Incorporating gout guideline advice into urate reports is associated with reduced hospital admissions: results of an observational study

Rheumatology ◽  
2021 ◽  
Author(s):  
Philip L Riches ◽  
Laura Downie ◽  
Carol Thomson
Keyword(s):  
Hospital Admissions ◽  
Relative Rate ◽  
Primary Diagnosis ◽  
Relative Increase ◽  
Local Data ◽  
Improved Outcomes ◽  
Significant Difference ◽  
Prescription Rates ◽  
The Impact ◽  
Health Boards

Abstract Objective To evaluate the impact of incorporating treatment guidance into reporting of urate test results. Methods Urate targets for clinically confirmed gout were added to urate results above 0.36 mmol/l requested after September 2014 within NHS Lothian. Scotland-wide data on urate-lowering therapy prescriptions and hospital admissions with gout were analysed between 2009 and 2020. Local data on urate tests were analysed between 2014 and 2015. Results Admissions with a primary diagnosis of gout in Lothian reduced modestly following the intervention from 111/year in 2010–2014 to 104/year in 2015–2019, a non-significant difference (P = 0.32). In contrast there was a significant increase in admissions to remaining NHS Scotland health boards (556/year vs 606/year, P < 0.01). For a secondary diagnosis of gout the number of admissions in NHS Lothian reduced significantly (58/year vs 39/year, P < 0.01) contrasting with a significant increase in remaining Scottish health boards (220/year vs 290/year, P < 0.01). The relative rate of admissions to NHS Lothian compared with remaining Scottish boards using a 2009 baseline were significantly reduced for both primary diagnosis of gout (1.06 vs 1.25, P < 0.001) and secondary diagnoses of gout (0.64 compared with 1.4, P < 0.001) after the intervention; however, there was no difference before the intervention. A relative increase in the prescription rates of allopurinol 300 mg tablets and febuxostat 120 mg tablets may have contributed to the improved outcomes seen. Conclusion Incorporation of clinical guideline advice into routine reporting of urate results was associated with reduced rates of admission with gout in NHS Lothian, in comparison with other Scottish health boards.

scholarly journals The impact of COVID-19 infection on hip fracture 30-day mortality

Trauma ◽  
2021 ◽  
pp. 146040862094972
Author(s):  
Ahmed Fadulelmola ◽  
Rob Gregory ◽  
Gavin Gordon ◽  
Fiona Smith ◽  
Andrew Jennings
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Hospital Admissions ◽  
The Elderly ◽  
Primary Outcome Measure ◽  
Time To Death ◽  
Significant Difference ◽  
The Mean ◽  
The Impact ◽  
Mean Time

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

scholarly journals Impact of COVID-19 pandemic on stroke admissions in Qatar

2021 ◽  
Vol 3 (1) ◽  
pp. e000084
Author(s):  
Naveed Akhtar ◽  
Salman Al Jerdi ◽  
Ziyad Mahfoud ◽  
Yahia Imam ◽  
Saadat Kamran ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Small Vessel Disease ◽  
Tertiary Care ◽  
Relative Increase ◽  
Large Vessel ◽  
Tertiary Care Centre ◽  
Transient Ischaemic Attacks ◽  
Stroke Mimics ◽  
Coronary Syndromes ◽  
The Impact

IntroductionThe COVID-19 pandemic has resulted in a dramatic unexplained decline in hospital admissions due to acute coronary syndromes and stroke. Several theories have emerged aiming to explain this decline, mostly revolving around the fear of contracting the disease and thus avoiding hospital visits.AimsIn this study, we aim to examine the impact of the COVID-19 pandemic on stroke admissions to a tertiary care centre in Qatar.MethodsThe Hamad General Hospital stroke database was interrogated for stroke admissions between September 2019 and May 2020. The number of stroke admissions, stroke subtypes and short-term outcomes was compared between the ‘pre-COVID-19’ period (September 2019 to February 2020) and the COVID-19 pandemic period (March to May 2020).ResultsWe observed a significant decline in monthly admissions in March (157), April (128) and May (135) compared with the pre-COVID-19 6-month average (229) (p=0.024). The reduction in admissions was most evident in functional stroke mimics. The average admissions decreased from 87 to 34 per month (p=0.0001). Although there were no significant differences in admissions due to ischaemic stroke (IS), intracranial haemorrhage or transient ischaemic attacks between the two periods, we noted a relative decrease in IS due to small vessel disease and an increase in those due to large vessel atherosclerosis in March to May 2020.ConclusionsThe decline in overall stroke admissions during the COVID-19 pandemic is most likely related to concerns of contracting the infection, evidenced mainly by a decline in admissions of stroke mimics. However, a relative increase in large vessel occlusions raises suspicion of pathophysiological effects of the virus, and requires further investigation.

