Screening and routine diagnosis of mental disorders among migrants in primary care: A cross-sectional study.

Background: Migrants in host countries are at risk for the development of mental health conditions. The two aims of the study were to describe routine diagnoses of mental disorders among migrant patients at primary healthcare level and the associated risk factors, and to test the utility of an innovative migrant mental health assessment by evaluating whether the health professionals followed the recommendations proposed by the clinical decision support system (CDSS) tool. Methods: A cross-sectional study was carried out in eight primary care centres (PCCs) in four non-randomly selected health regions of Catalonia, Spain from March to December 2018. Routine health data and mental health diagnoses based on the International Classification of Diseases (10th edition), including mental, behavioural and neuro developmental disorders (F01-F99), symptoms and signs involving emotional state (R45), and sleep disorders (G47), were extracted from the electronic health records. The proportion of mental health conditions was estimated and logistic regression models were used to assess any possible association with mental health disorders. The utility of the mental health assessment was assessed with the proportion of questionnaires performed by health professionals for migrants fulfilling the mental health screening criterion (country of origin with an active conflict in 2017) and the diagnoses given to the screened patients. Results: Of 14,130 migrants that visited any of the PCCs during the study period, 7,358 (52.1 %) were women with a median age of 38.0 years-old. There were 520/14,130 (3.7 %) migrant patients diagnosed with a mental disorder, being more frequent among women (342/7,358; 4.7 %, p-value < 0.001), migrants from Latin-America (177/3,483; 5.1 %, p < 0.001) and those who recently arrived in Spain (170/3,672; 4.6 %, p < 0.001). A lower proportion of mental disorders were reported in migrants coming from conflicted countries in 2017 (116/3,669, 3.2 %, p = 0.053).Out of the 547 mental health diagnoses reported in 520 patients, 69/14,130 (0.5 %) were mood disorders, 346/14,130 (2.5 %) anxiety disorders and 127/14,130 (0.9 %) sleeping disorders. Mood disorders were more common in migrants from Eastern Europe (25/2,971; 0.8 %, p < 0.001) and anxiety disorders in migrants from Latin-America (126/3,483; 3.6 %, p < 0.001), while both type of disorders were more often reported in women (p < 0.001).In the adjusted model, women (aOR: 1.5, [95 % CI 1.2-1.8, p < 0.001]), migrants with more than one visit to the health center during the study period (aOR: 4.4, [95 %CI 2.8-6.8, p < 0.001]) and who presented an infectious disease (aOR: 2.1, [95 %CI 1.5-3.1, p < 0.001]) had higher odds of having a mental disorder.Lastly, out of the 1,840 migrants coming from a conflicted country in 2017 who were attended in centres where the CDSS tool was implemented, 29 (1.6 %) had a mental health assessment performed and the tool correctly identified one individual. Conclusions: Mental health is a condition that may be overlooked in migrants at primary healthcare. Interventions at this level of care must be reinforced and adapted to the needs and circumstances of migrants to ensure equity in health services.

Drug-drug interactions in an intensive care unit and comparison of updates in two databases.

OBJECTIVE: Critically ill patients are at increased risk of drug-drug interactions  but their prevalence and clinical relevance remains unclear. The prevalence of  potential drug-drug interactions in an intensive care unit according to  Micromedex Drug-Reax® and Lexi-Interact® databases was studied and the  concordance between the two databases was assessed. In addition, drug-drug  interactions detected in 2013 were compared with those identified in 2018 to  determine updates between these years. METHOD: Between January and June 2013, 152 critical care patients were  prospectively included. Cardiac patients were excluded. Demographic and  clinical data together with the drugs administered on the first calendar day of  intensive care unit admission were recorded. Potential drug-drug interactions  were searched in both Drug-Reax® and Lexi-Interact ® and their prevalence,  level of severity and evidence were compared considering the same sample in  2013 and 2018. RESULTS: In 2013, 1,025 potential drug-drug interactions were identified, corresponding to 438 unique pairs. Lexi-Interact® identified more  interactions (92.8%) than Drug-Reax® (34.0%). The percentage of agreement between databases was 27.4%. The number of interactions  included in both databases increased after the five years but their level of  evidence   decreased. The most common potential drug-drug interactions involved sedatives and analgesics, intentionally prescribed concomitantly. Only two potential drug-drug interactions were classified as contraindicated by both  databases. None of the potential drug-drug interactions identified had a  noticeable clinical impact. Neither did they imply a prescription change. CONCLUSIONS: This study shows that the prevalence of potential drugdrug interactions in the intensive care unit is high, although their clinical relevance is generally low. Our data also show a lack of concordance between Drug-Reax® and Lexi-Interact®, as well as their  updates.

