Universitat Abat Oliba CEU

28 Oct 2024): Assessment of chronic overlapping pain comorbidities for the management of temporomandibular disorders: Secondary analysis of a randomized clinical trial, Physiotherapy Theory and Practice, ABSTRACT Background: Chronic painful temporomandibular disorders (TMD) are a functional pain syndrome that embodies a spectrum of clinical manifestations and expresses great complexity through the coexistence of multiple comorbidities. Objective: Evaluate the prevalence of pain comorbidities, explore the correlation between comor-bidities, kinesiophobia, catastrophizing, and pain disability at baseline, and determine variables of interest for prediction response to physiotherapy interventions at different follow-up times. Methods: This is a secondary analysis of a previously conducted randomized controlled trial (RCT). Outcomes and covariables for this secondary analysis were collected from subjects with chronic TMD (≥3 months), based on the DC/TMD diagnostic criteria, assigned to a multimodal treatment and a second manual therapy control group. The participants underwent follow-up assessment at 7 and 19 weeks. The outcomes (dependent variables) for these analyses were craniofacial pain disability, catastrophizing, and kinesiophobia. However, these outcomes were also used as covari-ables of interest in addition to comorbidity prevalence and severity at baseline for different analyses. We performed linear regression analyses to determine the association between our outcomes and covariables at baseline and at different follow-ups. Results: Comorbidity severity explained craniofacial pain disability at baseline, showing a strong correlation (Standardized B: 0.40, p-value: 0.017). Higher comorbidity severity, led to higher craniofacial pain score. Comorbidity severity and baseline catastrophizing predicted a better response to treatment for craniofacial pain improvements at short and long term (R 2 .22, p-value : 0.009 and R 2 .19, p-value: 0.02 respectively). Conclusion: This study provides insight into the prevention and clinical management of chronic pain related to TMD.

Hypertension is responsible for more than two million deaths due to cardiovascular disease annually in Latin America (LATAM), of which one million occurs before 70 years of age. Hypertension is the main risk factor for cardiovascular morbidity and mortality, affecting between 20 and 40% of LATAM adults. Since the publication of the 2017 LASH hypertension guidelines, reports from different LATAM countries have confirmed the burden of hypertension on cardiovascular disease events and mortality in the region. Many studies in the region have reported and emphasized the dramatically insufficient blood pressure control. The extremely low rates of awareness, treatment, and control of hypertension, particularly in patients with metabolic disorders, is a recognized severe problem in LATAM. Earlier implementation of antihypertensive interventions and management of all cardiovascular risk factors is the recognized best strategy to improve the natural history of cardiovascular disease in LATAM. The 2024 LASH guidelines have been developed by a large group of experts from internal medicine, cardiology, nephrology, endocrinology, general medicine, geriatrics, pharmacology, and epidemiology of different countries of LATAM and Europe. A careful search for novel studies on hypertension and related diseases in LATAM, together with the new evidence that emerged since the 2017 LASH guidelines, support all statements and recommendations. This update aims to provide clear, concise, accessible, and useful recommendations for health professionals to improve awareness, treatment, and control of hypertension and associated cardiovascular risk factors in the region.

Aim To evaluate the transfer effects of a home‐based computerized executive function intervention on non‐targeted cognitive functions (visual perception and memory), quality of life (QoL), and participation in children with cerebral palsy (CP), and to determine whether any improvements were maintained 9 months after the intervention. Method Sixty children with CP (aged 8–12 years) were randomly allocated to the intervention (15 females/15 males, mean age 10 years 4 months [SD = 1 years 8 months], age range 8–12 years) or waitlist (control) (15 females/15 males, mean age 10 years [SD = 1 years 9 months], age range 8–12 years) group. The intervention group underwent a home‐based executive function intervention programme for 30 minutes per day, 5 days a week, for 12 weeks. All participants were assessed before the intervention, immediately after and 9 months after the intervention was completed. Results After the intervention was completed, performance in immediate verbal memory, verbal learning, and visual perception (object and picture recognition) was significantly better in the intervention group than in the waitlist (control) group. No improvements were found in visual memory, visuospatial perception, QoL, or participation after the intervention. Scores at the follow‐up showed that any beneficial effects were not maintained 9 months after the intervention was completed. Interpretation A home‐based computerized executive function intervention produced transfer effects on memory and visual perception immediately after the intervention in children with CP, although any beneficial effects were not sustained at the 9‐month follow‐up.

