Exploring correlates of involuntary treatment in substance use disorders: a global systematic review and meta-analysis.

Given the legislative heterogeneity about involuntary treatment and psychoactive substance users, we opted to perform a systematic review and meta-analysis of the correlates of involuntary substance use disorders (SUD) treatment across different countries. We conducted research on the Pubmed database, searching for involuntary SUD treatment data worldwide. The systematic review analysed a total of 36 articles and included a sample of 47,739 patients. Our review highlights the elevated risk of involuntary treatment among male, unmarried individuals with alcohol and/or opioid use disorders. Targeted preventive and therapeutic interventions should focus on addressing the underlying factors contributing to involuntary treatment, such as psychosis, aggressiveness, suicidal ideation, legal problems, and severe social exposure. By targeting these factors and providing comprehensive care, we can strive to improve outcomes and reduce the burden of substance use disorders in this vulnerable population. It is essential to critically examine and understand the factors contributing to the selection of patients for compulsory treatment. By doing so, we can identify potential gaps or inconsistencies in the current processes and work towards ensuring that decisions regarding compulsory treatment are based on sound clinical and ethical principles.

A computational tool for trend analysis and forecast of the COVID-19 pandemic.

PURPOSE: This paper proposes a methodology and a computational tool to study the COVID-19 pandemic throughout the world and to perform a trend analysis to assess its local dynamics. METHODS: Mathematical functions are employed to describe the number of cases and demises in each region and to predict their final numbers, as well as the dates of maximum daily occurrences and the local stabilization date. The model parameters are calibrated using a computational methodology for numerical optimization. Trend analyses are run, allowing to assess the effects of public policies. Easy to interpret metrics over the quality of the fitted curves are provided. Country-wise data from the European Centre for Disease Prevention and Control (ECDC) concerning the daily number of cases and demises around the world are used, as well as detailed data from Johns Hopkins University and from the Brasil.io project describing individually the occurrences in United States counties and in Brazilian states and cities, respectively. U. S. and Brazil were chosen for a more detailed analysis because they are the current focus of the pandemic. RESULTS: Illustrative results for different countries, U. S. counties and Brazilian states and cities are presented and discussed. CONCLUSION: The main contributions of this work lie in (i) a straightforward model of the curves to represent the data, which allows automation of the process without requiring interventions from experts; (ii) an innovative approach for trend analysis, whose results provide important information to support authorities in their decision-making process; and (iii) the developed computational tool, which is freely available and allows the user to quickly update the COVID-19 analyses and forecasts for any country, United States county or Brazilian state or city present in the periodic reports from the authorities.

Cancer risk assessment and source apportionment of the gas- and particulate-phase of the polycyclic aromatic hydrocarbons in a metropolitan region in Brazil.

A risk assessment and a source apportionment of the particulate- and gas-phase PAHs were conducted in a high vehicular traffic and industrialized region in southeastern Brazil. Higher concentrations of PAHs were found during summer, being likely driven by the contributions of PAHs in the vapor phase caused by fire outbreaks during this period. Isomer ratio diagnostic and Principal Component Analysis (PCA) identified four potential sources in the region, in which the Positive Matrix Factorization (PMF) model confirmed and apportioned as gasoline-related (31.8%), diesel-related (25.1%), biomass burning (23.4%), and mixed sources (19.6%). The overall cancer risk had a tolerable value, with ∑CR = 4.6 × 10-5, being ingestion the major via of exposure (64% of the ∑CR), followed by dermal contact (33% of the ∑CR) and inhalation (3%). Mixed sources contributed up to 45% of the overall cancer risk (∑CR), followed by gasoline-related (up to 35%), diesel-related (up to 15%), and biomass burning (up to 10%). The risk assessment for individual PAH species allowed identifying higher CR associated with BaP, DBA, BbF, BaA, and BkF, species associated with gasoline-related and industrial sources. Higher risks were associated with PM2.5-bound PAHs exposure, mainly via ingestion and dermal contact, highlighting the need for measures of mitigation and control of PM2.5 in the region.

Benzodiazepines and Sleep Architecture: A Systematic Review.

