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Some challenges faced by people with autism spectrum disorder (ASD) when adapting to a neurotypical environment are related with the risk of suffering a psychiatric disorder. The aim of the present study is to conduct a systematic review on the prevalence of psychiatric disorders in adults with ASD (PROSPERO’s reference number CRD42016041948). Four databases (PubMed, PsycINFO, Web of Science and CINAHL) were used for the electronic search, and six editorials (Science Direct, Wiley, Springer, Taylor & Francis, SAGE Publishing and BioMed Central) were manually searched for studies not previously identified. Study eligibility criteria were observational studies on psychiatric comorbidity in adults (18 years or older) with ASD, based on standard diagnostic classifications (DSM/ICD), reported in English peer-reviewed journals. A total of 1288 and 24 references were identified by electronic and manual searches, respectively. Results showed that attention deficit and hyperactivity disorder is the most prevalent psychiatric disorder in adults with ASD. Mood and anxiety disorders are also very frequent among this population. The lowest comorbidity prevalence rates of all diagnostic categories are the ones related to substance use and eating disorders. These results show a need for a greater production of studies in this field, especially follow-up studies that focus on risk and protective factors for the emergence of psychiatric problems in adults with ASD. For this reason, it is imperative to create specific diagnostic tools that allow the assessment of mental pathology, attending to the particularities of its manifestation in people with ASD.

Background/Objective: This systematic review aims to evaluate the effect of interventions based on the mindfulness and/or acceptance process on ruminative thoughts, in patients with depression. Method: Electronic searches in Medline, Embase, Cochrane Central, PsycInfo, and Cinahl until December 2016, in addition to hand-searches of relevant studies, identified eleven studies that fulfilling inclusion criteria. Results: A meta-analysis of the effect of the intervention compared to usual care showed a significant and moderate reduction of ruminative thoughts ( g = −0.59, 95% CI: −0.77, −0.41; I 2 = 0%). Furthermore, findings suggest that mindfulness/acceptance processes might mediate changes in rumination, and that they in turn mediate in the clinical effects of interventions. A meta-analysis of three studies that compared the intervention to other active treatments (medication, behavioral activation and cognitive-behavioral therapy, respectively) showed no significant differences. Conclusions: Mindfulness-based cognitive therapy compared to usual care, produces a significant and moderate reduction in rumination. This effect seems independent of the treatment phase (acute or maintenance) or the number of past depressive episodes, and it was maintained one month after the end of treatment. However, further controlled studies with real patients that compare the most commonly used cognitive-behavioral techniques to treat ruminative thoughts to the acceptance and mindfulness techniques are needed.

ObjectiveThe Patient Activation Measure-13 (PAM-13) has been found useful for assessing patient knowledge, skills and confidence in management of chronic conditions, but the empirical evidence from mental health is sparse. The psychometric properties of PAM in out-patients waiting for treatment in community mental health centers (CMHC) have therefore been examined.MethodsA total of 290 adults from two CMHC completed PAM. An exploratory factor analysis was conducted with 273 patients. Data at baseline and after 4 weeks were used to analyze test-retest reliability (n=60) and to analyze the sensitivity to change (n=51).ResultsThe exploratory factor analysis revealed a fit for a two-factor model (Cronbach's α was 0.86 and 0.67), and was assessed for a one-factor model (α=0.87). The test-retest intraclass correlation coefficient was 0.76. Sensitivity to change was good with a statistically significant activation improvement (p

Introduction In the last years there has been a significant increase in reported cases of pertussis in developed countries, in spite of high rates of childhood immunization. Health institutions have recommended different vaccination strategies to reduce child morbidity and mortality: vaccination of adolescents and adults, pregnant women, people in contact with the newborn (cocoon strategy) and health care workers. The aim of this paper is to review the scientific evidence supporting these recommendations. Methods Systematic review on the effectiveness and cost-effectiveness of the above strategies for the reduction of morbidity and mortality from pertussis in infants under 12 months. The electronic databases Medline, PreMedline, Embase, CRD, Cochrane Central, and Trip Database were consulted from 1990 to October 2012. The evidence was assessed using the GRADE system. Results There were eight studies on the efficacy or safety of the strategies analyzed, and 18 economic evaluations. Direct evidence on the efficacy of these strategies is scarce. Economic evaluations suggest that vaccination of adolescents and adults would be cost-effective, although there is major uncertainty over the parameters used. Conclusions From the perspective of health technology assessment, there is insufficient evidence to recommend the vaccination strategies evaluated.

