Peat-based amendment of soils reduces the complexity of the volatile profile in cultivated black truffles.

BACKGROUND: Truffle cultivation is evolving rapidly and new agronomic practices such as 'truffle nests' (localized peat amendments of the orchard soil) are being developed. Truffle nests improve the shape of truffles and their depth in the soil and reduce the occurrence of insect damage but have also raised concerns about their impact on the ripeness and maturity of the harvested truffles. In this study, the effect of the nests on the volatile organic compounds profile and the aromatic profile of black truffles was evaluated, as well as the existence of perceptible sensorial differences in truffles. For this, truffles growing in nests were compared with truffles growing in the bulk soil of the same host tree. RESULTS: Gas chromatography showed that nest truffles had a less complex volatile organic compound profile than bulk-soil truffles. Olfactometry indicated that nest truffles were associated with higher modified frequency values of odorants corresponding to sulfur-containing compounds. Despite this, sensory evaluation with consumers could not clearly show that nest truffles can be distinguished sensorially from bulk-soil truffles. CONCLUSION: The results prove that soil conditions can influence the aromatic profile of truffles and thus suggest the possibility of managing truffle aroma using agronomic practices. © 2024 The Author(s). Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Satisfaction and use of the didactic simulator for learning the nursing process: an observational study.

INTRODUCTION: The implementation of Information and Communication Technology (ICT) in daily healthcare practice has become standardized. In relation to education within the nursing degree, ICTs make it possible to carry out practical immersion training from the" classroom or from any other place with an Internet connection, as evidenced by circumstances that have occurred in recent years, such as the pandemic caused by COVID-19. OBJECTIVE: Design and assess a didactic simulation program for the training of the nursing process that promotes learning in the nursing care METHODOLOGY: The methodological approach is quantitative and it is a descriptive cross-sectional study. The sampling method used was non-probabilistic by convenience. RESULTS: When observing the comparison of the averages of student satisfaction with respect to the didactic simulator, it is worth mentioning that all the items are above 2.80 on a score in which "0" is the minimum value and "5" the maximum value. The results of the use of the computer tool by the students, we highlight as significant data that all the items present an average equal to or lower than 3.04 out of 7, where "1" corresponds to a lot of use and "7" to little use. CONCLUSION: The implication of ICT in the teaching-learning process among Nursing Degree students, it is considered optimal. when analyzing the answers obtained in the items that refer to a higher ease in the execution of development of Care plans, a fundamental work in Nursing performance.

Elaboration and Characterization of Novel Kombucha Drinks Based on Truffles (Tuber melanosporum and Tuber aestivum) with Interesting Aromatic and Compositional Profiles.

The organoleptic and bioactive properties of truffles place these fungi as interesting materials for use in the of design functional foods based on fruiting bodies outside commercial standards. Moreover, kombucha beverages have become more popular in the Western world, leading to novel drinks using alternative substrates instead of tea leaves. In this work, two truffle species (Tuber melanosporum, TMEL; Tuber aestivum, TAES) and three different symbiotic consortia of bacteria and yeasts (SCOBYs: SC1, SC2, and SC3) were tested. Fermentation (21 days) was monitored in terms of physicochemical (pH, viscosity), biochemical (total carbohydrates, alcohol, soluble proteins, phenolic compounds), and sensory attributes (volatile organic compounds, VOCs). The obtained pH ranges were adequate, alcohol levels were undetectable or very low, and sugar content was lower than in traditional kombuchas or other beverages. In most cases, the usual bottling time could be applied (7-10 days), although longer fermentations are recommended (14 days) to reach higher protein and phenolic compounds contents. Truffle kombuchas produced up to 51 volatile organic compounds (alcohols, acids, esters, ketones, and aldehydes, among others), with TMEL showing a more complex profile than TAES. During the first week, acidic compound production was observed, especially acetic acid. Similar behavior in the VOC profile was reported with different SCOBYs.

Black Truffle Aroma Evaluation: SPME-GC-MS vs. Sensory Experts.

