Clinical and Ultrasonographic Effectiveness of Two Different Splints Used for the Treatment of Lateral Epicondylitis: A Prospective Randomized Controlled Study.

OBJECTIVE: This study compares the clinical and ultrasonographic efficacy of 2 splint types, the lateral epicondylitis band (LEB) and the wrist extensor splint (WES), for treatment of lateral epicondylitis (LE). DESIGN: Randomized controlled single-blind trial. SETTING: Outpatient clinic. PARTICIPANTS: 159 participants diagnosed with unilateral LE based on clinical and ultrasonographic findings, and 2-12 weeks from symptom onset, were included (N=159). INTERVENTIONS: One group received joint-protection education-only (wait-and-see), while the other 2 groups were fit with splints: one the LEB and the other the WES. Both splint groups received joint-protection education. MAIN OUTCOME MEASURES: The primary outcome measure was the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire. Secondary outcome measures were the Visual Analog Scale (VAS) for pain, hand grip strength by dynamometry, algometric measurements, patient satisfaction, and selected ultrasonographic parameters (maximum tendon thickness measurements (MTTM) in the capitellar-radiocapitellar region and total ultrasonography scale score [TUSS]). All outcomes were assessed at baseline, 3-weeks, and 6-weeks post intervention initiation. RESULTS: Participants' mean age was 46.85±8.63 years. Of the participants, 40.88% (n=65) were male and 59.12% (n=94) were female. The baseline median (1Q-3Q) values of PRTEE-total scores were 58.5 (51-68) for the LEB, 63.5 (56.25-70.25) for the WES and 57 (48-68) for the education-only groups. At 6-weeks, the PRTEE-total scores had decreased by 44 points for those randomized to the LEB, 46 points to the WES and 7 points in the education-only groups(P<.001). While the LEB and WES approaches were superior to the wait-and-see approach in algometric measurements, VAS, and PRTEE scores (P<.05), no significant changes were found in MTTM and TUSS values. The LEB group was superior to the WES group in hand grip strength and patient satisfaction (P<.05). CONCLUSION: Using either splint for 6 weeks can be considered effective for the relief of pain and increased functionality in persons with subacute LE, although the LEB had a more positive effect on grip strength and patient satisfaction than the WES.

A scientometric analysis and visualisation of elderly suicide research from 1951 to 2022.

BACKGROUND: There are still many gaps in both national and international literature on elderly suicide. This study aimed to identify the most influential journals in elderly suicide, the countries and authors that contribute the most to the field, and the trends in the field. MATERIAL AND METHODS: Studies published on elderly suicide between 1951 and 2022 were retrieved utilising the Web of Science Core Collection. Co-authorship analysis of countries and authors, as well as co-occurrence analysis of keywords, were conducted using VOSviewer 1.6.18. RESULTS: There were 2864 articles retrieved, including 95 countries, 889 academic journals, 9162 authors and 4160 keywords. The number of publications in this field has significantly increased after the 2000s, and the United States is the most productive country (996). The most prolific author is Yeates Conwell, while the journal with the highest number of publications in this field is the International Journal of Geriatric Psychiatry. Other than 'suicide' and 'elderly', the most trending keywords are 'depression', 'primary care', 'treatment', 'antidepressant', 'loneliness', 'quality of life' and 'COVID-19'. CONCLUSION: There has been an increase in both the thematic diversity and quantity of studies on elderly suicide over time. However, these publications predominantly originate from socioeconomically affluent countries with relatively low suicide rates. While the increasing numbers of publications from developing countries in recent years are promising, there is a greater need for publications from countries with lower socioeconomic status for the prevention or intervention of elderly suicides.

The identification of association between ultrasonographic enthesitis and the ASAS Health Index in patients with axial spondyloarthritis.

