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Flaquer-Galmés R, Campos D, Méndez V. Intermittent random walks under stochastic resetting. Phys Rev E 2024; 109:034103. [PMID: 38632743 DOI: 10.1103/physreve.109.034103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/06/2024] [Indexed: 04/19/2024]
Abstract
We analyze a one-dimensional intermittent random walk on an unbounded domain in the presence of stochastic resetting. In this process, the walker alternates between local intensive search, diffusion, and rapid ballistic relocations in which it does not react to the target. We demonstrate that Poissonian resetting leads to the existence of a non-equilibrium steady state. We calculate the distribution of the first arrival time to a target along with its mean and show the existence of an optimal reset rate. In particular, we prove that the initial condition of the walker, i.e., either starting diffusely or relocating, can significantly affect the long-time properties of the search process. Moreover, we demonstrate the presence of distinct parameter regimes for the global optimization of the mean first arrival time when ballistic and diffusive movements are in direct competition.
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Affiliation(s)
- Rosa Flaquer-Galmés
- Grupo de Física Estadística, Departament de Física, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Daniel Campos
- Grupo de Física Estadística, Departament de Física, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Vicenç Méndez
- Grupo de Física Estadística, Departament de Física, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Li G, Li Y, Lam AIF, Tang W, Seedat S, Barbui C, Papola D, Panter-Brick C, Waerden JVD, Bryant R, Mittendorfer-Rutz E, Gémes K, Purba FD, Setyowibowo H, Pinucci I, Palantza C, Acarturk C, Kurt G, Tarsitani L, Morina N, Burchert S, Patanè M, Quero S, Campos D, Huizink AC, Fuhr DC, Spiller T, Sijbrandij M, Hall BJ. Understanding the protective effect of social support on depression symptomatology from a longitudinal network perspective. BMJ Ment Health 2023; 26:e300802. [PMID: 38030405 PMCID: PMC10689368 DOI: 10.1136/bmjment-2023-300802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Higher social support protects people from developing mental disorders. Limited evidence is available on the mechanism through which social support plays this protective role. OBJECTIVE To investigate the stress-buffering process of social support on depressive symptoms using a novel longitudinal dynamic symptom network approach. METHODS A total of 4242 adult participants who completed the first two waves (from May to October 2020) of the International Covid Mental Health Survey were included in the study. Cross-lagged panel network modelling was used to estimate a longitudinal network of self-reported social support, loneliness and depressive symptoms. Standardised regression coefficients from regularised cross-lagged regressions were estimated as edge weights of the network. FINDINGS The results support a unidirectional protective effect of social support on key depressive symptoms, partly mediated through loneliness: A higher number of close confidants and accessible practical help was associated with decreased anhedonia (weight=-0.033) and negative self-appraisal symptoms (weight=-0.038). Support from others was also negatively associated with loneliness, which in turn associated with decreased depressed mood (weight=0.086) and negative self-appraisal (weight=0.077). We identified a greater number of direct relationships from social support to depressive symptoms among men compared with women. Also, the edge weights from social support to depression were generally stronger in the men's network. CONCLUSIONS Reductions in negative self-appraisal might function as a bridge between social support and other depressive symptoms, and, thus, it may have amplified the protective effect of social support. Men appear to benefit more from social support than women. CLINICAL IMPLICATIONS Building community-based support networks to deliver practical support, and loneliness reduction components are critical for depression prevention interventions after stressful experiences.
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Affiliation(s)
- Gen Li
- Center for Global Health Equity, New York University Shanghai, Shanghai, China
| | - Yifan Li
- Center for Global Health Equity, New York University Shanghai, Shanghai, China
| | - Agnes Iok Fong Lam
- Centre for Macau Studies, University of Macau, Macau, China
- Department of Communications, University of Macau, Macao, China
| | - Weiming Tang
- Center for Global Health Equity, New York University Shanghai, Shanghai, China
- University of North Carolina Project-China, Guangzhou, China
| | - Soraya Seedat
- SAMRC Genomics of Brain Disorders Research Unit, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, UK
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Judith van der Waerden
- Institut Pierre Louis d'Épidémiologie et de Santé Publique (iPLesp), Sorbonne Université and INSERM, Paris, Île-de- France, France
| | - Richard Bryant
- School of Psychology, UNSW, Sydney, New South Wales, Australia
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Katalin Gémes
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Fredrick D Purba
- Faculty of Psychology, Universitas Padjadjaran, Bandung, Indonesia
| | - Hari Setyowibowo
- Faculty of Psychology, Universitas Padjadjaran, Bandung, Indonesia
| | - Irene Pinucci
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Christina Palantza
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Ceren Acarturk
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Gülşah Kurt
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian Burchert
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Martina Patanè
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castello de la Plana, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
| | - Daniel Campos
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Anja C Huizink
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Daniela C Fuhr
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Tobias Spiller
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health research institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Brian J Hall
- Center for Global Health Equity, New York University Shanghai, Shanghai, China
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Llauradó A, Quintana M, Fonseca E, Abraira L, Toledo M, Requena M, Olivé M, Ballvé A, Campos D, Sueiras M, Santamarina E. Implications of starting antiepileptic treatment prior to electroencephalography in first epileptic seizures. Neurologia 2023; 38:647-652. [PMID: 37858895 DOI: 10.1016/j.nrleng.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure. METHODS We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72 hours after the seizure, and the factors related with seizure recurrence. RESULTS We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P = .25) or with the risk of recurrence within 6 months (P = .63). CONCLUSIONS Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.
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Affiliation(s)
- A Llauradó
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Quintana
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Fonseca
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - L Abraira
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Toledo
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Requena
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Olivé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Ballvé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - D Campos
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Sueiras
- Servicio, de Neurofisiología Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Santamarina
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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Moore MJ, Goldstein D, Hamm J, Figer A, Hecht JR, Gallinger S, Au HJ, Murawa P, Walde D, Wolff RA, Campos D, Lim R, Ding K, Clark G, Voskoglou-Nomikos T, Ptasynski M, Parulekar W. Erlotinib Plus Gemcitabine Compared With Gemcitabine Alone in Patients With Advanced Pancreatic Cancer: A Phase III Trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 2023; 41:4714-4720. [PMID: 37847995 DOI: 10.1200/jco.22.02770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
PURPOSE Patients with advanced pancreatic cancer have a poor prognosis and there have been no improvements in survival since the introduction of gemcitabine in 1996. Pancreatic tumors often overexpress human epidermal growth factor receptor type 1 (HER1/EGFR) and this is associated with a worse prognosis. We studied the effects of adding the HER1/EGFR-targeted agent erlotinib to gemcitabine in patients with unresectable, locally advanced, or metastatic pancreatic cancer. PATIENTS AND METHODS Patients were randomly assigned 1:1 to receive standard gemcitabine plus erlotinib (100 or 150 mg/d orally) or gemcitabine plus placebo in a double-blind, international phase III trial. The primary end point was overall survival. RESULTS A total of 569 patients were randomly assigned. Overall survival based on an intent-to-treat analysis was significantly prolonged on the erlotinib/gemcitabine arm with a hazard ratio (HR) of 0.82 (95% CI, 0.69 to 0.99; P = .038, adjusted for stratification factors; median 6.24 months v 5.91 months). One-year survival was also greater with erlotinib plus gemcitabine (23% v 17%; P = .023). Progression-free survival was significantly longer with erlotinib plus gemcitabine with an estimated HR of 0.77 (95% CI, 0.64 to 0.92; P = .004). Objective response rates were not significantly different between the arms, although more patients on erlotinib had disease stabilization. There was a higher incidence of some adverse events with erlotinib plus gemcitabine, but most were grade 1 or 2. CONCLUSION To our knowledge, this randomized phase III trial is the first to demonstrate statistically significantly improved survival in advanced pancreatic cancer by adding any agent to gemcitabine. The recommended dose of erlotinib with gemcitabine for this indication is 100 mg/d.
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Affiliation(s)
- Malcolm J Moore
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
| | - David Goldstein
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
| | - John Hamm
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
| | - Arie Figer
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
| | - Joel R Hecht
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
| | - Steven Gallinger
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
| | - Heather J Au
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
| | - Pawel Murawa
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
| | - David Walde
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
| | - Robert A Wolff
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
| | - Daniel Campos
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
| | - Robert Lim
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
| | - Keyue Ding
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
| | - Gary Clark
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
| | - Theodora Voskoglou-Nomikos
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
| | - Mieke Ptasynski
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
| | - Wendy Parulekar
- From the Divisions of Medical Oncology, Hematology, and Surgical Oncology, Princess Margaret Hospital, Toronto; National Cancer Institute of Canada Clinical Trials Group, Kingston; Algoma District Cancer Program, Sault Ste Marie, Ontario; Cross Cancer Institute, Edmonton, Alberta, Canada; the Australasian Gastrointestinal Tumor Group, Sydney, Australia; Norton Healthcare Pavilion, Louisville, KY; UCLA Medical Center, Los Angeles, CA; M. D. Anderson Cancer Centre, Houston, TX; OSI Pharmaceuticals, Boulder, CO; Sourasky Medical Centre, Tel Aviv, Israel; Great Poland Centre for Oncology, Poznan, Poland; Confidence Medical Centre, San Isidro, Argentina; and the National University Hospital, Singapore, Singapore
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Campos D, Maimí P, Martín A. Statistical Study of the Process Parameters for Achieving Continuous Consolidation of a Thermoplastic Composite. Materials (Basel) 2023; 16:6723. [PMID: 37895705 PMCID: PMC10608415 DOI: 10.3390/ma16206723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
Manufacturing components using thermoplastic composite materials necessitates a judicious balance among fabrication parameters, cost considerations and the ultimate quality of the elements produced. Continuous manufacturing technologies, exemplified by methods such as continuous compressing molding and glide forming, seek to revolutionize production through their continuous processing approach. This study aimed to investigate the effects different process parameters have on the final quality of the manufactured parts when a continuous manufacturing technology, such as glide forming, is applied to thermoplastic composite materials. An experimental rig was designed, and 19 samples were prepared using a unidirectional-carbon-fiber-reinforced LM-PAEK (low-melting polyaryletherketone) composite. The process parameters studied were temperature, pressure and forming speed. The quality of the final parts was evaluated based on their thickness and consolidation levels. The findings underscore the feasibility of leveraging continuous manufacturing technologies for producing components using thermoplastic composite materials, but the process parameters must be carefully controlled to ensure the quality of the final part. The models obtained could be used as a post-processing tool to predict thickness and consolidation levels when simulating the manufacture of a component on macroscale levels. Further research is needed to optimize the process parameters and study their effects on other thermoplastic composite materials.
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Affiliation(s)
- Daniel Campos
- AMADE-UdG Research Group, University of Girona, 17003 Girona, Spain;
- Applus+ Laboratories, 08193 Bellaterra, Spain;
| | - Pere Maimí
- AMADE-UdG Research Group, University of Girona, 17003 Girona, Spain;
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Martínez-Sanchis M, Vara MD, Herrero R, Campos D, García-Campayo J, Baños RM. Effectiveness of the Internet Attachment-Based Compassion Therapy (iABCT) to improve the quality of life and well-being in a population with chronic medical illness: A study protocol of a randomized controlled trial (SPIRIT compliant). PLoS One 2022; 17:e0278462. [PMID: 36574408 PMCID: PMC9794054 DOI: 10.1371/journal.pone.0278462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/02/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Chronic medical illnesses significantly and negatively affect the quality of life of individuals who suffer them and represent one of the most important challenges faced by healthcare providers and policy-makers due to its rising prevalence and high rates of comorbidity. Compassion-based interventions delivered over the Internet may be a useful approach to facilitate illness management and improve the quality of life of individuals with chronic medical conditions. OBJECTIVES The purpose of this study is to describe a protocol for a randomized controlled trial to test the efficacy of the Internet Attachment-Based Compassion Therapy (iABCT) to improve the quality of life and well-being of patients with chronic medical illnesses. METHOD A two-arm, parallel-group, randomized controlled trial (RCT) will be carried out, with three assessment points (baseline, 3-month, and 6-month) under two conditions: intervention group and control group (waiting list). The primary outcomes include the quality of life on the EuroQol 5-Dimensions Questionnaire (EQ-5D) and the Pemberton Happiness Index (PHI). Secondary outcomes, such as compassion, self-care behaviors, illness interference, self-criticism, symptomatology, attachment styles, social support, and illness perception, will be considered. Moreover, an assessment on satisfaction and usability will be carried out. A total of 68 participants as minimum will be recruited (34 per arm). Intent-to-treat mixed-model analyses without any ad hoc imputations will be conducted. CONCLUSIONS Findings of this study will provide new insights into the potential of self-applied compassion-based interventions (CBI) delivered online in the context of chronic medical illnesses, considering aspects of their implementation (e.g., facilitators, barriers) and mechanisms of change. TRIAL REGISTRATION The study is registered under Clinicaltrials.gov (NCT04809610) and it is currently in the participant recruitment phase.
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Affiliation(s)
- Marian Martínez-Sanchis
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Mª Dolores Vara
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
- CIBER-Obn Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain
- * E-mail:
| | - Rocío Herrero
- CIBER-Obn Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychology and Sociology, Faculty of Humanities and Educational Sciences, University of Zaragoza, Huesca, Spain
| | - Daniel Campos
- Department of Psychology and Sociology, Faculty of Humanities and Educational Sciences, University of Zaragoza, Huesca, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), (IIS Aragón), Zaragoza, Spain
| | - Javier García-Campayo
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), (IIS Aragón), Zaragoza, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Rosa Mª Baños
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
- CIBER-Obn Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain
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7
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Cristín J, Méndez V, Campos D. Informational Entropy Threshold as a Physical Mechanism for Explaining Tree-like Decision Making in Humans. Entropy (Basel) 2022; 24:1819. [PMID: 36554223 PMCID: PMC9778513 DOI: 10.3390/e24121819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
While approaches based on physical grounds (such as the drift-diffusion model-DDM) have been exhaustively used in psychology and neuroscience to describe perceptual decision making in humans, similar approaches to complex situations, such as sequential (tree-like) decisions, are still scarce. For such scenarios that involve a reflective prospection of future options, we offer a plausible mechanism based on the idea that subjects can carry out an internal computation of the uncertainty about the different options available, which is computed through the corresponding Shannon entropy. When the amount of information gathered through sensory evidence is enough to reach a given threshold in the entropy, this will trigger the decision. Experimental evidence in favor of this entropy-based mechanism was provided by exploring human performance during navigation through a maze on a computer screen monitored with the help of eye trackers. In particular, our analysis allows us to prove that (i) prospection is effectively used by humans during such navigation tasks, and an indirect quantification of the level of prospection used is attainable; in addition, (ii) the distribution of decision times during the task exhibits power-law tails, a feature that our entropy-based mechanism is able to explain, unlike traditional (DDM-like) frameworks.
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Affiliation(s)
- Javier Cristín
- Istituto Sistemi Complessi, Consiglio Nazionale delle Ricerche, UOS Sapienza, 00185 Rome, Italy
- Dipartimento di Fisica, Universita’ Sapienza, 00185 Rome, Italy
| | - Vicenç Méndez
- Grup de Física Estadística, Departament de Física, Facultat de Ciències, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
| | - Daniel Campos
- Grup de Física Estadística, Departament de Física, Facultat de Ciències, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
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8
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López-del-Hoyo Y, Fernández-Martínez S, Pérez-Aranda A, Barceló-Soler A, Guzman-Parra J, Varela-Moreno E, Campos D, Monreal-Bartolomé A, Beltrán-Ruiz M, Moreno-Küstner B, Mayoral-Cleries F, García-Campayo J. Effectiveness and implementation of an online intervention (MINDxYOU) for reducing stress and promote mental health among healthcare workers in Spain: a study protocol for a stepped-wedge cluster randomized trial. BMC Nurs 2022; 21:308. [PMCID: PMC9647243 DOI: 10.1186/s12912-022-01089-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
The World Health Organization has formally recognized that healthcare professionals are at risk of developing mental health problems; finding ways to reduce their stress is mandatory to improve both their quality of life and, indirectly, their job performance. In recent years, particularly since the COVID-19 pandemic outbreak, there has been a proliferation of online interventions with promising results. The purpose of the present study is twofold: to test the effectiveness of an online, self-guided intervention, MINDxYOU, to reduce the stress levels of healthcare workers; and to conduct an implementation study of this intervention. Additionally, an economic evaluation of the intervention will be conducted.