Nowadays, the truffle aroma attribute is not included as a quality parameter in the current recommendation that explains the truffle quality (UNECE standard 53 FFV3) and establishes the truffle commercial categories. However, the aroma is the main reason why truffles are worldwide appreciated. Indeed, more than 30 aromatic molecules compose it, and this is the reason why the human evaluation and identification of these odorants, without previous training, is quite subjective. Analytical techniques such as gas chromatography techniques, however, can establish an aromatic profile and detect potential aromatic markers. In this study, 16 tasting experts were trained to make more objective the truffle aroma evaluation and odorants identification. For this, a comparison between solid-phase microextraction gas chromatography coupled with mass spectrometry (SPME-GC-MS) and sensory expert evaluation was carried out in six sessions during different harvesting times in the black truffle season (December, January, and February). Both techniques were able to separate truffles depending on the harvesting time. Also, a list of volatile organic compounds related to the aromatic attributes was reported. This information will help to provide a more objective T. melanosporum truffle sensory evaluation.

Comprehensive Characterization of Tuber maculatum, New in Uruguay: Morphological, Molecular, and Aromatic Analyses.

Although only a few species of Tuber account for the major truffle sales volume, many species that are not considered delicacies are finding their way to the market, especially in regions where the traditionally appreciated ones do not occur. This is the case for whitish truffles. Specimens of whitish truffles were collected in pecan (Carya illinoinensis) orchards in Uruguay in October 2021. Morphological and molecular methods were used to characterize and assess their identity as Tuber maculatum Vittad. An SPME extraction of volatile compounds and GC-MS analyses were performed to characterize the aromatic profile of these specimens and evaluate their potential applications. Among the 60 VOCs detected, 3-octenone (mushroom odor), 3-octanol (moss, nut, mushroom odor), and 2H-pyran-2-one (no odor), followed by octen-1-ol-acetate (no odor) and 2-undecanone (orange, fresh, green odor) were the major compounds in T. maculatum fruiting bodies. The attributes of exotic edible mushrooms of commercial value in the region are highlighted. In particular, this work emphasizes the characteristics of truffles as a byproduct of pecan cultivation.

Chronic Obstructive Lung Disease: Treatment Guidelines and Recommendations for Referral and Multidisciplinary Continuity of Care.

Chronic Obstructive Pulmonary Disease (COPD) constitutes a major public health problem, and it is anticipated that its prevalence will continue to increase in the future. Its progressive nature requires a continuous and well-coordinated care approach. The follow-up for COPD should primarily focus on disease screening and control, which includes monitoring of pulmonary function, prevention of exacerbations, identification of aggravating factors and comorbidities, as well as ensuring treatment adequacy and adherence. However, existing clinical practice guidelines and consensus documents offer limited recommendations for the follow-up. In this context, we undertake a review of COPD treatment and the continuity of care recommendations endorsed by several scientific societies. Moreover, we underscore the importance of the involvement of nursing and community pharmacy in this process, as well as the utilization of quality indicators in the provision of care for the disease.

Recomendaciones SER sobre el manejo de los pacientes con fibromialgia. Parte I: diagnóstico y tratamiento / Recommendations by the Spanish Society of Rheumatology on Fibromyalgia. Part 1: Diagnosis and Treatment

Objetivo: Evitar el deterioro de los pacientes con fibromialgia por actuaciones perjudiciales en la práctica clínica potencialmente evitables. Métodos: Un panel multidisciplinar de expertos identificó las áreas claves, analizó la evidencia científica y formuló las recomendaciones a partir de esta evidencia y de técnicas cualitativas de «evaluación formal» o «juicio razonado». Resultados: Se han elaborado 39 recomendaciones sobre diagnóstico, tratamientos no eficaces ni seguros, educación del paciente y formación del profesional. En esta parte I se reflejan las 27 primeras, referidas a las 2 primeras áreas. Conclusiones: Establecer el diagnóstico mejora el afrontamiento del paciente y reduce los costes sanitarios. Se deben evitar AINE, opioides mayores y benzodiacepinas por los efectos adversos. No existe una evidencia sólida que justifique la asociación de fármacos. Tampoco existe una buena evidencia para recomendar ningún tipo de terapia complementaria. Las cirugías muestran más complicaciones y un grado de satisfacción menor por el paciente por lo que deben evitarse si la indicación no está claramente establecida.(AU)

