Impact of comorbid personality disorder on violence in psychosis

BackgroundThe impact of comorbid personality disorder on the occurrence of violence in psychosis has not been fully explored.AimsTo examine the association between comorbid personality disorder and violence in community-dwelling patients with psychosis.MethodA total of 670 patients with established psychotic illness were screened for comorbid personality disorder. Physical assault was measured from multiple data sources over the subsequent 2 years. Logistic regression was used to assess whether the presence of comorbid personality disorder predicted violence in the sample.ResultsA total of 186 patients (28%) were rated as having a comorbid personality disorder. Patients with comorbid personality disorder were significantly more likely to behave violently over the 2-year period of the trial (adjusted odds ratio = 1.71, 95% CI 1.05–2.79).ConclusionsComorbid personality disorder is independently associated with an increased risk of violent behaviour in psychosis.

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Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study

Critical Care ◽

10.1186/s13054-019-2706-0 ◽

2019 ◽

Vol 23 (1) ◽

Cited By ~ 1

Author(s):

François Dépret ◽

Clément Hoffmann ◽

Laura Daoud ◽

Camille Thieffry ◽

Laure Monplaisir ◽

...

Keyword(s):

Acute Kidney Injury ◽

Retrospective Study ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Kidney Injury ◽

Smoke Inhalation ◽

Logistic Regression Models ◽

Increased Risk ◽

The Impact

Abstract Background The use of hydroxocobalamin has long been advocated for treating suspected cyanide poisoning after smoke inhalation. Intravenous hydroxocobalamin has however been shown to cause oxalate nephropathy in a single-center study. The impact of hydroxocobalamin on the risk of acute kidney injury (AKI) and survival after smoke inhalation in a multicenter setting remains unexplored. Methods We conducted a multicenter retrospective study in 21 intensive care units (ICUs) in France. We included patients admitted to an ICU for smoke inhalation between January 2011 and December 2017. We excluded patients discharged at home alive within 24 h of admission. We assessed the risk of AKI (primary endpoint), severe AKI, major adverse kidney (MAKE) events, and survival (secondary endpoints) after administration of hydroxocobalamin using logistic regression models. Results Among 854 patients screened, 739 patients were included. Three hundred six and 386 (55.2%) patients received hydroxocobalamin. Mortality in ICU was 32.9% (n = 243). Two hundred eighty-eight (39%) patients developed AKI, including 186 (25.2%) who developed severe AKI during the first week. Patients who received hydroxocobalamin were more severe and had higher mortality (38.1% vs 27.2%, p = 0.0022). The adjusted odds ratio (95% confidence interval) of AKI after intravenous hydroxocobalamin was 1.597 (1.055, 2.419) and 1.772 (1.137, 2.762) for severe AKI; intravenous hydroxocobalamin was not associated with survival or MAKE with an adjusted odds ratio (95% confidence interval) of 1.114 (0.691, 1.797) and 0.784 (0.456, 1.349) respectively. Conclusion Hydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation. Trial registration ClinicalTrials.gov, NCT03558646

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Defining an Intraoperative Hypotension Threshold in Association with De Novo Renal Replacement Therapy after Cardiac Surgery

Anesthesiology ◽

10.1097/aln.0000000000003254 ◽

2020 ◽

Vol 132 (6) ◽

pp. 1447-1457 ◽

Cited By ~ 1

Author(s):

Janet M. C. Ngu ◽

Habib Jabagi ◽

Amy M. Chung ◽

Munir Boodhwani ◽

Marc Ruel ◽

...

Keyword(s):

