Application of the Simplified Psoriasis Index in the Routine Clinical Practice: A Pilot Study. / Aplicación del Simplified Psoriasis Index en la práctica clínica habitual: estudio piloto.

BACKGROUND AND OBJECTIVE: The Simplified Psoriasis Index (SPI) is a recently validated tool in Spanish that measures psoriasis severity by integrating 3 different spheres: clinical severity (SPI-s), psychosocial impact (SPI-p), and natural history (SPI-i). Our objective was to study the validity and equivalence of this new scale compared to routinely used scales such as the Psoriasis Area and Severity Index, PASI, and the Dermatology Life Quality Index (DLQI). MATERIALS AND METHODS: This was a cross-sectional and observational study that included 45 patients aged 18 to 74 years. Demographic data and information associated with psoriasis severity and the patients' quality of life were collected, using PASI, DLQI, and SPI simultaneously. The correlation of reference scales (PASI and DLQI) with SPI was examined. The degree of agreement between the 2 versions of SPI completed by the physician (proSPI-s) and self-administered by the patient (saSPI-s), was also studied. RESULTS: The mean age of the study population was 51 years, with a mean psoriasis history of 14.05 years. A strong correlation was found between PASI and proSPI-s (r=0.89), as well as between DLQI and SPI-p (r=0.89), with a moderate correlation being reported between PASI and saSPI-s (r=0.52). The degree of agreement between proSPI-s and saSPI-s was moderate. CONCLUSIONS: These findings represent the initial results of real clinical practice using the validated Spanish version of SPI, making its use truly promising in the routine clinical practice.

[Study of correlation between different scales that measure smoking dependence]. / Estudio de correlación entre diferentes escalas que miden la dependencia al tabaquismo.

OBJECTIVE: To analyze the correlation between the degrees of smoking dependence, measured with the Fagerström Test Nicotine Dependence (FTND), Glover-Nilsson Smoking Behavioral Dependence (GN-SBQ) and a measure of self-perceived-dependence (SPD). DESIGN: Cross-sectional descriptive observational study. SITE: Urban primary health-care center. PARTICIPANTS: Men and women between 18 and 65 years old, daily smokers, selected by non-random consecutive sampling. INTERVENTIONS: Self-administration of various questionnaires though an electronic device. MAIN MEASUREMENTS: Age, sex and nicotine dependence assessed by: FTND, GN-SBQ and SPD. Statistical analysis, with SPSS 15.0: descriptive statistics, Pearson correlation analysis and conformity analysis. RESULTS: Two hundred fourteen smokers were included, 54.7% were women. Median age 52 years (range: 27-65). Depending on the test used, different results of the high/very high degree of dependence were found: FTND 17.3%, GN-SBQ 15.4% and SPD 69.6%. A moderate magnitude (r≈0.5) correlation between the 3 test was found. When assessing concordance, comparing the FTND with SPD, 70.6% of smokers didn't coincide in the severity of dependence, reporting a milder degree of dependence with the FTND than with SPD. Comparing GN-SBQ versus FTND, showed conformity in 44.4% of patients while in 40.7%, the FTND underestimated the severity of dependence. Likewise, when comparing SPD with the GN-SBQ, in the 64% GN-SBQ underestimates, while in 34.1% smokers conformity was demonstrated. CONCLUSIONS: The number of patients who consider their SPD to be high/very high was four times higher compared to the GN-SBQ or the FNTD; the latter, being the most demanding, categorizing patients with very high dependence. Requiring a FTND score greater than 7 to prescribe drugs for smoking cessation may exclude subsidiary patients from receiving treatment.

Parental worry about children: Scale development and validation among Chinese parents of preschool children.

Chinese parents tend to exhibit a high level of worry about their children during the preschool years, which may adversely influence children's mental health. Few studies have investigated the content and intensity of parental worry about children among Chinese parents of preschool children. This study developed and validated the Parental Worry About Children Scale (PWCS) for Chinese parents of preschool children. A pool of 70 items was created after an open-ended questionnaire survey of 1069 Chinese parents of preschool children and an Internet-content analysis, followed by an assessment for content validity by eight experts. Exploratory factor analysis was then conducted with 680 Chinese parents of preschool children, resulting in the formal PWCS consisting of 40 items in four dimensions: physical well-being, psychological well-being, learning/living abilities, and future/uncertain risks. With a sample of 1548 Chinese parents of preschool children, the PWCS demonstrated good structural validity, internal consistency reliability, measure invariance across mothers and fathers, and criterion-related validity. The PWCS may help elucidate the characteristics and antecedents of parental worry about children and the mechanisms underlying its influence on children's mental health in the Chinese context. In clinical practice, this new instrument may facilitate the emergence of effective intervention strategies for alleviating parental worry about children and its negative impact on children's mental health.

