Clinical Characteristics of Older Adults Living in Foster Families in the French West Indies: Baseline Screening of the KArukera Study of Aging in Foster Families (KASAF) Cohort.

Background and Objectives: Foster families for older adults could represent a transitional or alternative model to nursing homes. The aim of this study was to describe the clinical characteristics of older adults in foster families and to compare them with those of residents in nursing homes in French West Indies. Research Design and Methods: This study is a cross-sectional analysis of the KArukera Study of Aging in Foster Families (KASAF) cohort. Sociodemographic and clinical characteristics were extracted. Dependency was assessed using the Activities of Daily Living (ADL) scale and cognition using the Mini-Mental State Examination (MMSE) scale. Age, gender, ADL, and MMSE scores were compared with nursing home residents from a twin study of KASAF (n = 332). Results: A total of 107 older adults (mean age 81.8 years; 61.7% women) were recruited in 56 foster families between September 2020 and May 2021. In all, 25.5% had diabetes mellitus and 45.8% suffered from hypertension. The mean MMSE score was 9.3 ± 10.1 and 76.0% had major cognitive impairment (MMSE score <18); 12.5% were diagnosed with Parkinson's disease, and 42.0% of the residents were confined to bed or in a wheelchair, with a mean ADL score of 1.5 ± 1.8. Almost all the residents (96.3%) benefited from a medical follow-up by a nurse who visited once or twice a day. Compared to older adults living in nursing homes, those in foster families were more frequently women (61.7% vs 49.4%) and had lower ADL score (1.5 vs 2.4) and lower MMSE score (9.3 vs 11.3). Discussion and Implications: The clinical profile of foster families' residents was quite similar to that of nursing home residents in terms of demographics, dementia, and dependency. Foster families might represent an interesting strategy to address the unmet clinical and social needs of dependent older adults, especially in countries where nursing homes are not sufficiently developed. Clinical Trials Registration Number: NCT04545775.

Association between Polypharmacy and Hospitalization among Older Adults Admitted to Emergency Departments for Falls in Guadeloupe: A Retrospective Cohort Study.

Introduction: Falls are a common geriatric syndrome in older people. Falls are associated with adverse health events such as dependency, unplanned emergency admissions and death. This study aimed to identify the factors associated with fall severity, such as diabetes, hypertension, heart disease, cognitive decline and polypharmacy, as well as sociodemographic characteristics in patients aged 70 years and over admitted to the emergency department in Guadeloupe. Method: A single-center, observational, retrospective study of patients aged 70 years and over admitted to the emergency department (ED) of the University Hospital of Guadeloupe for a fall between 1 May 2018 and 30 April 2019 was conducted. Fall severity was defined as the need for hospitalization. Bivariate analysis was used to determine the associations between fall severity and sociodemographic characteristics, comorbidities, history of falls and polypharmacy (defined as the daily use of at least five drugs). Polypharmacy was analyzed as a binary variable (>5 drugs daily; yes or no) in categories (0-3 (ref.), 4-6, 7-9 and ≥10 drugs). Results: During the study period, 625 patients who attended the ED for a fall were included. The mean age was 82.6 ± 7.6 years, and 51.2% were women. Of these, 277 patients (44.3%) were admitted to the hospital, and 3 patients (0.5%) died. In the bivariate analysis, only polypharmacy was associated with hospitalization for a fall (OR: 1.63 [95% CI: 1.33-2.02]). The odds ratios for the polypharmacy categories were 1.46 [95% CI 0.99-2.14], 1.65 [1.09-2.50] and 1.48 [0.76-2.85] for 4-6, 7-9 and ≥10 drugs, respectively. Conclusions: Polypharmacy was associated with hospitalization as a proxy for fall severity. A regular review of drug prescriptions is essential to reduce polypharmacy in older adults.

Malnutrition and its determinants among older adults living in foster families in Guadeloupe (French West Indies). A cross-sectional study.

