How much do adverse childhood experiences contribute to adolescent anxiety and depression symptoms? Evidence from the longitudinal study of Australian children.

This study aims to: (i) examine the association between adverse childhood experiences (ACEs) and elevated anxiety and depressive symptoms in adolescents; and (ii) estimate the burden of anxiety and depressive symptoms attributable to ACEs.Data were analyzed from 3089 children followed between Waves 1 (age 4-5 years) and 7 (16-17 years) of the Longitudinal Study of Australian Children. Logistic regression was used to estimate the associations between ACEs and child-reported elevated anxiety and depressive symptoms at age 16-17. Anxiety and depressive symptoms were measured using the Children's Anxiety Scale and Short Mood and Feelings Questionnaire, respectively. The punaf command available in STATA 14 was used to calculate the population attributable fraction (PAF).Before the age of 18 years, 68.8% of the children had experienced two or more ACEs. In the analysis adjusted for confounding factors, including co-occurring ACEs, both history and current exposure to bullying victimisation and parental psychological distress were associated with a statistically significant increased likelihood of elevated anxiety and depressive symptoms at age 16-17. Overall, 47% of anxiety symptoms (95% CI for PAF: 35-56) and 21% of depressive symptoms (95% CI: 12-29) were attributable to a history of bullying victimisation. Similarly, 17% (95% CI: 11-25%) of anxiety and 15% (95% CI: 4-25%) of depressive symptoms at age 16-17 years were attributable to parental psychological distress experienced between the ages of 4-15 years.The findings demonstrate that intervention to reduce ACEs, especially parental psychological distress and bullying victimisation, may reduce the substantial burden of mental disorders in the population.

Mortality data from omission of early thromboprophylaxis in critically ill patients highlights the importance of an individualised diagnosis-related approach.

BACKGROUND: Venous thromboembolism (VTE) prophylaxis is effective in reducing VTE events, however, its impact on mortality is unclear. We examined the association between omission of VTE prophylaxis within the first 24 h after intensive care unit (ICU) admission and hospital mortality. METHODS: Retrospective analysis of prospectively collected data from the Australian New Zealand Intensive Care Society Adult Patient Database. Data were obtained for adult admissions between 2009 and 2020. Mixed effects logistic regression models were used to evaluate the association between omission of early VTE prophylaxis and hospital mortality. RESULTS: Of the 1,465,020 ICU admissions, 107,486 (7.3%) did not receive any form of VTE prophylaxis within the first 24 h after ICU admission without documented contraindication. Omission of early VTE prophylaxis was independently associated with 35% increased odds of in-hospital mortality (odds ratios (OR): 1.35; 95% CI: 1.31-1.41). The associations between omission of early VTE prophylaxis and mortality varied by admission diagnosis. In patients diagnosed with stroke (OR: 1.26, 95% CI: 1.05-1.52), cardiac arrest (OR: 1.85, 95% CI: 1.65-2.07) or intracerebral haemorrhage (OR: 1.48, 95% CI: 1.19-1.84), omission of VTE prophylaxis was associated with increased risk of mortality, but not in patients diagnosed with subarachnoid haemorrhage or head injury. CONCLUSIONS: Omission of VTE prophylaxis within the first 24 h after ICU admission was independently associated with increased risk of mortality that varied by admission diagnosis. Consideration of early thromboprophylaxis may be required for patients with stroke, cardiac arrest and intracerebral haemorrhage but not in those with subarachnoid haemorrhage or head injury. The findings highlight the importance of individualised diagnosis-related thromboprophylaxis benefit-harm assessments.

Prevalence of common mental disorders in adult Syrian refugees resettled in high income Western countries: a systematic review and meta-analysis.

