A scalable approach for short-term disease forecasting in high spatial resolution areal data.

Short-term disease forecasting at specific discrete spatial resolutions has become a high-impact decision-support tool in health planning. However, when the number of areas is very large obtaining predictions can be computationally intensive or even unfeasible using standard spatiotemporal models. The purpose of this paper is to provide a method for short-term predictions in high-dimensional areal data based on a newly proposed "divide-and-conquer" approach. We assess the predictive performance of this method and other classical spatiotemporal models in a validation study that uses cancer mortality data for the 7907 municipalities of continental Spain. The new proposal outperforms traditional models in terms of mean absolute error, root mean square error, and interval score when forecasting cancer mortality 1, 2, and 3 years ahead. Models are implemented in a fully Bayesian framework using the well-known integrated nested Laplace estimation technique.

Serum cortisol levels and neuropsychological impairments in patients diagnosed with Fibromyalgia.

OBJECTIVE: To describe the relationship between neuropsychological variables and serum cortisol levels as a measure of physiological stress in patients with fibromyalgia. METHODOLOGY: A sample of 60 women was intentionally selected: 30 with Fibromyalgia diagnosis and 30 with normal controls. Cortisol levels were determined using two blood samples (AM and PM) and a neuropsychological and emotional battery was applied with a standardized protocol in Colombian population to evaluate different cognitive domains. Comparative and correlational non-parametric analyzes were performed, a multiple regression analysis to determine influences between variables. RESULTS: Significant differences between the study groups in the neuropsychological variables (attention, memory, language, visual-constructive praxis and executive functions (EF), (p<0.05) were found, obtaining better scores in the control group. Significant correlations between the cortisol profile, with false acknowledgments of Rey auditory- verbal learning test, and with perseverative errors of the Wisconsin test were found. Multiple regression analysis predicts the influence of memory and EF variables on the cortisol profile in an 88.7%. CONCLUSIONS: The findings show that, in patients with FM, there are neuropsychological alterations, mainly in executive functioning (cognitive flexibility) and episodic memory (evocation and storage). Likewise, executive dysfunction is related to physiological stress reciprocally and in turn are conditioned by emotional alterations such as symptoms of depression, which supports the neurophysiological model that compromises the hypothalamic-pituitary-adrenal axis and the prefrontal cortex, rich in corticosteroid receptors.

Urinary metabolomic profiling of a cohort of Colombian patients with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune and multisystem disease with a high public health impact. Lupus nephritis (LN), commonly known as renal involvement in SLE, is associated with a poorer prognosis and increased rates of morbidity and mortality in patients with SLE. Identifying new urinary biomarkers that can be used for LN prognosis or diagnosis is essential and is part of current active research. In this study, we applied an untargeted metabolomics approach involving liquid and gas chromatography coupled with mass spectrometry to urine samples collected from 17 individuals with SLE and no kidney damage, 23 individuals with LN, and 10 clinically healthy controls (HCs) to identify differential metabolic profiles for SLE and LN. The data analysis revealed a differentially abundant metabolite expression profile for each study group, and those metabolites may act as potential differential biomarkers of SLE and LN. The differential metabolic pathways found between the LN and SLE patients with no kidney involvement included primary bile acid biosynthesis, branched-chain amino acid synthesis and degradation, pantothenate and coenzyme A biosynthesis, lysine degradation, and tryptophan metabolism. Receiver operating characteristic curve analysis revealed that monopalmitin, glycolic acid, and glutamic acid allowed for the differentiation of individuals with SLE and no kidney involvement and individuals with LN considering high confidence levels. While the results offer promise, it is important to recognize the significant influence of medications and other external factors on metabolomics studies. This impact has the potential to obscure differences in metabolic profiles, presenting a considerable challenge in the identification of disease biomarkers. Therefore, experimental validation should be conducted with a larger sample size to explore the diagnostic potential of the metabolites found as well as to examine how treatment and disease activity influence the identified chemical compounds. This will be crucial for refining the accuracy and effectiveness of using urine metabolomics for diagnosing and monitoring lupus and lupus nephritis.

Big problems in spatio-temporal disease mapping: Methods and software.

BACKGROUND AND OBJECTIVE: Fitting spatio-temporal models for areal data is crucial in many fields such as cancer epidemiology. However, when data sets are very large, many issues arise. The main objective of this paper is to propose a general procedure to analyze high-dimensional spatio-temporal areal data, with special emphasis on mortality/incidence relative risk estimation. METHODS: We present a pragmatic and simple idea that permits hierarchical spatio-temporal models to be fitted when the number of small areas is very large. Model fitting is carried out using integrated nested Laplace approximations over a partition of the spatial domain. We also use parallel and distributed strategies to speed up computations in a setting where Bayesian model fitting is generally prohibitively time-consuming or even unfeasible. RESULTS: Using simulated and real data, we show that our method outperforms classical global models. We implement the methods and algorithms that we develop in the open-source R package bigDM where specific vignettes have been included to facilitate the use of the methodology for non-expert users. CONCLUSIONS: Our scalable methodology proposal provides reliable risk estimates when fitting Bayesian hierarchical spatio-temporal models for high-dimensional data.

