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Suicide poses a severe public health challenge worldwide, impacting individuals, families, work, and society. The multifaceted nature of suicide demands a complex approach involving psychological, biological, social, cultural, and environmental factors. Recognizing suicide’s status as the leading external cause of death in Spain, prevention increasingly incorporates technology, specifically mobile and software applications.
Methods
A systematic review of the effectiveness and safety of mobile and software applications was conducted (MEDLINE, Embase, CINAHL, and PsycINFO databases). Outcome variables included: suicide; suicidal behavior; suicidal intent; suicidal ideation/thinking; self-perceived suicide risk; using/seeking mental health services; associated mental symptoms; mental health-related quality of life; satisfaction of the user and the health professional; adverse events related to the app, as defined in the included studies. Studies that do not include suicidal behavior, intention, or ideation were excluded. Where available data allowed, a meta-analysis was conducted for each outcome variable.
Results
One systematic review and 13 randomized controlled trials (n=2,952) were analyzed. No significant differences were found in deaths by suicide or suicide attempts. At post-intervention, small but significant reductions were observed in suicidal ideation, hopelessness, depression, and worry, with anxiety reduction slightly above statistical significance. At follow-up (8 to 52 weeks), these variables also obtained significant results, except depression and suicidal ideation. Regarding safety, there was no significant difference in safety phone calls for participants with suicidal ideation.
Conclusions
The evidence on suicide prevention app effectiveness is of low quality, precluding conclusive findings. Attempt reduction is suggested at 21 percent, but the confidence interval includes a potential 60 percent increase. Evidence on suicide-related psychological variables (suicide ideation, depression, hopelessness, and anxiety) is of higher quality (low–moderate), but effects are small and clinically uncertain. Safety findings are uncertain, impacting risk/benefit balance.
The development of clinical practical guidelines (CPGs) has been evolving towards a standard methodology based on GRADE. While reviewing CPGs, we found valid recommendations and no evidence to update. Including these initial recommendations in addition to new recommendations as part of the scope can improve understanding of the issue.
Methods
To develop a standardized approach to the writing of recommendations when updating a CPG, we consulted several methodological handbooks: Scottish Intercollegiate Guidelines Network (SIGN) (2011 and 2019 version), National Institute for Health and Care Excellence (NICE) last update (2024), New Zealand Guidelines Group (NZGG) grading system, and Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence 2. We compared the wording and specific symbols used to express strength of recommendations and quality of evidence with those used by GRADE, as described in the methodology handbook for developing clinical practice guidelines in the Spanish National Health System (SNS).
Results
A table was developed to express the equivalence of wording and symbols of quality of evidence and grading of recommendations to align the expression of SIGN, NICE, OCEBM, and NZGG methods with GRADE terminology. SIGN and NICE methodologies did not utilize specific symbols to express strength of recommendations; SIGN did not utilize the GRADE approach to assess the quality of evidence. The NZGG system applied its own classification for quality assessment and grading of recommendations. Oxford OCEBM keeps the terminology of level of evidence and grading of recommendations.
Conclusions
Using wording and symbols equivalence to standardize the recommendations of different methods to GRADE could assist the process of updating CPGs with the GRADE-Adolopment approach. Recommendations that are still valid and have been developed rigorously could be integrated in an updated CPG avoiding the duplication of efforts, but this generates uncertainty, especially when the quality assessment is focused on the studies designs.
A conceptual framework, called Innovation of Health Technology Assessment Methods (IHTAM), has been developed to facilitate the understanding of how to innovate methods of health technology assessment (HTA). However, the framework applicability has not been evaluated in practice. Hence, we aimed to explore framework applicability in three cases of method innovation that are part of the HTx project and to develop a roadmap to improve framework applicability.
Methods
The IHTAM framework was applied to three cases of innovating HTA methods. We collected feedback from case study leaders and consortium members after a training session, an approximately 1-year follow-up of periodic case study meetings, and a general assembly meeting where innovation progresses of the three cases were reported through surveys and interviews. Feedback was then summarized using an open-coding technique.
Results
According to feedback, the framework provided a structured way of deliberation and helped to improve collaboration among HTA stakeholders. However, framework applicability could be improved if it was complemented by a roadmap with a loop structure to provide tailored guidance for different cases, and with items to elaborate actions to be taken by stakeholders. Accordingly, a 48-item roadmap was developed.
Conclusions
The IHTAM framework was generally applicable to the three case studies. A roadmap, with loop structure and actionable items, could complement the framework, and may provide HTA stakeholders with tailored guidance on developing new methods. To further examine the framework applicability, we recommend stakeholders to apply the IHTAM framework and its roadmap in future practice.
