Risk factors for schizophrenia. Follow-up data from the Northern Finland 1966 Birth Cohort Study

This paper updates single risk factors identified by the Northern Finland 1966 Birth Cohort Study up to the end of year 2001 or age 34. Impaired performance (e.g., delayed motor or intellectual development) or adverse exposures (e.g., pregnancy and birth complications, central nervous system diseases) are associated with an increased risk for schizophrenia. However, upper social class girls and clever schoolboys also have an increased risk to develop schizophrenia, contrasted to their peers. Individuals who subsequently develop schizophrenia follow a developmental trajectory that partly and subtly differs from that of the general population; this trajectory lacks flexibility and responsiveness compared to control subjects, at least in the early stages. We propose a descriptive, lifespan, multilevel systems model on the development and course of schizophrenia.

The critical dietary potassium concentration for induction of mineral disorders in non-lactating Welsh Mountain sheep

Diets with more than 30 g K/kg DM have previously been associated with hypomagnesaemia in grazing cattle, and to test whether such diets lead to mineral disorders in sheep, the absorption of Mg and other elements was investigated using experimental diets to which KC I had been added to provide 27, 29, 32 or 34 g K/kg DM. The apparent absorption, balance and apparent retention of Mg, and to a lesser extent Ca, were reduced for sheep offered the diets with 32 or 34 g K/kg DM. The absorption and retention of K, Na, P, Zn, Pb and Cd was not affected by treatment. The blood intracellular Ca concentration was reduced by the diets with 29, 32 or 34 g K/kg DM, compared to the diet with 27 g K/kg DM, but the concentration of other elements was unaffected. Blood plasma Ca concentration was increased at the highest level of K inclusion, providing evidence of mild hyperkalaemia and the involvement of Ca homeostatic mechanisms. It is concluded that Mg absorption by sheep will be impaired if the diet contains more than 30 g K/kg DM, equivalent to an intake of approximately 13 g K/d, but that a high K diet may be beneficial before parturition to accustom the sheep to Ca mobilization before lactation. (c) 2005 Elsevier B.V. All rights reserved.

An n-of-1 trial service in clinical practice: Testing the effectiveness of stimulants for attention-deficit/hyperactivity disorder

OBJECTIVE. We sought to describe the clinical use of n-of-1 trials for attention-deficit/hyperactivity disorder in publicly and privately funded family and specialized pediatric practice in Australia. METHODS. We used a within-patient randomized, double-blind, crossover comparison of stimulant (dexamphetamine or methylphenidate) versus placebo or alternative stimulant using 3 pairs of treatment periods. Trials were conducted from a central location using mail and telephone communication, with local supervision by the patients' clinicians. PATIENTS. Our study population included children with clinically diagnosed attention-deficit/ hyperactivity disorder who were aged 5 to 16 years and previously stabilized on an optimal dose of stimulant. They were selected because treatment effectiveness was uncertain. MAIN OUTCOME MEASURES. Our measures included number of patients recruited, number of doctors who used the service, geographic spread, completion rates, response rate, and post-n-of-1 trial decisions. RESULTS. Forty-five doctors across Australia requested 108 n-of-1 trials, of which 86 were completed. In 69 drug-versus-placebo comparisons, 29 children responded better to stimulant than placebo. Immediately posttrial, 19 of 25 drug-versus-placebo responders stayed on the same stimulant, and 13 of 24 nonresponders ceased or switched stimulants. In 40 of 63 for which data were available, posttrial management was consistent with the trial results. For all types of n-of-1 trials, management changed for 28 of 64 children for whom information was available. DISCUSSION. Attention-deficit/hyperactivity disorder n-of-1 trials can be implemented successfully by mail and telephone communication. This type of trial can be valuable in clarifying treatment effect when it is uncertain, and in this series, they had a noticeable impact on short-term management.