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1.
Cogn Behav Ther ; 51(2): 143-169, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-34184620

RESUMEN

The purpose of this randomized controlled trial was to test an internet-delivered version of cognitive processing therapy (CPT) for the psychological distress associated with bullying victimization. The sample comprised 52 adults (i.e. 69.20% women; mean age = 43.37 (SD = 12.47); 3.85% ethnic minority) who self-identified as having a lifetime history of bullying victimization. Participants were randomized into three groups, which received 12 sessions of internet-delivered, therapist-guided, and content-modified version of CPT, 12 sessions of internet-delivered and therapist-guided stress management (SM), or a waitlist. Treatment outcomes included maladaptive trauma appraisals, symptoms of posttraumatic stress disorder (PTSD), depression, general anxiety and stress, social anxiety, and anger. Hierarchical linear modeling was used to analyse the data. Findings indicated that CPT was effective in reducing the strength of maladaptive appraisals related to bullying victimization and symptoms of PTSD compared to the waitlist and SM. SM outperformed CPT and the waitlist in reducing symptoms of depression, general anxiety, and stress. In conclusion, the results of this trial suggest that internet-delivered CPT is effective for the psychological distress and maladaptive appraisals associated with bullying victimization but that adaptions might be needed to target more effectively symptoms of anxiety and depression.


Asunto(s)
Acoso Escolar , Terapia Cognitivo-Conductual , Víctimas de Crimen , Adulto , Terapia Cognitivo-Conductual/métodos , Víctimas de Crimen/psicología , Depresión/diagnóstico , Depresión/terapia , Etnicidad , Femenino , Humanos , Internet , Masculino , Grupos Minoritarios
2.
Subst Use Misuse ; 55(8): 1370-1377, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32253964

RESUMEN

Background: The Alcohol Use Disorders Identification Test (AUDIT) was developed as a screening tool for problematic alcohol use and an intervention framework to aid those who drink excessively. While the AUDIT is widely used with at-risk populations, such as military veterans, major gaps exist in the research literature regarding the construct validity of the AUDIT in military samples. Objectives: This study assessed the factor structure and measurement invariance of the AUDIT in a large sample of Canadian military veterans (N = 1669; 94.94% male). Methods: Exploratory factor analysis (EFA) was conducted using a random subsample (n = 825) to assess the underlying factor structure of the AUDIT. Confirmatory factor analysis (CFA), using the second subsample (n = 844), was used to cross-validate the factor structure revealed by EFA and compare it to other model variants. Finally, multigroup CFAs were conducted using the whole sample to further cross-validate the factor structure and examine measurement invariance in military veterans with and without clinical elevations in posttraumatic stress disorder (PTSD) symptoms. Results: Factor analyses revealed that a modified two-factor model provided a statistically better fit to the data compared to all other model variants; yet, the results did not confirm measurement invariance across military veterans with and without clinically significant symptoms of PTSD. Conclusions/Importance: The findings are in line with increasing evidence suggesting that two subscale scores should be calculated for the AUDIT. Results further suggest that care should be taken in interpreting AUDIT scores when PTSD symptoms are present for military veterans.


Asunto(s)
Alcoholismo , Trastornos por Estrés Postraumático , Veteranos , Alcoholismo/diagnóstico , Canadá , Análisis Factorial , Femenino , Humanos , Masculino , Trastornos por Estrés Postraumático/diagnóstico
3.
Cogn Behav Ther ; 48(1): 1-14, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30332919

