Perfiles de Personalidad en adolescentes con Trastornos por Ansiedad en Población General y Clínica / Personality Profiles in Adolescents with Anxiety Disorders in General and Clinical population

La personalidad es el trasfondo que determina la forma de pensar, sentir y comportarse e influye en la psicopatología. En este contexto, resulta relevante el estudio de la relación entre personalidad y ansiedad en la adolescencia. El principal objetivo de nuestro estudio es analizar las diferencias entre casos con Trastornos por Ansiedad (TA) y una muestra de población general (PG) en los diferentes perfiles / prototipos de personalidad (PRP) derivados del el Inventario clínico para adolescentes de Millon (MACI). Un segundo objetivo fue estudiar el modelo más parsimonioso de PRP capaz de predecir TA. Para responder a estos objetivos se utilizó un diseño observacional analítico y se realizó un muestreo aleatorio de adolescentes en PG (n = 461) y consecutivo de pacientes con TA, valorados según criterios DSM-5 (n = 77). Los instrumentos de medida utilizados fueron el MACI y Adolescent Symptom Inventory. Los PRP Introvertidos, Inhibidos, Pesimistas, Sumisos, Oposicionistas, Autopunitivos y Límites presentan una media significativamente mayor en TA y los PRP Histriónico y Egocéntrico en PG. El modelo más parsimonioso de PRP que mejor predice TA está conformado por tener mayor edad y los PRP más límite y menos rebelde. El estudio ofrece una imagen novedosa de los PRP en casos de TA que invitan a su estudio clínico, favoreciendo nuevos caminos de investigación que incluyan la personalidad en la heterogeneidad del trastorno. (AU)

Personality is the background that determines the way we think, feel and behave and influences psychopathology. In this context, the study of the relationship between personality and anxiety in adolescence is important. The main objective of our study is to analyse the differences between cases with Anxiety Disorders (AD) and a sample of general population (GP) in the different personality profiles / prototypes (PRP) derived from the Millon Adolescent Clinical Inventory (MACI). Secondary objective: to study the most parsimonious predictive model of PRP to predict AD. To respond to these objectives, an observational analytical design was used and a random sampling of adolescents in GP (n = 461) and consecutive sampling of patients with AD, assessed according to DSM-5 criteria (n = 77) was performed. The measurement instruments used were the MACI and the Adolescent Symptom Inventory. Introverted, Inhibited, Doleful, Submissive, Oppositional, Self-demeaning and Borderline PRPs present a significantly higher mean in AD and the Dramatizing and Egotistic PRPs in GP. The most parsimonious PRP model that best predicts AD is shaped by having older age and the most Borderline and least Unruly PRPs. The study offers a novel picture of PRPs in AD cases that invite their clinical study, favoring new paths of research that include personality in the heterogeneity of the disorder. (AU)

Insight into ADHD diagnosis with deep learning on Actimetry: Quantitative interpretation of occlusion maps in age and gender subgroups.

Attention Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder in childhood that often persists into adulthood. Objectively diagnosing ADHD can be challenging due to the reliance on subjective questionnaires in clinical assessment. Fortunately, recent advancements in artificial intelligence (AI) have shown promise in providing objective diagnoses through the analysis of medical images or activity recordings. These AI-based techniques have demonstrated accurate ADHD diagnosis; however, the growing complexity of deep learning models has introduced a lack of interpretability. These models often function as black boxes, unable to offer meaningful insights into the data patterns that characterize ADHD. OBJECTIVE: This paper proposes a methodology to interpret the output of an AI-based diagnosis system for combined ADHD in age and gender-stratified populations. METHODS: Our system is based on the analysis of 24 hour-long activity records using Convolutional Neural Networks (CNNs) to classify spectrograms of activity windows. These windows are interpreted using occlusion maps to highlight the time-frequency patterns explaining ADHD activity. RESULTS: Significant differences in the frequency patterns between ADHD and controls both in diurnal and nocturnal activity were found for all the populations. Temporal dispersion also presented differences in the male population. CONCLUSION: The proposed interpretation techniques for CNNs highlighted gender- and age-related differences between ADHD patients and controls. Leveraging these differences could potentially lead to improved diagnostic accuracy, especially if a larger and more balanced dataset is utilized. SIGNIFICANCE: Our findings pave the way for the development of an AI-based diagnosis system for ADHD that offers interpretability, thereby providing valuable insights into the underlying etiology of the disease.

Personalidad en adolescentes en muestra general y clínica / Personality in adolescents in a general and clinical sample

El objetivo principal del estudio fue analizar las diferencias entre muestra general y clínica en los prototipos de personalidad (PRP) del “Inventario clínico para adolescentes de Millón” (MACI). La metodología incluyó un diseño observacional y analítico, utilizando un muestreo de participantes (13-17 años) aleatorio polietápico, estratificado y proporcional por conglomerados en muestra general (n= 461) y un muestreo consecutivo en muestra clínica (n= 219). Encontramos que los PRP introvertido, inhibido, pesimista, rudo, oposicionista, autopunitivo y límite presentan una media significativamente mayor en muestra clínica y los PRP histriónico y conformista en muestra general. Se observa ausencia de diferencias significativas en los PRP egocéntrico, sumiso y rebelde. En la variable sexo observamos más diferencias significativas de PRP en muestra clínica que en la general y en la variable edad encontramos una tendencia lineal significativa descendente en los PRP sumiso o conformista y ascendente en los PRP rebelde y rudo en muestra general. El clínico debe estar alerta ante la interpretación de los PRP del MACI que no diferencian entre muestra general y clínica. (AU)

