Tooth loss and depression in Chilean participants of the National Health Survey 2016-2017: Oral and social functions mediation analysis.

BACKGROUND: Previous studies have indicated the association between poor oral health and depression in adults. This study evaluated oral and social functions contribution to the association between tooth loss and depressive symptoms in Chilean individuals. METHODS: We used data from the Chilean National Health Survey. The number of remaining teeth (≤19 versus ≥20 teeth) and anterior tooth losses were the exposure variables. Outcome was depression, measured through a self-report question and with the Composite International Diagnostic Interview - Short Form (CIDI SF). Mediating variables were determined by five questions, including problems regarding "speaking", "pain and suffering", "eating", "daily activities", and "social relationships". We performed logistic regression models adjusted by multiple confounders variables. Finally, we calculated indirect, direct effect, total effect, and the proportion mediated (PM). RESULTS: We included 5383 participants. The self-reported depression and suspected depression prevalence were 22,1 % and 14,0 % respectively. The total effect of fewer remaining teeth (≤19) on self-reported depression was 1.21 (95 % CI 1.02-1.44), and 1.09 (95 % CI 0.90-1.33) for suspected depression. All five variables of oral and social functions significantly mediated the association between tooth loss and depression. Feeling uncomfortable when speaking or eating discomfort were the most significant mediators. LIMITATIONS: The mediation analysis should be interpreted with caution due to the cross-sectional design. CONCLUSIONS: Deterioration of oral and social functions was a significant mediator in the association between tooth loss and depression, in particular feeling uncomfortable when speaking or eating. This mechanism should be considered in interventions to improve mental health.

Association between number of remaining teeth and incident depression in a rural Chilean cohort.

OBJECTIVES: Previous studies have established an association between tooth loss and depression. However, longitudinal evidence is scarce and needs to be verified in other populations. The aim of this study was to examine the longitudinal association between the number of remaining teeth and incident depression at 2- and 4-years follow-up in individuals enrolled in the Maule cohort (MAUCO) in Chile. METHODS: This prospective study used the information of individuals, aged 38 to 74 years, excluding those with depression at baseline. The number of remaining teeth at baseline was determined in four groups: "20 or more teeth", "10 to 19 teeth", "1 to 9 teeth" and "no natural teeth". Depression was measured through the PHQ-9. Logistic regression was performed to calculate the odds ratios (OR) for incidence depression at both periods of follow-ups, adjusting for age, sex, educational attainment, diabetes mellitus II, and stressful events at follow-up. Also, we performed adjusted multinomial logistic models to analysis the association between the number of remaining teeth and depression severity. RESULTS: In total individuals (n = 3335 at follow 1, n = 2461 at follow 2), all groups have ORs for incident depression above 1 considering 20 or more teeth as reference. In men, those with 10-19 teeth have 2.44 times higher odds of incident depression than those with 20 or more teeth (OR 2.44, CI 95% 1.33-4.50). Edentulous subjects at 4 years follow-up had 2.24 times higher odds of depression than those with more than 20 teeth (OR 2.24 CI 95%1.35-3.72). In women, the ORs (CI 95%) of incident depression were 2.56 (1.50-4.39), 1.56 (1.02-2.40) and 1.27 (0.90-1.81) for "none", "1-9", "10-19" respectively in comparison to the reference group. In edentulous individuals at baseline, the odds for each of the comparisons "mild vs no", "moderate vs no", "moderately severe vs no" and "severe vs no" were above 1, at both follow-ups. CONCLUSION: Individuals with less than 20 teeth in the mouth could had higher odds of incident depression at 2- and 4-years follow-up, with differences between men and women. Also, in our study, edentulism was associated with increased odds of incident depression at 4-years follow-up in women, and with higher levels of severity of depressive symptoms.

[Delirium, catatonia and substance withdrawal syndrome manifested as psychomotor agitation in COVID-19: a pharmacological management approach for the general hospital setting]. / Delirium, catatonía y síndrome de abstinencia manifestados como agitación psicomotora en COVID-19: una propuesta de manejo farmacológico en el hospital general.

