Long-Acting Injectable Second-Generation Antipsychotics in Seriously Ill Patients with Schizophrenia: Doses, Plasma Levels, and Treatment Outcomes.

This research studies the dose-plasma level (PL) relationship of second-generation antipsychotics, together with the treatment outcomes achieved, in seriously ill people with schizophrenia. An observational, prospective, one-year follow-up study was carried out with patients (N = 68) with severe schizophrenia treated with paliperidone three-month (PP3M) or aripiprazole one-month (ARIM). Participants were divided into standard-dose or high-dose groups. PLs were divided into "standard PL" and "high PL" (above the therapeutic reference range, TRR) groups. The dose/PL relationship, and severity, hospitalizations, tolerability, compliance, and their relationship with doses and PLs were evaluated. There was no clear linear relationship between ARIM or PP3M doses and the PLs achieved. In half of the subjects, standard doses reached PLs above the TRR. The improvements in clinical outcomes (decrease in clinical severity and relapses) were related to high PLs, without worse treatment tolerability or adherence. All participants remained in the study, regardless of dose or PL. Clinical severity and hospitalizations decreased significantly more in those patients with high PLs. Considering the non-linear dose-PL relationship of ARIM and PP3M in people with severe schizophrenia, PLs above the TRR are linked to better treatment outcomes, without worse tolerability. The need in a notable number of cases for high doses to reach those effective PLs is highlighted.

Concurrencia de trastorno por consumo de sustancias y de otro trastorno mental en personas en tratamiento por alguno de ellos en España / Co-occurrence of substance use disorders and other mental disorders in people undergoing specific treatment for any of them in Spain

La concurrencia de trastornos por consumo de sustancias (TUS) y de otros trastornos mentales (OTM) es desconocida en su conjunto en España, y su abordaje se hace desde diferentes redes asistenciales. El objetivo del presente estudio era conocer la prevalencia de esta comorbilidad tanto en las redes de tratamiento de las adicciones como en las de salud mental. Se diseñó un estudio observacional, transversal, multicéntrico, con una muestra aleatorizada de pacientes en tratamiento por TUS u OTM en diferentes Comunidades Autónomas (N=1.783). Se completó un cuestionario ad hoc on-line recogiendo variables sociodemográficas, sobre uso de sustancias, y de diagnósticos de TUS y de OTM. Los datos obtenidos en la encuesta arrojan una importante concurrencia de diagnósticos TUS y OTM. Se encontró una elevada prevalencia de OTM en aquellos en tratamiento en redes de adicciones por su TUS (71%) y también tanto de diagnósticos de T.U. de cualquier sustancia (68,9%) como de consumo activo de sustancias (50%, exceptuando tabaco) en las personas en tratamiento por diagnósticos de OTM en redes de salud mental. Y, además, relaciones significativas entre la adicción a determinadas sustancias y trastornos mentales concretos: trastorno de personalidad con todos los TUS; trastornos psicóticos con trastorno por uso de cannabis, pero no de cocaína; trastornos afectivos con trastornos por consumo de cocaína, y trastorno de ansiedad con trastorno por uso de cannabis. Este estudio aporta información preliminar sobre la elevada coexistencia en la práctica clínica habitual de trastornos adictivos y otros trastornos mentales en España, tanto en redes asistenciales de salud mental como específicas de adicciones. (AU)

The co-occurrence of substance use disorders (SUD) and other mental disorders (OMD) is assumed to be high but is, in fact, unknown in Spain; and it is approached from different healthcare networks. The objective of the present study was to know the prevalence of this co-occurrence, both in specific addiction treatment networks and in mental health networks, in Spain. An observational, multicenter cross study, with a randomized sample, of patients under treatment for SUD or OMD in different Autonomous Communities of Spain was carried out (N=1,783). A specific ad hoc online questionnaire collecting sociodemographic variables, substance use and diagnoses of SUD and OMD was completed. The data obtained in the survey show a significant concurrence of SUD and OMD diagnoses (in more than 60% of the patients). A high prevalence of OMD was found in those patients receiving treatment for their SUD (71%), and also of diagnoses of any SUD (68.9%) and active substance use (50%, except tobacco) in people receiving treatment for diagnoses of OMD. Also were found significant relationships between addiction to certain substances and specific mental disorders: personality disorders with all SUDs; psychotic disorders with cannabis use disorder, but not cocaine use disorder; affective disorders with cocaine use disorder, and anxiety disorders with cannabis use disorder. This study provides preliminary information about the high coexistence in routine clinical practice of addictive disorders and other mental disorders in different treatment settings in Spain. (AU)

Finite element method as an alternative to study the electronic structure of confined atoms.

