Priorities and challenges in social and healthcare policies for older people living in the Mediterranean basin: A Delphi panel study.

BACKGROUND: Recently, the countries in the Mediterranean basin (which share cultural ties) have been showing a common trend of declining social support for the elderly, with deficiencies in social care models for this demographic. Thus, this Delphi panel study analyzed the gaps in social and integrated care among the participating countries in a European research project. METHODS: This three-round Delphi panel study focused on the European countries of Greece and Spain and the non-European countries of Egypt, Lebanon, and Tunisia. In this project, experts were identified according to their level of expertise in the subject matter, their gender, and their membership in different social groups. Subsequently, they were asked to identify the current situation of social care, set future goals, and locate the gaps regarding the social and healthcare models for older people in the participating countries. The median score (Mdn) and interquartile range (IQR) were calculated to assess the degree of consensus on the different priorities. RESULTS: Among the participating countries, there was a lack of state agreements to maintain social care models, a lack of coordination between public and private institutions to provide social care services, territorial inequalities in terms of access and coverage of rights, and job insecurity for professionals. The desired situation was to integrate social and healthcare services with a person-centered social care model, thus promoting autonomy and empowering users and families in participation and decision-making. CONCLUSIONS: This Delphi study reveals significant disparities in social and healthcare policies for older adults across Mediterranean countries, highlighting shared challenges and specific national needs. European nations like Greece and Spain face fragmented systems, while non-European countries such as Lebanon, Egypt, and Tunisia lack specialized geriatric services and social security. All countries urgently need better professional training, social and economic empowerment of older adults, and integrated national strategies. These findings offer key insights for policymakers to develop equitable, sustainable solutions for aging populations.

Socio-Healthcare for Older People in the Mediterranean Basin: An Integrative Review and Quality Appraisal.

OBJECTIVES: The aging Mediterranean Basin population presents complex challenges for healthcare systems, which require innovative care approaches. The study aimed to critically assess 19 socio-healthcare practices in the Mediterranean Basin that target the elderly population by analyzing their theoretical foundations, integration of care services, ethical considerations, gender-specific approaches, and use of technology. DESIGN: An integrative literature review was conducted using a structured methodology. SAMPLE: Diverse sources across multiple languages were searched, with the inclusion criteria focusing on the alignment of socio-healthcare practices with the components of the nursing metaparadigm, the incorporation of transversal values, and relevance to the elderly population. RESULTS: The socio-healthcare practices exhibited common themes, such as person-centered care, interdisciplinary collaboration, and incorporation of technology for coordinated care delivery. Ethical principles of autonomy, dignity, and respect were central, with some socio-healthcare practices addressing gender-specific care needs. Evidence-based findings emphasized holistic care, integration, ethics, and innovation in elderly socio-healthcare. CONCLUSIONS: New eldercare frameworks should integrate these aspects, which offer a comprehensive approach to addressing the complex needs of elderly patients. Managers should design systems prioritizing patient well-being, whereas policymakers should develop equitable and high-quality care policies that collectively improve the well-being of the elderly population in the Mediterranean Basin.

Perception of Utility and Efficacy of Implementation of TEC-MED Model of Care for Frail Older People and Their Caregivers: A Qualitative Study.

