Completed Health Questionnaires Research Articles

Clinical Pharmacist role in a Medical Assistance Team during novel coronavirus (COVID-19) quarantine.

To the Editor, Quarantine to control infectious disease outbreaks such as COVID-19 has long been utilised by Australia, and involves restricting the movement of individuals or groups presumed to have been exposed to the home or a designated facility.1, 2 We describe a clinical pharmacist role servicing quarantined passengers on two separate occasions – involving an international cruise ship, and an international flight, respectively – where approximately 200 returned travellers on each occasion completed 14 days mandatory quarantine on Rottnest Island, 20 km offshore from Fremantle port. Rottnest Island has roughly 330 permanent residents, however it can accommodate 15 000 people in peak tourist periods.3 The island has basic medical services: a Nursing Post with two nurses, and a General Store with a Schedule 2 Poisons Permit and a limited range of medications. The Western Australian Medical Assistance Team (WAMAT) is a multidisciplinary health support team sent to disaster sites at short notice.4 WAMAT was deployed to Rottnest Island to provide medical management of passengers for the two quarantine periods. Tourists were evacuated and quarantine zones were established. WAMAT usually comprises medical doctors, registered nurses, paramedics and logisticians, and pharmacists are not routinely included. For the first quarantine period involving elderly cruise ship passengers, a pharmacist was requested to assist with the anticipated high medication burden. After this successful deployment, WAMAT also requested the pharmacist for the subsequent quarantine. Quarantined passengers completed health questionnaires on arrival. Medication resupplies used the Commonwealth ‘special authority for emergency supply of Schedule 4 medicines during COVID-19’ and were authorised by the pharmacist. New prescriptions were handwritten by the WAMAT doctor, screened by the pharmacist and emailed to Fiona Stanley Hospital (FSH), a quaternary hospital with governance for the Nursing Post, for dispensing. Medications were supplied in sealed boxes via the passenger ferry. WAMAT staff provided daily medical rounds, including assessment of passengers in their quarantine accommodation for COVID-19 symptoms. Several important pharmacist roles have been identified during the prevention, preparedness and response phases of disasters;5 however, to our knowledge there is no description in the literature of the pharmacist contribution to patient management during quarantine periods for a pandemic. The request for pharmacist inclusion in the WAMAT team during the second quarantine deployment is recognition of the unique skills they provide, particularly where access to standard medical care is limited. The authors have no conflicts of interests to declare.

Association between decision-making under risk conditions and on-road driving safety among older drivers.

Objective: Despite theoretical models emphasizing the likely importance of adaptive decision-making to maintaining safety on the roads, there has been a lack of research investigating this topic. This exploratory study aimed to determine if decision-making under risk conditions, as measured by the Game of Dice Task (GDT), can explain additional variance in on-road driving safety beyond other well-validated predictors. Method: Two hundred and thirty-nine cognitively normal Australian drivers aged 65-96 completed demographic and health questionnaires, vision testing, a neurocognitive test battery assessing cognitive flexibility, cognitive interference, episodic memory, verbal working memory, verbal fluency, and visuospatial function, the GDT-a lab-based assessment of decision-making under risk conditions, validated off-road driver screening measures and an on-road driving assessment along a standard route in urban traffic conditions administered by a trained Occupational Therapist (OT). Results: The number of risky choices made, but not the number of strategy changes, across trials of the GDT independently predicted on-road safety ratings after controlling for visual acuity, cognitive test performance, and off-road driver screening measures, B = -.146, 95% CI [-.276 to -.016]. Conclusion: Overall, this study offers the first evidence that decision-making is related to older adults' on-road driving safety, and makes recommendations for future research exploring the contribution of decision-making to on-road safety. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The role of caloric intake in the association of high salt intake with high blood pressure

