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OBJECTIVE: A lack of universal definitions for response and remission in pediatric obsessive-compulsive disorder (OCD) has hampered the comparability of results across trials. To address this problem, we conducted an individual participant data diagnostic test accuracy meta-analysis to evaluate the discriminative ability of the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) in determining response and remission. We also aimed to generate empirically derived cutoffs on the CY-BOCS for these outcomes. METHOD: A systematic review of PubMed, PsycINFO, Embase and CENTRAL identified 5,401 references; 42 randomized controlled clinical trials were considered eligible, and 21 provided data for inclusion (N = 1,234). Scores of ≤2 in the Clinical Global Impressions Improvement and Severity scales were chosen to define response and remission, respectively. A 2-stage, random-effects meta-analysis model was established. The area under the curve (AUC) and the Youden Index were computed to indicate the discriminative ability of the CY-BOCS and to guide for the optimal cutoff, respectively. RESULTS: The CY-BOCS had sufficient discriminative ability to determine response (AUC = 0.89) and remission (AUC = 0.92). The optimal cutoff for response was a ≥35% reduction from baseline to posttreatment (sensitivity = 83.9, 95% CI = 83.7-84.1; specificity = 81.7, 95% CI = 81.5-81.9). The optimal cutoff for remission was a posttreatment raw score of ≤12 (sensitivity = 82.0, 95% CI = 81.8-82.2; specificity = 84.6, 95% CI = 84.4-84.8). CONCLUSION: Meta-analysis identified empirically optimal cutoffs on the CY-BOCS to determine response and remission in pediatric OCD randomized controlled clinical trials. Systematic adoption of standardized operational definitions for response and remission will improve comparability across trials for pediatric OCD.
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Transtorno Obsessivo-Compulsivo , Criança , Humanos , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Projetos de PesquisaRESUMO
Anxiety disorders affect up to 50% of individuals with autism spectrum disorder (ASD) and are significantly impairing to the person affected, as well as to their loved ones. Cognitive-behavioral therapy (CBT) has been established as the gold-standard treatment for anxiety disorders among typically developing youth and adults, and demonstrates similar efficacy among youth with high-functioning autism (HFA). Many CBT interventions utilize a "full-package" treatment approach to treat co-occurring anxiety in youth with ASD. However, these service delivery systems are often therapist-intensive, costly, and impractical, thereby compromising full engagement and treatment adherence. This paper describes the design, rationale, and methodology of a study examining stepped-care CBT for youth with HFA and co-occurring anxiety - a clinical trial examining the efficacy of low-intensity, parent-led CBT as the first line of treatment and utilizing a more intensive, therapist-led intervention for nonresponders. The study will evaluate the potential benefits of stepped-care and parent-led therapist-assisted interventions, predictors of treatment response, and the economic value of using a stepped-care model. Implications for practice will be discussed.
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Humanos , Adolescente , Adulto , Transtorno Autístico , Transtorno do Espectro Autista , Ansiedade/terapia , Transtornos de Ansiedade/terapia , Pais , Resultado do Tratamento , CogniçãoRESUMO
Anxiety disorders affect up to 50% of individuals with autism spectrum disorder (ASD) and are significantly impairing to the person affected, as well as to their loved ones. Cognitive-behavioral therapy (CBT) has been established as the gold-standard treatment for anxiety disorders among typically developing youth and adults, and demonstrates similar efficacy among youth with high-functioning autism (HFA). Many CBT interventions utilize a "full-package" treatment approach to treat co-occurring anxiety in youth with ASD. However, these service delivery systems are often therapist-intensive, costly, and impractical, thereby compromising full engagement and treatment adherence. This paper describes the design, rationale, and methodology of a study examining stepped-care CBT for youth with HFA and co-occurring anxiety - a clinical trial examining the efficacy of low-intensity, parent-led CBT as the first line of treatment and utilizing a more intensive, therapist-led intervention for nonresponders. The study will evaluate the potential benefits of stepped-care and parent-led therapist-assisted interventions, predictors of treatment response, and the economic value of using a stepped-care model. Implications for practice will be discussed.
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Transtorno do Espectro Autista , Transtorno Autístico , Adolescente , Adulto , Ansiedade/terapia , Transtornos de Ansiedade/terapia , Cognição , Humanos , Pais , Resultado do TratamentoRESUMO
Childhood sexual abuse (CSA), a global public health problem, is often underreported especially in low-income countries such as El Salvador, and prevention efforts are needed. The purpose of this study was to examine knowledge, attitudes and experiences of CSA prevention and characteristics related to greater knowledge and openness to engaging in child abuse prevention among Salvadoran parents. Salvadoran parents (N = 478) completed questionnaires regarding demographics, definition and signs and symptoms of child abuse, personal experiences of CSA, CSA prevention training, and knowledge, attitudes and practices about preventing CSA. Most parents were knowledgeable about CSA, viewed CSA prevention as their responsibility, and had talked with their children about CSA, although 65.7% incorrectly believed that children are more likely to be abused by strangers. Parents with lower income were less knowledgeable and willing to participate in CSA prevention. CSA programing needs to involve parents and specifically target low-income parents.