BACKGROUND: Foster families may represent an alternative model for dependent older adults in many countries where nursing homes are insufficiently developed. This study aimed to assess the prevalence of malnutrition and its determinants in older adults living in foster families in Guadeloupe (French West Indies). METHODS: This cross-sectional study was gathered from the KASAF (Karukera Study of Ageing in Foster families) study (n = 107, 41M/66F, Mdn 81.8 years). Nutritional status was assessed with the Mini Nutritional Assessment Short-Form (MNA-SF). Clinical characteristics and scores on geriatric scales (Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL), Short Physical Performance Battery (SPPB), Center for Epidemiologic Studies- Depression (CESD) and Questionnaire Quality of Life Alzheimer's Disease (QoL-AD)) were extracted. Bivariate analysis and logistic models adjusted for age and gender were performed to test the association of nutritional status with socio-demographic variables and geriatric scales. RESULTS: Thirty (28.0%) older adults were malnourished (MNA-SF score ≤7). In bivariate analysis, malnutrition was associated with an increased prevalence of cardiovascular diseases (46.7% versus 19.5%, p = 0.004), the presence of hemiplegia (30.0% versus 6.5%, p = 0.003), a poorer cognitive status (MMSE score 4.7 ± 7.1versus 9.7 ± 10.7; p = 0.031), higher risk of depression (CESD score 27.3 ± 23.0 versus 13.5 ± 14.4; p = 0.035) and dependency (ADL score 1.9 ± 1.9 versus 2.3 ± 2.1; p<0.001). Malnutrition was also associated with lower caregivers'rating of QoL (QoL-AD score 21.8 ± 6.4 versus 26.0 ± 5.7; p = 0.001) but not by older adult's rating (24.1 ± 11.2 versus 28.3 ± 7.7; p = 0.156). Similar associations were observed in logistic models adjusted for age and gender. CONCLUSION: Malnutrition was common among foster families for older adults. Special attention towards the prevention and treatment of malnutrition in older adults from cardiovascular diseases, cognitive impairment, dependency and depression is necessary in this model of dependency support.

A probabilistic approach to compare the risk associated with heavy metals and bromine in honey from Dominican Republic, Mexico, Mozambique and Spain.

This study aims to analyse the risk to consumers given the presence of heavy metals and bromine in honey from different countries. A probabilistic approach was applied to assess carcinogenic risk. Concerning exposure, Al in Spain (3.3E-04 mg/kgBw/day), B in Dominican Republic and Mexico (2E-04 mg/kgBw/day in both cases) and Fe in Mexico and Mozambique had the highest values (5E-05 and 4.8E-05 mg/kgBw/day). In risk characterisation, the values were less than 1 for hazard index (HI), meaning that the consumption of honey represents a low level of concern for non-genotoxic effects. A combination of margin of exposure and probability of exceedance results that exposure to Pb pose no threat. The probability of suffering cancer for Br, Cd, Ni and Pb was lower than 1.0E-06 and, therefore, considered safe. However, the risk at the 95th percentile of Br in Dominican Republic was 1.18E-04 in adults and 2.45E-04 in children, exceeding 1.0E-04, and therefore, considered intolerable. Finally, the sensitivity analysis indicated that the most influential factor in the HI was the consumption in adults and the concentration of Ni in children, whereas for cancer risk, were the concentrations of Ni, Cd, Br and Pb, in both cases.

Carcinoma neuroendocrino de canal anal: presentación de un caso y revisión bibliográfica

Introducción: Los carcinomas neuroendocrinos (NEC) de canal anal son neoplasias extremadamente raras, representando del 1 a 1,6% de la totalidad de los tumores neuroendocrinos (NET). Suelen ser poco diferenciados, muy agresivos y con alta tendencia a metastatizar. Caso clínico: Mujer de 52 años diagnosticada de fisura anal. Durante la esfinterotomía lateral interna (ELI) se evidencia un pólipo milimétrico aparentemente hiperplásico. Biopsia: NEC de alto grado. En el estudio de extensión se observa engrosamiento de la mucosa del canal anal que invade el esfínter interno, sin enfermedad a distancia. Se realiza amputación abdominoperineal laparoscópica donde se objetiva infiltración del tabique rectovaginal, por lo que se realiza resección y vaginoplastia. AP: NEC con estadio PT4B N2A, por lo que se indica quimioterapia adyuvante. Discusión: La presentación clínica de los NEC de canal anal es inespecífica, diferenciándose de otros tumores colorrectales en que hasta el 67% de los pacientes presentan metástasis al diagnóstico, siendo la supervivencia media de 11 meses. Si diagnosticamos un NEC localizado de forma incidental, es fundamental la celeridad en su tratamiento, dada su agresividad.

Introduction: Neuroendocrine carcinomas (NEC) of the anal canal are extremely rare neoplasms, representing 1 to 1.6% of all neuroendocrine tumors (NET). They are usually poorly differentiated, very aggressive and with a high tendency to metastasize. Clinical case: A 52-year-old woman diagnosed with anal fissure. During the LIS, an apparently hyperplastic millimetric polyp is evidenced. Biopsy: high-grade NEC. The imaging study shows thickening of the mucosa of the anal canal that invades the internal sphincter, without metastases. We performed a laparoscopic abdominoperineal amputation, and noticed an infiltration of the rectovaginal septum, so resection and vaginoplasty was performed. Pathology: NEC with stage PT4B N2A, for which adjuvant chemotherapy is indicated. Discussion: The clinical presentation of NEC of the anal canal is nonspecific, differing from other colorectal tumors in that up to 67% of patients have metastases at diagnosis, with a median survival of 11 months. When an incidentally localized NEC is diagnosed, prompt treatment is essential, given its aggressiveness.

