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Se construyó un cuestionario para evaluar creencias centrales asociadas con los trastornos de la personalidad, fundamentadas en el Modelo de la Terapia Cognitiva. Se realizó el análisis estructural y la validez de contenido de la prueba en población universitaria de la ciudad de Medellín, Colombia. La muestra fue representativa y elegida al azar a través de un procedimiento polietápico. Un número de 809 estudiantes universitarios contestaron el cuestionario de creencias centrales de los trastornos de la personalidad (CCE-TP). Se realizó un análisis factorial exploratorio de la prueba, reagrupándose los ítems en 14 factores (F) que representan el 61,3% de la varianza. F1: CCE-TP antisocial (8 ítems, a 0,839); F2: CCE-TP esquizotípico/límite (8 ítems, a 0,846); F3: CCE-TP histriónico/patrón seductor (6 ítems, a 0,833); F4: CCE-TP paranoide (6 ítems, a 0,836); F5: CCE-TP por evitación / autopercepción negativa (5 ítems, a 0,755); F6: CCE-TP por dependencia (5 ítems, a 0,797); F7: CCE-TP histriónico/dependencia emocional (4 ítems, a 0,755); F8: CCETP obsesivo-compulsivo/perfeccionista (4 ítems, a 0,808); F9: CCE-TP por evitación/hipersensible (4 ítems, a 0,766); F10: CCE-TP obsesivo-compulsivo/ crítico frente a los demás (3 ítems, a 0,851); F11: CCE-TP narcisista (4 ítems, a 0,717); F12: CCE-TP pasivo-agresivo / temor a ser dominado (3 ítems, a 0,719); F13: CCE-TP pasivo-agresivo/crítico frente a la autoridad (3 ítems, a 0,685), y F14: CCE-TP esquizoide (2 ítems, a 0,774). El alfa de Cronbach de la prueba fue de 0,931.

Se construyó un cuestionario para evaluar creencias centrales asociadas con los trastornos de la personalidad, fundamentadas en el Modelo de la Terapia Cognitiva. Se realizó el análisis estructural y la validez de contenido de la prueba en población universitaria de la ciudad de Medellín, Colombia. La muestra fue representativa y elegida al azar a través de un procedimiento polietápico. Un número de 809 estudiantes universitarios contestaron el cuestionario de creencias centrales de los trastornos de la personalidad (CCE-TP). Se realizó un análisis factorial exploratorio de la prueba, reagrupándose los ítems en 14 factores (F) que representan el 61,3% de la varianza. F1: CCE-TP antisocial (8 ítems, a 0,839); F2: CCE-TP esquizotípico/límite (8 ítems, a 0,846); F3: CCE-TP histriónico/patrón seductor (6 ítems, a 0,833); F4: CCE-TP paranoide (6 ítems, a 0,836); F5: CCE-TP por evitación / autopercepción negativa (5 ítems, a 0,755); F6: CCE-TP por dependencia (5 ítems, a 0,797); F7: CCE-TP histriónico/ dependencia emocional (4 ítems, a 0,755); F8: CCETP obsesivo-compulsivo/perfeccionista (4 ítems, a 0,808); F9: CCE-TP por evitación/hipersensible (4 ítems, a 0,766); F10: CCE-TP obsesivo-compulsivo/ crítico frente a los demás (3 ítems, a 0,851); F11: CCE-TP narcisista (4 ítems, a 0,717); F12: CCE-TP pasivo-agresivo / temor a ser dominado (3 ítems, a 0,719); F13: CCE-TP pasivo-agresivo/crítico frente a la autoridad (3 ítems, a 0,685), y F14: CCE-TP esquizoide (2 ítems, a 0,774). El alfa de Cronbach de la prueba fue de 0,931.

We have studied the participation of platelet-activating factor (PAP) in antigen-induced arthritis in rabbits, as well as the possible co-operation between PAF and tumour necrosis factor (TNF) in their ability to induce joint inflammation when injected into the knees of healthy rabbits. The administration of two structurally different PAF receptor antagonists, BN52021 and Alprazolam, from 4 h before the intra-articular injection of ovalbumin in preimmunized rabbits, induced an important reduction in the synovial fluid volume, in the amount of cells infiltrating the articular cavity and the synovial membrane, as well as in the prostaglandin E2 (PGE2) concentration, Furthermore, proteoglycans of the articular cartilage, which were found diminished in animals with non-treated arthritis, were well preserved in rabbits treated with PAF antagonists. All the synovial fluids from joints with arthritis had detectable amounts of PAF. The injection of either TNF or PAF into the joints of normal rabbits induced a mild inflammation. When TNF was administered I h before PAF, a synergistic response was noted in the synovial fluid volume., in the accumulation of leucocytes, and in the amount of PGE2. The administration of BN50726, a hetrazepine with a potent PAF-receptor antagonist effect, induced a diminution in those parameters. Our results suggest that PAF may be an early and important mediator of joint damage, and that TNF can amplify the inflammatory response induced by PAF. PAF receptor antagonists could play some role in the treatment of inflammatory joint diseases. [ABSTRACT FROM AUTHOR]

