Therapeutic drug monitoring in inflammatory bowel diseases. Position statement of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis. / Monitorización terapéutica de los fármacos biológicos en la enfermedad inflamatoria intestinal. Documento de Posicionamiento del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU).

The treatment of inflammatory bowel disease has undergone a significant transformation following the introduction of biologic drugs. Thanks to these drugs, treatment goals have evolved from clinical response and remission to more ambitious objectives, such as endoscopic or radiologic remission. However, even though biologics are highly effective, a significant percentage of patients will not achieve an initial response or may lose it over time. We know that there is a direct relationship between the trough concentrations of the biologic and its therapeutic efficacy, with more demanding therapeutic goals requiring higher drug levels, and inadequate exposure being common. Therapeutic drug monitoring of biologic medications, along with pharmacokinetic models, provides us with the possibility of offering a personalized approach to treatment for patients with IBD. Over the past few years, relevant information has accumulated regarding its utility during or after induction, as well as in the maintenance of biologic treatment, in reactive or proactive strategies, and prior to withdrawal or treatment de-escalation. The aim of this document is to establish recommendations regarding the utility of therapeutic drug monitoring of biologics in patients with inflammatory bowel disease, in different clinical practice scenarios, and to identify areas where its utility is evident, promising, or controversial.

Parenting the parent without losing sight of the child. A qualitative study of therapists' experiences with intergenerational adversities in perinatal psychotherapy.

The complex work of addressing intergenerational adversities, like violence, abuse, and neglect through perinatal psychotherapy, is understudied. Especially noticeable is the paucity of studies giving voice to the therapists. This study explored therapeutic processes through the perspectives of seven Norwegian therapists. A qualitative approach was chosen with individual interviews and a follow-up focus group. Data were analyzed using reflexive thematic analysis. We identified one overarching theme: To maintain a reflective therapeutic capacity, and two main themes with associated subthemes: 1) Alliance work when a caring system comes to therapy to fight generations of adversities and 2) The complex therapeutic work of addressing generational adversities in perinatal psychotherapy. Findings from the present study indicate that maintaining a reflective stance is essential yet challenging when addressing intergenerational adversities, requiring a holding environment for the therapists. The primary vehicle of change was perceived as a safe enough therapeutic alliance to explore new ways of being together, contrasting earlier experiences. A key question raised was how to give caregivers enough time to trust the therapist without compromising the safety and development of the child. The essence of the therapeutic work was to reduce risk factors and increase protective factors through multiple ports of entry.

El complejo trabajo de abordar el tema de adversidades intergeneracionales, como violencia, abuso y negligencia a través de la sicoterapia perinatal, no se ha estudiado lo suficiente. Especialmente perceptible es la escasez de estudios que les den voz a los terapeutas. Este estudio exploró los procesos terapéuticos a través de perspectivas de siete terapeutas noruegos. Se escogió un acercamiento cualitativo con entrevistas individuales y un grupo de enfoque como seguimiento. Se analizaron los datos usando un análisis temático reflexivo. Identificamos un tema global: Mantener una capacidad terapéutica reflexiva, así como dos temas principales con subtemas asociados: 1) Trabajo en alianza cuando un sistema de cuidados llega a la terapia, para combatir generaciones de adversidades y 2) El complejo trabajo terapéutico de abordar el tema de adversidades generacionales en la sicoterapia perinatal. Los resultados del presente estudio indicaron que mantener una postura de reflexión es esencial, aunque desafiante, cuando se aborda el tema de adversidades generacionales, lo cual requiere un entorno o espacio favorable para los terapeutas. La percepción es que el vehículo primario para el cambio es una suficientemente segura alianza terapéutica para explorar nuevas maneras de vivir juntos, contrastando las experiencias anteriores. Una pregunta clave que se planteó fue cómo darles a los cuidadores suficiente tiempo para que le tengan confianza al terapeuta sin comprometer la seguridad y el desarrollo del niño. La esencia del trabajo terapéutico fue reducir los factores de riesgo e incrementar los factores de protección por medio de múltiples puertas de entrada.

Le travail complexe qui consiste à s'attaquer aux adversités intergénérationnelles comme la violence, la maltraitance et la négligence au travers de la psychothérapie périnatale est sous-étudié. On constate surtout la rareté d'études donnant la parole aux thérapeutes. Cette étude a exploré les processus thérapeutiques au travers des perspectives de sept thérapeutes norvégiens. Une approche qualitative a été choisie avec des entretiens individuels et un groupe d'étude de suivi. Des données ont été analysées en utilisant une analyse réflective thématique. Nous avons identifié un thème général: maintenir une capacité thérapeutique réflective et deux thèmes principaux avec des sous-thèmes liés: 1) le travail d'alliance quand un système attentif en arrive à la thérapie pour contrecarrer des générations d'adversités et 2) le travail thérapeutique complexe qui consiste à s'attaquer aux adversités intergénérationnelles en psychothérapie périnatale. Les résultats de cette étude ont indiqué que le maintien d'une position de réflexion est essentiel mais pose également un défi lorsqu'on on s'attaque aux adversités intergénérationnelles, exigeant un environnement thérapeutique soutenant pour les thérapeutes. Le principal véhicule de changement a été perçu comme une alliance thérapeutique étant assez sûre pour l'exploration de nouvelles façons d'être ensemble, en contraste avec des expériences précédentes. Une question clé qui a été soulevée était de comment donner aux personnes prenant soin des enfants assez de temps pour avoir confiance au thérapeute sans compromettre la sécurité et le développement de l'enfant. L'essence du travail thérapeutique a consisté à réduire les facteurs de risque et à accroître les facteurs protecteurs au travers de plusieurs ports d'entrée.

