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BACKGROUND: Esophageal squamous cell carcinoma (ESCC) patients carries a poor prognosis, with limited effective therapeutic targets. This study aimed to clarify the clinical significance of guanine nucleotide-binding protein like 3-like (GNL3L) protein expression in ESCC and its role in malignant progression. METHODS: GNL3L expression and associated cancer-promoting pathways in ESCC were interrogated via bioinformatics analysis through use of The Cancer Genome Atlas (TCGA) database. Subsequent verification of GNL3L protein expression in ESCC, coupled with clinical data, was conducted through immunohistochemistry and followed by a comprehensive prognostic analysis. We further investigated potential signaling pathways facilitating ESCC progression, employing a combination of bioinformatics analysis and immunohistochemical (IHC) experiments. RESULTS: Bioinformatics analysis unveiled a significant elevation in GNL3L expression, particularly in gastrointestinal tumors and ESCC. Immunohistochemistry confirmed elevated GNL3L expression in ESCC tissues. Regression analysis established a correlation between elevated GNL3L expression and advanced tumor node metastasis (TNM) stage, with high expression associated with poor prognosis in patients with ESCC. Our integrated approach of bioinformatics and IHC analysis indicated a potential role of the signal transducers and activators of transcription 3 (STAT3) signaling pathway in ESCC progression. CONCLUSIONS: High GNL3L expression significantly contributes to the malignant progression of ESCC. This study further elucidates the mechanisms driving ESCC progression and offers possible insights for more effective diagnosis and treatment strategies.

Fundación para la Investigación Biomédica del Hospital Universitario Puerta de Hierro-Majadahonda, Hematology Department, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), 18014 Granada, Spain Registro de Cáncer de Granada, Escuela Andaluza de Salud Pública (EASP), 18080 Granada, Spain Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain Hematology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación del Hospital Universitario 12 de Octubre, 28041 Madrid, Spain Immunology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain, Despite a lack of evidence, a bone marrow aspirate differential of 500 cells is commonly used in the clinical setting. We aimed to test the performance of 200-cell counts for daily hematological workup. In total, 660 consecutive samples were analyzed recording differentials at 200 and 500 cells. Additionally, immunophenotype results and preanalytical issues were also evaluated. Clinical and statistical differences between both cutoffs and both methods were checked. An independent control group of 122 patients was included. All comparisons between both cutoffs and both methods for all relevant types of cells did not show statistically significant differences. No significant diagnostic discrepancies were demonstrated in the contingency table analysis. This is a real-life study, and some limitations may be pointed out, such as a different sample sizes according to the type of cell in the immunophenotype analysis, the lack of standardization of some preanalytical events, and the relatively small sample size of the control group. The comparisons of differentials by morphology on 200 and 500 cells, as well as by morphology (both cutoffs) and by immunophenotype, are equivalent from the clinical and statistical point of view. The preanalytical issues play a critical role in the assessment of bone marrow aspirate samples., Fundación para la Investigación Biomédica del Hospital Universitario Puerta de Hierro-Majadahonda, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Registro de Cáncer de Granada, Escuela Andaluza de Salud Pública (EASP), Department of Preventive Medicine and Public Health, University of Granada, Hematology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación del Hospital Universitario 12 de Octubre, Immunology Department, Hospital Universitario Virgen de las Nieves, Fac. de Medicina, TRUE, pub

En 2011 se publicó la primera adaptación española del Inventario de Depresión de Beck-II (BDI-II), justo cuando se cumplía el 50º aniversario de la publicación de su primera edición. En este tiempo, el BDI se ha convertido en el cuestionario autoaplicado más utilizado en España y en el mundo para evaluar la gravedad de la depresión. En este trabajo se presentan las características básicas del BDI-II en relación con sus versiones anteriores (BDI-I y BDI-IA) y el proceso de su adaptación a la población española, se resumen las propiedades psicométricas de dicha adaptación y se discute su utilización en la práctica clínica, proponiéndose pautas y puntuaciones de corte para la evaluación de la gravedad de la depresión, la evaluación de la significación clínica de los cambios terapéuticos, el cribado de personas con depresión y la ayuda en el diagnóstico diferencial de los trastornos depresivos., The first Spanish adaptation of the Beck Depression Inventory-II (BDI-II) was published in 2011. This year marks the 50th anniversary of the publication of its first edition. In this time, the BDI has become the most widely used self-report instrument for assessing the severity of depression in Spain and worldwide. This paper presents the basic characteristics of the BDI-II in relation with its previous versions (BDI-I and BDI-IA), describes the process of its adaptation to the Spanish population, summarizes the psychometric properties of this adaptation, and discusses its use in the clinical practice. To this use, guidelines and cut-off scores are proposed for measuring the severity of depression, for evaluating the clinical significance of therapeutic change, for screening for depression, and for aiding in the differential diagnosis of depressive disorders., Depto. de Personalidad, Evaluación y Psicología Clínica, Fac. de Psicología, TRUE, pub

The unique principle of Ayurveda is Marma Sharira. The Veda also makes  mention of Marma (vital points in body). Aside from serving as anatomical  landmarks, Marma are also the places where the Tridosha (basic elements of  body) and its various forms, Prana, Ojasa or Soma, and Tejasa or Agni (vital  elements of the body), are present. There are several disorders that come from  harm to these Marma. Samhitas provide a clear definition of these illnesses'  ensuing signs and symptoms. Any lesion to these areas has the potential to cause  death, excruciating pain, incapacity, loss of function, and loss of sensation.  Therefore, it has been stated in the scriptures that even when doing procedures,  these crucial places should not be damaged and should be left intact. According  to recent studies, stimulating the Marma points close by can aid to reduce pain in  Marma points that are inflamed or uncomfortable. The therapeutic advantages of  Marma Therapy in treating a range of physical and mental illnesses have been  recorded in several research and textbooks. The goal of this work is to give an  Ayurvedic-based conceptual understanding of Marma.&nbsp

BACKGROUND: The prognostic importance of intraparotid lymph node metastasis (P+) in patients with primary parotid gland carcinoma is unclear. METHODS: Nineteen retrospective and noncomparative cohort studies, published between 1992 and 2020, met the inclusion criteria and included 2202 patients for this systematic review. RESULTS: The pooled prevalence of the P in adult patients in the unselected studies was 24.10% (95% confidence interval = 17.95-30.25). The number of P+ lymph nodes per patient was counted in only three studies and ranged from 1 to 11. The 5-year recurrence-free survival rate based on Kaplan-Meier analysis varied from 83% to 88% in P- patients compared to 36% to 54% in P+ patients. The average hazard ratio for tumor recurrence in patients with P+ compared to P- was 2.67 ± 0.58. CONCLUSIONS: P+ is an independent negative prognostic factor in primary parotid gland cancer and should be included into the treatment planning.

One of the limitations for the use of Healthrelated Quality of Life Questionnaires and the results reported by patients is the difficulty of interpreting the values obtained. The minimal important clinical difference is a measure that helps to understand the results of these questionnaires and assess the clinical relevance of the effect achieved by the intervention performed. In this paper, we review the concept of minimal important clinical difference, describe the methods used to obtain it, and expose its difficulties, limitations, and applicability. Within the results reported by patients, and particularly in quality of life, the minimal important clinical difference is a tool that helps clinicians to correctly use the measurement scales and interpret the effect of the interventions. With this article, we hope to facilitate the implementation and use of the minimal important clinical difference and the Health-related Quality of Life Questionnaires in routine practice with our patients., Una de las limitaciones para el uso de los Cuestionarios de Calidad de Vida Relacionada con la Salud y de los resultados reportados por pacientes es la dificultad de interpretar los valores obtenidos. La diferencia mínima clínica importante es una medida que ayuda a comprender los resultados de estos cuestionarios y valorar la relevancia clínica del efecto conseguido por la intervención realizada. En este trabajo revisamos el concepto de diferencia mínima clínica importante, describimos los métodos utilizados para su obtención y exponemos sus dificultades, limitaciones y aplicabilidad. Dentro de los resultados reportados por pacientes y, particularmente, en los de calidad de vida, la diferencia mínima clínica importante es una herramienta que ayuda a los clínicos a utilizar correctamente las escalas de medida e interpretar el efecto de las intervenciones. Con este artículo esperamos facilitar la implantación y uso de la diferencia mínima clínica importante y los Cuestionarios de Calidad de Vida Relacionada con la Salud en la práctica habitual con nuestros pacientes.

