Physical health, primary care utilization and long-term quality of life in borderline personality disorder: A 10-year follow-up study in a Spanish sample.

OBJECTIVE: We aimed to study physical health and primary care utilization in the long-term course of borderline personality disorder (BPD) and their impact on quality of life (QOL) in a Spanish clinical sample. METHODS: This study is part of a longitudinal study following a clinical cohort with BPD. A total of 41 participants were re-evaluated at 10-year follow-up, when current medical conditions, primary care utilization, and quality of life were assessed. Comparative population data were extracted from the Catalan Health Survey ESCA. RESULTS: 68% of BPD patients reported physical health problems, and 32% informed of multiple medical illnesses at follow-up. Higher rates of musculoskeletal disorders and frequent use of general practitioner (GP) consultations were reported by BPD patients compared to the general population. Differences in physical health and use of primary care services between remitted and non-remitted BPD patients were not significant. BPD remission was independently associated with better long-term QOL. Comorbid somatic diseases worsened the long-term QOL of non-remitted BPD patients. CONCLUSION: Chronic somatic conditions are prevalent in people with BPD and interact negatively with persistent BPD pathology, worsening their QOL in the long-term. Health care strategies in the assistance of long-lasting BPD patients are recommended.

Evolución clínica y funcional a largo plazo del trastorno límite de personalidad (AU) / Long-term clinical and functional evolution of borderline personality disorder

Hay una evidencia científica creciente que indica un pronóstico a largo plazo más favorable del esperado para las personas con trastorno límite de la personalidad (TLP). Los resultados de diversos estudios prospectivos a 5 años o más conducidos en muestras clínicas de varios países, incluida España, indican que el TLP tiende a la remisión diagnóstica a largo plazo, aunque se objetivan manifestaciones sintomáticas crónicas del trastorno y una comorbilidad psiquiátrica y médica clínicamente relevante en una parte de las personas con TLP. Así mismo, se informan de tasas de suicidio acumuladas elevadas a largo plazo en esta población. El funcionamiento social y general parece mejorar ligeramente a largo plazo, observándose dificultades persistentes de ajuste social en algunos individuos. Se requieren futuras investigaciones para la identificación de factores predictivos de estas diferencias en el curso del trastorno (AU)

There is growing evidence indicating a better prognosis for borderline personality disorder (BPD) in the long-term than it was expected. Findings of prospective studies at 5-year follow-up and beyond that were conducted in clinical samples from several countries, including Spain, suggest that BPD tends towards diagnostic remission in the long-term, although a portion of the people with BPD may present chronic symptoms of the disorder and other clinically relevant psychiatric and medical comorbidities. High cummulative suicide rates were reported in this population in the long-term. General and social functioning appear to improve slightly over time, with persistent difficulties in social adjustment observed in some individuals. Further research is required to identify predictive factors of these differences in the course of the disorder (AU)

Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies.

BACKGROUND: This meta-analytic review is the first to synthesise findings from prospective research on the long-term course of borderline personality disorder in adult clinical populations. METHODS: Systematic searches were conducted in Medline, PsycINFO, PsycArticles, PubMed and Scopus within the period 1990-2017. Inclusion criteria were: (1) adult BPD sample diagnosed by a validated, semi-structured interview; (2) at least two prospective assessments of outcomes; and (3) follow-up period ≥ 5 years. Quality of evidence was rated with the Systematic Assessment of Quality in Observational Research (SAQOR). Four outcomes were meta-analysed using mixed-effect methods: remission from BPD diagnosis, completed suicide, depressive symptoms, and functioning. Potential moderators regarding the natural course and the initial treatment received were studied. RESULTS: Eleven studies met the inclusion criteria, with 837 participants from nine countries being followed. Between 50% and 70% of the BPD patients achieved remission in the long-term. Significant reductions in depression and functional impairment were also found. Mean suicide rate ranged from 2% to 5%. Younger age was associated with higher likelihood for remission. Being female was correlated with lower functional improvement. Despite some positive trends, there were no significant associations between treatment moderators and the long-term outcome. CONCLUSIONS: Findings suggest that the course of BPD is characterised by symptomatic amelioration and a slight functional improvement in the long-term. Age and gender modulate the long-term prognosis and should be considered to adapt treatment resources. Further research is required to draw robust conclusions on the long-term effects of psychotherapeutic interventions.

miR-30c is specifically repressed in patients with active pulmonary tuberculosis.

