A state level analyses of suicide and the COVID-19 pandemic in Mexico

BACKGROUND

While suicide rates in high- and middle-income countries appeared stable in the early stages of the pandemic, we know little about within-country variations. We sought to investigate the impact of COVID-19 on suicide in Mexico's 32 states and to identify factors that may have contributed to observed variations between states.

METHODS

Interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from Jan 1, 2010, to March 31, 2020), comparing the expected number of suicides derived from the model with the observed number for the remainder of the year (April 1 to December 31, 2020) for each of Mexico's 32 states. Next, we modeled state-level trends using linear regression to study likely contributing factors at ecological level.

RESULTS

Suicide increased slightly across Mexico during the first nine months of the pandemic (RR 1.03; 95%CI 1.01-1.05). Suicides remained stable in 19 states, increase in seven states (RR range: 1.12-2.04) and a decrease in six states (RR range: 0.46-0.88). Suicide RR at the state level was positively associated with population density in 2020 and state level suicide death rate in 2019.

CONCLUSIONS

The COVID-19 pandemic had a differential effect on suicide death within the 32 states of Mexico. Higher population density and higher suicide rates in 2019 were associated with increased suicide. As the country struggles to cope with the ongoing pandemic, efforts to improve access to primary care and mental health care services (including suicide crisis intervention services) in these settings should be given priority.

Psilocybin in the treatment of obsessive-compulsive disorder: What do we know so far?

Introduction

Psilocybin is a naturally occurring plant alkaloid in mushrooms and a prodrug of psilocin. It is a serotonin receptor (5-HT2A) agonist and known psychedelic, with similar hallucinatory properties to lysergic acid diethylamide (LSD). It has been identified as a safe and effective option in treatment-resistant depression. Literature focus mainly on its use on depressive but its interest in other psychiatric disorders such as obsessive-compulsive disorder (OCD) has grown.

Objectives

To review the clinical evidence for the use of hallucinogens such as psilocybin in OCD.

Methods

Non-systematic review of literature found on PubMed/MEDLINE, Web of Science and Google Scholar, using the keywords “obsessive-compulsive disorder”, “psilocybin” and “hallucinogens”. Articles may include clinical trials, case report or case series. Articles found were admitted according to their relevance for the topic in review; only articles in English were included. Ongoing research trials on this topic were checked on ClinicalTrials.gov.

Results

So far, only one open-label non-randomized study directly assessed the effects of psilocybin on OCD patients that found acute reductions of obsessive-compulsive symptoms. Case reports of patients improving with off-label use of psilocybin are reported. There are two ongoing phase I research trials, aiming to explore the effect of the substance on symptomatology, hypothesizing that psilocybin will normalize cerebral connectivity and thus correlate with clinical improvement.

Conclusions

More research to establish the usefulness of psilocybin in OCD patients is needed; the collected data is encouraging are there may be a role for its use on this disorder.

Twelve-month mental health service use in six countries of the Americas: A regional report from the World Mental Health Surveys

AIMS

To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors associated with mental health treatment and adequacy of treatment.

METHODS

Data come from data collected from 6710 adults with 12 month mental disorder surveys across seven surveys in six countries in North (USA), Central (Mexico) and South (Argentina, Brazil, Colombia, Peru) America who were interviewed 2001-2015 as part of the World Health Organization (WHO) World Mental Health (WMH) Surveys. DSM-IV diagnoses were made with the WHO Composite International Diagnostic Interview (CIDI). Interviews also assessed service utilization by the treatment sector, adequacy of treatment received and socio-demographic correlates of treatment.

RESULTS

Little over one in four of respondents with any 12 month DSM-IV/CIDI disorder received any treatment. Although the vast majority (87.1%) of this treatment was minimally adequate, only 35.3% of cases received treatment that met acceptable quality guidelines. Indicators of social-advantage (high education and income) were associated with higher rates of service use and adequacy, but a number of other correlates varied across survey sites.

CONCLUSIONS

These results shed light on an enormous public health problem involving under-treatment of common mental disorders, although the problem is most extreme among people with social disadvantage. Promoting services that are more accessible, especially for those with few resources, is urgently needed.

Abstract P1-08-27: Advanced stage at diagnosis and worse clinicopathologic features in young woman with breast cancer. A sub-analysis of Brazilian population through the AMAZONA III study (GBECAM 0115)

BACKGROUND: Breast cancer (BC) in young women is uncommon and often more aggressive. There are disparities in terms of screening coverage, diagnostic features and access to optimal treatment among young BC patients worldwide. To better understand this scenario through real world data we performed a sub-analysis of AMAZONA III study. METHODS: The AMAZONA III study (GBECAM 0115) is a prospective registry that included 2950 women newly diagnosed with invasive BC in Brazil during the period of January 2016 to March 2018 within 22 sites. Of them, 2888 patients had valid data regarding age at diagnosis and complete baseline information. For the purpose of comparisons of epidemiologic and clinicopathologic features at the time of diagnosis of BC, patients were divided in two groups: women aged ≤40 years (Group 1) and >40 years (Group 2). Quantitative variables were expressed with mean, while categorical variables were described as their count and percentage and compared using the chi-square test. RESULTS: Of 2888 women, 486 (17%) were ≤40 years of age. No differences were found between ethnicity, performance status, body mass index, personal income, health insurance and family history of cancer between the two groups. Young women had higher educational level (p<0.001), were more involved into a labor activity (p<0.001) and were more frequently married (p<0.001). There were also significant differences regarding nulliparity (p<0.001) and previous use of oral contraceptives (p<0.001). Mode of detection of BC was symptomatic in 73.4% of young group versus 64.5% in older group and screen-detected was only 26.6% vs. 35.5% respectively (p<0.001). Table 1 describes clinicopathological characteristics of the two groups. Young women presented more frequently with stage III,T3/T4, Grade 3 tumors and HER-2 positive, Luminal B and triple negative subtypes. Women older than 40 years had more stage I, Luminal A and Grade 1/2 tumors. CONCLUSION: Brazilian women under the age of 40 have unfavorable clinicopathological features of BC at diagnosis with more aggressive subtypes and advanced stage compared with older women. No differences in socioeconomic and ethnical aspects were found but a higher percentage of young women had symptomatic detection of BC which could explain the later stage of disease at diagnosis. Young women were economically active and the majority married which highlights the socioeconomic impact of this disease in Brazil.

