We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The 2016 peace agreement between the Colombian government and the FARC-EP, and the demobilization of the latter, dismantled the governance structures in regions formerly under rebel control. Drawing from a relational security framework, this article explores how, across three case-studies, communities use their former experience of rebel governance as a framework through which they could express expectations and dissatisfaction with new types of order. This blueprint is also used to make specific demands to new or reconstituted armed groups and to take direct action to address governance gaps, reproducing and co-constructing order post-demobilization. However, we observe that both the organization of the community and the capacity and ideology of armed groups could also be limiting factors to the community’s reproduction of order post-demobilization. From a peacebuilding perspective, this means that there can be pressure from below in favor of remobilization, as a predictable insurgent order may be preferable to uncertainty.
This article discusses the relationship between particular and general customary international law, grappling with academic views affirming that, ordinarily, the emergence of the former is a stage in the consolidation of the latter. It is argued that the higher standard of State consent required for the configuration of bilateral or regional custom suggests otherwise. In addition, it is also contended that a distinctive kind of opinio juris must be present for particular custom to arise: a conviction from the States concerned that their conduct is governed by particular (as opposed to general) customary law.
An increase in the prevalence of obesity due to lockdown and confinement linked to COVID-19 is observed. Variations in the nutritional status of schoolchildren from Jujuy are analyzed in relation to confinement due to COVID-19 (2019–2021) and its relationship with socio-demographic variables and the school environment. This is an observational, descriptive study. Data from 56,695 schoolchildren aged 6–18 years old is analyzed based on two temporary cuts (2019 pre-confinement and 2021 post-confinement). The nutritional status of schoolchildren (underweight, overweight, and obese) was established using the IOTF (International Obesity Task Force) criterion. The prevalence of each nutritional phenotype was estimated by sex and age group, considering the following independent variables: setting (rural/urban), school management system (public/private), geographic altitude, and percentage of households with unmet basic needs (UBN) in the place where they attend school. Multiple proportions contrast was performed using Fisher's test, a transition matrix ws produced and a statistical model of proportional odds was fitted. It was observed that between 2019 and 2021, the prevalence of underweight decreased and the prevalence of overweight and obesity increased significantly. In 2021, 67% of schoolchildren maintained the same nutritional category that they had in 2019, 21% gained weight and 12% lost weight. The model explains about 52% of the total variability observed. The factors that are significantly correlated in the model are school cycle, age, geographic altitude, school setting, and % of households with UBN. The results indicate that during the COVID-19 pandemic, there was a shift to the right in the distribution of the nutritional status categories of the schoolchildren population in Jujuy, with a decrease in the prevalence of underweight and an increase in the prevalence of overweight and obesity with variations related to age, school location, geographic altitude, and socioeconomic characteristics of the households in the place where the children attended school.
There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research.
Aims
This study aimed to validate proxy tools for the short versions of the Positive and Negative Syndrome Scale (PANSS-6), Young Mania Rating Scale (YMRS-6) and Montgomery–Åsberg Depression Rating Scale (MADRS-6).
Method
A cross-sectional, multicentre study was conducted in a sample of 116 patients with first-episode psychosis from 12 public hospitals in Spain. Concordance between PANSS-6, YMRS-6 and MADRS-6 scores and their respective proxies was evaluated based on information from EHR clinical notes, using a variety of statistical procedures, including multivariate tests to adjust for potential confounders. Bootstrapping techniques were used for internal validation, and an independent cohort from the Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne, Switzerland) for external validation.
Results
The proxy versions correlated strongly with their respective standardised scales (partial correlations ranged from 0.75 to 0.84) and had good accuracy and discriminatory power in distinguishing between patients in and not in remission (percentage of patients correctly classified ranged from 83.9 to 91.4% and bootstrapped optimism-corrected area under the receiver operating characteristic curve ranged from 0.76 to 0.89), with high interrater reliability (intraclass correlation coefficient of 0.81). The findings remained robust in the external validation data-set.
Conclusions
The proxy instruments proposed for assessing psychotic and affective symptoms by reviewing EHR provide a feasible and reliable alternative to traditional structured psychometric procedures, and a promising methodology for real-world practice settings.
