Neighbourhood-level effects on psychoses: re-examining the role of context

BACKGROUND: The incidence of schizophrenia varies by individual-level characteristics and neighbourhood-level attributes. Few specific socio-environmental risk factors (SERFs) have been identified at the neighbourhood level. Cross-level interactions are poorly understood. We investigated these issues using data from the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP) study. METHOD: All incidence cases of ICD-10 schizophrenia (F20) and other non-affective psychoses (F21-29), aged 16-64 years, across 33 wards in Southeast London were identified over a 2-year period (1997-1999). Census data provided the denominator for each ward. Multilevel Poisson regression simultaneously modelled individual- and neighbourhood-level SERFs, including socio-economic deprivation, voter turnout (proxy for social capital), ethnic fragmentation (segregation) and ethnic density. RESULTS: A total of 218 subjects were identified during 565 576 person-years at risk. Twenty-three per cent of variance in incidence of schizophrenia across wards could be attributed to neighbourhood-level risk factors [95% confidence interval (CI) 9.9-42.2]. Thus, 1% increases in voter turnout [incidence rate ratio (IRR) 0.95, 95% CI 0.92-0.99] and ethnic segregation (IRR 0.95, 95% CI 0.92-0.99) were both independently associated with a reduced incidence of 5%, independent of age, sex, ethnicity, deprivation and population density. This was similar for other non-affective psychoses. There was some evidence that ethnic minority individuals were at greater risk of schizophrenia in areas with smaller proportions of minority groups (p=0.07). CONCLUSION: SERFs at individual and neighbourhood levels were implicated in the aetiology of psychosis, but we were unable to determine whether these associations were causal. Individual risk may be mediated by social capital, which could operate as a protective factor, perhaps moderating social stress in the onset of psychoses.     

Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study

BACKGROUND: The incidence of schizophrenia in the African-Caribbean population in England is reported to be raised. We sought to clarify whether (a) the rates of other psychotic disorders are increased, (b) whether psychosis is increased in other ethnic minority groups, and (c) whether particular age or gender groups are especially at risk. METHOD: We identified all people (n=568) aged 16-64 years presenting to secondary services with their first psychotic symptoms in three well-defined English areas (over a 2-year period in Southeast London and Nottingham and a 9-month period in Bristol). Standardized incidence rates and incidence rate ratios (IRR) for all major psychosis syndromes for all main ethnic groups were calculated. RESULTS: We found remarkably high IRRs for both schizophrenia and manic psychosis in both African-Caribbeans (schizophrenia 9.1, manic psychosis 8.0) and Black Africans (schizophrenia 5.8, manic psychosis 6.2) in men and women. IRRs in other ethnic minority groups were modestly increased as were rates for depressive psychosis and other psychoses in all minority groups. These raised rates were evident in all age groups in our study. CONCLUSIONS: Ethnic minority groups are at increased risk for all psychotic illnesses but African-Caribbeans and Black Africans appear to be at especially high risk for both schizophrenia and mania. These findings suggest that (a) either additional risk factors are operating in African-Caribbeans and Black Africans or that these factors are particularly prevalent in these groups, and that (b) such factors increase risk for schizophrenia and mania in these groups.     

SARS-CoV-2 new infections among health-care workers after the first dose of the BNT162b2 mRNA COVID-19 vaccine. A hospital-wide cohort study

ObjectivesTo evaluate the effect of mRNA severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination on the incidence of new SARS-CoV-2 infections in health-care workers (HCW).MethodsThe evolution of the incident rate of microbiologically confirmed SARS-CoV-2 infection in a cohort of 2590 HCW after BNT162b2 mRNA SARS-CoV-2 vaccination, compared with the rate in the community (n = 170 513) was evaluated by mixed Poisson regression models.ResultsA total of 1820 HCW (70.3% of total) received the first dose of the BNT162b2 mRNA vaccine between 10 January and 16 January 2021, and 296 (11.4%) received it the following week. All of them completed vaccination 3 weeks later. Incidence rates of SARS-CoV-2 infection after the first dose of mRNA SARS-CoV-2 vaccine declined by 71% (Incidence Rate Ratio (IRR) 0.286, 95% CI 0.174–0.468; p < 0.001) and by 97% (IRR 0.03, 95% CI 0.013–0.068; p < 0.001) after the second dose, compared with the perivaccine time. SARS-CoV-2 incidence rates in the community (with a negligible vaccination rate) had a much lower decline: 2% (IRR 0.984, 95% CI 0.943–1.028; p 0.47) and 61% (IRR 0.390, 95% CI 0.375–0.406; p < 0.001) for equivalent periods. Adjusting for the decline in the community, the reduction in the incident rates among HCW were 73% (IRR 0.272, 95% CI 0.164–0.451 p < 0.001) after the first dose of the vaccine and 92% (IRR 0.176, 95% CI 0.033–0.174; p < 0.001) after the second dose.ConclusionsmRNA SARS-CoV-2 vaccination is associated with a dramatic decline in new SARS-CoV-2 infection among HCW, even before the administration of the second dose of the vaccine.     

