Anatomic site variability in rat skeletal uptake and desorption of fluorescently labeled bisphosphonate

OBJECTIVES

Bisphosphonates commonly used to treat osteoporosis, Paget's disease, multiple myeloma, hypercalcemia of malignancy and osteolytic lesions of cancer metastasis have been associated with bisphosphonate-associated jaw osteonecrosis (BJON). The underlying pathogenesis of BJON is unclear, but disproportionate bisphosphonate concentration in the jaw has been proposed as one potential etiological factor. This study tested the hypothesis that skeletal biodistribution of intravenous bisphosphonate is anatomic site-dependent in a rat model system.

MATERIALS AND METHODS

Fluorescently labeled pamidronate was injected intravenously in athymic rats of equal weights followed by in vivo whole body fluorimetry, ex vivo optical imaging of oral, axial, and appendicular bones and ethylenediaminetetraacetic acid bone decalcification to assess hydroxyapatite-bound bisphosphonate.

RESULTS

Bisphosphonate uptake and bisphosphonate released per unit calcium were similar in oral and appendicular bones but lower than those in axial bones. Hydroxyapatite-bound bisphosphonate liberated by sequential acid decalcification was the highest in oral, relative to axial and appendicular bones (P < 0.05).

CONCLUSIONS

This study demonstrates regional differences in uptake and release of bisphosphonate from oral, axial, and appendicular bones of immune deficient rats.

The prevalence and trends of overweight, obesity and nutrition-related non-communicable diseases in the Arabian Gulf States

This paper reviews studies on the prevalence of overweight, obesity and related nutrition-related non-communicable diseases in Bahrain, Kuwait, Qatar, Oman, Saudi Arabia and the UAE. Obesity is common among women; while men have an equal or higher overweight prevalence. Among adults, overweight plus obesity rates are especially high in Kuwait, Qatar and Saudi Arabia, and especially among 30-60 year olds (70-85% among men; 75-88% among women), with lower levels among younger and elderly adults. The rate of increase in obesity was pronounced in Saudi Arabia and Kuwait. Prevalence of obesity is high among Kuwaiti and Saudi pre-schoolers (8-9%), while adolescent overweight and obesity are among the highest in the world, with Kuwait having the worst estimates (40-46%); however, comparison of child data is difficult because of differing standards. Among nutrition-related non-communicable diseases, hypertension and diabetes levels are very high and increase with age, with the UAE performing the worst because of a rapid rate of increase between 1995 and 2000. Additional monitoring of the prevalence of metabolic syndrome and cancers is necessary. Nationally representative longitudinal surveys with individual, household and community-level information are needed to determine the importance of various factors that contribute to these troubling trends.

A prospective observational study of attention-deficit hyperactivity disorder in Asia: baseline characteristics of symptom severity and treatment options in a paediatric population

OBJECTIVES

To better understand the burden and management of attention-deficit hyperactivity disorder in East Asia, this subanalysis of the baseline characteristics of a large prospective, observational, nonrandomized study investigating the relationships between symptom severity, treatments, co-morbidities, and health outcomes provides information about the diagnosis of, and treatment patterns for, attention-deficit hyperactivity disorder in this region.

METHODS

Outpatients with attention-deficit hyperactivity disorder symptoms participated in this 12-month study performed in China, Korea, and Taiwan. Patients were grouped according to whether they received conventional treatment or no or other treatment. Attention-deficit hyperactivity disorder symptom severity and co-morbidities were assessed using the Clinical Global Impressions-Attention-deficit Hyperactivity Disorder-Severity scale and Child Symptom Inventory-4: Parent Checklist (categories B to J) / Adolescent Symptom Inventory-4: Parent Checklist (categories L and O), respectively.

