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Introduction Thrombectomy in the carotid artery territory was recently shown to be effective up to 24 hours after symptoms onset. Methods We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6 hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. Results Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting > 50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24 hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. Conclusion In our experience, mechanical thrombectomy beyond 6 hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24 hours after onset merits study.

Resumen Introduccion El fenomeno de Raynaud (FR) es una respuesta vascular exagerada al frio o al estres que se manifiesta por cambios de coloracion de la piel; puede ser primario (RP) o secundario (RS). El objetivo de esta revision sistematica de la literatura (RSL) es describir y analizar las principales diferencias para la deteccion de cambios vasculares en FR entre la capilaroscopia (NC) y la termografia infrarroja (TRI). Metodos RSL siguiendo guias Prisma en las siguientes fuentes de informacion: Medline, Cochrane, Pubmed, ClinicalKey y ScienceDirect. Criterios de inclusion: articulos publicados hasta septiembre del 2020, observacionales o analiticos, que incluyeran poblacion con FR (primario o secundario), con evaluacion diagnostica concomitante utilizando NC (microscopica o videocapilaroscopia) y TRI. En la construccion de las ecuaciones de busqueda se utilizaron terminos MeSH («Thermography», «Microscopic angioscopy») y diferentes «Keywords» cruzadas a traves de diferentes operadores booleanos. Se utilizo la herramienta «Joanna Briggs Institute Critical Appraisal Tools for Use in Systematic Reviews Checklist» para evaluar el riesgo de sesgo. Se siguio la guia SWiM para sintetizar y presentar los resultados. Resultados Se identificaron 1.397 articulos, de los que luego de cribado y elegibilidad, se incluyeron cinco. Contemplaron poblaciones diferentes, evaluadas con equipos diferentes, dos articulos en ninos y tres articulos en adultos. La poblacion fue predominantemente caucasica y de genero femenino, en total 403 individuos (79 menores de edad). Los dos estudios realizados en poblacion pediatrica presentan resultados no concordantes y los estudios en poblacion adulta presentan similitudes en sus resultados (NC tecnica diagnostica que mejor discrimina RP de RS), pero con patologias del tejido conectivo asociadas a RS diferentes. Discusion A traves de RSL se presentan hallazgos microvasculares de dos herramientas diagnosticas (NC y TRI) cuando se utilizan de manera concomitante en el FR. No se puede concluir a partir de los cinco articulos que existan diferencias claras o ventajas/desventajas en el uso preferente de una de las dos tecnicas diagnosticas en el FR; el valor de la NC destaca para la diferencia entre RP y RS. Se requieren nuevos estudios para analizar diferencias entre las dos tecnicas.

Introduction The safety of electroconvulsive therapy has improved greatly over the last decades, making the potentially adverse effects on memory and other neurocognitive functions the main clinical aspect of concern in the present. In Colombia, the general population and healthcare professionals (even some psychiatrists) seem to have mostly negative opinions towards electroconvulsive therapy treatment, but maybe this could be reconsidered if more information is provided; therefore, the aim of the present study was to evaluate the changes in memory and the severity of the symptoms in a group of patients with severe depression before and after electroconvulsive therapy. Methods Twenty-three patients ranging in age from 23 to 70 years from the electroconvulsive therapy service at the San Juan de Dios Clinic (Manizales, Colombia) were recruited in order to assess the effect of electroconvulsive therapy on memory in patients with severe depression. Depressive symptoms and memory were assessed with the Hamilton Depression Scale (HAMD) and Rey Auditory Verbal Learning Test (RAVLT), respectively. The assessment was administered to participants before the initial treatment of electroconvulsive therapy series (0-1 day) and 2 days after their last treatment. Results Electroconvulsive therapy resulted in significant improvement in the rating of depression. There were no significant differences in the five learning trials, delayed recall, learning and forgetting scores from pre-treatment to post-treatment. Significant pre-treatment/post-treatment differences were found in the delayed recognition trial. Conclusions Pre- and post- electroconvulsive therapy cognitive assessment is a feasible and useful procedure. In general, memory performance does not worsen after electroconvulsive therapy in patients with depression. Only delayed recognition is affected a few days following electroconvulsive therapy, particularly in patients with low educational level and bitemporal (BT) electrode placement.

Resumen La retinopatia de Purtscher-like es una enfermedad ocular poco comun que se manifiesta con perdida subita de la vision, asociada con una patologia sistemica como lo es el lupus eritematoso sistemico. Se presenta el caso de un paciente masculino de 25 anos, con retinopatia Purtscher-like como primera manifestacion de lupus eritematoso sistemico, evaluado en un centro de alta complejidad de la ciudad de Medellin, Colombia. Se observa mejoria de signos y sintomas posteriormente al inicio de corticosteroides y terapia con ciclofosfamida intravenosa mensual. Se considera fundamental la valoracion oftalmologica temprana en pacientes con sospecha de enfermedades autoinmunes, para realizar diagnosticos tempranos y mejorar el pronostico de los pacientes.

An important window into sensorimotor function is how humans interact and stop moving projectiles, such as stopping a door from closing shut or catching a ball. Previous studies have suggested that humans time the initiation and modulate the amplitude of their muscle activity based on the momentum of the approaching object. However, real-world experiments are constrained by laws of mechanics, which cannot be manipulated experimentally to probe the mechanisms of sensorimotor control and learning. An augmented-reality variant of such tasks allows for experimental manipulation of the relationship between motion and force to obtain novel insights into how the nervous system prepares motor responses to interact with moving stimuli. Existing paradigms for studying interactions with moving projectiles use massless object and are primarily focused on quantifying gaze and hand kinematics. Here, we developed a novel collision paradigm using a robotic manipulandum where participants mechanically stopped a virtual object moving in the horizontal plane. On each block of trials, we varied the virtual object’s momentum by increasing either its speed or mass. Participants stopped the object by applying a force impulse that matched the object momentum. We observed that arm force increased as a function of object momentum linked to changes in virtual mass or speed, mirroring results from studies involving catching free-falling objects. In addition, increasing object speed resulted in later onset of hand force relative to the impending time-to-contact. These findings show that the present paradigm can be used to determine how humans process projectile motion for hand motor control.

