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Craving is considered one of the main factors responsible for relapse after smoking cessation. Cue exposure therapy (CET) consists of controlled and repeated exposure to drug-related stimuli in order to extinguish associated responses. The main objective of this study was to assess the validity of 7 virtual reality environments for producing craving in smokers that can be used within the CET paradigm. Forty-six smokers and 44 never-smokers were exposed to 7 complex virtual environments with smoking-related cues that reproduce typical situations in which people smoke, and to a neutral virtual environment without smoking cues. Self-reported subjective craving and psychophysiological measures were recorded during the exposure. All virtual environments with smoking-related cues were able to generate subjective craving in smokers, while no increase was observed for the neutral environment. The most sensitive psychophysiological variable to craving increases was heart rate. The findings provide evidence of the utility of virtual reality for simulating real situations capable of eliciting craving. We also discuss how CET for smoking cessation can be improved through these virtual tools. [ABSTRACT FROM AUTHOR]

The objectives of the present study were to analyze the pattern of tobacco use among Spanish adolescents, as well as to determine gender differences in specific risk factors of cigarette use. The study sample was made up of 1,483 boys and 1,358 girls, aged 12-16 (M = 14). Participants were asked to answer an ad-hoc instrument to evaluate the pattern of use, perceived availability, risk of harm, family- and peer-use, engagement in leisure activities, drive for thinness, and self-esteem. Results showed no gender differences in the pattern of use. With regard to risk and protector factors, a predictive analysis showed that peer-related variables were the most determinant for tobacco use both for boys and girls. Some gender differences were also detected: Playing sports was protective for boys only, and listening to music for girls only. Drive for thinness and self-esteem were not related to tobacco use for either boys or girls. These findings help increase our understanding of smoking risk factors in adolescence and to pay special attention to the group of friends when planning prevention programs to reduce risk factors. [ABSTRACT FROM AUTHOR]

In this study we present the addiction severity profile in a sample of 202 cocaine addicts, using the composite scores for each area of the EuropASI (European version of the ASI), which are compared with the severity ratings obtained through interviewers' subjective assessments. The results showed that the areas of the EuropASI which reflected the greatest severity according to the composite scores were, in the following order: employment/support, family/social situation, use of alcohol and psychiatric state. The results obtained with the composite scores show discrepancies with those obtained from the severity rating. Statistically significant differences were found in the areas of alcohol (Z = -6.205; p < 0.001), drugs (Z = -11.902; p < 0.001), family/social (Z = -6.915; p < 0.001) and psychiatric status (Z = -6.651; p < 0.001). The results call into question the reliability and validity of severity ratings obtained through interviewers' subjective assessments. For diagnosis and research, a more objective appraisal is recommended, using composite scores, since severity ratings depend totally on the interviewer's judgement, and do not appear to constitute a sound measure for estimating therapeutic change. [ABSTRACT FROM AUTHOR]

