A high fat to vitamin E ratio in the feed protects and improves uptake of the natural form of vitamin E in postweaning calves.

In postweaning calves, it is a challenge to maintain the plasma vitamin E level at or above the recommended level (3 µg/mL), which is linked to a good immune response. It has been unclear until now why the provision of solid feed with concentrations below 200 mg/kg feed of vitamin E is ineffective in maintaining the plasma vitamin E level of calves above the recommended plasma level postweaning. The present study was conducted to investigate if a high fat to vitamin E ratio in the concentrate could protect and improve the delivery of the natural form of vitamin E (RRR-α-tocopherol) to calves postweaning. Thirty calves were included in the experiment from 2 weeks preweaning until 2 weeks postweaning (Weeks -2, -1, 0 [weaning], 1, and 2 relative to weaning) and fed one of three concentrates in which lecithin mixture provided the fat supplement: control (77 mg/kg of vitamin E and 4.9% DM of crude fat; CONT), medium level of vitamin E supplemented (147 mg/kg of vitamin E and 7.7% DM of crude fat; MedVE) or high level of vitamin E supplemented (238 mg/kg of vitamin E and 12.4% DM of fat; HiVE). Thus, there was a comparable ratio of fat to vitamin E (520-630) in the three concentrates. During the 2 weeks postweaning, final body weight (92 ± 2 kg), average daily gain (917 ± 51 g/day) and concentrate intake (2.2 ± 0.09 kg/day; mean of treatment ± standard error) were unaffected by treatment and the interaction between treatment and week. There was an interaction between treatment and week for vitamin E intake pre- (p < 0.001) and postweaning (p < 0.001). There was an interaction between treatment and week (p < 0.001) for plasma vitamin E level postweaning, and it was 2.5, 3.1, and 3.8 µg/mL in CONT, MedVE, and HiVE, respectively, at Week 1 postweaning. In addition, plasma vitamin E levels at Week 2 postweaning were 2.6, 3.6 and 4.8 µg/mL in CONT, MidVE and HiVE respectively. The results show that 147 mg/kg of lecithin-protected vitamin E in the concentrate is needed to secure a plasma vitamin E level well above the recommended level. In addition, lecithin-protected vitamin E elevated the plasma level of triglycerides and nonesterified fatty acids.

Chronic care services and variation between Danish general practices: a nationwide cohort study.

BACKGROUND: Little is known about variations in the provision of chronic care services in primary care. AIM: To describe the frequency of chronic care services provided by GPs and analyse the extent of non-random variation in service provision. DESIGN AND SETTING: Nationwide cohort study undertaken in Denmark using data from 2016. METHOD: Information on chronic care services was obtained from national health registers, including annual chronic care consultations, chronic care procedures, outreach home visits, and talk therapy. The associations between services provided, patient morbidity, and socioeconomic factors were estimated. Service variations were analysed, and excess variation related to practice-specific factors was estimated while accounting for random variation. RESULTS: Chronic care provision was associated with increasing patient age, increasing number of long-term conditions, and indicators of low socioeconomic status. Variation across practices ranged from 1.4 to 128 times more than expected after adjusting for differences in patient population and random variation. Variation related to practice-specific factors was present for all the chronic care services that were investigated. Older patients with lower socioeconomic status and multimorbidity were clustered in practices with low propensity to provide certain chronic care services. CONCLUSION: Chronic care was provided to patients typically in need of health care, that is, older adults, those with multimorbidity, and those with low socioeconomic status, but service provision varied more than expected across practices. GPs provided slightly fewer chronic care services than expected in practices where many patients with multimorbidity and low socioeconomic status were clustered, suggesting inverse care law mechanisms.

Invited review: Freedom from thirst-Do dairy cows and calves have sufficient access to drinking water?

