Our study differs from previous studies in that it provides empirical evidence about changes in suicide attempts and completed suicides using nationwide, long term follow up after the FDA warnings (2005 10). Because depression is an independent risk factor for suicidality, and appropriate treatment with antidepressants is effective in reducing depressive symptoms, we hypothesized that decreasing rates of overall antidepressant treatment after the warnings would be associated with a net increase in suicide attempts among young people.MethodsHealth plans and data sourceThis study included 11 geographically distributed US healthcare organizations that provide care to a diverse population of 10 million people in 12 states. Members served by these systems are generally representative of each system’s geographic service area27 (see supplementary table A).Data were obtained from the HMO Research Network Virtual Data Warehouse.27 28 29 A common obstacle to multisite research projects is the variation in automated data systems between sites https://www.pandoracharmscanada.ca/, making it challenging to generate datasets that can be easily merged across sites.
Summary pointsPrimary hyperparathyroidism (PHPT) is the most common cause of hypercalcaemia in the ambulatory setting; malignancy and other secondary causes must be excludedPrimary hyperparathyroidism is diagnosed when intact parathyroid hormone is raised or mid to high normal in the setting of raised total or ionised calcium after exclusion of conditions that mimic PHPTMedical surveillance comprises annual measurement of serum calcium and creatinine, plus measurement of bone mineral density (at three sites) every one to two yearsSestamibi imaging is used for localisation before surgery and is not a diagnostic tool a negative scan does not exclude the diagnosis of PHPTSecondary hyperparathyroidism is commonly caused by vitamin D inadequacy or chronic kidney diseasePrimary hyperparathyroidism is the most common cause of hypercalcaemia in the ambulatory setting.1 2 Although this condition can occur at any age, it commonly affects people over the age of 50 years and postmenopausal women.2 3 Over the past few decades it has changed from being a condition usually defined by its symptoms to one that is often discovered on routine screening tests while the patient is still largely asymptomatic. In light of advances in research pandora rings, new guidelines on the diagnosis and management of asymptomatic primary hyperparathyroidism have recently been developed. We review the presentation, diagnosis, and management of primary hyperparathyroidism for the generalist doctor, with evidence drawn from randomised controlled trials, cohort studies, and the most recent consensus guidelines.Sources and selection criteriaWe searched Medline from 2002 to 2011 using the terms “primary hyperparathyroidism”, “diagnosis”, and “management of primary hyperparathyroidism”.