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Cross-national risk factors for childbirth-related PTSD: Findings from the INTERSECT study
(2025) Handelzalts, Jonathan E.; Ayers, Susan; Webb, Rebecca; Constantinou, Georgina; Lucas, Grace; Grollman, Christopher; Ohayon, Shay; Awad Sirhan, Natalia; Baird, Kathleen; Baldisserotto, Márcia; Batool, Ramish; Batool, Shahida; Caparros-Gonzalez, Rafael A.; Chorwe-Sungani, Genesis; Christoforou, Andri; Coo, Soledad; Costa, Raquel; Dikmen-Yildiz, Pelin; Ďuríčeková, Barbora; Dušová, Bohdana; Enea, Violeta; Garthus-Niegel, Susan; Grundström, Hanna; Gureje, Oye; Hadjigeorgiou, Eleni; Marie Haga, Silje; Horsch, Antje; Ionio, Chiara; Jarašiūnaitė-Fedosejeva, Gabija; Jomeen, Julie; Kazmierczak, Maria; Lalor, Joan; Milosavljevic, Maja; Nagle, Ursula; Nakić Radoš, Sandra; Nieminen, Katri; Damilola Oladeji, Bibilola; Osório, Flavia; Pawlicka, Paulina; Peled, Yoav
Background: Childbirth-related post-traumatic stress disorder (CB-PTSD) is an underrecognized condition with consequences for mothers and infants. This study aimed to determine risk factors for CB-PTSD symptoms across countries within a stress-diathesis framework, focusing on antenatal, birth-related, and postpartum predictors.
Methods: The INTERSECT cross-sectional survey (April 2021-January 2024) included 11,302 women at 6-12 weeks postpartum. The study was carried out across maternity services in 31 countries. Outcomes were CB-PTSD diagnosis, symptom severity, and perceived traumatic birth, assessed with the City Birth Trauma Scale. Multiple risk factors were assessed, including preexisting vulnerability, pregnancy, birth, and infant related factors. All models were adjusted for country-level variation as a random effect.
Results: Models explained substantial variance across all outcomes (conditional R2 = 0.53-0.58). Negative birth experience was the strongest predictor (e.g. odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.80-0.84 for diagnosis). Ongoing maternal complications predicted both CB-PTSD diagnosis and symptoms (e.g. OR = 1.61, 95% CI = 1.41-1.84), and major infant complications were associated with CB-PTSD diagnosis (OR = 1.63, 95% CI = 1.29-2.07). Reports of perceived danger to self or infant (criterion A) were linked to higher CB-PTSD symptoms and traumatic birth ratings (e.g., β =0.25, 95% CI = 0.21-0.29). Other predictors reached significance but showed small effects.
Conclusions: Findings support a stress-diathesis framework, showing that while pre-existing vulnerabilities contribute, birth-related stressors exert the strongest influence. Trauma-informed maternity care should prioritize these factors, with attention to women's appraisals of birth.
Synergy between resilience and empathy in health sciences students: A cross-sectional study
(2025) Díaz-Narváez, Víctor P.; Alonso Palacio, Luz Marina; Borja González, Juana; Rod, J. E.; De las Salas, Roxana; Alonso Cabrera, Jesús; Salcedo Salgado, Juan; Rodríguez Sanjuán, Alexander; Ríos García, Ana Liliana; Cano Barrios, Allison Elena; De la Cruz-Rocha, Edwin Rafael; Caro, Sara; Serrano Mariño, Dolores Vanessa; Ferreira Medina, Yanina; Hernández Bustos, Oscar E.; Espitia Nieto, Sandra; Hoyos De Los Ríos, Olga Lucia; Gamarra-Moncayo, José; Vilca, Lindsey W.; Reyes Reyes, Fernando Teddy; Reyes-Reyes, Alejandro; Cisneros, Ricardo; Velasco, Katherine; Carmona-Meza, Zenen
Background. Empathy is considered a key factor in patient satisfaction, treatment adherence, clinical outcomes, and professional fulfillment. Consequently, training health sciences students in empathy has become a priority in universities worldwide. However, empathy-focused interventions have not achieved the desired success due to the complex nature of empathy. Both internal and external factors shape and influence empathy. Resilience has been proposed as one such factor, but the association between these two concepts is poorly understood. This study aims to evaluate the association between different dimensions of resilience and empathy in health science students.
Methods. A Cross-sectional analysis evaluated the levels of empathy and resilience in 993 Medical, Nursing, and Dentistry students at Universidad del Norte using the Jefferson Scale of Empathy-Health Professions Students (JSE-HPS) and the Ecological, Engineering, Adaptation (EEA) Resilience Scale. Data were examined through univariate and multivariate normality analyses and descriptive statistics. To evaluate the theoretical structure of empathy and resilience, a confirmatory factor analysis (CFA) was performed on the three-dimensional models of each construct. Reliability was established using the Omega coefficient. Finally, structural equation modeling (SEM) with a robust maximum likelihood estimator was applied to analyze the association between resilience and empathy.
Results. The normal distribution assumptions were largely met for empathy scale data, its respective dimensions, and individual items. The theoretical model was well-supported for both constructs, and the data suggested acceptable reliability. SEM analysis revealed that the association between empathy and resilience dimensions vary. Ecological resilience was positively correlated with all empathy dimensions while engineering and adaptative resilience were negatively correlated with all three dimensions of empathy.