Clinical and Epidemiological Characteristics of Patients Being Treated for Scabies in Spain: Opportunities for Improvement - A Multicenter Cross-Sectional CLINI-AEDV Study. / Características clínicas y epidemiológicas de pacientes diagnosticados de escabiosis en España: oportunidades de mejora. Estudio transversal multicéntrico CLINI-AEDV.

BACKGROUND: Several studies support the hypothesis that scabies is on the rise in Spain. There are also concerns about the possible development of resistance to treatment and an increase in atypical presentations. The aims of this study were to describe the demographic and clinical characteristics of patients with scabies seen by dermatologists in Spain, to identify the possible emergence of atypical forms of scabies, and to explore the frequency of treatment failures and associated risk factors. METHODS: We conducted an observational, cross-sectional, multicenter study of data collected prospectively in April and May 2023 using the CLINI-AEDVp platform created by the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: Participating dermatologists from 31 hospitals in 15 of Spain's autonomous communities recorded 186 cases of active scabies (51% in women) during the study period. A diagnostic certainty level of A, B or C as per the International Alliance for the Control of Scabies Consensus Criteria was required for diagnosis. Overall, 92% of patients had typical scabies and 66% had already been treated with a scabicide for the current episode. Of the treated patients, only 36% had received and completed adequate treatment (including the simultaneous treatment of all household members) and 50% had not received clear written recommendations. CONCLUSIONS: In a high proportion of the cases of scabies studied, the patient had already received treatment. In those cases, we observed several remediable shortcomings that could explain why some of these treatments had failed. Remedying these deficiencies should lead to better control of scabies and an improved assessment of the actual effectiveness of currently available scabicides.

[Translated article] Clinical and Epidemiological Characteristics of Patients Being Treated for Scabies in Spain: Opportunities for Improvement - A Multicenter Cross-Sectional CLINI-AEDV Study.

BACKGROUND: Several studies support the hypothesis that scabies is on the rise in Spain. There are also concerns about the possible development of resistance to treatment and an increase in atypical presentations. The aims of this study were to describe the demographic and clinical characteristics of patients with scabies seen by dermatologists in Spain, to identify the possible emergence of atypical forms of scabies, and to explore the frequency of treatment failures and associated risk factors. METHODS: We conducted an observational, cross-sectional, multicenter study of data collected prospectively in April and May 2023 using the CLINI-AEDVp platform created by the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: Participating dermatologists from 31 hospitals in 15 of Spain's autonomous communities recorded 186 cases of active scabies (51% in women) during the study period. A diagnostic certainty level of A, B or C as per the International Alliance for the Control of Scabies Consensus Criteria was required for diagnosis. Overall, 92% of patients had clinical features of classic scabies and 66% had already been treated with a scabicide for the current episode. Of the treated patients, only 36% had received and completed adequate treatment (including the simultaneous treatment of all household members) and 50% had not received clear written recommendations. CONCLUSIONS: In a high proportion of scabies cases, the patient has already received treatment. In those cases, we observe several remediable shortcomings that could explain why some of these treatments fail. Remedying these deficiencies should lead to better control of scabies and an improved assessment of the actual effectiveness of currently available scabicides.

Long non-coding RNAs as modulators and therapeutic targets in non-alcoholic fatty liver disease (NAFLD).

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the world, with epidemiological studies indicating a 25% prevalence. NAFLD is considered to be a progressive disease that progresses from simple hepatic steatosis to non-alcoholic steatohepatitis (NASH), then to liver fibrosis, and finally to cirrhosis or hepatocellular carcinoma (HCC). Existing research has mostly elucidated the etiology of NAFLD, yet its particular molecular processes remain uncertain. Long non-coding RNAs (LncRNAs) have been linked in a wide range of biological processes in recent years, with the introduction of microarray and high-throughput sequencing technologies, and previous studies have established their tight relationship with several stages of NAFLD development. Existing studies have shown that lncRNAs can regulate the signaling pathways related to hepatic lipid metabolism, NASH, NASH-related fibrosis and HCC. This review aims to provide a basic overview of NAFLD and lncRNAs, summarize and describe the mechanisms of lncRNAs action involved in the development of NAFLD, and provide an outlook on the future of lncRNAs-based therapy for NAFLD.

