Sex differences in schizophrenia-spectrum diagnoses: results from a 30-year health record registry.

This study investigated sociodemographic and clinical differences between the sexes in individuals affected by schizophrenia-spectrum disorders (SSD) who accessed outpatient mental health services. Within a retrospective cohort of 45,361 outpatients receiving care in Ferrara (Italy) from 1991 to 2021, those with a SSD diagnosis were compared between the sexes for sociodemographic and clinical characteristics before and after the index date (when the ICD-9: 295.*diagnosis was first recorded) to assess early trajectory, age and type of diagnosis, and severity of illness indicated by medication use, hospitalization, and duration of psychiatric care. Predictors of discharge were also investigated. Among 2439 patients, 1191 were women (48.8%). Compared to men, women were significantly older at first visit (43.7 vs. 36.8 years) and at index date (47.8 vs. 40.6) with peak frequency at age 48 (vs. 30). The most frequent last diagnosis recorded before the index date was delusional disorder (27.7%) or personality disorder (24.3%) in men and depression (24%) and delusional disorder (30.1%) in women. After the index date, long-acting antipsychotics and clozapine were more frequently prescribed to men (46.5% vs. 36.3%; 13.2% vs. 9.4%, p < 0.05) and mood stabilizers and antidepressants to women (24.3% vs. 21.1%; 50.1% vs. 35.5%; p < 0.05). Women had fewer involuntary admissions (10.1% vs. 13.6%) and were more likely to be discharged as the time under care increased (p = 0.009). After adjusting for covariates, sex was not a significant predictor of discharge. Our study confirmed that sex differences exist in clinical and sociodemographic characteristics of outpatients with SSD and that gender considerations might influence the rapidity of diagnosis and medications prescribed. These findings highlight the need to implement a women-tailored approach in specialist care programs for psychoses.

First episode psychoses in people over-35 years old: uncovering potential actionable targets for early intervention services.

The traditional youth-oriented design of Early Intervention Services (EIS) may lead to the exclusion of patients who have their psychotic onset later in life. A retrospective study was conducted to compare first-episode psychosis (FEP) patients who accessed treatment when aged ≤ 35 years with those ≥36+. A total of 854 patients were identified among 46,222 individuals who had access to community psychiatric services from 1991 to 2021. FEP were aged 18-65, received care between 2012 and 2021 and had a diagnosis of affective or non-affective FEP. Two groups were identified (FEP diagnosed at age ≤ 35 vs ≥ 36) and compared for sociodemographic and clinical characteristics. Most patients were diagnosed when aged ≥ 36+ (61.8%). Compared to the ≤ 35 group, older patients were more likely to be women, married and diagnosed with affective psychosis, and they were less frequently hospitalized. Long-acting injectables antipsychotics (LAI) were less frequently prescribed in the ≥ 36+ group, whereas antidepressants were more frequently prescribed compared to those aged ≤ 35. In both age groups, women were less frequently prescribed LAIs compared to men. These findings highlight the need to reorient EIS to accommodate the needs of older FEP, especially women.

Establishment of a Public Mental Health Database for Research Purposes in the Ferrara Province: Development and Preliminary Evaluation Study.

Background: The immediate use of data exported from electronic health records (EHRs) for research is often limited by the necessity to transform data elements into an actual data set. Objective: This paper describes the methodology for establishing a data set that originated from an EHR registry that included clinical, health service, and sociodemographic information. Methods: The Extract, Transform, Load process was applied to raw data collected at the Integrated Department of Mental Health and Pathological Addictions in Ferrara, Italy, from 1925 to February 18, 2021, to build the new, anonymized Ferrara-Psychiatry (FEPSY) database. Information collected before the first EHR was implemented (ie, in 1991) was excluded. An unsupervised cluster analysis was performed to identify patient subgroups to support the proof of concept. Results: The FEPSY database included 3,861,432 records on 46,222 patients. Since 1991, each year, a median of 1404 (IQR 1117.5-1757.7) patients had newly accessed care, and a median of 7300 (IQR 6109.5-9397.5) patients were actively receiving care. Among 38,022 patients with a mental disorder, 2 clusters were identified; the first predominantly included male patients who were aged 25 to 34 years at first presentation and were living with their parents, and the second predominantly included female patients who were aged 35 to 44 years and were living with their own families. Conclusions: The process for building the FEPSY database proved to be robust and replicable with similar health care data, even when they were not originally conceived for research purposes. The FEPSY database will enable future in-depth analyses regarding the epidemiology and social determinants of mental disorders, access to mental health care, and resource utilization.