Neighbourhood Deprivation,Individual-Level and Familial-Level Socio-demographic Factors and Risk of Congenital Heart Disease: A Nationwide Study from Sweden

Objectives

The purpose of the study is to examine whether there is an association between neighbourhood deprivation and incidence of congenital heart disease (CHD), after accounting for family- and individual-level potential confounders.

Methods

All children aged 0 to 11 years and living in Sweden (n?=?748,951) were followed between January 1, 2000 and December 31, 2010. Data were analysed by multilevel logistic regression, with family- and individual-level characteristics at the first level and level of neighbourhood deprivation at the second level.

Results

During the study period, among a total of 748,951 children, 1499 (0.2 %) were hospitalised with CHD. Age-adjusted cumulative hospitalisation rates for CHD increased with increasing level of neighbourhood deprivation. In the study population, 1.8 per 1000 and 2.2 per 1000 children in the least and most deprived neighbourhoods, respectively, were hospitalised with CHD. The incidence of hospitalisation for CHD increased with increasing neighbourhood-level deprivation across all family and individual-level socio-demographic categories. The odds ratio (OR) for hospitalisation for CHD for those living in high-deprivation neighbourhoods versus those living in low-deprivation neighbourhoods was 1.23 (95 % confidence interval (CI)?=?1.04–1.46). In the full model, which took account for age, paternal and maternal individual-level socio-economic characteristics, comorbidities (e.g. maternal type 2 diabetes, OR?=?3.03; maternal hypertension, OR?=?2.01), and family history of CHD (OR?=?3.27), the odds of CHD were slightly attenuated but did not remain significant in the most deprived neighbourhoods (OR?=?1.20, 95 % CI?=?0.99–1.45, p?=?0.057).

Conclusions

This study is the largest so far on neighbourhood influences on CHD, and the results suggest that deprived neighbourhoods have higher rates of CHD, which represents important clinical knowledge. However, the association does not seem to be independent of individual- and family-level characteristics.

     

No evidence of time trends in the urban-rural differences in schizophrenia risk among five million people born in Denmark from 1910 to 1986

BACKGROUND: There have been conflicting reports on time trends in urban-rural differences in the incidence of schizophrenia. This study explored the potential time trends in these differences with regard to birth cohort and age at onset. METHOD: Linking data from the Danish Civil Registration system with data from the Danish Psychiatric Central Register, a cohort born in Denmark from 1910 to 1986 was established (5.05 million people). Overall, 23051 people were classified with schizophrenia in 1970-2001. RESULTS: Urban-rural differences in schizophrenia risk may have existed for people born in Denmark since 1910, and have existed at a constant level for people born from 1945 to 1986. Males aged <20 years had a risk of 3.90 [95% confidence interval (CI) 3.28-4.65] associated with urban birth while males >or=20 years had a risk of 2.12 (1.98-2.27). Females <20 years had a risk of 2.49 (95% CI 2.01-3.09) associated with urban birth while females >or=20 years had a risk of 1.90 (95% CI 1.74-2.08). At age 46, 1.84% (95% CI 1.76-1.93) of males and 1.05% (95% CI 0.99-1.12) of females born in the capital area had developed schizophrenia, while 0.81% (95% CI 0.75-0.86) of males and 0.56% (95% CI 0.51-0.60) of females born in the rural area had developed schizophrenia. CONCLUSIONS: There was no evidence of time trends in the urban-rural differences in the incidence of schizophrenia in Denmark, suggesting that the cause(s) responsible for these differences were not related to exposures that became more prevalent in urban areas over time. This finding is in contrast to findings from Finland and The Netherlands.     