Cardiac Surgery ◽

Risk Factor ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

De Novo ◽

Intraoperative Hypotension ◽

Increased Risk ◽

The Impact

Abstract Background Acute kidney injury (AKI) is a frequent and deadly complication after cardiac surgery. In the absence of effective therapies, a focus on risk factor identification and modification has been the mainstay of management. The authors sought to determine the impact of intraoperative hypotension on de novo postoperative renal replacement therapy in patients undergoing cardiac surgery, hypothesizing that prolonged periods of hypotension during and after cardiopulmonary bypass (CPB) were associated with an increased risk of renal replacement therapy. Methods Included in this single-center retrospective cohort study were adult patients who underwent cardiac surgery requiring CPB between November 2009 and April 2015. Excluded were patients who were dialysis dependent, underwent thoracic aorta or off-pump procedures, or died before receiving renal replacement therapy. Degrees of hypotension were defined by mean arterial pressure (MAP) as less than 55, 55 to 64, and 65 to 74 mmHg before, during, and after CPB. The primary outcome was de novo renal replacement therapy. Results Of 6,523 patient records, 336 (5.2%) required new postoperative renal replacement therapy. Each 10-min epoch of MAP less than 55 mmHg post-CPB was associated with an adjusted odds ratio of 1.13 (95% CI, 1.05 to 1.23; P = 0.002), and each 10-min epoch of MAP between 55 and 64 mmHg post-CPB was associated with an adjusted odds ratio of 1.12 (95% CI, 1.06 to 1.18; P = 0.0001) for renal replacement therapy. The authors did not observe an association between hypotension before and during CPB with renal replacement therapy. Conclusions MAP less than 65 mmHg for 10 min or more post-CPB is associated with an increased risk of de novo postoperative renal replacement therapy. The association between intraoperative hypotension and AKI was weaker in comparison to factors such as renal insufficiency, heart failure, obesity, anemia, complex or emergent surgery, and new-onset postoperative atrial fibrillation. Nonetheless, post-CPB hypotension is a potentially easier modifiable risk factor that warrants further investigation. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Reproductive Technologies and the Risk of Birth Defects

50 Studies Every Obstetrician-Gynecologist Should Know ◽

10.1093/med/9780190947088.003.0046 ◽

2021 ◽

pp. 251-256

Author(s):

Caitlin Sacha ◽

John Petrozza

Keyword(s):

Birth Defects ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Reproductive Technologies ◽

Adverse Outcomes ◽

Vitro Fertilization ◽

Increased Risk ◽

The Impact ◽

Fertile Women

Understanding the risks of adverse outcomes such as birth defects after the use of assisted reproductive technology (ART) is crucial for both OB/GYN physicians and patients suffering from infertility. In a South Australian population cohort study of 308,974 spontaneous and assisted pregnancies between 1986 and 2002 in women over age 20, assisted conceptions were associated with an increased risk of birth defects, including cerebral palsy, compared to spontaneous conceptions in fertile women (adjusted odds ratio 1.28, 95% confidence interval 1.16–1.41). However, when examining in vitro fertilization and intracytoplasmic sperm injection (ICSI) pregnancies, only ICSI with fresh transfer remained associated with an increased risk of birth defects compared to spontaneous conceptions in fertile women in adjusted models. These findings suggest that while patients should be counseled regarding the potential increased risk of birth defects with ART procedures such as ICSI, more research is needed regarding the impact of infertility itself and specific ART interventions on neonatal outcomes.

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Time to First Cigarette and Self-Reported Health Among US Adult Smokers

Tobacco Use Insights ◽

10.1177/1179173x18825262 ◽

2019 ◽

Vol 12 ◽

pp. 1179173X1882526 ◽

Cited By ~ 1

Author(s):

Baksun Sung

Keyword(s):

United States ◽

Propensity Score ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Smoking Behavior ◽

The United States ◽

Elevated Risk ◽

Poor Health ◽

Increased Risk ◽

Reported Health

Background: Numerous studies have reported that shorter time to first cigarette (TTFC) is linked to elevated risk for smoking-related morbidity. However, little is known about the influence of early TTFC on self-reported health among current smokers. Hence, the objective of this study was to examine the association between TTFC and self-reported health among US adult smokers. Methods: Data came from the 2012-2013 National Adult Tobacco Survey (NATS). Current smokers aged 18 years and older (N = 3323) were categorized into 2 groups based on TTFC: ≤ 5 minutes (n = 1066) and >5 minutes (n = 2257). Propensity score matching (PSM) was used to control selection bias. Results: After adjusting for sociodemographic and smoking behavior factors, current smokers with early TTFC had higher odds for poor health in comparison with current smokers with late TTFC in the prematching (adjusted odds ratio [AOR] = 1.65; 95% confidence interval [CI] = 1.31-2.08) and postmatching (AOR = 1.60; 95% CI = 1.22-2.09) samples. Conclusions: In conclusion, smokers with early TTFC were associated with increased risk of poor health in the United States. To reduce early TTFC, elaborate efforts are needed to educate people about harms of early TTFC and benefits of stopping early TTFC.

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Self-Reported Vision Impairment and Frailty among Older People with Low Cognitive Performance in Central Africa: EPIDEMCA Population-Based Study

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000518601 ◽

2021 ◽

pp. 1-7

Author(s):

Antoine Gbessemehlan ◽

Gilles Kehoua ◽

Catherine Helmer ◽

Cécile Delcourt ◽

Achille Tchalla ◽

...

