scholarly journals Electroconvulsive therapy and later stroke in patients with affective disorders

2018 ◽  
Vol 214 (3) ◽  
pp. 168-170 ◽  
Author(s):  
Maarten Pieter Rozing ◽  
Martin Balslev Jørgensen ◽  
Merete Osler
Keyword(s):  
Electroconvulsive Therapy ◽  
Cox Regression ◽  
Recurrent Stroke ◽  
Long Term Effects ◽  
National Patient Registry ◽  
Number Of Patients ◽  
National Patient ◽  
History Of

SummaryThe long-term effects of electroconvulsive therapy (ECT) on the risk of stroke are unknown. We examined the association between ECT and risk of incident or recurrent stroke. A cohort of 174 534 patients diagnosed with affective disorder between 2005 and 2016 in the Danish National Patient Registry were followed for stroke until November 2016. The association between ECT and stroke was analysed using Cox regression with multiple adjustment and propensity-score matching on sociodemographic and clinical variables. In 162 595 patients without previous stroke, 5781 (3.6%) were treated with ECT. The total number of patients developing stroke during follow-up was 3665, of whom 165 had been treated with ECT. In patients <50 years, ECT was not associated with stroke (adjusted hazard ratio (HR) = 1.29, 95% CI 0.87–1.93). In patients ≥50, ECT was associated with a lower risk of stroke (adjusted HR = 0.69, 95% CI 0.57–0.89), but this estimate was likely influenced by competing mortality risk. Of 11 939 patients with a history of stroke, 228 (1.9%) were treated with ECT. During follow-up, 2330 (19.5%) patients had a recurrence, of which 26 were patients treated with ECT. ECT was not associated with risk of a new event (HR = 0.69, 95% CI 0.46–1.00; P = 0.05). ECT is not associated with an elevated risk of incident or recurrent stroke.Declaration of interestNone.

Electroconvulsive therapy, depression severity and mortality: Data from the Danish National Patient Registry

2020 ◽  
Vol 34 (3) ◽  
pp. 273-279 ◽  
Author(s):  
Martin Balslev Jørgensen ◽  
Maarten Pieter Rozing ◽  
Charles H Kellner ◽  
Merete Osler
Keyword(s):  
Electroconvulsive Therapy ◽  
Cox Regression ◽  
Severe Depression ◽  
Patient Registry ◽  
Psychotic Symptoms ◽  
Mortality Data ◽  
Depression Severity ◽  
National Patient Registry ◽  
Danish National Patient Registry ◽  
National Patient

Background: The effects of electroconvulsive therapy are usually estimated from changes in depression scales from studies with relatively small patient samples. Larger patient samples can be achieved from epidemiological registers, which provide information on other social and clinical predictors, results and risks. Aims: To examine whether depression severity predicts the use of electroconvulsive therapy, risk of re-hospitalization, suicidal behaviour and mortality following electroconvulsive therapy in patients with major depression. Methods: A cohort of 92,895 patients diagnosed with single or recurrent depression between 2005 and 2016 in the Danish National Patient Registry was followed for electroconvulsive therapy and adverse outcomes. Associations between electroconvulsive therapy and outcomes were analysed using Cox regression. Results: A total of 5004 (5.4%) patients were treated with electroconvulsive therapy. Depression severity was the strongest predictor of electroconvulsive therapy. Electroconvulsive therapy was used more frequently above age 70, in those better educated or married, whereas comorbid alcohol abuse or history of prior stroke at study entry were associated with lower rates. Electroconvulsive therapy was associated with lower mortality. The adjusted hazard ratio for the association between electroconvulsive therapy and suicide in patients with mild depression was 6.99 (3.30–14.43), whereas it was 1.10 (0.55–2.20) in those with severe depression and psychotic symptoms. A similar pattern was seen for emergency contacts and attempted suicide. Conclusions: Electroconvulsive therapy was associated with lower all-cause mortality and the relative risk for re-hospitalization and attempted and committed suicide was lowest in patients with the most severe depression. Electroconvulsive therapy is an important treatment, with significant public health benefits, for patients with severe depression.

