Premature Mortality In People Research Articles

Decision support tool for physical health (DST-PH): stratifying risks to reduce avoidable deaths in people with intellectual disability

PurposePeople with intellectual disability die prematurely and from avoidable causes. Innovative solutions and proactive strategies have been limited in addressing this disparity. This paper aims to detail the process of developing a risk stratification tool to identify those individuals who are higher risk of premature mortality.Design/methodology/approachThis study used population health management principles to conceptualise a risk stratification tool for avoidable deaths in people with intellectual disability. A review of the literature examined the existing evidence of causes of death in people with intellectual disability. A qualitative methodology using focused groups of specialist clinicians was used to understand the factors that contributed towards avoidable deaths in people with intellectual disability. Delphi groups were used for consensus on the variables for inclusion in the risk stratification tool (Decision Support Tool for Physical Health).FindingsA pilot of the Decision Support Tool for Physical Health within specialist intellectual disability service demonstrated effective utility and acceptability in clinical practice. The tool has also demonstrated good face and construct validity. A further study is currently being completed to examine concurrent and predictive validity of the tool.Originality/valueTo the best of the authors’ knowledge, this is the only study that has used a systematic approach to designing a risk stratification tool for identifying premature mortality in people with intellectual disability. The Decision Support Tool for Physical Health in clinical practice aims to guide clinical responses and prioritise those identified as at higher risk of avoidable deaths.

Antidepressant treatment and mortality in people with comorbid depression and type 2 diabetes: UK electronic health record study.

Depression is associated with higher rates of premature mortality in people with physical comorbidities, such as type 2 diabetes. Conceptually, the successful treatment of depression in people with type 2 diabetes could prevent premature mortality. To investigate the association between antidepressant prescribing and the rates of all-cause and cause-specific (endocrine, cardiovascular, respiratory, cancer, unnatural) mortality in individuals with comorbid depression and type 2 diabetes. Using UK primary care records between years 2000 and 2018, we completed a nested case-control study in a cohort of people with comorbid depression and type 2 diabetes who were starting oral antidiabetic treatment for the first time. We used incident density sampling to identify cases who died and matched controls who remained alive after the same number of days observation. We estimated incidence rate ratios for the association between antidepressant prescribing and mortality, adjusting for demographic characteristics, comorbidities, medication use and health behaviours. We included 5222 cases with a recorded date of death, and 18 675 controls, observed for a median of 7 years. Increased rates of all-cause mortality were associated with any antidepressant prescribing during the observation period (incidence rate ratio 2.77, 95% CI 2.48-3.10). These results were consistent across all causes of mortality that we investigated. Antidepressant prescribing was highly associated with higher rates of mortality. However, we suspect that this is not a direct causal effect, but that antidepressant treatment is a marker of more severe and unsuccessfully treated depression.

Required elements for an educational programme for lay exercise instructors in charge of community-based exercise targeting young adults with schizophrenia spectrum disorders – A stakeholder focus group study

BackgroundExercise plays a crucial role in addressing the increased cardiometabolic morbidity and premature mortality in people with schizophrenia spectrum disorders. When delivered in community-based settings, exercise may also reduce loneliness, while promoting overall physical activity behaviours. Skilled instructors are essential to deliver effective community-based exercise; however, knowledge about their roles and required training is lacking. We aim to explore various stakeholders’ perspectives regarding lay exercise instructors’ roles, and the required elements in an educational programme supporting the delivery of community-based exercise for young adults with SSD.MethodsWe used semi-structured homogeneous focus groups with representatives from different stakeholder groups (i.e., including representatives of clinical staff within mental health, physiotherapists, exercise instructors, young adults with schizophrenia spectrum disorders, and relatives of individuals with schizophrenia spectrum disorders) targeted or affected by a community-based exercise intervention. Data were analysed using qualitative content analysis.ResultsWe conducted six focus groups comprising a total of 30 individuals representing five different stakeholder groups The analysis identified three categories: (i) awareness and understanding of mental illness, i.e., providing basic knowledge to dispel common myths and stigma regarding mental illness (ii) protecting youth identity, i.e., supporting the feeling of being more than just a patient, and (iii) promoting exercise as a shared activity, i.e., a communal pursuit, fostering personal growth among participants, their peers and the instructors.ConclusionsAn educational programme for lay exercise instructors delivering community-based exercise targeting young adults with SSD should empower the instructors to assume the role of guardians of an inclusive exercise culture. Educational elements identified were adapted and integrated into an educational programme implemented and evaluated as a part of the Vega trial. Our results may be transferable to the education of lay workers in mental health care where the aim is to facilitate sustainable, recreational, community-based activities.

