Benefits of EEG-Neurofeedback on the Modulation of Impulsivity in a Sample of Cocaine and Heroin Long-Term Abstinent Inmates: A Pilot Study.

The aim of this pilot study was to assess whether neurofeedback (NFB) can be useful in the treatment of impulsive behavior in long-term abstinent cocaine and heroin addicts. A single-blind sham-controlled NFB protocol was carried out to assess the effects of NFB on impulsivity in 20 (10 + 10) cocaine and heroin long-term abstinent addicts (Diagnostic and Statistical Manual of Mental Disorders [4th ed., text rev.; DSM-IV-TR]). Psychotic and neurologic diseases were excluded. Participants underwent 40 NFB sessions based on the very slow cortical potential range. Inhibitory deficits were specifically addressed through right and left prefrontal training. Clinical improvement was measured with Likert-type scales, the Hamilton Depression Rating Scale, and the State-Trait Anxiety Inventory, and impulsivity was assessed using the Barratt Impulsiveness Scale and the Continuous Performance Test. Although the results are preliminary due to the small sample size, the NFB-treated group showed a significant clinical improvement, including symptoms of anxiety and depression, with two differentiated time periods. No significant clinical improvement was found in the control group. A significant decrease in the post- versus pre-treatment measures of global impulsivity, nonplanning impulsivity, and error commission measures was found in the NFB-treated group; effect size (dKorr) in the pre-post control design was moderate. No significant change was found in the control group. Despite the limitations of this study, the results suggest that NFB is better than placebo in improving impulsivity and clinical symptoms of anxiety and depression in long-term abstinent cocaine- and heroin-dependent individuals.

[The concentration of per capita health costs and the control of risk]. / La concentración de los costes sanitarios per cápita y el control del riesgo.

The high concentration of sanitary expenses in a limited proportion of population has been object of study and analysis in the North-American environment. The limitations in the available data bases to contrast this fact in our country have allowed us to establish conclusions up to the present date about this matter. We analyse in this article the concentration of public sanitary expenses in a mutuality of sanitary assistance financed publicly and revises the implications it has on the sanitary policy and investigations in sanitary services. According to the total sanitary expenses, the level of concentration is similar to the one existing in the United States in the 70s, 5% of the population consumes 52% of the total expense. The limits of this study must be placed in the field of analysis since it only includes public expenses in sanitary assistance, and it should be advisable to know the total sanitary expenses per capita, but no available data have been found. The relevance of the implications for the policy and management of the sanitary expenses which can be extracted from this article makes us think deeply about the need of new sanitary statistics which allow us to know better the costs, use and state of individual health.