Injection Drug Use Trajectories among Migrant Populations: A Narrative Review

Background: Dual epidemics of injection drug use and blood-borne disease, characterized as “syndemics,” are present in a range of settings. Behaviors that drive such syndemics are particularly prevalent among mobile drug-using populations, for whom cross-border migration may pose additional risks. Objectives: This narrative review aims to characterize the risk factors for injection drug use initiation associated with migration, employing a risk environment framework and focusing on the San Diego–Tijuana border region as the most dynamic example of these phenomena. Methods: Based on previous literature, we divide migration streams into three classes: intra-urban, internal, and international. We synthesized existing literature on migration and drug use to characterize how mobility and migration drive the initiation of injection drug use, as well as the transmission of hepatitis and HIV, and to delineate how these might be addressed through public health intervention. Results: Population mixing between migrants and receiving communities and the consequent transmission of social norms about injection drug use create risk environments for injection drug use initiation. These risk environments have been characterized as a result of local policy environments, injection drug use norms in receiving communities, migration-related stressors, social dislocation, and infringement on the rights of undocumented migrants. Conclusion: Policies that exacerbate risk environments for migrants may inadvertently contribute to the expansion of epidemics of injection-driven blood-borne disease. Successful interventions that address emerging syndemics in border regions may therefore need to be tailored to migrant populations and distinguish between the vulnerabilities experienced by different migration classes and border settings.     

Chain Features and Their Influence on the Thermal Stability of Poly(propylene‐co‐1‐nonene) Copolymers

The thermal stability of several isotactic polypropylenes and propylene‐co‐1‐nonene copolymers is assessed under nitrogen by means of thermogravimetric analysis (TGA). The samples involve wide ranges of molecular weight, isotactic average length, and 1‐nonene content, in order to perform a comprehensive analysis of the effect that chain features exert on the apparent activation energy (E_a), in the initial stages of the molten state degradation. The degradation process correlates with chain mobility and, accordingly, with chain features that are linked to. Thus, microstructure and chain size are found to play a key role. In fact, isotactic average length of propylene sequences and molecular weight are driving factors in the E_a required for main chain thermal scission.     

Surgery of the parotid region: a new approach

Many disorders of the parotid gland require treatment by subtotal or total parotidectomy. In such situations functional and esthetic complications may arise due to the location of the incisions or from permanent or temporary injuries to the facial nerve. This report describes a modified revision that gives good esthetic and functional results. A review of a similar series of cases treated surgically by the same surgeons using Yoel and Bilesio's technique showed no differences in morbility associated with parotidectomy performed using the proposed incision.     

Substantia nigra in Parkinson’s disease: a multimodal MRI comparison between early and advanced stages of the disease

This study focused on the substantia nigra (SN) in Parkinson’s disease (PD). We measured its area and volume, mean diffusivity (MD), fractional anisotropy (FA) and iron concentration in early and late PD and correlated the values with clinical scores. Twenty-two early PD (EPD), 20 late PD (LPD) and 20 healthy subjects (age 64.7 ± 4.9, 60.5 ± 6.1, and 61 ± 7.2 years, respectively) underwent 1.5 T MR imaging with double-TI-IR T1-weighted, T2*-weighted and diffusion tensor imaging scans. Relative SN area, MD, FA and R2* were measured in ROIs traced on SN. Correlation with Unified Parkinson Disease Rating Scale (UPDRS) scores was assessed. In LPD, the SN area was significantly reduced with respect to EPD (p = 0.04) and control subjects (p < 0.001). In EPD, the SN area was also significantly smaller than in controls (p = 0.006). Similarly, the SN volume significantly differed between LPD and controls (p = 0.001) and between EPD and LPD (p = 0.049), while no significant differences were found between controls and EPD. Both SN area (r = 0.47, p = 0.004) and volume (r = 0.46, p = 0.005) correlated with UPDRS scores. At 1.5 T, SN morphological measurements were sensitive to early PD changes and able to track the disease progression, while MD and FA measures and relaxometry did not provide significant results.     

Orthostatic hypotension and cognitive impairment: a dangerous association?