1492. Gender-Specific Targets for Primary Prevention in People Living with HIV : Applying Life's Simple 7 to a Gender-Stratified Population of ART-Naive People Living with HIV in Tanzania

Abstract Background Cardiovascular disease (CVD) represents a major cause of premature mortality in people living with HIV (PLWH). However, morbidity is not equal between males and females. There is a need to better understand how gender influences cardiovascular health (CVH) in PLWH in order to identify targets for intervention. Therefore, we applied the Life's Simple Seven (LS7) scale to a gender-stratified cohort of ART-Naive PLWH and HIV-uninfected controls in adults. Methods A cross-sectional analysis was conducted on a cohort of ART-naive PLWH and HIV-uninfected adults recruited from HIV clinics between June 2016 and August 2019 in Mwanza, Tanzania (HIV&HTN cohort). We applied modified Life's Simple Seven (LS7) definitions (Table 1) and compared the distribution of Ideal LS7 metrics between males and females of both study groups. Each LS7 metric was categorized as ideal (2 points), intermediate (1 point) and poor (0 point) and ordinal regressions were employed to investigate associations between gender and each individual LS7 metric. Regressions were adjusted for HIV status, age, income, education level. Results Our study included 997 participants, with 493 PLWH (68.7% female) and 504 HIV-uninfected (66.4% female). As displayed in Figure 1, the distribution of Ideal LS7 metrics differed between the males and females in both study groups. Males had a higher prevalence of ideal physical activity (aOR=4.12 [95%CI=3.11 to 5.44], p< 0.001) and ideal BMI (aOR=5.10 [3.47 to 7.49], p< 0.001) but lower prevalence of ideal smoking (aOR=0.037 [0.021 to 0.065], p< 0.001) and ideal blood pressure (aOR= 0.65 [0.50 to 0.85], p=0.002). The magnitude of these differences also varied by HIV status such that they were larger in PLWH than HIV-uninfected group for smoking (41.3% vs 26.4%), physical activity (41.6% vs 24.8%) and blood pressure (12.7% vs 9.2%) metrics. By contrast, these differences were less pronounced in PLWH vs HIV-uninfected group for the BMI metric (23.1% vs 29.7%). Figure 1: Distribution of Ideal Life's Simple 7 metrics, stratified by gender for both PLWH and HIV-uninfected controls Conclusion Cardiovascular health profiles vary by gender and HIV status, with stark differences between male and female PLWH for most metrics. Gender-specific interventions targeting smoking cessation, blood pressure control in male PLWH and physical activity, weight loss in female PLWH are warranted to mitigate CVD risk. Disclosures All Authors: No reported disclosures

Caffeine exacerbates seizure-induced death via postictal hypoxia

Sudden unexpected death in epilepsy (SUDEP) is the leading epilepsy-related cause of premature mortality in people with intractable epilepsy, who are 27 times more likely to die than the general population. Impairment of the central control of breathing following a seizure has been identified as a putative cause of death, but the mechanisms underlying this seizure-induced breathing failure are largely unknown. Our laboratory has advanced a vascular theory of postictal behavioural dysfunction, including SUDEP. We have recently reported that seizure-induced death occurs after seizures invade brainstem breathing centres which then leads to local hypoxia causing breathing failure and death. Here we investigated the effects of caffeine and two adenosine receptors in two models of seizure-induced death. We recorded local oxygen levels in brainstem breathing centres as well as time to cessation of breathing and cardiac activity relative to seizure activity. The administration of the non-selective A1/A2A antagonist caffeine or the selective A1 agonist N6-cyclopentyladenosine reveals a detrimental effect on postictal hypoxia, providing support for caffeine modulating cerebral vasculature leading to brainstem hypoxia and cessation of breathing. Conversely, A2A activation with CGS-21680 was found to increase the lifespan of mice in both our models of seizure-induced death.