Tato bakalářská práce se zabývá všeobecnými informacemi o vitamínech skupiny B jednotlivě. U každého vitamínu je popsána jejich historie, funkce, výskyt, doporučené denní dávky, nedostatek a v některých případech i jejich vedlejší účinky při nadměrné suplementaci. Tato práce se také zaměřuje na jejich stanovení a klinické využití., This bachelor thesis is concern with general information of vitamins B group individually. For each vitamin there is their history, function, occurence, recommended daily allowances, deficiency and in some cases their side effects of excessive supplementation. The work also focuses on their determination and clinical use., Fakulta chemicko-technologická, 1. Prezentace výsledků baklářské práce. 2.Diskuze k posudku vedoucího bakalářské práce. 3. Studentka zodpověděla všechny dotazy a připomínky k BP., Dokončená práce s úspěšnou obhajobou

Lek-lek interakcije (LLI) su čest uzrok pojave neželjenih ishoda terapije kroz izmenu u efikasnosti ili bezbednosti terapije, a koji se može prevenirati. Posledice LLI nisu dovoljno istražene zbog njihovog neprepoznavanja. Lekovi u terapiji bolesti kardiovaskularnog sistema imaju veliki potencijal za stupanje u LLI, zbog svojih farmakokinetičkih i/ili farmakodinamskih karakteristika. Cilj istraživanja bila je identifikacija potencijalnih i klinički značajnih LLI, procena prevalence, karakteristika i prediktora u populaciji pacijenata sa kardiovaskularnim bolestima, kao i njihov uticaj na ishode terapije. Podaci o pacijentima su prikupljeni retrospektivno iz medicinske dokumentacije. Za identifikaciju LLI korišćena je baza Lexi-Interact, dok je statistička obrada podataka izvršena u programu PASW Statistics. Određena je visoka prevalenca potencijalno relevantnih LLI u populaciji pacijenata sa kardiovaskularnim bolestima, kako u trenutku prijema pacijenata na odeljenje kardiologije (60,7%), tako i tokom bolničkog lečenja (83,9%). Identifikovane su vrste, mehanizam, nivo rizika i stepen ozbiljnosti potencijalnih i ispoljenih LLI, identifikovani su prediktori za njihovu pojavu, izdvojene su subpopulacije pacijenata sa većom prevalencom, i ispitano je prisustvo dodatnih faktora rizika koji povećavaju rizik od manifestacije LLI. Procenjena je primena Lexi-Interact baze kao alata za identifikaciju LLI i optimizaciju terapije izborom alternativnog leka, a razmotrene su i mogućnosti unapređenja alerta uključivanjem karakteristika pacijenata kao modifikatora rizika. Prevalenca klinički značajnih LLI koje su bile povezane sa pojavom neželjenih reakcija na lek u trenutku hospitalizacije pacijenta iznosila je 9,7%. Razvijen je skor koji predviđa verovatnoću budućeg neželjenog događaja usled prisustva kumulativnog rizika od većeg broja potencijalnih LLI. Identifikacija pacijenata sa većim rizikom od pojave neželjenog događaja može olakšati prepoznavanje LLI i unaprediti primenu e, Drug-drug interactions(DDIs) represent one of the preventable causes of adverse therapy outcomes, through deteriorated efficacy and safety. The true extent of harm related to DDIs is not well established due to a lack of recognition. Cardiovascular disease (CVD) drugs are prone to interact in adverse way due to their pharmacokinetic/pharmacodynamic properties, and have been frequently implicated in adverse drug events. The study aimed to identify both potential and clinically significant DDIs, to assess their type, prevalence and predictors, and their impact on therapy outcomes. Data were retrospectively obtained from medical records. Lexi-Interact was used as the screening tool for DDIs, and statistics were performed using PASW. We found a high prevalence of potential DDIs in CVD patients: at the admission 60.7% and during hospital stay 83.9%. The study revealed the type, characteristics, risk rating and severity of DDIs; identified patients with higher exposure to DDIs, the predictors for their occurrence, as well as the presence of additional risk factors for DDIs manifestation. We assessed the utility of Lexi-Interact database in identifying potentially relevant DDIs, and the possibility of therapy optimization using an alternative drug. Our findings indicate the necessity of including the patients laboratory results or clinical data as DDIs risk modifier, to improve DDIs alert quality. DDI-related adverse drug reactions were found in 9.7% of patients at the admission. Given the high prevalence of CVD, DDI-related harm might be a significant burden worldwide. A prediction tool was developed to identify patients having high cumulative risk for the occurrence of an adverse event due to DDIs. Identification of high-risk patients might ease the recognition of DDI-related harm and improve the use of electronic databases in clinical practice.

Lek-lek interakcije (LLI) su čest uzrok pojave neželjenih ishoda terapije kroz izmenu u efikasnosti ili bezbednosti terapije, a koji se može prevenirati. Posledice LLI nisu dovoljno istražene zbog njihovog neprepoznavanja. Lekovi u terapiji bolesti kardiovaskularnog sistema imaju veliki potencijal za stupanje u LLI, zbog svojih farmakokinetičkih i/ili farmakodinamskih karakteristika. Cilj istraživanja bila je identifikacija potencijalnih i klinički značajnih LLI, procena prevalence, karakteristika i prediktora u populaciji pacijenata sa kardiovaskularnim bolestima, kao i njihov uticaj na ishode terapije. Podaci o pacijentima su prikupljeni retrospektivno iz medicinske dokumentacije. Za identifikaciju LLI korišćena je baza Lexi-Interact, dok je statistička obrada podataka izvršena u programu PASW Statistics. Određena je visoka prevalenca potencijalno relevantnih LLI u populaciji pacijenata sa kardiovaskularnim bolestima, kako u trenutku prijema pacijenata na odeljenje kardiologije (60,7%), tako i tokom bolničkog lečenja (83,9%). Identifikovane su vrste, mehanizam, nivo rizika i stepen ozbiljnosti potencijalnih i ispoljenih LLI, identifikovani su prediktori za njihovu pojavu, izdvojene su subpopulacije pacijenata sa većom prevalencom, i ispitano je prisustvo dodatnih faktora rizika koji povećavaju rizik od manifestacije LLI. Procenjena je primena Lexi-Interact baze kao alata za identifikaciju LLI i optimizaciju terapije izborom alternativnog leka, a razmotrene su i mogućnosti unapređenja alerta uključivanjem karakteristika pacijenata kao modifikatora rizika. Prevalenca klinički značajnih LLI koje su bile povezane sa pojavom neželjenih reakcija na lek u trenutku hospitalizacije pacijenta iznosila je 9,7%. Razvijen je skor koji predviđa verovatnoću budućeg neželjenog događaja usled prisustva kumulativnog rizika od većeg broja potencijalnih LLI. Identifikacija pacijenata sa većim rizikom od pojave neželjenog događaja može olakšati prepoznavanje LLI i unaprediti primenu e, outcomes, through deteriorated efficacy and safety. The true extent of harm related to DDIs is not well established due to a lack of recognition. Cardiovascular disease (CVD) drugs are prone to interact in adverse way due to their pharmacokinetic/pharmacodynamic properties, and have been frequently implicated in adverse drug events. The study aimed to identify both potential and clinically significant DDIs, to assess their type, prevalence and predictors, and their impact on therapy outcomes. Data were retrospectively obtained from medical records. Lexi-Interact was used as the screening tool for DDIs, and statistics were performed using PASW. We found a high prevalence of potential DDIs in CVD patients: at the admission 60.7% and during hospital stay 83.9%. The study revealed the type, characteristics, risk rating and severity of DDIs; identified patients with higher exposure to DDIs, the predictors for their occurrence, as well as the presence of additional risk factors for DDIs manifestation. We assessed the utility of Lexi-Interact database in identifying potentially relevant DDIs, and the possibility of therapy optimization using an alternative drug. Our findings indicate the necessity of including the patients laboratory results or clinical data as DDIs risk modifier, to improve DDIs alert quality. DDI-related adverse drug reactions were found in 9.7% of patients at the admission. Given the high prevalence of CVD, DDI-related harm might be a significant burden worldwide. A prediction tool was developed to identify patients having high cumulative risk for the occurrence of an adverse event due to DDIs. Identification of high-risk patients might ease the recognition of DDI-related harm and improve the use of electronic databases in clinical practice.

Background: Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference. Methods: After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, post-bronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores. Main outcomes: Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points. Findings: A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points. Conclusions: The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Background: Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference. Methods: After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, post-bronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores. Main outcomes: Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points. Findings: A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points. Conclusions: The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Psoriasis patients are known to have comorbid aortic vascular inflammation, which is one of the leading causes of cardiovascular morbidity and mortality in this population. Many studies report statistically significant improvements in aortic vascular inflammation after use of tumor necrosis factor inhibitors or interleukin-12/23 antagonists. However, the clinical significance in reduction of adverse cardiovascular events in psoriatic patients owing to biologic therapy has not been examined. Regardless of clinically significant cardiovascular benefits, dermatologists should continue to treat psoriasis patients optimally to mitigate the unfavorable effect this disease has on quality of life.

