A personalized intervention to prevent depression in primary care based on risk predictive algorithms and decision support systems: protocol of the e-predictD study

The predictD is an intervention implemented by general practitioners (GPs) to prevent depression, which reduced the incidence of depression-anxiety and was cost-effective. The e-predictD study aims to design, develop, and evaluate an evolved predictD intervention to prevent the onset of major depression in primary care based on Information and Communication Technologies, predictive risk algorithms, decision support systems (DSSs), and personalized prevention plans (PPPs). A multicenter cluster randomized trial with GPs randomly assigned to the e-predictD intervention + care-as-usual (CAU) group or the active-control + CAU group and 1-year follow-up is being conducted. The required sample size is 720 non-depressed patients (aged 18–55 years), with moderate-to-high depression risk, under the care of 72 GPs in six Spanish cities. The GPs assigned to the e-predictD-intervention group receive brief training, and those assigned to the control group do not. Recruited patients of the GPs allocated to the e-predictD group download the e-predictD app, which incorporates validated risk algorithms to predict depression, monitoring systems, and DSSs. Integrating all inputs, the DSS automatically proposes to the patients a PPP for depression based on eight intervention modules: physical exercise, social relationships, improving sleep, problem-solving, communication skills, decision-making, assertiveness, and working with thoughts. This PPP is discussed in a 15-min semi-structured GP-patient interview. Patients then choose one or more of the intervention modules proposed by the DSS to be self-implemented over the next 3 months. This process will be reformulated at 3, 6, and 9 months but without the GP–patient interview. Recruited patients of the GPs allocated to the control-group+CAU download another version of the e-predictD app, but the only intervention that they receive via the app is weekly brief psychoeducational messages (active-control group). The primary outcome is the cumulative incidence of major depression measured by the Composite International Diagnostic Interview at 6 and 12 months. Other outcomes include depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7), depression risk (predictD risk algorithm), mental and physical quality of life (SF-12), and acceptability and satisfaction (‘e-Health Impact' questionnaire) with the intervention. Patients are evaluated at baseline and 3, 6, 9, and 12 months. An economic evaluation will also be performed (cost-effectiveness and cost-utility analysis) from two perspectives, societal and health systems.Spanish Ministry of Health, the Institute of Health Carlos IIIThe European Regional Development Fund Una manera de hacer Europa (grant references: PI15/00401PI15/01035, and PI15/01021), the Andalusian Council of Health (grant reference: AP-0095-2016);Prevention and Health Promotion Research Network redIAPP (RD16/0007/0010RD16/0007/0005, RD16/0007/0003, and RD16/0007/0001), Ministry of Health of Andalusia (PS-0330- 2016)The Chronicity, Primary Care, and Prevention and Health Promotion Research Network RICAPPS (RD21/0016/0012RD21/0016/0005, RD21/0016/0010, and RD21/0016/0001)The Ministry of Science and Innovation, the Institute of Health Carlos III (SCIII)The European Funds of the Recovery, Transformation and Resilience Plan, and by the EU funds Next-Generatio

Use of a personalised depression intervention in primary care to prevent anxiety: a secondary study of a cluster randomised trial

Background In the predictD-intervention, GPs used a personalised biopsychosocial programme to prevent depression. This reduced the incidence of major depression by 21.0%, although the results were not statistically significant. Aim To determine whether the predictD-intervention is effective at preventing anxiety in primary care patients without depression or anxiety. Design and setting Secondary study of a cluster randomised trial with practices randomly assigned to either the predictD-intervention or usual care. This study was conducted in seven Spanish cities from October 2010 to July 2012. Method In each city, 10 practices and two GPs per practice, as well as four to six patients every recruiting day, were randomly selected until there were 26–27 eligible patients for each GP. The endpoint was cumulative incidence of anxiety as measured by the PRIME-MD screening tool over 18 months. Results A total of 3326 patients without depression and 140 GPs from 70 practices consented and were eligible to participate; 328 of these patients were removed because they had an anxiety syndrome at baseline. Of the 2998 valid patients, 2597 (86.6%) were evaluated at the end of the study. At 18 months, 10.4% (95% CI = 8.7% to 12.1%) of the patients in the predictD-intervention group developed anxiety compared with 13.1% (95% CI = 11.4% to 14.8%) in the usual-care group (absolute difference = –2.7% [95% CI = –5.1% to –0.3%]; P = 0.029). Conclusion A personalised intervention delivered by GPs for the prevention of depression provided a modest but statistically significant reduction in the incidence of anxiety

Exploratory Matching Model Search Algorithm (EMMSA) for Causal Analysis: Application to the Cardboard Industry

