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]     

Factors Associated With High Rates of Depressive Symptomatology in Older People in Vietnam

ObjectivesThis study aimed to identify the prevalence and correlates of depressive symptomatology among Vietnamese older people.MethodWe used baseline survey data collected in 2018 from the Longitudinal Study of Ageing and Health in Vietnam (LSAHV) conducted across seven regions and comprising 6,050 people aged 60 years and over of whom 4962 completed the brief 11-item Center for Epidemiological Studies-Depression (CES-D) scale. Clinically significant depressive symptomatology was a CES-D score of 8.8 or higher. The association between demographic, physical, and mental factors with depressive symptomatology was examined using univariate and multivariable logistic regression.ResultsThe prevalence of depressive symptomatology was 31.3% (95% CI 29.8% - 32.9%). Depressive symptomatology was highest among people living in the Central Coast region (46.8%, 95% CI 44.5% - 49.2%). Factors associated with depressive symptomatology from the multivariable model included female sex (OR 1.3, 95% CI: 1.1-1.6), rural residence (OR 1.4, 95%CI: 1.1-1.7), not having a partner (OR 1.6, 95% CI: 1.3-1.9), low income (OR 1.8, 95% CI: 1.5-2.1), and health-limitations on activities (OR 1.3, 95% CI: 1.1-1.6). Poorer self-rated mental health (OR 2.1, 95% CI:1.8-2.5) or general health status (OR 1.5, 95% CI: 1.3-1.9) was associated with a higher prevalence of depressive symptomatology, as was poorer function with respect to different activities of daily living, and dissatisfaction with current life (OR 6.1, 95% CI: 4.4-8.4).ConclusionsDepressive symptomatology was frequent among older Vietnamese. Efforts to improve mental health in older persons in Vietnam, including prevention, early intervention and better medical care, appear warranted.     

A family history of Parkinson's disease and its effect on other PD risk factors.

Parkinson's disease (PD) is likely a result of both inherited and exogenous factors. In a study of 144 PD cases and 464 controls, we used PD family history as a surrogate for inherited PD susceptibility. Cases were more likely to report a first- or second-degree relative with PD: 16.0 vs. 4.3%; odds ratio (OR) = 4. 2; 95% confidence interval (CI) = 2.3-7.6. A PD family history was a greater risk factor for PD in subjects under age 70 (OR = 8.8; 95% CI = 3.4-22.8) compared with those over 70 (OR = 2.8; 95% CI = 1.3-6. 1) and in men (OR = 8.1; 95% CI = 3.4-19.2) compared with women (OR = 2.6; 95% CI = 1.1-6.0). We also tested whether a PD family history modified the effects of other PD risk factors. In subjects with a PD family history, occupational exposure to copper, lead or iron increased the risk for PD (OR = 3.0; 95% CI = 0.7-13.3), but this was not the case for those without a family history (OR = 1.1; 95% CI = 0.7-1.6). Ever smoking cigarettes was inversely associated with PD in those without a PD family history (OR = 0.6; 95% CI = 0.4-0.9), but was positively associated with PD in those with a PD family history (OR = 1.7; 95% CI = 0.5-5.9). In summary, our results suggest that a PD family history, and perhaps, therefore, an inherited susceptibility, confers a greater risk for PD in men and individuals under 70 years of age and may modify the effects of environmental risk factors for PD.     

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.     

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.     