The role of capital in measuring resilience is investigated. Focusing on the current short-run and potential long-run growth paths of the economic system, we propose new indexes to separately measure adaptability and resistance to shocks, which are the essence of a system’s resilience. Capital dynamics during the transition and along the balanced growth path are used here instead of employment to represent the evolution of the size and composition of the economy. Our indexes measure adaptability and resistance by comparing the two capital growth rates. They are built by mimicking the average and variance of the difference in growth rates. In this new setting, investment and depreciation flows play an important role in explaining what the partial index of adaptability reveals. The available data on the USA and Spanish capital allow us to empirically compute the indexes and draw conclusions about their ability to resist shocks and absorb their effects. We conclude that the US economy is more adaptable and has a greater capacity to absorb impacts than the Spanish economy, but it is less resistant to disturbances.
Around 120 years ago, a burial was discovered in the Argaric settlement of San Antón, 60 km southeast of Alicante (Spain). Although it was similar to many others recorded during more than a century of research, some gold objects found made this burial exceptional in the Iberian Bronze Age funerary record. Based on the most recent archaeological data, this article reviews both the context and the whole set of grave goods. It also explores the intersocial relationships that these gold ornaments suggest, which directly or indirectly seem to point towards both eastern Mediterranean Europe as well as to the Carpathian Basin.
Three samples of volcanic tuff were hydrothermally altered at ∼82°C in a soxhlet apparatus for periods from 745 to 2706 h. The samples correspond to partially altered specimens of volcanic tuff with 6 wt. % (T3a) and 9 wt. % (T3b) smectite and to the calcination product of the latter (T3c). The calcination treatment melted the smectite in the sample. Untreated samples and alteration products were studied by X-ray diffraction (XRD), differential thermal analysis (DTA) and thermogravimetry (TG), scanning electron microscopy (SEM) with energy dispersive X-ray (EDX) analysis, and oxygen isotope analysis. DTA-TG of the <2-µm size fractions showed that there was a small increase of smectite relative to glass after alteration for samples T3a and T3b, with the amount of smectite increasing exponentially with time. No smectite formed in sample T3c. These results suggest that smectite acts as a nucleation site for the precipitation of new smectite. The amount of glass in the <2-µm size fraction increased, although slightly decreased relative to smectite. SEM-EDX analysis showed smectite with the approximate structural formula of Na0.22K0.08Mg0.12Ca0.03VI(Al1.47Fe0.05Mg0.48)IV(Si3.97Al0.03)O10(OH)2.
Oxygen isotope composition of the <2-µm size fraction became enriched in 18O by alteration, the >2-µm size fraction of T3b did not vary, and that of T3c was depleted in 18O. Our results are consistent with three processes during alteration: 1) oxygen isotope exchange between volcanic glass and water, 2) neoformation of smectite, and 3) hydration and consequent hydroxylation of the calcined glass.
Scanning electron microscopy has revealed the presence of spherical, lath and platy kaolinite in gels with Si/Al atomic ratio ranging from 1.84 to 0.76 that are hydrothermally treated under different temperature and time conditions. Hemispherical structures and excavated zones, at different stages of evolution, have been observed on the surface of the gel grains, indicating that spherical particles do not precipitate from the solution but are generated from the gels. The quantity of spherical particles depends on temperature, time and the chemical composition of the starting gel. Products from starting material with Si/Al ≈ 1 yield the highest quantity of these particles. Being metastable, sphere dissolution controls the chemistry of the solution and consequently the morphology of the precipitating crystals thus producing more elongated, curved and irregular outlines when gels with Si/Al ≈ 1 are hydrothermally treated.
Few studies have examined the psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC) in a large adolescent community sample, finding a significant disparity. This study explores the psychometric properties of the CD-RISC among Spanish adolescents by means of exploratory factor analysis (EFA), Rasch analysis, and measurement invariance (MI) across sex, as well as internal consistency and criterion validity. The sample was comprised of 463 adolescents (231 girls), aged 12 to 18 years, who completed the CD-RISC and other measures on emotional status and quality of life. The EFA suggested that the CD-RISC structure presented a unidimensional model. Consequently, shorter unidimensional CD-RISC models observed in the literature were explored. Thus, the Campbell-Sills and Stein CD–RISC–10 showed the soundest psychometric properties, providing an adequate item fit and supporting MI and non-differential item functioning across sex. Item difficulty levels were biased toward low levels of resilience. Some items showed malfunctioning in lower response categories. With regard to reliability, categorical omega was. 82. Strong associations with health-related quality of life, major depressive disorder symptoms, and emotional symptoms were observed. A weak association was found between resilience and the male sex. Campbell-Sills and Stein’s CD–RISC–10 model emerges as the best to assess resilience among Spanish adolescents, as already reported in adults. Thus, independently of the developmental stage, the core of resilience may reside in the aspects of hardiness and persistence.