Severe-COVID-19 and mortality among patients (pts) with prostate cancer (PCa) receiving androgen deprivation therapy (ADT).

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 39-39
Author(s):  
Matthew D Tucker ◽  
Andrew Lachlan Schmidt ◽  
Chih-Yuan Hsu ◽  
Yu Shyr ◽  
Andrew J. Armstrong ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Mortality Rate ◽  
Propensity Score ◽  
Viral Entry ◽  
Primary Diagnosis ◽  
Significant Difference ◽  
Secondary Endpoints ◽  
Retrospective Nature ◽  
Ecog Ps ◽  
The Impact

39 Background: The presence of progressing cancer, male sex and advanced age have been shown to increase the severity of coronavirus disease 2019 (COVID-19). Given that the androgen regulated gene TMPRSS2 has been implicated in SARS-CoV-2 viral entry, we hypothesized that ADT may improve COVID-19 outcomes. This analysis evaluated clinical outcomes of pts with PCa with concurrent SARS-CoV-2 infection and investigated the impact of ADT on occurrence of severe-COVID-19 and mortality. Methods: Data was obtained via the COVID-19 and Cancer Consortium (CCC19), a multicenter registry including >120 cancer centers with de-identified data from pts with COVID-19 and cancer. Men with confirmed SARS-CoV-2 infection and a primary diagnosis of prostate cancer were included: data cutoff of July 31, 2020. The primary endpoint was the development of severe-COVID-19 (death, ICU admission, or mechanical ventilation) among pts on ADT vs. those not on ADT at time of COVID-19 infection. Secondary endpoints included 30-day mortality based on ADT use. Mortality and development of severe-COVID-19 were assessed in Pts grouped by therapy: 1st generation androgen receptor inhibitor (ARI-1), 2nd generation ARI (darolutamide, enzalutamide, apalutamide, ARI-2), abiraterone/prednisone, and chemotherapy. Propensity score matching was utilized. Logistic regression was utilized to adjust for age, ECOG PS, comorbidities, and race. Results: 589 pts were included; median follow-up was 42 days (IQR 25-90) and 62% (363/589) were hospitalized. Severe-COVID-19 developed in 28% of pts and the all-cause 30-day mortality rate was 19%. There was no significant difference in the development of severe-COVID-19 or 30-day mortality between Pts on ADT vs not on ADT, whether using descriptive statistics with the entire population or using the propensity score matched population (Table). Among the descriptive population, the numerical rates of severe-COVID-19 and mortality were lowest in Pts receiving ARI-2, but sample size was low. Conclusions: The overall 30-day mortality rate and percentage developing severe-COVID-19 were high. There was no statistical difference in the development of severe-COVID-19 or mortality based on receipt of ADT; however, this analysis is limited by the retrospective nature and small N after propensity-matching. [Table: see text]

Classification of algogenic organic matter concerning its contribution to the bacterial regrowth potential and by-products formation

1998 ◽  
Vol 37 (2) ◽  
pp. 91-96 ◽  
Author(s):  
Wido Schmidt ◽  
Beate Hambsch ◽  
Heike Petzoldt
Keyword(s):  
Organic Matter ◽  
Chlorine Dioxide ◽  
Relative Increase ◽  
Residual Chlorine ◽  
Additional Increase ◽  
Bacterial Regrowth ◽  
Humic Compounds ◽  
Significant Difference ◽  
The Impact ◽  
By Products