The main objective of the study was to analyze the differences between samples from general and clinical sample in personality prototypes (PRP), derived from the Millon Adolescent Clinical Inventory (MACI). The methodology included an analytical and observational design with a random, multi-stage, stratified and proportional cluster sampling in general sample (n= 461) and consecutive sampling of clinical sample (n= 219), in adolescents between 13 and 17 years of age. We found introvert, inhibited, doleful, forceful, oppositional, self-demeaning and borderline PRP in the clinical sample and dramatizing and conforming PRP in the general sample present a significantly higher mean. There is a relevant absence of significant differences in egotistic, submissive and unruly PRP. By sex, more significant differences in PRP are observed in the clinical sample. By age, a significant downward linear trend in the submissive and conforming PRP is observed, as well as an upward trend in the unruly and forceful PRP in the general sample. The clinician must be alert in the interpretation of the MACI PRP that do not differentiate between general and clinical samples. (AU)

[Trend in medicines use for attention deficit hyperactivity disorder in children and adolescents (2010-2019).] / Tendencia del consumo de fárma-cos en el trastorno por déficit de atención e hiperactividad en niños y adolescentes (2010-2019).

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is a common childhood neurodevelopmental disorder characterised primarily by three core symptoms: inattention, hyperactivity and impulsivity. It is one of the most commonly diagnosed childhood psychiatric disorders, with a worldwide prevalence of between 3% and 5%, and between 6% and 7% in the Spanish population. The aim of the study is to analyse the trend in the consumption of drugs used for the treatment of ADHD between 2010-2019 in Castilla y León. METHODS: Epidemiological registry study of all dispensing in pharmacies in Castilla y León between 2010 and 2019 to patients under 19 years of age, of active substance N06BA04 (methylphenidate), N06BA09 (atomoxetine), N06BA12 (lisdexamfetamine), N06BA07 (modafinil) and C02AC02 (guanfacine). Data on drug use were obtained from the information system for the pharmaceutical provision of Castilla y León, CONCYLIA. Frequencies in absolute values and the corresponding percentages were calculated. Student's t-test was used to estimate differences between continuous variables and Pearson's Chi-square test for categorical variables, while the trend in consumption was analysed using the Cochran-Armitage test. RESULTS: ADHD medication was dispensed annually to 1.77% of the population, with consumption being more than three times higher in boys than in girls (2.69% vs 0.81%; p=0.001). The age group with the highest peak use was 10-14 years with 3.42%. Methylphenidate was the drug used by the highest percentage of the population (2.44%) followed by lisdexamfetamine (0.37%). CONCLUSIONS: Approximately 2 out of every 100 people aged 0-19 years were treated with some ADHD medication, mainly methylphenidate, in Castilla y León between 2010 and 2019.

OBJETIVO: El trastorno por déficit de atención e hiperactividad (TDAH) es un trastorno común del neurodesarrollo infantil que se caracteriza fundamentalmente por tres síntomas a nivel central: falta de atención, hiperactividad e impulsividad. Se trata de uno de los trastornos psiquiátricos infantiles más comúnmente diagnosticados, con una prevalencia a nivel mundial que oscila entre el 3% y el 5%, y entre el 6% y el 7% en la población española. El objetivo del estudio es analizar la tendencia del consumo de los fármacos utilizados para el tratamiento del TDAH entre los años 2010-2019 en Castilla y León. METODOS: Estudio epidemiológico de registro de todas las dispensaciones realizadas en las oficinas de farmacia de Castilla y León entre el año 2010 y 2019 a pacientes menores de 19 años, de los principios activos N06BA04 (metilfenidato), N06BA09 (atomoxetina), N06BA12 (lisdexanfetamina), N06BA07 (modafinilo) y C02AC02 (guanfacina). Los datos de utilización de medicamentos se obtuvieron a partir del sistema de información para la prestación farmacéutica de Castilla y León, CONCYLIA. Se calcularon frecuencias en valores absolutos y los porcentajes correspondientes. Se utilizó el test-t de Student para estimar diferencias entre variables continuas y el test Chi-cuadrado de Pearson para las categóricas, mientras que la tendencia de consumo se analizó mediante el test de Cochran-Armitage. RESULTADOS: Se dispensaron anualmente los medicamentos para el TDAH al 1,77% de la población, siendo el consumo más de tres veces mayor en niños que en niñas (2,69% vs 0,81%; p=0,001). La franja de edad donde se observó el mayor pico de consumo fue de los 10 a 14 años con un 3,42%. El metilfenidato fue el medicamento consumido por un mayor porcentaje de la población (2,44%) seguido de la lisdexanfetamina (0,37%). CONCLUSIONES: Aproximadamente 2 de cada 100 personas entre 0 y 19 años fueron tratadas con algún medicamento para la TDAH, fundamentalmente metilfenidato, en Castilla y León entre 2010 y 2019.

Trends in psychiatric hospitalization for alcohol and drugs in Castilla y León between 2005 and 2015. / Tendencias en la hospitalización psiquiátrica por alcohol y drogas en Castilla y León entre 2005 y 2015.

It has been estimated that alcohol, tobacco, and illicit drugs were responsible for more than 10 million deaths worldwide in 2016, and there are many opportunities for improvement. Regarding innovative data analysis, advances have been made in the extraction of information from administrative databases for analytics purposes. We studied trends in hospitalization rates for alcohol and drug abuse over eleven years with Joinpoint Trend Analysis software. This is a descriptive study of cross-associations in 3,758 hospital admissions of patients admitted with a main diagnosis of alcohol and drug abuse or dependence in psychiatry units of public health centres of Castilla y León (Spain) between 2005 and 2015. Hospitalization trends for alcohol and drug related conditions declined over the eleven-year period. Separately, there was a statistically significant decrease in alcohol and cocaine related conditions, but a strong upward trend in cannabis related conditions between 2013 and 2015. Alcohol was the main cause of admission to psychiatric units with a diagnosis of addiction. In the 11 years researched, there was a progressive and constant reduction in admissions for substance use except for cannabis. The innovative statistical methodology has already proven to be useful for identifying trends and changes in different pathologies over time.

