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Objective Previous imaging studies in patients with borderline personality disorder (BPD) have detected functional brain dysfunctions. Mindfulness training may improve the symptoms of BPD, although the neural mechanisms involved remain poorly understood. This study had several key aims: a) to investigate the role of right anterior insula (rAI) functional connectivity in modulating baseline emotional status in BPD, b) to compare differences in connectivity changes after mindfulness training versus interpersonal effectiveness intervention, and c) to explore the correlation between longitudinal changes in imaging data and clinical indicators. Methods Thirty-eight patients with BPD underwent resting-state functional magnetic resonance imaging. Participants completed self-report clinical scales and participated in a dialectical-behavioral therapy (mindfulness versus interpersonal effectiveness modules). Changes in clinical and imaging variables were evaluated longitudinally after completion of the first 10-week sessions of psychotherapeutic intervention. Results At baseline, the rAI was strongly connected with the other salience network nodes and anticorrelated with most core nodes of the default mode network (p < .05, corrected). The functional connectivity of the rAI correlated with emotional dysregulation and deficits in mindfulness capacities (p < .05, corrected). After completion of psychotherapeutic intervention, both groups (mindfulness and interpersonal effectiveness) showed divergent posttherapy functional connectivity changes, which were in turn associated with the clinical response. Conclusions The functional connectivity of the rAI seems to play an important role in emotion dysregulation and deficits in mindfulness capacities in individuals with BPD. Psychotherapy seems to modulate this functional connectivity, leading to beneficial changes in clinical variables.

To estimate the incidence and prevalence of multiple sclerosis (MS) in Malmö municipality in southwestern Sweden.Multiple sources were used in the case identification process. Case ascertainment was assessed by medical chart review including examinations such as magnetic resonance imaging, cerebrospinal fluid analyses, and relevant laboratory tests. Cases were classified according to the 2010 McDonald's diagnostic criteria. Onset-adjusted prevalence and a definition of onset symptoms were applied.The crude incidence of MS in 2001-2010 in Malmö municipality was 5.3/100,000 (95% confidence interval (CI): 4.5 to 6.2). There was a relapsing onset in 90.5% of cases. The female to male ratio was 1.8. The onset-adjusted prevalence for Dec 2010 was 133/100,000 (95% CI, 120 to 146) with a female to male ratio of 2.1.This is the first population-based epidemiological study in Skåne, the most southwestern part of Sweden showing a high incidence and prevalence. We found a lower incidence than expected according to previous nationwide figures, probably due to methodological differences between the studies. Our findings support the presence of a north-south gradient of MS prevalence in Sweden.

BACKGROUND: Non-suicidal self-injury (NSSI) is a serious public health concern among adolescents, especially in clinical settings. Social support plays a critical role in the onset and maintenance of NSSI in adolescence. NSSI is closely associated with borderline personality disorder (BPD), yet no previous work has analyzed the mediating role of borderline traits in the relationship between perceived social support (PSS) and NSSI. This study aimed to address this gap. METHODS: Participants were 228 adolescent patients (12 to 18 years old), who completed a clinical interview and self-report measures of BPD-traits, current psychological distress, emotion dysregulation and PSS. They were grouped based on the presence (vs. absence) of NSSI. Univariate and multivariate logistic regression analyses were used to identify risk factors of NSSI, and a mediation analysis was conducted to examine the intermediary role of borderline traits in the relationship between PSS and NSSI. RESULTS: NSSI was highly prevalent in our sample (58%) and was associated with higher clinical severity. Low PSS predicted NSSI in univariate, but not multivariate regression. Mediation analyses showed that borderline traits fully accounted for the relationship between low PSS and NSSI, even when controlling for current psychological distress and gender. LIMITATIONS: Cross-sectional design through self-report assessment. CONCLUSIONS: Findings suggest that adolescents with low PSS are especially vulnerable for developing NSSI due to elevated BPD traits. In clinical settings, interventions aimed to reduce borderline symptoms may be a promising treatment option for adolescents with NSSI and low PSS.

