Factores asociados al riesgo suicida en Andalucía. Estudio PISMA-ep suicidio

El suicidio es un importante problema de salud mental a nivel internacional. Más de 800.000 personas se suicidan cada año. La conducta suicida es más frecuente que el suicidio consumado y por cada suicidio consumado, se dan entre 10 y 20 casos de intento suicida (1).Los estudios epidemiológicos que toman en consideración la prevalencia y los factores asociados al riesgo suicida en diferentes poblaciones son escasos, no existiendo estudios previos sobre esta realidad en Andalucía. El objetivo de este estudio es conocer laprevalencia del riesgo suicida y analizar su asociación con variables demográficas, psicosociales y clínicas. Estudio transversal mediante una encuesta domiciliaria sobre una muestra representativa de adultos no institucionalizados de ambos sexos con edades comprendidas entre 18 y 75 años. 4507 sujetos fueron entrevistados utilizando la Entrevista Neuropsiquiátrica Internacional (MINI) (3) para evaluar el riesgo suicida actual. Se utilizaron instrumentos estandarizados para la evaluación de las siguientes variables independientes: demográficas (edad, género, estado civil, situación laboral, nivel educativo, nivel de urbanicidad del lugar de residencia y provincia de residencia), psicosociales (eventos vitales estresantes, experiencias de maltrato físico, psicológico y sexual en la infancia, funcionamiento personal y social, apoyo social y rasgos de personalidad: neuroticismo e impulsividad) y clínicas (historia familiar de problemas psiquiátricos, antecedentes de suicidio en la familia, dependencia a la nicotina y otras drogas y consumo de alcohol). Se realizó un análisis exploratorio de la distribución de los datos, incluyendo frecuencias y medias de todas las variables independientes. Se calculó la prevalencia del riesgo suicida actual (IC; 95%). Para el análisis univariante se utilizó el test chi-cuadrado y la prueba t-student y finalmente se realizó un análisis multivariante de regresión logística de efectos fijos, contralado por provincia. El 6,4% de la muestra de sujetos presentan riesgo de suicidio actual. Los resultados del modelo multivariante indican que las asociaciones estadísticamente significativas con el riesgo suicida actual fueron ser mujer, mayor edad, estar divorciado/separado/viudo/soltero, historia familiar de enfermedad mental, mayor número deeventos vitales estresantes, menos apoyo social, niveles mayores de neuroticismo, consumo elevado de alcohol, y dependencia a nicotina y otras drogas. Nuestros resultados son similares a los encontrados en otros estudios previos (4). Conclusiones Se trata del primer estudio epidemiológico realizado en Andalucía sobre el riesgo de suicidio, ofreciéndonos importantes resultados de interés clínico para la prevención del suicidio. Bibliografía 1. World Health Organisation. Prevention suicide: A global Imperative. 2014. Disponible en: ihttp://www.who.int/mental_health/suicide-prevention/world_report_2014/es/ 2. Hardt J., Bernert S., Matschinger H., Angermeier M.G., VilagutG., Bruffaerts R., et al. Systematic review of risk factors for suicide and suicide attempt among psychiatric J Affective Disorders 2015; 175: 168–174. 3. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Herqueta T, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl.20):22-33. 4. Nock M.K., Borges G, Bromet E.J., Cha C.B., Kessler R.C., Lee S.Suicide and suicidal behavior.Epidemiol Rev. 2008;30:133-54Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Undiagnosed mood disorders and sleep disturbances in primary care patients with chronic musculoskeletal pain.

Objective. The study aims to determine the prevalence of undiagnosed comorbid mood disorders in patients suffering chronic musculoskeletal pain in a primary care setting and to identify sleep disturbances and other associated factors in these patients, and to compare the use of health services by chronic musculoskeletal pain patients with and without comorbid mood disorders. Design. Cross-sectional study. Subjects. A total of 1,006 patients with chronic musculoskeletal pain from a representative sample of primary care centers were evaluated. Outcome Measures. Pain was measured using a visual analog scale and the Primary Care Evaluation of Mental Disorders questionnaire was used to measure mood disorders. Results. We observed a high prevalence of undiagnosed mood disorders in chronic musculoskeletal pain patients (74.7%, 95% confidence interval [CI] 71.9–77.4%), with greater comorbidity in women (adjusted odds ratio [OR] = 1.91, 95% CI 1.37–2.66%) and widow(er)s (adjusted OR = 1.87, 95% CI 1.19–2.91%). Both sleep disturbances (adjusted OR = 1.60, 95% CI 1.17–2.19%) and pain intensity (adjusted OR = 1.02, 95% CI 1.01–1.02%) displayed a direct relationship with mood disorders. Moreover, we found that chronic musculoskeletal pain patients with comorbid mood disorders availed of health care services more frequently than those without (P < 0.001). Conclusions. The prevalence of undiagnosed mood disorders in patients with chronic musculoskeletal pain is very high in primary care settings. Our findings suggest that greater attention should be paid to this condition in general practice and that sleep disorders should be evaluated in greater detail to achieve accurate diagnoses and select the most appropriate treatment

Cognition and functionality in delusional disorder.

