Anonymous Record Research Articles

Developing A Mobile Application to Determine the Psychological Wellness of University Students

of university students. Material and Methods: Using an innovative and interdisciplinary approach, this study follows a rigorous methodology from September 2022 to June 2023. The development of the mobile application followed a systematic and structured process to ensure functionality, usability, and reliability. Throughout all stages of development, professional support was sought from information technology to ensure the technical robustness, reliability, and effectiveness of the application. The study embraces four developmental stages including needs identification, technical development, intervention design, and promotion. These stages ensure a student-centered approach, while the application itself offers insights into depression, anxiety, stress, relationship violence attitudes, addiction, Internet addiction, sleep quality, and eating disorders. Results: A unique and all-inclusive mobile application was created to assess and enhance the psychological well-being of university students. With the real-time emotion monitoring feature of the application, students may keep an eye on their present emotional states and develop self-awareness. If long-term negative emotions are detected, the early warning system is activated and implemented. It provides uninterrupted referrals to qualified professionals for immediate response and support in emergency situations and an enhanced feedback mechanism for user complaints and suggestions. It also provides sensitive evaluation and triage processes by creating an anonymous system record to provide instant support, when necessary. The application also includes stress management guidance for students. Conclusion: This application provides real-time data that offers mental health professionals a comprehensive overview of students' psychological states.

Analysis of the impact of speed on traffic safety in the city of Banja Luka

Speed, as one of the basic parameters for the movement of an individual vehicle, is the main cause of traffic accidents. Inadequate speed often leads to traffic accidents with serious consequences, or often fatal accidents. By increasing the speed, visibility decreases, that is, it is more difficult to see other road users, which endangers their safety. By moving on the road, the vehicle achieves different speeds at different moments of time, that is, vehicles move at different speeds under the same road and ambient conditions. In this paper, an analysis of the impact of vehicle speed on traffic safety in the City of Banja Luka was performed, determining the state of the traffic infrastructure as well as its impact on the real speed of vehicle movement. The key results were obtained using the method of anonymous recording on three primary roads in the City of Banja Luka. The goal of the work is to determine, based on the actual situation on the ground, (the speeds measured at three locations in the city to), to what extent drivers respect the speed determined by adequate vertical signage.

What matters in the queer archive? Technologies of memory and Queering the Map

Queering the Map ( queeringthemap.com ) is a novel digital platform: a storymap, an anonymous collaborative record, an archive of queer experiences. To contribute to the platform, visitors make their own mark by clicking on an empty space on the map. As to what visitors contribute, the platform’s About section suggests, simply, ‘If it counts for you, then it counts for Queering the Map’. In this article, we probe this guiding principle. What does count in this context? What matters in the queer archive? Drawing on interviews with 14 site users and an analysis of nearly 2000 stories pinned to Australia on the map, we consider what platform practices reveal about queer collective memory-making, to illuminate the how and why of a queer archive. We see that relatability matters because of the affective, affirming and community-building seeds it can generate; situation matters because it is through participatory practices that recognition, visibility and community place- making are enacted; and, the everyday matters as the archive’s visitors collectively claim and gift their varied personal experiences. Through these themes we explore queer contributions or how site visitors are oriented towards giving something of themselves to the archive. We discuss how archival properties of the platform are key to (queer) participation, and to meaning-making – as distinct, as queer, as a valued record. Queering the Map, we argue, is significant in how space is made for queer representation, carving new contours for archival ‘evidence’ and community histories.

Acute coronary syndrome screening in patients presenting with arteriosclerosis in health check-ups: a case–control study

ObjectivesThis research aimed to develop a simple and effective acute coronary syndrome (ACS) screening model in order to intervene early and focus on prevention in patients presenting with arteriosclerosis.DesignA case–control...