Relationship between obesity and antipsychotic drug use in the adult population: a longitudinal, retrospective claim database study in Primary Care settings

OBJECTIVE: To describe the association between obesity and the use of antipsychotic drugs (APDs) in adult outpatients followed-up on in five Primary Care settings. METHODS: A longitudinal, retrospective design study carried out between July 2004 and June 2005, in patients who were included in a claim database and for whom an APD treatment had been registered. A body mass index (BMI) <30 kg/m(2) was defined as obesity. The main measurements were: use of APDs, demographics, medical background and co-morbidities, and clinical parameters. Logistic regression analysis and ANCOVA with Bonferroni adjustment were applied to correct the model. RESULTS: A total of 42,437 subjects (mean age: 50.8 (18.4) years; women: 54.5%; obesity: 27.3% [95% confidence intervals (CI), 26.9%-27.7%]) were analyzed. A total of 1.3% of the patients were receiving APDs, without statistical differences in distribution by type of drug (typical: 48.8%; atypical: 51.2%). Obesity was associated with the use of APDs [OR = 1.5 (CI: 1.3-1.8)], hypertension [OR = 2.4 (CI: 2.2-2.5)], diabetes [OR = 1.4 (CI: 1.3-1.5)] and dyslipidemia [OR = 1.3 (CI: 1.2-1.4)], p < 0.0001 in all cases. BMI was significantly higher in subjects on APDs; 28.8 vs. 27.3 kg/m(2), p = 0.002, and remained higher after adjusting by age and sex (mean difference 0.4 (CI: 0.1-0.7), p < 0.01). After adjusting by age, sex and the Charlson index, obese subjects generated higher average annual total costs than nonobese subjects; 811 (CI: 787-835) vs. 694 (CI: 679-709), respectively, p < 0.001. CONCLUSIONS: Obesity was associated with the use of APDs, regardless of the type of drug, and with the presence of hypertension, diabetes and dyslipidemia. Obesity was also associated with substantially higher health care costs.     

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.     

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.     

Association between lifestyle factors and mental health measures among community-dwelling older women

OBJECTIVE: To investigate the association between potentially modifiable lifestyle factors and cognitive abilities/depressive symptoms in community-dwelling women aged 70 years and over. METHOD: Cross-sectional study of community-dwelling women aged 70 years and over (n=278; mean age=74.6 years). Lifestyle variables assessed included smoking, alcohol consumption, physical activity, nutrition and education. The mental health measures of interest were depression, anxiety, quality of life and cognitive function, as assessed by the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), SF-36, and the Cambridge Cognitive Examination for Mental Disorders of the Elderly (CAMCOG), respectively. RESULTS: Physically active women were half as likely to be depressed (BDI score > or =10) and anxious (BAI score > or = 8) when compared to their physically inactive counterparts (OR=0.5, 95% CI=0.3-0.8 for both, adjusted for marital status and smoking in the case of depression). Having ever smoked more than 20 cigarettes per day was associated with increased risk of depression (OR=2.8, 95% CI=1.4-5.5, adjusted for marital status and physical activity). Moderate alcohol use was associated with increased likelihood of having a CAMCOG score within the highest 50 percentile (OR=2.0, 95% CI=1.1-3.5, adjusted for age and education), as was more than minimum statutory education (OR=2.0, 95% CI=1.1-3.5, adjusted for age and alcohol consumption). There was no obvious association between vitamin B12/folate deficiency or obesity with any of the measures of interest. CONCLUSIONS: The results of this study are consistent with the hypothesis that depression is directly associated with heavy smoking and inversely associated with physical activity. They also support the idea that non-harmful alcohol consumption is associated with better cognitive performance. Randomised clinical trials should be now designed to clarify whether management of lifestyle factors reduces the incidence of mood disorders and cognitive impairment in later life.     

The association of Toxoplasma gondii infection with neurocognitive deficits in a population-based analysis

Purpose

To examine the relationship between infection with Toxoplasma gondii (toxo) and cognition.

Methods

Multivariate logistic regression was used to test the association of toxo seropositivity with indices of cognitive function among over 4,200 adults in the third National Health and Nutrition Examination Survey.

