Modifiable dementia risk factors and AT(N) biomarkers: findings from the EPAD cohort.

Introduction: Modifiable risk factors account for a substantial proportion of Alzheimer's disease (AD) cases and we currently have a discrete AT(N) biomarker profile for AD biomarkers: amyloid (A), p-tau (T), and neurodegeneration (N). Here, we investigated how modifiable risk factors relate to the three hallmark AT(N) biomarkers of AD. Methods: Participants from the European Prevention of Alzheimer's Dementia (EPAD) study underwent clinical assessments, brain magnetic resonance imaging, and cerebrospinal fluid collection and analysis. Generalized additive models (GAMs) with penalized regression splines were modeled in the AD Workbench on the NTKApp. Results: A total of 1,434 participants were included (56% women, 39% APOE ε4+) with an average age of 65.5 (± 7.2) years. We found that modifiable risk factors of less education (t = 3.9, p < 0.001), less exercise (t = 2.1, p = 0.034), traumatic brain injury (t = -2.1, p = 0.036), and higher body mass index (t = -4.5, p < 0.001) were all significantly associated with higher AD biomarker burden. Discussion: This cross-sectional study provides further support for modifiable risk factors displaying neuroprotective associations with the characteristic AT(N) biomarkers of AD.

Family carers of people living with dementia and discussion board engagement in the Understanding Dementia Massive Open Online Course.

OBJECTIVES: This study compared discussion board involvement between family carers and non-carers in the Understanding Dementia Massive Open Online Course (UD-MOOC). METHODS: A mixed methods observational cohort study of family carers and non-carers was undertaken over the February-April 2020 UD-MOOC. Discussion board engagement was measured as number of posts and replies and examined longitudinally using mixed models. Discussion topics were explored through structural topic models (STM). Subsequently, thematic analysis of STM derived-topic exemplars was conducted to contextualise these discussions. RESULTS: Family carers were (n = 2320) found to post (p < 0.001) and reply (p = 0.029) significantly more often than non-carers (n = 2392). Of the 32-STM derived-topics, meaningful activities (mean Δ = 0.007, 95% CrI [0.005-0.100]), personal stories of diagnosis (mean Δ = 0.007, 95% CrI [0.005-0.009]), and family history of dementia (mean Δ = 0.006, 95% CrI [0.004-0.008]) were discussed significantly more frequently by family carers compared to non-carers. CONCLUSION: These results may reflect underlying motivational differences and circumstantial relevance. Perhaps the greater engagement by family carers is related to a sense of having inadequate relevant offline social resources, where engagement in the UD-MOOC discussion boards may serve as means to share experiences with others.

Evaluating the Effect of a Web-Based E-Learning Tool for Health Professional Education on Clinical Vancomycin Use: Comparative Study.

BACKGROUND: Internet-based learning for health professional education is increasing. It offers advantages over traditional learning approaches, as it enables learning to be completed at a time convenient to the user and improves access where facilities are geographically disparate. We developed and implemented the Vancomycin Interactive (VI) e-learning tool to improve knowledge on the clinical use of the antibiotic vancomycin, which is commonly used for treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). OBJECTIVE: The aims of this study were to evaluate the effect of the VI e-learning tool on (1) survey knowledge scores and (2) clinical use of vancomycin among health professionals. METHODS: We conducted a comparative pre-post intervention study across the 14 hospitals of two health districts in New South Wales, Australia. A knowledge survey was completed by nurses, doctors, and pharmacists before and after release of a Web-based e-learning tool. Survey scores were compared with those obtained following traditional education in the form of an email intervention. Survey questions related to dosing, administration, and monitoring of vancomycin. Outcome measures were survey knowledge scores among the three health professional groups, vancomycin plasma trough levels, and vancomycin approvals recorded on a computerized clinical decision support system. RESULTS: Survey response rates were low at 26.87% (577/2147) preintervention and 8.24% (177/2147) postintervention. The VI was associated with an increase in knowledge scores (maximum score=5) among nurses (median 2, IQR 1-2 to median 2, IQR 1-3; P<.001), but not among other professional groups. The comparator email intervention was associated with an increase in knowledge scores among doctors (median 3, IQR 2-4 to median 4, IQR 2-4; P=.04). Participants who referred to Web-based resources while completing the e-learning tool achieved higher overall scores than those who did not (P<.001). The e-learning tool was not shown to be significantly more effective than the comparator email in the clinical use of vancomycin, as measured by plasma levels within the therapeutic range. CONCLUSIONS: The e-learning tool was associated with improved knowledge scores among nurses, whereas the comparator email was associated with improved scores among doctors. This implies that different strategies may be required for optimizing the effectiveness of education among different health professional groups. Low survey response rates limited conclusions regarding the tool's effectiveness. Improvements to design and evaluation methodology may increase the likelihood of a demonstrable effect from e-learning tools in the future.