Sudden Death of Mental Health Service Users During a Pandemic; a follow up study of consecutive unexpected deaths during the current pandemic compared to a previous consecutive cohort of persons who took their own lives

IntroductionThe Covid pandemic has mental health consequences. This study examined service user suicides for thirteen months during the pandemic and “lock down” restrictions in Ireland .It compares variables from this group with a previous 2016 study examining service user suicides conducted in Ireland. Despite a previous trend of improving suicide there was an increase in people who were involved with mental health services completing suicide during the pandemic.ObjectivesTo hypothesize that social disequilibrium caused by the Covid pandemic and its control measures may remove the benefit of protective factors in suicide.MethodsThe 2016 study used the Suicide Support and Information System- Psychological Autopsy Model as its methodology.The Rosenberg criteria were used to make a determination of suicide. This 2021 study used an anonymous clinical record review to repeat some key variables identified in the SSIS-PAM work. Statiscal comparisons were made.ResultsThe pandemic group had a different pattern of suicide with low levels of significance between four variables. The majority were female, in a relationship, had jobs, no history of self-harm, no family history of mental illness, less addiction problems and in-patient care. Like the 2016 group they did have diagnoses of mental illness, were in regular contact with services and were prescribed medication. Their suicides were predominantly hanging and drowning.ConclusionsDuring the pandemic suicide increased. Protective factors such as relationships and employment were increased in pandemic suicides who also had less vulnerability factors such as addiction problems and self-harm. “Real time” suicide data collection such as a suicide observatory model might identify more significant trends.DisclosureNo significant relationships.

Appropriate definition of diabetes using an administrative database: A cross-sectional cohort validation study.

Aims/IntroductionThe purpose of the present study was to quantify errors in the diagnosis of diabetes for use in the national database, using a sufficient population size.Materials and methodsA claims database constructed by the JMDC (Tokyo, Japan), using standardized disease classifications and anonymous record linkage, was used in this validation study. We included patients with health insurance claims data from April 2005 to March 2019 in the JMDC claims database. We excluded patients without a record of specific health checkups in Japan. Sample size calculation was based on a 5% prevalence of diabetes and 0.4% absolute accuracy (i.e., 1,250,000 individuals), to calculate the sensitivity, specificity, positive predictive value and negative predictive value.ResultsIn total, 2,999,152 patients were included in this study, of which 165,515 were classified as having diabetes based on specific health checkups (validation cohort prevalence of 5.5%). The newly devised algorithm had three elements – the diagnosis‐related codes for diabetes without suspected flag, the medication codes for diabetes and then these two codes on the same record – and yielded a sensitivity of 74.6%, positive predictive value of 88.4% and Kappa Index of 0.80 (the highest values).ConclusionsIn future claims database studies, our validated algorithms will be useful as diagnostic criteria for diabetes.

Countrywide population movement monitoring using mobile devices generated (big) data during the COVID-19 crisis

Mobile phones have been used to monitor mobility changes during the COVID-19 pandemic but surprisingly few studies addressed in detail the implementation of practical applications involving whole populations. We report a method of generating a “mobility-index” and a “stay-at-home/resting-index” based on aggregated anonymous Call Detail Records of almost all subscribers in Hungary, which tracks all phones, examining their strengths and weaknesses, comparing it with Community Mobility Reports from Google, limited to smartphone data. The impact of policy changes, such as school closures, could be identified with sufficient granularity to capture a rush to shops prior to imposition of restrictions. Anecdotal reports of large scale movement of Hungarians to holiday homes were confirmed. At the national level, our results correlated well with Google mobility data, but there were some differences at weekends and national holidays, which can be explained by methodological differences. Mobile phones offer a means to analyse population movement but there are several technical and privacy issues. Overcoming these, our method is a practical and inexpensive way forward, achieving high levels of accuracy and resolution, especially where uptake of smartphones is modest, although it is not an alternative to smartphone-based solutions used for contact tracing and quarantine monitoring.