Results

Toxo-seropositive participants were more likely than seronegative participants to score in the worst quartile of the simple reaction time test (OR 1.3, 95 % CI 1.0, 1.6), symbol-digit substitution test (SDST, OR 1.5, 95 % CI 1.2, 1.9) and the serial-digit learning test (trials to criterion) (SDLTNT, OR 1.4, 95 % CI 1.1, 1.8) in models adjusted for age, race/ethnicity, gender and foreign birth. After further adjustment for all cofactors, the association between toxo seropositivity and these outcomes was no longer significant. However, seropositivity was associated with worse scores on the SDST (OR 2.9, 95 % CI 1.8, 4.8) among those in the lowest income category and the SDLTNT (OR 1.5, 95 % CI 1.1, 2.5) among those foreign born.

Conclusions

Toxo seropositivity may be associated with poor cognitive test scores in certain subgroups; however, causation cannot be established in this cross-sectional study.     

Lipoprotein (a) and other prothrombotic risk factors in Caucasian women with unexplained recurrent miscarriage. Results of a multicentre case-control study

From 1998 to 2003, 133 Caucasian women aged 17-40 years (median 29 years) suffering from unexplained recurrent miscarriage (uRM) were consecutively enrolled. In patients and 133 age-matched healthy controls prothrombotic risk factors (factor V (FV) G1691A, factor II (FII) G20210A, MTHFR T677T, 4G/5G plasminogen activator inhibitor (PAI)-1, lipoprotein (Lp) (a), protein C (PC), protein S (PS), antithrombin (AT), antiphospholipid/anticardiolipin (APA/ACA) antibodies) as well as associated environmental conditions (smoking and obesity) were investigated. 70 (52.6%) of the patients had at least one prothrombotic risk factor compared with 26 control women (19.5%; p<0.0001). Body mass index (BMI; p=0.78) and smoking habits (p=0.44) did not differ significantly between the groups investigated. Upon univariate analysis the heterozygous FV mutation, Lp(a) > 30 mg/dL, increased APA/ACA and BMI > 25 kg/m(2) in combination with a prothrombotic risk factor were found to be significantly associated with uRM. In multivariate analysis, increased Lp(a) (odds ratio (OR): 4.7/95% confidence interval (CI): 2.0-10.7), the FV mutation (OR:3.8/CI:1.4-10.7), and increased APA/ACA (OR: 4.5/CI: 1.1-17.7) had independent associations with uRM.     

Socioeconomic status during lifetime and cognitive impairment no-dementia in late life: the population-based aging in the Chianti Area (InCHIANTI) Study

Thousand and twelve dementia-free elderly (60–98 years old) enrolled in the InChianti Study (Italy) were evaluated at baseline (1998–2000) and at 3-year follow-up (2001–2003) with the aim of analyzing the association of lifetime socioeconomic status (SES) with prevalent and incident cognitive impairment no-dementia (CIND). SES was defined from information on formal education, longest held occupation, and financial conditions through life. CIND was defined as age-adjusted Mini-Mental State Examination score one standard deviation below the baseline mean score of participants without dementia. Logistic regression and Cox proportional-hazards models were used to estimate the association of SES with CIND. Demographics,occupation characteristics (i.e., job stress and physical demand), cardiovascular diseases, diabetes, apolipoprotein E (APOE)genotype, smoking, alcohol consumption, depressive symptoms, and C-reactive protein were considered potential confounders.Prevalence of CIND was 17.7%. In the fully adjusted model, low education (OR = 2.1; 95% confidence intervals, CI = 1.4 to 3.2)was associated with prevalent CIND. Incidence rate of CIND was 66.0 per 1000 person-years. Low education (HR = 1.7; 95% CI = 1.04 to 2.6) and manual occupation (HR = 1.9; 95% CI = 1.0 to 3.6) were associated with incident CIND. Among covariates,high job-related physical demand was associated with both prevalent and incident CIND (OR = 1.6; 95% CI = 1.1 to 2.4 and HR= 1.5; 95% CI = 1.0 to 2.3). After stratification for education, manual occupation was still associated with CIND among participants with high education (HR = 2.2; 95% CI = 1.2 to 4.3 versus HR= 1.4; 95% CI = 0.2 to 10.4 among those with low education). Proxy markers of lifetime SES (low education, manual occupation and high physical demand) are cross-sectional correlates of CIND and predict incident CIND over a three-year follow-up.     

