Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline.

Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams.Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations.Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes.Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.

Preventing ICU Subsyndromal Delirium Conversion to Delirium With Low-Dose IV Haloperidol: A Double-Blind, Placebo-Controlled Pilot Study.

OBJECTIVE: To compare the efficacy and safety of scheduled low-dose haloperidol versus placebo for the prevention of delirium (Intensive Care Delirium Screening Checklist ≥ 4) administered to critically ill adults with subsyndromal delirium (Intensive Care Delirium Screening Checklist = 1-3). DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Three 10-bed ICUs (two medical and one surgical) at an academic medical center in the United States. PATIENTS: Sixty-eight mechanically ventilated patients with subsyndromal delirium without complicating neurologic conditions, cardiac surgery, or requiring deep sedation. INTERVENTIONS: Patients were randomly assigned to receive IV haloperidol 1 mg or placebo every 6 hours until delirium occurred (Intensive Care Delirium Screening Checklist ≥ 4 with psychiatric confirmation), 10 days of therapy had elapsed, or ICU discharge. MEASUREMENTS AND MAIN RESULTS: Baseline characteristics were similar between the haloperidol (n = 34) and placebo (n = 34) groups. A similar number of patients given haloperidol (12/34 [35%]) and placebo (8/34 [23%]) developed delirium (p = 0.29). Haloperidol use reduced the hours per study day spent agitated (Sedation Agitation Scale ≥ 5) (p = 0.008), but it did not influence the proportion of 12-hour ICU shifts patients spent alive without coma (Sedation Agitation Scale ≤ 2) or delirium (p = 0.36), the time to first delirium occurrence (p = 0.22), nor delirium duration (p = 0.26). Days of mechanical ventilation (p = 0.80), ICU mortality (p = 0.55), and ICU patient disposition (p = 0.22) were similar in the two groups. The proportion of patients who developed corrected QT-interval prolongation (p = 0.16), extrapyramidal symptoms (p = 0.31), excessive sedation (p = 0.31), or new-onset hypotension (p = 1.0) that resulted in study drug discontinuation was comparable between the two groups. CONCLUSIONS: Low-dose scheduled haloperidol, initiated early in the ICU stay, does not prevent delirium and has little therapeutic advantage in mechanically ventilated, critically ill adults with subsyndromal delirium.

Rate of severe exacerbations, healthcare resource utilisation and clinical outcomes in patients with COPD in low-income and middle-income countries: results from the EXACOS International Study.

INTRODUCTION: The EXAcerbations of Chronic obstructive lung disease (COPD) and their OutcomeS (EXACOS) International Study aimed to quantify the rate of severe exacerbations and examine healthcare resource utilisation (HCRU) and clinical outcomes in patients with COPD from low-income and middle-income countries. METHODS: EXACOS International was an observational, cross-sectional study with retrospective data collection from medical records for a period of up to 5 years. Data were collected from 12 countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Guatemala, Hong Kong, Mexico, Panama, Russia and Taiwan. The study population comprised patients ≥40 years of age with COPD. Outcomes/variables included the prevalence of severe exacerbations, the annual rate of severe exacerbations and time between severe exacerbations; change in lung function over time (measured by the forced expiratory volume in 1 s (FEV1)); peripheral blood eosinophil counts (BECs) and the prevalence of comorbidities; treatment patterns; and HCRU. RESULTS: In total, 1702 patients were included in the study. The study population had a mean age of 69.7 years, with 69.4% males, and a mean body mass index of 26.4 kg/m2. The mean annual prevalence of severe exacerbations was 20.1%, and 48.4% of patients experienced ≥1 severe exacerbation during the 5-year study period. As the number of severe exacerbations increased, the interval between successive exacerbations decreased. A statistically significant decrease in mean (SD) FEV1 from baseline to post-baseline was observed in patients with ≥1 severe exacerbation (1.23 (0.51) to 1.13 (0.52) L; p=0.0000). Mean BEC was 0.198 x109 cells/L, with 64.7% of patients having a BEC ≥0.1 x109 cells/L and 21.3% having a BEC ≥0.3 x109 cells/L. The most common comorbidity was hypertension (58.3%). An increasing number of severe exacerbations per year was associated with greater HCRU. DISCUSSION: The findings presented here indicate that effective treatment strategies to prevent severe exacerbations in patients with COPD remain a significant unmet need in low-income and middle-income countries.