The convergence of researchers in the fields of flourishing, moral psychology, and social–emotional studies has reached a stage where developing a theory that connects emotional regulation and flourishing is meaningful. This theoretical investigation aims to uncover insights from the research of Magda B. Arnold, renowned for her theory of emotions, and lesser-known for her notion of the self-ideal, regarding the relationship between emotional regulation and flourishing. Our initial hypothesis posits that Arnold’s concept of self-ideal provides a framework for understanding how to foster emotional regulation in individuals by directing it toward constructive life objectives. To achieve this, we explore the current state of emotional regulation and flourishing and the relationship between these concepts; we consider the interconnectedness of emotion and self-ideal within Arnold’s theory and analyze its potential to serve as a foundation for building a theory relating flourishing and emotional regulation. We find in Arnold’s theory substantial ideas about the relationship between emotional regulation, flourishing, and self-ideal, as well as emerging empirical research relating to these themes. We conclude that Arnold’s research can serve as a catalyst for developing psychological intervention models that enhance emotional regulation and promote a flourishing life.

Sprumont (Games Econ Behav 2:378–394, 1990) introduces population monotonic allocation schemes (PMAS) and proves that every assignment game with at least two sellers and two buyers, where each buyer-seller pair derives a positive gain from trade, lacks a PMAS. In particular glove games lacks PMAS. We propose a new cooperative TU-game concept, population Lorenz-monotonic allocation schemes (PLMAS), which relaxes some population monotonicity conditions by requiring that the payoff vector of any coalition is Lorenz dominated by the corresponding restricted payoff vector of larger coalitions. We show that every TU-game having a PLMAS is totally balanced, but the converse is not true in general. We obtain a class of games having a PLMAS, but no PMAS in general. Furthermore, we prove the existence of PLMAS for every glove game and for every assignment game with at most five players. Additionally, we also introduce two new notions, PLMAS-extendability and PLMAS-exactness, and discuss their relationships with the convexity of the game.

Aims Guidelines recommend initiation of dual combination antihypertensive therapy, preferably single-pill combination (SPC), in most patients with hypertension. Evidence on narrowing gaps in clinical practice relative to guidelines is limited. Methods and Results Monte Carlo simulation was applied to 1.1 million patients qualifying for dual combination therapy from a previously conducted retrospective analysis of clinical practice, hospital statistics, and national statistics in the UK. We provide 10-year Kaplan-Meier event rates for the primary endpoint representing a composite of nonfatal myocardial infarction, nonfatal stroke (ischemic or hemorrhagic), nonfatal heart failure hospitalization or cardiovascular death. Cox model results from a previously conducted study were utilized to estimate baseline risk, together with evidence on risk reduction from the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) meta-analysis and published evidence on BP-lowering efficacy of antihypertensive therapies. In the overall population, estimated 10-year event rates for the primary endpoint in patients with 100% persistence in monotherapy were 17.0% for irbesartan (I) and 17.6% for ramipril (R). These rates were only modestly better than that observed in clinical practice (17.8%). In patients with 100% persistence in dual therapy, estimated event rates were 13.6% for combinations of Irbesartan + Amlodipine (ARR = 8.7% compared to untreated) and 14.3% for Ramipril + Amlodipine (ARR = 8.0% compared to untreated). The absolute risk of the primary endpoint was reduced by 15.9% in patients with ASCVD and 6.6% in those without ASCVD. Similarly, the absolute risk was reduced by 11.7% in diabetics and 7.8% in those without diabetes. Conclusion This study represents the first to investigate guidelines-based treatment in hypertensive patients and demonstrates the opportunity for considerable risk reduction by ensuring recommended dual therapy in clinical practice, particularly in the form of SPC with high persistence, relative to no treatment or monotherapy.