Physical Health of Members of the Public Who Experienced Terrorist Bombings in London on 07 July 2005

2010 ◽  
Vol 25 (2) ◽  
pp. 139-144 ◽  
Author(s):  
Michael A. Catchpole ◽  
Oliver Morgan
Keyword(s):  
Physical Health ◽  
Health Effects ◽  
Response Rate ◽  
Long Term Effects ◽  
Health Symptoms ◽  
The Public ◽  
Number Of Patients ◽  
London Bombings

AbstractIntroduction:On 07 July 2005, four bombs were detonated in London, killing 52 members of the public. Approximately 700 individuals received treatment either at the scene or at nearby hospitals.Hypothesis/Problem:Significant concerns about the potential long-term psychological and physical health effects of exposure to the explosions were raised immediately after the bombings. To address these concerns, a public health register was established for the purpose of following-up with individuals exposed to the explosions.Methods:Invitations to enroll in the register were sent to individuals exposed to the explosions. A range of health, emergency, and humanitarian service records relating to the response to the explosions were used to identify eligible individuals. Follow-up was undertaken through self-administered questionnaires. The number of patients exposed to fumes, smoke, dust, and who experienced blood splashes, individuals who reported injuries, and the type and duration of health symptoms were calculated. Odds ratios of health symptoms by exposure for greater or less than 30 minutes were calculated.Results:A total of 784 eligible individuals were identified, of whom, 258 (33%) agreed to participate in the register, and 173 (22%) returned completed questionnaires between 8 to 23 months after the explosions. The majority of individuals reported exposure to fumes, smoke, or dust, while more than two-fifths also reported exposure to blood. In addition to cuts and puncture wounds, the most frequent injury was ear damage. Most individuals experienced health symptoms for less than four weeks, with the exception of hearing problems, which lasted longer. Four-fifths of individuals felt that they had suffered emotional distress and half of them were receiving counseling.Conclusions:The results indicated that the main long-term health effects, apart from those associated with traumatic amputations, were hearing loss and psychological disorders. While these findings provide a degree of reassurance of the absence of long-term effects, the low response rate limits the extent to which this can be extrapolated to all those exposed to the bombings. Given the importance of immediate assessment of the range and type of exposure and injury in incidents such as the London bombings, and the difficulties in contacting individuals after the immediate response phase, there is need to develop better systems for identifying and enrolling exposed individuals into post-incident health monitoring.

scholarly journals Long-term mortality predictors in pulmonary embolism

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
R Caldeira Da Rocha ◽  
R Fernandes ◽  
M Carrington ◽  
F Claudio ◽  
J Pais ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Troponin I ◽  
Cox Regression ◽  
Imaging Features ◽  
All Cause Mortality ◽  
History Of ◽  
Acute Pe ◽  
Long Term Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute Pulmonary embolism(PE)is a common and potentially fatal medical condition.In contemporary adult population,PE is associated with increased long-term mortality. Purpose Identify predictors of long-term all-cause mortality in patients(pts)admitted due to pulmonary embolism. Methods Retrospective single-center study of hospitalized pts with acute PE between 2015 and 2018.We evaluated comorbidities, admission(AD)presentation such as vitals(with hypotension defined as systolic blood pressure(SBP)&lt;90mmHg,and tachycardia as &gt;100ppm),lab analyses during in-hospital period,imaging features. Mortality(long-term &gt;3months)was also assessed using national registry of citizens.We performed uni and multivariate analysis to compare clinical characteristics of pts who died and who survived,using Cox regression and Kaplan-Meier methods.For the predictor age we assessed discrimination power and defined the best cut-off using area under the ROC curve(AUC)method. Results From 2015 to 2018,182 pts were admitted with diagnosis of pulmonary embolism,60% female with a mean age of 74 ± 13years old.Seventy-one(39%)pts died after a median follow-up of 26[10-41]months.Pts who died were older(80 ± 8 vs71 ± 14,p &lt; 0.001).The best cut-off value of age to predict mortality with 70%sensitivity and 61%specificity was 77years old(AUC 0.703;CI95% 0.63-0.78).Pts who died had more frequently history of neoplasia (21%vs 9%,p = 0.009).The remaining comorbidities were similar in both groups.Pts who did not survive were more frequently hypotensive(28% vs 13%, p = 0.008),had higher creatinine(1.1[0.8-1.4] vs 1.0[0.8-1.2], p = 0.002), lactate(2.3[1.8-2.8]vs 1.8[1.5-2.0],p = 0.007)and NT-proBNP(4694[1498-12300]vs2070[492-6660], p &lt; 0.001)at AD.Maximum troponin I (0.176[0.037-0.727]vs0.126[0.050-0.365]ng/mL,p = 0.012) was also higher than in pts who survived. After adjusting for history of neoplasia,ADcreatinine and maximum troponin I,we found that age (HR1.057;95%CI 1.01-1.11,p = 0.021),AD SBP &lt; 90(HR 2.215;95%CI 1.03-4.76,p = 0.041),lactate(HR 1.17;95%CI 1.01-1.36,p = 0.035)and NT-proBNP(HR 1.510;95%CI 1.250-1.780,p &lt; 0.001)were independent predictors of all-cause mortality. Conclusion In our cohort,the long-term all-cause mortality was 39%over a median  follow-up of 26[10-41]months.In patients with pulmonary embolism,aside from already identified age(especially when ≥70 years old)and NT-proBNP,lactate should also be considered when evaluating long-term prognosis. Furthermore,hypotension at admission increases by 2fold long-term mortality in patients who suffered acute PE.