Background: Children and adolescents with chronic pain are a vulnerable population who often lack the resources to manage their condition. Due to high personal, social, and economic consequences, proper management in its early stages is key to reducing disability. The aim of this project is to co-develop a digital intervention for pediatric chronic pain (Digital SPA) with end-users and to evaluate its effectiveness and implementation outcomes in Spain., Methods: (Phase 1) Focus groups with patients, parents, and clinicians ( n  = 5-6 each) will inform about unmet pain care needs and provide a starting point for co-designing the intervention. (Phase 2) Content creation and usability testing will be based on the results of Phase 1, and the theory-driven development will follow the latest available evidence. The intervention will use validated psychological techniques focused on improving functioning by teaching pain coping skills. (Phase 3) Hybrid effectiveness-implementation trial. Participants ( n  = 195) will be adolescents aged 12-17 years old with chronic pain and one of their parents. Assessments include physical function, pain, sleep, anxiety, mood, satisfaction and adherence to the treatment, and number of visits to the emergency room. A qualitative framework analysis will be conducted with data from Phase 1. Effects of the intervention will be evaluated using linear multilevel modeling. The Consolidated Framework for Implementation Research (CFIR) and Behavioral Interventions Using Technology (BIT) frameworks will be used to evaluate implementation., Discussion: This study is expected to produce a co-created evidence-based digital intervention for pediatric chronic pain and a roadmap for successful implementation., Trial Registration Number Trn and Date of Registration: ClinicalTrials.gov (registered on 26 June 2023: https://clinicaltrials.gov/study/NCT05917626). Contributions to the literature The implementation of digital health interventions has two major gaps: (1) adherence to treatment is suboptimal, and (2) the process of making the interventions available to the end-user in a sustainable way is often unsuccessful.In this study, we expect that assessing users' needs and co-designing an intervention with them will improve adherence.Documenting the implementation process from the project inception and integrating the results into an implementation framework will allow for replication and extension in different contexts.This study will increase the knowledge about implementation in a vulnerable population: adolescents with chronic pain without access to in-person multidisciplinary pain care., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

[Purpose] Non-invasive and drug-free interventions for pain are being developed. One of them is ANF (which stands for "Amino Neuro Frequency") Therapy ® , which consists in the application of carbonized metal devices on a patient's skin. We aimed to: 1) test perceived changes in pain intensity after ANF application, 2) record frequency and severity of side effects, 3) assess clinician and patient satisfaction, 4) explore effects on swelling and range of motion (ROM). [Participants and Methods] In this real-world multisite observational study, N=113 physical therapists in 45 countries, applied ANF to N=1,054 patients (Mage=45.2, 56.2% female) with pain complaints. Demographic data, pain intensity (NRS-11), effects of ANF on swelling and ROM, clinician and patient satisfaction and side effects were collected. [Results] Main pain locations were: low back (14.9%), knee (12.4%), neck (10%), and shoulder (9.6%). Pre-treatment pain intensity was high (Mean=7.6, SD=1.9). It significantly decreased post-treatment (Mean=3.1, SD=2.0), t(1053)=7.25, with a large effect size (Cohen's d=2.2). Swelling decreased and ROM increased. Average satisfaction with ANF was 92/100. Patients often experienced mild side effects (42.3%): dry mouth, headache and fatigue. [Conclusion] Results show large effect sizes, high satisfaction, and mild and short-term side effects. This is very promising but should be interpreted with caution considering the study limitations., Competing Interests: RV has received scientific consulting fees from ANF Academy. IH works at ANF Academy. The rest of the authors have no conflicts of interest to declare., (2023©by the Society of Physical Therapy Science. Published by IPEC Inc.)

Background: Opioids are being prescribed widely, and increasingly, for the treatment of chronic non-cancer pain (CNCP). However, several side effects are associated with mid- and long-term opioid use and, for certain patients, with the risk of problematic opioid use. The aim of this study is to know the perception of the physicians about which variables could be associated with increased risk of patients with CNCP developing a problem of abuse or misuse of the prescribed opioid medication., Methods: Twenty-nine physicians with experience in CNCP pain management and opioids prescription participated in a two-round Delphi study focused on the risk factors for opioid misuse and abuse., Results: The variables that reached consensus regarding their relationship with the increased risk of suffering a problem of opioid abuse or misuse were: (1) Experiencing pain on a daily basis, (2) previous use of high-dose opioids, (3) generalized anxiety, (4) hopelessness, (5) benzodiazepine intake, (6) use of opioids for reasons other than pain, (7) family problems, family instability or family breakdown, and (8) having access to several opioid prescribers. The only variable that reached consensus regarding it not being associated to a possible risk of abuse or misuse was having mild pain intensity (0-4 on a NRS-11)., Conclusions: This study provides useful information that could help make decisions about the use of opioids for CNCP treatment and prevent future difficulties. Prospective studies testing the relationship of the variables that reached consensus with the risk of opioid misuse and abuse are warranted., Significance: This study shows the variables of CNCP that the professional must take into account in order to avoid possible problems when prescribing opioids., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2023 Galán, de la Vega, Esteve, López-Martínez, Fernández Baena and Ramírez-Maestre.)

