Cause-specific mortality and death certificate reporting in adults with moderate to profound intellectual disability

Background The study of premature deaths in people with intellectual disability (ID) has become the focus of recent policy initiatives in England. This is the first UK population‐based study to explore cause‐specific mortality in adults with ID compared with the general population. Methods Cause‐specific standardised mortality ratios (SMRs) and exact 95% confidence intervals were calculated by age and sex for adults with moderate to profound ID living in the unitary authorities of Leicester, Leicestershire and Rutland, UK, between 1993 and 2006. Causes of death were also studied to determine how often ID and associated conditions, such as Down syndrome, were mentioned. Results A total of 503 (17% of population) adults with ID died during the 14‐year study period (30 144 person‐years). Relatively high cause‐specific mortality was seen for deaths caused by congenital abnormalities (SMR = 8560), diseases of the nervous system and sense organs (SMR = 1630), mental disorders (other than dementia) (SMR = 1141) and bronchopneumonia (SMR = 647). Excess deaths were also seen for diseases of the genitourinary system or digestive system, cerebrovascular disease, other respiratory infections, dementia (in men only), other circulatory system diseases (in women only) and accidental deaths (in women only). Two‐fifths (n = 204; 41%) of deaths recorded in adults with ID mentioned ID or an associated condition as a contributing cause of death. Conclusions Strategies to reduce inequalities in people with ID need to focus on decreasing mortality from potentially preventable causes, such as respiratory infections, circulatory system diseases and accidental deaths. The lack of mention of ID on death certificates highlights the importance of effective record linkage and ID reporting in health and social care settings to facilitate the government's confidential inquiry into causes of death in this population.     

Changing patterns of suicide in a poor, rural county over the 20th century

Rural suicide rates have been shown to be disproportionately high in several countries. This study compares suicide rates in Cornwall with the rest of England and Wales over a 90-year period (1911–2001). Age and sex standardised mortality ratios were calculated for suicide and undetermined death for Cornwall standardised to England and Wales. From 1911 until the start of the Second World War, suicide rates were lower in Cornwall than England and Wales. Since the 1960s suicide rates in Cornwall have risen significantly above England and Wales. We have shown that the suicide rate in a poor, rural area has increased disproportionately compared to England and Wales over the last 35 years. This change has occurred in both sexes. Prior to this period the suicide rate was lower or about the same as that in England and Wales.     

Age, period of death and birth cohort effects on suicide mortality in Italy, 1955-1979

Trends in death rates from all suicides and specific methods of suicide in Italy over the period 1955-79 were analysed on the basis of age-specific and age-standardised rates, and through a log-linear Poisson model to isolate the effects of age, birth cohort and calendar period. In both sexes, a large decrease in mortality from suicide was evident in the late 1950's and early 1960's. Thereafter, death certification rates showed fluctuating trends up to the mid 1970's, when steady increases became evident for both sexes. Nevertheless, overall age-standardized mortality rates from suicide in the late 1970's were still considerably lower than in the two previous decades (15% in males, 7% in females). The observed variations in suicide mortality, mostly in males, can be explained in terms of period of death effect and be related to changes in the Italian economic situation. This view finds further support from analysis of age-specific trends (e.g. mortality rates in the younger age groups started rising in the early 1970's, together with a rise in unemployment rates among the young). Cohort curves for males born in the current century were U-shaped as well, with marked declines for generations born between 1905 and 1930, and moderate increases for more recent cohorts. For females, the cohort curve was remarkably flat. Some of the changes in the various methods of suicide can be explained in terms of well-defined exogenous factors (e.g., the large fall in poisoning by domestic gas is obviously attributable to domestic gas detoxification).     

