No man is an island: spatial clustering and access to primary care as possible targets for the development of new community mental health approaches

BACKGROUND

to understand if patients seen at Centro Hospitalar Psiquiátrico de Lisboa (CHPL) live in geographical clusters or randomly throughout the city, as well as determine their access to the psychiatric hospital and primary care facilities (PCF).

METHODS

spatial autocorrelation statistics were performed (queen criterion of contiguity), regarding all patients observed at CHPL in 2017 (at the census subsection level), and considering not only their overall number but also main diagnosis, and admission to the psychiatric ward - voluntary or compulsory. Distance to the hospital and to the closest PCF was measured (for each patient and the variables cited above), and the mean values were compared. Finally, the total number of patients around each PCF was counted, considering specified radius sizes of 656 and 1000 m.

RESULTS

All 5161 patients (509 psychiatric admissions) were geolocated, and statistical significance regarding patient clustering was found for the total number (p-0.0001) and specific group of disorders, namely Schizophrenia and related disorders (p-0.007) and depressive disorders (p-0.0002). Patients who were admitted in a psychiatric ward live farther away from the hospital (p-0.002), with the compulsory admissions (versus voluntary ones) living even farther (p-0.004). Furthermore, defining a radius of 1000 m for each PCF allowed the identification of two PCF with more than 1000 patients, and two others with more than 800.

CONCLUSIONS

as patients seem to live in geographical clusters (and considering PCFs with the highest number of them), possible locations for the development of programs regarding mental health treatment and prevention can now be identified.

Highly Sensitive Piezoresistive Graphene-Based Stretchable Composites for Sensing Applications

Nanocarbonaceous materials with specific geometries and physicochemical properties allow the development of high-performance polymer-based smart composite materials. Among them, chemical treatments of graphene allow tailoring its electrical conductivity and, therefore, tuning functional response of materials for sensing applications. Polymer-based nanocomposites have been developed from styrene-ethylene-butylene-styrene (SEBS), a high deformation thermoplastic elastomer, and different graphene-based fillers, including graphene oxide (GO), reduced graphene oxide (rGO), and graphene nanoplatelets (G-NPLs). It is shown that the electrical conductivity shows a percolation threshold around 2 wt % for GO and rGO, remaining nearly independent of the filler content for G-NPL filler contents up to 6 wt %. Furthermore, GO/SEBS and rGO/SEBS composites show high piezoresistive sensibility with gauge factors ranging from 15 up to 120 for strains up to 10%. Thus, GO/SEBS and rGO/SEBS composites can represent a new generation of materials for strain sensor applications, as demonstrated in their implementation in a hand glove prototype with finger movement monitoring.

Electromechanical Properties of PVDF-Based Polymers Reinforced with Nanocarbonaceous Fillers for Pressure Sensing Applications

Polymer-based composites reinforced with nanocarbonaceous materials can be tailored for functional applications. Poly(vinylidene fluoride) (PVDF) reinforced with carbon nanotubes (CNT) or graphene with different filler contents have been developed as potential piezoresistive materials. The mechanical properties of the nanocomposites depend on the PVDF matrix, filler type, and filler content. PVDF 6010 is a relatively more ductile material, whereas PVDF-HFP (hexafluropropylene) shows larger maximum strain near 300% strain for composites with CNT, 10 times higher than the pristine polymer. This behavior is similar for all composites reinforced with CNT. On the other hand, reduced graphene oxide (rGO)/PVDF composites decrease the maximum strain compared to neat PVDF. It is shown that the use of different PVDF copolymers does not influence the electrical properties of the composites. On the other hand, CNT as filler leads to composites with percolation threshold around 0.5 wt.%, whereas rGO nanocomposites show percolation threshold at ≈ 2 wt.%. Both nanocomposites present excellent linearity between applied pressure and resistance variation, with pressure sensibility (PS) decreasing with applied pressure, from PS ≈ 1.1 to 0.2 MPa⁻¹. A proof of concept demonstration is presented, showing the suitability of the materials for industrial pressure sensing applications.

Cognitive Stimulation in Older Adults: An Innovative Good Practice Supporting Successful Aging and Self-Care

The project Cognitive Stimulation in Older Adults: Intervention on Cognitive Frailty and Promotion of Self-Care (in brief the ECOG project) arises in a context of worldwide demographic aging, and is fostered by the need to provide a sustainable solution to the progressive increase in the prevalence of age-related cognitive impairment. The main goal of the ECOG project is to promote active citizenship in old age through the empowerment for autonomy and self-care. Namely, the ECOG team is working on the development of evidence-based programs and tools that promote gains in health in cognitively frail and cognitively impaired older adults from the community. It is also working on the transfer of ECOG products to the practice of health and social care, promoting active involvement of geriatric care institutions in the implementation of the ECOG programs and tools, and ensuring appropriate training of professionals. Finally, the ECOG team is deploying a digital platform to reach out to the broadest audience possible and support the remote access and scaling up of the ECOG products. The impacts expected at an individual level include improvements in cognition, functionality, and autonomy of older adults, with simultaneous reduction of depressive symptomatology, and increase in quality of life of both person cared and his/her caregiver. Regarding societal gains, we anticipate an increase in life expectancy and significant postponement of institutionalization associated with geriatric problems. We also believe that the wide implementation of the ECOG products will reduce the costs of interventions for cognitively impaired citizens, contributing to sustainability and efficiency of health systems.

Unilateral Seizures following Vincristine Intravenous Injection

A case of acute central nervous system toxicity following the intravenous injection of vincristine was observed in a patient treated with a chemotherapy regimen including cyclophosphamide, doxorubicin and prednisone for non-Hodgkin lymphoma. The neurological symptoms consisted of right-sided epileptiform jacksonian seizures limited to the face, that lasted about 10 min, followed by spontaneous recovery. A cerebrospinal fluid study and computed tomographic scan of the brain failed to reveal any central nervous system lymphomatous involvement.

Chronic renal failure in equine due to ascending pyelonephritis predisposed by cauda equina syndrome: case report

ABSTRACT This report describes the case of a mare, of the Campeiro breed, used as an embryo donor, which had recurrent cystitis and urinary incontinence crisis. Clinical signs evolved to progressive weight loss, anorexia, apathy, and isolation from the group. Physical examination showed tail hypotonia, perineal hypalgesia, rectal and bladder sagging compatible with signs related to cauda equina syndrome. Complementary laboratory and sonographic assessment, and necropsy confirmed the diagnosis of chronic renal failure (CRF), which was attributed to the ascending pyelonephritis. The examination of urine culture showed growth of bacteria of the genus Streptococcus sp. This is a rare case in the equine species where the lower motor neuron dysfunction led the development of infectious process in the urinary tract, progressing to renal chronic condition incompatible with life.