Daytime sleepiness and risk of coronary heart disease and stroke: results from the Nurses’ Health Study II

ObjectiveThe objective of this study was to determine whether daytime sleepiness is independently associated with coronary heart disease (CHD) and stroke or whether the positive association is explained by short sleep duration, disturbed sleep, and circadian disruption, conditions that are associated with cardiometabolic risk factors for vascular events.MethodsLongitudinal analyses of data from the Nurses’ Health Study II comprising 84,003 female registered nurses aged 37–54 at baseline were conducted in 2001 with follow-up until 2009. Multivariate Cox regression was used to explore the relationship between reported daytime sleepiness and the incidence of either CHD or stroke (n = 500 cases).ResultsWomen who reported daytime sleepiness almost every day, compared with rarely/never, had an elevated adjusted risk of cardiovascular disease (CVD) (hazard ratio (HR) = 1.58, 95% confidence interval (CI) 1.15–2.17). Controlling for sleep variables (sleep duration, snoring, shift work, and sleep adequacy) or potential metabolic biological mediators of disrupted sleep (diabetes, hypercholesterolemia, and hypertension) appreciably attenuated the relationship (HR = 1.17, 95% CI 0.84–1.65; and HR = 1.34, 95% CI 0.97–1.85, respectively). Controlling for both sleep variables and metabolic risk factors eliminated an independent association (HR = 1.09, 95% CI 0.77–1.53). A similar pattern was observed for CHD and stroke individually.ConclusionsDaytime sleepiness was not an independent risk factor for CVD in this cohort of women, but rather, was associated with sleep characteristics and metabolic abnormalities that are risk factors for CVD.     

Health behaviors among people with epilepsy—Results from the 2010 National Health Interview Survey

ObjectivesThis study aimed to estimate and compare the prevalence of selected health behavior—alcohol use, cigarette smoking, physical activity, and sufficient sleep—between people with and without a history of epilepsy in a large, nationally representative sample in the United States.MethodsWe used data from the 2010 cross-sectional National Health Interview Survey (NHIS) to compare the prevalence of each health behavior for people with and without epilepsy while adjusting for sex, age, race/ethnicity, and family income. We also further categorized those with epilepsy into active epilepsy and inactive epilepsy and calculated their corresponding prevalences.ResultsThe percentages of adults with a history of epilepsy (50.1%, 95% CI = 45.1%–55.2%) and with active epilepsy (44.4%, 95% CI = 37.6%–51.5%) who were current alcohol drinkers were significantly lower than that of those without epilepsy (65.1%, 95% CI = 64.2%–66.0%). About 21.8% (95% CI = 18.1%–25.9%) of adults with epilepsy and 19.3% (95% CI = 18.7%–19.9%) of adults without epilepsy were current smokers. Adults with active epilepsy were significantly less likely than adults without epilepsy to report following recommended physical activity guidelines for Americans (35.2%, 95% CI = 28.8%–42.1% vs. 46.3%, 95% CI = 45.4%–47.2%) and to report walking for at least ten minutes during the seven days prior to being surveyed (39.6%, 95% CI = 32.3%–47.4% vs. 50.8%, 95% CI = 49.9%–51.7%). The percentage of individuals with active epilepsy (49.8%, 95% CI = 42.0%–57.7%) who reported sleeping an average of 7 or 8 h a day was significantly lower than that of those without epilepsy (61.9%, 95% CI = 61.2%–62.7%).ConclusionsBecause adults with epilepsy are significantly less likely than adults without epilepsy to engage in recommended levels of physical activity and to get the encouraged amount of sleep for optimal health and well-being, promoting more safe physical activity and improved sleep quality is necessary among adults with epilepsy. Ending tobacco use and maintaining low levels of alcohol consumption would also better the health of adults with epilepsy.     