Tuberculous pleurisy (PLTB) is a common form of extrapulmonary tuberculosis. It often resolves without chemotherapy being hence considered a rather benign manifestation of the disease. Patients with PLTB mount an effective anti-mycobacterial response, unlike those with active pulmonary TB (pTB) that were shown to present an imbalance in plasma immune and endocrine mediators. In this work, we explored whether expression of the active isoform of the glucocorticoid receptor (hGRα) in the context of the inflammatory-anti-inflammatory responses of TB patients may be associated to microRNA levels. As expected, the inflammatory response triggered in patients coexists with increased circulating cortisol and altered hGRα levels in the peripheral blood mononuclear cells. However, while hGRα expression is significantly downregulated in PLTB, its levels in pTB patients are higher within the control values. These results point out to the existence of an additional mechanism tending to preserve hGRα levels probably to deal with the chronic inflammation observed in pTB. In this regard, we found that miR-30c is strongly downregulated in mononuclear cells of pTB patients compared to PLTB cases, showing an expression profile opposite to that seen with hGRα. Interestingly, low levels of miR-30c are specific for this active form of TB, as its expression is not altered in mononuclear cells from either healthy controls or patients with tuberculous or non-tuberculous pleurisy. Moreover, miR-30c and hGRα also showed an inverse expression pattern in M. tuberculosis-stimulated THP-1 macrophage cultures. In sum, our studies identify miR-30c as a specific correlate of pulmonary manifestations of TB, potentially involved in the altered glucocorticoid sensitivity observed in these patients.

Long-Term Course of Borderline Personality Disorder: A Prospective 10-Year Follow-Up Study.

The aim of this prospective study was to expand previously reported evidence on the 10-year clinical and functional course of borderline personality disorder (BPD) in a Spanish sample. Participants diagnosed with BPD were assessed at baseline and at 10-year follow-up to evaluate BPD symptomatology and other relevant clinical measures, suicidal behavior, dimensional personality traits, Axis I and II comorbidity, use of mental health resources, and psychosocial functioning. At the 10-year follow up, significant improvements were observed on BPD domains, suicidal behavior, and other clinical measures. Neuroticism, impulsiveness, and aggression-hostility features trended toward normalization, whereas activity and sociability were impaired over time. Comorbidity with Axis I and personality disorders remained high. Social functioning and occupational functioning were largely unchanged. These findings confirm the tendency toward a symptomatic remission of BPD over the long term with regard to symptom criteria and characteristic dimensional traits. However, psychosocial functioning remains impaired.

Prevalencia de fluorosis y experiencia de caries dental en un grupo de escolares en el área urbana del Municipio de Yondó (Antioquia, Colombia), 2010 / Prevalence of fluorosis and dental caries experience in a school age group in the urban area of the Municipality of Yondó (Antioquia, Colombia), 2010

Introducción y Objetivo: La caries dental y la fluorosis dental son problemas de Salud Pública que requieren sistemas de vigilancia y control en edades tempranas. El objetivo fue determinar la prevalencia de fluorosis dental en escolares de 12 años, y la historia de caries en escolares de 5 y 12 años en la Institución Educativa Luis Eduardo Díaz del área urbana del Municipio de Yondó (Antioquia) durante el año 2010. Materiales y Métodos: Estudio transversal en una población de 62 escolares de 5 años y 145 de 12 años. Se realizó examen clínico y se estableció la experiencia de caries dental (índices ceo-d; 5 años, COP-D; 12 años) y la prevalencia de fluorosis dental (Índice de Dean). Se calcularon frecuencias, medianas y promedios por sexo en el caso de caries dental y prevalencia de fluorosis global y por grados de severidad. Cálculo de razones de prevalencia de fluorosis por sexo con sus intervalos de confianza al 95% (RP, IC95%). Se analizaron las principales fuentes de agua del área de estudio. Resultados: El promedio ceo-d a los 5 años fue de 2,37 ±3,39, con experiencia de caries del 61%. A los 12 años se encontró un promedio COP-D de 0,73 ±1,28, y una experiencia de caries del 33,1%. No se encontraron diferencias estadísticamente significativas por sexo. La prevalencia global de fluorosis fue de 97,9%, con mayor prevalencia en hombres, aunque sin diferencias significativas (RP 1,05, IC95% 0,98- 1,12). El análisis fisicoquímico no mostró niveles altos de concentración de flúor en agua. Conclusión: Se encontraron niveles altos de experiencia de caries dental a los 5 años y alta prevalencia de Fluorosis a los 12 años que exigen acciones de mejoramiento y estrategias en salud pública para esta población.