Resumen Introduccion La miastenia gravis (MG) es un enfermedad autoinmune que afecta a la transmision nerviosa a nivel de la union neuromuscular causando debilidad muscular tipicamente fluctuante. Los estudios epidemiologicos constatan un aumento de las tasas de prevalencia de la MG y es especialmente evidente en la poblacion anciana. Objetivo Realizar un estudio epidemiologico retrospectivo para conocer las tasas de incidencia y prevalencia en la provincia de Ourense (Galicia) caracterizada por el envejecimiento poblacional. Material y metodos Los pacientes fueron reclutados de nuestra base de datos clinica de enfermedades neuromusculares y a traves de la busqueda de pacientes con prescripcion activa de bromuro de piridostigmina. La tasa de incidencia se estimo entre los anos 2009-2018. Se establecio la fecha de prevalencia al 31/12/2018. El censo de la provincia de Ourense al 1/1/2019 era de 307.651 habitantes, de los que 96.544 (31,4%) tenian una edad ≥ de 65 anos. Resultados Se identificaron 80 casos de MG. La prevalencia fue de 260 casos/1.000.000 habitantes (IC95%: 202,7-316,4), y en la poblacion ≥ 65 anos de 517,9/1.000.000 habitantes (IC95%: 363,2-672,9). La incidencia acumulada en el periodo de estudio fue de 15,4 casos/1.000.000 habitantes-ano. El inicio precoz (≤ 50 anos) ocurrio en el 29,1% de los casos. Conclusion La prevalencia de la MG en nuestra area sanitaria es de las mas altas entre las cifras previamente reportadas, y es una enfermedad muy prevalente en la poblacion anciana.

Background: Despite many publications on rehabilitation after repair of flexor tendon injuries of the hand, there is no consensus as to which method is superior. It is clear that nonadherence to postoperative therapy adversely affects the outcome after flexor tendon surgery. In the context of a developing country, the most important factor associated with poor outcome is late onset of rehabilitation therapy. An autonomous rehabilitation program is proposed, with the use of a low-cost splint and based on an online illustrative video with the expectation to improve adherence and patient compliance, thus ensuring satisfactory outcome. Methods: Twenty-two consecutive digits of 14 patients after flexor tendon repair in zone II were included. Autonomous early passive mobilization physical therapy and splinting started shortly after surgery, supported by an online available video depicting prescribed exercises; follow-up was continued until postoperative week 20. Patients were evaluated regarding range of motion, grip strength, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) disability scale. Results: Range of motion after 20 weeks according to the scoring system of the American Society of Surgery of Hand was excellent in 4, good in 11, and fair in 4 fingers. The mean total active motion score was 86% (95% confidence interval, 78%-93%). The mean grip strength at final follow-up was 86% of the contralateral hand. The mean QuickDASH score was 12.5 (2.3-31.8). Conclusion: This protocol achieves good results in range of motion and early return of function of the hand. We propose this simple, nonexpensive method to developing countries with less than optimal availability of health care.

Resumen Introduccion El sindrome de alfa-gal es una alergia alimentaria potencialmente grave producido por la presencia de IgE especifica para alfa-gal. El objetivo de este estudio es describir nuestra serie de 13 pacientes. Material y metodos Estudio retrospectivo de pacientes diagnosticados entre 2016 y 2017. Se realizaron pruebas cutaneas con extracto comercial y gelaspan asi como determinacion de IgE especifica para alfa-gal y diferentes tipos de carne. Resultados Se analizo a 13 pacientes diagnosticados de sindrome de alfa-gal, 9 de ellos con anafilaxia, de los cuales 6 habian sido diagnosticados de anafilaxia idiopatica. Todos presentaron prueba cutanea con gelaspan positiva, y no asi con los extractos comerciales, cuyos resultados fueron menos concluyentes. Conclusiones Creemos que la anafilaxia idiopatica puede esconder pacientes con sindrome de alfa-gal. La prueba cutanea con gelaspan es mas util que los extractos comerciales.

Introduction Alpha-gal syndrome is a potentially severe food allergy caused by the presence of alpha-gal-specific IgE. The aim of this study is to describe our series of 13 patients. Material and methods This work is a retrospective study of patients diagnosed in 2016 and 2017. Skin tests were performed with commercial extract and gelaspan as well as specific IgE determination for alpha-gal and different types of meat. Results Thirteen patients diagnosed with alpha-gal syndrome were analyzed; 9 of them had anaphylaxis, 6 of whom had been diagnosed with idiopathic anaphylaxis. All had a positive skin test with gelaspan, though this was not true with the commercial extracts, whose results were less conclusive. Conclusions We believe that a diagnosis of idiopathic anaphylaxis may prevent the identification of patients with alpha-gal syndrome. The gelaspan skin test is more useful than commercial extracts.

Introduction A burn injury is a very painful experience, with subsequent emotional problems, which have been gaining relevance to the extent that survival from burns has improved. Among the alterations of the mental sphere in this population is Acute Stress Disorder (ASD) that has been described in up to one-third of patients with major burns. Methodology A nested case-control study was carried out in a cohort of hospitalized patients in a burn referral unit, in patients over 16 years of age. A total of 135 patients, 41 cases, and 94 controls were included. All of them underwent a psychiatric interview, a standardized form was filled out on sociodemographic and clinical information, and the PID-5-BF scale was applied to evaluate associated personality elements. The diagnosis of acute stress was made with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Results The incidence of acute stress was 23.4%. When the clinical and sociodemographic characteristics of both the cases and the controls were compared, the risk factors were subsidized insurance, flame burn, burn in a special area, third-degree burn, high pain, stay in the Intensive Care Unit (ICU), peritraumatic amnesia and life threat. Patients also had a higher percentage of burned body surface, higher average pulse, longer hospital length of stay, higher average in the negative affect variable and in the psychoticism variable of the PID-5-BF scale. But for the multivariate analysis using logistic regression, the model that best explains the presence of acute stress only includes the variables life threat (Odds Ratio adjusted (ORa): 117.0; Confidence Interval (CI): 10.9-1258.5), severe pain (ORa: 9.9; CI: 1.8-52.8), electrical burn (ORa: 20.8; CI: 17.2-250), burn in a special area (ORa: 8.9; CI: 1, 0-76.8), third-degree burn (ORa: 10.4; CI: 0.7-166.7). Conclusion Acute stress disorder is frequent in the hospitalised burn population, and is more frequent than in other types of trauma. Associated factors with the presentation of Acute Stress Disorder are the feeling of life threat at the time of the burn, having pain classified as strong (Visual Analog Scale (VAS) 5-10), electrical burn, and burns in special areas.

