Avocados are a widely consumed fruit and are part of many Latin American cuisines and plant-based diets globally. However, producing avocados is water-intensive, and plantations can cause soil erosion and water stress. In Chile, avocados are produced in semiarid zones and require irrigation. They are widely consumed locally but are increasingly exported to meet growing global demand. This causes significant local conflicts over water, especially because of the system of private water rights in Chile. There are many gaps in understanding the complex and interconnected system of avocado production and international markets, especially its impacts on local communities and biodiversity.

The popularity of avocados has increased globally in alternative diets, alongside its integral role in Latin American cuisine. In Chile, avocados are grown extensively and intensively in orchards in the dry and Mediterranean climate of Central Chile. Avocado is a water-demanding crop and the severe water crisis in Chile has called attention to the conflicts caused by its water use. As most of the pressure to produce avocado comes from international demand but results in impacts on native ecosystems and local communities, avocado production in Chile is an example of a telecoupled system. Here, we characterize avocado production as a telecoupled social–ecological system in order to identify gaps in knowledge, based on a review of key studies. Research priorities include how to improve water-use efficiency, especially in the context of climate change; the impacts on biodiversity; and the socioeconomic dynamics between local communities, trade, and governance. The analysis is constrained by limited access to data and few interdisciplinary studies on the matter. To reduce the impacts of avocado production and increase its sustainability, there is an urgent need to amplify the interdisciplinary research that emphasizes the interconnections between the social and ecological components in avocado production in Chile.

Global avocado demand fuels local conflicts in Chile due to water stress and social–ecological pressures on communities.

Emerging evidence suggests a potential association between “leaky gut syndrome” and low-grade systemic inflammation in individuals with psychiatric disorders, such as schizophrenia. Gut dysbiosis could increase intestinal permeability, allowing the passage of toxins and bacteria into the systemic circulation, subsequently triggering immune-reactive responses. This study delves into understanding the relationship between plasma markers of intestinal permeability and symptom severity in schizophrenia. Furthermore, the influence of lifestyle habits on these intestinal permeability markers was determined.

Biomarkers of intestinal permeability, namely lipopolysaccharide-binding protein (LBP), lipopolysaccharides (LPS), and intestinal fatty acid binding protein (I-FABP), were analyzed in 242 adult schizophrenia patients enrolled in an observational, cross-sectional, multicenter study from four centers in Spain (PI17/00246). Sociodemographic and clinical data were collected, including psychoactive drug use, lifestyle habits, the Positive and Negative Syndrome Scale to evaluate schizophrenia symptom severity, and the Screen for Cognitive Impairment in Psychiatry to assess cognitive performance.

Results revealed elevated levels of LBP and LPS in a significant proportion of patients with schizophrenia (62% and 25.6%, respectively). However, no statistically significant correlation was observed between these biomarkers and the overall clinical severity of psychotic symptoms or cognitive performance, once confounding variables were controlled for. Interestingly, adherence to a Mediterranean diet was negatively correlated with I-FABP levels (beta = −0.186, t = −2.325, p = 0.021), suggesting a potential positive influence on intestinal barrier function.

These findings underscore the importance of addressing dietary habits and promoting a healthy lifestyle in individuals with schizophrenia, with potential implications for both physical and psychopathological aspects of the disorder.

The objective of this study is to describe the prevalence of benzodiazepine in a sample of patients (≥65 years) attended by liaison psychiatry units (LPU) in Spain and its possible relation to falls.

This is an observational., cross-sectional, multicenter study. We obtained data from a sample of 165 patients (≥65 years) admitted to 7 general hospitals in Spain referred from different departments to each liaison psychiatry unit. Data was collected for a month and a half period. Psychiatric evaluations were performed while the patients were on wards.