Since current recommendations call for a substantial reduction in overall sodium consumption, we tested whether or not these recommendations are implemented in common large subpopulations such as those with abnormal weight or hypertension in the current high sodium, high-calorie nutritional environment. In a national representative cross-sectional survey of the community-dwelling subjects aged 25–65 years conducted in Israel between 2015 and 2017, 582 randomly selected subjects completed health and dietary questionnaires, underwent blood pressure and anthropometric measurements and collected 24-h urine specimens, to assess dietary sodium intake. Overall mean 24-h sodium excretion was 3834 mg, more than double the recommended upper intake for adults < 1500 mg/day. Sodium excretion was directly related to caloric intake and blood pressure and linked to the presence of hypertension and overweight/obesity. The highest sodium excretion was seen in overweight/obese hypertensive subjects. This recent national survey shows a high consumption of sodium in the Israeli population and a dose–response association between caloric intake and urinary sodium excretion, independent of BMI and hypertension. Nevertheless, overweight/obese subjects with hypertension consume (excrete) more sodium than other BMI/ blood pressure-related phenotypes and may thus comprise a target subpopulation for future efforts to reduce sodium intake.

Early Acceptability of a Mobile App for Contact Tracing During the COVID-19 Pandemic in France: National Web-Based Survey.

BackgroundSeveral countries have implemented mobile apps in an attempt to trace close contacts of patients with COVID-19 and, in turn, reduce the spread of SARS-CoV-2. However, the effectiveness of this approach depends on the adherence of a large segment of the population.ObjectiveThe aims of this study were to evaluate the acceptability of a COVID-19 contact tracing mobile app among the French population and to investigate the barriers to its use.MethodsThe Health Literacy Survey 2019 questioned 1003 people in France during the COVID-19 pandemic on the basis of quota sampling. The survey collected sociodemographic characteristics and health literacy data, as well as information on participants’ communication with caregivers, trust in institutions, and COVID-19 knowledge and preventive behaviors. The acceptability of a mobile app for contact tracing was measured by a single question, the responses to which were grouped into three modalities: app-supporting, app-willing, and app-reluctant. Multinomial logistic regression analysis was performed to identify the factors associated with the acceptability of a mobile app during the COVID-19 pandemic.ResultsOnly 19.2% (193/1003) of all participants were app-supporting, whereas half of them (504/1003, 50.3%) were reluctant. The factors associated with willingness or support toward the contact tracing app included lower financial deprivation (app-willing: adjusted odds ratio [aOR] 0.8, 95% CI 0.69-0.93; app-supporting: aOR 0.7, 95% CI 0.58-0.84) and higher perceived usefulness of using a mobile app to send completed health questionnaires to doctors (app-willing: aOR 2.3, 95% CI 1.70-3.26; app-supporting: aOR 3.1, 95% CI 2.04-4.82). Furthermore, the likelihood of supporting the mobile app increased with age over 60 years (aOR 1.9, 95% CI 1.13-3.22), trust in political representatives (aOR 2.7, 95% CI 1.72-4.23), feeling concerned about the pandemic situation (aOR 2.2, 95% CI 1.47-3.32), and knowledge about the transmission of COVID-19 (aOR 2.0, 95% CI 1.39-2.96).ConclusionsThe most socioeconomically precarious people, who are at a higher risk of SARS-CoV-2 infection, are also the most reluctant to using a contact tracing mobile app. Therefore, optimal adherence can only be effective with a targeted discourse on public health benefits to adopt such an app, which should be combined with a reduction in inequalities by acting on structural determinants.

Mobility speed predicts new-onset hypertension: a longitudinal study.

