The incidence of non-affective psychotic disorders in Chile between 2005 and 2018: results from a national register of over 30 000 cases.

BACKGROUND: Evidence suggests the incidence of non-affective psychotic disorders (NAPDs) varies across persons and places, but data from the Global South is scarce. We aimed to estimate the treated incidence of NAPD in Chile, and variance by person, place and time. METHODS: We used national register data from Chile including all people, 10-65 years, with the first episode of NAPD (International Classification of Diseases, Tenth Revision: F20-F29) between 1 January 2005 and 29 August 2018. Denominators were estimated from Chilean National Census data. Our main outcome was treated incidence of NAPD and age group, sex, calendar year and regional-level population density, multidimensional poverty and latitude were exposures of interest. RESULTS: We identified 32 358 NAPD cases [12 136 (39.5%) women; median age-at-first-contact: 24 years (interquartile range 18-39 years)] during 171.1 million person-years [crude incidence: 18.9 per 100 000 person-years; 95% confidence interval (CI) 18.7-19.1]. Multilevel Poisson regression identified a strong age-sex interaction in incidence, with rates peaking in men (57.6 per 100 000 person-years; 95% CI 56.0-59.2) and women (29.5 per 100 000 person-years; 95% CI 28.4-30.7) between 15 and 19 years old. Rates also decreased (non-linearly) over time for women, but not men. We observed a non-linear association with multidimensional poverty and latitude, with the highest rates in the poorest regions and those immediately south of Santiago; no association with regional population density was observed. CONCLUSION: Our findings inform the aetiology of NAPDs, replicating typical associations with age, sex and multidimensional poverty in a Global South context. The absence of association with population density suggests this risk may be context-dependent.

Epistemonikos: a comprehensive database of systematic reviews for health decision-making.

BACKGROUND: Systematic reviews allow health decisions to be informed by the best available research evidence. However, their number is proliferating quickly, and many skills are required to identify all the relevant reviews for a specific question. METHODS AND FINDINGS: We screen 10 bibliographic databases on a daily or weekly basis, to identify systematic reviews relevant for health decision-making. Using a machine-based approach developed for this project we select reviews, which are then validated by a network of more than 1000 collaborators. After screening over 1,400,000 records we have identified more than 300,000 systematic reviews, which are now stored in a single place and accessible through an easy-to-use search engine. This makes Epistemonikos the largest database of its kind. CONCLUSIONS: Using a systematic approach, recruiting a broad network of collaborators and implementing automated methods, we developed a one-stop shop for systematic reviews relevant for health decision making.

Cannabinoids for the treatment of cannabis abuse disorder. / Cannabinoides para el tratamiento del trastorno por abuso de cannabis.

INTRODUCTION: Cannabis stands as the most used illegal drug in the world. Currently there are no pharmacologic alternatives to treat its addiction, so the use of Cannabinoids has been postulated as a therapeutic tool. They would act mainly through decrease in abstinence and craving symptoms but its effectiveness remains unclear. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified seven systematic reviews including 15 studies, of which four were randomized trials. We concluded the use of cannabinoids might result in little or no increase in abstinence at the end of treatment, and it probably increases adverse effects.

INTRODUCCIÓN: El cannabis se erige como la droga ilícita más consumida en el mundo. Actualmente no existen alternativas farmacológicas específicas para el tratamiento de su adicción, por lo que se ha postulado la utilidad del uso de cannabinoides como herramienta terapéutica. Ellos actuarían principalmente a través de la disminución de síntomas de abstinencia y craving (deseo o compulsión por consumir), pero su efectividad aún no está clara. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos siete revisiones sistemáticas que en conjunto incluyeron 15 estudios primarios, de los cuales cuatro corresponden a ensayos aleatorizados. Concluimos que el uso de cannabinoides podría resultar en poco o nulo aumento en la abstinencia al finalizar el tratamiento, y probablemente aumenta los efectos adversos.

Disruption of microglia histone acetylation and protein pathways in mice exhibiting inflammation-associated depression-like symptoms.