Methods
The current study has a hybrid effectiveness-implementation type 2 design. A stepped wedge cluster randomized trial design will be used, with a cohort of 180 healthcare workers recruited in two Spanish provinces (Malaga and Zaragoza). The recruitment stage will commence in October 2022. Frontline health workers who provide direct care to people in a hospital, primary care center, or nursing home setting in both regions will participate. The effectiveness of the intervention will be studied, with perceived stress as the main outcome (Perceived Stress Scale), while other psychopathological symptoms and process variables (e.g., mindfulness, compassion, resilience, and psychological flexibility) will be also assessed as secondary outcomes. The implementation study will include analysis of feasibility, acceptability, adoption, appropriateness, fidelity, penetration, and sustainability. The incremental costs and benefits, in terms of quality-adjusted life years, will be examined by means of cost-utility and cost-effectiveness analyses.
Discussion
MINDxYOU is designed to reduce healthcare workers’ stress levels through the practice of mindfulness, acceptance, and compassion, with a special focus on how to apply these skills to healthy habits and considering the particular stressors that these professionals face on a daily basis. The present study will show how implementation studies are useful for establishing the framework in which to address barriers to and promote facilitators for acceptability, appropriateness, adoption, feasibility, fidelity, penetration, and sustainability of online interventions. The ultimate goal is to reduce the research-to-practice gap.
Trial registration
This study was registered in ClinicalTrials.gov on 29/06/2022; registration number: NCT05436717.
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9
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Morgado Gomes AR, Saleiro D, Campos D, Gameiro JP, Sousa JP, Antonio NSC, Goncalves L. Acute coronary syndromes in the elderly: prognostic impact of anaemia. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The increase in life expectancy is a reality and cardiovascular disease incidence rises with it. The elderly are fragile patients with high prevalence of multiple comorbidities. Anaemia is one of them and, in most cases, has multifactorial causes. After an acute coronary syndrome (ACS), the thrombotic versus haemorrhagic risks in these patients are hard to balance.
Aim
The aim of this study is to evaluate prognostic impact of anaemia in the elderly after an ACS.
Methods
Retrospective analysis of consecutive patients admitted to a single Intensive Coronary Unit between 2009 and 2016 with the diagnosis of ACS. Patients younger than 80 years old were excluded. A complete blood count was collected upon admission and anaemia was defined for haemoglobin values below 12.5mg/dL. Cox regression analysis and Kaplan-Meyer curves were conducted to determine prognostic value of anaemia in this specific population. Multivariate analysis with other comorbidities and antithrombotic therapy was also performed.
Results
A total of 353 patients (median age of 84.0±6.0 years old; 52.1% males; 51.3% with anaemia) were enrolled. In cox regression analysis, anaemia predicted mortality (HR 1.614; 95% CI 1.199–2.172; P=0.002). In multivariate analysis – including gender, presence of hypertension, diabetes, chronic kidney disease and atrial fibrillation (AF) at admission, anaemia proved to be an independent predictor of mortality (HR 1.521, 95% CI 1.119–2.069, P=0.007). Adding all previous and discharge antithrombotic therapy – antiplatelet inhibition and oral anticoagulants – to the equation, anaemia maintained its prognostic value (HR 2.157; 95% CI 1.130–4.116; P=0.020). Both AF and being discharged from the hospital with ticagrelor also increased mortality risk in these patients (HR 2.188, 95% CI 1.177–4.070, P=0.13 for AF; HR 1.906, 05% CI 1.011–3.594, P=0.046 for ticagrelor at discharge).
Conclusions
After an ACS, anaemia proved to be an independent predictor of mortality in the elderly. This emphasizes the importance of its adequate aetiology investigation and treatment and careful selection of antithrombotic therapy following an ACS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - D Saleiro
- Coimbra Hospital and University Center , Coimbra , Portugal
| | - D Campos
- Coimbra Hospital and University Center , Coimbra , Portugal
| | - J P Gameiro
- Coimbra Hospital and University Center , Coimbra , Portugal
| | - J P Sousa
- Coimbra Hospital and University Center , Coimbra , Portugal
| | - N S C Antonio
- Coimbra Hospital and University Center , Coimbra , Portugal
| | - L Goncalves
- Coimbra Hospital and University Center , Coimbra , Portugal
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10
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Masó-Puigdellosas A, Campos D, Méndez V. Conditioned backward and forward times of diffusion with stochastic resetting: A renewal theory approach. Phys Rev E 2022; 106:034126. [PMID: 36266817 DOI: 10.1103/physreve.106.034126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
Stochastic resetting can be naturally understood as a renewal process governing the evolution of an underlying stochastic process. In this work, we formally derive well-known results of diffusion with resets from a renewal theory perspective. Parallel to the concepts from renewal theory, we introduce the conditioned backward B and forward F times being the times since the last and until the next reset, respectively, given that the current state of the system X(t) is known. These magnitudes are introduced with the paradigmatic case of diffusion under resetting, for which the backward and forward times are conditioned to the position of the walker. We find analytical expressions for the conditioned backward and forward time probability density functions (PDFs), and we compare them with numerical simulations. The general expressions allow us to study particular scenarios. For instance, for power-law reset time PDFs such that φ(t)∼t^{-1-α}, significant changes in the properties of the conditioned backward and forward times happen at half-integer values of α due to the composition between the long-time scaling of diffusion P(x,t)∼1/sqrt[t] and the reset time PDF.
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Affiliation(s)
- Axel Masó-Puigdellosas
- Grup de Física Estadística, Departament de Física, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Daniel Campos
- Grup de Física Estadística, Departament de Física, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Vicenç Méndez
- Grup de Física Estadística, Departament de Física, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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11
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Gémes K, Bergström J, Papola D, Barbui C, Lam AIF, Hall BJ, Seedat S, Morina N, Quero S, Campos D, Pinucci I, Tarsitani L, Deguen S, van der Waerden J, Patanè M, Sijbrandij M, Acartürk C, Burchert S, Bryant RA, Mittendorfer-Rutz E. Symptoms of anxiety and depression during the COVID-19 pandemic in six European countries and Australia - Differences by prior mental disorders and migration status. J Affect Disord 2022; 311:214-223. [PMID: 35598751 PMCID: PMC9119165 DOI: 10.1016/j.jad.2022.05.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 05/04/2022] [Accepted: 05/15/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Little is known about changes of mental health during the COVID-19 pandemic in potentially disadvantaged groups. We investigated changes in anxiety and depression symptoms during the first year of the pandemic in six European countries and Australia by prior mental disorders and migration status. METHODS Overall, 4674 adults answered a web-based survey in May-June 2020 and were followed by three repeated surveys up to February 2021. Information on psychosocial, financial and demographic, living conditions, prior mental disorders, depression and anxiety symptoms during the pandemic and migration status was collected. Weighted general estimation equations modelling was used to investigate the association between prior mental disorders, migration status, and symptoms over time. RESULTS Most participants were <40 years old (48%), women (78%) and highly educated (62%). The baseline prevalence of depressive and anxiety symptoms ranged between 19%-45% and 13%-35%, respectively. In most countries, prevalence rates remained unchanged throughout the pandemic and were higher among people with prior mental disorders than without even after adjustment for several factors. We observed interactions between previous mental disorders and symptoms of anxiety or depression over time in two countries. No difference by migration status was noted. LIMITATIONS Convenience sampling limits generalizability. Self-assessed symptoms of depression and anxiety might involve some misclassification. CONCLUSIONS Depression and anxiety symptoms were worse among individuals with prior mental disorders than without, but there was no clear trend of worsening mental health in the observed groups during the observed period.
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Affiliation(s)
- Katalin Gémes
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Jakob Bergström
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Agnes Iok Fong Lam
- Centre for Macau Studies, University of Macau, Macao (SAR), People's Republic of China
| | - Brian J Hall
- Center for Global Health Equity, New York University (Shanghai), Shanghai, People Republic of China; School of Public Health, New York University, New York, USA
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Naser Morina
- Department of Consultation-Liason Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
| | - Daniel Campos
- Department of Psychology and Sociology, University of Zaragoza, Huesca, Spain; Instituto de Investigación Sanitaria Aragón (IISAragon), Zaragoza, Spain
| | - Irene Pinucci
- Department of Human Neurosciences, Sapienza University of Rome, Italy; Department of Clinical, Neuro-, and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Séverine Deguen
- INSERM U1136, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Social Epidemiology Research Team, Paris, France; EHESP School of Public Health, Department of Environmental and Occupational Health, Rennes, France
| | - Judith van der Waerden
- INSERM U1136, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Social Epidemiology Research Team, Paris, France
| | - Martina Patanè
- Department of Clinical, Neuro-, and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro-, and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands
| | - Ceren Acartürk
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Sebastian Burchert
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | | | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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12
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Llauradó A, Campos D, Quintana M, Ballvé A, Fonseca E, Abraira L, Giffreu A, Toledo M, Santamarina E. Reponse of second-line treatment in focal status epilepticus: A tertiary hospital experience. Epilepsy Res 2022; 185:106988. [PMID: 35907324 DOI: 10.1016/j.eplepsyres.2022.106988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/02/2022] [Accepted: 07/16/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the response to various antiseizure medications (ASMs) in the treatment of focal status epilepticus (SE) in the established phase, and the effect of administering several ASMs prior to sedation. METHODS All SE cases in patients aged > 16 years treated with non-BZDs ASMs were prospectively collected in our centre from February 2011 to April 2019. In total, 281 episodes were analysed. RESULTS Median age at SE onset was 65.1 years; 47 % were focal motor and 53 % focal non-motor episodes. SE cessation was achieved in 79 % episodes with second-line drugs, whereas a third line (anesthetics) was required in 47 episodes. SE cessation was achieved in only 27 % with the first ASM, 48 % with the second, and 51 % with the third. Prompt resolution of the SE episode with a first or second ASM was associated with a better outcome than episodes requiring a larger number of drugs (p = 0.024). The first option in our sample was levetiracetam in 70 % of cases. Among the total of non-responding SE cases treated with levetiracetam as the first ASM option, 107 were subsequently given lacosamide (seizure cessation in 53.3 %) and 34 valproic acid (seizure cessation in 29.4 %) (p = 0.015). CONCLUSION Our findings further support the notion that early termination of SE with a first or second ASM confers a better functional outcome. The large difference in response between the first ASM and consecutive ones suggests that the sum of different ASMs might be the key to resolving focal SE.
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Affiliation(s)
| | - Daniel Campos
- Epilepsy Unit. Hospital Vall Hebron, Barcelona, Spain
| | | | | | - Elena Fonseca
- Epilepsy Unit. Hospital Vall Hebron, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit. Hospital Vall Hebron, Barcelona, Spain
| | | | - Manuel Toledo
- Epilepsy Unit. Hospital Vall Hebron, Barcelona, Spain
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13
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Tur C, Campos D, Suso-Ribera C, Kazlauskas E, Castilla D, Zaragoza I, García-Palacios A, Quero S. An Internet-delivered Cognitive-Behavioral Therapy (iCBT) for Prolonged Grief Disorder (PGD) in adults: A multiple-baseline single-case experimental design study. Internet Interv 2022; 29:100558. [PMID: 35865996 PMCID: PMC9294524 DOI: 10.1016/j.invent.2022.100558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
The death of a loved one has physical, psychological, and social consequences. Between 9.8 and 21.5 % of people who lose a loved one develop Prolonged Grief Disorder (PGD). Internet- and computer-based interventions (i.e., Internet-delivered Cognitive-Behavioral Therapy, iCBT) are cost-effective and scalable alternatives that make it possible to reach more people with PGD. The main goal of the present investigation was to examine the effect and feasibility (usability and satisfaction) of an iCBT (GROw program) for adults with PGD. A secondary objective was to detect adherence to the app (Emotional Monitor) used to measure daily grief symptoms. The study had a single-case multiple-baseline AB design with six participants. The GROw program is organized sequentially in eight modules, and it is based on the dual-process model of coping with bereavement. Evaluations included a pre-to-post treatment assessment of depression, grief symptoms, and typical grief beliefs, along with daily measures of symptom frequency and intensity on the Emotional Monitor App. Treatment opinions and adherence to the App were also collected. Efficacy data were calculated using a Nonoverlap of All Pairs (NAP) analysis and Reliable Change Index (RCI). The mean age of the sample was 29.5 years (SD = 8.19). Two participants dropped out of the study. Adherence to the App varied across patients (4.8 % -77.8 %). Most participants (75 %) showed a clinically significant change (recovered) in depression, and 50 % obtained a clinically significant improvement (recovered) in symptoms of loss and typical beliefs in complicated grief. The participants reported high usability and satisfaction with the treatment content and format. In sum, the GROw program was very well accepted and generally feasible, and it has strong potential for treating PGD. The results support scaling up the treatment by using more complex designs with larger samples (i.e., randomized controlled trials comparing GROw with active conditions).
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Affiliation(s)
- Cintia Tur
- Departmento de Psicología Básica, Clínica y Psicobiología. Universitat Jaume I, Castellón de la Plana, Spain
| | - Daniel Campos
- Departmento de Psicología y Sociología, Universidad de Zaragoza, Zaragoza, Spain,Instituto de Investigación Sanitaria Aragón (IISAragon), Zaragoza, Spain
| | - Carlos Suso-Ribera
- Departmento de Psicología Básica, Clínica y Psicobiología. Universitat Jaume I, Castellón de la Plana, Spain,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Lithuania
| | - Diana Castilla
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain,Universitat de València, València, Spain
| | - Irene Zaragoza
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Azucena García-Palacios
- Departmento de Psicología Básica, Clínica y Psicobiología. Universitat Jaume I, Castellón de la Plana, Spain,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Soledad Quero
- Departmento de Psicología Básica, Clínica y Psicobiología. Universitat Jaume I, Castellón de la Plana, Spain,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain,Corresponding author at: Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12006, Castellón, Spain.
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14
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Monteiro E, Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes A, Saleiro C, Campos D, Sousa J, Lopes J, Puga L, Teixeira R, Lourenco C, Madeira M, Goncalves L. Inflammation in acute coronary syndrome: prognostic significance. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
In patients with acute coronary syndrome (ACS) the acute phase reactant, C-reactive protein (CRP), might be significantly elevated. Several reports suggest that CRP may play a direct pathophysiological role on the development and progression of atherosclerosis, and CRP values correlate with infarct size when measured by magnetic resonance imaging.
Purpose
The aim of the present study was to evaluate the prognostic value of CRP in patients presenting with an ACS.
Methods
Retrospective analysis of 635 consecutively admitted patients due to ACS in a single coronary intensive care unit. CRP levels were measured at admission. Clinical variables and therapeutic strategies were examined. The primary endpoint analysed during follow-up was all-cause mortality. Possible predictors for all-cause mortality were assessed by Cox regression models. When statistically significant values were found in univariate analysis, multivariate analysis was used to determine whether CRP was an independent predictor of outcome.
Results
In the studied sample, 75% were male. Median age was 69 [interquartile range (IQR) 57–78]. ST-elevation myocardial infarction (STEMI) occurred in 39.6%, non-ST segment elevation myocardial infarction in 44.9% and unstable angina in 15.5% of the patients. Median left ventricular ejection fraction (LVEF) was 48% (IQR 40–55%) and median CRP level at admission 0.7 mg/dL (IQR 0.5–1.9 mg/dL). Regarding important comorbidities and past medical history, 75.9% had hypertension (HTN), 34.0% diabetes, 20.3% chronic kidney disease (CKD), 68.6% dyslipidaemia and 17.3% heart failure (HF). The median follow-up was 34 months (IQR 22–72). In univariate analysis, CRP was significantly associated with all-cause mortality (HR 1.06 per 1 mg/dL increase, 95% CI 1.04–1.08, p<0.001), as was gender, age, LVEF, STEMI and previous history of diabetes, HTN, CKD or HF. In multivariate analysis, CRP remained significantly associated with the primary endpoint (HR 1.02, 95% CI 1.00–1.05, p=0.033), as did age, LVEF and previous history of HF.