ObjectiveThe aim of this study was to investigate whether declining mobility and muscle strength predict new-onset hypertension in suburban-dwelling elderly individuals.MethodsThis study was designed as a longitudinal prospective cohort study. It was comprised of 362 individuals (mean age = 67.8 ± 6.2; 157 men) without hypertension at baseline. At baseline, all participants completed health questionnaires and underwent measurements of mobility [the Timed Up and Go test (TUGT) and 4-m walking test] and muscle strength (grip strength). At 1-year follow-up, we determined the number of participants who had developed new-onset hypertension. We then evaluated the relationship between above metrics and the development of hypertension.ResultsIn the present study, 94 (26.0%) participants developed hypertension after 1 year. After adjusting for mixed factors, the TUGT scores [hazard ratio = 1.15; 95% confidence interval (CI), 1.10–1.31; P = 0.030] were positively associated with the development of hypertension, while the 4-m walking test scores (hazard ratio = 0.07; 95% CI, 0.01–0.47; P = 0.007) showed an inverse relationship with hypertension incidence. Grip strength (hazard ratio = 1.03; 95% CI, 0.99–1.06; P = 0.098) was not significantly associated with hypertension incidence.ConclusionOur results indicate that people with declining mobility are significantly more likely to develop hypertension. Hence, improving mobility could be protective against hypertension for elderly individuals.

Health-Related Quality of Life in Adult Spanish Women with Endometriomas or Deep Infiltrating Endometriosis: A Case-Control Study.

Endometriosis is a disabling disease that may significantly compromise a woman’s social relationships, sexuality, and mental health. Considering the impact of endometriomas and deep infiltrating endometriosis (DIE) on quality of life and the limited number of papers on this topic, the objective of this study was to assess health-related quality of life (HRQoL) in adult Spanish women with the condition. A case-control study was conducted on a group of 99 patients with ovarian endometriomas or DIE and 157 controls. Women underwent physical and gynecological examinations, and they completed health questionnaires including the Short Form-12v2 (SF-12v2), a survey for HRQoL. Eight scales and two component summary scores (Physical (PCS) and Mental (MCS), respectively) were calculated. Women with endometriomas or DIE had significantly worse PCS: 47.7 ± 9.7 vs. 56.1 ± 5.9, respectively (p < 0.001) compared to controls, as well as lower scores on seven out of the eight scales (p < 0.01). No significant differences were found for the MCS. Conclusions: HRQoL was significantly lower in patients with endometriomas or DIE compared to controls. If confirmed, these results may have important implications for prevention, clinical practice, and intervention.

Joint Associations Between Body Mass Index and Waist Circumference With Atrial Fibrillation in Men and Women.

BackgroundAssociations between adiposity and atrial fibrillation (AF) might differ between sexes. We aimed to determine precise estimates of the risk of AF by body mass index (BMI) and waist circumference (WC) in men and women.Methods and ResultsBetween 2008 and 2013, over 3.2 million adults attended commercial screening clinics. Participants completed health questionnaires and underwent physical examination along with cardiovascular investigations, including an ECG. We excluded those with cardiovascular and cardiac disease. We used multivariable logistic regression and determined joint associations of BMI and WC and the risk of AF in men and women by comparing likelihood ratio χ2 statistics. Among 2.1 million included participants 12 067 (0.6%) had AF. A positive association between BMI per 5 kg/m2 increment and AF was observed, with an odds ratio of 1.65 (95% CI, 1.57–1.73) for men and 1.36 (95% CI, 1.30–1.42) for women among those with a BMI above 20 kg/m2. We found a positive association between AF and WC per 10 cm increment, with an odds ratio of 1.47 (95% CI, 1.36–1.60) for men and 1.37 (95% CI, 1.26–1.49) for women. Improvement of likelihood ratio χ2 was equal after adding BMI and WC to models with all participants. In men, WC showed stronger improvement of likelihood ratio χ2 than BMI (30% versus 23%). In women, BMI showed stronger improvement of likelihood ratio χ2 than WC (23% versus 12%).ConclusionsWe found a positive association between BMI (above 20 kg/m2) and AF and between WC and AF in both men and women. BMI seems a more informative measure about risk of AF in women and WC seems more informative in men.

Establishing a reproductive biorepository for basic and translational research: experience developing the reproductive subjects registry and sample repository.