Abstract Background Endometrial cancer is the most common gynecologic malignancy in Puerto Rico and the United States (US). Methods We compare the age-specific and age-adjusted incidence and mortality rates and the survival of endometrial cancer in Puerto Rico with that of non-Hispanic whites (NHW), non-Hispanic blacks (NHB) and Hispanics in the US. Data from the Puerto Rico Central Cancer Registry and the Surveillance, Epidemiology, and End Results program were analyzed from 1992-2003. Results Age-standardized incidence rates of endometrial cancer increased significantly (p < 0.05) in Puerto Rico (APC = 2.8%) and among NHB (APC = 1.9%) and remained constant (p > 0.05) for NHW (APC = -0.1%) and Hispanics in the US (APC = 0.4%). Mortality trends remained constant in all racial/ethnic groups (p > 0.05). For 1999-2003, women in Puerto Rico had similar incidence of endometrial cancer as Hispanics (Standardized rate ratio [SRR] = 0.94, 95% CI = 0.87-1.01), although their risk was lower than that of NHW (SRR = 0.56, 95% CI = 0.53-0.59) and NHB (SRR = 0.91, 95% CI = 0.84-0.98). Meanwhile, women in Puerto Rico had 15% higher risk of death than Hispanic women (SRR = 1.15, 95% CI = 1.03-1.30) similar risk than NHW (SRR = 0.93, 95% CI = 0.83-1.03), and lower risk than NHB (SRR = 0.51, 95% CI = 0.46-0.57). Puerto Rico (63.1%) and NHB (56.8%) had a lower 5-year survival than NHW (78.4%) and Hispanics (79.5%). An age-adjusted Cox proportional hazards model showed that compared with women in Puerto Rico, Hispanic women in the United States had 37% lower mortality risk (HR = 0.63, 95% CI = 0.56-0.71) and NHW had 53% lower mortality risk (HR = 0.47, 95% CI = 0.43-0.52) after 5 years of diagnosis; NHB women had 22% higher mortality risk than women in Puerto Rico (HR = 1.22, 95% CI = 1.09-1.36). Conclusions The lower burden of endometrial cancer in Puerto Rico suggests the presence of protective factors or lower exposure to risk factors in this population, although increases in incidence suggest changes in the occurrence of lifestyles and environmental risk factors. Meanwhile, the lower five-year survival from endometrial cancer among Puerto Ricans suggests a health disparity for this group in areas such as quality of care and/or differences in terms of stage at diagnosis and associated comorbidities. Assessment of disease risk factors and characteristics, and access and response to treatment is required to further understand these results.

Background: This cross-sectional study explored how masculinity beliefs may influence colorectal cancer (CRC) screening participation among ethnic subgroups of screening-age-eligible (45-75 years) Hispanic/Latino men., Methods: Using a consumer panel, we recruited self-identified Hispanic/Latino men fluent in English or Spanish, and residing in Florida, New York, or Texas. The Masculinity Barriers to Medical Care (MBMC) scale and its six subscales were used to assess masculinity beliefs. Multivariable logistic regression was used to estimate the association between MBMC and CRC screening participation, adjusting for Hispanic/Latino subgroup, marital status, survey language, age group, and health insurance status. Results were then stratified by Hispanic/Latino subgroup., Results: Of the participants (n=611), approximately 31% identified as Puerto Rican, 30% as other Hispanic/Latino, 26% as Mexican, and 14% as Cuban; 63% had ever been screened for CRC. We found no differences in the prevalence of screening participation by Hispanic/Latino subgroup. The majority of participants had completed both a stool-based test and an exam-based screening test (29.3%). After adjusting for confounding, MBMC reduced the odds of screening participation. Slight MBMC-subscale differences were observed by Hispanic/Latino subgroup. For example, higher scores on the Restrictive Emotionality subscale were associated with a lower likelihood of screening participation among Puerto Rican men, but higher odds of screening for Cuban men., Conclusions: Masculinity barriers to CRC screening may exist. Tailored interventions to address masculinity barriers among specific Latino subgroups may improve CRC screening uptake in this population., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

