Publications by authors named "Maria Cabello"

56 Publications

To be happy and behave in a healthier way. A longitudinal study about gender differences in the older population.

Psychol Health 2021 Aug 5:1-17. Epub 2021 Aug 5.

Department of Psychiatry, Universidad Autónoma de Madrid, Spain.

Introduction: Subjective well-being plays a key role in health. The objectives of this study are to analyse the longitudinal associations between subjective well-being dimensions and healthy behaviours, and to examine gender differences.

Method: A representative sample of 1,190 Spanish non-institutionalised adults aged 50+ were interviewed over a 6-year follow-up period. The Cantril scale was used to measure evaluative well-being. The Day Reconstruction Method measured experienced well-being. The Global Physical Activity Questionnaire was used, whereas fruit and vegetables, tobacco and alcohol consumption, and sleep quality were self-reported. The Generalised Estimating Equation was calculated.

Results: Women show significantly worse subjective well-being than men longitudinally. Higher scores in life satisfaction and positive affect were significantly related to a higher level of physical activity and better-quality sleep for both women and men. Associations between a higher life satisfaction and an adequate intake of fruits and vegetables and being a non-smoker was only found in women (OR = 1.05; 95% IC = 1.00, 1.10 and OR = 1.16; 95% IC = 1.09, 1.23, respectively).

Conclusion: Subjective well-being levels and frequencies in healthy behaviours are different in women and men. Subjective well-being interventions should take into account these differences in the frequency of healthy-unhealthy behaviours.
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http://dx.doi.org/10.1080/08870446.2021.1960988DOI Listing
August 2021

The effect of exposure to long working hours on depression: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.

Environ Int 2021 10 15;155:106629. Epub 2021 Jun 15.

Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland. Electronic address:

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates), supported by a large number of individual experts. Evidence from previous reviews suggests that exposure to long working hours may cause depression. In this article, we present a systematic review and meta-analysis of parameters for estimating (if feasible) the number of deaths and disability-adjusted life years from depression that are attributable to exposure to long working hours, for the development of the WHO/ILO Joint Estimates.

Objectives: We aimed to systematically review and meta-analyse estimates of the effect of exposure to long working hours (three categories: 41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on depression (three outcomes: prevalence, incidence and mortality).

Data Sources: We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies, including the WHO International Clinical Trial Registers Platform, Medline, PubMed, EMBASE, Web of Science, CISDOC and PsycInfo. We also searched grey literature databases, Internet search engines and organizational websites; hand-searched reference lists of previous systematic reviews; and consulted additional experts.

Study Eligibility And Criteria: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (aged <15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of exposure to long working hours (41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on depression (prevalence, incidence and/or mortality).

Study Appraisal And Synthesis Methods: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. Missing data were requested from principal study authors. We combined odds ratios using random-effects meta-analysis. Two or more review authors assessed the risk of bias, quality of evidence and strength of evidence, using Navigation Guide and GRADE tools and approaches adapted to this project.

Results: Twenty-two studies (all cohort studies) met the inclusion criteria, comprising a total of 109,906 participants (51,324 females) in 32 countries (as one study included multiple countries) in three WHO regions (Americas, Europe and Western Pacific). The exposure was measured using self-reports in all studies, and the outcome was assessed with a clinical diagnostic interview (four studies), interview questions about diagnosis and treatment of depression (three studies) or a validated self-administered rating scale (15 studies). The outcome was defined as incident depression in all 22 studies, with first time incident depression in 21 studies and recurrence of depression in one study. We did not identify any study on prevalence of depression or on mortality from depression. For the body of evidence for the outcome incident depression, we had serious concerns for risk of bias due to selection because of incomplete outcome data (most studies assessed depression only twice, at baseline and at a later follow-up measurement, and likely have missed cases of depression that occurred after baseline but were in remission at the time of the follow-up measurement) and due to missing information on life-time prevalence of depression before baseline measurement. Compared with working 35-40 h/week, we are uncertain about the effect on acquiring (or incidence of) depression of working 41-48 h/week (pooled odds ratio (OR) 1.05, 95% confidence interval (CI) 0.86 to 1.29, 8 studies, 49,392 participants, I 46%, low quality of evidence); 49-54 h/week (OR 1.06, 95% CI 0.93 to 1.21, 8 studies, 49,392 participants, I 40%, low quality of evidence); and ≥ 55 h/week (OR 1.08, 95% CI 0.94 to 1.24, 17 studies, 91,142 participants, I 46%, low quality of evidence). Subgroup analyses found no evidence for statistically significant (P < 0.05) differences by WHO region, sex, age group and socioeconomic status. Sensitivity analyses found no statistically significant differences by outcome measurement (clinical diagnostic interview [gold standard] versus other measures) and risk of bias ("high"/"probably high" ratings in any domain versus "low"/"probably low" in all domains).

Conclusions: We judged the existing bodies of evidence from human data as "inadequate evidence for harmfulness" for all three exposure categories, 41-48, 48-54 and ≥55 h/week, for depression prevalence, incidence and mortality; the available evidence is insufficient to assess effects of the exposure. Producing estimates of the burden of depression attributable to exposure to long working appears not evidence-based at this point. Instead, studies examining the association between long working hours and risk of depression are needed that address the limitations of the current evidence.
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http://dx.doi.org/10.1016/j.envint.2021.106629DOI Listing
October 2021

Loneliness and not living alone is what impacted on the healthcare professional's mental health during the COVID-19 outbreak in Spain.

Health Soc Care Community 2021 Mar 24. Epub 2021 Mar 24.

Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.

The present study is aimed at exploring the role of loneliness in the healthcare professionals' mental health during the COVID-19 outbreak in Spain. A total of 1,421 healthcare professionals who were in contact with at least one positive COVID-19 patient participated in a cross-sectional online survey from April to June 2020. Mental health was measured with the General Health Questionnaire-12, and loneliness was assessed with the 3-item UCLA Loneliness Scale. More than 80% of participants showed a certain prone to experience mental health problems, and 90% felt that they had not enough workplace protective measures to manage COVID-19 patients. Presence of loneliness was positively related to higher mental health problems after controlling for other covariates. Other factors related to higher mental health problems were a higher COVID-19 risk perception, being in quarantine, checking COVID-19-related news several times a day and having a lower training on managing infectious diseases. Neither living alone, nor supervisor social support, were related to healthcare professionals' mental health. Results suggest that the impact of COVID-19 in terms of mental health in the healthcare professionals could be more related to subjective appraisals of social isolation rather than to be physically alone. There were also a variety of cognitive, behavioural and training-related factors that were associated with the healthcare professionals' mental health, and that should be potentially managed in the mental healthcare interventions.
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http://dx.doi.org/10.1111/hsc.13260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250561PMC
March 2021

How does neighbourhood socio-economic status affect the interrelationships between functioning dimensions in first episode of psychosis? A network analysis approach.

