Impacto de problemas de salud mental y apoyo social en la calidad de sueño: Seguimiento longitudinal antes y durante la pandemia de COVID-19 en universitarios chilenos / Impact of mental health problems and social support on sleep quali-ty: Follow-up before and during the first eight months of the COVID-19 pandemic in Chilean university student

Introducción: Antecedentes refieren altos índices de problemas de salud mental en universitarios antes y durante la pandemia por COVID-19, con efectos sobre la baja calidad de sueño; sin embargo, el apoyo social percibido actuaría como un factor protector. Objetivo: Evaluar el impacto de la salud mental (ansiedad, depresión y estrés) sobre la calidad de sueño, de forma transversal y longitudinal, antes y durante la pandemia por COVID-19 en universitarios chilenos, verificando si el apoyo social percibido podría moderar esta relación. Material y Métodos: 1.619 universitarios en el año 2019 y 1.862 en el año 2020 respondieron cuestionarios orientados a medir depresión, ansiedad, estrés, calidad del sueño y apoyo social percibido. Con una fracción de la muestra que respondió en ambos años (n = 325) se realizó análisis longitudinal y se contrastaron los puntajes de los instrumentos entre ambos años, mediante una matriz de transición y un modelo de regresión múltiple. Resultados: Se encuentran altas prevalencias de problemas de salud mental, aumentando en el año 2020 la sintomatología moderada y grave. Se agudizan los problemas de sueño y la percepción de bajo apoyo social. Todas las variables de salud mental pueden predecir la calidad del sueño, excepto el apoyo social y longitudinalmente, aumenta la severidad de la baja calidad de sueño y la depresión. No se encuentran moderaciones significativas entre apoyo social percibido y el resto de las variables. Conclusiones: El efecto de la pandemia en la salud mental es complejo, requiriéndose acciones concretas para apoyar psicológicamente a los estudiantes.(AU)

Introduction: Research has revealed high rates of mental health problems in university students before and during the COVID-19 pan-demic, with effects on poor sleep quality; however, perceived social sup-port appears to act as a protective factor. Objective: To assess the impact of mental health (anxiety, depression, and stress) on sleep quality, cross-sectionally and longitudinally, before and during the COVID-19 pandemic in Chilean university students, verifying whether perceived social support could act as a moderatorin this relationship.Material and Methods: 1,619 university students in 2019 and 1,862 in 2020 answered questionnaires aimed at measuring depression, anxiety, stress, sleep quality, and perceived social support. Longitudinal analysis was per-formed with afraction of the sample that responded in both years (n= 325). The scores of the instruments for both years were contrasted using a transition matrix and a multiple regression model. Results: High prevalence rates of mental health problems were found, with moderate and severe symptoms increasing in 2020. Sleep problems and the perception of low social support worsened. All mental health variables were found to predict sleep quality except for social support; longitudinally, the severity of poor sleep quality and depression increased. No significant moderation effects were found between perceived social support and the rest of the variables. Conclusions: The effect of the pandemic on mental health is complex, re-quiring concrete actions to provide students with psychological suppor.(AU)

The mediating role of negative affectin the relationship between family functioning and subjective happiness in Spanish colleges tudents / El papel mediador del afecto negativo en la relación entre funcionamiento familiar y felicidad subjetiva en estudiantes universitarios españoles

Previous research shows that family functioning and an individ-ual’s temperamentalcharacteristics carry significant weight in explaining subjective happiness. However, thelink between these factors is scarcely considered in emerging adulthood. For moreunderstanding, the main aim of our study was to explore the mediating role of negativeaffect on the re-lationship between family functioning and subjective happiness among asample of 347 college students in Spain. Results showed moderate scores in family cohesion and flexibility were positively associated to a young per-son ́s subjective happiness, whilesome extreme scores in those scales showed the opposite pattern. In contrast, negativeaffect was negatively as-sociated to subjective happiness in collegestudents. SEManalyses revealed that negative affect fully mediates the relationship between bothbalanced and unbalanced family functioning and subjective happiness. As regardsdysfunctional family patterns, we found that negative affect fully mediated therelationship between disengaged, enmeshed and chaotic unbalanced scales, andsubjective happiness. However, this mediational pattern failed to replicate in theunbalanced rigid scale. The social and clinical implica-tions of these results on thepromotion of subjective happiness in early adulthood was discussed, taking into accountSpanishculturalbeliefsonfamily functioning and well-being.(AU)

Estudios previos muestran que el funcionamiento familiar y las características temperamentales del individuo tienen un peso importante en la explicación de su felicidad subjetiva. Sin embargo, el vínculo entre estos factores ha sido escasamente estudiado en la adultez emergente. El objetivo de nuestro trabajo fue explorar el papel mediador del afecto negativo en la relación entre funcionamiento familiar y felicidad en una muestra de 347 estudiantes universitarios españoles. Los análisis mostraron que puntuaciones moderadas en cohesión y flexibilidad familiar se asociaron positivamente a la felicidad subjetiva, al contrario que las puntuaciones extremas de dichas escalas. Por el contrario, el afecto negativo se asoció negativamente con la felicidad. Los análisis SEM mostraron que el afecto negativo medió la relación entre funcionamiento familiar (equilibrado y desequilibrado) y felicidad subjetiva. Con respecto a los patrones familiares disfuncionales, encontramos que el afecto negativo medió la relación entre las escalas de desapego, dependencia y caos, y felicidad. Sin embargo, este patrón mediacional no se observó para la escala de rigidez. Se discuten las implicaciones sociales y clínicas que estos resultados tienen en la promoción de la felicidad subjetiva en la adultez temprana, teniendo en cuenta las creencias culturales españolas sobre funcionamiento familiar y bienestar.(AU)

El papel mediador de la fuerza del compromiso entre los estilos de procesamiento de la identidad y el bienestar de jóvenes adultos emergentes / The mediating role of the strength of commitment between the styles of identity processing and the well-being of emerging young adults

