Correction to: Clozapine-related neutropenia, myocarditis and cardiomyopathy adverse event reports in Australia 1993-2014.

The authors would like to change the statement found in the results section of the abstract from "There were five reported deaths from neutropenia and cardiomyopathy." to "There were five, 13, and two reported deaths from neutropenia, myocarditis, and cardiomyopathy, respectively."

Clozapine-related neutropenia, myocarditis and cardiomyopathy adverse event reports in Australia 1993-2014.

RATIONALE: Clozapine is the gold-standard medicine for treating refractory schizophrenia but there are some notable serious adverse events (AE). We aimed to analyse reported rates of clozapine cardiac and haematological AEs in Australia. METHODS: Using data from the Therapeutic Goods Administration, we examined all reported clozapine AEs (1993-2014) with a specific focus on neutropenia, myocarditis and cardiomyopathy. We related AEs to clozapine-dispensing data in Queensland, scaled up to Australia. RESULTS: There were 8561 AEs reported: neutropenia (13.7%), myocarditis (9.3%) and cardiomyopathy (3.8%). Reported rates of myocarditis and cardiomyopathy increased after 1999 following a myocarditis case series from Sydney. Cardiomyopathy AE rates have remained stable since then but myocarditis AEs have increased steadily. Neutropenia was more common in women, while cardiomyopathy and myocarditis were more common in men. There were five, 13, and two reported deaths from neutropenia, myocarditis, and cardiomyopathy, respectively. CONCLUSIONS: The rates of serious AEs (including deaths) are low and likely an underestimate of true rates and need to be considered by clinicians in balancing the risks and benefits. Continued education on the monitoring and treatment of these AEs for consumers, carers and health professionals is essential and reporting these to the relevant national reporting agency is crucial.

Does leaving an abusive partner lead to a decline in victimization?

BACKGROUND: This paper investigates gender differences in persistence of intimate partner violence (IPV), for those remaining or leaving an abusive relationship. We followed a sample of males and females to examine whether leaving an abusive partner may alter the continuity of victimization. METHODS: Data were taken from the 21 and 30-year follow-ups of the Mater Hospital and University of Queensland Study of Pregnancy (MUSP) in Australia. A cohort of 1265 respondents, including 874 females and 391 males, completed a 21-item version of the Composite Abuse Scale. RESULTS: We found proportionally similar rates of IPV victimization for males and females at both the 21 and 30 year follow-ups. Females who reported they had an abusive partner at the 21 year follow-up were more likely to subsequently change their partner than did males. Harassment and then emotional abuse appeared to have a stronger association for females leaving a partner. For males, a reported history of IPV was not significantly associated with leaving the partner. There was no significant association between leaving (or not) a previous abusive relationship and later victimization, either for male or female respondents. CONCLUSION: Changing a partner does not interrupt the continuity of victimization either for male or female respondents, and previous IPV victimization remained a determining factor of re-abuse, despite re-partnering.

Genetic factors associated with iron storage in Australian blood donors.

BACKGROUND: Blood donors are at risk of developing iron deficiency and/or iron deficiency anaemia. This may affect their health and affect their eligibility to give subsequent donations. Investigating genetic factors that may predispose donors to high or low iron stores is of interest; this may assist with providing optimal management strategies for maintaining donor health. This study aimed to investigate whether the presence of selected single nucleotide polymorphisms (SNPs) affecting parameters of iron status were associated with ferritin levels in Australian donors. MATERIALS AND METHODS: Samples (n=800) were collected from non-first-time blood donors in Queensland. Plasma ferritin levels were quantified and the genotypes for ten SNPs, identified by a review of relevant literature, were determined for each sample. Associations between SNPs and ferritin levels were investigated. RESULTS: Three SNPs were associated with ferritin levels. In male donors, high ferritin levels were associated with the variant allele (G) of the SNP rs3923809 in the BTBD9 gene. An association with ferritin levels was also identified with the SNP rs235756 in the BMP2 gene in males. The SNP rs4820268 in the TMPRSS6 gene was associated with ferritin levels in females, with donors with the AG genotype being three times more likely to have low ferritin levels. DISCUSSION: Variants in the genes TMPRSS, BTBD9 and BMP2 were associated with ferritin levels in Australian blood donors. These findings provide support that genetic testing may be useful for the generation of predictive algorithms that may allow for management strategies to be tailor-made for individual donors.

Does having a difficult child lead to poor maternal mental health?

OBJECTIVES: Considerable evidence suggests maternal psychopathology influences that of their offspring. The probability of a reverse causal pathway has been only rarely considered but is a concern, given around 10% of children manifest mental impairment during their early years. This study determines the extent to which child behavior problems at ages 5 and 14 years are associated with mothers' mental health at 21 years post birth. STUDY DESIGN: Longitudinal study. METHODS: Data were taken from a sample of 3650 women from Mater and University of Queensland Study of Pregnancy birth cohort. Women's mental health was measured using the Mental Disorder Screening Tool at 21 years post birth. The Child Behavior Check List was used to measure internalizing, combined social/attention/thought disorder, and aggression at the age of 5 and 14 years. Logistic regression was used to derive odds ratios and 95% confidence intervals. A number of confounders were used to test for independence. RESULTS: Following all adjustments, child internalizing behaviors and combined social/attention/thought disorder at 5 years, and all measures of child behavior problem at 14 years were associated with mothers meeting criteria for mental health impairment at 21 years post birth. Moreover mothers of children with behavior problems at 14 years were approximately 2-3 times more likely to these meet these criteria. CONCLUSIONS: Mothers of children with behavior problems at 5 and 14 years of age were more likely to have mental health impairment at 21 years post birth. Child health professionals should be cognizant of the mother-child relationship having mutual mental health vulnerability.

