Air pollution and comorbidity burden influencing acute hospital mortality outcomes in a large academic teaching hospital in Dublin, Ireland: a semi-ecologic analysis.

OBJECTIVE: To investigate the extent to which air pollution interacts with comorbidity in determining mortality outcomes of emergency medical admissions. STUDY DESIGN: Routinely collected data were used to study all emergency medical admissions to an academic teaching hospital in Dublin, Ireland, from 2002 to 2018. Air pollution was measured by particulate matter with aerodynamic diameter ≤10 µm (PM10) and sulphur dioxide (SO2) levels on the day of admission. Comorbidity Score was measured using a previously derived score. METHODS: A multivariable logistic regression model was used to relate air pollutant levels, Comorbidity Scores, and their interaction to 30-day in-hospital mortality. RESULTS: There were 102,483 admissions in 58,127 patients over 17 years. Both air pollutant levels and Comorbidity Score were associated with 30-day in-hospital mortality. On admission days with PM10 levels above the median, mortality was higher (Odds ratio [OR] 1.09; 95% confidence interval [CI] 1.06, 1.18) at 11.2% (95% CI 10.5, 12) compared with 10.4% (95% CI 10, 10.7) on days when PM10 levels were below the median. On admission days with SO2 levels above the median, mortality was higher (OR 1.13; 95% CI 1.10, 1.16) at 12.2% (95% CI 11.4, 13) compared with 10.7% (95% CI 10.3, 11.1) on days when SO2 levels were below the median. Comorbidity Score was strongly associated with mortality (mortality rate of 8.9% for those with a 6-point score vs mortality rate of 30.3% for those with a 16-point score). There was limited interaction between air pollutant levels and Comorbidity Score. CONCLUSION: Both air pollution levels on the day of admission and Comorbidity Score were associated with 30-day in-hospital mortality. However, there was limited interaction between these two factors.

Pilot evaluation of an online weight management programme.

This intervention examined the efficacy of a six-week online weight loss programme. Students and staff of a third level institution (n=183) were recruited to the programme which provided individualised dietary advice for weight loss. Eighty-five participants (mean age 29.7 years, mean BMI 28.9kg/m2, 33% male) met the minimum inclusion criterion of logging on to the study website at least twice. All participants who completed the full six-week programme lost weight (n=31), with significant reductions in mean weight (2.8kg), BMI (0.9kg/m2) and waist circumference (4.1cm) observed between the start and end of the programme (all P<0.001). Among "completers", males lost more weight than females (4.2kg vs. 1.9kg, P=0.004). One in four completers lost >5% of their bodyweight, with reductions in biscuit and alcohol consumption being most predictive of weight loss. These findings suggest that individualised online dietary advice is effective in achieving short-term weight loss, especially in males.

Radiology imaging delays as independent predictors of length of hospital stay for emergency medical admissions.

AIM: To investigate the extent to which the time to completion for computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound could be shown to influence the length of stay and costs incurred while in hospital, while accounting for patient acuity. MATERIALS AND METHODS: All emergency admissions, totalling 25,326 imaging investigations between 2010-2014 were evaluated. The 50(th), 75(th), and 90(th) centiles of completion times for each imaging type was entered into a multivariable truncated Poisson regression model predicting the length of hospital stay. Estimates of risk (odds or incidence rate ratios [IRRs]) of the regressors were adjusted for acute illness severity, Charlson comorbidity index, chronic disabling disease score, and sepsis status. Quantile regression analysis was used to examine the impact of imaging on total hospital costs. RESULTS: For all imaging examinations, longer hospital lengths of stay were shown to be related to delays in imaging time. Increased delays in CT and MRI were shown to be associated with increased hospital episode costs, while ultrasound did not independently predict increased hospital costs. The magnitude of the effect of imaging delays on episode costs were equivalent to some measures of illness severity. CONCLUSION: CT, MRI, and ultrasound are undertaken in patients with differing clinical complexity; however, even with adjustment for complexity, the time delay in a more expeditious radiological service could potentially shorten the hospital episode and reduce costs.

Psychological distress leads to reduced physical activity and fitness in children: the Australian longitudinal LOOK study.

