Characteristics of Benign Paroxysmal Positional Vertigo Following an Earthquake.

INTRODUCTION: Benign Paroxysmal Positional Vertigo (BPPV) is a commonly encountered peripheral vestibular disorder. People exposed to massive earthquakes experience intense and long-term problem associated with dizziness. The purpose of our study is to investigate this relationship and to demonstrate the efficacy of the treatment modalities used in the management of patients with post-earthquake dizziness. METHODOLOGY: The study was carried out by examining the retrospective records of patients who presented with dizziness to the otorhinolaryngological outpatient unit before and after the Elazig earthquake that occurred on 24th Jan 2020. Parameters evaluated include patients' age and gender, onset of dizziness, accompanying symptoms and comorbidities, videonystagmography (VNG) findings, pre- and post-treatment Visual Analogue Scale (VAS), Dizziness Handicap Inventory (DHI), and Hospital Anxiety and Depression Scale (HADS). RESULTS: The number of patients who presented with dizziness to our outpatient clinic after the earthquake and were included in our study totaled 84. The number of patients who visited the outpatient clinic before the earthquake was identified to be 75. In the earthquake related group, while there was a statistically significant difference between residual symptoms (RS) and the need for repetitive repositioning maneuvers, there was no statistically significant difference detected for age, gender, and comorbidities. Also, no statistically significant difference was found in the pre- and post-treatment assessments of VAS, DHI, and HADS median values in the earthquake group. CONCLUSION: There was a remarkable increase in the number of patients presenting with dizziness in the early post-earthquake period. Management of these patients may differ from the classic BPPV. Residual symptoms appearing after performing repositioning maneuvers can be more commonly seen among these patients.

Caída y factores demográficos y clínicos en adultos mayores: estudio de seguimiento / Queda e fatores demográficos e clínicos no idoso: estudo de seguimento / Fall and demographic and clinical factors in older adults: follow-up study

OBJETIVO: Analizar los factores demográficos y clínicos relacionados a las caídas en el adulto mayor que viven en el domicilio en un seguimiento de cinco años. MÉTODO: Estudio cuantitativo y longitudinal retrospectivo realizado entre 2007/2008 y 2013 con 262 participantes brasileños con edad superior a 65 años. Se utilizaron los instrumentos de perfil demográfico, Mini Examen del Estado Mental, enfermedades autorreferidas, caídas y sus características, Escala de Fragilidad de Edmonton, Escala de Lawton y Brody y Medida de Independencia Funcional. Se realizaron análisis descriptivo, Chi cuadrado, prueba de Wilcoxon y prueba de modelos mixtos. Estudio aprobado por el comité de ética. RESULTADOS: La mayoría era del sexo femenino, con edad entre 65 a 79 años, escolaridad entre 1 a 4 años y jubilados. La prevalencia de caídas fue de 21,8% y 37,8% en ambas evaluaciones. Se verificó que para cada enfermedad más que el adulto mayor tiene, aumenta la chance de sufrir una nueva caída. Además, para cada punto más en la escala de fragilidad, el adulto mayor tiene mayor chance de caer. Por otro lado, para cada medicamento a menos que el adulto mayor utiliza, presenta 10% menos chance de caer. CONCLUSIÓN: La caída estuvo asociado a factores clínicos en el adulto mayor siendo necesario que el profesional de salud realice evaluaciones constantes para identificar este evento y sus desencadenantes

OBJETIVO: Analisar os fatores demográficos e clínicos relacionados à queda no idoso que vive no domicílio em um seguimento de cinco anos. MÉTODO: Estudo quantitativo e longitudinal retrospectivo realizado entre 2007/2008 e 2013 com 262 participantes brasileiros com idade superior de 65 anos. Foram utilizados os instrumentos de perfil demográfico, Mini Exame do Estado Mental, doenças autorreferidas, quedas e suas características, Escala de Fragilidade de Edmonton, Escala de Lawton y Brody y Medida de Independência Funcional. Realizaram-se análise descritivo, Qui quadrado, Teste de Wilcoxon e prova de modelos mistos. Estudo aprovado pelo comitê de ética. RESULTADOS: A maioria era do sexo feminino, com idade entre 65 e 79 anos, escolaridade entre 1 a 4 anos e aposentados. A prevalência da queda foi de 21,8% e 37,8% em ambas as avaliações. Verificou-se que para cada doença a mais que o idoso sofre, aumenta a chance de sofrer uma nova queda. Ademais, para cada ponto a mais na escala de fragilidade, o idoso apresenta uma maior chance de cair. Por outro lado, para cada medicamento a menos que o idoso utiliza, presenta chance 10% menor de cair. CONCLUSÃO: A queda esteve associada a fatores clínicos no idoso sendo necessário que o profissional de saúde realize avaliações constantes com a finalidade de identificar esse evento e seus desencadeantes

OBJECTIVE: To analyze the demographic and clinical factors related to falls of older adults living at home in a five-year follow-up. MATERIALS AND METHODS: Retrospective quantitative and longitudinal study conducted between 2007/2008 and 2013 with 262 Brazilians participants over 65 years old. We used the demographic profile, Mini-Mental State Examination, self-reported diseases, falls and their characteristics, Edmonton Frail Scale, Lawton and Brody Scale, Functional Independence Measure instruments. We performed descriptive analysis, Chi-squared, Wilcoxon test and mixed model test. RESULTS: Most participants were women, aged between 65 to 79 years, schooling between 1 to 4 years and retired. The prevalence of falls was 21.8% and 37.8% in both evaluations. We verified that the chance of suffering a new fall increases for each additional disease of the older adult. In addition, for each point to more on the frail scale, the older adult has a greater chance of falling. On the other hand, for each medication withdrawn, the chance of falling decreases 10%. CONCLUSION: The fall was associated with clinical factors in older adults, therefore constant evaluations must be carried out to identify this event and its triggers

Prevalence of and Risk Factors Associated With Mental Health Symptoms Among the General Population in China During the Coronavirus Disease 2019 Pandemic.