Los padres chinos tienden a demostrar un alto nivel de preocupación por sus hijos durante los años de preescolar, lo cual puede influir negativamente en la salud de mental de los niños. En pocos estudios se ha investigado el contenido y la intensidad de la preocupación de los padres por los niños entre los padres chinos de niños en edad preescolar. En este estudio se desarrolló y se validó la Escala de preocupación de los padres por los hijos (Parental Worry About Children Scale, PWCS) para padres chinos de niños en edad preescolar. Se creó un grupo de 70 ítems después de una encuesta abierta de 1069 padres chinos de niños en edad preescolar y un análisis de contenido de internet, seguido de una evaluación de validez del contenido realizada por ocho especialistas. Luego se llevó a cabo un análisis factorial exploratorio con 680 padres chinos de niños en edad preescolar, cuyo resultado fue la PWCS formal que consta de 40 ítems en cuatro dimensiones: bienestar físico, bienestar psicológico, habilidades de aprendizaje/para la vida y riesgos futuros/inciertos. Con una muestra de 1548 padres chinos de niños en edad preescolar, la PWCS demostró una buena validez estructural, fiabilidad de la coherencia interna, invariancia de las medidas entre las madres y los padres, y validez relacionada con el criterio. La PWCS puede contribuir a dilucidar las características y los antecedentes de la preocupación de los padres por los niños y los mecanismos que subyacen a su influencia en la salud mental de los niños en el contexto chino. En la práctica clínica, este nuevo instrumento puede facilitar el surgimiento de estrategias eficaces de intervención para aliviar la preocupación de los padres por los niños y su efecto negativo en la salud mental de los niños.

An adaptive plan for prioritizing road sections for fencing to reduce animal mortality.

Mortality of animals on roads is a critical threat to many wildlife populations and is poised to increase strongly because of ongoing and planned road construction. If these new roads cannot be avoided, effective mitigation measures will be necessary to stop biodiversity decline. Fencing along roads effectively reduces roadkill and is often used in combination with wildlife passages. Because fencing the entire road is not always possible due to financial constraints, high-frequency roadkill areas are often identified to inform the placement of fencing. We devised an adaptive fence-implementation plan to prioritize road sections for fencing. In this framework, areas along roads of high, moderate, and low levels of animal mortality (respectively, roadkill hotspots, warmspots, and coldspots) are identified at multiple scales (i.e., in circles of different diameters [200-2000 m] in which mortality frequency is measured). Fence deployment is based on the relationship between the amount of fencing being added to the road, starting with the strongest roadkill hotspots, and potential reduction in road mortality (displayed in mortality-reduction graphs). We applied our approach to empirical and simulated spatial patterns of wildlife-vehicle collisions. The scale used for analysis affected the number and spatial extent of roadkill hot-, warm-, and coldspots. At fine scales (e.g., 200 m), more hotspots were identified than at coarse scales (e.g., 2000 m), but combined the fine-scale hotspots covered less road and less fencing was needed to reduce road mortality. However, many short fences may be less effective in practice due to a fence-end effect (i.e., animals moving around the fence more easily), resulting in a trade-off between few long and many short fences, which we call the FLOMS (few-long-or-many-short) fences trade-off. Thresholds in the mortality-reduction graphs occurred for some roadkill patterns, but not for others. Thresholds may be useful to consider when determining road-mitigation targets. The existence of thresholds at multiple scales and the FLOMS trade-off have important implications for biodiversity conservation.

Un Plan Adaptativo para la Priorización de Secciones de Carretera para Cercar y Reducir la Mortalidad Animal Resumen La mortalidad de los animales en las carreteras es una amenaza muy importante para las poblaciones silvestres y se pronostica que aumentarán enérgicamente debido a la construcción continua y planeada de carreteras. Si estas nuevas carreteras no pueden evitarse, se necesitarán medidas efectivas de mitigación para detener la declinación de la biodiversidad. El cercado a lo largo de las carreteras reduce efectivamente los atropellamientos y se usa frecuentemente junto con los pasos de fauna. Ya que cercar por completo la carretera no siempre es posible debido a las restricciones financieras, es común identificar las áreas con una frecuencia alta de atropellamientos para que la colocación de cercas esté informada al respecto. Diseñamos un plan adaptativo de implementación de cercas para priorizar las secciones de carretera que requieren ser cercadas. En este marco de trabajo, identificamos las áreas a lo largo de las carreteras con un nivel alto, moderado y bajo de mortalidad animal (respectivamente, puntos calientes, cálidos y fríos de atropellamiento) a diferentes escalas (es decir, en círculos de diferentes diámetros [200-2000 m] dentro de los cuales se mide la frecuencia de la mortalidad). El despliegue de cercas está basado en la relación entre la cantidad de cercas que se van añadiendo a la carretera, iniciando en los puntos calientes de atropellamiento, y la reducción potencial de la mortalidad en la carretera (presentada en gráficas de reducción de la mortalidad). Aplicamos nuestra estrategia a los patrones espaciales empíricos y simulados de las colisiones entre vehículos y animales. La escala utilizada para el análisis afectó al número y a la extensión espacial de los puntos calientes, cálidos y fríos de los atropellamientos. A escalas finas (p. ej.: 200 m), se identificaron más puntos calientes que a escalas más amplias (p. ej.: 2000 m), pero combinadas las escalas finas, los puntos calientes cubrieron una superficie menor de la carretera y se necesitaron menos cercas para reducir la mortalidad. Sin embargo, muchas cercas cortas pueden ser menos efectivas en la práctica debido al efecto de fin de valla (es decir, que los animales se muevan alrededor de la cerca con mayor facilidad), lo que resulta en una compensación entre pocas cercas largas y muchas cercas cortas, que denominamos compensación de cercas FLOMS (pocas-largas-o-muchas-cortas). Los umbrales en las gráficas de reducción de la mortalidad se presentaron para algunos patrones de atropellamiento, pero no para otros. Los umbrales pueden ser útiles para considerar cuando se determinan los objetivos de mitigación para las carreteras. La existencia de los umbrales a escalas múltiples y la compensación de FLOMS tienen implicaciones importantes para la conservación de la biodiversidad.

