Escala de Nivel de Emoción Expresada: Validación española para población adolescente general y desarrollo de una versión corta

Expressed emotion is a construct that has so far been studied in a clinical population, although this work proposes its study in adolescent population without psychopathology. It has three aims: 1) To analyse the psychometric characteristics of the Level of Expressed Emotion Scale in the relationship of the Spanish adolescents with their father and their mother, considering different response format (dichotomic and polytomic); (2) To develop a short version of the scale; (3) To study the validity of the instrument as a measure of emotional climate of normative families. Participants were 827 adolescents from 12 to 17 years old. Data analysis included exploratory and confirmatory factor analysis and structural equation modelling. Results suggested a 4-factor structure in the short version composed by 16 items, with adequate psychometric properties. This is presented as an innovative and appropriate tool for the assessment of the emotional family climate, both for researchers and clinicians.La emoción expresada es un constructo que hasta ahora ha sido estudiado en poblaciones clínicas, aunque este estudio se propone su estudio en poblaciones adolescentes sin ninguna psicopatología. Este estudio tiene tres objetivos: 1) Analizar las propiedades psicométricas de la Escala de Nivel de Emoción Expresada para adolescentes españoles en su relación con su padre y su madre, considerando diferentes formatos de respuesta (dicotómico y politómico); 2) Desarrollar una versión corta de la escala; 3) Estudiar la validez de la escala como medida del clima emocional en familias normativas. La muestra estuvo compuesta de 827 adolescentes de entre 12 y 17 años. El análisis de datos incluyó análisis factoriales exploratorios y confirmatorios y modelado de ecuaciones estructurales. Los resultados sugieren una estructura de cuatro factores para la versión corta, compuesta por 16 ítems, con propiedades psicométricas adecuadas. La escala se presenta como una herramienta innovadora y apropiada para la evaluación del clima emocional familiar, tanto para el ámbito clínico como para el de investigación

Escala de Nivel de Emoción Expresada: Validación española para población adolescente general y desarrollo de una versión corta

Expressed emotion is a construct that has so far been studied in a clinical population, although this work proposes its study in adolescent population without psychopathology. It has three aims: 1) To analyse the psychometric characteristics of the Level of Expressed Emotion Scale in the relationship of the Spanish adolescents with their father and their mother, considering different response format (dichotomic and polytomic); (2) To develop a short version of the scale; (3) To study the validity of the instrument as a measure of emotional climate of normative families. Participants were 827 adolescents from 12 to 17 years old. Data analysis included exploratory and confirmatory factor analysis and structural equation modelling. Results suggested a 4-factor structure in the short version composed by 16 items, with adequate psychometric properties. This is presented as an innovative and appropriate tool for the assessment of the emotional family climate, both for researchers and cliniciansLa emoción expresada es un constructo que hasta ahora ha sido estudiado en poblaciones clínicas, aunque este estudio se propone su estudio en poblaciones adolescentes sin ninguna psicopatología. Este estudio tiene tres objetivos: 1) Analizar las propiedades psicométricas de la Escala de Nivel de Emoción Expresada para adolescentes españoles en su relación con su padre y su madre, considerando diferentes formatos de respuesta (dicotómico y politómico); 2) Desarrollar una versión corta de la escala; 3) Estudiar la validez de la escala como medida del clima emocional en familias normativas. La muestra estuvo compuesta de 827 adolescentes de entre 12 y 17 años. El análisis de datos incluyó análisis factoriales exploratorios y confirmatorios y modelado de ecuaciones estructurales. Los resultados sugieren una estructura de cuatro factores para la versión corta, compuesta por 16 ítems, con propiedades psicométricas adecuadas. La escala se presenta como una herramienta innovadora y apropiada para la evaluación del clima emocional familiar, tanto para el ámbito clínico como para el de investigación

Parental perception of child vulnerability and parental competence: The role of postnatal depression and parental stress in fathers and mothers