Children with Cerebral Palsy (CP) experience Social Cognition (SC) difficulties, which could be related to executive functioning. While motor interventions are common, there is limited knowledge about the impact of cognitive interventions on SC in this population. This study examined the relationship between SC and Executive Function (EF) skills and the effectiveness of an EF intervention that included some SC tasks for improving SC in children with CP. SC and EF domains were assessed in 60 participants with CP (30 females; 8–12 years). The relationship between SC and EF baseline scores was analyzed by bivariate correlations and contingency tables. Participants were matched by age, sex, motor ability, and intelligence quotient and randomized into intervention or control groups. The intervention group underwent a 12-week home-based computerized EF intervention. Analysis of covariance was used to examine differences in SC components between groups at post-intervention and 9 months after. Significant positive correlations were found between the SC and EF scores. The frequencies of impaired and average scores in SC were distributed similarly to the impaired and average scores in EFs. The intervention group showed significant improvements in Affect Recognition performance post-intervention, which were maintained at the follow-up assessment, with a moderate effect size. Long-term improvements in Theory of Mind were observed 9 months after. Conclusions: This study highlights the association between SC and EFs. A home-based computerized cognitive intervention program improves SC in children with CP. Including SC tasks in EF interventions may lead to positive short- and long-term effects for children with CP. Clinical trial registration: NCT04025749 retrospectively registered on 19 July 2019. What Is Known: • Executive functions and social cognition are associated with social and community participation in people with cerebral palsy. • A home-based computerized cognitive intervention can improve the executive functioning of children with cerebral palsy. What Is New: • Social cognition performance is related to core and higher-order executive functions. • A home-based computerized executive function intervention, including social cognition tasks, has positive short- and long-term effects on social cognition skills in children with cerebral palsy.

En este artículo se desarrollan elementos claves para pensar que, a pesar de que los debates teóricos cosmopolitas han sido determinados por una conceptualización eurocéntrica, existe una tradición intelectual latinoamericana que de manera renovadora ha abogado por el cosmopolitismo como práctica política esencial para el mundo moderno. Para desarrollar el análisis sobre cómo se formó y transformó el imaginario cosmopolita en América Latina en los doscientos años transcurridos desde el proceso de emancipación colonial, se discutirán dos momentos históricos específicos, así como las principales tradiciones intelectuales que identificamos con respecto del cosmopolitismo. El primer momento que será discutido es el de la formación de los estados nacionales (siglo XIX). En un segundo momento, se toma como objeto de análisis la discusión sobre la «cuestión racial» y poscolonial que emergieron en América Latina durante el siglo XX. Aunque sea correcto decir que el sendero histórico trazado no alcanza a abarcar todos los momentos y pensamientos definidores del imaginario cosmopolita en la región, sin embargo, ofrecemos una síntesis que es capaz de sostener el argumento sobre el proceso de desarrollo histórico conceptual del imaginario cosmopolita en América Latina.

This article introduces a relational approach to studying imaginaries of the future, emphasising their significance in comprehending present realities and the ongoing processes that interweave our social fabric. It posits ‘imaginaries of the future’ as a pivotal sociological concept for understanding the reciprocal social influences and uneven structural dynamics shaping the present. This work engages in a theoretical discourse, spotlighting the role of the future in contemporary social landscapes, while endorsing the suitability of the concept of imaginaries to elucidate how we collectively interlace our present through implicit dialogues with latent, emergent futures and glimpses of radical imagination. In this article, we advocate for sociological research on ‘imaginaries’, discussing the concept’s relevance to sociological theory and research. In addition, we make a case for examining futures as a subject of sociological research. Finally, we propose a conceptual framework for analysing imaginaries of the future from a relational sociological perspective, fostering interdisciplinary dialogue.