Background: The present study investigates the suitability of various treatment outcome indicators to evaluate performance of mental health institutions that provide care to patients with severe mental illness. Several categorical approaches are compared to a reference indicator (continuous outcome) using pretest-posttest data of the Health of Nation Outcome Sca

Psoriasis patients are known to have comorbid aortic vascular inflammation, which is one of the leading causes of cardiovascular morbidity and mortality in this population. Many studies report statistically significant improvements in aortic vascular inflammation after use of tumor necrosis factor inhibitors or interleukin-12/23 antagonists. However, the clinical significance in reduction of adverse cardiovascular events in psoriatic patients owing to biologic therapy has not been examined. Regardless of clinically significant cardiovascular benefits, dermatologists should continue to treat psoriasis patients optimally to mitigate the unfavorable effect this disease has on quality of life.

Objective: The aim was to examine whether the presence of pain (based on physical conditions and participants' report) and self-reported pain experience in adults with Down syndrome (DS) differ from general population controls.Design: Cross-sectional study of 224 adults with DS (mean age = 38.1 years, mild-severe intellectual disabilities) and 142 age-matched controls (median age = 40.5 years, mean estimated IQ = 105.7) in the Netherlands.Methods: File-based medical information was evaluated. Self-reported presence and experience of pain were assessed in rest and after movement during a test session (affect with facial affective scale (FAS: 0.04-0.97), intensity assessed with numeric rating scale (NRS: 0-10).Results: Compared with controls, more DS participants had physical conditions that may cause pain and/or discomfort ( p = .004, 50% vs 35%), but fewer DS participants reported pain during the test session ( p = .003, 58% vs 73%). Of the participants who indicated pain and comprehended self-reporting scales ( n = 198 FAS, n = 161 NRS), the DS group reported a higher pain affect and intensity than the controls ( p < .001, FAS: 0.75-0.85 vs 0.50-0.59, NRS: 6.00-7.94 vs 2.00-3.73).Conclusions: Not all adults with DS and painful/discomforting physical conditions reported pain. Those who did indicated a higher pain experience than adults from the general population. Research into spontaneous self-report of pain, repeated pain assessment, and acute pain is needed in people with DS for more insight into pain experience and mismatches between self-report and medical information.

Objective: The aim of the present study was to examine whether cognitive functioning (i.e., memory and executive functioning) is related to self-reported presence of pain (i.e., affirmative answer to the question whether the individual feels pain) and experience of pain (i.e., intensity and affect) in adults with Down syndrome (DS).Design, Setting, and Subjects: Cross-sectional study of 224 adults with DS (mean age = 38.1 years, mild-severe intellectual disabilities) in the Netherlands.Methods: File-based medical information was evaluated. Self-reported presence and experience of pain were assessed during a test session, both in rest and after movement (affect with the facial affective scale [FAS], intensity with the numeric rating scale [NRS]). Neuropsychological tests for memory and executive functioning were used.Results: Participants with lower memory scores were more likely to report the presence of pain, while controlling for age, gender, physical conditions that may cause pain, language comprehension, and vocabulary ( p = .030, 58.4% classification rate, N = 154). No statistically significant associations were found between executive functioning and self-reported presence of pain or between cognitive functioning and self-reported pain experience.Conclusions: Memory seems to be related to the self-reported presence of pain in adults with DS after explicit inquiry, although the clinical use of this model is yet limited. Therefore, further research is needed for insight into the role of cognitive processes in self-report (e.g., involving aspects such as acquiescence and repeated measurements) to evaluate whether neuropsychological examination could contribute to pain assessment in DS.

Una de las limitaciones de la investigación sobre prevención indicada de la depresión es que pocos trabajos han analizado la significación clínica de los efectos de la intervención. En el presente estudio, se asignaron al azar 170 cuidadoras no profesionales con síntomas depresivos a un grupo de intervención cognitivo-conductual (n = 88) o a un grupo control de atención habitual (n = 82). La intervención se aplicó en cinco sesiones de 90 minutos en grupos de aproximadamente cinco participantes, por psicólogos previamente entrenados. En la posintervención se encontró un porcentaje significativamente mayor de cuidadoras que alcanzaron un cambio clínicamente significativo en el grupo de intervención en comparación con el grupo control (62.5% vs. 15.9%; x 2 (1, N = 170) = 38.48, p < .001). Esto se mantuvo hasta los 12 meses de seguimiento, donde el 81.8% del grupo de intervención obtuvo un cambio clínicamente significativo frente al 17.1% del grupo control (x 2 (1, N = 170) = 71.18, p < .001). Las variables predictoras del cambio clínico para el grupo de intervención en la posintervención fueron dedicarse a las tareas domésticas y una mayor edad de la persona cuidada. En el seguimiento a 12 meses no se encontró ninguna variable predictora, One of the limitations of research in indicated prevention of depression is that few works have analyzed the clinical significance of the effects of the interventions. In this study, 170 non-professional caregivers with depressive symptoms were randomized to a cognitive-behavioral intervention group (n = 88) or to a usual-care control group (n = 82). The intervention was implemented in five weekly 90-minute sessions in groups of approximately five participants by trained psychologists. At postreatment, there was a significantly higher percentage of caregivers who achieved a clinically significant change in the intervention group compared to the control group (62.5% vs. 15.9%; x 2 (1, N = 170) = 38.48, p < .001). This was maintained until 12-month follow-up, when 81.8% of the intervention group obtained a clinically significant change compared to 17.1% in the control group (x 2 (1, N = 170) = 71.18, p < .001). The variables that predicted clinical change for the intervention group at postreatment were to be devoted to domestic work and older age of the care recipient. No predictors were found for the 12-month follow-up

En este trabajo se presentan dos técnicas para el análisis de datos de los diseños de caso único en la investigación de los tratamientos psicológicos: los índices de no solapamiento de datos para estimar el tamaño del efecto del tratamiento (o magnitud del cambio terapéutico) y la aproximación estadística de Jacobson y Truax (1991) para estimar la significación clínica del efecto. A partir del caso de una víctima del terrorismo que sufría de trastorno por estrés postraumático, trastorno depresivo mayor y trastorno de angustia con agorafobia y que recibió terapia cognitivo conductual centrada en el trauma, se ejemplifica el cálculo y aplicación del porcentaje de datos no solapados (PND), el porcentaje de datos que exceden la mediana (PEM), el no solapamiento de todos los pares (NAP) y la aproximación estadística a la significación clínica y se discuten sus ventajas y limitaciones como complemento al análisis visual de los datos., This paper presents two techniques for the data analysis of single case designs in psychological treatment research: indices of data overlap between phases to estimate the size of treatment effect (or the magnitude of therapeutic change) and Jacobson and Truax's (1991) statistical approach to estimate the clinical significance of treatment effect. Based on a case of a victim of terrorism who suffered from posttraumatic stress disorder, major depressive disorder and panic disorder with agoraphobia and received trauma-focused cognitive-behavioral therapy, this paper illustrates the computation and application ofpercentage of non-overlapping data (PND), percentage of data points exceeding the median (PEM), non overlap of all pairs (NAP), and statistical approach to clinical significance, and discusses their advantages and limitations as a complement of visual analysis of data., Ministerio de Ciencia e Innovación (MICINN), Depto. de Personalidad, Evaluación y Psicología Clínica, Fac. de Psicología, TRUE, pub

