Análisis de las alternativas terapéuticas del trastorno de pánico en atención primaria mediante un árbol de decisión

ResumenObjetivoAnalizar las diferentes estrategias terapéuticas para el trastorno de pánico, de forma que se facilite la toma de decisiones conjunta entre el profesional sanitario de atención primaria y el paciente.DiseñoAnálisis cuantitativo por árbol de decisión.Fuentes de datosRevisión del período de 1990 a 2008 en Medline, Embase, librería Cochrane Plus y Tripdatabase. Términos utilizados: “panic disorder”, “psychotherapy” y “drug therapy”.Selección de estudiosSumarios de pruebas, revisiones sistemáticas, metaanálisis y guías de práctica clínica.Extracción de datosa) Elaboración de un árbol de decisión con una única opción terapéutica; b) idéntico procedimiento con 2 opciones terapéuticas secuenciales, y c) análisis de sensibilidad para valorar la consistencia del modelo.ResultadosLa terapia cognitivo-conductual (TCC) obtiene la utilidad media esperada (UME) más elevada (UME = 0,58), seguida de los antidepresivos, inhibidores selectivos de la recaptación de serotonina (ISRS) (UME = 0,53) y de los antidepresivos tricíclicos (UME = 0,44). La secuencia TCC seguida de ISRS es la que obtiene una UME más alta (0,62). EL análisis de sensibilidad indica que el modelo no es suficientemente consistente.ConclusionesLa TCC en monoterapia o seguida de ISRS como estrategia secuencial serían las opciones terapéuticas con una mayor utilidad. Los resultados no son suficientemente consistentes, puesto que pueden variar claramente con la modificación de las variables más importantes dentro de unos rangos razonables.AbstractAimsTo analyse the different therapeutic alternatives for Panic Disorders to make it easier to make collaborative treatment decisions between patients and doctors in a Primary Care setting.DesignQuantitative analysis by a decision tree.Data SourcesTime period reviewed; 1990–2008 in Med-line, Embase, Cochrane-plus Library and Tripdatabase. Terms used “panic disorder”, “psychotherapy” and “drug therapy”.MethodsI) A decision tree was prepared with only one therapeutic option in each arm; II) The same procedure with two sequential therapeutic options; III) Sensitivity analysis to test the robustness of the model.Study selectionEvidence summary, systematic reviews, meta-analysis and clinical guidelines.ResultsCognitive-Behavioural Therapy (CBT) obtains the highest usefulness (UME=0.58), followed by the Selective serotonin reuptake inhibitors (SSRI) (UME=0.53) and by the tricyclic antidepressants (UME=0.44). CBT followed by SSRI is the therapeutic sequence with the highest usefulness (0.62). The sensitivity analysis suggests the model is not robust enough.ConclusionsThe CBT in monotherapy or followed by SSRI in a sequential strategy would be the options with the highest usefulness. The results are not robust enough because they can clearly vary with changes in the most important variables in a reasonable range

A physiology-inspired framework for holistic city simulations

Life, services and activities within cities have commonly been studied by separate disciplines, each one independent from the others. One such approach is the computer simulation, which enables in-depth modelling and cost-effective evaluation of city phenomena. However, the adoption of integrated city simulations faces several barriers, such as managerial, social, and technical, despite its potential to support city planning and policymaking. This paper introduces the City Physiology: a new conceptual framework to facilitate the integration of city layers when designing holistic simulators. The physiology is introduced and applied through a process of three steps. Firstly, a literature review is offered in order to study the terminology and the progress already made towards integrated modelling of different urban systems. Secondly, interactions between urban systems are extracted from the approaches studied before. Finally, the pipeline to carry out the integration strategy is described. In addition to providing a conceptual tool for holistic simulations, the framework enables the discovery of new research lines generated by previously unseen connections between city layers. Being an open framework, available to all researchers to use and broaden, the authors of this paper envisage that it will be a valuable resource in establishing an exact science of cities.Peer ReviewedPostprint (published version

