Is the last "man" standing in comedy the least funny? A retrospective cohort study of elite stand-up comedians versus other entertainers.

BACKGROUND: This study aimed to confirm, in a large, diverse cohort of elite Stand-up Comedians and other entertainers, that there is an inverse association between comedic ability and longevity. METHODS: This retrospective cohort study included 200 Stand-up Comedians (13% women), 113 Comedy Actors (17.5% women), and 184 Dramatic Actors (29.3% women) listed in the top 200 in each category in a popular online ranking website. Longevity within each group was examined adjusting for life expectancy by year of birth and within-group ranking score. RESULTS: Stand-up Comedians were younger than Comedy Actors (median birth year 1962 versus 1947: p<0.001) and Dramatic Actors (1962 versus 1946: p<0.001). Overall, 36/200 (18.0%), 33/114 (29.0%) and 56/184 (30.9%) of Stand-up Comedians, Comedy Actors and Dramatic Actors, respectively, had died (p=0.011). There was a significant gradient (p=0.011) in the age of death, with Stand-up Comedians dying at a younger age (67.1±21.3years) than their Comedy Actor (68.9±15.4years) and Dramatic Actor (70.7±16.6years) counterparts. Stand-up Comedians (38.9% versus 19.6%) were more likely to die prematurely compared to Dramatic Actors; p=0.043, OR 1.98; 95% CI 1.01 to 3.87). Independent of year of birth, for Stand-up Comedians alone, higher comedy rank was associated with shorter longevity (hazard ratio 0.938, 95% CI 0.880 to 0.999 for a 10-rank difference; p=0.045). CONCLUSIONS: These data reaffirm an adverse relationship between comedic ability and longevity, with elite Stand-up Comedians more highly rated by the public more likely to die prematurely.

Establishing a pragmatic framework to optimise health outcomes in heart failure and multimorbidity (ARISE-HF): A multidisciplinary position statement.

BACKGROUND: Multimorbidity in heart failure (HF), defined as HF of any aetiology and multiple concurrent conditions that require active management, represents an emerging problem within the ageing HF patient population worldwide. METHODS: To inform this position paper, we performed: 1) an initial review of the literature identifying the ten most common conditions, other than hypertension and ischaemic heart disease, complicating the management of HF (anaemia, arrhythmias, cognitive dysfunction, depression, diabetes, musculoskeletal disorders, renal dysfunction, respiratory disease, sleep disorders and thyroid disease) and then 2) a review of the published literature describing the association between HF with each of the ten conditions. From these data we describe a clinical framework, comprising five key steps, to potentially improve historically poor health outcomes in this patient population. RESULTS: We identified five key steps (ARISE-HF) that could potentially improve clinical outcomes if applied in a systematic manner: 1) Acknowledge multimorbidity as a clinical syndrome that is associated with poor health outcomes, 2) Routinely profile (using a standardised protocol - adapted to the local health care system) all patients hospitalised with HF to determine the extent of concurrent multimorbidity, 3) Identify individualised priorities and person-centred goals based on the extent and nature of multimorbidity, 4) Support individualised, home-based, multidisciplinary, case management to supplement standard HF management, and 5) Evaluate health outcomes well beyond acute hospitalisation and encompass all-cause events and a person-centred perspective in affected individuals. CONCLUSIONS: We propose ARISE-HF as a framework for improving typically poor health outcomes in those affected by multimorbidity in HF.

Dysfunctional metacognition and drive for thinness in typical and atypical anorexia nervosa.

BACKGROUND: Anorexia nervosa is complex and difficult to treat. In cognitive therapies the focus has been on cognitive content rather than process. Process-oriented therapies may modify the higher level cognitive processes of metacognition, reported as dysfunctional in adult anorexia nervosa. Their association with clinical features of anorexia nervosa, however, is unclear. With reclassification of anorexia nervosa by DSM-5 into typical and atypical groups, comparability of metacognition and drive for thinness across groups and relationships within groups is also unclear. Main objectives were to determine whether metacognitive factors differ across typical and atypical anorexia nervosa and a non-clinical community sample, and to explore a process model by determining whether drive for thinness is concurrently predicted by metacognitive factors. METHODS: Women receiving treatment for anorexia nervosa (n = 119) and non-clinical community participants (n = 100), aged between 18 and 46 years, completed the Eating Disorders Inventory (3(rd) Edition) and Metacognitions Questionnaire (Brief Version). Body Mass Index (BMI) of 18.5 kg/m(2) differentiated between typical (n = 75) and atypical (n = 44) anorexia nervosa. Multivariate analyses of variance and regression analyses were conducted. RESULTS: Metacognitive profiles were similar in both typical and atypical anorexia nervosa and confirmed as more dysfunctional than in the non-clinical group. Drive for thinness was concurrently predicted in the typical patients by the metacognitive factors, positive beliefs about worry, and need to control thoughts; in the atypical patients by negative beliefs about worry and, inversely, by cognitive self-consciousness, and in the non-clinical group by cognitive self-consciousness. CONCLUSIONS: Despite having a healthier weight, the atypical group was as severely affected by dysfunctional metacognitions and drive for thinness as the typical group. Because metacognition concurrently predicted drive for thinness in both groups, a role for process-oriented therapy in adults is suggested. Implications are discussed.