Background: Prolonged grief disorder (PGD) has been added to the ICD-11 and DSM-5-TR. The Traumatic Grief Inventory-Self Report Plus (TGI-SR+) assesses self-rated PGD intensity as defined in ICD-11 and DSM-5-TR. The TGI-SR + is available in multiple languages, but has not been validated yet in Norwegian.Objective: The aim of this study was to evaluate the psychometric properties of the Norwegian TGI-SR + .Method: Bereaved adults (N = 307) whose child or sibling died ≥6 months ago due to a sudden or violent loss completed the TGI-SR + and measures for posttraumatic stress, depression, and precursor PGD symptoms. We examined the factor structure and internal consistency of the ICD-11 and DSM-5-TR PGD items. Convergent validity and known-groups validity was evaluated. Probable PGD cases, pair-wise agreement between diagnostic scoring rules for both PGD criteria-sets, and cut-off scores were calculated.Results: The 1-factor model for ICD-11 and DSM-5-TR PGD showed the best fit and demonstrated good internal consistency. Convergent validity was supported by strong associations between summed ICD-11 and DSM-5-TR PGD scores and summed posttraumatic stress, depression, and precursor prolonged grief scores. Known-groups validity was supported by PGD intensity being related to educational level and time since loss. The perfect pair-wise agreement was reached using the ICD-11 and DSM-5-TR PGD diagnostic scoring rules. The optimal cut-off score for detecting probable PGD cases, when summing all TGI-SR + items, was ≥73.Conclusions: The Norwegian TGI-SR + seems a valid and reliable instrument to assess ICD-11 and DSM-5-TR PGD intensity after losing a child or sibling under traumatic circumstances.
The TGI-SR + is a self-report instrument assessing ICD-11 and DSM-5-TR prolonged grief disorder intensity.The Norwegian TGI-SR + seems to be a valid and reliable instrument to assess prolonged grief disorder intensity.Optimal cut-off for detecting probable prolonged grief disorder cases is ≥73 in this traumatically bereaved sample of parents and siblings.

BACKGROUND: Medical education has been changing, and the evaluation strategies that make it possible to address not only theoretical knowledge but also clinical skills. In Mental Health, these skills play a central role. The Objective Structured Clinical Examination (OSCE) is one of the evaluations that could assess clinical skills. This article describes the implementation and performance for the evaluation of undergraduate students since the OSCE\'s introduction in 2015.
METHODS: An explanation of the implementation is made, and a description of the OSCEs carried out to undergraduate medical students in the second semester of mental health, using the databases of the final practical examinations during those years. The perception of mental health teachers is also described.
RESULTS: The mental health OSCE implemented in 2015-2, is developed in the Simulated Hospital of the University and has five stations (interview, mental examination, diagnosis, treatment and information to the family and ethics). Between 2016-2 and 2019-2, 486 students performed OSCE with an average score of 3.85 (scale 0-5). It was observed that the grade obtained when evaluating anxiety disorders was below average, that of affective disorders above average, while that of psychotic disorders was within the average. The professors highlight the versatility, the comprehensive objective evaluation of the practical and theoretical aspects, and the possibility of comparison between the different groups.
CONCLUSIONS: The OSCE is an examination that provides the possibility to evaluate the competences in psychiatry of medical students and allows the identification of the aspects to be improved in the teaching learning process.

We describe in detail a twofold proposal for the creation, organization and sequential development of two bodies responsible for evaluating the efficiency of health technologies and policies in Spain and its possible design. It would constitute a key element in the process of re-organising the National Health System. The first, which could be adopted immediately, would be called the Office for the Evaluation of the Efficiency of Medicines, would be attached to the Spanish Agency for Medicines and Medical Devices as a functionally independent body and limited to evaluating the efficiency of medicines. The second, the National Health Evaluation Commission, in the form of an independent administrative body, would evaluate health technologies and possibly public health policies. Functional independence, adequate resources and anchoring in the values of good governance are the defining characteristics of this dual proposal.