Health Place 2021 May 18;69:102555. Epub 2021 Mar 18.

Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Del Hospital Universitario de La Princesa, IIS Princesa, CIBERSAM, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain. Electronic address:

The links between psychosis and socio-economic disadvantage have been widely studied. No previous study has analysed the interrelationships and mutual influences between functioning dimensions in first episode of psychosis (FEP) according to their neighbourhood household income, using a multidimensional and transdiagnostic perspective. 170 patients and 129 controls, participants in an observational study (AGES-CM), comprised the study sample. The WHO Disability Assessment Schedule (WHODAS 2.0) was used to assess functioning, whereas participants' postcodes were used to obtain the average household income for each neighbourhood, collected by the Spanish National Statistics Institute (INE). Network analyses were conducted with the aim of defining the interrelationships between the different dimensions of functioning according to the neighbourhood household income. Our results show that lower neighbourhood socioeconomic level is associated with lower functioning in patients with FEP. Moreover, our findings suggest that "household responsibilities" plays a central role in the disability of patients who live in low-income neighbourhoods, whereas "dealing with strangers" is the most important node in the network of patients who live in high-income neighbourhoods. These results could help to personalize treatments, by allowing the identification of potential functioning areas to be prioritized in the treatment of FEP according to the patient's neighbourhood characteristics.
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http://dx.doi.org/10.1016/j.healthplace.2021.102555DOI Listing
May 2021

The interplay between functioning problems and symptoms in first episode of psychosis: An approach from network analysis.

J Psychiatr Res 2021 04 15;136:265-273. Epub 2021 Feb 15.

Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, IIS Princesa, CIBERSAM, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain. Electronic address:

The relationship between psychotic symptoms and global measures of functioning has been widely studied. No previous study has assessed so far the interplay between specific clinical symptoms and particular areas of functioning in first-episode psychosis (FEP) using network analysis methods. A total of 191 patients with FEP (age 24.45 ± 6.28 years, 64.9% male) participating in an observational and longitudinal study (AGES-CM) comprised the study sample. Functioning problems were assessed with the WHO Disability Assessment Schedule (WHODAS), whereas the Positive and Negative Syndrome Scale (PANSS) was used to assess symptom severity. Network analysis were conducted with the aim of analysing the patterns of relationships between the different dimensions of functioning and PANSS symptoms and factors at baseline. According to our results, the most important nodes were "conceptual disorganization", "emotional withdrawal", "lack of spontaneity and flow of conversation", "delusions", "unusual thought content", "dealing with strangers" and "poor rapport". Our findings suggest that these symptoms and functioning dimensions should be prioritized in the clinical assessment and management of patients with FEP. These areas may also become targets of future early intervention strategies, so as to improve quality of life in this population.
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http://dx.doi.org/10.1016/j.jpsychires.2021.02.024DOI Listing
April 2021

Herbal and Dietary Supplements-Induced Liver Injury in Latin America: Experience From the LATINDILI Network.

Clin Gastroenterol Hepatol 2021 Jan 9. Epub 2021 Jan 9.

UGC de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red: Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.

Background: Herbal and dietary supplements (HDS) consumption, a growing cause of hepatotoxicity, is a common practice among Latin-American populations.

Objectives: To evaluate clinical, laboratory features and outcome in HDS-hepatotoxicity included in the Latin America-Drug Induced Liver Injury (LATINDILI) Network.

Methods: A total of 29 adjudicated cases of HDS hepatotoxicity reported to the LATINDILI Network from October 2011 through December 2019 were compared with 322 DILI cases due to conventional drugs and 16 due to anabolic steroids as well as with other series of HDS-hepatotoxicity.

Results: From 367 DILI cases, 8% were attributed to HDS. An increasing trend in HDS-hepatotoxicity was noted over time (p = .04). Camellia sinensis, Herbalife® products, and Garcinia cambogia, mostly used for weight loss, were the most frequently adjudicated causative agents. Mean age was 45 years (66% female). Median time to onset was 31 days. Patients presented typically with hepatocellular injury (83%) and jaundice (66%). Five cases (17%) developed acute liver failure. Compared to conventional medications and anabolic steroids, HDS hepatotoxicity cases had the highest levels of aspartate and alanine transaminase (p = .008 and p = .021, respectively), had more re-exposure events to the culprit HDS (14% vs 3% vs 0%; p = .026), and had more severe and fatal/liver transplantation outcomes (21% vs 12% vs 13%; p = .005). Compared to other DILI cohorts, less HDS hepatotoxicity cases in Latin America were hospitalized (41%).

Conclusions: HDS-hepatotoxicity in Latin-America affects mainly young women, manifests mostly with hepatocellular injury and is associated with higher frequency of accidental re-exposure. HDS hepatotoxicity is more serious with a higher chance of death/liver transplantation than DILI related to conventional drugs.
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http://dx.doi.org/10.1016/j.cgh.2021.01.011DOI Listing
January 2021

A network analysis approach to functioning problems in first psychotic episodes and their relationship with duration of untreated illness: Findings from the PAFIP cohort.

J Psychiatr Res 2021 04 22;136:483-491. Epub 2020 Oct 22.

CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; University Hospital Virgen del Rocío, Department of Psychiatry. Instituto de Investigación Sanitaria de Sevilla, IBiS, Sevilla, Spain; University of Sevilla, Sevilla, Spain.

Background: The domains of functioning affected by first episode of psychosis (FEP) could be analysed as forming a network of interacting or even reinforcing elements. The reasons why longer duration of untreated psychosis (DUP) might be related to higher disability are not still clear. The aim of the present study is to evaluate how different areas of functioning are inter-related according to the length of DUP in patients with FEP, with a particular focus on studying the relative influence of each other according to lengthy delays in initial treatment.

Method: 441 participants in an epidemiological and intervention program of first episode psychosis (PAFIP) were included in our study. Functioning problems at baseline were assessed with the WHO Disability Assessment Schedule (DAS). Three networks of functioning domains have been estimated according to the length of DUP.

