El impacto del nivel educativo en las valoraciones cognitivas de los pacientes jóvenes ingresados en rehabilitación tras un ictus isquémico / The impact of educational level on cognitive assessments in young patients admitted to rehabilitation after ischaemic stroke

Introducción y objetivo: Proponemos valorar el impacto del nivel educativo en las pruebas cognitivas al ingreso y al alta tras un periodo de rehabilitación cognitiva en los pacientes jóvenes tras un ictus isquémico. Materiales y métodos: Consideramos educación secundaria y superior (grupo A) y menos de 6 años de educación reglada (grupo B). Comparamos A y B mediante χ2 y Kruskal-Wallis. Estudiamos A y B como predictores de memoria verbal y de trabajo al alta. La memoria verbal y la memoria de trabajo las valoramos al ingreso y al alta mediante Rey Auditory Verbal Learning Test (RAVLT) y DIGITS del test Barcelona, espectivamente. Resultados: Analizamos n=277 pacientes (55% pertenecientes al grupo A, 51 años de edad media) ingresados a un centro especializado en España entre 2009 y 2019.Encontramos diferencias significativas (p<0,05) al ingreso, todas en favor del grupo A en las valoraciones de la atención, la inhibición, la visuopercepción, la visuoconstruccion, la fluencia verbal y la comprensión.En DIGITS y RAVLT-aprendizaje encontramos diferencias al ingreso. En DIGITS y RAVLT-reconocimiento encontramos diferencias al alta, todas en favor del grupo A. No encontramos diferencias en la edad, en la severidad, en el tiempo hasta el ingreso, ni en el tiempo de estadía ingresados.Tampoco encontramos diferencias en las ganancias cognitivas ni en la eficiencia del tratamiento en las pruebas de memoria.Los grupos A y B no predicen RAVLT (R2=0,53) ni DIGITS (R2=0,48). Conclusiones: El grupo A puntúa mejor en el 63% de las pruebas al ingreso y en el 75% de las pruebas al alta, los grupos A y B son similares en ganancias y eficiencia en las pruebas de memoria.(AU)

Introduction and objective: We propose to assess the impact of educational level on cognitive tests at admission and discharge after a period of cognitive rehabilitation in young patients after ischaemic stroke. Materials and methods: We considered secondary and higher education (group A) and less than 6 years of formal education (group B). We compared A and B using χ2 and Kruskal–Wallis. We studied A and B as predictors of verbal and working memory at discharge. Verbal and working memories were assessed at admission and discharge using Rey Auditory Verbal Learning Test (RAVLT) and DIGITS of the Barcelona Test respectively. Results: We analysed n=277 patients (55% belonging to A, mean age of 51 years) admitted to a specialised centre in Spain between 2009 and 2019.We found significant differences (P<.05) at admission, all in favour of A in the assessments of attention, inhibition, visuoperception, visuoconstruction, verbal fluency and comprehension.In DIGITS and RAVLT-learning we found differences at admission. In Digits and RAVLT-recognition we found differences at discharge, all in favour of A. We found no differences in age, severity, time at admission, or length of stay in hospital.Nor did we find differences in cognitive gains or treatment efficiency in memory tests.The groups A and B did not predict RAVLT (R2=.53) or DIGITS (R2=.48). Conclusions: A scores better in 63% of tests at admission and in 75% of tests at discharge, A and B are similar in gains and efficiency on memory tests.(AU)

[The impact of educational level on cognitive assessments in young patients admitted to rehabilitation after ischaemic stroke]. / El impacto del nivel educativo en las valoraciones cognitivas de los pacientes jóvenes ingresados en rehabilitación tras un ictus isquémico.

