Artículos de revista DCS - OZS Aldizkari artikuluak

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Open Access
Diagnostic value of the derived neutrophil-to-lymphocyte ratio for acute appendicitis
(Wiley, 2025-03-05) Moreno Alfonso, Julio César; Molina Caballero, Ada; Pérez Martínez, Alberto; Yárnoz Irazábal, María Concepción; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Background: The diagnosis of appendicitis in children can present several challenges,leading to an increased risk of complications. Herein, we aimed to evaluate the diagnosticvalue of the derived neutrophil-to-lymphocyte ratio (dNLR) as a novel adjunctive diagnostictool for appendicitis.Methods: Diagnostic study of patients with appendicitis and non-surgical abdominal pain(AP) admitted to our hospital between 2020 and 2022. White blood cell count (WBC),neutrophil-to-lymphocyte ratio (NLR), and dNLR were compared between the two groupsof patients.Results: Overall, 202 patients were enrolled: 101 with appendicitis (69% male, age9.9 years) and 101 with AP (56% male, age 9.4 years). WBC, NLR, and dNLR were higherin patients in the appendicitis group than in those in the AP group (16.47 versus11.18 10 3 cells/mm 3; 9.5 versus 3.3; and 5.2 versus 2.3; P ≤ 0.0001, respectively). Thesensitivity, speciﬁcity, positive predictive value, area under ROC curve, and cutoff point ofdNLR for the diagnosis of appendicitis were 71%, 74%, 73%, 0.811, and 3.78, respectively.The positive likelihood ratios for WBC, NLR, and dNLR were 1.95, 2.05 and 2.77.Conclusion: dNLR is a novel and noninvasive biomarker with high accuracy for diagnosingappendicitis. Its inclusion as an additional diagnostic tool in clinical practice may aid in determin-ing the need for further studies in cases with ambiguous presentations and a dNLR value ≥3.78.
Open Access
Neuromotor dysfunction as a major outcome domain of psychotic disorders: a 21-year follow-up study
(Elsevier, 2025-01-01) Peralta Martín, Víctor; García de Jalón, Elena; Moreno-Izco, Lucía; Peralta, David; Janda-Galán, Lucía; Sánchez Torres, Ana María; Cuesta, Manuel J.; SEGPEPs Group; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
Background The long-term stability of neuromotor domains assessed at the first episode of psychosis (FEP) and their ability for predicting a number of outcomes remains largely unknown, and this study addressed these issues. Methods This was a longitudinal study of 243 participants with FEP who were assessed at baseline for background variables and parkinsonism, dyskinesia, neurological soft signs (NSS) and catatonia, and reassessed 21 years later for the same neuromotor variables, psychopathology, functioning, personal recovery, cognitive performance and medical comorbidity. Stability of neuromotor ratings was assessed using the intraclass correlations coefficient and associations between the predictors and outcomes were examined using univariate and multivariate statistics. Results Baseline dyskinesia and NSS ratings showed excellent stability over time whereas that for parkinsonism and catatonia was relatively low. Neuromotor dysfunction at follow-up was independently predicted by a family history of schizophrenia, obstetric complications, neurodevelopmental delay, low premorbid IQ and baseline ratings of dyskinesia and NSS. Moreover, baseline dyskinesia and NSS ratings independently predicted more positive and negative symptoms, poor functioning and less personal recovery; catatonia predicted less personal recovery and more medical comorbidity. Baseline neuromotor ratings explained between 4% (for medical comorbidity) and 34% (for neuromotor dysfunction) of the variance in the outcomes. Lastly, neuromotor dysfunction at baseline highly predicted clinical staging at follow-up. Conclusion Baseline neuromotor domains show variable stability over time and relate distinctively to very long-term outcomes. Both baseline dyskinesia and NSS are trait markers of the disease process and robust predictors of the outcomes.
Open Access
The network structure of cognitive deficits in first episode psychosis patients
(Elsevier, 2022-06-01) Sánchez Torres, Ana María; Peralta Martín, Víctor; Gil Berrozpe, Gustavo José; Mezquida, Gisela; Ribeiro Fernández, María; Molina-García, Mariola; Amoretti, Silvia; Lobo, Antonio; González Pinto, Ana; Merchán-Naranjo, Jessica; Corripio, Iluminada; Vieta, Eduard; Serna, Elena de la; Bergé, Daniel; Bernardo, Miguel; Cuesta, Manuel J.; PEPs Group; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
Network analysis is an important conceptual and analytical approach in mental health research. However, few studies have used network analysis to examine the structure of cognitive performance in psychotic disorders. We examined the network structure of the cognitive scores of a sample of 207 first-episode psychosis (FEP) patients and 188 healthy controls. Participants were assessed using a battery of 10 neuropsychological tests. Fourteen cognitive scores encompassing six cognitive domains and premorbid IQ were selected to perform the network analysis. Many similarities were found in the network structure of FEP patients and healthy controls. Verbal memory, attention, working memory and executive function nodes were the most central nodes in the network. Nodes in both groups corresponding to the same tests tended to be strongly connected. Verbal memory, attention, working memory and executive function were central dimensions in the cognitive network of FEP patients and controls. These results suggest that the interplay between these core dimensions is essential for demands to solve complex tasks, and these interactions may guide the aims of cognitive rehabilitation. Network analysis of cognitive dimensions might have therapeutic implications that deserve further research.
