Understanding and Explaining Psychological Distress inInternational Students

Research indicates that international students report more psychological distress than domestic students. The aim of our research was to investigate levels of stress, depression, and anxiety, and in particular, psychological predictors for these symptoms among international students. International students (N= 103) from the University of Jyväskylä (Finland) completed questionnaires assessing their stress (PSS-10), depression (PHQ-9), anxiety (GAD-7), psychological inflexibility (AFQ-Y), mindfulness (FFMQ), and engaged living (ELS). A significant proportion of students experienced high levels of psychological distress, and those with elevated symptoms reported higher levels of psychological inflexibility, lower levels of mindfulness skills and value-based actions. Regression analyses suggested that living according to one’s values and value-based actions was the strongest predictor of stress and depression (approx. 25% of variance explained). On the other hand, the strongest predictor for symptoms of anxiety was acting with awareness (approx. 20% of variance explained). This study suggests that students with different types of distress might benefit from training in distinct psychological flexibility skills, and these skills could be embedded into the university counselling services (AU)

Perceived Caregiving Trajectories and their Relationship with Caregivers’ Burdens and Gains

The study explores the meanings that family caregivers of people with dementia ascribe to the past, present, and future of their role as a caregiver, and how their integration into caregiving trajectories is related to caregivers’ burdens and gains. The sample was made up of 197 family caregivers (M age = 62.1, SD = 12.3, 70.1% females). They completed three incomplete sentences regarding their past, present, and future caring role, the Zarit Burden Interview and the Gains Associated with Caregiving scale. Sentence completions were content analyzed, and the associations between the resulting trajectories and burdens and gains were studied by means of a one-way ANOVA. Caregivers differed in the meanings ascribed to past, present, and future of their role. Stable-negative (M = 43.6, SD = 13.3), regressive (M = 43.3, SD = 12.7), and present-enhancing (M = 37.4, SD = 13.7) trajectories showed higher levels of burdens than progressive (M = 31.3, SD = 12.3) and/or stable-positive trajectories (M = 26.1, SD = 13.7). Progressive trajectories (M = 38.9, SD = 15.7) were related to more gains than regressive trajectories (M = 28.6, SD = 12.7). Family caregivers’ evaluations of their past, present, and future are not only important separately, but their combination into caregiving trajectories is also relevant. Such trajectories might be relevant when designing interventions to help caregivers reduce their burden levels and increase the benefits ascribed to their experience. The most adaptive trajectory identified was the progressive one, whereas the regressive trajectory was the most dysfunctional. (AU)

Cuestionario de percepción de factores causales de la Covid-19 (CPFC-Covid-19) / [Questionnaire on the perception of causal factors of Covid-19 (CPFC-Covid-19)]

En el artículo se detalla el procedimiento de validación de un cuestionario que analiza la percepción de los factores causales de la pandemia de la COVID-19, el CPFC-COVID-19. Se realizó una prueba piloto con 55 sujetos, se analizó la validez de contenido y de comprensión a través del juicio de 8 expertos y la validez de constructo a través de un análisis factorial exploratorio. Además, se realizó un análisis factorial confirmatorio con una muestra de 427 personas, se calculó la validez convergente y se hizo un análisis descriptivo y de consistencia interna de los factores del cuestionario final. El CPFC-COVID-19 quedó constituido por 20 ítems y cuatro dimensiones: Distanciamiento social y Protección (DSP), Impacto psicológico percibido (IPP), Escepticismo (E) y Credibilidad de la información percibida (CIP). Los resultados demuestran la validez del cuestionario y unos altos índices de fiabilidad, lo que permite conocer las percepciones de la población acerca de los factores causales de la COVID-19.

The article details the validation procedure for a questionnaire that analyzes the perception of the causal factors of the COVID-19 pandemic, the CFPQ-COVID- 19. A pilot test was carried out with 55 subjects, its content and comprehension validity was analyzed through the judgment of 8 experts, and its construct validity through an exploratory factor analysis. In addition, a confirmatory factorial analysis was carried out with a sample of 427 people, the convergent validity was calculated, and a descriptive and internal consistency analysis of the factors of the final questionnaire was performed. The CPFC-COVID-19 finally comprised 20 items and four dimensions: Social distancing and Protection (SDP), Perceived psychological impact (PPI), Skepticism (S) and Credibility of perceived information (CPI). The results demonstrated the validity of the questionnaire and high reliability rates, which allows us to determine the perceptions of the population about the causal factors of COVID-19.