Los estilos de identidad buscan conocer cómo las personas se manejan diariamente en las situaciones buscando un compromiso identitario. En este trabajo se propone conocer si los estilos de identidad varían según la edad y el sexo, y analizar la relación entre estos y la fuerza del compromiso con variables de bienestar y malestar psicológico. Método: 278 participantes (M = 22.03; DT = 2.65) reclutados a través de un muestreo no probabilístico por bola de nieve cumplimentaron los cuestionarios. Resultados: Las mujeres puntuaron más alto en fuerza del compromiso y ellos adoptaron más un estilo difuso-evitativo. El estilo informacional correlacionó positivamente con las variables de bienestar (optimismo y florecimiento); el estilo normativo con depresión y ansiedad y el estilo difuso-evitativo correlacionó positivamente con las variables de malestar (depresión, ansiedad y estrés) y negativamente con las de bienestar. Finalmente, a mayor fuerza del compromiso más bienestar y menos malestar. La fuerza del compromiso media parcial o totalmente la relación entre estilos identitarios y las variables de bienestar/malestar. Conclusiones: Se deduce la importancia de la fuerza del compromiso en el bienestar personal y la necesidad de favorecer el desarrollo de la identidad de nuestros jóvenes.(AU)

Background:Identity styles seek to know how people handle themselves daily in situations looking for an identity commitment. This ar-ticle aims to find out whether identity styles vary according to age and sex, and to analyze the relation between these identity styles and the strength of commitment with variables of well-being and psychological distress. In ad-dition, it investigates whether commitment mediates between identity styles, well-being and psychological distress.Method:278 participants (M = 22.03; DT = 2.65), recruited through a non-probabilistic snowball sam-pling, completed the questionnaires. Results:Women scored higher in strength of commitment and men adopted a more diffusive-avoidant style. Age did not relate to identity style. The informational stylecorrelated posi-tively with well-being variables (flourishing and optimism); the normative style with depression and anxiety and the diffuse-avoidant style correlated positively with psychological distress (depression, anxiety and stress) and negatively with well-being. Finally, the greater the strength of commitment found, the more flourishing and optimism and the less psychological dis-tress there was. The strength of commitment partially or totally mediated the relationship between identity styles and thevariables of well-being / psychological distress. Conclusions:The importance of the strength of com-mitment in personal well-being and the necessity to favour the develop-ment of young people ́s identity is observed / deduced.(AU)

Modulatory effects of transcranial direct current stimulation of right insula on compassion motivation

Background: Compassion motivation is associated with increased heart rate variability (HRV), reflecting a calm and self-soothing physiological state. Recent work, however, suggests that this association is dynamic for the specific components of compassion. Objectives: The present study adopted anodal transcranial direct current stimulation (tDCS) targeting the right insula to see whether this would modulate the sensitivity to suffering and the commitment to engage in helpful actions (i.e., the components of compassion motivation). Method: Ninety-seven healthy individuals underwent 15-min anodal or sham tDCS over the frontotemporal lobe, while watching a video inducing empathic sensitivity and performing a Redistribution Game. Tonic and phasic HRV, dispositional traits, and momentary affects were assessed. Results: Compared to sham condition, anodal stimulation favored significant i) HRV reductions during the video and HRV increases during the Redistribution Game; ii) decreases in self-reported levels of negative affect and increases in positive affect during task when the latter was preceded by the video, without influencing altruistic behavior. Conclusions: Anodal tDCS over the right insula may modulate the engagement phase of compassion by intensifying the psychophysiological sensitivity to signals of distress and protecting from being subjectively overwhelmed by it. (AU)

Dreaming during a pandemic: Low incorporation of COVID-19-specific themes and lucidity in dreams of psychiatric patients and healthy controls

The present study examined the impact of the COVID-19 pandemic on the emotional quality of dreams, the incorporation of pandemic-related themes, and the occurrence of lucid dreaming. Dream reports and lucidity ratings of psychiatric outpatients (n = 30) and healthy controls (n = 81) during two lockdowns in Germany were compared to those of healthy controls (n = 33) before the pandemic. Results confirmed previous reports that pandemic-specific themes were incorporated into dreams. Overall, however, incorporation into dreams was rare. Contrary to expectations, psychiatric outpatients did not differ from controls in the frequency of dream incorporation of pandemic-related content. Moreover, incorporation was independent of psychiatric symptoms and loneliness. Loneliness was, however, associated with threat-related content, suggesting that it represents a risk for bad dreams but not for crisis-specific dream incorporation. Regarding lucid dreaming, both groups had similar scores for its underlying core dimensions, i.e., insight, control, and dissociation, during the two lockdowns. Scores for control and dissociation but not insight were lower compared to the pre-pandemic sample. Our working hypothesis is that REM sleep during lockdowns intensified as a means of increased emotional consolidation, rendering the associated mental state less hybrid and thereby less lucid. (AU)

Conscious knowledge of CS-UCS contingency information affects extinction retrieval of conditioned disgust responses: Findings from an online de novo disgust conditioning task

Objective: The present study aimed to establish and develop an online de novo conditioning paradigm for the measurement of conditioned disgust responses. We further explored the effects of explicit instructions about the CS-UCS contingency on extinction learning and retrieval of conditioned disgust responses. Method: The study included a sample of 115 healthy participants. Geometric figures served as conditioned stimuli (CS) and disgust-evoking pictures as unconditioned stimuli (UCS). During disgust conditioning, the CS+ was paired with the UCS (66% reinforcement) and the CS- remained unpaired; during extinction and retrieval, no UCS was presented. Half of the participants (n = 54) received instructions prior to the disgust extinction stating that the UCS will not be presented anymore. 1-2 days or 7-8 days later participants performed a retrieval test. CS-UCS contingency, disgust and valence ratings were used as dependent measures. Results: Successful acquisition of conditioned disgust response was observed on the level of CS-UCS contingency, disgust and valence ratings. While some decline in valence and disgust ratings during the extinction stage was observed, contingency instructions did not significantly affect extinction performance. Retrieval one week later revealed that contingency instructions increased the discrimination of the CSs. Conclusions: Extinction of conditioned disgust responses is not affected by explicit knowledge of the CS-UCS contingencies. However, contingency instructions prior to extinction seem to have a detrimental effect on long-term extinction retrieval. (AU)

