Effect of psychiatric illness and labour market status on suicide: a healthy worker effect?

STUDY OBJECTIVE: To describe the association between labour market status and death by suicide with focus on admission with a psychiatric disorder. DESIGN: Nested case-control study. Data from routine registers. SETTING: Entire Danish population. PARTICIPANTS: 9011 people aged 25-60 years who committed suicide during 1982-1997 and 180 220 matched controls. MAIN RESULTS: In the general population, not being fully employed is associated with a twofold to threefold increased relative risk of death by suicide, compared with being fully employed. In contrast, fully employed people who have been first admitted to a psychiatric hospital within the past year are at increased suicide risk. Patients who are unemployed, social benefits recipients, disability pensioners, or otherwise marginalised on the labour market have a suicide risk of 0.60 (95% CI: 0.46 to 0.78), 0.41 (0.23 to 0.74), 0.70 (0.45 to 1.08), and 0.86 (0.53 to 1.41), respectively. Although a similar risk decrease is found in women, men, people younger than 30 years, people older than 45 years, and in people who become unemployed, the reversed effect attenuates with time since admission, and little association is seen when a marginal structural model is applied. CONCLUSIONS: Although the results show an increased suicide mortality associated with unemployment and labour market marginalisation in the general population, the results suggest little or an inverse association between unemployment and suicide in people with psychiatric illness. The associations seen suggest the need to consider healthy worker selection effects when studying the causal pathway from unemployment and psychiatric illness to suicide.     

Carvedilol for heart failure: more than just a beta-blocker?

Carvedilol is a non-selective beta-blocker, and the only one, in recent clinical trials, to have shown a clear reduction in mortality. It is suggested that, compared with other beta-blockers, carvedilol has additional advantageous effects in heart failure, and should be considered as part of the routine treatment of heart failure.     

Comparing hospital costs: What is gained by accounting for more than a case-mix index?

We explore what effect controlling for various patient characteristics beyond a case-mix index (DRG) has on inferences drawn about the relative cost performance of hospital departments. We estimate fixed effect cost models in which 3754 patients are clustered within six Danish vascular departments. We compare a basic model including a DRG index only with models also including age and gender, health related characteristics, such as smoking status, diabetes, and American Society of Anesthesiogists score (ASA-score), and socioeconomic characteristics such as income, employment and whether the patient lives alone. We find that the DRG index is a robust and important explanatory factor and adding other routinely collected characteristics such as age and gender and other health related or socioeconomic characteristics do not seem to alter the results significantly. The results are more sensitive to choice of functional form, i.e. in particular to whether costs are log transformed. Our results suggest that the routinely collected characteristics such as DRG index, age and gender are sufficient when drawing inferences about relative cost performance. Adding health related or socioeconomic patient characteristics only slightly improves our model in terms of explanatory power but not when drawing inferences about relative performance. The results are, however, sensitive to whether costs are log transformed.     

Pathophysiology of cancer cachexia: much more than host-tumour interaction?

Cancer cachexia is a syndrome of progressive nutritional depletion which causes significant morbidity and mortality in cancer patients. One of the main pathogenetic mechanisms underlying cancer cachexia is a complex interaction between the host and the tumour. Tumour cells interact with host cells within the tumour mass resulting in the production of catabolic mediators which degrade host tissue. In addition, the host may mount an aberrant metabolic response to the tumour. However, in recent years, it has also been understood that patient factors, including age and levels of physical activity, and the specific mechanics of protein metabolism in cancer patients may also have a significant impact. In this review article, we not only summarise previous knowledge surrounding host-tumour interaction, but we also discuss these broader concepts in the pathogenesis of cancer cachexia. Clinicians should consider such concepts in the design of an effective multimodal therapy for cachexia.     

Effect of pets on human health: is there a correlation?

Is there a Relationship? Despite an increasing number of studies devoted to the health benefits of interacting with pets, the empirical evidence of such an effect still remains weak. Many reports comparing health-related variables in pet owners and non-owners do not find significant differences. Some studies find a statistical correlation between pet ownership and better health, but they do not adequately demonstrate that the better health is a result of the pet. There is experimental evidence suggesting that the presence of animals is associated with a lowering of cardiovascular responses to stressors. Accordingly, pets could be used in the therapy of stress-related diseases. Nevertheless, no consistent clinical studies testing this hypothesis have been carried out. Moreover, neither evolutionary nor learning hypothesis for the observed decrease in cardiovascular reactivity have been tested till now. Research on the benefits of pet ownership still are in its preliminary steps. Further studies are needed for the understanding of the underlying psychological mechanisms of human/animal relationship and its therapeutic possibilities.     