Mindfulness skills training is a core component of dialectical behavior therapy (DBT) that has proven to be an effective stand-alone treatment for the general symptoms commonly present in patients with borderline personality disorder (BPD). The aim of the present study was to compare the effectiveness of mindfulness-based DBT skills training (DBT-M) to interpersonal effectiveness-based DBT skills training (DBT-IE) in reducing BPD symptoms. We also evaluated the specific mechanism of action of these therapies through two proposed mediators: decentering and emotion dysregulation.A total of 102 participants diagnosed with BPD were included in the study. Multivariate repeated-measures ANOVAs were performed followed by a multiple mediation analysis.The analyses showed that DBT-M was more effective than DBT-IE in reducing BPD symptoms, although both interventions were effective in reducing emotion dysregulation. We identified a serial mediation model in which DBT-M reduced BPD symptoms by increasing decentering ability, which in turn reduced emotion dysregulation. This mediation effect showed that changes in decentering preceded improvements in emotion dysregulation.These findings underscore the key role of decentering as a primary mechanism of action in DBT-M, suggesting that this skill is a main component for BPD treatment.

Patients with borderline personality disorder (BPD) present dysfunctions of the default mode network (DMN). Mindfulness training has proven effective to improve the symptoms of BPD. The present study examines the effect of mindfulness training on BPD symptomatology and DMN activity during the performance of a working memory task in patients with BPD. Sixty-five individuals with BPD were randomized to receive psychotherapy with either the mindfulness module of dialectical behavioural therapy (DBT-M) or with interpersonal effectiveness module (DBT-IE). The impact of treatments was evaluated with clinical and mindfulness variables as well as with functional magnetic resonance imaging during performance of the task. Both groups showed improvement in BPD symptoms and other clinical variables after treatment. Unexpectedly, there were no between-group differences in DMN activation or deactivation. However, activation of the left anterior insula increased in both groups after the intervention. Compared with the control group, participants in the DBT-M group presented higher deactivation in a cluster extending bilaterally from the calcarine to the cuneus and superior occipital gyri.

The Technical Reports are intended mainly for internal use within the COSMO group (COSMO = Consortium for Small Scale Modeling), but also to inform other groups on model changes and research activities. The purpose of the Technical Reports is 1. to document scientific research activities, 2. to document technical changes to the model system, 3. to give an overview on new components of the model system.

We retrospectively assessed the effectiveness of azithromycin in preventing transmission of pertussis to a patient's household contacts. We also considered the duration between symptom onset in the primary patient and azithromycin administration. We categorized contacts into 4 groups: those treated within 21 days after illness onset in the primary patient. We studied 476 primary index patients and their 1,975 household contacts, of whom 4.5% were later identified as having pertussis. When contacts started chemoprophylaxis within 14 days after primary patient's symptom onset was less effective. We recommend that contacts of persons with pertussis begin chemoprophylaxis within

It is well known that Alzheimer's disease (AD), the most common form of dementia, is associated with deficits in cognitive processes including visual memory impairments. One technique that might be used to ameliorate these impairments is the differential outcomes procedure (DOP) that involves associating each to-be-remembered stimulus with a specific outcome. Objective: Previous research has demonstrated that the DOP can be used to reduce or eliminate the learning and memory deficits associated with animal models of amnesia and dementia. Furthermore, this procedure has been shown to improve delayed facial recognition in healthy older adults as well as in patients diagnosed with AD. The main aim of the present study is twofold: to extend these findings to other types of visual stimulus and to investigate the effect of the DOP in memory retention in AD patients. Method: Ten patients diagnosed with AD and 10 healthy controls participated in this study. The experiment included two phases. In the first one, they had to perform a delayed matching-to-sample task. In the second phase, participants performed a recognition memory task, designed to assess long-term retention, 1 h and 1 week after the training. Results: Participants showed a better memory-based performance as well as a higher long-term retention of the information when trained under the differential outcomes condition, relative to the non-differential outcomes condition. Conclusions: The DOP seems to be an effective, easy-to-implement, technique to enhance visual memory in AD patients.

