Center In Madrid Research Articles

Cost-Effectiveness and Cost-Utility Analysis of the Treatment of Emotional Disorders in Primary Care: PsicAP Clinical Trial. Description of the Sub-study Design.

Introduction: In the primary care (PC) setting in Spain, the prevalence of emotional disorders (EDs) such as anxiety, depression and somatoform disorder is high. In PC patients, these disorders are not always managed in accordance with the recommendations provided by clinical practice guidelines, resulting in major direct and indirect economic costs and suboptimal treatment outcomes. The aim is to analyze and compare the cost-effectiveness and cost-utility of group-based psychological therapy versus treatment as usual (TAU).Methods: Multicenter, randomized controlled trial involving 300 patients recruited from PC centers in Madrid, Spain, with symptoms or possible diagnosis of anxiety, mood (mild or moderate), or somatoform disorders. Patients will be randomized to one of two groups: an experimental group, which will receive group-based transdiagnostic cognitive-behavioral therapy (TD-CBT); and a control group, which will receive TAU (mainly pharmacological interventions) prescribed by their general practitioner (GP). Clinical assessment will be performed with the Patient Health Questionnaire (PHQ). Direct and indirect costs will be calculated and relevant socio-demographic variables will be registered. The Spanish version of the EuroQol 5D-5L will be administered. Patients will be assessed at baseline, immediately after treatment finalization, and at 6 and 12 months post-treatment.Discussion: To our knowledge, this is the first study to compare TD-CBT to TAU in the PC setting in Spain. This is the first comparative economic evaluation of these two treatment approaches in PC. The strength of the study is that it is a multicenter, randomized, controlled trial of psychotherapy and TAU for EDs in PC.Trial registration: Protocol code: ISCRCTN58437086; 20/05/2013. EUDRACT: 2013-001955-11. Protocol Version: 6, 11/01/2014.

Study about Knowledge and Use of Homeopathy for Pregnancy and Labour in a Primary Care Centre of Madrid

Study about Knowledge and Use of Homeopathy for Pregnancy and Labour in a Primary Care Centre of Madrid

Human Development Index (HDI) of the maternal country of origin as a predictor of perinatal outcomes - a longitudinal study conducted in Spain

BackgroundIn an era of worldwide population displacement, recent studies have identified strong associations between social situations and perinatal outcomes among immigrants. Little is known about the effect of maternal social background on pregnancy outcomes. The Human Development Index (HDI) assesses the following dimensions of human development: life expectancy, education level and income. The objective of our study was to determine if maternal HDI may be used to identify women at increased odds of poor pregnancy outcomes.MethodsWe conducted a longitudinal population-based study in a tertiary centre in Madrid, Spain. The outcome variables were maternal and perinatal/antenatal mortality, preeclampsia (PE), low birth weight (LBW), gestational diabetes mellitus (GDM), preterm delivery (PTD) before 37 and 34 gestational weeks, abnormal cardiotocography (CTG) during delivery, C-section (CS) due to abnormal CTG, pH < 7.10 at birth, Apgar at 5 min ≤ 7, and resuscitation type ≥3. We performed multivariate logistic regression analyses adjusted for potential confounding variables to evaluate the associations between maternal HDI and perinatal outcomes.ResultsIn total, 38,719 singleton infants who were born in our maternity ward between 2010 and 2016 and had perinatal outcome data available were included in this study. The neonates of women from medium/low HDI countries had significantly lower odds of low birth weight (LBW) than their very high HDI country counterparts (OR 0.63, 95% CI 0.55–0.72). However, the odds of PTD before 37 gestational weeks and PE were higher in the medium/low HDI group than the very high HDI group (OR 1.26, 95% CI 1.04–1.53; OR 1.35, 95% CI 1.02–1.79, respectively). Poorer neonatal outcomes were identified in the medium/low HDI group than the very high HDI group, including greater odds of abnormal CTG, CS due to abnormal CTG and Apgar 2 ≤ 7 (p < 0.05).ConclusionsOur findings suggest that the infants of mothers from medium/low HDI had lower odds of LBW but higher odds of PTD, PE and poor neonatal outcomes. These results support the hypothesis that maternal HDI can be used to understand the impact of maternal origin on pregnancy outcomes. Further studies are needed to confirm its validity.

