Effectiveness of trauma-focused cognitive behavioral therapy for terrorism victims with very long-term emotional disorders

Background: There are no published studies on the clinical utility of psychotherapy in victims of terrorism who suffer emotional disorders many years after the attacks. Method: A course of trauma-focused cognitive behavioral therapy was administered to 50 victims of terrorist attacks that occurred an average of 23 years previously and who presented isolated or concurrent posttraumatic stress disorder (PTSD; 74%), major depressive disorder (54%), panic disorder (38%), or other anxiety disorders (38%). Results: According to an intention-to-treat analysis (N=50), these percentages decreased significantly to 24% (PTSD and major depression), 16% (panic disorder) and 14% (other anxiety disorders) at 1-year follow-up. According to a complete data analysis, at posttreatment no victims (n=31) still presented major depressive or panic disorder, only 3.2% presented PTSD and 9.7% presented other anxiety disorders, whereas at 1-year follow-up, no victims presented any disorders (n=22). At posttreatment and at the 1-, 3-, 6-month, and 1-year follow-ups, large statistically and clinically significant decreases in PTSD, depression, and anxiety symptomatology were found (d=1.26 to 2.52 at 1-year follow-up). Conclusions: These results suggest that efficacious treatments for recent victims are also useful in the usual clinical practice for victims with very long-term emotional disorders

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Estrés postraumático, depresión y ansiedad a largo plazo en víctimas de atentados terroristas

El terrorismo se sitúa como uno de los principales problemas a abordar para la sociedad en la actualidad. Con la ocurrencia de ataques terroristas de carácter masivo, la investigación científica de las consecuencias psicológicas de vivir un atentado terrorista se incrementó de forma considerable. Aunque los datos apuntan a la aparición de síntomas y trastornos de estrés postraumático, ansiedad y depresión tras el atentado, tanto en el corto como en el medio y largo plazo, así como de otros comportamientos derivados como el consumo de sustancias o el riesgo de suicidio, resulta difícil extraer conclusiones al respecto si atendemos a otros factores que puedan estar en juego como el nivel de exposición al atentado o el tiempo transcurrido desde el ataque ya que, por ejemplo, no se conocen las consecuencias psicopatológicas a muy largo plazo, tras 5, 10, 20 años o más después de los atentados. Objetivos Ante esta situación de incertidumbre, la presente tesis doctoral plantea como objetivo general determinar las consecuencias psicopatológicas de sufrir un atentado terrorista varias décadas después de acontecer. De manera más específica, este trabajo trata de establecer: (1) la prevalencia a muy largo plazo de casos probables de trastorno por estrés postraumático, trastorno depresivo y trastorno de ansiedad en víctimas directas de atentados terroristas, y (2) delimitar si existen diferencias estadísticamente significativas en la prevalencia de dichos trastornos en función de grupos de víctimas delimitados por su exposición o relación con el atentado (heridos, familiares de fallecidos y familiares de heridos) según diferentes criterios para definir un caso probable de trastorno psicológico

Efficacy and clinical utility (effectiveness) of treatments for adult victims of terrorist attacks: a systematic review