In this work, a TiO 2 -decorated electrode was fabricated by dip coating activated carbon fibers (ACF) with TiO 2 , which were then used as a cathode for the photoelectro-Fenton (PEF) treatment of the pharmaceutical enalapril, an angiotensin-converting enzyme inhibitor that has been detected in several waterways. The TiO 2 coating was found to principally improve the electrocatalytic properties of ACF for H 2 O 2 production via the 2-e - O 2 reduction, in turn increasing enalapril degradation by PEF. The effect of the current density on the mineralization of enalapril was evaluated and the highest TOC removal yield (80.5% in 3 h) was obtained at 8.33 mA cm -2 , in the presence of 0.5 mmol L -1 of Fe 2+ catalyst. Under those conditions, enalapril was totally removed within the first 10 min of treatment with a rate constant k = 0.472 min -1 . In contrast, uncoated ACF only achieved 60% of TOC removal in 3 h at 8.33 mA cm -2 . A degradation pathway for enalapril mineralization is proposed, based on the degradation by-products identified during treatment. Overall, the results demonstrate the promises of TiO 2 cathodes for PEF, a strategy that has often been overlooked in favor of photoelectrocatalysis (PEC) based on TiO 2 -modified photoanodes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: Substance misuse has long been recognized as a major predisposing risk factor for traumatic injury. However, there still exists no clear scientific consensus regarding the impact of drug use on patient outcomes. Therefore, this study aims to evaluate the demographic profile, hospital-course factors, and outcomes of trauma patients based on their toxicology., Methods: This is a non-concurrent cohort study of 3709 patients treated at the Puerto Rico Trauma Hospital during 2002-2018. The sample was divided into four groups according to their toxicology status. Statistical techniques used included Pearson's chi-square test, Spearman correlation, and negative binomial and logistic regressions., Results: Admission rates for marijuana (rho = 0.87) and marijuana and cocaine positive (rho = 0.68) patients increased. Positive toxicology patients underwent surgery more often than negative testing patients (marijuana: 68.7%, cocaine: 65.6%, marijuana & cocaine: 69.8%, negative: 57.0%). Among patients with non-penetrating injuries, a positive toxicology for cocaine or marijuana was linked to a 48% and 42% increased adjusted risk of complications, 37% and 27% longer TICU LOS, and 32% and 18% longer hospital LOS, respectively., Conclusion: Our results show an association between positive toxicology for either marijuana, cocaine, or both with higher need for surgery. Additionally, our results show an increase in complications, TICU LOS, and hospital LOS among non-penetrating trauma patients testing positive for marijuana or cocaine. Therefore, this study provides valuable information on the clinical profile of patients with positive toxicology, suggesting they might benefit from more aggressive management., (© 2023. The Author(s).)

Objective: We aimed to estimate the overall distribution of odontogenic infection by socio-demographic and medical characteristics in patients admitted to the Adult University Hospital (AUH) in Puerto Rico (PR)., Methods: A cross-sectional study was undertaken with the medical charts of 129 patients (≥21 years) with odontogenic infection who had been admitted (2011-2015) to the AUH and treated by the Oral and Maxillofacial Surgery Post - graduate Program of the University of PR. The patients were selected from the hospital's billing database after having been identified using the International Classification of Diseases (9th and 10th revisions). The study variables included age, gender, municipality of residence, medical insurance, infection etiology, surgical and antibiotic treatments, length of stay (LOS), and the presence of diabetes. Descriptive and frequency statistics were calculated for all the variables; chi-squared, Kruskal-Wallis, Kendall tau, and Mann-Whitney tests were performed. A P < .05 was considered statistically significant., Results: The mean age of the subjects was 40.36 (SD: 14.74) years, and they ranged in age from 21 to 81 years; the majority were enrolled in the public health insurance plan of PR. The leading cause of infection was dental caries. Diabetes was associated with longer LOSs; P < .01., Conclusion: In our study, the relative frequency of admitted patients with an odontogenic infection, most of them with low income, increased over time with dental caries being the principal cause of infection.

Objective: Although the lack of health insurance has been linked to poor health outcomes in several diseases, this relationship is still understudied in trauma. There exist differences between the Puerto Rico health care system and that of the United States. We therefore aimed to assess mortality disparities related to insurance coverage at the Puerto Rico Trauma Hospital (PRTH)., Methods: A retrospective cohort study of patients who sustained penetrating injuries (presenting at the PRTH from 2000 to 2014) was performed. Individuals were classified by their insurance status. Study variables comprised demographics, clinical characteristics and outcomes. A logistic regression analysis was performed to identify the association between health insurance status and risk of dying., Results: Patients with public health insurance experienced more complications than did individuals who had private health insurance (PrHI) or who were uninsured. This group had longer durations of mechanical ventilation and spent more time in the hospital than did patients who had PrHI or who were uninsured. However, uninsured patients with gunshot wounds were 54% (adjusted odds ratio = 1.54; 95% CI: 1.01, 2.36) more likely to die than were their counterparts who had PrHI., Conclusion: Our study suggests that having health insurance could reduce a given patient mortality risk in trauma settings. More studies with larger samples are warranted to confirm these findings. If these findings hold true, then providing equitable access to health services for the entire population could prevent patients suffering trauma from having premature, preventable deaths.

