Cognitive rehabilitation program in patients with multiple sclerosis: A pilot study.

INTRODUCTION: In recent years, there has been an increase of studies dedicated to cognitive rehabilitation in patients with multiple sclerosis (MS); however, few of these analyze the impact on such variables as cognitive reserve. The study aims to explore the effects of a cognitive rehabilitation program comprising a combination of cognitive and physical exercises, as well as group sessions to improve cognitive performance, emotional state, and cognitive reserve index. METHOD: Fifty patients with MS were subdivided into 2 groups: the control group, which performed aerobic exercise (n=25), and the experimental group (n=25), which participated in the integrated cognitive rehabilitation program (ICRP). All participants were evaluated 3 times (baseline, post-treatment, and long-term) with the Brief Repeatable Battery of Neuropsychological Tests, Cognitive Reserve Scale, Beck Depression Inventory, and a scale evaluating trait and state anxiety. RESULTS: Compared with the control group, patients in the experimental group showed improvements in cognitive function, with significant changes in measures of information processing speed, attention, memory, cognitive reserve index, and long-term mood. CONCLUSIONS: The ICRP was effective in improving cognitive and emotional function in MS, and increased the cognitive reserve index.

The Mexican consensus on fecal incontinence.

Fecal incontinence is the involuntary passage or the incapacity to control the release of fecal matter through the anus. It is a condition that significantly impairs quality of life in those that suffer from it, given that it affects body image, self-esteem, and interferes with everyday activities, in turn, favoring social isolation. There are no guidelines or consensus in Mexico on the topic, and so the Asociación Mexicana de Gastroenterología brought together a multidisciplinary group (gastroenterologists, neurogastroenterologists, and surgeons) to carry out the «Mexican consensus on fecal incontinence¼ and establish useful recommendations for the medical community. The present document presents the formulated recommendations in 35 statements. Fecal incontinence is known to be a frequent entity whose incidence increases as individuals age, but one that is under-recognized. The pathophysiology of incontinence is complex and multifactorial, and in most cases, there is more than one associated risk factor. Even though there is no diagnostic gold standard, the combination of tests that evaluate structure (endoanal ultrasound) and function (anorectal manometry) should be recommended in all cases. Treatment should also be multidisciplinary and general measures and drugs (lidamidine, loperamide) are recommended, as well as non-pharmacologic interventions, such as biofeedback therapy, in selected cases. Likewise, surgical treatment should be offered to selected patients and performed by experts.

Preeclampsia and risk of maternal pulmonary hypertension at high altitude in Bolivia.

Women with a history of preeclampsia (PE) have a greater risk of pulmonary arterial hypertension (PAH). In turn, pregnancy at high altitude is a risk factor for PE. However, whether women who develop PE during highland pregnancy are at risk of PAH before and after birth has not been investigated. We tested the hypothesis that during highland pregnancy, women who develop PE are at greater risk of PAH compared to women undergoing healthy highland pregnancies. The study was on 140 women in La Paz, Bolivia (3640m). Women undergoing healthy highland pregnancy were controls (C, n = 70; 29 ± 3.3 years old, mean±SD). Women diagnosed with PE were the experimental group (PE, n = 70, 31 ± 2 years old). Conventional (B- and M-mode, PW Doppler) and modern (pulsed wave tissue Doppler imaging) ultrasound were applied for cardiovascular íííassessment. Spirometry determined maternal lung function. Assessments occurred at 35 ± 4 weeks of pregnancy and 6 ± 0.3 weeks after birth. Relative to highland controls, highland PE women had enlarged right ventricular (RV) and right atrial chamber sizes, greater pulmonary artery dimensions and increased estimated RV contractility, pulmonary artery pressure and pulmonary vascular resistance. Highland PE women had lower values for peripheral oxygen saturation, forced expiratory flow and the bronchial permeability index. Differences remained 6 weeks after birth. Therefore, women who develop PE at high altitude are at greater risk of PAH before and long after birth. Hence, women with a history of PE at high altitude have an increased cardiovascular risk that transcends the systemic circulation to include the pulmonary vascular bed.