The Home Visit Rating Scales: Revised, restructured, and revalidated.

The Home Visit Rating Scales (HOVRS) were initially developed from field-based descriptions of successful home visits and are supported by home-visiting research in multiple disciplines. Four home-visiting practices scales include indicators of relationship building with families, responsiveness to family strengths, facilitation of parent-child interaction, and collaboration with parents. Three family engagement scales include indicators of parent-child interaction, parent engagement, and child engagement in the visit. The original version, the HOVRS-1, was validated using video and data from two Early Head Start home-visiting programs. Conceptual and structural changes for the HOVRS-3 were designed to improve readability, usability, and clarity. Newly trained observers used the HOVRS-3 to observe archived videos from the original measurement sample. The HOVRS-3 showed good interrater reliability, scale internal consistency, convergent validity, predictive validity, practical significance, and version stability. When the HOVRS-3 home-visit quality scores were higher, it was twice as likely for parenting scores to be average or better and for child language to be at age level or better at age 3 years, over and above parenting and child language at age 1 year. The HOVRS can guide observations of home-visit quality in infant-toddler and early childhood programs to improve home-visiting practices and family engagement.

Las Escalas de Evaluación de Visitas a Casa inicialmente se desarrollaron a partir de las descripciones sobre el campo de exitosas visitas a casa y las mismas están apoyadas por la investigación sobre la visita a casa en múltiples disciplinas. Las escalas de prácticas de cuatro visitas a casa incluyen indicadores de relaciones establecidas con familias, sensibilidad hacia los puntos fuertes de la familia, el facilitar la interacción entre progenitor y niño, y la colaboración con los progenitores. Las escalas de participación de tres familias incluyen indicadores sobre la interacción entre progenitor y niño, la participación del progenitor, y la participación del niño en la visita. Se validó la versión original, HOVRS-1, usando un video e información de dos programas de visitas a casa de Un Comienzo Temprano (Early Head Start). Se diseñaron cambios conceptuales y estructurales para HOVRS-3 para mejorar la legibilidad, la disponibilidad para el uso y la claridad. Nuevos observadores entrenados usaron HOVRS-3 para observar videos archivados acerca de las medidas de la muestra original - HOVRS-3 mostró buena confiabilidad entre los evaluadores, consistencia interna de la escala, validez convergente, validez de predicción, importancia práctica y estabilidad de la versión. Cuando los puntajes de calidad de HOVRS-3 sobre la visita a casa fueron más altos, la inclinación de los puntajes de crianza de ser promedio o mejores fue dos veces mayor, así como también fue el lenguaje del niño de estar al nivel de la edad o mejor a los 3 años, muy por encima del lenguaje de crianza y del niño a la edad de un año. Las Escalas de Evaluación de Visitas a Casa pueden guiar las observaciones de la calidad de la visita a casa en programas para infantes y niños pequeñitos y en la temprana niñez para mejorar las prácticas de visitas a casa y la participación de la familia.

Les Echelles d'Evaluation de la Visite à Domicile ont été initialement développées à partir de descriptions sur le terrain de visites à domicile réussies et sont soutenues par les recherches sur les visites à domicile dans de multiples disciplines. Quatre échelles de pratique de visites à domicile incluent des indicateurs de développement de la relation avec les familles, la réaction aux forces familiales, la facilitation de l'interaction parent-enfant, et la collaboration avec les parents. Trois échelles d'engagement de la famille incluent des indicateurs d'interaction parent-enfant, d'engagement parental, et d'engagement de l'enfant durant la visite. La version originale, abrégée en anglais HOVRS-1, a été validée en utilisant des vidéos et des données de deux programmes de visites à domiciles américains dans le cadre du programme d'aide aux enfants défavorisés de Early Head Start. Les changements conceptuels et structurels du HOVRS-3 ont été faits afin d'améliorer sa lisibilité, sa facilité d'utilisation et sa clarté. De nouveaux observateurs fraîchement formés ont utilisé les afin d'observer des vidéos mises en archive de l'échantillon original de mesure. Les HOVRS-3 ont fait preuve d'une bonne fiabilité d'inter-évaluateur, d'une bonne cohérence interne à l'échelle, de validité convergente et de stabilité de version. Lorsque les scores de qualité de la visite à domicile HOVRS-3 étaient plus élevés il était deux fois plus probable que les scores de parentage soient moyens ou mieux et pour le langage de l'enfant qu'il soit au niveau de l'âge ou mieux à l'âge de 3 ans, bien au dessus du parentage et du langage de l'enfant à l'âge de 1 ans. Les Echelles d'Evaluation de la Visite à Domicile peuvent guider des observations de la qualité de la visite à domicile chez les nourrissons-petits-enfants et de programmes de la petite enfance afin d'améliorer les pratiques de visites à domicile et d'engagement de la famille.

