Multimorbidity and vulnerability among those living with psychosis in Indigenous populations in Cape York and the Torres Strait

2021 ◽  
pp. 000486742098483
Author(s):  
Fiona Charlson ◽  
Bruce Gynther ◽  
Karin Obrecht ◽  
Michael Waller ◽  
Ernest Hunter
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Psychotic Disorder ◽  
Odds Ratio ◽  
Torres Strait Islander ◽  
Psychotic Disorders ◽  
Indigenous Populations ◽  
High Rate ◽  
Cape York ◽  
Torres Strait

Objective: Previous research has found an alarmingly high rate of psychosis in Indigenous1 patients from remote communities of Cape York and the Torres Strait with the treated prevalence of psychosis four times higher than that found for the Australian population. This study assesses comorbid illness and risk factors among this same cohort of psychosis patients. Methods: Data were collated from a clinical database that contains complete psychiatric records from 1992 to 2015, extracted for all Indigenous patients who received treatment for a psychotic disorder from the Remote Area Mental Health Service. Descriptive analysis and logistic regression models explored differences across subgroups of ethnicity and sex, and relationships between co-morbid disorders and risk factors. All multivariate models included variables of age, year of birth, sex and ethnicity. Results: Sixty per cent of participants ( n = 256) experienced a comorbid mental or substance use disorder. Forty-five per cent ( n = 192) of participants experienced a physical comorbidity. The most frequent physical health outcomes were injury (29%, n = 93), diabetes (18%, n = 58) and cardiovascular disease (21%, n = 68). Risk factors considered to play a potential biological or neurodevelopmental role in the development of psychosis were approximately three times more likely in Aboriginal (odds ratio = 3.2; 95% confidence interval = [2.0, 4.9]) versus Torres Strait Islander patients, and those born after 1980 (odds ratio = 2.5; 95% confidence interval = [1.6, 3.9]) versus those born prior to 1980. Environmental or contextual factors were associated with significantly greater risk among Aboriginal (odds ratio = 3.8; 95% confidence interval = [2.4, 6.0]) compared with Torres Strait Islander patients. Conclusion: Our data expose the perinatal and early environment of Indigenous children who later developed a psychotic disorder. As risk factors for schizophrenia may be cumulative and interactive, both with each other and with critical periods of neurodevelopmental vulnerability, our results suggest possible causes for the increasing prevalence of psychotic disorders between 1992 and 2015.

Incarceration among adults living with psychosis in Indigenous populations in Cape York and the Torres Strait

2021 ◽  
pp. 000486742098524
Author(s):  
Fiona Charlson ◽  
Bruce Gynther ◽  
Karin Obrecht ◽  
Ed Heffernan ◽  
Michael David ◽  
...  
Keyword(s):  
Mental Health ◽  
Criminal Justice ◽  
Indigenous People ◽  
Psychotic Disorder ◽  
Cox Regression ◽  
Indigenous Populations ◽  
Cox Regression Analysis ◽  
History Of ◽  
Cape York ◽  
Torres Strait

Objective: The relationship between psychosis and contact with the criminal justice system for Indigenous people living in rural and remote areas is not well understood. In this study, the authors examine patterns of incarceration among Indigenous people living with psychosis in Cape York and the Torres Strait over two decades. Methods: Data were collated from a clinical database of complete psychiatric records from 1992 to 2015, extracted for all Indigenous patients with a psychotic disorder from the Remote Area Mental Health Service, and linked to the Queensland Corrections Service database. Descriptive statistics were calculated to compare characteristics between those incarcerated and those not incarcerated during the study period and to quantify patterns of incarceration including types of offences, time spent in custody and frequency of incarceration. Multivariate Cox regression analysis was used to assess associations between reported variables and ‘first incarceration’. Results: Forty-five percent of Aboriginal patients ( n = 116) were incarcerated compared with 31% of Torres Strait Islanders ( n = 41) ( p = 0.008), and the proportion of males incarcerated (51%, n = 141) was approximately twice that of females (24%, n = 35; p = 0.001). A cluster of first incarcerations were observed in close time proximity to diagnosis of psychosis. Individuals who had a history of both alcohol and cannabis use had approximately two times higher risk of being incarcerated following positive diagnosis compared to those without a history of substance use (hazard ratio = 1.85; 95% confidence interval: [1.08, 3.17]; p = 0.028). Males accounted for approximately 85% ( n = 328) of sentences. The most common most serious offence was causing physical harm to others (assault – n = 122, 31%). Conclusion: Our study found that for Aboriginal and Torres Strait Islander people with a psychotic disorder in North Queensland, criminal justice responses with resultant incarceration occurs frequently. Access to appropriate mental health services and diversion options for Indigenous Australians with psychosis should be a key public health and justice priority.