[Misdiagnosis of Gaucher disease in real life: Retrospective study of the French Gaucher's disease registry]. / Les erreurs diagnostiques de la maladie de Gaucher dans la vraie vie : étude rétrospective du Registre français de la Maladie de Gaucher.

INTRODUCTION: Gaucher disease is an autosomal recessive genetic disorder. It is caused by a deficiency of the lysosomal enzyme, glucocerebrosidase which leads to an accumulation of glucosylceramide in the macrophages. Splenomegaly, hepatomegaly, cytopenias (anemia, thrombocytopenia) and bone disorders are the main symptoms. The diagnosis is often delayed, leading to unnecessary investigations and treatments, and delaying the specific treatment. The primary objective of our study was to establish, in patients who had a diagnostic delay of more than one year, the reported misdiagnoses before the final diagnosis. The secondary objectives were to investigate the risk factors associated with error and delayed diagnosis. METHODS: Retrospective study including patients with Gaucher disease from the French Gaucher Disease Registry. Collection of data by a single investigator from a standardized form. RESULTS: Among 83 patients with a known diagnostic delay, 13 patients (15 %) had one or two misdiagnoses. These included osteo-articular diagnoses (osteomyelitis, osteoarthritis, arthritis, osteochondritis, rheumatic fever, n=8), haematological diagnoses (gestational thrombocytopenia, immunological thrombocytopenia, n=4), infectious diagnoses (visceral leishmaniasis, mononucleosis, n=2) and hemochromatosis. The osteo-articular and infectious diagnoses concerned the child and the adolescent while the haematological diagnoses and the hemochromatosis concerned the adult. No factors were found associated with misdiagnoses. Patients with a diagnostic delay greater than one year were less likely to have hepatosplenomegaly as the first symptom. CONCLUSION: There is a risk of diagnostic error related to phenotypic heterogeneity and lack of specificity of Gaucher disease symptoms. This study helps to better identify the misdiagnoses associated with Gaucher disease.

Issues of Elder Care among Migrant Workers in Contemporary Rural China: Filial Piety Redefined from a Foucauldian Perspective.

This article reports on research that explored rural migrant workers' experiences of returning to their hometown to provide care for elderly parents diagnosed with cancer. The authors used a culturally integrated approach to Foucauldian discourse analysis to consider how 24 participants narrated their experiences of care in China. The discourse of care demonstrated a strong commitment to filial piety despite their unique care challenges, and this commitment was bolstered by discourses that emphasized how much parents had sacrificed, as well as by a persistent forgetting of experiences or background details that suggested any lack of parental sacrifice in recent Chinese history. Policy implications related to enhancing filial care are discussed.

Tolerance and response to ketogenic therapy in neonates and infants younger than 4 months. Case series in a hospital center in Medellin, Colombia. / Tolerancia y respuesta a la terapia cetógena en neonatos y lactantes menores de 4 meses. Serie de casos en un centro hospitalario de Medellín, Colombia.

INTRODUCTION: Ketogenic therapy (KT) studies have focused in children older than 2 years and adults. Recently its efficacy in infants has been reported, but there are few studies in this age group. PATIENTS AND METHODS: We report a case series of nine newborn and children younger than 4 months of age with refractory epilepsy treated with KT. We retrospectively reviewed charts of children treated at our center between 2015-2021. RESULTS: Data was collected on seven patients. Six patients began having seizures on day one of life, one had seizures starting on day 45. Different epilepsy etiologies were found. KT was started as soon as 9 days of life. The average age at which ketogenic therapy was started was 24 days of life. Initially, the diet was started at 1:1 or 2:1 ratio, and was progressed to a 4:1 ratio. After one month of KT 5/7 patients experienced a significant reduction in seizure frequency (>50%) and 2/7 had complete seizure control. At six months, 4/7 patients achieve complete seizure freedom and 1/7 had >50% seizure reduction. Two patients were lost to follow-up. None of our patients reported gastrointestinal side effects that required diet adjustments. One patient had mild and one mild hypertriglyceridemia. CONCLUSION: Even though evidence about KT in young children are starting to emerge, our experience shows it can be successful in controlling seizure burden without considerable adverse effects. There is great research potential regarding KT in young children.

