Improving the quality and impact of public health social media activity in Scotland during 2016: #ScotPublicHealth.

Background: Social media, including Twitter, potentially provides a route to communicate public health messages to a large audience. Simple measures can boost onward broadcast to other users ('retweeting'). This study compares the impact of a structured programme of social media activity in Scotland during 2016 (using #ScotPublicHealth hashtag) with previous years. Methods: The Twitter search function was used to identify tweets between 2014 and 2016 inclusive. The first three tweets from each Twitter user were selected for each period. The number of retweets was used as a measure of impact. The quality of tweets was assessed by recording use of image, weblink (uniform resource locator or URL), mention of another Twitter user and/or hashtag, each of which have been shown to boost number of retweets. Results: The percentage of tweets with an image, URL and/or mention of another Twitter user increased during the period of study. The percentage of tweets retweeted during Scottish Public Health conferences increased from 43% in 2014 to 70% in 2016. The volume of tweeting also increased. Conclusions: The quality and impact of tweets sent by the Scottish Public Health community was higher during 2016 than previous years. Conference tweeting remains an area for improvement.

Outcomes of Childhood Asthma and Wheezy Bronchitis. A 50-Year Cohort Study.

RATIONALE: Cohort studies suggest that airflow obstruction is established early in life, manifests as childhood asthma and wheezy bronchitis, and continues into early adulthood. Although an association between childhood asthma and chronic obstructive pulmonary disease (COPD) in later life has been demonstrated, it is unclear if childhood wheezy bronchitis is associated with COPD. OBJECTIVES: To investigate whether childhood wheezy bronchitis increases the risk of COPD in the seventh decade. METHODS: A cohort of children recruited in 1964 at age 10 to 15 years, which was followed up in 1989, 1995, and 2001, was followed up again in 2014 when at age 60 to 65 years. Discrete time-to-event and linear mixed effects models were used. MEASUREMENTS AND MAIN RESULTS: FEV1 and FVC were measured. COPD was defined as post-bronchodilator FEV1/FVC <0.7. Childhood wheezing phenotype was related to 1989, 1995, 2001, and 2014 spirometry data. Three hundred thirty subjects, mean age 61 years, were followed up: 38 with childhood asthma; 53 with childhood wheezy bronchitis; and 239 control subjects (of whom 57 developed adulthood-onset wheeze between ages 16 and 46 yr). In adjusted multivariate analyses, childhood asthma was associated with an increased risk of COPD (odds ratio, 6.37; 95% confidence interval, 3.73-10.94), as was childhood wheezy bronchitis (odd ratio 1.81; 95% confidence interval, 1.12-2.91). The COPD risk increased with childhood asthma, and wheezy bronchitis was associated with reduced FEV1 that was evident by the fifth decade and not an accelerated rate of FEV1 decline. In contrast, adulthood-onset wheeze was associated with accelerated FEV1 decline. CONCLUSIONS: Childhood wheezy bronchitis and asthma are associated with an increased risk of COPD and reduced ventilatory function.

Tobacco, nicotine, and cannabis use and exposure in an Australian Indigenous population during pregnancy: A protocol to measure parental and foetal exposure and outcomes.

BACKGROUND: The Australian National Perinatal Data Collection collates all live and stillbirths from States and Territories in Australia. In that database, maternal cigarette smoking is noted twice (smoking <20 weeks gestation; smoking >20 weeks gestation). Cannabis use and other forms of nicotine use, for example vaping and nicotine replacement therapy, are nor reported. The 2021 report shows the rate of smoking for Australian Indigenous mothers was 42% compared with 11% for Australian non-Indigenous mothers. Evidence shows that Indigenous babies exposed to maternal smoking have a higher rate of adverse outcomes compared to non-Indigenous babies exposed to maternal smoking (S1 File). OBJECTIVES: The reasons for the differences in health outcome between Indigenous and non-Indigenous pregnancies exposed to tobacco and nicotine is unknown but will be explored in this project through a number of activities. Firstly, the patterns of parental and household tobacco, nicotine and cannabis use and exposure will be mapped during pregnancy. Secondly, a range of biological samples will be collected to enable the first determination of Australian Indigenous people's nicotine and cannabis metabolism during pregnancy; this assessment will be informed by pharmacogenomic analysis. Thirdly, the pharmacokinetic and pharmacogenomic findings will be considered against maternal, placental, foetal and neonatal outcomes. Lastly, an assessment of population health literacy and risk perception related to tobacco, nicotine and cannabis products peri-pregnancy will be undertaken. METHODS: This is a community-driven, co-designed, prospective, mixed-method observational study with regional Queensland parents expecting an Australian Indigenous baby and their close house-hold contacts during the peri-gestational period. The research utilises a multi-pronged and multi-disciplinary approach to explore interlinked objectives. RESULTS: A sample of 80 mothers expecting an Australian Indigenous baby will be recruited. This sample size will allow estimation of at least 90% sensitivity and specificity for the screening tool which maps the patterns of tobacco and nicotine use and exposure versus urinary cotinine with 95% CI within ±7% of the point estimate. The sample size required for other aspects of the research is less (pharmacokinetic and genomic n = 50, and the placental aspects n = 40), however from all 80 mothers, all samples will be collected. CONCLUSIONS: Results will be reported using the STROBE guidelines for observational studies. FORWARD: We acknowledge the Traditional Custodians, the Butchulla people, of the lands and waters upon which this research is conducted. We acknowledge their continuing connections to country and pay our respects to Elders past, present and emerging. Notation: In this document, the terms Aboriginal and Torres Strait Islander and Indigenous are used interchangeably for Australia's First Nations People. No disrespect is intended, and we acknowledge the rich cultural diversity of the groups of peoples that are the Traditional Custodians of the land with which they identify and with whom they share a connection and ancestry.

