The protective role of trait anxiety: a longitudinal cohort study

BACKGROUND: Most research has indicated that neuroticism (or trait anxiety) is associated with only negative outcomes. Such a common, heritable and variable trait is expected to have beneficial as well as detrimental effects. We tested the hypothesis that trait anxiety in childhood reduces the risk of dying from accidental causes in early adult life. METHOD: A longitudinal, population-based, birth cohort study of 4,070 men and women born in the UK in 1946. Trait anxiety as judged by teachers when the participants were 13 and 15 years old, and the neuroticism scale of a Maudsley Personality Inventory (MPI) when the participants were 16 years old. Outcomes were deaths, deaths from accidents, non-fatal accidents, and non-fatal accidents requiring medical intervention. RESULTS: Adolescents with low trait anxiety had higher rates of accident mortality to age 25 [low anxiety at 13, hazard ratio (HR) 5.9, low anxiety at 15, HR 1.8]. Low trait anxiety in adolescence was associated with decreased non-accidental mortality after age 25 (low anxiety at 13, HR 0; low anxiety at 15, HR 0.7; low neuroticism at 16, HR 0.7). CONCLUSIONS: High trait anxiety measured in adolescence is associated with reduced accidents and accidental death in early adulthood but higher rates of non-accidental mortality in later life.     

The association of unplanned pregnancy with perinatal depression: a longitudinal cohort study

Archives of Women's Mental Health - Perinatal depression is common, affecting approximately 7–13% of women. Studies have shown an association between unplanned pregnancy and perinatal...     

A longitudinal cohort study of elderly women with urinary tract infections

AIMS: the prevalence of urinary tract infections (UTI), urinary incontinence (UI), estrogen-use and overall mortality in a cohort of elderly women who had been treated for UTI in 1985-86 was re-assessed 10 years later. MATERIAL AND METHODS: a random sample of 6000 women from the birth cohorts 1900, 1905, 1910, 1915 and 1920 were invited in 1986 to complete a questionnaire about UTI, UI and estrogen use (response rate 70%; n = 4206). Treatment with antibiotics for UTI during 1985-86 was reported by 688 (17%) women. In 1995 a similar questionnaire was sent to the women from this group who were still alive (n = 434). Mortality in the women with a history of UTI was compared with an aged-matched control group of women who did not have UTI during 1985-86. RESULTS: the questionnaire was completed and returned by 361 (83%) women. Treatment for at least one UTI during the last 9 years was reported by 219 (61%) women. The number of episodes varied: 35% had one to two UTI, 28% had three to four UTI, 27% five to ten UTI and 10% had had more than 10 UTI. In 1986, the prevalence of UI was higher in women with a history of UTI than in the total population sample (30 vs. 17%; P < 0.001). The prevalence of UI had increased from 30% in 1986 to 33% in 1995 (P < 0.05). Mortality in the women with a history of UTI was higher than in the aged-matched control group (37 vs. 28%; P < 0.001). A total of 162 (45%) women had received estrogen therapy at some time after the age of 60 years and 140 (39%) reported that they were currently taking low potency estrogens. CONCLUSION: elderly women with a history of UTI had a continued high occurrence of UTI and UI, and overall mortality was higher in these women than in an age-matched control group of women from the total population.     

Dropout in a longitudinal, cohort study of urologic disease in community men

Background  

Reasons for attrition in studies vary, but may be a major concern in long-term studies if those who drop out differ systematically from those who continue to participate. Factors associated with dropout were evaluated in a twelve-year community-based, prospective cohort study of urologic disease in men.     

Predicting biopsychosocial outcomes for heroin users in primary care treatment: a prospective longitudinal cohort study

Background

Opiate substitution treatment for heroin users reduces mortality, illicit drug use, crime, and risk-taking behaviour, and improves physical, mental and social functioning. Few extended studies have been carried out in UK primary care to study factors predicting recovery.

Aim

To establish whether primary care opiate substitution treatment is associated with improvements in outcomes over 11 years, in delivering recovery, and to identify predictive factors.

Design and setting

A prospective longitudinal cohort study, with repeated measures in the Primary Care Addiction Service, Sheffield, 1999–2011.

Method

A total of 123 eligible patients were assessed using the Opiate Treatment Index at entry to treatment and at 1, 5, and 11 years. Clinical records were used to assess factors including employment and discharge status.

Results

At 11 years, there was a high rate of drug-free discharge (22.0%) and medically-assisted recovery (30.9%), and low mortality (6.5%). Continuous treatment was associated with being discharged drug free (P = 0.005). For those still in treatment, there were highly significant reductions in heroin use and injecting, and significantly improved psychosocial functioning. There were strong positive correlations between mental health, physical health, and social functioning. Patients in employment had significantly better psychological and social functioning (P = 0.017, P = 0.007, respectively).

Conclusion

Opiate substitution treatment is associated over 11 years with full recovery, drug-free discharge and medically-assisted recovery. There is a strong association between the psychosocial variables, suggesting that intervention in any one of these areas may have extended benefits, by impacting on related variables and employment. The best predictor of a drug-free discharge was continuous uninterrupted treatment.     

