New psychological therapies for irritable bowel syndrome: mindfulness, acceptance and commitment therapy (ACT).

The current goal of treatment in irritable bowel syndrome (IBS) focuses primarily on symptom management and attempts to improve quality of life. Several treatments are at the disposal of physicians; lifestyle and dietary management, pharmacological treatments and psychological interventions are the most used and recommended. Psychological treatments have been proposed as viable alternatives or compliments to existing care models. Most forms of psychological therapies studied have been shown to be helpful in reducing symptoms and in improving the psychological component of anxiety/depression and health-related quality of life. According to current NICE/NHS guidelines, physicians should consider referral for psychological treatment in patients who do not respond to pharmacotherapy for a period of 12 months and develop a continuing symptom profile (described as refractory irritable bowel syndrome). Cognitive behavioral therapy (CBT) is the best studied treatment and seems to be the most promising therapeutic approach. However, some studies have challenged the effectiveness of this therapy for irritable bowel syndrome. One study concluded that cognitive behavioral therapy is no more effective than placebo attention control condition and another study showed that the beneficial effects wane after six months of follow-up. A review of mind/body approaches to irritable bowel syndrome has therefore suggested that alternate strategies targeting mechanisms other than thought content change might be helpful, specifically mindfulness and acceptance-based approaches. In this article we review these new psychological treatment approaches in an attempt to raise awareness of alternative treatments to gastroenterologists that treat this clinical syndrome.

Self-quitting in a Spanish sample. An exploratory study. / Autoabandono del tabaco en una muestra española. Un estudio exploratorio.

Letter to the editor.

Se pretende realizar con el presente estudio, un análisis exploratorio de variables que puedan ayudar a explicar el éxito o fracaso en cesación tabáquica mediante autoabandono. El presente estudio obtuvo el informe favorable de la Comisión de Bioética de la Universidad de Almería, cuyo número de referencia es UALBIO2011/025. Los participantes del estudio se consiguieron mediante anuncios en prensa y radio y centros de salud, se les realizó una entrevista dirigida al registro de distintas variables relacionadas con el consumo de tabaco, edad de inicio, edad de abandono, años de uso del tabaco, número de cigarrillos al día y dependencia nicotínica.

Values in nursing students and professionals: An exploratory comparative study.

BACKGROUND: Many studies have explored personal values in nursing, but none has assessed whether the predictions made by the theory of intergenerational value change are true for the different generations of nursing professionals and students. This theory predicts a shift in those personal values held by younger generations towards ones focussed on self-expression. RESEARCH QUESTION: The purpose of the study was to identify intergenerational differences in personal values among nursing professionals and nursing students and to determine whether generational value profiles fit the predictions made by the theory. RESEARCH DESIGN: An exploratory comparative design with a cross-sectional survey method was used. PARTICIPANTS AND RESEARCH CONTEXT: Participants were recruited from four public hospitals and 10 Primary Care Centres in medium-size cities in Spain. A sample of 589 nurses and 2295 nursing students participated in the study. An open survey method was used to collect data that were classified grouping reported values into categories following a method of value lexicon construction and analysed by contingency tables with Pearson's χ (2) and standardized residuals. ETHICAL CONSIDERATIONS: Approval to conduct the study was obtained from the Deans of the nursing schools and the Directors of Nursing of the institutions. Anonymity was guaranteed, participation was voluntary and participants were informed of the purpose of the study. FINDINGS: The results can be synthesized in two age-related trends in the reporting of values among three groups of participants. First, among younger nurses and students, some nursing core values (e.g. ethical and professional) decreased in importance, while other values centred on social relationships and personal well-being increased. DISCUSSION AND CONCLUSION: This study shows intergenerational change in personal values among both nursing students and young nursing professionals. Findings suggest the need to pay more attention to value training and professional socialization during the schooling period.

Aplicación de un programa de mejora de la adherencia en pacientes hipertensos debutantes.

