Electroconvulsive therapy is a highly effective treatment for severe psychopharmacological resistant patients but it is also a procedure that involves open airway management and has been considered as an aerosol generating procedure. The COVID-19 pandemic, has resulted in reduction in ECT services internationally. The COVID-19 pandemic has dramatically and rapidly transformed hospitals in heavily affected areas, decreasing mental health services. The need to locate critical patients in spaces intended for anesthesia, where we usually administered ECT, has forced us to decrease the number of procedures and be highly selective. In the same way, continuation and maintenance ECT (m-ECT) have also been dramatically reduced. The risk of contagion urged us to develop a protocol involving other areas of the hospital

To create a safe circuit from admission to the hospital to the ECT including emergency room and psychiatric Ward

Review of the tliterature and published protocols Workshops with Preventive Medicine, Anaesthesia and Emergency Service to elaborate a protocol Submission of the protocol to Management of the Hospital

The protocol (Figure 1) began with the screening for COVID-19 in every patient. If the PCR was (+) the patient was not excluded. We moved treatment from the PACU into the OR and if a patient tested positive It was determined that the ECT was administered in the OR

That was provided with negative pressure. Circuits were established within the Psychiatric Ward and in the areas of the hospital involved to reduce risks and patients remained isolated until negative test was confirmed The number of persons present in the treatment room was kept to the absolute minimum required and appropriate personal protective equipment was used, as prescribed by the WHO

We must keep in mind treating the most vulnerable of our patients. ECT should be seen as an essential medical procedure and made available

No significant relationships.

Media multitasking (MMT) begins to play an increasingly important role in terms of the digitalization of everyday life. At the same time, the effect of MMT on efficiency is still poorly highlighted, especially among the younger generation (May, Elder, 2018; Patterson, 2017; Peifer, Zipp, 2019).

The aim is to identify types of MMT in children and compare them by productivity and time of task performance.

Quasi-experimental research, which included the performance of tasks on a computer and a smartphone, was conducted among children in three groups aged 7-10 years, 11-13 years, 14-16 years (N=154).

Based on a number of criteria, several types of behavior are identified in the MMT environment: two subgroups of “single-taskers” (23%), “light” (19%), “medium” (54%) and “heavy” (4%) MMT. Comparative analysis (p=0.027) reveals high scores for proper task performance of the subgroup “single-taskers1”, as well as “heavy” and “light” MMT. The other subgroup “single-taskers2” and “medium” MMT show, on the contrary, low productivity results. MMT groups also differ in terms of task performance time (p=0.006). The “light” and “heavy” MMT cope the fastest. The second place by the speed of task performance is held by “medium” MMTs and “single-taskers1”, and the slowest are “single-taskers2”.

The results show that both linear and nonlinear behavioral strategies can lead to a certain level of performance. Most children try to operate in the MMT mode and it is becoming the dominant and ubiquitous modus vivendi for the younger generation. The reported study was funded by RFBR, project No. 19-29-14181.

The reported study was funded by RFBR, project No. 19-29-14181.

The current stage of research on mental disorders is associated with the use of system approaches to the development of the scientific foundations of psychiatric care.

Approach to solving problems that arise in the diagnosis of psychopathological conditions, assessing their severity, as well as evaluating the effectiveness of psychosocial treatment and rehabilitation.

Clinical, psychometric, system analysis methods and algorithms of the Analytical Hierarchy Process (AHP) [1] were used.

When assessing a patient’s condition and behavior, it is necessary to make decisions (diagnosis, development of treatment and rehabilitation plans) based on heterogeneous information (genetic, neuronal and environmental, involving individual characteristics, as well as family and social context). This information is hierarchically organized and includes quantitative and qualitative data. Exposure at each of these different levels can affect the onset and course of the disease, and therefore should be considered in primary prevention and subsequent psychosocial therapy and rehabilitation of patients. Analysis of the problems of assessing psychopathological states and related psychosocial problems shows that these problems can be presented in the form of appropriate hierarchies, the structure of which must be taken into account when processing the initial information. The main advantages of the AHP include the use of the relationship scale (fundamental scale) for processing heterogeneous data based on expert, clinical information.

