CALMA, a Mobile Health Application, as an Accessory to Therapy for Reduction of Suicidal and Non-Suicidal Self-Injured Behaviors: A Pilot Cluster Randomized Controlled Trial.

The present study was aim to evaluate the acceptability and preliminary effectiveness of a mobile-health application, CALMA, based on dialectical behavioral therapy skills. CALMA was proposed as an adjunct to therapy for the reduction of non-suicidal and suicidal self-injury behaviors. A parallel design was used to compare the intervention group (DBT + CALMA) and the comparison group (DBT). Patients were randomized based on their groups following a randomized cluster design. After treatment, patients completed a follow-up assessment four weeks later. Each cluster was represented by a different DBT Skills Training Group offered weekly at FORO Foundation for Mental Health. Six DBT Skills Training groups were randomized to the intervention or comparison group. Twenty-one individuals met inclusion criteria and eighteen were included in the analysis. Acceptability was measured with the User Experience Questionnaire short version (UEQ-s) and preliminary efficacy with the Self-injurious thoughts and behaviors interview (SITBI). CALMA shows good acceptability to be used as an adjunct to therapy specific to the reduction of suicidal and non-suicidal self-directed violence. Evidence for preliminary efficacy included a high probability of decreased in more behaviors evaluated with the SITBI pre- and post-intervention for the group that received CALMA as compared to the comparison group. Our study provides initial evidence for the effectiveness and acceptability of CALMA. Future studies scaling up this intervention in a larger number of participants are necessary. CALMA may be especially useful in low and middle-income Latin American countries to improve access to evidence-based interventions openly available in Spanish and free to download.HighlightsCALMA is a DBT-based app aimed to reduce non-suicidal and suicidal self-directed violence.The app showed good acceptability by usersA high probability of decrease in suicidal ideation, suicidal plan, suicidal gesture, thoughts about NSSI and NSSI pre- and post-intervention was observed.

The history of multiple adverse childhood experiences in patients with schizophrenia is associated with more severe symptomatology and suicidal behavior with gender-specific characteristics.

The current study aims to compare the prevalence of adverse childhood experiences (ACEs) between patients with schizophrenia and non-psychiatric control group, and to analyze the association of having suffered multiple ACEs with clinical symptoms of schizophrenia and suicidal behavior. A multicenter, cross-sectional study was conducted across three facilities in Buenos Aires, Argentina. One-hundred patients with schizophrenia and 50 healthy subjects were assessed with the Adverse Childhood Experiences questionnaire (ACE-Q), the Positive and Negative Syndrome Scale (PANSS), and the Columbia-Suicide Severity Rating Scale (C-SSRS). We observed that the prevalence of at least one ACE in schizophrenic patients was almost double in comparison with the non-psychiatric control group. Multiple ACEs were associated with persistent auditory hallucinations and lower negative symptoms in both sexes. Higher frequency of death ideation and a higher number of suicide attempts were reported among women. The strength of this study is the possibility of comparing the presence of ACEs between schizophrenic patients and non-psychiatric control using the same questionnaire in an under-reported sample of low socio-economic patients assisted in public hospitals. A limitation is that the history of ACEs relied on the retrospective assessment of childhood experiences, and adults could over-report ACEs because of recall bias.

[Is it necessary to have advanced statistical knowledge to access medical literacy?] / ¿Es necesario tener conocimientos avanzados de estadística para acceder a las publicaciones médicas?

The introduction of statistical analysis in biomedical journals should be attributed to Dunn and Greenwood in the 1930s, who reflect the concepts of statistical analysis and interpretation. The aim of this study was to analyze the use of different statistical tests and the level of accessibility analysis-dependent and article-dependent of the original articles published in the journal Medicina (B Aires) in the period 2008-2017. A bibliometric, descriptive, observational, cross-sectional study was carried out, in which the original articles were evaluated according to the scale proposed by Mora Ripoll et al. From the 301 articles in Spanish reviewed, 96% presented statistical analyses. Among the 215 articles that used some inferential statistics technique, 49.7% used the chi-square test, z tests for proportions, the Fisher exact test or the McNemar test; 29.2% used student t-tests and z-tests, including the use of these techniques or the use of confidence intervals for medium-conformance contrasts, and/or median-homogeneity (two samples), in paired or independent samples. The results indicate that a reader who knows about the tests included in Level II will have statistical access to 75% of the original articles published. It was found that it is not necessary to have advanced knowledge of statistics to access most publications, but it is important that these contents are developed with emphasis on statistical reasoning over the application and use of software or the choice of the appropriate test.