OBJECTIVE: To test the effectiveness of a program to improve treatment adherence in new onset hypertensive patients. DESIGN: This is a quasi-experimental study. LOCATION: Four health centers in Almeria. PARTICIPANTS: A total of 120 subjects between 18 and 65 years, diagnosed with hypertension within the previous 12 months. MAIN MEASUREMENTS: The participants were divided into three groups: intervention group A, which received educational instruction, intervention group B, educational instruction and feedback process, and the control group C, received usual care. Adherence was determined by lifestyle (diet, physical activity, smoking, alcohol) and drug treatment. RESULTS: As regards diet and physical activity, there were significant differences between performance groups after intervention (p<0,05), with better adherence levels being found in group B subjects for these variables. Better adherence to pharmacological treatment was also observed in these patients. No significant results were found regarding alcohol and smoking. CONCLUSIONS: In the study population, patients undergoing educational instruction and feedback had better adherence levels than those who received only instruction or usual treatment.

Homogeneity and Thermal Stability of Sputtered Al0.7Sc0.3N Thin Films.

This work presents a study on the homogeneity and thermal stability of Al0.7Sc0.3N films sputtered from Al-Sc segmented targets. The films are sputtered on Si substrates to assess their structural properties and on SiO2/Mo-based stacked acoustic mirrors to derive their piezoelectric activity from the frequency response of acoustic resonators. Post-deposition annealing at temperatures up to 700 °C in a vacuum are carried out to test the stability of the Al0.7Sc0.3N films and their suitability to operate at high temperatures. Despite the relatively constant radial composition of the films revealed from RBS measurements, a severe inhomogeneity in the piezoelectric activity is observed across the wafer, with significantly poorer activity in the central zone. RBS combined with NRA analysis shows that the zones of lower piezoelectric activity are likely to show higher surface oxygen adsorption, which is attributed to higher ion bombardment during the deposition process, leading to films with poorer crystalline structures. AFM analysis reveals that the worsening of the material properties in the central area is also accompanied by an increased roughness. XRD analysis also supports this hypothesis, even suggesting the possibility of a ScN non-piezoelectric phase coexisting with the AlScN piezoelectric phase. Thermal treatments do not result in great improvements in terms of piezoelectric activity and crystalline structure.

A novel approach for venous occlusion after endocavitary leads. The balloon-assisted tracking technique.

The balloon-assisted tracking technique can be useful in short venous occlusions that conventional venoplasty fails. This technique could be feasible and with an expected low complication rate.

Drinking motives among Spanish and Hungarian young adults: a cross-national study.

AIMS: To investigate differences and similarities in college students' drinking motives in Spain and in Hungary. METHODS: A total of 550 Spanish (mean age 22.7, SD = 3.2) and 997 Hungarian (mean age 22.4, SD = 2.7) college students completed the Drinking Motive Questionnaire Revised Short Form (DMQ-R SF) and answered other alcohol-related questions. Data were analyzed by confirmatory factor analysis, t-test and structural equation modeling. RESULTS: The DMQ-R SF demonstrated good psychometric properties in both countries. The rank order of the motives (social > enhancement > coping > conformity) was identical in the two countries. However, Hungarian students scored higher on enhancement, social and coping motives than Spanish students. In both the Hungarian and the Spanish population, enhancement motives were associated with drinking frequency and drunkenness, while coping motives were associated with alcohol-related problems. Among Spanish students, a significant relationship was found between alcohol-related problems and enhancement motives as well. CONCLUSION: Despite the substantial differences in the drinking culture of both countries, drinking motives showed overwhelming similarities (e.g. rank order of motives and the particular relationships between motives and alcohol outcomes). Only few differences (e.g. Hungarian college students indicated a higher level of motives) were found in cross-national comparison. Our results imply that programs targeting risky drinking motives are likely to be successfully adapted to different drinking cultures in Europe.

[Brain abscess due to Nocardia sp. In an immunocompetent patient in Peru: a case report]. / Absceso cerebral por Nocardia sp. En un paciente inmunocompetente en el Perú: reporte de caso.

Cerebral nocardia infections is a rare entity, which has been mainly reported in immunosuppressed patients. Currently, there are no clinical guidelines for first-line treatment. Our case refers to an older immunocompetent adult, with encephalopathy and left hemiparesis, associated with lesions compatible with multiple brain abscess and suggestive of infectious etiology. He initially received treatment for tuberculosis, bacterial abscess, and toxoplasmosis, without a favorable clinical response. An empirical treatment for nocardiosis started, by using meropenem and trimethoprim / sulfamethoxazole, and clinical and imaging improvement was achieved. The occurrence of adverse events forces the temporary use of alternative medications. We highlight some criteria for including nocardiosis in the differential diagnosis in cases of multiple brain abscess and mention laboratory diagnostic methods and drugs to initiate empirical treatment.