We obtained a sample of 165 patients (78 women, 88 men) with a mean age of 76,03 years old (42.10% <75 years, 57,83% ≥ 75 years). Most of them were married and they lived accompanied (67,27%). Only 5,45% lived in a nursing home. 65,45% of patients had prescribed at least one psychotropic drug before LPU intervention; mainly (50,9%) benzodiazepines (60%women/40%men). 70,9% of these group of patients had more than one psychotropic drug prescribed before LPU. After LPU intervention in 39,39% at least one drug was withdrawn (in 50,81 % of cases benzodiazepines). Falls in the past 6 months were reported in 24.8% of total patients. Patients under benzodiazepine treatment had fallen in 29% of cases. After LPU intervention benzodiazepines were withdrawn in 56,25% % of them.

Benzodiazepines are widely used in our sample and frequently is associated with polypharmacy. LPU intervention might be a useful tool to reduce the use of them, specially for those who reported falls.

Longitudinal studies might be carried out to study these factors and their possible relationship with falls, given that Benzodiazepines are consistently associated with a higher risk of falls. It is unclear whether specific subgroups such as short-acting benzodiazepines and selective serotonin reuptake inhibitors are safer in terms of fall risk. Ppropriate prescription of medications such as BZDs is an important public health issue.

The objective of this study is to describe the diagnostic agreement between physicians and liaison psychiatry units (LPU) in 7 general hospitals of Spain for elderly patients and to analyze possible factors related to it.

This is an observational., cross-sectional, multicenter study. We obtained data from a sample of 165 patients (≥65 years) admitted to 7 general hospitals in Spain referred from different departments to each liaison psychiatry unit. Data was collected for a month and a half period. Psychiatric evaluations were performed while the patients were on wards.

We obtained a sample of 165 patients (78 women, 88 men) with a mean age of 76,03 years old (42.10% <75 years, 57,83% ≥ 75 years). Most of them were married and they lived accompanied (67,27%). Only 5,45% lived in a nursing home.

In 55.15% the main reason to referral was anxiety/depression symptoms. 42,42% had no psychiatry medical background. After LPU visit a new diagnosis was done in 56.96%. Main diagnoses were adjustments disorders (26,66%), delirium (20,6%) and no psychiatric pathology (14,54%)

Cohen’s kappa statistics were used to estimate the agreement between the diagnoses made by LPU and the diagnoses considered by the referring doctors. We obtained a moderate global agreement (kappa= 0,4971) between observers (0,424 for <75 years, 0,557 for ≥65 years) Moderate agreement was found for alcohol or substance abuse (kappa= 0,41) and low agreement was found for affective disorders (kappa= 0,3278) and delirium/ psychological and behavioral symptoms in dementia (Kappa= 0,2341).

We analyzed factors which might affect de agreement between physicians and LPU such is group of age, functional impairment, comorbidity by Charlson index and previous diagnosis of dementia.

Further longitudinal studies might help in the future to analyze the factors related to agreement between doctors and might help to establish educational programs

It is well known that geriatric patients are at increased risk of developing comorbid medical and psychiatric conditions, and a large proportion of them are admitted to psychiatric liaison units (LPUs). The aim of this study is to determine which clinical differences between age groups (65- 74 years and ≥75 years) are statistically significant to potentially warrant special attention when referring to an LPU.

This is an observational, cross-sectional and comparative multicentre study. We collected data from 165 patients (≥65 years) admitted to 7 Spanish general hospitals and referred to each LPU from different departments. Data were collected over a period of one and a half months. Psychiatric examinations were performed during the patients' stay in the wards. The sample was divided into two age groups of patients and a comparative analysis was done.

