Virtual Reality and Serious Videogame-Based Instruments for Assessing Spatial Navigation in Alzheimer's Disease: A Systematic Review of Psychometric Properties.

Over the past decade, research using virtual reality and serious game-based instruments for assessing spatial navigation and spatial memory in at-risk and AD populations has risen. We systematically reviewed the literature since 2012 to identify and evaluate the methodological quality and risk of bias in the analyses of the psychometric properties of VRSG-based instruments. The search was conducted primarily in July-December 2022 and updated in November 2023 in eight major databases. The quality of instrument development and study design were analyzed in all studies. Measurement properties were defined and analyzed according to COSMIN guidelines. A total of 1078 unique records were screened, and following selection criteria, thirty-seven studies were analyzed. From these studies, 30 instruments were identified. Construct and criterion validity were the most reported measurement properties, while structural validity and internal consistency evidence were the least reported. Nineteen studies were deemed very good in construct validity, whereas 11 studies reporting diagnostic accuracy were deemed very good in quality. Limitations regarding theoretical framework and research design requirements were found in most of the studies. VRSG-based instruments are valuable additions to the current diagnostic toolkit for AD. Further research is required to establish the psychometric performance and clinical utility of VRSG-based instruments, particularly the instrument development, content validity, and diagnostic accuracy for preclinical AD screening scenarios. This review provides a straightforward synthesis of the state of the art of VRSG-based instruments and suggests future directions for research.

Types of Psychiatric Beds and Mental Health Services in 16 Latin American Countries, 1990-2020.

OBJECTIVE: Latin America has undergone major changes in psychiatric services over the past three decades. The authors aimed to assess the availability of service data and changes in psychiatric services in this region during the 1990-2020 period. METHODS: The authors formed a research network to collect data on psychiatric service indicators gathered between 1990 and 2020 from national registries in Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Panama, Paraguay, Peru, and Uruguay. Indicators included psychiatric beds in psychiatric and general hospitals overall, for children and adolescents, and for forensic populations; residential beds for substance use treatment; treatment slots in residential facilities and day hospitals; and outpatient facilities. RESULTS: Data availability varied among countries, service indicators, and time points. The median prevalence of psychiatric beds decreased in psychiatric hospitals from 5.1 to 3.0 per 100,000 people (-42%) and in general hospitals from 1.0 to 0.8 (-24%). The median prevalence estimates of specialized psychiatric beds for children and adolescents (0.18) and for forensic populations (0.04) remained unchanged. Increases in prevalence were observed for residential beds for substance use treatment (from 0.40 to 0.57, 43% increase), available treatment slots in residential facilities (0.67 to 0.79, 17%), treatment slots in day hospitals (0.41 to 0.54, 32%), and outpatient facilities (0.39 to 0.93, 138%). CONCLUSIONS: The findings indicate that treatment capacity shifted from inpatient to outpatient and community care. Most countries had a bed shortage for acute psychiatric care, especially for children and adolescents and forensic patients. More comprehensive and standardized mental health service registries are needed.

Fairness: from the guts to the brain - a critical examination by Atlantic fellows of the Global Brain Health Institute.

In January 2023, the Global Brain Health Institute (GBHI) at UCSF hosted an online salon to discuss the relationship between fairness and brain health equity. We aimed to address two primary questions: first, how is fairness perceived by the public, and how does it manifest in societal constructs like equity and justice? Second, what are the neurobiological foundations of fairness, and how do they impact brain health? Drawing from interdisciplinary fields such as philosophy, psychology, and neuroscience, the salon served as a platform for participants to share diverse perspectives on fairness. Fairness is a multifaceted concept encompassing equity, justice, empathy, opportunity, non-discrimination, and the Golden Rule, but by delving into its evolutionary origins, we can verify its deep-rooted presence in both human and animal behaviors. Real-world experiments, such as Frans de Waal's capuchin monkey study, have proven enlightening, elucidating many mechanisms that have shaped our neurobiological responses to fairness. Contemporary cognitive neuroscience research further emphasizes the role of neuroanatomical areas and neurotransmitters in encoding fairness-related processes. We also discussed the critical interconnection between fairness and healthcare equity, particularly its implications for brain health. These values are instrumental in promoting social justice and improving health outcomes. In our polarized social landscape, there are rising concerns about a potential decrease in fairness and prosocial behaviors due to isolated social bubbles. We stress the urgency for interventions that enhance perspective-taking, reasoning, and empathy. Overall, fairness is vital to fostering an equitable society and its subsequent influence on brain health outcomes.