The importance of drinking water for production and animal welfare is widely recognized, but surveys and animal welfare assessment schemes suggest that many dairy calves and dairy cows do not have sufficient access. Limit milk-fed calves drink more water than calves fed milk ad libitum, but ad libitum milk-fed calves also require access to drinking water, as milk does not meet the animal's requirement for water. At hot ambient temperatures and when calves are sick, access to water is especially important and should be provided at all times. Many young calves do not have access to water throughout 24 h, and whether healthy young calves require free access to water at all times, or from which age, is not clear and requires further study. Dairy cow free water intake (FWI) is largely determined by milk yield, and high-yielding dairy cows may drink up 100 L of water per day. Dry matter, crude protein, and salt content of feed, as well as ambient temperature, have considerable effects on dairy cow water intake. Deprivation of water affects meal patterning for the cow, as well as increased subsequent rate of drinking and compensatory water intake. Although dairy cow ad libitum water intake may exceed the water provision necessary to maintain production, offering water for ad libitum intake may be necessary to safe guard animal welfare. Cattle are suction drinkers that prefer to drink from large open water surfaces, and Holstein dairy cows can drink at a rate of up to 24 L/min. Research on the effect of design and placement of water troughs for indoor-housed dairy cows on their drinking behavior and water intake is limited. Access to a water source at pasture increases the time cows spend there, and access to shade reduces water requirements during periods of warm weather. In both indoor and pastured cattle, there is a lack of knowledge about the effect of stocking of water troughs on competition, drinking behavior, and intake in dairy cows. Studies on the effect of available water trough length and placement, and of the number of cows being able to drink from the same trough of a given dimension, are needed to evaluate current recommendations.

Associations of Lifestyle and Anthropometric Factors With the Risk of Herpes Zoster: A Nationwide Population-Based Cohort Study.

The role of lifestyle in development of herpes zoster remains unclear. We examined whether smoking status, alcohol consumption, body mass index, or physical activity were associated with zoster risk. We followed a population-based cohort of 101,894 respondents to the 2010 Danish National Health Survey (baseline, May 1, 2010) until zoster diagnosis, death, emigration, or July 1, 2014, whichever occurred first. We computed hazard ratios for zoster associated with each exposure, using Cox regression with age as the time scale and adjusting for potential confounders. Compared with never smokers, hazards for zoster were increased in former smokers (1.17, 95% confidence interval (CI): 1.06, 1.30), but not in current smokers (1.00, 95% CI: 0.89, 1.13). Compared with low-risk alcohol consumption, neither intermediate-risk (0.95, 95% CI: 0.84, 1.07) nor high-risk alcohol consumption (0.99, 95% CI: 0.85, 1.15) was associated with zoster. We also found no increased hazard associated with weekly binge drinking versus not (0.93, 95% CI: 0.77, 1.11). Risk of zoster varied little by body mass index (referent = normal weight) and physical activity levels (referent = light level), with hazard ratios between 0.96 and 1.08. We observed no dose-response association between the exposures and zoster. The examined lifestyle and anthropometric factors thus were not risk factors for zoster.

Advanced Access scheduling in general practice and use of primary care: a Danish population-based matched cohort study.

BACKGROUND: Advanced access scheduling (AAS) allows patients to receive care from their GP at the time chosen by the patient. AAS has shown to increase the accessibility to general practice, but little is known about how AAS implementation affects the use of in-hours and out-of-hours (OOH) services. AIM: To describe the impact of AAS on the use of in-hours and OOH services in primary care. DESIGN & SETTING: A population-based matched cohort study using Danish register data. METHOD: A total of 161 901 patients listed in 33 general practices with AAS were matched with 287 837 reference patients listed in 66 reference practices without AAS. Outcomes of interest were use of daytime face-to-face consultations, and use of OOH face-to-face and phone consultations in a 2-year period preceding and following AAS implementation. RESULTS: No significant differences were seen between AAS practices and reference practices. During the year following AAS implementation, the number of daytime face-to-face consultations was 3% (adjusted incidence rate ratio [aIRR] = 1.03; 95% confidence interval [CI] = 0.99 to 1.07) higher in the AAS practices compared with the number in the reference practices. Patients listed with an AAS practice had 2% (aIRR = 0.98; 95% CI = 0.92 to 1.04) fewer OOH phone consultations and 6% (aIRR = 0.94; 95% CI = 0.86 to 1.02) fewer OOH face-to-face consultations compared with patients listed with a reference practice. CONCLUSION: This study showed no significant differences following AAS implementation. However, a trend was seen towards slightly higher use of daytime primary care and lower use of OOH primary care.

