Limited physical contact and interaction can lead adolescents to experience feelings of loneliness. Additionally, there is an observed increase in social media use among this age group. The entertainment and playful aspects of these platforms tend to captivate users, sometimes leading to addiction. This research aimed to analyze the relationship between the perception of loneliness and social media addiction in adolescents. A quantitative, non-experimental and descriptive-correlational approach with a cross-sectional design was employed. The utilized instruments included the Social Media Addiction Questionnaire (SMAQ) and the UCLA Loneliness Scale, version 3. The study involved 568 adolescents aged 12 to 18, selected through non-probability convenience sampling. The analysis revealed significant differences (p<0.01) in perceptions of loneliness and lack of control over social media use among females. It also showed differences in perceptions of loneliness among public school students (p<0.05). A direct, low positive correlation was found between perceptions of loneliness and social media addiction in this population (rs = 0.203; p<0.01).

El poco contacto físico e interacción podría llevar a los adolescentes a experimentar sentimientos de soledad. A su vez, se observa un aumento en el uso de las redes sociales por este grupo poblacional; los componentes lúdicos y de entretenimiento tienden a absorber a los usuarios, y llegan a desarrollar en algunos una adicción. El objetivo de la investigación que dio origen al presente artículo científico fue analizar la relación entre la percepción de soledad y la adicción a las redes sociales en adolescentes. Se utilizó un enfoque cuantitativo, no experimental, descriptivo-correlacional, de corte transversal. Los instrumentos utilizados fueron el Cuestionario de Adicción a Redes Sociales (ARS) y la Escala de Soledad de UCLA, versión 3. Participaron 568 adolescentes, entre 12 a 18 años, mediante un muestreo no probabilístico por conveniencia. El análisis mostró diferencias significativas (p<0.01) en la percepción de soledad y la falta de control en el uso de las redes sociales en cuanto al sexo femenino y en la percepción de soledad de los estudiantes de colegio público (p<0.05). Se encontró una relación directa, positiva baja entre la percepción de soledad y la adicción a las redes sociales en esta población (rs = 0.203; p<0.01).

ABSTRACT Objective To analyze the impact of Dual Diagnosis on patient’s work capacity and verify if the professional activity sector matters. Dual Diagnosis is defined by the coexistence of an Addiction and another psychiatric disorder. Methodology All patients admitted for inpatient treatment at Alcohol and New Addiction’s Treatment Unit from Lisbon’s Psychiatric Hospital Center, for six months, between 1st November 2021 and 30th April 2022, were selected and screened for sociodemographic and clinical characteristics (age, gender, education level, professional situation, and activity sector at admission as well as main admission diagnosis and other psychiatric comorbidities). Retrospective observative analysis focused on patient’s work capacity was conducted between patients who had been diagnosed with an Addiction Disorder and patients with Dual Diagnosis. Results Our sample had 78 patients and an average age of 51 years. From those, 31 had diagnosis of Addiction Disorder and 47 had Dual Diagnosis. Only 27% patients were still active at admission, with 15% being with temporary incapacity certificate, 41% being unemployed and 17% retired. A significant part of our sample worked in accommodation, transportation, and food services activities (29%), construction sector (19%) and in healthcare, education, and social work activities (17%). The unemployment rates between patients with an Addiction Disorder and Dual Diagnosis were similar. However, 39% of patients with an Addiction Disorder were active while only 19% with Dual Diagnosis were in the same state. Also of interest was that 34% of those with Dual Diagnosis worked in accommodation, transportation, and food services activities. Conclusions These results show that Dual Diagnosis may have a significant impact in the working capacity and suggest that there are important differences between professional activity sectors in patients with or without dual diagnosis.

