Las comunidades terapéuticas como tratamiento para las drogodependencias: una revisión sistemática del seguimiento a corto plazo

Objetivo. Las comunidades terapéuticas (CT) constituyen uno de los tratamientos más extensos para las drogodependencias; sin embargo, su investigación es escasa. El objetivo fue realizar una revisión sistemática para conocer los elementos metodológicos de los estudios de seguimiento a corto plazo y, a su vez, describir las consecuencias de las CT. Material y método. Se aplicó el "Preferred Reporting Items for Systematic reviews and meta- Analyses" (PRISMA) para la búsqueda en Medline, PsycINFO, PsycARTICLES y PsycCRITIQUES de estudios de seguimiento a corto plazo de CT entre 1980 y 2010. Resultados. El seguimiento consiste en un registro inicial y, al menos, otro al medio año de tratamiento; la muestra mínima contiene 60 usuarios con una mayor prevalencia de hombres solteros;el 50% continúa en seguimiento y/o alcanza la abstinencia. Conclusión. Las CT parecen ser beneficiosas para el ajuste del consumo y otros aspectos psicosociales, aunque la falta de información dificulta garantizar la comparación de estos hallazgos. © 2013 Elsevier España, S.L. y SET. Todos los derechos reservados

The Effect of Subsidence on Segmental and Global Lordosis at Long-term Follow-up After Anterior Cervical Discectomy and Fusion

Objective Subsidence following anterior cervical discectomy and fusion (ACDF) may lead to disruptions of cervical alignment and lordosis. The purpose of this study was to evaluate the effect of subsidence on segmental, regional, and global lordosis. Methods This was a retrospective cohort study performed between 2016–2021 at a single institution. All measurements were performed using lateral cervical radiographs at the immediate postoperative period and at final follow-up greater than 6 months after surgery. Associations between subsidence and segmental lordosis, total fused lordosis, C2–7 lordosis, and cervical sagittal vertical alignment change were determined using Pearson correlation and multivariate logistic regression analyses. Results One hundred thirty-one patients and 244 levels were included in the study. There were 41 one-level fusions, 67 two-level fusions, and 23 three-level fusions. The median follow-up time was 366 days (interquartile range, 239–566 days). Segmental subsidence was significantly negatively associated with segmental lordosis change in the Pearson (r = -0.154, p = 0.016) and multivariate analyses (beta = -3.78; 95% confidence interval, -7.15 to -0.42; p = 0.028) but no associations between segmental or total fused subsidence and any other measures of cervical alignment were observed. Conclusion We found that subsidence is associated with segmental lordosis loss 6 months following ACDF. Surgeons should minimize subsidence to prevent long-term clinical symptoms associated with poor cervical alignment

Holding blame at bay? ‘Gene talk’ in family members’ accounts of schizophrenia aetiology

We provide the first detailed analysis of how, for what purposes and with what consequences people related to someone with a diagnosis of schizophrenia use ‘gene talk'. The article analyses findings from a qualitative interview study conducted in London and involving 19 participants (mostly women). We transcribed the interviews verbatim and analysed them using grounded theory methods. We analyse how and for what purposes participants mobilized ‘gene talk' in their affectively freighted encounter with an unknown interviewer. Gene talk served to (re)position blame and guilt, and was simultaneously used imaginatively to forge family history narratives. Family members used ‘gene talk' to recruit forebears with no psychiatric diagnosis into a family history of mental illness, and presented the origins of the diagnosed family member's schizophrenia as lying temporally before, and hence beyond the agency of the immediate family. Gene talk was also used in attempts to dislodge the distressing figure of the schizophrenia-inducing mother. ‘Gene talk', however, ultimately displaced, rather than resolved, the (self-)blame of many family members, particularly mothers. Our article challenges the commonly expressed view that genetic accounts will absolve family members' sense of (self-)blame in relation to their relative's/relatives' diagnosis

A systematic review and synthesis of outcome domains for use within forensic services for people with intellectual disabilities

Aims. In response to the large number of people with intellectual disabilities (IDs) and offending behaviour being treated in psychiatric hospitals, this study identified and developed the domains that should be used to measure treatment outcomes for this population using both a systematic review and consultation exercises. Methods. A systematic search of relevant databases, and sixty studies met the eligibility criteria, and findings were synthesised using content analysis. The findings were refined within a consultation and consensus exercises with carers, service users, and experts. Results. The final framework encompassed three a priori superordinate domains (a) effectiveness, (b) patient safety, and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviours, reactive and restrictive interventions, quality of life and patient satisfaction. Conclusions. To index recovery, services need to measure outcome using this framework