Objective: To estimate the prevalence of short root anomaly (SRA) in a group of Puerto Ricans at the Advanced Education Program in Orthodontics of the University of Puerto Rico., Methods: A cross-sectional study was conducted with digital panoramic x-rays of 203 patients (112 females and 91 males; mean age: 17 years) in Puerto Rico. Utilizing the modified Lind's method, 406 maxillary right and left central incisors (1) were measured and evaluated for SRA. Root and crown length and R/C ratio were compared by sex and side. Linear regression was used to evaluate the associations between the R/C ratio and age, sex, and side (right/left). All the statistical analyses were evaluated using significance level of .05 (2)., Results: The prevalence of SRA was 0.49%. The average root and crown lengths for the maxillary right and left central incisors were 19.47 and 10.28 mm, respectively. Sex was associated with root and crown length, not with the R/C ratio. No differences were observed in the R/C ratio by the side. There were no significant associations between age, sex, and side and R/C ratio in the multivariate analysis., Conclusion: The prevalence of SRA in our population is lower than any reported in the literature. The R/C ratio in our Hispanic population was the highest compared with those of other ethnicities. Neither the sex nor the side of the incisor was associated with the R/C ratio. These findings are contrary to those of prior reports stating that males have higher R/C ratios than females.

Background: The earliest records in Britain for the western European house mouse (Mus musculus domesticus) date from the Late Bronze Age. The arrival of this commensal species in Britain is thought to be related to human transport and trade with continental Europe. In order to study this arrival, we collected a total of 16 ancient mouse mandibulae from four early British archaeological sites, ranging from the Late Bronze Age to the Roman period., Results: From these, we obtained ancient mitochondrial DNA (mtDNA) house mouse sequences from eight house mice from two of the sites dating from the Late Bronze to Middle Iron Age. We also obtained five ancient mtDNA wood mouse (Apodemus spp.) sequences from all four sites. The ancient house mouse sequences found in this study were from haplogroups E (N = 6) and D (N = 2). Modern British house mouse mtDNA sequences are primarily characterised by haplogroups E and F and, much less commonly, haplogroup D., Conclusions: The presence of haplogroups D and E in our samples and the dating of the archaeological sites provide evidence of an early house mouse colonisation that may relate to Late Bronze Age/Iron Age trade and/or human expansion. Our results confirm the hypothesis, based on zooarchaeological evidence and modern mtDNA predictions, that house mice, with haplogroups D and E, were established in Britain by the Iron Age and, in the case of haplogroup E, possibly as early as the Late Bronze Age.

Objective: Compare maxillary anterior dentition measurements, using Chu's proportion gauge with a T-bar tip (PG-TT) and a Two-Tip Compass (T-TC), in a group of Puerto Ricans, to determine the reliability of the PG-TT., Methods: This cross-sectional study was conducted at the University of Puerto Rico, School of Dental Medicine, Medical Sciences Campus. The participants (18-35 years old) were dental students or employees of the university. Previously, the examiner had been trained and calibrated in instrument usage. Calibration participants (n = 16) received an oral exam, prophylaxis, and a chlorhexidine mouthwash for home use. After 3 days, the upper-anterior teeth were measured using the 2 instruments. The agreement was determined using weighted kappa statistics (Kw), and 0.80 was the minimum acceptable level. The examiner achieved almost perfect agreement (inter-examiner KwT-TC = 0.95 [0.96-0.93]; KwPG-TT = 0.82 [0.81-0.87]) with a reference examiner., Results: Fifty participants (25 women and 25 men) were evaluated. Length: The teeth of the men presented an unacceptable level of agreement, except for in the right central incisors. For the women, a strong level of agreement was observed only in the lateral incisors and left canines. When the teeth of both sexes were considered, a strong level of agreement was detected, except for in the right canines and left central incisors. Width: The level of agreement was unacceptable, except for in the right canines (distal)., Conclusion: T-TC is a more reliable instrument to measure tooth dimensions as compared to the PG-TT.