Correlates of Undernutrition in Older People in Guadeloupe (French West Indies): Results from the KASADS Study.

Objectives: This study aimed to determine the risk factors for undernutrition in community-dwelling older adults in Guadeloupe (Caribbean islands). Methods: We used data from the KArukera Study of Aging-Drugs Storage (KASADS), an observational cross-sectional study of community-dwelling older people living in Guadeloupe. The Mini Nutritional Assessment (MNA) was used to assess the risk of undernutrition. An MNA-short form (SF) score ≤11 defined the risk of undernutrition. Depression was assessed using the Center for Epidemiologic Studies Depression (CES-D) scale, cognitive function was assessed using the Mini Mental State Examination (MMSE), frailty was assessed using the Study of Osteoporotic Fractures index (SOF), and dependency was assessed using Lawton's instrumental activities of daily living (IADL) scale. Bivariate and multivariate analyses were used to determine the correlates of undernutrition. Results: The study sample comprised 115 patients aged 65 years or older; 67.8% were women, and the mean age was 76 ± 7.8 years. The prevalence of undernutrition was 21.7% (95% CI = 15.2-30.1%). In our bivariate analysis, the risk of undernutrition was associated with MMSE score, IADL score, frailty, and CES-D score. We found no significant relation between nutrition risk and other variables, such as marital status, pain, or polypharmacy. In the multivariate analysis, the factors associated with the risk of undernutrition were MMSE score (Odd-Ratio (OR): 0.74 (0.58-0.97)) and CES-D score (OR: 1.13 (1.02-1.27)). Conclusions: Cognitive decline and the risk of depression were independently associated with the risk of undernutrition in community-dwelling older people in Guadeloupe. Although we cannot imply causality in this relation, the detection of these three key geriatric syndromes in community-dwelling elders is essential to prevent adverse health outcomes. Further studies are warranted to confirm these findings.

Profiles of Elderly Patients with Obesity Hypoventilation Syndrome in Martinique: A Single-Center Study.

Obesity hypoventilation syndrome (OHS) is a form of chronic respiratory insufficiency related to obesity that affects young and old people. Age appears to be associated with poorer response to treatment by nighttime ventilation. This study aimed to describe the characteristics of elderly subjects (>65 years) with OHS compared to younger patients, with a view to adapting therapy in older individuals. We conducted a retrospective study comparing socio-demographic, clinical, functional characteristics as well as treatment and outcomes between young (<65 years) and older (65 years and older) individuals with OHS at the University Hospital of Martinique. We included 143 patients (114 women), of whom 82 were 65 years or older (57%). Charlson index was higher in the older group. Patients in ≥65 years group were less frequently obese, but more frequently had diabetes mellitus, cardiac arrythmia and arterial hypertension compared to younger patients. There was no difference in the circumstances of diagnosis or arterial blood gas at diagnosis. At follow up, partial pressure of carbon dioxide (pCO2) was higher in ≥65 years group. Despite comparable NIV settings, apart from lower expiratory positive airway pressure (EPAP) with higher apnea-hypopnea index (AHI), patients in the ≥65-year-old group remained more frequently hypercapnic. In conclusion, over half (57%) of patients with OHS in our cohort were aged over 65 years. Older patients developed OHS at lower BMI levels than their younger counterparts, and more frequently, had comorbidities such as diabetes, hypertension and cardiac arrhythmia. Increased Charlson index, lower BMI and female sex were independent factors associated with OHS in the elderly.

The spider genus Pseudotyphistes (Araneae, Linyphiidae) in Uruguay: a new species and new records.

Pseudotyphistes deinceps Cajade n. sp. is described from Uruguay based on males and females. Illustrations of somatic and sexual characters and a distribution map of the species is provided. In addition, new records of Pseudotyphistes pennatus Brignoli, 1972 for the country are presented. Data of the natural history and conservation status of both species are discussed.

Inhibitory effects of 190 compounds against SARS-CoV-2 Mpr o protein: Molecular docking interactions.