Tofacitinib in the treatment of moderate to severe ulcerative colitis in Colombia: Real world experience. / Tofacitinib en el tratamiento de la colitis ulcerosa moderada a grave en Colombia: experiencia en mundo real.

INTRODUCTION: There are no studies on efficacy of tofacitinib for ulcerative colitis (UC) in Latin America. The aim of this study was to describe the efficacy and safety, in the real world, of patients with moderate-severe UC treated with tofacitinib in our setting. MATERIALS AND METHODS: Multicenter descriptive observational study, in patients with UC who received treatment with tofacitinib in induction phase for 8 weeks and then, maintenance therapy, between June 2019 and June 2022. RESULTS: Thirty-four adult patients, 50% female, mean age 38.1 (range 22-72) years. 76.5% pancolitis, and 20.6% left colitis. 79.4% failure to tumor necrosis factor inhibitors (anti-TNFs), and 35.3% to vedolizumab. 14.7% naïve to biologic therapy. 23.5% had previous extraintestinal manifestations. During induction, 58.8% of patients achieved clinical, biochemical and endoscopic remission. During maintenance, 76.9% of patients at 26 weeks and 66.6% at 52 weeks presented clinical remission. Eight patients presented adverse events, none of them cardiovascular or thromboembolic. 44.1% were steroid-dependent, and 23.5% required steroids as rescue therapy. 38.3% required an increase in tofacitinib to 10mg every 12h during maintenance. In 17.6% tofacitinib was discontinued due to lack of efficacy. We included three pediatric-aged female patients, mean age 15.3 (range 14-17) years, 2/3 with pancolitis and 1/3 with left colitis, all with prior exposure to biologic therapy, who had clinical, biologic and endoscopic remission at induction. CONCLUSIONS: In this first Latin American study with tofacitinib in UC, efficacy and safety are demonstrated in the treatment of our patients with moderate to severe activity.

Colombian experience with the use of tofacitinib in severe acute ulcerative colitis: A case series study. / Experiencia colombiana con el uso de tofacitinib en colitis ulcerosa aguda grave: estudio de serie de casos.

INTRODUCTION: Tofacitinib is indicated in patients with moderate to severe ulcerative colitis (UC); however, given its rapid onset of action, it may constitute an alternative in patients with hospitalized severe acute UC. There are few data on this indication in the literature. The aim of this study was to describe the efficacy and safety of tofacitinib in the management of patients with hospitalized UC, as well as its clinical characteristics and other treatment patterns. MATERIALS AND METHODS: Descriptive observational study of adults and children with CUAG treated with tofacitinib between June 2019 and December 2022 in Colombia. Sociodemographic and clinical variables were collected, therapeutic response was evaluated in different periods of time and descriptive analysis of quantitative and qualitative variables was performed. RESULTS: Six patients (five adults and one pediatric), mean age 33.2 (SD: 8.5) years, with CUAG. Symptom remission was obtained in 100% of patients at day 7 after tofacitinib initiation. In three patients information was obtained beyond 6 months, with 100% clinical, biochemical, and endoscopic remission and without requiring colectomy. In the case of the pediatric patient, symptom remission was achieved one week after starting tofacitinib, remaining in clinical, biochemical and endoscopic remission beyond 6 months. No serious adverse events were reported in any of the cases. CONCLUSIONS: Tofacitinib represents a rescue therapeutic alternative in CUAG, with rapid clinical response, adequate tolerance and less need for colectomy, being sustained for periods beyond 6 months.

Tofacitinib in the treatment of moderate to severe ulcerative colitis in Colombian pediatric patients: Real world experience. / Tofacitinib en el tratamiento de la colitis ulcerosa moderada a grave en pacientes pediátricos colombianos: experiencia en mundo real.

INTRODUCTION: There are no studies on efficacy of tofacitinib for moderate-severe ulcerative colitis (UC) in pediatric patients in Latin America. The aim of this study was to describe the efficacy and safety, in real world, treated with tofacitinib in our setting. MATERIALS AND METHODS: Case series of pediatric patients with UC who received treatment with tofacitinib in induction phase for 8 weeks and then maintenance therapy between November 2021 and February 2023. RESULTS: Four female patients, median age 14.5 (SD 2.1; RIQ 12.5-16.5) years, all with prior biologic exposure, all 4 with prior use of anti-TNF, and 2/4 with prior use of anti-integrin. Clinical, biochemical and endoscopic remission was obtained in 3/4 at induction. Information was obtained from 3 patients in 6-month maintenance, 2/3 remained in clinical, biochemical and endoscopic remission and 1/3 has not achieved biochemical or endoscopic remission. Information was obtained from 1 patient in 12-month maintenance, achieving clinical and biochemical remission, however, endoscopic remission has not been achieved. One patient was initiated for severe acute UC with risk of colectomy, with significant improvement after 7 days, reaching therapeutic objectives at induction. No serious adverse events were reported in any of the cases. CONCLUSIONS: Efficacy and safety are demonstrated with tofacitinib in pediatric patients. With high percentage of response in induction treatment, sustained over time, and safe. In the context of severe acute hospitalized UC, it has a role as a potential rescue therapy due to its rapid action.