TITLE: Tolerancia y respuesta a la terapia cetógena en neonatos y lactantes menores de 4 meses. Serie de casos en un centro hospitalario de Medellín, Colombia.Introducción. Los estudios para terapia cetógena (TC) se han concentrado en niños mayores de 2 años y adultos. Su eficacia en lactantes se ha descrito, pero hay pocos estudios en este grupo de edad. Pacientes y métodos. Se describe una serie de casos de nueve neonatos y lactantes menores de 4 meses de edad con epilepsia refractaria que recibieron tratamiento con TC. Se evaluaron, retrospectivamente, los registros clínicos de niños tratados entre 2015 y 2021. Resultados. Se recolectaron datos de siete pacientes. Seis pacientes iniciaron con crisis epilépticas el primer día de vida, y uno, el día 45. La etiología de la epilepsia fue variada (metabólica, genética y estructural). La TC se inició tan temprano como a los 9 días de vida. La edad promedio de inicio fue los 24 días de vida. Se inició con una tasa cetógena de 1:1 o 1:2, y se progresó posteriormente a 4:1. Después de un mes de TC, 5/7 pacientes presentaron una reducción significativa en la frecuencia de las crisis (>50%) y 2/7 experimentaron un control completo. A los seis meses, 4/7 pacientes lograron un control completo y 1/7 un control >50%. Dos pacientes se perdieron en el seguimiento. No se notificaron efectos gastrointestinales que obligaran al ajuste o la suspensión de la dieta. Se notificaron hipoglucemia e hipertrigliceridemia. Conclusión. A pesar de que la evidencia en la TC en lactantes y neonatos apenas está empezando a aparecer, nuestra experiencia muestra que puede ser una buena opción terapéutica para el control de las crisis epilépticas, sin efectos adversos importantes. Existe un gran potencial de investigación en el área de la TC en lactantes y neonatos.

Synthesis of Chitosan Microparticles Encapsulating Bacterial Cell-Free Supernatants and Indole Acetic Acid, and Their Effects on Germination and Seedling Growth in Tomato (Solanum lycopersicum).

Encapsulation of biostimulant metabolites has gained popularity as it increases their shelf life and improves their absorption, being considered a good alternative for the manufacture of products that stimulate plant growth and fruit production. Cell-free supernatants (CFS) were obtained from nine indole-3-acetic acid (IAA) producing bacterial strains. Stenotrophomonas maltophilia (PT53T) produced the highest concentration of IAA (15.88 µg/mL) after 48 h of incubation. CFS from this strain, as well as an IAA standard were separately encapsulated in chitosan microparticles (CS-MP) using the ionic gelation method. The CS-MP were analyzed by Fourier transform infrared spectroscopy (FTIR), showing absorption bands at 1641, 1547, and 1218 cm-1, associated with the vibrations of the carbonyl C=O, the N-H amine, and the bond between chitosan (CHI) and sodium tripolyphosphate (TPP). The effects of unencapsulated CFS, encapsulated CFS (EN-CFS), and encapsulated IAA standard (EN-IAA) on germination and growth of seven-day-old tomato (Solanum lycopersicum) seedlings were studied. Results showed that both EN-CFS and EN-IAA significantly (p < 0.05) increased seed germination rates by 77.5 and 80.8%, respectively. Both CFS and EN-IAA produced the greatest increase in aerial part length and fresh weight with respect to the treatment-free test. Therefore, it was concluded that the application of EN-CFS or EN-IAA could be a good option to improve the germination and growth of tomato seedlings.

[Effectiveness on adherence to biological drugs and experience of a pharmaceutical intervention based on CMO model in patients with rheumatic disease (AdhER-2 study)].