BACKGROUND: Insomnia, defined as a difficulty in initiating or maintaining sleep, is a relevant medical issue. Benzodiazepines (BZDs) are commonly prescribed to treat insomnia. Two phases characterize human sleep structure: sleep with Non-Rapid Eye Movement (NREM) and sleep with Rapid Eye Movement (REM). Physiological sleep includes NREM and REM phases in a continuous cycle known as "Sleep Architecture." OBJECTIVE: This systematic review summarizes the studies that have investigated effects of BZDs on Sleep Architecture. METHODS: The articles selection included human clinical trials (in English, Portuguese, or Spanish) only, specifically focused on BZDs effects on sleep architecture. PubMed, BVS, and Google Scholar databases were searched. RESULTS: Findings on BZDs effects on sleep architecture confirm an increase in stage 2 of NREM sleep and a decrease in time of stages 3 and 4 of NREM sleep with a reduction in time of REM sleep during the nocturnal sleep. CONCLUSION: Variations in NREM and REM sleep may lead to deficits in concentration and working memory and weight gain. The increase in stage 2 of NREM sleep may lead to a subjective improvement of sleep quality with no awakenings. BZDz should be prescribed with zeal and professional judgment. These patients should be closely monitored for possible long-term side effects.

Major depressive disorder as a risk factor for suicidal ideation for attendees of educational institutions: a meta-analysis and meta-regression.

OBJECTIVE: This study aimed to analyze the effect of major depressive disorder (MDD) as a risk factor for suicidal ideation in individuals whose ages varied from 11 to 24 years and who were attending educational institutions. DATA SOURCE: A systematic review was carried out by searching in PubMed and Biblioteca Virtual em Saúde (BVS). Original studies conducted in educational institutions, including individuals whose age varied from 11 to 24 years, in English, Spanish, or Portuguese were included. DATA SYNTHESIS: Eight studies were selected for the meta-analysis, including 35,443 youths, with an average age of 16.8 years, predominantly female (51.2%), and from middle-income Asian countries (91.6%). An odds ratio of MDD of 3.89 (95%CI 2.46-6.17) for suicide ideation in youth was found. Subgroup analysis showed higher effects in Asia (OR=4.71; 95%CI 3.22-6.89) than Americas (OR=1.71; 95%CI 1.44-2.03). The meta-regression model indicated that younger adolescents (coef=-0.63; 95%CI 1.09--0.18; p<0.01) and older studies (coef=-0.23; 95%CI 0.039--0.08; p<0.01) presented higher effects of MDD on suicidal ideation. CONCLUSIONS: Early detection and treatment of MDD in youth patients are of utmost importance for preventing suicidal ideation. Educational institutions could play an important role in the early detection and intervention.

A meta-analysis and meta-regression analysis of the global prevalence of obsessive-compulsive personality disorder.

There is a relative dearth of research on Obsessive-Compulsive Personality Disorder (OCPD), even if it has been recognized for over 100 years. Thus, the present study aims to review the worldwide prevalence of OCPD in different populations. The search was conducted employing the PubMed database of the US National Library of Medicine and Biblioteca Virtual em Saúde (BVS) to detect available studies showing OCPD prevalence rates. All the prevalence rates were extracted and aggregated through random-effects models. Meta-regression and sensitivity analyses were performed. The final sample was composed of 46 articles, including 89,264 individuals. We found that OCPD reports a high prevalence rate, with 6.5% (95%CI = 4.3-9.1%), and reaching even higher among psychiatric and clinical patient population. OCPD has presented stable prevalence rates worldwide throughout the past 28 years. There was no gender-related effect, but OCPD prevalence rates may decrease with age increase. There is a need to investigate personality disorders epidemiology based on the recently updated classification systems (i.e., DSM-5 and ICD-11). The present meta-analysis may suggest that the current diagnostic tools may detect OCPD in a cross-sectional assessment but not throughout the life of the person.

COVID-19 Trend Analysis in Mexican States and Cities.

This paper presents a trend analysis of the COVID-19 pandemics in Mexico. The studies were run in a subnational basis because they are more useful that way, providing important information about the pandemic to local authorities. Unlike classic approaches in the literature, the trend analysis presented here is not based on the variations in the number of infections along time, but rather on the predicted value of the final number of infections, which is updated every day employing new data. Results for four states and four cities, selected among the most populated in Mexico, are presented. The model was able to suitably fit the local data for the selected regions under evaluation. Moreover, the trend analysis enabled one to assess the accuracy of the forecasts.