Background: The aims are to evaluate the morphometry of the sellar region and propose a safety window on the floor of the sella turcica for the transsphenoidal approach in a Hispanic population. Materials and methods: We retrospectively analyzed 150 computed tomographic angiography sellar region images from asymptomatic patients. The images were evaluated intraobservatory by an expert radiologist. We measured: intercarotid distance of cavernous segment; depth of sella turcica; skull base angle; anterior distance, the distance between anterior spinal nasal and floor of the sella turcica; posterior distance, the distance between anterior spinal nasal and posterior wall of the sella turcica; anterior surgical angle, formed between the floor of the nostril and superior limit of the anterior wall of the sella turcica; and posterior angle, formed between the floor of the nostril and the inferior limit of the posterior wall of the sella turcica. Results: Safety window was based on two measures: the intercarotid distance and depth. The mean of the safety window is 151.13 mm 2 and 147.60 mm 2 for men and women respectively. The intercarotid distance was 17.83 mm. The depth of the sella turcica was 8.46 mm. The skull base angle was 112.13 grades. The anterior distance was 76.34 mm. The posterior distance was 87.59 mm. The anterior surgical angle was 32.76 grades. The posterior surgical angle was 87.59 grades. Conclusions: The surgical approach space is smaller in females. It could significate a more complicated surgery in this population. Anatomical understanding could reduce complications in hospitals without a neuronavigation system. The project was previously reviewed and approved by the local ethics and research committees of the University with the approval number AH19-00002 on April 25, 2019.

Resumen Objetivos Estudiar la distribucion espacio-temporal de los casos de enfermedad neumococica invasora (ENI) por serotipos resistentes a eritromicina y su relacion con el consumo comunitario de macrolidos y la cobertura vacunal infantil. Metodos Se seleccionaron los casos de ENI en mayores de 59 anos residentes en la Comunidad de Madrid (CM) notificados en el periodo de 2007 a 2016. Las variables estudiadas fueron obtenidas de los sistemas de informacion vacunal y de Prestacion Farmaceutica. Se utilizo el punto de corte (concentracion minima inhibitoria de eritromicina > 0,5 mg/L) de la clasificacion de EUCAST para definir los serotipos resistentes a eritromicina. Mediante JointPoint se estimaron las tendencias de las incidencias de casos por serotipos resistentes a eritromicina incluidos en la vacuna trecevalente (STVCN13) y no incluidos (STnoVCN13). La asociacion de esas incidencias con el consumo comunitario de macrolidos y la cobertura vacunal se hizo mediante modelos de Poisson. Para la deteccion de clusteres espacio-temporales se utilizo el estadistico Satscan. Resultados Se identificaron 1.936 casos, de ellos, se detecto que 427 serotipos eran resistentes a la eritromicina. La incidencia de todos los casos por serotipos resistentes fue descendente (AAPC: -5,40%). La incidencia de casos por STVCN13 resistentes a la eritromicina fue descendente con un porcentaje anual del cambio (APC: -13,8) y estuvo asociada inversamente a la cobertura vacunal infantil (IRR 0,641), mientras que la de casos por STnoVCN13 resistentes a eritromicina fue ascendente (APC: 4,5) y no se asocio con la cobertura. Se detecto un cluster por STnoVCN13 y ninguno por STVCN13 tras la inclusion de la trecevalente en el calendario vacunal infantil. Conclusiones El descenso de ENI por STVCN13 resistentes se asocio con el incremento de la cobertura vacunal infantil. La presencia de clusteres de casos por STnoVCN13, en el periodo posterior a la inclusion de la VCN13, indica reemplazo de serotipos. El aumento de los casos por STnoVCN13 resistentes podria estar relacionado por el reemplazo de los serotipos vacunales en la colonizacion nasofaringea, facilitada por el consumo de macrolidos todavia a niveles altos en la CM.

Statement of problem Artificial intelligence applications are increasing in prosthodontics. Still, the current development and performance of artificial intelligence in prosthodontic applications has not yet been systematically documented and analyzed. Purpose The purpose of this systematic review was to assess the performance of the artificial intelligence models in prosthodontics for tooth shade selection, automation of restoration design, mapping the tooth preparation finishing line, optimizing the manufacturing casting, predicting facial changes in patients with removable prostheses, and designing removable partial dentures. Material and methods An electronic systematic review was performed in MEDLINE/PubMed, EMBASE, Web of Science, Cochrane, and Scopus. A manual search was also conducted. Studies with artificial intelligence models were selected based on 6 criteria: tooth shade selection, automated fabrication of dental restorations, mapping the finishing line of tooth preparations, optimizing the manufacturing casting process, predicting facial changes in patients with removable prostheses, and designing removable partial dentures. Two investigators independently evaluated the quality assessment of the studies by applying the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies (nonrandomized experimental studies). A third investigator was consulted to resolve lack of consensus. Results A total of 36 articles were reviewed and classified into 6 groups based on the application of the artificial intelligence model. One article reported on the development of an artificial intelligence model for tooth shade selection, reporting better shade matching than with conventional visual selection; 14 articles reported on the feasibility of automated design of dental restorations using different artificial intelligence models; 1 artificial intelligence model was able to mark the margin line without manual interaction with an average accuracy ranging from 90.6% to 97.4%; 2 investigations developed artificial intelligence algorithms for optimizing the manufacturing casting process, reporting an improvement of the design process, minimizing the porosity on the cast metal, and reducing the overall manufacturing time; 1 study proposed an artificial intelligence model that was able to predict facial changes in patients using removable prostheses; and 17 investigations that developed clinical decision support, expert systems for designing removable partial dentures for clinicians and educational purposes, computer-aided learning with video interactive programs for student learning, and automated removable partial denture design. Conclusions Artificial intelligence models have shown the potential for providing a reliable diagnostic tool for tooth shade selection, automated restoration design, mapping the preparation finishing line, optimizing the manufacturing casting, predicting facial changes in patients with removable prostheses, and designing removable partial dentures, but they are still in development. Additional studies are needed to further develop and assess their clinical performance.