Mortality inequalities in Rome: the role of individual education and real estate market

Abstract Background Several indicators at individual and area level have been used to stratify the population. The aim of this work was to investigate the association between real estate prices, education and health status in Rome. Methods We used the administrative cohort of residents in Rome at the 2011 census. We followed subjects aged 18+ from 2011 to 2016 using anonymous record linkage procedures with administrative databases. The census includes several individual information, comprising sex, age, education, and residential urbanistic zone. From mortality register we collected date and cause of death. Real estate prices (€/m2) were available for each urbanistic zone. We classified the population in five categories according to the quintile of the distribution (1=highest prices, 5=lowest prices). We used adjusted Cox regression models to estimate the hazard ratios (HRs) and 95%CIs. Results We selected 2,053,668 subjects, not living in institutions at the time of the census survey. Women were 54% of the population; the mean age was 52 years (sd 18), 22.5% had a high education (university degree) and 37% a low education (≤ junior high school). During the follow-up, 126,548 subjects died. As expected educational level was strongly associated with all-cause mortality (39% higher risk of low vs. high educated). The mortality risk increased with decreasing real estate prices, taking account of age and sex. Compared to subjects living in highest prices areas, those living in level 2 areas had a HR = 1.08 (95%CI: 1.06-1.10), those in level 3 had a HR = 1.14 (95%CI: 1.12-1.16), those in level 4 a HR = 1.16 (95%CI 1.14-1.18), and finally those living in the cheapest areas a HR = 1.22 (95%CI: 1.20-1.25). When we considered both education and real estate prizes, the HRs marginally decreased. Conclusions There is an independent association of both individual education and socioeconomic characteristics of the area of residence and all-cause mortality. Key messages There are strong socioeconomic inequalities in Rome. A simple indicator such as real estate prices can be used to tackle inequalities.

P207 A quality improvement intervention to increase pneumococcal and influenza vaccination rates in immunosuppressed inflammatory arthritis patients

Abstract Background Pneumococcal and influenza vaccination rates have been suboptimal in studies of immunosuppressed patients. We aimed to assess barriers to and increase rates of 23-valent pneumococcal polysaccharide vaccine (PPSV23) and influenza vaccination in this group. Methods In 2017, Rheumatology outpatients completed an anonymous questionnaire recording vaccination knowledge, status and barriers. Simultaneously, a low-cost multifaceted quality improvement (QI) intervention was performed. All outpatients on oral steroids, immunosuppressant conventional synthetic disease modifying antirheumatic drugs (csDMARDs) or biologics (bDMARDs) were included in the study. In 2018, post-intervention, the clinic was re-assessed. Demographics, diagnosis, medications, smart phone access and willingness to use this for vaccination reminders were assessed for independent vaccination predictors using binary logistic regression analysis. Results 425 patients were included (72.6% rheumatoid arthritis, 74% women, 45.6% ≥60 years old). From 2017-2018, vaccination rates increased for PPSV23 {41.0% to 47.2% (p = 0.29)} and influenza {61.8% to 62.1% (p = 0.95)}. The most common reason for non-vaccination was lack of awareness. Following the intervention, this decreased for influenza (36.7% to 34.2%) and PPSV23 (82.1% to 76.4%). General Practitioners performed most vaccinations, only 3.6% were delivered in hospital. Significant predictors of PPSV23 vaccination were older age {≥80 years had an OR 41.66 (95% CI 3.69-469.8, P = 0.003), compared to ≤ 39 years}, bDMARD use (OR 2.80, 95% CI 1.24-6.32, P = 0.013) and adequate influenza vaccination (OR 9.01, 95% CI 4.40-18.42, P < 0.001). Up to date PPSV23 vaccination (OR 8.93, 95% CI 4.39-18.17, P < 0.001) predicted influenza vaccination. Conclusion PPSV23 and influenza vaccination rates were suboptimal and increased marginally. Point-of-care vaccination may be more effective. Disclosures K. Murray: None. C. Low: None. F. Young: None. A. O'Rourke: None. I. Callanan: None. E. Feeney: None. D. Veale: None.