INTRODUCTION AND OBJECTIVE: We propose to assess the impact of educational level on cognitive tests at admission and discharge after a period of cognitive rehabilitation in young patients after ischaemic stroke. MATERIALS AND METHODS: We considered secondary and higher education (group A) and less than 6 years of formal education (group B). We compared A and B using χ2 and Kruskal-Wallis. We studied A and B as predictors of verbal and working memory at discharge. Verbal and working memories were assessed at admission and discharge using Rey Auditory Verbal Learning Test (RAVLT) and DIGITS of the Barcelona Test respectively. RESULTS: We analysed n=277 patients (55% belonging to A, mean age of 51 years) admitted to a specialised centre in Spain between 2009 and 2019. We found significant differences (P<.05) at admission, all in favour of A in the assessments of attention, inhibition, visuoperception, visuoconstruction, verbal fluency and comprehension. In DIGITS and RAVLT-learning we found differences at admission. In Digits and RAVLT-recognition we found differences at discharge, all in favour of A. We found no differences in age, severity, time at admission, or length of stay in hospital. Nor did we find differences in cognitive gains or treatment efficiency in memory tests. The groups A and B did not predict RAVLT (R2=.53) or DIGITS (R2=.48). CONCLUSIONS: A scores better in 63% of tests at admission and in 75% of tests at discharge, A and B are similar in gains and efficiency on memory tests.

Relationships between surface free energy, surface texture parameters and controlled drug release in hydrophilic matrices.

The study of controlled release and drug release devices has been dominated by considerations of the bulk or average properties of material or devices. Yet the outermost surface atoms play a central role in their performance. The objective of this article has been to characterize the surface of hydrophilic matrix tablets using the contact angle (CA) method to ascertain the surface free energy, and atomic force microscopy (AFM) and confocal microscopy (CM) for the physical characterization of the surface of the hydrophilic matrix. The surface free energy results obtained show that hydroxypropylmethylcellulose K15M hinders the spreading of water on the surface of the tablet, such that the concentration of HPMC K15M increases the reaction rate of the hydrophobic interactions between the chains of HPMC K15M which increases with respect to the rate of penetration of water into the tablet. In this study, we developed a new method to characterize the swelling of the tablets and established a relationship between the new method based on microswelling and the swelling ratio parameter. The surface texture parameters have been determined and the morphology of the tablets of the different formulations and the evolution of the surface morphology after interacting with the water, swelling and forming a gel layer were characterized. This work represents significant progress in the characterization of matrix tablets.

Quality by Design approach to understand the physicochemical phenomena involved in controlled release of captopril SR matrix tablets.

The aim of this study is to obtain swelling controlled release matrix tablets of captopril using the Quality by Design methodology (ICH Q8) and to know the transport mechanisms involved in captopril release. To obtain the area of knowledge, the design of experiments studying the effect of two components (HPMC K15M and ethylcellulose) at different levels has been applied, with the captopril dissolution profile as the product's most important critical quality attribute (CQA). Different dissolution profiles have been obtained with the design of experiments performed, which is a key factor in the development of controlled release matrix tablets. Kinetic analysis according to the equations of Higuchi and Korsmeyer-Peppas demonstrates that the release mechanism is a mechanism of erosion when the whole percentage of the polymer is ethylcellulose, and a diffusion mechanism when the whole percentage of the polymer is HPMC K15M. The physico-chemical characteristics of the gel layer determine the release rate of captopril. The thickness of the gel layer, the porosity which is formed in the matrix upon contact with water, pore size, the swelling rate, the erosion rate of the matrix, and the physico-chemical characteristics of captopril, are factors related to the kinetic equations described and that allow us to predict the release mechanism of captopril. A new relationship of the kinetic equations governing the in vitro behavior with the physical characteristics of the gel layer of the different formulations has been established. This study shows that the size of water-filled pores and the degree of crosslinking between the chains of HPMC K15M of the matrix are related to the exponent n of the Korsmeyer-Peppas equation and the type of transport of the captopril from within the matrix to the dissolution medium, that is, if the transport is only through water-filled pores, or if a combination of diffusion occurs through water-filled pores with a transport through continuous polymeric networks.

Adaptation and validation of the Spanish version of the Spinal Cord Lesion-related Coping Strategies Questionnaire (SCL CSQ-S).

