The MABIC project: An effectiveness trial for reducing risk factors for eating disorders

Challenges in the prevention of disordered eating field include moving from efficacy to effectiveness and developing an integrated approach to the prevention of eating and weight-related problems. A previous efficacy trial indicated that a universal disordered eating prevention program, based on the social cognitive model, media literacy educational approach and cognitive dissonance theory, reduced risk factors for disordered eating, but it is unclear whether this program has effects under more real-world conditions. This effectiveness trial tested whether this program has effects when previously trained community providers in an integrated approach to prevention implement the intervention. The research design involved a multi-center non-randomized controlled trial with baseline, post-test and 1-year follow-up measures. The sample included girls in the 8th grade from six schools (n = 152 girls) in a city near Barcelona (intervention group), and from eleven schools (n = 413 girls) in four neighboring towns (control group). The MABIC risk factors of disordered eating were assessed as main outcomes. Girls in the intervention group showed significantly greater reductions in beauty ideal internalization, disordered eating attitudes and weight-related teasing from pretest to 1-year follow-up compared to girls in the control group, suggesting that this program is effective under real-world conditions

The MABIC project : an effectiveness trial for reducing risk factors for eating disorders

Challenges in the prevention of disordered eating field include moving from efficacy to effectiveness and developing an integrated approach to the prevention of eating and weight-related problems. A previous efficacy trial indicated that a universal disordered eating prevention program, based on the social cognitive model, media literacy educational approach and cognitive dissonance theory, reduced risk factors for disordered eating, but it is unclear whether this program has effects under more real-world conditions. This effectiveness trial tested whether this program has effects when previously trained community providers in an integrated approach to prevention implement the intervention. The research design involved a multi-center non-randomized controlled trial with baseline, post-test and 1-year follow-up measures. The sample included girls in the 8th grade from six schools (n = 152 girls) in a city near Barcelona (intervention group), and from eleven schools (n = 413 girls) in four neighboring towns (control group). The MABIC risk factors of disordered eating were assessed as main outcomes. Girls in the intervention group showed significantly greater reductions in beauty ideal internalization, disordered eating attitudes and weight-related teasing from pretest to 1-year follow-up compared to girls in the control group, suggesting that this program is effective under real-world condition

A school-based program implemented by community providers previously trained for the prevention of eating and weight-related problems in secondary-school adolescents : the MABIC study protocol

Background: The prevention of eating disorders and disordered eating are increasingly recognized as public health priorities. Challenges in this field included moving from efficacy to effectiveness and developing an integrated approach to the prevention of a broad spectrum of eating and weight-related problems. A previous efficacy trial indicated that a universal disordered eating prevention program, based on the social cognitive model, media literacy educational approach and cognitive dissonance theory, reduced risk factors for disordered eating, but it is unclear whether this program has effects under more real-world conditions. The main aim of this effectiveness trial protocol is to test whether this program has effects when incorporating an integrated approach to prevention and when previously-trained community providers implement the intervention. Methods/design: The research design involved a multi-center non-randomized controlled trial with baseline, post and 1-year follow-up measures. Six schools from the city of Sabadell (close to Barcelona) participated in the intervention group, and eleven schools from four towns neighboring Sabadell participated in the control group. A total of 174 girls and 180 boys in the intervention group, and 484 girls and 490 boys in the control group were registered in class lists prior to baseline. A total of 18 community providers, secondary-school class tutors, nurses from the Catalan Government's Health and School Program, and health promotion technicians from Sabadell City Council were trained and delivered the program. Shared risk factors of eating and weight-related problems were assessed as main measures. Discussion: It will be vital for progress in disordered eating prevention to conduct effectiveness trials, which test whether interventions are effective when delivered by community providers under ecologically valid conditions, as opposed to tightly controlled research trials. The MABIC project will provide new contributions in this transition from efficacy to effectiveness and new data about progress in the integrated approach to prevention. Pending the results, the effectiveness trial meets the effectiveness standards set down by the Society for Prevention Research. This study will provide new evidence to improve and enhance disordered eating prevention programs

