A multicentre ambispective observational study into the incidence and clinical management of aplastic anaemia in Spain (IMAS study).

Aplastic anemia (AA) is a rare, life-threatening hematological disease, with a poorly defined incidence. As the data available on AA varies substantially worldwide, a multicenter, ambispective, observational study was carried out between 2010 and 2019 to assess the incidence, clinical management and survival of AA at seven Spanish hospitals. The incidence of AA was 2.83 per million inhabitants per year, consistent with that reported previously in Europe, with a median age at diagnosis of 61 years-old (range 12-86), and a similar number of males and females. The initial diagnosis was severe or very severe AA in 55.8% of cases and 93.7% required transfusion. The most frequent first line therapy was anti-thymocyte globulin (ATG) plus cyclosporin A (CsA, 44.2%), followed by other CsA-based regimes (46.3%), with hematopoietic stem cell transplantation an infrequent 1st line therapy. The 6-month response rate was 68.2%, which then increased over a median follow-up of 3.9 years. The 5-year overall survival (5OS) was 73.6%, similar in severe (78.6%) and very severe AA patients (74.6%) but lower in moderate AA (MAA) patients (68.4%). The 5OS was 100% in 0-25 year-old patients but dropping to 58.3% in patients ≥ 60 years-old. At the last contact, 75.8% of the patients were alive. In conclusion, the incidence, characteristics and management of AA in our study are consistent with that reported previously. In terms of survival, although the global long-term OS rate was good, there is room for improvement, particularly in older patients. Finally, what appears to be a worse long-term survival of MAA patients, as reported previously, reinforces the importance of not underestimating this condition when diagnosed as MAA.

Environmental and economic assessment of biodegradable and compostable alternatives for plastic materials in greenhouses.

Plastics and other materials commonly used in horticulture for plant support (e.g. raffia) and soil protection (e.g. mulching film) pose a challenge to achieving a circular economy. These materials contaminate plant residues, hampering their direct reuse due to the need for separation and cleaning. As a result, contaminated plant residues is often landfilled or incinerated. This study investigates the replacement of conventional plastic raffia and mulching film with biodegradable and compostable alternatives. Polypropylene raffia is compared with a biodegradable viscose polymer and compostable jute fibre, while polyethylene mulching film is compared with a biodegradable polylactic acid film. Conventional and novel alternatives are compared economically using Life-Cycle Costing and environmentally using Life-Cycle Assessment. The economic assessment is based on case studies with two horticultural companies in Almeria (south-eastern Spain), while the environmental analysis uses data from the Ecoinvent database. The use of biodegradable and compostable alternatives for raffia and mulching film proved to be 49% more expensive than conventional options. However, when conventional plastic waste is incinerated rather than landfilled, biodegradable and compostable alternatives have a lower carbon footprint. Although biodegradable and compostable options can be more expensive and have higher impacts in certain situations, proper waste management can lead to environmental benefits. With optimisation and incentives, these alternative options support the transition of horticulture to a sustainable circular economy.

Assessment of hydrological, geological, and biological parameters of a river basin impacted by old Hg mining in NW Spain.

Mercury (Hg) is a toxic metal that can cause adverse effects for the health of ecosystems. The Caudal River is one of the main rivers in the Asturias region (NW Spain), whose basin is highly anthropized, hosting several Hg mines, closed in the last century. Arsenic (As) is also found in the mineral paragenesis of the Hg deposits, posing a greater environmental risk. In the mining sites, remaining old facilities and tailings continue to release these elements into the environment. In this work, samples of fluvial sediments and water were taken, both in areas affected by anthropic activity and in pristine areas, in order to establish the background levels for the critical elements. The mineralogical study of the sediments, combined with EDS microanalysis, is useful to identify mineralogical traps such as Fe oxides or clays to retain the As. The As content in all sampled sediments is above the threshold effect levels (TEL), the possible effect range within which adverse effects occasionally occur, according to the Canadian Sediment Quality Guidelines for the Protection of Aquatic Life. This fact is related to a naturally high geochemical background in the basin, due to the existing mineral deposits. The PEL threshold (the probable effect range within which adverse effects frequently occur) is exceeded by more than an order of magnitude in the sediments downstream of the Hg mines. In these points, the As content in the water, exceeding 700 µg L-1 As, is also above the quality standard established in Spanish legislation. As a result, the Caudal River tributaries in the lower part of the basin do not reach a good ecological state, according to the Hydrological Planning Office, and in some cases their state is deficient, showing low richness and high dominance of macroinvertebrates. Although the concentrations decrease with distance from the source, these findings justify the low ecological quality of the affected watercourses.