The Impact of Lithium Long-Term Medication on Suicidal Behavior and Mortality of Bipolar Patients

ABSTRACT

The article reviews the existing evidence and the concept of the anti-suicidal effect of lithium long-term treatment in bipolar patients. The core studies supporting the concept of a suicide preventive effect of lithium in bipolar patients come from the international research group IGSLI, from Sweden, Italy, and recently also from the U.S. Patients on lithium possess an eight- time lower suicide risk than those off lithium. The anti-suicidal effect is not necessarily coupled to lithium's episode suppressing efficacy. The great number of lives potentially saved by lithium adds to the remarkable benefits of lithium in economical terms. The evidence that lithium can effectively reduce suicide risk has been integrated into modern algorithms in order to select the optimal maintenance therapy for an individual patient.     

Suicide and other causes of death in a five-year follow-up of patients treated for self-poisoning in Oslo

This 5-year follow-up study includes all patients (n = 934; 50% females) treated for self-poisoning in Oslo during 1 year. Seventeen percent were considered suicide attempts upon admission, 25% among the nonabusers and 8% among the abusers. At follow-up, 122 patients were dead (61% males). The mortality rate was highest among the abusers. The mortality rate was similar (13%) among those who were considered to be suicidal on admittance and those who were not. The causes of death were suicide (28%), opiate abuse (16%), heart disease (14%), accidents or wounds (11%), alcoholism (9%) and others (22%). The standard mortality rate was highly increased in all groups (8 times on average), highest among the female opiate abusers, whose rate was 63 times higher than expected. The increased suicide rates (87 times for females, 27 times for males), however, may be a more relevant measure of mental morbidity than the standard mortality rate. Logistic regression analysis demonstrated that male sex, age above 50 years and the lowest social group were factors on admission associated with death in the follow-up period. Age above 50 years and suicidal attempt on admission were associated with subsequent suicide. The study strongly supports the idea of self-destructiveness and slow suicide in substance abuse.     

Are suicide trends among the young reversing? Age,period and cohort analyses of suicide rates in Sweden

Allebeck P, Brandt L, Nordstrom P, Åsgård U. Are suicide trends among the young reversing? Acta Psychiatr Scand 1996: 93: 43–48. © Munksgaard 1996. We analyzed suicide rates in Sweden 1952–1992 with the main purpose of following up the previously observed increasing suicide rate in young men, and applying age-period-cohort (APC) analyses to the trends in suicide mortality. APC analyses were performed by a graphical method and by multivariate log-linear regression. The suicide rate among 20–40 year-old men increased throughout the 1950s and 60s, but the increase has levelled off since the middle of the 1970s, and in some narrow age groups possibly even reversed. The suicide rate among men over 45 years has declined throughout the period. The suicide rate among women has remained more stable. APC analyses did not give clear evidence for a specific cohort or period effect, although addition of a cohort term in the analyses of men slightly improved the fit of the model. A longer follow-up of younger birth cohorts is needed to see whether the changes in male suicide rates will remain as a cohort effect.     

The effect of long-term lithium treatment on the mortality of patients with manic-depressive and schizoaffective illness.

Clinical research centers in Aarhus, Berlin, Hamilton and Vienna collected mortality data for 827 manic-depressive and schizoaffective patients given lithium treatment for more than 6 months. The average duration of the treatment was 81 months and the total time on lithium 5600 patient-years. For each patient, the mortality risk was calculated by entering the appropriate national life tables for the general population. The number of observed deaths was 44; the number of expected deaths was 49.7. The standardized mortality ratio, 0.89, did not differ significantly from 1.0. The mortality of manic-depressive patients is 2-3 times that of the general population. Our data show that the mortality of manic-depressive and schizoaffective patients given long-term lithium treatment does not differ significantly from that of the general population.     

