Mental wellbeing in non-ambulant youth with neuromuscular disorders: What makes the difference?

The physical and social challenges associated with neuromuscular disorders may impact mental wellbeing in non-ambulant youth during the more vulnerable period of adolescence. This cross-sectional survey investigated non-ambulant youths’ mental wellbeing and relationships with physical health, participation and social factors. The conceptual model was the International Classification of Functioning, Disability and Health (ICF). Thirty-seven youth aged 13 – 22 years old (mean age 17.4 years; n = 30 male; n = 24 Duchenne Muscular Dystrophy) and their parents provided biopsychosocial data through a comprehensive self-report questionnaire. The primary outcome measure was the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS). Relationships between mental wellbeing and variables within and across each ICF domain were explored using linear regression models. Mean WEMWBS scores (55.3/70 [SD 8.1]) were higher than for typically developing youth and comparable to youth with other chronic conditions. Over half of youth reported severe co-morbidities across all body systems. Multivariable modelling indicated that mental wellbeing was independently associated with academic achievement and perceived family support but not with physical health variables. Beyond management of physical co-morbidities, enabling youths’ educational attainment and attending to social support likely optimises youth’s wellbeing

Grip and muscle strength dynamometry in acute burn injury: Evaluation of an updated assessment protocol

External stabilization is reported to improve reliability of hand held dynamometry, yet this has not been tested in burns. We aimed to assess the reliability of dynamometry using an external system of stabilization in people with moderate burn injury and explore construct validity of strength assessment using dynamometry. Participants were assessed on muscle and grip strength three times on each side. Assessment occurred three times per week for up to four weeks. Within session reliability was assessed using intraclass correlations calculated for within session data grouped prior to surgery, immediately after surgery and in the sub-acute phase of injury. Minimum detectable differences were also calculated. In the same timeframe categories, construct validity was explored using regression analysis incorporating burn severity and demographic characteristics. Thirty-eight participants with total burn surface area 5 – 40% were recruited. Reliability was determined to be clinically applicable for the assessment method (intraclass correlation coefficient \u3e0.75) at all phases after injury. Muscle strength was associated with sex and burn location during injury and wound healing. Burn size in the immediate period after surgery and age in the sub-acute phase of injury were also associated with muscle strength assessment results. Hand held dynamometry is a reliable assessment tool for evaluating within session muscle strength in the acute and sub-acute phase of injury in burns up to 40% total burn surface area. External stabilization may assist to eliminate reliability issues related to patient and assessor strength

Patient attitudes towards analgesia and their openness to non-pharmacological methods such as acupuncture in the emergency department

Aims: To investigate patient attitudes to analgesia, opioids and non-pharmacological analgesia including acupuncture, in the ED. Methods: ED patients with pain were surveyed regarding: pain scores, satisfaction, addiction concern, non-pharmacological methods of pain relief, and acupuncture. Data were analysed using logistic regression. Results: Of 196 adult patients, 52.8% were ‘very satisfied’ with analgesia. Most patients (84.7%) would accept non-pharmacological methods including acupuncture (68.9%) and 78.6% were not concerned about addiction. Satisfaction was associated with male gender, and ‘adequate analgesia’ but not with opioids. Conclusion: Most patients were generally satisfied with ED analgesia and were open to non-pharmacologic analgesia including acupuncture

Irritable Bowel Syndrome patients exhibit depressive and anxiety scores in the subsyndromal range

Irritable bowel syndrome (IBS) patients frequently experience affective disorders and psychiatric outpatients frequently meet criteria for IBS. The exact nature of this co-morbidity is not clear. 34 patients with Rome-II diagnosed IBS were recruited from a Gastroenterology clinic. Patients with social anxiety disorder (10 SSRI-remitted and 7 untreated subjects) were used as a psychiatric comparison, 28 normal subjects from our register were included as a fourth group (Volunteers). Depressive and anxiety symptoms were measured by the Beck Depression Inventory (BDI) and Spielberger Trait Anxiety Inventory (STAI), respectively. Personality traits were measured with the Swedish universities Scales of Personality (SSP). IBS subjects had BDI and STAI scores intermediate between those of volunteers and patients, despite their lack of a co-morbid psychiatric diagnosis. A principle component factor analysis of the SSP dataset corresponded closely to the solution published with other samples. ANOVA revealed significant between-group differences for 7 of the 13 SSP variables