Results: All the DAS items took part in the different networks. We have not found differences across the edge weights in the short, medium and long DUP groups. The domains "social withdrawal", "participation in the household activities", "general interest and information", and "low level of activity" seem to act as bridge items with other areas of functioning in people with longer DUP.

Conclusions: Our results could have clinical implications for patients with longer DUP, in which case, social withdrawal, household activities, level of activity and general interest in the world around them, could be high-priority target areas of treatment, since they seem to be mediating the relation between others areas of functioning.
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http://dx.doi.org/10.1016/j.jpsychires.2020.10.019DOI Listing
April 2021

Psychosocial interventions for violence exposed youth - A systematic review.

Child Abuse Negl 2020 10 14;108:104530. Epub 2020 Aug 14.

Countway Library, Harvard School of Public Health, Boston, United States.

Background: Violence exposure (direct, indirect, individual, structural) affects youth mental health.

Objective: We aimed to evaluate the effectiveness of psychosocial interventions in addressing the sequelae of violence exposure on youth (15-24 years old) and evaluate whether moderating factors impact intervention effectiveness.

Methods: We systematically searched eight databases and reference lists to retrieve any studies of psychosocial interventions addressing mental health among youth aged 15-25 exposed to violence. We assessed study risk of bias using an adapted version of the Downs and Black's Risk of Bias Scale.

Results: We identified n = 3077 studies. Sixteen articles representing 14 studies met were included. The studies assessed direct and indirect individual violence exposure at least once. We pooled the data from the 14 studies and evaluated the effects. We estimated an average effect of r+ = 0.57 (RCTs: 95 % CI 0.02-1.13; observational studies: 95 % CI 0.27-86) with some heterogeneity (RCTs: I = 78.03, longitudinal studies: I = 82.93). The most effective interventions are Cognitive Behavioral Therapy, and Exposure Therapy with an exposure focus. However, due to the small number of studies we are uncertain about benefits of interventions.

Conclusions: No study assessed structural violence. Therefore, studies are needed to evaluate the effects of psychosocial interventions for youth exposed to direct, indirect, individual and structural violence.
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http://dx.doi.org/10.1016/j.chiabu.2020.104530DOI Listing
October 2020

Exploring the effect of loneliness on all-cause mortality: Are there differences between older adults and younger and middle-aged adults?

Soc Sci Med 2020 08 30;258:113087. Epub 2020 May 30.

Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, Spain.

Objective: This study aims to investigate the association between loneliness and all-cause mortality over a six-year follow-up period using the overall sample and by age groups (18-59 years and 60+ years).

Method: Data from a longitudinal, prospective study of a nationally-representative sample of the Spanish non-institutionalized adult population were analysed (n = 4467). Mortality was ascertained via linkage to the National Death Index or obtained during the household visits. The UCLA Loneliness Scale was used to measure loneliness. Sex, age, education, physical activity, tobacco consumption, body mass index, disability, depression, living situation, and social participation were also considered as covariates. Multivariable Cox proportional hazard models were carried out.

Results: A higher level of loneliness was not associated with mortality risk in fully covariate-adjusted models over the entire population (HR = 1.02; 95% CI = 0.94, 1.12). The interaction term between loneliness and age groups was significant, indicating that the rate for survival of loneliness varied by age (HR = 1.29; 95% CI = 1.02, 1.63 for young- and middle-aged individuals; HR = 0.96; 95% CI = 0.89, 1.04 for older adults).

Conclusions: The development of interventions aimed at tackling loneliness among young- and middle-aged adults might contribute to a mortality risk reduction. Future research is warranted to test whether our results can be replicated.
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http://dx.doi.org/10.1016/j.socscimed.2020.113087DOI Listing
August 2020

Profile of herbal and dietary supplements induced liver injury in Latin America: A systematic review of published reports.

Phytother Res 2021 Jan 11;35(1):6-19. Epub 2020 Jun 11.

Servicio de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga - IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Spain.

Hepatotoxicity related to HDS is a growing global health issue. We have undertaken a systematic review of published case reports and case series from LA from 1976 to 2020 to describe the clinical features of HDS related hepatotoxicity in this region. We search in PubMed, Web of Science, Scopus and specific LA databases according to PRISMA guidelines. Only HILI cases published in LA that met criteria for DILI definition were included. Duplicate records or reports that lacked relevant data that precluded establishing causality were excluded. Finally, 17 records (23 cases) were included in this review. Centella asiatica, Carthamus tinctorius, and Herbalife® were the most reported HDS culprit products, the main reason for HDS consumption was weight loss. The clinical characteristics of HDS hepatotoxicity in our study were compared to those of other studies in the USA, Europe and China showing a similar signature with predominance of young females, hepatocellular damage, a high rate of ALF and mortality, more frequent inadvertent re-challenge and chronic damage. This study underscores the challenge in causality assessment when multi-ingredients HDS are taken and the need for consistent publication practice when reporting hepatotoxicity cases due to HDS, to foster HDS liver safety particularly in LA.
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http://dx.doi.org/10.1002/ptr.6746DOI Listing
January 2021

Functioning profiles in a nationally representative cohort of Spanish older adults: A latent class study.

Health Soc Care Community 2020 11 5;28(6):2190-2198. Epub 2020 Jun 5.

Centre for Biomedical Research in Mental Health (CIBERSAM), Spain.

Ageing well involves individuals continuing participating in personal, social and civic affairs even in older age. From this standpoint, limitations in individual's functioning (beyond the mere absence of disease) may drastically impact on how well people becoming older. This study aimed to identify functional status profiles in a nationally representative sample of older adults, using latent class analysis methods. Moreover, it intended to study the how identified classes would be related to health-related outcomes later in life, as a way to provide some evidence on predictive validity. Data from a nationally representative sample of Spanish older adults (N = 2,118; 56.18% women; M = 71.50 years, SD = 7.76), were used. Profiles were identified according to a large set of functioning indicators from multiple domains using latent class analysis. Outcomes were studied over a 3-year follow-up, considering both the individual (quality of life, well-being and mortality) and institutional level (health service utilisation). As a result, seven profiles were identified: normative profile (showed by most participants), limited cognitive functioning class, limited global functioning class, limited mental and mobility functioning class, poor self-reported health class, limited sensory functioning class and limited objective functioning class. All the profiles with limitations across domains showed poor outcomes. Multidimensional limitations were related to the worst outcomes, especially when psychosomatic complaints and high feelings of loneliness were reported. To sum up, latent class analysis constitutes a suitable alternative to study population heterogeneity, providing relevant evidence to help making decision in public and community health.
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http://dx.doi.org/10.1111/hsc.13031DOI Listing
November 2020

Gender perspective in the analysis of the relationship between health and work cessation, and how to deal with it.

