To determine the minimum cost and affordability of three levels of diet quality in urban households in Cali, Colombia: a caloric-adequate diet, a nutrient-adequate diet, and a recommended diet.

Least-cost diets were estimated for different demographic groups. The Cost of Caloric Adequacy (CoCA) and the Cost of Nutrient Adequacy (CoNA) were computed using linear programming models. The Cost of Recommended Diet (CoRD) adheres to Colombia’s Food-Based Dietary Guidelines. Individualized costs were aggregated for a representative household, and affordability was assessed by comparing these costs with household food expenditures. Data sources included the National Administrative Department of Statistics, the Ministry of Health and Social Protection, and the Colombia Institute of Family Welfare.

Cali, Colombia

The per capita income and food expenditures of 885 urban households in Cali, taken from Colombia’s Great Integrated Household Survey.

The CoNA per 1,000 kcal indicates that women require more nutrient-dense diets than men. Limiting nutrients include vitamin C, vitamin A, vitamin B12, and calcium. Three food groups ―(1) meat, eggs, legumes, nuts, and seeds; (2) milk and dairy products; and (3) vegetables and fruits― account for about 70% of the CoRD. The affordability analysis shows that 42.66% of households in the 10th income percentile cannot afford the CoCA, none below the 20th percentile can afford the CoNA, and only those above the 40th percentile can afford the CoRD.

Urban households face significant barriers not only to affording diets that promote long-term health, but also to those that meet nutritional requirements.

Effective participation of individuals with disabilities in health technology assessment (HTA) processes is paramount. Aware of the reality of people with physical and organic disabilities, COGAMI (a not-for-profit umbrella organization of disability associations) conducted an internal study to gather perspectives on the participation of people with disabilities in HTA processes.

An ad hoc questionnaire of four open-ended questions was designed and distributed via email to COGAMI’s socio-health commission, representing 23 entities and 4,000 people in Galicia. A thematic analysis of the responses obtained was carried out.

Consensus underscores the fundamental role of individuals with disabilities and their representative organizations in HTA processes, though currently, only those with greater resources actively participate. The participants found that insufficient information reaching patient organizations hinders participation (e.g., lack of awareness in proposal submission), complicating their involvement. Additional challenges include accessibility and the digital divide. Proposed solutions involve enhancing communication channels and information accessibility, establishing collaborative frameworks nationally, and actively considering the disability condition to ensure a fair and equitable implementation.

This study suggests the need for concrete actions to enhance the participation of individuals with disabilities in HTA processes. Recommendations include improving communication channels, capacity building, and recognizing disability as a key element in HTA.

Patient participation in health technology assessment (HTA) plays an increasingly relevant role due to increased recognition of its essential contribution to addressing uncertainties in evidence and its real-world application. The objective is to analyze and describe how patients with chronic obstructive pulmonary disease (COPD) participate in the evaluation of transcutaneous capnography (TC) in the primary care setting.

The Spanish Association of Patients with Chronic Obstructive Pulmonary Disease facilitated contact with three COPD expert patients. A face-to-face video interview was conducted with each patient to know about their knowledge of the technology, real-life experiences, and expectations. Patients were informed of the objective of the evaluation and signed confidentiality and conflict of interest forms. All interviews were conducted in April 2023 by two researchers. Expert patients with COPD were able to participate in the review of the protocol and in the final version of the report. Literature searches were also conducted on patient perceptions of TC compared to arterial blood CO2 measurement.

All patients were male, older than 60 years and were ex-smokers with greater than 30 years of tobacco consumption. Patients highlighted the relevance of early detection of COPD to facilitate the planning and organization of treatment as their clinical situation progresses. Likewise, they also emphasized the importance of the implementation of less invasive tests, and the proximity and accessibility of primary care. Two studies reported greater patient satisfaction and less pain with TC than with arterial blood gases.

Expert patients show high expectations for the technology, as it is less invasive than arterial blood gases; they also acknowledged its proximity in primary care settings and the potential for detecting complications of oxygen therapy. Patient participation in HTA adds intangible value, as they provide “disease-specific knowledge” and real-life applicability of the technology.