The approach provides correct integration of heterogeneous characteristics when considering diagnostic procedures, psychosocial therapy and rehabilitation.1. Mitikhin V.G., Solokhina T.A. S.S. Korsakov Journal of Neurology and Psychiatry, 2019, 2: 49-54. doi:10.17116/jnevro201911902149

Delusional Disorders with Religious Content (DDRC) require careful study concerning their prevalence, psychopathological heterogeneity and the risk of destructive behavior.

To classify the clinical forms of DDRC

By clinical-psychopathological, follow-up and statistical approaches 2523 cases of patients with mental disorders who received inpatient care in a state clinic for year were analyzed; in 225 cases of total 2523 delusional disorders in schizophrenia (ICD-10: F20.0, F20.01, F20.02) were diagnosed.

The comparative analysis of delusional disorders (225 cases, 100%) with religious (70 cases -31.1%) and non-religious content (155 cases - 69.9%) revealed prevalence of DDRC in non-believers (p <0.01). Delusional destructive behavior occurred in 47.1% of 70 cases in patients with DDRC (15% of total 225).

The predominant content of DDRC (among the Delusions of Possession, Sinfulness/guilt, Messianism, Manichaean and the End-world Delusions) was the Delusions of Possession - 36.8%. Psychopathological heterogeneity of DDRC was identified and specific types of DDRC were described.

DDRC is associated with the development of massive psychopathological symptoms and significant severity, and often accompanied by various forms of destractive behavior. This circumstance requires constant and careful management of these patients, collection of their religious history and asks for specific therapeutic approaches.

No significant relationships.

No significant relationships.

From the life cycle perspective, the aging is described as the strengthening of adaptive resources and the capacity for recovery or compensation for losses. These skills are grounded in the coping strategies that individuals apply in order to effectively adapt to diverse situations. Emotion-focused, passive coping strategies are considered to be maladaptive in the long term. These strategies are associated with affective disorders, being these phenomena of great impact in older adults.

Verify if there is a relationship between emotion-focused coping strategies and depressive symptoms

The sample was composed of 418 healthy older adults, aged between 60 and 89 years with an average age of 69.67 years and SD = 7.24, 63.6% of the participants are women and the remaining 36.4% are men. The Coping Stress Questionnaire was used to evaluate strategies focused on emotion (Sandín & Chorot, 2003). The Center for Epidemiological Studies-Depression Scale (Radloff & Teri, 1986) was used to evaluate depressive symptoms.

Depressive symptomatology showed significant associations with all emotion-focused strategies: negative self-focus (.339), open emotional expression (.279), avoidance (.202) and religion (113) with a significance level of 0.05.

Emotion-focused coping strategies are associated with depressive symptomatology. Thus, it is considered that the use of these types of strategies in times of change or challenge will not benefit adaptation in the older adult. It is necessary to develop more active coping strategies for prevention in mental health during aging.

No significant relationships.

It is well-known that university students experience high levels of mental health problems (1). University life presents changes and challenges that can be stressful and may affect the mental health of its community (2,3). More than 20 years ago, the Social Affairs Service (SAS) of the University of Salamanca started a program that ensured the mental health care in their community. The Psychiatric Care Unit is part of this program and its objectives are: 1) to detect serious mental disorders; 2) treat mild mental disorders; 3) give information to prevent illness and promote mental health; 4) serve as support in patients with previous follow-up that has been discontinued due to the beginning of their studies; 5) liaise with referral psychiatrists.

To make known a Psychiatric Care Unit targeted in the university community

18 people between 19 and 52 years old (22% male, 78% female) were evaluated between November and December of 2020 in the Psychiatric Care Unit of the Social Affairs Service (PCU-SAS, University of Salamanca). The assessment consisted in an interview carried out by a psychiatrist, in the presence of a medical graduate. Every patient belong to the university community (students/ staff).

The most frequent diagnosis in the sample is Adjustment Disorder (F43.2). Substance use, eating disorders, low-self-concept, perfectionism and emotional dysregulation are very prevalent symptoms along our sample.

Universities should invest in creating environments that promote student and staff mental wellbeing. However, the current body of evidence is scarce and more research is needed to recommend what are the best strategies(4).

No significant relationships.

In pandemic conditions, obsessive rituals such as hygiene can be considered adaptive together with the extreme measures that must be followed to avoid contagion by Covid-19, we suggest that the stress the pandemic has caused may result in an increase in the percentage of OCD symptom and severity in the Chilean population at Santiago.

