Markers of brain injury and other stories . . .
BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i1985 (Published 13 April 2016) Cite this as: BMJ 2016;353:i1985
Bashed brain biomarker
The traumatised brain leaks glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) into the circulation. An American study of 1831 blood samples from 584 patients drawn in the week after head injury shows how these markers change over time and correlate with computed tomography findings (JAMA Neurol doi:10.1001/jamaneurol.2016.0039). But it’s not clear how this helps clinical management, and press hype about this “simple blood test” is taken apart in an article in Health News Review (http://bit.ly/1SaQRMM).
Treatment resistant schizophrenia
In a large Danish observational study, “treatment resistant” schizophrenia was defined by treatment with clozapine or hospital admission after two different drug treatments (Lancet Psychiatry doi:10.1016/S2215-0366(15)00575-1). Of 8044 patients, 1703 (21%) fulfilled these criteria during a median follow-up of 9.1 years. They showed a cluster of predictive factors that differed from classic risk factors for schizophrenia, leading the authors to wonder if treatment resistant disease might be a distinct subtype of schizophrenia and not just a more severe form.
Does rheumatoid response protect the heart?
The Swedish Biologics Register tracks people with rheumatoid arthritis who are treated with tumour necrosis factor inhibitors (TNFi). Analysis of acute coronary events in the first year after treatment over 6592 patient years suggests a protective effect in good responders (Ann Rheum Dis doi:10.1136/annrheumdis-2015-208995). However, the 95% confidence intervals are wide: compared with matched population control, the adjusted hazard ratio is 0.6-2.4 for good responders, 1.7-4.4 for moderate responders, and 1.5-4.4 for poor responders.
Shocking machines and hospices
Implantable cardioverter defibrillators can save people with heart failure from death due to ventricular arrhythmia, but in older people heart failure still carries a bad prognosis. In a Medicare registry study of 194 969 patients aged over 65, half were dead or in hospice based care five years later (Circulation doi:10.1161/CIRCULATIONAHA.115.020677). A third of the whole cohort received hospice care—a much higher proportion than in the UK.
Don’t just sit there in front of the TV
In 2013, 68% of 2034 Australian adults in an online survey thought it was appropriate to limit children’s screen time to the recommended ≤2 h/day (BMC Public Health doi:10.1186/s12889-016-2789-3). But most adults themselves spent >2 h watching TV and using the computer at home on work days (66%) and non-work days (88%). Grown-ups, honestly.
Assortative mating and mental illness
The “madness-runs-in-families” trope began in genealogies and novels then transmuted into modern genetics. But family patterns of psychiatric illness can be complicated by the tendency for people with a wide variety of psychiatric diagnoses to meet and show “assortative mating.” Using one case to five controls in a whole population Swedish database, investigators found non-random mating in psychiatric populations within 11 specific disorders and across the spectrum of psychiatric conditions (JAMA Psychiatry doi:10.1001/jamapsychiatry.2015.3192).
Sleeping on the kids’ ward
Lots of parents end up staying overnight with their children on paediatric wards, and 17 of them describe their travails in a qualitative study in (Arch Dis Child doi:10.1136/archdischild-2015-309458). Narratives like these are key to simple service improvement (such as reducing noise) and should be used routinely in all health settings.
Wine that makes glad the heart of man
The earliest writings to celebrate the happy effects of wine were hymns to the Sumerian goddess Ngeshtin-ana, followed 2000 years later by Psalm 104 v 15. Another 3000 years later, the journal Alcohol and Alcoholism surprisinglyjoins the refrain (doi:10.1093/alcalc/agw016). On the basis of a random sample of the Finnish population it states: “Consumption of wine with meals was associated with high socioeconomic status and high subjective well-being . . . Potential unknown confounders may exist, but the results underline a link between subjective well-being and drinking wine with meals.”
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