Lithium increases plasma brain-derived neurotrophic factor in acute bipolar mania: a preliminary 4-week study

Several studies have suggested an important role for brain-derived neurotrophic factor (BDNF) in the pathophysiology and therapeutics of bipolar disorder (BPD). The mechanisms underlying the therapeutic effects of lithium in BPD seem to involve a direct regulation of neurotrophic cascades. However, no clinical study evaluated the specific effects of lithium on BDNF levels in subjects with BPD. This study aims to investigate the effects of lithium monotherapy on BDNF levels in acute mania. Ten subjects with bipolar I disorder in a manic episode were evaluated at baseline and after 28 days of lithium therapy. Changes in plasma BDNF levels and Young Mania Rating Scale (YMRS) scores were analyzed. A significant increase in plasma BDNF levels was observed after 28 days of therapy with lithium monotherapy (510.9±127.1pg/mL) compared to pre-treatment (406.3±69.5pg/mL) (p=0.03). Although it was not found a significant association between BDNF levels and clinical improvement (YMRS), 87% of responders presented an increase in BDNF levels after treatment with lithium. These preliminary data showed lithium's direct effects on BDNF levels in bipolar mania, suggesting that short-term lithium treatment may activate neurotrophic cascades. Further studies with larger samples and longer period may confirm whether this biological effect is involved in the therapeutic efficacy of lithium in BPD.     

Polyvictimization and trauma in a national longitudinal cohort

This paper utilizes a national longitudinal probability sample of children to demonstrate how important exposure to multiple forms of victimization (polyvictimization) is in accounting for increases in children's symptomatic behavior. The study is based on two annual waves of the Developmental Victimization Survey that began with a nationally representative sample of children and youth ages 2 to 17. A broad range of victimization experiences were assessed using the 34-item Juvenile Victimization Questionnaire. Eighteen percent of the children experienced four or more different kinds of victimization (polyvictims) in the most recent year. Polyvictimization in the most recent year was highly predictive of trauma symptoms at the end of the year, controlling for prior victimization and prior mental health status. When polyvictimization was taken into account, it greatly reduced or eliminated the association between most other individual victimizations and symptomatology scores.     

Epidemiology and risk factors for recurrent severe lower limb cellulitis: a longitudinal cohort study

ObjectiveTo describe the epidemiology and risk factors for recurrence of severe lower leg cellulitis (LLC).MethodsA longitudinal cohort study using state-wide data of adults presenting with recurrent LLC following a primary episode occurring between January 2002 and December 2013. The incidence of recurrent LLC was estimated using the cumulative incidence function, accounting for mortality. Independent risk factors for recurrence were identified using Fine-Gray sub-distribution and Cox proportional hazards models.ResultsOf 36 276 patients presenting with their first episode of LLC, 4598 had at least one recurrence during the follow-up period. The cumulative incidence of first, second, and third recurrences at 12 months since previous infection was 6.3% (95% CI 6.0–6.5), 17.2% (95% CI 16.1–18.4), and 29.4% (95% CI 26.8–31.9), respectively, and at 5 years was 13.9% (95% CI 13.5–14.3), 35.9% (95% CI 34.2–37.5), and 52.9% (95% CI 49.5–56.2), respectively. The length of hospitalization increased from 3 days for the primary episode to 4 and 5 days for first and all subsequent recurrences, respectively. Independent risk factors for recurrent LLC included age, ethnicity (Indigenous Australian), local factors relating to lower leg pathology, conditions that commonly result in peripheral oedema, and systemic conditions that may be associated with increased leg size.ConclusionsLLC recurrences are frequent, and each episode increases the likelihood of subsequent recurrence and length of hospitalization. These data provide context and scope to develop workable and effective strategies to prevent secondary episodes for all cases of primary LLC.     

Various manifestations of hyperthyroidism in an ambulatory clinic: case studies

This study reviews five cases of women with hyperthyroidism, three black women and two Hispanic women. Initially, two patients presented with voice changes, weight loss, and increased appetite. Only two patients presented with classical symptoms of hyperthyroidism. Examination showed all patients had diffusely enlarged thyroids and exaggerated reflexes. Two patients showed Graves'' opthalmopathy.     