Opportunistic Screening in General Practice for Chlamydia Trachomatis in Young Men

Study Objective: There is little information available regarding the prevalence of Chlamydia Trachomatis in young men in the general population. The community based rate of infection is estimated to be 4.6%, but this is thought to reflect an over-representation of high-risk groups. The aims of this study were to1) estimate the rate of Chlamydia infection in young men attending general practitioners in the Perth metropolitan area, 2) assess behavioural factors associated having the disease and 3) assess GP management of patients testing positive. Methodology: Sexually active men (15-29 years) were recruited from 8 general practices in Perth, Western Australia. Participants were required to complete a questionnaire concerning their sexual orientation, history, behaviours and genital symptoms and provide a urine sample for PCR testing for Chlamydia. If a participant returned a positive PCR result, the treating doctor was contacted by a researcher 2 weeks following the test to assess patient follow up. Results: 401 men were recruited. 373 had urine results available. Of these 3.8% (95% CI, 2.1-6.2) returned a positive PCR result for Chlamydia Trachomatis. There were no remarkable differences between the sexual practices and behaviours of positive and negative participants, although we cannot exclude sampling bias given the small number of positive participants. All patients were followed up by their treating doctor once results were received. Despite the small number of positive participants, there was little relationship between self reported sexual behaviour or symptoms and incidence of Chlamydia in young men. Details of these findings will be provided at presentation. Conclusion: Given the asymptomatic nature, it may be appropriate to offer screening for at risk individuals, thereby moving towards curbing the increasing infection rate for this disease

Knowledge and attitudes of men to prostate cancer

Objective: To ascertain the current level of understanding about prostate cancer (PCa), including treatment options and potential side effects of treatment, among older men. Design and Setting: Questionnaires administered by general practitioners (GPs) in 5 general practices in the Perth metropolitan and regional areas of Western Australia. Participants: Convenience sample of men aged 40-80 years (n=503) with or without prostate cancer presenting for routine consultations. Main outcome measures: Knowledge and attitudes of men to prostate cancer Results: Eighty percent of men did not know the function of the prostate and 48% failed to identify PCa as the most common internal cancer in men. Thirty-five percent had no knowledge of the treatments for PCa and 53% had no knowledge of the side effects of treatments. Asked how they would arrive at a decision about treatment, 70% stated they would ask the GP/specialist for all their options and then decide themselves. Conclusion: This study confirms a deficit in knowledge of the disease among men in the at risk age group. Lack of knowledge encompassed areas which could delay diagnosis and hence treatment. Overall the population preferred some GP/specialist involvement in treatment decision making

Added value of second biopsy target in screen-detected widespread suspicious breast calcifications

Introduction: There is controversy on the optimal work‐up of screen‐detected widespread breast calcifications: whether to biopsy a single target or multiple targets. This study evaluates agreement between multiple biopsy targets within the same screen‐detected widespread (≥25 mm) breast calcification to determine if the second biopsy adds value. Methods: Retrospective observational study of women screened in a statewide general population risk breast cancer mammographic screening program from 2009 to 2016. Screening episodes recalled for widespread calcifications where further views indicated biopsy, and two or more separate target areas were sampled within the same lesion were included. Percentage agreement and Cohen\u27s Kappa were calculated. Results: A total of 293317 women were screened during 761124 separate episodes with recalls for widespread calcifications in 2355 episodes. In 171 women, a second target was biopsied within the same lesion. In 149 (86%) cases, the second target biopsy result agreed with the first biopsy (κ = 0.6768). Agreement increased with increasing mammography score (85%, 86% and 92% for score 3, 4 and 5 lesions). Same day multiple biopsied lesions were three times more likely to yield concordant results compared to post‐hoc second target biopsy cases. Conclusion: While a single target biopsy is sufficient to discriminate a benign vs. malignant diagnosis in most cases, in 14% there is added value in performing a second target biopsy. Biopsies performed prospectively are more likely to yield concordant results compared to post‐hoc second target biopsy cases, suggesting a single prospective biopsy may be sufficient when results are radiological‐pathological concordant; discordance still requires repeat sampling