Int J Occup Med Environ Health 2020 Apr 21;33(3):365-384. Epub 2020 Apr 21.

Jagiellonian University Medical College, Kraków, Poland (Department of Medical Sociology).

Objectives: The main objective of this study is to examine the relationship between health and an early exit from paid employment in the Finnish, Polish, and Spanish populations. The authors have addressed the following 3 issues: who chooses not to work according to gender patterns, whether the health status is a determinant of being non-employed, and what diseases are associated with being non-employed.

Material And Methods: The studied material consists of data from the Collaborative Research on Ageing in Europe (COURAGE in Europe) project. The analysis was based on a sample of 5868 individuals, including 1214 from Finland, 2152 from Poland and 2532 from Spain. In the paper, these data were complemented with the results of the PArticipation To Healthy Workplaces And inclusive Strategies in the Work Sector (PATHWAYS) project.

Results: The results of the study revealed that self-rated health was a strong predictor of being non-employed for different reasons. Chronic diseases, such as arthritis, angina, diabetes, chronic obstructive pulmonary disease, depression and hypertension, were typically associated with an increased risk of being non-employed due to health problems and early retirement. Women more frequently reported arthritis and depression, while a higher proportion of men suffered from angina and diabetes.

Conclusions: The results obtained by the authors highlight the importance of evaluating gender patterns in work cessation and, at the same time, the importance of gender-focused actions in terms of preventing withdrawal from the labor market. In principle, all chronic diseases have some impact on participation in the labor market. It is worth noting, however, that each of them affects workforce participation in a different manner, depending on the specific disease, country and gender. For this reason, tailored support to every individual's needs is highly recommended. Int J Occup Med Environ Health. 2020;33(3):365-84.
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http://dx.doi.org/10.13075/ijomeh.1896.01351DOI Listing
April 2020

Gender perspective in the analysis of the relationship between health and work cessation, and how to deal with it.

Int J Occup Med Environ Health 2020 Apr 21;33(3):365-384. Epub 2020 Apr 21.

Jagiellonian University Medical College, Kraków, Poland (Department of Medical Sociology).

Objectives: The main objective of this study is to examine the relationship between health and an early exit from paid employment in the Finnish, Polish, and Spanish populations. The authors have addressed the following 3 issues: who chooses not to work according to gender patterns, whether the health status is a determinant of being non-employed, and what diseases are associated with being non-employed.

Material And Methods: The studied material consists of data from the Collaborative Research on Ageing in Europe (COURAGE in Europe) project. The analysis was based on a sample of 5868 individuals, including 1214 from Finland, 2152 from Poland and 2532 from Spain. In the paper, these data were complemented with the results of the PArticipation To Healthy Workplaces And inclusive Strategies in the Work Sector (PATHWAYS) project.

Results: The results of the study revealed that self-rated health was a strong predictor of being non-employed for different reasons. Chronic diseases, such as arthritis, angina, diabetes, chronic obstructive pulmonary disease, depression and hypertension, were typically associated with an increased risk of being non-employed due to health problems and early retirement. Women more frequently reported arthritis and depression, while a higher proportion of men suffered from angina and diabetes.

Conclusions: The results obtained by the authors highlight the importance of evaluating gender patterns in work cessation and, at the same time, the importance of gender-focused actions in terms of preventing withdrawal from the labor market. In principle, all chronic diseases have some impact on participation in the labor market. It is worth noting, however, that each of them affects workforce participation in a different manner, depending on the specific disease, country and gender. For this reason, tailored support to every individual's needs is highly recommended. Int J Occup Med Environ Health. 2020;33(3):365-84.
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http://dx.doi.org/10.13075/ijomeh.1896.01351DOI Listing
April 2020

The relationship between all-cause mortality and depression in different gender and age groups of the Spanish population.

J Affect Disord 2020 04 28;266:424-428. Epub 2020 Jan 28.

Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain. Electronic address:

Background: Literature has shown that the effect of depression on all-cause mortality is stronger in men. However, it is less clear whether depression affects older and younger people equally. The present study is aimed to analyze whether depression is associated to all-cause mortality in different age and gender groups.

Methods: We analyzed a nationally representative sample of the Spanish adult population that was followed-up on for a period of 6 years (n = 4583). Unadjusted and adjusted cox proportional hazard regression models were conducted to test whether baseline depression was associated to all-cause mortality in the total sample and in the different gender and age specific groups, separately.

Results: Unadjusted analyses revealed that depression was associated with higher likelihood of having a shorter survival and dying, in the total sample and in both groups of men (18-64 and 65+ years). However, adjusted analyses stratified by age groups and gender revealed that depression was only a significant factor for all-cause mortality in 18-64 aged men (HR: 6.11; 95%CI= 2.16,17.23).

Limitations: Cause-specific mortality was not examined. Young adults and middle-aged participants were not analyzed separately.

Conclusions: The depression and all-cause mortality relationship was only found among young and middle-aged men. Further studies should consider whether the significant association between depression and all-cause mortality in young and middle-aged men is due to a behavior of seeking help less, the way depression is shaped in adult men, or to other clinical or health-system related factors.
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http://dx.doi.org/10.1016/j.jad.2020.01.162DOI Listing
April 2020

Are younger cohorts in the USA and England ageing better?

Int J Epidemiol 2019 12;48(6):1906-1913

Division of Data, Analytics and Delivery for Impact, Geneva, Switzerland.

Background: Whether worldwide increases in life expectancy are accompanied by a better health status is still a debate. People age differently, and there is a need to disentangle whether healthy-ageing pathways can be shaped by cohort effects. This study aims to analyse trends in health status in two large nationally representative samples of older adults from England and the USA.

Methods: The sample comprised 55 684 participants from the first seven waves of the English Longitudinal Study of Ageing (ELSA), and the first 11 waves of the Health and Retirement Study (HRS). A common latent health score based on Bayesian multilevel item response theory was used. Two Bayesian mixed-effects multilevel models were used to assess cohort effects on health in ELSA and HRS separately, controlling for the effect of household wealth and educational attainment.

Results: Similar ageing trends were found in ELSA (β = -0.311; p < 0.001) and HRS (β = -0.393; p < 0.001). The level of education moderated the life-course effect on health in both ELSA (β = -0.082; p < 0.05) and HRS (β = -0.084; p < 0.05). A birth-year effect was found for those belonging to the highest quintiles of household wealth in both ELSA (β = 0.125; p < 0.001) and HRS (β = 0.170; p < 0.001).