Characterizing social and cognitive EEG-ERP through multiple kernel learning.

EEG-ERP social-cognitive studies with healthy populations commonly fail to provide significant evidence due to low-quality data and the inherent similarity between groups. We propose a multiple kernel learning-based approach to enhance classification accuracy while keeping the traceability of the features (frequency bands or regions of interest) as a linear combination of kernels. These weights determine the relevance of each source of information, which is crucial for specialists. As a case study, we classify healthy ex-combatants of the Colombian armed conflict and civilians through a cognitive valence recognition task. Although previous works have shown accuracies below 80% with these groups, our proposal achieved an F1 score of 98%, revealing the most relevant bands and brain regions, which are the base for socio-cognitive trainings. With this methodology, we aim to contribute to standardizing EEG analyses and enhancing their statistics.

Educational inequalities in heart failure mortality and the cycles of the internal armed conflict in Colombia: An observational panel study of ecological data, 1999-2017.

Heart failure (HF) is a significant clinical problem and an important public health issue due to the morbidity and mortality that it causes, especially in a population that is aging and affected by social stressors such as armed conflict. We aim to describe the inequalities and trends of HF mortality by educational level in Colombia between 1999 and 2017 compared with the cycles of the internal armed conflict during the same period. An observational study of ecological data panels, with aggregates at the national level, was conducted. Information from death certificates with HF as the basic cause of death (COD) was used. Variables of the year of death, sex, age, department of residence, and educational level were considered. Mortality rates adjusted for age were calculated. A joinpoint regression was used to model the trend of rates by educational level. We found that both men and women with primary education had the highest adjusted mortality rates: among men, RR_primary = 19.06 deaths/100,000 inhabitants, SE = 0.13 vs. RR_tertiary = 4.85, SE = 0.17, and similar differences among women. Mortality rates tended to decrease at all educational levels, with a greater reduction in people with higher educational levels. In both sexes, the behavior of the relative index of inequality showed significant inequality, albeit with a strong reduction during the last decade. Mortality due to HF in Colombia shows inequalities by educational level. In the prevention of HF, education should be considered a structural social determinant. In addition, we analyzed the potential role of the Colombian long-term armed conflict in the observed trends. We highlighted the role of the health sector, together with other sectors (education, work, and housing), in developing intersectoral public policies that contribute to the reduction of cardiovascular mortality disparities.

A multi-lab test of the facial feedback hypothesis by the Many Smiles Collaboration.

Following theories of emotional embodiment, the facial feedback hypothesis suggests that individuals' subjective experiences of emotion are influenced by their facial expressions. However, evidence for this hypothesis has been mixed. We thus formed a global adversarial collaboration and carried out a preregistered, multicentre study designed to specify and test the conditions that should most reliably produce facial feedback effects. Data from n = 3,878 participants spanning 19 countries indicated that a facial mimicry and voluntary facial action task could both amplify and initiate feelings of happiness. However, evidence of facial feedback effects was less conclusive when facial feedback was manipulated unobtrusively via a pen-in-mouth task.

Validity of the ROX index in predicting invasive mechanical ventilation requirement in pneumonia.

BACKGROUND: The ROX index (Respiratory rate-OXygenation) has been described as a prediction tool to identify the need for invasive mechanical ventilation (IMV) in community-acquired pneumonia (CAP) with acute hypoxaemic respiratory failure treated with high-flow nasal cannula in order to avoid delay of a necessary intubation. However, its use in predicting the need for ventilatory support in hospitalised patients with CAP has not been validated. METHODS: This is a retrospective cohort study including subjects with CAP treated in the general ward, emergency service or intensive care unit of a third-level centre in Cundinamarca, Colombia, between January 2001 and February 2020. The ROX index was estimated as the ratio of oxygen saturation/fraction of inspired oxygen to respiratory rate. RESULTS: A total of 895 patients were included, of whom 93 (10%) required IMV. The ROX index proved to be a good predictor, presenting an area under the curve of receiver operating characteristics (AUROC) of 0.733 (95% CI 0.671 to 0.795, p<0.001) when determined by pulse oximetry and an AUROC of 0.779 (95% CI 0.699 to 0.859, p<0.001) when estimated by arterial blood gas (ABG) parameters, with an intraclass correlation of 0.894. The estimated cut-off point was 14.8; a score less than 14.8 indicates high risk of requiring IMV. CONCLUSION: The ROX index is a good predictor of IMV in hospitalised patients with CAP. It presents good performance when calculated through pulse oximetry and can replace the one calculated by ABG.