Objectives: To establish proof of concept of a prehabilitation intervention, a combination of education and behavioural change, preceding a physical activity programme in people with fibromyalgia (FM)., Settings: Open-label, feasibility clinical trial., Participants: Eleven people with FM (10 women)., Interventions: The prehabilitation intervention consisted of 4 weeks, 1 weekly session (~1 to 1.5 hours), aimed to increase self-efficacy and understand why and how to engage in a gentle and self-paced physical activity programme (6 weeks of walking with telephone support)., Primary and Secondary Outcome Measures: Primary outcome was the acceptability and credibility of the intervention by means of the Credibility/Expectancy Questionnaire. Secondary outcomes comprised scales to measure FM severity, specific symptoms and sedentary behaviour. An exit interview was conducted to identify the strengths and weaknesses and barriers to the intervention., Results: One participant dropped out due to finding the walking programme excessively stressful. Participants expected the intervention would improve their symptoms by 22%-38% but resulted in 5%-26% improvements. Participants would be confident in recommending this intervention to a friend who experiences similar problems. The interviews suggested that the fluctuation of symptoms should be considered as an outcome and that the prehabilitation intervention should accomodate these fluctuation. Additional suggestions were to incorporate initial interviews (patient-centred approach), to tailor the programmes to individuals' priorities and to offer a variety of physical activity programmes to improve motivation., Conclusions: This feasibility study demonstrated that our novel approach is acceptable to people with FM. Future interventions should pay attention to flexibility, symptoms fluctuation and patients support., Trial Registration Number: NCT03764397., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Substantial empirical evidence has shown that intolerance of uncertainty is a central transdiagnostic feature in psychopathology and it has been suggested to be a pain-related psychological factor contributing to the experience of chronic pain. However, research in this area is virtually nonexistent. The objective of this study was to investigate associations between pain severity, catastrophizing, and anxiety in people with chronic nononcological pain, while assuming that intolerance of uncertainty moderates these relationships., Methods: A convenience sample of 188 individuals with nononcological chronic pain (157 women and 32 men) participated in the study. We investigated the moderated mediation of intolerance of uncertainty between anxiety and catastrophizing and between catastrophizing and pain intensity., Results: The full moderated mediation model accounted for significant variance in pain intensity (R2 = 0.148, P< .001). Intolerance of uncertainty significantly moderated the interaction between anxiety and catastrophizing (B = 0.039, SE = 0.012, 95% CI [0.015, 0.063]) and between catastrophizing and pain intensity (B = -0.034, SE = 0.010, 95% CI [-0.054, -0.014]). Anxiety and intolerance of uncertainty did not interact in predicting catastrophizing, although an interaction effect was found between intolerance of uncertainty and catastrophizing in predicting pain intensity., Conclusion: This study is the first to address the interrelationship of intolerance of uncertainty, catastrophizing, and anxiety in relation to perceived pain intensity. The current findings support intolerance of uncertainty as a relevant psychological variable that is distinct from other relevant constructs in the setting of pain research and treatment., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Discectomy is the surgical treatment of choice for disc herniation. However, discectomy can lead to disc degeneration and vertebral instability over time. Interspinous devices (ISDs), added to conventional surgery, constitute a low-invasive alternative that attempts to prevent these complications. The aim of this study is to compare the long-term clinical and functional outcomes of patients undergoing conventional discectomy with those who had an ISD added during surgery., Methods: This analytical-descriptive, retrospective, and transversal studyinvestigated outcomes of 114 patients who underwent surgery for a lumbar disc herniation between 2008 and 2011. The results were evaluated with a minimum follow-up of 8 years (mean, 10 years) by means of different questionnaires: visual analog scale (VAS), Oswestry Disability Index (ODI), consumption of analgesic medication, work status, degree of satisfaction, and complications and reinterventions during the follow-up period., Results: At the end of the follow-up, an overall improvement of VAS of 5 points (71%) and ODI of 36 points (77%) was observed, with a degree of satisfaction of 76% with disc surgery. The analysis between both groups showed a better behavior in VAS and ODI in the implant group, with a pre- and postsurgery difference of 73% and 79% compared to 66% and 77% in the control group, respectively, though this finding was not statistically significant. The current analgesic consumption and the degree of satisfaction were also better in the group with an implant. Compared with the non-implant group, the number of reinterventions at the end of the follow-up was lower (7% vs 15.5%) and the time until the second intervention was higher (81.5 vs 41 months) in the group with an implant, but the differences were not statistically significant., Conclusions: Lumbar discectomy proved to be a safe technique for the treatment of disc herniation, and results are maintained over time. The additional gesture of adding an ISD to conventional discectomy improves clinical outcomes overall, but not in a statistically significant way. The lower number of reinterventions and the longer period without surgery being required may mean a certain protective effect of the ISD on the intervertebral disc being operated on., Competing Interests: Declaration of Conflicting Interests: The authors report no conflicts of interest in this work., (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2022 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.)