scholarly journals Parental risk factors for congenital diaphragmatic hernia – a large German case-control study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Felicitas Schulz ◽  
Ekkehart Jenetzky ◽  
Nadine Zwink ◽  
Charlotte Bendixen ◽  
Florian Kipfmueller ◽  
...  
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Environmental Risk ◽  
Odds Ratio ◽  
Alcohol Intake ◽  
Case Control Study ◽  
Case Control ◽  
Parental Risk Factors ◽  
Healthy Control ◽  
Control Study

Abstract Background Evidence for periconceptional or prenatal environmental risk factors for the development of congenital diaphragmatic hernia (CDH) is still scarce. Here, in a case-control study we investigated potential environmental risk factors in 199 CDH patients compared to 597 healthy control newborns. Methods The following data was collected: time of conception and birth, maternal BMI, parental risk factors such as smoking, alcohol or drug intake, use of hairspray, contact to animals and parental chronic diseases. CDH patients were born between 2001 and 2019, all healthy control newborns were born in 2011. Patients and control newborns were matched in the ratio of three to one. Results Presence of CDH was significantly associated with maternal periconceptional alcohol intake (odds ratio = 1.639, 95% confidence interval 1.101–2.440, p = 0.015) and maternal periconceptional use of hairspray (odds ratio = 2.072, 95% confidence interval 1.330–3.229, p = 0.001). Conclusion Our study suggests an association between CDH and periconceptional maternal alcohol intake and periconceptional maternal use of hairspray. Besides the identification of novel and confirmation of previously described parental risk factors, our study underlines the multifactorial background of isolated CDH.

scholarly journals Age and multimorbidities as poor prognostic factors for COVID-19 in hemodialysis: a Lebanese national study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mabel Aoun ◽  
Rabab Khalil ◽  
Walid Mahfoud ◽  
Haytham Fatfat ◽  
Line Bou Khalil ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Artery Disease ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Death Rate ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
National Study ◽  
Artery Disease

Abstract Background Hemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients. Methods This is an observational study that included all chronic hemodialysis patients in Lebanon who were tested positive for SARS-CoV-2 from 31st March to 1st November 2020. Data on demographics, comorbidities, admission to hospital and outcome were collected retrospectively from the patients’ medical records. A binary logistic regression analysis was performed to assess risk factors for mortality. Results A total of 231 patients were included. Mean age was 61.46 ± 13.99 years with a sex ratio of 128 males to 103 females. Around half of the patients were diabetics, 79.2% presented with fever. A total of 115 patients were admitted to the hospital, 59% of them within the first day of diagnosis. Hypoxia was the major reason for hospitalization. Death rate was 23.8% after a median duration of 6 (IQR, 2 to 10) days. Adjusted regression analysis showed a higher risk for death among older patients (odds ratio = 1.038; 95% confidence interval: 1.013, 1.065), patients with heart failure (odds ratio = 4.42; 95% confidence interval: 2.06, 9.49), coronary artery disease (odds ratio = 3.27; 95% confidence interval: 1.69, 6.30), multimorbidities (odds ratio = 1.593; 95% confidence interval: 1.247, 2.036), fever (odds ratio = 6.66; 95% confidence interval: 1.94, 27.81), CRP above 100 mg/L (odds ratio = 4.76; 95% confidence interval: 1.48, 15.30), and pneumonia (odds ratio = 19.18; 95% confidence interval: 6.47, 56.83). Conclusions This national study identified older age, coronary artery disease, heart failure, multimorbidities, fever and pneumonia as risk factors for death in patients with COVID-19 on chronic hemodialysis. The death rate was comparable to other countries and estimated at 23.8%.