Introduction and Objetive: Dental caries and dental Fluorosis are public health problems, which require surveillance and control systems in primary ages. We aim to determine the prevalence of dental Fluorosis in school children age 12 and the caries experience of school children between 5 and 12 years old at the Institution “Luis Eduardo Diaz”, located in the urban area of the Municipality of Yondó (Antioquia, Colombia), during 2010. Materials and Methods: A cross-sectional study was conducted in 62 scholars of 5 years and 145 scholars of 12 years. Clinical examinations were carried out and the caries dental experience was established (DMFT and dmf indexes) and the prevalence of dental Fluorosis (Dean’s index). Prevalence, mean and median and for sex were estimated in case of dental caries and the global prevalence of Fluorosis and taking into account severity groups and sex. We calculate the prevalence ratio for sex and the 95% confidence intervals (PR, 95% CI). The main water sources of the study area were analyzed. Results: Mean dmf for 5 years was 2,37(±3,39) and the dental experience was 61%. At 12 years a DMTF mean was 0,73 (±1,28) and the dental experience was 33,1%. No statistical significance was found for sex. The global prevalence of Fluorosis was of 97,9%, the frequency was higher in males but the differences do not have statistical significance (RP 1z5, 95%CI 0,98- 1,12). The physicochemical analysis did not show high levels of fluoride concentrations in water. Conclusion: Higher levels of dental caries in case of scholars of 5 years dental Fluorosis for scholars of 12 years were found. Improvement actions and public health strategies are required for these populations.

Caries dental y necesidades de tratamiento en el primer molar permanente en escolares de 12 años de las escuelas públicas del municipio de Rionegro (Antioquia, Colombia), 2010 / Dental Caries and Treatment Needs in the First P ermanent Mol ar in 12-year-old School children fr om P ublic Schools in the Municipal ity of Rionegro (Antioquia, Colombia), 2010

Antecedentes: es importante evaluar el primer molar permanente, ya que en edad escolares el diente permanente más afectado por caries. La prevalencia de caries en estos dientesse ha asociado con la actividad futura de caries. Objetivo: determinar la prevalencia decaries y las necesidades de tratamiento de los primeros molares permanentes en la poblaciónescolar de 12 años de las escuelas oficiales del municipio de Rionegro (Antioquia).Métodos: se realizó un estudio descriptivo transversal en 808 escolares de 12 años deescuelas públicas del municipio. Se analizó la prevalencia de caries dental en el primer molarpermanente por número y tipo de dientes afectados y de acuerdo con sexo, escolaridad,zona de residencia y afiliación al Sistema General de Seguridad Social en Salud (SGSSS).También se describieron las necesidades de tratamiento para cada primer molar permanente.Resultados: los molares inferiores presentaron la mayor prevalencia de cariesdental en relación con las variables de afiliación al SGSSS, sexo y zona de residencia;en estas dos últimas variables se evidenció más afectación en el primer molar inferiorderecho y concentración en este molar de las necesidades de tratamiento restaurativo.Conclusiones: aunque se cuenta con estudios previos sobre prevalencia de caries dentalen el municipio que muestran cumplimiento de metas de la Organización Mundial de laSalud, son más escasos los estudios que evalúen de manera individual los primeros molarespermanentes para orientar políticas de salud pública dirigidos a la preservación de estasimportantes estructuras dentales...

