影响青年脑卒中短期预后危险因素的系统评价

目的 评估影响青年脑卒中短期预后的危险因素.方法 计算机检索Cochrane图书馆、PubMed、中国学术期刊全文数据库、中国生物医学文献数据库和万方数据库,收集影响青年脑卒中短期预后危险因素的相关文献.应用RevMan 4.2.10软件对各个纳入研究的结果进行一致性检验和数据合并,并评估发表偏倚.结果 共纳入4项研究.系统评价显示危险因素影响短期预后的结果为:发病年龄[WMD=0.32,95％CI( -0.49～1.14)];男性[OR=1.11,95％CI(0.88～1.4)];女性[OR＝0.90,95％CI(0.71～1.13)];高血压病[OR＝1.04,95％CI(0.81～1.33)];糖尿病史[OR＝0.53,95％CI(0.39～0.71)];既往脑卒中家族史[OR=0.61,95％CI(0.37～1.01)];既往TIA史[OR＝2.46,95％CI(1.47～4.12)];甘油三酯水平[WMD＝0.09,95％CI(-0.10～0.27)];胆固醇水平[WMD＝-0.09,95％CI( -0.23～0.05)];入院时血糖水平[WMD=-0.71,95％CI( -1.05～ -0.37)].结论 糖尿病史、既往TIA病史、入院时血糖水平是青年脑卒中患者短期预后的独立预测因子,未发现发病年龄、性别、高血压病史、脑卒中家族史、TG、CHO对青年脑卒中患者短期预后的影响,有待于进一步研究.     

Cryptogenic stroke and patent foramen ovale: clinical clues to paradoxical embolism

BACKGROUND: Patent foramen ovale (PFO) is an independent risk factor for cerebral infarction. Since ~25% of the population have a PFO, the simple association of PFO with stroke is not enough to establish the diagnosis of paradoxical embolism. We evaluated possible clinical clues to the diagnosis of paradoxical embolism. METHODS: Among patients with cryptogenic ischemic stroke (CS) who were investigated for a right-to-left shunt (RLS), we compared clinical, coagulation and biochemical parameters in patients with PFO versus without PFO. RESULTS: Among 1689 new patients referred for TIA/non-disabling stroke between 2001 and 2007, 175 with cryptogenic stroke (CS) were investigated for RLS by transcranial Doppler (TCD) bubble studies; 89 (5.5%) with positive TCD had a PFO confirmed by TEE. In multivariate logistic regression, a history of DVT or pulmonary embolism (OR, 4.39; 95% CI, 1.23-15.69; p=0.023), prolonged travel (OR, 8.77; 95% CI, 1.775-43.3; p=0.008) , migraine (OR, 2.30: 95% CI, 1.07-4.92; p=0.031), a Valsalva maneuver preceding the onset of focal neurological symptoms (OR, 3.33; 95% CI, 1.15-9.64; p=0.026) and waking up with stroke/TIA (OR, 4.53, 95% CI, 1.26-16.2; p=0.018) were independently associated with PFO-associated cerebrovascular events. Patients with PFO had higher plasma total homocysteine levels than patients without PFO (8.9+/-3 versus 7.9+/-2.6 micromol/L respectively; p=0.021). CONCLUSIONS: A history of DVT or pulmonary embolism, migraine, recent prolonged travel, sleep apnea, waking up with TIA or stroke or a Valsalva maneuver preceding the event are clinical clues to the diagnosis of paradoxical embolism among patients with CS.     

C-reactive protein predicts further ischemic events in transient ischemic attack patients

BACKGROUND AND PURPOSE: Although patients with transient ischemic attack (TIA) experience cardiovascular events frequently, strong clinical predictors of recurrence are lacking. High-sensitivity C-reactive protein (hs-CRP) has been shown to be a powerful predictor of future first-ever and recurrent coronary and cerebral ischemic events. We aimed to investigate the relationship between hs-CRP and the risk of further ischemic events in TIA patients. METHODS: High-sensitivity C-reactive protein level was determined <24 h after symptom onset among 135 consecutive TIA patients and stroke recurrence or any new vascular event was recorded during 1 year follow-up period. RESULTS: A total of 38 (28.1%) patients experienced an end point event: 28 (20.7%) cerebral ischemic events, six (4.4%) heart ischemic events, four (3%) peripheral arterial disease, and nine (6.7%) vascular deaths. Cox proportional hazards multivariate analyses identified age [hazard ratio (HR) 1.07, 95% confidence interval (CI) 1.01-1.12, P = 0.01], large-artery occlusive disease (HR 2.73, 95% CI 1.16 to 6.41, P = 0.02) and hs-CRP> 4.1 mg/l (HR 2.81, 95% CI 1.12-7.10, P = 0.03) as independent predictors of stroke. Moreover, age (HR 1.05, 95% CI 1.01-1.10, P = 0.02), large-artery occlusive disease (HR 3.12, 95% CI 1.48-6.58, P < 0.01), coronary disease (HR 2.39, 95% CI 1.11-5.16, P = 0.03), and hs-CRP> 4.1 mg/l (HR 2.71, 95% CI 1.16-6.30, P = 0.02) were also independent predictors of any vascular event. CONCLUSIONS: High-sensitivity C-reactive protein serum level predicts further ischemic events following TIA. Routine CRP measurement might be a useful tool for identifying high-risk TIA patients in order to plan aggressive diagnostic protocols and prevention therapies.     