Study OCD symptoms and their severity during a contamination pandemic such as COVID and quarentine, and compare them to national reports of OCD prevalence in Chile. We hypothesize that OCD symptoms would be higher in these stressfull situations.

An online voluntary and annonymous survey was carried out asking about sociodemographic variables and the Y-BOCKS scale, an OCD symptom severity scale version already validated in Chile.

497 completed the survey and Y-BOCKS scale. 241 people which is equivalent to 48% of the sample presented scores that classified them as having OCD.Off these 30% had mild, 12% moderate and 7% severe symptoms. 85% of them were inquarantine for more than 2 months.

These results are above the 2% of OCD reported at the national level. These percentages may be due to a smaller sample size, but even so, the high percentages of people with symptoms during COVID and those who were in quarentine or lockdown for 2 months or more, stand out. Future analysis and research needs to be made. We ask ourselves wether is Covid, quarentine, or both and of so, how much each pf these contribute to these high percentages of OCD symptoms observed.

Studies on psychiatric patients have shown that the presence of autistic traits affects the effectiveness of the treatment, decreasing the likelihood of positive clinical outcomes.

The aim of the present study is to investigate which are the areas of overlap between psychiatric symptoms and the traits of the autism spectrum using a bayesian approach.

A sample of 190 adult psychiatric patients, diagnosed with schizophrenia, bipolar disorder, major depression, and personality disorder participated in the study. The RAADS-R questionnaire was used to assess the presence of autistic traits. The severity of psychiatric symptoms was measured with the BPRS and PANSS scales, the perceived well-being and disability using the Whodas and Whoqol scales, the TOL and STROOP for the measurement of executive functions, the attentional matrices for visual-spatial attention, the Raven for general cognitive skills.

No difference emerged between the diagnoses regarding the presence of symptoms of the autism spectrum, which affects 64% of subjects. Logistic regression showed that the severity of symptoms measured as BPRS and PANSS predicted the probability of having autistic traits. Bayesian regression showed that specific autistic traits are indicative of executive functions deficits. Namely, motor impairment severity measured at RAADS is strongly predicted by rule violation with number of correct moves measured at TOL. The other executive functions seemed to be only moderately linked to autistic traits.

These results provide new information about the expression of comorbidity with autism in psychiatric patients.

Patient microaggressions and hate speech affect practitioners in all fields of healthcare. In some facilities, 100% of healthcare workers report experiencing harassment and hate speech, with the aggressors most frequently being patients. To date, there has been no systematic review of policies, recommendations and trainings on patient microaggressions and hate speech against healthcare professionals.

A systematic review was conducted to identify recommendations and solutions for healthcare professionals on responding to patient microaggressions and hate speech. Additionally, websites of major healthcare professional organizations and the 6 largest healthcare systems were checked for policy statements related to discrimination by patients towards healthcare providers.

A literature search of PubMed, PsycINFO, Medline, ERIC and MedEdPORTAL. Articles that contained recommendations and trainings for responding to microaggressions and hate speech were retained. 13 Leading professional organizations and 6 healthcare systems were checked for policies on discrimination by patients.

Our review identified 27 studies providing recommendations and trainings for healthcare professionals to address patient hate speech and microaggressions. Three professional organizations but no healthcare systems had policies on discrimination by patients.

Seven trainings that equip providers with tools to address patient microaggressions and hate speech were identified. Trainings included the ERASE framework; Stop, talk, and roll; interrupting microaggressions; and the OWTFD tool. Nineteen studies outlined recommendations for healthcare professionals and systems on how to respond to patient offenses. Professional organizations and healthcare systems need to create policies to support healthcare professionals who face microaggressions and hate speech.

Holiender and Hirsch defined hysterical psychosis in 1964 and, while hysteria has a contemporary equivalent in somatoform/dissociation disorder, hysterical psychosis remains set adrift in the nosological understanding of psychiatric disorders.

To present a case report of a hysterical psychosis and to review this nosological construct.

Clinical interview, consultation of clinical records and review of literature using the Pubmed platform.