Strangulated prolapsed ureterocele in an adult female.

Ureterocele is a cystic dilation of the distal ureter that exits into the urinary bladder. It is a rare condition in adults of which women are the most affected. Its clinical manifestations are very broad and among them the presence of a vulvar mass and symptoms of urinary obstruction stand out. We report the case of a strangulated ureterocele prolapse in a 54-year-old woman with a vulvar mass and signs of urinary obstruction. Initial management with reduction of the mass and finally decided to perform a ureteral reimplantation. Favorable evolution in medical follow-up.

Populism in Peru: Populist attitudes and perception of the populist offer and its relationship with political cynicism and attitudes toward democracy.

Populism is a phenomenon that is gaining attention in Political Psychology. The goal of the current study was to determine the relationship between populist attitudes, based on the populist demand and the perception of the populist offer, and several indices of political cynicism and attitudes toward democracy in Peru. To do this, a quantitative correlational study including 391 participants from diverse Peruvian locations was carried out. Both populist attitudes and critical perception of the populist offer are found to be directly related to Political Cynicism in its dimensions of Political Distrust, Political Hopelessness, and Political Moral Laxity, and inversely related to the dimension of Political System Change. Similarly, both dimensions of populism are directly related to Democratic Support and inversely related to Democratic Satisfaction. The findings support the notion that populist attitudes emerge in the context of distrust of the system and express an ambivalent relationship with democracy. Furthermore, the various approaches developed by the social sciences to address the populist phenomenon are discussed in terms of their strengths and limitations.

Impact of a Novel Social Work Program on Access to Tertiary Care.

Background: In the movement for global health equity, increased research and funding have not yet addressed a shortage of evidence on effectively implementing context-specific interventions; one unmet need is facilitating access to specialty care within the public health sector in Mexico. Compañeros en Salud has been piloting a novel program, called Right to Healthcare (RTHC), to increase access to specialty care for the rural poor in Chiapas, Mexico. The RTHC program incorporates social work, patient navigation, referrals, direct economic support, and accompaniment for patients. Objectives: This study evaluates the effectiveness of the RTHC program. Primary outcomes analyzed included acceptance of any referral and attendance of any appointment. Secondary outcomes included acceptance of the first referral and rate of appointment attendance for patients with an accepted referral. Methods: Using referral process data for the years 2014 to 2019 from a public tertiary care hospital in Chiapas, 91 RTHC patients were matched using 2:1 optimal pair matching with a control cohort balancing covariates of patient age, sex, specialty referred to, level of referring hospital, and municipality. Findings: RTHC patients were more likely to have had an accepted referral (OR 17.42, 95% CI 3.68 to 414.16) and to have attended an appointment (OR 5.49, 95% CI 2.93 to 11.60) compared to the matched control group. RTHC patients were also more likely to have had their first referral accepted (OR 2.78, 95% CI 1.29 to 6.73). Among patients with an accepted referral, RTHC patients were more likely to have attended an appointment (OR 3.86, 95% CI 1.90 to 8.57). Conclusions: The results demonstrate that the RTHC model is successful in increasing access to specialty care by both increasing referral acceptance and appointment attendance.

Prevalence of Mental Health and Social Connection among Patients Seeking Tobacco Dependence Management: A Pilot Study.

INTRODUCTION: with regards to tobacco dependence management, there are certain barriers to successful smoking cessation for patients, such as untreated anxiety and depression. Complicating the impact of mental health morbidities on tobacco dependence may be the significant portion of patients whose mental health issues and limited social connections are undiagnosed and unaddressed. We hypothesize that patients with no prior mental health diagnoses who are treated for tobacco dependence have high rates of undiagnosed mental health morbidities. METHODS: patients were recruited from a tobacco treatment clinic in 2021. Every patient who came for an inaugural visit without a prior diagnosis of mental health disease was screened for depression, anxiety, social isolation and loneliness. Sociodemographic variables were collected. RESULTS: over a 12-month period, 114 patients were seen at the tobacco treatment clinic. Of these 114 patients, 77 (67.5%) did not have a prior diagnosis of a mental health disease. The mean age was 54.3 ± 11.2 years, 52 (67.5%) were females, and 64 (83.1%) were Black/African American. The mean age of starting smoking was 19.3 ± 5.2 years, and 43 (55.8%) had never attempted to quit smoking in the past. With regards to mental health screening, 32 (41.6%) patients had a score of 9 or greater on the Patient Health Questionnaire (PHQ) 9, 59 (76.6%) had a score of 7 or greater on the Generalized Anxiety Disorder (GAD) 7, 67 (87.0%) were identified with social isolation and 70 (90.1%) for loneliness on screening. CONCLUSION: there was a high prevalence of undiagnosed mental health morbidities and social disconnection in patients who were actively smoking and were struggling to achieve smoking cessation. While a larger scale study is necessary to reaffirm these results, screening for mental health morbidities and social disconnection may be warranted in order to provide effective tobacco dependence management.