Conclusions. There is no universal effect of resilience on empathy. Designers of empathy-focused educational interventions and researchers should consider the potential differential effects of different dimensions of resilience on different aspects of empathy. In particular, focusing on ecological resilience may create the conditions for achieved empathy to be expressed, while strategies to mitigate the potential negative impact of adaptive resilience on empathy should be further explored.
Sedentary Behavior, Physical Activity, and Health of Workers in Chile According to the National Health Survey-2017
(2025) Leppe Zamora, Jaime; Leppe Zamora, Marco; Roa-Alcaino, Sonia; Sarmiento, Olga Lucía
Background/Objectives: Sedentary behavior (SB) and physical activity (PA) are key determinants of health in occupational settings. This study aimed to analyze the levels of SB, PA, and their associations with health outcomes among Chilean workers using data from the National Health Survey-2017. Methods: A secondary analysis of 2042 workers aged ≥18 years was conducted. Occupations were classified using ISCO-08, and SB/PA were assessed using the Global Physical Activity Questionnaire (GPAQ). Health outcomes included musculoskeletal symptoms, hypertension, diabetes mellitus, metabolic syndrome, and cardiovascular risk. Results: Of the participants, 49.8% were women, and the mean age was 45 years (±13.7). The median SB was 120 min/day, with 32.6% accumulating ≥4 h/day. “Managers” exhibited the highest SB (median: 270 min/day). The median total PA was 123 min/day, and “Skilled agricultural, forestry, and fishery workers” reported the highest PA (median: 330 min/day). The SB (≥4 h/day) was significantly associated with musculoskeletal symptoms (OR: 1.61, 95% CI: 1.21–2.14) and hypertension (OR: 1.53, 95% CI: 1.07–2.18). PA showed no significant protective effect. Conclusions: SB and PA vary significantly across occupational groups. SB is associated with musculoskeletal symptoms. Health promotion programs should be tailored to specific occupational groups.
Percutaneous or surgical revascularization in patients with severe left main coronary artery disease in Latin America: A GRADE clinical practice guideline
(2025) Lamelas, Pablo; Pompeu, Michel; Izcovich, Ariel; Bottaro, Federico; Tisi Baña, Matias; Sosa Liprandi, María Inés; Lanas, Fernando; Vilca Mejia, Omar Asdrúbal; Zuñiga Luna, Mauricio; Aubanel, Patricia; Munera, Ana; Contreras Reyes, Juan; Bagur, Rodrigo; Whitlock, Richard; Garcia Garcia, Héctor; Mamas Mamas; Cohen, Mauricio G.; Ricalde, Alejandro; Abizaid, Alexandre; Mendiz, Oscar; Araya, Mario; Costa, Ricardo; Santaera, Omar; Hidalgo, Pedro; Caldonazo, Tulio; Baranchuk, Adrian; Ragusa, Martin Alberto; SOLACI; SIAC
Background
Severe left main coronary artery disease (LMD) poses a major treatment challenge in Latin America, where both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are used.
Methods
This guideline was developed de novo using the GRADE approach. A multidisciplinary panel reviewed evidence from a systematic review of randomized trials comparing PCI and CABG, incorporating a comprehensive literature search of patient values and preferences and outcome utilities. Thresholds were assigned for each clinical outcome, from small to large effect.
Results
Five randomized trials enrolling 4612 patients were included. At 30 days, PCI resulted in a large reduction in major bleeding and a small reduction in strokes. At 5 years, PCI was associated with a small to moderate increase of spontaneous myocardial infarction and a moderate to large increase in repeat revascularization. No important differences in short- or long-term mortality were observed between PCI and CABG. The overall certainty of evidence was rated low. There was a notable variability in patient values and a close call on the balance of effects.
Conclusions
For patients in Latin America with severe left main coronary artery disease, the guideline panel suggests either PCI or CABG. This is a conditional recommendation, based on low certainty in the evidence (⨁⨁◯◯). It applies when both procedures are clinically and anatomically appropriate and can be performed at centers meeting acceptable standards. The decision should be made through a shared decision-making process involving the patient and the multidisciplinary care team.
Revisión sistemática sobre modelos de habilidades socioemocionales en educación superior
(2025) Bruna, Daniela; Sánchez-Oñate, Alejandro Antonio; Cobo-Rendón, Rubia
El objetivo de este estudio fue caracterizar el abordaje de las habilidades socioemocionales (HSE) en la educación superior universitaria, basándose en modelos teóricos utilizados en la investigación empírica entre 2013 y 2023. La metodología empleada es una revisión sistemática siguiendo las directrices PRISMA, analizando estudios en inglés, español y portugués, y excluyendo investigaciones centradas en salud mental y postgrado. Se identifican 28 artículos que cumplen los criterios de inclusión, abarcando modelos teóricos como la inteligencia emocional, la teoría de la autodeterminación, el modelo CASEL, el modelo de Bar-On y la teoría de las inteligencias múltiples. Los resultados destacan la importancia de integrar HSE en los programas educativos universitarios para mejorar el bienestar y el rendimiento académico de los estudiantes. Se concluye que el desarrollo de programas personalizados, la formación del personal docente y la evaluación continua son claves para la implementación efectiva de estas habilidades en la educación superior.
