Low-level lithium in drinking water and subsequent risk of dementia: Cohort study.

BACKGROUND: Lithium, a mood stabilizer, is known to exhibit neuroprotective effects in animal models and may have anti-dementia effects. AIMS: We used data from Scottish Mental Survey 1932, a population-based cohort study, to investigate the association between lithium in drinking water and dementia rate in humans. METHOD: Lithium levels in drinking water from 285 sampling sites across Scotland dating from 2014 were obtained from the sole public water provider (Scottish Water). Dementia and non dementia cases were identified from cohort data by electronic health records until 2012, and linked to postcode. RESULTS: The mean lithium level at all sampling sites was 1.45 µg/L (SD 1.83, range 0.5-18.2) and was 1.26 (SD 0.63, range 0.55-9.19) for sites matched to participant data. Of 37,597 study members, 3605 developed dementia until June 2012. Lithium levels were positively associated with the risk of dementia in women (highest in second quartile, HR 1.17, 95%CI 1.04-1.32), but there was no relationship in men (highest in second quartile, HR 0.95, 95% CI 0.81-1.12). The pattern of association was explored further by decile, and in females there was an association between lithium level and increased dementia risk compared to the lowest decile (0.55-0.68 µg/L) in all deciles except the highest, corresponding with lithium levels 0.68-2.1 µg/L. CONCLUSIONS: Lithium levels in drinking water are very low across Scotland which limited detection of potential effect. Our results do not support an association between extremely low levels of lithium and later dementia risk. We found a trend to increased risk in females at lithium levels below but not above 2.1 µg/L.

Aluminium and fluoride in drinking water in relation to later dementia risk.

BACKGROUND: Environmental risk factors for dementia are poorly understood. Aluminium and fluorine in drinking water have been linked with dementia but uncertainties remain about this relationship. AIMS: In the largest longitudinal study in this context, we set out to explore the individual effect of aluminium and fluoride in drinking water on dementia risk and, as fluorine can increase absorption of aluminium, we also examine any synergistic influence on dementia. METHOD: We used Cox models to investigate the association between mean aluminium and fluoride levels in drinking water at their residential location (collected 2005-2012 by the Drinking Water Quality Regulator for Scotland) with dementia in members of the Scottish Mental Survey 1932 cohort who were alive in 2005. RESULTS: A total of 1972 out of 6990 individuals developed dementia by the linkage date in 2012. Dementia risk was raised with increasing mean aluminium levels in women (hazard ratio per s.d. increase 1.09, 95% CI 1.03-1.15, P < 0.001) and men (1.12, 95% CI 1.03-1.21, P = 0.004). A dose-response pattern of association was observed between mean fluoride levels and dementia in women (1.34, 95% CI 1.28-1.41, P < 0.001) and men (1.30, 95% CI 1.22-1.39, P < 0.001), with dementia risk more than doubled in the highest quartile compared with the lowest. There was no statistical interaction between aluminium and fluoride levels in relation with dementia. CONCLUSIONS: Higher levels of aluminium and fluoride were related to dementia risk in a population of men and women who consumed relatively low drinking-water levels of both.

Key Tenets of Classical Buddhist Dharma Leave Space for the Practice of Abortion and are Upheld by Contemporary Japanese Buddhist Mizuko Kuyo Remembrance Rituals.

Core Buddhist principles of continuity, karmic assignment, and emphasis on separation of mind from body, permit, though do not expressly advocate for, the practice of abortion. Further, in certain contemporary contexts, Buddhist practices exist to mitigate the suffering experienced by women who have lost an unborn child, whether through abortion or miscarriage. In modern-day Japan for example, many Buddhists practice mizuko kuyo, a set of formal remembrance rituals, which provides structured support to families in their efforts to mourn, to remember the departed, and to celebrate the redirection of human potential. This contemporary practice is consistent with aforementioned tenets of early Buddhist thought. Although seemingly oxymoronic, the Buddhist view of abortion and the mizuko kuyo rituals are human-centric, not only for the families but also for the redirected. Other societies, cultures, and theological perspectives have and may further benefit from reframing any interpretation of abortion, not as an inherently moral or immoral act (i.e., a binary), but rather as an act overwhelmingly characterized by the complexity of human emotion in the face of unimaginable loss. This humanistic conceptualization of abortion is manifested by the modern Buddhist practice of mizuko kuyo.

Childhood Cognitive Ability and Incident Dementia: The 1932 Scottish Mental Survey Cohort into their 10th Decade.