INTRODUCTION: The global population is ageing, and healthcare systems continue to adopt outdated social models of ageing that do not respond to older people's needs. The aim of this study was to explore the experiences of participants in the implementation of the Transcultural social-ethical-care (TEC-MED) model for integrated community care. METHODS: A qualitative descriptive research study was conducted. Qualitative data were collected through individual interviews and focus groups with purposive sampling. RESULTS: We gathered experiences from five older people, five informal caregivers, two training agents (nurses), six healthcare professionals and eight stakeholders (senior management of businesses, public administrators, researchers and educators). Four themes were extracted: TEC-MED as a new model of home care, TEC-MED model outcome, key role of training agent and platform and resources. Overall, all the participants were satisfied with the model and various positive outcomes were found. The TEC-MED model of care was inclusive and personalised and bridged the communication and integration gaps between different services for the care of dependent older people and their caregivers in the community. Recommendations were made for improvements to the model. CONCLUSION: New models of care that are inclusive, personalised and integrated are necessary to respond to the multiple needs of the older people. A model that integrates the multiple skills of healthcare professionals is an optimum solution in the care of the older people and their caregivers in Mediterranean countries. Similar research is imperative for other healthcare systems to help them prepare adequately to respond effectively to the needs of present and new generations of older people. IMPLICATIONS FOR PRACTICE: The TEC-MED model presents a promising approach to addressing the complex care needs of older people and their caregivers by fostering inclusivity, personalisation and integration across services. For nursing practice, this model emphasizes the importance of multidisciplinary collaboration and the role of nurses in facilitating the adoption of new care strategies. Implementing such models in everyday practice could improve the quality of care provided to older adults, enhancing communication between healthcare providers and ensuring that care is more aligned with the individual needs of patients. Furthermore, integrating digital platforms and targeted resources, as highlighted in the TEC-MED model, can aid in overcoming existing barriers in healthcare systems, improving the coordination of care at the community level.

Enhancing nursing care through technology and standardized nursing language: The TEC-MED multilingual platform.

PURPOSE: This study describes the design, integration, and semantic interoperability process of a minimum data set using standardized nursing language in the caring module of the TEC-MED care platform. METHODS: The caring module was developed in three phases (2020-2022): platform concept, functional design and construction, and testing and evaluation. Phases involved collaboration among academics, information technology developers, and social/healthcare professionals. Nursing taxonomies (NANDA-I, NOC, NIC) were integrated to support the nursing process. The platform was piloted in six Mediterranean countries. FINDINGS: The final platform features an assessment module with eight dimensions for data collection on older adults and their caregivers. A clinical decision support system links assessment data with nursing diagnoses, outcomes, and interventions. The platform is available in six languages (English, Spanish, French, Italian, Greek, and Arabic). Usability testing identified the need for improved Arabic language support. CONCLUSIONS: The TEC-MED platform is a pioneering tool using standardized nursing language to improve care for older adults in the Mediterranean. The platform's multilingualism promotes accessibility. Limitations include offline use and mobile app functionality. Pilot testing is underway to evaluate effectiveness and facilitate cross-cultural validation of nursing taxonomies. IMPLICATIONS FOR NURSING PRACTICE: The TEC-MED platform offers standardized nursing care for older adults across the Mediterranean, promoting consistent communication and evidence-based practice. This approach has the potential to improve care quality and accessibility for a vulnerable population.

OBJETIVO: Este estudio describe el diseño, la integración y el proceso de interoperabilidad semántica de un conjunto mínimo de datos utilizando un lenguaje estandarizado de enfermería en el módulo de atención de la plataforma de cuidados TEC­MED. MÉTODOS: El módulo de atención se desarrolló en tres fases (2020­2022): concepto de la plataforma, diseño y construcción funcional, y pruebas y evaluación. Las fases involucraron la colaboración entre académicos, desarrolladores de tecnología de la información y profesionales sociales/sanitarios. Se integraron taxonomías de enfermería (NANDA­I, NOC, NIC) para apoyar el proceso de enfermería. La plataforma se pilotó en seis países mediterráneos. RESULTADOS: La plataforma final presenta un módulo de evaluación con ocho dimensiones para la recopilación de datos sobre adultos mayores y sus cuidadores. Un Sistema de Apoyo a la Decisión Clínica (CDSS) vincula los datos de evaluación con diagnósticos, resultados e intervenciones de enfermería. La plataforma está disponible en seis idiomas (inglés, español, francés, italiano, griego, árabe). Las pruebas de usabilidad identificaron la necesidad de mejorar el soporte en idioma árabe. CONCLUSIONES: La plataforma TEC­MED es una herramienta pionera que utiliza un lenguaje estandarizado de enfermería para mejorar la atención a los adultos mayores en el Mediterráneo. La disponibilidad en varios idiomas de la plataforma promueve la accesibilidad a la misma. Las limitaciones incluyen el uso sin conexión y la funcionalidad de la aplicación móvil. Se están realizando pruebas piloto para evaluar la efectividad y facilitar la validación intercultural de las taxonomías de enfermería. IMPLICACIONES PARA LA PRÁCTICA DE ENFERMERÍA: La plataforma TEC­MED ofrece atención de enfermería estandarizada para los adultos mayores en todo el Mediterráneo, promoviendo la comunicación consistente y la práctica basada en evidencia. Este enfoque tiene el potencial de mejorar la calidad y accesibilidad de la atención para una población vulnerable.

