Impact of Postponement of Appointments on Vision and Psychological Well-Being Among Outpatients Attending Ophthalmology Clinics: A Malaysian Perspective.

INTRODUCTION: During the COVID-19 pandemic, non-frontline medical disciplines, including ophthalmology, were advised to minimize their services to channel crucial healthcare resources to manage the surge in COVID-19 cases. The ophthalmology department postponed all non-urgent appointments and elective surgical procedures. However, little is known about the visual and mental health impact of these changes in ophthalmology services. Therefore, our study aimed to explore the impact of postponement in ophthalmology outpatient clinic appointments towards visual acuity (VA) changes and the psychological well-being of patients during the COVID-19 pandemic in Malaysia. METHODOLOGY: This cross-sectional study, utilizing a convenience sampling method, recruited patients attending ophthalmology outpatient clinic services from July 2020 to June 2021 to participate in the study. The Snellen chart was used to measure the VA, and the Kessler psychological distress scale (K-10) was used to measure psychological distress levels among patients with (study) and without (controls) postponement of the appointment.  Results: A total of 485 patients were included in the data analysis; 267 study and 218 controls. There is a statistically significant difference in categorical change of VA (p < 0.001) and categorical K-10 score (p = 0.048) among the study and control groups. Nonetheless, a decline in VA alone does not show a statistically significant association with an increased probability of experiencing psychological distress (p=0.149). CONCLUSION: Postponement of ophthalmology appointments negatively affected the VA and the psychological well-being of patients. Appropriate assessment of patients before postponing their appointment is crucial to mitigate the worsening of VA and psychological distress.

Pathology stewardship in emergency departments: a single-site, retrospective, cohort study of the value of C-reactive protein in patients with suspected sepsis.

Increasing awareness of the importance of pathology stewardship in reducing low value care has led to scrutiny of appropriate laboratory test ordering. The objective of this study is to investigate the value of a commonly ordered laboratory test, the C-reactive protein (CRP), in decisions regarding diagnosis, management and disposition of emergency department (ED) patients with suspected sepsis. Retrospective chart reviews were performed on 1716 adult patients with suspected sepsis presenting to the Townsville University Hospital ED between 1 January 2021 and 30 June 2021. Suspected sepsis was defined as the emergency clinicians' decision to perform a blood culture. A CRP value of 10 mg/L or higher was defined as an elevated CRP. The primary outcome of interest was commencement of antibiotics in ED. Secondary outcomes include hospital admission (ward and ICU), hospital length of stay, mortality, documentation of indication for CRP testing, test parameters of CRP in detecting culture-positive bacteraemia and rates of bacteraemia with presumptive ED diagnosis. This study found no significant association between CRP values and antibiotic commencement (p=0.222), ward admission (p=0.071), ICU admission (p=0.248), hospital length of stay (p=0.164) or mortality (p=1.000). CRP had an area under the curve of 0.58 (95% CI 0.51-0.66) for detecting culture-positive bacteraemia. Sensitivity and specificity of CRP were 62.5% and 47.7%, respectively, at a threshold of 46 mg/dL. CRP testing is of little value in ED patients with suspected sepsis as it does not influence decision making about diagnosis, management, or disposition. Avoiding CRP testing in this patient cohort can contribute to pathology stewardship and optimal use of finite healthcare resources.

Who is donating to political parties in Queensland, Australia? An analysis of political donations from the food industry.

OBJECTIVE: Australia's dominant food system encourages the overconsumption of foods detrimental for human and planetary health. Despite this, Australia has limited policies to reduce the burden of disease and protect the environment. Political donations from the food industry may contribute to policy inertia on this issue. We aimed to explore the extent of political donations made by the food industry in Queensland and investigate the timing of public health nutrition policies in relation to these donations. DESIGN: We collected publicly declared political donations data in Queensland, Australia, as it has the most transparent donation records. Policy data were sourced from the Australian National and Queensland State Parliaments, and consultations from the Australian and New Zealand Ministerial Forum on Food Regulation. SETTING: Queensland, Australia. PARTICIPANTS: Not applicable. RESULTS: The Liberal National Party (LNP) received 68 % of all donations, with most immediately preceding the 2017 and 2020 state elections. The Australian Labor Party, despite forming government for the time period under study, received only 17 % of total donations. Most donations were given by the meat industry, followed by the sugar industry. Few policies exist to protect and improve human and planetary health, with limited associations with political donations for most industries except sugar. CONCLUSIONS: Industry preference for the LNP, particularly as most donations coincided with election periods, may be due to the party's emphasis on minimal state involvement in economic and social affairs. The relationship between industry donations and policies is not clear, partly due to the limited number of policies implemented overall.

miRNA-32 Drives Brown Fat Thermogenesis and Trans-activates Subcutaneous White Fat Browning in Mice.

Brown adipose tissue (BAT) activation and subcutaneous white fat browning are essential components of the thermogenic response to cold stimulus in mammals. microRNAs have been shown to regulate both processes in cis. Here, we identify miR-32 as a BAT-specific super-enhancer-associated miRNA in mice that is selectively expressed in BAT and further upregulated during cold exposure. Inhibiting miR-32 in vivo led to impaired cold tolerance, decreased BAT thermogenesis, and compromised white fat browning as a result of reduced serum FGF21 levels. Further examination showed that miR-32 directly represses its target gene Tob1, thereby activating p38 MAP kinase signaling to drive FGF21 expression and secretion from BAT. BAT-specific miR-32 overexpression led to increased BAT thermogenesis and serum FGF21 levels, which further promotes white fat browning in trans. Our results suggested miR-32 and Tob1 as modulators of FGF21 signaling that can be manipulated for therapeutic benefit against obesity and metabolic syndrome.