Dengue como enfermedad asociada causante de debut de lepra en estado reaccional: presentación de un caso / [Dengue as an associated disease causing the debut of leprosy in a reactional state: presentation of a case]

La lepra es una enfermedad de desarrollo lento, que puede presentar episodios agudos que se conocen como estados reaccionales o reacciones leprosas y obligan al paciente a buscar atención médica. Se presenta una paciente femenina, de 34 años de edad, que presentaba malestar general, con fiebre de 38 y 39oC, dolores articulares intensos, cefalea y lesiones en el cuerpo que describe como ronchas, en cuello, tórax y brazos, además con inflamación en cara, manos y pie e imposibilidad para la deambulación por el intenso dolor articular y muscular. Al examen dermatológico se constata cuadro cutáneo generalizado, polimorfo, constituido por placas eritematosas, infiltradas, de tamaños variables que confluyen para formar grandes placas de bordes bien definidos en número mayor a una veintena y diámetros que oscilan entre 3 a 6 cm, algunas con centro de piel normal, que se distribuyen respetando palma de las manos y planta de los pies. Se observa además infiltración de los pabellones auriculares y manos y pies con edemas. El diagnóstico final fue debut de Lepra Borderline lepromatosa en estado reaccional provocado por Dengue. Se concluye que, en cuanto a las enfermedades infecciosas, se considera que el daño en la inmunidad de los afectados por lepra, sobre todo durante el curso de los estados reaccionales, posee un papel importante pues los hace más susceptibles a adquirirlas. Paradójicamente estas entidades son las causantes de los estados reaccionales en muchos de los casos, al generar un círculo vicioso que dificulta establecer la relación directa entre ellas. (AU)

Leprosy is a slowly developing disease, which can present acute episodes known as reactional states or leprosy reactions that require the patient to seek medical attention. A 34-year-old female patient, with general malaise, consisting of fever of 38 and 39oC, intense joint pain, headache and body injuries described as hives on neck, chest and arms, also inflammation on face, hands and feet and inability to walk due to intense joint and muscle pain comes for medical attention The dermatological examination revealed a generalized, polymorphous skin picture, consisting of erythematous, infiltrated plaques of variable sizes that converge to form large plaques with well-defined edges over 20 twenty in number and diameters ranging from 3 to 6 cm, some with a central area of normal skin, distributed over the body respecting the palms of the hands and the soles of the feet. There is also infiltration of the ears and hands and feet with edema. The final diagnosis was the debut of lepromatous Borderline Leprosy in reactionary state caused by Dengue. It is concluded that with regard to infectious diseases, the defect of the immunological system of those affected by leprosy, especially during the course of reactional states, plays an important role since it makes them more susceptible to other infections. Paradoxically, these entities are the cause of reactional states in many cases, by generating a vicious circle that makes it difficult to establish a direct relationship between them. (AU)

Mola hidatiforme completa invasiva: una causa poco común de hipertiroidismo / Invasive complete hydatidiform mole: a rare cause of hyperthyroidism

