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Clinical Diagnosis of Mental Disorders Immediately Before and After Cancer Diagnosis: A Nationwide Matched Cohort Study in Sweden.


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Lu D, Andersson TM, Fall K et al. Clinical Diagnosis of Mental Disorders Immediately Before and After Cancer Diagnosis: A Nationwide Matched Cohort Study in Sweden. JAMA Oncol. 2016; 2: 1188-96. Abstract Importance Psychiatric comorbidities are common among patients with cancer. However, whether or not there is increased risk of mental disorders during the diagnostic workup leading to a cancer diagnosis was unknown. Objective To examine the relative risks of depression, anxiety, substance abuse, somatoform/conversion disorder, and stress reaction/adjustment disorder during the periods before and after cancer diagnosis compared with individuals without cancer. Design, Setting, and Participants Nationwide matched cohort study from January 1, 2001, to December 31, 2010, in a Swedish population and health registers. Main Outcomes and Measures We estimated the time-varying hazard ratios (HRs) of the first clinical diagnosis of the studied mental disorders from 2 years before cancer diagnosis, through the time of diagnosis, and until 10 years after diagnosis, adjusting for age, sex, calendar period, and educational level. To assess milder mental conditions and symptoms, we further assessed the use of related psychiatric medications for patients with cancer diagnosed during 2008-2009. Results The study included 304 118 patients with cancer and 3 041 174 cancer-free individuals who were randomly selected from the Swedish population and individually matched to the patients with cancer on year of birth and sex. The median age at diagnosis for the patients with cancer was 69 years, and 46.9% of the patients were female. The relative rate for all studied mental disorders started to increase from 10 months before cancer diagnosis (HR, 1.1; 95% CI, 1.1-1.2), peaked during the first week after diagnosis (HR, 6.7; 95% CI, 6.1-7.4), and decreased rapidly thereafter but remained elevated 10 years after diagnosis (HR, 1.1; 95% CI, 1.1-1.2). The rate elevation was clear for all main cancers except nonmelanoma skin cancer and was stronger for cancers of poorer prognosis. Compared with cancer-free individuals, increased use of psychiatric medications was noted from 1 month before cancer diagnosis and peaked around 3 months after diagnosis among patients with cancer. Conclusions and Relevance Patients diagnosed as having cancer had increased risks of several common mental disorders from the year before diagnosis. These findings support the existing guidelines of integrating psychological management into cancer care and further call for extended vigilance for multiple mental disorders starting from the time of the cancer diagnostic workup.
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2016-12-16

TRACT Proof of Concept - The Measurable Treatment Plan


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2016-12-08

A Measurable Treatment Plan


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The work was one basis of the TRACT concept: A measurable treatment plan: Using the Children’s Global Assessment and the Problem Severity scales as outcomes of clinical treatment.
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2016-12-08

Open FDA


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Since its launch in June 2014, the impetus for openFDA has been to make it easier to get access to publicly available FDA data. FDA’s goal is to make it simple for an application, mobile device, web developer, or researcher to use data from FDA.
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2016-11-24

Maternal Child Abuse is associated with increased risk of asthma and allergy in their 2-year-old children;


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Maternal History of Childhood Abuse and Risk of Asthma and Allergy in 2-Year-Old Children. Tomfohr-Madsen LM1, Bayrampour H, Tough S. Author information Abstract OBJECTIVES: Exposure to child abuse (CA) is associated with an increased risk of developing asthma and allergies; it is unknown if that risk is present across generations. This study investigated if 2-year-old children born to mothers with a history of CA were at an increased risk of receiving a diagnosis of asthma or allergies. METHODS: Data from 1,551 participants were collected as part of the All Our Babies (AOB) study, a prospective pregnancy cohort. During pregnancy, each woman provided information about her own history of CA, and at 24 months postpartum, she provided information about her child's medical diagnoses. Symptoms of maternal depression and anxiety were assessed during pregnancy and at 24 months postpartum. RESULTS: Unadjusted models showed that compared to children born to mothers without a history of CA, 2-year-old children born to mothers with a history of CA were more likely to have had a diagnosis of asthma (7.4% vs 4.2%, p = .016) or allergy (15.6% vs 9.2%, p < .001). Maternal symptoms of depression assessed in late pregnancy and symptoms of depression and anxiety at 24 months postpartum were significant mediators of the relationship between maternal CA and 2-year-old asthma diagnosis. Maternal symptoms of depression and anxiety assessed in late pregnancy were also significant mediators of the relationship between maternal CA and 2-year-old allergy diagnosis. CONCLUSIONS: The results indicate that maternal exposure to CA is associated with increased risk of asthma and allergy in their 2-year-old children; symptoms of maternal depression and anxiety were identified as pathways linking the variables. PMID: 27763990 DOI: 10.1097/PSY.0000000000000419
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2016-11-14