BACKGROUND: Peripheral immune challenge can elicit microglia activation and depression-related symptoms. The balance of inflammatory signals in the tryptophan pathway can skew the activity of indoleamine-pyrrole 2,3 dioxygenase (IDO1) towards the metabolization of tryptophan into kynurenine (rather than serotonin), and towards neuroprotective or neurotoxic metabolites. The proteome changes that accompany inflammation-associated depression-related behaviors are incompletely understood. METHODS: The changes in microglia protein abundance and post-translational modifications in wild type (WT) mice that exhibit depression-like symptoms after recovery from peripheral Bacille Calmette-Guerin (BCG) challenge were studied. This WT_BGG group was compared to mice that do not express depression-like symptoms after BCG challenge due to IDO1 deficiency by means of genetic knockout (BCG_KO group), and to WT Saline-treated (Sal) mice (WT_Sal group) using a mass spectrometry-based label-free approach. RESULTS: The comparison of WT_BCG relative to WT_Sal and KO_BCG mice uncovered patterns of protein abundance and acetylation among the histone families that could influence microglia signaling and transcriptional rates. Members of the histone clusters 1, 2 and 3 families were less abundant in WT_BCG relative to WT_Sal whereas members in the H2A family exhibited the opposite pattern. Irrespective of family, the majority of the histones were less abundant in WT_BCG relative to KO_BCG microglia. Homeostatic mechanisms may temper the potentially toxic effects of high histone levels after BCG challenge to levels lower than Sal. Histone acetylation was highest in WT_BCG and the similar levels observed in WT_Sal and KO_BCG. This result suggest that histone acetylation levels are similar between IDO1 deficient mice after immune challenge and unchallenged WT mice. The over-abundance of tyrosine 3-monooxygenase/tryptophan 5-monooxygenase activation proteins (14-3-3 series) in WT_BCG relative to KO_BCG is particularly interesting because these proteins activate another rate-limiting enzyme in the tryptophan pathway. The over-representation of alcoholism and systemic lupus erythematosus pathways among the proteins exhibiting differential abundance between the groups suggest that these disorders share microglia activation pathways with BCG challenge. The over-representation of phagosome pathway among proteins differentially abundant between WT_BCG and KO_BCG microglia suggest an association between IDO1 deficiency and phagocytosis. Likewise, the over-representation of the gap junction pathway among the differentially abundant proteins between KO_BCG and WT_Sal suggest a multifactorial effect of BCG and IDO1 deficiency on cell communication. CONCLUSIONS: The present study of histone acetylation and differential protein abundance furthers the understanding of the long lasting effects of peripheral immune challenges. Our findings offer insights into target proteins and mechanisms that provide clues for therapies to ameliorate inflammation-associated depression-related behaviors.

Priority setting for mental health research in Chile.

BACKGROUND: Scientific knowledge is a fundamental tool for making informed health policy decisions, but the link between health research and public policy decision-making is often missing. This study aims to identify and prioritize a national set of research gaps in mental health. METHODS: A multi-approach method to identify gaps in knowledge was developed, including (1) document analysis and identification of possible research questions, (2) interviews to Ministry of Health key informants, (3) focus groups with different stakeholders, and (4) a web consultation addressed to academics. The identified gaps were translated to a standardized format of research questions. Criteria for prioritization were extracted from interviews and focus groups. Then, a team of various professionals applied them for scoring each question research. FINDINGS: Fifty-four people participated in the knowledge gaps identification process through an online consultation (n = 23) and focus groups (n = 18). Prioritization criteria identified were: extent of the knowledge gap, size of the objective population, potential benefit, vulnerability, urgency and applicability. 155 research questions were prioritized, of which 44% were related to evaluation of systems and/or health programs, and 26% to evaluation of interventions, including questions related to cost-effectiveness. 30% of the research questions came from the online consultation, and 36% from key informants. Users groups contributed with 10% of total research questions. CONCLUSION: A final priority setting for mental health research was reached, making available for authorities and research agencies a list of 155 research questions ordered by relevance. The experience documented here could serve to other countries interested in developing a similar process.

