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Older subjects are susceptible to develop gambling problems, and researchers have attempted to assess the mechanisms underlying the gambling profile in later life. The objective of this study was to identify the main stressful life events (SLE) across the lifespan which have discriminative capacity for detecting the presence of gambling disorder (GD) in older adults. Data from two independent samples of individuals aged 50+ were analysed: N = 47 patients seeking treatment at a Pathological Gambling Outpatient Unit and N = 361 participants recruited from the general population. Sexual problems (p < 0.001), exposure to domestic violent behaviour (p < 0.001), severe financial problems (p = 0.002), alcohol or drug-related problems (p = 0.004) and extramarital sex (p < 0.001) were related to a higher risk of GD, while getting married (p = 0.005), moving to a new home (p = 0.003) and moving to a new city (p = 0.006) decreased the likelihood of disordered gambling. The accumulated number of SLE was not a predictor of the presence of GD (p = 0.732), but patients who met clinical criteria for GD reported higher concurrence of SLE in time than control individuals (p < 0.001). Empirical research highlights the need to include older age groups in evidence-based policies for gambling prevention, because these individuals are at high risk of onset and/or progression of behavioural addiction-related problems such as GD. The results of this study may be useful for developing reliable screening/diagnostic tools and for planning effective early intervention programmes aimed to reduce the harm related to the onset and evolution of problem gambling in older adults.
Background: Hand hygiene (HH) is the most important measure for preventing healthcare-associated infections. The objective is to gain insight into the evolution of the degree of compliance with recommendations (DCR) on HH and its associated factors in the surgical areas of a tertiary-care hospital. Methods: This observational, cross-sectional study, was repeated over time, with direct observation of the DCR on HH during the daily activity of healthcare workers in surgical areas: general surgery, urology, vascular surgery, traumatology, neurosurgery, thoracic surgery, heart surgery, pediatric surgery, otorhinolaryngology, gynecology and obstetrics, ophthalmology. Over 14 years (from 2005 to 2018), 15,946 HH opportunities were registered, together with different additional variables (age, sex, professional position, surgical area ). The 2 test was used to study the association and the crude, and adjusted odds ratios were used to quantify its magnitude. Results: The DCR on HH in surgical areas was 49.7% (95% CI, 48.9%–50.5%), and in the group of nonsurgical areas it was 53.4% (95% CI, 53.1%–54.1%). The area with the highest degree of compliance was urology (56.7%; 95% CI, 53.9%–59.6%), and the area with the lowest degree of compliance was traumatology (43.3%; 95% CI, 40.4%–46.2%). Some associated factors were the indications after an activity has been performed (58.6%; aOR, 2.7; 95% CI, 2.5–2.9) and the availability of pocket-size alcohol-based disinfectant (63.8%; aOR, 2.4; 95% CI, 2.2–2.5). Conclusions: The DCR on HH in surgical areas is lower than in other hospital areas, and there is still some margin for improvement. We have identified some modifiable factors that have an independent association with HH compliance in surgical areas. Focusing on them will increase compliance with HH with the ultimate goal of reducing healthcare-associated infections.
Background:Pseudomonas aeruginosa, is the third etiologic agent of healthcare associated infections, and the most frequent pathogen in ventilator-associated pneumonia (VAP). In critical care units is associated with high mortality, long hospital stay, and high healthcare-associated costs. We evaluated the effectiveness of filter placement in the water taps in critical care units to prevent the occurrence of healthcare-associated infections (HAIa) by Pseudomonas aeruginosa. Methods: This experimental study was both cross-over and open-label in nature. We included patients admitted for >24 hours in critical care units over 24 months. The study was divided into 4 periods of 6 months each. We divided the study into 2 groups: patients in units with filters and patients in units without filters. We compared the incidence density of P. aeruginosa HAIs (number of cases divided by the number of person days) according the ECDC definition of case criteria between the groups. The 2 test was used, and the magnitude of the association was calculated as a rate ratio with a 95% confidence interval, adjusted using a Poisson regression model. Results: Overall, 1,132 patients were included in the study: 595 in units with water tap filters and 537 in units without water tap filters. HAI incidence among patients in units with water tap filters was 5.3 per 1,000 person days stay; without water tap filters, HAI incidence was 4.7 per 1,000 person days stay (HR, 0.94; 95% CI, 0.47–1.90). Conclusions: The preliminary results of this study indicate a a lower incidence of P. aeruginosa HAIs in units with filters placed in water taps than in units without filters.
