Self-selection in epidemiological studies may introduce selection bias and influence the validity of study results. To evaluate potential bias due to self-selection in a large prospective pregnancy cohort in Norway, the authors studied differences in prevalence estimates and association measures between study participants and all women giving birth in Norway. Women who agreed to participate in the Norwegian Mother and Child Cohort Study (43.5% of invited; n = 73 579) were compared with all women giving birth in Norway (n = 398 849) using data from the population-based Medical Birth Registry of Norway in 2000-2006. Bias in the prevalence of 23 exposure and outcome variables was measured as the ratio of relative frequencies, whereas bias in exposure-outcome associations of eight relationships was measured as the ratio of odds ratios. Statistically significant relative differences in prevalence estimates between the cohort participants and the total population were found for all variables, except for maternal epilepsy, chronic hypertension and pre-eclampsia. There was a strong under-representation of the youngest women (<25 years), those living alone, mothers with more than two previous births and with previous stillbirths (relative deviation 30-45%). In addition, smokers, women with stillbirths and neonatal death were markedly under-represented in the cohort (relative deviation 22-43%), while multivitamin and folic acid supplement users were over-represented (relative deviation 31-43%). Despite this, no statistically relative differences in association measures were found between participants and the total population regarding the eight exposure-outcome associations. Using data from the Medical Birth Registry of Norway, this study suggests that prevalence estimates of exposures and outcomes, but not estimates of exposure-outcome associations are biased due to self-selection in the Norwegian Mother and Child Cohort Study.
The risk of psychiatric disorders is elevated among persons who report experiences of discrimination. These associations are more robust for chronic than for acute discrimination and for non-racial than for racial discrimination. Perceived discrimination constitutes an important stressor that should be taken into account in the aetiology of psychiatric disorders.
The objective of the study was to evaluate the response of generalized anxiety disorder (GAD) patients with prominent gastrointestinal (GI) symptoms to pregabalin (PGB) treatment. Data were pooled from six double-blind, placebo (PBO)-controlled, 4-6 week trials in outpatients who met Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria for GAD with a minimum Hamilton Anxiety Rating Scale (HAM-A) total score of 20. Treatment response was evaluated for three PGB fixed-dosage groups: 150, 300-450, and 600 mg/day, and for fixed doses of a benzodiazepine (alprazolam, 1.5 mg/day; lorazepam, 6 mg/day). A GI-high subgroup (high GI symptomatology) was defined by a baseline HAM-A item-11 (GI) score of 3 or greater (severe/very severe). At baseline, 301 patients (16.2%) met criteria for the GI-high subgroup. Baseline characteristics were approximately similar for the four study treatments in the GI-high subgroup. For the GI-high subgroup, last observation carried forward (LOCF) endpoint reduction in HAM-A was significantly higher on PGB-300/450 -13.8+/-1.2 and PGB-600 -14.7+/-1.0 compared with PBO -10.1+/-0.9 (P<0.01 for both comparisons); but the difference on PGB-150 did not achieve significance (-13.5+/-1.6; P=0.083). Also in the GI-high subgroup, endpoint reduction in HAM-A item-11 was significantly higher on PGB-300/450 compared with PBO (-1.93+/-0.16 vs. -1.52+/-0.13; P=0.04), but did not achieve significance on PGB-600 mg (-1.89+/-0.14; P=0.06), or PGB-150 mg (-1.90+/-0.23; P=0.16). In the GI-high subgroup, treatment with a benzodiazepine was not associated with significant endpoint reduction in either the HAM-A total score or the HAM-A item-11 score. Patients in the GI-high subgroup had higher discontinuation rates when treated with benzodiazepines, whereas treatment with PGB 300-600 mg/day was not associated with treatment-emergent worsening in GI symptoms compared with placebo. Treatment with PGB improved overall levels of anxiety, as well as specifically improving GI symptoms.
Read moreArticle AbstractIn March 2004, the US Food and Drug Administration (FDA) issued a public health advisory warning that antidepressant treatment may increase suicidality and worsen depression in adult and pediatric patients. Then, in May 2007, the FDA proposed that the black box warning in the prescribing information for antidepressants and other drugs used to treat depression be updated to include a warning about an increased risk of suicidality in young adults. In January 2008, the FDA announced that antiepileptic medication labeling will be required to include a warning about an increased risk of suicidality.
Read moreLandmark analysis showed substantial improvement in up to 10 years survival after hospitalization for a first AMI. A significantly lower age-adjusted case fatality in women > or =60 years already after 28 days compared with men is specifically noticed.
Read moreGrant, Jon E. MD, JD, MPH; Black, Donald W. MD; Stein, Dan J. MD, PhD; Potenza, Marc N. MD, PhD Author Information
Read moreComputer-assisted CBT programs provide a practice-based system for disseminating evidence-based mental health treatment in primary-care settings while maintaining treatment fidelity, even in the hands of novice clinicians.
Read morePatients suffering from SAD in different parts of the world share many features in common, and certain SSRIs are an effective treatment for this condition globally.
Read moreIdentified determinants accounted for <17% of the overall variation in plasma MMA. The difference in MMA between middle-aged and elderly individuals is only partly explained by creatinine and vitamin B(12) concentrations.
Read moreThese results confirm that the transcriptional profiles of peripheral immune tissues occur in parallel to changes in the brain and contain sufficient information for the efficient diagnostic prediction of stress-related neural states in mice. Future studies will need to evaluate the relevance of the predictor set of 50 genes within clinical settings, specifically within a context of stress-related disorders.
Read moreNo evidence is found to support subtyping SAD on the basis of either number of social fears or number of performance fears versus number of interactional fears.
Read moreBackground. Historically data on substance abuse in South Africa has been limited. This paper describes patterns of substance use based upon recent, nationally representative data. Methods. Data were derived from the 2002-2004 South Africa Stress and Health Study (SASH). A nationally representative household probability sample of 4351 adults was interviewed using the paper and pencil version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Data are reported for lifetime use, socio-demographic correlates of use, and age of cohort predicting lifetime use for four classes of drugs. Results. The estimate for cumulative occurrence of alcohol use was 38.7%; tobacco smoking, 30.0%; cannabis use, 8.4%; other drug use, 2.0% and extra-medical psychoactive drug use, 19.3%. There were statistically significant associations between male gender and alcohol, tobacco, cannabis and other drug use. Coloureds and Whites were more prone to have used alcohol, tobacco and other drugs compared to blacks. Clear cohort variations existed in the age of initiation of drug use; these were most marked for other drugs and for extra-medical drug use. Use of all drug types was much more common in recent cohorts, with a similar cumulative incidence of tobacco, alcohol and cannabis use across age cohorts. Conclusions. These epidemiological patterns of alcohol, tobacco, cannabis, other drugs and extra-medical drug taking provide the first nationally representative data. New findings on race and exploratory data on time trends provide a foundation for future epidemiological work on drug use patterns across birth cohorts and population subgroups in South Africa.
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