Despite the high level of standardization of the intracytoplasmic sperm injection (ICSI) technique, there are some aspects that deserve special attention and should still be improved. The major drawback of the technique is its invasiveness, as during cytoplasmic aspiration different structures of the oocyte may be lost or damaged. This is partly because the microtools used in ICSI were not specially designed for assisted reproduction but for other medical–biological disciplines. In view of the above caveats, the aim of the study was to compare the results of ICSI with the traditional oocyte-holding pipette and the oocyte-holding pipette without aspiration (PiWA). In total, 155 patients and 1037 oocytes were included in the study. In each ICSI cycle, half of the oocytes were microinjected using a traditional holding pipette and the other half using a PiWA. In result, the PiWA technique produced a significant increase in the fertilization rate: 88.12% (95%CI: 84.62–90.92%); holding pipette: 73.33% (95%CI: 68.72–77.49%). Also, it produced a significant decrease in the embryo degeneration rate compared with the traditional holding pipette [PiWA: 2.07% (95%CI: 1.11–3.8%); holding pipette: 4.51% (95%CI: 3.06–6.59%)]. Pregnancy rate depended on the holding technique used, both in single embryo transfers (n = 59; χ2 = 4.608; P-value = 0.032) and double embryo transfers (n = 156; χ2 = 4.344; P-value = 0.037); with PiWA presenting a significantly higher pregnancy rate than the traditional holding technique. Based on current evidence and the present results, improvements should focus on decreasing the invasiveness of the microinjection itself by minimizing or avoiding aspiration and cytoplasmic disorganization, as is successfully achieved with PiWA.
Mg-rich kaolinite and Mg+Ni-rich kaolinite have been synthesized in hydrothermal experiments (200 and 400°C) from poorly crystalline kaolinite and Mg- and Mg+Ni-bearing solutions. Al-rich serpentine and Al-rich chlorite were obtained as sub-products of the reactions. The formation of these phases occurred through a dissolution-precipitation mechanism that led to spherical kaolinite after short reaction times. A morphological evolution towards platy particles and stacks occurred at increasing run times.
Identification of the several phases was carried out using a combination of X-ray diffraction and transmission/analytical electron microscopy. Analytical data indicate that the Mg content in kaolinite increased as a function of the reaction time and temperature, reaching up to 0.46 atoms per half formula unit (a.p.h.f.u.). The measured (Mg+Ni) content reached up to 0.56 a.p.h.f.u.. Both the gradual increase of the b-cell parameter of kaolinite at increasing Mg contents and the presence of new bands on the FTIR spectra of the synthesized kaolinite point to a Mg-for-Al replacement in the octahedral sheet rather than to the presence of serpentine-like layers interstratified in the kaolinite structure.
The aim of our paper is to study some aspects of the textile industry of the city of Segovia and its land in the second half of the 16th century, interpreting them through spatial economy theories and specifically the industrial district approach. It is about seeing the competitive advantages of the integration and diffusion of the business organization in its geographical framework. The district's competitive advantages are linked to both transaction and production costs. One of them is to maximize the benefits of labor market segmentation with the emergence of a primary market for skilled labor. Another is the ease of diffusion of both technology and organizational and commercial techniques.
It has been estimated that about 5 million people of those affected with otitis media have cholesteatoma, however, its pathophysiology is unclear. In this study we aimed to detect Helicobacter pylori via polymerase chain reaction and real-time polymerase chain reaction in young patients with chronic otitis media.
Methods
Patients included in our prospective cross-sectional study had middle-ear/mastoid inflammation and underwent surgical procedures. Middle-ear mucosa samples were collected, and genomic DNA was extracted for H pylori detection by polymerase chain reaction and real-time polymerase chain reaction analyses. Sociodemographic data and gastroesophageal reflux symptoms were analysed.
Results
We included 49 patients with mean age of 12.7 ± 3.8 years. Twenty per cent of the patients were diagnosed with cholesteatoma. No increase in H pylori-amplified fluorescence was observed, indicating absence of H pylori.