Espiritualidad de profesionales de la salud en unidades de pacientes críticos en Chile durante el COVID-19
(2025) Guerra Guerrero, Verónica; Correa Schnake, Marcelo; Poblete Troncoso, Margarita; Páez, Andrea; Daneck Muñoz, María Carolina
La pandemia tuvo consecuencias multidimensionales. Los profesionales de la salud fueron afectados debido a situaciones estresantes y traumáticas a lo largo del tiempo. El objetivo es analizar la espiritualidad como uno de los temas principales derivados de las experiencias vividas por un grupo de profesionales de la salud en unidades de pacientes críticos durante la pandemia. Se trata de un estudio con enfoque fenomenológico hermenéutico, con entrevistas en profundidad a 30 profesionales de la salud en Chile. El análisis de datos fue de tipo temático y se mantuvo los resguardos éticos correspondientes. Se encontró que la espiritualidad se relaciona con la reflexión y creencias espirituales del equipo de salud, y que la espiritualidad se redescubre a partir de la experiencia profesional y personal deshumanizadora a la que conduce la pandemia.
Characteristics and temporality of the ventilatory techniques in the management of acute respiratory distress syndrome: A scoping review
(2025) Battalian, Théo; Escudero Romero, Raúl; Barzaga Molina, Arianne
Introduction: Acute Respiratory Distress Syndrome (ARDS) is a critical condition characterised by acute respiratory failure due to increased alveolar-capillary membrane permeability. This leads to non-cardiogenic pulmonary oedema, hypoxemia, and impaired respiratory compliance, significantly impacting patients’ survival and quality of life. The management of ARDS involves various ventilatory and non-ventilatory therapies. Understanding the optimal timing and application of these therapies is crucial for improving patient outcomes.
Aim of the study: This scoping review aims to identify and synthesise the ventilatory techniques used in managing ARDS, focusing on their temporality and the interplay between different therapies. The study seeks to synthesize the available evidence and summarize current management strategies, highlighting areas for further research and improvement in ARDS care.
Material and Methods: A systematic search of PubMed, EBSCO, and ScienceDirect databases was conducted, following the Joanna Briggs Institute guidelines (2015), for articles published between 2013 and 2023. Studies involving adult patients (18 years or older) diagnosed with ARDS and receiving ventilatory support in the ICU were included.
Exclusion criteria included other acute respiratory pathologies, clinically extreme obese patients, and patients with tracheostomy.
Results: 437 articles were identified through the database search, of which 23 met the inclusion criteria and were included in the final review. Most articles were published between 2015-2019 (43.5%), originated from the USA (34.78%), and employed observational study designs (73.91%). The included studies reported on patients aged between 23 and 79 years, with intrapulmonary causes being the most common aetiology for ARDS. Various ventilatory strategies were identified, including conventional oxygen therapy, high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), invasive ventilation (IMV), and combined approaches. Temporality was reported in 35% of the articles, but none of them as their primary focus.
Conclusions: The review highlights the diversity of ventilatory techniques employed in ARDS management and the importance of individualizing treatment strategies based on patient response and disease severity. The temporality of these interventions remains a crucial aspect, requiring further investigation to establish clearer guidelines for optimizing the timing and sequence of ventilatory support in ARDS. The findings underscore the need for future research
to focus on patient-centred outcomes and the long-term implications of ARDS management, including quality of life and functional status.
Chronic dizziness in older adults: Disrupted sensorimotor EEG beta oscillations during postural instability
(2025) Ellmers, Toby J.; Ibitoye, Richard; Castro, Patricia; Kal, Elmar C.; Kaski, Diego; Bronstein, Adolfo M.
Objective: Chronic dizziness is common in older adults, yet frequently occurs without a clear cause (‘idiopathic dizziness’). Patients experience subjective unsteadiness with minimal objective imbalance, potentially related to small vessel disease. Here we examine the hypothesis that this syndrome is associated with disrupted cortical processing of postural instability.
Methods: EEG and postural sway were recorded in 33 older adults with chronic, idiopathic dizziness (Age, Mean = 77.3 years, SD = 6.4, 61 % female) and 25 matched controls (Age, Mean = 76.9 years, SD = 6.0, 56 % female).
EEG was time-locked to spontaneous instances of postural instability and analysed via time–frequency decomposition.
Results: Significant between-group differences in EEG were observed during the early phase of postural instability (p < 0.05, cluster-corrected). Whilst controls exhibited broadband increase in EEG power across sensorimotor areas, dizzy patients displayed suppressed beta activity (19–24 Hz). Contrary to predictions, these differences did not relate to small vessel disease markers (rs < 0.05, ps > 0.720) but to fear of falling (r = -0.44, p = 0.001).
Conclusions: Previous work implies that suppressing cortical beta enhances the relay of sensory information. We therefore propose that the modulation in beta EEG observed in patients reflects an anxious, top-down strategy to ncrease sensitivity to instability, which paradoxically causes persistent feelings of subjective imbalance.
Significance: These results identify associations between idiopathic dizziness and disrupted sensorimotor beta activation during postural instability. Cortical beta during imbalance may be a possible biomarker of chronic, idiopathic dizziness in older adults and/or fear of falling.