Correlation between Implant Surface Roughness and Implant Stability: A Systematic Review.

The aim of this study was to find in the literature data on the relationship between implant surface roughness and implant stability achieved, from the time of placement to three months afterward, to help us to know what type of surface roughness is more favorable to guarantee implant stability and osseointegration. A systematic review was conducted in accordance with the PRISMA 2020 (Preferred Reporting Items for Systematic Review and Meta-analysis) statement, and the protocol was registered on the Open Science Framework. The specific inclusion and exclusion criteria were selected using the PICOS framework. The databases Medline (PubMed), Scopus, the Web of Science and The Cochrane Library were searched up to October 2023. The selection of studies and data extraction were conducted by two independent reviewers. The review included a total of 11 studies. A total of 1331 dental implant placements were identified. Two of the eleven selected studies were on humans in vivo, eight were on animals in vivo, and one was on animals in vitro. A statistically significant correlation between surface roughness and implant stability as measured by resonance frequency analysis (RFA) was not identified in ten of the eleven selected studies. It appears that there is no correlation between primary stability and the degree of implant roughness. However, there appears to be a correlation between the roughness of the implant and the degree of osseointegration, as indicated by bone-implant contact values. This correlation is more closely related to secondary stability. The great methodological variability makes it difficult to compare data and draw conclusions, so it would be desirable to agree on a common methodology to help draw appropriate conclusions from published studies.

Effectiveness of digital interventions to reduce school-age adolescent sexual risks: A systematic review.

INTRODUCTION: The increase in risky sexual behaviors among adolescent students has sparked alarm and has become an area of research interest. As adolescents prioritize confidentiality and accessibility, digital interventions are becoming increasingly relevant in sex education. We therefore posed the following research question: Are digital application interventions effective to prevent risky sexual behaviors in school adolescents? DESIGN: A systematic peer review was conducted between January and December 2023 in five databases (PubMed, Web of Science, Scopus, EMBASE, and PsycINFO) without restricting for language or year of publication. METHOD: We included randomized control trials or quasi-experimental studies that measured the effectiveness of interventions targeting young people aged 10-19 years or their parents and developed in a school setting. Interventions aimed at young people with intellectual disabilities, learning difficulties, or any disease requiring a specific intervention were excluded. RESULTS: The search ultimately yielded 27 studies covering a total of 18 digital interventions that demonstrated positive effects, not maintained over time, on knowledge, attitudes, and behaviors, although the latter to a lesser extent. DISCUSSION: We have found very interesting digital interventions with effects, among others, on knowledge, attitudes, and contraceptive use in adolescents. In general, digital interventions have positive effects on knowledge and attitudes, but it is more difficult to modify behaviors with strictly digital interventions or combined with complementary face-to-face sessions or group class activities. CONCLUSION: We thus believe that digital interventions are adequate to reduce adolescent sexual risk behaviors, and our systematic review facilitates the implementation of these interventions by sharing existing digital interventions that have had positive effects, as well as the main characteristics a digital intervention should possess to reduce sexually risky behaviors in adolescents. CLINICAL RELEVANCE: Digital interventions with adolescents improve sexual behaviors and can be a valuable resource in education on this topic due to their accessibility and confidentiality, two key points for young people.