The authors present a case of a 38 year-old woman, admitted in a psychiatric emergency department for bizarre behavior, restlessness, auditory (pseudo)hallucinations and emotional lability, starting 1 week after a personal development retreat. This is the second episode of this nature, the first being a 15-day hospitalization 7 years ago, with rapid stabilization, extensive examination and restitium ad integrum. The patient initiated Olanzapine and was referred to an outpatient clinic, with rapid stabilization and restitium ad integrum throughout follow-up. Given the episode and patient characteristics, a hysterical psychosis diagnosis may be accurate, taking into account the acute onset and course, the pleomorphic nature of symptoms and the presence of a disturbing life event. The authors propose reviewing the concept of hysterical psychosis regarding its clinical implications and debating its therapeutic and prognostic utility.

Hysterical psychosis may not be a mere historic footnote and encompasses an entity with distinctive diagnostic, prognostic and therapeutic characteristics. While its etiology may not be understood, its clinical implications ensure the need for future research.

No significant relationships.

In the midst of a global pandemic with a rising death toll, the children´s mental health can be easily overlooked in the country’s response. But this overlook would have devastating consequences for years to come.

The objective of this research is to compare children’s physical and mental development before, during and after the situation of social isolation caused by the pandemic of COVID-19.

The parents/guardians of 100 children aged between 0 and 5 years and 11 months old were asked to answer questions based on the ASQ-3 (Ages and Stages Questionnaire III), containing questions related to Communication, Gross Motor, Fine Motor, Problem Solving, and Personal-Social and ASQ- SE (Ages and Stages Questionnaires Social-Emotional) addressing issues of self-regulation, compliance, social-communication, adaptive functioning, autonomy, and affect. In addition, behavioral issues related to children’s mental health will be included, such as: aggressiveness, insomnia, lack of appetite, apathy, sadness, tiredness, lack of interest, hyperactivity, manias, tantrum, morning among others. Child development data will be collected before and during quarantine / isolation and later, in a second stage, after the end of social isolation.

The data will be analyzed in order to characterize child behavior before, during and after the period of social isolation, correlating the different areas of child development, especially mental health.

As argued, socially isolated children are at increased risk of health problems in adulthood. Furthermore, studies on social isolation have demonstrated that a lack of social relationships negatively impacts the development of the brain’s structure.

No significant relationships.

Quality of life should be an important issue to everyone. In the general population and in various medical disciplines, this topic has been studied extensively. In forensic psychiatry, this topic has received little attention so far.

Within this project a questionnaire that measures the quality of life in forensic hospitals was developed.

As a basis the questionnaire measuring the quality of prison life (MQPL) by Liebling et al. (2011), which was designed only for using in prisons, was used. First, this questionnaire was translated, then adapted to the living conditions in forensic hospitals and supplemented by questions regarding therapeutic support. For the psychometric evaluation of the instrument, a one-time survey was conducted at 13 forensic hospitals in Bavaria. A total of 255 patients took part, 25 of whom were female. In summary, the reliability of the MQPL can be rated as very good.

The factor structure was checked with a confirmatory factor analysis and was confirmed. There are significant differences between the 13 Bavarian forensic hospitals in the subscales admission to a forensic hospital, equal treatment, quality of accommodation and therapeutic services.

The great importance of the quality of life in the penal system is shown by the fact that a good quality of life contributes to reduced psychological distress of inpatients.

Bipolar disorder is presumed to involve difficulties in emotion regulation. However, little is known about the specific emotion regulation profile associated with this disorder.

To study emotion regulation in bipolar patients in remission phase and to determine the factors correlated with it.

A cross-sectional, descriptive and analytical study of 30 patients followed for bipolar disorder in remission, at the psychiatric outpatient clinic at the Hédi Chaker University Hospital in Sfax. We used a socio-demographic and clinical data sheet and the Cognitive Emotion Regulation Questionnaire (CERQ) which assesses cognitive strategies (maladaptive and adaptive) for regulating emotion.

The mean age of the patients was 43.77 years, the sex ratio was 0.5. Bipolar I disorder was diagnosed in 93% of patients. A good adherence to treatment was found in 86.7% of cases and a good social integration in 40%. The mean total score of the adaptive CERQ was 66.73 and the most used adaptive strategy was acceptation (mean score =13.87), while the mean total score of the maladaptive CERQ was 36.7 and the most used maladaptive strategy was self blame (mean score =9.47). Adaptive cognitive emotion regulation was predominant in 93.3% of patients. It was significantly correlated with good adherence to treatment (p = 0.047) and good social integration (p = 0.026).

