Towards closing socio-economic status disparities in COVID-19 premature mortality: a nationwide and trend analysis in Chile.

BACKGROUND: Socio-economic status (SES) disparities in coronavirus disease 2019 (COVID-19) mortality have been reported but complete information and time trends are scarce. In this study, we analysed the years of life lost (YLL) due to COVID-19 premature mortality during the pandemic in Chile and its evolution according to SES and sex compared with a counterfactual scenario [cerebrovascular accidents (stroke)]. METHOD: We used Chile's national mortality databases from 2020 to 2022. YLL and age-standardized YLL and mortality rates by sex and by epidemic waves were determined. The 346 communes were stratified into SES groups according to their poverty index quintile. Negative binomial regression models were used to test trends. RESULTS: In >2 years of the pandemic, the COVID-19 YLL was 975 937, corresponding to 61 174 deaths. The YLL rate per 100 000 inhabitants was 1027 for males and 594 for females. There was a heterogeneous distribution of YLL rates and the regional level. Communes in the most advantaged SES quintile (Q5) had the highest YLL during the first wave compared with those in the lowest SES quintile (Q1) (P < 0.001) but the opposite was true during the second wave. COVID-19 YLL trends declined and differences between Q1 and Q2 vs Q5 converged from the second to the fourth waves (0.33 and 0.15, Ptrend < 0.001 and Ptrend = 0.024). YLL declined but differences persisted in stroke (-0.002, Ptrend = 0.979). CONCLUSIONS: COVID-19 deaths resulted in a higher impact on premature death in Chile, especially in men, with a heterogeneous geographic distribution along the territory. SES and sex disparities in COVID-19 premature mortality had narrowed by the end of the pandemic.

Geographical disparities in obesity prevalence: small-area analysis of the Chilean National Health Surveys.

BACKGROUND: Previous representative health surveys conducted in Chile evidenced a high obesity prevalence rate among adults, especially in female and urban areas. Nevertheless, these have limited utility for targeted interventions and local source allocation for prevention. This study analyzes the increments in obesity prevalence rates in populations ≥15 years of age and the geographic variation at the regional level. We also assessed whether the obesity rates have different patterns on a smaller geographic level than national and regional ones. METHODS: This ecological study analyzed data from two representative national samples of adolescents and adults ≥15 years old, who participated in the last Chilean health surveys, 2009 (n = 5412) and 2016 (n = 6233). Obesity (body mass index≥30 kg/m2) rates were calculated on the national, regional, and Health service (HS) levels, being HS the smallest unit of analysis available. Obesity rates and relative increase to early identify target populations and geographic areas, with 95% confidence intervals (95% CI), were calculated using the sampling design of the national surveys, at the national and regional level, and by gender, age groups, and socioeconomic status. The Fay-Herriot (FH) models, using auxiliary data, were fitted for obesity rate estimates at the HS level. RESULTS: The relative increase in obesity rate was 37.1% (95%CI 23.3-52.9) at the national level, with a heterogeneous geographic distribution at the regional one. Southern regions had the highest obesity rates in both surveys (Aysén: 35.2, 95%CI 26.9-43.5 in 2009, 44.3 95%CI 37-51.7 in 2016), but higher increases were predominantly in the northern and central areas of the country (relative increase 91.1 95%CI 39.6-110.1 in Valparaiso and 81.6 95%CI 14.4-196.2 in Tarapacá). Obesity rates were higher in females, older age, and lower socioeconomic groups; nevertheless, relative increases were higher in the opposite ones. The FH estimates showed an obesity rates variation at the HS level, where higher rates tend to converge to specific HS areas of each region. CONCLUSION: Obesity rates and relative increase are diverse across subnational levels and substantially differ from the national estimates, highlighting a pattern that converges to areas with low-middle income households. Our results emphasize geographical disparities in obesity prevalence among adults and adolescents.

Ambient carbon monoxide and daily mortality: a global time-series study in 337 cities.

