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Patterns of death among suicide attempters, a psychiatric population and a general population.

This epidemeological study examines patterns of mortality for a population of suicide attempters, a psychiatric population without suicide attempts, and a general population without psychiatric histories in order to clarify earlier reports of differential risks of death associated with these groups. Mortality patterns were investigated over an 11-year period in terms of demographic characteristics and rates of death by various causes. Suicidal deaths were given special attention to identify variables that may have predictive validity for suicide. The results indicate that the suicide attempter group represents a distinctive demographic and mortality entity from either the psychiatric or general populations, and accounts for much of the increased risk of death previously attributed to the psychiatric population. Further, premature deaths due to suicide are strongly associated with the suicide attempter group. The psychiatric and general populations differ in relatively insignificant ways. These results suggest that a profitable approach to the prevention of suicide would be to focus on individuals who were at high risk within the suicide attempter population. Longer-term follow-up of these individuals is necessary if deaths due to suicide are to be prevented. Difficulties associated with implementation of preventive follow-up programs are also discussed.

Accidents

A technique for studying psychiatric morbidity in in-patient and out-patient series and in general population samples.

Many surveys of general populations have suggested a high untreated psychiatric morbidity, vairously referred to as mental illness, pre-clinical neurosis, minor neurosis, untreated depression, etc. An Index of Definition psychiatric disorders is described which incorporates cut-off points on the basis of symptoms rated in the Present State Examination. Eight degrees of definition are specified. At the "borderline disorder" level and above, disorders are sufficiently well defined to apply the CATEGO program of clinical classification. This procedure enables in-patients, out-patients and samples of the general population to be compared. Data from surveys in south-east London are presented in order to illustrate the technique. The main conclusion at this stage is that it is possible to identify, by strictly defined and repeatable procedures, a substantial proportion of people in the general population who have "borderline disorders" that can be tentatively classified in terms of the ICD. Whether it is clinically useful to do so requires further investigation. It is also suggested that techniques of this kind can be scientifically useful in comparing the level of morbidity in various populations, both referred and non-referred, and in testing theories concerned with the causes and treatment of various types of psychiatric disorders.

Ambulatory Care

The psychiatric status schedule as a measure of dimensions of psychopathology in the general population.

The Psychiatric Status Schedule (PSS) is a widely used interview that was designed to improve the research value of clinical judgments. Although it was developed with psychiatric patients, its authors hoped it could be used to evaluate nonpatients, a capability that would make it a much needed tool for epidemiologic research. The present study tests the internal consistency reliability of scales drawn from the PSS in both a general population sample (n. = 133) and a patient sample (n. = 100). Like the PSS's authors, we found a wide variety of clinically meaningful scales reliable for use with patients. In striking contrast, however, most of these proved unreliable in the general population sample. Speculative explanations are offered for the failure of most of the PSS scales in the general population sample and for the success of a few.

Adult

Health conditions in adults with atrial fibrillation compared with the general population: a population-based cross-sectional analysis.