Toward a broader understanding of split alliances in family therapy: Adding the therapist to the mix.

To broaden our understanding of a split alliance in family therapy, we investigated the frequencies and correlates of sessions in which therapists, youth, and caregivers reported markedly different perceptions of the alliance. The sample consisted of 156 Spanish families who received Alliance Empowerment Family Therapy (Escudero, Adolescentes y familias en conflicto, 2013) for child maltreatment. Family members and therapists rated the alliance on the SOFTA-s (Friedlander et al., Journal of Counseling Psychology, 2006, 53, 214) after sessions 3, 6, and 9; family members rated their perceptions of treatment progress before sessions 4, 7, and 10. A cluster analysis differentiated sessions with a split adult-youth alliance (27.7%) from a split family-therapist alliance (44.1%), and a balanced alliance (similar ratings across the three perspectives; 28.2%). Client-rated treatment progress was differentially associated with the type of alliance split and the average alliance rating, whereas better posttreatment outcomes (child functioning and family goal attainment) were associated with fewer sessions having either type of split alliance.

Con el fin de ampliar nuestros conocimientos de una alianza dividida en la terapia familiar, investigamos las frecuencias y las correlaciones de las sesiones en las cuales los terapeutas, los jóvenes y los cuidadores informaron percepciones marcadamente diferentes de la alianza. La muestra estuvo formada por 156 familias españolas que recibieron terapia familiar de empoderamiento y alianza (Escudero, 2013) para el maltrato infantil. Los miembros de la familia y los terapeutas calificaron la alianza en el SOATIF-s (Friedlander et al., 2006) después de las sesiones 3, 6 y 9; los familiares calificaron sus percepciones del avance del tratamiento antes de las sesiones 4, 7 y 10. Un análisis de agrupamiento diferenció las sesiones con una alianza dividida entre los adultos y los jóvenes (27.7 %) de una alianza dividida entre la familia y el terapeuta (44.1 %) y una alianza equilibrada (calificaciones similares entre las tres perspectivas; 28.2 %). El avance del tratamiento calificado por el paciente estuvo asociado diferencialmente con el tipo de alianza dividida y la calificación promedio de la alianza, mientras que los mejores resultados posteriores al tratamiento (el funcionamiento del niño y el logro de objetivos familiares) estuvieron asociados con menos sesiones que tenían cualquiera de los tipos de alianza dividida.

Therapist Adherence to Two Treatments for Adolescent Suicide Risk: Association to Outcomes and Role of Therapeutic Alliance.

In psychotherapy research, adherence refers to the extent to which therapists deliver a treatment as intended. This study examined whether therapist adherence to two different manualized treatments was associated with improved client outcomes and whether the association was moderated by therapeutic alliance. The study sample included 320 video recordings of therapy sessions from 118 cases in a randomized controlled trial (RCT) comparing attachment-based family therapy (ABFT) with family-enhanced nondirective supportive therapy (FE-NST). Recordings were selected from early, middle, and late stages of treatment. The adherence measure consisted of 24 items representing essential therapist interventions from both treatments. Trained raters coded tapes from both therapies. Adolescent self-report of alliance was measured at session 4. Adherence to ABFT was associated with a significant increase in family cohesion at mid-treatment but not at posttreatment. Adherence to FE-NST was significantly associated with an increase in suicide ideation posttreatment. Using therapeutic alliance as a moderator, adherence to ABFT was significantly associated with a reduction in suicide ideation, family conflict, and higher client satisfaction posttreatment. Alliance did not positively affect the association of FE-NST adherence to outcomes. Findings suggest that adherence to ABFT interventions may be better linked to treatment outcomes when adolescents feel a strong alliance with their therapist. Implications for future research and therapist training are explored.

En la investigación sobre psicoterapia, la adhesión se refiere al grado en el cual los terapeutas brindan un tratamiento según lo previsto. Este estudio analizó si la adhesión del terapeuta a dos tratamientos estandarizados diferentes estuvo asociada con mejores resultados en los pacientes y si la asociación estuvo moderada por la alianza terapéutica. La muestra del estudio incluyó 320 videograbaciones de sesiones de terapia de 118 casos en un ensayo aleatorizado controlado donde se comparó la terapia familiar basada en el apego (TFBA) con la terapia de apoyo no directiva optimizada por la familia (TAND-OF). Se eligieron grabaciones de las etapas iniciales, intermedias y finales del tratamiento. El instrumento de medición de la adhesión consistió en 24 ítems que representaban intervenciones esenciales del terapeuta de ambos tratamientos. Un grupo de calificadores capacitados codificaron las grabaciones de ambas terapias. El autoinforme de alianza de los adolescentes se midió en la cuarta sesión. La adhesión a la TFBA estuvo asociada con un aumento considerable de la cohesión familiar en la mitad del tratamiento, pero no después del tratamiento. La adhesión a la TAND-OF estuvo asociada considerablemente con un aumento de la ideación suicida después del tratamiento. Utilizando la alianza terapéutica como moderadora, la adhesión a la TFBA estuvo asociada considerablemente con una reducción de la ideación suicida, el conflicto familiar y una mayor satisfacción del paciente después del tratamiento. La alianza no afectó positivamente la asociación de la adhesión a la TAND-OF con los resultados. Los resultados sugieren que la adhesión a las intervenciones de TFBA puede asociarse mejor con los resultados del tratamiento cuando los adolescentes sienten una alianza fuerte con su terapeuta. Se analizan las implicancias para futuras investigaciones y para la capacitación de los terapeutas.