BACKGROUND: Neuropsychiatric symptoms can be part of the clinical spectrum of COVID-19 infections. AIM: To devise an evidence based clinical algorithm as a guide for clinicians, to identify and treat underlying clinical syndromes of psychomotor agitation, such as delirium, catatonia or substance withdrawal in patients who are hospitalized and infected with SARS-CoV-2. MATERIAL AND METHODS: A review of the literature about the pharmacological management of neuropsychiatric manifestations of COVID-19 at the general hospital, to develop a clinical protocol based on a consensus from an interdisciplinary expert panel at a Clinical Hospital. RESULTS: A consensual clinical algorithm for the management of delirium, catatonia, and substance withdrawal, manifested as psychomotor agitation in patients hospitalized with COVID-19, was developed as a clinical proposal for physicians at different levels of complexity in health services. CONCLUSIONS: Cooperation among different clinical units in the general hospital facilitated the implementation of a clinical algorithm for clinicians for the management of psychomotor agitation in COVID-19 patients.

Seminarios autogestionados de psiquiatría como modelo de participación estudiantil activa en pregrado. Experiencia 2014-2021 en la Pontificia Universidad Católica de Chile / Self-managed psychiatry seminars as a model of active student participation in undergraduate education

In the last decade, medical students stood out as active agents in their training, which implies their involvement in the design, implementation, evaluation, and curricular co-governance. This article describes a model of active undergraduate student participation from 2014 to 2021 and compares the face-to-face and synchronous online modalities, later brought forward by the SARS-COV-2 pandemic. Annually, a call was made to UC School of Medicine undergraduate students to establish the topics and areas to be addressed during self-managed seminars. Then, medical students located in Chile were invited to attend the activity. Psychiatry was established as a priority topic in six out of eight years. Five seminars were conducted, the last two in synchronous online mode. The number of people enrolled in the online modality increased by 251% compared to the face-to-face modality (face-to-face mean = 133 ± 33 SD; online mean = 336 ± 24SD), with no significant differences in rates of attendance between modalities (Odds ratio (OR) = 1,12; 95% CI= 0,82 - 1,55; p = 0,45). The online modality was associated with a higher proportion of enrollees belonging to an institution outside the Metropolitan Region (OR 12,63; 95% CI = 8,64 - 18,46; p < 0,01). The self-managed psychiatry seminars correspond to a model of active undergraduate student participation, with the synchronous online modality representing an opportunity to massify it throughout the national territory.

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care.

Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best ap-proaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision-making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low- and middle-income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low-resource settings may lead to wider learning from locally embedded strategies.

Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce.

