Self-reported health of Australian Defence Force personnel after use of anti-malarial drugs on deployment

The Departments of Defence and Veterans’ Affairs commissioned UQ School of Public Health to use data from health studies of the ADF deployments to East Timor and Bougainville to investigate anti-malarial drug use and health outcomes.\ua0This report presents the results of a descriptive analysis of self-reported anti-malarial drug use on deployment and self-reported health.Personnel who used the drug mefloquine reported more symptoms of psychological distress than those who used other anti-malarial drugs. However, the average differences observed were below the threshold of clinical significance and based on a small sample size in the mefloquine group.\ua0Fifty-seven participants (1.6% of the sample)\ua0mentioned the use of anti-malarial drugs as a concern in response to open-ended survey questions

Adaptation and validation of the Charlson Index for Read/OXMIS coded databases

BACKGROUND: The Charlson comorbidity index is widely used in ICD-9 administrative data, however, there is no translation for Read/OXMIS coded data despite increasing use of the General Practice Research Database (GPRD). Our main objective was to translate the Charlson index for use with Read/OXMIS coded data such as the GPRD and test its association with mortality. We also aimed to provide a version of the comorbidity index for other researchers using similar datasets. METHODS: Two clinicians translated the Charlson index into Read/OXMIS codes. We tested the association between comorbidity score and increased mortality in 146 441 patients from the GPRD using proportional hazards models. RESULTS: This Read/OXMIS translation of the Charlson index contains 3156 codes. Our validation showed a strong positive association between Charlson score and age. Cox proportional models show a positive increasing association with mortality and Charlson score. The discrimination of the logistic regression model for mortality was good (AUC = 0.853). CONCLUSION: We have translated a commonly used comorbidity index into Read/OXMIS for use in UK primary care databases. The translated index showed a good discrimination in our study population. This is the first study to develop a co-morbidity index for use with the Read/OXMIS coding system and the GPRD. A copy of the co-morbidity index is provided for other researchers using similar database

The combined diabetes and renal control trial (C-DIRECT) - a feasibility randomised controlled trial to evaluate outcomes in multi-morbid patients with diabetes and on dialysis using a mixed methods approach

Background: This cluster randomised controlled trial set out to investigate the feasibility and acceptability of the “Combined Diabetes and Renal Control Trial” (C-DIRECT) intervention, a nurse-led intervention based on motivational interviewing and self-management in patients with coexisting end stage renal diseases and diabetes mellitus (DM ESRD). Its efficacy to improve glycaemic control, as well as psychosocial and self-care outcomes were also evaluated as secondary outcomes. Methods: An assessor-blinded, clustered randomised-controlled trial was conducted with 44 haemodialysis patients with DM ESRD and ≥ 8% glycated haemoglobin (HbA1c), in dialysis centres across Singapore. Patients were randomised according to dialysis shifts. 20 patients were assigned to intervention and 24 were in usual care. The C-DIRECT intervention consisted of three weekly chair-side sessions delivered by diabetes specialist nurses. Data on recruitment, randomisation, and retention, and secondary outcomes such as clinical endpoints, emotional distress, adherence, and self-management skills measures were obtained at baseline and at 12 weeks follow-up. A qualitative evaluation using interviews was conducted at the end of the trial. Results: Of the 44 recruited at baseline, 42 patients were evaluated at follow-up. One patient died, and one discontinued the study due to deteriorating health. Recruitment, retention, and acceptability rates of C-DIRECT were generally satisfactory HbA1c levels decreased in both groups, but C-DIRECT had more participants with HbA1c < 8% at follow up compared to usual care. Significant improvements in role limitations due to physical health were noted for C-DIRECT whereas levels remained stable in usual care. No statistically significant differences between groups were observed for other clinical markers and other patient-reported outcomes. There were no adverse effects. Conclusions: The trial demonstrated satisfactory feasibility. A brief intervention delivered on bedside as part of routine dialysis care showed some benefits in glycaemic control and on QOL domain compared with usual care, although no effect was observed in other secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients

