Spanish Public Research Articles

Phenotypic Characterization of Laryngospasm: The Utility of Laryngeal Neurophysiological Studies

To determine the existence of laryngeal neuropathy and the influence of gastroesophageal reflux in patients with episodic laryngospasm. Single -center, observational study with prospective clinical collection. Prospective analysis of 18 Spanish patients with episodic laryngospasm in a Spanish Public Center collected by otolaryngologist. The recruitment dates were from January 2019 to December 2019. Data collection of 18 patients with episodic laryngospasm. Clinical characteristics, laryngeal neurophysiological studies and reflux esophageal testing were analyzed. All patients have a trigger for the laryngospasms, being the most prevalent adopting the supine position (27.7%). EMG and ENG were pathological in 83.3 and 63.6 % respectively. Chronic bilateral denervation (increased amplitude and duration of potentials) with signs of reinnervation in the non-active chronic phase (large polyphasia), was the most prevalent finding. Evidence of gastroesophageal reflux either by pH meter, Gastroscopy or both was found in 38.8 % of patients. Neurophysiological studies have confirmed the existence of laryngeal neuropathy in the majority of patients with laryngospasm. A substantial percentage of patients (38.8%) with laryngospasm had objective GERD and improved with PPIs. Laryngeal EMG and ENG can establish a more accurate diagnostic for episodic laryngospams and may supports treatment with neuromodulators.

Chromoblastomycosis-Leprosy Co-Infection in Central West Brazil. Presentation of Three Cases and Literature Review

Chromoblastomycosis and leprosy are chronic diseases with high prevalence in tropical and subtropical regions. Brazil is one of the countries with the highest incidence and prevalence for both diseases, however, reports of co-infections are scarce. The aim of this study was to describe three cases of chromoblastomycosis-leprosy co-infection in patients from Mato Grosso state, Brazil. A review of chromoblastomycosis-leprosy co-infection was performed of English, Portuguese and Spanish publications in LILACS, SciELO, PubMed and Web of Science databases using the descriptors (chromoblastomycosis OR cromoblastomicose OR cromoblastomicosis) AND (leprosy OR hanseníase OR lepra), without time period delimitation. Nineteen cases were included, 16 cases were published in 11 articles, plus the three cases reported in the current study. Most reported coninfection cases came from Brazil. Majority of the patients were male with a mean age of 52.2 years. Farmer was the main occupational activity reported. In 12 patients, the clinical signs and symptoms of leprosy started first. No contacts with patients affected by leprosy, armadillos or history of injuries at the anatomical site of chromoblastomycosis lesions were reported. Five leprosy patients who received steroid treatment for leprosy reactions or neuropathies, were diagnosed with chromoblastomycosis during immunosuppressive therapy. Four cases (21.1%) were reported among the elderly patients. Co-infections in patients with chromoblastomycosis or leprosy are uncommon, but the possibility should always be considered, especially if the patient is undergoing immunosuppressive treatment or is elder.

A systematic literature review of the economic evidence for transarterial radioembolization for the treatment of hepatocellular carcinoma.

