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Evaluate the relevance of the COVID 19 positive case detection policy or model implemented by the Ministry of Public Health (MPH) of Ecuador and to compare it with the experiences of other countries.
Data contained the daily reports publicized by the MPH. The formulations were carried out under the Conditioned Probability modality applying Bayes’ Theorem. All the COVID-19 tests applied in relation to the confirmed cases per million inhabitants were considered, in order to obtain their level of positivity, and compared with the experience of Iceland and South Korea.
The probability of detecting positive cases of COVID-19 in Ecuador was higher than Iceland and South Korea, since the diagnostic tests were aimed at symptomatic patients, without identifying asymptomatic or mild symptomatic, who play an important role in the transmission of the disease. In addition, many symptomatic patients were examined but will remain undiagnosed due to the unavailability of tests and the low quality of many of them.
The daily reports on the behavior of the COVID-19 issued by the Ecuadorian government do not adequately represent the growth in the number of those infected each day, nor the actual behavior of the epidemic, affecting possible control measures.
The coronavirus disease 2019 (COVID-19) pandemic has induced a reinforcement of infection control measures in the hospital setting. Here, we assess the impact of the COVID-19 pandemic on the incidence of nosocomial Clostridioides difficile infection (CDI).
We retrospectively compared the incidence density (cases per 10,000 patient days) of healthcare-facility–associated (HCFA) CDI in a tertiary-care hospital in Madrid, Spain, during the maximum incidence of COVID-19 (March 11 to May 11, 2020) with the same period of the previous year (control period). We also assessed the aggregate in-hospital antibiotic use (ie, defined daily doses [DDD] per 100 occupied bed days [BD]) and incidence density (ie, movements per 1,000 patient days) of patient mobility during both periods.
In total, 2,337 patients with reverse transcription-polymerase chain reaction–confirmed COVID-19 were admitted to the hospital during the COVID-19 period. Also, 12 HCFA CDI cases were reported at this time (incidence density, 2.68 per 10,000 patient days), whereas 34 HCFA CDI cases were identified during the control period (incidence density, 8.54 per 10,000 patient days) (P = .000257). Antibiotic consumption was slightly higher during the COVID-19 period (89.73 DDD per 100 BD) than during the control period (79.16 DDD per 100 BD). The incidence density of patient movements was 587.61 per 1,000 patient days during the control period and was significantly lower during the COVID-19 period (300.86 per 1,000 patient days) (P < .0001).
The observed reduction of ~70% in the incidence density of HCFA CDI in a context of no reduction in antibiotic use supports the importance of reducing nosocomial transmission by healthcare workers and asymptomatic colonized patients, reinforcing cleaning procedures and reducing patient mobility in the epidemiological control of CDI.
Social and environmental factors such as poverty or violence modulate the risk and course of schizophrenia. However, how they affect the brain in patients with psychosis remains unclear.
We studied how environmental factors are related to brain structure in patients with schizophrenia and controls in Latin America, where these factors are large and unequally distributed.
This is a multicentre study of magnetic resonance imaging in patients with schizophrenia and controls from six Latin American cities. Total and voxel-level grey matter volumes, and their relationship with neighbourhood characteristics such as average income and homicide rates, were analysed with a general linear model.
A total of 334 patients with schizophrenia and 262 controls were included. Income was differentially related to total grey matter volume in both groups (P = 0.006). Controls showed a positive correlation between total grey matter volume and income (R = 0.14, P = 0.02). Surprisingly, this relationship was not present in patients with schizophrenia (R = −0.076, P = 0.17). Voxel-level analysis confirmed that this interaction was widespread across the cortex. After adjusting for global brain changes, income was positively related to prefrontal cortex volumes only in controls. Conversely, the hippocampus in patients with schizophrenia, but not in controls, was relatively larger in affluent environments. There was no significant correlation between environmental violence and brain structure.
Our results highlight the interplay between environment, particularly poverty, and individual characteristics in psychosis. This is particularly important for harsh environments such as low- and middle-income countries, where potentially less brain vulnerability (less grey matter loss) is sufficient to become unwell in adverse (poor) environments.