The finite element method (FEM) based on a nonregular mesh is used to solve Hartree-Fock and Kohn-Sham equations for three atoms (hydrogen, helium, and beryllium) confined by finite and infinite potentials, defined in terms of piecewise functions or functions with a well-defined first derivative. This approach's reliability is shown when contrasted with Roothaan's approach, which depends on a basis set. Therefore, its exponents must be optimized for each confinement imposed over each atom, which is a monumental task. The comparison between our numerical approach and Roothaan's approach is made by using total and orbitals energies from the Hartree-Fock method, where there are several comparison sources. Regarding the Kohn-Sham method, there are few published data and consequently the results reported here can be used as a benchmark for future comparisons. The way to solve Hartree-Fock or Kohn-Sham equations by the FEM is entirely appropriate to study confined atoms with any form of confinement potential. This article represents a step toward developing a fully numerical quantum chemistry code free of basis sets to obtain the electronic structure of many-electron atoms confined by arbitrary confinement.

Gender and addiction and other mental disorders comorbidity: sociodemographic, clinical, and treatment differences.

The co-occurrence of substance use disorders (SUD) and other mental disorders (OMD) is assumed to be high, but the details are uncertain in Spain. The objective of the present study was to know the prevalence of this comorbidity, as well as the pharmacological treatment, both in specific addiction treatment networks and in mental health networks, with a gender perspective. Observational, multicenter study, with a randomized sample, of patients under treatment for SUD or OMD in Spain (N = 1783). A specific questionnaire, collecting sociodemographic and clinical variables, diagnosed SUD and OMD, and prescribed psychotropic drugs, was completed by treating clinicians. Differences between females and males were searched. A high prevalence of OMD was found in those patients treated for their SUD (71%), and also of diagnoses of SUD (59%) in people treated for OMD. Significant relationships between addiction to certain substances and specific mental disorders were found (with no main differences between women and men). The treatments for OMD were very common in the addiction treatment networks, but that of SUDs in those patients treated in the mental health networks was less than expected. A high prescription of benzodiazepines was found. Women were less frequently diagnosed with cannabis, opioid, and especially cocaine use disorders, and they had fewer psychotic disorders and more affective, anxiety, sleep, and eating disorders, with the rest being the same, including personality disorders. Women had fewer treatments with agonists and more with antagonists, and more prescriptions of anxiolytics and antidepressants. This study provides preliminary information on the coexistence in routine clinical practice of addictive disorders and other mental disorders in Spain, and on the treatment provided, and shows differences in prevalence and clinical characteristics, and especially in treatment approaches between women and men. Thus, should be useful to adapt the treatment response with greater precision, and with a gender perspective.

Factors and Practices Associated with Self-Medicating Children among Mexican Parents.

BACKGROUND: Pediatric self-medication is based on the subjective interpretation of symptoms in children by the mother or an adult, the decision to self-medicate is made by a third party. The objective of this work is to provide information on the factors and practices associated with the self-medication of children among parents in Mexico. METHODS: A cross-sectional and descriptive study was conducted between June 2020 and December 2021 on Mexican parents with children under 12 years of age. Online questionnaires were completed with sections on sociodemographic characteristics, use of medicines or medicinal plants and their treated symptoms, sources of collection, and their recommendation. RESULTS: A total of 9905 online surveys were completed with representation from the 32 states of Mexico, and the prevalence of self-medication was 49.6% (n = 4908). Associated factors were age, having two or more children, children with chronic illnesses, medium educational level, unemployment or employment unrelated to health, medium and high socioeconomic level, and lack of medical security. Respondents self-medicated their children on the recommendation of a family member or friend (55.8%), and own initiative (28%). The most used medication was VapoRub (61.3%), followed by paracetamol (56.9%) and chamomile (33.1%), and the most prevalent symptoms were flu/flow (47.7%) followed by cough (34.2%). The main reasons were perceiving symptoms as not serious (69.9%) and reusing medications (51.9%). CONCLUSIONS: There is a high prevalence of self-medication in children in Mexico, mainly associated with children with chronic diseases and families with three or more children.