This study aimed to evaluate association between the entheseal abnormalities in ultrasound and the Assessment of Spondyloarthritis International Society Health Index (ASAS HI) in patients with axial spondyloarthritis (axSpA). Seventy-four patients with axSpA were enrolled in this study. Ultrasonographic evaluation of entheses was performed by a blinded rheumatologist with the Madrid Sonographic Enthesitis Index (MASEI). The MASEI total score and the MASEI sub-scores (e.g., structural damage and activity scores) were calculated. The ASAS HI and the other SpA tools (e.g., Bath Ankylosing Spondylitis Disease Index, the Ankylosing Spondylitis Disease Activity Score) were used to evaluate patients' health and disease activity. Correlation and multivariate linear regression analyses were performed to assess the relationship between the MASEI and the ASAS HI. The mean score of the ASAS HI was 7.7 ± 4.6. The MASEI total score was calculated as 8.4 ± 6.8, while the mean MASEI-activity was 4.7 ± 3.6 and the mean MASEI-structural damage was 3.8 ± 4.5. There was no correlation between ASAS HI and MASEI total scores (r = 0.11, p = 0.34). However, the ASAS HI had a positive correlation with the MASEI-activity (r = 0.49, p < 0.001) and had a low negative correlation with the MASEI-structural damage (r = - 0.29, p < 0.05). In the linear regression model, the MASEI-activity and MASEI-structural damage were significantly related to the ASAS HI (ß = 0.72 and - 0.58, respectively; R2 = 0.53 p < 0.001). This study reported that the ASAS HI score was more negatively affected by active entheseal lesions rather than structural lesions. We suggest adding the entheses evaluation with ultrasonography to other tools for monitoring the health status of patients with axSpA.

Ancillary findings in distinguishing between anterior cruciate ligament mucoid degeneration and sprain on MRI: a practical approach.

BACKGROUND: Imaging findings of both anterior cruciate ligament (ACL) sprain and mucoid degeneration overlap in some cases, which may cause errors in magnetic resonance imaging (MRI) evaluation. PURPOSE: To determine the ancillary findings on MRI in distinguishing between ACL sprain and mucoid degeneration, and also to obtain a diagnostic scheme. MATERIAL AND METHODS: MRI scans of 77 patients with ACL mucoid degeneration and 77 cases with ACL sprain were retrospectively evaluated to compare with regard to parameters of age, sex, side, the status of posterior cruciate ligament - medial collateral ligament - lateral collateral ligament, bone marrow edema, intraosseous cyst, subchondral sclerosis, chondromalacia, meniscus tear, effusion, and osteochondral body. A decision tree algorithm was created to predict pathology in ACL, whether it was a sprain or mucoid degeneration. RESULTS: The prevalence of female sex, femoral intraosseous cyst, tibial intraosseous cyst, subchondral sclerosis, femoral chondromalacia, tibial chondromalacia, medial meniscus tear, and lateral meniscus tear were significantly higher in the ACL mucoid degeneration group (P < 0.001, P = 0.016, P < 0.001, P = 0.003, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively). The probability of being mucoid degeneration increased 41.2 times (95% confidence interval [CI] = 5.296-321.132) in cases with tibial intraosseous cyst and increased 1.05 times (95% CI = 1.010-1.080) with each one-year increase in age (P < 0.001 and P = 0.011, respectively). The decision tree algorithm had an overall accuracy of 79.2%. CONCLUSION: Ancillary findings are helpful in the diagnosis of suspicious cases for ACL mucoid degeneration and ACL sprain. The decision tree algorithm offers a practical and successful approach to this issue.

The validity and reliability of Turkish version of the children's home inventory for listening difficulties - (C.H.I.L.D) questionnaire.

OBJECTIVE: This study aimed to investigate the validity and reliability of the Turkish version of the Children's Home Inventory for Listening Difficulties - (C.H.I.L.D) questionnaire. METHODS: The study included 121 children with cochlear implants and their families aged 3-12 years and 171 children with normal hearing and their families. Confirmatory factor analysis (C.F.A.) was used to assess construct validity, Cronbach's alpha was used to analyze internal consistency and test-retest reliability was also investigated. RESULTS: The reliability coefficients of the entire C.H.I.L.D family member (C.H.I.L.D-FM) and children version (C.H.I.L.D-C) were 0.983, 0.978, and Cronbach's coefficients were 0.992, 0.992, and the corrected item-total correlations increased from 0.989 to 0.994 and from 0.988 to 0.994, respectively. The scale's construct validity was excellent, according to the CFA analyses. The goodness-of-fit indexes (for the parent's version 0.892 and for the child's version 0.867) demonstrated a good fit for the single-factor construct, with only the normed fit index revealing an acceptable fit. CONCLUSION: The Turkish version of the C.H.I.L.D is a reliable and valid evaluation test for children and their family members.

