A large multi-country outbreak of monkeypox across 41 countries in the WHO European Region, 7 March to 23 August 2022.

Following the report of a non-travel-associated cluster of monkeypox cases by the United Kingdom in May 2022, 41 countries across the WHO European Region have reported 21,098 cases and two deaths by 23 August 2022. Nowcasting suggests a plateauing in case notifications. Most cases (97%) are MSM, with atypical rash-illness presentation. Spread is mainly through close contact during sexual activities. Few cases are reported among women and children. Targeted interventions of at-risk groups are needed to stop further transmission.

Suicide and Self-Harm Risk Assessment: A Systematic Review of Prospective Research.

OBJECTIVE: Suicide and self-harm are widespread yet underreported. Risk assessment is key to effective self-harm and suicide prevention and management. There is contradicting evidence regarding the effectiveness of risk assessment tools in predicting self-harm and suicide risk. This systematic review examines the effect of risk assessment strategies on predicting suicide and self-harm outcomes among adult healthcare service users. METHOD: Electronic and gray literature databases were searched for prospective research. Studies were screened and selected by independent reviewers. Quality and level of evidence assessments were conducted. Due to study heterogeneity, we present a narrative synthesis under three categories: (1) suicide- and self-harm-related outcomes; (2) clinician assessment of suicide and self-harm risk; and (3) healthcare utilization due to self-harm or suicide. RESULTS: Twenty-one studies were included in this review. The SAD PERSONS Scale was the most used tool. It outperformed the Beck Scale for Suicide Ideation in predicting hospital admissions and stay following suicide and self-harm, yet it failed to predict repeat suicide and self-harm and was not recommended for routine use. There were mixed findings relating to clinician risk assessment, with some studies recommending clinician assessment over structured tools, whilst others found that clinician assessment failed to predict future attempts and deaths. CONCLUSIONS: There is insufficient evidence to support the use of any one tool, inclusive of clinician assessment of risk, for self-harm and suicidality. The discourse around risk assessment needs to move toward a broader discussion on the safety of patients who are at risk for self-harm and/or suicide.HIGHLIGHTSThere is insufficient evidence to support using standalone risk assessment tools.There are mixed findings relating to clinician assessment of risk.Structured professional judgment is widely accepted for risk assessment.

Feasibility of a multifaceted implementation intervention to improve attendance at diabetic retinopathy screening in primary care in Ireland: a cluster randomised pilot trial.

OBJECTIVES: Diabetic retinopathy screening (DRS) uptake is suboptimal in many countries with limited evidence available on interventions to enhance DRS uptake in primary care. We investigated the feasibility and preliminary effects of an intervention to improve uptake of Ireland's national DRS programme, Diabetic RetinaScreen, among patients with type 1 or type 2 diabetes. DESIGN/SETTING: We conducted a cluster randomised pilot trial, embedded process evaluation and cost analysis in general practice, July 2019 to January 2020. PARTICIPANTS: Eight practices participated in the trial. For the process evaluation, surveys were conducted with 25 staff at intervention practices. Interviews were conducted with nine staff at intervention practices, and 10 patients who received the intervention. INTERVENTIONS: The intervention comprised practice reimbursement, an audit of attendance, electronic prompts targeting professionals, General Practice-endorsed patient reminders and a patient information leaflet. Practices were randomly allocated to intervention (n=4) or wait-list control (n=4) (usual care). OUTCOMES: Staff and patient interviews explored their perspectives on the intervention. Patient registration and attendance, including intention to attend, were measured at baseline and 6 months. Microcosting was used to estimate intervention delivery cost. RESULTS: The process evaluation identified that enablers of feasibility included practice culture and capacity to protect time, systems to organise care, and staff skills, and workarounds to improve intervention 'fit'. At 6 months, 22/71 (31%) of baseline non-attenders in intervention practices subsequently attended screening compared with 15/87 (17%) in control practices. The total delivery cost across intervention practices (patients=363) was €2509, averaging €627 per practice and €6.91 per audited patient. Continuation criteria supported proceeding to a definitive trial. CONCLUSIONS: The Improving Diabetes Eye screening Attendance intervention is feasible in primary care; however, consideration should be given to how best to facilitate local tailoring. A definitive trial of clinical and cost-effectiveness is required with preliminary results suggesting a positive effect on uptake. TRIAL REGISTRATION NUMBER: NCT03901898.

