Protein Adequacy, Plant Protein Proportion, and Main Plant Protein Sources Consumed Across Vegan, Vegetarian, Pescovegetarian, and Semivegetarian Diets: A Systematic Review.

BACKGROUND: There are several types of plant-based diets, with unknown differences across diets on total/plant protein intake and variety of plant protein sources consumed. OBJECTIVES: This systematic review aimed to compare total protein intake, proportion of plant proteins, and main plant protein sources consumed across 4 primarily plant-based diets: vegan, vegetarian, pescovegetarian, and semivegetarian. METHODS: We included observational studies reporting on protein intake and/or protein sources in generally healthy adults that were published between 2002 and 2023. We determined the following: 1) % energy from total and plant protein; 2) the proportion of plant protein relative to total protein intake; and 3) main plant protein sources (median percentage contribution of each source to total plant protein intake; interquartile range) consumed across the 4 diets. The plant protein sources were broadly classified into the following United States Department of Agriculture food groups: grains; nuts and seeds; soy products; and beans, peas, and lentils. RESULTS: We included 13 studies reporting on protein intake/sources that were conducted in the United States, Europe, and South Korea. Of these, 7 reported on vegan, 11 on vegetarian, 7 on pescovegetarian, and 7 on semivegetarian diets with total protein intake ranging from 10% to 17.4%. Vegan diets had the highest plant protein proportion (range: 77%-98%) and semivegetarian diets the lowest (range: 37%-83%). Plant protein source contribution was the highest from grains (range: 60%-78%). Nuts and seeds were the most consumed in vegetarian diets (7.9%; 2.9%-10.3%) and least in semivegetarian diets (3.7%; 2%-14.8%). Soy products and beans, peas, and lentils were most consumed in vegan diets (17.3%; 16.3%-19.9, and 19.6%; 14.6%-21.3, respectively) and least in semivegetarian (3.7%; 1.3%-13.9%, and 8.5%; 5.2%-10.2%) diets. CONCLUSIONS: Vegan diets has the highest plant protein proportion and a variety of plant protein sources, while semivegetarian diets has the lowest plant protein proportion and mainly relied on grains as a plant protein source.

Depression, Anxiety, and Risk of Metabolic Syndrome in Women With Polycystic Ovary Syndrome: A Longitudinal Study.

CONTEXT: Patients with PCOS are at high risk of depression, anxiety, and metabolic syndrome (MetSyn), a key predictor of cardiovascular disease. The impact of depression and/or anxiety on MetSyn is unknown in this population. OBJECTIVE: To compare the risk of developing MetSyn in patients with PCOS with and without a history of depression and/or anxiety. DESIGN: Retrospective longitudinal cohort study (2008-2022) with median follow-up of 7 years. SETTING: Tertiary care ambulatory practice. PATIENTS OR OTHER PARTICIPANTS: Patients with hyperandrogenic PCOS and at least 2 evaluations for MetSyn ≥3 years apart (n=321). INTERVENTION(S): N/A. MAIN OUTCOME MEASURE(S): The primary outcome was risk of developing MetSyn. We hypothesized that this risk would be higher with a history of depression and/or anxiety. RESULTS: At the first visit, 33.0% had a history of depression and/or anxiety, with a third prescribed antidepressants or anxiolytics. Depression and/or anxiety increased risk of developing MetSyn during the study period (adjusted hazard ratio [aHR] 1.45, 95% CI 1.02-2.06, p=0.04) with an incidence of MetSyn of 75.3 compared to 47.6 cases per 100 person-years among those without (p=0.002). This was primarily driven by depression (aHR 1.56, 95% CI 1.10-2.20, p=0.01). CONCLUSIONS: Patients with PCOS and depression and/or anxiety have a high risk of developing MetSyn, with a stronger association between depression and MetSyn. Our findings highlight the urgent need for guideline-directed screening for depression and anxiety at time of diagnosis of PCOS as well as screening at subsequent visits to facilitate risk stratification for metabolic monitoring and early intervention in this high-risk group.

Association of household language and vision screening among children in the United States.