RESULTS

A total of 502 patients aged 6 to 18 years were enrolled. Investigators were psychiatrists (69%) and paediatricians (31%), who used the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (86%), the 10th revision of the International Classification of Diseases (6%), and other attention-deficit hyperactivity disorder diagnostic criteria (8%) for diagnosis. Pharmacotherapy was the most commonly prescribed treatment (n = 251; 50%), and treated patients were older (9.1 vs. 8.2 years; p < 0.001) and more severely ill (Clinical Global Impressions-Attention-deficit Hyperactivity Disorder- Severity scale, 4.6 vs. 4.2; p < 0.001) than those who were not treated. Anxiety and oppositional co-morbidities were commonly reported.

CONCLUSIONS

These data provide an insight into the demographics, diagnosis, and treatment of paediatric patients with attention-deficit hyperactivity disorder in East Asia, and provide a baseline for assessing changes in treatment practices in this population.

The Hepatitis A Virus Cellular Receptor, HAVcR-1, Reduces the Integrity of Human Endothelial Tight Junctions

Background: Disruption of Tight Junctions (TJ's) in endothelial cells can cause a leaky vascular bed and may therefore lead to vascular spread of cancer cells. Hepatitis A virus (HAV) cellular receptor HAVcR-1, also known as KIM-1/TIM-1, is the cellular receptor for the hepatotropic picornavirus that causes acute hepatitis-A in humans. Although HAVcR-1 is expressed in every human organ, the natural function of HAVcR-1 remains unknown. In the current study, we investigated the location, association and possible functionality of HAVcR-1 in human endothelial cells.Methods: HAVcR-1 protein in human endothelial cells was visualised using immunohistochemistry and mRNA transcript by RT-PCR. A hammerhead ribozyme transgene that specifically targeted human HAVcR-1 was constructed and used to knockdown endogenously expressed HAVcR-1 (HECVHKD); moreover, forced expression was obtained by insertion of a transgene into wild type endothelial cells (HECVHEX).TJ function was assessed using trans-endothelial resistance (TER) and paracellular permeability assays under the influence of HGF (40ng/ml) a cytokine we have previously shown to modulate TJs in human endothelial cells.Results: Human endothelial cells expressed HAVcR-1 at low levels. The location of both endogenous and forcibly expressed HAVcR-1 was at the cell-cell junction, at the region of the TJ. In this study, one of the first to examine the location and binding partners of HAVcR-1, expression of this receptor was targeted to the vicinity of intercellular junctions, via ZO-1, which further was demonstrated to be at the site of the TJ by its co-localisation with ZO-2. This was true of both endogenously and forcibly expressed protein. Moreover, HAVcR-1 was co-precipitated with the regulatory factor Rho C. Although there was no change in function of HECVHEX cells, the TJ function of the HECVHKD cells exhibited significantly reduced response to HGF over 2h (p&lt;0.01). Interestingly, there was no concurrent response in PCP.Conclusion: These results demonstrate for the first time that HAVcR-1 may have a previously undiscovered role in the regulation of TJ integrity in human endothelial cells.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2158.

Is the incidence of psychotic disorder in decline? Epidemiological evidence from two decades of research

BACKGROUND

It is unclear whether the incidence of first episode psychoses is in decline. We had the opportunity to determine whether incidence had changed over a 20-year period in a single setting, and test whether this could be explained by demographic or clinical changes.

METHODS

The entire population at-risk aged 16-54 in Nottingham over three time periods (1978-80, 1993-95 and 1997-99) were followed up. All participants presenting with an ICD-9/10 first episode psychosis were included. The remainder of the population at-risk formed the denominator. Standardized incidence rates were calculated at each time period with possible change over time assessed via Poisson regression. We studied six outcomes: substance-induced psychoses, schizophrenia, other non-affective psychoses, manic psychoses, depressive psychoses and all psychotic disorders combined.

