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Using The Wire in medical education. 在医学教育中使用电线。
IF 64.3 Pub Date : 2022-11-01 DOI: 10.1016/S2215-0366(22)00334-0
Kwame Nuako, Akeem Sule
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引用次数: 0
Maternal infection during pregnancy and likelihood of autism and intellectual disability in children in Sweden: a negative control and sibling comparison cohort study. 瑞典怀孕期间母亲感染与儿童自闭症和智力残疾的可能性:一项阴性对照和兄弟姐妹比较队列研究
IF 64.3 Pub Date : 2022-10-01 Epub Date: 2022-09-07 DOI: 10.1016/S2215-0366(22)00264-4
Martin Brynge, Hugo Sjöqvist, Renee M Gardner, Brian K Lee, Christina Dalman, Håkan Karlsson
<p><strong>Background: </strong>Maternal infections during pregnancy are associated with intellectual disability and autism in exposed children. Whether these associations are causal, and therefore should be targets of preventive strategies, remains unknown. We aimed to investigate these associations, to determine whether there is a causal role of maternal infection during pregnancy for children's risk of autism and intellectual disability, by accounting for unmeasured familial factors.</p><p><strong>Methods: </strong>We used a register-based cohort study design, and included children living in Stockholm County, Sweden, who were born in 1987-2010. We excluded children not born in Sweden, adopted children, and children with unknown biological mothers or fathers. Maternal infections during pregnancy, defined by ICD-8, ICD-9, and ICD-10 codes, were identified in the National Patient Register and Medical Birth Register. Children were followed up from birth to an outcome or a censoring event (death, migration from Stockholm, age 18 years, or Dec 31, 2016, whichever occurred first). The primary outcomes were diagnosis of autism or diagnosis of intellectual disability. We did a survival analysis to examine the association between inpatient and outpatient specialised care for any infection during pregnancy and likelihood of autism or intellectual disability in the child. To address potential residual confounding, we also estimated the relationship between maternal infection in the year preceding pregnancy as a negative control exposure and conducted a matched sibling analysis of sibling pairs who were discordant for autism or intellectual disability.</p><p><strong>Findings: </strong>647 947 children living in Stockholm County were identified and, after excluding 97 980 children, we included 549 967 in the study (267 995 [48·7%] were female and 281 972 [51·3%] were male; mean age at censoring 13·5 years [SD 5·0; range <1 to 18]; 142 597 [25·9%] had a mother who was not born in Sweden). 445 (1·3%) of 34 013 children exposed to maternal infection during pregnancy were diagnosed with intellectual disability and 1123 (3·3%) with autism. 5087 (1·0%) of 515 954 unexposed children were diagnosed with intellectual disability and 13 035 (2·5%) with autism. Maternal infection during pregnancy was associated with autism (hazard ratio [HR] 1·16, 95% CI 1·09-1·23) and intellectual disability (1·37, 1·23-1·51) in exposed children compared with unexposed children. Maternal infection in the year before pregnancy (negative control exposure) was also associated with autism (HR 1·25, 95% CI 1·14-1·36), but was not associated with intellectual disability (1·09, 0·94-1·27). In sibling comparisons, the associations with maternal infection during pregnancy were attenuated for autism (HR 0·94, 95% CI 0·82-1·08; n=21 864), but not to the same extent for intellectual disability (1·15, 0·95-1·40; n=9275).</p><p><strong>Interpretation: </strong>Although infections in pregnant women