Bridging public and private health services to best meet the cardiometabolic needs of people with severe mental illness: a retrospective cohort study.

Cardiovascular disease is the leading cause of premature mortality in people with severe mental illness (SMI). Despite this, there lacks consensus regarding the most appropriate platform to monitor and treat cardiometabolic risk factors in this cohort. The current study aims to evaluate the effectiveness of tailored cardiometabolic healthcare in a private, GP-led clinic for people with SMI. A total of 63 adults with SMI were referred to a private GP-led cardiometabolic clinic from a neighbouring inner-city mental health service, where they received individualised cardiometabolic healthcare free-of-charge between 2014 and 2020. Paired t test was used to measure change in cardiometabolic data over the course of treatment. Chi-squared and Fisher's Exact tests were used to examine differences in demographic data and client engagement. Over a mean period of 9months, there was a significant mean reduction of weight (2.1kg), BMI (0.72kg/m2) and waist circumference (6cm). Engagement over a longer period was associated with stable accommodation and improved cardiometabolic outcomes. Targeted referral for individualised cardiometabolic interventions can lead to clinically significant improvement in cardiometabolic outcomes, providing a cause for therapeutic optimism when approaching physical health in people with SMI.

Screening and prevalence of cardiometabolic risk factors in patients with severe mental illness: A multicenter cross-sectional cohort study in the Netherlands

BackgroundDue to increased cardiometabolic risks and premature mortality in people with severe mental illness (SMI), monitoring cardiometabolic health is considered essential. We aimed to analyse screening rates and prevalences of cardiometabolic risks in routine mental healthcare and its associations with patient and disease characteristics. MethodsWe collected screening data in SMI from three mental healthcare institutions in the Netherlands, using most complete data on the five main metabolic syndrome (MetS) criteria (waist circumference, blood pressure, HDL-cholesterol, triglycerides, fasting blood glucose) within a 30-day timeframe in 2019/2020. We determined screened patients' cardiometabolic risks and analysed associations with patient and disease characteristics using multiple logistic regression. ResultsIn 5037 patients, screening rates ranged from 28.8% (waist circumference) to 76.4% (fasting blood glucose) within 2019–2020, and 7.6% had a complete measurement of all five MetS criteria. Older patients, men and patients with psychotic disorders had higher odds of being screened. Without regarding medication use, risk prevalences ranged from 29.6% (fasting blood glucose) to 56.8% (blood pressure), and 48.6% had MetS. Gender and age were particularly associated with odds for individual risk factors. Cardiometabolic risk was present regardless of illness severity and did generally not differ substantially between diagnoses, in−/outpatients and institutions. ConclusionsDespite increased urgency and guideline development for cardiometabolic health in SMI last decades, screening rates are still low, and the MetS prevalence across screened patients is almost twice that of the general population. More intensive implementation strategies are needed to translate policies into action to improve cardiometabolic health in SMI.

Meeting the challenges of rising premature mortality in people with severe mental illness

People with severe mental illness are 4.5 times more likely to die prematurely than the general UK population. We review the drivers of poorer physical health across mental health conditions and propose some practical approaches to addressing this in the clinic.

A question prompt list for sudden unexpected death in epilepsy

A question prompt list for sudden unexpected death in epilepsy

Association between Life's Essential 8 score and risk of premature mortality in people with and without type 2 diabetes: A prospective cohort study.

