Mixed methods assessment of personal heat exposure, sleep, physical activity, and heat adaptation strategies among urban residents in the Boston area, MA.

The growing frequency, intensity, and duration of extreme heat events necessitates interventions to reduce heat exposures. Local opportunities for heat adaptation may be optimally identified through collection of both quantitative exposure metrics and qualitative data on perceptions of heat. In this study, we used mixed methods to characterize heat exposure among urban residents in the area of Boston, Massachusetts, US, in summer 2020. Repeated interviews of N = 24 study participants ascertained heat vulnerability and adaptation strategies. Participants also used low-cost sensors to collect temperature, location, sleep, and physical activity data. We saw significant differences across temperature metrics: median personal temperature exposures were 3.9 °C higher than median ambient weather station temperatures. Existing air conditioning (AC) units did not adequately control indoor temperatures to desired thermostat levels: even with AC use, indoor maximum temperatures increased by 0.24 °C per °C of maximum outdoor temperature. Sleep duration was not associated with indoor or outdoor temperature. On warmer days, we observed a range of changes in time-at-home, expected given our small study size. Interview results further indicated opportunities for heat adaptation interventions including AC upgrades, hydration education campaigns, and amelioration of energy costs during high heat periods. Our mixed methods design informs heat adaptation interventions tailored to the challenges faced by residents in the study area. The strength of our community-academic partnership was a large part of the success of the mixed methods approach.

Effect of Cognitive-Behavioral Therapy on Nocturnal Autonomic Activity in Patients with Fibromyalgia: A Preliminary Study.

Objective: fibromyalgia is a complex chronic pain syndrome characterized by widespread musculoskeletal pain, insomnia and autonomic alterations. Cognitive-behavioral therapy (CBT) is regarded as a promising treatment in fibromyalgia, but its impact on autonomic function remains uncertain. In this research, we studied the effect of CBT on autonomic functions in fibromyalgia. Methods: Twenty-five participants underwent overnight polysomnographic recordings before and after CBT programs focused on pain (CBT-P) or a hybrid modality focused on pain and insomnia (CBT-C). Sleep quality, daily pain, depression and anxiety were assessed by self-reported questionnaires. We analyzed heart rate variability (HRV) using high-frequency power (HF) as a marker for parasympathetic activity, and low-frequency power (LF) and the LF/HF ratio as relative sympathetic markers during wakefulness and at each sleep stage. Results: After treatment, 14 patients (/25, 58.0%) reported improvement in their sleep: 6 in the CBT-P condition (/12, 50%), and 8 in the CBT-C condition (/13, 61.5%). We found that, regardless of the type of CBT, patients who reported improvement in sleep quality (n = 14, 58%) had an increase in HF during stages N2 (p < 0.05) and N3 (p < 0.05). These changes were related to improvement in sleep quality (N2, r = −0.43, p = 0.033) but not to pain, depression or anxiety. Conclusions: This study showed an improvement in parasympathetic cardiac control during non-rapid-eye-movement sleep following CBT in fibromyalgia participants who reported better sleep after this therapy. CBT may have a cardio-protective effect and HRV could be used as a sleep monitoring tool in fibromyalgia.

Fibromyalgia as a Heterogeneous Condition: Subgroups of Patients Based on Physical Symptoms and Cognitive-Affective Variables Related to Pain.

Fibromyalgia (FM) is a chronic syndrome characterized by heterogeneous clinical manifestations, and knowing this variability can help to develop tailored treatments. To understand better the heterogeneity of FM the present cross-sectional study analyzed the role of several physical symptoms (pain, fatigue and poor sleep quality) and cognitive-affective variables related to pain (pain catastrophizing, pain vigilance, self-efficacy in pain management, and pain acceptance) in the configuration of clinical profiles. A sample of 161 women with FM fulfilled an interview and several self-report measures to explore physical symptoms, cognitive-affective variables, disability and psychopathology. To establish FM groups a hierarchical cluster analysis was performed. The findings revealed three clusters that differed in the grouping variables, Wilks' λ = .17, F(14, 304) = 31.50, p < .001, ηp2 = .59. Group 1 (n = 72) was characterized by high physical and psychological affectation, Group 2 (n = 19) by low physical affectation and high pain self-efficacy, and Group 3 (n = 70) by moderate physical affectation and low pain catastrophizing. The external validation of the clusters was confirmed, Wilks' λ = .72, F(4, 314) = 14.09, p < .001, ηp2 = .15, showing Group 1 the highest levels of FM impact and psychopathological distress. Considering the distinctive clinical characteristics of each subgroup therapeutic strategies addressed to the specific needs of each group were suggested. Assessing FM profiles may be key for a better understanding and approach of this syndrome.