One obstacle to the development of clinical practice guidelines (CPGs) for rare diseases (RDs) is the lack of scientific evidence. This can be partially overcome by involving patients in the development of CPGs. Our aim was to develop a process for involving patients with RDs in all stages of CPG development to ensure that their needs and expectations are addressed.

A literature search was conducted in the MEDLINE, Cochrane Library, and Embase databases and the websites of the European Organization for Rare Diseases, the National Organization for Rare Disorders, and INAHTA. Eligible articles reported methods for involving patients in CPGs, other clinical decision support tools, and research studies. A fit-for-purpose data extraction template was created to capture the following data: author, year, country, type of study, characteristics of the target population, and strategies for participation, engagement, and involvement of patients. Data were synthesized according to methods for recruiting, involving, or engaging patients and obtaining information from them. The entire process was performed by pairs of researchers.

A total of 1,113 records were identified once duplicates were deleted. Of these, 55 were included. The review collected data on types of patients (patient representatives or patient experts) and their recruitment, which could be classified as open or nominated. The various involvement strategies included consultation, participation, and communication. Differences between involving and engaging patients in the CPGs development process were noted. Procedures for obtaining the opinion of patients included surveys, interviews, workshops, and focus groups, among others. The review also provided information on the importance of involving patients in the dissemination and implementation stages of CPG development and the methods for doing so.

When patients with RDs are actively involved in all phases of CPG development, they can contribute to the identification, prioritization, and inclusion of topics pertinent to RDs as questions to be addressed in the CPGs. These aspects might otherwise be overlooked by clinical experts and researchers. Therefore, involving patients with RDs is a promising approach to addressing gaps in the management of these diseases.

Cannabinoid hyperemesis syndrome (CHS) is an underrecognized condition characterized by acute episodes of intractable nausea and vomiting, colic abdominal pain and restlessness related to chronic cannabis use. Antiemetics commonly fail to alleviate the severe nausea and vomiting. A very particular finding is the symptomatic relief with hot water. Antipsychotics (such as haloperidol), benzodiazepines and/or capsaicin cream appear to be the most efficacious in the treatment of this unique disorder. Precisely, it has been studied that transient relief of symptoms with topic capsaicin or hot water share the same pathophysiology. Nevertheless, abstinence from cannabis remains the most effective way of mitigating morbidity associated with CHS.

The objective is to study this phenomenom in our hospital and to alert of its existence in order to avoid a suspected misdiagnosis and overdiagnosis.

We report a case series of seven patients who attended the Emergency Room (ER) of a third level hospital located in Cantabria (Spain) where a psychiatric evaluation was demanded.

The reasons for consultation were agitation and/or compulsive vomit provocation and showers. They were all women, with a median age of 29 years (range 21 to 38), who all smoked cannabis and in probable high doses (seven to up to twenty joints per day, information was missing in three of the patients) and probable long duration of consumption (more than nine years up to twenty-three, information was missing in three of the patients).

One of the most striking findings is the time to diagnosis, being the median of years of more than eight (range from two to twenty-one). In all of the cases there is a hyperfrequentation to the ER for this reason (not counting other emergency centres we have in Cantabria which we don´t have access to), being the average of almost twenty-two times (thirteen up to thirty times), not diagnosing it until last visits. Another interesting fact is that Psychiatric evaluation is done approximately in a third of the visits, being the department that makes all of the diagnosis except in one case. In all of the cases there are a lot of diagnostic orientation doubts from different medical departments, being the two most common psychiatric misdiagnosis: Other Specified Anxiety Disorder and Other Specified Feeding or Eating Disorder. Two of the patients were hospitalized in an acute psychiatric unit for this reason, one of them nine times and the other patient, twice.

CHS has a very particular presentation which makes its recognition very simple. From our experience, it is an unknown entity for most of the doctors, something that needs to change in order to make a correct therapeutic management. Larger studies need to be done to make this findings more solid and for further information.

