Suicide attempt in first-episode psychosis: A 7.4 year follow-up study

BackgroundIndividuals with first-episode psychosis demonstrate high rates of suicide attempt (SA).Aims1) To examine the prevalence of, and risk factors for, SA in a first-episode psychosis (FEP) cohort over a 7.4 year follow-up period. 2) To investigate differences between single versus multiple suicide attempters.MethodsThis study reports baseline and follow-up data from a naturalistic, prospective follow-up of 413 FEP patients treated at a specialist early psychosis centre. Assessments were conducted at treatment entry, initial symptom remission or stabilization, and long term follow-up. Binary logistic regression models were used to assess unadjusted and adjusted associations between early illness and sociodemographic characteristics and two outcome measures: any SA during follow-up; and multiple SAs.ResultsFollow-up data were available for 282 participants. Sixty-one (21.6%) made a suicide attempt over the follow-up period, including 12 successful suicides. The following baseline risk factors increased the risk of any SA: history of self-harm (OR = 4.27; p < 0.001), suicidal tendencies (OR = 2.30; p = 0.022), being depressed for > 50% of the initial psychotic episode (OR = 2.49; p = 0.045), and hopelessness (OR = 2.03; p = 0.030). History of problem alcohol use increased the risk of multiple SAs (OR = 4.43; 95% CI (1.05–18.7); p = 0.043).DiscussionThe prevalence of suicide attempt in this study exceeds reports from short-term FEP studies but is comparable to longer term follow-up studies, indicating that risk remains elevated for at least 7 years following commencement of treatment. The key predictor of future suicide attempt was previous self-harm, indicating that interventions for self-harm are required.     

Exposure to suicide is associated with increased risk for suicidal thoughts and behaviors among National Guard military personnel

BackgroundResearch suggests that individuals who know someone who died by suicide are at increased risk for posttraumatic stress disorder (PTSD), depression, and recent suicidal thoughts. Studies have not yet investigated the association of suicide exposure with suicide attempts, however, especially among high-risk subgroups of military personnel such as the National Guard.ProceduresAn anonymous online survey was completed by 971 military personnel assigned to the National Guard in Utah and Idaho. Weighted analyses were conducted to ensure demographic matching to the full population. Univariate and multivariate logistic regression was used to test the association of suicide exposure with psychiatric condition, suicide ideation, and suicide attempts.Main findings65.4% of National Guard personnel reported knowing someone who had died by suicide. On average, participants knew 3.0 (SD = 2.0) suicide decedents. Total number of known suicide decedents was associated with significantly increased risk for PTSD (OR = 1.18, p = .008), depression (OR = 1.19, p = .003), and suicide ideation (OR = 2.48, p < .001), but not suicide attempt (OR = 1.34, p = .472). Perceived closeness to the suicide decedent was associated with significantly increased risk for PTSD (OR = 1.54, p < .001), depression (OR = 1.36, p = .031), suicide ideation (OR = 1.24, p = .039), and suicide attempt (OR = 1.69, p = .026). The majority of participants who experienced suicidal thoughts and attempts after the suicide exposure had a previous history of suicide ideation.ConclusionsSuicide exposure is common among National Guard personnel, and is associated with increased risk for PTSD, depression, and suicidal thoughts and behaviors. Risk is highest for those personnel who know multiple suicide decedents and were closer to the suicide decedent.     