e16159 Background: Evidence synthesis can be used to demonstrate the economic value of medical technologies. Transarterial radioembolization (TARE) is a clinically effective therapy for hepatocellular carcinoma (HCC); however, a synthesis of the comparative economic outcomes is lacking. This study systematically reviewed and summarized the available economic evaluations of TARE for the treatment of HCC. Methods: A systematic review of economic evaluations of TARE for HCC treatment following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. English and Spanish publications were identified from PubMed, Embase, Cochrane, MEDES, health technology assessment agencies, and scientific congress databases published through May 2021. Results: Among 423 records screened, 20 economic evaluations (two cost-effectiveness analyses (CEAs), eight cost-utility analyses (CUAs), one cost-minimization analysis, six cost analyses, and three budget impact analyses) met the pre-defined criteria for inclusion. Included studies were evaluated from a payer perspective (n = 20) and included both payer and societal perspectives (n = 2). Thirteen studies were published from a European perspective, six from the United States, and one from the Canadian perspective. Included studies evaluated early (n = 4) vs. intermediate and advanced HCC (n = 15). TheraSphere and Sir-Spheres were the most evaluated TARE therapies compared to transarterial chemoembolization (TACE) (n = 12) alone or TACE/sorafenib agents (n = 10). The time horizon in the included studies varied: TARE vs. sorafenib (5-years and lifetime) and TARE vs. TACE (5-years). Variability in health outcomes was observed with greater health benefits reported for TARE vs. TACE for intermediate (n = 1) and advanced-stage patients (n = 2) and TARE vs. sorafenib for intermediate (n = 1) and advanced-stage patients (n = 6). All CEAs compared the costs and survival benefits of TARE vs. TACE/Transarterial embolization (TAE)/sorafenib/tyrosine-kinase inhibitor. Of the 20 studies, TARE was associated with lower treatment costs in ten studies. From the payer perspective, TARE costs varied widely in the Barcelona Clinic Liver Cancer (BCLC) staging system and ranged from $1,770 (BCLC-A) to $66,800 (BCLC-C). The life-years gained (LYG) ranged from 1.1 years (TARE vs. sorafenib/lenvatinib) to 3.1 years (TARE vs. TACE/TAE/drug-eluting bead-TACE). The incremental cost-utility ratio (ICUR) for TARE vs. sorafenib ranged from $38,352/QALY to $71,386 (dominant) and one CUA of TARE vs. TACE and showed an ICUR of $22,181/QALY. Conclusions: Economic evaluations of TARE for HCC treatment are heterogeneous. Overall, TARE is a cost-effective short- and long-term treatment for HCC, driven by increased LYG compared to other HCC therapies.

Efficacy of Synchronous Remote-Based Interventions for Suicide Prevention among Adolescent and Adult Patients: A Systematic Review and Meta-Analysis

IntroductionSuicide is a universal, complex, and multifaceted public health problem that is among the leading causes of preventable death worldwide. The impact of suicide affects families, communities, and societies; hence its prevention is an emerging priority for public health systems.ObjectivesThe current systematic review aims to investigate the efficacy of distance suicide prevention strategies implemented through synchronous technology-based interventions (i.e., any digital tool that allows interactive and immediate real-time communication conducted remotely).MethodsThe bibliographic search has been carried out in the electronic databases MEDLINE/PubMed, PsycInfo, Scopus, and Web of Science, with no restrictions on the publication period and limited to publications in English or Spanish. Two reviewers independently will conduct screenings, data extraction, risk of bias (RoB), and methodological quality assessment.ResultsThe preliminary data searches seem to support the effectiveness of providing active contact to persons who have made a suicide attempt and indicate that receiving early specialized assistance decreases the relative risk of recurrence. The reduction would be attributable to improved detection of patients at increased risk and effective referral to emergency services.ConclusionsTelematics suicide prevention has been an emergent field for years, facilitated by the notably increased in acceptance and availability. Considering that distance programmes can reach affected individuals regardless of their location, it stands to reason that these interventions will be part of future suicide prevention efforts. The results will be discussed regarding (a) the effect size of the intervention outcomes and (b) the main moderators of the effectiveness found.DisclosureNo significant relationships.

Generalidades de la elaboración de la revisión sistemática en acupuntura

Evidence-based medicine aims to generate the archetype of the health professional in the “duty to be” and the “duty to do”. In this ideal, the physician should make judicious use of the best evidence in his daily practice. Evidence-based medicine practicing is based on the medical literature's systematic reviews to have the best evidence on specific clinical topics. Systematic reviews are the exhaustive search for evidence, organized, synthesized, evaluated, and critically analyzed. In the last two decades, several researchers published around 1000 acupuncture systematic reviews, which denotes the importance of systematic reviews. This article aims is to give an overview of the evidence-based medicine and the systematic reviews in acupuncture to give a series of publications in Spanish that make easer the generation of systematic reviews of this specialty.

