Tecnología digital e intervenciones para la salud mental: oportunidades y barreras

The growth of the Internet, mobile phones, social media and other digital technologies has changed our world in many ways. It has provided individuals with information that was previously only available to a select few. An example of the reach of technology is data that as of October 2012, there are over 6 billion phones worldwide (BBC, 2012). The availability of data in real time has presented hopes of intervening more efficiently and managing health problems by leveraging limited human resources. It also has an impact in changing the roles of providers and patients and in legal and ethical issues including privacy in digital health interactions. This paper will discuss why digital technology has received recent attention in the area of mental health, present some applications of technology for mental health to date, explore the challenges to full implementation in clinical settings, and present future opportunities for digital technologies.El crecimiento del Internet, los teléfonos móviles, las redes sociales y otras tecnologías digitales ha cambiado nuestro mundo de muchas maneras. Ha proporcionado a las personas con la información que antes sólo estaba disponible para un grupo selecto, por ejemplo a partir de octubre de 2012. Un ejemplo del alcance de la tecnología son los datos que dicen que hay más de 6 millones de teléfonos en todo el mundo (BBC, 2012). La disponibilidad de los datos en tiempo real a presentado la esperanza de intervenir de manera más eficiente y manejar los problemas de salud los recursos humanos limitados. También tiene un impacto en el cambio de los roles de los proveedores y los pacientes y en aspectos legales y éticos, incluyendo la privacidad en las interacciones de salud digital. Este artículo discutirá unas razones por cual la tecnología digital ha recibido atención recientemente en el área de salud mental, presentará algunas aplicaciones de la tecnología para mejorar la salud mental hasta la fecha, explorará algunas barreras para la diseminación en la práctica clínica, y presentará algunas oportunidades futuras de las tecnologías digitales

The Role of Community Pharmacists in the provision of Medication for Opioid Use Disorder Treatment in Rio Grande Valley

Background: The misuse of opioids, including prescription opioids, heroin, and fentanyl, has reached epidemic proportions in the US, resulting in more than 68,000 overdose deaths in 2020, and a total of $78.5 billion a year of economic burden. In response to this crisis, the US Department of Health and Human Services (DHHS) released a strategic plan to combat opioid abuse and misuse, recommending a multidisciplinary approach, including the inclusion of pharmacists in the efforts. The aim of this study is to examine pharmacists’ perception of their role in the provision of medication for opioid use disorders (MOUD) in addition to their attitudes towards integrating pharmacists in the provision of MOUD in OUD treatment programs. Methods: This study followed a descriptive qualitative design. Data were collected from participants (N=20), using in-depth, semi-structured interviews. Data were transcribed and entered into ATLAS.ti©, for coding and analysis. A thematic analysis approach was used to analyze the data. Results: Through the preliminary thematic analysis, five main themes emerged: perceived roles of pharmacists in the provision of MOUD, perceived barriers to integrating pharmacists into MOUD treatment programs, perceived facilitators of the integration, pharmacists’ desired education/training, and factors influencing the viability of integrating pharmacists into MOUD treatment centers/ programs. Pharmacists expressed immense interest in being part of MOUD treatment programs performing medication therapy management and counseling. Pharmacists listed potential lack of cooperation from providers and clinical logistical issues as barriers to integration and collaboration between pharmacists and providers and integrating pharmacists into smaller settings as facilitators of integration. Conclusion: The re-evaluation of how MOUD treatment is provided, and who are the health care professionals involved, is an important step to achieving the best patient health outcomes. Bringing pharmacists to the table will require careful study of both what they believe they can do and further analysis of what is preventing them from realizing or utilizing that potential. Pharmacists are eager and well equipped to be part of the provision of MOUD. However, education and training need to be designed to allow for more comprehensive preparation for this critical role

Luis Cousino Mac Iver : vida, obra e Influencia en el derecho penal Actual

96 p.Don Luís Cousino Mac Iver es reconocido y recordado como uno de los juristas chilenos mas importantes del siglo XX. De ello nace el interés de realizar un estudio sobre su vida y obra, así como de la influencia que ejerce en la doctrina penal actual. En la realización de este estudio se recopilan datos y antecedentes tanto biográficos como bibliográficos del autor en comento, con el fin de hacer un análisis de este y determinar la importancia de su obra. La influencia de Luís Cousino Mac Iver en el derecho penal actual se devela, a través de importantes textos penales de reciente data. La metodología a aplicar será la correspondiente a una investigación de carácter dogmático. En definitiva, queremos se resalte la importancia Luís Cousino Mac Iver en la historia y estudio del derecho penal chileno