This paper aims to present a methodology for the application of matching methods in industry to measure causal effect size. Matching methods allow us to obtain treatment and control samples with their covariates as similar as possible. The matching techniques used are nearest, optimal, full, coarsened exact matching (CEM), and genetic. These methods have been widely used in medical, psychological, and economic sciences. The proposed methodology provides two algorithms to execute these methods and to conduct an exhaustive search for the best models. It uses three conditions to ensure, as far as possible, the balance of all covariates, the maximum number of units in the treatment and control groups, and the most significant causal effect sizes. These techniques are applied in the carton board industry, where the causal variable is downtime, and the outcome variable is waste generated. A dataset from the carton board industry is used, and the results are contrasted with an expert in this process. Meta-analysis techniques are used to integrate the results of different comparative studies, which could help to determine and prioritize where to reduce waste. Two machines were found to generate more waste in terms of standardized measures whose values are 0.52 and 0.53, representing 48.60 and 36.79 linear meters (LM) on average for each production order with a total downtime of more than 3000 s. In general, for all machines, the maximum average wastage for each production order is 24.98 LM and its confidence interval is [13.40;36.23] LM. The main contribution of this work is the use of causal methodology to estimate the effect of downtime on waste in an industry. Particularly relevant is the contribution of an algorithm that aims to obtain the best matching model for this application. Its advantages and disadvantages are evaluated, and future areas of research are outlined. We believe that this methodology can be applied to other industries and fields of knowledge

Emotional stability and its relationship with the psychic damage among spanish victims of gender violence

The authors wish to express their gratitude to Spain ́s Administración de Justicia , to the women participating in this study, and to the Instituto de la Mujer (Ministry of Social Affairs).Introducción: La violencia contra la mujer constituye un problema de salud pública y se ha convertido en una de las principales causas de problemas de salud en las víctimas que la sufren. Se conoce poco sobre los factores de vulnerabilidad ante estas experiencias. El objetivo de este estudio es analizar la estabilidad/inestabilidad emocional como factor clave en la capacidad de afrontar una situación de violencia de género y sus consecuencias sobre la salud física y psíquica de las víctimas. Métodos: Se trata de un estudio trasversal realizado sobre una muestra de 151 mujeres españolas. Las mujeres fueron evaluadas mediante el Cuestionario de Salud General de Goldberg y el Inventario de Personalidad 16PF de Cattell. Resultados: Encontramos una relación significativa entre la estabilidad emocional y la puntuación total del Goldberg y sus cuatro subescalas de síntomas somáticos, ansiedad, adaptación socio-laboral y depresión (p<0.001). Conclusión: Niveles altos de estabilidad emocional podrían indicar fortaleza psicológica y menor vulnerabilidad, pudiendo favorecer que el daño psicológico en la mujer víctima sea menor.Introduction: Violence against women is a public health problem and has become one of the main causes of health problems in the victims who suffer. Little is known about the factors of vulnerability to these experiences. Objective: The aim of this study is to analyze the emotional stability/instability as the key factor for coping with a gender violence situation and its effects on the physical and psychic health of the victims. Methods: It´s a cross-sectional study conducted on a sample of 151 spanish women. The women were evaluated using the Goldberg General Health Questionnaire and Cattells 16PF Inventory. Results: Emotional stability was found to have a significant correlation with the Total Goldberg score and with its four subscales of symptoms, anxiety, withdrawal and depression (p<.001). Conclusion: A high emotional stability can be seen as an indicator of psychological strength and less vulnerability, hence less psychological damage of the victim

Maternal outcomes associated to psychological and physical intimate partner violence during pregnancy: A cohort study and multivariate analysis