Project Design and Management of Optimized Self-Protection Plans: A Case Study for Spanish Public Buildings

Self-protection plans are the fundamental tool established to prevent and control the risks that threaten people and assets. In turn, they are essential to provide an adequate response to possible emergency situations that may occur in public or private buildings, facilities, or events. In this context, current and future challenges advocate increasing the usefulness, versatility, and adaptability of self-protection plans. For this purpose, this paper aims to develop a conceptual model for the project management of self-protection plans with a lifecycle approach. The research provides results concerning guidelines, aspects, and potential regulations, technologies, tools, methodologies, and maintenance frameworks to be followed for any building in different project phases. The methodology followed has consisted of a process in stages, with literature review and a conceptual development to obtain an adaptable model to any public building. The adaptability of the framework relies on the definition of potential methods, information systems, and technologies that can support any phase during the Self-Protection Plan life cycle. Moreover, it was applied in a specific environment, such as in public buildings under the Spanish regulation using the most common tools and applications available. Results proved that although it is possible to make a base model applicable to any publicly owned building, there is an extensive and precise subsequent work of adaptation to specific cases in which the applicable legal framework makes this task challenging. Finally, the results obtained have allowed us to reflect on future research needs.

Genito Pelvic Pain/Penetration Disorder (GPPPD) in Spanish Women—Clinical Approach in Primary Health Care: Review and Meta-Analysis

Sexuality is a component of great relevance in humans. Sexual disorders are a major public health problem representing a high prevalence in the general population. DSM-5 genito-pelvic pain/penetration disorder (GPPPD) includes dyspareunia and vaginismus (DSM-IV-TR). To assess the importance of research on these disorders in Spain, we evaluated the Spanish scientific publications of primary and community care. The objective was to quantify the magnitude of the publications of GPPPD in Spanish women in primary and community care. For this, we used the method of conducting a systematic review and meta-analysis of studies evaluating GPPPD. As main results, of the 551 items found, we selected 11 studies that met the inclusion criteria. In primary care in Spain, one in nine women has these disorders; the percentage of women with GPPPD in this study (raw data) was 11.23% (95% CI: 0–29%) (vaginismus 5%; penetration pain 8.33%; dyspareunia 16.45%). These percentages can differ of those from other countries, and they are at the top of the data of the European countries (9−11.9%). There is much variability in the studies found in the world with respect to the prevalence of these health problems.

Students' Perceptions of University Corruption in a Spanish Public University: A Path Analysis.

Most research on corruption in educational settings has focused on a cross-national and macro-level analysis; however, to our knowledge, few papers have sought to explore individual perceptions that explain corruption in higher education. The present research aimed to disentangle students’ predictors of corrupt intention in a Spanish public university. A total of 933 undergraduate, postgraduate, and Ph.D. students filled out an online survey measuring four corruption scenarios: favoritism, bribery, fraud, and embezzlement. Path analysis (PA) revealed that justifiability, risk perception, and perceived prevalence of corruption were significant factors in predicting corrupt intention. Moreover, willingness to report a corrupt act was predicted by corrupt intention, justifiability, and risk perception. Corrupt behavior is a complex phenomenon explained not only by peers’ behavior, but also by their individual justifications and perception of risk. Education is not free of corruption, and universities must address this urgent problem in order to avoid future economic, societal, and ethical problems.

Translated article] Dermatology Care in Spanish Public Hospitals: A Mapping Study of Health Care Resources and Medical and Surgical Activity in Dermatology Departments in 2019