Objectives: The aim of this study was to investigate the consequences of the COVID-19 pandemic in women with non-malignant chronic pain, and to determine whether women exposed to traumatic situations prior to the outbreak would be at a higher risk of negative health impacts. Methods: A total of 365 women were divided into three subgroups according to whether or not they had experienced a traumatic event prior to COVID-19. They completed an online survey. Results: Significant differences were found between groups during lockdown: 1) more psychological abuse was experienced by the group of women who had experienced an interpersonal traumatic event prior to the pandemic than in the other subgroups; 2) physical activity levels were higher and scores on pain interference were lower in women in the non-traumatized subgroup than in the other subgroups; 3) pain interference was predicted by pain intensity, decreased social support, and resilience, whereas perceived well-being was predicted by pain interference. Conclusion: Women who had experienced a traumatic event prior to the pandemic suffered worse consequences of the COVID-19 lockdown, particularly greater pain interference, although resilience was shown to both mitigate pain interference and enhance perceived well-being., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Serrano-Ibáñez, Ramírez-Maestre, Ruiz-Párraga, Esteve and López-Martínez.)

Chromosome segregation requires that centromeres properly attach to spindle microtubules. This essential step regulates the accuracy of cell division and must therefore be precisely regulated. One of the main centromeric regulatory signaling pathways is the haspin-H3T3ph-chromosomal passenger complex (CPC) cascade, which is responsible for the recruitment of the CPC to the centromeres. During mitosis, the haspin kinase phosphorylates histone H3 at threonine 3 (H3T3ph), an essential epigenetic mark that recruits the CPC, in which the catalytic component is Aurora B kinase (AURKB). However, the centromeric haspin-H3T3ph-CPC pathway remains largely uncharacterized in mammalian male meiosis. We have analyzed haspin functions by either its chemical inhibition with LDN-192960 in cultured spermatocytes, or the ablation of the Haspin gene in Haspin-/- mice. Our studies suggest that haspin kinase activity is required for proper chromosome congression both during meiotic divisions and for the recruitment of Aurora B and kinesin MCAK (also known as KIF2C) to meiotic centromeres. However, the absence of H3T3ph histone mark does not alter borealin (or CDCA8) and SGO2 centromeric localization. These results add new and relevant information regarding the regulation of the haspin-H3T3ph-CPC pathway and centromere function during meiosis., Competing Interests: Competing interests The authors declare no competing or financial interests., (© 2022. Published by The Company of Biologists Ltd.)

Introduction: Accurate assessment of the risk of opioid abuse and misuse in people with noncancer chronic pain is crucial for their prevention. This study aimed to provide preliminary evidence of the diagnostic and predictive capacity of the Spanish versions of the Opioid Risk Tool (ORT) and the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R)., Methods: We used the Current Opioid Misuse Measure (COMM) as criterion measure to assess the capacity of each tool to identify patients misusing opioids at the time of the assessment. Eighteen months later, we used the COMM and the Drug Abuse Screening Test-10 (DAST-10) to assess their predictive capacity. In total, 147 people with noncancer chronic pain participated in the diagnostic study, and 42 in the predictive study., Results: Receiver operating curve analysis showed that the SOAPP-R had an excellent capacity to identify participants who were misusing opioids at the time of assessment (area under the curve [AUC] = 0.827). The diagnostic capacity of the ORT was close to acceptable (AUC = 0.649-0.669), whereas its predictive capacity was poor (AUC = 0.522-0.554). The predictive capacity of the SOAPP-R was close to acceptable regarding misuse (AUC = 0.672) and poor regarding abuse (AUC = 0.423)., Conclusion: In the setting of Spanish-speaking communities, clinicians should be cautious when using these instruments to make decisions on opioid administration. Further research is needed on the diagnostic and predictive capacity of the Spanish versions of both instruments., (© 2022. The Author(s).)

Some reinforced concrete structures must be repaired at an early stage in their life due to the oxidation processes suffered by their reinforcements; such processes involve serious pathologies that affect the stability and safety of buildings. Spanish legislation distinguishes several classes of environments, with non-aggressive and normal exposure providing a longer useful life of the structure. The present study shows that some structural elements in reinforced concrete, mainly the pillars in the area of contact with the ground, are exposed to significant corrosion by carbonation. This position of the structural elements dramatically and abruptly shortens the useful life of the models provided for the current regulations. A total of 17 pillars in 10 buildings of different ages and locations in the Spanish Mediterranean area, not subject to the presence of chlorides, have been analyzed. These buildings are situated in environments considered by the standard as normal and non-aggressive. The actual carbonation that these elements present have been compared with that which can be derived from the model established by Spanish regulations. Of these pillars, 14 present a carbonation higher than that derived from the model, and the last three pillars largely conform to the figures of the model. This significant deviation shows the need for a revision of the Spanish EHE 08 regulation, which should include aspects such as the action of dampness by capillarity and the differences in electrochemical potential between the different materials.

