A description of patients hospitalized in a quaternary care institution with cardiovascular disease and the need for continuous home oxygen therapy / Caracterización de los pacientes hospitalizados con enfermedad cardiovascular y requerimiento de oxigenoterapia continua domiciliaria en una institución de IV nivel de atención

Abstract Continuous home oxygen therapy (CHOT) is a widely used intervention but has scant evidence regarding its indications, benefits and the clinical predictors which could affect its requirement in patients with cardiovascular disease. Objective: to describe the patients with cardiovascular disease and the need for home oxygen therapy at the Fundación Cardioinfantil throughout 2018. Methods: a descriptive observational study. Hospitalized patients at Fundación Cardioinfantil from January 1, 2018, to December 31, 2018, diagnosed with cardiovascular disease and presenting their first request for home oxygen. Sociodemographic, clinical, laboratory, and imaging variables along with inpatient days and length of stay in the ICU, were collected. Results: 192 patients were studied. The median age was 74 years (IQR: 64, 25 - 81). The BMI was 25.98 kg/m2 (IQR: 22.74 - 29.67). A total of 47.9% of the population had coronary disease; 49.5% had heart failure; 27.1% had PH, 23% had OSAH, 6.3% had PTE and 16.7% had COPD. The average BNP was 1,430 SD 1,302. The average LVEF was 35.43% SD 15.35 and the median PASP was 53 mmHg (IQR 43 - 65). Altogether, 71.9% required ICU treatment. The average hospital stay was 14.08 days SD 10.1 days. A total of 20.8% of the patients had a PaO2 less than 55 mmHg; 77.1% belonged to the contributive social security regimen. Conclusions: we found that only a minority of the study patients for whom CHOT was ordered met the usually accepted criteria. Half of the patients had heart failure, most with reduced LVEF and elevated BNP, criteria which are not currently used for prescribing CHOT. More studies should be performed on the indications for supplementary oxygen therapy in this population. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2207).

Resumen La oxigenoterapia domiciliaria continua (OCD) es una intervención altamente utilizada, pero con escasa evidencia sobre sus indicaciones, beneficios y predictores clínicos que puedan influir sobre su requerimiento en pacientes con enfermedad cardiovascular. Objetivo: caracterizar los pacientes con enfermedad cardiovascular y requerimientos de oxígeno domiciliario hospitalizados en la Fundación Cardioinfantil durante el año 2018. Métodos: estudio observacional descriptivo, hospitalizados en la Fundación Cardioinfantil del 1° de enero del 2018 a 31 de diciembre del 2018 con diagnóstico de enfermedad cardiovascular y con primera solicitud de oxígeno domiciliario. Se tomaron variables sociodemográficas, clínicas, paraclínicas, imagenológicas, días de hospitalización y estancia de UCI. Resultados: se estudiaron 192 pacientes. La mediana de edad fue 74 años (RIQ: 64, 25-81). El IMC fue 25.98 Kg/m2 (RIQ: 22.74-29.67). El 47.9% de la población tenía enfermedad coronaria. El 49.5% de los pacientes presentaban falla cardiaca. El 27.1% tenía HTP, 23% SAHOS, 6.3% TEP y 16.7% EPOC. El promedio del BNP fue de 1430 DS 1302. La FEVI promedio fue de 35.43% DS 15.35 y la mediana PSAP fue de 53 mmHg (RIQ 43-65). El 71.9% requirió manejo en UCI. El promedio de estancia hospitalaria fue de 14.08 días DS 10.1 días. El 20.8% de los pacientes tenían una PaO2 menor a 55mmHg. El 77.1% pertenecían al régimen contributivo. Conclusiones: encontramos que sólo una minoría de pacientes estudiados a los que se le indicó OCD cumplían con los criterios actualmente aceptados. La mitad de los pacientes presentaban falla cardiaca, la mayoría con FEVI reducida y BNP elevado, criterios que actualmente no son utilizados para la prescripción de OCD. Se deben realizar más estudios sobre indicaciones de la terapia con oxígeno suplementario en esta población. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2207).

Norm-focused nudges influence pro-environmental choices and moderate post-choice emotional responses.

In this paper, we use choice architecture techniques to activate both social and personal norms, seeking to increase pro-environmental choices and to better understand the effect of such norm types on post-choice emotional responses. In four experiments, we make different social or personal norms salient by aligning choice environments with psychosocial mechanisms that activate different types of norms. We use different choice architecture techniques to change information, alter product sets, and generate the social consequences of choices. The target behavior, purchasing a recycled paper notebook, is captured through direct purchase behaviors or willingness to pay commitments. We find that choice architecture activates personal but not social norms, and that associated positive and negative emotions (guilt, shame, regret and pride) are elicited by choices but not by willingness to pay. Moreover, manipulating choice environment moderates the relationship between choice and norm-related emotions, such that positive emotional responses seem to be stronger than negative ones. The results suggest that choice architecture interventions can activate individual level beliefs about sustainability and help reduce the attitude-behavior gap.