OBJETIVE To characterise the impact of the COVID-19 pandemic on psychiatric hospitalisations in the Latin American and Caribbean (LAC) region. METHODS Descriptive study. 85 semi-structured interviews were conducted with health workers involved with psychiatric hospitalisations in general hospitals (GHs) and specialised psychiatric hospitals (SHs) from 18 LAC countries. The interviews were done between 8 May and 30 June 2020. The data were analysed quantitatively and qualitatively. RESULTS An initial decrease in the demand for hospitalisation is reported, attributed to the population's fear of approaching health services as well as restrictions on mobility. Stricter criteria for hospitalisation were reported with a double focus on the acute within the acute. The length of hospitalisations were mixed, with both increases and decreases in GHs and SHs. The therapeutic offer was drastically reduced, and interaction between hospitalised people and their support networks was restricted. CONCLUSIONS In the COVID-19 context, hospitalisation seems to be not the last but the only alternative for psychiatric treatment. The decrease in the number of beds in SHs could be a positive aspect for the reform of psychiatric care, but it is questioned since this reduction also occurs in GHs.

Resumen Introduccion El objetivo de este estudio es crear un modelo predictivo de estancia postoperatoria prolongada (EPP) en pacientes sometidos a reseccion pulmonar anatomica, validarlo en una serie externa y evaluar la influencia de la EPP en el reingreso y la mortalidad a 90 dias. Metodos Se incluyeron todos los pacientes registrados en la base de datos del GEVATS dados de alta tras la intervencion. Definimos la EPP como la permanencia postoperatoria en dias por encima del percentil 75 de estancia de todos los pacientes de la serie. Se realizo un analisis univariable y multivariable mediante regresion logistica y el modelo fue validado en una cohorte externa. Se analizo la posible asociacion entre la EPP y el reingreso y la mortalidad a 90 dias. Resultados Se incluyeron en el estudio 3473 pacientes. La mediana de estancia postoperatoria fue de 5 dias (RIQ:4-7). Ochocientos quince pacientes tuvieron una EPP (≥8 dias), de los que el 79,9% presentaron complicaciones postoperatorias. El modelo final incluyo como variables: edad, IMC, sexo varon, VEF1%ppo, DLCO%ppo y toracotomia; el AUC en la serie de derivacion fue de 0,684 (IC95%: 0,661-0,706) y en la de validacion de 0,73 (IC95%: 0,681-0,78). Se encontro una asociacion significativa entre la EPP y el reingreso (p Conclusiones Las variables edad, IMC, sexo varon, VEF1%ppo, DLCO%ppo y toracotomia afectan a la EPP. La EPP se asocia con un incremento del riesgo de reingreso y mortalidad a 90 dias. El 20% de las EPP no se relacionan con la ocurrencia de complicaciones postoperatorias.

Summary Background & aims COVID-19 patients present a high hospitalization rate with a high mortality risk for those requiring intensive care. When these patients have other comorbid conditions and older age, the risk for severe disease and poor outcomes after ICU admission are increased. The present work aims to describe the preliminary results of the ongoing NUTRICOVID study about the nutritional and functional status and the quality of life of adult COVID-19 survivors after ICU discharge, emphasizing the in-hospital and discharge situation of this population. Methods A multicenter, ambispective, observational cohort study was conducted in 16 public hospitals of the Community of Madrid with COVID-19 survivors who were admitted to the ICU during the first outbreak. Preliminary results of this study include data retrospectively collected. Malnutrition and sarcopenia were screened at discharge using MUST and SARC-F; the use of healthcare resources was measured as the length of hospital stay and requirement of respiratory support and tracheostomy during hospitalization; other study variables were the need for medical nutritional treatment; and patients’ functional status (Barthel index) and health-related quality of life (EQ-5D-5L). Results A total of 176 patients were included in this preliminary analysis. Most patients were male and older than 60 years, who suffered an average (SD) weight loss of 16.6% (8.3%) during the hospital stay, with a median length of stay of 53 (27–89.5) days and a median ICU stay of 24.5 (11–43.5) days. At discharge, 83.5% and 86.9% of the patients were at risk of malnutrition and sarcopenia, respectively, but only 38% were prescribed medical nutrition therapy. In addition, more than 70% of patients had significant impairment of their mobility and to conduct their usual activities at hospital discharge. Conclusions This preliminary analysis evidences the high nutritional and functional impairment of COVID-19 survivors at hospital discharge and highlights the need for guidelines and systematic protocols, together with appropriate rehabilitation programs, to optimize the nutritional management of these patients after discharge.

In recent years, the introduction of a series of biological drugs for the treatment of psoriasis has considerably increased the therapeutic armamentarium of doctors, and thus a strongly positive impact on the control of this condition has been achieved. With the purpose to provide the best recommendations for the use of these biological agents in patients with psoriasis, the Mexican group of psoriasis experts, PSOMEX, has developed recommendations in order to improve the understanding and therapeutic positioning of this type of medications.En los últimos años, la introducción de diversos medicamentos biológicos para el tratamiento de la psoriasis ha aumentado considerablemente el arsenal terapéutico del médico, con lo cual se ha logrado un fuerte impacto positivo en el control de la enfermedad. Con el fin de proveer de las mejores recomendaciones para el uso de estos biológicos en los pacientes afectados de psoriasis, el grupo mexicano de expertos en psoriasis PSOMEX ha formulado recomendaciones para mejorar la comprensión y el posicionamiento terapéutico de este tipo de medicamentos.