To report experience designing and establishing a reproductive registry and sample biorepository and to describe initial subject characteristics and biospecimens. Beginning in December 2017, patients presenting for reproductive care at the University of Michigan were approached for study enrollment. Following consent, subjects completed detailed reproductive and health questionnaires. A variety of reproductive specimens and tissues were collected and processed for multiple downstream applications. Subject enrollment began in December of 2017. There are currently 1798 subjects enrolled. Female participants report a variety of reproductive disorders. Available samples include semen, sperm, follicular fluid, granulosa cells, immature oocytes, ovarian and uterine tissue, and blood samples. We report the successful establishment of a reproductive registry and sample biorepository. Furthermore, we describe methods for collection and storage of a variety of reproductive tissue processed for multiple downstream translational applications.

Emerging New Psychiatric Symptoms and the Worsening of Pre-existing Mental Disorders during the COVID-19 Pandemic: A Canadian Multisite Study: Nouveaux symptômes psychiatriques émergents et détérioration des troubles mentaux préexistants durant la pandémie de la COVID-19: une étude canadienne multisite.

The coronavirus disease 2019 (COVID-19) pandemic has caused global disruptions with serious psychological impacts. This study investigated the emergence of new psychiatric symptoms and the worsening of pre-existing mental disorders during the COVID-19 pandemic, identified factors associated with psychological worsening, and assessed changes in mental health service use. An online survey was circulated between April 3 and June 23, 2020. Respondents were asked to complete mental health questionnaires based on 2 time referents: currently (i.e., during the outbreak) and in the month preceding the outbreak. A total of 4,294 Canadians between 16 and 99 years of age were subdivided based on the presence of self-reported psychiatric diagnoses. The proportion of respondents without prior psychiatric history who screened positive for generalized anxiety disorder and depression increased by 12% and 29%, respectively, during the outbreak. Occurrences of clinically important worsening in anxiety, depression, and suicidal ideation symptoms relative to pre-outbreak estimates were significantly higher in those with psychiatric diagnoses. Furthermore, 15% to 19% of respondents reported increased alcohol or cannabis use. Worse psychological changes relative to pre-outbreak estimate were associated with female sex, younger age, lower income, poorer coping skills, multiple psychiatric comorbidities, previous trauma exposure, deteriorating physical health, poorer family relationships, and lower exercising. Reductions in mental health care were associated with increased suicidal ideation. The worsening in mental health symptoms and the decline in access to care call for the urgent development of adapted interventions targeting both new mental disorders and pre-existing psychiatric conditions affected by the COVID-19 pandemic.

High Consumption of Red Meat Is Associated with Excess Mortality Among African-American Women

Red meat is a rich source of nutrients but is typically high in saturated fats. Carcinogenic chemicals can be formed during cooking and processing. Little is known about the relation of red meat consumption to mortality in African Americans (AAs), a group with excess mortality and high consumption of red meat relative to whites. Our objective was to assess the association between red meat consumption and mortality in AA women. The Black Women's Health Study (BWHS) is a prospective cohort study of AA women across the USA who completed health questionnaires at enrollment in 1995 (median age 38 y, median BMI 27.9kg/m2) and every 2 y thereafter. The analyses included 56,314 women who completed a validated FFQ and were free of cardiovascular disease and cancer at baseline in 1995. Exposures were total red meat, processed red meat, and unprocessed red meat consumption. Outcomes were all-cause and cause-specific mortality. Cox proportional hazards models with control for age, socioeconomic status, lifestyle factors, medical history, and dietary factors were used to estimate HRs with 95% CIs. During 22 y of follow-up through to 2017, we identified 5054 deaths, which included 1354 cardiovascular deaths and 1801 cancer deaths. The HR for all-cause mortality was 1.47 (95% CI: 1.33, 1.62) for the highest quintile of total red meat consumption relative to the lowest. Each 1 serving/d increase in red meat consumption was associated with a 7% (95% CI: 5%, 9%) increased risk of all-cause mortality. Red meat consumption was also associated with increased cardiovascular mortality, but not with cancer mortality. Results were similar for the consumption of processed and unprocessed red meat. Red meat consumption is associated with increased all-cause and cardiovascular mortality among AA women.