Introduction: Parents' perception that their child may be vulnerable to serious life-threatening illnesses can have negative effects on how they exercise their parenting. No studies have yet been carried out on parent´s perception of their child’s vulnerability, when the child has not suffered a severe illness. This study tries to analyze the relationship between parent´s perception of their children´s vulnerability and parental competence, and analyzes the mediating role of postnatal depression and parental stress. Method: The study was carried out on mothers and fathers of full-term infants who did not have any serious illnesses. A total of 965 people (385 fathers and 580 mothers) participated in the study. Results: The results revealed an association between parental perception of their child’s vulnerability and parent’s perception of parental competence through depression and parental stress. However, this association was different for fathers and mothers. Conclusion: The variable of perception of child’s vulnerability was a relevant factor to understand parental competence.This work was funded by the General Sub-Directorate for Evaluation and Promotion of Research (Institute of Health Carlos III, ISCIII) and co-funded by the European Regional Development Fund (FEDER) ``A way to make Europe'' (Project reference PI14/01549)

A single Spanish version of maternal and paternal postnatal attachment scales: validation and conceptual analysis

Background: Postnatal bonding constitutes a major process during the postpartum period, and there is evidence that bonding difficulties have negative consequences for parents’ mental health and the child’s development. However, the conceptualization of postnatal bonding presents inconsistencies, as well as problems in having instruments that encompasses the father figure. The objective was to adapt the maternal postnatal attachment scale (MPAS) and the paternal postnatal attachment scale (PPAS) to Spanish, to evaluate its validity and reliability and to analyze the construct dimensionality of both questionnaires from a gender perspective. Methods: Instrumental design. In 2016–2017, a sample of 571 mothers and 376 fathers, with children between 6 and 11 months of age, responded to the Spanish version of MPAS and PPAS, respectively. After a process of translation-back-translation of the instrument, we empirically analyzed the internal consistency (Cronbach alpha, composite reliability (CR)) construct and concurrent validity (with regard to postpartum depression and dyadic adjustment). Additionally, we studied the instrument’s content validity, using the Delphi methodology; and the differential analysis in both samples (mothers and fathers), examining the invariance. Results: A short version of 15 items was obtained, common for mothers and fathers. The results of the Delphi methodology showed a 100% inter-judge agreement, highlighting the absence of differences in the adequacy of the items as a function of the parents’ gender. Confirmatory factor analysis showed a good fit of three original factors proposed by the authors. The global Cronbach alpha coefficients in the total sample were adequate (mothers, 0.70; fathers, 0.78); and Cronbach alpha of each dimension in the case of mothers was 0.50 (Quality of bonding), 0.55 (Absence of hostility), and 0.60 (Pleasure in interaction); in the case of fathers, it was respectively 0.54, 0.64, and 0.72. CR of each dimension were: quality of bonding, 0.74 in mothers and 0.80 in fathers; absence of hostility, 0.93 in mothers and 0.94 in fathers; pleasure in interaction, 0.83 in mothers and 0.90 in fathers. With regard to the analysis of group invariance, the results revealed empirical evidence of configural and metric invariance. Concurrent validity showed moderate negative correlations for postnatal depression (mothers, r = −0.41, p < 0.001; fathers, r = −0.38, p < 0.001), and positive correlations for dyadic adjustment (mothers, r = 0.39, p < 0.001; fathers, r = 0.44, p < 0.001). Discussion: A new version of the instrument was generated, with good psychometric properties, adequate for use both with mothers and with fathers. This scale helps evaluate postnatal maternal and paternal bonding, allowing to study it from within the family system, a necessary step forward to advance perinatal mental health.This project was supported by the General Sub-Directorate for Evaluation and Promotion of Research (Institute of Health Carlos III, ISCIII) and co-funded by the European Regional Development Fund (FEDER) (No. PI14/01549)

Differential body composition effects of protease inhibitors recommended for initial treatment of HIV infection: A randomized clinical trial