STUDY DESIGN: Cross-sectional validation study. OBJECTIVES: To adapt the Spinal Cord Lesion-related Coping Strategies Questionnaire into the Spanish language (SCL CSQ-S) and to examine the relationship between coping strategies, global quality of life and psychological adaptation. SETTING: Data were collected through individuals with spinal cord injury (SCI) now living in the community who completed their routine follow-up assessment at the Institute Guttmann in Barcelona, Spain. METHODS: Forward and backward translation into Spanish of the English version of the questionnaire. Questionnaires of global Quality of Life, Community Integration, Coping, Depression, Anxiety and Functional Independence were administered to 349 adults with paraplegia and 162 adults with tetraplegia. Statistical analysis included confirmatory factor analysis and regression analysis. RESULTS: The factorial structure of the questionnaire was partly verified. The original correlated, three-factor model sufficiently fit the data obtained in this study: χ(2)(48)=109.46; P<0.001; Comparative Fit Index=0.96; Tucker-Lewis Index=0.96; Root Mean Square Error of Approximation=0.050 (0.038-0.062); Akaike information criterion=13.46. Items were found to be good indicators of their respective latent factors, showing adequate factorial charge ranges (between 0.41 and 0.75). The reliability coefficient (Cronbach's α) for the Acceptance subscale was 0.74, for Social reliance 0.76 and for Fighting spirit 0.69. Coping strategies as measured by SCL-CSQ-S contributed to the prediction of outcomes related to adaptation to disability. CONCLUSION: The results of the study show some evidence for the robustness of the structure of SCL CSQ-S and show that the Spanish version of the questionnaire largely replicate previous results. Coping strategies, especially Acceptance, are related to adaptation to injury.

The use of the SeDeM diagram expert system for the formulation of Captopril SR matrix tablets by direct compression.

The SeDeM diagram expert system has been used to study excipients, Captopril and designed formulations for their galenic characterization and to ascertain the critical points of the formula affecting product quality to obtain suitable formulations of Captopril direct compression SR matrix tablets. The application of the SeDeM diagram expert system enables selecting excipients with in order to optimize the formula in the preformulation and formulation studies. The methodology is based on the implementation of ICH Q8, establishing the design space of the formula with the use of experiment design, using the parameters of the SeDeM diagram expert system as system responses.

Psychometric evaluation of the Spanish version of the MPI-SCI.

STUDY DESIGN: Postal surveys. OBJECTIVES: To confirm the factor structure of the Spanish version of the MPI-SCI (MPI-SCI-S, Multidimensional Pain Inventory in the SCI population) and to test its internal consistency and construct validity in a Spanish population. SETTING: Guttmann Institute, Barcelona, Spain. METHODS: The MPI-SCI-S along with Spanish measures of pain intensity (Numerical Rating Scale), pain interference (Brief Pain Inventory), functional independence (Functional Independence Measure), depression (Beck Depression Inventory), locus of control (Multidimensional health Locus of Control), support (Functional Social Support Questionnaire (Duke-UNC)), psychological well-being (Psychological Global Well-Being Index) and demographic/injury characteristics were assessed in persons with spinal cord injury (SCI) and chronic pain (n=126). RESULTS: Confirmatory factor analysis suggested an adequate factor structure for the MPI-SCI-S. The internal consistency of the MPI-SCI-S subscales ranged from acceptable (r=0.66, Life Control) to excellent (r=0.94, Life Interference). All MPI-SCI-S subscales showed adequate construct validity, with the exception of the Negative and Solicitous Responses subscales. CONCLUSIONS: The Spanish version of the MPI-SCI is adequate for evaluating chronic pain impact following SCI in a Spanish-speaking population. Future studies should include additional measures of pain-related support in the Spanish-speaking SCI population.

[Developing the concept of neurosis (II): nosology and neurosis]. / La construcción del concepto de neurosis (II): Nosología y neurosis.

The apparition of the concept of "nervous alteration" in the XVII century, offers to psychiatry the possibility of a better and more solid development. Based on the Linneus idea of discrimination, description and classifications, nosologists constructed several ordinations of pathology. One of them, W. Cullen, using the nosologic method created the term "neurosis" to clarify these ideas in order to nervous alterations.

[Construction of the neurosis concept. Vapours and nerves]. / La construcción del concepto de neurosis. Los vapores y los nervios.

Physicians of the XVI and XVII century investigate medical alteration using galileic-newtonean paradigm. When they considered objectivity the signs of mental alterations they were able to construct explicative theories. In order to hystery they adhered to the theory of "vapours" and "nervous malady". In the present publication we considered the point in order to construct the idea of "neurosis".

