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2.
Lancet ; 394(10209): 1652-1667, 2019 11 02.
Artículo en Inglés | MEDLINE | ID: mdl-31668409

RESUMEN

We did a global review to synthesise data on the prevalence, harms, and interventions for stimulant use, focusing specifically on the use of cocaine and amphetamines. Modelling estimated the effect of cocaine and amphetamine use on mortality, suicidality, and blood borne virus incidence. The estimated global prevalence of cocaine use was 0·4% and amphetamine use was 0·7%, with dependence affecting 16% of people who used cocaine and 11% of those who used amphetamine. Stimulant use was associated with elevated mortality, increased incidence of HIV and hepatitis C infection, poor mental health (suicidality, psychosis, depression, and violence), and increased risk of cardiovascular events. No effective pharmacotherapies are available that reduce stimulant use, and the available psychosocial interventions (except for contingency management) had a weak overall effect. Generic approaches can address mental health and blood borne virus infection risk if better tailored to mitigate the harms associated with stimulant use. Substantial and sustained investment is needed to develop more effective interventions to reduce stimulant use.


Asunto(s)
Anfetaminas/efectos adversos , Trastornos Relacionados con Cocaína/mortalidad , Cocaína/efectos adversos , Adolescente , Adulto , Anfetaminas/uso terapéutico , Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Cardiovasculares/mortalidad , Estimulantes del Sistema Nervioso Central/uso terapéutico , Trastornos Relacionados con Cocaína/epidemiología , Trastornos Relacionados con Cocaína/prevención & control , Inhibidores de Captación de Dopamina/efectos adversos , Femenino , Infecciones por VIH/inducido químicamente , Infecciones por VIH/mortalidad , Hepatitis C/inducido químicamente , Hepatitis C/mortalidad , Humanos , Incidencia , Masculino , Trastornos Mentales/inducido químicamente , Trastornos Mentales/mortalidad , Persona de Mediana Edad , Prevalencia , Virosis/sangre , Virosis/inducido químicamente , Virosis/mortalidad , Adulto Joven
3.
Lancet ; 394(10211): 1827-1835, 2019 11 16.
Artículo en Inglés | MEDLINE | ID: mdl-31668728

RESUMEN

BACKGROUND: Systematic reviews have consistently shown that individuals with mental disorders have an increased risk of premature mortality. Traditionally, this evidence has been based on relative risks or crude estimates of reduced life expectancy. The aim of this study was to compile a comprehensive analysis of mortality-related health metrics associated with mental disorders, including sex-specific and age-specific mortality rate ratios (MRRs) and life-years lost (LYLs), a measure that takes into account age of onset of the disorder. METHODS: In this population-based cohort study, we included all people younger than 95 years of age who lived in Denmark at some point between Jan 1, 1995, and Dec 31, 2015. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and the date and cause of death was obtained from the Danish Register of Causes of Death. We classified mental disorders into ten groups and causes of death into 11 groups, which were further categorised into natural causes (deaths from diseases and medical conditions) and external causes (suicide, homicide, and accidents). For each specific mental disorder, we estimated MRRs using Poisson regression models, adjusting for sex, age, and calendar time, and excess LYLs (ie, difference in LYLs between people with a mental disorder and the general population) for all-cause mortality and for each specific cause of death. FINDINGS: 7 369 926 people were included in our analysis. We found that mortality rates were higher for people with a diagnosis of a mental disorder than for the general Danish population (28·70 deaths [95% CI 28·57-28·82] vs 12·95 deaths [12·93-12·98] per 1000 person-years). Additionally, all types of disorders were associated with higher mortality rates, with MRRs ranging from 1·92 (95% CI 1·91-1·94) for mood disorders to 3·91 (3·87-3·94) for substance use disorders. All types of mental disorders were associated with shorter life expectancies, with excess LYLs ranging from 5·42 years (95% CI 5·36-5·48) for organic disorders in females to 14·84 years (14·70-14·99) for substance use disorders in males. When we examined specific causes of death, we found that males with any type of mental disorder lost fewer years due to neoplasm-related deaths compared with the general population, although their cancer mortality rates were higher. INTERPRETATION: Mental disorders are associated with premature mortality. We provide a comprehensive analysis of mortality by different types of disorders, presenting both MRRs and premature mortality based on LYLs, displayed by age, sex, and cause of death. By providing accurate estimates of premature mortality, we reveal previously underappreciated features related to competing risks and specific causes of death. FUNDING: Danish National Research Foundation.


Asunto(s)
Trastornos Mentales/mortalidad , Indicadores de Calidad de la Atención de Salud , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Estudios de Cohortes , Dinamarca/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Humor/mortalidad , Mortalidad Prematura , Sistema de Registros , Trastornos Relacionados con Sustancias/mortalidad , Suicidio/estadística & datos numéricos , Adulto Joven
4.
Lakartidningen ; 1162019 Sep 27.
Artículo en Sueco | MEDLINE | ID: mdl-31573669

RESUMEN

MM-ARG, the Swedish maternal maternity mortality group within SFOG (Swedish Society of Obstetrics and Gynecology) has, since 2008, surveyed and analysed maternal deaths in Sweden with the aim to find and give feedback on lessons learned to the medical professions.  MM-ARG consists of obstetricians, midwives and anesthetists and the strength of the working model is that the profession itself takes responsibility for the scrutiny.  A summary of 67 known maternal deaths from 2007‒2017 is presented. Direct causes of death are dominated by hypertensive disease/preeclampsia, followed by thromboembolic disease, sepsis and obstetric bleeding. Indirect death, where a known or unknown underlying disease is exacerbated by pregnancy, is dominated by cardiovascular disease. This review shows that the diagnostics and clinical management could be improved. Besides obstetrics/gynecology, maternal mortality affects other specialties and thus holds important lessons to many.


