Food Insecurity and Hearing Loss Are Interrelated: A Cross-Sectional Population-Based Study

OBJECTIVES

We aimed to assess whether objectively measured hearing loss and self-perceived hearing handicap in adults are independently associated with food insecurity, and vice versa.

DESIGN

Cross-sectional population-based study.

POPULATION

2,500 participants aged 50+ years from the Blue Mountains Hearing Study, with both complete pure-tone audiometry data and information on food security status.

MEASUREMENTS

The pure-tone average of frequencies 0.5, 1.0, 2.0 and 4.0 kHz (PTA0.5-4KHz) >25 dB HL in the better ear, established the presence of hearing loss. Self-perceived hearing handicap was assessed by administering the Hearing Handicap Inventory for Elderly Screening (HHIE-S total scores of ≥8 indicates hearing handicap). A 12-item food security survey was administered, comprising statements related to individual and household food situations.

RESULTS

Food insecurity was reported by 12.8% of study participants. After adjusting for all potential confounders, any self-perceived hearing handicap significantly increased the likelihood of participants reporting food insecurity by 94% (p<0.0001). Participants reporting any, mild or severe self-perceived hearing handicap had around 2-fold greater odds of experiencing food insecurity. Objectively measured hearing loss did not significantly influence the food security status of study participants. Conversely, food insecurity was significantly associated with both objectively measured hearing loss and self-perceived hearing handicap: multivariate-adjusted OR 1.37 (95% CI 1.01-1.88) and OR 1.83 (95% CI 1.40-2.39), respectively.

CONCLUSIONS

Food insecurity was an important social determinant of hearing health among community-dwelling adults. Conversely, participants with a significant self-perceived hearing handicap were more likely to experience food insecurity. These findings add to our understanding of the substantial public health impact of both food insecurity and hearing loss and may highlight areas for future intervention.

Effects of seeking compensation on the psychological health and recovery of injured patients: the role of stress vulnerability and injury-related disability

BACKGROUND

Seeking compensation has been shown to have an adverse effect on the psychological health and recovery of injured patients, however, this effect requires clarification.

METHODS

A total of 2019 adults sustaining a traffic injury were recruited. Of these, 709 (35.1%) lodged a compensation claim. Interviews occurred at 1-, 6- and 12-month post-injury. Outcomes were psychological distress (posttraumatic stress (PTS) and depressive symptoms) and health-related functioning (HrF) (quality of life measured by EQ-5D-3L and disability by WHODAS) over 12-months post-injury. Covariates included individual stress vulnerability (preinjury, injury-related factors).

RESULTS

Compared with non-compensation participants, compensation groups had higher stress vulnerability (more severe injuries and negative reactions) and poorer baseline outcomes (psychological health and HrF). After adjustment, we found an effect of compensation on HrF [β-0.09 (-0.11 to -0.07), p < 0.001] and PTS [β = 0.36 (0.16 to 0.56), p = 0.0003], but not on depression [β = -0.07 (-0.42 to 0.28), p = 0.7]. Both groups improved over time. Vulnerable individuals (β = 1.23, p < 0.001) and those with poorer baseline outcomes (PTS: β = 0.06, p = 0.002; HrF: β = -1.07, p < 0.001) were more likely to lodge a claim. In turn, higher stress vulnerability, poor baseline outcomes and claiming compensation were associated with long-term psychological distress and HrF. Nevertheless, concurrent HrF in the model fully accounted for the compensation effect on psychological distress (β = -0.14, p = 0.27), but not vice versa.

CONCLUSIONS

This study provides convincing evidence that seeking compensation is not necessarily harmful to psychological health. The person's stress vulnerability and injury-related disability emerge as major risk factors of long-term psychological distress, requiring a whole-systems approach to address the problem.

A Systematic Review of Online Patient Resources to Support Shared Decision Making for Laparoscopic Cholecystectomy

BACKGROUND

RCS Eng, the Royal College of Surgeons of England, has published much information with regard to the consenting process. A majority of patients seek health information through online resources as well as discussing with the care givers. Therefore, it is necessary that online material is both of high quality and reliable for patients. We aimed to evaluate the quality and standard of the online patient information on laparoscopic cholecystectomy to help in the consenting process.

