Attention-deficit hyperactivity disorder (ADHD), substance use disorders, and criminality: a difficult problem with complex solutions.

The association between attention-deficit hyperactivity disorder (ADHD) and criminality has been increasingly recognized as an important societal concern. Studies conducted in different settings have revealed high rates of ADHD among adolescent offenders. The risk for criminal behavior among individuals with ADHD is increased when there is psychiatric comorbidity, particularly conduct disorder and substance use disorder. In the present report, it is aimed to systematically review the literature on the epidemiological, neurobiological, and other risk factors contributing to this association, as well as the key aspects of the assessment, diagnosis, and treatment of ADHD among offenders. A systematic literature search of electronic databases (PubMed, EMBASE, and PsycINFO) was conducted to identify potentially relevant studies published in English, in peer-reviewed journals. Studies conducted in various settings within the judicial system and in many different countries suggest that the rate of adolescent and adult inmates with ADHD far exceeds that reported in the general population; however, underdiagnosis is common. Similarly, follow-up studies of children with ADHD have revealed high rates of criminal behaviors, arrests, convictions, and imprisonment in adolescence and adulthood. Assessment of ADHD and comorbid condition requires an ongoing and careful process. When treating offenders or inmates with ADHD, who commonly present other comorbid psychiatric disorder complex, comprehensive and tailored interventions, combining pharmacological and psychosocial strategies are likely to be needed

Empirical examination of executive functioning, ADHD associated behaviors, and functional impairments in adults with persistent ADHD, remittent ADHD, and without ADHD

Background: Previous studies suggest that childhood attention deficit hyperactivity disorder (ADHD) may continue in adulthood, producing adverse effects. Therefore, identifying factors that help to differentiate characteristics of ADHD persistence and remission has practical implications for evaluation and treatment. The first aim of this study was to analyze differences in executive functions (shift, working memory, inhibition, and plan/organize), symptoms associated with ADHD (inattention, hyperactivity, emotional lability, and self-concept), and functional impairments in adults with persistent ADHD (ADHD-P), with remittent ADHD (ADHD-R), and without ADHD (N-ADHD). The second aim was to study the contribution of functional impairments in these three groups based on executive functions and associated ADHD behaviors. Methods: Participants were 115 adults, 61 with a childhood ADHD diagnosis (40 persisters and 21 remitters) and 54 individuals with typical development. Self-reports were collected on executive functions, symptoms associated with ADHD, and functional impairments. Multivariate Analyses of Variance were conducted to test differences between the ADHD-P, ADHD-R, and N-ADHD groups on the evaluated variables. In addition, analyses were performed using two structural equation models with observed variables (path analyses). Results: The results indicated that significant executive and behavioral impairments and adverse functional outcomes in different life domains are related to the diagnostic persistence of ADHD. Recovery from the disorder is associated with better results, although hyperactivity/restlessness behaviors and plan/organize deficits continue to be present in remitter individuals

Futuro de los programas de mantenimiento con antagonistas en tratamiento de la dependencia de opiáceos.

Introducción: El tratamiento con naltrexona, constituye una de las alternativas dentro de los programas de prevención de recaídas en la dependencia de opiáceos. Objetivo: Se revisan las características farmacológicas de la naltrexona y los aspectos clínicos de su administración en el tratamiento de dependientes de opiáceos, junto con los factores que pueden ayudar a mejorar la eficacia de los programas de mantenimiento con naltrexona. Resultados: La naltrexona, a dosis de 50 mg, bloquea los efectos farmacológicos y subjetivos de los opiáceos. Es habitualmente bien tolerada, provoca pocos efectos secundarios y por lo general leves, siendo las reacciones adversas graves infrecuentes. Problemas de adherencia terapéutica y cumplimiento de la medicación en los programas de mantenimiento con naltrexona han causado que, a pesar de sus diversas ventajas aparentes, su utilización en la práctica clínica haya permanecido bastante limitada. Como parte de un programa estructurado, la naltrexona parece ser eficaz, particularmente en grupos de pacientes específicos con alta motivación o con un buen apoyo familiar. Conclusiones: Una evolución favorable en un programa de mantenimiento con naltrexona requiere una relación terapéutica positiva, la monitorización cuidadosa del cumplimiento con la medicación y la utilización de intervenciones psicosociales adecuadas

