To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
OBJECTIVES/GOALS: The objectives are to assess the impact of cumulative grief on the development of Compassion Fatigue (CF) and Burnout Syndrome (BS) in HCPs who care for dying children. We will also evaluate the relationship between CF and cortisol patterns in HCPs. METHODS/STUDY POPULATION: Cross-sectional study to be conducted in a Pediatric Hospital in Puerto Rico. A sample of 50 pediatric nurses will be selected to collect the data to evaluate the occurrence of CF and BS among HCP caring for children during end of life (EoL). Study subjects will include nurses who care for dying children in the Intensive Care Units and Oncology ward. Nurses working in the pediatric ward will be included as the control group. Three validated instruments (Spanish Version) will be administered (Professional Quality of Life vIV, Maslach Burnout Inventory- HSS, briefCOPE scale). Cortisol samples in saliva and hair will also be taken to determine levels in these HCPs. RESULTS/ANTICIPATED RESULTS: Our expected outcome is that CF and BS will be more frequent in HCPs caring for children during EoL compared with controls and that EoL nurses will have higher scores on CF scale and more frequent dysregulated cortisol patterns. DISCUSSION/SIGNIFICANCE OF IMPACT: Understanding how HCPs cope with grief caused by child death and the occurrence of CF and BO in our hispanic population allowing us to develop support strategies based on the specific HCPs needs. This knowledge will help improve HCPs’ well-being and may diminish the physiologic impact on cortisol.
South American countries are important agricultural players worldwide. Pesticides are key components of their production systems and, in some cases, complement environmentally sound systems, such as no-till, which contributes to preserving soil productivity. In this review, presented in the symposium Global Perspective on Herbicides Being Banned during the 2019 Weed Science Society of America meeting, we describe the regulatory framework and current situation of restricted and banned herbicides in South America. We also discuss where the pressure for herbicide bans is coming from and the opportunities for improving herbicide use and public perception. Argentina, Brazil, Colombia, and Uruguay were chosen as representative countries of the region. They all have regulatory systems in place for pesticide registration and reevaluation based on science. Glyphosate, paraquat, and some 2,4-D formulations are in the spotlight. Glyphosate is being reevaluated in Brazil and, although banned within the city limits in some cities in Argentina and Uruguay, it can still be used in agriculture. Paraquat is prohibited for aerial applications in Colombia and is the only herbicide that needs a professional prescription in Uruguay. It was reevaluated in Brazil, resulting in a use-restriction phase in effect until 2020, when it will be permanently banned. Ester formulations of 2,4-D have been banned in Brazil since the early 2000s and have restrictions in some provinces in Argentina, where 2,4-D butyl and isobutyl esters will be prohibited starting April 2021. In Uruguay, atrazine is the only herbicide banned for agricultural use. The regulatory frameworks ensure that herbicides on the market are effective and safe. Reevaluation is an important part of the system and is conducted when there are reasonable concerns. There are opportunities to continue training pesticide handlers and applicators and to communicate the importance of adopting the best management practices where herbicides are part of the production system.
The hazardous environmental conditions hurricanes create might increase injury incidence almost 7 times. Therefore, a cohort study was performed at the Puerto Rico Trauma Hospital to compare morbidity and mortality patterns of patients after Hurricane Maria with a control period.
Admissions from September 20, 2017, through January 20, 2018, constituted the post-Maria period (473 patients); the corresponding months of the previous year comprised the pre-Maria period (439 patients). Comparisons were done using Pearson’s chi-square or Mann-Whitney U-tests, as appropriate. A logistic regression was performed to assess the association between mortality and the study period.
Postlandfall admissions among patients aged 40-64 y increased by 6.6%, while among subjects between ages 18 and 39 y dropped by 7.0% (P = 0.03). Falls, gunshots, and burns were the injury mechanisms that varied the most across the exposure period. The median Injury Severity Score (13 vs 12; P = 0.05) and the frequency of Glasgow Coma Scale scores ≤8 (17.1% vs 10.9%; P = 0.03) were higher among poststorm patients. Moreover, a 2-fold (odds ratio = 1.93; 95% CI: 1.07-3.47) increase in mortality was observed after Maria, when adjusting for covariates.