Many studies have addressed the relation between orthostatic hypotension (OH) and cognitive impairment (CI) in the elderly, in mild cognitive impairment, vascular and neurodegenerative dementias and movement disorders, such as Parkinson’s disease. However, results concerning both the increased coexistence of the two conditions and their causal relationship remain controversial. According to the literature three hypotheses can be formulated on the relation between OH and CI. In neurodegenerative disease, OH and CI may result from a common pathological process which affects areas involved in both cognition and cardiovascular autonomic control. Alternatively, OH may lead to cerebral hypoperfusion which is supposed to play a role in the development of CI. Finally, recent data suggest that CI should probably be considered more a transient symptom of OH than a chronic effect. This study reviews the literature reports on the relationship between OH and CI, and emphasises the need for longitudinal studies designed to investigate this topic.     

The impact of tutorial strategies on student nurses' accuracy in diagnostic reasoning in different educational settings: a double pragmatic trial in Italy

BACKGROUND: Italian Nursing Faculties use a range of tutorial strategies (laboratory sessions, intensive clinical tutoring, weekly tutoring) aimed to enhance nursing students' diagnostic reasoning: these strategies have different impacts on promoting student critical thinking. By using critical thinking methods, students develop abilities to check, monitor and constantly evaluate the accuracy of the diagnostic reasoning process. However, there is little evidence to show how effective tutorial strategies are on the accuracy of diagnostic reasoning. There is also very little known about the complexity of tutorial strategies because these are made up of several components (e.g. tutor questioning abilities, the value of the setting, the impact of the environment, the expertise of the tutor and the impact of the Faculty's philosophy of learning), tutorial strategies cannot be standardised and depend on multiple factors which are difficult to control. OBJECTIVES: The objective was to establish a relationship between tutorial strategies orientated to enhance critical thinking and the accuracy of diagnostic reasoning (i.e. the number of correct answers given by students on simulated cases in two different nursing education contexts). It was hypothesised that students who had had one laboratory session using intensive tutorial strategies had less probability of making reasoning errors in diagnosing a simulated case than a control group that had weekly tutorials or routine tutoring. DESIGN: A double pragmatic experimental study was adopted involving two Italian Nursing Faculties at universities in Verona and Udine. PARTICIPANTS: A total of 144 students in the first year of their Nursing Science Degree course were involved; in Verona, two random groups of 41students were taken (an intervention group and a control group). Random selections of 39 students for the intervention group and 29 students for a control group were made from the second campus in Udine. Data analysis was conducted comparing student outcomes in the same faculty (intra-trial analysis) and between the two campuses involved (inter-trial analysis). RESULTS: The students doing laboratory sessions and intensive clinical tutorials demonstrated fewer errors compared to the control group [OR 3.75; IC 95% 1.77-7.88], although the students who receive routine tutoring, demonstrated higher risk of mistaking the problems of the patient [OR 0.22; IC 0.95% 0.07-0.65]. CONCLUSION: From intra- and inter-trial analysis of the results, it can be concluded within limits, that those students who had had intensive tutorial strategies aimed developing critical thinking abilities, formulated fewer wrong hypotheses in the first list they made when confronted with a new nursing case. Faculties should consider these outcomes and develop strategies including intensive tutorial strategies for improving the accuracy of nursing students' clinical reasoning.     

Síndrome de Kounis intraoperatória com melhoria das alterações eletrocardiográficas e da situação hemodinâmica após a administração de nitroglicerina

A 58‐year‐old female without cardiovascular risk factors, was going to be operated to repair the rotator cuff. Induction and interscalene brachial plexus block were uneventful, but after her placement for surgery the patient started with severe bronchospasm, hypotension, cutaneous allergic reaction and ST elevation on the electrocardiogram. An anaphylactic shock was suspected and treated but until the perfusion of nitroglycerina was started no electrocardiographic changes resolved. After necessary diagnostic test the final diagnosis was variant I of Kounis syndrome due to cefazolin and rocuronium. Ephinephrine is the cornerstone of treatment for anaphylaxis but should we use it if the anaphylactic reaction is also accompanied by myocardial ischemia? The answer is that we should not use it because myocardial ischemia in this syndrome is caused by vasospasm, so it would be more useful drugs such as nitroglycerin. But what if we do not know if it is a Kounis syndrome or not? In this article we report our experience that maybe could help you in a similar situation.