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1.
J Affect Disord ; 284: 104-113, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592428

RESUMEN

BACKGROUND: The relationship between adolescent depressive symptoms and academic achievement remains poorly understood. The aim of this study was to help clarify the nature and directionality of this association. METHODS: We used a sample of 13,599 British adolescents (main sample of N=3,809 participants). We fitted cross-lagged panel models using four repeated measures of self-reported depressive symptoms and four measures of academic achievement based on British national records between 11-18 years, separately for male and female adolescents and considering polygenic risk scores (PRS) for educational attainment and depression, alongside other child and parental covariates. RESULTS: We found evidence of an overall negative association that was stronger in boys (R=-0.21, 95% CI -0.31 to -0.11) than in girls (-0.13, -0.31 to 0.05). Higher depressive symptoms were associated with lower academic achievement at a later stage up to the end of compulsory education (16 years), when the direction of the association reversed, although girls with lower achievement also appeared vulnerable to depressive symptoms at previous stages. The genetic variables derived for this study showed stronger associations for academic achievement, but the PRS for depression also showed a negative association with academic achievement in girls. Child intelligence quotient and peer victimization also showed relevant associations. LIMITATIONS: Observational design, variation around measurement times, missing data. CONCLUSIONS: Depressive symptoms and academic achievement should be considered jointly when designing school-based programmes for children and adolescents, alongside gender, child ability and school experience. Including genetic information in research can help to disentangle average from time-varying effects.

2.
PLoS One ; 15(11): e0242437, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33211766

RESUMEN

INTRODUCTION: Adverse childhood experiences (ACE) have been recognized as an important risk factor for suicidal behaviour among adults, but evidence from low and middle-income countries is lacking. This study explored associations between ACE and hospital admission due to non-fatal self-poisoning in Sri Lanka. METHODS: This was a case-control study. Adults admitted to a tertiary care hospital for medical management of self-poisoning were included as cases, and age and sex matched controls were recruited from the outpatient department. ACE were measured using the World Health Organization's Childhood Adversity Scale. Logistic regression models adjusting for age, sex, ethnicity, and religion were used to quantify the association between ACE and self-poisoning. RESULTS: The study included 235 cases and 451 controls. Cases were 2.5 times (95% CI 1.8, 3.6) more likely to report an ACE than controls and had higher ACE scores. Childhood physical abuse (OR 4.7, 95% CI 1.2, 19.0) and emotional abuse or neglect (OR 3.7, 95% CI 1.3, 10.1, and 3.7, 95% CI 2.3, 6.0 respectively), increased the risk of self-poisoning in adulthood, as did witnessing household violence (OR 2.2, 95% CI 1.4, 3.4), growing up in a household with a mentally ill or suicidal household member (OR 2.1, 95% CI 1.2, 3.4), and experiencing parental death/separation/divorce (OR 3.1, 95% CI 2.0, 4.9) as a child. CONCLUSIONS: Reducing exposures to ACEs should be a priority for prevention of suicide and self-harm in Sri Lanka. Innovative methods to increase support for children facing adversity should be explored.

3.
BMJ ; 371: m3934, 2020 11 25.
Artículo en Inglés | MEDLINE | ID: mdl-33239318

RESUMEN

OBJECTIVE: To determine the most effective interventions in recently detoxified, alcohol dependent patients for implementation in primary care. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: Medline, Embase, PsycINFO, Cochrane CENTRAL, ClinicalTrials.gov, and the World Health Organization's International Clinical Trials Registry Platform. STUDY SELECTION: Randomised controlled trials comparing two or more interventions that could be used in primary care. The population was patients with alcohol dependency diagnosed by standardised clinical tools and who became detoxified within four weeks. DATA EXTRACTION: Outcomes of interest were continuous abstinence from alcohol (effectiveness) and all cause dropouts (as a proxy for acceptability) at least 12 weeks after start of intervention. RESULTS: 64 trials (43 interventions) were included. The median probability of abstinence across placebo arms was 25%. Compared with placebo, the only intervention associated with increased probability of abstinence and moderate certainty evidence was acamprosate (odds ratio 1.86, 95% confidence interval 1.49 to 2.33, corresponding to an absolute probability of 38%). Of the 62 included trials that reported all cause dropouts, interventions associated with a reduced number of dropouts compared with placebo (probability 50%) and moderate certainty of evidence were acamprosate (0.73, 0.62 to 0.86; 42%), naltrexone (0.70, 0.50 to 0.98; 41%), and acamprosate-naltrexone (0.30, 0.13 to 0.67; 17%). Acamprosate was the only intervention associated with moderate confidence in the evidence of effectiveness and acceptability up to 12 months. It is uncertain whether other interventions can help maintain abstinence and reduce dropouts because of low confidence in the evidence. CONCLUSIONS: Evidence is lacking for benefit from interventions that could be implemented in primary care settings for alcohol abstinence, other than for acamprosate. More evidence from high quality randomised controlled trials is needed, as are strategies using combined interventions (combinations of drug interventions or drug and psychosocial interventions) to improve treatment of alcohol dependency in primary care. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016049779.