BACKGROUND: We aimed to assess the effectiveness on adherence to treatment with biologic disease modifying anti-rheumatic drugs (b-DMARD) and experience with providers of healthcare of a CMO pharmaceutical intervention care model in subjects with rheu-matoid arthritis, psoriatic arthritis, and ankylosing spondylitis stratified according to their needs. METHOD: Prospective, single-centre randomized controlled study. The study period was eleven months. Non-compliant patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondy-litis treated with b-DMARD were included. Patients were randomized to a control (CG) or intervention group (IG) who received regular or the CMO pharmaceutical intervention model treatment, respec-tively. Baseline and final adherence were determined using medication possession ratio, the Compliance Questionnaire on Rheu-matology, and Morisky Medication Adherence Scale. To assess baseline and final patient experience with providers of healthcare we applied the Chronic Patient Experience Assessment Instrument (IEXPAC). RESULTS: For the IG, one patient (5.6%) was categorized as priority 1, nine (50.0%) as priority 2, and eight (44.4%) as priority 3. Ninety pharmaceutical interventions were carried out (5.1±1.8 interventions / patient). At the end of the study, the IG showed higher fre-quency of patients who adhered to the pharmaceutical intervention (77.8 vs 18.8%; p=0.002) and higher mean IEXPAC score (7.6±1.3 vs 5.8±1.1; p <0.001) in comparison to the CG. Conclusion The CMO pharmaceutical intervention model significantly improves patient adherence to b-DMARD and their experience with the providers of healthcare.

Fear of Relapse Scale: Spanish version and psychometric characteristics in a sample of patients with Relapsing-Remitting multiple sclerosis.

INTRODUCTION: Relapses are a hallmark of multiple sclerosis, being a characteristic feature of relapsing-remitting multiple sclerosis (RRMS). The occurrence of a relapse constitutes a source of significant discomfort that impacts all domains of daily life of patients with multiple sclerosis (PwMS). In this study we first explored the psychometric properties of the Spanish version of the Fear of Relapse Scale (FoR) in a sample of patients with RRMS. Besides, we explored the relationship between the Fear of Relapse Scale with fatigue and cognitive perceived deficits in our PwMS sample. METHODS: An online cross-sectional survey was conducted on 173 MS patients from 12 Spanish-speaking countries (Argentina, Mexico, Uruguay, Dominican Republic, Spain, Cuba, Colombia, Guatemala, Chile, Paraguay, Peru, and El Salvador). Confirmatory factor analysis (CFA) was performed to assess the factor structure of the scale. Multiple linear regression was used to evaluate the effects of health self-perception, fatigue, and perceived cognitive deficits over fear of relapse. RESULTS: The three-factor model in the CFA yielded a good model fit (χ2/df = 2.25, P < .001, RMSEA = .078, CFI = .91). McDonalds' Omega of the FoR (Spanish version) was .91. There was a statistically significant inverse correlation between FoR and health self-perception, and a positive correlation between FoR, fatigue, and perceived cognitive deficits. Finally, level of fatigue was a predictor of fear of relapse. CONCLUSIONS: The Spanish version of the Fear of Relapse Scale is a valid and reliable instrument to explore the experience of fear of relapse in patients with RRMS.

Knowledge and beliefs about dementia among the general public: A preliminary report on the Cuban population.

BACKGROUND: The number of people diagnosed with dementia globally has dramatically increased in recent years. The objective of this study was to explore beliefs and knowledge among the Cuban population with regard to the risk factors that may lead to dementia and the actions that may be taken to prevent it. METHOD: In an exploratory cross-sectional study, we surveyed a total of 391 people aged between 18 and 96 years. The results were stratified by sex, age range, level of education, and contact with dementia. RESULTS: Dementia was the fourth most worrying disease. A total of 64.5% of participants believed that the risk of dementia could be reduced, and 60% that the appropriate time to begin prevention measures is after the age of 40. Cognitive stimulation and healthy diet were more frequently cited as useful activities to reduce risk. Survey respondents reported little presence in their lifestyle of behaviours that are beneficial for reducing the risk of dementia. CONCLUSIONS: Although dementia is an important health issue for respondents, their knowledge about disease prevention is still insufficient. The results obtained constitute a starting point for the design of policies aimed at increasing knowledge about the disease and improving prevention.