The use of film-based interventions in adolescent mental health education: A systematic review.

Film-based interventions have been embraced by adolescents as educational tools, but their efficacy in mental health education remains under-explored. In this review, we systematically examined the use of film-based interventions in adolescent mental health education. A systematic review of the empirical literature was conducted using the following databases: Academic Search Complete, Education Full Text [H.W. Wilson], CINAHL Plus with Full Text, Humanities Full Text [H.W. Wilson], MEDLINE, APA PsycArticles, APA PsycInfo, Psychology and Behavioral Sciences Collection, Social Sciences Full Text [H.W. Wilson], Soc Index, ERIC. Risk of Bias were assessed using Version 2 of the Cochrane RoB tool for randomised trials (RoB2) or the Cochrane Collaboration Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I). Ten peer-reviewed studies were included in this review. Film emerged as a promising education method for enhancing metal health literacy and reducing stigma. Mixed reports were found for improving attitudes towards help-seeking, with narrative-based films having a weaker effect on attitudes towards help-seeking when compared with more instructive approaches. No study focussed on resilience. This review highlights the utility and potential for film-based interventions in adolescent mental health education. Further research is warranted around how best to implement such interventions to engage adolescents.

Healthcare staff's views on responding to suicide and self-harm: Part II.

PURPOSE: To report on healthcare staff's views of the barriers to preventing suicide and self-harm. DESIGN AND METHODS: Using a qualitative approach, data were collected through "World Café" discussion forums and written submissions, and analyzed using reflexive thematic analysis. FINDINGS: Healthcare staff, including psychiatric nurses, perceived that a whole of society approach was needed for suicide and self-harm prevention. Support for those at the front line is needed as well as clear referral pathways and interagency working. PRACTICE IMPLICATIONS: Formalized support for staff working in healthcare should be given with a flexible and inclusive approach to service delivery adopted.

Healthcare staff's views on responding to suicide and self-harm: Part I.

PURPOSE: To explore healthcare staff's knowledge and awareness of, and responses to, suicide and self-harm. DESIGN AND METHODS: A qualitative design was adopted, and data were collected using a "World Café" approach (n = 143 participants), in addition to written submissions (n = 10). Data were analyzed using reflexive thematic analysis. FINDINGS: There was variation relating to awareness of and responses to suicide and self-harm. Participants highlighted the need for further staff education and training, and a review of standardized assessment tools and referral processes. PRACTICE IMPLICATIONS: Tailored training and education resources are required for healthcare staff. Clear protocols for assessing, treating, and referring people deemed at risk of suicide and self-harm are needed.

Staff awareness of suicide and self-harm risk in healthcare settings: A mixed-methods systematic review.

BACKGROUND: Suicide risk screening in healthcare settings plays a significant role in suicide prevention. Healthcare staff who are poorly informed about self-harm and suicide risk are less likely to identify and subsequently screen at-risk individuals. This mixed-method systematic review aimed to appraise and synthesise evidence from studies that explored and promoted healthcare staff's knowledge and awareness of suicide and self-harm risk in healthcare settings. METHODS: Electronic databases (CINAHL, MEDLINE, APA PsycInfo, APA PsycARTICLES, Psychology and behavioural Science Collection, ERIC, and SocINDEX), the Cochrane Library, and various grey literature databases were searched for relevant studies. The level of evidence and methodological quality of the included studies were assessed. RESULTS: Eighteen empirical studies were included. Levels of knowledge about suicide and self-harm risk varied significantly across the reviewed studies. Face-to-face group training and educational programmes, digital or online educational programmes, and an educational poster campaign were amongst the strategies used to promote awareness of suicide and self-harm risk, with the majority marginally succeeding in doing so. LIMITATIONS: The reviewed studies were heterogeneous in terms of design, interventions, and outcome measures which made it difficult to make comparisons. The overall level of scientific evidence was classified as being relatively low. The lack of blinding and lack of a control group were amongst the limitations for experimental studies. CONCLUSIONS: Long-term, routine face-to-face group training programmes should be established to educate healthcare staff about suicide risk across all professions and in specific patient groups.

Associations of self-reported physical activity and anxiety symptoms and status among 7,874 Irish adults across harmonised datasets: a DEDIPAC-study.

