Use of diagnostic tests in elderly patients consulting the emergency department. Analysis of the emergency department and elder needs cohort (EDEN-8).

OBJECTIVE: Analyse the association between the use of diagnostic tests and the characteristics of older patients 65 years of age or more who consult the emergency department (ED). METHODS: We performed an analysis of the EDEN cohort that includes patients who consulted 52 Spanish EDs. The association of age, sex, and ageing characteristics with the use of diagnostic tests (blood tests, electrocardiogram (ECG), microbiological cultures, X-ray, computed tomography, ultrasound, invasive techniques) was studied. The association was analysed by calculating the adjusted odds ratios (aOR) and their 95 % confidence intervals (CI) using a logistic regression model. RESULTS: A total of 25,557 patients were analysed. There was an increase in the use of diagnostic tests based on age, with an aOR for blood test of 1.805 (95 %CI 1.671 - 1.950), ECG 1.793 (95 %CI 1.664 - 1.932) and X-ray 1.707 (95 %CI 1.583 - 1.840) in the group of 85 years or more. The use of diagnostic tests is lower in the female population. Most ageing characteristics (cognitive impairment, previous falls, polypharmacy, dependence, and comorbidity) were independently associated with increased use of diagnostic tests. CONCLUSIONS: Age, and the characteristics of ageing itself are generally associated with a greater use of diagnostic tests in the ED.

The time for ambitious action is now: Science-based recommendations for plastic chemicals to inform an effective global plastic treaty.

The ubiquitous and global ecological footprint arising from the rapidly increasing rates of plastic production, use, and release into the environment is an important modern environmental issue. Of increasing concern are the risks associated with at least 16,000 chemicals present in plastics, some of which are known to be toxic, and which may leach out both during use and once exposed to environmental conditions, leading to environmental and human exposure. In response, the United Nations member states agreed to establish an international legally binding instrument on plastic pollution, the global plastics treaty. The resolution acknowledges that the treaty should prevent plastic pollution and its related impacts, that effective prevention requires consideration of the transboundary nature of plastic production, use and pollution, and that the full life cycle of plastics must be addressed. As a group of scientific experts and members of the Scientists' Coalition for an Effective Plastics Treaty, we concur that there are six essential "pillars" necessary to truly reduce plastic pollution and allow for chemical detoxification across the full life cycle of plastics. These include a plastic chemical reduction and simplification, safe and sustainable design of plastic chemicals, incentives for change, holistic approaches for alternatives, just transition and equitable interventions, and centering human rights. There is a critical need for scientifically informed and globally harmonized information, transparency, and traceability criteria to protect the environment and public health. The right to a clean, healthy, and sustainable environment must be upheld, and thus it is crucial that scientists, industry, and policy makers work in concert to create a future free from hazardous plastic contamination.

Hydroids from a reef system under the influence of the Amazon River plume, Brazil.

The Amazon Reef System (ARS) is one of the most important shallow and mesophotic reef ecosystems in the South Atlantic Ocean. The ARS consists mainly of extensive beds of calcareous algae interspersed by assemblages of octocorals and sponges. The enormous freshwater discharge from the Amazon River forms a plume along the extensive Amazon continental shelf, for which the hydroid community is still largely unknown. The aim of this study is to document the diversity and distribution of hydroids from the ARS, as well as to infer the influence of the plume on species composition in the different zones. Samples were collected at ninety-six stations between 15 and 240 m deep on the Amazon shelf. A total of 37 species were recorded in the studied area. Hydroid assemblages are richer in zones under lower river plume influence, and species composition differs significantly between zones with and without plume influence (PERMANOVA, p = 0.0025). The dissolved oxygen and nitrate ranges were the environmental variables significantly correlated with the hydroid distribution. This study is the first surveying the hydroid species composition and richness in the ARS, highlighting the presence of a typical reef biota and that further faunal studies in underexplored areas of the Atlantic should reveal the distribution of many poorly known hydroids species.

Short-term prognosis of polypharmacy in elderly patients treated in emergency departments: results from the EDEN project.

Background: Polypharmacy is a growing phenomenon among elderly individuals. However, there is little information about the frequency of polypharmacy among the elderly population treated in emergency departments (EDs) and its prognostic effect. This study aims to determine the prevalence and short-term prognostic effect of polypharmacy in elderly patients treated in EDs. Methods: A retrospective analysis of the Emergency Department Elderly in Needs (EDEN) project's cohort was performed. This registry included all elderly patients who attended 52 Spanish EDs for any condition. Mild and severe polypharmacy was defined as the use of 5-9 drugs and ⩾10 drugs, respectively. The assessed outcomes were ED revisits, hospital readmissions, and mortality 30 days after discharge. Crude and adjusted logistic regression analyses, including the patient's comorbidities, were performed. Results: A total of 25,557 patients were evaluated [mean age: 78 (IQR: 71-84) years]; 10,534 (41.2%) and 5678 (22.2%) patients presented with mild and severe polypharmacy, respectively. In the adjusted analysis, mild polypharmacy and severe polypharmacy were associated with an increase in ED revisits [odds ratio (OR) 1.13 (95% confidence interval (CI): 1.04-1.23) and 1.38 (95% CI: 1.24-1.51)] and hospital readmissions [OR 1.18 (95% CI: 1.04-1.35) and 1.36 (95% CI: 1.16-1.60)], respectively, compared to non-polypharmacy. Mild and severe polypharmacy were not associated with increased 30-day mortality [OR 1.05 (95% CI: 0.89-2.26) and OR 0.89 (95% CI: 0.72-1.12)], respectively. Conclusion: Polypharmacy was common among the elderly treated in EDs and associated with increased risks of ED revisits and hospital readmissions ⩽30 days but not with an increased risk of 30-day mortality. Patients with polypharmacy had a higher risk of ED revisits and hospital readmissions ⩽30 days after discharge.

