Purpose: AMI hospitalizations account for almost 90% of all AMI occurrences. They encompass incident and recurrent events; the first reflecting primary prevention and the second in-hospital care and secondary prevention. Our aim was to examine AMI hospitalization trends during 1994-2009 in Norway. Methods: All AMI hospitalizations during 1994-2009 were extracted from Cardiovascular disease in - CVDNOR, a research project including information on all patients hospitalized for a CVD event 1994-2009. First and recurrent hospitalizations were included. Overall age-standardized and age group specific hospitalization rates were calculated. Trends over time were explored by Poisson regression analyses, computing hospitalization rate ratios (HRR). Changes are reported separately for 1994-2000 and 2001-2009, to minimize the effect of changes in AMI diagnostic criteria (troponin introduction) around 2000-2001. Results: 241 207 AMI hospitalizations (39% women) were included. Overall, age-standardized hospitalization rates declined during 2001-2009 (HRR=0.93; 95% CI 0.92-0.95). In young adults (< 45 years) rates increased during 1994-2009; not significantly during 1994-2000 and significantly thereafter (HRR=1.11; 95% CI 1.01-1.21). In age group 85+ years, rates increased during 1994-2000 (HRR=1.53; 95% CI 1.45-1.62) but not thereafter. A decline was observed in age group 45-64 years only during 1994-2000 (HRR=0.90; 95% CI 0.87-0.94). In age group 65-84 years there was a decline both for 1994-2000 (HRR=0.96; 95% CI 0.93-0.98) and 2001-2009 (HRR=0.85; 95% CI 0.84-0.87) ![Figure][1] Age-standardized hospitalization rates Conclusion: Overall AMI hospitalizations rates in Norway declined after 2000, due to declining rates among patients 45-84 years. Increasing trends were observed in young adults and elderly over 85 years. [1]: pending:yes

The availability of a range of new psychotropic agents raises the possibility that these will be used for enhancement purposes (smart pills, happy pills, and pep pills). The enhancement debate soon raises questions in philosophy of medicine and psychiatry (eg, what is a disorder?), and this debate in turn raises fundament questions in philosophy of language, science, and ethics. In this paper, a naturalistic conceptual framework is proposed for addressing these issues. This framework begins by contrasting classical and critical concepts of categories, and then puts forward an integrative position that is based on cognitive-affective research. This position can in turn be used to consider the debate between pharmacological Calvinism (which may adopt a moral metaphor of disorder) and psychotropic utopianism (which may emphasize a medical metaphor of disorder). I argue that psychiatric treatment of serious psychiatric disorders is justified, and that psychotropics are an acceptable kind of intervention. The use of psychotropics for sub-threshold phenomena requires a judicious weighing of the relevant facts (which are often sparse) and values.

Drop out needs to be reduced to ensure effective treatment.

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Choline, obtained from diet and formed by biosynthesis, is the immediate precursor of betaine. Animal studies suggest an impact of choline on bone metabolism. We examined the associations of plasma choline and betaine with bone mineral density (BMD), the risk of hip fractures, and possible effect-modification by nicotine exposure. The Hordaland Health Study (1998 to 2000) included 7074 women and men (ages 46 to 49 or 71 to 74 years). In 5315, BMD was measured. The oldest (n = 3311) were followed for hip fractures through 2009. Risk associations were studied by logistic and Cox regression by comparing the lowest and middle tertiles with the highest, as well as trends across tertiles of plasma choline and betaine. In analyses adjusted for sex and age, participants in the lowest (odds ratio [OR] = 2.00, 95% confidence interval [CI] 1.69-2.37) and middle (OR = 1.39, CI 1.17-1.66) tertiles of plasma choline had an increased risk of low BMD (lowest quintile) (p trend < 0.001). Separate analyses for sex and age groups revealed the strongest relations in elderly women (lowest tertile: OR = 2.84, CI 1.95-4.14; middle tertile: OR = 1.80, CI 1.22-2.67, p trend < 0.001), and highest OR among those in the lowest tertile who were exposed to nicotine (OR = 4.56, CI 1.87-11.11). Low plasma choline was also associated with an increased risk of hip fracture in elderly women and men (lowest tertile: hazard ratio [HR] = 1.45, CI 1.08-1.94; middle tertile: HR = 1.13, CI 0.83-1.54, p trend = 0.012). In elderly women, the HR for hip fracture was 1.90 (CI 1.32-2.73) and 1.36 (CI 0.92-1.99) (p trend < 0.001) for lowest and middle tertiles of choline, and the highest HR was found among women in the lowest tertile exposed to nicotine (HR = 2.68, CI 1.16-6.19). Plasma betaine was not related to BMD or hip fracture. Low plasma choline was associated with low BMD in both sexes and increased the risk of hip fracture in elderly women. These results should motivate further studies on choline, nicotine exposure, and bone metabolism.

Purpose: To study potential differences in survival across levels of education in patients hospitalized for an incident acute myocardial infarction (AMI) during 2001-2009 in Norway. Methods: The Cardiovascular Disease in Norway (CVDNOR) project have collected data on all AMI hospitalizations between 1994 and 2009 through patient administrative systems at Norwegian hospitals and linked the data to the Cause of Death Registry, the Population Registry and the National Education Database. Incident AMI was defined as a hospitalization with an AMI-diagnosis (ICD9:410, ICD10: I21-I22) without any AMI-events the previous 7 years. Education were categorized as basic or no education, upper secondary education and tertiary education (college/university). Differences in 28-day and 1-year survival after an incident AMI across education levels where studied using Kaplan-Meier survival curves and Cox regression with adjustment for age, sex, calendar year, marital status and country of birth. Patients were followed until December 31st 2010. Results: 113 797 incident AMIs were identified (39.5% women). Median follow-up time was 5.4 years. Adjusted HRs (95% CI) for tertiary vs. basic education for 28-day and 1-year survival were 0.84 (0.80-0.89) and 0.82 (0.79-0.86). P-trend across the three educational groups were <0.001. Stratification on calendar year revealed increasing disparities in survival across educational groups during 2001-2009. Stratification on gender and age group (30-64 and ≥65) showed stronger associations between education and survival among women aged 30-64. 1-year survival after incident AMI 1-year survival after incident AMI Conclusion: Compared to patients with higher education, those with only basic education had significantly poorer 28-day and 1-year survival after an incident AMI. The disparities were largest among women < 65 years of age.