Background: Estimating the burden of intestinal colonization with antibiotic-resistant gram-negative bacteria (AR-GNB) is critical to understanding their global epidemiology and spread. We aimed to determine the prevalence of, and risk factors for, intestinal colonization due to AR-GNB in population-based hospital and community settings in Chile. Methods: Between December 2018 and May 2019, we enrolled randomly selected hospitalized adults in 4 tertiary-care public hospitals (Antofagasta, Santiago, Curico and Puerto Montt), and adults residing in a community-based cohort in the rural town of Molina. Following informed consent, we collected rectal swabs and epidemiological information through a standardized questionnaire. Swabs were plated onto MacConkey agar with 2 µg/mL ciprofloxacin or ceftazidime. All recovered morphotypes were identified, and antibiotic susceptibility testing was performed via disk diffusion. The primary outcome was the prevalence of colonization with fluoroquinolone (FQ)- or third-generation cephalosporin (3GC)–resistant GNB. The secondary outcome was the prevalence of colonization with multidrug-resistant (MDR) GNB, defined as GNB resistant to ≥3 antibiotic classes. Categories were not mutually exclusive. Bivariate and multivariate analyses were performed to describe risk factors for colonization with these categories. Results: In total, 775 hospitalized adults and 357 community participants were enrolled, with a median age of 60 years (IQR, 42–72) and 55 years (IQR, 48–62) years, respectively. Among hospitalized participants, the prevalence of colonization with FQ- or 3GC-resistant GNB was 47% (95% CI, 43%–50%) and 41% (95% CI, 38%–45%), respectively, whereas the prevalence of MDR-GNB colonization was 27% (95% CI, 24%–31%). In the community setting, the prevalence of colonization with either FQ-, 3GC-resistant GNB, or MDR-GNB was 40% (95% CI, 34%–45%), 29% (95% CI, 24%– 34%), and 5% (95% CI, 3%–8%), respectively. Independent risk factors for hospital MDR-GNB colonization included the hospital of admission, unit of hospitalization (intensive care units carried the highest risk), in-hospital antimicrobial exposure, comorbidities (Charlson index), and length of stay. In the community setting, recent antibiotic exposure (<3 months) predicted colonization with either FQ- or 3GC-resistant GNB, and alcohol consumption was inversely associated with MDR GNB colonization. Conclusions: A high burden of colonization with AR-GNB was observed in this sample of hospitalized and community-dwelling adults in Chile. The high burden of colonization with GNB resistant to commonly used antibiotics such as FQ and 3GC found in community dwellers, suggests that the community may be a relevant source of antibiotic resistance. Efforts to understand relatedness between resistant strains circulating in the community and the hospital are needed.
This study aims to generate country-specific norms for two episodic memory tasks and a verbal fluency test among middle-aged and older adults using nationally representative data from nine low-, middle-, and high-income countries.
Data from nine countries in Africa, Asia, Europe, and Latin America were analyzed (n = 42,116; aged 50 years or older). Episodic memory was assessed with the word list memory (three trials of immediate recall) and word list recall (delayed recall). Verbal fluency was measured through the animal naming task. Multiple linear regression models with country-specific adjustments for gender, age, education, and residential area were carried out.
Both age and education showed high influence on test performance (i.e. lower cognitive performance with increasing age and decreasing years of education, respectively), while the effect of sex and residential area on cognitive function was neither homogeneous across countries nor across cognitive tasks.
Our study provided sex-, age-, education-, and residential area-specific regression-based norms that were obtained from one of the largest normative study worldwide on verbal recall and fluency tests to date. Findings derived from this study will be especially useful for clinicians and researchers based at countries where cognitive norms are limited.
Motor abnormalities (MAs) are the primary manifestations of schizophrenia. However, the extent to which MAs are related to alterations of subcortical structures remains understudied.
