Prevalence of obsessive-compulsive symptoms in Schizophrenia patients treated with clozapine: an scoping review

Antecedentes: La esquizofrenia es un trastorno psiquiátrico complejo que afecta diversas funciones mentales. En pacientes tratados con clozapina, se ha observado que puede inducir o exacerbar síntomas obsesivo-compulsivos (SOC), lo cual dificulta la interpretación de los datos debido a la variabilidad en los reportes sobre su prevalencia y características. Objetivo: Esta revisión de alcance tiene como objetivo sintetizar la evidencia sobre la prevalencia de SOC en pacientes con esquizofrenia tratados con clozapina y explorar características de los síntomas (tipo y severidad), del tratamiento, la dosis promedio y el tiempo hasta la aparición o exacerbación de los síntomas. Material y métodos: Se utilizó la metodología PRISMA-ScR para guiar la búsqueda en bases de datos como PubMed, Lilacs, Embase y Scielo. Se incluyeron estudios observacionales en español, inglés, portugués y francés que reportan prevalencia, incidencia o frecuencia de SOC en pacientes mayores de 18 años con esquizofrenia tratados con clozapina. Se excluyeron estudios clínicos, cualitativos y con restricción de acceso. El riesgo de sesgo fue evaluado con herramientas del JBI. Resultados: Se incluyeron 14 estudios, reportando una prevalencia de SOC entre 20% y 76%, y SOC/TOC de novo entre 4,8% y 46,4%. La dosis promedio de clozapina fue de 196 a 525 mg/día, con un rango de tratamiento de 5 a 210 meses. Las obsesiones más comunes fueron agresión y comprobación, con severidad de leve a moderada. Conclusiones: La prevalencia de SOC en pacientes tratados con clozapina es variable y su relación con la dosis y duración del tratamiento requiere más investigación

Cross-culturally approaching the cycling behaviour questionnaire (CBQ) : Evidence from 19 countries

Peer reviewe

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Yes, size does matter (for cycling safety)! Comparing behavioral and safety outcomes in S, M, L, and XL cities from 18 countries

Although most actions aimed at promoting the use of active transport means have been conducted in ‘large’ cities, recent studies suggest that their cycling dynamics could hinder the efforts put into infrastructural, modal share, and cycling culture improvements. Aim: The present study aimed to assess the role of city sizes on riding behavioral and crash-related cycling outcomes in an extensive sample of urban bicycle users. Methods: For this purpose, a full sample of 5705 cyclists from &gt;300 cities in 18 countries responded to the Cycling Behavior Questionnaire (CBQ), one of the most widely used behavioral questionnaires to assess risky and positive riding behaviors. Following objective criteria, data were grouped according to small cities (S; population of 50,000 or fewer), medium cities (M; population between 50,000 and 200,000), large cities (L; population between 200,000 and one million), and megacities (XL; population larger than one million). Results: Descriptive analyses endorsed the associations between city size, cycling behavioral patterns, and mid-term self-reported crash outcomes. Also, it was observed a significant effect of the city size on cyclists' traffic violations and errors (all p &lt;.001). However, no significant effects of the city size on positive behaviors were found. Also, it stands out that cyclists from megacities self-reported significantly more violations and errors than any of the other groups. Further, the outcomes of this study suggest that city sizes account for cycling safety outcomes through statistical associations, differences, and confirmatory predictive relationships through the mediation of risky cycling behavioral patterns. Conclusion: The results of the present study highlight the need for authorities to promote road safety education and awareness plans aimed at cyclists in larger cities. Furthermore, path analysis suggests that “size does matter”, and it statistically accounts for cycling crashes, but only through the mediation of riders' risky behaviors.</p

Cross-culturally approaching the cycling behaviour questionnaire (CBQ) : evidence from 19 countries

Given different advances in applied literature, risky and positive behaviours keep gaining ground as key contributors for riding safety outcomes. In this regard, the Cycling Behaviour Question-naire (CBQ) represents one of the tools available to assess the core dimensions of cycling behaviour and their relationship with road safety outcomes from a behavioural perspective. Nevertheless, it has never been psychometrically approached through a cross-cultural perspec-tive. Therefore, this study aimed to perform the cross-cultural validation of the CBQ, examining its psychometric properties, reliability indexes, validity insights and descriptive scores in 19 countries distributed across five regions: Europe, America, Asia, Africa, and Oceania. For this purpose, it was used the data retrieved from a full sample of 7,001 urban cyclists responding to a large-scale electronic survey. Participants had a mean age of M = 36.15 (SD = 14.71), ranging between 16 and 83 years. The results of this large-scale study empirically support the assumption that the 29-item version of the CBQ has a fair dimensional structure and item composition, good internal consistency, reliability indexes, and an interesting set of validity insights. Among these results, there can be highlighted that: (i) Structurally speaking, the questionnaire works better under a three-factor dimensionality, keeping all its 29 items, whose factor loadings are >0.400 inGiven different advances in applied literature, risky and positive behaviours keep gaining ground as key contributors for riding safety outcomes. In this regard, the Cycling Behaviour Question-naire (CBQ) represents one of the tools available to assess the core dimensions of cycling behaviour and their relationship with road safety outcomes from a behavioural perspective. Nevertheless, it has never been psychometrically approached through a cross-cultural perspec-tive. Therefore, this study aimed to perform the cross-cultural validation of the CBQ, examining its psychometric properties, reliability indexes, validity insights and descriptive scores in 19 countries distributed across five regions: Europe, America, Asia, Africa, and Oceania. For this purpose, it was used the data retrieved from a full sample of 7,001 urban cyclists responding to a large-scale electronic survey. Participants had a mean age of M = 36.15 (SD = 14.71), ranging between 16 and 83 years. The results of this large-scale study empirically support the assumption that the 29-item version of the CBQ has a fair dimensional structure and item composition, good internal consistency, reliability indexes, and an interesting set of validity insights. Among these results, there can be highlighted that: (i) Structurally speaking, the questionnaire works better under a three-factor dimensionality, keeping all its 29 items, whose factor loadings are >0.400 inA