scholarly journals Risk of hypersensitivity pneumonitis and interstitial lung diseases among pigeon breeders

2016 ◽  
Vol 48 (3) ◽  
pp. 818-825 ◽  
Author(s):  
Christine Cramer ◽  
Vivi Schlünssen ◽  
Elisabeth Bendstrup ◽  
Zara Ann Stokholm ◽  
Jesper Medom Vestergaard ◽  
...  
Keyword(s):  
Lung Diseases ◽  
Hypersensitivity Pneumonitis ◽  
Cox Regression ◽  
Interstitial Lung Diseases ◽  
Protective Measures ◽  
National Patient Registry ◽  
Hazard Ratios ◽  
Increased Risk ◽  
National Patient

We studied the risk of hypersensitivity pneumonitis and other interstitial lung diseases (ILDs) among pigeon breeders.This is a retrospective follow-up study from 1980 to 2013 of 6920 pigeon breeders identified in the records of the Danish Racing Pigeon Association. They were compared with 276 800 individually matched referents randomly drawn from the Danish population. Hospital based diagnoses of hypersensitivity pneumonitis and other ILDs were identified in the National Patient Registry 1977–2013. Stratified Cox regression analyses estimated the hazard ratios (HR) of hypersensitivity pneumonitis and other ILDs adjusted for occupation, residence and redeemed prescription of medication with ILDs as a possible side-effect. Subjects were censored at death, emigration or a diagnosis of connective tissue disease.The overall incidence rate of ILD was 77.4 per 100 000 person-years among the pigeon breeders and 50.0 among the referents. This difference corresponded to an adjusted HR of 1.56 (95% CI 1.26–1.94). The adjusted HRs of hypersensitivity pneumonitis and other ILDs for pigeon breeders were 14.36 (95% CI 8.10–25.44) and 1.33 (95% CI 1.05–1.69), respectively.This study shows an increased risk of ILD among pigeon breeders compared with the referent population. Protective measures are recommended even though ILD leading to hospital contact remains rare among pigeon breeders.

Effects of carotid artery stenosis treatment on blood pressure

2012 ◽  
Vol 117 (4) ◽  
pp. 755-760 ◽  
Author(s):  
Joonho Chung ◽  
Byung Moon Kim ◽  
Ho Kyu Paik ◽  
Dong-Keun Hyun ◽  
Hyeonseon Park
Keyword(s):  
Blood Pressure ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Artery Stenosis ◽  
Percentage Change ◽  
Long Term Effects ◽  
Number Of Patients

Object The purpose of this study was to evaluate and compare the long-term effects of carotid endarterectomy (CEA) and carotid artery stenting (CAS) on blood pressure (BP). Methods Between January 2003 and December 2009, 134 patients underwent 145 procedures for treatment of carotid artery stenosis. Patients with at least 1 year of clinical and radiographic follow-up after treatment were included in this study. A total of 102 patients met this criterion and were placed in the CEA group (n = 59) or the CAS group (n = 43) according to their treatment. The percentage change in BP decrement and the number of patients with a normotensive BP were evaluated and compared between the groups. Results There were no significant differences between the groups with regard to baseline characteristics. Compared with the pretreatment BP, the follow-up BPs were significantly decreased in both groups. At the 1-year followup, the percentage change in the BP decrement was greater in the CAS group (percentage change: systolic BP 9.6% and diastolic BP 12.8%) than in the CEA group (percentage change: systolic BP 5.9% [p = 0.035] and diastolic BP = 8.1% [p = 0.049]), and there were more patients with a normotensive BP in the CAS group (46.5%) than in the CEA group (22.0%, p = 0.012). Conclusions Both CEA and CAS have BP-lowering effects. Carotid artery stenting seems to have a better effect than CEA on BP at the 1-year follow-up.

scholarly journals Medication safety in pregnancy – Results from the MoBa study

2014 ◽  
Vol 24 (1-2) ◽  
Author(s):  
Hedvig Nordeng ◽  
Eivind Ystrom ◽  
Malin Eberhard-Gran
Keyword(s):  
Medication Safety ◽  
Comparison Group ◽  
Over The Counter ◽  
National Patient Registry ◽  
Mother And Child ◽  
National Patient ◽  
Long Term Follow Up ◽  
In Pregnancy

