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Background The presence of depressive subsyndromal symptoms (SS) in bipolar disorder (BD) increases the risk of affective relapse and worsens social, cognitive functioning, and quality of life. Nonetheless, there are limited data on how to optimize the treatment of subthreshold depressive symptoms in BD. Mindfulness-Based Cognitive Therapy (MBCT) is a psychotherapeutic intervention that has been shown effective in unipolar depression. The assessment of its clinical effectiveness and its impact on biomarkers in bipolar disorder patients with subsyndromal depressive symptoms and psychopharmacological treatment is needed. Methods/design A randomized, multicenter, prospective, versus active comparator, evaluator-blinded clinical trial is proposed. Patients with BD and subclinical or mild depressive symptoms will be randomly allocated to: 1) MBCT added to psychopharmacological treatment; 2) a brief structured group psychoeducational intervention added to psychopharmacological treatment; 3) standard clinical management, including psychopharmacological treatment. Assessments will be conducted at screening, baseline, post-intervention (8 weeks) and 4 month follow-up post-intervention. The aim is to compare MBCT intervention versus a brief structured group psychoeducation. Our hypothesis is that MBCT will be more effective in reducing the subsyndromal depressive symptoms and will improve cognitive performance to a higher degree than the psychoeducational treatment. It is also hypothesized that a significant increase of BDNF levels will be found after the MBCT intervention. Discussion This is the first randomized controlled trial to evaluate the effects of MBCT compared to an active control group on depressive subthreshold depressive symptoms in patients with bipolar disorder. [ABSTRACT FROM AUTHOR]

Introduction: Although healthcare workers (HCWs) have reported mental health problems since the beginning of the COVID-19 pandemic, they rarely use psychological support. Here, we described the use of psychological support among HCWs in Spain over the 2-year period following the initial pandemic outbreak and explore its association with workplace- and COVID-19-related factors measured at baseline, in 2020. Materials and methods: We conducted a longitudinal study on HCWs working in Spain. We used an online survey to collect information on sociodemographic characteristics, depressive symptoms, workplace- and COVID-19-related variables, and the use of psychological support at three time points (2020, 2021, and 2022). Data was available for 296, 294, and 251 respondents, respectively at time points 1, 2, and 3. Results: Participants had a median age of 43 years and were mostly females (n = 242, 82%). The percentage of HCWs using psychological support increased from 15% in 2020 to 23% in 2022. Roughly one in four HCWs who did not use psychological support reported symptoms compatible with major depressive disorder at follow up. Baseline predictors of psychological support were having to make decisions about patients' prioritisation (OR 5.59, 95% CI 2.47, 12.63) and probable depression (wave 2: OR 1.12, 95% CI 1.06, 1.19; wave 3: OR 1.10, 95% CI 1.04, 1.16). Conclusions: Our results suggest that there is call for implementing mental health promotion and prevention strategies at the workplace, along with actions to reduce barriers for accessing psychological support. [ABSTRACT FROM AUTHOR]

We examined whether excess chronic medical comorbidity mediated excess COVID-19 inpatient mortality among people with mental disorders in the early phase of the pandemic, a question with important implications for public health and clinical decision-making. Using records of 2599 COVID-19 hospitalized patients, we conducted a formal causal mediation analysis to estimate the extent to which chronic comorbidity mediates the association between mental disorders and COVID-19 mortality. The Odds Ratio (95% CI) for Natural Indirect Effect and Controlled Direct Effect were 1.07(1.02, 1.14) and 1.40 (1.00, 1.95), respectively, suggesting that a large proportion of excess COVID-19 mortality among people with mental disorders may be explained by factors other than comorbidity. [ABSTRACT FROM AUTHOR]

It is unknown if, compared to a triple drug antiretroviral therapy, boosted protease inhibitor monotherapy leads to worse results in specific neuropsychological processes. In our study, we included patients virologically suppressed (≥1 year), on antiretroviral therapy, without concomitant major neurocognitive confounders, receiving boosted lopinavir or darunavir as monotherapy ( n = 96) or as triple therapy with two nucleoside reverse transcriptase inhibitors ( n = 95). All patients underwent a comprehensive neuropsychological test battery (14 neuropsychological measures, covering seven domains). Both groups were compared in average score distributions and rates of neuropsychological deficits. Similar comparisons were conducted only for patients with neurocognitive impairment. In the adjusted analysis, we found only small differences between groups in the entire sample: better verbal learning ( p = 0.02; d = 0.28) and verbal recall scores ( p < 0.01; d = 0.25) in patients on boosted protease inhibitor monotherapy and slightly better motor skills with dominant hand ( p = 0.02; d = 0.23) scores in patients on triple therapy. No greater proportion of deficits in the protease inhibitor monotherapy group was found in any neuropsychological measure. In neurocognitively impaired patients, we found similar outcomes in verbal learning, verbal recall, and motor skills with dominant hand but with larger effect sizes. Close similarities in the neurocognitive pattern between groups question the clinical relevance of the number of neuroactive drugs included in the regimen. These results also suggest that peripheral viral load control may be a good indicator of brain protection. [ABSTRACT FROM AUTHOR]

