The aims of this work were to evaluate whether the treatment of patients with fibromyalgia with memantine is associated with significant changes in metabolite concentrations in the brain, and to explore any changes in clinical outcome measures. Magnetic resonance spectroscopy was performed of the right anterior and posterior insula, both hippocampi and the posterior cingulate cortex. Questionnaires on pain, anxiety, depression, global function, quality of life and cognitive impairment were used. Ten patients were studied at baseline and after three months of treatment with memantine. Significant increases were observed in the following areas: N-acetylaspartate (4.47 at baseline vs. 4.71 at three months, p = 0.02) and N-acetylaspartate+N-acetylaspartate glutamate in the left hippocampus (5.89 vs. 5.98; p = 0.007); N-acetylaspartate+N-acetylaspartate glutamate in the right hippocampus (5.31 vs 5.79; p = 0.01) and the anterior insula (7.56 vs. 7.70; p = 0.033); glutamate+glutamine/creatine ratio in the anterior insula (2.03 vs. 2.17; p = 0.022) and the posterior insula (1.77 vs. 2.00; p = 0.004); choline/creatine ratio in the posterior cingulate (0.18 vs. 0.19; p = 0.023); and creatine in the right hippocampus (3.60 vs. 3.85; p = 0.007). At the three-month follow-up, memantine improved cognitive function assessed by the Cognition Mini-Exam (31.50, SD = 2.95 vs. 34.40, SD = 0.6; p = 0.005), depression measured by the Hamilton Depression Scale (7.70, SD = 0.81 vs. 7.56, SD = 0.68; p = 0.042) and severity of illness measured by the Clinical Global Impression severity scale (5.79, SD = 0.96 vs. 5.31, SD = 1.12; p = 0.007). Depression, clinical global impression and cognitive function showed improvement with memantine. Magnetic resonance spectroscopy could be useful in monitoring response to the pharmacological treatment of fibromyalgia.

Major depression etiopathogenesis is related to a wide variety of genetics, demographic and psychosocial factors, as well as to environmental factors. The objective of this study is to analyze sociodemographic and environmental variables that are related to the prevalence of depression through correlation analysis and to develop a regression model that explains the behavior of this disease from an ecological perspective. This is an ecological, retrospective, cross-sectional study. The target population was 1,148,430 individuals over the age of 16 who were registered in Aragon (Spain) during 2010, with electronic medical records in the community’s primary health care centers. The spatial unit was the Basic Health Area (BHA). The dependent variable was the diagnosis of Depression and the ecological independent variables were: Demographic variables (gender and age), population distribution, typology of the entity, population structure by sex and age, by nationality, by education, by work, by salary, by marital status, structure of the household by number of members, and state of the buildings. The results show moderate and positive correlations with higher rates of depression in areas having a higher femininity index, higher population density, areas with a higher unemployment rate and higher average salary. The results of the linear regression show that aging +75 and rural entities act as protective factors for depression, while urban areas and deficient buildings act as risk factors. In conclusion, the ecological methodology may be a useful tool which, together with the statistical epidemiological analysis, can help in the political decision making process.

Background: Naturalistic studies to assess the efficacy and pattern of use of computer-delivered psychotherapy programmes in real daily clinical conditions are infrequent Anxiety disorders are the most common mental disorders, and many of them do not receive adequate management, especially in primary care settings. The objective of this study is to assess the efficacy of an internet-delivered programme for anxiety in primary care.Methods: Multicentre, naturalistic study. Patients with generalised anxiety disorder were recruited (N=229). The generalised anxiety disorder 7-item scale (GAD 7) was the only outcome measured. Qualitative methods were used to analyse patient therapist interactions.Results: Only 13.5% of patients completed the programme. Analysis per intent-to-treat using Last Observation Carried Forward showed a significant GAD-7 decrease post treatment (-2.17; SD=4.77; p=0.001) (Cohen 's d=043) with a correlation between the number of sessions and decrease in anxiety (Rho=0.34, p=0.001). The analysis per protocol showed significantly decreased GAD-7 (-4.13; SD=6.82; p =0.002) (d=0.80). Withdrawal was related to low programme friendliness, lack of a partner, arid higher education. Only 1747% of the patients consulted their therapists. Facilitators were patient demand for information and sufficient time Barriers were lack of motivation and lack of connection vvilh the programme.Limitations: The main limitations of this study included the use of an open trial design, the lack of followup, and the inclusion of only one outcome (GAD 7).Conclusions: To our knowledge, this is the first study with computer delivered psychotherapy (CDP) on GAD. CDP for anxiety is efficacious in naturalistic environments. Specific facilitators and barriers should be considered. (C) 2015 Elsevier By. All rights reserved.