背景:妊娠期母体感染与暴露儿童的智力残疾和自闭症有关。这些联系是否有因果关系,因此是否应该成为预防战略的目标,目前尚不清楚。我们的目的是调查这些关联,通过考虑未测量的家族因素,确定怀孕期间母亲感染是否与儿童患自闭症和智力残疾的风险有因果关系。方法:采用基于登记的队列研究设计,纳入1987-2010年出生在瑞典斯德哥尔摩县的儿童。我们排除了非在瑞典出生的儿童、收养儿童和生母或生父不明的儿童。根据ICD-8、ICD-9和ICD-10代码定义的妊娠期间孕产妇感染,已在《国家患者登记册》和《医疗出生登记册》中确定。对儿童从出生开始进行随访,直到发生结果或审查事件(死亡、从斯德哥尔摩迁移、18岁或2016年12月31日,以先发生者为准)。主要结果是诊断为自闭症或诊断为智力残疾。我们做了一项生存分析,以检查怀孕期间任何感染的住院和门诊专科护理与儿童自闭症或智力残疾的可能性之间的关系。为了解决潜在的残留混淆,我们还估计了怀孕前一年母体感染与阴性对照暴露之间的关系,并对患有自闭症或智力残疾的兄弟姐妹进行了配对分析。研究结果:共有647947名儿童生活在斯德哥尔摩县,在排除97980名儿童后,我们将549967名儿童纳入研究,其中女性26995名(48.7%),男性281972名(51.3%);审查时平均年龄13.5岁[SD 5.0;解释:虽然孕妇的感染与其子女的自闭症和智力残疾都有关联,但与自闭症的关联似乎并没有反映出因果关系,而更可能是由家庭成员之间共有的因素来解释,比如遗传变异或共同环境的某些方面。因此,预防感染并不能降低自闭症的发病率。对于智力残疾,未测量的家族因素可能不能完全解释观察到的关联,并且不能排除母体感染的因果作用。在自闭症或智力残疾中,不能排除特殊但罕见的感染或不需要保健接触的感染的因果影响。资助:瑞典研究委员会、斯坦利医学研究所和自闭症之声。翻译:关于摘要的瑞典语翻译,见补充材料部分。
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引用次数: 9
Low use of the Management and Treatment Services for Psychosis in China. 中国精神病管理和治疗服务使用率低。
IF 64.3 Pub Date : 2022-10-01 DOI: 10.1016/S2215-0366(22)00303-0
Wei Zhou, Shuiyuan Xiao
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引用次数: 2
Kidney function in patients with bipolar disorder with and without lithium treatment compared with the general population in northern Sweden: results from the LiSIE and MONICA cohorts. 瑞典北部接受和未接受锂治疗的双相情感障碍患者的肾功能与一般人群的比较:来自LiSIE和MONICA队列的结果
IF 64.3 Pub Date : 2022-10-01 Epub Date: 2022-09-12 DOI: 10.1016/S2215-0366(22)00265-6
Filip Fransson, Ursula Werneke, Vesa Harju, Louise Öhlund, Julia de Man Lapidoth, P Andreas Jonsson, Bernd Stegmayr, Elinor Salander Renberg, Michael Ott
<p><strong>Background: </strong>The clinical relevance of lithium nephropathy is subject to debate. Kidney function decreases with age and comorbidities, and this decline might lead to attribution bias when erroneously ascribed to lithium. We aimed to investigate whether patients with bipolar or schizoaffective disorder had faster decline in estimated glomerular filtration rate (eGFR) compared with the general population, whether observed differences in the steepness of the decline were attributable to lithium, and whether such changes depended on the length of lithium exposure.</p><p><strong>Methods: </strong>In this cross-sectional cohort study, we used clinical data from the Lithium-Study into Effects and Side-effects (LiSIE) retrospective cohort study, which included patients with bipolar disorder or schizoaffective disorder whose medical records were reviewed up to Dec 31, 2017, and the WHO Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, covering a representative sample of the general population in northern Sweden aged 25-74 years. The primary outcome was the age-associated decline of creatinine-based eGFR, assessed using linear regression. We adjusted for sex and grouped for different lengths of lithium exposure (never or <1 year, 1-5 years, >5-10 years, and >10 years). For patients with moderate-to-severe kidney disease we identified the underlying nephropathy in the case records.