Mental health of migrants with pre-migration exposure to armed conflict: a systematic review and meta-analysis.

BACKGROUND: Exposure to armed conflict has been associated with negative mental health consequences. We aimed to estimate the prevalence of generalised anxiety disorder, major depressive disorder, and post-traumatic stress disorder among migrants exposed to armed conflict. METHODS: In this systematic review and meta-analysis, we searched online databases (Cochrane Library, Embase, LILACS, PsycInfo [via Ovid], PubMed, and Web of Science Core Collection) for relevant observational studies published between Jan 1, 1994, and June 28, 2021. We included studies that used standardised psychiatric interviews to assess generalised anxiety disorder, major depressive disorder, or post-traumatic stress disorder among migrants (refugees or internally displaced persons; aged ≥18 years) with pre-migration exposure to armed conflict. We excluded studies in which exposure to armed conflict could not be ascertained, studies that included a clinical population or people with chronic diseases that can trigger the onset of mental disease, and studies published before 1994. We used a random effects model to estimate each mental health disorder's pooled prevalence and random effects meta-regression to assess sources of heterogeneity. Two independent reviewers assessed the risk of bias for each study using the Joanna Briggs Institute Checklist for Prevalence Studies. The protocol was registered with PROSPERO, CRD42020209251. FINDINGS: Of the 13 935 studies identified, 34 met our inclusion criteria; these studies accounted for 15 549 migrants. We estimated a prevalence of current post-traumatic stress disorder of 31% (95% CI 23-40); prevalence of current major depressive disorder of 25% (17-34); and prevalence of generalised anxiety disorder of 14% (5-35). Younger age was associated with a higher prevalence of current post-traumatic stress disorder (odds ratio 0·95 [95% CI 0·90-0·99]), lifetime post-traumatic stress disorder (0·88 [0·83-0·92]), and current generalised anxiety disorder (0·87 [0·78-0·97]). A longer time since displacement was associated with a lower lifetime prevalence of post-traumatic stress disorder (0·88 [0·81-0·95]) and major depressive disorder (0·81 [0·77-0·86]). Migrating to a middle-income (8·09 [3·06-21·40]) or low-income (39·29 [11·96-129·70]) country was associated with increased prevalence of generalised anxiety disorder. INTERPRETATION: Migrants who are exposed to armed conflict are at high risk of mental health disorders. The mental health-care needs of migrants should be assessed soon after resettlement, and adequate care should be provided, with particular attention paid to young adults. FUNDING: Marie Sklodowska-Curie Actions (Horizon 2020-COFUND), MinCiencias (Colombia), and Swiss National Science Foundation.

The Dynamics of Implicit Intergroup Biases of Victims and Ex-combatants in Post-conflict Scenarios.

Strong group identities arise in intergroup conflict scenarios and perpetuate sectarian violence even in post-conflict scenarios. In particular, out-group negative implicit associations are predictors of decreased intergroup forgiveness, as well as increased distrust and aggression against the out-group. Thus, the presence of implicit intergroup (i.e., ex-combatants and victims) biases seems to be a relevant factor in post-conflict scenarios. Here, we aimed to explore whether negative biases toward the out-group are boosted by (a) previous exposure to conflict violence or (b) identification with an armed violent group. One hundred and twenty-eight participants, 65 ex-combatants from Colombian guerrillas and 63 victims of the armed conflict, were assessed with a modified version of the implicit association test (IAT). Our results revealed that the victim group showed a significant negative bias against ex-combatants. However, no bias toward the out-group (i.e., victims) or in-group favoritism was observed in the ex-combatant group. Similarly, we found that IAT scores were not associated with sociodemographical variables (i.e., sex, years of education, or type of dwelling), the levels of combat exposure, victimization armed-conflict-related experiences, or child abuse antecedents. Our results showed an unexpected lack of in-group bias in ex-combatants, potentially triggered by the effect of current demobilization and reintegration processes. Thus, negative associations with the out-group will persist in the framework of societal condemnation of the out-group. In contrast, these negative biases will tend to be abolished when entering in conflict with larger societal reintegration processes. The results reinforce the idea that reintegration may benefit from interventions at the societal level, including all actors of the conflict. In addition, our findings highlight the importance of implementing victim interventions aimed at reducing stigma and revengeful actions in spaces of collective disarmament.

