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A high percentage of patients have a diagnosis of adjustment disorder (AD) when they arrive at primary care (PC) appointments. However, most of them do not receive adequate psychological treatment. The present study’s aim is to determine the efficacy of a group psychological treatment program in patients with AD. The sample consisted of patients with AD from two PC units in Valencia, from which two groups were randomly generated: A treatment group (n = 31) and a waiting-list group (n = 20), homogeneous in terms of socio-demographic and psychometric variables prior to treatment. Treatment consisted of eight one-hour group sessions held on a weekly basis; taking a cognitive-behavioral approach, they addressed aspects like controlling anxiety, cognitive restructuring, and coping techniques. The variables analyzed were: Psychopathology (Revised Symptom Inventory, SCL–90–R), health-related quality of life (Health Questionnaire, SF–12), and risk of suicidal behavior (Suicide Risk Scale). Means comparisons, ANCOVAs, and tests of effect size were performed. Statistically significant differences were observed in the variables, such that after intervention, the experimental group exhibited less anxious (F = 4.11, p =.048, η2 = .08) and depressive symptoms (F = 2.41, p =.029, η 2= .10) and higher quality of life related to physical (F = 7.17, p =.010, η2 = .13) and emotional health (F = 10.31, p =.002, η2 = .18). For the reasons above, we conclude that a comprehensive approach to emotional distress in PC, including group psychological interventions, is one solution for the demand for social services, and could provide savings on economic as well as human costs.
The Shannon entropy based on the probability density function is a key information measure with applications in different areas. Some alternative information measures have been proposed in the literature. Two relevant ones are the cumulative residual entropy (based on the survival function) and the cumulative past entropy (based on the distribution function). Recently, some extensions of these measures have been proposed. Here, we obtain some properties for the generalized cumulative past entropy. In particular, we prove that it determines the underlying distribution. We also study this measure in coherent systems and a closely related generalized past cumulative Kerridge inaccuracy measure.
To compare the epidemiology, clinical characteristics, and mortality of patients with bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) versus ESBL-producing Klebsiella pneumoniae (ESBL-KP) and to examine the differences in clinical characteristics and outcome between BSIs caused by isolates with CTX-M versus other ESBL genotypes
As part of the INCREMENT project, 33 tertiary hospitals in 12 countries retrospectively collected data on adult patients diagnosed with ESBL-EC BSI or ESBL-KP BSI between 2004 and 2013. Risk factors for ESBL-EC versus ESBL-KP BSI and for 30-day mortality were examined by bivariate analysis followed by multivariable logistic regression.
The study included 909 patients: 687 with ESBL-EC BSI and 222 with ESBL-KP BSI. ESBL genotype by polymerase chain reaction amplification of 286 isolates was available. ESBL-KP BSI was associated with intensive care unit admission, cardiovascular and neurological comorbidities, length of stay to bacteremia >14 days from admission, and a nonurinary source. Overall, 30-day mortality was significantly higher in patients with ESBL-KP BSI than ESBL-EC BSI (33.7% vs 17.4%; odds ratio, 1.64; P=.016). CTX-M was the most prevalent ESBL subtype identified (218 of 286 polymerase chain reaction-tested isolates, 76%). No differences in clinical characteristics or in mortality between CTX-M and non–CTX-M ESBLs were detected.
Clinical characteristics and risk of mortality differ significantly between ESBL-EC and ESBL-KP BSI. Therefore, all ESBL-producing Enterobacteriaceae should not be considered a homogeneous group. No differences in outcomes between genotypes were detected.
The Spanish Network of Agencies for Health Technology Assessment (REDETS) is a group of eight agencies, units and services, depending on National and Regional Governments that coordinate their work within a common methodological framework, guided by the principles of mutual recognition and cooperation. In this work, guided by the necessity of implementing a Quality Management System, we present the process to achieve this objective.
As an initial step, a review was carried out based on a structured search strategy in the main electronic databases Medline and EMBASE, and a manual search in websites of national and international agencies (March 2016) in order to collate previous knowledge and experiences. Through the information included in this review, a proposal to create a quality, self-evaluating tool is necessary.
In total, 800 references were found and finally 6 studies were included in the review (1-3). All had a similar structure. Some lists of good practices, classified in dimensions related to different quality aspects in Health Technology Assessment (HTA) organizations, were found. Also some information about questions for evaluating quality standards was indicated. Taking all this information, a proposal of sixty-six standard titles was put forward. These standards were then grouped into twelve quality criteria structured in four dimensions: I Responsibility, II Clients and Stakeholders, III Production Process and IV Resources.