Background: Opioid therapy is utilized for a broad range of chronic pain conditions. Several studies have highlighted the adverse effects of opioid medication due to the misuse of these drugs. The gradual increase in the use of opioids has become a global phenomenon and is generating social concern. Several treatment guidelines have strongly recommended assessing the risks and benefits of pharmacological treatment with opioids. These guidelines also recommend the psychological assessment of patients with chronic noncancer pain in order to make informed decisions on the advisability of intervention with opioids. Some authors have emphasized the relevance of assessing the risk of opioid misuse in patients with noncancer chronic pain before initiating treatment., Methods and Analysis: Two studies will be conducted, each with a different primary objective. The primary objective of the first study (Study 1) will be to conduct a comprehensive investigation to identify the factors most closely associated with subsequent opioid misuse; and based on the results of Study 1, the primary objective of the second study (Study 2) will be to develop a brief, reliable, valid, and useful instrument that would enable health care providers to make decisions on opioid prescription and on the required level of monitoring and follow-up. These decisions would have positive consequences for patient wellbeing. Study 1 will include a logistic regression analysis to test the hypothetical model. Study 2 will have a longitudinal design and include three assessment sessions in order to develop a measure to assess the risk of prescribed opioid misuse and to analyse its reliability and validity. Participants will be individuals with chronic noncancer pain attending three Pain Units. These individuals will either be undergoing pharmacological treatment that includes opioid analgesics (Study 1, N = 400) or are going to commence such treatment (Study 2, N = 250)., Competing Interests: No authors have competing interests.

Background: The PASS-20 is a general measure of pain-related anxiety and fear. The aim of the present study was to adapt the questionnaire for use in Spanish-speaking populations., Methods: Sample 1 comprised 216 individuals with chronic spinal pain (114 women and 102 men); sample 2 comprised 85 individuals with acute spinal pain (62 women and 23 men). The dimensionality of the PASS-20-SV items was evaluated using Exploratory Factor Analysis and an optimal implementation of Parallel Analysis (robust maximum likelihood). Data from sample 1 was used to analyse internal consistency and convergent validity. Estimated test-retest stability and predictive validity were based on data from the sample 2 participants, who completed the first administration (T1) and a second administration (T2, 6 months later)., Results: The PASS-20-SV comprises two factors: pain-related anxiety and apprehension, and pain-related fear and avoidance. It has good to excellent reliability and adequate test-retest stability. The results support its convergent and predictive validity., Conclusions: The Spanish Version of the PASS-20 is a valid, reliable measure of pain-related anxiety and pain-related fear in Spanish-speaking patients.

Attention deficit hyperactivity disorder is the most common neuropsychological disorder in childhood and adolescence, affecting the basic psychological processes involved in learning, social adaptation and affective adjustment. From previous research, the disorder is linked to problems in different areas of development, with deficiencies in psychological processes leading to the development of the most common characteristics of the disorder such as inattention, excess of activity and lack of inhibitory control. As for the diagnosis, in spite of being a very frequent disorder, there are multiple controversies about which tools are the most suitable for evaluation. One of the most widespread tools in the professional field is behavior inventories such as the Strengths and Difficulties Questionnaires for Parents and Teachers or the ADHD Rating Scale-V. The main disadvantage of these assessment tools is that they do not provide an objective observation. For this reason, there are different studies focused on recording objective measures of the subjects' movement, since hyperkinesia is one of the most characteristic symptoms of this disorder. In this sense, we have developed an application that, using a Kinect device, is capable of measuring the movement of the different parts of the body of up to six subjects in the classroom, being a natural context for the student. The main objective of this work is twofold, on the one hand, to investigate whether there are correlations between excessive movement and high scores in the inventories for the diagnosis of ADHD, Rating Scale-V and Strengths and Difficulties Questionnaire (SDQ) and, on the other hand, to determine which sections of the body present the most significant mobility in subjects diagnosed with ADHD. Results show that the control group, composed of neurotypical subjects, presents less kinaesthetic activity than the clinical group diagnosed with ADHD. This indicates that the experimental group presents one of the main characteristics of the disorder. In addition, results also show that practically all the measured body parts present significant differences, being higher in the clinical group, highlighting the head as the joint with the highest effect size.