Importance: People exposed to coronavirus disease 2019 (COVID-19) and a series of imperative containment measures could be psychologically stressed, yet the burden of and factors associated with mental health symptoms remain unclear. Objective: To investigate the prevalence of and risk factors associated with mental health symptoms in the general population in China during the COVID-19 pandemic. Design, Setting, and Participants: This large-sample, cross-sectional, population-based, online survey study was conducted from February 28, 2020, to March 11, 2020. It involved all 34 province-level regions in China and included participants aged 18 years and older. Data analysis was performed from March to May 2020. Main Outcomes and Measures: The prevalence of symptoms of depression, anxiety, insomnia, and acute stress among the general population in China during the COVID-19 pandemic was evaluated using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Insomnia Severity Index, and Acute Stress Disorder Scale. Logistic regression analyses were used to explore demographic and COVID-19-related risk factors. Results: Of 71 227 individuals who clicked on the survey link, 56 932 submitted the questionnaires, for a participation rate of 79.9%. After excluding the invalid questionnaires, 56 679 participants (mean [SD] age, 35.97 [8.22] years; 27 149 men [47.9%]) were included in the study; 39 468 respondents (69.6%) were aged 18 to 39 years. During the COVID-19 pandemic, the rates of mental health symptoms among the survey respondents were 27.9% (95% CI, 27.5%-28.2%) for depression, 31.6% (95% CI, 31.2%-32.0%) for anxiety, 29.2% (95% CI, 28.8%-29.6%) for insomnia, and 24.4% (95% CI, 24.0%-24.7%) for acute stress. Participants with confirmed or suspected COVID-19 and their family members or friends had a high risk for symptoms of depression (adjusted odds ratios [ORs], 3.27 [95% CI, 1.84-5.80] for patients; 1.53 [95% CI, 1.26-1.85] for family or friends), anxiety (adjusted ORs, 2.48 [95% CI, 1.43-4.31] for patients; 1.53 [95% CI, 1.27-1.84] for family or friends), insomnia (adjusted ORs, 3.06 [95% CI, 1.73-5.43] for patients; 1.62 [95% CI, 1.35-1.96] for family or friends), and acute stress (adjusted ORs, 3.50 [95% CI, 2.02-6.07] for patients; 1.77 [95% CI, 1.46-2.15] for family or friends). Moreover, people with occupational exposure risks and residents in Hubei province had increased odds of symptoms of depression (adjusted ORs, 1.96 [95% CI, 1.77-2.17] for occupational exposure; 1.42 [95% CI, 1.19-1.68] for Hubei residence), anxiety (adjusted ORs, 1.93 [95% CI, 1.75-2.13] for occupational exposure; 1.54 [95% CI, 1.30-1.82] for Hubei residence), insomnia (adjusted ORs, 1.60 [95% CI, 1.45-1.77] for occupational exposure; 1.20 [95% CI, 1.01-1.42] for Hubei residence), and acute stress (adjusted ORs, 1.98 [95% CI, 1.79-2.20] for occupational exposure; 1.49 [95% CI, 1.25-1.79] for Hubei residence). Both centralized quarantine (adjusted ORs, 1.33 [95% CI, 1.10-1.61] for depression; 1.46 [95% CI, 1.22-1.75] for anxiety; 1.63 [95% CI, 1.36-1.95] for insomnia; 1.46 [95% CI, 1.21-1.77] for acute stress) and home quarantine (adjusted ORs, 1.30 [95% CI, 1.25-1.36] for depression; 1.28 [95% CI, 1.23-1.34] for anxiety; 1.24 [95% CI, 1.19-1.30] for insomnia; 1.29 [95% CI, 1.24-1.35] for acute stress) were associated with the 4 negative mental health outcomes. Being at work was associated with lower risks of depression (adjusted OR, 0.85 [95% CI, 0.79-0.91]), anxiety (adjusted OR, 0.92 [95% CI, 0.86-0.99]), and insomnia (adjusted OR, 0.87 [95% CI, 0.81-0.94]). Conclusions and Relevance: The results of this survey indicate that mental health symptoms may have been common during the COVID-19 outbreak among the general population in China, especially among infected individuals, people with suspected infection, and people who might have contact with patients with COVID-19. Some measures, such as quarantine and delays in returning to work, were also associated with mental health among the public. These findings identify populations at risk for mental health problems during the COVID-19 pandemic and may help in implementing mental health intervention policies in other countries and regions.

The mental health status of asylum seekers in middle- to high-income countries: a synthesis of current global evidence.