4.
Syst Rev ; 9(1): 244, 2020 10 19.
Artículo en Inglés | MEDLINE | ID: mdl-33076982

RESUMEN

BACKGROUND: Internalising problems, such as depression and anxiety, are common and represent an important economical and societal burden. The effectiveness of parenting interventions in reducing the risk of internalising problems in children and adolescents has not yet been summarised. The aims of this review are to assess the effectiveness of parenting interventions in the primary, secondary and tertiary prevention of internalising problems in children and adolescents and to determine which intervention components and which intervention aspects are most effective for reducing the risk of internalising problems in children and adolescents. METHODS: Electronic searches in OVID SP versions of MEDLINE, EMBASE and PsycINFO; Cochrane Central Register of Controlled Trials; EBSCO version of ERIC and ClinicalTrials.gov have been performed to identify randomised controlled trials or quasi-randomised controlled trials of parenting interventions. At least two independent researchers will assess studies for inclusion and extract data from each paper. The risk of bias assessment will be conducted independently by two reviewers using the Cochrane Collaboration's Risk of Bias Assessment Tool. Statistical heterogeneity is anticipated given potential variation in participant characteristics, intervention type and mode of delivery, and outcome measures. Random effects models, assuming a common between-study variability, will be used to account for statistical heterogeneity. Results will be analysed using a network meta-analysis (NMA). If appropriate, we will also conduct a component-level NMA, where the 'active ingredients' of interventions are modelled using a network meta-regression approach. DISCUSSION: Preventing and reducing internalising problems could have major beneficial effects at the economic and societal level. Informing policy makers on the effectiveness of parenting interventions and on which intervention's component is driving the effect is important for the development of treatment strategies. SYSTEMATIC REVIEW REGISTRATION: International Prospective Register for Systematic Reviews (PROSPERO) number CRD42020172251.

5.
Membranes (Basel) ; 10(10)2020 Oct 05.
Artículo en Inglés | MEDLINE | ID: mdl-33027973

RESUMEN

Popularity of hollow fiber-supported liquid membranes (HF-SLM) for liquid-phase microextraction (HF-LPME) has increased in the last decades. In particular, HF-SLM are applied for sample treatment in the determination and speciation of metals. Up to the date, optimization of preconcentration systems has been focused on chemical conditions. However, criteria about fiber selection are not reflected in published works. HFs differ in pore size, porosity, wall thickness, etc., which can affect efficiency and/or selectivity of chemical systems in extraction of metals. In this work, Ag+ transport using tri-isobutylphosphine sulfide (TIBPS) has been used as a model to evaluate differences in metal transport due to the properties of three different fibers. Accurel PP 50/280 fibers, with a higher effective surface and smaller wall thickness, showed the highest efficiency for metal transport. Accurel PP Q3/2 exhibited intermediate efficiency but easier handling and, finally, Accurel PP S6/2 fibers, with a higher wall thickness, offered poorer efficiency but the highest stability and capability for metal speciation. Summarizing, selection of the polymeric support of HF-SLM is a key factor in their applicability of LPME for metals in natural waters.

6.
Anal Bioanal Chem ; 412(8): 1863-1870, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31975154

RESUMEN

Hollow fibre-supported liquid membrane was used for Cu fractionation in marine waters, using di-2-pyridylketone benzoylhydrazone (dPKBH) as a carrier due to its capacity to transport dissolved inorganic Cu at natural seawater pH. Optimized conditions were dPKBH (0.5 mmol L-1), HNO3 (0.5 mol L-1) as acceptor agent, extraction time of 120 min and stirring speed of 800 rpm. Additionally, the selectivity of the method for the extraction of the inorganic Cu fraction was validated by comparing the experimental results with theoretical data, and a mathematical model was obtained for estimation of Cu linked to dissolved organic matter. The method was applied for the measurement of Cu fractions in real seawater samples. Results were successfully compared with the reference material BCR 403 and recovery analysis in waters from the Gulf of Cádiz, showing that it could be used as a simple approach for the study of different Cu fractions in marine waters. Graphical abstract.