Mortality inequalities in Rome: the role of individual education and neighbourhood real estate market

to investigate the association between real estate prices, education, and mortality. cohort study. residents in Rome at the 2011 Italian Census, not living in institutions, and living in the address reported in the Census survey. People aged 18-99 years were followed from 2011 to 2016 using anonymous record linkage procedures with administrative databases. The Census includes several individual information, such as gender, age, education, residential neighbourhood. Data and cause of death were collected from mortality register. Real estate prices (euros/m2) were available for each neighbourhood. adjusted Cox regression models (hazard ratios - HRs and 95%CIs) were used to estimate the association among individual education, real estate price in the neighbourhood, and mortality. the subjects selected were 2,051,376 (54% women, 22.5% with high education level). During the follow-up, 127,352 subjects died. Taking into account gender, age, marital status, and real estate prices, education level was strongly associated with all-cause mortality; compared to highly educated the higher mortality, risk was 35% (95%CI 32%-37%) for low education level and 16% (95%CI 14%-19%) for medium education level. Taking into account the same factors and education level, each increase of 1,000 euros in price/m2 was inversely associated with mortality (HR 0.96, 95%CI 0.96-0.97). there is an independent association between the two indicators and mortality in Rome. A simple indicator such as real estate prices can be used to tackle inequalities.

Anonymous Electronic Health Record Sharing Scheme Based on Decentralized Hierarchical Attribute-Based Encryption in Cloud Environment

The rapid development of communication technologies, the network, advanced computing methods and wireless medical sensors gives rise to a modern medical system. In this system, large-scale electronic health records (EHRs) are often outsourced to be stored at the third parties, such as cloud service providers (CSPs). However, CSPs are not trustworthy, that is, serious security and privacy concerns about cloud service exist because it may expose the user's sensitive data to CSPs or unauthorized users in transmission, storage and sharing. To prevent the privacy disclosure of patients better and realize information sharing more effectively, this paper proposes an anonymous EHRs sharing scheme based on decentralized hierarchical attribute-based encryption (ABE). In the proposed scheme, (1) Multiple attribute authority (AA) ABE is leveraged to achieve fine-grained and scalable data access control and avoid bottleneck. Meanwhile, hierarchical access tree is used to encrypt multiple files in one operation, thereby saving calculation and storage load greatly. Moreover, the hidden access policy enhances user privacy protection. (2) The global identifier (GID) of a user is introduced to resist the collusion attack of users. Subsequently, an anonymous key generation mechanism is equipped to prevent multiple AAs from building a full profile using the user's GID. (3) To ensure the correctness and integrity of EHRs, users can conduct double verification based on the verification tag and convergent key. Finally, the efficiency analysis and experiments show that the scheme meets the security requirements of key management and privacy preservation in cloud and is proven secure and efficient in practice under the decisional bilinear Diffie-Hellman (DBDH) assumption.

A quality improvement intervention failed to significantly increase pneumococcal and influenza vaccination rates in immunosuppressed inflammatory arthritis patients.