BACKGROUND: Even if neurocognition is known to affect functional outcomes in schizophrenia, no previous study has explored the impact of cognition on functionality in delusional disorder (DD). We aimed to assess the effect of clinical characteristics, symptom dimensions and neuropsychological performance on psychosocial functioning and self-perceived functional impairment in DD. METHODS: Seventy-five patients with a SCID-I confirmed diagnosis of DD underwent neurocognitive testing using a neuropsychological battery examining verbal memory, attention, working memory and executive functions. We assessed psychotic symptoms with the Positive and Negative Syndrome Scale, and calculated factor scores for four clinical dimensions: Paranoid, Cognitive, Affective and Schizoid. We conducted hierarchical linear regression models to identify predictors of psychosocial functioning, as measured with the Global Assessment of Functioning scale, and self-perceived functional impairment, as measured with the Sheehan's Disability Inventory. RESULTS: In the final linear regression models, higher scores in the Paranoid (β= 0.471, p < .001, r2 = 0.273) and Cognitive (β = 0.325, p < .001, r2 = 0.180) symptomatic dimensions and lower scores in verbal memory (β = -0.273, p < .05, r2 = 0.075) were significantly associated with poorer psychosocial functioning in patients with DD. Lower scores in verbal memory (β= -0.337, p < .01, r2 = 0.158) and executive functions (β= -0.323, p < .01, r2 = 0.094) were significantly associated with higher self-perceived disability. CONCLUSIONS: Impaired verbal memory and cognitive symptoms seem to affect functionality in DD, above and beyond the severity of the paranoid idea. This suggests a potential role for cognitive interventions in the management of DD

Schizophrenia risk conferred by rare protein-truncating variants is conserved across diverse human populations

Schizophrenia (SCZ) is a chronic mental illness and among the most debilitating conditions encountered in medical practice. A recent landmark SCZ study of the protein-coding regions of the genome identified a causal role for ten genes and a concentration of rare variant signals in evolutionarily constrained genes1. This recent study—and most other large-scale human genetics studies—was mainly composed of individuals of European (EUR) ancestry, and the generalizability of the findings in non-EUR populations remains unclear. To address this gap, we designed a custom sequencing panel of 161 genes selected based on the current knowledge of SCZ genetics and sequenced a new cohort of 11,580 SCZ cases and 10,555 controls of diverse ancestries. Replicating earlier work, we found that cases carried a significantly higher burden of rare protein-truncating variants (PTVs) among evolutionarily constrained genes (odds ratio = 1.48; P = 5.4 × 10−6). In meta-analyses with existing datasets totaling up to 35,828 cases and 107,877 controls, this excess burden was largely consistent across five ancestral populations. Two genes (SRRM2 and AKAP11) were newly implicated as SCZ risk genes, and one gene (PCLO) was identified as shared by individuals with SCZ and those with autism. Overall, our results lend robust support to the rare allelic spectrum of the genetic architecture of SCZ being conserved across diverse human populations.United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Mental Health (NIMH) R01MH109536 R01MH118278 R01MH124839 U01MH109536UK Research & Innovation (UKRI) Medical Research Council UK (MRC)Janette Mary O'Neil Research FellowshipNational Health and Medical Research Council (NHMRC) of AustraliaInstituto de Salud Carlos III Spanish GovernmentEuropean Regional Development Fund/European Social Fund A Way to Make Europe/Investing in Your FutureInstituto de Salud Carlos III Spanish GovernmentEuropean Regional Development Fund Funds from the European Commission, A Way of Making EuropeCentro de Investigacion Biomedica en Red de Salud Mental, Madrid Regional GovernmentFundacion Familia Alonso MR/L010305/1 MR/P005748/1Fundacion Alicia Koplowitz 1R01MH124851European Regional Development Fund Funds from the European Commission R01MH100125 1I01CX000995Ministry of Health, Italy P50MH066392Takeda Pharmaceutical Company LtdHoffmann-La RocheHoffmann-La RocheUnited States Department of Health & Human Services National Institutes of Health (NIH) - USA 1037196 1176716United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Mental Health (NIMH) 513861Australian Schizophrenia Research Bank PI18/00238 PI18/00467 B2017/BMD-3740 AGES-CM-2 115916 777394Neuroscience Research Australia PI18/00213 CPII21/00008 MS16/00153 PI19/024 R01MH085542 R01MH093725 P50MH080405 R01MH097276 RO1MH-075916 P50M096891 P50MH084053S1 R37MH057881 AG02219 AG05138 MH06692 R01MH110921 R01MH109677 R01MH109897 U01MH103392 U01MH116442 ZIC MH002903 HHSN271201300031C R01AG067025 R01AG065582 R01AG050986 R01MH125246 R01MH10605