The bacterial regrowth potential (BRP) and the by-products formation potential after the disinfection (DBP) are parameters recognized to be influenced by the origin of organic matter dissolved in water. A significant difference of the impact of humic compounds and algogenic organic matter (AOM), characteristic for raw waters from reservoirs, to both parameters can be assumed. In systematic laboratory experiments the influence of AOM on the BRP as well as DBP was examined. Different fractions of the AOM were chlorinated and treated with chlorine dioxide. In addition to that the influence of the ozonation was investigated. To assess the biodegradable fraction of the organic matter (BDOC) a large spectrum of by-products (aldehydes and keto-acids) was analyzed. The BRP in the water was determined by the measurement of the increase of biomass in the water samples. It could be proved, that the chlorination of intact algae cells containing waters may cause a significant increase of the biodegradability in the water if the residual chlorine is totally required. In the case of the disinfection of the AOM containing waters with chlorine dioxide the relative increase of the BRP was lower in comparison to the chlorinated waters. The preozonation of the algae containing waters indicates an additional increase of the BRP, but only by ozonation of the algae cells. The ozonation of the algae metabolites does not influence the BRP, but it causes a significant decrease of the THM-formation if chlorine is used for disinfection.

scholarly journals Perioperative rifaximin is not associated with enhanced functional and volumetric recovery after major liver resection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jan Bednarsch ◽  
Zoltan Czigany ◽  
Sven H. Loosen ◽  
Lara Heij ◽  
Lorenz Ruckgaber ◽  
...  
Keyword(s):  
Liver Function ◽  
Primary Endpoint ◽  
Major Hepatectomy ◽  
Controlled Trial ◽  
Liver Volume ◽  
Relative Increase ◽  
Control Group ◽  
Open Label ◽  
Significant Difference ◽  
The Impact

AbstractThe objective of this randomized controlled trial (RCT) was to assess the impact of rifaximin on the course of liver function, liver regeneration and volumetric recovery in patients undergoing major hepatectomy. The ARROW trial was an investigator initiated, single-center, open-label, phase 3 RCT with two parallel treatment groups, conducted at our hepatobiliary center from 03/2016 to 07/2020. Patients undergoing major hepatectomy were eligible and randomly assigned 1:1 to receive oral rifaximin (550 mg twice daily for 7–10 or 14–21 days in case of portal vein embolization preoperatively and 7 days postoperatively) versus no intervention. Primary endpoint was the relative increase in postoperative liver function measured by LiMAx from postoperative day (POD) 4 to 7. Secondary endpoint were the course of liver function and liver volume during the study period as well as postoperative morbidity and mortality. Between 2016 and 2020, 45 patients were randomized and 35 patients (16 individuals in the rifaximin and 19 individuals in the control group) were eligible for per-protocol analysis. The study was prematurely terminated following interim analysis, due to the unlikelihood of reaching a significant primary endpoint. The median relative increase in liver function from POD 4 to POD 7 was 27% in the rifaximin group and 41% in the control group (p = 0.399). Further, no significant difference was found in terms of any other endpoints of functional liver- and volume regeneration or perioperative surgical complications following the application of rifaximin versus no intervention. Perioperative application of rifaximin has no effect on functional or volumetric regeneration after major hepatectomy (NCT02555293; EudraCT 2013-004644-28).

scholarly journals Trends in admissions for acute respiratory infections in children: an inter-country comparison between Western Australia and England

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Hannah Moore ◽  
Tasmin Abdalla ◽  
Christopher Blyth ◽  
Ruth Gilbert ◽  
Pia Hardelid
Keyword(s):  
Western Australia ◽  
Hospital Admissions ◽  
Respiratory Infections ◽  
Laboratory Data ◽  
Primary Diagnosis ◽  
Respiratory Pathogens ◽  
Vaccination Programs ◽  
Admission Rates ◽  
Tract Infections ◽  
The Impact

