Bereavement and Substance Use Disorder

In the present chapter, we focused on the relationship between bereavement and addiction, specifically among those patients who have a diagnosis of substance use disorder. Although bereavement research has advanced greatly in recent years, there are few studies on bereavement among the drug-dependent population. The substance use disorder population often report life stories marked by painful experiences and loss. Different studies have remarked on the relationship between bereavement and substance use. Highlighting the possible relationship between the loss of a significant person and a substance use disorder could help to build a theoretical background as well as to improve the dishabituation treatment in addiction centers

Patrón comportamental en adolescentes con riesgo a los trastornos del espectro esquizofrénico

El objetivo principal de este estudio es evaluar si existen diferencias en los rasgos esquizotípicos y en el patrón comportamental en sujetos adolescentes normales con vulnerabilidad a los trastornos del espectro esquizofrénico comparados con sujetos controles. El déficit atencional (medido a través de CPT-IP) ha sido el criterio utilizado para identificar a los sujetos con vulnerabilidad a estos trastornos. Los sujetos que forman parte de este estudio (n=202) provienen de una muestra original de 1.498 adolescentes normales estudiantes de 8º de E.G.B., con una media de edad de 13,2 años. Los resultados obtenidos ponen de manifiesto que existen diferencias en las variables comportamentales estudiadas entre los sujetos de riesgo y los controles, señalando la existencia de más características de ansiedad, depresión, problemas sociales y problemas atencionales en los primeros. También se han observado diferencias comportamentales en función del sexo en el grupo con déficit atencional. Los resultados no muestran diferencias en cuanto a los rasgos esquizotípicos entre ambos gruposThe main aim of this study is to assess whether there are differences in schizotypal traits and behavioural patterns in normal adolescents at risk for schizophrenia spectrum disorders in comparison to normal controls. Attentional deficit (measured by means of the CPT-IP test) has been our criterion to identify at-risk subjects. Subjects composing the sample of the study (n=202) come from an original sample of 1.498 normal junior students (mean age 13.2). Results show that there are differences in the behavioral variables studied between at-risk subjects and controls. At-risk subjects displayed more anxious and depressive traits, social problems and attentional problems. Within attentional deficit subjects, sex differences have been also found. There were no differences in schizotypal traits between both group

Attention, memory, and verbal learning and their relation to schizotypal traits in unaffected parents of schizophrenic patients

The main objective of this ex post facto study is to compare the differences in cognitive functions and their relation to schizotypal personality traits between a group of unaffected parents of schizophrenic patients and a control group. A total of 52 unaffected biological parents of schizophrenic patients and 52 unaffected parents of unaffected subjects were assessed in measures of attention (Continuous Performance Test- Identical Pairs Version, CPT-IP), memory and verbal learning (California Verbal Learning Test, CVLT) as well as schizotypal personality traits (Oxford-Liverpool Inventory of Feelings and Experiences, O-LIFE). The parents of the patients with schizophrenia differ from the parents of the control group in omission errors on the Continuous Performance Test- Identical Pairs, on a measure of recall and on two contrast measures of the California Verbal Learning Test. The associations between neuropsychological variables and schizotpyal traits are of a low magnitude. There is no defined pattern of the relationship between cognitive measures and schizotypal traitsEl objetivo principal de este estudio ex post facto es comparar las diferencias de las alteraciones cognitivas y su relación con los rasgos de la personalidad esquizotípica entre un grupo de padres no afectados de pacientes esquizofrénicos y un grupo control. Se han evaluado 52 padres biológicos no afectados de pacientes esquizofrénicos y 52 padres no afectados de sujetos no afectados en medidas de atención (Continuous Performance Test- Identical Pairs Version, CPT-IP), memoria y aprendizaje verbal (California Verbal Learning Test, CVLT) así como en rasgos de personalidad esquizotípica (Oxford-Liverpool Inventory of Feelings and Experiences, O-LIFE). Los padres de los pacientes con esquizofrenia se diferencian de los padres del grupo control en los errores de omisión del Continuous Performance Test- Identical Pairs, en una medida de recuerdo y en dos índices de contraste del California Verbal Learning Test. No existe un patrón definido de la relación entre las medidas cognitivas y los rasgos de esquizotipi

Suport social percebut i risc de suïcidi entre la població drogodependent

Suport social; Trastorns relacionats amb substàncies; Conducta suïcidaApoyo social; Trastornos relacionados con sustancias; Conducta suicidaSocial support; Substance-Related Disorders; Suicidal behaviorEl suïcidi és un greu problema de salut pública que ha anat augmentant en els darrers anys (WHO, 2010). Diferents estudis (Conner, i Duberstein, 2004; Pompili, et al., 2010; Vaszari, et al., 2011) mostren com la població drogodependent és un col·lectiu especialment vulnerable al suïcidi. L’objectiu és analitzar la relació entre el risc de suïcidi i altres variables sociodemogràfiques i el suport social percebut dels pacients diagnosticats de trastorn per dependència a l’alcohol, a la cocaïna o a l’heroïna, que han viscut la pèrdua d’una persona significativa i que són atesos en un Centre d’Atenció i Seguiment (CAS) públic