This article has been accepted for publication in Clinical Infectious Diseases ©2014 The Authors .Published by Oxford University Press on Clinical Infectious Disease 60.5. DOI: 10.1093/cid/ciu898Background. It is unclear whether metabolic or body composition effects may differ between protease inhibitor-based regimens recommended for initial treatment of HIV infection. Methods. ATADAR is a phase IV, open-label, multicenter randomized clinical trial. Stable antiretroviral-naive HIV-infected adults were randomly assigned to atazanavir/ritonavir 300/100 mg or darunavir/ritonavir 800/100 mg in combination with tenofovir/emtricitabine daily. Pre-defined end-points were treatment or virological failure, drug discontinuation due to adverse effects, and laboratory and body composition changes at 96 weeks. Results. At 96 weeks, 56 (62%) atazanavir/ritonavir and 62 (71%) darunavir/ritonavir patients remained free of treatment failure (estimated difference 8.2%; 95%CI -0.6 to 21.6); and 71 (79%) atazanavir/ritonavir and 75 (85%) darunavir/ritonavir patients remained free of virological failure (estimated difference 6.3%; 95%CI -0.5 to 17.6). Seven vs. five patients discontinued atazanavir/ritonavir or darunavir/ritonavir due to adverse effects. Total and HDL cholesterol similarly increased in both arms, but triglycerides increased more in atazanavir/ritonavir arm. At 96 weeks, body fat (estimated difference 2862.2 gr; 95%CI 726.7 to 4997.7; P=0.0090), limb fat (estimated difference 1403.3 gr; 95%CI 388.4 to 2418.2; P=0.0071), and subcutaneous abdominal adipose tissue (estimated difference 28.4 cm2; 95%CI 1.9 to 55.0; P=0.0362) increased more in atazanavir/ritonavir than in darunavir/ritonavir arm. Body fat changes in atazanavir/ritonavir arm were associated with higher insulin resistance. Conclusions. We found no major differences between atazanavir/ritonavir and darunavir/ritonavir in efficacy, clinically-relevant side effects, or plasma cholesterol fractions. However, atazanavir/ritonavir led to higher triglycerides and total and subcutaneous fat than darunavir/ritonavir and fat gains with atazanavir/ritonavir were associated with insulin resistanceThis is an Investigator Sponsored Research study. It was supported in part by research grants from Bristol‐Myers Squibb and Janssen‐Cilag; Instituto de Salud Carlos III (PI12/01217) and Red Temática Cooperativa de Investigación en SIDA G03/173 (RIS‐EST11), Ministerio de Ciencia e Innovación, Spain. (Registration number: NCT01274780; registry name: ATADAR; EUDRACT; 2010‐021002‐38)

ADAMTS13 recovery in acute thrombotic thrombocytopenic purpura after caplacizumab therapy

Caplacizumab prevents the interaction between von Willebrand factor and platelets and is used to treat immune thrombotic thrombocytopenic purpura (iTTP). Its administration has been associated with a delay in ADAMTS13 activity restoration after plasma exchange (PEX) suspension. We analyzed the outcomes of 113 iTTP episodes, 75 of which were treated with caplacizumab, in 108 patients from the Spanish Registry of Thrombotic Thrombocytopenic Purpura. Caplacizumab shortened the time to platelet count normalization and reduced PEX requirement, exacerbations, and relapses. There was no difference in the time to achieve ADAMTS13 activity ≥20% after PEX end between caplacizumab-treated and nontreated episodes (median [interquartile range], 14.5 [7.7-27.2] vs 13.0 [8.0-29.0] days, P = .653). However, considering the 36 episodes in which caplacizumab was started ≤3 days after iTTP diagnosis, the time for ADAMTS13 restoration from PEX end was higher than in those episodes in which caplacizumab was started >3 days after iTTP diagnosis (20.0 [12.0-43.0] vs 11.0 [3.5-20.0] days, P = .003) or than in non-caplacizumab-treated episodes (P = .033). This finding could be related to a significantly shorter duration of PEX in early caplacizumab-treated episodes than in late caplacizumab-treated episodes (5.5 [4.0-9.0] vs 15.0 [11.0-21.5] days, P < .001) or non-caplacizumab-treated episodes (11.0 [6.0-26.0] days, P < .001). There were no differences in time to ADAMTS-13 restoration from PEX start (28.0 [17.2-47.5], 27.0 [19.0-37.5] and 29.5 [15.2-45.0] days in early caplacizumab-treated, late caplacizumab-treated and non-caplacizumab-treated episodes). Early administered caplacizumab does not prevent the requirement for immunosuppression but has beneficial effects by shortening PEX requirement without major safety concerns.Peer reviewe

