Posttraumatic Stress Disorder, Anxiety, and Depression Symptoms After Potentially Traumatic Events: Latent Classes and Cognitive Correlates.

ABSTRACT: People exposed to potentially traumatic events (PTEs) may develop distinct symptom patterns, which may require different therapeutic approaches. We aimed to identify classes of people exposed to PTEs based on the presence of posttraumatic stress disorder (PTSD) clusters, anxiety, and depression and to explore which cognitive factors (rumination, worry, and negative cognitions) are associated with class membership. Latent class analyses were conducted to identify subgroups of 258 PTE-exposed Spanish adults. A three-class solution emerged: a resilient class with low odds of all symptoms ( n = 188); a partial PTSD class, characterized by partial PTSD clusters, moderate anxiety, and low depression ( n = 36); and a high symptom class, characterized by high PTSD, moderate anxiety, and low depression ( n = 34). These classes related meaningfully to rumination, worry, and negative cognitions. Distinct symptom patterns of PTSD clusters, anxiety, and depression can be distinguished in people exposed to PTEs and relate to cognitive risk factors of psychopathology.

Relationships of the Big Five facets and dysfunctional attitudes with depression.

There are two parallel lines of research on the relationship between personality and depression, one based on the Big Five personality model and one on Beck's cognitive theory of depression. However, no study has jointly examined the dimensions and facets of the Big Five and the dysfunctional attitudes of Beck's theory. This was the objective of the present study. The Revised NEO Personality Inventory (NEO PI-R), the Dysfunctional Attitude Scale (DAS-A), and the Beck Depression Inventory (BDI-IA) were applied to 221 adults from the Spanish general population (53.7% females; mean age: 38.3 years). Various multiple linear regression analyses revealed that only the facet of depression was significantly related to depressive symptomatology. The different associations of the broad and specific personality traits and the need to control as many third variables as possible to prevent the finding of spurious relationships are discussed.

Complicated Grief in a Spanish Sample of Victims of Terrorism: Evidence of Validity of the Inventory of Complicated Grief.

The Inventory of Complicated Grief (ICG) is the most widely used instrument to measure complicated grief (CG), but its psychometric properties have hardly been examined in relatives of those who died by violent means. The objective of this study was to obtain evidence of validity of the ICG in a relatives of those who died due to terrorist attacks in Spain. The factorial structure, internal consistency, and relationship with depression, anxiety, and post-traumatic stress were analyzed in a Spanish sample of 211 relatives of people who died in terrorist attacks. The ICG presented a one-factor structure that supports the validity of its total score. This score showed excellent internal consistency indices (alpha = .927; omega = .932) and adequate correlation indices with depression, anxiety, and post-traumatic stress (r = .71, .63 and .76, respectively). The ICG provides reliable and valid measures of CG in adults who have lost a family member due to violent death.

Long-Term Posttraumatic Growth in Victims of Terrorism in Spain.

Background: Scientific literature on posttraumatic growth (PTG) after terrorist attacks has primarily focused on persons who had not been directly exposed to terrorist attacks or persons who had been directly exposed to them, but who were assessed few months or years after the attacks. Methods: We examined long-term PTG in 210 adults directly exposed to terrorist attacks in Spain a mean of 29.6 years after the attacks (range: 2-47 years). The participants had been injured by a terrorist attack (38.6%) or were first-degree relatives of people who had been killed or injured by a terrorist attack (41.4% and 20%, respectively). They completed diagnostic measures of emotional disorders and measures of PTSD and depression symptomatology, optimism, and PTG. Results: Multiple regression analyses revealed gender differences (women reported higher levels of PTG than did men) and a positive linear relationship between PTG and cumulative trauma after the terrorist attack. Some PTG dimensions were significantly associated with PTSD symptomatology, these associations being linear, not curvilinear. However, PTG was not associated with depression symptomatology, diagnosis of emotional disorders, age, elapsed time since the attack, or optimism. In comparison with survivors assessed 18 years after the 1995 Oklahoma City bombing, Spanish victims of terrorism showed higher levels of appreciation of life, but lower levels of relating to others and spiritual change. Conclusion: The findings underscore the influence of gender on PTG and provide support to the hypothesis that some emotional distress may be a necessary condition of PTG. Future studies on PTG after terrorist attacks should take into consideration the characteristics of the terrorist attack itself and the contexts of violence and threat in which it occurred. The political, social, and cultural characteristics of the community affected by it and the profile and characteristics of other traumatic events suffered after the attack should also be taken into account in further research.