Engaging with phenomenology: is it more of a challenge than it needs to be?

When seeking to understand the human condition, with all the problems this enterprise poses for traditional scientific research approaches, qualitative research is held to be in some ways superior to rigidly quantitative research. As a result, many beginning health researchers plan to employ a qualitative approach to explore topics that were previously inaccessible via traditional scientific means. However, implementing a qualitative approach is not an easy process and, in many cases, researchers must look long and hard to find material to assist them in developing their research plans. This may be particularly so in phenomenological research. This article examines some of the problems and pitfalls faced by phenomenological researchers new to the approach. Through accounts of personal experience, it highlights some of the areas where phenomenological researchers could be helpful by being less reticent about the process of implementing a phenomenological study.     

The correlation of fecundability among twins: evidence of a genetic effect on fertility?

BACKGROUND: Numerous rare genetic conditions are known to influence fecundability in both males and females. It is less clear to what extent more subtle genetic differences influence fecundability on a population level. METHODS: In 1994 a population-based survey was conducted among Danish twins born 1953-1982. Fecundability was assessed as the waiting time to pregnancy at the first attempt to achieve a pregnancy. RESULTS: The reported time to pregnancy for males was slightly shorter than for females but there were no sex differences in intrapair similarity. We found an intrapair correlation in time to pregnancy for 645 monozygotic twin pairs (r = 0.22; 95% confidence interval = 0.12 to 0.32), but no intrapair correlation for 826 like-sex dizygotic twin pairs (r = 0.00; 95% confidence interval = -0.09 to 0.10). CONCLUSIONS: The correlation in time to pregnancy for monozygotic twins suggests genetic factors, although similarities in reporting behaviors could also be contributing to the correlation. The lack of correlation in time to pregnancy for dizygotic twins indicates that possible genetic factors of importance for fecundabililty are acting nonadditively. Hence, it may prove difficult to identify specific gene variants that influence fecundability on a population level if their effects depend on gene-gene interactions.     

Apolipoprotein D and α1-microglobulin in human urine: effect of cadmium exposure

Summary Apolipoprotein D is a previously unrecognized urinary protein of unknown function which we have tested as a potential marker for kidney malfunction. This protein and ₁-microglobulin have been quantified by zone immunoelectrophoresis assay in urine samples from a group of eight men occupationally exposed to cadmium-containing welding fumes for many years. All these workers had highly elevated concentrations of urinary cadmium and indications of tubular proteinuria, as compared to a group of 50 apparently healthy normal men analyzed in parallel. The cadmium-exposed workers demonstrated three- and 15-fold average increases in apolipoprotein D and ₁-microglobulin, respectively, over normal values in urine, estimated both as excretion rates and as milligrams of protein per mmol of creatinine. All these increments were highly significantly different (P < 0.001) from the corresponding values of the reference group. Essentially the same results were obtained for each of the proteins from two independent consecutive samplings of the workers' urine. There were good linear (R = 0.70, 0.80) and logarithmic (R = 0.84, 0.81) correlations between the urinary concentrations of ₁-microglobulin and apolipoprotein D for both the reference and the study group. Although not as sensitive an indicator for tubular proteinuria as ₁-microglobulin, apolipoprotein D, being a storage-stable urinary protein, seems a valuable complement for the diagnosis of tubular malfunction.     

Health benefits of probiotics: are mixtures more effective than single strains?

Purpose  

Most studies on probiotics utilise single strains, sometimes incorporated into yoghurts. There are fewer studies on efficacy of mixtures of probiotic strains. This review examines the evidence that (a) probiotic mixtures are beneficial for a range of health-related outcomes and (b) mixtures are more or less effective than their component strains administered separately.     

A population-based case-control study on fruit and vegetable intake and lung cancer: a paradox effect?