Entertainment or Health? Exploring the Internet Usage Patterns of the Urban Poor: A Secondary Analysis of a Randomized Controlled Trial

BackgroundImportant gaps remain in our knowledge of how individuals from low socioeconomic position (SEP) use the Internet for resources and in understanding the full range of activities they perform online. Although self-report data indicate that low SEP individuals use the Internet less than high SEP people for health information and for other beneficial capital-enhancing activities, these results may not provide an accurate overall view of online use.ObjectiveThe aim of this study was to determine the ways in which low SEP individuals use the Internet, including for entertainment, social networking, and capital-enhancing functions, and how they are associated with health information seeking.MethodsDetailed Web tracking data were collected from 118 low SEP individuals who participated in the intervention group of a randomized controlled trial that provided Internet access. Websites were grouped by topic, including categories of capital-enhancing websites that provided access to resources and information. Different types of online activities were summed into an Internet use index. Single and multiple negative binomial regression models were fitted with the Internet use index as the predictor and health information seeking as the outcome. Next, models were fitted with low, medium, and high Web usage in capital-enhancing, entertainment, and social network categories to determine their associations with health information seeking.ResultsParticipants used the Web for diverse purposes, with 63.6% (75/118) accessing the Internet for all defined types of Internet use. Each additional category of Internet use was associated with 2.12 times the rate of health information seeking (95% CI 1.84-2.44, P<.001). Higher use of each type of capital-enhancing information was associated with higher rates of health information seeking, with high uses of government (incident rate ratio [IRR] 8.90, 95% CI 4.82-16.42, P<.001) and news (IRR 11.36, 95% CI 6.21-20.79, P<.001) websites associated with the highest rates of health information seeking compared to their lowest use categories. High entertainment website use (IRR 3.91, 95% CI 2.07-7.37, P<.001) and high social network use (IRR 2.06, 95% CI 1.08-3.92, P=.03) were also associated with higher health information seeking.ConclusionsThese data clearly show that familiarity and skills in using the Internet enhance the capacity to use it for diverse purposes, including health and to increase capital, and that Internet usage for specific activities is not a zero sum game. Using it for one type of topic, such as entertainment, does not detract from using it for other purposes. Findings may inform ways to engage low SEP groups with Internet resources.     

Allergic patients have more numerous and prolonged respiratory infections than nonallergic subjects

BACKGROUND: Allergic disorders are characterized by type 2 helper T cell (Th2)-polarization, thus physiological type 1 helper T cell (Th1)-dependent mechanisms involved in fighting respiratory infections (RI) may be defective. It has previously been reported that allergic children have more numerous and severe RI than nonallergic ones. OBJECTIVE: The aim of the study was to evaluate the number and duration of RI in adult allergic and nonallergic subjects. METHODS: Six hundred and twenty-four subjects were studied; 202 of them were allergic (i.e. suffering from allergic rhinitis). The number of RI as well as the duration of the disease were recorded for 2 years. RESULTS: Allergic subjects showed a significantly higher rate of RI episodes [adjusted incidence rate ratio (IRR) = 2.16, 95% confidence interval (CI) 1.94-2.41, P < 0.001] than subjects without allergy. The number of mild RI episodes was slightly higher in allergic subjects (IRR = 1.68, 95% CI 1.50-1.89, P < 0.001), while the number of severe episodes was markedly higher (IRR = 15.71, 95% CI 10.35-23.84, P < 0.001) when compared with nonallergic subjects. Moreover, allergic patients showed a longer total duration of RI than nonallergic subjects, with a mean difference of 17.4 days (95% CI 15.5-19.4, P < 0.001). CONCLUSIONS: This study provides evidence that adult allergic patients have more numerous and prolonged RI than nonallergic subjects.     

