In-Treatment Changes in Quality of Life-Related Variables in Therapeutic Communities for Cocaine Abusers: Are These Changes Associated with Clinical Outcomes?

Background: Few studies have explored changes in quality of life during the first three months of admission to a therapeutic community for addictions. The objective of this study was to determine the relationship between these changes and treatment outcomes at discharge. Methods: We undertook a prospective longitudinal study of 142 cocaine-dependent patients treated at a therapeutics community. All of these patients reached the 3-month evaluation and were subsequently followed until discharge. All participants completed the following measures: Health-Related Quality of Life for Drug Abusers Test; Beck Depression Inventory; State-Trait Anxiety Inventory; Opiate Treatment Index; Dual Diagnosis and Discharge Checklist. Results: At the 3-month assessment, scores on the Health-Related Quality of Life for Drug Abusers Test had increased significantly (Cohen's d: 0.92), while scores on the Opiate Treatment Index (Cohen's d: 0.86) and Beck Depression Inventory (Cohen's d: 0.20) scales both decreased significantly. A higher proportion of the patients considered to have achieved "clinically relevant" treatment outcomes at discharge versus those without clinically relevant outcomes were considered "recovered" according to the Reliable Change Index. Conclusions: An improvement in quality of life-related variables from baseline to the 3-month assessment was associated with better outcomes at discharge from the therapeutic community. The findings of this study may help us to optimise therapeutic interventions.The present study was funded by the National Plan on Drugs, Ministry of Health, Consumption and Social Welfare, Government of Spain [2007 no.2007i078]. The views expressed are those of the authors and do not necessarily represent those of the funding source

Modelos de organización de servicios para el tratamiento integrado de los trastornos mentales y las adicciones: elementos para una propuesta en Andalucía

Según el último informe del Observatorio Europeo de las Drogas y las Toxicomanías (2022), el consumo de sustancias ilegales se mantiene elevado en toda la Unión Europea, aunque se observan diferencias marcadas entre países. Aproximadamente, 22 millones de europeos adultos declararon haber consumido cannabis en el último año, siendo ésta la sustancia más consumida, seguida de los estimulantes (3,5 millones) y los opioides (un millón). No obstante, el consumo de estos últimos se asocia a una gran parte de los daños relacionados con las drogas ilegales. La epidemia del COVID-19 ha supuesto un rápido incremento del suministro y del consumo de drogas, lo que está suponiendo un nuevo reto asistencial. El informe admite claramente que el consumo se asocia a problemas de salud mental y complica la respuesta al tratamiento (Observa- torio Europeo de las Drogas y las Toxicomanías, 2022). En nuestro país, el informe del Observato- rio Español de las Drogas y las Adicciones (2022) señala que la sustancia más consumida durante el último año es el alcohol (77,2% de la población adulta), siendo este porcentaje del 39,4% para el tabaco, 37,5% para el cannabis, 10,9% para la cocaína y 0,1% para la heroína

Interaction of nanoparticles with substrates: effects on the dipolar behaviour of the particles

In this work, we present a numerical analysis of the surface electric field of a metallic nanoparticle (either 2D or 3D) interacting with a flat substrate underneath. The influence of the distance to the substrate, particle size, the surrounding media and the substrate optical properties is analyzed as a function of the incident wavelength. We show that these are crucial factors that change the field distribution associated to the dipolar behavior of the particle. A useful parameter for illustrating the changes in the angular distribution is θmax , the angle at which the maximum of the surface electric field is located

Surface inspection by monitoring spectral shifts of localized plasmon resonances

We present a numerical study of the spectral variations of localized surface plasmon resonances (LSPR) in a 3D-probe metallic nanoparticle scanned over an inhomoegeneous dielectric surface. The possibilities for both, index monitoring and lateral resolution at nanoscale level are explored, with special attention paid to the shape of the probe and the profile of the near field underneath

Polar decomposition of the Mueller matrix: a polarimetric rule of thumb for square-profile surface structure recognition

In this research, the polar decomposition (PD) method is applied to experimental Mueller matrices (MMs) measured on two-dimensional microstructured surfaces. Polarization information is expressed through a set of parameters of easier physical interpretation. It is shown that evaluating the first derivative of the retardation parameter, δ, a clear indication of the presence of defects either built on or dug in the scattering flat surface (a silicon wafer in our case) can be obtained. Although the rule of thumb thus obtained is established through PD, it can be easily implemented on conventional surface polarimetry. These results constitute an example of the capabilities of the PD approach to MM analysis, and show a direct application in surface characterization

Spectral behavior of the linear polarization degree at right-angle scattering configuration for nanoparticle systems