Background: Losing a family member during childhood is a potentially traumatic event and increases the risk of mental health difficulties. Adolescents have the right to express their views in research of relevance to them, but few studies have involved bereaved adolescents as collaborators (i.e. Patient and Public Involvement (PPI)). Furthermore, to ensure meaningful and non-tokenistic involvement, bereaved adolescents\' levels of participation and experiences of taking part in research need to be evaluated.Objectives: The aim was to describe and evaluate a PPI process working with bereaved adolescents to develop a self-management mobile app for adolescents in grief.Methods: The PPI process consisted of four workshops during which the app\'s logo, colours, name, content, and layout were discussed with six parentally bereaved adolescents aged 13-18 years. The adolescents were recruited through a non-profit organisation providing support for adolescents in grief. The PPI process was documented and evaluated using participant observations and an online survey completed by the adolescents, covering the themes of social context, participation, and influence.Results: The adolescents perceived the social context as comfortable and inclusive, where their knowledge was valued. Their participation was characterised by ownership and motivated by a desire to help others with similar experiences. The adolescents\' ability to participate in PPI activities was assisted by the researchers\' flexibility, although challenging assignments may have made participation harder. Throughout PPI activities, adolescents contributed with relevant input and reported feeling influential. The study reached the intended levels of participation and appeared to adequately fulfil the adolescents\' right to participation.Conclusions: Engaging adolescents who have undergone a potentially traumatic event, such as the loss of a family member, in research can enhance the overall relevance of the study. Moreover, it can entail a meaningful and positive experience for the participating adolescents, while also fulfilling their fundamental right to participation.
A collaborative process with parentally bereaved adolescents to develop a psychosocial self-management mobile app for adolescents in grief was described and evaluated.Adolescents made significant contributions, took ownership, and experienced having influence over the decisions made, which increased the relevance of the intervention.The collaborative process reached the intended level of participation and created a positive and meaningful experience for the adolescents.

OBJECTIVE: To evaluate the epidemiological evolution and economic impact of COVID-19 pandemic in the European Union (EU) and worldwide, and the effects of control strategies on them.
METHODS: We collected incidence, mortality, and gross domestic product (GDP) data between the first quarter of 2020 and of 2023. Then, we reviewed the effectiveness of the mitigation and zero-COVID control strategies. The statistical analysis was done calculating the incidence rate ratio (IRR) of two rates and its 95% confidence interval (CI).
RESULTS: In the EU, COVID-19 presented six epidemic waves. The sixth one at the beginning of 2022 was the biggest. Globally, the biggest wave occurred at the beginning of 2023. Highest mortality rates were observed in the EU during 2020-2021 and globally at the beginning of 2021. In mitigation countries, mortality was much higher than in zero-COVID countries (IRR=6.82 [95% CI: 6.14-7.60]; p<0.001). A GDP reduction was observed worldwide, except in Asia. None of the eight zero-COVID countries presented a GDP growth percentage lower than the EU percentage in 2020, and 3/8 in 2022 (p=0.054). COVID-19 pandemic caused epidemic waves with high mortality rates and a negative impact on GDP.
CONCLUSIONS: The zero-COVID strategy was more effective in avoiding mortality and potentially had a lower impact on GDP in the first pandemic year.

OBJECTIVE: Clinical protocols are tools for the delivery of optimal and quality healthcare. However, there are often shortcomings in the quality of their design that invalidate their implementation. The aim of this study is to describe a systematic evaluation of clinical protocols, to analyse their quality in order to enable their implementation.
METHODS: Descriptive study that included the clinical protocols assessed by the Committee of Reviewers of Clinical Practice Recommendations and Health Technologies of a tertiary hospital during 11years of its existence between 2013 and 2023. The AGREE instrument was used to assess the quality of the protocols received, calculating standardised scores by item and domain, and categorising them into: a)excellent (90-100%), b)good (70-89%), c)improvable (50-69%), d)very improvable (30-49%), e)deficient (10-29%), and f)very deficient: 0-9%.
RESULTS: Of the 59 documents received by the Commission, 32 were subsidised for AGREE evaluation. The highest scoring domain was «Scope and objective», with excellent scores for 29 protocols; the remaining domains had scores ranging from 58.5%-100% for «Rigour in elaboration» and 0-100% for «Independence». By items, scores ranged from 85.7-100% for «Target users of the protocol are clearly defined» to 0-100% for the items «Potential costs of implementing recommendations» and «Conflict of interest». Of the 32 protocols, 9 were highly recommended, 22 were recommended with modifications/conditions and one was not recommended.
CONCLUSIONS: The AGREE tool makes it possible to systematize both the drafting of clinical protocols by the authors and their evaluation by the Clinical Practice Recommendations and Health Technologies Review Committee. This makes it possible to have applicable and quality protocols in our hospital, which results in an improvement in the quality of healthcare.