RESUMO Objetivos Analisar o impacto da Patologia Dual na capacidade de trabalho e verificar se existe relevância com o setor de atividade profissional. A Patologia Dual define-se pela coexistência de uma Adição e de outra patologia psiquiátrica. Metodologia Todos os pacientes internados para tratamento na Unidade de Tratamento para Álcool e Novas Dependências do Centro Hospitalar Psiquiátrico de Lisboa, durante seis meses, entre 1 de novembro de 2021 e 30 de abril de 2022, foram selecionados e avaliados quanto a características sociodemográficas e clínicas (idade, género, nível de educação, situação profissional e setor de atividade aquando da admissão, bem como diagnóstico principal à admissão e outras comorbilidades psiquiátricas). Realizada uma análise observacional retrospetiva focada na capacidade de trabalho dos doentes entre aqueles diagnosticados apenas com uma Adição (com ou sem uso de substância) e doentes com o diagnóstico de Patologia Dual. Resultados A amostra incluiu 78 pacientes com uma idade média de 51 anos. Destes, 31 foram diagnosticados com uma Adição e 47 com Patologia Dual. Apenas 27% dos pacientes estavam com uma situação profissional ativa aquando da admissão hospitalar, com 15% em situação de incapacidade temporária para o trabalho, 41% em situação de desemprego e 17% na reforma. As principais áreas de atividades presentes na amostra pertenciam a três setores, sendo que 29% dos pacientes trabalhava no setor da restauração, hotelaria, transportes e outros serviços de lazer, 19% no setor da construção e 17% no setor da saúde, educação e serviços sociais. As taxas de desemprego presentes entre pacientes diagnosticados com Adição foram semelhantes à dos pacientes diagnosticados com Patologia Dual. No entanto, 39% dos pacientes com Adição encontravam-se com uma situação profissional ativa, enquanto que apenas 19% dos diagnosticados com Patologia Dual estavam profissionalmente ativos. Observamos ainda que 34% dos pacientes com patologia dual trabalhavam no setor da restauração, hotelaria, transportes e outros serviços de lazer. Conclusões Os resultados demonstram que a Patologia Dual pode ter um impacto significativo na capacidade de trabalho da população e sugerem que existem diferenças importantes entre os setores de atividade profissional em pacientes com ou sem o diagnóstico de Patologia Dual, contudo, são necessários estudos mais alargados nesta área.

Abstract The rise in the study of sexualised drug use among gay, bisexual and other men who have sex with men (MSM), known as chemsex, has generated a multiplicity of data that contribute to its problematisation as a public health issue through the link with HIV and addictions. The study of these practices, from a biomedical paradigm, has focused on risk and has contributed to its reduction as a unique and quantifiable phenomenon. This study aims to explore the experience of risk in the course of the practices, to find out what management strategies they employ in the face of risk and how they are generated. Semi-structured interviews were conducted with five chemsex practitioners in the Metropolitan Area of Barcelona and, subsequently, a thematic analysis was applied. The findings show how these men detect, assume and confront the risks present in these practices, where the type of relationships that take place and the social circle available to them are relevant. This study also highlights the creation of strategies based on experience and how the transmission of this knowledge among participants facilitates decision-making and risk management. gay MSM, MSM , (MSM) addictions practices paradigm phenomenon Semistructured Semi structured subsequently applied detect relevant decisionmaking decision making (MSM

Resumen El auge en el estudio del uso sexualizado de drogas entre hombres gais, bisexuales u otros hombres que tienen sexo con hombres (HSH), conocido como chemsex, ha generado una multiplicidad de datos que contribuyen a su problematización en tanto cuestión de salud pública a través del vínculo con el VIH y las adicciones. El estudio de estas prácticas, desde un paradigma biomédico, se ha centrado en el riesgo y ha contribuido a su reducción como fenómeno único y cuantificable. Este estudio tiene como objetivo explorar la vivencia del riesgo en el transcurso de las prácticas, para conocer qué estrategias de manejo emplean frente a éste y de qué manera son generadas. Se realizaron entrevistas semiestructuradas a cinco practicantes de chemsex en el Área Metropolitana de Barcelona y, posteriormente se aplicó un análisis temático. Los hallazgos muestran cómo estos hombres detectan, asumen y enfrentan los riesgos presentes en estas prácticas, donde toman relevancia el tipo de relaciones que allí se dan y el círculo social del que disponen. Este estudio destaca también la creación de estrategias basadas en la experiencia y cómo la transmisión de estos saberes entre participantes facilita la toma de decisiones y el manejo del riesgo. gais HSH, HSH , (HSH) adicciones prácticas biomédico cuantificable generadas temático detectan disponen (HSH

Abstract The rise in the study of sexualised drug use among gay, bisexual and other men who have sex with men (MSM), known as chemsex, has generated a multiplicity of data that contribute to its problematisation as a public health issue through the link with HIV and addictions. The study of these practices, from a biomedical paradigm, has focused on risk and has contributed to its reduction as a unique and quantifiable phenomenon. This study aims to explore the experience of risk in the course of the practices, to find out what management strategies they employ in the face of risk and how they are generated. Semi-structured interviews were conducted with five chemsex practitioners in the Metropolitan Area of Barcelona and, subsequently, a thematic analysis was applied. The findings show how these men detect, assume and confront the risks present in these practices, where the type of relationships that take place and the social circle available to them are relevant. This study also highlights the creation of strategies based on experience and how the transmission of this knowledge among participants facilitates decision-making and risk management.