Psychopathology as a Moderator of the Relationship Between Physical Symptoms and Impairment in Fibromyalgia Patients / Psicopatología Como Moderador de la Relación Entre Síntomas Físicos y Discapacidad en Pacientes con Fibromialgia

Background: Fibromyalgia (FM) is a chronic pain syndrome that is accompanied by notable psychological distress. However, little research has been done on how the psychopathological profi le of FM patients may infl uence their functional status. Method: Using the Symptom Checklist90-Revised the study examined the psychopathological dimensions of 181 women with FM, and the role of psychopathology as a moderator of the relationship between physical symptoms and impairment of functioning. Results: FM patients exhibited T-scores above the cutoff point (≥ 60) in all dimensions, and 76.2% were identifi ed as “clinical cases”. Somatization was a signifi cant predictor of pain intensity, somatization and obsessioncompulsion contributed signifi cantly to predicting poor sleep quality, while somatization, depression and anxiety were signifi cant predictors of impairment. Psychopathology was a statistically signifi cant moderator that increased the impact of poor sleep quality on impairment. Conclusions: The dysfunctional psychological style is key in the impairment associated with FM. The evaluation of psychopathological profi les can allow the early identifi cation of the patients who are most vulnerable to impaired functioning due to the presence of possible psychopathology, as well facilitating therapeutic adaptations. (AU)

Antecedentes: la fibromialgia (FM) es un síndrome de dolor crónico que se acompaña de importante malestar psicológico. Sin embargo, se ha investigado poco cómo el perfi l psicopatológico de los pacientes con FM puede infl uir en su estado funcional. Método: utilizando el Cuestionario de Síntomas-90- Revisado, se examinaron las dimensiones psicopatológicas de 181 mujeres con FM, y el papel de la psicopatología como moderador de la relación entre síntomas físicos y deterioro del funcionamiento. Resultados: las pacientes presentaron puntuaciones-T superiores al punto de corte (≥ 60) en todas las dimensiones, siendo el 76,2% de ellas identifi cadas como “caso clínico”. La somatización fue un predictor signifi cativo de la intensidad del dolor, la somatización y la obsesión-compulsión contribuyeron signifi cativamente a predecir la mala calidad del sueño, y la somatización, la depresión y la ansiedad fueron predictores signifi cativos del deterioro. La psicopatología fue un moderador estadísticamente signifi cativo que intensifi có el impacto de la mala calidad del sueño sobre el deterioro. Conclusiones: el estilo psicológico disfuncional es clave en el deterioro asociado a la FM. La evaluación del perfil psicopatológico puede permitir la identifi cación precoz de los pacientes más vulnerables al deterioro funcional debido a la presencia de posible psicopatología, así como facilitar las adaptaciones terapéuticas. (AU)

Combined cognitive-behavioral therapy for fibromyalgia: Effects on polysomnographic parameters and perceived sleep quality / Terapia cognitivo-conductual combinada para la fibromialgia: efectos sobre parámetros polisomnográficos y calidad del sueño percibida

BACKGROUND/OBJECTIVE: Cognitive-behavioral therapy (CBT) is one of the first-line treatments in the management of fibromyalgia (FM) and it has been applied with considerable success to treat the psychological processes associated with pain and insomnia. We hypothesized that treating sleep and pain jointly with new combined modalities of CBT may offer greater sleep-related benefits to patients. METHOD: Thirty-nine female patients with FM and insomnia were randomly allocated to receive CBT centered on pain (CBT-P) or combined CBT focused on pain and insomnia (CBT-C). Participants were assessed at baseline and post-treatment with the Pittsburgh Sleep Quality Index and an ambulatory polysomnography. RESULTS: Participants who received CBT-P showed increases in time in bed and total sleep time and decreases in light sleep, but there was no improvement in perceived sleep quality. Participants who received combined CBT-C showed more meaningful improvements related to refreshing sleep (i.e., higher sleep efficiency and less time awake and longer time in Stage 4 sleep), and these changes were concordant with a significant improvement in self-perceived sleep quality. CONCLUSIONS: This study suggests that new CBT-C approaches can improve insomnia-related clinical aspects

