BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d2709 (Published 04 May 2011) Cite this as: BMJ 2011;342:d2709

Women who fear childbirth are significantly more likely to have had mental health issues necessitating psychiatric care than women without such fears (BJOG 2011, doi:10.1111/j.1471-0528.2011.02967.x). Fearful and non-fearful women differed significantly from each other with regard to psychiatric inpatient care, outpatient care, and the use of psychotropic medication. The most prevalent mental health disorders in both groups involved mood and anxiety, and the major predictors of the need for psychiatric input after childbirth were previous psychiatric input and a fear of childbirth.

Long term results from a phase I/II trial show that stem cell transplantation is not suitable for most people with multiple sclerosis, but that it could be reserved for more aggressive cases that are still in the inflammatory phase of the disease, and for the malignant form—in which it can be life saving (Neurology 2011;76:1066-70, doi:10.1212/wnl.0b013e318211c537). Progression free survival at 15 years was significantly higher in patients with active central nervous system involvement than in those without, as shown clinically and on magnetic resonance imaging. Two of the 35 patients, however, died from transplant related complications.

Misclassification of deaths in South Africa has introduced a bias to the numbers of people said to be dying from HIV or AIDS. A team looking at data from WHO’s mortality database found that deaths from HIV/AIDS were often misattributed to fourteen other conditions. This analysis claims that the true cause specific mortality fraction rose from 19% to 48% over the period 1996-2006. More than 90% of deaths from HIV/AIDS were found to have been misattributed to other causes during this time (Bulletin of the World Health Organization 2011;89:278-85, doi:10.2471/BLT.11.086280).

Women with bipolar disorder may have the added burden of a hormonal fluctuation that could affect their experience of the condition. Almost 300 premenopausal women with bipolar disorder were followed up for a year. Researchers found that those with premenstrual exacerbation had a worse course of illness, a shorter time to relapse, and greater severity of symptoms than those without—but they were not more likely to experience rapid cycling (American Journal of Psychiatry 2011; 168:386-94, http://ajp.psychiatryonline.org)

Giving micronutrient supplements to patients with tuberculosis increases their grip strength and weight if they are HIV negative, but not if they are HIV positive (Journal of Nutrition 2011;141:685-91, doi:10.3945/jn.110.131672). Patients in a Tanzanian study were issued with a daily biscuit with or without micronutrients throughout the 60 days of intensive tuberculosis treatment. More work is needed, say the researchers, to develop effective supplementation for HIV positive patients being treated for tuberculosis.

Does disturbed sleep result in anxiety or depression in toddlers? Data from the Dutch Generation R study showed that disturbed sleep and the presence of parents during sleep onset at age 2 months and 24 months were associated with anxiety or depressive symptoms at three years. Short sleep duration and an absence of set bedtimes at 24 months (but not at 2 months) also preceded anxiety and depression, and were not caused by children’s anxiety or depressive symptoms at 18 months. Co-sleeping was not associated with anxiety or depression (Psychosomatic Medicine 2011;73:242-9, doi:10.1097/PSY.0b013e31820a4abb).

A review of patients undergoing primary isolated aortic valve replacement between 2003 and 2007 from an Italian regional registry reports that overall hospital mortality was 2.2%. Pulmonary artery pressures of greater than 60 mm Hg, dialysis, central neurological dysfunction, and severe chronic obstructive airway disease were among the independent predictors of hospital mortality. At three years, survival was 89.3%. In addition to the factors associated with death in hospital, being older than 80 and having an ejection fraction of 30-50% were independent risk factors for three year mortality (Journal of Thoracic and Cardiovascular Surgery 2011;141:940-7, doi:10.1016/j.jtcvs.2010.05.044).

The incidence of sudden infant death or severe, apparently life threatening events occurring within 24 hours of birth is reported to be 2.6 in 100 000 live births in Germany. More than half the 17 cases that met the search criteria happened within the first two hours of birth. Twelve infants were found lying on their mother’s chest or abdomen, or very close to and facing her, suggesting a potentially asphyxiating position. Seven events were only noticed by a health professional despite the mother being present and awake, suggesting that maternal fatigue may play a part (Pediatrics 2011;127:e869-73, doi:10.1542/peds.2010-2189).

A cohort of people living with HIV in Canada have been followed up with specific attention being paid to their employment status. Regression analyses showed that being employed is strongly related to better physical and mental health quality of life after controlling for potential confounding factors. Employment had a greater effect on physical quality of life than on mental health, and its effect on physical quality of life was stronger than that observed for ethnicity, social support, or having a diagnosis of AIDS (AIDS Care 2011;23:435-43, doi:10.1080/09540121.2010.507952).


Cite this as: BMJ 2011;342:d2709