Subclinical atherosclerosis in children and adolescents with congenital heart disease

2020 ◽  
pp. 1-8
Author(s):  
Silvia M. Cardoso ◽  
Michele Honicky ◽  
Yara M. F. Moreno ◽  
Luiz R. A. de Lima ◽  
Matheus A. Pacheco ◽  
...  
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Clinical Characteristics ◽  
Congenital Heart ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Media Thickness

Abstract Background: Subclinical atherosclerosis in childhood can be evaluated by carotid intima-media thickness, which is considered a surrogate marker for atherosclerotic disease in adulthood. The aims of this study were to evaluate carotid intima-media thickness and, to investigate associated factors. Methods: Cross-sectional study with children and adolescents with congenital heart disease (CHD). Socio-demographic and clinical characteristics were assessed. Subclinical atherosclerosis was evaluated by carotid intima-media thickness. Cardiovascular risk factors, such as physical activity, screen time, passive smoke, systolic and diastolic blood pressure, waist circumference, dietary intake, lipid parameters, glycaemia, and C-reactive protein, were also assessed. Factors associated with carotid intima-media thickness were analysed using multiple logistic regression. Results: The mean carotid intima-media thickness was 0.518 mm and 46.7% had subclinical atherosclerosis (carotid intima-media thickness ≥ 97th percentile). After adjusting for confounding factors, cyanotic CHD (odds ratio: 0.40; 95% confidence interval: 0.20; 0.78), cardiac surgery (odds ratio: 3.17; 95% confidence interval: 1.35; 7.48), and be hospitalised to treat infections (odds ratio: 1.92; 95% confidence interval: 1.04; 3.54) were associated with subclinical atherosclerosis. Conclusion: Clinical characteristics related to CHD were associated with subclinical atherosclerosis. This finding suggests that the presence of CHD itself is a risk factor for subclinical atherosclerosis. Therefore, the screen and control of modifiable cardiovascular risk factors should be made early and intensively to prevent atherosclerosis.

The use of clozapine in a rural and remote region of Australia

2020 ◽  
pp. 103985622097527
Author(s):  
Bridson Tahnee ◽  
Abeysundera Hesitha ◽  
Arunachalam Arulmathy ◽  
Lam Anthea ◽  
Mora Linda ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Torres Strait Islander ◽  
Psychotic Disorders ◽  
Clinical Information ◽  
Antipsychotic Treatment ◽  
Rural And Remote ◽  
Access To Treatment ◽  
Regional Area ◽  
The Mean ◽  
Torres Strait

Objective: Clozapine is the most effective antipsychotic available for treatment-resistant schizophrenia. Unfortunately, it is often underutilised or administered late in the treatment course, if at all. This issue is further augmented in rural and remote regions where access to treatment is sparse. This study is the first of its kind to investigate the use of clozapine in a remote and regional area of Australia with a high proportion of Aboriginal and/or Torres Strait Islander individuals. Methods: This study includes all individuals who were commenced on clozapine between June 2013 and June 2018. Relevant clinical information was sourced from electronic medical records and descriptive statistical analysis performed. Results: A total of 3850 patients with psychotic disorders were reviewed over 5 years, of whom 63 were commenced on clozapine. The majority were male ( n = 50, 79.4%) with a mean age of 33.9 years (standard deviation 11.0). A total of 34.9% ( n = 22) identified as Aboriginal and/or Torres Strait Islander. The mean length of time between diagnosis and commencement of clozapine was 7.2 years (standard deviation ±4.6 years), while the mean number of antipsychotic medications tried prior to clozapine was 4.2 (standard deviation ±1.6 antipsychotics). Clozapine was discontinued in 57.1% of the individuals in this study (41% within the first 12 months). The most common cause for cessation was poor compliance ( n = 19, 30.2%). Conclusion: While clozapine remains the most effective antipsychotic treatment, it is often commenced late in the treatment or ceased prematurely. Further work is required, particularly in remote and regional populations, to ensure treatment adherence for optimal patient outcomes.