Background This study aims to explore differences in personal narratives of the experience of illness and treatment in depressed oncologic patients who received either combined treatment for depression (psychotherapy plus antidepressants) or standard treatment (antidepressants alone). Methods We employed a qualitative research design based on grounded theory. Data were collected from eight videotaped focus groups and semi-structured interviews with a total of 28 participants. The research team reviewed interview transcripts and categorized the participants' responses using the ATLAS.ti (ATLAS.ti Scientific Software Development GmbH Hardenbergstr. 7 D-10623, Berlin) software package. Results Compared with patients in the standard treatment group, patients in the combined treatment group were better able to relate their experiences of physical and emotional discomfort and find meaning in the experience of illness by viewing cancer as a transformative experience. In addition, patients in the combined treatment group tended to use more active coping strategies based on acceptance of their situation and emphasized that psychotherapy had been helpful. Conclusions Qualitative analysis is an efficient method of examining the meaning of quantitative results in depth, particularly patients' perspectives on quality of life. Patients undergoing combined treatment consider psychotherapy to be a helpful tool and exhibit more personal growth than do patients undergoing standard treatment. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

To compare the effect of a mindfulness-based mobile application versus an in-person mindfulness-based training program in terms of reducing anxiety and increasing empathy, self-compassion, and mindfulness in a population of healthcare students. The authors conducted a single-blind, randomised controlled trial with three parallel groups. Participants were allocated to the mobile app, the in-person mindfulness-based program (IMBP), or a control group. Assessments at baseline and postintervention (8 weeks) included measures of anxiety, empathy, self-compassion, and mindfulness. Of 168 students randomised, 84 were analysed on an intention-to-treat basis (app: n = 31; IMBP: n = 23; control: n = 30). The mobile app group showed a large effect size for reductions in trait anxiety compared with controls (g = 0.85, p = 0.003), and a medium, nonsignificant effect compared with the IMBP group (g = 0.52, p = 0.152). Participants from both interventions experienced a significant increase in self-compassion and mindfulness compared with controls. Levels of empathy remained unchanged for the 3 arms. A mobile app can be as effective as an IMBP in reducing anxiety and increasing self-compassion and mindfulness among healthcare students. [ABSTRACT FROM AUTHOR]

Background: Legionella testing conducted at environmental laboratories plays an essential role in assessing the risk of disease transmission associated with water systems. However, drawbacks of culture-based methodology used for Legionella enumeration can have great impact on the results and interpretation which together can lead to underestimation of the actual risk. Up to 20% of the samples analysed by these laboratories produced inconclusive results, making effective risk management impossible. Overgrowth of competing microbiota was reported as an important factor for culture failure. For quantitative polymerase chain reaction (qPCR), the interpretation of the results from the environmental samples still remains a challenge. Inhibitors may cause up to 10% of inconclusive results. This study compared a quantitative method based on immunomagnetic separation (IMS method) with culture and qPCR, as a new approach to routine monitoring of Legionella. Results: First, pilot studies evaluated the recovery and detectability of Legionella spp using an IMS method, in the presence of microbiota and biocides. The IMS method results were not affected by microbiota while culture counts were significantly reduced (1.4 log) or negative in the same samples. Damage by biocides of viable Legionella was detected by the IMS method. Secondly, a total of 65 water samples were assayed by all three techniques (culture, qPCR and the IMS method). Of these, 27 (41.5%) were recorded as positive by at least one test. Legionella spp was detected by culture in 7 (25.9%) of the 27 samples. Eighteen (66.7%) of the 27 samples were positive by the IMS method, thirteen of them reporting counts below 103 colony forming units per liter (CFU l−1), six presented interfering microbiota and three presented PCR inhibition. Of the 65 water samples, 24 presented interfering microbiota by culture and 8 presented partial or complete inhibition of the PCR reaction. So the rate of inconclusive results of culture and PCR was 36.9 and 12.3%, respectively, without any inconclusive results reported for the IMS method. Conclusion: The IMS method generally improved the recovery and detectability of Legionella in environmental matrices, suggesting the possibility to use IMS method as valuable indicator of risk. Thus, this method may significantly improve our knowledge about the exposure risk to these bacteria, allowing us to implement evidence-based monitoring and disinfection strategies. [ABSTRACT FROM AUTHOR]

