Comorbidities in Chilean patients with psoriasis: a Global Healthcare Study on Psoriasis.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease associated with several important medical comorbidities. There are scant data available on the comorbidities of patients with psoriasis in South America. AIM: To examine the comorbidity profile of adult patients with psoriasis in Chile and its association with severity of psoriasis. METHODS: This was a multicentre, cross-sectional study involving 16 hospitals and clinics in Chile, which used a 48-item questionnaire to study clinician- and patient-reported outcomes and comorbidities. Inferential analyses were performed by psoriasis severity, using Fisher exact test, Student t-test and multivariable logistic regression. RESULTS: In total, 598 adult patients with psoriasis were included (51.1% male; mean age 49.2 ± 15.1 years); 48.5% mild and 51.4% moderate to severe; Psoriasis Area and Severity Index 11.6 ± 11.5; body surface area 14.7 ± 18.2%. Plaque psoriasis was the most common phenotype (90.2%), followed by guttate (13.4%). Psoriatic arthritis occurred in 27.3% of patients. Comorbidities were reported in 60.2% of all patients with psoriasis. Frequent concomitant diseases were obesity (25.3%), hypertension (24.3%), Type 2 diabetes mellitus (T2DM) (18.7%), dyslipidaemia (17.4%), metabolic syndrome (16.7%) and depression (14.4%). After adjustment, significant associations were found between moderate to severe psoriasis and obesity, T2DM and nonalcoholic fatty liver disease (NAFLD) compared with mild psoriasis. CONCLUSIONS: We report a large study of comorbidities, including depression, dyslipidaemia, T2DM and NAFLD, in people with psoriasis in Chile. The prevalence of comorbidities with psoriasis in Chile appears similar to that found in Western countries, and emphasizes the importance of assessing patients with psoriasis for risk factors for and presence of, comorbid disease in a multidisciplinary setting.

Prevalence and correlates of psychopathology in children and adolescents evaluated with the strengths and difficulties questionnaire dysregulation profile in a clinical setting.

BACKGROUND: The clinical presentation of children and adolescents referred to mental health services is frequently complicated by comorbid and severe affective and behavioral dysregulation. This dysregulation phenotype seems to be an indicator of overall psychopathology, symptom severity and functional impairment. Currently, this phenotype is assessed by the Child Behavior Checklist. However, the widely used Strengths and Difficulties Questionnaire (SDQ) has been recently validated to screen the Dysregulation Profile (SDQ-DP) in clinical settings. The objective of this study was to determine the prevalence and demographic, psychosocial and clinical correlates of the SDQ-DP phenotype in a Spanish clinical sample. SAMPLING AND METHODS: In a clinical sample of 623 consecutively referred children and adolescents (4-17 years old), we compared clinical and sociodemographic correlates between subjects who met the SDQ-DP criteria (DP) and those who did not (NO_DP). Sociodemographic data, parent-rated SDQ, Children's Global Assessment Scale, Clinical Global Impression, family Apgar scale and clinical diagnoses were collected by experienced child and adolescent psychiatrists. RESULTS: Overall in our sample, 175 subjects (28.1%) met the SDQ-DP criteria (DP group). Compared with the NO_DP group, the DP subjects had significantly higher scores on internalizing and externalizing psychopathology, problems with peers and overall problems as well as significantly lower scores on prosocial behavior. Clinical diagnoses assigned revealed that DP subjects showed significantly greater psychiatric comorbidity. DP subjects also showed significantly worse family functioning and increased symptom severity and significantly lower scores on psychosocial functioning. CONCLUSIONS: A high prevalence of children and adolescents with the dysregulated profile, assessed by the SDQ-DP, was found in our clinical setting. The SDQ-DP may serve as an index of overall psychological severity and functional impairment. In addition, it may indicate family dysfunction. Further research is needed to validate the clinical value of SDQ-DP by examining longitudinal stability, heritability, adult outcome, risk factors and diagnostic correlates.

Impact of Depression on Anxiety, Well-being, and Suicidality in Mexican Adolescent and Young Adult Students From Mexico City: A Mental Health Screening Using Smartphones.