Mirror image study (10 years of follow-up and 10 of standard pre-treatment) of psychiatric hospitalizations of patients with severe schizophrenia treated in a community-based, case-managed programme.

OBJECTIVES: To determine the psychiatric hospitalizations of patients with severe schizophrenia before (standard treatment in mental health centres) and during treatment in a comprehensive, community-based, case-managed programme, as well as the role played by antipsychotic medication (oral or long-acting injectable). METHODS: Observational, mirror image study of ten years of follow-up and ten retrospectives ('pre-treatment': standard), of patients with severe schizophrenia in a community-based programme, with pharmacological and psychosocial integrated treatment and intensive case management (N = 344). Reasons for discharge from the programme and psychiatric hospital admissions (and whether they were involuntary) were recorded ten years before and during treatment, as well as the antipsychotic medication prescribed. RESULTS: The retention achieved in the programme was high: after 10 years only 12.2% of the patients were voluntary discharges vs 84.3% on previous standard treatment. The number of patients with hospital admissions, and number of admissions due to relapses decreased drastically after entering the programme (P < .0001), as well the involuntary admissions (P < .001). Being on long-acting injectable antipsychotic medication was related with these results (P < .0001). CONCLUSIONS: Treatment of patients with severe schizophrenia in a comprehensive, community-based and case-managed programme achieved high retention rates, and was effective in drastically reducing psychiatric hospitalizations compared to the previous standard treatment in mental health units. Undergoing treatment with long-acting injectable antipsychotics was clearly linked to these outcomes.

Estudio en imagen en espejo (10 años de seguimiento y 10 de pretratamiento estándar) de ingresos hospitalarios de personas con esquizofrenia grave en un programa comunitario con gestión de casos / Mirror image study (10 years of follow-up and 10 of standard pre-treatment) of psychiatric hospitalizations of patients with severe schizophrenia treated in a community-based, case-managed programme

Objetivos:Conocer los ingresos en una unidad hospitalaria de psiquiatría de pacientes con esquizofrenia grave antes (tratamiento estándar en CSM) y después de su incorporación a un programa comunitario, integral y con gestión de casos. También la influencia de la medicación antipsicótica (oral o inyectable de larga duración) en ello.Método:Estudio observacional, en espejo, de 10 años de seguimiento y 10 retrospectivos («pretratamiento»: estándar) de pacientes con esquizofrenia grave en un programa comunitario, de tratamiento farmacológico y psicosocial integrado y con gestión de casos intensiva (n=344). Se registraron los motivos de alta en el programa y los ingresos hospitalarios (y si eran involuntarios) 10 años antes y durante el tratamiento. También los antipsicóticos utilizados.Resultados:La retención conseguida en el programa fue elevada: a los 10 años solo el 12,2% de los pacientes fueron altas voluntarias, frente a al 84,3% que lo habían sido en algún momento en el tratamiento estándar previo. El porcentaje de pacientes con ingresos hospitalarios y su número disminuyeron drásticamente tras la incorporación al programa (p<0,0001), así como su involuntariedad (p<0,0001). El hecho de estar con medicación antipsicótica inyectable de larga duración se relacionó estos resultados (p<0,0001).Conclusiones:La incorporación de pacientes con esquizofrenia grave a un programa integral, de base comunitaria y con gestión de casos intensiva consiguió una elevada retención en el tratamiento, y fue efectivo para disminuir drásticamente las hospitalizaciones por recaídas, comparado con el tratamiento estándar previo en CSM. El tratamiento con antipsicóticos inyectables de larga duración se relacionó con estos resultados. (AU)

Objectives:To determine the psychiatric hospitalizations of patients with severe schizophrenia before (standard treatment in mental health centres) and during treatment in a comprehensive, community-based, case- managed programme, as well as the role played by antipsychotic medication (oral or long-acting injectable).Method:Observational, mirror image study of ten years of follow-up and ten retrospectives (‘pre-treatment’: standard), of patients with severe schizophrenia in a community-based programme, with pharmacological and psychosocial integrated treatment and intensive case management (n=344). Reasons for discharge from the programme and psychiatric hospital admissions (and whether they were involuntary) were recorded ten years before and during treatment, as well as the antipsychotic medication prescribed.Results:The retention achieved in the programme was high: after 10 years only 12.2% of the patients were voluntary discharges vs 84.3% on previous standard treatment. The number of patients with hospital admissions, and number of admissions due to relapses decreased drastically after entering the programme (p<0,0001), as well the involuntary admissions (p<0,001). Being on long-acting injectable antipsychotic medication was related with these results (p<0,0001).Conclusions:Treatment of patients with severe schizophrenia in a comprehensive, community-based and case-managed programme achieved high retention rates, and was effective in drastically reducing psychiatric hospitalizations compared to the previous standard treatment in mental health units. Undergoing treatment with long-acting injectable antipsychotics was clearly linked to these outcomes. (AU)