We present a numerical study of the spectral evolution of the linear polarization degree at right-angle scattering configuration (PL(90º)) for two different particle systems: an isolated nanosphere and a nanodimer composed of two finite size spherical particles separated by a gap distance d. We shall focus on the influence of charge oscillation modes other than the dipolar on the linear polarization degree of the scattered light. The possibility of using this alternative parameter for characterizing nanoparticle systems and particle interaction is analyzed.We acknowledge financial support from USAITCA (US Army International Technology Center—Atlantic) under the project R&D1390-PH-01 and from the Ministry of Education of Spain under the project FIS2007-60158

On the performance of a tunable grating-based high sensitivity unidirectional plasmonic sensor

Optical biosensing is currently an intensively active research area, with an increasing demand of highly selective, sensitivity-enhanced and low-cost devices where different plasmonic approaches have been developed. In this work we propose a tunable optimized grating-based gold metasurface that can act both as a high sensitivity sensor device (up to 1500 nm/RIU) and as an unidirectional plasmon source. The theory behind surface plasmon polariton generation is recalled to thoroughly understand the influence that every parameter of the grating source has on the performance of the proposed device. The results and conclusions discussed here offer a key step toward the design of biosensors based on excitation of surface plasmons polaritons by grating-based structures or in the process of creating new nanophotonic circuit devices.We gratefully acknowledge financial support from Spanish national project INMUNOTERMO (No. PGC2018-096649-B-I). J. G-C. thanks the Ministry of science of Spain for his FPI grant. G. S. thanks the Ministry of education for his collaboration grant and P.A. acknowledges funding for a Ramon y Cajal Fellowship (Grant No. RYC-2016-20831)

Light scattering resonances in small particles with electric and magnetic properties

Lorenz–Mie resonances produced by small spheres are analyzed as a function of their size and optical properties ( ε≷0 , μ≷0 ). New generalized (μ≠1) approximate and compact expressions of the first four Lorenz–Mie coefficients ( a1 , b1 , a2 , and b2 ) are calculated. With these expressions and for small particles with various values of ε and μ, the extinction cross section (Qext) is calculated and analyzed, in particular for resonant conditions. The dependence on particle size of the extinction resonance, together with the resonance shape (FWHM), is also analyzed. In addition to the former analysis, a study of the scattering diagrams for some interesting values of ε and μ is also presented

Aspectos conceptuales sobre el proceso de decisión compartida en salud mental.

Uno de los cambios más importantes en la atención sanitaria de las últimas décadas, en lo que a las decisiones terapéuticas se refiere, ha sido la transición desde un modelo centrado en la enfermedad a uno centrado en el paciente. Esto conlleva la progresiva sustitución de una aproximación paternalista por una más deliberativa y, en relación a los tratamientos farmacológicos, del concepto de cumplimiento o adherencia al de concordancia o acuerdo terapéutico. El concepto de concordancia, por su parte, ha sido contemplado como el objetivo final de un proceso de negociación y corresponsabilidad en la decisión de elegir un tratamiento al que se ha denominado proceso de decisión compartida (PDC) (shared decision making). Hasta el momento, el PDC ha sido escasamente implantado en trastornos mentales graves, cuando no contestado como inadecuado dada la presunta alteración de la capacidad del paciente psiquiátrico gravemente enfermo para tomar decisiones. Sin embargo, esta incapacidad no siempre está presente por lo que la decisión compartida debe contemplarse como premisa y no como excepción. El PDC implica la implantación de un procedimiento en etapas (asociación médicopaciente, información sobre opciones, pros y contras, deliberación sobre las mismas y su relación con valores y preferencias del paciente, decisión consensuada). Una de las barreras más importantes para la aplicación del proceso de decisión compartida en salud mental es la cuestión de la capacidad del enfermo mental. Por ello, la evaluación de la capacidad debe hacerse central en la práctica clínica psiquiátrica

El proceso de decisión compartida en el tratamiento del paciente psiquiátrico: estudios empíricos y evaluación de la capacidad

Existe investigación empírica sobre experiencias de decisión compartida en salud mental, preferentemente en depresión y esquizofrenia, y algo menos en adicciones. La evidencia disponible a partir de los estudios llevados a cabo en los últimos años muestra que esta práctica mejora la calidad de las decisiones y parece efectiva en el proceso decisorio (aumenta el conocimiento y la participación, favorece una mayor congruencia con los valores y preferencias del paciente), aumentando, generalmente, la satisfacción del usuario. Sin embargo, existe escasa o mínima evidencia acerca de su eficacia sobre indicadores de resultados de salud. Uno de los elementos claves de los procesos de decisión compartida es la determinación de la capacidad del paciente para tomar la decisión clínica en cuestión. Se trata de un juicio clínico que posee un papel relevante en el difícil equilibrio entre autonomía y beneficencia/no maleficencia en la atención sanitaria. Así, una adecuada evaluación de la capacidad de tomar decisiones del paciente debe servir para proteger ambos principios y evitar dos tipos de errores: por un lado, el soslayar injustificadamente  la  autonomía  del  paciente  para salvaguardar su bienestar; por otro, el injustificable respeto a su autonomía al precio de su bienestar