Associations between chronic kidney disease and mental health disorders and psychoactive drugs in the UK general population

This thesis examined the association between chronic kidney disease (CKD) and both mental health disorders and psychoactive drugs, using a large contemporary UK database of routine medical record data (Clinical Practice Research Datalink [CPRD]). To fill the gap between what is known and what is unknown in this field, I focused on two main topics: (i) severe mental illness (SMI), with and without a history of lithium use, and CKD, and (ii) CKD and antidepressants (mainly prescribed for common mental health disorders such as depression and anxiety) and associated serious adverse outcomes. I first conducted a population-level validation study comparing prevalence estimates of decreased kidney function (defined as estimated glomerular filtration rate of <60 ml/min/1.73 m2) and renal replacement therapy (RRT) in the CPRD population with nationally representative statistics (Health Survey for England and UK Renal Registry). Findings suggested that most patients with decreased kidney function and RRT are probably captured in the CPRD. Secondly, I conducted a cross-sectional study on the association between SMI, including schizophrenia and bipolar disorder, and CKD (defined as two measurements of estimated glomerular filtration rate of <60 ml/min/1.73 m2 over ≥3 months in the past five years). Patients with SMI, especially lithium users, had a significantly higher prevalence of both CKD and RRT than the general population. Thirdly, I conducted a matched cohort study comparing the prevalence and incidence of antidepressant prescription between patients with and without CKD (matched for age, sex, general practice, and calendar time). Patients with CKD were approximately one and a half times more likely to receive antidepressants for mental health conditions such as depression and anxiety. Finally, I examined the gastrointestinal (GI) bleeding risk of selective serotonin reuptake inhibitors (SSRIs) by level of kidney function. While the relative risk for GI bleeding associated with SSRIs (i.e. the fully-adjusted rate ratio between periods with and without SSRI prescription) was constant regardless of baseline kidney function, the excess risk for GI bleeding associated with SSRIs (i.e. the fully-adjusted rate difference between periods with and without SSRI exposure) increased markedly as baseline kidney function deteriorated. In conclusion, a close association between CKD and mental health disorders was suggested in the UK general population. It is evident that patients with CKD are more likely to be prescribed antidepressants, and this may cause serious adverse outcomes such as GI bleeding associated with SSRIs. The risk-benefit balance of antidepressants for patients with CKD may need to be reconsidered in light of this new evidence

Author Correction: Changes in Distribution of Dry Eye Disease by the New 2016 Diagnostic Criteria from the Asia Dry Eye Society.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper

Electric field measurements of DC and long wavelength structures associated with sporadic-<i>E</i> layers and QP radar echoes

Electric field and plasma density data gathered on a sounding rocket launched from Uchinoura Space Center, Japan, reveal a complex electrodynamics associated with sporadic-<i>E</i> layers and simultaneous observations of quasi-periodic radar echoes. The electrodynamics are characterized by spatial and temporal variations that differed considerably between the rocket's upleg and downleg traversals of the lower ionosphere. Within the main sporadic-<i>E</i> layer (95–110 km) on the upleg, the electric fields were variable, with amplitudes of 2–4 mV/m that changed considerably within altitude intervals of 1–3 km. The identification of polarization electric fields coinciding with plasma density enhancements and/or depletions is not readily apparent. Within this region on the downleg, however, the direction of the electric field revealed a marked change that coincided precisely with the peak of a single, narrow sporadic-<i>E</i> plasma density layer near 102.5 km. This shear was presumably associated with the neutral wind shear responsible for the layer formation. The electric field data above the sporadic-<i>E</i> layer on the upleg, from 110 km to the rocket apogee of 152 km, revealed a continuous train of distinct, large scale, quasi-periodic structures with wavelengths of 10–15 km and wavevectors oriented between the NE-SW quadrants. The electric field structures had typical amplitudes of 3–5 mV/m with one excursion to 9 mV/m, and in a very general sense, were associated with perturbations in the plasma density. The electric field waveforms showed evidence for steepening and/or convergence effects and presumably had mapped upwards along the magnetic field from the sporadic-<i>E</i> region below. Candidate mechanisms to explain the origin of these structures include the Kelvin-Helmholtz instability and the <i>E_s</i>-layer instability. In both cases, the same shear that formed the sporadic-<i>E</i> layer would provide the energy to generate the km-scale structures. Other possibilities include gravity waves or a combination of these processes. The data suggest that these structures were associated with the lower altitude density striations that were the seat of the QP radar echoes observed simultaneously. They also appear to have been associated with the mechanism responsible for a well-defined pattern of "whorls" in the neutral wind data that were revealed in a chemical trail released by a second sounding rocket launched 15min later. Short scale (&lt;100 m) electric field irregularities were also observed and were strongest in the sporadic-<i>E</i> region below 110km. The irregularities were organized into 2–3 layers on the upleg, where the plasma density also displayed multiple layers, yet were confined to a single layer on the downleg where the plasma density showed a single, well-defined sporadic-<i>E</i> peak. The linear gradient drift instability involving the DC electric field and the vertical plasma gradient is shown to be incapable of driving the observed waves on the upleg, but may have contributed to the growth of short scale waves on the topside of the narrow unstable density gradient observed on the downleg. The data suggest that other sources of free energy may have been important factors for the growth of the short scale irregularities.<p> <b>Keywords.</b> Ionosphere (Mid-latitude ionosphere; Electric fields and currents; Ionospheric irregularities

