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Earlier activities on health technology assessment (HTA) started in Spain around 1984, with the creation of a National Advisory Board on HTA, and the development of national and regional HTA organizations in the early 1990s. In 2012, the Spanish Health Ministry established the Spanish Network for Health Technology Assessment of the National Health System (RedETS); funded at national level and including all public HTA organizations at national and regional levels. RedETSis focused on the assessment of nondrug health technologies to inform the revision (approval and funding or disinvestment) of the Benefit Portfolio of the Spanish NHS. In parallel with European Network for Health Technology Assessment (EUnetHTA), RedETS has been setting-up and sharing common procedures and methodological guidelines to ensure effective cooperation and mutual recognition of the scientific and technical production in HTA. The output of RedETS is fifty to sixty annual reports, including the production of full HTA reports, Clinical Practice Guidelines, methodological guidance reports, relative effectiveness assessments, tools to support shared decision making between patients and healthcare professionals, and monitoring studies. The HTA assessments requested by the Regional Health Authorities are the biggest component of the annual RedETS working plan. These assessment needs are identified according to a yearly process and prioritized by a Commission composed of representatives from all Spanish regions with the aid of the PRITEC tool. The objectives of this study are to report and update the normative and organizational state of HTA in Spain; describing noteworthy advances witnessed over the past 10 years, as well as discussing existing challenges.
We performed a molecular and epidemiologic study of a healthcare-associated rhinovirus outbreak to better understand transmission in neonatal intensive care settings. Sequencing of the 7 outbreak strains revealed 4 distinct clades, indicating multiple sources. A single clade infected 3 patients in adjacent rooms, suggesting horizontal transmission. We observed 1 rhinovirus-associated death.
The current study provided psychometric information on the parent and child version of the Behavioural Inhibition System (BIS)/Behavioural Approach System (BAS) scale. Parent-child agreement was evaluated (N = 217, 7.5 to 14 years, 50% boys). Moreover, absolute and rank order stability of mother-reported BIS/BAS scores over a 2-year period were assessed (N = 207, 5.5 to 11 years at baseline, 49% boys). Only full measurement invariant (sub-)scales were considered in the parent-child agreement and longitudinal stability assessment. Parent and child ratings were found to be measurement invariant but discrepant on BAS Drive and BAS Reward Responsiveness. In younger children, child ratings on BAS Drive tended to be higher than parent ratings, whereas in older children, child ratings tended to be lower than parent ratings. Further, the discrepancy between the BAS Drive ratings of fathers and children was higher than the discrepancy between the BAS Drive ratings of mothers and children. Finally, the study results suggested 2-year absolute and rank order stability of the measurement-invariant, mother-reported BIS and BAS Drive scores in children aged 5.5 to 11 years at baseline.
Unenhanced computed tomography (CT) has become a standard imaging technique for uncomplicated renal colic in many countries. The appropriate timing of CT imaging has not been established, and guidelines recommend that this imaging be performed between 1 and 7 days of presentation. The primary objective of this study was to determine the prevalence of alternative diagnosis identified with low-dose unenhanced CT in the emergency department (ED) in patients with suspected uncomplicated renal colic.
This prospective single-centre study was carried out in a large university hospital ED. Over a 6-month period, all patients with clinically diagnosed renal colic and a plan to be discharged underwent low-dose unenhanced CT in the ED. Pregnant women, women of childbearing age not willing to have a pregnancy test, and patients who had already undergone diagnostic imaging were excluded. The primary outcome was the number and nature of the alternative diagnosis. Univariate analyses were performed to assess factors associated with the primary outcome.
A total of 178 patients were screened, and 155 underwent CT in the ED. The mean age was 42.2 years; 69% were male. The diagnosis of uncomplicated renal colic was confirmed in 118 participants (76%); 27 (17%) had an inconclusive CT scan. Overall, 10 patients (6%; 95% confidence interval [CI] 3–10) had an alternative diagnosis, 5 of whom were subsequently hospitalized.
Low-dose unenhanced CT in the ED detects alternative diagnoses in 6% (95% CI 3–10) of patients with suspected uncomplicated renal colic, half of whom are subsequently hospitalized. Our prospective findings, which were similar to those reported in retrospective studies, are a potential argument for a systematic approach to ED imaging in suspected renal colic. Future research involving intervention and control groups would be helpful.