Spanish validation of the PAS-ADD Checklist Questionnaire for people with intellectual disabilities for Spanish population.

The Psychiatric Assessment Schedule for Adult with Developmental Disability (PAS-ADD) is an international reference tool for the diagnosis and assessment of mental health problems and behavioural disorders among people with intellectual disabilities. Although the original PAS-ADD instrument has been validated in the Spanish language, the shorter PAS-ADD Checklist has yet not been validated. The aim of this study is to validate the PAS-ADD Checklist for the Spanish population. The PAS-ADD Checklist Questionnaire was administered to 208 adults with intellectual disabilities at a vocational centre in Madrid, Spain. The psychometric analyses included internal consistency, inter-rater and test-retest reliability, Varimax rotation factor analysis for construct validity, criterion validity and feasibility. The Cronbach's alpha was 0.80 for the overall questionnaire and between 0.40 and 0.79 for the subscales. The Kappa coefficients for test-retest and inter-rater reliability were between 0.66 and 0.80. Varimax rotation factor analysis showed five well-defined factors. The Kappa coefficients for criterion validity were between 0.30 and 0.70. Feasibility was also good. The PAS-ADD Checklist is a feasible and reliable instrument for carrying out initial assessment of the mental health status of adults with intellectual disabilities, referring cases to more specialised diagnosis and treatment.

Bilingual Baby: Foreign Language Intervention in Madrid's Infant Education Centers

ABSTRACTThe first years of life represent a unique window of opportunity for foreign language learning. However, key questions are: How much and what kind of foreign language exposure is needed to ignite learning? We conducted a foreign language (English) intervention in four public Infant Education Centers in Madrid, Spain. Intervention children (N = 126, ages 7–33.5 months) experienced 18 weeks of daily, hour‐long, group English sessions with native‐speaking tutors, using a brain‐based method of infant language development. Intervention infants were compared to a matched Current Practice Comparison (CPC) group of peers in the same schools. Intervention children outperformed the CPC group, showing rapid gains on measures of English word comprehension and English speech production. Schools' neighborhood wealth was not a significant factor in learning. Follow‐up analyses show that the language gains were fully retained 18 weeks post‐intervention. Children's foreign language skills advance quickly in school using this research‐to‐practice curriculum.

La imagen en el cuerpo urbano. La transformación de Madrid hacia el consumo

El neoliberalismo ha supuesto una transformación en la conceptualización de las clases sociales y una reconfiguración de las relaciones entre ellas. En tal sentido, ha emprendido un cambio en los centros urbanos, intensificando su uso comercial y turístico a partir de la inversión pública en la imagen de la ciudad. En Madrid, entre los años 1998 y 2007, de hegemonía neoliberal, se ha invertido, precisamente, en proyectos que han cambiado la escena urbana, reforzando el carácter fetichista del espacio y fomentando, con ello, el reforzamiento de los valores de excelencia y prestigio social. A partir del análisis de la inversión pública en proyectos de escena urbana, se procede a estudiar aquí los efectos que las peatonalizaciones y semipeatonalizaciones han tenido en la conceptualización del centro de Madrid, en los años de máxima expansión neoliberal.

Estudio de derivaciones de Atención Primaria a centros de Salud Mental en pacientes adultos en la Comunidad de Madrid

In this paper, we analyze the sociodemographic, clinical, and health care variables included in the interconsultation reports (PIC) that bring adult patients over a period of 15 days, collected consecutively in the months of March through June 2015 from three mental health centers in Madrid (Colmenar Viejo CSM, Villaverde CSM, and Vallecas Villa CSM). The statistical analysis of data, including analysis of descriptive variables and dichotomous variables, shows the following results: two thirds of referrals are transfers to psychiatry and one third are transfers to clinical psychology; mean time in the waiting list is 74 days for clinical psychology consultation and 38 days for psychiatry consultation; preferential referrals are 31%, with 28 days of mean time in waiting list, being mostly intended for psychiatry; main referred pathologies are anxiety and adaptive and depressive disorders; 46.7% of patients transferred to mental health were already taking some psychiatric medication; clinical psychology referrals involve significantly younger and less medicated patients, significantly less preferential, and with fewer diagnostic and pharmacologic specifications in the PIC than psychiatry referrals. These results are consistent with previous studies, although we have not found other studies that include more than one mental health center, or analyze qualitative information contained in the inter-consultation reports.