The effect of milk feeding strategy and restriction of meal patterning on behavior, solid feed intake, and growth performance of male dairy calves fed via computer-controlled milk feeders.

Dairy calves are often offered milk allowance at a flat rate during the first 6 wk of life, although an initial high allowance followed by a stepwise reduction (step-down strategy) may correspond better to the calves' nutritional needs. The amount of milk offered per feeding is typically constant. However, during natural suckling, the daily number of milk meals (suckling frequency) declines with age, which may reflect increased consumption of solid feeds. Thus, allowing calves to pattern their meals on a computer-controlled feeder by placing less restriction on meal frequency may stimulate dairy calves' ingestion of solid feeds. This experiment investigated the effects of milk feeding strategy and milk feeding frequency on calves' feeding behavior, intake, and growth. Sixty-four male Holstein Friesian calves, purchased from conventional dairy farms, were housed in groups of 8 and fed milk replacer (MR) via computer-controlled milk feeders. From 14 d old, calves were assigned to either a conventional flat-rate milk allowance (CON: 6.5 L/d of MR from d 14 to 42; 4 L/d from d 43 to 49; 2 L/d from d 50 to 56 of age) or to stepwise reduction in milk allowance (STEP: 8 L/d of MR from d 14 to 28; 5 L/d from d 29 to 42; 4 L/d from d 43 to 49; 2 L/d from d 50 to 56 of age). Within each group of 8, 4 calves were randomly allocated to each of 2 milk feeding frequencies, either restricted portion size (RES: maximum milk portion size of 2.3 L/portion) or unrestricted portion size (UNRES). Concentrates, hay, and water were available ad libitum. Feeding behavior was recorded via video for 24 h on 26 and 40 d of age. On d 26, where STEP calves were offered 1.5 L/d more milk than CON calves, no difference was seen regarding the time spent eating concentrate (16.9 vs. 20.3 min/d). However, STEP calves spent more time eating concentrate on d 40, where these calves had 1.5 L/d less milk than CON (36.1 vs. 27.2 min/d). Thus, a lower daily milk allowance stimulated feeding on concentrate d 40, but not d 26. As predicted, UNRES calves spent more time eating concentrate (27.6 vs. 21.9 min/d) and more time eating hay (38.4 vs. 30.0 min/d) than RES calves. However, higher appetite for solid feeds by UNRES calves may not be explained by milk intake per se. Rather, this is likely due to their opportunity to have larger milk meals, which appeared to increase their appetite for milk (as indicated by longer time spent in the milk feeder; 64.0 vs. 48.8 min/d) as well as for solid feeds. Among CON calves, the UNRES treatment resulted in higher ADG 2 wk postweaning, but not among STEP calves. These findings partially support that relaxing restriction on milk portions helps calves to transition from milk to solid feeds before weaning off milk. However, more research is needed to determine how restriction on milk portions interacts with milk feeding strategy when a higher total milk allowance is offered.

Association between Mental Disorders and Subsequent Medical Conditions.

BACKGROUND: Persons with mental disorders are at a higher risk than the general population for the subsequent development of certain medical conditions. METHODS: We used a population-based cohort from Danish national registries that included data on more than 5.9 million persons born in Denmark from 1900 through 2015 and followed them from 2000 through 2016, for a total of 83.9 million person-years. We assessed 10 broad types of mental disorders and 9 broad categories of medical conditions (which encompassed 31 specific conditions). We used Cox regression models to calculate overall hazard ratios and time-dependent hazard ratios for pairs of mental disorders and medical conditions, after adjustment for age, sex, calendar time, and previous mental disorders. Absolute risks were estimated with the use of competing-risks survival analyses. RESULTS: A total of 698,874 of 5,940,299 persons (11.8%) were identified as having a mental disorder. The median age of the total population was 32.1 years at entry into the cohort and 48.7 years at the time of the last follow-up. Persons with a mental disorder had a higher risk than those without such disorders with respect to 76 of 90 pairs of mental disorders and medical conditions. The median hazard ratio for an association between a mental disorder and a medical condition was 1.37. The lowest hazard ratio was 0.82 for organic mental disorders and the broad category of cancer (95% confidence interval [CI], 0.80 to 0.84), and the highest was 3.62 for eating disorders and urogenital conditions (95% CI, 3.11 to 4.22). Several specific pairs showed a reduced risk (e.g., schizophrenia and musculoskeletal conditions). Risks varied according to the time since the diagnosis of a mental disorder. The absolute risk of a medical condition within 15 years after a mental disorder was diagnosed varied from 0.6% for a urogenital condition among persons with a developmental disorder to 54.1% for a circulatory disorder among those with an organic mental disorder. CONCLUSIONS: Most mental disorders were associated with an increased risk of a subsequent medical condition; hazard ratios ranged from 0.82 to 3.62 and varied according to the time since the diagnosis of the mental disorder. (Funded by the Danish National Research Foundation and others; COMO-GMC ClinicalTrials.gov number, NCT03847753.).