Impact of the lockdown period due to the COVID-19 pandemic in patients with inflammatory bowel disease.

INTRODUCTION: The lockdown period due to the coronavirus disease 2019 (COVID-19) in Spain probably had a significant emotional impact on chronic patients and hence on those who are suffering from inflammatory bowel disease (IBD) due to their high risk of emotional disorders. The aim of this study was to learn how COVID-19 influenced patients suffering from IBD during the quarantine period, focusing in particular on psychological distress through the Perceived Stress Scale-10 (PSS-10) and also the impact of the pandemic on therapeutic adherence using the Visual Analogue Scale (VAS). PATIENTS AND METHODS: A prospective, single-centre and analytical observational study was carried out in the IBD unit in August 2020. Patients were contacted and interviewed by phone. A descriptive analysis was carried out and subsequently the factors associated with the loss of therapeutic adherence and higher-moderate levels of stress were analyzed through logistic regression multivariate analyses. RESULTS: A total of 426 patients were included with a median PSS-10 score of 12 (10-16). A higher level of stress was reported by those who were not married, women and those who experienced an increase in IBD-related symptoms. Adherence to treatment was not associated with stress based on the PSS-10 questionnaire. CONCLUSIONS: Although the lockdown period due to the COVID-19 pandemic has probably had a significant emotional impact on Spaniards with IBD, IBD patients in general had lower PSS-10 scores.

[Health Professionals expectations' about the benefit of regular Primary Care interventions]. / Expectativas de los profesionales sanitarios sobre el beneficio obtenido por intervenciones habituales en atención primaria.

AIM: Examine the expectations expressed by healthcare professionals about the benefit of several primary prevention interventions that are usually carried out in The Primary Care Consultations with evidence from moderate-high validity studies. DESIGN: Descriptive Cross-sectional Study by Survey. SITTING: Spanish Primary Healthcare Centers, between February 6 and May 5, 2020. PARTICIPANTS: General Practitioner and other practicing Primary Care professionals. MAIN MEASUREMENTS: a) the number and percentage of participants whose estimate of benefit deviates from the benefit supported by the evidence; b) the magnitudes of OVERestimation, NORMOestimation and UNDERestimation of each participant and each professional subgroup. RESULTS: Of the 701 respondents (67% women), 694 answered all eight questions and 4 between one and seven. The overestimation of benefit in the 8 interventions ranged from 86% to 90% of all medical participants and between 90% and 96% of all nursing participants. CONCLUSIONS: Most of the surveyed (healthcare) professionals overestimate both, prevention activities and preventive treatments, this may lead them to instil false hope in patients, to put patients at risk of serious side effects arising from such interventions and to squander resources.

Relationship between the expression of complement inhibitory proteins and therapeutic efficacy of antibodies in breast cancer.

Complement regulatory proteins (mCRPs) CD55, CD46 and CD59 have been proposed as key elements in therapeutic resistance against cancer. mCRP-expressing tumor cells, in addition to hindering trastuzumab, pertuzumab and sacituzumab-govitecan therapeutic activity in breast cancer, can regulate biological processes that promote tumor progression. This review describes the structure of mCRPs and analyzes their expression using transcriptomic databases from breast cancer patients, in addition to collecting information on mCRPs interactions and signaling in tumor cells. Given that mCRPs are relevant targets, several strategies that have been explored for their inhibition and regulation in order to increase therapeutic efficacy and prevent cancer resistance and progression are described.

Se ha propuesto a las proteínas reguladoras de complemento (mCRP) CD55, CD46 y CD59 como piezas clave en la resistencia terapéutica contra el cáncer. Las células tumorales que expresan las mCRP, además de obstaculizar la actividad terapéutica de trastuzumab, pertuzumab y sacituzumab-govitecan en cáncer de mama, pueden regular procesos biológicos que promueven la progresión tumoral. Esta revisión describe la estructura de las mCRP y analiza su expresión a partir de bases de datos transcriptómicos de pacientes con cáncer de mama; también recopila información de interacciones y señalización de las mCRP en células tumorales. Dado que estas mCRP son dianas relevantes, se describen diversas estrategias para su inhibición y regulación para incrementar la eficacia terapéutica y evitar la resistencia y progresión del cáncer.