Following a hurricane, trauma centers might expect an older population, with more severe injuries and a 2-fold increased mortality risk.
The aim of this study was to identify risk factors in early postpartum that predict postpartum depression (PPD) at 6-8 weeks.
A prospective cohort of 309 women was studied between the 2nd-3rd days postpartum and at 6-8 weeks postpartum. Initially we administered a general information questionnaire that included obstetrical variables and history of personal and family affective disorders. Between the 2nd and 3rd days postpartum they filled out the Spanish version of the Edinburgh Postnatal Depression Scale (EPDS), Spielberg Anxiety Trait and State Inventory (STAI-R/S), Neuroticism Dimension (EPQ), St Paul Ramsey Questionnaire (life events) and Duke Social Support Scale. At 6-8 weeks postpartum they filled out again the EPDS. Women who scored ≥10 were screened as having PPD.
The incidence of PPD at 6-8 weeks was 14.6%. After Bonferroni correction, univariated analysis showed that previous personal history of depression (p<0.001), high neuroticism (p<0.001), low social support (p<0.002) and high EPDS (p<0.001) in the immediate postpartum were associated with PPD. Logistical regression analysis identified previous personal history of depression and high initial level of depression (OR=14.6; 95%CI=4.8-12.2; p<0.001) as risk factors for PPD. The absence of signification of the Hosmer-Lemersshow test (x2 =9.654; df=8; p=0.290) indicated the goodness-of-fit of the prediction model.
A previous history of depression and EPDS≥10 in the immediate postpartum allow to identify women with high risk of PPD before leaving the Obstetric Ward.
This study has been supported in part by grants: Instituto Carlos III: GO3/184; FIS: PI041783 and FIS 05/2565.
To examine whether the postpartum depression (PPD) subgroup with positive antithyroid antibodies (Ab+) compared with the PPD subgroup without positive presence of Ab (Ab -) have a different psycho-social and psychopathological characteristics.
One hundred three (N=103) patients with PPD according with DSM-IV criteria were included. Autoimmune status of the thyroid (Thyroperoxidasa antibodies, Thyroglobulin antibodies), severity of depression and anxiety (EPDS and 21-item Hamilton and STAI-S scales), psychosocial variables (Early Trauma Inventory, Saint Paul Ramsey Questionnaire, Marital Adjustment Test) were assessed joint with other several demographics and reproductive variables.
The presence of childhood sexual abuse in PPD women increase the probability of Ab(+) (OR= 2,528 ; 95% CI =1,00-6,39). The levels of Thyroid peroxidase antibodies (TPOAb) titers have a strongly correlation (p<0,000) with the levels of the Early Trauma Inventory.
The results of our study give a link between early stress, the immune system, and postpartum depression.The implication of the immunitary system in the etiopathogenesis of the PPD through the long lasting sensitization of the inflammatory response system and the endocrine system in front to stress behind the CNS and their transmisors and receptors activation is discussed.
To design a scale to measure perceived reasons to stay in violent partner relationships, and to carry out a preliminar analysis of its psychometric properties.
A 44 dicotomic items (true/false) self-report scale was designed (more a last open response question), elaborated according to published studies and open interviews with battered women. The questionnaire was administered to a pilot sample of 10 women to test its viability and comprehensibility. The questionnaire was then administered to a sample of 132 battered women. Exploratory factorial analysis was used to establish the underlying empirical structure. Internal consistency was calculated by mean of Cronbach's alfa coefficient.
The factor analysis identified two empirical factors: external factor (situational factor) and internal factor (psychological factors). Cronbach's alphas were 0.856 and 0.811, respectively.
The Block Escape in Intimate Partner Violence Scale is a reliable and easily comprehensible instrument mesuring percibed reasons of permanence with the aggressor. Its usefulness in both setting, clinical and social, will allow design with great effectiveness intervention strategies suitable for each case.