Background: Depression, anxiety, well-being, and suicidality are highly associated during adolescence and greatly predict mental health outcomes during adulthood. This study explored relationships between these variables among students from Mexico City.Methods: This representative cross-sectional study was carried out in education centers in Mexico City during the 2019-2020 academic year. Using a smartphone app, we implemented validated questionnaires for depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), well-being (World Health Organization 5 Well-Being Index), and risk of suicide (Columbia-Suicide Severity Rating Scale). Partial least squares structural equation modeling was performed for the entire sample and after stratifying by gender.Results: Out of 3,042 students, 1,686 were females; mean age of the sample was 17.3 years. Compared to males, females had higher levels of anxiety, depressive symptoms, and suicidal ideation and lower levels of self-perceived well-being. Structural equation models indicated that depression was the main predictor of the rest of the outcomes in the overall sample. The role of anxiety was heterogeneous across genders and not clearly correlated to suicidal behavior or well-being.Conclusions: Large-scale mental health screening using an online tool proved feasible, with high response rates. Depression was the most important factor influencing anxiety, suicidal behavior, and well-being in Mexican high school students. The roles of depression and anxiety were heterogeneous across genders.Trial Registration: ClinicalTrials.gov Identifier: NCT04067076.

Universal mental health screening with a focus on suicidal behaviour using smartphones in a Mexican rural community: protocol for the SMART-SCREEN population-based survey.

INTRODUCTION: Mental disorders represent the second cause of years lived with disability worldwide. Suicide mortality has been targeted as a key public health concern by the WHO. Smartphone technology provides a huge potential to develop massive and fast surveys. Given the vast cultural diversity of Mexico and its abrupt orography, smartphone-based resources are invaluable in order to adequately manage resources, services and preventive measures in the population. The objective of this study is to conduct a universal suicide risk screening in a rural area of Mexico, measuring also other mental health outcomes such as depression, anxiety and alcohol and substance use disorders. METHODS AND ANALYSIS: A population-based cross-sectional study with a temporary sampling space of 9 months will be performed between September 2019 and June 2020. We expect to recruit a large percentage of the target population (at least 70%) in a short-term survey of Milpa Alta Delegation, which accounts for 137 927 inhabitants in a territorial extension of 288 km2.They will be recruited via an institutional call and a massive public campaign to fill in an online questionnaire through mobile-assisted or computer-assisted web app. This questionnaire will include data on general health, validated questionnaires including Well-being Index 5, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale 2, Alcohol Use Disorders Identification Test, selected questions of the Drug Abuse Screening Test and Columbia-Suicide Severity Rating Scales and Diagnostic and statistical manual of mental disorders (DSM-5) questions about self-harm.We will take into account information regarding time to mobile app response and geo-spatial location, and aggregated data on social, demographical and environmental variables. Traditional regression modelling, multilevel mixed methods and data-driven machine learning approaches will be used to test hypotheses regarding suicide risk factors at the individual and the population level. ETHICS AND DISSEMINATION: Ethical approval (002/2019) was granted by the Ethics Review Board of the Hospital Psiquiátrico Yucatán, Yucatán (Mexico). This protocol has been registered in ClinicalTrials.gov. The starting date of the study is 3 September 2019. Results will serve for the planning and healthcare of groups with greater mental health needs and will be disseminated via publications in peer-reviewed journal and presented at relevant mental health conferences. TRIAL REGISTRATION NUMBER: NCT04067063.

Epidemiología del melanoma en poblacion de la provincia de Osorno: estudio retrospectivo 2016 - 2018 / Epidemiology of melanoma in the population of the province of Osorno: a retrospective study 2016 - 2018

El melanoma maligno ha aumentado su incidencia. En la provincia de Osorno, para el período 2016 ­ 2018, se registraron 55 casos nuevos de melanoma, con predominio en sexo femenino. Los subtipos extensivo superficial y nodular fueron los más frecuentes; no obstante el lentiginoso acral fue un grupo prevalente, siendo el sexo masculino el más afectado por esta variedad. Un 49,1% de los melanomas fueron detectados con Breslow mayor a 1 mm, siendo los hombres los más afectados por una pesquisa más tardía. Reforzar la cobertura de la atención primaria urbana y rural, como así la oferta de dermatólogos, impactarán en la mejora de estos índices.

The Malignant Melanoma has increased its incidence. In the province of Osorno, between 2016 ­ 2018 there were 55 new cases of melanoma, with predo-minance in the female sex. The superficial spreading and nodular subtypes were most common. However the acral lentiginous was a prevalent group, with the male sex being the most affected by this variety. A 49,1% of melanomas were detected with Breslow greater than 1mm, with men being the ones who presented later inquiries. The coverage of urban and rural primary care needs to be strengthened, just like supply of dermatologists, it will impact the improvement of these rates.