A magnetic composite was prepared by wet-impregnating a powder of a natural zeolite with a magnetic Fe oxide-containing synthetic material. Both starting materials were first characterized with X-ray diffraction, scanning electron microscopy, Mössbauer spectroscopy, and by isoelectric-point using vibrating-sample magnetometry. The synthetic Fe oxide-containing material was characterized as a mixture of magnetite (Fe3O4) and goethite (α-FeOOH). From the Fe Mössbauer analysis, the relative subspectral area for magnetite corresponds to 93(2)%; the remaining spectrum is assignable to goethite. After the impregnation process, magnetite was still identified in the composite material as a magnetic layer surrounding the zeolite particles; no magnetically ordered goethite could be detected. The Mössbauer pattern for this sample indicates a much more complex structure than for the precursor material, based on Fe oxides, with some more altered magnetite and an intense central doublet of (super)paramagnetic Fe3+, probably due to small Fe (hydr)oxides and/or to a residual contribution of Fe-bearing species from the starting zeolite material. The composite preparation procedure also promoted the change of the characteristic A-type zeolite to mordenite. The resulting magnetic composite presented a magnetic coercivity of as much as 0.140 A m−1, at 77 K. The final composite is now being evaluated as an adsorbent: results to date confirm that this novel magnetic material may have applications in the remediation of contaminated water bodies.
Hypotheses based on allocation theory and herbivore selection offer opposite predictions about how defence levels against herbivores change as the plant tissue grows. The growth differentiation balance hypothesis (GDBH) assumes that defences will be resource-limited in immature tissues and predict that defence levels increase as the plant tissue grows. Conversely, the optimal defence hypothesis (ODH) proposes that plants would have the highest level of defences in the parts that have the highest value in terms of fitness and/or are more frequently attacked by herbivores, such as young tissues. We examine whether spinescence in the shrub Rubus adenotrichos (blackberry) change as the leaf grows, and if this change is consistent with the GDBH or the ODH. We compare the petiole area occupied by prickles, the prickles density and the individual prickle area in mature versus young petioles from Rubus adenotrichos. Our results show that, in R. adenotrichos, young tissues are more protected than mature tissues. Prickles density and the petiole area occupied by prickles were up to 25% higher in young petioles than in mature ones. These results support the ODH, reinforcing the idea that extrinsic factors such as herbivores pressure might drive the change of structural defences level across leaf ontogeny.
The aim of this study was to understand the perspectives of female residents of Spain from West Africa in terms of the factors that condition their lives. Pierre Bourdieu’s theory and the model of intersectionality formed the framework we used to qualitatively analyse the life stories of these women, which was complemented with life lines. The results showed us that traditional practices such as female genital mutilation and forced marriage are part of the social habitus of this group and they relate to each other through the several types of violence that occurs throughout their lives. In addition, in reference to the African community, these women were no longer African, while in terms of the Spanish community, they did not seem Spanish. At a health, political, and social level, this knowledge can help us to understand this group and to create personalised targeted interventions for them.
Anandamide (AEA) and 2-arachidonoylglycerol (2-AG) play a pivotal role in stimulating motivational behavior toward food and energy metabolism. Aberrant functioning of the endocannabinoid system has been observed in extreme weight conditions (EWCs), suggesting it may influence pathophysiology. Then, we aimed to analyze fasting AEA and 2-AG plasma concentrations among individuals with EWC (i.e., anorexia nervosa [AN] and obesity with and without eating disorders [EDs]) compared with healthy controls (HCs), and its association with clinical variables and body mass index (BMI).
Methods
The sample included 113 adult women. Fifty-seven belonged to the obesity group, 37 without EDs (OB-ED) and 20 with ED (OB+ED classified within the binge spectrum disorders), 27 individuals from the AN group, and 29 from the HC group. Peripheral blood samples, several clinical variables, and BMI were evaluated.
Results
Unlike 2-AG, AEA concentrations showed significant differences between groups (p < 0.001). Increased AEA was observed in the OB-ED and OB+ED compared with both HC and AN group, respectively. Likewise, AEA was differentially associated with emotional dysregulation, general psychopathology, food addiction, and BMI in all clinical groups.
Conclusions
These results support the interaction between biological and clinical factors contributing to delineating vulnerability pathways in EWC that could help fit personalized therapeutic approaches.