BACKGROUND: Anxiety is an adaptive response to an objective or perceived threat; however, when symptoms become severe and chronic it that can become a maladaptive anxiety disorder. Limited evidence suggests that physical activity may be associated with prevention against anxiety. This study uses data from The Irish Longitudinal Study on Ageing (TILDA) and The Mitchelstown Cohort Study to investigate cross-sectional associations between physical activity and anxiety symptoms and status among Irish adults. METHODS: Both datasets were harmonized (n = 7874). The short form International Physical Activity Questionnaire measured physical activity. Participants were classified as meeting World Health Organization physical activity guidelines (≥150 min weekly of moderate intensity physical activity, ≥75 min weekly of vigorous intensity physical activity, or ≥ 600 MET-minutes) or not. They were also divided into three groups based on weekly MET-minutes of moderate-to-vigorous physical activity (Low: 0-599; Moderate: 600-1199; High: ≥1200), and three groups based on weekly minutes of walking (Low: 0-209; Moderate: 210-419; High: 420+). Anxiety symptoms were measured by the Hospital Anxiety and Depression Scale with a score of ≥8 indicating anxiety. Binomial logistic regression, adjusted for relevant confounders examined physical activity-anxiety associations. RESULTS: Females had higher rates of anxiety than males (28.0% vs 20.0%; p < 0.001). Following adjustment for relevant covariates, meeting physical activity guidelines was associated with 13.5% (95% CI: 2.0-23.7; p = 0.023) lower odds of anxiety. Moderate and High physical activity were associated with 13.5% (- 11.0-32.6; p = 0.254) and 13.6% (1.4-4.2; p = 0.030) lower odds of anxiety compared to Low physical activity, respectively. Moderate and High walking were associated with 2.1% (- 14.5-16.3; p = 0.789) and 5.1% (- 9.3-17.6; p = 0.467) lower odds of anxiety compared to Low walking, respectively. CONCLUSION: Meeting physical activity guidelines is associated with lower odds of anxiety, but the strength of associations did not increase considerably with increased physical activity levels.

The association between self-harm and area-level characteristics in Northern Ireland: an ecological study.

BACKGROUND: Factors contributing to suicidal behaviour are complex and multi-faceted. This study took an ecological approach to examine the association between area-level factors and rates of self-harm in Northern Ireland. METHODS: Data on self-harm presentations to emergency departments (EDs) were obtained from the Northern Ireland Self-harm Registry. The study included residents of Northern Ireland aged 16-64 years. Deprivation was measured using the Northern Ireland Multiple Deprivation Measure 2017. Population density and social fragmentation were calculated using measures from the 2011 census. Associations between area-level factors and self-harm rates were explored using negative binomial regression. RESULTS: Between 2013 and 2015, 14 477 individuals aged 16-64 years presented to EDs in Northern Ireland following self-harm. The rate of self-harm was 472 per 100 000 and was higher for male residents (478 vs. 467). Self-harm rates were highest in urban areas-680 per 100 000 in Belfast City and 751 per 100 000 in Derry City. Rates of self-harm in Northern Ireland were more than four times higher in the most deprived areas. A positive association with rates of self-harm held for the deprivation domains of employment, crime, education, health and income. There was a moderate association with population density. Some gender differences emerged, with associations with male rates of self-harm more pronounced. CONCLUSION: These findings indicate that self-harm rates are highest for those residing in highly deprived areas, where unemployment, crime and low level of education are challenges. Community interventions tailored to meet the needs of specific areas may be effective in reducing suicidal behaviour.

Associations of self-reported physical activity and depression in 10,000 Irish adults across harmonised datasets: a DEDIPAC-study.