To evaluate the association of cardiovascular health (CVH), measured by Life's Essential 8 score, with the risk of premature mortality and to determine the patterns of CVH-related differences in life expectancy among people with and without type 2 diabetes (T2D). This prospective study included 309,789 participants (age 56.6±8.1years; 46% men) enroled in the UK Biobank. The Life's Essential 8 composite measure consists of four health behaviours (diet, physical activity, nicotine exposure, and sleep) and four health factors (BMI, non-HDL cholesterol, blood glucose, and blood pressure), and the maximum CVH score was 100 points. CVH was categorised into low, moderate, and high groups. Premature death was defined as death before the age of 75. Cox proportional hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, and life expectancy was estimated. During a median follow-up of 12.7years, 13,683 cases of premature death were documented. Compared to participants with low CVH, the multivariable HRs (95% CIs) of premature death were 0.59 (0.56-0.62) and 0.42 (0.39-0.45) for the moderate and high CVH groups, respectively. This association was stronger in participants with T2D compared with those without T2D. At the age of 50years, compared to low CVH groups, high CVH was associated with a gain of 9.79 (9.70-9.87) and 5.58 (5.48-5.67) additional life years for men with and without T2D, respectively. The corresponding life gain for women with and without T2D was 24.21 (24.13-24.27) and 10.18 (10.10-10.27), respectively. Maintaining an ideal Life's Essential 8 score may provide more benefits for people with T2D than for those without T2D, including a lower risk of premature death and an increased lifespan.

Dead in Bed: A Rare Complication of Type 1 Diabetes Mellitus

Introduction: Type 1 diabetes or juvenile diabetes or insulin-dependent diabetes, is a chronic condition of autoimmune destruction of the beta cells in the pancreas due to which the pancreas makes little or no insulin. Treatment requires insulin supplementation, which has its own side effects. Dead in bed syndrome is the name given for fatal outcome seen in young diabetic patients who are found dead in morning in a clearly undisturbed surrounding. In most of the cases there is no history of diabetes related complication, and the post-mortem examination is ordinarily negative. Case description: We described a case of sudden death of a Type 1 Diabetic young female brought for post-mortem examination along with a short commentary on “Death in Bed Syndrome” seen in such diabetic individuals. At post-mortem examination the cause of death was not apparent. The biochemical and histopathological examination as well as the chemical analysis of viscera were inconclusive. No definite opinion was given regarding cause of death. However, the police insisted that death be declared natural or unnatural. Conclusion: To reduce premature mortality in people with childhood-onset diabetes focus should be on prevention of acute complications. Medicolegal experts should be careful in giving opinion in such cases and such opinion should be based on exclusion. Keywords: [Diabetes Mellitus, Sudden death, Hypoglycaemia, nocturnal]

Physical activity, exercise capacity and mortality risk in people with interstitial lung disease: A systematic review and meta-analysis.

Physical activity and exercise measures show potential to predict mortality in people with interstitial lung disease. This study summarized evidence on the association between physical activity and exercise capacity measures and mortality risk in people with interstitial lung disease and quantified its magnitude by meta-analysis. Systematic review and meta-analysis. PubMed, Scopus, Web of Science and EBSCO were searched until May 2020 with updates until September 2021. Two authors screened studies, extracted data, and assessed risk of bias. A random-effects meta-analysis for each physical activity measure was conducted using logarithmic hazard ratios. Fifty-two studies of 10,349-people with interstitial lung disease (64 ± 9 years; 67%men) were included. A significant association between at least one measure of physical activity and exercise and mortality risk was found in 44-studies. Most reported measures were the six-minute walk test, oxygen uptake (VO2), work (watts-W) and time spent in physical activity. Meta-analysis showed that individuals with six-minute walk distance < 250 m had more than twofold higher mortality risk, than those with six-minute walk distance ≥ 350 m. Individuals presenting a six-minute walk distance decrease ≥ 26 m over 6-48 months showed an almost threefold higher mortality risk. An increase of 10-20 W or 10 %predicted in workload and a time spent in physical activity ≥ 100 min/week or ≥0.031 kcal/min/kg/day were associated with an overall 12 % and 45 % lower mortality risk, respectively. Physical activity and exercise capacity measures were associated with mortality risk in people with interstitial lung disease. Most studies used the six-minute walk test and more evidence is needed on the other measures (i.e., VO2, work and physical activity time). Personalized interventions to improve physical activity and exercise capacity should be considered to delay premature mortality in people with interstitial lung disease. CRD42020187952.

