Private vs. public emergency visits for mental health due to heat: An indirect socioeconomic assessment of heat vulnerability and healthcare access, in Curitiba, Brazil.

Few studies have explored the influence of socioeconomic status (SES) on the heat vulnerability of mental health (MH) patients. As individual socioeconomic data was unavailable, we aimed to fill this gap by using the healthcare system type as a proxy for SES. Brazilian national statistics indicate that public patients have lower SES than private. Therefore, we compared the risk of emergency department visits (EDVs) for MH between patients from both healthcare types. EDVs for MH disorders from all nine public (101,452 visits) and one large private facility (154,954) in Curitiba were assessed (2017-2021). Daily mean temperature was gathered and weighed from 3 stations. Distributed-lag non-linear model with quasi-Poisson (maximum 10-lags) was used to assess the risk. We stratified by private and public, age, and gender under moderate and extreme heat. Additionally, we calculated the attributable fraction (AF), which translates individual risks into population-representative burdens - especially useful for public policies. Random-effects meta-regression pooled the risk estimates between healthcare systems. Public patients showed significant risks immediately as temperatures started to increase. Their cumulative relative risk (RR) of MH-EDV was 7.5 % higher than the private patients (Q-Test 26.2 %) under moderate heat, suggesting their particular heat vulnerability. Differently, private patients showed significant risks only under extreme heat, when their RR became 4.3 % higher than public (Q-Test 6.2 %). These findings suggest that private patients have a relatively greater adaptation capacity to heat. However, when faced with extreme heat, their current adaptation means were potentially insufficient, so they needed and could access healthcare freely, unlike their public counterparts. MH patients would benefit from measures to reduce heat vulnerability and access barriers, increasing equity between the healthcare systems in Brazil. AF of EDVs due to extreme heat was 0.33 % (95%CI 0.16;0.50) for the total sample (859 EDVs). This corroborates that such broad population-level policies are urgently needed as climate change progresses.

The ARIQUELI study: potentiation of quetiapine in bipolar I nonresponders with lithium versus aripiprazole.

BACKGROUND: The treatment of bipolar disorder (BD) remains a challenge due to the complexity of the disease. Current guidelines represent an effort to assist clinicians in routine practice but have several limitations, particularly concerning long-term treatment. The ARIQUELI (efficacy and tolerability of the combination of lithium or aripiprazole in young bipolar non or partial responders to quetiapine monotherapy) study aims to evaluate two different augmentation strategies for quetiapine nonresponders or partial responders in acute and maintenance phases of BD treatment. METHODS/DESIGN: The ARIQUELI study is a single-site, parallel-group, randomized, outcome assessor-blinded trial. BD I patients according to the DSM-IV-TR, in depressive, manic/hypomanic or mixed episode, aged 18 to 40 years, are eligible. After diagnostic assessments, patients initiated treatment in phase I with quetiapine. Nonresponders or partial responders after 8 weeks are allocated into one of two groups, potentiated with either lithium (0.5 to 0.8 mEq/l) or aripiprazole (10 or 15 mg). Patients will be followed up for 8 weeks in phase I (acute treatment), 6 months in phase II (continuation treatment) and 12 months in phase III (maintenance treatment). Outcome assessors are blinded to the treatment. The primary outcome is the evaluation of changes in mean scores on the CGI-BP-M between baseline and the endpoint at the end of each study phase. DISCUSSION: The ARIQUELI study is currently in progress, with patients undergoing acute treatment (phase I), potentiation (phase II) and maintenance (phase III). The study will be extended until January 2015. Trials comparing lithium and aripiprazole with potentiate treatment in young BD I nonresponders to quetiapine in monotherapy can provide relevant information on the safety of these drugs in clinical practice. Long-term treatment is an issue of great importance and should be evaluated further through more in-depth studies given that BD is a chronic disease. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01710163.