Actions to reduce carbon footprint in materials to healthcare buildings.

Building sector is a major contributor to the emissions of pollutant gases, which are responsible for health-damaging effects of climate change. To quantify and reduce these emissions. This comparative study is presented between two buildings that could have a sanitary or any other type of use. Both buildings have similar characteristics, except for their structures, one made of metal and the other of concrete. The design, structural calculation and three-dimensional dimensioning were performed using Building Information Modeling (BIM). The budget and the product carbon footprint study were also carried out, to calculate the level of emissions of each building. The study determined higher emissions for the metal-structured building, with 621.234 tCO2/tmaterial compared to 446.707 tCO2/tmaterial for the concrete building. To reduce these emissions, measures related to the replacement of the previously selected materials, by other materials with lower emission rates and identical functionality were presented, such as the replacement of metal building roof polyurethane, or the composition of cement for the concrete building. Both actions represented a reduction of 84.61% CO2 emissions for metal envelope building and 31.765% for the concrete structure. The results of this work will help to select more sustainable materials to use in the renovation of existing buildings, or in the construction of new buildings. For example, health-related buildings, currently in high demand, given the current pandemic situation caused by COVID-19.

Optical study to identify and quantify capsaicin in optical window.

Capsaicin is an active compound in hot peppers. It has been studied for its health benefits for humans. Optical spectroscopy is an important tool for determining the optical properties or chemical composition of matter. The aim of this research is proposing an optical method to identify and quantify capsaicin in the visible range. To achieve this goal, we combined absorption and diffuse reflectance spectroscopy techniques to compute the extinction coefficient. Moreover, the concentration of the analytes was determined using the optical properties of capsaicin. Our method is a promising tool for developing a classification of capsaicin according to its percentage in chilies. The extinction coefficients are reported for 507nm and 663nm, which are the most significative. In addition, the coefficients to build the mathematical model for capsaicin are reported for Kubelka-Munk model. Finally, a comparison between capsaicin vs chilies spectra was obtained to identify spectral response. Diffuse reflectance signals allowed the identification of capsaicin and opened the possibility of this fast and easy to do method for classification and quantification of bioactive compounds.

An Exploratory Data Analysis on the Influence of Role Rotation in a Small-Sided Game on Young Soccer Players.

The aim of the present study was to analyze the behavior of players in a standard small-sided game (SSG) according to the role played (offensive (OF), defensive (DF), and wildcard (W)) and its relationship with physical demands (PHYD), technical performance (TP), and internal load (RPE). A total of 24 young highly trained male soccer players (under 16: n = 12; under 19: n = 12) participated. During the SSG, the players alternated the three roles (OF, DF, and W). The duration of each repetition was 4 min with a passive rest of 3 min between them. Furthermore, it emphasized the high demand in all defensive parameters. In addition, DF roles showed higher values in PHYD and RPE, followed by the OF roles, and finally by the W roles. A complementary, positive moderate correlation was found between PHYD and RPE in the U16 dataset (r = 0.45, p < 0.006). Very large positive correlations were also found between PHYD and RPE in the U19 and merged dataset (r = 0.78, p < 0.001 and r = 0.46, p < 0.63, respectively). This information could be useful for coaches in order to structure the roles in SSGs and control training load.

Effect of a Mobile App on Preoperative Patient Preparation for Major Ambulatory Surgery: Protocol for a Randomized Controlled Trial.