Using Prazosin to Treat Posttraumatic Stress Disorder and Associations: A Systematic Review.

OBJECTIVE: A central adrenergic hyperactivation is described in the neurobiology of posttraumatic stress disorder (PTSD) with probable variable symptomatic impact. Few studies have evaluated using the alpha-1 adrenergic antagonist prazosin for such symptoms; however, given the likely pathophysiology involved, this drug may play an important role in the pharmacological approach to PTSD. METHODS: This study assessed articles already published on the use of prazosin through a systematic review along a timeline in view of the symptomatic target of difficult access by standardized treatments. The impact of using this medication for the general symptoms of PTSD is also discussed. Several databases were searched for articles in the literature on the use of prazosin to treat PTSD. RESULTS: A total of 168 articles were found containing search terms in the title or abstract. Overall, 85 articles met the criteria described, and 48 studies were explored to conduct the present systematic review. Most articles showed some improvement after prazosin administration, especially in relation to sleep symptoms (nightmares and night waking). Only one article demonstrated no improvement after the use of this drug. More randomized studies are needed. CONCLUSION: Several clinical studies demonstrated the relevant role of prazosin for treating PTSD symptoms. Prazosin is an affordable and cost-effective pharmacological option compared to other drugs used to treat PTSD.

Study of the COVID-19 pandemic trending behavior in Israeli cities.

This paper studies the trending behavior of the COVID-19 dynamics in Israeli cities. The model employed is used to describe, for each city, the accumulated number of cases, the number of cases per day, and the predicted final number of cases. The innovative analysis adopted here is based on the daily evolution of the predicted final number of infections, estimated with data available until a given date. The results discussed here are illustrative for six cities in Israel, including Jerusalem and Tel Aviv. They show that the model employed fits well with the observed data and is able to suitably describe the COVID-19 dynamics in a country strongly impacted by the disease that holds one of the most successful vaccination programs in the world.

Benzodiazepinics and the treatment of delirium: a literature review.

OBJECTIVE To discuss the role of the benzodiazepine class in delirium patient management. METHODS Using the PubMed database, articles were reviewed after the year 2000 containing in their title the words 'delirium' and 'benzodiazepines'. DISCUSSION Delirium is an acute confusional state that leads to altered attention, awareness, and cognition. It presents with some well-established risk factors, especially older individuals with cognitive decline. There is currently no definite consensus regarding its pathophysiology, nor regarding pharmacological measures, especially concerning the benzodiazepine class. CONCLUSION Evidence suggests that there may be a role for the use of pharmacological class in the treatment of this condition, indicating a change in the previously paradigmatic pattern of treatment.

A data-driven model to describe and forecast the dynamics of COVID-19 transmission.

This paper proposes a dynamic model to describe and forecast the dynamics of the coronavirus disease COVID-19 transmission. The model is based on an approach previously used to describe the Middle East Respiratory Syndrome (MERS) epidemic. This methodology is used to describe the COVID-19 dynamics in six countries where the pandemic is widely spread, namely China, Italy, Spain, France, Germany, and the USA. For this purpose, data from the European Centre for Disease Prevention and Control (ECDC) are adopted. It is shown how the model can be used to forecast new infection cases and new deceased and how the uncertainties associated to this prediction can be quantified. This approach has the advantage of being relatively simple, grouping in few mathematical parameters the many conditions which affect the spreading of the disease. On the other hand, it requires previous data from the disease transmission in the country, being better suited for regions where the epidemic is not at a very early stage. With the estimated parameters at hand, one can use the model to predict the evolution of the disease, which in turn enables authorities to plan their actions. Moreover, one key advantage is the straightforward interpretation of these parameters and their influence over the evolution of the disease, which enables altering some of them, so that one can evaluate the effect of public policy, such as social distancing. The results presented for the selected countries confirm the accuracy to perform predictions.

Identification of fractional-order transfer functions using exponentially modulated signals with arbitrary excitation waveforms.