Is using the Gail model to calculate the risk of breast cancer in the Venezuelan population justified?

Objective: To evaluate the accuracy of the Gail model (GM) in women who already have a diagnosis of breast cancer (BC) from the Breast Pathology Service, Hospital Oncology Department of the Venezuelan Social Security Institute (SOH-IVSS) in the period 2004-2014. To compare the accuracy of the GM in women aged above and below 40 years with a diagnosis of BC. Method: Descriptive, retrospective, cross-sectional, 830 records of patients diagnosed with BC were reviewed between 2004 and 2014. Results: The mean age for diagnosis of the disease was 46 ± 13 years; menarche age was 13 years ± 2; age at first birth 22 ± 5 years, with a history of biopsy 32 ± 11, the percentage of relatives with a primary history of BC reported (PHBC) 9.3%. Only 41% of women with a diagnosis of BC reported Gail >1.67 (positive Gail). In the dichotomous logistic regression that related positive Gail with the independent variables, it was observed: greater probability of positive Gail if menarche age <11 years (p < 0.036), PHBC (p = 0.005), previous biopsy (p = 0.007), age at first birth 25-29 years (p = 0.019). When stratifying by age, unlike the bivariate analysis, women over 40 years of age are more likely to have a positive Gail in menarche age <11 years (p = 0.008), PHBC (p = 0.001), previous biopsy (p = 0.025) when compared with younger women, the age at first birth between 25 and 29 years was statistically significant for both groups; however, the probability was higher in younger women (p = 0.008). Conclusion: There is no conclusive evidence to consider that the GM is applicable to Venezuelan women due to its low precision since it only identified 41% of the patients who had BC as high risk; however, when the factors are analysed separately, we found a higher probability of a positive Gail with statistical significance in EM <11 years, PHBC, previous biopsy and age at first birth 25-29 years; When stratifying by age, we observed that the age at first birth 25-29 years in women aged 40 or less increases the probability of a positive Gail. It is necessary to develop new risk assessment models that are adapted to our female population.

Automatic Assessment of Procedural Skills Based on the Surgical Workflow Analysis Derived from Speech and Video.

Automatic surgical workflow analysis (SWA) plays an important role in the modelling of surgical processes. Current automatic approaches for SWA use videos (with accuracies varying from 0.8 and 0.9), but they do not incorporate speech (inherently linked to the ongoing cognitive process). The approach followed in this study uses both video and speech to classify the phases of laparoscopic cholecystectomy, based on neural networks and machine learning. The automatic application implemented in this study uses this information to calculate the total time spent in surgery, the time spent in each phase, the number of occurrences, the minimal, maximal and average time whenever there is more than one occurrence, the timeline of the surgery and the transition probability between phases. This information can be used as an assessment method for surgical procedural skills.

Intentional Storytelling to Sustain Low-cost/Free Breast Cancer Services: A Latina Example of Community-driven Advocacy.

BACKGROUND: Community-based public health advocacy efforts are crucial to sustaining the low-cost/free breast cancer services that support underserved populations. OBJECTIVES: We introduce two ways in which narrative theory may be a useful tool for developing advocacy materials and provide an example, using a community-academic partnership to promote Latina breast health in Chicago, Illinois. METHODS: Community and academic partners 1) engaged 25 Spanish-speaking Latinas in an advocacy workshop, 2) leveraged narrative theory to develop multi-media advocacy materials, and 3) disseminated materials to policymakers. LESSONS LEARNED: Our project highlights 1) that narrative theory may be useful to describe how Latinas engage policy-makers in relation to their needs and cultural norms, 2) the importance of flexibility and offering community members multiple options to engage policymakers, and 3) the importance of leveraging partners' complementary strengths. CONCLUSIONS: Narrative theory may be a useful tool for developing advocacy materials in community-academic partnerships.