Anticipated fear and anxiety of Automated Driving Systems: Estimating the prevalence in a national representative survey

Background: Automated Driving Systems (ADS) may reshape mobility. Yet, related fear and anxiety are largely unknown. We estimated the prevalence and risk factors of anticipated anxiety towards ADS. Method: In a nationally representative face-to-face household survey, we assessed anticipated levels of anxiety towards ADS based on DSM-5 specific phobia criteria, using structured diagnostic interviews. We estimated weighted prevalences and conducted adjusted logistic regression models. Results: Of N = 2076 respondents, 40.82% (95%-confidence interval (CI) 37.73–43.98) anticipated experiencing some symptoms of phobia of ADS, 15.22% (CI 13.19–17.51) anticipated subthreshold phobia, and 3.39% (CI 2.42–4.75) anticipated full-blown phobia of ADS. Of subjects anticipating subthreshold phobia, 74.02% showed no strong, enduring fears of driving non-automated cars and 65.07% presented no other specific phobias (full-blown anticipated phobia: 50.37% and 50.03%, respectively). Anticipated phobia highly overlapped with anticipating marked or strong fears of passively encountering ADS in traffic (odds ratio 312.4–1982.2). Conclusion: About 20% of subjects anticipated at least subthreshold and 4% of subjects anticipated full-blown phobia of ADS. It appears to be distinct from fears related to non-automated driving and other specific phobias. Our findings call for prevention and treatment of phobia of ADS as they become increasingly ubiquitous. (AU)

The effects of stimulating the cerebellum on social sequences: A tDCS-fMRI pilot study

Research on the involvement of the cerebellum in social behavior and its relationship with social mentalizing has just begun. Social mentalizing is the ability to attribute mental states such as desires, intentions, and beliefs to others. This ability involves the use of social action sequences which are believed to be stored in the cerebellum. In order to better understand the neurobiology of social mentalizing, we applied cerebellar transcranial direct current stimulation (tDCS) on 23 healthy participants in the MRI scanner, immediately followed by measuring their brain activity during a task that required to generate the correct sequence of social actions involving false (i.e., outdated) and true beliefs, social routines and non-social (control) events. The results revealed that stimulation decreased task performance along with decreased brain activation in mentalizing areas, including the temporoparietal junction and the precuneus. This decrease was strongest for true belief sequences compared to the other sequences. These findings support the functional impact of the cerebellum on the mentalizing network and belief mentalizing, contributing to the understanding of the role of the cerebellum in social sequences. (AU)

The contribution of the cingulate cortex: treating depressive symptoms in first-episode drug naïve schizophrenia

Background: Our previous study has shown the cingulate cortex abnormalities in first-episode drug naïve (FEDN) schizophrenia patients with comorbid depressive symptoms. However, it remains largely unknown whether antipsychotics may induce morphometric change in cingulate cortex and its relationship with depressive symptoms. The purpose of this study was to further clarify the important role of cingulate cortex in the treatment on depressive symptoms in FEDN schizophrenia patients. Method: In this study, 42 FEDN schizophrenia patients were assigned into depressed patients group (DP, n = 24) and non-depressed patients group (NDP, n = 18) measured by the 24-item Hamilton Depression Rating Scale (HAMD). Clinical assessments and anatomical images were obtained from all patients before and after 12-week treatment with risperidone. Results: Although risperidone alleviated psychotic symptoms in all patients, depressive symptoms were decreased only in DP. Significant group by time interaction effects were found in the right rostral anterior cingulate cortex (rACC) and other subcortical regions in the left hemisphere. After risperidone treatment, the right rACC were increased in DP. Further, the increasing volume of right rACC was negatively associated with improvement in depressive symptoms. Conclusion: These findings suggested that the abnormality of the rACC is the typical characteristics in schizophrenia with depressive symptoms. It's likely key region contributing to the neural mechanisms underlying the effects of risperidone treatment on depressive symptoms in schizophrenia. (AU)

Relationship (in)congruency may differently impact mental health

Background: Being involved in romantic relationships has historically been related to better mental health compared to being single. However, research exploring heterogeneity within these status groups is still understudied. Our study examined the role of (in)congruency between relationship desire, dismissal, satisfaction with relationship status, and current relationship status on the mental health measured in terms of anxiety, depression, insomnia, and romantic loneliness. Method: The online questionnaire survey included 790 participants aged 18 – 40 (M = 26.51, SD = 5.60) at baseline and 421 at a 1-month follow-up. Participants represented five relationship statuses (single, casual dating, LAT relationships, cohabitation, and engagement/marriage). Results: Our results suggest that greater relationship desire and dismissal at baseline were associated with higher anxiety and depression in casual daters one month later, while greater relationship desire was linked to lower anxiety for individuals in living apart together relationships (LATs). Higher relationship dismissal in casual daters and engaged/married individuals was associated with lower insomnia. Higher satisfaction with relationship status was associated with lower depression in single individuals and lower romantic loneliness in cohabitors and engaged/married individuals. Conclusions: This study highlights that relationship (in)congruency may operate differently across various relationship status subgroups on mental health outcomes. (AU)

The effect of HD-tDCS on brain oscillations and frontal synchronicity during resting-state EEG in violent offenders with a substance dependence