Observing home-visiting quality across time: A longitudinal reliability study of the Home Visit Rating Scales.

Empirical examination of home-visiting quality over time is lacking in the research literature. To this end, this study examined the most recent edition of a widely used observational measure of home-visiting quality, the Home Visit Rating Scales (HOVRS), over four repeated assessments spanning an average of 6 months. Psychometric quality for the HOVRS Total and Home Visitor Practice Scales, including item ratings and calculated scores, across time was demonstrated. Stability indicators for the Family Engagement Scales varied, with superior reliability often indicated for individual ratings over the calculated score. The exploration of interrelationships among family demographics and change in HOVRS scores over time were largely insignificant. Interestingly, a decline in the Home Visitor Practice Scale significantly related to increased symptoms of maternal depression, possibly suggesting that home-visitors' focus shifted from children's needs to those of parents when mental health concerns were observed. Although this study is an examination of one program model and poses limited generalizability, it sets the stage for advancing the HOVRS and longitudinal measurement of home-visiting quality.

A la examinación empírica de la calidad de la visita a casa a través tiempo le hace falta literatura investigativa. Con este fin, este estudio examinó la más reciente edición de una ampliamente utilizada medida de la calidad de visita a casa, las Escalas de Evaluación de Visitas a Casa (HOVRS; Roggman et al., 2012) con respecto a cuatro evaluaciones repetidas durante un período promedio de seis meses. Se demostró la calidad sicométrica a través del tiempo para la Totalidad de HOVRS y las Escalas de Prácticas de Visitadores a Casa, incluyendo puntuación de categorías y puntajes calculados. Los indicadores de estabilidad para las Escalas de Participación de la Familia variaron, con una confiabilidad superior a menudo señalada para puntajes individuales sobre el puntaje calculado. La exploración de las interrelaciones entre los datos demográficos de la familia y el cambio en los puntajes de HOVRS a través del tiempo fue por la mayor parte insignificante. A manera de interés, una baja en la Escala de Práctica del Visitador a Casa se relacionó significativamente con el aumento de síntomas de depresión materna, posiblemente sugiriendo que el enfoque de los visitadores a casa cambió de las necesidades del niño a aquellas de los progenitores cuando se observaron preocupaciones de salud mental. Aunque este estudio representa una examinación del modelo de un programa y presenta una generalización limitada, el mismo sienta las bases para llevar adelante a HOVRS y las medidas longitudinales de la calidad de las visitas a casa.

L'examen empirique de la qualité de la visite à domicile au fil du temps n'aparaît pas dans les recherches. Pour y remédier, cette étude a examiné l'édition la plus récente d'une mesure d'observation de la qualité de la visite à domicile largement utilisée, les Echelles d'Evaluation de la Visite à Domicile (en anglais Home Visit Rating Scales, soit HOVRS; Roggman et al., 2012) au moyen de quatre évaluations répétées étalées sur une moyenne de six mois. La qualité psychométrique des HOVRS totales a été démontrée, y compris les évaluations des éléments et les scores calculés. Les indicateurs de stabilité pour les Echelles d'Engagement de la Famille ont varié, avec une fiabilité supérieure souvent indiquée pour les évaluations individuelles par rapport au score calculé. L'exploration de l'interdépendance existant entre la démographie familiale et le changement dans les scores HOVRS au fil du temps se sont avérés très négligeables. Non sans intérêt, un déclin dans l'Echelle de la Pratique du Visiteur à Domicile s'est avéré fortement lié à des symptômes accrus de dépression maternelle, suggérant peut-être que l'attention des visiteurs à domicile s'est déplacée des besoins des enfants à ceux des parents lorsque des inquiétudes sur la santé mentale ont été observées. Bien que cette étude ait été un examen d'un modèle de programme et pose une généralisabilité limitée, elle prépare le terrain de l'amélioration des HOVRS et de la mesure longitudinale de la qualité de la visite à domicile.

The Experience in Personal Social Systems Questionnaire (EXIS.pers): Development and Psychometric Properties.

This study presents the theoretical background, development, and psychometric properties of the German and English versions of the Experience in Personal Social Systems Questionnaire (EXIS.pers). It assesses how the members of a personal social system experience their situation within that system. It is designed as a research tool for interventions in which only one member of the system participates (e.g., Family Constellation Seminars). The EXIS.pers was created to measure change on the individual level relating to one's own important personal social system. In Study 1, we used exploratory factor analysis (EFA) for latent variable identification of the original German EXIS.pers (n = 179). In Studies 2 and 3, we used confirmatory factor analysis (CFA) to examine the dimensionality of the German (n = 634) and English (n = 310) EXIS.pers. Internal consistencies and cross-cultural structural equivalence were assessed. EFA indicated that a four-factor model provided best fit for the German EXIS.pers. For both the German and English EXIS.pers, CFA provided the best fit for a five-factor bi-level model that included a general factor (Experience In Personal Social Systems) and four dimensions (Belonging, Autonomy, Accord, Confidence). Good internal consistencies, external associations, and cross-cultural structural equivalence were demonstrated. This study provides first evidence for the German and English EXIS.pers as an economical and reliable measure of an individual's experience within his or her personal social systems.