Consumer interactions on social media have been analysed in the literature as sources of information about their ability to generate engagement and knowledge about how to interact with brands. The present study contributes to this line of research, focusing on empirically determining those elements that affect the interaction between a fast fashion brand and its users, providing central elements of brand strategies on Instagram. This study examines the engagement generated by Primark posts on Instagram based on three coding categories that analyse the content of the message, the communication strategy and the formal and product category aspects present in the posts. This study therefore identifies the variables with the greatest potential to generate engagement with this brand’s posts on Instagram, which in turn predicts previous unexplored outcomes such as brand image and consumer loyalty. This study also provides valuable academic insights and guides fast fashion brands in their social media strategies.

Background: Previous studies have evaluated the implementation of behavioral approaches in individuals with chronic temporomandibular disorders (TMDs). Objective: To evaluate the benefits of a behavioral approach to craniofacial pain. Second, we assessed the benefits of kinesiophobia, catastrophizing, mouth opening without pain, and forward head posture. Methods: Individuals with chronic TMDs were treated for five weeks. The intervention group (n = 17) underwent pain neuroscience education, manual therapy, and therapeutic exercise, whereas the control group (n = 17) underwent manual therapy only. Outcomes were evaluated immediately, at seven and 19 weeks follow-up. The assessment tools used were the Craniofacial Pain Disability Inventory, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Mandibular Range of Motion Scale, and Cervical Range of Motion Tool. Results: The interventions did not influence the differences in the improvements between the groups observed for craniofacial pain disability (inter-subject p 0.4). The intervention had a moderate influence on the improvement of kinesiophobia and catastrophizing (Inter-subject p 0.09 and 0.1 respectively) with a clinically significant effect size (Estimated mean (EM) −8.6 standard deviation (SD) ±3.48 p 0.019; and EM −7.6 SD ± 5.11 p 0.15 respectively). Conclusion: The behavioral approach improved catastrophizing and kinesiophobia outcomes in individuals with chronic TMDs.

The research work presented below addresses the possible concern of central bank independence through the development and application of econometric models. The complexity of the modelling has allowed a step further in corroborating that financial independence is not only linked to the appointments and pressures of the states regarding their economic policy but also the role that financial markets play by acting as a force that dictates and contaminates decisions of central banks. In this sense, the paper proposes a theoretical basis for recommendations on the application of the new monetary policy in a more complex environment, both due to the pandemic that was sweeping the world and the bulky debt that countries are carrying. The paper concludes with a series of measures and suggestions that could be addressed by monetary policymakers given the necessary but not easy normalization of monetary policy required at the global level.

A large body of evidence supports a close relationship between high blood pressure in middle age and the risk of cognitive impairment and dementia in the elderly. This is important because hypertension is the most prevalent cardiovascular risk factor in the world and the leading risk factor for global disease burden. On the other hand, neurological disorders are leading cause of disability-adjusted life-years and the second cause of death. In particular, Alzheimer’s disease and related dementias are the fifth leading cause of death globally. Given the projected trends in population ageing, growth, and survival, the number of people with dementia is expected to increase from 57 million cases globally in 2019 to 153 million cases in 2050, leading to a huge public health problem in all countries. Therefore, interventions addressed to modify and control risk factors such as hypertension will be key in reducing the expected increase in the number of individuals affected by dementia in the near future. The answer to the question whether is it possible to stop or delay the onset and progression of cognitive impairment and dementia by reducing blood pressure levels in patients with hypertension seems crucial. This chapter reviews the studies showing that antihypertensive treatment can modify the pathophysiology of the natural history of cognitive impairment in hypertensive patients, and delay the progression of mild cognitive decline towards dementia in many of these patients. Finally, in addition to the blood pressure targets to be achieved to optimize the treatment effect in reducing the incidence of dementia, results from recent analysis of randomized clinical trials showing that some antihypertensive drugs and strategies are more effective than others are discussed.