Patient self-management of oral anticoagulation with vitamin K antagonists in everyday practice : Clinical outcomes in a single centre cohort after long-term follow-up

Patient self-management (PSM) of vitamin K antagonists (VKA) seems a very promising model of care for oral anticoagulation in terms of efficacy and safety. In comparison with other management models of VKA therapy, the number of scientific publications supporting the advantages of PSM is more limited. Currently, most of the scarce information comes from randomized clinical trials. Moreover, a small number of studies have assessed PSM of VKA therapy in real life conditions. We analyzed clinical outcomes of 927 patients in a single center (6018.6 patient-years of follow-up). Recruitment took place between 2002 and 2017. All patients followed a structured training program, conducted by specialized nurses. Fifty percent of individuals had a mechanical heart valve (MHV), 23% suffered from recurrent venous thromboembolism (VTE) or high-risk thrombophilia, and 13% received VKA therapy because of atrial fibrillation (AF). Median follow-up was 6.5 years (range 0.1-15.97 years), median age was 58.1 years (IQR 48-65.9) and 46.5% were women. The incidence of major complications (either hemorrhagic or thromboembolic) was 1.87% patient-years (pt-ys) with a 95% CI of 1.54-2.27. The incidence of major thromboembolic events was 0.86% pt-ys (95% CI 0.64-1.13) and that of major hemorrhagic events was 1.01% pt-ys (95% CI 0.77-1.31). The incidence of intracranial bleeding was 0.22% pt-ys (95% CI 0.12-0.38). In terms of clinical indication for VKA therapy, the incidence of total major complications was 2.4% pt-ys, 2.0% pt-ys, 0.9% pt-ys and 1.34% pt-ys for MHV, AF, VTE and other (including valvulopathies and myocardiopathies), respectively. Clinical outcomes were worse in patients with multiple comorbidities, previous major complications during conventional VKA therapy, and in older individuals. The percentage of time in therapeutic range (TTR) was available in 861 (93%) patients. Overall, the mean (SD) of TTR was 63.6 ± 13.4%, being higher in men (66.2 ± 13.1%) than women (60.6 ± 13.2%), p < 0.05. In terms of clinically relevant outcomes (incidence of major complications and mortality), PSM in real life setting seems to be a very good alternative in properly trained patients

Biomonitoring of common organophosphate metabolites in hair and urine of children from an agricultural community

Levels of dialkylphosphate (DAP) metabolites were measured in hair and urine of children that lived close to intensively farmed areas of Almeria (Southeast Spain). The levels were used as proxies for exposure of these children to organophosphate pesticides (OPs). Determinants of exposure to DAPs were also examined. Urine and hair samples were collected from 222 children aged 3–11 years and information on lifestyle and dietary habits was collected from questionnaires administered to mothers. Urinary DAPs were analyzed by ultra-high performance liquid-chromatography coupled to triple-quadrupole tandem mass-spectrometry (UHPLC-QqQ-MS/MS) and hair DAPs by gas-chromatography coupled to mass spectrometry (GC–MS). Detection rates ranged from 21.8% for diethylphosphate (DEP) and diethylthiophosphate (DETP) to 35.9% for dimethylphosphate (DMP) in urine; and from 42.3% for DETP to 92.8% for DMP in hair. Diethyldithiophosphate (DEDTP) was detected in 0.5% of urine samples (one child), and in 26.6% of children's hair samples. A lack of correlation was observed for individual DAP metabolites and ΣDAPs between urine and hair samples, except for DEDTP. Urinary DAP levels of our child population were lower than those reported for children from other countries, including NHANES 1999–2000 data.This study was partially funded by the Ministry of Economy, Innovation, Science and Employment, Government of Andalucia (reference number P08-CTS-04313, FEDER funds)

Efecto de un tratamiento basado en ejercicio terapéutico con biofeedback en variables cinemáticas de sujetos con trastornos temporomandibulares