CDH2 mutation affecting N-cadherin function causes attention-deficit hyperactivity disorder in humans and mice.

Attention-deficit hyperactivity disorder (ADHD) is a common childhood-onset psychiatric disorder characterized by inattention, impulsivity and hyperactivity. ADHD exhibits substantial heritability, with rare monogenic variants contributing to its pathogenesis. Here we demonstrate familial ADHD caused by a missense mutation in CDH2, which encodes the adhesion protein N-cadherin, known to play a significant role in synaptogenesis; the mutation affects maturation of the protein. In line with the human phenotype, CRISPR/Cas9-mutated knock-in mice harboring the human mutation in the mouse ortholog recapitulated core behavioral features of hyperactivity. Symptoms were modified by methylphenidate, the most commonly prescribed therapeutic for ADHD. The mutated mice exhibited impaired presynaptic vesicle clustering, attenuated evoked transmitter release and decreased spontaneous release. Specific downstream molecular pathways were affected in both the ventral midbrain and prefrontal cortex, with reduced tyrosine hydroxylase expression and dopamine levels. We thus delineate roles for CDH2-related pathways in the pathophysiology of ADHD.

Satisfaction and experience with colorectal cancer screening: a systematic review of validated patient reported outcome measures.

BACKGROUND: Patient satisfaction or experience with colorectal cancer screening can determine adherence to screening programs. An evaluation of validated patient reported outcome measures (PROMs) for measuring experience or satisfaction with colorectal cancer screening does not exist. Our objective was to identify and critically appraise validated questionnaires for measuring patient satisfaction or experience with colorectal cancer screening. METHODS: We conducted a systematic review following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. We conducted searches on MEDLINE, EMBASE, PsychINFO, CINAHL and BiblioPRO and assessed the methodological quality of studies and measurement properties of questionnaires according to the COSMIN guidelines for systematic reviews of PROMs. PROSPERO registration number: CRD42019118527. RESULTS: We included 80 studies that used 75 questionnaires, of which only 5 were validated. Four questionnaires measured satisfaction with endoscopy: two in the context of colorectal cancer screening (for colonoscopy and sigmoidoscopy) and two for non-screening endoscopy. One questionnaire measured satisfaction with bowel preparation. The methodological quality of studies was variable. The questionnaires with evidence for sufficient content validity and internal consistency were: the CSSQP questionnaire, which measures safety and satisfaction with screening colonoscopy, and the Post-Procedure questionnaire which measures satisfaction with non-screening endoscopic procedures. CONCLUSIONS: This systematic review shows that a minority of existing PROMs for measuring patient satisfaction with colorectal cancer screening are validated. We identified two questionnaires with high potential for further use (CSSQP and the Post-Procedure questionnaire).

Cognitive rehabilitation program in patients with multiple sclerosis: A pilot study.

INTRODUCTION: In recent years, there has been an increase of studies dedicated to cognitive rehabilitation in patients with multiple sclerosis (MS); however, few of these analyze the impact on such variables as cognitive reserve. The study aims to explore the effects of a cognitive rehabilitation program comprising a combination of cognitive and physical exercises, as well as group sessions to improve cognitive performance, emotional state, and cognitive reserve index. METHOD: Fifty patients with MS were subdivided into 2 groups: the control group, which performed aerobic exercise (n=25), and the experimental group (n=25), which participated in the integrated cognitive rehabilitation program (ICRP). All participants were evaluated 3 times (baseline, post-treatment, and long-term) with the Brief Repeatable Battery of Neuropsychological Tests, Cognitive Reserve Scale, Beck Depression Inventory, and a scale evaluating trait and state anxiety. RESULTS: Compared with the control group, patients in the experimental group showed improvements in cognitive function, with significant changes in measures of information processing speed, attention, memory, cognitive reserve index, and long-term mood. CONCLUSIONS: The ICRP was effective in improving cognitive and emotional function in MS, and increased the cognitive reserve index.

Hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli infection in Argentina: update of serotypes and genotypes and their relationship with severity of the disease.

BACKGROUND: Shiga toxin-producing Escherichia coli (STEC) infection is the most common cause of hemolytic uremic syndrome (HUS). Only few studies correlated serotypes and stx genotypes with disease severity. This study aimed to update STEC serotypes, stx genotypes, and virulence factors (eae and ehxA) in a cohort of patients with STEC-HUS and investigate whether they influence the severity of disease. METHODS: In this multicentric study, children hospitalized between 2005 and 2016 with STEC-HUS confirmed by the National Reference Laboratory were included. Serotypes (O157, O145, O121, and others), stx genotypes (stx1a, stx2a, stx2c, stx2d, and others), and virulence factors were analyzed, and their association with dialysis requirement (>10 days); severe neurological, cardiovascular, and/or bowel involvement; and death was assessed. RESULTS: The records of 280 patients were reviewed; 160 females, median age 21 months (IQR18m). STEC O157 was isolated in 206 (73.6%) patients, O145 in 47 (16.8%), O121 in 15 (5.4%), and other serotypes in 12 (4.2%). The stx2a/2c genotype was carried by 179 (63.9%) strains, stx2a by 94 (33.6%), stx1a/stx2a by five (1.8%), and stx1a only by two (0.7%). All strains except six harbored eae and ehxA genes. Fifty-nine (21.1%) patients had severe neurological involvement, 29 (10.4%) severe bowel injury, 14 (5%) cardiovascular involvement, 53 (18.9%) required > 10 days of dialysis, and 12 (4.3%) died. Neither serotypes nor stx genotypes detected were significantly linked to severity. CONCLUSIONS: Serotype O157 and virulence stx2a/2c, eae, ehxA genotype are prevalent in Argentina, and no relationship was found between severity and serotypes and genotypes of STEC detected.

Acute peritoneal dialysis, complications and outcomes in 389 children with STEC-HUS: a multicenter experience.

BACKGROUND: Management of acute kidney injury (AKI) in children with hemolytic uremic syndrome induced by a Shiga toxin-producing Escherichia coli infection (STEC-HUS) is supportive; however, 40 to 60% of cases need kidney replacement therapy (KRT). The aim of this study was to analyze procedure complications, especially peritonitis, and clinical outcomes in children with AKI secondary to STEC-HUS treated with acute PD. METHODS: This is a multicenter retrospective study conducted among thirty-seven Argentinian centers. We reviewed medical records of 389 children with STEC-HUS hospitalized between January 2015 and February 2019 that required PD. RESULTS: Complications associated with PD were catheter malfunction (n = 93, 24%), peritonitis (n = 75, 19%), fluid leaks (n = 45, 11.5%), bleeding events (n = 23, 6%), and hyperglycemia (n = 8, 2%). In the multivariate analysis, the use of antibiotic prophylaxis was independently associated with a decreased risk of peritonitis (hazard ratio 0.49, IC 95% 0.29-0.81; p = 0.001), and open-surgery catheter insertion was independently associated with a higher risk (hazard ratio 2.8, IC 95% 1.21-6.82; p = 0.001). Discontinuation of PD due to peritonitis, severe leak, or mechanical complications occurred in 3.8% of patients. No patient needed to be transitioned to other modality of KRT due to inefficacy of the technique. Mortality during the acute phase occurred in 2.8% patients due to extrarenal complications (neurological and cardiac involvement), not related to PD. CONCLUSIONS: Acute PD was a safe and effective method to manage AKI in children with STEC-HUS. Prophylactic antibiotics prior to insertion of the PD catheter should be considered to decrease the incidence of peritonitis.

Exploring the Differential Effect of Life Satisfaction on Low and High-Cost Pro-Environmental Behaviors.