Addressing Reproducibility Challenges in High-Throughput Photochemistry.

Light-mediated reactions have emerged as an indispensable tool in organic synthesis and drug discovery, enabling novel transformations and providing access to previously unexplored chemical space. Despite their widespread application in both academic and industrial research, the utilization of light as an energy source still encounters challenges regarding reproducibility and data robustness. Herein we present a comprehensive head-to-head comparison of commercially available batch photoreactors, alongside the introduction of the use of batch and flow photoreactors in parallel synthesis. Hence, we aim to establish a reliable and consistent platform for light-mediated reactions in high-throughput mode. Herein, we showcase the identification of several platforms aligning with the rigorous demands for efficient and robust high-throughput experimentation screenings and library synthesis.

Treatment patterns and factors associated with adherence in pulmonary arterial hypertension.

OBJECTIVE: Improving understanding of actual pulmonary hypertension (PH) treatment adherence patterns is crucial to properly treating these patients. We aimed to primarily assess adherence to treatments used for pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) specific therapies, identify potential factors related to it and secondly describe its treatment patterns. METHODS: A 6-month observational cross-sectional study in a tertiary care hospital was conducted. Patients with PH-targeted therapy who picked it up in the ambulatory hospital pharmacy and who had been on treatment with the same drug for at least 1 year were included. Adherence was assessed as: 1) Proportion of days covered (PDC); and 2) Simplified Medication Adherence Questionnaire (SMAQ). PDC ≥80% was considered adherent. Statistical analyses were performed to evaluate the study outcomes. Logistic regressions were estimated to identify the association between baseline characteristics and factors associated with adherence. P < 0.05 indicated statistical significance. RESULTS: A total of 63 patients with 127 different treatments were included, 71.4% were females with a mean age (SD) of 59 (15) years. PAH was the most common diagnosis (74.6%). Double therapy was used in 39.7% of patients, being the combination of Macitentan + Tadalafil and Ambrisentan + Tadalafil the most prescribed. Endothelin receptor antagonists were the most used treatment (40.2%). Adherence according to PDC was 93.7%, showing no great differences depending on the targeted drug used, and according to SMAQ 61.9%. The agreement degree of both methods was slight (65.1%; Kappa 0.12). Only female sex (OR: 0.23, 95% CI: 0.06-0.90; p = 0.035) was associated with worse adherence in the SMAQ method but not in the PDC. Adverse events were reported by a 55.6% of participants and the perception of effective treatment was high (95.2%). CONCLUSIONS: Adherence to PH therapy differs depending on the assessment method; PDC showed greater adherence rate than SMAQ. According to SMAQ, female sex may have a negative impact on adherence in this cohort, but PDC revealed no factors influencing it. No notable differences in adherence between treatment types were found and generally patients felt the treatments were effective in controlling their disease.

Beliefs About Cannabis Use Among Male and Female Andalusian Adolescents.

Objectives: This study assessed potential differences between girls and boys in the prevalence rates of cannabis use, sociodemographic factors, and beliefs about cannabis use. Methods: 1,896 Andalusian adolescents aged 14-18 participated in an online survey based on the I-Change model. The survey assessed their beliefs about cannabis use, including attitudes, social influences, self-efficacy, action planning, and intention to use. Multivariate analyses of variance were then conducted to examine potential gender differences in these beliefs, while controlling for last month's cannabis use. Results: Significantly more boys used cannabis in the last month, had boyfriends/girlfriends, and had more pocket money compared to girls. Additionally, girls - in comparison to boys - were more convinced of the disadvantages of cannabis use, but were also more convinced of some of the advantages (such as freedom from boredom, and medicinal use), reported having less favorable social norms for cannabis use, had more female best friends using cannabis, and felt pressure to use cannabis from their female peers. Conclusion: These findings highlight the need for cannabis prevention programs to consider gender differences in beliefs about cannabis use. Programs should not only address general risk factors for cannabis use but also evaluate if their interventions effectively target beliefs that are particularly important for girls and boys.