Föreliggande studie syftade till att undersöka det transdiagnostiska och känslofokuserade KBT-behandlingsprogrammet Unified Protocol i gruppformat på en allmänpsykiatrisk öppenvårdsmottagning. Studien använde sig av case series design på tre patienter med en ångestproblematik som primärdiagnos. Studien följde förändringar i symtom av depression, ångest och upplevd livskvalitet samt känsloregleringsfärdigheter under tolv veckors behandling. Författarna ville även undersöka om stärkta känsloregleringsfärdigheter och symtomlindring sammanföll samt huruvida de förstnämnda föregick symtomlindring. För datainsamlingen har använts sex subskalor som mäter känsloregleringsfärdigheter i avsikt att matcha sex av behandlingsmodulerna i Unified Protocol. Dessa färdigheter var ”Kognitiv omvärdering”, ”Icke-acceptans”, ”Mål”, ”Medvetenhet”, ”Aversion mot obehag” och ”Uthärda obehag”. Symtomförändringar har kontinuerligt mätts med testerna OASIS och ODSIS. Därtill skedde mätningar av depressionssymtom och ångestsymtom samt upplevd livskvalitet med BAI, BDI-II och WHOQOL-BREF. Författarna har undersökt om förändringar har skett i enlighet med Reliable Change index och klinisk signifikans. Resultaten visade på symtomlindring och förhöjd livskvalitet hos en patient. I det andra fallet skedde ingen förändring av symtom eller livskvalitet. I det tredje fallet skedde viss symtomlindring. Vissa känsloregleringsfärdigheter stärktes hos patienterna. Delvis sammanföll känsloregleringsfärdigheter och symtomlindring, men de förstnämnda föregick inte symtomlindring nära i tid. Studien visar att Unified Protocol är ett intressant behandlingsprogram för en allmänpsykiatrisk mottagning, men ytterligare forskning behövs för att fastställa om behandlingen i gruppformat är lika effektiv som en individualiserad behandling., The present study aimed to investigate the transdiagnostic and emotion-focused CBT treatment program Unified Protocol in a group format in a general psychiatric outpatient clinic. The study used case series design on three patients with anxiety problems as primary diagnosis. The study followed changes in symptoms of depression, anxiety and perceived quality of life and emotion regulation skills during the twelve weeks of treatment. The authors also wanted to examine the covariance between strengthed emotion regulation skills and symptom relief and whether the former preceded the symptoms. For data collection was used six subscales that measure emotion regulation skills in order to match six of the processing modules of the Unified Protocol. These skills were "Cognitive reappraisal", "Nonacceptance", "Goal", "Awareness", "Distress aversion" and "Aversion endurance". Symptom changes are continuously measured by tests OASIS and ODSIS. In addition, measurements were made of the symptoms of depression and anxiety symptoms, and perceived quality of life with BAI, BDI-II and WHOQOL-BREF. The authors have investigated whether changes have been made in accordance with the Reliable Change Index and clinical significance. The results showed symptom relief and increased quality of life of one patient. In the second case, there was no change of symptoms or quality of life. In the third case occurred some symptom relief. Some emotion regulation skills strengthened for the patients. Partly, there was a covariance between emotion regulation skills and symptom relief, but the former preceded not symptom close in time. The study shows that the Unified Protocol is an interesting treatment of a general psychiatric clinic, but further research is needed to determine if the treatment in a group format is as effective as an individualized therapy.

Föreliggande studie syftade till att undersöka det transdiagnostiska och känslofokuserade KBT-behandlingsprogrammet Unified Protocol i gruppformat på en allmänpsykiatrisk öppenvårdsmottagning. Studien använde sig av case series design på tre patienter med en ångestproblematik som primärdiagnos. Studien följde förändringar i symtom av depression, ångest och upplevd livskvalitet samt känsloregleringsfärdigheter under tolv veckors behandling. Författarna ville även undersöka om stärkta känsloregleringsfärdigheter och symtomlindring sammanföll samt huruvida de förstnämnda föregick symtomlindring. För datainsamlingen har använts sex subskalor som mäter känsloregleringsfärdigheter i avsikt att matcha sex av behandlingsmodulerna i Unified Protocol. Dessa färdigheter var ”Kognitiv omvärdering”, ”Icke-acceptans”, ”Mål”, ”Medvetenhet”, ”Aversion mot obehag” och ”Uthärda obehag”. Symtomförändringar har kontinuerligt mätts med testerna OASIS och ODSIS. Därtill skedde mätningar av depressionssymtom och ångestsymtom samt upplevd livskvalitet med BAI, BDI-II och WHOQOL-BREF. Författarna har undersökt om förändringar har skett i enlighet med Reliable Change index och klinisk signifikans. Resultaten visade på symtomlindring och förhöjd livskvalitet hos en patient. I det andra fallet skedde ingen förändring av symtom eller livskvalitet. I det tredje fallet skedde viss symtomlindring. Vissa känsloregleringsfärdigheter stärktes hos patienterna. Delvis sammanföll känsloregleringsfärdigheter och symtomlindring, men de förstnämnda föregick inte symtomlindring nära i tid. Studien visar att Unified Protocol är ett intressant behandlingsprogram för en allmänpsykiatrisk mottagning, men ytterligare forskning behövs för att fastställa om behandlingen i gruppformat är lika effektiv som en individualiserad behandling., The present study aimed to investigate the transdiagnostic and emotion-focused CBT treatment program Unified Protocol in a group format in a general psychiatric outpatient clinic. The study used case series design on three patients with anxiety problems as primary diagnosis. The study followed changes in symptoms of depression, anxiety and perceived quality of life and emotion regulation skills during the twelve weeks of treatment. The authors also wanted to examine the covariance between strengthed emotion regulation skills and symptom relief and whether the former preceded the symptoms. For data collection was used six subscales that measure emotion regulation skills in order to match six of the processing modules of the Unified Protocol. These skills were "Cognitive reappraisal", "Nonacceptance", "Goal", "Awareness", "Distress aversion" and "Aversion endurance". Symptom changes are continuously measured by tests OASIS and ODSIS. In addition, measurements were made of the symptoms of depression and anxiety symptoms, and perceived quality of life with BAI, BDI-II and WHOQOL-BREF. The authors have investigated whether changes have been made in accordance with the Reliable Change Index and clinical significance. The results showed symptom relief and increased quality of life of one patient. In the second case, there was no change of symptoms or quality of life. In the third case occurred some symptom relief. Some emotion regulation skills strengthened for the patients. Partly, there was a covariance between emotion regulation skills and symptom relief, but the former preceded not symptom close in time. The study shows that the Unified Protocol is an interesting treatment of a general psychiatric clinic, but further research is needed to determine if the treatment in a group format is as effective as an individualized therapy.

En sus 25 años de existencia, el Inventario de Ansiedad de Beck (BAI) se ha convertido en el cuestionario autoaplicado para evaluar la gravedad de la ansiedad más utilizado en los países con mayor producción científica en psicología, aunque en España dicho instrumento sigue siendo el Cuestionario de Ansiedad Estado-Rasgo (STAI). En este trabajo se presentan las características básicas del BAI en comparación con la escala de Ansiedad Rasgo del STAI, se describe el proceso de adaptación del BAI a la población española, se resumen las propiedades psicométricas de dicha adaptación y se discute su utilización en la práctica clínica, para lo cual se calculan baremos y puntuaciones de corte para la evaluación de la gravedad de la ansiedad, la evaluación de la significación clínica de los cambios terapéuticos, el cribado de personas con ansiedad clínica y la ayuda en el diagnóstico diferencial de los trastornos de ansiedad., In its 25 years of existence, the Beck Anxiety Inventory (BAI) has become the most widely used self-report instrument for assessing the severity of anxiety in the countries with higher research productivity in psychology, although in Spain this instrument is still the State-Trait Anxiety Inventory (STAI). This paper presents the basic characteristics of the BAI in comparison with the Trait Anxiety scale of the STAI, describes the process of adaptation of the BAI to the Spanish population, summarizes the psychometric properties of this adaptation, and discusses its use in the clinical practice. To this use, norms and cut-off scores are calculated in order to measure the severity of anxiety, evaluate the clinical significance of therapeutic change, screen for clinical anxiety, and aid in the differential diagnosis of anxiety disorders., Depto. de Personalidad, Evaluación y Psicología Clínica, Fac. de Psicología, TRUE, pub

Minimal important differences (MIDs) for patient-reported outcomes (PROs) are often estimated by selecting a clinical variable to serve as an anchor. Then, differences in the clinical anchor regarded as clinically meaningful or important can be used to estimate the corresponding value of the PRO. Although these MID values are sometimes estimated by regression techniques, we show that this is a biased procedure and should not be used; alternative methods are proposed.

Minimal important differences (MIDs) for patient-reported outcomes (PROs) are often estimated by selecting a clinical variable to serve as an anchor. Then, differences in the clinical anchor regarded as clinically meaningful or important can be used to estimate the corresponding value of the PRO. Although these MID values are sometimes estimated by regression techniques, we show that this is a biased procedure and should not be used; alternative methods are proposed.

Introduction: Congenital anomalies of posterior arch of atlas are very rare. Most of the time detection of this developmental anomaly is incidental while investigating for neck pain and stiffness or injury involving the region of head and neck. Aim: Our aim was to determine the incidence of posterior arch anomaly of atlas in Maharashtra region. 75 dried human atlas vertebrae were included for this study. Observations: We detected Type A and B in our study. Results: The incidence of posterior arch anomaly is 4% i.e. 3 out of 75 vertebrae. We detected Type A and B in our study and these types are generally asymptomatic. Type C to E may be associated with neurological deficit. Conclusion: It is essential for the clinicians to recognize the condition and the specific type of anomaly in order to distinguish it from fractures secondary to trauma and for the proper guidance of the patients accordingly.