BACKGROUND: The immense social upheaval and ongoing humanitarian crisis created by the 2011 war in Syria has forced millions of civilians to flee their homeland, many of whom seek refugee status in Western nations. Whilst it is known that the prevalence of mental illness is higher within refugee populations, this systematic review and meta-analysis aims to pool the prevalence rates of common mental disorders (namely posttraumatic stress disorder, depression and generalized anxiety disorder) in adult Syrian refugees resettled in high income Western countries. METHODS: Seven electronic databases (Medline, PsychInfo, CINAHL, PTSDpubs, SCOPUS, PubMed and Embase) were searched up to the 31st of December 2020. Using pre-determined inclusion and exclusion criteria, relevant articles were screened by title and abstract, and later by full text. A meta-analysis was used to estimate the prevalence rates for each mental illness. RESULTS: Eleven studies met the eligibility criteria for the systematic review. Nine of these studies had a low-moderate risk of bias and were included in the meta-analysis. Of the 4873 refugees included in the meta-analysis, the total pooled prevalence rate of having any of the three mental disorders was 33% (CI 95%, 27-40%), 40% for anxiety (CI 95%, 31-50%), 31% for depression (CI 95%, 20-44%) and 31% for PTSD (CI 95%, 22-41%). A meta-regression revealed that the total pooled prevalence rate for having any of the three mental disorders was not influenced by age, host country, duration in host country, educational or marital status. CONCLUSIONS: Despite significant study heterogeneity, the prevalence rates of common mental disorders in adult Syrian refugees resettled in high-income Western countries are significantly higher than reported rates in the general population.

A Delphi study to identify intervention priorities to prevent the occurrence and reduce the impact of adverse childhood experiences.

OBJECTIVE: There is a lack of a systematic, coordinated approach to reducing the occurrence and impact of adverse childhood experiences. Hence, identifying feasible intervention priorities in this field will help inform policy and reformation of ongoing service delivery. The objective of this study was to identify expert consensus-driven priority interventions for reducing the occurrence and impact of adverse childhood experiences in children under 8 years of age in the Australian context. METHODS: A three-round online Delphi survey was conducted to establish consensus on 34 interventions for adverse childhood experiences identified through a literature search. Six were general categories of interventions, 6 were broad intervention programmes and 22 were specific interventions. Participants were 17 health practitioners, 15 researchers, 9 policy experts, 7 educators and 3 consumer advocates with expertise in adverse childhood experiences or child mental health. Consensus was defined as an intervention being rated as 'very high priority' or 'high priority' according to its importance and feasibility by ⩾75% of all experts. RESULTS: Seven of the 34 interventions were endorsed as priority interventions for adverse childhood experiences. These included four general categories of intervention: community-wide interventions, parenting programmes, home-visiting programmes and psychological interventions. Two broad intervention programmes were also endorsed: school-based anti-bullying interventions and psychological therapies for children exposed to trauma. Positive Parenting Program was the only specific intervention that achieved consensus. CONCLUSION: This is the first study to identify stakeholder perspectives on intervention priorities to prevent the occurrence and impact of adverse childhood experiences. Prioritisation of effective, feasible and implementable intervention programmes is an important step towards better integration and coordination of ongoing service delivery to effectively prevent and respond to adverse childhood experiences.

The association between adverse childhood experiences and common mental disorders and suicidality: an umbrella review of systematic reviews and meta-analyses.

Adverse childhood experiences (ACEs) are related to increased risk of common mental disorders. This umbrella review of systematic reviews and meta-analyses aimed to identify the key ACEs that are consistently associated with increased risk of mental disorders and suicidality. We searched PsycINFO, PubMed, and Google Scholar for systematic reviews and meta-analyses on the association between ACEs and common mental disorders or suicidality published from January 1, 2009 until July 11, 2019. The methodological quality of included reviews was evaluated using the AMSTAR2 checklist. The effect sizes reported in each meta-analysis were combined using a random-effects model. Meta-regressions were conducted to investigate whether associations vary by gender or age of exposure to ACEs. This review is registered with PROSPERO (CRD42019146431). We included 68 reviews with moderate (55%), low (28%) or critically low (17%) methodological quality. The median number of included studies in these reviews was 14 (2-277). Across identified reviews, 24 ACEs were associated with increased risk of common mental disorders or suicidality. ACEs were associated with a two-fold higher odds of anxiety disorders (pooled odds ratios (ORs): 1.94; 95% CI 1.82, 2.22), internalizing disorders (OR 1.76; 1.59, 1.87), depression (OR 2.01; 1.86, 2.32) and suicidality (OR 2.33; 2.11, 2.56). These associations did not significantly (P > 0.05) vary by gender or the age of exposure. ACEs are consistently associated with increased risk of common mental disorders and suicidality. Well-designed cohort studies to track the impact of ACEs, and trials of interventions to prevent them or reduce their impact should be global research priorities.