Keyword(s):

Older People ◽

Cognitive Performance ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Central Africa ◽

Population Based ◽

Vision Impairment ◽

Sub Saharan Africa ◽

Population Based Study ◽

The Impact

Introduction: Very little is known about the impact of vision impairment (VI) on physical health in late-life in sub-Saharan Africa populations, whereas many older people experience it. We investigated the association between self-reported VI and frailty in Central African older people with low cognitive performance. Methods: It was cross-sectional analysis of data from the Epidemiology of Dementia in Central Africa (EPIDEMCA) population-based study. After screening for cognitive impairment, older people with low cognitive performance were selected. Frailty was assessed using the Study of Osteoporotic Fracture index. Participants who met one of the 3 parameters assessed (unintentional weight loss, inability to do 5 chair stands, and low energy level) were considered as pre-frail, and those who met 2 or more parameters were considered as frail. VI was self-reported. Associations were investigated using multinomial logistic regression models. Results: Out of 2,002 older people enrolled in EPIDEMCA, 775 (38.7%) had low cognitive performance on the screening test. Of them, 514 participants (sex ratio: 0.25) had available data on VI and frailty and were included in the analyses. In total, 360 (70%) self-reported VI. Prevalence of frailty was estimated at 64.9% [95% confidence interval: 60.9%–69.1%] and 23.7% [95% CI: 20.1%–27.4%] for pre-frailty. After full adjustment, self-reported VI was associated with frailty (adjusted odds ratio = 2.2; 95% CI: 1.1–4.3) but not with pre-frailty (adjusted odds ratio = 1.8; 95% CI: 0.9–3.7). Conclusion: In Central African older people with low cognitive performance, those who self-reported VI were more likely to experience frailty. Our findings suggest that greater attention should be devoted to VI among this vulnerable population in order to identify early frailty onset and provide adequate care management.

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Abstract WP200: Post-operative Infection Does not Increase Risk of Post-operative Stroke: Analysis From a Nationwide Quality Initiative Program

Stroke ◽

10.1161/str.47.suppl_1.wp200 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Benjamin R Kummer ◽

Rebecca Hazan ◽

Hooman Kamel ◽

Alexander E Merkler ◽

Joshua Z Willey ◽

...

Keyword(s):

Ischemic Stroke ◽

Odds Ratio ◽

Postoperative Infection ◽

Adjusted Odds Ratio ◽

Risk Of Infection ◽

Postoperative Stroke ◽

Increased Risk ◽

Increase Risk ◽

Initiative Program ◽

The Relationship

Introduction: Infection has been described as a trigger for acute ischemic stroke, but the relationship between postoperative infection and the risk of postoperative stroke is unclear. We investigated the association between postoperative infection and stroke using the American College of Surgeons National Surgical Quality Initiative Program (NSQIP) database. Hypothesis: Postoperative infection is associated with an increased risk of postoperative stroke. Methods: We used the NSQIP database to identify all patients who underwent surgery between the years of 2000 and 2010 and developed a postoperative stroke within 30 days of surgery. The group was further stratified according to the presence of infection preceding stroke. Using a logistic regression model adjusted for age, race, sex, medical comorbidities, surgical type, and dichotomized functional status, we compared the risk of stroke in patients with and without preceding infections, and investigated the risk of infection following stroke. Results: 729,886 surgical patients were identified, of whom 2,703 (0.3%) developed postoperative stroke. 848 (0.12%) patients developed both postoperative stroke and infection. Among patients who had postoperative stroke, 100 (3.7%) had developed an infection prior to developing a stroke. Patients with infection prior to stroke had a lower risk of stroke than patients who did not develop infection prior to stroke (adjusted odds ratio [OR] 0.25, 95%CI 0.20-0.32). 748 patients (0.1%) developed an infection after having a postoperative stroke. These patients had a higher risk of infection (incidence rate ratio 2.76, 95%CI 2.57-2.97) and a higher odds of infection (adjusted odds ratio [OR] 3.47, 95%CI 3.18-3.78) than patients who did not have a stroke. Conclusions: We found that the presence of a preceding infection was associated with a low risk of postoperative stroke in a large surgical inpatient sample. Although the total number of strokes may have been under-reported, these results conflict with other studies that report that infection is a trigger for ischemic stroke. Further analyses using more granular data are needed to investigate the relationship between postoperative infection and the risk of postoperative stroke.

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Association of ABO haplotypes with the risk of venous thrombosis: impact on disease risks estimation

Blood ◽

10.1182/blood.2020008997 ◽

2020 ◽

Author(s):

Louisa Goumidi ◽

Florian Thibord ◽

Kerri L. Wiggins ◽

Ruifang Li-Gao ◽

Michael R Brown ◽

...