7.
Res Synth Methods ; 11(1): 91-104, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31330089

RESUMEN

This paper considers the problem in aggregate data meta-analysis of studies reporting multiple competing binary outcomes and of studies using different summary formats for those outcomes. For example, some may report numbers of patients with at least one of each outcome while others may report the total number of such outcomes. We develop a shared parameter model on hazard ratio scale accounting for different data summaries and competing risks. We adapt theoretical arguments from the literature to demonstrate that the models are equivalent if events are rare. We use constructed data examples and a simulation study to find an event rate threshold of approximately 0.2 above which competing risks and different data summaries may bias results if no adjustments are made. Below this threshold, simpler models may be sufficient. We recommend analysts to consider the absolute event rates and only use a simple model ignoring data types and competing risks if all of underlying events are rare (below our threshold of approximately 0.2). If one or more of the absolute event rates approaches or exceeds our informal threshold, it may be necessary to account for data types and competing risks through a shared parameter model in order to avoid biased estimates.


Asunto(s)
Metaanálisis como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento , Administración Oral , Algoritmos , Anticoagulantes/uso terapéutico , Infecciones Asintomáticas , Fibrilación Atrial/tratamiento farmacológico , Simulación por Computador , Dabigatrán/efectos adversos , Hemorragia/inducido químicamente , Humanos , Funciones de Verosimilitud , Motivación , Infarto del Miocardio/inducido químicamente , Oportunidad Relativa , Modelos de Riesgos Proporcionales , Factores de Riesgo , Accidente Cerebrovascular/inducido químicamente , Accidente Cerebrovascular/prevención & control , Warfarina/efectos adversos
8.
BJPsych Open ; 6(1): e6, 2019 Dec 12.
Artículo en Inglés | MEDLINE | ID: mdl-31829293

RESUMEN

BACKGROUND: Depressive symptoms show different trajectories throughout childhood and adolescence that may have different consequences for adult outcomes. AIMS: To examine trajectories of childhood depressive symptoms and their association with education and employment outcomes in early adulthood. METHOD: We estimated latent trajectory classes from participants with repeated measures of self-reported depressive symptoms between 11 and 24 years of age and examined their association with two distal outcomes: university degree and those not in employment, education or training at age 24. RESULTS: Our main analyses (n = 9399) yielded five heterogenous trajectories of depressive symptoms. The largest group found (70.5% of participants) had a stable trajectory of low depressive symptoms (stable-low). The other four groups had symptom profiles that reached full-threshold levels at different developmental stages and for different durations. We identified the following groups: childhood-limited (5.1% of participants) with full-threshold symptoms at ages 11-13; childhood-persistent (3.5%) with full-threshold symptoms at ages 13-24; adolescent onset (9.4%) with full-threshold symptoms at ages 17-19; and early-adult onset (11.6%) with full-threshold symptoms at ages 22-24. Relative to the majority 'stable-low' group, the other four groups all exhibited higher risks of one or both adult outcomes. CONCLUSIONS: Accurate identification of depressive symptom trajectories requires data spanning the period from early adolescence to early adulthood. Consideration of changes in, as well as levels of, depressive symptoms could improve the targeting of preventative interventions in early-to-mid adolescence.

9.
Lancet Psychiatry ; 6(12): 1011-1020, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31734106

RESUMEN

BACKGROUND: Rates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in children and young people, with schools at the forefront of implementation. There is limited information for the comparative effectiveness of the multiple interventions available. METHODS: We did a systematic review and network meta-analysis, searching MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled trials for published and unpublished, passive and active-controlled randomised and quasi-randomised trials. We included educational setting-based, universal, or targeted interventions in which the primary aim was the prevention of anxiety and depression in children and young people aged 4-18 years. Primary outcomes were post-intervention self-report anxiety and depression, wellbeing, suicidal ideation, or self-harm. We assessed risk of bias following the Cochrane Handbook for Systematic Reviews of Interventions. We estimated standardised mean differences (SMD) using random effects network meta-analysis in a Bayesian framework. The study is registered with PROPSERO, number CRD42016048184. FINDINGS: 1512 full-text articles were independently screened for inclusion by two reviewers, from which 137 studies of 56 620 participants were included. 20 studies were assessed as being at low risk of bias for both random sequence generation and allocation concealment. There was weak evidence to suggest that cognitive behavioural interventions might reduce anxiety in primary and secondary settings. In universal secondary settings, mindfulness and relaxation-based interventions showed a reduction in anxiety symptoms relative to usual curriculum (SMD -0·65, 95% credible interval -1·14 to -0·19). There was a lack of evidence to support any one type of intervention being effective to prevent depression in universal or targeted primary or secondary settings. Comparison-adjusted funnel plots suggest the presence of small-study effects for the universal secondary anxiety analysis. Network meta-analysis was not feasible for wellbeing or suicidal ideation or self-harm outcomes, and results are reported narratively. INTERPRETATION: Considering unclear risk of bias and probable small study effects for anxiety, we conclude there is little evidence that educational setting-based interventions focused solely on the prevention of depression or anxiety are effective. Future research could consider multilevel, systems-based interventions as an alternative to the downstream interventions considered here. FUNDING: UK National Institute for Health Research.


