Internalizing and externalizing symptoms and suicidal behaviour in young people: a systematic review and meta-analysis of longitudinal studies.

OBJECTIVE: To assess internalizing and externalizing symptoms as risk factors for suicidal behaviour and suicide among adolescents and young adults. METHOD: We conducted a systematic review of articles published until January 2017. We identified 26 883 potential papers; 1701 full-text articles were assessed for eligibility, of which 1479 were excluded because of methodological reasons. Diverse meta-analyses were performed for each group of symptoms. Odds ratios (ORs) and 95% confidence intervals (95% CI) or beta coefficients for categorical variables, and effect size (ES) were calculated for continuous variables. RESULTS: Finally, 41 studies were included, involving participants aged 12-26 years for a systematic review, and 24 articles were included for meta-analysis. The meta-analysis showed that youths with any internalizing (ES = 0.93) or externalizing symptoms (ES = 0.76 and OR = 2.59) were more likely to attempt suicide in future. This effect was also seen in depression symptoms (OR = 6.58 and ES = 1.00), legal problems (OR = 3.36), and anxiety (ES = 0.65). CONCLUSION: Reported internalizing and externalizing symptoms are predictors of suicide behaviour in young people; therefore, the detection and management of these symptoms in young populations could be a crucial strategy for preventing suicidality in this group.

Sexual orientation and suicidal behaviour in adolescents and young adults: systematic review and meta-analysis.

BackgroundResearch suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors.AimsTo assess sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults.MethodA systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12-26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis.ResultsSexual orientation was significantly associated with suicide attempts in adolescents and youths (OR = 2.26, 95% CI 1.60-3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR = 2.21, 95% CI 1.21-4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups.ConclusionsSexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population.

Exposure to violence, a risk for suicide in youths and young adults. A meta-analysis of longitudinal studies.

OBJECTIVE: To assess the association and magnitude of the effect of early exposure to different types of interpersonal violence (IPV) with suicide attempt and suicide death in youths and young adults. METHOD: We searched six databases until June 2015. Inclusion criteria were as follows: (1) assessment of any type of IPV as risk factor of suicide attempt or suicide: (i) child maltreatment [childhood physical, sexual, emotional abuse, neglect], (ii) bullying, (iii) dating violence, and (iv) community violence; (2) population-based case-control or cohort studies; and (3) subjects aged 12-26 years. Random models were used for meta-analyses (Reg: CRD42013005775). RESULTS: From 23 682 articles, 29 articles with 143 730 subjects for meta-analyses were included. For victims of any IPV, OR of subsequent suicide attempt was 1.99 (95% CI: 1.73-2.28); for child maltreatment, 2.25 (95% CI: 1.85-2.73); for bullying, 2.39 (95% CI: 1.89-3.01); for dating violence, 1.65 (95% CI: 1.40-1.94); and for community violence, 1.48 (95% CI: 1.16-1.87). Young victims of IPV had an OR of suicide death of 10.57 (95% CI: 4.46-25.07). CONCLUSION: Early exposure to IPV confers a risk of suicide attempts and particularly suicide death in youths and young adults. Future research should address the effectiveness of preventing and detecting early any type of IPV exposure in early ages.

What do Spaniards read about the prudent use of anti-microbial agents and what do they really do?

OBJECTIVES: The prudent use of antibiotics (PUA) is promoted not only by public information campaigns, but also in the printed media and on websites. This study assesses the correspondence between PUA information in the Spanish printed media and on websites and the messages put out by national campaigns. Spaniards' use of antibiotics following the campaigns was also analysed. METHODS: A two-phase descriptive study was carried out. First, antibiotics-related news in the Spanish printed media (January 2007-May 2009) and institutional and news media websites (March-May 2009) were systematically reviewed using a data collection tool. In addition, a telephone survey on antibiotics-related knowledge and behaviours was carried out with a random sample of 1526 people living in Spain who had recently received medical care. RESULTS: In total, 29 news items containing nine different messages were identified. All the messages were similar to those promoted by the campaigns. The survey showed that even after the campaigns, relevant gaps in knowledge about the PUA persist, particularly among men (p = .005), those living in rural areas (p = .02) and the elderly (p < .001). Keeping left-over antibiotics was associated with ignorance about the association between antibiotic use and resistance (OR 3.1, 95% CI 2.3-4.2). Also, patients who ask their doctor about drug interactions are less likely to self-medicate (p = .04). CONCLUSIONS: The information reaching the Spanish public via the media seems to be similar to the messages transmitted by public information campaigns. Nevertheless, there appears to be considerable room for improvement. Promoting an active role in patients might reduce self-medication.