Hydatidiform mole (HM) is a form of gestational trophoblastic disease, which can be classified as complete or partial and is characterized by high levels of human chorionic gonadotropin (HCG). Hyperthyroidism results from the effect of β-hCG on TSH receptors. Clinical case: A 53-year-old multiparous woman, with no relevant history, was admitted to the Gynaecology Emergency Department with a clinic presentation of hypogastralgia and hyperemesis gravidarum with 1 month of evolution and symptoms of hyperthyroidism. The investigation showed a distended uterus with echogenic material with a thickness of 81 mm at filled by uterine cavity. β-hCG> 10000mIU / mL. She was admitted for suction curettage, and the resulting sample was compatible with HM. The additional analytical study showed primary hyperthyroidism and negative thyroid autoimmunity. Thyroid ultrasound was unaltered. The patient started therapy with metibasol and propanolol, showing clinical and analytical improvement. She also underwent, total abdominal hysterectomy and bilateral annexectomy with general anaesthesia, without complications. Chest x-ray without changes. Through histological analysis it was determined that the diagnosis was that of an invasive complete HM. Sixteen weeks after surgery, she presented β-hCG <2mIU / mL and normal thyroid function. The patient is still being monitored in the Gynaecology outpatient consultation. Thyroid function should be included in the laboratory analysis of HM. Removing the source of β-hCG allows the resolution of hyperthyroidism. However, due to the risk of thyroid storm, it is crucial to control the thyroid function before performing the surgical procedure. Given the possibility of persistence of trophoblastic tissue, it is essential to maintain regular follow-up with β-hCG assays. (AU)

Infección por SARS-CoV-2: un factor predisponente para síndrome coronario agudo / SARS-CoV-2 infection: A predisposing factor for acute coronary syndrome

Introducción: Se han reportado series de casos de SCA en pacientes COVID 19. Nuestro objetivo fue describir su incidencia, características, y pronóstico a 3 meses. Para contextualizar esta incidencia se comparó con la incidencia de SCA intrahospitalarios durante el mismo periodo del 2019.MétodosEstudio observacional de cohortes multicéntrico, de 3.108 pacientes COVID-19 ingresados en dos hospitales madrileños, entre el 1 de marzo y 15 de mayo de 2020. Diez pacientes sufrieron un SCA durante la fase hospitalaria realizándose un seguimiento clínico de 3 meses. Se estudiaron asimismo los pacientes con SCA intrahospitalarios durante el mismo periodo del 2019.ResultadosLa incidencia de SCA en COVID-19 fue 3,31‰, significativamente superior a la del periodo 2019, de 1,01‰ (p=0,013). Los pacientes COVID-19 con SCA, tenían una infección grave, mayoritariamente SCACEST (80%) y enfermedad multivaso (67%). La tasa de mortalidad (30%) y reingresos hospitalarios a 3 meses (20%) fueron muy elevadas.ConclusionesEl SCA es una complicación más frecuente de lo habitual en COVID-19 grave pero poco común y con mal pronóstico inmediato y a 3 meses. (AU)

Introduction: Several case series of ACS have been reported in COVID 19 patients. We aim to study its incidence, characteristics, and three-month prognosis. To put this incidence in perspective we compared it with the incidence of in-hospital ACS during the same period of 2019.MethodsObservational multicenter cohort study of 3,108 COVID-19 patients admitted to two hospitals in Madrid between March 1st and May 15th, 2020. Ten patients suffered an ACS while being hospitalized for COVID 19 and were followed for three months. The ACS incidence in hospitalized patients during the same period of 2019 was also studied.ResultsThe incidence of ACS in COVID-19 patients was 3.31 ‰, significantly higher than in the 2019 period, 1.01 ‰ (p = 0.013). COVID-19 patients that suffered and ACS frequently had a severe infection, presented with STEMI (80%), and had multivessel disease (67%). Mortality rate (30%) and hospital readmissions at three months (20%) were very high.ConclusionsSevere COVID-19 patients develop ACS more frequently than expected. Although the overall incidence was low, it carried a poor immediate and three-month prognosis. (AU)

Rating criteria of the causal nexus in Whiplash Associated Disorders: A study of interrater reliability / Criterios para el establecimiento del nexo causal en síndrome de latigazo cervical: un estudio de concordancia interobservadores