Quantifying links between acute myocardial infarction and depression, anxiety and schizophrenia using case register databases

AIMS: To quantify the association between depression and acute myocardial infarction (AMI) in a large sample using case registers, and examine whether any such link is specific to depression or might more reflect mental illness status in general. METHODS AND RESULTS: Accessing the Danish Psychiatric Central Research Register (PCR), patients with a diagnosis of depression were extracted and followed for up to 24 years for episodes of AMI. We used mentally healthy age- and sex-matched controls, and as comparator diagnostic groups, we studied patients with anxiety and schizophrenia. A positive association between depression and AMI was found with an incidence rate ratio (IRR) of 1.16 (CI: 1.10-1.22). The association was not unique for the depressed individuals, but was also found for anxiety patients, where it was even stronger (IRR=1.56, CI: 1.35-1.79) than for the depressed patients. A negative association (IRR=0.77, CI: 0.65-0.91) was quantified for schizophrenia, arguing against any link with AMI being determined by psychiatric disorder status per se. LIMITATIONS: Being a register study, not all potential confounding variables could be examined. CONCLUSION: Findings quantify significant associations between depression and AMI as well as between anxiety and AMI, and argue that these two psychiatric disorders should be added to the list of risk factors to coronary artery disease.     

First psychiatric hospitalizations in the US military: the National Collaborative Study of Early Psychosis and Suicide (NCSEPS)

BACKGROUND: Military samples provide an excellent context to systematically ascertain hospitalization for severe psychiatric disorders. The National Collaborative Study of Early Psychosis and Suicide (NCSEPS), a collaborative study of psychiatric disorders in the US Armed Forces, estimated rates of first hospitalization in the military for three psychiatric disorders: bipolar disorder (BD), major depressive disorder (MDD) and schizophrenia. METHOD: First hospitalizations for BD, MDD and schizophrenia were ascertained from military records for active duty personnel between 1992 and 1996. Rates were estimated as dynamic incidence (using all military personnel on active duty at the midpoint of each year as the denominator) and cohort incidence (using all military personnel aged 18-25 entering active duty between 1992 and 1996 to estimate person-years at risk). RESULTS: For all three disorders, 8723 hospitalizations were observed in 8,120,136 person-years for a rate of 10.7/10,000 [95% confidence interval (CI) 10.5-11.0]. The rate for BD was 2.0 (95% CI 1.9-2.1), for MDD, 7.2 (95% CI 7.0-7.3), and for schizophrenia, 1.6 (95% CI 1.5-1.7). Rates for BD and MDD were greater in females than in males [for BD, rate ratio (RR) 2.0, 95% CI 1.7-2.2; for MDD, RR 2.9, 95% CI 2.7-3.1], but no sex difference was found for schizophrenia. Blacks had lower rates than whites of BD (RR 0.8, 95% CI 0.7-0.9) and MDD (RR 0.8, 95% CI 0.8-0.9), but a higher rate of schizophrenia (RR 1.5, 95% CI 1.3-1.7). CONCLUSIONS: This study underscores the human and financial burden that psychiatric disorders place on the US Armed Forces.     

Hospitalization rates differ by hepatitis C satus in an urban HIV cohort

OBJECTIVE: To determine whether hepatitis C virus (HCV) infection status affected hospitalization rates, intensive care utilization rates, and discharge diagnoses between 1995 and 2000 in patients with HIV. METHODS: We conducted a prospective cohort study of 3730 HIV patients who were longitudinally followed between 1995 and 2000. All hospitalizations of these patients were classified as an opportunistic illness (OI) using the 1993 indicator diagnoses in the case definition of AIDS, complication of injection drug use (IDU) (abscess, cellulitis, osteomyelitis, bacteremia, endocarditis, and poisoning by analgesics), liver-related complication (acute and subacute necrosis of the liver, chronic liver disease and cirrhosis, liver abscess, hepatic coma, portal hypertension, hepatorenal syndrome, hepatocellular carcinoma, and gastrointestinal bleed), or other. Negative binomial regression was used to assess for risk factors for hospitalization. MAIN OUTCOME MEASURES: Inpatient hospitalization and intensive care utilization rates and discharge diagnoses. RESULTS: Nearly half (42.8%) of our cohort was infected with HCV. Between 1995 and 2000, hospitalization rates for HCV-negative patients decreased from 61.9 to 33.9 per 100 patient-years (PY) of follow-up (P = 0.007). Hospitalization rates decreased between 1995 and 1997 for HCV-positive patients from 55.4 to 43.5 per 100 PY but increased between 1997 and 2000 from 43.5 to 62.9 per 100 PY (P = 0.001). When stratified by diagnostic category, IDU-related complications increased from 13.6 to 18.4 admissions per 100 PY and liver-related complications increased from 5.4 to 26.7 admissions per 100 PY between 1995 and 2000 in HCV-positive patients (P < 0.001); however, OIs remained relatively unchanged from 1995 to 2000, with 14.6 to 13.0 hospitalizations per 100 PY. In multivariate analysis, HCV infection (incidence rate ratio [IRR] = 1.75, 95% confidence interval [CI]: 1.47, 2.07), female gender (IRR = 1.56, 95% CI: 1.32, 1.85), age <37 years (IRR = 1.19, 95% CI: 1.01, 1.41), African American ethnicity (IRR = 1.30, 95% CI: 1.05, 1.61), and CD4 cell count <50 cells mm3 (IRR = 2.20, 95% CI: 1.72, 2.83) were predictive of hospitalization. CONCLUSIONS: Our data indicate that hospitalization rates decreased significantly between 1995 and 2000 for HCV-negative patients but increased significantly for HCV-positive patients. Hospitalization rates for IDU- and liver-related complications increased during this time interval in coinfected patients. In the era of highly active antiretroviral therapy, HIV/HCV-coinfected patients are more likely to suffer from higher hospitalization rates, which will require more health care resources.     