BACKGROUND: Epidemiological evidence on short-term association between ambient carbon monoxide (CO) and mortality is inconclusive and limited to single cities, regions, or countries. Generalisation of results from previous studies is hindered by potential publication bias and different modelling approaches. We therefore assessed the association between short-term exposure to ambient CO and daily mortality in a multicity, multicountry setting. METHODS: We collected daily data on air pollution, meteorology, and total mortality from 337 cities in 18 countries or regions, covering various periods from 1979 to 2016. All included cities had at least 2 years of both CO and mortality data. We estimated city-specific associations using confounder-adjusted generalised additive models with a quasi-Poisson distribution, and then pooled the estimates, accounting for their statistical uncertainty, using a random-effects multilevel meta-analytical model. We also assessed the overall shape of the exposure-response curve and evaluated the possibility of a threshold below which health is not affected. FINDINGS: Overall, a 1 mg/m3 increase in the average CO concentration of the previous day was associated with a 0·91% (95% CI 0·32-1·50) increase in daily total mortality. The pooled exposure-response curve showed a continuously elevated mortality risk with increasing CO concentrations, suggesting no threshold. The exposure-response curve was steeper at daily CO levels lower than 1 mg/m3, indicating greater risk of mortality per increment in CO exposure, and persisted at daily concentrations as low as 0·6 mg/m3 or less. The association remained similar after adjustment for ozone but was attenuated after adjustment for particulate matter or sulphur dioxide, or even reduced to null after adjustment for nitrogen dioxide. INTERPRETATION: This international study is by far the largest epidemiological investigation on short-term CO-related mortality. We found significant associations between ambient CO and daily mortality, even at levels well below current air quality guidelines. Further studies are warranted to disentangle its independent effect from other traffic-related pollutants. FUNDING: EU Horizon 2020, UK Medical Research Council, and Natural Environment Research Council.

Cotinine Enhances Fear Extinction and Astrocyte Survival by Mechanisms Involving the Nicotinic Acetylcholine Receptors Signaling.

Fear memory extinction (FE) is an important therapeutic goal for Posttraumatic stress disorder (PTSD). Cotinine facilitates FE in rodents, in part due to its inhibitory effect on the amygdala by the glutamatergic projections from the medial prefrontal cortex (mPFC). The cellular and behavioral effects of infusing cotinine into the mPFC on FE, astroglia survival, and the expression of bone morphogenetic proteins (BMP) 2 and 8, were assessed in C57BL/6 conditioned male mice. The role of the α4ß2- and α7 nicotinic acetylcholine receptors (nAChRs) on cotinine's actions were also investigated. Cotinine infused into the mPFC enhanced contextual FE and decreased BMP8 expression by a mechanism dependent on the α7nAChRs. In addition, cotinine increased BMP2 expression and prevented the loss of GFAP + astrocytes in a form independent on the α7nAChRs but dependent on the α4ß2 nAChRs. This evidence suggests that cotinine exerts its effect on FE by modulating nAChRs signaling in the brain.

Ambient Particulate Air Pollution and Daily Mortality in 652 Cities.