Conclusions
In our study, CRP at admission was an independent risk factor for all-cause mortality following an ACS. This finding indicates that inflammation associated with the acute event has a significant impact in the long-term prognosis. More evidence is needed to determine if treating inflammation (and when, in the course of the disease) could result in better outcomes.
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Affiliation(s)
- E Monteiro
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - J Barbosa
- Faculty of Medicine University of Porto, Porto, Portugal
| | - J Guimaraes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - D Fernandes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - G Costa
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - A Gomes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - D Campos
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - J Sousa
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - L Puga
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - R Teixeira
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - M Madeira
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro Hospitalar E Universitario De Coimbra, Coimbra, Portugal
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15
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Quero S, Palau-Batet M, Tur C, Mor S, Campos D, Rachyla I, Grimaldos J, Marco JH. Effect of an internet-based intervention for adjustment disorder on meaning in life and enjoyment. Curr Psychol 2022. [DOI: 10.1007/s12144-022-03177-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Abstract
Introduction
Positive psychological variables, such as meaning in life and the capacity for enjoyment, are important resilience factors against negative behaviors and symptoms. These constructs are related to better emotional regulation strategies, a greater perception of control over one’s life, and better mental health in general. Adjustment disorder (AjD) is a prevalent condition defined as the failure to adapt to a stressful event.
Objective
This study presents secondary analysis data on the effect of an Internet-delivered cognitive-behavioral therapy intervention (iCBT) for AjD on meaning in life and capacity for enjoyment, compared to a control group.
Method
The sample consisted of 68 participants with AjD. 34 in the iCBT condition and 34 in the control group). Meaning in life was assessed by the Purpose-in-Life Test-10, and the Environmental Rewards Observation Scale was used to assess the capacity for enjoyment. The iCBT intervention focused on acceptance and processing of the stressful event. Intent-to-treat mixed-model analyses without any ad hoc imputations and using Cohen’s d effect comparisons were conducted.
Results
The results revealed a significant main effect of time and a significant group x time interaction in all the measures. Significantly higher pre-post score differences were found in the treatment condition.
Discussion
Meaning in life and capacity for enjoyment can change after an iCBT intervention for AjD. Therapeutic implications of the results and future lines of research about the role of meaning in life in AjD are discussed.
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16
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Méndez V, Masó-Puigdellosas A, Campos D. Nonstandard diffusion under Markovian resetting in bounded domains. Phys Rev E 2022; 105:054118. [PMID: 35706242 DOI: 10.1103/physreve.105.054118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
We consider a walker moving in a one-dimensional interval with absorbing boundaries under the effect of Markovian resettings to the initial position. The walker's motion follows a random walk characterized by a general waiting time distribution between consecutive short jumps. We investigate the existence of an optimal reset rate, which minimizes the mean exit passage time, in terms of the statistical properties of the waiting time probability. Generalizing previous results, we find that when the waiting time probability has first and second finite moments, resetting can be either (i) never beneficial, (ii) beneficial depending on the distance of the reset point to the boundary, or (iii) always beneficial. Instead, when the waiting time probability has the first or the two first moments diverging we find that resetting is always beneficial. Finally, we have also found that the optimal strategy to exit the domain depends on the reset rate. For low reset rates, walkers with exponential waiting times are found to be optimal, while for high reset rate, anomalous waiting times optimize the search process.
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Affiliation(s)
- Vicenç Méndez
- Grup de Física Estadística. Departament de Física. Facultat de Ciències. Edifici Cc. Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona) Spain
| | - Axel Masó-Puigdellosas
- Grup de Física Estadística. Departament de Física. Facultat de Ciències. Edifici Cc. Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona) Spain
| | - Daniel Campos
- Grup de Física Estadística. Departament de Física. Facultat de Ciències. Edifici Cc. Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona) Spain
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17
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Díaz EN, Le Q, Campos D, Reyes JM, Wright JA, Greaney ML, Lindsay AC. Central American Parents' Preferences for Content and Modality for a Family-Centered Intervention to Promote Healthful Energy Balance-Related Behaviors of Their Preschool-Age Children. Int J Environ Res Public Health 2022; 19:ijerph19095080. [PMID: 35564475 PMCID: PMC9101972 DOI: 10.3390/ijerph19095080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 02/01/2023]
Abstract
This formative research used a cross-sectional survey to assess interest in informational content and intervention modalities for the design of an early childhood obesity prevention intervention for Central American families from the Northern Triangle countries (El Salvador, Guatemala, and Honduras) living in the United States. A total of 74 parents (36 mothers, 38 fathers) with a mean age of 31.6 years (SD = 5.6) completed the survey; 59.5% of whom were born outside of the United States. Although most parents reported being very interested in receiving information related to the seven assessed energy balance-related behaviors, there were significant differences by parents’ gender and nativity. Most parents endorsed remote modalities for content delivery via text/SMS, WhatsApp, and e-mail. However, respondents were also receptive to in-person delivery provided by community health workers. There were also significant differences in parents’ preferences for intervention modalities by parents’ gender and nativity. Future steps should include investigating different intervention modalities and their integration into a linguistic and culturally sensitive family-based intervention to promote healthful energy balance-related behaviors of preschool-age children in Central American families originating from the Northern Triangle countries.
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Affiliation(s)
- Elizabeth N. Díaz
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (E.N.D.); (D.C.); (J.M.R.); (J.A.W.)
| | - Qun Le
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA 01854, USA;
| | - Daniel Campos
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (E.N.D.); (D.C.); (J.M.R.); (J.A.W.)
| | - Jesnny M. Reyes
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (E.N.D.); (D.C.); (J.M.R.); (J.A.W.)
| | - Julie A. Wright
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (E.N.D.); (D.C.); (J.M.R.); (J.A.W.)
| | - Mary L. Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA;
| | - Ana Cristina Lindsay
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (E.N.D.); (D.C.); (J.M.R.); (J.A.W.)
- Correspondence:
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18
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Vilk O, Campos D, Méndez V, Lourie E, Nathan R, Assaf M. Phase Transition in a Non-Markovian Animal Exploration Model with Preferential Returns. Phys Rev Lett 2022; 128:148301. [PMID: 35476490 DOI: 10.1103/physrevlett.128.148301] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
We study a non-Markovian and nonstationary model of animal mobility incorporating both exploration and memory in the form of preferential returns. Exact results for the probability of visiting a given number of sites are derived and a practical WKB approximation to treat the nonstationary problem is developed. A mean-field version of this model, first suggested by Song et al., [Modelling the scaling properties of human mobility, Nat. Phys. 6, 818 (2010)NPAHAX1745-247310.1038/nphys1760] was shown to well describe human movement data. We show that our generalized model adequately describes empirical movement data of Egyptian fruit bats (Rousettus aegyptiacus) when accounting for interindividual variation in the population. We also study the probability of visiting any site a given number of times and derive a mean-field equation. Our analysis yields a remarkable phase transition occurring at preferential returns which scale linearly with past visits. Following empirical evidence, we suggest that this phase transition reflects a trade-off between extensive and intensive foraging modes.
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Affiliation(s)
- Ohad Vilk
- Racah Institute of Physics, The Hebrew University of Jerusalem, Jerusalem 91904, Israel
- Movement Ecology Lab, Department of Ecology, Evolution and Behavior, Alexander Silberman Institute of Life Sciences, Faculty of Science, The Hebrew University of Jerusalem, Jerusalem 91904, Israel
- Minerva Center for Movement Ecology, The Hebrew University of Jerusalem, Jerusalem 91904, Israel
| | - Daniel Campos
- Grup de Física Estadística, Dept. de Física, Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona), Spain
| | - Vicenç Méndez
- Grup de Física Estadística, Dept. de Física, Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona), Spain
| | - Emmanuel Lourie
- Movement Ecology Lab, Department of Ecology, Evolution and Behavior, Alexander Silberman Institute of Life Sciences, Faculty of Science, The Hebrew University of Jerusalem, Jerusalem 91904, Israel
- Minerva Center for Movement Ecology, The Hebrew University of Jerusalem, Jerusalem 91904, Israel
| | - Ran Nathan
- Movement Ecology Lab, Department of Ecology, Evolution and Behavior, Alexander Silberman Institute of Life Sciences, Faculty of Science, The Hebrew University of Jerusalem, Jerusalem 91904, Israel
- Minerva Center for Movement Ecology, The Hebrew University of Jerusalem, Jerusalem 91904, Israel
| | - Michael Assaf
- Racah Institute of Physics, The Hebrew University of Jerusalem, Jerusalem 91904, Israel
- Institute for Physics and Astronomy, University of Potsdam, Potsdam 14476, Germany
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19
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Mor S, Botella C, Campos D, Carlbring P, Tur C, Quero S. An internet-based treatment for flying phobia using 360° images: A feasibility pilot study. Internet Interv 2022; 28:100510. [PMID: 35242593 PMCID: PMC8866141 DOI: 10.1016/j.invent.2022.100510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND More research is needed in the field of Internet-delivered Cognitive Behavioral Treatments (ICBTs) for specific phobia in order to understand which characteristics are important in online exposure scenarios. The aim of the present work was to conduct a feasibility pilot study to explore participants' opinions, preferences, and acceptability ratings of two types of images (still images vs 360° navigable images) in an ICBT for Flying Phobia (FP). A secondary aim was to test the potential effectiveness of the two active treatment arms compared to a waiting list control group. An exploratory aim was to compare the role of navigable images vs. still images in the level of sense of presence and reality judgment and explore their possible mediation in treatment effectiveness. METHODS Participants were randomly allocated to three conditions: NO-FEAR Airlines with still images (n = 26), NO-FEAR Airlines with still and navigable images (n = 26), and a waiting list group (n = 26). Primary outcome measures were participants' opinions, preferences, satisfaction, and acceptance regarding the images used in the exposure scenarios. Secondary outcome measures included FP symptomatology outcomes and measures of sense of presence and reality judgment. RESULTS Participants in the study preferred navigable images over still images before and after treatment (over 84%), and they considered them more effective and logical for the treatment of their problem. However, adherence in the experimental conditions was low (42.3% dropout rate), and more participants withdrew from the group that included navigable images compared to the group that only included still images (14 vs. 8), with no statistical differences in attrition between the two conditions. NO-FEAR Airlines proved to be effective in reducing FP symptomatology compared to the control group, with large between-group effect sizes on all FP measures (ranging from 0.76 to 2.79). No significant mediation effect was found for sense of presence or reality judgment in treatment effectiveness. DISCUSSION The results of the current study suggest that participants prefer more immersive images in exposure scenarios, providing data that can help to design useful exposure scenarios to treat specific phobias in the future. They also provide evidence supporting the effectiveness of an ICBT for FP. TRIAL REGISTRATION Registered at Clinicaltrials.gov (NCT03900559) on April 9, 2019. Retrospectively registered.
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Affiliation(s)
- Sonia Mor
- Universitat Jaume I, Castellón, Spain
| | - Cristina Botella
- Universitat Jaume I, Castellón, Spain,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
| | - Daniel Campos
- Department of Psychology and Sociology, University of Zaragoza, Huesca, Spain,Instituto de Investigación Sanitaria Aragón (IISAragon), Zaragoza, Spain
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Soledad Quero
- Universitat Jaume I, Castellón, Spain,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain,Corresponding author at: Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain.
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20
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García-Campayo J, Moyano N, Modrego-Alarcón M, Herrera-Mercadal P, Puebla-Guedea M, Campos D, Gascón S. Validation of the Spanish Version of the Lucidity and Consciousness in Dreams Scale. Front Psychol 2021; 12:742438. [PMID: 34744915 PMCID: PMC8566340 DOI: 10.3389/fpsyg.2021.742438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022] Open
Abstract
Lucid dreaming, a specific phenomenon of dream consciousness, refers to the experience being aware that one is dreaming. The primary aim of this research was to validate a Spanish version of the Lucidity and Consciousness in Dreams scale (LuCiD). A secondary aim was to explore whether meditation experience and mindfulness trait were related to LuCiD scores. Data from 367 Spanish men (34.6%) and women (65.4%) who completed LuCiD, the Five Facets of Mindfulness Questionnaire (FFMQ), and the Positive and Negative Affect Schedule (PANAS) were examined. From the total sample, 40.3% indicated some experience with formal meditation (meditators), while 59.7% did not have any meditation experience (non-meditators). A random subsample of 101 participants, who completed LuCiD for a second time after a period of 10–15days, was used for test–retest reliability analysis. The LuCiD scale comprises 28 items distributed across eight factors: insight, control, thought, realism, memory, dissociation, negative emotion, and positive emotion. Factor structure, reliability by both internal consistency and test–retest reliability, and construct and concurrent validity were tested. Confirmatory factor analysis (CFA) confirmed the original eight-factor model, showing goodness of fit in contrast to a single-factor model. Item 15 was deleted from the Dissociation factor as it performed poorly (i.e., skewness and kurtosis, non-normal distribution of responses, and corrected item–total correlation under 0.40). The scale showed adequate values of internal consistency (between α=0.65 for Memory and α=0.83 for Positive Emotion) and test–retest reliability by significant Pearson correlations (p<0.001) for each factor. The scores of meditators were higher for the LuCiD scale Insight and Dissociation factors, in contrast to those of non-meditators. The Observing facet of mindfulness was positively associated with all LuCiD factors, except Realism and Positive Emotion, and the Acting with Awareness facet showed a negative correlation with the LuCiD factor Realism. Finally, positive and negative affects was associated with the LuCiD factors Positive Emotion and Negative Emotion. This study provides a valid and reliable measure for exploring lucidity and consciousness in dreams for a Spanish population, Moreover, the results suggest a relationship with meditation experience, mindfulness trait, and positive and negative affect.
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Affiliation(s)
- Javier García-Campayo
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain.,Primary Care Prevention and Health Promotion Research Network, Madrid, Spain.,Hospital Universitario Miguel Servet, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Nieves Moyano
- Department of Psychology, Faculty of Humanities and Educational Sciences, University of Jaén, Jaén, Spain
| | - Marta Modrego-Alarcón
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.,Department of Psychology and Sociology, Faculty of Humanities and Educational Sciences, University of Zaragoza, Huesca, Spain
| | - Paola Herrera-Mercadal
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.,Department of Psychology and Sociology, Faculty of Humanities and Educational Sciences, University of Zaragoza, Huesca, Spain
| | - Marta Puebla-Guedea
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.,Department of Psychology and Sociology, Faculty of Social and Labor Sciences, University of Zaragoza, Zaragoza, Spain
| | - Daniel Campos
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.,Department of Psychology and Sociology, Faculty of Humanities and Educational Sciences, University of Zaragoza, Huesca, Spain
| | - Santiago Gascón
- Department of Psychology and Sociology, Faculty of Social Sciences and Humanities, University of Zaragoza, Teruel, Spain
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21
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Monteiro E, Pedro Barbosa J, Guimaraes J, Fernandes D, Costa G, Gomes A, Saleiro C, Campos D, Sousa J, Lopes J, Puga L, Teixeira R, Lourenco C, Madeira M, Goncalves L. Prognostic significance of percutaneous coronary intervention associated blood loss in acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Antiplatelet and anticoagulants are one of the mainstay treatment of acute coronary syndrome (ACS), however they are associated with a significant increase of bleeding risk. While anaemia is a recognized predictor of adverse outcomes, it is unknown if a variation of haemoglobin (HB) levels, even without associated anaemia, has the same impact.
Purpose
The aim of this study was to determine the prognostic impact of HB variation after percutaneous coronary intervention (PCI) in ACS patients.
Methods
Retrospective analysis of 822 consecutive patients admitted due to ACS and treated with PCI, in a single coronary intensive care unit. Delta HB – ΔHB – (HB at admission – HB 24 hours after PCI) was calculated. Clinical variables and therapeutic strategies were examined. The primary endpoint analysed during follow-up was all-cause mortality. Possible predictors for all-cause mortality were assessed by Cox regression models. When statistically significant values were found in univariate analysis, multivariate analysis was used to determine whether ΔHB was independent from other known factors in predicting the outcome.