COVID-19 has caused many deaths since the first outbreak in 2019. The burden on healthcare systems around the world has been reduced by the success of vaccines. However, population adherence and the occurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants are still challenging tasks to be affronted. In addition, the newly approved drug presents some limitations in terms of side effects and drug interference, highlighting the importance of searching for new antiviral agents against SARS-CoV-2. The SARS-CoV-2 main protease (Mpr o ) represents a versatile target to search for new drug candidates due to its essential role in proteolytic activities responsible for the virus replication. In this work, a series of 190 compounds, composed of 27 natural ones and 163 synthetic compounds, were screened in vitro for their inhibitory effects against SARS-CoV-2 Mpro . Twenty-five compounds inhibited Mpro with inhibitory constant values (Ki ) between 23.2 and 241 µM. Among them, a thiosemicarbazone derivative was the most active compound. Molecular docking studies using Protein Data Bank ID 5RG1, 5RG2, and 5RG3 crystal structures of Mpro revealed important interactions identified as hydrophobic, hydrogen bonding and steric interactions with amino acid residues in the active site cavity. Overall, our findings indicate the described thiosemicarbazones as good candidates to be further explored to develop antiviral leads against SARS-CoV-2. Moreover, the studies showed the importance of careful evaluation of test results to detect and exclude false-positive findings.

Correlates of Health-Related Quality of Life in Community-Dwelling Older Adults in Guadeloupe (French West Indies): Results from the KASADS Study.

OBJECTIVES: The aim of this study was to determine the correlates of health-related quality of life (HRQoL) in community-dwelling older adults in Guadeloupe. METHODS: We used the Karukera Study of Aging-Drugs Storage (KASADS), an observational, cross-sectional study on community-dwelling older people living in Guadeloupe. A visual analogue scale ranging from 0 to 100 was used to assess HRQoL. RESULTS: The study sample consisted of 115 patients aged 65 years or older; 67.8% were women. Participants were 76 (±7.8) years old with a mean HRQoL of 66.2 (±20.3). The correlates of HRQoL were complaints of pain (p < 0.001) and IADL dependency (p = 0.030) after adjustment. We found no significant interactions between HRQoL and other variables such as marital status, socio-educational level and cognitive decline. CONCLUSIONS: Pain and IADL dependency were independently associated with lower HRQoL in community-dwelling older people in Guadeloupe.

The Health Care Trajectories of Older People in Foster Families: Protocol for an Observational Study.

BACKGROUND: With aging of the population, the search for alternative models of care adapted to older people with dependency is necessary. In this setting, foster families (1-3 older people per family) could be an alternative to nursing homes, residential care facilities, or community- and home-based care. OBJECTIVE: The KArukera Study of Ageing in Foster Families is a prospective cohort study designed to investigate the care pathways of older people with dependency in foster care over a year. The 1-year hospitalization rate (main objective), cost of hospitalization, incidence of mortality, prevalence of geriatric syndromes, and quality of life of residents will be assessed. Quality of life and burnout of their respective foster caregivers will also be studied. METHODS: This study cohort will include 250 older people living in foster families in Guadeloupe (French West Indies), as well as their respective foster caregivers. Both older people and caregivers will be interviewed concurrently on site at three time points: (1) at baseline, (2) at 6 months, and (3) at 12 months. For older people, we will collect anthropometric measures, cognitive impairment, depressive and anxiety symptoms, functional abilities, physical frailty, information on general health status, quality of life, and care pathways (hospitalization, mortality, and medical and paramedical consultations). We will also assess the quality of life and burnout symptoms of family caregivers at each follow-up. A phone update of vital status (alive or death) and care pathways of residents will be carried out at 3 and 9 months after the baseline examination. RESULTS: Recruitment opened in September 2020 and ended in May 2021, with 109 older people recruited and 56 respective foster caregivers. The 1-year follow-up was ended in June 2022. Data analyses are ongoing and the first results are expected to be published in May 2023. CONCLUSIONS: Foster families are a potentially innovative way to accommodate dependent older people. This study could help define the clinical profile of older people adapted to foster families in the transition from frailty to dependency. The effectiveness of foster families, in terms of hospitalizations and mortality, will be compared with other models of care, particularly nursing homes. In this setting, a twin study carried out in nursing homes in Guadeloupe with similar aims and outcomes will be conducted. Beyond mortality and morbidity, the numerous outcomes will allow us to assess the evolution of geriatric syndromes over time. TRIAL REGISTRATION: ClinicalTrials.gov NCT04545775; https://clinicaltrials.gov/ct2/show/NCT04545775. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40604.

A new Sarcophaginae (Diptera: Sarcophagidae) from Brazil: the peculiar colour of Petrolina bifasciata gen. nov., sp. nov., from the Caatinga xeric shrubland of northeastern Brazil.