BACKGROUND: Depression is a prevalent, debilitating, and often recurrent mood disorder for which successful first-line treatments remains limited. The purpose of this study was to investigate the cross-sectional associations between self-reported physical activity (PA) and depressive symptoms and status among Irish adults, using two existing datasets, The Irish Longitudinal Study on Ageing (TILDA) and The Mitchelstown Cohort Study. METHODS: The two selected databases were pooled (n = 10,122), and relevant variables were harmonized. PA was measured using the short form International Physical Activity Questionnaire. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression (CES-D) questionnaire. Participants were classified as meeting World Health Organization moderate-to-vigorous PA (MVPA) guidelines or not, and divided into tertiles based on weekly minutes of MVPA. A CES-D score of ≥16 indicated elevated depressive symptoms. Data collection were conducted in 2010-2011. RESULTS: Significantly higher depressive symptoms were reported by females (7.11 ± 7.87) than males (5.74 ± 6.86; p < 0.001). Following adjustment for age, sex, BMI, and dataset, meeting the PA guidelines was associated with 44.7% (95%CI: 35.0 to 52.9; p < 0.001) lower odds of elevated depressive symptoms. Compared to the low PA tertile, the middle and high PA tertiles were associated with 25.2% (95%CI: 8.7 to 38.6; p < 0.01) and 50.8% (95%CI: 40.7 to 59.2; p < 0.001) lower odds of elevated depressive symptoms, respectively. CONCLUSION: Meeting the PA guidelines is associated with lower odds of elevated depressive symptoms, and increased volumes of MVPA are associated with lower odds of elevated depressive symptoms.

Associations between physical behaviour patterns and levels of depressive symptoms, anxiety and well-being in middle-aged adults: a cross-sectional study using isotemporal substitution models.

OBJECTIVE: To examine the compositional effects of physical behaviour on mental health. DESIGN: Cross-sectional study. SETTING: A population-representative random sample (Mitchelstown cohort) was recruited from a large primary care centre in Mitchelstown, County Cork, Ireland. PARTICIPANTS: In total 3807 potential participants were selected from the practice list. Following exclusion of duplicates, deaths and ineligibles, 3043 were invited to participate and of these, 2047 (49.2% men) completed the questionnaire and physical examination components of the baseline assessment during the study period (April 2010 and May 2011). Accelerometers were introduced into the study in January 2011. Of the 745 participants seen between January and May of 2011, 475 (44.6% men) subjects (response rate 64%) agreed to participate and of these 397 (46.1% men) had valid accelerometer data. PRIMARY AND SECONDARY OUTCOME MEASURES: Participants wore the wrist GENEActiv accelerometer for 7 consecutive days. Data were summarised into 60 s epochs and activity categorised as sedentary behaviour, light or moderate-to-vigorous physical activity (MVPA). Levels of depressive and anxiety symptoms were assessed using the Centre for Epidemiologic Studies Depression scale and the Hospital Anxiety and Depression Scale. Well-being was assessed using the WHO-5 well-being scale. RESULTS: In adjusted isotemporal models, a 30 min increase in light activity per day was associated with a significant decrease in levels of anxiety symptoms (B=-0.34; 95% CI -0.64 to -0.04) and a significant increase in levels of well-being (B=0.58; 95% CI 0.05 to 1.11). No statistically significant associations were observed between any physical behaviour and depressive symptoms or when sedentary behaviour was substituted with MVPA (P>0.05). CONCLUSION: Although based on a cross-sectional study, the findings suggest that substituting light activity for sedentary behaviour may have positive associations with symptoms of anxiety and reported well-being among middle-aged adults.

Replacement of Sedentary Time with Physical Activity: Effect on Lipoproteins.

PURPOSE: Limited data on the relationship between physical activity and lipoprotein particle profiles exist. Our objective was to investigate associations between objectively measured physical activity and lipoprotein particle size and number, and specifically whether substituting daily sedentary behavior with light activity or moderate-to-vigorous physical activity (MVPA) is associated with beneficial alterations to the lipoprotein profile among adults and those at increased cardiometabolic risk (obese and insulin-resistant subjects). METHODS: Sedentary behavior and physical activity intensity and duration were measured for 7 consecutive days using the GENEActiv accelerometer in a cross-sectional adult cohort (n = 396; mean age, 59.6 ± 5.5 yr). Lipoprotein particle size and subclass concentrations were determined using nuclear magnetic resonance spectroscopy. Isotemporal substitution regression modeling quantified the associations between replacing 30 min·d of sedentary behavior with equal amounts of light activity and MVPA on lipoprotein profiles. RESULTS: Daily duration of MVPA was inversely associated with large VLDL particles and lipoprotein insulin resistance scores (P < 0.05, after adjustment for sedentary time and other confounding factors). Reallocating 30 min of sedentary time with MVPA, but not light activity, was associated with less large VLDL particles resulting in more favorable average VLDL particle size and improved lipoprotein insulin resistance score (P < 0.05). Analysis of high-cardiometabolic-risk groups revealed similar beneficial alterations to VLDL profiles (P < 0.05) with substitution of sedentary time for MVPA among the insulin-resistant (homeostasis model assessment for insulin resistance ≥75th percentile) but not the obese (body mass index ≥30 kg·m) individuals. CONCLUSIONS: Daily MVPA duration and theoretical replacement of sedentary time with MVPA, but not light activity, were associated with less atherogenic VLDL profiles, particularly among the insulin-resistant individuals. These findings, which require further investigation, highlight the need to develop physical activity interventions aimed at improving atherogenic dyslipidemia and lowering cardiometabolic risk.