RESULTS

Three hundred and forty-seven participants with a first episode psychosis during 1.2 million person-years of follow-up over three time periods were identified. The incidence of non-affective or affective psychoses had not changed over time following standardization for age, sex and ethnicity. We observed a linear increase in the incidence of substance-induced psychosis, per annum, over time (incidence rate ratios: 1.15; 95% CI 1.05-1.25). This could not be explained by longitudinal changes in the age, sex and ethnic structure of the population at-risk.

CONCLUSIONS

Our findings suggest psychotic disorders are not in decline, though there has been a change in the syndromal presentation of non-affective disorders, away from schizophrenia towards other non-affective psychoses. The incidence of substance-induced psychosis has increased, consistent with increases in substance toxicity over time, rather than changes in the prevalence or vulnerability to substance misuse. Increased clinical and popular awareness of substance misuse could also not be excluded.

Investigating whether adverse prenatal and perinatal events are associated with non-clinical psychotic symptoms at age 12 years in the ALSPAC birth cohort

BACKGROUND

Non-clinical psychosis-like symptoms (PLIKS) occur in about 15% of the population. It is not clear whether adverse events during early development alter the risk of developing PLIKS. We aimed to examine whether maternal infection, diabetes or pre-eclampsia during pregnancy, gestational age, perinatal cardiopulmonary resuscitation or 5-min Apgar score were associated with development of psychotic symptoms during early adolescence.

METHOD

A longitudinal study of 6356 12-year-old adolescents who completed a semi-structured interview for psychotic symptoms in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. Prenatal and perinatal data were obtained from obstetric records and maternal questionnaires completed during pregnancy.

RESULTS

The presence of definite psychotic symptoms was associated with maternal infection during pregnancy [adjusted odds ratio (OR) 1.44, 95% confidence interval (CI) 1.11-1.86, p=0.006], maternal diabetes (adjusted OR 3.43, 95% CI 1.14-10.36, p=0.029), need for resuscitation (adjusted OR 1.50, 95% CI 0.97-2.31, p=0.065) and 5-min Apgar score (adjusted OR per unit decrease 1.30, 95% CI 1.12-1.50, p<0.001). None of these associations were mediated by childhood IQ score. Most associations persisted, but were less strong, when including suspected symptoms as part of the outcome. There was no association between PLIKS and gestational age or pre-eclampsia.

CONCLUSIONS

Adverse events during early development may lead to an increased risk of developing PLIKS. Although the status of PLIKS in relation to clinical disorders such as schizophrenia is not clear, the similarity between these results and findings reported for schizophrenia indicates that future studies of PLIKS may help us to understand how psychotic experiences and clinical disorders develop throughout the life-course.

Association of measures of fetal and childhood growth with non-clinical psychotic symptoms in 12-year-olds: the ALSPAC cohort

BACKGROUND

Previous studies have suggested that impaired fetal and childhood growth are associated with an increased risk of schizophrenia, but the association of pre-adult growth with non-clinical psychotic symptoms (psychosis-like symptoms) in children is not known.

AIMS

To explore the associations of body size at birth and age 7.5 years with childhood psychosis-like symptoms.

METHOD

Prospective cohort of children followed up from birth to age 12: the ALSPAC cohort.

RESULTS

Data on 6000 singleton infants born after 37 weeks of gestation. A one standard deviation increase in birth weight was associated with an 18% reduction in the risk of definite psychosis-like symptoms after adjusting for age and gestation (Odds ratio (OR) = 0.82, 95% CI = 0.73-0.92, P = 0.001). This association was partly confounded by maternal anthropometry, smoking during pregnancy, socioeconomic status and IQ. A similar association was seen for birth length and psychosis-like symptoms, which disappeared after controlling for birth weight. There was little evidence for an association of 7-year height or adiposity with psychosis-like symptoms.

CONCLUSIONS

Measures of impaired fetal, but not childhood, growth are associated with an increased risk of psychosis-like symptoms in 12-year-olds.

