The premorbid phase of treatment-resistant schizophrenia (TRS) may reveal underlying mechanisms and inform early interventions. According to the neurodevelopmental hypothesis, treatment resistance may be linked to pronounced developmental impairments. We examined school grades and attendance trajectories in children who later developed TRS.

This case-control study analyzed school grade point average and attendance among all individuals born after 1990 and started on clozapine in Chile’s public health system as a proxy for TRS. Control groups included children later diagnosed with treatment-responsive schizophrenia, bipolar disorder, and unaffected classmates. Linear mixed models accounted for individual and school-level confounders.

We included 1072 children (9929 observations, 29.3% female) subsequently diagnosed with TRS, 323 (2802 observations, 25.7% female) with schizophrenia, 175 (1784 observations, 53.8% female) bipolar disorder, and 273,260 (533,335 observations, 47% female) unaffected classmates. Children who later developed TRS had worse grades across levels than their classmates (−0.26 SD [−0.2, −0.4]), but not treatment-responsive schizophrenia. All severe mental illness groups showed grade declines in later school levels, with TRS showing steeper linear decline than treatment-responsive schizophrenia (group×age of −0.03; 95%CI −0.04, −0.01) and steeper quadratic decline than bipolar disorder (group×age2 of −0.005; −0.01, −0.001). Attendance declined over time in the two groups developing schizophrenia compared to their classmates. Those developing TRS experienced the sharpest drop (group×age compared to schizophrenia −0.03; −0.05, −0.01 and bipolar disorder −0.027; −0.049, −0.006).

TRS may stem from a more aggressive pathological process or pronounced late-maturation abnormality, rather than an early premorbid impairment, suggesting an intervention target.

Prolonged childhood and adolescent loneliness (CAL) is linked to various adverse mental health outcomes, yet its impact on schizophrenia spectrum disorders (SSD) has been understudied. While loneliness is associated with psychosis and worsens symptoms in SSD, few studies have explored the long-term effects of early loneliness on SSD risk. Understanding how CAL interacts with genetic liability to schizophrenia is essential for identification of high-risk individuals.

This study evaluated whether prolonged CAL is associated with increased SSD risk and examined the interaction between CAL and genetic liability for schizophrenia. Gender differences in these associations were also explored.

Data from the European Gene–Environment Interactions in Schizophrenia (EU-GEI) study were analysed, including 1261 individuals with SSD, 1282 unaffected siblings and 1525 healthy controls. CAL was retrospectively assessed for periods before age 12 years and age 12–16 years. Genetic risk was measured using polygenic risk scores for schizophrenia. Logistic regression models and the Relative Excess Risk due to Interaction (RERI) method were used to examine gene–environment interactions, with stratification by gender.

Prolonged CAL was associated with higher odds of SSD (odds ratio [95% CI] = 5.20 [3.85−7.01] for loneliness before age 12; odds ratio [95% CI] = 7.26 [5.63−9.38] for loneliness during adolescence). The interaction between CAL and genetic risk was strongest during adolescence (RERI [95% CI] = 23.46 [10.75−53.53]). Females showed a greater effect (odds ratio [95 %CI] = 10.04 [6.80−14.94]) than males (odds ratio [95% CI] = 5.50 [3.95−7.66]). Incorporating CAL and genetic interaction increased predictive values to 17% for SSD risk − rising to 22.5% in females − compared with 2.6 and 2.8%, respectively, for genetic risk alone.

Prolonged CAL significantly increases SSD risk, particularly in females. The inclusion of CAL alongside genetic risk substantially enhances predictive accuracy. Early identification of CAL could inform preventive strategies, especially in genetically vulnerable populations.

Mitral regurgitation (MR) is the most prevalent valvular heart disease worldwide and is frequently underdiagnosed and undertreated, resulting in a substantial healthcare burden. This project aimed to define an optimized patient journey, identifying specific unmet needs and pain points in the management of MR in Spain, and to propose a set of recommendations that can be implemented at a clinical level.

Using the Population, Intervention, Comparator, and Outcomes search strategy, a pragmatic literature review was conducted to contextualize the comprehensive management of patients with MR in Spain. Subsequently, a Delphi panel consisting of two rounds of questionnaires was implemented. Unmet needs detected for MR management along the patient journey were validated by a panel of clinical experts incorporating different profiles. A battery of actions to improve the MR patient journey was also gathered (first round), which were then systematically reviewed and prioritized by the experts using hierarchical point allocation methods (second round) based on their relevance and feasibility within the National Health System.

A set of actions was proposed for the following core phases: detection-diagnosis, treatment-decision, treatment, and follow up. Actions for detection-diagnosis should be prioritized since boosting patient referral to specialized centers was considered crucial. Within the treatment-decision stage, experts emphasized strengthening healthcare services communication and training on risk stratification. For treatment, early referral to specialized centers was prioritized. Optimizing follow up required educating patients and relatives on adherence and self-care. Finally, experts supported a common pathway for heart valve diseases such as MR, tricuspid regurgitation, and aortic stenosis. Specifically, they concluded that optimization of tricuspid regurgitation management aligned with the actions proposed for MR.

Altogether, unmet needs and critical aspects in each of the management steps of MR in Spain were detected and an array of potential actions was suggested by clinical experts. The evaluation of such actions resulted in a preliminary strategic plan that can help prioritize interventions and healthcare policies regarding the optimization of the healthcare journey for patients with MR (and other valvulopathies) in Spain.