Methodological and strategic insights for online survey studies: an analysis based on the CHERRIES checklist.

The use of online surveys has become a valuable and widely employed tool in health research. However, the use of such instruments necessitates methodological rigor and optimization in their design to achieve the best response rates. Drawing upon relevant literature and the international CHERRIES guidelines for the development of online surveys, this article addresses methodological aspects related to ethical considerations and data protection (with reference to the Association of Internet Research's online ethics guide), study design and validation, recruitment, data collection processes, and data management and analysis. In conclusion, given the context of overexposure to online surveys, which can influence recruitment and response rates, strategies for their maximization are provided, encompassing both static and dynamic aspects of survey design.

Use of Tirzepatide in Adults with Type 2 Diabetes Mellitus: Scientific Evidence and Practical Aspects.

Tirzepatide is a novel antidiabetic medication a single-molecule, agonist to the glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors. It is approved in the USA and EU for the treatment of type 2 diabetes mellitus (T2DM) and obesity. Due to the potential novelty represented by incorporating tirzepatide to clinical practice, we aim to review practical aspects of tirzepatide use in T2DM and the supporting scientific evidence. A group of ten endocrinologists involved as investigators in the phase 3 SURPASS clinical trial program followed a nominal group technique, a qualitative research methodology designed as a semi-structured group discussion to reach a consensus on the selection of a set of practical aspects. The scientific evidence for tirzepatide has been reviewed with respect to a number of patients' clinical profiles and care goals. Information of interest related to adverse events, special warnings and precautions, and other considerations for tirzepatide use has been included. Finally, information provided to the patients has been summarized. The practical aspects reported herein may be helpful in guiding physicians in the use of tirzepatide and contribute to optimizing the management of T2DM.

Alerta Cannabis: A Tailored-Computer Web-Based Program for the Prevention of Cannabis Use in Adolescents: A Cluster-Randomized Controlled Trial Protocol.

BACKGROUND: The growing use of cannabis in adolescence is a public health problem that must be addressed through prevention. In Spain, the average age of initiation of cannabis use in the adolescent population is 14.8 years. At 14 years, the lifetime prevalence of cannabis use is 11.7%, which increases to 51.,5% at the age of 18; the prevalence of cannabis use in the population aged 14 to 18 years is 28.6%, a figure that must be tried to reduce, that is why this school prevention program is proposed: Alerta Cannabis. METHODS: The Alerta Cannabis research project consists of design, implementation, and evaluation. In the first phase, a computer-tailored eHealth program (Alerta Cannabis) is developed based on the I-Change Model, an integrated model based on three main behavioral change processes: awareness, motivation, and action. This program consists of four 30-minute sessions that will provide culturally adapted and personalized advice to motivate students not to use cannabis through text feedback, animations, and gamification techniques. This phase will also include usability testing. In the implementation phase, secondary school students from Western Andalusia, Spain (Seville, Cádiz, Huelva, and Córdoba) and Eastern Andalusia (Jaén, Málaga, and Granada) will be randomized to an experimental condition (EC) or a control condition (CC) for a cluster randomized clinical trial (CRCT). Each condition will have 35 classes within 8 schools. GI will receive the online intervention Alerta Cannabis. EC and CC will have to fill out a questionnaire at baseline, six months, and twelve months of follow-up. In the last phase, the effect of Alerta Cannabis is evaluated. The primary outcomes are the lifetime prevalence of cannabis use and its use in the last 30 days and at 6 months. At 12 months of follow-up, the prevalence in the last 12 months will also be assessed. The secondary outcome is the intention to use cannabis. DISCUSSION: The study tests the effect of the innovative program specifically aimed to reduce the use of cannabis in the adolescent population through eHealth in Spain. The findings aim to develop and implement evidence-based cannabis prevention interventions, which could support school prevention, for instance, the assistance of school nurses. If the program proves to be effective, it could be useful to prevent cannabis use on a national and international scale. TRIAL REGISTRATION: NCT05849636. Date of registration: March 16, 2023.