Obstetric complications and Apgar score in early-onset schizophrenic patients with prominent positive and prominent negative symptoms

The objective of the study was to find associations between obstetric complications (OCs) history and schizophrenia course and symptoms. We analysed the obstetric and psychiatric history of 50 DSM IV schizophrenic subjects who experienced their first schizophrenia episode in adolescence, and 30 healthy controls. Obstetrical data and Apgar scores were obtained from medical records and evaluated with the Lewis and Murray Scale. Based on patients' documentation [including longitudinal evaluation with Positive and Negative Syndrome Scale (PANSS)] the symptom profile and the course of schizophrenia were determined. Results: we distinguished two major groups of patients: with prominent negative and prominent positive symptoms. Schizophrenics with prominent negative symptoms and a chronic schizophrenia course had significantly more definite OCs and lower Apgar scores than patients with prominent positive symptoms and controls. Subjects who had a positive OCs history were more than four times likely to develop schizophrenia in adolescence than those without such a history (OR=4.64; 95% CI=1.29-17.51) with the likelihood of developing schizophrenia with prominent negative symptoms especially high (OR=7.31; 95% CI=1.80-29.65). An Apgar score of between 0 and 3 after birth was associated with an increased risk for developing schizophrenia (OR=2.25; 95% CI=0.56-9.12), especially with prominent negative symptoms (OR=3.71; 95% CI=0.84-16.32). The findings support the hypothesis of a role of OCs in developing early-onset schizophrenia and suggest the associations of the OCs history with a specific symptoms profile (prominent negative symptoms) and a chronic course of schizophrenia.     

Significance of microbleeds in patients with transient ischaemic attack

Background and purpose: The aim of this study was to determine the prognostic significance of microbleeds in TIA‐patients. In patients with a transient ischaemic attack (TIA), the prognostic value of microbleeds is unknown. Methods: In 176 consecutive TIA patients, the number, size, and location of microbleeds with or without acute ischaemic lesions were assessed. We compared microbleed‐positive and microbleed‐negative patients with regard to the end‐point stroke within 3 months. Results: Four of the seven patients with subsequent stroke had microbleeds. Microbleed‐positive patients had a higher risk for stroke [odds ratios (OR) 8.91, 95% CI 1.87–42.51, P < 0.01] than those without microbleeds. Microbleed‐positive patients with accompanying acute ischaemic lesions had a higher stroke risk than those with neither an acute ischaemia nor a microbleed (OR 6.20, 95% CI 1.10–35.12; P = 0.04). Conclusion: Microbleeds alone or in combination with acute ischaemic lesions may increase the risk for subsequent ischaemic stroke after TIA within 3 months.     