Results
In the studied sample, 75.4% were male. Mean age was 66.4±13.1. ST-elevation myocardial infarction (STEMI) occurred in 45.5%, non-ST segment elevation myocardial infarction in 42.6% and unstable angina in 11 9% of the studied population. Moderate to severe systolic dysfunction was present in 23.5% of the cases. Regarding comorbidities and past medical history, 76% had hypertension (HTN), 30.3% diabetes, 16.4% chronic kidney disease (CKD), 62.2% dyslipidaemia and 10.5% heart failure (HF). Mean HB at admission was 13.8±1.8 g/dL, mean HB after PCI was 12.9±1.9 g/dL and mean ΔHB was 0.9±1.1 g/dL. The mean follow-up was 51.6±30.6 months. In univariate analysis, ΔHB was significantly associated with all-cause mortality (HR 1.15 per 1 g/dL loss, 95% CI 1.01–1.30, p=0.04), as was HB at admission, HB after PCI, age, sex, diabetes, HTN, dyslipidaemia, CKD and moderate to severe systolic dysfunction. In multivariate analysis, ΔHB remained significantly associated with the endpoint and gained even more statistical power (HR 1.25, 95% CI 1.10–1.43, p<0.01). HB at admission and after PCI, age, CKD and moderate to severe systolic dysfunction were also independent predictors of this outcome.
Conclusions
In our study, irrespective of the admission and discharge HB, ΔHB was associated with more adverse outcomes in patients submitted to PCI. Hence, even patients with a normal HB after PCI have a worse long-term prognosis if a negative variation of HB occurs. This highlights the importance of identifying and optimising all the correctable factors that might lead to an increased bleeding risk.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Monteiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | | | - J Guimaraes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - D Fernandes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - G Costa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - A Gomes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - D Campos
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Sousa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Puga
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - R Teixeira
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - M Madeira
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro hospitalar de Coimbra, Coimbra, Portugal
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Diaz-Sanahuja L, Campos D, Mira A, Castilla D, García-Palacios A, Bretón-López JM. Efficacy of an internet-based psychological intervention for problem gambling and gambling disorder: Study protocol for a randomized controlled trial. Internet Interv 2021; 26:100466. [PMID: 34646753 PMCID: PMC8501496 DOI: 10.1016/j.invent.2021.100466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/15/2021] [Accepted: 09/29/2021] [Indexed: 01/06/2023] Open
Abstract
UNLABELLED Gambling Disorder is a prevalent non-substance use disorder, which contrasts with the low number of people requesting treatment. Information and Communication Technologies (ICT) could help to enhance the dissemination of evidence-based treatments and considerably reduce the costs. The current study seeks to assess the efficacy of an online psychological intervention for people suffering from gambling problems in Spain. The proposed study will be a two-arm, parallel-group, randomized controlled trial. A total of 134 participants (problem and pathological gamblers) will be randomly allocated to a waiting list control group (N = 67) or an intervention group (N = 67). The intervention program includes 8 modules, and it is based on motivational interviewing, cognitive-behavioral therapy (CBT), and extensions and innovations of CBT. It includes several complementary tools that are present throughout the entire intervention. Therapeutic support will be provided once a week through a phone call with a maximum length of 10 min. The primary outcome measure will be gambling severity and gambling-related cognitions, and secondary outcome measures will be readiness to change, and gambling self-efficacy. Other variables that will be considered are depression and anxiety symptoms, positive and negative affect, difficulties in emotion regulation strategies, impulsivity, and quality of life. Individuals will be assessed at baseline, post-treatment, and 3-, 6-, and 12-month follow-ups. During the treatment, participants will also respond to a daily Ecological Momentary Intervention (EMI) in order to evaluate urges to gamble, self-efficacy to cope with gambling urges, gambling urge frequency, and whether gambling behaviour occurs. The EMI includes immediate automatic feedback depending on the participant's responses. Treatment acceptance and satisfaction will also be assessed. The data will be analysed both per protocol and by Intention-to-treat. As far as we know, this is the first randomized controlled trial of an online psychological intervention for gambling disorder in Spain. It will expand our knowledge about treatments delivered via the Internet and contribute to improving treatment dissemination, reaching people suffering from this problem who otherwise would not receive help. TRIAL REGISTRATION Clinicaltrials.gov as NCT04074681. Registered 22 July 2019.
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Key Words
- A, Action
- C, Contemplation
- CBT
- CBT, Cognitive Behavioral Therapy
- CIDI, Composite International Diagnostic Interview
- CONSORT-EHEALTH, Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth
- DERS, Difficulties in Emotion Regulation Scale
- DGOJ, Directorate General for the Regulation of Gambling
- DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
- DSM-III-R, Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition Revised
- DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
- EDBs, Emotion Driven Behaviours
- EMA, Ecological Momentary Assessment
- EMI, Ecological Momentary Intervention
- Efficacy
- Emotion regulation
- G-SAS, The Gambling Symptom Assessment Scale
- GD, Gambling Disorder
- GE, Gambling Expectancies
- GI, Gambling history interview and current gambling situation and related variables assessment
- GRCS-S, Gambling-Related Cognitions Scale
- GSEQ, Gambling Self-Efficacy Questionnaire
- Gambling
- HADS, Hospital Anxiety Depression Scale
- IB, Interpretative Bias
- IC, Illusion of Control
- ICD-10, International Statistical Classification of Diseases and Related Health Problems 10th Revision
- ISG, Perceived Inability to Stop Gambling
- Internet
- M, Maintenance
- MFS, Monitoring, Feedback and Support
- MI, Motivational Interviewing
- MINI, Mini International Neuropsychiatric Interview
- NA, Negative Affect
- NODS, NORC DSM-IV Screen for Gambling Problems
- OASIS, The Overall Anxiety Severity and Impairment Scale
- ODSIS, The Overall Depression Severity and Impairment Scale
- P, Precontemplation
- PA, Positive Affect
- PANAS, The Positive and Negative Affect Schedule
- PC, Predictive Control
- PFIs, Personal Feedback Interventions
- QLI, Quality Life Index
- RCT, Randomized Controlled Trial
- SCID-P, The Structured Clinical Interview
- SPIRIT, Standard Protocol Items Recommendations for Interventional Trials
- SUS, System Usability Scale
- UPPS-P, The Short UPPS-P Impulsivity Scale
- URICA, The University of Rhode Island Change Assessment Scale
- WL, Waiting List
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Affiliation(s)
- Laura Diaz-Sanahuja
- Universitat Jaume I, Castellón, Spain
- Corresponding author at: Department of Basic Psychology, Clinical and Psychobiology, Universitat Jaume I, Avenida de Vicent Sos Baynat, s/n, 12071 Castellón, (Spain).
| | - Daniel Campos
- Universidad de Zaragoza, Huesca, Spain
- Instituto de Investigación Sanitaria Aragón (IISAragon), Zaragoza, Spain
| | | | - Diana Castilla
- Universidad de Valencia, Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Azucena García-Palacios
- Universitat Jaume I, Castellón, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Juana María Bretón-López
- Universitat Jaume I, Castellón, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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23
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Tur C, Campos D, Herrero R, Mor S, López-Montoyo A, Castilla D, Quero S. Internet-delivered Cognitive-Behavioral Therapy (iCBT) for Adults with Prolonged Grief Disorder (PGD): A Study Protocol for a Randomized Feasibility Trial. BMJ Open 2021; 11:e046477. [PMID: 34230018 PMCID: PMC8261880 DOI: 10.1136/bmjopen-2020-046477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/11/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Grief is an emotional reaction to the loss of a loved one with a natural recovery. Approximately 10% of people who lose a loved one develop prolonged grief disorder (PGD). Internet-based and computer-based interventions (ie, internet-delivered cognitive-behavioural therapy, iCBT) are a cost-effective alternative that makes it possible to reach more people with PGD. The main aim of this study is to assess the feasibility of a new iCBT-called GROw-for PGD. As a secondary objective, the potential effectiveness of GROw will be explored. METHODS AND ANALYSIS This study is a two-arm feasibility randomised trial. A total of 48 adults with PGD who meet the eligibility criteria will be randomised to the experimental group (iCBT: GROw) or the active control group (face-to-face CBT treatment). The treatment is organised sequentially in eight modules in the iCBT format and 8-10 sessions in the face-to-face format, and both formats have the same therapeutic components. There will be five assessment points with qualitative and quantitative evaluations: screening, baseline, after the intervention, 3-month follow-up and 12-month follow-up. Consistent with the objectives, the measures are related to the feasibility outcomes for the main aim of the study (participant adherence, expectations and satisfaction with the treatment, preferences, alliance and utility) and psychological and mental health outcomes for secondary analyses (symptoms of grief, symptoms of depression, symptoms of anxiety, affectivity, quality of life, work and social adaptation, post-traumatic growth, purpose in life, mindfulness and compassion). ETHICS AND DISSEMINATION The Ethics Committee of the Universitat Jaume I (Castellón, Spain) granted approval for the study (CD/002/2019). Dissemination will include publications and presentations at national and international conferences. TRIAL REGISTRATION NUMBER NCT04462146.
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Affiliation(s)
- Cintia Tur
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Daniel Campos
- Department of Psychology and Sociology, University of Zaragoza, Huesca, Spain
| | - Rocio Herrero
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Sonia Mor
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Alba López-Montoyo
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Diana Castilla
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
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Campos D, Cristín J, Méndez V. Optimal escape-and-feeding dynamics of random walkers: Rethinking the convenience of ballistic strategies. Phys Rev E 2021; 103:052109. [PMID: 34134199 DOI: 10.1103/physreve.103.052109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/13/2021] [Indexed: 11/07/2022]
Abstract
Excited random walks represent a convenient model to study food intake in a media which is progressively depleted by the walker. Trajectories in the model alternate between (i) feeding and (ii) escape (when food is missed and so it must be found again) periods, each governed by different movement rules. Here, we explore the case where the escape dynamics is adaptive, so at short times an area-restricted search is carried out, and a switch to extensive or ballistic motion occurs later if necessary. We derive for this case explicit analytical expressions of the mean escape time and the asymptotic growth of the depleted region in one dimension. These, together with numerical results in two dimensions, provide surprising evidence that ballistic searches are detrimental in such scenarios, a result which could explain why ballistic movement is barely observed in animal searches at microscopic and millimetric scales, therefore providing significant implications for biological foraging.
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Affiliation(s)
- Daniel Campos
- Grup de Física Estadística, Departament de Física. Facultat de Ciències, Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona), Spain
| | - Javier Cristín
- Grup de Física Estadística, Departament de Física. Facultat de Ciències, Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona), Spain
| | - Vicenç Méndez
- Grup de Física Estadística, Departament de Física. Facultat de Ciències, Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona), Spain
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Martínez-Rubio D, Martínez-Brotons C, Monreal-Bartolomé A, Barceló-Soler A, Campos D, Pérez-Aranda A, Colomer-Carbonell A, Cervera-Torres S, Solé S, Moreno Y, Montero-Marín J. Protective role of mindfulness, self-compassion and psychological flexibility on the burnout subtypes among psychology and nursing undergraduate students. J Adv Nurs 2021; 77:3398-3411. [PMID: 33905551 DOI: 10.1111/jan.14870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 01/31/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022]
Abstract
AIMS To explore the relationship between mindfulness, self-compassion and psychological flexibility, and the burnout subtypes in university students of the Psychology and Nursing degrees, and to analyse possible risk factors for developing burnout among socio-demographic and studies-related characteristics. DESIGN Cross-sectional study conducted on a sample of 644 undergraduate students of Nursing and Psychology from two Spanish universities. METHODS The study was conducted between December 2015 and May 2016. Bivariate Pearson's correlations were computed to analyse the association between mindfulness facets, self-compassion and psychological flexibility, and levels of burnout. Multivariate linear regression models and bivariate and multivariate binary logistic regressions were also computed. RESULTS The three subtypes of burnout presented significant correlations with psychological flexibility, self-compassion and some mindfulness facets. Psychological flexibility, self-compassion and the mindfulness facets of observing and acting with awareness were significantly associated to burnout. Among the risk factors, 'year of study' was the only variable to show significantly higher risk for every burnout subtype. CONCLUSION The significant associations found between mindfulness, self-compassion, psychological flexibility and burnout levels underline the need of including these variables as therapeutic targets when addressing the burnout syndrome in university students. IMPACT Undergraduate students, especially those of health sciences, often experience burnout. This study delves into the protective role of some psychological variables: mindfulness, self-compassion and psychological flexibility. These should be considered as potentially protective skills for developing burnout, and therefore, undergraduate students could be trained on these abilities to face their studies and their future profession to prevent experiencing burnout syndrome.
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Affiliation(s)
- David Martínez-Rubio
- Psicoforma, Integral Psychology Center, Valencia, Spain.,Excellence Research Network PROMOSAM (PSI2014-56303-REDT), Madrid, Spain.,Department of Psychology, Faculty of Health Sciences, Universidad Europea de Valencia, Valencia, Spain
| | | | - Alicia Monreal-Bartolomé
- Aragon Institute for Health Research, IIS Aragon, Zaragoza, Spain.,Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
| | - Alberto Barceló-Soler
- Aragon Institute for Health Research, IIS Aragon, Zaragoza, Spain.,Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
| | - Daniel Campos
- Aragon Institute for Health Research, IIS Aragon, Zaragoza, Spain.,Department of Psychology and Sociology, University of Zaragoza, Huesca, Spain
| | - Adrián Pérez-Aranda
- Aragon Institute for Health Research, IIS Aragon, Zaragoza, Spain.,Department of Basic Psychology, Faculty of Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain.,AGORA Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Ariadna Colomer-Carbonell
- AGORA Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | | | - Silvia Solé
- Facultat d'Infermeria i Fisioteràpia, Grup GESEC, Universitat de Lleida, Lleida, Spain
| | - Yolanda Moreno
- Department of Sciences (FCAFD), Faculty of Physical Activity and Sport Sciences, Catholic University of Valencia San Vicente Mártir, Valencia, Spain
| | - Jesús Montero-Marín
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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Llauradó A, Quintana M, Fonseca E, Abraira L, Toledo M, Requena M, Olivé M, Ballvé A, Campos D, Sueiras M, Santamarina E. Implications of initiating antiseizure drugs prior to the performance of EEG in first epileptic seizures. Neurologia 2021; 38:S0213-4853(21)00053-0. [PMID: 33875301 DOI: 10.1016/j.nrl.2021.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure. METHOD We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72hours after the seizure, and the factors related with seizure recurrence. RESULTS We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P=.25) or with the risk of recurrence within 6 months (P=.63). CONCLUSIONS Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.
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Affiliation(s)
- A Llauradó
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Quintana
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Fonseca
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - L Abraira
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Toledo
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Requena
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Olivé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - A Ballvé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - D Campos
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Sueiras
- Servicio, de Neurofisiología Clínica, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Santamarina
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España.
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Ballvé A, Salas‐Puig J, Quintana M, Campos D, Llauradó A, Raspall M, Fonseca E, Abraira L, Santamarina E, Toledo M. Levetiracetam as first-line monotherapy for Idiopathic Generalized Epilepsy in women. Acta Neurol Scand 2021; 143:407-412. [PMID: 33452703 DOI: 10.1111/ane.13389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Levetiracetam (LEV) is effective in Idiopathic Generalized Epilepsy (IGE) and seems to be a good alternative to valproic acid in women of childbearing age. However, there is lack of approval for this indication as monotherapy. The aim of this study is to assess the efficacy of LEV as a first-line therapy in this population. METHODS The study is a descriptive analysis of women aged between 16 and 45 years old diagnosed with IGE and treated with LEV as first-line monotherapy. Minimum follow-up was 24 months. RESULTS 26 women. Mean age: 25.4 years (17-43). 14 Juvenile Myoclonic Epilepsy; 8 Tonic-Clonic Seizures Alone; 4 Juvenile Absence. Mean follow-up: 68.3 months (24-120). 11 patients (40.7%) continued to take LEV as monotherapy, of which 10 were seizure-free, and three (11.5%) continue to be seizure-free after withdrawing LEV. 12 patients (46.2%) required a change of treatment: 25% (3/12) due to lack of efficacy, 42% (5/12) due to adverse effects and 33% (4/12) due to both. Irritability was the most frequent adverse effect. At the last assessment, three patients (11.5%) continued to have seizures despite polytherapy. Estimated retention rates were 78.1% at one year (SE 7.3%) and 51% at 5 years (SE 9.8%). Estimated median retention time is 72 months (CI 95%: 50.9-93.1). CONCLUSION LEV could be an effective drug as first-line treatment for IGE in women of childbearing potential. The adverse effects are its main limitation. Comparative studies are needed in order to establish it for this indication.