Dynamic networks of psychotic symptoms in adults living in precarious housing or homelessness

2021 ◽  
pp. 1-11
Author(s):  
Andrea A. Jones ◽  
Kristina M. Gicas ◽  
Sara Mostafavi ◽  
Melissa L. Woodward ◽  
Olga Leonova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Community Sample ◽  
Dynamic Networks ◽  
Premature Mortality ◽  
Psychotic Symptoms ◽  
Network Measures ◽  
History Of ◽  
Precarious Housing

Abstract Background People living in precarious housing or homelessness have higher than expected rates of psychotic disorders, persistent psychotic symptoms, and premature mortality. Psychotic symptoms can be modeled as a complex dynamic system, allowing assessment of roles for risk factors in symptom development, persistence, and contribution to premature mortality. Method The severity of delusions, conceptual disorganization, hallucinations, suspiciousness, and unusual thought content was rated monthly over 5 years in a community sample of precariously housed/homeless adults (n = 375) in Vancouver, Canada. Multilevel vector auto-regression analysis was used to construct temporal, contemporaneous, and between-person symptom networks. Network measures were compared between participants with (n = 219) or without (n = 156) history of psychotic disorder using bootstrap and permutation analyses. Relationships between network connectivity and risk factors including homelessness, trauma, and substance dependence were estimated by multiple linear regression. The contribution of network measures to premature mortality was estimated by Cox proportional hazard models. Results Delusions and unusual thought content were central symptoms in the multilevel network. Each psychotic symptom was positively reinforcing over time, an effect most pronounced in participants with a history of psychotic disorder. Global connectivity was similar between those with and without such a history. Greater connectivity between symptoms was associated with methamphetamine dependence and past trauma exposure. Auto-regressive connectivity was associated with premature mortality in participants under age 55. Conclusions Past and current experiences contribute to the severity and dynamic relationships between psychotic symptoms. Interrupting the self-perpetuating severity of psychotic symptoms in a vulnerable group of people could contribute to reducing premature mortality.

scholarly journals Risk factors for oral health in young, urban, Aboriginal and Torres Strait Islander children

2018 ◽  
Vol 64 (1) ◽  
pp. 72-81 ◽  
Author(s):  
K Butten ◽  
NW Johnson ◽  
KK Hall ◽  
J Anderson ◽  
M Toombs ◽  
...  
Keyword(s):  
Risk Factors ◽  
Oral Health ◽  
Torres Strait Islander ◽  
Torres Strait

Risk factors for blood-contaminated cerebrospinal fluid collection in dogs

2019 ◽  
Vol 186 (16) ◽  
pp. e8-e8
Author(s):  
Aran Nagendran ◽  
Daniel Sanchez-Masian ◽  
Erika Bersan ◽  
Camilla Jayne Cooper ◽  
Rita Gonçalves
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Body Condition Score ◽  
Fluid Collection ◽  
Final Diagnosis ◽  
Time Of Day ◽  
Blood Contamination ◽  
Potential Risk Factors

ObjectiveTo determine the risk factors for blood contamination during cerebrospinal fluid (CSF) collection in dogs.Study design and methodsThis is a prospective study of 170 CSF samples. Data collected included signalment of the patient, body condition score, site of CSF collection (cerebellomedullary cistern (CMC) or lumbar cistern (LC)), number of attempts, clinician expertise, final diagnosis, time of day, skull conformation and day of the week. Analysis of the CSF samples was then performed, and the presence of blood contamination (red blood cells >500/µl) was recorded. Logistic regression was used to quantify the association of potential risk factors of the procedure. Multivariate analysis was performed on the variables that were statistically significant.ResultsOf the 170 CSF samples, 53 per cent were collected from the CMC (n=90) and 47 per cent from the LC (n=80). Blood contamination was seen in 20 per cent (n=34) of the samples, 8.9 per cent (n=8) in CMC and 32.5 per cent (n=26) in LC samples. Increased odds of obtaining a contaminated CSF sample were associated with lower level of clinician expertise (odds ratio: 2.5; 95 per cent confidence interval: 0.9–6.7; P=0.046) and with LC versus CMC collection site (odds ratio: 8.1; 95 per cent confidence interval: 2.1–12.9; P=0.001).Clinical significanceThere is increased likelihood of blood contamination when collecting CSF from the LC compared with the CMC site. Increased clinician experience reduced the risk of CSF blood contamination, but none of the other variables examined significantly influenced this.

