Défices neuro-psicológicos nas perturbações internalizantes e externalizantes: Implicações para aumentar a eficácia das intervenções cognitivo-comportamentais em crianças e adolescentes

Over the past three decades, our understanding of the nature, assessment and treatment of childhood mental disorders has increased significantly. Some of the most recent advances come from transdiagnostic and neuropsychological-based approaches. While the relationship of similar neuropsychological deficits with some mental disorders, such as neurodevelopmental and severe mental disorders like schizophrenia or bipolar disorder, is widely established, there is more controversy about their relationship with the so-called internalizing and externalizing disorders. In this article, our goal was to highlight the potential of incorporating cognitive strategies from integrative neuropsychological and transdiagnostic approaches to improve the effectiveness of empirically-supported cognitive-behavioral therapy for internalizing and externalizing mental disorders in childhood and adolescence. The results of the present work indicate that the vast majority of internalizing disorders, including the presence of anxiety, depressive, trauma- and stress-related, and obsessive-compulsive and related disorders, as well as externalizing symptoms (corresponding to conduct disorder and ODD), present neuropsychological deficits and that their consideration may be relevant to improve the effectiveness of psychotherapeutic interventions in children and adolescents by incorporating neuropsychology-based assessment and treatment tools. The inclusion of neuropsychological support strategies in therapy for childhood mental disorders implies an advance and has clear implications for the enhancement of psychological care for childhood mental disorders.Ao longo das últimas três décadas, a nossa compreensão da natureza, avaliação e tratamento das perturbações mentais na infância aumentou significativamente. Alguns dos avanços mais recentes derivam de abordagens transdiagnósticas e neuropsicológicas. Embora a relação de défices neuropsicológicos com algumas perturbações mentais, como as perturbações neurodesenvolvimentais e com perturbações mentais graves, como a esquizofrenia e a perturbação bipolar, seja amplamente reconhecida, existe maior controvérsia acerca da sua relação com as perturbações internalizantes e externalizantes. Este artigo teve como objetivo destacar o potencial de incorporar estratégias cognitivas derivadas de abordagens transdiagnósticas neuropsicológicas integradoras para aumentar a eficácia de tratamentos cognitivo-comportamentais empiricamente validados para perturbações internalizantes e externalizantes na infância e na adolescência. Os resultados do presente trabalho indicam que tanto a vasta maioria de perturbações internalizantes (incluindo perturbações de ansiedade, perturbações depressivas, perturbações relacionadas com trauma e fatores de stress, e perturbações obsessivo-compulsivas e relacionadas) como perturbações externalizantes (como perturbação do comportamento e perturbação desafiante de oposição), apresentam défices neuropsicológicos, e que a consideração destes défices pode ser relevante para melhorar a eficácia de intervenções psicoterapêuticas com crianças e adolescentes, incorporando ferramentas neuropsicológicas de avaliação e tratamento. A inclusão de estratégias neuropsicológicas de suporte na intervenção terapêutica para as perturbações mentais infantis implica um avanço e tem implicações claras na melhoria de cuidados psicológicos a esta população

Which Psychosocial Strengths Could Combat the Adolescent Suicide Spectrum? Dissecting the Covitality Model

Objective: Covitality is a meta-construct of positive intra/interpersonal self-schemas that organize and process life experiences. Its synergy favors psychosocial adjustment and prevents mental health problems during adolescence. At these ages, suicide is one of the leading causes of death worldwide. The purpose of this study was to determine which psychosocial strengths of the covitality model could combat adolescent suicide spectrum. Method: Participants were 5,528 Spanish adolescents aged 12-18 years, 50.74% females. The assessment protocol was completed in schools, under the supervision of the research staff. Statistical analyses were conducted using hurdle models, i.e., modeling zero-inflated count data. This process provided two sets of outcomes: the association in probabilistic terms between psychosocial strengths and the absence of suicide indicators (i.e., non-occurrence) and the association of these assets via regression coefficients with increased experimentation (i.e., duration/quantity). Results: All psychosocial strengths of the covitality model were related to the non-ocurrence of suicidal thoughts and behaviors, but not all to a shorter duration/quantity of their phenotypic manifestations. Covitality obtained greater association values on suicidal tendencies than its components analyzed independently. Belief in self and engaged living were the second-order factors with the higher estimating capacity. Specifically, emotional self-awareness, enthusiasm, gratitude, family support, and behavioral self-control were key first-order assets. Conclusions: These findings suggest that training adolescents in covitality assets could be an effective strategy for universal prevention against premature suicide. Moreover, this study provide evidence on which psychosocial strengths could counteract each phenotypic manifestation of suicide in order to customize selective and indicated preventive actions