Objective: This study aimed to evaluate the impact of early tracheostomy (ET, ≤7 days) versus that of late tracheostomy (LT, >7 days) on outcomes such as hospital length of stay (LOS), intensive care unit (ICU) days, mechanical ventilation (MV) days, and mortality ratio., Methods: A historical cohort study was undertaken using charts of patients admitted to the Puerto Rico Trauma Hospital who required MV and underwent tracheostomies, from 2000 to 2013. A logistic regression was performed to evaluate the association between timing of tracheostomy and complications and mortality. To estimate the relationship between ET and outcomes related to hospital stay, a binomial-negative regression was performed. A P < 0.05 was considered statistically significant., Results: A total of 1134 patients were evaluated, 313 of whom underwent ET and 821 underwent LT. Early tracheostomy patients had a lower Injury Severity Score compared with their counterparts (P = 0.004) and showed lower complications (respiratory failure: odds ratio [OR], 0.61; 95% confidence interval [CI], 0.45-0.84; acute respiratory distress syndrome: OR, 0.44; 95% CI, 0.30-0.64; pneumonia: OR, 0.53; 95% CI, 0.40-0.71; septicemia: OR, 0.48; 95% CI, 0.33-0.70; bacteremia: OR, 0.59; 95% CI, 0.40-0.86) than LT patients. Those with ET had lower MV days (RRadj, 0.74; 95% CI, 0.68-0.82), ICU days (RRadj, 0.66; 95% CI, 0.59-0.73), and LOS (RRadj, 0.74; 95% CI, 0.69-0.80) compared with those with LT, after adjusting for age, Injury Severity Score, and complications. However, there were no differences in mortality ratio (ORadj, 0.66; 95% CI, 0.44-1.01) among ET and LT patients, after adjusting for confounders., Conclusions: Our results suggested that ET reduced complications, MV days, ICU days, and LOS, having an indirect effect on mortality ratio. Standardized protocols for ET are recommended to enhance health outcomes in trauma patients.

Background: Esophageal injuries are rare, life-threatening, events with an overall reported incidence of less than 3%. In rare cases, trauma due to blunt or penetrating injuries cause esophageal perforations, which account for less than 15% of all esophageal injuries., Materials and Methods: A case-series study was conducted to describe the outcomes and management of all the traumatic esophageal injuries at the Puerto Rico Trauma Hospital (PRTH) from 2000 through 2017. These cases were evaluated in terms of etiology of perforation, mechanism of injury and esophageal level., Results: Sixteen patients were treated for esophageal injuries at the PRTH between 2000 and 2017. Of these patients, 15 (93.7%) were males with a median age of 24.5 years (16, 49). Regarding the etiology of the esophageal perforation, 2 (12.5%) patients suffered blunt esophageal trauma, and 14 (87.5%) patients had penetrating trauma to the esophagus. The most common mechanism of perforation was gunshot wound 10 (62.4%), followed by stab wound 4 (25.0%), and the least common were motor vehicle collision 1 (6.3%) and pedestrian injured by traffic 1 (6.3%). Regarding esophageal location, 9 (56.3%) patients presented cervical, 6 (37.5%) thoracic, and 1 (6.3%) abdominal injuries. Most patients 13 (81.3%) had a prompt diagnosis of traumatic esophageal perforation, while 3 (18.7%) patients had a delayed diagnosis. Only 2 (12.5%) deaths occurred among our 16 patients, including 1 (6.3%) in delayed diagnosed subjects., Conclusion: Esophageal perforation is a life-threatening condition and should be treated urgently. An early diagnosis and prompt surgical treatment completed in the first 24-h is fundamental for a good outcome.