Culturally adapted meta-debriefing: a mixed-methods study of reflective practice in Spanish-speaking simulation faculty development in Chile
(2025) Armijo-Rivera, Soledad; Vergara, Karen; Vicencio, Scarlett; Foss, Brynjar; Maldonado, Marcia
Background: Simulation-based education has expanded across Latin America, creating demand for contextually relevant faculty development. Meta-debriefing, defined as a facilitated conversation following a debriefing, can strengthen debriefer performance. However, its implementation and effectiveness in Spanish-speaking settings remain underexplored. The CORE model (context, observation, reflection, and enhanced practice) provides structural guidance, but its adaptation to regional cultures has not been studied.
Methods: We conducted a concurrent mixed-methods study of one experienced meta-debriefer interacting and facilitating 15 remote meta-debriefing sessions with interprofessional novice debriefers. Quantitative data were derived from audio-recorded sessions using DASH, SET-M, a CORE-aligned checklist, and a meta-debriefing pillars tool. Qualitative data consisted of written observer reports, analyzed using inductive content analysis, and triangulated across sources.
Results: Quantitative analysis revealed high adherence to the CORE model and consistent demonstration of the four meta-debriefing pillars. Peer-assessed DASH scores ranged from 6.8 to 7.0, while SET-M items were consistently marked as achieved. Qualitatively, the meta-debriefer demonstrated behaviors aligned with psychologically safe, context-dependent, theoretically grounded, and formative facilitation. The meta-debriefer used cultural metaphors (e.g., "boli," "cazuelas," and a prisoner's song) to clarify structure and normalize reflection. Five reflection strategies emerged as central to generating debriefer insight: (1) Structured reorientation, (2) constructivist linkage to clinical identity, (3) metaphorical framing, (4) strategic questioning (e.g., advocacy & inquiry, circular inquiry), and (5) emotional normalization.
Conclusion: This study demonstrates how meta-debriefing, when implemented through culturally sensitive and structured approaches like CORE, supports transformative learning among simulation debriefers. Meta-debriefer's relational style, use of shared narratives, and context-sensitive scaffolding activated learner-centered reflection. As meta-debriefing models gain traction in Latin America and beyond, this study highlights the value of culturally responsive faculty development strategies that integrate local language, values, and pedagogical traditions into simulation-based education.
Indicators of psychiatric institutionalization in Southeast Asia between 1990 and 2024
(2025) Mundt, Adrian; Arafat, S. M. Yasir; Dorji, Chencho; Desousa, Avinash; Chadda, Rakesh; Gowda, Guru; Orus, Cristian; Kesavan, Muralidharan; Ibrahim, Athifa; Luitel, Nagendra; Gambheera, Harischandra; Kittirattanapaiboon, Phunnapa; Priebe, Stefan; Rozas, Enzo
Background: This study aimed to assess indicators of psychiatric institutionalization and their changes over time across the Southeast Asia Region (SEAR).
Methods: We collected numbers of psychiatric beds, specialized forensic psychiatric beds, beds in residential facilities for people living with chronic mental illness and prison populations in the 11 SEAR member states between 1990 and 2024 using primary and secondary data sources. We calculated median rates per 100,000 population, as well as percent changes of the median rates between the first and last available data points. We also compared findings in SEAR with OECD countries.
Findings: Psychiatric bed numbers and prison population were available from 10 countries. Bed prevalence increased in seven countries, but decreased in three. The median psychiatric bed prevalence was 1.5 at the first and 2.9 per 100,000 population at the last data point (+94%). The prison population increased in nine countries, with the median rate changing from 60 to 123 (+106%). Data on specialized forensic psychiatric beds were available from seven countries, with a range of 0.0-0.5 beds at the last data point. Based on data from five countries, the median prevalence of beds in residential facilities increased from 1.3 to 2.3. Psychiatric bed prevalence was on average about 5% of that in the OECD, while prison population rates were similar to those in OECD countries.
Interpretation: Psychiatric bed provision in the SEAR is among the lowest worldwide. In contrast, incarceration rates are similar to those in high-income regions. Most countries have increased the prevalence of psychiatric beds over the past three decades, but they remain scarce, and further investments need consideration.
Funding: Agencia Nacional de Investigación y Desarrollo (ANID), Chile.
Efficacy of platelet-rich-fibrin for the treatment of alveolar osteitis: a systematic review and meta-analysis
(2025) Ávila-Oliver, Camila; Veloso, Valentina; Laissle, Germán; Rojas, Ana María; Verdugo-Paiva, Francisca; Ramos-Rojas, José
Background: This systematic review aims to provide an updated summary of the available evidence on the role of platelet-rich fibrin (PRF) in the treatment of alveolar osteitis.
Material and Methods: Searches were conducted in several electronic databases, including PubMed, EBSCO, Cochrane Central Register of Controlled Trials (CENTRAL) LILACS and ClinicalTrials.gov. No date or language restrictions were applied. Two reviewers independently evaluated eligible studies according to predefined criteria and extracted data using a standardized form. Meta-analyses were performed to estimate results and the certainty of evidence, using the GRADE approach, was assessed.