BACKGROUND: The prevention of dementia is a global priority but its etiology is poorly understood. Early life cognitive ability has been linked to subsequent dementia risk but studies to date have been small and none has examined sex differences. METHODS: In the 1932 Scottish Mental Survey cohort, we related intelligence test scores at age 11 years in 16,370 boys and 16,097 girls (born in 1921) to incident dementia ages ≥65 years as ascertained using probabilistic linkage to electronic health records up to the age of 92 years (1,231 cases in men, 2,163 in women; median follow-up 15 years). RESULTS: Compared with the highest intelligence group (IQ ≥115), dementia risk was raised in the lowest-scoring category (<85) and these associations were stronger for women (hazard ratio; 95% confidence interval: 1.51; 1.29, 1.76) than men (1.19; 0.98, 1.44; P value for interaction by gender: 0.054). There was evidence of a dose-response association between childhood IQ and dementia in women (IQ 100-114.9 compared with ≥115: 1.18; 1.03, 1.34; IQ 85-99.9: 1.32; 1.15, 1.51; P value for trend <0.001) but not in men (1.05; 0.89, 1.24 and 1.01; 0.85, 1.21; 0.44). CONCLUSIONS: Childhood intelligence is related to subsequent dementia risk but this association is not the same in men and women. See video abstract at, http://links.lww.com/EDE/B184.

Geographical variation in dementia: examining the role of environmental factors in Sweden and Scotland.

BACKGROUND: This study aimed to estimate the magnitude of geographical variation in dementia rates and suggest explanations for this variation. Small-area studies are scarce, and none has adequately investigated the relative contribution of genetic and environmental factors to the distribution of dementia. METHODS: We present 2 complementary small-area hierarchical Bayesian disease-mapping studies using the comprehensive Swedish Twin Registry (n = 27,680) and the 1932 Scottish Mental Survey cohort (n = 37,597). The twin study allowed us to examine the effect of unshared environmental factors. The Scottish Mental Survey study allowed us to examine various epochs in the life course-approximately age 11 years and adulthood. RESULTS: We found a 2- to 3-fold geographical variation in dementia odds in Sweden, after twin random effects-likely to capture genetic and shared environmental variance-were removed. In Scotland, we found no variation in dementia odds in childhood but substantial variation, following a broadly similar pattern to Sweden, by adulthood. CONCLUSIONS: There is geographical variation in dementia rates. Most of this variation is likely to result from unshared environmental factors that have their effect in adolescence or later. Further work is required to confirm these findings and identify any potentially modifiable socioenvironmental risk factors for dementia responsible for this geographical variation in risk. However, if these factors do exist and could be optimized in the whole population, our results suggest that dementia rates could be halved.

Hint, hint: theory of mind performance in schizotypal individuals.

Studying Theory of Mind (ToM) performance in nonclinical populations may assist our understanding of underlying cognitive processes and contributing factors. ToM was assessed in three groups of psychometrically identified schizotypes, namely, individuals elevated on scales assessing positive schizotypy, those elevated on scales assessing negative schizotypy, and those elevated on both positive and negative schizotypy scales, using two hinting tasks. Individuals characterized by positive schizotypy showed poorer ToM performance compared with controls. The results suggest that individuals with elevated positive schizotypy scores experience more difficulty inferring the meaning of others' mental states (i.e., intentions) via indirect speech, such as hints. The negative schizotypy group did not differ from the nonschizotypy group in ToM performance. These findings are considered in terms of cognitive processing styles and implications for possible intervention. They also provide support for the inclusion of multiple groups of schizotypal individuals when assessing social cognition.

Bisexual desire and familism: Latino/a bisexual young men and women in New York City.

Families are of critical importance for Latino communities in the USA. Familism - or the cultural value that weighs on interdependence between nuclear and extended family members for support, emotional connectedness, familial honour, loyalty and solidarity - has been demonstrated to reduce sexual health risks among heterosexual youth, yet this relationship has not been examined among Latino bisexual teenagers. In this study, we examined how familism shapes sexual-decision making regarding behaviour and expressions of bisexuality among Latino youth. To accomplish this, we conducted 25 in-depth interviews and ethnographic observations among bisexual male and female youth (15-19 years of age) for nine months in New York City. We carried out a recurrent theme analysis together with the selection of case studies to illustrate key themes regarding familism and Latino teenage bisexuality. Findings suggest that bisexual Latino youth valued closeness to their families by maintaining family ties and seeking their emotional and material support. The negative consequence for those who wanted to keep their bisexuality private is the constant surveillance of the family network. Familism is a complex construct that has a strong potential for providing insights into sexual health practices of bisexual Latino youth.

Appropriateness of unscheduled hospital admissions from care homes.

Unscheduled hospital admissions from care homes are common and potentially avoidable but little guidance is available as to what constitutes an appropriate hospital admission. We surveyed healthcare professionals' opinions on a range of common scenarios affecting care-home residents. We developed seven clinical vignettes and an accompanying questionnaire. We used purposive sampling to obtain opinions from relevant primary care and secondary care teams. We asked assessors to comment on whether they would favour hospital admission and to justify their response using pre-selected options and/or free text. Admission to hospital was judged inappropriate in 54.6% of responses. Opinion on admission varied according to the case, with fewer than half of respondents agreeing for three of the seven cases. Recurring themes were uncertainty around services available to care homes and anticipatory care planning. The lack of consensus suggests that concepts surrounding inappropriate care-home admission are not shared by staff who provide care for this patient group.