OBJECTIVES: The therapeutic use of nutrient-based 'nutraceuticals' and plant-based 'phytoceuticals' for the treatment of mental disorders is common; however, despite recent research progress, there have not been any updated global clinical guidelines since 2015. To address this, the World Federation of Societies of Biological Psychiatry (WFSBP) and the Canadian Network for Mood and Anxiety Disorders (CANMAT) convened an international taskforce involving 31 leading academics and clinicians from 15 countries, between 2019 and 2021. These guidelines are aimed at providing a definitive evidence-informed approach to assist clinicians in making decisions around the use of such agents for major psychiatric disorders. We also provide detail on safety and tolerability, and clinical advice regarding prescription (e.g. indications, dosage), in addition to consideration for use in specialised populations. METHODS: The methodology was based on the WFSBP guidelines development process. Evidence was assessed based on the WFSBP grading of evidence (and was modified to focus on Grade A level evidence - meta-analysis or two or more RCTs - due to the breadth of data available across all nutraceuticals and phytoceuticals across major psychiatric disorders). The taskforce assessed both the 'level of evidence' (LoE) (i.e. meta-analyses or RCTs) and the assessment of the direction of the evidence, to determine whether the intervention was 'Recommended' (+++), 'Provisionally Recommended' (++), 'Weakly Recommended' (+), 'Not Currently Recommended' (+/-), or 'Not Recommended' (-) for a particular condition. Due to the number of clinical trials now available in the field, we firstly examined the data from our two meta-reviews of meta-analyses (nutraceuticals conducted in 2019, and phytoceuticals in 2020). We then performed a search of additional relevant RCTs and reported on both these data as the primary drivers supporting our clinical recommendations. Lower levels of evidence, including isolated RCTs, open label studies, case studies, preclinical research, and interventions with only traditional or anecdotal use, were not assessed. RESULTS: Amongst nutraceuticals with Grade A evidence, positive directionality and varying levels of support (recommended, provisionally recommended, or weakly recommended) was found for adjunctive omega-3 fatty acids (+++), vitamin D (+), adjunctive probiotics (++), adjunctive zinc (++), methylfolate (+), and adjunctive s-adenosyl methionine (SAMe) (+) in the treatment of unipolar depression. Monotherapy omega-3 (+/-), folic acid (-), vitamin C (-), tryptophan (+/-), creatine (+/-), inositol (-), magnesium (-), and n-acetyl cysteine (NAC) (+/-) and SAMe (+/-) were not supported for this use. In bipolar disorder, omega-3 had weak support for bipolar depression (+), while NAC was not currently recommended (+/-). NAC was weakly recommended (+) in the treatment of OCD-related disorders; however, no other nutraceutical had sufficient evidence in any anxiety-related disorder. Vitamin D (+), NAC (++), methylfolate (++) were recommended to varying degrees in the treatment of the negative symptoms in schizophrenia, while omega-3 fatty acids were not, although evidence suggests a role for prevention of transition to psychosis in high-risk youth, with potential pre-existing fatty acid deficiency. Micronutrients (+) and vitamin D (+) were weakly supported in the treatment of ADHD, while omega-3 (+/-) and omega-9 fatty acids (-), acetyl L carnitine (-), and zinc (+/-) were not supported. Phytoceuticals with supporting Grade A evidence and positive directionality included St John's wort (+++), saffron (++), curcumin (++), and lavender (+) in the treatment of unipolar depression, while rhodiola use was not supported for use in mood disorders. Ashwagandha (++), galphimia (+), and lavender (++) were modestly supported in the treatment of anxiety disorders, while kava (-) and chamomile (+/-) were not recommended for generalised anxiety disorder. Ginkgo was weakly supported in the adjunctive treatment of negative symptoms of schizophrenia (+), but not supported in the treatment of ADHD (+/-). With respect to safety and tolerability, all interventions were deemed to have varying acceptable levels of safety and tolerability for low-risk over-the-counter use in most circumstances. Quality and standardisation of phytoceuticals was also raised by the taskforce as a key limiting issue for firmer confidence in these agents. Finally, the taskforce noted that such use of nutraceuticals or phytoceuticals be primarily recommended (where supportive evidence exists) adjunctively within a standard medical/health professional care model, especially in cases of more severe mental illness. Some meta-analyses reviewed contained data from heterogenous studies involving poor methodology. Isolated RCTs and other data such as open label or case series were not included, and it is recognised that an absence of data does not imply lack of efficacy. CONCLUSIONS: Based on the current data and clinician input, a range of nutraceuticals and phytoceuticals were given either a supportive recommendation or a provisional recommendation across a range of various psychiatric disorders. However several had only a weak endorsement for potential use; for a few it was not possible to reach a clear recommendation direction, largely due to mixed study findings; while some other agents showed no obvious therapeutic benefit and were clearly not recommended for use. It is the intention of these guidelines to inform psychiatric/medical, and health professional practice globally.

Delirium, catatonía y síndrome de abstinencia manifestados como agitación psicomotora en COVID-19: una propuesta de manejo farmacológico en el hospital general / Delirium, catatonia and substance withdrawal syndrome manifested as psychomotor agitation in COVID-19: a pharmacological management approach for the general hospital setting

BACKGROUND: Neuropsychiatric symptoms can be part of the clinical spectrum of COVID-19 infections. AIM: To devise an evidence based clinical algorithm as a guide for clinicians, to identify and treat underlying clinical syndromes of psychomotor agitation, such as delirium, catatonia or substance withdrawal in patients who are hospitalized and infected with SARS-CoV-2. MATERIAL AND METHODS: A review of the literature about the pharmacological management of neuropsychiatric manifestations of COVID-19 at the general hospital, to develop a clinical protocol based on a consensus from an interdisciplinary expert panel at a Clinical Hospital. Results: A consensual clinical algorithm for the management of delirium, catatonia, and substance withdrawal, manifested as psychomotor agitation in patients hospitalized with COVID-19, was developed as a clinical proposal for physicians at different levels of complexity in health services. CONCLUSIONS: Cooperation among different clinical units in the general hospital facilitated the implementation of a clinical algorithm for clinicians for the management of psychomotor agitation in COVID-19 patients.