The American Academy of Pediatrics recommends annual testing in children beginning at 3 years of age to detect vision problems and prevent amblyopia. However, rates of vision testing in children from non-English primary language (NEPL) households are not well delineated. This study analyzed the 2018-2020 National Survey of Children's Health to examine patterns and predictors of vision testing among children from NEPL households. In this nationally representative cohort of 89,697 children 3-17 years of age, 70.9% of children received vision testing during the previous 12 months. Children from non-English-speaking households were less likely to undergo vision testing (64.3% vs 72.0%; aOR [95% CI] = 0.83 [0.72-0.95], P = 0.008). Decreased vision testing among children from NEPL households was driven by lower rates of testing at school (16.1% vs 21.0%; 0.72 [0.57-0.89], P = 0.009) or from an ophthalmologist or optometrist (49.0% vs 54.0%; 0.72 [0.61-0.85], P = 0.0004), whereas children from NEPL households were more likely to receive vision testing at health clinics (14.4% vs 3.1%; 3.25 [2.40-4.39], P < 0.0001). No differences were observed in rates of testing by a pediatrician (41.1% vs 44.0%; 1.05 [0.89-1.23], P = 0.69). Interventions to improve language services and health literacy are warranted to increase rates of vision testing among children from NEPL households.

Disease Awareness Among Patients With Age-Related Macular Degeneration: Patterns and Predictors.

Purpose: To examine the prevalence and predictors of patient awareness of their disease in adults with age-related macular degeneration (AMD). Methods: This study analyzed 5553 adults 40 years or older in the 2005-2008 National Health and Nutrition Examination Survey who underwent retinal imaging. AMD was determined based on retinal images. Patient awareness of their AMD was assessed by a self-reported AMD diagnosis. Multivariable logistic regression models were constructed to examine the association of patient awareness of their AMD with sociodemographic characteristics and specific AMD lesion types on retinal imaging. Results: AMD was identified in 425 of the adults surveyed (6.5%) (95% confidence interval [CI], 5.5%-7.5%), including 87.7% (95% CI, 82.9%-92.5%) with early AMD and 12.3% (95% CI, 7.5%-17.1%) with late AMD. Among adults with either type of AMD on retinal imaging, 17.5% (95% CI, 13.1%-22.0%) were aware of their disease, which included 11.6% (95% CI, 8.4%-14.9%) with early AMD and 59.2% (95% CI, 43.1%-75.3%) with late AMD (P < .0001). In the same group, those aged 60 years or older (odds ratio [OR], 33.46; 95% CI, 7.67-146.03) and with a best-corrected visual acuity of 20/40 or worse (OR, 4.63; 95% CI, 2.95-7.26) had higher awareness of their AMD diagnosis, whereas Hispanic (OR, 0.28; 95% CI, 0.09-0.88) vs White adults and those who did not speak English at home (OR, 0.05; 95% CI, 0.01-0.41) had lower awareness of their diagnosis. Conclusions: Fewer than 1 in 5 adults with AMD were aware of their personal diagnosis, including fewer than 3 in 5 adults with late AMD. Older adults and those with worse vision were more likely to know they have AMD, whereas Hispanic adults and those who did not speak English at home were less likely. Efforts to increase patients' awareness of their AMD may improve rates of follow-up and prevent vision loss.

Patient satisfaction with telemedicine and in-person visits in reproductive endocrinology and infertility clinics.

RESEARCH QUESTION: Is patient satisfaction higher with telemedicine visits or in-person visits for an initial consultation in the ambulatory fertility setting? DESIGN: A survey study of fertility patients who had an initial consultation visit between January 2018 and September 2022 was conducted using a nationally distributed survey. Patient satisfaction and other outcomes pertaining to patient experience were compared between telemedicine and in-person visits. RESULTS: In total, 682 participants completed the survey nationwide; of these, 425 respondents had an in-person visit and 257 respondents had a telemedicine visit. Age, geographic region, race, education level, employment status, income level and marital status did not differ between the groups. Overall, 69.6% of participants were satisfied with telemedicine visits, with improvement in partner participation. More patients were satisfied with in-person visits compared with telemedicine visits (82.6% versus 69.6%, P<0.001), and more patients preferred in-person visits to telemedicine visits regardless of the type of appointment they had for their initial visit. In a subgroup analysis of patients seen during the coronavirus disease 2019 pandemic, patients who had telemedicine visits were younger, more likely to be White, more educated and had a higher income compared with patients who had in-person visits. CONCLUSIONS: Previously, the impact of telemedicine in the fertility setting was largely unknown. This study demonstrated that the majority of patients were satisfied with health care through telemedicine visits. However, patients were more satisfied with in-person visits, and preferred in-person visits to telemedicine visits. Further studies are needed to help clarify the differences in patient satisfaction with visit type, and to assess the role of telemedicine in future fertility care.