Results: The search strategy yielded 1.706 references. Finally, 4 randomized trials were included and assessed quantitatively. Overall, the risk of bias was low for 75% of the domains reviewed across studies. The studies included a total of 179 patients, where the intervention group received PRF, and the control group received several treatment alternatives, including iodoform gauze, zinc oxide eugenol, and saline solution. Results showed that the use of PRF may decrease pain severity measured on day 3 (MD -1.66, CI 95%, -4.11 to 0.78) and on day 7 (MD -1.57, CI 95%, -4.00 to 0.88), and improves alveolar socket healing (SMD 2.25; 95% CI 1.70 to 2.80; p<0.00001; I2=12%).
Conclusions: The results of this study demonstrate that PRF improves alveolar healing, reduces analgesic use in patients, and likely increases overall clinical efficacy, making it a valuable alternative in the treatment of alveolar osteitis. Despite these findings, this review also showed a great degree of uncertainty on the impact of PRF on pain severity associated with alveolar osteitis. Although these results are promising, further randomized clinical trials with standardized methodologies must be performed to validate these findings.
Dyspnea in pregnancy. Can POCUS be the game changer?
(2025) Ghiringhellia, Juan; Arzola, Cristian; Zasso, Fabricio
Dyspnea is a common symptom during pregnancy, but it can present a diagnostic challenge. While it may often be attributed to physiological changes it may also signal serious underlying conditions such as asthma crisis, infection, pulmonary edema (PEd), pulmonary embolism, and amniotic fluid embolism.
Point-of-care ultrasound (POCUS) is a swift and effective bedside modality for assessing acute or critical medical conditions. It can be used as an alternative or alongside traditional formal ultrasound conducted by a radiology-cardiology service. This review explores the role of POCUS in the parturient experiencing shortness of breath, highlighting the potential value of maternal cardiopulmonary POCUS in obstetric anesthesia, facilitating timely treatment and providing immediate differential diagnosis in potentially unstable patients. As an example, a case is discussed involving a sudden onset of PEd and loss of consciousness in a 48-year-old patient who underwent a category-1 cesarean section under general anesthesia. POCUS identified severely decreased global systolic function and confirmed pulmonary edema through the presence of B-Kerley lines, providing a swift guidance for intraoperative inotropic support and fluid management while excluding other causes of pathological dyspnea in pregnancy.
Efficacy of lactobacillus spp. Interventions to modulate mood symptoms: A scoping review of clinical trials
(2025) Fernández-Rodríguez, Diego; Bravo, María Consuelo; Pizarro, Marcela; Vergara-Barra, Pablo; Hormazábal, María José; Leonario-Rodriguez, Marcell
Probiotics containing Lactobacillus spp. have demonstrated immunological and gastrointestinal benefits and may aid in recovery from mood disorders. However, evidence of their mood-modulating efficacy remains inconsistent. Aim: To analyze the efficacy of probiotic interventions with Lactobacillus spp. in modulating mood in humans. A scoping review was conducted following the PRISMA guidelines. A systematic search of the PubMed and Scopus databases was performed using nine Boolean combinations of the terms “mental”, “mental diseases”, “mental disorders”, “gastrointestinal microbiome”, “gut microbiome”, “gut microbiota”, and “lactobacillus”. The search was limited to clinical trials published in English and limited to ten years of publication. Eligible studies met the following criteria: (a) probiotic interventions in adults, with or without mood disturbances; (b) the use of Lactobacillus spp., either alone or in combination; (c) mood assessment instruments applied pre- and post-intervention; and (d) reporting of probiotic concentrations. Trials involving populations with other psychiatric or neurological diagnoses or those combining probiotics with additional mood-modulating nutrients were excluded. From 3291 records, 17 clinical trials met the inclusion criteria. Data extracted included the author, year, population, country of origin, probiotic strain(s), dosage, intervention mode and duration, and outcomes related to the microbial composition, biomarkers, and microbial metabolites. Trials were categorized by probiotic type (single vs. multi-species) and participant profile (healthy individuals and those with depressive symptoms or specific physiological conditions). Preliminary evidence from single-strain interventions, particularly high-dose L. plantarum administered for ≥8 weeks, suggests potential improvements in anxiety, sleep quality, and inflammatory biomarkers. Multi-species formulations yielded reductions in depressive symptoms and changes in neurobiological markers. Nonetheless, substantial heterogeneity in strains, dosages, durations, and outcome measures limited cross-study comparisons. Lactobacillus spp. interventions show promising mood-modulating potential, especially with specific strains and prolonged administration. Standardized protocols, rigorous controls, and clearly defined clinical cohorts are needed to establish robust, evidence-based recommendations.
Peruvian validation and standardization of the TabCAT-brain health assessment
(2025) Muñoz-Najar, Andrés; Montemurro Garcia, Manuel Fernelly; Tejada, María del Carmen; Rivera-Fernández, Claudia; Sánchez-Fernández, Miguel; Custodio, Nilton; Possin, Katherine L.; Tsoy, Elena; Lanata, Serggio; Soto-Añari, Marcio
Introduction: Detecting cognitive impairment in low-educated and marginalized populations may result in under- or over-estimation of diagnoses due to reliance on non-validated approaches and normative data. This study validates and standardizes TabCAT-BHA for older adults living in the Andean region of Peru using regression-based normalization. Methods: Two hundred fifty-eight participants were assessed with the MMSE, RUDAS, and TabCAT-BHA. Classified as either cognitively healthy or impaired based on Clinical Dementia Rating criteria. Results: By incorporating sex, place of residence, age, and years of education as covariates, the TabCAT-BHA demonstrated greater accuracy in detecting cognitive impairment (AUC = 75.3%) compared to the MMSE (AUC = 66.4%) and RUDAS (AUC = 71.4%). After incorporating only significant sociodemographic predictors, TabCAT-BHA obtained better AUC (77.4%) compared to MMSE (66.6%) and RUDAS (71.9%). Discussion: The TabCAT-BHA proves to be a valid tool for detecting cognitive impairment, and incorporating sociodemographic factors improves its accuracy in marginalized settings of Peru.