None Declared

This study is based on our experience at public hospitals and private clinics of Toledo and Madrid, where we have addressed the treatment of children and adolescents presenting with Eating Disorders (EDs). Our intervention focuses on the application of brief psychotherapy, with particular emphasis on the effectiveness of Eye Movement Desesitization and Reprocessing (EMDR) in these cases.

The primary objective of this study is to determine the benefits of applying EMDR in cases of pediatric and adolescent EDs in comparison to other psychotherapeutic techniques.

Over a period of one year, brief psychotherapy sessions were conducted with children and adolescents diagnosed with EDs. An integrative approach was used, combining family sistemic therapy, cognitive-behavioural therapy techniques, and brief psychodynamic approaches, along with EMDR sessions. Pre and post treatment assessments were conducted to measure changes in symptoms and patients’ quality life.

The results obtained reveal significant improvements in patient symptomatology, including a notable reduction in food-anxiety, dietary restriction and compensatory behaviours. Furthermore, improvements were observed in body image perception and patiends’ overall quality of life. Incidence of relapse cases was minimal.

Our experience suggests that the application of a brief psychotherapy approach, combined with EMDR sessions, can be highly effective in treating children and adolescents with EDs. Early intervention and individualized adaptation of therapies are essential for achieving positive and lasting outcomes in this patient group. These findings underscore the importance of considering integrative approaches in the care of EDs in young population.

None Declared

Major depressive disorder (MDD) is defined as a mental disorder of multifactorial etiology, which presents with mood disturbance, mainly sadness associated with loss of interest or pleasure. Light therapy (LT) is a therapeutic intervention consisting of daily exposure to a light source. This study aims to evaluate the effects of LT on anxious-depressive symptomatology and sleep in a sample of patients diagnosed with depression.

This study aims to evaluate the effects of LT on anxious-depressive symptomatology and sleep in a sample of patients diagnosed with depression.

Prospective case-control study, in which the cases are outpatients diagnosed with MDD and the controls are healthy individuals. Both groups underwent LT sessions and were assessed by means of validated scales, anxiety and depression symptoms before and after LT sessions, as well as changes in sleep patterns through a sleep measuring device.

11 cases and 18 controls were included in the study. Of the participants, 62.1% were female and 37.9% were male. The mean age of the sample was 54.03 □ 11.55 years. There were significant case differences in the pre and post LT scores of the depression scale. There were no significant differences in the changes in superficial, deep and total sleep and in the anxiety scale scores.

In the sample analysed, LT has significant effects on the cases at the level of the depression scale.

None Declared

Anticipatory grief is frequently experienced by family caregivers of persons with dementia. It is defined as the feelings of pain and loss that appear in the caregiver prior to the death of the person cared for, and it is linked to negative consequences for the physical and psychological caregiver’s health. However, more research is needed about this construct. The purpose of this work was to explore the differences regarding gender and kinship in anticipatory grief in caregivers and to explore its associations with distress experienced by the caregivers.

The sample consisted of 70 caregivers. The anticipatory grief was measured with the Caregiver Grief Scale (CGS; Meichsner et al., 2016). Also, frequency of problematic behaviours in the person with dementia and caregiver reactions to them (RMPBC; Teri et al., 1992), depressive symptomatology (CES-D; Radloff, 1977), guilt (CGQ; Losada et al., 2010), anxiety (Tension Sub-scale of POMS’s Questionnaire; Fernández et al., 2000), emotional ambivalence (CAS; Losada et al., 2017) and the experiential avoidance in caregiving (EACQ; Losada et al., 2014) were measured.

Independent-samples T-tests were conducted to study if there were differences in anticipatory grief according to the gender of the caregiver and the kinship with the person with dementia. Secondly, Pearson correlations were conducted to study the associations between anticipatory grief and emotional distress variables.

The results showed no significative differences according to the gender of the caregiver in anticipatory grief. However, a longer caregiver ́s age and being a spouse caregiver was related to a greater anticipatory grief. Regarding the person cared for, behavioral problems and caregivers ́ reaction to them were associated with anticipatory grief. With regard to caregiver ́s emotional distress, significant and positive correlations were also obtained between anticipatory grief and its subscales with depressive symptomatology, guilt, anxiety, emotional ambivalence and experiential avoidance in caregiving.