Breast cancer features by age groups at diagnosis in Brazilian women.InformationGroup 1 (≤40 years)Group 2 (> 40 years)p-valueN: 2888486 (16.83%)2402 (83.17%) Stage at diagnosis  p< 0.001I76 (19.2%)541 (27.8%) II156 (39.4%)816 (41.9%) III146 (36.8%)489 (25.1%) IV19 (4.6%)101 (5.2%) Tumor size  p< 0.001T1114 (27.1%)749 (36.9%) T2141 (33.6%)764 (37.6%) T3101 (24.1%)282 (13.9%) T464 (15.2%)235 (11.6%) Tumor grade  p < 0.001Grade 146 (10.7%)381 (17.9%) Grade 2198 (46.2%)1150 (52.0%) Grade 3185 (43.1%)641 (30.1%) Molecular Subtype  p < 0.001Luminal A106 (30.6%)957 (51.3%) Luminal B - HER 2 negative55 (15.8%)212 (11.4%) Luminal B- HER 2 positive79 (22.8%)298 (16.0%) HER 2 positive27 (7.8%)135 (7.2%) Triple negative80 (23.0%)264 (14.1%) 

Citation Format: Franzoi MA, Rosa D, Barrios C, Bines J, Cronemberger E, Queiroz G, Cordeiro de Lima VC, Junior R, Couto J, Emerenciano K, Resende H, Crocamo S, Reinert T, Van Evyl B, Neron Y, Dybal V, Lazaretti N, Costamilan RdC, de Andrade D, Mathias C, Zerwes Vacaro G, Borges G, Silva K, Werutsky G, Morelle A, Sampaio Filho CA, Mano M, Zaffaroni F, Simon S, Liedke PE. Advanced stage at diagnosis and worse clinicopathologic features in young woman with breast cancer. A sub-analysis of Brazilian population through the AMAZONA III study (GBECAM 0115) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-27.

Abstract P1-08-29: Current status of clinical and pathological characteristics of breast cancer patients in Brazil: Results of the AMAZONA III study (GBECAM 0115)

BACKGROUND

Breast cancer (BC) is the most common tumor in women in Brazil with about 60 thousand new cases estimated per year. In low and middle-income countries, patients with BC are diagnosed with more advanced stages as compared with high-income countries. In Brazil, disparities in access to new therapies are recognized; previous data suggests worse survival of BC patients treated in the public system. The aim of AMAZONA III study (GBECAM 0115) is to describe the current status of BC care in Brazil. Here we report patients data at baseline.

METHODS

The AMAZONA III is a prospective BC registry that included women 18 years or older with newly diagnosed stage I to IV BC from 22 sites in Brazil in the period of January 2016 to March 2018. All patients provided written informed consent; data was collected from interview and medical charts, comprising clinical-demographic variables, initial treatment and a planned follow-up for 5 years. BC subtypes were defined by hormone receptor (HR) expression, HER2 status and grade according to von Minckwitz G. et al 2012. Here we present a descriptive analysis of the patients' baseline characteristics. Continuous variables are shown as mean (standard-deviation) and categorical variables by its absolute and relative frequencies. The study is registered in clinicaltrials.gov NCT02663973.

RESULTS

A total of 2950 patients were included in the study. Median age at diagnosis was 53 years old (8.4% <= 35 years, 34.8% 36-50 years, 56.8% > 50 years), 58.6% were white, 34.4% had brown skin-color, 83% had children before BC diagnosis (median of 1 child/patient) and 63.1% had public health insurance. In terms of method of detection 34% were screen-detected whereas 66% were symptomatic, the last was even higher (70%) in patients in younger than 50 years. The distribution of BC stage at diagnosis was I (26.4%), II (41.6%), III (27%) and IV (5%). The most common histologies were ductal (80.9%) and lobular carcinoma (6.9%). The pathological characteristics were HR positive in 78.0%, HER-2 positive in 23.4% and grade 2 in 51%. BC subtypes were as follows: Luminal A 48%, Luminal B 12%, Luminal HER2 positive 17%, Non-luminal HER2 positive 7.3% and Triple negative 15.5%.

DISCUSSION

Breast cancer is diagnosed at an earlier age among Brazilian patients. The majority of patients were detected through symptomatic BC and therefore a significant proportion is still diagnosed in stages III and IV. Among other factors, these findings could have a significant impact in treatment outcomes. Further analysis of this large cohort of patients will help to identify other important elements and direct future strategies for breast cancer control.

TRIAL REGISTRY: NCT02663973

KEYWORDS: Breast Cancer; Epidemiology; Treatment; Brazil

Citation Format: Rosa D, Barrios C, Bines J, Werustky G, Cronemberger E, Queiroz GS, Lima VC, Freitas-Júnior R, Couto J, Emerenciano K, Resende H, Crocamo S, Reinert T, Van Eyil B, Néron Y, Dybal V, Lazaretti N, Costamilan RC, Andrade DA, Mathias C, Vacaro GZ, Borges G, Torres KL, Morelle A, Sampaio Filho CA, Mano M, Zaffaroni F, Simon S. Current status of clinical and pathological characteristics of breast cancer patients in Brazil: Results of the AMAZONA III study (GBECAM 0115) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-29.

Psychotic experiences and religiosity: data from the WHO World Mental Health Surveys

OBJECTIVES

Religiosity is often associated with better health outcomes. The aim of the study was to examine associations between psychotic experiences (PEs) and religiosity in a large, cross-national sample.

METHODS

A total of 25 542 adult respondents across 18 countries from the WHO World Mental Health Surveys were assessed for PEs, religious affiliation and indices of religiosity, DSM-IV mental disorders and general medical conditions. Logistic regression models were used to estimate the association between PEs and religiosity with various adjustments.

RESULTS

Of 25 542 included respondents, 85.6% (SE = 0.3) (n = 21 860) respondents reported having a religious affiliation. Overall, there was no association between religious affiliation status and PEs. Within the subgroup having a religious affiliation, four of five indices of religiosity were significantly associated with increased odds of PEs (odds ratios ranged from 1.3 to 1.9). The findings persisted after adjustments for mental disorders and/or general medical conditions, as well as religious denomination type. There was a significant association between increased religiosity and reporting more types of PEs.

CONCLUSIONS

Among individuals with religious affiliations, those who reported more religiosity on four of five indices had increased odds of PEs. Focussed and more qualitative research will be required to unravel the interrelationship between religiosity and PEs.

Abstract P1-17-10: Survival outcomes related to health care coverage in breast cancer patients with brain metastases in Brazil: A sub-analysis from the LACOG-0312 study

Background

The incidence of brain metastases among women with metastatic breast cancer (MBC) ranges from 10 to 30% depending of breast cancer (BC) subtype. Inequities in the access to optimal treatment and shorter survival of BC by type of health care coverage were previously reported in an observational study in Brazil. The present analysis aims to analyze the impact of the type of health care coverage on survival outcomes of patients with MBC and brain involvement.

Methods

LACOG-0312 is a retrospective cohort study that enrolled patients with metastatic or locally advanced/recurrent unresectable BC diagnosed during 2012 in Brazil. Overall survival (OS) was defined as the time from the diagnosis of brain metastases and death from any cause. Comparisons were made using the Kaplan-Meier method based on the type of health care coverage (public vs. private) among patients who developed brain metastases. Cox regression analysis was performed for identification of independent prognostic factors associated with survival after brain metastases diagnosis.

Results

Among the 690 MBC patients included in the LACOG-0312 study, 145 (21%) were diagnosed with brain metastases. Of them, 94 (71,75%) were covered by the Brazilian public health care and 37 (28,25%) had private coverage. Baseline characteristics such as age at MBC diagnosis, stage IV at diagnosis and tumor subtypes were similar between both groups.