INTRODUCTION: The last 5 years have witnessed a significant increase in the number of people fleeing their countries of origin and seeking refuge in host countries. By the end of 2018, there were 3.5 million asylum seekers awaiting outcomes on their applications, the majority of whom were hosted by middle- to high-income countries. This review aimed to identify and synthesize current knowledge regarding the mental health status of asylum seekers in middle- to high-income countries. SOURCES OF DATA: A search was conducted across various databases for research literature published within the last 5 years (2014-2019). The final review and synthesis included 25 articles. AREAS OF AGREEMENT: Findings highlighted significant differences in the mental health status of asylum seekers compared to those with refugee status and permanent residence. AREAS OF CONTROVERSY: Guidelines from the World Health Organization and the United Nations High Commissioner for Refugees emphasize the need to understand and address mental health issues. Instead, there have been policy changes in many host countries regarding asylum applications, and the associated effects of these changes have been shown to negatively impact mental health. GROWING POINTS: The synthesized findings from the present review provide information regarding the current mental health status of asylum seekers hosted by middle- to high-income countries. Areas of intervention and resource allocation were also identified. AREAS TIMELY FOR DEVELOPING RESEARCH: Future research should consider the impact of large-scale, low-cost interventions to support the mental health of those seeking asylum.

Delirium in Elderly Patients:Frequency and Precipitants in a Tertiary Hospital Setting.

OBJECTIVE: There is paucity of information on delirium in sub-Saharan Africa (SSA) particularly in the older persons (>60 years of age), leaving questions about the burden of the disease in an environment with lower health care standards. In this article, we set out to determine the frequency, precipitants and symptomatology of delirium in elderly patients admitted into medical wards in a teaching hospital in South-West Nigeria. METHODS: This was a descriptive study involving a pre-planned sample of one hundred and fifty patients aged 60 years and over, assessed for cognitive impairment and delirium using the previously validated IDEA cognitive screen, and the Confusion Assessment Method (CAM) respectively. Diagnosis of delirium was made using the CAM and DSM-IV criteria. RESULTS: Delirium was diagnosed in 32 patients giving a frequency of 21.3% (95%CI: 14.7-30.0%). Patients with delirium were significantly older (p<0.05). A quarter of the patients had dementia. Hypertension was a notable co-morbid condition. All the patients had altered sleep wake cycle, inattention, disorientation, and altered consciousness. Neurological diseases were the most common precipitant. There was a good agreement between the DSM-IV and CAM diagnoses. CONCLUSION: Delirium is common in hospitalised elderly patients particularly those with neurological diseases. Co-morbidities like hypertension, dementia, and depression should be looked for in delirious elderly patients.

Mental health, family roles and employment status inside and outside the household in Spain / Salud mental, rol familiar y situación laboral dentro y fuera del hogar en España

Objective: To document the prevalence of poor mental health by gender and social class, and to analyze if poor mental health is associated with the family roles or the employment status inside and outside the household. Method: A cross-sectional study based on a representative sample of the Spanish population was carried out (n = 14,247). Mental health was evaluated using GHQ-12. Employment status, marital status, family roles (main breadwinner and the person who mainly carries out the household work) and educational level were considered as explanatory variables. Multiple logistic regression models stratified by gender and social class were fitted and adjusted odds ratios (aOR) were obtained. Results: Gender and social class differences in the prevalence of poor mental health were observed. Unemployment was associated with higher prevalence. Among men the main breadwinner role was related to poor mental health mainly in those that belong to manual classes (aOR = 1.2). Among women, mainly among nonmanual classes, these problems were associated to marital status: widowed, separated or divorced (aOR = 1.9) and to dealing with the household work by themselves (aOR = 1.9). Conclusions: In Spain, gender and social class differences in mental health still exist. In addition, family roles and working situation, both inside and outside the household, could constitute a source of inequalities in mental health

Objetivo: Conocer la prevalencia de mala salud mental por sexo y clase social, y analizar si la salud mental se relaciona con los roles familiares y la situación laboral fuera y dentro del hogar. Método: Se realizó un diseño transversal basado en una muestra representativa de la población española (n = 14.247). La salud mental se evaluó mediante el GHQ-12. Se consideraron como variables explicativas la situación laboral, el estado civil, el rol familiar (sustentador principal y persona que realiza el trabajo doméstico) y el nivel de estudios. Se ajustaron modelos de regresión logística estratificados por sexo y se obtuvieron las odds ratio ajustadas (ORa). Resultados: Se observaron diferencias en la prevalencia de mala salud mental por sexo y clase social. El desempleo se asoció con mayor prevalencia. En hombres pertenecientes a clases menos favorecidas, el rol de sustentador principal se relacionó con mala salud mental (Ora = 1,2) En mujeres que pertenecían a clases más favorecidas, el estado civil viuda, separada o divorciada (ORa = 1,9) y realizar el trabajo doméstico solas (ORa = 1,9) se relacionaron con mala salud mental. Conclusiones: En España, en salud mental continúa habiendo diferencias de sexo y clase social. Además, el rol familiar y la situación laboral fuera y dentro del ámbito doméstico podrían constituir también una fuente de desigualdad en salud mental

Parietal Involvement in Constructional Apraxia as Measured Using the Pentagon Copying Task.

Deficits in copying ("constructional apraxia") is generally defined as a multifaceted deficit. The exact neural correlates of the different types of copying errors are unknown. To assess whether the different categories of errors on the pentagon drawing relate to different neural correlates, we examined the pentagon drawings of the MMSE in persons with subjective cognitive complaints, mild cognitive impairment, or early dementia due to Alzheimer's disease. We adopted a qualitative scoring method for the pentagon copy test (QSPT) which categorizes different possible errors in copying rather than the dichotomous categories "correct" or "incorrect." We correlated (regional) gray matter volumes with performance on the different categories of the QSPT. Results showed that the total score of the QSPT was specifically associated with parietal gray matter volume and not with frontal, temporal, and occipital gray matter volume. A more fine-grained analysis of the errors reveals that the intersection score and the number of angles share their underlying neural correlates and are associated with specific subregions of the parietal cortex. These results are in line with the idea that constructional apraxia can be attributed to the failure to integrate visual information correctly from one fixation to the next, a process called spatial remapping.