Pneumococcal and influenza vaccination rates have been suboptimal in studies of immunosuppressed patients. We aimed to assess barriers to and increase rates of 23-valent pneumococcal polysaccharide vaccine (PPSV23) and influenza vaccination in this group. The primary endpoint was a statistically significant increase in adequate PPSV23 and influenza vaccination. In 2017, rheumatology outpatients completed an anonymous questionnaire recording vaccination knowledge, status, and barriers. Simultaneously, a low-cost multifaceted quality improvement (QI) intervention was performed. All outpatients on oral steroids, immunosuppressant conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biologics disease-modifying antirheumatic drugs (bDMARDs) were included in the study. In 2018, post-intervention, the clinic was re-assessed. Demographics, diagnosis, medications, smart phone access, and willingness to use this for vaccination reminders were assessed for independent vaccination predictors using binary logistic regression analysis. Four hundred twenty-five patients were included (72.6% rheumatoid arthritis, 74% women, 45.6% ≥60years old). From 2017 to 2018, PPSV23 vaccination rates changed from 41.0 to 47.2% (P = 0.29) and influenza from 61.8 to 62.1% (P = 0.95). The most common reason for non-vaccination was lack of awareness. Following the intervention, this changed for influenza (36.7 to 34.2%) and PPSV23 (82.1 to 76.4%). General practitioners performed most vaccinations, only 3.6% were delivered in the hospital. Significant predictors of PPSV23 vaccination were older age {≥ 80years had an OR 41.66 (95% CI 3.69-469.8, P = 0.003), compared with ≤ 39years}, bDMARD use (OR 2.80, 95% CI 1.24-6.32, P = 0.013), and adequate influenza vaccination (OR 9.01, 95% CI 4.40-18.42, P < 0.001). Up-to-date PPSV23 vaccination (OR 8.93, 95% CI 4.39-18.17, P < 0.001) predicted influenza vaccination. PPSV23 and influenza vaccination rates were suboptimal. The intervention did not cause a statistically significant change in vaccination rates. Point-of-care vaccination may be more effective.Key Points• Low vaccination rates amongst immunosuppressed inflammatory arthritis outpatients• Less than 5% of vaccinations occurred in hospital• There was no statistically significant difference in the rates of adequate PPSV23 (41.0 to 47.2%) or influenza (61.8 to 62.1%) vaccination following our intervention.

From Stranger to Family or Something in Between: Donor Linking in an Era of Retrospective Access to Anonymous Sperm Donor Records in Victoria, Australia

Abstract In June 2015, the state of Victoria, Australia retrospectively opened its sperm and egg donors’ records, becoming only the second jurisdiction in the world to do so and the first where substantial pre-legislative records are available and stored in a central register. The new legislation gave donor-conceived adults and donors who were conceived or donated under conditions of anonymity (ie prior to 1988) the right to apply to the state’s Central Register for each other’s identifying information, which is released to them if the subject of the application consents. Between the introduction of the law and its further amendment in March 2017, more than 100 applications were made. Through a thematic analysis of donor-conceived adults’ and donors’ Statements of Reasons – a written document applicants were required to complete when they applied – the article explores applicants’ motivations for applying, the information they sought, and their goals with regard to contact. The study found that most applicants were driven by curiosity and a desire for personal information about the other party. They also expressed a strong desire to meet and have an ongoing relationship with the subject of their application. The study also revealed an unanticipated desire on the part of previously anonymous donors for information about their offspring, suggesting future research could explore the emotional needs of donors in greater depth.

“Like being trapped in a drum”: The Poetics of Resonance in Frances Itani’s Deafening

This paper considers how Frances Itani’s Deafening imaginatively rethinks our understanding of the Great War in the age of postmemory. Seeing as the novel is set in Canada and Europe during the First World War and takes as its protagonist a deaf woman, the poetic attention given to the senses as a horizon of phenomenological experience magnifies the moral bonds that the characters establish in defi ance of both deafness and death. Guided by the theoretical reasoning of Marianne Hirsch, Elaine Scarry, and Alison Landsberg as well as contemporary phenomenological thinking, most significantly that of Edward S. Casey, Steven Connor, Michel Serres, and Jean-Luc Nancy, this paper examines how the novel’s attentiveness to the materiality of the body in regard to the ethical collisions of sound and silence as well as life and death contributes to a poetics of resonance that generates prosthetic memories, turning the anonymous record of war into a private experience of moral endurance inscribed on the ear of historical legacy.

Dietary Patterns Are Associated with Cardiovascular and Cancer Mortality among Swiss Adults in a Census-Linked Cohort