La nocardiosis cerebral es una entidad rara que ha sido reportada principalmente en inmunosuprimidos, y en la actualidad no se dispone de guías clínicas que recomienden un tratamiento de primera línea. Presentamos el caso de un adulto mayor, inmunocompetente, con cuadro de encefalopatía y hemiparesia izquierda, asociado a lesiones compatibles con absceso cerebral múltiple y sugerente de etiología infecciosa. Recibió, inicialmente, tratamiento para la tuberculosis, absceso bacteriano y toxoplasmosis, sin respuesta clínica favorable. Se inició un tratamiento empírico para la nocardiosis con meropenem y trimetoprim/sulfametoxazol, y se logró mejoría clínica e imagenológica. La ocurrencia de eventos adversos obliga el uso temporal de medicamentos alternativos. Se resaltan algunos criterios a considerar para incluir la nocardiosis en el diagnóstico diferencial en los casos de absceso cerebral múltiple y se mencionan los métodos diagnósticos de laboratorio y los fármacos para iniciar un tratamiento empírico.

Virtual reality on mobile phones to reduce anxiety in outpatient surgery.

When undergo ambulatory surgical operations, the majority of patients experience high level of anxiety. Different experimental studies have shown that distraction techniques are effective in reducing pain and related anxiety. Since Virtual reality (VR) has been demonstrated a good distraction technique, it has been repeatedly used in hospital contexts for reducing pain in burned patients, but it has never been used during surgical operations. With the present randomized controlled study we intended to verify the effectiveness of VR in reducing anxiety in patients undergoing ambulatory operations under local or regional anaesthesia. In particular, we measured the degree to which anxiety associated with surgical intervention was reduced by distracting patients with immersive VR provided through a cell phone connected to an HMD compared to a no-distraction control condition. A significant reduction of anxiety was obtained after 45 minutes of operation in the VR group, but not in the control group and, after 90 minutes, the reduction was larger in the experimental group than in other one. In conclusion, this study presents an innovative promising technique to reduce anxiety during surgical interventions, even if more studies are necessary to investigate its effectiveness in other kinds of operations and in larger numbers of patients.

Cyborg mini-trainer.

We present the smallest surgical trainer with a total weight of 400 gr, built in aluminum of 25 cm large and 24 cm wide, and 23 cm high. It's a system integrated by a small and open module, a lamp and a microcamera connected to a Head Mounted display. It holds two endoscopic instruments, and items to make knots or sutures and enhance visual-motor coordination. The vision we got is by a small microcamera displayed to a Head Mounted Display HMD. This surgical trainer is the smallest in the worldwide, easy to install, and easy to carry.

[An exploratory study on the development of beliefs about symptoms as signals of arterial hypertension]. / Un estudio exploratorio sobre el desarrollo de creencias sobre síntomas como señales de hipertensión arterial.

An exploratory study on the development of beliefs about symptoms as signals of arterial hypertension. In spite of hypertension is known as an asymptomatic health problem, most of the people with such a diagnosis are convinced of experiencing very specific symptoms associated to specific changes in blood pressure (BP). In addition, such beliefs may affect treatment adherence. Previous studies have shown that hypertensive patients use the information they considered right about BP symptoms to regulate the type of decisions they follow in adhering to treatment. The aim of this study is to explore specific variables related with the formation of beliefs about symptoms in a sample of 171 hypertensive patients. Results show that 81,3% of the patients perceived specific symptoms related to changes in hypertension as well as that variables related with the development of these beliefs were mostly: (1) the presence of symptoms during the diagnosis process, (2) the occurrence of hypertensive crisis, and (3) the information provided by others concerning the relationships between symptoms and BP changes. The importance of paying attention to the beliefs of specific symptoms as well as to the circumstances related with the formation process of such beliefs is discussed.