Neighbourhood Deprivation,Individual-Level Familial and Socio-Demographic Factors and Diagnosed Childhood Obesity: A Nationwide Multilevel Study from Sweden

ObjectivesTo examine whether there is an association between neighbourhood deprivation and diagnosed childhood obesity, after accounting for family- and individual-level socio-demographic characteristics.MethodsAn open cohort of all children aged 0-14 years was followed between January 1, 2000 and December 31, 2010. Childhood residential locations were geocoded and classified according to neighbourhood deprivation. Data were analysed by multilevel logistic regression, with family- and individual-level characteristics at the first level and level of neighbourhood deprivation at the second level.ResultsDuring the study period, among a total of 948,062 children, 10,799 were diagnosed with childhood obesity. Age-adjusted cumulative incidence for diagnosed childhood obesity increased with increasing level of neighbourhood deprivation. Incidence of diagnosed childhood obesity increased with increasing neighbourhood-level deprivation across all family and individual-level socio-demographic categories. The odds ratio (OR) for diagnosed childhood obesity for those living in high-deprivation neighbourhoods versus those living in low-deprivation neighbourhoods was 2.44 (95% confidence interval (CI) = 2.22-2.68). High neighbourhood deprivation remained significantly associated with higher odds of diagnosed childhood obesity after adjustment for family- and individual-level socio-demographic characteristics (OR = 1.70, 95% CI = 1.55-1.89). Age, middle level family income, maternal marital status, low level education, living in large cities, advanced paternal and maternal age, family history of obesity, parental history of diabetes, chronic obstructive pulmonary disease, alcoholism and personal history of diabetes were all associated with higher odds of diagnosed childhood obesity.ConclusionsOur results suggest that neighbourhood characteristics affect the odds of diagnosed childhood obesity independently of family- and individual-level socio-demographic characteristics.Key Words: Childhood obesity, Neighbourhood-level deprivation, Incidence, Socio-demographic factors, Multilevel modelling     

Relationship between criminal legal system exposure and health care utilization in US adults with diabetes: A cross-sectional study

BackgroundBlack Americans have a higher prevalence of diabetes compared to White Americans and have higher rates of complications and death. Exposure to the criminal legal system (CLS) is a social risk factor for chronic disease morbidity and mortality with significant overlap with populations most likely to experience poor diabetes outcomes. However, little is known about the association between CLS exposure and healthcare utilization patterns among U.S. adults with diabetes.MethodsUsing data from the National Survey of Drug Use and Health (2015-2018) a cross-sectional, nationally representative sample of U.S. adults with diabetes was created. Negative binomial regression was used to test the association between lifetime CLS exposure and three utilization types (emergency department (ED), inpatient, and outpatient) controlling for relevant socio-demographic and clinical covariates.ResultsOf 11,562 (weighted to represent 25,742,034 individuals) adults with diabetes, 17.1% reported lifetime CLS exposure. In unadjusted analyses, exposure was associated with increased ED (IRR 1.30 95% CI 1.17-1.46) and inpatient utilization (IRR 1.23, 95% CI 1.01-1.50), but not outpatient visits (IRR 0.99 95% CI 0.94-1.04). The association between CLS exposure and ED (IRR 1.02, p=0.70) and inpatient utilization (IRR 1.18, p=0.12) was attenuated in adjusted analyses. Low socioeconomic status, comorbid substance use disorder, and comorbid mental illness were independently associated with health care utilization in this population.ConclusionsAmong those with diabetes, lifetime CLS exposure is associated with higher ED and inpatient visits in unadjusted analyses. Adjusting for socioeconomic status and clinical confounders attenuated these relationships, thus more research is needed to understand how CLS exposure interacts with poverty, structural racism, addiction and mental illness to influence health care utilization for adults with diabetes.     