Neutering of cats has been associated with significant weight gain in the weeks following surgery. The present study aimed to evaluate the effectiveness of a moderate fat, low-energy dry expanded diet in reducing weight gain in growing pet cats when fed as part of a weight-control regimen over the 6 months post-neutering. Cats in participating primary care veterinary hospitals were enrolled at neutering and assigned to receive one of the two dietary treatments based on the hospital of origin. Owners of cats in the treatment group were instructed to feed the trial diet at maintenance (324·7 kJ/kg BW0·711 per d). Instructions for the control group were to feed the cat's regular diet according to the manufacturer's recommendations. Body weight and condition were evaluated by veterinarians at enrolment, 2-weeks, and 1–4 and 6 months after surgery. Body condition score (five-point scale) was compared between enrolment and each subsequent visit, controlling for enrolment age and sex. Percentage change in body weight was evaluated via multivariate mixed modelling to account for repeated measures. A total of 187 cats (eighty-seven females and 100 males) with a mean age of 5·2 (sd 0·8) months and mean weight of 2·8 (sd 0·6) kg from fifty-one hospitals completed the trial. The odds of being scored as overweight were 4·1 times as great for cats in the control v. treatment groups (95 % CI 2·1, 8·2). Percentage change in body weight differed significantly with enrolment age (P = 0·007) and approached significance between diet groups (P = 0·08). Cats fed the trial diet had a significantly reduced incidence of overweight in the 6 months following neutering.
vascular dementia (VaD) and mixed Alzheimer's disease (AD/VaD) are common. How best to monitor treatment is not clear. Our objective was to compare responsiveness and construct validity of change scores, following donepezil treatment, of the standardized Mini-Mental State Examination (sMMSE) and other measures potentially usable in primary care.
A six-month, outcome measurement study. The Disability Assessment for Dementia (DAD), CLOX-1 and 2, Phonetic Fluency, a short Neuropsychiatric Inventory, (the NPI-Q), Clinical Global Impression (CGI) and the SymptomGuide™ (SG) were measured. Construct validity was tested by correlating change scores, and responsiveness by calculating standardized response means (SRMs).
Of 148 treated patients, 116 completed. The mean sMMSE increased by 0.7 (95% Confidence Interval (CI) = -0.005, 1.41; p=0.06; SRM= 0.15). There was no statistically significant difference in the DAD. The NPI-Q (-1.4; 95% CI = -2.08, -0.72; p<0.01; SRM=0.24), ClOX-1 (0.9; 95% CI = 0.19, 1.61; p<0.01; SRM=0.21), ClOX-2 (0.9; 95% CI = 0.17, 1.63; p=0.03; SRM=0.26), Phonetic Fluency (0.9; 95% CI = 0.19, 1.61; p=0.02; SRM=0.21) and SG (0.35; 95% CI = 0.20,0.51; p<0.01; SRM=0.28) each detected significant improvement. The CGI suggested improvement in 74 completers (64%) - mostly “minimal” (44/116, 38%) - while 21/116 (18%) were worse. Change scores at 24 weeks were at best modestly correlated with each other (range -0.22 to 0.30).
Different measures showed different responsiveness, in a setting in which the mean treatment effect seems to have been small, but clinically detectable. Patient-centered and executive function measures might be useful in vascular and mixed dementia.
The Montreal Cognitive Assessment (MoCA) is a brief instrument developed for the screening of milder forms of cognitive impairment, having surpassed the well-known limitations of the MMSE. The aim of the present study was to validate the MoCA as well as its short version, which was proposed by the NINDS-CSN VCI Harmonization Standards for screening Vascular Dementia (VaD) patients. The results, based on a homogeneous sample of 34 VaD patients, indicate that the MoCA is a psychometrically valid and reliable instrument for cognitive screening in VaD patients, showing excellent discriminant validity. Both the full and short versions of the MoCA had excellent diagnostic accuracy in discriminating VaD patients, exhibiting an area under curve (AUC) higher than the MMSE [AUC(MoCA full version) = .950; 95% IC = .868–.988; AUC(MoCA short version) = .936; 95% IC = .849–.981; AUC(MMSE) = .860; 95% IC = .754–.932]. With a cutoff below 17 on the MoCA full version and 8 on the short version, the results for sensitivity, specificity, positive and negative predictive values, and classification accuracy were superior compared to the MMSE. In conclusion, both versions of the MoCA are valid, reliable, sensitive and accurate screening instruments for VaD patients. (JINS, 2012, 18, 1–10)
Cette recherche vise à examiner empiriquement l'idée commune que les Suisses romands parlent lentement. Nous avons comparé, en parole lue, diverses variables temporelles produites par des locuteurs provenant d'une variété régionale française (Brunoy en Ile-de-France) et de deux variétés régionales suisses romandes (Neuchâtel et Nyon), et ce, en tenant compte de l’âge et du sexe des locuteurs. Les résultats montrent, d'une part, que, parmi les diverses variables temporelles, seule la vitesse d'articulation permet de distinguer les locuteurs des trois variétés régionales. D'autre part, ils soulignent le rôle différent, selon la variété régionale, que jouent l’âge et le sexe des locuteurs dans la production de la vitesse d'articulation.
