Association of schizophrenia with low maternal body mass index, small size at birth, and thinness during childhood

BACKGROUND: Nutritional factors in early life may contribute to the neurodevelopmental deficit in schizophrenia. This study explores the influence of maternal body size, size at birth, and childhood growth on future risk for schizophrenia. SUBJECTS AND METHODS: This population-based cohort study comprised births at Helsinki University Central Hospital in Helsinki, Finland, from 1924 to 1933. Prospective data from birth and school health records of 7086 individuals were collected and linked to the Finnish Hospital Discharge Register. RESULTS: Schizophrenia or schizoaffective disorder had been diagnosed in 114 individuals. A lower late-pregnancy maternal body mass index (BMI) increased the risk (odds ratio [OR], 1.09 per kilogram/meter(2); 95% confidence interval [CI], 1.02-1.17) for schizophrenia among the offspring. The risk of schizophrenia increased with low birth weight (OR, 1.48 per kilogram; 95% CI, 1.03-2.13), shortness at birth (OR, 1.12 per centimeter; 95% CI, 1.03-1.22), and low placental weight (OR, 1.22 per 100 g; 95% CI, 1.04-1.43). Schizophrenia cases were thinner than comparison subjects from 7 to 15 years of age. In a joint model comprising late-pregnancy maternal BMI, body size at birth, and childhood BMI, childhood BMI was an independent predictor of schizophrenia, whereas other factors exhibited attenuated effects. CONCLUSION: Indicators of intrauterine and childhood undernutrition are associated with an increased lifetime risk of schizophrenia.     

Is carbamazepine teratogenic? A prospective controlled study of 210 pregnancies

The Israeli Teratogen Information Service prospectively followed up 210 pregnancies with first trimester carbamazepine exposure. Pregnancy outcome was compared with that of two overlapping controls, matched and general (n = 629), exposed to nonteratogenic agents. Our study suggests a twofold increase in the rate of major congenital anomalies (12/160 [carbamazepine] versus 18/560 [general control]; relative risk 2.24; 95% CI 1.1-4.56) and a birth weight reduction of approximately 250 g after in utero exposure to carbamazepine.     

Women with schizophrenia: pregnancy outcome and infant death among their offspring

Schizophrenia in the mother may imply an increased risk of adverse pregnancy outcome. However, inconclusive findings, unknown pathological mechanisms and possible confounding by social factors and smoking requests further explorations. The aim of this study were to (1) examine non-optimal pregnancy outcome using data from a population-based cohort, controlling for covariates known to influence fetal growth; and (2) perform separate analyses of women diagnosed before childbirth and women hospitalized for schizophrenia during pregnancy. The study sample comprised 2096 births by 1438 mothers diagnosed with schizophrenia (of whom 696 mothers were antenatal diagnosed and 188 admitted during pregnancy) and 1,555,975 births in the general population. We found significantly increased risks for stillbirth, infant death, preterm delivery, low birth weight, and small-for-gestational-age among the offspring of women with schizophrenia. Women with an episode of schizophrenia during pregnancy had the highest risks (e.g., low birth weight; OR 4.3, 95% CI 2.9-6.6 and stillbirth; OR 4.4, 95% CI 1.4-13.8). Controlling for a high incidence of smoking during pregnancy among schizophrenic women (51% vs. 24% in the normal population) and other maternal factors (single motherhood, maternal age, parity, maternal education, mothers' country of birth and pregnancy-induced hypertensive diseases) in a multiple regression model, reduced the risk estimates markedly. However, the risks for adverse pregnancy outcomes were even after adjustments generally doubled for women with an episode of schizophrenia during pregnancy compared to women in the control group (e.g., low birth weight; OR 2.3, 95% CI 1.5-3.5, preterm delivery; OR 2.4, 95% CI 1.5-3.8 and stillbirth; OR 2.5, 95% CI 0.8-7.9). The risks for preterm delivery and low birth weight were significantly elevated throughout the analyses. We conclude that schizophrenia in the mother implies an increased risk for poor perinatal outcome, not fully explained by maternal factors, and a need to consider a common familial (probably genetic) vulnerability for pre- and perinatal stress and schizophrenia.     