ANTECEDENTES/OBJETIVO: La terapia cognitivo-conductual (TCC) es un tratamiento de primera línea para abordar la fibromialgia (FM) que se ha aplicado con cierto éxito para el tratamiento del dolor y el insomnio. Se hipotetiza que intervenir sobre el sueño y el dolor con una modalidad combinada de TCC (TCC-C) puede mejorar el sueño de estos pacientes. MÉTODO: Treinta y nueve mujeres con FM e insomnio fueron aleatorizadas para recibir TCC centrada en dolor (TCC-D) o TCC-C. Se evaluaron al inicio y en el post-tratamiento con el Índice de Calidad del Sueño de Pittsburgh y polisomnografía ambulatoria. RESULTADOS: Las participantes en la TCC-D mostraron aumentos del tiempo en cama y del tiempo total de sueño, y un descenso del sueño ligero, pero no hubo una mejora en la calidad del sueño percibida. Las participantes en la TCC-C mostraron mejoras significativas relacionadas con el sueño reparador (mayor eficiencia del sueño, menos tiempo de vigilia y más tiempo en fase 4 del sueño), y estos cambios fueron congruentes con una mejora en la calidad del sueño percibida. CONCLUSIONES: Este estudio sugiere que nuevos enfoques TCC-C en FM pueden mejorar aspectos clínicos relacionados con el insomnio

Combined cognitive-behavioral therapy for fibromyalgia: Effects on polysomnographic parameters and perceived sleep quality.

Background/Objective: Cognitive-behavioral therapy (CBT) is one of the first-line treatments in the management of fibromyalgia (FM) and it has been applied with considerable success to treat the psychological processes associated with pain and insomnia. We hypothesized that treating sleep and pain jointly with new combined modalities of CBT may offer greater sleep-related benefits to patients. Method: Thirty-nine female patients with FM and insomnia were randomly allocated to receive CBT centered on pain (CBT-P) or combined CBT focused on pain and insomnia (CBT-C). Participants were assessed at baseline and post-treatment with the Pittsburgh Sleep Quality Index and an ambulatory polysomnography.Results: Participants who received CBT-P showed increases in time in bed and total sleep time and decreases in light sleep, but there was no improvement in perceived sleep quality. Participants who received combined CBT-C showed more meaningful improvements related to refreshing sleep (i.e., higher sleep efficiency and less time awake and longer time in Stage 4 sleep), and these changes were concordant with a significant improvement in self-perceived sleep quality. Conclusions: This study suggests that new CBT-C approaches can improve insomnia-related clinical aspects.

Antecedentes/Objetivo: La terapia cognitivo-conductual (TCC) es un tratamiento de primera línea para abordar la fibromialgia (FM) que se ha aplicado con cierto éxito para el tratamiento del dolor y el insomnio. Se hipotetiza que intervenir sobre el sueño y el dolor con una modalidad combinada de TCC (TCC-C) puede mejorar el sueño de estos pacientes. Método: Treinta y nueve mujeres con FM e insomnio fueron aleatorizadas para recibir TCC centrada en dolor (TCC-D) o TCC-C. Se evaluaron al inicio y en el post-tratamiento con el Índice de Calidad del Sueño de Pittsburgh y polisomnografía ambulatoria. Resultados: Las participantes en la TCC-D mostraron aumentos del tiempo en cama y del tiempo total de sueño, y un descenso del sueño ligero, pero no hubo una mejora en la calidad del sueño percibida. Las participantes en la TCC-C mostraron mejoras significativas relacionadas con el sueño reparador (mayor eficiencia del sueño, menos tiempo de vigilia y más tiempo en fase 4 del sueño), y estos cambios fueron congruentes con una mejora en la calidad del sueño percibida. Conclusiones: Este estudio sugiere que nuevos enfoques TCC-C en FM pueden mejorar aspectos clínicos relacionados con el insomnio.

Clinical Manifestations of Trauma Exposure in Fibromyalgia: The Role of Anxiety in the Association Between Posttraumatic Stress Symptoms and Fibromyalgia Status.