Median time to develop brain metastases after diagnosis of MBC was 14 months in the whole population with no differences between public and private patients (13 vs. 17 months p=0.172).

Median OS from the date of brain metastases diagnosis was similar for both groups: 10.0 months in private and 9.0 months in public health insured patients (HR 0.92 – 95%CI 0.55-1.51; p=0.729). In a multivariable analysis including type of health care coverage, only the triple negative BC subtype was associated with a worse survival post brain metastases diagnosis.

Conclusion

Our study indicates that health care coverage is not associated with survival outcomes in patients with MBC and brain metastases. Potential differences in the access to optimal care such as radiotherapy, surgery and systemic treatments may not play a significant role in the survival of theses patients possibly due to small clinical benefit of the current treatment options for brain metastases in breast cancer.

Citation Format: Albuquerque C, Debiasi M, Werutsky G, Uema D, Cronenberger E, Cordeiro de Lima VC, de Sant'ana RO, Bines J, Santi PX, Goés RS, Liedke P, Batista MLM, Dybal V, Nerón YV, Beato CA, Borges G, Giacomazzi J, dos Santos LV, Ismael G, Rosa DD, Azambuja A, Andrade D, Martinez-Mesa J, Zaffaroni F, Barrios CH. Survival outcomes related to health care coverage in breast cancer patients with brain metastases in Brazil: A sub-analysis from the LACOG-0312 study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-17-10.

Abstract P4-10-17: Survival outcomes related to health care coverage in metastatic breast cancer in Brazil: A sub-analysis from the LACOG-0312 study

Background

Metastatic breast cancer (MBC) is an incurable disease in which latest therapies have evolving and improving patients survival. Inequities in the access to optimal treatment and shorter survival of BC by type of health care coverage were previously reported in an observational study in Brazil. In Brazil patients with private health coverage have access to the most recent therapies, however the public health system does not provide several therapies approved for the treatment of MBC such as everolimus, trastuzuman, eribulin, TDM-1, pertuzumab among others. The present analysis aims to analyze the impact of the type of health care coverage on survival outcomes of patients with MBC.

Methods

LACOG-0312 is a retrospective cohort study that enrolled patients with metastatic or locally advanced/recurrent unresectable BC diagnosed during 2012 in Brazil. Overall survival was defined as the time from the diagnosis of MBC and death from any cause. Comparisons were made using the Kaplan-Meier method based on the type of health care coverage (public vs. private). Cox regression analysis was performed for identification of independent prognostic factors associated with overall survival.

Results

A total of 634 patients with MBC were included in the study. Baseline characteristics by type of health care coverage was similar for visceral disease (43% in public and 44% in private, p=0.78), age at MBC diagnosis (median 62 years in public and 64 years in private, p=0.25), BC subtype (p=0.89), however more patients public insured were metastatic at diagnosis (42% vs. 33%) and had performance status >= 2 (12% vs. 3%).

The proportion of patients that received any first-line systemic therapy was similar in both groups (95.2% in public and 95.5% in private, p=1.0), however more patients with private insurance received second (82% vs. 71.6%, p=0.013) and third line (56% vs. 45%, p=0.024) therapy compared to public health covered patients.

OS from the date of MBC diagnosis in whole population was 36 months. There was no difference in terms of OS between private (42 months) and public (35 months) health insured patients (p=0.65). OS by BC subtype was 15 months for triple negative, 23 months in HER2 positive, 44 and 42 months for Luminal A and B respectively. There was no difference in OS by type of health insurance coverage in any BC subtypes.

In a multivariate analysis type of health care coverage did not associate with survival, only triple negative (HR (95% CI) – 3.495 (2.448 - 4.989); p <0.001), HER2 positive (HR (95% CI) - 2.287 (1.394 - 3.572); p = 0.001) BC subtypes and visceral metastases (HR (95% CI) – 1.413 (1.075 - 1.858); p <0.013) were correlated with a worse survival.

Conclusion

Our study suggestes that health care coverage is not associated with survival outcomes in patients with MBC. Potential differences in the access to optimal systemic treatments may not play a significant role in the survival of these patients. Real-world studies addressing the impact of new cancer therapies for different BC subtypes in MBC are needed.

Citation Format: Werutsky G, Zaffaroni F, Uema D, Cronenberger E, Cordeiro de Lima VC, de Sant'ana RO, Bines J, Santi PX, Goés RS, Liedke P, Batista MLM, Dybal V, Nerón YV, Beato CA, Borges G, Giacomazzi J, dos Santos LV, Ismael G, Rosa DD, Azambuja A, Andrade D, Martinez-Mesa J, Debiasi M, Barrios CH. Survival outcomes related to health care coverage in metastatic breast cancer in Brazil: A sub-analysis from the LACOG-0312 study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-17.

Recovery from DSM-IV post-traumatic stress disorder in the WHO World Mental Health surveys

BACKGROUND

Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors.

METHODS

The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD.

RESULTS

20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2-0.3] early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant ORs for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66-55% v. 43%) and later-recovery (75-68% v. 39%).

CONCLUSIONS

We found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.

Hazardous drinking and exposure to interpersonal and community violence on both sides of the U.S. -Mexico border

Objective

Different patterns of heavy drinking occur by country and proximity to the U.S. Mexico border. Few studies describe the impact of violence on drinking between countries and along the border.

Methods

Survey data is from U.S. Mexican origin adults living in Texas and Mexican border and non-border cities, N=4,796. Participants were asked about alcohol consumption, interpersonal physical violence (IPV) and exposure to community violence. Monthly hazardous drinking (5+/4+ for men/women) was the primary outcome. Multivariate logistic regression model comparisons identified best predictors.

Results

In the U.S. hazardous drinking was associated with past year IPV (OR_adj=2.5; 1.8-3.5) and community violence (OR_adj=1.4; 1.1-1.8). In Mexico, IPV (OR_adj=3.9; 2.0-7.4) and border proximity (OR_adj=0.5; 0.4-0.8) were associated with hazardous drinking but not community violence.

Conclusion

Hazardous drinking is associated with IPV in both countries, but violence did not explain border hazardous drinking differences where they existed in Mexico.

Abstract P6-16-04: Real World data and patterns of care of metastatic breast cancer (MBC) in Brazil: First results of LACOG 0312 retrospective study

Background

Randomised clinical trials (RCT) are considered a gold standard generating efficacy and safety data supporting drug approval. However, real world data (RWD) reflecting health care delivery is becoming increasingly important. RWD on patient profiles and patterns of care in MBC are scarce in developing countries. As an example, observational studies suggest that despite guideline recommendations clearly indicating ET for hormone receptor positive MBC, a considerable proportion of patients in clinical practice begin chemotherapy in early lines of therapy. This pragmatic information addresses the uptake and applicability of the RCT results and should be able to help informing health care planning complementing RCT generated data. The objective of this study is to describe patient characteristics and evaluate actual physician-reported treatments for MBC in Brazil.