Dysfunctional Attitudes in Victims of Terrorism: Validity Evidence for the DAS-A.

BACKGROUND: The Dysfunctional Attitudes Scale, Form A (DAS-A), is the reference instrument for measuring dysfunctional attitudes which, according to Beck's cognitive theory, constitute the key vulnerability factor for depression. The psychometric properties of the Spanish version of the DAS-A have been examined in university students, but not in people with psychological disorders, despite being one of the most widely-used instruments in research and clinical practice of cognitive therapy for depression. The objective of the present study was to obtain validity evidence for the DAS-A in victims of terrorism with and without emotional disorders. METHOD: The DAS-A's factor structure, internal consistency, and relationship with depression were analyzed in 196 victims of terrorism with emotional disorders and 280 victims without disorders. RESULTS: In both samples, the DAS-A exhibited a structure with three correlated factors: Achievement-Perfectionism, Dependency-Need for Approval, and Autonomous Attitude. In general, the total scale and the subscales showed good or adequate indices of internal consistency (alphas and omegas = .60 - .89) and a relationship with depression ( r =.22 - .44). CONCLUSIONS: The DAS-A provides reliable, valid measures of depressogenic dysfunctional attitudes in Spanish adults with emotional disorders and victims of terrorism.

Desarrollo de la Escala de Actitudes Disfuncionales Traumáticas (EADT) para víctimas de terrorismo / Development of the traumatic dysfunctional attitude scale (EADT) for victims of terrorism

Introduction and objectives. Post-traumatic stress disorder (PTSD) is the most common psychological disorder in victims of terrorism. Cognitive models of PTSD postulate that dysfunctional attitudes play a fundamental role in its etiology, maintenance, and treatment. The objective of this study was to develop a self-report instrument to assess traumatic dysfunctional attitudes typical of victims of terrorism: the Traumatic Dysfunctional Attitude Scale (EADT by its original Spanish acronym). Materials and method. The EADT items were extracted from 480 recorded hours of trauma-focused cognitive-behavioral therapy administered to 59 victims of terrorism with PTSD and after an analysis of items’ content and intelligibility by a group of psychologists. A preliminary 84-item version was administered to a sample of 253 victims of terrorism along with measures of PTSD, depression, and depressive dysfunctional attitudes. Results. A series of factorial and reliability analyses on the preliminary version allowed one to arrive at a definitive version composed of 34 items and three correlated factors: dangerous world, negative view of society and the human being, and chronicity of distress. The psychometric analyses of the definitive version revealed good evidence concerning the internal structure of the test, score internal consistency, the differentiation of known groups, and the relationships with conceptually related constructs. Conclusions. The EADT is a simple instrument whose scores have good psychometric properties and can be useful to assess, both in research and applied contexts, the dysfunctional attitudes that victims of terrorism may present.

Introducción y objetivos. El trastorno de estrés postraumático (TEPT) es el trastorno psicológico más frecuente en las víctimas del terrorismo. Los modelos cognitivos del TEPT postulan que las actitudes disfuncionales desempeñan un papel fundamental en su etiología, mantenimiento y tratamiento. El objetivo de este estudio fue desarrollar un instrumento de autoinforme para evaluar las actitudes disfuncionales traumáticas específicas de las víctimas del terrorismo: la Escala de Actitudes Disfuncionales Traumáticas (EADT). Materiales y método. Los ítems de la EADT fueron extraídos de 480 horas grabadas de terapia cognitivo-conductual centrada en el trauma aplicada a 59 víctimas del terrorismo con TEPT y tras un análisis del contenido e inteligibilidad de los ítems por un grupo de psicólogos. Una versión preliminar de 84 ítems se aplicó a una muestra de 253 víctimas del terrorismo junto con medidas de TEPT, depresión y actitudes disfuncionales depresivas. Resultados. Una serie de análisis factoriales y de fiabilidad sobre la versión preliminar permitió llegar a una versión definitiva compuesta por 34 ítems y tres factores correlacionados: mundo peligroso, visión negativa de la sociedad y del ser humano, y cronificación del malestar. Los análisis psicométricos de la versión definitiva revelaron buenos datos empíricos para la estructura interna de la EADT, la consistencia interna de sus puntuaciones, la diferenciación de grupos contrastados y las relaciones con constructos conceptualmente relacionados. Conclusiones. La EADT es un instrumento sencillo cuyas medidas presentan buenas propiedades psicométricas y pueden ser útiles para evaluar, tanto en contextos de investigación como aplicados, las actitudes disfuncionales que pueden presentar las víctimas del terrorismo.