A new genus and species, Petrolina bifasciata gen. nov., sp. nov. (Diptera: Sarcophagidae, Sarcophaginae), with only two black stripes dorsally on thorax, is described from both sexes. The type material was collected in fragments of seasonally dry tropical forest in the state of Pernambuco, northeastern Brazil. The new genus and species is morphologically similar to genera Rafaelia Townsend and Malacophagula Bequaert. However, the atypical two thoracic black stripes and phallic morphology give evidence to the proposal of a new genus in Sarcophaginae.

Terapia ocupacional desde una perspectiva ecosocial de la salud mental / Occupational therapy from an ecosocial perspective of mental health

Resumen Se describe la experiencia de un proyecto de huerta terapéutica ubicada en las inmediaciones del Servicio de psiquiatría del Hospital Guillermo Grant Benavente (HGGB) de Concepción, Chile, liderada por la Organización No Gubernamental Rebrota (ONG Rebrota) en base a la perspectiva eco-social aplicada en personas con necesidades de salud mental. Se objetiva analizar la experiencia de Terapia Ocupacional Ecosocial como herramienta práctica para la transformación de los territorios, permitiendo a los terapeutas ocupacionales comprender la interacción entre la sociedad y la naturaleza como un proceso socioecológico que impacta en diferentes esferas de los seres humanos, especialmente en la participación social y la salud mental. Utilizando la metodología descriptiva del Modelo Procesal de Emprendimiento Eco-social realizamos una orientación práctica de acciones para que las comunidades, insertas en sus entornos naturales y culturales, logren descubrirse reflexivamente generando procesos de salud colectiva. La Terapia Ocupacional Ecosocial desarrolla praxis que mejoran la salud y promueven el bienestar de las personas, grupos y/o comunidades, generando un impacto positivo en los socio-ecosistemas y construyen comunidades más saludables, inclusivas, sostenibles. La Terapia Ocupacional Ecosocial es una invitación a generar proyectos de investigación-acción para mitigar el impacto social sobre la naturaleza en un contexto de crisis climática, donde encontramos comunidades en la génesis de saberes transculturales que nos permitan desarrollar una praxis transformadora para el buen vivir en sintonía con nuestro entorno; mientras mejoran su bienestar y participación, desde una perspectiva de derechos humanos y justicia ocupacional.

Abstract It is described the experience of a therapeutic garden project located in the vicinity of the Psychiatry Service of the Guillermo Grant Benavente Hospital (HGGB) in Concepción, Chile, led by the Non-Governmental Organization Rebrota (ONG Rebrota) based on the ecosocial perspective applied in people with mental health needs. It aims to analyze this Eco-social Occupational Therapy experience as a practical tool for the transformation of territories, allowing occupational therapists to understand the interaction between society and nature as a socio-ecological process that impacts different spheres of human beings, especially in social participation and mental health. Using the descriptive methodology of the Eco-social Entrepreneurship Process Model, we carry out a practical orientation of actions so that communities, inserted in their natural and cultural environments, can discover themselves reflexively, generating collective health processes. Eco-social Occupational Therapy develops practices that improve health and promotes the well-being of individuals, groups and/or communities, generating a positive impact on socio-ecosystems and building healthier, more inclusive, and sustainable communities. Eco-social Occupational Therapy is an invitation to generate research-action projects to mitigate the social impact on nature in a context of the climate crisis, where we find communities in the genesis of transcultural knowledge that allows us to develop a transformative praxis for good living in tune with our environment; while improving their well-being and participation, from a human rights and occupational justice perspectives.

Detección precoz de desviaciones y promoción de las habilidades sociales del lactante con la escala ADBB durante el seguimiento pediátrico: experiencia en un centro de salud pública de alta vulnerabilidad social / Early detection of deviations and promotion of infant social skills using the ADBB scale during pediatric follow-up: experience at a public health center of high social vulnerability / Detecção precoce de desvios e promoção de habilidades sociais infantis utilizando a escala ADBB durante o acompanhamento pediátrico: experiência num centro público de saúde de alta vulnerabilidade social