Pregnancy, delivery and perinatal outcome in female survivors of polio

OBJECTIVE: To investigate possible effects on pregnancy, delivery and perinatal outcome in female survivors of polio. METHODS: In a cohort design, data from the national population based Medical Birth Registry of Norway (MBRN) were used to compare all 2495 births recorded 1967-1998 by female survivors of polio with all 1.9 mill non-polio deliveries. The results were adjusted for time period, maternal age, and birth order by unconditional logistic regression, with effects presented as adjusted Odds Ratios (OR) with a corresponding 95% Confidence Interval (CI) and p values. RESULTS: Female polio survivors had a higher occurrence of pre-eclampsia (3.4% vs. 2.8%, p=0.003, OR=1.4, CI=1.1-1.7), gestational proteinuria (1.3% vs. 0.5%, p<0.001, OR=2.0, CI=1.4-2.8), renal disease prior to pregnancy (1.4% vs. 0.9%, p=0.001, OR=1.8, CI=1.2-2.5), vaginal bleeding (3.8% vs. 2.0%, p<0.001, OR=1.7, CI=1.4-2.1), and urinary tract infection during pregnancy (3.5% vs. 2.4%, p<0.001, OR=1.7, CI=1.4-2.1). Deliveries complicated by obstruction of the birth process were more common in the polio group (6.1% vs. 2.0%, p<0.001, OR=4.8, CI=4.0-5.6), and cesarean section was performed at a higher rate throughout the time period (13.2% vs. 8.3%, p<0.001, OR=2.7, CI=2.4-3.1). Infants of polio mothers had a lower mean birth weight (3383 g vs. 3483 g, p<0.001), and more often had a birth weight below 2500 g (6.9% vs. 5.2%, p=0.001, OR=1.3, CI=1.1-1.5). There was no difference regarding pregnancy length. The risk of perinatal death was increased (2.1% vs. 1.1%, p=0.05, OR=1.3, CI=1.0-1.7). CONCLUSION: Pregnancy in female survivors of polio is associated with an increased risk for complications during pregnancy and delivery, as well as an adverse perinatal outcome. Awareness towards risk factors should improve pre-natal care and possibly prevent complications.     

Night waking in Thai infants at 3 months of age: association between parental practices and infant sleep

BACKGROUND AND PURPOSE: Night waking is common among infants and can create sleep deficit in both parents and infants. Sleep practices are influenced by cultural variations which may affect the prevalence and associated factors of frequent night waking. Our objective was to determine whether differences in parental practices related to infant sleep are associated with frequent night waking in Thai infants. METHODS: A cross-sectional survey based on interviews with parents of infants aged three months, birth weight greater than 2500 g, conducted under the Prospective Cohort study of Thai Children (PCTC). RESULTS: Of the total sample, 82.9% (3172 of 3826) of parents provided completed night waking information. The mean number (+/-standard deviation [SD]) of awakenings per night was 2.7+/-1.1, 47.3% awoke 1-2 times per night, and 46.9% awoke 3-4 times per night. The group of frequent night wakers (more than 14 night wakings per week, n=1634) was compared with the group of infrequent night wakers (n=1538). Significant and independent associations were present between frequent night waking and male gender (odds ratio [OR] of 1.5; 95% confidence interval [CI], 1.3-1.8), more than three naps per day (OR, 1.3; CI, 1.1-1.5), use of a swinging or rocking cradle (OR, 1.5; CI, 1.2-1.98), falling asleep while feeding (OR, 1.3; CI, 1.1-1.5), and breastfeeding only (OR, 1.2; CI, 1.1-1.4). No significant association was noted between frequent night waking and parental age, education, occupation, household income, type of parental response to infant's nighttime crying, or type of diaper. CONCLUSION: An association with frequent night waking was demonstrated with various factors of parental practice related to infant sleep, such as number of naps, use of a swinging or rocking cradle, breastfeeding only, and falling asleep while feeding. Further documentation of these associations may be clinically important. Implementing preventive interventions may be able to reduce frequent night waking in early infancy.     