Methods

This analysis addresses the first 362 patients included in LACOG-0312, a retrospective study planning to recruit over 700 patients (cut-off date April 30th 2016) with recurrent locally advanced or MBC diagnosed in 2012 in 18 institutions across Brazil. Patient characteristics, type of health insurance coverage, treatment and survival outcome were analysed.

Results

Median age at BC diagnosis was 53 years and 37% were premenopausal. Regarding the educational level, 63.2% had completed elementary (primary) schooling, 75.7% were covered by the public health system while 24.3% had some form of private coverage. 70% of patients had hormone receptor positive (HR+) and 18% had HER2 positive tumors. Median disease free survival time from surgery was 29 months. Interestingly, 30% of patients underwent a biopsy of a metastatic site. Of the 362 patients, 349 (96.9%) received some form of palliative systemic therapy. Median time from diagnosis of metastatic disease to first-line therapy initiation was 46 days but a significant difference was noted between patients with public versus private health insurance (50 vs. 33 days p=0.012). Half of the patients received at least 3 lines of therapy (chemo or endocrine) to a maximum of 9 lines. In patients with HR+ tumors, endocrine therapy was administered in 47% in first, 65% in second and 61% in third-line, respectively. Median overall survival (OS) from diagnosis of metastatic disease was 34 months (CI 95%: 25.7-44.3) and no differences in OS were observed between patients with public or private coverage (34 months vs. 35 months p=0.808). Causes of death were cancer in 85.2% of patients and treatment toxicity in 3.6%.

Conclusion

Our study included a population with predominantly low educational level and mostly public health insurance. This likely corresponds to the majority of cases and reflects cancer care patterns in Brazil and many developing countries. A considerable proportion of patients were premenopausal at MBC diagnosis. More than half of HR+ patients received at least 3 lines of endocrine therapy although 54% of them had chemotherapy as the first systemic treatment. Patients from the public health system experienced a delay in starting first-line therapy but this didn't seem to jeopardize cancer outcomes in this setting.

Citation Format: Barrios CH, Uema D, Cronenberger E, Lima V, Bines J, de Sant'ana RO, Batista ML, Dybal V, Liedke P, Beato C, Nerón YV, Giacomazzi J, dos Santos L, Ismael G, Azambuja A, Andrade D, Rosa DD, Borges G, Mano M, Martinez-Mesa J, Zaffaroni F, Werutsky G. Real World data and patterns of care of metastatic breast cancer (MBC) in Brazil: First results of LACOG 0312 retrospective study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-16-04.

Sexology population characterization – a two years’ experience at a Lisbon specialized centre

Introduction

Within psychiatry, sexology is a very particular area of expertise both by the nature and specificity of its diagnosis, as by the various difficulties and challenges their patients place. Sexology is a sub-specialty niche, but also a vast universe that covers such diverse conditions as paraphilia, gender dysphoria or sexual dysfunction. The sexology consultation of Santa Maria Hospital (HSM) is one of the biggest centers specialized in sexual disorders in the country. Consultations depend on the collaboration of a sexologist psychiatrist and psychiatry residents in close connection with endocrinology, urology and plastic surgery services.

Objective

We intend to conduct a characterization of the population observed in the HSM sexology consultation, in a period of 2 years, from the analyses of different general and diagnosis-specific relevant variables.

Methods

We intent to make a descriptive analysis of the population that attended the sexology consultation over the last 2 years. The sample study refers to all patients who have been specifically referred to sexology department or that directly requested access to this consultation. Data will be collected from medical computer records.

Results

Through systematic evaluation of different variables we can possibly conclude by some putative associations. A comprehensive characterization of this particular population is a possible method for a better and deeper insight on the diagnosis itself.

Conclusions

The purpose of this work is to increase peers’ sensitivity both to sexology and to the patients sexology serves.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

About an exhibitionism clinical case: Entity's review and state of the art exposure

Introduction

Exhibitionistic disorder may be present when there is sexual arousal from the exposure of one's genitals to an unsuspecting and nonconsenting person. This disorder prevalence is unknown but we know it is highly unusual in females. It generally starts at adolescence and its course is likely to vary with age. There are temperamental and environmental risk factors.

Most of what we know about exhibitionistic disorder is largely based on research with individuals convicted for criminal acts involving genital exposure, and this may represent an important bias. From a clinical case of exhibitionism, the authors intend to review this type of paraphilia from an historical, conceptual and etiologic point of view.

Objective

To review the concept behind this diagnosis and its evolution, the comprehensive theories that attempt to justify and frame it, as well as the type of intervention currently considered to be the state of the art.

Methods

Patient's observation and assessment, along with an extensive review of the relevant literature.

Conclusions

Starting from a real clinical case, the authors present a general theoretical review on the subject.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Barriers to mental health treatment: results from the WHO World Mental Health surveys

BACKGROUND

To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders.

METHOD

Data were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n = 63,678) and analyzed at different levels of clinical severity.

RESULTS

Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders).

CONCLUSIONS

Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.

Barriers to mental health treatment: results from the WHO World Mental Health surveys

BACKGROUND

To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders.

METHOD

Data were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n = 63,678) and analyzed at different levels of clinical severity.

RESULTS

Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders).

CONCLUSIONS

Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.

Suicidality, ethnicity and immigration in the USA

BACKGROUND

Suicide is the 11th leading cause of death in the USA. Suicide rates vary across ethnic groups. Whether suicide behavior differs by ethnic groups in the USA in the same way as observed for suicide death is a matter of current discussion. The aim of this report was to compare the lifetime prevalence of suicide ideation and attempt among four main ethnic groups (Asians, Blacks, Hispanics, and Whites) in the USA.

METHOD

Suicide ideation and attempts were assessed using the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI). Discrete time survival analysis was used to examine risk for lifetime suicidality by ethnicity and immigration among 15 180 participants in the Collaborative Psychiatric Epidemiological Surveys (CPES), a group of cross-sectional surveys.

RESULTS

Suicide ideation was most common among Non-Hispanic Whites (16.10%), least common among Asians (9.02%) and intermediate among Hispanics (11.35%) and Non-Hispanic Blacks (11.82%). Suicide attempts were equally common among Non-Hispanic Whites (4.69%), Hispanics (5.11%) and Non-Hispanic Blacks (4.15%) and less common among Asians (2.55%). These differences in the crude prevalence rates of suicide ideation decreased but persisted after control for psychiatric disorders, but disappeared for suicide attempt. Within ethnic groups, risk for suicidality was low among immigrants prior to migration compared to the US born, but equalized over time after migration.

CONCLUSIONS

Ethnic differences in suicidal behaviors are explained partly by differences in psychiatric disorders and low risk prior to arrival in the USA. These differences are likely to decrease as the US-born proportion of Hispanics and Asians increases.