Introducción: el retraimiento del lactante es un signo de riesgo de desviaciones en el desarrollo y la salud mental infantil asociado a perturbaciones sostenidas en la interacción padres-bebé. Para este estudio se amplió la formación de un grupo de pediatras, médicos de familia y otros profesionales del primer nivel de un centro de salud de una zona de alta vulnerabildad social en una perspectiva interdisciplinaria del impacto de las interacciones tempranas en el neurodesarrollo y en la salud psicoemocional de los primeros años de vida, junto con la aplicación de un instrumento validado internacionalmente para la detección de retraimiento (escala ADBB, Alarme Détresse Bébé, Guedeney 2001) y estrategias para promover las habilidades sociales del lactante durante el control pediátrico. Objetivo: el estudio fue para evaluar el efecto de este abordaje en el seguimiento pediátrico de un grupo de lactantes a través de la detección de retraimiento y en comparación con otro grupo atendido en el mismo centro de salud sin el abordaje propuesto. Material y métodos: se realizó la detección de retraimiento con ADBB a 101 lactantes de 2 a 11 meses filmados en controles pediátricos durante 2016-2017 en un centro de salud pública de Montevideo. De total, 58 tuvieron seguimiento pediátrico con cuatro pediatras y una médica de familia con el abordaje propuesto y fueron evaluados con ADBB en dos tiempos, entre los 2 y 5 meses y entre los 8 y 11 meses de edad. Los 43 restantes acudieron al control pediátrico habitual en el centro de salud y fueron evaluados con ADBB entre los 8 y 11 meses. Todos los lactantes fueron evaluados con ADBB por expertos independientes. Resultados: de los 58 lactantes atendidos con el abordaje propuesto, 22% presentó retraimiento entre los 2 y 5 meses, y 14% entre los 8 y 11 meses. En el grupo atendido en los controles pediátricos regulares sin el abordaje propuesto, se detectó 53% de retraimiento entre los 8 y 11 meses de edad (p <0,001). Conclusiones: La detección precoz de retraimiento junto con estrategias para la promoción de las habilidades sociales del lactante durante el segui- miento pediátrico podría favorecer una perspectiva más integral y preventiva de la salud, incidiendo en el cuidado del neurodesarrollo y de la salud mental infantil desde el primer nivel.

Introduction: infant withdrawal is a sign of risk for deviations in child development and mental health associated with sustained disturbances in parent-infant interaction. For this study, a group of pediatricians, family doctors and other professionals of the Primary Care Level of a health center in an area of high social vulnerability was trained including an interdisciplinary perspective regarding the impact of early interactions on the neurodevelopment and psychological and emotional health of the first years of life. Similarly, we applied an internationally validated instrument for the detection of withdrawal (ADBB scale, Alarme Détresse Bébé, Guedeney 2001) and strategies to promote infant social skills during the pediatric check-ups. Objective: the study was to evaluate the effect of this approach in the pediatric follow-up of a group of infants through the detection of withdrawal and to compare it with another group assisted in the same center that did not receive the same approach. Material and methods: withdrawal with ADBB was detected in 101 infants aged 2 to 11 months filmed in pediatric controls during 2016-2017 in a public health center in Montevideo. In total, 58 had pediatric follow-up with four pediatricians and one family physician using the approach proposed in this study and were evaluated with ADBB in two stages, between 2 and 5 months and between 8 and 11 months of age. The remaining 43 attended the usual pediatric control at the health center and were evaluated with ADBB between 8 and 11 months. All infants were evaluated with ADBB by independent experts. Results: of the 58 infants treated with the approach proposed in this study, 22% presented withdrawal between 2 and 5 months, and 14% between 8 and 11 months. In the group attended in regular pediatric check-ups without using the proposed approach, 53% of withdrawal was detected between 8 and 11 months of age (p <0.001). Conclusions: the early detection of withdrawal to gether with strategies for the promotion of infant social skills during pediatric follow-up could favor a more comprehensive and preventive health perspective and enable practitioners to focus on the children neurodevelopmental and mental health from primary care assistance.

Introduccion: a abstinencia infantil é um sinal de risco para os desvios no desenvolvimento infantil e na saúde mental associados a distúrbios sustenta- dos na interação pais-bebê. Para este estudo, expandiuse a formação de um grupo de pediatras, médicos de família e outros profissionais do primeiro nível de um centro de saúde numa área de alta vulnerabilidade social, utilizando uma perspectiva interdisciplinar do impacto das interações precoces no neurodesenvolvimento e na saúde psicoemocional dos primeiros anos de vida, juntamente com a aplicação de um instrumento validado internacio- nalmente para a detecção de abstinência (escala ADBB, Alarme Détresse Bébé, Guedeney 2001) e estratégias para promover habilidades sociais infan- tis durante o controle pediátrico. Objetivo: do estudo foi avaliar o efeito dessa abordagem no acompanhamento pediátrico de um grupo de lactentes por meio da detecção de abstinência e comparálo com outro grupo atendido no mesmo centro de saúde, más sem utilizar a abordagem proposta. Material e Métodos: a abstinência com ADBB foi detectada em 101 lactentes com idades entre 2 e 11 meses filmados em controles pediátricos durante 2016-2017 num Centro de Saúde Pública em Montevidéu. No total, 58 tiveram acompanhamento pediátrico com quatro pediatras e um médico de família e receberam a abordagem proposta e foram avaliados com o ADBB em dois estágios, entre 2 e 5 meses e entre 8 e 11 meses de idade. Os 43 restantes compareceram ao controle pediátrico habitual no centro de saúde e foram avaliados com ADBB entre 8 e 11 meses. Todos os lactentes foram avaliados com o ADBB por especialistas independentes. Resultados: dos 58 lactentes tratados com a abordagem proposta, 22% apresentaram abstinência entre 2 e 5 meses e 14% entre 8 e 11 meses. No grupo atendido em check-ups pediátricos regulares sem a abordagem proposta, 53% de desistência (retraimiento) foi detectada entre 8 e 11 meses de idade (p <0,001). Conclusões: a detecção precoce da abstinência, aliada a estratégias de promoção de habilidades sociais infantis durante o acompanhamento pediá- trico, poderia favorecer uma perspectiva de saúde mais abrangente e preventiva, com foco no cuidado do neurodesenvolvimento e da saúde mental infantil desde o primeiro nível de saúde.