Background and Aims Glycated hemoglobin (HbA1c) is currently used to diagnose diabetes mellitus, while insulin has been relegated to research. Both, however, may help understanding the metabolic syndrome and profiling patients. We examined the association of HbA1c and fasting insulin with clustering of metabolic syndrome criteria and insulin resistance as two essential characteristics of the metabolic syndrome. Methods We used baseline data from 3200 non-diabetic male participants in the Aragon Workers' Health Study. We conducted analysis to estimate age-adjusted odds ratios (ORs) across tertiles of HbA1c and insulin. Fasting glucose and Homeostatic model assessment - Insulin Resistance were used as reference. Here we report the uppermost-to-lowest tertile ORs (95%CI). Results Mean age (SD) was 48.5 (8.8) years and 23% of participants had metabolic syndrome. The ORs for metabolic syndrome criteria tended to be higher across HbA1c than across glucose, except for high blood pressure. Insulin was associated with the criteria more strongly than HbA1c and similarly to Homeostatic model assessment - Insulin Resistance (HOMA-IR). For metabolic syndrome, the OR of HbA1c was 2.68, of insulin, 11.36, of glucose, 7.03, and of HOMA-IR, 14.40. For the clustering of 2 or more non-glycemic criteria, the OR of HbA1c was 2.10, of insulin, 8.94, of glucose, 1.73, and of HOMA-IR, 7.83. All ORs were statistically significant. The areas under the receiver operating characteristics curves for metabolic syndrome were 0.670 (across HbA1c values) and 0.770 (across insulin values), and, for insulin resistance, 0.647 (HbA1c) and 0.995 (insulin). Among non-metabolic syndrome patients, a small insulin elevation identified risk factor clustering. Conclusions HbA1c and specially insulin levels were associated with metabolic syndrome criteria, their clustering, and insulin resistance. Insulin could provide early information in subjects prone to develop metabolic syndrome.

Fibromyalgia (FM) is a prevalent and disabling chronic disease. Recent studies have found elevated levels of glutamate in several brain regions, leading to hypotheses about the usefulness of glutamate blocking drugs such as memantine in the treatment of FM. The aim of this study is to evaluate the efficacy of memantine in the treatment of pain and other clinical variables (global function, clinical impression, depression, anxiety, quality of life) in FM patients. Trial Design: A double-blind parallel randomised controlled trial was developed. A total of 63 patients diagnosed with FM were recruited from primary health care centres in Zaragoza, Spain. Memantine was administered at doses of 20 mg/day after one month of titration. Assessments were carried out at baseline, post-treatment, and 3and 6-month follow-ups. Compared with a placebo group, memantine significantly decreased ratings on a pain visual analogue scale (Cohen’s d=1.43 at 6 months) and pain measured with a sphygmomanometer (d=1.05). All other secondary outcomes except anxiety also improved, with moderateto-large effect sizes at 6 months. Compared to placebo, the absolute risk reduction obtained with memantine was 16.13% (95% CI=2.0-32.6%), and the number needed to treat (NNT) was 6.2 (95% CI=3-47). Tolerance was good, with dizziness (8 patients) and headache (4 patients) being the most frequent side effects of memantine. Although additional studies with larger samples and longer follow-ups are needed, this study provides preliminary evidence of the utility of memantine for the treatment of FM. Trial registration Current Controlled Trials ISRCTN45127327 EUDRACT 2011-006244-73