Efficacy and safety of treatment with biologicals (benralizumab,dupilumab, mepolizumab,omalizumab and reslizumab) for severe eosinophilic asthma. A systematic review for the EAACI Guidelines - recommendations on the use of biologicals in severe asthma

Five biologicals have been approved for severe eosinophilic asthma, a well-recognized phenotype. Systematic reviews (SR) evaluated the efficacy and safety of benralizumab, dupilumab, mepolizumab, omalizumab and reslizumab (alphabetical order) compared to standard of care for severe eosinophilic asthma. PubMed, Embase and Cochrane Library were searched to identify RCTs and health economic evaluations, published in English. Critical and important asthma-related outcomes were evaluated for each of the biologicals. The risk of bias and the certainty of the evidence were assessed using GRADE. 19 RCTs (three RCTs for benralizumab, three RCTs for dupilumab, three RCTs for mepolizumab, five RCTs for omalizumab and five RCTs for reslizumab), including subjects 12 to 75 years old (except for omalizumab including also subjects 6-11 years old), ranging from 12 to 56 weeks were evaluated. All biologicals reduce exacerbation rates with high certainty of evidence: benralizumab incidence rate ratio (IRR) 0.53 (95% CI 0.39 to 0.72), dupilumab (IRR) 0.43 (95% CI 0.32 to 0.59), mepolizumab IRR 0.49 (95% CI 0.38 to 0.66), omalizumab (IRR) 0.56 (95% CI 0.40 to 0.77) and reslizumab (IRR) 0.46 (95% CI 0.37 to 0.58). Benralizumab, dupilumab and mepolizumab reduce the daily dose of oral corticosteroids (OCS) with high certainty of evidence. All evaluated biologicals probably improve asthma control, QoL and FEV₁, without reaching the minimal important difference (moderate certainty). Benralizumab, mepolizumab and reslizumab slightly increase drug-related adverse events (AE) and drug-related serious AE (low to very low certainty of evidence). The incremental cost-effectiveness ratio per quality-adjusted life year value is above the willingness to pay threshold for all biologicals (moderate certainty). Potential savings are driven by decrease in hospitalizations, emergency and primary care visits. There is high certainty that all approved biologicals reduce the rate of severe asthma exacerbations and for benralizumab, dupilumab and mepolizumab for reducing OCS. There is moderate certainty for improving asthma control, QoL, FEV₁. More data on long-term safety are needed together with more efficacy data in the paediatric population.     

社区精神分裂症家属生存质量与患者社会功能相关分析

目的探讨社区精神分裂症患者社会功能对家属生存质量的影响。方法对179例社区精神分裂症患者进行社会功能缺陷筛选表(SDSS)评定,对患者家属用世界卫生组织生存质量测定量表简表(WHOQOL-BREF)进行评定,并对患者的社会功能与家属生存质量进行相关分析。结果社区精神分裂症患者的SDSS总分及各分量表分与WHOQOL-BREF分呈显著负相关(r=-0.247,P<0.001)。结论社区精神分裂症患者的社会功能与家属的生存质量密切相关,社区精神分裂症患者的社会功能损失越重,家属的生活质量越差。     

A Mendelian randomization study of the causal association between anxiety phenotypes and schizophrenia