Implementació del protocol per a la guia del trastorn per dèficit d’ atenció amb hiperactivitat als centres de salut mental infantojuvenil del sistema públic de salut a Catalunya: estudi controlat no aleatoritzat

Introducció: L´any 2014, el 0.97% de la població catalana entre 0 i 17 anys tenia un diagnòstic de TDAH i era tractada als Centres de Salut Mental Infantil i Juvenil (CSMIJ). Però la situació a Catalunya era molt heterogènia, i les dades de percentatge de diagnòstic de TDAH en els CSMIJs anaven des del 2.3 % al 56%. Els fàrmacs indicats per al TDAH s´utilitzaven només en un 20-30 % dels casos diagnosticats i els tractament psicològics i familiars eren molt irregulars. Objectius: Amb la intenció de disminuir la variabilitat clínica no justificada, i millorar l´atenció a aquest trastorn, el Departament de Salut va encarregar al Consell Assessor de Salut mental, la constitució d’un grup de treball per elaborar un Protocol pel maneig del TDAH a Catalunya, amb la indicació d’adaptar la “Guía de Práctica Clínica sobre el Trastorno por Défi cit de Atención con Hiperactividad (TDAH) en Niños y Adolescentes”. Aquest protocol es va presentar al maig del 2015 i es va dissenyar un pla d’implementació que es va dur a terme en 7 CSMIJs pilot durant l´any 2016 i 2017, i va ser posteriorment avaluat. Material i mètode: Aquest estudi, prospectiu, controlat, no aleatoritzat, avalua els efectes de la implementació del protocol en el la prevalença de diagnòstic de TDAH en les primeres visites als CSMIJs de Catalunya, i en l’ús de teràpies indicades en el TDAH. També analitza la relació entre altres variables clíniques com les visites a urgències i les fractures i el tractament prescrit. Resultats: Després de la implementació del protocol, s´objectiva una disminució de les diferències territorials inicials en la prevalença del diagnòstic de TDAH de manera estadísticament signifi cativa (p< 0,05) . No s´observen canvis signifi catius entre els dos grups en l´increment de fàrmacs indicats per al TDAH, però si una reducció signifi cativa en l’ús de benzodiacepines en els pacients amb TDAH en els centres actius (p<0.05). Entre els pacients amb diagnòstic de TDAH, s´observa una diferència estadísticament signifi cativa (p<0.001) en el % de fractures entre els nens medicats amb fàrmacs indicats i els medicats amb altres psicòtrops o no medicats. Conclusió: La implementació del protocol de maneig del TDAH mostra efi càcia en la reducció de diferències territorials en la prevalença de diagnòstic de TDAH en la població atesa a Catalunya. Mostra també una millora en la prescripció farmacològica en base a l’evidència en aquest trastorn. Les diferències en fractures en funció del tractament per al TDAH que es troben en la població catalana amb TDAH i menor de 18 anys, repliquen les publicades a nivell internacional.Introducción: En el año 2014, 0.97% de la población catalana entre 0 y 17 años tenía un diagnóstico de TDAH y era tratada en los Centros de Salud Mental Infantil y Juvenil (CSMIJ). Pero la situación en Cataluña era muy heterogénea, y los datos de porcentaje de diagnóstico de TDAH en los CSMIJs iban des del 2.3 % al 56%. Los fármacos indicados para el TDAH se utilizaban solo en un 20-30 % de los casos diagnosticados y los tratamientos psicológicos y familiares eren muy irregulares. Objetivos: Con la intención de disminuir la variabilidad clínica no justificada, y mejorar la atención a este trastorno, el Departament de Salut encargó al al Consell Assessor de Salut mental, la constitución de un grupo de trabajo para elaborar un Protocolo para el manejo del TDAH en Cataluña, con la indicación de adaptar la “Guía de Práctica Clínica sobre el Trastorno por Déficit de Atención con Hiperactividad (TDAH) en Niños y Adolescentes”. Este protocolo se presentó en mayo de 2015 y se diseñó un plan de implementación que se realizó en 7 CSMIJ piloto durante los años 2016 y 2017, y fue posteriormente evaluado. Material y método: Este estudio, prospectivo, controlado, no