Diagnostic Value of Time-Constrained Naming Test in Mild Cognitive Impairment.

BACKGROUND: Naming difficulties have recently garnered more interest in elderly individuals with mild cognitive impairment (MCI). We anticipate that naming tests with the consideration of response time can provide more informative and distinct neuropsychological profiles of individuals with MCI. METHODS: Naming tests were administered to 76 elderly individuals with MCI and 149 healthy elderly (HE). We analyzed the impact of MCI on naming performance and occurrence of "delayed" response. We also validated the predictive power of naming tests with a time-constrained scoring system. RESULTS: MCI participants performed poorer on the noun naming test than HE participants (p = 0.014). MCI was significantly associated with the occurrence of "delayed" response on the noun (odds ratio [OR] = 3.57; 95% confidence interval [CI] = 1.78-7.17) and verb naming tests (OR = 4.66; 95% CI = 2.07-10.46). The time-constrained naming scores were significantly better able to distinguish the MCI from the HE group than the conventional spontaneous naming score on both the noun (p < 0.001) and verb (p = 0.002) naming tests. CONCLUSIONS: Our findings broaden the knowledge related to the naming ability in individuals with MCI, with respect to the response time. We also confirmed the validity of the naming tests by applying the "delayed" responses as supplementary assessments in the diagnosis of MCI.

Charlson Comorbidity Index, inappropriate medication use and cognitive impairment : Bermuda Triangle.

BACKGROUND: The aim is to evaluate the association between the Charlson Comorbidity Index (CCI), polypharmacy, inappropriate medication use and cognitive impairment in long-term care facility patients. METHODS: A cross-sectional study including 105 long-term care facility residents was performed. The Charlson Comorbidity Index (CCI) was used. Inappropriate drug use (IDU) was defined according to the STOPP (Screening Tool of Older People's Prescriptions) criteria. Univariate analysis to identify variables associated with patient outcome related with cognitive impairment was investigated with χ2, Pearson correlation, Fisher exact, and Mann-Whitney U test where appropriate. For the multivariate analysis, the possible factors identified with univariate analysis were further entered into logistic regression analysis. RESULTS: A significant difference was found between gender, CCI and cognitive impairment (p = 0.038, p = 0.01). While every one point increment in the CCI increases the risk of cognitive impairment 3.1 fold (95% CI = 1.8-5.4, p < 0.001), hypertension increases the risk 12 fold (95% CI = 2.5-67.8, p = 0.002). While the correlation between Mini-Mental Status Examination (MMSE) score and polypharmacy is significant (p = 0.015), the correlation between MMSE and IDU was insignificant (p = 0.739). The association of urogenital system drugs and dementia was significant (p = 0.044). CONCLUSIONS: Comorbidities, especially hypertension and old age, are risk factors for cognitive impairment. Polypharmacy correlates with MMSE and is considered a risk factor for cognitive impairment. Inappropriate medication use is high among long-term care facility residents. More studies on large cohorts are needed regarding optimal drug prescription and detection of specific drugs that may have an impact on cognitive performance.

Asociación entre el tabaquismo actual y el deterioro cognitivo y su relación con la edad: estudio transversal realizado en Xi’an (China) / Association between current smoking and cognitive impairment depends on age: A cross-sectional study in Xi’an, China

Antecedentes: El consumo de tabaco es un factor de riesgo modificable para el deterioro cognitivo, no entendiéndose plenamente la relación entre dichas situaciones. El objetivo de este trabajo fue identificar la posible asociación entre el consumo actual de tabaco y el deterioro cognitivo, dependiendo de la edad, en la población rural de China. Métodos: El estudio incluyó a 1.782 participantes (de 40 años de edad o más) que vivían en un pueblo rural de las cercanías de Xi’an (China). Se recogieron datos acerca del historial de consumo de tabaco y la función cognitiva. La función cognitiva se puntuó mediante la escala Mini-Mental State Examination. El efecto de la edad en la relación entre el consumo de tabaco actual y el deterioro cognitivo se analizó mediante análisis de interacción y estratificación, utilizando modelos de regresión logística. Resultados: El análisis de interacción reflejó que el consumo de tabaco actual guarda una relación positiva con el deterioro cognitivo (odds ratio [OR]=9,067; intervalo de confianza del 95% [IC 95%] 1,3056-2,979; p=0,026). Sin embargo, el plazo de interacción y la edad del tabaquismo actual guardan una relación negativa con el deterioro cognitivo (OR=0,969; IC 95% 0,939-0,999; p=0,045). La regresión logística estratificada reflejó que en el subestrato de 40 a 65 años, la OR del tabaquismo actual es de 1,966 (p=0,044), mientras que en el subestrato > 65 años, la OR es de 0,470 (p=0,130). Esto significa que la asociación entre el tabaquismo actual y el deterioro cognitivo con la edad podría ser positiva (OR>1) en los subestratos de menor edad, aunque no existe una diferencia significativa en subestratos de mayor edad. Conclusiones: En conclusión, el tabaquismo actual podría estar positivamente asociado al deterioro cognitivo en la edad mediana, aunque dicha relación disminuye con el incremento de la edad (AU)