Optimización del proceso de molienda de semillas de quinoa, con y sin tratamiento hidrotérmico

La quinoa, Chenopodium quinoa Willd, es un pseudocereal de origen andino que se cultiva desde hace mas de 5000 años. Uno de los principales subproductos de su procesamiento es la harina integral, ya que puede ser empleada en diversas preparaciones alimenticias, domésticas o industriales. El objetivo del presente estudio fue optimizar el proceso de molienda de granos de quinoa, crudos y cocidos, utilizando un diseño factorial fraccionario, según la metodología de Taguchi. Se aplicó un diseño ortogonal L8 (27) con tres factores a dos niveles cada uno, y sus correspondientes interacciones. Las variables estudiadas fueron: humedad de semillas, tamaño de malla y velocidad de dosificación del molino, en los siguientes niveles: 7 y 12%; 0,12 y 0,25 mm; 13,6 ± 0,3 y 26,7 ± 1,7 g/min, respectivamente. Como variable de salida se estableció el porcentaje de harina, calculado como el peso de harina que atravesó la criba del molino, respecto al peso inicial del grano molido. Se emplearon semillas de quinoa provenientes de la provincia de Salta, que fueron desaponificadas mediante lavado por flujo continuo de agua, secadas en lecho fluidizado a 50 ºC y molidas en molino de martillo. Para el caso de las semillas cocidas, las mismas fueron tratadas con vapor a presión durante 10 minutos, previo al secado. La dosificación del molino fue realizada con un dosificador diseñado ad hoc. La composición química proximal, así como la determinación del color en las harinas con rendimientos extremos, se establecieron por métodos oficiales. Los mayores rendimientos fueron 77,5 ± 2,5 % y 56,17 ± 1,69 % para semillas crudas y cocidas, respectivamente. Se observó que, para semillas crudas, los factores humedad y malla y la interacción malla-velocidad de dosificación tuvieron la mayor influencia positiva sobre el rendimiento de la molienda; sin embargo, la dosificación por sí sola no mostró un impacto significativo en el parámetro de salida. Para semillas cocidas, el factor malla y las interacciones humedad–malla y humedad-velocidad de dosificación produjeron la mayor influencia positiva sobre el rendimiento de la molienda. No se observaron diferencias significativas en el contenido proteico (p < 0,05) entre las semillas crudas y cocidas y sus respectivas harinas, encontrándose valores entre 16 y 20%, aproximadamente.https://www.dropbox.com/s/9g07vrdzyn4ixcd/Libro%20de%20Res%C3%BAmenes.pdfFil: Cervilla, Natalia. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Instituto de Ciencia y Tecnología de los Alimentos; Argentina.Fil: Mufari, Jesica. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Instituto de Ciencia y Tecnología de los Alimentos; Argentina.Fil: Calandri, Edgardo. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Instituto de Ciencia y Tecnología de los Alimentos; Argentina.Fil: Garcia, Jorge. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Departamento Aeronáutica; Argentina.Fil: Guzman, Carlos. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Departamento Aeronáutica; Argentina.Alimentos y Bebida

Prevalence and Risk Factors Associated with Tumors and Other Structural Anomalies in Brain MRI Performed to Rule out Secondary Headache: A Multicenter Observational Study