Observations of aerosols in the free troposphere and marine boundary layer of the subtropical Northeast Atlantic: discussion of processes determining their size distribution

During July 1994, submicron aerosol size distributions were measured at two sites on Tenerife, Canary Islands. One station was located in the free troposphere (FT), the other in the marine boundary layer (MBL). Transport toward these two sites was strongly decoupled: the FT was first affected by dust and sulfate-laden air masses advecting from North Africa and later by clean air masses originating over the North Atlantic, whereas the MBL was always subject to the northeasterly trade wind circulation. In the FT the submicron aerosol distribution was predominantly monomodal with a geometric mean diameter of 120 nm and 55 nm during dusty and clean conditions, respectively. The relatively small diameter during the clean conditions indicates that the aerosol originated in the upper troposphere rather than over continental areas or in the lower stratosphere. During dusty conditions the physical and chemical properties of the submicron aerosol suggest that it has an anthropogenic origin over southern Europe and that it remains largely externally mixed with the supermicron mineral dust particles during its transport over North Africa to Tenerife. Apart from synoptic variations, a strong diurnal variation in the aerosol size distribution is observed at the FT site, characterized by a strong daytime mode of ultrafine particles. This is interpreted as being the result of photoinduced nucleation in the upslope winds, which are perturbed by anthropogenic and biogenic emissions on the island. No evidence was found for nucleation occurring in the undisturbed FT. The MBL site was not strongly affected by European pollution during the period of the measurements. The MBL aerosol size distribution was bimodal, but the relative concentration of Aitken and accumulation mode varied strongly. The accumulation mode can be related to cloud processing of the Aitken mode but also to pollution aerosol which was advected within the MBL or entrained from the FT. No bursts of nucleation were observed within the MBL

Risk of venous thromboembolism in children after general surgery

Background/purpose: The purpose of the study was to determine absolute and relative rates of venous thromboembolism (VTE) following general surgical procedures in children compared to the general population. Methods: We analyzed data from all patients under the age of 18 years in the Clinical Practice Research Datalink, linked to Hospital Episode Statistics from England (2001–2011) undergoing a general surgical procedure and population controls. Crude rates of VTE and adjusted hazard ratios were calculated using Cox regression. Results We identified 15,637 children who had a surgical procedure with 161,594 controls. Six children undergoing surgery had a VTE diagnosed in the year after compared to five children in the population cohort. The overall rate of VTE following surgery was 0.4 per 1000 person years (pyrs) (95% confidence interval [CI] 0.15–0.88) compared to 0.04 per 1000 pyrs (95% CI 0.02–0.09) in the population cohort. This represented a 9 fold increase in risk compared to the population cohort (adjusted hazard ratio [HR] 8.80; 95% CI 2.59–29.94). Conclusions Children are at increased risk for VTE following general surgical procedures compared to the general population however the absolute risk is small and given this the benefits of thromboprophylaxis need to be balanced against the risk of complications following its use

Characteristics and outcomes of hospitalised patients with vertebral fragility fractures: a systematic review

Background: The complex management for patients presenting to hospital with vertebral fragility fractures provides justification for the development of specific services for them. A systematic review was undertaken to determine the incidence of hospital admission, patient characteristics, and health outcomes of vertebral fragility fracture patients to inform the development of such a service. Methods: Non-randomised studies of vertebral fragility fracture in hospital were included. Searches were conducted using electronic databases and citation searching of the included papers. Results: 19 studies were included. The incidence of hospital admission varied from 2.8-19.3 per 10,000/year. The average patient age was 81 years, the majority having presented with a fall. A diagnosis of osteoporosis or previous fragility fracture was reported in around one third of patients. Most patients (75% men and 78% women) had five or more co-pathologies. Most patients were managed non-operatively with a median hospital length of stay of 10 days. One third of patients were started on osteoporosis treatment. Inpatient and one year mortality was between 0.9-3.5%, and 20–25% respectively: between 34-50% were discharged from hospital to a care facility. Many patients were more dependent with activities of daily living on discharge compared to their pre-admission level. Older age and increasing comorbidities was associated with longer hospital stay and higher mortality. Conclusion: These findings indicate that specific hospital services for patients with vertebral fragility fractures should take into consideration local hospitalisation rates for the condition, and should be multifaceted - providing access to diagnostic, therapeutic, surgical and rehabilitation interventions