Statins and Risk of Intracerebral Hemorrhage in Individuals With a History of Stroke.

Background and Purpose- It has been suggested that statins increase the risk of intracerebral hemorrhage in individuals with a history of stroke, which has led to a precautionary principle of avoiding statins in patients with prior intracerebral hemorrhage. However, such prescribing reticence may be unfounded and potentially harmful when considering the well-established benefits of statins. This study is so far the largest to explore the statin-associated risk of intracerebral hemorrhage in individuals with prior stroke. Methods- We conducted a population-based, propensity score-matched cohort study using information from Danish national registers. We included all individuals initiating statin treatment after a first-time stroke diagnosis (intracerebral hemorrhage, N=2728 or ischemic stroke, N=52 964) during 2002 to 2016. For up to 10 years of follow-up, they were compared with a 1:5 propensity score-matched group of statin nonusers with the same type of first-time stroke. The difference between groups was measured by adjusted hazard ratios for intracerebral hemorrhage calculated by type of first-time stroke as a function of time since statin initiation. Results- Within the study period, 118 new intracerebral hemorrhages occurred among statin users with prior intracerebral hemorrhage and 319 new intracerebral hemorrhages in users with prior ischemic stroke. The risk of intracerebral hemorrhage was similar for statin users and nonusers when evaluated among those with prior intracerebral hemorrhage, and it was reduced by half in those with prior ischemic stroke. These findings were consistent over time since statin initiation and could not be explained by concomitant initiation of other medications, by dilution of treatment effect (due to changes in exposure status over time), or by healthy initiator bias. Conclusions- This large study found no evidence that statins increase the risk of intracerebral hemorrhage in individuals with prior stroke; perhaps the risk is even lower in the subgroup of individuals with prior ischemic stroke.

Risk of diabetic complications and subsequent mortality among individuals with schizophrenia and diabetes - a population-based register study.

BACKGROUND: Individuals with schizophrenia often develop diabetes, but little is known about their risk of diabetic complications. We aimed to study incidence of registered diabetic complications and subsequent mortality in individuals with schizophrenia and diabetes compared to individuals with diabetes only. METHODS: We conducted a cohort study using nationwide registers and followed all individuals in the entire Danish population diagnosed with diabetes from 1997 to 2017. Incidence rate ratios (IRR) of diabetic complications, all-cause and cause-specific mortality rate ratios (MRR) were estimated by Cox regression comparing individuals diagnosed with schizophrenia and diabetes to individuals diagnosed only with diabetes. RESULTS: In a cohort of 239,118 individuals with diagnosed diabetes, the incidence of any diabetic complication was similar in females with schizophrenia and diabetes compared to females with diabetes only; IRR = 0.93 (95%CI: 0.84-1.02), and significantly lower in males; IRR = 0.85 (95%CI: 0.78-0.92). The all-cause mortality for individuals with a diagnosis of a diabetic complication was higher in individuals with schizophrenia and diabetes than in those with diabetes only; MRR = 1.92 (95%CI: 1.65-2.23) for females and MRR = 1.69 (95%CI: 1.49-1.92) for males. Among those without diabetic complications, schizophrenia was also associated with a higher mortality. CONCLUSIONS: Individuals with schizophrenia and diabetes had similar or lower rates of diabetic complications, compared to those with diabetes only. Among those with diabetic complications, schizophrenia was associated with higher mortality. Similar, among those without diabetic complications, schizophrenia was also associated with higher mortality. Hence, diabetic complications do not seem to explain the excess mortality seen in individuals with schizophrenia.