This study aims to outline Clostridioides difficile infection (CDI) trends and outcomes in Mexican healthcare facilities during the COVID-19 pandemic.

Observational study of case series.

Sixteen public hospitals and private academic healthcare institutions across eight states in Mexico from January 2016 to December 2022.

CDI patients.

Demographic, clinical, and laboratory data of CDI patients were obtained from clinical records. Cases were classified as community or healthcare-associated infections, with incidence rates calculated as cases per 10,000 patient days. Risk factors for 30-day all-cause mortality were analyzed by multivariate logistic regression.

We identified 2,356 CDI cases: 2,118 (90%) were healthcare-associated, and 232 (10%) were community-associated. Common comorbidities included hypertension, diabetes, and cancer. Previous high use of proton-pump inhibitors, steroids, and antibiotics was observed. Recurrent infection occurred in 112 (5%) patients, and 30-day mortality in 371 (16%). Risk factors associated with death were a high Charlson score, prior use of steroids, concomitant use of antibiotics, leukopenia, leukocytosis, elevated serum creatine, hypoalbuminemia, septic shock or abdominal sepsis, and SARS-CoV-2 coinfection. The healthcare-associated CDI incidence remained stable at 4.78 cases per 10,000 patient days during the pre-and pandemic periods. However, the incidence was higher in public hospitals.

Our study underscores the need for routine epidemiology surveillance and standardized CDI classification protocols in Mexican institutions. Though CDI rates in our country align with those in some European countries, disparities between public and private healthcare sectors emphasize the importance of targeted interventions.

Rapid population growth in urban areas requires an effective transposition of sustainable development goals to the urban realm, for which the New Urban Agenda was adopted by most countries worldwide. The progress report of its implementation was discussed in this study to identify strengths and weaknesses in the process that assist nations in the design and application of effective actions to achieve a more sustainable urban development.

The adoption of the 2030 Agenda represents a daunting challenge for countries worldwide, which found its continuation in the New Urban Agenda (NUA) geared predominantly toward urban settlements. Although the achievement of the sustainable development goals (SDGs) has been widely monitored by global and national institutions, the progress of the NUA has not been properly addressed to date. With the purpose of filling this gap, this study aims to gauge the implementation level of the NUA through the analysis of all status reports issued hitherto by countries, on the basis of the reporting template designed to this effect by the United Nations. Findings revealed the scarce attention paid to report national progress on the application of the NUA, particularly marked in the most developed economies. Reporting guidelines showed a poor coverage of the SDGs, being mostly focused on a limited number of these as well as the institutional and economic dimensions. The low level of NUA implementation and the questionable effectiveness of the reporting framework for monitoring are main conclusions. Some recommendations were lastly suggested to enhance the application process of the NUA.

Most countries worldwide show little interest in the application of the New Urban Agenda.

Suicide is one of the main external causes of death worldwide. People who have already attempted suicide are at high risk of new suicidal behavior. However, there is a lack of information on the risk factors that facilitate the appearance of reattempts. The aim of this study was to calculate the risk of suicide reattempt in the presence of suicidal history and psychosocial risk factors and to estimate the effect of each individual risk factor.

This systematic review and meta-analysis were conducted following the PRISMA-2020 guidelines. Studies on suicide reattempt that measured risk factors were searched from inception to 2022. The risk factors studied were those directly related to suicide history: history of suicide prior to the index attempt, and those that mediate the transition from suicidal ideation to attempt (alcohol or drug misuse, impulsivity, trauma, and non-suicidal self-injury).

The initial search resulted in 11 905 articles. Of these, 34 articles were selected for this meta-analysis, jointly presenting 52 different effect sizes. The pooled effect size across the risk factors was significant (OR 2.16). Reattempt risk may be increased in presence of any of the following risk factors: previous history, active suicidal ideation, trauma, alcohol misuse, and drug misuse. However, impulsivity, and non-suicidal self-injury did not show a significant effect on reattempt.

Most of the risk factors traditionally associated with suicide are also relevant when talking about suicide reattempts. Knowing the traits that define reattempters can help develop better preventive and intervention plans.

There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research.

This study aimed to validate proxy tools for the short versions of the Positive and Negative Syndrome Scale (PANSS-6), Young Mania Rating Scale (YMRS-6) and Montgomery–Åsberg Depression Rating Scale (MADRS-6).

A cross-sectional, multicentre study was conducted in a sample of 116 patients with first-episode psychosis from 12 public hospitals in Spain. Concordance between PANSS-6, YMRS-6 and MADRS-6 scores and their respective proxies was evaluated based on information from EHR clinical notes, using a variety of statistical procedures, including multivariate tests to adjust for potential confounders. Bootstrapping techniques were used for internal validation, and an independent cohort from the Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne, Switzerland) for external validation.

The proxy versions correlated strongly with their respective standardised scales (partial correlations ranged from 0.75 to 0.84) and had good accuracy and discriminatory power in distinguishing between patients in and not in remission (percentage of patients correctly classified ranged from 83.9 to 91.4% and bootstrapped optimism-corrected area under the receiver operating characteristic curve ranged from 0.76 to 0.89), with high interrater reliability (intraclass correlation coefficient of 0.81). The findings remained robust in the external validation data-set.

The proxy instruments proposed for assessing psychotic and affective symptoms by reviewing EHR provide a feasible and reliable alternative to traditional structured psychometric procedures, and a promising methodology for real-world practice settings.