World's Greatest Public Health Research Articles

Trends in the impact of suicide compared to other external causes of death: From 1995 to 2020

BackgroundSuicide is one of the world's greatest public health problems. More than 700,000 people lose their lives to suicide every year. While funding for mental health waits to be increased, thousands of suicides occur every day. Material and methodsThis study aims to quantify the global impact of suicide compared to other external causes of death in terms of years of potential life lost (YPLL), and how this will change between 1995 and 2020. Our source of information is the World Health Organization (WHO) mortality database. We then use YPLL, a standard measure of premature mortality and burden of disease that brings precision to the assessment of the impact of different causes of death. This, combined with the compound annual growth rate (CAGR) as a way of expressing increase, gives us a better understanding of the real situation and trends of suicide compared to other external causes of death in different countries worldwide. ResultsBased on the available sources of information and the selection criteria, we obtained a sample of 69 countries. The CAGR for all causes per capita decreased over the observed period in 65 countries, and it increases in 4 countries. In contrast, the CAGR specifically for suicide decreased in 49 countries, while an increase was observed in 20 countries. ConclusionsPrevention of most external causes of mortality shows promising data in most countries. However, this is not the case for suicide. Thus, YPLL due to suicide have decreased to a comparatively lesser extent and have even increased in some countries, a very worrying situation that poses many clinical and epidemiological challenges.

Knowledge of breast cancer and self-diagnostic skills amongst women in the United Arab Emirates

Background: Globally, breast cancer remains one of the world's greatest public health problems and a leading cause of death. Breast malignancies are considered as the major sites for tumors diagnosed in the United Arab Emirates (UAE) and they pose a significant concern for the general public's well-being. Aim: To conduct a descriptive cross-sectional study to determine the knowledge of breast cancer and self-diagnostic skills amongst women in the UAE. Methodology: The study was conducted for 1 month, based on an online survey designed via Microsoft Forms. It composed of 20 closed multiple-choice questions, which helped to assess the participant's knowledge of breast cancer and self-diagnostic skills. A total of 584 female participants were included in the study, out of which 498 (85.3%) were Emirati while 86 (14.7%) were non-Emirati females. Results: Despite the government's effort in enhancing breast cancer awareness programs across the UAE, only 6% of the females had excellent knowledge about breast cancer, 35% good, 46% average and 13% demonstrated poor knowledge. While only 4% had excellent breast self-examination skills, 17% had good skills, 61% had average skills and 18% had poor skills. A more concerning point was the least concern that females had towards non-lump breast cancer symptoms. Results from the current study showed that UAE female residents have an average knowledge of breast cancer and poor breast cancer self-diagnostic skills. Conclusion: The UAE government must emphasize the importance of breast screening practices, which may positively enhance breast-screening responses and practices amongst women in the UAE.

Proteínas homólogas de unión a reticulocitos de Plasmodium falciparum involucradas en el proceso de invasión al eritrocito: Revisión de la literatura

Introducción. La malaria es uno de los mayores retos de salud pública a nivel mundial, es causada principalmente por los parásitos Plasmodium falciparum y Plasmodium vivax. Durante el proceso de invasión, se encuentran involucradas las proteínas homólogas de unión a reticulocitos de Plasmodium falciparum PfRH1, PfRH2a, PfRH2b, PfRH4 y PfRH5, que tras su unión a receptores específicos de membrana permiten la invasión del merozoíto al eritrocito. Objetivo. Compilar y resumir las características moleculares y estructurales de las interacciones entre las proteínas pertenecientes a la familia de proteínas homólogas de unión a reticulocitos de Plasmodium falciparum y los receptores expresados en la célula del hospedero. Método. Revisión descriptiva sobre las proteínas homólogas de unión a reticulocitos de Plasmodium falciparum involucradas en el proceso de invasión al eritrocito. Esta revisión, incluye literatura publicada hasta el año 2020 en bases de datos electrónicas especializadas en investigación biomédica. Se encontraron 105 documentos, de los cuales se seleccionaron 70 y se excluyeron 11 por no presentar los criterios de inclusión, analizando un total de 59 referencias. Conclusión. La invasión del merozoíto es mediada por interacciones específicas de los ligandos de las familias EBL y PfRH. La unión de las proteínas PfRH1 y PfRH2b a sus receptores en el eritrocito, dan lugar a la liberación de la proteína EBL-175, que junto con PfRH4 median la formación de una unión estrecha entre el parásito y los glóbulos rojos, permitiendo así, la unión de la proteína PfRH5 a basigina y la entrada del parásito a la célula del hospedero.