A physiology-inspired framework for holistic city simulations

Life, services and activities within cities have commonly been studied by separate disciplines, each one independent from the others. One such approach is the computer simulation, which enables in-depth modelling and cost-effective evaluation of city phenomena. However, the adoption of integrated city simulations faces several barriers, such as managerial, social, and technical, despite its potential to support city planning and policymaking. This paper introduces the City Physiology: a new conceptual framework to facilitate the integration of city layers when designing holistic simulators. The physiology is introduced and applied through a process of three steps. Firstly, a literature review is offered in order to study the terminology and the progress already made towards integrated modelling of different urban systems. Secondly, interactions between urban systems are extracted from the approaches studied before. Finally, the pipeline to carry out the integration strategy is described. In addition to providing a conceptual tool for holistic simulations, the framework enables the discovery of new research lines generated by previously unseen connections between city layers. Being an open framework, available to all researchers to use and broaden, the authors of this paper envisage that it will be a valuable resource in establishing an exact science of cities.Peer ReviewedPostprint (published version

Post-traumatic stress disorder associated with natural and human-made disasters in the World Mental Health Surveys

Background: Research on post-traumatic stress disorder (PTSD) following natural and human-made disasters has been undertaken for more than three decades. Although PTSD prevalence estimates vary widely, most are in the 20–40% range in disaster-focused studies but considerably lower (3–5%) in the few general population epidemiological surveys that evaluated disaster-related PTSD as part of a broader clinical assessment. The World Mental Health (WMH) Surveys provide an opportunity to examine disaster-related PTSD in representative general population surveys across a much wider range of sites than in previous studies. Method: Although disaster-related PTSD was evaluated in 18 WMH surveys, only six in high-income countries had enough respondents for a risk factor analysis. Predictors considered were socio-demographics, disaster characteristics, and pre-disaster vulnerability factors (childhood family adversities, prior traumatic experiences, and prior mental disorders). Results: Disaster-related PTSD prevalence was 0.0–3.8% among adult (ages 18+) WMH respondents and was significantly related to high education, serious injury or death of someone close, forced displacement from home, and pre-existing vulnerabilities (prior childhood family adversities, other traumas, and mental disorders). Of PTSD cases 44.5% were among the 5% of respondents classified by the model as having highest PTSD risk. Conclusion: Disaster-related PTSD is uncommon in high-income WMH countries. Risk factors are consistent with prior research: severity of exposure, history of prior stress exposure, and pre-existing mental disorders. The high concentration of PTSD among respondents with high predicted risk in our model supports the focus of screening assessments that identify disaster survivors most in need of preventive interventions

Drivers of variation in seagrass-associated amphipods across biogeographical areas

Amphipods are one of the dominant epifaunal groups in seagrass meadows. However, our understanding of the biogeographical patterns in the distribution of these small crustaceans is limited. In this study, we investigated such patterns and the potential drivers in twelve Cymodocea nodosa meadows within four distinctive biogeographical areas across 2000 Km and 13° of latitude in two ocean basins (Mediterranean Sea and Atlantic Ocean). We found that species abundances in the assemblage of seagrass-associated amphipods differed among areas following a pattern largely explained by seagrass leaf area and epiphyte biomass, while the variation pattern in species presence/absence was determined by seagrass density and epiphyte biomass. Seagrass leaf area was also the most important determinant of greater amphipod total density and species richness, while amphipod density also increased with algal cover. Overall, our results evidenced that biogeographical patterns of variation in amphipod assemblages are mainly influenced by components of the habitat structure, which covary with environmental conditions, finding that structurally more complex meadows harboring higher abundance and richness of amphipods associated.info:eu-repo/semantics/publishedVersio

Drivers of variation in seagrass-associated amphipods across biogeographical areas