</p><p><strong>Findings: </strong>From LiSIE, we included 785 patients (498 [63%] female and 287 [37%] male), with a mean age of 49·8 years (SD 13·2; range 25-74). From MONICA, we included 1549 individuals (800 [52%] female and 749 [48%] male), with a mean age of 51·9 years (13·8; 25-74). No ethnicity data were collected. Adjusted for duration of lithium exposure, eGFR declined by 0·57 mL/min/1·73 m<sup>2</sup>/year (95% CI 0·50-0·63) in patients with bipolar disorder or schizoaffective disorder and by 0·57 mL/min/1·73 m<sup>2</sup>/year (0·53-0·61) in the reference population. Lithium added 0·54 mL/min/1·73 m<sup>2</sup> (0·43-0·64) per year of treatment (p<0·0001). After more than 10 years on lithium, decline was significantly steeper than in all other groups including the reference population (p<0·0001). Lithium nephropathy was judged to be the commonest cause of moderate-to-severe chronic kidney disease, but comorbidities played a role. The effect of lithium on eGFR showed a high degree of inter-individual variation.</p><p><strong>Interpretation: </strong>Steeper eGFR decline in patients with bipolar disorder or schizoaffective disorder can be attributed to lithium, but the trajectory of kidney function decline varies widely. Comorbidities affecting kidneys should be treated assertively as one possible means to affect the trajectory. In patients with a fast trajectory, a trade-off is required between continuing lithium to treat mental health problems and discontinuing lithium for the sake of renal health.</p><p><strong>Funding:
背景:锂肾病的临床相关性存在争议。肾功能随年龄和合并症而下降,当错误地归因于锂时,这种下降可能导致归因偏差。我们的目的是调查双相或分裂情感障碍患者的肾小球滤过率(eGFR)是否比一般人群下降得更快,是否观察到下降的陡峭程度的差异可归因于锂,以及这种变化是否取决于锂暴露的时间长短。方法:在这项横断面队列研究中,我们使用了锂离子研究的疗效和副作用(LiSIE)回顾性队列研究的临床数据,其中包括截至2017年12月31日的医疗记录的双相情感障碍或精神分裂情感障碍患者,以及世卫组织监测心血管疾病趋势和决定因素(MONICA)研究,涵盖了瑞典北部25-74岁的普通人群的代表性样本。主要结果是基于肌酐的eGFR的年龄相关性下降,使用线性回归进行评估。我们调整了性别,并根据不同的锂暴露时间(从未、5-10年和>10年)进行分组。对于中度至重度肾病患者,我们在病例记录中确定了潜在的肾病。结果:LiSIE纳入785例患者(女性498例[63%],男性287例[37%]),平均年龄49.8岁(SD 13.2;25 - 74)范围。MONICA共纳入1549例个体(女性800例[52%],男性749例[48%]),平均年龄51.9岁(13.8岁;25 - 74)。未收集种族数据。根据锂暴露时间调整后,双相情感障碍或分裂情感障碍患者的eGFR下降了0.57 mL/min/ 1.73 m2/年(95% CI 0.50 - 0.63),参考人群的eGFR下降了0.57 mL/min/ 1.73 m2/年(0.53 - 0.61)。锂添加量为0.54 mL/min/ 1.73 m2(0.43 - 0.64) /年(解释:双相情感障碍或分裂情感障碍患者的eGFR下降更陡可归因于锂,但肾功能下降的轨迹差异很大。影响肾脏的合并症应作为影响预后的一种可能手段予以果断治疗。在快速发展的患者中,需要在继续使用锂治疗精神健康问题和为了肾脏健康停止使用锂之间进行权衡。资助:瑞典北博滕县研究和学习基金、Visare Norr(北部县议会区域联合会基金)、瑞典肾脏基金会(Njurfonden)、瑞典肾脏协会(Njurförbundet)、北博滕分会。翻译:关于摘要的瑞典语翻译,请参阅补充资料部分。
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引用次数: 12
All-cause and cause-specific mortality among people with severe mental illness in Brazil's public health system, 2000-15: a retrospective study. 2000- 2015年巴西公共卫生系统中严重精神疾病患者的全因和特定原因死亡率:一项回顾性研究
IF 64.3 Pub Date : 2022-10-01 Epub Date: 2022-08-11 DOI: 10.1016/S2215-0366(22)00237-1
Ana Paula Souto Melo, Ilse N Dippenaar, Sarah Charlotte Johnson, Nicole Davis Weaver, Francisco de Assis Acurcio, Deborah Carvalho Malta, Antônio Luiz P Ribeiro, Augusto Afonso Guerra Júnior, Eve E Wool, Mohsen Naghavi, Mariangela Leal Cherchiglia
<p><strong>Background: </strong>People with severe mental illness have a mortality rate higher than the general population, living an average of 10-20 years less. Most studies of mortality among people with severe mental illness have occurred in high-income countries (HICs). We aimed to estimate all-cause and cause-specific relative risk (RR) and excess mortality rate (EMR) in a nationwide cohort of inpatients with severe mental illness compared with inpatients without severe mental illness in a middle income country, Brazil.