De la traza al detalle: analizando la construcción a través del dibujo

Las trazas originales de las casas, aunque poco desarrolladas, definían el proyecto y determinaban la construcción. La investigación se apoya en una selección de documentos gráficos, entendidos como modelos de estudio o casos-tipo que se repiten, y se detiene en la línea y sus distintas expresiones, la sombra, el color, las texturas de los materiales empleados y en los primeros planos acotados. La introducción de los nuevos materiales y técnicas constructivas y la necesidad de una nueva definición gráfica de los proyectos permiten situar el origen del detalle constructivo y estudiar su evolución. La construcción de casas en el centro histórico de Madrid y su formalización gráfica se funden en un objetivo principal, el análisis del contenido gráfico de los proyectos y su definición constructiva (1600-1900). La posibilidad reciente de obtener reproducciones de los originales en color aporta un nuevo enfoque a este singular estudio.

Historical Quarries, Decay and Petrophysical Properties of Carbonate Stones Used in the Historical Center of Madrid (Spain)

The carbonate stones that make up the four fountains of the 18th century located in the Paseo del Prado of Madrid (Spain) are studied. The documentary search in historical archives, together with the petrographic, cartographic and paleontological studies permitted to determine that the fountains have been built with dolostone of the Castrojimeno Formation, with gastropods of the Trochactaeon Lamarcki specie of the Santonian (Upper Cretaceous). The historical quarries from which the ashlars have been extracted is located in Reduena Village. The petrophysical properties of this dolostone (effective porosity, bulk density, mercury intrusion porosity, ultrasound wave propagation velocity, micro-roughness and color) have been calculated and compared with Colmenar de Oreja limestone. Each of the four fountains has a circular pylon at the base, a central column that holds a smaller pylon and is topped by a sculpture that serves as a spout. A bomb destroyed three ashlars of the basal pylon, column, small pylon and the sculpture of the SE fountain, during the Spanish Civil War, in 1936. These damaged elements were replaced by other carved limestones from Colmenar de Oreja in 1944. The four sculptures had been replaced in 1996 with resin replicas and the originals are preserved in the San Isidro. Los origenes de Madrid museum. The study of the petrophysical properties of the sculptures located in the museum allowed us to determine the decay of different stone types. The analysis of micro-roughness was employed to define that the dissolution effect on the sculptures is different between dolostone and limestone. Reduena dolostone is more resistant to dissolution effect than Colmenar de Oreja limestome.

Trapped in a moral order

This paper focuses on the forms of reflexivity that emerge in the conversational narratives of Latin American teenage school girls co-produced during sociolinguistic interviews, in a multicultural school in the centre of Madrid. The narratives about confrontation at school portray the girls’ actions and ways of making sense of such behaviours, in the course of their migrant life trajectories. Understanding narratives as communicative repertoires (Rymes 2014) of an interactive and situated nature makes them suitable discursive spaces for revealing the moral identity constructed, and the moral order evoked in these narratives. Herein we analyse stories recounting conflicts with three different groups of opponents: female peers, teachers and parents. It is in recounting and evaluating moments of conflict that social actors call upon their systems of beliefs and values. The failure of the girls’ secondary school and all the negative repercussions of such failure are central to the ethnographic circumstances in which their narratives are produced. Some attention will be given to the researcher’s reflexivity, as a co-teller of the narratives gathered, but also in the interpretations made of the data in the light of expectations built up over time regarding the social actors’ academic trajectories.