This study was supported in part by grant-58/05 from the Ministerio de Trabajo y Asuntos Sociales. Instituto de la Mujer.
To examine the postpartum thyroid dysfunction (PPTD) and positive thyroid antibodies (Ab+) frequency in the Postpartum Depression (PPD) and to investigate if the PPD patients subgroup with PPTD and/or Ab+ have different characteristics.
Eighty one (N=81) patients with PPD, according with DSM-IV criteria, were included. Thyroid function (Free T3, Free T4,TSH), autoimmune status of the thyroid (Thyroperoxidasa antibodies, Thyroglobulin antibodies) and severity of depression (EPDS and 21-item Hamilton scales), were assessed joint with other several demographics, psycho-social and reproductive variables.
Twenty per cent of the patients with PPD had positive thyroid antibodies and 14% present PPTD. Prior history of early stressors in the PPD patients were significantly related with the presence of Ab+: the presence of childhood maltreatments and/or sexual abuse increased thirteen times the probability of Ab+ (OR: 13,01, 95% CI, 2.01-84.02). Greater number of total stressors were associated with Ab+ (p< 0,030), and Ab+ women showed a higher average of total stressors (2,1) than antibody negative women (1,52). Depressed women with PPTD had positive correlation with previous depressive episodes (p< 0,008).
The depressed postpartum women with dysregulation of pituitary-thyroid axis have more early childhood stressors and previous depressive episode. The implication of the inmunitary system and the HPT axis in the etiopathogenesis of the PPD through the activation of the response in front to stress is discussed.
There is no empirical research on the occurrence of postnatal psychiatric morbidity in Spanish population. To determine the prevalence rate of DSM-IV psychiatric disorders in postpartum Spanish mothers.
A two-phase cross-sectional epidemiological study. Women consecutively attending in the routine postnatal check-up (at six weeks after delivery) in the Department of Obstetric and Gynaecology of the Clinic Hospital during one year were included. In the first phase, 1453 women were screened with the EPDS. In the second phase, based upon EPDS outcomes, participants were stratified and randomly selected within each stratum for clinical evaluation with the Structured Clinical Interview (SCID) for DSM-IV to determine psychiatric status. Weighted prevalence and its 95% Confidence Intervals (95%CI) were obtained for DSM-IV diagnostic groups.
The overall 6-weeks prevalence rate for postpartum psychiatric disorders was 18.1% (95% CI 15.0-21.8). The most prevalent DSM-IV diagnostic group was mood disorders (9.8%; 95% CI 7.9-12.1), follow-up by adjustment disorders group (4.3%; 95% CI 3.0-6.3), anxiety diagnostic group (3.9%; 95% CI 2.5-5.8) and “other” disorders group (1.1%; 95% CI: 0.3-3.8%).
This results shows the heterogeneity of postnatal psychiatric morbidity. We found that DSM-IV diagnosis of mood disorders in postpartum women were more prevalent than anxiety disorders, in contrast with recent studies in postnatal community women. Clinical and research evaluation of mental health in postpartum women should include a full range of mental disorders.
This study has been supported in part by grant 13/00 from Ministery of Work and Social Affairs, Institute of Women, Spain.
Pharmacologic treatment of mood disorders reduces morbidity of depressive disorders and improves quality of life. Not all patients benefit from treatment. Close to 30% to 40% does not improve enough to the first antidepressant they receive. Many factors are assumed to contribute to this. In the last years it has been studied genetic factors predisposing to drug response or side effects in mood disorders. The efficacy of antidepressant action has been associated to several polymorphisms located in candidate genes related to serotonin pathway.
The prevalence of major depression occurring in the postpartum (PPD) is estimated at 4%-6% and results in considerable morbidity for women, their infants and families. The period of higher risk of PPD appear to occur close to the time of birth between 8 to 24 weeks. It seems that PPD episode is severe and longer than episodes outside this period of life. Initial results showed that women with PPD experienced fewer episodes during illness course compared to non postpartum women and less comorbidity with personality disorders.