Se presenta una revisión sobre la eficacia y utilidad clínica de los tratamientos para los trastornos mentales en víctimas adultas del terrorismo. Una búsqueda en PsycINFO, PILOTS y MEDLINE encontró ocho estudios, todos sobre el trastorno por estrés postraumático (TEPT): siete sobre la terapia cognitivo conductual centrada en el trauma y uno sobre la de exposición en combinación con un inhibidor selectivo de la recaptación de serotonina, pero ninguno sobre otros fármacos, otras terapias psicológicas no cognitivo conductuales u otros trastornos mentales. Los resultados sugieren que: (a) la terapia cognitivo conductual centrada en el trauma no sólo es eficaz y útil en la práctica clínica para el tratamiento del TEPT en víctimas adultas del terrorismo, sino actualmente la terapia de elección y (b) la investigación futura debería desarrollar, adaptar y probar tratamientos para los otros trastornos mentales que pueden sufrir las víctimas del terrorismo (p. ej., trastornos depresivos y de ansiedad, duelo complicado) y para las víctimas de los países no desarrollados y no occidentales que son los que sufren en mayor medida el terrorismo.A review of the efficacy and clinical utility (effectiveness) of the treatments for mental disorders in adult victims of terrorism is presented. A search in PsycINFO, PILOTS and MEDLINE found eight studies, all of them on posttraumatic stress disorder (PTSD): seven on trauma-focused cognitive-behavioral therapy and one on exposure therapy in combination with a selective inhibitor of serotonin reuptake, but none on other medications, other non-cognitive-behavioral psychological therapies or other mental disorders. The results of this review suggest that: (a) trauma-focused cognitive behavioral therapy is not only efficacious and useful in clinical practice for the treatment of PTSD in victims of terrorism, but also currently the therapy of choice, and (b) future research should develop, adapt and test treatments for other mental disorders that victims of terrorism may suffer from (e.g., depressive and anxiety disorders, complicated grief) and for victims of non-developed, non-Western countries that are the countries that suffer most from terrorism.Ministerio de Ciencia e Innovación (MICINN)Asociación Víctimas del Terrorismo (AVT)Depto. de Personalidad, Evaluación y Psicología ClínicaFac. de PsicologíaTRUEpu

Programa de tratamiento educativo y terapéutico por maltrato familiar ascendente

Manual elaborado con la colaboración de expertos en la materia pertenecientes a la Clínica Universitaria de la Universidad Complutense de Madrid. Se trata de un programa de trabajo para la intervención en los casos de menores que han agredido a sus progenitores. Este manual está compuesto por tres volúmenes que abarcan, dentro de un tratamiento integral, la intervención con el menor por un lado, con los padres por otro y con la familia en su conjunto, con el fin de lograr un impacto global que normalice la dinámica familiar, modificando las circunstancias que propiciaron el conflicto.Depto. de Personalidad, Evaluación y Psicología ClínicaFac. de PsicologíaFALSEpu

In vivo effect of mouthwashes on viable viral load of SARS-CoV-2 in saliva: a pilot study

ABSTRACTCurrent data on the efficacy of antiseptic mouthwashes to reduce viral load are contradictory. Firstly, in vitro data indicate very strong virucidal effects that are not replicated in clinical studies. Secondly, most clinical studies identify a limited effect, do not include a control/placebo group, or do not evaluate viral viability in an infection model. In the current manuscript, we perform a double-blind, randomized clinical trial where salivary viral load was measured before and after the mouthwash, and where saliva samples were also cultured in an in vitro infection model of SARS-CoV-2 to evaluate the effect of mouthwashes on viral viability. Our data show a 90–99% reduction in SARS-CoV-2 salivary copies with one of the tested mouthwashes, although we show that the remaining viruses are mostly viable. In addition, our data suggest that the active ingredient concentration and the overall excipients’ formulation can play an important role; and most importantly, they indicate that the effect is not immediate, being significant at 15 min and having maximum effectiveness after 1 h. Thus, we show that some oral mouthwashes can be useful in reducing viral transmission, although their efficacy must be improved through refined formulations or revised protocols

Effect of oral antiseptics in reducing SARS-CoV-2 infectivity: evidence from a randomized double-blind clinical trial

Background: In vitro studies have shown that several oral antiseptics have virucidal activity against SARS-CoV-2. Thus, mouthwashes have been proposed as an easy to implement strategy to reduce viral transmission. However, there are no data measuring SARS-CoV-2 viability after mouthwashes in vivo. Methods: In this randomized double-blind, five-parallel-group, placebo-controlled clinical trial, SARS-CoV-2 salivary viral load (by quantitative PCR) and its infectious capacity (incubating saliva in cell cultures) have been evaluated before and after four different antiseptic mouthwashes and placebo in 54 COVID-19 patients. Results: Contrary to in vitro evidence, salivary viral load was not affected by any of the four tested mouthwashes. Viral culture indicated that cetylpyridinium chloride (CPC) significantly reduced viral infectivity, but only at 1-hour post-mouthwash. Conclusion: These results indicate that some of the mouthwashes currently used to reduce viral infectivity are not efficient in vivo and, furthermore, that this effect is not immediate, generating a false sense of security.Trial registration: ClinicalTrials.gov identifier: NCT04707742.