Association of dietary intake, physical activity, and sedentary behaviours with overweight and obesity among 282,213 adolescents in 89 low and middle income to high-income countries.

BACKGROUND: Adolescent overweight and obesity are well documented in high-income countries (HICs). They are also emerging as a global public health concern in low-and middle-income countries (LMICs), yet there is a lack of reliable, national-level data to inform policies and interventions. This study aimed to estimate the prevalence of overweight and obesity and assess associated lifestyle risk factors amongst school-going adolescents in LMICs as well as HICs. METHODS: A total of 282,213 samples were drawn from 89 LMICs and HICs in the 'latest Global School-based Student Health Survey' of school children, aged 11-17 years, during 2003 to 2015, in the six World Health Organisation (WHO) regions. The prevalence of adolescent overweight and obesity were estimated using the WHO BMI-for-age growth standards. A multinomial logistic regression model was employed to estimate the adjusted (age and sex) association of food patterns, physical activity, and sedentary behaviours with adolescent overweight and obesity. RESULTS: The pooled prevalence of overweight and obesity amongst adolescents was 10.12%, and 4.96%, respectively, ranging from 2.40% in Sri Lanka to 29.08% in Niue for overweight and 0.40% in Sri Lanka to 34.66% in the Cook Islands for obesity. Overweight and obesity were associated with unhealthy dietary intake and lifestyles including respectively fast-food intake (adjusted relative risk ratio, RRR = 1.09; 95% CI: 1.05-1.12 and RRR = 1.32; 95% CI: 1.26-1.38), a high level of carbonated soft drinks consumption (RRR = 1.19; 1.12-1.24 and RRR = 1.28; 1.18-1.38), a low level of physical activity (RRR = 1.11; 1.06-1.17 and 1.20; 1.12-1.28), and high level of sedentary behaviours (RRR = 1.33; 1.27-1.39 and RRR = 1.73; 1.63-1.84). Adolescents who consumed vegetables at least two times per day had a lower risk of overweight (22%) and obesity (17%) than those who did not consume vegetables per day. CONCLUSIONS: Adolescent overweight and obesity represent a global public health problem and can possibly track into adult weight status and morbidity. School-based obesity prevention that promotes environmental and policy changes related to healthy dietary practices and active living are urgently needed to curb the trend.

Poor adherence and persistence to sodium glucose co-transporter 2 inhibitors in real-world settings: Evidence from a systematic review and meta-analysis.

AIMS: Despite increasing prescription of sodium glucose co-transporter 2 (SGLT2) inhibitors, there is limited insight of the patterns of use among patients with diabetes prescribed these drugs. This study aimed to summarize available real-world data on the adherence and persistence to SGLT2 inhibitors. MATERIALS AND METHODS: A systematic review for observational studies reporting the adherence and persistence to SGLT2 inhibitors was performed in Medline, Embase, and Web of Science from their inception to October 2019. Data were analysed via random-effects meta-analysis. RESULTS: A total of 22 studies (31 cohorts) comprising 123 854 individuals prescribed SGLT2 inhibitors from eight countries were included. The pooled mean proportions of days covered [PDC] at six months and one year were 0.77 (95% confidence interval [CI] 0.72-0.82) and 0.72 (95% CI 0.66-0.77), respectively. The pooled proportions adherent (PDC ≥0.80) at six months and one year were 59.5% (95% CI 52.9-65.9) and 49.0% (95% CI 42.3-55.8), respectively. The pooled proportions of people persistent at six months, one year, and two years were 80.1% (95% CI 75.8-84.0), 61.8% (95% CI 57.8-65.7), and 45.9% (95% CI 35.5-56.5), respectively. When persistence was defined as the absence of ≥90-days gap, the equivalent pooled proportions persistent were 81.5% (95% CI 73.1-88.6), 58.9% (95% CI 53.1-64.6), and 34.7% (95% CI 33.6-35.8). Adherence and persistence appeared to vary across different SGLT2 inhibitors. CONCLUSIONS: Real-world adherence and persistence to SGLT2 inhibitors is poor. Hence, targets for improving treatment adherence and persistence need to be identified and appropriate interventions implemented.