Hypophosphatemic Rickets in Colombia: A Prevalence-Estimation Model in Rare Diseases. 2018.

Background: Hypophosphatemic rickets is a rare, genetic syndrome with multisystem involvement. It causes skeletal abnormalities, painful enthesopathies, increased risk of fracture, and short stature; leading to a substantial burden of disease, disability, and worsening of quality of life. To improve health conditions of people living with this disease, it is essential to know its prevalence which is currently unknown in Colombia. This study aimed to estimate the prevalence of hypophosphatemic rickets in Colombia by using a mathematical model and national statistic records. Methods: We executed a model to estimate probabilities of transitions between health, disease, and death states (Markov chains). The model was fed with international prevalences taken from original studies (systematic review) and administrative records' data from SISPRO (a national health information system) using the International Classification of Diseases (ICD-10) E833 code, vital statistics, and census data. World Health Organization's (WHO) DISMOD II software was used to develop the model. Findings: The estimated overall prevalence of hypophosphatemic rickets in Colombia in 2018 was 2·03 cases per 100 000 people (981 affected people), with a sensitive range of 1·97 to 2·09. The estimated prevalence by sex was 2·61 (645 people) and 1·43 (336 people) cases per 100 000 women and men, respectively. Interpretation: Our overall estimated prevalence shows consistency with original international data. This is the first prevalence estimation of hypophosphatemic rickets in Colombia and will be relevant to support public health decisions for rare diseases and to provide a pre-test probability framework in clinical practice. DISMOD II and the model are useful tools to estimate the prevalence of rare and orphan diseases, when probabilistic studies cannot be carried out. There are limited bibliographic resources worldwide reporting prevalence values supported by original studies. Our study can be used as a cost-effective methodology reference in this regard, especially for Latin America. Funding: Ultragenyx Pharmaceutical, as a donation.

Mental health outcomes in communities exposed to Armed Conflict Experiences.

BACKGROUND: Populations exposed to Armed Conflict Experiences (ACE) show different levels of impact in their mental health (i.e. clinical and positive components); however, there is limited evidence related to mental health of general population (civilians not classified as victims) exposed to ACE. Government guided mental health assessments exclude this population. The use of a newly validated Extreme Experiences Scale (EX2) seems appropriate to classify victims, ex-combatants, and civilians for their mental health assessment. METHODS: Here, we propose a novel approach to identify relationships between individuals classified with different levels of ACE exposure-independent of their legal role in the armed conflict, and mental health outcomes. According to the cut-off points derived from the scores of EX2, we classified the sample in low and high exposure to ACE. RESULTS: The high-level ACE group (scores > 2.5) included 119 subjects, and the low-level ACE was constituted by 66 subjects. Our results evidence that people with high exposure to ACE experiment higher odds to present anxiety disorders, risk of suicide, or post-traumatic stress disorder, as well as increased cognitive empathy (i.e., fantasy dimension). CONCLUSION: These findings allowed us to identify the influence of ACE on mental health outcomes beyond the conventional frame (victim or ex-combatant), and to discuss effective interventions and implementation of mental health strategies in these communities. We expect to help the health system to focus on key vulnerable subjects by including civilians not recognized as victims, which are neglected from most of the public health screening, assessment, and interventions.

Attentional bias during emotional processing: Behavioral and electrophysiological evidence from an Emotional Flanker Task.