Gaming Disorder Scale for Parents: Reliability and Validity Study of the Turkish Form. / Ebeveynlere Göre Oyun Oynama Bozuklugu Ölçegi: Türkçe Formunun Geçerlik ve Güvenirlik Çalismasi.

OBJECTIVE: This study aimed to conduct the validity and reliability study of the Turkish version of the Gaming Disorder Scale for Parents (GADIS-P). METHODS: In this methodological study, the study sample consisted of 345 parents who had children within the age range of 10-17 years who played digital games. The study data were collected through the Gaming Disorder Scale for Parents, the Scale for Determining Parents' Perceptions of Computer Game Addiction, and the Digital Parenting Attitude Scale. The Cronbach's alpha analysis for reliability, item total correlation analysis, confirmatory and exploratory factor analysis for construct validity, and clustering analysis for identifying gaming disorder according to the scale scores were used. RESULTS: It was determined that the content validity index of the scale was 0.97, that item loads varied between 0.617 and 0.863 according to exploratory factor analysis, and that the scale had good fit indices in the confirmatory factor analysis. The Cronbach's reliability coefficient of the scale was found to be α=0.907, and the item total correlations were determined to be adequate. The criterion validity analysis found a positive and strong correlation with the Scale for Identifying Parents' Perceptions Regarding Digital Game Addiction (r=0.717 p0.001). As a result of the clustering analysis, it was determined that the cut-off value was found as >9 points for "Cognitive Behavioral Symptoms" subscale and as >6 points for "Negative Consequences" subscale. CONCLUSION: The results obtained show that the Turkish version of the Gaming Disorder Scale for Parents is a valid and reliable measurement tool.

Evaluation of dental students' knowledge, attitudes and behaviors regarding COVID-19 infection: a cross-sectional survey.

BACKGROUND: This study aimed to determine the differences between preclinical and clinical dental students' knowledge, attitudes, and behaviors regarding Coronavirus disease (COVID-19). METHODS: A cross-sectional study was carried out among 303 undergraduate dental students (107 clinical students and 196 preclinical students). Questionnaires were given to the participants using an online data collection platform. The online questionnaire covered the dental students' socio-demographic information and their knowledge, attitudes and behaviors of Coronavirus disease. RESULTS: More frequently than preclinical students, clinical students benefited from the latest information about the COVID-19 outbreak obtained from television, internet news sites, and the World Health Organization website (P<0.05). The use of other protective equipment other than gloves and goggles has changed from "No" before the pandemic to "Yes" onset of the pandemic (P<0.001). The knowledge level of infection control in dentistry increased significantly more for clinical students than for preclinical students (P<0.001). CONCLUSIONS: Although dental students show reasonable knowledge, attitudes and behavior about COVID-19, attention should be taken to provide education on infectious diseases, starting from preclinical classes, and to make real information resources provided by global and national health authorities accessible to students.

Does mechanical bowel preparation really prevent complications after colorectal surgery depending on the lesion localization? A myth or fact?

Objectives: Despite being routinely used before elective colorectal surgery in most surgical clinics, mechanical bowel preparation (MBP) remains controversial. This study aimed to investigate postoperative complications and outcomes of right, left, or rectosigmoid resection without MBP. Material and Methods: Patients who underwent elective colorectal surgery without mechanical bowel preparation and oral antibiotics between January 2011 and December 2021 were included in the study. Patients were categorized according to the side of resection, and these subgroups were compared for anastomotic leakage, surgical site infections (SSI), and overall morbidity measured using the Clavien-Dindo complication grade. Results: Data of 422 patients were analyzed. Overall anastomotic leakage was found in 14 patients (3.3%), SSI in 46 (10.9%), collection in 14 (3.3%), mortality in 18 (4.3%), and reoperation in 17 (%4) patients. Anastomotic leakage was observed in six (3.9%) in right colectomy, two (1.9%) in left colectomy, and in six (3.7%) patients in the rectosigmoid resection group when the groups were evaluated separately. There was no statistical difference between the groups (p= 0.630). Furthermore, there was no statistical difference between the groups regarding collection and reoperation (p values were p= 0.31, and p= 0.251, respectively). Conclusion: Study results showed that anastomotic leakage, surgical site infection, intra-abdominal collection, reoperation, and mortality rates were similar to the current literature obtained from the studies with mechanical bowel preparation. In addition, these results were found to be similar according to the resection site.