Antihypertensive treatment reduces the risk of stroke recurrence and is beneficial in patients with hypertension and even in subjects who were normotensive before suffering the first stroke. The optimal blood pressure (BP) target after stroke is not the same for all patients and depends on age, frailty, and comorbidities, among other conditions. In addition to lifestyle changes (smoking cessation, Mediterranean or DASH diet, alcohol cessation, low-salt consumption, weight loss, physical activity), antihypertensive trials suggest that benefits largely depend on BP lowering per se, and then all available drugs and rational combinations can be used. However, the choice of specific drugs and targets should be individualized based on patient characteristics for which specific agents are indicated. Antihypertensive treatment with angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB), in association with thiazide or thiazide-like diuretics and dihydropyridine calcium channel blockers (CCB) has demonstrated the greatest benefits for stroke patients. Combination therapy is more effective than monotherapy and should be initiated once post-stroke patients are stabilized, usually several days or weeks after the event. The preferred strategy for secondary prevention of stroke in patients with type 2 diabetes mellitus (T2DM) should include a combination of metformin and glucagon-like peptide-1 receptor antagonist (GLP-1RA). Meta-analyses in T2DM patients suggest greater benefits for pioglitazone and some GLP-1RA compared to other classes of antidiabetic medications. Despite the significant cardiovascular benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i), they have not demonstrated to reduce the risk of recurrent stroke. In addition to lifestyle-behavioural changes, aggressive management of dyslipidaemia is recommended by major guidelines for secondary prevention of stroke. For high-risk patients, low density lipoprotein-C (LDL-C) target is <70 mg/dL. For very high-risk patients, LDL-C goal <55 mg/dL is recommended. High-intensity statin therapy is the first line treatment. If LDL-C targets are not achieved, ezetimibe and/or proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) should be added. If the patient has baseline triglyceride levels between 150 and 500 mg/dL, treatment with IPE may be considered to lower risk of recurrent events.

Students’ academic and social adaptation is linked to factors such as their initial study motivations, the atmosphere of the academic environment and their perception of academic wellbeing. This paper analyses the initial adaptation of first-degree students in their first semester through a quantitative ex post facto study with a descriptive-exploratory approach, using a questionnaire as the information-gathering instrument. Findings shed light on the concept of initial adaptation itself (through the creation of an index) and validate the study of the construct through three factors: initial motivation, the academic environment and perception of academic wellbeing. Also, the influence on initial adaptation of the academic and social context of the degree course taken is demonstrated:, as the constitutive features of the degree contribute information predicting how students will integrate into the institution. Therefore, it is suggested that institutional means and actions should be designed and put in place in accordance with measurements that indicate how students function best in a specific context (the bachelor’s degree), in order to boost motivation and the perception of academic wellbeing.

Background: The purpose of this exploratory study is to examine the role of sociodemographic, clinical, and cognitive - both objective and subjective - factors in overall and in specific domains of psychosocial functioning, in patients with depression at different clinical states of the disease (remitted and non-remitted). Methods: A sample of 325 patients with major depressive disorder, 117 in remission and 208 in non-remission, were assessed with a semi-structured interview collecting sociodemographic, clinical, cognitive (with neuropsychological tests and the Perceived Deficit Questionnaire), and functional (Functioning Assessment Short Test) characteristics. Backward regression models were conducted to determine associations of global and specific areas of functioning with independent factors, for both clinical states. Results: Residual depressive symptomatology and self-appraisal of executive competence were significantly associated with psychosocial functioning in remitted patients, in overall and some subdomains of functioning, particularly cognitive and interpersonal areas. While depressive symptoms, executive deficits and self-appraisal of executive function were significantly related to functional outcomes in non-remitted patients, both in overall functioning and in most of subdomains. Discussion: This study evidences the strong association of one's appraisal of executive competence with psychosocial functioning, together with depressive symptoms, both in remitted and non-remitted patients with depression. Therefore, to achieve full recovery, clinical management of patients should tackle not only the relief of core depressive symptoms, but also the cognitive ones, both those that are objectified with neuropsychological tests and those that are reported by the patients themselves.