Little research has investigated how traumatic experiences relate to fibromyalgia (FM). We explored the presence of trauma exposure in a sample of Spanish participants with FM and examined the associations between (a) the number and type of traumatic experiences and posttraumatic stress disorder (PTSD) symptoms and (b) the severity of clinical manifestations in FM, testing for possible mediation models. Participants were 173 FM patients and 53 healthy controls aged 24 to 66 years. Traumatic event type (physical trauma, physical and sexual abuse, psychological trauma), PTSD symptoms, pain intensity, sleep disturbance, anxiety, depression, coping style, and daily functioning were evaluated via self-report. Fibromyalgia patients reported a higher percentage of trauma exposure than controls, more traumatic experiences (mainly emotional and physical trauma), and more PTSD symptoms, Hedges' gs/Cohen's ds = 0.42-0.76. Most FM patients reported having experienced their most distressing traumatic experience and PTSD symptoms before FM diagnosis. PTSD symptom severity was associated with more pain, sleep disturbances, anxiety, depression, coping style, and functional impairment, rs = .23-.33, ps = .025-.008. A multiple mediation analysis showed a significant indirect effect of anxiety in the association between PTSD symptoms and daily functioning. In a subset of FM patients, PTSD symptoms were associated with major clinical symptoms. The results suggest future research should explore the effectiveness of trauma-focused therapy compared to standard cognitive behavioral therapy for these patients.

Catastrophizing, Acceptance, and Coping as Mediators Between Pain and Emotional Distress and Disability in Fibromyalgia.

Catastrophizing, acceptance, and coping have an important predictive value in chronic pain; however, it is not known which of these variables has the greatest contribution in fibromyalgia (FM). This study explored the mediating role of catastrophizing, acceptance, and coping in the relationship between pain and emotional distress/disability in a FM sample. Ninety-two FM patients and 51 healthy participants controls were evaluated on pain- and psychological-related variables. Catastrophizing, acceptance, behavioral coping, and emotional coping were significantly correlated with emotional distress and/or disability. Catastrophizing had a significant effect as a mediator on the relationship between pain and depression/anxiety. The current management of FM could improve by including cognitive techniques aimed at modifying the negative appraisal of pain.

Using Actigraphy and mHealth Systems for an Objective Analysis of Sleep Quality on Systemic Lupus Erythematosus Patients.

INTRODUCTION: Although sleep alterations can be an important factor contributing to the clinical state of Systemic Lupus Erythematosus, there are no studies to adequately assess sleep quality in this type of disease. OBJECTIVES: The aim of this work is to analyse the sleep quality of Systemic Lupus Erythematous (SLE) patients based on more objective information provided by actigraphy and mobile systems. The idea is to carry out a comprehensive study by analysing how environmental conditions and factors can affect sleep quality. METHODS: In traditional methods the information for assessing sleep quality is obtained through questionnaires. In this work, a novel method is proposed by combining these questionnaires that provide valuable but subjective information with actigraphy and a mobile system to collect more objective information about the patient and their environment. The method provides mechanisms to detect how sleep hygiene could be associated directly with the sleep quality of the subjects, in order to provide a custom intervention to SLE patients. Moreover, this alternative provides ease of use, and non-intrusive ICT (Information and Communication Technology) through a wristband and a mHealth system. The mHealth system has been developed for environmental conditions sensing. This consists of a mobile device with built-in sensors providing input data about the bedroom environment during sleep, and a set of services of the Environmental Monitoring System for properly managing the configuration, registration and fusion of those input data. In previous studies, this information has never been taken into account. However, the information could be relevant in the case of SLE patients. The sample is composed of 9 women with SLE and 11 matched controls with a mean age of 35.78 and 32.18, respectively. Demographic and clinical variables between SLE patients and healthy controls are compared using the Fisher exact test and the Mann-Whitney U test. Relationships between psychological variables, actigraphy measures, and variables related to environmental conditions are analysed with Spearman's rank correlation coefficient. RESULTS: The SLE group showed poorer sleep quality, and more pain intensity, fatigue and depression than the healthy controls. Significant differences between SLE women and healthy controls in measures of actigraphy were not found. However, the fusion of the measures of the environmental conditions that were collected by the mobile system and actigraphy, has shown that light, and more specifically temperature have a direct relation with several measures of actigraphy which are related to sleep quality. It should be emphasize this result because usually the sleep problems are assessment through self-reported measures which had not revealed this association. Moreover, there are no previous studies that analyse these aspects in bedroom environments of SLE patients directly from objective measures. CONCLUSIONS: The results indicate the need to complement the subjective evaluation of sleep with objective measures. The use of actigraphy in combination with a new mHealth system provides a complete assessment especially relevant to chronic conditions as SLE. Both systems incorporate this objective information directly from objective measures in a non-intrusive way. Moreover, the measures of bedroom environmental variables provide useful and relevant clinical information to assess what is happening daily and not occasionally. This could lead to more customized interventions and adapt the treatment to each individual.