Acceptability of remote prescribing and postal delivery services for contraceptive pills and treatment of uncomplicated Chlamydia trachomatis

ObjectivesThe digitalisation of sexual and reproductive health (SRH) services offers valuable opportunities to deliver contraceptive pills and chlamydia treatment by post. We aimed to examine the acceptability of remote prescribing...

Abstract 14913: The Impact of the Wearable Cardioverter-defibrillators on Quality of Life: Insights From the Vest Trial

Background: There is scant research on the effect of wearable cardioverter-defibrillators (WCDs) on quality of life (QOL). One retrospective observational study concluded that WCDs have a negative impact. The VEST Trial was a randomized controlled trial of the WCD allowing a more definitive and complete analysis of QOL among WCD users. Hypothesis: We sought to determine if the WCD impacts patient-reported QOL, including depression, anxiety, and physical activity levels. Methods: In the VEST trial, participants with severe left ventricular dysfunction (EF≤35%) after MI were randomized in a 2:1 ratio to receive a WCD plus guideline directed therapy (GDMT) versus GDMT alone. During the 3-month follow-up period, participants were asked to complete QOL assessments and health questionnaires. Results: 1524 participants were randomized to WCD plus GDMT versus 778 participants to GDMT alone. The mean age was 60.9±12.6 years and 61.4±12.3 years in the two groups, respectively. Participants were 73.5% male, had an average body-mass index of 28.4±5.5 kg/m2, and a mean EF of 28%. During a mean follow-up of 84.3±15.6 days, health questionnaires and QOL assessments were completed by 1340 participants, including 898 receiving WCD plus GDMT, and 442 receiving GDMT alone. See Table 1 for the results of QOL assessments and health questionnaires. There were no differences in QOL according to the SF-36 physical and mental component scores, and EQ-5D scores between WCD plus GDMT versus GDMT alone. There were also no differences in depression (CES-D 10), anxiety (State-Trait Anxiety Inventory), physical activity (International Physical Activity Questionnaire), or self-reported health scale between groups (all p&gt;0.05). Conclusions: In post-MI patients with low EF, the WCD does not affect QOL, depression, anxiety, physical activity, or self-reported health. Prescribers can be reassured that the WCD has no detrimental impact on patient-reported health measures.

Safety, Effectiveness, and Uptake of Exercise Medicine Integrated Within a Cancer Care Center.

The aim of this study was to evaluate the safety, effectiveness, and acceptability of an exercise clinic co-located within a cancer treatment center to identify best practices for integrating exercise medicine into cancer care. Two-hundred thirty-seven patients were referred to the exercise clinic and completed self-report health and demographic questionnaires. Further assessments were conducted at baseline on 67 patients and following completion of the exercise program by 46 patients. Endpoints included muscular strength, physical function, cardiorespiratory fitness, body composition, quality of life, and fatigue scores. Adverse events were tracked throughout exercise participation to evaluate program safety. Exercise programming co-located and aligned with cancer treatment in a real-world clinical setting appears to be safe with only four minor exercise-related adverse events. Effectiveness was demonstrated by all physical performance (2.9%-9.5%), strength (7.4%-27.6%), and balance (10.1%) improving and some patients reported outcomes exhibiting modest but clinically relevant benefit. Importantly, no outcomes including fatigue worsened even though the patients were undergoing radiation and/or chemotherapy. Assessment of patient physical and self-reported outcomes should be co-located where they receive oncological treatment and/or exercise medicine to increase uptake of this aspect of the service. Future work should incorporate and describe program and implementation design to help identify best practices in exercise oncology programming. Nurses are a primary driver of exercise among patients receiving treatment for cancer. Their regular patient interactions offer a practical opportunity to collect and record important exercise-related information from patients. As organizations look to develop plans to implement exercise into standard practice, input from nurses is critical to ensure program feasibility.