Schizophrenia shows a genetic correlation with both anxiety disorder and neuroticism, a trait strongly associated with anxiety. However, genetic correlations do not discern causality from genetic confounding. We therefore aimed to investigate whether anxiety‐related phenotypes lie on the causal pathway to schizophrenia using Mendelian randomization (MR). Four MR methods, each with different assumptions regarding instrument validity, were used to investigate casual associations of anxiety and neuroticism related phenotypes on schizophrenia, and vice versa: inverse variance weighted (IVW), weighted median, weighted mode, and, when appropriate, MR Egger regression. MR provided evidence of a causal effect of neuroticism on schizophrenia (IVW odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.12–1.59), but only weak evidence of a causal effect of anxiety on schizophrenia (IVW OR: 1.10, 95% CI: 1.01–1.19). There was also evidence of a causal association from schizophrenia liability to anxiety disorder (IVW OR: 1.28, 95% CI: 1.18–1.39) and worry (IVW beta: 0.05, 95% CI: 0.03–0.07), but effect estimates from schizophrenia to neuroticism were inconsistent in the main analysis. The evidence of neuroticism increasing schizophrenia risk provided by our results supports future efforts to evaluate neuroticism‐ or anxiety‐based therapies to prevent onset of psychotic disorders.     

No association observed between schizophrenia and non‐HLA coeliac disease genes: Integration with the initial MYO9B association with coeliac disease

Schizophrenia is a severe psychotic illness with a heterogeneous presentation and a devastating impact on social and occupational function. Worldwide variations in schizophrenia incidence rates suggest that local conditions may modify disease risk. The human leukocyte antigen (HLA) region has been confirmed to be associated with schizophrenia by genome‐wide association studies in populations across the world. While the presence of autoimmune processes in a subgroup of schizophrenia cases is contentious, the immune system could allow environmental exposures to lead to schizophrenia by generating improper immune response. To investigate this topic, we reviewed the current evidence of the relationship between schizophrenia and coeliac disease. Based on this review, we performed genetic analysis of the MYO9B gene and the IL‐2/IL‐21 locus by genotyping SNPs that have been previously associated with coeliac disease or schizophrenia in 223 families, 108 unrelated individuals with schizophrenia and 120 controls. Finding no evidence for association with these two loci in our study samples, we applied meta‐analytic techniques to combine our findings with previous reports. This synthesis, in light of our review of previous reports, suggests a differing developmental trajectory for schizophrenia and coeliac disease. It is possible that these two conditions do not share any functional overlap. © 2011 Wiley‐Liss, Inc.     

Absolute CD4 vs. CD4 percentage for predicting the risk of opportunistic illness in HIV infection

Current guidelines recommend consideration of CD4 cell percentage as well as CD4 cell count in therapeutic decisions. The relative value of CD4 cell count compared with CD4 cell percentage in predicting risk of AIDS-defining illnesses (ADIs) in the post-HAART (highly active antiretroviral therapy) era is unknown. Data from an observational clinical cohort of adult HIV-infected patients were used to assess the risk of developing an ADI associated with specific absolute CD4 counts (CD4) and CD4%'s (CD4%) using all CD4-CD4% pairs obtained after January 1996. The incidence of developing an ADI was assessed over a maximum of 6 months after the CD4-CD4% pair was obtained. Using multivariable negative binomial regression, the incidence rate ratio (IRR) for developing an ADI by CD4 and CD4% categories was computed. A total of 15,736 CD4-CD4% pairs from 2185 patients who developed 608 ADIs was analyzed. The IRR for developing an ADI by absolute CD4 was 17.9 (95% CI: 13.2, 24.4) events/100 person-years for <50 cells/mm, 6.2 (95% CI: 4.4, 7.9) for 50-100 cells/mm, and 2.7 (95% CI: 1.9, 4.0) for 100-200 cells/mm, compared with the referent stratum of 200-350 cells/mm. Without adjustment for absolute CD4, the IRR was 14.4 (95% CI: 9.3,22.6) for CD4% <7%, 3.7 (95% CI: 2.4,5.9) for 7-14%, 1.9 (95% CI: 1.1, 3.1) for 15-21%, compared with the referent stratum of >21%. However, in a multivariable analysis adjusting for absolute CD4, CD4%, and other clinical and demographic variables, the absolute CD4 but not the CD4% was associated strongly with developing an ADI. The results suggest that CD4% adds little further predictive information after accounting for the absolute CD4 count for the short-term risk of developing an ADI. The absolute CD4 count is the more important measure of immune status and is preferred over the CD4% for making treatment decisions in HIV-infected adults.     