Background: Cigarette smoking is a modifiable risk factor for cognitive impairment, while the relationship between current smoking and cognitive impairment is not fully understood. The objectives were to identify a possible association between current smoking and cognitive impairment depending on age in the Chinese rural population. Methods: Data for the study consisted of 1,782 participants (40 years and older) who lived in a rural village in the vicinity of Xi’an, China. Data about smoking history and cognitive function were collected. Cognitive function was scored by the Mini-Mental State Examination. The effect of age on the relationship between current smoking and cognitive impairment was analyzed with interaction and stratified analysis by logistic regression models. Results: Interaction analysis showed that current smoking is positively related with cognitive impairment (odds ratio [OR]=9.067; 95% confidence interval [95% CI] 1.305-62.979; P=.026). However, the interaction term, age by current smoking, is negatively related with cognitive impairment (OR=0.969; 95%CI 0.939-0.999; P=.045). Stratified logistic regression showed that in the 40-65 years of age sublayer, OR of current smoking is 1.966 (P=.044), whereas in the>65 years of age sublayer, the OR is 0.470 (P=.130). This means that the association between current smoking and cognitive impairment with age might be positive (OR>1) in lower age sublayers, but no significant difference in higher age sublayers. Conclusions: In conclusion, current smoking might be positively associated with cognitive impairment in the middle-aged but the relationship declines with increasing age (AU)

A Multi-institutional Prospective Observational Study of Stereotactic Radiosurgery for Patients With Multiple Brain Metastases (JLGK0901 Study Update): Irradiation-related Complications and Long-term Maintenance of Mini-Mental State Examination Scores.

PURPOSE: The JLGK0901 study showed the noninferiority of stereotactic radiosurgery (SRS) alone as initial treatment of 5 to 10 brain metastases (BMs) compared with 2 to 4 BMs in terms of overall survival and most secondary endpoints (Lancet Oncol 2014;15:387-95). However, observation periods were not long enough to allow confirmation of the long-term safety of SRS alone in patients with 5 to 10 BMs. METHODS AND MATERIALS: This was a prospective observational study of Gamma Knife SRS-treated patients with 1 to 10 newly diagnosed BMs enrolled at 23 facilities between March 1, 2009, and February 15, 2012. RESULTS: The 1194 eligible patients were categorized into the following groups: group A, 1 tumor (n=455); group B, 2 to 4 tumors (n=531); and group C, 5 to 10 tumors (n=208). Cumulative rates of Mini-Mental State Examination (MMSE) score maintenance (MMSE score decrease <3 from baseline) determined with a competing risk analysis of groups A, B, and C were 93%, 91%, and 92%, respectively, at the 12th month after SRS; 91%, 89%, and 91%, respectively, at the 24th month; 89%, 88%, and 89%, respectively, at the 36th month; and 87%, 86%, and 89%, respectively, at the 48th month (hazard ratio [HR] of group A vs group B, 0.719; 95% confidence interval [CI], 0.437-1.172; P=.18; HR of group B vs group C, 1.280; 95% CI, 0.696-2.508; P=.43). During observations ranging from 0.3 to 67.5 months (median, 12.0 months; interquartile range, 5.8-26.5 months), as of December 2014, 145 patients (12.1%) had SRS-induced complications. Cumulative complication incidences by competing risk analysis for groups A, B, and C were 7%, 8%, and 6%, respectively, at the 12th month after SRS; 10%, 11%, and 11%, respectively, at the 24th month; 11%, 11%, and 12%, respectively, at the 36th month; and 12%, 12%, and 13%, respectively, at the 48th month (HR of group A vs group B, 0.850; 95% CI, 0.592-1.220; P=.38; HR of group B vs group C, 1.052; 95% CI, 0.666-1.662, P=.83). Leukoencephalopathy occurred in 12 of the 1074 patients (1.1%) with follow-up magnetic resonance imaging and was detected after salvage whole-brain radiation therapy in 11 of these 12 patients. In these 11 patients, leukoencephalopathy was detected by magnetic resonance imaging 5.2 to 21.2 months (median, 11.0 months; interquartile range, 7.0-14.4 months) after whole-brain radiation therapy. CONCLUSIONS: Neither MMSE score maintenance nor post-SRS complication incidence differed among groups A, B, and C. This longer-term follow-up study further supports the already-reported noninferiority hypothesis of SRS alone for patients with 5 to 10 BMs versus 2 to 4 BMs.

Características del trabajo y estrategias de atención en salud mental con el consumidor de crack / Características do trabalho e estratégias de cuidado em saúde mental com o usuário de crack / Characteristics of work and strategies in mental health care with crack user

Objetivo: Conocer características del trabajo y estrategias de atención en salud mental con los consumidores de crack, en un Centro de Atención Psicosocial para alcohol y otras drogas (CAPS AD). Método: Estudio de caso cualitativo, evaluativo, desarrollado en un CAPS AD de Rio Grande do Sul, Brasil. Se utilizó, como referente teórico-metodológico, la Evaluación de Cuarta Generación. La recolecta de datos fue de enero a marzo de 2013. Se realizaron 36 entrevistas con trabajadores, usuarios, familiares y coordinadores. Resultados: El cotidiano del servicio permite espacios flexibles que incentivan la creatividad y la centralidad en el usuario. Prioriza el vínculo y la escucha para fortalecer la relación con el usuario y fragilizar la relación con la droga. Consideraciones finales: Se consideró la importancia de los servicios sustitutivos en la consolidación de estrategias de cuidado diversificadas, que repiensen la centralidad en la droga y rescaten el protagonismo del usuario (AU)