Obstructive Sleep Apnea Syndrome in the Sao Paulo Epidemiologic Sleep Study

ObjectiveTo estimate the prevalence of Obstructive Sleep Apnea Syndrome (OSAS), using current clinical and epidemiological techniques, among the adult population of Sao Paulo, Brazil.MethodsThis population-based survey used a probabilistic three-stage cluster sample of Sao Paulo inhabitants to represent the population according to gender, age (20–80 years), and socio-economic status. Face-to-face interviews and in-lab full-night polysomnographies using a nasal cannula were performed. The prevalence of OSAS was determined according to the criteria of the most recent International Classification of Sleep Disorders (ICDS-2) from American Academy of Sleep Medicine (2005).ResultsA total of 1042 volunteers underwent polysomnography (refusal rate = 5.4%). The mean age ± SD was 42 ± 14 years; 55% were women and 60% had a body mass index > 25 kg/m². OSAS was observed in 32.8% of the participants (95% CI, 29.6–36.3). A multivariate logistic regression model identified several independent and strong associations for the presence of OSAS: men had greater association than women (OR = 4.1; 95% CI, 2.9–5.8; P < 0.001) and obese individuals (OR = 10.5; 95% CI, 7.1–15.7; P < 0.001) than individuals of normal weight. The adjusted association factor increased with age, reaching OR = 34.5 (95% CI, 18.5–64.2; P < 0.001) for 60–80 year olds when compared to the 20–29 year old group. Low socio-economic status was a protective factor for men (OR = 0.4), but was an associated factor for women (OR = 2.4). Self-reported menopause explained this increased association (age adjusted OR = 2.1; 95% CI, 1.4–3.9; P < 0.001), and it was more frequent in the lowest class (43.1%) than either middle class (26.1%) or upper class (27.8%) women.ConclusionsThis study is the first apnea survey of a large metropolitan area in South America identifying a higher prevalence of OSAS than found in other epidemiological studies. This can be explained by the use of the probabilistic sampling process achieving a very low polysomnography refusal rate, the use of current techniques and clinical criteria, inclusion of older groups, and the higher prevalence of obesity in the studied population.     

Frequency and predictors of perioperative psychiatric symptom worsening among patients with psychiatric disorders

ObjectiveThis study aimed to clarify the frequency of perioperative psychiatric symptom worsening among patients with psychiatric disorders and investigate factors predictive of symptom aggravation.MethodThis study adopted a retrospective cohort study design. The sample consisted of perioperative inpatients who were diagnosed with psychiatric disorders on admission and received psychiatric intervention between January 1, 2015 and November 31, 2017.ResultsOf 176 inpatients who met our inclusion criteria, 15 (8.5%) exhibited symptom worsening. Factors associated with symptom worsening included changes in surface morphology during surgery (p < 0.01; odds ratio (OR) = 10.58; 95% confidence interval (CI), 3.40–32.87), otolaryngological surgery (p = 0.01; OR = 6.95; 95% CI, 1.81–26.75), stay in the intensive care unit (p < 0.01; OR = 5.65; 95% CI, 1.79–17.81), and surgery duration longer than 180 min (p = 0.03; OR = 3.40; 95% CI, 1.04–11.13).ConclusionThis was the first retrospective analysis to focus on the perioperative worsening of psychiatric symptoms. As only few inpatients exhibited symptom aggravation, general hospitals without psychiatric beds can receive perioperative patients with psychiatric comorbidity. However, caution should be exercised to address the potential worsening of symptoms in cases of surface-morphology changing surgery, otolaryngological surgery, long-duration operations, and when ICU stay is required.     

Psychosocial work-related predictors and consequences of personal burnout among staff working with people with intellectual disabilities

The purposes of this study were to investigate the potential predictors of personal burnout among staff working with people with intellectual disabilities and to investigate whether personal burnout is associated with health and work-related outcomes. A cross-sectional survey was carried out in 2011 in 30 residential facilities in northern Germany (N = 409, response rate 45%). The German standard version of the Copenhagen Psychosocial Questionnaire was used. In a multiple logistic regression analysis, we identified factors which were predictive of personal burnout, such as work–privacy conflict (OR = 1.04, 95% CI 1.03, 1.05), emotional demands (OR = 1.03, 95% CI 1.01, 1.05), role conflicts (OR = 1.02, 95% CI 1.02, 1.03), job insecurity (OR = 1.03, 95% CI 1.01, 1.05) and feedback (OR = 0.98, 95% CI 0.97, 0.99). These factors explained 49% of the total variance. Higher levels of personal burnout were significantly correlated with higher rates of intention to leave the job and cognitive stress symptoms (p < .01). Low values of personal burnout were associated with greater job satisfaction, good general health, and higher satisfaction with life (p < .01). The present study indicates that improving the psychosocial work environment at the organizational level may reduce personal burnout and may also diminish unfavorable outcomes, such as intention to leave or job dissatisfaction.     