aleatorizado, evalúa los efectos de la implementación del protocolo en el la prevalencia de diagnóstico de TDAH en les primeras visites en los CSMIJs de Cataluña, y en el uso de terapias indicadas en el TDAH. També analiza la relación entre otras variables clínicas como les visites a urgencias i les fractures y el tratamiento prescrito. Resultados: Después de la implementación del protocolo, se objetiva una disminución de les diferencias territoriales iniciales en la prevalencia del diagnóstico de TDAH de manera estadísticamente significativa (p< 0,05). No se observan cambios significativos entre los dos grupos en el incremento de fármacos indicados para el TDAH, pero si una reducción significativa en el uso de benzodiacepinas en los pacientes con TDAH en los centres activos (p<0.05). Entre los pacientes con diagnóstico de TDAH, se observa una diferencia estadísticamente significativa (p<0.001) en el % de fracturas entre los menores medicados con fármacos indicados i los medicados con otros psicótropos o no medicados. Conclusión: La implementación del protocolo de manejo del TDAH muestra eficacia en la reducción de diferencias territoriales en la prevalencia de diagnóstico de TDAH en la población atendida en Cataluña. Muestra también una mejora en la prescripción farmacológica en base a la evidencia en este trastorno. Les diferencias en fracturas en función del tratamiento para el TDAH que se encuentran en la población catalana con TDAH menor de 18 años, replican les publicadas a nivel internacional.Introduction: In 2014, 0.97% of Catalan population between 0 and 17 years old had a diagnosis of ADHD and was treated at the Centers for Children’s and Youth Mental Health (CSMIJ). But the situation in Catalonia was very heterogeneous, and the data on the percentage of ADHD diagnosis in the CSMIJs ranged from 2.3% to 56%. The drugs indicated for ADHD were used only in 20-30% of the diagnosed cases and the psychological and family treatments were very irregular. Objectives: In order to reducing unjustified clinical variability and improving care for this disorder, the Department of Health proposed to the Consell Assessor de Salut mental, to set up a working group to develop a Protocol for the management of ADHD in Catalonia, with the indication to adapt the “Guía de Práctica Clínica sobre el Trastorno por Déficit de Atención con Hiperactividad (TDAH) en Niños y Adolescentes” This protocol was presented in May 2015 and an implementation plan was designed that was carried out in 7 pilot CSMIJs during the years 2016 and 2017, and was subsequently evaluated. Material and method: This is a prospective, controlled, non-randomized study to evaluate the effect of protocol’s implementations on the prevalence of ADHD diagnosis in the first visits in the CSMIJs of Catalonia, and on the use of indicated therapies in ADHD. It also analyzes the relationship between other clinical variables: fractures in emergency setting and prescribed treatment. Results: After the protocol’s implementation, a statistically significant decrease in the initial territorial differences in ADHD prevalence was observed (p <0.05). No significant changes in the increase of ADHD indicated drugs were observed between the two groups, but there was a significant reduction in the use of benzodiazepines in patients with ADHD in the active centers (p <0.05). Among patients diagnosed with ADHD, a statistically significant difference (p <0.001) was observed in the % of fractures between indicated drugs medication patients and those medicated with other psychotropic or non-medicated patients. Conclusion: ADHD protocol’s implementation shows efficacy in reducing territorial differences in the prevalence of ADHD diagnosis in the population treated in Catalonia. It also shows an improvement in the use of evidence based drug in ADHD. The differences founded in in fractures depending on ADHD treatment, replicate those internationally published.Universitat Autònoma de Barcelona. Programa de Doctorat en Psiquiatri