La introducción de análisis estadísticos en revistas biomédicas debe atribuirse a Dunn y a Gree wood en la década del 30, quienes reflejan los conceptos del análisis e interpretación estadística. El objetivo del trabajo fue analizar la utilización de distintas pruebas estadísticas y el grado de accesibilidad análisis-dependiente y artículo-dependiente de los artículos originales publicados en la revista Medicina (B Aires) en el período 2008-2017. Se realizó un estudio bibliométrico, descriptivo, observacional, de corte transversal, en el cual se incluyeron los artículos originales que fueron evaluados de acuerdo a la escala propuesta por Mora Ripoll y col. Se revisaron 301 artículos en idioma español, el 96% presentó análisis estadísticos. Entre los 215 artículos que emplearon alguna técnica de estadística inferencial, el 49.7% utilizó la prueba chi-cuadrado, pruebas z para proporciones, el test exacto de Fisher o prueba de McNemar. El 29.2% empleó pruebas t de student y pruebas z, incluyendo el uso de estas técnicas o de intervalos de confianza para contrastes de conformidad de medianas, y/o homogeneidad de medianas (dos muestras), en muestras apareadas o independientes. Los resultados indican que un lector conocedor de las pruebas incluidas en el Nivel II tendrá acceso estadístico al 75% de los artículos originales publicados. Se comprobó que no es necesario tener conocimientos avanzados de estadística para acceder a la mayoría de las publicaciones, pero sí es importante que estos contenidos sean desarrollados haciendo hincapié en el razonamiento estadístico por sobre la aplicación y utilización de software o la elección del test adecuado.

¿ Es necesario tener conocimientos avanzados de estadística para acceder a las publicaciones módicas? / Is it necessary to have advanced statistical knowledge to access medical literacy?

La introducció;n de análisis estadísticos en revistas biomó;©dicas debe atribuirse a Dunn y a Greewood en la dó;©cada del 30, quienes reflejan los conceptos del análisis e interpretació;n estadística. El objetivo del trabajo fue analizar la utilizació;n de distintas pruebas estadísticas y el grado de accesibilidad análisis-dependiente y artículo-dependiente de los artículos originales publicados en la revista Medicina (B Aires) en el período 2008-2017. Se realizó; un estudio bibliomó;©trico, descriptivo, observacional, de corte transversal, en el cual se incluyeron los artículos originales que fueron evaluados de acuerdo a la escala propuesta por Mora Ripoll y col. Se revisaron 301 artículos en idioma espaó;±ol, el 96% presentó; análisis estadísticos. Entre los 215 artículos que emplearon alguna tó;©cnica de estadística inferencial, el 49.7% utilizó; la prueba chi-cuadrado, pruebas z para proporciones, el test exacto de Fisher o prueba de McNemar. El 29.2% empleó; pruebas t de student y pruebas z, incluyendo el uso de estas tó;©cnicas o de intervalos de confianza para contrastes de conformidad de medianas, y/o homogeneidad de medianas (dos muestras), en muestras apareadas o independientes. Los resultados indican que un lector conocedor de las pruebas incluidas en el Nivel II tendrá acceso estadístico al 75% de los artículos originales publicados. Se comprobó; que no es necesario tener conocimientos avanzados de estadística para acceder a la mayoría de las publicaciones, pero sí es importante que estos contenidos sean desarrollados haciendo hincapí en el razonamiento estadístico por sobre la aplicació;n y utilizació;n de software o la elecció;n del test adecuado.