Violence is a major problem in our society and therefore research into the neural underpinnings of aggression has grown exponentially. Although in the past decade the biological underpinnings of aggressive behavior have been examined, research on neural oscillations in violent offenders during resting-state electroencephalography (rsEEG) remains scarce. In this study we aimed to investigate the effect of high-definition transcranial direct current stimulation (HD-tDCS) on frontal theta, alpha and beta frequency power, asymmetrical frontal activity, and frontal synchronicity in violent offenders.Fifty male violent forensic patients diagnosed with a substance dependence were included in a double-blind sham-controlled randomized study. The patients received 20 minutes of HD-tDCS two times a day on five consecutive days. Before and after the intervention, the patients underwent a rsEEG task.Results showed no effect of HD-tDCS on the power in the different frequency bands. Also, no increase in asymmetrical activity was found. However, we found increased synchronicity in frontal regions in the alpha and beta frequency bands indicating enhanced connectivity in frontal brain regions as a result of the HD-tDCS-intervention.This study has enhanced our understanding of the neural underpinnings of aggression and violence, pointing to the importance of alpha and beta frequency bands and their connectivity in frontal brain regions. Although future studies should further investigate the complex neural underpinnings of aggression in different populations and using whole-brain connectivity, it can be suggested with caution, that HD-tDCS could be an innovative method to regain frontal synchronicity in neurorehabilitation. (AU)

Fixation disparity and refractive error among first-year optometry students / Disparidad de fijación y error de refracción entre estudiantes de primer año de optometría

Purpose: To determine the fixation disparity and refractive error of first-year optometry students to ascertain any relationship between them and also identify any association between fixation disparity and visual symptoms at near. Method: It was an analytical cross-sectional study involving 85 participants aged 17 to 27 years (18.60 ± 1.37), 41% of whom were males. Subjective refraction was done at 3 m and fixation disparity was measured with and without spectacle correction using the Wesson Fixation Disparity Card. All analysis was set within a 95% confidence interval with a p-value ≤ 0.05 considered statistically significant. Results: Refractive error ranged from 0.25 SEQ (spherical equivalent) to 5.50 SEQ. Mean fixation disparity ranged from 2.9 ± 2.6 to 3.9 ± 2.8 min arc. There was no statistically significant correlation between refractive error and fixation disparity without correction (r = −0.180, p = 0.098) and with correction (r = 0.155, p = 0.157). For fixation disparity in the ortho and exo direction, mean fixation disparity with correction of participants who experienced headaches during or after reading (5.1 ± 2.6 min arc) was significantly higher (p = 0.032) than participants who did not (2.0 ± 2.6 min arc). Conclusion: Myopia is common among first-year optometry students. Refractive error has no significant effect on fixation disparity. Headache is significantly associated with exo fixation disparity at near.(AU)

A lower birth weight percentile is associated with central corneal thickness thinning: Results from the Gutenberg Prematurity Eye Study (GPES)

Purpose: Prematurity, prenatal growth restriction, and retinopathy of prematurity (ROP) are associated with altered ocular geometry, such as a steeper corneal shape in childhood, but it is unclear whether perinatal history affects corneal thickness development, so this study investigated whether corneal thickness in adulthood is affected by perinatal history. Marterials and Methods: The Gutenberg Prematurity Eye Study (GPES) is a retrospective cohort study with a prospective ophthalmologic examination in Germany. The corneal thickness was measured by Scheimpflug imaging (Pentacam HR, Oculus Optikgeräte GmbH, Wetzlar, Germany), and the relationship between perinatal parameters respective birth weight percentile and corneal thickness at different locations was assessed using uni- and multivariable linear regression models. Covariates included age, sex, mean corneal radius, white-to-white distance, gestational age, birth weight percentile, ROP occurrence, and treatment. The main outcome measures were corneal thickness at the apex, the pupil center, and the corneal periphery. Results: The corneal thickness was measured in 390 participants (754 eyes, mean age 29.7+/-8.7 years, 224 females). In multivariable analyses, a lower birth weight percentile was associated with a lower corneal thickness at the apex (B = 0.20, p = 0.003) and the pupil (B = 0.19, p = 0.007). These effects diminished towards the corneal periphery and were not observed beyond the 4-mm diameter circle around the thinnest corneal position. Neither gestational age, ROP occurrence, or ROP treatment affected the corneal thickness. Conclusion: A lower birth weight percentile in subjects born preterm as a proxy for restricted fetal growth is associated with corneal thickness thinning in adults aged 18 to 52 years, indicating that corneal thickness development, particularly in the corneal center, may originate in the fetal stage. (AU)

Effect of incubation and analysis temperatures on sperm kinematics and morphometrics during human semen analysis / Efecto de las temperaturas de incubación y análisis sobre la cinemática y la morfometría de los espermatozoides durante el análisis de semen humano

Introduction: Human semen analysis must be performed after the liquefaction of the ejaculate. This takes place about 30min after ejaculation and samples must be maintained in the lab during this time. The temperatures for this incubation and the final analysis of motility are crucial but seldom taken into account. This study aims to examine the effect of these temperatures on various sperm parameters both manually (sperm count, motility, morphology, viability, chromatin condensation and maturation and DNA fragmentation) and CASA (kinematics and morphometrics, using an ISAS®v1 CASA-Mot and CASA-Morph systems, respectively) analyzed. Methods: Seminal samples from thirteen donors were incubated for 10min at 37°C followed by additional 20min at either room temperature (RT, 23°C) or 37°C and then examined following WHO 2010 criteria. Results: The data obtained show that there were no significant differences (P>0.05) in the subjective sperm quality parameters with incubation temperature. On the other hand, the head sperm morphometric parameters were significantly higher after room temperature incubation showing, in addition, lower ellipticity (P<0.05). Furthermore, kinematic parameters were evaluated both at RT and 37°C for the two incubation temperatures. In general, the four temperature combinations showed that kinematic parameters followed this order: RT-RT Conclusions: Our results showed that temperature control during both incubation and analysis is needed for accurate semen analysis, recommending the use of 37°C during the entire process. (AU)

