Overall we found a strong and coherent relationship between self-reported folic acid use and plasma folate at week 18. We also found that plasma folate at week 18 did not reflect self-reported supplementation before week 8. For periconceptional supplementation per se, self-report data may offer a better measure.

Methyl group donors and intermediates of one-carbon metabolism affect DNA synthesis and DNA methylation, and may thereby affect prostate carcinogenesis. Choline, the precursor of betaine, and the one-carbon metabolite sarcosine have been associated with increased prostate cancer risk. Within JANUS, a prospective cohort in Norway (n = 317,000) with baseline serum samples, we conducted a nested case-control study among 3,000 prostate cancer cases and 3,000 controls. Using conditional logistic regression, odds ratios (ORs) and 95% confidence intervals (CIs) for prostate cancer risk were estimated according to quintiles of circulating betaine, dimethylglycine (DMG), sarcosine, glycine and serine. High sarcosine and glycine concentrations were associated with reduced prostate cancer risk of borderline significance (sarcosine: highest vs. lowest quintile OR = 0.86, CI = 0.72-1.01, p(trend) = 0.03; glycine: OR = 0.83, CI = 0.70-1.00, p(trend) = 0.07). Serum betaine, DMG and serine were not associated with prostate cancer risk. However, individuals with a high glycine/serine ratio were at decreased prostate cancer risk (OR = 0.74, CI = 0.69-0.85, p(trend) < 0.001). This population-based study suggested that men with high serum sarcosine or glycine concentrations have modestly reduced prostate cancer risk. Ratios of metabolites reflecting one-carbon balance may be associated with prostate cancer risk, as demonstrated for the glycine/serine ratio, and should be explored in future studies.

"No health without mental health" has become a rallying call for the World Health Organization and numerous service providers, training institutions, health researchers, and advocacy groups around the world. It is timely to consider the implications of this call for South Africa. We review key evidence regarding the burden and risk factors for mental disorders in South Africa and crucial challenges for local mental health services and research. We emphasize that mental disorders are more impairing but less treated than physical disorders, and that existing services need to be scaled up and adapted to the local context. New research is needed to determine what interventions work best in the South African context.

Most previous studies have shown that women with pregestational type 1 diabetes are at considerably higher risk of pregnancy complications and adverse pregnancy outcomes compared with women without diabetes. Few population-based studies have investigated the risk of perinatal death among women with type 1 diabetes separately in term and preterm births. The primary aim of this population-based study was to compare the risk of stillbirth, infant death, preterm delivery, and preeclampsia between women with pregestational type 1 diabetes and a background population of women without diabetes. A secondary aim was to examine the risks of adverse birth outcomes in preterm and term deliveries separately. Data were obtained by linking the Medical Birth Registry of Norway and the Norwegian Childhood Diabetes Registry for all births occurring after 22 weeks of gestation between 1985 and 2004. The study cohort included 1307 babies born to mothers with type 1 diabetes in the Diabetes Registry during the study period; the background comparison group included 1,161,092 babies born during the same period to mothers without type 1 diabetes. Logistic regression was used to estimate risks of adverse birth outcomes in the 2 groups, adjusting for potential confounding variables. Stillbirth and perinatal death occurred about 3 times more often among the pregnancies in women with type 1 diabetes than those in the background population; the odds ratio (OR) for stillbirth (≥22 weeks of gestation) was 3.6 (95% confidence interval [CI], 2.5–5.3) and for perinatal death (stillbirth or death in the first week of life) was 2.9 (95% CI, 2.0–4.1). The risk of infant death in the first year of life in the diabetes group was twice that of the background population (OR, 1.9; 95% CI, 1.1–3.2). With respect to preterm birth (<37 weeks of gestation) and preeclampsia, the risks were approximately 5 to 6 times higher; the ORs were 4.9 (95% CI, 4.3–5.5) and 6.3 (95% CI, 5.5–7.2), respectively. Adjustment for potential confounding variables had little effect on the data. Stratified analyses of the risk of mortality and other adverse birth outcomes separately for preterm and term births showed that the excess mortality risk was confined to term births with approximately a 5-fold increased risk of stillbirth and infant mortality. These findings show a substantially higher risk of adverse pregnancy outcomes, including infant death, among women with pregestational type 1 diabetes compared with the background population. The increased risk of adverse outcomes appears limited to term births.

These data support the proposed diagnostic criteria for HPD in adults. Although most adult patients have urges to pull or experience a sense of relief on pulling, as in the case of skin-picking disorder, such phenomena are not universal and so should not be included in the diagnostic criteria. An additional criterion focused on repeated attempts to decrease or stop hair-pulling seems warranted.

HIV-associated neurocognitive disorders (HAND) remain prevalent, especially in regions like South Africa where HIV prevalence is high but access to antiretroviral treatment (ART) is limited. The incidence of HIV dementia (HAD) has been halved with the use of ART, but the prevalence remains high. Appropriate brief screening tools to screen for HAD are needed in order to facilitate treatment initiation. The validity of the International HIV Dementia Scale has not been established in a region where infection with HIV clade C is predominant. The International HIV Dementia Scale (IHDS) was administered together with a detailed neuropsychological test battery to 96 HIV-positive individuals who had not received ART and who were attending primary care HIV clinics. The validity of the IHDS was established using a receiver operating characteristic (ROC) analysis. HIV-positive individuals displayed greater impairment when compared to HIV-negative controls on the IHDS and a range of neuropsychological tests. Neuropsychological tests discriminated well across HAND categories for HIV-positive individuals. In ROC analysis, the IHDS showed an area under the curve of 0.64, with a sensitivity of 45% and specificity of 79% at a cutoff score of 10. Individuals with HAD, who screened negative on the IHDS, performed poorly on some tests of executive function. These data suggest that the IHDS may have limitations as a tool to screen for HAD in South Africans infected with HIV. Variable performance in neuropsychological testing may account for false negative screens. The inclusion of brief tests of executive function in a screening battery should be considered.

