A study of frailty, falls, bone mineral density and fractures among HIV-positive and HIV-negative controls in England and Ireland, the POPPY study

Effective antiretroviral therapy (ART) has prolonged life expectancy among people living with HIV (PLWH) in most parts of Europe, but as PLWH are ageing, this group is now starting to experience signs of compromised health, with particular concerns around possible increased rates of frailty, falls and fractures. In this thesis I use data from the Pharmacokinetic and Clinical Observations in People Over Fifty (POPPY) study (699 older (≥50 years) PLWH, 374 younger (<50 years) PLWH and 304 HIV-negative controls (≥50 years)) to examine some of the challenges of ageing in PLWH in England and Ireland. In particular, I investigate frailty, falls, bone mineral density (BMD), fractures and fracture (hip and major-osteoporotic) risk among PLWH and HIV-negative controls, and examine their associations with demographic, clinical, lifestyle and HIV-specific factors. Results highlight that older PLWH experience increased frailty, a higher prevalence of falls and a greater loss of BMD than younger PLWH and similarly-aged HIV-negative controls. Furthermore, this thesis highlights the importance of demographic characteristics, lifestyle traits, depressive symptoms, physical functioning and HIV-specific factors for the development of frailty, falls and low BMD in PLWH. Among PLWH, I also explore whether the effect of age on the prevalence of frailty could be explained by the effect of HIV parameters by investigating the association of HIV-specific parameters with each of the outcomes considered. Finally, I explore the link between pharmacokinetic (PK) parameters of commonly used nucleoside reverse transcriptase inhibitors (NRTIs) with BMD and with the 10-year probability of fracture. This thesis identified groups at heightened risk for frailty, falls and low BMD, fractures and fracture risk experiencing poor health outcomes against the backdrop of overall improvement of life span among PLWH and aims to inform policy for optimising treatment, tailored to the needs of this population

The Effects of Thermal Sensation and Acclimatisation on Cognitive Performance of Adult Female Students in Saudi Arabia Using Multivariable - Multilevel Statistical Modelling

In the hot climate of Saudi Arabia, people living year-round in air-conditioned spaces are likely to develop high expectations for homogeneity and cool temperatures, becoming potentially more sensitive if thermal conditions deviate from the comfort zone they expect. This paper presents the results from a field intervention investigating the association between participants’ thermal sensations with cognitive performance in a female university in Saudi Arabia. The climatic context plays a key role in choosing Saudi Arabia, whereas the total reliance on air-conditioners (AC) for cooling is believed to have significant effects on occupants’ perceptions of the comfort temperature. Results reveal discrepancies in the actual thermal sensations between the Saudi and non-Saudi participants which affected their performances. “Cool” and “Slightly Cool” sensations versus neutral were associated with significant lower percentage of errors and significant higher speed for all participants independently of any association with ethnicity and acclimatization. The estimates remained significant even after adjusting for ethnicity and the number of years spent in the country and the set temperature of AC at home. Implications of the study suggest a preference for staying cool when working independently of acclimatization status

Combined effects of ventilation rates and indoor temperatures on cognitive performance of female higher education students in a hot climate

Impairment in mental functions attributed to the effects of indoor air quality and thermal conditions has received considerable attention in the past decade, particularly for educational buildings where students’ cognitive performance is essential to foster learning. This study explores the combined effects of indoor temperatures and CO2 levels as markers for ventilation rates on cognitive performance among female students (16– 23 years old) in Saudi Arabia. The longitudinal experiments involved nine conditions combining three CO2 concentration levels (achieved via changes in ventilation) and three temperature levels involving 499 participants, all exposed to the nine conditions. The study implemented a computer- based cognitive performance battery with “9Button” keyboards. Univariable and multivariable multilevel regression models explored the association of indoor temperature and CO2 levels (as markers for ventilation rates) with cognitive performance after adjusting for potential confound-ers. Potential benefits were found on speed and accuracy of tasks of cognitive perfor-mance when indoor temperature was set between 20 and 23ºC and at CO2 levels of 600 ppm compared to higher temperatures and poorer ventilation rates and that both ventilation and thermal environmental control are important and need to be improved for achieving optimum learning conditions. Nevertheless, the results are relevant for short-term exposures lasting no more than 2 h

First- and Second-Trimester Reference Intervals for Thyroid Hormones during Pregnancy in “Rhea” Mother-Child Cohort, Crete, Greece

Estimation and interpretation of thyroid function tests in pregnant women is of utmost importance for maternal, fetal and neonatal health. Our objective was to calculate laboratory- and geography-specific reference intervals for thyroid hormones during pregnancy in an iodine-sufficient area of the Mediterranean, Crete, Greece. This project was performed in the context of “Rhea” mother-child cohort. Fulfillment of extensive questionnaires and estimation of free triiodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), and antithyroid antibodies were performed. The reference population was defined using inclusion criteria regarding thyroidal, obstetric, and general medical status of women. Reference interval for TSH was 0.05–2.53 μIU/mL for the first and 0.18–2.73 μIU/mL for the second trimester. 6,8% and 5,9% of women in the first and second trimester, respectively, had TSH higher than the upper reference limit. These trimester-specific population-based reference ranges are essential in everyday clinical practice for the correct interpretation of thyroid hormone values and accurate classification of thyroid disorders