Physical trauma and risk of multiple sclerosis: A systematic review and meta-analysis of observational studies

BackgroundWe aimed to examine physical trauma as a risk factor for the subsequent diagnosis of MS.MethodsWe searched for observational studies that evaluated the risk for developing MS after physical trauma that occurred in childhood (≤ 20 years) or “premorbid” (> 20 years). We performed a meta-analysis using a random effects model.ResultsWe identified 1362 individual studies, of which 36 case–control studies and 4 cohort studies met the inclusion criteria for the review. In high quality case–control studies, there were statistically significant associations between those sustaining head trauma in childhood (OR = 1.27; 95% CI, 1.12–1.44; p < 0.001), premorbid head trauma (OR = 1.40; 95% CI, 1.08–1.81; p = 0.01), and other traumas during childhood (OR = 2.31; 95% CI, 1.06–5.04; p = 0.04) and the risk of being diagnosed with MS. In lesser quality studies, there was a statistical association between “other traumas” premorbid and spinal injury premorbid. No association was found between spinal injury during childhood, or fractures and burns at any age and the diagnosis of MS. The pooled OR of four cohort studies looking at premorbid head trauma was not statistically significant.ConclusionsThe result of the meta-analyses of high quality case–control studies suggests a statistically significant association between premorbid head trauma and the risk for developing MS. However, cohort studies did not. Future prospective studies that define trauma based on validated instruments, and include frequency of traumas per study participant, are needed.     

Characteristics of suicide among diabetes patients: A population based study of suicide victims in Northern Finland

ObjectiveRecent case reports of insulin suicides have raised the need to study in detail the suicides among diabetes patients.MethodsThe data consisted of 2489 suicides (2030 men, 459 women) in Northern Finland during 1988 to 2010. The suicide victims with hospital-treated type 1 (n = 27) or type 2 diabetes (n = 51) were compared with those without diabetes (n = 2411).ResultsOf all suicide victims, 3.1% had diabetes (34.6% type 1 and 65.4% type 2 diabetes). 24.0% of victims with type 2 diabetes were under the influence of alcohol when they died from suicide, while the proportion was 44.4% in type 1 diabetes and 46.6% in victims without diabetes (P = 0.007). Compared to those with type 2 diabetes or without diabetes, victims with type 1 diabetes had suffered more commonly from depression (44.4%, 23.5%, 19.9%, respectively) (P = 0.006) and chosen self-poisoning as suicide method (48.1%, 31.4%, and 18.0%) (P < 0.001). In victims with type 1 diabetes insulin as a suicide method covered half of the self-poisoning cases, while the proportion in type 2 diabetes was 13%.ConclusionWe suggest that physicians who treat diabetes patients should evaluate co-occurring depression and substance abuse, both of which are major risk factors of suicide.     

Effects of glutathione S-transferase M1 and T1 deletions on Parkinson's disease risk among a North African population

PurposeIn this study, the effects of glutathione S-transferase polymorphisms Mu1 (GSTM1) and glutathione S-transferase polymorphisms Theta1 (GSTT1) on Parkinson's disease (PD) risk factor were evaluated in a Tunisian population.MethodsThese polymorphisms were analyzed in 229 healthy Tunisian subjects and 64 Tunisian patients with PD, using a polymerase chain reaction (PCR). Statistical analysis was performed using SPSS 18.0. The relative associations between the GST genotypes and PD were assessed by calculating the odds ratios (ORs) and 95% confidence intervals (CIs).ResultsThe study results demonstrated that the individuals with GSTM1 [OR = 3.93, 95% CI: 1.98–7.92, P = 10^?6] and GSTT1 [OR = 5.45, 95% CI: 2.90–10.30, p = 10^?6] were statistically associated with the risk of PD. A significant association was also found between the individuals with both GSTM1/T1 null genotypes and PD risk [OR = 22.10, 95% CI: 6.99–73.75, P = 10^?6].ConclusionThese genotyping findings suggest that the absence of both GSTM1 and GSTT1 activity could be a contributory factor for the development of PD.     

Risk factors associated with short sleep duration among Chinese school-aged children