Premature mortality in people affected by co-occurring homelessness, justice involvement, opioid dependence, and psychosis: a retrospective cohort study using linked administrative data

SummaryBackgroundHomelessness, opioid dependence, justice involvement, and psychosis are each associated with an increased risk of poor health and commonly co-occur in the same individuals. Most existing studies of mortality associated with this co-occurrence rely on active follow-up methods prone to selection and retention bias, and focus on a limited set of specific exposures rather than taking a population-based approach. To address these limitations, we did a retrospective cohort study using linked administrative data.MethodsIn this retrospective cohort study, we linked a population register of adults resident in Glasgow, UK, to administrative datasets from homelessness and criminal justice services; community pharmacies; and a clinical psychosis registry with data from April 1, 2010 to March 31, 2014. Linkage to death registrations from April 1, 2014 to March 31, 2019 provided follow-up data on premature mortality (age <75 years) from all causes, non-communicable diseases, and causes considered potentially avoidable through health-care or public health intervention. We estimated hazard ratios (HR) using Poisson regression, adjusting for age, gender, socioeconomic deprivation, and calendar time.FindingsOf 536 653 cohort members, 11 484 (2·1%) died during follow-up. All-cause premature mortality was significantly higher among people with multiple exposures than among people with single exposures, and among people with any exposure than among people with none (eg, homelessness plus other exposures vs no exposures: HR 8·4 [95% CI 7·3–9·5]; homelessness alone vs no exposures: HR 2·2 [1·9–2·5]). Avoidable premature mortality was highest among those with multiple exposures (eg, imprisonment plus other exposures vs no exposures: HR 10·5 [9·1–12·3]; imprisonment alone vs no exposures: HR 3·8 [3·0–4·8]). Premature mortality from non-communicable disease was higher among those with any exposures than among those with none, despite accounting for a lower proportion of deaths in the exposed group; although in some cases there was little difference between estimates for single versus multiple exposures.InterpretationThe co-occurrence of at least two of homelessness, opioid dependence, justice involvement, or psychosis is associated with very high rates of premature mortality, particularly from avoidable causes of death, including non-communicable disease. Responding to these findings demands wide-ranging efforts across health-care provision, public health, and social policy. Future work should examine the timing and sequencing of exposures to better understand the causal pathways underlying excess mortality.FundingChief Scientist Office, Medical Research Council, NHS Research Scotland.

Obesity, metabolic risk and adherence to healthy lifestyle behaviours: prospective cohort study in the UK Biobank

BackgroundContested evidence suggests that obesity confers no risk to health in people who have a healthy lifestyle, particularly if there are no metabolic complications of obesity. The aim was to examine the association between adherence to lifestyle recommendations and the absence of metabolic complications on the incident or fatal cardiovascular disease and all-cause mortality across different categories of body mass index (BMI).MethodsThis contemporary prospective cohort study included 339,902 adults without cardiovascular disease at baseline, recruited between 2006 and 2010 from the UK Biobank and followed until 2018–2020. The main exposures were four healthy lifestyle behaviours: never smoker, alcohol intake ≤ 112g/ week, 150 min moderate physical activity or 75 min vigorous activity/week, ≥ 5 servings of fruit or vegetables/day, and we assessed these overall and across the BMI groups. Metabolic complications of excess adiposity were hypertension, diabetes and hyperlipidaemia, and we examined whether obesity was associated with increased risk in the absence of these complications. The outcomes were all-cause mortality, death from, and incident cardiovascular disease (CVD).ResultsIndividuals who met four lifestyle recommendations but had excess weight had higher all-cause mortality; for BMI 30–34.9 kg/m2, the hazard ratio (HR) was 1.42 (95% confidence interval 1.20 to 1.68), and for BMI ≥ 35 kg/m2, HR was 2.17 (95% CI 1.71 to 2.76). The risk was lower, but still increased for people with no metabolic complications; for all-cause mortality, BMI 30–34.9 kg/m2 had an HR of 1.09 (95% CI 0.99 to 1.21), and BMI ≥ 35 kg/m2 had an HR of 1.44 (95% CI 1.19 to 1.74) for all-cause mortality. Similar patterns were found for incident and fatal CVD.ConclusionsMeeting healthy lifestyle recommendations, or the absence of metabolic complications of obesity offsets some, but not all, of the risk of subsequent CVD, and premature mortality in people with overweight or obesity. Offering support to achieve and maintain a healthy weight and to adopt healthy behaviours are likely to be important components in effective preventative healthcare.