Threatening stimuli seem to capture attention more swiftly than neutral stimuli. This attention bias has been observed under different experimental conditions and with different types of stimuli. It remains unclear whether this adaptive behaviour reflects the function of automatic or controlled attention mechanisms. Additionally, the spatiotemporal dynamics of its neural correlates are largely unknown. The present study investigates these issues using an Emotional Flanker Task synchronized with EEG recordings. A group of 32 healthy participants saw response-relevant images (emotional scenes from IAPS or line drawings of objects) flanked by response-irrelevant distracters (i.e., emotional scenes flanked by line drawings or vice versa). We assessed behavioural and ERP responses drawn from four task conditions (Threat-Central, Neutral-Central, Threat-Peripheral, and Neutral-Peripheral) and subjected these responses to repeated-measures ANOVA models. When presented as response-relevant targets, threatening images attracted faster and more accurate responses. They did not affect response accuracy to targets when presented as response-irrelevant flankers. However, response times were significantly slower when threatening images flanked objects than when neutral images were shown as flankers. This result replicated the well-known Emotional Flanker Effect. Behavioural responses to response-relevant threatening targets were accompanied by significant modulations of ERP activity across all time-windows and regions of interest and displayed some meaningful correlations. The Emotional Flanker Effect was accompanied by a modulation over parietal and central-parietal regions within a time-window between 550-690ms. Such a modulation suggests that the attentional disruption to targets caused by response-irrelevant threatening flankers appears to reflect less neural resources available, which are seemingly drawn away by distracting threatening flankers. The observed spatiotemporal dynamics seem to concur with understanding of the important adaptive role attributed to threat-related attention bias.

From discourse to pathology: Automatic identification of Parkinson's disease patients via morphological measures across three languages.

Embodied cognition research on Parkinson's disease (PD) points to disruptions of frontostriatal language functions as sensitive targets for clinical assessment. However, no existing approach has been tested for crosslinguistic validity, let alone by combining naturalistic tasks with machine-learning tools. To address these issues, we conducted the first classifier-based examination of morphological processing (a core frontostriatal function) in spontaneous monologues from PD patients across three typologically different languages. The study comprised 330 participants, encompassing speakers of Spanish (61 patients, 57 matched controls), German (88 patients, 88 matched controls), and Czech (20 patients, 16 matched controls). All subjects described the activities they perform during a regular day, and their monologues were automatically coded via morphological tagging, a computerized method that labels each word with a part-of-speech tag (e.g., noun, verb) and specific morphological tags (e.g., person, gender, number, tense). The ensuing data were subjected to machine-learning analyses to assess whether differential morphological patterns could classify between patients and controls and reflect the former's degree of motor impairment. Results showed robust classification rates, with over 80% of patients being discriminated from controls in each language separately. Moreover, the most discriminative morphological features were associated with the patients' motor compromise (as indicated by Pearson r correlations between predicted and collected motor impairment scores that ranged from moderate to moderate-to-strong across languages). Taken together, our results suggest that morphological patterning, an embodied frontostriatal domain, may be distinctively affected in PD across languages and even under ecological testing conditions.

Prevalencia y factores asociados a sintomatología depresiva y ansiedad rasgo en estudiantes universitarios del área de la salud / Prevalence of depressive and anxiety symptomatology/traits and its associated factors in university students from a medical faculty

Resumen Los estudiantes universitarios del área de la salud describen una mayor prevalencia de sintomatología depresiva y ansiosa asociada a fallas en su rendimiento académico. La comprensión de esta relación es crucial para la implementación de intervenciones en salud mental. Este trabajo pretende determinar la prevalencia de sintomatología depresiva y ansiedad rasgo y su relación con factores demográficos y asociados con el desempeño académico en estudiantes de pregrado. Se realizó un estudio transversal en 325 estudiantes de medicina de la universidad de Antioquia. De la población estudiada el 30,15% presentó algún síntoma de depresión, mientras que el 26,5% describió alta ansiedad. Los modelos de regresión sugieren que variables académicas como sentir angustia ante una actividad evaluativa, dificultades en la relación con sus compañeros y sentirse decaído explican la presencia de los síntomas/rasgos. Se sugiere implementar estrategias institucionales para mitigar estos síntomas y fortalecer el apoyo psicopedagógico.

Abstract University students from health careers describe a high prevalence of depression and anxiety symptoms. This situation has been associated with lower academic performance. The comprehension of this relationship is crucial for the implementation of interventions in mental health from higher education institutions. This work aims to determine the prevalence of depressive and anxiety symptoms/traits in undergraduate students and its relation with demographic factors and academic performance. We used a cross-sectional approach in 325 medical students from the University of Antioquia. A 30.15% of them described at less one symptom of depression. A 26.5% of the sample reported high anxiety traits scores. The logistic regression models implemented suggested that academic variables such as feeling distress before presenting an academic test; presenting difficulties with their classmates, and feeling sadness, explain the presence of symptoms/traits. To implementing institutional strategies might strengthen the psycho-pedagogical support.