BACKGROUND: Atrial fibrillation (AF) prevalence is rising due to population ageing and comorbidity is an increasing problem. The aim of this study was to examine the prevalence and association of coexisting health conditions among adults with AF in the general population. METHODS: Cross-sectional analysis of Clinical Practice Research Datalink (CPRD) primary care electronic medical records in England linked to hospital admissions as of 30 November 2015. CPRD is broadly representative of the UK general population in terms of age, sex and ethnicity. We estimated prevalence and used logistic regression examining risk factors of age, sex and socioeconomic status (SES) to compare prevalence of 252 physical and mental health conditions and 23 higher level health condition groups in adults with AF compared with adults without AF. RESULTS: 34 338 adults with AF (57% male; 83% ≥65 years) and 907 739 without AF (49% male; 23% ≥65 years) were identified. Adjusted for age and sex, adults with AF were significantly more likely to have 20/23 (87%) health condition groups than adults without AF. The most prevalent health condition groups in adults with AF were cardiovascular (prevalence of 89% in adults with AF vs 26% in adults without AF, adjusted OR (aOR) 5.82, 95% CI 5.60 to 6.05), gastrointestinal (62% vs 37%, aOR 1.34, 95% CI 1.31 to 1.38) and orthopaedic (58% vs 24%, aOR 1.32, 95% CI 1.29 to 1.35). 151/252 individual conditions were significantly more common in adults with AF including cardiovascular conditions such as cardiomyopathy (4.5% vs 0.3%, aOR 9.58, 95% CI 8.88 to 10.35) and heart failure (18% vs 0.7%, aOR 9.07, 95% CI 8.70 to 9.46), and non-cardiovascular conditions such as pleural effusion (16% vs 1.8%, aOR 3.55, 95% CI 3.42 to 3.67) and oesophageal malignancy (0.3% vs 0.0%, aOR 2.14, 95% CI 1.69 to 2.70). Associations were similar after SES adjustment. CONCLUSIONS: While cardiovascular conditions are highly prevalent and strongly associated with AF, a wide spectrum of non-cardiovascular conditions were also strongly associated, requiring a greater understanding of managing comorbid conditions with management principles contradictory to AF.

Humans

Analysis of the cores of asbestos bodies from members of the general population: patients with probable low-degree exposure to asbestos.

Asbestos bodies were isolated from the lungs of 21 patients who had 300 to 9,000 of such bodies/g of lung tissue, a concentration frequently found in manual laborers in the general population who are not primary asbestos workers. All of the 123 bodies examined by electron diffraction produced diffraction patterns consistent with amphibole varieties of asbestos. Electron microprobe analysis (energy dispersive x-ray spectroscopy) of 46 bodies revealed that 38 of the cores were composed of the commercial amphiboles, amosite and crocidolite, whereas only 8 were composed of the noncommercial amphiboles, anthophyllite and tremolite. Review of the occupations of these patients revealed that all but one had blue-collar jobs. For many of these persons, putative sources of asbestos exposure such as construction work could be defined, but for some, the source could not be determined. One woman was apparently exposed to asbestos in the practice of her hobby of ceramics, in which she used anthophyllite-contaminated clay. We concluded that commercial amosite/crocidolite asbestos forms the cores of most asbestos bodies in manual laborers in the general population and that the source is usually occupational.

Adult

Proteomics-Based Soluble Urokinase Plasminogen Activator Receptor Levels Are Associated With Adverse Cardiovascular Outcomes in the General Population: Insights From the UK Biobank.

BACKGROUND: Elevated soluble urokinase plasminogen activator receptor (suPAR) levels are associated with inflammation, immune activation, and major adverse cardiovascular events in coronary artery disease. Encoded by the PLAUR gene, suPAR levels are influenced by the rs4760 genetic variant. Whether proteomics-based suPAR levels predict adverse outcomes in the general population remains unknown. METHODS: Proteomics-based suPAR levels were measured using the Olink Immunoassay in 33&#x2009;963 UK Biobank participants without known coronary artery disease. Fine-Gray and Cox proportional hazards models assessed associations between suPAR and major adverse cardiovascular events (primary outcome: cardiovascular mortality, nonfatal myocardial infarction, or stroke), cardiovascular mortality, and all-cause mortality (secondary outcomes), after adjustment for demographic and clinical risk factors, hs-CRP (high-sensitivity C-reactive protein), and the rs4760 variant. Incremental discrimination was evaluated using C-statistics. RESULTS: Participants were aged 56.4 (SD, 8.2) years; 45% were men, and 93.4% were White. Over a median follow-up of 14&#x2009;years (476&#x2009;177 person-years), 10.7% experienced major adverse cardiovascular events, 2.6% experienced cardiovascular mortality, and 9.4% experienced all-cause mortality. Each 1-SD increment in proteomics-based suPAR was associated with significantly higher risk of major adverse cardiovascular events (hazard ratio [HR], 3.2 [95% CI, 2.9-4.5]), cardiovascular mortality (HR, 5.9 [95% CI, 5.1-6.9]), and all-cause mortality (HR, 5.0 [95% CI, 4.6-5.5]), independent of clinical risk factors and hs-CRP. Additional adjustment for rs4760 did not attenuate these associations. Proteomics-based suPAR significantly improved discrimination beyond clinical risk factors (C-statistic: 0.719 versus 0.732; P<0.001). CONCLUSIONS: Proteomics-based suPAR independently predicts adverse cardiovascular outcomes in the general population, beyond conventional risk factors, hs-CRP, and genetic predisposition to elevated suPAR levels.