Introduction: Congenital anomalies of posterior arch of atlas are very rare. Most of the time detection of this developmental anomaly is incidental while investigating for neck pain and stiffness or injury involving the region of head and neck. Aim: Our aim was to determine the incidence of posterior arch anomaly of atlas in Maharashtra region. 75 dried human atlas vertebrae were included for this study. Observations: We detected Type A and B in our study. Results: The incidence of posterior arch anomaly is 4% i.e. 3 out of 75 vertebrae. We detected Type A and B in our study and these types are generally asymptomatic. Type C to E may be associated with neurological deficit. Conclusion: It is essential for the clinicians to recognize the condition and the specific type of anomaly in order to distinguish it from fractures secondary to trauma and for the proper guidance of the patients accordingly.

Coronary CT angiography has revolutionized the management approaches in patients with atypical chest pain and nonspecific symptoms that may not be related to the cardiac disease. Presence of extracardiac findings on coronary CT angiography is very common, and some of these findings have clinical significance which requires additional workup to improve patient outcome. The aim of this study is to prospectively assess the prevalence and spectrum of extracardiac findings in 300 patients suspected of cardiac disease, based on coronary CT angiography. CT imaging appearances of extracardiac findings with potential clinical significance are presented.

The first Spanish adaptation of the Beck Depression Inventory-II (BDI-II) was published in 2011. This year marks the 50th anniversary of the publication of its first edition. In this time, the BDI has become the most widely used self-report instrument for assessing the severity of depression in Spain and worldwide. This paper presents the basic characteristics of the BDI-II in relation with its previous versions (BDI-I and BDI-IA), describes the process of its adaptation to the Spanish population, summarizes the psychometric properties of this adaptation, and discusses its use in the clinical practice. To this use, guidelines and cut-off scores are proposed for measuring the severity of depression, for evaluating the clinical significance of therapeutic change, for screening for depression, and for aiding in the differential diagnosis of depressive disorders., En 2011 se publicó la primera adaptación española del Inventario de Depresión de Beck-II (BDI-II), justo cuando se cumplía el 50º aniversario de la publicación de su primera edición. En este tiempo, el BDI se ha convertido en el cuestionario autoaplicado más utilizado en España y en el mundo para evaluar la gravedad de la depresión. En este trabajo se presentan las características básicas del BDI-II en relación con sus versiones anteriores (BDI-I y BDI-IA) y el proceso de su adaptación a la población española, se resumen las propiedades psicométricas de dicha adaptación y se discute su utilización en la práctica clínica, proponiéndose pautas y puntuaciones de corte para la evaluación de la gravedad de la depresión, la evaluación de la significación clínica de los cambios terapéuticos, el cribado de personas con depresión y la ayuda en el diagnóstico diferencial de los trastornos depresivos., Depto. de Personalidad, Evaluación y Psicología Clínica, Fac. de Psicología, TRUE, pub

Smarttelefonen används alltmer som redskap i psykoterapeutisk behandling men hittills har ingen kontrollerad studie provat om behandling av social fobi kan förmedlas genom smarttelefon. Denna randomiserade och kontrollerade studie undersökte guidad självhjälpsbehandling vid social fobi förmedlad via smarttelefon med syfte att dels jämföra behandlingar och dels att studera olika patientfaktorers betydelse för behandlingsutfall. Totalt randomiserades 52 deltagare till kognitiv beteendeterapi (KBT) (n=27) eller interpersonell terapi (IPT) (n=25) i ett nio veckor långt behandlingsprogram. Det primära utfallsmåttet var Liebowitz Social Anxiety Scale- self rate (LSAS-SR) och behandlingsutfall studerades dels som grad av symptomreduktion och dels som klinisk signifikant förbättring. Signifikant fler deltagare blev kliniskt signifikant förbättrade i gruppen som tilldelats behandling med KBT i jämförelse med gruppen som tilldelats IPT. Ålder, kön, utbildningsnivå, initial depressionsgrad, initial svårighetsgrad, andel datoranvändning i behandling samt initial vana vid smarttelefon, hade inte något signifikant samband med behandlingsutfall. En tendens till signifikant skillnad avseende svårighetsgrad antydde att generaliserad social fobi skulle kunna vara förknippad med en högre grad av symptomreduktion än specifik social fobi. Sammantaget framkom inga indikationer på att någon av dessa patientfaktorer hade betydelse för deltagarens möjlighet att tillgodogöra sig behandlingen i denna studie., The use of smartphones as a tool for administering psychological treatment is increasing, however, there is so far no controlled studies showing that social anxiety disorder (SAD) can be treated in this way. This randomized and controlled study, examines Internet based treatment administered through smartphones for social anxiety disorder. Two different types of treatment are compared, and the importance of different patient related factors for the treatment outcome was explored. In total, 52 participants were randomly selected to participate in Cognitive Behavior Therapy CBT (n=27) or Interpersonal Therapy (IPT) (n=25) targeting their SAD. The treatment lasted for nine weeks. The primary outcome measure was Liebowitz social anxiety scale- self rate (LSAS-SR) and treatments outcome was studied both in terms of symptom reduction, and in terms of clinical significant improvement. The result suggested that significant more patients were clinically significantly improved among those receiving CBT, as compared to the group that received IPT. Age, gender, level of education, initial level of depression, initial level of severity, amount of computer usages in treatment, as well as initial experience of smartphone usages, showed no relationship with the treatment outcome. The result showed a tendency to significant difference regarding the initial level of severity, suggesting that generalized social anxiety disorder could be associated with a higher degree of symptom reduction than specific social anxiety disorder. The conclusion drawn from this result is that none of the patient factors were related to the treatment effect.

The prevention of eating disorders is considered, mainly by psychologists of health, a priority task to cover. In accord to this idea it was decided to analyze and evaluate the effectiveness of two intervention programs based in different strategies. The nonrandom sample consisted of n=58 students with a mean age of x.=13.43 (SD=1.14), which were randomly assigned to two different selective prevention programs: Psychoeducation (n = 28; age of x. =13.46, SD=1.17) and Virtual reality Reinforced (n=30; age of x. =13.40, SD=1.13). The results showed nodifferences betweenprograms. However, when each was evaluated (pretest / postest) results werepositive and statistically significant (p ..001) in those variables associatedwithbody image anddisordered eating. In additionthere was asignificant decreaseinthe percentageof participants whowere placedat risk (clinical significance) as a result ofthe preventive programs. These findingsare encouragingbecause of the importanceinvolvedin reducingrisk factors andtheeffect it has onthe health ofadolescents., La prevencion de los trastornos alimentarios es considerada por los psicologos de la salud como una tarea prioritaria a cubrir. De acuerdo con esta idea se propuso analizar y evaluar la eficacia de dos programas de intervencion basados en distintas estrategias. La muestra no probabilistica estuvo formada por 58 estudiantes, con edad promedio de 13.43, (DE=1.14). Las participantes se asignaron al azar a dos distintos programas de prevencion selectiva: Psicoeducacion (n=28; x. de edad=13.46, DE=1.17) y Realidad Virtual Reforzada (n=30; x. de edad=13.40, DE=1.13). Los resultados muestran que no se detectaron diferencias entre los programas. Al evaluar el efecto de los dos programas por separado (prestest-postest) se obtuvieron resultados positivos y estadisticamente significativos (p..001) en variables asociadas con imagen corporal y conductas alimentarias de riesgo. Ademas se observo una disminucion importante en el porcentaje de participantes que se ubicaban en riesgo (significancia clinica) como producto de los programas. Estos hallazgos son alentadores debido a la importancia implicada en la disminucion de factores de riesgo y el efecto que tiene en la salud de las adolescentes.