Dysfunctional Attitudes in Victims of Terrorism: Validity Evidence for the DAS-A / Actitudes Disfuncionales en Víctimas del Terrorismo: Evidencias deValidez de la DAS-A

Background: The Dysfunctional Attitudes Scale, Form A (DAS-A), isthe reference instrument for measuring dysfunctional attitudes which,according to Beck’s cognitive theory, constitute the key vulnerabilityfactor for depression. The psychometric properties of the Spanish versionof the DAS-A have been examined in university students, but not inpeople with psychological disorders, despite being one of the most widely-used instruments in research and clinical practice of cognitive therapyfor depression. The objective of the present study was to obtain validity evidence for the DAS-A in victims of terrorism with and without emotional disorders. Method: The DAS-A’s factor structure, internal consistency,and relationship with depression were analyzed in 196 victims of terrorism with emotional disorders and 280 victims without disorders. Results: In both samples, the DAS-A exhibited a structure with three correlatedfactors: Achievement-Perfectionism, Dependency-Need for Approval, and Autonomous Attitude. In general, the total scale and the subscales showedgood or adequate indices of internal consistency (alphas and omegas = .60- .89) and a relationship with depression (r =.22 - .44). Conclusions: TheDAS-A provides reliable, valid measures of depressogenic dysfunctionalattitudes in Spanish adults with emotional disorders and victims ofterrorism.

Antecedentes: la Escala de Actitudes Disfuncionales,Forma A (DAS-A), es el instrumento de referencia para medir las actitudes disfuncionales que, según la teoría cognitiva de Beck, constituyen el factorde vulnerabilidad clave para la depresión. Las propiedades psicométricasde la versión española de la DAS-A han sido examinadas en estudiantesuniversitarios, pero no en personas con trastornos psicológicos, a pesar deser uno de los instrumentos más utilizados en la investigación y prácticaclínica de la terapia cognitiva de la depresión. El objetivo del presente estudio fue obtener evidencias de validez de la DAS-A en víctimas delterrorismo con y sin trastornos emocionales. Método: se analizó laestructura factorial, consistencia interna y relación con la depresión en196 víctimas con trastornos emocionales y 280 sin trastornos.Resultados: la DAS-A presenta, en las dos muestras, una estructura de tres factores correlacionados: logro-perfeccionismo, dependencia-necesidad deaprobación y actitud autónoma. La escala total y las subescalas mostraron,en general, índices buenos o adecuados de consistencia interna (alfasy omegas= .60 - .89) y de relación con la depresión (r = .22 - .44).Conclusiones: la DAS-A proporciona medidas fiables y válidas de las actitudes disfuncionales depresógenas en adultos españoles con trastornos emocionales y en víctimas del terrorismo.

La Lista de Verificación del Trastorno de Estrés Postraumático (PCL) en víctimas del terrorismo: análisis comparativo de las propiedades psicométricas de su aplicación telefónica frente a presencial / The PTSD Checklist (PCL) in victims of terrorism: Comparative analysis of the psychometric properties of its administration by telephone vs. in person