Tratamiento psicológico en pacientes lupus eritematoso sistémico: una revisión sistemática / Psychological treatment in patients with systemic lupus erythematosus: a systematic review

El propósito de esta revisión sistemática fue explorar las intervenciones psicológicas aplicadas a pacientes con lupus eritematoso sistémico (LES) y analizar su utilidad para promover una adaptación favorable en el área psicológica, social y física. Se realizó una exhaustiva búsqueda en las bases de datos Scopus, Medline, PsycINFO y Cochrane Library y se seleccionaron investigaciones empíricas publicadas entre 2005 y 2016. Los estudios reflejaron diferentes opciones terapéuticas: terapia cognitivo-conductual, expresión emocional escrita, entrenamiento en atención plena y una combinación de psicoeducación y psicoterapia en grupo. Los resultados muestran que estas intervenciones pueden repercutir positivamente en la calidad de vida, la ansiedad, la depresión, el estrés, la salud mental, la imagen corporal, el manejo de la enfermedad, las relaciones interpersonales, la fatiga, y el dolor. Sin embargo, los estudios presentan notables limitaciones metodológicas que impiden extraer conclusiones definitivas. Por ello, se considera imprescindible la realización de ensayos controlados aleatorizados de mayor calidad metodológica que permitan cuantificar la eficacia de las intervenciones psicológicas en LES y establecer la superioridad de un tratamiento frente a otro.

The purpose of this systematic review was to explore psychological interventions applied to patients with systemic lupus erythematosus (SLE) and analyze their usefulness in promoting a favorable adaptation in the psychological, social and physical area. A comprehensive search bases Scopus, Medline, PsycINFO and Cochrane Library data was performed and empirical research published between 2005 and 2016 were selected studies reflected different therapeutic options: cognitive behavioral therapy, emotional writing, and mindfulness training a combination of group psychoeducation and psychotherapy. The results show that these interventions can positively impact the quality of life, anxiety, depression, stress, mental health, body image, disease management, interpersonal relationships, fatigue, and pain. However, studies have significant methodological limitations that prevent definitive conclusions. Therefore, it is considered essential to perform randomized controlled trials of higher methodological quality to quantify the effectiveness of psychological interventions in sle and establish the superiority of one treatment over another.

Beneficios clínicos globales de la terapia cognitivo conductual para el insomnio y de la terapia basada en conciencia plena aplicadas a la fibromialgia: revisión sistemática y metaanálisis / Global clinical benefits of cognitivebehavioral therapy for insomnia and mindfulness-based therapy applied to fibromyalgia: systematic review and meta-analysis

La terapia cognitivo conductual centrada en el insomnio (TCC-I) resulta de utilidad para mejorar el sueño y otras manifestaciones de la fibromialgia (FM). Asimismo, se ha sugerido que la terapia basada en conciencia plena (TBCP) puede contribuir a atenuar el insomnio, pero se desconoce si comporta mayores beneficios clínicos que la TCC-I en la FM. Esta revisión analiza el valor de la TBCP para abordar el sueño, el dolor, la depresión y el deterioro en la FM y su eficacia diferencial respecto a la TCC-I. Se examinaron las bases de datos MEDLINE, PsyARTICLES, SCOPUS y Cochrane Library en el período 2000-2015 y se seleccionaron los ensayos controlados aleatorizados que hubieran aplicado TCC-I o TBCP en pacientes con FM, identificándose 11 estudios. La TCC-I logró cambios superiores a los de la TBCP en el sueño pero inferiores en el dolor, y ambas terapias consiguieron mejorías importantes en depresión y deterioro, aunque de magnitud favorable a la TCC-I. Se sugiere la posibilidad de extender los beneficios clínicos que posibilita la TCC-I en la FM incorporando los principios de conciencia plena