Humans

Proteomic discovery analysis of quantitatively assessed emphysema in the general population. The MESA Lung Study.

BACKGROUND: Pulmonary emphysema occurs frequently in older adults, often without airflow limitation. Its presence predicts symptoms, respiratory hospitalizations and deaths, and all-cause mortality. Proteomics may provide further insights into emphysema pathogenesis and inform therapeutic targets. OBJECTIVE: We performed a proteomic discovery analysis of percent emphysema on computed tomography (CT) in a population-based, multiethnic sample from the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study. Replication was performed in two chronic obstructive pulmonary disease (COPD)-based studies, the SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) and the Genetic Epidemiology of COPD (COPDGene) Study. METHODS: MESA recruited participants from the general population in 2000-02. The MESA Lung Study performed full-lung CT scans in 2010-12. Percent emphysema was defined as the percentage of lung voxels&#x2009;<&#x2009;-950 Hounsfield units. Over 7,200 plasma aptamers were measured via SomaScan. Cross-sectional linear and least absolute shrinkage and selection operator (LASSO) regression models were adjusted for demographics, anthropometrics, smoking, renal function, and scanner parameters. Statistical significance was defined as a false discovery rate p-value&#x2009;<&#x2009;0.05. Gene Ontology (GO)/Reactome enrichment analyses were performed. LASSO-selected proteins' predictive performance was evaluated. RESULTS: Among 2,504 participants in the MESA Lung Study, mean age was 69.4&#xa0;years, 1,291 had ever smoked, and median percent emphysema-like lung was 1.4%. In total, 1,234 aptamers were significantly associated with percent emphysema in the MESA Lung Study, and 35 replicated in the SPIROMICS and COPDGene Studies. Novel associations included protein family with sequence similarity (FAM) 177A1, syntenin-2, ubiquitin carboxyl-terminal hydrolase 25, and uncharacterized protein C20orf173. Previously identified emphysema-associated proteins included soluble advanced glycosylation end product-specific receptor (sRAGE), protein S100-A12, high mobility group protein B1, and roundabout homolog 2. Enrichment analyses identified 40 GO biological processes, including chemokine production and regulation and cell-cell adhesion and regulation, and two Reactome pathways, including RAGE signaling. In tenfold cross-validation, novel proteins were largely retained by LASSO (R2&#x2009;=&#x2009;5.4%), improved overall model performance (R2&#x2009;=&#x2009;24.8%), and uniquely explained greater variance in percent emphysema. CONCLUSIONS: This analysis in a general population sample identified novel and previously characterized proteins whose functional roles were validated by GO/Reactome enriched pathways, offering new insights into emphysema pathophysiology and therapeutics.

Humans

[Dispensary ignored schizophrenic disorders detected during clinico-epidemiologic study of older age groups of the general population].

A screening of 1462 individuals over 60 years of age in the general population of one of the districts of a large industrial city, detected 28 individuals (1,6% of all studied individuals), with mental disorders, which could be attributed to the schizophrenic spectrum. However, only in 8 cases (0,6%) they could be considered as psychotic forms of schizophrenia requiring active observation or treatment. In the remaining 15 cases (1% of the studied population) the psychotic states (productive disorders) were rudimentary, with a prevalence of deficitary changes. Most individuals with such disturbances were not in need of constant treatment or regular examinations in the dispensary.