Validity of the clinical and content scales of the Multiphasic Personality Inventory Minnesota 2 for the diagnosis of psychogenic non-epileptic seizures.

INTRODUCTION: The use of the Multiphasic Personality Inventory Minnesota 2 (MMPI-2) for the diagnosis of psychogenic non-epileptic seizures (PNES) is controversial. This study examines the validity of the clinical scales and, unlike previous works, the content scales. METHODS: Cross-sectional study of 209 patients treated in the epilepsy unit. We performed a logistic regression analysis, taking video-electroencephalography as the reference test, and as predictor variables age, sex, IQ and clinical (model A) or content scales (model B) of the MMPI-2. The models were selected according to the Aikake index and compared using the DeLong test. RESULTS: We analyzed 37 patients with PNES alone, or combined with seizures, and 172 patients with seizures only. The model consisting of sex, Hs (hypochondriasis) and Pa (paranoia) showed a sensitivity of 77.1%, a specificity of 76.8%, a percentage of correct classification of 76.8%, and an area under the curve (AUC) of 0.836 for diagnosing CNEP. Model B, consisting of sex, HEA (health concerns) and FRS (fears), showed a sensitivity of 65.7%, a specificity of 78.0%, a percentage of correct classification of 75.9% and an AUC of 0.840. DeLong's test did not detect significant differences. CONCLUSIONS: The MMPI-2 has a moderate validity for the diagnosis of PNES in patients referred to an epilepsy unit. Using content scales does not significantly improve results from the clinical scales.

Predictive scoring systems in multiorgan failure: A cohort study.

OBJECTIVE: An evaluation is made of the hospital mortality predicting capacity of the main predictive scoring systems. DESIGN: A 2-year retrospective cohort study was carried out. SETTING: A third level ICU with surgical and medical patients. PATIENTS: All patients with multiorgan failure during the first day in the ICU. MAIN VARIABLES: APACHE II and IV, SAPS II and III, MPM II and hospital mortality. RESULTS: A total of 568 patients were included. Mortality rate: 39.8% (226 patients). Discrimination (area under the ROC curve; 95% CI): APACHE IV (0.805; 0.751-0.858), SAPS II (0.755; 0.697-0.814), MPM II (0.748; 0.688-0.809), SAPS III (0.737; 0.675-0.799) and APACHE II (0.699; 0.633-0.765). MPM II showed the best calibration, followed by SAPS III. APACHE II, SAPS II and APACHE IV showed very poor calibration. Standard mortality ratio (95% CI): APACHE IV 1.9 (1.78-2.02); APACHE II 1.1 (1.07-1.13); SAPS III 1.1 (1.06-1.14); SAPS II 1.03 (1.01-1.05); MPM 0.9 (0.86-0.94). CONCLUSIONS: APACHE IV showed the best discrimination, with poor calibration. MPM II showed good discrimination and the best calibration. SAPS II, in turn, showed the second best discrimination, with poor calibration. The APACHE II calibration and discrimination values currently disadvise its use. SAPS III showed good calibration with modest discrimination. Future studies at regional or national level and in certain critically ill populations are needed.

[Factors associated with colon cleansing measured with the Boston scale in routine clinical practice]. / Factores asociados al nivel de limpieza colónica medido mediante la escala de Boston en la práctica clínica habitual.

INTRODUCTION: The Boston scale is useful to standardize colon cleansing at colonoscopy. The aim of this study was to analyze the degree of preparation before colonoscopy and the factors associated with cleansing in routine clinical practice. MATERIAL AND METHODS: We included colonoscopies performed from January to June 2013. Exclusion criteria were age <15 years, a history of colon surgery, inflammatory bowel disease, and active gastrointestinal bleeding. The standard preparation was CitraFleet. The parameters related to the degree of bowel cleansing (using the Boston scale) were age, sex, indication, colonoscopy shift (morning or afternoon), patient origin (outpatient or hospitalized), and colonoscopy findings. RESULTS: We analyzed 947 colonoscopies, with exclusion of 297. A total of 5.8% (38/650) of the colonoscopies were incomplete, 50% due to lack of preparation. The mean age of the patients was 61.27 years (SD: 16.1), and 51.8% were women. The distribution of the Boston scale was 0-3 in 6.3%, 4-5 in 12.6%, 6-7 in 30.6%, and 8-9 in 50.4%, with a mean 7.04 (SD: 2.03). On multivariate analysis, the factors statistically associated with better preparation were younger age, afternoon colonoscopy and the outpatient setting. The percentage of polyps in patients with a Boston scale score ≤5 was 10% compared with 27.8% in patients with a score > 5 (P=.014). CONCLUSION: In clinical practice, 80% of patients had an acceptable level of preparation. Older patients, those undergoing colonoscopy in the morning and hospitalized patients would be candidates for measures to improve the degree of colonic preparation.

The neurologist facing pain in dementia.