Co-occurrence of substance use disorders and other mental disorders in people undergoing specific treatment for any of them in Spain. / Concurrencia de trastorno por consumo de sustancias y de otro trastorno mental en personas en tratamiento por alguno de ellos en España.

The co-occurrence of substance use disorders (SUD) and other mental disorders (OMD) is assumed to be high but is, in fact, unknown in Spain; and it is approached from different healthcare networks. The objective of the present study was to know the prevalence of this co-occurrence, both in specific addiction treatment networks and in mental health networks, in Spain. An observational, multicenter cross study, with a randomized sample, of patients under treatment for SUD or OMD in different Autonomous Communities of Spain was carried out (N=1,783). A specific ad hoc online questionnaire collecting sociodemographic variables, substance use and diagnoses of SUD and OMD was completed.The data obtained in the survey show a significant concurrence of SUD and OMD diagnoses (in more than 60% of the patients). A high prevalence of OMD was found in those patients receiving treatment for their SUD (71%), and also of diagnoses of any SUD (68.9%) and active substance use (50%, except tobacco) in people receiving treatment for diagnoses of OMD. Also were found significant relationships between addiction to certain substances and specific mental disorders: personality disorders with all SUDs; psychotic disorders with cannabis use disorder, but not cocaine use disorder; affective disorders with cocaine use disorder, and anxiety disorders with cannabis use disorder. This study provides preliminary information about the high coexistence in routine clinical practice of addictive disorders and other mental disorders in different treatment settings in Spain.

La concurrencia de trastornos por consumo de sustancias (TUS) y de otros trastornos mentales (OTM) es desconocida en su conjunto en España, y su abordaje se hace desde diferentes redes asistenciales. El objetivo del presente estudio era conocer la prevalencia de esta comorbilidad tanto en las redes de tratamiento de las adicciones como en las de salud mental. Se diseñó un estudio observacional, transversal, multicéntrico, con una muestra aleatorizada de pacientes en tratamiento por TUS u OTM en diferentes Comunidades Autónomas (N=1.783). Se completó un cuestionario ad hoc on-line recogiendo variables sociodemográficas, sobre uso de sustancias, y de diagnósticos de TUS y de OTM.Los datos obtenidos en la encuesta arrojan una importante concurrencia de diagnósticos TUS y OTM. Se encontró una elevada prevalencia de OTM en aquellos en tratamiento en redes de adicciones por su TUS (71%) y también tanto de diagnósticos de T.U. de cualquier sustancia (68,9%) como de consumo activo de sustancias (50%, exceptuando tabaco) en las personas en tratamiento por diagnósticos de OTM en redes de salud mental. Y, además, relaciones significativas entre la adicción a determinadas sustancias y trastornos mentales concretos: trastorno de personalidad con todos los TUS; trastornos psicóticos con trastorno por uso de cannabis, pero no de cocaína; trastornos afectivos con trastornos por consumo de cocaína, y trastorno de ansiedad con trastorno por uso de cannabis. Este estudio aporta información preliminar sobre la elevada coexistencia en la práctica clínica habitual de trastornos adictivos y otros trastornos mentales en España, tanto en redes asistenciales de salud mental como específicas de adicciones.

Mangroves protect coastal economic activity from hurricanes.

This paper evaluates whether mangroves can mitigate the impact of hurricanes on economic activity. The paper assembles a regionwide panel dataset that measures local economic activity using nightlights, potential hurricane damages using a detailed wind field model, and mangrove protection by mapping the width of mangrove forests on the path to the coast. The results show that hurricanes have negative short-run effects on economic activity, with losses likely concentrated in coastal lowlands that are exposed to both wind and storm surge hazards. In these coastal lowlands, the estimates show that nightlights decrease by up to 24% in areas that are unprotected by mangroves. By comparison, the impact of the hurricanes observed in the sample is fully mitigated in areas protected by mangrove belts of 1 km or more.