ResumenObjetivoDada la carencia de un registro de utilidades en población española para su uso en evaluaciones económicas, se desarrolló una revisión sistemática de utilidades o preferencias por estados de salud obtenidas de población española con el fin último de crear un catálogo accesible a los investigadores. En este artículo se detallan las utilidades relacionadas con la salud mental.MétodoRevisión sistemática de la literatura, con búsquedas en MEDLINE, CRD, Embase, PsycINFO, CINAHL, Cochrane y otras bases de datos. La estrategia de búsqueda combinó términos relacionados con utilidades y con España. Los criterios de inclusión eran población residente, afectada o no por alguna enfermedad; utilidades valoradas con cuestionarios validados en España (EQ-5D, HUI, SF-6D) o siguiendo técnicas directas (equivalencia temporal, standard gamble, escala visual analógica). Se realizó una síntesis narrativa de los artículos incluidos, detallando los resultados relacionados con problemas de salud mental.ResultadosSe incluyeron 103 estudios, de los que se extrajeron 742 utilidades. Se identificaron 69 utilidades relacionadas con trastornos mentales y del comportamiento, extraídas de 12 estudios. El instrumento más empleado fue el cuestionario EQ-5D. Gran parte de los artículos excluidos evaluaba la calidad de vida, pero sin ofrecer el valor de la utilidad.ConclusionesLa presente revisión añade valor al estudio de las utilidades en España mediante la recopilación de valores que puedan ser incluidos en evaluaciones económicas, permitiendo además identificar lagunas en la investigación en este campo. Los valores relacionados con la salud mental identificados se asemejan a otros informados en la literatura internacional.AbstractObjectivesCurrently, there is no registry of utility values for the Spanish population that could potentially be used in economic evaluations. Consequently, a systematic review of utilities or preferences for health states in the Spanish population was conducted. The results related to mental health are reported.MethodsA systematic review of the literature was conducted. The main databases searched were MEDLINE, CRD, Embase, PsycINFO, CINAHL, and Cochrane. The search strategy combined terms related to utilities and Spain. The inclusion criteria comprised the resident population in Spain, whether affected by any disease or not; the reported utilities had to be evaluated through a tool validated in Spain (i.e., EQ-5D, HUI, SF-6D) and/or following accepted techniques (e.g., time trade-off, standard gamble, or the visual analog scale). A narrative synthesis of articles was undertaken and the results related to mental health summarized.ResultsA total of 103 articles were finally included, from which 742 utility values were extracted. Sixty-nine utility values related to mental health and behavioral disorders were extracted from 12 studies. The most widely used tool was the E5-QD questionnaire. Most of the excluded articles evaluated quality of life but did not provide an estimation of utilities.ConclusionsThis review adds value to research on utilities in Spain by gathering values to be included in economic evaluations, as well as by identifying research gaps in this field. The utility values related to mental health identified in this study are similar to those reported in international publications.

Summary In the last two decades there has been a growing recognition in the Spanish National Health System (NHS) of the importance of considering patients’ values and preferences in clinical decisions. Patient participation in shared decision making (SDM) is gaining importance as a suitable approach to patient-health professional communication and decision making in Spain. In addition, the NHS is funding the development of patients’ decision aids (PtDAs) for shared decision making (SDM) by Health Technology Assessment Agencies. However, the NHS has still not incorporated reforms in law that includes SDM and PtDAs as a key component of health care services and professional curricula, nor is there a standardised implementation of interventions to support decisions in routine care. Most patients are not very familiar with their rights to be kept informed and participate in their own health care decisions. Most professionals are not familiar with or educated about patients’ rights to be kept informed and participate in health care decisions either. The future of SDM in Spain is promising. The next course of action should be to maintain the production and adaptation of high-quality PtDAs while at the same time reinforcing effective dissemination strategies among patients and training programmes for professionals focused on SDM.

Objective This study presents ongoing research aimed at understanding the suitability and impact of various decision aids (DAs) on patients with different chronic conditions in the Spanish National Health System. Methods A three-phase process was employed to develop and evaluate DAs for patients with hip or knee osteoarthritis (OA), benign prostatic hyperplasia (BPH), and depression, including: (1) systematic reviews on the effectiveness of shared decision making (SDM) interventions (including DAs); (2) the development of DAs; (3) a pilot study assessing the DAs. Results Systematic reviews carried out highlight that there are few studies assessing the effectiveness of DAs for OA, BPH, and depression. The development of DAs and their assessment currently differs for each medical condition. The DAs assessed for OA and BHP are well accepted. In a pilot study with OA patients, the DA produced a significant improvement in the decisional conflict “informed” subscale. Conclusion Research on SDM and DAs for different chronic conditions is at a very early stage in Spain. It is not possible to draw any definite conclusions about the effectiveness of DAs for clinical practice. Practice implications It is necessary to conduct more high quality studies to evaluate the effects of DAs in the Spanish context.

ResumenEste proyecto apoya la iniciativa, promovida por el Sistema Nacional de Salud en España, de facilitar materiales informativos, en formato impreso o interactivo, que impulsen la participación ciudadana en las decisiones y los cuidados de salud. Se presenta la recientemente creada Plataforma Web PyDEsalud.com, dirigida a personas afectadas por enfermedades crónicas de gran impacto socioeconómico, como son el cáncer de mama, la depresión o la diabetes. Siguiendo una metodología científica de trabajo, esta Plataforma incluye tres módulos de servicios informativos (Experiencias de pacientes, Toma de decisiones compartida y Necesidades de investigación), dirigidos a promocionar la educación sanitaria de pacientes y familiares.AbstractThis project supports the initiative promoted by the Spanish National Health System to provide informational materials, in printed or interactive format, to encourage public participation in decision making and healthcare. We present the newly created PyDEsalud.com, a web platform aimed at people with chronic diseases with a high socioeconomic impact, such as breast cancer, depression, and diabetes. This platform uses scientific methodology and contains three information service modules (Patients’ experiences, Shared decision making, and Research needs), aimed at promoting health education for patients and families.