Leukotriene B4-loaded microspheres: a new therapeutic strategy to modulate cell activation

<p>Abstract</p> <p>Background</p> <p>Leukotriene B₄(LTB₄) is a potent inflammatory mediator that also stimulates the immune response. In addition, it promotes polymorphonuclear leukocyte phagocytosis, chemotaxis, chemokinesis and modulates cytokines release. Regarding chemical instability of the leukotriene molecule, in the present study we assessed the immunomodulatory activities conferred by LTB₄released from microspheres (MS). A previous oil-in-water emulsion solvent extraction-evaporation method was chosen to prepare LTB₄-loaded MS.</p> <p>Results</p> <p>In the mice cremasteric microcirculation, intraescrotal injection of 0.1 ml of LTB₄-loaded MS provoked significant increases in leukocyte rolling flux, adhesion and emigration besides significant decreases in the leukocyte rolling velocity. LTB₄-loaded MS also increase peroxisome proliferator-activated receptor-α (PPARα) expression by murine peritoneal macrophages and stimulate them to generate nitrite levels. Monocyte chemoattractant protein-1 (MCP-1) and nitric oxide (NO) productions were also increased when human umbilical vein and artery endothelial cells (HUVECs and HUAECs, respectively) were stimulated with LTB₄-loaded MS.</p> <p>Conclusion</p> <p>LTB₄-loaded MS preserve the biological activity of the encapsulated mediator indicating their use as a new strategy to modulate cell activation, especially in the innate immune response.</p

El papel mediador de las fortalezas psicológicas entre la interferencia académica/laboral y la salud mental durante el confinamiento por COVID-19

The psychological impact due to the coronavirus pandemic (COVID-19) has been evidenced. Some of the variables associated with this have been the presence of previous financial problems, being students or being inactive, all of them issues related to the work and academic scope. Consequently, the main objective of the work was to analyze the mediating role that personal strengths for mental health have in the face of academic/work interference caused by lockdown due to COVID-19 in Spain based on work status (students, workers active and inactive), controlling in turn for other sociodemographic variables (sex and age). For the data collection of this descriptive cross-sectional study, an online survey was used, composed of instruments to assess the degree of interference in academic/work activities (ad hoc), maladaptive coping strategies (COPE-28), resilience (CD-RISC), covitality (SEHS), healthy habits (ad hoc), psychological well-being (WHO-5) and psychological distress (PHQ-4). The results showed: on the one hand, that the groups of students and inactivity showed worse mental health indicators and personal resources, while the opposite effect was found in the group of active workers; and, on the other hand, the PROCESS mediation models (model 4) evidenced a damping effect of personal resources between perceived academic/work interference and psychological adjustment indicators (well-being and psychological distress), regardless of the work category. In conclusion, the protective role of personal resources in psychological adjustment during lockdown due to COVID-19 is highlightedEl impacto psicológico debido a la pandemia por coronavirus (COVID-19) ha sido evidenciado. Algunas de las variables asociadas a éste han sido la presencia de problemas financieros previos, ser estudiantes o encontrarse inactivo, todas ellas cuestiones relacionadas con el ámbito laboral y académico. En consecuencia, el objetivo principal del trabajo fue analizar el papel mediador que tienen las fortalezas personales para la salud mental frente a la interferencia académica/laboral provocada por el confinamiento debido a la COVID-19 en España en función del estatus laboral (estudiantes, trabajadores activos e inactivos), controlando a su vez otras variables sociodemográficas (sexo y edad). Para la recogida de datos del presente estudio descriptivo de corte transversal se utilizó una encuesta online, compuesta por instrumentos para valorar el grado de interferencia en las actividades académicas/laborales (ad hoc), las estrategias de afrontamiento desadaptativas (COPE-28), la resiliencia (CD-RISC), la covitalidad (SEHS), los hábitos saludables (ad hoc), el bienestar psicológico (WHO-5) y malestar psicológico (PHQ-4). Los resultados mostraron, por un lado, que los colectivos de estudiantes y de inactividad manifestaron peores indicadores de salud mental y recursos personales, mientras que el efecto contrario fue hallado en el grupo de trabajadores activos; y, por otro lado, los modelos de mediación PROCESS (modelo 4) evidenciaron un efecto amortiguador de los recursos personales entre la interferencia académica/laboral percibida y los indicadores de ajuste psicosocial (bienestar y malestar psicológico), independientemente de la categoría laboral. En conclusión, se destaca la función protectora de los recursos personales en el ajuste psicosocial durante el periodo de confinamiento por COVID-19