Open Access
The role of premorbid IQ and age of onset as useful predictors of clinical, functional outcomes, and recovery of individuals with a first episode of psychosis
(MDPI, 2021-06-02) Molina-García, Mariola; Fraguas, David; Rey-Mejías, Ángel del; Mezquida, Gisela; Sánchez Torres, Ana María; Amoretti, Silvia; Lobo, Antonio; González Pinto, Ana; Andreu-Bernabeu, Álvaro; Corripio, Iluminada; Vieta, Eduard; Baeza, Inmaculada; Mané, Anna; Cuesta, Manuel J.; Serna, Elena de la; Payá, Beatriz; Zorrilla, Iñaki; Arango, Celso; Bernardo, Miguel; Rapado-Castro, Marta; Parellada, Mara; PEPs Group; Ciencias de la Salud; Osasun Zientziak
Background: premorbid IQ (pIQ) and age of onset are predictors of clinical severity and long-term functioning after a first episode of psychosis. However, the additive influence of these variables on clinical, functional, and recovery rates outcomes is largely unknown. Methods: we characterized 255 individuals who have experienced a first episode of psychosis in four a priori defined subgroups based on pIQ (low pIQ < 85; average pIQ ≥ 85) and age of onset (early onset < 18 years; adult onset ≥ 18 years). We conducted clinical and functional assessments at baseline and at two-year follow-up. We calculated symptom remission and recovery rates using the Positive and Negative Symptoms of Schizophrenia Schedule (PANSS) and the Global Assessment Functioning (GAF or Children-GAF). We examined clinical and functional changes with pair-wise comparisons and two-way mixed ANOVA. We built hierarchical lineal and logistic regression models to estimate the predictive value of the independent variables over functioning or recovery rates. Results: early-onset patients had more severe positive symptoms and poorer functioning than adult-onset patients. At two-year follow-up, only early-onset with low pIQ and adult-onset with average pIQ subgroups differed consistently, with the former having more negative symptoms (d = 0.59), poorer functioning (d = 0.82), lower remission (61% vs. 81.1%), and clinical recovery (34.1% vs. 62.2%). Conclusions: early-onset individuals with low pIQ may present persistent negative symptoms, lower functioning, and less recovery likelihood at two-year follow-up. Intensive cognitive and functional programs for these individuals merit testing to improve long-term recovery rates in this subgroup.
Open Access
A neuropsychological study on Leonhard's nosological system
(Springer, 2022-04-01) Cuesta, Manuel J.; Sánchez Torres, Ana María; Gil Berrozpe, Gustavo José; Lorente Omeñaca, Ruth; Moreno-Izco, Lucía; Peralta Martín, Víctor; SEGPEPs Group; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
Phenotype validation of endogenous psychosis is a problem that remains to be solved. This study investigated the neuropsychological performance of endogenous psychosis subtypes according to Wernicke–Kleist–Leonhard’s classification system (WKL). The participants included consecutive admissions of patients with schizophrenia spectrum disorder or mood disorder with psychotic symptoms (N = 98) and healthy comparison subjects (N = 50). The patients were assessed by means of semi-structured interviews and diagnosed through the WKL system into three groups: a manic-depressive illness and cycloid psychosis group (MDC), unsystematic schizophrenia (USch) and systematic schizophrenia (SSch). All the participants completed a comprehensive neuropsychological battery. The three Leonhard’s psychosis subtypes showed a common neuropsychological profile with differences in the severity of impairment relative to healthy controls. MDC patients showed better performance on premorbid intelligence, verbal memory and global cognitive index than USch and SSch patients, and they showed better performance on processing speed, and working memory than SSch patients. USch patients outperformed SSch patients in verbal memory, working memory and global cognitive index. Neuropsychological performance showed a modest accuracy for classification into the WKL nosology. Our results suggest the existence of a common profile of cognitive impairment cutting across WKL subtypes of endogenous psychosis but with significant differences on a severity continuum. In addition, classification accuracy in the three WKL subtypes by means of neuropsychological performance was modest, ranging between 40 and 64% of correctly classified patients.
Open Access
Prospective long-term cohort study of subjects with first-episode psychosis examining eight major outcome domains and their predictors: study protocol
(Frontiers Media, 2021-03-19) Peralta Martín, Víctor; Moreno-Izco, Lucía; García de Jalón, Elena; Sánchez Torres, Ana María; Janda-Galán, Lucía; Peralta, David; Fañanás, Lourdes; Cuesta, Manuel J.; SEGPEPs Group; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
Background: Our current ability to predict the long-term course and outcome of subjects with a first-episode of psychosis (FEP) is limited. To improve our understanding of the long-term outcomes of psychotic disorders and their determinants, we designed a follow-up study using a well-characterized sample of FEP and a multidimensional approach to the outcomes. The main goals were to characterize the long-term outcomes of psychotic disorders from a multidimensional perspective, to address the commonalities and differential characteristics of the outcomes, and to examine the common and specific predictors of each outcome domain. This article describes the rationale, methods, and design of a longitudinal and naturalistic study of subjects with epidemiologically defined first-admission psychosis. Methods: Eligible subjects were recruited from consecutive admissions between January 1990 and December 2009. Between January 2018 and June 2021, we sought to trace, re-contact, and re-interview the subjects to assess the clinical course, trajectories of symptoms and functioning, and the different outcomes of psychotic disorders. Since this is a naturalistic study, the research team will not interfere with the subjects' care and treatment. Predictors include antecedent variables, first-episode characteristics, and illness-related variables over the illness course. We assess eight outcome domains at follow-up: psychopathology, psychosocial functioning, self-rated personal recovery, self-rated quality of life, cognitive performance, neuromotor dysfunction, medical and psychiatric comorbidities, and mortality rate. The range of the follow-up period will be 10–31 years with an estimated mean of 20 years. We estimate that more than 50% of the baseline sample will be assessed at follow-up. Discussion: The study design was driven by the increasing need to refine the ability to predict the different clinical outcomes in FEP, and it aims to close current gaps in knowledge, with a broad approach to both the definition of outcomes and their determinants. To the best of our knowledge, this study is one of the few attempting to characterize the very long-term outcome of FEP and the only study addressing eight major outcome domains. We hope that this study helps to better characterize the long-term outcomes and their determinants, enabling better risk stratification and individually tailored, person-based interventions.