Measuring Perceptions of the Therapeutic Alliance in Individual, Family, and Group Therapy from a Systemic Perspective: Structural Validity of the SOFTA-s.

This study examined the multidimensional structure of the client and therapist versions of the self-report measure, System for Observing Family Therapy Alliances (SOFTA-s; Friedlander, Escudero, & Heatherington, Therapeutic alliances in couple and family therapy: An empirically informed guide to practice. Washington, DC: American Psychological Association, 2006) across three distinct therapeutic modalities (individual, family, group). Specifically, we investigated whether the originally theorized model of four first-order factors (Engagement in the Therapeutic Process, Emotional Connection with the Therapist, Safety within the Therapeutic System, and Shared Sense of Purpose within the Family) would be reflected in a second-order factor (Therapeutic Alliance). The sample included 105 therapists who worked with 858 clients (165 individuals, 233 families, and 43 groups) in several Spanish community agencies. To control for dependent data, we used multilevel modeling. Results of the multilevel confirmatory factor analyses showed adequate reliabilities, fit indices, and factor loadings across the three therapy contexts for both versions of the measure (client and therapist). Adequate measurement invariance was also found across respondents and therapy modalities. Taken together, these results support the structural validity of the SOFTA-s, a brief and flexible self-report alliance measure that can be used reliably in clinical practice as well as in studies of individual, family, and group therapy.

Este estudio examinó la estructura multidimensional de las versiones del paciente y del terapeuta de la herramienta de medición por autoinforme, "Sistema de Observación de Alianza Terapéutica en Intervención Familiar" (System for Observing Family Therapy Alliances, SOFTA-s; Friedlander, Escudero, & Heatherington, 2006) entre tres modalidades terapéuticas diferentes (individual, familiar, grupal). Específicamente, investigamos si el modelo teorizado originalmente de cuatro factores de primer orden (participación en el proceso terapéutico, conexión emocional con el terapeuta, seguridad dentro del sistema terapéutico y un objetivo en común dentro de la familia) se reflejaría en un factor de segundo orden (alianza terapéutica). La muestra consistió en 105 terapeutas que trabajaron con 858 pacientes (165 individuos, 233 familias y 43 grupos) en varios organismos de comunidades españolas. Para evaluar los datos dependientes, utilizamos el modelo multinivel. Los resultados de los análisis factoriales confirmatorios multinivel demostraron fiabilidades, índices de ajuste y cargas factoriales adecuadas entre los tres contextos de terapia para ambas versiones de la herramienta de medición (paciente y terapeuta). También se halló una invariancia de medición adecuada entre los encuestados y las modalidades de terapia. En conjunto, estos resultados respaldan la validez estructural del SOFTA-s, una herramienta de medición de la alianza breve y flexible por autoinforme que puede utilizarse de manera fiable en la práctica clínica, así como en estudios de la terapia individual, familiar y grupal. Este estudio examinó la estructura multidimensional de las versiones del paciente y del terapeuta de la herramienta de medición por autoinforme, "Sistema de Observación de Alianza Terapéutica en Intervención Familiar" (System for Observing Family Therapy Alliances, SOFTA-s; Friedlander, Escudero, & Heatherington, 2006) entre tres modalidades terapéuticas diferentes (individual, familiar, grupal). Específicamente, investigamos si el modelo teorizado originalmente de cuatro factores de primer orden (participación en el proceso terapéutico, conexión emocional con el terapeuta, seguridad dentro del sistema terapéutico y un objetivo en común dentro de la familia) se reflejaría en un factor de segundo orden (alianza terapéutica). La muestra consistió en 105 terapeutas que trabajaron con 858 pacientes (165 individuos, 233 familias y 43 grupos) en varios organismos de comunidades españolas. Para evaluar los datos dependientes, utilizamos el modelo multinivel. Los resultados de los análisis factoriales confirmatorios multinivel demostraron fiabilidades, índices de ajuste y cargas factoriales adecuadas entre los tres contextos de terapia para ambas versiones de la herramienta de medición (paciente y terapeuta). También se halló una invariancia de medición adecuada entre los encuestados y las modalidades de terapia. En conjunto, estos resultados respaldan la validez estructural del SOFTA-s, una herramienta de medición de la alianza breve y flexible por autoinforme que puede utilizarse de manera fiable en la práctica clínica, así como en estudios de la terapia individual, familiar y grupal.

Couple Satisfaction, Depressive Symptoms, and the Therapeutic Alliance: A Systemic Perspective.