Introducción y objetivos: En muchas situaciones tales como las de confinamiento provocadas por la pandemia de la COVID-19, es imposible aplicar los instrumentos psicológicos presencialmente, como originalmente se concibieron. Sin embargo, el modo de aplicación puede afectar a las propiedades psicométricas de las medidas de un instrumento. La Lista de Verificación del Trastorno de Estrés Postraumático (del inglés PTSD Checklist; en adelante PCL) es uno de los instrumentos más utilizados para evaluar presencialmente la sintomatología del trastorno de estrés postraumático (TEPT). Este es el primer estudio que analiza y compara la estructura factorial, consistencia interna y validez diagnóstica, nomológica y de grupos contrastados de las medidas de la PCL aplicada presencial y telefónicamente. Material y métodos: Se administró la PCL en ambos formatos a una muestra de 634 personas víctimas del terrorismo junto con una entrevista diagnóstica estructurada y medidas de depresión y ansiedad. Resultados: Las puntuaciones de ambas formas de aplicación de la PCL presentan una misma estructura unifactorial, índices excelentes de consistencia interna (alfa > .90) e índices muy buenos de validez diagnóstica para identificar el TEPT (AUC > .90); ambas discriminan significativamente y con tamaños del efecto grandes (d = 0.88–2.84) entre víctimas con TEPT, con trastornos depresivos o de ansiedad y sin trastornos, y ambas presentan correlaciones significativas y grandes con medidas de otros constructos con los que el TEPT guarda una estrecha relación: depresión y ansiedad. Conclusiones: Los resultados sugieren que la PCL se puede aplicar telefónicamente con las mismas garantías psicométricas que presencialmente.(AU)

Introduction and objectives: In many situations, such as confinement situations caused by the COVID-19 pandemic, it is not possible to administer psychological instruments in person, as originally contemplated in their development. However, the mode of administration can affect the psychometric properties of instrument scores. The PTSD Checklist (PCL) is one of the most widely used instruments for assessing the symptoms of posttraumatic stress disorder (PTSD) in person. This study is the first research that has analyzed and compared the factorial structure, the internal consistency, the validity of contrasted groups, the diagnostic validity, and the nomological validity of scores on the PCL administered in person and by telephone. Material and methods: The PCL was administered in both application modes to a sample of 634 victims of terrorism along with a structured diagnostic interview and measures of depression and anxiety. Results: Scores on both administration modes of the PCL have the same unifactorial structure, excellent indexes of internal consistency (alpha > .90) and very good indexes of diagnostic validity to identify the PTSD (AUC > .90), discriminate significantly and with large effect sizes (d = 0.88–2.84) between victims with PTSD, with depressive or anxiety disorders and without disorders, and present significant and large correlations with measures of other constructs with which PTSD is closely related, namely depression and anxiety. Conclusions: The results suggest that the PCL can be administered over the telephone with the same psychometric guarantees as in person.(AU)

Duelo complicado: Una revisión sistemática de la prevalencia, diagnóstico, factores de riesgo y de protección en población adulta de España / Complicated grief: A systematic review of the prevalence, diagnosis, risk and protective factors in the adult population of Spain

El objetivo principal de este trabajo fue revisar el estado de la investigación psicopatológica del duelo complicado en población adulta de España. Una búsqueda sistemática en PsycINFO, PsycArticles, PTSDpubs y PSICODOC identificó 13 estudios en los que, en conjunto, se había evaluado a 1,655 adultos. Los resultados de esta revisión ponen de manifiesto que no existe consenso en el diagnóstico de duelo complicado, en el uso de instrumentos de detección ni en los factores de riesgo y protección del duelo complicado. La prevalencia media ponderada basada en 6 de los estudios revisados fue de 21,53%. Tomando en consideración el tipo de instrumento de medida del duelo utilizado, se obtuvo una prevalencia de 7,67-10,68% en aquellos estudios que utilizaban instrumentos diagnósticos y de 28,77% en los instrumentos sintomáticos. Los resultados indican que el duelo complicado se relaciona con: un menor nivel socioeconómico y situación laboral desfavorable, la pérdida de un hijo o cónyuge, menor edad del fallecido, vulnerabilidad psicológica previa, consumo de psicofármacos y comorbilidad con otros trastornos. El apoyo social, los cuidados paliativos, las estrategias de afrontamiento centradas en el problema, el empleo de actividades agradables y la trascendencia o espiritualidad se presentan como factores protectores