Tensión individualismo-gregarismo en la configuración psicológica del ser humano, I: apuntes sobre el surgimiento y las variaciones históricas del yo / Individualism-Gregariousness Tension in the Psychological Configuration of the Human Being, I: Notes on the Emergence and Historical Variations of the Self

This article presents the idea of articulating the concepts of individualism and gregariousness as two elements in tension in the psychological configuration of human beings, and the historical variations in self-configurations. The essay explores the genesis and evolution of the archetypes of the self developed in the different historical contexts throughout the history of humanity. This analysis connects with the functional and contextual perspective facilitating an inclusive vision of the behavioral repertoires that are articulated through the concepts of individualism, gregariousness, and the self. The main characteristics of the two groups of self-configurations emerged throughout the history of the human being are described: archetypes of gregarious selves, and archetypes of individualistic selves. Differentiating three individualistic archetypes such as romantic self, modernist self, and postmodernist self (AU)

Absceso cerebral por Nocardia sp. En un paciente inmunocompetente en el Perú: reporte de caso / Brain abscess due to Nocardia sp. In an immunocompetent patient in Peru: a case report

RESUMEN La nocardiosis cerebral es una entidad rara que ha sido reportada principalmente en inmunosuprimidos, y en la actualidad no se dispone de guías clínicas que recomienden un tratamiento de primera línea. Presentamos el caso de un adulto mayor, inmunocompetente, con cuadro de encefalopatía y hemiparesia izquierda, asociado a lesiones compatibles con absceso cerebral múltiple y sugerente de etiología infecciosa. Recibió, inicialmente, tratamiento para la tuberculosis, absceso bacteriano y toxoplasmosis, sin respuesta clínica favorable. Se inició un tratamiento empírico para la nocardiosis con meropenem y trimetoprim/sulfametoxazol, y se logró mejoría clínica e imagenológica. La ocurrencia de eventos adversos obliga el uso temporal de medicamentos alternativos. Se resaltan algunos criterios a considerar para incluir la nocardiosis en el diagnóstico diferencial en los casos de absceso cerebral múltiple y se mencionan los métodos diagnósticos de laboratorio y los fármacos para iniciar un tratamiento empírico.

ABSTRACT Cerebral nocardia infections is a rare entity, which has been mainly reported in immunosuppressed patients. Currently, there are no clinical guidelines for first-line treatment. Our case refers to an older immunocompetent adult, with encephalopathy and left hemiparesis, associated with lesions compatible with multiple brain abscess and suggestive of infectious etiology. He initially received treatment for tuberculosis, bacterial abscess, and toxoplasmosis, without a favorable clinical response. An empirical treatment for nocardiosis started, by using meropenem and trimethoprim / sulfamethoxazole, and clinical and imaging improvement was achieved. The occurrence of adverse events forces the temporary use of alternative medications. We highlight some criteria for including nocardiosis in the differential diagnosis in cases of multiple brain abscess and mention laboratory diagnostic methods and drugs to initiate empirical treatment.

A longitudinal study of symptoms beliefs in hypertension.

A longitudinal study was conducted to assess the presence of beliefs about symptoms related to hypertension and the time since diagnosis in which they appear. A randomly selected sample of hypertensive patients (67% women, mean age 53.27 years and range 20-65) was divided into four groups according to the time from diagnosis. All patients (N = 171) were interviewed at the beginning (initial assessment) and 12 months later (final assessment) and the patients (n = 75) who did not report beliefs about symptoms at the initial assessment were interviewed in a follow-up schedule. The results showed that 56% of patients reported beliefs about symptoms at the initial assessment, and this percentage increased to 77% at the final assessment (p < .001) finding significant differences between the two groups with a more recent diagnosis and the two groups of long-standing patients. Longitudinal analysis of the group with the recent diagnosis showed that the critical period for the emergence of beliefs was the first year from diagnosis. This period could be decisive in order to prevent them. Healthcare professionals should pay attention to the emergence of these beliefs, as they could negatively affect treatment adherence.

Se realizó un estudio para evaluar creencias sobre síntomas relacionados con la hipertensión y el tiempo transcurrido desde el diagnóstico. Una muestra elegida al azar de pacientes con hipertensión (media de edad 53,27 años, rango 20-65; 67% mujeres) se dividió en cuatro grupos de acuerdo al tiempo transcurrido desde el diagnóstico. Se entrevistó a todos los pacientes (N = 171) al comienzo del estudio (evaluación inicial) y 12 meses después (evaluación final). A los pacientes que no informaron creencias en síntomas (n = 75) se les entrevistó cada tres meses de acuerdo a un programa de seguimiento. Los resultados indicaron que en la evaluación inicial el 56% de los pacientes informó creencias en síntomas, elevándose al 77% en la evaluación final (p < .001), y diferencias significativas entre los grupos con menor y mayor tiempo desde el diagnóstico. El análisis longitudinal del grupo de pacientes de reciente diagnóstico mostró que el primer año es el período crítico para la emergencia de creencias en síntomas, información que resulta clave para planear la prevención. Los profesionales de la salud deberían prestar atención a la emergencia de creencias en síntomas dado que pueden afectar negativamente a la adherencia al tratamiento.