Background: To analyze the factor structure and psychometric properties of the TFEQ in a morbid obese Spanish sample of bariatric surgery candidates. Method: Multi-trait/ multi-item analyses and alpha coefficients were conducted to test the convergent /discriminant validity and the internal consistency reliability. Principal components analyses (varimax) were used to explore the factor structure. Sub-group factor analyses by gender, age and body mass index (BMI) were conducted to identify unstable items. Results: The internal structure of the original TFEQ factors was unsatisfactory, especially the Disinhibition Scale. Most Disinhibition and Hunger items were grouped on one factor labeled "Dysregulation Eating". Cognitive Restraint was split into two factors. The first one, related to the behavioral component of Restraint, labeled "Restrained Behaviour" and the second one related to weight and eating concerns called "Predisposition to Restraint". Conclusions: The original factor structure of the TFEQ was not replicated. A revised 23-item instrument, representing the three new derived factors is offered as a valid screening instrument for severely obese patients. [ABSTRACT FROM AUTHOR]

In a cross-sectional study of aviremic neurocognitively impaired patients receiving protease inhibitors as triple-drug therapy (n = 30) or as monotherapy (n = 22), we found no statistically significant differences in the types of cognitive domains involved or severity of cognitive deficit. Cerebrospinal fluid concentrations of total proteins, total tau, myelin basic protein, neuron-specific enolase, β2 microglobulin, S100B protein, or prevalence of cerebrospinal fluid HIV-RNA detection by standard (6.3% vs 7.1% P = 1) or ultrasensitive assays (50% vs 71.4%, P = 0.28) were similar in both groups. These results do not suggest important differences in the pattern of neurocognitive impairment between groups receiving very different antiretroviral strategies. [ABSTRACT FROM AUTHOR]

Background Although scientific knowledge about the benefits of probiotic use in cystis fibrosis (CF) is scarce, their expectative is promising. The aim of this work was to analyze the effect of a Lactobacillus reuteri probiotic preparation versus placebo in CF patients. Methods A prospective, double blind, crossover and with placebo study was carried out in 30 CF patients from two Spanish hospitals. Patients were randomized in Group A (6 months of probiotic followed by 6 months of placebo) and Group B (6 months of placebo followed by 6 months of probiotic). GIQLI (gastrointestinal) and SF-12 (general) health tests were performed after probiotic and placebo intakes. Fat absorption coefficient, calprotectin, and inflammatory interleukin quantification were determined in fecal samples. Total fecal DNA was obtained and metagenomic 454-pyrosequencing was applied to analyze the microbiome composition. STATA v12 MP software was used for statistical analyses. Results Statistically significant improvement in the gastrointestinal health and decrease of the calprotectin levels were demonstrated in patients after probiotic exposure, in comparison with placebo. All CF subjects reported good tolerance to L. reuteri without secondary effects. Metagenomic analysis showed an important dysbiosis in CF gut microbiota associated with a high concentration of Proteobacteria. Probiotic intake was followed by a reduction in the total bacterial density, mostly due to a considerable reduction in the γ-Proteobacteria phylum; and an important increase of the microbial diversity with a higher representation of Firmicutes. Conclusions Probiotics might ameliorate the dysbiosis of CF gut microbiota, characterized by a high density of Proteobacterial organisms. L. reuteri significantly decrease intestinal inflammation and increase digestive comfort. [ABSTRACT FROM AUTHOR]

A prospective study showed no relevance of the number of antiretrovirals used to preserve neurocognitive function in aviremic human immunodeficiency virus (HIV)–positive patients, with important implications concerning HIV-associated neurocognitive disorders and the use of nucleoside-sparing regimens.Background. The evolution of neurocognitive performance in aviremic human immunodeficiency virus (HIV)–positive patients treated with <3 antiretrovirals is unknown.Methods. We prospectively included aviremic (≥1 year) HIV-positive patients, without concomitant major neurocognitive confounders, currently receiving boosted lopinavir or darunavir as monotherapy (n = 67) or triple antiretroviral therapy (ART) (n = 67) for ≥1 year. We evaluated neurocognitive function (7 domains) at baseline and after 1 year. We performed analysis of covariance to evaluate if 1 additional year of exposure to monotherapy compared with triple ART had an effect on Global Deficit Score (GDS) changes after adjustment for potential confounders. We also compared the evolution of neurocognitive performance and impairment rates.Results. Intention-to-treat analysis showed that monotherapy did not influence 1-year GDS change after adjustment for significant confounders (age, ethnicity, duration of therapy, hepatitis C virus status, and HOMA-IR index); the adjusted effect was −0.04 (95% confidence interval, −.14 to .05; P = .38). Neurocognitive stability was observed with monotherapy and triple therapy (GDS crude mean change, −0.09 [95% confidence interval, −.16 to −.01] vs −0.08 [−.14 to −.02]), after 1 year of follow-up, similar proportions of patients changed neurocognitive status from impaired to unimpaired (monotherapy, 4 of 18 [22.2%]; triple therapy, 4 of 19 [21.1%]; P = .91) and vice versa (monotherapy, 5 of 44 [10.2%] and triple therapy, 3 of 45 [6.3%]; P = .48). Similar results were observed in an on-treatment analysis and with use of clinical ratings instead of GDS changes.Conclusions. The number of antiretrovirals included in the ART regimen does not seem to influence the evolution of neurocognitive function in HIV-infected patients with suppressed plasma viremia. [ABSTRACT FROM AUTHOR]