Risk factors for multiple intracranial aneurysms

BACKGROUND AND PURPOSE: The presence of multiple intracranial aneurysms may be a sign of significant risk factors for aneurysm formation that differ from those factors that increase risk for aneurysm rupture. Only 2 studies concern independent risk factors for multiple aneurysms, and the results are in part controversial. This study was designed to identify independent risk factors for multiple intracranial aneurysms in patients with subarachnoid hemorrhage. METHODS: Of 266 patients with aneurysmal subarachnoid hemorrhage (139 men and 127 women, aged 15 to 60 years), 80 (30%) had multiple intracranial aneurysms. The prevalence of several health-related habits, previous diseases, and medications of these patients were compared by multiple logistic regression between those with single and those with multiple aneurysms. RESULTS: On the basis of multivariate statistics, only regular cigarette smoking at any time was a significant risk factor for the presence of multiple aneurysms. The odds ratio (OR) of smoking for multiple aneurysms was 2.10 (95% CI, 1.06 to 4.13) after adjustment for age and sex. After additional adjustment for hypertension, the risk was 2.06 (95% CI, 1. 04 to 4.07). Of other variables, only age (OR, 1.02 per year; 95% CI, 1.00 to 1.05; P=0.09) and female sex (OR, 1.60; 95% CI, 0.90 to 2. 85; P=0.11) showed a tendency to increase the risk for multiple aneurysms after adjustment for smoking. On the other hand, patients with hypertension had significantly (P=0.029) more aneurysms (1. 61+/-1.04) than did those without (1.37+/-0.68), although they did not more frequently have multiple aneurysms. CONCLUSIONS: Cigarette smoking and possibly also age and female sex seem to be risk factors for multiple intracranial aneurysms in patients of working age who have suffered a subarachnoid hemorrhage. Patients with hypertension seem to have more aneurysms than those without.     

Social, demographic, and clinical factors related to disruptive behaviour in hospital.

OBJECTIVE: This study addresses 2 issues: first, whether the diagnosis of borderline personality disorder (BPD) or borderline traits differentiates adult patients who demonstrate disruptive behaviour during hospitalization from those patients who do not; and second, whether other clinical variables can be assessed during the emergency visit to differentiate patients who are likely to show disruptive behaviour in hospital from those who are not. METHOD: We completed a case-control, chart-based, retrospective analysis of patients consecutively admitted to an inpatient psychiatric service. We assembled 44 subjects who demonstrated evidence of disruptive behaviour during inpatient hospitalization. These subjects were matched with 61 control subjects admitted during the same time period. Potential participants were excluded if they had a diagnosis of schizophrenia, psychotic disorders, delirium, or dementia or if they had a diagnosis receiving a psychotic specifier. RESULTS: Univariate analyses revealed that patients with disruptive behaviour were significantly more likely to have been diagnosed with BPD or borderline traits than the comparison group (32.6% vs 13.4%; chi2 = 4.45, df 1; P < 0.05). According to stepwise logistic regression analysis, 4 variables significantly contributed to the final model (R2 = 0.37, P < 0.001) predicting disruptive behaviours with the following odds ratios (ORs): Axis III infectious diseases (OR 7.63; 95% CI, 1.41 to 41.67), Axis IV housing problems (OR 3.58; 95% CI, 1.21 to 10.64), history of suicidal behaviours (OR 3.46; 95% CI, 1.24 to 9.71), and problems with primary supports (OR 0.12; 95% CI, 0.03 to 0.46). This last variable was related to a reduced risk of disruptive behaviours in hospital. CONCLUSIONS: Patients at risk for disruptive behaviour during psychiatric hospitalization are characterized by a history of suicidal or impulsive-aggressive behaviour and social disadvantage.     

Mefloquine increases the risk of serious psychiatric events during travel abroad: a nationwide case-control study in the Netherlands

BACKGROUND: Psychiatric events during travel abroad account for a large percentage of medical repatriations arranged by insurance companies. Several risk factors have been proposed for such events, one of these being use of mefloquine. We investigated the risk of psychiatric events during use of mefloquine. METHOD: We performed a nationwide case control study using medical records from 4 large alarm centers in the Netherlands. Cases were patients contacting the alarm centers because of psychiatric events, according to International Code Primary Care code P (all psychiatric symptoms) or International Classification of Diseases, Ninth Edition, codes 290-319 (all psychiatric syndromes). To every case we matched up to 6 controls by alarm center, calendar time, and continent of travel. All controls had contacted the alarm centers because of nonpsychiatric medical reasons. Shortly after the anticipated day of return, cases and controls received a questionnaire regarding travel characteristics, gender, age, marital status, education, weight, height, general health, history of psychiatric diseases, use of medicines, smoking status, alcohol intake, coffee intake, and use of malaria prophylaxis. Dates of travel for the source population were between September 1, 1997, and June 1, 2000. RESULTS: The study population consisted of 111 cases and 453 controls. The risk of psychiatric events during the use of mefloquine was 3.5 (95% CI = 1.4 to 8.7). In females, the risk was strongly increased, with an odds ratio of 47.1 (95% CI = 3.8 to 578.6). Stratification for history of psychiatric diseases showed that the risk of psychiatric events during use of mefloquine in cases without a history of psychiatric diseases was 3.8 (95% CI = 1.4 to 10.1), whereas the risk in cases with a history of psychiatric diseases was 8.0 (95% CI = 1.8 to 35.8). CONCLUSION: The use of mefloquine is associated with an increased risk of psychiatric events in females and in patients with a history of psychiatric diseases.     