Substance use policy and practice in the COVID-19 pandemic: Learning from early pandemic responses through internationally comparative field data.

The COVID-19 pandemic has created an unprecedented natural experiment in drug policy, treatment delivery, and harm reduction strategies by exposing wide variation in public health infrastructures and social safety nets around the world. Using qualitative data including ethnographic methods, questionnaires, and semi-structured interviews with people who use drugs (PWUD) and Delphi-method with experts from field sites spanning 13 different countries, this paper compares national responses to substance use during the first wave of the COVID-19 pandemic. Field data was collected by the Substance Use x COVID-19 (SU x COVID) Data Collaborative, an international network of social scientists, public health scientists, and community health practitioners convened to identify and contextualise health service delivery models and social protections that influence the health and wellbeing of PWUD during COVID-19. Findings suggest that countries with stronger social welfare systems pre-COVID introduced durable interventions targeting structural drivers of health. Countries with fragmented social service infrastructures implemented temporary initiatives for PWUD led by non-governmental organisations. The paper summarises the most successful early pandemic responses seen across countries and ends by calling for greater systemic investments in social protections for PWUD, diversion away from criminal-legal systems toward health interventions, and integrated harm reduction, treatment and recovery supports for PWUD.

Speech-Based Surgical Phase Recognition for Non-Intrusive Surgical Skills' Assessment in Educational Contexts.

Surgeons' procedural skills and intraoperative decision making are key elements of clinical practice. However, the objective assessment of these skills remains a challenge to this day. Surgical workflow analysis (SWA) is emerging as a powerful tool to solve this issue in surgical educational environments in real time. Typically, SWA makes use of video signals to automatically identify the surgical phase. We hypothesize that the analysis of surgeons' speech using natural language processing (NLP) can provide deeper insight into the surgical decision-making processes. As a preliminary step, this study proposes to use audio signals registered in the educational operating room (OR) to classify the phases of a laparoscopic cholecystectomy (LC). To do this, we firstly created a database with the transcriptions of audio recorded in surgical educational environments and their corresponding phase. Secondly, we compared the performance of four feature extraction techniques and four machine learning models to find the most appropriate model for phase recognition. The best resulting model was a support vector machine (SVM) coupled to a hidden-Markov model (HMM), trained with features obtained with Word2Vec (82.95% average accuracy). The analysis of this model's confusion matrix shows that some phrases are misplaced due to the similarity in the words used. The study of the model's temporal component suggests that further attention should be paid to accurately detect surgeons' normal conversation. This study proves that speech-based classification of LC phases can be effectively achieved. This lays the foundation for the use of audio signals for SWA, to create a framework of LC to be used in surgical training, especially for the training and assessment of procedural and decision-making skills (e.g., to assess residents' procedural knowledge and their ability to react to adverse situations).

Use of marble sludge waste in the manufacture of eco-friendly materials: applying the principles of the Circular Economy.

The marble industry generates enormous amounts of waste every year, whose incorrect management can lead to environmental problems. The Circular Economy model can provide an effective solution to this issue, an aspect that has been addressed in this research. The suitability of a marble sludge generated in the ornamental rock industry of Andalusia (Spain) has been assessed as raw material in ceramic bricks. Mixtures containing a clayey base and 0, 2.5, 5, 7.5, and 10 wt% of marble powder have been shaped into 60 × 30 × 10-mm3 prismatic specimens and sintered at 950 °C in a muffle. The main technological properties of the bricks related to color, shrinkage, porosity, water absorption, suction, and compressive strength have been determined. The addition of marble sludge has fostered the development of a lighter color, together with a significant increase of the open porosity. This aspect has implied, on the one hand, higher water absorption and suction results and, on the other hand, a decrease of the density and the mechanical strength. The correlations obtained after applying Shapiro-Wilk normality tests and r Pearson coefficients endorse the clear relationship between the addition of marble powder and the abovementioned effects on the technological properties of the sintered bricks. All the measured properties fully meet the brick standardized requirements, which would indicate that the recycling of marble wastes could be a promising alternative to obtain eco-friendly lightweight ceramic materials.