A comparison of community-residing older adults with frontal and parkinsonian gaits

Frontal gaits (FG) and parkinsonian gaits (PG) are common neurological gait abnormalities in older adults. It may be difficult to distinguish these gaits as they share common clinical characteristics such as unsteadiness, slowing, and shuffling. Of 488 community-residing subjects in an aging study, 11 were diagnosed with FG and 9 with PG at baseline clinical evaluations. Subjects with FG were older than subjects with PG (84.5 vs. 77.7 years, p<0.001). As expected, parkinsonian signs such as tremor and rigidity were associated with PG and frontal release signs with FG. Subjects with PG had more falls (67% vs. 18%, p=0.02). They performed worse on a panel of executive function tests, although the scores were significantly different only on the verbal fluency test (17.0 vs. 28.3, p=0.009). Advancing age was associated with FG (OR=1.3, 95% CI=1.1-1.4) but not PG (OR=1, 95% CI=0.9-1.1). Medical illnesses were not significantly associated with FG. Diabetes (OR=4.1, 95% CI=1.1-15.5), strokes (OR=4.3, 95% CI=1.1-17.3), and depression (OR=5.1, 95% CI=1.2-20.8) were associated with PG. Despite similar gait characteristics, FG may be distinguished from PG by associated clinical signs, frequency of falls, and the neuropsychological profile. Vascular risk factors and depression were strongly associated with PG, and should be explored further.     

Active and passive cigarette smoking and risk of intracranial meningioma

Motivated by prior studies, we examined associations between cigarette smoking and risk of intracranial meningioma in a population-based case-control study, including 200 cases and 2 controls matched to each case on age and sex. Subjects were asked to recall their history of active and passive cigarette smoking occurring 10 or more years before the date of meningioma surgery. Ever active smoking was associated with an increased risk of meningioma in men (OR = 2.1; 95% CI 1.1-4.2) but not in women (OR = 0.7; 95% CI 0.5-1.1). The statistical interaction by gender was significant (p = 0.01). In men, risk increased with increasing number of cigarettes smoked daily (p for trend = 0.04). In women, the trend was opposite (p for trend = 0.08). Among never active smokers, passive smoking from a spouse was associated with increased risk in both sexes (OR 2.0; 95% CI 1.1-3.5), and risk increased with increasing duration of exposure (p for trend = 0.02). Uncertain is whether these findings reflect a true biological phenomenon or result from chance or uncontrolled confounding.     

Demographic, family, and occupational characteristics associated with major depression: the Harvard study of moods and cycles

OBJECTIVE: This study assesses the extent to which women with and without major depression differ by demographic, familial, and occupational characteristics. METHOD: From a community-based sample, the authors identified 332 women with and 644 women without current or past major depression based on Structured Clinical Interviews for DSM-IV. Demographic and background interviews were conducted in-person. RESULTS: Depressed women were more likely to have gained >or =35 lbs between age 18 and study enrollment (OR=1.6, 95% CI 1.1-2.5), experienced divorce (OR=2.0, 95% CI 1.4-2.8), or changed occupations (OR=1.5, 95% CI 1.1-2.1) compared with non-depressed women. Compared with women with no brothers, those with > or =1 brothers were less likely to have a history of depression (OR=0.8, 95% CI 0.6-1.1), whereas compared with women with no sisters, those with > or =1 sisters were more likely to have current or past depression (OR=1.4, 95% CI 1.0-1.9). These findings were not influenced by family sibship size. CONCLUSION: These results illustrate demographic differences between women with and without major depression and that sibship gender rather than size may also influence risk.     