Addition of aerobic exercise to antidepressant drug monotherapy for major depressive disorder in adults. / Adición de ejercicio aeróbico a monoterapia de fármacos con efecto antidepresivo para la terapia de trastorno depresivo mayor en adultos.

INTRODUCTION: Major depressive disorder is frequent and implies a high morbimortality. The addition of exercise has been proposed to improve the response rate to pharmacological monotherapy. However, this intervention is still controversial. METHODS: We searched Epistemonikos, the largest database of systematic reviews in health, maintained by screening multiple sources of information, including MEDLINE/PubMed, EMBASE, and Cochrane. We extracted data from the identified reviews, analyzed the data from the primary studies, performed a meta-analysis, and prepared a summary table of the results using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. RESULTS AND CONCLUSIONS: We identified 20 systematic reviews that together included 15 primary studies. Of these, eight were randomized trials. We con-clude that the addition of aerobic exercise to pharmacological monotherapy for patients with major depression could slightly decrease the severity of depressive symptoms with low certainty of evidence.

INTRODUCCIÓN: El trastorno depresivo mayor corresponde a una patología frecuente e implica una alta morbimortalidad. Se ha propuesto la adición de ejercicio para mejorar la tasa de respuesta a la monoterapia farmacológica, sin embargo, esta intervención aún es controvertida. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el tamizaje de múltiples fuentes de información, incluyendo MEDLINE/PubMed, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método Grading of Recommendations Assessment, Development and Evaluation, GRADE. RESULTADOS Y CONCLUSIONES: Identificamos 20 revisiones sistemáticas que en conjunto incluyeron 15 estudios primarios. De ellos, ocho corresponden a ensayos aleatorizados. Concluimos que la adición de ejercicio aeróbico a la monoterapia farmacológica para pacientes con depresión podría disminuir levemente la severidad de los síntomas de depresión con certeza de la evidencia baja.

[Self-managed psychiatry seminars as a model of active student participation in undergraduate education]. / Seminarios autogestionados de psiquiatría como modelo de participación estudiantil activa en pregrado. Experiencia 2014-2021 en la Pontificia Universidad Católica de Chile.

In the last decade, medical students stood out as active agents in their training, which implies their involvement in the design, implementation, evaluation, and curricular co-governance. This article describes a model of active undergraduate student participation from 2014 to 2021 and compares the face-to-face and synchronous online modalities, later brought forward by the SARS-COV-2 pandemic. Annually, a call was made to UC School of Medicine undergraduate students to establish the topics and areas to be addressed during self-managed seminars. Then, medical students located in Chile were invited to attend the activity. Psychiatry was established as a priority topic in six out of eight years. Five seminars were conducted, the last two in synchronous online mode. The number of people enrolled in the online modality increased by 251% compared to the face-to-face modality (face-to-face mean = 133 ± 33 SD; online mean = 336 ± 24SD), with no significant differences in rates of attendance between modalities (Odds ratio (OR) = 1,12; 95% CI= 0,82 - 1,55; p = 0,45). The online modality was associated with a higher proportion of enrollees belonging to an institution outside the Metropolitan Region (OR 12,63; 95% CI = 8,64 - 18,46; p < 0,01). The self-managed psychiatry seminars correspond to a model of active undergraduate student participation, with the synchronous online modality representing an opportunity to massify it throughout the national territory.

[Negative effects of the patients' rights law and neuro-rights bill in Chile]. / Efectos negativos en la investigación y el quehacer médico en Chile de la Ley 20.584 y la Ley de Neuroderechos en discusión: la urgente necesidad de aprender de nuestros errores.

Recently, the Chilean Senate approved the main ideas of a constitutional reform and a Neuro-rights bill. This bill aims to protect people from the potential abusive use of "neuro-technologies". Unfortunately, a literal interpretation of this law can produce severe negative effects both in the development of neuroscience research and medical practice in Chile, interfering with current treatments in countless patients suffering from neuropsychiatric diseases. This fear stems from the observation of the negative effects that recent Chilean legislations have produced, which share with the Neuro-Rights Law the attempt to protect vulnerable populations from potential abuse from certain medical interventions. In fact, Law 20,584 promulgated in 2012, instead of protecting the most vulnerable patients "incapacitated to consent", produced enormous, and even possibly irreversible, damage to research in Chile in pathologies that require urgent attention, such as many neuropsychiatric diseases. This article details the effects that Law 20.584 had on research in Chile, how it relates to the Neuro-Rights Law, and the potential negative effects that the latter could have on research and medical practice, if it is not formulated correcting its errors.