The Montreal Cognitive Assessment (MoCA) is a brief instrument developed for the screening of milder forms of cognitive impairment. The present study aims to assess the construct related validity of the MoCA through the establishment of the factorial, convergent, and discriminant related validities, and the reliability of data. In a Portuguese sample of 830 participants, several models were tested using Confirmatory Factor Analysis. Although all tested models showed a good fit, the six-factor model based on the conceptual model proposed by the MoCA's authors showed a significantly better fit. The results allowed us to establish the factorial, convergent, and discriminant validity of this six-dimensional structure. An overall psychometric adequacy of the items, and a good reliability were also found. This study contributes to overcome an important gap in the construct related validity of this instrument. The present findings corroborate the six-dimensional structure of the MoCA and provide good evidence of the construct related validity. The MoCA has proved to be an appropriate measure for cognitive screening taking into account different cognitive domains, which will enable clinicians and researchers to use this test and its six latent dimensions to achieve a better understanding of the individuals’ cognitive profile. (JINS, 2012, 18, 242–250)
Public service organisations are preoccupied with understanding how good performance can be achieved: what matters is what works. But delivering high-quality services requires a far wider array of evidence than just that on effectiveness – we need, for example, knowledge about the scale, source and structuring of social problems; practical ‘know-how’ to support effective programme implementation in local contexts; and insights into the relationships between values and policy directions.
Research can make an important contribution to the development of public services and policy programmes, and it can enrich debates about the nature of social problems and what works in addressing them. However, such positive research impacts are far from routine, and the impact of research is not always positive. Negative impacts may, for example, arise in situations where tentative or highly specific findings are seized upon too readily or applied too widely.
Despite this, the overzealous use of research is not normally considered to be the main problem. Quite the opposite; researchers and others are often disappointed that clear findings are overlooked or ignored when decisions are made about the direction and delivery of services. This view is supported by many studies that have found that practice often lags behind the best available evidence about what works and that it may remain out of step for quite some time.
Previous studies of people convicted of homicide have used different
definitions of mental disorder.
To estimate the rate of mental disorder in people convicted of homicide;
to examine the relationship between definitions, verdict and outcome in
A national clinical survey of people convicted of homicide
(n=1594) in England and Wales (1996–1999). Rates of
mental disorder were estimated based on: lifetime diagnosis, mental
illness at the time of the offence, contact with psychiatric services,
diminished responsibility verdict and hospital disposal.
Of the 1594, 545 (34%) had a mental disorder: most had not attended
psychiatric services; 85 (5%) had schizophrenia (lifetime); 164 (10%) had
symptoms of mental illness at the time of the offence; 149 (9%) received
a diminished responsibility verdict and 111 (7%) a hospital disposal –
both were associated with severe mental illness and symptoms of
The findings suggest an association between schizophrenia and conviction
for homicide. Most perpetrators with a history of mental disorder were
not acutely ill or under mental healthcare at the time of the offence.
Some perpetrators receive prison sentences despite having severe mental
Suicide prevention is a health service priority. Suicide risk may be
greatest during psychiatric in-patient admission and following
To describe the social and clinical characteristics of a comprehensive
sample of in-patient and post-discharge cases of suicide.
A national clinical survey based on a 4-year (1996–2000) sample of cases
of suicide in England and Wales who had been in recent contact with
mental health services (n=4859).