Conclusion
Due to the absence of amplification for H pylori and the fact that albumin was amplified in all samples, we conclude that H pylori does not appear to be a causal factor.
The coronavirus disease 2019 (COVID-19) has serious physiological and psychological consequences. The long-term (>12 weeks post-infection) impact of COVID-19 on mental health, specifically in older adults, is unclear. We longitudinally assessed the association of COVID-19 with depression symptomatology in community-dwelling older adults with metabolic syndrome within the framework of the PREDIMED-Plus cohort.
Methods
Participants (n = 5486) aged 55–75 years were included in this longitudinal cohort. COVID-19 status (positive/negative) determined by tests (e.g. polymerase chain reaction severe acute respiratory syndrome coronavirus 2, IgG) was confirmed via event adjudication (410 cases). Pre- and post-COVID-19 depressive symptomatology was ascertained from annual assessments conducted using a validated 21-item Spanish Beck Depression Inventory-II (BDI-II). Multivariable linear and logistic regression models assessed the association between COVID-19 and depression symptomatology.
Results
COVID-19 in older adults was associated with higher post-COVID-19 BDI-II scores measured at a median (interquartile range) of 29 (15–40) weeks post-infection [fully adjusted β = 0.65 points, 95% confidence interval (CI) 0.15–1.15; p = 0.011]. This association was particularly prominent in women (β = 1.38 points, 95% CI 0.44–2.33, p = 0.004). COVID-19 was associated with 62% increased odds of elevated depression risk (BDI-II ≥ 14) post-COVID-19 when adjusted for confounders (odds ratio; 95% CI 1.13–2.30, p = 0.008).
Conclusions
COVID-19 was associated with long-term depression risk in older adults with overweight/obesity and metabolic syndrome, particularly in women. Thus, long-term evaluations of the impact of COVID-19 on mental health and preventive public health initiatives are warranted in older adults.
This paper proposes a proper compass adjustment method using only a GPS (or any other GNSS receiver) and a single visual reference to enhance the efficiency of compass adjustment. During compass adjustment, the ship proceeds on magnetic courses using a gyroscopic or satellite compass and considering magnetic declination. However, non-magnetic compasses are only compulsory for ships of 500 gross tonnage or upwards (SOLAS V/19.2.5.1). Many ships of less than 500 gross tonnage have only a magnetic compass to indicate heading. In these cases, a minimum of five leading lines or a minimum of five bearings of conspicuous and distant points or sun azimuths are necessary to adjust the compass. This makes compass adjustment more laborious and time consuming. To expedite this process, a reliable and practical method was developed to use the courses over ground given by a GNSS receiver and a single visual reference instead of the headings provided by a gyroscopic or satellite compass. The method is valid for all ships, but is primarily intended for those equipped with only a magnetic compass to indicate heading.
This paper focuses on the state of precarious work in Spain: Are all those who work as self-employed persons and interns truly operating under those descriptions, or are many of them employees so precariously engaged that they have no labour contracts? If so, how has this come to pass? Why is it increasingly happening? This paper raises some answers based on the Marxist approach. We link employment instability to increased exploitation of the Spanish labour force. This trend is a reaction by capital to low rates of profit and the implementation of particular governmental economic policies implemented to meet the demands of the European Union. Due to the precariousness of work, prospects for achieving a stable and autonomous life for a large cohort of Spain’s working youth are seriously threatened.
Psychopathology and side effects of antipsychotic drugs contribute to worsening physical health and long-term disability, and increasing the risk of mortality in these patients. The efficacy of exercise on these factors is not fully understood, and this lack of knowledge may hamper the routine application of physical activity as part of the clinical care of schizophrenia.
Aims
To determine the effect of exercise on psychopathology and other clinical markers in patients with schizophrenia. We also looked at several moderators.
Method
MEDLINE, Web of Science, Scopus, CINAHL, SPORTDiscus, PsycINFO, and Cochrane Library databases were systematically searched from inception to October 2022. Randomized controlled trials of exercise interventions in patients 18–65 years old diagnosed with schizophrenia disorder were included. A multilevel random-effects meta-analysis was conducted to pool the data. Heterogeneity at each level of the meta-analysis was estimated via Cochran’s Q, I2, and R2.
Results
Pooled effect estimates from 28 included studies (1,460 patients) showed that exercise is effective to improve schizophrenia psychopathology (Hedges’ g = 0.28, [95% CI 0.14, 0.42]). Exercise presented stronger effects in outpatients than inpatients. We also found exercise is effective to improve muscle strength and self-reported disability.