Commentary on: Sesso HD, Christen WG, Bubes V, et al. Multivitamins in the prevention of cardiovascular disease in men: the Physicians' Health Study II randomized controlled trial. JAMA 2012;308:1751–60.[OpenUrl][1][CrossRef][2][PubMed][3] Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Behavioural risk factors, including tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol, are estimated to be responsible for about 80% of coronary heart disease and cerebrovascular disease.1 Until 2000, observational studies found inverse associations between vitamin intake and CVD outcomes. Thus, randomised controlled clinical trials (RCTs) were needed to test the effect of vitamin supplementation in primary or secondary prevention of CVD.2 The Physicians' Health Study II (PHSII) RCT is the largest to date, … [1]: {openurl}?query=rft.jtitle%253DJAMA%26rft.stitle%253DJAMA%26rft.issn%253D0002-9955%26rft.aulast%253DSesso%26rft.auinit1%253DH.%2BD.%26rft.volume%253D308%26rft.issue%253D17%26rft.spage%253D1751%26rft.epage%253D1760%26rft.atitle%253DMultivitamins%2Bin%2Bthe%2Bprevention%2Bof%2Bcardiovascular%2Bdisease%2Bin%2Bmen%253A%2Bthe%2BPhysicians%2527%2BHealth%2BStudy%2BII%2Brandomized%2Bcontrolled%2Btrial.%26rft_id%253Dinfo%253Adoi%252F10.1001%252Fjama.2012.14805%26rft_id%253Dinfo%253Apmid%252F23117775%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1001/jama.2012.14805&link_type=DOI [3]: /lookup/external-ref?access_num=23117775&link_type=MED&atom=%2Febmed%2F18%2F6%2F218.atom

Although skin picking has been documented in the medical literature since the 19th century, only now is it receiving serious consideration as a DSM psychiatric disorder in discussions for DSM-5. Recent community prevalence studies suggest that skin picking disorder appears to be as common as many other psychiatric disorders, with reported prevalences ranging from 1.4% to 5.4%. Clinical evaluation of patients with skin picking disorder entails a broad physical and psychiatric examination, encouraging an interdisciplinary approach to evaluation and treatment. Approaches to treatment should include cognitive-behavioral therapy (including habit reversal or acceptance-enhanced behavior therapy) and medication (serotonin reuptake inhibitors, N-acetylcysteine, or naltrexone). Based on clinical experience and research findings, the authors recommend several management approaches to skin picking disorder.

The TPB may be a useful theoretical model for predicting the referral practices of traditional healers. The empirical data here may be useful for future work designing interventions to provide traditional healers with the information and skills they require to appropriately refer patients with mental illness.

Objectives: We describe the incidence of chronic laryngitis (CL) and identify the most common presenting symptoms and initial treatments used. Methods: We retrospectively identified patients with a diagnosis of CL who were seen among a primary care cohort at an urban academic medical center from 2009 to 2010. The incidence of CL was calculated. Symptoms, first-visit treatment, smoking, and demographics were recorded. Results: Of a population of 40,317 people, 280 received a new diagnosis of CL over a 2-year period, representing a yearly incidence of 3.47 cases per 1,000 people. The subjects consisted of 160 women and 120 men. Race was recorded as black (126), Hispanic (47), white (68), or other (39). The mean age was 52.9 years (range, 20 to 90 years). The initial therapies included proton pump inhibitors (79%), voice therapy (17%), nasal steroid (13%), antihistamine (4%), amitriptyline (4%), other (17%), and none (11%). The most common symptoms were dysphonia (53%), pain/soreness (45%), globus sensation (40%), cough (33%), excessive throat clearing (28%), and dysphagia (32%). An otolaryngologist saw 93% of the cases. Conclusions: The yearly CL incidence was 3.47 per 1,000 people. Up to 21% of the population may develop CL in their lifetime. Most of the patients in this cohort were referred to otolaryngologists, and the majority were treated with proton pump inhibitors. Dysphonia, globus sensation, and pain were the most common symptoms. Population surveys could be used to define undiagnosed disease and the overall prevalence of CL.

Advances in the basic neuroscience of fear conditioning and extinction, as well as in the clinical neuroscience of posttraumatic stress disorder (PTSD), have laid the foundations for research on the pharmacotherapy of PTSD. Clinical trials have ranged from early work on tricyclic antidepressants and benzodiazepines through to more recently introduced antidepressants, and on to a range of other psychotropic agents. Despite the growing database of trials, the area remains a controversial one insofar as key systematic reviews in the field have emphasized the methodological limitations of existing work. Here, we briefly review the existing literature on the pharmacotherapy of PTSD, attempting to highlight key clinical lessons, and important areas for future research.

Brief depression screening instruments in both general and HIV-PHC are as accurate as the long ones. Brief scales may have an edge over the longer instruments since they can be administered in a much shorter time. However, because the ultra brief scales do not include the whole spectrum of depression symptoms including suicide, their use should be followed by a detailed diagnostic interview.