Parents' Knowledge and Attitudes Regarding Teething Signs and Symptoms.

Purpose:> To determine the level of knowledge and attitudes of parents regarding teething signs and symptom. Methods: A 55-question survey was administered to 120 parents of children aged six to 36 months who sought care from April 2021 to April 2022 at the Department of Pedodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey. The questionnaire investigated parents' sociodemographic characteristics, their knowledge about the teething process, which signs and symptoms they observed and their approaches toward them. Results: The mean duration of teething was 7.5±1.9 (standard deviation) months (minimum=four months; maximum=15 months). The most common sign or symptom observed during teething was restlessness (87.5 percent). There was no significant relationship between the level of teething knowledge and the socioeconomic status of the families. Conclusion: Parents' knowledge levels about teething process could be increased.

Violence in emergency service: The situation of general surgeons in Turkey.

BACKGROUND: Violence in healthcare in public health is a problem about socio-economic and personal development that is un-fortunately seen in every service but more frequently in emergency departments. In our study, we aimed to determine the violence experiences of general surgeons in the emergency room and their perceptions about it. METHODS: The study is designed in a cross-sectional type. We sent a survey containing 11 questions to the e-mails of 941 general surgeons registered in the National Trauma and Emergency Surgery Association in August-September 2019. The rate of participation to the online survey was 9.98%. RESULTS: The participants who have been subjected to violence in anyway and who have never encountered violence were 64.9% and 16.0%, respectively. Female surgeons composed 10.6% of the participants and their rate of exposure to violence was 90.0%. When the number of patients accepted by the surgeon increased, the rate of being exposed to violence rose (p=0.014). Those who're ex-posed to verbal violence applied to courts less frequently (p=0.046). The surgeons whose had to applied to courts could not receive remarkable support from their institutions. The participants stated that who're source of violence should get effective punishments and victims should be strongly supported. CONCLUSION: The specialists exposed to violence in the emergency room include general surgeons. Increase of the risk of ex-posure to violence for surgeons correlates workload. Verbal violence moved to the court stage has observed less frequently than the physical. It would be appropriate to take serious sanctions strengthened by legal regulations as the first step toward a solution.

Do We Underestimate Colorectal Cancer Patients Under 50?

<b> Introduction:</b> Early-onset colorectal cancer (EOCRC) accounts for approximately 10% of all colorectal cancers (CRCs). EOCRC has a certain hereditary predisposition and distinct clinicopathological and molecular features compared to the traditional average-onset of colorectal cancer (AOCRC). As previous publications have shown, EOCRC has a more advanced TNM stage and a more aggressive tumor histopathology. </br></br> <b> Aim:</b> In this study, we aimed to evaluate the differences and similarities of EOCRC compared to AOCRC based on clinicopathological characteristics. </br></br> <b>Material and methods:</b> Between January 2010 and December 2020, 394 patients with inclusion criteria who were operated on at the 3rd level health center for colorectal cancer were included in the study. Patients were divided into two groups as EOCRC (50 years and under) and AOCRC. Pearson's chi-square test was used to compare categorical variables in independent groups. In addition, logistic regression analysis was performed using the Backward method with the variables whose relationship with the age group was evaluated, with P < 0.100. </br></br> <b>Results:</b> Our final analysis included 80 EOCRC cases and 314 controls. When the EOCRC group was compared with the AOCRC group, there was no statistically significant difference between gender, tumor location, T stage of the tumor, and survival (P = 0.190, P = 0.924, P = 0.165, P = 0.574). However, a statistically significant difference in the N stage, degree of differentiation, lymphovascular invasion (LVI) and perineural invasion (PNI) status, and P-values were: P = 0.006, P = 0.029, P = 0.019, and P = 0.003, respectively. </br></br> <b>Conclusion:</b> EOCRC has more aggressive tumor biology than AOCRC. Our study shows that more advanced N stage, poor differentiation, tumor deposits, LVI, and PNI are seen more frequently in EOCRC.

A novel reduction support frame for management of unstable tibial fractures with intramedullary nail: Preliminary report.

