Integrating mental health services into a general hospital in Puerto Rico.

The prevalence of mental health problems in the general population should be carefully considered. The literature has reported a high co-morbidity of medical and mental illnesses; therefore, collaborative efforts incorporating psychological services into medical settings are imperative. In Puerto Rico, this is not a regular practice in general hospitals. Improving access to mental health services is a challenge and requires the creation of new venues within the healthcare system. This paper describes the theoretical framework, mission, and objectives of the Clinical Psychology Services Program (CPSP) implemented at Damas Hospital in Puerto Rico. From December 2002 to December 2010, a total of 13,580 visits were made to inpatients in diverse clinical units of the hospital; 61% of all inpatients evaluated met the criteria for at least one mental health disorder based on the DSM-IV-TR. The CPSP's outcomes highlight the acceptance and relevance of incorporating mental health services and clinical psychologists into general hospitals.

A comparison of albuterol solution nebulized versus albuterol powder given by breath activated metered dose inhaler

The goal of the present study was to compare the efficacy of nebulized vs powdered albuterol in patients with exacerbated bronchial asthma who required hospitalization. From January to May 1990 known asthmatics admitted with acute exacerbation were included by established criteria. Two groups were randomized. Group I for Albuterol powder 200 micrograms inhaled q 4 hours. Group II with Albuterol nebulized solution 2.5 mg inhaled q 4 hrs. Force Vital Capacity and Force Expiratory Volume in one second were measured with a pressure differential transducer upon admission, 30 minutes and 24-hours following therapies. Absolute FEV1 improvement was calculated. Statistical analysis was performed using student's T-Test and Fisher's exact Test with significance established at p > 0.01. Fifteen patients enrolled in both groups, two patients of group I were excluded from the statistic analysis due to refusal to continue with the therapy. Both groups were comparable with respect to sex, asthma exacerbations/year, smoking history and hospital length of stay. FVC and FEV1 were comparable also. In contrast, there were significant difference when the absolute improvement were compared. The mean +/- SE for FEV1 absolute improvement at the first 30 min was 0.42 +/- 0.08 lts for the Group I versus 0.65 +/- 0.6 lts in the Group II. In the next 24 hours, Group I was 0.16 +/- 0.2 lts versus 0.30 +/- 0.7 lts in Group II (p > .01). We conclude that although the dose equivalence of both delivery systems have not been established in our study, the nebulized solution was more effective during the first 24 hours of hospitalization than the dry powder

A comparison of albuterol solution nebulized versus albuterol powder given by breath activated metered dose inhaler.

The goal of the present study was to compare the efficacy of nebulized vs powdered albuterol in patients with exacerbated bronchial asthma who required hospitalization. From January to May 1990 known asthmatics admitted with acute exacerbation were included by established criteria. Two groups were randomized. Group I for Albuterol powder 200 micrograms inhaled q 4 hours. Group II with Albuterol nebulized solution 2.5 mg inhaled q 4 hrs. Force Vital Capacity and Force Expiratory Volume in one second were measured with a pressure differential transducer upon admission, 30 minutes and 24-hours following therapies. Absolute FEV1 improvement was calculated. Statistical analysis was performed using student's T-Test and Fisher's exact Test with significance established at p > 0.01%. Fifteen patients enrolled in both groups, two patients of group I were excluded from the statistic analysis due to refusal to continue with the therapy. Both groups were comparable with respect to sex, asthma exacerbations/year, smoking history and hospital length of stay. FVC and FEV1 were comparable also. In contrast, there were significant difference when the absolute improvement were compared. The mean +/- SE for FEV1 absolute improvement at the first 30 min was 0.42 +/- 0.08 lts for the Group I versus 0.65 +/- 0.6 lts in the Group II. In the next 24 hours, Group I was 0.16 +/- 0.2 lts versus 0.30 +/- 0.7 lts in Group II (p > .01). We conclude that although the dose equivalence of both delivery systems have not been established in our study, the nebulized solution was more effective during the first 24 hours of hospitalization than the dry powder.

Environmental factors precipitating bronchial asthma exacerbations in southern Puerto Rico: a pilot study.

The purpose of the study was to correlate environmental factors that may play a role in triggering asthma attacks requiring admissions. A retrospective analysis of 320 asthmatic admissions from January 1987 to December 1989 was conducted in two community hospitals in our area. Information from the U.S. Weather Bureau pertaining to temperature, barometric pressure, wind velocity, and precipitation was analyzed. The readings from the Puerto Rican Environmental Agency for Total Suspended Particles (TSP-10) during that period were also reviewed. Our results indicate that the female patients accounted for the majority of the asthmatic admissions: 74.3% versus 26% in males. Eighty-four percent of the patients had a history of asthma attacks and 67% had previous hospitalizations due to asthma exacerbations. Correlation between asthma family history and age was found in only two age groups, 31-40 and 71-80 years. Rhinitis and asthma exacerbations were strongly linked only in the age group of 31-40 years. Active cigarette smoking was strongly associated with asthma exacerbations only in the age group of 61-70 years. Environmental data indicated that there was not a consistent pattern of monthly admissions; however, there was a significant association between admissions and increased precipitation, high counts of annual TSP-10, and decreased wind velocity. In view of our findings, asthmatics living on islands such as Puerto Rico might be affected by an additive effect of pollutants, by local and mainland emissions that are transported by the air currents, leading to a higher incidence of asthma exacerbations.