Recent insights into egg quality and larval vitality of the European eel Anguilla anguilla.

To date, the eel industry still depends on wild-caught juveniles that are grown to marketable size. There is an urgent need to close the eel life cycle in captivity to make aquaculture independent of the natural population. With this artificial reproduction protocol, yolk-sac larvae can be produced but egg quality may be impaired. Low survival rates and high deformity rates are frequently observed during the first week after hatching. Over the past four years, we have conducted studies with the aim to optimize the artificial reproduction protocol, thereby focussing on increasing egg and larval quality. Weekly carp or salmon pituitary extract (PE) treatment was successfully replaced with recombinant gonadotropins (rGTHs) to mature female eels and produce larvae. 17α,20ß-dihydroxy-4-pregnen-3-one (DHP) was replaced with upstream precursor progesterone (P) to induce the endogenous production of DHP by the female eel. DHP and P were found equally potent in inducing oocyte maturation and ovulation. The effects of antibiotics on larval survival and the occurrence of deformities were investigated. Antibiotic treatment increased survival and decreased the occurrence of deformities indicating bacterial infection as an important cause. A deformity determination key for young eel larvae has been developed that provides a framework of reference for larval deformities which will be instrumental with gaining insights on the reasons behind each larval deformity. These improvements of the artificial reproduction protocol and hatchery practices will contribute to the production of robust eel larvae that survive, grow and metamorphose into juveniles that will later be able to reproduce in captivity.

The psychometric properties of the Burnout Assessment Tool in Norway: A thorough investigation into construct-relevant multidimensionality.

OBJECTIVE: The World Health Organization recognizes burnout as an occupational issue. Nevertheless, accurately identifying employee burnout remains a challenging task. To complicate matters, current measures of burnout have demonstrated limitations, prompting the development of the Burnout Assessment Tool (BAT). Given these circumstances, conducting an in-depth examination of the BAT's construct-relevant multidimensionality is crucial. METHOD: This study focuses on both the original 23-item BAT and the short 12-item version, using modern factor analytic methods to investigate reliability, validity, and measurement invariance in a representative sample from Norway (n = 493; 49.54% women). RESULTS: Our findings revealed that the bifactor exploratory structural equation modeling solution (burnout global factor and four specific burnout component factors) best explained the data for both BAT versions. All factors demonstrated adequate omega coefficients, with the global factor showing exceptional strength. Both BAT versions correlated highly with each other and with another burnout measure, suggesting convergent validity. Furthermore, both BAT versions achieved full (strict) measurement invariance based on gender. Finally, our results showed that burnout acts as a mediator in our proposed job demands-resources model as preliminary evidence of predictive validity. CONCLUSIONS: The study validates the Burnout Assessment Tool in the Norwegian context. The study supports the reliability, validity, and unbiased nature of the tool across genders. The findings also reinforce the importance of job demands and resources, along with burnout as a key mediator, in understanding workplace dynamics in accordance with job demands-resources theory.

The psychometric properties and measurement invariance of the Burnout Assessment Tool (BAT-23) in South Africa.

BACKGROUND: Burnout is an increasing public health concern that afflicts employees globally. The measurement of burnout is not without criticism, specifically in the context of its operational definition as a syndrome, also recently designated as such by the World Health Organisation. The Burnout Assessment Tool (BAT-23) is a new measure for burnout that addresses many of the criticisms surrounding burnout scales. The aim of this study is to determine the validity, reliability, and measurement invariance of the BAT-23 in South Africa. METHOD: A quantitative, cross-sectional survey, approach was taken (n = 1048). Latent variable modelling was implemented to investigate the construct-relevant multidimensionality that is present in the BAT. For measurement invariance, the configural, metric, scalar, and strict models were tested. RESULTS: The analyses showed that the hierarchical operationalisation of BAT-assessed burnout was the most appropriate model for the data. Specifically, a bifactor ESEM solution. Composite reliability estimates were all well above the cut-off criteria for both the global burnout factor and the specific factors. The measurement invariance tests showed that gender achieved not only strong invariance, but also strict invariance. However, ethnicity initially only showed strong invariance, but a test of partial strict invariance did show that the mean scores could be fairly compared between the groups when releasing certain constraints. CONCLUSIONS: The BAT-23 is a valid and reliable measure to investigate burnout within the Southern African context.