P3-07-37: Clinical Characteristics and Treatment of Brazilian Women with Breast Cancer at Public and Private Institutions

Background: Breast cancer is the most common type of cancer among Brazilian women with almost 50.000 new cases per year. There are few data regarding the clinical presentation, treatment and specially outcome of this population. Brazilian health system is composed by Public institutions (Pu); Private centers (Pr) and some institutions that assist both Public and Private patients (PuPr).

Material and Methods: We collected data from 17 cancer centers distributed throughout Brazil among Pu; Pr and PuPr centers. We've analyzed data from 1-clinical characteristics, 2- pathologic characteristics and 3-type of treatment received among 2435 patients from May 2008 to May 2009.

Results: Mean age at diagnosis was 53 years, with about 30% below age 50. Most of the cases were Invasive Ductal Cancer (83%). Stage 0 was seen in 3.2%, Stage I in 21,8%, Stage II in 46,6%, Stage 3 in 24,6% and Stage IV in 3,9 %. Clinical Stage III + IV was seen in 18,5% of the Pu institutions, only 3,7% of the Pr ones and about 6,2% among those PuPr. Hormone receptors were positive in 55%. Her-2 was overexpressed in 27,3% of the patients, and triple negative were seen in 11,6%. Most of the patients were submitted to surgery (92,9%). In Pu institutions only 36% of the patients were submitted to Breast Conserving Surgery (BCS) and in the Pr institutions 49,4% of the patients were submitted to BCS and in the PuPr 47%. Breast reconstruction was made in 15,8% and did not differ between Pu and Pr institutions. Sentinel node biopsy was done in 30,6% of the patients (26,8% of the patients from the Pr institutions and 26,8% of the Pu ones and 33% among PuPr). Neoadjuvant treatment was done in 21,5% of the patients (Pu=27,2%; Pr=13,9% and PuPr 13,2%). Most of this neoadjuvant treatment was chemotherapy (93,8%) and only 4,3% was hormonetherapy (HT). 30% of the patients received AC, 41% A+taxane and 18,9% FAC/FEC. Besides we have almost 30% of Her-2 overexpressed only 1,1% of the patients received trastuzumab in the neoadjuvant setting. Tamoxifen was used in 48,3% when neoadjuvant HT was done, and aromatase inhibitor (AI) was used in 34,5%. Most of the patients received any kind of adjuvant treatment (89,2%). Chemotherapy was done in 76,6% and hormonetherapy in 69,8%. When chemotherapy was used the preference regiment was FAC/FEC (27,3%), followed by CMF (17,5%) and AC (11,9%). Trastuzumab was use in only 5,8% of the patients (Pu=6,8%, Pr=18,3% and PuPr 3% among all patients that received chemotherapy). In the adjuvant setting, Tamoxifen (TAM) was prescribed in 69,8% of the cases (Pu=87,6%, Pr=79,6% and PuPr 78,8%), AI in 8,2% (Pu=5,9%, Pr=9,3% and PuPr 13,8%), and sequential TAM/AI in 6,6% (Pu=6,1%, Pr=8,3% and PuPr 6,4%). About 17% of the patients had metastasis.

Conclusions: There are important differences between the public and private institutions in Brazil, the patients from the Pu institutions were five times more likely to be diagnosed in stage III or IV, they usually receive neoadjuvant treatment, and when surgery was done, most of them were treated with radical procedures. Besides the overexpression of Her-2 (30%) a minority of the patients received treatment with trastuzumab even for the Private centers (high cost for a developing country).

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-37.

The Influence of Surface Standardization of Lithium Disilicate Glass Ceramic on Bond Strength to a Dual Resin Cement

In vitro studies to assess bond strength between resins and ceramics have used surfaces that have been ground flat to ensure standardization; however, in patients, ceramic surfaces are irregular. The effect of a polished and unpolished ceramic on bond strength needs to be investigated. Sixty ceramic specimens (20×5×2 mm) were made and divided into two groups. One group was ground with 220- to 2000-grit wet silicon carbide paper and polished with 3-, 1-, and ¼-μm diamond paste; the other group was neither ground nor polished. Each group was divided into three subgroups: treated polished controls (PC) and untreated unpolished controls (UPC), polished (PE) and unpolished specimens (UPE) etched with hydrofluoric acid, and polished (PS) and unpolished specimens (UPS) sandblasted with alumina. Resin cement cylinders were built over each specimen. Shear bond strength was measured, and the fractured site was analyzed. Analysis of variance (ANOVA) and Tukey post hoc tests were performed. PE (44.47 ± 5.91 MPa) and UPE (39.70 ± 5.46 MPa) had the highest mean bond strength. PS (31.05 ± 8.81 MPa), UPC (29.11 ± 8.11 MPa), and UPS (26.41 ± 7.31 MPa) were statistically similar, and PC (24.96 ± 8.17 MPa) was the lowest. Hydrofluoric acid provides the highest bond strength regardless of whether the surface is polished or not.

Exposure to alcohol, drugs and tobacco and the risk of subsequent suicidality: findings from the Mexican Adolescent Mental Health Survey

AIMS

To examine whether the association between prevalence measures of suicidality and substance abuse/dependence among adolescents (1) is attenuated when temporal priority of exposure and outcome are taken into account, (2) extends to substance use (i.e. without disorder), (3) applies to tobacco use and dependence independent of illicit drugs and alcohol use/disorder, and (4) is confounded by comorbid mental illness.

DESIGN

Discrete-time survival models were applied to retrospectively reported age of onset of first suicidal ideation, plan and attempt and age of onset of first substance use and disorder.

PARTICIPANTS

3005 adolescents aged 12-17 residing in the Mexico City Metropolitan Area in 2005.

MEASUREMENTS

The World Mental Health computer-assisted adolescent version of the Composite International Diagnostic Interview was used to assess suicidal outcomes and psychiatric disorders including substance dependence/abuse.

FINDINGS

Use of and dependence on tobacco is as strong a predictor of subsequent suicidality as is use of and dependence with abuse of alcohol and drugs. The association between substance use and subsequent suicidality is not fully accounted for by comorbid mental illness.

CONCLUSION

Efforts to reduce the use as well as the abuse of alcohol, drugs and tobacco may help reduce the risk of subsequent suicidal behaviors among adolescents in Mexico.

The more you drink, the harder you fall: a systematic review and meta-analysis of how acute alcohol consumption and injury or collision risk increase together

Alcohol consumption causes injury in a dose-response manner. The most common mode of sustaining an alcohol-attributable injury is from a single occasion of acute alcohol consumption, but much of the injury literature employs usual consumption habits to assess risk instead. An analysis of the acute dose-response relationship between alcohol and injury is warranted to generate single occasion- and dose-specific relative risks. A systematic literature review and meta-analysis was conducted to fill this gap. Linear and best-fit first-order model were used to model the data. Usual tests of heterogeneity and publication bias were run. Separate meta-analyses were run for motor vehicle and non-motor vehicle injuries, as well as case-control and case-crossover studies. The risk of injury increases non-linearly with increasing alcohol consumption. For motor vehicle accidents, the odds ratio increases by 1.24 (95% CI: 1.18-1.31) per 10-g in pure alcohol increase to 52.0 (95% CI: 34.50-78.28) at 120 g. For non-motor vehicle injury, the OR increases by 1.30 (95% CI: 1.26-1.34) to an OR of 24.2 at 140 g (95% CI: 16.2-36.2). Case-crossover studies of non-MVA injury result in overall higher risks than case-control studies and the per-drink increase in odds of injury was highest for intentional injury, at 1.38 (95% CI: 1.22-1.55). Efforts to reduce drinking both on an individual level and a population level are important. No level of consumption is safe when driving and less than 2 drinks per occasion should be encouraged to reduce the risk of injury.