Genome-wide search for schizophrenia susceptibility loci: The NIMH genetics initiative and millennium consortium

Schizophrenia has a complex pattern of inheritance, indicative of interactions among multiple genes and environmental factors. The detection and replication of specific susceptibility loci for such complex disorders are facilitated by the availability of large samples of affected sib pairs and their nuclear families, along with standardized assessment and systematic ascertainment procedures. The NIMH Genetics Initiative on Schizophrenia, a multisite collaborative study, was established as a national resource with a centralized clinical data base and cell repository. The Millennium Schizophrenia Consortium has completed a genome-wide scan to detect susceptibility loci for schizophrenia in 244 individuals from the nuclear families of 92 independent pairs of schizophrenic sibs ascertained by the NIMH Genetics Initiative. The 459 marker loci used in the scan were spaced at 10-cM intervals on average. Individuals of African descent were higher than those of European descent in their average heterozygosity (79% vs. 76%, P < .0001) and number of alleles per marker (9.2 vs. 8.4, P < .0001). Also, the allele frequencies of 73% of the marker loci differed significantly (P < .01) between individuals of European and African ancestry. However, regardless of ethnic background, this sample was largely comprised of schizophrenics with more than a decade of psychosis associated with pervasive social and occupational impairment. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 81:275–281, 1998. © 1998 Wiley-Liss, Inc.     

Epidemiology of Injuries in National Collegiate Athletic Association Women's Basketball: 2014–2015 Through 2018–2019

ContextFrequent inspection of sports-related injury epidemiology among National Collegiate Athletic Association (NCAA) women''s basketball student-athletes is valuable for identifying injury-related patterns.BackgroundEmerging patterns in epidemiology of NCAA women''s basketball injuries are unknown though general sports medicine practices, and playing rules and regulations have evolved in recent years.MethodsAthlete exposures (AEs) and injury incidence data were reported to the NCAA Injury Surveillance Program between 2014–2015 and 2018–2019. Injury counts, rates, and proportions were used to examine injury characteristics, and injury rate ratios (IRRs) were used to assess injury rate differences.ResultsPractice and competition injury rates were 5.93 and 10.35 per 1000 AEs, respectively. Preseason injury rates were higher than regular (IRR = 1.41; 95% CI = 1.31, 1.53) and postseason (IRR = 3.12; 95% CI = 2.39, 4.07). Ankle sprains (14.3%), concussions (7.5%), and anterior cruciate ligament tears (2.5%) were the most commonly reported injuries.SummaryHigher rates of practice and competition injuries, as well as ankle sprains, were observed relative to previous reports; continuous monitoring is necessary to identify potential contributing factors to these trends.     

Hyperhomocysteinemia, methylenetetrahydrofolate reductase 677TT genotype, and the risk for schizophrenia: a Dutch population based case-control study.

Evidence for an involvement of aberrant homocysteine metabolism in the aetiology of schizophrenia is limited and controversial. A case-control study was performed to quantify the risk of schizophrenia in the presence of elevated homocysteine concentrations or homozygosity for the 677C --> T polymorphism (677TT) in the methylenetetrahydrofolate reductase (MTHFR) gene in subjects of Dutch ancestry. We determined the 677C --> T MTHFR genotype distribution in 254 well-defined patients and 414 healthy controls. Plasma homocysteine concentrations were measured in 62 patients with schizophrenia and 432 control subjects. When homocysteine concentrations were stratified into quartiles of the control distribution, we calculated an increased risk for schizophrenia in the fourth and third quartile versus the lowest quartile [odds ratio (OR) = 3.3; 95% confidence interval (CI): 1.2-9.2, and OR = 3.1; 95% CI: 1.2-8.0, respectively]. A significant dose-response relation of increasing homocysteine levels and increasing risk for schizophrenia was observed (P = 0.036). The 677TT genotype was associated with an OR of 1.6 [95% CI: 0.96-2.8] of having schizophrenia. Heterozygosity for the T allele compared to 677CC subjects accounted for an OR of 1.3 [95% CI: 0.91-1.8]. Elevated homocysteine levels and the MTHFR 677TT genotype are associated with an increased risk for schizophrenia. These observations support a causal relation between disturbed homocysteine metabolism and schizophrenia.