Decreased processing speed might account for working memory span deficit in schizophrenia, and might mediate the associations between working memory span and clinical symptoms.

OBJECTIVE: Verbal working memory span is decreased in patients with schizophrenia, and this might contribute to impairment in higher cognitive functions as well as to the formation of certain clinical symptoms. Processing speed has been identified as a crucial factor in cognitive efficiency in this population. We tested the hypothesis that decreased processing speed underlies the verbal working memory deficit in patients and mediates the associations between working memory span and clinical symptoms. METHOD: Forty-nine schizophrenia inpatients recruited from units for chronic and acute patients, and forty-five healthy participants, were involved in the study. Verbal working memory span was assessed by means of the letter-number span. The Digit Copy test was used to assess motor speed, and the Digit Symbol Substitution Test to assess cognitive speed. RESULTS: The working memory span was significantly impaired in patients (F(1,90)=4.6, P<0.05). However, the group difference was eliminated when either the motor or the cognitive speed measure was controlled (F(1,89)=0.03, P=0.86, and F(1,89)=0.03, P=0.88). In the patient group, working memory span was significantly correlated with negative symptoms (r=-0.52, P<0.0001) and thought disorganisation (r=-0.34, P<0.025) scores. Regression analyses showed that the association with negative symptoms was no longer significant when the motor speed measure was controlled (ß=-0.12, P=0.20), while the association with thought disorganisation was no longer significant when the cognitive speed measure was controlled (ß=-0.10, P=0.26). CONCLUSIONS: Decrement in motor and cognitive speed plays a significant role in both the verbal working memory impairment observed in patients and the associations between verbal working memory impairment and clinical symptoms.

[Advanced squamous carcinoma of external ear canal]. / Carcinoma escamoso avanzado de conducto auditivo externo.

Squamous carcinoma of the external ear canal (CEEC) is an uncommon neoplasm which prognostic changes following the tumour spread. Because of its location in ECC as well as the anatomical fissures between osseous and cartilaginous parties it's possible the spread to areas of surgical accessibility complicated restricting the complete tumoral removal. We report one of those cases, when first visited had already meningeal infiltration and was accordingly treated with radiotherapy. Analysis of the case and review of the literature.

Intervención en poblaciones de riesgo (2): los bebedores de riesgo / Interventions in populations at risk (II): risky drinkers

La mayor parte de daños y costes sociosanitarios asociados al alcohol se producen en sujetos consumidores no dependientes. El 9,5% de la población adulta española son bebedores de riesgo. La OMS, mediante el Collaborative Study on Alcohol Early Interventions in Primary Health Care Settings, ha desarrollado una estrategia de detección e intervención precoz en bebedores de riesgo. La primera fase del estudio permitió validar un instrumento de cribado (el cuestionario AUDIT). En la segunda fase se evidenció la efectividad de las intervenciones breves (Drinkless program), y en la tercera se analizaron cuales son las estrategias de marketing y formación para diseminar las intervenciones breves en la atención primaria. La cuarta fase se centra precisamente en la diseminación generalizada de las intervenciones breves en atención primaria. El programa ‘Beveu Menys’ (Beba menos) es la experiencia pionera. Mediante técnicas de formación de formadores y creando una intensa coordinación entre la atención primaria y los centros de drogodependencias, se ha desarrollado un programa que permite abordar tanto a los consumidores de riesgo como a los pacientes con dependencia alcohólica (AU)

Most of the alcohol related harm occurs in non dependent drinkers. 9.5% of spanish adult population are risky drinkers. WHO conducts through the WHO Collaborative Study on Alcohol Early Interventions in Primary Health Care Settings, a cross-national study which aims to develop effective instruments for early detection and brief intervention in risky drinkers. Phase I of the Study was devoted to the design and validation of a screening tool (the AUDIT questionnaire). In Phase II, efficacy of brief interventions (using the Drinkless program) was shown. Phase III focused on marketing and support strategies most efficient to widespread brief interventions in Primary Health Care. Phase IV aims at real dissemination of brief interventions in Primary Health Care. The ‘Beveu Menys’ (Drink less) program is pioneering the experience. Through training the trainers strategies, based on the Skills for change package, and establishing solid coordination between PHC Centres and specialized alcohol units, the program allows general practitioners and nurses to handle with both, risky drinkers and alcoholics (AU)

[The ISCA (Systematic Interview of Alcohol Consumption), a new instrument to detect risky drinking]. / El ISCA (Interrogatorio Sistematizado de Consumos Alcohólicos): un nuevo instrumento para la identificación prematura de bebedores de riesgo.

BACKGROUND: The World Health Organisation Collaborative Project on Alcohol and Primary Health Care has stressed the need to develop standardised screening tools to enable early identification. The aim of this study was to develop a new systematic tool to register alcohol consumption and to validate its usefulness in order to detect risky drinking in primary health care settings. SUBJECTS AND METHOD: The Systematic Interview of Alcohol Consumption (ISCA) was administered together with the Alcohol Use Disorders Identification Test (AUDIT), which was used as main external criterium, to 255 patients who attended 5 primary health care centers. RESULTS: The correlation between both procedures was highly positive and significant (r = 0.831; p < 0.001). The cut-off scores (> 28 for men and > 17 for women) showed an ISCA sensitivity rank to detect risky drinking of 70-81% for men and 46-100% for women. The ISCA specificity ranks were 82-99% and 97-100%, respectively. CONCLUSIONS: The ISCA seems to be useful to detect risky drinking and it is easy to administer by primary health care professionals. ISCA and AUDIT can be used indistinctly and complementarily.