Structure and Functioning of Acute Inpatient Psychiatric Units in Spain : Qualitative Study

As a consequence of the decentralization of health care provision to the different Regions (called Autonomous Communities) in Spain, different health care models and resources have been developed for psychiatric patients. It would be very useful to obtain comprehensive and comparative data on health care models, resources, and activity of acute inpatient psychiatric units (AIPUs) as a key part of mental health systems. The aim of this study was to determine the current state of AIPUs in Spain through a national scorecard that allows the current situation to be visualized in terms of resources, processes, and outputs. A 104-item online questionnaire was sent to all the AIPUs of the different Regions in Spain. It was divided into 11 sections, including data on the resources, processes, and outputs of the AIPUs plus general data, an indicator dashboard, and good practices. The questionnaire was completed by 60.0% (117/195) of the AIPUs invited to participate. The information collected has allowed us to obtain a detailed snapshot of the current situation of AIPUs in Spain at the levels of infrastructure and material resources, staffing, organization and activity of the units, coordination with other units, guidelines, processes and protocols used, participation and communication with patients and their families, teaching activity, and research linked to the units. This project aimed to help understand the general situation of AIPUs in Spain and its different Regions, contribute to enhancing the benchmarking and harmonization among Spanish Regions, and provide data for future comparisons with other countries. RR1-10.2196/2621

Venciendo la degradación climática del patrimonio pétreo mediante recubrimiento con nanomateriales basados en carbono

Resumen de la comunicación oral presentada en el XVII Simposio de Investigadores Jóvenes de la RSEQ, celebrado en la Universidad de Alcalá de Henares, 23-26 noviembre 2021.Cada año se notan más los efectos del cambio climático, que conllevan episodios de lluvia más agresivos y cambios térmicos más acusados. Estos cambios meteorológicos suponen un impacto muy grave, como el daño que pueden generar al patrimonio pétreo, altamente amenazado sobretodo en piedras blandas debido a su susceptibilidad a daños ocasionados por el agua. Las administraciones responsables de la protección del patrimonio tratan de paliar este desgaste con medidas que buscan proteger el bien de interés, pero bajo la máxima de que sean tratamientos que no alteren la apariencia física del mismo y que sean reversibles. Estos tratamientos que se realizan, si bien no son agresivos con el monumento, resultan muy costosos e ineficaces cuando, por causa de la escasez de recursos, no pueden realizarse con la frecuencia requerida (al menos una vez cada 5 años). Y esto conduce a que muchos monumentos esperando el tratamiento van abandonándose a su suerte. Nuestro equipo ya ha logrado encontrar y patentar una posible alternativa de protección basada en óxido de grafeno, de excelentes características: un recubrimiento transparente, más duradero, resistente e inocuo para la piedra. Además, se cumplen los requerimientos específicos de la protección monumental, que es no poner en riesgo el aspecto físico ni la estética del monumento. Además, mediante la actual financiación del MICINN se explorarán otros nanomateriales sostenibles y biodegradables. Esta prometedora idea supondrá que ni la economía, pues es barato y perdura su protección periodos superiores a los 10 años, ni el medio ambiente, pues buscamos recubrimientos que cumplan con los principios de sostenibilidad ambiental, fueran afectadas. Y además este proyecto combina estos trabajos y pruebas con el desarrollo de una herramienta digital SIG que permita evaluar y calcular el mejor tratamiento y su coste para distintos monumentos de un territorio, así como gestionar mejor los limitados recursos de las administraciones que custodian estos monumentos, indicando la fecha y localización de las aplicaciones y la prioridad de actuación bajo criterios objetivos.Overcoming the climatic degradation of the stone-based cultural heritage by shielding with sustainable nanomaterials (NANOSHIELD). Proyecto MICINN Retos PID2020-120439RA-I00

1st International Experts' Meeting on Agitation: Conclusions Regarding the Current and Ideal Management Paradigm of Agitation.

