Search

This cohort study examines 20 years of data for Danish patients who had electroconvulsive therapy (ECT) to compare the risk of hospitalization or suicidal behavior between patients who had continuing and maintenance ECT vs acute ECT alone. Key Points: Question: Is continuing electroconvulsive therapy (ECT) after an acute ECT series associated with better relapse prevention than other treatment strategies? Findings: In this cohort study involving 19 944 patients who had ECT, continuing ECT was associated with a decreased risk of rehospitalization after the acute ECT series and also associated with reduced treatment costs. Meaning: Continuing ECT after a successful acute treatment series should likely be considered more often. Importance: Large-scale evidence for the efficacy of continuation and maintenance electroconvulsive therapy (c/mECT) is lacking. Objective: To provide an exhaustive and naturalistic insight into the real-world outcomes and the cost-effectiveness of c/mECT in a large dataset. Design, Setting, and Participants: This cohort study included all patients in the Danish National Patient Registry who initiated treatment with ECT from 2003 through 2022. The data were analyzed from October 2023 to February 2024. Exposures: ECT. An algorithm to identify c/mECTs in the dataset was developed: (>3 treatments with ≥7 and <90 days between adjacent treatments, occurring within a time frame of 180 days [cECT] or more [mECT] after an acute [aECT] series). Main Outcomes and Measures: The association of c/mECT with subsequent 6- to 12-month risk of hospitalization or suicidal behavior using Cox proportional hazard regression with multiple adjustments and aECT only as a reference, propensity score matching, and self-controlled case series analysis using a Poisson regression model. A cost-effectiveness analysis based on hospitalization and ECT expenses was made. Results: A total of 19 944 individuals were treated with ECT (12 157 women [61%], 7787 men [39%]; median [IQR] age, 55 [41-70] years). Of these, 1533 individuals (7.7%) received c/mECT at any time point (1017 [5.1%] cECT only and 516 [2.6%] mECT). Compared with patients receiving aECT only, c/mECT patients more frequently experienced schizophrenia (odds ratio [OR], 2.14; 95% CI, 1.86-2.46) and schizoaffective disorder (OR, 2.42; 95% CI, 1.90-3.09) and less frequently unipolar depression (OR, 0.56; 95% CI, 0.51-0.62). In all models, c/mECT was associated with a lower rate of hospitalization after finishing aECT (eg, 6-month adjusted hazard ratio, 0.68; 95% CI, 0.60-0.78 [Cox regression]; 6-month incidence rate ratio, 0.51; 95% CI, 0.41-0.62 [Poisson regression]). There was no significant difference in the risk of suicidal behavior. Compared with the periods before the end of aECT, c/mECT was associated with a substantial reduction in total treatment costs. Conclusions and Relevance: In a nationwide and naturalistic setting, c/mECT after aECT was infrequently used but associated with a lower risk of readmission than aECT alone. The totality of the evidence indicates that c/mECT should be considered more often to prevent relapse after successful aECT in patients whose condition does not respond sufficiently to other interventions. [ABSTRACT FROM AUTHOR]

Background. The hypothalamo-pituitary-thyroid axis has been widely implicated in modulating the aging process. Life extension effects associated with low thyroid hormone levels have been reported in multiple animal models. In human populations, an association was observed between low thyroid function and longevity at old age, but the beneficial effects of low thyroid hormone metabolism at middle age remain elusive. Methods. We have compared serum thyroid hormone function parameters in a group of middle-aged offspring of long-living nonagenarian siblings and a control group of their partners, all participants of the Leiden Longevity Study. Results. When compared with their partners, the group of offspring of nonagenarian siblings showed a trend toward higher serum thyrotropin levels (1.65 vs 157 mU/L, p =.11) in conjunction with lower free thyroxine levels (15.0 vs 15.2 pmol/L, p = .045) and lower free triiodothyronine levels (4.08 vs 4.14 pmol/L, p = .024). Conclusions. Compared with their partners, the group of offspring of nonagenarian siblings show a lower thyroidal sensitivity to thyrotropin. These findings suggest that the favorable role of low thyroid hormone metabolism on health and longevity in model organism is applicable to humans as well. Key Words: Thyroid--Longevity--Endocrinology. doi: 10.1093/gerona/glp200

Author(s): Maarten P. Rozing (corresponding author) [1, 2]; Thomas B. L. Kirkwood [1, 3]; Rudi G. J. Westendorp [1, 2] arising from X. Dong, B. Milholland & J. Vijg Nature [...]

