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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-020-01157-x.

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.

Electronic supplementary material

The online version of this article (doi:10.1186/s13033-017-0168-9) contains supplementary material, which is available to authorized users.

[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% 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.

[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.

[Simultaneous pancreas-kidney transplantation. First cases in Chile]

We report two insulin dependent diabetic patients with a past history of 21 and 30 years complicated with retinopathy, neuropathy and nephropathy with arterial hypertension and kidney failure. Simultaneous pancreas-kidney transplantation was done 8 and 18 months after starting hemodialysis, performing a double intraperitoneal implant with pancreato-duodeno-vesical anastomosis and contralateral kidney grafting with uretero vesical anastomosis using antireflux techniques. In the second case, a second kidney transplant from the same donor was needed, due to a thrombosis of renal vein. There was one rejection episode in each case but renal or pancreatic function was not impaired. Other observed complications were metabolic acidosis and hyperkalemia due to urine loss of bicarbonate, moderate arterial hypertension and bacterial and fungal infections. There was a graft dysfunction due to the association of vancomycin and cyclosporin. In conclusion, in the two presented patients, simultaneous pancreas-kidney transplantations were successful and they remain free of insulin or dialytic therapy 4 and 9 months after the operation.

[False high levels glycosylated hemoglobin in 2 diabetic patients with persistence of fetal hemoglobin]

Two diabetic patients with unusual high levels of glycosylated hemoglobin measured by ion exchange chromatography are described. Further studies revealed a persistence of fetal hemoglobin in both cases. This condition produces falsely high levels of glycosylated hemoglobin, when ion exchange chromatography is used. These cases may be overtreated with risk of hypoglycemia. Patients with inappropriate levels of glycosylated hemoglobin should be investigated for hemoglobinopathies.

[Evidence of genetic and environmental factors in manual laterality. Study of 120 Mexican families]

Environmental factors as well as different modes of inheritance has been suggested to explain the etiology of left-handedness. In order to improve knowledge of this problem, manual skill (MS) of parents (n = 234), siblings (n = 506) and children (n = 126) of 60 right-handed (RHI) and 60 left-handed (LHI) index cases (IC), born in Mexico City, were studied. Parents and siblings of both IC had similar frequencies of left-handedness. Quite the contrary, 36.7% of children of LHI were left-handed, while 7.3% children of RHI happen to be left-handed (P < 0.00025). No differences were found in the appearance of perinatal environmental factors. These findings are explained in part according to the pressure exerted by parents and/or teachers for dextrality. The impact of this influence modifies the effect of several unknown genes (multifactorial inheritance). The understanding of the above mechanisms in the etiology of MS is relevant not only for academic purposes, but for the educational sphere as well.

Incongruent parenthood in a Mexican mestizo population as determined by HLA typing

The incidence of incongruent parenthood was determined by confronting the declared familial relationship of 98 father-mother-son/daughter trinomials (drawn from the Centro Médico Nacional-IMSS (CMN-IMSS) Kidney Transplant Program) with their HLA-A and B antigens. Fourteen (14.3%) discrepant cases were found: three each with the putative father (3.1%) or with the putative mother (3.1%), two with either father or mother (though impossible to determine precisely with whom) (2.0%), and six with both parents (6.1%). Several possible explanations of these findings were considered, such as out-of-wedlock pregnancies, complex known or unknown, declared or undeclared social circumstances frequently related to the population studied (i.e. imminent kidney transplantation) and technical pitfalls. These data underscore the level of possible "noise" and imprecision in population genetics; genetic-epidemiology and transplantation programs.

[Histocompatibility antigens and acute vascular purpura]

INTRODUCTION

Some kidney diseases are associated to HLA antigens. Nyulassy found an increase in HLA-B35 in patients with Henoch-Schönlein's purpura suffering nephritis (HSP-N). Our study searched for associations of HLA antigens and anaphylactoid purpura nephritis in Mexican mestizo patients.

MATERIAL AND METHODS

HLA-A,B, and C antigens were detected by two-step microcytotoxicity in 22 patients with HSP-N and compared to those of 665 healthy subjects of the same ethnic background.

RESULTS

A significant association was found between HSP-N and HLA-Aw19 single (pc less than 0.05) or in haplotype form (Aw19-B35) (pc less than 0.005). HLA B35 alone was associated to HSP-N but only at non corrected level (pc less than 0.05).

DISCUSSION

The significant association between HLA-Aw19 and Aw19-B35 and HSP-N may indicate a risk factor in Mexican mestizo patients to develop this case.