Introducción: El análisis de semen humano debe realizarse después de la licuefacción del eyaculado. Esto ocurre aproximadamente a los 30minutos después de la eyaculación. Las temperaturas para esta incubación y el análisis final de la motilidad son cruciales, pero rara vez se tienen en cuenta. Este estudio tiene como objetivo examinar el efecto de estas temperaturas en varios parámetros de los espermatozoides tanto de forma manual (recuento de espermatozoides, motilidad, morfología, viabilidad, condensación y maduración de la cromatina y fragmentación del ADN) como CASA (cinemática y morfometría, utilizando un CASA-Mot ISAS®v1 y Sistemas CASA-Morph, respectivamente) analizados. Métodos: Las muestras seminales de 13 donantes se incubaron durante 10minutos a 37°C, seguidas de 20minutos adicionales a temperatura ambiente (TA, 23°C) o a 37°C y luego se examinaron siguiendo los criterios de la OMS 2010. Resultados: Los datos obtenidos muestran que no hubo diferencias significativas (p>0,05) en los parámetros subjetivos de calidad del esperma con la temperatura de incubación. Por otro lado, los parámetros morfométricos de la cabeza de los espermatozoides fueron significativamente más altos después de la incubación a temperatura ambiente, mostrando, además, una elipticidad más baja (p<0,05). Además, los parámetros cinemáticos se evaluaron tanto a temperatura ambiente como a 37°C para las dos temperaturas de incubación. En general, las cuatro combinaciones de temperatura mostraron que los parámetros cinemáticos siguieron este orden: RT-RT < RT-37 < 37-37 < 37-RT (temperaturas de incubación y análisis, respectivamente). Conclusiones: Nuestros resultados mostraron que el control de la temperatura durante la incubación y el análisis es necesario para un análisis de semen preciso, recomendando el uso de 37°C durante todo el proceso. (AU)

Relación terapéutica e influencia de la formación en la calidad de la misma en fisioterapeutas españoles: estudio observacional / 10.1016/j.ft.2022.11.005

Objetivo La relación terapéutica (RT) es determinante para el desarrollo y los resultados terapéuticos en fisioterapia. Se precisa formación del personal sanitario en métodos para llevarla a cabo. No se han encontrado publicaciones sobre la repercusión de este tipo de formación en la RT entre fisioterapeutas y pacientes. El objetivo fue evaluar las competencias de los fisioterapeutas españoles para el establecimiento de la RT y determinar si la realización de formación específica en RT influye en dicha relación. Métodos Estudio descriptivo transversal mediante encuesta electrónica a fisioterapeutas colegiados en España. Se incluyeron datos sociodemográficos, el cuestionario Working Alliance Inventory-Short (WAI-S) compuesto por 3 subescalas: establecimiento del vínculo y acuerdo en objetivos y tareas entre fisioterapeuta y paciente, y una pregunta dicotómica sobre la formación específica en RT de más de 5horas de duración. Resultados Participaron 264 fisioterapeutas. La puntuación más alta se obtuvo en la subescala vínculo y la más baja en metas. Las mujeres obtuvieron mayores puntuaciones en la subescala vínculo. Los fisioterapeutas con formación puntuaron más en todas las subescalas, y significativamente en la subescala metas. Una proporción mayor de mujeres realizó formación específica. Existe asociación directa entre la experiencia y las subescalas vínculo y tareas. No se encontraron diferencias significativas en los resultados del WAI-S en función de ninguna de las variables laborales analizadas. Conclusiones Los fisioterapeutas españoles tienen dificultades para establecer objetivos conjuntos. La formación específica en RT mejora todos los componentes del WAI-S, sobre todo la instauración conjunta de objetivos. Mayor experiencia profesional y ser mujer influye positivamente en una mejor RT (AU)

Objective The therapeutic relationship (RT) is determinant for the development and therapeutic results in physiotherapy. Training of health personnel in methods to carry it out is required. No publications have been found on the impact of this type of training on the RT between physiotherapists and patients. To evaluate the competencies of Spanish physiotherapists in establishing RT and to determine whether specific training in RT influences this relationship. Methods Cross-sectional descriptive study by means of an electronic survey of registered physiotherapists in Spain. We included sociodemographic data, the Working Alliance Inventory-Short (WAI-S) questionnaire composed of three subscales: establishment of the BOND and agreement on OBJETIVES and TASKS between physiotherapist and patient, and a dichotomous question on specific training in RT of more than 5h duration. Results A total of 264 physical therapists participated. The highest score was obtained in the subscale BOND, the lowest in GOAL. Women obtained higher scores on the BOND subscale. Physiotherapists with training scored higher on all subscales, and significantly higher on the GOAL subscale. A higher proportion of women undertook specific training. There was a direct association between experience and the subscales BOND and TASK. No significant differences were found in WAI-S scores as a function of any of the work variables analyzed. Conclusions Spanish physiotherapists have difficulties in establishing joint objectives. Specific training in RT improves all the components of the WAI-S, especially the joint establishment of objectives. More professional experience and being a woman have a positive influence on a better RT (AU)

Educación, ejercicio terapéutico y terapia manual en el dolor orofacial. Estudio de casos / Education, therapeutic exercise, and manual therapy approaches in orofacial pain. Case reports