SummaryAimTo evaluate the efficacy of memantine on metabolite levels in different areas of the brain and to determine whether changes in metabolite levels correlate with clinical variables in Fibromyalgia (FM) patients.MethodsDoubled‐blind parallel randomized controlled trial. Twenty‐five patients diagnosed with FM were enrolled in the study. Patients were administered questionnaires on pain, anxiety, depression, quality of life, and cognitive impairment, and single‐voxel MRS of the brain was performed. All assessments were performed at baseline and after 6 months of treatment with memantine or placebo.ResultsPatients treated with memantine exhibited a significant increase in the glutamate (P = 0.010), glutamate/creatine ratio (P = 0.013), combined glutamate + glutamine (P = 0.016) and total N‐acetyl‐aspartate (NAA+NAAG) (P = 0.034) in the posterior cingulate cortex compared with those on placebo. Furthermore, the memantine group exhibited increases in creatine (P = 0.013) and choline (Cho) (P = 0.025) in the right posterior insula and also a correlation between choline and the Fibromyalgia Impact Questionnaire (FIQ) in the posterior insula (P = 0.050) was observed.ConclusionMemantine treatment resulted in an increase in cerebral metabolism in FM patients, suggesting its utility for the treatment of the illness.

Self-compassion is a key psychological construct for assessing clinical outcomes in mindfulness-based interventions. The aim of this study was to validate the Spanish versions of the long (26 item) and short (12 item) forms of the Self-Compassion Scale (SCS).

Analizar la asociación entre tiempo sentado y biomarcadores de resistencia a la insulina e inflamación en una población de trabajadores varones. Estudio transversal realizado sobre 929 voluntarios, pertenecientes a la cohorte del Aragon Workers’ Health Study. Se obtuvieron datos sociodemográficos, antropométricos, farmacológicos y bioquímicos: lipídicos —colesterol total, colesterol unido a lipoproteínas de alta y baja densidad, triglicéridos, apolipoproteínas A1 y B100 y lipoproteína (a)—, glucídicos —glucosa, glucohemoglobina, homeostasis model assessment of insulin resistance, insulina y cociente triglicéridos/colesterol unido a lipoproteínas de alta densidad— e inflamatorios —proteína C reactiva y leucocitos—. El tiempo sentado y la actividad física realizada se obtuvieron mediante cuestionarios. Se realizó un análisis de prevalencias y medianas según terciles de sedentarismo y multivariable (regresión lineal bruta y ajustada) con los biomarcadores de inflamación y de resistencia a la insulina. Los trabajadores más sedentarios presentan unas medianas de índice de masa corporal, perímetro de cintura y presión arterial sistólica mayores, con una tendencia significativa de aumento en cada tercil, peor perfil lipídico, valores más elevados de proteína C reactiva, homeostasis model assessment of insulin resistance, cociente triglicéridos/colesterol unido a lipoproteínas de alta densidad e insulina. En el modelo de regresión lineal bruta y ajustada, encontramos una asociación significativa de estas últimas variables con el tiempo de posición de sentado medido en horas (β = 0,07 [log proteína C reactiva]; β = 0,05 [log homeostasis model assessment of insulin resistance]; β = 0,23 [triglicéridos/colesterol unido a lipoproteínas de alta densidad], y β = 0,44 [insulina]) que no se modifican tras ajustar por los equivalentes metabólicos-h/semana. Los trabajadores más sedentarios presentan parámetros inflamatorios y de resistencia a la insulina más altos de manera independiente de la actividad física realizada. To analyze the association between sitting time and biomarkers of insulin resistance and inflammation in a sample of healthy male workers. Cross-sectional study carried out in a sample of 929 volunteers belonging to the Aragon Workers’ Health Study cohort. Sociodemographic, anthropometric, pharmacological and laboratory data were collected: lipids—total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, apolipoproteins A-1 and B-100, lipoprotein (a)—, insulin resistance—glucose, glycated hemoglobin, homeostasis model assessment of insulin resistance, insulin, and triglyceride/high-density lipoprotein cholesterol ratio—, and inflammatory profile—C-reactive protein and leukocytes. Information on sitting time and physical activity was assessed using a questionnaire. Sedentary behavior was analyzed in terms of prevalences and medians, according to tertiles, using a multivariate model (crude and adjusted linear regression) with biomarkers of inflammation and insulin resistance. The most sedentary individuals had higher body mass index, greater waist circumference, and higher systolic blood pressure, with a significant upward trend in each tertile. Likewise, they had a worse lipid profile with a higher C-reactive protein level, homeostasis model assessment of insulin resistance index, triglyceride/high-density lipoprotein cholesterol ratio, and insulin concentration. In the multivariate analysis, we observed a significant association between the latter parameters and sitting time in hours (log C-reactive protein [β =0.07], log homeostasis model assessment of insulin resistance index [β = 0.05], triglyceride/high-density lipoprotein cholesterol ratio [β = 0.23], and insulin [β = 0.44]), which remained after adjustment for metabolic equivalents-h/week. Workers who spend more time sitting show a worse inflammatory and insulin resistance profile independently of the physical activity performed. Full English text available from: www.revespcardiol.org/en