Asunto(s)
Mortalidad Materna , Adolescente , Adulto , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/prevención & control , Femenino , Humanos , Muerte Materna , Trastornos Mentales/mortalidad , Trastornos Mentales/prevención & control , Hemorragia Posparto/mortalidad , Hemorragia Posparto/prevención & control , Preeclampsia/mortalidad , Preeclampsia/prevención & control , Embarazo , Complicaciones del Embarazo/prevención & control , Complicaciones Infecciosas del Embarazo/mortalidad , Complicaciones Infecciosas del Embarazo/prevención & control , Complicaciones Neoplásicas del Embarazo/mortalidad , Complicaciones Neoplásicas del Embarazo/prevención & control , Calidad de la Atención de Salud , Sociedades Médicas , Suicidio/prevención & control , Suecia/epidemiología , Tromboembolia/mortalidad , Tromboembolia/prevención & control
5.
Actas esp. psiquiatr ; 47(5): 179-189, sept.-oct. 2019. tab
Artículo en Español | IBECS | ID: ibc-185170

RESUMEN

Introducción. El suicidio es un problema de salud importante en España. Examinamos la relación entre la reincidencia de los intentos y el nivel de letalidad alcanzado, y el perfil de los pacientes reincidentes que realizan intentos más letales. El objetivo es establecer los factores sociodemográficos y clínicos predictores de una mayor letalidad y reincidencia. Método. Todos los pacientes atendidos por intento suicida en un área sanitaria de 360.000 habitantes de 2009 a 2014 (N = 711) fueron valorados de forma sistemática. Comparamos las características clínicas y demográficas en función de la letalidad (leve versus moderada-severa) y la reincidencia (1-2 intentos versus > 2 intentos) usando análisis univariantes y modelos de regresión. Posteriormente, repe-timos los análisis tras distribuir la muestra en cuatro grupos en función de la presencia o ausencia de alta letalidad y/o reincidencia. Resultados. La reincidencia se asoció con la edad media (35-65 años), inactividad laboral, y los trastornos de personalidad o por uso de sustancias. La letalidad se asoció con el género masculino, edades extremas, método violento y los trastornos afectivos, pero no con la reincidencia. La coincidencia de múltiples intentos y letalidad severa en un mismo paciente parece relacionarse con el grupo de edad de 35-65 años, sexo masculino, uso de métodos violentos, trastornos mentales y la inactividad laboral. Conclusiones. Distintos factores demográficos y clínicos se asocian al riesgo de letalidad médica y de reincidencia. Nuestros resultados muestran que aquellos pacientes que repiten los intentos y realizan al menos un intento de alta letalidad, tienen mayor presencia de psicopatología, sobre todo trastornos afectivos


Introduction. Suicidal behaviour is a major health problem in Spain. The aim of this study is to examine the relationship between the recurrence of suicide attempts and the level of lethality reached, and the profile of repeaters who perform more lethal attempts. Method. All patients admitted for attempted suicide in a health area of 360,000 inhabitants from 2009 to 2014 (N = 711) were systematically assessed. We compared clinical and demographic characteristics of these patients in terms of lethality (low versus moderate-severe) and recidivism (1-2 attempts versus >2 attempts) using univariate analyses and regression models. Later, we repeated the analyses after distributing the sample into four groups depending on the presence or absence of high lethality and/or recidivism. Results. Recidivism was associated with the middle-age group (35-65 years), the lack of professional activity, and personality or substance use disorders. Lethality was associated with male gender, extreme age-groups, the use of a violent method, and affective disorders, but not with recidivism. Multiple suicide attempts and high lethality in a single patient was associated with 35-65 years age-group, male gender, violent methods, mental disorders, and inactivity. Conclusions. Different demographic and clinical factors indicate an increased risk of medical lethality and recurrence in suicidal patients. Our results show that at least some recidivist patients end up making more lethal and violent attempts with the passage of time, especially if they have psychiatric comorbidity


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Intento de Suicidio/psicología , Trastorno de Personalidad Antisocial/mortalidad , Trastornos Relacionados con Sustancias/mortalidad , Reincidencia/psicología , Modelos Lineales , Trastornos Relacionados con Sustancias/psicología , Trastornos del Humor/psicología , Trastornos Mentales/mortalidad , Trastornos Mentales/psicología
6.
Maturitas ; 129: 76-84, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31547918