Short-term prognosis of polypharmacy in elderly patients treated in emergency departments: results from the EDEN project Management elderly patients with polypharmacy is becoming a major challenge to the emergency services. The progressive aging of the population is producing a progressive increase in the number of patients treated with multiple comorbidities and chronic medications. It's well known that polypharmacy is associated with an increase in hospital admissions and health care system costs. However, the impact of polypharmacy over the risk of new visits to the emergency rooms is not well defined. Understanding the impact of polypharmacy on the frequency of new visits to the emergency room and on patient mortality is the first step to establish prevention measures for new visits, proposing improvements in chronic treatment at discharge. This study aimed to determine the prevalence and effect on short-term prognosis of polypharmacy in elderly patients treated in Emergency departments. The authors used a retrospective multipurpose registry in 52 hospitals in Spain. This study includes 25,557 patients with a mean age of 78 years. On admission, the median number of drugs was 6 (IQR: 3­9), with 10,534 (41.2%) patients taking 5­9 drugs and 5,678 (22.2%) taking ⩾10 drugs. In these patients comorbidities were associated with an increase in the number of drugs. In the patients with severe polypharmacy (⩾10 drugs), diuretics were the most frequently drugs prescribed, followed by antihypertensives and statins. The results obtained indicate that polypharmacy is a frequent phenomenon among the elderly population treated in Emergency departments, being antihypertensives the most frequently used drugs in this population. Those patients who takes ⩾10 drugs have a higher risk of new visits to the emergency room and hospital readmissions in short term period.

Elevated cholesterol in ATAD3 mutants is a compensatory mechanism that leads to membrane cholesterol aggregation.

Aberrant cholesterol metabolism causes neurological disease and neurodegeneration, and mitochondria have been linked to perturbed cholesterol homeostasis via the study of pathological mutations in the ATAD3 gene cluster. However, whether the cholesterol changes were compensatory or contributory to the disorder was unclear, and the effects on cell membranes and the wider cell were also unknown. Using patient-derived cells, we show that cholesterol perturbation is a conserved feature of pathological ATAD3 variants that is accompanied by an expanded lysosome population containing membrane whorls characteristic of lysosomal storage diseases. Lysosomes are also more numerous in Drosophila neural progenitor cells expressing mutant Atad3, which exhibit abundant membrane-bound cholesterol aggregates, many of which co-localize with lysosomes. By subjecting the Drosophila Atad3 mutant to nutrient restriction and cholesterol supplementation, we show that the mutant displays heightened cholesterol dependence. Collectively, these findings suggest that elevated cholesterol enhances tolerance to pathological ATAD3 variants; however, this comes at the cost of inducing cholesterol aggregation in membranes, which lysosomal clearance only partly mitigates.

'We see they are abandoned': Social support between people discharged from long-term psychiatric hospitalizations and their neighbors in Argentina.

BACKGROUND: Neighbors are an important component of personal social network (PSN) and despite their peripheral role and being considered as familiar strangers, they typically provide instrumental support. For people who is discharged after long-term psychiatric hospitalizations, neighbors would offer other types of social support and play a different role fostering the process of becoming full member of a given community. AIMS: To analyze the effects of neighboring on both, those who have had long-term psychiatric hospitalizations and their neighbors. METHOD: Data was collected between 2020 and 2021, including interviews with formal care staff of three housing support experiences in Argentina, and short testimonies from formerly discharged mental health service users living in the community and their neighbors. We analyzed the data using the Framework Method with a focus on the different aspects of social support and equity and reciprocity theories. RESULTS: Results suggest that emotional support was a frequent function displayed by neighbors toward people with a history of long-term psychiatric hospitalizations, which differs from typical neighboring relationships. CONCLUSIONS: Despite reciprocity was observed, users and neighbors displayed an unbalanced helping relationship.

The Global Plastics Treaty: An Endocrinologist's Assessment.

Plastics are everywhere. They are in many goods that we use every day. However, they are also a source of pollution. In 2022, at the resumed fifth session of the United Nations Environment Assembly, a historic resolution was adopted with the aim of convening an Intergovernmental Negotiating Committee to develop an international legally binding instrument on plastic pollution, including in the marine environment, with the intention to focus on the entire life cycle of plastics. Plastics, in essence, are composed of chemicals. According to a recent report from the secretariat of the Basel, Rotterdam, and Stockholm conventions, around 13 000 chemicals are associated with plastics and plastic pollution. Many of these chemicals are endocrine-disrupting chemicals and, according to reports by members of the Endocrine Society and others, exposure to some of these chemicals causes enormous costs due to the development of preventable diseases. The global plastics treaty brings the opportunity for harmonized, international regulation of chemicals with endocrine disrupting properties present in plastic products.