Objective: To prevent the impairment of fibromyalgia patients due to harmful actions in daily clinical practice that are potentially avoidable. Methods: A multidisciplinary team identified the main areas of interest and carried out an analysis of scientific evidence and established recommendations based on the evidence and “formal evaluation” or “reasoned judgment” qualitative analysis techniques. Results: A total of 39 recommendations address diagnosis, unsafe or ineffective treatment interventions and patient and healthcare workers’ education. This part I shows the first 27 recommendations on the first 2 areas. Conclusions: Establishing a diagnosis improves the patient's coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established.(AU)

Recomendaciones SER sobre el manejo de los pacientes con fibromialgia. Parte II: educación del paciente y formación de los profesionales / Recommendations by the Spanish Society of Rheumatology on the Management of Patients with Fibromyalgia. Part II

Objetivo: Evitar el deterioro de los pacientes con fibromialgia por actuaciones perjudiciales en la práctica clínica potencialmente evitables. Métodos: Un panel multidisciplinar de expertos identificó las áreas clave, analizó la evidencia científica y formuló las recomendaciones a partir de esta evidencia y de técnicas cualitativas de «evaluación formal» o «juicio razonado». Resultados: Se han elaborado 39 recomendaciones sobre diagnóstico, tratamientos no eficaces ni seguros, educación del paciente y formación del profesional. En esta parteII se reflejan las 12 recomendaciones, referidas a las dos últimas áreas. Conclusiones: Un buen conocimiento de la fibromialgia por el paciente mejora el afrontamiento y la aceptación de la enfermedad reduciendo la gravedad de algunas manifestaciones clínicas. Los profesionales sanitarios que tratan a los pacientes con fibromialgia deben tener una buena formación sobre esta enfermedad para mejorar los resultados del tratamiento y la relación con el paciente.(AU)

Objective: To prevent the deterioration of patients with fibromyalgia due to potentially avoidable harmful actions in clinical practice. Methods: A multidisciplinary panel of experts identified key areas, analysed the scientific evidence and formulated recommendations based on this evidence and qualitative techniques of «formal assessment» or «reasoned judgement». Results: Thirty-nine recommendations were made on diagnosis, ineffective and unsafe treatments, patient education and practitioner training. This partII shows the 12 recommendations, referring to the latter two areas. Conclusions: Good knowledge of fibromyalgia on the part of patients improves their coping and acceptance of the disease and reduces the severity of some clinical manifestations. Healthcare professionals treating patients with fibromyalgia should be well trained in this disease to improve treatment outcomes and patient relationships.(AU)

El eje intestino-cerebro en el trastorno por déficit de atención/hiperactividad: papel de la microbiota / The gut-brain axis in attention deficit hyperactivity disorder: the role of the microbiota

Introducción. El trastorno por déficit de atención/hiperactividad (TDAH) presenta una etiología compleja, atribuida principalmente a múltiples genes de susceptibilidad y factores ambientales. No obstante, los estudios genéticos de asociación han sido inconsistentes, identificando variantes genéticas de efecto moderado que explican una pequeña proporción de la heredabilidad estimada del trastorno (< 10%). Recientes estudios sugieren que la microbiota intestinal y la dieta desempeñan un papel importante en el desarrollo y los síntomas de diferentes trastornos mentales. Sin embargo, en la actualidad no existe una claridad absoluta al respecto. El presente proyecto propone un abordaje alternativo para identificar mecanismos a través de los cuales el ecosistema microbiano intestinal y la dieta podrían contribuir a la presencia del TDAH. Objetivo. Identificar biomarcadores para el TDAH a través del estudio de la microbiota intestinal. Sujetos y métodos. Estudio transversal de pacientes adultos con TDAH (n = 100) y de individuos control (n = 100). En ambos grupos se tomarán medidas de evaluación de TDAH y hábitos alimentarios. Se obtendrán muestras fecales para la extracción del ADN bacteriano, que permitirán caracterizar la microbiota intestinal de los participantes, para posteriormente realizar un estudio de asociación metagenómico e intentar correlacionar la composición bacteriana intestinal con subtipos clínicos del trastorno. Resultados y conclusiones. Se espera que la comparación de los perfiles de microbiota intestinal entre sujetos con TDAH y controles ayude a explicar la heterogeneidad clínica del trastorno e identificar nuevos mecanismos implicados en su desarrollo (AU)