Elevated antimüllerian hormone levels are not associated with preterm delivery after in vitro fertilization or ovulation induction.

OBJECTIVE: To investigate the association between antimüllerian hormone (AMH) and preterm birth risk in a larger cohort of patients who underwent either in vitro fertilization or ovulation induction with intrauterine insemination at a US academic fertility center. DESIGN: Retrospective cohort study. SETTING: Single academic fertility center. PATIENT(S): Live singleton births from patients who underwent in vitro fertilization or ovulation induction between 2016 and 2020 at a single academic fertility center were included in this study. Patients were excluded if they had a missing prepregnancy AMH level, a pregnancy using donor oocytes or a gestational carrier, multiple gestations, a delivery before 20 weeks gestation, or a cerclage in place. INTERVENTION(S): AMH level. MAIN OUTCOME MEASURE(S): The primary outcome was the proportion of preterm delivery. Secondary outcomes included the rate of pregnancy-induced hypertension, gestational diabetes, and small for gestational age. RESULT(S): In the entire cohort (n = 875), 8.4% of deliveries were preterm. The mean AMH values were similar between those with term and preterm births (3.9 vs. 4.2 ng/mL). Similar proportions of patients with term and preterm deliveries had AMH levels greater than the 75th percentile (25% vs. 21%). The odds of preterm birth were similar by AMH quartile after adjusting for the history of preterm birth. Similarly, in the polycystic ovary syndrome (PCOS) cohort, there was no difference between mean AMH values of term and preterm births (n = 139, 9.6 vs. 10.0 ng/mL). The proportions of patients with PCOS with AMH levels greater than the 75th percentile were similar between those with term and preterm deliveries (25% vs. 22%). The odds of preterm birth were similar by the AMH quartile after adjusting for the history of preterm birth. CONCLUSION(S): Elevated AMH levels were not associated with an increased risk of preterm birth in patients who conceived after in vitro fertilization and ovulation induction, including patients with PCOS. Although studies suggest that AMH levels may help stratify the risk of preterm birth in this population, our findings indicate that further studies are needed before clinical application.

Insulin resistance, cognition, and Alzheimer disease.

Chronic diseases of aging are increasingly common. Dementia, often due to multiple etiologies including Alzheimer disease (AD), is at the forefront. Previous studies have reported higher rates of dementia among persons with diabetes, yet less is known about how insulin resistance relates to cognition. This article reviews recently published data on the relationship of insulin resistance to cognition and AD, and remaining knowledge gaps in the field are discussed. A structured review of studies was conducted over a 5-year period, investigating insulin and cognitive function in adults with a baseline mean age of ≥65 years. This search yielded 146 articles, of which 26 met the predetermined inclusion and exclusion criteria. Among the nine studies that specifically examined insulin resistance and cognitive dysfunction and/or decline, eight studies suggest an association, but some only in subanalyses. Results are mixed in studies relating insulin to structural and functional changes on brain imaging, and data on intranasal insulin for cognition remain unclear. Future avenues are proposed to elucidate the impact of insulin resistance on brain structure and function, including cognition, in persons with and without AD.

New metrics of dietary carbohydrate quality.

PURPOSE OF REVIEW: The aim of this study was to introduce novel metrics of dietary carbohydrates quality relevant for products and diets. RECENT FINDINGS: Carbohydrate quality has long been associated with a low glycemic index. More recently, novel metrics of carbohydrate quality featuring variations of total carbohydrates-fibers-free sugars ratios have been applied to carbohydrate-rich foods, including grains, beans, vegetables, and fruit. High scoring products had higher levels of health-promoting nutrients (protein, dietary fiber, iron, magnesium, zinc, potassium, selenium, and various B-vitamins) and lower levels of nutrients of public health concern (total sugar, added/free sugars, and fat profile). Cross-sectional studies also found variants of carbohydrate quality metrics to be associated with better markers of cardiometabolic disease, including lower levels of blood triglycerides:high-density lipoprotein cholesterol ratio, homeostatic model assessment of insulin resistance, and SBP. SUMMARY: New ratio-based carbohydrate quality metrics are built around high fiber and whole grain content, combined with a low free sugar content. Such metrics allow the identification of food products of higher overall nutritional quality, and are associated with improved diet quality and certain health outcomes.