OBJETIVO: Los pacientes críticos presentan un mayor riesgo de interacciones farmacológicas, aunque su prevalencia y relevancia clínica siguen  sin estar claras. En el presente estudio se analizó la prevalencia de  interacciones farmacológicas potenciales en una unidad de cuidados intensivos  mediante las bases de datos Micromedex Drug-Reax® y Lexi-Interact® y se  evaluó la concordancia entre ambas bases de datos. También se compararon  las interacciones farmacológicas detectadas en 2013 con las identificadas en  2018 para evaluar las actualizaciones realizadas durante este periodo de  tiempo. Método: Entre enero y junio de 2013 se incluyeron de forma prospectiva 152  pacientes críticos. Los pacientes cardiacos fueron excluidos. Se registraron los  datos demográficos y clínicos junto con los fármacos administrados durante el  primer día de ingreso en la unidad de cuidados intensivos. Las interacciones se  buscaron tanto en Micromedex Drug-Reax® como en Lexi-Interact® y se  comparó su prevalencia, el nivel de severidad y la evidencia considerando la  misma muestra en 2013 y 2018. Resultados: En 2013 se identificaron 1.025 interacciones farmacológicas potenciales, correspondientes a 438 pares únicos. Lexi- Interact® identificó más interacciones (92,8%) que Drug-Reax® (34,0%). El  porcentaje de concordancia entre las dos bases de datos fue del 27,4%. El  número de interacciones incluidas en ambas bases de datos aumentó durante  los cinco años, pero su nivel de evidencia disminuyó. Las interacciones  farmacológicas potenciales más comunes incluyeron sedantes y analgésicos,  rescritos intencionadamente de forma concomitante. Sólo dos interacciones farmacológicas potenciales fueron clasificadas como contraindicadas por ambas  bases de datos. Ninguna de las interacciones identificadas tuvo un impacto clínico notable ni supuso un cambio de prescripción. CONCLUSIONES: ste estudio muestra que la prevalencia de interacciones farmacológicas potenciales en las unidades de cuidados intensivos es alta,  aunque su relevancia clínica es generalmente baja. Nuestros datos también  muestran la falta de concordancia entre Drug-Reax® y Lexi- Interact®, así  como sus actualizaciones.

Increasing cancer permeability by photodynamic priming: from microenvironment to mechanotransduction signaling.

The dense cancer microenvironment is a significant barrier that limits the penetration of anticancer agents, thereby restraining the efficacy of molecular and nanoscale cancer therapeutics. Developing new strategies to enhance the permeability of cancer tissues is of major interest to overcome treatment resistance. Nonetheless, early strategies based on small molecule inhibitors or matrix-degrading enzymes have led to disappointing clinical outcomes by causing increased chemotherapy toxicity and promoting disease progression. In recent years, photodynamic therapy (PDT) has emerged as a novel approach to increase the permeability of cancer tissues. By producing excessive amounts of reactive oxygen species selectively in the cancer microenvironment, PDT increases the accumulation, penetration depth, and efficacy of chemotherapeutics. Importantly, the increased cancer permeability has not been associated to increased metastasis formation. In this review, we provide novel insights into the mechanisms by which this effect, called photodynamic priming, can increase cancer permeability without promoting cell migration and dissemination. This review demonstrates that PDT oxidizes and degrades extracellular matrix proteins, reduces the capacity of cancer cells to adhere to the altered matrix, and interferes with mechanotransduction pathways that promote cancer cell migration and differentiation. Significant knowledge gaps are identified regarding the involvement of critical signaling pathways, and to which extent these events are influenced by the complicated PDT dosimetry. Addressing these knowledge gaps will be vital to further develop PDT as an adjuvant approach to improve cancer permeability, demonstrate the safety and efficacy of this priming approach, and render more cancer patients eligible to receive life-extending treatments.