Suicidal ideation and suicidal attempts among adults with chronic diseases: A cross-sectional study

IntroductionAbout 14% of the global burden of disease has been attributed to neuropsychiatric disorders. The aim of this study was to show the general picture of suicidal ideation and behavior among Korean, and to test the hypothesis that there is a positive association between diseases and suicidality.MethodA total of 19,599 individuals were asked if they had any chronic diseases, suicidal ideation and attempts. The data from the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V, 2010–2012) conducted by Korea Centers for Disease Control and Prevention (KCDC) were examined.ResultsStroke and osteoarthritis were associated with a 1.81 and 1.27 times increase in the odds of suicidal ideation, respectively (95% CI = 1.24–2.65; 95% CI = 1.09–1.48). Angina pectoris and osteoarthritis were associated with a 3.88 and 2.09 times increase in the odds of suicide attempts (95% CI = 1.78–8.43; 95% CI = 1.24–3.55). Having pulmonary tuberculosis increased the odds of a suicide attempt 12-fold (OR = 12.47, 95% CI = 1.12–138.66). Having renal failure was associated with a 4.92 times increase in the odds of suicide attempts (95% CI = 1.25–19.30). Having lung cancer or cervical cancer increased the odds of suicide attempts more than 10-fold (OR = 11.53, 95% CI = 1.03–128.80; OR = 17.66, 95% CI = 1.58–197.01).ConclusionsVarious diseases were risk factors for suicidality. Physicians' communication skills for frank and clear discussions about suicidality should be developed through various training courses.     

Interferon-beta and disability progression in relapsing-remitting multiple sclerosis

ObjectiveTo assess the impact of interferon (IFN)-beta treatment on the progression of unremitting disability in IFN-beta treated and untreated relapsing-remitting (RR) patients with multiple sclerosis (MS) using prospective cohort study.MethodsA cohort of 419 RRMS (236 IFN-beta-treated and 183 untreated) patients was followed for up to 7 years. Cox proportional hazards regression models adjusted for the number of relapses in the last year before first visit was used to assess the differences between the two groups for the three end points: secondary progression (SP), and sustained Expanded Disability Status Scale (EDSS) score 4 and 6. Time from disease onset was used as survival time variable.ResultsThe IFN-beta-treated group showed a highly significant reduction (hazard ratio [HR], 0.34, 95% confidence interval [CI] 0.19–0.61, p < 0.001) in the risk of SP when compared with untreated patients. There were significant differences in favor of the IFN-beta-treated group for the end point EDSS score of 4 (HR = 0.45, 95%CI 0.28–0.73, p = 0.001) and EDSS score of 6 (HR = 0.34, 95%CI 0.16–0.75, p = 0.007).ConclusionThis observational study further supports the notion that IFN-beta could have potential beneficial effect on disease progression in RRMS.     

The risk and associated factors of methamphetamine psychosis in methamphetamine-dependent patients in Malaysia

ObjectiveThe objective of this study was to determine the risk of lifetime and current methamphetamine-induced psychosis in patients with methamphetamine dependence. The association between psychiatric co-morbidity and methamphetamine-induced psychosis was also studied.MethodsThis was a cross-sectional study conducted concurrently at a teaching hospital and a drug rehabilitation center in Malaysia. Patients with the diagnosis of methamphetamine based on DSM-IV were interviewed using the Mini International Neuropsychiatric Interview (M.I.N.I.) for methamphetamine-induced psychosis and other Axis I psychiatric disorders. The information on sociodemographic background and drug use history was obtained from interview or medical records.ResultsOf 292 subjects, 47.9% of the subjects had a past history of psychotic symptoms and 13.0% of the patients were having current psychotic symptoms. Co-morbid major depressive disorder (OR = 7.18, 95 CI = 2.612–19.708), bipolar disorder (OR = 13.807, 95 CI = 5.194–36.706), antisocial personality disorder (OR = 12.619, 95 CI = 6.702–23.759) and heavy methamphetamine uses were significantly associated with lifetime methamphetamine-induced psychosis after adjusted for other factors. Major depressive disorder (OR = 2.870, CI = 1.154–7.142) and antisocial personality disorder (OR = 3.299, 95 CI = 1.375–7.914) were the only factors associated with current psychosis.ConclusionThere was a high risk of psychosis in patients with methamphetamine dependence. It was associated with co-morbid affective disorder, antisocial personality, and heavy methamphetamine use. It is recommended that all cases of methamphetamine dependence should be screened for psychotic symptoms.     