Background and objectiveNo recent data on health care resources and medical and surgical activity in Spanish dermatology departments are available in the literature. The aim of this study was to compile this information for 2019. Material and methodsCross-sectional study based on an online survey sent to the heads of dermatology departments at public hospitals in Spain. ResultsOf the 162 department heads contacted, 59 answered the survey (participation rate, 36.4%). General findings included a shortage of staff, especially dermatologists, in hospitals of low and medium complexity. The main reason given for the shortage of dermatologists was a lack of interested applicants. Large hospital complexes had more infrastructure and equipment. Over 50% of the departments surveyed used a combination of in-person and virtual visits. Psoriasis units were the most common specialized care units. Approximately 75% of the hospitals had operating rooms with an anesthetist. More complex procedures such as sentinel lymph node biopsy and Mohs micrographic surgery were performed more often in large hospital complexes. Hospitalization and the presence of dermatology residents working call shifts were also more common in these hospitals. Teaching and research activity differed according to hospital complexity. ConclusionsWe have mapped health care resource availability and medical and surgical activity in Spanish dermatology departments prior to the COVID-19 pandemic. Our findings could be useful for improving clinical management and defining future actions and areas for improvement.

Coverage and distribution of altmetric mentions in Spain: a cross-country comparison in 22 research fields

Since their formal proposal in 2010, various studies have been carried out on altmetrics from different perspectives and at different levels. However, the problem of the country-specific differences found in such studies has not been addressed in depth and considering the wide range of social media sources. This paper presents a cross-country comparison of altmetric coverage between Spain and a selection of 16 countries (EU-15 and the United States) in 22 research fields. All Spanish publications indexed in Web of Science that were published between 2016 and 2020, as well as all mentions of their altmetrics collected on Altmetric.com, were retrieved. The results show that, of the 434,827 Spanish publications considered, 55% are found on Altmetric.com. General altmetric coverage in Spain is similar to that in the rest of Europe and the United States, but it is in areas such as Arts & Humanities and Social Sciences where the lowest levels of coverage are found, although in the case of the latter the publications receive a higher number of mentions. Spanish publications reach a total of 3,569,553 mentions from different social media platforms, but Twitter is the main source of these mentions, accounting for 89%. Differences between research fields are also found, such as Environment & Ecology receiving a higher number of policy mentions.

Loyalty in the Newsroom. Employment Relationships in Public Service Broadcasting

ABSTRACT Very little research has decried the chronic deterioration of the working conditions of journalists. Public service broadcasters, which are often seen as paradigms of stable employment relationships, have been influenced by a highly competitive industry characterised by the outsourcing of content generation and the erosion of working conditions. The Spanish Public Radio and Television Corporation (RTVE) is no exception, in a context also influenced by the political clientelism distinguishing Mediterranean media systems. Accordingly, this study resorts to the classical exit, voice, and loyalty model to stress the importance of employment relationships for journalists. From this perspective, the analysis of TVE newsroom discourses invites the exploration of the role of the supervisor in access to employment and career opportunities, as well as its possible polarising effects that make it difficult for journalists to offer their full loyalty to the citizenry.

Implementing Heat-Stable Carbetocin for Postpartum Haemorrhage Prevention in Low-Resource Settings: A Rapid Scoping Review.

Heat-stable carbetocin (HSC), a long-acting oxytocin analogue that does not require cold-chain transportation and storage, is effective in preventing postpartum haemorrhage (PPH) in vaginal and caesarean deliveries in tertiary-care settings. We aimed to identify literature documenting how it is implemented in resource-limited and lower-level maternity care settings to inform policies and practices that enable its introduction in these contexts. A rapid scoping review was conducted with an 8-week timeframe by two reviewers. MEDLINE, EMBASE, Emcare, the Joanna Briggs Institute Evidence-Based Practice Database, the Maternity and Infant Care Database, and the Cochrane Library were searched for publications in English, French, and Spanish from January 2011 to September 2021. Randomized and non-randomized studies examining the feasibility, acceptability, and health system considerations in low-income and lower-middle-income countries were included. Relevant data were extracted using pretested forms, and results were synthesized descriptively. The search identified 62 citations, of which 12 met the eligibility criteria. The review did not retrieve studies focusing on acceptability and health system considerations to inform HSC implementation in low-resource settings. There were no studies located in rural or lower-level maternity settings. Two economic evaluations concluded that HSC is not feasible in terms of cost-effectiveness in lower-middle-income economies with private sector pricing, and a third one found superior care costs in births with PPH than without. The other nine studies focused on demonstrating HSC effectiveness for PPH prevention in tertiary hospital settings. There is a lack of evidence on the feasibility (beyond cost-effectiveness), acceptability, and health system considerations related to implementing HSC in resource-constrained and lower-level maternity facilities. Further implementation research is needed to help decision-makers and practitioners offer an HSC-inclusive intervention package to prevent excessive bleeding among pregnant women living in settings where oxytocin is not available or of dubious quality.

