Salud mental en Chile y Finlandia: desafíos y lecciones / Mental health in Chile and Finland: challenges and lessons

This article analyses and compares the epidemiology of mental disorders and relevant public policies in Chile and Finland. In Chile, a specific mental health law is still lacking. While both countries highlight the role of primary care, Finland places more emphasis on participation and recovery of service users. Comprehensive mental health policies from Finland, such as a successful suicide prevention program, are presented. Both countries have similar prevalence of mental disorders, high alcohol consumption and high suicide rates. In Chile, the percentage of total disease burden due to psychiatric disorders is 13% and in Finland 14%. However, the resources to address these issues are very different. Finland spends 4.5% of its health budget on mental health, while in Chile the percentage is 2.2%. This results in differences in human resources and service provision. Finland has five times more psychiatric outpatient visits, four times more psychiatrists, triple antidepressant use and twice more clinical guidelines for different psychiatric conditions. In conclusion, both countries have similar challenges but differing realities. This may help to identify gaps and potential solutions for public health challenges in Chile. Finland’s experience demonstrates the importance of political will and long-term vision in the construction of mental health policies.

Improved biological performance of magnesium by micro-arc oxidation

Magnesium and its alloys have recently been used in the development of lightweight, biodegradable implant materials. However, the corrosion properties of magnesium limit its clinical application. The purpose of this study was to comprehensively evaluate the degradation behavior and biomechanical properties of magnesium materials treated with micro-arc oxidation (MAO), which is a new promising surface treatment for developing corrosion resistance in magnesium, and to provide a theoretical basis for its further optimization and clinical application. The degradation behavior of MAO-treated magnesium was studied systematically by immersion and electrochemical tests, and its biomechanical performance when exposed to simulated body fluids was evaluated by tensile tests. In addition, the cell toxicity of MAO-treated magnesium samples during the corrosion process was evaluated, and its biocompatibility was investigated under in vivo conditions. The results of this study showed that the oxide coating layers could elevate the corrosion potential of magnesium and reduce its degradation rate. In addition, the MAO-coated sample showed no cytotoxicity and more new bone was formed around it during in vivo degradation. MAO treatment could effectively enhance the corrosion resistance of the magnesium specimen and help to keep its original mechanical properties. The MAO-coated magnesium material had good cytocompatibility and biocompatibility. This technique has an advantage for developing novel implant materials and may potentially be used for future clinical applications.

Effects of 5-aza-2′deoxycytidine on RECK gene expression and tumor invasion in salivary adenoid cystic carcinoma

Reversion-inducing cysteine-rich protein with kazal motifs (RECK), a novel tumor suppressor gene that negatively regulates matrix metalloproteinases (MMPs), is expressed in various normal human tissues but downregulated in several types of human tumors. The molecular mechanism for this downregulation and its biological significance in salivary adenoid cystic carcinoma (SACC) are unclear. In the present study, we investigated the effects of a DNA methyltransferase (DNMT) inhibitor, 5-aza-2′deoxycytidine (5-aza-dC), on the methylation status of the RECK gene and tumor invasion in SACC cell lines. Methylation-specific PCR (MSP), Western blot analysis, and quantitative real-time PCR were used to investigate the methylation status of the RECK gene and expression of RECK mRNA and protein in SACC cell lines. The invasive ability of SACC cells was examined by the Transwell migration assay. Promoter methylation was only found in the ACC-M cell line. Treatment of ACC-M cells with 5-aza-dC partially reversed the hypermethylation status of the RECK gene and significantly enhanced the expression of mRNA and protein, and 5-aza-dC significantly suppressed ACC-M cell invasive ability. Our findings showed that 5-aza-dC inhibited cancer cell invasion through the reversal of RECK gene hypermethylation, which might be a promising chemotherapy approach in SACC treatment.