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Abuso Sexual na Infância/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Pais , Pobreza , Adulto , Criança , El Salvador , Feminino , Humanos , MasculinoRESUMO
RESUMEN: Introducción: La Reforma de Salud del 2005 estableció la mediación como un procedimiento obligatorio para la justicia civil, con el objeto de evitar la judicialización de la salud. Esta investigación ahonda en las características de las mediaciones odontológicas del sistema público de salud en Chile. Material y Método: Estudio transversal, de mediaciones generadas por atenciones odontológicas otorgadas en el sistema público de salud entre los años 2005 y 2015 informadas por Unidad de Mediación del Consejo de Defensa del Estado (CDE). Resultados: No se dispone de anterior al año 2010 por falta de registro. Por tanto, solo fue factible analizar desde 2010 al 2015. Se registran 127 mediaciones ingresadas odontológicas, el 61% reclamantes son mujeres. 60,6% proviene de la atención secundaria. 83,4% (106 casos) el reclamo es contra el establecimiento y el tratante. Sólo el 22% logra acuerdo. De estos, el 10% solo requiere explicaciones y solo el 28,5% solicita indemnización. Conclusiones: Una mejor relación profesional-paciente disminuye el riesgo de judicialización, así como una mejor difusión del procedimiento de mediación aumentaría tasa de acuerdos.
ABSTRACT: Introduction: The 2005 Health Reform established mediation as a mandatory procedure for civil justice, in order to avoid prosecution of health. This research delves into the characteristics of the dental mediations of the Chilean public health system. Material and method: Cross-sectional study of mediations generated by dental care granted in the public health system between 2005 and 2015, reported by the Mediation Unit of the State Defense Council (CDE). Results: Not available prior to 2010 due to the lack of registration. Therefore, an analysis was only feasible from 2010 to 2015. There are 127 dentistry mediations registered, 61% of the claimants are women. 60.6% come from secondary care. 83.4% (106 cases) the claim is against the establishment and the practitioner. Only 22% achieve agreement. Of these, 10% only require explanations and only 28.5% ask for compensation. Conclusions: A better professional-patient relationship reduces the risk of prosecution, and a better dissemination of the mediation procedure would increase agreement rate.
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Humanos , Masculino , Feminino , Saúde Pública , Odontologia em Saúde Pública , Assistência Odontológica , Negociação , Compensação e Reparação , Judicialização da Saúde , Estudos TransversaisRESUMO
The stability of aflatoxins B1, B2, G1, and G2 was studied in solutions containing different concentrations of water, acetonitrile, and/or methanol, and in autosampler vials treated with nitric acid or silanized. When stored at room temperature (20 degrees C) for 24 h, aflatoxins G1 and G2 were stable only in solutions containing 100% organic solvent, whereas aflatoxins B1 and B2 were stable in solutions of methanol-water and acetonitrile-water at greater than 60 and 40% organic content, respectively. At 5 degrees C, aflatoxins G1 and G2 showed a significant decrease in concentration only when kept in less than 20% aqueous organic solvent. Significant loss of aflatoxins was realized in standard, commercially available amber type I borosilicate autosampler vials, but chemical etching of the vials with nitric acid or with silanization prevented aflatoxin degradation. These results indicate that aflatoxins are unstable in aqueous solutions and that this instability can be counteracted by the presence of at least 20% organic solvent and keeping the solutions at 5 degrees C or by the use of treated vials.
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Aflatoxina B1/análise , Aflatoxinas/análise , Técnicas de Química Analítica/métodos , Acetonitrilas/química , Estabilidade de Medicamentos , Cinética , Metanol/química , Modelos Químicos , Ácido Nítrico/química , Compostos Orgânicos/química , Silanos/química , Silicatos/química , Soluções , Solventes , Temperatura , Água/químicaRESUMO
Objective: a study was conducted to evaluate two sources of omega-3 (n-3) fatty acid enrichment, namely a trout by-product meal (TBPM) and tuna fish oil (TFO), as potential sources for egg yolk n-3 enrichment. Methods: Seventy-27 week old commercial layers were assigned to each of seven dietary treatments, as follows. Group 1: control; group 2: 5% TBPM; group 3: 10% TBPM; group 4: 15% TBPM; group 5: 20% TBPM; group 6: 2% TFO; and group 7: 3% TFO. The experimental diets were fed for 28 days. Results: no effect on production parameters was caused by the experimental diets. All diets containing TBPM or TFO significantly (p<0.05) increased n-3 egg yolk fatty acid content. Dietary levels of 5-20% TBPM increased egg yolk n-3 content between 1.97 and 3.54 times compared with control eggs. TFO levels of 2% and 3% increased the n-3 egg yolk content 3.37 and 4.13 times, respectively, compared with control eggs. The n-6/n-3 ratio in egg yolk lipids was significantly (p<0.05) decreased by the experimental diets. The n-6/n-3 ratio in control eggs was 16.79 compared with ratios ranging from 4.34 to 8.11 in enriched eggs. Conclusions: the results showed that both TBPM and TFO are good sources of n-3 fatty acid enrichment in eggs. Further studies are required in order to determine the effects of TBPM and TFO inclusion on the organoleptic quality of eggs.
