Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study

<b>Objective</b> To assess the nature and extent of physical-health comorbidities in people with schizophrenia and related psychoses compared with controls. <p></p> <b>Design </b>Cross-sectional study. <p></p> <b>Setting </b>314 primary care practices in Scotland. <p></p> <b>Participants </b>9677 people with a primary care record of schizophrenia or a related psychosis and 1 414 701 controls. Main outcome measures Primary care records of 32 common chronic physical-health conditions and combinations of one, two and three or more physical-health comorbidities adjusted for age, gender and deprivation status. <p></p> <b>Results</b> Compared with controls, people with schizophrenia were significantly more likely to have one physical-health comorbidity (OR 1.21, 95% CI 1.16 to 1.27), two physical-health comorbidities (OR 1.37, 95% CI 1.29 to 1.44) and three or more physical-health comorbidities (OR 1.19, 95% CI 1.12 to 1.27). Rates were highest for viral hepatitis (OR 3.98, 95% CI 2.81 to 5.64), constipation (OR 3.24, 95% CI 3.00 to 4.49) and Parkinson's disease (OR 3.07, 95% CI 2.42 to 3.88) but people with schizophrenia had lower recorded rates of cardiovascular disease, including atrial fibrillation (OR 0.62, 95% CI 0.51 to 0.73), hypertension (OR 0.71, 95% CI 0.67 to 0.76), coronary heart disease (OR 0.75, 95% CI 0.61 to 0.71) and peripheral vascular disease (OR 0.83, 95% CI 0.71 to 0.97).<p></p> <b>Conclusions </b>People with schizophrenia have a wide range of comorbid and multiple physical-health conditions but are less likely than people without schizophrenia to have a primary care record of cardiovascular disease. This suggests a systematic under-recognition and undertreatment of cardiovascular disease in people with schizophrenia, which might contribute to substantial premature mortality observed within this patient group. <p></p&gt

Do managed clinical networks improve quality of diabetes care? : Evidence from a retrospective mixed methods evaluation

Peer reviewedPostprin

Clients’ Hope Arises from Social Workers’ Compassion: Young Clients’ Perspectives on Surmounting the Obstacles of Disadvantage

While social workers strive to build disadvantaged African American youths’ resilience by improving services, rarely are those youths’ perspectives included in research. In a previous evaluation of an after-school program, disadvantaged African American youths prioritized instructors’ compassion and said compassion engendered hope. This study explores their connection between compassion and hope more deeply. Focusing on Snyder’s hope theory, this study examines the connection between compassion and hope as individual traits (using standardized scales) and as relational, action-based experiences (using qualitative analysis of interview data). Instructor actions that youths identified as compassionate and as engendering hope were encouragement, problem solving, responsive empathy, and affirming that good choices could bring about good futures. Youths built their hope by internalizing their instructors’ compassion

Complexity of a complex trait locus: HP, HPR, haemoglobin and cholesterol

HP and HPR are related and contiguous genes in strong linkage disequilibrium (LD), encoding haptoglobin and haptoglobin-related protein. These bind and chaperone free Hb for recycling, protecting against oxidation. A copy number variation (CNV) within HP (Hp1/Hp2) results in different possible haptoglobin complexes which have differing properties. HPR rs2000999 (G/A), identified in meta-GWAS, influences total cholesterol (TC) and LDL-cholesterol (LDL-C). We examined the relationship between HP CNV, HPR rs2000999, Hb, red cell count (RCC), LDL-C and TC in the British Women's Heart and Health Study (n=2779 for samples having CNV, rs2000999, and phenotypes). Analysing single markers by linear regression, rs2000999 was associated with LDL-C (β=0.040 mmol/L, p=0.023), TC (β=-0.040 mmol/L, p=0.019), Hb (β=-0.044 g/dL, p=0.028) and borderline with RCC (β=-0.032 × 10(12)/L, p=0.066). Analysis of CNV by linear regression revealed an association with Hb (Hp1 vs Hp2, β=0.057 g/dL, p=0.004), RCC (β=0.045 × 10(12)/L, p=0.014), and showed a trend with LDL-C and TC. There were 3 principal haplotypes (Hp1-G 36%; Hp2-G 45%; Hp2-A 18%). Haplotype comparisons showed that LDL-C and TC associations were from rs2000999; Hb and RCC associations derived largely from the CNV. Distinct genotype-phenotype effects are evident at the genetic epidemiological level once LD has been analysed, perhaps reflecting HP-HPR functional biology and evolutionary history. The derived Hp2 allele of the HP gene has apparently been subject to malaria-driven positive selection. Haptoglobin-related protein binds Hb and apolipoprotein-L, i.e. linking HPR to the cholesterol system; and the HPR/apo-L complex is specifically trypanolytic. Our analysis illustrates the complex interplay between functions and haplotypes of adjacent genes, environmental context and natural selection, and offers insights into potential use of haptoglobin or haptoglobin-related protein as therapeutic agents.Philip A.I. Guthrie, Santiago Rodriguez, Tom R. Gaunt, Debbie A. Lawlor George Davey Smith, Ian N.M. Da