Satisfaction with hospital care at the end of life. / Satisfacción con la atención hospitalaria al final de la vida.

OBJECTIVES: To determine the satisfaction of relatives of deceased patients with the care received in a palliative care unit (PCU) and compare it with cases in which a team with specific psychological care were not involved. MATERIAL AND METHODS: An anonymous survey (n=202) was administered to the relatives (response rate, 42.1%), which evaluated 9 issues related to the process of dying and the overall assessment of the care. RESULTS: The overall satisfaction was high (mean score of 9.22); the score for the full team was 9.40, while that of the team without the psychologist was 8.40 (P=.005). The items that scored highest were "team availability", "information received" and "assistance for facing the disease", followed by "pain control", "peaceful death", "assistance for patient-family communication", "grief support" and "quality of life". CONCLUSIONS: Based on the relatives' assessment, the hospital PCU teams help increase the quality of care at the end of life.

Effect of growth temperature and pH on the aminopeptidase activity of Pseudomonas putida, P. fluorescens and Flavobacterium odoratum; the 4-nitroaniline test is reliable.

No significant difference (p > 0.05) was observed in the specific aminopeptidase activity (SAA) developed by Pseudomonas fluorescens, P. putida and Flavobacterium odoratum either growing at pH 5.0-6.5 or at 7 and 12 degrees C. Nevertheless, a significant difference was found when comparing the SAA of these organisms. The SAA of F. odoratum was lower than those of pseudomonads. The 4-nitroaniline test is reliable to estimate the G(-) load of fresh food products.

Use and dependence on opioid drugs in the Spanish population with chronic pain: Prevalence and differences according to sex. / Uso y dependencia de fármacos opioides en población española con dolor crónico: prevalencia y diferencias de género.

OBJECTIVES: To analyse the prevalence in the use and dependence on opioid drugs in the Spanish population with chronic pain and evaluate the differences according to sex. PATIENTS AND METHODS: The demographic variables, opioid treatment characteristics and use of other substances were assessed in 229 users of opioid drugs. A descriptive bivariate analysis of the data was performed. RESULTS: Forty-six percent of the patients met the criteria of dependence on opioid drugs (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV-TR]). Alcohol and cannabis consumption was greater in the men. The rates of dependence on the use of opioid drugs were significantly higher in the extended treatments. CONCLUSIONS: Planning for treatments with opioids and strategies for preventing inappropriate use should not depend on the patient's sex. We need further studies on the medical and psychological variables related to the use of and dependence on opioids.

[Changes in quality of life in patients undergoing bariatric surgery following 24-months: comparison between gastric bypass and tubular vertical gastrectomy]. / Evolución de la calidad de vida a los 24 meses de seguimiento en pacientes sometidos a cirugía bariátrica: comparación entre el bypass gástrico y la gastrectomía vertical tubular.

BACKGROUND: Bariatric surgery has become the procedure of choice to deal with morbid and super-morbid obesity, with the greatest chance of success. The objectives of this study were: a) to analyse the evolution of the percentage of excess BMI lost (PEBMIL) and quality of life in the medium and long term after bariatric surgery; b) to evaluate the differences in PEBMIL and quality of life according to the surgical technique performed; and c) examine the relationship between PEBMIL and quality of life. METHODS: One hundred and ninety-one subjects participated in the present study, undergoing bariatric surgery with follow-up at 12 and 24 months after surgery. The SF-36 and OP-53 questionnaires were administered to assess the quality of life after surgery. RESULTS: There was a statistically significant reduction in the percentage of excess BMI lost at 12 and 24 months; and a significant improvement in quality of life at 12 months, which remained stable at 24 months for most variables. Taking into account the surgical technique, those undergoing gastric bypass surgery show a greater loss of PEBMIL at 12 and 24 months, and significant improvement at one year of evaluation in most of the dimensions that measure quality of life with respect to the tubular vertical gastrectomy technique. CONCLUSION: Bariatric surgery is effective in reducing the excess of BMI lost and significantly improving the quality of life of morbidly obese patients in the long term. Key words. Bariatric surgery. Quality of life. Morbid obesity.

Longitudinal association between self-injurious thoughts and behaviors and suicidal behavior in adolescents and young adults: A systematic review with meta-analysis.

