Complex chronic conditions among children born to women with schizophrenia.

PURPOSE: Maternal schizophrenia is linked to complications in offspring near the time of birth. Whether there is also a higher future risk of the child having a complex chronic condition (CCC) - a pediatric condition affecting any bodily system expected to last at least 12 months that is severe enough to require specialty care and/or a period of hospitalization - is not known. METHODS: In this population-based health administrative data cohort study (Ontario, Canada, 1995-2018), the risk for CCC was compared in 5066 children of women with schizophrenia (the exposed) vs. 2,939,320 unexposed children. Adjusted hazard ratios (aHR) were generated for occurrence of any CCC, by CCC category, and stratified by child sex, and child prematurity. RESULTS: CCC was more frequent in the exposed (7.7 per 1000 person-years [268 children]) than unexposed (4.2 per 100 person-years [124,452 children]) - an aHR of 1.25 (95% CI 1.10-1.41). aHRs were notably higher in 5 of 9 CCC categories: neuromuscular (1.73, 1.28-2.33), cardiovascular (1.94, 1.64-2.29), respiratory (1.83, 1.32-2.54), hematology/immunodeficiency (2.24, 1.24-4.05) and other congenital or genetic defect (1.59, 1.16-2.17). The aHR for CCC was more pronounced among boys (1.32, 1.13-1.55) than girls (1.16, 0.96-1.40), and of similar magnitude in term (1.22, 1.05-1.42) and preterm infants (1.18, 0.95-1.46). CONCLUSIONS: The risk for a CCC appears to be higher in children born to women with schizophrenia. This finding introduces opportunities for targeted preconception counselling, optimization of maternal risk factors, and intervention to support a vulnerable parent population who will experience unique challenges caring for a child with CCCs.

Sustained effect of the aromatase inhibitors anastrozole and letrozole on endometrial thickness in patients with endometrial hyperplasia and endometrial carcinoma.

OBJECTIVE: To investigate whether there may be a role for aromatase inhibitors (AIs) in the treatment of endometrial hyperplasia (EH) and endometrial adenocarcinoma (EA) in postmenopausal women, a retrospective study on the effect of aromatase inhibitors (anastrozole or letrozole) was conducted for 16 patients who were not amenable to surgical treatment. MAIN OUTCOME MEASURE: Resolution of endometrial thickening measured by transvaginal ultrasound at 3-month intervals; the response of metastases was assessed by standard oncological criteria. RESULTS: In all, 16 patients were studied. The BMI of 13 of the 16 patients was known and ranged from 20.7 to 47.7 (mean 34.5) kg/m(2). During treatment with AIs, mean endometrial thickness in the eight patients with EH decreased progressively by 81.7% from 14.7 mm at the start of treatment to 2.7 mm following 36 months of treatment. A greater original mean endometrial thickness of 17 mm was seen in the four patients with localised EA, this fell progressively by 67.1% to 5.6 mm following 36 months of treatment. No responses were seen in four patients with metastatic disease. CONCLUSION: Our results indicate that treatment of EH with anastrozole or letrozole can reduce endometrial thickness as seen ultrasonically, and that in some cases AI treatment can reduce endometrial thickness in patients with localised EA. We found no evidence to indicate that AI treatment prevents disease progression in patients with metastatic EA. Further investigations will be necessary to validate our findings from this small retrospective study and to compare AI inhibitor treatment with topical progestogen therapy.

Geriatric day hospitals: consultant and community units compared.

A consultant-led day hospital in a district general hospital (DGH) was compared with general practitioner-controlled day hospitals in community hospitals (CHs). CHs were more generously provided for their populations, 3.87 compared with 1.38 places per 1000, but less well staffed at 70% of the DGH levels. Patients were similar demographically and in dependence, but differed in some diagnoses; 33% of CH patients were referred for social reasons alone, compared with 2% in the DGH. CH patients received fewer treatment sessions each day, 2.11 compared with 2.55 in the DGH and the difference was mainly in medical input. Median duration of attendance was 332 days in the CH and 92 days in the DGH; the 6-month discharge rate was 67% in the CH and 35% in the DGH, with 48% of patients attending for more than a year in the CH compared with 24% in the DGH. This study suggests that while the DGH unit provides an active service the CH units offer supportive care which largely duplicates that which could be provided more cheaply in day centres.

Agranulocytosis during malaria prophylaxis with Maloprim (pyrimethamine and dapsone).

A case of agranulocytosis during malaria prophylaxis with Maloprim (pyrimethamine and dapsone) is described. At the recommended dose of one tablet weekly this is apparently a rare occurrence but highlights one of the hazards in a changing climate of malarial prophylaxis in which the use of Maloprim is increasing.