Prevención secundaria antitrombótica intensiva tardía luego de un infarto del miocardio ¿Cuándo, en quiénes y cómo? / Late intensive antithrombotic secondary prevention after myocardial infarction. When, in whom and how?

La probabilidad de nuevos eventos cardiovasculares mayores (ECVM) en pacientes luego de un infarto agudo del miocardio depende de diferentes variables, como el tiempo que haya pasado después del primer evento, el escenario de presentación (síndrome coronario agudo con/sin elevación del ST) y los factores de riesgo asociados. Dichos eventos se han relacionado con la respuesta proinflamatoria persistente1, la actividad plaquetaria y la actividad de la trombina2. La llegada de medicamentos con actividad antitrombótica más potente y específica en puntos clave del proceso trombótico ha permitido evaluar su efecto en el escenario de la prevención secundaria antitrombótica intensiva luego del primer año de un infarto del miocardio3. En este tipo de prevención se han propuesto diferentes estrategias terapéuticas, entre ellas se ha extendiendo la doble terapia antiplaquetaria (DTA) (4, iniciando terapias antiplaquetarias adicionales5, o usando dosis bajas de anticoagulantes directos más aspirina6. Sin embargo, las características similares y, a su vez, heterogéneas en esta población, generan dudas de cuándo, en quiénes y cómo usar este tipo de terapia.

An examination of the association between early initiation of substance use and interrelated multilevel risk and protective factors among adolescents.

One of the major goals of drug use prevention programs is to delay the age of onset of substance use. What is called early initiation, usually occurring in adolescents under the age of 15, is a salient predictor of Substance Use Disorders later in adulthood. The causes of early initiation are complex and multifaceted and this has led to the identification of a rich set of risk and protective factors that influence age of onset. Nonetheless, there is little knowledge about the interdependence of these factors in their impact on early initiation. This paper addresses this question by applying Multiple Correspondence Analysis to data on family, community and social risk and protective factors from over 1200 adolescents. We find that community and to a lesser extent social factors are the most clearly associated to early initiation and we compare our results to those obtained from linear regression analyses of the same data that do not incorporate interdependence and find opposite results. We discuss the differences between linear regressions and MCA to evaluate the interplay of risk and protective factors and the implications of our findings for health policy and the design of prevention interventions aimed at delaying age of onset.

The complementary role of affect-based and cognitive heuristics to make decisions under conditions of ambivalence and complexity.

Little is known about the interplay between affective and cognitive processes of decision making within the bounded rationality perspective, in particular for the debate on adaptive decision making and strategy selection. This gap in the knowledge is particularly important as affect and deliberation may direct preferences in opposite directions. How do decision makers solve such dissonance? In this paper, we address this question by exploring the use of integral affect as a choice heuristic in comparison with and in conjunction to "take the best," and weighted addition of attributes (WADD). We operationalize theories of reliance on affect in choice through a "Take the emotionally best" algorithm. Its predictive power is experimentally tested against other models, including mixed-sequential cognitive/affective procedures. We find that individual decisions are better predicted by a sequential combination of "Take the emotionally best" and "Take the best" with a slight dominance of the former. Conditions of cognitive/affective ambivalence, low discrimination ability and high complexity provide the cognitive architecture where such blended choice strategies predict decisions more precisely. This implies that reliance on integral affect may precede the use of cognitive cues following an ecological rationality perspective rather than supporting a kind of competition between affect and cognition as implied in current literature.

Prosocial Behavior and Subjective Insecurity in Violent Contexts: Field Experiments.

Subjective insecurity is a key determinant of different forms of prosocial behavior. In Study 1, we used field experiments with farmers in Colombian villages exposed to different levels of violence to investigate how individual perceptions of insecurity affect cooperation, trust, reciprocity and altruism. To do so, we developed a cognitive-affective measure of subjective insecurity. We found that subjective insecurity has a negative effect on cooperation but influences trust and altruism positively. In Study 2, carried out three years after Study 1, we repeated the initial design with additional measures of victimization. Our goal was to relate subjective insecurity with actual victimization. The findings of Study 2 support the initial results, and are robust and consistent for cooperative behavior and trust when including victimization as a mediator. Different indicators of victimization are positively correlated with subjective insecurity and an aggregate index of victimization has a negative direct effect on cooperation and trust.