Peripheral BDNF levels in individuals at ultra-high risk for psychosis: A systematic review
(2025) Contreras, Omar; Rivera, Carla; Villaseca, Carolina; Mas, Francisco; Cartes, Benjamín; Castillo-Passi, Rolando; Nieto, Rodrigo R.
Background/Objectives: Brain-derived neurotrophic factor (BDNF) is a neurotrophin critical for neurogenesis and synaptic plasticity, and alterations in its peripheral levels have been associated with schizophrenia and other psychotic disorders. However, findings on peripheral BDNF levels in individuals at ultra-high risk (UHR) for psychosis have been inconsistent. This review synthesizes current evidence comparing peripheral BDNF levels in UHR populations with those in healthy controls (HCs), first-episode psychosis (FEP), and chronic schizophrenia (CS), focusing on BDNF’s potential relevance as a biomarker of psychosis risk and subsequent clinical course. Methods: A systematic search of PubMed, Scopus, and Web of Science identified studies reporting baseline peripheral BDNF levels in UHR individuals compared with HC, FEP, or CS. Of 755 records retrieved, 608 unique titles/ abstracts were screened, 49 full texts reviewed, and 8 studies included. Two reviewers independently screened, extracted data, and assessed risk of bias. Given marked clinical and methodological variability, results were synthesized narratively. Results: Eight studies met eligibility criteria and were synthesized across three analytical categories: (1) UHR vs. HC; (2) UHR vs. FEP or CS; and (3) longitudinal outcomes. Findings were inconsistent; some studies reported lower BDNF in UHR relative to comparison groups, whereas others found no differences or higher levels, often influenced by clinical or methodological factors. Longitudinal analyses did not reveal consistent prognostic value, and heterogeneity precluded meta-analysis. Conclusions: Findings across studies were inconsistent and limited by small samples, as well as by methodological heterogeneity. While current evidence does not support its prognostic use, peripheral BDNF may still hold potential as part of a biomarker framework if evaluated in larger, standardized, and rigorously controlled studies.
Food additives in Latin America: a descriptive analysis of the packaged food supply in five countries
(2025) Zancheta, Camila; Grilo, Mariana; Ayala, Salvador; Duran, Ana; Canella, Daniela; Mora, Mercedes; Ulloa, Victoria; Tolentino, Lizbeth; Reyes, Marcela; Corvalan, Camila
Background: Latin America is distinguished by diverse regulatory frameworks and evolving dietary patterns, including the weakening of traditional diets and the increasing consumption of ultra-processed foods (UPFs). Predominantly produced by transnational corporations, UPFs rely heavily on food additives to achieve desirable sensory properties (e.g., flavor, color), ensure food safety, and extend shelf life. Over the past decade, research has increasingly shown that higher consumption of UPFs is associated with poor health outcomes, and food additives have emerged as a potential mechanism underlying this association. However, few studies have systematically analyzed the presence of food additives in the food supply. This study aimed to assess the distribution and patterns of food additives in packaged foods from five Latin American countries.
Methods: Data were obtained from packaged foods and beverages sold in supermarkets in Brazil (2017; n = 9,673), Mexico (2017; n = 15,846), Chile (2018; n = 13,913), Colombia (2018; n = 8,282), and Ecuador (2019; n = 2,083). We used the list of ingredients to search for food additives described in the Codex Alimentarius. We assessed the prevalence of specific food additives, categorized their functional classes, and applied exploratory factor analysis to identify patterns of food additive use, overall and in each country.
Results: Food additives were present in over 75% of the studied products, ranging from 76.1% in Colombia to 84.0% in Ecuador. Food categories with the highest prevalence of additives (> 90%) included confectionery, dairy products, bakery items, and meat products. Most products contained two or more additives (64.3%); nearly 10% contained ten or more. We observed consistent results on the most used additives (i.e., flavorings, citric acid, phosphates, and lecithin) and patterns of food additives used across countries, although differences were observed in the use of specific additives, particularly low-calorie sweeteners and colorings.
Conclusion: Food additives are widely used in the packaged food supply of Latin American countries, and variations in the use of specific food additives likely reflect differences in regulatory frameworks, industry practices, and consumer preferences across countries. Given the increasing concern about the potential health effects of food additives, there is an urgent need to strengthen monitoring efforts and further investigate population-level exposures and associated health outcomes.