We obtained a sample of 165 patients with a mean age of 76.03 years (42.10% < 75 years, 57.83% ≥ 75 years). We analysed several variables between two age groups: the youngest (65- 74 years) and the oldest (≥75 years). In the younger group (mean age 69.87 years), the mean Barthel index before admission was 93.23 (52.1% with independent ambulation) and at the time of our first assessment was 54.62, before 82.71 of the older group (mean age 80.63). The mean Lawton index was 4.44 (6.35 for the older group) and the Charlson index was 6.38 (5.6 for the older group). 21.11% reported falls in the last 6 months, compared to 27.6% in the older group. The most common reason for referral was anxiety/depression symptoms in both groups (52.12% and 56.53%) and agitation (24.46% in the older group). After the LPU visit, the main diagnoses were adjustment disorder in both groups (25.3% and 25.53%) and delirium in the older group (23.4%). Antidepressants and benzodiazepines were the most common psychotropic drugs prescribed before the LPU visit, and benzodiazepines were the most common drugs discontinued after the LPU visit in both groups.

Clinical differences were found between two age groups (65-74 years and ≥75 years) at LPU, which could allow professionals to improve their attention and interventions.

Delirium is an acute and fluctuating disorder characterized by a disturbance in attention and cognition that is commonly observed in hospitalized older adults; being present in up to 23% of patients admitted to a general medical service and as many as 85% of patients in the intensive care unit. Delirium causes complications such as increased morbidity, persistent functional decline, mortality, increased frailty and increased length of hospital stay. Nonetheless, it is often underdiagnosed, especially when it occurs in its hypoactive form. The objective of this study is to describe characteristics and factors associated with the presence of delirium in patients ≥65 years treated by the liaison psychiatric units in seven general hospitals.

This is an observational, cross-sectional, multicentre study. We obtained data from a sample of 165 patients (≥65 years) admitted to seven general hospitals in Spain referred from different departments to each liaison psychiatry unit. Data was collected for a month and a half period. Psychiatric evaluations were performed while the patients were on wards.

We obtained a sample of 165 patients (78 women, 88 men) with a mean age of 76,03 years old (42.10% <75 years, 57,83% ≥ 75 years). Most of them were married and they lived accompanied (67,27%). Delirium was diagnosed in 20% of the consultations. A multivariate analysis was developed with the presence of delirium as the independent variable. The nature of the underlying pathology, the presence of a previous mental disorder, functionality using the Barthel and Lawton Brody Indexes and the prescribed pharmacological treatments were used as dependent variables. Cohen’s kappa statistics were used to estimate the agreement between delirium diagnose made by psychiatrists and the diagnoses considered by the referring doctors. Low agreement was found for the presence of delirium (Kappa= 0,2341). We also explored the relationship between the presence of delirium and the mean length of stay, as well as the discharge destination of these patients.

There are still many difficulties in the diagnosis and treatment of patients with delirium. Better knowledge of the factors associated with its appearance would improve the management of these patients.

Older patients (≥65yo) admitted to general hospitals have increased in the past years. This resulted in an increase in hospitalization periods, health costs, and morbi-mortality rates in this group of patients.

Previous evidence points that the reduced time to referral (TTR) to Consultation-Liaison Psychiatry Units (CLP) leads to a reduced length of stay (LOS) in GH improving long-term prognosis of medical conditions.

This study aims to explore whether a prior disability in older patients leads to delay the search for psychiatric help. And to explore whether early referral to CLP is associated with reduced LOS in general hospitals.

This is an observational, cross-sectional, multicentre study. We obtained a complete data set from a sample of 152 patients (≥65 years old) admitted to 7 general hospitals in Spain referred to CLP unit for 1,5 months.

Mean age of the sample was 76.3 (±6.4). TTR was 14.5 (±18.0) days. LOS was 26.7 (±22.4) days, and length of stay after consultation was 12.3 (±10.3) days. Barthel Index before admission was 87.3 (±18.0) and Lawton&Brody Index before admission was 5.3 (2.7). We found a significant positive association of Barthel Index (r=0.17, p=0.042) and Lawton&Brody Index (r=0.20, p=0.014) before admission with TTR, which indicates that patients with a worse clinical status were attended earlier. Similarly, antecedents of both falling episodes (r=-0.2, p= 0.013) and walking difficulties (r=-0.24, p= 0.003) were associated with shorter TTR. TTR in Medical Departments was 11.7 (±15.0) days and in Surgical Departments was 24.0 (±22.8) days (t=-3.5, p= 0.001). TTR showed a highly significant positive correlation with LOS (r=0.89, p<0.0001) and a more discrete positive correlation with length of stay after consultation (r=0.20, p=0.016).