[Attitudes of neighbors about the treatment and community life of people with severe mental health disorders in Argentina]. / Actitudes de vecinos acerca del tratamiento y la vida en comunidad de personas con problemáticas severas de salud mental en Argentina.

A psychiatric reform is underway in Latin America and the Caribbean. Specifically in Argentina, a model of community mental health is being built, and prolonged psychiatric hospitalizations are still taking place, especially in neuropsychiatric hospitals. Therefore, it is necessary to closely monitor the psychiatric reform. One of the possible ways to monitor the reform is by analyzing society's attitudes towards prolonged psychiatric hospitalization as a mean of mental health treatment. Thus, an analytical observational study was conducted at the Buenos Aires Province, Argentina, in 2021, to analyze the behavior of neighbors of people who had prolonged psychiatric hospitalizations and who received housing support. Questionnaires were applied to neighbors and non-neighbors, addressing the behaviors toward prolonged psychiatric hospitalization as a mean of treatment, social distance toward people who were hospitalized, as well as specific interviews with key informants from neighborhoods where people with severe mental health disorders and who receive housing support live. Based on the answers of neighbors and non-neighbors, no statistically significant differences were identified in behaviors toward prolonged psychiatric hospitalization as a mean of treatment, nor for social distance in relation to people who were hospitalized. Key informants conditioned their assessment of prolonged hospitalization and valued the role of support teams in making community life viable.

La reforma psiquiátrica se encuentra en proceso en la región de América Latina y el Caribe. Específicamente en Argentina, el modelo de salud mental comunitaria está en construcción, siendo aún observable la presencia de internaciones psiquiátricas prolongadas, principalmente en hospitales neuropsiquiátricos. Resulta así necesario monitorear la reforma psiquiátrica, siendo una de las vías para ello el análisis de las actitudes de la sociedad hacia la internación psiquiátrica prolongada como modalidad de atención en salud mental. Así, se realizó un estudio observacional analítico en la Provincia de Buenos Aires, Argentina, en el año 2021, en donde se analizaron las actitudes de vecinos de personas que tuvieron internaciones psiquiátricas prolongadas y que recibían apoyos a la vivienda. Se hicieron cuestionarios a vecinos y no vecinos, indagándose por las actitudes hacia la internación psiquiátrica prolongada como modalidad de tratamiento, así como la distancia social hacia personas que tuvieron internaciones psiquiátricas, y también entrevistas a profundidad con informantes clave de barrios en donde habitan personas con problemáticas severas de salud mental y que reciben apoyos a la vivienda. No se identificaron diferencias estadísticamente significativas en las actitudes en relación a la internación psiquiátrica prolongada como modalidad de tratamiento de vecinos y no vecinos, ni tampoco respecto a la distancia social hacia personas que tuvieron internaciones psiquiátricas. Los informantes clave condicionaron su valoración sobre la internación prolongada, y valoraron el rol de los equipos de apoyo para posibilitar la vida en comunidad.

Uma reforma psiquiátrica está em curso na América Latina e Caribe. Especificamente na Argentina, um modelo de saúde mental comunitária está sendo construído, ainda acontecendo internações psiquiátricas prolongadas, principalmente em hospitais neuropsiquiátricos. Faz-se necessário, portanto, o acompanhamento da reforma psiquiátrica. Uma das formas de fazê-lo é analisando as atitudes da sociedade frente à internação psiquiátrica prolongada como forma de tratamento da saúde mental. Assim, foi realizado um estudo observacional analítico na Província de Buenos Aires, Argentina, no ano de 2021, onde foram analisadas as atitudes de vizinhos de pessoas que tiveram internações psiquiátricas prolongadas e que receberam apoio habitacional. Foram aplicados questionários a vizinhos e não vizinhos, questionando as atitudes em relação à internação psiquiátrica prolongada como forma de tratamento, bem como a distância social em relação às pessoas que foram internadas, e também entrevistas específicas com informantes-chave de bairros onde vivem pessoas com problemas graves de saúde mental e que recebem apoio habitacional. Com base nas respostas de vizinho e não vizinhos, não foram identificadas diferenças estatisticamente significantes nas atitudes em relação à internação psiquiátrica prolongada como forma de tratamento, nem em relação à distância social em relação às pessoas que foram internadas. Os informantes-chave condicionaram sua avaliação da hospitalização prolongada e valorizaram o papel das equipes de apoio na viabilização da vida comunitária.

Influence of dairy products consumption on oral cancer risk: A meta-analysis.