Efectos negativos en la investigación y el quehacer médico en Chile de la Ley 20.584 y la Ley de Neuroderechos en discusión: la urgente necesidad de aprender de nuestros errores / Negative effects of the patients' rights law and neuro-rights bill in Chile

Recently, the Chilean Senate approved the main ideas of a constitutional reform and a Neuro-rights bill. This bill aims to protect people from the potential abusive use of "neuro-technologies". Unfortunately, a literal interpretation of this law can produce severe negative effects both in the development of neuroscience research and medical practice in Chile, interfering with current treatments in countless patients suffering from neuropsychiatric diseases. This fear stems from the observation of the negative effects that recent Chilean legislations have produced, which share with the Neuro-Rights Law the attempt to protect vulnerable populations from potential abuse from certain medical interventions. In fact, Law 20,584 promulgated in 2012, instead of protecting the most vulnerable patients "incapacitated to consent", produced enormous, and even possibly irreversible, damage to research in Chile in pathologies that require urgent attention, such as many neuropsychiatric diseases. This article details the effects that Law 20.584 had on research in Chile, how it relates to the Neuro-Rights Law, and the potential negative effects that the latter could have on research and medical practice, if it is not formulated correcting its errors.

Disfunción tiroidea y trastornos del ánimo: revisión del estado del arte / Thyroid dysfunction and mood disorders: review of the state of the art

La relación entre función tiroidea y trastornos del ánimo se ha observado desde hace más de 50 años. Las hormonas tiroideas, actúan en el cerebro modulando génicamente proteínas asociadas a la fisiopatología de los trastornos del ánimo y potenciando los sistemas de neurotransmisión serotoninérgica y noradrenérgica. En el tratamiento de un episodio depresivo, la normalización de hormonas tiroideas es fundamental, y debe realizarse en todo paciente con sintomatología anímica, especialmente en aquellos con respuestas insuficientes a tratamiento, que requieren niveles de hormonas más estrictos que lo recomendado para población general. En pacientes eutiroideos, la potenciación con triyodotironina ha sido probada, pero también se ha utilizado T4 en altas dosis en casos resistentes, en que se postula que pudiese existir un estado de resistencia a hormonas tiroideas, no reflejado en los niveles hormonales periféricos evaluados rutinariamente. Las enzimas deiodasas, el receptor de hormona tiroidea, y el transportador de hormona tiroidea en la barrera hematoencefálica son blancos a investigar. Los objetivos de la presente revisión son ofrecer orientaciones respecto del uso de hormonas tiroideas en pacientes con trastornos del ánimo, una puesta al día sobre la relación entre hormonas tiroídeas y sistema nervioso central, y las interacciones entre psicofármacos y función tiroidea.

The relationship between thyroid function and mood disorders has been observed for more than 50 years. Thyroid hormones act in the brain genetically modulating proteins associated with the pathophysiology of mood disorders and potentiating the serotonergic and noradrenergic neurotransmission systems. In the treatment of a depressive episode, the normalization of thyroid hormones is essential, and should be performed in all patients with mood symptoms, especially in those with insufficient responses to treatment, which require more stringent hormone levels than recommended for the general population. In euthyroid patients, potentiation with triiodothyronine has been proven, but T4 has also been used in high doses in resistant cases, in which it is postulated that there might be a state of resistance to thyroid hormones, not reflected in the peripheral hormonal levels evaluated routinely. The enzymes deiodasas, the thyroid hormone receptor, and the thyroid hormone transporter in the blood brain barrier are white to investigate. The objectives of this review are to provide guidance regarding the use of thyroid hormones in patients with mood disorders, an update on the relationship between thyroid hormones and central nervous system, and the interactions between psychoactive drugs and thyroid function.

Validity and Performance of the Patient Health Questionnaire (PHQ-2) for Screening of Depression in a Rural Chilean Cohort.