Costos médicos directos por intento de suicidio en pacientes del hospital mental de Antioquia, Colombia

[RESUMEN]. Objetivo. Analizar el comportamiento de los costos médicos directos en relación al número de intentos de suicidio y comparar los costos de atención cognitivo-conductual respecto al tratamiento convencional. Métodos. Se cuantificaron los costos por prestación de servicios hospitalarios por intento de suicidio en 248 pacientes con diagnóstico de enfermedad mental atendidos en la empresa social del estado (E.S.E.) Hospital Mental de Antioquia y se implementó una evaluación de costo-consecuencia. Resultados. Se encontró que los costos directos promedio de la atención de pacientes con cuatro o más intentos de suicidio fueron equivalentes a 5 641 dólares estadounidenses (USD), con una diferencia de USD 5 490 respecto al grupo con un solo intento. Además, dichos costos aumentaron conforme se incrementó el número de intentos. Por último, el diagnóstico de enfermedad mental (p. ej., cronicidad), el método de intento y la necesidad de servicios especializados se relacionaron con el incremento en los costos directos. Conclusiones. La implementación de estrategias preventivas desde la salud pública que evalúen y hagan seguimiento a los factores psicosociales podría reducir la presentación de la problemática y de sus costos médicos directos.

[ABSTRACT]. Objective. Analyze the behavior of direct medical costs in relation to the number of suicide attempts and compare the costs of cognitive-behavioral therapy with those of conventional treatment. Methods. The cost of hospital services for attempted suicide was quantified for 248 patients with a diagnosis of mental illness treated at the Antioquia Mental Hospital, a state social enterprise (E.S.E.), and a cost-outcome analysis was performed. Results. It was found that the average direct cost of care for patients with four or more suicide attempts was equivalent to US$ 5,641, a US$ 5,490 difference vis-à-vis the group with a single attempt. Moreover, the cost increased with the number of attempts. Finally, the diagnosis of mental illness (e.g., chronicity), the method used in the suicide attempt, and the need for specialized services were associated with the increase in direct costs. Conclusions. The use of a public health approach involving preventive strategies that assess and monitor psychosocial factors could reduce the problem and its direct medical costs.

[RESUMO]. Objetivo. Examinar o comportamento dos custos médicos diretos em relação ao número de tentativas de suicídio e comparar o custo da terapia cognitivocomportamental e do tratamento convencional. Métodos. O custo por prestação de serviços hospitalares por tentativa de suicídio foi mensurado em 248 pacientes com diagnóstico de doença mental atendidos no Hospital Mental de Antioquia, um serviço da previdência social do Estado, e foi conduzida uma análise de custo-consequência. Resultados. Verificou-se que os custos diretos médios do atendimento de pacientes com quatro ou mais tentativas de suicídio foram equivalentes a US$ 5.641, com uma diferença de US$ 5.490 em relação aos custos para os pacientes com uma única tentativa de suicídio. Estes custos aumentaram conforme aumentou o número de tentativas. O diagnóstico de doença mental (por exemplo, doença crônica), o método de tentativa de suicídio e a necessidade de serviços especializados foram relacionados ao aumento dos custos diretos. Conclusões. A implementação de estratégias de prevenção de uma perspectiva de saúde pública para avaliar e monitorar os fatores psicossociais poderia contribuir para reduzir a ocorrência do problema e os custos médicos diretos correspondentes.

[Direct medical costs of suicide attempts by patients in Columbia's Antioquia Mental HospitalCustos médicos diretos por tentativa de suicídio em pacientes do hospital de saúde mental de Antioquia, Colômbia]. / Costos médicos directos por intento de suicidio en pacientes del hospital mental de Antioquia, Colombia.

OBJECTIVE: Analyze the behavior of direct medical costs in relation to the number of suicide attempts and compare the costs of cognitive-behavioral therapy with those of conventional treatment. METHODS: The cost of hospital services for attempted suicide was quantified for 248 patients with a diagnosis of mental illness treated at the Antioquia Mental Hospital, a state social enterprise (E.S.E.), and a cost-outcome analysis was performed. RESULTS: It was found that the average direct cost of care for patients with four or more suicide attempts was equivalent to US$ 5,641, a US$ 5,490 difference vis-à-vis the group with a single attempt. Moreover, the cost increased with the number of attempts. Finally, the diagnosis of mental illness (e.g., chronicity), the method used in the suicide attempt, and the need for specialized services were associated with the increase in direct costs. CONCLUSIONS: The use of a public health approach involving preventive strategies that assess and monitor psychosocial factors could reduce the problem and its direct medical costs.