Does replacing sedentary behaviour with light or moderate to vigorous physical activity modulate inflammatory status in adults?

BACKGROUND: Sedentary behaviour, obesity and insulin resistance are associated with pro-inflammatory status. Limited data on whether physical activity modulates inflammatory status and counteracts obesity and insulin resistance associated low-grade inflammation exist. Our objective was to investigate associations between objectively measured physical activity and inflammatory status, and specifically whether substituting daily sedentary behaviour with light activity or moderate to vigorous physical activity (MVPA), is associated with beneficial alterations to the inflammatory profile among middle-aged adults and those at increased cardiometabolic risk (obese and insulin resistant subjects). METHODS: Data are from a sub-sample of the Mitchelstown cohort; a population-based cross-sectional sample of 2047 Irish adults. Physical activity intensity and duration were measured in 396 participants for 7-consecutive days using the GENEActiv accelerometer. Isotemporal regression analysis examined the associations between replacing 30 min per day of sedentary behaviour with equal amounts of light activity and MVPA on inflammatory factors (serum acute-phase reactants, adipocytokines, pro-inflammatory cytokines and white blood cells (WBC)). RESULTS: Reallocating 30 min of sedentary time with MVPA was associated with a more favourable inflammatory profile characterized by higher adiponectin and lower complement component C3 (C3), leptin, interleukin 6 (IL-6) and WBC concentrations (P < 0.05). No significant effects were noted with substitution of sedentary time with light activity. Among the obese subjects replacing sedentary behaviour with an equivalent amount of MVPA was associated with lower WBC counts (P < 0.05); no associations were detected among the insulin resistant (HOMA-IR >75th percentile) subjects. Among the non-obese and non-insulin resistant subjects substituting 30 min of sedentary behaviour with MVPA was associated with decreased C3, IL-6 and WBC concentrations. CONCLUSIONS: Replacing sedentary behaviour with MVPA modulates pro-inflammatory status. These findings, which highlight the need for the developing randomized trials aimed at lowering cardiometabolic risk, warrant further investigation.

The paradox of public holidays: Hospital-treated self-harm and associated factors.

BACKGROUND: Recent research on the patterns of self-harm around public holidays is lacking. This study used national data to examine the patterns of hospital-treated self-harm during public holidays, and to examine associated factors. METHODS: Data on self-harm presentations to all emergency departments were obtained from the National Self-Harm Registry Ireland. The association between self-harm presentations and public holidays was examined using univariate and multivariate Poisson regression analyses. RESULTS: A total of 104,371 presentations of self-harm were recorded between 2007 and 2015. The mean number of self-harm presentations was 32 on public holidays. St. Patrick's Day had the highest number of presentations compared to all other public holidays, with a daily mean of 44 presentations. Across all years, self-harm presentations during public holidays had a 24% increased risk of involving alcohol consumption compared to all other days and this effect was most pronounced during the Christmas period. The association with alcohol remained significant at a multivariate level. Presentations on public holidays were more likely to attend out of normal working hours. An increase in male presentations involving self-cutting was observed on public holidays and there was an over-representation of males presenting for the first time. LIMITATIONS: It is likely that extent of alcohol involvement in self-harm presentations reported here is an underestimate, as it was dependent on the information being recorded by the attending clinician. CONCLUSIONS: Public holidays are associated with an elevated number of self-harm presentations to hospital, with presentations to hospital involving alcohol significantly increased on these days. Hospital resources should be targeted to address increases during public holidays, including during out-of-hours. Involvement of alcohol may delay delivery of care to these patients in emergency settings.