ABSTRACTObjectiveAcute respiratory infections (ARI) including bronchiolitis, pneumonia and influenza are a major cause of hospital admissions in children worldwide. Linkage of administrative health datasets provides a platform to investigate temporal and seasonal trends in large populations over many years. We examined the similarities and differences in ARI admissions using linked datasets in Western Australia and England. ApproachThrough the availability of common data items in each jurisdiction, identical coding and data cleaning principles were applied to both datasets. Hospital admissions for ARI in children aged <5 years between 2000 and 2012 were identified using International Classification of Diseases diagnosis codes. Admission rates per 1000 child-years by age, gender and admission year were calculated in each jurisdiction. A total population birth cohort was available in Western Australia and the denominator was person time at risk whereas for England, all hospitalisations were used with the mid-year population as the denominator. ResultsThe overall incidence of ARI was 18.3/1000 child-years in Western Australia and 14.4/1000 in England. In both countries, the highest incidence of ARI was observed in infants (47.9/1000 child-years in Western Australia and 42.1/1000 child-years in England). Bronchiolitis was the most common primary diagnosis in infants in both countries, accounting for 79.7% of ARI admissions in Western Australia and 78.3% in England. The most common primary diagnosis in 1-4 year olds was unspecified lower respiratory tract infections in England (48.8% of ARI admissions in this age group) and pneumonia in Western Australia (43.9% of ARI admissions in 1-4-year-olds). The annual incidence rate for ARI hospitalisations declined in Western Australia from 2000 to 2006 and since remained steady. ARI admission rates increased in England throughout the study period. Admission rates across all age groups were 1.1-1.5 times higher in boys than girls in both countries. ConclusionThe availability of similar datasets in two economically similar countries in different hemispheres has afforded the opportunity to characterise and compare the epidemiology of paediatric respiratory infections over a 13 year period. Future analyses will allow us to assess differences in coding practices, seasonality and risk factors such as socio-economic deprivation and prematurity. Furthermore the availability of linked laboratory data for respiratory pathogens in each jurisdiction will allow for comparisons of pathogen-specific epidemiology and the impact of universal vaccination programs.

Patients’ expectations and experiences with a mental health supportive text messaging program: a mixed-methods evaluation (Preprint)

2021 ◽  
Author(s):  
Reham Shalaby ◽  
Wesley Vuong ◽  
Ejemai Eboreime ◽  
Shireen Surood ◽  
Andrew Greenshaw ◽  
...  
Keyword(s):  
Mental Health ◽  
User Satisfaction ◽  
Text Messaging ◽  
Univariate Analysis ◽  
Primary Diagnosis ◽  
Text Messages ◽  
Ethics Research ◽  
Significant Difference ◽  
Acute Psychiatric Care ◽  
The Impact

BACKGROUND Web-based services are economic and easily scalable means of support that use existing technology. Text4Support is a supportive complementary texting service provided remotely to support people with different mental health conditions after they are discharged from the hospital. OBJECTIVE We aimed to assess user satisfaction with the Text4Support service for a better understanding of subscribers’ experiences METHODS This is a mixed-method assessment using quantitative and qualitative secondary data of a pilot observational controlled trial. The trial included 181 patients discharged from acute psychiatric care and distributed into four randomized groups. Out of the four study groups in the initial study, two groups were included in this analysis who received supportive text messages (89 patients), either alone or alongside peer support service. Thematic and descriptive analyses were employed. Univariate analysis was conducted to examine differences in feedback based on sex at birth and primary diagnosis. RESULTS Out of 89 participants, 39 completed the follow-up survey yielding a response rate of 40.4%. The principal findings were that Text4Support was well-perceived with a high satisfaction rate either regarding the feedback of the messages or their perceived impact. Meanwhile, there was no statistically significant difference between satisfactory items based on subscriber’s sex at birth or primary diagnosis. The initial patients’ expectations were either neutral or positive in relation to the expected nature and/or the impact of the received messages upon their mental wellbeing. Additionally, the subscribers were satisfied with the frequency of the messages as provided once daily for six consecutive months. The participants recommended more personalized messages and/or mutual interaction with healthcare personnel. CONCLUSIONS Text4Support was generally well perceived by patients after their hospital discharge, regardless of their sex at birth or mental health diagnosis. Further personalization and interactive platforms were recommended that may need to be considered when designing similar future services. CLINICALTRIAL The study received ethics approval from the Health Ethics Research Board of the University of Alberta (Ref # Pro00078427) and operational approval from Alberta Health Services, the regional health authority. All patients provided written informed consent. The study was registered with clinicaltrials.gov (Trial registration number NCT03404882).