Height and timing of growth spurt during puberty in young people living with vertically acquired HIV in Europe and Thailand.

OBJECTIVE: The aim of this study was to describe growth during puberty in young people with vertically acquired HIV. DESIGN: Pooled data from 12 paediatric HIV cohorts in Europe and Thailand. METHODS: One thousand and ninety-four children initiating a nonnucleoside reverse transcriptase inhibitor or boosted protease inhibitor based regimen aged 1-10 years were included. Super Imposition by Translation And Rotation (SITAR) models described growth from age 8 years using three parameters (average height, timing and shape of the growth spurt), dependent on age and height-for-age z-score (HAZ) (WHO references) at antiretroviral therapy (ART) initiation. Multivariate regression explored characteristics associated with these three parameters. RESULTS: At ART initiation, median age and HAZ was 6.4 [interquartile range (IQR): 2.8, 9.0] years and -1.2 (IQR: -2.3 to -0.2), respectively. Median follow-up was 9.1 (IQR: 6.9, 11.4) years. In girls, older age and lower HAZ at ART initiation were independently associated with a growth spurt which occurred 0.41 (95% confidence interval 0.20-0.62) years later in children starting ART age 6 to 10 years compared with 1 to 2 years and 1.50 (1.21-1.78) years later in those starting with HAZ less than -3 compared with HAZ at least -1. Later growth spurts in girls resulted in continued height growth into later adolescence. In boys starting ART with HAZ less than -1, growth spurts were later in children starting ART in the oldest age group, but for HAZ at least -1, there was no association with age. Girls and boys who initiated ART with HAZ at least -1 maintained a similar height to the WHO reference mean. CONCLUSION: Stunting at ART initiation was associated with later growth spurts in girls. Children with HAZ at least -1 at ART initiation grew in height at the level expected in HIV negative children of a comparable age

Experience sampling methods for the personalised prediction of mental health problems in Spanish university students: protocol for a survey-based observational study within the PROMES-U project

IntroductionThere is a high prevalence of mental health problems among university students. Better prediction and treatment access for this population is needed. In recent years, short-term dynamic factors, which can be assessed using experience sampling methods (ESM), have presented promising results for predicting mental health problems.Methods and analysisUndergraduate students from five public universities in Spain are recruited to participate in two web-based surveys (at baseline and at 12-month follow-up). A subgroup of baseline participants is recruited through quota sampling to participate in a 15-day ESM study. The baseline survey collects information regarding distal risk factors, while the ESM study collects short-term dynamic factors such as affect, company or environment. Risk factors will be identified at an individual and population level using logistic regressions and population attributable risk proportions, respectively. Machine learning techniques will be used to develop predictive models for mental health problems. Dynamic structural equation modelling and multilevel mixed-effects models will be considered to develop a series of explanatory models for the occurrence of mental health problems.Ethics and disseminationThe project complies with national and international regulations, including the Declaration of Helsinki and the Code of Ethics, and has been approved by the IRB Parc de Salut Mar (2020/9198/I) and corresponding IRBs of all participating universities. All respondents are given information regarding access mental health services within their university and region. Individuals with positive responses on suicide items receive a specific alert with indications for consulting with a health professional. Participants are asked to provide informed consent separately for the web-based surveys and for the ESM study. Dissemination of results will include peer-reviewed scientific articles and participation in scientific congresses, reports with recommendations for universities’ mental health policy makers, as well as a well-balanced communication strategy to the general public