The role of life satisfaction as a determinant of pro-environmental behavior remains largely unexplored in the extant literature. Using a sample of undergraduate students, we explore the effect of life satisfaction on low- and high-cost pro-environmental behaviors. While low-cost pro-environmental behavior has been defined as recycling activities, high-cost pro-environmental behavior is defined in a contingent valuation framework in which respondents are asked about their willingness to pay extra for offsetting CO2 emissions, thus avoiding treating the proposed payment as symbolic. Controlling for demographic characteristics and environmental concern, results suggest that life satisfaction has a slightly stronger, and more significant, effect on high-cost pro-environmental behavior than in low-cost pro-environmental behavior. This study also finds that environmental concern and having siblings with a university degree increases the probability of engaging in both behaviors. However, family income is a better predictor of high-cost pro-environmental behavior than of low-cost pro-environmental behavior.

[Adherence to biological therapies in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. (Study ADhER-1)]. / Adherencia terapéutica a fármacos biológicos en pacientes con artritis reumatoide, artritis psoriásica y espondilitis anquilosante. (Estudio ADhER-1).

BACKGROUND: To quantify adherence to biological disease-modifying anti-rheumatic drugs (DMARD) and to determine the factors that can predict adherence in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis in daily clinical practice. METHODS: An observational, descriptive, cross-sectional and single-center study was carried out. Patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis who were in treatment with subcutaneous biological DMARD were included. Variables related to socioeconomic status, disease, biological therapy and safety were recorded. Adherence was calculated by using medication possession ratio, Compliance Questionnaire on Rheumatology and Morisky Medication Adherence Scale Questionnaire. RESULTS: One hundred twelve patients and 6 different biological DMARDs were included. Mean age was 56.8±13.2 years and 52.7% were women. The percentage of adherent patients was 59.3% in rheumatoid arthritis, 62.5% in psoriatic arthritis and 76.2% in ankylosing spondylitis. Lesser adherence was associated with the administration of the drug by a family member and/or caregiver (odds ratio: 9.6; 95% confidence interval: 1.5-61.8 (p <.05)). There were no differences between adherent and non-adherent patients in terms of the biological DMARD used. CONCLUSIONS: There are no differences in adherence to biological therapies among patients with chronic inflammatory arthropathies. Adherence correlates negatively with administration of biological DMARD by a family member and / or caregiver.

Changes in brain activity associated with cognitive-behavioral exposure therapy for specific phobias: searching for underlying mechanisms. / Cambios en la actividad cerebral asociados a la terapia de exposición cognitivo-conductual para fobias específicas: búsqueda de los mecanismos subyacentes.

INTRODUCTION: The current evidence collected consistent results about morphological and functional brain changes produced by psychological treatment. Exposure cognitive-behavioral therapy (CBT) is currently the most effective psychological treatment for phobias. AIMS: To explore the brain activation and self-reported changes in patients with specific phobias to small animals who underwent a CBT exposure program and to prove if the CBT program made phobic patients process feared stimuli similarly to non-phobic persons. SUBJECTS AND METHODS: The sample consisted of 32 adults, of which 16 (5 males and 11 females; mean age: 38.08) had specific phobia to small animals and 16 (4 males and 12 females; mean age: 21.81) had no phobias. A univariate before-and-after treatment design were used. In addition, the scores of the non-phobic group in self-reports and brain activity were compared with the post-treatment scores of the phobic group. RESULTS: Data show significant changes in brain activity, and improvements in self-reported measures because of applying CBT to specific phobias. As a highlight, participants showed a greater activation in points of the precuneus after receiving CBT. Also, when compared with non-phobic participants, phobic patients still remain with both fear and defensive responses to phobic stimuli. CONCLUSIONS: The precuneus seems to be a regulator that reorganizes the processing of phobic stimuli. It can imply as CBT/ exposure also active acceptance, self-awareness, and self-efficacy mechanisms.