BACKGROUND: Anaesthesiology training programs in Europe vary in duration, content, and requirements for completion. This survey-based study conducted by the Trainees Committee of the European Society of Anaesthesiology and Intensive Care explores current anaesthesia training designs across Europe.
METHODS: Between May and July 2018, we sent a 41-item online questionnaire to all National Trainee Representatives, members of the National Anaesthesiologists Societies Committee, and Council Representatives of the European Society of Anaesthesiology and Intensive Care (ESAIC) of all member countries. We cross-validated inconsistent data with different country representatives.
RESULTS: Forty-three anaesthesiologists from all 39 associated ESAIC countries completed the questionnaire. Results showed considerable variability in teaching formats, frequency of teaching sessions during training, and differences in assessments made during and at the end of training. The reported duration of training was 60 months in 59% (n = 23) of participating countries, ranging from 24 months in Russia and Ukraine to 84 months in the UK.
CONCLUSIONS: This study shows the significant differences in anaesthesiology training formats across Europe, and highlights the importance of developing standardised training programs to ensure a consistent level of training and to improve patient safety. This study provides valuable insights into European anaesthesia training, and underlines the need for further research and collaboration to improve requirements.

OBJECTIVE: We aimed to develop of a risk stratification model for the pharmaceutical care (PC) of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments.
METHODS: The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through three workshops and a pilot study. Variables were defined, grouped into four dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into three priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score.
RESULTS: The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score =11); social and health variables and cognitive and functional status (maximum = 19); clinical and health services utilization (maximum = 25); and treatment-related (maximum = 41). From the results of applying the model to the 199 patients enrolled, the cutoff points for categorization were 28 or more points for priority 1, 16 to 27 points for priority 2 and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of \'clinical and health services utilization\' and \'treatment-related\'. Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level.
CONCLUSIONS: This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.

The independent evaluation report on the performance of the National Health System in the face of the COVID crisis is rigorous, well thought out and well executed. It has benefited from the participation of numerous experts and institutions. The altruistic effort of the coordinators and hundreds of experts, professionals and citizens is noteworthy, which does not justify the asymmetry between \"everything for free\" when it comes to shared intelligence, and market prices when it comes to commissioning reports from consultancy firms that are sometimes not worth the cost. The valuable work has suffered from unexplained delays and delayed dissemination that do not bode well for whether there is interest in learning from the pandemic or leaving it behind and forgetting it. Indeed, valuable reports provided by the public administration itself (listed in the report) have still not been made public, despite the request of the coordinators. However, the mere fact that the evaluation has been carried out under the influence and pressure of scientists and professionals should encourage the actions of civil society organisations. Advocacy is needed to ensure that public administrations see collective intelligence as an invaluable resource to be nurtured and stimulated. Regular accountability of executive powers at all levels needs to be pursued vigorously. Many sensible proposals to improve healthcare have been ignored, but we learned that achievements are made with perseverance. It is not an option, it is part of the core business of public health.