Background: The role of dairy product consumption on oral cancer risk is not yet fully clarified. Some studies have observed an inverse association between dairy consumption and oral cancer risk. This study aimed to determine the influence of dairy product consumption (milk, cheese, yogurt, butter) on oral cancer risk. Methods: A search for studies on dairy products and oral cancer was conducted in the following databases: PubMed (MEDLINE, Cochrane Library), Web of Science (WoS), and Scopus. The estimation of the odds ratio (OR) effect was performed with the generic inverse variance method using the logarithm of the effect with the standard error (SE) and 95% confidence intervals. Results: Twenty-one studies with 59271 participants (8,300 oral cancer patients and 50971 controls) were included in this meta-analysis. All dairy products significantly reduced oral cancer risk except butter (P=0.16). Milk intake reduced oral cancer risk by 27% (OR: 0.73; P<0.001); yogurt consumption by 25% (OR: 0.75; P<0.001), and cheese consumption by 21% (OR:0.79; P<0.01). Conclusion: Regular consumption of dairy products reduces oral cancer risk between 21% and 27%.

Plasma sodium concentration in older patients as an indicator of severity in emergencies: Results from the Emergency Department and Elder Needs-16 study. / Estudio EDEN-16: sodio plasmático determinado a la llegada a urgencias como indicador de gravedad en pacientes ancianos.

OBJECTIVES: To study baseline factors associated with hypo- and hypernatremia in older patients attended in emergency departments (EDs) and explore the association between these dysnatremias and indicators of severity in an emergency. MATERIAL AND METHODS: We included patients attended in 52 Spanish hospital EDs aged 65 years or older during a designated week. All included patients had to have a plasma sodium concentration on record. Patients were distributed in 3 groups according to sodium levels: normal, 135-145 mmol/L; hyponatremia, 135 mmol/L; or hypernatremia > 145 mmol/L. We analyzed associations between sodium concentration and 24 variables (sociodemographic information, measures of comorbidity and baseline functional status, and ongoing treatment for hypo- or hypernatremia). Indicators of the severity in emergencies were need for hospitalization, in-hospital mortality, prolonged ED stay (> 12 hours) in discharged patients, and prolonged hospital stay (> 7 days) in admitted patients. We used restricted cubic spline curves to analyze the associations between sodium concentration and severity indicators, using 140 mmol/L as the reference. RESULTS: A total of 13 368 patients were included. Hyponatremia was diagnosed in 13.5% and hypernatremia in 2.9%. Hyponatremia was associated with age ($ 80 years), hypertension, diabetes mellitus, an active neoplasm, chronic liver disease, dementia, chemotherapy, and needing help to walk. Hypernatremia was associated with needing help to walk and dementia. The percentages of cases with severity indicators were as follows: hospital admission, 40.8%; in-hospital mortality, 4.3%; prolonged ED stay, 15.9%; and prolonged hospital stay, 49.8%. Odds ratios revealed associations between lower sodium concentration cut points in patients with hyponatremia and increasing need for hospitalization (130 mmol/L, 2.24 [IC 95%, 2.00-2.52]; 120 mmol/L, 4.13 [3.08-5.56]; and 110 mmol/L, 7.61 [4.53-12.8]); risk for in-hospital death (130 mmol/L, 3.07 [2.40-3.92]; 120 mmol/L, 6.34 [4.22- 9.53]; and 110 mmol/L, 13.1 [6.53-26.3]); and risk for prolonged ED stay (130 mmol/L, 1.59 [1.30-1.95]; 120 mmol/L, 2.77 [1.69-4.56]; and 110 mmol/L, 4.83 [2.03-11.5]). Higher sodium levels in patients with hypernatremia were associated with increasing need for hospitalization (150 mmol/L, 1.94 [1.61-2.34]; 160 mmol/L, 4.45 [2.88-6.87]; 170 mmol/L, 10.2 [5.1-20.3]; and 180 mmol/L, 23.3 [9.03-60.3]); risk for in-hospital death (150 mmol/L, 2.77 [2.16-3.55]; 160 mmol/L, 6.33 [4.11-9.75]; 170 mmol/L, 14.5 [7.45-28.1]; and 180 mmol/L, 33.1 [13.3-82.3]); and risk for prolonged ED stay (150 mmol/L, 2.03 [1.48-2.79]; 160 mmol/L, 4.23 [2.03-8.84]; 170 mmol/L, 8.83 [2.74-28.4]; and 180 mmol/L, 18.4 [3.69-91.7]). We found no association between either type of dysnatremia and prolonged hospital stay. CONCLUSION: Measurement of sodium plasma concentration in older patients in the ED can identify hypo- and hypernatremia, which are associated with higher risk for hospitalization, death, and prolonged ED stays regardless of the condition that gave rise to the dysnatremia.