We presented preliminary socio-demographic, clinical and genetic data (5-HTTLPPR polymorphism) of a case control studied of women with PPD naturalist treated with SSRI visited at the Perinatal Psychiatric Unit. All women were diagnosed by a DSM-IV structured interview and assessed for personality traits. Therapeutical SSRI response was evaluated by the Edinburgh Postnatal Depression Scale and the Hamilton rating Scale for depression at baseline, 8 weeks and 24 weeks of treatment.
This project is funded in part by Marató-TV3, GO3/184, and FIS-05/2565.
Substance use in pregnancy is an increasingly common problem and become an important public health issue.
To determine the obstetric and perinatal outcomes of self-reported substance use (licit and illicit drugs) during pregnancy in Spanish women sample.
An observational, longitudinal cohort study of 309 Spanish Caucasian women and her newborn child. Psychiatric disorders during pregnancy and neonatal death were excluded. After written informed consent,women and newborn were evaluated at 2nd-day postpartum. Variables included: socio-demographic, obstetric, mothers'psychiatric condition, self-reported substance use, perinatal outcomes.
Sixty-six percent of women reported substance use during pregnancy: 59% caffeine, 26% tobacco, 9% alcohol, and 1% cannabis. Incidence of poor outcomes: Apgar scores <8 at 5 minutes after birth (Apgar5) 9.3% (N=29), gestational age at delivery <37 weeks 4.8% (N=15), birth weight <2.5 kg 7.2%(N=22), congenital malformations 2.9%(N=9). Women with newborn who had Apgar5 <8 have consumed more tobacco (271/124 cigarettes;p=0.004) and caffeine (47/32;p=0.051) in the last month of pregnancy than those with Apgar5 ≥8. Logistic regression analysis showed that the risk of Apgar5 <8 was 18.5 times greater (OR=6.001;95%CI=2.009-170.903) in women with lower educational level comparing with women with higher educational level.
The dose of tobacco and caffeine used during the last month of pregnancy are associated with poor outcome (Apgar5<8) in a sample of women of general population.These results need to be tested in a bigger sample.
This work has been done in part with Grants: Instituto Carlos III: GO3/184; FIS: PI041783.
Although perfectionism has generally been associated with depressive illness in general, there are no studies on its role in major depression in the postnatal period. The aim of the present study was to explore the relationship between perfectionism and major postpartum depression.
In this case-control study, we compared the differences in perfectionism dimensions between 122 women with major postpartum depression (SCID-I; DSM-IV) and 115 healthy postpartum women. The Frost Multidimensional Perfectionism Scale (FMPS) was used to assess perfectionism. Other variables were also considered: Socio-demographic and obstetric data, psychiatric history, other personality traits, social support, life events and genotype combinations according to serotonin transporter expression (5-HTTLPR and Stin2 VNTR polymorphisms).
Multivariate models confirmed perfectionism as an independent factor associated with major postpartum depression. The FMPS dimension concern over mistakes was associated with a 4-fold increase in risk for major postpartum depression (OR = 4.14; 95%CI: 1.24–13.81). Neuroticism, personal psychiatric history and 5-HTT low-expressing genotypes at one of the loci were also identified as independent factors.
Perfectionism, and particularly the concern over mistakes perfectionism dimension, is associated with major postpartum depression. These results highlight the importance of assessing personality traits together with other risk factors to identify women at risk of depression after childbirth.
Effective and safe prescription of individualized opioid-doses for opioid-dependent is a complicated task for the clinician, due inter-individual differences in dosage requirements and narrow therapeutic range.
Mu-opioid receptor gene (OPRM1) plays a key role in addiction. A118G-rs1799971 polymorphism in OPRM1 is probably the most promising biomarker of better response in opioid-dependents.
Gene polymorphisms in CYP450-isoenzymes (CYP3A5, CYP3A4, CYP2D6, CYP2B6, CYP1A2, CYP2C9 and CYP2C19) also significantly influence pharmacokinetics and effects of opioids and concomitant treatments.