Selective serotonin reuptake inhibitors and risk of epilepsy after traumatic brain injury - A population based cohort study.

OBJECTIVE: Traumatic brain injury (TBI) is common and associated with a marked increased risk of developing epilepsy. Animal studies indicate that treatment with selective serotonin reuptake inhibitors (SSRIs) may increase the risk of epilepsy after TBI. The aim of this study was to investigate whether use of SSRIs modifies the risk of epilepsy after TBI. METHODS: This was a cohort study of 205,715 persons, who suffered a TBI in Denmark from 1996 to 2013. For each person with TBI, we matched 10 reference persons (N = 2,057,150) who were alive on the day of TBI and who had the same age and gender but had no history of TBI. We used a stratified Cox regression to calculate the relative risk of epilepsy after TBI for persons exposed to TBI, SSRI or both after adjustment for income, civil status, medical and neurological comorbidities, severe mental disease, and substance abuse. RESULTS: The risk of epilepsy was 5.61 times higher for persons who used SSRI at time of TBI (adjusted Hazard Ratio (aHR): 5.61 (95% CI: 4.88; 6.45)), 3.23 times higher for persons who had a TBI but did not use SSRI at time of TBI (aHR: 3.23 (95% CI: 3.12;3.35)), and 1.31 times higher for persons who used SSRI but had no TBI (aHR: 1.31 (95% CI: 1.18; 1.45)) compared to persons unexposed to both TBI and SSRI. CONCLUSIONS: This large population based cohort study showed that people using SSRI at the time of a TBI had higher risk of developing epilepsy compared to people not using SSRI at the time of TBI. The results are in line with those of animal studies and calls for further studies to evaluate whether the association is due to SSRIs or to the underlying disease (e.g. depression or anxiety).

Statins and Risk of Intracerebral Haemorrhage in a Stroke-Free Population: A Nationwide Danish Propensity Score Matched Cohort Study.

BACKGROUND: Statins may increase the risk of intracerebral haemorrhage (ICH) in individuals with previous stroke. It remains unclear whether this applies to individuals with no history of stroke. This study is the first to explore the statin-associated risk of ICH in stroke-free individuals while considering the timing of statin initiation. METHODS: We conducted a population-based, propensity score matched cohort study using information from five Danish national registers. We included all stroke-free individuals initiating statins in 2004-2013 and a propensity score matched group of non-users. Adjusted hazard ratios (aHRs) for ICH risk among statin users compared to non-users were calculated as a function of time since statin initiation. FINDINGS: 519,894 stroke-free individuals initiating statins and their 1:5 matched stroke-free reference subjects were included and followed for up to ten years. During this period, 1409 ICHs occurred in statin users. Statin users had an overall aHR of 0.85 (95% confidence interval: 0.80-0.90) compared to non-users, but this risk was modified by time since statin initiation. Statin users and non-users had similar ICH risk during the first six months after statin initiation. Hereafter, statin users had a 22-35% lower risk throughout the study period. INTERPRETATION: Statin users had lower ICH risk than non-users from six months after statin initiation. This finding could not be explained by healthy initiator bias or differences between users and non-users in terms of sociodemographic characteristics, comorbidity, or parallel treatment regimens. Our study suggests that statin use in stroke-free populations is associated with reduced ICH risk. FUNDING: The Novo Nordisk Foundation.

Maternal bereavement shortly before or during pregnancy and risk of postpartum psychotic illness: a population-based study from Denmark and Sweden.