Interacciones farmacológicas en una unidadde cuidados intensivos y comparación de lasactualizaciones de dos bases de datos / Drug-drug interactions in an intensive care unit and comparison of updates in two databases

Objetivo: Los pacientes críticos presentan un mayor riesgo de interacciones farmacológicas, aunque su prevalencia y relevancia clínica siguen sinestar claras. En el presente estudio se analizó la prevalencia de interaccionesfarmacológicas potenciales en una unidad de cuidados intensivos mediantelas bases de datos Micromedex Drug-Reax® y Lexi-Interact® y se evaluó laconcordancia entre ambas bases de datos. También se compararon las interacciones farmacológicas detectadas en 2013 con las identificadas en 2018para evaluar las actualizaciones realizadas durante este periodo de tiempo.Método: Entre enero y junio de 2013 se incluyeron de forma prospectiva 152 pacientes críticos. Los pacientes cardiacos fueron excluidos. Seregistraron los datos demográficos y clínicos junto con los fármacos administrados durante el primer día de ingreso en la unidad de cuidados intensivos. Las interacciones se buscaron tanto en Micromedex Drug-Reax®como en Lexi-Interact® y se comparó su prevalencia, el nivel de severidady la evidencia considerando la misma muestra en 2013 y 2018.Resultados: En 2013 se identificaron 1.025 interacciones farmacológicas potenciales, correspondientes a 438 pares únicos. Lexi-Interact® identificó más interacciones (92,8%) que Drug-Reax® (34,0%). El porcentajede concordancia entre las dos bases de datos fue del 27,4%. El número deinteracciones incluidas en ambas bases de datos aumentó durante los cinco años, pero su nivel de evidencia disminuyó. Las interacciones farmacológicas potenciales más comunes incluyeron sedantes y analgésicos, prescritos intencionadamente de forma concomitante. Sólo dos interaccionesfarmacológicas potenciales fueron clasificadas como contraindicadas porambas bases de datos. Ninguna de las interacciones identificadas tuvo unimpacto clínico notable ni supuso un cambio de prescripción. (AU)

Objective: Critically ill patients are at increased risk of drug-druginteractions but their prevalence and clinical relevance remains unclear.The prevalence of potential drug-drug interactions in an intensive careunit according to Micromedex Drug-Reax® and Lexi-Interact® databaseswas studied and the concordance between the two databases wasassessed. In addition, drug-drug interactions detected in 2013 werecompared with those identified in 2018 to determine updates betweenthese years.Method: Between January and June 2013, 152 critical care patientswere prospectively included. Cardiac patients were excluded. Demographic and clinical data together with the drugs administered on the firstcalendar day of intensive care unit admission were recorded. Potentialdrug-drug interactions were searched in both Drug-Reax® and Lexi-Interact® and their prevalence, level of severity and evidence were comparedconsidering the same sample in 2013 and 2018.Results: In 2013, 1,025 potential drug-drug interactions were identified,corresponding to 438 unique pairs. Lexi-Interact® identified more interactions (92.8%) than Drug-Reax® (34.0%). The percentage of agreementbetween databases was 27.4%. The number of interactions included inboth databases increased after the five years but their level of evidence decreased. The most common potential drug-drug interactions involvedsedatives and analgesics, intentionally prescribed concomitantly. Onlytwo potential drug-drug interactions were classified as contraindicated byboth databases. None of the potential drug-drug interactions identifiedhad a noticeable clinical impact. Neither did they imply a prescriptionchange. (AU)

Improving the detection of infectious diseases in at-risk migrants with an innovative integrated multi-infection screening digital decision support tool (IS-MiHealth) in primary care: a pilot cluster-randomized-controlled trial.