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Affiliation(s)
- Alejandro Ballvé
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
| | - Javier Salas‐Puig
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
| | - Manuel Quintana
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Epilepsy Research Group Vall d'Hebron Research Institute (VHIR Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
| | - Daniel Campos
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
| | - Arnau Llauradó
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
| | - Miquel Raspall
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Department of Paediatric Neurology Vall d'Hebron University Hospital Barcelona Spain
| | - Elena Fonseca
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Epilepsy Research Group Vall d'Hebron Research Institute (VHIR Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
| | - Laura Abraira
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Epilepsy Research Group Vall d'Hebron Research Institute (VHIR Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
| | - Estevo Santamarina
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Epilepsy Research Group Vall d'Hebron Research Institute (VHIR Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
| | - Manuel Toledo
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Epilepsy Research Group Vall d'Hebron Research Institute (VHIR Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
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Mor S, Botella C, Campos D, Tur C, Castilla D, Soler C, Quero S. An Internet-based treatment for Flying Phobia using 360° images: Study protocol for a feasibility pilot study. Internet Interv 2021; 24:100387. [PMID: 33936953 PMCID: PMC8076687 DOI: 10.1016/j.invent.2021.100387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 03/15/2021] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Flying Phobia (FP) is a prevalent disorder that can cause serious interference in a person's life. ICBT interventions have already shown their efficacy in several studies, but studies in the field of specific phobias are still scarce. Moreover, few studies have investigated the feasibility of using different types of images in exposure scenarios in ICBTs and no studies have been carried out on the role of sense of presence and reality judgement. The aim of the present study is to explore the feasibility of an ICBT for FP (NO-FEAR Airlines) using two types of images with different levels of immersion (still and navigable images). A secondary aim is to explore the potential effectiveness of the two experimental conditions using two types of images compared to a waiting list control group. Finally, the role of navigable images compared to the still images in the level of anxiety, sense of presence, and reality judgement will also be explored. This paper presents the study protocol. METHODS This study is a three-armed feasibility pilot study with the following conditions: NO-FEAR Airlines with navigable images, NO-FEAR Airlines with still images, and a waiting list group. A minimum of 60 participants will be recruited. The intervention will have a maximum duration of 6 weeks. Measurements will be taken at four different moments: baseline, post-intervention, and two follow-ups (3- and 12-month). Participants' opinions, preference, satisfaction and acceptance regarding the images used in the exposure scenarios will be assessed. FP symptomatology outcomes will also be considered for secondary analyses. The anxiety, sense of presence, and reality judgement in the exposure scenarios will also be analysed. DISCUSSION This study will conduct a pilot study on the feasibility of an ICBT for FP and it is the first one to explore the evaluation of patients of the two type of images (still and navigable) and the role of presence and reality judgement in exposure scenarios delivered through the Internet. Research in this field can have an impact on the way these scenarios are designed and developed, as well as helping to explore whether they have any effect on adherence. TRIAL REGISTRATION NCT03900559. Trial Registration date 3 April 2019, retrospectively registered.
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Affiliation(s)
- Sonia Mor
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Cristina Botella
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
| | - Daniel Campos
- Department of Psychology and Sociology, University of Zaragoza, Huesca, Spain
- Instituto de Investigación Sanitaria Aragón (IISAragon), Zaragoza, Spain
| | - Cintia Tur
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | | | | | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
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García-Tornel Á, Campos D, Rubiera M, Boned S, Olivé-Gadea M, Requena M, Ciolli L, Muchada M, Pagola J, Rodriguez-Luna D, Deck M, Juega J, Rodríguez-Villatoro N, Sanjuan E, Tomasello A, Piñana C, Hernández D, Álvarez-Sabin J, Molina CA, Ribó M. Ischemic Core Overestimation on Computed Tomography Perfusion. Stroke 2021; 52:1751-1760. [PMID: 33682453 DOI: 10.1161/strokeaha.120.031800] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Álvaro García-Tornel
- Stroke Unit, Department of Neurology (A.G.-T., D.C., M. Rubiera, S.B., M.O.-G., M. Requena, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., E.S., J.A.-S., C.A.M., M.Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Daniel Campos
- Stroke Unit, Department of Neurology (A.G.-T., D.C., M. Rubiera, S.B., M.O.-G., M. Requena, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., E.S., J.A.-S., C.A.M., M.Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Marta Rubiera
- Stroke Unit, Department of Neurology (A.G.-T., D.C., M. Rubiera, S.B., M.O.-G., M. Requena, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., E.S., J.A.-S., C.A.M., M.Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Sandra Boned
- Stroke Unit, Department of Neurology (A.G.-T., D.C., M. Rubiera, S.B., M.O.-G., M. Requena, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., E.S., J.A.-S., C.A.M., M.Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Marta Olivé-Gadea
- Stroke Unit, Department of Neurology (A.G.-T., D.C., M. Rubiera, S.B., M.O.-G., M. Requena, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., E.S., J.A.-S., C.A.M., M.Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology (A.G.-T., D.C., M. Rubiera, S.B., M.O.-G., M. Requena, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., E.S., J.A.-S., C.A.M., M.Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Ludovico Ciolli
- Stroke Unit, Neurology Unit, Department of Neuroscience, Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Italy (L.C.)
| | - Marian Muchada
- Stroke Unit, Department of Neurology (A.G.-T., D.C., M. Rubiera, S.B., M.O.-G., M. Requena, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., E.S., J.A.-S., C.A.M., M.Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Jorge Pagola
- Stroke Unit, Department of Neurology (A.G.-T., D.C., M. Rubiera, S.B., M.O.-G., M. Requena, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., E.S., J.A.-S., C.A.M., M.Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - David Rodriguez-Luna
- Stroke Unit, Department of Neurology (A.G.-T., D.C., M. Rubiera, S.B., M.O.-G., M. Requena, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., E.S., J.A.-S., C.A.M., M.Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Matias Deck
- Stroke Unit, Department of Neurology (A.G.-T., D.C., M. Rubiera, S.B., M.O.-G., M. Requena, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., E.S., J.A.-S., C.A.M., M.Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Jesus Juega
- Stroke Unit, Department of Neurology (A.G.-T., D.C., M. Rubiera, S.B., M.O.-G., M. Requena, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., E.S., J.A.-S., C.A.M., M.Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Noelia Rodríguez-Villatoro
- Stroke Unit, Department of Neurology (A.G.-T., D.C., M. Rubiera, S.B., M.O.-G., M. Requena, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., E.S., J.A.-S., C.A.M., M.Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Estela Sanjuan
- Stroke Unit, Department of Neurology (A.G.-T., D.C., M. Rubiera, S.B., M.O.-G., M. Requena, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., E.S., J.A.-S., C.A.M., M.Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Alejandro Tomasello
- Department of Interventional Neurorradiology (A.T., C.P., D.H.), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Carlos Piñana
- Department of Interventional Neurorradiology (A.T., C.P., D.H.), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - David Hernández
- Department of Interventional Neurorradiology (A.T., C.P., D.H.), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - José Álvarez-Sabin
- Stroke Unit, Department of Neurology (A.G.-T., D.C., M. Rubiera, S.B., M.O.-G., M. Requena, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., E.S., J.A.-S., C.A.M., M.Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Carlos A Molina
- Stroke Unit, Department of Neurology (A.G.-T., D.C., M. Rubiera, S.B., M.O.-G., M. Requena, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., E.S., J.A.-S., C.A.M., M.Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Marc Ribó
- Stroke Unit, Department of Neurology (A.G.-T., D.C., M. Rubiera, S.B., M.O.-G., M. Requena, M.M., J.P., D.R.-L., M.D., J.J., N.R.-V., E.S., J.A.-S., C.A.M., M.Ribó), Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
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Trombka M, Demarzo M, Campos D, Antonio SB, Cicuto K, Walcher AL, García-Campayo J, Schuman-Olivier Z, Rocha NS. Mindfulness Training Improves Quality of Life and Reduces Depression and Anxiety Symptoms Among Police Officers: Results From the POLICE Study-A Multicenter Randomized Controlled Trial. Front Psychiatry 2021; 12:624876. [PMID: 33716824 PMCID: PMC7952984 DOI: 10.3389/fpsyt.2021.624876] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Police officers' high-stress levels and its deleterious consequences are raising awareness to an epidemic of mental health problems and quality of life (QoL) impairment. There is a growing evidence that mindfulness-based interventions are efficacious to promote mental health and well-being among high-stress occupations. Methods: The POLICE study is a multicenter randomized controlled trial (RCT) with three assessment points (baseline, post-intervention, and 6-month follow-up) where police officers were randomized to mindfulness-based health promotion (MBHP) (n = 88) or a waiting list (n = 82). This article focuses on QoL, depression and anxiety symptoms, and religiosity outcomes. Mechanisms of change and MBHP feasibility were evaluated. Results: Significant group × time interaction was found for QoL, depression and anxiety symptoms, and non-organizational religiosity. Between-group analysis showed that MBHP group exhibited greater improvements in QoL, and depression and anxiety symptoms at both post-intervention (QoL d = 0.69 to 1.01; depression d = 0.97; anxiety d = 0.73) and 6-month follow-up (QoL d = 0.41 to 0.74; depression d = 0.60; anxiety d = 0.51), in addition to increasing non-organizational religiosity at post-intervention (d = 0.31). Changes on self-compassion mediated the relationship between group and pre-to-post changes for all QoL domains and facets. Group effect on QoL overall health facet at post-intervention was moderated by mindfulness trait and spirituality changes. Conclusion: MBHP is feasible and efficacious to improve QoL, and depression and anxiety symptoms among Brazilian officers. Results were maintained after 6 months. MBHP increased non-organizational religiosity, although the effect was not sustained 6 months later. To our knowledge, this is the first mindfulness-based intervention RCT to empirically demonstrate these effects among police officers. Self-compassion, mindfulness trait, and spirituality mechanisms of change are examined. Clinical Trial Registration: www.ClinicalTrials.gov. identifier: NCT03114605.
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Affiliation(s)
- Marcelo Trombka
- Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Innovations and Interventions for Quality of Life Research Group, Porto Alegre, Brazil
- Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Cambridge Health Alliance, Center for Mindfulness and Compassion, Cambridge, MA, United States
| | - Marcelo Demarzo
- Mente Aberta, Brazilian Center for Mindfulness and Health Promotion, Department of Preventive Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Daniel Campos
- Department of Psychology and Sociology, University of Zaragoza, Huesca, Spain
- Grupo de Investigación en Salud Mental en Atención Primaria, Miguel Servet University Hospital, Zaragoza, Spain
| | - Sonia B. Antonio
- Mente Aberta, Brazilian Center for Mindfulness and Health Promotion, Department of Preventive Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Karen Cicuto
- Mente Aberta, Brazilian Center for Mindfulness and Health Promotion, Department of Preventive Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Ana L. Walcher
- Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Innovations and Interventions for Quality of Life Research Group, Porto Alegre, Brazil
- Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Javier García-Campayo
- Grupo de Investigación en Salud Mental en Atención Primaria, Miguel Servet University Hospital, Zaragoza, Spain
| | - Zev Schuman-Olivier
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Cambridge Health Alliance, Center for Mindfulness and Compassion, Cambridge, MA, United States
| | - Neusa S. Rocha
- Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Innovations and Interventions for Quality of Life Research Group, Porto Alegre, Brazil
- Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Llauradó A, Quintana M, Ballvé A, Campos D, Fonseca E, Abraira L, Toledo M, Santamarina E. Factors associated with resistance to benzodiazepines in status epilepticus. J Neurol Sci 2021; 423:117368. [PMID: 33652289 DOI: 10.1016/j.jns.2021.117368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate factors related to benzodiazepine (BZD) resistance in status epilepticus (SE) with a focus on their relationship with the etiology of the episode. METHODS All SE cases in patients aged >16 years treated with BZDs were prospectively collected in our center from February 2011 to April 2019. The registry included demographics, SE type and etiology, the timing and duration of BZD administration, and the outcome. In total, 371 episodes were analyzed. RESULTS Median age at SE onset was 61.3 years; the most frequent etiology was acute symptomatic (55.8%). SE with prominent motor symptoms occurred in 63.3%. Median time to BZD administration was 2 h. We studied the correlation between two-time variables: time from SE onset to BZD administration and time from BZD administration to resolution of SE (response); we observed that timely administration correlated with a faster response in patients with prominent motor symptoms (p = 0.017), SE due to a chronic structural cerebral lesion (p = 0.004), and patients with a history of seizures (p = 0.013). In these subgroups (prominent motor symptoms or chronic structural lesion) BZD administration within the first 4.5 h was highly associated with shorter post-BZD SE duration (p < 0.001). SIGNIFICANCE The relationship between prompt BZD administration and subsequent duration of SE was found to depend to some extent on the etiology of the episode: patients with chronic structural lesions and those with previous epilepsy responded faster to BZDs. Semiology may have also its impact, as the presence of prominent motor symptoms showed also a faster response.
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Affiliation(s)
- Arnau Llauradó
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Alejandro Ballvé
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Daniel Campos
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain.
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Carvalho Dias M, Gabriel D, Saraiva M, Campos D, Requena M, García-Tornel Á, Muchada M, Boned S, Rodriguez-Luna D, Rodriguez-Villatoro N, Pagola J, Juega J, Deck M, Ribo M, Tomasello A, Molina CA, Rubiera M. Spontaneous systolic blood pressure drop early after mechanical thrombectomy predicts dramatic neurological recovery in ischaemic stroke patients. Eur Stroke J 2021; 5:362-369. [PMID: 33598554 DOI: 10.1177/2396987320933384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 05/18/2020] [Indexed: 01/01/2023] Open
Abstract
Introduction Spontaneous blood pressure drop within the first 24 h has been reported following arterial recanalisation in ischaemic stroke patients. We aimed to assess if spontaneous blood pressure drop within the first hour after mechanical thrombectomy is a marker of early neurological recovery. Patients and methods Retrospective observational single-centre study including ischaemic stroke patients treated with mechanical thrombectomy. Blood pressure parameters from admission, mechanical thrombectomy start, mechanical thrombectomy end and hourly within 24 h after mechanical thrombectomy were reviewed. Primary outcome was early dramatic neurological recovery (8-point-reduction in NIHSS or NIHSS ≤ 2 at 24 h). Secondary outcome was functional independence at 90 days (mRankin 0-2). Results We included 458 patients in our analysis. Two-hundred (43.7%) patients achieved dramatic neurological recovery following mechanical thrombectomy. One hour after mechanical thrombectomy end, median systolic blood pressure was significantly different between outcome groups (129 vs. 138 mmHg, p = 0.005) and a higher drop in median systolic blood pressure was seen in the dramatic neurological recovery group (15 vs. 9 mmHg). Optimal cut-off for predicting dramatic neurological recovery was a systolic blood pressure drop of 10.5 mmHg (sensitivity 0.54, specificity 0.55, AUC 0.55). On multivariate analysis, spontaneous systolic blood pressure drop was associated with higher odds of achieving dramatic neurological recovery (OR for 10 mmHg blood pressure drop 1.14, 95% CI 1.01-1.29, p = 0.04). No significative association between any blood pressure parameter drop and functional independence at 90 days was found. Discussion We hypothesised that spontaneous systolic blood pressure drop is a marker of successful reperfusion and, therefore, a marker of improvement of cerebral autoregulation due to the reduced final ischaemic core. Conclusion Spontaneous systolic blood pressure drop after mechanical thrombectomy is an early predictor of dramatic neurological recovery.
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Affiliation(s)
- Mariana Carvalho Dias
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Denis Gabriel
- Neurology Department, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Marlene Saraiva
- Neurology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Daniel Campos
- Stroke Unit, Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Manuel Requena
- Stroke Unit, Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Marian Muchada
- Stroke Unit, Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Sandra Boned
- Stroke Unit, Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Jorge Pagola
- Stroke Unit, Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Jesus Juega
- Stroke Unit, Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Matías Deck
- Stroke Unit, Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Carlos A Molina
- Stroke Unit, Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Marta Rubiera
- Stroke Unit, Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain
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Saleiro C, Lopes J, Campos D, Puga L, Costa M, Goncalves L, Teixeira R. Direct oral anticoagulants versus vitamin-K antagonists for left ventricular thrombus - a systemic review and meta-analysis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Left ventricular (LV) thrombus is a current clinical problem. The incidence of systemic embolism (SE) is up to 16% in these patients and international guidelines recommend anticoagulation with vitamin-K antagonists (VKAs). Data on direct oral anticoagulants (DOACs) for LV thrombus is increasing but still with conflicting results.