Risk of suicide according to the level of psychiatric contact in the older people: Analysis of national health insurance databases in Taiwan

PurposeSuicide in the older people is a serious problem worldwide; however the effect of psychiatric contact on the risk of suicide has not been fully explored. The aim of this study was to investigate the relationship between psychiatric contact and suicide in the older people in Taiwan.MethodsA population-based database was used in this national case–control study. Propensity score matching was used to match older people who did and did not commit suicide from 2010 to 2012 by calendar year, gender, age, and area of residence. The level of psychiatric contact in the preceding year was classified as “no psychiatric contact,” “only outpatient psychiatric contact,” “psychiatric emergency room contact,” or “psychiatric hospital admission”. Conditional logistic regression analysis was used to assess associations between variables and the risk of suicide.ResultsA total of 2528 older people committed suicide from 2010 to 2012, with a crude suicide mortality rate of 3.37/10,000. Compared to those who had no psychiatric contact in the preceding year, the adjusted odds ratios of suicide were 10.15 (95% CI = 5.8–17.7) for those who had psychiatric emergency room contact, 6.57 (95% CI = 3.7–11.6) for those who had psychiatric hospital admissions, and 3.64 (95% CI = 3.0–4.4) for those with only outpatient psychiatric contact. The risk of suicide was higher in those who had depression (OR = 3.49, 95% CI = 2.2–5.4) and bipolar disorder (OR = 1.98, 95% CI = 1.1–3.6). Patients with cancer were associated with suicide (OR = 8.96, 95% CI = 5.6–14.4).ConclusionsThe positive association with suicide and the level of psychiatric contact in the preceding year in older people indicated that the health personnel need to do a better job in determining possible risk for older people who had psychiatric contact, especially in emergency visit or psychiatric admission. A systematic approach to quality improvement in these settings is both available and necessary. Careful discharge planning and safe transitions of care to outpatient services are required for suicide prevention of high-risk patients after discharge.     

Depression and anxiety in patients with diabetes in a Moroccan region

AimsTo estimate prevalence of anxiety and depression in patients with diabetes mellitus and identify their determinants.MethodsA cross-sectional study was conducted at Hassan II University-Hospital of Fes in 2019–2020. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariate analysis by logistic regression was used to determine factors associated with depression and anxiety, adjusting for confounding factors. All statistical analyses were conducted using EPIINFO7.ResultsA total of 243 diabetics were included in the study. The average age of the participants was 48.07 ± 14.25 years, 58% were females and 72% were diagnosed with diabetes type II. The prevalence of depressive symptoms and anxiety symptoms was (18, 1%, CI_95% = (13–23)) and (29.6%, CI_95% = (24–35)), respectively. The prevalence of depression and anxiety was higher among women than man and increases with increasing duration of the disease. In multivariate analysis, illiterates (OR = 3.19, CI_95% = (1.46–6.98)), those with depression (OR = 3.61, CI_95% = (1.78–7.32)), and type 1 diabetics (OR = 3.22, CI_95% = (1.44–7.21)) are a higher risk of developing anxiety. Depression was associated with older age (OR = 2, 65, CI_95% = (1, 14–6, 14)), use of insulin (OR = 3.77 CI_95% = (1.50–9.44)) and anxiety symptoms (OR = 4, 27, CI_95% = (2, 05–8, 91)).ConclusionHigh prevalence of depressive and anxiety symptoms in diabetics suggests consideration of psychological aspect in implementation of diabetes managing program.     