Our patients with euthymic bipolar disorder showed a satisfying level of adaptive emotion regulation strategies. A cognitive remediation seems important to embetter this capacity and improve the income of the disease.

No significant relationships.

Stress is one of the biggest problems leading a large portion of people to seek medical or psychotherapeutic management, while a large portion of hospital staff report high levels of work-related stress.

The purpose of this intervention was to implement a psychoeducation seminar on stress management by implementing diaphragmatic breathing exercises and to detect the reduction of its levels in nursing staff.

The study took place at the General Hospital of Nikaia. Fifty employees, 38 women, aged 20-60 (M=37.4±10.5) participated in a two-hour group psychoeducation workshop, concerning psychoeducation on stress and application in diaphragmatic breathing exercises. The measurement of the success of the intervention was performed using a proportional stress assessment scale before and after the intervention. Statistical analysis was performed with SPSS26.

Stress levels before the intervention ranged from 0 to 10 (M=5.7±5.7) while after the intervention ranged from 0 to 7 (M=2.3±2.04). Age did not appear to play a role in stress reduction, but was found to be positively and significantly associated with pre-existing stress in employees (r=0.423 p=0.002). On the contrary, gender was found to be related both to the pre-existence of stress, with women reporting the highest levels (t=-3.534 p=0.001), and to the reduction of stress after the intervention (t=-2,534 p=0.001).

The above findings indicate the importance of implementing group psychoeducation programs to reduce stress at the organizational level, a very important result considering the cumulative effect that the recent existence of covid-19 has had on nursing staff.

No significant relationships.

Empathizing with others’ pain appears to recruit the whole pain matrix, including a collection of frontal regions involved in the affective, motivational, cognitive, and attentional dimension of pain.

This research explored how the modulation of interoceptive attentiveness (IA) can influence the frontal (dorsolateral prefrontal cortex -DLPFC- and somatosensory cortices) activity related to the emotional regulation and sensory response of observing pain in others.

22 healthy participants were required to observe face versus hand, painful/non-painful stimuli in an individual versus social condition while brain hemodynamic response (oxygenated [O2Hb] and deoxygenated hemoglobin [HHb] components) was measured by functional Near-Infrared Spectroscopy (fNIRS). The sample was divided into experimental (EXP) and control (CNT) groups and the EXP group was explicitly required to focus on its interoceptive correlates while observing the stimuli.

In the individual condition, higher brain responsiveness was detected for painful confronted to non-painful stimuli, and a left/right hemispheric lateralization was found for the individual and social condition, respectively. Besides, both groups showed higher DLPFC activation for face stimuli displayed in the individual condition compared to hand stimuli in the social condition. However, face stimuli activation prevailed for the EXP group, suggesting the direct interoceptive phenomenon has certain features, namely it manifests itself in the individual condition and for pain stimuli.

We can conclude that IA modulation promoted the recruitment of internal adaptive regulatory strategies engaging both DLPFC and somatosensory regions towards emotionally relevant stimuli (painful faces displayed in the individual condition). Therefore IA could be trained for promoting emotion regulation and empathic response.

Available evidence shows that countries may shield their population’s exposure and vulnerability to mental health risks during and after an economic recession by strengthening their policies and reorienting their budgets. Populations’ mental health protection during economic crises can only be achieved by the policies of different sectors. Social protection, social programmes and social safety nets proved to be fundamental buffers against inequalities in mental health. Several actions have proven to be effective in this area, including measures to improve social protection, reduce income inequalities, and mitigate the impacts of unemployment. To address the negative consequences of unemployment, active labour market programmes, including special programmes for unemployed young people and families, programmes to promote the employment of people with disabilities, and debt relief programmes should be implemented. The response of the health system is critical. During and after economic recessions, it is fundamental to ensure the responsiveness and effectiveness of the mental health system. To attain this goal, mental health services that are closer to the populations and that facilitate the early identification of mental health problems and the implementation of integrated interventions should be strengthened. The latter is a crucial approach to tackle the mental health problems that more often worsen in periods of economic instability, such as depression, suicidal behaviour and heavy drinking. A special attention should also be dedicated to strengthening the network of community-based mental health services, promoting the integration of mental health in primary care, and enhancing the coordination between mental health services and social care.

No significant relationships.