Patterns and predictors of treatment seeking after onset of a substance use disorder.

BACKGROUND: We studied survey respondents aged 18 through 54 years to determine consistent predictors of treatment seeking after onset of a DSM-III-R substance use disorder. METHODS: Survey populations included a regional sample in Ontario (n = 6261), a national sample in the United States (n = 5388), and local samples in Fresno, Calif (n = 2874) and Mexico City, Mexico (n = 1734). The analysis examined the effects of demographics, symptoms, and types of substances on treatment seeking. RESULTS: Between 50% (Ontario) and 85% (Fresno) of people with substance use disorders seek treatment but the time lag between onset and treatment seeking averages a decade or more. Consistent predictors of treatment seeking include: (1) late onset of disorder (odds ratio [OR], 3.8; 95% confidence interval [CI], 2.6-5.6 for late [> or =30 years] vs early [1-15 years] age at first symptom of disorder); (2) recency of cohort (OR, 3.4; 95% CI, 2.3-5.0 for most recent [aged 15-24 years at interview] vs earliest [aged > or =45 years] cohorts); (3) 4 specific dependence symptoms (using larger amounts than intended, unsuccessful attempts to cut down use, tolerance, and withdrawal symptoms), with ORs ranging between 1.6 (95% CI, 1.3-2.0) and 2.7 (95% CI, 2.1-3.6) for people with vs without these symptoms; and (4) use vs nonuse of cocaine (OR, 2.1; 95% CI, 1.6-2.7) and heroin (OR, 2.6; 95% CI, 1.1-6.0). CONCLUSIONS: Although most people with substance use disorders eventually seek treatment, treatment seeking often occurs a decade or more after the onset of symptoms of disorder. While treatment seeking has increased in recent years, it is not clear whether this is because of increased access, increased demand, increased societal pressures, or other factors.     

Synergistic effect of thrombomodulin promoter -33G/A polymorphism and smoking on the onset of acute myocardial infarction

Thrombomodulin is an endothelial cell surface receptor for thrombin. It plays an important role in the regulation of blood coagulation by decreasing thrombin activity and activating protein C. This study examined the possible association between the thrombomodulin -33G/A polymorphism and acute myocardial infarction. We recruited 278 patients (mean age 57.5 years, 241 men) with documented myocardial infarction and 450 age- and sex-matched control subjects. Polymerase chain reaction and single-strand conformation polymorphism was used to define the thrombomodulin -33G/A polymorphism. The frequency of the thrombomodulin GA+AA genotype among patients with myocardial infarction was higher than that in control subjects (22.7% vs. 16.2%, odds ratio [OR] 1.5, 95% confidence interval [CI] 1.0 to 2.2). The -33G/A polymorphism (GA+AA genotype) was significantly associated with myocardial infarction (OR 1.6, 95% CI 1.1 to 2.5) as was hypertension, diabetes mellitus and smoking. Among young myocardial infarction patients (age < or =45 years, n = 72), the frequency of -33G/A polymorphism was more significantly higher than that in control subjects (29.2% vs. 16.2%, OR 2.1, 95% CI 1.2 to 3.8). The -33G/A polymorphism (OR 2.3, 95% CI 1.3 to 4.1) and smoking (OR 4.5, 95% CI 2.5 to 7.9) were the only independent risk factors for young myocardial infarction. Furthermore, among patients who did not smoke, the polymorphism was associated with a nonsignificant increase in the risk of young myocardial infarction (OR 1.9, 95% CI 0.6 to 5.6); whereas, in the presence of smoking, the increase was statistically significant (OR 2.3, 95% CI 1.2 to 4.7). Smoking carriers of the thrombomodulin -33G/A polymorphism had a nearly 10-fold increased risk of young myocardial infarction (OR 9.8, 95% CI 4.3 to 22.4) when compared with nonsmoking non-carriers. We concluded that there was a significant association between the thrombomodulin -33G/A polymorphism and myocardial infarction in our population, especially in young patients. The clinical effect of this genetic factor was enhanced by smoking.     