A bi-directional association between weight change and health-related quality of life: evidence from the 11-year follow-up of 9916 community-dwelling adults.

PURPOSE: To examine the prospective associations between body mass index (BMI) and health-related quality of life (HRQoL). METHODS: Data were extracted from a longitudinal, nationally representative sample of 9916 men and women aged 18 years and over who were followed annually between 2006 and 2016 in the Household, Income and Labour Dynamics in Australia (HILDA) survey. HRQoL was assessed using the self-administered SF-36 questionnaire annually between 2006 (baseline) and 2016. BMI was calculated from self-reported height and weight and was classified into the following four categories of baseline BMI: underweight (< 18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2) and obese (≥ 30 kg/m2). We used linear mixed-effects regression models to investigate the associations between change in BMI (kg/m2) and concurrent changes in HRQoL scores over 11 years. RESULTS: BMI gain was associated with deterioration of Physical Component Summary (PCS) (P < 0.001), but not with change in Mental component summary (MCS) over the 11-year period. BMI gain was inversely associated (P < 0.001) with five of the eight HRQoL domains (physical functioning, role physical, bodily pain, general health and vitality) with a significant graded association according to baseline BMI category. Over the 11-year study period, every unit increase in PCS was associated with a decrease of 0.02 (P < 0.001), 0.03 (P < 0.001) and 0.04 (P < 0.001) BMI units per year among participants who were normal, overweight and obese at baseline, respectively. Five of the eight domains of HRQoL (physical functioning, role physical, bodily pain, general health and vitality) were inversely associated with BMI (P < 0.001) with a significant graded association according to baseline BMI category. CONCLUSIONS: Weight gain was not only associated with deterioration of HRQoL, and vice versa. The bi-directional association was stronger for physical than mental domains of HRQoL.

Association between depression, anxiety and weight change in young adults.

BACKGROUND: To investigate whether there are bi-directional associations between anxiety and mood disorders and body mass index (BMI) in a cohort of young adults. METHODS: We analysed data from the 2004-2006 (baseline) and 2009-2011 (follow-up) waves of the Childhood Determinants of Adult Health study. Lifetime DSM-IV anxiety and mood disorders were retrospectively diagnosed with the Composite International Diagnostic Interview. Potential mediators were individually added to the base models to assess their potential role as a mediator of the associations. RESULTS: In males, presence of mood disorder history at baseline was positively associated with BMI gain (ß = 0.77, 95% CI: 0.14-1.40), but baseline BMI was not associated with subsequent risk of mood disorder. Further adjustment for covariates, including dietary pattern, physical activity, and smoking reduced the coefficient (ß) to 0.70 (95% CI: 0.01-1.39), suggesting that the increase in BMI was partly mediated by these factors. In females, presence of mood disorder history at baseline was not associated with subsequent weight gain, however, BMI at baseline was associated with higher risk of episode of mood disorder (RR per kg/m2: 1.04, 95% CI: 1.01-1.08), which was strengthened (RR per kg/m2 = 1.07, 95% CI: 1.00-1.15) after additional adjustment in the full model. There was no significant association between anxiety and change in BMI and vice-versa. CONCLUSION: The results do not suggest bidirectional associations between anxiety and mood disorders, and change in BMI. Interventions promoting healthy lifestyle could contribute to reducing increase in BMI associated with mood disorder in males, and excess risk of mood disorder associated with BMI in females.

Risk Prediction Models for Incident Heart Failure: A Systematic Review of Methodology and Model Performance.