Desarrollo de cárcavas y cursos de agua en la cuenca del Río Quinto, centro-oeste de Argentina

A lo largo de las últimas décadas se ha visto una aparición notable de cárcavas y cursos de agua en la cuenca del Rio Quinto, provincia de San Luis, Argentina. El fenómeno causa severos daños a la infraestructura existente, y convierte importantes parcelas agrícolas en tierras improductivas. El presente manuscrito analiza los factores principales que contribuyen a la erosión de suelos y la formación de nuevos cursos en la región. También se investiga la naturaleza de los depósitos de detrito en el área. La relación entre sedimentos, fisiografía, cambio climático, y uso de la tierra ha creado condiciones particulares que favorecerían la perdida de cohesión y la erosión de los suelos. El aumento de las precipitaciones habría también contribuido con el desarrollo de cárcavas, mientras que la escorrentía superficial sobre antiguos cauces podría haber reactivado el sistema de drenaje regional. El sifonamiento constituiría un mecanismo adicional para la remoción de sedimentos. La presencia de materiales finos, altos niveles de sodio, y una elevada alcalinidad facilitarían los procesos de dispersión y la inestabilidad de los suelos. La disolución de carbonatos sería importante en horizontes calcáreos. El desarrollo de cursos fluviales se aceleró durante los últimos años como resultado de un clima más húmedo y la deforestación. Es de esperar que el problema se intensifique en años venideros. Se observa una serie de depósitos lobulados en el margen distal de los arroyos, que serían el resultado de la sedimentación esporádica de torrentes de barro y flujos hiperconcentrados cuando la energía del sistema se disipa. Los resultados de la investigación proveen un material de referencia útil para la prevención y la implementación de medidas de control en la región.The last decades have seen a dramatic increase in gully erosion and the development of watercourses in the Rio Quinto basin, within the San Luis province of Argentina. The phenomenon is causing severe damage to existing infrastructure, as well as making large areas of agricultural land unproductive. This paper analyses the key factors that contribute to soil denudation and the formation of new channels in the region. The nature of the debris deposition is also explored. The interconnection between sediment types, physiography, climate change, and land cover has created unique conditions that make the area susceptible to a loss of soil cohesion and erosion. An increase in precipitation would have contributed to gully initiation over time, while overland flow exploited older stream channels which led to the reactivation of the drainage system. Piping is another mechanism controlling the removal of sediments in the subsurface. Fine-grained materials, high levels of sodium, and elevated alkalinity facilitate dispersion processes that render the soil structure unstable. Carbonate dissolution also appears to be significant in calcareous layers. Fluvial development has recently accelerated due to a wetter climate and land clearing, and is likely to worsen in coming years. Lobate deposits are present at the downslope end of major streams, and these sediments would represent the episodic deposition of debris torrents and hyperconcentrated flows as the system energy dissipates. Results of the study constitute a useful reference both for prevention and for the implementation of mitigation measures in the region.Fil: Gallardo, Adrian Hugo. Universidad Nacional de San Luis. Facultad de Ciencias Físico Matemáticas y Naturales. Departamento de Geología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Luis; ArgentinaFil: Giaccardi, Aldo Darío. Universidad Nacional de San Luis. Facultad de Ciencias Físico Matemáticas y Naturales. Departamento de Geología; ArgentinaFil: Aguilera, Hector David. Universidad Nacional de San Luis. Facultad de Ciencias Físico Matemáticas y Naturales. Departamento de Geología; ArgentinaFil: Battistino, Yesica Noemí. Universidad Nacional de San Luis. Facultad de Ciencias Físico Matemáticas y Naturales. Departamento de Geología; ArgentinaFil: Martinez, Amancay Nancy. Universidad Nacional de San Luis. Facultad de Ciencias Físico Matemáticas y Naturales. Departamento de Geología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Luis; Argentin

Inflammatory markers and bone mass in children with overweight/obesity: the role of muscular fitness