Mindfulness-based cognitive therapy (MBCT) is a third wave cognitive-behavioral therapy (CBT) that incorporates meditation exercises in the classical, structured intervention. Mindfulness has been associated with psychological well-being, and certain symptoms that occur in major depressive disorder (MDD), e.g. worries, ruminations, ideas of incapacity or self-devaluation, are considered potential targets for MBCT.

To evaluate the current level of evidence for the MCBT efficacy in MDD.

A literature serach was performed in the main electronic databases, targeting clinical trials that evaluated in a randomized manner the efficacy of MCBT versus active comparators or placebo in patients with MDD.

MBCT was efficient in a 10-week randomized controlled trial (RCT) versus standard treatment, and it decreased ruminations, increased patients quality of life, mindfulness abilities, and self-compassion. In another randomized, 8-week RCT, MBCT prevented relapses in MDD, with similar rates when compared to psychoeducation and standard treatment. A 26-month follow-up study evidenced the persistence of symptoms improvement detected after 12 months of the trial, when compared to active control group and treatment as usual. MCBT was compared to cognitive therapy in a randomized 8-week trial, and both treatments had similar efficacy in MDD relapse prevention.

MCBT may be an useful adjuvant to the current treatment in acute MDD, but it may also decrease the risk of relapse after psychotherapy termination.

Psychotherapy of patients suffering from schizophrenic disorders remains controversial. There are promising descriptions of psychothereputic interventions in combination with pharmacological treatment. Some empirical studies show that different forms of psychotherapy are effective. However, there are few models to combine different psychotherapeutic strategies in a comprehensive way.

We here propose a model of integrative psychotherapy that is based on the therapeutic alliance and the general principles of understanding and communication. It comprises interpersonal, behavioral, psychodynamic, and existential elements.

Theoretical principles of different psychotherapeutic schools are applied hermeneutically to a case of schizophrenia. Thus, general methods of psychotherapy gain contextual meaning by the analysis of an individual narrative. The patient himself assessed and approved his case report.

After remission of the acute symptoms, integrative psychotherapy played the major role in the recovery of a young musician. It is shown how the therapeutic alliance and communication in a general sense interacted with behavioral, cognitive, psychodynamic, and existential techniques. It is demonstrated narratively how recovery was facilitated, adjunct to pharmacological treatment, by method-integrative psychotherapy. Basic cognitive-behavioral techniques ensured at first the stabilization of the patient. Then psychodynamic remembering, repeating, and working through became possible. Finally, existential topics and creative solutions dominated the sessions.

Psychotherapeutic method-integration is necessary to treat patients with various mental disorders especially schizophrenia. We propose an ABCDE-Model that comprises the following principles: Therapeutic alliance (A); behavior change (B); cognitive reflection on dysfunctional meanings and beliefs (C); psychodynamic remembering, repeating, and working through (D); and existential understanding and communication (E).

Suicidogenic effects COVID-19 pandemic are expected to reveal themselves not immediately, but within a longer period.

To evaluate the prevalence of suicidal tendencies in university students during the COVID-19 outbreak and specify the psychosocial characteristics of the students with a low anti-suicidal barrier to mitigate their suicide risks.

The research was done via an on-line survey, which covered 536 students of both sexes (aged 21.46±2.95), who studied in Russian universities and who filled in a structured questionnaire during their distance learning due to COVID-19 outbreak.

We revealed that 11.38% of the respondents (57.47% of whom are males) with a low anti-suicidal barrier showed suicidal tendencies by allowing the possibility of committing a suicide in a certain situation. Among them were more Russian students than international ones (p=.0272). They also certainly exceeded the students with the developed anti-suicidal barrier in taking alcohol (p=.0126), in underestimating their own health (p=.0053), in expressing happiness (p=.0001), and in degree of religious belief (p=.0001). They perceived the situation associated with the COVID-19 outbreak with a more strongly manifested anxiety due to the fear of their own infection with coronavirus (p=0.0347). At the same time, they acted less responsibly in following personal restrictive measures aimed to reduce the risk of infection (p=.0002).

Students with suicidal tendencies during the COVID-19 outbreak present a risk group in COVID-19 spread and infection. The pandemic can intensify anti-vital sufferings and enhance the risk of committing suicide in individuals with suicidal tendencies, which should be taken into account in prevention programs.