Frailty index, mortality, and length of stay in a geriatric short-stay unit in Guadeloupe.

Context: The COVID-19 pandemic has placed a tremendous stress on healthcare systems and caused reorganization. As the pandemic intensifies, identifying the profile of patients with COVID-19 was primordial in order to predict negative outcomes and organize healthcare resources. Age is associated with COVID-19's mortality, but for obvious ethical reasons, chronological age cannot be the sole criterion for predicting negative outcomes. Objective: The objective of this study was to determine the relationship between frailty index (FI) and length of hospital stay, and death in a non-COVID population of patients aged 75 years old and above. Methods and design: A retrospective, analytical, single-centered observational study was performed in the geriatric short-stay accommodation unit at Guadeloupe University Hospital. For this study, 158 patients who were at least 75 years old were recruited from November 2020 to May 2021. FI was calculated as the number of deficits in a participant divided by the total number of deficits considered (the cut-off of FI is.25 in outpatient). Multivariate logistics regression analyses were conducted to assess the association between frailty and death, and length of stay. Results: The average age of the participants was 85.7 ± 6.74 with a range of 75-104. Twenty-four of the patients died during hospitalization. FI was only significantly associated with mortality even after adjustment for age and gender (HR 26.3, 95% CI 1.7-413.4, P = 0.021). The association was stronger in the highest tertile of the FI (age- and gender-adjusted HR 4.6, 95% CI 1.39-15.11, P = 0.01). There was no significant interaction between FI and length of stay. Conclusion: Our study shows an association between FI (in terms of age-related deficit accumulation) and mortality in a non-COVID geriatric short-stay unit in Guadeloupe. The FI seems to have a lower capacity to catch events such as length of stay in this very complex population. Further research studies have to be conducted for better understanding and investigation of our findings.

Cardiopatía asociada a infección por VIH / HIV-associated heart disease

Resumen La infección por VIH continúa representando un problema sanitario de primer orden en el mundo. El aumento de la esperanza de vida gracias a la terapia antirretroviral ha aumentado la prevalencia de la enfermedad de manera importante. La infección por VIH es una causa importante de cardiopatía adquirida, en especial en relación con el desarrollo de cardiopatía isquémica (manifestación cardiovascular más frecuente en los países desarrollados en la actualidad). Se presenta el caso de una paciente de 42 años, con infección por VIH, sin factores de riesgo cardiovascular clásicos, quien presentó un síndrome coronario agudo de alto riesgo. Se discuten la etiopatogenia de la cardiopatía isquémica asociada a la infección por VIH y sus aspectos particulares diagnósticos y terapéuticos.

Abstract Human immunodeficiency virus (HIV) infection continues to be a leading health problem worldwide. Increased life expectancy due to antiretroviral therapy has significantly increased the prevalence of the disease. Human immunodeficiency virus infection is an important cause of acquired heart disease, especially the development of ischemic heart disease (the most common cardiovascular manifestation in developed countries today). We present the case of a 42-year-old patient with HIV infection with no classical cardiovascular risk factors who developed a high-risk acute coronary syndrome. We discuss the etiopathogenesis of HIV-associated ischemic heart disease and its particular diagnostic and therapeutic aspects.

The Impact of an Interactive Guidance Intervention on Sustained Social Withdrawal in Preterm Infants in Chile: Randomized Controlled Trial.