A Multi-Criteria decision analysis framework to determine the optimal combination of energy efficiency and indoor air quality schemes for English school classrooms

Maintaining good Indoor Environmental Quality (IEQ) in English schools in terms of overheating and air quality is important for the health and educational performance of children. Improving energy efficiency in school buildings is also a key part of UK’s carbon emissions reduction strategy. To address the trade-offs between energy efficiency and IEQ, a Multi–Criteria Decision Analysis (MCDA) framework based on an English classroom stock model was used. The aim was to determine robust optimal school building interventions across a set of criteria (including child health, educational attainment and building energy consumption) and settings (comprising different climate scenarios, construction eras, geographical regions and school geographical orientations). Each intervention was made up of the pairwise combination of an energy efficiency retrofit scheme and an IEQ improvement scheme. The MCDA framework was applied to the school building stock in England. This study shows that the framework represents a transparent approach to support decision making in determining the optimal school building intervention from different perspectives. The optimal interventions included measures that improved IEQ and resulting indoor learning environments, such as external shading, or increased albedo and internal blinds, for the particular set of interventions, criteria and stakeholders in this study. The results of the MCDA analysis were sensitive to the preferences elicited from stakeholders on the relative importance of the criteria and to the range of interventions and criteria selected for evaluation

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Estimation and interpretation of thyroid function tests in pregnant women is of utmost importance for maternal, fetal and neonatal health. Our objective was to calculate laboratory-and geography-specific reference intervals for thyroid hormones during pregnancy in an iodine-sufficient area of the Mediterranean, Crete, Greece. This project was performed in the context of &quot;Rhea&quot; mother-child cohort. Fulfillment of extensive questionnaires and estimation of free triiodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), and antithyroid antibodies were performed. The reference population was defined using inclusion criteria regarding thyroidal, obstetric, and general medical status of women. Reference interval for TSH was 0.05-2.53 μIU/mL for the first and 0.18-2.73 μIU/mL for the second trimester. 6,8% and 5,9% of women in the first and second trimester, respectively, had TSH higher than the upper reference limit. These trimester-specific population-based reference ranges are essential in everyday clinical practice for the correct interpretation of thyroid hormone values and accurate classification of thyroid disorders

A Multi-Criteria decision analysis framework to determine the optimal combination of energy efficiency and indoor air quality schemes for English school classrooms

Maintaining good Indoor Environmental Quality (IEQ) in English schools in terms of overheating and air quality is important for the health and educational performance of children. Improving energy efficiency in school buildings is also a key part of UK's carbon emissions reduction strategy. To address the trade-offs between energy efficiency and IEQ, a Multi–Criteria Decision Analysis (MCDA) framework based on an English classroom stock model was used. The aim was to determine robust optimal school building interventions across a set of criteria (including child health, educational attainment and building energy consumption) and settings (comprising different climate scenarios, construction eras, geographical regions and school geographical orientations). Each intervention was made up of the pairwise combination of an energy efficiency retrofit scheme and an IEQ improvement scheme. The MCDA framework was applied to the school building stock in England. This study shows that the framework represents a transparent approach to support decision making in determining the optimal school building intervention from different perspectives. The optimal interventions included measures that improved IEQ and resulting indoor learning environments, such as external shading, or increased albedo and internal blinds, for the particular set of interventions, criteria and stakeholders in this study. The results of the MCDA analysis were sensitive to the preferences elicited from stakeholders on the relative importance of the criteria and to the range of interventions and criteria selected for evaluation

Pain in people living with HIV and its association with healthcare resource use, well-being and functional status

Objective: We describe the prevalence of pain and its associations with healthcare resource utilisation and quality-of-life. Design: The POPPY Study recruited three cohorts: older PLWH (≥50 years, n = 699), younger demographically/lifestyle similar PLWH (<50 years, n = 374) and older demographically/lifestyle similar HIV-negative (≥50 years, n = 304) people from April 2013-February 2016. Methods: Current pain and pain-related healthcare use was collected via a self-reported questionnaire. Logistic regression assessed between-group differences in the prevalence of pain in the past month and current pain after controlling for potential confounders. Associations between current pain and healthcare resource use, reported joint problems, depressive symptoms, quality-of-life and functional status were assessed in PLWH using Mann-Whitney U and Chi-squared tests. Results: Pain in the past month was reported by 473/676 (70.0%) older PLWH, 224/357 (62.7%) younger PLWH and 188/295 (63.7%) older HIV-negative controls (p = 0.03), with current pain reported in 330 (48.8%), 134 (37.5%) and 116 (39.3%), respectively (p = 0.0007). Older PLWH were more likely to experience current pain, even after adjustment for confounders. Of those with pain in the past month, 56/412 (13.6%) had missed days of work or study due to pain, and 520 (59%) had seen a doctor about their pain. PLWH experiencing current painhad more depressive symptoms, poorer quality-of-life on all domains, and greater functional impairment, regardless of age group. Conclusions: Even in the effective ART era, pain remains common in PLWH and has a major impact on quality-of-life and associated healthcare and societal costs. Interventions are required to assist clinicians and PLWH to proactively manage pain

Cohort profile: the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) study

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