The main objective of this research was to review the status of the psychopathological research of complicated grief in adult population of Spain, specifically the prevalence and risk factors. A systematic review of PsycINFO, PsycArticles, PTSDpubs, and PSICODOC databases identified 12 studies in which, overall, 1.627 adults had been evaluated. The results of this review show that there is no consensus about the diagnosis of complicated grief, the use of detection instruments, or the risk and protective factors for complicated grief. The weighted mean prevalence based on 6 of the reviewed studies was 21.53%. Taking into account the type of grief measurement used, a prevalence of 7.67 - 10.68% was obtained in those studies that used diagnostic instruments, and 28.77% in those using symptomatic instruments. The results indicate that complicated grief is related to: a lower socioeconomic level and unfavorable work situation, the loss of a child or spouse, younger age of the deceased, previous psychological vulnerability, the use of psychotropic medication, and comorbidity with other disorders. Social support, palliative care, problem-centered coping strategies, the use of pleasant activities, and transcendence or spirituality are shown as protective factors

Growing Up With Terrorism: The Age at Which a Terrorist Attack Was Suffered and Emotional Disorders in Adulthood.

Abundant scientific literature shows that exposure to traumatic situations during childhood or adolescence has long-term psychopathological consequences, for example, in the form of a higher prevalence of emotional disorders in adulthood. However, an evolutionary perspective suggests that there may be differential vulnerabilities depending on the age at which the trauma was suffered. As there are no studies on the psychopathological impact in adulthood of attacks suffered during childhood or adolescence, the objective of this study was to analyze the influence of the age at which a terrorist attack was suffered in the presence of emotional disorders many years after the attack. A sample of 566 direct and indirect victims of terrorist attacks in Spain was recruited, of whom 50 people were between the age of 3 and 9 when they suffered the attack, 46 were between 10 and 17 years old, and 470 were adults. All of them underwent a structured diagnostic interview (SCID-I-VC) an average of 21 years after the attacks. No significant differences were found between the three age groups at which the attack occurred in terms of the current prevalence of post-traumatic stress disorder, major depressive disorder, or anxiety disorders. The results of several multiple binary logistic regression analyses also indicated that, after controlling for the effect of sex, current age, the type of victims, and the time since the attack, the age at which the attack was suffered was not related to the current prevalence of those emotional disorders. The results are discussed concerning the differences between various types of trauma and in the context of the theories that propose that traumatic experiences are processed differently at different ages and can lead to differences in the likelihood of developing different emotional disorders.

Desarrollo de una versión breve de la PTSD Checklist (PCL) basada en la definición de trastorno de estrés postraumático de la CIE-11 / Development of a short version of the PTSD (PCL) based on the ICD-11 definitions of posttraumatic stress disorder

Introducción y objetivos. El objetivo principal del presente estudio fue desarrollar, a partir de la Lista de Verificación del Trastorno de Estrés Postraumático (PCL), una medida de autoinforme de la sintomatología de estrés postraumático basada en los criterios sintomáticos de la CIE-11 para el trastorno de estrés postraumático (TEPT). Material y métodos. Se seleccionaron siete ítems de la PCL para formar la PCL-CIE-11 y se analizaron sus propiedades psicométricas en una muestra de 634 víctimas del terrorismo a las que se aplicó la versión específica de la PCL (PCL-S) junto con una entrevista diagnóstica estructurada y medidas de depresión y ansiedad. Resultados. La PCL-CIE-11 muestra una estructura unifactorial con buenos índices de ajuste que se replica en dos submuestras de víctimas creadas aleatoriamente a partir de la muestra global, y presenta índices excelentes o muy buenos de consistencia interna (α > .85) y de validez diagnóstica para identificar el TEPT (AUC > .90 y kappa ≥ .75). La escala también discrimina significativamente y con tamaños del efecto grandes (d = 0.88 – 2.32) entre víctimas con TEPT, víctimas con trastornos depresivos o de ansiedad y víctimas sin trastornos, presenta correlaciones significativas y grandes con medidas de depresión y ansiedad, dos constructos con los que el TEPT guarda una estrecha relación, y muestra una correlación muy elevada, de .95, con la PCL-S completa. Conclusiones. La PCL-CIE-11 es una versión breve de la PCL-S que presenta buenas propiedades psicométricas y puede ser útil para evaluar la presencia y gravedad de la sintomatología del TEPT tanto desde la perspectiva del DSM como de la CIE-11.(AU)