Intimate partner violence (IPV) is a public health problem that affects millions of women worldwide and can occur during both pregnancy and the perinatal period. We aimed to evaluate if the experience of psychological and physical intimate partner violence (IPV) adversely affects pregnancy outcomes. We established a cohort of 779 consecutive mothers receiving antenatal care including ultrasound and giving birth in 15 public hospitals, drawn using cluster sampling of all obstetric services in Andalusia, Spain (February-June 2010). Trained midwives gathered IPV data using the Index of Spouse Abuse validated in the Spanish language (score ranges: 0–100, higher scores reflect more severe IPV; cutoffs: physical IPV = 10, psychological IPV = 25). Socio-demographic data, including lack of kin support, maternal outcomes, and hospitalization were collected. Multivariate logistic regression estimated adjusted odds ratios (AOR), with 95% confidence intervals (CI), of the relationship between psychological and physical IPV and maternal outcomes, controlling for socio-demographic characteristics. Response rate was 92.2%. Psychological IPV, reported by 21.0% (n = 151), was associated significantly with urinary tract infection (127 (23%) vs 56 (37%); AOR = 1.9; 95%CI = 1.2–3.0), vaginal infection (30 (5%) vs 20 (13%); AOR = 2.4; 95%CI = 1.2–4.7) and spontaneous preterm labour (32 (6%) vs 19 (13%); AOR = 2.2; 95% CI = 1.1–4.5). Physical IPV, reported by 3.6% (n = 26), was associated with antenatal hospitalizations (134 (19%) vs 11 (42%); AOR = 2.6; 95%CI = 1.0–7.1). Lack of kin support was associated with spontaneous preterm labour (AOR = 4.7; 95%CI = 1.7–12.8). Mothers with IPV have higher odds of complications. Obstetricians, gynaecologists and midwives should act as active screeners, particularly of the undervalued psychological IPV, to reduce or remedy its effects.This work was supported by the Ministry of the Economy and Competitiveness of Spain, National Project I+D+I (FEM2016-79049-R) to SMH

Propensity score analysis of psychological intimate partner violence and preterm birth

This study was funded by the Ministry of the Economy and Competitiveness of Spain (National Project I + D + I: FEM2016-79049-R).Psychological intimate partner violence (IPV), a global public health problem, affects mothers during pregnancy. We evaluated its relationship with preterm birth. We established a cohort of 779 consecutive mothers receiving antenatal care and giving birth in 15 public hospitals in Spain. Trained midwives collected IPV data using the Index of Spouse Abuse validated in the Spanish language. Preterm was defined as birth before 37 completed weeks of gestation. Gestational age was estimated by early ultrasound. With multivariate logistic regression we estimated the relative association of IPV with preterm birth as adjusted odds ratios (AOR), with 95% confidence intervals (CI). In propensity score analysis, using weighting by inverse probability of exposure to IPV, the whole sample was used for estimating the absolute difference in probability of preterm amongst offspring born to mothers with and without IPV. Socio-demographic and other pregnancy characteristics served as covariates in both analyses. Preterm occurred in 57 (7.3%) pregnancies. Psychological IPV, experienced by 151 (21%) mothers, was associated with preterm birth (11.9% vs 6.5%; AOR = 2.4; 95% CI = 1.1–5.0; p = 0.01). The absolute preterm difference in psychological IPV compared to normal was 0.08 (95% CI = 0.01–0.16; p = 0.04). The probability of preterm birth was 8% higher on average in women with psychological IPV during pregnancy. As our analysis controlled for selection bias, our findings give credence to a causal inference. Screening and management for psychological IPV during pregnancy is an important step in antenatal care to prevent preterm birth.Ministry of the Economy and Competitiveness of Spain FEM2016-79049-

Aminopeptidase Activities Interact Asymmetrically between Brain, Plasma and Systolic Blood Pressure in Hypertensive Rats Unilaterally Depleted of Dopamine

Brain dopamine, in relation to the limbic system, is involved in cognition and emotion. These functions are asymmetrically processed. Hypertension not only alters such functions but also their asymmetric brain pattern as well as their bilateral pattern of neurovisceral integration. The central and peripheral renin-angiotensin systems, particularly the aminopeptidases involved in its enzymatic cascade, play an important role in blood pressure control. In the present study, we report how these aminopeptidases from left and right cortico-limbic locations, plasma and systolic blood pressure interact among them in spontaneously hypertensive rats (SHR) unilaterally depleted of dopamine. The study comprises left and right sham and left and right lesioned (dopaminedepleted) rats as research groups. Results revealed important differences in the bilateral behavior comparing sham left versus sham right, lesioned left versus lesioned right, and sham versus lesioned animals. Results also suggest an important role for the asymmetrical functioning of the amygdala in cardiovascular control and an asymmetrical behavior in the interaction between the medial prefrontal cortex, hippocampus and amygdala with plasma, depending on the left or right depletion of dopamine. Compared with previous results of a similar study inWistar-Kyoto (WKY) normotensive rats, the asymmetrical behaviors differ significantly between both WKY and SHR strains.Junta de Andalucia PAI CVI-221 CTS 43

Asymmetric Interaction of Neuropeptidase Activities between Cortico-Limbic Structures, Plasma and Cardiovascular Function after Unilateral Dopamine Depletions of the Nigrostriatal System