This article summarizes the results of several of our studies on medication safety in pregnancy based on the Norwegian Mother and Child Cohort Study (MoBa). Medications investigated include antidepressants, NSAIDs, codeine, triptans, paracetamol and certain herbals. A major advantage of these studies is that MoBa has information on prescribed medications, over-the-counter medications and herbal medications. Moreover, MoBa enables the possibility of including a disease comparison group, and long-term follow-up into childhood. The size of MoBa enables designs like the sibling-design, which offers important advantages over studies comparing unrelated individuals. The possibility of linking MoBa to nationwide registries like the NorPD and the National Patient Registry enables validation of medication exposures and childhood diagnosis. Pharmacoepidemiological studies are vital to our understanding of the safety of medications in pregnancy, but great care must be taken in the analysis and interpretation of observational data to avoid problems of confounding and bias.

scholarly journals Persistent Symptoms in Post-COVID-19 Patients Attending Follow-Up OPD at Sukraraj Tropical and Infectious Disease Hospital (STIDH), Kathmandu, Nepal

2021 ◽  
Vol 6 (3) ◽  
pp. 113
Author(s):  
Anup Bastola ◽  
Richa Nepal ◽  
Bikesh Shrestha ◽  
Kijan Maharjan ◽  
Sanjay Shrestha ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Care Hospital ◽  
Long Term Effects ◽  
Persistent Symptoms ◽  
History Of ◽  
Polymerase Chain ◽  
Disease Hospital ◽  
Time Of Presentation

The long-term effects of COVID-19 among survivors is a matter of concern. This research aimed to study persistent symptoms in post-COVID-19 patients attending a follow-up clinic at a tertiary care hospital in Nepal. All patients, presenting to the outpatient clinic during the study duration of six weeks, with history of positive reverse transcriptase- polymerase chain reaction for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) at least two weeks prior to presentation, were included. The duration of follow-up ranged from 15 till 150 days with the mean duration of 28 days after diagnosis of COVID-19. Of 118 patients, 43 (36.4%) had a history of mild COVID-19, 15 (12.8%) had moderate, and 60 (50.8%) had severe. At the time of presentation, 97 (82.2%) patients reported that they had at least one persistent/new symptom beyond two weeks from the diagnosis of COVID-19. Dyspnea, fatigue, chest heaviness, and cough were the commonest persistent complaints in 48 (40.7%), 39 (33.1%), 33 (28%), and 32 (27.1%) patients, respectively. The findings in our study highlight the need for extended monitoring of post-COVID-19 patients following discharge, in order to understand and mitigate long-term implications of the disease.

scholarly journals Differences in long-term all-cause and cardiovascular mortality according to heart failure aetiology in ambulatory patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Spitaleri ◽  
G Cediel ◽  
E Santiago-Vacas ◽  
P Codina ◽  
M Domingo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Mortality ◽  
Lower Risk ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Real Life ◽  
Cardiovascular Death ◽  
Number Of Patients

Abstract Background Heart failure (HF) is the final stage of many cardiac disorders. Mortality in heart HF remains challenging despite improvement in outcomes proved in clinical trials in HF with reduced ejection fraction and it can be influenced by the aetiology of HF. Purpose To assess differences in long-term mortality (up to 18 years) in a real-life cohort of HF outpatients according to the aetiology of HF. Methods Consecutive patients with HF admitted at the HF Clinic from August 2001 to September 2019 were included. Follow-up was closed at 30.9.2020. HF aetiology was divided into ischemic heart disease (IHD), dilated cardiomyopathy (CM) –including non-compaction CM–, hypertensive CM, alcohol-derived CM, drug-derived CM, valvular disease, hypertrophic CM and others. For the present analysis, this latter group was excluded due to the big heterogeneity and limited number of patients in each subtype of aetiology. All-cause death and cardiovascular death were the primary end-points. Fine & Gray method for competing risk was used for cardiovascular mortality analysis. Results Out of 2387 patients included (age 66.5±12.5 years, 71.3% men, LVEF 35.4%±14.2, mainly in NYHA class II [65.5%] and III [26.5%]), 1317 deaths were recorded (731 from cardiovascular cause) during a maximum follow-up of 18 years (median 4.1 years [IQR 2–7.8] for the total cohort, 5.3 years [IQR 2.6–9.7] for survivors). Figure 1 shows Cox regression multivariable analysis for all-cause death and cardiovascular mortality. Considering IHD aetiology as reference, only dilated CM showed significantly lower risk of all-cause death, and only drug-induced CM showed higher risk of all-cause death. However, when cardiovascular mortality was considered almost all aetiologies showed significant lower risk of cardiovascular death than IHD. Figure 2 shows adjusted survival curves (A) and adjusted incidence curves of cardiovascular death (B) based on HF aetiology. Conclusions After adjusting for multiple prognostic factors among the studied HF aetiologies, dilated CM and drug-related CM showed the lowest and the highest risk of all-cause death, respectively. Patients with IHD showed the highest adjusted risk of cardiovascular death. FUNDunding Acknowledgement Type of funding sources: None.