OBJETIVO: Examinar o comportamento dos custos médicos diretos em relação ao número de tentativas de suicídio e comparar o custo da terapia cognitivo-comportamental e do tratamento convencional. MÉTODOS: O custo por prestação de serviços hospitalares por tentativa de suicídio foi mensurado em 248 pacientes com diagnóstico de doença mental atendidos no Hospital Mental de Antioquia, um serviço da previdência social do Estado, e foi conduzida uma análise de custo-consequência. RESULTADOS: Verificou-se que os custos diretos médios do atendimento de pacientes com quatro ou mais tentativas de suicídio foram equivalentes a US$ 5.641, com uma diferença de US$ 5.490 em relação aos custos para os pacientes com uma única tentativa de suicídio. Estes custos aumentaram conforme aumentou o número de tentativas. O diagnóstico de doença mental (por exemplo, doença crônica), o método de tentativa de suicídio e a necessidade de serviços especializados foram relacionados ao aumento dos custos diretos. CONCLUSÕES: A implementação de estratégias de prevenção de uma perspectiva de saúde pública para avaliar e monitorar os fatores psicossociais poderia contribuir para reduzir a ocorrência do problema e os custos médicos diretos correspondentes.

Attentional bias during emotional processing: evidence from an emotional flanker task using IAPS.

Attention is biased towards threat-related stimuli. In three experiments, we investigated the mechanisms, processes, and time course of this processing bias. An emotional flanker task simultaneously presented affective or neutral pictures from the international affective picture system database either as central response-relevant stimuli or surrounding response-uninformative flankers. Participants' response times to central stimuli was measured. The attentional bias was observed when stimuli were presented either for 1500 ms (Experiment 1) or 500 ms (Experiment 2). The threat-related attentional bias held regardless of the stimuli competing for attention even when presentation time was further reduced to 200 ms (Experiment 3). The results indicate that automatic and controlled mechanisms may interact to modulate the orientation of attention to threat. The data presented here shed new light on the mechanisms, processes, and time course of this long investigated by still largely unknown processing bias.

Costos médicos directos por intento de suicidio en pacientes del hospital mental de Antioquia, Colombia / Direct medical costs of suicide attempts by patients in Columbia's Antioquia Mental Hospital / Custos médicos diretos por tentativa de suicídio em pacientes do hospital de saúde mental de Antioquia, Colômbia

RESUMEN Objetivo Analizar el comportamiento de los costos médicos directos en relación al número de intentos de suicidio y comparar los costos de atención cognitivo-conductual respecto al tratamiento convencional. Métodos Se cuantificaron los costos por prestación de servicios hospitalarios por intento de suicidio en 248 pacientes con diagnóstico de enfermedad mental atendidos en la empresa social del estado (E.S.E.) Hospital Mental de Antioquia y se implementó una evaluación de costo-consecuencia. Resultados Se encontró que los costos directos promedio de la atención de pacientes con cuatro o más intentos de suicidio fueron equivalentes a 5 641 dólares estadounidenses (USD), con una diferencia de USD 5 490 respecto al grupo con un solo intento. Además, dichos costos aumentaron conforme se incrementó el número de intentos. Por último, el diagnóstico de enfermedad mental (p. ej., cronicidad), el método de intento y la necesidad de servicios especializados se relacionaron con el incremento en los costos directos. Conclusiones La implementación de estrategias preventivas desde la salud pública que evalúen y hagan seguimiento a los factores psicosociales podría reducir la presentación de la problemática y de sus costos médicos directos.

ABSTRACT Objective Analyze the behavior of direct medical costs in relation to the number of suicide attempts and compare the costs of cognitive-behavioral therapy with those of conventional treatment. Methods The cost of hospital services for attempted suicide was quantified for 248 patients with a diagnosis of mental illness treated at the Antioquia Mental Hospital, a state social enterprise (E.S.E.), and a cost-outcome analysis was performed. Results It was found that the average direct cost of care for patients with four or more suicide attempts was equivalent to US$ 5,641, a US$ 5,490 difference vis-à-vis the group with a single attempt. Moreover, the cost increased with the number of attempts. Finally, the diagnosis of mental illness (e.g., chronicity), the method used in the suicide attempt, and the need for specialized services were associated with the increase in direct costs. Conclusions The use of a public health approach involving preventive strategies that assess and monitor psychosocial factors could reduce the problem and its direct medical costs.