BACKGROUND: Adolescents with previous self-injurious thoughts and behaviors (SITB) have over 2-fold risk of dying by suicide, higher than older ages. This meta-analysis aims to disentangle the association of each SITB with subsequent suicidal behavior in adolescence/young adulthood, the contribution of each SITB, and the proportion of suicide deaths with no previous suicide attempt. METHODS: We searched 6 databases until June 2015. INCLUSION CRITERIA: 1. Assessment of any previous SITB [a) suicidal thoughts and behaviors (ideation; threat/gesture; plan; attempt); b) non-suicidal thoughts and behaviors (thoughts; threat/gesture; self-injury); c) self-harm] as a risk factor of suicide attempt or suicide death; 2. Case-control or cohort studies; 3. Subjects aged 12-26y. Random effect models, metaregression analyses including mental health and environmental variables, and population attributable risks (PAR)s were estimated. RESULTS: From 23,682 potentially eligible articles, 29 were included in the meta-analysis (1,122,054 individuals). While 68% of all youth suicide deaths had no previous suicide attempt, suicide death was very strongly associated with any previous SITB (OR=22.53, 95%CI: 18.40-27.58). Suicide attempts were also associated with a history of previous SITB (OR=3.48, 95%CI: 2.71-4.43). There were no moderating effects for mental health and environmental features. The PAR of previous SITB to suicide attempts is 26%. LIMITATIONS: There is considerable heterogeneity between the available studies. Due to limitations in the original studies, an over-estimation of the proportion dying at their first attempt cannot be ruled out, since they might have missed unrecognized previous suicide attempts. CONCLUSIONS: Although more than two thirds of suicide deaths in adolescence/young adulthood have occurred with no previous suicidal behavior, previous SITBs have a much higher risk of dying by suicide than previously reported in this age group.

[Communication skills: a preventive factor in Burnout syndrome in health professionals]. / Las habilidades de comunicación como factor preventivo del síndrome de Burnout en los profesionales de la salud.

BACKGROUND: Health professionals are a group that suffers high levels of job stress and burnout. The aim of this study is to demonstrate empirically that the healthcare count on communication skills helps prevent Burnout Syndrome. METHOD: An observational, analytical, cross-sectional study was proposed, involving a sample of 927 health professionals (197 doctors, 450 nurses and 280 auxiliary nurses). Participants completed questionnaires measuring communication skills in health care (EHC-PS) and the Maslach Burnout Inventory Human Services Survey (MBI-HSS). RESULTS: A negative and statistically significant correlation between the different dimensions of communication skills and emotional exhaustion and depersonalization dimensions of burnout was obtained. On the other hand, a positive and statistically significant correlation between the dimensions of communication skills and the personal accomplishment dimension of burnout was observed. CONCLUSIONS: It was shown that the communication skills of health professionals provide protection from and cushion Burnout Syndrome.

Quality of life of the Spanish burn patient.

This is a study of the quality of life as performed on a sample of 115 Spanish patients treated for burns in the Burn Care Unit of the Alicante General Hospital. Through the application of the sole existing scale for measuring quality of life specific to burn patients, the following percentages of alterations were obtained: 9.7% in physical domains; 14.2% in body image; 27.4% in psychological domains; and 22.5% for the complete scale. Results similar to those published by the original authors of the scale have been encountered by us and we are now able to confirm that the questionnaire "adapted and validated" in Spanish is equally capable of measuring changes in quality of life of the group studied herein.

Health Psychology 2000:The Development of Professional Health Psychology: European Federation of Professional Psychologists' Associations (EFPPA) Task Force on Health Psychology Final Report.

This Final Report of the European Federation of Professional Psychologists' Associations (EFPPA) Task Force on Health Psychology defines the nature and scope of health psychology and its possible future development to the year 2000 and beyond. Training needs and objectives are specified for professional health psychologists working in Europe. Practical and policy implications of medical progress and societal changes are discussed. The future development of health psychology as a profession depends on putting theory and policy into practice through the implementation of high quality training. Currently there are relatively few European countries where this has yet happened. Training programmes need to be introduced in all European countries within the framework of each member- country's national laws, regulations and practices.

Doctors' decision-making on giving information to cancer patients.