Defining dietary guidelines requires a quantitative assessment of the influence of diet on the development of diseases. The aim of the study was to investigate how dietary patterns were associated with mortality in a general population sample of Switzerland. We included 15,936 participants from two population-based studies (National Research Program 1A (NRP1A) and Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA)—1977 to 1993) who fully answered a simplified 24-h dietary recall. Mortality data were available through anonymous record linkage with the Swiss National Cohort (follow-up of up to 37.9 years). Multiple correspondence analysis and hierarchical clustering were used to define data-driven qualitative dietary patterns. Mortality hazard ratios were calculated for all-cause, cancer and cardiovascular mortality using Cox regression. Two patterns were characterized by a low dietary variety (“Sausage and Vegetables”, “Meat and Salad”), two by a higher variety (“Traditional”, “High-fiber foods”) and one by a high fish intake (“Fish”). Males with unhealthy lifestyle (smokers, low physical activity and high alcohol intake) were overrepresented in the low-variety patterns and underrepresented in the high-variety and “Fish” patterns. In multivariable-adjusted models, the “Fish” (hazard ratio = 0.82, 95% CI (0.68–0.99)) and “High-fiber foods” (0.85 (0.72–1.00)) patterns were associated with lower cancer mortality. In men, the “Fish” (0.73 (0.55–0.97)) and “Traditional” (0.76 (0.59–0.98)) patterns were associated with lower cardiovascular mortality. In summary, our results support the notion that dietary patterns affect mortality and that these patterns strongly cluster with other health determinants.

The Impact of Cervical Musculoskeletal Disorders on UK Consultant Plastic Surgeons: Can We Reduce Morbidity With Applied Ergonomics?

Based on anecdotal and observational evidence, we hypothesized that the prevalence of cervical musculoskeletal disorder (C-MSD) would be high among plastic surgeons. A questionnaire review was undertaken to test this hypothesis. Ergonomic assessment was undertaken to assess causal factors of C-MSD. An anonymous questionnaire recording demographics, physical symptoms and behavioral responses to C-MSD was distributed to UK Plastic Surgery consultants. The postural impact of wearing loupes was assessed using motion capture techniques and recording cervical muscular activity. The questionnaire response rate was 81%. The prevalence of cervical spine morbidity was recorded as 32%. Employment implications included 28% of the cohort requiring sick leave. The professional impact was 7% permanently modifying their practice. There were 2 factors significant for C-MSD, the surgeons' age and the duration in hours of wearing loupes per week. Ergonomic assessment of surgeons operating in loupes demonstrated: 1. increased forward and lateral cervical flexion; 2. increased cervical muscular activity to maintain the protracted "head forward" posture; and 3. prolonged static posturing to maintain head position for visual focus. Table height adjustment and variation of loupe working distance can reduce neck flexion. Cervical morbidity is a prevalent problem among plastic surgeons. Long procedures, static postures and neck flexion result in the "head forward" posture. This posture exaggerates when operating with loupe magnification. Early-middle-aged consultants are more prone to cervical morbidity hence afflicted when at the top of their game. The work force is diminished for a potentially avoidable morbidity. Rather than accept this morbidity, co-operation between plastic surgeons and ergonomist may help to reduce injury.

Canalización de vías venosas periféricas difíciles y utilidad de técnicas ecográficas en un Servicio de Urgencias

Objective: to find out the factors associated with “difficult venous access” (DVA) in adult patients managed at the Emergency Unit, as well as to describe the use by nurses of ultrasound-assisted puncture techniques (ultrasound-assisted (UA) technique and ultrasound-guided (UG) technique), and the degree of success of each one vs. the traditional catheterization technique. Method: a descriptive transversal study conducted in adult patients with “difficult venous access” seen at the Emergency Unit of the Hospital de Manacor (Majorca). The nurse conducting the catheterization completed an anonymous record with variables associated with their intervention, the health of the patient, and success in each one of the techniques. The contrast hypothesis tests used to determine association were Mann-Whitney’s U for quantitative variables and Square Chi for categorical variables. Results: fifty-one (51) cases were studied. The DVA-associated variables were: not finding veins at palpation (72.6%), not finding visible veins (66.7%), previous history of difficulty (66.7%) and >2 failed catheterization attempts (49%). The most common acute factor was hypotension (29.4%), the most usual chronic factors were obesity (45.1%), chemotherapy treatment (29.4%) and diabetes (23.5%). The “blind” technique was used in 40 patients, and ultrasound-assisted techniques were used in 39 cases, which were more effective than the usual approach (p<0.05).Conclusions: there are signs of the presence of factors associated with difficulty in peripheral puncture; ultrasound techniques offer an effective solution for these cases, leading to a lower number of punctures.