BACKGROUND: The systematic evaluation of the results of time-series studies of air pollution is challenged by differences in model specification and publication bias. METHODS: We evaluated the associations of inhalable particulate matter (PM) with an aerodynamic diameter of 10 µm or less (PM10) and fine PM with an aerodynamic diameter of 2.5 µm or less (PM2.5) with daily all-cause, cardiovascular, and respiratory mortality across multiple countries or regions. Daily data on mortality and air pollution were collected from 652 cities in 24 countries or regions. We used overdispersed generalized additive models with random-effects meta-analysis to investigate the associations. Two-pollutant models were fitted to test the robustness of the associations. Concentration-response curves from each city were pooled to allow global estimates to be derived. RESULTS: On average, an increase of 10 µg per cubic meter in the 2-day moving average of PM10 concentration, which represents the average over the current and previous day, was associated with increases of 0.44% (95% confidence interval [CI], 0.39 to 0.50) in daily all-cause mortality, 0.36% (95% CI, 0.30 to 0.43) in daily cardiovascular mortality, and 0.47% (95% CI, 0.35 to 0.58) in daily respiratory mortality. The corresponding increases in daily mortality for the same change in PM2.5 concentration were 0.68% (95% CI, 0.59 to 0.77), 0.55% (95% CI, 0.45 to 0.66), and 0.74% (95% CI, 0.53 to 0.95). These associations remained significant after adjustment for gaseous pollutants. Associations were stronger in locations with lower annual mean PM concentrations and higher annual mean temperatures. The pooled concentration-response curves showed a consistent increase in daily mortality with increasing PM concentration, with steeper slopes at lower PM concentrations. CONCLUSIONS: Our data show independent associations between short-term exposure to PM10 and PM2.5 and daily all-cause, cardiovascular, and respiratory mortality in more than 600 cities across the globe. These data reinforce the evidence of a link between mortality and PM concentration established in regional and local studies. (Funded by the National Natural Science Foundation of China and others.).

Correction to: Intranasal Cotinine Plus Krill Oil Facilitates Fear Extinction, Decreases Depressive-Like Behavior, and Increases Hippocampal Calcineurin A Levels in Mice.

The original version of this article unfortunately contained mistake in its Funding inforation.

Intranasal Cotinine Plus Krill Oil Facilitates Fear Extinction, Decreases Depressive-Like Behavior, and Increases Hippocampal Calcineurin A Levels in Mice.

Failure in fear extinction is one of the more troublesome characteristics of posttraumatic stress disorder (PTSD). Cotinine facilitates fear memory extinction and reduces depressive-like behavior when administered 24 h after fear conditioning in mice. In this study, it was investigated the behavioral and molecular effects of cotinine, and other antidepressant preparations infused intranasally. Intranasal (IN) cotinine, IN krill oil, IN cotinine plus krill oil, and oral sertraline were evaluated on depressive-like behavior and fear retention and extinction after fear conditioning in C57BL/6 mice. Since calcineurin A has been involved in facilitating fear extinction in rodents, we also investigated changes of calcineurin in the hippocampus, a region key on contextual fear extinction. Short-term treatment with cotinine formulations was superior to krill oil and oral sertraline in reducing depressive-like behavior and fear consolidation and enhancing contextual fear memory extinction in mice. IN krill oil slowed the extinction of fear. IN cotinine preparations increased the levels of calcineurin A in the hippocampus of conditioned mice. In the light of the results, the future investigation of the use of IN cotinine preparations for the extinction of contextual fear memory and treatment of treatment-resistant depression (TRD) in PTSD is discussed.

Intranasal cotinine improves memory, and reduces depressive-like behavior, and GFAP+ cells loss induced by restraint stress in mice.

Posttraumatic stress disorder (PTSD), chronic psychological stress, and major depressive disorder have been found to be associated with a significant decrease in glial fibrillary acidic protein (GFAP) immunoreactivity in the hippocampus of rodents. Cotinine is an alkaloid that prevents memory impairment, depressive-like behavior and synaptic loss when co-administered during restraint stress, a model of PTSD and stress-induced depression, in mice. Here, we investigated the effects of post-treatment with intranasal cotinine on depressive- and anxiety-like behaviors, visual recognition memory as well as the number and morphology of GFAP+ immunoreactive cells, in the hippocampus and frontal cortex of mice subjected to prolonged restraint stress. The results revealed that in addition to the mood and cognitive impairments, restraint stress induced a significant decrease in the number and arborization of GFAP+ cells in the brain of mice. Intranasal cotinine prevented these stress-derived symptoms and the morphological abnormalities GFAP+ cells in both of these brain regions which are critical to resilience to stress. The significance of these findings for the therapy of PTSD and depression is discussed.