OBJETIVO: Estudiar los factores basales asociados a hiponatremia e hipernatremia en pacientes mayores atendidos en urgencias y la relación de estas disnatremias con eventos indicadores de gravedad. METODO: Se incluyeron durante una semana a todos los pacientes atendidos en 52 servicios de urgencias hospitalarios españoles de edad $ 65 años con determinación de sodio plasmático. Se formaron tres grupos: sodio normal (135-145 mmol/L), hiponatremia ( 135 mmol/L) e hipernatremia (> 145 mmol/L). Se investigó la relación de 24 factores sociodemográficos, de comorbilidad, estado funcional basal y tratamiento crónico con hipo e hipernatremia. Como eventos de gravedad se recogieron necesidad de hospitalización, mortalidad intrahospitalaria, estancia prolongada en urgencias (> 12 horas) en dados de alta y hospitalización prolongada (> 7 días) en hospitalizados, y se analizó su relación con la concentración de sodio mediante curvas spline cúbicas restringidas ajustadas, tomando el valor 140 mmol/L como referencia. RESULTADOS: Se incluyeron 13.368 pacientes (13,5% hiponatremia, 2,9% hipernatremia). La hiponatremia se asoció a edad $ 80 años, hipertensión arterial, diabetes mellitus, neoplasia activa, hepatopatía crónica, demencia, tratamiento con quimioterápicos y ayuda para la deambulación, y la hipernatremia a dependencia, necesidad de ayuda para deambular y demencia. La hospitalización fue del 40,8%, la mortalidad intrahospitalaria del 4,3%, la estancia prolongada en urgencias del 15,9% y la hospitalización prolongada del 49,8%. A mayor hiponatremia, mayor necesidad de hospitalización (sodio 130 mmol/L: OR:2,24; IC 95%: 2,00-2,52; 120 mmol/L: 4,13, 3,08-5,56; 110 mmol/L: 7,61, 4,53-12,8), mortalidad intrahospitalaria (130 mmol/L: 3,07, 2,40-3,92; 120 mmol/L: 6,34, 4,22-9,53; 110 mmol/L: 13,1, 6,53-26,3) y estancia prolongada en urgencias (130 mmol/L: 1,59, 1,30-1,95; 120 mmol/L: 2,77, 1,69-4,56; 110 mmol/L: 4,83, 2,03-11,5), y a mayor hipernatremia mayor necesidad de hospitalización (150 mmol/L: 1,94, 1,61-2,34; 160 mmol/L: 4,45, 2,88-6,87; 170 mmol/L: 10,2, 5,1-20,3; 180 mmol/L: 23,3, 9,03-60,3), mortalidad intrahospitalaria (150 mmol/L: 2,77, 2,16-3,55; 160 mmol/L: 6,33, 4,11-9,75; 170 mmol/L: 14,5, 7,45-28,1; 180 mmol/L: 33,1, 13,3-82,3) y estancia prolongada en urgencias (150 mmol/L: 2,03, 1,48-2,79; 160 mmol/L: 4,23, 2,03-8,84; 170 mmol/L: 8,83, 2,74-28,4; 180 mmol/L: 18,4, 3,69-91,7). No hubo asociación entre estas disnatremias y hospitalización prolongada. CONCLUSIONES: El sodio plasmático determinado en urgencias en pacientes mayores permite identificar hiponatremias e hipernatremias, las cuales se asocian a un riesgo incrementado de hospitalización, mortalidad y estancia prolongada en urgencias independientemente de la causa que haya generado la disnatremia.

A survey of epibiont hydrozoans on Sargassum.

The brown alga Sargassum provides a natural substrate occupied by hydrozoans in shallow marine waters. A global count in 2007 listed 39 epibiotic species of Hydrozoa growing on Sargassum, but more studies have been published since, therefore, an update is timely, particularly due to the increased abundance of Sargassum in the Caribbean. This review, based on a recent literature survey and new records from Mexico, includes 133 publications of epibiotic hydrozoans on Sargassum spanning 220 years, from 1802 to 2022. A total of 131 hydrozoan species were recorded on 26 species of Sargassum, most belonging to the subclass Hydroidolina (130), with only one record of a trachyline medusa (Gonionemus vertens, subclass Trachylinae). Most publications centered on the Tropical Atlantic, where the greatest number of hydrozoan species (67 species) were recorded. All hydrozoan species possess a hydrorhiza, except one hydromedusae species that attach to Sargassum via adhesive tentacles. Most of the hydrozoan species associated with Sargassum exhibited a benthic life cycle (93 species) and are comprised of erect, branched colonies (67 species) and large hydrothecae (69 species). Although the number of studies of epibiotic hydrozoans on Sargassum has increased since the mid-20th century, nevertheless hydrozoan richness has not reached an asymptote. Therefore, more sampling of Sargassum species would likely identify more hydrozoan species associated with Sargassum, especially among benthic Sargassum, and might help reveal potential biogeographical and ecological patterns between Sargassum and hydrozoan epibionts.

Tracking SARS-CoV-2 introductions in Mozambique using pandemic-scale phylogenies: a retrospective observational study.