Do Participants With Different Patterns of Loss to Follow-Up Have Different Characteristics? A Multi-Wave Longitudinal Study.

BACKGROUND: To identify patterns of loss to follow-up and baseline predictors of each pattern. METHODS: The Mater-University Study of Pregnancy collected baseline information for 7718 pregnant women who attended Mater Hospital in Brisbane, Australia, from 1981 through 1983. Follow-up data for 6753 eligible participants were collected at 6 months, 5 years, 14 years, 21 years, and 27 years after giving birth. Participants were partitioned into groups of 'Always Responders', 'Returners', 'Leavers', 'Intermittents', and 'Never Responders'. Multinomial logistic regression was used to simultaneously compare baseline characteristics of the last four groups with 'Always Responders'. RESULTS: Being younger, less educated, having no partner, and living in rented housing were associated with being a 'Returner'. Not owning housing, receiving welfare benefits, and being younger, less educated, not married, a smoker, an Aboriginal/Islander, and born in a non-English-speaking country were associated with being a 'Leaver', an 'Intermittent', or a 'Never-responder'. Having higher mental health score and drinking before pregnancy were associated with being a 'Leaver' or an 'Intermittent'. Being unemployed and not physically active were associated with being a 'Leaver' or 'Never Responder'. The groups 'Leavers' and 'Never Responders' were the most different from the 'Always Responders'. The group that was most similar to 'Always Responders' was the 'Returners'. CONCLUSIONS: Patterns of loss to follow-up should be considered in the application of missing data techniques, where researchers make assumptions about the characteristics of those subjects who do not respond to assess the type of missing data. This information can be used to prevent individuals who are at high risk of dropping out of a study from doing so.

Ethics and professionalism in general practice placements: what should students learn?

BACKGROUND: A diverse range of ethical and professionalism issues has been identified in Australian general practice. OBJECTIVE: To establish which of these issues general practitioner (GP) teachers and students consider the most important, to enable GP teachers to facilitate student learning in this domain. METHODS: A survey instrument was developed and distributed to GP teachers and medical students. Participants rated the importance of students learning about each of 32 different ethical issues. Students rated their confidence in managing these areas. RESULTS: GP teachers and students agreed on many of the most important issues (including patient confidentiality, medical mistakes, working with colleagues and drug-seeking patients); there are also some interesting differences. Student confidence in patient confidentiality was very high, but particularly low in career and training decisions and medical mistakes. DISCUSSION: Students want to learn more about career and training decisions and medical mistakes. They may underestimate the complexity of confidentiality and professional relationships in general practice.

How confident are general practitioners in teaching medical students about ethical issues on general practice placements?

BACKGROUND: Despite a paucity of evidence to guide teaching about medical professionalism and ethical issues, there is a widespread consensus that medical students should learn about these issues on clinical placements. Exploring the confidence of general practitioners (GPs) in teaching various topics will identify areas for further discussion, support and/or training. METHODS: A survey was developed and distributed to 65 teaching practices. Thirty-seven GPs responded by rating their confidence in teaching about 32 different ethical issues. RESULTS: Overall, GPs were confident in teaching about these issues. Confidence was lowest for doctors' social and political responsibilities; ethical lapses in colleagues; impairment in colleagues; cross-cultural issues; and moral motivation, judgement, courage and sensitivity. DISCUSSION: Further training for GP teachers may be particularly useful in the important areas of impairment and lapses in colleagues, and cross-cultural issues. Uncertainty about the scope of doctors' social and political responsibilities may limit GP confidence in teaching in these areas.

Mental disorder assessed by General Health Questionnaire and back pain among postmenopausal Iranian women.

The aim of this study was to investigate the association between mental disorder and back pain among postmenopausal Iranian women. Three thousand six hundred and fifty five postmenopausal women were interviewed in the second National Health Survey (2nd NHS) in the year 2000, in Iran. Of whom, 2953 women were included in this study. Back pain (BKP) was considered as dependent variable and mental disorder as independent variable. Factors like age, Body Mass Index (BMI), residential area, employment, literacy, smoking habit, marital status and spinal fractures were considered as confounders. Logistic regression models have been applied for data analysis. The BKP prevalence was 40.1% and the prevalence of mental disorder was 44.3%. After adjustment for confounders, mental disorder was positively associated with BKP, OR (CI): 1.615 (1.36, 1.91). This study confirmed that BKP and mental disorder are common problems and these two factors are associated amongst postmenopausal women. Further longitudinal studies are recommended to specify casual inferences.