Age Factors

Responses to isoproterenol in a general population sample.

The response of forced expiratory flow to inhalation of isoproterenol was evaluated in a general population sample of 1,063 subjects. Percentage changes in the forced expiratory volume in 1 sec and in the maximal flow measured at 50 percent of the initial expired forced vital capacity appeared to be the best indicators of responsiveness to bronchodilator. Subjects with a history of asthma more often showed responsiveness than did the remainder of the population, even when their initial function was within normal limits. Over-all, a high proportion of subjects with abnormalities in baseline forced expiratory volume in 1 sec or maximal flow after exhalation of 50 per cent of the forced vital capacity showed sufficient improvement after bronchodilator to cause their values after isoproterenol to fall within the normal range. The data suggest that responsiveness to bronchodilator aerosol may be a useful guide to the presence of bronchial reactivity in epidemiologic studies of obstructive airway diseases.

Adult

Immediate skin-test reactivity in a general population sample.

To assess the prevalence and distribution of allergic skin-test reactions in a general population sample, allergy prick tests were applied to 3101 subjects older than 2 years of age. Test materials included allergens common to the Tucson environment, and subjects were randomly stratified by age, sex, and socioeconomic status. No difference in the prevalence of measurable reactions was found among male subjects versus female subjects. A definite age relation was apparent, however, with the peak prevalence of reactivity (more than 40%) occurring during the third decade, and falling rapidly past age 50. When present, reactions tended to be multiple, highly reproducible, and more frequent among those in the higher socioeconomic strata. The prick test was judged to be a useful tool for the assessment of atopy.

Age Factors

The epidemiology of hyperlipoproteinemia in a Rumanian general population sample. Study of 7,085 cases.

Using a two stages screening method the prevalence in the general population of hyperlipoproteinemias (HLP), separated in the five types proposed by Fredrickson, Levy and Lees, and adopted by WHO has been studied. The study included 7,085 subjects of both sexes, aged 25-65 years, representing 84,52 % of a population taken at random within a district of Bucarest. HLP was found in 1,013 cases, i.e. 14,29 % of the investigated population. 48.37 % were men and 51.63 % women. The prevalence of HLP was lowest in the first decace of age studied (25-35 years) and highest in the last two decades (45-65 years). Overweight was more frequently encountered in these patients (64.46 %) than in the total population (32.3 %). Of the 1,013 cases with HLP, 42.35 % (6.05 % of the total population) were of type IV, 27.05 % (3.86 % of the total population) of type II-b, 22.80 % (3.26 % of the total population) of type II-a, 4.74 % (0.67 % of the total population) of the type III and 3.06 % (0.43 % of the total population) of the type V. 22.70 % of the HLP patients were considered primary familial HLP, 66.54 % primary non-familial HLP and 10.76 % secondary HLP; IN 109 secondary HLP, the most frequently encountered disease was diabetes mellitus (42.20 %), followed by hypothyroidism (24.77 %), alcoholism (12.84 %), obstructive liver diseases (9.17 %), pancreatitis (5.50 %), nephrotic syndrome (2.75 %) and treatment with estrogens and steroids (2.75 %).

Adult

Echocardiographic spectrum of posterior systolic motion of the mitral valve in the general population.

The prevalence of mitral valve prolapse has been established in selected groups of patients but not in the general population. The present study was designed to define the echocardiographic spectrum of mitral valve motion in a population of young individuals without clinical evidence of significant cardiac disease or hypertension. Echocardiograms were performed on 136 normal volunteers. Six subjects (4.4 per cent) had mitral valve prolapse. Eighteen subjects (13.2 per cent) had a lesser degree of posterior systolic motion of the mitral valve leaflets which was suggestive but not diagnostic of prolapse. Minor degrees of posterior systolic mitral valve motion may represent a variant of normal. Caution should be exercised in making the echocardiographic diagnosis of mitral prolapse until this question is settled.

Adolescent

International consensus guidance for general population screening for islet autoantibodies to diagnose early-stage type 1 diabetes: a nominal group technique process.