Introduction. Attention deficit hyperactivity disorder (ADHD) has a complex aetiology, mainly attributed to a number of susceptibility genes and environmental factors. Genetic association studies, however, have been inconsistent and have identified genetic variants with a moderate effect that explain a small proportion of the estimated inheritability of the disorder (< 10%). Recent studies suggest that the gut microbiota and diet play an important role in the development and symptoms of different mental disorders. Nevertheless, no clear evidence exists on the issue. This project proposes an alternative approach to identify mechanisms by which the intestinal microbial ecosystem and diet could contribute to the presence of ADHD. Aim. To identify biomarkers for ADHD by examining the gut microbiota. Subjects and methods. We conducted a cross-sectional study of adult patients with ADHD (n = 100) and control subjects (n = 100). Measures of ADHD evaluation and eating habits were performed in both groups. Samples of faecal material were obtained from which to extract bacterial DNA, then used to characterise the participants’ gut microbiota. A metagenomics association study was later performed to attempt to correlate the bacterial composition of the intestine with the clinical subtypes of the disorder. Results and conclusions. Comparing the gut microbiota profiles of subjects with ADHD and controls is expected to help account for the clinical heterogeneity of the disorder and identify new mechanisms involved in its development (AU)

Validación al español de la ADHD Rating Scale (ADHD-RS) en adultos: relevancia de los subtipos clínicos / Spanish validation of the adult Attention Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS): relevance of clinical subtypes

Introducción. El trastorno por déficit de atención e hiperactividad (TDAH) tiene una prevalencia de entre el 2,5 y el 4% de la población general adulta. La Attention Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS) es una escala autoinformada de 18 ítems para la evaluación de los síntomas del TDAH en adultos. El objetivo del presente estudio es realizar la validación de la versión española de la ADHD-RS. Material y método. Se incluyó una muestra de 304 adultos con TDAH y 94 controles sanos sin TDAH. El diagnóstico de TDAH se evaluó con la Entrevista Clínica Estructurada para el DSM-IV (SCID-I) y la Entrevista Diagnóstica para TDAH en Adultos de Conners para el DSM-IV (CAADID-II). Para determinar la validez interna de la estructura de 2 dimensiones de la ADHD-RS se realizó un análisis factorial exploratorio. Los coeficientes α se realizaron como medida de la consistencia interna de las dimensiones consideradas. Mediante un estudio de regresión logística se evaluó el modelo en términos de especificidad, sensibilidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Resultados. La media de edad de los participantes fue de 33,29 años (DE=10,50), con un 66% de hombres (sin diferencias entre los 2 grupos). El análisis factorial se realizó con un análisis de componentes principales seguido de una normalización por la rotación varimax. La medida de Kaiser-Meyer-Olkin para el test de adecuación de muestras fue de 0,868 (notable) y el test de esfericidad de Bartlett fue 2 (153)=1.835,76, p<0,0005, indicando que el análisis factorial es adecuado. Este modelo de 2 factores explica el 37,8% de la varianza. El coeficiente α de los 2 factores es 0,84 y 0,82. La estrategia original proponía un punto de corte de 24: sensibilidad (81,9%), especificidad (74,7%), VPP (50,0%), VPN (93,0%), coeficiente kappa 0,78 y área bajo la curva (AUC) 0,89. La nueva estrategia de puntuación sugerida por nuestro grupo propone diferentes puntos de corte según las diferentes presentaciones clínicas de TDAH. El punto de corte para la presentación combinada de TDAH es 24: sensibilidad (81,9%), especificidad (87,3%), VPP (78,6%), VPN (89,4%), coeficiente kappa 0,88 y AUC 0,94, mientras que el punto de corte para la presentación predominante con falta de atención sería 21: sensibilidad (70,2%), especificidad (76,1%), VPP (71,7%), VPN (74,8%), coeficiente kappa 0,88 y AUC 0,94. Conclusiones. La versión española de la ADHD-RS es una escala válida para discriminar correctamente adultos con TDAH de personas sin TDAH. La nueva propuesta de puntuación sugiere la relevancia de las presentaciones clínicas en los diferentes puntos de corte seleccionados (AU)