Autonomy-supportive agents: whose support matters most, and how does it unfold in the workplace?

Managers and colleagues satisfy others' need for autonomy, but employees can also satisfy their own need by engaging in autonomy crafting practices. Although all three sources of autonomy support can benefit employee outcomes, they may not be equally beneficial. Furthermore, their benefits may not be straightforward, but rather a psychological process unfolding. To test these assumptions, the aim of the present study was twofold: to determine whether the different sources of support explained significantly different amounts of variance in autonomy satisfaction when compared and to understand the psychological process through which autonomy support from three sources influenced performance, more specifically, whether autonomy support indirectly affected performance through perceived autonomy satisfaction and work engagement in serial. In a sample of 278 employees, autonomy support from others (especially managers) and autonomy crafting played a role in autonomy satisfaction. Furthermore, the results indicated that autonomy support was associated with performance through its serial associations with autonomy satisfaction and work engagement. The results emphasized the importance of autonomy support for performance, enabling organizations to proactively design interventions to improve engagement and performance. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03550-9.

Optimization of PEGylated KL4 Peptide for siRNA Delivery with Improved Pulmonary Tolerance.

Pulmonary delivery of small interfering RNA (siRNA) is a promising therapeutic strategy for treating various respiratory diseases but an effective carrier for the delivery of siRNA into the cells of the lungs and a robust gene-silencing effect is still lacking. Previously, we reported that the KL4 peptide, a synthetic cationic peptide with a repeating KLLLL sequence, can mediate effective siRNA transfection in lung epithelial cells but its high hydrophobic leucine content, and hence poor water solubility, limits its application as a delivery vector. Here, we show that the covalent attachment of monodisperse poly(ethylene glycol) (PEG) improves the solubility of KL4 and the uptake of its complex with siRNA into lung epithelial cells, such that very robust silencing is produced. All PEGylated KL4 peptides, with PEG length varying between 6 and 24 monomers, could bind and form nanosized complexes with siRNA, but the interaction between siRNA and peptides became weaker as the PEG chain length increased. All PEGylated KL4 peptides exhibited satisfactory siRNA transfection efficiency on three human lung epithelial cell lines, including A549 cells, Calu-3 cells, and BEAS-2B cells. The PEG12KL4 peptide, which contains 12 monomers of PEG, was optimal for siRNA delivery and also demonstrated a low risk of inflammatory response and toxicity in vivo following pulmonary administration.

Energy efficiency of digestible protein, fat and carbohydrate utilisation for growth in rainbow trout and Nile tilapia.

Currently, energy evaluation of fish feeds is performed on a digestible energy basis. In contrast to net energy (NE) evaluation systems, digestible energy evaluation systems do not differentiate between the different types of digested nutrients regarding their potential for growth. The aim was to develop an NE evaluation for fish by estimating the energy efficiency of digestible nutrients (protein, fat and carbohydrates) and to assess whether these efficiencies differed between Nile tilapia and rainbow trout. Two data sets were constructed. The tilapia and rainbow data set contained, respectively, eight and nine experiments in which the digestibility of protein, fat and energy and the complete energy balances for twenty-three and forty-five diets was measured. The digestible protein (dCP), digestible fat (dFat) and digestible carbohydrate intakes (dCarb) were calculated. By multiple regression analysis, retained energy (RE) was related to dCP, dFat and dCarb. In tilapia, all digestible nutrients were linearly related to RE (P<0·001). In trout, RE was quadratically related to dCarb (P<0·01) and linearly to dCP and dFat (P<0·001). The NE formula was NE=11·5×dCP+35·8×dFAT+11·3×dCarb for tilapia and NE=13·5×dCP+33·0×dFAT+34·0×dCarb-3·64×(dCarb)2 for trout (NE in kJ/(kg0·8×d); dCP, dFat and dCarb in g/(kg0·8×d)). In tilapia, the energetic efficiency of dCP, dFat and dCarb was 49, 91 and 66 %, respectively, showing large similarity with pigs. Tilapia and trout had similar energy efficiencies of dCP (49 v. 57 %) and dFat (91 v. 84 %), but differed regarding dCarb.