Suicide after discharge from psychiatric inpatient care: a case-control study in Hong Kong

OBJECTIVE: To identify the risk period and the risk factors for suicide in Chinese psychiatric patients after discharge from inpatient psychiatric treatment. The nature of psychiatric aftercare provided to these patients was also explored. METHOD: A case control study with 73 patients who were discharged from a large psychiatric unit in Hong Kong between January 1996 and December 1999 and had received coroners' verdict of suicide or undetermined death within the same period. Controls were 73 surviving patients discharged from the same unit. They were individually matched for sex, age, psychiatric diagnosis, and date of discharge. RESULTS: Post-discharge clustering of suicides was observed among the cases. Nearly 80% of them died within 1 year of discharge. The most common principal diagnosis among the cases was schizophrenia and related psychotic disorders. Multivariate analysis showed that suicide was associated with: unemployment (OR = 12.2, 95% CI = 2.1 - 70.4), past suicidal attempts (OR = 3.4, 95% CI = 1.2 - 9.6), maternal mental illness (OR = 13.4, 95% CI = 1.0 - 170.0), and suicidal ideation or attempt before the last admission (OR = 5.0, 95% CI = 1.4 - 18.0). The psychiatric aftercare received by cases and controls were generally similar. However, cases were more likely to have had contact with health care services in the last week before death (OR = 4.0, 95% CI = 1.3 - 11.9). CONCLUSIONS: Suicidal risk is high in Chinese psychiatric patients soon after discharge. They share some common risk factors for suicide identified in Western studies but several differences are evident: the predominance of schizophrenia in the suicides; the lower prevalence of substance abuse and comorbidity; the low proportion of patients living alone; and the increased clinical contact before death but the less suicidal intent expressed in Chinese patients. It is necessary to consider these socio-cultural factors in assessment of suicidal risk and implementation of suicide prevention strategies in Chinese psychiatric patients.     

A community stroke study: Factors influencing stroke awareness and hospital arrival time

Background: One reason patients do not receive thrombolytic therapy for the treatment of stroke is late arrival to the emergency department (ED). One factor could be due to lack of awareness of stroke symptoms. We tested our hypothesis at 2 hospitals in central Illinois. Objective: To determine hospital arrival times and the level of stroke awareness in an urban/rural setting. Methods: Data were collected from transient ischemic attack (TIA)/stroke patients over a 6-month period. Patients were asked if they knew they were having a stroke, time from symptom onset to hospital arrival, and how they arrived at the hospital. Patient medical records were reviewed to determine risk factor data and classify stroke subtype using the Trial of ORG-10172 in Acute Stroke Treatment (TOAST) criteria. Results: Data were obtained from 185 patients. Only 33% of patients arrived at the hospital within 2 hours of symptom onset. Predictors for early arrival were identified as perceived awareness of having a stroke (odds ratio [OR] = 2.13, 95% confidence interval [CI], 1.01-4.46), calling 911 (OR = 3.40, 95% CI, 1.70-6.82), and TIA (OR = 3.57, 95% CI, 1.50-8.61). Twenty-six percent of the patients were aware they were having a stroke. Diagnosis of a TIA was identified as a predictor of stroke awareness (OR = 2.46, 95% CI, 1.01-5.96). Patients who did not have any stroke risk factors were more aware of having a stroke compared with patients who had documented risk factors (OR = 3.33, 95% CI, 1.09-10.0). Conclusions: Results from this study indicate a lack of public knowledge regarding stroke symptoms in this urban/rural community.     

Role of a stroke data bank in evaluating cerebral infarction subtypes: patterns and outcome of 1,776 consecutive patients from the Besançon stroke registry