</p><p><strong>Methods: </strong>This national retrospective cohort study included all patients hospitalised through the Brazilian Public Health System (Sistema Único de Saúde [SUS]-Brazil) between Jan 1, 2000, and April 21, 2015. Probabilistic and deterministic record linkages integrated data from the Hospital Information System (Sistema de informações Hospitalares) and the National Mortality System (Sistema de Informação sobre Mortalidade). Follow-up duration was measured from the date of the patients' first hospitalisation until their death, or until April 21, 2015. Severe mental illness was defined as schizophrenia, bipolar disorder, or depressive disorder by ICD-10 codes used for the admission. RR and EMR were calculated with 95% CIs, comparing mortality among patients with severe mental illness with those with other diagnoses for patients aged 15 years and older. We redistributed deaths using the Global Burden of Diseases, Injuries, and Risk Factors Study methodology if ill-defined causes of death were stated as an underlying cause.</p><p><strong>Findings: </strong>From Jan 1, 2000, to April 21, 2015, 72 021 918 patients (31 510 035 [43·8%] recorded as male and 40 974 426 [56·9%] recorded as female; mean age 41·1 (SD 23·8) years) were admitted to hospital, with 749 720 patients (372 458 [49·7%] recorded as male and 378 670 [50·5%] as female) with severe mental illness. 5 102 055 patient deaths (2 862 383 [56·1%] recorded as male and 2 314 781 [45·4%] as female) and 67 485 deaths in patients with severe mental illness (39 099 [57·9%] recorded as male and 28 534 [42·3%] as female) were registered. The RR for all-cause mortality in patients with severe mental illness was 1·27 (95% CI 1·27-1·28) and the EMR was 2·52 (2·44-2·61) compared with non-psychiatric inpatients during the follow-up period. The all-cause RR was higher for females and for younger age groups; however, EMR was higher in those aged 30-59 years. The RR and EMR varied across the leading causes of death, sex, and age groups. We identified injuries (suicide, interpersonal violence, and road injuries) and cardiovascular disease (ischaemic heart disease) as having the highest EMR among those with severe mental illness. Data on ethnicity were not available.</p><p><strong>Interpretation: </strong>In contrast to studies from HICs, inpatients with severe mental illness in Brazil had high RR for idiopathic epilepsy, tuberculosis, HIV, and acute hepatitis, and no sig
背景:严重精神疾病患者的死亡率高于一般人群,平均寿命少10-20年。大多数关于严重精神疾病患者死亡率的研究都发生在高收入国家。我们的目的是在中等收入国家巴西的一项全国严重精神疾病住院患者队列中,与非严重精神疾病住院患者相比,估计全因和病因特异性相对风险(RR)和超额死亡率(EMR)。方法:这项全国性回顾性队列研究纳入了2000年1月1日至2015年4月21日期间通过巴西公共卫生系统(Sistema Único de Saúde [SUS]-巴西)住院的所有患者。概率和确定性记录链接整合了来自医院信息系统(Sistema de informações Hospitalares)和国家死亡率系统(Sistema de informa o sobre Mortalidade)的数据。随访时间从患者首次住院之日起至患者死亡,或至2015年4月21日止。根据入院时使用的ICD-10代码,严重精神疾病被定义为精神分裂症、双相情感障碍或抑郁症。以95% ci计算RR和EMR,比较15岁及以上严重精神疾病患者与其他诊断患者的死亡率。如果将不明确的死亡原因作为潜在原因,我们使用全球疾病、伤害和风险因素负担研究方法重新分配死亡人数。结果:2000年1月1日至2015年4月21日,共登记患者72 021 918例,其中男性31 510 035例(43.8%),女性40 974 426例(56.9%);平均年龄41.1岁(SD 23.8),其中重度精神疾病749 720例(男性372 458例(49.7%),女性378 670例(50.5%))。共登记了5 102 055例患者死亡(男性2 862 383例(56.1%),女性2 314 781例(45.4%))和67 485例重度精神疾病患者死亡(男性39 099例(57.9%),女性28 534例(42.3%))。与非精神科住院患者相比,重度精神疾病患者全因死亡率RR为1.27 (95% CI 1.27 - 1.28), EMR为2.52(2.44 - 2.61)。全因RR在女性和年轻人群中较高;然而,EMR在30-59岁的人群中较高。RR和EMR因主要死亡原因、性别和年龄组而异。我们确定伤害(自杀、人际暴力和道路伤害)和心血管疾病(缺血性心脏病)在严重精神疾病患者中具有最高的EMR。没有关于种族的数据。解释:与HICs的研究相比,巴西严重精神疾病住院患者的特发性癫痫、结核病、艾滋病毒和急性肝炎的RR较高,癌症死亡率与无严重精神疾病住院患者相比无显著差异。应优先处理这些已查明的原因,以最大限度地预防严重精神疾病患者的死亡,特别是在巴西这样精神卫生投资较少的中等收入国家。资助:比尔和梅林达·盖茨基金会、米纳斯吉拉斯州和平与发展基金会、FAPEMIG、巴西高级和平与发展协调组织、巴西高级和平与发展协调组织。
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引用次数: 11
Social thinning and stress generation after childhood maltreatment: a neurocognitive social transactional model of psychiatric vulnerability. 儿童虐待后社会变薄和压力产生:精神脆弱性的神经认知社会交易模型。
IF 64.3 Pub Date : 2022-10-01 Epub Date: 2022-08-01 DOI: 10.1016/S2215-0366(22)00202-4