Immigration to the USA and risk for mood and anxiety disorders: variation by origin and age at immigration

BACKGROUND

Risk for mood and anxiety disorders associated with US-nativity may vary across immigrant groups.

METHOD

Using data from the National Epidemiological Study of Alcohol and Related Conditions (NESARC), we examined the association of lifetime risk for mood and anxiety disorders with US-nativity and age at immigration across seven subgroups of the US population defined by country or region of ancestral origin: Mexico, Puerto-Rico, Cuba, Central and South America, Western Europe, Eastern Europe, and Africa and the Caribbean. Discrete time survival models were used to compare lifetime risk between the US-born, immigrants who arrived in the USA prior to the age of 13 years and immigrants who arrived in the USA at the age of 13 years or older.

RESULTS

The association of risk for mood and anxiety disorders with US-nativity varies significantly across ancestral origin groups (p<0.001). Among people from Mexico, Eastern Europe, and Africa or the Caribbean, risk for disorders is lower relative to the US-born among immigrants who arrived at the age of 13 years or higher (odds ratios in the range 0.34-0.49) but not among immigrants who arrived prior to the age of 13 years. There is no association between US-nativity and risk for disorder among people from Western Europe and Puerto Rico.

CONCLUSIONS

Low risk among immigrants relative to the US-born is limited to groups among whom risk for mood and anxiety disorder is low in immigrants who spent their pre-adolescent years outside of the USA.

Mental disorders and termination of education in high-income and low- and middle-income countries: epidemiological study

BACKGROUND

Studies of the impact of mental disorders on educational attainment are rare in both high-income and low- and middle-income (LAMI) countries.

AIMS

To examine the association between early-onset mental disorder and subsequent termination of education.

METHOD

Sixteen countries taking part in the World Health Organization World Mental Health Survey Initiative were surveyed with the Composite International Diagnostic Interview (n=41 688). Survival models were used to estimate associations between DSM-IV mental disorders and subsequent non-attainment of educational milestones.

RESULTS

In high-income countries, prior substance use disorders were associated with non-completion at all stages of education (OR 1.4-15.2). Anxiety disorders (OR=1.3), mood disorders (OR=1.4) and impulse control disorders (OR=2.2) were associated with early termination of secondary education. In LAMI countries, impulse control disorders (OR=1.3) and substance use disorders (OR=1.5) were associated with early termination of secondary education.

CONCLUSIONS

Onset of mental disorder and subsequent non-completion of education are consistently associated in both high-income and LAMI countries.

Treatment of mental disorders for adolescents in Mexico City

OBJECTIVE

This study describes the prevalence, adequacy and correlates of 12-month mental health service use among participants in the Mexican Adolescent Mental Health Survey.

METHODS

The authors conducted face-to-face household surveys of a probability sample of 3005 adolescents aged 12-17 years residing in the Mexico City metropolitan area during 2005. The prevalence of mental health disorders and the use of services were assessed with the computer-assisted adolescent version of the World Mental Health Composite International Diagnostic Interview. Correlates of service use and adequate treatment were identified in logistic regression analyses that took into account the complex sample design and weighting process.

FINDINGS

Less than one in seven respondents with psychiatric disorders used any mental health services during the previous year. Respondents with substance-use disorders reported the highest prevalence of service use and those with anxiety disorders the lowest. Approximately one in every two respondents receiving any services obtained treatment that could be considered minimally adequate.

CONCLUSION

We found large unmet needs for mental health services among adolescents with psychiatric disorders in Mexico City. Improvements in the mental health care of Mexican youth are urgently needed.

The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative

OBJECTIVES

To estimate the prevalence and workplace consequences of adult attention-deficit/hyperactivity disorder (ADHD).

METHODS

An ADHD screen was administered to 18-44-year-old respondents in 10 national surveys in the WHO World Mental Health (WMH) Survey Initiative (n = 7075 in paid or self-employment; response rate 45.9-87.7% across countries). Blinded clinical reappraisal interviews were administered in the USA to calibrate the screen. Days out of role were measured using the WHO Disability Assessment Schedule (WHO-DAS). Questions were also asked about ADHD treatment.

RESULTS

An average of 3.5% of workers in the 10 countries were estimated to meet DSM-IV criteria for adult ADHD (inter-quartile range: 1.3-4.9%). ADHD was more common among males than females and less common among professionals than other workers. ADHD was associated with a statistically significant 22.1 annual days of excess lost role performance compared to otherwise similar respondents without ADHD. No difference in the magnitude of this effect was found by occupation, education, age, gender or partner status. This effect was most pronounced in Colombia, Italy, Lebanon and the USA. Although only a small minority of workers with ADHD ever received treatment for this condition, higher proportions were treated for comorbid mental/substance disorders.

CONCLUSIONS

ADHD is a relatively common condition among working people in the countries studied and is associated with high work impairment in these countries. This impairment, in conjunction with the low treatment rate and the availability of cost-effective therapies, suggests that ADHD would be a good candidate for targeted workplace screening and treatment programs.

Depth of Cure of Dental Resin Composites: ISO 4049 Depth and Microhardness of Types of Materials and Shades

Achieving a high degree of cure throughout a 2 mm thickness of light-activated resin composite did not occur for many types and shades of resin composite. Clinicians should check the depth of cure by using the scraping method.

Early alcohol or tobacco onset and transition to other drug use among students in the state of Morelos, Mexico

In this study, we explored if patterns in the transition from alcohol/tobacco in the Mexican State of Morelos, Mexico are similar to those observed in other countries.

METHODS

The data were from a representative sample of youth age 11-21 years (n = 13,105), who participated in a paper-and-pencil survey in middle schools, high schools, and colleges in the State of Morelos, Mexico. Drug use was assessed via the standardized instrument mostly used in Mexican student surveys. Cox's models for discrete time-survival analyses, stratified by school and age group were used to estimate the risk of drug use in relation to age of alcohol and tobacco use initiation by gender, while accommodating the complex survey design.

RESULTS

About 5% of the students were estimated to have used drugs in their life. Male early users of alcohol or tobacco were more likely to use other drugs, compared to students who did not have an early alcohol or tobacco onset.

COMMENT

Further studies on social mechanisms might help to account for observed similarities in patterns of drug involvement in different countries, even in the context of important differences in rates of drug use.