RESUMEN

This article presents a broad narrative review of the epidemiological evidence on how and why the mental health of older adults varies by gender. We draw upon international research literatures spanning gerontology and population mental health, as well as major reports from global health agencies. Compared with older men, older women are more likely to experience common mental disorders such as depression and anxiety, although the gender gap is smaller than it is at younger ages. In contrast, the mortality-related impacts of poor mental health, including suicide, are more severe for older men. These gendered patterns vary by country and other social contexts. Factors proposed to account for these findings include cultural and social norms, differentiation of gender roles, disadvantage and (dis)empowerment across the life course, and the coping styles of older men. However, little research has explicitly tested these explanations. Research to date has overwhelmingly focused on identifying differences in the mental health of older men and women. Notably, most studies have been restricted to binary comparisons, lacking the data to disentangle sex and gender dynamics, and few studies have examined the mental health of minority gendered adults in later life. Finally, there remains a need for high-quality population-based research into the mental health of those aged over 80 that includes coverage of people living in residential aged care settings.


Asunto(s)
Trastornos Mentales/epidemiología , Salud Mental , Adaptación Psicológica , Factores de Edad , Ansiedad/epidemiología , Depresión/epidemiología , Identidad de Género , Humanos , Trastornos Mentales/mortalidad , Factores Sexuales , Normas Sociales , Suicidio
7.
Nord J Psychiatry ; 73(6): 357-364, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31271336

RESUMEN

Background: Psychiatric disorders tend to be developmental, and longitudinal settings are required to examine predictors of psychiatric phenomena. Replicating and combining data and results from different birth cohorts, which are a source of reliable data, can make research even more valuable. The Finnish Psychiatric Birth Cohort Consortium (PSYCOHORTS) project combines birth cohorts in Finland. Aim: The aim of this paper is to introduce content, plans and perspectives of the PSYCOHORTS project that brings together researchers from Finland. In addition, we illustrate an example of data harmonization using available data on causes of death. Content: PSYCOHORTS includes eight Finnish birth cohorts. The project has several plans: to harmonize different data from birth cohorts, to incorporate biobanks into psychiatric birth cohort research, to apply multigenerational perspectives, to integrate longitudinal patterns of marginalization and inequality in mental health, and to utilize data in health economics research. Data on causes of death, originally obtained from Finnish Cause of Death register, were harmonized across the six birth cohorts using SAS macro facility. Results: Harmonization of the cause of death data resulted in a total of 21,993 observations from 1965 to 2015. For example, the percentage of deaths due to suicide and the sequelae of intentional self-harm was 14% and alcohol-related diseases, including accidental poisoning by alcohol, was 13%. Conclusions: PSYCOHORTS lays the foundation for complex examinations of psychiatric disorders that is based on compatible datasets, use of biobanks and multigenerational approach to risk factors, and extensive data on marginalization and inequality.


Asunto(s)
Trastornos Mentales/mortalidad , Adolescente , Adulto , Alcoholismo/mortalidad , Alcoholismo/psicología , Causas de Muerte , Estudios de Cohortes , Femenino , Finlandia/epidemiología , Humanos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Factores de Riesgo , Conducta Autodestructiva/mortalidad , Conducta Autodestructiva/psicología , Factores Socioeconómicos , Suicidio/estadística & datos numéricos , Adulto Joven
8.
Lancet Psychiatry ; 6(9): 753-765, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31320283

RESUMEN

BACKGROUND: Antipsychotic drugs might cause acutely occurring, serious side-effects and thus contribute to the increased physical morbidity and mortality observed in patients with severe mental health disorders. We examined this hypothesis by doing a meta-analysis of International Conference on Harmonisation-Good Clinical Practice-defined serious adverse events occurring in placebo-controlled trials of antipsychotics. METHODS: For this systematic review and meta-analysis, we included randomised controlled trials (RCTs) comparing second-generation antipsychotics with placebo. We searched MEDLINE, Embase, Cochrane CENTRAL, BIOSIS, PsycINFO, PubMed, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform for trials published in any language from database inception up until Jan 27, 2017. Trials were included without limitations in population (diagnostic category, age, sex, ethnicity), dosing regimen, blinding status, duration, or publication year. Only psychological studies lasting less than 1 day and trials done in mainland China were excluded. We contacted pharmaceutical companies, drug regulatory authorities, and study investigators for additional data. The primary outcome was the number of patients with at least one somatic serious adverse event. We estimated minimum and maximum numbers of patients with the outcome in each study group and synthesised the results with odds ratios (ORs) in a common-effects meta-analysis. This study is registered with PROSPERO, number CRD42016033930. FINDINGS: We identified 597 RCTs, comprising 108 664 participants, that met the inclusion criteria. 314 trials (67 642 participants) with details on individual serious adverse events available constituted the main dataset for meta-analysis. 88% of these were 13 weeks (approximately 3 months) or shorter in duration (median 6 weeks, IQR 4-9). At least one somatic serious adverse event occurred in 698 (1·63%) to 862 (2·02%) of 42 600 patients on antipsychotics, and in 343 (1·37%) to 419 (1·67%) of 25 042 patients on placebo. The odds ratios (ORs) were 1·24 (95% CI 1·08-1·42) and 1·24 (1·10-1·41) based on the minimum and maximum estimate, respectively. In predefined subgroup analyses we found evidence suggesting a larger effect in older patients (>65 years; OR 1·56, 95% CI 1·22-1·98; 1·58, 1·25-1·99) as compared with adults (18-65 years; 1·09, 0·91-1·29; 1·10, 0·95-1·28); likewise in children or adolescents (<18 years) although the evidence was more uncertain (1·49, 0·81-2·75; 1·54, 0·85-2·77). Of 597 included RCTs, 30 (5%), 358 (60%), and 209 (35%) were rated at high, moderate, or low risk of bias, respectively. τ2 was zero for both analyses of the primary outcome (minimum estimate, maximum estimate). A Bayesian sensitivity analysis using external information on heterogeneity gave similar results. INTERPRETATION: We found evidence that antipsychotics cause short-term somatic serious adverse events on top of somatic serious adverse events occurring independent of treatment. This effect appears to be mainly driven by results in older patients. Hence, clinicians should be aware that antipsychotics are potentially toxic, particularly when treating patients sharing risk factors with the older population. FUNDING: German Ministry of Education and Research.