Impact of SARS-Cov-2 infection in patients with hypertrophic cardiomyopathy : results of an international multicentre registry

To describe the natural history of SARS-CoV-2 infection in patients with hypertrophic cardiomyopathy (HCM) compared with a control group and to identify predictors of adverse events. Three hundred and five patients [age 56.6 ± 16.9 years old, 191 (62.6%) male patients] with HCM and SARS-Cov-2 infection were enrolled. The control group consisted of 91 131 infected individuals. Endpoints were (i) SARS-CoV-2 related mortality and (ii) severe clinical course [death or intensive care unit (ICU) admission]. New onset of atrial fibrillation, ventricular arrhythmias, shock, stroke, and cardiac arrest were also recorded. Sixty-nine (22.9%) HCM patients were hospitalized for non-ICU level care, and 21 (7.0%) required ICU care. Seventeen (5.6%) died: eight (2.6%) of respiratory failure, four (1.3%) of heart failure, two (0.7%) suddenly, and three (1.0%) due to other SARS-CoV-2-related complications. Covariates associated with mortality in the multivariable were age {odds ratio (OR) per 10 year increase 2.25 [95% confidence interval (CI): 1.12-4.51], P = 0.0229}, baseline New York Heart Association class [OR per one-unit increase 4.01 (95%CI: 1.75-9.20), P = 0.0011], presence of left ventricular outflow tract obstruction [OR 5.59 (95%CI: 1.16-26.92), P = 0.0317], and left ventricular systolic impairment [OR 7.72 (95%CI: 1.20-49.79), P = 0.0316]. Controlling for age and sex and comparing HCM patients with a community-based SARS-CoV-2 cohort, the presence of HCM was associated with a borderline significant increased risk of mortality OR 1.70 (95%CI: 0.98-2.91, P = 0.0600). Over one-fourth of HCM patients infected with SARS-Cov-2 required hospitalization, including 6% in an ICU setting. Age and cardiac features related to HCM, including baseline functional class, left ventricular outflow tract obstruction, and systolic impairment, conveyed increased risk of mortality

Propiedades psicométricas del Pain and Sensitivity Reactivity Scales (PSRS) en población neurotípica infantojuvenil

La percepción del dolor y la reactividad sensorial se presenta como una tarea difícil para la ciencia al ser considera una respuesta subjetiva que depende de diferencias individuales. Esta dificultad se incrementa aún más si la población de estudio incluye a niños y a adolescentes. Para la medición de esta respuesta se pueden utilizar medidas neurofisiológicas o escalas estandarizadas que cuantifiquen la información. Esta evaluación es de suma importancia, ya que puede detectar si existe una dificultad para recibir e interpretar los estímulos sensoriales tanto exteroceptivos como interoceptivos. Sin embargo, aún no existe una escala dimensional para población infanto-juvenil que aborde este campo. El objetivo de este estudio es presentar las propiedades psicométricas del Pain and Sensitivity Reactivity Scale (PSRS) en población infanto-juvenil neurotípica. La muestra está formada por más de 1000 niños y adolescentes de 12 a 17 años. La versión infanto-juvenil de la PSRS está formada tres escalas que hacen referencia al dolor, la hiposensibilidad e hipersensibilidad. Los resultados muestran una consistencia interna adecuada tanto para las diferentes escalas y como para el instrumento. Por último, en el análisis factorial exploratorio aparecen las tres dimensiones principales. En conclusión, poder evaluar la percepción del dolor y la reactividad sensorial en población infanto-juvenil puede ayudar a contextualizar problemas conductuales, emocionales e incluso académicos que pueden estar encubiertos por el desconocimiento que tanto el propio individuo muestra sobre su percepción como por el desconocimiento que familiares y profesionales de la educación presentan sobre las diferencias en la reactividad sensorial y la percepción del dolor.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech