Search

Background: Chronic benzodiazepine use is a challenge in primary care practice. Protocols to support safe discontinuation are still needed, especially in countries with high utilization rates.Objectives: To evaluate the feasibility, effectiveness, and safety of a benzodiazepine discontinuation protocol in primary care setting.Methods: Nonrandomized, single-arm interventional study, at primary care units. Family physicians (FPs) recruited patients (18-85 years-old) with benzodiazepine dependence and chronic daily use ≥3 months. Patients with daily dosages ≥30 mg diazepam-equivalent, taking zolpidem, with a history of other substance abuse or major psychiatric disease were excluded. After the switch to diazepam, the dosage was gradually tapered according to a standardized protocol. Primary endpoint was the percentage of patients who stopped benzodiazepine at the intervention last visit. Dosage reduction, withdrawal symptoms, patients' and FPs' satisfaction with the protocol were evaluated.Results: From 66 enrolled patients (74% female; 66.7% aged >64 years; median time of benzodiazepine use was 120 months), 2 withdrew due to medical reasons and 3 presented protocol deviations. Overall, 59.4% of participants successfully stopped benzodiazepine (60.7% when excluding protocol deviations). Men had higher probability of success (relative risk = 0.51, P = 0.001). A total of 31 patients reported at least 1 withdrawal symptom, most frequently insomnia and anxiety. Most of participating FP considered the clinical protocol useful and feasible in daily practice. Among patients completing the protocol, 77% were satisfied. For the patients who reduced dosage, 85% kept without benzodiazepines after 12 months.Conclusion: The discontinuation protocol with standardized dosage reduction was feasible at primary care and showed long-term effectiveness. [ABSTRACT FROM AUTHOR]

ABSTRACT The contamination of aquatic environments by microplastic has become a major threat to biodiversity. The presence of microplastic is documented in the aquatic fauna of the oceans, but, in the Amazon basin, reports on microplastic occurrence are few. The present study surveyed microplastic occurrence in fishes in an area of the Peruvian Amazon. We sampled 61 specimens of 15 commercial species from local markets in the city of Iquitos, Loreto Department. We detected a total of 2337 microplastic particles, 1096 in the gills and 1241 in the internal organs (esophagus, stomach, intestine, liver, gonads, pancreas, swim bladder and heart). The prevalence of microplastic particles was 100% and the overall average abundance was of 38.3 particles per individual (17.9 particles per individual in gills and 20.3 particles per individual in internal organs). Most particles were found in carnivorous fish. There was no correlation of particle abundance with fish standard length and weight. These results provided evidence of the degree of microplastic contamination of the fish fauna in the region of Iquitos.

The increasingly intense competition in organisations means that they have to develop strategies to differentiate themselves. One of these strategies consists of using internal communication to improve the company’s attractiveness to outside talent and increase its attractiveness to its existing employees. However, this relationship still needs to be studied in the existing literature. This review aims to find and understand the main recommendations to be used in internal communication to improve employer branding. Nine open access scientific articles published between 2013 and 2023 on Scopus and Web of Science, written in English, met the inclusion criteria. Internal communication has been proven to play a crucial role in employer branding. The review presents a series of guidelines that can be incorporated into internal communication to strengthen the employer brand. These relate to communication qualities, knowing how to listen to and respect employees, maintaining responsiveness, providing feedback and the flow of company-related information, and choosing the appropriate communication channels. This study contributes to the ongoing scientific community by summarising and exploring the literature from the past decade. Its findings enhance our understanding of this field of study and strongly advocate for future research.

Exploratory approaches for first-in-human clinical studies have evolved over the last few years and have stimulated the issuance of national regulatory guidances in some European countries as well as the United States. With the increasing implementation of these approaches and the recent preparation of a multiregional regulatory guidance (ICH M3 rev2), an exchange of experiences on the opportunities and challenges of exploratory clinical trials was desirable; thus, a workshop focusing on the use of this clinical approach was planned and conducted in Lisbon, Portugal, March 18–19, 2009 sponsored by the Portuguese Health Authority (INFARMED) and DIA. The structure of the workshop focused in three main areas. Regulatory representatives from Portugal, Belgium, Germany, the United Kingdom and the United States formally reviewed their experiences. This was followed by a discussion on issues from an ethics review perspective as well as an insight to the opportunities in the area of biologics. The industry perspective was presented by representatives from Merck, Pfizer, J&J, Novartis, Speedel, AstraZeneca, GSK, and Roche. Finally, through break out sessions, issues were identified to be addressed moving forward. It is the purpose of this paper to report on the outcome of this workshop. Clin Trans Sci 2010; Volume #: 1–4 [ABSTRACT FROM AUTHOR]

Three new complexes [Mo(η3-C3H5)Br(CO)2{iPrN=C(R)C5H4N}], where R = H (IMP = N-isopropyl 2-iminomethylpyridine), Me, and Ph, were synthesized and characterized, and were fluxional in solution. The most interesting feature was the presence, in the crystal structure of the IMP derivative, of the two main isomers (allyl and carbonyls exo), namely the equatorial isomer with the Br trans to the allyl and the equatorial with the Br trans to one carbonyl, the position trans to the allyl being occupied by the imine nitrogen atom. For the R = Me complex, the less common axial isomer was observed in the crystal. These complexes were immobilized in MCM-41 (MCM), following functionalization of the diimine ligands with Si(OEt)3, in order to study the catalytic activity in olefin epoxidation of similar complexes as homogeneous and heterogeneous catalysts. FTIR, 13C- and 29Si-NMR, elemental analysis, and adsorption isotherms showed that the complexes were covalently bound to the MCM walls. The epoxidation activity was very good in both catalysts for the cis-cyclooctene and cis-hex-3-en-1-ol, but modest for the other substrates tested, and no relevant differences were found between the complexes and the Mo-containing materials as catalysts.

The objective of this work is to develop a simple methodology for high resolution crop suitability analysis under current and future climate, easily applicable and useful in Least Developed Countries. The approach addresses both regional planning in the context of climate change projections and pre-emptive short-term rural extension interventions based on same-year agricultural season forecasts, while implemented with off-the-shelf resources. The developed tools are applied operationally in a case-study developed in three regions of Guinea-Bissau and the obtained results, as well as the advantages and limitations of methods applied, are discussed. In this paper we show how a simple approach can easily generate information on climate vulnerability and how it can be operationally used in rural extension services.