Characterizing the Accessibility and Content of Surgical and Medical Retina Fellowship Program Websites.

Purpose: To assess the accessibility and content of surgical and medical retina fellowship websites. Methods: The websites of all surgical and medical retina fellowship programs were examined. Each program's website was evaluated based on information available on 10 recruitment and 10 training criteria. The presence of the criteria was summed to calculate a total content score (range, 0-20). Also examined were the differences in website content score by number of fellows, geographic location, and Association of University Professors of Ophthalmology (AUPO) compliance. Results: This study identified 102 surgical and 25 medical retina programs. Overall, 91.2% of surgical and 88.0% of medical retina programs had an accessible website. The surgical retina program website contained a mean of 9.8 of the total criteria, including 4.9 recruitment criteria and 5.2 training criteria, with no significant differences by number of fellows, geography, or AUPO status. Medical retina websites contained a mean of 9.3 total criteria, including 4.5 recruitment criteria and 4.9 training criteria. Website content scores for medical retina programs were associated with geography and AUPO status, which was consistent when stratifyed by recruitment and training criteria. Conclusions: Most surgical and medical retina fellowships have an accessible program website. However, there are opportunities to improve the completeness and consistency of information on these websites. Improved websites can help programs attract well-suited candidates and might address multiple inefficiencies in the application process.

Measures of carbohydrate quality and their association with diet quality and cardiometabolic health outcomes in Singapore middle-aged and older adults.

BACKGROUND AND AIMS: Carbohydrate quality may play a key role in cardiometabolic health and disease risk. This study aimed to assess the dietary carbohydrate quality of the free-living middle-aged and older adults in Singapore, and its association with overall diet quality and cardiometabolic health. METHODS AND RESULTS: This cross-sectional study examined the diet and cardiometabolic disease risk indicators of middle-aged and older adults in Singapore (n = 104). Dietary carbohydrate quality was assessed as the pass and fail rate of the population to four measures of carbohydrate quality: (i) dietary fiber recommended daily allowance (RDA), (ii) whole-grain recommendation, (iii) free sugar recommendation, and (iv) carbohydrate metrics. The association between each carbohydrate quality measure and diet quality, as well as cardiometabolic health, was assessed. Except for free sugar recommendation, the carbohydrate quality of the population was found to be poor with a low adherence (20-36%) to three measures. Subjects meeting these measures had generally higher intakes of fiber, protein, and most micronutrients compared with subjects who failed. Meeting different variants of the carbohydrate metrics was associated with 60% lower odds of pre-hypertensive blood pressure (p = 0.037; p = 0.047), and meeting the dietary fiber RDA was associated with lower waist circumference (p = 0.021). CONCLUSION: An improvement in carbohydrate quality is warranted among free-living middle-aged and older adults in Singapore. Not all measures of carbohydrate quality were equally effective in preserving overall diet quality; the carbohydrate metrics and dietary fiber RDA can be identified as effective measures in relation to cardiometabolic disease risk. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ CLINICAL TRIAL REGISTRATION: NCT03554954, 13 Sept. 2018.

Delayed or Forgone Healthcare Due to COVID-19 among Adults with Vision Impairment.

INTRODUCTION: Decreased public transit, no­visitor policies, and other restrictions to reduce the spread of COVID­19 may limit healthcare access for vision impaired adults. This study aimed to assess rates of healthcare delayed or forgone due to COVID­19 among adults with low vision. METHODS: Data were analyzed from the 2021 National Health Interview Survey, a representative sample of US adults. Vision and hearing impairment were determined by self­report. The primary study outcome was delayed or canceled medical care due to COVID­19. Multivariable logistic regression models adjusted for gender, age, race, education, insurance, income, region, and chronic comorbidities were constructed to examine associations of medical care delayed due to COVID­19. RESULTS: Overall, 1.6% (n=457) of adults had vision impairment and 1.6% (n=438) had hearing impairment. Vision impairment was not associated with having taken a COVID­19 test (P=0.34) or previous COVID­19 infection (P=0.46). Adults with vs without low vision had higher rates of delayed (30.7% vs 19.2%, 1.86 [1.43-2.42], P<.0001) and cancelled care due to COVID-19 (23.9% vs 12.2%, 2.21 [1.66-2.94], P<.0001). Even compared to adults with hearing impairment, those with vision impairment were more likely to report canceled medical care due to COVID­19 (1.20 [1.02-1.41], P=0.03). CONCLUSION: Adults with low vision had increased risk of delayed and canceled medical care due to COVID­19, with increased rates of canceled medical care even when compared to those with hearing impairment. These results suggest COVID­19 and interventions to limit its spread have had a disproportionate impact on adults with low vision and place them at risk of poor health outcomes.