Se presentan los resultados de fluorescencia de rayos-X realizados a 12 artefactos provenientes de contextos funerarios Chinchorro, Arica, norte de Chile, focalizándose la discusión en el manganeso (Mn). La muestra con mayor concentración de Mn fue analizada con espectrometría Raman, para avanzar en la identificación estructural del cromóforo negro correspondiente. Todos los artefactos dieron positivo para la presencia de Mn con un rango de 1,11%-63,66%, considerándose antrópico sobre 2% (83,33% del total) y el pigmento analizado fue identificado como criptomelano y goetita.
Schizophrenia is a complex disorder involving deficits in both cognitive and emotional processes. Specifically, a marked deficit in cognitive control has been found, which seems to increase when dealing with emotional information.
Aims
With the aim of exploring the possible common links behind cognitive and emotional deficits, two versions of the emotional Stroop task were administered.
Method
In the cognitive-emotional task, participants had to name the ink colour (while ignoring the meaning) of emotional words. In contrast, the emotional-emotional task consisted of emotional words superimposed on emotional faces, and the participants had to indicate the emotional valence of the faces. Fifty-eight participants (29 in-patients diagnosed with schizophrenia and 29 controls) took part in the study.
Results
Patients and controls showed similar response times in the cognitive-emotional task; however, patients were significantly slower than controls in the emotional-emotional task. This result supports the idea that patients show a more pronounced impairment in conflict modulation with emotional content. Besides, no significant correlations between the tasks and positive or negative symptoms were found. This would indicate that deficits are relatively independent of the clinical status of patients. However, a significant correlation between the emotional-emotional task and cognitive symptoms was found.
Conclusions
These findings suggest a restricted capacity of patients with schizophrenia to deal with the attentional demands arising from emotional stimuli.
CHDs are the most common type of birth defect. One in four newborns with a heart defect has a critical CHD. In Mexico, there is a lack of data available to determine its prevalence. Pulse oximetry screening programmes have been implemented worldwide, reporting opportunity areas in algorithm interpretation and data management. Our study aims to share preliminary results of a 3-year experience of a multicentre pulse oximetry screening programme that addresses critical challenges.
Materials and methods:
This retrospective study examined the reports of newborns screened from February 2016 to July 2019 from five hospitals. Two algorithms –the New Jersey and the American Academy of Pediatrics– were implemented over consecutive periods. The algorithms’ impact was assessed through the calculation of the false-positive rate in an eligible population.
Results:
A total of 8960 newborns were eligible for the study; from it, 32.27% were screened under the New Jersey and 67.72% under the American Academy of Pediatrics algorithm – false-positive rate: 1% (CI 95: ± 0.36%) and 0.71% (CI 95: ± 0.21%), respectively. Seventy-nine newborns were referred, six were diagnosed with critical CHD, and six with CHD. The critical CHD estimated prevalence was 6.69:10,000 newborns (CI 95: ± 5.36). Our results showed that the algorithm was not related to the observable false-positive rate reduction.
Discussion:
Other factors may play a role in decreasing the false-positive rate. Our experience implementing this programme was that a systematic screening process led to more confident results, newborn’s report interpretation, and follow-up.
Central and southern Mexico represents a strategic place to understand the dynamics of Pangaea break-up and its influences on the evolution of the Pacific margin of North America. Lower–Middle Jurassic volcano-sedimentary successions, and scarce magmatic rocks, crop out discontinuously across this region and have been interpreted either as a vestige of a continental arc or as several deposits of syn-rift magmatism. At present, their origin is controversial. Available geochemical data on these igneous rocks suggest that they represent almost pure crustal melts produced in a rift environment rather than in an arc. In fact, the studied rocks exhibit the high silica contents and moderate to strong peraluminous character typical of sediment melts. The enriched isotopic composition (high 86Sr/87Sr and low 143Nd/144Nd) and the age distributions of inherited zircon grains readily identify the widespread Upper Triassic metasedimentary sequences presently exposed in southwestern and central Mexico as the most likely crustal source of these Jurassic igneous rocks. Accordingly, we argue that these Early–Middle Jurassic magmas originated in a syn-rift igneous province associated with extensional-driven crustal attenuation in the context of Pangaea fragmentation. Our findings also constrain post-Pangaea subduction initiation to be younger than Middle Jurassic time in central and southern Mexico.