Type 1 diabetes is an autoimmune disease that targets and destroys insulin-producing beta cells in the pancreatic islets. The incidence of type 1 diabetes is rising globally. At the clinical diagnosis of type 1 diabetes, between 20% and 67% of children and adolescents present with diabetic ketoacidosis (DKA) requiring hospitalisation, and one-third of these require intensive care. Type 1 diabetes can be detected in early stages, prior to the insulin-requiring clinical diagnosis, through screening for islet autoantibodies (IAbs). Identifying individuals with early-stage type 1 diabetes, combined with monitoring of and education on disease progression, prevents DKA and results in a milder clinical onset. This allows for timely insulin initiation in outpatient settings and improved long-term glucose management. Early diagnosis also enables access to novel disease-modifying therapies that can delay the clinical onset of diabetes. In this international consensus, we provide guidance on the principles and practice of implementing general population screening for IAbs to diagnose early-stage type 1 diabetes. We also outline the minimum requirements for establishing effective population screening programmes to diagnose early-stage type 1 diabetes through IAb detection. This consensus statement has been endorsed by the following professional associations: Advanced Technologies & Treatments for Diabetes (ATTD); Association of Diabetes Care and Education Specialists (ADCES); Association Belge Du Diab&#xe8;te; Associazione Medici Diabetologi (AMD); Australian Diabetes Society (ADS); Belgian Diabetes Liga; Breakthrough T1D; Czech Diabetes Society (&#x10c;DS); EASD; Finnish Diabetes Association (FDS); Fondazione Italiana Diabete (FID); International Diabetes Federation (IDF)-Europe; International Society of Paediatric and Adolescent Diabetes (ISPAD); Paediatric Endocrinology Nursing Society (PENS); Polish Diabetes Society; Portuguese Diabetes Association (APDP); Sociedade Portuguesa de Diabetologia (SPD); Societ&#xe0; Italiana di Diabetologia (SID); Soci&#xe9;t&#xe9; Francophone du Diab&#xe8;te (SFD) and Type 1 Diabetes Exchange (T1D Exchange).

Consensus report

Recent results of health examinations on the general population in cadmium-polluted and control areas in Japan.

Health examinations by a revised method aimed at detecting renal tubular dysfunctions more effectively were conducted on the general population aged 50 years and over in cadmium-polluted areas (1826 persons) and control areas (1611 persons) in four prefectures in Japan in 1976. Although detailed analysis of the data is not yet completed, some of the results obtained are described here. The prevalence of glucosuria and low molecular weight proteinuria, frequency of decreased % TRP, and cadmium concentrations in urine are higher in the cadmium-polluted areas than in the controls. Clinically diagnosed cases with tubular dysfunctions seem to follow the same trend as above, though these cases are very few in number and they are limited to the advanced age group. When cadmium concentration in rice is taken as an index, a dose-response relationship is not necessarity explicit in the observations by prefecture. However, suggestive data are obtained in the observation by district in one cadmium-polluted area.

Adult

Suicide in schizophrenics, manics, depressives, and surgical controls. A comparison with general population suicide mortality.

This article reports suicide risk among 200 schizophrenic, 100 manic, and 225 depressive patients, and 160 surgical controls. The suicide experience of the study subjects was compared to that of the population of the state of Iowa, the geographical area and population from which the subjects were selected. The suicide experience of the surgical controls was not significantly different from that of the general population. On the other hand, increased risk of suicide was found in all psychiatric groups except female schizophrenics. Suicide appeared pronounced particularly in male patients with affective disorders during the first decade of the follow-up period.

Adult

Measurements of drinking patterns in the general population and possible applications in studies of the role of alcohol in cancer.