Rol de la inteligencia artificial en la reducción de biopsias innecesarias en lesiones mamarias BI-RADS 4 en imágenes
(2026) Astudillo, Magdalena; Baraqui, Florencia; Saieg , María; Florencia Bozzo; Roman, Martin
Introducción: El cáncer de mama es la neoplasia más frecuente en mujeres y una de las principales causas de mortalidad femenina. Su diagnóstico se realiza mediante mamografía, ecografía y resonancia magnética, sin embargo, estas técnicas presentan especificidad limitada, conduciendo a procedimientos invasivos innecesarios en una proporción significativa de casos. En este contexto, la inteligencia artificial emerge como herramienta complementaria a la interpretación radiológica. Objetivo: Analizar la evidencia científica actual acerca del rol de la IA en la radiología mamaria y su impacto en la reducción de biopsias innecesarias en lesiones BI-RADS 4. Metodología: Se realizó una búsqueda sistemática en PubMed, Google Scholar, ScienceDirect, RSNA y MDPI, utilizando descriptores MeSH relacionados con cáncer de mama, radiología mamaria, IA y deep learning, con límite de 10 años (2015-2025). De 134 artículos identificados, se seleccionaron 21 para análisis final. Desarrollo: Los estudios revisados demuestran que los modelos de aprendizaje profundo mejoran el rendimiento diagnóstico en las tres modalidades principales. En mamografía, estos algoritmos identifican una proporción significativa de lesiones BI-RADS 4 como potencialmente
benignas manteniendo alta sensibilidad, con potencial para reducir biopsias innecesarias. En ecografía y resonancia magnética, la integración de radiómica e inteligencia artificial mejora la especificidad diagnóstica en la diferenciación de lesiones benignas y malignas respecto a la evaluación visual convencional. Conclusión: La IA tiene amplio potencial para optimizar la interpretación de imágenes mamarias, contribuyendo a reducir biopsias innecesarias en
lesiones BI-RADS 4 y a un diagnóstico más preciso y eficiente.
Introduction: Breast cancer is the most common malignancy in women worldwide and a leading cause of female mortality. Diagnosis relies on imaging modalities—primarily mammography, ultrasound, and MRI—which present limited specificity, leading to unnecessary invasive procedures in a significant proportion of cases. In this context, artificial intelligence emerges as a complementary tool to radiological interpretation. Objective: To analyze the current scientific evidence on the application of AI in breast radiology and its impact on the reduction of unnecessary biopsie in BI-RADS 4 lesions. Methodology: A systematic search was conducted in PubMed, Google Scholar, ScienceDirect, RSNA and MDPI using MeSH descriptors related to breast cancer, breast imaging, AI and deep learning, restricted to the last 10 years (2015-2025). Of 134 articles identified, 21 were selected for final analysis. Discussion: The reviewed studies demonstrate that deep learning models improve diagnostic performance across the three main imaging modalities. In mammography, these algorithms identify a significant proportion of BI-RADS 4 lesions as potentially benign while maintaining high sensitivity, with potential to reduce unnecessary biopsies. In ultrasound and MRI, the integration of radiomics and artificial intelligence significantly improves diagnostic specificity in differentiating benign from malignant lesions compared to conventional visual assessment. Conclusion: AI has broad potential to optimize breast image interpretation, contributing to reducing unnecessary biopsies in BI-RADS 4 lesions and enabling more accurate and efficient diagnosis.
Baseline clinical characterization of participants in the Accelerating Medicines Partnership Schizophrenia Program
(2025) Addington, Jean; Liu, Lu; Chu, Monica; Jungert, Karl; Penzel, Nora; Pasternak, Ofer; Farina, Emily; Carrion, Ricardo E.; Corcoran, Cheryl M.; Mittal, Vijay A.; Strauss, Gregory P.; Yung, Alison R.; Alameda, Luis; Arango, Celso; Borders, Owen; Bouix, Sylvain; Breitborde, Nicholas J. K.; Broome, Matthew R.; Cadenhead, Kristin S.; Castillo-Passi, Rolando I.; Chen, Eric Yu Hai; Choi, Jimmy; Coleman, Michael J.; Conus, Philippe; Diaz-Caneja, Covadonga M.; Ellman, Lauren M.; Fusar Poli, Paolo; Gaspar, Pablo A.; Gerber, Carla; Glenthøj, Louise Birkedal; Horton, Leslie E.; Hui, Christy Lai Ming; Kambeitz, Joseph; Kambeitz-Ilankovic, Lana; Kapur, Tina; Kelly, Sinead; Kerr, Melissa J.; Keshavan, Matcheri S.; Kim, Minah; Kim, Sung-Wan
Background. This paper focuses on the baseline clinical characterization of the participants in the Accelerating Medicines Partnership Schizophrenia (AMP SCZ) program. The AMP SCZ program is designed to investigate a wide array of clinical variables and biomarkers in a total of 2040 clinical high-risk (CHR) participants and 652 community control (CC) participants.
Methods. The dataset analyzed includes 1642 individuals at clinical high risk for psychosis and 519 CCs. Key measures include the Positive Symptoms and Diagnostic Criteria for the Comprehensive Assessment of At-Risk Mental States Harmonized with the Structured Interview for Psychosis-Risk Syndromes, which determined CHR criteria and the severity of attenuated psychotic symptoms (APS). Other measures included the Structured Clinical Interview for DSM-5, scales to assess negative symptoms, depression, suicidal ideation, substance use, social and role functioning, and a selection of patient-reported outcomes.