Mirror image study (10 years of follow-up and 10 of standard pre-treatment) of psychiatric hospitalizations of patients with severe schizophrenia treated in a community-based, case-managed programme. / Estudio en imagen en espejo (10 años de seguimiento y 10 de pretratamiento estándar) de ingresos hospitalarios de personas con esquizofrenia grave en un programa comunitario con gestión de casos.

OBJECTIVES: To determine the psychiatric hospitalizations of patients with severe schizophrenia before (standard treatment in mental health centres) and during treatment in a comprehensive, community-based, case- managed programme, as well as the role played by antipsychotic medication (oral or long-acting injectable). METHOD: Observational, mirror image study of ten years of follow-up and ten retrospectives ('pre-treatment': standard), of patients with severe schizophrenia in a community-based programme, with pharmacological and psychosocial integrated treatment and intensive case management (n=344). Reasons for discharge from the programme and psychiatric hospital admissions (and whether they were involuntary) were recorded ten years before and during treatment, as well as the antipsychotic medication prescribed. RESULTS: The retention achieved in the programme was high: after 10 years only 12.2% of the patients were voluntary discharges vs 84.3% on previous standard treatment. The number of patients with hospital admissions, and number of admissions due to relapses decreased drastically after entering the programme (p<0,0001), as well the involuntary admissions (p<0,001). Being on long-acting injectable antipsychotic medication was related with these results (p<0,0001). CONCLUSIONS: Treatment of patients with severe schizophrenia in a comprehensive, community-based and case-managed programme achieved high retention rates, and was effective in drastically reducing psychiatric hospitalizations compared to the previous standard treatment in mental health units. Undergoing treatment with long-acting injectable antipsychotics was clearly linked to these outcomes.

Self-medication practice in pregnant women from central Mexico.

Self-medication during pregnancy represents a serious threat for mother and child health. The objective of this study was to evaluate the prevalence and the factors associated with self-medication among Mexican women living in the central region of Mexico. This is a descriptive interview-study of 1798 pregnant women or women who were pregnant no more than 3 years ago, when the interview was carried out. Data analysis was carried out with chi-square analysis and odds ratio. The prevalence of self-medication (allopathic drugs, medicinal plants, and other products, including vitamins, food supplements, among others) was 21.9%. The factors associated (p < 0.05) with self-medication were: higher education (college and postgraduate), smoking, and consumption of alcohol. Smoking was the strongest factor (OR: 2.536; 1.46-4.42) associated to self-medication during pregnancy, followed by consumption of alcohol (OR: 2.06; 1.38-3.08), and higher education (OR: 1.607; 1.18-2.19). Medicinal plant consumption was associated with nausea, constipation, migraine, and cold (p < 0.05), whereas he self-medication of allopathy was associated with gastritis and migraine (p < 0.05). Self-medication was influenced mainly by a relative or friend, who recommended the use of herbal medicine/allopathic medication. Two of the most common medicinal plants (arnica and ruda) here informed are reported to induce abortion or toxicity during pregnancy. The findings showed that self-medication (medicinal plants and allopathic medication) is a common practice among pregnant women from central Mexico. Adequate counselling of pregnant women by healthcare professionals about the potential risks of self-medication with herbal medicine and allopathic drugs during pregnancy is strongly warranted.

Chemical characterization, pharmacological effects, and toxicity of an ethanol extract of Celtis pallida Torr. (Cannabaceae) aerial parts.