To analyze the association between change in HbA1c during the first 6 years after diagnosis of Type 2 diabetes mellitus (Type 2 DM) and incident micro- and macrovascular morbidity and mortality during 13 years thereafter. This is an observational study of the participants in the intervention arm of the randomized controlled trial Diabetes Care in General Practice (DCGP) in Denmark. 494 newly diagnosed persons with Type 2 DM aged 40 years and over with three or more measurements of HbA1c during six years of intervention were included in the analyses. Based on a regression line, fitted through the HbA1c-measurements from 1 to 6 years after diabetes diagnosis, glycaemic control was characterized by the one-year level of HbA1c after diagnosis, and the slope of the regression line. Outcomes were incident diabetes-related morbidity and mortality from 6 to 19 years after diabetes diagnosis. The association between change in HbA1c (the slope of the regression line) and clinical outcomes were assessed in adjusted Cox regression models. The median HbA1c level at year one was 60 (IQR: 52–71) mmol/mol or (7.65 (IQR: 6.91–8.62) %). Higher HbA1c levels one year after diagnosis were associated with a higher risk of later diabetes-related morbidity and mortality. An increase in HbA1c during the first 6 years after diabetes diagnosis was associated with later microvascular complications (HR per 1.1 mmol/mol or 0.1% point increase in HbA1c per year; 95% CI) = 1.14; 1.05–1.24). Change in HbA1c did not predict the aggregate outcome 'any diabetes-related endpoint, all-cause mortality, diabetes-related mortality, myocardial infarction, stroke, or peripheral vascular diseases. We conclude that suboptimal development of glycaemic control during the first 6 years after diabetes diagnosis was an independent risk factor for microvascular complications during the succeeding 13-year follow-up, but not for mortality or macrovascular complications. [ABSTRACT FROM AUTHOR]

Hypnotic-sedative medication is globally widely prescribed. Its use has been implicated with falls and fractures, yet this association may be due (in part) to confounding by indication. To evaluate the risk of falls and fractures in users of benzodiazepines, Z-drugs, or melatonin. We conducted a self-controlled case series comprising persons living in Denmark aged 15 years and older (n= 699,335) with a first-time purchase of benzodiazepines, Z-drugs, or melatonin between 2003 and 2016. The main exposures were defined as the purchase of benzodiazepines, Z-drugs, or melatonin from a pharmacy registered in the Danish National Prescription Registry. Incident falls and fractures were registered in the Danish National Patient Registry between 2000 and 2018. Associations were examined in a self-controlled case-series analysis, and conditional Poisson regression was used to derive incidence rate ratios (IRR) of the risk of falls and fractures during six predefined periods. In total, 62,105 (8.7%) of the study population experienced a fall accident that required admission to a hospital or visit to an emergency clinic during any of the six predefined periods. Compared with the non-treatment period, the risk of falls was highest in the pre-treatment period (IRR=1.96 (1.82-2.10)), slightly higher in the initial treatment period (IRR=1.22 (1.12-1.33)) and similar in the consolidated treatment period (IRR=1.07 (0.95-1.20)). The higher risk in the pre-treatment period was especially seen for men and in the oldest age group, whereas there was no association in the age group below 40 years. During the six predefined periods, 36,808 persons suffered a fracture. When analyses were repeated with fractures as the outcome, the risk was higher in all periods compared to the non-treatment period, with the highest risk in the pre-treatment periods. Analyses that were further restricted to hip fractures only as the outcome, yielded similar results. Although falls and fractures occur more often in persons treated with sedative-hypnotic medication, the higher risk of falls and fractures in the pre-treatment period suggests that this association is better explained by other factors than by the adverse effects of the sedative-hypnotic medication. This work was supported by the Danish Council for Independent Research (grant ID: DFF–6110-00195). The study funder had no role in the study design; data collection, analysis, interpretation, or writing of the report. [ABSTRACT FROM AUTHOR]