Resumen El auge en el estudio del uso sexualizado de drogas entre hombres gais, bisexuales u otros hombres que tienen sexo con hombres (HSH), conocido como chemsex, ha generado una multiplicidad de datos que contribuyen a su problematización en tanto cuestión de salud pública a través del vínculo con el VIH y las adicciones. El estudio de estas prácticas, desde un paradigma biomédico, se ha centrado en el riesgo y ha contribuido a su reducción como fenómeno único y cuantificable. Este estudio tiene como objetivo explorar la vivencia del riesgo en el transcurso de las prácticas, para conocer qué estrategias de manejo emplean frente a éste y de qué manera son generadas. Se realizaron entrevistas semiestructuradas a cinco practicantes de chemsex en el Área Metropolitana de Barcelona y, posteriormente se aplicó un análisis temático. Los hallazgos muestran cómo estos hombres detectan, asumen y enfrentan los riesgos presentes en estas prácticas, donde toman relevancia el tipo de relaciones que allí se dan y el círculo social del que disponen. Este estudio destaca también la creación de estrategias basadas en la experiencia y cómo la transmisión de estos saberes entre participantes facilita la toma de decisiones y el manejo del riesgo.

Abstract Objective: To evaluate the effectiveness of a family intervention in grief complicated by a couple breakup. Materials and method: Research with a mixed intervention approach in three stages (diagnosis-implementation-evaluation). In the first, an observational, cross-sectional, descriptive study was carried out, with a simple random sample with replacement n=99. Field's "Romantic Breakup Distress Scale" and Smilkstein's family APGAR were applied, with prior informed consent. Five families with complicated grief and family dysfunction were included. Methods and techniques of working with family were used. In the third stage, a quasi-experimental design was used with pretest and posttest of complicated grief and family APGAR. SPSS V25 was used to capture and analyze data, with descriptive and analytical statistics with Student's t test. Results: They were women 81.8%, with age Ⱦ=34.19-29 37.4%, high school 37.4%, separated 59.6%, divorced 49.4%. With complicated grief 14%, family dysfunction 13%. Families with complicated grief were dysfunctional 53.8%. Risk factors: conflict in paternalfilial subsystem, addictions, economy. Protective factors: religious, artistic, educational and medical groups. The actions focused on cognitive-behavioral-emotional intervention. In pretest/posttest evaluation, complicated grief presented a mean difference of Ⱦ=8.500, ŝ± 8.925, and 95% CI: Li: 3.347 Ls:13.653, with student's t=3.564 and df=13 and p value=0.003, statistically significant, mean difference for family Apgar of Ⱦ= 3.357 with ŝ±1.946, 95% CI: Li:2.234, Ls:4.481 with student's t=6.456 and df=13, p value=0.001, statistically significant. Conclusions: The effect of the family intervention modified complicated grief and improved family dynamics and functionality. Conclusions: The effect of the family intervention modified complicated grief and improved family dynamics and functionality.

Resumen Objetivo: Evaluar la eficacia de una intervención familiar en duelo complicado por ruptura de pareja. Materiales y método: Investigación con enfoque mixto de intervención en tres etapas (diagnóstica-implementación-evaluación). En la primera se realizó estudio observacional, transversal, descriptivo, con muestra aleatoria simple con remplazo n=99. Se aplicó “Escala de Distrés por Ruptura Amorosa” de Field y APGAR familiar de Smilkstein, previo consentimiento informado. Se incluyeron cinco familias con duelo complicado y disfunción familiar. Se emplearon métodos y técnicas de trabajo con familia. En la tercera etapa se utilizó diseño cuasi experimental con pretest y postest de duelo complicado y APGAR familiar. Para la captura y análisis de datos se empleó el SPSS V25, con estadística descriptiva y analítica con prueba t de student. Resultados. Fueron mujeres 81.8%, con edad Ⱦ=34,19-29 37.4%, bachillerato 37.4%, separados 59.6%, divorciados 49.4%. Con duelo complicado 14%, disfunción familiar 13%. Las familias con duelo complicado fueron disfuncionales 53.8%. Los factores de riesgo: conflicto en subsistema paterno filial, adicciones, economía. Factores protectores: grupos religiosos, artísticos, educativos y médicos. Las acciones se centraron en intervención cognitivo-conductual-emocional. En evaluación pretest/postest, el duelo complicado presentó diferencia de medias de Ⱦ=8.500, ŝ± 8.925, e IC95%: Li: 3.347 Ls:13.653, con t de student=3.564 y gl=13 y valor de p=0.003, estadísticamente significativo, diferencia de medias para Apgar familiar de Ⱦ= 3.357 con ŝ±1.946, IC95%: Li:2.234, Ls:4.481 con t de student=6.456 y gl=13, valor de p=0.001, estadísticamente significativo. Conclusiones: El efecto de la intervención familiar modificó el duelo complicado y mejoró la dinámica y funcionalidad familiar.