Objectives and aims
Association of heroin-dose requirements to OPRM1-rs1799971, CYP3A4-rs2740574 and CYP3A5- rs776746 gene polymorphisms in patients from a Heroin Prescription Program (PPH) in Andalusia.
Series of cases: 15 patients with opioid-addiction. Collection of heroin-doses/patient administered for a year. Genotyping of A118G, CYP3A4 and CYP3A5 polymorphisms was performed by Polymerase Chain Reaction and Restriction Fragment Length Polymorphism.
Eleven patients were AA homozygous (11/15;73.33%) and four heterozygous AG (4/15;26.67%) for A118G-OPRM1; median doses: 179.57[157.85,225.49] and 271.38[145.11,288.88]mg/day respectively were no statistically different (p=0.240). Four subjects presented doses>250mg/day, showing an association of AG-OPRM1 genotype with higher doses, OR:30.00(CI95%:1.41,638.15);p=0.033.
Fourteen patients were homozygous AA and GG for CYP3A4 and CYP3A5 respectively (14/15;93.33%), and one patient was heterozygous AG(1/15;6.66%) for both isoenzymes and presented a high dose(280 mg/day).
Higher heroin-doses (>250mg/day) were associated to AG genotype for OPRM1-A118G, despite the great variability in the dose prescription avoided to find an association between OPRM1 genotype and the specific administered dose.
Pharmacogenetic analysis, focused on OPRM1-A118G, may be a useful tool to adjust the pharmacotherapeutic dose in each case.
Opioid addiction is a serious health/social problem, associated with high morbidity and mortality.Several gene polymorphisms on the mu-opioid receptor gene(OPRM1), which plays an important role in reward system, have been related to opioid dependence (A118G, C17T, C2044A). A118G is the most studied and probably the most promising biomarker of better response in these patients, despite discrepancies has been manifested even in studies conducted on the same ethnicity.
Objectives and aims
Description of A118G, C17T and C2044A allele frequencies in an opioid-dependent population. Evaluation of the association of A118G gene polymorphism with opioid dependence.
Case group: 16 patients with opioid addiction, included in a Heroin Prescription Program in Andalusia, based on the protocolized individual prescription of diacetylmorphine. Control group: 32 non opioid-dependent subjects.Genotyping of A118G, C17T and C2044A was performed by Polymerase Chain Reaction and Restriction Fragment Length Polymorphism.
Case group: 12 patients were AA homozygous (12/16;75%) and 4 patients were heterozygous AG (4/12;25%) for A118G. All patients were homozygous CC for C17T and C2044A (16/16;100%). The distribution of the genotype frequencies of OPRM1 gene polymorphisms in the case series were not statistically different from those reported for European populations in HapMap for A118G (p=0.6418) and the GENO PANEL for C17T. Control group:19 patients were AA homozygous(19/32; 59.4%) and 13 patients were heterozygous AG (13/32;40.6%) for A118G. This polymorphism was not associated to opioid addiction (p=0.3503).
Distribution of genotype frequencies in opioid dependants corresponded to specific frequencies from European population for A118G and C17T polymorphisms. OPRM1 gene polymorphisms were not associated to opioid addiction in this population.
To our knowledge, only one study has assessed the risk of relapse of affective disorders after discontinuation of antidepressants in pregnancy (Cohen et al, 2006). The factors associated with antidepressant discontinuation are unknown.
To describe the factors associated to discontinuation of Selective Serotonin Reuptake Inhibitors (SSRI) in pregnant women and the rates of reintroduction of SSRIs throughout pregnancy.
A transversal study was conducted at the Perinatal Psychiatry Program. Total sample was composed by 201 pregnant women with depressive or anxiety disorder (DSM-IV criteria) who received SSRI at the time conception. Clinical and socio-demographic variables were collected at the first visit. Descriptive analysis was performed; categorical variables were compared by using Chi-square statistics or Fisher's exact test and continuous measures were compared by t tests.