Results. CHR participants presented with more severe ratings on all clinical measures and poorer functioning relative to the CC. There were a few significant small associations between measures of APS and other clinical measures.
Conclusion. The results from this study support previous research indicating that CHR individuals face serious clinical challenges beyond the risk of developing psychosis. Findings indicate significant associations among various clinical measures, underscoring the complex nature of the CHR population. Limitations are acknowledged, including the preliminary nature of the data and the need for more in-depth analyses from AMP SCZ papers already in progress. Future work will focus on longitudinal data and further exploration of clinical variables and their relationship with biomarkers.
Sample Ascertainment and recruitment sources in the Accelerating Medicines Partnership Schizophrenia Program
(2025) Addington, Jean; Shalev, Amy; Liu, Lu; Jahraus, Cari; Chu, Monica; Farina, Emily; Fusar Poli, Paolo; Marcy, Patricia J.; Nunez, Angela R.; Calkins, Monica E.; Alameda, Luis; Arango, Celso; Borders, Owen; Bouix, Sylvain; Breitborde, Nicholas J. K.; Broome, Matthew R.; Cadenhead, Kristin S.; Carrion, Ricardo E.; Castillo-Passi, Rolando I.; Chen, Eric Yu Hai; Choi, Jimmy; Coleman, Michael J.; Conus, Philippe; Corcoran, Cheryl M.; Diaz-Caneja, Covadonga M.; Ellman, Lauren M.; Gaspar, Pablo A.; Gerber, Carla; Glenthøj, Louise Birkedal; Horton, Leslie E.; Hui, Christy Lai Ming; Kambeitz, Joseph; Kambeitz-Ilankovic, Lana; Kapur, Tina; Kelly, Sinead; Kerr, Melissa J.; Keshavan, Matcheri S.; Kim, Minah; Kim, Sung-Wan; Koutsouleris, Nikolaos
Background. This paper presents the recruitment sources of clinical high-risk (CHR) and community controls (CC) from the Accelerating Medicines Partnership Schizophrenia (AMP SCZ) program, which aims to study various clinical variables and biomarkers in 2040 CHR and 652 CC participants.
Methods. A total of 1640 CHR and 514 CC had recruitment source data. The Positive Symptoms and Diagnostic Criteria for the Comprehensive Assessment of At-Risk Mental States Harmonized with the SIPS was utilized to assess CHR criteria and severity of attenuated psychotic symptoms (APSs), and the Global Functioning: Social Scale was used for social functioning. Participants were recruited through various methods, including referrals from healthcare providers, schools, and community agencies, and self-referrals via outreach efforts and advertising.
Results. Participants were recruited from 13 different sources, with self-referral being the most common for both CHR and CC. Other notable sources included child and youth services and psychiatric hospitals and departments. Regional differences in recruitment patterns were observed across continents. Differences in age, APS, and social functioning for CHR participants were examined in the top 5 recruitment sources. Overall, self-referred individuals were typically older, with less severe APS and higher levels of functioning, whereas those from adult community mental health services had poorer functioning and more severe APS. The remaining recruitment groups fell between these 2 extremes.
Conclusion. This paper highlights the diverse recruitment sources for the AMP SCZ program. Self-referral was a significant source, particularly in North America, reflecting changing help-seeking behaviors influenced by the internet and social media. The findings underscore the importance of understanding recruitment sources to optimize future CHR research.
Early high‑sensitivity troponin elevation and short‑term mortality in sepsis: a systematic review with meta‑analysis
(2025) Gajardo, Abraham I. J.; Ferrière‑Steinert, Santiago; Valenzuela Jiménez, Joaquín; Heskia Araya, Sebastián; Kouyoumdjian Carvajal, Thomas; Ramos-Rojas, José; Medel, Juan Nicolás
Background Serum cardiac troponin (cTn) elevation is a well-established phenomenon in sepsis. However, the clinical significance of this phenomenon with high-sensitivity (hs) assays and the current sepsis definition needs to be settled.
Research Question What is the association between early serum cTn levels measured by hs-assays and the risk of short-term mortality in septic patients?
Study Design and Methods We conducted a systematic review using a comprehensive PubMed, Scopus, and Embase search. Studies were eligible if they reported association data on early hs-cTn and mortality in an adult sample with sepsis that met the Sepsis-3 definition. For the synthesis of the effect of hs-cTn on mortality, we applied random effect models on the pooled unadjusted and adjusted odds ratio (OR and aOR, respectively) of elevated vs. normal hs-cTn serum values, and on the crude standardized mean difference (SMD) of hs-cTn between survivors and non-survivors.
Results In total, 6242 patients from 17 studies were included, with short-term mortality rates ranging from 16.9% to 53.8%. Using a crude analysis, non-survivor patients showed higher hs-cTn than survivors (SMD of 0.87, 95%CI: 0.41–1.33). Elevated hs-cTn was associated with increased mortality (OR = 1.78, 95% CI: 1.41–2.25). However, this prognostic effect was absent in studies that adjusted for different confounders (aOR = 1.06, 95% CI: 0.99–1.14).
Discussion and Conclusions Non-survivors of sepsis exhibited significantly elevated hs-cTn levels. While elevated hs-cTn levels are associated with an increased risk of mortality, they are not independently associated with this outcome in sepsis.