Stress and depression can affect an individual's level of physical activity and fitness, which may place them at risk of developing cardiovascular disease. This study investigates the longitudinal effects of stress and depression on physical activity and cardiorespiratory fitness among youth. Six hundred and seventy-six children, initially aged 8 years, from the LOOK study completed a modified version of the Children's Depression Inventory, the Children's Stress Questionnaire, and objective physical activity and cardiorespiratory fitness assessments on three occasions, every 4 years. Depressive symptoms had a direct effect (longitudinal) on the cardiorespiratory fitness of girls, with a similar trend for boys. In cross-sectional analyses, a child who identified with more symptoms of depression and stress was likely to be less fit and less physically active, which in girls extended to less moderate-to-vigorous physical activity. Our findings, that both physical activity and fitness are impacted by depression and stress may contribute to strategies directed towards achieving enhanced physical activity and reductions in obesity.

Benefits of early development of eye-hand coordination: evidence from the LOOK longitudinal study.

We investigated longitudinal and cross-sectional relationships between eye-hand coordination (EHC) and cardiorespiratory fitness (multistage run), physical activity (pedometers), percent body fat (%BF, dual energy x-ray absorptiometry), body image, and organized sport participation (questionnaires) in 406 boys and 384 girls at 8 and 10 years of age. EHC was measured by a throw and wall-rebound catch test involving 40 attempts of increasing difficulty. Median EHC improved during two years from 18 to 32 (boys) and 9 to 24 (girls), and gender differences and improvements were both significant (P < 0.001). Cross-sectional analyses showed that boys and girls with better EHC were fitter (P < 0.001), and a longitudinal relationship showed that girls who improved their EHC over the two years became fitter (P < 0.001). There was also evidence that children with better EHC possessed a more positive body image (P = 0.05 for combined sex data), but there was no evidence of any relationships between EHC and %BF or PA (both P > 0.3). Finally, even at age 8 years, boys and girls participating in organized sport possessed better EHC than non-participants. These data provide evidence for the premise that early acquisition of this single motor skill promotes the development of a child's fitness, body image, and participation in sport.

Modelling change in adolescent smoking behaviour: stability of predictors across analytic models.

OBJECTIVES: The current paper examined the variability of predictors of changes in adolescent smoking across linear and nonlinear analytic models. DESIGN: Three analytic models typically used to model adolescent smoking behaviour were tested: one linear model of change (standard linear), one static linear model (pre-post linear) and one nonlinear model of change (cusp catastrophe). Variability in model composition was assessed by examining the pattern of variables achieving statistical significance and proportion of variance explained. METHODS: Model testing was conducted on data from Australian adolescents successfully tracked through a 12-month longitudinal study of smoking (N = 779). The survey measured demographics, self-reported smoking, smoking among friends and family, self-esteem, neuroticism, coping, stress and risk taking. RESULTS: The results indicated that while predictors of change were invariant across analytic models explanatory power varied markedly. Models of change in smoking that included simple, interacted or polynomial forms of initial conditions (past behaviour) explained more than four times the variance of models without. CONCLUSIONS: These results justified confidence in the predictors of change in adolescent smoking across analytic models. A secondary implication was that more research into past behaviour's role in the context of dynamical models of adolescent smoking and other health behaviour is needed.

Symptoms of stress and depression effect percentage of body fat and insulin resistance in healthy youth: LOOK longitudinal study.

OBJECTIVE: This study examined the longitudinal and cross-sectional effects of both psychosocial stress and depressive symptoms on insulin resistance and percentage body fat in a cohort of healthy Australian children, following them from childhood into adolescence. METHOD: Participants were 791 healthy, initially Grade 2 children (7-8 years; 394 girls), selected from the general community. Psychosocial stress was assessed using the Children's Stress Questionnaire, while depressive symptoms were assessed using the Children's Depression Inventory. Fasting blood samples for serum insulin and plasma glucose were collected to calculate the homeostasis model assessment-insulin resistance (HOMA-IR). Other measurements were height, weight, percentage body fat (dual energy x-ray absorptiometry), physical activity (pedometers), and pubertal maturation (Tanner score). RESULTS: Boys who reported more symptoms of depression had higher insulin resistance, irrespective of adiposity (p = .016); and longitudinally, we found a trend for boys who developed more depressive symptoms to develop higher insulin resistance (p = .073). These findings did not extend to girls. Furthermore, boys and girls with higher depressive symptoms had a higher percentage of body fat (p = .011 and .020, respectively); and longitudinally, boys whose depressive symptoms increased became fatter (p = .046). CONCLUSION: Our data provide evidence that early symptoms of depression increase insulin resistance, independent of adiposity. Our evidence that early symptoms of depression may lead to overweight, and obesity provides further reason to suggest that early attention to children with depression, even in preclinical stages, may reduce risk of chronic disease in later life. (PsycINFO Database Record

A cusp catastrophe model analysis of changes in adolescent substance use: assessment of behavioural intention as a bifurcation variable.