This research was funded by MCIN/AEI/10.13039/501100011033, grant number PID2020118224RB-I00.Headache disorders (HDs) are among the most common conditions of the central nervous system, with an estimated prevalence of 50% in adult population. The aim of this work is to analyze the prevalence of structural anomalies that may explain HDs in MRI exams performed to rule out secondary headache in real-world practice, as well as risk factors associated with these lesions. We conducted a retrospective observational study based on a consecutive case series of all patients that underwent brain MRI due to headache from 1 January 2019 to 31 May 2019. We included patients from six MRI diagnostic centers accounting for four provinces of Andalusia (southern Spain). Bivariate and multivariate logistical regression models were performed to identify risk factors associated with the outcomes (1) presence of a structural finding potentially explaining headache, (2) presence of intracranial space-occupying lesions (SOLs), and (3) presence of intracranial tumors (ITs). Of the analyzed sample (1041 patients), a structural finding that could explain headache was found in 224 (21.5%) patients. SOLs were found in 50 (6.8%) patients and ITs in 12 (1.5%) patients. The main factors associated with structural abnormalities were female sex (OR, 1.35; 95% CI, 1.02–1.85), accompanying symptoms (OR, 1.34; 95% CI, 1.05–1.89), use of gadolinium-based contrast agents (OR, 1.89; 95% CI, 1.31–2.72) and previously known conditions potentially explaining headache (OR, 2.44; 95% CI, 1.55–3.84). Female sex (p = 0.048) and accompanying symptoms (p = 0.033) were also associated with ITs in bivariate analyses. Our results may be relevant for different medical specialists involved in the diagnosis, management and prevention of headache. Moreover, the risk factors identified in our study might help the development of public health strategies aimed at early diagnosis of brain tumors. Future studies are warranted to corroborate our findings.MCIN/AEI/10.13039/501100011033 PID2020118224RB-I0

Different presence of Chlamydia pneumoniae, herpes simplex virus type 1, human herpes virus 6, and Toxoplasma gondii in schizophrenia: meta-analysis and analytical study

In the present study we have performed both a meta-analysis and an analytical study exploring the presence of Chlamydia pneumoniae, herpes simplex virus type 1, human herpes virus 6, and Toxoplasma gondii antibodies in a sample of 143 schizophrenic patients and 143 control subjects. The meta-analysis was performed on papers published up to April 2014. The presence of serum immunoglobulin G and immunoglobulin A was performed by enzyme-linked immunosorbent assay test. The detection of microbial DNA in total peripheral blood was performed by nested polymerase chain reaction. The meta-analysis showed that: 1) C. pneumoniae DNA in blood and brain are more common in schizophrenic patients; 2) there is association with parasitism by T. gondii, despite the existence of publication bias; and 3) herpes viruses were not more common in schizophrenic patients. In our sample only anti-Toxoplasma immunoglobulin G was more prevalent and may be a risk factor related to schizophrenia, with potential value for prevention.Part of this work was presented at the Royal Academy of Medicine of Spain

Interaction Effect between Physical Activity and the BDNF Val66Met Polymorphism on Depression in Women from the PISMA-ep Study

This study was partially funded by the Consejeria de Salud, Junta de Andalucia (PI3222009), Consejeria de Innovacion, Proyecto de Excelencia (CTS-2010-6682), the Institute of Health Carlos III (Co-funded by European Regional Development Fund/European Social Fund "A way to make Europe"/"Investing in your future") (projects PI18/00238 and PI18/00467), the Marie Curie Research Grants Scheme (FP7 626235), and by a NARSAD Young Investigator Grant from the Brain & Behavior Research Foundation (22514). Juan Antonio Zarza-Rebollo was supported by the Spanish Ministry of Economy and Competitiveness (BES-2017-082698). Elena Lopez-Isac received financial support from the Spanish Ministry of Science and Innovation Juan de la Cierva Incorporacion Program (grant code IJC2019-040080-I/AEI/10.13039/501100011033). AnaMPerez-Gutierrez was supported by a grant from the Ministry of Economy and Competitiveness and Institute of Health Carlos III (FI19/00228), and Margarita Rivera was supported by the Ministry of Economy and Competitiveness Ramon y Cajal Program (RYC-2014-15774).The relationship between depression and the Val66Met polymorphism at the brain-derived neurotrophic factor gene (BDNF), has been largely studied. It has also been related to physical activity, although the results remain inconclusive. The aim of this study is to investigate the relationship between this polymorphism, depression and physical activity in a thoroughly characterised sample of community-based individuals from the PISMA-ep study. A total of 3123 participants from the PISMAep study were genotyped for the BDNF Val66Met polymorphism, of which 209 had depression. Our results are in line with previous studies reporting a protective effect of physical activity on depression, specifically in light intensity. Interestingly, we report a gene-environment interaction effect in which Met allele carriers of the BDNF Val66Met polymorphism who reported more hours of physical activity showed a decreased prevalence of depression. This effect was observed in the total sample (OR = 0.95, 95%CI = 0.90–0.99, p = 0.027) and was strengthened in women (OR = 0.93, 95%CI = 0.87–0.98, p = 0.019). These results highlight the potential role of physical activity as a promising therapeutic strategy for preventing and adjuvant treatment of depression and suggest molecular and genetic particularities of depression between sexes.Junta de Andalucia PI3222009Consejeria de Innovacion, Proyecto de Excelencia CTS-2010-6682Institute of Health Carlos III (European Regional Development Fund/European Social Fund "A way to make Europe"/"Investing in your future") PI18/00238 PI18/00467Marie Curie Research Grants Scheme FP7 626235NARSAD 22514Spanish Government BES-2017-082698Spanish Ministry of Science and Innovation Juan de la Cierva Incorporacion Program IJC2019-040080-I/AEI/10.13039/501100011033Ministry of Economy and CompetitivenessInstituto de Salud Carlos III FI19/00228Ministry of Economy and Competitiveness Ramon y Cajal Program RYC-2014-1577

