Cholangiocarcinoma (CCA) is the second most lethal primary hepatic malignancy. It has been well-reported that most cancer patients prefer to die at home or in a hospice facility. However, there is limited data on the place of death for CCA patients. We evaluated trends and disparities in place of death for patients with CCA from 1999 to 2020.

Using the CDC WONDER database (1999–2020), we calculated the frequency of CCA deaths at home/hospice and the average annual percentage change (AAPC) over this period stratified by race, age, gender, and region. We employed logistic regression to assess for associations between these variables and place of death for patients whose death was attributed to CCA.

Among 140,422 deaths, a rise in deaths occurred in home/hospice facilities compared to inpatient medical or nursing facilities across all variables examined. Blacks and individuals ≥ 85 had the highest proportion of deaths outside of home/hospice. However, Blacks showed the highest AAPC (8.56%) in home/hospice deaths, followed by Asians (AAPC 8.44%). In contrast, individuals aged 45–54 saw the lowest AAPC (4.27%). Non-whites were less likely to die at home/hospice, with Blacks demonstrating the lowest adjusted odds ratio (aOR 0.64). Those ≥ 85 were less likely to die in home/hospice (aOR 0.78), whereas individuals aged between 55–64 (aOR 1.11) and 65–74 (aOR 1.12) had increased odds of dying in these settings. Patients from the Western region were the most likely to die at home/hospice (aOR 1.04).

Our study highlights disparities in place of death of patients with CCA amongst races, regions, and ages. Non-whites, extremes of ages, and patients from the Northeast have disproportionately poor outcomes in terms of end-of-life care in the US. These findings emphasize the need for efforts to address sociodemographic disparities in end-of-life care to improve patient-centered health outcomes.

The at-risk mental state (ARMS) describes individuals at high risk of developing schizophrenia or psychosis. This study aimed at exploring the demographic characteristics of individuals who transitioned to psychosis from a large multicenter factorial design trial.

This was a secondary analysis of large multicenter randomised controlled trial of minocycline and/or omega-3 fatty acids added to treatment as usual for at-risk mental states. Participants (n = 326) were randomised to minocycline, omega-3, combined minocycline and omega-3 or to double placebo for 6 months. The primary outcome was transition to psychosis at 12 months.

Forty-five (13.8%) participants transitioned to psychosis. The mean age of participants was 23.31 (5.31 SD) and 15.6% no formal education, 8.9% primary, 48.9% matriculation, 8.9% intermediate and 15.6% graduation and above. Majority 66% of participants were male and 71.1% single, 66.7% living in a joint family, 44.4% were employed, 24% students, 17.8% household/housewife and 3% unemployed. Interestingly 36.8% participants had a family history of psychosis, followed by 21.0% any unknown mental illnesses, 15.8% bipolar disorder, 15.8% depression, 5.3% anxiety and 5.3% intellectual disability. The mean total score for the Prodromal Questionnaire was 8.93, with a standard deviation of 1.67. The mean score on the Comprehensive Assessment for At Risk Mental State (CAARMS) unusual thoughts was 3.98 (SD = 0.84), Non-Bizarre Ideas 3.64 (SD = 0.77), Perceptual Abnormalities 3.76 (SD = 0.71) and disorganized speech 2.49 (SD = 1.12). Participants had mean Social and Occupational Functioning (SOFAS) score of 66.67 which suggests moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).

Transition to psychosis appears to have different demographic and clinical correlates which may have the causal relationship to transition. The cross-comparative studies are warranted to understand differences and similarities between the groups.

Elevated risk of psychosis for ethnic minority groups has generally been shown to be mitigated by high ethnic density. However, past survey studies examining UK Pakistani populations have shown an absence of protective ethnic density effects, which is not observed in other South Asian groups.

To assess the ethnic density effect at a local neighbourhood level, in the UK Pakistani population in East Lancashire.

Data was collected by the East Lancashire Early Intervention Service, identifying all cases of first episode psychosis (FEP) within their catchment area between 2012 and 2020. Multilevel Poisson regression analyses were used to compare incidence rates between Pakistani and White majority groups, while controlling for age, gender and area-level deprivation. The ethnic density effect was also examined by comparing incidence rates across high and low density areas.

A total of 455 cases of FEP (364 White, 91 Pakistani) were identified. The Pakistani group had a higher incidence of FEP compared to the White majority population. A clear effect of ethnic density on rates of FEP was shown, with those in low density areas having higher incidence rates compared to the White majority, whereas incidence rates in high density areas did not significantly differ. Within the Pakistani group, a dose-response effect was also observed, with risk of FEP increasing incrementally as ethnic density decreased.

Higher ethnic density related to lower risk of FEP within the Pakistani population in East Lancashire, highlighting the impact of local social context on psychosis incidence.

The need for an age-appropriate in-patient service for 16- to 17-year-olds led to the development of a 6-bed acute admissions unit in a non-metropolitan county in the UK. We provide a descriptive evaluation of the first 2 years of its operation. All admissions from April 2010 to March 2012 were reviewed, clinical details systematically recorded and descriptively analysed.

Ninety-seven young people were admitted during this period (a third were compulsorily detained under the Mental Health Act 1983). The average length of stay was 3–4 weeks. The most common presenting complaints were self-harm and low mood, usually in the context of life events and childhood adversity. Nearly half had substance misuse and other risk-taking behaviours. A third presented with psychotic symptoms. Adjustment and anxiety disorders were most common, followed by alcohol/substance use disorders, depressive illnesses and psychotic illnesses. Comorbidity was the rule rather than the exception. Most patients improved by the time of discharge.

The unit provides an accessible and effective age-appropriate service and is likely to constitute an important component of the comprehensive child and adolescent mental health service strategy in the county.