BACKGROUND: From the start of the SARS-CoV-2 outbreak, global sequencing efforts have generated an unprecedented amount of genomic data. Nonetheless, unequal sampling between high-income and low-income countries hinders the implementation of genomic surveillance systems at the global and local level. Filling the knowledge gaps of genomic information and understanding pandemic dynamics in low-income countries is essential for public health decision making and to prepare for future pandemics. In this context, we aimed to discover the timing and origin of SARS-CoV-2 variant introductions in Mozambique, taking advantage of pandemic-scale phylogenies. METHODS: We did a retrospective, observational study in southern Mozambique. Patients from Manhiça presenting with respiratory symptoms were recruited, and those enrolled in clinical trials were excluded. Data were included from three sources: (1) a prospective hospital-based surveillance study (MozCOVID), recruiting patients living in Manhiça, attending the Manhiça district hospital, and fulfilling the criteria of suspected COVID-19 case according to WHO; (2) symptomatic and asymptomatic individuals with SARS-CoV-2 infection recruited by the National Surveillance system; and (3) sequences from SARS-CoV-2-infected Mozambican cases deposited on the Global Initiative on Sharing Avian Influenza Data database. Positive samples amenable for sequencing were analysed. We used Ultrafast Sample placement on Existing tRees to understand the dynamics of beta and delta waves, using available genomic data. This tool can reconstruct a phylogeny with millions of sequences by efficient sample placement in a tree. We reconstructed a phylogeny (~7·6 million sequences) adding new and publicly available beta and delta sequences. FINDINGS: A total of 5793 patients were recruited between Nov 1, 2020, and Aug 31, 2021. During this time, 133 328 COVID-19 cases were reported in Mozambique. 280 good quality new SARS-CoV-2 sequences were obtained after the inclusion criteria were applied and an additional 652 beta (B.1.351) and delta (B.1.617.2) public sequences were included from Mozambique. We evaluated 373 beta and 559 delta sequences. We identified 187 beta introductions (including 295 sequences), divided in 42 transmission groups and 145 unique introductions, mostly from South Africa, between August, 2020 and July, 2021. For delta, we identified 220 introductions (including 494 sequences), with 49 transmission groups and 171 unique introductions, mostly from the UK, India, and South Africa, between April and November, 2021. INTERPRETATION: The timing and origin of introductions suggests that movement restrictions effectively avoided introductions from non-African countries, but not from surrounding countries. Our results raise questions about the imbalance between the consequences of restrictions and health benefits. This new understanding of pandemic dynamics in Mozambique can be used to inform public health interventions to control the spread of new variants. FUNDING: European and Developing Countries Clinical Trials, European Research Council, Bill & Melinda Gates Foundation, and Agència de Gestió d'Ajuts Universitaris i de Recerca.

Repercussions of COVID-19 on psychiatric inpatient care in Latin America and the Caribbean.

OBJETIVE: To characterise the impact of the COVID-19 pandemic on psychiatric hospitalisations in the Latin American and Caribbean (LAC) region. METHODS: Descriptive study. 85 semi-structured interviews were conducted with health workers involved with psychiatric hospitalisations in general hospitals (GHs) and specialised psychiatric hospitals (SHs) from 18 LAC countries. The interviews were done between 8 May and 30 June 2020. The data were analysed quantitatively and qualitatively. RESULTS: An initial decrease in the demand for hospitalisation is reported, attributed to the population's fear of approaching health services as well as restrictions on mobility. Stricter criteria for hospitalisation were reported with a double focus on the acute within the acute. The length of hospitalisations were mixed, with both increases and decreases in GHs and SHs. The therapeutic offer was drastically reduced, and interaction between hospitalised people and their support networks was restricted. CONCLUSIONS: In the COVID-19 context, hospitalisation seems to be not the last but the only alternative for psychiatric treatment. The decrease in the number of beds in SHs could be a positive aspect for the reform of psychiatric care, but it is questioned since this reduction also occurs in GHs.

Repercusiones de la COVID-19 en la Internación Psiquiátrica en América Latina y el Caribe

Objetivo: Caracterizar el impacto de la pandemia por COVID-19 en las internaciones psiquiátricas en la región de América Latina y el Caribe. Métodos: Estudio descriptivo. Se realizaron 85 entrevistas semiestructuradas con trabajadores de hospitales generales (HG) y hospitales especializados (HE) en salud mental en 18 países de la región de América Latina y el Caribe entre el 8 de mayo y el 30 de junio de 2020. Los datos se analizaron cuantitativa y cualitativamente. Resultados: Se reporta una disminución inicial en la demanda de internación, atribuida al temor de la población a acercarse a los servicios, así como a restricciones en la movilidad. Se indican criterios más estrictos para internar con una doble focalización de lo agudo dentro de lo agudo. Los tiempos de internación presentaron un comportamiento mixto, tanto de aumento como de disminución en HG y en HE. La oferta terapéutica durante la internación se vio drásticamente reducida, y se restringió la interacción de las personas internadas con sus redes de apoyo. Conclusiones: La internación pareciera estar siendo no la última, sino la única alternativa de tratamiento psiquiátrico en el contexto de la pandemia. La reducción de camas en los HE podría ser un aspecto positivo para la reforma de la atención, pero es puesto en duda, ya que dicha reducción también se produce en los HG.