RESUMEN

Numerous studies have demonstrated the efficacy of cognitive processing therapy (CPT) for treating posttraumatic stress disorder (PTSD). Two prior meta-analyses of studies are available but used approaches that limit conclusions that can be drawn regarding the impact of CPT on PTSD outcomes. The current meta-analysis reviewed outcomes of trials that tested the efficacy of CPT for PTSD in adults and evaluated potential moderators of outcomes. All published trials comparing CPT against an inactive control condition (i.e. psychological placebo or wait-list) or other active treatment for PTSD in adults were included, resulting in 11 studies with a total of 1130 participants. CPT outperformed inactive control conditions on PTSD outcome measures at posttreatment (mean Hedges' g = 1.24) and follow-up (mean Hedges' g = 0.90). The average CPT-treated participant fared better than 89% of those in inactive control conditions at posttreatment and 82% at follow-up. Results also showed that CPT outperformed inactive control conditions on non-PTSD outcome measures at posttreatment and follow-up and that CPT outperformed other active treatments at posttreatment but not at follow-up. Effect sizes of CPT on PTSD symptoms were not significantly moderated by participant age, number of treatment sessions, total sample size, length of follow-up, or group versus individual treatment; but, older studies had larger effect sizes and percent female sex moderated the effect of CPT on non-PTSD outcomes. These meta-analytic findings indicate that CPT is an effective PTSD treatment with lasting benefits across a range of outcomes.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Trastornos por Estrés Postraumático/terapia , Humanos , Resultado del Tratamiento
4.
Cogn Behav Ther ; 47(6): 462-469, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-29764341

RESUMEN

The present study examined sudden gains (SGs; large symptom improvements between adjacent treatment sessions) and its association with treatment outcome in a randomized-controlled trial comparing cognitive-behavioral group therapy (CBGT) versus group psychotherapy (GPT; designed to incorporate only non-specific factors) for social anxiety disorder (SAD). SAD symptoms were assessed after each treatment session in a sample of 45 college students. Independent assessors evaluated symptom severity at baseline, post-treatment and follow-up. A total of 10 (22.2%) participants experienced SGs during treatment. No differences were found in symptom improvement at post-treatment or follow-up between individuals with and without SGs. SGs appeared at similar rates across both treatments but were associated with greater improvements at post-treatment and follow-up in GPT compared to CBGT. Majority of SGs in CBGT occurred early in treatment before the provision of specific treatment techniques. These results suggest that non-specific treatment factors may be important in promoting SGs.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Fobia Social/terapia , Psicoterapia de Grupo/métodos , Adolescente , Adulto , Femenino , Humanos , Masculino , Estudiantes , Resultado del Tratamiento , Universidades , Adulto Joven
5.
Behav Sci (Basel) ; 13(7)2023 Jul 11.
Artículo en Inglés | MEDLINE | ID: mdl-37504024

RESUMEN

Cognitive theories of post-traumatic stress disorder (PTSD) feature appraisal of trauma as a critical factor in the development and maintenance of the disorder. Here we explored appraisals of social trauma (severe rejection or humiliation). Participants were outpatients with social anxiety disorder (SAD) and clinically significant PTSD symptoms (PTSS) after social trauma (n = 15); two clinical control groups of either SAD (n = 32) or obsessive-compulsive disorder (OCD; n = 13); and a control group with no diagnoses (n = 38). Measures included a clinical interview to assess social trauma and related open-ended appraisals and the Posttraumatic Cognitions Inventory (PTCI). Raters blind to group assignment performed content analyses of appraisals. Results showed that the PTSS group scored significantly higher than either clinical group on the PTCI SELF subscale. Only the SELF subscale predicted a diagnosis of both PTSS and SAD. All but one PTSS participant reported primarily negative beliefs about their social trauma, and the most common categories were flawed self and others are critical or cruel. Post-traumatic appraisals implicated in the course of PTSD are significant in how individuals respond to social trauma, with negative self-cognitions linked to both PTSS and SAD.

6.
J Anxiety Disord ; 72: 102228, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32361167

RESUMEN

The key characteristic of a traumatic event as defined by the Diagnostic and Mental Manual of Mental Disorders (DSM) seems to be a threat to life. However, evidence suggests that other types of threats may play a role in the development of PTSD and other disorders such as social anxiety disorder (SAD). One such threat is social trauma, which involves humiliation and rejection in social situations. In this study, we explored whether there were differences in the frequency, type and severity of social trauma endured by individuals with a primary diagnosis of SAD (n = 60) compared to a clinical control group of individuals with a primary diagnosis of obsessive compulsive disorder (OCD, n = 19) and a control group of individuals with no psychiatric disorders (n = 60). The results showed that most participants in this study had experienced social trauma. There were no clear differences in the types of experiences between the groups. However, one third of participants in the SAD group (but none in the other groups) met criteria for PTSD or suffered from clinically significant PTSD symptoms in response to their most significant social trauma. This group of SAD patients described more severe social trauma than other participants. This line of research could have implications for theoretical models of both PTSD and SAD, and for the treatment of individuals with SAD suffering from PTSD after social trauma.