This paper proposes a new identification method based on an exponential modulation scheme for the determination of the coefficients and exponents of a fractional-order transfer function. The proposed approach has a broader scope of application compared to a previous method based on step response data, in that it allows for the use of arbitrary input signals. Moreover, it dispenses with the need for repeated simulations during the search for the best fractional exponents, which significantly reduces the computational workload involved in the identification process. Two examples involving measurement noise at the observed system output are presented to illustrate the effectiveness of the proposed method when compared to a conventional output-error optimization approach based on the polytope algorithm. In both examples, the proposed method is found to provide a better trade-off between computational workload and accuracy of the parameter estimates for different realizations of the noise.

Adaptive wavelet EMG compression based on local optimization of filter banks.

This paper presents an adaptive wavelet technique for compression of surface electromyographic signals. The technique employs an optimization algorithm to adjust the wavelet filter bank in order to minimize the distortion of the compressed signal. Orthogonality of the transform is ensured by using a restriction-free parametrization described elsewhere. A case study involving real-life isotonic and isometric electromyographic signals is presented for illustration. The results show that the proposed approach outperforms the standard non-optimized wavelet technique in terms of the percent residual difference for a given compression factor.

Major depressive disorder as a risk factor for suicidal ideation for attendees of educational institutions: a meta-analysis and meta-regression / Transtorno depressivo maior como fator de risco para ideação suicida em alunos de instituições educacionais: uma metanálise e metarregressão

Abstract Objective: This study aimed to analyze the effect of major depressive disorder (MDD) as a risk factor for suicidal ideation in individuals whose ages varied from 11 to 24 years and who were attending educational institutions. Data source: A systematic review was carried out by searching in PubMed and Biblioteca Virtual em Saúde (BVS). Original studies conducted in educational institutions, including individuals whose age varied from 11 to 24 years, in English, Spanish, or Portuguese were included. Data synthesis: Eight studies were selected for the meta-analysis, including 35,443 youths, with an average age of 16.8 years, predominantly female (51.2%), and from middle-income Asian countries (91.6%). An odds ratio of MDD of 3.89 (95%CI 2.46-6.17) for suicide ideation in youth was found. Subgroup analysis showed higher effects in Asia (OR=4.71; 95%CI 3.22-6.89) than Americas (OR=1.71; 95%CI 1.44-2.03). The meta-regression model indicated that younger adolescents (coef=-0.63; 95%CI 1.09--0.18; p<0.01) and older studies (coef=-0.23; 95%CI 0.039--0.08; p<0.01) presented higher effects of MDD on suicidal ideation. Conclusions: Early detection and treatment of MDD in youth patients are of utmost importance for preventing suicidal ideation. Educational institutions could play an important role in the early detection and intervention.

Resumo Objetivo: Analisar o efeito do transtorno depressivo maior (TDM) como fator de risco para a ideação suicida em indivíduos com idades entre 11 e 24 anos que frequentam instituições de ensino. Fontes de dados: Revisão sistemática realizada até agosto de 2020 por meio de buscas nas bases United States National Library of Medicine (PubMed) e Biblioteca Virtual em Saúde (BVS), sem limitações quanto à data de publicação. Síntese dos dados: Oito estudos foram selecionados para a metanálise, incluindo 35.443 jovens com idade média de 16,8 anos, predominantemente do sexo feminino (51,2%) e de países asiáticos de renda média (91,6%). Foi encontrado odds ratio (OR) de TDM de 3,89 (intervalo de confiança — IC95% 2,46-6,17) para a ideação suicida em jovens. A análise de subgrupo mostrou efeitos maiores na Ásia (OR=4,71; IC95% 3,22-6,89) do que nas Américas (OR=1,71; IC95% 1,44-2,03). O modelo de metarregressão demonstrou que adolescentes mais jovens (coef=-0,63; IC95% -1,09--0,18; p＜0,01) e estudos mais antigos (coef=-0,23; IC95% -0,039--0,08; p＜0,01) apresentaram maiores efeitos do TDM sobre a ideação suicida. Conclusões: Observou-se relação entre TDM e ideação suicida no continente asiático, entre adolescentes mais jovens e em estudos mais antigos.

On the Effects of Artificial Feeding on Bee Colony Dynamics: A Mathematical Model.