Caracterización clínica-epidemiológica de pacientes con coinfección criptococosis - VIH del Hospital José Rodríguez 2015 – 2016

Contexto: La criptococosis una micosis sistémica producida por el Cryptococcus neoformans se presenta en pacientes con VIH/SIDA con inmunosupresión avanzada causando la muerte de las dos terceras partes de éstos pacientes. Objetivo: Caracterizar clínica y epidemiológicamente los pacientes que presentan coinfección criptococosis y VIH del Hospital José Daniel Rodríguez Maridueña en el período 2015 - 2016. Metodología: Estudio descriptivo, transversal, retrospectivo basado en el análisis de las historias clínicas de los pacientes con diagnóstico de ingreso de criptococosis y VIH, del Hospital Dr. José Rodríguez ingresados entre los años 2015 y 2016. Analizado mediante Razón de prevalencias y OR e IC95% calculado mediante distribución binomial y la interacción entre las variables se analizó mediante regresión logística. Resultados: La tasa de coinfección fue 46,7% (IC95% 39,48-53,84), el análisis conjunto de las variables demostró que estas personas son menores de 32 años (ORajustada 2,24; IC95% 1,09-4,57), casado o en unión libre (ORajustada 2,56; IC95% 1,26-5,26), que supera la primaria (ORajustada 3,36; IC95% 1,52-7,42), consumidor de drogas (ORajustada 2,63; IC95% 1,28-5,26), con una carga viral mayor a 100000 copias de RNA/mL (ORajustada 3,74; IC95% 1,80-7,80). Conclusiones: El perfil de riesgo del paciente con coinfección criptococosis y VIH fue ser adulto joven, casado o en unión libre, con un nivel de instrucción superior a la primaria, que consume drogas, con una carga viral mayor a 100000 copias de RNA/ml.

The Antidepressant and Cognitive Improvement Activities of the Traditional Chinese Herb Cistanche

More than ten percent of people suffer from at least one episode of depression and related mental disorders in a lifetime, and depression and related mental disorders are one of the world's greatest public health problems. A multiple system theory holds that dysregulation of the multiple systems underlies the pathogenesis of depression and related mental disorders, and new therapies based on the multiple system dysregulation theory are urgently needed. In this study, the antidepressant effect of decoction from herb Cistanche deserticola Y.C.Ma and Cistanche tubulosa was examined. Herb Cistanche decoction reduced the immobility period significantly in the mouse tail suspension test. Mice treated with herb decoction showed an improved ability of spatial learning and memory in the Morris water maze test. Groups treated herb decoction displayed a downregulated monoamine oxidase (MAO) activity; the dopamine (DA) concentration in the brain was upregulated, indicating herb Cistanche decoction improved the nerve excitability; the serum concentration of corticosterone (CORT) was downregulated, showing that mice benefited from a reduced stress level. Hence, the antidepressant efficacy and mechanism of traditional Chinese herb Cistanche were explored in this study. Herb Cistanche showed a potential to be developed as a complementary and alternative therapy for depression.

Aberrant H3.3 dynamics in NAc promote vulnerability to depressive-like behavior

Human major depressive disorder (MDD), along with related mood disorders, is among the world's greatest public health concerns; however, its pathophysiology remains poorly understood. Persistent changes in gene expression are known to promote physiological aberrations implicated in MDD. More recently, histone mechanisms affecting cell type- and regional-specific chromatin structures have also been shown to contribute to transcriptional programs related to depressive behaviors, as well as responses to antidepressants. Although much emphasis has been placed in recent years on roles for histone posttranslational modifications and chromatin-remodeling events in the etiology of MDD, it has become increasingly clear that replication-independent histone variants (e.g., H3.3), which differ in primary amino acid sequence from their canonical counterparts, similarly play critical roles in the regulation of activity-dependent neuronal transcription, synaptic connectivity, and behavioral plasticity. Here, we demonstrate a role for increased H3.3 dynamics in the nucleus accumbens (NAc)-a key limbic brain reward region-in the regulation of aberrant social stress-mediated gene expression and the precipitation of depressive-like behaviors in mice. We find that molecular blockade of these dynamics promotes resilience to chronic social stress and results in a partial renormalization of stress-associated transcriptional patterns in the NAc. In sum, our findings establish H3.3 dynamics as a critical, and previously undocumented, regulator of mood and suggest that future therapies aimed at modulating striatal histone dynamics may potentiate beneficial behavioral adaptations to negative emotional stimuli.