When the United States invaded Nicaragua in 1912 the popular reaction in El Salvador was so strong that it completely upended politics. The article argues that this anti-imperialist movement, completely ignored by the current historiography, forced Salvadorean governments to make decisions regarding foreign policy that would have been unthinkable had it not been for the pressure from below. Popular pressures contributed to limit the scope of the final version of the Chamorro–Bryan Treaty between the United States and Nicaragua. The treaty did not include Platt Amendment-like provisions. Moreover, the Wilson administration abandoned the idea of extending a protectorate to all the Central American countries and building a naval base in the Gulf of Fonseca.
Humans can see the world around them, imagine how it might be different, and translate those imaginings into reality ‥ or at least try to. This ability plays a significant role in our lineage’s evolutionary success. Meaning, imagination, and hope are as central to the human evolutionary story as are bones, genes, and ecologies. Paleoanthropological, archaeological, and biological data make it abundantly clear that the human lineage, over the last 2 million years, has undergone specific morphological changes alongside less easily measurable, but significant behavioral and cognitive shifts as it has forged and been shaped by a new niche, a highly distinctive way of being in the world – a human niche, a niche in which imagination is a key factor. This chapter offers a brief overview of this history and highlights how developmental processes of the human body and brain evolve as a system that is always in concert with, and mutually co-constitutive of, the linguistic, socially mediated and constructed structures, institutions, and beliefs that make up key aspects of the human niche.
In Chile, two quinoa ecotypes are grown: salares, also present in the highlands of Bolivia, and coastal, in central and southern areas of the country, at sea level. Genotypes from the coastal ecotype have characteristics that differentiate them from the most popular quinoa genotypes grown in the Andean Region of South America. The objectives of this study were: (1) to determine the cardinal temperatures for seed germination in quinoa genotypes from coastal and salares ecotypes cultivated in Chile, and (2) to study the presence of physiological dormancy (PD) in these genotypes. Seed germination from nine quinoa genotypes, two from salares and seven from coastal ecotypes, was evaluated in a gradient of temperatures between 11 and 42°C. Germination was also evaluated at 20°C at 0, 7 and 15 months from harvest. Results showed that seed from the nine genotypes germinated at their maximum percentage between 11 and 35°C. However, their faster germination occurred between 25 and 35°C. There was a significant difference between optimum temperature for germination between genotypes from coastal (28°C) and salares (30°C). An increase in germination rates after 7 months of storage suggested the presence of a non-deep PD in seeds from coastal ecotype, which may be useful to improve pre-harvest sprouting resistance in quinoa breeding programmes.
The giant gypsum crystals of Naica cave have fascinated scientists since their discovery in 2000. Human activity has changed the microclimate inside the cave, making scientists wonder about the potential environmental impact on the crystals. Over the last 9 years, we have studied approximately 70 samples. This paper reports on the detailed chemical–structural characterization of the impurities present at the surface of these crystals and the experimental simulations of their potential deterioration patterns. Selected samples were studied by petrography, optical and electronic microscopy, and laboratory X-ray diffraction. 2D grazing incidence X-ray diffraction, X-ray μ-fluorescence, and X-ray μ-absorption near-edge structure were used to identify the impurities and their associated phases. These impurities were deposited during the latest stage of the gypsum crystal formation and have afterward evolved with the natural high humidity. The simulations of the behavior of the crystals in microclimatic chambers produced crystal dissolution by 1–4% weight fraction under high CO2 concentration and permanent fog, and gypsum phase dehydration under air and CO2 gaseous environment. Our work suggests that most surface impurities are of natural origin; the most significant anthropogenic damage on the crystals is the extraction of water from the caves.
Latin America is one of the world's only regions to have witnessed a fall in income inequality during the 2000s. This paper evaluates the role fiscal policy played in this change. Recent scholarship has examined this in individual countries; lacking is a regional perspective. We examine the effects of nine fiscal instruments on income inequality in 17 countries between 1990 and 2014. Fiscal policy had a positive – albeit small – effect in reducing income inequality, especially from 2003, working best at the urban level. Public spending on education, personal income taxes and social contributions were especially instrumental in reducing income inequality.
One hypothesis proposed to underlie formal thought disorder (FTD), the incoherent speech is seen in some patients with schizophrenia, is that it reflects impairment in frontal/executive function. While this proposal has received support in neuropsychological studies, it has been relatively little tested using functional imaging. This study aimed to examine brain activations associated with FTD, and its two main factor-analytically derived subsyndromes, during the performance of a working memory task.