Evaluating the efficacy of endoscopic thoracic sympathectomy for generalized social anxiety disorder with blushing complaints: a comparison with sertraline and no treatment-santiago de chile 2003-2009.

OBJECTIVE: No study has yet compared the efficacy of endoscopic thoracic sympathectomy for treating facial blushing with other treatment or no treatment. We conducted a prospective, observational, open-label, clinical study to compare endoscopic thoracic sympathectomy for blushing with generalized social anxiety disorder versus sertraline treatment and no treatment. METHOD: Three-hundred and thirty consecutive patients seeking treatment for their blushing were assessed by psychiatric interview and patient-rated scales. The Brief Social Phobia Scale was the primary outcome measure. Patients meeting Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria for generalized social anxiety disorder, scoring 20 points or more in the Brief Social Phobia Scale and 19 points or more in the Social Phobia Inventory were considered eligible and followed up for a mean of 11 months (range 1-64) after endoscopic thoracic sympathectomy or initiation of sertraline. RESULTS: At baseline, 97 percent of the endoscopic thoracic sympathectomy-treated group, 87 percent of the sertraline-treated group, and 78 percent of the nontreated group rated their blushing as being "severe" or "extreme." At follow up, 16 percent of endoscopic thoracic sympathectomy-treated patients, 32 percent of sertraline-treated patients, and 57 percent of untreated patients reported this degree of blushing. At endpoint, Brief Social Phobia Scale total scores exhibited a greater decline with either treatment than with no treatment. Nonetheless, in comparison to no treatment, only the results obtained with endoscopic thoracic sympathectomy achieved statistical significance (p=0.003). Compensatory sweating occurred in 99 percent of patients who underwent endoscopic thoracic sympathectomy. High degrees of satisfaction with treatment were reported by 89 percent of patients undergoing endoscopic thoracic sympathectomy and by 59 percent of patients taking medication. CONCLUSION: Endoscopic thoracic sympathectomy was associated to a greater reduction of blushing and Brief Social Phobia Scale scores, and higher degrees of satisfaction with treatment, in comparison to sertraline and no treatment.

Acido fólico y vitamina B12 en niños, adolesdentes y mujeres embarazadas en Venezuela / Folic acid and vitamin B12 in children, adolescents and pregnant women in Venezuela

Las consecuencias de la deficiencia de ácido fólico y vitamina B12 en el apropiado desarrollo y funcionamiento del organismo están bien documentadas. Este trabajo tiene como objetivo determinar la magnitud de la deficiencia de ácido fólico y vitamina B12 en grupos vulnerables, pertenecientes a los estratos socioeconómicos bajos (Graffar IV y V) en Venezuela. La muestra proviene de tres encuestas de Condiciones de Vida, cuyo trabajo de campo ejecutó Fundacredesa, entre los años 2001 y 2003 en 14 ciudades del país, en la Gran Caracas y en el Estado Vargas. Se procesaron 5658 muestras de suero y se determinó ácido fólico y vitamina B12 por radio inmuno ensayo, de infantes, niños, adolescentes y mujeres embarazadas de los estratos más pobres. La prevalencia de deficiencia de ácido fólico varió entre 27,5 a 81,79 por ciento en los diferentes grupos estudiados. La deficiencia de vitamina B12 en la muestra de las principales ciudades (Nacional) fue de 11,4 por ciento, pero existió también un porcentaje similar de exceso de vitamina B12 sérica. La prevalencia de deficiencia de ácido fólico y vitamina B12 en embarazadas de la Gran Caracas fue de 36,32 y 61,34 por ciento, respectivamente. La prevalencia de deficiencia de ácido fólico fue alta, especialmente en mujeres en edad reproductiva, adolescentes embarazadas y en la población estudiada en el Estado Vargas. Es perentorio que esta situación reciba una intervención inmediata, por medio de programas de suplementación a los grupos vulnerables y la ampliación del espectro de la fortificación de alimentos con este nutriente