There is a well-established bidirectional, negative association between couple satisfaction and depressive symptoms. Yet, a family systems perspective emphasizes the role of the therapist in interrupting this recursive cycle between couple satisfaction and depressive symptoms. The current study utilized longitudinal data to explore the bidirectional associations between depressive symptoms and couple satisfaction, moderated by the therapeutic alliance over the course of therapy. The study included 108 couples participating in couple therapy at a university training clinic. Couples rated their depressive symptoms and couple satisfaction separately before the intake session and at the end of the fourth session, and they also reported their individual therapeutic alliance with the therapist at the end of the second and third sessions. Actor-partner interdependence moderation model analysis revealed several moderation effects. In general, with low therapeutic alliance, couples with higher initial symptoms (such as depressive symptoms and low couple satisfaction) reported more severe symptoms at the fourth session, compared to those who had fewer initial symptoms. The moderating effect of alliance on a couple's symptoms was found both among individuals, and between partners. Systemic clinical implications and suggestions for future research are discussed.

Hay una asociación bidireccional y negativa firmemente establecida entre la satisfacción en la pareja y los síntomas depresivos. Sin embargo, la perspectiva de sistemas familiares enfatiza el papel que desempeña el terapeuta en la interrupción de este ciclo recurrente entre la satisfacción en la pareja y los síntomas depresivos. El presente estudio utilizó datos longitudinales para analizar las asociaciones bidireccionales entre los síntomas depresivos y la satisfacción en la pareja, moderadas por la alianza terapéutica durante el transcurso de la terapia. El estudio incluyó 108 parejas que participaron en terapia de pareja en una clínica universitaria de formación. Las parejas calificaron sus síntomas depresivos y la satisfacción en la pareja por separado antes de la sesión de ingreso y al final de la cuarta sesión, y también informaron su alianza terapéutica individual con el terapeuta al final de la segunda y la tercera sesión. El análisis del modelo de moderación de la interdependencia entre el actor y la pareja reveló varios efectos de la moderación. En general, con una alianza terapéutica baja, las parejas con síntomas iniciales más altos (como síntomas depresivos y baja satisfacción en la pareja) informaron síntomas más intensos en la cuarta sesión en comparación con aquellos que tenían menos síntomas iniciales. El efecto moderador de la alianza en los síntomas de la pareja se halló tanto entre las personas como entre las parejas. Se debaten las consecuencias clínicas sistémicas y las sugerencias para futuras investigaciones.

[Tinea capitis: clinical features and therapeutic alternatives]. / Tinea capitis: aspectos clínicos y alternativas terapéuticas.

A descriptive observational and cross-sectional study was carried out. The clinical characteristics, etiologic agents, treatments and outcome of 33 cases of tinea capitis in the Mycology Unit at Francisco J. Muñiz Hospital of Buenos Aires City between January 2015 and December 2019 were analyzed. The median age of the patients was 7 years, 21 of whom were male, 3 were HIV-positive and 22 had pets. The isolated etiologic agents were the following: Microsporum canis in 22 cases, Trichophyton tonsurans in 8, Nannizzia gypsea in 2 and Trichophyton mentagrophytes in one patient. Suppurative tinea capitis (krion Celsi) was detected in 10 cases and the same number of patients presented other skin locations of their dermatophytosis in addition to those in the scalp. Twenty-one cases were orally treated with griseofulvin and 12 with terbinafine. Those patients with suppurative tinea capitis received drops of betamethasone by mouth besides the antifungal drugs. All patients had good clinical and mycological response to the treatments, all lesions disappeared, and mycological studies turned negative by the end of the treatments. We conclude that both drugs were effective for the treatment of tinea capitis; however, lesions in those cases receiving terbinafine involuted more slowly.

[Mobile applications to improve drug adherence: Review and quality analysis]. / Aplicaciones móviles para mejorar la adherencia a la medicación: revisión y análisis de calidad.

OBJECTIVE: To review the mobile apps in the Spanish market to improve adherence to medications and evaluate their characteristics and quality to identify high-quality applications. METHOD: A review was carried out following a stepwise procedure similar to a systematic review of the scientific literature. Apple Apps Store and Google Play Store mobile application digital distribution platforms. Applications aimed at supporting self-management of treatment, which generate reminders, in Spanish, updated in the last 2 years and free. We evaluate the applications according to a set of characteristics considered desirable and the quality with the Mobile App Rating Scale tool. RESULTS: Out of 708 applications, 3 applications were selected. The Medisafe and Mytherapy applications had 89% and 78% of the desirable characteristics, respectively. Sergio Licea's application only had 56%. The highest global quality score was obtained by the MyTherapy application (3.79/5, IQR: 3-4), followed by Medisafe (3.72/5, (IQR: 3-4) and, finally, Sergio Licea (2.87/5, IQR: 2-4). The quality assessment coincides with the user assessment. There are many available applications, however, most did not meet the selection criteria. CONCLUSIONS: A systematic stepwise process was able to identify the quality application to be tested in a future study that will provide evidence on the use of a multicomponent intervention to improve medication adherence.

Validation and psychometric properties of the 8-item Morisky Medication Adherence Scale (MMAS-8) in type 2 diabetes patients in Spain.

