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El ejercicio de una profesión se realiza en el contexto de la atribución de un conjunto de competencias legales. Desde su reconocimiento como profesión regulada, la psicología clínica ha experimentado un recorrido y consolidación. El objetivo de este trabajo ha sido revisar las competencias legales de la psicología clínica en España. Se ha realizado una revisión narrativa no sistemática de la legislación, jurisprudencia y bibliografía. Los resultados se han agrupado en: 1) Evaluación, diagnóstico y tratamientos psicológicos; 2) Emisión de informes; 3) Derivación a dispositivos/programas, indicación de ingresos y altas y petición de pruebas; 4) Docencia universitaria y 5) Responsabilidades legales. Los psicólogos clínicos tienen reconocida su capacidad legal para un conjunto amplio de actividades clínicas, de gestión, docentes e investigadoras. Algunas actividades se ven limitadas en la práctica, y para otras no existe un marco legal establecido que permita su desempeño.

La variabilidad en la práctica clínica en psicología clínica en España es ha sido escasamente estudiado. Este estudio describe la variabilidad en las respuestas asistenciales de Psicología Clínica en los Centros y consultas externas de Salud Mental de la Comunidad de Madrid, a través de una encuesta informada por 120 psicólogos/as clínicos/as del Servicio Madrileño de Salud, y analizar factores que puedan relacionarse con ella. El riesgo de mala salud mental del área de salud se relaciona con una lista de espera más larga y realización de grupos de psicoterapia. La renta media del área de salud y los años de experiencia se asociaron a una mayor probabilidad de realizar grupos. La gestión privada de los dispositivos se asoció con una menor duración de las primeras consultas y sucesivas y con una demora temporal entre consultas mayor. Se discuten las implicaciones de estos resultados.

Variations in clinical practice in clinical psychology may involve, among other aspects, the type of treatment, the waiting time to receive it, and its duration. There have been few studies that have examined the variability in mental health care in Spain. The objective of this study has been to describe the variability in the assistance responses of Clinical Psychologist in Mental Health Center and hospital outpatient consultations in the Community of Madrid, through a survey reported by clinical psychologists, and to analyze factors that may be related to this variability. 120 responses were obtained, 36% of SERMAS clinical psychologists. The risk of poor mental health in the health area was related to a longer waiting list for clinical psychology and with the completion of therapy groups. The mean income of the health area and the professional's years of experience were also associated with a greater probability of carrying out groups of psychotherapy. The private management of the public devices was associated with a shorter time for first consultation and subsequent appointments and a longer time delay between appointments. The factors related to the organizational offer are the ones that most influence the healthcare variables examined. The implications of these results are discussed. La variabilidad en la práctica clínica en psicología clínica en España es ha sido escasamente estudiado. Este estudio describe la variabilidad en las respuestas asistenciales de Psicología Clínica en los Centros y consultas externas de Salud Mental de la Comunidad de Madrid, a través de una encuesta informada por 120 psicólogos/as clínicos/as del Servicio Madrileño de Salud, y analizar factores que puedan relacionarse con ella. El riesgo de mala salud mental del área de salud se relaciona con una lista de espera más larga y realización de grupos de psicoterapia. La renta media del área de salud y los años de experiencia se asociaron a una mayor probabilidad de realizar grupos. La gestión privada de los dispositivos se asoció con una menor duración de las primeras consultas y sucesivas y con una demora temporal entre consultas mayor. Se discuten las implicaciones de estos resultados.

La variabilidad en la práctica clínica en psicología clínica en España es ha sido escasamente estudiado. Este estudio describe la variabilidad en las respuestas asistenciales de Psicología Clínica en los Centros y consultas externas de Salud Mental de la Comunidad de Madrid, a través de una encuesta informada por 120 psicólogos/as clínicos/as del Servicio Madrileño de Salud, y analizar factores que puedan relacionarse con ella. El riesgo de mala salud mental del área de salud se relaciona con una lista de espera más larga y realización de grupos de psicoterapia. La renta media del área de salud y los años de experiencia se asociaron a una mayor probabilidad de realizar grupos. La gestión privada de los dispositivos se asoció con una menor duración de las primeras consultas y sucesivas y con una demora temporal entre consultas mayor. Se discuten las implicaciones de estos resultados.

The practice of a profession takes place in the context of the assignment of a set of legal competencies. Since its recognition as a regulated profession, clinical psychology has undergone a process of evolution and consolidation. The aim of this work was to review the legal competencies of clinical psychology in Spain. A non-systematic narrative review of legislation, jurisprudence and bibliography has been carried out. The results were grouped into: 1) Assessment, diagnosis and psychological treatment; 2) Issuance of reports; 3) Referral to services/programs, indication of admission and discharge, and request for testing; 4) University teaching; and 5) Legal responsibilities. Clinical psychologists are recognized as having legal capacity for a wide range of clinical, management, teaching and research activities. Some activities are limited in practice and others have no established legal framework for their performance.