Amphipods are one of the dominant epifaunal groups in seagrass meadows. However, our understanding of the biogeographical patterns in the distribution of these small crustaceans is limited. In this study, we investigated such patterns and the potential drivers in twelve Cymodocea nodosa meadows within four distinctive biogeographical areas across 2000 Km and 13° of latitude in two ocean basins (Mediterranean Sea and Atlantic Ocean). We found that species abundances in the assemblage of seagrass-associated amphipods differed among areas following a pattern largely explained by seagrass leaf area and epiphyte biomass, while the variation pattern in species presence/absence was determined by seagrass density and epiphyte biomass. Seagrass leaf area was also the most important determinant of greater amphipod total density and species richness, while amphipod density also increased with algal cover. Overall, our results evidenced that biogeographical patterns of variation in amphipod assemblages are mainly influenced by components of the habitat structure, which covary with environmental conditions, finding that structurally more complex meadows harboring higher abundance and richness of amphipods associated.This work was supported by the Portuguese Foundation for Science and Technology (FCT) under the contract program DL57/2016/CP1361/CT0004 and CCMAR through the projects UIDB/04326/2020, UIDP/04326/2020 and LA/P/0101/2020

Modulation of the autophagic pathway inhibits HIV-1 infection in human lymphoid tissue cultured ex vivo

A complex link exists between HIV-1 and autophagy, and discordant results have been reported in different in vitro models regarding the way HIV and autophagy modulate each other. Despite this, there is very limited knowledge about the interplay between HIV and autophagy in vivo in lymphoid tissue, due in part by the lack of cell models that recapitulate the in vivo setting. Here, we evaluate the interrelationship between HIV and autophagy using human ex vivo lymphoid tissue cultures as an HIV infection model. Our results showed that human lymphoid aggregated cultures (HLACs) from tonsillar tissue displayed fully functional autophagic activity. In this system, HIV infection resulted in an increase in autophagy. Notably, we observed that both, autophagy-enhancing (rapamycin) or blocking drugs (3-methyladenine, chloroquine and bafilomycin), were able to decrease HIV-DNA levels and HIV replication. Therefore, efficient HIV-1 replication requires a fine-tuned level of autophagy, so modifications of this balance will have a negative impact on its replication. Therefore, targeting the autophagic pathway could be a new therapeutic approach to be explored to treat HIV-1 infection. Ex vivo cultures of human lymphoid tissue are a suitable model to obtain further insights into HIV and its intricate relationship with autophagy

The Camp Nou Stadium as a testbed for city physiology: a modular framework for urban digital twins

In this paper, the Camp Nou stadium is used as a testbed for City Physiology, a theoretical framework for urban digital twins. With this case study, the modularity and adaptability of the framework, originally intended for city-scale simulations, are tested on a large facility venue. As a proof of concept, several statistical techniques and an agent-based simulation platform are coupled to simulate a crowd in the stadium, and a process of four steps is followed to build the case study. Both the conceptual (interdomain) and technical (domain specific) layers of the digital twin are defined and connected in a nonlinear process so that they represent the complexity of the object to be simulated. &e result obtained is a strategy to build a digital twin from the domain point of view, paving the way for more complex, more ambitious simulatorsThis project has received funding from the European Union’s Horizon 2020 Research and Innovation Programme under the IoTwins Project (Grant agreement no. 857191). I. Meta was partially funded by the Agencia Estatal de Investigación-Ministerio de Ciencia Innovación (AEI MICINN) and the European Social Fund (ESF) under the FPI program (scholarship no. PRE2019-090239).Peer ReviewedPostprint (published version

El derecho a la protección social de las víctimas de la violencia de género. Estudio sistemático del título II de la L. O. 1/2004, de 28 de diciembre, de protección integral contra la violencia de género de acuerdo con la distribución territorial del Estado

La violencia de género, cuyas víctimas son mujeres en el 90% de los casos, constituye un problema acuciante que afecta a todos los países. Si nos fijamos en la sociedad española, de acuerdo con los datos obtenidos por el barómetro del Centro de Investigaciones Sociológicas de marzo de 2004 (estudio n.º 2.558 ), el 72% de las personas entrevistadas consideraban «muy frecuentes» o «bastan te frecuentes» las agresiones y los maltratos físicos en la pare ja. De hecho, según datos de un informe del Observatorio contra la violencia doméstica y de género del Consejo General del Poder Judicial (2006), hasta junio del año pasa do se celebraron 40.792 juicios por delitos y faltas relacionados con la viol encia contra las mujeres.Investigación financiada mediante subvención recibida de acuerdo con lo previsto en la Orden TAS/1051/2005, de 12 de abril (subvenciones para el Fomento de la Investigación de la Protección Social –FIPROS-