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

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

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

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

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

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

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

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

Asking patients about their general level of functioning: Is IT worth IT for common mental disorders?

Functional disability (FD) is a diagnostic criterion for the psychiatric diagnosis of many mental disorders (e.g. generalized anxiety disorder (GAD); major depressive episode (MDE)). We aimed to assess the contribution of measuring FD to diagnosing GAD and MDE using clinical (Global Assessment of Functioning, GAF) and self-reported methods (Analog scale of functioning, ASF and World Health Organization Disability Assessment Schedule WHODAS 2.0). Patients seeking professional help for mood/anxiety symptoms (N=244) were evaluated. The MINI interview was used to determine the presence of common mental disorders. Symptoms were assessed with two short checklists. Logistic and hierarchical logistic models were used to determine the diagnostic accuracy and the added diagnostic value of FD assessment in detecting GAD and MDE. For GAD, FD alone had a diagnostic accuracy of 0.79 (GAF), 0.79 (ASF) and 0.78 (WHODAS) and for MDE of 0.83, 0.84 and 0.81, respectively. Self-reported measures of FD improved the diagnostic performance of the number of symptoms (4% AUC increase) for GAD, but not for MDE. If assessed before symptom evaluation, FD can discriminate well between patients with and without GAD/MDE. When assessed together with symptoms, self-reported methods improve GAD detection rates.

Concurrent Koro and Cotard syndromes in a Spanish male patient with a psychotic depression and cerebrovascular disease.

Koro and Cotard syndromes are uncommon conditions described in a variety of psychiatric and medical disorders. The authors report the third case of a simultaneous presentation of both syndromes, in a 62-year-old inpatient Spanish male with major depressive disorder with psychotic features, parkinsonism and cognitive impairment. A discussion of the literature and the possible relationship between both syndromes and other neuropsychiatric disorders are presented.

Analysis of the renal transplant waiting list in the País Valencià (Spain).

In this paper we analyse the renal transplant waiting list of the País Valencià in Spain, using Queueing theory. The customers of this queue are patients with end-stage renal failure waiting for a kidney transplant. We set up a simplified model to represent the flow of the customers through the system, and perform Bayesian inference to estimate parameters in the model. Finally, we consider several scenarios by tuning the estimations achieved and computationally simulate the behaviour of the queue under each one. The results indicate that the system could reach equilibrium at some point in the future and the model forecasts a slow decrease in the size of the waiting list in the short and middle term.

Informe de diálisis y trasplante correspondiente al año 2002 de la Sociedad Española de Nefrología y Registros Autonómicos / The year 2002 Spanish Nephrology Society Report on Dialysis and Transplantation and Autonomic Registries

No disponible

[Analysis of survival in dialysis: hemodialysis versus peritoneal dialysis and the significance of comorbidity]. / Análisis de la supervivencia en diálisis: hemodiálisis vs diálisis peritoneal y la importancia de la comorbilidad.

To choose the best possible dialysis technique for those patients with end-stage renal disease continues to be a matter of debate. Even after putting aside the evident influence that economic and geographic factors as well as the health politics may have in the selection of the technique, different studies comparing survival between hemodialysis (HD) and peritoneal dialysis (PD) have shown contradictory results which could be explained by the differing methodological and statistical methods used together with the different influence assigned to the comorbidity found when starting the treatment, a situation that has increased the confusion about this topic. Based on this we performed a retrospective analysis with a follow-up time of seven years including all those patients who started dialytic treatment in our area, with a final number of 3.106 hemodialysis patients and 542 peritoneal dialysis patients. Those patients who were transferred to another treatment technique during the time of the study were excluded. Age higher than 70 years, cardiovascular disease, liver disease, diabetes mellitus and the presence of dyslipidemia were included as comorbidity factors. Peritoneal dialysis patients were younger than those treated by hemodialysis (54.53 vs 60.1 years), but suffered from higher cardiovascular comorbidity and were more often diabetic. The global survival was the same in both groups up to 32 months of treatment. Although no differences were found when comparing those patients without comorbidity factors, those with comorbidity had better survival on hemodialysis. Age higher than 70 years was the only comorbidity factor with statistically significant difference for a better survival in hemodialysis.