Objetivo: Conhecer características do trabalho e estratégias de cuidado em saúde mental com o usuário de crack, a partir do cotidiano de um Centro de Atenção Psicossocial para álcool e outras drogas (CAPS AD). Método: Estudo qualitativo, avaliativo, tipo estudo de caso, desenvolvido em um CAPS AD, Rio Grande do Sul, Brasil. Utilizou-se, como referencial teórico-metodológico, a Avaliação de Quarta Geração. A coleta de dados ocorreu de janeiro a março de 2013. Realizaram-se 36 entrevistas com trabalhadores, usuários, familiares e gestores. Resultados: O cotidiano do serviço propicia espaços flexíveis que estimulam a criatividade e a centralidade no usuário. Prioriza o vínculo e a escuta para fortalecer a relação com o usuário e enfraquecer sua relação com a droga. Considerações finais: Considera-se a importância dos serviços substitutivos na consolidação de estratégias de cuidado diversificadas, que possam ressignificar a centralidade da droga e resgatar o protagonismo do usuário (AU)

Objective: To know work characteristics and care strategies in mental health with crack users, from the daily life of a Psychosocial Care Center for Alcohol and Other Drugs (CAPS AD). Method: Qualitative and evaluative study, case study, developed in a CAPS AD, Rio Grande do Sul, Brazil. It was used as theoretical and methodological framework, the Fourth Generation Evaluation. Data collection occurred from January to March 2013. There were 36 interviews with workers, users, family members and managers. Results: The service daily provides flexible spaces that stimulate creativity and centrality in the user. Prioritizes bonding and listening to strengthen the relationship with the user and weaken their relationship with the drug. Final considerations: It is considered the importance of substitutive services in the consolidation of diversified care strategies that can reframe the centrality of drug and rescue user's protagonism (AU)

¿Existe relación entre el consumo de marihuana y el riesgo de presentar alteraciones psiquiátricas? / Is there a link between marijuana use and the risk of having psychiatric disorders?

Importancia: Es conocido que existe una alta proporción de la población general que consume marihuana de la misma manera que hay cada vez más países que legalizan su uso creativo, y que autorizan la utilización médica de esta sustancia. Esta situación genera una preocupación clínica y sobre todo de política sanitaria sobre los posibles efectos mentales de la utilización del cannabis. El objetivo de este estudio es examinar la asociación prospectiva entre el consumo de cannabis y el riesgo de enfermedad mental y del consumo de sustancias adictivas en la población general adulta. Método: Se utilizó una muestra representativa de población adulta de Estados Unidos (EE.UU.) mayor de 18 años, que fue entrevistada con 3 años de diferencia en el contexto del estudio National Epidemiologic Survey on Alcohol and Related Conditions (situación 1, entre 2001-2, y situación 2, entre 2004-5). El primer análisis se hizo en 34.653 respondedores que fueron entrevistados en ambas situaciones. El análisis de los resultados se realizó entre el 15 de marzo y el 30 de noviembre del 2015. Se aplicó una metodología estadística de regresión múltiple y de propensión que estimara la fuerza de la asociación independiente entre el consumo de cannabis en la situación 1, y la incidencia y prevalencia de alteraciones psiquiátricas en la situación 2. Los trastornos psiquiátricos fueron evaluados por una entrevista estructurada at hoc (la «Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV»). En ambos análisis se utilizaron el mismo grupo de factores confusores utilizados en la situación de partida 1, incluyendo las características sociodemográficas, la historia familiar de utilización y abuso de sustancias, ambiente familiar desestructurado, pérdida de familiares en la infancia, escasa autoestima, alteración social, educación, traumatismo reciente, alteraciones psiquiátricas presentes y anteriores e historia de divorcios. Resultados: Tras el análisis por regresión múltiple de los 34.653 respondedores a la entrevista (14.564 varones [47,9%], con una edad media de 45,1±17,3 años) el consumo de cannabis en la situación 1 (2001-2) se manifiestó en 1.279 individuos y estuvo asociada significativamente con disfunciones en la utilización de sustancias adictivas en la situación 2 (2004-5); o sea, el odds ratio (OR) de asociarse a cualquier trastorno en el consumo de sustancias adictivas fue de 6,2 (IC 95%: 4,1-9,4), de cualquier trastorno relacionado con el consumo de alcohol OR: 2,7 (IC 95%: 1,9-38), de cualquier trastorno relacionado con el consumo de cannabis OR: 9,5 (IC 95%: 6,4-14,1), cualquier otro trastorno relacionado con el abuso de drogas OR: 2,6 (IC 95%: 1,6-4,4), y con la dependencia de la nicotina OR: 1,7 (IC 95%: 1,2-2,4); pero no se asoció con trastorno del estado de ánimo OR: 1,1 (IC 95%: 0,8-1,4) o con los trastorno de ansiedad OR: 0,9 (IC 95%: 0,7-1,1). El mismo comportamiento en los resultados se dio en el análisis por regresión múltiple en la situación 2 en las alteraciones psiquiátricas, y en la propensión según concordancia en la incidencia y prevalencia de alteraciones psiquiátricas. Conclusiones: Concluyen que en la población general, la utilización del cannabis se asocia con un aumento del riesgo de diversas alteraciones en la utilización de sustancias adictivas. Tanto los médicos como los responsables de las políticas sanitarias deben ser conscientes de este tipo de asociaciones y tenerlas en especial consideración (AU)

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Potential Value of Impaired Cognition in Stroke Prediction: A U.K. Population-Based Study.