Objetivo: se realizó un estudio para evaluar dos potenciales fuentes de enriquecimiento de ácidos grasos omega-3 (n-3) en yema de huevo: ensilaje de vísceras de trucha (TBPM) y aceite de atún (TFO). Métodos: un total de 70 gallinas de postura de 27 semanas se asignaron a siete tratamientos dietarios, así: grupo 1: control; grupo 2: 5% TBPM; grupo 3: 10% TBPM; grupo 4: 15% TBPM; grupo 5: 20% TBPM; grupo 6: 2% TFO y grupo 7: 3% TFO. Las dietas experimentales se suministraron durante 28 días. Resultados: no se encontraron efectos sobre los parámetros productivos a causa de las dietas experimentales, pero todas las dietas suplementadas con TBPM o TFO causaron un aumento significativo (p<0.05) en el contenido de n-3 de la yema. La suplementación de 5-20% de TBPM causó un incremento de n-3 de 1.97 a 3.54 veces, comparado con el contenido de n-3 de los huevos control. La suplementación de 2% y 3% de TFO incrementó en contenido de n-3 en 3.37 y 4.13 veces, respectivamente. La relación n-6/n-3 en los lípidos de la yema aumentó significativamente en las dietas experimentales siendo esta relación de 16.79 en los huevos control y de 4.34-8.11 en los huevos de gallinas suplementadas con las fuentes de n-3. Conclusiones: los resultados del presente estudio demuestran que tanto el TBPM como el TFO constituyen fuentes apropiadas de enriquecimiento de huevos con ácidos grasos n-3. Se requieren más estudios para determinar los efectos de estas materias primas en la calidad organoléptica del huevo.
Objetivo: Foi realizado um estudo para avaliar duas fontes potenciais de enriquecimento de ômega-3 (n-3) na gema de ovo: silagem de vísceras de truta (TBPM) e óleo de atum (TFO). Métodos: Um total de 70 galinhas poedeiras de 27 semanas, foram atribuídas a sete tratamentos dietéticos: grupo 1: controle, grupo 2: 5%TBPM, grupo 3: 10% TBPM, grupo 4: 15% TBPM, grupo 5: 20% TBPM, grupo 6: 2% TFO e grupo 7: TFO 3%. As dietas experimentais foram subministradas durante 28 dias. Resultados: Não foram encontradas diferencias nos parâmetros de produção por causa das dietas experimentais, mas todas as dietas suplementadas com TFO ou TBPM causaram um aumento significativo (p<0.05) no conteúdo de n-3 da gema. A suplementação de 5-20% de TBPM causou um aumento de n-3 de 1.97 a 3.54 vezes, em comparação com o conteúdo de n-3 do controle. A suplementação de 2% e 3% de TFO aumentou o conteúdo de n-3 em 3.37 e 4.13 vezes, respectivamente. A relação n-6/n-3 nos lipídios da gema aumentou significativamente nas dietas experimentais, sendo esta relação de 16.79 nos ovos do controle e de 4.43 a 8.11 em ovos de galinha suplementados com fontes de n-3. Conclusões: Os resultados deste estudo demonstram que o TFO e o TBPM são fontes apropriadas de enriquecimento de ovos com n-3 ácidos graxos. Mais estudos são necessários para determinar os efeitos dessas matérias primas na qualidade organoléptica do ovo.
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A study was conducted to determine the cytochrome (CYP) P450 enzymes responsible for the bioactivation of aflatoxin B1 (AFB1) into its epoxide form (AFBO) in duck liver microsomes. Six male and six female 6-week-old Pekin ducks were used. The biochemical toxicology strategies applied included the use of selective inhibitors, prototype substrate activity for specific human P450s, correlation between aflatoxin bioactivation and enzymatic activity of prototype substrates, and the expression of specific CYP450 enzymes using antibodies against human CYP450s. Enzymatic activity was detected for the duck orthologues CYP1A1/2, CYP2A6 and CYP3A4 but not for the CYP2D6 orthologue. Immunoreactive proteins for CYP1A1, CYP2A6 and CYP3A4 were also detected. Inhibition studies suggested that the duck turkey CYP2A6 orthologue and, to a lesser extent, the CYP1A1 orthologue are involved in the bioactivation of AFB1. Correlation studies, however, suggest that CYP3A4, CYP2A6 and CYP1A1/2 are all involved in AFBO formation. The finding that four CYP enzymes may be involved in AFB1 bioactivation in ducks could explain the high sensitivity of this species to AFB1. Further studies are needed to fully elucidate the phase I hepatic metabolism of AFB1 in ducks, the only poultry species that develops hepatic cancer from AFB1 exposure.