Asunto(s)
Ansiedad/prevención & control , Depresión/prevención & control , Metaanálisis en Red , Servicios de Salud Escolar , Adolescente , Ansiedad/terapia , Niño , Preescolar , Terapia Cognitivo-Conductual , Depresión/terapia , Humanos , Ideación Suicida
10.
MDM Policy Pract ; 4(2): 2381468319866828, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31453363

RESUMEN

Objectives. Determine the optimal, licensed, first-line anticoagulant for prevention of ischemic stroke in patients with non-valvular atrial fibrillation (AF) in England and Wales from the UK National Health Service (NHS) perspective and estimate value to decision making of further research. Methods. We developed a cost-effectiveness model to compare warfarin (international normalized ratio target range 2-3) with directly acting (or non-vitamin K antagonist) oral anticoagulants (DOACs) apixaban 5 mg, dabigatran 150 mg, edoxaban 60 mg, and rivaroxaban 20 mg, over 30 years post treatment initiation. In addition to death, the 17-state Markov model included the events stroke, bleed, myocardial infarction, and intracranial hemorrhage. Input parameters were informed by systematic literature reviews and network meta-analysis. Expected value of perfect information (EVPI) and expected value of partial perfect information (EVPPI) were estimated to provide an upper bound on value of further research. Results. At willingness-to-pay threshold £20,000, all DOACs have positive expected incremental net benefit compared to warfarin, suggesting they are likely cost-effective. Apixaban has highest expected incremental net benefit (£7533), followed by dabigatran (£6365), rivaroxaban (£5279), and edoxaban (£5212). There was considerable uncertainty as to the optimal DOAC, with the probability apixaban has highest net benefit only 60%. Total estimated population EVPI was £17.94 million (17.85 million, 18.03 million), with relative effect between apixaban versus dabigatran making the largest contribution with EVPPI of £7.95 million (7.66 million, 8.24 million). Conclusions. At willingness-to-pay threshold £20,000, all DOACs have higher expected net benefit than warfarin but there is considerable uncertainty between the DOACs. Apixaban had the highest expected net benefit and greatest probability of having highest net benefit, but there is considerable uncertainty between DOACs. A head-to-head apixaban versus dabigatran trial may be of value.

11.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(4): 173-178, jul.-ago. 2019. ilus, tab
Artículo en Inglés | IBECS | ID: ibc-183583

RESUMEN

Background: The classic surgical spinal dural closure technique in surgery on intradural lesions is performed with continuous suture or loose stitches using 4-0 to 6-0 polypropylene monofilament or nylon suture. Dural closure with suture causes irritant damage to the dural/arachnoid interface. The penetrating suture causes new dural holes. Even the needle of the suture can cause harm to the patient and the surgeon. For these reasons, other non-penetrating techniques for dural closure have been sought. Objective: The purpose of this review was to show the efficacy of using the titanium clip (U-clip) (Ligaclip-MCA of Ethicon Endo-Surgery, LLC, Medical GmbH, Norderstedt, Germany) with a flat internal surface in spinal neurosurgical procedures, and to evaluate the effects of its use on post-operative magnetic resonance imaging (MRI). Methods: We performed a retrospective analysis of a cohort of 50 consecutive patients who underwent intradural spinal surgeries for intradural spinal lesions in the neurosurgery department of our institution between 2013 and 2018. Results: The mean follow-up period was 27 months. No patient developed a post-operative cerebrospinal fluid (CSF) dural-cutaneous fistula. CSF leakage was not observed in the control MRIs at 6 weeks. Conclusions: We describe, for the first time, the use of this type of U-clip with a flat inner side. The non-penetrating titanium U-clip facilitates effective and rapid dural closure at all spinal levels due to its flat internal face when closed. The U-clips did not cause significant artefacts or distortions on the magnetic resonance imaging


