Abstract
Background and Hypothesis
Facial Emotion Recognition is a key domain of social cognition associated with psychotic disorders as a candidate intermediate phenotype. In this study, we set out ...to investigate global and specific facial emotion recognition deficits in first-episode psychosis, and whether polygenic liability to psychotic disorders is associated with facial emotion recognition.
Study Design
828 First Episode Psychosis (FEP) patients and 1308 population-based controls completed assessments of the Degraded Facial Affect Recognition Task (DFAR) and a subsample of 524 FEP and 899 controls provided blood or saliva samples from which we extracted DNA, performed genotyping and computed polygenic risk scores for schizophrenia (SZ), bipolar disorder (BD), and major depressive disorder (MD).
Study Results
A worse ability to globally recognize facial emotion expressions was found in patients compared with controls B= −1.5 (0.6), 95% CI −2.7 to −0.3, with evidence for stronger effects on negative emotions (fear B = −3.3 (1.1), 95% CI −5.3 to −1.2 and anger B = −2.3 (1.1), 95% CI −4.6 to −0.1) than on happiness B = 0.3 (0.7), 95% CI −1 to 1.7. Pooling all participants, and controlling for confounds including case/control status, facial anger recognition was associated significantly with Schizophrenia Polygenic Risk Score (SZ PRS) B = −3.5 (1.7), 95% CI −6.9 to −0.2.
Conclusions
Psychosis is associated with impaired recognition of fear and anger, and higher SZ PRS is associated with worse facial anger recognition. Our findings provide evidence that facial emotion recognition of anger might play a role as an intermediate phenotype for psychosis.
RESUMEN La integración del cuidado de la salud individual con el de la población a través de la salud pública se ha podido llevar a cabo de forma efectiva a partir del modelo de la atención primaria ...orientada a la comunidad. En Cuba, la atención primaria es la base del sistema nacional de salud, con acceso universal y cuidado de los individuos, sus familias y la comunidad. El sistema nacional de salud y la atención primaria orientada a la comunidad contribuyen a la mejora de la salud y a la disminución de desigualdades en salud e iniquidades en la provisión de servicios. Este artículo presenta su descripción y análisis.
Vaccinating children has been an unquestioned tradition for many years. However, there is now great concern over the growing rejection of childhood vaccination, as well as other less evident ...obstacles that affect vaccination coverage.Multiple factors are involved in the rejection of a specific vaccine or vaccination in general, including actions by anti-vaccination groups, as well as disinformation or the dissemination of erroneous information. In some countries, delays in completing the immunization schedule may be due to poor program management. These factors compromise effective vaccination coverage, constituting a serious threat to public health.Susceptible populations constantly change, due to epidemiological shifts determined by phenomena such as globalization and various conflicts that interfere in the operation of health services. In recent years there have been outbreaks of previously controlled diseases such as diphtheria, whooping cough, and measles, resulting both from imported cases and from deficiencies in national immunization programs.This paper explores different aspects of the increasing frequency of vaccine rejection. There is a need for a review of its causes and for the design of innovative strategies and approaches to regain acceptance of vaccination and its place as the most cost-effective tool in public health.
Streptococcus pneumoniae isolated from patients with invasive pneumococcal disease has been subjected to laboratory-based surveillance in Latin American and Caribbean countries since 1993. Invasive ...pneumococcal diseases remain a major cause of death and disability worldwide, particularly in children. We therefore aimed to assess the direct effect of pneumococcal conjugate vaccines (PCVs) on the distribution of pneumococcal serotypes causing invasive pneumococcal disease in children younger than 5 years before and after PCV introduction.
We did a multicentre, retrospective observational study in eight countries that had introduced PCV (ie, PCV countries) in the Latin American and Caribbean region: Argentina, Brazil, Chile, Colombia, Dominican Republic, Mexico, Paraguay, and Uruguay. Cuba and Venezuela were also included as non-PCV countries. Isolate data for Streptococcus pneumoniae were obtained between 2006 and 2017 from children younger than 5 years with an invasive pneumococcal disease from local laboratories or hospitals. Species' confirmation and capsular serotyping were done by the respective national reference laboratories. Databases from the Sistema Regional de Vacunas (SIREVA) participating countries were managed and cleaned in a unified database using Microsoft Excel 2016 and the program R (version 3.6.1). Analysis involved percentage change in vaccine serotypes between pre-PCV and post-PCV periods and the annual reporting rate of invasive pneumococcal diseases per 100 000 children younger than 5 years, which was used as a population reference to calculate percentage vaccine type reduction.
Between 2006 and 2017, 12 269 isolates of invasive pneumococcal disease were collected from children younger than 5 years in the ten Latin American and Caribbean countries. The ten serotypes included in ten-valent pneumococcal conjugate vaccine (PCV10) decreased significantly (p<0·0001) after any PCV introduction, except for the Dominican Republic. The percentage change for the ten vaccine serotypes in PCV10 countries was −91·6% in Brazil (530 72·9% of 727 before, 27 6·1% of 441 after); −85·0% in Chile (613 72·6% of 844 before, 44 10·9% of 404 after); −84·7% in Colombia (231 63·1% of 366 before, 34 9·7% of 352 after); and −73·8% in Paraguay (127 77·0% of 165 before, 22 20·2% of 109 after). In the 13-valent pneumococcal conjugate vaccine (PCV13) countries, the percentage change for the 13 vaccine serotypes was −59·6% in Argentina (853 85·0% of 1003 before, 149 34·3% of 434 after); −16·5% in the Dominican Republic (95 80·5% of 118 before, 39 67·2% of 58 after); −43·7% in Mexico (202 73·2% of 276 before, 63 41·2% of 153 after); and −45·9% in Uruguay (138 80·7% of 171 before, 38 43·7% of 87 after). Annual reporting rates showed a reduction from −82·5% (6·21 before vs 1·09 after per 100 000, 95% CI −61·6 to −92·0) to −94·7% (1·15 vs 0·06 per 100 000, −89·7 to −97·3) for PCV10 countries, and −58·8% (2·98 vs 1·23 per 100 000, −21·4 to −78·4) to −82·9% (7·80 vs 1·33 per 100 000, −76·9 to −87·4) for PCV13 countries. An increase in the amount of non-vaccine types was observed in the eight countries after PCV introduction together with an increase in their percentage in relation to total invasive strains in the post-PCV period.