Mortality and suicide rates of involuntarily committed patients

The mortality and suicide rates for involuntarily committed patients in Denmark are presented. Two cohorts of psychiatric patients committed to a mental hospital from January 1, 1971 to December 31, 1975 (8322 people) and January 1, 1981 to December 31, 1985 (5253 people) have been followed. The standard mortality rate (SMR) in relation to the total Danish population were 4.9 (4.5–5.4) and 5.2 (4.7–5.8), respectively, for the two cohorts, during the first year after involuntarily commitment to a mental hospital. During the same period, the SMR for suicide among the committed patients were 44.9 (37.1–53.9) and 30.9 (24.2–38.9), respectively. The crude suicide rates among the committed patients during the first year after the commitment were 14.3 and 14.0, respectively, per 1000 years, unchanged between the cohorts. Short length of stay in hospital (< 14 days), a nonpsychotic main diagnosis, male sex, and age 35 years or more were equally related to high risk of suicide in the 1971 cohort as evaluated to proportional hazard methods (Cox regression), and short length of stay and commitment on the danger indication provided the most information in relation to high suicidal risk in the 1981 cohort. Methodological problems and the reasons for the results are discussed.     

The Psychological Autopsy and Determination of Child Suicides: A Survey of Medical Examiners

This study explored the decision-making processes of medical examiners in the determination of child suicide. Ninety-four medical examiners completed a survey regarding those factors considered when making a child suicide determination, sources of information used, and considerations in accident vs. suicide classifications. No significant differences between groups of respondents were observed. Well-known risk factors such as suicide notes were considered by virtually all participants, but other risk factors (e.g., substance abuse) were not consistently taken into consideration. Common sources of information included informant interviews and review of records. Results indicate that age and evidence of intent are critical considerations in this process. Implications in terms of misclassification and prevention efforts are discussed.     

The Relationship of Self-reported Executive Functioning to Suicide Ideation and Attempts: Findings from a Large U.S.-based Online Sample

An increasing number of studies demonstrate that individuals with a history of suicidality exhibit impaired executive functioning abilities. The current study examines whether these differences are linked to suicidal thoughts or suicidal acts—a crucial distinction given that most people who think about suicide will not act on their thoughts. A large online sample of U.S. participants with a history of suicide ideation (n = 197), suicide attempts (n = 166), and no suicidality (n = 180) completed self-report measures assessing executive functioning, suicide ideation and attempts; in addition, depression, self-efficacy, and history of drug abuse and brain injury were assessed as potential covariates. Individuals with recent suicide attempts reported significantly worse executive functioning than ideators. This difference was not accounted for by depression, self-efficacy, history of drug abuse or brain injury. Self-reported executive functioning may represent an important short-term risk factor for suicide attempts.     

Alpers' disease — A variant of Creutzfeldt-Jakob disease and subacute spongiform encephalopathy?

Summary A case of Alpers' disease is described and the findings analysed in relation to subacute spongiform encephalopathy and Creutzfeldt-Jakob disease, suggest that these three diseases have enough in common to indicate that they represent the same reaction of the brain at different ages and are all possibly based on an anoxic or vascular pathogenesis.

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Zusammenfassung Ein Fall von Alpersscher Krankheit wird beschrieben und die Befunde in ihrer Beziehung zur subakuten spongiformen Encephalopathie und zur Jakob-Creutzfeldtschen Krankheit erörtert. Die Annahme wird vorgebracht, daß diese drei Krankheitsbilder durch einige Gemeinsamkeiten auf eine und dieselbe Reaktionsform des Gehirns, die mit dem Alter differiert, hinweisen und möglicherweise eine anoxische oder vasculäre Pathogenese besitzen.

