Antidepressants are essential in managing depression, including treatment-resistant cases. Public perceptions of these medications, shaped by social media platforms like X (formerly Twitter), can influence treatment adherence and outcomes. This study explores public attitudes toward antidepressants through sentiment and topic modeling analysis of tweets in English and Spanish from 2007 to 2022.

Tweets mentioning antidepressants approved for depression were collected. The analysis focused on selective serotonin reuptake inhibitors (SSRIs) and glutamatergic drugs. Sentiment analysis and topic modeling were conducted to identify trends, concerns, and emotions in discussions across both languages.

A total of 1,448,674 tweets were analyzed (1,013,128 in English and 435,546 in Spanish). SSRIs were the most mentioned antidepressants (27.9% in English, 58.91% in Spanish). Pricing and availability were key concerns in English tweets, while Spanish tweets highlighted availability, efficacy, and sexual side effects. Glutamatergic drugs, especially esketamine, gained attention (15.61% in English, 25.23% in Spanish), evoking emotions such as fear, sadness, and anger. Temporal analysis showed significant increases in discussions, with peaks in 2012 and 2021 for SSRIs in Spanish, and exponential growth from 2018 to 2021 for glutamatergic drugs. Emotional tones varied across languages, reflecting cultural differences.

Social media platforms like X provide valuable insights into public perceptions of antidepressants, highlighting cultural variations in attitudes. Understanding these perceptions can help clinicians address concerns and misconceptions, fostering informed treatment decisions. The limitations of social media data call for careful interpretation, emphasizing the need for continued research to improve pharmacovigilance and public health strategies.

Achieving sustainability on the ground poses a challenge in decoding globally defined goals, such as sustainable development goals, and aligning them with local perspectives and realities. This decoding necessitates the understanding of the multifaceted dimensions of the sustainability challenges in a given context, including their underlying causes. In case studies from Brazilian drylands, we illustrate how an enhanced multiscale participatory method, combined with systems thinking tools, can shed light on systemic structures that currently entrench unsustainable development trajectories. This method offers insights into co-designing potential pathways toward sustainable futures and unlocking transformative capacities of the local population.

Translating United Nations global sustainable development goals (SDGs) into actions that address local realities and aspirations is an urgent challenge. It requires new thinking and approaches that foster the discussion about the main challenges to implementing the SDGs at multiple levels. This paper presents a novel multiscale participatory approach that combines the popular Three Horizons diagram with the formalism of causal loop diagrams in systems thinking. We present results from six multi-stakeholder dialogues held across drylands in Brazil with a focus on desired futures aligned with SDGs. Focusing on identifying the root causes and systemic structures of unsustainability, participants identified lock-ins, leverage points, and interventions for how these could be changed. The core lock-ins are the discontinuity of public policies, and the historical land and power concentration reinforced by the current expansion of large-scale agricultural, mining, and energy projects. The proposed interventions are structural and – if implemented – would contribute to achieving SDGs in an integrated manner. The unique approach developed in this study can provide leverage as it bridges the inclusivity of participatory visioning with the change potential of systems thinking tools to tackle root causes and unleash societal transformations.

We are not achieving SDGs. Understanding root causes of unsustainability is critical to move toward sustainable and just futures.

Suicide poses a severe public health challenge worldwide, impacting individuals, families, work, and society. The multifaceted nature of suicide demands a complex approach involving psychological, biological, social, cultural, and environmental factors. Recognizing suicide’s status as the leading external cause of death in Spain, prevention increasingly incorporates technology, specifically mobile and software applications.

A systematic review of the effectiveness and safety of mobile and software applications was conducted (MEDLINE, Embase, CINAHL, and PsycINFO databases). Outcome variables included: suicide; suicidal behavior; suicidal intent; suicidal ideation/thinking; self-perceived suicide risk; using/seeking mental health services; associated mental symptoms; mental health-related quality of life; satisfaction of the user and the health professional; adverse events related to the app, as defined in the included studies. Studies that do not include suicidal behavior, intention, or ideation were excluded. Where available data allowed, a meta-analysis was conducted for each outcome variable.