Introduction. Adult attention deficit hyperactivity disorder (ADHD) has a prevalence between 2.5% and 4% of the general adult population. Over the past few decades, self-report measures have been developed for the current evaluation of adult ADHD. The ADHD-RS is a 18-items scale self-report version for assessing symptoms for ADHD DSM-IV. A validation of Spanish version of the ADHD-RS was performed. Material and method. The sample consisted of 304 adult with ADHD and 94 controls. A case control study was carried out (adult ADHD vs. non ADHD). The diagnosis of ADHD was evaluated with the Structured Clinical Interview for DSM-IV (SCID-I) and the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID-II). To determinate the internal validity of the two dimensions structure of ADHD-RS an exploratory factor analysis was performed. The α-coefficients were taken as a measure of the internal consistency of the dimensions considered. A logistic regression study was carried out to evaluate the model in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV). Results. Average age was 33.29 (SD=10.50) and 66% of subjects were men (there were no significant differences between the two groups). Factor analysis was done with a principal component analysis followed by a normalized varimax rotation. The Kaiser-Meyer-Olkin measure of sampling adequacy tests was .868 (remarkable) and the Bartlett's test of sphericity was 2 (153)=1,835.76, P<.0005, indicating the appropriateness of the factor analysis. This two-factor model accounted for 37.81% of the explained variance. The α-coefficient of the two factors was .84 and .82. The original strategy proposed 24 point for cut-off: sensitivity (81.9%), specificity (74.7%), PPV (50.0%), NPV (93.0%), kappa coefficient .78 and area under the curve (AUC) .89. The new score strategy proposed by our group suggests different cut-off for different clinical presentations. The 24 point is the best cut-off for ADHD combined presentation: sensitivity (81.9%), specificity (87.3%), PPV (78.6%), NPV (89.4%), kappa coefficient .88 and AUC .94, and 21 point is the best cut-off for ADHD predominantly inattentive presentation: sensitivity (70.2%), specificity (76.1%), PPV (71.7%), NPV (74.8%), kappa coefficient .88 and AUC .94. Conclusions. In this study, the Spanish version of the ADHD-RS is a valid scale to discriminate between ADHD adults and controls. The new proposed score strategy suggests the relevance of clinical presentations in the different cut-offs selected (AU)

Prevalence of impaired fasting glucose and type 1 and 2 diabetes mellitus in a large nationwide working population in Spain / Prevalencia de la glucemia alterada en ayunas, diabetes tipo 1 (DM1) y diabetes tipo 2 (DM2) en una población trabajadora en España