Quantitative information on alcohol consumption patterns derives from four possible sources: indirect measures, observational studies, aggregate consumption statistics, and sample surveys of general populations. The potentials and problems of each method are briefly discussed, with primary attention to the various traditions of survey questioning and data analysis. While medically oriented epidemiologists have often used only an overall drinking volume measure, social scientists have pointed to the importance also of variability in characterizing drinking, particularly in relation to social and casualty as opposed to chronic health problems with drinking. The dimensions of drinking patterns which might be relevant to hypothesized linkages of alcohol and cancer are discussed. It is suggested that measurement will need to extend beyond volume of drinking and may indeed involve studies of new kinds of dimensions in the patterning of drinking.

Alcohol Drinking

The SELENOP Polymorphism rs7579 Predicts Hepatic Steatosis in Females With Insulin Resistance in the General Population.

CONTEXT: Selenoprotein P is a hepatokine associated with several metabolic processes. Rs7579 (C > T) is a SeP-related functional single nucleotide polymorphism. OBJECTIVE: In this study, we aimed to identify the environmental factors affecting the relationship between rs7579 and metabolic diseases, such as metabolic dysfunction-associated steatotic liver disease, in the general population. METHODS: This cross-sectional study was based on the Shika Study, a survey of residents in the Noto Peninsula of Ishikawa Prefecture. We analyzed a total of 900 adults, measuring full-length selenoprotein P (FL-SeP) serum levels using a sol-particle homogeneous immunoassay. RESULTS: We observed that selenium and FL-SeP serum levels were associated with dyslipidemia. In males, serum selenium was associated with dyslipidemia and hepatic steatosis. However, in females, FL-SeP tended to be associated with diabetes. Participants carrying the TT genotype and hepatic steatosis exhibited higher levels of liver enzymes, insulin, the homeostatic model assessment of insulin resistance (HOMA-IR), and the homeostasis model assessment of &#x3b2;-cell function than those without hepatic steatosis or with other genotypes. In females carrying the TT genotype of rs7579, hepatic steatosis, hypertension, diabetes, obesity, and metabolic syndrome were associated with higher HOMA-IR levels. CONCLUSION: In this study, we revealed that the association between metabolic diseases and HOMA-IR differed single nucleotide polymorphism genotype and sex dependently. In females carrying the TT genotype of rs7579, hepatic steatosis-associated metabolic disorders (diabetes, hypertension, obesity, and metabolic syndrome) were associated with higher HOMA-IR. The results of this study open the way to genetic signatures-based personalized preventive medicines.

CCDC152

Polygenic risk scores and lifestyle factors predicting new onset of type 2 diabetes in the Japanese general population.

PURPOSE: This study investigated the association of polygenic risk scores (PRS) and lifestyle factors with type 2 diabetes mellitus development in Japanese populations and evaluated whether PRS can improve diabetes risk prediction beyond traditional risk factors. METHODS: We conducted a cross-sectional and a longitudinal study using the Shika resident cohort (n = 895) and the Toshiba worker cohort (n = 7019), respectively. Participants were categorized into low, intermediate, and high genetic risk groups using PRS constructed with genome-wide association study data from East Asian populations. We defined diabetes based on hemoglobin A1c, fasting blood glucose, self-reported diagnosis, or medication use. The associations of PRS and lifestyle factors with diabetes development were analyzed using multivariate logistic regression and Cox proportional hazards models. RESULTS: Higher PRS were associated with increased diabetes risk in both cohorts (resident cohort: odds ratio 4.51, 95% CI 2.53-8.04; worker cohort: hazard ratio 1.50, 95% CI 1.23-1.83 for high vs low PRS), which remained consistent across age, body mass index, and comorbidities. Regular exercise, absence of hypertension, and absence of dyslipidemia were associated with lower diabetes risk, particularly in the high PRS group. The addition of PRS to conventional prediction models improved the discrimination of diabetes risk. MAIN CONCLUSION: PRS are associated with diabetes risk in Japanese general populations, independent of traditional risk factors. Nonetheless, healthy lifestyle habits may reduce diabetes risk even among genetically susceptible individuals, which support the utility of PRS for personalized diabetes risk assessment and prevention strategies.

Adult