RESUMEN En Ecuador se evidencia una creciente proliferación privada de Centros Especializados de Tratamientos para Adicciones (CETAD), pues el Estado no satisface con sus infraestructuras. Establecimientos que acarrean gravísimas denuncias por violación a derechos humanos y normas bioéticas. El propósito de este artículo comprende un análisis del desempeño ético y en derechos humanos a nivel de la salud mental dentro de estos “tratamientos”. Se realiza una revisión bibliográfica donde se exploraron 70 artículos, seleccionando los 31 principales publicados entre el 2017 al 2022 de las bases de datos: Scielo, MEDLINE, Dialnet, Psicodoc, PsycArticles. Destaca como resultado, que existe coincidencia en que el Estado debe asumir activamente los procesos de rehabilitación para drogodependencias, pues la propagación de centros privados se ha convertido en un negociado, donde se vulneran normas constitucionales y parámetros bioéticos. Se concluye que, a nivel de la salud, la infracción de códigos deontológicos, éticos, y derechos humanos, atentan contra las normas bioéticas.

ABSTRACT In Ecuador, there is evidence of a growing private proliferation of "Specialized Addiction Treatment Centers" - CETAD, since the State does not supply itself with its infrastructures. Establishments that carry very serious complaints for violation of human rights and bioethical standards. The purpose of this work includes an analysis of the ethical and human rights performance at the level of mental health within these "treatments". In this bibliographic review, 70 articles were explored, selecting the 31 main ones published between 2017 and 2022 from the databases: Scielo, MEDLINE, Dialnet, Psicodoc, PsycArticles. As a result, it stands out that the State must actively assume the rehabilitation processes for drug addictions, since the spread of private centers has become a business, where constitutional norms and bioethical parameters are violated. It is concluded that, at the health level, the violation of deontological, ethical, and human rights codes violates bioethical standards.

ABSTRACT Objetivo: Determinar costos directos del tratamiento en tres grupos de pacientes con tuberculosis pulmonar (TP): ambulatorios-adherentes (AA), hospitalizados adherentes (HA) y hospitalizados no adherentes (HNA). Material y métodos: Se consideraron tres grupos: ambulatorios-adherentes, hospitalizados adherentes y hospitalizados no adherentes. Se determinaron costos directos desde la perspectiva del financiador, según modulación del Gobierno de la Ciudad de Buenos Aires a julio 2022, cotización peso/dólar 140. El costo de las drogas antituberculosis fue provisto por el Programa de Tuberculosis del Gobierno de la Ciudad de Buenos Aires. Resultados: Se incluyeron 10 pacientes ambulatorios adherentes. El tiempo de tratamiento fue de 24 ± 2,52 semanas; la adherencia, el 100 %. El costo directo fue de USD 257,79 por paciente (RIQ = 191,6-328,55). Se incluyeron 20 pacientes hospitalizados no adherentes y 10 hospitalizados adherentes, sin diferencias en edad y género entre ellos. Los primeros tenían mayor carga tabáquica, situación de calle, desnutrición, alcoholismo, adicciones y HIV (todos p < 0,05). El tiempo de primer tratamiento fue para hospitalizados no adherentes 5,5 semanas (RIQ = 3-8) y 24 semanas para hospitalizados adherentes. La duración en hospitalizados no adherentes de siguientes tratamientos fue de 0,5-9 semanas. El costo final alcanzó USD 8165,87 por paciente (RIQ = 4706,45- 12 897,82) en hospitalizados no adherentes y USD 4015,26 (RIQ = 3458,15-4482,6), en hospitalizados adherentes (p < 0,01). Conclusión: El costo directo del tratamiento en ambulatorios adherentes fue USD 257 por paciente. El costo directo del abandono del tratamiento de hospitalizados no adherentes es el doble que en hospitalizados adherentes (USD 8165 vs. USD 4015). El costo de tratar a ambulatorios adherentes es quince veces menor que internarlos. Es el primer estudio de costos directos en nuestro país sobre el tema. Se deben instrumentar programas de mejora de adherencia al tratamiento para evitar un alto costo sanitario, drogorresistencia y aumento de la morbimortalidad.