Background: Evaluation of the first permanent molar is important since it is the tooth thatis most affected from dental cavities in schoolers. Caries prevalence of this molar has beenassociated with future caries activity. Objective: Determine caries prevalence and treatmentneeds in the first permanent molar of a 12-year-old population from public schools in themunicipality of Rionegro (Antioquia). Methods: A descriptive study in 808 12-year-old schoolchildren from public schools in Rionegro was conducted. Caries prevalence in the first permanentmolar was analyzed regarding number and type of teeth affected and associationwith sex, grade, zone of residence, and type of affiliation to the social security system (SSS).Needs for dental treatment in this molar were also described. Results: Lower molars werethe most affected by dental caries in relationship with sex, SSS, and zone of residence; in thelatter two dental cavities were more prevalent in the right lower first molar, tooth in which theneed for restorative treatment is higher than the other first molars. Conclusions: Althoughthere are previous studies on the dental health status in Rionegro and indicators show thatthe goals of the World Health Organization are being met, evaluative research focused onthe first permanent molar is scarce and necessary given its importance for health publicpolicymaking intended to preserve this teeth...

Relation of osteocalcin with insulin resistance and histopathological changes of non alcoholic fatty liver disease.

BACKGROUND: Osteocalcin is a hormone with a complex cross-talk between adipose tissue and the skeleton. The aim of the present study was to explore the relation of osteocalcin with histopathological changes of NALFD patients. SUBJECTS: A population of 69 NAFLD patients was analyzed. A liver biopsy was realized. Weight, fat mass, body mass index, basal glucose, insulin, insulin resistance (HOMA), total cholesterol, LDLcholesterol, HDL-cholesterol, triglycerides and osteocalcin levels were measured. RESULTS: Patients were divided in two groups by median osteocalcin value (11.34 ng/mL), group I (patients with the low values) and group II (patients with the high values). Only liver fibrosis frequencies were different between groups (group I: 22.9% vs group II: 9.4%; p < 0.05). Patients in group I had higher levels of glucose (115.6 ± 28.1 mg/dL vs. 103.7 ± 24.3 mg/dL; p < 0.04), HOMA (4.6 ± 3.1 units vs. 3.6 ± 1.8 units; p < 0.04), weight (102.9 ± 32.4 kg vs. 85.9 ± 16.8 kg; p = 0.002) and body mass index (38.3 ± 11.4 kg/m(2) vs. 30.1 ± 5.7 kg/m(2); p = 0.001)) than patients in group II. Osteocalcin was inverse correlated with glucose (r =-0.4; p = 0.002) and HOMA (r = -0.3:p = 0.01). CONCLUSION: Osteocalcin is associated with liver fibrosis. However, this association disappeared in a multivariate analysis, and HOMA remained as an independent factor.

Prevalence of drug-resistant Mycobacterium tuberculosis in patients under intermittent or daily treatment.

OBJECTIVE: To compare the prevalence rates of drug-resistant Mycobacterium tuberculosis in patients under intermittent treatment with those observed in patients under daily treatment. METHODS: We used World Health Organization data regarding 5,138 patients with active pulmonary TB in Brazil, separated into two groups: patients in the Federal District of Brasília, treated with a one-month daily regimen followed by an intermittent thrice-weekly regimen; and patients in other parts of Brazil, treated with a daily regimen only. The resistance pattern was categorized as primary or acquired, based on the history of previous treatment. Multidrug resistance was defined as resistance to at least isoniazid and rifampin, whereas monoresistance was defined as resistance to only one drug. RESULTS: The prevalence of primary resistance in the Federal District of Brasília and in the other parts of Brazil, respectively, was as follows: overall, 9.2% and 9.3% (p = 0.94); monoresistance, 6.6% and 6.9% (p = 0.89); and multidrug resistance, 1.0% and 1.2% (p = 0.85). The prevalence of acquired resistance in the Federal District of Brasília and in the other parts of Brazil, respectively, was as follows: overall, 15.8% and 26.8% (p = 0.39); monoresistance, 5.3% and 13.7% (p = 0.33); and multidrug resistance, 0.0% and 10.2% (p = 0.16). CONCLUSIONS: No significant differences were found between patients treated with an intermittent regimen and those treated with a daily regimen in term of resistance rates.