Conclusions: Health inequalities have increased in recent cohorts, with the wealthiest participants presenting a better health status in both the USA and English populations. Actions to promote health in the ageing population should consider the increasing inequality scenario, not only by applying highly effective interventions, but also by making them accessible to all members of society.
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http://dx.doi.org/10.1093/ije/dyz126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929538PMC
December 2019

Patterns of mandibular asymmetries in two types of companion rabbits.

Anat Histol Embryol 2020 Mar 18;49(2):227-232. Epub 2019 Nov 18.

Department of Animal Science, ETSEA, University of Lleida, Lleida, Spain.

Developmental instability hypothesis suggests that asymmetric variation can partially reflect the body's inability to buffer environmental and/or genetic perturbations. Fluctuating asymmetry (FA), that is random differences between the left and right sides of body features that are symmetric at the population level, can assess this approach. Another kind of asymmetry is directional asymmetry (DA) which appears when the left and right sides differ consistently from each other. Extreme selection for morphological traits, as appear in some companion rabbits selected for a paedomorphic (dwarf rabbits) or gerontomorphic (belier rabbits) appearance, may cause abnormal functional conditions, which in turn could be expressed as significative degrees of asymmetries. To study these phenomena, we analysed 62 mandibles of companion rabbits (20 beliers and 42 dwarfs) by means of geometric morphometric methods and quantified their size and shape asymmetric variation (both FA and DA) using 18 landmarks on the lateral side. FA was present in both types but in different degrees, being higher among dwarfs. It is considered that this type is subject to deeper changes than among beliers, and therefore, there is higher pressure on the phenotype. This observation could be assumed to be an adaptive response, coming out as FA. The presence of DA was significative and similar for two types. This likely indicates common masticatory lateralization, a pattern that has been detected in other domestic mammals. The methodological framework presented in this study can be valuable for future works focused on genetically and/or environmentally related form study in pets.
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http://dx.doi.org/10.1111/ahe.12517DOI Listing
March 2020

Burden of influenza-associated respiratory hospitalizations in the Americas, 2010-2015.

PLoS One 2019 6;14(9):e0221479. Epub 2019 Sep 6.

National Institute of Health, Bogota, Colombia.

Background: Despite having influenza vaccination policies and programs, countries in the Americas underutilize seasonal influenza vaccine, in part because of insufficient evidence about severe influenza burden. We aimed to estimate the annual burden of influenza-associated respiratory hospitalizations in the Americas.

Methods: Thirty-five countries in the Americas with national influenza surveillance were invited to provide monthly laboratory data and hospital discharges for respiratory illness (International Classification of Diseases 10th edition J codes 0-99) during 2010-2015. In three age-strata (<5, 5-64, and ≥65 years), we estimated the influenza-associated hospitalizations rate by multiplying the monthly number of respiratory hospitalizations by the monthly proportion of influenza-positive samples and dividing by the census population. We used random effects meta-analyses to pool age-group specific rates and extrapolated to countries that did not contribute data, using pooled rates stratified by age group and country characteristics found to be associated with rates.

Results: Sixteen of 35 countries (46%) contributed primary data to the analyses, representing 79% of the America's population. The average pooled rate of influenza-associated respiratory hospitalization was 90/100,000 population (95% confidence interval 61-132) among children aged <5 years, 21/100,000 population (13-32) among persons aged 5-64 years, and 141/100,000 population (95-211) among persons aged ≥65 years. We estimated the average annual number of influenza-associated respiratory hospitalizations in the Americas to be 772,000 (95% credible interval 716,000-829,000).

Conclusions: Influenza-associated respiratory hospitalizations impose a heavy burden on health systems in the Americas. Countries in the Americas should use this information to justify investments in seasonal influenza vaccination-especially among young children and the elderly.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221479PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6730873PMC
March 2020

Burden of influenza-associated respiratory hospitalizations in the Americas, 2010-2015.

PLoS One 2019 6;14(9):e0221479. Epub 2019 Sep 6.

National Institute of Health, Bogota, Colombia.

Background: Despite having influenza vaccination policies and programs, countries in the Americas underutilize seasonal influenza vaccine, in part because of insufficient evidence about severe influenza burden. We aimed to estimate the annual burden of influenza-associated respiratory hospitalizations in the Americas.

Methods: Thirty-five countries in the Americas with national influenza surveillance were invited to provide monthly laboratory data and hospital discharges for respiratory illness (International Classification of Diseases 10th edition J codes 0-99) during 2010-2015. In three age-strata (<5, 5-64, and ≥65 years), we estimated the influenza-associated hospitalizations rate by multiplying the monthly number of respiratory hospitalizations by the monthly proportion of influenza-positive samples and dividing by the census population. We used random effects meta-analyses to pool age-group specific rates and extrapolated to countries that did not contribute data, using pooled rates stratified by age group and country characteristics found to be associated with rates.

Results: Sixteen of 35 countries (46%) contributed primary data to the analyses, representing 79% of the America's population. The average pooled rate of influenza-associated respiratory hospitalization was 90/100,000 population (95% confidence interval 61-132) among children aged <5 years, 21/100,000 population (13-32) among persons aged 5-64 years, and 141/100,000 population (95-211) among persons aged ≥65 years. We estimated the average annual number of influenza-associated respiratory hospitalizations in the Americas to be 772,000 (95% credible interval 716,000-829,000).

Conclusions: Influenza-associated respiratory hospitalizations impose a heavy burden on health systems in the Americas. Countries in the Americas should use this information to justify investments in seasonal influenza vaccination-especially among young children and the elderly.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221479PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6730873PMC
March 2020

Longitudinal properties of the PARADISE24fin questionnaire in treatment of substance use disorders.

Addict Behav 2019 08 17;95:125-128. Epub 2019 Mar 17.

A-Clinic Foundation, Ratamestarinkatu 7 A, 00520 Helsinki, Finland. Electronic address:

Aim: Improvement of overall functioning is an important goal in the treatment of substance use disorders, and thus tools for monitoring change are needed. The current study aimed to evaluate the longitudinal metric invariance and sensitivity to change for the PARADISE24fin questionnaire.