Step-Count Accuracy of 3 Motion Sensors for Older and Frail Medical Inpatients.

OBJECTIVE: To measure the step-count accuracy of an ankle-worn accelerometer, a thigh-worn accelerometer, and a pedometer in older and frail inpatients. DESIGN: Cross-sectional design study. SETTING: Research room within a hospital. PARTICIPANTS: Convenience sample of inpatients (N=32; age, ≥65 years) who were able to walk 20m independently with or without a walking aid. INTERVENTIONS: Patients completed a 40-minute program of predetermined tasks while wearing the 3 motion sensors simultaneously. Video recording of the procedure provided the criterion measurement of step count. MAIN OUTCOME MEASURES: Mean percentage errors were calculated for all tasks, for slow versus fast walkers, for independent walkers versus walking-aid users, and over shorter versus longer distances. The intraclass correlation was calculated, and accuracy was graphically displayed by Bland-Altman plots. RESULTS: Thirty-two patients (mean age, 78.1±7.8y) completed the study. Fifteen (47%) were women, and 17 (51%) used walking aids. Their median speed was .46m/s (interquartile range [IQR], .36-.66m/s). The ankle-worn accelerometer overestimated steps (median error, 1% [IQR, -3% to 13%]). The other motion sensors underestimated steps (median error, 40% [IQR, -51% to -35%] and 38% [IQR -93% to -27%], respectively). The ankle-worn accelerometer proved to be more accurate over longer distances (median error, 3% [IQR, 0%-9%]) than over shorter distances (median error, 10% [IQR, -23% to 9%]). CONCLUSIONS: The ankle-worn accelerometer gave the most accurate step-count measurement and was most accurate over longer distances. Neither of the other motion sensors had acceptable margins of error.

Number of Days Required to Estimate Habitual Activity Using Wrist-Worn GENEActiv Accelerometer: A Cross-Sectional Study.

INTRODUCTION: Objective methods like accelerometers are feasible for large studies and may quantify variability in day-to-day physical activity better than self-report. The variability between days suggests that day of the week cannot be ignored in the design and analysis of physical activity studies. The purpose of this paper is to investigate the optimal number of days needed to obtain reliable estimates of weekly habitual physical activity using the wrist-worn GENEActiv accelerometer. METHODS: Data are from a subsample of the Mitchelstown cohort; 475 (44.6% males; mean aged 59.6±5.5 years) middle-aged Irish adults. Participants wore the wrist GENEActiv accelerometer for 7-consecutive days. Data were collected at 100Hz and summarised into a signal magnitude vector using 60s epochs. Each time interval was categorised according to intensity based on validated cut-offs. Spearman pairwise correlations determined the association between days of the week. Repeated measures ANOVA examined differences in average minutes across days. Intraclass correlations examined the proportion of variability between days, and Spearman-Brown formula estimated intra-class reliability coefficient associated with combinations of 1-7 days. RESULTS: Three hundred and ninety-seven adults (59.7±5.5yrs) had valid accelerometer data. Overall, men were most sedentary on weekends while women spent more time in sedentary behaviour on Sunday through Tuesday. Post hoc analysis found sedentary behaviour and light activity levels on Sunday to differ to all other days in the week. Analysis revealed greater than 1 day monitoring is necessary to achieve acceptable reliability. Monitoring frame duration for reliable estimates varied across intensity categories, (sedentary (3 days), light (2 days), moderate (2 days) and vigorous activity (6 days) and MVPA (2 days)). CONCLUSION: These findings provide knowledge into the behavioural variability in weekly activity patterns of middle-aged adults. Since Sunday differed from all other days in the week this suggests that day of the week cannot be overlooked in the design and analysis of physical activity studies and thus should be included in the study monitoring frames. Collectively our data suggest that six days monitoring, inclusive of Saturday and Sunday, are needed to reliably capture weekly habitual activity in all activity intensities using the wrist-worn GENEActiv accelerometer.

A Review of the Accuracy and Utility of Motion Sensors to Measure Physical Activity of Frail, Older Hospitalized Patients.

