A systematic review of mortality in schizophrenia - Is the differential mortality gap worsening over time?

Context Despite improvements in mental health services in recent decades, it is unclear whether the risk of mortality in schizophrenia has changed over time. Objective To explore the distribution of standardized mortality ratios (SMRs) for people with schizophrenia. Data Sources Broad search terms were used in MEDLINE, PsychINFO, Web of Science, and Google Scholar to identify all studies that investigated mortality in schizophrenia, published between January 1, 1980, and January 31, 2006. References were also identified from review articles, reference lists, and communication with authors. Study Selection Population-based studies that reported primary data on deaths in people with schizophrenia. Data Extraction Operationalized criteria were used to extract key study features and mortality data. Data Synthesis We examined the distribution of SMRs and pooled selected estimates using random-effects meta-analysis. We identified 37 articles drawn from 25 different nations. The median SMR for all persons for all-cause mortality was 2.58 (10%-90% quantile, 1.18-5.76), with a corresponding random-effects pooled SMR of 2.50 (95% confidence interval, 2.18-2.43). No sex difference was detected. Suicide was associated with the highest SMR (12.86); however, most of the major causes-of-death categories were found to be elevated in people with schizophrenia. The SMRs for all-cause mortality have increased during recent decades (P = .03). Conclusions With respect to mortality, a substantial gap exists between the health of people with schizophrenia and the general community. This differential mortality gap has worsened in recent decades. In light of the potential for second-generation antipsychotic medications to further adversely influence mortality rates in the decades to come, optimizing the general health of people with schizophrenia warrants urgent attention

Generationing development

The articles in this special issue present a persuasive case for accounts of development to recognise the integral and fundamental roles played by age and generation. While the past two decades have witnessed a burgeoning of literature demonstrating that children and youth are impacted by development, and that they can and do participate in development, the literature has tended to portray young people as a special group whose perspectives should not be forgotten. By contrast, the articles collected here make the case that age and generation, as relational constructs, cannot be ignored. Appropriating the term ‘generationing’, the editors argue that a variety of types of age relations profoundly structure the ways in which societies are transformed through development – both immanent processes of neoliberal modernisation and the interventions of development agencies that both respond and contribute to these. Drawing on the seven empirical articles, I attempt to draw some of the ideas together into a narrative that further argues the case for ‘generationing’ but also identifies gaps, questions and implications for further research

Impact of patient and public involvement on enrolment and retention in clinical trials: Systematic review and meta-analysis

© Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to. Objective To investigate the impact of patient and public involvement (PPI) on rates of enrolment and retention in clinical trials and explore how this varies with the context and nature of PPI. Design Systematic review and meta-analysis. Data sources Ten electronic databases, including Medline, INVOLVE Evidence Library, and clinical trial registries. Eligibility criteria Experimental and observational studies quantitatively evaluating the impact of a PPI intervention, compared with no intervention or non-PPI intervention(s), on participant enrolment and/or retention rates in a clinical trial or trials. PPI interventions could include additional non-PPI components inseparable from the PPI (for example, other stakeholder involvement). Data extraction and analysis Two independent reviewers extracted data on enrolment and retention rates, as well as on the context and characteristics of PPI intervention, and assessed risk of bias. Random effects meta-analyses were used to determine the average effect of PPI interventions on enrolment and retention in clinical trials: main analysis including randomised studies only, secondary analysis adding non-randomised studies, and several exploratory subgroup and sensitivity analyses. Results 26 studies were included in the review; 19 were eligible for enrolment meta-analysis and five for retention meta-analysis. Various PPI interventions were identified with different degrees of involvement, different numbers and types of people involved, and input at different stages of the trial process. On average, PPI interventions modestly but significantly increased the odds of participant enrolment in the main analysis (odds ratio 1.16, 95% confidence interval and prediction interval 1.01 to 1.34). Non-PPI components of interventions may have contributed to this effect. In exploratory subgroup analyses, the involvement of people with lived experience of the condition under study was significantly associated with improved enrolment (odds ratio 3.14 v 1.07; P=0.02). The findings for retention were inconclusive owing to the paucity of eligible studies (odds ratio 1.16, 95% confidence interval 0.33 to 4.14), for main analysis). Conclusions These findings add weight to the case for PPI in clinical trials by indicating that it is likely to improve enrolment of participants, especially if it includes people with lived experience of the health condition under study. Further research is needed to assess which types of PPI work best in particular contexts, the cost effectiveness of PPI, the impact of PPI at earlier stages of trial design, and the impact of PPI interventions specifically targeting retention. Systematic review registration PROSPERO CRD42016043808

Sex disaggregation alone will not energize equality

The need to include gender in energy policy, practice and research is largely accepted. However, when research that merely disaggregates by sex is used to inform energy efficiency initiatives, it often reproduces stereotypical understandings of sex differences, which can harm rather than promote gender equality

The Non-coplanar 6-Li(p,pd)4-He Reaction at 120 and 200 MeV

This research was sponsored by the National Science Foundation Grant NSF PHy 87-1440

Recruitment and retention of participants in UK surgical trials : survey of key issues reported by trial staff

Source of Funding This research was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) (NIHR-BRC-1215-20008) and by the Medical Research Council (MRC) Network of Hubs for Trials Methodology Research (MR/L004933/1-N66), as part of the wider PIRRIST project. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The Health Services Research Unit, University of Aberdeen, receives core funding from the Chief Scientist Office of the Scottish Government Health Directorates. The funders had no input into the study design, data collection, analysis, interpretation or manuscript writing. ACKNOWLEDGEMENTS We are grateful to all survey respondents and to PIRRIST study collaborators and advisers who helped to promote survey. We thank Caroline Jordan and Liz Woolliams for providing administrative support; Rebecca Harmston for providing valuable advice from a patient perspective; Murat Akkulak at the Royal College of Surgeons for providing the RCS portfolio of surgical trials; Amadea Turk for helping to identify potential participants; and colleagues who kindly piloted and helped to improve the survey including Kerry Avery, Karen Barnett, Helen Bulbeck, Marloes Franssen, Nicola Higgins, Jennifer Hirst, Lynne Maddocks, Peter McCulloch, James Shepperd, Jean Simmonds and Sharon Tonner. Anonymised survey data can be made available on request. Please contact the corresponding author. This study was not preregistered. The authors declare no potential competing interests.Peer reviewedPublisher PD