Background: Cluster headache (CH) is a type of headache that has a global prevalence of 0.5-3/1000 people, provokes severe, strictly unilateral pain through the first branch of the trigeminal nerve, and is associated with observable autonomous responses. CH provokes intense pain and decreases quality of life. Objective: In this study, we aimed to carry out a systematic review of the effectiveness of non-invasive neuromodulation of the vagus nerve in patients with cluster headaches, which was registered on PROSPERO No. CRD42021265126. Methods: Six databases were used from their date of inception to February 2023 to obtain studies with the group intervention of non-invasive neuromodulation of the vagus nerve for cluster headache, with outcomes based on pain attacks, duration, and disabilities. Data on the subjects, group intervention, main outcomes, and results were collected by two authors. Results: The search provided 1003 articles, with three clinical trials being eligible for inclusion in the review. The methodological quality scores ranged from 6 to 8 points (mean: 7.3, SD: 0.8) out of a maximum of 10 points. The post-treatment results showed some positive effects using n-VNS as a treatment for cluster headache, more specifically regarding cervical neuromodulation of the vagus nerve. Conclusions: The systematic review found moderate-to-high-quality evidence supporting that n-VNS and cervical n-VNS may have some positive effects at the end of the treatment being effective to relieve the frequency and intensity of cluster headaches. The poor quantity of studies available and the lack of homogeneity in the study protocols did not allow the pooling of data for a meta-analysis.

Objectives: To evaluate the association between chronic low back pain (LBP) and painful temporomandibular disorders (TMDs). Methods: Systematic review of observational studies. Searches were conducted using OVID MEDLINE, CINHAL, Web of Science, and PUBMED databases up to October 21, 2022. Qualitative and quantitative analyses were performed. Risk of bias (RoB) was assessed using the Quality in Prognosis Studies tool (QUIPS). Results: Eight studies were included in the present review. The first-onset of TMDs was more likely in patients with previous chronic LBP (hazard ratio (HR) 1.53 [95% Confidence interval (CI): 1.28;1.83, p<0.00001]). In addition, patients with chronic LBP had 3.25 times the odds (OR) [95% CI: 1.94; 5.43, p<0.00001] of having chronic TMDs than those who did not have chronic LBP. In addition, the higher the exposure to chronic LBP, the higher the risk of developing a first-onset of TMDs. Conclusions: Chronic LBP can be considered a risk/contributing factor for painful TMDs. Although there is a high certainty in the evidence linking chronic LBP with the risk of a first-onset of TMDs, there are insufficient studies to draw definitive conclusions. Furthermore, while an association between chronic LBP and chronic TMDs and a dose-effect was observed between these two conditions, a limited number of studies and evidence exists to support these findings. Future studies are needed to increase the body of evidence. Keywords: Chronic pain, low back pain, facial pain, temporomandibular joint disorders, temporomandibular joint dysfunction syndrome, craniomandibular disorders, myofascial pain syndromes.

Given the development of artificial intelligence (AI) and the conditions of vulnerability of large sectors of the population, the question emerges: what are the ethical limits of technologies in patient care? This paper examines this question in the light of the “language of nature” and of Aristotelian causal analysis, in particular the concept of means and ends. Thus, it is possible to point out the root of the distinction between the identity of the person and the entity of any technology. Nature indicates that the person is always an end in itself. Technology, on the contrary, should only be a means to serve the person. The diversity of their respective natures also explains why their respective agencies enjoy diverse scopes. Technological operations (artificial agency, artificial intelligence) find their meaning in the results obtained through them (poiesis). Moreover, the person is capable of actions whose purpose is precisely the action itself (praxis), in which personal agency and, ultimately, the person themselves, is irreplaceable. Forgetting the distinction between what, by nature, is an end and what can only be a means is equivalent to losing sight of the instrumental nature of AI and, therefore, its specific meaning: the greatest good of the patient. It is concluded that the language of nature serves as a filter that supports the effective subordination of the use of AI to its specific purpose, the human good. The greatest contribution of this work is to draw attention to the nature of the person and technology, and about their respective agencies. In other words: listening to the language of nature, and attending to the diverse nature of the person and technology, personal agency, and artificial agency.