Electroconvulsive therapy for catatonia in juvenile neuropsychiatric lupus.

Neuropsychiatric manifestations are serious and frequent complications of systemic lupus erythematous (SLE). Catatonia is a neuropsychiatric disorder characterized by motor disturbance (including waxy flexibility and catalepsy), stupor, excitement, negativism, mutism, echopraxia and echolalia. Catatonia associated with SLE has been only rarely reported, especially in children. Here we present a case of a 14-year-old patient encountered in consultation-liaison psychiatry who presented catatonia associated with SLE. Her catatonia was refractory to treatment with pulse methylprednisolone, intravenous cyclophosphamide and rituximab. The patient responded to a combined therapy of electroconvulsive therapy and benzodiazepines. The present case suggests that although rarely reported, catatonia seen in the background of SLE should be promptly identified and treated to reduce the morbidity.

Casting a Wider Net: On the Utilitarian Nature of Burnout Assessment in the Workplace.

Some consider the burnout label to be controversial, even calling for the abandonment of the term in its entirety. In this communication, we argue for the pragmatic utility of the burnout paradigm from a utilitarian perspective, which advocates the greatest good for the most significant number of employees in organisations. We first distinguish between mild work-related burnout complaints and more severe burnout that can be identified in some contexts. We address the classification of burnout as an 'occupational phenomenon' by the World Health Organization and its ambiguous status in the ICD-11, highlighting the challenge of universally diagnosing burnout as a condition. We argue that a purely clinical approach might be too reactive as it normally only identifies employees with a diagnosable condition. We posit that early detection of burnout through valid assessment can identify struggling employees who do not yet have a diagnosable condition. This proactive approach can help prevent escalation into mental health crises and is more sensible for organisations in terms of effectiveness and employee retention.

Clinical management of contrast-induced neurotoxicity: a systematic review.

BACKGROUND: Contrast-induced neurotoxicity (CIN) is an increasingly recognised complication following endovascular procedures utilising contrast. It remains poorly understood with heterogenous clinical management strategies. The aim of this review was to identify commonly employed treatments for CIN to enhance clinical decision making. METHODS: A systematic search of Embase (1947-2022) and Medline (1946-2022) was conducted. Articles describing (i) patients with a clinical diagnosis of CIN, (ii) with radiological exclusion of other pathologies, (iii) detailed report of treatments, and (iv) discharge outcomes, were included. Data relating to demographics, procedure, symptoms, treatment and outcomes were extracted. RESULTS: A total of 73 patients were included, with a median age of 64 years. The most common procedures were cerebral angiography (42.5%) and coronary angiography (42.5%), and the median volume of contrast administered was 150 ml. The most common symptoms were cortical blindness (38.4%) and reduced consciousness (28.8%), and 84.9% of patients experienced complete resolution at the time of discharge. Management included intravenous fluids to dilute contrast in the cerebrovasculature (54.8%), corticosteroids to reduce blood-brain barrier damage (47.9%), antiseizure (16.4%) and sedative (16.4%) medications. Mannitol (13.7%) was also utilised to reduce cerebral oedema. Intensive care admission was required for 19.2% of patients. No statistically significant differences were observed between treatment and discharge outcomes. CONCLUSIONS: The clinical management of CIN should be considered on a patient-by-patient basis, but may consist of aggressive fluid therapy alongside corticosteroids, as well as other supportive therapy as required. Further examination of CIN management is required to define best practice.

Neuroradiological features of contrast-induced neurotoxicity: A systematic review and pooled analysis.