Alcohol use among children and adolescents with chronic pain. Scoping review.

AIM: To examine and map alcohol consumption in children and adolescents with chronic pain (CP). METHOD: A scoping review of international databases (CINAHL, WOS, PubMed, PsycINFO, Scopus, Embase, and MEDLINE) and grey literature was conducted between September 2022 and February 2023. Documents addressing the relationship between alcohol consumption and CP in children and adolescents, published in English and Spanish between 2012 and 2023, were included. Those papers with a population suffering from CP derived from neurodegenerative diseases, chronic infectious diseases or cognitive impairment were excluded. We assessed the level of evidence (LE) and the degree of recommendation (DR) of the studies included in accordance with the Scottish Intercollegiate Guidelines Network. Finally, 11 documents were considered out of the 479 reviewed. RESULTS: The relationship between substance consumption and CP in adolescents is a scarcely investigated topic. While there is a trend towards lower rates of alcohol consumption in youth with pain, there is evidence suggesting an association, particularly in cases of intense pain. The use of various substances, both legal and illegal, for pain management underscores the importance of comprehensively addressing this phenomenon in this population. CONCLUSIONS: Further research is needed to assess the relationship between alcohol consumption in children and adolescents with CP.

Evidence that the domesticated fungus Leucoagaricus gongylophorus recycles its cytoplasmic contents as nutritional rewards to feed its leafcutter ant farmers.

Leafcutter ants farm a fungal cultivar (Leucoagaricus gongylophorus) that converts inedible vegetation into food that sustains colonies with up to millions of workers. Analogous to edible fruits of crops domesticated by humans, L. gongylophorus has evolved specialized nutritional rewards-swollen hyphal cells called gongylidia that package metabolites and are consumed by ant farmers. Yet, little is known about how gongylidia form, and thus how fungal physiology and ant provisioning collectively govern farming performance. We explored the process of gongylidium formation using advanced microscopy to image the cultivar at scales of nanometers, and both in vitro experiments and in silico analyses to examine the mechanisms of gongylidia formation when isolated from ant farmers. We first used transmission electron, fluorescence, and confocal microscopy imaging to see inside hyphal cells. This imaging showed that the cultivar uses a process called autophagy to recycle its own cellular material (e.g. cytosol, mitochondria) and then shuttles the resulting metabolites into a vacuole whose continual expansion displaces other organelles and causes the gongylidium cell's bulging bulb-like appearance. We next used scanning electron microscopy and light microscopy to link this intracellular rearrangement to the external branching patterns of gongylidium cells as they clump together into edible bundles called staphyla. We next confirmed that autophagy plays a critical role in gongylidium formation both: (1) in vitro as gongylidium suppression occurred when isolated fungal cultures were grown on media with autophagy inhibitors, and (2) in silico as differential transcript expression (RNA-seq) analyses showed upregulation of multiple autophagy gene isoforms in gongylidia relative to undifferentiated hyphae. While autophagy is a ubiquitous and often highly derived process across the tree of life, our study reveals a new role for autophagy as a mechanism of functional integration between ant farmers and their fungal crop, and potentially as a signifier of higher-level homeostasis between uniquely life-time committed ectosymbionts.

Adolescents and youths' opinions about the factors associated with cannabis use: a qualitative study based on the I-Change model.