Asunto(s)
Antipsicóticos/efectos adversos , Trastornos Mentales/tratamiento farmacológico , Placebos/efectos adversos , Trastornos Somatosensoriales/inducido químicamente , Adolescente , Adulto , Anciano , Antipsicóticos/clasificación , Antipsicóticos/uso terapéutico , China/epidemiología , Humanos , Incidencia , Trastornos Mentales/mortalidad , Persona de Mediana Edad , Placebos/administración & dosificación , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Trastornos Somatosensoriales/epidemiología , Trastornos Somatosensoriales/mortalidad , Adulto Joven
9.
Environ Sci Pollut Res Int ; 26(23): 24272-24285, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31230236

RESUMEN

Temperature is associated with mortality risk across cities. However, there is lack of study investigating the summer effect on mortality associated with mental/behavioral disorders, especially in cities with subtropical climate. In addition, summer mortality in subtropical cities is different from tropical cities, and previous studies have not investigated the urban environmental inequality on heat mortality associated with mental/behavioral disorders. A register-based study was developed to estimate the temperature effects on decedents on days with 50th percentile of average daily temperature between 2007 and 2014 in Hong Kong (n = 133,359). Poisson regression was firstly applied to estimate the incidence rate ratio (IRR) from the summer temperature effects on all-cause mortality, cardiovascular mortality, respiratory mortality, and mortality associated with mental/behavioral disorders. For a 1 °C increase in average temperature on days with temperature ≥ 24.51 °C, IRRs of mortality associated with mental and behavioral disorders on lag 0 and lag 1 days were 1.033 [1.004, 1.062] and 1.030 [1.002, 1.060], while temperature effects on cardiovascular mortality and respiratory mortality during normal summer days (not extreme heat events) were not significant. A further investigation with linear regression has shown that decedents with mental/behavioral disorders on higher temperature days resided in areas with lower percentage of sky view, lower percentage of vegetation cover, higher level of neighborhood-level PM2.5, higher level of neighborhood-level NO, and higher level of neighborhood-level black carbon (BC). In order to develop protocols for community healthcare based on the "Leaving no one behind" scheme documented in the 2016 Sustainable Development Goals report of the United Nations, it is necessary to include heat effects on mental/behavioral disorders, especially people with dementia, for community planning and healthcare development.


Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Trastornos Mentales/mortalidad , Temperatura Ambiental , Ciudades , Hong Kong/epidemiología , Calor , Humanos , Mortalidad/tendencias , Estaciones del Año
10.
Z Psychosom Med Psychother ; 65(2): 129-143, 2019 Jun.
Artículo en Alemán | MEDLINE | ID: mdl-31154922

RESUMEN

The risk of medical comorbidity in mental disorders with a particular focus on depressive syndromes Objectives: It has long been recognized that certain mental disorders, and in particular depressive syndromes, are associated with increased medical comorbidity. However, reliable data on the prevalence of comorbid medical diagnoses as well as the impact of these comorbidities on mortality are often rare and sometimes conflicting. Methods: A systematic literature review was conducted using PubMed and Google Scholar to provide a critical account of the current state of research on the comorbidities of medical and mental disorders, with a particular focus on depressive syndromes. Results: Among patients with mental disorders, all-cause mortality is about doubled as compared to the general population causing a significantly shortened life expectancy in the range of one to two decades. This excess mortality is primarily due to increased physical morbidity and mortality, and it cannot be excluded that, for patients with severe mental disorders, excess mortality has been increased over time. Depressive syndromes are often linked to a broad range of somatic symptoms and can be found in diseases, such as heart disease, stroke, diabetes mellitus, overweight/obesity, and asthma. Conclusion: Current studies provide ample evidence of close interactions between physical and mental health. Further developments in the field of psychosomatic medicine should take into consideration the health-related consequences of these interactions.