The usefulness for indicated prevention of severe mental disorders should play a central part in the further development of CBT.

Schizophrenic, severe major depressive and bipolar disorders often do not respond sufficiently to the usual pharmacotherapy and therefore constitute the world's greatest public health problem (1). Thus, we have every reason to be happy that we can offer cognitive behavior therapy (CBT) as an effective non-pharmacological adjunct to the millions of people who are treated for those conditions worldwide. Obviously there are methodological problems as well as discrepant and negative results in numerous studies and meta-analyses on the effectiveness of complementary CBT in the above disease groups. Overall, however, the evidence speaks much more for than against the assumption that CBT or CBT-oriented strategies may improve the outcome of pharmacological treatment and prophylaxis, especially for treatment-resistant or chronic patients. On the other hand, the “promise of CBT” should not be overestimated in this important area of therapeutics. Taken as a whole, the hitherto achieved effects are only moderate, and data concerning bipolar disorders are not sufficient. Also, the evidence of efficacy for CBT should not mean that other approaches are now excluded from the search for useful psychotherapies for severe mental disorders. The traditional vulnerability-stress-coping models and also the newer salience theory of psychoses (2) offer a good framework for the development and use of psychological treatment strategies. They show, in fact, that different environmental stressors as well as personal and environmental protective factors may be involved in each individual case. CBT programs can target various but obviously not all of these psychosocial factors. Furthermore, important psychosocial influences such as trauma or migration interact with genetic-epigenetic and other biological factors (3). Therefore, even enthusiastic psychotherapists should not ignore that treatment and prophylaxis of severe mental disorders primarily deal with the current correction and future prevention of disorder-specific neuronal network pathologies in the human brain. The more we understand these pathologies, the more it will be possible to correct the network alterations by means of targeted neuromodulation. Research is currently testing new psychotropic drugs, neuroprotective substances and various brain stimulation methods to achieve this goal. The debate on “promise and limitations of CBT” reflects the presently unsatisfactory state of development. To date there are still no really causally effective psychotropic drugs available for the treatment of severe mental disorders, due to the lack of knowledge about etiology. That is why we try to combine substances which only influence the final pathogenetic pathways, and therefore are only partially effective, with complementary psychological interventions. Here, CBT has proven particularly useful, as it has a favorable impact on some of the psychosocial factors which are important for the release of and coping with the clinical symptoms. Nevertheless, the therapeutic problems are far from being solved, and the search for causal treatment approaches must go on. The directions for future research should include further testing of CBT in the initial high-risk states of psychosis or bipolar disorders (4). In persons who have already suffered from long courses of these diseases, with relapses or chronicity, CBT can only be an adjunct and at best produce the effects described in Thase et al's paper (5). Often the primary therapeutic goal of recovery is not at all achievable and what can be obtained is only coping with symptoms or loss of functions in order to reduce the burden of the disease and improve the quality of life. On the contrary, in the high-risk states, which can nowadays be characterized very well for psychoses (6) and increasingly better for severe mood disorders (7), we just observe initial changes of experience which, depending on the individual constellation of stressors and protective factors, can progress or not to the actual disease. The prevention of the outbreak of severe mental disorders is what is meant by the concept of indicated prevention (8). Right from the beginning, CBT was involved in the studies of indicated prevention of schizophrenia and has repeatedly been shown to be effective as the sole therapy without concurrent use of medication (9). It seems to be able to even prevent the transition of early cognitive disorders into attenuated psychotic symptoms and their transition into full schizophrenic symptoms (10). If this approach of indicated prevention is successfully transferred also to severe mood disorders, it promises to be much more useful in the fight against the world's greatest public health problem than the late adjunctive strategy (11).

Antidepressant Activity of Astilbin: Involvement of Monoaminergic Neurotransmitters and BDNF Signal Pathway

Depression and related mood disorders are among the world's greatest public health problems. Previous studies have demonstrated that astilbin (AST) has broad pharmacological functions which may modulate numerous pathways, such as antioxidant, scavenging free radicals, anti-inflammatory and so on, similarly to some of other flavonoids. In this study, the antidepressant-like effect of AST was investigated using chronic unpredictable mild stress (CUMS) model of depression in mice. The results showed that chronic administration of AST at doses of 10, 20 and 40 mg/kg (intraperitoneally (i.p.), 21 d) reduced depressive-like behaviors of mice in the forced swim test (FST), tail suspension test (TST) and sucrose preference test (SPT) without affecting locomotor activity. AST increased the contents of serotonin (5-HT) and dopamine (DA) in the frontal cortex of CUMS mice. Additionally, it was shown that AST treatment restored the CUMS-induced inhibition of extracellular signal-regulated kinase (ERK) 1/2 and AKT phosphorylation in the frontal cortex, conformed to the brain-derived neurotrophic factor (BDNF) expression. Our findings suggest that AST has antidepressant activities and the mechanisms, at least in part, relate to up-regulation of monoaminergic neurotransmitters (5-HT and DA) and activation of the BDNF signaling pathway.