Prevalência de Mycobacterium tuberculosis resistente em pacientes sob tratamento parcialmente intermitente ou sob tratamento diário / Prevalence of drug-resistant Mycobacterium tuberculosis in patients under intermittent or daily treatment

OBJETIVO: Comparar as taxas de prevalência de Mycobacterium tuberculosis resistentes entre pacientes sob tratamento parcialmente intermitente e daqueles sob tratamento diário. MÉTODOS: Foram utilizados dados da Organização Mundial de Saúde de 5.138 pacientes com TB pulmonar bacilífera no Brasil, que foram separados em dois grupos: um grupo de pacientes do Distrito Federal submetidos a um regime intermitente de três tomadas semanais após o primeiro mês de regime diário, e um grupo de pacientes dos estados brasileiras, submetidos somente a um regime diário. O padrão de resistência foi categorizado em resistência primária ou adquirida, conforme a existência de tratamento anterior. Além disso, multirresistência foi definida como a resistência simultânea à isoniazida e à rifampicina, enquanto monorresistência como a resistência a uma única droga. RESULTADOS: A prevalência da resistência primária como um todo no Distrito Federal e no restante do Brasil foi de 9,2 por cento e 9,3 por cento (p = 0,94), respectivamente. A prevalência de monorresistência foi de 6,6 por cento e 6,9 por cento (p = 0,89), respectivamente, e a de multirresistência, 1,0 por cento e 1,2 por cento (p = 0,85), respectivamente. A prevalência de resistência adquirida como um todo no Distrito Federal e no restante do Brasil foi de 15,8 por cento e 26,8 por cento (p = 0,39), respectivamente. A prevalência de monorresistência adquirida foi de 5,3 por cento e 13,7 por cento (p = 0,33), respectivamente, e a de multirresistência, 0,0 por cento e 10,2 por cento (p = 0,16), respectivamente. CONCLUSÕES: Não houve diferença significativa entre os índices de resistência observados na comunidade usuária do esquema parcialmente intermitente e do diário.

OBJECTIVE: To compare the prevalence rates of drug-resistant Mycobacterium tuberculosis in patients under intermittent treatment with those observed in patients under daily treatment. METHODS: We used World Health Organization data regarding 5,138 patients with active pulmonary TB in Brazil, separated into two groups: patients in the Federal District of Brasília, treated with a one-month daily regimen followed by an intermittent thrice-weekly regimen; and patients in other parts of Brazil, treated with a daily regimen only. The resistance pattern was categorized as primary or acquired, based on the history of previous treatment. Multidrug resistance was defined as resistance to at least isoniazid and rifampin, whereas monoresistance was defined as resistance to only one drug. RESULTS: The prevalence of primary resistance in the Federal District of Brasília and in the other parts of Brazil, respectively, was as follows: overall, 9.2 percent and 9.3 percent (p = 0.94); monoresistance, 6.6 percent and 6.9 percent (p = 0.89); and multidrug resistance, 1.0 percent and 1.2 percent (p = 0.85). The prevalence of acquired resistance in the Federal District of Brasília and in the other parts of Brazil, respectively, was as follows: overall, 15.8 percent and 26.8 percent (p = 0.39); monoresistance, 5.3 percent and 13.7 percent (p = 0.33); and multidrug resistance, 0.0 percent and 10.2 percent (p = 0.16). CONCLUSIONS: No significant differences were found between patients treated with an intermittent regimen and those treated with a daily regimen in term of resistance rates.

¿Contribuyen los programas de prevención y tratamiento de la hipertensión arterial al control de la enfermedad? / Are the hypertension treatment and prevention programs helping to control the disease?