Methods: A total of 1153 patients with substance use disorders completed the PARADISE24fin in two measurement occasions along their treatment. Patients were categorized into three groups according to their treatment status at the second occasion (end of the treatment, on-treatment follow-up, and re-start treatment). The latent structure of the PARADISE24fin questionnaire was analyzed in the two measurement occasions with confirmatory factor analyses. Evidence of the PARADISE24fin sensitivity to change was studied comparing mean change scores for the three treatment status groups.

Results: The PARADISE24fin showed a strong longitudinal metric invariance across the two occasions in the three treatment status groups. The PARADISE24fin scores decreased during treatment, especially among the group of patients that had completed their treatment.

Conclusions: The PARADISE24fin is a reliable questionnaire to measure changes in psychosocial difficulties in substance use disorders overtime.
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http://dx.doi.org/10.1016/j.addbeh.2019.03.009DOI Listing
August 2019

WHO/ILO work-related burden of disease and injury: Protocol for systematic reviews of exposure to long working hours and of the effect of exposure to long working hours on depression.

Environ Int 2019 04 6;125:515-528. Epub 2019 Feb 6.

University of South Australia, Adelaide, Australia. Electronic address:

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing a joint methodology for estimating the national and global work-related burden of disease and injury (WHO/ILO joint methodology), with contributions from a large network of experts. In this paper, we present the protocol for two systematic reviews of parameters for estimating the number of deaths and disability-adjusted life years from depression attributable to exposure to long working hours, to inform the development of the WHO/ILO joint methodology.

Objectives: We aim to systematically review studies on occupational exposure to long working hours (Systematic Review 1) and systematically review and meta-analyse estimates of the effect of long working hours on depression (Systematic Review 2), applying the Navigation Guide systematic review methodology as an organizing framework, conducting both systematic reviews in tandem and in a harmonized way.

Data Sources: Separately for Systematic Reviews 1 and 2, we will search electronic academic databases for potentially relevant records from published and unpublished studies, including Medline, EMBASE, Web of Science, CISDOC and PsycINFO. We will also search electronic grey literature databases, Internet search engines and organizational websites; hand search reference list of previous systematic reviews and included study records; and consult additional experts.

Study Eligibility And Criteria: We will include working-age (≥15 years) participants in the formal and informal economy in any WHO and/or ILO Member State, but exclude child workers (<15 years) and unpaid domestic workers. For Systematic Review 1, we will include quantitative prevalence studies of relevant levels of occupational exposure to long working hours (i.e. 35-40, 41-48, 49-54 and ≥55 h/week) stratified by country, sex, age and industrial sector or occupation, in the years 2005-2018. For Systematic Review 2, we will include randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the relative effect of relevant level(s) of long working hours on the incidence of or mortality due to depression, compared with the theoretical minimum risk exposure level (i.e. 35-40 h/week).

Study Appraisal And Synthesis Methods: At least two review authors will independently screen titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. At least two review authors will assess risk of bias and the quality of evidence, using the most suited tools currently available. For Systematic Review 2, if feasible, we will combine relative risks using meta-analysis. We will report results using the guidelines for accurate and transparent health estimates reporting (GATHER) for Systematic Review 1 and the preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA) for Systematic Review 2.

Prospero Registration Number: CRD42018085729.
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http://dx.doi.org/10.1016/j.envint.2018.11.011DOI Listing
April 2019

[Prevalence and intensity of geohelminths infection characterizing the socio-cultural and environmental factors that affect the infection of school children, Paraguay, 2015].

Rev Chilena Infectol 2018;35(5):501-508

Organización Panamericana de la Salud, Asunción, Paraguay.

Introduction: Currently, Paraguay has no data on the prevalence of soil-transmitted geohelminth infection in schoolchildren aged 6 to 12 years.

Aim: To determine the prevalence and intensity of infection by Ascaris lumbricoides, Trichuris trichiura and hookworms and the socio-cultural-environmental characteristics of the affected population.

Methods: Descriptive, cross-sectional study, in three semi-tropical climatic zones: continental, semi steppe and humid. A total of 1,404 schoolchildren from 20 schools in eight departments were selected from the country's three climate zones. Copro-parasitological exams were analyzed in situ with the Kato-Katz method.

Results: The national prevalence for geohelminthiasis was 3.73% (95% CI = 2.8-4.8). The risk factors found were consumption of well water OR: 2.88 (95% CI = 1.64-2.07), ground floor in housing OR: 2.56 (95% CI = 1.45-4.50) and lack of flushing water baths in households OR: 2.29 (95% CI = 1.23-4.28).

Conclusion: Although the national prevalence of geohelminthiasis was low, it is recommended to promote good hygienic practices, use of footwear, and safe water consumption, as well as designing interventions with all relevant sectors to improve access to safe water and improved basic sanitation facilities.
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http://dx.doi.org/10.4067/s0716-10182018000500501DOI Listing
August 2019

Identifying psychosocial difficulties of inpatients with substance use disorders: evaluation of the usefulness of the PARADISE24 for clinical practise.

Disabil Rehabil 2020 01 5;42(1):130-136. Epub 2018 Sep 5.

Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid, Spain.

Improvements in overall functioning and well-being are important goals in the treatment of substance use disorders. The aim of the current study was to evaluate the usefulness of the PARADISE24 instrument for studying the scope and severity of psychosocial difficulties by comparing the results with other measures in the context of substance use disorders. This cross-sectional study included two independent inpatient samples. The first sample consisted of 80 interviews including the PARADISE24 and 10 other measures. The second sample consisted of the responses of 1082 inpatients to a self-administered PARADISE24 questionnaire. Inpatients with substance use disorders had experienced a wide range of psychosocial difficulties and the two samples produced similar results. Highest scores were observed for emotional difficulties. The PARADISE24 showed convergent validity with measures of disability and depressive symptoms and discriminant validity with personality traits and environmental factors (i.e., social support and caretaker's empathy). Psychosocial difficulties were inversely associated with quality of life and self-assessed health. The PARADISE24 provides a wide range of useful information on psychosocial difficulties for clinical work and it can be used as a self-administered questionnaire in the evaluation and treatment of substance use disorders.Implications for rehabilitationIndividuals undergoing inpatient treatment for substance use disorders experience various and severe psychosocial difficulties.The PARADISE24 is an evidence-based instrument for assessing the scope and severity of 24 common psychosocial difficulties among neurological and psychiatric disorders.The PARADISE24 also offers a time-efficient method which can be used as a self-administered questionnaire in the context of substance use disorders.Comparison between the PARADISE24 and 10 commonly used measures showed that the PARADISE24 covered a wide variety of clinically relevant issues in one questionnaire.
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http://dx.doi.org/10.1080/09638288.2018.1493543DOI Listing
January 2020

Identifying the Employment Needs of People With Chronic Health Conditions in Europe.