Epidemiology and clinical domains of Behçet's disease in the Cantabria region, Northern Spain.

The prevalence of Behçet's disease (BD) has a considerable geographical and temporal variability. Data regarding epidemiology in Spain are limited. Our study aimed to assess the epidemiology and clinical domains of BD in a population-based cohort from Northern Spain and to compare the results with other geographical areas of other countries. We conducted a cross-sectional study of a well-defined population in Northern Spain. Cases of suspected BD between January 1980 and December 2018 were identified. The diagnosis of BD was established according to the International Study Group (ISG) for Behçet's Disease. The incidence of BD between 1999 and 2018 was estimated by sex, age, and year of diagnosis. Of 120 patients with probable BD, 59 patients met ISG criteria and were finally included in the study, with a male/female ratio of 0.97; mean age 49.7±14.7 years. Incidence during the period of study was 0.492 per 100,000 people, observing an increase from January 1999 to December 2018. Prevalence was 10.14 per 100,000 inhabitants in 2018. Clinical manifestations were relapsing aphthous stomatitis (100%), genital ulcers (78%), skin involvement (84.7%), joint involvement (64.4%), uveitis (55.9%), central nervous system (16.9%), vascular (10.2%), and gastrointestinal manifestations (6.8%). The prevalence of BD in Cantabria is higher than in other Southern European countries. This difference may reflect a combination of geographic, genetic, or methodological variations, as well as the free accessibility to the Spanish Public Health System for the entire population. Clinical phenotypes observed are similar to those described in other world regions.

The Burden of Critical Illness in Hospitalized Children in Low- and Middle-Income Countries: Protocol for a Systematic Review and Meta-Analysis.

BackgroundThe majority of childhood deaths occur in low- and middle-income countries (LMICs). Many of these deaths are avoidable with basic critical care interventions. Quantifying the burden of pediatric critical illness in LMICs is essential for targeting interventions to reduce childhood mortality.ObjectiveTo determine the burden of hospitalization and mortality associated with acute pediatric critical illness in LMICs through a systematic review and meta-analysis of the literature.Data Sources and Search StrategyWe will identify eligible studies by searching MEDLINE, EMBASE, CINAHL, and LILACS using MeSH terms and keywords. Results will be limited to infants or children (ages >28 days to 12 years) hospitalized in LMICs and publications in English, Spanish, or French. Publications with non-original data (e.g., comments, editorials, letters, notes, conference materials) will be excluded.Study SelectionWe will include observational studies published since January 1, 2005, that meet all eligibility criteria and for which a full text can be located.Data ExtractionData extraction will include information related to study characteristics, hospital characteristics, underlying population characteristics, patient population characteristics, and outcomes.Data SynthesisWe will extract and report data on study, hospital, and patient characteristics; outcomes; and risk of bias. We will report the causes of admission and mortality by region, country income level, and age. We will report or calculate the case fatality rate (CFR) for each diagnosis when data allow.ConclusionsBy understanding the burden of pediatric critical illness in LMICs, we can advocate for resources and inform resource allocation and investment decisions to improve the management and outcomes of children with acute pediatric critical illness in LMICs.

Evaluation of the implantation of transpedicular screws in spinal instrumentation with free-hand technique and navigation-assisted with intraoperative computed tomography: An analytical-positional study.