A primary care research agenda for multiple long-term conditions:A Delphi study

BackgroundMultiple long-term conditions (MLTC, multimorbidity) has been identified as a priority research topic, globally. Research priorities from the perspectives of patients and research funders have been described. Although most care for MLTC is delivered in primary care, the priorities of academic primary care have not been identified. AimTo identify and prioritise the academic primary care research agenda for MLTC.Design and SettingThree-phase study with primary care MLTC researchers from the UK and other high-income countries.Method(i) Open-ended survey question; (ii) face-to-face workshop to elaborate questions with researchers from the UK and Ireland; (iii) and a two-round Delphi consensus survey with international multimorbidity researchers.ResultsTwenty-five primary care researchers responded to the initial open-ended survey and generated 84 potential research questions. In the subsequent workshop discussion (18 participants), this list was reduced to 31 questions. The long list of 31 research questions was included in round one of the Delphi; 27 of the 50 (54%) round one and 24 of the 27 to round two (89%) invitees took part in the Delphi. Ten questions reached final consensus. These focused broadly on addressing complexity of the patient group with (a) development of new models of care for multimorbidity, (b) methods and data development.ConclusionThese high priority research questions offer funders and researchers a basis upon which to build future grant calls and research plans. Addressing complexity in our research is needed to inform improvements in our systems of care and for prevention.<br/

Factors affecting use of unscheduled care for people with advanced cancer:a retrospective cohort study in Scotland

BACKGROUND: People with advanced cancer frequently attend unscheduled care, but little is known about the factors influencing presentations. Most research focuses on accident and emergency (A&amp;E) and does not consider GP out-of-hours (GPOOH).AIM: To describe the frequency and patterns of unscheduled care use by people with cancer in their last year of life and to examine the associations of demographic and clinical factors with unscheduled care attendance.DESIGN AND SETTING: Retrospective cohort study of all 2443 people who died from cancer in Tayside, Scotland, during 2012-2015. Clinical population datasets were linked to routinely collected clinical data using the Community Health Index (CHI) number.METHOD: Anonymised CHI-linked data were analysed in SafeHaven, with descriptive analysis, using binary logistic regression for adjusted associations.RESULTS: Of the people who died from cancer, 77.9% (n = 1904) attended unscheduled care in the year before death. Among unscheduled care users, most only attended GPOOH (n = 1070, 56.2%), with the rest attending A&amp;E only (n = 204, 10.7%), or both (n = 630, 33.1%). Many attendances occurred in the last week (n =1360, 19.7%), last 4 weeks (n = 2541, 36.7%), and last 12 weeks (n = 4174, 60.3%) of life. Age, sex, deprivation, and cancer type were not significantly associated with unscheduled care attendance. People living in rural areas were less likely to attend unscheduled care: adjusted odds ratio (aOR) 0.64 (95% confidence interval = 0.50 to 0.82). Pain was the commonest coded clinical reason for presenting (GPOOH: n = 482, 10.5%; A&amp;E: n = 336, 28.8%). Of people dying from cancer, n = 514, 21.0%, were frequent users (≥5 attendances/year), and accounted for over half (n = 3986, 57.7%) of unscheduled care attendances.CONCLUSION: Unscheduled care attendance by people with advanced cancer was substantially higher than previously reported, increased dramatically towards the end of life, was largely independent of demographic factors and cancer type, and was commonly for pain and palliative care.</p

Xenon in Mercury-Manganese Stars

Previous studies of elemental abundances in Mercury-Manganese (HgMn) stars have occasionally reported the presence of lines of the ionized rare noble gas Xe II, especially in a few of the hottest stars with Teff ~ 13000--15000 K. A new study of this element has been undertaken using observations from Lick Observatory's Hamilton Echelle Spectrograph. In this work, the spectrum synthesis program UCLSYN has been used to undertake abundance analysis assuming LTE. We find that in the Smith & Dworetsky sample of HgMn stars, Xe is vastly over-abundant in 21 of 22 HgMn stars studied, by factors of 3.1--4.8 dex. There does not appear to be a significant correlation of Xe abundance with Teff. A comparison sample of normal late B stars shows no sign of Xe II lines that could be detected, consistent with the expected weakness of lines at normal abundance. The main reason for the previous lack of widespread detection in HgMn stars is probably due to the strongest lines being at longer wavelengths than the photographic blue. The lines used in this work were 4603.03A, 4844.33A and 5292.22A.Comment: 8 pages, 4 figures. Accepted by Monthly Notices of the Royal Astronomical Society, 8 January 200