Behavioural intention was advanced as an alternative bifurcation variable to peer pressure in the context of a cusp catastrophe model of changes in adolescent substance use (Clair, 1998; Byrne, Mazanov & Gregson, 2001). Three sets of models were tested using data from a 12 month longitudinal study of adolescent smoking in Australia: the first with peer pressure only as the bifurcation term, the second with behavioural intention only and the third with both. In isolation both bifurcation variables performed similarly (adjusted-R2 and beta). In the third model, peer pressure edged out behavioural intention as an indicator of catastrophic change. Post hoc analysis revealed the polynomial and simple terms of initial conditions were more important than the bifurcation variable to explain change in smoking behaviour. This provoked a call for more work on finding an appropriately complex (non-straight line), theoretically justifiable mathematical model of adolescent substance use. Overall, behavioural intention was considered equivalent to peer pressure as a bifurcation variable although further research is needed to confirm this result.

Improved outcomes of high-risk emergency medical admissions cared for by experienced physicians.

BACKGROUND: Physician experience has been shown to improve clinical outcomes. Limited numbers of experienced clinicians make it unfeasible that they would care for all patients. We hypothesized that physician experience would impact outcomes for patients with high, but not low, risk of mortality. METHODS: All emergency admissions from 2002 to 2013 were studied. Two groups at low and high risk for mortality (1.3% (95% CI: 1.13, 1.62) vs. 19.4% (95% CI: 18.5, 20.3)) were defined by a risk prediction method comprising acute Illness Severity Score, Charlson Comorbidity Index and sepsis status. Length of stay (LOS) and 30-day in-hospital mortality were the primary end points. Consultant experience was studied univariately and also entered into a multiple logistic regression model to predict 30-day in-hospital survival. A zero-truncated Poisson regression model assessed LOS and incidence rate ratios (IRR) were calculated. RESULTS: Over the 12-year study period 66 933 admissions were recorded in 36 271 patients. High-risk patients cared for by more experienced (≥20 years qualified) physicians had a lower 30-day in-hospital mortality (19.4 vs. 17.1% P < 0.001), relative risk reduction 11.9%. The multivariable odds ratio of a 30-day in-hospital death for an experienced physician was 0.89 (95% CI: 0.82, 0.97; P = 0.009). LOS was shorter for high-risk patients allocated to experienced physicians with a multivariable IRR of 0.77 (95% CI: 0.94, 0.99; P = 0.02). No difference in outcomes was found for low-risk patients. CONCLUSION: High-risk but not low-risk patients have improved outcomes when cared for by physicians with greater experience.

Dietary contributors to hypertension in adults reviewed.

Recent national surveys which measured respondents' blood pressure (BP) levels have shown a high prevalence of hypertension amongst the Irish population, with approximately two-thirds of men and over half of women aged 45 years and over affected. Higher prevalence rates are observed with advancing age. Established diet- and lifestyle-related risk factors for hypertension such as high salt intake, high alcohol consumption and physical inactivity are pervasive in Ireland and are believed to contribute significantly to the high national prevalence of this condition. Additional dietary deficits have been implicated in the development of hypertension, however, including low fruit and vegetable intake, low dairy food consumption and low intake of oily fish. Deficiencies of single micro-nutrients such as folate, riboflavin, vitamin C and vitamin D have also been recently recognised as risk factors for hypertension. For each of these factors, there is evidence that the food and nutrient intakes of many Irish adults fall short of the ideal. These dietary and nutritional deficits, when superimposed on Ireland's existing health-subversive behaviours and escalating rates of obesity, constitute a potent constellation of risk factors for hypertension. However, they also represent viable and potentially effective targets for health promotion initiatives. This review aims to describe the main nutritional, dietary and lifestyle contributors to hypertension in Ireland with a view to informing future interventions aimed at alleviating Ireland's burden of hypertensive disease.

Psychological responses to illness and outcome after survived myocardial infarction: a long term follow-up.