Conclusions
Our meta-analysis demonstrated that exercise could be an important part in the management and treatment of schizophrenia. Considering the current evidence, aerobic and high-intensity interval training exercises may provide superior benefits over other modalities. However, more studies are warranted to determine the optimal type and dose of exercise to improve clinical outcomes in people with schizophrenia.
The environmental conditions in Maritime Antarctica are more favorable to soil development than in continental areas, which is reflected in the content and type of clay minerals present. In this context, soil clay minerals of Fildes Peninsula, South Shetland Islands were studied with the aim of relating them to periglacial and paraglacial processes as possible indicators of initial pedogenic processes. In this work, textural, mineralogical and crystallochemical characterization of clay minerals as well as chemical and physical soil analyses were carried out. The soil samples represented various surface cover types present on Fildes Peninsula. All samples were composed mainly of clay minerals, plagioclase, quartz and minor zeolites and pyroxene. The clay mineral content was very variable and reached up to 63% w/w. The clay minerals present are mainly smectite, vermiculite, chlorite and minor kaolinite, mica, corrensite and interstratified illite–smectite, with smectite and vermiculite dominating in almost all of the samples. The primary minerals display chemical alteration, and smectite formed by alteration of plagioclase. The clay mineral types were related to the parent material, which was affected by low-grade metamorphism and hydrothermal alteration that transformed biotite and chlorite into vermiculite via interstratified chlorite–vermiculite. Furthermore, this process and/or ongoing surface weathering transformed vermiculite into smectite. The genetic relationship observed between vermiculite and smectite suggests progressive alteration and transformation into a phase with intermediate composition between vermiculite and smectite. Therefore, vermiculite could be at least in part the smectite precursor. Samples closer to the current Collins Glacier front are composed mainly of vermiculite, with the greatest chemical variation occurring where the soils were developed from a mixture of initially glacially transported volcanic rocks through periglacial and fluvial processes. The clay minerals from the centre and south of Fildes Peninsula are mixtures of montmorillonite and vermiculite, as well as of chlorite and corrensite in various proportions. The clay minerals in soils developed on the west coast are a mixture of Fe-rich montmorillonite and vermiculite.
Aging is a multifactorial process influenced by both biological and sociocultural factors. The objective of this study was to identify current and past factors with an impact on the quality of aging in a sample of people 65 years of age or older born in the postwar period after the Spanish civil war. Socioeconomic, health, anthropometric, and food consumption data were collected in public Leisure Centers for the elderly in Madrid. The sample consists of 587 people (64.6% women), with a mean age of 71.8 ±5.3 years. Following the World Health Organization (WHO) guidelines regarding what is considered Healthy Aging, an index called the Index of Quality of Aging was calculated from four variables: the Mini Mental State Examination score, perception of health, satisfaction with life and the number of diseases that affect daily life. Another index called the Diet Inflammation Index was created based on the inflammatory or anti-inflammatory potential of different foods. The Index of Quality of Ageing was used as a dependent variable in linear regression models for men and women. Differences by gender were observed in the factors that influence the quality of aging. Education had a positive influence on men quality of ageing while it does not on women. In these, a relationship between the quality of the current diet and the quality of aging was observed.
The aim of the study was to investigate the association between pre-gestational carbohydrate quality index (CQI) and the incidence of gestational diabetes mellitus (GDM). Data from the ‘Seguimiento Universidad de Navarra’ (SUN) cohort were used, which includes 3827 women who notified at least one pregnancy between December 1999 and December 2019. We used a validated semi-quantitative 136-item FFQ to evaluate dietary exposures at baseline and at 10-year follow-up. The CQI was defined by four criteria: glycaemic index, whole-grain/total-grain carbohydrate, dietary fibre intake and solid/total carbohydrate ratio. We fitted generalised estimating equations with repeated measurements of the CQI to assess its relationship with incident GDM. A total of 6869 pregnancies and 202 new cases of incident GDM were identified. The inverse association between the global quality of carbohydrate and the development of GDM was not statistically significant: OR the highest v. the lowest CQI category: 0·67, 95 % CI (0·40, 1·10), Pfor trend = 0·10. Participants at the highest CQI category and with daily carbohydrate amounts ≥50 % of total energy intake had the lowest incidence of GDM (OR = 0·29 (95 % CI (0·09, 0·89)) compared with those with the lowest quality (lowest CQI) and quantity (≤40 %). Further studies are needed to overcome the limitations of our study. Those studies should jointly consider the quality and the quantity of dietary carbohydrates, as the quality might be of importance, especially in women with a higher intake of carbohydrates.