Sudden unexpected death in epilepsy.

Sudden unexpected death in epilepsy (SUDEP) is a major contributor to premature mortality in people with epilepsy. This review provides an update on recent findings on the epidemiology of SUDEP, clinical risk factors and potential mechanisms. The overall risk rate of SUDEP is approximately 1 per 1000 patients per year in the general epilepsy population and that children and older adults have a similar incidence. Generalized convulsive seizures (GCS), perhaps through their effects on brainstem cardiopulmonary networks, can cause significant postictal respiratory and autonomic dysfunction though other mechanisms likely exist as well. Work in animal models of SUDEP has identified multiple neurotransmitter systems, which may be future targets for pharmacological intervention. There are also chronic functional and structural changes in autonomic function in patients who subsequently die from SUDEP suggesting that some SUDEP risk is dynamic. Modifiable risks for SUDEP include GCS seizure frequency, medication adherence and nighttime supervision. Current knowledge of SUDEP risk factors has identified multiple targets for SUDEP prevention today as we await more specific therapeutic targets that are emerging from translational research studies.

How does cold weather affect the heart of patients with bipolar disorder?

Bipolar disorders (BD) are a complex group of severe, chronic and systemic disorders and it knows no age, racial, social class, geographic, or national boundaries.1 Unfortunately, people with BD have an average mortality rate that is higher than the general population, corresponding to a 10- to 20-years shortened life expectancy.1 Thus, the occurrence of cardiovascular disease (CVD) is the most common cause of premature mortality in people with bipolar disorders.

Phew! time to focus on physical health and wellbeing: improving the assessment and management of physical health in an early intervention in psychosis service

AimsNICE guidelines recommend that patients under Early Intervention (EI) in Psychosis Services have systematic monitoring and intervention of cardiometabolic risk factors. We undertook a Quality Improvement Project (QIP) in the Bath and North East Somerset (BaNES) EI Team to improve rates of compliance with national guidelines. We aimed to increase the percentage of service users with a physical health assessment documented in the past 12 months. Other aims included improving monitoring of physical health parameters in those taking antipsychotic medication and increasing the delivery of interventions for abnormal results.BackgroundThe most common cause of premature mortality in people who experience psychosis and schizophrenia is cardiovascular disease. The 'Standards for Early Intervention in Psychosis Service' states that patients should be offered personalised healthy lifestyle interventions, including advice on diet, physical activity, and access to smoking cessation services. Physical health should be monitored at least annually, with more frequent assessments if antipsychotic medication is prescribed.MethodWe identified seven key factors for improving physical health: Body Mass Index (BMI), Blood Pressure, Glucose Regulation, Blood Lipids, Smoking, Alcohol and Illicit drug use. Baseline compliance and intervention rates were measured in March 2019. Six ‘Plan, Do, Study, Act’ Cycles were completed over the following ten months. Examples of the changes made included: a new online diary and whiteboard, abbreviation of the assessment form, teaching for the EI team, and a new weekly ‘Physical Health and Wellbeing’ (PHeW) Clinic. This clinic involved phlebotomy, discussions around lifestyle choices, review of medication side effects, and neurological examination.We measured the compliance with guidelines each month and the total number of interventions delivered at three-monthly intervals. We collected qualitative feedback on these changes in team meetings and with written questionnaires (including feedback from patients).ResultDocumentation of all key factors doubled from 30.2% at baseline to 63.3% in January 2020. The total number of interventions for raised BMI and lipid levels also increased. Feedback from staff and patients was positive. The clinic helped start conversations with patients about lifestyle choices, prompting improvements in weight, physical activity, lipid levels, and alcohol intake. Patient awareness and ownership over their physical health also improved.ConclusionThis project utilised multiple strategies to reduce health complications for BaNES EI service users. A structural change in the assessment and management of physical health proved to be an effective and sustainable solution to optimise the health and wellbeing of this patient group.