World Antibiotic Awareness Week and European Antibiotic Awareness Day, November 2018: An analysis of the impact of Twitter activity.

INTRODUCTION: International antibiotic awareness and stewardship campaigns use social media to disseminate campaign materials. Analysis of campaigns during 2016 and 2017 identified a wide range of hashtags in use, potentially leading to confusion and dilution of the campaign message. This study aimed to examine the impact of different hashtags on the dissemination of information during European Antibiotic Awareness Day and World Antibiotic Awareness Week, November 2018. METHODS: Tweets were prospectively extracted using Followthehashtag and analysed in Excel and R (14 400 tweets by 5 899 tweeters, with 60 222 retweets). Descriptive analysis and multivariable logistic regression analyses were adjusted for potential confounders. RESULTS: There was a positive association between retweets received and inclusion of media, hashtag(s), mention of other tweeter(s), and number of followers. There was hashtag drift (e.g. the unofficial #WAAW2018 hashtag was used more frequently than the official campaign #WAAW18 hashtag). Analysis of five popular hashtags from the European and worldwide campaigns found a positive association between retweets and the unofficial hashtag #WAAW2018 and the long-established #AntibioticGuardian hashtag. #AntibioticResistance (another official hashtag) was the most frequently used hashtag but did not have a consistent positive association with retweets. Analysis of the contribution of tweeters - tweeters, retweeters, and mentions of tweeters - demonstrated 32 534 accounts in total, 95% of which tweeted and/or retweeted, the great majority being retweeters. CONCLUSION: This study demonstrates the breadth of participation in international antibiotic awareness campaigns, but also the need for clarity about campaign hashtags, and the need to search beyond official hashtags when evaluating the impact of a campaign.

Occupational exposure to asthmagens and adult onset wheeze and lung function in people who did not have childhood wheeze: A 50-year cohort study.

BACKGROUND: There are few prospective studies that relate the development of adult respiratory disease with exposure to occupational asthmagens. OBJECTIVE: To evaluate the risk of adult onset wheeze (AOW) and obstructive lung function associated with occupational exposures over 50years. METHODS: A population-based randomly selected cohort of children who had not had asthma or wheezing illness, recruited in 1964 at age 10-15years, was followed-up in 1989, 1995, 2001 and 2014 by spirometry and respiratory questionnaire. Occupational histories were obtained in 2014 and occupational exposures determined with an asthma-specific job exposure matrix. The risk of AOW and lung function impairment was analysed in subjects without childhood wheeze using logistic regression and linear mixed effects models. RESULTS: All 237 subjects (mean age: 61years, 47% male, 52% ever smoked) who took part in the 2014 follow-up had completed spirometry. Among those who did not have childhood wheeze, spirometry was measured in 93 subjects in 1989, in 312 in 1995 and in 270 subjects in 2001 follow-up. For longitudinal analysis of changes in FEV1 between 1989 and 2014 spirometry records were available on 191 subjects at three time points and on 45 subjects at two time points, with a total number of 663 records. AOW and FEV1

ADHD outside the laboratory: boys' executive function performance on tasks in videogame play and on a visit to the zoo.