OBJECTIVES: To determine whether the association between impaired cognition and greater risk of incident stroke is also observed when cognitive impairment is defined using different criteria for mild cognitive impairment (MCI). DESIGN: Prospective cohort study with 10 years of follow-up. SETTING: Large multicentre study in the United Kingdom. PARTICIPANTS: Individuals (aged 64-105) from the Medical Research Council Cognitive Function and Ageing Study (N = 13,004). From this, a subsample of 2,640 individuals was selected based on age, center, and cognitive ability to undergo a detailed cognitive assessment. MEASUREMENTS: Information on sociodemographic characteristics, health, cognition, and functional ability was collected in an interview. The Geriatric Mental State Automated Geriatric Examination for Computer Assisted Taxonomy and the Cambridge Cognitive Examination were used to determine cognitive status. Stroke incidence was derived from self-report, informant report, and death certificates. Participants were divided into no, mild, moderate, and severe cognitive impairment according to their baseline Mini-Mental State Examination (MMSE) score. MCI criteria were used to classify persons into four groups: no cognitive impairment, MCI, severe impairment (i.e. other cognitive impairment no dementia: OCIND) and dementia. RESULTS: Over 10 years, 703 incident strokes occurred. Lower MMSE score at baseline was associated with greater risk of incident stroke. When cognitive status was determined according to MCI criteria, those with severe impairment (odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.0-2.2) and dementia (OR = 2.6, 95% CI = 1.6-3.4) had a significantly greater risk of stroke than those with no cognitive impairment. CONCLUSION: Criteria for MCI, defined using MMSE scores or clinical criteria, can capture individuals at greater stroke risk. The results highlight the need to focus on stroke risk in individuals even with MCI.

Relationships between early maladaptive schemas, mindfulness, self-compassion, and psychological distress

Early maladaptive schemas (EMSs) are maladaptive beliefs about oneself and one’s relationships with others that originate from adverse childhood experiences and lead to psychological distress when activated. Schema therapy (ST) was developed to treat EMSs and maladaptive coping responses to the triggering of EMSs. Mindfulness-based interventions are increasingly used in ST. The purpose of the present study was to explore the relationships between EMSs, mindfulness, self-compassion, and psychological distress. The Young Schema Questionnaire (YSQ-S3), the Five Facet Mindfulness Questionnaire (FFMQ-SF), the Self-Compassion Scale (SCS-SF), and the Brief Symptom Inventory (BSI) were administered to 212 undergraduate psychology students (mean age= 21.8 years, SD= 4.4). The results showed negative associations between EMSs and mindfulness and self-compassion. Mindfulness and self-compassion mediated, but did not moderate, the associations between EMSs and psychological distress. It is concluded that low mindfulness and low self-compassion are mechanisms through which EMSs exert their effect on psychological distress. These findings support the use of techniques aimed at enhancing mindfulness and self-compassion in the treatment of EMSs (AU)

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Validation of a Spanish Version of the Mental Health Continuum-Short Form Questionnaire / Validación de la versión en español del Cuestionario del Continuo de Salud Mental-Versión Corta

BACKGROUND: The Mental Health Continuum-Short Form (MHC-SF) is a multidimensional measure of well-being designed to assess emotional, psychological and social well-being. It has been translated into different languages; however, there is no validated Spanish version. Our aim was to provide the Spanish-speaking community with a validated version of the MHC-SF. METHOD: We translated the questionnaire into Spanish (s-MHC-SF) and assessed its validity in a sample of 3,355 Chilean adults. The data was subjected to a confirmatory factor analysis using the original correlated-traits three-factor model and a recently described bifactor model. RESULTS: The scores obtained with s-MHC-SF had excellent reliability (α = .94). While the correlated-traits three-factor model provided an acceptable fit to the data, the bifactor model yielded a superior fit. According to measurement invariance results, both models could be used to compare scores over gender, geographical region, age, and time in the sample. CONCLUSION: s-MHC-SF is a valid questionnaire for the evaluation of personal well-being in Spanish-speaking populations

ANTECEDENTES: el Mental Health Continuum-Short Form (MHC-SF) es un instrumento multidimensional diseñado para evaluar los componentes emocional, psicológico y social del bienestar personal. Ha sido traducido a varios idiomas; sin embargo, no hay una versión validada en español. Nuestro objetivo fue proveer a la comunidad hispanoparlante de una versión válida del MHC-SF. MÉTODO: MHC-SF se tradujo al español (s-MHC-SF) y se aplicó a una muestra de 3.355 adultos chilenos. Se realizó un análisis factorial confirmatorio usando el modelo original de tres factores correlacionados y un modelo bifactorial recientemente descrito. RESULTADOS: los puntajes obtenidos con el s-MHC-SF mostraron alta confiabilidad (α = .94). Mientras el modelo correlacionado presentó un ajuste aceptable a los datos, el bifactorial mostró un ajuste superior. Según las pruebas de invarianza de medición, ambos modelos podrían ser utilizados para comparar puntajes según sexo, edad, región geográfica y tiempo en la muestra. CONCLUSIÓN: s-MHC-SF es un cuestionario válido para evaluar el bienestar en la población de habla hispana

The Clinic for Assessment of Youth at Risk (CAYR): 10 years of service delivery and research targeting the prevention of psychosis in Montreal, Canada.

