performed to determine the relationship between lymphocyte count and mortality. Classification and Regression Tree analysis was used to identify the best cut-off of lymphocyte count for mortality associated with candidemia. From 296 cases of candidemia, 115 died, (39.8% 30-day mortality). Low lymphocyte count was related to mortality and poor outcome (p < 0.001). Lymphocyte counts <0.703 × 109 cells/L at diagnosis (area under the curve (AUC)-ROC, 0.783 ± 0.042; 95% confidence interval (CI), 0.700–0.867, p < 0.001), and lymphocyte count <1.272 × 109 cells/L five days later (AUC-ROC, 0.791 ± 0.038; 95%CI, 0.716–0.866, p < 0.001) increased the odds of mortality five-fold (odds ratio (OR), 5.01; 95%CI, 2.39–10.93) at time of diagnosis, and three-fold (OR, 3.27; 95%CI, 1.24–8.62) by day 5, respectively. Low lymphocyte count is an independent predictor of mortality in patients with candidemia and might serve as a biomarker for predicting candidemia-associated mortality and poor outcome.Junta de Castilla y León (grant VA161G18

HGF, IL-1α, and IL-27 are robust biomarkers in early severity stratification of COVID-19 patients

© 2021 by the authors.Pneumonia is the leading cause of hospital admission and mortality in coronavirus disease 2019 (COVID-19). We aimed to identify the cytokines responsible for lung damage and mortality. We prospectively recruited 108 COVID-19 patients between March and April 2020 and divided them into four groups according to the severity of respiratory symptoms. Twenty-eight healthy volunteers were used for normalization of the results. Multiple cytokines showed statistically significant differences between mild and critical patients. High HGF levels were associated with the critical group (OR = 3.51; p < 0.001; 95%CI = 1.95–6.33). Moreover, high IL-1α (OR = 1.36; p = 0.01; 95%CI = 1.07–1.73) and low IL-27 (OR = 0.58; p < 0.005; 95%CI = 0.39–0.85) greatly increased the risk of ending up in the severe group. This model was especially sensitive in order to predict critical status (AUC = 0.794; specificity = 69.74%; sensitivity = 81.25%). Furthermore, high levels of HGF and IL-1α showed significant results in the survival analysis (p = 0.033 and p = 0.011, respectively). HGF, IL-1α, and IL 27 at hospital admission were strongly associated with severe/critical COVID-19 patients and therefore are excellent predictors of bad prognosis. HGF and IL-1α were also mortality biomarkers.This work was supported by the Carlos III Health Institute (Grant COV20/00491)

HGF, IL-1α, and IL-27 Are Robust Biomarkers in Early Severity Stratification of COVID-19 Patients

Producción CientíficaPneumonia is the leading cause of hospital admission and mortality in coronavirus disease 2019 (COVID-19). We aimed to identify the cytokines responsible for lung damage and mortality. We prospectively recruited 108 COVID-19 patients between March and April 2020 and divided them into four groups according to the severity of respiratory symptoms. Twenty-eight healthy volunteers were used for normalization of the results. Multiple cytokines showed statistically significant differences between mild and critical patients. High HGF levels were associated with the critical group (OR = 3.51; p < 0.001; 95%CI = 1.95–6.33). Moreover, high IL-1α (OR = 1.36; p = 0.01; 95%CI = 1.07–1.73) and low IL-27 (OR = 0.58; p < 0.005; 95%CI = 0.39–0.85) greatly increased the risk of ending up in the severe group. This model was especially sensitive in order to predict critical status (AUC = 0.794; specificity = 69.74%; sensitivity = 81.25%). Furthermore, high levels of HGF and IL-1α showed significant results in the survival analysis (p = 0.033 and p = 0.011, respectively). HGF, IL-1α, and IL 27 at hospital admission were strongly associated with severe/critical COVID-19 patients and therefore are excellent predictors of bad prognosis. HGF and IL-1α were also mortality biomarkers.Instituto de Salud Carlos III (grant COV20/00491