The introduction of statistical analysis in biomedical journals should be attributed to Dunn and Greenwood in the 1930s, who reflect the concepts of statistical analysis and interpretation. The aim of this study was to analyze the use of different statistical tests and the level of accessibility analysis-dependent and article-dependent of the original articles published in the journal Medicina (B Aires) in the period 2008-2017. A bibliometric, descriptive, observational, cross-sectional study was carried out, in which the original articles were evaluated according to the scale proposed by Mora Ripoll et al. From the 301 articles in Spanish reviewed, 96% presented statistical analyses. Among the 215 articles that used some inferential statistics technique, 49.7% used the chi-square test, z tests for proportions, the Fisher exact test or the McNemar test; 29.2% used student t-tests and z-tests, including the use of these techniques or the use of confidence intervals for medium-conformance contrasts, and /or median-homogeneity (two samples), in paired or independent samples. The results indicate that a reader who knows about the tests included in Level II will have statistical access to 75% of the original articles published. It was found that it is not necessary to have advanced knowledge of statistics to access most publications, but it is important that these contents are developed with emphasis on statistical reasoning over the application and use of software or the choice of the appropriate test.

Prevalence of potentially inappropriate medications in older adults in Argentina using Beers criteria and the IFAsPIAM List.

Background Medications in which the risk of adverse events exceeds the expectations of clinical benefits are called potentially inappropriate medications (PIMs). To identify the use of PIMs in elderly patients, the most commonly used tool are the Beers criteria, developed for the population of the United States. Recently, a consensus panel of Argentine experts developed the first Latin American tool, called the IFAsPIAM List. Objective The present study aimed to identify PIM prescriptions in elderly outpatients, to estimate the prevalence of PIMs, and to evaluate their possible relation with polypharmacy and gender and age of the patients. Also, we aimed to compare the results obtained by using the Beers criteria and the IFAsPIAM List. Setting Ten community pharmacies of Rosario, Santa Fe, Argentina. Methods A cross-sectional observational study was conducted between February and September 2015. Data were acquired from 56,952 prescriptions prescribed to 2231 patients aged 65 years old or older. To detect the use of PIMs, we used two tools: the Beers criteria and the IFAsPIAM List. Main outcome measure The prevalence of PIM use according to the Beers criteria and the IFAsPIAM List. Results The monthly average of medications dispensed per patient was 4.35 ± 2.18 and 42.27% of the patients presented major polypharmacy. The prevalence of PIMs was 72.75% according to the Beers criteria and 71.13% according to the IFAsPIAM List (Kappa coefficient k = 0.72), and was significantly higher in patients with major polypharmacy, older than 75 years old, and females. The most frequent PIMs prescribed were anxiolytics, analgesics and antipsychotics. Conclusions The IFAsPIAM List is an effective tool to evaluate the prescription of PIMs in the elderly. The results showed a high prevalence of PIMs with a multicausal origin and directly associated with polypharmacy. As clarified by the authors of the IFAsPIAM List, the criteria specified in the list do not substitute the clinical evaluation of each patient.

Potentially Inappropriate Medications in Elderly Ambulatory Patients: A Comparative Study between a Primary Health Care Center and a Community Pharmacy.

OBJECTIVE: This study aims to compare, both qualitatively and quantitatively, the medication dispensed to elderly patients in a primary health care center (PHC) and a community pharmacy (CP) in Argentina and to identify the prescription of potentially inappropriate medications (PIMs). METHODS: A cross-sectional observational study. Data were acquired from 886 prescriptions in the PHC and 2368 in the CP between February and April 2015. Dispensed medications were coded according to the Anatomical, Therapeutic, and Chemical (ATC) classification system. The frequency of prescriptions for each of them was determined. The number and monthly average of drugs dispensed were calculated for each patient. The use of PIMs was identified using Beers Criteria. RESULTS: In both institutions, the means of medications dispensed per individual and month were similar: 3.69 ± 1.93 in the PHC and 3.46 ± 2.18 in the CP. Most of the medications corresponded to cardiovascular system agents. In the CP, 111 prescriptions (4.69%) dispensed to 51 patients (19.39%) were identified as PIMs. In the PHC, 72 prescriptions (8.13%) dispensed to 27 patients (28.42%) were identified as PIMs. In patients with major polymedication the possibility of consuming these drugs was 2.55 times higher in the CP and 2.60 times higher in the PHC. The percentage of PIM prescriptions was significantly higher in the PHC, although the percentage of patients receiving them did not differ significantly. CONCLUSIONS: The prevalence of PIMs found in this population is relevant enough to implement measures that address the problem in an integral way, to improve the quality of prescriptions and the health outcomes of patients.