Seventy patients with schizophrenia showing a full range of FTD scores and 70 matched healthy controls underwent fMRI during the performance of the 2-back version of the n-back task. Whole-brain corrected, voxel-based correlations with FTD scores were examined in the patient group.
During 2-back performance the patients showed clusters of significant inverse correlation with FTD scores in the inferior frontal cortex and dorsolateral prefrontal cortex bilaterally, the left temporal cortex and subcortically in the basal ganglia and thalamus. Further analysis revealed that these correlations reflected an association only with ‘alogia’ (poverty of speech, poverty of content of speech and perseveration) and not with the ‘fluent disorganization’ component of FTD.
This study provides functional imaging support for the view that FTD in schizophrenia may involve impaired executive/frontal function. However, the relationship appears to be exclusively with alogia and not with the variables contributing to fluent disorganization.
Previously, we showed the usefulness of the REF scale to assess referential thinking (Rodríguez-Testal et al., 2001; 2009) although it isn’t specific for patients with psychotic disorders (Rodríguez-Testal et al., 2008).
This instrumental work aims to replicate the exploratory factor analysis about the Referential Thinking Scale (REF scale) already developed by Lenzenweger et al. (1997) to examine its multidimensionality.
Participants: The analyzed sample consisted of 193 participants (67.36% women, mean 28.36 years old, SD = 10.35), of whom 131 were patients.
Design, materials and procedure: We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language. This questionnaire consists of 34 items that assess the frequency of referential thinking on a dichotomic scale (true/false). We used SPSS 15.0 to conduct a principal-components factor analysis with a varimax and oblimin rotation.
The principal-components factor analysis method led to 5 factors that explain 37.35% of variance for the rotated solution. Because of inter-factors correlations are small, we considered these factors as being independent. The five factors were labeled as: Laughter, Commentaries (it accounted for 8.92% of variance); Guilt (it accounted for 8.77% of variance); Causal Explanations (it accounted for 7.17% of variance); Songs, Newspapers, Books (it accounted for 6.44% of variance); and Attention, Appearance (it accounted for 6.04% of variance).
It's obtained the five factors isolated in previous studies (Lenzenweger et al., 1997; Rodríguez-Testal et al., 2001). However, the multidimensionality of the REF scale must be viewed with caution because of a small percentage of explained variance.
The use of psychiatric services has been associated with a wide range of clinical variables. However, information about the impact of adolescent personality pathology related to hospital admissions is limited.
To analyze the different combination of personality pathology associated to variables of psychiatric hospital admissions (number of admissions, total of days spent as psychiatric inpatient, average of days for admission, and number of admissions in a day care hospital).
The ICD-10 and DSM-IV modules of the semi-structured interview IPDE (International Personality Disorders Examination) were administered, in a sample of 107 adolescent psychiatric patients (M=15.8, SD=0.8 years old; age rank 15-17; 79% female).
Personality pathology group identified by the IPDE showed significantly higher number (p< .001) of psychiatric admissions (M=1.48) than no personality pathology group (M=0.57), but not significant higher number of admissions in a day care hospital. Psychotic patients showed the highest rate of admissions (M=2.88). In present sample, between 30% and 38% of all hospital admitted patients showed a Cluster B personality disorder (PD).The users of psychiatric inpatient services with a complex PD (two o more PD from different clusters) presents in average: 2-2.5 admissions, 34-53 total days spent as psychiatric inpatient, and 11-16 days on each admission.
Patients with psychotic disorders or complex PD were the highest users of inpatients services, but not of day care hospital admissions.
Kernberg's classification of personality disorders (1987) differentiates psychic organization according to the severity: neurotic, borderline and psychotic. Lenzenweger et al. (2001) used a reduced version of IPO with 57 items developed by Kernberg and Clarkin (1995).
Objectives and hypothesis
IPO was applied in a sample of patients and a control group. We expected to find an adequate reliability and validity of the inventory. Scales adequately distinguish content borderline, neurotic and psychotic.
Participants: 288 subjects (64.9% women), 116 patients attended to private clinical practice from February 2007 to September 2009. 172 control subjects matched by sex, social class and sincerity (EPI).
Transversal design, a measure collective in the comparison group and individual in patients ones. A group of patients was selected for the retest (n = 88).