Introduction and objectives Quantification of cardiovascular risk has been based on scores such as Framingham, Framingham-REGICOR, SCORE or Life's Simple 7 (LS7). In vitro, animal, and randomized clinical studies have shown that polyphenols may provide benefits to the vascular system and reduce the inflammatory response. However, some clinical-epidemiological studies have yielded inconsistent results. Our aim was to assess the possible association between intake of the various polyphenol classes and established cardiovascular scores. Methods This cross-sectional analysis involved 6633 PREDIMED-Plus study participants. Food polyphenol content was estimated by a semiquantitative food frequency questionnaire , adjusted for total energy intake according to the residual method. The association between polyphenol intake and cardiovascular risk was tested using linear regression analyses. Results Total polyphenol and flavonoid intake were directly and significantly associated only with the LS7 scale. Intake of lignans was directly and significantly associated with SCORE and LS7 scales, stilbene intake with SCORE, and phenolic acid intake with Framingham and Framingham-REGICOR scores. Other polyphenol classes were associated in a protective and significant manner in Framingham, SCORE and LS7 scores. In women, intake of all the polyphenol classes, except phenolic acids, showed a protective trend in the results of the Framingham, Framingham-REGICOR scores and LS7 scale. Conclusions An inverse association was found between consumption of the ‘other polyphenols’ class and, especially among women, with estimated cardiovascular risk. The results were similar to those of Framingham, Framingham-REGICOR and LS7 (after eliminating the diet component) and differed from those of SCORE, but the predictors included were limited in the latter case.

Background: Heart failure (HF) with preserved ejection fraction (HFpEF) and monoclonal gammopathy of uncertain significance (MGUS) are two entities that share pathophysiological mechanisms. The aim herein, was to assess the prevalence of MGUS in patients with HFpEF and no left ventricular (LV) hypertrophy, as well as its association with a pre-specified clinical endpoint at 12 months. Methods: The present study prospectively enrolled 69 patients admitted with HF, with ejection fraction ≥ 50%, and LV wall thickness < 12 mm. All patients were screened for MGUS. Clinical events were determined over a 12 month follow-up. The pre-specified composite clinical endpoint was readmission for HF or death. Results: The prevalence of MGUS in this population was 13%. There were no differences in the incidence of the composite clinical endpoint between patients with and without MGUS. Multivariate analysis showed that treatment with angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) was associated with fewer clinical events (HR: 0.153, 95% CI: 0.037–0.622, p = 0.009) and indicated a trend to lower risk of readmission for HF and death. Beta-blockers were associated with lower rates of the composite clinical endpoint (HR: 0.192, 95% CI: 0.05–0.736, p = = 0.016), readmission for HF (HR: 0.272, 95% CI: 0.087–0.851, p = 0.025) and indicated a trend to lower mortality. Moreover, potassium serum levels > 5 mEq/L were associated with higher rates of the composite endpoint (HR: 6.074, 95% CI: 1.6–22.65, p = 0.007). Conclusions: The prevalence of MGUS in patients with HFpEF without hypertrophy was 3-fold that of the general population. There was no significant correlation between clinical outcomes and the presence of MGUS. Beta-blockers and ACEIs/ARBs reduced the composite of mortality and readmissions for HF in HFpEF patients. Hyperpotassemia was related to worse prognosis, This work was supported by grants from Instituto de Salut Carlos III (PI19/00655), financed jointly with European Regional Development Funds (ERDF)

Postmortem normothermic regional perfusion (NRP) is a rising preservation strategy in controlled donation after circulatory determination of death (cDCD). Herein, we present results for cDCD liver transplants performed in Spain 2012-2019, with outcomes evaluated through December 31, 2020. Results were analyzed retrospectively and according to recovery technique (abdominal NRP [A-NRP] or standard rapid recovery [SRR]). During the study period, 545 cDCD liver transplants were performed with A-NRP and 258 with SRR. Median donor age was 59 years (interquartile range 49-67 years). Adjusted risk estimates were improved with A-NRP for overall biliary complications (OR 0.300, 95% CI 0.197-0.459, p

Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving "Aortic teams" made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of "AORTIC TEAM"(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended.

Resumen Objetivo Valoracion de la tasa de reintervencion en pacientes con margenes de reseccion positivos tras cirugia conservadora inicial por cancer de mama y estimacion del coste para el hospital. Metodos Estudio observacional de la tasa de afectacion de los margenes quirurgicos de la pieza de reseccion tras la cirugia conservadora inicial en mujeres con carcinoma de mama invasor durante los anos 2018-2019 en el H. U. de Tarragona Joan XXIII (HUTJ23), estableciendo en que casos fue precisa la realizacion de una segunda intervencion sobre la mama. Se estiman los costes directos anadidos que supone el segundo procedimiento quirurgico y se compara con el gasto segun los pesos establecidos por el Servicio Catalan de Salud segun el nivel del hospital y los Grupos Relacionados por el Diagnostico (GRD) fijados por el Sistema Nacional de Salud. Resultados Se incluyo a 146 pacientes con diagnostico de cancer de mama invasor. Encontramos margenes positivos tras la cirugia conservadora inicial en el 20,55% de los casos. Se reintervino al 19,17% del total de pacientes, generando las reintervenciones un coste de 129.696,089€, siendo 82.654,34€ para cirugia conservadora (3.757,01€ de media por paciente) y de 47.042,55€ en las mastectomias (6.720,36€ de media por paciente). Conclusiones La afectacion de los margenes tras cirugia conservadora de la mama es sinonimo de reintervencion, lo que supone una serie de costes directos que dependen del tipo de cirurgia y el regimen escogido (ambulatoria u hospitalizada). Es recomendable controlar los factores que inciden en los margenes afectos para minimizar su impacto.