INTRODUCTION: Ageing, a common background in dementia, is usually associated with painful disorders. Nevertheless, the use of analgesics is limited due to poor communication. On the other hand, dementia lesions are placed in the nociceptive pathways. For this reason, the painful experience becomes different and distinctive for every lesional type. COURSE: The lateral nociceptive pathway (lateral thalamic nuclei and primary parietal cortex), which is in charge of the primary pain perception, is preserved in dementia. Thereafter, the shear painful perception, including pain intensity and threshold, remains unmodified. Distinctly, the medial pain pathways are affected by dementia lesions. In this pathway are included: the intralaminar thalamic nuclei, the pons (locus ceruleus:LC), the mesencephalon (periaacueductal grey substance: PGS), the hypothalamus (paraventricular nuclei, mamilary tuberculum) and different areas of the parietal (primary, secondary, operculum), temporal (amigdala, hypoccampus) and frontal (anterior cingular: ACC). As a consequence, the features of pain executed by these areas will be compromised: the cognitive assessment, the mood and emotion inherent to pain, the pain memory or the autonomic responses are modified in dementia. Specifically, in Alzheimer's disease (AD) there is a reduction in the anticipatory and avoidance responses and also a flattening of the autonomic responses. These are essentially secondary to the degenerative changes in the medial temporal (pain memory) and ACC (cognitive and mood aspects) areas. In vascular dementias, there is a cortico-subcortical deafferentation secondary to the white matter lesions. The consequence is the presence of hyperpathy and hyperalgesia. In the frontotemporal dementias, there is a reduction in pain expressivity. It is linked to the lesions in the orbitofrontal and anterior temporal areas, which are responsible of the emotional aspects of pain. In Parkinson's disease, painful conditions are a common characteristic. They are attributed to an early lesion in the LC, which reduces its prominent antinociceptive activity. Finally, in the demented patients there is a lack of expectations to analgesic treatments. This means an absence of the placebo effect, which is, alongside the pharmacokinetic action, an inherent part of the analgesic response. The placebo response is related to activity in the ACC and PGS. Giving its lack, higher doses of analgesics are necessary in dementias. CONCLUSIONS: The assessment of pain in dementia is rather complex, which is the main reason for the scarcity of the analgesic treatment in dementias. It must be specific and systematic. For this purpose, the pain scales are a useful tool. For communicative patients, simple visual scales are helpful, meanwhile in the non-communicative patients the multidimensional scales are the most suitable. By this means, the expressive, motor, emotional, functional and social interactions are evaluated. Pain may be responsible of progression and cognitive deterioration in dementia. This evolution could be reversible, and consequently it has to be foreseen in order to implement analgesic treatment. Trying to minimize adverse events, it has to be potent but closely monitored.

[Validation of EMINA and EVARUCI scales for assessing the risk of developing pressure ulcers in critical patients]. / Validación de las escalas de valoración de riesgo de úlceras por presión EMINA y EVARUCI en pacientes críticos.

OBJECTIVE: To contribute to the validation of the EMINA and EVAUCI scales for assessing the risk of pressure ulcers in the critical patient and compare their predictive capacity in this same context. METHOD: Prospective study from December 2012 until June 2013. SETTING: Polyvalent intensive care unit of 14 beds in a reference hospital for two sanitary areas. PATIENTS: patients of 18 years of age or older and without pressure ulcers were included. They were followed until development of a pressure ulcer of grade I or greater, medical discharge, death or 30 days. MAIN VARIABLES: presence of ulcers, daily score of the risk of developing pressure ulcers through EMINA and EVARUCI evaluation. The validity of both scales was calculated using sensitivity, specificity, and positive and negative predictive value. The level of significance was P≤0.05. RESULTS: A total of 189 patients were evaluated. 67.2% were male with a mean age of 59.4 (DE: 16,8) years old, 53 (28%) developed pressure ulcers, being the incidence rate of 41 ulcers per 1000 admission days. The mean day of diagnosis was 7.7 days (DE: 4,4) and the most frequent area was the sacrum. The sensitivity and specificity for the mean of observations was 94.34 (IC95% 87.17-100) and 33.33 (IC95% 25.01-41.66) for the EMINA scale for a risk>10 and 92.45 (IC95% 84.40-100) and 42.96 (IC95% 34.24-51.68) for the EVARUCI scale for a risk of>11. CONCLUSIONS: No differences were found in predictive capacity of both scales. For sensitivities>90%the scales show to be insufficiently specific in the pressure ulcer risk detection in critical patients.

Successes and challenges from formation to implementation of eleven broad-extent conservation programs.