ObjectivesTo examine risk factors regarding short sleep duration among Chinese school-aged children.MethodsA random sample of 20,778 children aged around 5–11 years participated in a cross-sectional survey, which was conducted in eight cities of China in 2005. A parent-administered questionnaire was used to collect information on children’s sleep duration and possible related factors from eight domains. Short sleep duration was defined as total sleep duration <9 h per day.ResultsIn all, 28.3% of the sampled children slept <9 h per day. The multivariate logistic regression identified, after adjusting for demographic and socioeconomic variables, factors associated with short sleep duration: more television viewing during weekdays (OR = 1.21, p = 0.004), more frequent computer/internet using (OR = 1.17, p = 0.006), earlier school starting time (OR = 1.10, p = 0.020), more time on homework during weekdays (OR = 1.66, p < 0.001) and weekends (OR = 1.14, p = 0.001), poor bedtime hygiene (e.g., having drinks with caffeine after 6:00PM [OR = 1.22, p < 0.001], doing exciting activities during bedtime [OR = 1.16, p < 0.001], and irregular bedtime [OR = 1.55, p < 0.001]), and shorter sleep duration of parents (mother: OR = 1.31, p < 0.001 for sleep duration <6 h and OR = 1.24, p = 0.006 for 6–8 h; father: OR = 1.52, p < 0.001 for <6 h and OR = 1.19, p < 0.001 for 6–8 h).ConclusionsFactors associated with sleep duration covered multidimensional domains among school-aged children. Compared to sleep environments and chronic health problems, school schedules, lifestyle patterns, and parents’ sleep habits had greater impact on children’s sleep duration, indicating the existing chronic sleep loss in school children could be, at least partly, intervened by reducing the use of visual technologies, by changing the school schedules, by improving the sleep hygiene routine, and by regulating parents’ sleep habits.     

Rs3761389 polymorphism in autoimmune regulator (AIRE) gene is associated with susceptibility of myasthenia gravis in Chinese patients

Polymorphism in autoimmune regulator (AIRE) gene is associated with various autoimmune disorders. Abnormal AIRE expression is associated with the development of myasthenia gravis (MG). We investigated the association of polymorphism in AIRE gene and the clinical features and severity of MG. The frequencies of alleles and genotypes were compared between 480 MG patients and 487 healthy controls, as well as among subgroups of MG patients. The frequencies of rs3761389 G allele in MG group (OR = 1.213, CI 95% 1.014–1.451, p = 0.035) and in mild (Oosterhuis score 0–2) subgroup (OR = 1.393, CI 95% 1.110–1.751, p = 0.004) were significantly higher than those in the control group. There were significant differences in the frequencies of rs3761389 genotypes (OR = 1.20, CI 95% 1.00–1.43, p = 0.046, log-additive model) and mild subgroup (OR = 1.32, CI 95% 1.03–1.69, p = 0.0058, log-additive model) compared with the control group. A Logistic regression analysis did not identify rs3761389 genotype as an independent risk factor to predict the severity of MG. This study provides the necessary preliminary data on the association with rs3761389 in AIRE gene with the susceptibility of MG, but not with the severity of MG.     

Sudden unexpected death in epilepsy: Knowledge and experience among U.S. and Canadian neurologists

ImportanceSudden unexpected death in epilepsy (SUDEP) is a common cause of mortality in patients with the disease, but it is unknown how neurologists disclose this risk when counseling patients.ObjectiveThis study aimed at examining SUDEP discussion practices of neurologists in the U.S. and Canada.DesignAn electronic, web-based survey was sent to 17,558 neurologists in the U.S. and Canada. Survey questions included frequency of SUDEP discussion, reasons for discussing/not discussing SUDEP, timing of SUDEP discussions, and perceived patient reactions. We examined factors that influence the frequency of SUDEP discussion and perceived patient response using multivariate logistic regression.ParticipantsThe participants of this study were neurologists who completed postgraduate training and devoted > 5% of their time to patient care.ResultsThere was a response rate of 9.3%; 1200 respondents met eligibility criteria and completed surveys. Only 6.8% of the respondents discussed SUDEP with nearly all (> 90% of the time) of their patients with epilepsy/caregivers, while 11.6% never discussed it. Factors that independently predicted whether SUDEP was discussed nearly all of the time were the following: number of patients with epilepsy seen annually (OR = 2.01, 95% CI = 1.20–3.37, p < 0.01) and if the respondent had a SUDEP case in the past 24 months (OR = 2.27, 95% CI = 1.37–3.66, p < 0.01). A majority of respondents (59.5%) reported that negative reactions were the most common response to a discussion of SUDEP. Having additional epilepsy/neurophysiology training was associated with an increased risk of a perceived negative response (OR = 1.36, 95% CI = 1.02–1.82, p = 0.038), while years in practice (OR = 0.85, 95% CI = 0.77–0.95, p < 0.005) and seeing both adults and children were associated with a decreased likelihood of negative response (OR = 0.15, 95% CI = 0.032–0.74, p = 0.02).ConclusionsU.S. and Canadian neurologists rarely discuss SUDEP with all patients with epilepsy/caregivers though discussions are more likely among neurologists who frequently see patients with epilepsy or had a recent SUDEP in their practice. Perceived negative reactions to SUDEP discussions are common but not universal; more experienced neurologists may be less likely to encounter negative reactions, suggesting that there may be ways to frame the discussion that minimizes patient/caregiver distress.     