RESUMO Objetivo Examinar o comportamento dos custos médicos diretos em relação ao número de tentativas de suicídio e comparar o custo da terapia cognitivo-comportamental e do tratamento convencional. Métodos O custo por prestação de serviços hospitalares por tentativa de suicídio foi mensurado em 248 pacientes com diagnóstico de doença mental atendidos no Hospital Mental de Antioquia, um serviço da previdência social do Estado, e foi conduzida uma análise de custo-consequência. Resultados Verificou-se que os custos diretos médios do atendimento de pacientes com quatro ou mais tentativas de suicídio foram equivalentes a US$ 5.641, com uma diferença de US$ 5.490 em relação aos custos para os pacientes com uma única tentativa de suicídio. Estes custos aumentaram conforme aumentou o número de tentativas. O diagnóstico de doença mental (por exemplo, doença crônica), o método de tentativa de suicídio e a necessidade de serviços especializados foram relacionados ao aumento dos custos diretos. Conclusões A implementação de estratégias de prevenção de uma perspectiva de saúde pública para avaliar e monitorar os fatores psicossociais poderia contribuir para reduzir a ocorrência do problema e os custos médicos diretos correspondentes.

Brain Information Sharing During Visual Short-Term Memory Binding Yields a Memory Biomarker for Familial Alzheimer's Disease.

BACKGROUND: Alzheimer's disease (AD) as a disconnection syndrome which disrupts both brain information sharing and memory binding functions. The extent to which these two phenotypic expressions share pathophysiological mechanisms remains unknown. OBJECTIVE: To unveil the electrophysiological correlates of integrative memory impairments in AD towards new memory biomarkers for its prodromal stages. METHODS: Patients with 100% risk of familial AD (FAD) and healthy controls underwent assessment with the Visual Short-Term Memory binding test (VSTMBT) while we recorded their EEG. We applied a novel brain connectivity method (Weighted Symbolic Mutual Information) to EEG data. RESULTS: Patients showed significant deficits during the VSTMBT. A reduction of brain connectivity was observed during resting as well as during correct VSTM binding, particularly over frontal and posterior regions. An increase of connectivity was found during VSTM binding performance over central regions. While decreased connectivity was found in cases in more advanced stages of FAD, increased brain connectivity appeared in cases in earlier stages. Such altered patterns of task-related connectivity were found in 89% of the assessed patients. CONCLUSIONS: VSTM binding in the prodromal stages of FAD are associated to altered patterns of brain connectivity thus confirming the link between integrative memory deficits and impaired brain information sharing in prodromal FAD. While significant loss of brain connectivity seems to be a feature of the advanced stages of FAD increased brain connectivity characterizes its earlier stages. These findings are discussed in the light of recent proposals about the earliest pathophysiological mechanisms of AD and their clinical expression.

Atypical Modulations of N170 Component during Emotional Processing and Their Links to Social Behaviors in Ex-combatants.

Emotional processing (EP) is crucial for the elaboration and implementation of adaptive social strategies. EP is also necessary for the expression of social cognition and behavior (SCB) patterns. It is well-known that war contexts induce socio-emotional atypical functioning, in particular for those who participate in combats. Thus, ex-combatants represent an ideal non-clinical population to explore EP modulation and to evaluate its relation with SCB. The aim of this study was to explore EP and its relation with SCB dimensions such as empathy, theory of mind and social skills in a sample of 50 subjects, of which 30 were ex-combatants from illegally armed groups in Colombia, and 20 controls without combat experience. We adapted an Emotional Recognition Task for faces and words and synchronized it with electroencephalographic recording. Ex-combatants presented with higher assertion skills and showed more pronounced brain responses to faces than Controls. They did not show the bias toward anger observed in control participants whereby the latter group was more likely to misclassify neutral faces as angry. However, ex-combatants showed an atypical word valence processing. That is, words with different emotions yielded no differences in N170 modulations. SCB variables were successfully predicted by neurocognitive variables. Our results suggest that in ex-combatants the links between EP and SCB functions are reorganized. This may reflect neurocognitive modulations associated to chronic exposure to war experiences.