Health-related quality of life in women with polycystic ovary syndrome attending to a tertiary hospital in Southeastern Spain: a case-control study

BackgroundPolycystic ovary syndrome (PCOS) is a chronic condition with symptoms affecting many women at reproductive age and evaluating their health-related quality of Life (HRQoL) is an important issue. Moreover, differences in the HRQoL between women with different PCOS phenotypes have never been analyzed. Therefore, the aim of our study was to compare the HRQoL between women with PCOS -and its phenotypes- and controls attending to a tertiary hospital.MethodsA group of 117 women with PCOS and 153 controls were studied between 2014 and 2016. Controls were women without PCOS attending the gynecological outpatient clinic for routine examinations. Cases were women attending the same setting and diagnosed with PCOS. PCOS diagnose was performed following the Rotterdam Criteria and women were further classified by anovulatory or ovulatory phenotypic subtype. Women underwent physical and gynecological exams and completed health questionnaires including the Short Form-12v2. Eight scales and two component summary scores [Physical (PCS) and Mental (MCS), respectively] were calculated. Bivariate and multivariate analyses were performed to assess differences in HRQoL between women with PCOS and controls.ResultsAll women with PCOS and anovulatory PCOS presented lower score in PCS compared to controls [mean (95%CI): 53.7 (52.5–54.9) and 52.9 (51.5–54.4) vs. 55.8 (54.8–56.8); p-values< 0.01], as well as lower scores for five out of the eight scales (p-values < 0.05) after adjusting by age, body mass index, infertility, educational level and current occupation. No significant differences were observed for the MCS between women with or without PCOS or its phenotypic subtypes.ConclusionsHRQoL was significantly decreased in adult women with PCOS and its anovulatory phenotype compared to controls attending the outpatient clinic of a tertiary hospital. These results may have implications for the clinical practice and suggest the need for specific interventions in women with PCOS.

Remote Home Monitoring of Older Surgical Cancer Patients: Perspective on Study Implementation and Feasibility

BackgroundRemote home monitoring might fill the perceived surveillance gap after hospital discharge. However, it is unclear whether older oncologic patients will be able to use the required new digital technologies. The study aimed to assess the feasibility of postoperative remote home monitoring for this population.MethodsThis observational cohort study recruited patients aged 65 years or older scheduled for oncologic surgery. The study patients used a mobile application and activity tracker preoperatively until 3 months postoperatively. A subset of the patients used additional devices (thermometer, blood pressure monitor, weight scale) and completed electronic health questionnaires 2 weeks after hospital discharge. Feasibility was assessed by the study completion rate, compliance in using components of the information technology system, acceptability [Net Promotor Score (NPS)] and usability [System Usability Scale (SUS)]. The NPS score varied from − 100 to + 100. An SUS higher than 68 was considered above average.ResultsOf 47 participants (mean age, 72 years; range, 65–85 years), 37 completed a follow-up assessment, yielding a completion rate of 79%. Compliance in using the activity tracker (n = 41) occurred a median of 81 days [interquartile range (IQR), 70–90 days] out of 90 post-discharge days. Compliance in measuring vital signs and completing health questionnaires varied from a median of 10.5 days (IQR, 4.5–14.0 days) to 12 days (IQR, 5–14 days) out of 14 days. The NPS was + 29.7%, and the mean SUS was 74.4 ± 19.3.ConclusionOlder oncologic patients in the study considered postoperative home monitoring acceptable and usable. Once they consented to participate, the patients were compliant, and the completion rate was high.

Introducing ExHiBITT – Exploring Host microBIome inTeractions in Twins –, a colon multiomic cohort study