Effect of dose on the frequency of major birth defects following fetal exposure to lamotrigine monotherapy in an international observational study

Data from the International Lamotrigine Pregnancy Registry were analyzed to examine the effect of maximal first-trimester maternal dose of lamotrigine monotherapy on the risk of major birth defects (MBDs). Among 802 exposures, the frequency of MBDs was 2.7% (95% confidence interval [CI] 1.8-4.2%). The distribution of dose did not differ between infants with and those without MBDs (mean 248.3 milligrams per day [mg/day] and 278.9 mg/day, respectively, median 200 mg/day for both groups). A logistic regression analysis showed no difference in the risk of MBDs as a continuous function of dose (summary odds ratio [OR] per 100 mg increase =0.999, 95% CI 0.996-1.001). There was also no effect of dose, up to 400 mg/day, on the frequency of MBDs.     

Alcohol consumption is associated with a decreased risk of venous thrombosis

Moderate alcohol consumption is associated with lower levels of several coagulation factors. It is an established protective factor for cardiovascular disease; however, the effect on venous thrombosis is unknown. In a large population-based case-control study, we evaluated the association between alcohol consumption and the risk of venous thrombosis. The MEGA study included consecutive patients with a first venous thrombosis between March 1999 and September 2004 from six anticoagulation clinics in the Netherlands. Partners of patients were asked to participate, and additional controls were recruited using a random digit dialling method. All participants completed a standardized questionnaire, and blood samples were collected. A total of 4,423 patients and 5,235 controls were included in the analyses. Alcohol consumption was associated with a reduced risk of venous thrombosis, with 2-4 glasses per day resulting in the largest beneficial effect (odds ratio [OR] 0.67, 95% confidence interval [CI95] 0.58-0.77) compared to abstainers. The effect was more pronounced in women (OR 0.66, CI95 0.53-0.84) than men (OR 0.82, CI95 0.63-1.07) and also more striking for pulmonary embolism (OR 0.56, CI95 0.46-0.70) than for deep venous thrombosis of the leg (OR 0.74, CI95 0.63-0.88). Compared to abstainers, fibrinogen levels were decreased in individuals who consumed alcohol (maximum decrease: 0.30 g/l). Factor VII and von Willebrand levels were mildly decreased in these individuals but not consistently over the categories of alcohol consumption. In conclusion, alcohol consumption is associated with a reduced risk of venous thrombosis, which may be in part mediated by decreased fibrinogen levels.     

Gene polymorphisms in the TNF locus and the risk of myocardial infarction

We investigated two genetic polymorphisms in the tumor necrosis factor locus (TNF-alpha -308 G-->A and LT-alpha +252 A-->G) as risk factors for coronary atherothrombotic disease (CAD) by determining its prevalence in 148 survivors of myocardial infarction (MI) with angiographically-proven severe CAD, and in 148 age-, gender- and race-matched controls. The odds ratio (OR) for MI related to the mutant TNF-alpha and LT-alpha alleles was 0.8 (CI95: 0.4-1.3) and 1. 3 (CI95: 0.8-2.0), respectively. We also sought interaction of smoking and metabolic risk factors for MI with each mutant genotype. Smokers not carrying the LT-alpha +252 A-->G mutation had a risk of MI of 2.7 (CI95: 1.4-5.4) whereas in smoking carriers the risk was 6. 9 (CI95: 3.4-14.1). An interactive effect of the LT-alpha mutation may also exist with dyslipidemia (OR for MI in non-carriers was 12 [CI95: 3.2-41.3] and in carriers the OR was 39, [CI95: 5.1-301] and with obesity (OR for MI was 2.7, [CI95: 1-7.2] in non-carriers and in carriers the OR was 6 [CI95: 2.1-16.8]). Lastly, the OR for MI in obese non-carriers of TNF-alpha -308 G-->A was 2.8 (CI95: 1.3-6) and in obese carriers the OR was 14.5 (CI95: 1.8-113). Although significant interactive effects could not be detected, the findings suggest that interaction of polymorphisms in the TNF locus with major risk factors for CAD may exist, and should be explored in larger studies.     

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.     