SIREVA laboratory surveillance was able to confirm the effect of PCV vaccine on serotypes causing invasive pneumococcal disease in the eight PCV countries. Improved monitoring of the effect and trends in vaccine type as well as in non-vaccine type isolates is needed, as this information will be relevant for future decisions associated with new PCVs.
None.
For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.
Pneumococcal protein vaccine based on pneumococcal surface protein A (PspA) is in development with the potential to offer broad range of protection against different strains. We have investigated the ...frequency of PspA family 1 (Fam1) and family 2 (Fam2) proteins among
Streptococcus pneumoniae recovered from ongoing surveillance in Brazil. Fam1 and Fam2 were expressed in comparable rates among 366 isolates, with the potential coverage of 94.3%. PspA families were not associated to age group or source of isolates. However, considering the significant tendency of increasing prevalence of Fam2 associated to widespread dissemination of the genetically-related resistant strains, the monitoring of the PspA families derived from population-based data may be necessary in the context of vaccine development.
Use of litigation to ensure and guarantee access to medical inputs constitutes one of the most effective strategies to ensure observance (or remedy the violation) of the right to health, often in ...relation to other fundamental human rights such as the right to life or to bodily integrity.More frequently, and in multiple national contexts, judges and courts support lawsuits filed by individuals who need immediate access to health technologies. On many occasions, the rulings that force the State and its institutions to guarantee the supply of a given product do not take into account the reasons the State gives for not providing it, which can range from cost-effectiveness calculations and evaluation, to public policy planning and implementation.Use and abuse of legal proceedings by interested third parties threaten the legitimacy of an instrument that has contributed, without a doubt, to strengthening public engagement in the defense of people's rights, including the right to health.This document is an attempt to provide a context for the evolution of this phenomenon with regard to the instruments, mechanisms, and procedures commonly used by health authorities to efficiently organize access to health technologies. In addition, steps to follow are suggested for both national and regional settings.
•We performed a retrospective review of 56 myelofibrosis patients transplanted from mismatched family donors.•Neutrophil engraftment at a median of 20days was observed in 82%.•Low rates of acute GVHD ...grades II to IV were observed in 28% (16% to 40%) and grades III to IV in 9% (2% to 16%).•Chronic GVHD at 1 year was found in 45% (32% to 58%).•Overall survival at 2years was 56% (41% to 70%).
This analysis included 56 myelofibrosis (MF) patients transplanted from family mismatched donor between 2009 and 2015 enrolled in the European Society for Blood and Marrow Transplantation database. The median age was 57years (range, 38 to 72); 75% had primary MF and 25% had secondary MF. JAK2 V617F was mutated in 61%. Donors were HLA mismatched at 2 or more loci. Stem cells were sourced from bone marrow in 66% and peripheral blood in 34%. The median CD34+ cell dose was 4.8 × 106/kg (range, 1.7 to 22.9; n = 43). Conditioning was predominantly myeloablative in 70% and reduced intensity in the remainder. Regimens were heterogeneous with thiotepa, busulfan, fludarabine, and post-transplant cyclophosphamide used in 59%. The incidence of neutrophil engraftment by 28days was 82% (range, 70% to 93%), at a median of 21days (range, 19 to 23). At 2years the cumulative incidence of primary graft failure was 9% (95% CI 1% to 16%) and secondary graft failure was 13% (95% CI 4% to 22%). The cumulative incidence of acute graft-versus-host disease (GVHD) grades II to IV and III to IV was 28% (95% CI 16% to 40%) and 9% (95% CI 2% to 17%) at 100days. The cumulative incidence of chronic GVHD at 1 year was 45% (95% CI 32% to 58%), but the cumulative incidence of death without chronic GVHD by 1 year was 20% (95% CI 10% to 31%). With a median follow-up of 32 months, the 1- and 2-year overall survival was 61% (95% CI 48% to 74%) and 56% (95% CI 41% to 70%), respectively. The 1- and 2- year progression-free survival was 58% (95% CI 45% to 71%) and 43% (95% CI 28% to 58%), respectively, with a 2-year cumulative incidence of relapse of 19% (95% CI 7% to 31%). The 2-year nonrelapse mortality was 38% (95% CI 24% to 51%). This retrospective study of MF allo-SCT using family mismatched donors demonstrated feasibility of the approach, timely neutrophil engraftment in over 80% of cases, and acceptable overall and progression-free survival rates with relapse rates not dissimilar to the unrelated donor setting. However, strategies to minimize the risk of graft failure and the relatively high nonrelapse mortality need to be used, ideally in a multicenter prospective fashion.
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