A major focus in the literature about doctor-patient communication is information-giving. In the case of cancer patients, one significant issue is which factors determine whether and how, general practitioners and oncologists give information to their patients. Whatever may be the content of information, the most important choice for the doctor is to give information or not. Our research group at the Department of Health Psychology has conducted investigations in order to identify the significant determinants of decisions concerning giving information to cancer patients. A sample of 60 doctors from Alicante province in Spain were asked their criteria for giving information about a cancer diagnosis. Results showed that perceived intelligence and emotional control in the patients were the best predictors of the decision by doctors to give information. Age and socio-economic status were also significantly associated with the doctors' information-giving practices. These data suggest that the criteria for giving information to cancer patients are subjective and show a strong cultural influence.

[The perceived quality of hospital care]. / Calidad percibida del cuidado hospitalario.

INTRODUCTION: SERVQUAL has been introduced in the healthcare sector as an alternative to the patient satisfaction measures. SERVQUAL is one of the most used questionnaires to measure the customers' perceived quality. It is based on the disconfirmation paradigm (expectations-minus-perceptions). However, the structure, validity and reliability of this questionnaire have not been assessed in the Spanish hospital context. METHODS: Three main targets defined in this study: 1) analyze the SERVQUAL's factorial solution, 2) determine which of its scales (perceptions, expectations, and expectations-minus-perceptions) has higher predictive efficiency, and 3) develop a new version for hospital setting (which was called SERVQHOS). A descriptive study based on surveys with multivariate analysis of data was conducted. Eight-hundred-twenty-six subjects were interviewed. All were attended in the Alicante's, Elche's, or Elda's hospital. RESULTS: A five-factor solution of the SERVQUAL was not corroborated. The perceptions scale obtained a higher predictive efficiency than expectations and expectations-minus-perceptions scales. Four factors were identified using SERVQHOS (56% explained variance). Perceptions-SERVQHOS gathered a greater predictive capacity that the scores derived from the difference among expectations and perceptions. This result was obtained in both criteria: patient satisfaction (55% explained variance) and whether the respondents would recommend the hospital (76.36% right classifications with respect to response levels of the criterion). CONCLUSIONS: Before using SERVQUAL is highly recommended to realize a validation procedure of this questionnaire. SERVQHOS has shown adequate reliability and validity. However, there were some methodological problems using it. The most important inconvenience was that perceptions' scores showed greater predictive capacity than expectations-minus-perceptions.

[What do patients think of public hospitals? Analysis of the perceived quality levels of 5 hospitals]. / Qué opinan los pacientes de los hospitales públicos? Análisis de los niveles de calidad percibida en cinco hospitales.

OBJECTIVE: To compare the opinions of patients assisted in 5 hospitals. DESIGN: Descriptive study based in a survey by mail has been used in all cases. INSTRUMENTS: The SERVQHOS questionnaire. SUBJECTS: 930 patients. Answer rate around 35%. RESULTS: 19% of the patients would not recommend the hospital. 59.2% was shown satisfied and 3.1% very unsatisfied. To know the doctor's and nurse's name were related to perceived quality. The frequency with which the patients said to have been correctly informed was not related to quality. Neither age nor patient's sex showed a relationship with perceived quality. CONCLUSION: The patients value the hospital positively although there are an important number of unsatisfied patients.

Calidad de vida en pacientes sometidos a cirugía bariátrica: evolución y determinantes / Quality of life in patients undergoing bariatric surgery: evolution and determinants

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[Measuring patient satisfaction and identifying opportunities for improvement in the preparation of bariatric surgery patients]. / Medida de la satisfacción del paciente e identificación de oportunidades de mejora en la preparación de pacientes de cirugía bariátrica.

OBJECTIVE: To evaluate the satisfaction of patients candidates for bariatric surgery with the performance of a group training program prior to surgery, identifying opportunities for improvement in the program and evaluating participants satisfaction following their implementation. METHOD: An "ad hoc" designed survey was used, addressed to assess opinions on different aspects of the program, overall satisfaction and identification of areas for improvement. The survey was administered to two groups of patients: the first after one year of implementation of the program to identify suggestions for improvement, and the second after one year of the implementation of the improvement. A total of 112 patients were assessed, 66 in the first pass of the questionnaire and 46 in the second. Both groups were homogeneous in demographic variables RESULTS: The main improvement detected was expert patients in the preparation of the program. After implantation, slight changes in the ratings of the questions were produced, that were not significant. Overall satisfaction rose from 9.5 to 9.74 out of 10. The other proposals for improvement were to improve audiovisuals and to fit the room furniture to the characteristics of the patients. CONCLUSIONS: The very high satisfaction levels obtained are usual in studies on hospital satisfaction, our results still being above the studies consulted, as well as in levels of excellence. This prevents statistically significant differences being found. There were no significant differences in the results before and after implementation of improvement. Continuous assessment allows new possibilities for improvement.