A refrigeração no diagnóstico de Salmonella spp. utilizando o método microbiológico tradicional e reação em cadeia da polimerase em carcaças de frango / The cooling on the diagnostic of Salmonella spp. using traditional microbiologic method and the polymerase chain reaction in poultry carcasses

A pesquisa de Salmonella em carcaças de aves tem mostrado resultados discrepantes, dependendo se as amostras foram colhidas ainda na indústria, imediatamente após o chiller ou no comércio varejista, quando se encontram submetidas à refrigeração por vários dias. Técnicas mais sensíveis, tais como a Reação em Cadeia pela Polimerase (PCR), podem fornecer dados importantes sobre o efeito do resfriamento sobre as células do patógeno, comparando seus resultados com os da metodologia microbiológica convencional (MC). Foram colhidas 130 carcaças de frango, sendo que 65 foram obtidas ainda na indústria (pós-chiller) e imediatamente analisadas e 65 carcaças embaladas e estocadas a 5°C por 72 horas (simulando o varejo), sendo então realizada a pesquisa do patógeno por ambas as técnicas. Do total analisado (130 amostras), a PCR foi capaz de detectar 58 positivas (44,6 por cento) e a MC 50 (38,5 por cento). Ambas as técnicas detectaram um número superior de amostras positivas para Salmonella em carcaças colhidas ainda na indústria, quando comparadas às do varejo. A PCR detectou 50,77 por cento de positividade em amostras da indústria e 38,46 por cento em amostras do varejo. Para a MC, esses valores foram de 46,15 por cento (indústria) e 30,77 por cento (varejo). Concluímos que o resfriamento das carcaças a 5°C por 72 horas pode ser um fator limitante na detecção de Salmonella quando a pesquisa do patógeno se faz pela metodologia microbiológica convencional.

The survey of Salmonella in poultry carcasses has shown conflicting results, depending on whether the samples were taken yet in the factory, immediately after the chiller or retail market, when they are subjected to refrigeration for several days. More sensitive techniques such as Polymerase Chain Reaction (PCR) can provide important data on the effect of cooling on the cells of the pathogen by comparing their results with those of conventional microbiological methods (CM). It was collected 130 chicken carcasses, wich 65 were obtained yet in the industry (post-chiller) and immediately analyzed and 65 carcasses packaged and stored at 5°C for 72 hours (simulating retail), and then research of the pathogen was performed by both techniques. Of the analyzed total (130 samples), PCR was able to detect 58 positive (44.6 percent) and CM, 50 (38.5 percent). Both techniques detected a higher number of samples positive for Salmonella on carcasses collected yet in the factory when compared to those of retail. The PCR detected 50.77 percent of positive industry samples and 38.46 percent of retail samples. CM for these values was 46.15 percent (factory) and 30.77 percent (retail). We conclude that the cooling of the carcasses for at 5°C for 72 hours can be a limiting factor in the detection of Salmonella when the pathogen research is done by conventional microbiological methods.

SHORT COMMUNICATION: Apolipoprotein E genotype and cognition in bipolar disorder.

Apolipoprotein E (APOE) has been extensively studied as a risk factor for sporadic and late onset Alzheimer's Disease (AD). APOE allele (∗)3, the most frequent variant, is not associated to cognitive dysfunction (CD) or to increased AD risk. Differently, the (∗)4 allele is a well-established risk factor for CD, while the (∗)2 allele is associated with survival and longevity. CD is an important feature of Bipolar Disorder (BD) and recent data suggest that CD may be one of its endophenotypes, although controversial results exist. The aim of this research is to study the association of APOE genotype (APOE) and neurocognitive function in a sample of drug free young BD-type I patients. Sample consisted of 25 symptomatic BD (type I) patients (age 18-35 years old). They were submitted to an extensive neuropsychological evaluation and genotyped for APOE. Subjects with allele (∗)2 presented better cognitive performance. The presence of allele (∗)4 was associated with worse performance in a few executive tasks. APOE (∗)3(∗)3 was associated with overall severe dysfunction on cognitive performance. In young individuals with nontreated BD-type I, APOE may predict cognitive performance. Further and larger studies on APOE and cognition in BD are required to clarify whether APOE is a BD cognitive endophenotype.