Resumen Introduccion Las baterias neuropsicologicas empleadas tradicionalmente para el diagnostico del deterioro cognitivo (DC) en la esclerosis multiple son pruebas complejas que conllevan mucho tiempo. Se necesitan test mas simples para detectar el DC en la practica clinica diaria. Objetivo Evaluar la validez diagnostica y la fiabilidad de la escala Montreal Cognitive Assessment (MoCA) como herramienta de cribado de DC en la esclerosis multiple frente a la Bateria Neuropsicologica Breve. Material y metodos Se seleccionaron 52 pacientes (61,5% mujeres, edad media [desviacion estandar] 41,7 [11,5] anos). Se analizaron la fiabilidad (consistencia interna, interobservador y test-retest) y la validez de constructo (analisis factorial, coeficiente de correlacion de Pearson y coeficiente de determinacion) y de criterio (curva ROC, sensibilidad, especificidad, acuerdo global, valores predictivos positivo y negativo, cocientes de probabilidad positivo y negativo y nomograma de Fagan). Resultados La prevalencia de DC fue del 21,2% segun la Bateria Neuropsicologica Breve y del 25% segun el MoCA. El MoCA mostro buena consistencia interna (alfa de Cronbach 0,822) y buena fiabilidad interobservador y test-retest (coeficiente de correlacion intraclase de 0,80 y 0,96, respectivamente). El coeficiente de correlacion entre la puntuacion total de la Bateria Neuropsicologica Breve y el MoCA fue de 0,82. El punto optimo de corte en la curva ROC fue 25-26, con una sensibilidad del 91% y una especificidad del 93%. Conclusion El MoCA es una herramienta de cribado valida y fiable para la deteccion de DC en pacientes con esclerosis multiple.

Introduction Widespread white matter abnormalities and alterations in glutamate levels have been reported in patients with schizophrenia. We hypothesized that alterations in white matter integrity and glutamate levels in individuals at clinical high risk (CHR) for psychosis are associated with the subsequent development of psychosis. Methods Participants included 33 antipsychotic naive CHR (Female 7/Male 26, Age 19.55 (4.14) years) and 38 healthy controls (Female 10/Male 28, Age 20.92 (3.37) years). Whole brain diffusion tensor imaging for fractional anisotropy (FA) and right frontal white matter proton magnetic resonance spectroscopy for glutamate levels were acquired. CHR participants were clinically followed for 2 years to determine conversion to psychosis. Results CHR participants that transitioned to psychosis (N = 7, 21%) were characterized by significantly lower FA values in the posterior thalamic radiation compared to those who did not transition and healthy controls. In the CHR group that transitioned to psychosis only, positive exploratory correlations between glutamate levels and FA values of the posterior thalamic radiation and the retrolenticular part of the internal capsule and a negative correlation between glutamate levels and the cingulum FA values were found. Conclusion The results of the present study highlight that alterations in white matter structure and glutamate are related with the conversion to psychosis.

OBJECTIVE To analyze the clinical and radiologic results, the survival and complications obtained in 70 year or older patients who underwent cementless total knee arthroplasty (TKA). MATERIAL AND METHOD An observational study of patients operated between January 2014 and December 2016 was carried out according to the Natural Knee model (Zimmer®, USA). The main variables were the Oxford Knee Score, the visual analog scale, the presence of radiolucencies, complications, survival and reasons for revision. RESULTS Of 104 TKA, 86 were available for revision. The median age was 76 years. The mean follow-up was 5.4 years (range 3.7-6.9). The Oxford Knee Score punctuation showed a median of 17 presurgical (range 0-40) and 37 post surgical (range 5-48), P

PURPOSE: SSFS is an underdiagnosed complication of craniectomized patients, which mainly presents with headache, motor weakness, and cognitive impairments. In these patients, cranioplasty improves these symptoms. Furthermore, patients without a classical SSFS have been shown to improve their neurological functions after reconstructive surgery. Amongst the many different pathophysiological theories proposed, the changes of CBP caused by the cranial defect might have a role in the neurological deficiencies. We have studied CBP in twelve cortical areas of both hemispheres, using 99mTc-HMPAO SPECT-CT before and after cranioplasty.METHODS: Twenty-eight craniectomized patients subject to reconstructive surgery were studied with 99mTc- HMPAO in three different times, before cranioplasty, a week after, and three months later. The images were processed with quantification software comparing CBP of 24 cortical areas with a reference area , and with a database of normal individuals. A mixed effects model was used to determine the signification of CBP changes in the cortex regions of both the damaged and undamaged brain hemispheres.RESULTS: CBP increased significantly in both hemispheres after cranioplasty both in ratio (β=0.019 p-value=0,030 first post-surgical SPECT-CT and β=0.021 p-value=0,015 in the second study, vs. pre-surgical) and Z-score (β=0.220 p-value=0,026 and β=0.279 p-value=0,005 respectively). Nine of twelve areas of the damaged side had a significant lower CBP ratio and Z-score than the undamaged. Posterior cingulate showed an increased CBP ratio (p-value=0,034) and Z-score(p-value0,028) in the first post-surgical SPECT-CT.CONCLUSION: CBP changes significantly in specific cortical areas after cranioplasty, which might explain the clinical improvements observed. Posterior cingulate changes might explain some improvements in attention impairments described. 99mTc-HMPAO SPECT-CT might be a valid tool to assess CBP changes in these patients and could have a role in the management of craniectomized individuals.CLINICAL TRIAL REGISTRATIONNot applicable

There are prototypes of social housing massively built in contrasting climatic conditions, generating thermal comfort needs that are difficult to satisfy by the users themselves. Variation of indoor air volume in living spaces where the use of air conditioning and natural ventilation strategies provides elements to improve thermal comfort conditions. This research shows the thermal performance located in a representative social housing according to Mexico's National Housing Commission. Operative temperature results from a benchmark case were compared to six Virtual Evaluation Models, using the Dynamic Thermal Simulation tool Design Builder® from the perspective of probability. The main objective was to determine the minimum use of active systems with different indoor air volumes and improve comfort conditions to promote sustainable living in social housing. The analysis was conducted under an adaptive comfort range according to three different climate conditions in Mexico adopting a Numerical Theoretical Method. The main findings can be divided into two parts: a) the impact of the indoor air volume on thermal performance was evidenced in a proportion of time in three representative climates of the central region of Mexico, and b) no relationship was found between indoor air volume and thermal comfort in sub-humid cold climate; in sub-humid temperate climate, the same number of comfort hours was found in two different models, and in sub-humid warm climate, an inversely proportional relationship was found between indoor air volume and the comfort hours. This findings implies a greater knowledge relative to what we know about sub-humid cold, temperate and warm climates.