Introducción: La técnica quirúrgica clásica de cierre de la duramadre espinal en cirugía en lesiones intradurales se realiza con sutura continua o puntos sueltos usando monofilamento de polipropileno 4-0 a 6-0 o sutura de nylon. El cierre dural con sutura causa daño irritante a la interfaz dural/aracnoidea. La sutura penetrante causa nuevos agujeros durales. Incluso la aguja de la sutura puede causar daño al paciente y al cirujano. Por estas razones, se han buscado otras técnicas no penetrantes para el cierre de la duramadre. Objetivo: El propósito de esta revisión fue mostrar la eficacia del uso del clip de titanio (U-Clip(R)) (Ligaclip MCA de Ethicon Endo-Surgery, LLC, Medical GmbH, Norderstedt, Alemania) con una superficie interna plana en procedimientos neuroquirúrgicos espinales, y para evaluar los efectos de su uso en los controles de resonancia magnética (RM) postoperatoria. Métodos: Se realizó un análisis retrospectivo de una cohorte de 50 pacientes consecutivos que se sometieron a cirugías intradurales espinales en el departamento de neurocirugía de nuestra institución entre 2013 y 2018. Resultados: El período medio de seguimiento fue de 27 meses. Ningún paciente desarrolló fístula dural-cutánea del líquido cefalorraquídeo (LCR) postoperatoria. No se observó fuga del LCR en las RM de control a las 6 semanas. Conclusiones: Describimos, por primera vez, el uso de este tipo U-Clip(R) con un lado interior plano. El U-Clip(R) de titanio no penetrante facilita el cierre dural efectivo y rápido en todos los niveles espinales debido a su cara interna plana cuando está cerrado. Los U-Clip(R) no causaron artefactos o distorsiones significativas en la RM


Asunto(s)
Humanos , Duramadre/cirugía , Técnicas de Sutura , Pérdida de Líquido Cefalorraquídeo/cirugía , Procedimientos Neuroquirúrgicos/métodos , Estudios Retrospectivos , Estudios de Cohortes , Anastomosis Quirúrgica
12.
JAMA Netw Open ; 2(6): e196587, 2019 06 05.
Artículo en Inglés | MEDLINE | ID: mdl-31251383

RESUMEN

Importance: Less favorable trajectories of depressive mood from adolescence to early adulthood are associated with current and later psychopathology, impaired educational attainment, and social dysfunction, yet the genetic and environmental risk factors associated with these trajectories are not fully established. Examining what risk factors are associated with different trajectories of depressive mood could help identify the nature of depression symptoms and improve preventive interventions for those at most risk. Objective: To examine the differential associations of genetic and environmental risk factors with trajectories of depression symptoms among individuals observed from ages 10 to 24 years. Design, Setting, and Participants: In a longitudinal cohort study established in 1990 and currently ongoing (the Avon Longitudinal Study of Parents and Children [ALSPAC]), growth mixture modeling was used to identify trajectories of depression symptoms in 9394 individuals in the United Kingdom. Associations of different risk factors with these trajectories were then examined. Analysis was conducted between August 2018 and January 2019. Main Outcomes and Measures: Trajectories were composed from depression symptoms measured using the Short Mood and Feelings Questionnaire at 9 occasions from ages 10 to 24 years. Risk factors included sex, a polygenic risk score taken from a recent genome-wide association study of depression symptoms, maternal postnatal depression, partner cruelty to the offspring's mother when the child was aged 2 to 4 years, childhood anxiety at age 8 years, and being bullied at age 10 years. Results: Data on all risk factors, confounders, and the outcome were available for 3525 individuals, including 1771 (50.2%) who were female. Trajectories were assessed between the mean (SD) age of 10.7 (0.3) years and mean (SD) age of 23.8 (0.5) years. Overall, 5 distinct trajectories of depression symptoms were identified: (1) stable low (2506 individuals [71.1%]), (2) adolescent limited (325 individuals [9.2%]), (3) childhood limited (203 individuals [5.8%]), (4) early-adult onset (393 individuals [11.1%]), and (5) childhood persistent (98 individuals [2.8%]). Of all the associations of risk factors with trajectories, sex (odds ratio [OR], 6.45; 95% CI, 2.89-14.38), the polygenic risk score for depression symptoms (OR, 1.47; 95% CI, 1.10-1.96), and childhood anxiety (OR, 1.30; 95% CI, 1.16-1.45) showed the strongest association with the childhood-persistent trajectory of depression symptoms compared with the stable-low trajectory. Maternal postnatal depression (OR, 2.39; 95% CI, 1.41-4.07) had the strongest association with the early-adult-onset trajectory, while partner cruelty to mother (OR, 2.30; 95% CI, 1.36-3.90) had the strongest association with the adolescent-limited trajectory. Bullying (OR, 8.08; 95% CI, 4.92-13.26) showed the strongest association with the childhood-limited trajectory. Conclusions and Relevance: The least favorable trajectories of depression symptoms (childhood persistent and early-adult onset) were associated with both genetic and environmental risk factors, but the 2 trajectories of limited duration that had resolved by early adulthood (childhood limited and adolescent limited) were not associated with the polygenic risk score or maternal postnatal depression. Bullying was strongly associated with both the childhood-persistent and childhood-limited trajectories, suggesting that this risk factor may have a time-specific effect. These findings suggest that examining genetic and multiple time-specific environmental antecedents could help identify trajectories of varying onset and chronicity.