BACKGROUND: Contrast-induced neurotoxicity (CIN), is an increasingly recognised complication of endovascular procedures, presenting as a spectrum of neurological symptoms that mimic ischaemic stroke. The diagnosis of CIN remains a clinical challenge, and stereotypical imaging findings are not established. This study was conducted to characterise the neuroimaging findings in patients with CIN, to raise diagnostic awareness and improve decision making. METHODS: We performed a systematic review of PubMed and Embase databases from inception (1946/1947) to June 2023 for reports of CIN following administration of iodinated contrast media. Studies with a final diagnosis of CIN, which provided details of neuroimaging were included. All included cases were pooled and descriptive analysis was conducted. RESULTS: A total of 84 patients were included, with a median age of 64 years. A large proportion of patients had normal imaging (CT 40.8 %, MRI 53.1 %). CT abnormalities included cortical/subarachnoid hyperattenuation (42.1 %), cerebral oedema/sulcal effacement (26.3 %), and loss of grey-white differentiation (7.9 %). Frequently reported MRI abnormalities included brain parenchymal MRI signal change (40.8 %) and cerebral oedema (12.2 %), most commonly observed on FLAIR sequences (26.5 %). Characterisation of imaging findings according to anatomical location and clinical symptoms has been conducted. CONCLUSIONS: Neuroimaging is an essential part of the diagnostic workup of CIN. Analysis of the anatomical location and laterality of imaging abnormalities may suggest relationship between radiological features and actual clinical symptoms, although this remains to be confirmed with dedicated study. Radiological abnormalities, particularly CT, appear to be transient and reversible in most patients.

A validation study of the Occupational Depression Inventory in Poland and Ukraine.

This study examined the psychometric and structural properties of the Polish and Ukrainian versions of the Occupational Depression Inventory (ODI). We relied on two samples of Polish employees (NSample1 = 526, 47% female; NSample2 = 164, 64% female) and one sample of Ukrainian employees (NSample3 = 372, 73% female). In all samples, the ODI exhibited essential unidimensionality and high total-score reliability (e.g., McDonald's omegas > 0.90). The homogeneity of the scale was strong (e.g., 0.59 ≤ scale-level Hs ≤ 0.68). The ODI's total scores thus accurately ranked individuals on a latent occupational depression continuum. We found evidence of complete measurement invariance across our samples, a prerequisite for between-group comparisons involving observed scores. Looking into the criterion validity of the ODI, we found occupational depression to correlate, in the expected direction, with resilience and job-person fit in six areas of working life-workload, control, rewards, community, fairness, and values. The prevalence of occupational depression was estimated at 5% in Sample 1, 18% in Sample 2, and 3% in Sample 3. Our findings support the use of the ODI's Polish and Ukrainian versions. This study adds to a growing corpus of research suggesting that the ODI is a robust instrument.

The burnout-depression conundrum: investigating construct-relevant multidimensionality across four countries and four patient samples.

This research seeks to contribute to the ongoing discussion about the distinctive nature of burnout and depression. In a first study, we relied on employee samples from four European countries (N = 5199; 51.27% women; Mage = 43.14). In a second study, we relied on a large sample of patients (N = 5791; 53.70% women; Mage = 39.54) who received a diagnosis of burnout, depressive episode, job strain, or adaptation disorder. Across all samples and subsamples, we relied on the bifactor exploratory structural equation modelling to achieve an optimal disaggregation of the variance shared across our measures of burnout and depression from the variance uniquely associated with each specific subscale included in these measures. Our results supported the value of this representation of participants' responses, as well as their invariance across samples. More precisely, our results revealed a strong underlying global factor representing participants' levels of psychological distress, as well as the presence of equally strong specific factors supporting the distinctive nature of burnout and depression. This means that, although both conditions share common ground (i.e. psychological distress), they are not redundant. Interestingly, our results also unexpectedly suggested that suicidal ideation might represent a distinctive core component of depression.

Is it time to rethink microsurgical training for the treatment of intracranial aneurysms in Australia?