BACKGROUND: Inadequate preoperative patient preparation causes organizational, economic, and emotional problems to patients and professionals. In Spain, no current evidence is available on either the rate of compliance or the impact of good compliance with preoperative recommendations by patients in the ambulatory setting. However, it is known that around 25% of surgical cancellations in the major ambulatory surgery (MAS) are due to poor compliance with these recommendations and, therefore, avoidable. Introducing innovative tools based on mobile health (mHealth) apps may help patients meet the preoperative recommendations and, consequently, reduce the rate of cancellations in the ambulatory setting. OBJECTIVE: The objective of this study was to evaluate the effectiveness of the Listeo+ mHealth app as a tool for improving compliance with preoperative recommendations in MAS versus standard of care (SOC). METHODS: A multicenter, randomized, open-label clinical trial that compares SOC with the additional use of Listeo+, a specific mHealth app for MAS preoperative patient monitoring, is being conducted. The study will include patients aged ≥18 years with surgical indication for MAS who meet the necessary technological and connectivity requirements. Patients in the control group will receive written preoperative recommendations, while those in the intervention group will additionally use the Listeo+ mHealth app. There will be a competitive recruitment of 790 patients during 6 months in 4 hospitals in Andalusia (Spain) that belong to the National Health System. The primary efficacy outcome is the level of compliance with preoperative recommendations. Secondary outcomes include the rate of cancellations, associated resource consumption, and perceived usability and utility with Listeo+ by participants of the intervention group. Simple randomization 1:1 procedure will be used to allocate patients to each study group. RESULTS: The technological development of Listeo+ and the integration and interoperability of information systems was completed in September 2017. Subsequently, simulation tests were performed with Listeo+, and a pilot study was initiated with real patients that concluded successfully in October 2017. Patient recruitment began in December 2017 in the 4 participating centers. After an intermediate analysis performed 10 months after the start of the recruitment phase, the data collection and cleaning phases are estimated to be completed in April 2019, and the analysis with the final results will be conducted in July 2019. CONCLUSIONS: Progress in the integration and interoperability of information systems represents a major step forward in the field of mHealth. The app will allow health professionals to monitor in real-time patients' preparation and critical preoperative recommendations fulfillment. We expect a reduction in avoidable preoperative cancellations due to a lack of or a poor patient preparation. Self-assessed Web-based questionnaires and focus group will provide important information about the perceived usability and utility of Listeo+ app among patients and health care professionals. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/10938.

New species of the earthworm genus Zapatadrilus (Clitellata, Acanthodrilidae) from northern Mexico.

Three new species of the earthworm genus Zapatadrilus are described from Tamaulipas, Mexico: Zapatadrilus aurelius sp. nov., Zapatadrilus huastecus sp. nov., and Zapatadrilus montezumensis sp. nov. Delimitation of the new species was supported by morphological and molecular (genetic distances) evidence. Diagnostic characters of the three new species include: tubulo-racemose prostates in segments 18 and 20, penial setae absent, typhlosole present and intestine beginning in 17/18. Z. montezumensis sp. nov. is separated by its metandric condition, Z. aurelius sp. nov. by the last hearts in 13 and Z. huastecus sp. nov. by the shape of the spermathecae and patterns of genital markings.

Women's Participation in a Postconflict Community in Peru.

The impact of the internal armed conflict in Peru (1980-2000) was felt in many regions in this South American country, and especially in rural regions such as the Southern Andean province of Cotabambas in the Apurímac department. This article describes and analyzes the actions and results of a community mental health project in this area that aimed to address the conflict's aftermath. The intervention used participatory strategies to identify the communities' prioritized problems, established actions appropriate to the cultural characteristics of the population, and implemented creative and recreational initiatives that responded to communities' needs. Based on democratic dialogue, horizontal relations, and reciprocity, the targeted communities became protagonists in the process of psychosocial transformation that fostered individual and collective exercise of rights, individual human development, and democratic community building.

Incidentes críticos de violencia urbana vinculados al radicalismo islamista en España: simulación y análisis de un escenario / Critical incidents of urban violence linked to Islamist radicalism in Spain: simulation and analysis of a scenario

La amenaza del radicalismo islamista y del terrorismo derivado ideológicamente se han convertido en problemas estructurales que van a perdurar en los próximos años, sin visos de tener una solución a corto plazo. En el contexto de la Unión Europea, y en España en particular, existen indicadores que hacer pensar en la posibilidad de que en un futuro próximo se intensifiquen los incidentes críticos de violencia urbana anclados en un conflicto de identidades culturales interpretadas en clave Islam-Occidente. Este hecho, además de ser negativo para la convivencia y la cohesión social, podría ser aprovechado por las estrategias globales de los movimientos islamistas más extremos. Con el fin de llevar a cabo medidas proactivas que minimicen la polarización social y la radicalización de la ciudadanía, se simula un escenario a modo de hipótesis plausible y se evalúa desde una perspectiva psicosocial mediante un análisis DAFO (debilidades, amenazas, fortalezas y oportunidades). Se concluye respondiendo a algunas preguntas que pueden considerarse de utilidad para la toma de decisiones de los responsables políticos y con unas líneas estratégicas básicas desde un punto de vista de la gestión de la seguridad pública.