Resumen La enfermedad de Kummel es una fractura-aplastamiento de un cuerpo vertebral precedida por un traumatismo menor, cuya etiologia mas aceptada es la necrosis avascular. Es mas frecuente en individuos con factores de riesgo como osteoporosis o tratamiento prolongado con corticoides. Inicialmente, suele presentar pruebas radiologicas normales y un periodo asintomatico, con aparicion progresiva del dolor junto a probable cifosis y signo del vacio o absceso liquido en las pruebas radiologicas, pudiendo llegar a crear compromiso nervioso/medular. Presentamos el caso de un varon de 76 anos que ingresa en nuestro centro para el diagnostico diferencial de una lesion unica vertebral; tras la realizacion de las pruebas de imagen y biopsia se llega al diagnostico definitivo de enfermedad de Kummel. El diagnostico de confirmacion de esta enfermedad se alcanza mediante la biopsia vertebral, pero dada su naturaleza invasiva, las tecnicas de imagen toman un papel relevante. En relacion con las pruebas de imagen metabolicas, la gammagrafia osea ha demostrado ser una de las herramientas mas sensibles para detectar isquemia en fases mas tempranas o para conocer si afecta a otras localizaciones. El rastreo corporal de cuerpo completo con difosfonatos muestra un aumento de actividad en relacion con la actividad osea remodelativa en este cuadro. El estudio de tres fases permite diferenciar si se trata de un proceso agudo/subagudo o cronico, lo que influye en la decision terapeutica. Es importante el conocimiento de esta enfermedad para realizar diagnostico diferencial con patologia tumoral o infecciosa e insistir en la realizacion de pruebas de imagen ante la persistencia del dolor con una placa inicial normal.

Resumen Objetivo Caracterizacion de una muestra de pacientes hospitalizados por complicaciones de la infeccion COVID-19 con atencion a potenciales determinantes pronosticos de su evolucion e impacto del tratamiento rehabilitador en el desempeno funcional, motor y respiratorio. Metodo Estudio descriptivo, retrospectivo, longitudinal de una cohorte de pacientes ingresados con diagnostico de COVID-19 que requirieron tratamiento rehabilitador en el Hospital Universitario Virgen de las Nieves de Granada desde marzo a junio de 2020, evaluados al ingreso, alta y a los tres meses mediante escalas de condicion fisica (IFIS), valoracion funcional: general (Rankin, Barthel), respiratoria (mMRC, BORG) y marcha (FAC). Resultados Se incluyeron 30 pacientes, edad media 62,8 (54-70) anos, 80% alguna comorbilidad: hipertension 66,7%, obesidad 36,7%, diabetes 33,3%. Estancia hospitalaria media de 45,4 dias, 86,7% requirio Unidad de Cuidados Intensivos (UCI) (29,1 dias), de ellos 76,7% ventilacion mecanica. El 86,7% de los pacientes presentaron alguna complicacion, siendo mayor la polineuropatia/miopatia del paciente critico (83,3% de los pacientes). Al alta, un 80% requirio ayuda para caminar. El indice de funcionalidad mostro una evolucion en «U» al ingreso, alta y a los tres meses (Barthel 93,8; 60,0; 91,6, respectivamente). Se encontro un mayor deterioro funcional (Barthel Conclusion Los ingresos hospitalarios por COVID-19 implican complicaciones a nivel funcional, respiratorio y de la marcha mayoritariamente graves pero reversibles parcialmente a los tres meses con tratamiento rehabilitador. Se describen factores potencialmente pronosticos que merecen estudios prospectivos.

University Business Incubators (UBIs) are ideal spaces for supporting and developing novice entrepreneurs and their businesses. In the current study, we explore whether such incubators can also be considered an ideal space for building dyadic relationships between incubatees based on trust and knowledge exchange, and whether this can encourage commitment in the relationship. To this end, we propose that the perception of shared values from the academic world may foster such trust. Furthermore, perceiving there may be supplementary and complementary resources encourages the exchange of knowledge, the specific resource on which UBI businesses are based. At the same time, empathy between academic incubatees leads to relational commitment being reinforced.

Resumen Introduccion y objetivos HeartLogic es un algoritmo multiparametrico incorporado a desfibriladores automaticos implantables (DAI). La alerta asociada predice descompensaciones de insuficiencia cardiaca (IC). Nuestro objetivo es analizar la asociacion entre alertas y eventos clinicos bajo un protocolo de seguimiento comun en un registro multicentrico. Metodos Se evaluaron la fase 1 (investigadores ciegos al estado de la alerta) y las fases 2 y 3 (tras la activacion de HeartLogic, segun practica local y un protocolo comun respectivamente). Resultados Se incluyo a 288 pacientes en 15 centros. En fase 1, tras una media de observacion de 10 meses, hubo 73 alertas (0,72 alertas/paciente-ano), con 8 hospitalizaciones y 2 visitas a urgencias por IC (0,10 eventos/ano-paciente). No hubo hospitalizaciones fuera del periodo de alerta. Las fases activas tuvieron una media de seguimiento de 16 (IC95%, 15-22) meses, con 277 alertas (0,89 alertas/ano-paciente); 33 se asociaron con hospitalizaciones o muerte por IC, 46 con descompensaciones menores y 78 con otros eventos. La tasa de alertas inexplicables fue 0,39/ano-paciente. Fuera del estado de alerta solo hubo una hospitalizacion y una descompensacion menor. La mayoria de las alertas (el 82% en fase 2 y el 81% en fase 3; p = 0,861) se gestionaron a distancia. La mediana de NT-proBNP fue superior en estado de alerta que fuera de el (7.378 frente a 1.210 pg/ml; p Conclusiones El indice HeartLogic se asocio con descompensaciones de IC y otros eventos relevantes, con baja tasa de alertas inexplicables. Un protocolo estandarizado permitio detectar y actuar a distancia con seguridad sobre las alertas.