The DEBIT trial: an intervention to reduce antipsychotic polypharmacy prescribing in adult psychiatry wards - a cluster randomized controlled trial

BACKGROUND

Clinical guidelines advise against prescribing more than one antipsychotic with limited exceptions. Despite this, surveys continue to report high antipsychotic polypharmacy rates. The aim of the study was to investigate the effectiveness of a multi-faceted intervention in reducing prescribing of antipsychotic polypharmacy on general adult psychiatry wards, compared with guidelines alone.

METHOD

A pragmatic cluster randomized controlled trial recruited 19 adult psychiatric units (clusters) from the South West of England. Participants were all ward doctors and nurses. The multi-faceted intervention comprised: an educational/CBT workbook; an educational visit to consultants; and a reminder system on medication charts.

RESULTS

The odds of being prescribed antipsychotic polypharmacy in those patients prescribed antipsychotic medication was significantly lower in the intervention than control group when adjusted for confounders (OR 0.43, 95% CI 0.21-0.90, p=0.028). There was considerable between-unit variation in polypharmacy rates and in the change in rates between baseline and follow-up (5 months after baseline).

CONCLUSION

The intervention reduced levels of polypharmacy prescribing compared to guidelines alone although the effect size was relatively modest. Further work is needed to elicit the factors that were active in changing prescribing behaviour.

A modified fascia iliaca compartment block has significant morphine-sparing effect after total hip arthroplasty

We assessed whether a modified fascia iliaca compartment block in unilateral total hip arthroplasty provides a morphine-sparing effect in the first 24 hours. This involved a randomised, double blind study of 44 patients. Both groups received a modified fascia iliaca block with the trial group receiving 30 ml 0.5% bupivacaine with 1:200,000 adrenaline, 150 microg clonidine and 9 ml 0.9% saline and the control group receiving 40 ml 0.9% saline. Otherwise both groups received identical care with a subarachnoid block for operative anaesthesia. Patient-controlled morphine analgesia was commenced postoperatively and data were collected at three, six, 12 and 24 hours post commencement of surgery. We found that the trial group used less morphine at 12 and 24 hours (P < 0.001). The median morphine usage at 24 hours was 37.5 mg in the control patients and 22 mg in the trial patients. Pain scores were similar between groups. We conclude that a modified fascia iliaca compartment block has a significant morphine-sparing effect in unilateral total hip arthroplasty.

Minor physical anomalies in patients with first-episode psychosis: their frequency and diagnostic specificity

BACKGROUND

An increased prevalence of minor physical anomalies (MPAs) has been extensively documented in schizophrenia but their specificity for the disorder remains unclear. We investigated the prevalence and the predictive power of MPAs in a large sample of first-episode psychotic patients across a range of diagnoses.

METHOD

MPAs were examined in 242 subjects with first-episode psychosis (50% schizophrenia, 45% affective psychosis and 5% substance-induced psychosis) and 158 healthy controls. Categorical principal components analysis and analysis of variance were undertaken, and individual items with the highest loading were tested using the chi2 test.

RESULTS

Overall facial asymmetry, assymetry of the orbital landmarks, and frankfurt horizontal significantly differentiated patients with schizophrenia and affective psychosis from controls, as did a 'V-shaped' palate, reduced palatal ridges, abnormality of the left ear surface and the shape of the left and right ears. Patients with affective psychosis had significantly lowered eye fissures compared with control subjects.

CONCLUSIONS

MPAs are not specific to schizophrenia, suggesting a common developmental pathway for non-affective and affective psychoses. The topographical distribution of MPAs in this study is suggestive of an insult occurring during organogenesis in the first trimester of pregnancy.