Evolución de la calidad de vida a los 24 meses de seguimiento en pacientes sometidos a cirugía bariátrica: comparación entre el bypass gástrico y la gastrectomía vertical tubular / Changes in quality of life after 24 months in patients undergoing bariatric surgery: comparison between gastric bypass and tubular vertical gastrectomy

Fundamento: La cirugía bariátrica se ha convertido en el procedimiento de elección para afrontar, con las mayores posibilidades de éxito, los casos de obesidad mórbida y super-mórbida. Los objetivos de este estudio son: a) analizar la evolución del porcentaje del exceso de índice de masa corporal perdido (PEIMCP) y la calidad de vida a medio y largo plazo tras la cirugía bariátrica; b) evaluar las diferencias en PEIMCP y calidad de vida en función de la técnica quirúrgica realizada; y c) examinar la relación entre PEIMCP y la calidad de vida. Material y métodos: Han intervenido en el estudio 191 sujetos intervenidos de cirugía baríátrica con seguimiento a los 12 y 24 meses tras la cirugía. Se administraron los cuestionarios SF-36 y OP-53 para evaluar la calidad de vida tras la cirugía de manera autoinformada. Resultados: Se observa una reducción del porcentaje del exceso de índice de masa corporal (IMC) perdido estadísticamente significativa a los 12 y 24 meses y una mejora significativa en la calidad de vida a los 12 meses, que se mantuvo estable a los 24 meses para la mayoría de las variables. Los pacientes intervenidos mediante bypass gástrico muestran una mayor pérdida de PEIMCP a los 12 y 24 meses, y mejora significativa al año de evaluación en la mayoría de las dimensiones que miden calidad de vida con respecto a la técnica de gastrectomía vertical tubular. Conclusión: La cirugía bariátrica es eficaz para disminuir el porcentaje del exceso de IMC perdido y mejorar significativamente la calidad de vida de los pacientes con obesidad mórbida a largo plazo (AU)

Background: Bariatric surgery has become the procedure of choice to deal with morbid and super-morbid obesity, with the greatest chance of success. The objectives of this study were: a) to analyse the evolution of the percentage of excess BMI lost (PEBMIL) and quality of life in the medium and long term after bariatric surgery; b) to evaluate the differences in PEBMIL and quality of life according to the surgical technique performed; and c) examine the relationship between PEBMIL and quality of life. Methods: One hundred and ninety-one subjects participated in the present study, undergoing bariatric surgery with follow-up at 12 and 24 months after surgery. The SF-36 and OP-53 questionnaires were administered to assess the quality of life after surgery. Results: There was a statistically significant reduction in the percentage of excess BMI lost at 12 and 24 months; and a significant improvement in quality of life at 12 months, which remained stable at 24 months for most variables. Taking into account the surgical technique, those undergoing gastric bypass surgery show a greater loss of PEBMIL at 12 and 24 months, and significant improvement at one year of evaluation in most of the dimensions that measure quality of life with respect to the tubular vertical gastrectomy technique. Conclusion: Bariatric surgery is effective in reducing the excess of BMI lost and significantly improving the quality of life of morbidly obese patients in the long term (AU)

["Good practices" and patient satisfaction]. / "Buenas prácticas" y satisfacción del paciente.

OBJECTIVE: The Patient Autonomy Act should contribute to a "patient-centred" health care. The study objectives were to determine to what extent patients believe that their basic rights under the LAP (best practices) are being met. Secondly, to study the relationship between this performance and reported patient satisfaction levels. MATERIALS & METHODS: A total of 13,773 patients were interviewed (31.7% >60 years and 53.6% women) receiving health care at 21 Spanish public hospitals. The number of "good practices" (GP) was analysed using descriptive statistics; relationship between GP and satisfaction was measured using logistic regression. RESULTS: The medical discharge information was one of the most established practices. The compliance level ranged from 97.4% of parents of children over 6 years in paediatric service and 76.2% of patients attending obstetric services. The welcome process (Odds Ratio 3.53, IC-95% CI; 1.95-6.41, P<0.001), informed consent (Odds Ratio 2.77, 95% CI; 1.40-5.47), to recognize which type of professional was providing care at all the times (Odds Ratio 3.36, 95% CI; 1.96-5.78), were the aspects that increased probability that the patient felt satisfied. CONCLUSIONS: Compliance to patient rights was increased in all services analysed. When these rights are respected patient satisfaction increases.