Spinal instrumentation using transpedicular screws has been used for decades to stabilize the spine. In October 2018, an intraoperative CT system was acquired in the Neurosurgery service of the University Hospital Complex of Vigo, this being the first model of these characteristics in the Spanish Public Health System, so we began a study from January 2015 to December 2019 to assess the precision of the transpedicular screws implanted with this system compared with a control group performed with the classical technique and final fluoroscopic control. The study was carried out in patients who required transpedicular instrumentation surgery, in total 655 screws were placed, 339 using the free-hand technique (Group A) and 316 assisted with intraoperative CT navigation (Group B) (p>0.05). Demographic characteristics, related to surgery and the screw implantation grades were assessed using the Gertzbein-Robbins classification. 92 patients were evaluated, between 12 and 86 years (average: 57.1 years). 161 thoracic screws (24.6%) and 494 lumbo-sacral screws (75.4%) were implanted. Of the thoracic screws, 33 produced a pedicle rupture. For the lumbo-sacral screws, 71 have had pedicle violation. The overall correct positioning rate for the free-hand group was 72.6% and for the CT group it was 96.5% (p<0.05). The accuracy rate is higher in thoracic-lumbar instrumentation in the navigation group versus free-hand group with fluoroscopic control.

Evaluation of the implantation of transpedicular screws in spinal instrumentation with free-hand technique and navigation-assisted with intraoperative computed tomography: An analytical-positional study

BackgroundSpinal instrumentation using transpedicular screws has been used for decades to stabilize the spine. In October 2018, an intraoperative CT system was acquired in the Neurosurgery service of the University Hospital Complex of Vigo, this being the first model of these characteristics in the Spanish Public Health System, so we began a study from January 2015 to December 2019 to assess the precision of the transpedicular screws implanted with this system compared with a control group performed with the classical technique and final fluoroscopic control. MethodsThe study was carried out in patients who required transpedicular instrumentation surgery, in total 655 screws were placed, 339 using the free-hand technique (Group A) and 316 assisted with intraoperative CT navigation (Group B) (p>0.05). Demographic characteristics, related to surgery and the screw implantation grades were assessed using the Gertzbein–Robbins classification. Results92 patients were evaluated, between 12 and 86 years (average: 57.1 years). 161 thoracic screws (24.6%) and 494 lumbo-sacral screws (75.4%) were implanted. Of the thoracic screws, 33 produced a pedicle rupture. For the lumbo-sacral screws, 71 have had pedicle violation. The overall correct positioning rate for the free-hand group was 72.6% and for the CT group it was 96.5% (p<0.05). ConclusionThe accuracy rate is higher in thoracic-lumbar instrumentation in the navigation group versus free-hand group with fluoroscopic control.

Mapping the Field of Child Marriage: Evidence, Gaps, and Future Directions From a Large-Scale Systematic Scoping Review, 2000–2019

The 2030 Agenda for Sustainable Development explicitly calls for an end to child, early, and forced marriages, a harmful practice that has been experienced by 650 million girls and women globally. The COVID-19 pandemic threatens to halt progress toward this goal and highlights the need to assess research progress and link emerging knowledge with efforts to prevent and respond to child marriage. We conducted a systematic search of publications focused on child marriage covering four languages (English, Spanish, Portuguese, and French), encompassing a 20-year period (1 January 2000–31 December 2019) and including peer-reviewed and gray literature across all major geographic regions of the world. Our review identified and analyzed 1,068 publications from an initial number of 4,081 abstracts screened, finding that studies on the prevalence, determinants, and consequences of child marriage represented a majority of the total publications. Including publications in Spanish and Portuguese yielded results from Latin America and the Caribbean, Mozambique, and Europe, and including publications in French yielded results from West Africa and the Maghreb, in addition to English language publications covering both these and other parts of the word. Our review of the evolution and distribution of research over time and space calls for a greater focus of research on interventions preventing child marriage and responding to the needs of individuals married as children, a multilinguistic approach to knowledge exchange, and for research to be conducted in neglected high-prevalence settings.