Asunto(s)
Fobia Social/psicología , Trauma Psicológico/psicología , Interacción Social , Trastornos por Estrés Postraumático/psicología , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Modelos Psicológicos , Trastorno Obsesivo Compulsivo/psicología , Fobia Social/complicaciones , Fobia Social/terapia , Trauma Psicológico/complicaciones , Trauma Psicológico/terapia , Trastornos por Estrés Postraumático/complicaciones , Trastornos por Estrés Postraumático/terapia
7.
Mol Immunol ; 106: 99-107, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30593934

RESUMEN

The majority of studies of vaccine responses in Atlantic salmon have focused on several weeks after vaccination, and employed a limited number of marker genes. In this study, novel techniques were used to examine a broad panel of expressed genes and antibody repertoire of Atlantic salmon following vaccination. Salmon parr were vaccinated with a multivalent oil-based vaccine, and blood plasma and head kidney were sampled at several time-points between 0-35 days post vaccination. Saline-injected fish were used as control at all time-points. Microarray analyses showed increased expression of immune genes from the first day to the end of study in the head kidney of vaccinated fish. Genes up-regulated in the late phase included several leukocyte markers and components of the oxidative burst complex. A suite of genes that can take part in B cells differentiation were up-regulated from day 14, at which time secretory IgM transcripts also peaked. This coincided with marked increased plasma titres of non-vaccine specific antibodies binding to a hapten-carrier antigen DNP-KLH, while antibodies to bacterial components of the vaccine, Moritella viscosa and Aeromonas salmonicida, first showed significantly elevated antibody levels at day 21, and at a markedly lower magnitude than the non-vaccine specific titres. Sequencing of the variable region of IgM heavy chain (CDR3) revealed higher cumulative frequencies of unique clonotypes in vaccinated salmon starting from day 14 when specific antibodies were first detected. Reduced sequence variance of CDR3 suggested expansion of recently emerged clonotypes. Overall, the results presented here follow a broad panel of gene expression, immunoglobulin sequencing and plasma antibody titres in the first few weeks after vaccination of Atlantic salmon, pointing to a potentially important contribution of non-vaccine specific antibody responses early in the vaccine response.


Asunto(s)
Aeromonas salmonicida/inmunología , Anticuerpos Antibacterianos/inmunología , Vacunas Bacterianas/inmunología , Proteínas de Peces/inmunología , Regulación de la Expresión Génica/inmunología , Inmunoglobulina M/inmunología , Moritella/inmunología , Salmo salar/inmunología , Vacunación , Animales , Vacunas Bacterianas/farmacología , Regulación de la Expresión Génica/efectos de los fármacos , Salmo salar/microbiología
8.
Health Promot Chronic Dis Prev Can ; 38(10): 368-379, 2018 Oct.
Artículo en Inglés, Francés | MEDLINE | ID: mdl-30303657

RESUMEN

INTRODUCTION: Screen time, a proxy for sedentary behaviours, has emerged as a critical health determinant among youth in contemporary societies, where most aspects of youth life involve access to screen-time devices. An understudied approach to reducing screen time among youth is bullying reduction. This study aims to understand the association between bullying perpetration, victimization, youth perception of the school environment and multiple screen-time behaviours. METHODS: A total of 44,861 youth aged between 13 and 18 years in two Canadian provinces completed a validated questionnaire that collected student data on health behaviours and outcomes, including multiple screen-time behaviours, bullying perpetration and victimization, and school connectedness. The outcome variables were total screen time, time spent watching television, playing video games, internet surfing, and communication- based screen-time behaviours. Using a random intercept, the final models were built using PROC MIXED in SAS 9.4. These models were adjusted for age, ethnicity, weekly disposable income, daylight hours, and weather variables. RESULTS: Compared to youth who reported non-involvement in bullying, youth who were bullies, victims, or both bullies and victims spent on average more minutes per day in front of screens across all screen time categories. Youth who felt happy and safe at school, and who perceived their teachers as being fair, reported lower levels of multiple screen-time behaviours. CONCLUSION: With non-involvement in bullying showing a strong negative association with multiple screen-time behaviours, school policies to address bullying and screen time through school connectedness could offer a novel approach in minimizing these harmful behaviours.