     

胰岛素抵抗与缺血性脑血管病之间关系的动态研究

目的；研究胰岛素抵抗与缺血性脑血管病之间的关系。方法：选取脑梗死病人作为研究对象，测定血糖，胰岛素，Ｃ－Ｐ等指标，以胰岛素敏感指数与对照组比较。结果：ＦＩＮＳ，Ｃ－Ｐ和ＩＳＩ均有显著性差异，ＩＳＩ与ＦＩＮＳ和Ｃ－Ｐ存在极显著负相关Ｃ－Ｐ与ＦＩＮＳ存在极显著正相关，与ＩＳＩ存在极显著负相关。     

The effect of L-DOPA on postural reflexes in parkinson's disease

Summary The supraspinatus muscle contracts in response to the loading of the upper arm. 20 patients with Parkinson's disease and 10 healthy subjects underwent EMG examination of the supraspinatus muscle on both sides, with the arms held in the normal dependent position parallel to the body. In all the normals these muscles responded by slight contraction, while no activity was recorded in any of the patients, due to impairment of postural reflexes.2 weeks after starting treatment with L-DOPA, 18 out of 20 patients regained activity of the supraspinatus.EMG of the supraspinatus muscle may serve as an additional tool in assessing Parkinsonian patients with L-DOPA therapy.

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Zusammenfassung Durch den Musculus supraspinatus wird der Oberarm abduziert. Bei 20 Patienten mit Parkinsonscher Krankheit und bei 10 gasunden Vergleichspersonen wurde das Elektromyogramm des Musculus supraspinatus beidseits mit herunterhängendem Arm abgeleitet. In allen Normalpersonen reagierte dieser Muskel mit einer leichten Kontraktion, während keine Aktivität bei den Patienten abgeleitet wurde. Dies war auf eine Hemmung der Haltungsreflexe zurückzuführen. 2 Wochen nach Beginn einer L-DOPA-Behandlung trat bei 18 der 20 Patienten eine Aktivität im Musculus supraspinatus in Erscheinung. Das Elektromyogramm des Musculus supraspinatus kann als weiteres Mittel zur Beurteilung von Parkinson-Patienten unter L-DOPA-Therapie dienen.

     

The increase of Parkinson's disease mortality could be due to a cohort effect

Introduction – An increase of Parkinson's disease (PD) mortality has been observed in various countries during the last 3 decades. An analysis was done in order to define whether this trend could be due to a cohort effect. Material & methods – The mortality from PD in Italy during the period 1963–1987 was analyzed by means of a simplified cohort method. A mortality rate ratio (MRR) was also calculated, reporting all rates to 1906–1910 birth-cohort. Results – The mean annual mortality rates from PD sharply increased during the period of the study. The MRRs increased from the cohort born between 1881 and 1885, to a maximum in the cohort born between 1906 and 1910, and then markedly decreased in the following cohorts. Conclusion – According to our findings, the increase of PD mortality could be partly ascribed to an higher risk of dying from PD experienced by the cohorts of people born in the first decade of this century.     

The use of motor vehicle exhaust for suicide and the availability of cars

A study of the states of the United States showed that suicide rates using car exhaust were lower in states that had lower rates of car ownership, a greater proportion of the population living in non-urban areas and that were further north. The implications of these results for a public health approach to suicide prevention are discussed.     

The use of standardised short-term and working memory tests in aphasia research: a systematic review

Impairments of short-term and working memory (STM, WM), both verbal and non-verbal, are ubiquitous in aphasia. Increasing interest in assessing STM and WM in aphasia research and clinical practice as well as a growing evidence base of STM/WM treatments for aphasia warrant an understanding of the range of standardised STM/WM measures that have been utilised in aphasia. To date, however, no previous systematic review has focused on aphasia. Accordingly, the goals of this systematic review were: (1) to identify standardised tests of STM and WM utilised in the aphasia literature, (2) to evaluate critically the psychometric strength of these tests, and (3) to appraise critically the quality of the investigations utilising these tests. Results revealed that a very limited number of standardised tests, in the verbal and non-verbal domains, had robust psychometric properties. Standardisation samples to elicit normative data were often small, and most measures exhibited poor validity and reliability properties. Studies using these tests inconsistently documented demographic and aphasia variables essential to interpreting STM/WM test outcomes. In light of these findings, recommendations are provided to foster, in the future, consistency across aphasia studies and confidence in STM/WM tests as assessment and treatment outcome measures.