Preliminary experience of an expert panel using Triangle Wound Assessment for the evaluation of chronic wounds.

OBJECTIVE: Wound assessment is an essential part of wound management and has traditionally focused on the wound bed. The Triangle of Wound Assessment (Triangle) is a new assessment tool that includes a holistic evaluation of the patient with a wound. The aim of this pilot study was to describe the use of the Triangle in our clinical practice in Spain. METHODS: Prospective, consecutive patients, male and female, over 18 years old, with wounds of any aetiology and duration, who attended the centres involved in the study, were recruited between May and June 2017. The TWA was used during the first presentation, to assess the wound bed, edge and periwound skin. The study's expert panel met to discuss the results collected by the assessment, as well as the advantages and disadvantages of the system. RESULTS: We recruited 90 patients. Non-viable tissue (necrotic/sloughy) was recorded in 57.8% of the patients, elevated exudate (medium/high) in 52.2%. Approximately 25% of the patients had signs or symptoms of local infection. Maceration was the most prevalent issue recorded on the wound edge and periwound skin assessment, affecting 31.1% and 30.0% of the patients, respectively. The presence of hyperkeratosis was high for the study population as the main aeitologies of the wounds identified here were DFU. CONCLUSIONS: The implementation of Triangle Wound Assessment could help in the holistic approach to patient care by focusing on more than local wound care, identifying barriers to achieving wound healing and evaluating wound response and patient compliance.

Estudio de la situación nutricional y hábitos alimentarios de escolares de diferentes comunidades indígenas del municipio de Ixhuatlán de madero, estado de veracruz (méxico) / A study of nutritional status and dietary habits among schoolchildren from different indigenous communities within the municipality of Ixhuatlán de madero, state of veracruz (mexico)

México está inmerso en una situación de transición social y nutricional con consecuencias para la población general. Este estudio tuvo como objetivo analizar el estado nutricional de escolares indígenas mexicanos, dependiendo de su género, edad y comunidad indígena y analizar sus hábitos alimenticios. Estudio transversal realizado en 230 escolares (7-12 años de edad), reclutados de seis comunidades indígenas en México. Se evaluó el peso, la talla, talla sentado y el índice de masa corporal (IMC) de los sujetos. Para conocer sus hábitos alimentarios, los sujetos también participaron en una entrevista semi-estructurada y se les pidió que respondieran a un cuestionario de frecuencia de alimentos. Existieron diferencias significativas en la talla y talla sentado por edad (p < 0.05) y no por sexo. El 17.8% presentó exceso de peso (sobrepeso + obesidad), con diferencias por edad (p < 0.05), siendo superior en chicos (20.3%) frente a chicas (14.8%). Existió asociación (p = 0.005) entre estado nutricional y comunidad de pertenencia. Existió una elevada ingesta diaria de carbohidratos (refrescos) 70.8% y de grasa mediante frituras (78.7% de casos). Existe una creciente prevalencia de sobrepeso y obesidad entre la población infantil perteneciente a las comunidades más aisladas y cuyo abastecimiento dependía del acceso a la tienda de cada comunidad(AU)

