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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Epidemiology in the past was concerned essentially by the study of infectious diseases which were the cause of huge mortalities especially since urbanisation was initiated. Epidemics of pest, typhus, cholera, influenza a.o. were common. The epidemics were halted by better hygiene, vaccination and antibiotics. Since the second world war epidemiology was dominated by an "epidemic" of new chronic diseases, especially heart disease and cancer. This was due to an increase in life span and to an increase in smoking habits and in the intake of saturated fat and a too small intake of fruit and vegetables combined with a too high intake of salt (NaCl). Gradually epidemiology evolved as the study of the causes, the distribution, the risk factors and the prevention of chronic diseases, but also including accidents, suicide, depression a.o., diseases with a mass occurrence at the population level. The importance of nutrition as a determinant of health gradually became recognized, but remains undervalued by the medical profession. Mortality at the population level follows some simple mathematical laws and can be represented accurately (r2>0.99) between the ages of 35 and 84 year by either Gompertz equations (ln mortality versus age) or by a polynomial equation (ln mortality versus age, age2). This is valid for all populations and both sexes and remains valid at times of great and rapid changes in mortality. This shows that measures for prevention should be directed towards the total population. The future of epidemiology should be directed towards the slowing of the ageing process at the population level by a healthy life style consisting of: not smoking, avoiding obesity, a fair amount of physical activity and a healthy nutrition i.e little salt, little saturated fat, an adequate amount of omega-3 fatty acids and a large amount of fruit and vegetables, with an occasional glass of red wine. This contains the secret of a long and healthy life. Conceptually it will be important to determine whether a maximum human life span, genetically determined, exists. A maximal rectangularization of the mortality curve should then be the ultimate goal. At the same time the possible re-emergence of old and new infectious diseases (SARS, Ebola, BSE, AIDS) should be kept in mind.
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PMID:Epidemiology: past, present and future. 1564 67

Bipolar disorder is a chronic, intermittent illness that is associated with high morbidity and mortality. In addition, patients with bipolar disorder often have comorbid psychiatric conditions (such as anxiety disorders, alcohol or substance abuse, and eating disorders) or medical disorders (such as obesity), which result in increased burden of illness for the patients, family members, and treating clinicians. Although bipolar disorder consists of recurring episodes of mania and depression, patients spend more time depressed than manic. Bipolar depression is associated with a greater risk of suicide and of impairment in work, social, or family life than mania. This health burden also results in direct and indirect economic costs to the individual and society at large. Bipolar depression is often undiagnosed or misdiagnosed as unipolar depression, resulting in incorrect or inadequate treatment. Available treatments for bipolar depression include medications such as lithium, selected anticonvulsants, and the atypical antipsychotics. Traditional antidepressants are not recommended as monotherapy for bipolar depression as they can induce switching to mania. Early and accurate diagnosis, aggressive management, and earlier prophylactic treatment regimens are needed to overcome the impact of depressive episodes in patients with bipolar disorder.
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PMID:The impact of bipolar depression. 1603 96

This study was conducted to explore the association between attempted suicides and body mass index (BMI, kg/m2) in a family sample of 2547 individuals. As a comparison, a national NESARC (the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions) sample of 41 589 individuals was included to validate the observed association. Compared to average weight, extreme obesity showed significantly increased odds for attempted suicides both in family sample (odds ratio (OR) = 3.37 and 95% confidence interval (CI) = 1.59-7.13 for BMI = 40- < 50 kg/m2; OR = 3.85 and 95% CI = 1.71-8.66 for BMI > or = 50 kg/m2) and in NESARC sample (OR = 2.11 and 95% CI = 1.59-2.81 for BMI = 40- < 50 kg/m2; OR = 2.56 and 95% CI = 1.34-4.92 for BMI> or = 50 kg/m2) after adjustment for sociodemographic factors. Compared to general population, the risk for attempted suicide was 87 and 122% higher for those with BMI=40- < 50 and > or = 50 kg/m2, respectively. The pattern of results in the family and population studies indicates that extreme obesity is strongly associated with attempted suicide.
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PMID:Extreme obesity is associated with attempted suicides: results from a family study. 1623 Oct 27

The proportion of the United States population living with bariatric surgery has increased exponentially since the mid 1990s. It is pertinent to study and understand the mortality patterns of this emergent population cohort and determine the role bariatric surgery may play in these mortality patterns. We present the forensic and clinical characteristics of three cases of suicide following bariatric surgery for the treatment of morbid obesity. The clinical history in each case included recurrent major depressive disorder before and after surgery. Surgery-suicide intervals were 12 months, 27 months and 26 months, respectively. Pre-surgery and pre-mortem body mass indices were 37.7 and 22.2 kg/m(2); 42.0 and 25.0 kg/m(2); 39.5 and 29.4 kg/m(2). Depressive disorder may persist in the bariatric surgery patient despite successful surgical control of obesity.
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PMID:Suicides following bariatric surgery for the treatment of obesity. 1692 67

Suicide in anorexia nervosa and bulimia nervosa is a major cause of death. Meta-analyses have shown that individuals suffering from anorexia nervosa and bulimia nervosa commit suicide more often than their counterparts in the general population; also a few studies have suggested that suicide is the major cause of death among patients with anorexia nervosa, refuting the assumption that inanition generally threatens the life of these patients. Data concerning suicide in bulimia nervosa, on the other hand, are still scarce but suicide attempts are easily found among cohorts of patients with bulimia nervosa, which constitutes a risk factor for completed suicide. Suicidality in obesity and individuals with disturbed weight status has been reported. Both in the case of bulimia nervosa and obesity more long-term follow-up studies need to be completed before the risk of suicide for such disorders may be compared with that for anorexia nervosa.
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PMID:Suicide and attempted suicide in eating disorders, obesity and weight-image concern. 1705 16