Psychotic symptoms and paranoid ideation in a nondemented population-based sample of the very old.

BACKGROUND: Psychotic symptoms are reported to be uncommon in the elderly, and may be underrated in traditional epidemiological studies. METHODS: Psychotic symptoms, physical disorders, disability in daily life, and sensory impairments were assessed using results of psychiatric and physical examinations, key-informant interviews, and medical record reviews in a representative sample of nondemented individuals aged 85 years living in the community or in institutions in G?teborg, Sweden (n = 347). The sample was observed for 3 years regarding psychotic symptoms, mortality, and incident dementia. RESULTS: The prevalence of any psychotic symptom was 10.1% (95% confidence interval [CI], 7.1%-13.7%); hallucinations, 6.9% (95% CI, 4.5%-10.1%); and delusions, 5.5% (95% CI, 3.3%-8.4%). The prevalence of paranoid ideation was 6.9% (95% CI, 4.5%-10.1%). Stepwise logistic regression analyses showed that hallucinations were associated with major depressive syndrome (odds ratio [OR], 3.9; 95% CI, 1.3-11.9), disability in daily life (OR, 5.2; 95% CI, 1.8-14.9), and visual deficits (OR, 3.4; 95% CI, 1.0-11.1). Delusions were associated with disability in daily life (OR, 4.9; 95% CI, 1.8-13.3). Paranoid ideation was associated with visual deficits (OR, 3.6; 95% CI, 1.2-10.5) and myocardial infarction (OR, 4.6; 95% CI, 1.7-12.6). Hallucinations (OR, 3.1; 95% CI, 1.4-6.8), delusions (OR, 2.9; 95% CI, 1.2-6.9), and paranoid ideation (OR, 2.7; 95% CI, 1.2-6.2) were each related to increased incidence of dementia from 85 to 88 years of age. Hallucinations and paranoid ideation were associated with increased 3-year mortality in women but not in men. CONCLUSIONS: We found a higher prevalence of psychotic symptoms and paranoid ideation in the elderly than previously reported, and these symptoms were associated with a poor prognosis.     

Fracture risk is increased in epilepsy

OBJECTIVES: To study fracture rates and risk factors for fractures in non-institutionalized patients with epilepsy. MATERIAL AND METHODS: Historical follow-up. Self-administered questionnaires were issued to 755 patients with epilepsy (ICD 10: G40.0 to G40.9) and 1000 randomly selected controls from the background population. RESULTS: A total of 345 patients (median age: 45, range 17-80 years) and 654 control subjects (median age: 43, range 19-93 years) returned the questionnaire. Before epilepsy was diagnosed there was no difference in overall fracture rate between patients and controls (RR = 1.0, 95% CI: 0.8-1.3). After the diagnosis the overall fracture rate was significantly higher in the patients (RR = 2.0, 95% CI: 1.6-2.5). Fractures of the spine, forearms, femurs, lower legs, and feet and toes were significantly increased. Fractures related to seizures accounted for 33.9% (95% CI: 25.3-43.5%) of all fractures. After elimination of seizure related fractures the increase in fracture frequency was only borderline significant: RR = 1.3 (95% CI: 1.0-1.7, P = 0.042). No difference in fracture energy between patients and controls was observed (low energy fractures: 1.7/1.4%, medium energy fractures: 59.8/52.0%, and high energy fractures: 38.3/46.6%). Use of phenytoin (OR = 2.4, 95% CI: 1.1-5.4) and a family fracture history (OR = 2.4, 95% CI: 1.3-4.6) was associated with an increased fracture risk. CONCLUSIONS: Fractures were more common in epileptics than in controls especially among users of phenytoin. Most of the increase in fracture frequency was related to seizures and not to low bone biomechanical competence.