Violence related injuries in the emergency room: alcohol, depression, and conduct problems

OBJECTIVE

The aim of this study was to obtain epidemiological measures of the association between alcohol consumption and emergency room (ER) attendance due to violence, compared to the general population in the city of Pachuca, Mexico, during October-November, 1996 and June-July, 1997.

METHOD

The study was a population-based case-control design.

INTERVENTION AND MEASUREMENTS

Data consisted of an interviewer-administered questionnaire, collected on a 24-h basis, during the entire week.

SETTING AND PARTICIPANTS

Cases were 127 patients (78% male) admitted to the ER because of an injury that was the result of violence (being in a fight or being attacked by someone). A sample of residents from Pachuca (n = 920) was the comparison group.

RESULTS

Patients reporting drinking within 6h compared to nondrinkers were more likely to suffer a violence-related injury [34.0 (17.5-66.2)] and alcohol dependent patients were more likely to be involved in a violence-related injury [7.4 (3.5-15.6)] compared to noncurrent drinkers. When both alcohol prior and alcohol dependence were considered simultaneously in multiple models among current drinkers, patients with violence-related injuries were more likely to report alcohol prior but not to be positive for alcohol dependence. Depressive symptoms, but not conduct problem behavior, were also associated with violent injury in simultaneous regressions that included alcohol variables.

CONCLUSIONS

In the city of Pachuca, Mexico, a large relationship between drinking prior to the event and violence-related injury, regardless of alcohol dependence, was found. Depression was also related to violence, suggesting the need for more comprehensive intervention with these patients.

Episodic alcohol use and risk of nonfatal injury

Usual and acute alcohol consumption are important risk factors for injury. Although alcohol-dependent people are thought to be at increased risk of injury, there are few reports suggesting that their risk is greater than that of nondependent alcohol users in a given episode of alcohol use. The authors conducted a case-crossover analysis of data on 705 injury patients from a hospital emergency department in Mexico City, Mexico, collected in 2002. The majority of the sample was male (60%) and over 30 years old (51%). With use of a multiple matching approach that took into account three control time periods (the day prior to the injury, the same day in the previous week, and the same day in the previous month), the estimated relative risk of injury for patients who reported having consumed alcohol within 6 hours prior to injury (17% of the sample) was 3.97 (95% confidence interval: 2.88, 5.48). This increase in the relative risk was concentrated within the first 2 hours after drinking; there was a positive association of increasing risk with increasing number of drinks consumed. These data suggested that relative risk estimates were the same for patients with and without alcohol use disorders.

Acute effects of vanadate oligomers on heart, kidney, and liver histology in the Lusitanian toadfish (Halobatrachus didactylus)

The contribution of vanadate oligomers to the acute histological effects of vanadium was analyzed in the heart, kidney, and liver of Halobatrachus didactylus (Schneider, 1801). A sublethal vanadium dose (5 mM, 1 mL/kg) in the form of metavanadate (containing ortho and metameric species) or in the form of decavanadate (containing only decameric species) was intraperitoneally administered by injection, and specimens of H. didactylus were sacrificed at one and seven days postinjection. Sections of heart ventricle and renal and hepatic tissue were stained with hematoxylin-eosin and examined by light microscopy to identify vanadium-induced tissue injury. In addition, PicroSirius-stained ventricular sections were analyzed by bipolarized light microscopy to determine the fraction of myocardium occupied by the ventricular wall structural elements (collagen I, collagen III, and cardiac muscle). Both vanadate solutions produced similar effects in the renal tissue. Morphological alterations included damaged renal tubules showing disorganized epithelial cells in different states of necrosis. Reabsorbed renal tubules and hyperchromatic interstitial tissue were also observed. The hepatic tissue presented hyperchromatic and hypertrophied nuclei, along with necrotic and hypertrophied hepatocytes, and more severe changes were observed in the liver with exposure to decavanadate. Vanadate oligomers promoted evident tissue lesions in the kidney and liver, but not in the cardiac tissue. However, cardiac tissue structural changes were produced. For example, decavanadate induced a hypertrophy of the ventricle due to a decrease in the percentage of myocardium occupied by collagen fibers. In general, decavanadate was shown to be more toxic than metavanadate.

Minimally invasive approach to traumatic intracerebral hematomas

Trauma is one of the leading causes of death in Brazil. We report on 28 cases of traumatic intracerebral hematomas operated on via a minimally invasive approach. A simplified method of localization and right placement of the burr hole is described in details, as well as the technique used in all cases. Every patient was submitted to pre- and postoperative CT scan (computerized tomography) and had the volume of the hematoma measured before the surgical procedure to compare the efficacy of the treatment. No patient needed a second operation, even though in some cases there were residual hematomas. We believe that this approach can be done with safety and replace a standard craniotomy in selected cases.

Characteristics of Mexican women admitted to emergency care units. Alcohol consumption and related problems

OBJECTIVE

This article describes the demographic characteristics and psychological differences in a sample of female heavy and non-heavy drinkers who attended three emergency services of the Mexican city of Pachuca, Hidalgo.

MATERIAL AND METHODS

A sample of patients seen at emergency services (ES) patients over the age of 18 was selected using ES admission forms. Twenty-five-minute, face-to-face interviews were conducted by a group of trained interviewers. Patients answered various questionnaires and scales to measure alcohol consumption and to provide information on variables that have proved to be related to female drinking.

RESULTS

Thirty-six women (5.2%) out of 717 of the total number of women were found to be heavy drinkers according to the TWEAK scale. This group of women had 2.3 times the risk of becoming depressed, 2.87 times the risk of taking other drugs, 1.95 times the likelihood of having been sexually abused and 1.57 times the risk of displaying suicidal ideation.

CONCLUSIONS

Data from this small analysis confirm international findings that problem drinking among females throughout the life cycle is linked to depression. As regards the screening instruments employed, it is necessary to conduct more in-depth research to enrich their contents and increase their reliability and validity when used among female populations. In this study, the TWEAK proved to be extremely useful for studies in emergency services.

Orbital apex syndrome due to aspergillosis: case report

We report the case of a 73-year-old female who presented facial numbness and pain in the first division of the trigeminal nerve, ptosis, diplopia and visual loss on the right side for the previous four months. The neurological, radiological and histological examination demonstrated a rare case of invasive fungal aspergillosis of the central nervous system, causing orbital apex syndrome, later transformed in temporal brain abscess. She died ten months later due to respiratory and renal failure in spite of specific antimycotic therapy.

Risk factors and outcome in 100 patients with aneurysmal subarachnoid hemorrhage

OBJECTIVE

Clinical and surgical outcome of patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm were assessed in comparison to pre-operative data and risk factors such as previous medical history, clinical presenting condition, CT findings and site of bleeding.

METHODS

We evaluated 100 consecutive patients with aneurysmal SAH. Gender, color, history of hypertension, smoking habit, site and size of aneurysm, admittance and before surgery Hunt Hess scale, need for cerebro-spinal fluid shunt, presence of complications during the surgical procedure, Glasgow Outcome Scale, presence of vasospasm and of rebleeding were assessed and these data matched to outcome. For statistical analysis, we applied the chi-squared test or Fisher's test using the pondered kappa coefficient. Kruskal-Wallis test was used for comparison of continue variables. Tendency of proportion was analyzed through Cochran-Armitage test. Significance level adopted was 5%.