Rationale and Objectives: The aim of the study was to analyze 1) whether the metabolite levels in the posterior cingulate cortex (PCC) are different in healthy individuals compared to a group of patients with cognitive impairment and/or pain and 2) whether there exists a correlation between brain metabolites and the age of a patient.Materials and Methods: Two hundred seven patients with cognitive impairment and/or pain (66 mild cognitive impairment, 54 fibromyalgia, 36 Alzheimer disease, 33 interictal migraine, 10 somatization disorder, and 8 after trigeminal neuralgia, and 193 healthy participants adjusted for gender and age. Proton magnetic resonance spectroscopy (MRS) of the brain was performed with the voxel placed in the ventral PCC and postprocessed with LCModel (Stephen Provencher, Oakville, Ontario, Canada).Results: Using linear regression and adjusting for gender and age, mean brain metabolite values for the pathological group, when compared-to healthy controls, were significantly lower in N-acetylaspartate (P = .003) and N-acetylaspartate/creatine (P = .015) and significantly greater in glutamate + glutamine (P < .001) and glutamate + glutamine/creatine (P < .000). All metabolites were significantly correlated with age: glutamate, glutamate + glutamine, N-acetylaspartate, and their creatine ratios exhibited a negative correlation, whereas myoinositol and choline exhibited a positive correlation.Conclusions: Although the number of patients is relatively small with heterogeneous state of disease, MRS in PCC may serve as a useful noninvasive tool for diagnostic of patients with cognitive impairment and pain.