Asunto(s)
Causas de Muerte , Comorbilidad , Trastornos Mentales/mortalidad , Trastorno Depresivo/mortalidad , Humanos
11.
Artículo en Inglés | MEDLINE | ID: mdl-31083523

RESUMEN

This work studies the health status of two populations similar in most social and environmental interactions but one: the individuals from one population are victims of an internal armed conflict. Both populations are located in the Risaralda province, Colombia and the data for this study results from a combination of administrative records from the health system, between 2011 and 2016. We implemented a methodology based on graph theory that defines the system as a set of heterogeneous social actors, including individuals as well as organizations, embedded in a biological environment. The model of analysis uses the diagnoses in medical records to detect morbidity and mortality patterns for each individual (ego-networks), and assumes that these patterns contain relevant information about the effects of the actions of social actors, in a given environment, on the status of health. The analysis of the diagnoses and causes of specific mortality, following the Social Network Analysis framework, shows similar morbidity and mortality rates for both populations. However, the diagnoses' patterns show that victims portray broader interactions between diagnoses, including mental and behavioral disorders, due to the hardships of this population.


Asunto(s)
Conflictos Armados/psicología , Estado de Salud , Trastornos Mentales/epidemiología , Trastornos Mentales/mortalidad , Morbilidad , Adulto , Anciano , Anciano de 80 o más Años , Colombia/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad
12.
Lancet Psychiatry ; 6(6): 506-517, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31097399

RESUMEN

BACKGROUND: Neighbourhood social context might play a role in modifying mortality outcomes in severe mental illness, but has received little attention to date. Therefore, we aimed to assess in an ethnically diverse and urban location the association of neighbourhood-level characteristics and individual-level factors for all-cause, natural-cause, and unnatural-cause mortality in those with severe mental illness. METHODS: We did a retrospective cohort study using a case-registry from a large secondary mental health-care Trust in an ethnically diverse and urban location in south London, UK. Linked data for deaths and areas of residence were identified from the case-registry. We included all individuals aged 15 years or more at the time of diagnosis for a severe mental illness from Jan 1, 2007, to Dec 31, 2014. We used individual-level information in our analyses, such as gender, marital status, and the presence of current or previous substance use disorders. We assessed neighbourhood or area-level indicators at the Lower Super Output Area level. Association of neighbourhood-level characteristics, which included the interaction between ethnicity and own ethnic density, deprivation, urbanicity, and social fragmentation, alongside individual-level factors for all-cause, natural-cause, and unnatural-cause mortality in those with severe mental illness was assessed. FINDINGS: A total of 18 201 individuals were included in this cohort for analyses, with a median follow-up of 6·36 years. There were 1767 (9·7%) deaths from all causes, 1417 (7·8%) from natural causes, and 192 (1·1%) from unnatural causes. In the least ethnically dense areas, the adjusted rate ratio (aRR) for all-cause mortality in ethnic minority groups with severe mental illness compared with white British people with severe mental illness were similar (aRR 0·96, 95% CI 0·71-1·29); however in the highest ethnic density areas, ethnic minority groups with severe mental illness had a lower risk of death (aRR 0·52, 95% CI 0·38-0·71; p<0·0001), with similar trends for natural-cause mortality (p=0·071 for statistical interaction). In the cohort with severe mental illness, residency in deprived, urban, and socially fragmented neighbourhoods was not associated with higher mortality rates. Compared with the general population, age-standardised and gender-standardised mortality ratios were elevated in the cohort with severe mental illness across all neighbourhood-level characteristics assessed. INTERPRETATION: For ethnic minority groups with severe mental illness, residency in areas of higher own-group ethnic density is associated with lower mortality compared to white British groups with severe mental illness. FUNDING: Health Foundation, National Institute for Health Research, EU Seventh Framework, and National Institute of Mental Health.


Asunto(s)
Trastornos Mentales/etnología , Trastornos Mentales/mortalidad , Análisis Multinivel/métodos , Adolescente , Adulto , Femenino , Humanos , Masculino , Sistema de Registros , Estudios Retrospectivos , Factores Socioeconómicos , Reino Unido/etnología , Salud Urbana , Remodelación Urbana , Adulto Joven
13.
J Occup Health ; 61(4): 269-277, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30977205

RESUMEN

OBJECTIVES: Cerebrovascular and cardiovascular diseases (CCVDs) and mental disorders, including suicide, are prevalent among overworked individuals in Japan. The 2014 legislation regarding the prevention of overwork-related deaths and disorders has accelerated the research in this field and ultimately the implementation of preventive actions. METHODS: To understand the current problematic situations, the Research Center for Overwork-Related Disorders of the National Institute of Occupational Safety and Health, Japan, conducted analyses of compensated claims for overwork-related CCVDs and mental disorders that were recognized from January 2010 to March 2015. RESULTS: The majority of CCVD cases were the men in their 50s. Transport and postal activities was the highest risk industry. Cerebrovascular cases were higher than cardiovascular ones. Long working hours was the principal factor for CCVDs. The mental disorder cases comprised approximately 70% men and affected younger age groups (peak in the third decade) with various industries at risk. In men, there was an almost equal number of F3 (Mood [affective] disorders) and F4 (Neurotic, stress-related, and somatoform disorders) diagnoses according to the 10th revision of the International Classification of Diseases and Related Health Problems. A larger number of women were diagnosed to have F4. The mental disorder cases were associated not only with long working hours, but also with injuries and disasters as well as interpersonal conflict at work. CONCLUSIONS: Multiple, simultaneous actions need to be made by employees, employers, researchers, and the authorities to achieve the goal of reducing the number of workers suffering from the overwork-related CCVDs and mental disorders.