Background: In patients who remain virologically suppressed in plasma with triple-drug ART a switch to protease inhibitor monotherapy maintains high rates of suppression; however it is unknown if protease inhibitor monotherapy is associated to a higher rate of neurocognitive impairment. Methods: In this observational, cross-sectional study we included patients with plasma virological suppression (≥1 year) without concomitant major neurocognitive confounders, currently receiving for ≥1 year boosted lopinavir or darunavir as monotherapy or as triple ART. Neurocognitive impairment was defined as per the 2007 consensus of the American Association of Neurology. The association between neurocognitive impairment and protease inhibitor monotherapy, adjusted by significant confounders, was analysed. Results: Of the 191 included patients - triple therapy: 96, 1–2 years of monotherapy: 40 and >2 years of monotherapy: 55 - proportions (95% CI) with neurocognitive impairment were: overall, 27.2% (20.9–33.6); triple therapy, 31.6% (22.1–41.0); short-term monotherapy, 25.0% (11.3–38.7); long-term monotherapy: 21.4% (10.5–32.3); p = 0.38. In all groups, neurocognitive impairment was mildly symptomatic or asymptomatic by self-report. There were not significant differences in Global Deficit Score by group. In the regression model confounding variables for neurocognitive impairment were years on ART, ethnicity, years of education, transmission category and the HOMA index. Adjusted by these variables the Odds Ratio (95% CI) for neurocognitive impairment of patients receiving short-term monotherapy was 0.85 (0.29–2.50) and for long-term monotherapy 0.40 (0.14–1.15). Conclusions: Compared to triple drug antiretroviral therapy, monotherapy with lopinavir/ritonavir or darunavir/ritonavir in patients with adequate plasma suppression was not associated with a higher rate of asymptomatic neurocognitive impairment than triple drug ART. [ABSTRACT FROM AUTHOR]

Summary backgbound Tumour necrosis factor-α (TNF-α) is a cytokine with numerous immunological and metabolic activities. Receptors for TNF-α have been demonstrated in thyroid follicular cells and TNF-α and its receptors have been implicated in the cytotoxic mechanisms that characterize the thyroid destruction in autoimmune thyroid disease. In patients with Graves’ disease, serum levels of TNF-α have been reported to be elevated and administration of TNF-α to humans has been shown to induce hormonal alterations resembling those seen in the nonthyroidal illness syndrome. objective To evaluate serum concentrations of TNF-α and the soluble receptor for TNF-α (sTNFR-I) in a group of patients with thyroid dysfunction before and after normalization of thyroid function with appropriate therapy. design We studied 20 patients with hypothyroidism (18 women and 2 men, mean age ± SD, 48·8 ± 16·1 years) and 20 patients with hyperthyroidism (14 women and 6 men, age 44·6 ± 15·9 years). Patients were assessed at the time of diagnosis and again after normalization of thyroid function tests with appropriate therapy. A group of 20 healthy subjects (15 women and 5 men, age 44·9 ± 15·1 years) were also studied as a control group. setting All subjects were ambulatory and were studied as outpatients during visits to the endocrinology clinic. measurements Serum concentrations of free T4 (FT4), total T3, TSH, TNF-α and sTNFR-I were measured in all subjects. TNF-α and sTNFR-I were measured using a quantitative enzyme immunoassay. results In patients with hypothyroidism serum concentrations of TNF-α (3·17 ± 1·18 pg/ml) and sTNFR-I (1273 ± 364 pg/ml) were significantly higher than those found in controls (2·42 ± 0·76 pg/ml, P < 0·05, and 971 ± 235 pg/ml, P < 0·01, respectively). Normalization of thyroid function with... [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article on the diagnosis of the first case of secondary-ebola virus disease (EVD) outside Africa in Spain in the October 6, 2014 issue.

The article focuses on the Psychosocial Protocol and health emergency for diagnosis and controlling ebola virus disease (EVD) in Spain. Topics discussed include need for psychosocial intervention and public health planning, focus of mental health team (MHT) to manage stress symptoms, and conducting telephone interviews everyday with patients under observation.