Associations between psychotic-like experiences and mental health status and other psychopathologies among Japanese early teens

Psychotic-like experiences (PLEs) are considered predictive of mental health problems later in life. However, little has been known about the mental health status and psychopathological distress in adolescents with PLEs in the general population. To investigate the associations between PLEs and mental health status or psychopathologies in a community sample of adolescents in a school-based cross-sectional fashion, PLEs were studied using a self-rating questionnaire in 5073 Japanese junior-high school students aged 12-15 years. Mental health status was evaluated using the 12-item General Health Questionnaire (GHQ-12). Psychopathologies, lifestyle, victimization, and interpersonal and help-seeking attitudes were also studied using a self-rating questionnaire. Fifteen percent of the students reported definitely having experienced at least one PLE. A dose-response relationship between the severity of PLEs and the prevalence of poor mental health status was observed. PLEs were also significantly associated with psychopathologies (strong anxiety in the classroom: OR = 1.4, 95% CI 1.2-1.6; suicidal ideation: OR = 2.1, 95% CI 1.8-2.4; self-harm behaviors: OR = 1.4, 95% CI 1.0-1.9; difficulty falling asleep due to hypersensitivity to environmental noise: OR = 1.7, 95% CI 1.4-2.0; difficulty concentrating due to hypersensitivity to environmental noise: OR = 1.5, 95% CI 1.3-1.8; physically assaulting others: OR = 1.3, 95% CI 1.0-1.5; bullying others, OR = 1.3, 95% CI 1.1-1.5; irritability when exchanging e-mails: OR = 1.3, 95% CI 1.0-1.6). Adolescents with PLEs in the community suffer from a wide range of psychopathological problems during crucial developmental periods [corrected]     

Congenital anomalies associated with autism spectrum disorders

This study examined whether major congenital structural anomalies identified in infancy occurred more frequently in children later diagnosed with autism spectrum disorders (ASD; n=417; 341 males, 76 females) than in comparison children (n=2,067; 1,681 males, 386 females). Participants were sampled from infants born at Kaiser Permanente Northern California facilities between 1995 and 1999 who remained health plan members for at least 2 years (n=88,163). Comparison children were frequency-matched to children with ASD according to sex, birth year, and birth hospital. Congenital anomalies were diagnosed in 10.8% of children with ASD and 6.2% of comparison children (crude odds ratio [ORc] 1.8, 95% confidence interval [CI] 1.3-2.6). This association remained significant after adjustment for key maternal and infant covariates (adjusted OR [ORa] 1.7, 95% CI 1.1-2.4). Almost all organ-system anomaly categories were more prevalent in children with ASD, however only gastrointestinal anomalies were significantly associated with ASD in adjusted analyses (1.9 vs 0.4%, ORa 5.1, 95% CI 1.8-14.1).     

Very preterm birth, birth trauma, and the risk of anorexia nervosa among girls.

BACKGROUND: Obstetrical complications, based on parental recall, have been reported to be associated with development of anorexia nervosa. We used prospectively collected data about pregnancy and perinatal factors to examine the subsequent development of anorexia nervosa. METHODS: This population-based, case-control study was nested in cohorts defined by all liveborn girls in Sweden from 1973 to 1984. From the Swedish Inpatient Register, 781 girls had been discharged from any hospital in Sweden with a main diagnosis of anorexia nervosa at the age of 10 to 21 years. For each case, 5 controls were randomly selected, individually matched by year and hospital of birth (n = 3905). Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for potential risk factors. RESULTS: Increased risk of anorexia nervosa was found for girls with a cephalhematoma (OR, 2.4; 95% CI, 1.4-4.1) and for very preterm birth (< or = 32 completed gestational weeks) (OR, 3.2; 95% CI, 1.6-6.2). In very preterm births, girls who were small for gestational age faced higher risks (OR, 5.7; 95% CI, 1.1-28.7) than girls with higher birth weight for gestational age (OR, 2.7; 95% CI, 1.2-5.8). CONCLUSIONS: Our results show that perinatal factors, possibly reflecting brain damage, had independent associations with anorexia nervosa. These risk factors may uncover the mechanisms underlying the development of the disorder, even if only a fraction of cases of anorexia nervosa may be attributable to perinatal factors.     