There is solid evidence of an association between several psychological flexibility processes, particularly pain acceptance, and adaptation to chronic pain. However, there are relatively few studies on the relationship between pain acceptance and opioid misuse in chronic pain patients. Thus, the aim of the present study was to test a hypothetical model in which pain acceptance would regulate pain sensations and pain-related thoughts and emotions, which would be related to opioid misuse. The sample comprised 140 chronic pain patients attending two hospitals. All patients were receiving pharmacological treatment, including opioid analgesics. Structural equation modelling analyses showed a significant association between higher pain acceptance and lower pain intensity and catastrophizing, and lower levels of anxiety and depression. Only higher anxiety and depression were significantly associated with increased opioid misuse. The results suggest that levels of anxiety, depression, and pain acceptance must be assessed before opioids are prescribed. Pain acceptance implies a relationship with internal events that protects against anxiety and depression and thus against opioid misuse. Acceptance and Commitment Therapy appears to be particularly appropriate for these patients.

In December 2019, Spain considered for the first time the presence of radon to the Technical Building Code (Basic Document HS 6: Radon Exposure Protection), although it only mentions minimum presences and the need for ventilation. This research shows that in buried structures or in places with little ventilation, even in soils with a low probability of granite, a high content of radon gas can be found. The city of Alicante has been used as a measurement location for different architectural sites; here, the level of 100 Bq/m 3 is the first threshold where the gas must be monitored, and the level of 300 Bq/m 3 is the maximum threshold above which corrective ventilation measures must be taken. The research conducted during the years 2015 and 2016 shows that it is necessary to account for also the areas considered to be "low presence of radon gas" to achieve healthy constructions. The renewal of air in the different places will be tested for the presence of radon, i.e., the greater the accumulation is, the less ventilation and the greater the risk of accumulation of radon gas. This study is located in the city of Alicante, where the seven civil constructions are located: two Civil War shelters, the Santa Barbara Castle, the Ereta Powder Keg, the Luceros-Marq and Serra Grossa railway tunnels and the Británica underground deposits. Radon gas is currently a concern for major health and medical agencies because it is considered to be a chemical element that is very harmful to people. The World Health Organization is one of the organisations that has the objective of studying and researching this element, to develop solutions. Radon gas is normally found in a gaseous state and is highly radioactive. It is present in many terrains and it is mostly found in those with granite; although the presence of this element is very low, there is always a minimum presence. In the past, in nongranite soils, the dose of radon was considered to be so low that it was insignificant. Therefore, in this research, the aim is to consider the high presence of radon gas in nongranite soils as long as the conditions for its accumulation are present.

Background : Psychological factors of patients may influence physicians' decisions on prescribing opioid analgesics. However, few studies have sought to identify these factors. The present study had a double objective: (1) To identify the individual factors that differentiate patients who had been prescribed opioids for the management of chronic back pain from those who had not been prescribed opioids and (2) to determine which factors make significant and independent contributions to the prediction of opioid prescribing. Methods : A total of 675 patients from four primary care centers were included in the sample. Variables included sex, age, pain intensity, depressive symptoms, pain catastrophizing, and pain acceptance. Results : Although no differences were found between men and women, participants with chronic noncancer pain who were prescribed opioids were older, reported higher levels of pain intensity and depressive symptoms, and reported lower levels of pain-acceptance. An independent association was found between pain intensity and depressive symptoms and opioid prescribing. Conclusions : The findings suggest that patient factors influence physicians' decisions on prescribing opioids. It may be useful for primary care physicians to be aware of the potential of these factors to bias their treatment decisions.

The term Attention Deficit Hyperactivity Disorder (ADHD) has a long history of problems behind it. The origin of all these problems lies in the lack of agreement in the assessment procedures and evaluation instruments. The diagnosis is clinical and is determined by the observation and information provided by parents and teachers. So, this is highly subjective and leads to disparate results. Therefore, on the one hand the inaccuracy of the diagnosis of ADHD, which has been based on subjective criteria, together with the fact that hyperactivity is one of the main symptoms of this disorder, implies that several studies (with limitations) have been carried out to record objective measures of movement in subjects in at least the last ten years. In order to solve some of this derived problems and limitations of previous studies, a computer program has been developed to objectively record the amount of movement of subjects. The main objective of this study is threefold: first to register the amount of movement of both experimental group and control group, then to compare them with the movement registered by observers and finally to determine the validity of the software developed as a tool to support the diagnosis of ADHD. Results show that there are significant differences in the amount of objective movement between a clinical group of subjects with ADHD and a control group, obtaining a higher average of movement the experimental group. In addition, results also demonstrate that the developed software is a valid tool for the evaluation of movement that solves the limitations of previous studies. The proposed tool is developed from different aspects to give it a multidisciplinary character.