J Occup Environ Med 2018 11;60(11):e618-e624

Department of Psychiatry, Universidad Autonoma de Madrid, Madrid, Spain (Dr Ávila, Dr Ayuso-Mateos, and Dr Cabello); Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain (Dr Ávila, Dr Ayuso-Mateos, Dr Cabello); Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain (Dr Ávila, Dr Ayuso-Mateos, Dr Cabello); Research Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain (Ms Muñoz-Murillo); Department of Neurology, Public Health and Disability Unit, Neurological Institute "C. Besta" IRCCS, Foundation, Milan, Italy (Dr Scaratti); Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-Universität, Munich, Germany (Dr Coenen); Department of Special Education, University of Thessaly, Volos, Greece (Dr Vlachou); Neurorehabilitation, KABEG Gailtal-Klinik, Hermagor, Austria (Dr Fheodoroff); Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland (Ms Pilat); Development Unit for Employment Rehabilitation, University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia (Dr Tabaj); Department of Rehabilitation Medicine. Faculty of Medicine Charles University, Prague, Czech Republic (Dr Svestkova); European Association of Service providers for Persons with Disabilities, Brussels, Belgium (Ms Kadyrbaeva).

Objectives: The main goal of this study was to compare the employment needs experienced by people with different chronic health conditions and in different welfare systems.

Methods: A total of 688 participants with six chronic health conditions were collected in nine countries representing four welfare systems in Europe (Continental, Mediterranean, Postcommunist, and Scandinavian).

Results: Raising awareness of what is to live with a chronic health condition in the workplace was the area perceived as more favorable. The types of employment needs were different across the social welfare systems but did not vary among the different chronic health conditions groups.

Conclusion: Although diverse, there appear to be some common needs transversal to the working experience of people with chronic health problems. Actions to improve the employability of people with chronic health conditions should be tailored to each welfare system.
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http://dx.doi.org/10.1097/JOM.0000000000001425DOI Listing
November 2018

Working definitions, subjective and objective assessments and experimental paradigms in a study exploring social withdrawal in schizophrenia and Alzheimer's disease.

Neurosci Biobehav Rev 2019 02 24;97:38-46. Epub 2018 Jun 24.

Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy.

Social withdrawal is one of the first and common signs of early social dysfunction in a number of important neuropsychiatric disorders, likely because of the enormous amount and complexity of brain processes required to initiate and maintain social relationships (Adolphs, 2009). The Psychiatric Ratings using Intermediate Stratified Markers (PRISM) project focusses on the shared and unique neurobiological basis of social withdrawal in schizophrenia, Alzheimer and depression. In this paper, we discuss the working definition of social withdrawal for this study and the selection of objective and subjective rating scales to assess social withdrawal chosen or adapted for this project. We also discuss the MRI and EEG paradigms selected to study the systems and neural circuitry thought to underlie social functioning and more particularly to be involved in social withdrawal in humans, such as the social perception and the social affiliation networks. A number of behavioral paradigms were selected to assess complementary aspects of social cognition. Also, a digital phenotyping method (a smartphone application) was chosen to obtain real-life data.
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http://dx.doi.org/10.1016/j.neubiorev.2018.06.020DOI Listing
February 2019

Factors Related to Unemployment in Europe. A Cross-Sectional Study from the COURAGE Survey in Finland, Poland and Spain.

Int J Environ Res Public Health 2018 04 11;15(4). Epub 2018 Apr 11.

Neurological Institute C. Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, 20133 Milan, Italy.

: Research addressing the impact of a large number of factors on unemployment is scarce. We aimed to comprehensively identify factors related to unemployment in a sample of persons aged 18-64 from Finland, Poland and Spain. : In this cross-sectional study, factors from different areas were considered: socio-demographic indicators, health habits, chronic conditions, health state markers, vision and hearing indicators, and social networks and built environment scores. : Complete data were available for 5003 participants, mean age 48.1 (SD 11.5), 45.4% males. The most important factors connected to unemployment were health status indicators such as physical disability (OR = 2.944), self-rated health (OR = 2.629), inpatient care (OR = 1.980), and difficulties with getting to the toilet (OR = 2.040), while the most relevant factor related to employment were moderate alcohol consumption (OR = 0.732 for non-heavy drinkers; OR = 0.573 for infrequent heavy drinkers), and being married (OR = 0.734), or having been married (OR = 0.584). Other factors that played a significant role included presence of depression (OR = 1.384) and difficulties with near vision (OR = 1.584) and conversation hearing (OR = 1.597). : Our results highlight the importance of selected factors related to unemployment, and suggest public health indications that could support concrete actions on modifiable factors, such as those aimed to promote physical activity and healthy behaviors, tackling depression or promoting education, in particular for the younger.
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http://dx.doi.org/10.3390/ijerph15040722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5923764PMC
April 2018

Validity of the PARADISE24 questionnaire in people with substance use disorders: A measure to assess psychosocial difficulties.

Drug Alcohol Depend 2018 06 27;187:66-71. Epub 2018 Mar 27.

A-Clinic Foundation, Ratamestarinkatu 7 A, 00520, Helsinki, Finland.

Objectives: Psychosocial difficulties (PSDs) are common in people with substance use disorders (SUDs). The PARADISE24 has been shown to be an adequate tool for measuring PSDs in inpatients with SUDs. The aim of this study is to evaluate the psychometric properties of the PARADISE24 in a sample of patients with SUDs.

Methods: 2637 participants with SUDs completed the PARADISE24 questionnaire during their treatment. The latent structure of the PARADISE24 questionnaire was analyzed in the outpatient sample by means of exploratory and confirmatory factor analysis (EFA and CFA). Metric invariance was then assessed in relation to the inpatient sample using multiple group CFA. Finally, evidences of known-groups validity were checked to test the ability of the questionnaire to differentiate between socio-demographic and clinical groups.

Results: The one-factor model presented an adequate fit in both the EFA (CFI = 0.98; TLI = 0.98; RMSEA = 0.07) and the CFA (CFI = 0.98; TLI = 0.98; RMSEA = 0.07) solutions. The reliability of the scale was found to be high (α = 0.93). Strict metric invariance between inpatients and outpatients was achieved (RMSEA = 0.063; TLI = 0.983; CFI = 0.981). The PARADISE24 was able to discriminate between the inpatients and outpatients at both latent (d = 0.98) and observed levels (d = 0.86).