Methods
We performed a systematic review and meta-analysis of studies assessing the efficacy of DOACs versus VKAs in LV thrombus resolution, SE events and/or stroke and bleedings events. We systematically searched PubMed and Cochrane database for studies comparing DOACs versus VKAs as anticoagulant strategy for LV thrombus. Random-effects meta-analysis was performed.
Results
Four studies were included: n= 727 patients (DOACs group – 243 patients vs VKAs group – 484 patients). There is a 40% reduction in the odds for achieving thrombus resolution in the group of patients treated with DOACs (pooled OR 0.60; 95% CI 0.43-0.85; I2 =0%; P = 0.003) - Figure 1A. No difference between groups for the odds of SE and/or stroke was observed during follow-up (pooled OR 1.75; 95% CI 0.92-3.35; I2 =0%; P = 0.09) - Figure 1B. Bleedings events were not different between both anticoagulant strategies (pooled OR 0.65; 95% CI 0.30-1.39; I2= 0%, P = 0.26) - Figure 1C.
Conclusion
Although probably with less efficacy for thrombus resolution, the use of DOAC for LV thrombus does not seem to increase the risk of SE and/or stroke or bleedings events compared to VKAs.
Abstract Figure 1 - Pooled analysis (DOAC vs VKA)
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Affiliation(s)
- C Saleiro
- University Hospitals of Coimbra, Coimbra, Portugal
| | - J Lopes
- University Hospitals of Coimbra, Coimbra, Portugal
| | - D Campos
- University Hospitals of Coimbra, Coimbra, Portugal
| | - L Puga
- University Hospitals of Coimbra, Coimbra, Portugal
| | - M Costa
- University Hospitals of Coimbra, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
| | - R Teixeira
- University Hospitals of Coimbra, Coimbra, Portugal
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Ferreira J, Raposo EP, Araújo HA, da Luz MGE, Viswanathan GM, Bartumeus F, Campos D. Landscape-scaled strategies can outperform Lévy random searches. Phys Rev E 2021; 103:022105. [PMID: 33736114 DOI: 10.1103/physreve.103.022105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
Information on the relevant global scales of the search space, even if partial, should conceivably enhance the performance of random searches. Here we show numerically and analytically that the paradigmatic uninformed optimal Lévy searches can be outperformed by informed multiple-scale random searches in one (1D) and two (2D) dimensions, even when the knowledge about the relevant landscape scales is incomplete. We show in the low-density nondestructive regime that the optimal efficiency of biexponential searches that incorporate all key scales of the 1D landscape of size L decays asymptotically as η_{opt}∼1/sqrt[L], overcoming the result η_{opt}∼1/(sqrt[L]lnL) of optimal Lévy searches. We further characterize the level of limited information the searcher can have on these scales. We obtain the phase diagram of bi- and triexponential searches in 1D and 2D. Remarkably, even for a certain degree of lack of information, partially informed searches can still outperform optimal Lévy searches. We discuss our results in connection with the foraging problem.
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Affiliation(s)
- J Ferreira
- Laboratório de Física Teórica e Computacional, Departamento de Física, Universidade Federal de Pernambuco, Recife-PE, 50670-901, Brazil
| | - E P Raposo
- Laboratório de Física Teórica e Computacional, Departamento de Física, Universidade Federal de Pernambuco, Recife-PE, 50670-901, Brazil
| | - H A Araújo
- Laboratório de Física Teórica e Computacional, Departamento de Física, Universidade Federal de Pernambuco, Recife-PE, 50670-901, Brazil
- Departamento de Matemática, Universidade Federal de Pernambuco, Recife-PE, 50670-901, Brazil
| | - M G E da Luz
- Departamento de Física, Universidade Federal do Paraná, Curitiba-PR, 81531-980, Brazil
| | - G M Viswanathan
- Department of Physics, Universidade Federal do Rio Grande do Norte, Natal-RN, 59078-970, Brazil
- National Institute of Science and Technology of Complex Systems, Universidade Federal do Rio Grande do Norte, Natal-RN, 59078-970, Brazil
| | - F Bartumeus
- Centre d'Estudis Avançats de Blanes-CEAB-CSIC, Girona, 17300, Spain
- CREAF, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, 08193, Spain
- Institució Catalana de Recerca i Estudis Avançats-ICREA, Barcelona, 08010, Spain
| | - D Campos
- Grup de Física Estadística, Departament de Física, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, 08193, Spain
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Méndez V, Masó-Puigdellosas A, Sandev T, Campos D. Continuous time random walks under Markovian resetting. Phys Rev E 2021; 103:022103. [PMID: 33736111 DOI: 10.1103/physreve.103.022103] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
We investigate the effects of Markovian resetting events on continuous time random walks where the waiting times and the jump lengths are random variables distributed according to power-law probability density functions. We prove the existence of a nonequilibrium stationary state and finite mean first arrival time. However, the existence of an optimum reset rate is conditioned to a specific relationship between the exponents of both power-law tails. We also investigate the search efficiency by finding the optimal random walk which minimizes the mean first arrival time in terms of the reset rate, the distance of the initial position to the target, and the characteristic transport exponents.
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Affiliation(s)
- Vicenç Méndez
- Grup de Física Estadística, Departament de Física, Facultat de Ciències, Edifici Cc., Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona), Spain
| | - Axel Masó-Puigdellosas
- Grup de Física Estadística, Departament de Física, Facultat de Ciències, Edifici Cc., Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona), Spain
| | - Trifce Sandev
- Research Center for Computer Science and Information Technologies, Macedonian Academy of Sciences and Arts, Bul. Krste Misirkov 2, 1000 Skopje, Macedonia
- Institute of Physics and Astronomy, University of Potsdam, D-14776 Potsdam-Golm, Germany
- Institute of Physics, Faculty of Natural Sciences and Mathematics, Ss. Cyril and Methodius University, Arhimedova 3, 1000 Skopje, Macedonia
| | - Daniel Campos
- Grup de Física Estadística, Departament de Física, Facultat de Ciències, Edifici Cc., Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona), Spain
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36
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Olivé-Gadea M, Requena M, Campos D, Garcia-Tornel A, Deck M, Muchada M, Boned S, Rodríguez N, Juega J, Rodríguez-Luna D, Pagola J, Rubiera M, Hernández-Jiménez M, Molina CA, Ribo M. Defining a Target Population to Effectively Test a Neuroprotective Drug. Stroke 2021; 52:505-510. [PMID: 33423513 DOI: 10.1161/strokeaha.120.032025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We aim to identify the subgroup of acute ischemic stroke patients with higher probabilities of benefiting from a potential neuroprotective drug using baseline outcome predictors and test whether different selection criteria strategies can improve detected treatment effect. METHODS We analyzed the association between final infarct volume (FIV), measured on 24- to 72-hour computed tomography, and National Institutes of Health Stroke Scale at discharge/day 5 of acute stroke patients who underwent endovascular treatment. Models were adjusted for age, sex, and affected hemisphere. We analyzed the impact of absolute (5-15 mL) and relative (33%) FIV reductions in the National Institutes of Health Stroke Scale in the whole population and in different subsets of patients selected according to baseline imaging criteria using computed tomography perfusion. RESULTS We analyzed 627 patients; association between FIV and 5-day National Institutes of Health Stroke Scale was best described with a quadratic function, with a regression coefficient β=1.56 ([95% CI, 1.45-1.67] P<0.001) in the adjusted analysis. In the models considering a fixed absolute (5/15 mL) FIV reduction, treatment effect was highest when patients with predicted larger FIV were excluded, whereas in a 33% FIV reduction model, treatment effect increased with the exclusion of patients with expected excellent outcomes. CONCLUSIONS Patients either with excellent outcomes after endovascular thrombectomy or with large infarcts may dilute the treatment effect in stroke neuroprotective drug trials. Computed tomography perfusion on admission may help selecting adequate patients according to expected drug effect profile.
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Affiliation(s)
- Marta Olivé-Gadea
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).,Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo)
| | - Manuel Requena
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).,Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo)
| | - Daniel Campos
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).,Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo)
| | - Alvaro Garcia-Tornel
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).,Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo)
| | - Matías Deck
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).,Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo)
| | - Marian Muchada
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).,Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo)
| | - Sandra Boned
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).,Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo)
| | - Noelia Rodríguez
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).,Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo)
| | - Jesús Juega
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).,Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo)
| | - David Rodríguez-Luna
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).,Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo)
| | - Jorge Pagola
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).,Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo)
| | - Marta Rubiera
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).,Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo)
| | | | - Carlos A Molina
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).,Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo)
| | - Marc Ribo
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo).,Departament de Medicina, Universitat Autònoma de Barcelona, Spain (M.O.-G., M. Requena, D.C., A.G.-T., M.D., M.M., S.B., N.R., J.J., D.R.-L., J.P., M. Rubiera, C.A.M., M. Ribo)
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Julian GS, Accetturi Pititto LM, Miresashvili N, Broe Honoré J, Lopes Assis Coelho RC, Campos D. Cost of microvascular complications in people with diabetes from a public healthcare perspective: a retrospective database study in Brazil. J Med Econ 2021; 24:1002-1010. [PMID: 34344240 DOI: 10.1080/13696998.2021.1963572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM To evaluate direct medical costs incurred by patients with diabetes in the periods before and after experiencing a microvascular complication from a Brazilian public healthcare system perspective. MATERIALS AND METHODS This was a retrospective, observational study using the Brazilian Unified Health System (DATASUS) database. Direct medical costs (hospitalization and outpatient) were extracted for patients with evidence of diabetes and a microvascular complication (January 2012-December 2018) and converted to 2019 US Dollars (USD). Length of hospital stays was also extracted. Mixed-effects logistic regression explored associations between demographic/clinical characteristics and incurrence of high direct medical costs (defined as the highest tertile of the annual costs ranked by median cost in the total population). RESULTS In total, 2,096 patients with diabetes experienced a microvascular complication and met study inclusion/exclusion criteria. Median [interquartile range] annual costs (USD/patient) were 176.3 [91.0; 481.2] at baseline, increasing to 1,678.5 [287.0; 6,908.4] and 5,172.4 [274.8; 7,395.9] in the first and second year after the complication, respectively. Median hospital stay was 2.0 and 3.0 days at baseline and in the first year, respectively. The odds of incurring high costs were substantially elevated in the first and second years (odds ratios of 69.9 and 84.7, respectively, vs. baseline, both p < .001). LIMITATIONS The DATASUS database covers secondary and tertiary care (not primary), adding selection bias to our sample. Additionally, our findings may not apply to the entire Brazilian population, as around 25% have some access to private healthcare. CONCLUSIONS This study demonstrates a large increase in costs, from the perspective of the Brazilian public healthcare system, in patients with diabetes after experiencing a microvascular complication compared with pre-complication costs. In addition to providing up-to-date cost estimates, our findings highlight the need to appraise the cost-effectiveness of evidence-based strategies that reduce the risk of diabetes-related microvascular complications in Brazilian patients.
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Cristín J, Bartumeus F, Méndez V, Campos D. Occupancy patterns in superorganisms: a spin-glass approach to ant exploration. R Soc Open Sci 2020; 7:201250. [PMID: 33489274 PMCID: PMC7813257 DOI: 10.1098/rsos.201250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
Emergence of collective, as well as superorganism-like, behaviour in biological populations requires the existence of rules of communication, either direct or indirect, between organisms. Because reaching an understanding of such rules at the individual level can be often difficult, approaches carried out at higher, or effective, levels of description can represent a useful alternative. In the present work, we show how a spin-glass approach characteristic of statistical physics can be used as a tool to characterize the properties of the spatial occupancy patterns of a biological population. We exploit the presence of pairwise interactions in spin-glass models for detecting correlations between occupancies at different sites in the media. Such correlations, we claim, represent a proxy to the existence of planned and/or social strategies in the spatial organization of the population. Our spin-glass approach does not only identify those correlations but produces a statistical replica of the system (at the level of occupancy patterns) that can be subsequently used for testing alternative conditions/hypothesis. Here, this methodology is presented and illustrated for a particular case of study: we analyse occupancy patterns of Aphaenogaster senilis ants during foraging through a simplified environment consisting of a discrete (tree-like) artificial lattice. Our spin-glass approach consistently reproduces the experimental occupancy patterns across time, and besides, an intuitive biological interpretation of the parameters is attainable. Likewise, we prove that pairwise correlations are important for reproducing these dynamics by showing how a null model, where such correlations are neglected, would perform much worse; this provides a solid evidence to the existence of superorganism-like strategies in the colony.
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Affiliation(s)
- Javier Cristín
- Grup de Física Estadística, Departament de Física, Facultat de Ciències), Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
| | - Frederic Bartumeus
- Centre d’Estudis Avançats de Blanes (CEAB-CSIC), Carrer Cala Sant Francesc 14 17300 Girona, Spain
- ICREA, Institut Català de Recerca i Estudis Avançats, 08010 Barcelona, Spain
- CREAF, Centre de Recerca Ecològica i Aplicacions Forestals, 08193 Barcelona, Spain
| | - Vicenç Méndez
- Grup de Física Estadística, Departament de Física, Facultat de Ciències), Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
| | - Daniel Campos
- Grup de Física Estadística, Departament de Física, Facultat de Ciències), Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
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Campos D, Escudero-Marín M, Snitman CM, Torres-Espínola FJ, Azaryah H, Catena A, Campoy C. The Nutritional Profile of Food Advertising for School-Aged Children via Television: A Longitudinal Approach. Children (Basel) 2020; 7:children7110230. [PMID: 33212760 PMCID: PMC7698276 DOI: 10.3390/children7110230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/16/2022]
Abstract
The prevalence of childhood obesity continues to increase. Screen time, one of the most documented reasons for the obesogenic environment, enhances childhood obesity, since advertisements for unhealthy food products are still broadcast on channels for children. This is presently one of the main challenges for the government in Spain, since the current laws and obligations are not updated. This study aims to analyze food advertising aimed at children on Spanish television in 2013 and 2018 on children's and general channels to test the effect of laws and obligations over time. In total, we viewed 512 h of the most viewed channels, two children's and two general channels, during the week and on weekends during specific periods of 2013 and 2018. Food advertising was categorized as core, non-core, and other food advertisement (CFA, NCFA, and OFA, respectively) according to the nutritional profile. A total of 2935 adverts were analyzed, 1263 in 2013 and 1672 in 2018. A higher proportion of NCFAs were broadcast on children's channels than in prior years, rising from 52.2% to 69.8% (p < 0.001). Nowadays, the risk of watching NCFAs on children's channels compared to general channels turns out to be higher (Odds ratio > 2.5; p < 0.001), due to exposure to adverts for high-sugar and high-fat foods such as cakes, muffins, cookies, and fried and frozen meals rich in fat. In conclusion, the trends of nutritional profiles in food advertising on television are worsening over time, since the prevalence of NCFAs was higher in 2018 than in 2013. Currently, CFAs are not mainly broadcast on children's channels, confirming high-risk exposure to non-core food advertising by watching them. Thus, food advertising laws and obligations should be adapted to increase compliance.
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Affiliation(s)
- Daniel Campos
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (M.E.-M.); (F.J.T.-E.); (H.A.)
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain;
- Correspondence: (D.C.); (C.C.); Tel.: +34-678-725-790 (D.C.); +34-607-631-601 (C.C.)
| | - Mireia Escudero-Marín
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (M.E.-M.); (F.J.T.-E.); (H.A.)
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain;
| | - Camila M. Snitman
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain;
| | - Francisco J. Torres-Espínola
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (M.E.-M.); (F.J.T.-E.); (H.A.)
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain;
| | - Hatim Azaryah
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (M.E.-M.); (F.J.T.-E.); (H.A.)
