An inter-laboratory study of DNA-based identity, parentage and species testing in animal forensic genetics.

The probative value of animal forensic genetic evidence relies on laboratory accuracy and reliability. Inter-laboratory comparisons allow laboratories to evaluate their performance on specific tests and analyses and to continue to monitor their output. The International Society for Animal Genetics (ISAG) administered animal forensic comparison tests (AFCTs) in 2016 and 2018 to assess the limitations and capabilities of laboratories offering forensic identification, parentage and species determination services. The AFCTs revealed that analyses of low DNA template concentrations (≤300 pg/µL) constitute a significant challenge that has prevented many laboratories from reporting correct identification and parentage results. Moreover, a lack of familiarity with species testing protocols, interpretation guidelines and representative databases prevented over a quarter of the participating laboratories from submitting correct species determination results. Several laboratories showed improvement in their genotyping accuracy over time. However, the use of forensically validated standards, such as a standard forensic short tandem repeat (STR) kit, preferably with an allelic ladder, and stricter guidelines for STR typing, may have prevented some common issues from occurring, such as genotyping inaccuracies, missing data, elevated stutter products and loading errors. The AFCTs underscore the importance of conducting routine forensic comparison tests to allow laboratories to compare results from each other. Laboratories should keep improving their scientific and technical capabilities and continuously evaluate their personnel's proficiency in critical techniques such as low copy number (LCN) analysis and species testing. Although this is the first time that the ISAG has conducted comparison tests for forensic testing, findings from these AFCTs may serve as the foundation for continuous improvements of the overall quality of animal forensic genetic testing.

Contribution of the Economic Crisis to the Risk Increase of Poor Mental Health in a Region of Spain.

Previous research suggests that the economic crisis can affect mental health. The purpose of this study was to analyse the association of risk of poor mental health with various socioeconomic, demographic, health, quality of life, and social support variables; and to evaluate the contribution of socioeconomic variables most affected by the beginning of the economic crisis (employment situation and income) on the changes in the prevalence of the risk of poor mental health between 2005 and 2010. A study of prevalence evolution in adult population residents of the Valencian Community in the Spanish Mediterranean was conducted. We studied 5781 subjects in 2005 and 3479 in 2010. Logistic regression models have been adjusted to analyse the association between variables. A standardisation procedure was carried out to evaluate which part of the changes in overall prevalence could be attributed to variations in the population structure by age, sex, employment status, and income between the years under study. The prevalence of GHQ+ increased from 2005 to 2010, in both men and women. Several variables were closely associated with the risk of poor mental health (sex, age, country of birth, number of nonmental chronic diseases, social support, disability, cohabitation in couple, employment status, and income). The changes produced as a result of the onset of the economic crisis in income and unemployment (increase in low income and in unemployment rates) contributed to the increase of poor mental health risk. This could confirm the sensitivity of mental health to the economic deterioration caused by the crisis.

Is recession bad for your mental health? The answer could be complex: evidence from the 2008 crisis in Spain.

BACKGROUND: We explored the impact of 2008 recession on the prevalence of mental health problems in Spain. METHODS: Repeated cross-sectional survey design. Datasets from 2006 and 2011 were used, and temporal change was examined. The study was conducted on the economically active population (16-64 years old). The two surveys included 29,478 and 21,007 people, obtaining a 96 and 89.6% response rate, respectively. Multiple logistic regression models were adjusted to identify poor mental health risk factors. A standardisation analysis was performed to estimate the prevalence of people at risk of poor mental health (GHQ+). RESULTS: The prevalence of GHQ+ following the crisis increased in men and decreased in women. Two logistic regression analyses identified GHQ+ risk factors. From 2006 to 2011, unemployment rose and income fell for both men and women, and there was a decline in the prevalence of somatic illness and limitations, factors associated with a higher prevalence of GHQ+. After controlling for age, the change in employment and income among men prompted an increase in the prevalence of GHQ+, while the change in somatic illness and limitations tended to mitigate this effect. After the recession, unemployed men showed a better level of somatic health. The same effects were not detected in women. CONCLUSIONS: The economic recession exerted a complex effect on mental health problems in men. The reduction of prevalence in women was not associated with changes in socioeconomic factors related to the economic crisis nor with changes in somatic health.

How does family intervention improve the outcome of people with schizophrenia?