Embargo
Publishing trends, motivations, and obstacles among pediatric surgeons: an international survey on research dissemination and peer review challenges
(Thieme, 2025-04-04) Aubert, Ophelia; Gazzaneo, Marta; Moreno Alfonso, Julio César; Ulman, Hilmican; Garnier, Hanna; Ure, Benno; Lacher, Martin; Ciencias de la Salud; Osasun Zientziak
Objective: this study aims to assess publishing trends, motivations, preferences, and challenges among pediatric surgeons globally. Methods: a cross-sectional survey was conducted among pediatric surgeons from multiple countries, distributed through the Trainees of European Pediatric Surgery (TEPS) network and social media. The anonymous questionnaire contained 26 items focusing on journal preferences, motivations for publishing, obstacles faced, peer-review experiences, open access publishing, and methods of research dissemination. Results: a total of 172 responses were collected from pediatric surgeons in 33 countries. Most respondents worked in tertiary hospitals (88%) and were consultants or senior attendings (49%). Over half (65%) had published at least one scientific paper in the last 3 years. PubMed was the primary search engine (82%), and pediatric surgical journals were the preferred outlets for publication (87%). Key motivations for choosing a journal were impact factor (22%) and scope (19%), while publication costs (38%) and slow review processes (22%) were the primary deterrents. Open access publication options were used by more than half of respondents, with a third spending less than €2,500 on fees. Social media, particularly Instagram, emerged as a popular platform for research dissemination. Conclusion: pediatric surgeons prefer publishing in specialized journals, with impact factor and scope being key drivers of journal choice. Publication costs and the peer-review process are the most significant obstacles. Efforts to address these challenges, such as reducing fees and enhancing the review process, are crucial for facilitating research dissemination in pediatric surgery.
Open Access
Relapse of first-episode schizophrenia patients and neurocognitive impairment: the role of dopaminergic and anticholinergic burden
(Elsevier, 2022-10-01) Cuesta, Manuel J.; Ballesteros, Alejandro; Sánchez Torres, Ana María; Amoretti, Silvia; López-Ilundain, José M.; Merchán-Naranjo, Jessica; González-Ortega, Itxaso; Salgado, Purificación; Rodríguez-Jiménez, Roberto; Roldán-Bejarano, Alexandra; Sarró, Salvador; Ibáñez, Ángela; Usall, Judith; Escartí, Maria José; Moreno-Izco, Lucía; Mezquida, Gisela; Parellada, Mara; González Pinto, Ana; Berrocoso, Esther; Bernardo, Miguel; 2EPs Group; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
Background: the prevention of relapse may be a key factor to diminish the cognitive impairment of first-episode schizophrenia (FES) patients. We aimed to ascertain the effects of relapse, and dopaminergic and anticholinergic treatment burdens on cognitive functioning in the follow-up. Methods: ninety-nine FES patients participated in this study. Cognitive assessments were performed at baseline and after 3 years of follow-up or, in those patients who relapsed, after >2 months of stabilization of the new acute psychotic episode. The primary outcomes were final cognitive dimensions. Results: repeated measures MANOVA analyses showed improvements in the whole sample on the end-point assessments in processing speed and social cognition. However, only impairment in social cognition showed a significant interaction with relapse by time in this sample. Relapse in FES patients was significantly associated with poor performance on end-point assessments of working memory, social cognition and global cognitive score. Anticholinergic burden, but not dopaminergic burden, was associated with verbal memory impairment. These significant associations resulted after controlling for baseline cognitive functioning, relapse and dopaminergic burden. Conclusions: the relationship between relapse and cognitive impairment in recovered FES patients seems to be particularly complex at the short-term follow-up of these patients. While relapse was associated with working memory, social cognition impairments and global cognitive score, anticholinergic burden might play an additional worsening effect on verbal memory. Thus, tailoring or changing antipsychotics and other drugs to reduce their anticholinergic burden may be a potential modifiable factor to diminish cognitive impairment at this stage of the illness.