A nivel mundial, se ha estimado que el alcohol, el tabaco y las drogas han sido responsables de más de 10 millones de muertes en 2016, y que existe mucho margen para reducir la mortalidad. Se han realizado avances en la extracción de información de bases de datos administrativas con el fin de analizar grandes volúmenes de datos sanitarios. Hemos estudiado las tendencias en las tasas de hospitalización con diagnóstico de adicción a alcohol y drogas durante once años con el software Joinpoint Trend Analysis. Se trata de un estudio descriptivo de asociación cruzada de 3.758 ingresos hospitalarios de pacientes con diagnóstico principal de abuso o dependencia de alcohol y drogas en unidades de Psiquiatría de centros públicos de Castilla y León entre 2005 y 2015. Las tendencias en la hospitalización por adicción al alcohol y/o drogas disminuyeron a lo largo de los once años. Además de una reducción estadísticamente significativa de los ingresos por alcohol y cocaína, se apreció una fuerte tendencia al alza en los ingresos por cannabis entre 2013 y 2015. El alcohol fue durante todo el periodo de estudio la principal causa de ingreso y el que más días de hospitalización ha generado. No obstante, en los 11 años se observó una reducción progresiva y constante en los ingresos por todas las sustancias a excepción del cannabis. La metodología utilizada ya ha demostrado ser muy útil para identificar cambios de tendencias en diferentes patologías.

Construct Validity of the Routine Assessment of Patient Index Data 3 (RAPID3) in the Evaluation of Axial Spondyloarthritis.

OBJECTIVE: Although there are different tools to evaluate axial spondyloarthritis (axSpA), they are hardly used in routine clinical practice due to time constraints. The Routine Assessment of Patient Index Data 3 (RAPID3) is a composite measure feasible for use as a sole metric in busy clinics. We aimed to test its measurement properties in patients with axial SpA in a real-world clinical setting. METHODS: This cross-sectional study included 131 consecutive patients with axial SpA. The convergent (Spearman ρ) and discriminant (receiver-operating characteristic [ROC] curve analysis) validity of RAPID3 were tested against several axSpA-specific measures (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Ankylosing Spondylitis Disease Activity Score [ASDAS], Bath Ankylosing Spondylitis Functional Index [BASFI], and modified Stoke Ankylosing Spondylitis Spinal Score [mSASSS]). A multivariate model was built to detect disease factors associated with RAPID3 remission (values ≤ 3). RESULTS: The study included 82 men and 49 women, with a median age of 55 (IQR 46-61) years, and a median disease duration of 11 (IQR 6-24) years. Mean RAPID3 was 9.45 ± 6.7. The BASDAI showed moderate correlation with ASDAS (ρ 0.66, P < 0.0001), but higher correlations with BASFI (ρ 0.78, P < 0.0001) and RAPID3 (ρ 0.75, P < 0.0001). The ASDAS had moderate correlations with BASFI, BASDAI, and RAPID3 (ranges 0.66-0.68, P < 0.0001). Higher correlations were found between BASFI and BASDAI (ρ 0.78, P < 0.0001), and BASFI and RAPID3 (ρ 0.73, P < 0.0001). The mSASSS did not show any correlation with any of the above composite measures. κ agreement between RAPID3 remission and other SpA remission criteria was moderate (κ 0.46-0.56). The RAPID3 thresholds to define remission ranged from values ≤ 2 to ≤ 6 with areas under the ROC curve between 0.86-0.91. Female sex (OR 0.34, 95% CI 0.12-0.90, P = 0.03) and nonsteroidal antiinflammatory drug intake (OR 0.26, 95% CI 0.10-0.66, P = 0.005) were independently associated with lower odds of achieving RAPID3 remission. CONCLUSION: RAPID3 demonstrated construct validity in this cross-sectional study. This index can be useful for a more comprehensive assessment of axSpA in busy clinical settings.

Tendencias en la hospitalización psiquiátrica por alcoholy drogas en Castilla y León entre 2005 y 2015 / Trends in psychiatric hospitalization for alcohol and drugs in Castilla y León between 2005 and 2015

A nivel mundial, se ha estimado que el alcohol, el tabaco y las drogashan sido responsables de más de 10 millones de muertes en 2016, yque existe mucho margen para reducir la mortalidad. Se han realizadoavances en la extracción de información de bases de datos administrativas con el fin de analizar grandes volúmenes de datos sanitarios. Hemosestudiado las tendencias en las tasas de hospitalización con diagnóstico de adicción a alcohol y drogas durante once años con el softwareJoinpoint Trend Analysis. Se trata de un estudio descriptivo de asociación cruzada de 3.758 ingresos hospitalarios de pacientes con diagnóstico principal de abuso o dependencia de alcohol y drogas en unidadesde Psiquiatría de centros públicos de Castilla y León entre 2005 y 2015.Las tendencias en la hospitalización por adicción al alcohol y/o drogasdisminuyeron a lo largo de los once años. Además de una reducciónestadísticamente significativa de los ingresos por alcohol y cocaína, seapreció una fuerte tendencia al alza en los ingresos por cannabis entre2013 y 2015. El alcohol fue durante todo el periodo de estudio la principal causa de ingreso y el que más días de hospitalización ha generado.No obstante, en los 11 años se observó una reducción progresiva y constante en los ingresos por todas las sustancias a excepción del cannabis.La metodología utilizada ya ha demostrado ser muy útil para identificarcambios de tendencias en diferentes patologías. (AU)