Mexico is currently immersed in a context of social and nutritional transition with important consequences for the general population. This study aimed to analyze the nutritional status of indigenous Mexican school children, depending on their gender, age and indigenous community. We also wished to analyze their eating habits. A cross-sectional study performed on 230 school children (7-12 years of age), recruited from six indigenous communities in Mexico. Weight, standing height, sitting height, and body mass index (BMI) of the subjects were evaluated. To assess their eating habits, the subjects also participated in a semi-structured interview and were asked to respond to a food frequency questionnaire. There were significant differences in standing height and sitting height in regard to age (p<0.05) though not in regard to gender. The 17.8% of the subjects had excess weight (overweight + obesity) with significant differences for age (p < 0.05). There was a higher percentage of excess weight among boys (20.3%) than among girls (14.8%). Our study also detected an association (p = 0.005) between nutritional status and indigenous community. The eating habits of the children were characterized by a high daily ingestion of carbohydrates in the form of soft drinks (70.8%) and fat from fried foods (78.7%). There is a growing prevalence of overweight and obesity in the child population in the more isolated indigenous communities, whose food supply directly depends on access to grocery stores at each location(AU)

Medical Costs of Persons with Drug Use Disorders Among Medicaid Managed Care Beneficiaries in Puerto Rico : Comparison of the Direct Services Costs Incurred by Beneficiaries With and Without a Drug Use Disorder.

Drug use disorders (DUDs) can substantially increase the costs of health care, especially when left untreated. Yet, not much is known about the specific types of medical services that give rise to these cost differences. This study aimed to estimate the medical costs of beneficiaries with DUDs enrolled in the Medicaid Managed Care (MMC) program in Puerto Rico using claims data. These were compared to those of a matched group of patients without DUDs. On average, each beneficiary with a DUD incurred in $4539 annually on medical services compared to $2601 in the matched comparison group, a cost differential of $1938. Close to half of these additional medical costs (43.4%) were generated in the physical health services sector. Counts of service claims were also higher for beneficiaries with DUDs than for beneficiaries without DUDs in all service types, except in outpatient and laboratory services for physical health. A host of access strategies and treatment modalities should be tested to assess the extent to which providing adequate access and adequate treatment for a DUD can contribute to cost savings.

A comparison of radio-frequency biomotion sensors and actigraphy versus polysomnography for the assessment of sleep in normal subjects.

PURPOSE: This paper aims to compare the absolute performance of three noncontact sleep measurement devices for measuring sleep parameters in normal subjects against polysomnography and to assess their relative performance. METHODS: The devices investigated were two noncontact radio-frequency biomotion sensors (SleepMinder (SM) and SleepDesign (HSL-101)) and an actigraphy-based system (Actiwatch). Overnight polysomnography measurements were carried out in 20 normal subjects, with simultaneous assessment of sleep parameters using the three devices. The parameters measured included total sleep time (TST), sleep efficiency (SE), sleep-onset latency (SOL), and wake-after-sleep onset (WASO). The per-epoch agreement level for sleep/wake distinction was evaluated. RESULTS: The TSTs reported by the three devices were 426 ± 34, 434 ± 22, and 441 ± 16 min, for the SM, HSL-101, and Actiwatch, respectively, against polysomnogram (PSG)-reported TST of 391 ± 49 min. The SOLs were 10 ± 10, 5 ± 6, and 3 ± 2 min for the SM, HSL-101 and Actiwatch, respectively against PSG SOL of 19 ± 13 min. The WASO times were 46 ± 33, 43 ± 22, and 38 ± 17 min, as against PSG-reported 69 ± 46 min. All three devices had a statistically significant bias to overestimate sleep time and underestimate WASO and SOL compared with PSG. The performance of the three devices was basically equivalent, with only minor interdevice differences. The overall per-epoch agreement levels were 86 % for the SM, 86 % for the HSL-101, and 85 % for the Actiwatch. CONCLUSIONS: Noncontact biomotion approaches to sleep measurement provided reasonable estimates of TST, but with a bias to over-estimation of sleep. The radio-frequency biomotion sensors provided similar accuracies for sleep/wake determination in normal subjects as the actigraph used in this study and slightly improved estimates of TST, SOL, and WASO.

Addressing the HIV/AIDS epidemic among Puerto Rican people who inject drugs: the need for a multiregion approach.