This paper proposes a new mathematical model to evaluate the effects of artificial feeding on bee colony population dynamics. The proposed model is based on a classical framework and contains differential equations that describe the changes in the number of hive bees, forager bees, and brood cells, as a function of amounts of natural and artificial food. The model includes the following elements to characterize the artificial feeding scenario: a function to model the preference of the bees for natural food over artificial food; parameters to quantify the quality and palatability of artificial diets; a function to account for the efficiency of the foragers in gathering food under different environmental conditions; and a function to represent different approaches used by the beekeeper to feed the hive with artificial food. Simulated results are presented to illustrate the main characteristics of the model and its behavior under different scenarios. The model results are validated with experimental data from the literature involving four different artificial diets. A good match between simulated and experimental results was achieved.

Benzodiazepinics and the treatment of delirium: a literature review

SUMMARY OBJECTIVE To discuss the role of the benzodiazepine class in delirium patient management. METHODS Using the PubMed database, articles were reviewed after the year 2000 containing in their title the words 'delirium' and 'benzodiazepines'. DISCUSSION Delirium is an acute confusional state that leads to altered attention, awareness, and cognition. It presents with some well-established risk factors, especially older individuals with cognitive decline. There is currently no definite consensus regarding its pathophysiology, nor regarding pharmacological measures, especially concerning the benzodiazepine class. CONCLUSION Evidence suggests that there may be a role for the use of pharmacological class in the treatment of this condition, indicating a change in the previously paradigmatic pattern of treatment.

RESUMO OBJETIVO Discutir o papel da classe de benzodiazepínicos no manejo do paciente em delirium. MÉTODOS Utilizando base de dados PubMed, foram revisados artigos posteriores ao ano 2000 contendo em seu título as palavras ''delirium'' e ''benzodiazepines''. DISCUSSÃO O delirium é um estado confusional agudo, que cursa com alteração da atenção, consciência e cognição. Apresenta-se com alguns fatores de risco bem estabelecidos, sobretudo em indivíduos de maior idade e com declínio cognitivo. Não há, atualmente, um consenso definido quanto a sua fisiopatologia, tampouco referente às medidas farmacológicas, principalmente acerca da classe dos benzodiazepínicos. CONCLUSÃO Evidências sugerem que pode haver um papel do uso da classe farmacológica no tratamento do quadro em questão, indicando uma mudança no padrão anteriormente paradigmático do tratamento.

From one side to the other: what is essential? Perception of oncology patients and their caregivers in the beginning of oncology treatment and in palliative care.

OBJECTIVE: To evaluate the perception of oncology patients and their caregivers upon diagnosis and beginning of the therapy and during palliative care. METHODS: A cross-sectional study at the oncology and palliative care outpatients clinics of the Faculdade de Medicina do ABC. Clinical and demographic data from patients and their caregivers were collected and questionnaires regarding the elements considered important in relation to the treatment were applied. RESULTS: We enrolled 32 patients and 23 caregivers that were initiating treatment at the oncology outpatient clinic, as well as 20 patients and 20 caregivers at the palliative care clinic. Regarding the patients treated at the oncology clinic, the issues considered most important were a physician available to discuss the disease and answer questions (84%), trust in the physician (81%), and a physician with accessible language (81%). For their caregivers, the following issues were considered extremely important: trust in the medical team that treats the patients (96%), and the same medical team taking care of their relatives (87%). As to patients treated at the palliative care clinic, trust in the physician (83%), to be with people considered important to them (78%), and to be treated preserving their dignity (72%) were considered extremely important. For their caregivers, to receive adequate information about the disease and the treatment's risks and benefits (84%), and sincere communication of information about the disease (79%) were considered extremely relevant. CONCLUSION: Confidence through good communication and consistency in care were fundamental values to achieve satisfaction among caregivers and patients with cancer during all the course of disease development.

Purified dry extract of Paullinia cupana (guaraná) (PC-18) for chemotherapy-related fatigue in patients with solid tumors: an early discontinuation study.