Asunto(s)
Depresión Posparto/psicología , Depresión/genética , Responsabilidad Parental/psicología , Padres/psicología , Adolescente , Niño , Depresión/epidemiología , Depresión/psicología , Femenino , Interacción Gen-Ambiente , Estudio de Asociación del Genoma Completo , Humanos , Estudios Longitudinales , Masculino , Psicopatología , Factores de Riesgo , Reino Unido/epidemiología , Adulto Joven
13.
Psychol Med ; 49(12): 1937-1947, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31179960

RESUMEN

Cognitive-behavioural therapy (CBT) is an effective treatment for depressed adults. CBT interventions are complex, as they include multiple content components and can be delivered in different ways. We compared the effectiveness of different types of therapy, different components and combinations of components and aspects of delivery used in CBT interventions for adult depression. We conducted a systematic review of randomised controlled trials in adults with a primary diagnosis of depression, which included a CBT intervention. Outcomes were pooled using a component-level network meta-analysis. Our primary analysis classified interventions according to the type of therapy and delivery mode. We also fitted more advanced models to examine the effectiveness of each content component or combination of components. We included 91 studies and found strong evidence that CBT interventions yielded a larger short-term decrease in depression scores compared to treatment-as-usual, with a standardised difference in mean change of -1.11 (95% credible interval -1.62 to -0.60) for face-to-face CBT, -1.06 (-2.05 to -0.08) for hybrid CBT, and -0.59 (-1.20 to 0.02) for multimedia CBT, whereas wait list control showed a detrimental effect of 0.72 (0.09 to 1.35). We found no evidence of specific effects of any content components or combinations of components. Technology is increasingly used in the context of CBT interventions for depression. Multimedia and hybrid CBT might be as effective as face-to-face CBT, although results need to be interpreted cautiously. The effectiveness of specific combinations of content components and delivery formats remain unclear. Wait list controls should be avoided if possible.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Trastorno Depresivo Mayor/terapia , Multimedia , Adulto , Depresión/terapia , Humanos , Metaanálisis en Red , Ensayos Clínicos Controlados Aleatorios como Asunto , Listas de Espera
14.
Int J Epidemiol ; 48(6): 2001-2009, 2019 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-31071211

RESUMEN

BACKGROUND: Many studies have examined 'non-specific' vaccine effects on infant mortality: attention has been particularly drawn to diphtheria-tetanus-pertussis (DTP) vaccine, which has been proposed to be associated with an increased mortality risk. Both right and left censoring are common in such studies. METHODS: We conducted simulation studies examining right censoring (at measles vaccination) and left censoring (by excluding early follow-up) in a variety of scenarios in which confounding was and was not present. We estimated both unadjusted and adjusted hazard ratios (HRs), averaged across simulations. RESULTS: We identified scenarios in which right-censoring at measles vaccination was informative and so introduced bias in the direction of a detrimental effect of DTP vaccine. In some, but not all, situations, adjusting for confounding by health status removed the bias caused by censoring. However, such adjustment will not always remove bias due to informative censoring: inverse probability weighting was required in one scenario. Bias due to left censoring arose when both health status and DTP vaccination were associated with mortality during the censored early follow-up and was in the direction of attenuating a beneficial effect of DTP on mortality. Such bias was more severe when the effect of DTP changed over time. CONCLUSIONS: Estimates of non-specific effects of vaccines may be biased by informative right or left censoring. Authors of studies estimating such effects should consider the potential for such bias and use appropriate statistical approaches to control for it. Such approaches require measurement of prognostic factors that predict censoring.


Asunto(s)
Vacuna contra Difteria, Tétanos y Tos Ferina/administración & dosificación , Vacuna Antisarampión/administración & dosificación , Mortalidad , Sesgo de Selección , Vacuna contra Difteria, Tétanos y Tos Ferina/efectos adversos , Femenino , Humanos , Esquemas de Inmunización , Lactante , Masculino , Vacuna Antisarampión/efectos adversos , Modelos de Riesgos Proporcionales , Reino Unido , Vacunación
15.
Value Health ; 22(3): 303-312, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30832968