Introduction and objectives. The main objective of the present study was to develop, from the PTSD Checklist (PCL), a self-report measure of posttraumatic stress symptoms based on the ICD-11 symptomatic criteria for posttraumatic stress disorder (PTSD). Material and methods. Seven PCL items were selected to develop the PCL-ICD-11, and its psychometric properties were analyzed in a sample of 634 victims of terrorism who completed the specific version of the PCL (PCL-S) along with a structured diagnostic interview and measures of depression and anxiety. Results. The results indicate that the PCL-ICD-11 shows a unifactorial structure with good fit indices that is replicated in two subsamples of victims created randomly from the global sample. The PCL-ICD-11 shows excellent indices of internal consistency (α > .85) and very good indices of diagnostic validity to identify PTSD (AUC > .90 and kappa ≥ .75), discriminates significantly and with large effect sizes (d = 0.88 – 2.32) between victims with PTSD, victims with depressive or anxiety disorders and victims without disorders, presents significant and large correlations with measures of depression and anxiety, two constructs with which PTSD it is closely related, and shows a very high correlation of .95 with the complete PCL-S. Conclusions. The PCL-ICD-11 is a short version of the PCL-S that has good psychometric properties and can be useful to assess the presence and severity of PTSD symptoms from both the DSM and ICD-11 perspectives.(AU)

Screening Program for Imported Diseases in Immigrant Women: Analysis and Implications from a Gender-Oriented Perspective.

The female immigrant population is especially vulnerable to imported diseases. We describe the results of a prospective screening program for imported diseases performed in immigrant female patients. The protocol included tests for HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum, Trypanosoma cruzi, Strongyloides stercoralis and Schistosoma spp., intestinal parasites, malaria, and the detection of microfilaremia, according to the patient's origin. Six hundred eleven patients were studied. The most frequent imported diseases were intestinal parasitosis (39.4%), followed by syphilis (14.6%), HIV infection (9%), chronic HCV (5%), and HBV (3.3%). Most of the cases of HIV (78%) and HBV (85%) were diagnosed in patients aged between 16 and 45 years. Hepatitis C virus appeared mostly in patients in the 46- to 65-year range (P = 0.001; odds ratio [OD]: 3.667 [1.741-7.724]) or older than 65 years (P = 0.0001; OR: 26.350 [7.509-92.463]). Syphilis was diagnosed more frequently in patients older than 46 years (P = 0.0001; OR: 4.273 [2.649-6.893]). Multivariate analysis confirmed a greater presence of HCV infection (P = 0.049) and syphilis (P = 0.0001) in patients aged between 46 and 65 years. In 15.4% of patients, screening did not find any pathology. These data show a high prevalence of imported diseases in the female immigrant population, which may have serious consequences in terms of morbimortality and vertical transmission. Our results encourage the establishment of policies of active screening both in women of childbearing age and within the specific pregnancy screening programs.

Pseudomonas aeruginosa nosocomial meningitis in neurosurgical patients with intraventricular catheters: Therapeutic approach and review of the literature / Meningitis nosocomial por Pseudomonas aeruginosa en pacientes portadores de catéteres intraventriculares: aproximación terapéutica y revisión de la literatura

BACKGROUND: Pseudomonas aeruginosa neurosurgical meningitis is a rare entity, usually related with intraventricular catheters and associated with high mortality rates. We describe the clinical characteristics, treatment and outcomes of a series of neurosurgical meningitis caused by P. aeruginosa along 1990-2016. METHODS: Descriptive, retrospective study of all postsurgical meningitis due to P. aeruginosa related to intraventricular catheters in Hospital Universitario Central de Asturias, between 1990 and 2016. Clinical features, therapeutic approaches and prognostic factors were analyzed statistically. A binary logistic regression analysis was performed to determine the factors influencing the infection mortality. RESULT: 51 episodes from 51 different patients with CSF culture positive for P. aeruginosa were reviewed. Seventeen patients (33.3%) died as a direct consequence of the infection. Univariate analysis showed that mortality was higher in the group of patients treated with ceftazidime (12 vs. 15, p = 0.068, OR 3.040 [0.877-10.544]) and lower in patients whom had received intrathecal therapy (2 vs. 13, p = 0.050, OR 4.64 [0.80-34.93]), without differences observed between those patients treated with aminoglycosides or with colistin. Any patient treated with colistin died (0 vs. 6, p = 0.067, OR: not defined). In the multivariate analysis mortality was only significant higher for patients without catheter withdrawal (p = 0.014) and lower for those patients who received intrathecal therapy (p = 0.05) or adequate empirical treatment (p = 0.006). CONCLUSIONS: The mortality of P. aeruginosa meningitis is high especially in infections without catheter withdrawal and in patients for whom the intrathecal route of administration was not used. Catheter withdrawal was an independent factor of good outcome in our series