BACKGROUND: Management of unstable tibial fractures (UTF) can be challenging due to widening of the proximal and distal metaphyseal zone, soft tissue problems, and poor vascularity. We aimed to compare the effect of novel tibial orthopedic reduction support (TORS) frame constructed by re-used tubular external fixator systems and manual traction with regard to the quality of re-duction, and fracture healing. METHODS: A total of 65 patients who were admitted with UTF and underwent intramedullary nailing were assessed; 43 patients un-derwent manual traction technique, and 22 patients underwent TORS technique. The sagittal and coronal plane angulations were eval-uated in initial postoperative radiographs, and radiologic union scores for tibial fractures (RUST) were compared at follow-up X-rays. RESULTS: The mean age of patients was 43.49±19.09 years in the manual-traction group and 43.41±16.8 years in the TORS group. The mean coronal plane angulation was 1.84±3.16 in the manual traction group and 1.86±4.21 in the TORS group. The mean sagittal plane angulation was 1.19±1.93 in manual traction group and 0.32±0.65 in the TORS group. The number of coronal and sagittal plane angulations >5° was higher in manual traction group than TORS group. The mean RUST was significantly higher in the TORS group than in the manual traction group at 6th, 9th, and 12th-month controls. The union rates were also higher in the TORS group at 9th and 12th-month controls. CONCLUSION: TORS frame is a simple and cheap technique and should be considered as reduction support in the management of UTF by intramedullary nailing.

Predictive Factors for Unnecessary Axillary Dissection According to SLN Metastasis in T1, T2 Stage Breast Cancer.

The axillary nodes' status is essential in determining the treatment algorithm according to complete clinical staging. Unnecessary axillary lymph node dissection (ALND) has been prevented after sentinel lymph node biopsy (SLNB) has occurred in current practice. However, approximately half of patients with positive SLNB do not have axillary metastatic lymph nodes. Our study aims to predict unnecessary ALND in patients with SLN metastases by evaluating the patients' clinicopathological data. In total, 221 patients with macrometastasis in SLNB who underwent completion ALND were evaluated retrospectively. Patients were divided into two groups: patients with metastases only in the sentinel lymph node and additional axillary lymph nodes. Univariate and multivariate logistic regression analyses were used to analyze the correlation between SLN metastasis and axillary lymph node metastasis; clinicopathological characteristics, including patient age, menopause status, tumor size and grade, receptor status proliferative marker status, and molecular subtypes of the tumor. In the evaluation of T1-2, cN0 breast cancer patients with SLNB in the form of macrometastasis, only SLNB metastasis was found in 118 (53.4%) patients. In 103 (46.6%) patients, additional axillary node metastasis was observed. The risk of additional nodal spread correlated with patient age older than fertility age (age of 49) (p = 0.015, OR: 1.96, 95% CI: 1.14-3.39) and the number of increased metastatic sentinel nodes (p < 0.001). In line with the data shown by our study, the rate of axillary metastases increases in patients over the age of fertility and as the number of metastatic SLNs increases.

Bibliometric analysis of orthopedic theses in Turkey.

OBJECTIVES: This study aims to investigate the topics distribution trend and evaluate the characteristics of orthopedics and traumatology residency theses during a 20-year period using a bibliometric analysis. MATERIALS AND METHODS: Between January 2000 and December 2020, orthopedics and traumatology residency theses of all centers providing postgraduate education in Turkey were reviewed from the online application of the National Thesis Center of Higher Education Council. Using the advanced search screen, a total of 1,907 theses were reached. Massachusetts University Orthopaedics and Traumatology Fellowship Programs and Turkish Society of Orthopaedics and Traumatology sub-study groups. RESULTS: During the study period, the three most studied topics ones were orthopedic trauma (n=536; 28.1%), adult reconstruction and arthroplasty (n=301; 15.8%) and spine surgery (n=203; 10.6%). The least studied subject was bone and soft tissue tumors with 3.8% (n=73). The topic with the highest rate of publication in all years was again orthopedic trauma. There was a very strong positive (r=0.876) correlation between the total number of thesis publications and the years (p<0.001; R2=0.767). Based on institutions types, the number of theses published in the training and research hospitals increased as of 2016. More theses were published than expected on orthopedic trauma, adult reconstruction and arthroplasty, sports injuries and arthroscopy, shoulder and elbow surgery, foot and ankle surgery in the training and research hospitals (p=0.003). CONCLUSION: The orthopedic research trends were differentiated over the years in our country. The classification of the orthopedic thesis topics shows in which orthopedics subfield research subjects are concentrated in our country and in which fields, research is needed.