Asunto(s)
Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/mortalidad , Salud Laboral/legislación & jurisprudencia , Ocupaciones/estadística & datos numéricos , Tolerancia al Trabajo Programado , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/mortalidad , Trastornos Cerebrovasculares/epidemiología , Trastornos Cerebrovasculares/mortalidad , Humanos , Japón/epidemiología , Trastornos Mentales/epidemiología , Trastornos Mentales/mortalidad , Suicidio/estadística & datos numéricos , Carga de Trabajo/legislación & jurisprudencia , Carga de Trabajo/estadística & datos numéricos
14.
J Occup Health ; 61(4): 288-296, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31025505

RESUMEN

OBJECTIVES: Recently, overwork-related disorders have become a major public health concern in Korea. This study investigated the current trends of working hours, causes of death in the working population, and compensation rates. METHODS: We reviewed the current trends of working hours, cause of death statistics in the working population, industrial accident compensation insurance (IACI) statistics, issues of compensation and prevention of work-related cerebro-cardio vascular diseases (CCVDs), mental disorders, and suicide. RESULTS: Although weekly working hours and the proportion of long working days have decreased, workers in small companies with fewer than five employees and those in the service sector continue to work long hours. The age standardized mortality due to CCVD and suicide was highest among those with managerial roles. In total, 589 CCVD cases and 104 mental disorder or suicide cases were compensated as occupational diseases in 2017. Between 2016 and 2017, 61% of 59 compensated suicides were related to overwork, specifically: long working hours, increased responsibility, or increased workload. The Korean government has introduced various policies to reduce working hours and to increase compensation approval rate for overwork-related CCVDs. Stakeholders have called for the introduction of independent laws to prevent overwork-related disorders, change organizational culture, and address the blind spots of the IACI Act and Labor Standard Act. CONCLUSIONS: Prevention and compensation policies have improved working conditions in Korea, but there remains much to be done. This review significantly contributes to the understanding of the overall policies and research to prevent overwork-related disorders in Korea.


Asunto(s)
Política de Salud/legislación & jurisprudencia , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/prevención & control , Ocupaciones/estadística & datos numéricos , Tolerancia al Trabajo Programado , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/mortalidad , Trastornos Cerebrovasculares/epidemiología , Trastornos Cerebrovasculares/mortalidad , Humanos , Trastornos Mentales/epidemiología , Trastornos Mentales/mortalidad , Enfermedades Profesionales/mortalidad , República de Corea/epidemiología , Suicidio/estadística & datos numéricos
15.
Circ Cardiovasc Imaging ; 12(3): e008236, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30866646

RESUMEN

Background Cardiovascular mortality is the leading contributor to the shortened life expectancy in patients with severe mental illness (SMI), but efforts to predict cardiovascular outcomes in these patients have been lacking. In this study, we aimed to determine the severity of coronary artery calcification (CAC), and its effect on mortality rates in patients with SMI, compared with the general population. Methods All individuals with a registered cardiac computed tomography for calcium scoring in the Western Denmark Heart Registry, from January 1, 2008 to December 31, 2016, were included. We identified patients diagnosed with SMI ( International Classification of Diseases, Tenth Revision: F20, F30, F31), whereas the remaining individuals were used as a comparison group. Results Among 48 757 individuals, including 564 patients with SMI (1.2%), we found no difference in CAC score between patients with SMI and the comparison group. SMI patients with CAC >100 had an increased mortality rate (hazard ratio, 3.16; 95% CI, 1.41-7.06), as well as SMI patients with CAC <100 (hazard ratio, 3.95; 95% CI, 2.36-6.62), compared with the comparison group with CAC <100 as reference, adjusted for age, sex, and calendar period. Conclusions Patients with SMI have increased cardiovascular risks, but show no difference in CAC score, compared with the comparison group. Mortality rates were increased in patients with SMI, independent of CAC severity; however, the relatively large number of noncardiovascular causes of death in this sample might indicate other contributing factors to death than coronary artery disease in this sample of SMI patients.


Asunto(s)
Enfermedad de la Arteria Coronaria/mortalidad , Trastornos Mentales/mortalidad , Calcificación Vascular/mortalidad , Anciano , Angiografía por Tomografía Computarizada , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Dinamarca , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Persona de Mediana Edad , Pronóstico , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Calcificación Vascular/diagnóstico por imagen
16.
Neuropsychobiology ; 78(1): 38-47, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30921807