Attenuated stress response to acute lipopolysaccharide challenge and ethanol administration in vasopressin V1b receptor knockout mice

The arginine vasopressin (Avp) 1b receptor (Avpr1b) present on anterior pituitary corticotrophs is involved in the stimulation of adrenocorticotrophic hormone (ACTH) secretion, especially during times of stress. Corticotrophin-releasing hormone (CRH) is considered the major ACTH secretagogue during acute stress whereas Avp appears to be the more dominant mediator of the hypothalamic-pituitary-adrenal (HPA) axis response during chronic stress situations. To investigate the role of the Avpr1b in the HPA axis response to acute stress, we measured ACTH and corticosterone (CORT) plasma levels in Avpr1b knockout (KO) mice and wild-type controls in response to bacterial lipopolysaccharide (LPS) challenge and ethanol (EtOH) administration. Mice deficient in Avpr1b had markedly compromised plasma ACTH and CORT responses to acute (30 min) LPS, but normal ACTH and CORT response to more extended exposure (4 h) to the immune system activator. The plasma ACTH and CORT levels stimulated by intoxicating, sedative doses of EtOH (3.2 and 4 g/kg) were significantly decreased in the Avpr1b KO mice compared to wild-type littermates. Significantly higher EtOH-induced plasma ACTH and CORT secretion was measured in female than in male Avpr1b wild-type mice. There were no differences in the blood alcohol levels following acute EtOH administration in Avpr1b KO or wild-type mice of either gender. Our results clearly suggest that Avpr1b plays a significant role in the HPA axis response to acute immune stress and EtOH intoxication.

The effect of timing of mineral supplementation of the ewe diet in late pregnancy on immunoglobulin G absorption by the lamb

Two experiments were carried out to examine the effects of the timing and duration of mineral supplementation of the ewe's diet in the final 6 weeks of gestation on immunoglobulin G (IgG) absorption by their progeny. In experiment 1, 60 single-bearing ewes were allocated to one of four dietary treatments (no. = 15) and offered a basal diet of grass silage ad libitum, containing 50 g/kg molassed sugar-beet pulp, which was supplemented with concentrates for the final 7 weeks of pregnancy and were additionally provided with a daily mineral/vitamin supplement for the final 6 weeks (W-6), 4 weeks (W-4), 2 weeks (W-2) or no mineral/vitamin supplement, (control; W-0). The supplement contained Ca, P, Na, Mg, Mn, Zn, Se, Co, I and vitamin E and was offered at the daily rate of 48 g per ewe. The ewes were milked at 1, 10 and 18 h post partum and measured quantities of colostrum, proportional to birth weight were fed back to the progeny via a stomach tube. At each milking, colostrum yield was recorded and colostrum samples taken to determine the concentration and yield of IgG. Treatment had no effect (P > 0.05) on the yields of colostrum or IgG to 18 h post partum. The efficiency of IgG absorption was lower (P < 0.001) in the progeny of ewes who received supplementary minerals (W-6, 0.069, W-4, 0.078, W-2, 0.072, W-0, 0.261; s.e. 0.0244. P < 0.001) regardless of the duration of the mineral/vitamin supplementation period and this resulted in a reduced concentration of IgG in the lamb's serum. In experiment 2, 40 twin-bearing ewes were allocated to one of four dietary treatments (no. = 10) and offered a basal diet of grass silage ad libitum which was supplemented initially with 500 g of a concentrate containing 140 g crude protein (CP) per kg from day 98 to 133 of gestation and then replaced with 700 g/day of a concentrate containing 180 g/kg CP from day 134 of gestation until lambing, in addition to one of the following mineral/vitamin supplementation treatments : no supplementary minerals, W0 (control); 48 g of supplement per ewe per day in weeks 6 and 5 pre- partum (W6–5), or weeks 4 and 3 pre-partum (W4–3), or for the final 2 weeks pre-partum (W2–1). The ewes were milked and the lambs fed as in experiment 1. Again, treatment had no effect (P > 0.05) on the yields of colostrum or IgG to 18 h post partum. When ewes were offered the mineral/vitamin supplement in the final 2 weeks of gestation their progeny had a lower (P < 0.01) serum IgG concentration (4.6 g/l) than in the control treatment (14.0 g/l) or when the supplement was offered either in weeks 3 and 4 (11.3 g/l) or weeks 5 and 6 pre-partum (14.3 g/l). IgG absorption efficiency followed the same pattern as lamb serum IgG concentration. We conclude that supplementation of the ewe's diet at the level used in these studies for the final 2 weeks of pregnancy results in the production of offspring with a reduced ability to absorb colostral IgG. Furthermore, in order for this impairment of the IgG absorptive ability of the lamb to manifest itself the supplementation must occur for the final 2 weeks of gestation and supplementation for a 2-weekly period earlier in gestation will not elicit the same effect.