Among the 134 women in the sample, 71 (53%) discontinued treatment with SSRI when they know they are pregnant. Socio-demographic and clinical characteristics did not differ significantly between women who maintain and women who discontinued treatment. Only unplanned pregnancy was associated with major risk of discontinuation treatment (OR 2.86, IC95 1.4–5.7). Also, women who discontinued medication had higher scores on EPDS and STAI (p < .05).
Nearly 58% (n = 41) of women who discontinued SSRI reintroduced antidepressant therapy during pregnancy, most of them between first and second trimester.
Unplanned pregnancy was a risk factor for abrupt discontinuation of SSRIs in pregnant women with depressive or anxiety disorder. More than half of pregnant women who discontinued SSRIs reintroduced antidepressant therapy during pregnancy.
A non-pharmacological method to reduce anxiety is “progressive relaxation” (PR). The aim of the method is to reduce mental stress and associated mental processes by means of progressive suppression of muscle tension. The study was addressed to evaluate changes in brain glucose metabolism induced by PR in patients under a stressing state generated by a diagnostic medical intervention. The effect of PR was compared to a dose of sublingual diazepam, with the prediction that both interventions would be associated with a reduction in brain metabolism. Eighty-four oncological patients were assessed with 18F-fluorodeoxyglucose-positron emission tomography. Maps of brain glucose distribution from 28 patients receiving PR were compared with maps from 28 patients receiving sublingual diazepam and with 28 patients with no treatment intervention. Compared to reference control subjects, the PR and diazepam groups showed a statistically significant, bilateral and generalized cortical hypometabolism. Regions showing the most prominent changes were the prefrontal cortex and anterior cingulate cortex. No significant differences were identified in the direct comparison between relaxation technique and sublingual diazepam. Our findings suggest that relaxation induced by a physical/psychological procedure can be as effective as a reference anxiolytic in reducing brain activity during a stressful state.
The consumption of toxic substances often causes agitation, which makes more difficult the pharmacological management of the symptoms.
About one case, a search was performed of the different therapeutic options in the agitation takes place in the context of intoxication.
Thirty-five-year-old male patient diagnosed of dual pathology under treatment since 2003 in our outpatient. The patient shows paranoid schizophrenia disorder due to alcohol, cannabis and cocaine use disorder, summing up different pharmacological treatments with no remission. Whilst the examination is taking place the patient is under alcohol and cannabis effects. His physical and verbal behaviour are aggressive showing psychotic instability. The therapeutic team administers loxapine to its patient.
The inhaled loxapine turned out to be a good alternative in the case given.
Handling agitation when toxics are involved is complex. The new formulation of inhaled loxapine helps to control agitation quickly and it might be a feasible option for this kind of patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
As island ecosystems are among the most critical breeding habitats for seabirds, their protection should enhance population viability for many species. The Peruvian Diving-petrel Pelecanoides garnotii breeds only in Chile and Perú, is an endangered seabird with historically large populations of over 100,000 breeding pairs, but fewer than 1,000 remained in the 1980s and it became the first endangered seabird of the Humboldt Current System. In Chile, they breed on five islands, three of which are legally protected, but only two have a management plan. Between 2010 and 2014, we evaluated the density of nests, burrow occupancy, and colony patch sizes on the islands to estimate the breeding population. The population trend was assessed by compiling historical data available in the literature and several unpublished technical reports. The current breeding population size in Chile was ∼12,500 breeding pairs (95% CI: 10,613–14,676 pairs) that is ∼34% of the breeding pairs reported for Peru (∼36,450 pairs). Choros Island, the only island with adequate protection, accounted for ∼95% of the total breeding population of the Peruvian Diving-petrel in Chile. Historical population trends showed a significant increase in breeding pairs during recent years on Choros Island. It seems that the adequate legal protection of Choros Island is leading to the recovery of Peruvian Diving-petrels, demonstrating that protection of breeding colonies remains an essential strategy for the conservation of endemic seabirds.