ETHNOPHARMACOLOGICAL RELEVANCE: Celtis pallida Torr (Cannabaceae) is employed as a folk medicine for the treatment of inflammation, pain, skin infections, and diarrhea, among other diseases. AIM OF THE STUDY: The purpose of this work was to assess the chemical composition, the in vitro and in vivo toxicity, the antimicrobial, anti-inflammatory, antidiarrheal, antinociceptive, locomotor, and sedative effects of an ethanolic extract obtained from Celtis pallida aerial parts (CPE). MATERIALS AND METHODS: The composition of CPE was carried out by GC-MS. The in vitro and in vivo toxic activity of CPE was estimated with the comet assay (10-1000 µg/ml) for 5 h in peripheral blood mononuclear cells, and the acute toxicity test (500-5000 mg/kg p.o.), for 14 days, respectively. The antimicrobial effect of CPE was evaluated using the minimum inhibitory concentration (MIC) assay, whereas the antidiarrheal activity (10-200 mg/kg p.o.) was calculated using the castor oil test. The antinociceptive effects of CPE (50-200 mg/kg p.o.) were estimated with the acetic acid and formalin tests, as well as the hot plate test. The sedative and locomotor activities of CPE (50-200 mg/kg p.o.) were assessed with the pentobarbital-induced sleeping time test and the rotarod test, respectively. RESULTS: The main compound found in CPE was the triterpene ursolic acid (22% of the extract). CPE at concentrations of 100 µg/ml or higher induced genotoxicity in vitro and showed low in vivo toxicity (LD50 > 5000 mg/kg p.o.). Additionally, CPE lacked (MIC > 400 µg/ml) antimicrobial activity but exerts antinociceptive (ED50 = 12.5 ±â€¯1.5 mg/kg) and antidiarrheal effects (ED50 = 2.8 mg/kg), without inducing sedative effects or altering the locomotor activity. The antinociceptive activity of CPE suggests the participation of adrenoceptors, as well as the nitric oxide/cyclic guanosine monophosphate (cGMP) pathway. CONCLUSION: C. pallida exerts its antinociceptive effects probably mediated by the nitric oxide/cyclic guanosine monophosphate (cGMP) pathway.

Medicinal Plants from North and Central America and the Caribbean Considered Toxic for Humans: The Other Side of the Coin.

The consumption of medicinal plants has notably increased over the past two decades. People consider herbal products as safe because of their natural origin, without taking into consideration whether these plants contain a toxic principle. This represents a serious health problem. A bibliographic search was carried out using published scientific material on native plants from Mexico, Central America, and the Caribbean, which describe the ethnobotanical and toxicological information of medicinal plants empirically considered to be toxic. A total of 216 medicinal plants belonging to 77 families have been reported as toxic. Of these plants, 76 had been studied, and 140 plants lacked studies regarding their toxicological effects. The toxicity of 16 plants species has been reported in clinical cases, particularly in children. From these plants, deaths have been reported with the consumption of Chenopodium ambrosioides, Argemone mexicana, and Thevetia peruviana. In most of the cases, the principle of the plant responsible for the toxicity is unknown. There is limited information about the toxicity of medicinal plants used in Mexico, Central America, and the Caribbean. More toxicological studies are necessary to contribute information about the safe use of the medicinal plants cited in this review.

One Health Economics to confront disease threats.

Global economic impacts of epidemics suggest high return on investment in prevention and One Health capacity. However, such investments remain limited, contributing to persistent endemic diseases and vulnerability to emerging ones. An interdisciplinary workshop explored methods for country-level analysis of added value of One Health approaches to disease control. Key recommendations include: 1. systems thinking to identify risks and mitigation options for decision-making under uncertainty; 2. multisectoral economic impact assessment to identify wider relevance and possible resource-sharing, and 3. consistent integration of environmental considerations. Economic analysis offers a congruent measure of value complementing diverse impact metrics among sectors and contexts.

Use of medicinal plants by health professionals in Mexico.

ETHNOPHARMACOLOGICAL RELEVANCE: The use of medicinal plants in Mexico has been documented since pre-Hispanic times. Nevertheless, the level of use of medicinal plants by health professionals in Mexico remains to be explored. AIM OF THE STUDY: To evaluate the use, acceptance and prescription of medicinal plants by health professionals in 9 of the states of Mexico. MATERIALS AND METHODS: Direct and indirect interviews, regarding the use and acceptance of medicinal plants, with health professionals (n=1614), including nurses, physicians, pharmacists, and odontologists from nine states in Mexico were performed from January 2015 to July 2016. The interviews were analyzed with the factor the informant consensus (FIC). RESULTS: The information obtained indicated that 46% of those interviewed feel patients should not use medicinal plants as an alternative therapy. Moreover, 54% of health professionals, and 49% of the physicians have used medicinal plants as an alternative therapy for several diseases. Twenty eight percent of health professionals, and 26% of the physicians, have recommended or prescribed medicinal plants to their patients, whereas 73% of health professionals were in agreement with receiving academic information regarding the use and prescription of medicinal plants. A total of 77 plant species used for medicinal purposes, belonging to 40 botanical families were reported by the interviewed. The results of the FIC showed that the categories of diseases of the digestive system (FIC=0.901) and diseases of the respiratory system (FIC=0.898) had the greatest agreement. CONCLUSIONS: This study shows that medicinal plants are used for primary health care in Mexico by health professionals.