Epidemiological support for genetic variability at hypothalamic–pituitary–adrenal axis and serotonergic system as risk factors for major depression

Background: Major depressive disorder (MDD) is a serious, and common psychiatric disorder worldwide. By the year 2020, MDD will be the second cause of disability in the world. The Granad∑p study is the first, to the best of our knowledge, epidemiological study of mental disorders carried out in Andalusia (South Spain), being one of its main objectives to identify genetic and environmental risk factors for MDD and other major psychiatric disorders. In this study, we focused on the possible association of 91 candidate single nucleotide polymorphisms (SNPs) with MDD.Methods: A total of 711 community-based individuals participated in the Granad∑p study. All individuals were extensively assessed for clinical, psychological, sociodemographic, life style, and other environmental variables. A biological sample was also collected for subsequent genetic analyses in 91 candidate SNPs for MDD. DSM-IV diagnosis of MDD was used as the outcome variable. Logistic regression analysis assuming an additive genetic model was performed to test the association between MDD and the genetic data. The experiment-wide significance threshold adjusted with the SNP spectral decomposition method provided a maximum P-value (8×10-3) required to identify an association. Haplotype analyses were also performed.Results: One SNP (rs623580) located in the tryptophan hydroxylase 1 gene (TPH1; chromosome 11), one intergenic variant (rs9526236) upstream of the 5-hydroxytryptamine receptor 2A gene (HTR2A; chromosome 13), and five polymorphisms (rs17689966, rs173365, rs7209436, rs110402, and rs242924) located in the corticotropin-releasing hormone receptor 1 gene (CRHR1; chromosome 17), all showed suggestive trends for association with MDD (P<0.05). Within CRHR1 gene, the TATGA haplotype combination was found to increase significantly the risk for MDD with an odds ratio =1.68 (95% CI: 1.16–2.42, P=0.006).Conclusion: Although limited, perhaps due to insufficient sample size power, our results seem to support the notion that the hypothalamic–pituitary–adrenal and serotonergic systems are likely to be involved in the genetic susceptibility for MDD. Future studies, including larger samples, should be addressed for further validation and replication of the present findings.This work was mostly funded by an Andalusian Health System Health Council grant (PI0322/2009) and partially by Astra-Zeneca in agreement with CIBERSAM. It was also supported by a PhD grant from the Spanish Ministry of Education (AP2010-3563), and by the Andalusian Council of Innovation (CTS-6682)

Trombosis venosa profunda de miembro superior, embarazo y trombofilia múltiple

We present the case of a 11-week pregnant woman with previous history of recurrent venous thromboembolic disease consulting for a new episode of deep vein thrombosis despite anticoagulation and adequate therapeutic compliance. She is diagnosed of a high risk thrombophilia. It is discussed the therapeutic management and the most important aspects of anticoagulation in a pregnant woman with thrombophilia.Se expone el caso de una gestante de 11 semanas con historia previa de enfermedad tromboembólica venosa  de repetición que acude por un episodio de trombosis venosa profunda de miembro superior izquierdo, a pesar de encontrarse recibiendo tratamiento anticoagulante con buen cumplimiento terapéutico. En el estudio realizado se diagnostica una trombofilia de alto riesgo. Se discute el manejo terapéutico que se llevó a cabo en esta paciente y los aspectos más destacados de la anticoagulación en la embarazada con trombofilia