Nick Taub

Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project

Objective:  To describe the 12‐month and lifetime prevalence rates of mood, anxiety and alcohol disorders in six European countries.

The Management of Thrombosis in the Antiphospholipid-Antibody Syndrome

BACKGROUND The antiphospholipid-antibody syndrome is a thrombophilic disorder in which venous or arterial thrombosis, or both, may occur in patients with antiphospholipid antibodies. The optimal treatment of these patients is unclear. We assessed the efficacy of warfarin, low-dose aspirin, or both in the secondary prevention of thrombosis in patients with the syndrome. METHODS One hundred forty-seven patients (124 [84 percent] of whom were female) with the antiphospholipid-antibody syndrome and a history of thrombosis were studied retrospectively. The syndrome was primary in 62 patients and was associated with systemic lupus erythematosus in 66 patients and lupus-like disease in 19. Each patients history was reviewed. RESULTS One hundred one patients (69 percent) had a total of 186 recurrences of thrombosis. The median time between the initial thrombosis and the first recurrence was 12 months (range, 0.5 to 144 months). Treatment with high-intensity warfarin (producing an international normalized ratio of > or = 3) with or without low-dose aspirin (75 mg per day) was significantly more effective (P < 0.001 by the log-rank test) than treatment with low-intensity warfarin (producing an international normalized ratio of < 3) with or without low-dose aspirin or treatment with aspirin alone in preventing further thrombotic events (recurrence rates per patient-year, 0.013, 0.23, and 0.18, respectively). The rate of recurrence of thrombosis was highest (1.30 per patient-year) during the first six months after the cessation of warfarin therapy. Complications involving bleeding occurred in 29 patients during warfarin therapy and were severe in 7 (0.071 and 0.017 occurrence per patient-year, respectively). CONCLUSIONS The risk of recurrent thrombosis in patients with the antiphospholipid-antibody syndrome is high. Long-term anticoagulation therapy in which the international normalized ratio is maintained at or above 3 is advisable in these patients.

Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

Objective:  This manuscript examines the impact of mental health state and specific mental and physical disorders on work role disability and quality of life in six European countries.

Use of mental health services in Europe : results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project

Objective:  Comprehensive information about access and patterns of use of mental health services in Europe is lacking. We present the first results of the use of health services for mental disorders in six European countries as part of the ESEMeD project.

Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

Objective:  To describe the 12‐month and lifetime prevalence rates of mood, anxiety and alcohol disorders in six European countries.

12-Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project

Objective:  Comorbidity patterns of 12‐month mood, anxiety and alcohol disorders and socio‐demographic factors associated with comorbidity were studied among the general population of six European countries.

International variation in histologic grading is large, and persistent feedback does not improve reproducibility.

Histologic grading systems are used to guide diagnosis, therapy, and audit on an international basis. The reproducibility of grading systems is usually tested within small groups of pathologists who have previously worked or trained together. This may underestimate the international variation of scoring systems. We therefore evaluated the reproducibility of an established system, the Banff classification of renal allograft pathology, throughout Europe. We also sought to improve reproducibility by providing individual feedback after each of 14 small groups of cases. Kappa values for all features studied were lower than any previously published, confirming that international variation is greater than interobserver variation as previously assessed. A prolonged attempt to improve reproducibility, using numeric or graphical feedback, failed to produce any detectable improvement. We then asked participants to grade selected photographs, to eliminate variation induced by pathologists viewing different areas of the slide. This produced improved kappa values only for some features. Improvement was influenced by the nature of the grade definitions. Definitions based on “area affected” by a process were not improved. The results indicate the danger of basing decisions on grading systems that may be applied very differently in different institutions.

Maternal caffeine intake during pregnancy and risk of fetal growth restriction: a large prospective observational study

Correction to Maternal caffeine intake during pregnancy and risk of fetal growth restriction: a large prospective observational study, dx.doi.org/10.1136/bmj.a2332 available on the LRA at http://hdl.handle.net/2381/16058

Nutritional status of hospitalized acute stroke patients

The nutritional status of 201 hospitalized stroke patients was assessed from anthropometric, haematological and biochemical data in an observational prospective study. On admission, sixty-two (31%) stroke patients had BMI < 20, ninety-nine (49%) had a triceps skinfolds thickness below the 25th centile, twenty-five (12%) had a mid-arm circumference below the 25th centile and thirty-eight (19%) had a serum albumin concentration below 35 g/l. Baseline nutritional status was worse among those who later died or remained in hospital compared with those discharged and most patients who remained in hospital showed marked and significant deterioration in all measures of nutritional status within 4 weeks of hospitalization. After adjusting for age, stroke severity and co-morbidity, low serum albumin concentrations of these patients in hospital were a strong and independent predictor of death following acute stroke (odds ratio 1.13 (95% CI 1.01-1.27) for 1 g/l lower serum albumin concentration).

The Predictive Role of 24-Hour Compared to Casual Blood Pressure Levels on Outcome following Acute Stroke

The predictive value of casual blood pressure (BP) levels following acute stroke on outcome is currently unclear. This may in part reflect the observer bias and variability of casual recordings, which are reduced with 24-hour recordings. We therefore proposed to assess the prognostic significance of 24-hour compared to casual BP in predicting 30-day mortality, dependency and neurological outcome. A total of 136 consecutive patients were assessed within 24 h of ictus by one observer, with casual and 24-hour BP recording, and National Institutes of Health Stroke Scale and Modified Rankin Scale scores. Repeat assessments were made at 7 and 30 days. Admission casual and 24-hour systolic BP (SBP) and diastolic BP levels were significantly higher in patients with poor outcome at 1 month following acute stroke, whether expressed in terms of mortality, dependency or neurological deterioration, on single-variable logistic regression analysis. However, of these variables, only admission 24-hour (not casual) SBP remained a significant outcome predictor in a multiple model containing factors with an established association with poor prognosis. The odds ratio for outcome of death or dependency associated with each 10-mm-Hg increase in 24-hour SBP at admission was 1.88 (95% confidence interval: 1.27-2.78). For an outcome of death or high dependency, the model had a specificity of 75% and sensitivity of 76% when tested by the jackknife technique. Therefore, increasing 24-hour BP levels following acute stroke predict poor outcome. Whether BP should be reduced pharmacologically in the acute stroke period now warrants a suitable prospective intervention trial.