Loot box purchases and their relationship with internet gaming disorder and online gambling disorder in adolescents: A prospective study

In recent years, the video game industry has introduced Loot Box (LB), a new type of microtransaction in which a gamer uses real currency to purchase a random virtual item within a video game. Recently, LBs became more widespread and there is evidence suggesting their similarity to online gambling. Although some studies have investigated the association between LBs with disordered gaming and disordered gambling, very few have done so with clinical indicators of these problems. Furthermore, to the best of our knowledge no longitudinal evidence of such relationships currently exists in the literature. Therefore, the present study aimed to 1) ascertain the stability of LB purchasing in minors and 2) investigate the associations between LB purchasing with gambling online and online gambling disorder within six months. A prospective cohort study was conducted at two time points six months apart. In total, 2.213 Spanish adolescents (1.067 [48.9%] boys) aged between 11 and 17 years participated in both waves. The purchase of LBs was prevalent and stable in the sample across the six months. While a positive relationship was found between purchasing LBs and online gambling six months later, the relationships between purchasing LBs and the presentation of online gambling disorder and gaming disorder require further study

Utilização de Cateteres Venosos Centrais numa Unidade de Cuidados Intensivos Pediátricos

ResumoA colocação de cateteres venosos centrais (CVC) em crianças é uma técnica com riscos consideráveis pelo que a sua indicação deve ser criteriosa e executada por profissionais experientes.Objectivos1) Estudar a incidência de complicações dos CVC e relacioná-las com factores de risco.2) Auditar o protocolo em vigor desde 1998 na Unidade de Cuidados Intensivos do Departamento de Pediatria do HFF.Doentes e Métodos:Durante 3 anos foram colocados 121 CVC em 88 crianças com uma duração total de cateterismo de 1198 dias; idade media de 39,95m, PRISM médio de 31, 30 (25%) estavam ventilados e 23 (19%) tinham patologia cirúrgica. Os CVC foram colocados segundo a técnica de Seldínger, mais frequentemente nas subclávias; as crianças foram sedadas com midazolam e ketamina durante o procedimento.As complicações foram classificadas em imediatas ou tardias e estas últimas em infecciosas e não infecciosas. As complicações infecciosas foram classificadas segundo os critérios do "International Sepsis Fórum" de Fevereiro de 2001. Para a análise estatística foi utilizado o teste do Chi-quadrado.Resultados93 (76,8%) cateteres foram colocados nas veias subclávias, 15 (12,4%) nas femorais e 12 (9.9%) nas jugulares internas. 72 (59,5%) tinham lúmen duplo e 9 (7,4%) triplo. A duração média do cateterismo foi de 9,9 dias. Foi administrada alimentação parentérica cm 51 (42,1%) cateteres. Era 86 (71%) cateteres não houve complicações. Em 3 (2,5%) houve complicações imediatas relacionadas com a colocação do cateter. As complicações nao infecciosas observadas foram: 15 (12,4%) oclusões, 6 (5%) exteriorizações acidentais, 4 (3,3%) compromissos mecânicos, 2 (1,7%) tromboses e uma embolia. Registaram-se 3 (2,47%) complicações infecciosas relacionadas com o CVC, o que corresponde a 1 infecção por cada 393 dias de cateterismo. A sua incidência está estatisticamente relacionada com a duração do cateterismo superior a duas semanas (p = 0,01). Os microorganismos isolados foram; Enterococcus faecalis, Candido giabatra, Klebsiela pneumoniae.Conclusões1) As complicações na canalização da subclávia podem diminuir significativamente quando este é o vaso preferencialmente puncionado e se utiliza uma sedação adequada;2) O risco de infecção com ponto de partida do cateter eslá significativamente relacionada cora a duração do cateterismo (> a 14 dias)

Patología dual en unidad de asistencia a alcohólicos en el área sanitaria de A Coruña

La patología dual hace referencia a la presentación en un mismo paciente de un trastorno mental y un trastorno adictivo. Esta presencia concomitante tiene implicaciones clínicas, evolutivas y terapéuticas relevantes. Material y métodos: Se realiza un estudio descriptivo, de carácter retrospectivo sobre una muestra de 95 pacientes que iniciaron tratamiento en la Unidad de Asistencia a Alcohólicos del área sanitaria de A Coruña durante el último cuatrimestre del año 2010. Resultados: algo más de la mitad de los pacientes asistidos en este dispositivo (55%) cumplen criterios de patología dual. La droga más consumida es el alcohol. La comorbilidad más prevalente en el Eje I son los trastornos de ansiedad y los del estado de ánimo. En el Eje II destaca los TP antisocial y límite. Conclusiones: La prevalencia de patología dual en este dispositivo alcanza es similar a la de estudios equivalentes como el estudio de la red de Madrid para abuso o dependencia de alcohol y muy aproximada a la de la red gallega de adicciones

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Small Towns, una realidad urbana en la Hispania romana (II)

Congreso Internacional MARQ Museo Arqueológico de Alicante: 26-28 de Octubre de 2021.Las ciudades pequeñas/Small Towns de la Península Ibérica son la abrumadora mayoría de las aproximadamente 400 ciudades que en época romana existieron en Hispania, es decir casi una quinta parte de las aprox. 2000 ciudades del Imperio Romano entero. De ahí que resulta de interés como punto de partida y base de estudio para la investigación, a pesar de las dificultades de definición. Mientras que los intentos anteriores buscaban utilizar el término en su calidad de clasificador para poder elaborar una jerarquía de asentamientos, y así asignar a cada uno de ellos su lugar en la clasificación y de esa manera describir sus propiedades correspondientes, aqui se propone la utilización del término Small Towns solo en su calidad de aspecto diferenciador con vistas a las capitales de provincia y de conventus, manteniendo toda su imprecisión para asentamientos con o sin trama urbana extendida, en un sentido amplio y genérico sin condicionantes ni jurídicos ni políticos. Las Small Towns suelen y pueden tener, con alguna variedad, características urbanas como edificios sacros y públicos, una muralla defensiva y casas urbanas. Sin embargo, suele observarse una desproporción entre la edificación pública y sacra por un lado y la privada por el otro en el sentido, de que la primera tenga una clara predominancia sobre la segunda tanto en calidad como en cantidad. Por otro lado les suelen faltar a las Small Towns otros criterios importantes habituales de los centros mayores como son la alta densidad de población, altos estándares de calidad, un cierto grado de diversificación económica, un plan urbanístico de circulación. Esas características ausentes son compensadas, por el otro lado, con un elemento del que se nutre a través de la carga generada por la (excesiva) edificación sacra y pública, y que le proporciona aquel atributo, que resume en sí la esencia de los centros mayores, que es la más típica y la que más los destaca: un exceso de significado.Esta publicación ha sido posible gracias a la financiación de la subvención global de la Junta de Extremadura, a través de la Consejería de Ciencia, Economía y Agenda Digital al Instituto de Arqueología de Mérida (Referencia 20164499).Peer reviewe

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status