Agitation is a heterogeneous concept without a uniformly accepted definition, however, it is generally considered as a state of cognitive and motor hyperactivity characterized by excessive or inappropriate motor or verbal activity with marked emotional arousal. Not only the definition but also other aspects of agitated patients' care are still unsolved and need consensus and improvement. To help the discussion about agitation among experts and improve the identification, management, and treatment of agitation, the 1st International Experts' Meeting on Agitation was held in October 2016 in Madrid. It was attended by 20 experts from Europe and Latin America with broad experience in the clinical management of agitated patients. The present document summarizes the key conclusions of this meeting and highlights the need for an updated protocol of agitation management and treatment, the promotion of education and training among healthcare professionals to improve the care of these patients and the necessity to generate clinical data of agitated episodes

Health care and societal costs of the management of children and adolescents with attention-deficit/hyperactivity disorder in Spain: a descriptive analysis

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition in childhood (5.3% to 7.1% worldwide prevalence), with substantial overall financial burden to children/adolescents, their families, and society. The aims of this study were to describe the clinical characteristics of children and adolescents with ADHD in Spain, estimate the associated direct/indirect costs of the disorder, and assess whether the characteristics and financial costs differed between children/adolescents adequately responding to currently available pharmacotherapies compared with children/adolescents for whom pharmacotherapies failed. Methods: This was a multicenter, cross-sectional, descriptive analysis conducted in 15 health units representative of the overall Spanish population. Data on demographic characteristics, socio-occupational status, social relationships, clinical variables of the disease, and pharmacological and non-pharmacological treatments received were collected in 321 children and adolescents with ADHD. Direct and indirect costs were estimated over one year from both a health care system and a societal perspective. Results: The estimated average cost of ADHD per year per child/adolescent was €5733 in 2012 prices; direct costs accounted for 60.2% of the total costs (€3450). Support from a psychologist/educational psychologist represented 45.2% of direct costs and 27.2% of total costs. Pharmacotherapy accounted for 25.8% of direct costs and 15.5% of total costs. Among indirect costs (€2283), 65.2% was due to caregiver expenses. The total annual costs were significantly higher for children/adolescents who responded poorly to pharmacological treatment (€7654 versus €5517; P = 0.024), the difference being mainly due to significantly higher direct costs, particularly with larger expenses for non-pharmacological treatment (P = 0.012). Conclusions: ADHD has a significant personal, familial, and financial impact on the Spanish health system and society. Successful pharmacological intervention was associated with lower overall expenses in the management of the disorde

Performance study of graphene oxide as an antierosion coating for ornamental and heritage dolostone

9 figures, 2 tables.-- Supplementary information available.Concern for the perpetuation of stone monuments is deeply ingrained in humans; however, despite the attempts made in this field, there is still a great deal of effort needed to bring about advancements in the conservation of ornamental stone. Erosive agents, such as rain, extreme temperatures, and chemical and biological agents, threaten our stone heritage and gradually wear away buildings, sculptures, and other monuments found all around the world. Limestone and dolostone have been widely used throughout history, given their ease of extraction and workability. Nevertheless, these properties make them particularly vulnerable to the aforementioned erosive agents, for which the main solution at present is costly and time-consuming restoration. Given the scarcity of effective and durable agents to prevent the deterioration of ornamental and heritage stones, and as graphene oxide (GO) has recently shown impressive effectiveness for this task, this work will further explore the viability of GO as a protective coating for monumental dolostone. For this purpose, GO is sprayed over dolostone surfaces by water dispersion with no adjuvants. The coating performance is assessed in terms of thermal stress, optical inspection (structured light 3D scanner), colorimetry, leachate analysis, and electron microscopy. The main results show that spray-coated GO over stone surfaces creates a highly protective and durable barrier without altering their aesthetic qualities.This research received funding from the University of León (ULE-PoC 2018) and Fundación General de la ULE y de la Empresa (FGULEM) under projects 2019/00149/001 and 2020. This research was also funded through an awarded MICINN project (PID2020-120439RA-I00). The authors are also thankful to the “Applied innovation against climate change and other aggressions on stone monuments (PRESERVARTE)” project of the Regional Ministry of Culture and Tourism of Castilla y León, which will be used to complement this research in the future.Peer reviewe