We aimed to investigate the associations of MAs and basal ganglia abnormalities in first-episode psychosis (FEP) and healthy controls. Magnetic resonance imaging was performed on 48 right-handed FEP and 23 age-, gender-, handedness-, and educational attainment-matched controls, to obtain basal ganglia shape analysis, diffusion tensor imaging techniques (fractional anisotropy and mean diffusivity), and relaxometry (R2*) to estimate iron load. A comprehensive motor battery was applied including the assessment of parkinsonism, catatonic signs, and neurological soft signs (NSS). A fully automated model-based segmentation algorithm on 1.5T MRI anatomical images and accurate corregistration of diffusion and T2* volumes and R2* was used.
FEP patients showed significant local atrophic changes in left globus pallidus nucleus regarding controls. Hypertrophic changes in left-side caudate were associated with higher scores in sensory integration, and in right accumbens with tremor subscale. FEP patients showed lower fractional anisotropy measures than controls but no significant differences regarding mean diffusivity and iron load of basal ganglia. However, iron load in left basal ganglia and right accumbens correlated significantly with higher extrapyramidal and motor coordination signs in FEP patients.
Taken together, iron load in left basal ganglia may have a role in the emergence of extrapyramidal signs and NSS of FEP patients and in consequence in the pathophysiology of psychosis.
DSM-5 proposed a new operational system by using the number of fulfilled criteria as an indicator of gambling disorder severity. This method has proven to be controversial among researchers and clinicians alike, due to the lack of studies indicating whether severity, as measured by these criteria, is clinically relevant in terms of treatment outcome. Additionally, numerous studies have highlighted the associations between gambling disorder and impulsivity, though few have examined the impact of impulsivity on long-term treatment outcomes.
In this study, we aimed to assess the predictive value of DSM-5 severity levels on response to cognitive-behavioral therapy (CBT) in a sample of male adults seeking treatment for gambling disorder (n = 398). Furthermore, we explored longitudinal predictors of CBT treatment response at a follow-up, considering UPPS-P impulsivity traits.
Our study failed to identify differences in treatment outcomes between patients categorized by DSM-5 severity levels. Higher baseline scores in negative urgency predicted relapse during CBT treatment, and higher levels of sensation seeking were predictive of drop-out from short-term treatment, as well as of drop-out at 24-months.
These noteworthy findings raise questions regarding the clinical utility of DSM-5 severity categories and lend support to the implementation of dimensional approaches for gambling disorder.
Placental function can be modified by maternal obesity affecting the materno-fetal fatty acid transport process. We analyze for the first time the in vivo materno-fetal kinetic transfer of fatty acids (FA) labeled with stable isotopes in control and obese pregnant women.
Materials and Methods:
Labelled FA with similar metabolism (stearic acid: 13C-SA, palmitic acid: 13C-PA and oleic acid: 13C-OA) were orally administered at -4 h, -8 h, and -12 h, respectively prior to elective caesarean section to 10 pregnant women with a body mass index (BMI) > 30 and 10 with BMI 25–30 (control). Placenta, venous and arterial cord blood were collected obtaining a wide range of FA enrichments. A combined experimental and computational modeling analysis was applied.
FA Fractional synthesis rate (FSR) in placenta was 11–12% per hour. No differences were observed between control and normo-lipidemic obese pregnant women. It was not possible to estimate FA FSR in cord blood with this oral bolus dose approach. Computational modelling demonstrated a good fit to the data when all maternal plasma lipid classes were included but not with modelling based only on the non-esterified FA fraction (NEFA). The estimated materno-fetal 13C-FA transfer was around 1%.
Our approach using multiple 13C-FA tracers allowed us to estimated FSR in placental/maternal plasma but not in fetal/maternal compartments. Computational modelling showed a consistent time course of placental 13C-FA transfer and predicted total fetal FA accumulation during the experiment. We conclude that in addition to NEFA in the maternal circulation, maternal plasma VLDL and other lipoproteins are important contributors to placental FA transfer to the fetus.
