Seguridad y eficacia del tratamiento antiTNF para la enfermedad de Crohn en nuestro medio

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 22-09-201

Effects of cognitive stimulation program on cognition and mood in older adults, stratified by cognitive levels: A randomized controlled trial

Purpose of the research Cognitive stimulation (CS) is defined as activities that involve cognitive processing, usually conducted in a social context and often in a group. This study aims to evaluate the effects of a personalized-adapted CS program in older adults on global cognition, neuropsychological constructs, activities of daily living (ADLs), and mood. Materials and methods The randomized controlled single-blind trial involving 337 participants (235 women and 102 men) ≥ 65 years of age in a Primary Care centre classified participants into 4 groups: 101 for the no deterioration (ND) group; 100 for the subjective cognitive impairment (SCI) group; 108 for the level deterioration (LD) group and 28 for the moderate deterioration group. The intervention consisted of a personalized CS adapted program for 10 weeks. Follow-up assessments were conducted post-intervention, and at 6 and 12 months. The primary outcome was global cognition measured by the Spanish version of the Mini-Mental State Examination. The secondary outcomes were measured by the Barthel Index, the Lawton and Brody Scale, the Goldberg Questionnaire (anxiety sub-scale) and the abbreviated Yesavage Geriatric Depression Scale. Results The intervention showed a tendency of improvement on global cognition and different cognitive functions for groups with no deterioration or level deterioration. The group with moderate deterioration improved in anxiety. Conclusions The findings demonstrated benefits in global cognition, different cognitive functions, semantic fluency, IADLs and anxiety. The most benefits are given in the intermediate groups, SCI, and LD. Moreover, the intervention works by increasing the benefits in the different phases

Utility of PHQ-2, PHQ-8 and PHQ-9 for detecting major depression in primary health care: a validation study in Spain

Background: Primary health care (PHC) professionals may play a crucial role in improving early diagnosis of depressive disorders. However, only 50% of cases are detected in PHC. The most widely used screening instrument for major depression is the Patient Health Questionnaire (PHQ), including the two-, eight- and nine-item versions. Surprisingly, there is neither enough evidence about the validity of PHQ in PHC patients in Spain nor indications about how to interpret the total scores. This study aimed to gather validity evidence to support the use of the three PHQ versions to screen for major depression in PHC in Spain. Additionally, the present study provided information for helping professionals to choose the best PHQ version according to the context. Methods: The sample was composed of 2579 participants from 22 Spanish PHC centers participating in the EIRA-3 study. The reliability and validity of the three PHQ versions for Spanish PHC patients were assessed based on responses to the questionnaire. Results: The PHQ-8 and PHQ-9 showed high internal consistency. The results obtained confirm the theoretically expected relationship between PHQ results and anxiety, social support and health-related QoL. A single-factor solution was confirmed. Regarding to the level of agreement with the CIDI interview (used as the criterion), our results indicate that the PHQ has a good discrimination power. The optimal cut-off values were: ⩾2 for PHQ-2, ⩾7 for PHQ-8 and ⩾8 for PHQ-9. Conclusions: PHQ is a good and valuable tool for detecting major depression in PHC patients in Spain

Utility of PHQ-2, PHQ-8 and PHQ-9 for detecting major depression in primary health care: a validation study in Spain

Primary health care (PHC) professionals may play a crucial role in improving early diagnosis of depressive disorders. However, only 50% of cases are detected in PHC. The most widely used screening instrument for major depression is the Patient Health Questionnaire (PHQ), including the two-, eight- and nine-item versions. Surprisingly, there is neither enough evidence about the validity of PHQ in PHC patients in Spain nor indications about how to interpret the total scores. This study aimed to gather validity evidence to support the use of the three PHQ versions to screen for major depression in PHC in Spain. Additionally, the present study provided information for helping professionals to choose the best PHQ version according to the context

Uncontrolled donation after circulatory death: A cohort study of data from a long‐standing deceased‐donor kidney transplantation program.