Eamon McCrory, Lucy Foulkes, Essi Viding

Childhood maltreatment is associated with significant, enduring risk of psychiatric disorder. In this paper, we review how neurocognitive alterations after maltreatment might indirectly increase the risk of psychiatric disorder via their impact on social functioning. We propose a neurocognitive social transactional model, within which the neurocognitive sequelae of maltreatment are postulated to affect how an individual's social architecture is constructed across development, including the quality and quantity of relationships in an individual's social network. We review extant evidence in two areas in relation to maltreatment: stress generation (a process by which individuals are more likely to experience interpersonal stressor events) and social thinning (an attenuation in the number and quality of relationships over time). We consider how neurocognitive alterations could contribute to these interactive and autocatalytic social processes, which gradually impoverish an individual's actual or potential social environment and ultimately increase psychiatric risk. We conclude by considering the implications of this neurocognitive social transactional model for the prevention of psychiatric disorder after childhood maltreatment.

儿童虐待与显著的、持久的精神障碍风险相关。在本文中,我们回顾了虐待后的神经认知改变如何通过其对社会功能的影响间接增加精神障碍的风险。我们提出了一个神经认知社会交易模型,在该模型中,虐待的神经认知后遗症被假设为影响个体在整个发展过程中如何构建社会结构,包括个体社会网络中关系的质量和数量。我们回顾了与虐待有关的两个领域的现有证据:压力产生(个体更有可能经历人际压力源事件的过程)和社会变薄(随着时间的推移,关系的数量和质量的衰减)。我们考虑神经认知改变如何促成这些相互作用和自催化的社会过程,这些过程逐渐使个人实际或潜在的社会环境变得贫瘠,并最终增加精神风险。我们通过考虑这种神经认知社会交易模型对儿童虐待后精神障碍预防的影响来得出结论。
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引用次数: 16
More than a little sound. 不止是一点点声音。
IF 64.3 Pub Date : 2022-10-01 DOI: 10.1016/S2215-0366(22)00306-6
Michelle Izmaylov
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引用次数: 0
The way forward against intimate partner violence in the Philippines. 菲律宾反对亲密伴侣暴力的前进道路。
IF 64.3 Pub Date : 2022-10-01 DOI: 10.1016/S2215-0366(22)00274-7
Lea Elora A Conda, Gianica Reena S Monteagudo, Bradley Ashley G Ong, Aubrey Melody R Rocimo
{"title":"The way forward against intimate partner violence in the Philippines.","authors":"Lea Elora A Conda,&nbsp;Gianica Reena S Monteagudo,&nbsp;Bradley Ashley G Ong,&nbsp;Aubrey Melody R Rocimo","doi":"10.1016/S2215-0366(22)00274-7","DOIUrl":"https://doi.org/10.1016/S2215-0366(22)00274-7","url":null,"abstract":"","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"e45"},"PeriodicalIF":64.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40365848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Suicide prevention in Syria. 叙利亚的自杀预防。
IF 64.3 Pub Date : 2022-10-01 DOI: 10.1016/S2215-0366(22)00299-1
Sarya Swed, Mohammed Amir Rais, Ahmed Aljabali, Abdelmonem Siddiq, Mohamed Elsayed, Sheikh Shoib
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引用次数: 1
The mental health consequences of indigenous language loss. 土著语言丧失对精神健康的影响。
IF 64.3 Pub Date : 2022-10-01 DOI: 10.1016/S2215-0366(22)00300-5
Md Omar Faruk, Simon Rosenbaum
{"title":"The mental health consequences of indigenous language loss.","authors":"Md Omar Faruk,&nbsp;Simon Rosenbaum","doi":"10.1016/S2215-0366(22)00300-5","DOIUrl":"https://doi.org/10.1016/S2215-0366(22)00300-5","url":null,"abstract":"","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"e46"},"PeriodicalIF":64.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40365849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
期刊
The lancet. Psychiatry
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