Hirsutism is associated with increased hospitalization for mental health disorders.

Hirsutism is a common condition characterized by excess hair growth and may lead to psychosocial distress and substantial mental health (MH) burden. These psychosocial manifestations may lead to MH emergencies and hospitalization. However, the prevalence and predictors of MH hospitalization associated with hirsutism are not well-understood. The objective of this study was to determine the likelihood and associations of MH hospitalization among females in the US with hirsutism. Data were analyzed from female inpatients in the 2005-2014 National Inpatient Sample, a representative sample of US hospitalizations. Multivariable logistic regression models were constructed to examine the association of MH hospitalization and comorbidities with hirsutism diagnosis. Patients with hirsutism were more likely to also have a comorbid MH disorder, compared to those without hirsutism (49.5% vs 27.5%, odds ratio [95% CI]: 3.33 [3.14-3.54]), including higher odds of having 14 of the 15 MH disorders studied. Moreover, those with hirsutism had higher odds of hospitalization for a MH disorder in multivariable logistic regression models adjusted for sex, age, and insurance coverage (14.0% vs 3.6%, 3.84 [3.50-4.21]). The mean length of hospital stay (LOS) for a MH disorder was greater among inpatients with vs without hirsutism (12.8 vs 7.1 days, ß [95% CI]: 5.71 [4.24-7.18]). There were two-way interactions of hirsutism and MH hospitalization as predictors of longer LOS. Among female inpatients with hirsutism, MH hospitalization was associated with younger age, having health insurance, and longer LOS, and inversely associated with elective admission. In conclusion, female inpatients with hirsutism have higher odds of comorbid MH disorders and MH hospitalizations, with much longer LOS. Patients may benefit from increased access to outpatient follow-up, as poor disease control may contribute to worse MH outcomes and more frequent hospitalization.

Association of Pediatric Strabismus and Functional Impairment: A Cross-sectional Nationwide Analysis.

PURPOSE: To examine the association of childhood strabismus with functional limitation to identify particular domains of impairment. METHODS: The authors analyzed 201 children ages 5 to 17 years with strabismus enrolled in the 1996-2015 Medical Expenditure Panel Surveys, representative annual surveys of the U.S. POPULATION: Functional impairment was assessed using the Columbia Impairment Scale (CIS), a validated measure of behavioral and psychosocial functioning. A CIS score of 16 or greater defined clinically significant functional impairment. Multivariate regression models adjusted for age, sex, race, ethnicity, household income, geographic location, and insurance type were constructed to examine the association of strabismus diagnosis with overall impairment and individual domains of function. RESULTS: Children diagnosed as having strabismus had higher rates of clinically significant functional impairment compared to those without strabismus (15.1% vs 9.1%, adjusted odds ratio [95% CI]: 1.82 [1.11 to 2.97], P = .02). Moreover, strabismus diagnosis was associated with higher rates of problems with getting along with their mother (1.70 [1.21 to 2.40], P = .003) and father (1.66 [1.16 to 2.38], P = .006), getting along with other children (1.67 [1.16 to 2.40], P = .006), behavior at home (1.94 [1.37 to 2.74], P = .0002), staying out of trouble (1.52 [1.04 to 2.23], P = .03), nervousness (1.49 [1.05 to 2.11], P = .02), and getting involved with sports and hobbies (1.55 [1.03 to 2.34], P = .04). CONCLUSIONS: Childhood strabismus is associated with 1.8-fold greater odds of clinically significant functional impairment, with greater dysfunction in specific relationship and behavioral domains. Functional burden may be an important consideration in management decisions. [J Pediatr Ophthalmol Strabismus. 2023;60(4):268-276.].