Based on the systematic review, we developed a proposal for a self-evaluating tool and this is the baseline for a common Quality Management System for the Spanish Network of HTA Agencies. The quality management process will require the development of a handbook by each member of REDETS that will be based on agreed quality standards.
The patterns of comorbidity among mental disorders have led researchers to model the underlying structure of psychopathology. While studies have suggested a structure including internalizing and externalizing disorders, less is known with regard to the cross-national stability of this model. Moreover, little data are available on the placement of eating disorders, bipolar disorder and psychotic experiences (PEs) in this structure.
We evaluated the structure of mental disorders with data from the World Health Organization Composite International Diagnostic Interview, including 15 lifetime mental disorders and six PEs. Respondents (n = 5478–15 499) were included from 10 high-, middle- and lower middle-income countries across the world aged 18 years or older. Confirmatory factor analyses (CFAs) were used to evaluate and compare the fit of different factor structures to the lifetime disorder data. Measurement invariance was evaluated with multigroup CFA (MG-CFA).
A second-order model with internalizing and externalizing factors and fear and distress subfactors best described the structure of common mental disorders. MG-CFA showed that this model was stable across countries. Of the uncommon disorders, bipolar disorder and eating disorder were best grouped with the internalizing factor, and PEs with a separate factor.
These results indicate that cross-national patterns of lifetime common mental-disorder comorbidity can be explained with a second-order underlying structure that is stable across countries and can be extended to also cover less common mental disorders.
Traumatic events are associated with increased risk of psychotic experiences, but it is unclear whether this association is explained by mental disorders prior to psychotic experience onset.
To investigate the associations between traumatic events and subsequent psychotic experience onset after adjusting for post-traumatic stress disorder and other mental disorders.
We assessed 29 traumatic event types and psychotic experiences from the World Mental Health surveys and examined the associations of traumatic events with subsequent psychotic experience onset with and without adjustments for mental disorders.
Respondents with any traumatic events had three times the odds of other respondents of subsequently developing psychotic experiences (OR=3.1, 95% CI 2.7–3.7), with variability in strength of association across traumatic event types. These associations persisted after adjustment for mental disorders.
Exposure to traumatic events predicts subsequent onset of psychotic experiences even after adjusting for comorbid mental disorders.
Although childhood adversities are known to predict increased risk of post-traumatic stress disorder (PTSD) after traumatic experiences, it is unclear whether this association varies by childhood adversity or traumatic experience types or by age.
To examine variation in associations of childhood adversities with PTSD according to childhood adversity types, traumatic experience types and life-course stage.
Epidemiological data were analysed from the World Mental Health Surveys (n = 27017).
Four childhood adversities (physical and sexual abuse, neglect, parent psychopathology) were associated with similarly increased odds of PTSD following traumatic experiences (odds ratio (OR)=1.8), whereas the other eight childhood adversities assessed did not predict PTSD. Childhood adversity–PTSD associations did not vary across traumatic experience types, but were stronger in childhood-adolescence and early-middle adulthood than later adulthood.
Childhood adversities are differentially associated with PTSD, with the strongest associations in childhood-adolescence and early-middle adulthood. Consistency of associations across traumatic experience types suggests that childhood adversities are associated with generalised vulnerability to PTSD following traumatic experiences.
A new three-dimensional finite-element model of the steady-state dynamics of temperate glaciers has been developed and applied to Johnsons Glacier, Livingston Island, Antarctica, with the aim of determining the velocity and stress fields for the present glacier configuration. It solves the full Stokes system of differential equations without recourse to simplifications such as those involved in the shallow-ice approximation. Rather high values of the stiffness parameter B (∼0.19–0.23MPaa1/3) are needed to match the observed ice surface velocities, although these results do not differ much from those found by other authors for temperate glaciers. Best-fit values of the coefficient k in the sliding law (*2.2–2.7 x 103m a–1MPa–2) are also of the same order of magnitude as those found by other authors. The results for velocities are satisfactory, though locally there exist significant discrepancies between computed and observed ice surface velocities, particularly for the vertical ones. This could be due to failures in the sliding law (in particular, the lack of information on water pressure), the use of an artificial down-edge boundary condition and the fact that bed deformation is not considered. For the whole glacier system, the driving stress is largely balanced by the basal drag (80% of the driving stress). Longitudinal stress gradients are only important in the divide areas and near the glacier terminus, while lateral drag is only important at both sides of the terminal zone.