Objetive: To characterise the impact of the COVID-19 pandemic on psychiatric hospitalisations in the Latin American and Caribbean (LAC) region. Methods: Descriptive study. 85 semi-structured interviews were conducted with health workers involved with psychiatric hospitalizations in general hospitals (GHs) and specialised psychiatric hospitals (SHs) from 18 LAC countries. The interviews were done between 8 May and 30 June 2020. The data were analysed quantitatively and qualitatively. Results: An initial decrease in the demand for hospitalization is reported, attributed to the population's fear of approaching health services as well as restrictions on mobility. Stricter criteria for hospitalization were reported with a double focus on the acute within the acute. The length of hospitalizations were mixed, with both increases and decreases in GHs and SHs. The therapeutic offer was drastically reduced, and interaction between hospitalised people and their support networks was restricted. Conclusions: In the COVID-19 context, hospitalization seems to be not the last but the only alternative for psychiatric treatment. The decrease in the number of beds in SHs could be a positive aspect for the reform of psychiatric care, but it is questioned since this reduction also occurs in GHs.

'Now you will understand what it is like to be confined': Did COVID-19 lockdowns affect perceptions about long-term psychiatric hospitalizations? A report from Argentina.

BACKGROUND: Lockdowns have been one of the government's primary measures to control COVID-19, especially during the initial waves of the pandemic, but there is concern on the impact of lockdowns on people's mental health. Confinement is still today the reality of many people with severe mental illness in many places of the world. OBJECTIVE: Given that the general population experienced confinement during the COVID-19 pandemic, we sought to explore if that affected perceptions about long-term psychiatric hospitalizations. METHODS: About 134 residents from middle-class neighborhoods in urban settings in the Province of Buenos Aires, Argentina, were surveyed. Participants were asked if they felt emotionally affected by the pandemic and lockdown, and about their perceptions of long-term psychiatric hospitalizations. Association between personal emotional impact by the pandemic or lockdown with perceptions about long-term psychiatric hospitalization were analyzed using chi-square test. Qualitative analysis of pandemic and lockdown effects was held. RESULTS: Respondents tended to overlap the emotional effects of the pandemic and the lockdown. Some responses explicitly referred to confinement. No association was observed between emotional impact by the pandemic or lockdown and perceptions about long-term psychiatric hospitalization among the sample. The general population's perceptions of long-term psychiatric hospitalization do not appear to be affected by the first-hand experience of confinement, which suggest persistence of stigma, and the need to reconsider public policies and actions that attempt to impact on it.

Superior mesenteric ganglion via ovarian plexus nerve involved in the cross-talk between noradrenaline and GnRH in rat ovaries.

There is evidence of the existence of an intraovarian gonadotropin-releasing hormone (GnRH) system. There are also reports about the influence of extrinsic ovarian innervation in gonadal function. Therefore, it is interesting to study the relationship between ovarian sympathetic innervation and GnRH to shed light on possible physiological and pathophysiological implications. This work aimed to investigate whether noradrenergic stimulation of the superior mesenteric ganglion (SMG) can modify the levels of ovarian GnRH and cause functional and morphological changes in the gonad through the ovarian plexus nerve (OPN), during estrus and diestrus II in rats. The SMG-OPN-Ovary system and an ovary without extrinsic innervation were removed from Holtzman rats in estrus and diestrus II stages and placed in specially designed cuvettes containing Krebs-Ringer buffer. In the experimental groups, SMGs and denervated ovaries were stimulated with 10-6 M noradrenaline (NA). GnRH and progesterone levels (in the ovarian incubation medium) and the mRNA expression of 3beta-hydroxysteroid dehydrogenase (Hsd3b3), 20alpha-hydroxysteroid dehydrogenase (Akr1c18), Bax, and Bcl2 were analyzed. Histological studies of the ovaries were performed. In estrus, NA decreased GnRH levels in both experimental schemes. Furthermore, progesterone levels increased while the Akr1c18 expression and Bax/Bcl2 ratio decreased, without causing changes in ovarian morphology. In diestrus, the noradrenergic stimulation of the ganglion increased GnRH levels, decreased progesterone levels, and increased Akr1c18 expression and Bax/Bcl2 ratio. Follicles with histoarchitecture alterations and corpus luteum with signs of cell death were observed. In denervated ovaries, NA increased the levels of GnRH and progesterone. Furthermore, NA decreased the Bax/Bcl2 ratio and histological studies revealed signs compatible with a possible atretogenic effect. In conclusion, noradrenergic stimulation of the SMG-OPN pathway regulates ovarian cyclicity. The SMG modulates the cross-talk between NA and ovarian GnRH, protecting the ovary from atretogenic effects and luteal apoptosis during estrus while inducing luteal regression in the diestrus II.

[Repercussions of COVID-19 on psychiatric inpatient care in Latin America and the Caribbean]. / Repercusiones de la COVID-19 en la Internación Psiquiátrica en América Latina y el Caribe.