Toxoplasma gondii and other risk factors for schizophrenia: an update

The failure to find genes of major effect in schizophrenia has refocused attention on nongenetic, including infectious factors. In a previous study, antibodies to Toxoplasma gondii were found to be elevated in 23 studies of schizophrenia (OR 2.73; 95% CI 2.10-3.60). The current study replicates this finding with 15 additional studies (OR 2.71; 95% CI 1.93-3.80) and compares this with other identified schizophrenia risk factors. The highest risk factors are having an affected mother (relative risks [RR] 9.31; 95% CI 7.24-11.96), father (RR 7.20; 95% CI 5.10-10.16), or sibling (RR 6.99; 95% CI 5.38-9.08) or being the offspring of immigrants from selected countries (RR 4.5; 95% CI 1.5-13.1). Intermediate risk factors, in addition to infection with T. gondii, include being an immigrant from and to selected countries (RR 2.7; 95% CI 2.3-3.2), being born in (RR 2.24; 95% CI 1.92-2.61) or raised in (RR 2.75; 95% CI 2.31-3.28) an urban area, cannabis use (OR 2.10-2.93; 95% CI 1.08-6.13), having minor physical anomalies (OR 2.23; 95% CI 1.42-3.58), or having a father 55 or older (OR 2.21-5.92; 95% CI 1.46-17.02). Low-risk factors include a history of traumatic brain injury (OR 1.65; 95% CI 1.17-2.32), sex abuse in childhood (OR 1.46; 95% CI 0.84-2.52), obstetrical complications (OR 1.29-1.38; 95% CI 1.00-1.84), having a father 45 or older (OR 1.21-1.66; 95% CI 1.09-2.01), specific genetic polymorphisms (OR 1.09-1.24; 95% CI 1.06-1.45), birth seasonality (OR 1.07-1.95; 95% CI 1.05-2.91), maternal exposure to influenza (RR 1.05; 95% CI 0.98-1.12), or prenatal stress (RR 0.98-1.00; 95% CI 0.85-1.16).     

Overweight, weight concerns, and bulimic behaviors among girls and boys.

OBJECTIVE: To assess the prevalence rates and correlates of overweight, concern with weight, and bulimic behaviors. METHOD: A survey was completed by a population-based sample of 16,114 boys and girls aged 9 to 14 years. RESULTS: Although fewer girls (19%) than boys (26%) were overweight, more girls (25% versus 22%) perceived themselves as overweight (p < .001). The proportion of girls reporting trying to lose weight increased with age (p < .001). The prevalence of binge eating at least monthly increased with age among the girls, but remained stable among the boys. The prevalence of purging was low (< or = 1%) and comparable between genders until age 13. Among the 13- and 14-year-olds, girls were significantly more likely than boys to report using laxatives or vomiting to control weight (p < or = .001). Purging was independently positively associated with stage of pubertal development (girls: odds ratio [OR] = 2.1, 95% confidence interval [CI] 1.6-2.7; boys: OR = 1.5, 95% CI 1.0-2.2) and overweight (girls: OR = 1.9, 95% CI 1.2-3.0; boys: OR = 2.7, 95% CI 1.4-5.1). CONCLUSIONS: Misperception of being overweight and concern with weight were common. Purging was a very rare behavior, but increased with pubertal development. Among the girls, the prevalence increased sharply around the onset of adolescence.     

Low molecular weight heparin versus aspirin for acute ischemic stroke: A systematic review

Aspirin is the standard treatment for acute ischemic stroke, although heparins are widely prescribed. We performed a systematic review of randomized controlled trials to compare the safety and efficacy of low molecular weight heparins (LMWH) with aspirin in acute ischemic stroke. Two completed randomized controlled trials involving 1,933 patients were identified; 1 trial only included patients with presumed cardioembolic stroke. As compared with aspirin, treatment with heparin was associated with a significant reduction in symptomatic venous thromboembolism (odds ratio [OR] - 0.29, 95% confidence interval [CI] - 0.12-0.66) and an increase in major extracranial hemorrhage (OR - 2.57, 95% CI - 1.01-6.52). Nonsignificant increases in end-of-treatment case fatality (OR - 1.35, 95% CI - 0.87-2.08) and symptomatic intracranial haemorrhage (OR - 1.82, 95% CI - 0.68-4.87) were seen; symptomatic intracranial haemorrhage was significantly raised (OR - 4.26, 95% CI - 1.04-17.4) with heparin in patients treated within 24 hours of stroke onset. Stroke recurrence (OR - 1.24, 95% CI - 0.79-1.94) and deterioration (OR - 1.13, 95% CI - 0.85-1.50) during treatment and end-of-trial death (OR - 1.00, 95% CI - 0.77-1.30) or dependency and case fatality (OR - 1.03, 95% CI - 0.85-1.25) did not differ between the 2 treatments. No benefit of LMWH over aspirin was seen in patients with presumed cardioembolic stroke. Low molecular weight heparin should not replace aspirin in the routine management of patients with ischemic stroke, including those with presumed cardioembolic stroke. Copyright © 2002 by National Stroke Association     