La teràpia dialèctica conductual (TDC) és una teràpia efectiva per al tractament del trastorn límit de la personalitat (TLP). Algunes de les limitacions a l’hora d’implementar-la són l’elevat nombre de pacients que abandona la teràpia abans de finalitzar-la, i el fet de ser una teràpia llarga i costosa. S’ha observat que el mòdul de mindfulness de la TDC per si sol és eficaç per a disminuir la severitat del TLP, tanmateix no hi ha estudis que avaluïn sobre quin símptoma específic del TLP és eficaç cada un dels mòduls, ni quins possibles correlats neurobiològics rauen als efectes de la teràpia. La present tesis es constitueix de dos blocs. El primer bloc (estudi 1), pretén avaluar els factors relacionats amb l’abandonament prematur de la TDC. El segon bloc (estudis 2 i 3) pretén comparar dos dels mòduls de la TDC: el mòdul de mindfulness (TDC-M) i el mòdul d’efectivitat interpersonal (TDC-EI) entre sí. L’estudi 2 analitza l’eficàcia de cada un dels mòduls sobre els dos símptomes nuclears del TLP, la desregulació emocional i la impulsivitat. L’estudi 3 pretén trobar el correlat neurobiològic associat als beneficis de la teràpia, posant especial atenció als efectes del mindfulness en la default mode network (DMN). Els resultats mostren que la comorbiditat amb trastorn per consum de cocaïna, la comorbiditat amb trastorn de conducta alimentària i les altes puntuacions en impulsivitat prediuen l’abandonament prematur de la psicoteràpia. També mostren que els mòduls de mindfulness i d’efectivitat interpersonal per si sols i per separat són beneficiosos per a disminuir la severitat global del TLP, la desregulació emocional, l’ansietat i la simptomatologia depressiva. En canvi, els beneficis en impulsivitat només es donen en el grup de mindfulness. Respecte els correlats neurobiològics, no observem canvis en la DMN, en canvi sí que observem un increment en l’activitat de la ínsula anterior després de realitzar la teràpia independentment del mòdul. En conjunt els resultats d’aquesta tesis permeten conèixer els factors associats amb l’abandonament prematur, i permeten afirmar que els mòduls de mindfulness i d’efectivitat interpersonal per si sols són efectius per a millorar gran part de la simptomatologia associada al TLP i que aquesta millora va associada amb canvis en l’activitat cerebral. Dialectical Behaviour Therapy (DBT) is an effective treatment for people with borderline personality disorder (BPD). Limitations of the therapy include the high number of patients who prematurely drop out from therapy, and its length and associated costs, which gives importance to the study of its components separately. The mindfulness module of DBT by itself has proven effective to reduce BPD severity, however there are no studies that examine which specific symptoms benefit from mindfulness, nor what neurobiological mechanisms may underlie its benefits. The present thesis is constituted by two blocks: The first one (study 1) assesses the factors associated with early dropout from DBT. The second block (studies 2 and 3) compare two of the DBT modules: the mindfulness module (DBT-M) and the interpersonal effectiveness module (DBT-IE). Study 2 assesses the efficacy of every single module in two of the nuclear BPD symptoms, emotional dysregulation and impulsivity. Study 3 assesses the neurobiological correlations associated with the theapy with special attention to the mindfulness effects on the default mode network (DMN). The results show comorbidity with cocaine use disorder, comorbidity with eating disorder and high connections to impulsivity are associated with early dropout from therapy. Both modules DBT-M and DBT-IE separately are effective in decreasing BPD severity, emotional dysregulation, anxiety and depression, however only the mindfulness module was effective in decreasing impulsivity. Regarding neurobiological correlation, changes in the DMN were not observed, however, an increase in activity in the anterior insula was observed after the therapy in both modules. Together the results of the present thesis contribute to knowledge of the factors associated with dropout, and affirm that the modules of mindfulness and interpersonal effectiveness separately are effective to improve BPD symptomatology and that the improvements are associated with changes in brain activity.

Around 5% of patients with chronic hepatitis C virus (HCV) infection treated with direct-acting antiviral (DAA) agents do not achieve sustained virological response (SVR). The currently approved retreatment regimen for prior DAA failure is a combination of sofosbuvir, velpatasvir, and voxilaprevir (SOF/VEL/VOX), although there is little data on its use in clinical practice. The aim of this study was to analyse the effectiveness and safety of SOF/VEL/VOX in the real-world setting.

L’objectiu d’aquest treball és estudiar el patrimoni de la farmàcia donat per la família Ríos, que es conserva a l’Hospital Nostra Senyora de Gràcia de Saragossa. Aquest patrimoni material està format pels mobles, pots de farmàcia, decoració i d’altres elements que converteixen la farmàcia en un espai únic i de gran valor patrimonial., The aim of this article is to highlight the heritage of the pharmacy donated by the Ríos family that is preserved in the Hospital Nuestra Señora de Gracia of Zaragoza. This material heritage consists of furniture, a jar collection, decoration and other features that make it a unique space of great heritage value., El objetivo de este trabajo es poner en valor el patrimonio de la farmacia donado por la familia Ríos, que se conserva en el Hospital Nuestra Señora de Gracia de Zaragoza. Este patrimonio material se compone de mobiliario, botamen, decoración y otros elementos que la convierten en un espacio único y de gran valor patrimonial.