Introducción: la hipertensión arterial (HTA) es una enfermedad silenciosa y progresiva que puede desencadenar daños significativos en un órgano blanco , lo que requiere de acciones de educación para la salud. Objetivo: analizar la opinión que tienen los usuarios de diferentes Empresas Prestadoras de Servicios de Salud (EPS) de Medellín, sobre la contribución de los programas de control de HTA al manejo de la enfermedad y a la modificación de factores de riesgo que permitan su control. Materiales y métodos: estudio descriptivo transversal, se seleccionó una muestra por conveniencia en las EPS participantes. Resultados: el 52% de los usuarios percibe que dejó o disminuyó el consumo de licor por las recomendaciones del programa. De los usuarios que no fumaban al momento de la encuesta, el 42% fueron fumadores y de estos, 26% dejaron de fumar por dichas recomendaciones. El 74% realizaban actividad física y de estos, el 65% afirmaron haberla iniciado por su participación en el programa. En cuanto a la alimentación las recomendaciones que más practicaban los asistentes fueron la disminución en el consumo de grasas (92%), disminución del consumo de sal (91%) y la no adición de sal a las preparaciones (86%). Conclusiones: las actividades de educación para la salud, en opinión de los usuarios, fomentan prácticas cotidianas que contribuyen al manejo y control de la de la HTA.

Background: hypertension is a progressive disease that remains as an asymptomatic disease for a long period of time, causing damage on specific organs like heart, kidney, and blood vessels; for that reason prevention and educational health programs should be implemented. Objective: to analyze, the view that patients have about health service’s hypertension programs that help patients to control and prevent the disease risk factors. Materials and methods: it is a descriptive cross sectional study; the sample was selected in a not probabilistic approach from the participating health services. Results: 52% of the patients perceived that drinking alcohol decreased due to the recommendations given in the program, and also 42 % that were active smokers at the moment of the interview, 26 % quit smoking with those recommendations. 74 % of participants do exercises then 65% told to start work out when they were involved in the program. About food intake 92% of the Participants reported reduction in fat intake, 91% in salt consumption and 86 % decrease salt addition to food. Conclusions: health education activities given to patients help them to take part in their control and prevention of hypertension disease.

El aprendizaje basado en problemas en la formación de profesionales de la salud, Rionegro-Antioquia: 1996 / problems based learning -PBL- in health professional formation

Investigación realizada en el Programa UNI-Rionegro con docentes y estudiantes de enfermería, medicina, odontología, bacteriología, y nutrición y dietética de la Universidad de Antioquia, la cual se trazó como objetivos: Reunir desde una experiencia de enseñanza de Aprendizaje Basado en Problemas -ABP- elementos conceptuales y metodológicos orientados a la construcción de un currículo problematizador, observar resultados en el campo del conocimiento declarativo y en habilidades para resolver problemas, observar resultados de formación interdisciplinaria y detectar fortalezas y debilidades del ABP en esta formación con participación de la comunidad. Como variable independiente operó un tratamiento triple: ABP, interdisciplinariedad, y participación comunitaria. Como variables dependientes se observaron efectos del tratamiento sobre aprendizajes específicos de los participantes, desarrollo de la habilidad de problemas, desempeño del trabajo interdisciplinario, vinculación de la comunidad a la solución de problemas, actitud de estudiantes y docentes frente al método. Las poblaciones para evaluar efectos de las variables dependientes fueron estudiantes y docentes de las profesiones antes mencionadas, y madres comunitarias de los hogares infantiles. Paralelamente a la muestra experimental se seleccionó una muestra control de estudiantes de las mismas carreras y semestres, que asistieron a otros campos de práctica bajo metodologías convencionales. Para obtener información sobre las variables dependientes se construyó una escala de actitudes y una prueba de habilidades.A partir de un problema central los estudiantes generaron subproblemas desde cuatro núcleos: Diagnóstico de hogares infantiles, promoción de la salud, crecimiento y desarrollo de los niños y trabajo interdisciplinario y en equipo. Estos típicos fueron abordados por medio de documentación, observación directa, relacionamiento, explicación y generación de nuevos subproblemas. El diseño metodológico trabajó un esquema mixto cuali-cuantitativo. Para la variable habilidades, se manejó un diseño cuasiexperimental y el análisis final se adelantó entre promedios de ganancias pretest - postest de grupos experimental y control. Para las otras variables se trabajó un diseño cualitativo de construcción de categorídas conceptuales y análisis de las mismas, teniendo como norte los propósitos de la investigación.