Validity of PHQ-2 to screen for depression was assessed in an agricultural population in Chile. The sample included 4767 adults enrolled from 2014 to 2017 in a population-based cohort of chronic disease in Maule, Chile. Receiver operating characteristic (ROC) curve analysis was used to find the optimal PHQ-2 cut-off for depression, defined as the highest Youden index, using PHQ-9 as a reference standard. Sensitivity, specificity, and Youden J index were calculated for every cut-off point of PHQ-2. Prevalence of depression measured by PHQ-9 and PHQ-2 was 18% and 18.4%, respectively. Corresponding rates for women were 24.7% and 23.6%, and 8.3% and 10.9 for men. The optimal PHQ-2 cut-off score was 3, achieved with a sensitivity of 74.6%, specificity 93.9%, and Youden index of 0.68. The area under the curve for the ROC analysis ROC curve was 0.92 (95% CI 0.91-0.93). PHQ-2 has good performance for use as a test for depression screening in a rural population of Chile and can be easily applied in areas with low resources.

Is augmentation with folate effective for major depressive disorder? / ¿Es efectiva la potenciación con folato para el trastorno depresivo mayor?

INTRODUCTION: Antidepressant treatment does not lead to a satisfactory response in a significant proportion of patients with depression. It has been postulated that co-administration of pharmacologically standardized nutrients (nutraceuticals), such as folate, would potentiate the effect of antidepressants. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified four systematic reviews including nine studies overall, of which eight were randomized trials. We concluded augmentation with folate for the treatment of major depressive disorder probably results in little or no difference in depressive symptoms. It would be interesting to evaluate the effects of specific presentation forms of folate or in population with objective folate deficit.

INTRODUCCIÓN: En una proporción importante de los pacientes con depresión, el tratamiento antidepresivo no lleva a una respuesta satisfactoria. Actualmente se postula que la coadministración de nutrientes estandarizados farmacológicamente (nutracéuticos), como el folato en este caso, podrían potenciar los efectos de los antidepresivos. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cuatro revisiones sistemáticas que en conjunto incluyen nueve estudios primarios, de los cuales, ocho son ensayos aleatorizados. Concluimos que la potenciación con folato en el tratamiento del trastorno depresivo mayor probablemente resulta en poca o nula diferencia en los síntomas depresivos. Pudiese ser interesante evaluar el efecto de formas de presentación específicas del folato o en población con déficit objetivado.

Evidence-based practice in Chile.

Over the past few decades, the emergence of evidence-based practice medicine (EBP) has allowed a change in the integration of knowledge with policy making and health service development, and Chile has been influenced by EBP with no exemption. In this paper, we will describe the impact of the EBP model at different levels of the Chilean health system, including the development of national clinical guidelines, medical training and in-patient involvement in health awareness.

¿Es efectiva la potenciación con folato para el trastorno depresivo mayor? / Is augmentation with folate effective for major depressive disorder?

INTRODUCCIÓN: En una proporción importante de los pacientes con depresión, el tratamiento antidepresivo no lleva a una respuesta satisfactoria. Actualmente se postula que la coadministración de nutrientes estandarizados farmacológicamente (nutracéuticos), como el folato en este caso, podrían potenciar los efectos de los antidepresivos. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cuatro revisiones sistemáticas que en conjunto incluyen nueve estudios primarios, de los cuales, ocho son ensayos aleatorizados. Concluimos que la potenciación con folato en el tratamiento del trastorno depresivo mayor probablemente resulta en poca o nula diferencia en los síntomas depresivos. Pudiese ser interesante evaluar el efecto de formas de presentación específicas del folato o en población con déficit objetivado.

INTRODUCTION: Antidepressant treatment does not lead to a satisfactory response in a significant proportion of patients with depression. It has been postulated that co-administration of pharmacologically standardized nutrients (nutraceuticals), such as folate, would potentiate the effect of antidepressants. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified four systematic reviews including nine studies overall, of which eight were randomized trials. We concluded augmentation with folate for the treatment of major depressive disorder probably results in little or no difference in depressive symptoms. It would be interesting to evaluate the effects of specific presentation forms of folate or in population with objective folate deficit.

