PLoS medicine
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The impact of light exposure on mental health is increasingly recognised. Modifying inpatient evening light exposure may be a low-intensity intervention for mental disorders, but few randomised controlled trials (RCTs) exist. We report a large-scale pragmatic effectiveness RCT exploring whether individuals with acute psychiatric illnesses experience additional benefits from admission to an inpatient ward where changes in the evening light exposure are integrated into the therapeutic environment. ⋯ Modifying the evening light environment in acute psychiatric hospitals according to chronobiological principles does not change duration of admissions but can have clinically significant benefits without increasing side effects, reducing patient satisfaction or requiring additional clinical staff.
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Clozapine is widely regarded as a highly efficacious psychotropic drug that is largely underused worldwide. Recent disproportionality analyses and nationwide case-control studies suggested a potential association between clozapine use and hematological malignancy (HM). Nevertheless, the absolute rate difference is not well-established due to the absence of analytic cohort studies. The clinical significance of such a potential risk remains unclear. ⋯ Absolute rate difference in HM incidence associated with clozapine is small despite a 2-fold elevated rate. Given the rarity of HM and existing blood monitoring requirements, more restrictive indication for clozapine or special warnings may not be necessary.
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Psychiatric patients experience lower life expectancy compared to the general population. Conditional cash transfer programmes (CCTPs) have shown promise in reducing mortality rates, but their impact on psychiatric patients has been unclear. This study tests the association between being a Brazilian Bolsa Família Programme (BFP) recipient and the risk of mortality among people previously hospitalised with any psychiatric disorders. ⋯ BFP appears to reduce mortality rates among psychiatric patients. While not designed to address elevated mortality risk in this population, this study highlights the potential for poverty alleviation programmes to mitigate mortality rates in one of the highest-risk population subgroups.
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Tuberculosis (TB) imposes a substantial health and economic burden on many populations and countries, but lack of funding has significantly contributed to several countries falling short of global TB reduction targets. Furthermore, existing assessments of the economic impact of TB do not capture the impacts on productivity and economic growth or the pathways by which epidemiology, demography, and the economy interact. Evidence is needed to answer how investment in treatment and control measures may help to mitigate the twin Indian health and macroeconomic burdens of TB over the coming decades. ⋯ In this study, we find that even our least effective, but most accessible, revised TB treatment regimen has the potential to generate US$28bn in GDP gains. Clearly, the economic gains of increasing case detection rates and implementing improved TB treatment regimens hinges on both the feasibility and timeframe over which they can be achieved in practice. Nevertheless, the revised TB treatment regimen is readily accessible, and our results therefore demonstrate that there is room for undertaking substantial additional investment in control and treatment of TB in India, in order to reduce the suffering of TB patients while maintaining acceptable provision of resourcing elsewhere in the Indian economy.
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Human papillomavirus (HPV) testing of self-collected vaginal samples has potential to improve coverage of cervical screening programmes, but current guidelines mostly require those HPV positive on a self-sample to attend for routine screening. ⋯ HPV type and Ct value on HPV-positive self-samples may be used for triage. The difference in the risk of CIN2+ in these groups appears sufficient to justify differential clinical management. A prospective study employing such triage to evaluate laboratory workflow, acceptability, and follow-up procedure and to optimise clinical performance seems warranted.