Purpose: Postpartum psychosis is a rare but severe complication following childbirth, with unknown etiology. This study investigated whether the death of a close family member - a source of severe stress - the year before or during pregnancy was associated with an increased risk of psychotic illness in the postpartum period among women without and with a history of psychiatric disorder. Methods: We studied live births in Denmark during 1978-2008 and births in Sweden during 1973-2006 (n=5,246,978). Information on death of women's relatives and partners and sociodemographic, health-, and pregnancy-related factors was obtained through linkage with nationwide registries. Results: The death of a close relative the year before or during pregnancy was not associated with psychotic illness during the first 90 days postpartum among women without (adjusted HR 1.02, 95% CI 0.76-1.37) or with a history of psychiatric disorder (HR 0.96, 95% CI 0.74-1.25). Similarly, there was no association between bereavement and risk of postpartum psychosis according to the timing of the loss (the year before or during pregnancy), the relative's cause of death (natural or unnatural), or the woman's relationship to the deceased (parent/sibling or partner/older child). Conclusions: Death of a close relative, one of the most severe sources of stress, before or during pregnancy was not associated with postpartum psychosis. Therefore, these data do not support the hypothesis that severely stressful life events, such as bereavement around the time of pregnancy, are associated with postpartum psychosis.

Premature mortality in persons with epilepsy and schizophrenia: A population-based nationwide cohort study.

OBJECTIVE: To determine the mortality for persons with epilepsy and schizophrenia by absolute and relative measures. METHODS: This is a population-based nationwide cohort study of persons born in Denmark from 1960 to 1987 who were alive and residing in Denmark on their 25th birthday. We identified persons diagnosed with epilepsy and schizophrenia prior to their 25th birthday and followed them to death, emigration, or December 31, 2012, whichever came first. The primary outcome was overall mortality. Data were analyzed using Cox regressions. RESULTS: Persons were followed for 24 167 573 person years; the median was 15 years. The mortality rate ratio was 4.4 (95% confidence interval [CI] = 4.1-4.7) for persons with epilepsy, 6.6 (95% CI = 6.1-7.1) for persons with schizophrenia, and 12.8 (95% CI = 9.1-18.1) for persons with both disorders, compared with persons without these disorders. The estimated cumulative mortality at the age of 50 years was 3.1% (95% CI = 3.0-3.1) for persons without epilepsy and schizophrenia, 10.7% (95% CI = 9.7-11.8) for persons with epilepsy, 17.4% (95% CI = 16.0-18.8) for persons with schizophrenia, and 27.2% (95% CI = 15.7-40.1) for persons with both disorders. SIGNIFICANCE: Persons with epilepsy and schizophrenia have very high mortality; more than one in four persons with both disorders died between the age of 25 and 50 years, indicating that these patients need special clinical attention.

Frequency of health care utilization in the year prior to completed suicide: A Danish nationwide matched comparative study.

BACKGROUND: Suicide accounts for more than 800,000 annual deaths worldwide. Some of these deaths may be preventable by timely identification of individuals at risk and effective intervention. General practitioners (GPs) may have the potential to play an important role in this process. AIM: The present study aimed to assess the frequency of primary health care utilization in the year preceding suicide. METHODS: Using Danish national registers, we identified all persons who died by suicide in Denmark from 1997 through 2013 and assessed the frequency of their primary care utilization and compared it with that of an age- and sex-matched reference group sampled from the background population. RESULTS: We identified 11,191 persons who died by suicide (males: 8,095, females: 3,096). Compared with the reference group (N = 55,955), a greater proportion attended general practice in the year before index date (83% vs. 76%). In the last month before index date, these figures were 32.0% and 19.4%, respectively, corresponding to a difference of 12.0 95% CI: (11.1; 12.9) percentage points after adjustment for demographic characteristics and physical comorbidity. Suicide cases had a higher GP attendance in every week in the year before suicide, but the difference increased specifically in the last four months. CONCLUSION: More than 30% attended the GP in the month before the suicide. This indicates that general practice could be a possible place to identify suicide cases and offer intervention. However, although this proportion represents a markedly higher GP attendance than seen in the reference group, almost 70% of those who died by suicide did not attend primary care in the month before the suicide. Our study suggests that it is important that the GPs have easy access to effective suicide prevention programs for patients at risk of suicide, and that persons with suicidal thoughts are encouraged to contact their GP.

Depression, antidepressants, and the risk of non-valvular atrial fibrillation: A nationwide Danish matched cohort study.