Efectividad de las intervenciones psicológicas basadas en el modelo transteórico (MTT) del cambio para el control metabólico de pacientes diabéticos / Effectiveness of psychological interventions based on the transtheoretical model (MTT) of change for metabolic control of diabetic patients

Objetivo: Evaluar el rol de las intervenciones basadas en el Modelo Transteórico (MTT) para mejorar el autocuidado de pacientes con diabetes mellitus tipo 1 ó tipo 2 (DM1, DM2). Metodología: Se realizó una búsqueda (mayo 2017), en las bases de datos Pubmed, Academic Search Complete y PsycInfo, utilizando términos en inglés relacionados con Glucose Metabolic Disorder, Motivational Interviewing y Randomized Control Trial. Criterios de inclusión: pacientes diabéticos, mayores de 18 años, estudios realizados en atención primaria y cuyo resultado primario fuere el control glicémico. La selección de estudios fue realizada de forma independiente por MP y LR, resolviendo discrepancias con CC. Los resultados son presentados en base al protocolo PRISMA. Resultados: Se identificaron 455 estudios, en base a título y resumen se seleccionaron 68, de los cuales 8 cumplían con los criterios de inclusión. Los participantes presentaban entre 53 y 64 años de edad. No se encontraron estudios con población con DM1. No se encontraron resultados significativos para el control metabólico. Sin embargo, cuatro de los estudios demostraron que el MTT fue efectivo para aumentar la actividad física y dos reportaron mejorar la adherencia al tratamiento farmacológico y mitigar las barreras percibidas para la toma de medicamentos. Conclusiones: Intervenciones psicológicas basadas en el MTT para el cambio de estilo de vida de los pacientes con DM2, favorecen el autocuidado de la enfermedad a través de la adherencia al tratamiento farmacológico y actividad física. No existe evidencia que sugiera que estas intervenciones impacten directamente en el control metabólico. (AU)

Objetive: To establish the role of health behavior interventions based on the Transtheorical Model (TTM), in the treatmentand management of type 1 and type diabetes mellitus (DM1, DM2). Methods: The databases Pubmed, Academic Search Complete and PsycInfo were searched for studies published before May 2017, with the Mesh terms Glucose Metabolic Disorder, Transtheoretical Model. Randomized controlled trials were analyzed. Inclusion criteria: adults with DM1 or DM2, studies conducted in primary care services, glycemic control as primary outcome. Study selection and inclusion was conducted by MP and LR, solving discrepancies with CC. Results :are presented according to the PRISMA statement. Results: 455 studies were initially identified from the selected databases. 68 studies were identified through title and abstract, and analyzed in detail. 8 studies fulfilled inclusion criteria. Participant's age ranged from 53 to 64 years old. There were no studies conducted with DM1patients. There were no significant results for glycemic control. Nonetheless, 4 studies showed that TTM is effective in increasing physical activity and 2 studies showed a significant improvement in treatment adherence and lower psychological limitations to pharmacological adherence. Conclusions: Health behavior interventions based on the TTM for lifestyle changes, have a positive impact in the self-management of patients with type 2 diabetes mellitus. (AU)

Examining the relationship between physical illness and depression: Is there a difference between inflammatory and non inflammatory diseases? A cohort study.

BACKGROUND: There is evidence that inflammation may play a role in the association between physical illness and depression. Our aim was to compare the impact of chronic medical conditions on incidence of depression and to examine if risk of depression varies in terms of the presence and degree of inflammation. METHODS: This is a secondary analysis conducted within the Spanish sample of the predictD-study. PARTICIPANTS: 5437. PRIMARY OUTCOME: Incident major depression measured with the Composite International Diagnostic Interview. EXPOSURE: Presence of chronic medical conditions recorded by GPs using the International Classification of Primary Care, ICPC-2. All analyses were conducted using multivariable logistic regression to allow adjustment for confounders. RESULTS: The odds of depression are higher in almost all inflammatory than in non-inflammatory illnesses. There is an increasing risk of depression as a consequence of an increasing inflammatory load, with higher odds of depression in the autoimmune group than in the cardio-metabolic group, while both had higher odds of depression than the non-inflammatory groups. CONCLUSIONS: Inflammation may be part of the pathway by which chronic physical illness leads to depression. Future studies should examine the role of inflammation in the prevention and management of depression.