This study is the largest to date investigating the effects of polymorphisms affecting smoking behavior on lung cancer risk using circulating cotinine measures as proxies for recent smoking behavior.

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During the 2009 influenza A (H1N1) pandemic, pregnant women were vulnerable to severe influenza, with increased risks of adverse fetal outcomes and maternal death. Pregnant women were advised to be vaccinated in the second or third trimester. After this pandemic, national health data were used to assess the effectiveness of pandemic vaccine in pregnant women and the effect of vaccination or influenza on fetal survival. Information on women of reproductive age in Norway was linked to national health registries. Of 1,153,738 females, aged 13 to 49 years, 117,026 gave birth in 2009 or 2010. The analyses included 113,331 women. The main pandemic wave in Norway occurred between October 1 and December 31, 2009. Exposure to influenza was defined as a contact with a primary care physician that led to a diagnosis of influenza with the gestational day as the time metric and vaccination and pandemic exposure as time-dependent exposure variables. Fetuses of mothers who were unvaccinated, vaccinated before pregnancy, or vaccinated on the day of delivery or thereafter were classified as unexposed to the vaccine. Hazard ratios (HRs) were estimated. The primary end point was fetal death. In 2009 and 2010, 117,347 births were recorded among women who became pregnant during the eligible time window, including 570 fetal deaths (4.9/1000 births). Of 113,331 eligible singleton pregnancies, 492 ended in fetal death (4.3 deaths/1000 births). Among 99,539 women who delivered outside the pandemic window, 410 fetal deaths occurred (4.1 deaths/1000 births). Pandemic vaccinations began in October 2009, and 97% of vaccinations were given by December 31, 2009. A total of 25,976 children were born after their mothers were vaccinated during pregnancy; 78 fetal deaths occurred. Among 87,335 women pregnant during the pandemic but unvaccinated, 414 fetal deaths were reported. Of 46,491 women in the second or third trimester during the pandemic wave, 54% were vaccinated. A clinical diagnosis of influenza during the pandemic was made for 2278 eligible pregnant women, among whom 16 fetal deaths occurred. Of 516 women with positive laboratory results for the A(H1N1)pdm09 strain, 5 fetal deaths occurred. Vaccination during pregnancy reduced the risk of receiving a clinical diagnosis of influenza (adjusted HR, 0.30). Women who were exposed to the pandemic had an increased risk of fetal death (adjusted HR, 1.26) as did women with a clinical diagnosis of influenza (adjusted HR, 1.91). Unvaccinated women had a higher risk of fetal death during the pandemic (HR, 1.25). One fetal death occurred among 40 pregnant women hospitalized with influenza during the pandemic. No association was found between vaccination and preterm delivery, low birth weight at term, and low Apgar score at term. This study found no evidence that influenza vaccination of pregnant women increased the risk of fetal death. For pregnant women who had a clinical diagnosis of influenza, the risk of fetal death nearly doubled. Given the danger posed by maternal influenza virus infection for fetal survival, these results provide additional evidence that vaccination of pregnant women during an influenza pandemic does not harm, and may benefit, the fetus. Withholding influenza vaccination from pregnant women in their second or third trimester has no basis, given that these women can be vulnerable to the severe effects of influenza.

Aim This study assessed the efficacy of agomelatine (1,2,3), in the prevention of relapse in non-depressed out-patients with DSM-IV-TR defined Generalized Anxiety Disorder (GAD) and the tolerability. Methods GAD patients received open label agomelatine (25–50 mg/day). At week 4 the dose was increased for patients with insufficient improvement (blinded criteria). At week 16, responders were randomised to maintenance treatment with either agomelatine, or placebo for a 26 week period. Then, agomelatine treated-patients were re-randomised to an agomelatine arm or to a placebo arm, to confirm the lack of discontinuation symptoms (on the DESS check-list). The primary outcome was the time to relapse (days) during the 26 week double-blind treatment period, as estimated using the Kaplan-Meier method. Relapse was defined as HAMA total score &gt; = 15 or withdrawal for lack of efficacy (in the investigator's opinion, based on both HAM-A and CGI scores). Results 477 patients entered the open-label phase and 329 completed this period. 228 patients were randomly assigned to receive agomelatine (114 patients) or placebo (114 patients). The incidence over time of relapse was significantly lower with agomelatine compared to placebo (19.7% versus 31.7% log rank test p = 0.046) during the double-blind treatment period. During the double-blind treatment period 12.4% patients with agomelatine and 9.6% with placebo reported at least one emergent adverse event related to the study treatment. There was no discontinuation syndrome in agomelatine treated patients. Conclusion Agomelatine was efficacious in preventing relapse in GAD, with maintenance of efficacy over 6 months, and good tolerability.

To our knowledge, this is the first controlled evidence of the efficacy of olanzapine monotherapy in an exclusively non-combat related chronic PTSD group. Despite the small sample size, these data suggest that olanzapine may have a role in the treatment of PTSD. These findings warrant replication in a larger sample.