It has been estimated that alcohol, tobacco, and illicit drugs were responsible for more than 10 million deaths worldwide in 2016, andthere are many opportunities for improvement. Regarding innovativedata analysis, advances have been made in the extraction of information from administrative databases for analytics purposes. We studiedtrends in hospitalization rates for alcohol and drug abuse over elevenyears with Joinpoint Trend Analysis software. This is a descriptive studyof cross-associations in 3,758 hospital admissions of patients admittedwith a main diagnosis of alcohol and drug abuse or dependence inpsychiatry units of public health centres of Castilla y León (Spain)between 2005 and 2015. Hospitalization trends for alcohol and drugrelated conditions declined over the eleven-year period. Separately,there was a statistically significant decrease in alcohol and cocainerelated conditions, but a strong upward trend in cannabis relatedconditions between 2013 and 2015. Alcohol was the main cause ofadmission to psychiatric units with a diagnosis of addiction. In the11 years researched, there was a progressive and constant reductionin admissions for substance use except for cannabis. The innovativestatistical methodology has already proven to be useful for identifyingtrends and changes in different pathologies over time. (AU)

[Impact of COVID-19 on mortality in the autonomous community of Castilla y León (Spain)]. / Impacto de la COVID-19 en la mortalidad de la comunidad autónoma de Castilla y León.

OBJECTIVE: To estimate the increase in mortality associated with the SARS-CoV-2 coronavirus pandemic in the autonomous community of Castilla y León (Spain). METHOD: Ecological study based on population and death data for the months of March 2016 to 2020 in Castilla y León. The general and provincial standardized rates, the relative risks of the year 2020 with respect to previous years and the risks adjusted by sex, periods and province, using Poisson regression, were calculated. Trend analysis was performed using joinpoint linear regression. RESULTS: An increase in mortality was observed in March 2020 with respect to previous years, with an increase of 39% for men (relative risk [RR]: 1.39; 95% confidence interval [95%CI]: 1.32-1.47) and 28% for women (RR: 1.28; 95%CI: 1.21-1.35). The model predicts excess mortality of 775 deaths. In the trend analysis there is a significant turning point in 2019 in men, globally and for almost all provinces. The increase in mortality is general, although heterogeneous by sex, age group and province. CONCLUSIONS: Although the observed increase in mortality cannot be totally attributed to the disease, it is the best estimate we have of the real impact on deaths directly or indirectly related to it. The number of declared deaths only reaches two thirds of the increase in mortality observed.

Objective ADHD Diagnosis Using Convolutional Neural Networks Over Daily-Life Activity Records.

Attention Deficit/Hyperactivity Disorder (ADHD) is the most common neurobehavioral disorder in children and adolescents. However, its etiology is still unknown, and this hinders the existence of reliable, fast and inexpensive standard diagnostic methods. OBJECTIVE: This paper proposes an end-to-end methodology for automatic diagnosis of the combined type of ADHD. METHODS: Diagnosis is based on the analysis of 24 hour-long activity records using Convolutional Neural Networks to classify spectrograms of activity windows. RESULTS: We achieve up to [Formula: see text] average sensitivity, [Formula: see text] specificity and AUC values over [Formula: see text]. Overall, our figures overcome those obtained by actigraphy-based methods reported in the literature as well as others based on more expensive (and not so convenient) acquisition methods. CONCLUSION: These results reinforce the idea that combining deep learning techniques together with actimetry can lead to a robust and efficient system for objective ADHD diagnosis. SIGNIFICANCE: Reliance on simple activity measurements leads to an inexpensive and non-invasive objective diagn-ostic method, which can be easily implemented with daily devices.

Impacto de la COVID-19 en la mortalidad de la comunidad autónoma de Castilla y León / Impact of COVID-19 on mortality in the autonomous community of Castilla y León (Spain)

OBJETIVO: Estimar el aumento de la mortalidad asociado a la pandemia por SARS-CoV-2 en la comunidad autónoma de Castilla y León. MÉTODO: Estudio ecológico basado en los datos de población y los fallecimientos correspondientes a los meses de marzo de los años 2016 a 2020 en Castilla y León. Se calcularon las tasas estandarizadas globales y por provincias, los riesgos relativos del año 2020 respecto a los años previos y los riesgos ajustados por sexo, periodo y provincia mediante regresión de Poisson. Se hizo un análisis de tendencias mediante regresión lineal joinpoint. RESULTADOS: En marzo de 2020 se observó un aumento de la mortalidad respecto a los años previos, con un incremento del 39% para los hombres (riesgo relativo [RR]: 1,39; intervalo de confianza del 95% [IC95]: 1,32-1,47) y del 28% para las mujeres (RR: 1,28; IC95: 1,21-1,35). El modelo predice un exceso de mortalidad en 2020 de 775 fallecimientos. En el análisis de tendencias hay un punto de inflexión significativo en 2019 para los varones, globalmente y para casi todas las provincias. El aumento de la mortalidad es global, aunque heterogéneo por sexos, grupos de edad y provincias. CONCLUSIONES: Aunque el aumento de la mortalidad observado no puede ser totalmente atribuido a la enfermedad, es la mejor estimación que tenemos del impacto real en muertes directamente o indirectamente relacionadas con ella. El número de muertes declaradas solo alcanza dos terceras partes del aumento de la mortalidad observado

OBJECTIVE: To estimate the increase in mortality associated with the SARS-CoV-2 coronavirus pandemic in the autonomous community of Castilla y León (Spain). METHOD: Ecological study based on population and death data for the months of March 2016 to 2020 in Castilla y León. The general and provincial standardized rates, the relative risks of the year 2020 with respect to previous years and the risks adjusted by sex, periods and province, using Poisson regression, were calculated. Trend analysis was performed using joinpoint linear regression. RESULTS: An increase in mortality was observed in March 2020 with respect to previous years, with an increase of 39% for men (relative risk [RR]: 1.39; 95% confidence interval [95%CI]: 1.32-1.47) and 28% for women (RR: 1.28; 95%CI: 1.21-1.35). The model predicts excess mortality of 775 deaths. In the trend analysis there is a significant turning point in 2019 in men, globally and for almost all provinces. The increase in mortality is general, although heterogeneous by sex, age group and province. CONCLUSIONS: Although the observed increase in mortality cannot be totally attributed to the disease, it is the best estimate we have of the real impact on deaths directly or indirectly related to it. The number of declared deaths only reaches two thirds of the increase in mortality observed