The prevention of eating disorders is considered, mainly by psychologists of health, a priority task to cover. In accord to this idea it was decided to analyze and evaluate the effectiveness of two intervention programs based in different strategies. The nonrandom sample consisted of n=58 students with a mean age of x.=13.43 (SD=1.14), which were randomly assigned to two different selective prevention programs: Psychoeducation (n = 28; age of x. =13.46, SD=1.17) and Virtual reality Reinforced (n=30; age of x. =13.40, SD=1.13). The results showed nodifferences betweenprograms. However, when each was evaluated (pretest / postest) results werepositive and statistically significant (p ..001) in those variables associatedwithbody image anddisordered eating. In additionthere was asignificant decreaseinthe percentageof participants whowere placedat risk (clinical significance) as a result ofthe preventive programs. These findingsare encouragingbecause of the importanceinvolvedin reducingrisk factors andtheeffect it has onthe health ofadolescents., La prevencion de los trastornos alimentarios es considerada por los psicologos de la salud como una tarea prioritaria a cubrir. De acuerdo con esta idea se propuso analizar y evaluar la eficacia de dos programas de intervencion basados en distintas estrategias. La muestra no probabilistica estuvo formada por 58 estudiantes, con edad promedio de 13.43, (DE=1.14). Las participantes se asignaron al azar a dos distintos programas de prevencion selectiva: Psicoeducacion (n=28; x. de edad=13.46, DE=1.17) y Realidad Virtual Reforzada (n=30; x. de edad=13.40, DE=1.13). Los resultados muestran que no se detectaron diferencias entre los programas. Al evaluar el efecto de los dos programas por separado (prestest-postest) se obtuvieron resultados positivos y estadisticamente significativos (p..001) en variables asociadas con imagen corporal y conductas alimentarias de riesgo. Ademas se observo una disminucion importante en el porcentaje de participantes que se ubicaban en riesgo (significancia clinica) como producto de los programas. Estos hallazgos son alentadores debido a la importancia implicada en la disminucion de factores de riesgo y el efecto que tiene en la salud de las adolescentes.

Smarttelefonen används alltmer som redskap i psykoterapeutisk behandling men hittills har ingen kontrollerad studie provat om behandling av social fobi kan förmedlas genom smarttelefon. Denna randomiserade och kontrollerade studie undersökte guidad självhjälpsbehandling vid social fobi förmedlad via smarttelefon med syfte att dels jämföra behandlingar och dels att studera olika patientfaktorers betydelse för behandlingsutfall. Totalt randomiserades 52 deltagare till kognitiv beteendeterapi (KBT) (n=27) eller interpersonell terapi (IPT) (n=25) i ett nio veckor långt behandlingsprogram. Det primära utfallsmåttet var Liebowitz Social Anxiety Scale- self rate (LSAS-SR) och behandlingsutfall studerades dels som grad av symptomreduktion och dels som klinisk signifikant förbättring. Signifikant fler deltagare blev kliniskt signifikant förbättrade i gruppen som tilldelats behandling med KBT i jämförelse med gruppen som tilldelats IPT. Ålder, kön, utbildningsnivå, initial depressionsgrad, initial svårighetsgrad, andel datoranvändning i behandling samt initial vana vid smarttelefon, hade inte något signifikant samband med behandlingsutfall. En tendens till signifikant skillnad avseende svårighetsgrad antydde att generaliserad social fobi skulle kunna vara förknippad med en högre grad av symptomreduktion än specifik social fobi. Sammantaget framkom inga indikationer på att någon av dessa patientfaktorer hade betydelse för deltagarens möjlighet att tillgodogöra sig behandlingen i denna studie., The use of smartphones as a tool for administering psychological treatment is increasing, however, there is so far no controlled studies showing that social anxiety disorder (SAD) can be treated in this way. This randomized and controlled study, examines Internet based treatment administered through smartphones for social anxiety disorder. Two different types of treatment are compared, and the importance of different patient related factors for the treatment outcome was explored. In total, 52 participants were randomly selected to participate in Cognitive Behavior Therapy CBT (n=27) or Interpersonal Therapy (IPT) (n=25) targeting their SAD. The treatment lasted for nine weeks. The primary outcome measure was Liebowitz social anxiety scale- self rate (LSAS-SR) and treatments outcome was studied both in terms of symptom reduction, and in terms of clinical significant improvement. The result suggested that significant more patients were clinically significantly improved among those receiving CBT, as compared to the group that received IPT. Age, gender, level of education, initial level of depression, initial level of severity, amount of computer usages in treatment, as well as initial experience of smartphone usages, showed no relationship with the treatment outcome. The result showed a tendency to significant difference regarding the initial level of severity, suggesting that generalized social anxiety disorder could be associated with a higher degree of symptom reduction than specific social anxiety disorder. The conclusion drawn from this result is that none of the patient factors were related to the treatment effect.

Smarttelefonen används alltmer som redskap i psykoterapeutisk behandling men hittills har ingen kontrollerad studie provat om behandling av social fobi kan förmedlas genom smarttelefon. Denna randomiserade och kontrollerade studie undersökte guidad självhjälpsbehandling vid social fobi förmedlad via smarttelefon med syfte att dels jämföra behandlingar och dels att studera olika patientfaktorers betydelse för behandlingsutfall. Totalt randomiserades 52 deltagare till kognitiv beteendeterapi (KBT) (n=27) eller interpersonell terapi (IPT) (n=25) i ett nio veckor långt behandlingsprogram. Det primära utfallsmåttet var Liebowitz Social Anxiety Scale- self rate (LSAS-SR) och behandlingsutfall studerades dels som grad av symptomreduktion och dels som klinisk signifikant förbättring. Signifikant fler deltagare blev kliniskt signifikant förbättrade i gruppen som tilldelats behandling med KBT i jämförelse med gruppen som tilldelats IPT. Ålder, kön, utbildningsnivå, initial depressionsgrad, initial svårighetsgrad, andel datoranvändning i behandling samt initial vana vid smarttelefon, hade inte något signifikant samband med behandlingsutfall. En tendens till signifikant skillnad avseende svårighetsgrad antydde att generaliserad social fobi skulle kunna vara förknippad med en högre grad av symptomreduktion än specifik social fobi. Sammantaget framkom inga indikationer på att någon av dessa patientfaktorer hade betydelse för deltagarens möjlighet att tillgodogöra sig behandlingen i denna studie., The use of smartphones as a tool for administering psychological treatment is increasing, however, there is so far no controlled studies showing that social anxiety disorder (SAD) can be treated in this way. This randomized and controlled study, examines Internet based treatment administered through smartphones for social anxiety disorder. Two different types of treatment are compared, and the importance of different patient related factors for the treatment outcome was explored. In total, 52 participants were randomly selected to participate in Cognitive Behavior Therapy CBT (n=27) or Interpersonal Therapy (IPT) (n=25) targeting their SAD. The treatment lasted for nine weeks. The primary outcome measure was Liebowitz social anxiety scale- self rate (LSAS-SR) and treatments outcome was studied both in terms of symptom reduction, and in terms of clinical significant improvement. The result suggested that significant more patients were clinically significantly improved among those receiving CBT, as compared to the group that received IPT. Age, gender, level of education, initial level of depression, initial level of severity, amount of computer usages in treatment, as well as initial experience of smartphone usages, showed no relationship with the treatment outcome. The result showed a tendency to significant difference regarding the initial level of severity, suggesting that generalized social anxiety disorder could be associated with a higher degree of symptom reduction than specific social anxiety disorder. The conclusion drawn from this result is that none of the patient factors were related to the treatment effect.

Clinicians use general practice guidelines as a source of support for their intervention, but how much confidence should they place on these recommendations? How much confidence should patients place on these recommendations? Various instruments are available to assess the quality of evidence of research, such as the revised Wong scale (R-Wong) which examines the quality of research design, methodology and data analysis, and the revision of the assessment of multiple systematic reviews (R-AMSTAR), which examines the quality of systematic reviews.The Grading of Recommendation Assessment, Development, and Evaluation (GRADE) Working Group developed an instrument called the GRADE system in order to grade the quality of the evidence in studies and to evaluate the strength of recommendation of the intervention that is proposed in the published article. The GRADE looks at four factors to determine the quality of the evidence: study design, study quality, consistency, and directness. After combining the four components and assessing the grade of the evidence, the strength of recommendation of the intervention is established. The GRADE, however, only makes a qualitative assessment of the evidence and does not generate quantifiable data.In this study, we have quantified both the grading of the quality of evidence and also the strength of recommendation of the original GRADE, hence expanding the GRADE. This expansion of the GRADE (Ex-GRADE) permits the creation of a new instrument that can produce tangible data and possibly bridge the gap between evidence-based research and evidence-based clinical practice.

Bokinformation: Varje år berörs hundratusentals personer av psykosociala och pedagogiska interventioner. Det handlar exempelvis om behandling av missbruk, insatser för utsatta barn och läsundervisning i grundskolan. Endast undantagsvis har dessa interventioner utvärderats, vilket innebär att vi inte vet vilken effekt de har eller om de rentav kan skada. I antologin Att göra effektutvärderingar beskrivs hur man genomför effektutvärderingar, som ger kunskap om hur interventioner fungerar. Boken ger detaljerad och praktisk vägledning som är till nytta för alla som är intresserade av att lära sig mer om effektutvärderingar – både forskarstuderande och forskare som redan ansvarat för effektutvärderingar. Ämnen som tas upp är bland annat forskningsetik, studiedesign, mätinstrument, urval och rekrytering av undersökningspersoner, datainsamling, ekonomiska analyser, dataanalys och tolkning samt rapportskrivning. Bokens författare har lång erfarenhet inom området och representerar olika discipliner såsom psykologi, folkhälsovetenskap, socialt arbete, pedagogik, statistik, epidemiologi, sociologi, evolutionsbiologi, medicinsk vetenskap och datavetenskap. Redaktör för boken är Knut Sundell, docent i psykologi och socialråd på Socialstyrelsen, som har lång erfarenhet av att utvärdera interventioner inom förskola, skola och socialtjänst.