The purpose of this study was to estimate the frequency of various risk factors, courses and outcome of infarct subtypes in a large hospital-based stroke registry. METHODS: From 1987 to 1994, 1,776 stroke patients with a first-ever infarction were included in the Besan?on Stroke Registry. All patients were evaluated by a standard protocol (risk factors, stroke onset, stroke courses, clinical characteristics, neuroimaging, Doppler ultrasonography and cardiac investigations). Outcome was evaluated at 30 days using the Rankin scale. RESULTS: There were 1,012 men (mean age 67.2 +/- 13.7 years) and 764 women (mean age 71.4 +/- 15.6 years). At least two neuroimaging examinations were performed in 81.4% (n = 1,446) of the patients and an infarct was visible in 80.9% (n = 1,436). The second neuroimaging examination (CT or MRI) was performed after 8.2 +/- 1.6 days. 85.4% of patients were admitted on the first day of the stroke: 28.3% within 3 h and 48.4% within 6 h. In addition, stroke severity was well correlated with the short time interval between stroke onset and admission. Past medical history of hypertension was the major risk factor occurring in 57.5% of all types of infarction. While diabetes was more frequently found in small deep infarct, atrial fibrillation and history of heart failure were found in anterior circulation infarcts. The distribution of clinical presentations was conventional. Hemorrhagic transformation was found in 14.9% of the patients, especially in MCA and PCA infarcts. In all patients, logistic regression analysis determined independent predictive factors for death: clinical deterioration at the 48th hour (OR 7.5, 95% CI 4.9-11.3), initial loss of consciousness (OR 3. 3, 95% CI 2.1-4.9), age (OR 1.05, 95% CI 1.03-1.06), complete motor deficit (OR 2.6, 95% CI 1.7-3.8), history of heart failure (OR 1.9, 95% CI 1.3-3.0), lacunar syndrome (OR 0.25, 95% CI 0.10-0.60) and regressive stroke onset (OR 0.24, 95% CI 0.10-0.52). However, the outcome was clearly correlated with the infarct location. The in-hospital mortality rate was lowest in patients with small deep infarct (2.9%) or border zone infarcts (3.4%) and the highest in patients with total middle cerebral artery infarct (47.4%) or multiple infarcts (27.6%). CONCLUSION: Our registry appears to be a useful tool to understand the course and outcome of a large group of nonselected patients with subtypes of infarction. It can also help to analyze the influence of specific stroke management in the different categories of stroke types.     

Survey of blood pressure control status in patients with ischemic stroke or transient ischemic attack in China

OBJECTIVE: We sought to assess the current status of blood pressure control and the use of antihypertensive drugs in patients with ischemic stroke (IS) or transient ischemic attack (TIA) in China. SUBJECTS AND METHODS: A cross-sectional study (across 19 urban outpatient clinics) on secondary stroke prevention measures was conducted. All subjects diagnosed with IS or TIA at neurological clinics were enrolled consecutively. Face to face interviews were conducted by a trained neurologist and research assistant using questionnaire at the same day of enrollment. RESULTS: A total of 2283 IS or TIA patients were included in the survey. A history of hypertension was present in 1509 patients, of which 896 (59.4%) had uncontrolled blood pressure. A history of hypertension was absent in 603 patients, of whom 162 (26.9%) had uncontrolled blood pressure. In addition, 495 (88.9%) of patients with diabetes mellitus had uncontrolled blood pressure (systolic blood pressure > or = 130 mmHg or diastolic blood pressure > or = 80 mmHg). In multivariate logistic regression analysis, having monthly income of > 1000 yuan [odds ratio (OR): 2.040; 95% confidence interval (CI): 1.277-3.259), female (OR: 1.546; 95% CI: 1.174-2.034) and smoking habits (OR: 1.428; 95% CI: 1.014-2.013) remained significantly associated with blood pressure control. In contrast, compound preparation (OR: 0.685; 95% CI: 0.473-0.993) was inversely associated with the likelihood of blood pressure control. CONCLUSION: Blood pressure control rate among IS or TIA patients in major metropolitan clinics is an important issue in China which might largely influence the efforts in stroke prevention and treatment. Further works are needed to develop substantive quality improvement strategies of stroke secondary prevention care.     

Symptomatic carotid stenosis and stroke risk in patients with transient ischemic attack according to the tissue-based definition