Neurotrophin blood-based gene expression and social cognition analysis in patients with autism spectrum disorder

Autism spectrum disorders (ASD) comprise neurodevelopmental disorders with clinical onset during the first years of life. The identification of peripheral biomarkers could significantly impact diagnosis and an individualized, early treatment. Although the aetiology of ASD remains poorly understood, there is increasing evidence that neurotrophins and their receptors represent a group of candidate genes for ASD pathophysiology and biomarker research. Total messenger RNA (mRNA) from whole blood was obtained from adolescents and adults diagnosed as ASD (n = 21) according to DSM-IV criteria and confirmed by the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R) algorithms, as well as healthy controls (n = 10). The mRNA expression of neurotrophins (BDNF, NT3 and NT4) and their receptors (TrkA, TrkB and p75 (NTR) ) was determined by quantitative real-time polymerase chain reaction (qRT-PCR). Moreover, social cognition abilities of ASD patients and controls were determined according to three Theory of Mind (ToM) tests (Reading the Mind in the Eyes, Faux pas, and Happé stories). The NT3 and NT4 mRNA expression in the whole blood was significantly lower in ASD compared to healthy controls, while p75(NTR) was higher (P < 0.005). In addition, lower scores in three of the ToM tests were observed in ASD subjects compared to controls. A significant (P < 0.005) ToM impairment in Happé stories test was demonstrated in ASD. Nevertheless, no correlations were observed between neurotrophins and their receptors expressions and measures of ToM. Given their potential as peripheral blood-based biomarkers, NT3, NT4 and p75 (NTR) mRNA expression patterns may be useful tools for a more personalized diagnostics and therapy in ASD. Further investigations with larger numbers of samples are needed to verify these results

Eficacia de una Intervención Interdisciplinar en Adolescentes con Retraimiento Social en Hospitalización Parcial de Salud Mental

Introduction: Social withdrawal is a common feature in different mental disorders in childhood and adolescence, with psychological and behavioral consequences in the long term. It is important to assess and intervene in these cases to allow adequate development and social functioning in the adolescence. This study aimed to analyze the efficacy of a specific interdisciplinary intervention for adolescents with social withdrawal mental disorder, admitted to a partial hospitalization, compared with a control group that received the regular outpatient treatment. Methods: The intervention group consisted of 38 adolescents with a mean age of 15.2 years, mostly male, who received the interdisciplinary intervention in partial hospitalization. The control group had 38 participants, mostly boys, with a mean age of 14.6 years. Social competence was evaluated from the perspective of professionals, parents and teenagers, using respectively, the scale for the Assessment of Communication and Interaction Skills (ACIS), Social Functioning Scale (SFS) and Social Adaptation Self-evaluation Scale (SASS) at different time points according to the group (pre, post and follow-up to three months). Results: The results suggest a significant improvement and large effect size (d ≥ 0.8) in almost all areas of social competence in interdisciplinary intervention after partial hospitalization, compared with the control group. Conclusions: Changes are proposed to improve the efficacy of intervention for adolescents with social withdrawal, which is indispensable for their good functioning and future social adjustmentIntroducción: El retraimiento social es un rasgo común en diversos trastornos mentales en la infancia y adolescencia, con consecuencias psicológicas y conductuales a largo plazo. Es importante valorar e intervenir en estos casos para permitir un desarrollo y funcionamiento social adecuados en la adolescencia. Este estudio pretende analizar la eficacia de una intervención interdisciplinar específica en retraimiento social para adolescentes con trastorno mental ingresados en hospitalización parcial, comparándola con un grupo control que recibía el tratamiento ambulatorio habitual. Material y métodos: El grupo intervención estuvo constituido por 38 adolescentes con edad media de 15,2 años, mayoritariamente de sexo masculino, que recibieron la intervención interdisciplinar en hospital de día. El grupo control contó con 38 participantes, la mayor parte chicos, con edad media de 14,6 años. Para la evaluación de la competencia social desde la perspectiva de los profesionales, los padres y los propios adolescentes, se emplearon respectivamente, la Escala de Evaluación de las Habilidades de Comunicación e Interacción Social (ACIS), la Escala de Funcionamiento Social (SFS) y la Escala Autoaplicada de Adaptación Social (SASS), en distintos momentos temporales según el grupo (pre, post y seguimiento a los tres meses). Resultados: Los resultados sugieren una mejora significativa y con tamaño del efecto grande (d ≥ 0,8) en casi todas las áreas de competencia social tras la intervención interdisciplinar en hospitalización parcial, comparadas con el grupo control. Conclusiones: Se detallan las modificaciones propuestas para mejorar la eficacia de la intervención de los adolescentes con retraimient