Open Access
The Spanish Polygenic Score reference distribution: a resource for personalized medicine
(Nature, 2025-04-24) Carmona, Rosario; Roldán, Gema; Fernández-Rueda, José L.; Navarro, Arcadi; Peña-Chilet, María; Pasalodos-Sanchez, S.; Aquino, V.; Perez-Florido, J.; Bostelmann, G.; Ayuso, C.; Minguez, P.; Avila-Fernandez, A.; Corton, M.; Artuch, R.; Borrego, S.; Antiñolo, G.; Carracedo, A.; Amigo, J.; Castaño, L. A.; Tejada, I.; Delmiro, A.; Espinos, C.; Grinberg, D.; Guillén, E.; Lapunzina, P.; Lopez-Escámez, J. A.; Gallego-Martinez, A.; Martí, R.; Rovira, E.; Millán, J. M.; Moreno, M. A.; Morin, M.; Moreno-Galdó, A.; Fernández-Cancio, M.; Morte, B.; Mulero, V.; García, D.; Nunes, V.; Palau, F.; Perez, B; Perona, R.; Pujol, A.; Ramos, F.; Lopez, E.; Ribes, A.; Rosell, J.; Surrallés, J.; Dopazo, Joaquín; López López, Daniel; Alonso Sánchez, Ángel Miguel; Salgado Garrido, Josefa; Ciencias de la Salud; Osasun Zientziak
Here we present the Polygenic Score (PGS) distributions for 3124 common diseases and quantitative traits observed in the Spanish population. To achieve so, the genomes and exomes of 2190 unrelated individuals of Spanish ancestry were used. The analysis covered a wide range of diseases and traits, including both complex disorders, such as various types of cancer, and disorders associated with the digestive, cardiovascular, neuronal, and immune systems, as well as quantitative traits like hematological and anthropometric measurements. The resulting PGS distributions provide valuable insights into the genetic architecture of the Spanish population, offering a comprehensive framework for investigating disease susceptibility and potential risk factors in this specific population. The study has also explored potential relationships between diseases and traits based on PGS pairwise correlations, revealing significant correlations that warrant further investigation. These findings have contributed to increase our understanding of the genetic basis of human traits and have implications for personalized medicine and public health interventions in the Spanish population. In addition, for the sake of reproducibility, we provide a data processing pipeline, enabling the computation of PGS for external genomes and exomes. The pipeline, accessible on GitHub, supports parallel tasks on various computing platforms and contributes to the standardization of PGS comparisons globally. Lastly, a user-friendly web interface facilitates the exploration of PGS reference distributions, featuring a detailed table, distribution plots, and filtering options. This interface enhances accessibility for researchers and clinicians, fostering informed decision-making based on population-specific PGS distributions. The PGS reference distributions can be explored at the SpPGS Atlas repository through the web interface: https://csvs.clinbioinfosspa.es/?tab=pgs.
Open Access
Validity and utility of a set of clinical criteria for cognitive impairment associated with psychosis (CIAPs)
(Elsevier, 2020-11-01) Cuesta, Manuel J.; Sánchez Torres, Ana María; Lorente Omeñaca, Ruth; Zandio, María; Moreno-Izco, Lucía; Peralta Martín, Víctor; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
Schizophrenia and other psychoses display a common profile of mild to moderate cognitive deficits that are associated with poor functional outcomes. Cognitive impairment is usually evaluated by neuropsychological assessment, and interview-based measures with good psychometric properties and high utility for clinical practice are now available. However, the extent to which a set of clinical criteria can be used as proxy measures of cognitive deficits in this population has not been tested. This study aimed to examine the empirical validity of a set of clinical criteria for cognitive impairment associated with psychosis (CIAPs). Ninety-eight patients with non-pure affective psychosis and 50 healthy-matched controls were included. The CIAPs criteria were empirically tested against antecedent, concurrent and outcome validators and by means of a neuropsychological evaluation based on MATRICS Consensus Cognitive Battery (MCCB). The CIAPs criteria showed strong associations with outcomes and certain antecedent validators and moderate associations with concurrent validators. The CIAPs criteria achieved superior neuropsychological validity compared to current DSM 5 criteria for schizophrenia, the B-criterion of DSM 5 schizophrenia or a combination of both criteria. Cognitive impairment associated with psychosis can be clinically assessed and is a useful tool for clinical practice and predicting outcomes of schizophrenia and related psychosis.
Open Access
The longitudinal effect of antipsychotic burden on psychosocial functioning in first-episode psychosis patients: the role of verbal memory
(Cambridge University Press, 2020-04-24) Ballesteros, Alejandro; Sánchez Torres, Ana María; López-Ilundain, José M.; Mezquida, Gisela; Lobo, Antonio; González Pinto, Ana; Pina-Camacho, Laura ; Corripio, Iluminada; Vieta, Eduard; Serna, Elena de la; Mané, Anna; Bioque, Miquel; Moreno-Izco, Lucía; Espliego, Ana; Lorente Omeñaca, Ruth; Amoretti, Silvia; Bernardo, Miguel; Cuesta, Manuel J.; PEPs Group; Ciencias de la Salud; Osasun Zientziak
Background. Previous literature supports antipsychotics¿ (AP) efficacy in acute first-episode psychosis (FEP) in terms of symptomatology and functioning but also a cognitive detrimental effect. However, regarding functional recovery in stabilised patients, these effects are not clear. Therefore, the main aim of this study is to investigate dopaminergic/anticholinergic burden of (AP) on psychosocial functioning in FEP. We also examined whether cognitive impairment may mediate these effects on functioning. Methods. A total of 157 FEP participants were assessed at study entry, and at 2 months and 2 years after remission of the acute episode. The primary outcomes were social functioning as measured by the functioning assessment short test (FAST). Cognitive domains were assessed as potential mediators. Dopaminergic and anticholinergic AP burden on 2-year psychosocial functioning [measured with chlorpromazine (CPZ) and drug burden index] were independent variables. Secondary outcomes were clinical and socio-demographic variables. Results. Mediation analysis found a statistical but not meaningful contribution of dopaminergic receptor blockade burden to worse functioning mediated by cognition (for every 600 CPZ equivalent points, 2-year FAST score increased 1.38 points). Regarding verbal memory and attention, there was an indirect effect of CPZ burden on FAST (b = 0.0045, 95% CI 0.0011¿0.0091) and (b = 0.0026, 95% CI 0.0001¿0.0006) respectively. However, only verbal memory post hoc analyses showed a significant indirect effect (b = 0.009, 95% CI 0.033¿0.0151) adding premorbid IQ as covariate. We did not find significant results for anticholinergic burden. Conclusion. CPZ dose effect over functioning is mediated by verbal memory but this association appears barely relevant.