BACKGROUND: Numerous models predicting the risk of incident heart failure (HF) have been developed; however, evidence of their methodological rigor and reporting remains unclear. This study critically appraises the methods underpinning incident HF risk prediction models. METHODS AND RESULTS: EMBASE and PubMed were searched for articles published between 1990 and June 2016 that reported at least 1 multivariable model for prediction of HF. Model development information, including study design, variable coding, missing data, and predictor selection, was extracted. Nineteen studies reporting 40 risk prediction models were included. Existing models have acceptable discriminative ability (C-statistics > 0.70), although only 6 models were externally validated. Candidate variable selection was based on statistical significance from a univariate screening in 11 models, whereas it was unclear in 12 models. Continuous predictors were retained in 16 models, whereas it was unclear how continuous variables were handled in 16 models. Missing values were excluded in 19 of 23 models that reported missing data, and the number of events per variable was < 10 in 13 models. Only 2 models presented recommended regression equations. There was significant heterogeneity in discriminative ability of models with respect to age (P < .001) and sample size (P = .007). CONCLUSIONS: There is an abundance of HF risk prediction models that had sufficient discriminative ability, although few are externally validated. Methods not recommended for the conduct and reporting of risk prediction modeling were frequently used, and resulting algorithms should be applied with caution.

Cause of neonatal deaths in Northern Ethiopia: a prospective cohort study.

BACKGROUND: Despite the significant reduction in childhood mortality, neonatal mortality has shown little or no concomitant decline worldwide. The dilemma arises in that the lack of documentation of cause of death in developing countries, where registration of vital events is virtually nonexistent. Understanding of the causes of death in neonates is important to guide public health interventions. The present study identifies the common causes of neonatal death in Ethiopia. METHODS: A prospective cohort study was conducted among neonates born between April 2014 and July 2014 in seven hospitals, in Tigray region, Ethiopia. Mothers were interviewed by midwifes respecting risk factors and infant survival. For neonates who died in hospital, causes of death were extracted from medical records, whereas a verbal autopsy method provided presumptive assignment of cause of death for those infants who died at home. RESULTS: Of the1152 live births, there were 68 deaths (63 per 1000 live births). Two thirds of deaths were attributable to prematurity 23 (34%) or asphyxia 21 (31%). Slight variance was seen between the morality patterns in early and late neonatal periods. In the early neonatal period, 37% were due to prematurity, while asphyxia (35%) was more common in the late neonatal period. All infection-related deaths occurred in neonate-mother dyads from rural areas. CONCLUSION: Prematurity, asphyxia, and infections were the leading causes of neonatal deaths in Tigray region during the study period. Causes of deaths identified during early and late neonatal mortality differed, which clearly indicates the need for responsive and evidence-based interventions and policies.

The impact of dietary risk factors on the burden of non-communicable diseases in Ethiopia: findings from the Global Burden of Disease study 2013.

BACKGROUND: The burden of non-communicable diseases (NCDs) has increased in sub-Saharan countries, including Ethiopia. The contribution of dietary behaviours to the NCD burden in Ethiopia has not been evaluated. This study, therefore, aimed to assess diet-related burden of disease in Ethiopia between 1990 and 2013. METHOD: We used the 2013 Global Burden of Disease (GBD) data to estimate deaths, years of life lost (YLLs) and disability-adjusted life years (DALYs) related to eight food types, five nutrients and fibre intake. Dietary exposure was estimated using a Bayesian hierarchical meta-regression. The effect size of each diet-disease pair was obtained based on meta-analyses of prospective observational studies and randomized controlled trials. A comparative risk assessment approach was used to quantify the proportion of NCD burden associated with dietary risk factors. RESULTS: In 2013, dietary factors were responsible for 60,402 deaths (95% Uncertainty Interval [UI]: 44,943-74,898) in Ethiopia-almost a quarter (23.0%) of all NCD deaths. Nearly nine in every ten diet-related deaths (88.0%) were from cardiovascular diseases (CVD) and 44.0% of all CVD deaths were related to poor diet. Suboptimal diet accounted for 1,353,407 DALYs (95% UI: 1,010,433-1,672,828) and 1,291,703 YLLs (95% UI: 961,915-1,599,985). Low intake of fruits and vegetables and high intake of sodium were the most important dietary factors. The proportion of NCD deaths associated with low fruit consumption slightly increased (11.3% in 1990 and 11.9% in 2013). In these years, the rate of burden of disease related to poor diet slightly decreased; however, their contribution to NCDs remained stable. CONCLUSIONS: Dietary behaviour contributes significantly to the NCD burden in Ethiopia. Intakes of diet low in fruits and vegetables and high in sodium are the leading dietary risks. To effectively mitigate the oncoming NCD burden in Ethiopia, multisectoral interventions are required; and nutrition policies and dietary guidelines should be developed.