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain;
| | - Andrés Catena
- Mind, Brain and Behaviour International Research Centre (CIMCYC), University of Granada, 18011 Granada, Spain;
| | - Cristina Campoy
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (M.E.-M.); (F.J.T.-E.); (H.A.)
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain;
- Instituto de Investigación Biosanitaria de Granada (Ibs-GRANADA), Health Sciences Technological Park, 18012 Granada, Spain
- Spanish Network of Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada’s Node, Institute of Health Carlos III, 28029 Madrid, Spain
- Correspondence: (D.C.); (C.C.); Tel.: +34-678-725-790 (D.C.); +34-607-631-601 (C.C.)
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Sousa J, Puga L, Ribeiro J, Lopes J, Saleiro C, Gomes R, Campos D, Lourenco C, Goncalves L. Statins for venous thromboembolism prevention: old dog, new tricks. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Statins are highly effective in preventing major acute cardiovascular events in the setting of atherosclerotic arterial disease. On the other hand, given their antithrombotic and anti-inflammatory properties, statins may also attenuate patients' odds of developing venous thromboembolism (VTE). However, clinical studies have yielded variable estimates of this effect.
Purpose
To perform a meta-analysis designed to evaluate the extent to which statin use influences the rate of subsequent VTE events.
Methods
We systematically searched MEDLINE, Embase, Web of Science, Cochrane Library and Google Scholar for both randomized controlled trials (RCTs) and observational studies addressing the association between statins and VTE risk, published up until December 1, 2019. Manually reviewed references and key investigators interaction via e-mail correspondence were also data sources. RCTs comparing the effects of statin therapy with those of a placebo or no treatment were included, while interventional studies appraising different lipid-lowering pharmacological strategies were not. Observational studies encompassed both cohort and case-control designs. The primary endpoints were general VTE, deep vein thrombosis or pulmonary embolism. Patients with cancer, heart failure and chronic kidney disease (CKD) were further investigated separately. Study-specific relative risks (RRs) were pooled using generic inverse variance outcome meta-analytic technique with a random-effects model.
Results
23 RCTs comprising 118.464 participants, 12 cohort studies encompassing 2.881.184 patients and 9 case-control studies including 354.367 patients were regarded as eligible for quantitative evaluation. Specifically, 5 observational studies comprising 9.656 cancer patients, 3 studies encompassing 9.693 heart failure patients and 4 studies including 4.353 CKD patients were gathered. In RCTs, statin therapy was proven slightly superior to placebo or no treatment in lowering VTE incidence (RR 0.85, 95% CI 0.73–0.99, p=0.04, i2=14%). Observational studies were found to corroborate this effect, with statin treatment resulting in VTE risk reduction overall (RR 0.72, 95% CI 0.64–0.81, p<0.001, i2=84%) and in both cohort (RR 0.86, 95% CI 0.83–0.90, p<0.001, i2=85%) and case-control (RR 0.68, 95% CI 0.57–0.82, p<0.001, i2=80%) designs. This positive effect held true in cancer patients (RR 0.56, 95% CI 0.33–0.95, p=0.03, i2=78%), but not in those with heart failure (RR 0.7, 95% CI 0.42–1.16, p=0.17, i2=2%) and CKD (RR 1.04, 95% CI 0.67–1.60, p=0.87, i2=0%).
Conclusion
Currently available evidence suggests that statins significantly reduce patients' odds of developing VTE. Given their favorable safety profile and low cost, statin treatment should now be considered in high-risk individuals, particularly in those with cancer.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J.P Sousa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Puga
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Ribeiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - R Gomes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - D Campos
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro hospitalar de Coimbra, Coimbra, Portugal
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Sousa J, Puga L, Ribeiro J, Lopes J, Saleiro C, Gomes R, Campos D, Lourenco C, Goncalves L. Provisional versus 2-stent strategies for coronary bifurcations: is a bird in the hand worth two in the bush? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Among all subsets of coronary artery lesions, bifurcations stand out due to high incidence, demanding percutaneous interventions (PCIs) and poor outcomes. Amid the different PCI strategies, the provisional (PS) approach is generally recommended over 2-stent (TS) techniques, but this paradigm has been challenged.
Purpose
To compare PS with TS for PCI of coronary bifurcation lesions, concerning procedural aspects and both immediate and long-term patient outcomes.
Methods
Retrospective study encompassing patients consecutively referred to a tertiary interventional cardiology unit for coronary angiography, who were found to have at least 1 native bifurcation lesion. According to operator experience and angiographic features, patients were managed with PS or/(and) TS. Procedural aspects regarding radiological variables, angiographic success and immediate complications were reviewed, as were in-hospital outcomes. Besides, clinical follow-up, by clinic appointment or telephone calling, was performed targeting stent failure, target vessel revascularization (TVR), acute coronary syndromes (ACS), heart failure and mortality.
Results
From January 2010 to June 2017, 404 patients with 433 bifurcation lesions were included. Median age was 70 (62–77) years and 25.3% were female. Median follow-up was 2 (1–3) years. Chronic angina was the dominant PCI context (61.3%) with 9.7% presenting with ST-segment elevation myocardial infarction (MI). Medina class 1,1,1 was documented in 54.1% and 64.9% of lesions were hailed as true bifurcations. 303 patients underwent PS, whereas 67 were managed with TS, with TAP (43.3%) and mini-crush (34.3%) as the leading techniques. True bifurcations were more frequently approached with TS (p<0.001), whereas PCI context did not influence procedure selection. Fluoroscopy time (p<0.001), radiation dose (p=0.003) and contrast volume (p=0.009) were higher in the TS subgroup. OCT guidance (p=0.039) was also more common with TS. Angiographic success was uniformly high (95.1% for PS and 97% for TS), while procedural complications, including iatrogenic coronary dissections (7.4%, mostly minor) and slow-reflow (3.5%), were homogenously low. Acute kidney injury and type 4a MI occurred in 14.5% and 32.3%, respectively, also with no difference between groups. As for long-term outcomes, stent failure, encompassing both stent thrombosis (1 event) and restenosis (4.2%), occurred more often with TS (p=0.046), with ACS events (9.5%) following the same trend (p=0.08). In turn, rates of TVR (12.5%), heart failure hospitalization (6.2%) and mortality, regardless of its cardiovascular nature, were similar.
Conclusion
PS outperforms TS during follow-up, particularly due to lower stent failure odds. Thus, this study further supports the concept of PS as the standard approach for coronary bifurcation lesions.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J.P Sousa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Puga
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Ribeiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - R Gomes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - D Campos
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro hospitalar de Coimbra, Coimbra, Portugal
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Lopes J, Saleiro C, Campos D, Sousa J, Puga L, Gomes A, Ribeiro J, Lourenco C, Silva J, Goncalves L. Gender in non- ST elevation myocardial infarction and unstable angina: is there any equality? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Historically, women (W) with acute coronary syndrome (ACS) have worse outcomes compared with men (M). This fact may occur due to gender-specific differences in the presentation and management of patients (P), which were mainly observed in studies dealing with ST-segment elevation infarction (STEMI). There seems to be a gap of knowledge in gender-specific differences in non- ST elevation myocardial infarction (NSTEMI) and unstable angina (UA).
Purpose
Assess gender-specific differences in presentation, treatment and outcomes in NSTEMI and UA patients.
Methods
A retrospective cohort study from consecutive ACS patients enrolled in a multicentre national registry from October 2010 to December 2018 was conducted, identifying 11394 P admitted with NSTEMI or UA. Demographic, clinical and treatment variables were compared between male gender and female gender P.
A Cox multivariate regression was performed to evaluate predictor factors of stablished endpoints: mortality at 1-year (1y) and cardiovascular (CV) hospitalization at 1-year.
Results
A total 11394 P were included, 8145 M (71.5%) and 3249 W (28.5%), mean age of 68±13. W, comparing with M, had higher age (72±12 vs 66±13, p=0.001), higher prevalence of hypertension (85% vs 72%, p=0.001) and diabetes (41% vs 34%, p=0.001) and longer time from symptoms to hospital admission (360 minutes vs 297 minutes, p=0.001). Chest pain was less frequent as first symptom in W (85.6% vs 91.3%, p=0.001). In medical treatment, W had higher chance of not having administration of a loading dose of P2Y12 inhibitor (22.1% vs 18.1, p=0.001) and of being medicated with clopidogrel (85.7% vs 82.1%, p=0.002). At discharge, W were less frequently medicated with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (82.6% vs 84.4, p=0.028). Coronary angiography was less frequently performed in W (77.3% vs 85.7%, p=0.001). Coronary artery disease was less frequently found in the female gender (12.4% vs 4.8%, p=0.001).
In-hospital mortality was higher in W (2.9% vs 2.1%), but in the multivariate analysis the female gender was not an independent predictor of in-hospital mortality (OR 1.05 [0.67- 1.65], p=0.823). 1-year mortality was higher in W (9.2% vs 7.3%) and 1-year CV hospitalization was higher in M (16.8% vs 14.4%). After adjusting for covariates in Cox regression analysis, difference was still significant for mortality (HR= 1.274 [1.038 - 1.564], p=0.02) and hospitalization (HR = 0.852 [0.726- 0.998], p=0.047).
Conclusion
In this NSTEMI and UA cohort, there are important gender-specific differences in comorbidities, diagnosis, management and outcomes. Gender was an independent predictor of 1-year mortality and 1-year CV hospitalization, but not an independent predictor for in-hospital mortality.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Lopes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Saleiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - D Campos
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Sousa
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Puga
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A Gomes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Ribeiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Lourenco
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Silva
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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Morgado Gomes A, Campos D, Saleiro C, Gameiro Lopes J, Sousa J, Puga L, Antonio N, Goncalves L. Global longitudinal strain and chronic kidney disease prognostic impact on acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Impaired left ventricular ejection fraction (LVEF) and chronic kidney disease (CKD) have been associated with poorer outcomes in acute coronary syndrome (ACS). Increasing evidence on global left ventricular longitudinal strain (GLS) suggests superiority over left ventricular ejection fraction (LVEF) in risk stratification.
Methods
This study was based on a retrospective analysis of consecutive patients admitted to a Coronary Care Unit between 2009 and 2016. Baseline characteristics and echocardiographic parameters, including LVEF, were assessed. For each patient, a two-dimensional speckle tracking of the left ventricle was assessed and average GLS was calculated using 2, 3 and 4-chamber views. Blood creatinine was measured during hospital stay and used to estimate glomerular filtration rate (GFR) with Modification of Diet in Renal Disease (MDRD) equation. A cox regression analysis was performed to determine mortality prediction value of average GLS, LVEF and GFR in this population. Receiver operating characteristic (ROC) curve analysis was conducted and area under the curve (AUC) was estimated.
Results
A total of 85 patients (66.7±12.7 years old; 78.8% males) were enrolled. LVEF mean was 49.4±9.8% and average GLS was −16.0±4.0%. GFR median was 80.0±48.9 ml/min/1.73m2. In cox regression analysis, worse average GLS was associated with greater mortality (HR 0.721; 95% CI 0.599–0.867; P=0.001). GFR was inversely related to death (HR 0.967; 95% CI 0.944–0.991, P=0.008). In cox regression analysis using average GLS and GFR as covariates, both proved to be independent predictors of mortality (for average GLS, HR 0.748; 95% CI 0.610–0.918, P=0.005; for GFR, HR 0.974; 95% CI 0.949–0.999; P=0.044). The AUC of average GLS to predict mortality was 0.78 (P<0.001, sensitivity 50.7% and specificity 100%) and for average GLS and GFR combined was 0.85 (P<0.001, sensitivity 84.0% and specificity 77.8%). Although LVEF proved to be a mortality predictor, the AUC obtained by ROC curve analysis was inferior to average GLS, with statistical significance (P=0.043).
Conclusions
GLS and CKD proved to be independent predictors of mortality in ACS patients. GLS showed superiority when compared to LVEF in risk stratification and in the future it might replace LVEF. The model combining GLS and GFR emphasized the increased risk of CKD patients and how they should be seen as high-risk patients.
ROC curve analysis
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - D Campos
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | | | - J.P Sousa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Puga
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - N Antonio
- University Hospitals of Coimbra, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
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Lopes J, Monteiro M, Campos D, Saleiro C, Costa S, Sousa J, Puga L, Gomes A, Silva J, Ferreira M, Goncalves L. Isolated apical perfusion defect in SPECT-CT scans, is there any prognostic value? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Myocardial perfusion imaging (MPI) plays a significant role in diagnostic and therapeutic decision making in coronary artery disease (CAD). An isolated apical defect in the 17th segment in SPECT/CT scans is a common finding, sometimes attributed to the apical thinning phenomenon. However, the clinical significance of apical thinning or other isolated apical defects is unknown.
Purpose
The purpose of this study is to assess the prognostic impact of an isolated apical perfusion defect (17th segment) in patients (P) with suspicion of significant CAD.
Methods
A cohort of 612 consecutive P that underwent a MPI test with a SPECT/CT scanner, between January 2017 and December 2017, in a single nuclear medicine centre, was included in this retrospective study.
The inclusion criteria for this study were either a normal perfusion exam (group 1 – G1) or only an isolated apical defect in the 17th segment, either reversible suggesting ischemia (group 2 – G2) or fixed suggesting necrosis (group 3 – G3). Images with and without attenuation correction were analysed. Mean follow-up was 29±4 months.
The chi square test was used for categorical variables, and analysis of variance for continuous variables. Binary logistic regression was used to control for confounding.
Results
A total of 612 P were included (57% male sex, mean age of 69±10) and divided in G1 (n=494, 80.7%), G2 (n=62, 10%) and G3 (n=56, 9.2%). P in G3 had higher body mass index (31±7, p=0.028) and higher prevalence of dyslipidemia (84%, p=0.001), while P in G1 had lower ejection fraction at rest (54±15, p=0.001). There was no association between the presence of isolated apical defect and all- cause mortality (G1 = 7.3% vs G2 = 6.5% vs G3 = 5.4%, p=0.851). There was a statistically significant difference between groups in the referral for coronary angiography in the bivariate analysis (G1 = 7.9% vs G2 = 35.5% vs G3 = 10.7%, p=0.001), but this association did not remain when accounted for potential confounders (angina, ejection fraction, previous CAD and diabetes) – OR=3.94, 95% CI: [0.968–16.093], p=0.056.
In those P that underwent coronary angiography, there was no statistically significant difference between the 3 groups in revascularization of significant CAD (G1 = 38.5% vs G2 = 36.4% vs G3 = 50%, p=0.830). During the follow-up time, 11 P of group 1 suffered an acute coronary syndrome (ACS), but there were no events in group 2 or 3.
Conclusion
Isolated apical myocardial defect on a SPECT/CT exam has no association with all-cause mortality in this patients. There is no significant difference in referral for coronary angiography or need for coronary revascularization between P with normal exams and P with isolated apical defects.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Lopes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - M Monteiro
- University Hospitals of Coimbra, Nuclear Medicine, Coimbra, Portugal
| | - D Campos
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Saleiro
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - S Costa
- University Hospitals of Coimbra, Internal Medicine, Coimbra, Portugal
| | - J Sousa
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Puga
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A Gomes
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Silva
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - M Ferreira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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Sousa J, Puga L, Ribeiro J, Lopes J, Saleiro C, Gomes R, Campos D, Lourenco C, Goncalves L. Ranolazine as you have never seen it before: an antiarrhythmic for atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Currently available pharmacological options for rhythm control in atrial fibrillation (AF) are overshadowed by suboptimal efficacy and both frequent and potentially severe adverse events. Recent studies have added evidence to the hypothesis that ranolazine might exert antiarrhythmic effects, particularly in atrial tachyarrhythmias.
Purpose
To perform a systematic review with meta-analysis in order to ascertain the potential role of ranolazine in the management of AF.
Methods
We systematically searched MEDLINE, Embase and Scopus for randomized controlled trials (RCTs) and cohort studies addressing the association between ranolazine and AF outcomes, published up until December 1, 2019. The primary endpoint was incidence of AF, which was evaluated under a ranolazine versus placebo design. In this regard, patients in the setting of postcardiac surgery were further investigated separately. Secondary endpoints included AF cardioversion outcomes, which were addressed through comparison between ranolazine plus amiodarone and amiodarone alone for proportional efficacy and temporal requirements (time-to-cardioversion). The latter analysis was also undertaken in a dose-sensitive fashion (≤1000mg vs. 1500mg of ranolazine). Tertiary endpoints covered AF burden and episodes, in paroxysmal AF patients, and safety outcomes, namely death, QTc interval prolongation and hypotension. Study-specific odds ratios (ORs) were pooled using meta-analytic techniques with a random-effects model.