History of major depression as a barrier to health behavior changes after a chronic disease diagnosis

ObjectiveTo examine whether changes in smoking, drinking, and physical activity after a chronic disease diagnosis differ between middle-aged and older adults with and without a history of major depression.MethodsIndividual-level data came from 1996 to 2010 waves of the U.S. Health and Retirement Study. Chronic disease diagnosis was ascertained from self-reports of physician diagnosed diseases. Major depression was assessed by the short-form Composite International Diagnostic Interview. Mixed-effects logistic regressions were performed to estimate the potential moderating effect of a history of major depression.ResultsBaseline major depression was associated with a more than 3-fold increase (OR = 4.48, 95% CI = 2.27–8.86) in the odds of smoking and 37% decrease (OR = 0.63, 95% CI = 0.52–0.75) in the odds of staying physically active, but not with odds of excessive drinking. After a chronic disease diagnosis, the odds of smoking was reduced by 75% (OR = 0.25, 95% CI = 0.20–0.32), the odds of excessive drinking was reduced by 47% (OR = 0.53, 95% CI = 0.47–0.61), and the odds of staying physically active was reduced by 30% (OR = 0.70, 95% CI = 0.63–0.78). There was a significant interaction effect for smoking such that the decline in the odds of smoking was smaller among adults with a history of major depression.ConclusionChronic disease diagnosis may be an important teachable moment for health behavior change, but the behavior changing effect may be smaller for those with a history of major depression especially when it comes to smoking.     

Association between methylenetetrahydrofolate reductase C677T polymorphism and epilepsy susceptibility: A meta-analysis

PurposeMethylenetetrahydrofolate reductase (MTHFR) C677T polymorphism has been implicated as a potential risk factor for epilepsy. To date, many case–control studies have investigated the association between MTHFR C677T polymorphism and epilepsy susceptibility. However, those findings were inconsistent. The objective of this study is to evaluate the precise association between MTHFR C677T polymorphism and epilepsy.MethodsAn electronic search of PubMed, EMBASE for papers on the MTHFR C677T polymorphism and epilepsy susceptibility was performed. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the association.ResultsTen case–control studies containing 1713 cases and 1867 controls regarding MTHFR C677T polymorphism were selected. A significant association between the MTHFR C677T polymorphism and epilepsy susceptibility was revealed in this meta-analysis (for T vs. C: OR = 1.19, 95% CI = 1.08–1.32; for TT + CT vs. CC: OR = 1.20, 95% CI = 1.05–1.38; for TT vs. CC: OR = 1.48, 95% CI = 1.20–1.83; for TT vs. CT + CC: OR = 1.35, 95% CI = 1.12–1.64). In subgroup analysis by ethnicity, the results also indicated the association between the MTHFR C677T polymorphism and epilepsy susceptibility within the Asian populations (for T vs. C: OR = 1.55, 95% CI = 1.15-2.07; for TT + CT vs. CC: OR = 1.67, 95% CI = 1.08-2.59; for TT vs. CC: OR = 2.33, 95% CI = 1.30-4.20; for TT vs. CT + CC: OR = 1.89, 95% CI = 1.12-3.18).ConclusionThe results indicated that MTHFR C677T polymorphism was associated with an increased risk of epilepsy. However, further studies in various regions are needed to confirm the findings from this meta-analysis.     

Relation of baseline presence and severity of renal disease to long-term mortality in persons with known stroke

BackgroundLittle is known about the long-term prognostic impact of baseline chronic kidney disease (CKD) on outcomes after stroke. We assessed the association of diagnosis and severity of baseline CKD with risk of mortality among persons with a history of stroke.MethodsData from the National Health and Nutrition Examination Survey (NHANES) a nationally representative sample of US adults were analyzed. The study population consisted of 425 individuals aged ≥55 years with a baseline history of stroke followed-up from NHANES III survey participation (1988–1994) through mortality assessment in 2000. CKD outcomes were glomerular filtration rate (GFR) <60 mL/min/1.73 m² and urinary albumin to creatinine ratio (UACR) >30 mg/g of creatinine. CKD severity was categorized per national guidelines. Proportional hazard regression (Cox) was utilized to explore the independent relationship between CKD vs. all-cause and cardiovascular mortality after adjusting for confounders.ResultsAmong the cohort, 55.8% were female, 77.3% aged ≥65 years. Baseline serum creatinine was higher among persons with known stroke who later died vs. remained alive (p < 0.01). Multivariable models showed that persons with low GFR (HR, 1.87 95% CI = 1.30–2.68), CKD stages 1–2 (HR 1.84; 95% CI = 1.06–3.20), 3 (HR 2.58; 95% CI = 1.54–4.32), and 4–5 (HR 5.93; 95% CI = 2.31–5.20) but not elevated UACR, had an independently higher relative hazard of death compared to individuals without these conditions. Similar results were seen with cardiovascular-specific mortality.ConclusionsBaseline CKD, even of mild severity, is an independent predictor of future mortality among persons with known stroke.     

