All-cause mortality in the cohorts of the Spanish AIDS Research Network (RIS) compared with the general population: 1997Ł2010

Abstract Background: Combination antiretroviral therapy (cART) has produced significant changes in mortality of HIVinfected persons. Our objective was to estimate mortality rates, standardized mortality ratios and excess mortality rates of cohorts of the AIDS Research Network (RIS) (CoRIS-MD and CoRIS) compared to the general population. Methods: We analysed data of CoRIS-MD and CoRIS cohorts from 1997 to 2010. We calculated: (i) all-cause mortality rates, (ii) standardized mortality ratio (SMR) and (iii) excess mortality rates for both cohort for 100 personyears (py) of follow-up, comparing all-cause mortality with that of the general population of similar age and gender. Results: Between 1997 and 2010, 8,214 HIV positive subjects were included, 2,453 (29.9%) in CoRIS-MD and 5,761 (70.1%) in CoRIS and 294 deaths were registered. All-cause mortality rate was 1.02 (95% CI 0.91-1.15) per 100 py, SMR was 6.8 (95% CI 5.9-7.9) and excess mortality rate was 0.8 (95% CI 0.7-0.9) per 100 py. Mortality was higher in patients with AIDS, hepatitis C virus (HCV) co-infection, and those from CoRIS-MD cohort (1997. Conclusion: Mortality among HIV-positive persons remains higher than that of the general population of similar age and sex, with significant differences depending on the history of AIDS or HCV coinfection

Diagnóstico y tratamiento de la fobia a tragar en la infancia y adolescencia: estudio de casos

Diagnosis and treatment of swallowing phobia in childhood and adolescence: case study. Swallowing phobia is characterized by excessive fear of choking on food, liquids or pills, with significant physical and functional consequences. Evidence of treatment response and efficacy is still limited to a few studies. Considering the important repercussions that this disorder generates in children and adolescents, further knowledge is needed on the available treatment protocols and their effects in all levels of care. The objective of this descriptive retrospective study is to analyze the clinical aspects and treatment outcomes of thirteen cases treated at the Child and Youth Mental Health Center of the Corporació Parc Taulí (Sabadell, Barcelona). The age range of the patients was 7-15 years (M = 10.2; SD = 2.5); and 69% of cases were women. Results suggest the disorder is established gradually and responds adequately to psychological treatment, mainly with cognitive-behavioral therapy, applied either in partial hospitalization or outpatient unit. Early, intensive and interdisciplinary intervention increases the efficacy of the applied therapy and facilitates the resolution of the associated functional and social impairment. It is essential to include this disorder in the differential diagnosis of eating disorders in childhood, and the knowledge gathered by community professionals, in order to establish an adequate assessment, early treatment, and follow-up that improves therapeutic outcomesLa fobia a tragar se caracteriza por miedo excesivo a atragantarse al ingerir comida, líquidos o pastillas, con consecuencias físicas y funcionales de importancia. Son escasos los estudios que describen y aportan datos de la eficacia de los tratamientos para la fobia a tragar. Teniendo en cuenta las importantes repercusiones que este trastorno genera en niños y adolescentes, es necesario un mayor conocimiento de los protocolos disponibles y sus efectos en todos los niveles asistenciales. El objetivo de este estudio descriptivo retrospectivo fue analizar los aspectos clínicos y resultados del tratamiento aplicado en trece casos atendidos en el Centro de Salud Mental Infanto-Juvenil de la Corporació Parc Taulí (Sabadell, Barcelona). El rango de edad de los pacientes fue 7-15 años (M = 10.2; DT = 2.5); el 69% eran mujeres. Se instaura de forma gradual y responde adecuadamente al tratamiento psicológico, principalmente con terapia cognitivo-conductual, aplicado en hospitalización parcial o ambulatoriamente. La intervención precoz, intensiva e interdisciplinar aumenta la eficacia de la terapéutica empleada y facilita la resolución de las consecuencias funcionales y sociales asociadas. Es indispensable la inclusión de este trastorno en el diagnóstico diferencial de los trastornos de alimentación en la infancia, y su conocimiento por parte de los profesionales comunitarios, con la finalidad de establecer un adecuado plan de valoración, tratamiento precoz y seguimiento que mejore los resultados terapéuticos

Diagnóstico y tratamiento de la fobia a tragar en la infancia y adolescencia: estudio de casos