Open Access
The network and dimensionality structure of affective psychoses: an exploratory graph analysis approach
(Elsevier, 2020-12-01) Peralta Martín, Víctor; Gil Berrozpe, Gustavo José; Sánchez Torres, Ana María; Cuesta, Manuel J.; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
Background: The dimensional symptom structure of classes of affective psychoses, and more specifically the relationships between affective and mood symptoms, has been poorly researched. Here, we examined these questions from a network analysis perspective. Methods: Using Exploratory Graph Analysis (EGA) and network centrality parameters, we examined the dimensionality and network structure of 28 mood and psychotic symptoms in subjects diagnosed with schizoaffective disorder (n=124), psychotic bipolar disorder (n=345) or psychotic depression (n=245), such as in the global sample of affective psychoses. Results: EGA identified four dimensions in subjects with schizoaffective or bipolar disorders (depression, mania, positive and negative) and three dimensions in subjects with psychotic depression (depression, psychosis and activation). The item composition of dimensions and the most central symptoms varied substantially across diagnoses. The most central (i.e., interconnected) symptoms in schizoaffective disorder, psychotic bipolar disorder and psychotic depression were hallucinations, delusions and depressive mood, respectively. Classes of affective psychoses significantly differed in terms of network structure but not in network global strength. Limitations: The cross-sectional nature of this study precludes conclusions about the causal dynamics between affective and psychotic symptoms. Conclusion: EGA is a powerful tool for examining the dimensionality and network structure of symptoms in affective psychoses showing that both the interconnectivity pattern between affective and psychotic symptoms and the most central symptoms vary across classes of affective psychoses. The findings outline the value of specific diagnoses in explaining the relationships between mood and affective symptoms.
Open Access
Cognitive, community functioning and clinical correlates of the Clinical Assessment Interview for Negative Symptoms (CAINS) in psychotic disorders
(Springer, 2021-12-01) Cuesta, Manuel J.; Sánchez Torres, Ana María; Lorente Omeñaca, Ruth; Moreno-Izco, Lucía; Peralta Martín, Víctor; SEGPEPs Group; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
Negative symptoms are a core dimension of schizophrenia and other psychoses that account for a large degree of the poor functional outcomes related to these disorders. Newer assessment scales for negative symptoms, such as the Clinical Assessment Interview for Negative Symptoms (CAINS), provide evidence for separate dimensions of motivational and pleasure (MAP) and expression (EXP) dimensions. This study was aimed at extending the analysis of the clinical, functional and cognitive correlates of CAINS dimensions in a sample of patients with psychotic disorders (n=98) and 50 healthy controls. A psychopathological evaluation was conducted by using the Comprehensive Assessment of Symptoms and History (CASH). To assess the extrapyramidal signs, the UKU scale was used. Community functioning was evaluated by means of real-world and functional attainment measures. Additionally, a full neuropsychological test battery was administered. Pearson correlation and hierarchical multiple linear regression analyses were performed to identify the infuencing and predictive factors associated with the CAINS dimensions. The MAP and EXP dimensions showed strong associations with the Scale for the Assessment of Negative Symptoms (SANS) items and were not signifcantly associated with extra-pyramidal or cognitive defcits. The MAP and EXP CAINS dimensions revealed good predictive validity for real-world functioning and functional attainment measures. These fndings suggest that the CAINS scale endorses good convergent validity for the assessment of negative symptoms and is very useful in the prediction of psychosocial functioning. In addition, the CAINS dimensions might provide advantages over old assessment scales on disentangling the complex associations between negative symptoms and cognitive impairment.
Open Access
Quality of life in long-term cancer-free breast cancer survivors in Spain: a descriptive study
(Nature, 2025-07-03) Soto Ruiz, María Nelia; Escalada Hernández, Paula; Pimentel Parra, Gustavo Adolfo; García Vivar, Cristina; Ciencias de la Salud; Osasun Zientziak
This study aimed to assess the quality of life (QOL) of long-term breast cancer survivors (LT-BCS), disease-free 5 years after completing primary treatments, and to identify sociodemographic and clinical factors associated with their QOL. A descriptive cross-sectional study was conducted with LT-BCS from the Navarra region in Spain. The QOL was assessed using the Spanish version of the QOL scale for cancer survivors. Sociodemographic and clinical data, time since treatment completion, and lifestyle factors were also collected. Bivariate statistical analysis and multiple regression were used to explore associations between independent variables and QOL and its domains. A total of 188 LT-BCS participated, with a mean age of 57.55 years and a mean survival time of 10.22 years. The overall QOL score was 5.77/10, with physical well-being scoring the highest and spiritual wellbeing the lowest. Age, occupation, and moderate physical activity were associated with better QOL, while total mastectomy, early menopause, and recurrences had a negative impact. Radiotherapy was associated with improved overall QOL. Regression models confirmed these associations, except for spiritual well-being. The study identifies key factors affecting the QOL of LT-BCS, a population that has been relatively underrepresented in scientific literature. It provides valuable insights into their distinct physical and psychological sequelae, contributing to a more comprehensive understanding of their long-term well-being. Sequelae of breast cancer persist, affecting long-term survivors’ wellbeing. Despite the growing importance of supportive care, many women lack proper follow-up. This study underscores the need for strategies such as survivorship care plans to improve coordination and support, addressing both psychological impacts and physical well-being.