BACKGROUND: Case volume and complexity for microsurgical treatment of cerebral aneurysms have changed due to the growing use of endovascular therapy in clinical practice. The authors sought to quantify the clinical exposure of Australian neurosurgery trainees to cerebral aneurysm microsurgery. METHODS: This observational, retrospective cross-sectional study examined the Australian National Hospital Morbidity database for all admissions related to microsurgical and endovascular treatment of aneurysmal subarachnoid haemorrhage (aSAH) and unruptured intracranial aneurysms (UIAs) for the years 2008 to 2018. Procedural volumes were compared with neurosurgical trainee figures to investigate the rate of procedural exposure relative to the neurosurgical workforce. RESULTS: A total of 8,874 (41.6%) microsurgical procedures (3,662 for aSAH, 5,212 for UIAs), and 12,481 (58.4%) endovascular procedures (6,018 for aSAH, 6,463 for UIAs) were performed. Trainee exposure to microsurgery in aSAH declined from 9.1 to 7.3 cases per trainee per annum (mean 7.7), with case complexity confined mostly to simple anterior circulation aneurysms. There are significant state-by-state differences in the preferred treatment modality for aSAH. During the same study period, the number of microsurgical cases for UIAs increased (from 8.9 to 13.5 cases per trainee per annum, mean 11.0). Significantly more endovascular procedures are performed than microsurgery (10.7 to 17.0, mean 12.7 cases, for aSAH; 8.0 to 21.5, mean 13.7 cases, for UIAs). CONCLUSIONS: Trainee exposure to open aneurysm surgery for aSAH have significantly declined in both case volume and complexity. There is an overall increase in the number of surgeries for elective aneurysms, but this varies widely from state-to-state.

Big number, big body: Jersey numbers alter body size perception.

Vision has been shown to be an active process that can be shaped by top-down influences. Here, we add to this area of research by showing a surprising example of how visual perception can be affected by cognition (i.e., cognitive penetration). Observers were presented, on each trial, with a picture of a computer-generated football player and asked to rate the slenderness of the player on an analog scale. The results of two experiments showed that observers perceived athletes wearing small jersey numbers as more slender than those with high numbers. This finding suggests that the cognition of numbers quantitatively alters body size perception. We conjecture that this effect is the result of previously learned associations (i.e., prior expectations) affecting perceptual inference. Such associations are likely the result of implicit learning of the statistical regularities of number and size attributes co-occurrences by the nervous system. We discuss how these results are consistent with previous research on statistical learning and how they fit into the Bayesian framework of perception. The current finding supports the notion of top-down influences of cognition on perception.

Burnout of emergency nurses in a South African context: the role of job demands and resources, and capabilities.

Emergency nurses are prone to burnout due to the nature of their profession and working environment, potentially putting their sustainable employability at risk and so too the care provided by and success of emergency departments. Psychological research has predominantly focused on samples drawn from western, educated, industrialized, rich, and democratic (WEIRD) societies, concerning a small part of the world population. Consequently, this study investigated emergency nurses' burnout in a non-WEIRD society and assessed the role of job demands-resources and work capabilities on their burnout levels. A total of 204 emergency nurses in a South African context participated in a cross-sectional survey. The Job Demands-Resources Scale, the Capability Set for Work Questionnaire, and the Burnout Assessment Tool-Short Form were administered. Using and developing knowledge and skills and building and maintaining meaningful relationships were the strongest work capabilities of emergency nurses. In contrast, earning a good income, involvement in important decisions, and contributing to something valuable were the weakest capabilities. Latent class analysis resulted in three capability sets: a robust capability set, an inadequate capability set, and a weak capability set. Regarding job resources, emergency nurses with a robust capability set reported better relationships with their supervisors and higher job autonomy than the inadequate and weak capability sets. In addition, emergency nurses with a robust capability set reported better co-worker relationships and better access to good equipment than those with a weak capability set. Nurses with an inadequate capability set experienced significantly more challenging job demands than the other two sets. Finally, nurses with a weak capability set (compared to the robust capability set) experienced significantly higher levels of exhaustion and mental distance. Improving emergency nurses' job resources (especially relationships with co-workers and supervisors, job autonomy, and equipment sufficiency) would increase their capabilities, decreasing their burnout levels, especially exhaustion and mental distance.