RESUMEN

PURPOSE: Seattle-inspired rock and roll superstar Chris Cornell died by suicide in May 2017. In the northern hemisphere, May represents the peak of the widely replicated but still unexplained seasonal spring rhythm in suicide. Years earlier, Cornell had suffered openly from recurrent bouts of severe depression, and his early musical lyrics do indeed suggest an enduring sensitivity to the vicissitudes of depressed and suicidal states. Cornell's most famous song, Black Hole Sun, suggests a mixed mood state, the incidence of which also peaks in the spring. The present work explores Cornell's May suicide from a chronobiologic perspective. METHODS: Review of Cornell's lyrics and literature on suicide. RESULTS: Cornell's lyrics contain clear indicators of mixed depressive and seasonal imagery, highlighting 3 fundamental axioms of suicidology: (1) the yearly suicide rhythm peaks in May in the northern hemisphere, (2) mixed depressive states are particularly lethal, and (3) the suicide risk increases dramatically when recovering from depression and mood turns mixed. CONCLUSIONS: Cornell, in his life and music, left us with a novel and important hypothesis about the spring seasonality of suicide, namely, that the yearly suicide risk becomes maximal when winter turns to spring and there emerges a deadly mixed mood state under a May photoperiod, i.e., the suicide risk is maximal when a Black Hole Sun occurs in May. It is hoped that Cornell's legacy and sensitive hypothesis inspire research into the etiology and treatment of the spring seasonality of suicide risk and mixed mood states. LIMITATIONS: The Cornell hypothesis was formulated based in part on several speculative inferences regarding the course of his functioning just prior to his suicide.


Asunto(s)
Personajes , Música , Estaciones del Año , Suicidio , Historia del Siglo XXI , Humanos , Medicina en las Artes , Trastornos Mentales/mortalidad , Fotoperiodo , Estados Unidos
17.
Br J Cancer ; 120(8): 840-847, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30837680

RESUMEN

BACKGROUND: Among patients with cancer, prior research suggests that patients with mental illness may have reduced survival. The objective was to assess the impact of psychiatric utilisation (PU) prior to cancer diagnosis on survival outcomes. METHODS: All residents of Ontario diagnosed with one of the top 10 malignancies (1997-2014) were included. The primary exposure was psychiatric utilisation gradient (PUG) score in 5 years prior to cancer: 0: none, 1: outpatient, 2: emergency department, 3: hospital admission. A multivariable, cause-specific hazard model was used to assess the effect of PUG score on cancer-specific mortality (CSM), and a Cox proportional hazard model for effect on all-cause mortality (ACM). RESULTS: A toal of 676,125 patients were included: 359,465 (53.2%) with PUG 0, 304,559 (45.0%) PUG 1, 7901 (1.2%) PUG 2, and 4200 (0.6%) PUG 3. Increasing PUG score was independently associated with worse CSM, with an effect gradient across the intensity of pre-diagnosis PU (vs PUG 0): PUG 1 h 1.05 (95% CI 1.04-1.06), PUG 2 h 1.36 (95% CI 1.30-1.42), and PUG 3 h 1.73 (95% CI 1.63-1.84). Increasing PUG score was also associated with worse ACM. CONCLUSIONS: Pre-cancer diagnosis PU is independently associated with worse CSM and ACM following diagnosis among patients with solid organ malignancies.


Asunto(s)
Trastornos Mentales/psicología , Neoplasias/psicología , Anciano , Canadá/epidemiología , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Trastornos Mentales/complicaciones , Trastornos Mentales/mortalidad , Trastornos Mentales/patología , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/mortalidad , Neoplasias/patología , Modelos de Riesgos Proporcionales
18.
PLoS One ; 14(2): e0213145, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30817792

RESUMEN

OBJECTIVE: Breathing difficulties and respiratory diseases have been under-reported in Emergency Medical Services research, despite these conditions being prevalent with substantial mortality. Our aim was two-fold; 1) to investigate the diagnostic pattern and mortality among EMS patients to whom an ambulance was dispatched due to difficulty breathing, and 2) to investigate the initial symptoms and mortality for EMS patients diagnosed with respiratory diseases in hospital. METHODS: Population-based historic cohort study in the North Denmark Region 2012-2015. We included two patient groups; 1) patients calling the emergency number with breathing difficulty as main symptom, and 2) patients diagnosed with respiratory diseases in hospital following an emergency call. Main outcome was estimated 1- and 30-day mortality rates. RESULTS: There were 3803 patients with the symptom breathing difficulty, nearly half were diagnosed with respiratory diseases 47.3%, followed by circulatory diseases 13.4%, and symptoms and signs 12.0%. The 1-day mortality rate was highest for circulatory diseases, then respiratory diseases and other factors. Over-all 30-day mortality was 13.2%, and the highest rate was for circulatory diseases (17.7%) then respiratory diseases and other factors. A total of 4014 patients were diagnosed with respiratory diseases, 44.8% had the symptom breathing difficulty, 13.4% unclear problems and 11.3%. chest pain/heart disease. 1-day mortality rates were highest for decreased consciousness, then breathing difficulties and unclear problem. Over-all 30-day mortality rates were 12.5%, the highest with symptoms of decreased consciousness (19.1%), then unclear problem and breathing difficulty. There was an overlap of 1797 patients between the two groups. CONCLUSIONS: The over-all mortality rates alongside the distribution of symptoms and diagnoses, suggest the breathing difficulty patient group is complex and has severe health problems. These findings may be able to raise awareness towards the patient group, and thereby increase focus on diagnostics and treatment to improve the patient outcome.