Background: The colon is populated by approximately 1012 microorganisms, but the relationships between this microbiome and the host health status are still not completely understood. Here, our objective is to present the cohort characteristics of ExHiBITT – Exploring Host microBIome inTeractions in Twins – including i) biomedical phenotypes, ii) environmental factors and ii) colonoscopic findings. Methods: Participants from the TwinsUK cohort were recruited to study the interactions between the microbiome and host adaptive immunity. In total, 205 monozygotic twins were recruited from the wider TwinsUK cohort. They completed health questionnaires, and provided saliva, blood, colon biopsies from three different locations, caecal fluid, and two faecal samples. Results: A significant proportion of this apparently normal cohort had colonic polyps (28%), which are of interest as potential precursors of colorectal cancer, and, as expected, the number of polyps found was significantly correlated with BMI and age. Hitherto undiagnosed diverticulosis was also not infrequently found during colonoscopy (26%) and was associated with changes in Hybrid Th1-17 cells in the colon. Twin proband co-occurrence rate for diverticulosis (82%) was much higher than for polyps (42%). Familial factors affecting morphology or tolerance may contribute to the ease of endoscopy, as both the time to reach the caecum and pain perceived were highly concordant (proband concordance: 85% and 56%, respectively). Conclusions: We found the expected positive relationship between BMI and colonoscopic anomalies such as diverticular disease and polyps in the whole population, but within twin pairs this association was reversed. This suggests that familial factors confound these associations. Host and microbial next generation sequencing and metabolomics of the samples collected are planned in this cohort.

Lung function and respiratory outcomes in teenage boys and girls born very prematurely.

Male sex in prematurely born infants has been associated with worse respiratory outcomes in early childhood. Respiratory outcomes at 11 to 14 years of age in children born very prematurely and routinely exposed to antenatal corticosteroids and postnatal surfactant would differ according to sex. Analysis of follow-up data. Three hundred and nineteen children born before 29 weeks of gestational age from the United Kingdom Oscillation Study. Spirometry was used to assess forced expiratory flow at 75%, 50%, and 25% of expired vital capacity (FEF75 , FEF50 , and FEF25 ), forced expiratory volume in 1 second (FEV1 ), peak expiratory flow (PEF), and forced vital capacity (FVC). Lung volumes were measured using a helium dilution technique (FRCHe ) and by plethysmography (FRCpleth ). Total lung capacity (TLC) and residual volume (RV) were calculated. Mean lung function measurements were compared using linear mixed models and reported as unadjusted and adjusted for neonatal and age 11 to 14 years factors. The participants also completed health questionnaires and provided a urine sample for assessment of passive or active smoking. Three (FEF25 , FEF25-75 , FEV1 ) lung function measures showed significant differences in favor of females after adjustment. The percentage of children with abnormal lung function (below 5th centile for normal) had adjusted differences between 10 and 30 percentage points, for example, for FEF25 15% females compared with 26% males. Among extremely prematurely born school children airway function was significantly worse in males.

POC-MON: A Novel and Cost-Effective Pocket Lemon Sniff Test (PLST) for Early Detection of Major Depressive Disorder

Effective treatment of depression requires early detection. Major Depressive Disorder (MDD) is a global health and economic concern affecting over 300 million people, according to the World Health Organization. Approximately 21 million Americans experienced at least one depressive episode in 2017. A silent but deadly killer — depressive symptoms are frequently masked and therefore increases suicidal risk, resulting in about 1 million deaths annually, including teenagers. Undiagnosed and untreated depression is commonly linked to public bombings, mass killings, and school shootings in the U.S. Depressive symptoms overlap with olfactory regions, which led to several studies of the correlation between sense of smell and depression. The alarming rise of depression, its related crimes, suicides, and lack of inexpensive, quick tools in detecting early depression — this study aims in demonstrating decreased olfaction and depression correlation. Forty-two subjects (ages 13-83) underwent POC-MON (Pocket Lemon) assessment — an oven-dried lemon peel sniff test, subjected to distance measurement when odor first detected (threshold) and completed Patient Health Questionnaires (PHQ-9). POC-MON and PHQ-9 scores yielded a correlation of 20% and 18% for the right and left nostrils, respectively. Among male (n=17) subjects, the average distance of POC-MON and PHQ-9 scores produced a correlation of 14% and 16% for the right and left nostrils, respectively. Females (n=25) demonstrated a correlation of 28% and 21% for the right and left nostrils, respectively. These results suggest the correlation between olfaction and depression in diagnosing its early-stage, using a quick, inexpensive, and patient-friendly tool — POC-MON.