There were 754 (16%) current in-patients and a further 1100 (23%) had
been discharged from psychiatric in-patient care less than 3 months
before death. Nearly a quarter of the in-patient deaths occurred within
the first 7 days of admission; 236 (31%) occurred on the ward, the
majority by hanging. Post-discharge suicide was most frequent in the
first 2 weeks after leaving hospital; the highest number occurred on the
Suicide might be prevented among in-patients by improving ward design and
removing fixtures that can be used in hanging. Prevention of suicide
after discharge requires early community follow-up and closer supervision
of high-risk patients.
Suicide prevention is a health service priority but the most effective
approaches to prevention may differ between different patient groups.
To describe social and clinical characteristics in cases of suicide from
different age and diagnostic groups.
A national clinical survey of a 4-year (1996–2000) sample of cases of
suicide in England and Wales where there had been recent (< 1 year)
contact with mental health services (n=4859).
Deaths of young patients were characterised by jumping from a height or
in front of a vehicle, schizophrenia, personality disorder, unemployment
and substance misuse. In older patients, drowning, depression, living
alone, physical illness, recent bereavement and suicide pacts were more
common. People with schizophrenia were often in-patients and died by
violent means. About athird of people with depressive disorder died
within a year of illness onset. Those with substance dependence or
personality disorder had high rates of disengagement from services.
Prevention measures likely to benefit young people include targeting
schizophrenia, dual diagnosis and loss of service contact; those aimed at
depression, isolation and physical ill-health should have more effect on
Information on suicide by psychiatric patients from ethnic minority groups is scarce.
To establish the number of patients from ethnic minorities who kill themselves; to describe their suicide methods, and their social and clinical characteristics.
A national clinical survey was based on a 4-year sample of suicides in England and Wales. Detailed data were collected on those who had been in contact with mental health services in the year before death.
In total 282 patients from ethnic minorities died by suicide – 6% of all patient suicides. The most common method of suicide was hanging; violent methods were more common than in White patient suicides. Schizophrenia was the most common diagnosis. Ethnic minority patients were more likely to have been unemployed than White patients and to have had a history of violence and recent non-compliance. In around half, this was the first episode of self-harm. Black Caribbean patients had the highest rates of schizophrenia (74%), unemployment, living alone, previous violence and drug misuse.
In order to reduce the number of suicides byethnicminority patients, services should address the complex health and social needs of people with severe mental illness.
To evaluate the validity of a food-frequency questionnaire (FFQ) for assessment of the dietary intakes of polyunsaturated fatty acids (PUFAs) against a biochemical marker of fat intake, erythrocyte cell membrane phospholipid levels, during pregnancy.
Developmental Neurobiology Department, National Institute of Perinatology, Mexico City.
One hundred forty-six healthy pregnant women during the last trimester of pregnancy. Among women enrolled, the first 35 pregnant women (24%) had their erythrocytes analysed for fatty acid status.
We administered an FFQ and compared intakes of PUFAs against their erythrocyte cell membrane concentrations, processed by gas chromatography.
Pearson correlation coefficients among α-linolenic acid (ALN), docosahexaenoic acid (DHA) and eicosapentaenoic acid in erythrocyte cell membranes against their crude dietary counterparts were 0.32, 0.35 and 0.36 (each P < 0.05). In a simple linear regression, erythrocyte DHA and arachidonic acid (AA) were significantly related to their respective dietary intakes (β = 0.30, 95% confidence interval (CI): 0.007–0.60, P = 0.045 for DHA; β = 0.49, 95% CI: 0.010–0.98, P = 0.044 for AA). Erythrocyte cell membrane ALN concentration (%/total) was only marginally related to ALN dietary intake (mg day−1) (β = 0.52, 95% CI: −0.020–1.10, P = 0.061). However, after adjustment for long-chain n–3 PUFA/AA, this association reached significance (β = 0.44, 95% CI: 0.026–0.825, P = 0.038). Main dietary sources for n–3 PUFAs were canned tuna fish and fresh catfish; for n–6 these were eggs and cow's milk. The use of this FFQ in these pregnant Mexican women provided estimates of average long-term intakes of PUFAs and correlated reasonably well with their erythrocyte cell membrane phospholipid status. However, we need to consider that, during pregnancy, there is a faster turnover of PUFAs from fat storage that may modify the profile of erythrocyte PUFAs and lower the correlation between dietary intake and erythrocyte PUFAs.
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