Introducción: El diagnóstico del síndrome de latigazo cervical está sujeto a criterios ambiguos, algunos de ellos de naturaleza subjetiva, que impide un alto porcentaje de acuerdo interjueces, y compromete seriamente la replicabilidad de los diagnósticos. El objetivo de este estudio es evaluar la concordancia interjueces de 4 expertos en medicina legal, quienes establecen el nexo causal de los pacientes que han sufrido un accidente de tránsito. Material y método: Trescientos pacientes que sufrieron un accidente de circulación fueron evaluados por 4 expertos en medicina legal. Realizaron 2 valoraciones del nexo causal, una sin estudio de la biomecánica y otra con este estudio. El grado de concordancia de las valoraciones fue calificado con el coeficiente de correlación intraclase (ICC) y el índice de concordancia (IC). Resultados: Los resultados de la valoración previa al estudio biomecánico de la lesión arrojan valores moderados-altos (ICC=0,70; CI=0,60). Asimismo, los valores observados en la valoración con el estudio de la biomecánica también indican un acuerdo moderado-alto (ICC=0,78, CI=0,67). Conclusiones: El estudio de la biomecánica mejora la concordancia de forma leve. A pesar de ello, el citado estudio no ayuda a reducir la proporción de casos dudosos y la mejora no alcanza niveles aceptables. Se observan diferencias significativas entre las clasificaciones, lo que sugiere que la metodología de valoración propuesta no es lo suficientemente uniforme como para alcanzar consenso. (AU)

Introduction: The diagnosis of Whiplash Associated Disorders is subject to various criteria, some of a subjective nature, which impedes a high percentage of agreement among raters of the causal nexus. It is necessary to develop an evidence-based methodology to maximize the uniformity of this diagnosis. Our objective is to assess the interrater reliability of four experts in legal medicine who establish the causal nexus of traffic accident patients. Material and method: 300 traffic accident patients evaluated by 4 legal medicine experts. They conducted two ratings, one without and one with a study of the biomechanics of the accident. The degree of concordance of the ratings was studied by the intraclass correlation coefficient (ICC) and the concordance index (CI). Results: The results of both the intraclass correlation coefficient and the concordance index of the rating prior to the biomechanical study of the injury yield moderate-high values (ICC=.70; CI=.60). Likewise, the values observed in the rating with the study of biomechanics also indicate moderate-high agreement (ICC=.78, CI=.67). Conclusions: The study of biomechanics slightly improves concordance. However, the aforementioned study does not help to reduce the proportion of doubtful cases and the levels of improvement are not acceptable. There are significant differences between the classifications, suggesting that the proposed valuation methodology is not uniform enough to reach a consensus. (AU)

Adecuación de la seguridad del metamizol y agranulocitosis / Adequacy of the safety of metamizole and agranulocytosis

Objetivo: Analizar si la nota informativa de la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), de 30 de octubre del 2018, sobre agranulocitosis y metamizol contiene la información precisa y necesaria para proteger a los pacientes de la aparición de esta reacción adversa (RA) y si la documentación oficial de los medicamentos con metamizol para médicos, farmacéuticos y población general está adaptada a las directrices de la AEMPS para disminuir el riesgo. Emplazamiento y participantes: Nota informativa, búsqueda bibliográfica, información sobre los medicamentos con metamizol comercializados en España en la Agencia Europea del Medicamento, fichas técnicas, prospectos, base de datos de información sanitaria Bot PLUS y Catálogo de Especialidades Farmacéuticas. Notificación de 4casos de agranulocitosis por metamizol posteriores a la fecha de la nota informativa. Intervenciones y mediciones principales: Comparación de los puntos clave de la nota informativa y de los documentos oficiales sobre metamizol con la bibliografía. Descripción de 4casos de agranulocitosis por metamizol y aplicación del algoritmo de causalidad y gravedad. Resultados: La nota informativa presenta ausencias y dudas respecto a la bibliografía y al uso de metamizol en la práctica asistencial. Los documentos oficiales presentan faltas de actualización, indicaciones no aprobadas y dosis superiores a las recomendadas. La nota informativa no ha frenado la presentación de casos de agranulocitosis por metamizol. Conclusiones: La nota informativa de la AEMPS es mejorable y es necesario actualizar los documentos oficiales de información sobre el metamizol para profesionales sanitarios y pacientes para disminuir el riesgo de agranulocitosis.(AU)