Instruments. We applied IPO, the BPRS, MCMI-II and MIPS. Diagnoses according to DSM-IV-TR.
Internal consistency (Cronbach) was adequate for the three scales: .83; .90 and .89. The testretest reliability was correct for a mean interval of 44 days (.78; .81; .78). The validity analyses differed between diagnostic groups in Axis I (p< .05), but not in the clusters of personality (p>.05). No differences in BPRS with scale of borderline, but yes with neurotic and psychotic ones. The MCMI-II was properly differentiated by the three scales of the IPO.
The IPO is an useful scale with reliability and validity. The main drawback concerns certain aspects of the borderline scale.
In Andalucia (Spain), exist a high prescription of antidepressants, joined to an elevated variability in the choice of it.
To describe associated variables with the prescription of antidepressants in Andalucia. To determinate percentage of depresive disorder in antidepressants users.
Primary Health Care, with Health Centers of Andalusian Community participating.
Subjects od the study
Patients older than 18 years old, users of antidepressants. The inclusion in the study will require informed consent by the patient.
Variables to measure
Sociodemographics; Familiars and Personals precedents of mental disorders; number and duration of episodes in which it has taken antidepressants; Hamilton anxiety-depression index; Beck‘s depression index; Diagnosis of depressive disorder or another with need of antidepressant treatment; Comorbility ; Origin of the presciption. Variables in relation with the prescriptor will be mesurement.
It is calculated by accepting a signification level of 95%, and a percentage of depresive disorder over antidepressants users unknowed (p = q = 50%). A sample size of 770 patients is estimated, including losses.
Determinations will be carried out through descriptive statistics; frequency distribution, dispersion and central tendency measurements. A measurement of possible associations between variables through contrast of hypothesis test will also be calculated. So, Pearson's chi-square test for qualitatives variables and analysis of variance (ANOVA) for quantitatives. The study will be finished studig association between potentials variables existing in antidepressants users and depression diagnosis through model of binary logistic regression.
Previously (Rodríguez-Testal et al., 2001) we analysed the multidimensionality of Referential Thinking Scale, obtaining similar results to original research of Lenzenweger et al. (1997) but warning about the construction of subscales.
In this study we intended to analyse if the REF Scale is a good indicator to differentiate the two subtypes of paranoia “Bad Me” and “Poor Me” (Trower & Chadwick, 1995).
Participants: We analyzed data from a different sample of previous studies with 326 participants (64.11% women, mean age 30.8, SD = 10.84), of whom 212 were patients.
Design, materials and procedure: We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language, of which we deleted two items because of psychometric criteria, resulting 32 dichotomic items. We used SPSS 15.0 to conduct a principal-components factor analysis with a varimax and oblimin rotation, retaining two factors.
Two factors explained 31.32% of the variance (rotated solution). We interpreted factor through factor loadings higher than .42. Factor 1 accounted for 18.28% of the variance and it's associated with referential laughter, commentaries and guilt. Factor 2 accounted for 13.05% of the variance and it's associated with referential concerns related to the media.
Since the inter-factor correlation is moderate (.44) and there are no relevant clinical differences about the content between the two factors, the REF scale is a one-dimensional measure. Therefore, two big factors don’t emerge from the REF scale related to referential concerns about laughter-commentaries and guilt that correspond to “Poor Me” and “Bad Me”, respectively.
In previous works we demonstrated the utility of the REF scale for the assessment referential thinking (Rodríguez-Testal et al., 2001) although it wasn't specific for patients with psychotic disorder (Rodríguez-Testal et al., 2008).
Objectives and hypotheses
We analyzed the psychometric properties of reliability and validity of the REF scale. We compared the differences in referential thinking between subjects with and without psychopathology. In the patient group we will not obtain differences in referential-thinking between diagnosis types of Axis I, Axis II, or patients with diagnoses on both axes.
Participants: 120 subjects, 70 patients attending a private center of clinic psychology, 64.3 % women, mean age = 35.21 (SD = 10.5) and 50 controls selected from the normal population, 54 % women, mean age = 33.48 (SD = 10.83).
It was applied a cross design for a correlation method of comparison between groups. All the analysis were accepted at p< .05.