Functional remission and employment among patients with schizophrenia in Malaysia

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

Excessive risk of cancer and in particular lymphoid malignancy in myasthenia gravis patients: A population-based cohort study

The exact relationship between myasthenia gravis (MG) and extrathymic malignancies has not been established thus far. Occasional cases of MG have been reported in association with lymphoma or other lymphoproliferative disorders. To determine the risk of extrathymic malignancy with particular attention on lymphoid malignancy for MG patients in a large cohort representing 99% of the Taiwan population, claims data from the Taiwan National Health Insurance Database were used to conduct retrospective cohort analyses. The study cohort comprised 3671 MG patients who were 10-fold frequency matched by age and sex, and assigned the same index year without MG. Cox proportional hazard regression analysis was conducted to estimate the risk of cancer. The MG cohort had a 1.74-fold increased risk of developing cancer compared to the comparison cohort (HR = 1.74, 95% CI = 1.47–2.05). After adjusting for confounders and relative to the cohort, patients with MG had a 2.27-fold increased risk of developing lymphoid malignancies (HR = 2.27, 95% CI = 1.06–4.88) and a 118.47-fold increased risk of thymus cancer (HR = 118.47, 95% = 42.57–329.71). This population based retrospective case-control study confirms and extends previous observations on the association between MG and lymphoid malignancies.     

Febrile convulsions increase risk of Tourette syndrome

PurposeFebrile convulsion (FC) and Tourette syndrome (TS) are both common neurological disorders in infants and children. Both disorders share clinical similarities, such as paroxysmal symptoms with normal neurodevelopment and expected remission over time. This population-based study investigated the association between FC with TS during childhood neurodevelopment.MethodWe used the Taiwan National Health Insurance Research Database to conduct a retrospective cohort analysis on 1586 FC patients. A reference cohort of 6344 non-FC patients, matched for age, sex, urbanization level, parental occupation, and index year, was used for comparison. The risk of the occurrence of TS in FC patients was assessed using a Cox proportional hazard regression model.ResultsThe overall incidence of TS was higher in the FC cohort than in the non-FC cohort (28.5 vs 13.9 per 10,000 person-years; adjusted hazard ratio = 1.91, 95% confidence interval = 1.32–2.75). The associated risk factors for FC patients to develop TS were boys, children living in rural areas, and children whose parents held blue-collar positions. Moreover, the risk of TS in FC patients rose from 0.89 to 16.0 (trend test P < 0.0001) when the frequency of FC-related medical visits increased from 1 to 2 times to more than 4 times. The adjusted hazard ratio for TS in related to FC-related medical visits was 1.02 (95% CI = 1.02–1.03) per one frequency increment.ConclusionFC may increase the risk of subsequent TS occurrence in children. Children who had frequent medical visits for FC were particularly vulnerable.     

Risk factors for child mental health problems in Lithuania: The role of parental nationality

