All-cause mortality among people with serious mental illness (SMI), substance use disorders, and depressive disorders in southeast London: a cohort study

<p>Abstract</p> <p>Background</p> <p>Higher mortality has been found for people with serious mental illness (SMI, including schizophrenia, schizoaffective disorders, and bipolar affective disorder) at all age groups. Our aim was to characterize vulnerable groups for excess mortality among people with SMI, substance use disorders, depressive episode, and recurrent depressive disorder.</p> <p>Methods</p> <p>A case register was developed at the South London and Maudsley National Health Services Foundation Trust (NHS SLAM), accessing full electronic clinical records on over 150,000 mental health service users as a well-defined cohort since 2006. The Case Register Interactive Search (CRIS) system enabled searching and retrieval of anonymised information since 2008. Deaths were identified by regular national tracing returns after 2006. Standardized mortality ratios (SMRs) were calculated for the period 2007 to 2009 using SLAM records for this period and the expected number of deaths from age-specific mortality statistics for the England and Wales population in 2008. Data were stratified by gender, ethnicity, and specific mental disorders.</p> <p>Results</p> <p>A total of 31,719 cases, aged 15 years old or more, active between 2007-2009 and with mental disorders of interest prior to 2009 were detected in the SLAM case register. SMRs were 2.15 (95% CI: 1.95-2.36) for all SMI with genders combined, 1.89 (1.64-2.17) for women and 2.47 (2.17-2.80) for men. In addition, highest mortality risk was found for substance use disorders (SMR = 4.17; 95% CI: 3.75-4.64). Age- and gender-standardised mortality ratios by ethnic group revealed huge fluctuations, and SMRs for all disorders diminished in strength with age. The main limitation was the setting of secondary mental health care provider in SLAM.</p> <p>Conclusions</p> <p>Substantially higher mortality persists in people with serious mental illness, substance use disorders and depressive disorders. Furthermore, mortality risk differs substantially with age, diagnosis, gender and ethnicity. Further research into specific risk groups is required.</p

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

What Do We Really Know about Cognitive Inhibition? Task Demands and Inhibitory Effects across a Rang

Our study explores inhibitory control across a range of widely recognised memory and behavioural tasks. Eighty-seven never-depressed participants completed a series of tasks designed to measure inhibitory control in memory and behaviour. Specifically, a variant of the selective retrieval-practice and the Think/No-Think tasks were employed as measures of memory inhibition. The Stroop-Colour Naming and the Go/No-Go tasks were used as measures of behavioural inhibition. Participants completed all 4 tasks. Task presentation order was counterbalanced across 3 separate testing sessions for each participant. Standard inhibitory forgetting effects emerged on both memory tasks but the extent of forgetting across these tasks was not correlated. Furthermore, there was no relationship between memory inhibition tasks and either of the main behavioural inhibition measures. At a time when cognitive inhibition continues to gain acceptance as an explanatory mechanism, our study raises fundamental questions about what we actually know about inhibition and how it is affected by the processing demands of particular inhibitory tasks

K-ras mutation in the tumour of King Ferrante I of Aragon (1431-1494) and environmental mutagens at the Aragonese Court of Naples

The autopsy of the mummy of Ferrante I of Aragon, King of Naples (1431-1494) revealed an adenocarcinoma extensively infiltrating the muscles of the small pelvis. A molecular study of neoplastic tissue observed a typical mutation of the K-ras gene codon 12: the normal sequence GGT (qlycine) was altered into GAT (aspartic acid). The recorded genetic change represents the most frequent mutation of the K-ras gene in sporadic colorectal cancer and is characteristic of the effects of alkylating agents. Recent studies have focused the importance of some alkylating agents such as the endogenous N-nitroso compounds (NOC). Increased intake of red meat, such as beef, lamb or pork, induces a significant threefold increase of faecal NOC levels, with a range of exposure in faeces similar to that from tobacco-specific NOC in cigarette smoke. The study of alimentary regimens of the Italian Renaissance courts, and in particular of the Aragonese court of Naples, produced evidence of very high red meat consumption, attested also by the palaeonutritional data. Therefore, the alimentary 'environment' of the Neapolitan court of the 15th century with the abundance of natural endogenous alkylating agents, can well explain the K-ras mutation causing the tumour that killed the Aragonese king over five centuries ago

Nostra esperienza nel trattamento del varicocele in regime di day-surgery

Negli ultimi anni l’interesse crescente per le metodiche mininva - sive ha spinto a rivalutare la tecnica chirurgica di varicocelectomia sottoinguinale nel trattamento del varicocele idiopatico. Gli Autori, tra il 1998 ed il 2001, hanno sottoposto a varicocelec - tomia sottoinguinale 29 pazienti di cui 14 affetti da varicocele idiopa - tico di III grado, 11 di II grado, 3 di I grado ed 1 subclinico. Dei 29 pazienti solo 10 presentavano anamnesi sfavorevole per paternità. Tutti gli interventi sono stati eseguiti in anestesia locale e in regime di day-surgery. Gli Autori discutono i risultati e concludono che la varicocelecto - mia sottoinguinale con dispositivi ottici di ingrandimento rappresen - ta il “gold standard” nel trattamento del varicocele idiopatico, in quanto consente di ridurre al minimo il tasso di recidive, di limitare l’incidenza delle complicanze post-operatorie, di migliorare qualiquantitativamente le capacità riproduttive del liquido seminale, di abbassare significativamente i costi di gestione dell’ammalato, di mantenere in limiti accettabili la durata dell’intervento e di essere di facile apprendimento ed esecuzione