The Eurasian red squirrel ( Sciurus vulgaris ) is an emblematic species for conservation, and its decline in the British Isles exemplifies the impact that alien introductions can have on native ecosystems. Indeed, red squirrels in this region have declined dramatically over the last 60 years due to the spread of squirrelpox virus following the introduction of the gray squirrel ( Sciurus carolinensis ). Currently, red squirrel populations in Britain are fragmented and need to be closely monitored in order to assess their viability and the effectiveness of conservation efforts. The situation is even more dramatic in the South of England, where S. vulgaris survives only on islands (Brownsea Island, Furzey Island, and the Isle of Wight). Using the D-loop, we investigated the genetic diversity and putative ancestry of the squirrels from Southern England and compared them to a European dataset composed of 1,016 samples from 54 populations. We found that our three populations were more closely related to other squirrels from the British Isles than squirrels from Europe, showed low genetic diversity, and also harbored several private haplotypes. Our study demonstrates how genetically unique the Southern English populations are in comparison with squirrels from the continental European range. We report the presence of four private haplotypes, suggesting that these populations may potentially harbor distinct genetic lineages. Our results emphasize the importance of preserving these isolated red squirrel populations for the conservation of the species., Competing Interests: None declared.

Objective: Temporary intravascular shunts (TIVSs) are commonly used as a damagecontrol procedure in trauma settings. Currently, there is scarce literature in the civilian field, and what there is is limited to large trauma centers with multiple resources. Therefore, we aimed to describe TIVS usage, and the outcomes of that usage, at Puerto Rico Trauma Hospital., Materials and Methods: This is a case series conducted from 2009 to 2013 with 32 patients who suffered vascular trauma, of which 13 needed TIVSs. Data related to age, trauma mechanism, injured vessel, type of shunt, Glasgow Coma Scale, vital signs, and mortality were collected. The analysis was carried out using descriptive statistics. This protocol was approved by the IRB of the Medical Sciences Campus., Results: The most frequent mechanism of injury was a gunshot (11/13; 84.6%). The most commonly injured vessel was the superficial femoral artery. Indwelling time ranged from 6 to 96 hours. Only 2 of the 13 (15.4%) patients with shunts reported thrombosis. Furthermore, we performed 4 (30.7% of the patients) prophylactic fasciotomies and 4 (30.7% of the patients) amputations; 4 of the 13 (30.7%) patients died from unrelated causes., Conclusion: Our results are consistent with those in the literature, which supports our contention that a TIVS can be an effective component of damage-control vascular surgery and can, in both military and civilian settings, aid in extremity amputation prevention. Furthermore, it has been established that a TIVS can be fashioned from any available hollow tube. However, further research is needed to evaluate the safety of an improvised catheter of this nature.

Objective: To determine what ocular symptoms and signs are most common and if there are any associations with comorbid conditions in patients with Chikungunya fever., Methods: A retrospective data review and analysis of the ocular symptomatology of 139 patients with Chikungunya fever who visited a local emergency room from August through September 2014. Frequencies were calculated, and Pearson's chisquare test employed. All the patients were confirmed as having Chikungunya with IgM (ELISA) before admittance into the study., Results: Of the 139 patients, 42 (30.2%) had red eyes, 27 (19.4%) had conjunctivitis, and 13 (9.4%) had symptoms related to anterior uveitis, such as unilateral red eye, ciliary flush, or irregular pupil(s). Patients with a history of diabetes, hypertension, or cancer were more likely to have both red eyes (p = 0.033) and the symptomatology of anterior uveitis (p = 0.006), while patients with nausea or vomiting were more likely to have red eyes only (p = 0.001)., Conclusions and Relevance: Red eyes, conjunctivitis, and anterior uveitis occur frequently in patients with Chikungunya fever. Systemic diseases, such as diabetes, hypertension, and cancer, may increase the risk of such ocular manifestations. Routine ophthalmic evaluation is warranted in patients with these medical conditions. The relevance of this study lies in the fact that this disease remains an important public health issue, since such ocular sequelae as may be present can range from mild to severe, either as an acute or a delayed manifestation.