We confirm that a shorter TTR to CLP was related to a shorter LOS. Also, patients in medical wards had shorter TTR. In contrast to our hypothesis, we found that a higher disability prior to hospitalization led to earlier referral to CLP, meaning that these patients were assessed and treated earlier leading to better long- term prognosis and lower health costs.

Ageism is defined by the World Health Organization as stereotypes, prejudice, and discrimination towards others or oneself based on age. Ageism is thought to pose a risk to the physical and mental health of older adults, but little is known about how to measure it in LPUs. We propose that a form of ageism can be detected by comparing the referrals made by liaison psychiatry services among patients over age 65 at discharge with functional status and medical comorbidity. Our hypothesis is that the worse the functional index and medical comorbidity, the fewer referrals to psychiatric services and the more referrals to primary care physicians.

This is an observational, cross-sectional, multicenter study. We obtained data from a sample of 165 patients (≥65 years) admitted to seven general hospitals in Spain referred from different departments to each LPU. Data was collected over a period of one and a half months. Psychiatric evaluations were performed while the patients were in the wards. Sociodemographic, clinical, and care variables were collected. Functional status was measured with the Barthel and Lawton index and comorbidity with the Charlson index.

We obtained a sample of 165 patients with a mean age of 76,03 years old. The mean Barthel index was 87,18 previous admission and 61,15 at the time of our first visit. The mean Lawton index was 5,266667 and the Charlson index was 6,03. The different options for referral were primary care physician, psychiatric facilities, nursing homes, substance use centers, or exitus. Statistical analysis was performed using the nonparametric Kruskal-Wallis test to determine if there were significant differences (p < 0,05) between the indices and referrals. Contrary to our hypothesis, statistical significance was observed only for the Lawton index, but with more referrals to psychiatric facilities among patients with the worst functional scores. No other statistical significance was observed.

Functional status and medical comorbidity did not play a role in the referral of inpatients managed by LPUs. Further studies are needed to clarify whether there is any form of ageism in the referral of elderly inpatients attended by Psychiatric Liaison Units.

The current study aimed to evaluate the psychometric properties and diagnostic accuracy of the 32-item version of the Multilingual Naming Test (MINT) in a sample of English and Spanish monolinguals and bilingual older adults from two ethnic groups (EA; European Americans and HA; Hispanic American) with typical and atypical aging. An IRT model was used to identify 24 MINT Items assessed across ethnicity and language testing groups (Spanish and English). We analyzed the discriminant and predictive validity of the 32-item and 24-item scales across diagnostic groups (cognitively normal [CN], mild cognitive impairment [MCI], and dementia [AD]). Diagnostic accuracy was then assessed with both versions applying ROC (Receiver Operating Characteristics) curve reporting using AUC (Area Under the Curve). We expected the MINT to distinguish between the CN and AD groups but not between CN and MCI and the MCI and AD. We conducted IRT analyses to evaluate the cross-language validity of the items from the 32-item MINT in English and Spanish through Rasch Analysis across our two ethnic groups. Finally, we tested the association between MINT scores and MRI volumetric measures of language-related areas in both cerebral hemispheres’ temporal and frontal lobes.

The sample comprised 281 participants (178 females) enrolled in the 1Florida Alzheimer’s Disease Research Center (ADRC), with 175 participants self-identified as HA (51 tested in English and 124 in Spanish) and 106 EA, all of them monolingual English speakers. The participants were classified into three diagnostic groups: 1. CN (n = 94); 2. MCI (n = 148); and 3. AD (n = 39). Participants are evaluated yearly through a comprehensive neuropsychological battery, including the MINT is a standard CN task that requires patients to retrieve words upon presentation of a line drawing.