Background and Purpose: Symptomatic carotid stenosis (sCS), a common cause of transient ischemic attack (TIA), is correlated with higher stroke risk. We investigated the frequency and associated factors of sCS in patients with TIA and the association between sCS and stroke risk following TIA. Methods: Over a three-year period (2011–2013), 861 consecutive patients with TIA, who were admitted to the Department of Neurology at the University of Lübeck, Germany, were included in a monocenter study and prospectively evaluated. Diagnosis of TIA was in accordance with the tissue-based definition (transient neurological symptoms without evidence of infarction by brain imaging). Results: Of 827 patients (mean age, 70 ± 13.2 years; 49.7% women), 64 patients (7.7%; 95% confidence interval [CI], 5.9%–9.7%) exhibited sCS and 3 patients (0.3%) showed an occlusion of the corresponding internal carotid artery. Logistic regression revealed that sCS was associated with male sex (odds ratio [OR], 2.7; 95% CI, 1.2–3.6; p = 0.012), amaurosis fugax (OR, 8.1; 95% CI, 3.4–19–4; p < 0.001), unilateral weakness (OR, 3.4; 95% CI, 1.9–6.1; p < 0.001), symptom duration less than 1 h (OR, 2.0; 95% CI, 1.1–3.4; p = 0.019) and previous stroke (OR, 2.7; 95% CI, 1.5–4.7; p = 0.001). During hospitalization (mean, 6.6 days), five patients (0.6%; 95% CI, 0.1%–1.2%) suffered from stroke. The stroke risk was higher in patients with sCS than in those without sCS (6.3% vs. 0.1%; p < 0.001), whereas the recurrent TIA risk (2.6%) did not differ between the groups (4.7% vs. 2.5%; p = 0.29). Conclusion: SCS appears to be associated with a higher risk of stroke in patients with TIA defined according to the tissue-based definition.     

Risk factors and outcome of subtypes of ischemic stroke. Data from a multicenter multinational hospital-based registry. The European Community Stroke Project

BACKGROUND: Information on determinants and prognosis of ischemic stroke subtypes is scarce. We aimed at evaluating risk factors, pathogenesis, treatment and outcome of different ischemic stroke subtypes. METHODS: In a European Concerted Action involving seven countries, ischemic stroke subtypes defined according to the Oxfordshire Community Stroke Project (OCSP) were evaluated for demographics, baseline risk factors, resource use, 3-month survival, disability (Barthel Index) and handicap (Rankin Scale). RESULTS: During the 12-month study period, cerebral infarction was diagnosed in 2740 patients with first-in-a-lifetime stroke (mean age 70.5+/-12.4 years, 53.4% males). OCSP classification was achieved in 2472 (90.2%). Of these, 26.7% were total anterior circulation infarctions (TACI), 29.9% partial anterior circulation infarctions (PACI), 16.7% posterior circulation infarctions (POCI) and 26.7% lacunar infarctions (LACI). In multivariate analysis, atrial fibrillation was predictive of TACI (odds ratio [OR], 1.61; 95% CI, 1.28-2.03), hypertension (OR, 1.38; 95% CI, 1.16-1.65) and myocardial infarction (OR, 1.42; 95% CI, 1.08-1.86) predictive of PACI, hypertension (OR, 1.25; 95% CI, 1.04-1.50) predictive of LACI. A negative association was observed between TACI and hypertension (OR, 0.51; 95% CI, 0.42-0.61). Discharge home was 50% less probable in TACI and PACI than in LACI patients. As compared to LACI, TACI significantly increased the risk of 3-month death (OR, 5.73; 95% CI, 3.91-8.41), disability (OR, 3.27; 95% CI, 2.30-4.66) and handicap (OR, 2.71; 95% CI, 1.91-3.85). CONCLUSIONS: Ischemic stroke subtypes have different risk factors profile, with consequences on pathogenesis and prognosis. Information on determinants of the clinical syndromes may impact on prevention and acute-phase interventions.     

Correlates of schizophrenia spectrum disorders in children and adolescents cared for in community settings

BACKGROUND: This study examined the prevalence and correlates of schizophrenia spectrum disorders (SSD) among a national sample of 9006 children. METHODS: Clinician-assigned diagnoses were used to divide the sample into two groups: children with SSD and children with other Axis I disorders. RESULTS: Three percent of the sample had a SSD diagnosis. African American (OR=1.71, 95% CI: 1.11, 2.65) and Hispanic race/ethnicity (OR=1.96, 95% CI: 1.31, 2.94), a greater number of comorbid psychiatric diagnoses (three diagnoses, OR=2.22, 95% CI: 1.49, 3.31), a history of attempting suicide (OR=1.45; 95% CI: 1.05, 2.02), and past residential treatment (OR=1.59; 95% CI: 1.11, 2.28) were all associated with increased odds of SSD diagnosis. CONCLUSIONS: Although schizophrenia spectrum disorders in youth are rare, children with these disorders present with a distinct risk profile that may inform service planning and delivery and assist in identifying individuals early in the course of their illness.     