Calving from tidewater glaciers and ice shelves accounts for around half the mass loss from both polar ice sheets, yet the process is not well represented in prognostic models of ice dynamics. Benn and others proposed a calving criterion appropriate for both grounded and floating glacier tongues or ice shelves, based on the penetration depth of transverse crevasses near the calving front, computed using Nye’s formula. The criterion is readily incorporated into glacier and ice-sheet models, but has not been fully validated with observations. We apply a three-dimensional extension of Benn and others’ criterion, incorporated into a full-Stokes model of glacier dynamics, to estimate the current position of the calving front of Johnsons Glacier, Antarctica. We find that two improvements to the original model are necessary to accurately reproduce the observed calving front: (1) computation of the tensile deviatoric stress opening the crevasse using the full-stress solution and (2) consideration of such a tensile stress as a function of depth. Our modelling results also suggest that Johnsons Glacier has a polythermal structure, rather than the temperate structure suggested by earlier studies.
A new 10 year surface mass balance (SMB) record of Hurd and Johnsons Glaciers, Livingston Island, Antarctica, is presented and compared with earlier estimates on the basis of local and regional meteorological conditions and trends. Since Johnsons is a tidewater glacier, we also include a calving flux calculation to estimate its total mass balance. The average annual SMB over the 10 year observation period 2002–11 is −0.15 ± 0.10 m w.e. for Hurd Glacier and 0.05 ± 0.10 m w.e. for Johnsons Glacier. Adding the calving losses to the latter results in a total mass balance of −0.09 ± 0.10 m w.e. There has been a deceleration of the mass losses of these glaciers from 1957–2000 to 2002–11, which have nearly halved for both glaciers. We attribute this decrease in the mass losses to a combination of increased accumulation in the region and decreased melt. The increased accumulation is attributed to larger precipitation associated with the recent deepening of the circumpolar pressure trough, while the melt decrease is associated with lower summer surface temperatures during the past decade.
The synthesis and antiprotozoal activity of some simple dialkyl pyrazole-3,5-dicarboxylates (compounds 2–6) and their sodium salts (pyrazolates) (compounds 7–9) against Trypanosoma cruzi, Leishmania infantum and Leishmania braziliensis are reported. In most cases the studied compounds showed, especially against the clinically significant amastigote forms, in vitro activities higher than those of the reference drugs (benznidazole for T. cruzi and glucantime for Leishmania spp.); furthermore, the low non-specific cytotoxicities against Vero cells and macrophages shown by these compounds led to good selectivity indexes, which are 8–72 times higher for T. cruzi amastigotes and 15–113 times higher for Leishmania spp. amastigotes than those of the respective reference drugs. The high efficiency of diethyl ester 3 and its sodium salt 8 against the mentioned protozoa was confirmed by further in vitro assays on infection rates and by an additional in vivo study in a murine model of acute and chronic Chagas disease. The inhibitory capacity of compounds 3 and 8 on the essential iron superoxide dismutase of the aforementioned parasites may be related to the observed anti-trypanosomatid activity. The low acute toxicity of compounds 3 and 8 in mice is also reported in this article.
Major depressive disorder (MDD) is a leading cause of disability worldwide.
To examine the: (a) 12-month prevalence of DSM-IV MDD; (b) proportion aware that they have a problem needing treatment and who want care; (c) proportion of the latter receiving treatment; and (d) proportion of such treatment meeting minimal standards.
Representative community household surveys from 21 countries as part of the World Health Organization World Mental Health Surveys.
Of 51 547 respondents, 4.6% met 12-month criteria for DSM-IV MDD and of these 56.7% reported needing treatment. Among those who recognised their need for treatment, most (71.1%) made at least one visit to a service provider. Among those who received treatment, only 41.0% received treatment that met minimal standards. This resulted in only 16.5% of all individuals with 12-month MDD receiving minimally adequate treatment.
Only a minority of participants with MDD received minimally adequate treatment: 1 in 5 people in high-income and 1 in 27 in low-/lower-middle-income countries. Scaling up care for MDD requires fundamental transformations in community education and outreach, supply of treatment and quality of services.