Objective: To analyze whether the drug safety update issued by the Spanish Agency of Medicines and Healthcare Products (AEMPS), dated October 30, 2018, on agranulocytosis and metamizole contains accurate and necessary information to protect patients from the presentation of this adverse reaction (AR) and if the official documentation of medicines containing metamizole for doctors, pharmacists and the general population conforms to the guidelines of the AEMPS to reduce this risk. Setting and participants: Drug safety update, bibliographic search, information at the European Medicines Agency on metamizole drugs marketed in Spain, technical datasheets, leaflets, Bot PLUS Health Information Database and Catalog of Pharmaceutical Specialties. Notification of 4cases of agranulocytosis due to metamizole after the drug safety update was issued. Main interventions and measurements: Comparison of the key points of the drug safety update and official documents on metamizole with the bibliography. Description of the 4cases of agranulocytosis due to metamizole and application of the causality and severity algorithm. Results: The drug safety update contains omissions and contradiction in respect to the bibliography and the actual use of metamizole in healthcare practice. The official documents show a lack of updating, unapproved indications and doses higher than those recommended. The drug safety update has not stopped the presentation of cases of agranulocytosis due to metamizole. Conclusions: The AEMPS drug safety update can be improved and it is necessary to update the official information documents on metamizole for health professionals and patients in order to decrease the risk of agranulocytosis.(AU)

Prevalencia y determinantes de la lactancia materna: estudio Zorrotzaurre / Prevalence and determinants of breastfeeding: the Zorrotzaurre study

INTRODUCCIÓN Y OBJETIVOS: la lactancia materna (LM) es un método de alimentación infantil que aporta múltiples beneficios para la salud de los lactantes y las madres. Este estudio pretende determinar la prevalencia de la LM durante el primer año de vida de los hijos/as de una serie de mujeres que dan a luz en una clínica privada de Bizkaia, e identificar los determinantes facilitadores y los motivos de abandono. MÉTODO: estudio observacional, descriptivo, longitudinal y prospectivo de una muestra aleatoria de 453 recién nacidos (RN), reclutada entre 2016 y 2017. RESULTADOS: en total, 366 mujeres aceptaron participar en todas las fases de estudio. La prevalencia de la lactancia materna exclusiva (LME) fue del 51,7 % al inicio, del 77,1 % al alta y del 21,6 % al sexto mes; y la de la LM, del 87,1 % al inicio, del 48,4 % al sexto mes y del 20,6 % al año. Los factores facilitadores de la LME fueron: al inicio, no utilizar nido ni sacaleches; 15 días satisfacción con la LM y no utilizar chupete ni sacaleches; 4 meses satisfacción con la LM; 6 meses acudir a Grupos de Apoyo a la Lactancia (GAL) y no introducir alimentación complementaria (AC); los de la LM al año, acudir a GAL. Los principales motivos de abandono fueron: la iniciativa propia, la incorporación al trabajo y la escasa ganancia de peso del RN. CONCLUSIONES: uno de cada 5 RN recibieron LME hasta los 6 meses y LM hasta el año. Sería necesario promover estrategias que favorezcan el amamantamiento, como: suprimir el nido, desaconsejar el sacaleches y el chupete al inicio, iniciar la AC a partir del sexto mes y organizar GAL durante el primer año

INTRODUCTION AND OBJECTIVES: breastfeeding (BF) is a feeding method that provides multiple benefits for the health of infants and their mothers. This study aimed to determine the prevalence of BF during the first year of life of children of women who gave birth in a private clinic in Biscay, Basque Country, Spain, and to identify the facilitating determinants and reasons for abandonment. METHOD: an observational, descriptive, longitudinal and prospective study in a random sample of 453 newborns (NBs) recruited between 2016 and 2017. RESULTS: in all, 366 women agreed to participate in all the study phases. The prevalence of exclusive breastfeeding (EBF) was 51.7 % at baseline, 77.1 % at discharge, and 21.6 % after sixth months; and that of BF, 87.1 % at the beginning, 48.4 % at month six, and 20.6 % at one year. The facilitating factors of EBF were: at the beginning, not using a nest or breast pump; 15 days satisfaction with LM and not using a pacifier or breast pump; 4 months satisfaction with LM; 6 months attending Lactation Support Groups (GAL) and not introducing complementary feeding (CA); and those of LM at 1 year, attending GAL. The main reasons for abandonment were: own initiative, incorporation to work, and little weight gain by the NB. CONCLUSIONS: one in 5 newborns received EBF up to 6 months and BF up to one year. It would be necessary to promote strategies that favor breastfeeding, such as eliminating the nest, advising against breast pumps and pacifiers at the beginning, starting CA from the sixth month, and organizing GALs during the first year