Comparison of Alzheimer's disease risk factors in white and African American families

The associations between alcohol, smoking, and head injury and the risk of AD in 443 African American and 2,336 white participants in the MIRAGE Study were evaluated. Alcohol had a modest protective effect in whites (odds ratio [OR] = 0.82, 95% CI = 0.68 to 0.99), with a similar trend in African Americans (OR = 0.88, 95% CI = 0.54 to 1.4). Head trauma increased the risk of AD in whites (OR = 2.3, 95% CI = 1.8 to 3.0) and African Americans (OR = 2.9, 95% CI = 1.2 to 7.0). Smoking was not associated with AD risk in whites (OR = 0.88, 95% CI = 0.73 to 1.1) or African Americans (OR = 1.0, 95% CI = 0.69 to 1.5). These risks were similar across subsets stratified by the presence or absence of the APOE epsilon4 allele.     

Mortality in epilepsy in the first 11 to 14 years after diagnosis: multivariate analysis of a long-term, prospective, population-based cohort

The United Kingdom National General Practice Study of Epilepsy is a prospective, population-based study of newly diagnosed epilepsy. A cohort of 792 patients has now been followed for up to 14 years (median follow-up [25th, 75th percentiles] 11.8 years, range 10.6-11.7 years), a total of 11,400 person-years. These data are sufficient for a detailed analysis of mortality in this early phase of epilepsy. Over 70% of patients in this cohort have developed lasting remission from seizures, although the mortality rate in the long term was still twice that of the general population. The standardized mortality ratio (SMR), the number of observed deaths per number of expected deaths, was 2.1 (95% confidence interval [CI] = 1.8, 2.4). Patients with acute symptomatic epilepsy (SMR 3.0; 95% CI = 2.0, 4.3), remote symptomatic epilepsy (SMR 3.7; 95% CI = 2.9, 4.6), and epilepsy due to congenital neurological deficits (SMR 25; 95% CI = 5.1, 73.1) had significantly increased long-term mortality rates, whereas patients with idiopathic epilepsy did not (SMR 1.3; 95% CI = 0.9, 1.9). This increase in mortality rate was noted particularly in the first few years after diagnosis. Multivariate Cox regression and time-dependent co-variate analyses were utilized for the first time in a prospective study of mortality in epilepsy. The former showed that patients with generalized tonic-clonic seizures had an increased risk of mortality. The hazard ratio (HR), or risk of mortality in a particular group with a particular risk factor compared to another group without that particular risk factor, was 6.2 (95% CI = 1.4, 27.7; p = 0.049). Cerebrovascular disease (HR 2.4; 95% CI = 1.7, 3.4; p < 0.0001), central nervous system tumor (HR 12.0; 95% CI = 7.9, 18.2; p < 0.0001), alcohol (HR 2.9; 95% CI = 1.5, 5.7; p = 0.004), and congenital neurological deficits (HR 10.9; 95% CI = 3.2, 36.1; p = 0.003) as causes for epilepsy and older age at index seizure (HR 1.9; 95% CI = 1.7,2.0; p < 0.0001) were also associated with significantly increased mortality rates. These hazard ratios suggest that epilepsy due to congenital neurological deficits may carry almost the same risk of mortality as epilepsy due to central nervous system tumors and that epileptic seizures subsequent to alcohol abuse may carry almost the same risk of mortality as epilepsy due to cerebrovascular disease. The occurrence of one or more seizures before the index seizure (the seizure that led to the diagnosis of epilepsy and enrolment in the study) was associated with a significantly reduced mortality rate (HR 0.57; 95% CI = 0.42, 0.76; p = 0.00001). Time-dependent co-variate analysis was used to examine the influence of ongoing factors, such as seizure recurrence, remission, and antiepileptic drug use, on mortality rates in the cohort. Seizure recurrence (HR 1.30; 95% CI = 0.84, 2.01) and antiepileptic drug treatment (HR 0.97; 95% CI = 0.67, 1.38) did not influence mortality rate. There were only 5 epilepsy-related deaths (1 each of sudden unexpected death in epilepsy, status epilepticus, burns, drowning, and cervical fracture), suggesting that death directly due to epileptic seizures is uncommon in a population-based cohort with epilepsy.     

