Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring

Background Adverse effects of maternal substance use during pregnancy on fetal development may increase risk of psychopathology. Aims To examine whether maternal use of tobacco, cannabis or alcohol during pregnancy increases risk of offspring psychotic symptoms. Method A longitudinal study of 6356 adolescents, age 12, who completed a semi-structured interview for psychotic symptoms in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. Results Frequency of maternal tobacco use during pregnancy was associated with increased risk of suspected or definite psychotic symptoms (adjusted odds ratio 1.20, 95% CI 1.05–1.37, P = 0.007). Maternal alcohol use showed a non-linear association with psychotic symptoms, with this effect almost exclusively in the offspring of women drinking >21 units weekly. Maternal cannabis use was not associated with psychotic symptoms. Results for paternal smoking during pregnancy and maternal smoking post-pregnancy lend some support for a causal effect of tobacco exposure in utero on development of psychotic experiences. Conclusions These findings indicate that risk factors for development of non-clinical psychotic experiences may operate during early development. Future studies of how in utero exposure to tobacco affects cerebral development and function may lead to increased understanding of the pathogenesis of psychotic phenomena

Effects of interleukin-1β Inhibition on blood pressure, incident hypertension, and residual inflammatory risk

While hypertension and inflammation are physiologically inter-related, the effect of therapies that specifically target inflammation on blood pressure is uncertain. The recent CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) afforded the opportunity to test whether IL (interleukin)-1β inhibition would reduce blood pressure, prevent incident hypertension, and modify relationships between hypertension and cardiovascular events. CANTOS randomized 10 061 patients with prior myocardial infarction and hsCRP (high sensitivity C-reactive protein) ≥2 mg/L to canakinumab 50 mg, 150 mg, 300 mg, or placebo. A total of 9549 trial participants had blood pressure recordings during follow-up; of these, 80% had a preexisting diagnosis of hypertension. In patients without baseline hypertension, rates of incident hypertension were 23.4, 26.6, and 28.1 per 100-person years for the lowest to highest baseline tertiles of hsCRP (P>0.2). In all participants random allocation to canakinumab did not reduce blood pressure (P>0.2) or incident hypertension during the follow-up period (hazard ratio, 0.96 [0.85–1.08], P>0.2). IL-1β inhibition with canakinumab reduces major adverse cardiovascular event rates. These analyses suggest that the mechanisms underlying this benefit are not related to changes in blood pressure or incident hypertension

The National Exercise Referral Framework

A 2013 Review of the HSE funded GP Exercise Referral Programme (GPERP) highlighted the need for a new National Exercise Referral Framework (NERF). The evidence suggests that exercise referral is an effective targeted health intervention for specific patients and with the increasing prevalence of chronic disease it is imperative that we examine, design and progress the implementation of scalable, sustainable evidence-based, interventions, integrated across the health system to improve the health and wellbeing of the population. The development of this proposed National Exercise Referral Framework, commissioned by Health Promotion and Improvement, was led by DCU involving a multi-disciplinary Working Group and supported by a HSE Cross-Divisional Group. We are grateful to the Working Group and in particular to Dr Catherine Woods and the team in DCU for their extensive work and commitment to this project. There are a number of practical steps now required to determine the feasibility of the proposed framework as a national model namely, identification of a sustainable funding model; design and development of chronic disease care pathways and a phased implementation plan that would build on the existing programmes. The Health & Wellbeing Division of the HSE will lead the next phase of this project

Counseling versus antidepressant therapy for the treatment of mild to moderate depression in primary care: economic analysis.

OBJECTIVE: To compare the cost-effectiveness of generic psychological therapy (counseling) with routinely prescribed antidepressant drugs in a naturalistic general practice setting for a follow-up period of 12 months. METHODS: Economic analysis alongside a randomized clinical trial with patient preference arm. Comparison of depression-related health service costs at 12 months. Cost-effectiveness analysis of bootstrapped trial data using net monetary benefits and acceptability curves. RESULTS: No significant difference between the mean observed costs of patients randomized to antidepressants or to counseling (342 pounds sterling vs 302 pounds sterling , p = .56 [t test]). If decision makers are not willing to pay more for additional benefits (value placed on extra patient with good outcome, denoted by K, is zero), then we find little difference between the treatment modalities in terms of cost-effectiveness. If decision makers do place value on additional benefit (K > 0 pounds sterling), then the antidepressant group becomes more likely to be cost-effective. This likelihood is in excess of 90% where decision makers are prepared to pay an additional 2,000 pounds sterling or more per additional patient with a good global outcome. The mean values for incremental net monetary benefits (INMB) from antidepressants are substantial for higher values of K (INMB = 406 pounds sterling when K = 2,500 pounds sterling). CONCLUSION: For a small proportion of patients, the counseling intervention (as specified in this trial) is a dominant cost-effective strategy. For a larger proportion of patients, the antidepressant intervention (as specified in this trial) is the dominant cost-effective strategy. For the remaining group of patients, cost-effectiveness depends on the value of K. Since we cannot observe K, acceptability curves are a useful way to inform decision makers