La construcción del concepto de neurosis. Los vapores y los nervios. / [Construction of the neurosis concept. Vapours and nerves]

Physicians of the XVI and XVII century investigate medical alteration using galileic-newtonean paradigm. When they considered objectivity the signs of mental alterations they were able to construct explicative theories. In order to hystery they adhered to the theory of [quot ]vapours[quot ] and [quot ]nervous malady[quot ]. In the present publication we considered the point in order to construct the idea of [quot ]neurosis[quot ].

La construcción del concepto de neurosis (II): Nosología y neurosis. / [Developing the concept of neurosis (II): nosology and neurosis]

The apparition of the concept of [quot ]nervous alteration[quot ] in the XVII century, offers to psychiatry the possibility of a better and more solid development. Based on the Linneus idea of discrimination, description and classifications, nosologists constructed several ordinations of pathology. One of them, W. Cullen, using the nosologic method created the term [quot ]neurosis[quot ] to clarify these ideas in order to nervous alterations.

[The psychiatric diagnostic task]. / La tarea diagnóstica psiquiátrica.

When glancing through the works of different authors, two different modes--related to a predominance of either the naturalistic believes, or the crisis thereof--can be detected. Of both modes, the former devised diagnosis as aimed at a cognitive goal yielding a kind of "photograph" of symptoms and signs that had been scrutinized. The latter devised diagnosis as a task that had to be undertaken. The main points of both trends are reviewed.

La tarea diagnóstica psiquiátrica. / [The psychiatric diagnostic task]

When glancing through the works of different authors, two different modes--related to a predominance of either the naturalistic believes, or the crisis thereof--can be detected. Of both modes, the former devised diagnosis as aimed at a cognitive goal yielding a kind of [quot ]photograph[quot ] of symptoms and signs that had been scrutinized. The latter devised diagnosis as a task that had to be undertaken. The main points of both trends are reviewed.

Significación de la nomenclatura psiquiátrica / Psychiatric nomenclature signification

A partir de su etimología se destaca el inicial poder proclamante e invocante del concepto de nomenclatura, caracterizado después como sistema de significaciones que distingue, instituye, ordena y jerarquiza. En psiquiatría la nomenclatura aclara el conocimiento y permite su desarrollo y teorización. Ubica la enfermedad mental primero en la observación, después en la palabra, en un camino que va de la gramática nosológica a la comprensión de la persona-en-situación, esto es, el espacio abierto del ecosistema

[Structure of a delusion. IV. Composition of a delusional text]. / La textura de un delirio. IV. Composición del texto delirante.

The delusional text organizes and disposes itself in a peculiar way. Certain organizators --in Eugenio's case there are five--conform to a distributive pattern charged of the distribution of the text sequences. But delusion is not disorder and Eugenio's text is organized in the axe "dependence-law" in its double meaning of "precept sanction vs. observance and infraction". This dualism is characteristic of the delusional text and its coherence depends on the articulation between sequences. This text is defined by these relations and does not constitute an "illness" as naturalism thought. It is an attempt to answer, though in a deviated and distorted way, questions that the world poses building, thus, a different world. The delusional polisemia grown out of this conective signification is, at the same time, metonimic. This last character is of great importance as it bears an influence on the signification and pushes it into a rational "restauration". This is the task of the argumentation. But the structure, which was conective at first, becomes afterwards implicative. The meaning becomes its opposite and changes its order. This process is not total and, on the text, there are intermediate meanings in coexistance. When the meaning inverts its order it results in the configuration of the special kind of negation which is proper of this delusional text.

[Structure of a delusion. III. The imaginary plot]. / La textura de un delirio. III. La tramazón imaginaria.

The "hole" in the text is filled again in a delusional imaginary way. This signifies that in this structural place interweaves a replacing texture to disemble the "hole" and reconstruct -in a symbolic way, of course--a new world. This texture has an especific structure. In the first place imaginary cluster in "themes" interconnected in a scheme -skema was in ancient grechian world the figure, the external way, the appearence--this is a kind of compromise between imaginary and speech, where the roles are binary distributed; but as both contradictory poles coexists, the resulta sunks in ambigüity. The scheme is, then, concealer and articulates incompatible poles in other different way. Ideological modifications articulate to at this same level. In the second place the "themes" suposse the existence of imaginary topics developed in the significant axis of antropological origin. In these "themes" the delusional imaginary material disposes in ciphered "thematic storings" and "structural knots". This cipher belongs to the legal area of personalization but as infraction. The delusional text never is transgresive and as it remains in the same legal area, it becomes prisoner of the symbolic network area which forbides to change and to expand. The speech now appears as the bolt of the imaginery area.