Cognitive-behavioral therapy focused on insomnia (CBT-I) is useful to improve sleep and other manifestations of fibromyalgia (FM). It has also been suggested that mindfulness-based therapy (MBT) may help alleviate insomnia, but it is unknown whether its clinical benefits are higher than CBT-I on FM. This review analyzes the value of the MBT to address sleep, pain, depression and impairment in FM and its differential efficacy regarding CBT-I. The MEDLINE, PsyARTICLES, SCOPUS and Cochrane Library databases for the period 2000-2015 were examined, and randomized controlled trials that implemented CBT-I or MBT in patients with FM were selected, and 11 studies were identified. CBT-I achieved higher changes than MBT in sleep but lower changes in pain, and both therapies achieved significant improvements in depression and impairment, although favorable magnitude to CBT-I. The possibility of extending the clinical benefits that enable CBT-I on the FM incorporating the principles of mindfulness is suggested

Sleep disturbances in fibromyalgia syndrome: the role of clinical and polysomnographic variables explaining poor sleep quality in patients.

BACKGROUND: Sleep complaints are one of the most frequent and relevant symptoms that characterize fibromyalgia syndrome (FMS). However, objective sleep disturbances have not been consistently described across FMS studies. It is therefore commonly accepted that FMS patients experience sleep misperception, even though no studies have investigated the contribution of polysomnographic parameters to determine subjective sleep quality in FMS. We aimed to compare sleep variables (polysomnographic parameters and subjective sleep quality) between FMS patients and healthy controls. Furthermore, we also aimed to define the predictors of subjective sleep quality in FMS. METHODS: We performed in-home polysomnography to 99 women (53 FMS patients and 36 healthy controls). We also collected subjective ratings of sleep quality, daytime sleepiness, pain, depression, and anxiety. RESULTS: Multivariate analysis showed that groups differed in polysomnographic parameters (p = 0.015)--after accounting for age, body mass index, and antidepressant consumption. Specifically, FMS patients exhibited lower sleep efficiency, greater percentage of stage N1 and wakefulness, and more frequent awakenings than controls (p-values < 0.05). Patients also complained about poorer subjective sleep quality (p <0.001). Percentage of time awake (as obtained by polysomnography), depression levels, and antidepressant consumption predicted self-reported sleep quality in FMS patients (adjusted R2 = 0.33, p <0.001). CONCLUSIONS: One night of in-home polysomnography supports the hypothesis that women with FMS show polysomnographic alterations compared to age-matched controls. In addition, the time spent awake is the best predictor of subjective sleep quality, although greater levels of depression and antidepressant consumption might result in exaggerated complaints. These findings contribute to our understanding of FMS symptoms and its management.

Conceptos generales. Calendarios de vacunación sistemática del niño y del adulto en España. Impacto de los programas de vacunación / Vaccination - General concepts. Systematic vaccination schedules for the child and adult in Spain. Impact of vaccination programs

Uno de los campos de mayor importancia en la promoción de la salud es la prevención de las enfermedades infecciosas mediante las vacunas. Vacuna es cualquier preparación destinada a generar inmunidad contra una enfermedad estimulando la producción de anticuerpos. Hay dos tipos básicos: vivas atenuadas e inactivadas; sus características son diferentes y condicionan su uso. Las propiedades principales de una vacuna son seguridad y eficacia protectora. Las vacunas pueden administrarse en base a indicaciones individualizadas según distintos factores (personales, ambientales…) o de forma sistemática como parte de los calendarios vacunales. En España, el primer calendario de vacunación infantil se implantó en 1975. Actualmente son las comunidades autónomas las responsables de establecer las recomendaciones vacunales. La incidencia de las enfermedades frente a las que se vacuna y las coberturas de vacunación son los criterios de valoración esenciales de los programas vacunales. En España la incidencia de enfermedades inmunoprevenibles es baja. En cuanto a las coberturas vacunales, son altas en la infancia, pero en adolescentes, adultos y grupos de riesgo no siempre son adecuadas

One area of major importance in promoting health is the prevention of infectious diseases through vaccination. Vaccine is any preparation intended to generate immunity against a disease by stimulating the production of antibodies. There are two basic types: live attenuated and inactivated, with different characteristics that determine their use. The main properties of a vaccine are safety and protective efficacy. The vaccines can be administered based on individualized directions depending on various factors (personal, environmental…), or systematically as part of the immunization schedules. In Spain, the first childhood immunization schedule was implemented in 1975. The Autonomous Communities are currently responsible for establishing vaccine recommendations. The incidence of vaccine-preventable diseases and vaccination coverage are essential criteria for the evaluation of vaccination programs. In Spain the incidence of vaccine-preventable diseases is low. Vaccination coverage is high in childhood, but in adolescents, adults and groups at risk it is not always appropriate

Relationships between physical symptoms, emotional distress, and pain appraisal in fibromyalgia: the moderator effect of alexithymia.