Effects of the COVID-19 pandemic on mental health (anxiety and depression symptoms) in the United States of America / Efectos de la pandemia por COVID-19 en la salud mental (síntomas de ansiedad y depresión) en Estados Unidos de América

Abstract Introduction: The COVID-19 pandemic has had a significant mental health impact in the United States of America and around the world. Objective: To assess some of the effects of the COVID-19 pandemic on the mental health of U.S. adult population, as well as the relationship between the average number of new COVID-19 cases and the average frequency of symptoms of anxiety, depression, and anxiety or depression between April 23 and October 26, 2020. Materials and methods: Retrospective study. Psychosocial and demographic data were obtained from the Household Pulse Survey community-based website. Data about the number of new COVID-19 cases detected in the USA during the study period were taken from the Our World in Data website. The Spearman's rank correlation coefficient was used to evaluate the strength of the relationships between the average of new COVID-19 cases during the study period and the average frequency of symptoms of anxiety, depression, and anxiety or depression. These correlations were also assessed in a subgroup analysis (sex, age group, education level, and ethnicity). Results: A total of 1 351 911 U.S. adults completed the survey. The average rates of depression, anxiety, and anxiety or depression symptoms were 25.711.6%, 31.912.0%, and 36.8±2.0%, respectively. The average number of new COVID-19 cases was positively correlated with the mean frequency of anxiety, depression, and anxiety or depression symptoms (r=0.858, r=0.710, and r=0.887; p<0.001). Likewise, positive correlations between the average number of new cases and the mean frequency of anxiety or depressive symptoms were found in the subgroups (r=0.484-0.917). Conclusions: According to our findings, the number of new COVID-19 cases detected during the study period in the USA was positively correlated with the frequency of anxiety or depression symptoms in the participants, that is, as the number of new cases increased, so did the frequency of the symptoms associated with these mental disorders.

Resumen Introducción. La pandemia por COVID-19 ha tenido un grave impacto en la salud mental tanto en Estados Unidos de América, como en todo el mundo. Objetivo. Evaluar algunos de los efectos de la pandemia por COVID-19 en la salud mental de la población adulta de Estados Unidos, así como la relación entre la media de nuevos casos de COVID-19 y la frecuencia promedio de síntomas de ansiedad, de depresión y de ansiedad o depresión entre el 23 de abril y el 26 de octubre de 2020. Materiales y métodos. Estudio retrospectivo. Los datos psicosociales y demográficos se obtuvieron del sitio web de la encuesta basada en la comunidad Household Pulse Survey y los datos sobre el número de nuevos casos de COVID-19 detectados en Estados Unidos durante el período de estudio, del sitio web Our Worldin Data. Se utilizó el coeficiente de correlación de Spearman para evaluar la fuerza de las correlaciones entre el promedio de casos nuevos de COVID-19 durante el período de estudio y la frecuencia promedio de síntomas de ansiedad, de depresión, y de ansiedad o depresión. Estas correlaciones también se evaluaron en un análisis de subgrupos (sexo, grupo de edad, nivel educativo y etnia). Resultados. En total, 1 351 911 adultos estadounidenses completaron la encuesta. Las tasas promedio de síntomas de depresión, de ansiedad, y de ansiedad o depresión fueron 25.711.6%, 31.912.0% y 36.812.0%, respectivamente. El promedio de nuevos casos de COVID-19 se correlacionó positivamente con la frecuencia media de síntomas de ansiedad, de depresión, y de ansiedad o depresión (r=0.858, r=0.710 y r=0.887; p<0.001). Asimismo, en el análisis de subgrupos se encontraron correlaciones positivas entre el número promedio de casos nuevos y la frecuencia media de síntomas de ansiedad o depresión r=0.484-0.917). Conclusiones. El número de casos nuevos de COVID-19 detectados durante el periodo de estudio en Estados Unidos se correlacionó positivamente con la frecuencia de síntomas de ansiedad o depresión en los participantes, es decir, a medida que el número de nuevos casos aumentaba, también lo hacía la frecuencia de los síntomas de estos trastornos mentales.