Fibropapillomatosis (FP) can be an important conservation threat to green sea turtles (Chelonia mydas) due to its widespread distribution and complex aetiology. Thus, understanding the impacts of FP in sea turtle populations is a research priority towards conservation efforts. The body condition index (BCI), based on straight carapace length (SCL) and body mass (BM), is an accurate indicator of body-nutritional condition that can be used in routine green turtle health evaluations. This study aimed to compare BCI in FP-free (N = 369) and FP-affected (N = 518) green turtles from Brazilian feeding areas. Body condition indices were evaluated in terms of the South-west Atlantic Fibropapillomatosis Score – FPSSWA (mild, moderate and severe), study sites (five Brazilian states), origin (intentional capture, fishery, stranding and afloat) and sex (when known). Curved and straight carapace lengths, and body mass were recorded in order to calculate BCI. Statistical analysis revealed significant differences in BCI among green turtles from different study areas (P = 0.02), and lower BCI values in FP-free than in FP-positive individuals (P < 0.0001). With regards to origin, the highest BCI was found in the intentional capture group (N = 245; 1.47 ± 0.16), followed by fishery (N = 180; 1.46 ± 0.20). Analysis according to sex revealed a higher mean BCI among females than males (P < 0.017). This study provides relevant data on the health and nutritional status of green turtles along the Brazilian coast, in important feeding areas for this species.
A 6–18 GHz high-power amplifier (HPA) design in GaN on SiC technology is presented. This power amplifier consists of a two-stage corporate amplifier with two and four transistors, respectively. It has been fabricated on UMS using their 0.25 µm gate length process, GH25. A study of the suitable attachment method and measurement on wafer and on jig are detailed. This HPA exhibits an averaged output power of 39.2 dBm with a mean gain of 11 dB in saturation and a 24.5% maximum power added efficiency in pulse mode operation with a duty cycle of 10% with a 25 µs pulse width.
This study examined (1) the association of dietary energy density from solid (EDS) and solid plus liquids (EDSL) with adiposity and cardiometabolic risk factors (CRF) in children with overweight and obesity, (2) the effect of under-reporting on the mentioned associations and (3) whether the association between ED and body composition and CRF is influenced by levels of physical activity. In a cross-sectional design, 208 overweight and obese children (8–12-year-old; 111 boys) completed two non-consecutive 24 h recalls. ED was calculated using two different approaches: EDS and EDSL. Under-reporters were determined with the Goldberg method. Body composition, anthropometry and fasting blood sample measurements were performed. Moderate to vigorous physical activity (MVPA) was registered with accelerometers (7-d-register). Linear regressions were performed to evaluate the association of ED with the previously mentioned variables. Neither EDS nor EDSL were associated with body composition or CRF. However, when under-reporters were excluded, EDS was positively associated with BMI (P=0·019), body fat percentage (P=0·005), abdominal fat (P=0·008) and fat mass index (P=0·018), while EDSL was positively associated with body fat percentage (P=0·008) and fat mass index (P=0·026). When stratifying the group according to physical activity recommendations, the aforementioned associations were only maintained for non-compliers. Cluster analysis showed that the low-ED and high-MVPA group presented the healthiest profile for all adiposity and CRF. These findings could partly explain inconsistencies in literature, as we found that different ED calculations entail distinct results. Physical activity levels and excluding under-reporters greatly influence the associations between ED and adiposity in children with overweight and obesity.
Leishmaniasis is considered a parasitic disease that still causes serious consequences for mankind, because it presents a high mortality rate worldwide. Considered multi-hosts, the parasites of the genus Leishmania are able of infecting a wide variety of animal species. The dog was considered the main source of infection of visceral leishmaniasis (VL), in the urban area. However, the role of other animal species in the epidemiological cycle of the disease, such as cattle, remains unclear. Therefore, the aim of the present study was to evaluate the occurrence of Leishmania spp. in 100 bovines (Bos taurus) from an area endemic for canine VL, using blood culture and molecular analysis. By the sequencing analysis, one sample showed 100% similarity with Leishmania infantum. The results provide the first case of L. infantum isolation in one bovine from the periurban areas of Bauru, state of São Paulo, Brazil.