There are an estimated 4.1 million people who are classified as American Indian and Alaska Native alone or in combination with one or more other races. This racial group composes 1.5% of the total U.S. population. The leading causes of illness and death among American Indians are heart disease, cancer, unintentional injuries (accidents), diabetes, and stroke. American Indians also have a high prevalence of obesity, chronic renal failure, alcoholism, and are at increased risk for mental health issues and suicide. In an effort to build a trusted relationship with these patients and become an active participant in their care, the health care provider must demonstrate respect for the traditions of the American Indian.
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PMID:Native Americans: traditional healing. 1749 60

Cardiovascular disease (CVD), which includes coronary heart, cerebrovascular, and peripheral vascular disease, is the leading cause of death in the United States and most developed countries, accounting for about 50% of all deaths. The major risk factors include obesity and its consequences, dyslipidemia, hypertension, insulin resistance leading to diabetes, and cigarette smoking. In developing countries, CVD will become the leading cause of death due to alarming increases in obesity, sedentary lifestyles, cigarette smoking, and improvements in prevention and treatment of malnutrition and infection. Compared with nonschizophrenics, patients with schizophrenia have a 20% shorter life expectancy (i.e., from 76 to 61 years). In general populations, about 1% die from suicide compared with about 10% among patients with schizophrenia (relative risk = 10). For CVD, the corresponding figures are 50% and about 75% (relative risk = 1.5). In patients with schizophrenia, however, CVD occurs more frequently and accounts for more premature deaths than suicide. Patients with schizophrenia have alarmingly higher rates of obesity, dyslipidemia, hypertension, diabetes, and cigarette smoking than nonschizophrenic individuals in the general population. Compounding these data, patients with schizophrenia have less access to medical care, consume less medical care, and are less compliant. Primary prevention strategies should include the choice of antipsychotic drug regimens that do not adversely affect the major risk factors for CVD.
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PMID:Increasing global burden of cardiovascular disease in general populations and patients with schizophrenia. 1753 93

People with schizophrenia are at greater risk of obesity, Type 2 diabetes, dyslipidaemia and hypertension than the general population. This results in an increased incidence of cardiovascular disease (CVD) and reduced life expectancy, over and above that imposed by their mental illness through suicide. Several levels of evidence from data linkage analyses to clinical trials demonstrate that treatment-related metabolic disturbances are commonplace in this patient group, and that the use of certain second-generation antipsychotics may compound the risk of developing the metabolic syndrome and CVD. In addition, smoking, poor diet, reduced physical activity and alcohol or drug abuse are prevalent in people with schizophrenia and contribute to the overall CVD risk. Management and minimization of metabolic risk factors are pertinent when providing optimal care to patients with schizophrenia. This review recommends a framework for the assessment, monitoring and management of patients with schizophrenia in the UK clinical setting.
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PMID:Minimising metabolic and cardiovascular risk in schizophrenia: diabetes, obesity and dyslipidaemia. 1765 24

Schizophrenia is a life-threatening disease associated with mortality rates that are two to three times higher than those expected/observed in the general population. It is associated with high levels of suicide, particularly in young male patients soon after diagnosis. Delays in treating schizophrenia could contribute to the high number of suicides during this period. However, approximately two-thirds of the excess mortality is caused by natural deaths. Patients with schizophrenia die from the same diseases as people in the general population. The number of deaths caused by cardiovascular disease, as in the general population, is high and could be reduced by the modification of certain lifestyle factors, such as diet and exercise. Careful monitoring of patients' weight, blood pressure, blood glucose levels and serum lipid levels will not only provide an opportunity to educate patients about lifestyle choices that contribute to cardiovascular disease but will also give them a better chance of receiving early treatment for disorders that contribute to cardiovascular disease, such as obesity, type 2 diabetes, hypertension and dyslipidaemia. Careful selection of antipsychotic drugs, some of which are associated with side effects such as weight gain and cardiac disorders, will also help reduce co-morbidity and mortality among patients with schizophrenia.
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PMID:Mortality in schizophrenia. 1794

Attempted suicide and suicide are prevalent in individuals with bipolar disorder (BD). Extant evidence indicates that history of suicide attempts, percentage of time spent in a depressed state, and hostility are factors associated with suicide attempts and completed suicide. Childhood adversity (eg, sexual and physical abuse) is emerging as a risk factor for suicide attempts in adults with BD. The pertinacity of medical comorbidity (eg, obesity, metabolic syndrome) in the bipolar population is further underscored by its preliminary association with suicidality. Biomarkers such as cerebrospinal fluid monoamine metabolite levels may be predictive of suicide attempts and lethality in BD. Compelling evidence supports an antisuicide effect of long-term lithium prophylaxis; lithium's salutary effect is mediated primarily by reduced lethality of suicidal acts. Conventional unimodal antidepressants may engender or exacerbate suicidality in susceptible individuals with BD. A nascent database suggests that adjunctive psychosocial interventions may further reduce suicide risk in bipolar individuals.
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PMID:Bipolar disorder and suicide: research synthesis and clinical translation. 1826 97


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