110 p.Los trastornos temporomandibulares (TTM) tienen alta prevalencia en la población adulta laboralmente activa. Actualmente se ha demostrado la eficacia del ejercicio y biofeedback en el tratamiento de patologías musculoesqueléticas, pero existe escasa información de ambas modalidades en el manejo de los TTM. El propósito del estudio es establecer los efectos del tratamiento basado en ejercicio terapéutico con biofeedback en variables cinemáticas durante la apertura y cierre mandibular en el plano frontal y sagital de pacientes con TTM. Se realizó un ensayo clínico aleatorizado en treinta y dos jóvenes universitarios. Fueron divididos en un grupo experimental (GE) y grupo control (GC), los cuales se evaluaron con el Índice temporomandibular de Fricton y Shiffman e Índice de discapacidad cervical. Se registraron variables cinemáticas durante el gesto mandibular a dos velocidades pre y post entrenamiento. Fueron intervenidos durante cuatro semanas con terapia de distracciones, ejercicios de resistencia y control motor. Se analizaron las diferencias con pruebas para muestras independientes pre y post intervención. Resultados: el índice de Fricton y Shiffman mostró una disminución en los puntajes del GC y GE (p=0,000) en relación a sus basales, al igual que el índice de discapacidad cervical en el GE (p=0,001). Se observó a velocidad rápida (VR) una disminución en la amplitud de anteposición de cabeza del GE en relación a su basal (p=0,006) y esta disminución fue mayor que el GC (p=0,011); una disminución en la amplitud de la extensión de cabeza en relación a sus basales en el GC (p=0,003) y GE (p=0,000). Se mostró mayor disminución del desplazamiento vertical post intervención en el GE (p=0,006) a VR. Conclusión: La incorporación de biofeedback a un programa de ejercicios genera mejores cambios en las variables cinemáticas, disminuyendo la disfunción durante la apertura y cierre mandibular a VR en comparación a una intervención de solo ejercicio terapéutico. // ABSTRACT: Temporomandibular disorders (TMD) have a high prevalence in the active adult population. Currently, the effectiveness of exercise and biofeedback in the treatment of musculoskeletal pathologies has been demonstrated, but there is little information on both modalities in the management of this condition. The purpose of the study is to establish the effects of treatment based on therapeutic exercise with biofeedback on kinematic variables during mandibular opening and closing in the frontal and sagittal plane of patients with TMD. A randomized clinical trial was conducted in thirty-two university students. They were divided into a experimental group (EG) and control group (CG), which were evaluated with the Fricton and Shiffman Temporomandibular Index and Cervical Disability Index. Kinematic variables were recorded during the mandibular gesture at two pre and post training speeds. They were operated for four weeks with distraction therapy, resistance exercises and motor control. Differences were analyzed with tests for independent samples pre and post intervention. Results: the Fricton and Shiffman index showed a decrease in the GC and GE scores (p = 0.000) in relation to their baseline, as did the cervical disability index in the EG (p = 0.001). A decrease in the amplitude of the head of the head of the EG in relation to its baseline (p = 0.006) was observed at rapid speed (RS) and this decrease was greater than the GC (p = 0.011); a decrease in the amplitude of the head extension in relation to its baseline in the GC (p = 0.003) and GE (p = 0.000). There was a greater decrease in post-intervention vertical displacement in the EG (p = 0.006) at RS. Conclusion: The incorporation of biofeedback into an exercise program generates better changes in kinematic variables, reducing dysfunction during the opening and closing of the mandible to VR compared to an intervention of only therapeutic exercise

ENE-COVID nationwide serosurvey served to characterize asymptomatic infections and to develop a symptom-based risk score to predict COVID-19

Objectives: To characterize asymptomatic SARS-CoV-2 infections and develop a symptom-based risk score useful in primary healthcare. Study design and setting: Sixty-one thousand ninty-two community-dwelling participants in a nationwide population-based serosurvey completed a questionnaire on COVID-19 symptoms and received an immunoassay for SARS-CoV-2 IgG antibodies between April 27 and June 22, 2020. Standardized prevalence ratios for asymptomatic infection were estimated across participant characteristics. We constructed a symptom-based risk score and evaluated its ability to predict SARS-CoV-2 infection. Results: Of all, 28.7% of infections were asymptomatic (95% CI 26.1-31.4%). Standardized asymptomatic prevalence ratios were 1.19 (1.02-1.40) for men vs. women, 1.82 (1.33-2.50) and 1.45 (0.96-2.18) for individuals <20 and ≥80 years vs. those aged 40-59, 1.27 (1.03-1.55) for smokers vs. nonsmokers, and 1.91 (1.59-2.29) for individuals without vs. with case contact. In symptomatic population, a symptom-based score (weights: severe tiredness = 1; absence of sore throat = 1; fever = 2; anosmia/ageusia = 5) reached standardized seroprevalence ratio of 8.71 (7.37-10.3), discrimination index of 0.79 (0.77-0.81), and sensitivity and specificity of 71.4% (68.1-74.4%) and 74.2% (73.1-75.2%) for a score ≥3. Conclusion: The presence of anosmia/ageusia, fever with severe tiredness, or fever without sore throat should serve to suspect COVID-19 in areas with active viral circulation. The proportion of asymptomatics in children and adolescents challenges infection control.The ENE-COVID study was supported by the Spanish Ministry of Health, the Institute of Health Carlos III, and the Spanish National Health System. The funders were in- volved in the study logistics, but they had no role in study design or in the collection, analysis, interpretation of data, or the decision to submit the article for publicationS