Severe mental illness and chronic kidney disease: a cross-sectional study in the United Kingdom

OBJECTIVE: We investigated the burden of chronic kidney disease (CKD) among patients with severe mental illness (SMI). METHODS: We identified patients with SMI among all those aged 25–74 registered in the UK Clinical Practice Research Datalink as on March 31, 2014. We compared the prevalence of CKD (two measurements of estimated glomerular filtration rate <60 mL/min/1.73 m2 for ≥3 months) and renal replacement therapy between patients with and without SMI. For patients with and without a history of lithium prescription separately, we used logistic regression to examine the association between SMI and CKD, adjusting for demographics, lifestyle characteristics, and known CKD risk factors. RESULTS: The CKD prevalence was 14.6% among patients with SMI and a history of lithium prescription (n = 4,295), 3.3% among patients with SMI and no history of lithium prescription (n = 24,101), and 2.1% among patients without SMI (n = 2,387,988; P < 0.001). The prevalence of renal replacement therapy was 0.23%, 0.15%, and 0.11%, respectively (P = 0.012). Compared to patients without SMI, the fully adjusted odds ratio for CKD was 6.49 (95% CI 5.84–7.21) for patients with SMI and a history of lithium prescription and 1.45 (95% CI 1.34–1.58) for patients with SMI and no history of lithium prescription. The higher prevalence of CKD in patients with SMI may, in part, be explained by more frequent blood testing as compared to the general population. CONCLUSION: CKD is identified more commonly among patients with SMI than in the general population

Evolution of cooperation driven by zealots

Recent experimental results with humans involved in social dilemma games suggest that cooperation may be a contagious phenomenon and that the selection pressure operating on evolutionary dynamics (i.e., mimicry) is relatively weak. I propose an evolutionary dynamics model that links these experimental findings and evolution of cooperation. By assuming a small fraction of (imperfect) zealous cooperators, I show that a large fraction of cooperation emerges in evolutionary dynamics of social dilemma games. Even if defection is more lucrative than cooperation for most individuals, they often mimic cooperation of fellows unless the selection pressure is very strong. Then, zealous cooperators can transform the population to be even fully cooperative under standard evolutionary dynamics.Comment: 5 figure

Population Structure and Transmission Dynamics of Plasmodium vivax in the Republic of Korea Based on Microsatellite DNA Analysis

Vivax malaria is widely prevalent, mainly in Asia and South America with 390 million reported cases in 2009. Worldwide, in the same year, 2.85 billion people were at risk. Plasmodium vivax is prevalent not only in tropical and subtropical areas but also in temperate areas where there are no mosquitoes in cold seasons. While most malaria researchers are focusing their studies on the parasite in tropical areas, we examined the characteristics of P. vivax in South Korea (temperate area) temporally, using 10 highly polymorphic microsatellite DNA (a short tandem repeat DNA sequence) in the parasite genome, and highlighted the differences between the tropical and temperate populations. We found that the South Korean P. vivax population had low genetic diversity and low recombination rates in comparison to tropical P. vivax populations that had been reported. We also found that some of the parasite clones in the population were changing from 1994 to 2008, evidence suggesting the continual introduction of the parasite from other populations, probably from North Korea. Polymorphic DNA markers of the P. vivax parasite are useful tools for estimating the situation of its transmission in endemic areas

Molecular Typing of Trypanosoma cruzi Isolates, United States

Studies have characterized Trypanosoma cruzi from parasite-endemic regions. With new human cases, increasing numbers of veterinary cases, and influx of potentially infected immigrants, understanding the ecology of this organism in the United States is imperative. We used a classic typing scheme to determine the lineage of 107 isolates from various hosts