Yes, size does matter (for cycling safety)! Comparing behavioral and safety outcomes in S, M, L, and XL cities from 18 countries

Abstract Although most actions aimed at promoting the use of active transport means have been conducted in 'large' cities, recent studies suggest that their cycling dynamics could hinder the efforts put into infrastructural, modal share, and cycling culture improvements. Aim The present study aimed to assess the role of city sizes on riding behavioral and crash-related cycling outcomes in an extensive sample of urban bicycle users. Methods For this purpose, a full sample of 5705 cyclists from >300 cities in 18 countries responded to the Cycling Behavior Questionnaire (CBQ), one of the most widely used behavioral questionnaires to assess risky and positive riding behaviors. Following objective criteria, data were grouped according to small cities (S; population of 50,000 or fewer), medium cities (M; population between 50,000 and 200,000), large cities (L; population between 200,000 and one million), and megacities (XL; population larger than one million). Results Descriptive analyses endorsed the associations between city size, cycling behavioral patterns, and mid-term self-reported crash outcomes. Also, it was observed a significant effect of the city size on cyclists' traffic violations and errors (all p < .001). However, no significant effects of the city size on positive behaviors were found. Also, it stands out that cyclists from megacities self-reported significantly more violations and errors than any of the other groups. Further, the outcomes of this study suggest that city sizes account for cycling safety outcomes through statistical associations, differences, and confirmatory predictive relationships through the mediation of risky cycling behavioral patterns. Conclusion The results of the present study highlight the need for authorities to promote road safety education and awareness plans aimed at cyclists in larger cities. Furthermore, path analysis suggests that 'size does matter', and it statistically accounts for cycling crashes, but only through the mediation of riders' risky behaviors

Cross-culturally approaching the cycling behaviour questionnaire (CBQ): Evidence from 19 countries

Given different advances in applied literature, risky and positive behaviours keep gaining ground as key contributors for riding safety outcomes. In this regard, the Cycling Behaviour Questionnaire (CBQ) represents one of the tools available to assess the core dimensions of cycling behaviour and their relationship with road safety outcomes from a behavioural perspective. Nevertheless, it has never been psychometrically approached through a cross-cultural perspective. Therefore, this study aimed to perform the cross-cultural validation of the CBQ, examining its psychometric properties, reliability indexes, validity insights and descriptive scores in 19 countries distributed across five regions: Europe, America, Asia, Africa, and Oceania. For this purpose, it was used the data retrieved from a full sample of 7,001 urban cyclists responding to a large-scale electronic survey. Participants had a mean age of M = 36.15 (SD = 14.71), ranging between 16 and 83 years. The results of this large-scale study empirically support the assumption that the 29-item version of the CBQ has a fair dimensional structure and item composition, good internal consistency, reliability indexes, and an interesting set of validity insights. Among these results, there can be highlighted that: (i) Structurally speaking, the questionnaire works better under a three-factor dimensionality, keeping all its 29 items, whose factor loadings are &gt;0.400 in all cases; (ii) The CBQ shows greater reliability indexes than in previous applications using smaller samples, with good Cronbach’s alphas [0.768 - 0.915], McDonald’s omegas [0.770 - 0.913] and Composite Reliability Indexes [981 - 0.994]; and (iii) Robust tests comparing riding behaviours of riders with different levels of risk perception and crash involvement support the concurrent validity of the Cycling Behaviour Questionnaire. These outcomes endorse the usefulness of the CBQ to assess both risky and positive riding behaviours of cyclists in different countries, contributing to assess and improve cycling safety from the human factors approac

Colombian surgical outcomes study insights on perioperative mortality rate, a main indicator of the lancet commission on global surgery – a prospective cohort studyResearch in context

Summary: Background: Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia. Methods: A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions. Findings: 3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively. Interpretation: The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care. Funding: This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017