Prevalence of heart failure in Australia: a systematic review.

BACKGROUND: In the absence of a systematic collection of data pertaining to heart failure, summarizing the data available from individual studies provides an opportunity to estimate the burden of heart failure. The present study systematically reviewed the literature to estimate the incidence and prevalence rates of heart failure in Australia. METHODS: Studies reporting on prevalence or incidence of heart failure published between 1990 and 2015 were identified through a systematic search of Embase, PubMed, Ovid Medline, MeSH, Scopus and websites of the Australian Institute of Health, and Welfare and Australian Bureau of Statistics. RESULTS: The search yielded a total of 4978 records, of which thirteen met the inclusion criteria. There were no studies reporting on the incidence of heart failure. The prevalence of heart failure in the Australian population ranged between 1.0% and 2.0%, with a significant proportion of cases being previously undiagnosed. The burden of heart failure was higher among Indigenous than non-Indigenous Australians (age-standardized prevalence rate ratio of 1.7). Heart failure was prevalent in women than men, and in rural and remote regions than in the metropolitan and capital territories. CONCLUSION: This systematic review highlights the limited available data on the epidemiology of heart failure in Australia. Population level studies, using standardized approaches, are needed in order to precisely describe the burden of HF in the population.

Evaluation of machine learning-based models for prediction of clinical deterioration: A systematic literature review.

BACKGROUND AND OBJECTIVE: Early identification of patients at risk of deterioration can prevent life-threatening adverse events and shorten length of stay. Although there are numerous models applied to predict patient clinical deterioration, most are based on vital signs and have methodological shortcomings that are not able to provide accurate estimates of deterioration risk. The aim of this systematic review is to examine the effectiveness, challenges, and limitations of using machine learning (ML) techniques to predict patient clinical deterioration in hospital settings. METHODS: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and meta-Analyses (PRISMA) guidelines using EMBASE, MEDLINE Complete, CINAHL Complete, and IEEExplore databases. Citation searching was carried out for studies that met inclusion criteria. Two reviewers used the inclusion/exclusion criteria to independently screen studies and extract data. To address any discrepancies in the screening process, the two reviewers discussed their findings and a third reviewer was consulted as needed to reach a consensus. Studies focusing on use of ML in predicting patient clinical deterioration that were published from inception to July 2022 were included. RESULTS: A total of 29 primary studies that evaluated ML models to predict patient clinical deterioration were identified. After reviewing these studies, we found that 15 types of ML techniques have been employed to predict patient clinical deterioration. While six studies used a single technique exclusively, several others utilised a combination of classical techniques, unsupervised and supervised learning, as well as other novel techniques. Depending on which ML model was applied and the type of input features, ML models predicted outcomes with an area under the curve from 0.55 to 0.99. CONCLUSIONS: Numerous ML methods have been employed to automate the identification of patient deterioration. Despite these advancements, there is still a need for further investigation to examine the application and effectiveness of these methods in real-world situations.

Community-based lifestyle intervention for diabetes (Co-LID study) management rural Nepal: study protocol for a clustered randomized controlled trial.

BACKGROUND: Type 2 diabetes mellitus (T2DM) has increased globally; with a disproportionate burden in South and Southeast Asian countries, including Nepal. There is an urgent need for clinically and cost-effective culturally adapted T2DM management programs. In this study, we aim to assess the effectiveness of community based culturally appropriate lifestyle intervention in improving the management and care of people with T2DM. METHODS: We will conduct a cluster randomized control trial to evaluate the effectiveness of community based culturally appropriate lifestyle intervention in improving T2DM outcomes. The trial will be conducted in 30 randomly selected healthcare facilities from two purposively selected districts (Kavrepalanchowk and Nuwakot districts) of Bagmati province, Nepal. The selected healthcare facilities are being randomized into 15 interventions (n = 15) and usual care (n = 15) groups. Those in the intervention will receive group-based 12 an hour-long fortnightly session delivered over 6 months period. The intervention package includes 12 planned modules related to diabetes care, ongoing support, supervision and monitoring, follow-up from the trained community health workers, and educational materials on diabetes self-management. The participants in the usual care groups will receive pictorial brochure on diabetes management and they will continue receiving the usual care available from the local health facilities. The primary outcome is HbA1c level, and the secondary outcomes include quality of life, health care utilization, and practice of self-care behaviour, depression, oral health quality of life, and economic assessment of the intervention. Two points measurements will be collected by the trained research assistants at baseline and at the end of the intervention. DISCUSSION: This study will provide tested approaches for culturally adapting T2DM interventions in the Nepalese context. The findings will also have practice and policy implications for T2DM prevention and management in Nepal. TRIAL REGISTRATION: Australia and New Zealand Clinical Trial Registry (ACTRN12621000531819). Registered on May 6, 2021.