B-36 Effects of Electroconvulsive Therapy on Cognitive Performance and Depressive Symptoms: A Naturalistic Study

2019 ◽  
Vol 34 (6) ◽  
pp. 982-982
Author(s):  
S Goegan ◽  
G Hasey ◽  
E Ballantyne ◽  
E MacKillop ◽  
J King ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Performance ◽  
Electroconvulsive Therapy ◽  
Long Term Effects ◽  
Subjective Memory ◽  
Neuropsychological Status ◽  
Naturalistic Setting ◽  
Short And Long Term

Abstract Objective 1) Examine the short- and long-term effects of electroconvulsive therapy (ECT)—conducted in a naturalistic treatment setting—on objective and subjective cognitive functioning. 2) Examine the long-term effects of naturalistic ECT on depressive symptoms. Method Participants (N = 108) were outpatients (aged 18-65) diagnosed with a Major Depressive Episode who received ECT at St. Joseph’s Healthcare Hamilton, Ontario. Parameters of ECT varied clinically. Participants completed a cognitive and psychological test battery at baseline (n = 108), mid-treatment (n = 82), 2–6-weeks post-ECT (n = 52), 6-months post-ECT (n = 24), and 12-months post-ECT (n = 14) that included Repeatable Battery for Assessment of Neuropsychological Status (RBANS), Squire Subjective Memory Questionnaire (SSMQ), Beck Depression Inventory-II (BDI-II), and WHO Disability Assessment Schedule (WHODAS-2). Results Overall cognitive performance (total RBANS scaled scores) did not improve from baseline to 2-6 weeks post-ECT (p = 0.156), significantly improved from baseline to 6-months post-ECT (t(22) = -2.34, p = .026, CI: = -8.93– -0.63), but were not maintained at 12-months post-ECT (p = 0.20). SSMQ scores significantly worsened from baseline to mid-ECT (t(75) = -5.04, p < .001, CI: -17.53– -7.60), but returned to baseline levels by 2–6-weeks post-ECT. Depressive symptoms (BDI-II) significantly improved by the 4th ECT session and gains were maintained across all timepoints (p < 0.004). WHODAS-2 scores significantly improved from baseline and were maintained across follow-up (t < 0.05). Conclusion ECT was effective at improving depressive symptoms in a naturalistic setting with diverse patient presentations. Preliminary findings show minimal, if any, gains in cognitive performance–although, functioning did not appear to worsen following ECT. RBANS may not be sufficiently sensitive. Developing recommendations for conducting and evaluating ECT in naturalistic settings marks an essential next step.

Idiopathic precocious puberty in girls: Long-term effects on adolescent behavior

1986 ◽  
Vol 113 (4_Suppl) ◽  
pp. S247-S253 ◽  
Author(s):  
ANKE A. EHRHARDT ◽  
HEINO F.L. MEYER-BAHLBURG
Keyword(s):  
Precocious Puberty ◽  
Spatial Perception ◽  
School Achievement ◽  
Long Term Effects ◽  
Normal Range ◽  
Cognitive Pattern ◽  
History Of ◽  
Psychiatric Sequelae

ABSTRACT Precocious puberty in girls has endocrinological as well as behavioral implications. We present data from a first systematic controlled follow-up study of 16 adolescent girls with a history of idiopathic precocious puberty (IPP) compared to closely pairmatched adolescent control subjects of comparable pubertal status and normal pubertal history. Findings in four areas of behavior are reported: (1) Psychiatric sequelae: the IPP sample showed an increase in minor psychopathological symptoms. (2) Psychosexual development: The IPP sample was advanced in sociosexual milestones, albeit mostly within the normal range for adolescents. (3) Intelligence: IQ was not different from controls. However, school achievement was accelerated during childhood. (4) Cognitive pattern: The IPP sample had lower spatial perception scores than controls.

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