Evolución temporal de los partos múltiples en Castilla y León durante 13 años / Multiple birth trends in the region of Castilla y León (Spain) in a 13 year period

Introducción: La prevalencia del embarazo múltiple está experimentando un ascenso en los últimos años, lo que conlleva un aumento de la morbimortalidad fetal y de la morbilidad materna. El objetivo de este estudio es analizar la evolución de los partos múltiples en Castilla y León durante 13 años y sus implicaciones maternas y fetales. Material y métodos: Estudio de asociación cruzada, sobre el conjunto mínimo básico de datos (CMBD), de altas hospitalarias de la red Sanidad de Castilla y León (SACYL) entre 2001 y 2013. Se realizó un análisis de tendencias mediante regresión lineal de joinpoint, un análisis ritmométrico y un análisis multivariante mediante regresión logística binaria. Resultados: A lo largo de los 13 años de estudio se observa una tendencia creciente en la proporción de partos múltiples, en contraste con los únicos, con un porcentaje anual de cambio del 3,4% (IC del 95%: 2,5-4,4%). Se encontró asociación estadística entre la edad materna, la tolerancia anormal a la glucosa, el parto operatorio, la macrosomía fetal, el parto prematuro, la muerte fetal, las malposiciones fetales, la fecundación in vitro y los estados hipertensivos maternos y el parto gemelar, destacando que la fecundación in vitro se asocia con un exceso de riesgo de 9,3 veces de parto múltiple (IC del 95%: 7,4-11,5), así como la edad de la madre se asocia con un exceso de riesgo del 5% por cada año de edad (OR: 1,05; IC 95%: 1,04-1,05). No se evidenció estacionalidad en los partos múltiples en contraposición con los únicos. Conclusiones: Los partos múltiples experimentaron un continuo ascenso, sin seguir un ritmo estacional, asociados a la extensión del uso de las técnicas de reproducción asistida y al retraso en la edad de la maternidad, lo que conlleva mayor morbimortalidad fetal y materna

Introduction: Multiple pregnancy has increased in prevalence in the last few years, which could lead to more foetal and maternal morbidity issues. The aim of this study is to describe the trend of multiple pregnancy deliveries in Castilla y León during the last 13years and the subsequent impact on foetal and maternal health. Material and methods: Data was collected from the hospital discharge reports registered in the Regional Health-care database (SACYL: Health care in Castilla y León) between 2001 and 2013. A cross sectional descriptive study was conducted, including trend analysis with log-linear joint point model, a rhythm metric study, as well as a risk assessment with multivariate analysis. Results: A pronounced upward trend was observed in the proportion of multiple deliveries in this time period, compared to single ones, with an annual percentage change of 3.4% (95% CI: 2.5-4.4). Multiple pregnancy was significantly correlated with advanced maternal age, abnormal glucose tolerance, dystocia and caesarean section delivery, premature birth, foetal malposition, foetal macrosomia, stillbirth, in vitro fertilisation, and hypertensive episodes of pregnancy. In vitro fertilization showed a 9.3 fold increased risk in multiple pregnancy (95% CI: 7.4-11.5), with maternal age increasing the risk up to 5% per year of age (OR: 1.05: 95%CI: 1.04-1.05). No seasonal rhythm was observed in multiple deliveries compared with single ones. Conclusion: Multiple pregnancy has experienced a continuous increase, with no seasonal trend, and is associated with the increase in assisted reproductive technology and advanced maternal age. This involves more problems regarding foetal and maternal morbidity and mortality

[Multiple birth trends in the region of Castilla y León (Spain) in a 13 year period]. / Evolución temporal de los partos múltiples en Castilla y León durante 13 años.

INTRODUCTION: Multiple pregnancy has increased in prevalence in the last few years, which could lead to more foetal and maternal morbidity issues. The aim of this study is to describe the trend of multiple pregnancy deliveries in Castilla y León during the last 13years and the subsequent impact on foetal and maternal health. MATERIAL AND METHODS: Data was collected from the hospital discharge reports registered in the Regional Health-care database (SACYL: Health care in Castilla y León) between 2001 and 2013. A cross sectional descriptive study was conducted, including trend analysis with log-linear joint point model, a rhythm metric study, as well as a risk assessment with multivariate analysis. RESULTS: A pronounced upward trend was observed in the proportion of multiple deliveries in this time period, compared to single ones, with an annual percentage change of 3.4% (95% CI: 2.5-4.4). Multiple pregnancy was significantly correlated with advanced maternal age, abnormal glucose tolerance, dystocia and caesarean section delivery, premature birth, foetal malposition, foetal macrosomia, stillbirth, in vitro fertilisation, and hypertensive episodes of pregnancy. In vitro fertilization showed a 9.3 fold increased risk in multiple pregnancy (95% CI: 7.4-11.5), with maternal age increasing the risk up to 5% per year of age (OR: 1.05: 95%CI: 1.04-1.05). No seasonal rhythm was observed in multiple deliveries compared with single ones. CONCLUSION: Multiple pregnancy has experienced a continuous increase, with no seasonal trend, and is associated with the increase in assisted reproductive technology and advanced maternal age. This involves more problems regarding foetal and maternal morbidity and mortality.