A national act (Order SSI/1356/2015) regulating Post-Launch Evidence Generation (PLEG) studies was set in Spain in 2015. These PLEG studies are to inform decisions about technologies already included in the Benefit Portfolio of the Spanish National Health System (SNHS) in order to confirm/exclude/modify their terms of use. Once a PLEG is established the selected hospitals provide the technology according to a common protocol and register outcomes until the required sample size is reached.
Methods
The PLEG studies are prospective, observational and single arm studies on safety, effectiveness and cost-effectiveness of a technology in real practice. The technology is selected because of the identification of an evidence gap, usually through a health technology assessment (HTA) report made by an agency of the Spanish Network of HTA Agencies (RedETS). The execution of a PLEG is assigned to one of the RedETS Agencies, which is responsible of delivering annual reports and a final report when the objectives are reached.
Results
The following six PLEG studies, all of them on medical devices, have been launched in Spain so far, i) Endobronchial valve for patients with persistent air leak; ii) Biodegradable esophageal stent; iii) Percutaneous mitral valve repair system by clip; iv) Left Atrial Appendage Closure Device; v) Sensor-based glucose monitoring systems for children with type 1 diabetes mellitus; vi) Left ventricular assist devices for destination therapy. Five studies will finish their data collection by the end of 2020 or during 2021.
Conclusions
A new national procedure using PLEG has been made available in Spain facilitating the use of real-world evidence to inform national decision-making on the financing of selected technologies due to uncertainties about their effectiveness, safety, cost-effectiveness and organizational impact. The studies are requiring a high amount of coordination tasks, as they are involving an average of 21 hospitals each. The usefulness and suitability of this procedure to achieve its objectives must be evaluated once their results are available.
The literature has demonstrated how the relationship between cognitive or emotional intelligence and age exhibits an inverted-U-shape and that this decline can be mitigated by an individual’s cognitive reserve (CR). Rather less is known, however, about the pattern of changes in cognitive empathy or the ability to recognize the thoughts or feelings of others.
Objectives:
The aim of the present study was firstly to analyze the effect of age, gender, and CR (measured through educational level), on the capacity to show cognitive empathy. Secondly, we aimed to evaluate what type of relationship—linear or quadratic—exists between age and cognitive empathy. We finally aimed to analyze the moderator role of educational level on the relationship between age and cognitive empathy.
Participants:
Totally, 902 Spanish adults aged between 18 and 79 years (M = 43.53, SD = 11.86; 57% women).
Measurements:
Participants were asked to indicate their educational level (primary, high school, or college education) and their cognitive empathy was assessed using the Eyes test.
Results:
Women scored higher than men on cognitive empathy. Participants with a college education had higher scores on cognitive empathy than those with a lower educational level. Additionally, the relationship between age and cognitive empathy fit an inverted-U-shaped curve, consistent with the data found for cognitive and emotional intelligence. Finally, the age-related decrease in cognitive empathy appeared to be mitigated by a higher educational level, but only in those individuals aged 35 years and above. Limitations and clinical implications are discussed.
The Monitoring Studies (MS) program, the approach developed by RedETS to generate postlaunch real-world evidence (RWE), is intended to complement and enhance the conventional health technology assessment process to support health policy decision making in Spain, besides informing other interested stakeholders, including clinicians and patients. The MS program is focused on specific uncertainties about the real effect, safety, costs, and routine use of new and insufficiently assessed relevant medical devices carefully selected to ensure the value of the additional research needed, by means of structured, controlled, participative, and transparent procedures. However, despite a clear political commitment and economic support from national and regional health authorities, several difficulties were identified along the development and implementation of the first wave of MS, delaying its execution and final reporting. Resolution of these difficulties at the regional and national levels and a greater collaborative impulse in the European Union, given the availability of an appropriate methodological framework already provided by EUnetHTA, might provide a faster and more efficient comparative RWE of improved quality and reliability at the national and international levels.