BACKGROUND: There is strong evidence of the efficacy of family psychosocial interventions for schizophrenia, but evidence of the role played by the attitudes of relatives in the therapeutic process is lacking. METHOD: To study the effect of a family intervention on family attitudes and to analyse their mediating role in the therapeutic process 50 patients with schizophrenia and their key relatives undergoing a trial on the efficacy of a family psychosocial intervention were studied by means of the Affective Style Coding System, the Scale of Empathy, and the Relational Control Coding System. Specific statistical methods were used to determine the nature of the relationship of the relatives' attitudes to the outcome of family intervention. RESULTS: Family psychosocial intervention was associated with a reduction in relatives' guilt induction and dominance and an improvement in empathy. Empathy and lack of dominance were identified as independent mediators of the effect of family psychosocial intervention. The change in empathy and dominance during the first 9 months of the intervention predicted the outcome in the following 15 months. CONCLUSION: Relatives' empathy and lack of dominance are mediators of the beneficial effect of family psychosocial intervention on patient's outcome.

Psychometric behaviour of the strengths and difficulties questionnaire (SDQ) in the Spanish national health survey 2006.

BACKGROUND: The Strengths and Difficulties Questionnaire (SDQ) is a tool to measure the risk for mental disorders in children. The aim of this study is to describe the diagnostic efficiency and internal structure of the SDQ in the sample of children studied in the Spanish National Health Survey 2006. METHODS: A representative sample of 6,773 children aged 4 to 15 years was studied. The data were obtained using the Minors Questionnaire in the Spanish National Health Survey 2006. The ROC curve was constructed and calculations made of the area under the curve, sensitivity, specificity and the Youden J indices. The factorial structure was studied using models of exploratory factorial analysis (EFA) and confirmatory factorial analysis (CFA). RESULTS: The prevalence of behavioural disorders varied between 0.47% and 1.18% according to the requisites of the diagnostic definition. The area under the ROC curve varied from 0.84 to 0.91 according to the diagnosis. Factor models were cross-validated by means of two different random subsamples for EFA and CFA. An EFA suggested a three correlated factor model. CFA confirmed this model. A five-factor model according to EFA and the theoretical five-factor model described in the bibliography were also confirmed. The reliabilities of the factors of the different models were acceptable (>0.70, except for one factor with reliability 0.62). CONCLUSIONS: The diagnostic behaviour of the SDQ in the Spanish population is within the working limits described in other countries. According to the results obtained in this study, the diagnostic efficiency of the questionnaire is adequate to identify probable cases of psychiatric disorders in low prevalence populations. Regarding the factorial structure we found that both the five and the three factor models fit the data with acceptable goodness of fit indexes, the latter including an externalization and internalization dimension and perhaps a meaningful positive social dimension.Accordingly, we recommend studying whether these differences depend on sociocultural factors or are, in fact, due to methodological questions.

[Laparoscopic radical nephrectomy. Procedure, results, and complications]. / Nefrectomía radical laparoscópica. Técnica, resultados y complicaciones.

Surgery is the treatment of choice for clear cell renal carcinoma not responding to chemotherapy, radiotherapy, or immunotherapy. The surgical procedure used has evolved over time in the past 40 years, mainly because of the development and widespread use of diagnostic procedures such as ultrasonography and CT. As a direct consequence, parenchymal-sparing surgery was no longer only used for patients with solitary kidneys and its indication started to be extended to patients with tumors up to 4 cm in diameter, in whom it has been shown to be a safe and effective alternative to radical nephrectomy. The other important milestone in development of renal cancer surgery undoubtedly was the revolution started in the 90s with advent of laparoscopic renal surgery, which has become established over the past 20 years approximately. Laparoscopic surgery initially raised concern about oncological safety, but clinical series with sufficiently long follow-up times and large sample sizes are now available to consider the laparoscopic approach as a reliable procedure. Technological development has caused the laparoscopic technique to be no longer seen as a procedure for the future, but rather as an absolutely current technique which should be implemented in most urology departments. Implementation of any new procedure usually involves a number of complications which we should be prepared to assume, while making every effort to try and prevent them. It is therefore essential to develop, and to implement using common sense, a training program on the procedure. Selection of patients and conditions to be treated is a crucial part of such a program.

Self-reported chronic mental health problems and mental health service use in Spain.