INTRODUCTION: Le temps passé devant un écran, une mesure des comportements sédentaires, s'est révélé être un déterminant essentiel de la santé chez les jeunes dans les sociétés contemporaines, où la majorité des dimensions de leur vie comprennent l'accès à un écran. Une approche peu étudiée pour réduire le temps passé devant un écran chez les jeunes est son association avec la réduction de l'intimidation. Cette étude vise à comprendre le lien entre la perpétration de l'intimidation, la victimisation, la perception des jeunes à l'égard du milieu scolaire et divers comportements associés au temps passé devant un écran. MÉTHODOLOGIE: Un total de 44 861 jeunes de 13 à 18 ans ont répondu, dans deux provinces canadiennes, à un questionnaire validé recueillant des données autodéclarées sur les comportements de santé et leurs effets, notamment divers comportements associés au temps passé devant un écran, la perpétration de l'intimidation, la victimisation et le sentiment d'appartenance à l'école. Les variables à l'étude étaient le temps total passé devant un écran et celui passé spécifiquement à regarder la télévision, à jouer à des jeux vidéo, à naviguer sur Internet ainsi que celui consacré à des comportements en lien avec la communication. Les modèles finaux ont été élaborés avec PROC MIXED dans SAS 9.4 à l'aide d'une modélisation à valeur aléatoire. Ils ont été ajustés selon l'âge, l'origine ethnique, le revenu hebdomadaire disponible, les heures de clarté et les variables météorologiques. RÉSULTATS: Comparativement aux jeunes n'ayant signalé aucune participation à l'intimidation, les jeunes qui s'étaient livrés à des actes d'intimidation, les jeunes victimes d'intimidation et les jeunes ayant été à la fois intimidateurs et victimes d'intimidation passaient en moyenne plus de minutes par jour devant un écran toutes catégories de temps d'écran confondues. Les jeunes qui ont déclaré être heureux et se sentir en sécurité à l'école et qui considéraient leurs enseignants comme justes présentaient des niveaux moins élevés pour divers comportements associés au temps passé devant un écran. CONCLUSION: Puisqu'une forte corrélation négative a été observée entre la non-participation à l'intimidation et divers comportements associés au temps passé devant un écran, les politiques scolaires visant à accroître le sentiment d'appartenance à l'école pour lutter contre l'intimidation et réduire le temps passé devant un écran pourraient offrir une approche novatrice de réduction de ces comportements néfastes.


Asunto(s)
Conducta del Adolescente , Acoso Escolar/estadística & datos numéricos , Víctimas de Crimen/estadística & datos numéricos , Conductas Relacionadas con la Salud , Instituciones Académicas , Tiempo de Pantalla , Adolescente , Conducta del Adolescente/psicología , Alberta , Acoso Escolar/psicología , Víctimas de Crimen/psicología , Femenino , Felicidad , Humanos , Relaciones Interpersonales , Masculino , Apego a Objetos , Ontario , Psicología del Adolescente , Seguridad , Encuestas y Cuestionarios
9.
Nucleic Acids Res ; 33(1): 135-42, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-15642699

RESUMEN

We have recently sequenced the genome of a novel thermophilic bacteriophage designated as TS2126 that infects the thermophilic eubacterium Thermus scotoductus. One of the annotated open reading frames (ORFs) shows homology to T4 RNA ligase 1, an enzyme of great importance in molecular biology, owing to its ability to ligate single-stranded nucleic acids. The ORF was cloned, and recombinant protein was expressed, purified and characterized. The recombinant enzyme ligates single-stranded nucleic acids in an ATP-dependent manner and is moderately thermostable. The recombinant enzyme exhibits extremely high activity and high ligation efficiency. It can be used for various molecular biology applications including RNA ligase-mediated rapid amplification of cDNA ends (RLM-RACE). The TS2126 RNA ligase catalyzed both inter- and intra-molecular single-stranded DNA ligation to >50% completion in a matter of hours at an elevated temperature, although favoring intra-molecular ligation on RNA and single-stranded DNA substrates. The properties of TS2126 RNA ligase 1 makes it very attractive for processes like adaptor ligation, and single-stranded solid phase gene synthesis.