Keyword(s):

Venous Thrombosis ◽

Blood Group ◽

Plasma Levels ◽

Odds Ratio ◽

Prediction Models ◽

Genetic Risk Score ◽

Individual Risk ◽

Abo Blood Group ◽

Increased Risk ◽

The Impact

Genetic risk score (GRS) analysis is an increasingly popular approach to derive individual risk prediction models for complex diseases. In the context of venous thrombosis (VT), any GRS shall integrate information at the ABO blood group locus, the latter being one of the major susceptibility locus for this disease. However, there is yet no consensus about which single nucleotide polymorphisms (SNPs) must be investigated when one is interested in properly assessing the association of ABO locus with VT risk. Using comprehensive haplotype analyses of ABO blood group tagging SNPs in up to 5,425 cases and 8,445 controls from 6 studies, we demonstrated that using only rs8176719 (tagging O1) to correctly assess the impact of ABO locus on VT risk is suboptimal as 5% of rs8176719-delG carriers are not exposed at higher VT risk. Instead, we recommend to use 4 SNPs, rs2519093 (tagging A1), rs1053878 (A2), rs8176743 (B) and rs41302905 (O2) in any analysis aimed at assessing the impact of ABO locus on VT risk to avoid any risk misestimation. Compared to O1 haplotype that can be inferred from these 4 SNPs, the A2 haplotype is associated with a modest increase in VT risk (odds ratio ~1.2), A1 and B haplotypes are associated with a ~1.8 fold increased risk while O2 tend to be slightly protective (odds ratio ~0.80). In addition, our analyses clearly showed that while the A1 an B blood group are associated with increased vWF and FVIII plasma levels only the A1 blood group is associated wih ICAM plasma levels but in an opposite direction, leaving additional avenues to be explored in order to fully understand the whole spectrum of biological effect of ABO locus on cardiovascular traits.

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Risk of miscarriage in women with psychiatric disorders

The British Journal of Psychiatry ◽

10.1192/bjp.2020.259 ◽

2021 ◽

pp. 1-6

Author(s):

Maria C. Magnus ◽

Alexandra Havdahl ◽

Nils-Halvdan Morken ◽

Knut-Arne Wensaas ◽

Allen J. Wilcox ◽

...

Keyword(s):

Psychiatric Disorders ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Depressive Disorders ◽

Somatoform Disorders ◽

Psychiatric Diagnoses ◽

Schizophrenia Spectrum Disorders ◽

Birth Registry ◽

Increased Risk ◽

Wide Range

Background Some psychiatric disorders have been associated with increased risk of miscarriage. However, there is a lack of studies considering a broader spectrum of psychiatric disorders to clarify the role of common as opposed to independent mechanisms. Aims To examine the risk of miscarriage among women diagnosed with psychiatric conditions. Method We studied registered pregnancies in Norway between 2010 and 2016 (n = 593 009). The birth registry captures pregnancies ending in gestational week 12 or later, and the patient and general practitioner databases were used to identify miscarriages and induced abortions before 12 gestational weeks. Odds ratios of miscarriage according to 12 psychiatric diagnoses were calculated by logistic regression. Miscarriage risk was increased among women with bipolar disorders (adjusted odds ratio 1.35, 95% CI 1.26–1.44), personality disorders (adjusted odds ratio 1.32, 95% CI 1.12–1.55), attention-deficit hyperactivity disorder (adjusted odds ratio 1.27, 95% CI 1.21–1.33), conduct disorders (1.21, 95% CI 1.01, 1.46), anxiety disorders (adjusted odds ratio 1.25, 95% CI 1.23–1.28), depressive disorders (adjusted odds ratio 1.25, 95% CI 1.23–1.27), somatoform disorders (adjusted odds ratio 1.18, 95% CI 1.07–1.31) and eating disorders (adjusted odds ratio 1.14, 95% CI 1.08–1.22). The miscarriage risk was further increased among women with more than one psychiatric diagnosis. Our findings were robust to adjustment for other psychiatric diagnoses, chronic somatic disorders and substance use disorders. After mutual adjustment for co-occurring psychiatric disorders, we also observed a modest increased risk among women with schizophrenia spectrum disorders (adjusted odds ratio 1.22, 95% CI 1.03–1.44). Conclusions A wide range of psychiatric disorders were associated with increased risk of miscarriage. The heightened risk of miscarriage among women diagnosed with psychiatric disorders highlights the need for awareness and surveillance of this risk group in antenatal care.