[Structure of a delusion. II. The distortion stage]. / La textura de un delirio. II. Momento de la distorsión.

When one considers a text which deviates from the ordinary and logic rules of language and is pervaded by imagination, the intent of reasoning over its content impedes the adequate comprehension of the various significations born by the mentioned text. This difficulty of reasoning is due to the coexistence of significations incompatible among them. If we also take account the historic lag, the argumentation and the underestimation of the others by the author (they are only the 'redundant ones'), it becomes evident that we are to reconstruct a situation which is dangerously fragile. There is an added obstacle, the fact that the text has a significance in three levels - historic, fantastic and delusional-in which each message is decodified. The family, culture and belief contexts are the necessary material resources. The text becomes in this way, conventional, increasing its semantic credibility. The delusion, in spite of its appearing as a creation, is not more than a redundancy with which the author seeks a conciliation between incompatible ideas. Its significance changes, then, constantly and instead of informing, blocks its comprehension and frustrates the reader. To succeed in the recreation of a world in which the conditions mentioned be accomplished, it is necessary to persuade. That's way it is necessary for the author to legitimate the imaginary fillings of the text. The intent of symbolizing turns the deviation into distortion, second structural moment of delusion whose principal purpose is at the service of the new identity. The text is arranged as an inventio rethorica by means of the enthymem, procedure by which it becomes linked to the already mentioned semantic credibility. In this way the estimation of the other changes. They are taken into account according to their capacity of sending back what the deluded person wants to hear. The distortion is not limited to the text; it also reaches the appreciation of the others. All this ends in a complex rethoric development in which digressions, the slide of significations, and the anaphoras (repetions) abund. This repetition sends back to 'something-already-known', impossible of being symbolically expressed, but which constitutes the reference always present. We are again before an imaginary filling of the 'hole' of the text, where the delusional synecdoche places a part instead of the whole. A text construed in this way is never convincent nor conveys certitude. The delusional text needs to keep attached to the opinion of others. The author of a delusional text needs them as an essential public that may help him to convince himself of the text.

La textura de un delirio. II. Momento de la distorsión / [Structure of a delusion. II. The distortion stage]

When one considers a text which deviates from the ordinary and logic rules of language and is pervaded by imagination, the intent of reasoning over its content impedes the adequate comprehension of the various significations born by the mentioned text. This difficulty of reasoning is due to the coexistence of significations incompatible among them. If we also take account the historic lag, the argumentation and the underestimation of the others by the author (they are only the ’redundant ones’), it becomes evident that we are to reconstruct a situation which is dangerously fragile. There is an added obstacle, the fact that the text has a significance in three levels - historic, fantastic and delusional-in which each message is decodified. The family, culture and belief contexts are the necessary material resources. The text becomes in this way, conventional, increasing its semantic credibility. The delusion, in spite of its appearing as a creation, is not more than a redundancy with which the author seeks a conciliation between incompatible ideas. Its significance changes, then, constantly and instead of informing, blocks its comprehension and frustrates the reader. To succeed in the recreation of a world in which the conditions mentioned be accomplished, it is necessary to persuade. That’s way it is necessary for the author to legitimate the imaginary fillings of the text. The intent of symbolizing turns the deviation into distortion, second structural moment of delusion whose principal purpose is at the service of the new identity. The text is arranged as an inventio rethorica by means of the enthymem, procedure by which it becomes linked to the already mentioned semantic credibility. In this way the estimation of the other changes. They are taken into account according to their capacity of sending back what the deluded person wants to hear. The distortion is not limited to the text; it also reaches the appreciation of the others. All this ends in a complex rethoric development in which digressions, the slide of significations, and the anaphoras (repetions) abund. This repetition sends back to ’something-already-known’, impossible of being symbolically expressed, but which constitutes the reference always present. We are again before an imaginary filling of the ’hole’ of the text, where the delusional synecdoche places a part instead of the whole. A text construed in this way is never convincent nor conveys certitude. The delusional text needs to keep attached to the opinion of others. The author of a delusional text needs them as an essential public that may help him to convince himself of the text.