Desde 2018 los Centros de Atención Primaria (AP) del Servicio Madrileño de Salud (SERMAS) ofrecen atención psicológica especializada. Se analizan indicadores asistenciales informados por 17 de los 21 facultativos/as de psicología clínica que trabajan en AP y sus propuestas para ampliar la cartera de servicios, a través de una encuesta online en 2022. El tiempo medio de espera para primera consulta fue de 30 días. El número medio de pacientes nuevos semanales fue de 20, 7 pacientes diarios en individual y 5 grupos de terapia a la semana. La carga media por profesional se encontraba en 318 pacientes. El 35% cambiarían de trabajo. Quedan múltiples retos en el desarrollo de la atención psicológica especializada en este nivel como aumentar la ratio de psicólogos/as clínicos/as, diversificar la cartera de servicios, coordinación y trabajo en equipo, turnos de trabajo y reducir la sobrecarga asistencial.

ObjectivesTo assess the efficacy of a single intradiscal injection of allogeneic bone marrow mesenchymal stromal cells (BM-MSCs) versus a sham placebo in patients with chronic low back pain (LBP).MethodsParticipants were randomised in a prospective, double-blind, controlled study to receive either sham injection or intradiscal injection of 20 million allogeneic BM-MSC, between April 2018 and December 2022. The first co-primary endpoint was the rate of responders defined by improvement of the Visual Analogue Scale (VAS) for pain of at least 20% and 20 mm, or improvement of the Oswestry Disability Index (ODI) of 20% between baseline and month 12. The secondary structural co-primary endpoint was assessed by the disc fluid content measured by quantitative MRI T2, between baseline and month 12. Secondary endpoints included pain VAS, ODI, the Short Form (SF)-36 and the minimal clinically important difference in all timepoints (1, 3, 6, 12 and 24 months). We determined the immune response associated with allogeneic cell injection between baseline and 6 months. Serious adverse events (SAEs) were recorded.Results114 patients were randomised (n=58, BM-MSC group; n=56, sham placebo group). At 12 months, the primary outcome was not reached (74% in the BM-MSC group vs 69% in the placebo group; p=0.77). The groups did not differ in all secondary outcomes. No SAE related to the intervention occurred.ConclusionsWhile our study did not conclusively demonstrate the efficacy of allogeneic BM-MSCs for LBP, the procedure was safe. Long-term outcomes of MSC therapy for LBP are still being studied.Trial registration numberEudraCT 2017-002092-25/ClinicalTrials.gov: NCT03737461.

Background Myocardial injury after non-cardiac surgery (MINS) is a frequent complication caused by cardiac and non-cardiac pathophysiological mechanisms, but often it is subclinical. MINS is associated with increased morbidity and mortality, justifying the need to its diagnose and the investigation of their causes for its potential prevention. Methods Prospective, observational, pilot study, aiming to detect MINS, its relationship with silent coronary artery disease and its effect on future adverse outcomes in patients undergoing major non-cardiac surgery and without postoperative signs or symptoms of myocardial ischemia. MINS was defined by a high-sensitive cardiac troponin T (hs-cTnT) concentration > 14 ng/L at 48–72 h after surgery and exceeding by 50% the preoperative value; controls were the operated patients without MINS. Within 1-month after discharge, cardiac computed tomography angiography (CCTA) and magnetic resonance imaging (MRI) studies were performed in MINS and control subjects. Significant coronary artery disease (CAD) was defined by a CAD-RADS category ≥ 3. The primary outcomes were prevalence of CAD among MINS and controls and incidence of major cardiovascular events (MACE) at 1-year after surgery. Secondary outcomes were the incidence of individual MACE components and mortality. Results We included 52 MINS and 12 controls. The small number of included patients could be attributed to the study design complexity and the dates of later follow-ups (amid COVID-19 waves). Significant CAD by CCTA was equally found in 20 MINS and controls (30% vs 33%, respectively). Ischemic patterns (n = 5) and ischemic segments (n = 2) depicted by cardiac MRI were only observed in patients with MINS. One-year MACE were also only observed in MINS patients (15.4%). Conclusion This study with advanced imaging methods found a similar CAD frequency in MINS and control patients, but that cardiac ischemic findings by MRI and worse prognosis were only observed in MINS patients. Our results, obtained in a pilot study, suggest the need of further, extended studies that screened systematically MINS and evaluated its relationship with cardiac ischemia and poor outcomes. Trial registration Clinicaltrials.gov identifier: NCT03438448 (19/02/2018).