Community beliefs toward causes of illness: cross cultural studies in Tolotang and Ammatoa Ethnics in Indonesia

Objective: This study aimed to compare community beliefs regarding causes of illness and preventive actions of two minority ethnic groups in Indonesia. Method: A qualitative design with an ethnographic and phenomenological approach with a total of 18 participants. Result: The Ammatoa Kajang and Towani Tolotang do believe that many factors determine health status. Both ethnics keep the faith that fail to follow tribe's rules and disobedience to their customs and values inherited from their ancestors will affect their health. The most significant similarity is the way they respect their community leader and traditions. Although both ethnics believe that disease caused by evil spirits, they have a different perspective on disease prevention. While Ammatoa Kajang emphasis more on adherence to Ammatoa's instructions, Towani Tolotang perceives that they should maintain good relations and perform self-control. Conclusion: There is a need to develop health policies and programs for indigenous community without compromising preserved cultural values. (AU)

Síndrome de Cushing secundario a interacción entre dipropionato de betametasona tópico y darunavir/cobicistat / Cushing's syndrome due to interaction between topical betamethasone dipropionate and darunavir/cobicistat

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Chronic pancreatitis with polycystic kidney disease: A rare coincidence? / Pancreatitis crónica con enfermedad renal poliquística: ¿una rara coincidencia?

INTRODUCTION: In children, chronic pancreatitis (CP) is usually associated with anatomical anomalies of the pancreas and biliary tract or is genetically determined. Autosomal dominant polycystic kidney disease (ADPKD) may present with extrarenal cyst formation, sometimes involving the pancreas. Large enough, these cysts may cause pancreatitis in ADPKD patients. Case presentation: Herein, we present a case of a 12-year-old Caucasian girl with recurrent pancreatitis with no identifiable traumatic, metabolic, infectious, drug, or immunologic causes. Structural anomalies of the pancreas, including cysts, were ruled out by imaging. However, bilateral cystic kidneys were found as an incidental finding. Her family history was negative for pancreatitis, but positive for polycystic kidney disease. Molecular analysis of ADPKD-causing mutations revealed a novel c.9659C>A (p.Ser3220*) mutation in the PKD1 gene confirming the clinical suspicion of ADPKD. Although CP may rarely occur as an extrarenal manifestation of ADPKD with pancreatic cysts, it is unusual in their absence. Thus, molecular analysis of pancreatitis susceptibility genes was performed and a homozygous pathologic c.180C>T (p.G60=) variant of the CTRC gene, known to increase the risk of CP, was confirmed. CONCLUSION: This is the first reported case of a pediatric patient with coincidence of genetically determined CP and ADPKD. Occurrence of pancreatitis in children with ADPKD without pancreatic cysts warrants further investigation of CP causing mutations

INTRODUCCIÓN: En niños, la pancreatitis crónica (CP, por sus siglas en inglés) generalmente se asocia con anomalías anatómicas del páncreas y el tracto biliar, o está genéticamente determinada. La enfermedad renal poliquística autosómica dominante (ADPKD, por sus siglas en inglés) puede presentarse con la formación de quistes extrarrenales, que a veces afecta al páncreas. Suficientemente grandes, estos quistes pueden causar pancreatitis en pacientes con ADPKD. Presentación del caso: Presentamos el caso de una niña caucásica de 12 años con pancreatitis recurrente sin causas identificables traumáticas, metabólicas, infecciosas, farmacológicas o inmunológicas. Las anomalías estructurales del páncreas, incluidos los quistes, se descartaron mediante imágenes. Sin embargo, los riñones quísticos bilaterales se encontraron como un hallazgo accidental. Su historia familiar fue negativa para la pancreatitis, pero positiva para la enfermedad renal poliquística. El análisis molecular de las mutaciones causantes de ADPKD reveló una nueva mutación c.9659C>A (p.Ser3220*) en el gen PKD1 que confirma la sospecha clínica de ADPKD. Aunque la CP rara vez ocurre como una manifestación extrarrenal de ADPKD con quistes pancreáticos es inusual. Por lo tanto, se realizó el análisis molecular de los genes de susceptibilidad a pancreatitis y se confirmó una variante homocigótica patológica c.180C>T (p.G60=) del gen CTRC, que se sabe que aumenta el riesgo de CP. CONCLUSIÓN: Este es el primer caso reportado de un paciente pediátrico con coincidencia de CP y ADPKD genéticamente determinados. La aparición de pancreatitis en niños con ADPKD sin quistes pancreáticos justifica una mayor investigación de CP que causan mutaciones