Impact of the Promoting Physical Activity in Regional and Remote Cancer Survivors intervention on health-related quality of life in breast and colorectal cancer survivors

Background: The PPARCS trial examined the efficacy of a distance-based wearable and health coaching intervention to increase physical activity (PA) in breast and colorectal cancer (CRC) survivors living in non-metropolitan areas. This paper examines the effects of the intervention on health-related quality of life (HRQoL) at 12 weeks (T2; end of intervention) and 24 weeks (T3; follow-up). Methods: Participants that were insufficiently physically active and had successfully completed cancer treatment were randomised to an intervention or control group. PA was assessed using an ActiGraph (GT9X) at baseline, T2, and T3. Intervention effects on HRQoL were analysed using quantile regression comparing treatment groups across time. Results: A total of 87 were randomised to intervention and control groups. There were generally no statistically significant differences between the groups on any HRQoL item except for pain. There was an arm (F(1, 219) = 5.0. p = 0.027) and time (F(2,221) = 4.8, p = 0.009) effect, reflecting the higher pain scores in the control group when collapsed across time points (median difference 16.7, CI 1.9 to 31.4, p = 0.027). For global HRQoL, the intervention group increased by 8.3 points between T1 and T2. The overall group median when collapsed across time was 16.7 points CI 8.2 to 25.2, p Conclusions: While the PPARCS intervention resulted in significant increases in PA, participants indicated a high HRQoL at baseline, leaving little room for improvement. Findings suggest that PA may improve global HRQoL and pain in breast and CRC survivors.</p

The efficacy of resistance training in addition to usual care for adults with acute burn injury: A randomised controlled trial

Resistance training immediately after a burn injury has not been investigated previously. This randomised, controlled trial assessed the impact of resistance training on quality of life plus a number of physical, functional and safety outcomes in adults with a burn injury. Patients were randomly assigned to receive, in addition to standard physiotherapy, four weeks of high intensity resistance training (RTG) or sham resistance training (CG) three days per week, commenced within 72h of the burn injury. Outcome data was collected at six weeks, three and six months after burn injury. Quality of life at 6 months was the primary endpoint. Data analysis was an available cases analysis with no data imputed. Regression analyses were used for all longitudinal outcome data and between-group comparisons were used for descriptive analyses. Forty-eight patients were randomised resistance training (RTG) (n=23) or control group (CG) (n=25). The RTG demonstrated improved outcomes for the functional domain of the Burn Specific Health Scale-Brief (p=0.017) and the Quick Disability of Arm Shoulder and Hand (pp=0.001). Total quality of life scores, lower limb disability, muscle strength and volume were not seen to be different between groups (p\u3e0.05). Resistance training in addition to usual rehabilitation therapy showed evidence of improving functional outcomes, particularly in upper limb burn injuries. Additionally, resistance training commenced acutely after a burn injury was not seen to be harmful to patients. Crown Copyright © 2020 Published by Elsevier Ltd. All rights reserved

Demographic and clinical predictors of trait impulsivity in Parkinson’s disease patients

Background: Impulsive behaviour has become increasingly recognised as a neuropsychiatric complication of Parkinson’s disease (PD). Thought to be a product of compromised cognitive control, the spectrum of impulsive behaviours in PD ranges from cognitive disinhibition to impulse control disorders (ICDs). Objective: At present, there are no indicators for trait impulsivity in PD. The objective of the current study was to identify demographic and clinical predictors of susceptibility to trait impulsivity in a cohort of PD patients. Methods: The current study assessed impulsivity using the Barratt Impulsiveness Scale 11 (BIS-11) in a cohort of 87 PD patients. General linear models (GLMs) were used to identify clinical and demographic variables predictive of heightened BIS-11 second-order attentional and nonplanning subscale scores. Results: Male gender, no history of smoking, postsecondary education, and heightened disease severity were predictive of increased BIS-11 attentional scores (p \u3c 0.05). Similarly, male gender, after secondary education, and disease severity were predictive of increased BIS-11 nonplanning scores (p \u3c 0.05). Contrary to previous reports, dopaminergic medication use was not a significant determinant of either BIS-11 subscale scores. Conclusions: Several demographic and clinical variables including male gender, no history of past smoking, after secondary education, and elevated disease severity are associated with impulsivity in PD