TITLE: Cambios en la actividad cerebral asociados a la terapia de exposición cognitivo-conductual para fobias específicas: búsqueda de los mecanismos subyacentes.Introducción. La evidencia disponible recoge resultados consistentes sobre cambios cerebrales morfológicos y funcionales producidos por el tratamiento psicológico. La terapia cognitivo-conductual (TCC) de exposición es actualmente el tratamiento psicológico más eficaz para las fobias. Objetivos. Explorar los cambios cerebrales y autoinformados en pacientes con fobias específicas a animales pequeños sometidos a un programa de TCC de exposición y comprobar si el programa consiguió que estos pacientes procesaran los estímulos temidos de manera similar a las personas no fóbicas. Sujetos y métodos. La muestra estuvo compuesta por 32 adultos, de los que 16 (5 hombres y 11 mujeres; edad media: 38,08 años) tenían un diagnóstico de fobia específica a animales pequeños y 16 (4 hombres y 12 mujeres; edad media: 21,81 años) no tenían dicho diagnóstico. Se utilizó un diseño univariado de tratamiento antes-después. Las puntuaciones del grupo sin fobia en autoinformes y activación cerebral se compararon con las puntuaciones del grupo con fobia posteriores al tratamiento. Resultados. Los datos muestran cambios significativos en la actividad cerebral y mejoras en las medidas autoinformadas debido a la aplicación de la TCC a la fobia específica. Tras recibir TCC, los participantes mostraron una mayor activación en puntos del precúneo. Además, comparado con los participantes sin fobia, los pacientes fóbicos mantenían las respuestas defensivas y de miedo ante los estímulos fóbicos. Conclusiones. El precúneo parece ser un regulador que reorganiza el procesamiento de los estímulos fóbicos. Puede implicar que la TCC de exposición, además, activa mecanismos de aceptación, autoconciencia y autoeficacia.

Not Seeing the Forest for the Trees: The Impact of Multiple Labelling on Consumer Choices for Olive Oil.

Multiple quality labels that signal whether a particular food has special characteristics relating to geographical origin or production method have become standard within European food policy. The aim of this paper was to investigate how two of these labels in particular influence consumers' food choices. We assessed consumers' preferences for an extra virgin olive oil (EVOO) displaying EU quality labels and focus on whether they are complements or substitutes. In order to do so, we used a discrete choice experiment (DCE) to estimate main and two-way interactions effects with data from a self-administrated survey in a Spanish region. Results indicate that while consumers positively value both the Protected Designation of Origin (PDO) and the organic labels, the valuation for PDO is almost double that of the valuation of the organic label. Furthermore, the findings show that for a majority of consumers considered both labels substitutes, while a small group considered them complements. These findings can help producers identify an optimal labelling strategy to maximize returns on certification investments.

Efficacy and safety of a simplified SBRT regimen for central and peripheral lung tumours.

BACKGROUND: Evaluate the safety, toxicity and efficacy of an institutional-simplified SBRT protocol with two short SBRT regimens (three or five fractions) for the treatment of lung cancer and oligometastases, according to the volume and localization of tumours. METHODS: Patients with stage I (T1 or T2) non-small cell lung cancer or lung oligometastases were treated from August 2011 to October 2015. Patients were required to be considered medically inoperable and were discussed in a multidisciplinary team. RESULTS: 100 patients were analysed, 59 had a peripheral location (P), and 41 a central location (C).All patients finished their SBRT course without interruptions related to acute toxicity. The most frequent acute toxicity was grade 1 asthenia, only one patient developed grade 3 toxicity (pneumonitis) and there were no grade 4 or 5 acute toxicities. Three asymptomatic radiation-induced rib fractures were identified, the 1 and 2-year rib fracture-free survival were 97% and 94%, respectively. Two-year progression-free survival and 2-year overall survival of all patients were 52% and 70%, respectively, with a median PFS and OS of 26 and 43 months. Survival free of local progression (SFLP) at 2 years was 89%. A higher PFS in primary lung cancer compared with metastatic tumours was observed, with a median of 35 months with 19 months (p = 0.01). However, no statistical difference was observed in terms of OS between both diseases. CONCLUSIONS: SBRT in lung cancer with three sessions for peripheral tumours and five sessions for central tumours may be safely delivered, with low morbidity.