Same-sex sexual behavior and psychiatric disorders: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)

BACKGROUND: It has been suggested that homosexuality is associated with psychiatric morbidity. This study examined differences between heterosexually and homosexually active subjects in 12-month and lifetime prevalence of DSM-III-R mood, anxiety, and substance use disorders in a representative sample of the Dutch population (N = 7076; aged 18-64 years). METHODS: Data were collected in face-to-face interviews, using the Composite International Diagnostic Interview. Classification as heterosexual or homosexual was based on reported sexual behavior in the preceding year. Five thousand nine hundred ninety-eight (84.8%) of the total sample could be classified: 2.8% of 2878 men and 1.4% of 3120 women had had same-sex partners. Differences in prevalence rates were tested by logistic regression analyses, controlling for demographics. RESULTS: Psychiatric disorders were more prevalent among homosexually active people compared with heterosexually active people. Homosexual men had a higher 12-month prevalence of mood disorders (odds ratio [OR] = 2.93; 95% confidence interval [CI] = 1.54-5.57) and anxiety disorders (OR = 2.61; 95% CI = 1.44-4.74) than heterosexual men. Homosexual women had a higher 12-month prevalence of substance use disorders (OR = 4.05; 95% CI = 1.56-10.47) than heterosexual women. Lifetime prevalence rates reflect identical differences, except for mood disorders, which were more frequently observed in homosexual than in heterosexual women (OR = 2.41; 95% CI = 1.26-4.63). The proportion of persons with 1 or more diagnoses differed only between homosexual and heterosexual women (lifetime OR = 2.61; 95% CI = 1. 31-5.19). More homosexual than heterosexual persons had 2 or more disorders during their lifetimes (homosexual men: OR = 2.70; 95% CI = 1.66-4.41; homosexual women: OR = 2.09; 95% CI = 1.07-4.09). CONCLUSION: The findings support the assumption that people with same-sex sexual behavior are at greater risk for psychiatric disorders.     

Maternal herpes labialis in pregnancy and neural tube defects

According to previous case reports, some congenital abnormalities (CAs) of the brain, such as microcephaly, are a result of intrauterine herpes simplex virus infection. A population-based case-control study was conducted to determine the risk of neural tube defects (NTDs) after maternal herpes labialis infection during pregnancy. Data were taken from the Hungarian Case-Control Surveillance of Congenital Abnormalities from 1980 to 1996, which included 1202 children with NTDs and 21641 comparison children with CAs other than NTDs. The adjusted relative risks (odds ratio [OR]) for NTDs associated with maternal herpes labialis in the first trimester of pregnancy was OR 1.19 (95% confidence interval [CI] 0.68-2.06), and in the entire pregnancy was OR 0.94 (95% CI 0.61-1.44). Self-reported maternal herpes labialis during pregnancy was not associated with a substantially increased risk of NTDs in infants.     

PRNP Val129 homozygosity increases risk for early-onset Alzheimer's disease

We analyzed the PRNP M129V polymorphism in a Dutch population-based early-onset Alzheimer's disease sample. We observed a significant association between early-onset Alzheimer's disease and homozygosity of M129V (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1-3.3; p = 0.02) with the highest risk for V homozygotes (OR, 3.2; 95% CI, 1.4-7.1; p < 0.01). In patients with a positive family history, these risks increased to 2.6 (95% CI, 1.3-5.3; p < 0.01) and 3.5 (95% CI, 1.3-9.3; p = 0.01), respectively.