A population-based case-control study was carried out in Northwest Spain to analyze the effect of fruit and vegetable intake on the appearance of lung cancer. A non-significant protective association was found for overall consumption of leafy green and other vegetables, with consumption once a day or more vs. less than once a week yielding odds ratios of 0.63 [95% confidence interval (CI) = 0.24-1.63] for leafy green vegetables and 0.64 (95% CI = 0.30-1.36) for other vegetables. A significant protective association was found for potato consumption. No protective associations were recorded for fruit, whether overall or singly; instead, fruit consumption once a day or more vs. less than once a week registered a risk of 2.16 (95% CI = 1.02-4.58). Although the possibility that this effect may be due to a phenomenon of reverse causation cannot be ruled out, these results could support other reports and hypotheses which indicate that the protective effect of fruit might not be as pronounced as generally thought.     

#41-S anxiety on colombian children: Are more girls affected than boys?

PURPOSE: To compare by gender symptoms of anxiety in children living in Colombia SA, exposed to the stress of current civil war.METHODS: A total of 399 school-aged children/adolescents from a stratified, random sample of Belen, Boyaca and Bucaramanga, Santander were evaluated. Children and their parents were assessed with the Screen for Child Anxiety Related Emotional Disorders (SCARED).RESULTS: The overall response rate was 97.6% consisting of 229 girls and 170 boys with a mean age of 12.7 years (range 8-18 years). Among all of children, 294 (73.68%) reported a total score of >25, which is the cut-off score for anxiety disorders. Of the girls, 201 (87.77%) had a total score of >25, and 93 (54.71%) of the boys had total scores of >25 (χ² = 55.019, d.f. = 1, p < 0.0001)CONCLUSION: Our results suggest that these children, exposed to dangerous and violent situations in their environment, are experiencing higher levels of anxiety symptoms, which is particularly true for girls.     

Effect of alcohol on risk of coronary heart disease and stroke: causality, bias, or a bit of both?

Epidemiological studies of middle-aged populations generally find the relationship between alcohol intake and the risk of coronary heart disease (CHD) and stroke to be either U- or J-shaped. This review describes the extent that these relationships are likely to be causal, and the extent that they may be due to specific methodological weaknesses in epidemiological studies. The consistency in the vascular benefit associated with moderate drinking (compared with non-drinking) observed across different studies, together with the existence of credible biological pathways, strongly suggests that at least some of this benefit is real. However, because of biases introduced by: choice of reference categories; reverse causality bias; variations in alcohol intake over time; and confounding, some of it is likely to be an artefact. For heavy drinking, different study biases have the potential to act in opposing directions, and as such, the true effects of heavy drinking on vascular risk are uncertain. However, because of the known harmful effects of heavy drinking on non-vascular mortality, the problem is an academic one. Studies of the effects of alcohol consumption on health outcomes should recognise the methodological biases they are likely to face, and design, analyse and interpret their studies accordingly. While regular moderate alcohol consumption during middle-age probably does reduce vascular risk, care should be taken when making general recommendations about safe levels of alcohol intake. In particular, it is likely that any promotion of alcohol for health reasons would do substantially more harm than good.     

Nutrition and aberrant DNA methylation patterns in atherosclerosis: more than just hyperhomocysteinemia?

Methylation is a reversible modification of DNA participating in epigenetic regulation of gene expression. It is now clear that atherosclerosis is associated with aberrant DNA methylation patterns in the vascular tissue and peripheral blood cells, but the origin of this anomaly is poorly understood. Based on evidence that global DNA hypomethylation coexists with hyperhomocysteinemia in advanced human atherosclerosis, it is widely assumed that altered DNA methylation patterns in atherosclerosis are mainly secondary to a decrease in factors essential for the synthesis of S-adenosyl methionine (SAM, the main methyl group donor in DNA methylation reactions), such as folate and vitamin B-12, or to homocysteine-induced blocking of SAM biosynthesis. Nonetheless, recent work expanded this view by showing that both local DNA hyper- and hypomethylation occur in early atherosclerosis in normohomocysteinemic mice and that atherogenic lipoprotein profiles promote DNA hypermethylation in cultured human macrophages. These findings suggest that during early atherosclerosis, nutritional factors affect DNA methylation patterns by mechanisms that are likely to be independent of vitamin or homocysteine levels. These data have the potential to assist in the identification of preventive or therapeutic avenues for cardiovascular disease.