BACKGROUND: To learn about the experiences and opinions of adolescent non-consumers and regular cannabis users about cannabis use and the factors that determine its use, using the I-Change explanatory model as a basis. METHODS: Qualitative methodology with a content analysis was used. Focus groups were conducted with adolescents who were non-regular cannabis users (those who had not tried cannabis or had only experimented with it before) and semi-structured interviews were conducted with adolescent and young adult in recovery who were in a detoxification program. A deductive analysis of the audio-recorded and transcribed interviews was performed, using the domains of the I-Change Model as a reference. RESULTS: Personal problems, social problems or family problems can lead to cannabis use. There was a lack of knowledge and low risk perception about consumption of this drug. There are other factors that influence consumption, the perception of advantages, such as the feeling of freedom and the influence of the peer group. The consumption of this substance in girls is changing, becoming more and more equal to that of boys. The family has an important role to play in preventing drug use. CONCLUSION: Knowledge of these factors is of vital importance as a prior step to the development of efficient intervention measures adjusted to the needs identified and the characteristics of the population.

Evaluating the influence of sleep quality and quantity on glycemic control in adults with type 1 diabetes.

Background: Sleep quality disturbances are frequent in adults with type 1 diabetes. However, the possible influence of sleep problems on glycemic variability has yet to be studied in depth. This study aims to assess the influence of sleep quality on glycemic control. Materials and methods: An observational study of 25 adults with type 1 diabetes, with simultaneous recording, for 14 days, of continuous glucose monitoring (Abbott FreeStyle Libre system) and a sleep study by wrist actigraphy (Fitbit Ionic device). The study analyzes, using artificial intelligence techniques, the relationship between the quality and structure of sleep with time in normo-, hypo-, and hyperglycemia ranges and with glycemic variability. The patients were also studied as a group, comparing patients with good and poor sleep quality. Results: A total of 243 days/nights were analyzed, of which 77% (n = 189) were categorized as poor quality and 33% (n = 54) as good quality. Linear regression methods were used to find a correlation (r =0.8) between the variability of sleep efficiency and the variability of mean blood glucose. With clustering techniques, patients were grouped according to their sleep structure (characterizing this structure by the number of transitions between the different sleep phases). These clusters showed a relationship between time in range and sleep structure. Conclusions: This study suggests that poor sleep quality is associated with lower time in range and greater glycemic variability, so improving sleep quality in patients with type 1 diabetes could improve their glycemic control.

Accelerated Synthesis of Bicyclo[1.1.1]pentylamines: A High-Throughput Approach.

Strained bicyclic substructures such as bicyclo[1.1.1]pentylamines (BCPAs) are increasingly targeted in medicinal chemistry as arylamine bioisosteres. Here, we leverage high-throughput automated synthesis to rapidly develop library-amenable reaction conditions and maximize design space to expand access to BCPAs. This new protocol relies on a copper-mediated C-N coupling approach and uses accessible and bench-stable iodo-BCP building blocks. Its applicability has been exemplified by incorporating BCPs in drug-like compounds, providing straightforward access to a library of valuable aniline-like isosteres.

Cost-effectiveness and cost-utility analyses of a web-based computer-tailored intervention for prevention of binge drinking among Spanish adolescents.

BACKGROUND: Binge drinking (BD) among adolescents is a public health concern worldwide. This study assessed the cost-effectiveness and cost-utility of a web-based computer-tailored intervention to prevent BD in adolescence. METHODS: The sample was drawn from a study evaluating the Alerta Alcohol program. The population consisted of adolescents 15 to 19 years of age. Data were recorded at baseline (January to February 2016) and after 4 months (May to June 2017) and were used to estimate costs and health outcomes, as measured by the number of BD occasions and quality-adjusted life years (QALYs). Incremental cost-effectiveness and cost-utility ratios were calculated from National Health Service (NHS) and societal perspectives and for a time horizon of 4 months. A multivariate deterministic sensitivity analysis of best/worst scenarios by subgroups was used to account for uncertainty. RESULTS: The cost of reducing BD occasions by one per month was €16.63 from the NHS perspective, which from the societal perspective resulted in savings of €7986.37. From the societal perspective, the intervention resulted in an incremental cost of €71.05 per QALY gained from the NHS perspective and this was dominant, resulting in savings of €34,126.64 per QALY gained in comparison with the control group. Subgroup analyses showed that the intervention was dominant for girls from both the perspectives and for individuals 17 years or older from the NHS perspective. CONCLUSIONS: Computer-tailored feedback is a cost-effective way to reduce BD and increase QALYs among adolescents. However, long-term follow-up is needed to evaluate more fully changes in both BD and health-related quality of life.