ANTECEDENTES: La meningitis nosocomial por Pseudomonas aeruginosa es una entidad poco frecuente, generalmente relacionada con catéteres intraventriculares y asociada con altas tasas de mortalidad. Se describen las características clínicas, con especial hincapié en su tratamiento, de una serie de meningitis neuroquirúrgicas por P. aeruginosa entre 1990 y 2016. MÉTODOS: Estudio descriptivo, retrospectivo, de todas las meningitis posquirúrgicas por P. aeruginosa relacionadas con catéteres intraventriculares en el Hospital Universitario Central de Asturias entre 1990 y 2016, con especial hincapié en los enfoques terapéuticos y factores pronósticos. Los factores asociados con mortalidad se analizaron mediante regresión logística binaria. RESULTADOS: Se revisaron 51 episodios de 51 pacientes diferentes con cultivos de LCR positivos para P. aeruginosa. Diecisiete pacientes (33,3%) murieron como consecuencia directa de la infección. La mortalidad fue mayor en el grupo de pacientes tratados con ceftazidima (12 vs. 15, p = 0,068, OR 3,040 [0,877-10,544]) y menor en los pacientes que habían recibido terapia intratecal (2 vs. 13, p = 0,050, OR 4,64 [0,80-34,93]), sin diferencias en estos últimos entre los tratados con aminoglucósidos o con colistina. Ningún paciente tratado con colistina falleció (0 vs. 6, p = 0,067, OR no definida). El análisis multivariable únicamente confirmó la asociación con la ausencia de terapia intratecal (p = 0,05) o tratamiento empírico adecuado (p = 0,006). CONCLUSIONES: La mortalidad de la meningitis por P. aeruginosa es elevada, especialmente en pacientes en quienes no se utilizó la vía de administración intratecal. La retirada del catéter fue un factor independiente de buena evolución en nuestra serie

Pseudomonas aeruginosa nosocomial meningitis in neurosurgical patients with intraventricular catheters: Therapeutic approach and review of the literature.

BACKGROUND: Pseudomonas aeruginosa neurosurgical meningitis is a rare entity, usually related with intraventricular catheters and associated with high mortality rates. We describe the clinical characteristics, treatment and outcomes of a series of neurosurgical meningitis caused by P. aeruginosa along 1990-2016. METHODS: Descriptive, retrospective study of all postsurgical meningitis due to P. aeruginosa related to intraventricular catheters in Hospital Universitario Central de Asturias, between 1990 and 2016. Clinical features, therapeutic approaches and prognostic factors were analyzed statistically. A binary logistic regression analysis was performed to determine the factors influencing the infection mortality. RESULT: 51 episodes from 51 different patients with CSF culture positive for P. aeruginosa were reviewed. Seventeen patients (33.3%) died as a direct consequence of the infection. Univariate analysis showed that mortality was higher in the group of patients treated with ceftazidime (12 vs. 15, p=0.068, OR 3.040 [0.877-10.544]) and lower in patients whom had received intrathecal therapy (2 vs. 13, p=0.050, OR 4.64 [0.80-34.93]), without differences observed between those patients treated with aminoglycosides or with colistin. Any patient treated with colistin died (0 vs. 6, p=0.067, OR: not defined). In the multivariate analysis mortality was only significant higher for patients without catheter withdrawal (p=0.014) and lower for those patients who received intrathecal therapy (p=0.05) or adequate empirical treatment (p=0.006). CONCLUSIONS: The mortality of P. aeruginosa meningitis is high especially in infections without catheter withdrawal and in patients for whom the intrathecal route of administration was not used. Catheter withdrawal was an independent factor of good outcome in our series.