Population-Wide Data Linkage to Reduce Premature Mortality in Women Who Use Mental Health Services In NSW

IntroductionCancer deaths are a major contributor to premature mortality in people with mental health conditions. Some cancers occur more often in people with mental health conditions because of increased risk factors. However, most premature cancer mortality in people with mental health conditions arises from increased cancer case fatality rates due to health care related factors. While there is substantial evidence that a problem exists, further evidence is needed to support effective action and the translation of research findings into better policy, services and care.&#x0D; Objectives and ApproachThe NSW Mental Health Living Longer program involves population-wide data linkage that combines records from nine NSW data collections. Our collection includes over 120 million records for more than nine million people. This presentation focuses on the use of linked data to develop indicators to support reporting on premature breast and cervical cancer mortality for women living with mental illness. These indicators will be used to identify variation in care, assess areas for targeted intervention, and evaluate the effectiveness of research translation into more effective care.&#x0D; ResultsThis work is ongoing and will be finalised by August 2020. We will use regression techniques to examine predictors of participation in breast and cervical cancer screening for women who use mental health services in NSW. These results will be used to assess geographical variation in risk-adjusted screening participation rates. We will also present methods and results for measuring incidence and stage at presentation, as well as 5 year survival for women who use mental health services in NSW.&#x0D; Conclusion / ImplicationsIf cancer survival is a key measure of the effectiveness of healthcare systems, then reduced survival in people with mental health problems reflects less effective health care. Improving screening and treatment services is likely to be the most important strategy for reducing the cancer mortality gap for women with mental illness.

Gaps and challenges: WHO treatment recommendations for tobacco cessation and management of substance use disorders in people with severe mental illness

BackgroundPeople with severe mental disorders (SMD) experience premature mortality mostly from preventable physical causes. The World Health Organization (WHO) have recently produced guidelines on the management of physical health conditions in SMD. This paper presents the evidence which led to the recommendations for tobacco cessation and management of substance use disorders in SMD.MethodsScoping reviews informed 2 PICO (Population Intervention, Comparator, Outcome) questions relating to tobacco cessation and management of substance use disorders in SMD. Systematic searches led to the identification of systematic reviews with relevant evidence to address these questions. Retrieved evidence was assessed using GRADE methodology, informing the development of guidelines.ResultsOne thousand four hundred thirty-four records were identified through systematic searches for SMD and tobacco cessation, of which 4 reviews were included in GRADE tables and 18 reviews in narrative synthesis. For SMD and substance use disorders, 4268 records were identified, of which 4 studies from reviews were included in GRADE tables and 16 studies in narrative synthesis.People with SMD who use tobacco should be offered combined pharmacological (Varenicline, Bupropion or Nicotine Replacement Therapy) and non-pharmacological interventions such as tailored directive and supportive behavioural interventions. For people with SMD and substance use disorders (drug and/or alcohol), interventions should be considered in accordance with WHO mhGAP guidelines. Prescribers should note potential drug-drug interactions. Recommendation were conditional and based on low/very low certainty of evidence with a scarcity of evidence from low- and middle-income settings.ConclusionsThese guidelines mark an important step towards addressing premature mortality in people with SMD. The dearth of high-quality evidence and evidence from LMIC settings must inform the future research agenda.Guidelines: https://www.who.int/mental_health/evidence/guidelines_physical_health_and_severe_mental_disorders/enhttps://www.who.int/publications-detail/mhgap-intervention-guide%2D%2D-version-2.0

The relationship between hopelessness and risk factors for early mortality in people with a lived experience of a serious mental illness

ABSTRACT The purpose of this study was to explore the relationships between self-reported hopelessness and risk factors for premature mortality in people with serious mental illness (SMI). Data were extracted from the 2014 Health Center Patient Survey (N = 5,592). Having a diagnosis of SMI was significantly associated with self-reported hopelessness. Hypertension or high blood pressure, congestive heart failure, and chronic obstructive pulmonary disorder were significantly associated with self-reported hopelessness. Higher levels of hopelessness were found to be significantly associated with increased alcohol consumption. Hopelessness may be an important dimension of health in people with SMI.