[Eating disorders inventory scores among mothers of adolescents with and without eating disorders]. / Las madres de adolescentes y jóvenes chilenos con trastornos alimentarios.

BACKGROUND: Parents have a control role in the development and treatment of eating disorders among teenagers. AIM: To compare attitudes, beliefs and behaviors between mothers of patients with eating disorders and mothers of teenagers without these disorders. MATERIAL AND METHODS: Twenty one mother-sibling pairs of adolescents with eating disorders and 15 pairs of adolescents without this condition, but of similar age, were studied. The eating disorders inventory (EDI-2), a self administered questionnaire that includes 91 items, was applied. RESULTS: No differences in any of the subscales of EDI-2 were observed between mothers of teenagers with or without eating disorders. No differences in perfectionism, maturity fears, impulsivity and interpersonal distrust were observed between adolescents with and without eating disorders. The latter had a lesser drive for thinness and inefficacy. CONCLUSIONS: In this sample, no differences in behaviors, attitudes and beliefs about food, were observed between mothers of adolescents with and without eating disorders.

[Access to social networks and health care among extremely poor people]. / Acceso a redes sociales y de salud de población en extrema pobreza.

BACKGROUND: Extremely poor people have more problems to have access to social networks and health care. AIM: To evaluate the access to health services and the perception about these services of adults living in conditions of extreme poverty. MATERIAL AND METHODS: A survey was applied to 361 people living in slums aged 15 to 77 years (83% females), that were living in these conditions for a mean of 11 years. Twenty six in-depth interviews were also performed to prototypical subjects living in extreme poverty. RESULTS: Ten percent of subjects were illiterate. Sixty two percent were unsatisfied with their access to health services and 32% were not registered in primary health clinics. Among children of less than 6 years of age, 22% were delayed in their vaccination schedule and 32% were not withdrawing the milk delivered by the complementary feeding program of the clinic. The qualitative analysis revealed that the lack of access to health care is associated with the feeling of exclusion, mutual distrust and lack of resolution of health problems. CONCLUSIONS: People living in extreme poverty are distrustful and perceive obstacles to have access to the health care system.

Las madres de adolescentes y jóvenes chilenos con trastornos alimentarios / Eating disorders inventory scores among mothers of adolescents with and without eating disorders

Background: Parents have a control role in the development and treatment of eating disorders among teenagers. Aim: To compare attitudes, beliefs and behaviors between mothers of patients with eating disorders and mothers of teenagers without these disorders. Material and methods: Twenty one mother-sibling pairs of adolescents with eating disorders and 15 pairs of adolescents without this condition, but of similar age, were studied. The eating disorders inventory (EDI-2), a self administered questionnaire that includes 91 items, was applied. Results: No differences in any of the subscales of EDI-2 were observed between mothers of teenagers with or without eating disorders. No differences in perfectionism, maturity fears, impulsivity and interpersonal distrust were observed between adolescents with and without eating disorders. The latter had a lesser drive for thinness and inefficacy. Conclusions: In this sample, no differences in behaviors, attitudes and beliefs about food, were observed between mothers of adolescents with and without eating disorders.

Acceso a redes sociales y de salud de población en extrema pobreza / Access to social networks and health care among extremely poor people

Background: Extremely poor people have more problems to have access to social networks and health care. Aim: To evaluate the access to health services and the perception about these services of adults living in conditions of extreme poverty. Material and methods: A survey was applied to 361 people living in slums aged 15 to 77 years (83 percent females), that were living in these conditions for a mean of 11 years. Twenty six in-depth interviews were also performed to prototypical subjects living in extreme poverty. Results: Ten percent of subjects were illiterate. Sixty two percent were unsatisfied with their access to health services and 32 percent were not registered in primary health clinics. Among children of less than 6 years of age, 22 percent were delayed in their vaccination schedule and 32 percent were not withdrawing the milk delivered by the complementary feeding program of the clinic. The qualitative analysis revealed that the lack of access to health care is associated with the feeling of exclusion, mutual distrust and lack of resolution of health problems. Conclusions: People living in extreme poverty are distrustful and perceive obstacles to have access to the health care system.