AIMS: To validate a translated and culturally adapted version of the Morisky Medication Adherence Scale for use in Spanish population, and to examine the psychometric properties of this scale in patients with type 2 diabetes mellitus in Spain. DESIGN: This cross-sectional study was conducted in a single university hospital in Spain. Patients diagnosed with type 2 diabetes mellitus at least 1 year before inclusion, being treated with anti-diabetic medication were included. INTERVENTION: We used the Spanish version of the scale to measure treatment adherence. PRINCIPAL MEASUREMENTS: three level categorical scale is broken down into low adherence (score of <6), medium adherence (score of 6 to <8) and high adherence (score of 8). To validate the questionnaire, we measured internal consistency through Cronbach's α, confirmed construct validity through an exploratory principal component analysis and assessed test-retest reliability. RESULTS: 232 patients met the inclusion criteria. The Cronbach's α coefficient was 0.40 (95% CI 0.28-0.52). The exploratory principal component analysis showed three components. The intraclass correlation coefficient was 0.718 (95% CI 0.564-0.823). CONCLUSIONS: the Spanish version of the Morisky Medication Adherence scale showed low internal consistency, the exploratory factor analysis identified three dimensions, and the test-retest reliability was acceptable, therefore, psychometric properties of MMAS-8 are not suitable for measuring medication adherence in type 2 diabetes mellitus patients from Spain.

[Introduction of rapid streptococcal antigen test: can its use improve adherence to antibiotic therapy?] / Implantación de una prueba rápida de infección estreptocócica: ¿su uso también mejora la adherencia antibiótica?

OBJECTIVE: To evaluate the influence of the result of a rapid streptococcal antigen test in paediatric pharyngotonsillitis infections, in terms of improvement of antibiotic therapy adherence. DESIGN: Randomized community clinical trial with two study groups. LOCATION: Primary Care Centers in Central Catalonia. PARTICIPANTS: Patients aged from 3 to 15 years, who were attended at paediatric consultations on suspicion of pharyngotonsillitis caused by an infection between November 2010 and February 2011 (both included), were included in the study on a consecutive basis. 557 patients met the inclusion criteria and 519 were evaluated. INTERVENTION: The control group received the usual diagnostic-therapeutic algorithm. Rapid streptococcal antigen test was additionally performed to experimental group participants and it was indicated the more convenient treatment. MAIN MEASUREMENTS: Antibiotic adherence, non-adherence causes and socio-demographic risk factors were evaluated via telephone survey. RESULTS: Antibiotics were prescribed to 65.6% and paediatricians of the control group were more likely to prescribe antibiotic than the ones in the intervention group (88.5% vs 45.5%, p< 0.0001). 64.8% followed doctor's treatment orders, being failure following medication scheduling the main cause of non-adherence (25.6%). Medication adherence was higher in the experimental group (68%) than in the control group (62.9%) but no significant differences were found. CONCLUSION: Rapid strep test, complementing the use of Centor Criteria avoids unnecessary antibiotics prescriptions, but had not been proven to be effective in increasing medication adherence.

Therapeutic Utility of Discussing Therapist/Client Intersectionality in Treatment: When and How?

The impact of the therapeutic alliance on positive clinical outcomes has been established in the literature; however, literature is lacking on how the intersection of therapist and client identities influences this process. We propose that the relational intersectionality resulting from similarities or differences in therapist and client identities has the potential to impact the bonds, tasks, and goals of treatment (key components of the therapeutic alliance; Bordin, 1979) depending on how it is addressed or avoided in therapy. In this paper, we present a model containing pragmatic steps therapists can follow to navigate these conversations with clients in a way that is therapeutically beneficial and culturally sensitive and attuned. Additionally, we provide suggestions for using the proposed model to train new student therapists (or expose experienced therapists) to ideas of intersectionality and social justice by reflecting on the intersection of their own identities, acknowledging dynamics of power and oppression, and understanding how this could shape their relationship with clients.

En la bibliografía se ha establecido el efecto que tiene la alianza terapéutica en los resultados clínicos positivos; sin embargo, existe escasa bibliografía sobre cómo la intersección de las identidades del terapeuta y del paciente influye en este proceso. Proponemos que la interseccionalidad relacional resultante de las similitudes o las diferencias en las identidades del terapeuta y del paciente tiene posibilidades de influir en los vínculos, las tareas y los objetivos del tratamiento (componentes clave de la alianza terapéutica; Bordin, 1979) según como se aborde o se evada en la terapia. En este artículo presentamos un modelo que contiene pasos pragmáticos que los terapeutas pueden seguir para orientar estas conversaciones con los pacientes de una manera que sea beneficiosa a nivel terapéutico y que esté adaptada a las particularidades culturales y las tenga en cuenta. Además, ofrecemos sugerencias para usar el modelo propuesto a fin de capacitar a nuevos estudiantes de terapia, o para exponer a terapeutas experimentados, a ideas de interseccionalidad y justicia social mediante la reflexión sobre la intersección de sus propias identidades, el reconocimiento de la dinámica de poder y opresión y la comprensión de cómo esto podría moldear su relación con los pacientes.