Introducción Los trastornos temporomandibulares son la causa más común de dolor crónico orofacial. Intervenciones pasivas como la terapia manual (TM) es de las herramientas más utilizadas. Sin embargo, este tipo de abordajes puede resultar insuficiente. La investigación de nuevas estrategias, ahora de naturaleza activa, como son el ejercicio o la educación, es necesaria para generar un cambio en la práctica clínica de los profesionales sanitarios y brindar una atención completa al paciente con dolor crónico. Objetivos Analizar el efecto de tres abordajes principales de forma combinada sobre el dolor, factores psicosociales, variables funcionales y biomecánicas. Métodos Se siguió un diseño de estudio de casos compuesto por tres sujetos divididos en tres modelos de intervención: educación para el dolor y terapia manual (PEdu+TM), ejercicio terapéutico y terapia manual (PEjerc+TM) y terapia manual cervical y orofacial (PTM). El periodo de intervención duró 3-4 semanas; las medidas fueron tomadas en tres momentos: preintervención, postintervención inmediata y 45 días postintervención. Dolor, características psicosociales y funcionalidad del paciente fueron evaluadas con diferentes herramientas validadas. Resultados Los resultados mostraron a corto plazo una mejora en todas las variables analizadas en el PEdu+TM y en el PEjerc+TM, pero no en el PTM. A medio plazo (45 días postintervención), el PEdu+TM mostró beneficios en todas las variables estudiadas mientras que el PEjerc+TM generó cambios positivos en las mismas variables excluyendo el dolor. Conclusión El tratamiento combinado podría ser una intervención más eficaz que la terapia manual a solas, siendo necesarios ensayos clínicos aleatorizados que corroboren dichos hallazgos (AU)

Introduction Temporomandibular disorders are the most common cause of chronic orofacial pain. Passive interventions such us manual therapy (MT) is being one of the most used tools. However, this type of approach may be insufficient. The investigation of new strategies, now of an active nature such as exercise or education, it is necessary to generate a change in the clinical practice of health professionals and provide comprehensive care to patients with chronic pain. Objectives To analyze the effect of three main approaches in combination on pain, psychosocial factors, functional and biomechanical variables. Methods A case study design was followed consisting of three subjects divided into three intervention models: pain education and manual therapy (PEdu+TM), therapeutic exercise and manual therapy (PExer+TM), and cervical and orofacial manual therapy (PTM). The intervention period lasted 3-4 weeks, the measurements were taken at three moments: pre-intervention, immediate post-intervention and 45 days post-intervention. Pain, psychosocial characteristics and functionality of the patient were evaluated with different validated tools. Results The results showed in the short-term an improvement in all the variables analyzed in the PEdu+TM and in the PExer+TM, but not in the PTM. In the medium term (45 days post-intervention), the PEdu+TM showed benefits in all the variables studied, while the PExer+TM generated positive changes in the same variables, excluding pain. Conclusion Combined treatment could be a more effective intervention than manual therapy alone, requiring randomized clinical trials to corroborate these findings (AU)

Enfermedad arterial periférica en pacientes en hemodiálisis 10 años después / Peripheral arterial disease in hemodialysis patients 10 years later

Antecedentes y objetivo: Los pacientes con enfermedad renal crónica en hemodiálisis presentan gran comorbilidad cardiovascular. La enfermedad arterial periférica (EAP) se asocia a mayor mortalidad y ha incrementado el interés en su detección precoz y tratamiento. El objetivo del presente trabajo es determinar la frecuencia y gravedad de EAP sintomática, establecer su relación con la mortalidad en pacientes en hemodiálisis que han sido tratados precozmente y compararlos con una cohorte de nuestro centro ya reportada. Material y métodos:Estudio retrospectivo sobre una cohorte de todos los pacientes incidentes desde 2014 y seguidos hasta diciembre de 2019. Se recogieron datos demográficos, riesgo cardiovascular, la presencia de EAP sintomática basal y durante el seguimiento. Con la escala Rutherford se graduaron los síntomas o lesiones tróficas.Resultados: Inicialmente eran 91 pacientes y se perdió seguimiento de 7 casos que no incluyeron en el estudio. Edad 64±16 años, hombres 51,6% (47/91)). El porcentaje de EAP basal fue del 10,7% (9/84). Durante una mediana de seguimiento de 35 meses (20-57), el diagnóstico de EAP aumentó al 25% (21/84). La mitad de los enfermos con EAP (52,38% [11/21]) obtuvo una puntuación mayor de 3 de la clasificación clínica de Rutherford que corresponde con estadios severos. Requirieron reintervención por reaparición de los síntomas 13/21 pacientes (61,9% de los casos con EAP).El desarrollo de EAP se asoció de forma significativa con la presencia de un índice de Charlson elevado (3,9±2,1 vs. 7,7±3,5; p:0,001), con ser varón (19 vs. 2; p=0,001), diabético (no: 7; sí: 15; p=0,001) y con el antecedente de cardiopatía isquémica crónica (no: 13; sí:8; p=0,001), de forma que un 38,1% (8/21) presentó cardiopatía isquémica en los pacientes que desarrollaron EAP mientras que en ausencia de EAP la presencia de cardiopatía isquémica fue de un 9,5% (6/63). Además, más de la mitad (66,7% [14/21]) de los que desarrollaron EAP eran diabéticos (AU)

Background and objective: Patients with chronic kidney disease on hemodialysis present high cardiovascular comorbidity. Peripheral arterial disease (PAD) is associated with higher mortality and the interest in its early detection and treatment is increasing. The objective of this study is to determine the frequency and severity of symptomatic PAD, and to establish its relationship with mortality in hemodialysis patients that have received treated early and compare them with a cohort of our center already reported. Material and methods: Retrospective study on a cohort of incident patients since 2014 and followed up until December 2019. Demographic data, cardiovascular risk, the presence of symptomatic PAD at baseline and during follow-up were collected. Trophic lesions were graded using the Rutherford scale. Results: Initially, there were 91 patients and 7 cases that were not included in the study were lost to follow-up. Age 64±16 years, men 51.6% (47/91). The percentage of baseline PAD was 10.7% (9/84). During a median follow-up of 35 months (20–57), the diagnosis of PAD increased to 25% (21/84). Half of the patients with PAD (52.38% [11/21]) obtained a score greater than 3 in the Rutherford Clinical Classification, which corresponds to severe disease. 13/21 patients required reoperation due to recurrence of symptoms (61.9% of cases with PAD). The development of PAD was significantly associated with the presence of an elevated index of Charlson (3.9±2.1 vs 7.7±3.5; P=.001) with being male (19 vs 2; P=.001), diabetic (no: 7; yes: 15; P=.001) and with a history of chronic ischemic heart disease (no: 13; yes: 8; P=.001), so that 38.1% (8/21) had ischemic heart disease in patients who developed PAD, while in the absence of PAD the presence of ischemic heart disease was 9.5% (6/63). Furthermore, more than half (66.7% [14/21]) of those who developed PAD were diabetic. (AU)