BACKGROUND: There are major shortfalls in the identification and screening of at-risk migrant groups. This study aims to evaluate the effectiveness of a new digital tool (IS-MiHealth) integrated into the electronic patient record system of primary care centres in detecting prevalent migrant infections. IS-MiHealth provides targeted recommendations to health professionals for screening multiple infections, including human immunodeficiency virus (HIV), hepatitis B and C, active tuberculosis (TB), Chagas disease, strongyloidiasis and schistosomiasis, based on patient characteristics (including variables of country of origin, age and sex). METHODS: A pragmatic pilot cluster-randomized-controlled trial was deployed from March to December 2018. Eight primary care centres in Catalonia, Spain, were randomly allocated 1:1 to use of the digital tool for screening, or to routine care. The primary outcome was the monthly diagnostic yield of all aggregated infections. Intervention and control sites were compared before and after implementation with respect to their monthly diagnostic yield using regression models. This study is registered on international standard randomised controlled trial number (ISRCTN) (ISRCTN14795012). RESULTS: A total of 15 780 migrants registered across the eight centres had at least one visit during the intervention period (March-December 2018), of which 14 598 (92.51%) fulfilled the criteria to be screened for at least one infection. There were 210 (2.57%) individuals from the intervention group with new diagnoses compared with 113 (1.49%) from the control group [odds ratio: 2.08, 95% confidence interval (CI) 1.63-2.64, P < 0.001]. The intervention centres raised their overall monthly diagnosis rate to 5.80 (95% CI 1.23-10.38, P = 0.013) extra diagnoses compared with the control centres. This monthly increase in diagnosis in intervention centres was also observed if we consider all cases together of HIV, hepatitis B and C, and active TB cases [2.72 (95% CI 0.43-5.00); P = 0.02] and was observed as well for the parasitic infections' group (Chagas disease, strongyloidiasis and schistosomiasis) 2.58 (95% CI 1.60-3.57; P < 0.001). CONCLUSIONS: The IS-MiHealth increased screening rate and diagnostic yield for key infections in migrants in a population-based primary care setting. Further testing and development of this new tool is warranted in larger trials and in other countries.

Drug related problems in clinical practice: a cross-sectional study on their prevalence, risk factors and associated pharmaceutical interventions.

Drug-related problems (DRP) cause preventable negative health outcomes, especially during hospital admissions. The aim of our study was to examine the prevalence and characteristics of DRP in regular clinical pharmacy, as well as to determine those factors associated with a higher risk of DRP in the hospital setting. We analyzed data from a standardized registry database of regular pharmacy practice (2015- 2016). DRP were classified according to the Pharmaceutical Care Network Europe v6.2 classification. Cross-sectional data were obtained from 1602 adults admitted to medical wards. Crude and adjusted binary logistic regressions were performed to identify associations between potential risk factors and DRP. Overall DRP prevalence was high across medical specialties (45,1%), in a population characterized by advanced age, polypharmacy and multimorbidity. Problems leading to DRP were mainly classified into two domains (effectiveness and adverse reactions), being drug and dose selection the most frequent causes. Interventions were accepted and DRP were totally or partially solved in 74.1% and 4.81% of cases, respectively. In the adjusted model polypharmacy, allergies, BMI > 25 kg/m2 and clearance < 30 mL/min were associated with a higher risk of DRP. The participation of clinical pharmacists into multidisciplinary teams promotes the detection and solution of DRP. Polypharmacy, obesity, renal impairment and allergy are associated with a higher risk of DRP during admission.

La construcción del Apego, la cohesión diádica y la comunicación en pacientes con trastornos de la conducta alimentaria / The construction of attachment, dyadic cohesion, and communication in disordered versus non-disordered eating

Este trabajo presenta un estudio en que se comparan tres muestras de participantes(30 pacientes con un trastorno alimentario restrictivo, 30 con un trastorno alimentariocompulsivo y 30 sin trastorno alimentario) en cuanto a su construcción del apego, lacohesión diádica y la comunicación en sus familias. Los tres constructos fueron evaluados mediante una norma de Rejilla de Cosntructos Personales específicamente diseñada para ajustarse a los objetivos del estudio. Ninguno de los dos grupos con trastorno alimentario difirió el grupo control en sus puntuaciones de apego. Sin embargo, las puntuaciones medias del grupo con trastorno alimentario compulsivo fueron significativamente inriores a las del grupo sin trastorno alimentario en las dimensiones de cohesión diádicay comunicación, aunque no en la de apego. En el trabajo se comentan estos resultados en términos de probables patrones diferenciales de negación y evitación de conflictos en ambos subtipos de trastorno alimentario

This paper presents a study comparing three samples of participants (30 patientswith a restrictive eating disorder; 30 with a compulsive eating disorder; and 30 withouteating disorders) in terms of their construction of attachment, dyadic cohesion, andcommunication. The three constructs were assessed by means of a form of Personal Construct Grid specificaclly designed to accomodate our research aims. None of the two eating disordered groups differed from the non-disordered eating group in their scoringof attachment. However, the mean scores of the compulsive eating disorder group were significantly lower than the ones of the non-eating disorder group in dyadic cohesionand communication, but not in attachment. The paper discusses these results in terms of likely differential pattern of conflict denial and avoidance between both subtypes of eating disorder (AU)