Improving parental sensitivity is an important objective of interventions to support families. This study examined reliability and validity of parental sensitivity ratings using a novel package of an e-learning tool and an interactive decision tree provided through a mobile application, called the OK! package. Independent raters assessed parental sensitivity using the OK! package (N = 11 raters) and the NICHD Parental Sensitivity rating scales (N = 22 raters) on the basis of videotaped mother-child interactions at 10- or 12-months-old (N = 294) and at 24-months-old (N = 204) from the Dutch longitudinal cohort study Generation2 . Mothers reported on children\'s externalizing and internalizing problems and social competence when children were 4 and 7 years old. Results showed excellent single interrater reliability for raters using the OK! package (mean ICC = .79), and strong evidence for convergent validity at 10- or 12-month-old (r = .57) and 24-month-old (r = .65). Prospective associations of neither parental sensitivity rated using the OK! package or the NICHD Parental Sensitivity rating scales with child developmental outcomes were statistically significant (p > .05), with overlapping 95% confidence intervals for both measures. The OK! package provides a promising direction for testing alternatives to current training and instruction modalities.
Mejorar la sensibilidad de progenitores es un objetivo importante de intervenciones para ayudar a las familias. Este estudio examinó la confiabilidad y validez de los puntajes de sensibilidad de progenitores usando un novedoso paquete de una herramienta de e-aprendizaje y un árbol interactivo de decisión, ofrecido a través de una aplicación móvil llamada ¡Paquete OK! Calificadores independientes evaluaron la sensibilidad de progenitores usando el ¡Paquete OK! (N = 11 calificadores) y las escalas de puntajes de Sensibilidad del Progenitor de NICHD (N = 22 calificadores) sobre la base de las interacciones madre-niño grabadas en video a los 10 o 12 meses de edad (N = 294) y a los 24 meses de edad (N = 204) del grupo holandés de estudio longitudinal Generación 2. Las madres reportaron sobre los problemas de externalización e internalización de los niños y la competencia social cuando los niños tenían 4 y 7 años. Los resultados muestran una excelente sola confiabilidad entre calificadores para los calificadores que usaron el ¡Paquete OK! (media ICC = .79), y una fuerte evidencia para la validez convergente a los 10 o 12 meses de edad (r = .57) y a los 24 meses de edad (r = .65). Las asociaciones probables, ni de la sensibilidad del progenitor evaluada usando el ¡Paquete OK! ni de las escalas de puntajes de Sensibilidad del Progenitor NICHD, con los resultados del desarrollo del niño, fueron estadísticamente significativas (p > .05), con intervalos de confiabilidad que coincidían 95% para ambas medidas. El ¡Paquete OK! Ofrece una prometedora directriz para examinar alternativas al entrenamiento y modalidades de instrucción actuales.
L\'amélioration de la sensibilité parentale est un objectif important d\'interventions pour soutenir les familles. Cette étude a examiné la fiabilité et la validité de la sensibilité parentale utilisant une nouvelle approche combinant un outil de formation en ligne et un arbre de décision interactif offert au travers d\'une application mobile, appelée l\'approche OK!. Des évaluateurs indépendants ont évalué la sensibilité parentale en utilisant l\'approche OK! (N = 11 évaluateurs) et les échelles d’évaluation de le sensibilité parentale NICHD (N = 22 évaluateurs) sur la base d\'interactions mère-enfant filmées à la vidéo à 10- ou 12 mois N = 294) et à 24 mois (N-204) de l’étude de cohorte longitudinale hollandaise Generation2. Les mères ont signalé les problèmes d\'externalisation et d\'internalisation des enfants et leur compétence sociale lorsque les enfants avaient 4 et 7 ans. Les résultats ont démontré une excellente fiabilité entre les évaluateurs pour les évaluateurs utilisant l\'approche OK! (moyenne ICC = ,79(, et de fortes preuves d\'une validité convergente à 10 ou 12 mois (r = ,57) et à 24 mois (r = ,65). Les associations prospectives d\'aucune sensibilité parentale évaluée en utilisant l\'approche OK! ou les échelles d’évaluation de la sensibilité parentale NICHD ave des résultats développementaux de l\'enfant étaient statistiquement significatives (p . ,05) avec un chevauchement des intervalles de confiance de 95% pour les deux mesures. L\'approche OK! offre une direction prometteuse d\'alternatives des tests aux modalités de formation et d\'instruction actuelles.