Safety and effectiveness of spinal dural defect repair in the management of superficial siderosis: A systematic review and patient-level analysis.

OBJECTIVE: Superficial siderosis (SS) is a disabling neurodegenerative condition that may be caused by spinal dural defects. Surgical repair is increasingly performed, however clinical outcomes remain unclear. METHODS: A systematic search of PubMed, MEDLINE, and EMBASE was conducted (inception to February 2020). Studies reporting cases of (i) superficial siderosis, (ii) spinal dural defect, (iii) and surgical closure of the defect were included. Demographic characteristics, clinical presentation, operative technique and clinical outcome were extracted for patient-level analysis. RESULTS: A total of 26 publications were included, which reported 38 patients with a median age of 58 years, and a male predominance (78.9 %). Ataxia (85.7 %) and hearing loss (80.0 %) were the most common presenting symptoms. The causative dural defect was most commonly ventral in location (91.7 %) and most commonly identified by CT myelography (48.6 %). Operative technique was highly variable and included primary suture, fibrin glue, dural substitute, or tissue (fat or muscle) graft. Clinical improvement was reported in 21 %, with stabilisation of symptoms in the majority (66 %) and clinical deterioration in 13.2 %. Surgical complications were observed in 7.9 %. CONCLUSION: In patients with superficial siderosis and spinal dural defect, operative closure leads to improvement or stabilisation of symptoms in the vast majority (87%) of patients.

The induction of oocyte maturation and ovulation in the European eel (Anguilla anguilla): in vitro and in vivo comparison of progesterone with 17α,20ß-dihydroxy-4-pregnen-3-one.

Ovulation in European eel is induced by injection of 17α,20ß-dihydroxy-4-pregnen-3-one (DHP) as the maturation-inducing hormone (MIH). Female eels need to ovulate within 18 h after injection to release good quality eggs. Progesterone (P), as an upstream precursor of DHP, may promote endogenous DHP production and improve egg quality. The purpose of this study was therefore to compare treatment of P with DHP on batch level, in vitro, to determine dose-response effects, and in vivo, at a single dose. For the in vitro experiment, ovarian tissue was extracted and placed in culture plates containing hormone-free medium and media supplemented with the treatment: DHP at 1, 10 and 100 ng mL-1, or P at 10, 100 and 1,000 ng mL-1. At the start of incubation, the folliculated oocytes were sampled for histology, microscopy and qPCR. After incubation for 12 and 18 h, the oocytes were sampled for microscopy and qPCR analysis. For the in vivo experiment, females were either injected with DHP or P at a dose of 2 mg kg-1 to assess their effects on ovulation and reproductive success. At the moment of release, eggs were sampled for RNA sequencing to compare effects of DHP and P on the expression of genes involved in egg quality aspects. Remaining eggs were fertilized and larval viability was recorded. Both DHP and P were able to induce GVBD (DHP at 10 and 100 ng mL-1, P at 100 and 1,000 ng mL-1) in vitro. Expression of genes involved in oocyte maturation and ovulation was similar in vitro for both DHP and P treatments. Regarding the in vivo results, RNAseq results reflected similar DHP and P effects on the expression of genes involved in egg quality aspects. Females injected with either DHP or P ovulated, released eggs, and were equally able to produce larvae without any differences in reproductive success. Our results support the conclusion that DHP and P work equally well in vitro and in vivo. P is more attractive to apply as the price is 3,000 times lower than the price of DHP.

Current knowledge and perspectives of contrast-induced neurotoxicity: A survey of Australian clinicians.