ABSTRACT Objective: To determine the direct costs of the treatment in three groups of patients with pulmonary tuberculosis (PTB): adherent outpatients (AOs), hospitalized-adherent (HA), and hospitalized non-adherent (HNA). Methods: Three groups were considered: AOs, HA, and HNA patients. Direct costs were determined from the perspective of the funder, based on the cost modules pro-vided by the Government of the City of Buenos Aires (GCBA) as of July 2022, with a peso/dollar exchange rate of 140. The cost of antituberculous drugs was provided by the Tuberculosis Program of the GCBA. Results: Ten AOs were included, with a treatment duration of 24±2.52 weeks and 100 % adherence. The direct cost was US$ 257.79 per patient (IQR [interquartile range]=191.6-328.55). Twenty HNA patients and ten HA patients were included, with no differences between the groups in age and gender. HNA patients showed the following characteristics: higher smoking load, homelessness, malnutrition, alcoholism, addictions, and HIV (all p<0.05). The duration of the first treatment was 5.5 weeks for HNA patients (IQR=3-8), and 24 weeks for HA patients. The duration of subsequent treatments for HNA patients ranged from 0.5 to 9 weeks. The final cost was US$ 8,165.87 per patient (IQR=4,706.45-12,897.82) in the HNA group and US$ 4,015.26 per patient (IQR=3,458.15-4,482.6) in the HA group (p<0.01). Conclusion: The direct cost of treatment in AOs was US$ 257 per patient. The direct cost of treatment withdrawal in HNA patients is twice the cost of HA patients (US$ 8,165 vs. US$ 4,015). The cost of treating AOs is fifteen times lower than the cost of hospitalizing them. This is the first study about direct costs on this topic to be conducted in our country. Programs to improve treatment adherence should be implemented to prevent high healthcare costs, drug resistance, and increased morbidity and mortality.

ABSTRACT Objetivo: Determinar costos directos del tratamiento en tres grupos de pacientes con tuberculosis pulmonar (TP): ambulatorios-adherentes (AA), hospitalizados adherentes (HA) y hospitalizados no adherentes (HNA). Material y métodos: Se consideraron tres grupos: ambulatorios-adherentes, hospitaliza dos adherentes y hospitalizados no adherentes. Se determinaron costos directos desde la perspectiva del financiador, según modulación del Gobierno de la Ciudad de Buenos Aires a julio 2022, cotización peso/dólar 140. El costo de las drogas antituberculosis fue provisto por el Programa de Tuberculosis del Gobierno de la Ciudad de Buenos Aires. Resultados: Se incluyeron 10 pacientes ambulatorios adherentes. El tiempo de trata miento fue de 24 ± 2,52 semanas; la adherencia, el 100 %. El costo directo fue de USD 257,79 por paciente (RIQ = 191,6-328,55). Se incluyeron 20 pacientes hospitalizados no adherentes y 10 hospitalizados adherentes, sin diferencias en edad y género entre ellos. Los primeros tenían mayor carga tabáquica, situación de calle, desnutrición, al coholismo, adicciones y HIV (todos p < 0,05). El tiempo de primer tratamiento fue para hospitalizados no adherentes 5,5 semanas (RIQ = 3-8) y 24 semanas para hospitalizados adherentes. La duración en hospitalizados no adherentes de siguientes tratamientos fue de 0,5-9 semanas. El costo final alcanzó USD 8165,87 por paciente (RIQ = 4706,45- 12 897,82) en hospitalizados no adherentes y USD 4015,26 (RIQ = 3458,15-4482,6), en hospitalizados adherentes (p < 0,01). Conclusión: El costo directo del tratamiento en ambulatorios adherentes fue USD 257 por paciente. El costo directo del abandono del tratamiento de hospitalizados no adherentes es el doble que en hospitalizados adherentes (USD 8165 vs. USD 4015). El costo de tratar a ambulatorios adherentes es quince veces menor que internarlos. Es el primer estudio de costos directos en nuestro país sobre el tema. Se deben instrumentar programas de mejora de adherencia al tratamiento para evitar un alto costo sanitario, drogorresistencia y aumento de la morbimortalidad.

ABSTRACT Objective: To determine the direct costs of the treatment in three groups of patients with pulmonary tuberculosis (PTB): adherent outpatients (AOs), hospitalized-adherent (HA), and hospitalized non-adherent (HNA). Methods: Three groups were considered: AOs, HA, and HNA patients. Direct costs were determined from the perspective of the funder, based on the cost modules pro-vided by the Government of the City of Buenos Aires (GCBA) as of July 2022, with a peso/dollar exchange rate of 140. The cost of antituberculous drugs was provided by the Tuberculosis Program of the GCBA. Results: Ten AOs were included, with a treatment duration of 24±2.52 weeks and 100 % adherence. The direct cost was US$ 257.79 per patient (IQR [inter quartile range]=191.6-328.55). Twenty HNA patients and ten HA patients were included, with no differences between the groups in age and gender. HNA patients showed the following characteristics: higher smoking load, homelessness, malnutrition, alcoholism, addictions, and HIV (all p<0.05). The duration of the first treatment was 5.5 weeks for HNA patients (IQR=3-8), and 24 weeks for HA patients. The duration of subsequent treatments for HNA patients ranged from 0.5 to 9 weeks. The final cost was US$ 8,165.87 per patient (IQR=4,706.45-12,897.82) in the HNA group and US$ 4,015.26 per patient (IQR=3,458.15-4,482.6) in the HA group (p<0.01). Conclusion: The direct cost of treatment in AOs was US$ 257 per patient. The direct cost of treatment withdrawal in HNA patients is twice the cost of HA patients (US$ 8,165 vs. US$ 4,015). The cost of treating AOs is fifteen times lower than the cost of hospitalizing them. This is the first study about direct costs on this topic to be conducted in our country. Programs to improve treatment adherence should be implemented to prevent high healthcare costs, drug resistance, and increased morbidity and mortality.