Objetive: To characterise the impact of the COVID-19 pandemic on psychiatric hospitalisations in the Latin American and Caribbean (LAC) region. Methods: Descriptive study. 85 semi-structured interviews were conducted with health workers involved with psychiatric hospitalisations in general hospitals (GHs) and specialised psychiatric hospitals (SHs) from 18 LAC countries. The interviews were done between 8 May and 30 June 2020. The data were analysed quantitatively and qualitatively. Results: An initial decrease in the demand for hospitalisation is reported, attributed to the population's fear of approaching health services as well as restrictions on mobility. Stricter criteria for hospitalisation were reported with a double focus on the acute within the acute. The length of hospitalisations were mixed, with both increases and decreases in GHs and SHs. The therapeutic offer was drastically reduced, and interaction between hospitalised people and their support networks was restricted. Conclusions: In the COVID-19 context, hospitalisation seems to be not the last but the only alternative for psychiatric treatment. The decrease in the number of beds in SHs could be a positive aspect for the reform of psychiatric care, but it is questioned since this reduction also occurs in GHs.

Actitudes de vecinos acerca del tratamiento y la vida en comunidad de personas con problemáticas severas de salud mental en Argentina / Attitudes of neighbors about the treatment and community life of people with severe mental health disorders in Argentina / Atitudes de vizinhos sobre o tratamento e a vida comunitária de pessoas com problemas graves de saúde mental na Argentina

Resumen: La reforma psiquiátrica se encuentra en proceso en la región de América Latina y el Caribe. Específicamente en Argentina, el modelo de salud mental comunitaria está en construcción, siendo aún observable la presencia de internaciones psiquiátricas prolongadas, principalmente en hospitales neuropsiquiátricos. Resulta así necesario monitorear la reforma psiquiátrica, siendo una de las vías para ello el análisis de las actitudes de la sociedad hacia la internación psiquiátrica prolongada como modalidad de atención en salud mental. Así, se realizó un estudio observacional analítico en la Provincia de Buenos Aires, Argentina, en el año 2021, en donde se analizaron las actitudes de vecinos de personas que tuvieron internaciones psiquiátricas prolongadas y que recibían apoyos a la vivienda. Se hicieron cuestionarios a vecinos y no vecinos, indagándose por las actitudes hacia la internación psiquiátrica prolongada como modalidad de tratamiento, así como la distancia social hacia personas que tuvieron internaciones psiquiátricas, y también entrevistas a profundidad con informantes clave de barrios en donde habitan personas con problemáticas severas de salud mental y que reciben apoyos a la vivienda. No se identificaron diferencias estadísticamente significativas en las actitudes en relación a la internación psiquiátrica prolongada como modalidad de tratamiento de vecinos y no vecinos, ni tampoco respecto a la distancia social hacia personas que tuvieron internaciones psiquiátricas. Los informantes clave condicionaron su valoración sobre la internación prolongada, y valoraron el rol de los equipos de apoyo para posibilitar la vida en comunidad.

Abstract: A psychiatric reform is underway in Latin America and the Caribbean. Specifically in Argentina, a model of community mental health is being built, and prolonged psychiatric hospitalizations are still taking place, especially in neuropsychiatric hospitals. Therefore, it is necessary to closely monitor the psychiatric reform. One of the possible ways to monitor the reform is by analyzing society's attitudes towards prolonged psychiatric hospitalization as a mean of mental health treatment. Thus, an analytical observational study was conducted at the Buenos Aires Province, Argentina, in 2021, to analyze the behavior of neighbors of people who had prolonged psychiatric hospitalizations and who received housing support. Questionnaires were applied to neighbors and non-neighbors, addressing the behaviors toward prolonged psychiatric hospitalization as a mean of treatment, social distance toward people who were hospitalized, as well as specific interviews with key informants from neighborhoods where people with severe mental health disorders and who receive housing support live. Based on the answers of neighbors and non-neighbors, no statistically significant differences were identified in behaviors toward prolonged psychiatric hospitalization as a mean of treatment, nor for social distance in relation to people who were hospitalized. Key informants conditioned their assessment of prolonged hospitalization and valued the role of support teams in making community life viable.

Resumo: Uma reforma psiquiátrica está em curso na América Latina e Caribe. Especificamente na Argentina, um modelo de saúde mental comunitária está sendo construído, ainda acontecendo internações psiquiátricas prolongadas, principalmente em hospitais neuropsiquiátricos. Faz-se necessário, portanto, o acompanhamento da reforma psiquiátrica. Uma das formas de fazê-lo é analisando as atitudes da sociedade frente à internação psiquiátrica prolongada como forma de tratamento da saúde mental. Assim, foi realizado um estudo observacional analítico na Província de Buenos Aires, Argentina, no ano de 2021, onde foram analisadas as atitudes de vizinhos de pessoas que tiveram internações psiquiátricas prolongadas e que receberam apoio habitacional. Foram aplicados questionários a vizinhos e não vizinhos, questionando as atitudes em relação à internação psiquiátrica prolongada como forma de tratamento, bem como a distância social em relação às pessoas que foram internadas, e também entrevistas específicas com informantes-chave de bairros onde vivem pessoas com problemas graves de saúde mental e que recebem apoio habitacional. Com base nas respostas de vizinho e não vizinhos, não foram identificadas diferenças estatisticamente significantes nas atitudes em relação à internação psiquiátrica prolongada como forma de tratamento, nem em relação à distância social em relação às pessoas que foram internadas. Os informantes-chave condicionaram sua avaliação da hospitalização prolongada e valorizaram o papel das equipes de apoio na viabilização da vida comunitária.