RESUMEN

BACKGROUND: Prosthetic implants used in total hip replacements (THR) have a range of bearing surface combinations (metal-on-polyethylene, ceramic-on-polyethylene, ceramic-on-ceramic, and metal-on-metal), head sizes (small [<36 mm in diameter] and large [≥36 mm in diameter]), and fixation techniques (cemented, uncemented, hybrid, and reverse hybrid). These can influence prosthesis survival, patients' quality of life, and healthcare costs. OBJECTIVES: To compare the lifetime cost-effectiveness of implants for patients of different age and sex profiles. METHODS: We developed a Markov model to compare the cost-effectiveness of various implants against small-head cemented metal-on-polyethylene implants. The probability that patients required 1 or more revision surgeries was estimated from analyses of more than 1 million patients in the UK and Swedish hip joint registries, for men and women younger than 55, 55 to 64, 65 to 74, 75 to 84, and 85 years and older. Implant and healthcare costs were estimated from local procurement prices, national tariffs, and the literature. Quality-adjusted life-years were calculated using published utility estimates for patients undergoing THR in the United Kingdom. RESULTS: Small-head cemented metal-on-polyethylene implants were the most cost-effective for men and women older than 65 years. These findings were robust to sensitivity analyses. Small-head cemented ceramic-on-polyethylene implants were most cost-effective in men and women younger than 65 years, but these results were more uncertain. CONCLUSIONS: The older the patient group, the more likely that the cheapest implants, small-head cemented metal-on-polyethylene implants, were cost-effective. We found no evidence that uncemented, hybrid, or reverse hybrid implants were the most cost-effective option for any patient group. Our findings can influence clinical practice and procurement decisions for healthcare payers worldwide.


Asunto(s)
Artroplastia de Reemplazo de Cadera/economía , Artroplastia de Reemplazo de Cadera/instrumentación , Toma de Decisiones Clínicas/métodos , Análisis Costo-Beneficio/métodos , Prótesis de Cadera/economía , Diseño de Prótesis/economía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis/métodos , Suecia/epidemiología , Reino Unido/epidemiología
16.
Neurocirugia (Astur) ; 30(4): 173-178, 2019.
Artículo en Inglés, Español | MEDLINE | ID: mdl-30782504

RESUMEN

BACKGROUND: The classic surgical spinal dural closure technique in surgery on intradural lesions is performed with continuous suture or loose stitches using 4-0 to 6-0 polypropylene monofilament or nylon suture. Dural closure with suture causes irritant damage to the dural/arachnoid interface. The penetrating suture causes new dural holes. Even the needle of the suture can cause harm to the patient and the surgeon. For these reasons, other non-penetrating techniques for dural closure have been sought. OBJECTIVE: The purpose of this review was to show the efficacy of using the titanium clip (U-clip) (Ligaclip-MCA of Ethicon Endo-Surgery, LLC, Medical GmbH, Norderstedt, Germany) with a flat internal surface in spinal neurosurgical procedures, and to evaluate the effects of its use on post-operative magnetic resonance imaging (MRI). METHODS: We performed a retrospective analysis of a cohort of 50 consecutive patients who underwent intradural spinal surgeries for intradural spinal lesions in the neurosurgery department of our institution between 2013 and 2018. RESULTS: The mean follow-up period was 27 months. No patient developed a post-operative cerebrospinal fluid (CSF) dural-cutaneous fistula. CSF leakage was not observed in the control MRIs at 6 weeks. CONCLUSIONS: We describe, for the first time, the use of this type of U-clip with a flat inner side. The non-penetrating titanium U-clip facilitates effective and rapid dural closure at all spinal levels due to its flat internal face when closed. The U-clips did not cause significant artefacts or distortions on the magnetic resonance imaging.


Asunto(s)
Pérdida de Líquido Cefalorraquídeo/prevención & control , Duramadre/cirugía , Complicaciones Posoperatorias/prevención & control , Instrumentos Quirúrgicos , Procedimientos Quirúrgicos sin Sutura/instrumentación , Adulto , Anciano , Femenino , Humanos , Laminectomía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Estudios Retrospectivos , Neoplasias de la Médula Espinal/cirugía , Titanio
17.
BMJ Glob Health ; 4(Suppl 1): e000858, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30775014

RESUMEN

Public health and health service interventions are typically complex: they are multifaceted, with impacts at multiple levels and on multiple stakeholders. Systematic reviews evaluating the effects of complex health interventions can be challenging to conduct. This paper is part of a special series of papers considering these challenges particularly in the context of WHO guideline development. We outline established and innovative methods for synthesising quantitative evidence within a systematic review of a complex intervention, including considerations of the complexity of the system into which the intervention is introduced. We describe methods in three broad areas: non-quantitative approaches, including tabulation, narrative and graphical approaches; standard meta-analysis methods, including meta-regression to investigate study-level moderators of effect; and advanced synthesis methods, in which models allow exploration of intervention components, investigation of both moderators and mediators, examination of mechanisms, and exploration of complexities of the system. We offer guidance on the choice of approach that might be taken by people collating evidence in support of guideline development, and emphasise that the appropriate methods will depend on the purpose of the synthesis, the similarity of the studies included in the review, the level of detail available from the studies, the nature of the results reported in the studies, the expertise of the synthesis team and the resources available.