BackgroundWe compare the mental health status of children who reside in Lithuania with parents who are either Lithuanian nationals or non-Lithuanian nationals.MethodData were drawn from the School Child Mental Health Europe survey (SCMHE), a cross-sectional survey of school children aged 6–11 years. A total of 1152 Lithuanian children participated, among them 11.7% from a non-Lithuanian family. Child mental health was assessed using the Dominique Interactive (DI) and the parent- and teacher Strength and Difficulties Questionnaire (SDQ). Parental attitudes were evaluated, and socio-demographics were collected.ResultsOverall 26.7% of non-Lithuanian versus 17.2% of Lithuanian children reported having an internalizing disorder (p = 0.01) mainly due to separation anxiety (16.4% versus 10.2%, p = 0.04). Odds ratio (OR) for child-reported internalizing disorders was 1.86 (95% CI = 1.17–2.96) once adjusted for other factors including being a girl, to be younger, parental unemployment and low caring and low autonomy parental attitudes which were associated with greater odds of internalizing disorders. In addition, 31.9% of non-Lithuanian reported suicidal thoughts versus 22.0% of Lithuanian children p = .02); OR = 1.60 (95% CI = 1.04–2.46) once adjusted for single parent, parental unemployment, parental alcohol problems and overreactivity attitude.ConclusionsBeing a non-national minority in Lithuania is a risk factor for child mental health. These findings suggest that further studies are needed to inform local policy-makers on targeted prevention and intervention programs in these children.     

Smoking and sleep disorders in Chinese adolescents

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

Increased depression risk among patients with chronic osteomyelitis

ObjectiveInflammatory processes, which provoke alternations of neurotransmitter metabolism, neuroendocrine function, and neuroplasticity in the brain, might promote depression. In depression patients who do not exhibit risk factors, including hypertension, diabetes, coronary heart disease, stroke, Parkinson's disease and dementia, particularly in young people, inflammation is a likely risk factor for depression. We explored whether chronic osteomyelitis (COM), a chronic inflammatory disease, increases depression risk.MethodsA Taiwanese national insurance claims data set of more than 22 million enrollees was used to select 15,529 COM patients without depression history and 62,116 randomly selected age- and gender-matched controls without depression and COM history to trace depression development for an 12-year follow-up period from January 1, 1999 to December 31, 2010. The depression risk was analyzed using the Cox proportional hazards regression model.ResultsThe above-mentioned risk factors for depression were more frequent in the COM cohort, who exhibited significantly higher depression risk than the control group did. Comparing only those without comorbidities, the COM group exhibited higher depression risk than the control group did (hazard ratio [HR] = 3.04, 95% confidence interval [CI]: 2.55–3.62). The younger population carried even greater risk (age < 45: HR = 6.08, 95% CI: 1.71–7.85; age > 65: HR = 1.75, 95% CI: 1.39–2.19).ConclusionsThis is the first study connecting COM to increased risk of developing depression. The outcomes suggest that COM is a substantial depression predictor and call for a closer focus on these patients for more rigorous depression prevention, particularly in young people.     

Risk factors for amyloid positivity in older people reporting significant memory concern

ObjectiveThe goal of this study is to identify risk factors for the presence of amyloid accumulation in the brains of patients reporting subjective cognitive decline (SCD). Identifying such risk factors will help better identify patients who ought to receive neuroimaging studies to confirm plaque presence and begin intervention, as well as enhancing the study of the pathogenesis of Alzheimer's disease.MethodsNinety-nine SCD participants (72.2 ± 5.6 years, 57.6% female) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) underwent florbetapir PET. Logistic regression analysis was conducted to examine the relationship between the presence of an increased amyloid signal (amyloid positivity) and several potential risk factors, including: demographics, APOE ε4 genotype, family history of dementia, history of hypertension, history of cigarettes smoking, cognitive function and depressive symptoms.ResultsBeing female was a significant risk factor for amyloid positivity (OR = 4.915, 95% CI = 1.709–14.139), as was being an APOE ε4 carrier (OR = 2.985, 95% CI = 1.084–8.219) and having a history of cigarette smoking (OR = 4.091, 95% CI = 1.483–11.285).ConclusionOur study demonstrates that female gender, APOE ε4 genotype, and history of cigarettes smoking are associated with amyloid positivity in patients with SCD.     