The purpose of this review was to examine the utility and accuracy of commercially available motion sensors to measure step-count and time spent upright in frail older hospitalized patients. A database search (CINAHL and PubMed, 2004-2014) and a further hand search of papers' references yielded 24 validation studies meeting the inclusion criteria. Fifteen motion sensors (eight pedometers, six accelerometers, and one sensor systems) have been tested in older adults. Only three have been tested in hospital patients, two of which detected postures and postural changes accurately, but none estimated step-count accurately. Only one motion sensor remained accurate at speeds typical of frail older hospitalized patients, but it has yet to be tested in this cohort. Time spent upright can be accurately measured in the hospital, but further validation studies are required to determine which, if any, motion sensor can accurately measure step-count.

Defining metabolically healthy obesity: role of dietary and lifestyle factors.

BACKGROUND: There is a current lack of consensus on defining metabolically healthy obesity (MHO). Limited data on dietary and lifestyle factors and MHO exist. The aim of this study is to compare the prevalence, dietary factors and lifestyle behaviours of metabolically healthy and unhealthy obese and non-obese subjects according to different metabolic health criteria. METHOD: Cross-sectional sample of 1,008 men and 1,039 women aged 45-74 years participated in the study. Participants were classified as obese (BMI ≥ 30 kg/m(2)) and non-obese (BMI < 30 kg/m(2)). Metabolic health status was defined using five existing MH definitions based on a range of cardiometabolic abnormalities. Dietary composition and quality, food pyramid servings, physical activity, alcohol and smoking behaviours were examined. RESULTS: The prevalence of MHO varied considerably between definitions (2.2% to 11.9%), was higher among females and generally increased with age. Agreement between MHO classifications was poor. Among the obese, prevalence of MH was 6.8% to 36.6%. Among the non-obese, prevalence of metabolically unhealthy subjects was 21.8% to 87%. Calorie intake, dietary macronutrient composition, physical activity, alcohol and smoking behaviours were similar between the metabolically healthy and unhealthy regardless of BMI. Greater compliance with food pyramid recommendations and higher dietary quality were positively associated with metabolic health in obese (OR 1.45-1.53 unadjusted model) and non-obese subjects (OR 1.37-1.39 unadjusted model), respectively. Physical activity was associated with MHO defined by insulin resistance (OR 1.87, 95% CI 1.19-2.92, p = 0.006). CONCLUSION: A standard MHO definition is required. Moderate and high levels of physical activity and compliance with food pyramid recommendations increase the likelihood of MHO. Stratification of obese individuals based on their metabolic health phenotype may be important in ascertaining the appropriate therapeutic or intervention strategy.

Population pharmacokinetics of phenobarbital in infants with neonatal encephalopathy treated with therapeutic hypothermia.

OBJECTIVE: Phenobarbital is the first-line treatment for neonatal seizures. Many neonates with hypoxic ischemic encephalopathy are treated with therapeutic hypothermia, and about 40% have clinical seizures. Little is known about the pharmacokinetics of phenobarbital in infants with hypoxic ischemic encephalopathy who undergo therapeutic hypothermia. The objective of this study was to determine the effect of therapeutic hypothermia on phenobarbital pharmacokinetics, taking into account maturational changes. SETTING: Level 3 neonatal ICU. PATIENTS: Infants with hypoxic ischemic encephalopathy and suspected seizures, all treated with phenobarbital. Some of these infants also received treatment with therapeutic hypothermia. INTERVENTIONS: None. DESIGN: A retrospective cohort study of 39 infants with hypoxic ischemic encephalopathy treated with phenobarbital (20 were treated with therapeutic hypothermia and 19 were not). MEASUREMENTS AND MAIN RESULTS: Data on phenobarbital plasma concentrations were collected in 39 subjects with hypoxic ischemic encephalopathy with or without therapeutic hypothermia. Using nonlinear mixed-effects modeling, population pharmacokinetics of phenobarbital were developed with a total of 164 plasma concentrations. A one-compartment model best described the pharmacokinetics. The clearance of phenobarbital was linearly related to body weight and matured with increasing age with a maturation half-life of 22.1 days. Therapeutic hypothermia did not influence the pharmacokinetic parameters of phenobarbital. CONCLUSIONS: Therapeutic hypothermia does not influence the clearance of phenobarbital after accounting for weight and age. Standard phenobarbital dosing is appropriate for the initial treatment of seizures in neonates with hypoxic ischemic encephalopathy treated with therapeutic hypothermia.