This work was supported by Junta de Andalucia through the research groups PAI CVI-221 (Peptides and Peptidases) and CTS 438 (Group for Neurological Diseases Research in Southern Spain).In emotional processing, dopamine (DA) plays an essential role, and its deterioration involves important consequences. Under physiological conditions, dopamine exhibits brain asymmetry and coexists with various neuropeptides that can coordinate the processing of brain functions. Brain asymmetry can extend into a broader concept of asymmetric neurovisceral integration, including behavior. The study of the activity of neuropeptide regulatory enzymes (neuropeptidases, NPs) is illustrative. We have observed that the left and right brain areas interact intra- and interhemispherically, as well as with peripheral tissues or with physiological parameters such as blood pressure or with behaviors such as turning preference. To obtain data that reflect this integrative behavior, we simultaneously analyzed the impact of left or right brain DA depletion on the activity of various NPs in corticolimbic regions of the left and right hemispheres, such as the medial prefrontal cortex, amygdala and hippocampus, as well as on the plasma activity of the same aminopeptidase activities (APs) and on systolic blood pressure (SBP). Intra- and inter-hemispheric interactions as well as the interactions of NPs from the left or right hemispheres were analyzed with the same plasma APs and the SBP obtained from sham and from left or right lesioned rats. The results demonstrate a complex profile depending on the hemisphere considered. They definitively confirm an asymmetric neurovisceral integration and reveal a higher level of inter-hemispheric corticolimbic interactions including with SBP after left dopamine depletion.Junta de Andalucia PAI CVI-221 CTS 43

Influence of cavity preparation technique (rotary vs. ultrasonic) on microleakage and marginal fit of six end-root filling materials

Objectives: To evaluate in vitro the effect of cavity preparation with microburs and diamond-coated ultrasonic tips on the microleakage and marginal fit of six end-root filling materials. Study Design. The following materials were assessed: amalgam (Amalcap), zinc oxide eugenol (IRM), glass ionomer (Vitrebond), compomer (Cavalite), mineral particle aggregate (MTA) and composite (Clearfil). Cavity preparation was performed with microburs or diamond ultrasonic tips in single-root teeth. The seal was evaluated in two experiments: a microleakage assay on the passage of dye to the interface; and a scanning electron microscopy study and analysis of epoxy resin replicas, measuring the size of gaps in the interface between filling material and cavity walls. Multifactorial ANOVA, multiple comparison test and Student?s t test were used for statistical analyses of the data, considering p<0.05 to be significant. Results: Clearfil and MTA achieved a hermetic seal. Leakage and interface gap size was greater with Cavalite than with Clearfil and MTA, followed by Vitrebond and IRM. The worst seal was obtained with Amalcap. The use of diamond-coated ultrasonic tips improved the seal and reduced the gap when using materials that did not hermetically seal the cavity (Amalcap, IRM, Cavalite, Vitrebond). The preparation technique did not affect materials that achieved a hermetic seal (Clearfil, MTA). Conclusions: Clearfil and MTA obtained a hermetic seal due to their excellent marginal fit and are the most recommended materials for clinical use, taking account of their sealing capacity. Ultrasonic cavity preparation is preferable because it improves the seal and marginal fit of materials that do not achieve a hermetic seal of the cavity (Amalcap, IRM, Cavalite, Vitrebond)

Etiological and Resistance Profile of Bacteria Involved in Urinary Tract Infections in Young Children

The objective of this study was to identify the bacteria most frequently responsible for urinary tract infection (UTI) in the population of under-2-year-olds in our geographic area and to evaluate the activity of antibiotics widely used for UTI treatment during a 4-year study period. Materials and Methods. A retrospective analysis was conducted of data on the identification and susceptibility of microorganisms isolated in urine samples from children under 2 years of age. A total of 1,045 uropathogens were isolated. Escherichia coli accounted for the majority (60.3%) of these, followed by Enterococcus faecalis (22.4%) and Klebsiella spp. (6.5%). The highest E. coli susceptibility rates (>90%) were to piperacillin-tazobactam, cefuroxime, cefotaxime, ceftazidime, imipenem, gentamicin, nitrofurantoin, and fosfomycin, and the lowest were to amoxicillin-clavulanic acid and cotrimoxazole. Among all bacteria isolated, we highlight the overall high activity of piperacillin-tazobactam, imipenem, nitrofurantoin, and fosfomycin against both community and hospital isolates and the reduced activity of amoxicillin-clavulanic acid, cephalosporins, gentamicin, and cotrimoxazole. There was no significant change in the total activity of any of the studied antibiotics over the 4-year study period. Empiric treatment with amoxicillin-clavulanic acid, cotrimoxazole, cephalosporins, and gentamicin may be inadequate due to their limited activity against uropathogens in our settingParts of this work were supported by the CTS-521 research grou