Conclusions: The PARADISE24 is a unidimensional tool that is reliable for assessing and comparing PSDs in both outpatients and inpatients with SUDs. Further research is required for evaluating the ability of the PARADISE24 to quantify longitudinal changes in PSDs.
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http://dx.doi.org/10.1016/j.drugalcdep.2018.02.012DOI Listing
June 2018

What Persons with Chronic Health Conditions Need to Maintain or Return to Work-Results of an Online-Survey in Seven European Countries.

Int J Environ Res Public Health 2018 03 26;15(4). Epub 2018 Mar 26.

Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Department of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), 81377 Munich, Germany.

Chronic health conditions represent the major share of the disease burden in Europe and have a significant impact on work. This study aims to: (1) identify factors that have a negative or positive impact on the work lives of persons with chronic health conditions; (2) explore the needs of these persons to maintain a job or return to work and (3) compare these results with respect to these persons' occupational status. An online survey was performed in seven European countries. Open-ended survey questions were analyzed using qualitative methods. In total, 487 participants with six chronic health conditions participated. The majority of participants named work-related aspects (such as career development, stress at the workplace, work structure and schedule as well as workload), support of others and attitudes of others as being the factors positively and negatively impact their work lives the most. Our study shed light on the importance of changing the attitudes of supervisors and co-workers to counteract stigmatization of persons with chronic health conditions in the workplace. In conclusion, this study provides a basis for developing new strategies of integration and reintegration at work for persons with chronic health conditions in European countries.
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http://dx.doi.org/10.3390/ijerph15040595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5923637PMC
March 2018

Herbal and Dietary Supplement-Induced Liver Injuries in the Spanish DILI Registry.

Clin Gastroenterol Hepatol 2018 09 4;16(9):1495-1502. Epub 2018 Jan 4.

Unidad de Gestión Clínica de Aparato Digestivo, Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, CIBERehd, Málaga, Spain.

Background & Aims: There have been increasing reports of liver injury associated with use of herbal and dietary supplements, likely due to easy access to these products and beliefs among consumers that they are safer or more effective than conventional medications. We aimed to evaluate clinical features and outcomes of patients with herbal and dietary supplement-induced liver injuries included in the Spanish DILI Registry.

Methods: We collected and analyzed data on demographic and clinical features, along with biochemical parameters, of 32 patients with herbal and dietary supplement-associated liver injury reported to the Spanish DILI registry from 1994 through 2016. We used analysis of variance to compare these data with those from cases of liver injury induced by conventional drugs or anabolic androgenic steroid-containing products.

Results: Herbal and dietary supplements were responsible for 4% (32 cases) of the 856 DILI cases in the registry; 20 cases of DILI (2%) were caused by anabolic androgenic steroids. Patients with herbal and dietary supplement-induced liver injury were a mean age of 48 years and 63% were female; they presented a mean level of alanine aminotransferase 37-fold the upper limit of normal, 28% had hypersensitivity features, and 78% had jaundice. Herbal and dietary supplement-induced liver injury progressed to acute liver failure in 6% of patients, compared with none of the cases of anabolic androgenic steroid-induced injury and 4% of cases of conventional drugs. Liver injury after repeat exposure to the same product that caused the first DILI episode occurred in 9% of patients with herbal and dietary supplement-induced liver injury vs none of the patients with anabolic androgenic steroid-induced injury and 6% of patients with liver injury from conventional drugs.

Conclusion: In an analysis of cases of herbal and dietary supplement-induced liver injury in Spain, we found cases to be more frequent among young women than older patients or men, and to associate with hepatocellular injury and high levels of transaminases. Herbal and dietary supplement-induced liver injury is more severe than other types of DILI and re-exposure is more likely. Increasing awareness of the hepatoxic effects of herbal and dietary supplements could help physicians make earlier diagnoses and reduce the risk of serious liver damage.
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http://dx.doi.org/10.1016/j.cgh.2017.12.051DOI Listing
September 2018

Association of loneliness with all-cause mortality: A meta-analysis.

PLoS One 2018 4;13(1):e0190033. Epub 2018 Jan 4.

Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.

Introduction: Loneliness has social and health implications. The aim of this article is to evaluate the association of loneliness with all-cause mortality.

Methods: Pubmed, PsycINFO, CINAHL and Scopus databases were searched through June 2016 for published articles that measured loneliness and mortality. The main characteristics and the effect size values of each article were extracted. Moreover, an evaluation of the quality of the articles included was also carried out. A meta-analysis was performed firstly with all the included articles and secondly separating by gender, using a random effects model.

Results: A total of 35 articles involving 77220 participants were included in the systematic review. Loneliness is a risk factor for all-cause mortality [pooled HR = 1.22, 95% CI = (1.10, 1.35), p < 0.001] for both genders together, and for women [pooled HR = 1.26, 95% CI = (1.07, 1.48); p = 0.005] and men [pooled HR = 1.44; 95% CI = (1.19, 1.76); p < 0.001] separately.

Conclusions: Loneliness shows a harmful effect for all-cause mortality and this effect is slightly stronger in men than in women. Moreover, the impact of loneliness was independent from the quality evaluation of each article and the effect of depression.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190033PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5754055PMC
January 2018

Association of loneliness with all-cause mortality: A meta-analysis.

PLoS One 2018 4;13(1):e0190033. Epub 2018 Jan 4.

Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.

Introduction: Loneliness has social and health implications. The aim of this article is to evaluate the association of loneliness with all-cause mortality.

Methods: Pubmed, PsycINFO, CINAHL and Scopus databases were searched through June 2016 for published articles that measured loneliness and mortality. The main characteristics and the effect size values of each article were extracted. Moreover, an evaluation of the quality of the articles included was also carried out. A meta-analysis was performed firstly with all the included articles and secondly separating by gender, using a random effects model.

Results: A total of 35 articles involving 77220 participants were included in the systematic review. Loneliness is a risk factor for all-cause mortality [pooled HR = 1.22, 95% CI = (1.10, 1.35), p < 0.001] for both genders together, and for women [pooled HR = 1.26, 95% CI = (1.07, 1.48); p = 0.005] and men [pooled HR = 1.44; 95% CI = (1.19, 1.76); p < 0.001] separately.

Conclusions: Loneliness shows a harmful effect for all-cause mortality and this effect is slightly stronger in men than in women. Moreover, the impact of loneliness was independent from the quality evaluation of each article and the effect of depression.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190033PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5754055PMC
January 2018
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