Morbidity associated with sleep disorders in primary care: a longitudinal cohort study

Objective: Few epidemiologic studies evaluate the relative contribution of different risk factors on sleep problems. The aim of the present study was to assess demographics, comorbid characteristics, and health outcomes in patients with sleep disorders.Method: A population-based cohort study with nested case-control analysis was conducted in adults using the U.K. General Practice Research Database. Information was collected for 12,437 patients with a new sleep disorder diagnosis during the year 1996 and 18,350 age- and sex-matched controls. Logistic regression analysis was used to compute odds ratios (OR) and 95% confidence intervals (CI).Results: The incidence of a new sleep disorder diagnosis was 12.5 per 1000 person-years. There was a clear association of sleep disorders with smoking and excessive alcohol consumption; prior psychiatric disorders, including stress (OR = 3.6, 95% CI = 2.9 to 4.4) and depression (OR = 3.1, 95% CI = 2.8 to 3.3); prior circulatory diseases, including heart failure (OR = 1.8, 95% CI = 1.4 to 2.2) and coronary heart disease (OR = 1.4, 95% CI = 1.2 to 1.6); and prior gastrointestinal diseases, including gastroesopha-geal reflux disease (OR = 1.4, 95% CI = 1.2 to 1.7) and irritable bowel syndrome (OR = 1.5, 95% CI = 1.2 to 1.9). Use of hypnotics and anti-depressants was increased in the year after diagnosis. Relative 1-year mortality risk was 3-fold higher in the sleep disorder group than in controls, with a noticeably higher proportion of deaths due to suicide.Conclusion: The fact that sleep disorders were associated with several morbidities, most strongly with psychiatric disorders as well as with increased mortality, underscores the importance of sleep problems as indicators of health status.     

Familial and environmental risk factors in Parkinson's disease: a case-control study in north-east Italy

BACKGROUND AND OBJECTIVE: The aetiology of Parkinson's disease remains unknown, although both genetic susceptibility and environmental factors are considered putative contributors to its origin. We performed a case-control study to investigate the association of familial and environmental risk factors with Parkinson's disease (PD). METHODS: We studied 136 patients with neurologist confirmed PD and 272 age- and sex-matched controls, affected by neurological diseases not related to PD. The risk of developing idiopathic PD associated with the following familial and environmental factors: positive family history of PD, positive family history of essential tremor (ET), age of mother at subject's birth, rural birth, rural living, well water use, farming as an occupation, exposure to pesticides, head tremor, exposure to general anaesthesia and to ionizing radiations, food restriction, concentration camp imprisonment and smoking has been assessed by using univariate and multivariate statistical techniques. RESULTS: In the conditional multiple logistic regression analysis, positive family history of PD (OR 41.7, 95% CI 12.2-142.5, P < 0.0001), positive family history of ET (OR 10.8, 95% CI 2.6-43.7, P < 0.0001), age of mother at subject's birth (OR 2.6, 95% CI 1.4-3.7, P=0.0013), exposure to general anaesthesia (OR 2.2, 95% CI 1.3-3.8, P=0.0024), farming as an occupation (OR 7.7, 95% CI 1.4-44.1, P=0.0212) and well water use (OR 2.0, 95% CI 1.1-3.6, P=0.0308) exhibited a significant positive association with PD, whereas smoking showed a trend toward an inverse relationship with PD (OR 0.7, 95% CI 0.4-1.1, P < 0.06). CONCLUSIONS: We conclude that both familial and environmental factors may contribute to PD aetiology.     

A 4-year longitudinal study on risk factors for alcoholism

BACKGROUND: Longitudinal studies are needed to resolve inconsistencies in previous findings regarding antecedents of alcoholism. OBJECTIVE: To investigate genetic and environmental risk factors for alcoholism. DESIGN: A 4-year longitudinal cohort study. SETTING: General community. PARTICIPANTS: A population-based cohort was randomly selected from 4 aboriginal groups in Taiwan. Cohort subjects free from any alcohol use disorder at phase 1 (n=499) were reassessed approximately 4 years later (phase 2). The percentage of participants who completed the study was 98.4%. MAIN OUTCOME MEASURES: A standardized semistructured clinical interview for alcoholism and other psychiatric comorbidity was used in both phases of the study. The main outcome measure was the incidence of alcohol use disorder. Specific risk factors examined included sociodemographic factors, family history of alcoholism, extent of acculturation, psychiatric comorbidity, and alcohol-metabolizing genes. RESULTS: Using Cox proportional hazards regression analysis, the risk for alcoholism was significantly higher among subjects who were male (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.79-4.32), aged 15 to 24 years (OR, 5.05; 95% CI, 2.06-6.18), unmarried (OR, 1.60; 95% CI, 1.03-2.49), and employed (OR, 2.25; 95% CI, 1.34-3.77) and had a higher educational level (OR, 1.76; 95% CI, 1.12-2.75), a family history of alcoholism (OR, 1.73; 95% CI, 1.06-2.83), and a higher extent of cultural assimilation (OR, 2.07; 95% CI, 1.28-3.35). Two specific risk pathways emerged on multivariate analysis: the highest risk was among subjects aged 25 to 34 years with anxiety disorders (OR, 16.86; 95% CI, 3.98-71.41), and the other was among men with the less active ADH2*1 gene (OR, 5.87; 95% CI, 2.73-12.60). CONCLUSION: Based on incidence cases of alcoholism among aboriginal Taiwanese, this study confirms the significant roles of anxiety disorders and of the ADH2*1 allele as antecedents of alcoholism among specific age and sex groups.     