Objectives To examine which inflammatory markers are associated with bone mass and whether this association varies according to muscular fitness in children with overweight/obesity. Methods Plasma interleukin-1β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α), epidermal growth factor, vascular endothelial growth factor A (VEGF), and C-reactive protein were analyzed in 55 children aged 8–11 years. A muscular fitness score was computed. Bone mineral content (BMC) of the total body-less head (TBLH) and lumbar spine (LS) were assessed using dual-energy x-ray absorptiometry. Results IL-6 (β = −0.136) and VEGF (β = −0.099) were associated with TBLH BMC, while TNF-α (β = −0.345) and IL-1β (β = 0.212) were associated with LS BMC (P < 0.05). The interaction effect of muscular fitness showed a trend in the association of VEGF with TBLH BMC (P = 0.122) and TNF-α with LS BMC (P = 0.057). Stratified analyses by muscular fitness levels showed an inverse association of VEGF with TBLH BMC (β = −0.152) and TNF-α with LS BMC (β = −0.491) in the low-fitness group, while no association was found in the high-fitness group. Conclusion IL-6, VEGF, TNF-α, and IL-1β are significantly associated with bone mass. Higher muscular fitness may attenuate the adverse effect of high VEGF and TNF-α on bone mass

Influence of SC-HAZ microstructure on the mechanical behavior of Si-TRIP steel welds

Transformation induced plasticity (TRIP) steel provides enormous potential for auto-body construction in the automotive sector, owing to its enhanced mechanical behavior. In this work, Si-alloyed TRIP steel is joined by employing laser beam welding (LBW) and by utilizing two arc welding processes: gas tungsten arc welding (GTAW) and gas metal arc welding (GMAW) in order to assess the effect of the net heat input on the microstructure, the uniaxial tensile properties and the forming response. Results indicate that in spite of the Si content in TRIP steel; precipitation and growth of carbides (tempering) are observed in both: the martensite islands and the retained austenite phase, thus leading to the measurable softening at the sub-critical heat affected zone (SCHAZ) of the arc welded samples. Although the failure location was predominantly found at the sub-critical heat affected zone of the GMAW samples, the maximum stress and elongation was basically controlled by the total extension of the weldment including fusion zone and heat affected zone. While the limiting dome height upon tension-tension (T-T) and tension-compression (T-C) depended primarily on the fusion zone hardness, weld width and geometry of the sample; the fracture location was outside the weld for T-C, whereas the fracture initiated at the weld in T-T samples. LBW specimens showed optimum forming performance.Transformation induced plasticity (TRIP) steel provides enormous potential for auto-body construction in the automotive sector, owing to its enhanced mechanical behavior. In this work, Si-alloyed TRIP steel is joined by employing laser beam welding (LBW) and by utilizing two arc welding processes: gas tungsten arc welding (GTAW) and gas metal arc welding (GMAW) in order to assess the effect of the net heat input on the microstructure, the uniaxial tensile properties and the forming response. Results indicate that in spite of the Si content in TRIP steel; precipitation and growth of carbides (tempering) are observed in both: the martensite islands and the retained austenite phase, thus leading to the measurable softening at the sub-critical heat affected zone (SCHAZ) of the arc welded samples. Although the failure location was predominantly found at the sub-critical heat affected zone of the GMAW samples, the maximum stress and elongation was basically controlled by the total extension of the weldment including fusion zone and heat affected zone. While the limiting dome height upon tension-tension (T-T) and tension-compression (T-C) depended primarily on the fusion zone hardness, weld width and geometry of the sample; the fracture location was outside the weld for T-C, whereas the fracture initiated at the weld in T-T samples. LBW specimens showed optimum forming performance

Phosphatidylserine-liposomes Promote Tolerogenic Features on Dendritic cells in human Type 1 Diabetes by apoptotic Mimicry