Many studies have explored the relationship between diabetes mellitus (DM) and tuberculosis (TB) demonstrating increased risk of TB among patients with DM and poor prognosis of patients suffering from the association of DM/TB. Owing to a paucity of studies addressing this question, it remains unclear whether patients with DM and TB are more likely than TB patients without DM to be grouped into molecular clusters defined according to the genotype of the infecting Mycobacterium tuberculosis bacillus. That is, whether there is convincing molecular epidemiological evidence for TB transmission among DM patients. Objective: We performed a systematic review and meta-analysis to quantitatively evaluate the propensity for patients with DM and pulmonary TB (PTB) to cluster according to the genotype of the infecting M. tuberculosis bacillus. We conducted a systematic search in MEDLINE and LILACS from 1990 to June, 2016 with the following combinations of key words \"tuberculosis AND transmission\" OR \"tuberculosis diabetes mellitus\" OR \"Mycobacterium tuberculosis molecular epidemiology\" OR \"RFLP-IS6110\" OR \"Spoligotyping\" OR \"MIRU-VNTR\". Studies were included if they met the following criteria: (i) studies based on populations from defined geographical areas; (ii) use of genotyping by IS6110- restriction fragment length polymorphism (RFLP) analysis and spoligotyping or mycobacterial interspersed repetitive unit-variable number of tandem repeats (MIRU-VNTR) or other amplification methods to identify molecular clustering; (iii) genotyping and analysis of 50 or more cases of PTB; (iv) study duration of 11 months or more; (v) identification of quantitative risk factors for molecular clustering including DM; (vi) > 60% coverage of the study population; and (vii) patients with PTB confirmed bacteriologically. The exclusion criteria were: (i) Extrapulmonary TB; (ii) TB caused by nontuberculous mycobacteria; (iii) patients with PTB and HIV; (iv) pediatric PTB patients; (v) TB in closed environments (e.g. prisons, elderly homes, etc.); (vi) diabetes insipidus and (vii) outbreak reports. Hartung-Knapp-Sidik-Jonkman method was used to estimate the odds ratio (OR) of the association between DM with molecular clustering of cases with TB. In order to evaluate the degree of heterogeneity a statistical Q test was done. The publication bias was examined with Begg and Egger tests. Review Manager 5.3.5 CMA v.3 and Biostat and Software package R were used. Selection criteria were met by six articles which included 4076 patients with PTB of which 13% had DM. Twenty seven percent of the cases were clustered. The majority of cases (48%) were reported in a study in China with 31% clustering. The highest incidence of TB occurred in two studies from China. The global OR for molecular clustering was 0.84 (IC 95% 0.40-1.72). The heterogeneity between studies was moderate (I2 = 55%, p = 0.05), although there was no publication bias (Beggs test p = 0.353 and Eggers p = 0.429). There were very few studies meeting our selection criteria. The wide confidence interval indicates that there is not enough evidence to draw conclusions about the association. Clustering of patients with DM in TB transmission chains should be investigated in areas where both diseases are prevalent and focus on specific contexts.

Genotyping and georeferencing in tuberculosis (TB) have been used to characterize the distribution of the disease and occurrence of transmission within specific groups and communities. The objective of this study was to test the hypothesis that diabetes mellitus (DM) and pulmonary TB may occur in spatial and molecular aggregations. Retrospective cohort study of patients with pulmonary TB. The study area included 12 municipalities in the Sanitary Jurisdiction of Orizaba, Veracruz, México. Patients with acid-fast bacilli in sputum smears and/or Mycobacterium tuberculosis in sputum cultures were recruited from 1995 to 2010. Clinical (standardized questionnaire, physical examination, chest X-ray, blood glucose test and HIV test), microbiological, epidemiological, and molecular evaluations were carried out. Patients were considered \"genotype-clustered\" if two or more isolates from different patients were identified within 12 months of each other and had six or more IS6110 bands in an identical pattern, or < 6 bands with identical IS6110 RFLP patterns and spoligotype with the same spacer oligonucleotides. Residential and health care centers addresses were georeferenced. We used a Jeep hand GPS. The coordinates were transferred from the GPS files to ArcGIS using ArcMap 9.3. We evaluated global spatial aggregation of patients in IS6110-RFLP/ spoligotype clusters using global Moran´s I. Since global distribution was not random, we evaluated \"hotspots\" using Getis-Ord Gi* statistic. Using bivariate and multivariate analysis we analyzed sociodemographic, behavioral, clinic and bacteriological conditions associated with \"hotspots\". We used STATA® v13.1 for all statistical analysis. From 1995 to 2010, 1,370 patients >20 years were diagnosed with pulmonary TB; 33% had DM. The proportion of isolates that were genotyped was 80.7% (n = 1105), of which 31% (n = 342) were grouped in 91 genotype clusters with 2 to 23 patients each; 65.9% of total clusters were small (2 members) involving 35.08% of patients. Twenty three (22.7) percent of cases were classified as recent transmission. Moran`s I indicated that distribution of patients in IS6110-RFLP/spoligotype clusters was not random (Moran`s I = 0.035468, Z value = 7.0, p = 0.00). Local spatial analysis showed statistically significant spatial aggregation of patients in IS6110-RFLP/spoligotype clusters identifying \"hotspots\" and \"coldspots\". GI* statistic showed that the hotspot for spatial clustering was located in Camerino Z. Mendoza municipality; 14.6% (50/342) of patients in genotype clusters were located in a hotspot; of these, 60% (30/50) lived with DM. Using logistic regression the statistically significant variables associated with hotspots were: DM [adjusted Odds Ratio (aOR) 7.04, 95% Confidence interval (CI) 3.03-16.38] and attending the health center in Camerino Z. Mendoza (aOR18.04, 95% CI 7.35-44.28). The combination of molecular and epidemiological information with geospatial data allowed us to identify the concurrence of molecular clustering and spatial aggregation of patients with DM and TB. This information may be highly useful for TB control programs.