Síntomas afectivo-conductuales y estrategias de afrontamiento del dolor en pacientes con fibromialgia (FM) / Affective - behavioral symptoms and coping strategies of pain in patients with fibromyalgia (FM)

Resumen Objetivo: La fibromialgia (FM) es un síndrome de dolor crónico generalizado, asociado a alteraciones emocionales y comportamentales. El objetivo de este estudio fue identificar los síntomas afectivo-conductuales y las estrategias cognitivas de afrontamiento en la percepción de dolor de pacientes con FM. Material y métodos: Se realizó un estudio de corte transversal, con análisis de casos y controles, con una muestra de dos grupos de mujeres, en la ciudad de Barranquilla (Colombia): 34 con diagnóstico de FM y 30 controles, a quienes se les realizó evaluación de síntomas psicológicos y de percepción de dolor. Resultados: Los pacientes con FM presentan significativamente mayores síntomas afectivo-conductuales (ansiedad, depresión, insomnio, somatización y disfunción social) que los sujetos controles (p<0.001), así como una tendencia a utilizar la retirada social como estrategia de afrontamiento (p<0.005). De acuerdo con el análisis factorial, la percepción de dolor y los síntomas afectivo-conductuales en pacientes con FM se agruparon en un mismo factor, lo cual demostró interdependencia de las variables. Conclusiones: Los síntomas afectivo-conductuales se asocian a la percepción de dolor y se relacionan con la utilización de estrategias pasivas y centradas en la emoción como mecanismo para afrontar la experiencia de dolor.

Abstract Objective: Fibromyalgia (FM) is a syndrome of chronic widespread pain associated with emotional and behavioral disorders. The purpose of the study was to identify the affective -behavioral symptoms and cognitive coping strategies involved in the perception of pain in patients with FM. Material and methods: A cross-sectional study was performed, with analysis of cases and controls, with a sample of two groups of women, in the city of Barranquilla (Colombia). Affective - behavioral symptoms and cognitive coping strategies were assessed in 34 patients with FM and 30 controls matched by age and educational level. Results: Our findings indicate greater affective and behavioral symptoms in patients with FM (anxiety, depression, insomnia, somatization and social dysfunction) (p<0.001) and a tendency to use social withdrawal as a coping strategy (p<0.005). According to factor analysis, pain perception and affective-behavioral symptoms were grouped in a single factor, demonstrating interdependence between variables. Conclusions: The affective-behavioral symptoms are associated with perception of pain and are relate to the use of passive strategies, and focused on emotion as a mechanism to confront the experience of pain.

Niveles de cortisol sérico y alteraciones neuropsicológicas en pacientes con diagnóstico de Fibromialgia / Serum cortisol levels and neuropsychological impairments in patients diagnosed with Fibromyalgia

Objetivo. Describir la relación entre variables neuropsicológicas y niveles de cortisol sérico; como una medida de estrés fisiológico; en pacientes con fibromialgia. Metodología. Se seleccionó intencionalmente una muestra de 60 mujeres: 30 con diagnóstico de Fibromialgia y 30 controles normales. Se determinaron los niveles de cortisol mediante dos muestras de sangre (AM y PM) y se realizó una batería neuropsicológica y emocional, con un protocolo estandarizado en población colombiana para evaluar diferentes dominios cognitivos. Se hicieron análisis comparativo y correlacional no paramétrico, un análisis de regresión múltiple para determinar influencias entre las variables. Resultados. Se encontraron diferencias significativas entre los grupos de estudio en las variables neuropsicológicas (atención, memoria, lenguaje, praxis viso-constructiva y funciones ejecutivas (FE), (p<0,05), obteniendo mejores puntajes el grupo control. Se hallaron correlaciones significativas entre el perfil de cortisol, con falsos reconocimientos del test de aprendizaje auditivo verbal de Rey y con errores perseverativos del test de Wisconsin. El análisis de regresión múltiple predice la influencia de las variables de memoria y FE en el perfil de cortisol en un 88,7%. Conclusiones. Los hallazgos demuestran que, en pacientes con FM, existen alteraciones neuropsicológicas, principalmente en funcionamiento ejecutivo (flexibilidad cognitiva) y memoria episódica (evocación y almacenamiento). Igualmente, la disfunción ejecutiva está relacionada con el estrés fisiológico de manera recíproca y a su vez son condicionadas por alteraciones emocionales como síntomas de depresión, lo cual soporta el modelo neurofisiológico que compromete el eje hipotálamo-hipófisis-adrenal y la corteza pre-frontal, rica en receptores de córticoesteroides (AU)

Objective. To describe the relationship between neuro-psychological variables and serum cortisol levels as a measure of physiological stress in patients with fibromyalgia. Methodology. A sample of 60 women was intentionally selected: 30 with Fibromyalgia diagnosis and 30 with normal controls. Cortisol levels were determined using two blood samples (AM and PM) and a neuropsychological and emotional battery was applied with a standardized protocol in Colombian population to evaluate different cognitive domains. Comparative and correlational non-parametric analyzes were performed, a multiple regression analysis to determine influences between variables. Results. Significant differences between the study groups in the neuropsychological variables (attention, memory, language, visual-constructive praxis and executive functions (EF), (p<0.05) were found, obtaining better scores in the control group. Significant correlations between the cortisol profile, with false acknowledgments of Rey auditory-verbal learning test, and with perseverative errors of the Wisconsin test were found. Multiple regression analysis predicts the influence of memory and EF variables on the cortisol profile in an 88.7%. Conclusions. The findings show that, in patients with FM, there are neuropsychological alterations, mainly in executive functioning (cognitive flexibility) and episodic memory (evocation and storage). Likewise, executive dysfunction is related to physiological stress reciprocally and in turn are conditioned by emotional alterations such as symptoms of depression, which supports the neurophysiological model that compromises the hypothalamic-pituitary-adrenal axis and the prefrontal cortex, rich in corticosteroid receptors (AU)