Type 1 diabetes (T1D) is a metabolic disease caused by the autoimmune destruction of insulin-producing β-cells. With its incidence increasing worldwide, to find a safe approach to permanently cease autoimmunity and allow β-cell recovery has become vital. Relying on the inherent ability of apoptotic cells to induce immunological tolerance, we demonstrated that liposomes mimicking apoptotic β-cells arrested autoimmunity to β-cells and prevented experimental T1D through tolerogenic dendritic cell (DC) generation. These liposomes contained phosphatidylserine (PS)—the main signal of the apoptotic cell membrane— and β-cell autoantigens. To move toward a clinical application, PS-liposomes with optimum size and composition for phagocytosis were loaded with human insulin peptides and tested on DCs from patients with T1D and control age-related subjects. PS accelerated phagocytosis of liposomes with a dynamic typical of apoptotic cell clearance, preserving DCs viability. After PS-liposomes phagocytosis, the expression pattern of molecules involved in efferocytosis, antigen presentation, immunoregulation, and activation in DCs concurred with a tolerogenic functionality, both in patients and control subjects. Furthermore, DCs exposed to PS-liposomes displayed decreased ability to stimulate autologous T cell proliferation. Moreover, transcriptional changes in DCs from patients with T1D after PS-liposomes phagocytosis pointed to an immunoregulatory prolife. Bioinformatics analysis showed 233 differentially expressed genes. Genes involved in antigen presentation were downregulated, whereas genes pertaining to tolerogenic/ anti-inflammatory pathways were mostly upregulated. In conclusion, PS-liposomes phagocytosis mimics efferocytosis and leads to phenotypic and functional changes in human DCs, which are accountable for tolerance induction. The herein reported results reinforce the potential of this novel immunotherapy to re-establish immunological tolerance, opening the door to new therapeutic approaches in the field of autoimmunity.This work has been funded by a grant from the Spanish Government (FIS PI15/00198) co-financed with the European Regional Development funds (FEDER), by Fundació La Marató de TV3 (28/201632-10), by Catalan AGAUR (project 2014 SGR1365) and by CERCA Program/Generalitat de Catalunya. CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM) is an initiative from Instituto de Salud Carlos III. ICN2 acknowledges the support of the Spanish MINECO through the Severo Ochoa Centers of Excellence Program, under grant SEV-2013-0295. This work has been supported by positive discussion through A FACTT network (Cost Action BM1305: www.afactt.eu). COST is supported by the EU Framework Program Horizon 2020. SR-F is supported by the Agency for Management of University and Research Grants (AGAUR) of the Generalitat de Catalunya

Percepción de riesgo ante el cambio climático en estudiantes de Medicina de la Universidad de Ciencias Médicas de La Habana

Introduction: the study of the incidence of climate change on human health makes it possible to design and integrate protection and prevention measures.Objective: to characterize the risk perception of medical students at the University of Medical Sciences of Havana on the effects of climate change on human health.Methods: observational, descriptive and cross-sectional study between January and April 2021. The sample consisted of 166 medical students from the University of Medical Sciences of Havana. The information was obtained through a Google form.Results: 87,95 % of the students evaluated climate change as a harmful phenomenon; 77,72 % considered it an influential factor in the mortality figures. More than 80 % identified vulnerability in their communities and personal health. 96,98 % recognized the role of climate change in the genesis of diseases. 30,2 % related climate change to respiratory diseases and 13,25 % to infectious diseases. 77,71 % of those surveyed considered climate change as a phenomenon related to outbreaks of cholera and malaria, and 50 % with yellow fever and dengue.Conclusions: there was a perception by students of medical sciences in Havana about climate change and its relationship to human health. Students identify the effect of climate change on the genesis of infectious diseases such as cholera and malaria, but to a lesser extent with respiratory diseases.Introducción: el estudio de la incidencia del cambio climático sobre la salud humana posibilita diseñar e integrar medidas de protección y prevención.Objetivo: caracterizar la percepción de riesgo de los estudiantes de medicina de la Universidad de Ciencias Médicas de La Habana sobre los efectos del cambio climático en la salud humana.Métodos: estudio observacional, descriptivo y transversal entre enero y abril de 2021. La muestra estuvo constituida por 166 estudiantes de Medicina de la Universidad de Ciencias Médicas de La Habana. La información fue obtenida mediante un formulario de Google.Resultados: el 87,95 % de los estudiantes evaluó al cambio climático como un fenómeno dañino; el 77,72 % lo consideró un factor influyente en las cifras de mortalidad. Más del 80 % identificó vulnerabilidad en sus comunidades y salud personal. El 96,98 % reconoció el papel del cambio climático en la génesis de enfermedades. El 30,2 % relacionó el cambio climático con enfermedades respiratorias y el 13,25 % con enfermedades infecciosas. El 77,71 % de los encuestados consideró el cambio climático como fenómeno relacionado a brotes de cólera y malaria, y el 50 % con la fiebre amarilla y el dengue.Conclusiones: existió una percepción por parte de los estudiantes de las ciencias médicas de La Habana sobre el cambio climático y su relación a la salud humana. Los estudiantes identifican el efecto del cambio climático en la génesis de enfermedades infectocontagiosas como cólera y malaria, pero en menor medida con enfermedades respiratorias.