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

ANDREAS VESALIUS IN PISA

Andreas Vesalius is the most commanding figure in European medicine, after Galen and before Harvey. His dissections and lectures were in considerable demand. Having just published the De humani corporis fabbrica, and before operating as a private physician of Emperor Charles V, the anatomist spent some months conducting demonstrations of anatomy at the universities of Bologna, Pisa and Florence. The present study aim to reconstruct the journey he made to Pisa, where he was invited by Duke Cosimo I De’ Medici. The work of Andrea Corsini and O’Malley, the study of Vesalio’s Epistola… rationem modumque propinandi radicis Chynae dedocti... , and some unpublished documents make possible a more detailed reconstruction of the period Vesalio spent in the Nuovo Studio Pisano, carrying out public human dissections, discussing and refuting most of the Galenic doctrine

La medicina omeopatica nel meridione d'Italia prima dell'Unità.

La frammentazione politica della penisola italica nella prima metà del XIX secolo è tale da condizionare molti fattori, compresi gli eventi culturali in generale e lo sviluppo scientifico in particolare. Un esempio eclatante è senz’altro rappresentato dalla particolare distribuzione che la nuova disciplina medico-terapica, nota come Omeopatia, avrà nelle diverse zone del Paese per tutto il XIX secolo ma, soprattutto, nel periodo preunitario. Se la nascita del concetto di omeopatia si deve ai medici inglesi Edward Jenner e William Hunter è merito del tedesco Samuel Friedrich Christian Hahnemann (1755-1843) averlo strutturato in dottrina terapeutica, come reazione personale alla inutilità ed alla pericolosità della farmacopea e dei rimedi dell’epoca. La neonata disciplina ha come sua prima area di massima accoglienza gli ambienti militari austriaci. La gran maggioranza dei medici dell’esercito è composta, già nel primo ventennio del XIX secolo, da medici omeopati e da alti graduati che, insieme a personaggi della nobiltà Asburgica, ne sono ferventi sostenitori. Non deve quindi stupire se la diffusione del sistema terapeutico omeopatico in Europa seguirà, almeno inizialmente, i percorsi di occupazione militare e di conquista territoriale da parte dell’esercito austriaco. Uno dei primissimi territori ad essere interessato al fenomeno è sicuramente il Regno delle due Sicilie. L’inizio e lo sviluppo dell’omeopatia a Napoli ed in Sicilia sono ben documentati. Rare notizie si hanno per la Puglia. In Abruzzo si sviluppa un movimento che ha un ruolo non secondario nella diffusione delle teorie hahnemanniane supportato com’è dal Giornale Abruzzese di Scienze, Lettere e Arti, mentre Melchiorre Delfico, protagonista per eccellenza della cosiddetta Rinascenza teramana, mostra una partecipazione attenta nei confronti dei progressi di questa peculiare disciplina. Assolutamente prive di qualsiasi tipo di notizia sull’argomento, sono al momento la Calabria e la Basilicata. La Calabria costituisce quasi un caso a parte dal momento che viene raccontata, nelle riviste scientifico-letterarie napoletane dell’epoca, come una terra disperata, isolata e trascurata dalla quale nessun contributo culturale, tantomeno scientifico, si sarebbe mai potuto evolvere

A forgotten Italian pathologist: Angelo Maffucci (1845–1903) and his scientific thought

Maffucci had been interested in experimental pathology since 1879. His activity is documented by some experimental works mainly performed at the "Incurabili" Hospital of Neaples, Italy, where he first approached this discipline under the direction of the well-known German pathologist Otto von Schrön. His publications between the years 1882 and 1887, when he was already director to Pisa, were concerned with the infectious embryo pathology, the absorption in the peritoneum and in the articulations, as well as with hypertrophic cirrhosis of the liver, which represented a perfect combination of experimentation and autopsy. His first work on infectious embryo pathology, published in 1887, strongly contributed to the understanding of the different infectious pathologies and asserted unequivocally the need for experimentation in the fields of medical and biological sciences. For this important contribution in the field of pathology and for his brilliant ideas, the National Academy of Lincei awarded the scientist a gold medal in 1903