High levels of HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs (PRPWID) since early in the HIV epidemic. Advances in HIV prevention and treatment have reduced HIV among people who inject drugs (PWID) in the United States. We examined HIV-related data for PRPWID in Puerto Rico and the US Northeast to assess whether disparities continue. Injection drug use as a risk for HIV is still overrepresented among Puerto Ricans. Lower availability of syringe exchanges, drug abuse treatment, and antiretroviral treatment for PWID in Puerto Rico contribute to higher HIV risk and incidence. These disparities should be addressed by the development of a federally supported Northeast-Puerto Rico collaboration to facilitate and coordinate efforts throughout both regions.

[NURSING MANAGEMENT: CREATION OF A HOSPITAL COMPLEX. AREA II OF THE MURCIA HEALTH CARE SERVICE (CARTAGENA)]. / Gestión de enfermería: proceso de creacín de un compleoj hospitaalrio. AÁea II del Servicio Murciano de Salud (Cartagena).

INTRODUCTION: This paper analyzes, by a descriptive study, the closing of the Basic Hospital of the Defence the restructuration of the Santa María del Rosell University Hospital, and the moving of both to a new hospital: the Santa Lucía University Hospital. This process was carried out in coordination with a coincident objective: the creation of an only management staff for the area. The aim is the analysis of the opening of a hospital complex that coincided with the restructuration of the health area. METHODOLOGY: This paper analyzes the actions in relation to the scheduling, training and moving, that concerned above 600 hospital beds and 275.000 inhabitants. Analyzes the intervention in infrastructures, logistics and training. The whole process is seen from de nursery point of view, as a professional stratus that knows the roles of the hospital and personnel. The period of the study comprises since October2010, beginning of the activity in the new hospital, to November 2011, moment of the effective culmination of the move. RESULT: The result of the works carried out was the transfer of people and roles in a very short time (eleven months). All the patients were moved without any event. CONCLUSION: During the whole process healthcare continuity was obtained, whit the less economic impact, as in patients and professionals. From the point of view of future and practical implications, the basis for a modern and qualified provision of services have been established; and best results from means provided have been obtained in relation to health care quality.

Evaluación de la calidad de vida relacionada con la salud en la diabetes mellitus tipo 2 / Assessment of health-related quality of life in type 2 diabetes mellitus

La calidad de vida relacionada con la salud recoge las percepciones del paciente sobre su bienestar en todos los aspectos de su vida cotidiana, y su estudio y evaluación permiten valorar el impacto de la enfermedad y los tratamientos sobre el enfermo. Los instrumentos que suelen emplearse para medirla son los cuestionarios, que son herramientas dinámicas, pues están en continuo proceso de desarrollo, mejora y validación. En este trabajo se realiza una revisión actualizada de los instrumentos de medida de diferentes aspectos de la calidad de vida relacionada con la salud de pacientes con diabetes mellitus tipo 2, que hayan sido empleados o que pueden emplearse en pacientes de habla hispana. También se orienta sobre los tipos de instrumentos validados, genéricos y específicos, más idóneos a emplear, en función de los objetivos de los clínicos e investigadores interesados en los sentimientos, autovaloraciones o conductas de los pacientes con diabetes tipo 2. Además, se detallan las características principales de los cuestionarios recomendados, sus indicaciones de uso, así como referencias de entidades que facilitan su consulta y acceso en línea; de entre los disponibles, los que se encuentran más avalados por la literatura científica para evaluar los aspectos más generales del estado de salud en personas diabéticas son el SF-36 y el EQ-5D; para valorar el impacto específico de la diabetes sería recomendable el uso del ADDQoL y el DQoL. Se ofrecen, además, pautas generales para familiarizarse con este tipo de medidas y orientarse en la metodología de su uso e interpretación de los resultados.

Assessing need for medication-assisted treatment for opiate-dependent prison inmates.

Individuals with a history of heroin dependence are overrepresented in American correctional facilities and 75% of inmates with a drug use disorder do not receive treatment during incarceration or after release. Medication-assisted treatment (MAT) with opiate agonists, such as methadone or buprenorphine, constitutes standard of care; to guide planning for an expansion of drug treatment services in correctional facilities, a needs assessment was conducted at the Department of Correction and Rehabilitation (DCR) of Puerto Rico (PR). The authors report on the research process, the findings that informed their recommendations for the DCR to expand MAT for eligible inmates, and lessons learned.