Neutralization of endogenous digitalis-like compounds alters catecholamines metabolism in the brain and elicits anti-depressive behavior

Depressive disorders are among the world's greatest public health problems. Na +, K +-ATPase is the established receptor for the steroidal digitalis-like compounds (DLC). Alteration in brain Na +, K +-ATPase and DLC have been detected in depressive disorders raising the hypothesis of their involvement in these pathology. The present study was designed to further elaborate this hypothesis by investigating the behavioral and biochemical consequences of neutralization in brain DLC activity attained by anti-ouabain antibodies administrations, in normal Sprague–Dawley (SD) and in the Flinders Sensitive Line (FSL) of genetically depressed rats. Chronic i.c.v. administration of anti-ouabain antibodies to FSL rats elicited anti-depressive behavior. Administration of anti-ouabain antibodies intracerebroventriculary (i.c.v.) to SD rats significantly changed the levels of catecholamines and their metabolites in the hippocampus, ventral tegmentum and nucleus accumbence. These results are in accordance with the notion that endogenous DLC may be involved in the manifestation of depressive disorders and suggests that alteration in their levels may be of significant therapeutic value.

Antidepressant Effects of a Plant-Derived Flavonoid Baicalein Involving Extracellular Signal-Regulated Kinases Cascade

Depression and related mood disorders are among the world's greatest public health problems. Previous studies have demonstrated that baicalein (Bai), one plant-derived active flavonoid, exhibits neuroprotection against ischemic brain injury and stimulates the levels of phosphorylation of extracellular signal-regulated kinase (pERK) and brain-derived neurotrophic factor (BDNF) expression in vivo. In this study, the antidepressant-like effects of baicalein was investigated using acute and chronic animal models of depression. The results showed that acute application of Bai at doses of 1, 2 and 4 mg/kg by intraperitoneal injection (i.p.) significantly reduced the immobility time in the forced swimming test (FST) and tail suspending test (TST) of mice. In addition, the chronic application of Bai by i.p. for 21 d also reduced the immobility time and improved locomotor activity in chronic unpredictable mild stress (CMS) model rats. Furthermore, it was shown that Bai reversed the reduction of extracellular ERKs phosphorylation and the level of BDNF expression in the hippocampus of CMS model rats. These results suggest that Bai produce an antidepressant-like effect and this effect is at least partly mediated by hippocampal ERK-mediated neurotrophic action.

Pharmacotherapy of Mood Disorders

The mood disorders-primarily major depressive disorder and bipolar affective disorder-constitute one of the world's greatest public health problems and are associated with significant reductions in productivity, health, and longevity. In addition, people who suffer from these common illnesses, along with their families and loved ones, experience an incalculable toll on quality of life. Dating to the introduction of the first effective therapies for mood disorders in the late 1950s and 1960s, various types of pharmacotherapy have become a mainstay for the management of mood disorders, particularly more severe, chronic, and recurrent forms of depression and most forms of bipolar disorder. This review examines recent developments in the pharmacotherapy of both forms of mood disorder, comparing the newer antidepressants such as the selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors with their predecessors (the monoamine oxidase inhibitors and tricyclic antidepressants) and likewise comparing the older standard for management of bipolar disorder, lithium, with newer classes of medications, such as a selected group of anticonvulsants and the atypical antipsychotics. Although these newer classes of medications have generally improved upon the earlier treatments in terms of better tolerability and safety, there are no universally effective pharmacologic treatments for mood disorders, and careful medical management of these medications is still warranted.

Recent advances in our understanding of human host responses to tuberculosis

Tuberculosis remains one of the world's greatest public health challenges: 2 billion persons have latent infection, 8 million people develop active tuberculosis annually, and 2–3 million die. Recently, significant advances in our understanding of the human immune response against tuberculosis have occurred. The present review focuses on recent work in macrophage and T-cell biology that sheds light on the human immune response to tuberculosis. The role of key cytokines such as interferon-γ is discussed, as is the role of CD4+ and CD8+ T cells in immune regulation in tuberculosis, particularly with regard to implications for vaccine development and evaluation.