Statistics in the detection of scientific misconduct.


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The paper by Bolland et al.1 in this issue had a longer “gestation” than usual at Neurology®; it was received on December 4, 2015. We usually review on a tight timeline and publish important work quickly. But this manuscript has a different focus as it presents a statistical analysis that demonstrates probable scientific misconduct (fraud) on a large scale.
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2016-11-11

American Academy press release on Scientific misconduct.


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A new study suggests probable scientific misconduct in at least some of 33 bone health trials published in various medical journals.
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2016-11-11

Spill over viruses


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Throughout the last few decades, diseases that spill over from animals to humans have been on the rise. What’s behind their increase, and can we do anything to combat these dangerous foes? Join scientists as they investigate the rise of spillover viruses like Zika, Ebola and Nipah, and learn what science can do to anticipate and prevent epidemics around the world.
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2016-10-31

WHO Global Surge Training


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WHO Global Surge Training: Testing the “new skeleton” of WHO emergency operations
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2016-10-31

WWF report on species decline


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The global population of wild animals has declined 60 per cent since 1970 and is set to drop another seven per cent by 2020 due to human impact on the environment, according to a WWF report.
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2016-10-31

15 MOOCs for Spanish-speaking healthcare providers


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SOS Telemedicina cursos en línea cuenta con el apoyo de profesionales de la medicina, especialistas en diversas áreas de la salud, capacitados para ofrecer información validada científicamente en apoyo al personal de salud y a la comunidad, haciendo énfasis en la embarazada, las madres, los niños y los adolescentes.
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2016-10-25

Action Mental Health


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Best Essential international mental health resources
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2016-10-24

A Novel Population-Based Health Index for Mental Disorder


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A novel population-based health index was identified, in addition to calculation of the rates of psychiatric disorder in a random sample from a large urban centre.
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2016-10-22

Brain Development and function: Understanding reflexes


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A short audio visual tutortial that provides basic understanding of central nervous system reflexes.
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2016-10-20

Cognitive and memory enhancing drugs


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Since human beings have encounted stimulants, we have been fascinated by the potential effects of substances on cognitive function, memory, and intelligence, as,for example, exemplified in the theme of the film "Limitless". Currently, brain imaging is being used to market supplements that supposedly enhance brain function, memory, and, by implication, intelligence. This is the essence of positivism in a reductionist approach to scientific inquiry. Accordingly, increased brain activity is equivalent to more or better use of the brain somehow and that the absence of activity is equivalent to less effective brain function. Aside from the evidence indicating that the brain can metabolize glucose anaerobicly, as do muscles, who is to say that the surface of the brain does not act more like the retina in terms of integrating in transmitting the signals from impinging light frequencies to the visual cortex: signalling to the brain from the retina is based on inhibition of intrinsic activity. In essence what we see is sculpted by what gets turned off. This was suggested by Pribram in the early 70s as a mechanism by which information enters consciousness. Taking a drug to general increase activity in the brain in a non-specific way has nothing to do with intelligence, and while overall capacity might increase in a transient way, while a drug is active, history has shown us that there is invariably a downside to using stimulants as cognitive enhancers.
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2016-10-19