OBJECTIVES: To determine the prevalence of self-reported chronic mental health problems (MHPs) and mental health service use and their determinants, among the Spanish population over 14 years of age. METHODS: Data from the 1999 Spanish Survey on Disabilities, Deficiencies, and State of Health were used. The survey is a cross-sectional study based on a multi-stage stratified sample of all the non-institutionalized Spanish population aged over 14 years (n=59,101, 11% non-responders). Multivariate logistic regression analysis were used. RESULTS: 10.7% of the Spanish population suffer from an MHP. The highest prevalences were found in women, divorced/separated persons, those with a lower level of education and income, and those suffering from a chronic somatic problem. The number of days of daily activity lost was 2-fold greater among those with an MHP than among those with a chronic somatic problem. Greater use of mental health services was associated with loss of daily activity, having a higher level of education, invalidity or disability. The probability of MHP being referred from primary to mental healthcare is reduced if somatic comorbidity is present. CONCLUSION: MHPs have a high prevalence and a significant repercussion on the patient's life. An inverse relationship was found between certain risk factors for MHPs and the use of services, which suggests inequality. Problems of accessibility are identified.

Open and laparoscopic nephroureterectomy for urothelial tumors of the upper urinary tract: initial experience.

OBJECTIVE: Advances in urological laparoscopy have increased the oncological safety of this approach for managing upper urinary tract tumours, although the open surgical route remains the method of choice. This article describes our experience of the laparoscopic approach over the past four years compared to open surgery. MATERIALS AND METHODS: Between 1995 and 2009 a total of 95 nephroureterectomies were carried out to remove tumours: 70 by open surgery and 25 by laparoscopy. Lumbotomy with endoscopic detachment of the ureter was the most common approach in open surgery, while transperitoneal access was used for laparoscopy in all cases, with laparoscopic bladder cuff resection in most patients (56%). RESULTS: The mean procedure time for open nephroureterectomies was 205 min (130-300), with a mean blood loss of 525 ml (100-1,800) involving 17 (24.2%) transfusions. The mean hospital stay was 8.4 days (3-30). The mean procedure time for the laparoscopic nephroureterectomies was 189 min (120-270), with a mean blood loss of 130 ml (100-400) and 4 (16%) transfusions. The mean hospital stay was 4.5 (2-28) days. CONCLUSIONS: The patients who underwent the laparoscopic procedure had a lower transfusion rate and shorter hospital stay. Oncological control was similar for both approaches, although laparoscopy requires greater monitoring and a larger caseload.

Relationship between family attitudes and social functioning in schizophrenia: a nine-month follow-up prospective study in Spain.

The objective was to study the relationship between family attitudes and social functioning in schizophrenia. A cohort of 80 patients was followed-up for 9 months after their hospitalization. The relatives' critical attitude and poor empathic attitude were measured by means of the Semantic Differential and the Questionnaire of Empathy, respectively. Time of useful work and social relations of the patients were measured before admission and at the end of follow-up. Symptoms, premorbid adjustment, and other course and demographic factors were also measured. Significant relationships were found between the relatives' poor empathic attitude and the patients' occupational functioning and social relations. These associations were maintained after controlling for the effects of other prognostic factors. These results suggest that empathy in the relative is an independent predictor of social functioning in people with schizophrenia. Different attitudinal dimensions of family attitudes might show different relationships with the social and clinical outcomes in this disorder.

[Quality of the physician-patient relation and results of clinical encounters in primary care in Alicante: a study with focal groups]. / Calidad de la relación médico paciente y resultados de los encuentros clínicos en atención primaria de Alicante: un estudio con grupos focales.

BACKGROUND: The relationship between the quality of the physician-patient relationship and the outcomes of the clinical encounters in primary care are examined. METHOD: Focus groups of physicians and patients. A total of 24 professionals and 22 patients took part. RESULTS: The physicians perceived a relationship to exist between the scarcity of healthcare resources (short length of time with each patient, care-providing overload, lack of specific resources, lack of training), conflicts with "difficult" patients and the influence of the psychosocial factors in the clinical encounter and error, burnout, defensive medicine and the low quality of the services. Communication/examination-related problems during the clinical interview and by negative feelings acted as intermediary factors in this relationship. The patients perceived a relationship to exist between an operating pattern characterized by short office visits scheduled at an overloaded pace and physician, patient communications problems and error and conflict in the clinical encounter. There is also a relationship between the physician's humanist attitude and a better outcome of the health problems. The objectives and priorities of the health care system, out of touch with the needs of the community, are seen as being key determining factors as regards the lacks considered to exist. CONCLUSIONS: The physician-patient relationship processes play a mediating role between the health care resources and the outcomes of the clinical encounters. Improving the care provided and the physician-patient relationship in primary care requires a multi-dimensional approach and view which goes beyond the measures taken regarding individual physician and patient-related factors.