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Symptoms may be more useful prognostic markers for mental illness than diagnoses. We sought to investigate symptom domains in women with pre-existing severe mental illness (SMI; psychotic and bipolar disorder) as predictors of relapse risk during the perinatal period.
Data were obtained from electronic health records of 399 pregnant women with SMI diagnoses from a large south London mental healthcare provider. Symptoms within six domains characteristically associated with SMI (positive, negative, disorganization, mania, depression, and catatonia) recorded in clinical notes 2 years before pregnancy were identified with natural language processing algorithms to extract data from text, and associations investigated with hospitalization during pregnancy and 3 months postpartum.
Seventy-six women (19%) relapsed during pregnancy and 107 (27%) relapsed postpartum. After adjusting for covariates, disorganization symptoms showed a positive association at borderline significance with relapse during pregnancy (adjusted odds ratio [aOR] = 1.36; 95% confidence interval [CI] = 0.99–1.87 per unit increase in number of symptoms) and depressive symptoms negatively with relapse postpartum (0.78; 0.62–0.98). Restricting the sample to women with at least one recorded symptom in any given domain, higher disorganization (1.84; 1.22–2.76), positive (1.50; 1.07–2.11), and manic (1.48; 1.03–2.11) symptoms were associated with relapse during pregnancy, and disorganization (1.54; 1.08–2.20) symptom domains were associated with relapse postpartum.
Positive, disorganization, and manic symptoms recorded in the 2 years before pregnancy were associated with increased risk of relapse during pregnancy and postpartum. The characterization of routine health records from text fields is relatively transferrable and could help inform predictive risk modelling.
Research in schizophrenia and pregnancy has traditionally been conducted in small samples. More recently, secondary analysis of routine healthcare data has facilitated access to data on large numbers of women with schizophrenia.
To discuss four scientific advances using data from Canada, Denmark and the UK from population-level health registers and clinical data sources.
Narrative review of research from these three countries to illustrate key advances in the area of schizophrenia and pregnancy.
Health administrative and clinical data from electronic medical records have been used to identify population-level and clinical cohorts of women with schizophrenia, and follow them longitudinally along with their children. These data have demonstrated that fertility rates in women with schizophrenia have increased over time and have enabled documentation of the course of illness in relation with pregnancy, showing the early postpartum as the time of highest risk. As a result of large sample sizes, we have been able to understand the prevalence of and risk factors for rare outcomes that would be difficult to study in clinical research. Advanced pharmaco-epidemiological methods have been used to address confounding in studies of antipsychotic medications in pregnancy, to provide data about the benefits and risks of treatment for women and their care providers.
Use of these data has advanced the field of research in schizophrenia and pregnancy. Future developments in use of electronic health records include access to richer data sources and use of modern technical advances such as machine learning and supporting team science.
Two recent meta-analyses claim that abortion leads to a deterioration in mental health. Previous reviews concluded that the mental health outcomes following an unwanted pregnancy are much the same whether the woman gives birth or terminates the pregnancy, although there is an increased mental health risk with an unwanted pregnancy. Meta-analysis is particularly susceptible to bias in this area. The physical health outcomes for women with an unwanted pregnancy have improved greatly by making abortion legal. To further improve the mental health outcomes associated with an unwanted pregnancy we should focus practice and research on the individual needs of women with an unwanted pregnancy, rather than how the pregnancy is resolved.
In 1990 a stone covered pit containing a Trevisker Ware vessel was found eroding from the cliffs at Harlyn Bay and excavated. The vessel contained cremated bone from several individuals with some animal bone, quartz pebbles, and a small bronze pendant. A radiocarbon date on the cremated bone fell in the range 2120–1880 cal bc and is a valuable addition to the small number of securely-dated Early Bronze Age burials in Cornwall with metalwork associations. This early date also makes a major contribution to the debate on the sequence of Trevisker Ware as the vessel, of gabbroic clay, has a band of incised chevron decoration. Lipid residue analysis showed traces of ruminant dairy fat. This paper examines the significance of unmounded burial sites in Cornwall and also assesses the importance of Early Bronze Age burials around Harlyn Bay which have produced an unusually wide range of artefacts.
The production of extracellular polysaccharide (EPS) molecules is a common feature of many bacteria (Whitfield and Valvano, 1993; Roberts, 1996). These molecules may be linked to the cell surface and organized into a discrete structure termed the capsule or, alternatively, may comprise an amorphous slime layer that is easily sloughed off from the cell surface. In essence, EPS provides a hydrated negatively charged gel that surrounds the bacterium and it is the physicochemical properties of this gel that account for the biological properties of bacterial capsules. A striking feature of bacterial capsular polysaccharides is their diversity, both in terms of component sugars and the glycosidic bond between repeating sugar residues. Even within a single bacterial species, there can be enormous structural diversity. For instance, in the case of Streptococcus pneumoniae there are in excess of 90 capsular serotypes. This diversity has important implications for the design of vaccine formulations that are based on capsular polysaccharides. Paradoxically, amongst this array of structural diversity, there are capsular polysaccharide molecules that are conserved across different bacterial species, such as the Escherichia coli K1 and Neisseria meningitidis serogroup B capsular polysaccharide (Jennings, 1990). Both the diversity of capsular polysaccharides and the conservation of certain polysaccharide structures across species barriers raise questions about the evolution of capsule gene clusters and the selective pressures that drive structural diversity.
For nearly 70 years, from the pioneering experiments of F. Griffith on the transformation of avirulent unencapsulated pneumococci to encapsulation and virulence (Griffith, 1928), it has been known that the expression of a capsule is an essential virulence factor.
During the middle years of the nineteenth century a significant number of American Negro reformers visited Britain. Their visits have not passed unnoticed. As J. H. Franklin has remarked, “More than a score of black abolitionists went to England, Scotland, France and Germany… Almost everywhere they were received with enthusiasm and were instrumental in linking up the humanitarian movement with various reform movements on both sides of the Atlantic.” Benjamin Quarles, furthermore, has commented on some of their work in Britain.
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