Background: Sustained social withdrawal is a key indicator of child emotional distress and a risk factor for psychological development. Preterm infants have a higher probability of developing sustained social withdrawal than infants born full-term during their first year. Objective: To compare the effect of a behavioral guidance intervention to that of routine pediatric care on sustained social withdrawal behavior in preterm infants. Design: Multicenter randomized clinical trial. Participants: Ninety nine moderate and late preterm newborns and their parents were recruited and randomized into two groups, i.e., Intervention (n = 49) and Control (n = 50). Both groups attended medical check-ups at 2, 6 and 12 months and were assessed with the Alarm Distress Baby Scale. The intervention group received a standardized behavioral intervention if the neonatologist detected sustained social withdrawal. Also, parents filled out the Edinburgh Postnatal Depression Scale, the modified-Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale-revised. Results: At baseline, the prevalence of withdrawal was 4.0% (95% CI: 0.03-14.2) for the control group and 22.4% (95% CI: 13.0-35.9) for the intervention group [OR = 0.22, p = 0.028 (95% CI =0.06-0.84)]. At 6 months, the prevalence was 10.0% (95% CI: 3.9-21.8) for the control group and 6.1% (95% CI: 2.1-16.5) for the intervention group [OR = 2.09, p = 0.318 (95% CI = 0.49-8.88)]. At 12 months, the prevalence was 22.0% (95% CI: 12.8-35.2) for the control group and 4.1% (95% CI: 1.1-13.7) for the intervention group [OR = 6.63, p = 0.018 (95% CI = 1.39-31.71)]. Logistic generalized estimating equation models were performed. The pooled crude OR (considering diagnosis at 6 and 12 months) was 3.54 [p = 0.022 (95% CI = 1.20-10.44); Cohen's d= 0.70]. In the case of pooled adjusted OR, the model considered diagnosis (0 = Withdrawal, 1 = Normal) as the dependent variable, time of evaluation (1= 6 months, 2 = 12 months) and group (0 = Control, 1 = Experimental) as factors. In this case, the pooled adjusted OR was 3.57 [p = 0.022 (95% CI = 1.20-10.65); Cohen's d = 0.70]. Conclusion: Assessment and intervention of sustained social withdrawal in preterm infants via standardized instruments benefits families by reducing its prevalence, and possible associated negative outcomes. Clinical Trial Registration: ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT03212547, identifier: NCT03212547.

Follow-up of primary melanoma patients with high risk of recurrence: recommendations based on evidence and consensus.

In spite of the good prognosis of patients with early-stage melanoma, there is a substantial proportion of them that develop local or distant relapses. With the introduction of targeted and immune therapies for advanced melanoma, including at the adjuvant setting, early detection of recurrent melanoma and/or second primary lesions is crucial to improve clinical outcomes. However, there is a lack of universal guidelines regarding both frequency of surveillance visits and diagnostic imaging and/or laboratory evaluations. In this article, a multidisciplinary expert panel recommends, after careful review of relevant data in the field, a consensus- and experience-based follow-up strategy for melanoma patients, taking into account prognostic factors and biomarkers and the high-risk periods and patterns of recurrence in each (sub) stage of the disease. Apart from the surveillance intensity, healthcare professionals should focus on patients' education to perform regular self-examinations of the skin and palpation of lymph nodes.

Economic evaluation of long-term albumin use in cirrhosis patients from the Mexican healthcare system perspective.

INTRODUCTION AND OBJECTIVES: Liver cirrhosis is a major public health issue associated with high morbidity and mortality. The ANSWER trial showed that long-term human albumin (LTA) infusions led to significant reduction of complications and mortality in patients with uncomplicated ascites. The present study aimed to assess the incremental cost of cirrhosis patients treated with LTA plus standard medical treatment (SMT) versus those treated with SMT from the perspective of the Mexican Social Security Institute (IMSS). MATERIAL AND METHODS: Cost of illness for patients with cirrhosis and grade 2-3 ascites treated with SMT or with SMT and LTA (following the treatment regimen from ANSWER) over a one-year period was estimated according to the IMSS perspective. Rates of treatments, complications and hospitalizations were based on results from the ANSWER trial. Unit costs from IMSS were gathered from public sources and transformed to 2020 Mexican $ (Mex$). RESULTS: The use of LTA is estimated to require additional annual expenditure derived from the pharmacological cost of human albumin and by the follow up visits required for LTA administration (Mex$28,128). However, this cost may potentially be counterbalanced by the reduction in paracentesis, cirrhosis-related complications and hospitalizations which would lead to cost savings of Mex$33,417 per patient/year. CONCLUSIONS: Based on the ANSWER trial results, our study suggests that LTA may result in improved clinical outcomes and reduced costs for the IMSS when administered to cirrhosis patients with uncomplicated ascites.