Alexithymia is a personality construct that is frequently identified in fibromyalgia (FM). Previous studies have explored the relationship between alexithymia and emotional distress in this disease. Yet, the additional link with factors of pain appraisal is unknown. This study examined the moderating effect of alexithymia in the relationship between emotional distress and pain appraisal in 97 FM women. A control group of 100 healthy women also participated in the study. All participants completed several self-reports about pain experience, sleep quality, impairment, emotional distress, pain appraisal, and alexithymia. FM women showed significantly more difficulty in identifying and describing feelings, but less externally oriented thinking than healthy women. In the clinical group, difficulty in identifying feelings and difficulty in describing feelings significantly correlated with lower sleep quality, higher anxiety and depression, and increased pain catastrophizing and fear of pain. Difficulty in describing feelings significantly correlated with higher pain experience and vigilance to pain. Externally oriented thinking was not correlated with any of the clinical variables. Difficulty in identifying feelings moderated the relationship between anxiety and pain catastrophizing, and difficulty in describing feelings moderated the relationship between anxiety and fear of pain. Implications of the findings for the optimization of care of FM patients are discussed.

[Vaccination--General concepts. Systematic vaccination schedules for the child and adult in Spain. Impact of vaccination programs]. / Conceptos generales. Calendarios de vacunación sistemática del niño y del adulto en España. Impacto de los programas de vacunación.

One area of major importance in promoting health is the prevention of infectious diseases through vaccination. Vaccine is any preparation intended to generate immunity against a disease by stimulating the production of antibodies. There are two basic types: live attenuated and inactivated, with different characteristics that determine their use. The main properties of a vaccine are safety and protective efficacy. The vaccines can be administered based on individualized directions depending on various factors (personal, environmental…), or systematically as part of the immunization schedules. In Spain, the first childhood immunization schedule was implemented in 1975. The Autonomous Communities are currently responsible for establishing vaccine recommendations. The incidence of vaccine-preventable diseases and vaccination coverage are essential criteria for the evaluation of vaccination programs. In Spain the incidence of vaccine-preventable diseases is low. Vaccination coverage is high in childhood, but in adolescents, adults and groups at risk it is not always appropriate.

Spanish version of the pain vigilance and awareness questionnaire: psychometric properties in a sample of women with fibromyalgia

Excessive attention to pain is a common psychological characteristic among people who suffer from chronic pain. The Pain Vigilance and Awareness Questionnaire (PVAQ) is an internationally accepted tool to assess this feature, although there is no validated version of this measure for Spanish people with fibromyalgia. Since this pain syndrome mainly affects women, the aim of this study was to determine the psychometric properties of the PVAQ in Spanish women with fibromyalgia. A group of 242 women diagnosed with fibromyalgia aged between 20 and 66 years participated in the study. The goodness of fit of several structures of the PVAQ reported in previous studies was compared via confirmatory factor analysis. A two-factor solution (active vigilance and passive awareness) of the 9-item shortened version (PVAQ-9) was identified as the most appropriate (RMSEA = .08, NNFI = .96, CFI = .97, GFI = .87). It showed good reliability (internal consistency α = .82), convergent validity and divergent validity (p < .01). The optimal cutoff point for identifying fibromyalgia women with worse daily functioning was a score of 24.5, with a sensitivity of .71 and a specificity of .75. The relevance of vigilance to pain for clinical research in fibromyalgia is discussed (AU)

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Cognitive-behavioral therapy for insomnia and sleep hygiene in fibromyalgia: a randomized controlled trial.