Psychological responses to illness were examined in 120 survivors of myocardial infarction (MI) within two weeks of the clinical event. An attempt was then made to follow these patients over two years to investigate the influence of illness behaviour on outcome, defined cardiologically, occupationally and subjectively. Illness behaviour related only tenuously to cardiological and occupational outcome at two years after MI, though associations were rather more prominent where a subjective assessment of well-being constituted the outcome variable. This was in contrast with associations evidence eight months after MI. It was suggested that the influence of illness behaviour on the more objective and important measures of outcome (cardiological and occupational) is almost fully apparent at eight months after MI.

Adolescent stress and future smoking behaviour: a prospective investigation.

OBJECTIVE: Adolescent stress has been retrospectively associated with various measures of smoking behaviour in school-aged samples. The present study sought to extend this to a prospective investigation in order to examine the possibly formative influences of stress on the onset of smoking in adolescents. METHOD: A 12-month follow-up study related sources and degree of adolescent stress measured at study commencement with the onset of smoking behaviour 12 months later in a large cohort of adolescents attending Australian secondary schools. RESULTS: Adolescent stress was only weakly related to smoking onset in adolescent males and even this could possibly be explained by other factors. In adolescent girls, however, prospective associations were stronger and more broadly represented across the various domains of adolescent stress, suggesting that stress may exert a formative influence on smoking onset for girls. CONCLUSION: Management strategies for adolescent stress may be an affective target for smoking prevention programs among adolescent girls.

Type A behaviour and the experience of affective discomfort.

Early views of the Type A behaviour pattern (TABP) sought to disengage it from either neuroticism or emotional distress. Recent evidence challenging these views has, however, recommended a reevaluation of the area. Data arising from the present study indicate the TABP to be statistically related to measures of both neuroticism and emotional distress, though whether this association extends to a conceptional similarity, particularly with the former, is a matter for further discussion.

The effect of exercise on depression, anxiety and other mood states: a review.

This paper addresses the current literature related to investigations of the link between exercise treatments and depression, anxiety and other mood states. Results from these investigations are supportive of the anti-depressant, anti-anxiety and mood enhancing effects of exercise programs. There were considered to be, however, a number of potential methodological problems in many of the research studies; the nature of these were considered. Finally, some possible directions for future research are outlined.

Occupation, type A behavior and self-reported angina pectoris.

The utility of the Type A Behavior Pattern (TABP) as an explanatory concept in psychosomatic medicine has recently been challenged by the appearance of data casting doubt on associations between the TABP and coronary disease. The present study examined an interactive view of the relationship between the TABP and self-reported angina pectoris by suggesting that the TABP exerts a pathogenic influence only under certain occupational conditions. The data gave broad support to this view, and while the results are as yet preliminary, they point to a means of extending the usefulness of the TABP as a variable in epidemiological studies of cardiovascular disease.

Personality, stress and the decision to commence cigarette smoking in adolescence.

Adolescent cigarette smoking is an increasing health risk behaviour in many societies. The reasons why adolescents commence smoking are patently complex, though it has been suggested that young people take up this behaviour as a means of stress reduction during the difficult and challenging time of adolescence. This paper reports data which suggests that adolescent stress, broadly defined, does indeed relate to the decision to commence smoking by young people. Moreover, though the personality attribute of neuroticism is independently associated with this decision, it does not mediate the association between stress and smoking onset. The implications of these data for adolescent smoking prevention programs are discussed.

Illness behaviour and psychosocial outcome after a heart attack.

Patterns of illness behavior evident soon after myocardial infarction (MI) were examined in relation to psychosocial outcome eight months later. Significant associations, largely between illness behaviour reflecting affective distress and aspects of psychosocial outcome, hint at a causal relationship between the two. The importance of this is considered in terms of the clinical management of MI survivors.

Sex differences in the reporting of symptoms of depression in the general population.

The notion of sex differences in depression is well documented in the clinical literature. The origin of such differences is rather less well understood, though some recent opinion has it that sex differences represent no more than measurement artifact based on social influences on the reporting of emotional symptoms. The present study examined sex differences in the reporting of depressive symptoms in a random sample of a general population. Differences in prevalence were found to exist in the expected direction. Moreover, it was found that sex differences held as prominently for somatic symptoms of depression as for emotional or affective symptoms. This latter point is contrary to predictions which can be made on the basis of the "artifact' theory fo sex differences in depression, and leads to the conclusion that such differences represent a real clinical phenomenon.