Clinicians use general practice guidelines as a source of support for their intervention, but how much confidence should they place on these recommendations? How much confidence should patients place on these recommendations? Various instruments are available to assess the quality of evidence of research, such as the revised Wong scale (R-Wong) which examines the quality of research design, methodology and data analysis, and the revision of the assessment of multiple systematic reviews (R-AMSTAR), which examines the quality of systematic reviews.The Grading of Recommendation Assessment, Development, and Evaluation (GRADE) Working Group developed an instrument called the GRADE system in order to grade the quality of the evidence in studies and to evaluate the strength of recommendation of the intervention that is proposed in the published article. The GRADE looks at four factors to determine the quality of the evidence: study design, study quality, consistency, and directness. After combining the four components and assessing the grade of the evidence, the strength of recommendation of the intervention is established. The GRADE, however, only makes a qualitative assessment of the evidence and does not generate quantifiable data.In this study, we have quantified both the grading of the quality of evidence and also the strength of recommendation of the original GRADE, hence expanding the GRADE. This expansion of the GRADE (Ex-GRADE) permits the creation of a new instrument that can produce tangible data and possibly bridge the gap between evidence-based research and evidence-based clinical practice.

The RAINBOW program, a Child and Family-Focused Cognitive Behavioral Therapy program (CFF-CBT) for Pediatric Bipolar Disorder (PBD) designed for children aged 8-12 years and their parents, in a parallel group format, has been adapted to adolescents aged 14-17. The aim of this study was to investigate if CFF-CBT is effective and feasible for adolescents and their parents in Sweden. Method: The sample of seven adolescents with PBD and eleven parents participated in the Rainbow-program consisting of 12 sessions over a three month period. The adolescents and parents were assessed pre- and post treatment with focus on symptoms of mania and depression, psychosocial functioning, expressed emotion and increased knowledge and skills to cope with the disorder. For the adolescents a case series design was used and clinical significance applied as statistical method. A quasi-experimental design with paired t-test was also used. Results: Psychosocial functioning improved when rated by parents and clinicians. Parent self rated Expressed Emotions improved. No changes were observed in symptoms of mania and depression. Conclusions: The RAINBOW program seems feasible and possibly effective for adolescents and their families in Sweden with minor adaptations.

Background: This study examined the perceived effectiveness of a 15-week community-based program for 46 children exposed to intimate partner violence (IPV) and their mothers. Aims: The primary aims were to describe the children who entered one of the existing community-based programs in terms of behavioral problems and to evaluate the impact of the program on children's general behavioral functioning as assessed by their mothers. Results: Children's rated behavioral problems (SDQ) dropped following treatment; the effect size was in the medium range. The social impairment caused by the problems decreased as well. The effect regarding behavioral problems was not related to the degree of exposure to IPV or the mothers own changes in trauma symptoms following treatment. Results were analyzed as well at the individual level with the Reliable Change Index (RCI), which showed that the majority of children were unchanged following treatment. Conclusions: One implication from the study is the need for baseline screening and assessment. About half of the current sample had a clinical symptom picture indicating the need for specialized psychiatric/psychotherapeutic treatment. Furthermore, the reduction in behavioral problems was significant but many children still had high levels of behavioral problems after treatment, indicating a need of a more intense or a different type of intervention.

The RAINBOW program, a Child and Family-Focused Cognitive Behavioral Therapy program (CFF-CBT) for Pediatric Bipolar Disorder (PBD) designed for children aged 8-12 years and their parents, in a parallel group format, has been adapted to adolescents aged 14-17. The aim of this study was to investigate if CFF-CBT is effective and feasible for adolescents and their parents in Sweden. Method: The sample of seven adolescents with PBD and eleven parents participated in the Rainbow-program consisting of 12 sessions over a three month period. The adolescents and parents were assessed pre- and post treatment with focus on symptoms of mania and depression, psychosocial functioning, expressed emotion and increased knowledge and skills to cope with the disorder. For the adolescents a case series design was used and clinical significance applied as statistical method. A quasi-experimental design with paired t-test was also used. Results: Psychosocial functioning improved when rated by parents and clinicians. Parent self rated Expressed Emotions improved. No changes were observed in symptoms of mania and depression. Conclusions: The RAINBOW program seems feasible and possibly effective for adolescents and their families in Sweden with minor adaptations.

Syftet med denna pilotstudie var att undersöka möjligheten att behandla patienter med social fobi inom psykiatrin med en guidad internetbaserad självhjälpsbehandling. Författarna undersökte även hur självhjälps- behandlingen upplevdes av patienterna. Fem deltagare rekryterades till studien där en så kallad case series-design tillämpades. För att utvärdera behandlingen och dess effektivitet användes en analysmetod kallad Jacobson-Truax. Denna metod syftar till att mäta klinisk signifikans och valdes delvis på grund av det låga deltagarantalet, men också på grund av bristen på studier som undersöker denna typ av signifikans inom aktuellt forskningsområde. Resultaten från studien ger vissa indikationer på att patienter med social fobi kan dra nytta av aktuell behandling, fyra av fem deltagare förändrades i positiv riktning. Resultaten från föreliggande studie kan indikera trender. För att kunna dra vidare slutsatser kring huruvida aktuellt behandlingsprogram är effektivt för patienter med social fobi inom psykiatrin, bör emellertid fler studier, med ett större urval genomföras., The purpose of this pilot study was to examine the possibility of treating patients within a psychiatric setting with an internet-based guided self-help treatment. The authors also looked into how the self-help treatment was evaluated by the patients. Five participants were recruited to the study and a so-called case series was employed as design. To evaluate the effectiveness of the treatment a method called Jacobson-Truax was used. This method aims to measure clinical significance and was partly utilized because of the small number of participants in the study, but also because of the absence of studies examining this type of significance in the research field of today. The results from this study showed that there are some indications that patients with social phobia can benefit from the current treatment. Four out of five patients showed improvements after the treatment. The results in the current study can indicate trends. However, to gain further proof about whether the current treatment program is effective for patients with social phobia within a psychiatric setting, more studies, with a larger sample is needed.

Syftet med denna pilotstudie var att undersöka möjligheten att behandla patienter med social fobi inom psykiatrin med en guidad internetbaserad självhjälpsbehandling. Författarna undersökte även hur självhjälps- behandlingen upplevdes av patienterna. Fem deltagare rekryterades till studien där en så kallad case series-design tillämpades. För att utvärdera behandlingen och dess effektivitet användes en analysmetod kallad Jacobson-Truax. Denna metod syftar till att mäta klinisk signifikans och valdes delvis på grund av det låga deltagarantalet, men också på grund av bristen på studier som undersöker denna typ av signifikans inom aktuellt forskningsområde. Resultaten från studien ger vissa indikationer på att patienter med social fobi kan dra nytta av aktuell behandling, fyra av fem deltagare förändrades i positiv riktning. Resultaten från föreliggande studie kan indikera trender. För att kunna dra vidare slutsatser kring huruvida aktuellt behandlingsprogram är effektivt för patienter med social fobi inom psykiatrin, bör emellertid fler studier, med ett större urval genomföras., The purpose of this pilot study was to examine the possibility of treating patients within a psychiatric setting with an internet-based guided self-help treatment. The authors also looked into how the self-help treatment was evaluated by the patients. Five participants were recruited to the study and a so-called case series was employed as design. To evaluate the effectiveness of the treatment a method called Jacobson-Truax was used. This method aims to measure clinical significance and was partly utilized because of the small number of participants in the study, but also because of the absence of studies examining this type of significance in the research field of today. The results from this study showed that there are some indications that patients with social phobia can benefit from the current treatment. Four out of five patients showed improvements after the treatment. The results in the current study can indicate trends. However, to gain further proof about whether the current treatment program is effective for patients with social phobia within a psychiatric setting, more studies, with a larger sample is needed.