El insomnio y la pobre calidad de sueño se asocian a un mal control de crisis en pacientes con epilepsia

ObjectivesThis study aimed to assess the presence of sleep disorders in patients with epilepsy and to analyse their association with seizure control.MethodsWe performed a cross-sectional study of patients with epilepsy, recruited consecutively between September 2017 and December 2018. Patients were classified as having good seizure control (no seizures in the last 4 weeks) or poor seizure control (at least one seizure in the last 4 weeks). We performed intergroup comparisons for demographic and clinical data, insomnia (Insomnia Severity Index [ISI]), excessive daytime sleepiness (Epworth Sleepiness Scale [ESS]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), depression (Beck Depression Inventory-II [BDI-II]), and quality of life (Quality of Life in Epilepsy Inventory-10 [QOLIE-10]).ResultsThe sample included a total of 123 patients, of whom 31.7% had excessive daytime sleepiness (ESS ≥ 10), 50.4% had insomnia (ISI ≥ 10), and 53.6% had poor sleep quality (PSQI ≥ 5). According to our multivariate analysis, presence of seizures was associated with unemployment (odds ratio [OR] = 4.7; 95% confidence interval [CI], 1.36-19.2; P = .02), a higher number of antiepileptic drugs (OR = 5.87; 95% CI, 1.81-27.1; P < .001), insomnia (OR = 1.9; 95% CI, 1.1-9.3; P = .04), and poor sleep quality (OR = 2.8; 95% CI, 1.9-10.32; P = .01).ConclusionsSleep disorders are common in patients with epilepsy. Insomnia and poor sleep quality were associated with poor seizure control. These findings support the hypothesis that sleep disorders constitute a significant comorbidity of epilepsy, especially in patients with poor seizure control.     

Suicide risk among individuals with sleep disturbances in Japan: a case–control psychological autopsy study

ObjectiveThis case–control psychological autopsy study aimed to explore a relationship between sleep disturbances and suicide among Japanese, as well as determine the importance and usability of screening for sleep disturbances in suicide prevention.MethodsA semi-structured interview was conducted with the close family members of 49 adult suicide completers and 145 gender-, age-, and residential municipality-matched living controls. The survey included sections on demographics, sleep disturbances, and mental disorders. Conditional logistic regression analyses were performed to compare sleep disturbance prevalence between the two groups.ResultsA significantly higher prevalence of sleep disturbances was found among the suicide group (75.5%) compared to the controls (11.0%) (odds ratio [OR]=21.6, p < 0.001). The association remained significant after adjusting for mental disorders (OR = 12.7, p < 0.001). The population attributable risk percent of suicide associated with sleep disturbances and mental disorders was estimated to be 56.4% and 35.3%, respectively.ConclusionsThe study confirmed that sleep disturbances are an important risk factor of suicide, independent of mental disorders. Sleep disturbances accounted for a greater proportion of suicide cases than did mental disorders in the Japanese population given the higher prevalence, and could thus be considered an important target in suicide prevention in Japan.     

Impact of insurance status and race on receipt of treatment for acoustic neuroma: A national cancer database analysis