Comparative levels of excessive daytime sleepiness in common medical disorders

IntroductionSleep restriction and sleep disorders are common causes of excessive daytime sleepiness (EDS). Medical disorders (MD) can also cause EDS, but previous studies have used non-standardized measures, selected samples, or have examined EDS in singular disorders. This study describes the relative degree of EDS associated with medical disorders to provide comparative data across a range of common medical conditions in a large unselected community-based sample.MethodsResponses of 2612 individuals (aged 18–65) were assessed after excluding those with suspected sleep disordered breathing, narcolepsy, and shift workers. Participants across a range of medical disorders were evaluated using the Epworth Sleepiness Scale (ESS) and patient reports of nocturnal sleep.ResultsSixty-seven percent of the sample reported a MD. The prevalence of EDS (ESS ? 10) was 31.4% in individuals with MD and increased as a function of a number of MD (0 MD = 29.4%, 1 MD = 28.4%, 2 MD = 31.0%, 3 MD = 35.3%, 4 MD = 38.4%). Disorders which were independent predictors of EDS were ulcers OR = 2.21 (95% CI = 1.35–3.61), migraines OR = 1.36 (95% CI = 1.08–1.72), and depression OR = 1.46 (95% CI = 1.16–1.83) after controlling for other conditions, age, gender, time in bed, caffeine, smoking and alcohol use. Participants with ulcers had the highest prevalence of sleepiness, 50.0%, as well as the highest level of problems falling asleep (40.8%) and awakenings during the night (62.5%).ConclusionsIndividuals with ulcers, migraines, and depression have independent and clinically significant levels of EDS relative to other common MD.     

Development and validation of an epidemiologic case definition of epilepsy for use with routinely collected Australian health data

ObjectivesWe report the diagnostic validity of a selection algorithm for identifying epilepsy cases.Study design and settingRetrospective validation study of International Classification of Diseases 10th Revision Australian Modification (ICD-10AM)-coded hospital records and pharmaceutical data sampled from 300 consecutive potential epilepsy-coded cases and 300 randomly chosen cases without epilepsy from 3/7/2012 to 10/7/2013. Two epilepsy specialists independently validated the diagnosis of epilepsy. A multivariable logistic regression model was fitted to identify the optimum coding algorithm for epilepsy and was internally validated.ResultsOne hundred fifty-eight out of three hundred (52.6%) epilepsy-coded records and 0/300 (0%) nonepilepsy records were confirmed to have epilepsy. The kappa for interrater agreement was 0.89 (95% CI = 0.81–0.97). The model utilizing epilepsy (G40), status epilepticus (G41) and ≥ 1 antiepileptic drug (AED) conferred the highest positive predictive value of 81.4% (95% CI = 73.1–87.9) and a specificity of 99.9% (95% CI = 99.9–100.0). The area under the receiver operating curve was 0.90 (95% CI = 0.88–0.93).ConclusionWhen combined with pharmaceutical data, the precision of case identification for epilepsy data linkage design was considerably improved and could provide considerable potential for efficient and reasonably accurate case ascertainment in epidemiological studies.     

Active epilepsy prevalence,the treatment gap,and treatment gap risk profile in eastern China: A population-based study

We measured the prevalence of active epilepsy and investigated the treatment gap and treatment gap risk profile in eastern China.This was a cross-sectional population-based survey conducted in Zhejiang, China, from October 2013 to March 2014. A total 54,976 people were selected using multi-stage cluster sampling. A two-stage questionnaire-based process was used to identify patients with active epilepsy and to record their demographic, socioeconomic, and epilepsy-related features. Logistic regression analysis was used to analyze risk factors of the treatment gap in eastern China, as adjusted for age and sex.We interviewed 50,035 people; 118 had active epilepsy (2.4‰), among which the treatment gap was 58.5%. In multivariate analysis, failure to receive appropriate antiepileptic treatment was associated with higher seizure frequency of 12–23 times per year (adjusted odds ratio = 6.874; 95% confidence interval [CI] = 2.372–19.918), > 24 times per year (adjusted odds ratio = 19.623; 95% CI = 4.999–77.024), and a lack of health insurance (adjusted odds ratio = 7.284; 95% CI = 1.321–40.154).Eastern China has relatively lower prevalence of active epilepsy and smaller treatment gap. Interventions aimed at reducing seizure frequency, improving the health insurance system should be investigated as potential targets to further bridge the treatment gap.