[Cost-effectiveness of a TLC-NOSF polyurethane foam dressing]. / Coste-Efectividad de un apósito de espuma de poliuretano con TLC-NOSF.

Chronic wounds represent a drain on the Spanish health system, nowdays is necessary an optimization of the resources used and that is for this that is necessary justify the use of the products over others through cost-effective studies for to show the economic benefit to professionals and the life quality of patient. This article compares the use of a new technology for format polyurethane foam, TLC-NOSF, with the most commonly used products for treating wounds. This comparison is made using a cost-effectiveness model (Markov Model). The results demonstrate that treatment with polyurethane foam dressing with TLC-NOSF are cost-effective versus treatments with polyurethane foams most commonly used in Spain.

[A proposal for a protocol of neuropsychological assessment for use in addictions]. / Propuesta de un protocolo para la evaluación neuropsicológica de las adicciones.

INTRODUCTION: Interest in the brain processes involved in establishing, maintaining and overcoming addictions has led to the development, in recent years, of a number of neurocognitive models with a substantial amount of empirical support. However, agreement still needs to be reached regarding the clinical evaluation tests that can be administered and the reason for doing so. The aim of this work is to outline some of the most useful neuropsychological tests for evaluating addicts, as well as the scales of day-to-day symptoms and occupational performance tests that have been validated in Spanish for this population. DEVELOPMENT: The cognitive sub-processes addressed in this work, which have proved to be useful in the syndromic diagnosis of addictions, are processing speed, selective and sustained attention, alternating and divided attention, attentional amplitude and central executive, memory, cognitive flexibility and fluency, response inhibition, planning, abstraction, decision-making and, lastly, theory of mind. A protocol involving two 50-minute sessions is proposed, where the second session is optional depending on the needs and suitability in each case. CONCLUSIONS: This protocol offers several important advantages for physicians, including systemisation, the possibility of replication and convergence among evaluators or delimitation of the sub-processes that can be evaluated by sharing the same scheme. Moreover, it can all be carried out in sessions that are short enough to allow them to be offered by nearly all services that attend to addicts who request treatment.

[Prefrontal symptoms assessment: psychometric properties and normative data of the Dysexecutive Questionnaire (DEX) in a sample from the Spanish population]. / Evaluación de los síntomas prefrontales: propiedades psicométricas y datos normativos del cuestionario disejecutivo (DEX) en una muestra de población española.

INTRODUCTION: Research on the deficits derived from alterations in the prefrontal circuits has been conducted almost exclusively from a categorical perspective, which differentiates normal from pathological functioning. The functioning of the prefrontal cortex, however, can be seen as a continuous dimension. The Dysexecutive Questionnaire (DEX) was created with the intention of being useful as a qualitative measure of the symptoms of 'dysexecutive syndrome' in day-to-day life. AIM. To explore the psychometric properties of the self-reported DEX in a broad sample of the non-clinical population with a view to providing interpretations that can be of use in clinical practice. SUBJECTS AND METHODS: The Spanish version of the DEX was administered to 1013 non-clinical individuals living in Madrid, Saragossa, Asturias, Navarre and Seville (380 males and 633 females). RESULTS: The factorial study conducted in parallel reveals the existence of two factors with adequate consistency and internal validity indices: items that explore difficulties in beginning, maintaining and organising behaviour (disorganisation/apathy) and items related with the interruption of behaviour in situations where it is inappropriate (disinhibition/impulsivity). The distribution according to age matches the developmental premises. The following cut-off points are proposed: < 10, optimal functioning; 10-18, sub-optimal functioning within normality; 19-28, moderately dysexecutive functioning that requires identification of the possible causes, and > 28, important degree of dysexecutive disorder that would include severe pathologies. CONCLUSIONS: The DEX may be useful as an instrument for detecting subjects with demonstrable brain disorders and those with deficient executive functioning without the presence of any known or identifiable pathology.