MO364ASSOCIATION OF AKI-EVENT DEFINED BY DIFFERENT DEFINITIONS WITH IN-HOSPITAL MORTALITY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Fateme Nateghi ◽  
Konstantinos Makris ◽  
Pierre Delanaye ◽  
Hans Pottel
Keyword(s):  
Logistic Regression ◽  
Hospital Mortality ◽  
Hospital Admissions ◽  
Kidney Injury ◽  
Relative Increase ◽  
Local Health ◽  
Absolute Increase ◽  
Severe Stage ◽  
Stage 1 ◽  
The Impact

Abstract Background and Aims Studies have shown that millions of hospitalized patients suffer from Acute Kidney Injury (AKI) per year which increases mortality risk for these patients. Different definitions for AKI have been proposed during the past years such as RIFLE (2002) and AKIN (2004). In 2012, KDIGO published a clinical practice guideline harmonizing AKIN and RIFLE into one general guideline which classifies AKI into 3 stages, where stage 1 is defined as an absolute increase of SCr ≥ 0.3 mg/dl over 48 hours or a relative increase in SCr ≥ 50% from baseline within the previous 7 days. A recent study [Sparrow et al., 2019] evaluated the impact of further categorizing AKI stage 1 into 2 stages based on SCr criteria. The study separates KDIGO AKI stage 1 and AKIN stage 1 into 2 stages (KDIGO-4 and AKIN-4) based on the different SCr criteria. Having different AKI definitions makes it challenging to analyze AKI incidence and associated outcomes among studies. The present study aimed to investigate the incidence of AKI events defined by 4 different definitions (standard AKIN and KDIGO, and modified AKIN-4 and KDIGO-4) and its association with in-hospital mortality. Method Retrospective clinical data available for all adult (≥18 years old) hospital admissions to a local health district in Athens, Greece between October 1999 and March 2019 was used in the analysis. We excluded patients whose time between admission and discharge was less than 7 days. Also, patients with less than 5 Scr measurements were omitted from the analysis resulting in the final cohort of 7242 admissions. We used the AKIN, KDIGO, AKIN-4, and KDIGO-4 definitions to check the incidence of AKI. As our second goal, we assessed associations of AKI-events with in-hospital mortality, adjusted for characteristics (age, sex, AKI staging) using multivariable logistic regression. Results The incidence of in-hospital AKI using the modified KDIGO-4 was 6.72% for stage 1a, 15.71% for stage 1b, 8.06% for stage 2, and 2.97% for stage 3; however, these percentages for AKIN-4 were 11.5%, 5.83%,1.75%, and 0.33% for stage 1a, stage 1b, stage 2, and stage 3, respectively. Using the standard KDIGO and AKIN definition, 19.08 and 14.05 % developed stage 1, respectively. To find the association between AKI stages and in-hospital mortality, we considered the most severe stage of AKI reached by a patient. Results of logistic regression models show that in-hospital mortality increased as the stage of AKI events increased for both KDIGO-4 and AKIN-4 (Table 1). Table 2 shows the same results using the original KDIGO and AKIN definitions. Conclusion The results of both definitions (AKIN-4 and KDIGO-4) show a significant association with mortality, but KDIGO-4 has a larger odds ratio meaning that AKI classification based on KDIGO-4 has a stronger association with mortality than AKI classification based on AKIN-4. However, based on our results, splitting stage 1 to stage 1a and stage 1b does not seem to make a difference; hence, using KDIGO-4 as a replacement for KDIGO would not have a significant impact on capturing AKI events.