scholarly journals Prevalence and risk factors of Neospora caninum infection in ovine flocks of central-western Mexico

2019 ◽  
Vol 67 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Jesús Manuel Romo-Gallegos ◽  
Carlos Cruz-Vázquez ◽  
Leticia Medina-Esparza ◽  
Miguel Ramos-Parra ◽  
Dora Romero-Salas
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Animal Species ◽  
Neospora Caninum ◽  
Domestic Animal ◽  
Caninum Infection ◽  
Blood Samples ◽  
Western Mexico ◽  
The Mean

This study, carried out in 13 sheep flocks of central-western Mexico, aimed to identify the prevalence of anti-N. caninum antibodies, to develop a risk analysis of the infection and to estimate the prevalence of parasite DNA in blood. A total of 368 serum and blood samples were subjected to ELISA and PCR tests, respectively, and the association between the prevalence of antibodies and some management factors was estimated. The overall prevalence of anti-N. caninum antibodies was 13.5% [50/368; 95% confidence interval (CI) 10–17], ranging from 2.7 to 90% per flock, and 92% of the farms had seropositive animals. In ewes the prevalence was 14% (48/348, 95% CI 10–17) and in rams 10% (2/20; 95% CI 1– 33). The mean prevalence of Neospora DNA in blood was 27% (99/368, 95% CI 22–31), implying a range between 16 and 82%. In rams, the prevalence was 5% (1/20 95% CI 2–26), while in ewes it was 28% (98/348, 95% CI 23–33). The agreement between the tests was k = 0.19. The presence of other domestic animal species in the farms [odds ratio (OR) 4.4] and the consumption of placental debris, fetuses and stillborn lambs by dogs living in the farms (OR 5.8) were demonstrated to be risk factors.

Perioperative complications in a paediatric cardiac surgery program with limited systemic resources

2020 ◽  
Vol 30 (11) ◽  
pp. 1659-1665
Author(s):  
Igor V. Polivenok ◽  
William M. Novick ◽  
Aleksander V. Pyetkov ◽  
Marcelo Cardarelli
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Operative Mortality ◽  
Perioperative Complications ◽  
Failure To Rescue ◽  
Middle Income ◽  
Paediatric Cardiac Surgery ◽  
Complications Rate

AbstractBackground:The perioperative complications rate in paediatric cardiac surgery, as well as the failure-to-rescue impact, is less known in low- and middle-income countries.Aim:To evaluate perioperative complications rate, mortality related to complications, different patients’ demographics, and procedural risk factors for perioperative complication and post-operative death.Methods:Risk factors for perioperative complications and operative mortality were assessed in a retrospective single-centre study which included 296 consecutive children undergoing cardiac surgery.Results:Overall mortality was 5.7%. Seventy-three patients (24.7%) developed 145 perioperative complications and had 17 operative mortalities (23.3%). There was a strong association between the number of perioperative complications and mortality – 8.1% among patients with only 1 perioperative complication, 35.3% – with 2 perioperative complications, and 42.1% – with 3 or more perioperative complications (p = 0.007). Risk factors of perioperative complications were younger age (odds ratio 0.76; (95% confidence interval 0.61, 0.93), previous cardiac surgery (odds ratio 3.5; confidence interval 1.33, 9.20), extracardiac structural anomalies (odds ratio 3.03; confidence interval 1.27, 7.26), concomitant diseases (odds ratio 3.23; confidence interval 1.34, 7.72), and cardiopulmonary bypass (odds ratio 6.33; confidence interval 2.45, 16.4), whereas the total number of perioperative complications per patient was the only predictor of operative death (odds ratio 1.89; confidence interval 1.06, 3.37).Conclusions:In a program with limited systemic resources, failure-to-rescue is a major contributor to operative mortality in paediatric cardiac surgery. Despite the comparable crude mortality, the operative mortality among patients with perioperative complications in our series was significantly higher than in the developed world. A number of initiatives are needed in order to improve failure-to-rescue rates in low- and middle-income countries.

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