A meta-analysis comparing the effectiveness of alternate day fasting, the 5:2 diet, and time-restricted eating for weight loss.

OBJECTIVE: The objective of this meta-analysis was to compare the effectiveness of different intermittent fasting (IF) regimens on weight loss, in the general population, and compare these to traditional caloric energy restriction (CER). METHODS: Three databases were searched from 2011 to June 2021 for randomized controlled trials (RCTs) that assessed weight loss and IF, including alternate day fasting (ADF), the 5:2 diet, and time-restricted eating (TRE). A random effect network analysis was used to compare the effectiveness between the three regimens. Meta-regression analysis was presented as weighted mean differences of body weight loss. RESULTS: The exploratory random effects network analysis of 24 RCTs (n = 1768) ranked ADF as the most effective, followed by CER and TRE. The meta-analysis showed that IF regimens resulted in similar weight loss to CER (mean difference 0.26 kg, 95% CI: -0.31 to 0.84; p = 0.37). Compliance was generally high (>80%) in trials shorter than 3 months. CONCLUSIONS: The present meta-analysis concludes that IF is comparable to CER and a promising alternative for weight loss. Among the three regimens, ADF showed the highest effectiveness for weight loss, followed by CER and TRE. Further well-powered RCTs with longer durations of intervention are required to draw solid conclusions.

Assessment of the Web Site Availability and Content of Pediatric Ophthalmology Fellowship Programs: A Cross-Sectional Nationwide Study.

Background Fellowship program Web sites are a crucial source of information for prospective pediatric ophthalmology applicants, especially in light of the restrictions on in-person interactions due to the coronavirus disease 2019 pandemic. Objective This study examined all pediatric ophthalmology fellowship Web sites for availability and presented recruitment and training content. Methods A full list of all pediatric ophthalmology and strabismus (POAS) fellowship programs were compiled from the Association of University Professors of Ophthalmology (AUPO) directory and the San Francisco Match (SFMatch) application listing. Each fellowship was queried by Google Internet search to identify the program's corresponding Web site. The content of Web sites was evaluated using 20 predetermined recruitment and training criteria. All data were collected in February 2022. Kruskal-Wallis and Mann-Whitney U tests were constructed to examine differences by geographic location, program size, number of teaching faculty, and affiliation with a top ophthalmology residency program. Results There were 45 pediatric ophthalmology fellowships identified from the AUPO and SFMatch. All pediatric ophthalmology fellowships had an available program Web site. However, there was significant variability in content, and the average Web site had approximately half of the evaluated criteria. POAS Web sites reported a greater number of recruitment criteria than program training criteria. There were no differences by program size, number of faculty, affiliation with a top residency program, or geographic location in the number of observed criteria. Conclusions This study provides data to drive efforts to improve pediatric ophthalmology fellowship Web sites. Pediatric ophthalmology fellowship Web sites are missing important information, and there are opportunities to improve program Web sites, regardless of program size, number of faculty, affiliation with a top residency, and geographic location. Informative, accurate Web sites may attract qualified candidates, and as a result, elevate the likelihood that interviewed candidates are well-suited to the program. As such, improvements to fellowship Web sites can streamline the application process and increase a program's success rate in the match.

Observed behaviours and suicide assessment language post-Mental Health First Aid training in Australia and the United States: a mixed methods study using discourse analysis.