BACKGROUND: Depression is associated with an increased risk of a series of cardiovascular diseases and with increased symptom burden in patients with atrial fibrillation. The aim of this study was to determine the association between depression as well as antidepressant treatment and the risk of incident atrial fibrillation. DESIGN: A nationwide register-based study comparing the atrial fibrillation risk in all Danes initiating antidepressant treatment from 2000 to 2013 ( N = 785,254) with that in a 1:5-matched sample from the general population. METHODS: Cox regression was used to estimate adjusted hazard ratios (aHRs) and associated 95% confidence intervals (95% CIs), both after initiation of treatment and in the month before when patients were assumed to have medically untreated depression. RESULTS: Antidepressant treatment was associated with a three-fold higher risk of atrial fibrillation during the first month (aHR = 3.18 (95% CI: 2.98-3.39)). This association gradually attenuated over the following year (aHR = 1.37 (95% CI: 1.31-1.44) 2-6 months after antidepressant therapy initiation, and aHR = 1.11 (95% CI: 1.06-1.16) 6-12 months after). However, the associated atrial fibrillation risk was even higher in the month before starting antidepressant treatment (aHR = 7.65 (95% CI: 7.05-8.30) from 30 to 15 days before, and aHR = 4.29 (95% CI: 3.94-4.67) the last 15 days before). Overall, 0.4% of patients were diagnosed with atrial fibrillation from 30 days before to 30 days after antidepressant treatment. CONCLUSIONS: Antidepressant users had a substantially increased atrial fibrillation risk, particularly before treatment initiation. Whether this mirrors a causal relation between depression and atrial fibrillation may have large consequences for public health and should be discussed.

Early treatment with talk therapy or antidepressants in severely bereaved people and risk of suicidal behavior and psychiatric illness: an instrumental variable analysis.

PURPOSE: Losing a loved one to death is a common and natural life-course experience. Still, bereavement has been associated with an increased risk of suicidal behavior and psychiatric hospitalization and little is known of how to counter these adverse events. We aimed to study the effect of early treatment in primary care with talk therapy (TT) or antidepressants (AD) in severely bereaved people. METHODS: We conducted a population-based cohort study including 207,435 adult Danes who experienced a severe loss in 1996-2013. We compared treatment and no treatment with either of the two treatment regimens within 6 months after the loss. The main outcome was a serious mental health condition (defined as suicide, deliberate self-harm, or psychiatric hospitalization) occurring >6 months after bereavement. Adjusted risk differences (RDs) 2 years after bereavement were calculated using both standard regression analysis and instrumental variable analysis (IVA) in which estimated physician preferences for treatment served as instruments. RESULTS: The standard adjusted regression analysis showed a higher risk of developing a serious mental health condition associated with both TT (RD, 7.1; 95% CI, 5.0 to 9.1 per 1000 people) and AD (RD, 30.1; 95% CI, 25.7 to 34.6 per 1000 people). The IVA, which was used to control for unmeasured confounding, showed that TT was associated with a lower risk of a serious mental health condition (RD, -17.1; 95% CI, -30.7 to -3.5 per 1000 people), whereas the results were inconclusive for AD (RD, -8.6; 95% CI, -62.6 to 45.4 per 1000 people). CONCLUSION: This study suggests that early treatment with TT is associated with reduced long-term risk of serious mental health conditions in severely bereaved people. No clear benefit or harm of treatment with AD after bereavement was ascertained since the statistical precision was low.

Correction to: Impact of socioeconomic position and distance on mental health care utilization: a nationwide Danish follow-up study.

In the original publication of this article, Table 3 was published incorrectly. The corrected table is shown below.

[Mental-physical multimorbidity].

Mental-physical multimorbidity is highly prevalent and challenges the conventional thinking of the single disease paradigm in healthcare systems. Mental and physical health are closely related in a bidirectional manner. Persons with mental-physical multimorbidity experience a heavy symptom and treatment burden in addition to a lower quality of life and an impaired medical prognosis. Healthcare is complicated by symptom overlap, poor communication and uncoordinated care. New cross-sectional and patient-centred approaches are necessary to counter the adversities of mental-physical multimorbidity.