The term double tooth is used to describe the developmental dental abnormalities called gemination and fusion. Gemination is an attempted, incomplete division of a single tooth germ during the proliferation stage of odontogenesis, while fusion is the union of two or more independently developing teeth. Although the prevalence of primary double teeth is low, double teeth are of clinical interests because of the associated clinical problems. The clinical problems associated with the condition in the primary dentition are often downplayed for various reasons in spite of their importance. Primary double teeth ought to be carefully investigated so that these clinical problems which may affect the permanent dentition can be effectively managed. Perhaps primary double teeth have not received adequate documentation in our environment because of the low prevalence. This paper presents four primary double teeth in three patients. One of the cases presented occurred bilaterally, a relatively uncommon phenomena. The associated clinical problems are illustrated in the cases and the management discussed. Although primary double teeth are asymptomatic and in some cases may not interfere with function, they do have associated clinical problems. Early diagnosis and regular clinical and radiographic observations are necessary for effective management and appropriate treatment of the anomaly.

The term double tooth is used to describe the developmental dental abnormalities called gemination and fusion. Gemination is an attempted, incomplete division of a single tooth germ during the proliferation stage of odontogenesis, while fusion is the union of two or more independently developing teeth. Although the prevalence of primary double teeth is low, double teeth are of clinical interests because of the associated clinical problems. The clinical problems associated with the condition in the primary dentition are often downplayed for various reasons in spite of their importance. Primary double teeth ought to be carefully investigated so that these clinical problems which may affect the permanent dentition can be effectively managed. Perhaps primary double teeth have not received adequate documentation in our environment because of the low prevalence. This paper presents four primary double teeth in three patients. One of the cases presented occurred bilaterally, a relatively uncommon phenomena. The associated clinical problems are illustrated in the cases and the management discussed. Although primary double teeth are asymptomatic and in some cases may not interfere with function, they do have associated clinical problems. Early diagnosis and regular clinical and radiographic observations are necessary for effective management and appropriate treatment of the anomaly.

Syftet med denna pilotstudie var att undersöka möjligheten att behandla patienter med social fobi inom psykiatrin med en guidad internetbaserad självhjälpsbehandling. Författarna undersökte även hur självhjälps- behandlingen upplevdes av patienterna. Fem deltagare rekryterades till studien där en så kallad case series-design tillämpades. För att utvärdera behandlingen och dess effektivitet användes en analysmetod kallad Jacobson-Truax. Denna metod syftar till att mäta klinisk signifikans och valdes delvis på grund av det låga deltagarantalet, men också på grund av bristen på studier som undersöker denna typ av signifikans inom aktuellt forskningsområde. Resultaten från studien ger vissa indikationer på att patienter med social fobi kan dra nytta av aktuell behandling, fyra av fem deltagare förändrades i positiv riktning. Resultaten från föreliggande studie kan indikera trender. För att kunna dra vidare slutsatser kring huruvida aktuellt behandlingsprogram är effektivt för patienter med social fobi inom psykiatrin, bör emellertid fler studier, med ett större urval genomföras., The purpose of this pilot study was to examine the possibility of treating patients within a psychiatric setting with an internet-based guided self-help treatment. The authors also looked into how the self-help treatment was evaluated by the patients. Five participants were recruited to the study and a so-called case series was employed as design. To evaluate the effectiveness of the treatment a method called Jacobson-Truax was used. This method aims to measure clinical significance and was partly utilized because of the small number of participants in the study, but also because of the absence of studies examining this type of significance in the research field of today. The results from this study showed that there are some indications that patients with social phobia can benefit from the current treatment. Four out of five patients showed improvements after the treatment. The results in the current study can indicate trends. However, to gain further proof about whether the current treatment program is effective for patients with social phobia within a psychiatric setting, more studies, with a larger sample is needed.

The inter-subjective and dialogical nature of narrative therapy, as commonly practiced, remains unarticulated. Further, there currently exists no rigorous empirical research investigating the process or outcome of narrative therapy. The research aim, to investigate the process and outcome of narrative therapy, comprised theoretical and empirical objectives. The first objective was to articulate a theoretical synthesis of narrative theory, research and practice. The process of narrative reflexivity was identified as a theoretical construct linking narrative theory with narrative research and practice. The second objective was to substantiate this synthesis empirically by examining narrative therapy processes, specifically narrative reflexivity and the therapeutic alliance, and their relation to therapy outcomes. The third objective was to support the proposed synthesis of theory, research and practice and provide quantitative evidence for the utility of narrative therapy, by evaluating depressive symptom and inter-personal relatedness outcomes through analyses of statistical significance, clinical significance and benchmarking. Founded in theories of self, language and narrative (James, 1890; Bruner, 1986; Gergen, 1991; Hollway, 2006; Vygotsky, 1934/ 1987), narrative therapy was conceptualized as involving dialogical and intra-personal processes. Narrative therapists generally apply a story metaphor and commonly focus on the inter-personal field (White, 2007). This thesis recognised the storied and inter-personal nature of narrative therapy, but proposed this does not represent narrative therapy in its entirety. The notion of story connotes monological processes, inconsistent with the conversations of narrative practice, and neglect of intra-personal dimensions is inconsistent with narrative notions of inter-subjectivity. This thesis proposed an integration of dialogical narrative theory (Cooper, 2003; Hermans & Kempen, 1993; Lysaker & Lysaker, 2006) and narrative re

Sixty-four individuals with social phobia (social anxiety disorder) were assigned to a multimodal cognitive-behavioral treatment package or to a waiting list control group. Treatment consisted of a 9-week, Internet-delivered, self-help program that was combined with 2 group exposure sessions in real life and minimal therapist contact via e-mail. Results were analyzed on an intention-to-treat basis, including all randomized participants. From pre- to posttest, treated participants in contrast to controls showed significant improvement on most measured dimensions (social anxiety scales, general anxiety and depression levels, quality of life). The overall within- and between-groups effect sizes were Cohen's d = 0.87 and 0.70, respectively. Treatment gains were maintained at 1-year follow-up. The results from this study support the continued use and development of Internet-distributed, self-help programs for people diagnosed with social phobia.

Objectives: To investigate the short-term and long-term effectiveness of two, brief, preventive, work stress management programmes. One programme was a cognition-focused programme, the other was a newly developed intervention in which physical exercise and relaxation were combined. It was hypothesised that the newly developed intervention would be more effective in reducing psychological complaints than the cognitive intervention. Both programmes consisted of four sessions in a period of 10 weeks. Methods: From a working population engaged in a periodic health check-up, employees above a minimum stress level (n = 396) were invited to participate in a randomised comparative outcome study with pre-trial, post-trial and 6-month follow-up measures. After giving informed consent 130 participants entered the study (response rate 33%). Outcome measures consisted of three self-reported questionnaires on psychological complaints. Results: It was found that both interventions revealed a positive impact on psychological complaints, burnout and fatigue, both at short-term and at 6-month follow-up. No statistical interaction effects between the two interventions were found. Calculation of the clinical significance of the effects indicated that 50% of the employees with psychological complaints who participated in the physical intervention and 60% of the employees who participated in the cognitive intervention improved and returned to functioning within normal range both in the short term and in the long term at 6 months. Conclusion: The data indicate that interventions were equally effective on psychological complaints, burnout and fatigue. © Springer-Verlag 2005.

The t(12;21) (p13;q22) translocation resulting in ETV6/RUNX1 (previously named TEL/AML1) gene fusion is present in about 25% of children with precursor B-lineage acute lymphoblastic leukemia (B-ALL). We successfully tested 275 precursor BALL samples from children aged 1 to 17 years to determine the relation between t(12;21) and in vitro cellular drug resistance, measured by the fluorometric microculture cytotoxicity assay (FMCA). Samples from 83 patients (30%) were positive for t(12;21). The ETV6/RUNX1(+) samples were significantly more sensitive than ETV6/RUNX1(-) samples to doxorubicin, etoposide, amsacrine, and dexamethasone, whereas the opposite was true for cytarabine. After matching for unevenly distributed patient characteristics, that is, excluding patients with high hyperdiploidy (> 51 chromosomes), t(g;22), t(1;19), or 11q23 rearrangement, the ETV6/RUNX1(+) samples remained significantly more sensitive to doxorubicin (P = .001) and etoposide (P = .001). For the other drugs tested (amsacrine, cytarabine, dexamethasone, prednisolone, vincristine, 6-thioguanine, and 4-hydroper-oxy-cyclophosphamide), no significant difference in cellular drug sensitivity was found. In conclusion, we found that the presence of the t(12;21) translocation in childhood precursor B-ALL is associated with a high tumor cell sensitivity to doxorubicin and etoposide. High throughput techniques should now be used to elucidate the cellular mechanisms by which ETV6/RUNX1 gene fusion is linked to increased sensitivity to these drugs.