Asunto(s)
Disnea/diagnóstico , Disnea/mortalidad , Servicios Médicos de Urgencia , Anciano , Anciano de 80 o más Años , Ambulancias , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/mortalidad , Estudios de Cohortes , Dinamarca/epidemiología , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/mortalidad , Persona de Mediana Edad , Trastornos Respiratorios/diagnóstico , Trastornos Respiratorios/mortalidad , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/mortalidad
19.
Int J Radiat Oncol Biol Phys ; 104(4): 748-755, 2019 07 15.
Artículo en Inglés | MEDLINE | ID: mdl-30904707

RESUMEN

PURPOSE: The impact of psychiatric comorbidities on the cost of cancer care in radiation oncology practices is not well studied. We assessed the acute and 24-month follow-up costs for patients with and without pre-existing psychiatric comorbidities undergoing radiation therapy. METHODS AND MATERIALS: Patients with cancer undergoing radiation therapy at our institution from 2009 to 2014 were denoted as having pre-existing psychiatric conditions (Psych group) if they had associated billing codes for any of the 422 International Classification of Diseases, 9th revision psychiatric conditions during the 12 months before their cancer diagnosis. The Elixhauser comorbidity index was calculated, excluding psychiatric categories. Medicare reimbursement was assigned to professional services, and Medicare departmental cost-to-charge ratios were applied to service line hospital charges and adjusted for inflation to create 2017 standardized costs. Acute (0-6 month) and follow-up (6-24 month) costs were subcategorized into clinic, emergency department, hospital inpatient, and outpatient costs. RESULTS: Among 1275 patients, 126 (9.9%) had at least 1 pre-existing psychiatric diagnosis. On univariate analysis, both acute and long-term costs were higher in the Psych group. The largest significant differences in costs were follow-up hospital inpatient costs ($5861 higher; 95% confidence interval [CI], $687-$11,035; P = .002), follow-up hospital outpatient costs ($2086 higher; 95% CI, -$142 to $4,314; P = .040), and follow-up emergency department costs ($396 higher; 95% CI, $149-$643; P < .001). Age, race, sex, and treatment modalities were comparable, but the Psych group patients had more median comorbidities (2 vs 1) and had more respiratory cancer diagnoses than the nonpsychiatric group (31% vs 17%). On multivariate analysis adjusted for age, sex, cancer diagnosis, and comorbidities, global follow-up costs remained 150% higher in the Psych group (P < .001). Acute costs were similar after adjustment (P = .63). CONCLUSIONS: Psychiatric comorbidities independently predict elevated healthcare costs in patients treated for cancer. Radiation oncology payment models should consider adjustments to account for psychiatric comorbidities because addressing these may mitigate cost differential.


Asunto(s)
Cuidados Posteriores/economía , Costos de la Atención en Salud , Trastornos Mentales/economía , Neoplasias/radioterapia , Cobertura de Afecciones Preexistentes/economía , Anciano , Análisis de Varianza , Comorbilidad , Intervalos de Confianza , Costos y Análisis de Costo , Femenino , Costos de Hospital , Humanos , Estimación de Kaplan-Meier , Masculino , Medicare/economía , Trastornos Mentales/clasificación , Trastornos Mentales/mortalidad , Neoplasias/economía , Neoplasias/mortalidad , Cobertura de Afecciones Preexistentes/clasificación , Tasa de Supervivencia , Estados Unidos
20.
Am J Clin Oncol ; 42(4): 355-362, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30844850

RESUMEN

OBJECTIVES: To determine the risk and risk factors for mental illness among colorectal cancer (CRC) survivors across short-term and long-term follow-up periods. METHODS: We used the Utah Cancer Registry to identify CRC survivors diagnosed between 1997 and 2013. Mental health diagnoses were available in electronic medical records and statewide facilities data that were linked by the Utah Population Database. CRC survivors were matched to individuals from a general population cohort. The risk of developing a mental illness was compared between cohorts. The association between mental illness and mortality was also analyzed. RESULTS: In total, 8961 CRC survivors and 35,897 individuals in a general population cohort were identified. CRC survivors were at increased risk for any mental health diagnosis at 0 to 2 years (hazard ratio [HR], 3.70; 95% confidence interval [CI], 3.47-3.95), >2 to 5 years (HR, 1.23; 95% CI, 1.09-1.38), and >5 years (HR, 1.20; 95% CI, 1.07-1.36) after cancer diagnosis. CRC survivors were also at increased risk of depressive disorders specifically during the same time periods. At >5 years, CRC survivors still had an increased risk of developing many mental health diagnoses. Factors associated with increased risk of any mental health disorder among CRC survivors included colostomy and Charlson Comorbidity Index of 1+. There was an increased risk of death for CRC survivors diagnosed with any mental health disorder (HR, 2.18; 95% CI, 2.02-2.35) and depression (HR, 2.10; 95% CI, 1.92-2.28). CONCLUSIONS: CRC survivors are at increased risk for mental health disorders in the short-term and long-term. Survivors who develop mental health disorders also experience decreased survival.


Asunto(s)
Supervivientes de Cáncer/psicología , Supervivientes de Cáncer/estadística & datos numéricos , Neoplasias Colorrectales/complicaciones , Trastornos Mentales/mortalidad , Sistema de Registros/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Estudios de Cohortes , Neoplasias Colorrectales/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Trastornos Mentales/etiología , Trastornos Mentales/psicología , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Tasa de Supervivencia
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