Análisis de la supervivencia en diálisis: hemodiálisis vs diálisis peritoneal y la importancia de la comorbilidad / Survival analysis in dialysis: hemodialysis vs peritoneal dialysis and the importance of comorbidity

La indicación de la mejor técnica de diálisis para los pacientes con insuficiencia renal crónica terminal, sigue siendo hoy en día motivo de una amplia discusión. Dejando de lado la influencia que los factores económicos, geográficos o de políticas de salud tienen sobre esta indicación, los estudios de supervivencia comparada entre Hemodiálisis (HD) y Diálisis peritoneal (DP) con resultados contradictorios a favor y en contra de ambas técnicas, solo ha contribuido a crear una mayor confusión. Los diferentes diseños metodológicos, estadísticos y la distinta valoración que de la comorbilidad al inicio del tratamiento se da en cada uno de los trabajos, son algunas de las razones que justifican estas contradicciones. Planteamos un análisis retrospectivo y longitudinal de 7 años de seguimiento, de todos aquellos pacientes incidentes de nuestro entorno que iniciaron programa de diálisis en alguna de las dos posibles modalidades (HD vs DP) y no cambiaron de técnica durante el tiempo del estudio, analizando la comorbilidad al inicio y su impacto sobre la supervivencia. Como factores comórbidos se valoró: ser mayor de 70 años, la patología cardio-vascular, la hepatopatía, la diabetes mellitus y la presencia de dislipemia. Se estudiaron un total de 3.106 pacientes en hemodiálisis y 542 en diálisis peritoneal. Ambos grupos solo presentaron diferencias respecto a su edad media, siendo ésta menor en diálisis peritoneal que en hemodiálisis: 54,53 frente a 60,1 años (p < 0,05). La población en DP presentó una mayor comorbilidad por diabetes mellitus (p: 0,04) y de alteraciones lipídicas, sin evidenciarse diferencias significativas para el resto de factores comórbidos. La supervivencia general resultó prácticamente idéntica entre ambas poblaciones hasta los 32 meses. Tampoco se encontraron diferencias al comparar ambas técnicas respecto a los pacientes con ausencia de comorbilidad, pero su existencia, si supuso mejores supervivencias para los pacientes en hemodiálisis. Del análisis de los diferentes factores comórbidos y su repercusión sobre la supervivencia, solo el ser mayor de 70 años resultó significativo a favor de la hemodiálisis (AU)

[Pilomatrixoma and differential diagnosis of parotid area tumors]. / El pilomatrixoma en el diagnóstico diferencial de los tumores de la región parotídea.

A case report of pilomatrixoma, benign neoplasy, originated of the skin annexes, which localisation force us to rule out a parotid tumor. Our intention is to include the pilomatrixoma among the possible differential diagnosis of calcified masses inside the growths of the parotid gland.

Buschke-Löwenstein tumor and immunity.

We report the case of an alcoholic patient, 41 years old, with negative results of serologic tests for human immunodeficiency virus (HIV) with a perianal Buschke-Löwenstein tumor present for eight years and exceptionally large. The patient's cell-mediated immunity was evaluated by two functional tests: the Multitest IMC (Institut Mérieux, Lyon) and the dinitrochlorobenzene (DNCB) test. The patient neither responded to any Multitest antigens nor was sensitized by DNCB. We consider that the immune short-age in this patient could influence the appearance of the Buschke-Löwenstein tumor.

[Fibrous diaphragm of the nasopharynx]. / Diafragma fibroso de rinofaringe.

A case of nasopharyngeal fibrous diaphragm of unknown origin is reported. In view of the scarcity of publications about this disorder, this new case is interesting. A differential diagnosis is made with choanal atresia and nasopharyngeal stenosis. Aspects of the etiology, clinical manifestations, and treatment are discussed.

[Undifferentiated carcinoma, or lymphoepithelioma, of the base of the tongue]. / Carcinoma indiferenciado o linfoepitelioma de base de lengua.

The histologic features of undifferentiated carcinoma of the base of the tongue and lymphoepithelioma, or lymphoepithelial carcinoma, of the nasopharynx are identical and can be considered synonymous. The frequency of undifferentiated nasopharyngeal carcinoma (lymphoepithelioma) located on the base of the tongue is discussed because undifferentiated carcinoma of the base of the tongue is considered to be the same tumor.