Acoustic neuroma (AN) management involves surgery, radiation, or observation. Previous studies have demonstrated that patient race and insurance status impact in-hospital morbidity/mortality following surgery; however the nationwide impact of these demographics on the receipt of each treatment modality has not been examined. The National Cancer Data Base (NCDB) from 2004 to 2013 identified AN patients. Multivariate analysis adjusted for several variables within each treatment modality, including patient age, race, sex, income, primary payer for care, tumor size, and medical comorbidities. Patients who were African-American (OR = 0.7; 95%CI = 0.5–0.9; p = 0.01), elderly (minimum age 65) (OR = 0.4; 95%CI = 0.4–0.6; p < 0.0001), on Medicare (OR = 0.6; 95% CI = 0.4–0.7; p = 0.0005), or treated at a community hospital (OR = 0.4; 95%CI = 0.2–0.7; p = 0.007) were less likely to receive surgery. Patients on Medicaid (OR = 1.2; 95%CI = 0.8–1.8; p = 0.04) or treated at an integrated network (OR = 1.2; 95%CI = 0.9–1.6; p = 0.0004) were more likely to receive surgery. Patients who were elderly (OR = 2.2; 95%CI = 1.7–2.9; p < 0.0001) or treated in a comprehensive cancer center (OR = 1.5; 95%CI = 1.3–1.9; p = 0.02) were more likely and Medicaid patients (OR = 0.8; 95%CI = 0.5–1.2; p = 0.04) were less likely to receive radiation. Patients who were elderly (OR = 2.2; 95%CI = 1.7–2.7; p < 0.0001), African-American (OR = 1.5; 95%CI = 1.1–2.0; p = 0.01), on Medicare (OR = 1.8; 95%CI = 1.4–2.3; p = 0.0003), or treated in a community hospital (OR = 3.0; 95%CI = 1.6–5.6; p = 0.0007) were more likely to receive observation. Patients on Medicaid (OR = 0.8; 95%CI = 0.5–1.2; p = 0.04) or treated in an integrated network (OR = 0.8; 95%CI = 0.6–1.0; p = 0.0001) were less likely to receive observation. African-American race, elderly age, and community hospital treatment triaged towards observation/away from surgery; age also triaged towards radiation. Conversely, integrated networks triaged towards surgery/away from observation; comprehensive cancer centers triaged towards radiation. Medicaid insurance triaged towards surgery/away from radiation/observation; this may be detrimental since lack of private insurance is a known risk factor for increased in-hospital postoperative morbidity.     

Variant rs1906591 on chromosome 4q25 confers increased risk of cardioembolic stroke in Chinese patients

Ischemic stroke (IS) is a heterogeneous multifactorial disorder caused by both genetic and environmental factors. A genome-wide association study on stroke in Caucasians identified a variant on chromosome 4q25 that is significantly associated with IS, with the strongest risk for cardioembolic stroke (CES). The current study aims to investigate the association of the rs1906591 variant on 4q25 with IS through a case-control study in a Chinese Han population. A total of 712 IS patients and 774 control subjects were involved in the current research. Stroke subtyping was performed according to the Trial of Org 10172 in Acute Stroke Treatment criteria. The genotypes were determined using the SNaPshot technique. The association of the genotypes with the risk of IS was estimated using logistic regression analysis. The rs1906591 single nucleotide polymorphism variant was associated with the CES subtype in both recessive and additive models (recessive model: odds ratio [OR] = 2.58, 95% confidence interval [CI] 1.47–4.53, p = 0.001, adjusted OR = 2.71, 95% CI 1.48–4.96, p = 0.001; additive model: OR = 2.50, 95% CI 1.19–5.25, p = 0.015, adjusted OR = 2.83, 95% CI 1.24–6.50, p = 0.013). This result indicates that patients with the AA genotype have a higher rate of CES than other genotypes. However, the rs1906591 variant was not significantly associated with the overall incidence of stroke or other stroke subtypes. The rs1906591 variant is significantly associated with CES in the Chinese Han population, but not with other stroke subtypes.     

Functional remission and employment among patients with schizophrenia in Malaysia

ObjectiveThe study aimed to determine the rates of functional remission and employment as well as the factors associated with functional remission among patients with Schizophrenia, receiving community psychiatric service in an urban setting in Malaysia.MethodsFrom a total of 250 patients randomly selected, 155 fulfilled the study requirement and were assessed on their functional remission status using the Personal and Social Performance Scale. The relationships between functional remission and socio-demographic factors, clinical factors, social support, symptom remission and rates of hospitalization were examined.ResultsThe results revealed that 74% (n = 115) of the respondents had functional remission with only 20% (n = 31) currently employed. Functional remission was found to be significantly associated with good social support (84.4% versus 36.4% p < 0.001, OR = 9.487 [95% CI = 4.008–22.457]); shorter illness duration of less than 10 years (81.2% versus 66.7% p = 0.038, OR = 2.167 [95% CI = 1.035–4.535]); good medication compliance (79.1% versus 50.0% p = 0.002, OR = 3.778 [95% CI = 1.570–9.090]); hospital admissions of lower than 3 per year (80.5% versus 44.4% p < 0.001 OR = 5.150 [95% CI = 2.145–12.365]) and; symptomatic remission (87.3% versus 37.4% p < 0.001 [95% CI = 0.070 (0.029–0.168]). A multiple regression analysis revealed only social support, lower hospitalization rate and symptom remission, as significant predictors of functional remission.ConclusionA majority of patients with Schizophrenia in this study achieved functional remission, however, only a small percentage of them were employed. Functional remission was influenced by severity of illness and levels of social support in these patients.     