One current theory of attention-deficit/hyperactivity disorder (ADHD) proposes that a primary deficit in behavioral inhibition gives rise to secondary deficits in 4 executive functions and motor control. To date, empirical support for this model is based primarily on laboratory-based cognitive methods. This study assessed behavioral inhibition and executive functioning in children with ADHD in 2 real-life contexts: videogames (motor-skill target game, cognitively demanding adventure game) and an outing at the zoo (route tasks). Participants were a community sample of 57 boys diagnosed with ADHD (20 inattentive, 37 combined type) and 57 normally developing control boys, matched individually for age and nonverbal IQ. Operationally defined measures of behavioral inhibition and specific executive functions were derived from these activities and assessed under contrasting conditions of low or high working memory and distractor loads. There were no group differences in basic motor skills on the target game, nor in terms of the ability to inhibit a prepotent or ongoing response in the adventure videogame. However, boys with ADHD exhibited more self-talk, more effortful response preparation, and completed fewer challenges in the latter videogame. Also, they manifested inhibition deficits in terms of interference control during the route task at the zoo and took longer to complete the tasks. Typically, these differences were greatest under conditions of high working memory and distractor loads. Findings from this study suggest that cognitive difficulties in ADHD may be context dependent and that ADHD is associated with deficits in some but not all aspects of behavioral inhibition.

Executive function and ADHD: a comparison of children's performance during neuropsychological testing and real-world activities.

OBJECTIVE: Current understanding of executive function deficits in Attention-Deficit/Hyperactivity Disorder (ADHD) is derived almost exclusively from neuropsychological testing conducted in laboratory settings. This study compared children's performance on both neuropsychological and real-life measures of executive function and processing speed. METHOD: The Stroop and Wisconsin Card Sorting Task (WCST) were selected as neuropsychological measures, whereas route tasks in a videogame and at the zoo were used to index real-life measures. Participants comprised a community sample of 22 unmedicated boys with ADHD individually matched on age and IQ with 22 normally developing control boys. RESULTS: There were no group differences in executive function on the Stroop or zoo tasks, but the ADHD group exhibited deficits in set-shifting as assessed by the WCST (perseverative errors and responses) and videogame play (fewer challenges completed). Also, the ADHD group showed slowed processing speed on the Stroop (slower color naming) and zoo activity (longer time to complete task), as well as a slower rate of acquisition of the sorting rule on the WCST (more trials to complete first category). Efficient and flexible videogame play (number of challenges completed) was related positively to efficacy on the Stroop (number of items named correctly in the interference and two control conditions) and inversely related to set-shifting problems on the WCST (perseverative responses and errors). Also, problems in goal-directed behavior at the zoo (number of deviations from designated route) were related to problems in set-shifting on the WCST (perseverative responding). CONCLUSIONS: Children with ADHD exhibit impairments in executive function and processing speed in real-world activities as well as in neuropsychological testing. Cognitive deficits detected by standardized neuropsychological testing are related to performance difficulties in real-world activities.

Rasch-transformed raw scores and Two-way ANOVA: a simulation analysis.

This article demonstrates, through the exposition of underestimated variable effects or spurious interaction effects, the inherent inadequacy of untransformed 0-1 raw scores for analysis via Two-Way analysis of variance (ANOVA). The pioneering work in this field, conducted in the 1990's by Dr. Susan Embretson of the University of Kansas, USA, is highlighted, and the eminent suitability of Rasch transformations of 0-1 raw scores for analysis via Two-Way ANOVA is also demonstrated. In this study Monte Carlo techniques or simulations are utilized to determine the precise psychometric conditions under which differences between raw scores and Rasch transformations of those raw scores are detectable via Two-Way ANOVA. This study partially replicates Dr. Embretson's studies, and also defines the extent of underestimation and spuriousness which ensue when uniform or skewed distributions of item difficulties are used instead of normal distributions, and misfitting raw data are utilized instead of fitting data.

Test scores, measurement, and the use of analysis of variance: an historical overview.

In order to establish a firmer statistical foundation from which to draw inferences from factorial design study data, transformations of raw scores are occasionally employed in order to make their distributions more generally normal or to provide linearity. To date, few studies have been conducted to determine whether or not raw scores transformed or otherwise constitute measures for the purposes of statistical analysis. In this article, the historical development of the understanding of the term "measurement" by researchers in the social sciences is traced, and the development and use of One and Two-way ANOVA by researchers in the social sciences are presented and evaluated.

Immediate and early discharge for patients with exacerbations of chronic obstructive pulmonary disease: is there a role in "real life"?

An exacerbation of chronic obstructive pulmonary disease (COPD) is the most common respiratory condition necessitating admission to hospital. Many of these are relatively mild in nature and as a consequence, there is increasing interest in immediate and early discharge of patients with nonsevere exacerbations. Following initial assessment, "hospital at home" or "assisted discharge" schemes enable suitable patients with COPD to be discharged into the community earlier than normally anticipated. The putative implication is that substantial financial savings can be made in addition to increasing the availability of in-patient beds, without compromising patient care or satisfaction. We highlight the current literature which has evaluated the role of hospital at home and assisted discharge schemes and discuss our own "real life" service operating in a large teaching hospital in Scotland.