Light-Absorbing Material Extracted From Cloud Droplets and Its Effect on Cloud Albedo

Using the counterflow virtual impactor, a new instrument for sampling cloud droplets, measurable levels of light-absorbing material were found to exist inside droplets in stratocumulus clouds off the coast of southern California. Eighty percent of the samples of droplet residue material had light absorption coefficients ranging from 6 to 20 × 10⁻⁸ m⁻¹ (where m⁻¹ means per meter of distance in the cloud, not in the cloud droplet nor in the dried bulk aerosol material). Calculated soot concentrations were between 23 and 79 ng soot g⁻¹ of cloud water. These values are in general agreement with aerosol, rainwater, and snow measurements from other experiments and suggest that the coastal clouds were influenced by continental air. Aircraft measurements determined that the sampled clouds had average liquid water contents of 0.24–0.31 g m⁻³, effective droplet radii of 5.0–7.8 μm, and optical thicknesses of 14–28. Radiative transfer calculations indicate that even at the most sensitive wavelength, the maximum amount of light-absorbing material from cloud air and inside cloud droplets in this experiment would not significantly alter the albedos of the clouds that were measured. The same amount could possibly affect the albedo of much thicker clouds or of snowpacks (which have relatively large particles and optical thicknesses)

Assessment of Pneumonia in Older Adults: Effect of Functional Status

Evaluate the effect of preadmission functional status on severity of pneumonia, length of hospital stay (LOS), and all-cause 30-day and 1-year mortality of adults aged 60 and older and to understand the effect of pneumonia on short-term functional impairment. DESIGN : Prospective cohort study. SETTING : University hospital. PARTICIPANTS : One hundred twelve patients with radiograph-proven pneumonia (mean age 74.6) were enrolled. MEASUREMENTS : Functional status and comorbidities were assessed using the Functional Autonomy Measurement System (SMAF) and Charlson Comorbidity Index. Clinical information was used to calculate the Pneumonia Prognostic Index (PPI). RESULTS : Eighty-four (75%) patients were functionally independent (FI) before admission, with a SMAF score of 40 or lower. Dementia and aspiration history were higher in the group that was functionally dependent (FD) before admission ( P <.001). The FI group had less-severe pneumonia per the PPI and shorter mean LOS±standard deviation (5.62±0.51 days) than the FD group (11.42±2.58, P <.004). The FI group had lower 1-year mortality (19/65, 23%) than the FD group (14/28, 50%), and the difference remained significant after adjusting for Charlson Index and severity of illness ( P =.009). All patients lost function after admission, with loss being more pronounced in the FI group (mean change 19.24±12.9 vs 4.72±6.55, P <.001). CONCLUSION : Older adults who were FI before admission were more likely to present with less-severe pneumonia and have a shorter LOS. In addition, further loss of function was common in these patients. Assessment of function before and during hospitalization should be an integral part of clinical evaluation in all older adults with pneumonia.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66281/1/j.1532-5415.2006.00797.x.pd

Baseline characteristics of an incident haemodialysis population in Spain: results from ANSWER—a multicentre, prospective, observational cohort study

Background. The ANSWER study aims to identify risk factors leading to increased cardiovascular morbidity and mortality in a Spanish incident haemodialysis population. This paper summarizes the baseline characteristics of this population