Introduction and objectives: To analyze the association between sitting time and biomarkers of insulin resistance and inflammation in a sample of healthy male workers.Methods: Cross-sectional study carried out in a sample of 929 volunteers belonging to the Aragon Workers' Health Study cohort. Sociodemographic, anthropometric, pharmacological and laboratory data were collected: lipids-total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, apolipoproteins A-1 and B-100, lipoprotein (a)-, insulin resistance-glucose, glycated hemoglobin, homeostasis model assessment of insulin resistance, insulin, and triglyceride/ highdensity lipoprotein cholesterol ratio-, and inflammatory profile-C-reactive protein and leukocytes. Information on sitting time and physical activity was assessed using a questionnaire. Sedentary behavior was analyzed in terms of prevalences and medians, according to tertiles, using a multivariate model (crude and adjusted linear regression) with biomarkers of inflammation and insulin resistance.Results: The most sedentary individuals had higher body mass index, greater waist circumference, and higher systolic blood pressure, with a significant upward trend in each tertile. Likewise, they had a worse lipid profile with a higher C-reactive protein level, homeostasis model assessment of insulin resistance index, triglyceride/ high-density lipoprotein cholesterol ratio, and insulin concentration. In the multivariate analysis, we observed a significant association between the latter parameters and sitting time in hours (log C-reactive protein [b = 0.07], log homeostasis model assessment of insulin resistance index [b = 0.05], triglyceride/ high-density lipoprotein cholesterol ratio [b = 0.23], and insulin [b = 0.44]), which remained after adjustment for metabolic equivalents-h/ week.Conclusions: Workers who spend more time sitting show a worse inflammatory and insulin resistance profile independently of the physical activity performed. (C) 2013 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S. L. All rights reserved.

To evaluate the efficacy of memantine on metabolite levels in different areas of the brain and to determine whether changes in metabolite levels correlate with clinical variables in Fibromyalgia (FM) patients. Doubled-blind parallel randomized controlled trial. Twenty-five patients diagnosed with FM were enrolled in the study. Patients were administered questionnaires on pain, anxiety, depression, quality of life, and cognitive impairment, and single-voxel MRS of the brain was performed. All assessments were performed at baseline and after 6 months of treatment with memantine or placebo. Patients treated with memantine exhibited a significant increase in the glutamate ( P  = 0.010), glutamate/creatine ratio ( P  = 0.013), combined glutamate + glutamine ( P  = 0.016) and total N -acetyl-aspartate (NAA+NAAG) ( P  = 0.034) in the posterior cingulate cortex compared with those on placebo. Furthermore, the memantine group exhibited increases in creatine ( P  = 0.013) and choline (Cho) ( P  = 0.025) in the right posterior insula and also a correlation between choline and the Fibromyalgia Impact Questionnaire (FIQ) in the posterior insula ( P  = 0.050) was observed. Memantine treatment resulted in an increase in cerebral metabolism in FM patients, suggesting its utility for the treatment of the illness.

BACKGROUND:Fibromyalgia is a prevalent chronic rheumatic disease of great clinical importance. Recent studies have found raised levels of glutamate in the insula, hippocampus and posterior cingulate cortex regions of the brains of fibromyalgia (FM) patients. This finding has led researchers to speculate about the usefulness of glutamate-blocking drugs such as memantine in the treatment of fibromyalgia. The hypothesis of this study is that the administration of memantine will reduce the glutamate levels, and futhermore, will decrease the perceived pain. The aim of this study is to evaluate the efficacy of memantine in the treatment of pain (pain perception). A secondary objective is to evaluate the efficacy of memantine in the treatment of other clinical symptoms of FM, and to evaluate the efficacy of memantine in reducing brain levels of glutamate, and its effects on the central nervous system as a whole.METHOD/DESIGN:A double-blind parallel randomized controlled trial. Participants, Seventy patients diagnosed with FM will be recruited from primary health care centers in Zaragoza, Spain. Intervention. The subjects will be randomized in two groups: A) A treatment group (n = 35), which will receive 20 mg of memantine daily; B) A control group (n = 35), to which will be administered a placebo. There will be a six-month follow-up period (including a titration period of one month). Outcomes. The main efficacy variable of this study is pain (pain perception). The secondary efficacy variables are clinical symptoms (pain threshold, cognitive function, health status, anxiety, depression, clinical impression and quality of life) and glutamate levels in different regions of the brain, which will be assessed by magnetic resonance spectroscopy. Randomization and blinding. Randomization has been computer-generated, and the random allocation sequence will be implemented by telephone. Subjects of the study and the research assistants will be blinded to group assignment.DISCUSSION:There is a need for the development of innovative and more effective treatments for fibromyalgia. This clinical trial will determine whether memantine can be an effective pharmacological treatment for fibromyalgia patients.TRIAL REGISTRATION:Current Controlled Trials http://ISRCTN45127327 EUDRACT 2011-006244-73.