Cannabis, opiniones y ciencias / Cannabis, opinions and sciences

Reflexionamos sobre el debate que existe en la comunidad científica acerca de los artículos de opinión que plantean valorar el posible uso terapéutico que puede tener el consumo regulado del Cannabis y, por otra parte, los estudios que muestran la relación entre el consumo de esta sustancia y el riesgo de enfermedad mental. Se diferencia entre "riesgo de enfermedad" y causalidad y se explica el concepto de estocasticidad en psiquiatría. Debemos valorar, así mismo, "el coste de oportunidad que está suponiendo que el debate sobre el cannabis se siga planteando como un conflicto bélico entre partidarios y detractores del uso de esta sustancia milenaria y compleja"

We reflect on the debate that exists in the scientific community about the opinion articles that propose assessing the possible therapeutic use that the regulated cannabis consumption can have and on the other hand the studies that show the relationship between the consumption of this substance and the risk of mental illness. Differs between "risk of disease" and causality, and explain the concept of stochasticity in psychiatry. We must value "the loss of opportunity that is assuming that the debate on cannabis continues to arise as a war conflict between supporters and detractors of the uso of this ancient and complex substance"

El papel del azar en el progreso de la medicina / The role of chance in the progress of medicine

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Toxicidad hepática inducida por terbinafina / Terbinafine-induced hepatotoxicity

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Contributions of Causality Processing Models to the Study of Discourse Comprehension and the Facilitation of Student Learning / La contribución de los modelos de procesamiento de la causalidad al estudio de la comprensión del discurso y la facilitación del aprendizaje del alumno

Discourse comprehension involves the establishment of semantic or meaningful causal connections. The aim of this paper is to review four models that have contributed to the study of the establishment of these connections: the Causal Chain Model, the Causal Network Model, the Causal Inference Maker, and the Landscape Model. These models contribute to the facilitation of student learning, given that they provide useful tools for improvement of texts structure in order to promote the establishment of meaningful connections and the revision of students’ prior incorrect ideas, and for the design of interventions that promote the generation of inferences and the monitoring of comprehension. The presentation of their key ideas, of empirical support for their psychological validity, and of applications to education will allow us to highlight the contributions that these models make to our understanding of the importance of the processing of causality for discourse comprehension and the facilitation of student learning

La comprensión del discurso implica establecer conexiones causales semánticas o significativas. El objetivo de este artículo es revisar cuatro modelos que han contribuido al estudio del establecimiento de estas conexiones: el modelo de cadena causal, el modelo de red causal, el modelo generador de inferencias causales y el modelo de paisaje. Estos modelos contribuyen a facilitar el aprendizaje de los estudiantes, dado que proporcionan herramientas útiles para mejorar la estructura de los textos con el fin de promover el establecimiento de conexiones significativas y la revisión de las ideas previas incorrectas de los estudiantes, y para el diseño de intervenciones que promuevan la generación de inferencias y el monitoreo de la comprensión. La presentación de sus ideas clave, de la evidencia empírica que apoya su validez psicológica y de las aplicaciones de sus herramientas a la educación permitirá resaltar las principales nociones que estos modelos hacen a nuestro entendimiento de la importancia del procesamiento de la causalidad para la comprensión del discurso y la facilitación del aprendizaje de los estudiantes

A propósito del artículo "Utilización del torniquete en la asistencia extrahospitalaria: revisión sistemática" / Reflections on the article "Tourniquet use in out-of-hospital emergency care: a systematic review"

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