Purpose: To examine the associations of accelerometer-derived steps volume and intensity with hospitalizations and all-cause mortality in older adults. Methods: This prospective cohort study involved 768 community-dwelling Spanish older adults (78.8 § 4.9 years, mean § SD; 53.9% females) from the Toledo Study for Healthy Aging (2012 2017). The number of steps per day and step cadence (steps/min) were derived from a hip-mounted accelerometer worn for at least 4 days at baseline. Participants were followed-up over a mean period of 3.1 years for hospitalization and 5.7 years for all-cause mortality. Cox proportional hazards regression models were used to estimate the individual and joint associations between daily steps and stepping intensity with hospitalizations and all-cause mortality. Results: Included participants walked 5835 § 3445 steps/day (mean § SD) with an intensity of 7.3 § 4.1 steps/min. After adjusting for age, sex, body mass index (BMI), education, income, marital status and comorbidities, higher step count (hazard ratio (HR) = 0.95, 95% confidence inter vals (95%CI: 0.90 1.00, and HR = 0.87, 95%CI: 0.81 0.95 per additional 1000 steps) and higher step intensity (HR = 0.95, 95%CI: 0.91 0.99, and HR = 0.89, 95%CI: 0.84 0.95 per each additional step/min) were associated with fewer hospitalizations and all-cause mortality risk, respectively. Compared to the group having low step volume and intensity, individuals in the group having high step volume and intensity had a lower risk of hospitalization (HR = 0.72, 95%CI: 0.52 0.98) and all-cause mortality (HR = 0.60, 95%CI: 0.37 0.98). Conclusion: Among older adults, both high step volume and step intensity were significantly associated with lower hospitalization and all-cause mortality risk. Increasing step volume and intensity may benefit older people.

Resumen Antecedentes y objetivo Las alteraciones vestibulares se encuentran ligadas a un grupo de patologias que pueden afectar estructuras vestibulares, auditivas, o ambas partes del oido interno del ser humano. El problema abordado en este estudio responde a una escasez de informacion sobre el perfil audiologico de las personas que cursan con alteraciones vestibulares en Costa Rica. Existen investigaciones internacionales que abordan este tema, pero no hay registros de estudios realizados en la poblacion costarricense. Es por este motivo que surge el interes de desarrollar esta investigacion, cuyo objetivo es caracterizar el perfil audiologico y los grados de discapacidad en las personas con alteraciones vestibulares pertenecientes a la consulta del Centro Equilibra, durante los meses de septiembre a noviembre de 2019. Pacientes y metodos Se realizo un estudio descriptivo, transversal, cuantitativo y observacional-analitico con pacientes mayores de 18 anos que acudieron al Centro Equilibra. Las principales variables analizadas fueron el sexo, la edad, los antecedentes patologicos personales, el diagnostico medico, los sintomas vestibulares primarios, las manifestaciones auditivas y los grados de discapacidad. Resultados Se obtuvieron datos de 177 personas, donde las alteraciones vestibulares se presentaron mas en el sexo femenino (razon 2,6:1). La media de edad fue de 56 anos. El 53,7% presento perdida auditiva, de tipo neurosensorial, ligera, gradualmente descendente. El 33,9% de la poblacion presento acufeno, en su mayoria en frecuencias agudas. En la poblacion adulta el 52% presento algun grado de percepcion de discapacidad auditiva; contrariamente, en los adultos mayores la mayoria (77%) no presento ningun grado de discapacidad. El 87% de las personas percibieron discapacidad vestibular debido a su alteracion vestibular. Conclusiones La perdida auditiva fue la manifestacion auditiva mas comun, y aunque el analisis estadistico demuestra que no se relaciona directamente con las alteraciones vestibulares, si se relaciona con las enfermedades metabolicas concomitantes. Por esta razon es necesario promover la prevencion de enfermedades metabolicas como una de las medidas para mejorar la salud auditiva, incluso desde edades tempranas.

OBJECTIVE: The COVID-19 pandemic has affected specialized healthcare training at all levels. Surgical learning has been severely affected, and the impact on orthopedic surgery residency training has so far not been assessed. MATERIAL AND METHODS: An online survey of 17 questions was sent via web link to orthopedic surgery residents throughout Spain between February 10, 2021 and February 28, 2021. The effects of the COVID-19 pandemic on the care and training activities of residents were analyzed. RESULTS: A total of 307 orthopedic surgery residents from all over Spain responded to the online survey. A total of 77.2% of the respondents had to suspend their rotations. Of these, 67.5% would like to resume the rotations they missed during the pandemic. A total of 69.7% of scheduled surgeries were suspended. Surgical activity was completely stopped for an average of 8 weeks. 66.8% of the residents consider that their surgical training has been affected and this will have repercussions on their future work. 49.5% considered the online training offered to be insufficient. Of the total number of respondents, 52.1% considered that the impact of the pandemic situation on their training situation was bad or very bad. CONCLUSIONS: The data collection shows a negative impact on both theoretical and clinical training. This study highlights the need to continue offering quality training by maximizing learning opportunities.

OBJECTIVE To determine the effectiveness of a brief intervention in increasing influenza vaccination coverage compared with the usual advice in people who refuse it, and to record the main reasons for refusing to be vaccinated. METHOD A cluster randomized clinical trial was conducted in which the study population was individuals with high risk factors who initially had refused to be vaccinated against influenza. Professionals (doctors and nurses) who voluntarily accepted to participate were assigned randomly to the intervention group (brief intervention) and the control group (usual advice). RESULTS 57 professionals recruited 524 people who had previously declined the influenza vaccination (271 in the control group and 253 in the intervention group). Brief intervention showed its effectiveness with an odds ratio of 2.48 (1.61-3.82; p