Validez de un modelo reducido de items del DSM-IV según respuesta de padres y profesores en el diagnóstico del Trastorno por Déficit de Atención con Hiperactividad Combinado / Validity of a reduced model of items of DSM-IV criteria according to the parents’ and teachers’ responses in the diagnostic of the Attention Deficit Hyperactivity Disorder (Combined Type

Objetivo: Buscar un modelo reducido de síntomas del Trastorno por Déficit de Atención con Hiperactividad Combinado (TDAH-C), que presente adecuada validez de criterio para el diagnóstico del trastorno. Metodología: Contexto de estudio epidemiológico. Muestra de 1095 casos entre 6 y 16 años [4.38 % TDAH-C]. Selección de casos con primera fase psicométrica de sospecha TDAH-C que requiere que ADHD RS-IV, implementado por padres (PA) y profesores (PR), supere el PC 90. Segunda fase: Los casos seleccionados se evalúan mediante entrevista clínica modelo DISC-IV (DSM-IV) para confirmar TDAH-C. Se implementa regresión logística para buscar modelo parsimonioso de ítems que permita predecir TDAH-C. Resultados: El modelo de ítems que permite predecir TDAH-C contiene 8 de 36 ítems del ADHD RS-IV contestados por PA y PR. Considerando odss ratio del modelo de regresión logística, los ítems del ADHD RS-IV presentan un ranking de 15PR > 1PA > 16PR > 12PA > 17PA > 10PA > 14PA > 4PR. El modelo presenta validez de criterio para TDAH-C clínico (sensibilidad: 97.9 %. Especifidad: 93.8%. Razón de verosimilitud: 16.02). Conclusiones: Es posible reducir la lista de síntomas de TDAH-C con buena validez de criterio, manteniendo los que proporcionan mayor discriminación entre TDAH-C y población general

Main Objective: To look for a reduced model of symptoms of the attention deficit hyperactivity disorder combined type (ADHD-C), that shows suitable levels of criterion validity for the diagnostic of the disease. Methods: Epidemiological study. Sample of 1095 children between 6 and 16 years. First stage: psicometric study using ADHD RS-IV answered by parents (P) and teachers (T). ADHD is suspected when both questionnaires are over 90th percentile. Second stage: Clinical interview DISC-IV (DSM-IV) only in those selected cases to confirm ADHD-C. Logistic regression is implemented to find the most parsimonious model to predict ADHD-C. Results: The model that predicts clinical ADHD-C consists of 8 of the 36 items of the ADHD RS-IV answered by P and T. If we consider the Odds Ratio obtained by regression, the items present a ranking of: 15 T> 1 P> 16 T> 12 P> 17 P> 10 P> 14 P> 4 T. The model has criterion validity for symptomatic ADHD-C (sensitivity: 97.9%. Specificity: 93.8%. Likelihood ratio: 16.02). Conclusions: It is possible to reduce the list of symptoms of ADHD-C with good criterion validity, removing redundant items and keeping those that provide greater discrimination between ADHD-C and the general population

Prevalencia del trastorno negativista desafiante en España / Prevalence of oppositional defiant disorder in Spain

Introducción: El trastorno negativista desafiante (TND) se caracteriza por un patrón de comportamiento negativista, desafiante, desobediente y hostil, dirigido a las figuras de autoridad. El TND es uno de los motivos más frecuentes de consulta clínica en salud mental durante la infancia y adolescencia. Presenta gran morbilidad y disfuncionalidad, mostrando repercusiones futuras si no es tratado de forma temprana. Objetivo: Determinar la tasa de prevalencia de TND en escolares de 6-16 años de Castilla y León (España). Material y métodos: Estudio epidemiológico poblacional, con diseño muestral polietápico estratificado, proporcional y por conglomerados. Muestra analizada: 1.049 sujetos. Casos definidos según criterios DSM-IV. Resultados: La prevalencia de TND es 5,6% (IC 95%: 4,2-7%). Prevalencia género masculino = 6,8%; femenino = 4,3%. Prevalencia educación secundaria = 6,2%; educación primaria = 5,3%. No existen diferencias significativas en función del sexo, edad, tipo de centro, ni por zona sociodemográfica. La prevalencia de TND sin considerar deterioro funcional aumentaría al 7,4%. Los casos de TND presentan significativamente peores resultados académicos (resultados académicos globales, lectura, matemáticas y expresión escrita) y peor conducta en clase (relación con compañeros, respeto a las normas, destrezas de organización, realización de tareas académicas e interrupción de la clase). Conclusiones: Castilla y León presenta una tasa de prevalencia de TND levemente superior a la observada en publicaciones internacionales. En función de su distribución por edad, morbilidad y repercusión clínica disfuncional, parece necesaria una planificación sanitaria que incida en un diagnóstico temprano e intervención preventiva (AU)

Introduction: Oppositional defiant disorder (ODD) is characterized by a pattern of negative, defiant, disobedient and hostile behavior toward authority figures. ODD is one of the most frequent reasons for clinical consultation on mental health during childhood and adolescence. ODD has a high morbidity and dysfunction, and has important implications for the future if not treated early. Objective: To determine the prevalence of ODD in schoolchildren aged 6-16 years in Castile and Leon (Spain). Material and methods: Population study with a stratified multistage sample, and a proportional cluster design. Sample analyzed: 1,049. Cases were defined according to DSM-IV criteria. Results: An overall prevalence rate of 5.6% was found (95% CI: 4.2%---7%). Male gender prevalence = 6.8%; female = 4.3%. Prevalence in secondary education = 6.2%; primary education = 5.3%. No significant differences by gender, age, grade, type of school, or demographic area were found. ODD prevalence without considering functional impairment, such as is performed in some research, would increase the prevalence to 7.4%. ODD cases have significantly worse academic outcomes (overall academic performance, reading, maths and writing), and worse classroom behavior (relationship with peers, respect for rules, organizational skills, academic tasks, and disruption of the class). Conclusions: Castile and Leon has a prevalence rate of ODD slightly higher to that observed in international publications. Depending on the distribution by age, morbidity and clinical dysfunctional impact, an early diagnosis and a preventive intervention are required for health planning (AU)

Prevalence of oppositional defiant disorder in Spain.