A longitudinal study of serum IgE in a community cohort: Correlations with age, sex, smoking, and atopic status

A number of factors, including age, sex, smoking habits, and atopic status have been reported in cross-sectional studies to influence levels of serum IgE. We have examined the effects of these variables on serum IgE in a community population cohort of 1109 subjects during a longitudinal study in which two serum samples were obtained 8 years apart from each subject. For the entire cohort, mean serum IgE level changed little during the follow-up period (28.9 versus 26.0 IU/ml). Most of the decreases were observed in children and young adults. Subjects more than the age of 35 years demonstrated no systematic change in serum IgE levels. By the end of follow-up (when there were few subjects still less than 16 years of age), significant relationships of IgE to age could no longer be demonstrated in nonatopic subjects. Also, in the nonatopic subjects of this cohort, there were no significant differences in IgE levels between the sexes. Among atopic subjects, there was a clear tendency for IgE to decrease with age, with atopic women more than 35 years of age demonstrating greater declines in IgE levels during follow-up than men of comparable age. The IgE levels in atopic male subjects were significantly higher than in atopic female subjects after the age of 35 years. Smoking was associated with an elevation in serum IgE. In this cohort, the smoking effect appeared to be limited to male subjects.(ABSTRACT TRUNCATED AT 250 WORDS)     

Subspecialty training in the ambulatory clinic: a preliminary investigation of an endocrinology curriculum.

PURPOSE: There is scant literature on education in the ambulatory subspecialty clinic. This preliminary study was conducted to investigate subspecialty education, using endocrinology as a model. METHOD: In 2002, a questionnaire was mailed to 90 former University of Virginia internal medicine (IM) residents who completed training between 1998 and 2001. The questionnaire asked how well residency prepared them to take care of patients with various endocrine disorders, and to state the best and worst parts of their endocrine training. In 2001-02, 11 fourth-year medical students and 26 senior IM residents rotating on the endocrinology service were asked to record their patient encounters in logbooks. This information was compared to the perceived strengths and weaknesses of endocrine training. RESULTS: Sixty-one residents (68%) completed questionnaires. Significant differences were found in perceived preparedness to care for patients with various endocrine disorders, with diabetes, hypothyroidism, and osteoporosis as strengths and reproductive disorders representing a significant weakness. Fifteen residents (58%) and ten students (91%) completed logs. The logbooks revealed that current learners were well exposed to patients with diabetes and thyroid disorders during the block rotation, but saw relatively few patients with other endocrine disorders. CONCLUSION: Former IM residents felt well prepared by residency to manage certain common endocrine problems, but felt significantly less prepared for other problems, most notably reproductive disorders. University of Virginia's curriculum was modified using information from this study to improve the educational experience in endocrinology. More studies are needed to define optimal strategies for teaching and learning in the subspecialty clinic.     

Evidence for longitudinal ambulatory care rotations: a review of the literature.

PURPOSE: Block ambulatory rotations and longitudinal ambulatory care experiences are now common in U.S. medical schools, but little is known about their efficacy. Through a structured review of the medical literature from 1966 through March 2000, the authors summarize the characteristics of, the evidence for, and the evaluation of longitudinal ambulatory care rotations. METHOD: The authors searched Medline using the terms "outpatients," "continuity of patient care," "ambulatory care," "mentors," "preceptorship," "graduate medical education," "curriculum," and "clinical clerkship" cross-matched to "medical students" and "internship and residency" for literature published from 1966 through March 2000. They narrowed the list to only articles containing empirical outcome data focusing on medical students' experiences in longitudinal ambulatory care rotations. Each study was scored to assess its strengths and weaknesses. RESULTS: Seven articles met the search criteria. The articles identified the benefits of longitudinal ambulatory care experiences, including developing effective patient interactions and understanding chronic diseases. There were little or no differences in the students' overall knowledge acquisition when those with longitudinal experiences were compared with those in block rotations. DISCUSSION: Although longitudinal ambulatory care experiences are now common in medical schools, evidence supporting their widespread implementation is sparse. Few studies employ rigorous methods to evaluate educational outcomes. Research to identify benefits and costs, improve the quality and consistency of the students' experiences, and develop other innovative ways of teaching and learning ambulatory care is needed.     

Predictors of smoking initiation among schoolchildren in Tunisia: a 4 years cohort study

Objective

To identify predictors of smoking initiation among non smoking Tunisian school children; and to propose efficient antismoking strategies in order to prevent smoking initiation.

Methods

It was a cohort study surveying prospectively for four years pupils attending schools in Sousse city in Tunisia. 441 non smoking pupils aged 13–15 years attending secondary schools in Sousse.Data were collected by a self administered questionnaire during class session. Two ways cross tabulation, univariate and multivariate logistic regression analyses were the main analytical methods.

Results

57.1% of the surveyed population were girls, 42.9 % were boys. 63% had at least one of their peers who smoked. Before 1999, 16.6% had already tried to smoke, 29.5% had already experienced alcohol. In 2003, smoking prevalence was 17%. 4.8% were girls; 33.3% of boys; p<0,001). 69.9 % of these smokers declared that they would carry on smoking during the following five years. Predictors which were highly associated with smoking initiation were previous experimentation with alcohol and tobacco, having a smoking best friend, lack of sensitization from the part of the school, believing that smoking makes one feel cool and that tobacco shouldn''t be forbidden in public places.

Conclusion

Intervention programs should target young children to avoid experiencing the first cigarette. Multidisciplinary management including community and school based intervention highlighted by mass media campaigns may provide schoolchildren with skills to resist smoking peers prompts to adopt unhealthy habits such as smoking.