Relationship between peritoneal solute transport and dialysate inflammatory markers in peritoneal dialysis patients: A cross-sectional study / Relación entre el transporte de soluto peritoneal y los marcadores inflamatorios del diálisis peritoneal en pacientes en diálisis peritoneal: un estudio transversal

Background: The associated factors of peritoneal small solute transport was not fully understood. This research aimed to investigate the connection between dialysate inflammatory markers (e.g. macrophage migration inhibitory factor, MIF) in peritoneal dialysis (PD) effluent and peritoneal solute transport rate (PSTR) properties. Subjects and design: A total of 80 stable PD patients in the First ShaoYang Hospital were enrolled in present study. Overnight PD effluent and serum inflammatory markers including MIF, MCP-1, VEGF, IL-6, TNFα and TGFβ were detected. Pearson correlation analysis and Logistic regression was performed to determine the risk factors for the increased PSTR. Results: A trend toward increased values of MIF, MCP-1 and IL-6 in PD effluent was observed in subjects with high PSTR when compared with those with low PSTR. The Pearson correlation test showed that D/P Cr exhibited positive correlations with dialysis effluent MIF (r=0.32, p=0.01), MCP-1 (r=0.47, p=0.01), IL-6 (r=0.48, p=0.01). Conversely, no significant correlation was found between D/P Cr and TGF-β (r=0.04, p=0.70), TNF-ɑ (r=0.22, p=0.05), VEGF (r=0.02, p=0.86) and serum inflammatory markers. In the unadjusted regression analysis, dialysis effluent MIF (OR 2.41), MCP-1 (OR 1.72), IL-6 (OR 1.55) were associated with high PSTR condition. Multivariate logistic regression analysis showed that the adjusted odds ratios (OR) of dialysis effluent MIF for high PSTR were 2.47 in all subjects (p=0.03). Conclusion: Elevated MIF, MCP-1 and IL-6 levels in PD effluent were associated with increased PSTR. Elevated dialysis effluent MIF levels was an independent risk factor for high PSTR in subjects with PD treatment. (AU)

Antecedentes: Los factores asociados del transporte peritoneal de pequeños solutos no se conocen completamente. Esta investigación tuvo como objetivo investigar la conexión entre los marcadores inflamatorios del dializado (por ejemplo, el factor inhibidor de la migración de macrófagos [MIF]) en el efluente de diálisis peritoneal (DP) y las propiedades de la tasa de transporte de solutos peritoneal (PSTR). Sujetos y diseño: Se incluyó un total de 80 pacientes con DP estable en el primer Hospital de Shaoyang. Se detectaron efluentes de DP nocturnos y marcadores inflamatorios séricos, incluyendo MIF, MCP-1, VEGF, IL-6, TNF -ɑ, TGF -β. Se realizó un análisis de correlación de Pearson y regresión logística para determinar los factores de riesgo para la PSTR aumentada. Resultados: Se observó una tendencia hacia valores incrementados de MIF, MCP-1 e IL-6 en el efluente de DP en sujetos con PSTR alta, en comparación con aquellos con PSTR baja. La prueba de correlación de Pearson mostró que D/Pcr exhibe correlaciones positivas con el MIF del efluente diálisis (r = 0,32, p = 0,01), MCP-1 (r = 0,47, p = 0,01), IL-6 (r = 0,48, p = 0,01). Por el contrario, no se encontró una correlación significativa entre D/Pcr y TGF-β (r = 0,04, p = 0,70), TNF-ɑ (r = 0,22, p = 0,05), VEGF (r = 0,02, p = 0,86) y marcadores séricos de inflamación. En el análisis de regresión no ajustado, el MIF del efluente diálisis (OR 2,41), la MCP-1 (OR 1,72), la IL-6 (OR 1,55) se asociaron con una PSTR elevada. El análisis de regresión logística multivariante mostró que las odds ratios (OR) ajustadas del MIF del efluente diálisis para PSTR alta fueron de 2,47 en todos los sujetos (p = 0,03). Conclusión: Los niveles elevados de MIF, MCP-1 y IL-6 en el efluente de DP se asociaron con un aumento de la PSTR. Los niveles elevados del MIF del efluente diálisis fueron un factor de riesgo independiente para PSTR elevada en sujetos tratados con DP. (AU)

The role of decoy receptor 3 in inflammation and atherosclerosis in patients with chronic kidney disease and renal transplant patients / El papel del decoy receptor 3 en la inflamación y la ateroesclerosis en pacientes con enfermedad renal crónica y pacientes con trasplante renal

Introduction: The cardiovascular risk has been increased in chronic kidney disease associated with chronic inflammation and atherosclerosis. Decoy receptor 3, is a member of the TNF receptor superfamily and associated with inflammation and atherosclerosis. The aim of our study is to determine the relationship, between serum DcR3 levels and inflammatory markers in patients with renal transplantation, those receiving dialysis treatment and cases with chronic renal failure that did not receive replacement therapy, and to evaluate their correlation with USG findings. Material and methods: A total of 150 patients aged between 22–86 years, consisting of 4 groups, namely renal transplantation, dialysis, predialysis chronic kidney disease and control groups, were included in the study. Serum decoy receptor 3, VCAM-1, ICAM-1 and IL-8 measured with ELISA method. Carotid intima-media thickness and presence of carotis arter plaque performed by ultrasound probe, non-invasively. Results: All serum markers were higher in dialysis and pre-dialysis chronic kidney disease groups compared to renal transplant and control groups (p<0.05). Serum decoy receptor 3 level (median(min–max)) of renal transplant group (0.49ng/mL (0.19–1.65)) was higher than control group (0.35ng/mL (0.19–2.22)). There was no difference between patients receiving dialysis (0.89ng/mL (0.41–4.98)) and patients with pre-dialysis chronic kidney disease (0.71ng/mL (0.29–1.68)). There was no difference between patient groups in terms of the presence of plaque. (AU)

