Epilepsy following simple febrile seizure in a rural community in Tanzani

Objective: To study the outcome of subsequent epilepsy following a single uncomplicated febrile seizure in a cohort of children aged six months to six years followed up for a ten year period.Design: Observational prospective cohort studySetting: Mahenge epilepsy clinic, Ulanga district, Morogoro region, Tanzania.Subjects: Children aged six months to six years living in Ulango District, Morogoro Region, Tanzania.Results: A total of 6522 children aged six months to six years lived in the study area. Of these 213 (3%) had experienced one uncomplicated febrile seizures within six months of the commencement of the study. At the end of ten years follow-up period 145(65%) were still living in the study area. Of these 44 (30%) had developed epilepsy giving an equivalent of cumulative incidence rate of 3.8 per 100 person years. The age of onset of first uncomplicated FS between the ages of two to five years was significantly associated with the development of later epilepsy in comparison to other ages X2 26.43; P<0.001. This difference was significantly accumulative with time of follow-up. The number of recurrent febrile seizures significantly influenced the development of later epilepsy.X2 = 32.3; p =<0.001 with relative risk (odds ratio 5.4, 95% CI 2.6-11.41 P<0.001). A positive family history of FS significantly influenced the development of later epilepsy. X2 P<0.001 with relative risk (odds ratio 3.2, 95% CI 2.0-5.1; p<0.001. A positive family history of epilepsy did not significantly influence the development of later epilepsy X2 = 38.1; P <0.212. Conclusion: Cumulative incidence of epilepsy in rural Tanzanian children following a single uncomplicated FS was small but higher than that reported in developed countries. This risk was influenced independently by the number of recurrent FS, family history of FS, and the age of onset of the first ever FS

Frequency of anxiety after stroke: a systematic review and meta-analysis of observational studies.

BACKGROUND AND PURPOSE: Negative psychological outcomes occur frequently after stroke; however, there is uncertainty regarding the occurrence of anxiety disorders and anxiety symptoms after stroke. A systematic review of observational studies was conducted that assessed the frequency of anxiety in stroke patients using a diagnostic or screening tool. SUMMARY OF REVIEW: Databases were searched up to March 2011. A random effects model was used to summarize the pooled estimate. Statistical heterogeneity was assessed using the I(2) statistic. Forty-four published studies comprising 5760 stroke patients were included. The overall pooled estimate of anxiety disorders assessed by clinical interview was 18% (95%confidence interval 8-29%, I(2)  = 97%) and was 25% (95% confidence interval 21-28%, I(2)  = 90%) for anxiety assessed by rating scale. The Hospital Anxiety and Depression Scale-Anxiety subscale 'probable' and 'possible' cutoff scores were the most widely used assessment criteria. The combined rate of anxiety by time after stroke was: 20% (95% confidence interval 13-27%, I(2)  = 96%) within one-month of stroke; 23% (95% confidence interval 19-27%, I(2)  = 84%) one to five-months after stroke; and 24% (95% confidence interval 19-29%, I(2)  = 89%) six-months or more after stroke. CONCLUSION: Anxiety after stroke occurs frequently although methodological limitations in the primary studies may limit generalizability. Given the association between prevalence rates and the Hospital Anxiety and Depression Scale-Anxiety cutoff used in studies, reported rates could in fact underrepresent the extent of the problem. Additionally, risk factors for anxiety, its impact on patient outcomes, and effects in tangent with depression remain unclear

Prostate specific antigen testing policy worldwide varies greatly and seems not to be in accordance with guidelines: a systematic review

<p>Abstract</p> <p>Background</p> <p>Prostate specific antigen (PSA) testing is widely used, but guidelines on follow-up are unclear.</p> <p>Methods</p> <p>We performed a systematic review of the literature to determine follow-up policy after PSA testing by general practitioners (GPs) and non-urologic hospitalists, the use of a cut-off value for this policy, the reasons for repeating a PSA test after an initial normal result, the existence of a general cut-off value below which a PSA result is considered normal, and the time frame for repeating a test.</p> <p><it>Data sources</it>. MEDLINE, Embase, PsychInfo and the Cochrane library from January 1950 until May 2011.</p> <p><it>Study eligibility criteria</it>. Studies describing follow-up policy by GPs or non-urologic hospitalists after a primary PSA test, excluding urologists and patients with prostate cancer. Studies written in Dutch, English, French, German, Italian or Spanish were included. Excluded were studies describing follow-up policy by urologists and follow-up of patients with prostate cancer. The quality of each study was structurally assessed.</p> <p>Results</p> <p>Fifteen articles met the inclusion criteria. Three studies were of high quality. Follow-up differed greatly both after a normal and an abnormal PSA test result. Only one study described the reasons for not performing follow-up after an abnormal PSA result.</p> <p>Conclusions</p> <p>Based on the available literature, we cannot adequately assess physicians’ follow-up policy after a primary PSA test. Follow-up after a normal or raised PSA test by GPs and non-urologic hospitalists seems to a large extent not in accordance with the guidelines.</p

Measuring multimorbidity in a working population: the effect on incident sickness absence.

PURPOSE: Multimorbidity research typically focuses on chronic and common diseases in patient and/or older populations. We propose a multidimensional multimorbidity score (MDMS) which incorporates chronic conditions, symptoms, and health behaviors for use in younger, presumably healthier, working populations. METHODS: Cross-sectional study of 372,370 Spanish workers who underwent a standardized medical evaluation in 2006. We computed a MDMS (range 0-100) based on the sex-specific results of a multicorrespondence analysis (MCA). We then used Cox regression models to assess the predictive validity of this MDMS on incident sickness absence (SA) episodes. RESULTS: Two dimensions in the MCA explained about 80 % of the variability in both sexes: (1) chronic cardiovascular conditions and health behaviors, and (2) pain symptoms, in addition to sleep disturbances in women. More men than women had at least one condition (40 vs 15 %) and two or more (i.e., multimorbidity) (12 vs 2 %). The MDMS among those with multimorbidity ranged from 16.8 (SD 2.4) to 51.7 (SD 9.9) in men and 18.5 (SD 5.8) to 43.8 (SD 7.8) in women. We found that the greater the number of health conditions, the higher the risk of SA. A higher MDMS was also a risk factor for incident SA, even after adjusting for prior SA and other covariates. In women, this trend was less evident. CONCLUSIONS: A score incorporating chronic health conditions, behaviors, and symptoms provides a more holistic approach to multimorbidity and may be useful for defining health status in working populations and for predicting key occupational outcomes.This study was partially supported by the Plan Estatal de I+D+i 2013–2016 and the ISCIII-Subdirección General de Evaluación y Fomento de la Investigación (Grant PI13/00749) and FEDER, by the CIBER of Epidemiology and Public Health in Spain and by discretionary funds from The University of Texas School of Public Health (UTSPH), under a joint Letter of Agreement between Universitat Pompeu Fabra and the UTSPH