Integration of conservation partnerships across geographic, biological, and administrative boundaries is increasingly relevant because drivers of change, such as climate shifts, transcend these boundaries. We explored successes and challenges of established conservation programs that span multiple watersheds and consider both social and ecological concerns. We asked representatives from a diverse set of 11 broad-extent conservation partnerships in 29 countries 17 questions that pertained to launching and maintaining partnerships for broad-extent conservation, specifying ultimate management objectives, and implementation and learning. Partnerships invested more funds in implementing conservation actions than any other aspect of conservation, and a program's context (geographic extent, United States vs. other countries, developed vs. developing nation) appeared to substantially affect program approach. Despite early successes of these organizations and benefits of broad-extent conservation, specific challenges related to uncertainties in scaling up information and to coordination in the face of diverse partner governance structures, conflicting objectives, and vast uncertainties regarding future system dynamics hindered long-term success, as demonstrated by the focal organizations. Engaging stakeholders, developing conservation measures, and implementing adaptive management were dominant challenges. To inform future research on broad-extent conservation, we considered several challenges when we developed detailed questions, such as what qualities of broad-extent partnerships ensure they complement, integrate, and strengthen, rather than replace, local conservation efforts and which adaptive management processes yield actionable conservation strategies that account explicitly for dynamics and uncertainties regarding multiscale governance, environmental conditions, and knowledge of the system?

Multiorgan failure in the serious trauma patient.

Multiorgan failure remains one of the leading causes of late morbidity and mortality after severe trauma. In the early phase, it is related with an uncontrolled hyper-inflammation state, whereas in the late phase (>72 h), septic complications play a major role. We review the underlying pathophysiology, the evaluation with different scales and the clinical factors associated with multiorgan failure, as well as potential treatment options.

[Long covid and disability]. / Covid persistente y discapacidad.

Long covid is a health problem that will entail a high hidden cost attributable to the pandemic years after it because it affects the work capacity of many workers. Given the millions of covid-19 cases worldwide and current research showing that one in 7covid-19 patients remain symptomatic at 12 weeks, the number of long covid patients is likely to be substantial. Long covid is characterized by heterogeneous sequelae that often affect multiple systems, organs with an impact on the functioning and capacity of the worker. Workers with long covid symptoms can return to their occupation but this involves a complex individualized approach to the impact of symptoms on work, adjustments and modifications to the workplace. Patients with long covid typically report prolonged multisystem involvement and signicant disability. The psychological cost to the worker must also be addressed. A survey by the Community of Madrid (CCOO, SATSE, CSIF, AMYTS) in 2022 reveals that 24.5% of those affected by long covid were sick for more than 12 months; 30% of those affected by persistent covid need and adaption to their workplace. In Spain, more than 10million people infected with SARS-CoV-2 have been reported since the pandemic began, so it is estimated that there could be one million people with persistent covid. In 2021 alone there were more than 2.6 million sick leave due to covid-19 in Spain, the average duration of which was 10 days. One hundred million people around the world suffer from persistent covid, but few countries officially count them, nor do they help those affected with employment. In advanced countries, like the United States, long covid is treated as a disability,and the number of people with disabilities working or looking for work increased by 1.36 million, an increase of 23%, between January 2021 and January 2022. In the United Kingdom, some 200,000 people are not working or are not looking for work due to long-term health problems attributable to long covid, since the pandemic began.

Comparison of repeatability of subjective appetite sensations in men and women at different menstrual cycle phase.

Introduction: Introduction: appetite can be measured through subjective sensations of appetite (SSA), which can be assessed by means of scales, the most relevant being the visual analog scales (VAS). Objective: to analyze the repeatability of VAS in men and women in follicular phase (FF) and luteal phase (LF) of the menstrual cycle Materials and methods: 34 men and women were included. VAS of subjective appetite sensations (SAS) were applied before and after standardized breakfast in two sessions. Results: women LP showed intra-class correlation coefficient (ICC) values greater than 0.5, and most of VAS in women FP and men showed ICC values greater than 0.7. The ICC of hunger and desire to eat were different between men and women LP. Comparisons of these ICC´s showed that only hunger and desire to eat were different between men and women. Conclusion: repeatability of VAS was similar between men and women in different stages of menstrual cycle. This is the first study to assess repeatability of VAS in women in LP and to objectively compare the repeatability of VAS to evaluate SAS.

Introducción: Introducción: el apetito se puede medir a través de sensaciones subjetivas del apetito (SSA), las cuales pueden evaluarse mediante escalas, siendo las más relevantes las escalas analógicas visuales (EAV). Objetivo: analizar la repetibilidad de las EAV en hombres y mujeres en fase folicular (FF) y fase lútea (FL) del ciclo menstrual. Material y métodos: se incluyeron 34 hombres y mujeres. Se aplicaron las EAV para las SSA antes y después de un desayuno estandarizado en dos sesiones. Resultados: las mujeres FL mostraron valores de coeficiente de correlación intraclase (CCI) superiores a 0,5 y la mayoría de EAV de mujeres FF y hombres mostraron valores de CCI superiores a 0,7. La comparación de los CCI mostró que solo hambre y el deseo por comer fue diferente entre hombres y mujeres. Conclusión: la repetibilidad de las EAV fue similar entre hombres y mujeres en diferentes etapas del ciclo menstrual. Este es el primer estudio que evalúa la repetibilidad de las EAV en mujeres FL y que compara objetivamente la repetibilidad de EAV para evaluar SSA.

[Predictive validity of the risk SCORE model in a Mediterranean population with arterial hypertension]. / Validez en la predicción de riesgo de la escala SCORE en una población mediterránea con hipertensión arterial.