Reflexivity on stories of conflict among Latin American teenage school girls in a multicultural school in Madrid

This paper looks at forms of reflexivity and the moral positioning of social actors, displayed in conversational narratives about school conflict, co-produced by Latin American girls during sociolinguistic interviews with a female researcher of Latin American origin, in a multicultural school in the centre of Madrid. Understanding narratives as communicative practices makes them suitable discursive spaces for revealing the moral positioning and moral orders constructed in discourse. These discursive positionings need to be considered in the light of the ethnographic conditions under which such narratives emerge (Patino-Santos, 2016). Herein, I analyse narratives recounting conflicts from two different groups – female secondary school students and their teachers – based on the notion that it is in recounting and evaluating moments of conflict that social actors call upon their systems of beliefs and values. The failure of the girls’ secondary school and all the negative repercussions of such failure are central to problematising the social circumstances in which their narratives are produced.

More than morbid curiosities

This paper forms a study of three anatomical–anthropological museums established by Dr Pedro González Velasco in the second half of the nineteenth century. The first two of these were set up in Velasco’s own home, while the third evolved into the great Anthropological Museum that Velasco built near the Retiro Park, now in the centre of Madrid. The building remains standing and presently houses the National Museum of Anthropology. An analysis is presented of the circumstances that brought about the formation of all three museums, which prove to be related to the study and teaching of anatomy and also to Velasco’s political projects for the regeneration and modernization of Spanish medicine. We explore the collections (of anatomy, physical anthropology, teratology, zoology, ethnography and miscellaneous curiosities), revealing that – despite the lack of system in most of its non-anatomical collections – Velasco’s third museum, at least, was much more than a simple repository of morbid curiosities.

Allen Cognitive Level Screen for the classification of subjects treated for addiction

Introduction The Cognitive Disabilities Model (CDM) is an occupational approach that can allow the classification of the functional-cognitive abilities of persons with addictions. The objective of the study was to explore the applicability of the ACLS-5 to assess a sample of persons undergoing addiction-rehabilitation treatment. Methods A sample of 232 participants was recruited from an outpatient treatment centre in Madrid (Spain). The ACLS-5, the Montreal Cognitive Assessment (MoCA), and the Prefrontal Symptom Inventory (PSI) were administered. Sociodemographic and addiction-related data were also obtained. Results Half of the sample showed serious deficits in functional cognition, which ultimately could be related to problems in their daily performance. Scores of ACLS-5 showed significant correlations with the severity of addiction, with those obtained with the MoCA, and with attentional symptoms on the PSI scale. Conclusions The data suggest the applicability of the ACLS-5 in assessing the degree of functional cognition in subjects treated for addiction, providing evidence to support ecological validity and facilitating the development of well-targeted cognitive rehabilitation programmes from an occupational perspective. The use of occupational-based instruments to assess the functioning of those with addictions is a requirement of occupational therapy professionals working in this general area.

Effectiveness of dry needling for chronic nonspecific neck pain: a randomized, single-blinded, clinical trial.

Chronic neck pain attributed to a myofascial pain syndrome is characterized by the presence of muscle contractures referred to as myofascial trigger points. In this randomized, parallel-group, blinded, controlled clinical trial, we examined the effectiveness of deep dry needling (DDN) of myofascial trigger points in people with chronic nonspecific neck pain. The study was conducted at a public Primary Health Care Centre in Madrid, Spain, from January 2010 to December 2014. A total of 130 participants with nonspecific neck pain presenting with active myofascial trigger points in their cervical muscles were included. These participants were randomly allocated to receive: DDN plus stretching (n = 65) or stretching only (control group [n = 65]). Four sessions of treatment were applied over 2 weeks with a 6-month follow-up after treatment. Pain intensity, mechanical hyperalgesia, neck active range of motion, neck muscle strength, and perceived neck disability were measured at baseline, after 2 sessions of intervention, after the intervention period, and 15, 30, 90, and 180 days after the intervention. Significant and clinically relevant differences were found in favour of dry needling in all the outcomes (all P < 0.001) at both short and long follow-ups. Deep dry needling and passive stretching is more effective than passive stretching alone in people with nonspecific neck pain. The results support the use of DDN in the management of myofascial pain syndrome in people with chronic nonspecific neck pain.

Bipolar disorder and substance use disorders. Madrid study on the prevalence of dual disorders/pathology.