[Gender difference and mortality in a cohort of heroin users in the Provinces of Modena and Ferrara, 1975-1999]. / Differenze di genere e mortalità in una coorte di eroinomani nelle province emiliane di Modena e Ferrara, 1975-1999.

OBJECTIVE: To analyse overall and cause-specific hazards of death in a cohort of heroin users, separately by gender, survival and other risk factors. DESIGN AND SETTING: Longitudinal study of intravenous heroin users; subjects were enrolled between 1975 and 1999 in public health services of the Provinces of Modena and Ferrara and were included in a treatment program. MAIN OUTCOME MEASURES: For each gender, age-standardized mortality rates and standardized mortality ratios (SMR) for all causes and for specific causes. Kaplan-Meier method was used for estimating survival probability and Cox regression model to estimate hazard ratios (HR) of death. RESULTS: in the cohort of 4.644 intravenous drug users, 801 deaths were observed. In both sexes, mortality due to AIDS was lower in subjects enrolled in 1990-99 than among those enrolled in 1980-89. Mortality caused by overdose was particularly high in males enrolled between 1995-99. (SMRs in males and females were respectively 12.12 (95% CI 11.22-13.08) and 20.26 (17.23-23.83). Survival probability at 20 years of observation was 62% (60% for males and 68% for females). Risk of death was highest in males, in subjects enrolled after age 25, in subjects with a low educational level and in unemployed persons. CONCLUSION: Gender and socioeconomic conditions are important determinants of mortality among heroin users. The increase in deaths from heroin overdose in subjects enrolled in the recent years requires particular attention.

[Mortality risk in intravenous drug users in Emilia Romagna region and its socio-demographic determinants. Results of a longitudinal study]. / La mortalità dei tossicodipendenti nella Regione Emilia Romagna e i suoi determinanti. Risultati di uno studio longitudinale.

Results on general and cause-specific mortality in a retrospective cohort of intravenous drug users in the Emilia Romagna Region (Italy) are presented. Four thousand two hundred and sixty subjects (3324 males, 936 females) in public treatment centres in Piacenza, Modena and Ferrara provinces have been observed for up to 20 years in the period 1975-95. AIDS age-adjusted death rates dramatically increased all during the period, while overdose and other causes (mostly accidental) increase up to the early nineties and then tend to decrease. This last pattern has not been described in other Italian cohorts, and could be related with changes in therapeutic strategies. General mortality is very high in this cohort, as in other studies (males: SMR 16.7, LC 15.3-18.2; females: SMR 33.4, LC 27.9-39.9). Survival probability after 15 years of observation is 65% in males and females combined. Apart from overdose and AIDS, other relevant excesses are observed for accidental deaths (especially car accidents), cirrhosis, infective causes and cancer in males; in females, accidental deaths (among which homicides) and digestive tract diseases. A higher death risk is observed for males who began drug use before age 20, who contacted treatment centres in the nineties and at an older age, and who came in contact with the law.

Transcriptional response of the obligatory aerobe Trichoderma reesei to hypoxia and transient anoxia: implications for energy production and survival in the absence of oxygen.

Oxygen is essential for the survival of obligatorily aerobic eukaryotic microorganisms, such as the multicellular fungus Trichoderma reesei. However, the molecular basis for the inability of such cells to survive for extended periods under anoxic conditions is not fully understood. Using cDNA microarray analysis, we show that changes in oxygen availability have a drastic effect on gene expression in T. reesei. The expression levels of 392 (19.6%) out of 2000 genes examined changed significantly in response to hypoxia, transient anoxia, and reoxygenation. In addition to modulating many genes with no previously assigned function, cells respond to hypoxia by readjusting the balance of expression between genes required for energy production and consumption, and altering the expression of genes involved in protective mechanisms and signaling pathways. Moreover, we show that transient anoxia strongly represses genes for enzymes that are critical for glycolysis, and are essential for energy production under anaerobic conditions. Our study thus reveals crucial differences between the facultative anaerobe Saccharomyces cerevisiae and T. reesei with regard to the oxygen-dependent transcriptional control of the glycolytic pathway, which can account for the differential survival of the two species in the absence of oxygen.