Asunto(s)
Bacteriófagos/enzimología , ADN de Cadena Simple/metabolismo , ARN Ligasa (ATP)/metabolismo , Secuencia de Aminoácidos , Estabilidad de Enzimas , Datos de Secuencia Molecular , ARN Ligasa (ATP)/genética , ARN Ligasa (ATP)/aislamiento & purificación , Alineación de Secuencia , Temperatura , Thermus/virología
10.
J Psychosom Res ; 98: 34-39, 2017 07.
Artículo en Inglés | MEDLINE | ID: mdl-28554370

RESUMEN

OBJECTIVE: The Childhood Illness Attitude Scales (CIAS) were created as a developmentally appropriate measure for symptoms of health anxiety (HA) in school-aged children. Despite overall sound psychometric properties reported in previous studies, more comprehensive examination of the latent structure and potential response bias in the CIAS is needed. The purpose of the present study was to cross-validate the latent structure of the CIAS across genders and to examine gender-specific variations in CIAS scores. METHODS: The sample comprised data from 602 Canadian and Danish school-aged children (Mage=10.54, SD=0.99; 52.5% girls). Confirmatory factor analyses were conducted to test 3-, modified 3-, and 4-factor models in both samples. Multigroup confirmatory factor analysis was performed to test factor structure invariance across boys and girls in a combined sample. Differential Item Functioning (DIF) was assessed using test characteristic curves. RESULTS: A modified 3-factor solution (i.e., fears=11 items, help-seeking=6 items, and symptom effects=4 items) provided the best fit to the data (χ2 (364, N=602)=681.7, p<0.001; χ2/df=1.803; RMSEA=0.037; CFI=0.926). The factor structure was stable, well-fitting, and indicated measurement invariance across groups. DIF analyses revealed no gender-based response bias at the scale level. CONCLUSION: Results support a revised 3-factor version of the CIAS that can be used with confidence to assess symptoms of HA in school-aged boys and girls.


Asunto(s)
Actitud Frente a la Salud , Psicometría , Análisis de Varianza , Canadá , Niño , Miedo , Femenino , Humanos , Masculino , Distribución por Sexo
11.
Psychiatry Res ; 246: 745-749, 2016 Dec 30.
Artículo en Inglés | MEDLINE | ID: mdl-27836241

RESUMEN

Previous research on bully perpetration and psychiatric outcomes has been limited to examination of lifetime associations and has not included evaluation of posttraumatic stress disorder (PTSD), despite previously reported correlations between PTSD and anger and aggression. The purpose of the present study was to provide a comprehensive evaluation of the association between bullying behaviour and mental disorders within a past-year framework. Data was obtained from Wave 2 of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC; n=34,653), a nationally-representative survey of American adults. Cross-tabulations and logistic regression analyses were conducted to evaluate the relationship between bullying behaviour and psychiatric diagnosis. A total of 239 individuals (138 males, 101 females) reported engaging in bullying behaviour within the past-year. Mood, anxiety, substance use, and personality disorders were all more common among bully perpetrators compared to others. Of note, strong associations were found between PTSD and bully perpetration. Findings from the current study demonstrate strong associations between bullying perpetration and mental health concerns. The proximity of bullying behaviors and mental health concerns may be important, suggesting avenues for efforts at intervention and bullying prevention.