SUMMARY OBJECTIVE: In this study, we aimed to evaluate the relationships between Internet addiction, smartphone addiction, sleep quality, and academic success. METHODS: In this cross-sectional study, high-school students were surveyed to evaluate sleep quality, Internet addiction, and smartphone addiction. Students were queried about their demographics, and grade averages from the previous term were taken as an indicator of academic success. RESULTS: A total of 1,959 students were enrolled in this study, with 1,034 (52.8%) girls and 925 (47.2%) boys, and the median age of the participants was 16 (13–21) years. Multivariate analyses found that poor sleep quality in students who did not have breakfast before going to school was 1.58 times higher than those who did (p<0.001). Students who stayed in a dormitory had 1.79 times more poor sleep quality than those who stayed with their family, and a one-unit increase in the total score of the Young’s Internet Addiction Test short form resulted in a 1.08-fold increase (both, p<0.001). CONCLUSION: Our study has shown that students’ sleep quality was predicted to be lower if they stayed in a dormitory and skipped breakfast. In addition, Internet and smartphone addictions have a negative effect on sleep quality and academic performance. OBJECTIVE addiction success METHODS crosssectional cross sectional highschool high demographics RESULTS 1959 1 959 1,95 1034 034 1,03 52.8% 528 52 8 (52.8% 92 47.2% 472 47 2 (47.2% boys 13–21 1321 13 21 (13–21 years 158 58 1.5 p<0.001. p0001 p p<0.001 . 0 001 (p<0.001) 179 79 1.7 family oneunit one unit Youngs Young s 1.08fold 108fold fold 1.08 08 both, both (both p<0.001) CONCLUSION addition performance 195 95 1,9 103 03 1,0 52.8 5 (52.8 9 47.2 4 (47.2 13–2 132 (13–2 15 1. p000 p<0.00 00 (p<0.001 17 7 08fold 108 1.0 19 1, 10 52. (52. 47. (47. 13– (13– p00 p<0.0 (p<0.00 (52 (47 (13 p0 p<0. (p<0.0 (5 (4 (1 p<0 (p<0. ( p< (p<0 (p< (p

Abstract Objective Impulsivity has been robustly linked to various addictions, including behavioral addictions. This systematic review aimed to investigate possible relationships between impulsivity and gaming disorder. Method A total of 1,710 empirical studies, without date or language restrictions, were retrieved from Biblioteca Virtual em Saúde, Cumulative Index to Nursing and Allied Health Literature, PubMed, PsycNET, Scopus, and Web of Science databases. In total, 16 studies met the inclusion criteria and were included for extraction, quantitative analysis, and integrative synthesis. Results Overall, a positive association was observed between gaming disorder and both self-reported measures of impulsivity and behavioral measures of impulsivity. Gaming disorder was associated with the presence of high-risk trends, high sensitivity to rewards, reduced inhibitory control, and low self-control among video game players. Conclusion The present systematic review provides preliminary support for the robust association between impulsivity and gaming disorder. However, given the methodological heterogeneity in assessment instruments and statistical procedures, the identified association should be interpreted cautiously. addictions 1710 1 710 1,71 restrictions Saúde Literature PubMed PsycNET Scopus databases extraction analysis synthesis Overall selfreported self reported highrisk risk trends rewards control selfcontrol players However procedures cautiously 171 71 1,7 17 7 1,

Resumo Objetivo A impulsividade tem estado fortemente ligada a vários tipos de dependência, incluindo as dependências comportamentais. Esta revisão sistemática visou investigar possíveis relações entre a impulsividade e o transtorno por jogos eletrônicos. Método Um total de 1.710 estudos empíricos, sem restrições de data ou linguagem, foram recuperados das bases de dados Biblioteca Virtual em Saúde, Cumulative Index to Nursing and Allied Health Literature, PubMed, PsycNET, Scopus, e Web of Science. No total, 16 estudos preencheram os critérios de inclusão e foram incluídos para extração, análise quantitativa, e síntese integrativa. Resultados Observou-se uma associação positiva entre o transtorno por jogos eletrônicos e as medidas de impulsividade e de comportamento de impulsividade autorrelatadas. O transtorno por jogos eletrônicos foi associado à presença de tendências de alto risco, alta sensibilidade às recompensas, controle inibitório reduzido, e baixo autocontrole entre os jogadores. Conclusão A presente revisão fornece apoio preliminar para uma associação robusta entre a impulsividade e o transtorno por jogos eletrônicos. Contudo, dada a heterogeneidade metodológica nos instrumentos de avaliação e procedimentos estatísticos, esta associação deve ser interpretada com cautela. dependência comportamentais 1710 1 710 1.71 empíricos linguagem Saúde Literature PubMed PsycNET Scopus Science extração quantitativa integrativa Observouse Observou se autorrelatadas risco recompensas reduzido jogadores Contudo estatísticos cautela 171 71 1.7 17 7 1.