Effectiveness of problem-based learning methodology in undergraduate medical education: a scoping review

BackgroundProblem-based learning (PBL) is a pedagogical approach that shifts the role of the teacher to the student (student-centered) and is based on self-directed learning. Although PBL has been adopted in undergraduate and postgraduate medical education, the effectiveness of the method is still under discussion. The author’s purpose was to appraise available international evidence concerning to the effectiveness and usefulness of PBL methodology in undergraduate medical teaching programs. MethodsThe authors applied the Arksey and O’Malley framework to undertake a scoping review. The search was carried out in February 2021 in PubMed and Web of Science including all publications in English and Spanish with no limits on publication date, study design or country of origin. ResultsThe literature search identified one hundred and twenty-four publications eligible for this review. Despite the fact that this review included many studies, their design was heterogeneous and only a few provided a high scientific evidence methodology (randomized design and/or systematic reviews with meta-analysis). Furthermore, most were single-center experiences with small sample size and there were no large multi-center studies. PBL methodology obtained a high level of satisfaction, especially among students. It was more effective than other more traditional (or lecture-based methods) at improving social and communication skills, problem-solving and self-learning skills. Knowledge retention and academic performance weren’t worse (and in many studies were better) than with traditional methods. PBL was not universally widespread, probably because requires greater human resources and continuous training for its implementation. ConclusionPBL is an effective and satisfactory methodology for medical education. It is likely that through PBL medical students will not only acquire knowledge but also other competencies that are needed in medical professionalism.

Unified Protocol in a Group Format for Improving Specific Symptoms of Emotional Disorders in the Spanish Public Health System.

The Unified Protocol (UP) for the transdiagnostic treatment of emotional disorders (EDs) has demonstrated its efficacy in improving dimensions shared by EDs, but there is insufficient evidence regarding the specific symptoms of each ED. The main objective of the study was to evaluate the efficacy of the UP applied in a group format compared with individual Treatment as Usual (TAU), in improving specific ED symptoms. The study sample (n=243) was a subset of participants of a randomized controlled trial conducted in the Spanish public health system. Specific symptoms assessed from pre-treatment to the six-month follow-up were: depressive, agoraphobic, generalized anxiety, panic, and obsessive-compulsive symptoms. Personality dimensions and quality of life were also measured. There were statistically significant changes after the UP in all the study variables (0.44 = d = 1.35). Changes in depressive symptoms, obsessive-compulsive disorder, and perceived quality of life were superior in the UP. The results support the efficacy of group UP for improving both transdiagnostic dimensions and specific ED symptoms, as well as quality of life, through the public health-care system.

The burden of illness of rheumatoid arthritis in Latin America-A systematic literature review.

Rheumatoid arthritis (RA) is a chronic autoimmune disease which, when left untreated, may result in the destruction of multiple joints and damage a wide variety of body systems, including the skin, eyes, lungs, heart, and blood vessels. The objective of this study was to conduct a systematic review of disease burden for RA in Argentina, Brazil, Colombia, Mexico, and Venezuela. PubMed/Medline, Embase, and Web of Science were searched for publications in English, Spanish, or Portuguese from 2008 through June 2018. A total of 1700 records were retrieved and 36 articles were included. The estimated prevalence of RA for these countries ranged from 0.15% (Colombia) to 2.8% (Mexico). The Global Burden of Disease initiative 2019 estimated that RA accounted for 0.13% of world disability-adjusted life-years. For Latin America, these figures were higher: Argentina 0.16%, Brazil 0.16%, Colombia 0.21%, Mexico 0.30%, and Venezuela 0.24%. RA has a negative impact on physical, mental, and emotional well-being as shown by substantially lower scores on measures of quality of life (SF-36) compared with the general population. The annual direct cost in Mexico was estimated at US$3599 per person. For patients with severe RA in Brazil these costs were approximately US$10000. Data from other studied countries were similar. Though evidence of the full cost and impact of RA in Latin American countries is scarce and additional studies are needed, the burden of RA in these regions is significant and comparable to other parts the world.