To screen or not to screen? Vitamin D deficiency in chronic mental illness.

OBJECTIVES: The objective of the current study was to examine the pathology test utilisation of 25-hydroxyvitamin D (25(OH)D) within an Australian inpatient psychiatric setting. METHOD: A retrospective audit of 300 random hospital files of those admitted as inpatients between Nov 2014 and Nov 2015 was undertaken. Data was quantitatively analysed and described. RESULTS: The number of inpatients who had a vitamin D determination during their admission was 37/300 (12.33%). The mean vitamin D level of those tested was 51.63 nmol/l. Of those that were tested, 18/37 (48.6%) were mildly to moderately deficient. There was a statistically significant difference in age and length of stay between those that were and were not tested for vitamin D levels, p-value <0.001 and 0.017, respectively. In addition, a simple linear regression indicated a weak association between length of stay and vitamin D levels. CONCLUSION: This audit highlights vitamin D screening inadequacy. More research is recommended to establish tangible benefits of supplementation, while local practice provides valuable data for education and policy purposes.

Exploration of food addiction in people living with schizophrenia.

The term food addiction (FA) denotes a concept among researchers and lay consumers as a behavioural phenotype related to excessive food consumption. In this study we examined the prevalence of FA using the validated Yale Food Addiction Scale (YFAS) as well as the dimensional symptom count. In addition, we explored associations between participant characteristics and FA diagnosis. Outpatients attending a clozapine clinic and possessing a diagnosis of schizophrenia were invited to complete an anonymous survey using the YFAS. Ninety three surveys were used to calculate the diagnostic YFAS criteria for FA. The prevalence of FA found in this sample was 26.9%. Among individuals who did not meet "diagnostic" criteria FA, 77.4% endorsed 3 or more symptoms but did not report distress or impairment. The most common food addiction symptom was a persistent desire or repeated unsuccessful attempts to cut down consumption (97.9%). The significant finding in association between individual's characteristics and diagnosis of FA was employment. Several factors related to reported results are postulated and discussed. The current study has found the prevalence of FA amongst people living with schizophrenia to be higher than the general populations but not as high as populations with disordered eating.

Design and Implementation of a Novel Web-Based E-Learning Tool for Education of Health Professionals on the Antibiotic Vancomycin.

BACKGROUND: Traditional approaches to health professional education are being challenged by increased clinical demands and decreased available time. Web-based e-learning tools offer a convenient and effective method of delivering education, particularly across multiple health care facilities. The effectiveness of this model for health professional education needs to be explored in context. OBJECTIVES: The study aimed to (1) determine health professionals' experience and knowledge of clinical use of vancomycin, an antibiotic used for treatment of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and (2) describe the design and implementation of a Web-based e-learning tool created to improve knowledge in this area. METHODS: We conducted a study on the design and implementation of a video-enhanced, Web-based e-learning tool between April 2014 and January 2016. A Web-based survey was developed to determine prior experience and knowledge of vancomycin use among nurses, doctors, and pharmacists. The Vancomycin Interactive (VI) involved a series of video clips interspersed with question and answer scenarios, where a correct response allowed for progression. Dramatic tension and humor were used as tools to engage users. Health professionals' knowledge of clinical vancomycin use was obtained from website data; qualitative participant feedback was also collected. RESULTS: From the 577 knowledge survey responses, pharmacists (n=70) answered the greatest number of questions correctly (median score 4/5), followed by doctors (n=271; 3/5) and nurses (n=236; 2/5; P<.001). Survey questions on target trough concentration (75.0%, 433/577) and rate of administration (64.9%, 375/577) were answered most correctly, followed by timing of first level (49%, 283/577), maintenance dose (41.9%, 242/577), and loading dose (38.0%, 219/577). Self-reported "very" and "reasonably" experienced health professionals were also more likely to achieve correct responses. The VI was completed by 163 participants during the study period. The rate of correctly answered VI questions on first attempt was 65% for nurses (n=63), 68% for doctors (n=86), and 82% for pharmacists (n=14; P<.001), reflecting a similar pattern to the knowledge survey. Knowledge gaps were identified for loading dose (39.2% correct on first attempt; 64/163), timing of first trough level (50.3%, 82/163), and subsequent trough levels (47.9%, 78/163). Of the 163 participants, we received qualitative user feedback from 51 participants following completion of the VI. Feedback was predominantly positive with themes of "entertaining," "engaging," and "fun" identified; however, there were some technical issues identified relating to accessibility from different operating systems and browsers. CONCLUSIONS: A novel Web-based e-learning tool was successfully developed combining game design principles and humor to improve user engagement. Knowledge gaps were identified that allowed for targeting of future education strategies. The VI provides an innovative model for delivering Web-based education to busy health professionals in different locations.