Open Access
The effectiveness of family health conversations delivered by nurses: a systematic review
(Wiley, 2025-08-05) Østergaard, Birte; Svavarsdottir, Erla Kolbrun; Brødsgaard, Anne; Rosenstrøm, Stine; García Vivar, Cristina; Konradsen, Hanne; Dieperink, Karin Brochstedt; Imhof, Lorenz; Mahrer-Imhof, Romy; Luttik, Marie Louise; Ciencias de la Salud; Osasun Zientziak
Aim: to extract and interpret quantitative data exploring the effectiveness of family health conversations (FHCs) on family functioning, perceived support, health-related quality of life, caregiver burden and family health in families living with critical or chronic health conditions. Background: addressing the health of families affected by critical or chronic illnesses requires focused attention. The effective integration of FHCs is hampered by a scarcity of rigorous quantitative studies that provide solid evidence on best practices and outcomes. Design: a systematic review following the Joanna Briggs Institute guidelines. Methods: the review is reported according to the PRISMA 2020 checklist. Appropriate studies were searched in PubMed, CINAHL, PsycINFO, Scopus and Cochrane Databases. Results of the search were imported into the Covidence web-based program. Included were studies with a quantitative research design, delivered to families with critical or chronic health conditions, describing FHCs based on the Calgary Family Assessment Model and/or the Calgary Family Intervention Model, and/or the Illness Beliefs Model, using reliable and validated instruments, published between 2008 and 2023, and written in English. Results: in total, 24 papers met the inclusion criteria. Sixteen papers used a quasi-experimental design, eight of which included a control group. Two papers used a mixed methods design, and six papers were randomised controlled trials (RCTs). A statistically significant effect of FHCs on family functioning was reported in two RCTs and three quasi-experimental papers. We also found that a statistically significant effect of FHCs was reported on perceived support in 9 of 15 papers, quality of life in 4 of 11 papers and caregiver burden in 1 of 3 papers. Conclusion and implications for clinical practice: the interventions reviewed revealed variability and partial results concerning the effectiveness of FHCs on family functioning. More rigorous research about short-term, intermediate- and long-term effectiveness is needed before conclusions can be drawn. Reporting method: the study is reported according to the PRISMA 2020 (Preferred Reporting Items for Systematic reviews and Meta-Analyses). Patient or public contribution: no patient or public contribution. Data were gathered from previously published studies.
Open Access
Effect of a Multicomponent Exercise Program with Virtual Reality (MEP-VR) versus standard approaches on functional and cognitive domains in hospitalised geriatric patients: study protocol for a randomized controlled trial
(Elsevier, 2025-07-01) Ferrara, Maria Cristina; Zambom Ferraresi, Fabíola; Galbete Jiménez, Arkaitz; Fernández González de la Riva, María Luisa; Izco-Cubero, Maite; García Baztán, Agurne; Capón Sáez, Amaya; Domínguez-Mendoza, Soledad ; Marín Epelde, Itxaso; Zambom Ferraresi, Fabrício; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Gobierno de Navarra / Nafarroako Gobernua
Antecedentes: Los modelos de atención convencionales para los adultos mayores a menudo ignoran los efectos negativos de la hospitalización y descuidan los beneficios potenciales de la tecnología. Este ensayo tiene como objetivo investigar los efectos del Programa de Ejercicio Multicomponente con Realidad Virtual (MEP-VR) sobre los resultados funcionales y cognitivos en adultos mayores hospitalizados, en comparación con el MEP solo o con los enfoques de atención habituales. Métodos: Este ensayo controlado aleatorizado de grupos paralelos de tres brazos incluirá 255 participantes de 75 años o más, con una puntuación del índice de Barthel de al menos 60, capaces de caminar y cooperar, con una estancia hospitalaria estimada de al menos cuatro días y que proporcionen consentimiento informado. Se excluirá a los pacientes con demencia grave, enfermedad terminal o inestabilidad clínica. Los participantes serán asignados aleatoriamente a un grupo de control o a uno de los dos grupos de intervención. Los grupos de intervención recibirán un programa MEP-VR o solo MEP, consistente en ejercicio aeróbico supervisado, entrenamiento de resistencia y entrenamiento del equilibrio, con o sin un componente de realidad virtual. La intervención tendrá lugar durante cuatro días consecutivos y cada sesión durará entre 30 y 40 minutos. La medida de resultado primaria serán los cambios funcionales en el momento del alta. También se evaluarán la cognición, el estado de ánimo, la calidad de vida y la usabilidad de la realidad virtual inmersiva (RVI). Discusión: Los avances tecnológicos están aumentando rápidamente con el envejecimiento de la población, creando beneficios potenciales para la integración de la tecnología en el cuidado de adultos mayores. Este estudio evalúa la implementación de RVI combinada con MEP. Si nuestra hipótesis resulta acertada, allanará el camino para modificar el sistema de hospitalización, ayudando a reducir la carga crítica para la atención sanitaria que supone la discapacidad adquirida en el hospital en la población de edad avanzada. Registro del ensayo: Este estudio fue aprobado por el Comité Ético de Investigación Clínica de Navarra el 14 de junio de 2021 (PI 2021 90). El ensayo se registró de forma retrospectiva en ClinicalTrials.gov,número de registro NCT06469554.