INTRODUCTION: Oppositional defiant disorder (ODD) is characterized by a pattern of negative, defiant, disobedient and hostile behavior toward authority figures. ODD is one of the most frequent reasons for clinical consultation on mental health during childhood and adolescence. ODD has a high morbidity and dysfunction, and has important implications for the future if not treated early. OBJECTIVE: To determine the prevalence of ODD in schoolchildren aged 6-16 years in Castile and Leon (Spain). MATERIAL AND METHODS: Population study with a stratified multistage sample, and a proportional cluster design. Sample analyzed: 1,049. Cases were defined according to DSM-IV criteria. RESULTS: An overall prevalence rate of 5.6% was found (95% CI: 4.2%-7%). Male gender prevalence=6.8%; female=4.3%. Prevalence in secondary education=6.2%; primary education=5.3%. No significant differences by gender, age, grade, type of school, or demographic area were found. ODD prevalence without considering functional impairment, such as is performed in some research, would increase the prevalence to 7.4%. ODD cases have significantly worse academic outcomes (overall academic performance, reading, maths and writing), and worse classroom behavior (relationship with peers, respect for rules, organizational skills, academic tasks, and disruption of the class). CONCLUSIONS: Castile and Leon has a prevalence rate of ODD slightly higher to that observed in international publications. Depending on the distribution by age, morbidity and clinical dysfunctional impact, an early diagnosis and a preventive intervention are required for health planning.

Relación entre infarto de miocardio y ritmo circadiano en pacientes atendidos por un servicio de emergencias prehospitalario / Relation between myocardial infarction and cyrcadian rhythm in patients attended in a prehospital emergency service

Fundamento y objetivo. El objetivo de este estudio es analizar la presencia de ritmo circadiano en la hora de inicio del infarto agudo de miocardio atendido por un sistema de emergencias prehospitalario, y la influencia en dicho ritmo de algunos factores de riesgo cardiovascular modificables y no modificables como posibles moduladores de ese patrón circadiano. Pacientes y método. Análisis retrospectivo de 709 pacientes con diagnóstico clínico confirmado in situ de infarto agudo de miocardio. Se analizan las variables: hora de inicio de los síntomas, edad, sexo, cardiopatía isquémica previa, hipertensión arterial, diabetes mellitus, dislipidemia y tabaquismo. El análisis de ritmo se ha efectuado utilizando un test simple de igualdad de series basado en el análisis cosinor de múltiples sinusoides, eligiendo 3 armónicos (24,12 y 8h) para su ajuste. Resultados. La hora de inicio del infarto muestra ritmo circadiano (p<0,001), con un pico máximo a las 10.39 y un valle a las 4.28, mostrando una curva sinusoidal ajustada de aspecto bimodal, con un pico matinal predominante y otro vespertino de menor amplitud. Todos los subgrupos categorizados por la presencia de las variables analizadas presentaron ritmo circadiano, con una curva sinusoidal similar a la de la población global. Los pacientes fumadores muestran un pico vespertino predominante. Conclusiones. El infarto de miocardio presenta ritmo circadiano. El tabaquismo y la diabetes modifican el patrón de ritmo circadiano habitual del infarto(AU)

Background and objectives. The aim of this study is to analyze the presence of circadian rhythm in the time of onset of symptoms of acute myocardial infarction treated by a prehospital emergency system and the influence of modifiable cardiovascular risk factors and non-modifiable as modulators of that circadian rhythm. Patients and methods. Retrospective analysis of 709 patients clinically diagnosed with acute myocardial infarction on-site in the prehospital setting. The variables were time to onset of symptoms, age, sex, previous ischemic heart disease, hypertension, diabetes mellitus, hyperlipidemia and smoking. We analyzed the rhythm with cosinor multiple sinusoid method, with 3 harmonics (24, 12 and 8h) for the adjustment. Results. The time of onset of pain showed circadian rhythm (P <,001), peaking at 10.39 and a valley at 4.28, showing a sinusoidal curve fitting bimodal aspect with a predominant morning peak and another evening one of lower amplitude. All subgroups categorized by the study variables showed circadian rhythm, with a cosine curve similar to the global infarction. Smokers had a predominantly evening peak. Conclusions. Acute myocardial infarction shows a circadian rhythm. Smoking and diabetes mellitus can modify the standard incidence rate of occurrence of myocardial infarction(AU)

[Relation between myocardial infarction and circadian rhythm in patients attended in a prehospital emergency service]. / Relación entre infarto de miocardio y ritmo circadiano en pacientes atendidos por un servicio de emergencias prehospitalario.

BACKGROUND AND OBJECTIVES: The aim of this study is to analyze the presence of circadian rhythm in the time of onset of symptoms of acute myocardial infarction treated by a prehospital emergency system and the influence of modifiable cardiovascular risk factors and non-modifiable as modulators of that circadian rhythm. PATIENTS AND METHODS: Retrospective analysis of 709 patients clinically diagnosed with acute myocardial infarction on-site in the prehospital setting. The variables were time to onset of symptoms, age, sex, previous ischemic heart disease, hypertension, diabetes mellitus, hyperlipidemia and smoking. We analyzed the rhythm with cosinor multiple sinusoid method, with 3 harmonics (24, 12 and 8h) for the adjustment. RESULTS: The time of onset of pain showed circadian rhythm (P <,001), peaking at 10.39 and a valley at 4.28, showing a sinusoidal curve fitting bimodal aspect with a predominant morning peak and another evening one of lower amplitude. All subgroups categorized by the study variables showed circadian rhythm, with a cosine curve similar to the global infarction. Smokers had a predominantly evening peak. CONCLUSIONS: Acute myocardial infarction shows a circadian rhythm. Smoking and diabetes mellitus can modify the standard incidence rate of occurrence of myocardial infarction.

Automatic diagnosis of ADHD based on multichannel nonlinear analysis of actimetry registries.