INTRODUCTION AND OBJECTIVES: Hypertension is the most prevalent risk factor globally. Calculation of cardiovascular risk in hypertensive patients before initiation of treatment is recommended. This study aimed to assess the predictive value and clinical utility of the SCORE scale in preventing cardiovascular events and all-cause mortality in patients with hypertension. METHODS: Patients with hypertension from the ESCARVAL-RISK cohort were included. Cardiovascular risk was calculated using the SCORE scale. All deaths and cardiovascular events were recorded during a 5-year follow-up period. Sensitivity, specificity and predictive values were calculated for different cut-off points and the effect of different risk factors on the diagnostic accuracy of SCORE charts were assessed. RESULTS: In a final cohort of 9834 patients, there were 555 cardiovascular events and 69 deaths. The recommended risk value for initiating drug treatment (5%) had a specificity of 92% for death and 91% for cardiovascular events, and a sensitivity of 20% for death and 22% for cardiovascular events. In addition, the scale classified 80.4% of patients who experienced a cardiovascular event and 78.3% of those who died as low risk. Age, body mass index, retinopathy and anticoagulant therapy were associated with reduced predictive ability of the SCORE scale, while being female was associated with better risk prediction. CONCLUSIONS: The predictive ability of the SCORE scale for cardiovascular disease and total mortality in patients with hypertension is limited.

Prognostic value of scales for aneurysmal subarachnoid hemorrhage: Report of a reference center in Peru.

INTRODUCTION: Multiple scales have been designed to stratify the severity and predict the prognosis in the initial evaluation of patients with aneurysmal subarachnoid hemorrhage (aSAH). Our study aimed to validate the most commonly used prognostic scales for aSAH in our population: Hunt-Hess, modified Hunt-Hess, World Federation of Neurosurgical Societies (WFNS), Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage (PAASH), and Barrow Aneurysm Institute (BAI) scales. METHODS: This study includes all aSAH cases treated at our institution between June 2019 and December 2020. We developed a retrospective cohort by reviewing medical records and radiologic images performed during hospitalization. The outcome was evaluated using the modified Rankin scale (mRS). It was defined as a poor outcome (mRS 4-5) and mortality (mRS 6). The ROC curves and the area under the curve (AUC) of each of the prognostic scales were calculated to evaluate their prognostic prediction capacity. RESULTS: A total of 142 patients were diagnosed with aSAH. A poor outcome occurred in 52.1% of the patients, whereas mortality was 27.5%. The AUC of the scales studied was similar and no significant difference was found between them for predicting a poor outcome (P = .709) or mortality (P = .715). CONCLUSION: We determined that the prognostic scales for aSAH had a similar predictive value for poor clinical outcomes and mortality in our institution, with no significant difference. Thus, we recommend the most simple and well-known scale used institutionally.

Appropriateness of behavioural scales in the monitoring of pain in the critically ill patient unable to self-report.

Appropriateness is a dimension of quality that evaluates the effective use of technologies, resources or interventions in specific situations or populations, assessing whether our interventions do more benefit than harm. The evidence regarding pain monitoring in the critically ill patient points to the periodic assessment of pain using appropriate tools, with the aim of improving pain management and more efficient use of analgesics in the intensive care unit. The first step would be to assess the patient's ability to communicate or self-report and, based on this, to select the most appropriate pain assessment tool. In patients who are unable to self-report, behavioural pain assessment tools are recommended. When we talk about the suitability of behavioural scales for pain monitoring in critically ill patients unable to self-report, we refer to their use with a clear clinical benefit, i.e. using the right tool for pain assessment to be effective, efficient and consistent with bioethical principles. To our knowledge, there are no published data on the suitability of pain assessment tools in unable to self-report critically ill patients, so, in the framework of continuous quality improvement in pain care, new research should incorporate this approach by integrating the best scientific evidence with current clinical practice.

A new standardized nomenclature in neurosurgery: Criteria and quantitative and qualitative evaluation indicators of medical procedures.

PURPOSE: Update the list of medical acts in the specialty of Neurosurgery, eliminating obsolete acts and adding the new surgical techniques developed in recent years, so that they are faithfully adapted to the usual medical practice of our specialty, as well as establishing the general principles and defining the grading criteria, quantitative indicators and assessment scales. METHODS: The elaboration of the new nomenclator was divided into 3 phases: 1) identification and selection of medical acts, 2) establishment of the degree of difficulty of each of them based on the experience and the time necessary for their completion, as well as the percentage and severity of the possible complications and 3) consensus with the members of the SENEC through their individualized submission, making the necessary adjustments and subsequent approval in the general assembly of SENEC. RESULTS: The new nomenclator has 255 medical acts grouped into 4 groups: consultations and visits, therapeutic acts, diagnostic procedures and surgical interventions. 42 procedures included in the OMC nomenclator have been eliminated due to being obsolete, not related to the specialty or being too vague. New techniques have been included and medical acts have been more precisely defined. CONCLUSIONS: This nomenclator provides up-to-date terminology and will serve to offer the portfolio of services, measure and know the relative value of our activity and the approximate costs of the procedures, and additionally, to carry out longitudinal comparative studies. It should be a tool to improve patient care and minimise geographic variability in all healthcare settings.