Trends and risk factors for omission of early thromboprophylaxis in Australian and New Zealand ICUs between 2009 and 2020.

PURPOSE: Venous thromboembolism (VTE) prophylaxis is effective in reducing VTE events; however, it is underutilized in critically ill patients. We examined trends and risk factors for omission of early thromboprophylaxis within the first 24 h after admission in Australian and New Zealand intensive care units (ICUs) between 2009 and 2020. METHODS: Retrospective analysis of data from the Australian New Zealand Intensive Care Society Adult Patient Database. Data were obtained for 1,465,020 adult admissions between 2009 and 2020. Mixed effects logistic regression modeling (accounting for the random effects of the contributing ICUs) was used to identify factors associated with omission of early thromboprophylaxis. RESULTS: A total of 107,486 (7.3%) ICU patients did not receive any form of thromboprophylaxis within the first 24 h after ICU admission without obvious reasons. Omission of early thromboprophylaxis declined from 13.7% in 2009 to 4% in 2020 (by 70.8%) (P < 0.001). Younger patients were more like to miss out on VTE prophylaxis (odds ratios (OR)per 10-year increase 0.94, 95% CI 0.95-0.99). A documented process for monitoring VTE prophylaxis (ORs 0.90, 95% CI 0.87-0.93) and having a medical lead, dedicated for coordinating ICU quality (ORper 0.1 increase in full-time equivalent 0.97, 95% CI 0.93-0.99), are associated with less omission of VTE prophylaxis. CONCLUSION: Omission of thromboprophylaxis within the first 24 h after ICU admission has declined steadily over the past decade. Documented process for monitoring VTE prophylaxis and having a medical lead for coordinating quality of ICU care could be potential targets for sustaining the improvement in VTE prophylaxis use.

Association between frailty, delirium, and mortality in older critically ill patients: a binational registry study.

BACKGROUND: Frailty and delirium are prevalent among older adults admitted to the intensive care unit (ICU) and associated with adverse outcomes; however, their relationships have not been extensively explored. This study examined the association between frailty and mortality and length of hospital stay (LOS) in ICU patients, and whether the associations are mediated or modified by an episode of delirium. METHODS: Retrospective analysis of data from the Australian New Zealand Intensive Care Society Adult Patient Database. A total of 149,320 patients aged 65 years or older admitted to 203 participating ICUs between 1 January 2017 and 31 December 2020 who had data for frailty and delirium were included in the analysis. RESULTS: A total of 41,719 (27.9%) older ICU patients were frail on admission, and 9,179 patients (6.1%) developed delirium during ICU admission. Frail patients had significantly higher odds of in-hospital mortality (OR: 2.15, 95% CI 2.05-2.25), episodes of delirium (OR: 1.86, 95% CI 1.77-1.95), and longer LOS (log-transformed mean difference (MD): 0.24, 95% CI 0.23-0.25). Acute delirium was associated with 32% increased odds of in-hospital mortality (OR: 1.32, 95% CI 1.23-1.43) and longer LOS (MD: 0.54, 95% CI 0.50-0.54). The odds ratios (95% CI) for in-hospital mortality were 1.37 (1.23-1.52), 2.14 (2.04-2.24) and 2.77 (2.51-3.05) for non-frail who developed delirium, frail without delirium, and frail and developed delirium during ICU admission, respectively. There was very small but statistically significant effect of frailty on in-hospital mortality (b for indirect effect: 0.00037, P < 0.001) and LOS (b for indirect effect: 0.019, P < 0.001) mediated through delirium. CONCLUSION: Both frailty and delirium independently increase the risk of in-hospital mortality and LOS. Acute delirium is more common in frail patients; however, it does not mediate or modify a clinically meaningful amount of the association between frailty and in-hospital mortality and LOS.