AIM: In the context of an increasing focus on indicated prevention of psychotic disorders, we describe the operation of the Clinic for Assessment of Youth at Risk (CAYR) over 10 years, a specialized service for identification, monitoring and treatment of young individuals who meet ultra-high risk (UHR) criteria for psychosis, and its integration within the Prevention and Early Intervention Program for Psychosis (PEPP) in Montreal, Canada. METHODS: We outline rationale, development, inclusion and exclusion criteria, assessment, services offered, community outreach and liaison with potential referral sites, and our research focus on risk and protective factors related to the neural diathesis-stress model of psychosis. RESULTS: Between January 2005 and December 2014, CAYR has received 370 referrals and accepted 177 patients who met UHR criteria based on the Comprehensive Assessment for At Risk Mental States. Conversion rates to a first episode of psychosis were 11%. Our research findings point to high subjective stress levels, poor self-esteem, social support and coping skills, and a dysregulation of the hypothalamus-pituitary-adrenal axis during the high-risk phase. CONCLUSIONS: Our efforts at community outreach have resulted in increasing numbers of referrals and patients accepted to CAYR, highlighting the relevance of and need for a high-risk programme in the Montreal area. Patients with psychotic symptoms can be immediately assigned to the first-episode psychosis clinic within PEPP, which has likely contributed to the low conversion rates observed in the UHR group. Our research findings on stress and protective factors emphasize the importance of psychosocial interventions for high-risk patients.

Negative Aging Stereotypes Impair Performance on Brief Cognitive Tests Used to Screen for Predementia.

OBJECTIVES: There is today ample evidence that negative aging stereotypes impair healthy older adults' performance on cognitive tasks. Here, we tested whether these stereotypes also decrease performance during the screening for predementia on short cognitive tests widely used in primary care. METHOD: An experiment was conducted on 80 healthy older adults taking the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) under Threat or Reduced-threat condition. RESULTS: Stereotype threat significantly impaired older adults' performance on both tests, resulting in 40% of older adults meeting the screening criteria for predementia, compared with 10% in Reduced-threat condition (MMSE and MoCA averaged). DISCUSSION: Our research highlights the influence of aging stereotypes on short cognitive tests used to screen for predementia. It is of critical importance that physicians provide a threat-free testing environment. Further research should clarify whether this socially induced bias may also operate in secondary care by generating false positives.

Exportation and Validation of Latent Constructs for Dementia Case Finding in a Mexican American Population-based Cohort.

BACKGROUND: The latent variable "δ" has been validated as a dementia phenotype. δ can be extracted from Spearman's general intelligence factor "g" in any data set that contains measures of cognition and instrumental activities of daily living (IADL). We used δ composites ("d-scores") to estimate the prevalence of dementia in the Hispanic Established Population for Epidemiological Studies in the Elderly (H-EPESE). METHOD: δ was constructed from Mini-Mental State Examination, a clock-drawing task (CLOX), and IADL. δ's H-EPESE factor weights were validated in the well-characterized Texas Alzheimer's Research and Care Consortium (TARCC). Optimal thresholds for the discrimination between "Alzheimer's disease" (AD) versus normal controls (NCs) were determined by receiver operating characteristic curve. Those thresholds were used to estimate the prevalence of dementia in H-EPESE. RESULTS: Each δ homolog fits its source's data well. d-scores were strongly associated with Clinical Dementia Rating scale Sum of Boxes (r = .74-.85, all p < .001], and accurately distinguished AD cases from NCs, in both Mexican Americans (MAs) and non-Hispanic Whites (NHWs) [c = 0.94-0.96]. The TARCC MA threshold estimated the prevalence of dementia at 21.4% in H-EPESE. The NHW threshold estimated the prevalence of dementia at 21.0%. CONCLUSIONS: It is possible to export δ composites from populations to well-characterized cohorts for validation.

Loneliness and Cognitive Function in Older Adults: Findings From the Chinese Longitudinal Healthy Longevity Survey.

OBJECTIVES: To examine the relationship between loneliness and cognitive function and to explore the mediating role of physical health on the loneliness-cognition relationship in Chinese older adults (OAs). METHOD: Data came from a nationally representative sample of 14,199 Chinese OAs (aged 65+) from 2002, 2005, 2008, and 2011 waves of the Chinese Longitudinal Healthy Longevity Survey. A latent variable cross-lagged panel model combined with mediation analysis was used to determine the relationship between loneliness and cognitive function and the mediating effect of increase in the number of chronic conditions (ΔNCCs) on the ascertained loneliness-cognition relationship. RESULTS: Severe loneliness at prior assessment points was significantly associated with poorer cognitive function at subsequent assessments, and vice versa. The ΔNCCs partially mediated this prospective reciprocal relationships, accounting for 2.58% of the total effect of loneliness on cognition and 4.44% of the total effect of cognition on loneliness, respectively. DISCUSSION: Loneliness may predict subsequent cognitive decline, and vice versa. This loneliness-cognition relationship is partially explained by their impact on physical health. Multidisciplinary interventions aimed at reducing loneliness and cognitive decline per se and their associated risk factors as well as improving chronic illness management would be beneficial for emotional well-being and cognitive health in OAs.