One systematic review and 13 randomized controlled trials (n=2,952) were analyzed. No significant differences were found in deaths by suicide or suicide attempts. At post-intervention, small but significant reductions were observed in suicidal ideation, hopelessness, depression, and worry, with anxiety reduction slightly above statistical significance. At follow-up (8 to 52 weeks), these variables also obtained significant results, except depression and suicidal ideation. Regarding safety, there was no significant difference in safety phone calls for participants with suicidal ideation.

The evidence on suicide prevention app effectiveness is of low quality, precluding conclusive findings. Attempt reduction is suggested at 21 percent, but the confidence interval includes a potential 60 percent increase. Evidence on suicide-related psychological variables (suicide ideation, depression, hopelessness, and anxiety) is of higher quality (low–moderate), but effects are small and clinically uncertain. Safety findings are uncertain, impacting risk/benefit balance.

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.

Epilepsy affects approximately 10.5 million individuals under the age of 15 years worldwide. In Spain, 3.7 per 1,000 inhabitants aged 6 to 14 years have epilepsy, making it the third most common neurological emergency. Drug resistance is observed in eight to 33 percent of cases. Responsive neurostimulation (RNS) systems could improve seizure control in pediatric patients who are not eligible for brain surgery.

We systematically searched for articles published up to September 2022 in the following bibliographic databases: MEDLINE, Embase, Web of Science, and CINAHL. We included primary experimental and observational studies as well as case series studies addressing the safety, efficacy, and cost effectiveness of RNS in the treatment of drug-resistant pediatric epilepsy.

Two systematic reviews of prospective and retrospective case series studies and four primary experimental studies were identified. The case series studies found that a large proportion of pediatric patients responded to RNS, with a reduction of between 50 and 75 percent in the frequency of seizures. The intensity and duration of seizures also decreased after using RNS. Adverse effects of the RNS implantation process were related to infections, erythema, and hematomas. Only one study (n=17) reported moderate adverse effects related to stimulation (dysesthetic pain in the upper and lower right limb), but there were no serious reactions leading to RNS discontinuation.

Randomized controlled trials in pediatric drug-resistant populations ineligible for brain surgery with adequate sample sizes are needed to determine the effectiveness of RNS in terms of seizure frequency, duration, and intensity. No cost-effectiveness studies have been conducted on RNS in this cohort.

There is heterogeneity in the long-term trajectories of depressive symptoms among patients. To date, there has been little effort to inform the long-term trajectory of symptom change and the factors associated with different trajectories. Such knowledge is key to treatment decision-making in primary care, where depression is a common reason for consultation. We aimed to identify distinct long-term trajectories of depressive symptoms and explore pre-treatment characteristics associated with them.

A total of 483 patients from the PsicAP clinical trial were included. Growth mixture modeling was used to identify long-term distinct trajectories of depressive symptoms, and multinomial logistic regression models to explore associations between pre-treatment characteristics and trajectories.

Four trajectories were identified that best explained the observed response patterns: “recovery” (64.18%), “late recovery” (10.15%), “relapse” (13.67%), and “chronicity” (12%). There was a higher likelihood of following the recovery trajectory for patients who had received psychological treatment in addition to the treatment as usual. Chronicity was associated with higher depressive severity, comorbidity (generalized anxiety, panic, and somatic symptoms), taking antidepressants, higher emotional suppression, lower levels on life quality, and being older. Relapse was associated with higher depressive severity, somatic symptoms, and having basic education, and late recovery was associated with higher depressive severity, generalized anxiety symptoms, greater disability, and rumination.

There were different trajectories of depressive course and related prognostic factors among the patients. However, further research is needed before these findings can significantly influence care decisions.

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.

Contextual memory, which refers to the ability to remember spatial or temporal circumstances related to an event, is affected early in Alzheimer’s Disease (AD). Computerized cognitive tasks have been suggested to be an ecological way to assess memory, but there are few studies that utilize these tools. Studying contextual memory via a computerized task in a Colombian kindred with autosomal dominant AD due to the Presenilin-1 (PSEN1) E280A mutation and a well-characterized disease progression may help us understand contextual memory changes in the preclinical AD stage. In this study we investigated whether a novel computerized task examining contextual memory can help identify those at increased risk for dementia.