Are patients in the IBD clinic at risk of proctitis secondary to sexually transmitted infections?

ObjectiveTo gauge the potential risk of sexually transmitted infection (STI) as a cause of proctitis in a cohort of patients with inflammatory bowel disease (IBD) and to gauge whether this...

Real-Life Outcomes for Patients with Asthma Prescribed Spacers for Use with Either Extrafine- or Fine-Particle Inhaled Corticosteroids

Spacers are often used with pressurized metered-dose inhalers (pMDIs) to eliminate the need for coordinating inhalation with actuation. To investigate the real-life effectiveness of spacers prescribed for use with either extrafine- or fine-particle inhaled corticosteroids (ICSs). This historical matched cohort study examined anonymous medical record data over 2 years (1-year baseline, 1-year outcome) for patients with asthma aged 12 to 80 years initiating ICSs by pMDI with or without prescribed spacer. We compared outcomes for spacer versus no-spacer arms, matched for key baseline and asthma-related characteristics, within 2 ICS cohorts: (1) extrafine-particle ICS (beclomethasone) and (2) fine-particle ICS (fluticasone). Effectiveness end points were compared using conditional regression methods. Matched spacer and no-spacer arms of the extrafine-particle ICS cohort each included 2090 patients (69% females; median age, 46-47 years) and the 2 arms of the fine-particle ICS cohort each included 444 patients (67% females; median age, 45 years). With extrafine-particle ICS, we observed no significant difference between spacer and no-spacer arms in severe exacerbation rate (primary end point): adjusted rate ratio, 1.01 (95% CI, 0.83-1.23). With fine-particle ICS, the severe exacerbation rate ratio with spacers was 0.77 (0.47-1.25). Oropharyngeal candidiasis incidence was low and similar in spacer and no-spacer arms for both ICS cohorts. We found no evidence that prescribed spacer devices are associated with improved asthma outcomes for extrafine- or fine-particle ICS administered by pMDI. These findings challenge long-standing assumptions that spacers should improve pMDI effectiveness and indicate the need for pragmatic trials of spacers in clinical practice.

Type A personality and its association with mortality: Considering different analysis approaches of the Bortner Scale

IntroductionType A behaviour pattern (TABP) is defined as the combination of competitive need for achievement, sense of time urgency, aggressiveness, and hostility. Studies raised evidence for an association between TABP and cardiovascular disease. Recent studies on its association with mortality showed contradicting results and used different methods to measure TABP.Objectives/aimsInvestigating the association between TABP and all-cause, CVD, and all-cancer mortality.MethodsWe used data of the MONICA and the NRP1A studies that were linked with the Swiss National Cohort (SNC) (n = 7997). Essentially, the SNC is an anonymous record linkage of census, migration and mortality data. TABP was measured by the Bortner Scale. To determine the all-cause, CVD, and cancer mortality risk a Cox regression was performed. Following Edwards et al. (1990), we analysed the Bortner Scale in two different ways: all items and its two dimensions (speed and competitiveness) separately.ResultsWe found a significant association of the Bortner Scale with all-cause mortality in women (adjusted for sociodemographic factors HR 1.02, 95% CI 1.00–1.03, additionally adjusted for lifestyle factors–smoking, alcohol intake, physical activity, BMI category–1.01, 1.00–1.03). The subscale of competitiveness was associated with all-cause and CVD mortality in women. Interestingly, stratifying for lifestyle variables revealed that the association was only present in those having a healthy lifestyle, e.g. non-smoking or non-hazardous alcohol intake.ConclusionsThe Bortner Scale and its subscale of competitiveness were associated with mortality in women. In those having great health awareness, this might offer potential for further reduction of mortality risk.Disclosure of interestThe authors have not supplied their declaration of competing interest.