Seasonal and interannual variability in grey seal diets on Sable Island, eastern Scotian Shelf

We studied seasonal and interannual variability in the diet of grey seals (Halichoerus grypus) using faecal samples collected from Sable Island, Nova Scotia between 1991 and 1998. More than 28,000 prey from at least 28 taxa were identified from 1,245 faecal samples collect mainly in spring, fall and winter. Sand lance (Ammodytes dubius) dominated the diet in all seasons and years, but the importance of this and other species varied over time. There was also evidence of seasonal and interannual variation in the size of prey consumed both within and among species. We compared diet composition with estimates of prey numbers and biomass from annual researchtrawl surveys conducted in March and July. Species-specific numerical corrections were applied to otolith counts to account for the complete digestion of otoliths, and fish catchability correction factors applied to trawl survey catches to account for trawl selectivity. Based on an odds ratio index of prey selectivity, grey seals positively selected sand lance in both seasons. Other species were either relatively avoided or eaten roughly in proportion to their estimated abundance.

Performance during consecutive days of laboratory time-trials in young and veteran cyclists

AIM

There is a common belief amongst athletes and coaches that older athletes need longer recovery time between training sessions and following competition. This study was undertaken to investigate the influence of age on recovery from high intensity endurance exercise in well-trained cyclists.

METHODS

Nine young and 9 veteran cyclists (mean+/-SD: young 24+/-5 years, veteran 45+/-6 years) performed 3 consecutive days (T1-T3) of laboratory based cycling time trials of 30-min duration (TT30). Mean power output, heart rate (HR), and blood lactate were measured throughout each TT30. Non-specific performance tests of fatigue were undertaken before and after the TT30 on each test day. Non-specific tests included, a maximal voluntary isometric contraction of the quadriceps muscle (MVIF), a countermovement jump (CMJ), a 10-s cycle sprint (10ST), and serum creatine kinase activity (CK).

RESULTS

Statistical analysis revealed that there were no significant group differences between young and veteran subjects for initial fitness or training status. Over T1-T3 both groups maintained average power during the TT30 (young and veteran results combined; 3.49+/-0.38, 3.5+/-0.36 and 3.52+/-0.35 W x kg(-1), T1-T3, respectively). For both groups serum CK activity was significantly elevated at T2 and T3, and mean HR during the TT30 was significantly lower at T3 (approximately 3 b x min(-1)). There were no group differences or significant within group interactions across the 3 days for MVIF or 10ST but there was a significantly lower CMJ height by T3 in both young and veteran (approximately 3%). MVIF was significantly lower after TT30 each day but had fully recovered by the following day.

CONCLUSIONS

These findings suggest that high-intensity endurance performance is maintained in both well-trained young and veteran cyclists following 3 consecutive days of maximal 30-min laboratory time trials.

The cardiovascular and respiratory health of people with schizophrenia

OBJECTIVE

To examine the cardiovascular and respiratory health of people with severe mental illness (SMI) and compare findings with the Health Surveys for England.

METHOD

A prospective, multi-centre observational prevalence study of 602 patients with schizophrenia-related psychoses carried out in six locations across the UK over 24 months.