Multimorbidity and health care service utilization in the Australian workforce: Findings from the National Health Survey

Objectives: The aim of this study was to understand the patterns of health care service utilization in employees with multimorbidity. Methods: Data were obtained from the 2011 to 2012 cross-sectional Australian National Health Survey. Past-month health care service utilization was collected for each chronic condition from a pre-specified list. Descriptive, logistic, and Poisson regression analyses were used. The data were weighted to produce nationally representative estimates. Results: Multimorbid employees with arthritis had higher adjusted arthritis-specific general practitioner (GP) visit rates [rate ratio (RR) = 1.7, 95% confidence interval (95% CI) = 1.1 to 2.2, P < 0.001] than employees with arthritis alone. Similarly, multimorbid employees with cardiovascular disease (CVD) had higher adjusted CVD-specific specialist visit rates (RR = 1.6, 95% CI = 1.1 to 2.5, P < 0.05) and 2.5 times (95% CI = 1.5 to 4.0, P < 0.001) more CVD-specific other health professional visits than employees with CVD alone. Conclusions: Given the increasing number of employees managing work and chronic illnesses, these findings have implications for health services and employers

Students' Learning Strategies With Multiple Representations: Explanations of the Human Breathing Mechanism

The purpose of this study was to understand how students utilized multiple representations to learn and explain science concepts, in this case the human breathing mechanism. The study was conducted with Grade 11 students in a human biology class. Semistructured interviews and a two-tier diagnostic test were administered to evaluate students’ learning strategies of integrating multiple representations. The functions of multiple representations (complementary, constraining, and deeper understanding) suggested by Ainsworth (2008) were adapted as the analytical framework to better describe the participating students’ learning strategies with multiple representations (access complementary information, apply one representation to interpret the other, and evaluate representations). The categorization of students’ learning strategies facilitated interpreting their diverse understanding in relation to the multiple representations. In addition to a summary of students’ learning strategies, three case examples are presented to show how the framework was applied in the analysis and to discuss how the learning strategies interacted with students’

Internal representation and factional faultlines as antecedents for board performance in social enterprises

There is an increasing scholarly interest in how social enterprises manage their hybrid nature. As hybrid organizational forms, social enterprises combine mission-driven social goals and revenue generating activities in a variety of organizational constellations and in diverse institutional contexts. Acknowledging the potentially conflicting demands that institutional environments impose on social enterprises there is an increasing research interest in the existence and proliferation of these conflicting demands at the organizational level. Some researchers have pointed to the importance of particular management practices and governance characteristics – such as authority relations and internal representation – as mechanisms to deal with the conflicting demands at the organizational level. This paper adds to this stream of literature by taking into account the organizational level dynamics of internal representation and the proliferation of factional groups in the boards of directors of hybrid organizational forms and their impact on board performance, ultimately influencing the organizational performance

The Significance of the J-Curve in Hypertension and Coronary Artery Diseases

The J-curve effect describes an inverse relation between low blood pressure (BP) and cardiovascular complications. This effect is more pronounced in patients with preexisting coronary artery disease (CAD), hypertension or left ventricular hypertrophy (LVH). The recent large clinical outcomes trials have observed a J-curve effect between a diastolic BP of 70-80 mmHg as well as a systolic BP <130 mmHg. The J-curve phenomenon does not appear in stroke or renal disease. This is because the coronary arteries are perfused during diastole, but the cerebral and renal perfusion mainly occurs in systole. Therefore, caution should be taken to maintain the diastolic blood pressure (DBP) at minimum of 70 mmHg and possibly to maintain the DBP between 80-85 mmHg in patients with severe LVH, CAD or vascular diseases. BP control in high-risk elderly patients should be carefully done as undergoing aggressive therapy to lower the systolic blood pressure below 140 mmHg can cause cardiovascular complications due to the severely reduced DBP and increased pulse pressure

Status of Exosphaeroma amplicauda (Stimpson, 1857), E-aphrodita (Boone, 1923) and description of three new species (Crustacea, Isopoda, Sphaeromatidae) from the north-eastern Pacific

Exosphaeroma amplicauda (Stimpson, 1857) from the west coast of North America is reviewed and redescribed and revealed to be a group of closely related species. A neotype is designated and the species redescribed based on the neotype and topotypic specimens. Exosphaeroma amplicauda is known only from the coast of California, at Marin, Sonoma and San Mateo Counties. E. aphrodita (Boone, 1923), type locality La Jolla, California and previously considered nomen dubium is taken out of synonymy and re-validated. A further three species: E. paydenae sp. n., E. russellhansoni sp. n., and E. pentcheffi sp. n. are described herein. Sphaeroma octonctum Richardson, 1899 is placed into junior synonymy with Exosphaeroma amplicauda. A key to the Pacific West Coast Exosphaeroma is provided