Introducción: El riesgo cardiovascular se ha incrementado en la enfermedad renal crónica asociada con la inflamación crónica y la ateroesclerosis. El decoy receptor 3 (DcR3) es un miembro de la superfamilia de receptores de TNF y está asociado con inflamación y ateroesclerosis. El objetivo de nuestro estudio es determinar la relación entre los niveles séricos de DcR3 y los marcadores inflamatorios en pacientes con trasplante renal, los que reciben tratamiento de diálisis y los casos con insuficiencia renal crónica que no recibieron terapia sustitutiva, y evaluar su correlación con los hallazgos de la ultrasonografía (USG). Material y métodos: Se incluyeron en el estudio un total de 150 pacientes con edades comprendidas entre los 22 y los 86 años. Así, hay 4 grupos, que en concreto son: trasplante renal, diálisis, enfermedad renal crónica prediálisis y grupos de control. Suero DcR3, VCAM-1, ICAM-1 e IL-8 fueron medidos con el método ELISA. Espesor de la íntima-media carotídea y presencia de placa de la arteria carótida fue realizada por sonda ecográfica de forma no invasiva. Resultados: Todos los marcadores séricos fueron más altos en diálisis y enfermedad renal crónica previa a la diálisis grupos en comparación con los grupos de control y de trasplante renal (p<0,05). Nivel de DcR3 en suero (mediana [min-máx]) del grupo de trasplante renal (0,49ng/ml [0,19-1,65]) fue mayor que el grupo de control (0,35ng/ml [0,19-2,22]). No hubo diferencia entre los pacientes que recibieron diálisis (0,89ng/ml [0,41-4,98]) y los pacientes con enfermedad renal crónica prediálisis (0,71ng/ml [0,29-1,68]). No hubo diferencia entre los grupos de pacientes en cuanto a la presencia de placa. (AU)

Effects of vitamin C supplementation on oxidative stress and serum paraoxonase/arylesterase activities in patients on long-term hemodialysis / Efectos de la suplementación con vitamina C sobre el estrés oxidativo y las actividades de paraoxonasa/arilesterasa sérica en pacientes en hemodiálisis a largo plazo

Background: Oxidative stress increases oxidizability of apolipoprotein-B containing lipoproteins and decreases paraoxonase (PON) activity in hemodialysis (HD) patients and plays an important part in the development of atherosclerotic cardiovascular diseases. In HD patients, plasma ascorbic acid (AA) levels are decreased either due to the loss by hemodialysis membranes or due to malnutrition and contribute to the imbalance of antioxidant defense mechanisms. We hypothesized that long-term ascorbic acid (AA) supplementation recovers oxidizability of lipoproteins in HD patients by reinforcing PON activity. Methods: Twenty-nine adult patients were treated with 100mg and 500mg AA at the end of each HD session thrice a week for two consecutive 16 weeks-periods, respectively. Blood samples were obtained before the first HD session and prior to the first HD sessions following the 100mg AA-supplemented and the 500mg AA-supplemented periods. Results: PON activities were significantly increased after 100mg (p<0.05) and 500mg AA (p<0.001) supplementation periods compared to the basal level. Apo-B lipoprotein oxidizability (Δ-MDA) was significantly decreased after 500mg AA supplementation compared to both basal (p<0.05) and 100mg AA supplementation periods (p<0.05). Plasma AA concentrations were negatively correlated with Δ-MDA levels (R=−0.327; p<0.01). Conclusion: Our results suggest that long-term parenteral 500mg AA supplementation improves PON activity alleviating apo B-containing lipoproteins oxidizability in HD patients. (AU)

Antecedentes: El estrés oxidativo aumenta la susceptibilidad a la oxidación de las apolipoproteínas-B que contienen lipoproteínas y reduce la actividad de paraoxonasa (PON) en pacientes de hemodiálisis (HD) formando un papel importante en el desarrollo de enfermedades arterioescleróticas cardiovasculares. En pacientes de HD, los niveles de ácido ascórbico (AA) plasmático disminuyen debido a la pérdida por membranas de hemodiálisis o por desnutrición, y contribuye al desequilibrio de los mecanismos de defensa antioxidantes. Nuestra hipótesis es que a largo plazo la suplementación con AA recupera la susceptibilidad a la oxidación de las lipoproteínas en pacientes de HD al reforzar la actividad de PON. Métodos: Se trataron 29 pacientes adultos con 100 y 500mg de AA al final de cada sesión de HD/3 veces por semana/durante 2 períodos consecutivos de 16 semanas, respectivamente. Se obtuvieron muestras de sangre antes de la primera sesión de HD y previo a las primeras sesiones de HD luego de los 100mg suplementados con AA y los periodos suplementados con 500mg de AA. Resultados: Las actividades de PON aumentaron significativamente después de los periodos de suplementación de 100mg (p<0,05) y de 500mg de AA (p<0,001) comparados con el nivel base. La susceptibilidad a la oxidación de la lipoproteína apoB (Δ-MDA) disminuyó significativamente luego de la suplementación de 500mg de AA en comparación con períodos de valores base (p<0,05) y los de 100mg de AA (p<0,05). La correlación entre las concentraciones de plasma AA y los niveles de Δ-MDA resultó negativa (R=−0,327; p<0,01). Conclusión: Nuestros resultados sugieren que la suplementación parenteral a largo plazo de 500mg de AA mejora la actividad de PON mitigando la susceptibilidad a la oxidación de las lipoproteínas que contienen apoB en pacientes en HD. (AU)