Despite good long-term outcomes of kidney transplants from controlled donation after circulatory death (DCD) donors, there are few uncontrolled DCD (uDCD) programs. This longitudinal study compares outcomes for all uDCD (N = 774) and all donation after brain death (DBD) (N = 613) kidney transplants performed from 1996 to 2015 at our center. DBD transplants were divided into those from standard-criteria (SCD) (N = 366) and expanded-criteria (N = 247) brain-dead donors (ECD). One-, 5-, and 10-year graft survival rates were 91.7%, 85.7%, and 80.6% for SCD; 86.0%, 75.8%, and 61.4% for ECD; and 85.1%, 78.1%, and 72.2% for uDCD, respectively. Graft survival was worse in recipients of uDCD kidneys than of SCD (P = .004) but better than in transplants from ECD (P = .021). The main cause of graft loss in the uDCD transplants was primary nonfunction. Through logistic regression, donor death due to pulmonary embolism (OR 4.31, 95% CI 1.65-11.23), extrahospital CPR time ≥75 minutes (OR1.94, 95%CI 1.18-3.22), and in-hospital CPR time ≥50 minutes (OR 1.79, 95% CI 1.09-2.93) emerged as predictive factors of primary nonunction. According to the outcomes of our long-standing kidney transplantation program, uDCD could help expand the kidney donor pool.post-print1,71 M

Development and Validation of a Mobile Application as an Adjuvant Treatment for People Diagnosed with Long COVID-19: Protocol for a Co-Creation Study of a Health Asset and an Analysis of Its Effectiveness and Cost-Effectiveness

Objective: To analyse the overall effectiveness and cost-efficiency of a mobile application (APP) as a community health asset (HA) with recommendations and recovery exercises created bearing in mind the main symptoms presented by patients in order to improve their quality of life, as well as other secondary variables, such as the number and severity of ongoing symptoms, physical and cognitive functions, affective state, and sleep quality. Methods: The first step was to design and develop the technologic community resource, the APP, following the steps involved in the process of recommending health assets (RHA). After this, a protocol of a randomised clinical trial for analysing its effectiveness and cost-efficiency as a HA was developed. The participants will be assigned to: (1st) usual treatment by the primary care practitioner (TAU), as a control group; and (2nd) TAU + use of the APP as a HA and adjuvant treatment in their recovery + three motivational interviews (MI), as an interventional group. An evaluation will be carried out at baseline with further assessments three and six months following the end of the intervention. Discussion: Although research and care for these patients are still in their initial stages, it is necessary to equip patients and health care practitioners with tools to assist in their recovery. Furthermore, enhanced motivation can be achieved through telerehabilitation (TR)

Stellar populations across galaxy bars in the MUSE TIMER project

Stellar populations in barred galaxies save an imprint of the influence of the bar on the host galaxy’s evolution. We present a detailed analysis of star formation histories (SFHs) and chemical enrichment of stellar populations in nine nearby barred galaxies from the TIMER project. We used integral field observations with the MUSE instrument to derive unprecedented spatially resolved maps of stellar ages, metallicities, [Mg/Fe] abundances, and SFHs, as well as Hα as a tracer of ongoing star formation. We find a characteristic V-shaped signature in the SFH that is perpendicular to the bar major axis, which supports the scenario where intermediate-age stars (∼2 − 6 Gyr) are trapped on more elongated orbits shaping a thinner part of the bar, while older stars (> 8 Gyr) are trapped on less elongated orbits shaping a rounder and thicker part of the bar. We compare our data to state-of-the-art cosmological magneto-hydrodynamical simulations of barred galaxies and show that such V-shaped SFHs arise naturally due to the dynamical influence of the bar on stellar populations with different ages and kinematic properties. Additionally, we find an excess of very young stars (< 2 Gyr) on the edges of the bars, predominantly on the leading side, thus confirming typical star formation patterns in bars. Furthermore, mass-weighted age and metallicity gradients are slightly shallower along the bar than in the disc, which is likely due to orbital mixing in the bar. Finally, we find that bars are mostly more metal-rich and less [Mg/Fe]-enhanced than the surrounding discs. We interpret this as a signature that the bar quenches star formation in the inner region of discs, usually referred to as star formation deserts. We discuss these results and their implications on two different scenarios of bar formation and evolution

Professional interventions to implement guidelines to prevent hazardous alcohol consumption by patients in primary care settings (Protocol)

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