Earlier activities on health technology assessment (HTA) started in Spain around 1984, with the creation of a National Advisory Board on HTA, and the development of national and regional HTA organizations in the early 1990s. In 2012, the Spanish Health Ministry established the Spanish Network for Health Technology Assessment of the National Health System (RedETS); funded at national level and including all public HTA organizations at national and regional levels. RedETSis focused on the assessment of nondrug health technologies to inform the revision (approval and funding or disinvestment) of the Benefit Portfolio of the Spanish NHS. In parallel with European Network for Health Technology Assessment (EUnetHTA), RedETS has been setting-up and sharing common procedures and methodological guidelines to ensure effective cooperation and mutual recognition of the scientific and technical production in HTA. The output of RedETS is fifty to sixty annual reports, including the production of full HTA reports, Clinical Practice Guidelines, methodological guidance reports, relative effectiveness assessments, tools to support shared decision making between patients and healthcare professionals, and monitoring studies. The HTA assessments requested by the Regional Health Authorities are the biggest component of the annual RedETS working plan. These assessment needs are identified according to a yearly process and prioritized by a Commission composed of representatives from all Spanish regions with the aid of the PRITEC tool. The objectives of this study are to report and update the normative and organizational state of HTA in Spain; describing noteworthy advances witnessed over the past 10 years, as well as discussing existing challenges.
Since ancient times, lubricants have been used to reduce friction and wear problems of mechanical systems. However, nowadays, there is a constant effort to improve their performance through additives so that they can accomplish properly in this modern world. In that sense, in this study, it was proposed the use of Poly(ε-Caprolactone) (PCL) as a biodegradable additive in Castor oil. The effect that this additive has on the tribological properties of AISI 4140 steel/Al2O3 tribosystem was analyzed. For this purpose, PCL was dissolved in Castor oil at 65 °C for 15 minutes. Later, once the lubricant formulations got into room temperature, friction tests were conducted with a ball-on-disk configuration. Several experiments were systematically carried out in order to study the factors that could influence the performance of the tribological system, for instance: additive concentration, velocity, temperature, and wear track radius. The kinetic friction coefficient was used to analyze the results as an output variable. The parameters in which the best friction behavior was observed were employed again to compare the efficiency of the polymeric additive by profoundly analyzing and comparing the wear response of the system. The PCL additive showed great results by decreasing friction up to 30% compared to the neat Castor oil. Nevertheless, as the opposite effect, this additive increased the steel wear to almost half an order of magnitude. Given the above, this investigation showed that, with further studies, Poly(ε-Caprolactone) could be used as an additive in vegetable oil-based lubricants for the improvement of friction performance.
In this work, the synthesis of starch-clay nanocomposites was carried out. For this purpose, natural starch was extracted from rice grains and it was characterized by structural and spectrophotometric techniques. Afterwards, it was used as the polymer matrix for the synthesis of nanocomposites crosslinked with different agents: glycerol, citric acid (CA) and sodium trimetaphosphate (STMP). As a reinforcement phase, a natural Mexican clay from the Montmorillonite-type (Mt), was employed, which was modified with a cationic surfactant, hexadecyltrimethylammonium bromide (HDTMA-Br), in order to exchange cations, present in the interlaminar spaces of the raw clay mineral with those of the cationic surfactant; thus, changing its nature from hydrophilic to hydrophobic. Characterization, of both natural and organo-modified clays, was carried out by means of scanning electron microscopy (SEM), to determine the change in morphology between these two minerals; X-ray diffraction analysis (XRD), to obtain the crystalline structure of the organo-modified clay and that of the raw clay mineral (Mt). Also, the Fourier transform infrared spectroscopy (FTIR) was employed to determine materials spectra, and their thermal stability was evaluated by means of the thermogravimetric analysis (TGA). On the other hand, the synthesis of these nanocomposites was performed using different crosslinking agents, glycerol, CA or STMP, in order to identify the effect of them into the final properties of these materials.