Accuracy in discriminating blood glucose levels in a sample of children with type 1 diabetes.

The present study explores accuracy in estimating blood glucose levels (BGL) in children with type 1 diabetes and analyzes the kinds of symptoms and cues which they use to estimate their BGL. Forty two children with type 1 diabetes completed a SI/IC-3 scale consisting of 28 items (22 symptoms and 6 feelings), indicating those which they perceived at the time and their intensity. They estimated their BGL and gave reasons for their estimation, before having a blood glucose level analysis performed. The results indicated great variability in the accuracy of estimating BGL. They showed failures in the correct discrimination of symptoms of hypoglycemia as well as the presence of false beliefs regarding indicative symptoms of hyperglycemia, and the absence of symptoms as an indicator for euglycemia, beliefs which provoke different and frequent errors in the estimation of BGL. Correct use of external signs is shown to be related to correct estimations of normal BGL, as well as hypoglycemia and hyperglycemia. We discuss the implications these results could have on designing psychological intervention procedures for diabetics in the form of training programs to discriminate BGL accurately, taking into account these findings and previous studies completed in the same field.

Aproximación contextual-funcional a la psicopatía: análisis de casos / A functional-contextual approach to psychopathy: Cases Analysis

No disponible

This paper proposes a functional interpretation of psychopathic behavior as an alternative to formal attempts to explain this rare, complex and, dangerous pattern of behaviors. First of all, the contextual-functional approach is briefly summarized. In second place, four well-known historical cases of psychopathy are briefly described and analyzed. According to a functional approach, the key issues are the contingencies occurring in the personal histories of such individuals as well as the derived transformation of functions that established such rare and dangerous pattern of behavior regulation. A brief analysis is made of the cognitive and emotional characteristics traditionally predicated as exclusive of psychopathy (as lack of empathy, emotional responsiveness, impulsivity, the need of power, etcetera) that sets the stage for an interpretative analysis about the conditions that might be involved in the emergence and expansion of the behaviors typically categorized with the psychopathic label. This analysis focuses on the personal history and describes the confluence of conditions that form thoughts/beliefs about oneself and the others, that establishes as dominant reinforcers obtaining immediate pleasure and escaping aversive funtions as well as feeling unlimited power upon others. This analysis might indicate that the exceptionality of psychopathy migth lie on the occurrence of very extreme specific and unusual conditions and the non-occurrence of those conditions that might prevent the building of repertoires as those described in psychopathy. Therefore, the functional-contextual interpretation characterizes psychopaths persons not as having specific differences in their brains or having difficulties for the formation of adaptive cognitive functioning and behavior regulation, to give account for their psychopatic behavior

Efectos del cambio a café filtrado sobre los niveles séricos de colesterol / A reversal study on the effects of change to filtered coffee on serum cholesterol levels

No disponible

Unfiltered coffee consumption has been associated to the increase in serum cholesterol levels. The aim of this population study was to verify if the change in the type of coffee consumed from unfiltered to filtered produces effects on the serum cholesterol levels of the participants. The sample was formed of 30 volunteers (9 men) with no health problems (age range= 18-47; average= 28.2; SD= 8.8). The study was structured according to an A-B-A reversible design with simultaneous replications between subjects. During the Baseline and Reversion phases (A), participants consumed unfiltered coffee in their usual way, while in the Intervention Phase (B) they consumed only filtered coffee. Participants were divided into two subgroups according to their serum level of cholesterol LDL at Baseline Phase (resulting in a subgroup formed by 16 participants with LDL <115 mg/dL, and a subgroup formed by 14 participants with LDL ≥115 mg/dL). Results indicated that 90% of participants showed decrease in their serum cholesterol LDL level at the end of the Intervention Phase contingent to coffee change with an increase in their serum cholesterol LDL level at the end of the Reversion Phase when they returned to consuming unfiltered coffee. Also a change in serum cholesterol HDL level was shown by 93% of participants, with an increase in serum cholesterol HDL level contingent on the change to filtered coffee and a decrease when they return to consume unfiltered coffee. The implications of these findings and the limitations of the study are discussed