scholarly journals Seasonality in schizophrenia—An analysis of a nationwide registry with 110,735 hospital admissions

2020 ◽  
Vol 63 (1) ◽  
Author(s):  
B. Hinterbuchinger ◽  
D. König ◽  
A. Gmeiner ◽  
S. Listabarth ◽  
M. Fellinger ◽  
...  
Keyword(s):  
Seasonal Variations ◽  
Multiple Testing ◽  
Hospital Admissions ◽  
Seasonal Pattern ◽  
Influencing Factor ◽  
Total Sample ◽  
Seasonal Patterns ◽  
Significant Difference ◽  
Level Of Significance ◽  
The Impact

Abstract Background. Seasonal patterns in hospitalizations have been observed in various psychiatric disorders, however, it is unclear whether they also exist in schizophrenia. Previous studies found mixed results and those reporting the presence of seasonality differ regarding the characteristics of these patterns. Further, they are inconclusive whether sex is an influencing factor. The aim of this study was therefore to examine if seasonal patterns in hospitalizations can be found in schizophrenia, with special regard to a possible influence of sex, by using a large national dataset. Methods. Data on all hospital admissions within Austria due to schizophrenia (F20.0–F20.6) for the time period of 2003–2016 were included. Age standardized monthly variation of hospitalization for women and men was analyzed and the level of significance adjusted for multiple testing. Results. The database comprised of 110,735 admissions (59.6% men). Significant seasonal variations were found in the total sample with hospitalization peaks in January and June and a trough in December (p < 0.0001). No significant difference in these patterns was found between women and men with schizophrenia (p < 0.0001). Conclusion. Our study shows that schizophrenia-related hospitalizations follow a seasonal pattern in both men and women. The distribution of peaks might be influenced by photoperiod changes which trigger worsening of symptoms and lead to exacerbations in schizophrenia. Further research is necessary to identify underlying factors influencing seasonal patterns and to assess whether a subgroup of patients with schizophrenia is especially vulnerable to the impact of seasonal variations.

How does gender influence age at first hospitalization for schizophrenia? A transnational case register study

1989 ◽  
Vol 19 (4) ◽  
pp. 903-918 ◽  
Author(s):  
H. Häfner ◽  
A. Riecher ◽  
K. Maurer ◽  
W. Löffler ◽  
P. Munk-Jørgensen ◽  
...  
Keyword(s):  
Gender Differences ◽  
Gender Difference ◽  
Help Seeking ◽  
Hospital Admissions ◽  
Age Of Onset ◽  
Occupational Status ◽  
Case Register ◽  
Significant Difference ◽  
Selection Factors ◽  
The Impact

SYNOPSISNumerous studies have reported a lower mean age at first hospitalization for schizophrenia in males than in females. For this finding not only a gender difference in age at first onset of schizophrenia, but also other factors can be responsible. With the aim of providing a comprehensive analysis of gender differences in onset, symptomatology and course of schizophrenia, we started by testing the hypothesis postulating a gender difference in mean age at first hospitalization. By using the Danish and the Mannheim psychiatric case registers we analysed all hospital admissions for schizophrenia and related diagnoses and all previous admissions for other diagnoses of the Danish population in 1976 and those of the inhabitants of the German city of Mannheim in the period of 1978–80. Artefacts were controlled for systematically. The impact of intervening variables such as selection factors as well as the influence of gender on the ascription of a diagnosis of schizophrenia for the first time were assessed. We found a mean difference of 5 to 6 years in age at first hospitalization between males and females in both countries when a broad definition of the diagnosis was used and of 4 to 5 years when a restrictive definition was applied. The higher mean age at first hospitalization among females is not attributable to artefacts, diagnostic procedures or to any essential extent to gender differences in help-seeking behaviour or occupational status. When a distinction was made between ‘single’ and ‘married’, the significant difference in age at first hospitalization between the sexes disappeared in singles. With case register data and without knowing the chronological order of marriage and onset of the disease, it remains an open question whether this finding can be explained by purely correlative associations between sex, marital status and age of onset or by causal effects.

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