Longitudinal research is needed to determine predictive factors of healthcare utilization and medication intake in people with non-specific spinal pain. This study aims to prospectively examine the predictive value of sex, age, work status, pain intensity, pain acceptance, disability, depression, pain anxiety, and catastrophizing in relation to healthcare utilization and medication intake in people with non-specific spinal pain. Participants were 79 patients with non-specific spinal pain of 6 to 9 months' duration. They were followed-up at 6 months and 12 months. At enrolment they were administered a battery of questionnaires assessing the predictive variables. Healthcare utilization and medication intake were assessed at follow-ups 1 and 2. At follow-up 1, higher pain acceptance was associated with less healthcare utilization and less medication intake, while male sex was associated with less medication intake. At follow-up 2, higher pain-related disability was associated with higher healthcare use, and pain intensity was associated with higher medication intake. These results suggest that during the early stages of non-specific spinal pain chronification, pain acceptance and the avoidance of pain-related disability-understood as giving up normal activities-can lead to reductions in healthcare utilization and medication intake.

This longitudinal study explored whether activity patterns change over time in a sample of 56 individuals with chronic musculoskeletal pain over a 15-day period. Once a day, the participants recorded their level of pain intensity and the degree to which they had engaged in several specific activity patterns. Linear mixed models with random coefficients were used to investigate the rate of change in the activity patterns. Age, sex, pain intensity, and pain duration were controlled. The results show that excessive persistence was the only self-reported activity pattern to show a linear change over the 15-day period. There was a decrease in excessive persistence, and this decrease was slower with higher levels of activity avoidance. However, no significant association was found between sex, age, pain intensity, and pain duration and excessive persistence at baseline or change over time. At baseline, a positive association was found between excessive persistence and pain avoidance, pain-related persistence, and pacing to reduce pain, and a negative association was found between excessive persistence and pacing to save energy for valued activities. This result suggests a profile characterized by alternate periods of high and low activity that, in this study, were unrelated to longitudinal changes in pain intensity., Competing Interests: The authors declare no conflict of interest.

The aim of this study was to validate the Spanish version of the Defensive Pessimism Questionnaire. A sample of undergraduate students (N = 539) was measured on defensive pessimism using the Defensive Pessimism Questionnaire (DPQ), optimism and pessimism using the Life Orientation Test (LOT), positive and negative affect using the Positive and Negative Affect Schedule, and anxiety using the trait subscale of the State and Trait Anxiety Inventory. A Spanish version of the DPQ (DPQ-SV) is presented. Exploratory and Robust Confirmatory Factor Analysis had a bi-dimensional structure (Reflectivity and Negative Expectation). Omega coefficient showed a high internal consistency and the temporal stability was high in each dimension. Both DPQ-SV subscales (Negative Expectation and Reflectivity) showed adequate convergence with LOT-optimism and LOT-pessimism. Reflectivity showed adequate criterion validity with trait-anxiety and negative affect, but inadequate criterion validity with positive affect. Negative Expectation showed excellent criterion validity with trait-anxiety and negative affect and good criterion validity with positive affect. Finally, mediation analysis showed that Negative Expectation had a significant indirect mediating effect between trait-anxiety and negative affect. Reflectivity had a significant indirect mediating effect between trait-anxiety and negative and positive affect. Analysis of the psychometric properties of the DPQ-SV subscale scores showed that it is a two factor adequate measurement tool for its use in this type of samples., Competing Interests: The authors have declared that no competing interests exist.

Background: The literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder (PTSD). An association has been found between PTSD and substance abuse. PTSD is a severe disorder that should be taken into account when opioids are prescribed. It has been found that the prevalence of opioid use disorder (OUD) in chronic pain patients is higher among those with PTSD than those without this disorder., Aim: To perform a systematic review on the association between PTSD, chronic non-cancer pain (CNCP), and opioid intake ( i.e ., prescription, misuse, and abuse)., Methods: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Patient, Intervention, Comparator, and Outcomes (PICOS) criteria were formulated a priori in the protocol of the systematic review. A search was conducted of the PROSPERO database. In March 2019, searches were also conducted of 5 other databases: PubMed, MEDLINE, PsycINFO, Web of Science, and PILOTS. The Scottish Intercollegiate Guidelines Network checklist for cohort studies was used to assess the selected studies for their methodological quality and risk of bias. Each study was evaluated according to its internal validity, participant sampling, confounding variables, and the statistical analysis., Results: A total of 151 potentially eligible studies were identified of which 17 were retained for analysis. Only 10 met the selection criteria. All the studies were published between 2008 and 2018 and were conducted in the United States. The eligible studies included a total of 1622785 unique participants. Of these, 196516 had comorbid CNCP and PTSD and were consuming opiates. The participants had a cross-study mean age of 35.2 years. The majority of participants were men (81.6%). The most common chronic pain condition was musculoskeletal pain: back pain (47.14% across studies; range: 16%-60.6%), arthritis and joint pain (31.1%; range: 18%-67.5%), and neck pain (28.7%; range: 3.6%-63%). In total, 42.4% of the participants across studies had a diagnosis of PTSD (range: 4.7%-95%). In relation to opioid intake, we identified 2 different outcomes: opioid prescription and OUD. All the studies reported evidence of a greater prevalence of PTSD in CNCP patients who were receiving prescribed opioids and that PTSD was associated with OUD in CNCP patients., Conclusion: Opioid analgesic prescription as the treatment of choice for CNCP patients should include screening for baseline PTSD to ensure that these drugs are safely consumed., Competing Interests: Conflict-of-interest statement: The authors have no conflict of interest for this manuscript., (©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.)