PURPOSE: Paullinia cupana (guaraná) is an Amazonian plant that has been previously shown to be effective in treating chemotherapy-related fatigue (CRF) in patients with breast cancer. We aimed to evaluate the efficacy of a purified dry extract of P. cupana (PC-18) in patients with various solid tumors treated with chemotherapy. METHODS: We included 40 patients with solid tumors who showed increases in their Brief Fatigue Inventory (BFI) questionnaire scores after 1 week of systemic chemotherapy. PC-18 was administered at 37.5 mg by mouth two times per day (PO bid), starting after 1 week of chemotherapy, for 3 weeks (induction phase). Patients who had an improvement in or stabilization of their BFI scores were randomized to receive either PC-18 at the same dose or placebo for the following 3 weeks (maintenance phase). RESULTS: After PC-18 treatment, the BFI fatigue scores improved or stabilized in 36 out of the 40 patients (mean BFI score difference = 2.503; 95% confidence interval: 1.716-3.375, p = .0002). Three weeks after randomization (16 patients on PC-18 and 17 on placebo), we observed no significant differences in the BFI, Functional Assessment of Chronic Illness Therapy, Hospital Anxiety and Depression Scale, and Pittsburgh Sleep Quality Index scores between patients randomized to PC-18 versus placebo. CONCLUSIONS: We conclude that the PC-18 extract may be effective for the treatment of CRF in patients with a variety of solid tumors. A conditioning effect, which was observed in patients who had a beneficial effect of PC-18 on CRF, may explain the better than expected fatigue scores of the placebo-treated patients.

From one side to the other: what is essential? Perception of oncology patients and their caregivers in the beginning of oncology treatment and in palliative care / De um lado ao outro: o que é essencial? Percepção dos pacientes oncológicos e de seus cuidadores ao iniciar o tratamento oncológico e em cuidados paliativos

Objective To evaluate the perception of oncology patients and their caregivers upon diagnosis and beginning of the therapy and during palliative care. Methods A cross-sectional study at the oncology and palliative care outpatients clinics of the Faculdade de Medicina do ABC. Clinical and demographic data from patients and their caregivers were collected and questionnaires regarding the elements considered important in relation to the treatment were applied. Results We enrolled 32 patients and 23 caregivers that were initiating treatment at the oncology outpatient clinic, as well as 20 patients and 20 caregivers at the palliative care clinic. Regarding the patients treated at the oncology clinic, the issues considered most important were a physician available to discuss the disease and answer questions (84%), trust in the physician (81%), and a physician with accessible language (81%). For their caregivers, the following issues were considered extremely important: trust in the medical team that treats the patients (96%), and the same medical team taking care of their relatives (87%). As to patients treated at the palliative care clinic, trust in the physician (83%), to be with people considered important to them (78%), and to be treated preserving their dignity (72%) were considered extremely important. For their caregivers, to receive adequate information about the disease and the treatment’s risks and benefits (84%), and sincere communication of information about the disease (79%) were considered extremely relevant. Conclusion Confidence through good communication and consistency in care were fundamental values to achieve satisfaction among caregivers and patients with cancer during all the course of disease development. .

Objetivo Avaliar a percepção dos pacientes oncológicos e de seus cuidadores no início da abordagem diagnóstica e terapêutica, e durante os cuidados paliativos. Métodos Estudo transversal, realizado nos ambulatórios de oncologia e cuidados paliativos vinculados a Faculdade de Medicina do ABC. Foram coletados dados clínicos e demográficos de pacientes e de seus cuidadores, e aplicados questionários referentes aos elementos a serem elencados como importantes em relação ao tratamento. Resultados Foram incluídos 32 pacientes e 23 cuidadores que iniciavam o tratamento nos ambulatórios de oncologia, bem como 20 pacientes e 20 cuidadores nos ambulatórios de cuidados paliativos. Em relação aos pacientes do ambulatório de oncologia, os itens considerados mais importantes foram: médico disponível para discutir a doença e responder dúvidas (84%), confiança nos médicos (81%) e médico com linguagem acessível (81%). Para seus cuidadores, os seguintes aspectos foram considerados extremamente importantes: confiança nos médicos que cuidam do paciente (96%) e mesma equipe médica cuidando do seu familiar (87%). Para pacientes do ambulatório de cuidados paliativos, foram considerados extremamente importantes: confiança nos médicos (83%), estar com pessoas consideradas importantes (78%) e ser tratado de modo que preservasse sua dignidade (72%). Para seus cuidadores, foram considerados extremamente importantes: receber informação adequada sobre a doença e os riscos e benefícios do tratamento (84%), e sinceridade na comunicação das informações a respeito da doença (79%). ...