Results
A total of 10 RCTs comprising 8.109 participants and 3 cohort studies encompassing 37.112 patients were regarded as eligible for evaluation. Ranolazine was found to attenuate patients' odds of developing AF (OR 0.53, 95% CI: 0.41–0.69, p<0.001, i2=58%). This effect held true, with an even larger effect size, in the context of post-cardiac surgery (OR 0.34, 95% CI: 0.16–0.72, p=0.005, i2=64%). Ranolazine increased the chances of successful AF cardioversion when added to amiodarone over amiodarone alone (OR 6.67, 95% CI: 1.49–29.89, p=0.01, i2=76%), while significantly reducing time-to-cardioversion [SMD 9.54h, 95% CI: −13.3–5.75, p<0.001, i2=99%]. Interestingly, cardioversion was faster with ≤1000mg of ranolazine (SMD −13.16h, 95% CI: −15.07–11.25, p<0.001, i2=95%) than with 1500mg (SMD −3.57h, 95% CI: −5.06–2.08, p<0.001, i2=23%). In paroxysmal AF, ranolazine was also proved to significantly reduce both AF burden and episodes. There were no safety signals regarding mortality odds, QTc interval prolongation (mostly clinically insignificant) and hypotension (mostly transitory).
Conclusion
Current evidence suggests that ranolazine provides an effective and safe option for a chemical rhythm control strategy in AF management, a field in which medical breakthroughs are desperately needed.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J.P Sousa
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Puga
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Ribeiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - J Lopes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Saleiro
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - R Gomes
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - D Campos
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - C Lourenco
- Centro hospitalar de Coimbra, Coimbra, Portugal
| | - L Goncalves
- Centro hospitalar de Coimbra, Coimbra, Portugal
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Fernandes GDS, Campos D, Ballalai A, Palhares R, Alvares-da-Silva MR, Palhares DMF, Neto BHF, Barros FMDR, Gil RDA, Chagas A, Carrilho FJ. Author Correction: Epidemiological and Clinical Patterns of Newly Diagnosed Hepatocellular Carcinoma in Brazil: the Need for Liver Disease Screening Programs Based on Real-World Data. J Gastrointest Cancer 2020; 52:959. [PMID: 33103212 DOI: 10.1007/s12029-020-00539-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gustavo Dos Santos Fernandes
- Centro de Oncologia, Hospital Sírio-Libanês, SGAS 613/614, Conjunto E, Lote 95, Brasilia, DF, CEP 70200730, Brazil. .,Sociedade Brasileira de Oncologia Clínica, Sao Paulo, SP, Brazil.
| | | | | | | | - Mario R Alvares-da-Silva
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Daniel M F Palhares
- Centro de Oncologia, Hospital Sírio-Libanês, SGAS 613/614, Conjunto E, Lote 95, Brasilia, DF, CEP 70200730, Brazil
| | - Ben-Hur F Neto
- Consultant Surgeon at Diagnósticos da América SA (DASA) e Associação Brasileira de Linfoma e Leucemia (ABRALE), Sao Paulo, SP, Brazil
| | | | - Roberto de A Gil
- Serviço de Oncologia Clínica do INCA e Oncoclínica Centro de Tratamento Oncológico, Rio de Janeiro, RJ, Brazil
| | - Aline Chagas
- Hospital das Clínicas da Faculdade de Medicina da USP e Instituto do Câncer do Estado de São Paulo (ICESP), Sao Paulo, SP, Brazil
| | - Flair José Carrilho
- Hospital das Clínicas da Faculdade de Medicina da USP e Instituto do Câncer do Estado de São Paulo (ICESP), Sao Paulo, SP, Brazil
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Llauradó A, Santamarina E, Fonseca E, Olivé M, Requena M, Sueiras M, Guzmán L, Ballvé A, Campos D, Seijó I, Abraira L, Quintana M, Toledo M. How soon should urgent EEG be performed following a first epileptic seizure? Epilepsy Behav 2020; 111:107315. [PMID: 32694039 DOI: 10.1016/j.yebeh.2020.107315] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Patients with a first unprovoked epileptic seizure are often seen in emergency services. Electroencephalography (EEG) is indicated for diagnosing epilepsy, but the optimal time to perform this test has not been defined. This study aimed to determine the time interval following a seizure within which EEG has the greatest diagnostic yield. METHODS We conducted a retrospective study of all adult patients with a first unprovoked seizure who had undergone emergency EEG (July 2014-December 2019). Data collection included demographics, seizure type, time interval to EEG study, EEG pattern identified, and the prescription after emergency assessment. An optimal cut-off point for time to EEG was obtained, and an adjusted regression model was performed to establish associations with the presence of epileptiform abnormalities. RESULTS A total of 170 patients were included (mean age: 50.7 years, 40.6% women). Epileptiform discharges were identified in 34.1% of recordings, nonepileptiform abnormalities in 46.5%, and normal findings in 19.4%. A lower latency from seizure to EEG was associated with a higher probability of finding epileptiform discharges (median: 12.7 in the epileptiform EEGs vs. 20 h in the nonepileptiform EEGs, p < 0.001). The time interval associated with the highest probability of detecting an epileptiform EEG pattern was within the first 16 h after seizure onset: 52.1% of recordings performed before the 16-h cut-off showed these abnormal patterns compared with 20.2% performed after (p < 0.001). These findings were not related to the presence of an epileptogenic lesion in neuroimaging or to other clinical variables. The finding of epileptiform abnormalities was followed by a greater prescription of antiseizure drugs (96.4% vs. 66% in nonepileptiform patterns, p < 0.001). CONCLUSION The diagnostic yield of EEG following a first unprovoked epileptic seizure is highest when this test is performed within the first 16 h after onset of the event.
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Affiliation(s)
- A Llauradó
- Neurology Department, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - E Santamarina
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain.
| | - E Fonseca
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - M Olivé
- Neurology Department, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - M Requena
- Neurology Department, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - M Sueiras
- EEG Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - L Guzmán
- EEG Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - A Ballvé
- Neurology Department, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - D Campos
- Neurology Department, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - I Seijó
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - L Abraira
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - M Quintana
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - M Toledo
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
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Fernandes GDS, Campos D, Ballalai A, Palhares R, da Silva MRA, Palhares DMF, Neto BHF, Barros FMDR, Gil RDA, Chagas A, Carrilho FJ. Epidemiological and Clinical Patterns of Newly Diagnosed Hepatocellular Carcinoma in Brazil: the Need for Liver Disease Screening Programs Based on Real-World Data. J Gastrointest Cancer 2020; 52:952-958. [PMID: 32918274 PMCID: PMC8376733 DOI: 10.1007/s12029-020-00508-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose Describe sociodemographic and clinical characteristics of patients with hepatocellular carcinoma (HCC) and establish their history in the Brazilian public health system. Methods Retrospective observational study was conducted using the database from the Department of Informatics of the Unified Health System (DataSUS). Patients with at least one claim of HCC between July/2011 and June/2016 were included. A record linkage methodology was performed to obtain longitudinal data across different databases. Demographic and clinical data were evaluated, including the time elapsed between diagnosis of HCC risk-factors and the cancer development. Data was analyzed using descriptive statistics. Results A total of 28,822 HCC cases were identified between July/2011 and June/2016. Mean age was 59.7 years (SD = 14.7), and most patients were men (55.9%). The highest relative number of HCC cases was detected in the south of Brazil (> 20 cases/100,000 inhabitants). About 86.5% of the patients had diagnosis of HCC without previous liver diseases. Only 8% had diagnosis of chronic viral hepatitis and 3.5% cirrhosis. About 76% were diagnosed at an advanced stage, and only 11% of the patients had early stage HCC. Approximately 58% of patients with previous underlying liver diseases were diagnosed at early stages, compared with only 24% of patients without prior record of underlying diseases. Conclusion The diagnosis of HCC in the Brazilian public health is usually made in patients with no previous diagnosis of liver disease and in advanced stages, when no curative treatment is available and survival rates are low. Public health policies are key for the screening and monitoring liver disease and, consequently, HCC.
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Affiliation(s)
- Gustavo Dos Santos Fernandes
- Centro de Oncologia, Hospital Sírio-Libanês, SGAS 613/614, Conjunto E, Lote 95, Brasilia, DF, CEP 70200730, Brazil. .,Sociedade Brasileira de Oncologia Clínica, Sao Paulo, SP, Brazil.
| | | | | | | | - Mario R A da Silva
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Daniel M F Palhares
- Centro de Oncologia, Hospital Sírio-Libanês, SGAS 613/614, Conjunto E, Lote 95, Brasilia, DF, CEP 70200730, Brazil
| | - Ben-Hur F Neto
- Consultant Surgeon at Diagnósticos da América SA (DASA) e Associação Brasileira de Linfoma e Leucemia (ABRALE), Sao Paulo, SP, Brazil
| | | | - Roberto de A Gil
- Serviço de Oncologia Clínica do INCA e Oncoclínica Centro de Tratamento Oncológico, Rio de Janeiro, RJ, Brazil
| | - Aline Chagas
- Hospital das Clínicas da Faculdade de Medicina da USP e Instituto do Câncer do Estado de São Paulo (ICESP), Sao Paulo, SP, Brazil
| | - Flair José Carrilho
- Hospital das Clínicas da Faculdade de Medicina da USP e Instituto do Câncer do Estado de São Paulo (ICESP), Sao Paulo, SP, Brazil
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Azaryah H, Verdejo-Román J, Martin-Pérez C, García-Santos JA, Martínez-Zaldívar C, Torres-Espínola FJ, Campos D, Koletzko B, Pérez-García M, Catena A, Campoy C. Effects of Maternal Fish Oil and/or 5-Methyl-Tetrahydrofolate Supplementation during Pregnancy on Offspring Brain Resting-State at 10 Years Old: A Follow-Up Study from the NUHEAL Randomized Controlled Trial. Nutrients 2020; 12:E2701. [PMID: 32899673 PMCID: PMC7551257 DOI: 10.3390/nu12092701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 01/10/2023] Open
Abstract
Recent studies have shown that maternal supplementation with folate and long-chain polyunsaturated fatty acids (LC-PUFAs) during pregnancy may affect children's brain development. We aimed at examining the potential long-term effect of maternal supplementation with fish oil (FO) and/or 5-methyl-tetrahydrofolate (5-MTHF) on the brain functionality of offspring at the age of 9.5-10 years. The current study was conducted as a follow-up of the Spanish participants belonging to the Nutraceuticals for a Healthier Life (NUHEAL) project; 57 children were divided into groups according to mother's supplementation and assessed through functional magnetic resonance imaging (fMRI) scanning and neurodevelopment testing. Independent component analysis and double regression methods were implemented to investigate plausible associations. Children born to mothers supplemented with FO (FO and FO + 5-MTHF groups, n = 33) showed weaker functional connectivity in the default mode (DM) (angular gyrus), the sensorimotor (SM) (motor and somatosensory cortices) and the fronto-parietal (FP) (angular gyrus) networks compared to the No-FO group (placebo and 5-MTHF groups, n = 24) (PFWE < 0.05). Furthermore, no differences were found regarding the neuropsychological tests, except for a trend of better results in an object recall (memory) test. Considering the No-FO group, the aforementioned networks were associated negatively with attention and speed-processing functions. Mother's FO supplementation during pregnancy seems to be able to shape resting-state network functioning in their children at school age and appears to produce long-term effects on children´s cognitive processing.
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Affiliation(s)
- Hatim Azaryah
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (H.A.); (J.A.G.-S.); (C.M.-Z.); (F.J.T.-E.); (D.C.)
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
| | - Juan Verdejo-Román
- Mind, Brain and Behaviour International Research Centre (CIMCYC), University of Granada, 18011 Granada, Spain; (J.V.-R.); (C.M.-P.); (M.P.-G.); (A.C.)
| | - Cristina Martin-Pérez
- Mind, Brain and Behaviour International Research Centre (CIMCYC), University of Granada, 18011 Granada, Spain; (J.V.-R.); (C.M.-P.); (M.P.-G.); (A.C.)
| | - José Antonio García-Santos
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (H.A.); (J.A.G.-S.); (C.M.-Z.); (F.J.T.-E.); (D.C.)
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (Ibs-GRANADA), Health Sciences Technological Park, 18012 Granada, Spain
| | - Cristina Martínez-Zaldívar
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (H.A.); (J.A.G.-S.); (C.M.-Z.); (F.J.T.-E.); (D.C.)
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
| | - Francisco J. Torres-Espínola
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (H.A.); (J.A.G.-S.); (C.M.-Z.); (F.J.T.-E.); (D.C.)
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
| | - Daniel Campos
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (H.A.); (J.A.G.-S.); (C.M.-Z.); (F.J.T.-E.); (D.C.)
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
| | - Berthold Koletzko
- Ludwig-Maximiliams-Universität München, Dr. von Hauner Children’s Hospital, University of Munich Hospitals, 80337 Munich, Germany;
| | - Miguel Pérez-García
- Mind, Brain and Behaviour International Research Centre (CIMCYC), University of Granada, 18011 Granada, Spain; (J.V.-R.); (C.M.-P.); (M.P.-G.); (A.C.)
| | - Andrés Catena
- Mind, Brain and Behaviour International Research Centre (CIMCYC), University of Granada, 18011 Granada, Spain; (J.V.-R.); (C.M.-P.); (M.P.-G.); (A.C.)
| | - Cristina Campoy
- Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain; (H.A.); (J.A.G.-S.); (C.M.-Z.); (F.J.T.-E.); (D.C.)
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (Ibs-GRANADA), Health Sciences Technological Park, 18012 Granada, Spain
- Spanish Network of Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada’s Node, Institute of Health Carlos III, 28029 Madrid, Spain
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Julian GS, Campos D, Broe Honore J, Sauer Tobaruella F, Hyun Yoon J, Hallén N. Cost of macrovascular complications in people with diabetes from a public healthcare perspective: a retrospective database study in Brazil. J Med Econ 2020; 23:985-993. [PMID: 32372710 DOI: 10.1080/13696998.2020.1764966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Aims: To evaluate costs in patients with diabetes who experienced a macrovascular complication from a Brazilian public healthcare system perspective.Materials and methods: A retrospective, observational study that utilized the database of the Brazilian Unified Health System (DATASUS). Data for direct medical costs (hospitalization and outpatient) were extracted for patients with diabetes and a macrovascular complication (1 January 2012-31 December 2018) and converted to US Dollars (2019 USD). Mixed-effects logistic regression explored associations between demographic and clinical characteristics with the incurrence of high direct medical costs.Results: In total, 1,668 (0.2%) patients with diabetes met study inclusion criteria and experienced a macrovascular complication, either alone (N = 1,193) or together with a microvascular complication (N = 475). Median [95% CI] annual costs (USD/patient) were 130.5 [90.7; 264.2] at baseline, increasing to 334.0 [182.2; 923.5] in the first year after the complication. The odds of incurring high costs were significantly elevated in the first and second year (vs. baseline), and in patients who experienced a macrovascular and microvascular complication (vs. macrovascular alone) (all p < 0.001).Limitations: The DATASUS database does not cover primary care (it covers secondary and tertiary care), adding a selection bias to the sample. Additionally, our findings may not be representative of the entire Brazilian population given that approximately 75% of the population of Brazil depend exclusively on the SUS, while the remaining 25% have some access to private healthcare.Conclusions: This study has demonstrated higher medical costs from the perspective of the Brazilian public healthcare system in patients with diabetes after experiencing a macrovascular complication, either alone or in conjunction with a microvascular complication, in comparison with costs before the complication(s). In addition to providing up-to-date cost estimates, our findings highlight the need to implement strategies to reduce the cardiovascular risk in Brazilian patients with diabetes and drive cost savings.
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Affiliation(s)
| | | | | | | | - Jung Hyun Yoon
- Novo Nordisk Farmacêutica Do Brasil Ltda, São Paulo, Brazil
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