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Adaptación cultural del Instrumento "Patrones de Comunicación Familiar- R"

El objetivo de este estudio ha sido obtener una versión española adaptada culturalmente del instrumento �Patrones de comunicación familiar (PCFR, versión revisada), empleando procedimientos rigurosos en el proceso de retrotraducción y en el estudio empírico posterior. La muestra consistió en 455 estudiantes universitarios y se obtuvieron dos subescalas para la dimensión de la orientación a la conversación (�Expresión de ideas� y �Aceptación de la diferencia�) y dos para la dimensión de la orientación a la conformidad (�Rechazo de la diferencia� y �Ánimo a la obediencia�). Las escalas demostraron buenas cualidades psicométricas y una adecuada validez convergente, concurrente y de contenido, aunque es necesario profundizar en las dimensiones �orientación a la conformidad�. El análisis factorial confirmatorio respaldó la validez de constructo del instrumento, demostrando su utilidad en la evaluación familiar.The aim of this study was to obtain a culturally adapted Spanish version of the �Revised family communication patterns instrument (RFCP), using rigorous procedures in the retro-translation process and in the subsequent empirical study. The sampling consisted of 455 university students and two subscales for the conversation orientation were obtained (�Ideas expression� and �Differences acceptance�) and two for the conformity orientations (�Differences rejection� and �Obedience encourage�). All the scales proved to have good psychometric qualities and suitable convergent, concurrent and content validity, yet it is necessary to go more deeply into the conformity orientation. The construct validity was supported by a confirmatory factorial analysis showing that the RFCP is a useful instrument for family assessment

Cultural Adaptation of the Family Communication Patterns Instrument-R Adaptación cultural del Instrumento “Patrones de Comunicación Familiar- R”

The aim of this study was to obtain a culturally adapted Spanish version of the &amp;ldquo;Revised family communication patterns instrument (RFCP), using rigorous procedures in the retro-translation process and in the subsequent empirical study. The sampling consisted of 455 university students and two subscales for the conversation orientation were obtained (&amp;ldquo;Ideas expression&amp;rdquo; and &amp;ldquo;Differences acceptance&amp;rdquo;) and two for the conformity orientations (&amp;ldquo;Differences rejection&amp;rdquo; and &amp;ldquo;Obedience encourage&amp;rdquo;). All the scales proved to have good psychometric qualities and suitable convergent, concurrent and content validity, yet it is necessary to go more deeply into the conformity orientation. The construct validity was supported by a confirmatory factorial analysis showing that the RFCP is a useful instrument for family assessment. El objetivo de este estudio ha sido obtener una versi&amp;oacute;n espa&amp;ntilde;ola adaptada culturalmente del instrumento &amp;ldquo;Patrones de comunicaci&amp;oacute;n familiar (PCFR, versi&amp;oacute;n revisada), empleando procedimientos rigurosos en el proceso de retrotraducci&amp;oacute;n y en el estudio emp&amp;iacute;rico posterior. La muestra consisti&amp;oacute; en 455 estudiantes universitarios y se obtuvieron dos subescalas para la dimensi&amp;oacute;n de la orientaci&amp;oacute;n a la conversaci&amp;oacute;n (&amp;ldquo;Expresi&amp;oacute;n de ideas&amp;rdquo; y &amp;ldquo;Aceptaci&amp;oacute;n de la diferencia&amp;rdquo;) y dos para la dimensi&amp;oacute;n de la orientaci&amp;oacute;n a la conformidad (&amp;ldquo;Rechazo de la diferencia&amp;rdquo; y &amp;ldquo;&amp;Aacute;nimo a la obediencia&amp;rdquo;). Las escalas demostraron buenas cualidades psicom&amp;eacute;tricas y una adecuada validez convergente, concurrente y de contenido, aunque es necesario profundizar en las dimensiones &amp;ldquo;orientaci&amp;oacute;n a la conformidad&amp;rdquo;. El an&amp;aacute;lisis factorial confirmatorio respald&amp;oacute; la validez de constructo del instrumento, demostrando su utilidad en la evaluaci&amp;oacute;n familiar