Perceived control has shown predictive value for anxiety severity symptoms as well as cognitive-behavior therapy outcomes. The most commonly used measure of perceived control is the Anxiety Control Questionnaire (ACQ), and more recently the ACQ Revised (ACQ-R). However, both questionnaires have shown structural inconsistencies among several studies. Also, although the ACQ and ACQ-R seem to be multidimensional instruments, a single total score have been commonly used. This study examined the internal structure of the ACQ-R Spanish version using exploratory factor and exploratory bi-factor analysis in a sample of 382 college students and 52 people diagnosed of panic disorder (with or without agoraphobia). Also, in this study we assessed the preliminary diagnostic value of the ACQ-R scores. The results indicated that the ACQ-R Spanish version structure consisted of two factors: one related with perceived control of internal emotional reactions (Emotion Control) and another related with perceived control of external events (Threat and Stress Control). Both specific factors can be adequately summarized by a general factor (General Anxiety Perception of Control; CFI = .973, TLI = .954, RMSEA = .039; p = .002), which accounted for 70% of the common explained variance. The correlations between the ACQ-R scores and with variables like anxiety (r = –.66) or anxiety sensitivity (r = –.50) presented the expected pattern of results. Either the two dimensions structure or the total score have proved to be a good tool to distinguish between participants with panic disorder and non-clinical samples (area under the curve = 0.79).
We have found a mistake in the proofs of Navarro (2008, Theorem 2.3(b) and 2.3(c)) due to misapplication of properties of hazard rate and likelihood ratio orders. In this paper we show with an example that the stated results do not hold. This example is interesting since it proves some unexpected properties for these orderings under the formation of coherent systems. The result stated in Navarro (2008, Theorem 2.3(a)) for the usual stochastic order is correct.
The aim of this study was to assess the effect of ovine bulk tank somatic cell count (BTSCC) on composition, proteose-peptone (p-p) content and casein fractions as indicating parameters for proteolysis and coagulating properties of milk. A total of 97 samples of bulk tank milk from Manchega breed ewe flocks were grouped according to somatic cell count (SCC) into four classes: fewer than 500 000 cells/ml, from 500 000 to 10 00 000 cells/ml, from 10 00 000 to 15 00 000 and more than 15 00 000 cells/ml. The casein : protein ratio and lactose content decreased with BTSCC. Proteolysis increased with BTSCC, causing a drop in β-casein and an increase in the γ-caseins from a concentration of 500 000 cells/ml. Regarding coagulation behaviour, the rennet clotting time (RCT) and firming time (k20) rose from 10 00 000–15 00 000 cells/ml of milk. The results showed that the impairment of milk quality and milk ability to make cheese as affected by intramammary infection (IMI) can be inferred from the bulk tank milk of flocks with poor udder health.
To prospectively assess the associations between lean fish, fatty fish and total fish intakes and risk of stroke in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain).
Fish intake was estimated from a validated dietary questionnaire. Cox proportional hazards regression models were used to assess the association between the intakes of lean fish, fatty fish and total fish and stroke risk. Models were run separately for men and women.
Five Spanish regions (Asturias, San Sebastian, Navarra, Granada and Murcia).
Individuals (n 41 020; 15 490 men and 25 530 women) aged 20–69 years, recruited from 1992 to 1996 and followed-up until December 2008 (December 2006 in the case of Asturias). Only participants with definite incident stroke were considered as cases.
During a mean follow-up of 13·8 years, 674 strokes were identified and subsequently validated by record linkage with hospital discharge databases, primary-care records and regional mortality registries, comprising 531 ischaemic, seventy-nine haemorrhagic, forty-two subarachnoid and twenty-two unspecific strokes. After multiple adjustments, no significant associations were observed between lean fish, fatty fish and total fish consumption and the risk of stroke in men or women. In men, results revealed a non-significant trend towards an inverse association between lean fish (hazard ratio=0·84; 95 % CI 0·55, 1·29, Ptrend=0·06) and total fish consumption (hazard ratio=0·77; 95 % CI 0·51, 1·16, Ptrend=0·06) and risk of total stroke.
In the EPIC-Spain cohort, no association was found between lean fish, fatty fish and total fish consumption and risk of stroke.