Old age constitutes a vulnerable stage for developing gambling-related problems. The aims of the study were to identify patterns of gambling habits in elderly participants from the general population, and to assess socio-demographic and clinical variables related to the severity of the gambling behaviours. The sample included N = 361 participants aged in the 50–90 years range. A broad assessment included socio-demographic variables, gambling profile and psychopathological state. The percentage of participants who reported an absence of gambling activities was 35.5 per cent, while 46.0 per cent reported only non-strategic gambling, 2.2 per cent only strategic gambling and 16.3 per cent both non-strategic plus strategic gambling. Gambling form with highest prevalence was lotteries (60.4%), followed by pools (13.9%) and bingo (11.9%). The prevalence of gambling disorder was 1.4 per cent, and 8.0 per cent of participants were at a problematic gambling level. Onset of gambling activities was younger for men, and male participants also reached a higher mean for the bets per gambling-episode and the number of total gambling activities. Risk factors for gambling severity in the sample were not being born in Spain and a higher number of cumulative lifetime life events, and gambling severity was associated with a higher prevalence of tobacco and alcohol abuse and with worse psychopathological state. Results are particularly useful for the development of reliable screening tools and for the design of effective prevention programmes.
Data on short-term peripheral intravenous catheter–related bloodstream infections per 1,000 peripheral venous catheter days (PIVCR BSIs per 1,000 PVC days) rates from Latin America are not available, so they have not been thoroughly studied.
Methods:
International Nosocomial Infection Control Consortium (INICC) members conducted a prospective, surveillance study on PIVCR BSIs from January 2010 to March 2018 in 100 intensive care units (ICUs) among 41 hospitals, in 26 cities of 9 countries in Latin America (Argentina, Brazil, Colombia, Costa Rica, Dominican-Republic, Ecuador, Mexico, Panama, and Venezuela). The Centers for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) definitions were applied, and INICC methodology and INICC Surveillance Online System software were used.
Results:
In total, 10,120 ICU patients were followed for 40,078 bed days and 38,262 PVC days. In addition, 79 PIVCR BSIs were identified, with a rate of 2.06 per 1,000 PVC days (95% confidence interval [CI], 1.635–2.257). The average length of stay (ALOS) of patients without a PIVCR BSI was 3.95 days, and the ALOS was 5.29 days for patients with a PIVCR BSI. The crude extra ALOS was 1.34 days (RR, 1.33; 95% CI, 1.0975–1.6351; P = .040).
The mortality rate in patients without PIVCR BSI was 3.67%, and this rate was 6.33% in patients with a PIVCR BSI. The crude extra mortality was 1.70 times higher. The microorganism profile showed 48.5% gram-positive bacteria (coagulase-negative Staphylococci 25.7%) and 48.5% gram-negative bacteria: Acinetobacter spp, Escherichia coli, and Klebsiella spp (8.5% each one), Pseudomonas aeruginosa (5.7%), and Candida spp (2.8%). The resistances of Pseudomonas aeruginosa were 0% to amikacin and 50% to meropenem. The resistance of Acinetobacter baumanii to amikacin was 0%, and the resistance of coagulase-negative Staphylococcus to oxacillin was 75%.
Conclusions:
Our PIVCR BSI rates were higher than rates from more economically developed countries and were similar to those of countries with limited resources.
Older subjects are susceptible to develop gambling problems, and researchers have attempted to assess the mechanisms underlying the gambling profile in later life. The objective of this study was to identify the main stressful life events (SLE) across the lifespan which have discriminative capacity for detecting the presence of gambling disorder (GD) in older adults. Data from two independent samples of individuals aged 50+ were analysed: N = 47 patients seeking treatment at a Pathological Gambling Outpatient Unit and N = 361 participants recruited from the general population. Sexual problems (p < 0.001), exposure to domestic violent behaviour (p < 0.001), severe financial problems (p = 0.002), alcohol or drug-related problems (p = 0.004) and extramarital sex (p < 0.001) were related to a higher risk of GD, while getting married (p = 0.005), moving to a new home (p = 0.003) and moving to a new city (p = 0.006) decreased the likelihood of disordered gambling. The accumulated number of SLE was not a predictor of the presence of GD (p = 0.732), but patients who met clinical criteria for GD reported higher concurrence of SLE in time than control individuals (p < 0.001). Empirical research highlights the need to include older age groups in evidence-based policies for gambling prevention, because these individuals are at high risk of onset and/or progression of behavioural addiction-related problems such as GD. The results of this study may be useful for developing reliable screening/diagnostic tools and for planning effective early intervention programmes aimed to reduce the harm related to the onset and evolution of problem gambling in older adults.