Síndrome de atrapamiento del nervio pudendo / Pudendal nerve entrapment syndrome

Introducción: el síndrome de atrapamiento del nervio pudendo se caracteriza por dolor vulvar, perineal, trastornos de la incontinencia fecal y urinaria, disfunción sexual y frecuentemente dolor quemante en el talón; se encuentra también dolor clitoridio. Objetivos: presentar dos casos del síndrome de atrapamiento del nervio pudendo y su tratamiento conservador (infiltrativo). Métodos: se describen dos casos con síndrome de atrapamiento del nervio pudendo, la primera de 36 años y 7 años con dolor y la segunda con 38 años y 8 años con dolor en el hospital "Abel Santamaría Cuadrado", durante los años 2007 y 2008. Resultados: se realizó tratamiento infiltrativo con esteroides en la zona del dolor cada 4-6 sem con cuatro o 6 dosis. Conclusiones: las pacientes tuvieron mejoría clínica del dolor con el tratamiento infiltrativo.

Introduction: this syndrome is characterized by vulvar, perineal pain, fecal and urinary incontinence, sexual dysfunction, burning pain in the heel and costal ridge; clitoridean pain is also found. Objectives: to present two cases suffering from Pudendal Nerve Entrapment Syndrome, applying a conservative treatment (infiltration block). Methods: two cases suffering from Pudendal Nerve Entrapment Syndrome are described in this paper. The first one was 36 years old women with and 7 year-pain and the second one was 38 years old woman with 8 year-pain. Both were treated at Abel Santamaría Cuadrado Teaching General Hospital from 2007 to 2008. Results: infiltration block with steroids in the pain region every 4-6 week per four or 6 doses was performed. Conclusion: the patients showed significant clinical improvement of the pain and symptoms disappeared.

Zootherapeutic practices in Aquismón, San Luis Potosí, México.

ETHNOPHARMACOLOGICAL IMPORTANCE: Animal derived products have been a source of medicinal compounds since ancient times. This work documents the use of animal species in traditional medicine in the municipality of Aquismón, San Luis Potosí, México. MATERIALS AND METHODS: Direct interviews were performed with inhabitants from Aquismón. The interviews were analyzed with two quantitative tools: (a) the informant consensus (ICF) that estimates the level of agreement about which animals may be used for each category and (b) the relative importance (RI) that determines the extent of potential utilization of each species. RESULTS: A total of 24 animal species used for medicinal purposes, belonging to 22 families and 4 taxonomic categories, were reported by interviewees. Nine medicinal species had not been reported in scientific literature. The results of the IFC showed that diseases of the respiratory systems had the greatest agreement. The most versatile species according to their RI are Crotalus atrox and Mephitis macroura. CONCLUSION: Further studies with medicinal fauna from Aquismón are required for the experimental validation of their traditional uses, especially with Mephitis macroura and Crotalus atrox.

Tratamiento del tabaquismo en los centros de drogodependencias y alcoholismo en España. Estado de la situación y perspectivas / Smoking cessation programs in centres specialised in treating drug abuse and alcoholism in Spain: present situation and future

Se analiza en una muestra de 142 centros, la mayoría de drogodependencias y algunos de alcoholismo, de 11 comunidades autónomas españolas, los programas que realizan para el tratamiento del tabaquismo. El 55.6% llevan a cabo tratamiento de fumadores. A lo largo del año 2004 en dichos centros hubo una demanda de tratamiento por parte de 3.771 personas. Fueron tratadas unas 3.000, finalizando el tratamiento la mitad de ellas. Los niveles de abstinencia indicados para el final del tratamiento como en los seguimientos a los 6 y 12 meses son buenos, en relación a los estudios clínicos publicados. El tratamiento más utilizado es el combinado (psicológico y farmacológico) seguido del psicológico. Suelen ser los distintos profesionales del equipo terapéutico los que llevan a cabo el tratamiento. Indican varias limitaciones para realizar este tratamiento, incluidos los presentes en cualquier adicción (ej., baja motivación de los fumadores), carencia de tiempo, poco personal, etc. Aprecian un claro incremento de la demanda, tanto de personas que acuden con solo dependencia de la nicotina como de sus usuarios clásicos que están a tratamiento por otras dependencias. Tienen clara su relevancia profesional en el tratamiento de esta adicción y la alta eficacia de los tratamientos que llevan a cabo con los fumadores. Ven necesario que se les aporten más medios para hacer frente al incremento continuo de demanda que están teniendo para el tratamiento de la dependencia de la nicotina en sus centros