The prevalence of diabetes after gestational diabetes - An Australian perspective.

BACKGROUND: Women with gestational diabetes mellitus (GDM) are likely to develop diabetes in later life. International reports and reviews indicate a variable but generally high rate of conversion. However, data from international reports are difficult to apply to an Australian population. AIM: To investigate in Australia, in a representative population, the prevalence of diabetes developing in women who have been diagnosed with one criteria and who have had uniform standards of clinical care. MATERIAL AND METHODS: This study considered women referred with a diagnosis of GDM according to the Australasian Diabetes in Pregnancy Society criteria and seen by one practitioner over a 20 year period, from 1991 to 2010. The area of referral had an ethnic distribution similar to the overall Australian demography. RESULTS: Despite, in some cases, being more than 25 years since the pregnancy, more than half the women were contactable and the majority agreed to have their diabetes status declared or determined. The overall prevalence was 10.3%. The prevalence at each 10 year age increment was more than twice the figure reported from the AusDiab study. A higher maternal body mass index and a positive family history of diabetes were the strongest predictive factors. The prevalence of undiagnosed diabetes was 0.9%. CONCLUSION: In a representative population, after GDM, the prevalence of diabetes of 10.3% was far lower than that reported internationally but was still about twice the rate for the overall Australian population.

Sequential processing in an auditory equiprobable Go/NoGo task with variable interstimulus interval.

A recent series of studies of the auditory equiprobable Go/NoGo task, using fixed interstimulus intervals (ISIs), proposed a processing schema relating observed event-related potential (ERP) components to sequential processing stages. However, it has been demonstrated that attention and ERP components can be affected by the predictable rhythmic timing of fixed ISIs. Hence the aim of the current study was to test the robustness of that processing schema with an unpredictable arrhythmic variable ISI. EEG was recorded from 30 university students at 30 scalp sites in an unwarned auditory equiprobable Go/NoGo task using a variable ISI. Following our previous studies, Go and NoGo ERP components were derived using temporal principal components analysis (PCA). Of the unrestricted Varimax-rotated factors, seven were identifiable as components based on their topography, polarity, and latency: two subcomponents of the N1 (N1-1, and processing negativity, PN), P2/N2b, N2c/P3a, P3b, and two subcomponents of the slow wave (SW-1 and SW-2). These components showed Go/NoGo effects comparable to those previously noted with fixed ISI, supporting the proposed processing schema. The Late Positivity (LP) component, previously speculated to mark cortical deactivation after processing the NoGo stimulus, was not present in the sequence of components. In its absence, activity underlying the observed sustained P300/late positive complex may be involved in processing temporally-uncertain stimuli.

Sequential processing in the equiprobable auditory Go/NoGo task: children vs. adults.

OBJECTIVE: To compare sequential processing in the unwarned auditory equiprobable Go/NoGo task in children and adults, in the context of a recently developed adult schema. METHODS: Adult and child samples completed an equiprobable auditory Go/NoGo task while EEG was recorded from 19 channels. Go and NoGo ERPs were decomposed using unrestricted Varimax-rotated PCAs for the groups separately, and in combination. The separate adult and child components were compared using the Congruence Coefficient. Brain sources of each assessed component were examined using eLORETA. RESULTS: Corresponding adult/child components were tentatively identified: two N1 subcomponents (N1-1, PN) and P2, followed by N2, P3 (separate P3a/P3b in children), the classic Slow Wave (SW), and a diffuse Late Positivity (LP). While early and late components showed similarities, the intermediate P2 and N2 differed substantially in their stimulus effects. CONCLUSIONS: Aspects of "Go" vs. "NoGo" categorisation differ between adults and children, but subsequent processing reflected in the different Go/NoGo P3 components, and their sequellae, are similar. SIGNIFICANCE: This is the first detailed examination of child responses in this paradigm. The tested schema appears relatively robust in adults, and the child results may aid our understanding of developmental aspects of cognitive processing in normal and atypical individuals.