BACKGROUND: Mental Health First Aid (MHFA) training teaches participants how to respond to mental health crises, including suicide. Little is known about the impact of training on participants' observed MHFA behaviours. This exploratory study aimed to compare MHFA-trained Australian and US student pharmacists' performance and suicide assessment language during simulated patient role-play (SPRP) assessments. METHODS: Student pharmacists (n = 265) completed MHFA training and participated (n = 81) in SPRPs with simulated patients (SP) who were people with lived experience of mental illness. Each SPRP was marked by three raters (student, tutor and SP). One-way ANOVA, chi-squared tests and independent samples t-tests were used to compare scores and pass/fail rates, where appropriate. Transcribed audio-recordings of suicide assessments underwent discourse analysis. A chi-squared test was conducted to investigate the differences in how suicide assessment language was coded across six discursive frames ('confident'/'timid', 'empathetic'/'apathetic', and 'direct'/'indirect'). RESULTS: Three raters assessed 81 SPRPs, resulting in quantitative analysis of 243 rubrics. There were no significant differences between student pharmacists' mean scores and pass/fail rates across countries. Overall, both cohorts across Australia and the US performed better during the mania scenario, with a low failure rate of 13.9 and 19.0%, respectively. Most students in both countries passed their SPRP assessment; however, 27.8% did not assess for suicide or used indirect language during suicide assessment, despite completing MHFA training. Australian student pharmacists demonstrated, more direct language (76.9% versus 67.9%) and empathy (42.3% versus 32.1%) but less confidence (57.7% versus 60.7%) compared to US student pharmacists, during their suicide assessment; however, these differences were not statistically significant. CONCLUSIONS: Findings indicate most MHFA-trained student pharmacists from Australia and the US can provide MHFA during SPRPs, as well as assess for suicide directly, empathetically and confidently. This exploratory study demonstrates the importance of practicing skills post-training and the need for further research exploring participants' hesitance to assess for suicide, despite training completion.

Minding the Bathwater: Fertility and Reproductive Toxicity in the Age of Immuno-Oncology.

Immune checkpoint inhibition has resulted in significant efficacy across many cancer types, including melanoma. Melanoma is the second most common cancer among those of reproductive age, yet the reproductive toxicities of adjuvant and first-line immunotherapy are largely unknown.The normal innate and adaptive immune systems play a vital role in reproductive organ homeostasis of men and women and are essential for implantation, fertility, and a successful pregnancy. The programmed cell death-1 receptor/programmed cell death receptor ligand-1 (PD-1/PD-L1) pathway is essential in several aspects of fertility and pregnancy. Recent studies have largely focused on the role of the PD-1/PD-L1 pathway in fetomaternal tolerance, highlighting the importance of intact immune regulation in promoting a successful pregnancy.In this review, we describe a case of a reproductive-aged female with stage IIIC melanoma who sought guidance on family planning after pembrolizumab therapy. We discuss the known fertility-related toxicities of immune checkpoint inhibitors, the potential targets for reproductive toxicity in males and nonpregnant females, and the implications of anti-PD-1 therapy in relation to fetomaternal tolerance. Informed decision making will benefit from data and consensus.

Stroke reperfusion treatment trends in New Zealand: 2019 & 2020.

AIM: This study assessed stroke reperfusion treatments trends in 2019 and 2020 with comparison back to 2015. Additional analyses looked at differences by sex and ethnicity. METHOD: The National Stroke Register contains data on all stroke patients who received reperfusion therapies since 2015. Outcomes included treatment rates, delays, mortality and complications by year, sex, and ethnicity. Continuous variables were compared using the Wilcoxon Rank-Sum Test and presented as p-values. Rate-based results were compared using incidence rate comparison and presented as p-values +/- 95% confidence intervals. RESULTS: In 2020, 11.3% (828/7333) received intravenous thrombolysis (IVT) and 5.5% (404/7333) underwent stroke clot retrieval (SCR), increasing from 6.5% (389/5963) and 0.5% (30/5963) in 2015, respectively. Among reperfused patients (IVT, SCR, both), 8.3% had died at seven days and 3.0% (29/959) experienced sICH. Door-to-treatment time was stable between 2019 and 2020, with median (IQR) of 61 (44-84) and 61 (41-87) minutes, respectively. Initial presentation to a SCR centre was associated with shorter onset-to-reperfusion time of 286 (206-566) minutes, compared with 403 (295-550) minutes (p<0.001). While onset-to-door time was shorter for Maori (72 (44-112) minutes, p<0.001) and Pacific patients (70 (48-105) minutes, p=0.03) compared with NZ Europeans, door-to-needle time was longer in Maori (66 (48-88) compared to 59 (41-83) minutes (p=0.001). Female (73.7+/15.3 years) patients were on average 4.4 years older than males (69.3+/-14.6 years) and less likely to receive thrombolysis (12.7% vs 14.9%, p=0.02). CONCLUSION: Reperfusion therapy rates continue to rise, now driven by increasing rates of SCR. Longer door-to-needle time in Maori and lower reperfusion rates in women require further exploration and attention.