RESULTS

Compared with general population subjects, people with SMI reported higher rates of angina and respiratory symptoms and had poor lung function. Much of this increased risk could be explained by lifestyle risk factors; there were increased levels of obesity among younger people with SMI.

CONCLUSION

Key indicators of the cardiovascular and respiratory health of people with SMI are poor compared with those of the general population. Care plans should prioritize interventions to attenuate lifestyle risk factors. Evidence of increasing obesity in younger patients is of particular concern, predicting even greater health needs in the future.

Maintenance antipsychotic medication patterns in outpatient schizophrenia patients: a naturalistic cohort study

OBJECTIVE

Newer antipsychotics are increasingly used in schizophrenia maintenance. The UK change has been slow with little known on switching patterns. We aimed to investigate antipsychotic prescribing patterns in schizophrenia patients.

METHOD

A naturalistic six-site cohort sample of 600 patients were interviewed by researchers at 6-monthly intervals for 2 years to record their clinical and social functioning; use of services and medication for the preceding 6 months was obtained by structured extraction from clinical case notes.

RESULTS

Alterations in antipsychotic medication were frequent in this group, mainly during periods of inpatient care. Atypical prescribing increased steadily, though slowly, across the period. Polypharmacy was less than anticipated.

CONCLUSION

Inpatient care remains the main forum for switching of antipsychotics. The UK maintains a slow shift to atypical antipsychotics.

The association of fetal and childhood growth with risk of schizophrenia. Cohort study of 720,000 Swedish men and women

Previous investigations of the association of schizophrenia with patterns of pre- and post-natal growth have been based on small numbers of cases or have not taken account of the effects of prematurity on birthweight. We investigated the association of fetal growth with schizophrenia in a large cohort of Swedish males and females. We linked data from the Swedish Medical Birth Register (1973-1980), Inpatient and Discharge Register (1988-2002), Military Service Conscription Register (1990-1997), and the Population and Housing Censuses (1970 and 1990). Altogether 719,476 males and females were followed up from the age of 16 for a mean of 9.9 years. There were 736 incident cases of schizophrenia. Even in models that did not control for gestational age there was little evidence of an association between birthweight and schizophrenia (hazard ratio per kg increase in birthweight: 0.90 (95% CI 0.78 to 1.03); the hazard ratio in babies weighing <2.5 kg compared to 3.5-4.0 kg was 1.29 (95% CI 0.85 to 1.96). There was an inverse association of birth length with schizophrenia across the range of birth lengths. Short babies were at an increased risk (hazard ratio per 10 cm increase in birth length: 0.53, 95% CI 0.31 to 0.89 (fully adjusted model)). All associations were little changed when analyses were restricted to term (>36 week gestation) babies. In males, low body mass index and short height at age 18 were associated with increased risk. There is some evidence that patterns of risk in relation to fetal growth differ depending on post-natal growth patterns: the increased risk associated with low body mass index was restricted to long babies who became light adults. The exposures underlying these associations and the biological mechanisms mediating them require clarification.

Pathways to care and ethnicity. 1: Sample characteristics and compulsory admission. Report from the AESOP study

BACKGROUND

Many studies have found high levels of compulsory admission to psychiatric hospital in the UK among African-Caribbean and Black African patients with a psychotic illness.

AIMS

To establish whether African-Caribbean and Black African ethnicity is associated with compulsory admission in an epidemiological sample of patients with a first episode of psychosis drawn from two UK centres.

METHOD

All patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas were included in the (AESOP) study. For this analysis we included all White British, other White, African-Caribbean and Black African patients from the AESOP sampling frame. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes.

RESULTS

African-Caribbean patients were significantly more likely to be compulsorily admitted than White British patients, as were Black African patients. African-Caribbean men were the most likely to be compulsorily admitted.

CONCLUSIONS

These findings suggest that factors are operating at or prior to first presentation to increase the risk of compulsory admission among African-Caribbean and Black African patients.