Attention-Deficit Hyperactivity Disorder (ADHD) is the most common mental health problem in childhood and adolescence. It is commonly diagnosed by means of subjective methods which tend to overestimate the severity of the pathology. A number of objective methods also exist, but they are either expensive or time-consuming. Some recent proposals based on nonlinear processing of activity registries have deserved special attention. Since they rely on actigraphy measurements, they are both inexpensive and non-invasive. Among these methods, those shown to have higher reliability are based on single-channel complexity assessment of the activity patterns. This way, potentially useful information related to the interaction between the different channels is discarded. In this paper we propose a new methodology for ADHD diagnosis based on joint complexity assessment of multichannel activity registries. Results on real data show that the proposed method constitute a useful diagnostic aid tool reaching 87:10% sensitivity and 84.38% specificity. The combination of ADHD indicators extracted with the proposed method with single-channel complexity-based indices previously proposed lead to sensitivity and specifity values above 90%.

Utilidad de un modelo estadístico de estilos cognitivos en el trastorno por déficit de atención con hiperactividad / Utility of a statistical model of cognitive styles in attention deficit hyperactivity disorder

El objetivo de este estudio fue buscar el mejor modelo estadístico de estilos cognitivos, basado en las pruebas MFFT-20, CEFT y STROOP para predecir el trastorno por déficit de atención con hiperactividad (TDAH), analizando la validez del modelo para el diagnóstico del trastorno. Se estudió una muestra de 100 casos de TDAH (criterios DSM-IV) y 100 controles entre 7 y 11 años. Los controles fueron reclutados de forma aleatoria y emparejados según edad, sexo y zona sociodemográfica con los casos. Los casos presentaron en promedio mayor impulsividad (d: 1,28), menor flexibilidad cognitiva (d: ,91) y más dependencia de campo (d: 1,62) que los controles. El modelo de regresión logística que mejor predice TDAH está formado por las variables edad, CEFT, MFFT-20 y STROOP, y la fórmula derivada del modelo presenta una sensibilidad del 85% y especifidad del 85% para TDAH, tomando como prueba de referencia criterios DSM-IV. El modelo estadístico de estilos cognitivos presenta indicadores de adecuada validez diagnóstica en TDAH, contribuyendo a incrementar la objetividad en su análisis (AU)

The purpose of this study was to determine the best statistical model of cognitive styles, based on the MFFT-20, CEFT and Stroop tests to predict attention deficit hyperactivity disorder (ADHD), analyzing the validity of the model for the diagnosis of the disease. We studied 100 ADHD cases (DSM-IV criteria) and 100 controls, age ranging between 7 and 11 years. Controls were randomly recruited and matched in age, gender and sociodemographic area with ADHD cases. On average, ADHD cases showed more impulsiveness (d: 1.28), less cognitive flexibility (d: 0.91) and more field dependence (d: 1.62) than controls. The logistic regression model that predicts ADHD best is made up of age, CEFT, MFFT-20 and Stroop tests and the formula derived from the model shows 85% sensitivity and 85% specificity for ADHD, regarding the DSM-IV criteria as the standard. The statistical model of cognitive styles presents valid indicators to diagnose ADHD, contributing to an increase in the objectivity of its analysis (AU)

Validez de los criterios DSM-IV según respuesta de los padres en el diagnóstico del trastorno por déficit de atención con hiperactividad / Validity of the DSM-IV criteria according to the parents´ response in the diagnosis of the attention deficit hyperactivity disorder

Introducción. Objetivos: Estudiar la validez para el diagnóstico del trastorno por déficit de atención con hiperactividad (TDAH), de cada uno de los ítems DSM-IV y buscar un modelo reducido de ítems que ayude a detectar casos de niños con TDAH. Sujetos y método. Se utilizan los datos de un estudio epidemiológico sobre TDAH con una muestra de 1095 casos. El 6.6% son TDAH. Casos de TDAH definidos según ADHD RS-IV y criterios clínicos DSM-IV. Controles definidos por exclusión. Resultados. El modelo de regresión logística que mejor predice el fenotipo inatento está compuesto por los ítems del ADHD RS-IV (versión padres) 1, 3, 9, 15 y 17 (Se: 96.7%, Es: 81.5%); el fenotipo hiperactivo/impulsivo por los ítems 2, 4, 10, 12, 14 y 16 (Se: 96.6%, Es: 81%) y el fenotipo combinado por los ítems 9, 10, 12, 14 y 15 (Se: 100 %, Es: 82.6%). Existe una reducción del 66% de los ítems en el fenotipo combinado. Conclusiones. Es posible reducir la lista de síntomas de TDAH con unos niveles de validez adecuados y determinados ítems parecen tener mayor capacidad para determinar decisiones diagnósticas (AU)

Introduction. Objective: To study the validity of each of the items DSM-IV for the diagnosis of the Attention Deficit Hyperactivity Disorder (ADHD), and to look for a reduced model of items that allows predicting ADHD. Subjects and methods: We use the information of an epidemiological study on ADHD with a sample of 1095 children. 6.6 % are ADHD cases. ADHD cases are defined according to ADHD RS-IV and clinical criteria DSM-IV. Controls are defined by exclusion. Results: The model of logistic regression that better predicts the inattentive phenotype is composed by the items of the ADHD RS-IV (parents’ version) 1, 3, 9, 15 and 17 (Sensitivity: 96.7%, Specificity: 81.5%); the hyperactive / impulsive phenotype by the items 2, 4, 10, 12, 14 and 16 (Sensitivity: 96.6%, Specificity: 81%) and the combined phenotype by the items 9, 10, 12, 14 and 15 (Sensitivity: 100%, Specificity: 82.6%). A reduction of 66 % of the items in the combined phenotype is detected. Conclusions: It is possible to reduce the list of ADHD symptoms with suitable levels of validity and all the items should not have the same weight at the moment of making diagnostic decisions (AU)