RESUMO Objetivo: identificar os fatores preditivos associados ao atraso de consolidação em 6 meses e à não união em 12 meses em fraturas da diáfise da tíbia tratadas com haste intramedular (HIM). Métodos: O estudo longitudinal retrospectivo de coorte incluiu 218 pacientes, que apresentaram fraturas da díafise da tíbia e receberam HIM entre janeiro de 2015 e março de 2022. Os desfechos principais pesquisados foram atraso de consolidação em 6 meses de acompanhamento, e não união em 12 meses. Coletou-se dados de uma variedade de fatores de risco. Utilizou-se análise de regressão logística bivariada para explorar os fatores preditivos de atraso de consolidação e não união. Resultados: Aos 6 meses, a incidência de atraso de consolidação foi de 28,9%. Os preditores de atraso de consolidação incluem cobertura de retalho, trauma de alta energia, fraturas expostas, uso de fixação externa como tratamento estagiado, porcentagem de contato cortical em fraturas simples, escore RUST e infecção pós-operatória. Após 12 meses, a taxa de não união foi de 15,6%, com fatores preditivos sendo necessidade de cobertura por retalho, lesão vascular, trauma de alta energia, fraturas expostas, uso de fixação externa como tratamento estagiado, porcentagem de contato cortical em fraturas simples e infecção pós-operatória. Nível de Evidência III; Estudo Longitudinal Retrospectivo. Objetivo 1 HIM. . (HIM) Métodos 21 pacientes 201 2022 acompanhamento Coletouse Coletou se risco Utilizouse Utilizou Resultados 289 28 9 28,9% retalho energia expostas estagiado pósoperatória. pósoperatória pós operatória. operatória pós-operatória 156 15 15,6% vascular III Retrospectivo (HIM 2 20 202 28,9 15,6 28, 15,

ABSTRACT Objective: Identify the predictors associated with delayed union at 6 months and non-union at 12 months in tibial shaft fractures treated with intramedullary nailing (IMN). Methods: This retrospective longitudinal study included a cohort of 218 patients who sustained tibial shaft fractures and received IMN between January 2015 and March 2022. We gathered data on a range of risk factors, including patient demographics, trauma intensity, associated injuries, fracture characteristics, soft tissue injuries, comorbidities, addictions, and treatment-specific factors. We employed logistic bivariate regression analysis to explore the factors predictive of delayed union and non-union. Results: At the 6-month follow-up, the incidence of delayed union was 28.9%. Predictors for delayed union included flap coverage, high-energy trauma, open fractures, the use of external fixation as a staged treatment, the percentage of cortical contact in simple type fractures, RUST score, and postoperative infection. After 12 months, the non-union rate was 15.6%. Conclusion: the main predictors for non-union after IMN of tibial shaft fractures are related to the trauma energy. Furthermore, the initial treatment involving external fixation and postoperative infection also correlated with non-union. Level of Evidence III; Retrospective Longitudinal Study. Objective nonunion non 1 IMN. . (IMN) Methods 21 201 2022 demographics intensity injuries characteristics comorbidities addictions treatmentspecific specific nonunion. union. Results 6month month followup, followup follow up, up follow-up 289 28 9 28.9% coverage highenergy high energy score 156 15 15.6% Conclusion Furthermore III Study (IMN 2 20 202 28.9 15.6 28. 15.

ABSTRACT The experience of homelessness is associated with strong stigmatization processes, which are often reflected in the treatment received from professionals and the healthcare system itself. This article aims to analyze the experiences of participants in a program for homeless individuals in Barcelona called Primer la Llar within the healthcare system, and how the stigma they suffer affects the care processes. This program follows the Housing First model, a social intervention that proposes providing housing without preconditions to individuals with long histories of street living, who suffer from severe mental disorders and/or addictions. Based on individual interviews with 20 participants conducted between 2016 and 2020, it is observed that in certain cases, entering the program, having housing availability, support from professionals, and the development of their own strategies had positive effects on improving their health, although they continue to perceive discriminatory attitudes in some medical settings. It is suggested that the transformation regarding stigmatization be understood broadly, affecting individuals, institutions, and society as a whole.