RESULTS

Patients studied were mainly white, female, without previous history of hypertension and non-smokers. Upon hospital admittance, grade 2 of Hunt-Hess scale was most frequently observed (34%), while grade 3 of Fisher scale was the most prevalent. Single aneurysms were most frequent at anterior circulation, between 12 and 24 mm. The most frequent Glasgow Outcome Scale observed was 5 (60%). Hunt Hess upon the moment of surgery and presence of complications during surgical procedure showed positive correlation with clinical outcome (p=0.00002 and p=0.001, respectively). Other variables were not significantly correlated to prognosis. Tendency of proportion was observed between Hunt-Hess scale and Fisher scale.

CONCLUSION

Among variables such as epidemiological data, previous medical history and presenting conditions of patients with ruptured aneurysms, the Hunt-Hess scale upon the moment of surgery and the presence of surgical adversities are statistically related to degree of disability.

A comparison of substance use and injury among Mexican American emergency room patients in the United States and Mexicans in Mexico

BACKGROUND

Emergency room (ER) studies have found differences in the association of alcohol with injury (intentional and unintentional) across cultures. These differences may be due to differences in drinking patterns across cultures. Few comparative data have been reported on associations of alcohol and injury between Mexican American ER patients and ER patients living in Mexico, and general population studies suggest that Mexican Americans may adopt more frequent heavy drinking patterns after migrating to the United States.

METHODS

A comparative analysis of drinking, drug use, and injury was performed in probability samples of 550 ER patients from Santa Clara County (San Jose, CA) and 1417 ER patients in Pachuca (Hidalgo), Mexico.

RESULTS

Both injured and uninjured (i.e., medical conditions) patients in Pachuca were less likely to report heavy drinking, drug use, drunkenness, or alcohol-related problems compared with those in Santa Clara. Those scoring high on level of acculturation in Santa Clara were more likely to report both drinking and drug use before the event, and heavy drinking, drug use, and consequences related to drinking in the last year compared with those scoring lower. Those scoring low on acculturation were similar on substance use variables to those in the Pachuca sample.

CONCLUSIONS

Findings suggest that alcohol's association with injury may not just reflect typical drinking patterns in a culture. Among Mexican Americans, this association my vary by acculturation, and those migrating to the United States may be at increased risk for alcohol-related injury as their drinking patterns undergo change to those of the dominant culture. The ER, in this context, may take on increasing importance as a site for health services providers to implement intervention and prevention services for alcohol-related consequences in this ethnic group.

The measurement of drinking patterns and consequences in Mexico

The paper addresses the experiences of measuring and monitoring patterns of alcohol consumption and consequences in Mexico, provides an overview of alcohol use and problems, describes local cultural values that influence patterns of drinking, and discusses measurement implications.

Selection of screening items for alcohol abuse and alcohol dependence among Mexicans and Mexican Americans in the emergency department

OBJECTIVE

This article reports on the selection of screening items to detect Mexican or Mexican-American patients in the emergency department (ED) who have alcohol problems and could benefit from an intervention or a referral for treatment. Items are tested against the Rapid Alcohol Problems Screen (RAPS), which has been optimized from standard screening instruments and has outperformed these instruments.

METHOD

The performance of individual items from standard screening instruments (CAGE, TWEAK, AUDIT, TRAUMA and BMAST) against International Classification of Diseases, Tenth Revision and Diagnostic and Statistical Manual, Fourth Revision criteria for alcohol abuse and dependence was evaluated in a merged probability sample (N = 869; 72% men) of 537 ED patients from three hospitals in Pachuca, Mexico, and 332 Mexican-American ED patients in Santa Clara County, CA. Logistic regression and tree-classification models were used for item selection.

RESULTS

We found a prevalence of 15% for alcohol dependence and a prevalence of 28% for alcohol abuse or dependence in the merged sample. The RAPS items did not perform as well in terms of sensitivity (93%) as the optimal five items identified in these analyses (sensitivity = 98%) for alcohol dependence, but did demonstrate better specificity (79%) than the optimal five items (65%), which is an important consideration in a time of cost containment. Both sets of items showed better sensitivity and positive predictive value but similar Receiver Operating Characteristic values for respondents in the high acculturation group compared to those at other levels of acculturation. Differences in positive predictive value across all subgroups tended to increase at increased cutpoints, especially for the RAPS.

CONCLUSIONS

These analyses suggest that the RAPS performs favorably compared to those items optimized, in this sample of Hispanic ED patients. Based on comparative item performance in these analyses, the RAPS may hold promise as a useful tool for screening for alcohol dependence, but requires further evaluation as a stand-alone instrument in comparison with other standard screening instruments.

[Influence of the family history of alcohol consumption in men and women]

OBJECTIVE

To assess the risk for alcohol abuse among individuals with a positive family history of alcohol abuse (FH+).

MATERIAL AND METHODS

The study population was a sample (n = 8,890) drawn from a 1988 national survey on addictions in Mexico City's urban population. Data analysis consisted of frequency and association measures, using family history of alcohol abuse as the exposure factor.

RESULTS

Prevalence of heavy drinking was 13.7% for males and 0.6% for females. Alcohol dependence syndrome was found in 9.9% of males and 0.6% of females. Men with HF+ were twice more likely to develop dependence syndrome than HF- males. The odds ratio for women was 1.27.

CONCLUSIONS

Differential patterns by gender were found for familial transmission of alcohol abuse; parental alcohol intake is a main risk factor for developing alcohol dependence syndrome.

Performance of screening instruments for alcohol problems in the ER: a comparison of Mexican-Americans and Mexicans in Mexico

The performance of standard screening instruments and alternate measures against ICD-10 (International Classification of Diseases, 10th revision) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th revision) criteria for alcohol dependence and separately for harmful drinking/abuse were compared between probability samples of 1511 emergency room (ER) patients from three hospitals in Pachuca, Mexico, and 586 Mexican-American ER patients in Santa Clara County, California. Sensitivity was highest for the Alcohol Use Disorders Identification Test (AUDIT), TWEAK, and Rapid Alcohol Problems Screen (RAPS) for alcohol dependence; sensitivity was highest for holding five or more drinks for harmful drinking/abuse in both samples. All instruments performed better for alcohol dependence than for abuse/harmful drinking. Arrests for drinking and driving performed better in Santa Clara than in Pachuca, while a positive Breathalyzer reading and reporting drinking prior to the event performed better in Pachuca; both were significantly more sensitive among the injured compared to the noninjured in Pachuca. The data suggest that instrument performance may be similar between those in Pachuca and those in the low acculturation group in Santa Clara, relative to those scoring higher on acculturation. While standard screening instruments appear to work reasonably well in both samples for alcohol dependence, variation across gender, injury, and acculturation subgroups suggests attention should be given to choosing the "best" instrument.