The threat of Islamist radicalism and terrorism derived ideologically have become structural problems that will endure in the coming years, no sign of having a short term solution. In the context of the European Union, and in Spain in particular, there are indicators that suggest the possibility that in the near future will intensify the critical incidents of urban violence, anchored in Islam-Western cultural identities key conflict are numerous. This fact, in addition to being negative for coexistence and social cohesion could be exploited by the global strategies of the most extreme Islamist movements. In order to carry out proactive measures that minimize social polarization and citizenship radicalization, we simulate a scenario as a plausible hypothesis which is evaluated from a psychosocial perspective using a SWOT analysis (strengths, weaknesses, opportunities and threats). We concluded with the response to some questions that we consider useful for decision-making of policymakers and with a basic strategic lines from a point of view of the management of public security.

Acupuntura con estimulación manual en la cefalea migrañosa / Manual Stimulation Acupuncture in the Migraine

Introducción: la acupuntura es una terapia alternativa en la cefalea migrañosa. Objetivo: comparar la efectividad del tratamiento acupuntural con el farmacológico y conocer cómo se modifica su evolución con la aplicación de la acupuntura. Método: se realizó un estudio cuasiexperimental en 240 pacientes atendidos en consulta de Medicina Tradicional y Natural del Hospital Clínico Quirúrgico Lucia Iñiguez con diagnóstico de migraña desde el 1 de enero de 2010 al 31 de diciembre de 2013. Se dividió a los pacientes en dos grupos, a uno se le realizó tratamiento acupuntural con estimulación manual y al otro tratamiento farmacológico. Se aplicó el test de c2 para identificar si existía asociación entre la evolución buena y la aplicación de la acupuntura. Resultados: la evolución según comienzo del alivio de los síntomas fue buena en el grupo con acupuntura en el 57,5% de los pacientes en comparación con el 25% en el grupo control. En relación con la intensidad del dolor, fue buena en el 55% en el grupo con tratamiento acupuntural contra el 32,5% en el grupo control, y muestra una asociación significativa entre la evolución buena de los pacientes y la aplicación del tratamiento acupuntural, la cual se mostró también en la disminución de los días con cefalea y la mejoría en la calidad de vida de los pacientes. Conclusiones: la aplicación de la acupuntura resultó una terapéutica efectiva en el manejo de estos pacientes.

Introduction: acupuncture is an alternative therapy for migraine headache. Objective: to compare the effectiveness of acupuncture treatment with the drug and to know the evolution changes when using acupuncture. Method: a quasi-experimental study in 240 patients with migraine at Traditional and Natural Medicine Consultation at Lucia Iñiguez Surgical Clinical Hospital, in Holguín, from January 2010 to December 2013 was carried out. The sample was divided into two groups: the first group was treated with the use of acupuncture and the other one with the use of drug treatment. The c2 test was used to identify association between the patients' good evolution and the use of acupuncture. Results: considering the symptom relief, the evolution was good in the group with acupuncture therapy (57.5%) comparing with the control group (25%). The pain intensity was good in 55% in the group with acupuncture treatment against 32.5% in the control group, showing a significant association between good patient outcomes and the application of acupuncture treatment, which was also showed in the decrease headache days and the quality of life improvement in patients. Conclusions: the use of acupuncture was an effective therapy in the management of these patients.

Consultation-liaison psychiatry: how far have we come?

This article takes stock of how far the field of consultation-liaison psychiatry has come since its inception in the 20th century. In order to do this, we review its past in terms of its knowledge base in psychosomatic medicine and in terms of its practice at the bedside in the general hospital setting. We also offer a contemporary account of the field and finish with a subjective view of the opportunities and pitfalls faced during the next phase of consultation-liaison psychiatry in the 21st century.