We obtained a ceiling effect in four items (Butterfly, Glove, Watch, and Candle). Four items were easier in English (Blind, Gauge, Porthole, and Pestle) and four in Spanish (Dustpan, Funnel, Anvil, and Mortar). In the 32-item version of the MINT, EA scored significantly higher than HA, but when removing those eight items, the ethnic difference was attenuated and no longer statistically significant (controlling for education). The ROC curves showed that both versions of the MINT had poor accuracy when identifying CN participants and were acceptable in identifying dementia participants but unacceptable for classifying MCI participants. The 32-item MINT in English and Spanish and the 24-item MINT in Spanish were significantly correlated with the bilateral MTG. However, the 24-item MINT in English was only correlated with this area’s volume in the right hemisphere. The left FG correlated with MINT scores regardless of language and MINT version. We also found some differential correlations depending on the language of administration. The bilateral hippocampi, STG, MTG and FG, and right ITG were significantly correlated only with MINT Spanish scores, while the left ITG was significant only when either version of the MINT was administered in English.

Our results highlight the importance of analyzing cross-cultural samples when implementing neuropsychological tests.

Gambling disorder (GD) and bulimic spectrum eating disorders (BSDs) not only share numerous psychopathological, neurobiological, and comorbidity features but also are distinguished by the presence of inappropriate behaviours related to impulsivity and compulsivity. This study aimed to emphasise the differences and similarities in the main impulsivity and compulsivity features between GD and BSD patients, and to analyse the potential influence of sex in these domains.

Using self-reported and neurocognitive measures, we assessed different impulsive–compulsive components in a sample of 218 female and male patients (59 with BSD and 159 with GD) and 150 healthy controls.

We observed that GD and BSDs exhibited elevated levels of impulsivity and compulsivity in all the dimensions compared to healthy controls. Moreover, these disorders showed differences in several personality traits, such as high novelty seeking in GD, and low persistence and high harm avoidance in BSDs. In addition, patients with BSDs also displayed a trend towards greater impulsive choice than GD patients. Regarding sex effects, GD women presented higher overall impulsivity and compulsivity than GD men. Nevertheless, no sex differences were found in BSDs.

Clinical interventions should consider these deficits to enhance their effectiveness, including adjunctive treatment to target these difficulties. Our findings also provide support to the relevance of sex in GD, which should also be considered in clinical interventions.

Hospitalizations among skilled nursing facility (SNF) residents in Detroit increased in mid-March 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. Outbreak response teams were deployed from local healthcare systems, the Centers for Disease Control and Prevention (CDC), and the Detroit Health Department (DHD) to understand the infection prevention and control (IPC) gaps in SNFs that may have accelerated the outbreak.

We conducted 2 point-prevalence surveys (PPS-1 and PPS-2) at 13 Detroit SNFs from April 8 to May 8, 2020. The DHD and partners conducted facility-wide severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing of all residents and staff and collected information regarding resident cohorting, staff cohorting, and personnel protective equipment (PPE) utilized during that time.

Resident cohorting had been implemented in 7 of 13 (58.3%) SNFs prior to point-prevalence survey 1 (PPS-1), and other facilities initiated cohorting after obtaining PPS-1 results. Cohorting protocols of healthcare practitioners and environmental service staff were not established in 4 (31%) of 13 facilities, and in 3 facilities (23.1%) the ancillary staff were not assigned to cohorts. Also, 2 SNFs (15%) had an observation unit prior to PPS-1, 2 (15%) had an observation unit after PPS-1, 4 (31%) could not establish an observation unit due to inadequate space, and 5 (38.4%) created an observation unit after PPS-2.

On-site consultations identified gaps in IPC knowledge and cohorting that may have contributed to ongoing transmission of SARS-CoV-2 among SNF residents despite aggressive testing measures. Infection preventionists (IPs) are critical in guiding ongoing IPC practices in SNFs to reduce spread of COVID-19 through response and prevention.