We analyzed in a sample of 142 Centers of Drug Abuse and Alcoholism, in 11 regions of Spain, the programs that they carry out for smoking cessation. The 55.6% of centers carries out treatment of smokers. Along the year 2004 in this centers had a treatment demand of 3,771 smokers, 3,000 were treated, concluding the treatment half of them. The levels of abstinence for the end of the treatment and in the 6- and 12-months followup are good, in relation to the published clinical studies. The most utilized treatment are the combined (psychological and pharmacological) followed by the psychological treatment. They are usually apply by diferent professionals as therapits. They indicate several limitations to carry out this treatment, included usual in any addiction (e.g., the smokers’ low motivation), lack of time, limited personal, etc. They appreciates a clear increment of the demand, so much of people that they go with single nicotine dependence like of its classic users that are to treatment for other dependences. This data indicated the professional relevance of Centers of Drug Dependence in the treatment of nicotine dependence and the high effectiveness of the treatments that carry out with the smokers. They consider necessary that they have more means to make in front of the continuous increment of demand that they are having for the treatment of the nicotine dependence in their centers

El mercado de medicamentos en el Perú: ¿Libre o regulado?

"Este estudio analiza los niveles de concentración del mercado peruano, continúa con un análisis regulatorio de dos casos bastante interesantes —el brasileño y el español—, además de realizar la comparación de precios con estos dos países para aquellos medicamentos más utilizados. Se concluye que no existen tendencias claras en el análisis de comparación internacional: los precios de los medicamentos peruanos no son necesariamente más caros que los precios de los otros dos países a pesar de que estos tengan políticas de medicamentos diferentes: Brasil aplica el control de precios máximos mediante reajustes anuales, en tanto que en España se aplica una política de precios de referencia."

Trastornos de personalidad y dependencia de heroína: una relación por determinar / Personality disorders and heroin dependence: a relationship to dicover

El interés por los trastornos de personalidad (TP) en el campo de las adicciones radica en su importancia epidemiológica, su papel etiológico y su influencia en el pronóstico y tratamiento de la drogodependencia. Numerosos estudios muestran que los TP son comunes entre los adictos, aunque en muchos se solapan conductas derivadas de la propia dependencia con las descriptivas de determinados TP, lo que dificulta su diagnóstico. Esto último es más evidente en el caso de la dependencia por opioides, donde el TP disocial es el más notificado, seguido del de inestabilidad emocional. En cualquier caso, la mayoría de los heroinómanos diagnosticados de TP presentan más de uno. Se han propuesto al menos tres vías causales para la adicción en las que los factores de personalidad son etiológicamente importantes. En cuanto a su influencia en la evolución de la dependencia y en el pronóstico de los tratamientos, en general parecen ensombrecerlos, con más abandonos de tratamiento y mayor y más problemático consumo de drogas. Pero parece que pueden beneficiarse en igual medida que los adictos sin TP de los apoyos terapéuticos. De hecho, la mejora de la efectividad de los tratamientos de la dependencia de heroína pasará por una mayor detección y abordaje de los TP. En el presente artículo se revisan todos estos aspectos. Además, se describen los hallazgos en pacientes en PMMs en Asturias respecto a TP y su relación con la gravedad de la adicción y los resultados del tratamiento (AU)

There is a strong interest in the field of drug abuse about personality disorders (PD), due to their epidemiological importance, etiological role, influence on drug dependence prognosis and treatment possibilities. A large number of studies have shown that PD are very common among drug abusers, although in most of them it is not clear if some behaviour is related with PD or with drug dependence itself, what difficulties its diagnosis. This is even more relevant is heroin addicts, among which antisocial is the most reported PD, and borderline is the second one. Anyway, most of the heroin addicts with PD show more than one. Three causes for addiction in which personality factors are etiologically important have been proposed. About their influence in prognosis of the dependence and its treatment, it has been shown that worsens both in general terms, with higher rates of treatment discharge, drug consumption and related problems. However, therapeutic interventions with patients with PD seem to be as effective as with no PD. Moreover, drug abuse treatment effectiveness would be improving by giving greater attention to the detection and care to personality disorders. All these issues are reviewed in this paper. Moreover, findings of Asturian researches on PD, severity of addiction and methadone maintenance treatment outcomes are shown (AU)