Given its prevalence and impact on public health, the comorbidity of bipolar and substance use disorders is one of the most relevant of dual diagnoses. The objective was to evaluate the characteristics of patients from community mental health and substance abuse centres in Madrid. The sample consisted of 837 outpatients from mental health and substance abuse centres. We used the Mini International Neuropsychiatric Interview (MINI) and Personality Disorder Questionnaire (PDQ4+) to evaluate axis I and II disorders. Of these patients, 174 had a lifetime bipolar disorder, 83 had bipolar disorder type I and 91 had type II. Most patients had dual pathology. Of the 208 participants from the mental health centres, 21 had bipolar disorder and 13 (61.9%) were considered dually-diagnosed patients, while 33.2% of non-bipolar patients had a dual diagnoses (p = 0.03). Of the 629 participants from the substance abuse centres, 153 patients (24.3%) had a bipolar diagnosis. Bipolar dual patients had higher rates of alcohol and cocaine dependence than non-bipolar patients. Moreover, age at onset of alcohol use was earlier in bipolar duallydiagnosed patients than in other alcoholics. Bipolar dually-diagnosed patients had higher personality and anxiety disorder comorbidities and greater suicide risk. Thus, alcohol and cocaine are the drugs most associated with bipolar disorder. Given the nature of the study, the type of relationship between these disorders cannot be determined.

EP04.01: Clinical application of CASSEAL in two different hospitals: an extended axial echocardiographic protocol for prenatal diagnosis

To compare the results concerning the clinical application of CASSEAL in two centres in Madrid with different level of complexity when it is applied for the US routine scan in the 2nd trimester of pregnancy. CASSEAL explores the super extended fetal cardiovascular system and it is based on the acquisition of 9 axial views, from the umbilical vein to the subclavian arteries. CASSEAL was applied in a cross-sectional study on singleton and multiple gestations from 19–22 weeks attending for routine US examination in Hospital Gregorio Marañón (HGUGM) and Hospital Gómez Ulla (HCDGU). The recruitment period was 6 and 4 months, respectively. One observer in HGUGM and 3 observers in HCDGU participated in the study. Previously estimated Kappa index was 0.89. The results concerning feasibility of CASSEAL were obtained for both centres. A total of 309 fetuses were evaluated; 184 fetuses from HGUGM and 125 from HCDGU. Pathological cases were excluded from the analysis. Mean gestational age was 20 (±0.5) weeks. Table 1 shows the feasibility results. Median exploration time was 4 minutes (IQR, 3–6 minutes) and 4 (IQR, 3–5 minutes) minutes, respectively. CASSEAL views were feasible and reproducible. VIII view (Thy-box) presented the lowest frequency of visualisation in both centres. CASSEAL may be useful for systematising the US exploration of fetal cardiovascular structures and could contribute to the prenatal diagnosis cardiovascular abnormalities.

Estela funeraria de cronología omeya aparecida en Madrid (308/921)

The main aim of this article is the translation and study of a funerary inscription appeared in the historical centre of Madrid. It contains the epitaph of a man who died in the year 308/921. This inscription has a big historical interest because of its early chronology and because of being the first Arabic stele of the Andalusian period found in Madrid.

A timber-framed construction system preserved: the historic centre of Madrid

Many timber-framed buildings of two to six storeys built between the sixteenth and nineteenth centuries have been preserved in the historic centre of Madrid. In recent decades there has been a growing interest in conserving them, although structural decay has led to the demolition of many. The latest General Urban Plan for Madrid published a catalogue for special protection, including more than 9000 historic buildings and making their preservation compulsory. An underlying structural theory will be expounded from the following elements: a barely known timbered construction system within its context; building regulations to assure the stability of timbered walls; and any written or graphic evidence from original projects. The purpose is to highlight the origin of a modular construction system starting with the earliest records in 1606, regulated in 1719, developed in the 1800s and analysed in preserved buildings. The final decades of the 1800s point to the end of timbered walls and the beginning of a new construction system. Study of the most common damage, inspected together with current methods of repair and conservation policy, will reveal further details.