RESUMEN El tránsito por el sinhogarismo está asociado a procesos de fuerte estigmatización que, en muchas ocasiones, tienen su reflejo en el trato que reciben por parte de las y los profesionales y del propio sistema de atención en salud. Este artículo tiene como objetivo analizar las experiencias que tuvieron en el sistema sanitario las y los participantes de un programa para personas sin hogar en Barcelona llamado Primer la Llar, y cómo el estigma que sufren estas personas llega a condicionar los procesos de atención. Dicho programa sigue el modelo Housing First, una intervención social que propone la entrada a una vivienda sin condiciones previas a personas con largas trayectorias de vida en la calle, que sufren trastornos mentales graves y/o adicciones. A partir de entrevistas individuales con 20 participantes, realizadas entre 2016 y 2020, se observa que, en determinados casos, el ingreso en el programa, la disponibilidad de una vivienda, el soporte de profesionales y el desarrollo de estrategias propias tuvieron efectos positivos en la mejora de su salud, aunque continúan percibiendo actitudes discriminatorias en algunos espacios médicos. Se plantea la necesidad de que la transformación respecto a la estigmatización sea entendida en un sentido amplio, en las personas, en las instituciones y en la sociedad.

Resumo Depender de auxílio para a realização de atividades instrumentais da vida diária (AIVDs) na velhice revela robustas relações com vulnerabilidades ao bem-estar e riscos à saúde mental. O presente estudo examinou a formação de agrupamentos de pessoas idosas residentes na comunidade segundo o tipo de atividades instrumentais nas quais há dependência e o relato de sintomas depressivos particulares. Foram utilizados os dados dos 419 participantes (80+ 4,5 anos; 69,4% feminino) da coleta de seguimento do estudo FIBRA - Fragilidade em Idosos Brasileiros. A prevalência de dependência para AIVDs foi de 49,64% de 29,1% para depressão, segundo o escore total da GDS-15. Por meio de análise de cluster foram identificados quatro grupos de manifestação de dependência segundo o número, tipo de AIVD e associações com condições sociodemográficas, saúde, autonomia e controle percebidos. Análises de regressão multinomial identificaram diferenças nas razões de chance para um dos sintomas depressivos que compõem a GDS-15, após ajuste de variáveis. Em relação ao cluster funcionalmente preservado (cluster 1), itens representativos de rebaixamento em afetos positivos e disposição física (“anedonia”) foram mais prováveis no cluster 2. O cluster 3, com maiores dependências para AIVDs realizadas fora do domicílio, foi caracterizado por experiências de isolamento social. O Cluster 4, com maior número de tipos de dependências, apresentou maior probabilidade de apresentar sintomas depressivos centrais de depressão clínica. As evidências sugerem validade em especificar relações entre dependências e experiências emocionais as quais podem fazer parte dos planos de cuidado e políticas públicas em saúde e envelhecimento.

Abstract Depending on help to carry out instrumental activities of daily living (IADLs) in old age reveals robust relationships with vulnerabilities to well-being and risks to mental health. The present study examined the formation of groups of elderly people living in the community according to the type of instrumental activities in which there is dependence and the report of particular depressive symptoms. Data from 419 participants (80+ 4.5 years old; 69.4% female) from the follow-up collection of the FIBRA study - Frailty in Brazilian Elderly people were used. The prevalence of dependence for IADLs was 49.64% of 29.1% for depression, according to the total GDS-15 score. Through cluster analysis, four groups of manifestation of dependence were identified according to the number, type of IADL, and associations with sociodemographic conditions, health, perceived autonomy, and control. Multinomial regression analyzes identified differences in odds ratios for one of the depressive symptoms that make up the GDS-15, after adjusting variables. Regarding the functionally preserved cluster (cluster 1), items representative of downgrading in positive affects and physical disposition (“anhedonia”) were more likely in cluster 2. Cluster 3, with greater dependencies for IADLs performed outside the home, was characterized by experiences of social isolation. Cluster 4, with the highest number of types of addictions, was more likely to have central depressive symptoms of clinical depression. The evidence suggests validity in specifying relationships between addictions and emotional experiences which may be part of care plans and public policies in health and aging.

Abstract Diversion of substances from the care of the intended patient is a significant problem in healthcare. Patients are harmed by the undertreatment of pain and suffering, transmission of disease, as well as the risk associated with impaired vigilance. Healthcare providers may be harmed by the physical and mental impact of their addictions. Healthcare systems are placed in jeopardy by the legal impact associated with illegal routes of drug release including sanction and financial liability and loss of public trust. Healthcare institutions have implemented many measures to reduce diversion from the perioperative area. These efforts include education, medical record surveillance, automated medication dispensing systems, urine drug testing, substance waste management systems, and drug diversion prevention teams. This narrative review evaluates strengths, weaknesses, and effectiveness of these systems and provides recommendations for leaders and care providers. healthcare suffering disease vigilance addictions trust area education surveillance testing teams strengths weaknesses