INTRODUCTION:This work aimed to determine whether (1)H magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are correlated with years of meditation and psychological variables in long-term Zen meditators compared to healthy non-meditator controls. MATERIALS AND METHODS:Design. Controlled, cross-sectional study. Sample. Meditators were recruited from a Zen Buddhist monastery. The control group was recruited from hospital staff. Meditators were administered questionnaires on anxiety, depression, cognitive impairment and mindfulness. (1)H-MRS (1.5 T) of the brain was carried out by exploring four areas: both thalami, both hippocampi, the posterior superior parietal lobule (PSPL) and posterior cingulate gyrus. Predefined areas of the brain were measured for diffusivity (ADC) and fractional anisotropy (FA) by MR-DTI. RESULTS:Myo-inositol (mI) was increased in the posterior cingulate gyrus and Glutamate (Glu), N-acetyl-aspartate (NAA) and N-acetyl-aspartate/Creatine (NAA/Cr) was reduced in the left thalamus in meditators. We found a significant positive correlation between mI in the posterior cingulate and years of meditation (r = 0.518; p = .019). We also found significant negative correlations between Glu (r = -0.452; p = .045), NAA (r = -0.617; p = .003) and NAA/Cr (r = -0.448; P = .047) in the left thalamus and years of meditation. Meditators showed a lower Apparent Diffusion Coefficient (ADC) in the left posterior parietal white matter than did controls, and the ADC was negatively correlated with years of meditation (r = -0.4850, p = .0066). CONCLUSIONS:The results are consistent with the view that mI, Glu and NAA are the most important altered metabolites. This study provides evidence of subtle abnormalities in neuronal function in regions of the white matter in meditators.

AIM:To describe current profile of patients with cardiovascular disease (CVD) and assessing changes through last decade.METHODS:Comparison of patients with established CVD from two similar cross-sectional registries performed in 1999 (n = 6194) and 2009 (n = 4639). The types of CVD were coronary heart disease (CHD), heart failure (HF) and atrial fibrillation (AF). Patients were collected from outpatient clinics. Investigators were 80% cardiologist and 20% primary care practitioners. Clinical antecedents, major diagnosis, blood test results and medical treatments were collected from all patients.RESULTS:An increase in all risk factors, except for smoking, was observed; a 54.4% relative increase in BP control was noted. CHD was the most prevalent CVD but HF and AF increased significantly, 41.5% and 33.7%, respectively. A significant reduction in serum lipid levels was observed. The use of statins increased by 141.1% as did all cardiovascular treatments. Moreover, the use of angiotensin-renin system inhibitors in patients with HF, beta-blockers in CHD patients or oral anticoagulants in AF patients increased by 83.0%, 80.3% and 156.0%, respectively (P < 0.01).CONCLUSION:The prevalence of all cardiovascular risk factors has increased in patients with CVD through last decade. HF and AF have experienced the largest increases.

BACKGROUND AND OBJECTIVES:Research in the United States tends to indicate that immigrants from most sociogeographic regions have considerably lower substance use disorder (SUD) rates than native born individuals. We aimed to analyze the differences between immigrants and native born population regarding substance abuse and dependence. This objective was approached using data from the ARACAT cross-sectional multicenter study in primary care settings of two different Spanish regions: Aragon and Catalonia.METHODS:Three thousand six patients (1,503 immigrants randomly selected and 1,503 native born paired by age and gender) were interviewed using the Mini-International Neuropsychiatric Interview.RESULTS:Reported substance abuse and dependence were more prevalent in the native born population than in immigrants (alcohol abuse 5.1% vs. 2.6% p < .0001, alcohol dependence 3.3% vs. 2.6% n.s., other abuse 3.4% vs. .4% p < .0001, other dependence .5% vs. 4.0% p < .0001). Large differences were detected between different ethnic groups. Sociodemographic characteristics such as female gender, older age, higher level of education or stable housing (among others), were found to be protective against different SUDs.CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE:Immigrants have lower levels of alcohol and substance abuse, however, those that do consume show higher levels of both comorbid mental disorders and problematic alcohol/substance use. It would appear to be the case that issues specific to immigrant cultures, such as extreme stigmatization of substance and alcohol use, may serve to promote social marginalization and inhibit treatment access.