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Musculoskeletal Pain and Impact on Performance in Orchestra Musicians and Actors

Medical Problems of Performing Artists ◽

10.21091/mppa.2004.2009 ◽

2004 ◽

Vol 19 (2) ◽

pp. 55-61

Author(s):

K Engquist ◽

P Ørbaek ◽

K Jakobsson

Keyword(s):

Musculoskeletal Pain ◽

Odds Ratio ◽

Reference Group ◽

Study Groups ◽

Physical Work ◽

Prevalence Odds Ratio ◽

Cross Sectional ◽

Body Regions ◽

Increased Risk ◽

The Impact

We studied the prevalence of musculoskeletal pain and its impact on performance in orchestra musicians and in a reference group of actors, who share the mental stress in a performance situation, but without having the physical work load from an instrument. Swedish musicians (n = 103) from symphony and chamber orchestras and actors (n = 106) participated in a cross-sectional questionnaire study. Musculoskeletal pain was assessed by a further developed Standardized Nordic Questionnaire. The impact of pain on performance (pain affecting playing capacity, decreased playing time, and change of technique) and trouble-related sick leave also was assessed. Pain intensity was assessed by visual analogue scales. Musculoskeletal pain in the neck and shoulders was the most frequently reported problem, with similar prevalence among musicians and actors, around 25% for present pain and 20% for chronic pain (1-year prevalence). Around 10% of the musicians and 5% of the actors reported pain in the hands. Oral pain was reported by 12% of the musicians and 18% of the actors. The number of affected body regions and the intensity of pain were similar in the study groups. The musicians had an increased risk for pain affecting playing capacity. For the neck, the prevalence odds ratio (POR) was 3.0 (95%CI 1.2-7.2; adjusted for age and gender). String instrumentalists had higher risk estimates than nonstring instrumentalists. A gender difference was not observed. Pain in the oral region affecting playing capacity was less common in musicians, with a prevalence odds ratio of 0.4 (95%CI 0.1-0.8). Even though the prevalence of musculoskeletal pain was similar in the two groups of performing artists, the consequences for the work situation were more serious among musicians.

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Morbidity After Symptomatic Hemorrhage of Cerebral Cavernous Malformation

Stroke ◽

10.1161/strokeaha.120.029942 ◽

2020 ◽

Vol 51 (10) ◽

pp. 2997-3006

Author(s):

Li Ma ◽

Shuo Zhang ◽

Zongze Li ◽

Chun-Xue Wu ◽

Zhaozhao Wang ◽

...

Keyword(s):

Calibration Curve ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Cavernous Malformation ◽

Cerebral Cavernous Malformation ◽

Developmental Venous Anomaly ◽

Venous Anomaly ◽

Discriminative Ability ◽

Increased Risk

Background and Purpose: Symptomatic hemorrhage contributes to an increased risk of repeated bleeding and morbidity in cerebral cavernous malformation (CCM). A better understanding of morbidity after CCM hemorrhage would be helpful to identify patients of higher risk for unfavorable outcome and tailor individualized management. Methods: We identified 282 consecutive patients who referred to our institute from 2014 to 2018 for CCM with symptomatic hemorrhage and had an untreated follow-up period over 6 months after the first hemorrhage. The morbidity after hemorrhage was described in CCM of different features. Nomogram to predict morbidity was formulated based on the multivariable model of risk factors. The predictive accuracy and discriminative ability of nomogram were determined with concordance index (C-index) and calibration curve, and further validated in an independent CCM cohort of a prospective multicenter study from 2019 to 2020. Results: The overall morbidity of CCM was 26.2% after a mean follow-up of 1.9 years (range 0.5–3.5 years) since the first hemorrhage. The morbidity during untreated follow-up was associated with hemorrhage ictus (adjusted odds ratio per ictus increase, 4.17 [95% CI, 1.86–9.33]), modified Rankin Scale score at initial hemorrhage (adjusted odds ratio per point increase, 2.57 [95% CI, 1.82–3.63]), brainstem location (adjusted odds ratio, 2.93 [95% CI, 1.28–6.68]), and associated developmental venous anomaly (adjusted odds ratio, 2.21 [95% CI, 1.01–4.83]). Subgroup analysis revealed similar findings in brainstem and non-brainstem CCM. Nomogram was contracted based on these features. The calibration curve showed good agreement between nomogram prediction and actual observation. The C-index of nomogram predicting morbidity was 0.83 (95% CI, 0.77–0.88). In validation cohort, the nomogram maintained the discriminative ability (C-index, 0.87 [95% CI, 0.78–0.96]). Conclusions: Multiple symptomatic hemorrhages, initial neurological function after hemorrhage, brainstem location, and associated developmental venous anomaly were associated with morbidity of CCM hemorrhage. The nomogram represented a practical approach to provide individualized risk assessment for CCM patients. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT04076449.

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