A group of 31 non-carriers (mean age=38.97±6.11; mean education=11.45±4.34) and 15 cognitively unimpaired PSEN1E280A mutation carriers from the Colombia-Boston (COLBOS) Biomarker Study (mean age=35.67±5.50), mean education=10.60±3.83) performed the “MAPP Room Memory Task” on a computer. As part of this task, participants are asked to remember ten rooms and the specific location of a few objects for later recall. During the immediate recall phase, participants are asked to recognize the objects presented in each room (Immediate Object Recognition) and their location (Immediate Object Placement). During the subsequent delay phase of the task, participants are asked to select the correct room in which an object was first presented (Delayed Room Recognition) and place the objects previously seen in each room (Delayed Object Placement). We conducted Mann Whitney U tests to analyze differences between groups and Spearman Rho correlations to examine associations among the Room Memory Task performance, age, education, and Mini Mental State Examination (MMSE).

There were no differences in age or education between carriers and non-carriers (p>0.05, for both). Carriers had worse Delayed Room Recognition than non-carriers (Carriers mean score=0.893±0.18, non-carriers mean score=0.987±0.05; U=168.0, p=0.02), while there were no differences in the other task conditions (all p>0.05). In carriers, education was positively associated with Immediate Object Placement (rs=0.61, p=0.02), Delayed Object Placement (rs=0.76, p=0.001), and Delayed Room Recognition (rs=0.68, p=0.006). There were no significant associations between Room Memory Task conditions and age or MMSE scores in carriers. Further, no significant associations were observed between Room Memory Task performance, and age, education or MMSE scores in non-carriers.

Our preliminary findings show that the MAPP Room Memory Task, in particular the Delayed Room Recognition condition, may be helpful to discriminate those at increased risk of dementia. Future studies with larger samples using the Room Memory Task and AD-related biomarkers are needed to examine whether this task can be sensitive to early preclinical changes associated with AD and can potentially help track disease progression in those at risk.

Although several studies have documented the impact of the COVID-19 pandemic on mental health, the long-term effects remain unclear.

To examine longitudinal changes in mental health before and during the consecutive COVID-19 waves in a well-established probability sample.

An online survey was completed by the participants of the COVID-19 add-on study at four time points: pre-COVID-19 period (2014–2015, n = 1823), first COVID-19 wave (April to May 2020, n = 788), second COVID-19 wave (August to October 2020, n = 532) and third COVID-19 wave (March to April 2021, n = 383). Data were collected via a set of validated instruments, and analysed with latent growth models.

During the pandemic, we observed a significant increase in stress levels (standardised β = 0.473, P < 0.001) and depressive symptoms (standardised β = 1.284, P < 0.001). The rate of increase in depressive symptoms (std. covariance = 0.784, P = 0.014), but not in stress levels (std. covariance = 0.057, P = 0.743), was associated with the pre-pandemic mental health status of the participants. Further analysis showed that secondary stressors played a predominant role in the increase in mental health difficulties. The main secondary stressors were loneliness, negative emotionality associated with the perception of COVID-19 disease, lack of resilience, female gender and younger age.

The surge in stress levels and depressive symptoms persisted across all three consecutive COVID-19 waves. This persistence is attributable to the effects of secondary stressors, and particularly to the status of mental health before the COVID-19 pandemic. Our findings reveal mechanisms underlying the surge in mental health difficulties during the COVID-19 waves, with direct implications for strategies promoting mental health during pandemics.

It has been estimated that about 5 million people of those affected with otitis media have cholesteatoma, however, its pathophysiology is unclear. In this study we aimed to detect Helicobacter pylori via polymerase chain reaction and real-time polymerase chain reaction in young patients with chronic otitis media.

Patients included in our prospective cross-sectional study had middle-ear/mastoid inflammation and underwent surgical procedures. Middle-ear mucosa samples were collected, and genomic DNA was extracted for H pylori detection by polymerase chain reaction and real-time polymerase chain reaction analyses. Sociodemographic data and gastroesophageal reflux symptoms were analysed.

We included 49 patients with mean age of 12.7 ± 3.8 years. Twenty per cent of the patients were diagnosed with cholesteatoma. No increase in H pylori-amplified fluorescence was observed, indicating absence of H pylori.

Due to the absence of amplification for H pylori and the fact that albumin was amplified in all samples, we conclude that H pylori does not appear to be a causal factor.