BACKGROUND: Contrast-induced Neurotoxicity (CIN) is an increasingly recognised complication following endovascular procedures. It remains a relatively unexplored clinical entity, and we sought to characterise clinician perspectives towards CIN, as well as identify gaps in knowledge and provide directions for future research. METHODS: An online survey was distributed to members of the Australian and New Zealand Society of Neuroradiology, as well as several Australian tertiary hospitals. Questions related to clinical exposure to CIN, diagnosis, management and pathophysiology were explored. Descriptive analysis was conducted on survey responses, and statistical analysis was performed using Chi-square and Fisher's exact test as appropriate. RESULTS: A total of 95 survey responses were recorded (26.8% response rate). Only 28.4% of respondents were comfortable in diagnosing CIN, and even fewer (24.2%) were comfortable in independently managing CIN patients. Based on clinician opinion, symptoms including impaired consciousness and cortical blindness were thought to be most associated with CIN, whilst the radiological findings of parenchymal oedema and cortical enhancement were considered to be most indicative of CIN. Most clinicians agreed that further investigation is required related to pathophysiology (86.3%), diagnosis (83.2%), and treatment (82.1%). CONCLUSION: CIN is a poorly understood complication following endovascular procedures. Significant gaps in clinical understanding are evident, and further investigation is vital to improve diagnosis and management.

Cumulative Time of Cigarette Smoking Is Associated with a Greater Risk of Aneurysmal Subarachnoid Hemorrhage and Younger Age at Presentation: A Nationwide Observation Study.

BACKGROUND: Smoking is known to be associated with an increased risk of intracranial aneurysm rupture; however, the risk in smokers stratified by age, sex, and aneurysm location is not clear. METHODS: A retrospective study of all aneurysmal subarachnoid hemorrhage (aSAH) cases in Australia between 2008 and 2018 was conducted. The relative risk of aSAH in smokers compared with nonsmokers was calculated on the basis of nationwide smoking statistics and was stratified according to sex, age group, and aneurysm location. RESULTS: Out of 12,915 aSAH patients, 3249 (25.2%) were active smokers. Across both men and women, smoking increased the risk of aSAH by 2.4× in 30- to 39-year-olds (95% CI 2.1-2.7), 2.4× in 40- to 49-year-olds (95% CI 2.2-2.7), 2.3× in 50- to 59-year-olds (95% CI 2.1-2.4), and 1.8× in 60- to 69-year-olds (95% CI 1.7-2.0) with less of an effect in smokers younger than 30 years (RR: 1.2, 95% CI 1.0-1.5) and older than 70 years (RR: 1.0, 95% CI 0.9-1.2). Compared with a nonsmoker younger than 30 years old, the relative risk of aSAH increased by an average of 7.2 for every decade spent smoking in women and an average of 4.0 for every decade spent smoking in men. Additionally, smokers were 5.2× more likely to present before 50 years of age. CONCLUSIONS: Smoking increased the risk of aSAH by 2-fold between the ages of 30 and 60. Smokers experienced aSAH at younger ages.

Aneurysmal subarachnoid haemorrhage in Indigenous and non-Indigenous Australians: A retrospective study assessing patient characteristics and outcome.

INTRODUCTION: Smoking and hypertension are prevalent among Indigenous Australians (Aboriginal and Torres Strait Islanders). We investigated if these risk factors suggest a greater rate of aneurysmal subarachnoid haemorrhage in Indigenous Australians (IA) compared to non-IA. MATERIALS AND METHODS: A retrospective cross-sectional study was performed on data retrieved from the Nationwide Hospital Morbidity Database for all aSAH cases in Australia between 2012 and 2018. Patient characteristics, radiological findings, aneurysm characteristics, treatment characteristics and discharge outcomes were assessed. Crude and age-adjusted incidences, trends of aSAH and case fatality rate over time were calculated. RESULTS: A total of 12,286 patients were included (285 IA, 12,001 non-IA). Indigenous aSAH patients were significantly younger than non-IA, with 89.8 percent of IA younger than 65 years old (p < 0.001). Crude annual incidences were similar between the 2 cohorts, however age-adjusted incidence shows a RR = 1.4 at 45-59 years in IA patients, compared with their non-IA counterparts. 30-day mortality was similar between the two groups, at 25.3 and 26.9% for IA and non-IA groups, respectively. CONCLUSION: This 10 year nationwide retrospective study highlights a disparity between the crude and age-adjusted incidence of aSAH in IA compared to non-IA.