Introduction: To report the prevalence of impaired fasting glucose (IFG), undiagnosed and diagnosed diabetes, and their association to occupational categories in a representative sample of working population in Spain. Materials and methods: A cross-sectional study of workers who attended routine medical check-ups from January 2007 to December 2007. A structured questionnaire was completed, and physical examinations and routine serum biochemical tests were performed. IFG was defined as fasting glucose levels ranging from 100 to 125 mg/dl with no diagnosis of T1DM or T2DM; T1DM was defined as previous diagnosis of T1DM; and T2DM as previous diagnosis of T2DM, treatment with oral antidiabetic drugs or insulin or fasting glucose levels ≥126 mg/dl, according to ADA criteria. Results: Of the 371,997 participants (median age 35 [interquartile range 29-44] years), 72.4% were male. Raw prevalence rates (95% CI) of IFG, undiagnosed (UKDM), and previously known type 2 (KDM2) and type 1 (KDM1) diabetes were 10.4% (10.3-10.5%), 1.3% (1.2-1.3%), 1.1% (1.1-1.2%), and 0.3% (0.3–0.3%), respectively. With the exception of KDM1, prevalence of these conditions increased with age and was greater among manual/blue-collar workers (12.1%, 1.5%, 1.3% and 0.3%, respectively) as compared to non-manual/white-collar workers (7.3%, 0.8%, 0.8% and 0.3%, respectively). Age- and sex-adjusted prevalence rates of IFG, UKDM and KDM2 were 13.1%, 2.0% and 2.4%, respectively. Discussion: In this sample of Spanish working population, impaired glycemic profiles were common. Prevalence rates of IFG and T2DM were high among blue-collar workers (except for T1DM). These data emphasize the need for earlier structured preventive schemes (AU)

Objetivo: Describir la prevalencia de glucemia alterada en ayunas (GAA), diabetes no diagnosticada y diabetes, y su asociación con categorías profesionales en una muestra representativa de población trabajadora en España. Material y métodos: Estudio transversal en trabajadores que realizaron revisión médica entre enero y diciembre de 2007. Se realizó exploración física, análisis de sangre y se utilizó un cuestionario estructurado. Se definió GAA como glucosa en ayunas 100-125 mg/dl sin diagnóstico de diabetes tipo 1 (DM1) o diabetes tipo 2 (DM2); DM1 como diagnóstico previo de DM1; y DM2, según criterios ADA, como diagnóstico previo de DM2, tratamiento con antidiabéticos orales o insulina, glucosa en ayunas ≥ 126 mg/dl. Resultados: De los 371.997 participantes (mediana de edad 35 [rango intercuartílico 29-44] años), el 72,4% eran varones. La prevalencia (IC 95%) de GAA, diabetes no diagnosticada y DM2 y DM1 conocidas previamente fue del 10,4% (10,3-10,5%); 1,3% (1,2-1,3%); 1,1% (1,1-1,2%) y 0,3% (0,3-0,3%), respectivamente. Excepto para DM1, la prevalencia aumentó con la edad y fue mayor en trabajadores manuales (12,1; 1,5; 1,3; y 0,3% respectivamente) que en trabajadores no manuales (7,3; 0,8; 0,8; y 0,3% respectivamente). La prevalencia de GAA, diabetes no diagnosticada y DM2 ajustada por edad y sexo fue del 13,1, 2,0 y 2,4% respectivamente. Conclusiones: En esta muestra de población trabajadora en España, las alteraciones del perfil glucémico fueron frecuentes. En trabajadores manuales (excepto en DM1) las prevalencias de GAA y DM2 fueron mayores. Estos datos resaltan la necesidad de programas preventivos de intervención más temprana (AU)

Tratamiento del trastorno por déficit de atención/ hiperactividad en la edad adulta a través de la realidad virtual mediante un programa de mindfulness / Treatment of attention deficit hyperactivity disorder in adults using virtual reality through a mindfulness programme