In the present investigation, biocomposites were synthesized from a polymeric alginate matrix in which the carrot residue and a natural bentonite (ANat / Bio) or an iron-modified clinoptilolite-type zeolite (ZFe / Bio) were supported. Their properties were evaluated adsorbents in contact with aqueous solutions of methylene blue (MB). In the first hour of contact, 46% removal was obtained for the ZFe / Bio biocomposite and 60% for the ANat / Bio biocomposite; reaching 100% removal for the ZFe / Bio biocomposite and 98% for the ANat / Bio biocomposite after 24 hours. The biocomposites were characterized by Scanning Electron Microscopy (SEM) and Fourier Transformed Infrared Spectroscopy (FTIR).
The aim of this piece of research was to study the existence of clusters based on anger, empathy and cortisol and testosterone measures associated with aggressive behavior in school-aged children. The sample group comprised 139 eight-year-old children (80 boys and 59 girls). Aggressive behavior was measured using the Direct and Indirect Aggression Scale. Both psychological and biological variables were used to determine psychobiological profiles. The psychological variables considered were trait anger, measured using the State-Trait Anger Expression Inventory for Children and Adolescents, and empathy, measured using the Empathy Quotient-Child Version. Testosterone and cortisol concentrations were measured through saliva samples and analyzed using an ELISA (Enzyme-linked immunosorbent assay). A Cluster Analysis revealed three clusters which were clearly different as regards their psychological and biological characteristics. The analysis of variance (ANOVA) revealed that the cluster characterized by having higher anger levels, lower empathy levels and higher testosterone and cortisol levels was more aggressive than the other two (p < .0001, η2 = .19). The results indicate that studying psychological and biological variables together may help establish differentiated aggression patterns among children.
Bipolar disorder (BD) and schizophrenia (SZ) are characterized by neurocognitive and functional deficits with marked heterogeneity. It has been suggested that BD with a history of psychotic symptoms (BD-P) could constitute a phenotypically homogeneous subtype characterized by greater neurocognitive and functional impairments, or by a distinct trajectory of such deficits. The aim of this study was to compare the neurocognitive and functional course of euthymic BD-P, euthymic BD patients without a history of psychosis (BD-NP), stabilized patients with schizophrenia and healthy subjects, during a five-year follow-up.
Neurocognitive and psychosocial function was examined in 100 euthymic patients with BD (50 BD-P, 50 BD-NP), 50 stabilized patients with schizophrenia (SZ), and 51 healthy controls (HC) at baseline (T1), and after a 5-year follow-up (T2).
The course of both neurocognitive performance and functional outcome of patients with SZ and BD (BD-P and BD-NP) is stable. The profile of neurocognitive impairment of patients with SZ or BD (BD-P and BD-NP), is similar, with only quantitative differences circumscribed to certain domains, such as working memory. The subgroup of patients with BD-NP does not show functional deterioration.
We have not found evidence of progression in the neurocognitive or psychosocial impairment in any of the three groups of patients, although it cannot be dismissed the possibility of a subset of patients with a progressive course. Other longitudinal studies with larger samples and longer duration are necessary to confirm these findings.
The neurocognitive trajectory in bipolar disorder (BD) is variable, with controversial findings, and most evidence come from cross-sectional studies. We aimed to examine the course of neurocognitive functioning in a sample of euthymic BD patients in comparison with a control group during a 5-year follow-up.
Ninety-nine euthymic bipolar patients and 40 healthy controls were assessed using a comprehensive neurocognitive battery (six neurocognitive domains) at baseline (T1) and then at 5-year follow-up (T2) in a longitudinal study.
No evidence of a progression in neurocognitive dysfunction was found either in cognitive composite index or in any of the neurocognitive domains for the whole cohort. However, there was a negative correlation between number of manic episodes and hospitalisations due to manic episodes and change in neurocognitive composite index (NCI) during the follow-up. Moreover, patients with higher number of manic and hypomanic episodes have a greater decrease in NCI, working memory and visual memory. History of psychotic symptoms was not related to the trajectory of neurocognitive impairment.
Our results suggest that, although the progression of cognitive decline is not a general rule in BD, BD patients who have a greater number of manic or hypomanic episodes may constitute a subgroup characterised by the progression of neurocognitive impairment. Prevention of manic and hypomanic episodes could have a positive impact on the trajectory of cognitive function.