大脑中动脉分布区缺血性卒中患者的临床和影像学特征及复发危险因素

目的 分析大脑中动脉（middle cerebral artery,MCA）分布区非心源性缺血性卒中患者的临床和影像 学特征及复发的危险因素。 方法 连续入选发病7 d以内的MCA分布区非心源性缺血性卒中患者。收集患者的人口学信息、血管 病的危险因素和发病时的主要症状及体征,评价患者的头颅磁共振影像包括急性梗死灶的部位、 数量、分布特征、责任动脉有无狭窄、缺血性卒中的病因分型。随访患者1年内有无缺血性卒中或短暂 性脑缺血发作（transient ischemic attack,TIA）复发,通过多元Logistic回归分析患者复发的危险因素。 结果 研究共入组926例患者,责任MCA狭窄≥70%的患者（447例）常见多发梗死灶（338例,75.6%） 和分水岭梗死（317例,70.9%）,而责任MCA无狭窄或狭窄程度<70%患者（479例）常见MCA穿支分 布区单发梗死灶（247例,55.3%）。冠状动脉粥样硬化性心脏病[比值比（odds ratio,OR）7.55,95%可 信区间（confidence interval,CI）2.85～20.0,P <0.001]、缺血性卒中病史（OR 3.49,95%CI 1.52～8.01, P =0.003）、缺血性卒中发病前3个月内反复TI A史（OR 22.7,95%CI 8.35～61.6,P <0.001）、新发梗死 灶为多发（OR 5.26,95%CI 1.33～20.8,P =0.018）是患者1年内缺血性卒中或TIA复发的危险因素。 结论 对于非心源性缺血性卒中患者,MCA分布区梗死灶的分布特征与MCA狭窄程度有关。新发梗 死灶为多发、既往有缺血性心脑血管病病史的患者1年缺血性卒中或TIA复发风险高。     

颅内外动脉纡曲狭窄特点与临床表现及相关危险因素分析

目的 研究颅内外动脉纡曲狭窄特点与临床表现及相关危险因素。方法 2218例45～89岁患者行全脑血管造影术。根据数字减影血管造影（d igi tal s u btracti onangiography,DSA）影像,将颅内外动脉形态分为动脉纡曲延长和狭窄,临床特点分为头痛头昏、短暂性脑缺血发作（transient ischemic attack,TIA）和脑梗死,危险因素包括高龄、原发性高血压及糖尿病等。应用χ2检验,对动脉纡曲延长、狭窄分布及临床特点进行比较。应用Logistic回归分析对颅内外动脉狭窄纡曲的危险因素进行多因素分析。结果 2218例造影显示动脉纡曲延长和狭窄1816例,动脉纡曲延长发生率为76.1%,动脉狭窄发生率为23.9%。颈内动脉系统“S”型纡曲和“O”型纡曲临床表现为脑梗死分别为40.0%和47.9%。椎-基底动脉系统“S”型纡曲和“O”型纡曲临床表现为TIA,分别为57.6%和25.0%。颈内动脉系统重度狭窄临床表现为TIA（45.3%）和脑梗死（35.8%）。椎-基底动脉系统中、重度狭窄临床表现为TIA,分别为48.6%和48.4%。年龄（OR =3.28,95% CI 2.16～4.75）、原发性高血压（OR =3.17,95% CI2.12～4.69）、体质指数（body mass index,BMI）（OR =2.95,95% CI 2.02～4.31）和糖尿病（OR =2.82,95% CI 1.96～3.87）与颅内外动脉狭窄纡曲密切相关。结论 颅内外动脉纡曲类型及狭窄程度与临床表现之间有明显相关性,颅内外动脉纡曲狭窄的危险因素主要为年龄、原发性高血压、BMI和糖尿病等。