Asunto(s)
Trastornos de Ansiedad/epidemiología , Acoso Escolar/estadística & datos numéricos , Trastornos del Humor/epidemiología , Trastornos de la Personalidad/epidemiología , Trastornos por Estrés Postraumático/epidemiología , Adolescente , Adulto , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Sustancias/epidemiología , Estados Unidos/epidemiología , Adulto Joven
12.
PLoS One ; 10(9): e0137374, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26375388

RESUMEN

Phage vB_Tsc2631 infects the extremophilic bacterium Thermus scotoductus MAT2631 and uses the Ts2631 endolysin for the release of its progeny. The Ts2631 endolysin is the first endolysin from thermophilic bacteriophage with an experimentally validated catalytic site. In silico analysis and computational modelling of the Ts2631 endolysin structure revealed a conserved Zn2+ binding site (His30, Tyr58, His131 and Cys139) similar to Zn2+ binding site of eukaryotic peptidoglycan recognition proteins (PGRPs). We have shown that the Ts2631 endolysin lytic activity is dependent on divalent metal ions (Zn2+ and Ca2+). The Ts2631 endolysin substitution variants H30N, Y58F, H131N and C139S dramatically lost their antimicrobial activity, providing evidence for the role of the aforementioned residues in the lytic activity of the enzyme. The enzyme has proven to be not only thermoresistant, retaining 64.8% of its initial activity after 2 h at 95°C, but also highly thermodynamically stable (Tm = 99.82°C, ΔHcal = 4.58 × 10(4) cal mol(-1)). Substitutions of histidine residues (H30N and H131N) and a cysteine residue (C139S) resulted in variants aggregating at temperatures ≥75°C, indicating a significant role of these residues in enzyme thermostability. The substrate spectrum of the Ts2631 endolysin included extremophiles of the genus Thermus but also Gram-negative mesophiles, such as Escherichia coli, Salmonella panama, Pseudomonas fluorescens and Serratia marcescens. The broad substrate spectrum and high thermostability of this endolysin makes it a good candidate for use as an antimicrobial agent to combat Gram-negative pathogens.


Asunto(s)
Bacteriófagos/enzimología , Dominio Catalítico , Endopeptidasas/química , Endopeptidasas/metabolismo , Thermus/virología , Secuencia de Aminoácidos , Bacteriófagos/fisiología , Cationes Bivalentes/farmacología , Estabilidad de Enzimas , Modelos Moleculares , Datos de Secuencia Molecular , Cloruro de Sodio/farmacología , Especificidad por Sustrato , Temperatura
13.
Scand J Infect Dis ; 36(2): 102-5, 2004.
Artículo en Inglés | MEDLINE | ID: mdl-15061662

RESUMEN

Dietary fish oil is believed to have a beneficial effect in various infections and in autoimmune disorders. This effect may correspond to an altered immune response. In order to discover whether the effect of dietary fish oil is different in various infections, we studied the survival of mice fed fish oil or corn oil supplemented diets and infected in the lungs with either Klebsiella pneumoniae or Streptococcus pneumoniae. 120 NMRI mice were divided into 4 groups, of which 2 groups were fed a fish oil supplemented diet and 2 a corn oil supplemented diet. After 6 weeks the mice were infected in the lungs with Klebsiella pneumoniae (fish oil groups and corn oil groups) or with Streptococcus pneumoniae serotype 3 (both groups). The survival rate was monitored. The experiment was performed twice. The survival of the mice fed fish oil enriched diet and infected with Klebsiella pneumoniae was significantly better compared with the mice fed corn oil enriched diet (p = 0.0001 and p = 0.0013). No difference was found between the mice fed corn oil enriched diet or fish oil enriched diet and infected with Streptococcus pneumoniae serotype 3 (p = 0.74 and p = 0.15). Our results indicate that dietary fish oil has a beneficial effect on survival of mice after experimental pneumoniae when infected with Klebsiella pneumoniae, but not after infection with Streptococcus pneumoniae serotype 3.


Asunto(s)
Suplementos Dietéticos , Aceites de Pescado/farmacología , Infecciones por Klebsiella/mortalidad , Infecciones por Klebsiella/terapia , Infecciones Neumocócicas/mortalidad , Infecciones Neumocócicas/terapia , Animales , Modelos Animales de Enfermedad , Femenino , Klebsiella pneumoniae , Ratones , Ratones Endogámicos , Probabilidad , Distribución Aleatoria , Valores de Referencia , Medición de Riesgo , Sensibilidad y Especificidad , Streptococcus pneumoniae , Análisis de Supervivencia
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