The results suggest that anticipatory grief may have a relevant role in the well-being of dementia family caregivers. Therefore, it is necessary to consider this process in the assessment and intervention in this context with caregivers.

Caring for a relative with dementia is a chronic stress situation related to negative consequences such as elevated depressive and anxiety symptoms. A possible mediator variable explored to explain pathways from chronic stress to emotional distress is emotional ambivalence towards the care-recipient (the simultaneous experience of positive and negative feelings towards the care-recipient). Emotional ambivalence, measured with questionnaires, presents significant associations with depression and anxiety in family carers of people with dementia. However, the self-report of emotional ambivalence is susceptible to being influenced by social desirability. The aim of this study is to present preliminary results that analyze implicit ambivalence and its association with emotional distress in family carers of people with dementia.

54 caregivers participated in the study (mean age = 61.2, SD = 12.92, 81.5% women). To explore implicit emotional ambivalence, we adapted a sequential priming paradigm developed to measure implicit ambivalence about significant others (Zayas & Shoda, 2015). Two priming stimuli were used: a) neutral (e.g., RRR) and b) valenced prime (i.e., the name of the care-recipient). The targets were positive and negative words that participants have to categorize as positive or negative.

A facilitation-inhibition indexes for positive and negative targets were calculated by subtracting the mean reaction time (RT) for valenced prime from the mean RT for neutral primes. Positive values show a facilitation effect of the valenced prime (i.e., the name of the care-recipient), and negative values inhibition. Participants were classified depending on their results of this indexes: a) positive (facilitation of positive information, inhibition of negative information), b) negative (facilitation of negative information, inhibition of positive information), c) flat (inhibition of positive and negative information), and d) ambivalence (facilitation of positive and negative information). ANOVAS were performed to explore differences between groups in emotional distress. The preliminary results showed that the ambivalence group might present more depressive symptoms compared with the positive group.

This is the first study that analyzed implicit ambivalence in family carers of people with dementia. The preliminary results show the relevance of exploring implicit processes to explain emotional distress in this population.

To identify urinary catheter (UC)–associated urinary tract infection (CAUTI) incidence and risk factors.

A prospective cohort study.

The study was conducted across 623 ICUs of 224 hospitals in 114 cities in 37 African, Asian, Eastern European, Latin American, and Middle Eastern countries.

The study included 169,036 patients, hospitalized for 1,166,593 patient days.

Data collection took place from January 1, 2014, to February 12, 2022. We identified CAUTI rates per 1,000 UC days and UC device utilization (DU) ratios stratified by country, by ICU type, by facility ownership type, by World Bank country classification by income level, and by UC type. To estimate CAUTI risk factors, we analyzed 11 variables using multiple logistic regression.

Participant patients acquired 2,010 CAUTIs. The pooled CAUTI rate was 2.83 per 1,000 UC days. The highest CAUTI rate was associated with the use of suprapubic catheters (3.93 CAUTIs per 1,000 UC days); with patients hospitalized in Eastern Europe (14.03) and in Asia (6.28); with patients hospitalized in trauma (7.97), neurologic (6.28), and neurosurgical ICUs (4.95); with patients hospitalized in lower–middle-income countries (3.05); and with patients in public hospitals (5.89).

The following variables were independently associated with CAUTI: Age (adjusted odds ratio [aOR], 1.01; P < .0001), female sex (aOR, 1.39; P < .0001), length of stay (LOS) before CAUTI-acquisition (aOR, 1.05; P < .0001), UC DU ratio (aOR, 1.09; P < .0001), public facilities (aOR, 2.24; P < .0001), and neurologic ICUs (aOR, 11.49; P < .0001).

CAUTI rates are higher in patients with suprapubic catheters, in middle-income countries, in public hospitals, in trauma and neurologic ICUs, and in Eastern European and Asian facilities.

Based on findings regarding risk factors for CAUTI, focus on reducing LOS and UC utilization is warranted, as well as implementing evidence-based CAUTI-prevention recommendations.