Our daily environments are complex, composed of objects with different features. These features can be categorized into low-level features, e.g., an object position or temperature, and high-level features resulting from a pre-processing of low-level features for decision purposes, e.g., a binary value saying if it is too hot to be grasped. Besides, our environments are dynamic, i.e., object states can change at any moment. Therefore, robots performing tasks in these environments must have the capacity to (i) identify the next action to execute based on the available low-level and high-level object states, and (ii) dynamically adapt their actions to state changes. We introduce a method named Interaction State-based Skill Learning (IS 2 L), which builds skills to solve tasks in realistic environments. A skill is a Bayesian Network that infers actions composed of a sequence of movements of the robot's end-effector, which locally adapt to spatio-temporal perturbations using a dynamical system. In the current paper, an external agent performs one or more kinesthetic demonstrations of an action generating a dataset of high-level and low-level states of the robot and the environment objects. First, the method transforms each interaction to represent (i) the relationship between the robot and the object and (ii) the next robot end-effector movement to perform at consecutive instants of time. Then, the skill is built, i.e., the Bayesian network is learned. While generating an action this skill relies on the robot and object states to infer the next movement to execute. This movement selection gets inspired by a type of predictive models for action selection usually called affordances. The main contribution of this paper is combining the main features of dynamical systems and affordances in a unique method to build skills that solve tasks in realistic scenarios. More precisely, combining the low-level movement generation of the dynamical systems, to adapt to local perturbations, with the next movement selection simultaneously based on high-level and low-level states. This contribution was assessed in three experiments in realistic environments using both high-level and low-level states. The built skills solved the respective tasks relying on both types of states, and adapting to external perturbations.

Background : The variables that underlie comorbid chronic pain and posttraumatic stress symptoms (PTSS) are not yet clearly established. Objective : The aim of the present study was to analyse the role of the behavioural inhibition system (BIS), behavioural approach system (BAS) and experiential avoidance (EA) in pain adjustment (i.e. pain intensity, daily functioning and pain-related impairment) in patients with chronic pain and PTSS. Methods : A battery of instruments was administered to 388 chronic pain patients. The sample was divided into those with PTSS ( n = 194) and those without PTSS ( n = 194). Results : Significant differences were found between groups in the BIS, EA, impairment and daily functioning. No differences were found between groups in the BAS. Structural equation modelling showed that the BIS and EA were associated with worse adjustment in the 194 patients with both chronic pain and PTSS. The BAS was associated with a lower level of pain and greater daily functioning. Conclusion : The findings provide evidence that BIS and BAS activation and EA play a role in adjustment to chronic pain in patients with concurrent PTSS. These results may help guide the development of psychological treatments for patients with both conditions.

Gray's Reinforcement Sensitivity Theory postulates two distinct neurophysiological systems that underlie thoughts, emotions, and behavior: the Behavioral Inhibition System (BIS) and the Behavioral Approach System (BAS). Preliminary research suggests that both systems may play relevant roles in the adjustment of individuals with chronic pain. However, there is a lack of research on the extent to which emotional regulation (i.e., cognitive reappraisal and expressive suppression) mediates the associations between BIS and BAS activation and emotional responses in individuals with chronic pain. The aim of this study was to test a model of the associations between the BIS and BAS, cognitive reappraisal and expressive suppression, and positive and negative affect in individuals with chronic musculoskeletal pain. In total, 516 participants were interviewed. Structural Equation Modeling was used to estimate the associations between variables. The empirical model showed a good fit to the data (χ 2 /df = 1.95; RMSEA = 0.04; GFI = 0.99; AGFI = 0.98; CFI = 0.99). The hypothesized model received partial support. The BIS was associated with cognitive reappraisal and expressive suppression; cognitive reappraisal was associated with negative and positive affect; expressive suppression was positively associated with affect; and the BAS was not associated with the emotional regulation strategies assessed. However, the BIS and BAS were both directly associated with negative and positive affect. The results suggest that individuals with chronic pain with higher BIS activation appear to use greater expressive suppression. Cognitive reappraisal strongly mediated the BIS-negative affect association. The results also suggest that BAS activation may have a weak or inconsistent association with emotional regulation approaches in individuals with chronic pain. These data provide new and relevant information on the potential role of the BIS and BAS as predictors of psychological functioning in individuals with chronic pain. They suggest that the BIS-BAS model of chronic pain may need to be modified to take into account the potential negative effects of BAS activation. The findings suggest that treatments for emotional regulation could potentially reduce the negative impact of chronic pain via BIS.