This study aims to examine the prevalence and characteristics of physical, emotional and sexual childhood abuse. It also examines whether other non-abuse types of childhood adversities related to maladaptive family functioning and separations during childhood can be used as markers for the presence of childhood abuse. Participants (N = 237) were women at 2–3 days after delivery that completed the Spanish-validated version of the Early Trauma Inventory Self Report (ETI-SR; Bremner, Bolus, & Mayer, 2007; Plaza et al., 2011), designed to assess the presence of childhood adversities. Results show that 29% of the women had experienced some type of childhood abuse, and 10% more than one type. Logistic regression analyses indicate that childhood parental death is a risk marker for childhood emotional abuse (OR: 3.77; 95% CI: 1.327–10.755; p <.013), childhood parental substance abuse is a risk marker for childhood sexual (OR: 3.72; 95% CI: 1.480–9.303; p < .005) and physical abuse (OR: 2.610; 95% CI: 1.000–6.812; p < .05) and that childhood family mental illness is a risk marker for childhood emotional (OR: 2.95; 95% CI: 1.175–7.441; p < .021) and sexual abuse (OR: 2.55; 95% CI: 1.168–5.580; p < .019). The high prevalence of childhood abuse indicates a need for assessment during the perinatal period. Screening for childhood family mental illness, parental substance abuse, and parental death - all identified risk factors for reporting childhood abuse - can help to identify women that should be assessed specifically regarding abuse.
To outline the specifics of recruitment and selection in the international context.
To describe categories of international employees.
To identify and explain the international recruitment and selection process.
To illustrate potential challenges of international selection and recruitment from the employee and company perspectives.
After reading this chapter, students will be able to:
develop an international recruitment and selection plan for different types of multinational company
create a set of interview questions for an international post
determine a set of selection criteria for different types of international employees
evaluate indicators of selection and recruitment effectiveness.
Careful planning is needed to ensure that international recruitment, and selection can deploy the right candidates to international posts. Failure to do so may result in inefficient use of time, financial losses or even risk to a company’s reputation. HR managers in multinational companies (MNCs) should consider various issues when preparing for international recruitment and selection, mainly because of cultural or national differences between the country in which an MNC is headquartered (the parent country) and the countries in which they have subsidiaries (host countries). These differences affect international recruitment and selection because:
employment legislation varies across countries
the pool of job applicants for international posts is wider – MNCs can choose from parent-country nationals (PCNs), host-country nationals (HCNs) and third-country nationals (TCNs) as well as, increasingly, self-initiated expatriates (SIEs) and skilled migrants (SMs)
a thorough and specific job analysis for international posts is required, even if the same type of post is advertised (for instance, the competencies a manager needs in Australia might be different from those a manager needs in another cultural context)
needs specific to advertising international posts drive MNC selection practices, from filling a position to developing the managerial skills of existing staff (Brookfield Global Relocation Services, 2012).
Olive oil is well known for its cardioprotective properties; however, epidemiological data showing that olive oil consumption reduces incident CHD events are still limited. Therefore, we studied the association between olive oil and CHD in the European Prospective Investigation into Cancer and Nutrition (EPIC) Spanish cohort study. The analysis included 40 142 participants (38 % male), free of CHD events at baseline, recruited from five EPIC-Spain centres from 1992 to 1996 and followed up until 2004. Baseline dietary and lifestyle information was collected using interview-administered questionnaires. Cox proportional regression models were used to assess the relationship between validated incident CHD events and olive oil intake (energy-adjusted quartiles and each 10 g/d per 8368 kJ (2000 kcal) increment), while adjusting for potential confounders. During a 10·4-year follow-up, 587 (79 % male) CHD events were recorded. Olive oil intake was negatively associated with CHD risk after excluding dietary mis-reporters (hazard ratio (HR) 0·93; 95 % CI 0·87, 1·00 for each 10 g/d per 8368 kJ (2000 kcal) and HR 0·78; 95 % CI 0·59, 1·03 for upper v. lower quartile). The inverse association between olive oil intake (per 10 g/d per 8368 kJ (2000 kcal)) and CHD was more pronounced in never smokers (11 % reduced CHD risk (P = 0·048)), in never/low alcohol drinkers (25 % reduced CHD risk (P < 0·001)) and in virgin olive oil consumers (14 % reduced CHD risk (P = 0·072)). In conclusion, olive oil consumption was related to a reduced risk of incident CHD events. This emphasises the need to conserve the traditional culinary use of olive oil within the Mediterranean diet to reduce the CHD burden.