Introducción. El trastorno por déficit de atención/hiperactividad (TDAH) es un trastorno del neurodesarrollo altamente prevalente, presenta una elevada comorbilidad con sintomatología afectiva y ansiosa, afecta a la funcionalidad de la persona que lo padece, tienen una baja adhesión terapéutica y genera unos costes sociales y personales elevados. El mindfulness es un tratamiento psicológico que ha demostrado ser eficaz para el TDAH. La realidad virtual es un tratamiento altamente utilizado en fobias y extendido a otras patologías con resultados positivos. Objetivo. Desarrollar el primer tratamiento con realidad virtual y mindfulness para el TDAH en la edad adulta, que suponga un aumento en la adhesión terapéutica y reduzca costes. Pacientes y métodos. Estudio piloto de 25 pacientes tratados con realidad virtual, mediante cuatro sesiones de 30 minutos, y 25 mediante psicoestimulantes. Se tomarán medidas de evaluación pretratamiento, postratamiento y postratamiento a los 3 y 12 meses, tanto de TDAH como de depresión, ansiedad, funcionalidad y calidad de vida. Se analizarán posteriormente con el programa SPSS v. 20 y se realizará un ANOVA de grupos independientes para ver las diferencias entre tratamientos y un test-retest para detectar el mantenimiento de los cambios. Resultados y conclusiones. Es necesaria la utilización de tratamientos que sean efectivos, supongan una reducción en los costes y un aumento en la adhesión terapéutica. El tratamiento con realidad virtual se plantea como una alternativa a los tratamientos clásicos, que sea más breve y atractiva para los pacientes (AU)

Introduction. Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder, which presents a high comorbidity with anxiety and affective signs and symptoms. It has repercussions on the functioning of those suffering from it, who also have low therapy compliance and generate a significant cost both at a personal level and for society. Mindfulness is a psychological treatment that has proved to be effective for ADHD. Virtual reality is widely used as treatment in cases of phobias and other pathologies, with positive results. Aims. To develop the first treatment for ADHD in adults based on virtual reality and mindfulness, while also resulting in increased treatment adherence and reduced costs. Patients and methods. We conducted a pilot study with 25 patients treated by means of virtual reality, in four 30-minute sessions, and 25 treated with psychostimulants. Measures will be taken pre-treatment, post-treatment and at 3 and 12 months post-treatment, to evaluate both ADHD and also depression, anxiety, functionality and quality of life. Data will be later analysed with the SPSS v. 20 statistical program. An ANOVA of independent groups will be performed to see the differences between treatments and also a test-retest to detect whether the changes will be maintained. Results and conclusions. It is necessary to use treatments that are effective, reduce costs and increase therapy adherence. Treatment with virtual reality is an interesting alternative to the classical treatments, and is shorter and more attractive for patients (AU)

Sesgos de confusión por indicación y gravedad en estudios observacionales / Confounding bias due to indication and severity in observational studies

Los estudios observacionales están sujetos a sesgos que pueden conducir a una interpretación errónea de los resultados. El presente estudio tuvo como objetivo determinar la influencia del tratamiento con omeprazol sobre la duración de la baja laboral en pacientes con esguince de tobillo que tomaban antiinflamatorios no esteroideos. Se utilizaron los registros de la base de datos de la mutua Ibermutuamur. Encontra de lo esperado, se observó que los pacientes que recibieron omeprazol presentaron una baja más prolongada que los que no recibieron omeprazol. Es probable que estos hallazgos se deban a la influencia de un sesgo de confusión por gravedad, pues los pacientes que recibieron omeprazol presentaban un esguince más grave, aunque no se puede descartar un sesgo de confusión por indicación. Para evitar la influencia de estos errores sistemáticos se deben controlar los sesgos a lo largo de todo el estudio, desdeel diseño hasta el análisis de los datos (AU)

Observational studies are subject to biases that may lead to mis interpretation of the results. This studyaimed to determine the influence of omeprazole treatment on the duration of sick leave in patients with ankle sprains treated with non-steroidal anti-inflammatory drugs. We used the Ibermutuamur database. Contrary to our expectations, sick leave was longer in patients who received omeprazole than in those who did not. These findings were probably due to the influence of a bias due to confounding by severity,given that patients who received omeprazole had a worse kind of ankle sprain; however, a bias due to confounding by indication cannot be excluded. To avoid the influence of these systematic errors, biases should be monitored from the design stage to the data analysis stage (AU)

Neumopericardio tardío tras pericardiocentesis / Late pneumopericardium after pericardiocentesis

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