Die Verbesserung der elterlichen Sensibilität ist ein wichtiges Ziel von Maßnahmen zur Unterstützung von Familien. Diese Studie untersuchte Reliabilität und Validität von Ratings elterlicher Sensibilität. Hierzu wurden ein neuartiges Paket aus einem E-Learning-Tool und ein interaktiver Entscheidungsbaum aus einer mobilen Anwendung genutzt, das so genannte OK!-Paket. Unabhängige Rater beurteilten die elterliche Sensibilität mit Hilfe des OK!-Pakets (N = 11 Rater) und der NICHD-Ratingskala für elterliche Sensibilität (N = 22 Rater) auf der Grundlage von auf Video aufgenommenen Mutter-Kind-Interaktionen im Alter von 10 oder 12 Monaten (N = 294) und im Alter von 24 Monaten (N = 204) aus der niederländischen Längsschnittkohortenstudie Generation 2. Die Mütter machten Angaben über externalisierende und internalisierende Probleme der Kinder sowie über ihre soziale Kompetenz, als die Kinder 4 und 7 Jahre alt waren. Die Ergebnisse zeigten eine ausgezeichnete Interrater-Reliabilität für Rater, die das OK!-Paket verwendeten (mittlerer ICC = .79), und starke Hinweise auf konvergente Validität im Alter von 10 oder 12 Monaten (r = .57) und im Alter von 24 Monaten (r = .65). Die prospektiven Assoziationen zwischen der elterlichen Sensibilität, die mit dem OK!-Paket oder der NICHD-Ratingskala für elterliche Sensibilität bewertet wurde, und den Entwicklungsoutcomes des Kindes waren statistisch signifikant (p > .05), wobei sich die 95%-Konfidenzintervalle für beide Maße überschnitten. Das OK!-Paket bietet eine vielversprechende Perspektive für die Erprobung von Alternativen zu den derzeitigen Trainings- und Unterrichtsmodalitäten.
親の感受性を向上させることは、家族を支援する介入の重要な目的である。本研究では、OK！パッケージと呼ばれる、モバイルアプリケーションを通じて提供されるe-ラーニングツールと対話型意思決定ツリーの新しいパッケージを用いて、親の感受性の評価の信頼性と妥当性を検討した。オランダの縦断的コホート研究Generation2の生後10ヵ月または12ヵ月(N = 294)および24ヵ月(N = 204)の母子のやりとりをビデオ撮影し、独立した評価者がOK！パッケージ(N = 11人)およびNICHDの親の感受性評価尺度(N = 22人)を用いて親の感受性を評価した。母親は、子どもが4歳と7歳のときに、子どもの外因性・内因性問題と社会的能力について報告した。その結果、OK！パッケージを使用した評価者では、1回の評価者間信頼性が優れており(平均ICC = 0.79)、生後10ヵ月または12ヵ月(r = 0.57)および24ヵ月(r = 0.65)において、収束的妥当性を示す強い証拠が示された。OK！パッケージで評価された親の感受性とNICHDの親の感受性評価尺度のいずれも、子どもの発達結果との前向きな関連は統計的に有意であり(p>0.05)、95％の信頼区間が重なり合った。OK！パッケージは、現在のトレーニングや指導方法に代わるものをテストするための有望な方向性を提供する。.
提升父母敏感性是家庭支持干预措施的一项重要目标。本研究使用一种新型的电子学习工具和互动决策树的组合, 即称为OK!包的移动应用程序, 检验了父母敏感性评分的可靠性和有效性。独立评估者使用OK!包(N = 11位评估者)和NICHD父母敏感性评分量表(N = 22位评估者), 基于“第二代荷兰纵向队列研究”中录制的10个月或12个月大(N = 294)以及24个月大(N = 204)的母婴互动录像进行评估。母亲报告了孩子4岁和7岁时的外化问题、内化问题以及社交能力。研究结果表明, 使用OK!包的评估者具有出色的单一评估者间可靠性(平均ICC = .79), 并且在10个月或12个月龄(r = .57)和24个月龄(r = .65)方面显示了较强的收敛效度证据。然而, 无论是使用OK!包, 还是NICHD父母敏感性评分量表评估的父母敏感性与儿童发育结果之间的前瞻性关联均不具有统计学意义(p > .05), 两种评估方法的95%置信区间存在重叠。OK!包为测试当前培训和指导模式的替代方案提供了有前途的方向。.
يعد تحسين حساسية الوالدين هدفاً مهماً للتدخلات لدعم الأسر. تناولت هذه الدراسة موثوقية وصلاحية تقييمات حساسية الوالدين باستخدام حزمة جديدة من أداة للتعلم لإلكتروني وشجرة قرارات تفاعلية مقدمة من خلال تطبيق للهاتف المحمول يسمى حزمة OK. قام مجموعة من المقيمين المستقلين بتقييم حساسية الوالدين باستخدام حزمة(OK) )(N = 11ومقاييس تصنيف حساسية الوالدين )(N = 22 استناداً إلى التفاعلات المسجلة بالفيديو بين الأم والطفل في عمر 10 أو 12 شهراً )(N = 294وفي عمر 24 شهرًا(N = 204) من دراسة طولية هولندية. أبلغت الأمهات عن مشاكل الأطفال من حيث التنشئة والاستيعاب والكفاءة الاجتماعية عندما كان عمر الأطفال 4 و 7 سنوات. أظهرت النتائج موثوقية ممتازة للمقيمين الفرديين الذين يستخدمون حزمة (OK) ICC = .79)) ودليل قوي على الصلاحية المتقاربة عند عمر 10 أو 12 شهرًا(r = .57) وعمر 24 شهرًا )65(r = .. أظهرت النتائج ارتباطات إحصائية قوية بين الحساسية الوالدية ونتائج نمو الطفل (p<.05)، مع فواصل ثقة متداخلة بنسبة 95% لكلا المقياسين. توفر حزمة (OK) اتجاهاً واعدًا لاختبار البدائل لطرائق التدريب والتعليم الحالية.