Open Access
Influence of clinical and neurocognitive factors in psychosocial functioning after a first episode non-affective psychosis: differences between males and females
(Frontiers Media, 2022-10-20) Serra-Navarro, María; Amoretti, Silvia; Verdolini, Norma; Forte, María Florencia; Sánchez Torres, Ana María; Vieta, Eduard; Clougher, Derek; Lobo, Antonio; González Pinto, Ana; Panadero-Gómez, Rocío; Roldán, Alexandra; Carvalho, André F.; Serna, Elena de la; Toll, Alba; Ramos-Quiroga, Josep Antoni; Torrent, Carla; Cuesta, Manuel J.; Bernardo, Miguel; PEPs Group; Ciencias de la Salud; Osasun Zientziak
Background: Deficits in psychosocial functioning are present in the early stages of psychosis. Several factors, such as premorbid adjustment, neurocognitive performance, and cognitive reserve (CR), potentially influence functionality. Sex differences are observed in individuals with psychosis in multiple domains. Nonetheless, few studies have explored the predictive. factors of poor functioning according to sex in first-episode psychosis (FEP). This study aimed to explore sex differences, examine changes, and identify predictors of functioning according to sex after onset. Materials and methods: The initial sample comprised 588 individuals. However, only adults with non-affective FEP (n = 247, 161 males and 86 females) and healthy controls (n = 224, 142 males and 82 females) were included. A comprehensive assessment including functional, neuropsychological, and clinical scales was performed at baseline and at 2-year follow-up. A linear regression model was used to determine the predictors of functioning at 2-year follow-up. Results: FEP improved their functionality at follow-up (67.4% of both males and females). In males, longer duration of untreated psychosis (β = 0.328, p = 0.003) and worse premorbid adjustment (β = 0.256, p = 0.023) were associated with impaired functioning at 2-year follow-up, while in females processing speed (β = 0.403, p = 0.003), executive function (β = 0.299, p = 0.020) and CR (β = −0.307, p = 0.012) were significantly associated with functioning. Conclusion: Our data indicate that predictors of functioning at 2-year followup in the FEP group differ according to sex. Therefore, treatment and preventative efforts may be adjusted taking sex into account. Males may benefit from functional remediation at early stages. Conversely, in females, early interventions centered on CR enhancement and cognitive rehabilitation may be recommended.
Open Access
A clinical staging model of psychotic disorders based on a long-term follow-up of first-admission psychosis: a validation study
(Elsevier, 2023-04-01) Peralta Martín, Víctor; García de Jalón, Elena; Moreno-Izco, Lucía; Peralta, David; Janda-Galán, Lucía; Sánchez Torres, Ana María; Cuesta, Manuel J.; SEGPEPs Group; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
We examined the empirical validity of a staging model of psychotic disorders primarily based on their long-term course. The model distinguished 6 consecutive stages (2A, 2B, 3A, 3B, 4A, 4B) based on symptom recurrence, persistence and progression, such as functional decline. We analyzed data from 243 participants with first-admission psychosis who were followed-up for a mean of 20.9 years and assessed for 22 baseline variables, 23 construct-related variables and 31 outcome variables. Later stages scored significantly poorer than early stages on most validators by showing generally medium to large effect sizes and a dose-response pattern, thus confirming the validity of the model. For each set of validators, differences between consecutive stages were especially evident for stages 2 and 3A, although many variables from each validation realm also differentiated between the consecutive stages 3A and above. Baseline predictors including familial load of schizophrenia, neurodevelopmental impairment, childhood adversity, treatment delay, negative symptoms, neurological impairment and poor early response to treatment, independently accounted for 49.9% of the variance of staging. A staging model of psychosis based primarily on its long-term course has sound construct, outcome and predictive validity, which may inform about stage indicators and predictors of clinical stages from psychosis onset.