BACKGROUND:Major depression will become the second most important cause of disability in 2020. Computerized cognitive-behaviour therapy could be an efficacious and cost-effective option for its treatment. No studies on cost-effectiveness of low intensity vs self-guided psychotherapy has been carried out. The aim of this study is to assess the efficacy of low intensity vs self-guided psychotherapy for major depression in the Spanish health system.METHODS:The study is made up of 3 phases: 1.- Development of a computerized cognitive-behaviour therapy for depression tailored to Spanish health system. 2.- Multicenter controlled, randomized study: A sample (N=450 patients) with mild/moderate depression recruited in primary care. They should have internet availability at home, not receive any previous psychological treatment, and not suffer from any other severe somatic or psychological disorder. They will be allocated to one of 3 treatments: a) Low intensity Internet-delivered psychotherapy + improved treatment as usual (ITAU) by GP, b) Self-guided Internet-delivered psychotherapy + ITAU or c) ITAU. Patients will be diagnosed with MINI psychiatric interview. Main outcome variable will be Beck Depression Inventory. It will be also administered EuroQol 5D (quality of life) and Client Service Receipt Inventory (consume of health and social services). Patients will be assessed at baseline, 3 and 12 months. An intention to treat and a per protocol analysis will be performed.DISCUSSION:The comparisons between low intensity and self-guided are infrequent, and also a comparative economic evaluation between them and compared with usual treatment in primary. The strength of the study is that it is a multicenter, randomized, controlled trial of low intensity and self-guided Internet-delivered psychotherapy for depression in primary care, being the treatment completely integrated in primary care setting.TRIAL REGISTRATION:Clinical Trials NCT01611818.

Perceived incongruity between the individual and the job on work-life areas such as workload, control, reward, fairness, community and values have implications for the dimensions of burnout syndrome. The “Areas of Work-life Scale” (AWS) is a practical instrument to measure employees´ perceptions of their work environments.

OBJECTIVE:The aim of this paper is to explore the prevalence of psychiatric morbidity in different immigrant groups in Spain. In keeping with prior studies carried out in Europe, it is expected that the immigrant population will have elevated levels of psychopathology, with some variation across immigrant groups. METHOD: DESIGN:Multicenter, observational, cross-sectional study. SETTING:Primary care settings of two Spanish regions. SAMPLE:N=1.503 immigrants paired with the same number of Spanish controls, adjusted by gender and age. VARIABLES:Demographic variables, MINI International Neuropsychiatric Interview and Standardized Polyvalent Psychiatric Interview, somatic symptoms section. Student's t tests, ORs and logistic regressions were used to analyze the data. RESULTS:No differences in psychiatric morbidity were found (native born 30.9%, population vs. immigrants 29.6%, OR=.942, CI=.806-1.100) when comparing immigrants to native born Spaniards. Relative to Spaniards (30.9%), Latin American immigrants had significantly higher levels of psychopathology (36.8%), Sub-Saharan Africans (24.4%) and Asians (16%) had significantly lower levels, and Eastern Europeans (31.4%) and North Africans (26.8%) showed no significant difference. CONCLUSIONS:The hypotheses were only partially supported. Although overall immigrants did not differ from the native born population, when analyzed by geographic origin, only Latin Americans had higher levels of psychopathology. It is concluded that multiple factors need to be taken into consideration when studying the mental health of immigrants given that different immigrant groups have different levels of psychopathology.