Impact of the first wave of the COVID-19 pandemic on non-COVID inpatient care in southern Spain.

We assessed the impact of the first wave of COVID-19 pandemic on non-COVID hospital admissions, non-COVID mortality, factors associated with non-COVID mortality, and changes in the profile of non-COVID patients admitted to hospital. We used the Spanish Minimum Basic Data Set with diagnosis grouped according to the Diagnostic Related Groups. A total of 10,594 patients (3% COVID-19; 97% non-COVID) hospitalised during the first wave in 2020 (27-February/07-June) were compared with those hospitalised within the same dates of 2017-2019 (average annual admissions: 14,037). We found a decrease in non-COVID medical (22%) and surgical (33%) hospitalisations and a 25.7% increase in hospital mortality among non-COVID patients during the first pandemic wave compared to pre-pandemic years. During the officially declared sub-period of excess mortality in the area (17-March/20-April, in-hospital non-COVID mortality was even higher (58.7% higher than the pre-pandemic years). Non-COVID patients hospitalised during the first pandemic wave (compared to pre-pandemic years) were older, more frequently men, with longer hospital stay and increased disease severity. Hospitalisation during the first pandemic wave in 2020, compared to hospitalisation during the pre-pandemic years, was an independent risk factor for non-COVID mortality (HR 1.30, 95% CI 1.07-1.57, p = 0.008), reflecting the negative impact of the pandemic on hospitalised patients.

Which factors are associated with cannabis use among adolescents in Andalusia? An application of the I-Change model.

BACKGROUND: Cannabis use is increasing among Andalusian adolescents, causing health, social and financial problems. School nurses visit schools and provide health promotion to adolescents in Andalusia. In order to better tailor health promotion programs, it is important to understand the sociodemographic and motivational factors related to cannabis use in Andalusian adolescents. DESIGN/METHODS: In this cross-sectional study, 369 students (aged 15-18 years) from secondary schools in Andalusia were involved. An anonymous questionnaire based on the I-Change Model was self-administered during school hours. Cannabis users were compared with non-cannabis users regarding sociodemographic and motivational factors. Contingency tables, mean comparison tests, and logistic regression analyses were conducted. RESULTS: The prevalence of cannabis use in the last year was 21.6%. Non-cannabis users had a few positive beliefs toward cannabis use (e.g. the ability to relax or medical benefits), as well as users. Users recognized some disadvantages of cannabis use but played down their importance and mentioned more advantages. Moreover, social influence, especially from peers, plays a critical role in cannabis use. Specific social situations and moods seemed to be special risk factors for cannabis use, such as being at a celebration or feeling good. Results of regression analysis showed that cannabis use is mainly associated with age, low family function, low family affluence, high pocket money, perceiving few disadvantages of cannabis use, much social modeling of cannabis use, social norm and pressure favoring cannabis, low self-efficacy to resist using cannabis and positive intentions to use cannabis. CONCLUSIONS: Based on our results, prevention programmes lead by nurses can be tailored to the factors important to prevent cannabis use, focusing on outlining the disadvantages of cannabis use, alternatives for using cannabis when feeling good, increasing salience of healthy social influences and reinforcing self-efficacy to resist temptations to use cannabis are recommended. CLINICAL RELEVANCE: Nurses need to know the sociodemographic factors and motivations associated with the use of cannabis in adolescents in order to establish effective preventive interventions at school.