Tratamiento Psicológico por Videoconferencia de una Víctima de Terrorismo con Trastorno por Estrés Postraumático y Otros Trastornos Emocionales Comórbidos 30 Años después del Atentado / Videoconference-delivered psychological treatment for a victim of terrorism with posttraumatic stress disorder and other comorbid emotional disorders 30 years after the terrorist attack

En este trabajo se muestra la efectividad o utilidad clínica de la terapia cognitivo-conductual centrada en el trauma (TCCCT) cuando se aplica por videoconferencia a un paciente de 52 años víctima directa de un atentado terrorista sufrido hace 30 años, que presentaba trastorno por estrés postraumático (TEPT), trastorno depresivo mayor, fobia social y trastorno obsesivo-compulsivo. Tras 36 sesiones de tratamiento, se produjo una reducción clínicamente significativa de la sintomatología postraumática, ansiosa y depresiva, la cual se mantuvo estable a largo plazo. La TCC-CT aplicada por videoconferencia parece ser efectiva cuando se utiliza con víctimas del terrorismo que sufren TEPT y otros trastornos comórbidos a muy largo plazo, aunque la comorbilidad y la cronicidad parecen requerir un aumento en el número de sesiones

This paper shows the effectiveness or clinical utility of trauma-focused cognitive-behavioral treatment (TF-CBT) that was delivered by videoconference in a 52 year old patient who was victim of a terrorist attack 30 years ago and suffered from posttraumatic stress disorder (PTSD) comorbid with major depressive disorder (MDD), social phobia, and obsessive-compulsive disorder (OCD). After 36 sessions, a clinically significant decrease in posttraumatic, depressive and anxious symptomatology was obtained and remained stable in the long term. TF-CBT delivered by videoconference seems to be effective when is used with victims of terrorism suffering from PTSD and comorbid emotional disorders in the very long term, although comorbidity and chronicity seem to an increase in the number of treatment sessions

Sensory-directed identification of creaminess-enhancing volatiles and semivolatiles in full-fat cream.

Aimed at defining the chemical nature of creaminess-related flavor compounds in dairy products on a molecular level, a full-fat cream was analyzed for sensorially active volatiles and semivolatiles by means of activity-guided screening techniques. Application of the aroma extract dilution analysis on an aroma distillate prepared from pasteurized cream (30% fat) revealed delta-decalactone, (Z)-6-dodeceno-gamma-lactone, gamma-dodecalactone, delta-dodecalactone, and 3-methylindole with by far the highest flavor dilution (FD) factors among the 34 odor-active volatiles identified. Using a complementary approach involving silica column chromatography and fractionated high-vacuum distillation combined with sensory experiments enabled the additional identification of delta-tetradecalactone, delta-hexadecalactone, gamma-tetradecalactone, gamma-hexadecalactone, and delta-octadecalactone as semivolatile flavor components in the cream fat. Although a series of lactones is present in dairy cream, spiking of cream samples with individual lactones revealed that only the delta-tetradecalactone is able to enhance the typical retronasal creamy flavor of the product when added in amounts above its threshold level of 66 micromol/kg. Rather than contributing to the retronasal aroma of cream, first evidence was found that, particularly, gamma- and delta-octadecalactones and gamma- and delta-eicosalactones are able to influence the melting behavior of cream in the oral cavity.

Aroma release and retronasal perception during and after consumption of flavored whey protein gels with different textures. 1. in vivo release analysis.

The influence of gel texture on retronasal aroma release during mastication was followed by means of real-time proton-transfer reaction mass spectrometry and compared to sensory perception of overall aroma intensity. A clear correlation was found between individual-specific consumption patterns and the respective physicochemical release patterns in vivo. A modified data analysis approach was used to monitor the aroma changes during the mastication process. It was found that the temporal resolution of the release profile played an important role in adequate description of the release processes. On the basis of this observation, a hypothesis is presented for the observed differences in intensity rating.