Cross-sectional study of adult women with low back pain: Demographic and clinical profile and factors associated with disability

ObjectiveTo identify sociodemographic, clinic profile and factors associated with low back pain (LBP) in women who consult for this reason. MethodsCross-sectional study carried 28 October 2010 and 29 April 2011 out in 2 primary care centers in Cordoba and 1 private center in Madrid. A total of 364 women participated, with ages 20–65 years (of the 466 women contacted, 33 were excluded for inability to contact them, 29 did not attend the interview and 40 refused to participate). These women had consulted because of back pain located between the twelfth rib and the gluteal fold, with or without pain that went down the leg. They were interviewed by means of a questionnaire and the performance test was evaluated by Active Straight Leg Raise (ASLR) test. Outcome measuresPresence and intensity of LBP, Oswestry Disability Index (ODI), number of births, urinary incontinence (UI), ASLR test, digestive, respiratory and osteoarticular comorbidity, diabetes, high blood pressure, drugs, physical activity and sociodemographic data.A descriptive and multivariate statistical analysis was performed. ResultsMean age 46 years, 24% with chronic pain, 43% with UI and positive ASLR and 39% severe disability grade (ODI>40%). In the multivariate analysis the variables associated with severe disability caused by LBP were sciatica (OR 7.439; 95% CI: 3.979–10.898), osteoarthritis (OR 3.366; 95% CI: −0.312 to 7.044), LBP intensity (OR 3.094; 95% CI: 2.303–3.885), ASLR+ (OR 2.313; 95% CI: 1.599–3.027), increased use of drugs (OR 0.811; 95% CI: 0.114–1.517) and IU (OR 0.407; 95% CI: 0.073–0.741). Conclusions39% of women have severe incapacity that is related to the presence of sciatica, osteoarthritis, LBP intensity, ASLR+, drugs and IU.

Propuesta de un programa de intervención educativa para facilitar la inclusión de alumnos con discapacidad en educación física (Propose of an educative intervention program for inclusion of children with disability in general physical education)

En este trabajo se presenta el diseño y estructura de un programa de intervención educativa en Educación Física: «Deporte Inclusivo en la Escuela». La propuesta, destinada a profesores y alumnos de Secundaria y Bachillerato, persigue promover la práctica deportiva inclusiva en los centros educativos, dando a conocer los diferentes deportes paralímpicos, para concienciar sobre la situación de las personas con discapa­cidad en la práctica deportiva. El diseño está basado en las teorías del Contacto y del Comportamiento Planificado, ambas evidenciadas como eficaces para la formación de actitudes. La estructura que conforma el programa está compuesta por una serie de actividades y recursos didácticos como una charla de un deportista paralímpico, tres unidades didácticas (una por ciclo), material audiovisual de apoyo y un encuentro deportivo inclusivo con todos los centros participantes en el programa. Una de las características más relevantes de la propuesta es el uso de una metodología de carácter inclusivo, ya sea incluyendo a los alumnos con discapacidad presentes en los centros, o simulando la situación de discapacidad los alumnos que no la poseen. La exposición teórica se apoya en datos de la implementación llevada a cabo hasta el momento en 38 centros educativos de Madrid y Barcelona.Palabras clave. actitud, inclusión, discapacidad, Educación Física, programa intervención, deporte inclusivo.Abstract. In this paper, it´s presented the design and structure of an educational intervention program in Physical Education: «Inclusive School Sports (ISS)». It´s propose for teachers and middle and high school students, aims promote inclusive sports in schools and different Paralympics sports through an inclusive methodology and raising awareness about the situation of people with disability in sport practice. The design is based on the contact and of planned behavior theories, both are evidenced as effective in attitudes training. The structure program is composed of a series of activities and educational resources such as a talk by a Paralympics sportiest, three teaching units (one per cycle) and inclusive sporting event with all participants in the program centers. The newest program is the methodology propose by inclusive perspective, so including students with disabilities present in the centers, or simulating the situation of disabilities students. The program has been implemented in 38 educative centre of Madrid and Barcelona. It´s present a approach to the evaluation and advances in the results.Keywords: attitude, inclusion, disability, Physical Education, intervention program, inclusive sport.