[Estimation of the probability of heterozygosity in Duchenne-type progressive muscular dystrophy]

The severe Duchenne type of muscular dystrophy is inherited as an X-linked recessive trait. Approximately two thirds of healthy female heterozygous carriers have a high serum creatine kinase (SCK). A suspected carrier with a normal SCK level therefore, presents an important problem in genetic counselling. Based on Bayesian methods, Emery and Hollyway derived a formula which is applicable when the sporadic case is either the son or brother of a consultant and which also includes information on SCK levels in the consultant and in normal daughters and sisters. The present paper describes the results obtained with use of this formula in 27 families with at least a propositus with Duchenne muscular dystrophy.

Variability between and within laboratories in the analysis of structural chromosomal abnormalities

The frequency of structural chromosomal aberrations in two samples (AM and PM of the same day) from each of nine normal subjects, cultured in two different laboratories, was studied by six observers. The results were analyzed in order to determine the relative importance of inter- and intralaboratory factors in the variability of chromosomal abnormalities. In addition to the difference in the frequency of the abnormalities between the subjects studied, there were differences due to observers from different laboratories (P less than 0.01), as well as between laboratories (P less than 0.01). These results could be explained in part by insufficient agreement between observers from different laboratories and by differences in the quality of the method used.

Complex segregation analysis of diabetes mellitus

Complex segregation analysis was applied to a sample of 12,293 nuclear families each with at least 1 diabetic patient. The families were divided into two groups depending on the proband's treatment: insulin-dependent (IDG) and insulin-independent (IIG). Heterogeneity analysis has revealed a highly significant difference in the IIG group when families were divided into different mating types. The higher recurrence risk was found in the group with affected mothers. Also evidence for a major recessive gene was found in the IGG group, while it was not possible to distinguish between the hypothesis for absence of a major locus and absence of polygenic inheritance in the IDG group. Risks to develop the disease were calculated for a few typical situations.

Intestinal lactase deficiency and milk drinking capacity in the adult

The milk drinking capacity of 200 adults was determined experimentally and the results correlated with their milk drinking habits and intestinal lactase activity as judged by a lactose tolerance test. Of the group 65.5% were found to have deficient lactase activity and 5.3% experienced severe gastrointestinal symptoms with 250 ml of milk; 28.2% with 500 ml; 26.0% with 750 ml; 15.3% with 1000 ml and 25.2% tolerated the latter amount without difficulty. Of the normal individuals, 92.7% tolerated 1000 ml without symptoms. Intestinal lactase activity seemed to be important in determining the extremes of milk ingestion: four or more glasses per day or no milk ingestion, but had little effect in the intermediate pattern of milk consumption. It is concluded that intestinal lactase deficiency has clinical relevance and should be considered when nutritional supplementation with milk is contemplated.

A glucose 6-phosphate dehydrogenase Gd (-) Castilla variant characterized by mild deficiency associated with drug-induced hemolytic anemia

Erythrocyte G-6-PD deficiency is an X-chromosome-linked hereditary trait which is common in many ethnic groups. A deficiency of G-6-PD in red cells is often associated with hemolytic anemia. This report defines a new variant designated as Gd (-) Castilla, which is associated with drug-induced hemolysis. The red cell G-6-PD activity of the variant subject is about 20% of normal. The variant enzyme is thermolabile in vitro and it has faster than normal anodal electrophoretic mobility and normal substrate affinity. The hemolytic problem of the subject might be correlated to sensitivity to NADPH inhibition and molecular instability of the variant enzyme.

Thyroid autoimmunity: increased frequency in relatives of insulin-dependent diabetes patients

Thyroid antibodies were found significantly more often in insulin-dependent diabetics than in their spouses or in non-insulin-dependent diabetics. The poor correlation between presence of thyroid autoimmunity and duration of disease and the significantly increased prevalence of thyroid antibodies in first-degree relatives of insulin-dependent probands are interpreted to suggest that thyroid autoimmunity in probands with insulin-dependent diabetes is not secondary to diabetes. Since married couples in which both members had thyroid antibodies were not found more frequently than predicted by chance alone, acquired environmental factors are not the sole determinants of familial thyroid autoimmunity in diabetes; it is likely that inherited predisposition is of major importance. Relatives of probands with thyroid antibodies have significantly higher frequency of these antibodies than do relatives of negative probands. This finding suggests that there are several kinds of insulin-dependent diabetes, one of which may be an "autoimmune" disease.

Brachydactyly type B and symphalangism in different members of a Mexican family

A patient with typical brachydactyly type B is described. By history, 4 generations had some affected members and it was possible to examine a sister and 2 children of the proposita. These individuals in addition to the brachydactyly had symphalangism, an abnormality not previously described in association with brachydactyly type B.