Trends and Impact Factors of Mental Health Service Utilization among Resettled Humanitarian Migrants in Australia: Findings from the BNLA Cohort Study.

Resettled humanitarian migrants (HMs) have high levels of mental disorders, but factors associated with the utilization of mental health services (MHS) are poorly understood. We aimed to explore trends and impact factors of MHS utilization among HMs in the process of resettlement in Australia. A total of 2311 HMs from the 1st (2013), 3rd, and 5th (2018) waves of a national cohort study were included. MHS utilization in the past year was assessed by two indicators: having MHS contacts and the frequency of MHS contacts. Trends were identified by Cochran-Armitage tests, and generalized linear mixed models and ordered logistic models were fitted to explore impact factors of MHS utilization. The proportion of having MHS contacts significantly rose from 13.0% to 29.4% over the five years. MHS utilization was mainly driven by perceived needs, such as post-traumatic stress disorders and the degree of post-migration stress. Unemployment and strong belongingness to the local community were also associated with having MHS contacts. No significant gender difference was found in having MHS contacts but females tended to contact MHS more frequently. Resettled HMs have a persistent dilemma of high mental illness prevalence and MHS underutilization. Sustainable mental health education and long-term resettlement services targeted at social integration that consider gender difference are urgently needed in host countries.

Weight Gain After Smoking Cessation and Risk of Major Chronic Diseases and Mortality.

Importance: Smoking cessation is frequently followed by weight gain; however, whether weight gain after quitting reduces the health benefits of quitting is unclear. Objective: To examine the association between weight change after smoking cessation and the risk of cardiovascular diseases (CVD), type 2 diabetes, cancer, chronic obstructive pulmonary disease (COPD), and all-cause mortality. Design, Setting, and Participants: This cohort study analyzed data from a nationally representative sample of Australian adults aged 18 years or older who were studied between 2006 and 2014. Smoking status and anthropometric measurements were self-reported annually. Cox proportional hazards regressions were used to determine the hazard ratios (HRs) for the association between changes in weight and body mass index (BMI) and the risk of CVD, type 2 diabetes, cancer, COPD, and mortality. Data were analyzed in January 2019. Exposures: Annual self-reported smoking status; years since quitting. Main Outcomes and Measures: Weight gain after quitting, incident CVD, type 2 diabetes, cancer, COPD, and all-cause mortality. Results: Of a total 16 663 participants (8082 men and 8581 women; mean [SD] age, 43.7 [16.3] years), those who quit smoking had greater increases in weight (mean difference [MD], 3.14 kg; 95% CI, 1.39-4.87) and BMI (MD, 0.82; 95% CI, 0.21-1.44) than continuing smokers. Compared with continuing smokers, the HRs for death were 0.50 (95% CI, 0.36-0.68) among quitters who lost weight, 0.79 (95% CI, 0.51-0.98) among quitters without weight change, 0.33 (95% CI, 0.21-0.51) among quitters who gained 0.1 to 5.0 kg, 0.24 (95% CI, 0.11-0.53) among quitters who gained 5.1 to 10 kg, and 0.36 (95% CI, 0.16-0.82) among quitters who gained more than 10 kg. The HRs for death were 0.61 (95% CI, 0.45-0.83) among quitters who lost BMI, 0.86 (95% CI, 0.51-1.44) among quitters without change in BMI, 0.32 (95% CI, 0.21-0.50) among quitters who gained up to 2 in BMI, and 0.26 (95% CI, 0.16-0.45) among quitters who gained more than 2 in BMI. Conclusions and Relevance: This cohort study found that smoking cessation was accompanied by a substantial weight gain; however, this was not associated with an increased risk of chronic diseases or an attenuation of the mortality benefit of cessation.