Sleep disturbances play an important role in the exacerbation of pain and other troubling symptoms reported by patients with fibromyalgia (FM). The objective of this trial was to analyze the efficacy of a cognitive-behavioral therapy for insomnia (CBT-I) versus a sleep hygiene (SH) education program at improving sleep and other clinical manifestations in FM. Sixty-four FM women with insomnia were randomly assigned to the CBT-I or the SH groups, and 59 completed the treatments (30 in the CBT-I group and 29 in the SH group). Participants completed several self-report questionnaires at pre-, post-treatment and follow-ups. The CBT-I group reported significant improvements at post-treatment in several sleep variables, fatigue, daily functioning, pain catastrophizing, anxiety and depression. The SH group only improved significantly in subjective sleep quality. Patients in the CBT-I group showed significantly greater changes than those in the SH group in most outcome measures. The findings underscore the usefulness of CBT-I in the multidisciplinary management of FM.

Fibromyalgia: gender differences and sleep-disordered breathing.

OBJECTIVES: The prevalence of fibromyalgia (FM) is much lower in men than in women. Therefore, current knowledge about this chronic pain syndrome emerged mainly from research on women. The aim of the present study was to compare clinical symptoms and sleep parameters between male and female FM patients. METHODS: Forty FM patients (18 men and 22 women) aged 48.00±8.45 years were evaluated with questionnaires on pain, sleep, fatigue, depression, anxiety and functional impact, and polysomnography (PSG). RESULTS: 61% of male FM patients had an apnea-hypopnea index (AHI) greater than 15, compared to 31.8% of women, and a desaturation index (DI) above five, which was twice more prevalent in men than in women. In addition, males had poorer sleep quality (16.05±2.92% vs. 13.08±3.88%; p=0.01) and slow wave sleep (SWS) (stage 3 duration: 9.02±7.84% vs. 14.44±7.32%; p=0.03) than women. No differences were found between the two groups in the level of pain, emotional distress, or daily functioning. However, pain in men, fatigue in women, and functional impact in both sexes seemed to be related to worse sleep quality. Also in women, alterations in total sleep time (TST) and rapid eye movement (REM) sleep features appeared to be related to emotional status. CONCLUSIONS: Alterations in sleep respiratory patterns were more highly prevalent in male than in female FM patients. More so in male FM patients, the alterations in sleep patterns, non-refreshing sleep, and other FM-related symptoms observed in this population might be part of a primary sleep-disordered breathing.

Papel de las cogniciones disfuncionales sobre el sueño en la baja calidad del sueño informada por los pacientes con fibromialgia / Role of dysfunctional beliefs about sleep on the poor sleep quality reported by patients with fibromyalgia

La mayoría de pacientes con fibromialgia (FM) presenta un notable problema de insomnio, que suele contemplarse como una mera consecuencia del dolor. Uno de los principales factores de mantenimiento del insomnio crónico son las creencias disfuncionales sobre el sueño, aunque ningún estudio ha analizado la posible contribución de dichas creencias a los problemas del sueño observados en la FM. En esta investigación 90 mujeres con FM y 70 mujeres sanas completaron diversas medidas de autoinforme sobre sueño, dolor, estado de ánimo y funcionamiento diario. Se observó que ambos grupos se diferencian de forma significativa en todas las variables, asociándose la peor calidad del sueño del grupo clínico a más dolor, depresión, ansiedad y menor nivel de funcionamiento. Además, las pacientes con FM muestran más creencias disfuncionales sobre el sueño que correlacionan significativamente con diversas medidas. La intensidad del dolor, la depresión y las creencias disfuncionales sobre las consecuencias del insomnio en la salud son predictores significativos de pobre calidad del sueño. Se debaten las implicaciones de los resultados de cara al actual tratamiento de la FM (AU)

Most patients with fibromyalgia (FM) have a significant problem of insomnia, which is usually considered as a simple consequence of pain. Disfunctional beliefs about sleep are one of the main maintenance factors of chronic insomnia. However no studies have analyzed the possible contribution of these beliefs to the sleep problems observed in FM. In the present study, 90 women with FM and 70 healthy women completed several self-report measures about sleep, pain, mood state, and daily functioning. Both groups differed significantly in all the variables. In the clinical group, poor sleep quality correlates with greater pain, depression, anxiety and low level of functioning. In addition, patients with FM showed more disfunctional beliefs about sleep, wich correlate significantly with several measures. Pain intensity, depression and disfunctional beliefs about the consequences of insomnia for health are significant predictors of poor sleep quality. The implications of these findings for current treatment of FM are discussed