Evaluation of the predictive indices for candidemia in an adult intensive care unit

INTRODUCTION: To evaluate predictive indices for candidemia in an adult intensive care unit (ICU) and to propose a new index. METHODS: A prospective cohort study was conducted between January 2011 and December 2012. This study was performed in an ICU in a tertiary care hospital at a public university and included 114 patients staying in the adult ICU for at least 48 hours. The association of patient variables with candidemia was analyzed. RESULTS: There were 18 (15.8%) proven cases of candidemia and 96 (84.2%) cases without candidemia. Univariate analysis revealed the following risk factors: parenteral nutrition, severe sepsis, surgical procedure, dialysis, pancreatitis, acute renal failure, and an APACHE II score higher than 20. For the Candida score index, the odds ratio was 8.50 (95% CI, 2.57 to 28.09); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.78, 0.71, 0.33, and 0.94, respectively. With respect to the clinical predictor index, the odds ratio was 9.45 (95%CI, 2.06 to 43.39); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.89, 0.54, 0.27, and 0.96, respectively. The proposed candidemia index cutoff was 8.5; the sensitivity, specificity, positive predictive value, and negative predictive value were 0.77, 0.70, 0.33, and 0.94, respectively. CONCLUSIONS: The Candida score and clinical predictor index excluded candidemia satisfactorily. The effectiveness of the candidemia index was comparable to that of the Candida score. .

A method to adjust for ascertainment bias in the evaluation of cancer registry data.

Using the trend of age-standardized incidence rate of cancers (ASR) is inaccurate for registration with incomplete reporting, especially in developing registries. The relative age-standardized ratio (RASR) is a new measure that takes ascertainment bias of registration into account. RASR is calculated from the ASR for each cancer divided by the ASR for leukemia. Leukemia was chosen as the reference because its ASR is rather constant over time in valid registries. The adjusted relative age-standardized rate (ARASR with same unit as ASR) is calculated by multiplying the RASR for a specific cancer in a particular year by the sum of ASRs of that cancer over the years for which a trend is being determined and then dividing result by the sum of RASRs of the cancer for those years. Two likely assumptions are behind use of ARASR, first, constant ASR of leukemia over time, second, if under/over-registration occurs, it happens for all cancers to the same extent (random under/over-reporting). Using the ARASR with empirical data of valid Finnish and SEER cancer registries proved that trend of ASRs for each cancer is almost equal to its ARASR. Using trends of ARASRs instead of ASRs in a registry with incomplete data collection in first years of registration demonstrated more realistic results. In conclusion, the ARASR is more accurate than the ASR for studying cancer incidence trends in registries with incomplete reporting. ARASRs in different countries or different times are comparable since they are age-standardized. Moreover, comparison between trends of ASRs and ARASRs can be used as a test for validity of registration.

Lucha contra las enfermedades cardiovasculares en el Uruguay / Fight against the cardiovascular diseases in Uruguay

Este trabajo recoge datos preliminares de un estudio comparativo de mortalidad por enfermedad cardiovascular en elaboración. La mortalidad por enfermedades del aparato circulatorio ocupa en Uruguay el primer lugar entre las causas de muerte con una tasa de 352/100.000 h. (1996). Considerando los grupos de enfermedades, el primer lugar lo ocupan las cerebrovasculares con una tasa de 114/100.000 h. y en la que predomina el sexo femenino. En segundo lugar se ubican las isquémicas con una tasa de 101/100.000 h. y predominio del sexo masculino. El tercer lugar corresponde a las enfermedades hipertensivas, con tasas y valores muy inferiores. En la mayoría de los países de la región estas enfermedades ocupan el primer lugar dentro de las causas de muerte. En el presente informe se presentan datos de Uruguay y de otros cuatro países: Argentina, Bulgaria, EE.UU. y Finlandia, según el último año con información disponible. La comparación de las tasas de mortalidad ajustadas por edad, muestra a Uruguay en un nivel bajo (211/100.000 h.) similar a Finlandia (210/100.000 h.) y algo superior a Estados Unidos (192/100.000 h.) con una tasa algo mayor (260/100.000 h.) está Argentina y en un nivel más elevado se encuentra Bulgaria (424/100.000 h.). El análisis de las tendencias en períodos de 7 a 10 años muestra que la mortalidad por enfermedades del aparato circulatorio en Uruguay se comporta entre 1986 y 1993 en forma similar a EE.UU. dentro de un rango que no supera el valor de tasa ajustada de 250/100.000 h. y una tendencia negativa (descendente) con una pendiente de valor de b = -5,4. También es similar la mortalidad en Finlandia aunque la tendencia decreciente es más pronunciada (b= -7,19). Argentina muestra una tendencia decreciente (b = - 5,4) con valores algo superiores. Los valores más elevados y crecientes (b = + 3,7) de la mortalidad por estas causas correspondieron a Bulgaria.