78 Development of a Multifactorial Assessment of Dizziness for Middle-Aged and Older People

Abstract Background More than 10% of people aged 50 years and older report dizziness. Despite available treatments, dizziness remains unresolved for many people due in part to sub-optimal assessment. Aims to identify factors associated with dizziness handicap in middle-aged and older people to identify targets for intervention to address this debilitating problem. Methods This secondary analysis of baseline and prospective data from a randomised-controlled trial involved 305 individuals aged 50-92 years reporting significant dizziness in the past year. Participants were classified as having either mild or no dizziness handicap (score &amp;lt; 31) or moderate / severe dizziness handicap (score: 31-100) based on the dizziness handicap inventory (DHI). Participants completed health questionnaires and underwent assessments of psychological well-being, lying and standing blood pressure, vestibular function, strength, vision, proprioception, processing speed, balance, stepping and gait. Participants also reported dizziness episodes in monthly diaries for 6 months following baseline assessment. Participants reported dizziness episodes in monthly diaries for six months following baseline assessment. Results DHI scores ranged from 0-86 with 95 participants (31%) reporting moderate/severe dizziness handicap. Binary logisitic regression identified a postive Dix-Hallpike test for benign paroxysmal positional vertigo, cardiovascular medicationuse, high postural sway when standing on the floor with eyes closed and severe anxiety, as significant and independent predictors of moderate.severe dizziness handicap. Poor balance (high sway) also significantly identified participants who reported frequent (&amp;gt; or = weekly, n=134) dizziness episodes. Conclusion Assessment of cardiovascular medication use, benign paroxysmal positional vertigo, anxiety and postural sway identify middle aged and older people with significant dizziness handicap. A multifactorial assessment including these facotrs may assist in tailoring evidence-based therapies to alleviate dizziness handicap in this group.

Safety and tolerability of experimental hookworm infection in humans with metabolic disease: study protocol for a phase 1b randomised controlled clinical trial

BackgroundAbdominal obesity and presence of the metabolic syndrome (MetS) significantly increase the risk of developing diseases such as Type 2 diabetes mellitus (T2DM) with escalating emergence of MetS and T2DM constituting a significant public health crisis worldwide. Lower prevalence of inflammatory and metabolic diseases such as T2DM in countries with higher incidences of helminth infections suggested a potential role for these parasites in the prevention and management of certain diseases. Recent studies confirmed the potential protective nature of helminth infection against MetS and T2DM via immunomodulation or, potentially, alteration of the intestinal microbiota. This Phase 1b safety and tolerability trial aims to assess the effect of inoculation with helminths on physical and metabolic parameters, immune responses, and the microbiome in otherwise healthy women and men.MethodsParticipants eligible for inclusion are adults aged 18–50 with central obesity and a minimum of one additional feature of MetS recruited from the local community with a recruitment target of 54. In a randomised, double-blind, placebo-controlled design, three groups will receive either 20 or 40 stage three larvae of the human hookworm Necator americanus or a placebo. Eligible participants will provide blood and faecal samples at their baseline and 6-monthly assessment visits for a total of 24 months with an optional extension to 36 months. During each scheduled visit, participants will also undergo a full physical examination and complete diet (PREDIMED), physical activity, and patient health (PHQ-9) questionnaires. Outcome measurements include tolerability and safety of infection with Necator americanus, changes in metabolic and immunological parameters, and changes in the composition of the faecal microbiome.DiscussionRising cost of healthcare associated with obesity-induced metabolic diseases urgently calls for new approaches in disease prevention. Findings from this trial will provide valuable information regarding the potential mechanisms by which hookworms, potentially via alterations in the microbiota, may positively influence metabolic health.Trial registrationThe protocol was registered on ANZCTR.org.au on 05 June 2017 with identifier ACTRN12617000818336.Alternatively, a Google search using the above trial registration number will yield a direct link to the trial protocol within the ANZCTR website.