Smoking and sleep disorders in Chinese adolescents

ObjectiveTo investigate the association between adolescent smoking and sleep disorders.MethodsIn the Hong Kong student obesity surveillance project, 29,397 Chinese students, aged 12–18 years, completed a health survey. Insomnia was defined as having any of the following three symptoms: difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and early morning awakening (EMA). The presence of snoring and difficulty breathing during sleep (DBS) was also reported. Logistic regression yielded adjusted odds ratios (ORs) for each sleep disorder by smoking status.ResultsCompared with never smokers, the ORs (95% CI) of insomnia were 1.39 (1.25–1.54) for experimenters (smoked once or a few times) and 0.91 (0.83–1.00) for current smokers. The corresponding ORs were 1.42 (1.16–1.74) and 3.58 (3.15–4.06) for snoring (P for trend < 0.001) and 1.40 (1.10–1.79) and 3.39 (2.97–4.03) for DBS (P for trend < 0.001). Current smokers compared with never smokers were less likely to report DIS (OR = 0.43, 95% CI = 0.38–0.50, P < 0.001) and EMA (OR = 0.83, 95% CI = 0.73–0.94, P = 0.003), but more likely to report DMS (OR = 1.45, 95% CI = 1.28–1.63, P < 0.001).ConclusionsIn terms of dosage, adolescent smoking was associated with snoring and DBS, with increasing ORs from never smokers to experimental and current smokers. Current smoking was associated positively with DMS, but negatively with DIS and EMA.     

Association of stress coping strategies with Internet addiction in college students: The moderating effect of depression

BackgroundThis study examined the association between stress-related coping strategies and Internet addiction and the moderating effect of depression in a sample of Taiwanese college students.MethodA total of 500 college students (238 men and 262 women) participated in this study. Internet addiction was assessed using the Chen Internet Addiction Scale. Participants’ stress coping strategies and depressive symptoms were measured using the Coping Orientation to Problems Experienced and the Beck Depression Inventory-II, respectively. We used t and chi-square tests to examine differences in demographic characteristics, depression, and stress coping strategies between participants with and without Internet addiction. Significant variables were used in a logistic regression model to examine the association between stress coping strategies and Internet addiction and the moderating effect of depression on the association.ResultsResults indicated that use of restraint coping was negatively associated with Internet addiction (odds ratio [OR] = 0.886, 95% confidence interval [CI]: 0.802–0.977), whereas denial (OR = 1.177, 95% CI: 1.029–1.346) and mental disengagement (OR = 2.673, 95% CI: 1.499–4.767) were positively associated with Internet addiction. Depression had a moderating effect on the association between denial and Internet addiction (OR = 0.701, 95% CI: 0.530–0.927).ConclusionsStress coping strategies and depression are important factors to evaluate when developing intervention programs targeting college undergraduate students with Internet addiction.     

A cohort study of patients with anemia on admission and fatality after acute ischemic stroke

Reduced blood hemoglobin levels may impair oxygen delivery to the brain and hinder neurological improvement. We prospectively registered consecutively hospitalized Chinese patients with acute ischemic stroke within 24 hours of symptom onset to investigate whether anemia on admission influences case fatality and functional outcome of acute ischemic stroke at 12 months. Anemia was defined as a blood hemoglobin level of < 120 g/L for women, and < 130 g/L for men. We also performed a meta-analysis of the current cohort and previously published studies. We included 1176 patients, of whom 351 patients (29.8%) had anemia. Age (odds ratio [OR] = 1.02, 95% confidence interval [CI]: 1.01–1.03), history of hemorrhagic stroke (OR = 3.34, 95% CI: 1.17–9.56), alcohol consumption (OR = 0.59, 95% CI: 0.38–0.92), and estimated glomerular filtration rate < 60 mL/minute per 1.73 m² (OR = 1.34, 95% CI: 1.00–1.80) were the independent predictors of anemia. After adjustment for potential confounders, anemia on admission was shown to be an independent predictor of death at discharge and at 12 months (OR = 1.66, 95% CI, 1.08–2.56; OR = 1.56, 95% CI, 1.05–2.31). A meta-analysis of six included studies involving 3810 participants confirmed that anemia on admission was an independent predictor of death at the end of follow-up (OR = 1.67, 95% CI, 1.25–2.08). Further studies are required to confirm these findings.