Diagnosis and treatment of swallowing phobia in childhood and adolescence: case study. Swallowing phobia is characterized by excessive fear of choking on food, liquids or pills, with significant physical and functional consequences. Evidence of treatment response and efficacy is still limited to a few studies. Considering the important repercussions that this disorder generates in children and adolescents, further knowledge is needed on the available treatment protocols and their effects in all levels of care. The objective of this descriptive retrospective study is to analyze the clinical aspects and treatment outcomes of thirteen cases treated at the Child and Youth Mental Health Center of the Corporació Parc Taulí (Sabadell, Barcelona). The age range of the patients was 7-15 years (M = 10.2; SD = 2.5); and 69% of cases were women. Results suggest the disorder is established gradually and responds adequately to psychological treatment, mainly with cognitive-behavioral therapy, applied either in partial hospital-ization or outpatient unit. Early, intensive and interdisciplinary intervention increases the efficacy of the applied therapy and facilitates the resolution of the associated functional and social impairment. It is essential to include this disorder in the differential diagnosis of eating disorders in childhood, and the knowledge gathered by community professionals, in order to establish an adequate assessment, early treatment, and follow-up that improves therapeutic outcomes.La fobia a tragar se caracteriza por miedo excesivo a atragantarse al ingerir comida, líquidos o pastillas, con consecuencias físicas y funcionales de importancia. Son escasos los estudios que describen y aportan datos de la eficacia de los tratamientos para la fobia a tragar. Teniendo en cuenta las importantes repercusiones que este trastorno genera en niños y adolescentes, es necesario un mayor conocimiento de los protocolos disponibles y sus efectos en todos los niveles asistenciales. El objetivo de este estudio descriptivo retrospectivo fue analizar los aspectos clínicos y resultados del tratamiento aplicado en trece casos atendidos en el Centro de Salud Mental Infanto-Juvenil de la Corporació Parc Taulí (Sabadell, Barcelona). El rango de edad de los pacientes fue 7-15 años (M = 10.2; DT = 2.5); el 69% eran mujeres. Se instaura de forma gradual y responde adecuadamente al tratamiento psicológico, principalmente con terapia cognitivo-conductual, aplicado en hospitalización parcial o ambulatoriamente. La interven-ción precoz, intensiva e interdisciplinar aumenta la eficacia de la terapéutica empleada y facilita la resolución de las consecuencias funcionales y sociales asociadas. Es indispensable la inclusión de este trastorno en el diagnóstico diferencial de los trastornos de alimentación en la infancia, y su conocimiento por parte de los profesionales comunitarios, con la finalidad de establecer un adecuado plan de valoración, tratamiento precoz y seguimiento que mejore los resultados terapéuticos

High PEEP with recruitment maneuvers versus Low PEEP During General Anesthesia for Surgery -a Bayesian individual patient data meta-analysis of three randomized clinical trials

Background: The influence of high positive end-expiratory pressure (PEEP) with recruitment maneuvers on the occurrence of postoperative pulmonary complications after surgery is still not definitively established. Bayesian analysis can help to gain further insights from the available data and provide a probabilistic framework that is easier to interpret. Our objective was to estimate the posterior probability that the use of high PEEP with recruitment maneuvers is associated with reduced postoperative pulmonary complications in patients with intermediate-to-high risk under neutral, pessimistic, and optimistic expectations regarding the treatment effect. Methods: Multilevel Bayesian logistic regression analysis on individual patient data from three randomized clinical trials carried out on surgical patients at Intermediate-to-High Risk for postoperative pulmonary complications. The main outcome was the occurrence of postoperative pulmonary complications in the early postoperative period. We studied the effect of high PEEP with recruitment maneuvers versus Low PEEP Ventilation. Priors were chosen to reflect neutral, pessimistic, and optimistic expectations of the treatment effect. Results: Using a neutral, pessimistic, or optimistic prior, the posterior mean odds ratio (OR) for High PEEP with recruitment maneuvers compared to Low PEEP was 0.85 (95% Credible Interval [CrI] 0.71 to 1.02), 0.87 (0.72 to 1.04), and 0.86 (0.71 to 1.02), respectively. Regardless of prior beliefs, the posterior probability of experiencing a beneficial effect exceeded 90%. Subgroup analysis indicated a more pronounced effect in patients who underwent laparoscopy (OR: 0.67 [0.50 to 0.87]) and those at high risk for PPCs (OR: 0.80 [0.53 to 1.13]). Sensitivity analysis, considering severe postoperative pulmonary complications only or applying a different heterogeneity prior, yielded consistent results. Conclusion: High PEEP with recruitment maneuvers demonstrated a moderate reduction in the probability of PPC occurrence, with a high posterior probability of benefit observed consistently across various prior beliefs, particularly among patients who underwent laparoscopy