We reached adequate internal consistency (Cronbach's alpha= .90, split-half reliability= .83 and .82). The test-restest reliability was significant (mean interval of 44 days). There are significant differences in referential thinking between subjects with and without psychopathology (t=3.8; p=.001). There are significant differences in referential thinking between types of diagnoses (F=3.99; p=.001).
The REF scale has adequate psychometric properties (reliability and validity). It discriminated between patients and no-patients, and between the different types of diagnoses, especially for those who suffer psychotic disorders.
In previous works we used the REF scale of referential thinking as criterion of therapeutic evolution (Benítez-Hernández et al., 2006; Rodríguez-Testal et al., 2009).
Objectives and hypotheses
We designed a group therapy of social skills for monitoring and modification of the referential thinking. We predict a decrease of referential thinking (frequency and intensity) both in pretest and posttest measures for each session, as in the progress of the all sessions as a whole.
Participants: 5 women from 24 to 38 years old with the diagnoses: Panic Disorder with Agoraphobia and history of Sexual Abuse; generalized Social Phobia; Avoidance Personality Disorder; Bipolar I Disorder; Obsessive-Compulsive Disorder and Avoidance Personality Disorder. It's employed a longitudinal design (brief time-series) of REF measurement (frequency and intensity) at a weekly interval. C Young (p < 0.01) was used for the statistical analysis of the data, t (paired samples) and the method of least squares to obtain the trend line.
#1: frequency-posttest (p=.01).
#2: intensity-pretest (p =.01); intensity-posttest, C =.663 (p< .01).
#3: intensity-pretest, C =.772 (p< .01), intensity-posttest, C =.681 (p< .01).
#4: frequency-pretest, C =.695 (p< .01), frequency- posttest, C =.74 (p< .01).
#5: frequency-pretest and frequency-posttest (p>.01).
Preliminary analysis indicates an improvement of referential thinking in the frequency and intensity both intra and inter-sessions. More therapy sessions are needed to reflect a change statistically significant.
In previous works we found that REF scale (Lenzenweger et al., 1997) is a stable and reliable measure (Rodríguez-Testal et al., 2009).
In this study we assess the sensitivity of REF scale to detect the disorganization of patient's mental state longitudinally.
Participants: It's a 35-year-old man diagnosed with Schizotypal Personality Disorder. He had a psychotic breakdown and he is being treated with haloperidol. The psychological intervention is cognitive type.
Design, materials and procedure: We used an experimental adaptation of the REF-scale. This self-applied scale consists of 34 items that evaluate the referential thinking in Likert format. We employed a longitudinal design (brief time-series). C Young (p < 0.01) was used for the statistical analysis of the data and the method of least squares to obtain the trend line. We included 103 measures registered at an interval of 3 days.
It's observed a significant declining trend in the whole of the measures both intensity and frequency from the beginning of therapy. However, we observed a significant declining trend in intensity but not in frequency when we analyzed the data from the 50th measurement, which was the period during which the patient got worse.
It's confirmed again that the REF-scale is a stable and reliable measure. It's able to detect changes in the patient's evolution of the referential thinking from the beginning of therapy. In addition, the REF-scale is sensitive detecting decompensations in patients. Therefore, we conclude REF scale is a useful measure for the subsequent decision-making therapeutic.
We created an experimental adaptation of the REF scale (Lenzenweger et al., 1997), in a Likert format for discriminate between frequency and intensity of referential thinking (Rodríguez-Testal et al., 2008).
Objectives and hypotheses
We try to verify if the Likert format of the REF discriminates between controls and patients, and also in patients with different diagnoses. We predict that there will be differences in frequency and intensity between patients and controls.
Participants: 108 subjects, 40 patients from a private center of clinical psychology, 55% women, mean age = 35.70 (SD = 12.42) and 68 controls selected from the normal population, 50% women, mean age = 36.35 (SD = 12.99).
It was applied a cross design for a correlation method of comparison between groups. All the analysis were accepted at p< .05.
No differences in referential thinking between patients and controls with Likert format in frequency (t = 1.496, P = 1.14), although there were differences in intensity (t = 2.30, p =.023). No significant differences in referential thinking between types of diagnoses with the Likert format (X2 = 6.63, p =. 249).
The Likert format of the REF scale adequately discriminates between patients and controls in intensity but not in frequency. This format doesn't discriminate between different diagnoses. The Likert format induces and overestimates the response.