18.
J Hazard Mater ; 370: 63-69, 2019 05 15.
Artículo en Inglés | MEDLINE | ID: mdl-29456129

RESUMEN

Transition metals Cd, Pd and Ag are toxic even at very low concentration. Cd is considered a priority substance; while, Pd and Ag are emerging pollutants. Membrane technologies have been applied for their extraction; however, they require important amounts of reagents, time and energy. Additionally, effective reagents for metal extraction in saline natural waters are limited. In this case, hollow fiber liquid phase micro-extraction with a configuration of solvent bar (SBME) using the ionic liquid Cyphos® 101 as extractant is proposed. Optimized conditions for SBME of Cd, Ag and Pd were 50% Cyphos® 101 in the organic solution, extraction time 30 min and 800 rpm stirring rate. Leaching was in all cases lower than 0.1%. Metallic concentrations were measured by flame atomic absorption spectroscopy. The method was applied to the extraction of Ag, Cd and Pd in natural water samples. Except for waste water, Pd extraction was higher than 90% in all cases. Cd (≈100%) and Ag (93-95%) offered their best results for saline samples. Concluding, the proposed system is a low cost and green methodology that allows a simple and fast extraction of trace pollutants such as Ag, Cd and Pd in different natural waters, including highly saline samples.

19.
Sci Total Environ ; 650(Pt 1): 27-33, 2019 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-30195129

RESUMEN

Ag can be found in the ocean at the ultra-trace level, mainly as AgCln(n-1)- and complexed by dissolved organic matter (Ag-DOM). However, methods for studying Ag speciation in marine waters are limited by the lack of extractants capable to separate organic and inorganic silver species in natural conditions of seawater samples. In this work, a two-phase solvent bar micro-extraction method using the ionic liquid trihexyltetradecylphosphonium chloride (Cyphos® 101) was applied for selective micro-extraction of AgCln(n-1)- from organic silver in marine waters, working at seawater pH,. The application to real samples was performed under the following conditions: 2.5% Cyphos® 101 in kerosene solution with 10% dodecan-1-ol inside the fiber, and 30 min of sample extraction at a stirring rate of 800 rpm. The proposed SBME was successfully used for estimation of Ag fractions in waters from the Bay of Cádiz (South-west Spain) showing its applicability for a simple, fast and environmentally friendly speciation of silver in marine water samples. The method presented a linear response up to 500 ng L-1 and a detection limit of 0.4 ng L-1, using GF-AAS for instrumental determination.

20.
Molecules ; 23(11)2018 Nov 17.
Artículo en Inglés | MEDLINE | ID: mdl-30453649

RESUMEN

Developments in the liquid micro-extraction of trace metals from aqueous phases have proven to be limited when extended from pure water to more complex and demanding matrices such as sea water or wastewater treatment effluents. To establish a system that works under such matrices, we successfully tested three task-specific ionic liquids, namely trihexyltetradecyl- phosphonium-, methyltrioctylphosphonium- and methyltrioctylammonium 3-hydroxy-2-naphthoate in two-phase solvent bar micro-extraction (SBME) experiments. We describe the influence of pH, organic additives, time, stirring rate and volume of ionic liquid for multi-elemental micro-extraction of Cu, Ag, Cd and Pb from various synthetic and natural aqueous feed solutions. Highest extraction for all metals was achieved at pH 8.0. Minimal leaching of the ionic liquids into the aqueous phase was demonstrated, with values < 30 mg L-1 DOC in all cases. Sample salinities of up to 60 g L-1 NaCl had a positive effect on the extraction of Cd, possibly due to an efficient extraction mechanism of the present chlorido complexes. In metal-spiked natural feed solutions, the selected SBME setups showed unchanged stability under all conditions tested. We could efficiently (≥85%) extract Cu and Ag from drinking water and achieved high efficacies for Ag and Cd from natural sea water and hypersaline water, respectively. The method presented here proves to be a useful tool for an efficient SBME of heavy metals from natural waters without the need to pretreat or modify the sample.


Asunto(s)
Ácidos Carboxílicos/química , Líquidos Iónicos/química , Microextracción en Fase Líquida , Metales Pesados/química , Naftalenos/química , Solventes/química , Agua/química , Fenómenos Químicos , Cobre/química , Iones
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