Open Access
The economic and social burden of pediatric cerebral palsy in Spain: a cost-of-illness study
(Frontiers Media, 2025-07-23) Nova Díaz, Diana Marcela; Arana-Rivera, Paloma; Sánchez Iriso, Eduardo; Aguilera Albesa, Sergio; Ciencias de la Salud; Osasun Zientziak; Economía; Ekonomia; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa; Gobierno de Navarra / Nafarroako Gobernua
Background: Cerebral palsy (CP) is the leading cause of motor disability in children and a lifelong condition with no cure, imposing a significant economic burden on families and healthcare systems. However, the economic impact of pediatric CP remains underexplored in Spain, hindering the development of costeective policies. Cost-of-illness (COI) studies are essential to quantify disease burden and guide resource allocation. This study aims to classify and estimate the economic and social costs of pediatric CP in Spain from a societal perspective, considering healthcare, government, and family burdens. Additionally, it evaluates the caregiving burden experienced by primary caregivers. Methods: A bottom–up, disease-specific COI study was conducted from a societal perspective using data from a population-based epidemiological registry of CP. Data collection included structured questionnaires and administrative records from regional healthcare and government sources, covering a 1-year period. The Zarit Burden Interview was used to assess caregiver burden. The study captures direct, indirect, and out-of-pocket costs, including productivity losses associated with caregiving. Results: The study included 148 children with CP (mean age: 9.72) and their primary caregivers (66% female, mean age: 42.97 years). Medical care costs averaged e3,801 (3.72%), while out-of-pocket expenses totalled e7,041 (6.89%), largely driven by complementary and alternative therapies used by 64% of families. Special education represented e8,932 (8.75%), whereas caregiver productivity losses were the largest component (e60,638; 59.37%). The mean annual societal cost per child was e102,135, over thirty times Spain’s mean per capita healthcare expenditure. However, using a conservative assumption that valued the caregiver’s time at the minimum wage, the social costs would be e70,190 per child. Children with severe motor impairment (GMFCS III–V) had nearly twice the cost of those with milder impairments (GMFCS I–II) (1.96; 95% CI: 1.92–2.01). Conclusions: The economic burden of pediatric CP is largely driven by caregiving and non-medical costs, highlighting gaps in financial and social support. These findings call for targeted policies to reduce caregiver strain and enhance funding for assistive services, improving equity in CP care. Additionally, comprehensive cost-eectiveness analyses are needed to guide resource allocation and ensure sustainable support strategies.
Open Access
In-depth mass-spectrometry reveals phospho-RAB12 as a blood biomarker of G2019S LRRK2-driven Parkinson's disease
(Oxford University Press, 2024-12-20) Cortés, Adriana; Phung, Toan K.; Mena, Lorena de ; Garrido, Alicia; Infante, Jon; Ruíz-Martínez, Javier; Galmés-Ordinas, Miquel À.; Glendinning, Sophie; Pérez, Jesica ; Roig, Ana ; Soto, Marta; Cosgaya, Marina; Ravasi, Valeria; Fernández, Manel; Rubiano-Castro, Alejandro ; Díaz, Ramón; Hernández-Eguiazu, Haizea ; Sánchez-Quintana, Coro; Vinagre-Aragón, Ana; Mondragón, Elisabet; Croitoru, Ioana; Rivera-Sánchez, María ; Corrales-Pardo, Andrea; Sierra, María; Tolosa, Eduardo; Malagelada, Cristina; Nirujogi, Raja S.; Fernández Irigoyen, Joaquín; Santamaría Martínez, Enrique; Alessi, Dario R.; Martí, María J.; Ezquerra, Mario; Fernández-Santiago, Rubén; Ciencias de la Salud; Osasun Zientziak
Leucine-rich repeat kinase 2 (LRRK2) inhibition is a promising disease-modifying therapy for LRRK2-associated Parkinson's disease (L2PD) and idiopathic PD. However, pharmacodynamic readouts and progression biomarkers for clinical trials aiming for disease modification are insufficient, given that no endogenous marker reflecting enhanced kinase activity of the most common LRRK2 G2019S mutation has yet been reported in L2PD patients.Using phospho-/proteomic analyses, we assessed the impact of LRRK2-activating mutations in peripheral blood mononuclear cells from an LRRK2 clinical cohort from Spain (n = 174). The study groups encompassed G2019S L2PD patients (n = 37), non-manifesting LRRK2 mutation carriers of G2019S (here termed G2019S L2NMCs) (n = 27), R1441G L2PD patients (n = 14), R1441G L2NMCs (n = 11), idiopathic PD patients (n = 40) and healthy controls (n = 45).We identified 207 differentially regulated proteins in G2019S L2PD compared with controls (39 upregulated and 168 downregulated) and 67 in G2019S L2NMCs (10 upregulated and 57 downregulated). G2019S downregulated proteins affected the endolysosomal pathway, proteostasis and mitochondria, e.g. ATIC, RAB9A or LAMP1. At the phospho-proteome level, we observed increases in endogenous phosphorylation levels of pSer106 RAB12 in G2019S carriers, which were validated by immunoblotting after 1 year of follow-up (n = 48). Freshly collected peripheral blood mononuclear cells from three G2019S L2PD, one R1441G L2PD, one idiopathic PD and five controls (n = 10) showed strong diminishment of pSer106 RAB12 phosphorylation levels after in vitro administration of the MLi-2 LRRK2 inhibitor. Using machine learning, we identified an 18-feature G2019S phospho-/protein signature discriminating G2019S L2PD, L2NMCs and controls with 96% accuracy that was correlated with disease severity, i.e. UPDRS-III motor scoring.Using easily accessible peripheral blood mononuclear cells from a LRRK2 clinical cohort, we identified elevated levels of pSer106 RAB12 as an endogenous biomarker of G2019S carriers. Our data suggest that monitoring pSer106 RAB12 phosphorylation could be a relevant biomarker for tracking LRRK2 activation, particularly in G2019S carriers. Future work might determine whether pSer106 RAB12 could help with patient enrichment and monitoring drug efficacy in LRRK2 clinical trials. The LRRK2 activating mutation G2019S is the most frequent genetic cause of Parkinson's disease. Through phospho-proteome analysis of blood, Cort & eacute;s et al. identify elevated phospho-RAB12 levels as an endogenous biomarker of G2019S mutation carriers, with potential utility in clinical trials.