METHODS

A search was carried out as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Sources were assessed using five validated scoring tools: Flesch-Kincaid Reading Ease Score (readability), DISCERN and IPDAS scores (quality of content) and HONcode and the Information Standard Certification (standards of accreditation).

RESULTS

The average readability of all websites was higher than recommended for patient literature. Less than half of the sources had received HONcode or Information Standard accreditation. On grading of quality and content, across validated scoring tools, no source achieved the minimum recommended level.

CONCLUSION

Online patient information related to laparoscopic cholecystectomy is of poor quality. We recommend a multidisciplinary approach to participate in publishing more readable online resources of a higher standard to help patients and clinicians in consent and shared decision making.

Outcomes after traffic injury: mental health comorbidity and relationship with pain interference

BACKGROUND

Mental health symptoms, like depressive mood (DM) and post-traumatic stress (PTS), and pain interference (PI) with daily functioning often co-occur following traffic injury and their comorbidity can complicate recovery. This study aimed to map the course and overlapping trajectories of mental health symptoms, and associations with PI in a traffic injury population.

METHODS

In total, 2019 adults sustaining minor-to-moderate traffic injury were recruited within 28 days post-injury and assessed using phone interviews at 1, 6 and 12-months post-injury. Trajectories of DM, PTS and PI were established and relationships between DM, PTS and PI trajectories were explored using dual trajectory modelling. Bio-psychosocial predictors (e.g. pre-injury health, catastrophizing, acute distress, quality of life, social support) of mental health trajectories were investigated.

RESULTS

Up to five typical post-trauma trajectories were identified for DM, PTS and PI. Most people were in a resilient mental health trajectory (over 60%, DM or PTS), or in a chronic PI trajectory (almost 60%) 12 months post-injury. While recovery/resilient mental health trajectories were strongly interrelated (73.4% joint probability and > 94% conditional probabilities), DM/PTS comorbidity in chronic trajectories was not straightforward, suggesting a possibly asymmetric relationship. That is, persistent DM was more likely associated with persistent PTS (90.4%), than vice versa (31.9%), with a 22.5% probability that persistent PTS was associated with none or milder depression (i.e. following a recovery/resilient DM trajectory). An asymmetrical relationship was also found between mental health and PI. The majority of those with persistent PI were likely to be in a recovery/resilient DM/PTS trajectory (almost 70%), but those in a non-resilient DM/PTS trajectory showed a high risk of persistent PI. Predictors of non-resilient mental health trajectories included poorer pre-injury health and social support, and shared factors like acute psychological distress and pain catastrophizing.

CONCLUSIONS

Strong interrelations were confirmed between mental health symptoms and PI following traffic injury. However, persistent DM was more strongly linked to persistent PTS, than vice versa. Persistent PI was only linked with persistent DM/PTS in vulnerable subgroups. Early psychiatric/psychological interventions should target elevated psychological distress and negative appraisals in vulnerable individuals, to reduce long-term mental health morbidity/comorbidity and PI.

TRIAL REGISTRATION

ACTRN12613000889752.

Outcomes and risk factors of cholecystectomy in high risk patients: A case series

Introduction

Many studies looked at outcomes and risk factors in laparoscopic cholecystectomies in general, including a few studies on risk factors and scoring systems in predicting conversion to open surgery. Little data has been produced on high-risk patients undergoing cholecystectomy. Identifying risk factors in this group could help stratify decision making regarding best management strategies.

The aim of this study was to investigate outcomes of laparoscopic cholecystectomies in patients with ASA 3 and 4.

Methods

Data was collected and collated from a prospectively maintained database of all laparoscopic cholecystectomies performed by 13 general surgeons in a single unit. Case notes were reviewed for all patients with ASA 3 and 4 between 2013 and 2017. Data analysis was performed using R studio v 3.4.

Results

244 cases were reviewed. Common bile duct was dilated in 52 cases (21.31%). Gall bladder wall was thick in 102 (41.8%) of the patients. Surgery was elective in 203 (83.2%) of the patients. ERCP was performed in 41 (16.9%) of the patients prior to surgery. 150 patients (62.2%) stayed for 1 day while 36 (14.9%) stayed for 2 days and the remaining 55 (22.9%) stayed for 3 days or more. Complications occurred in 37 (15.16%) of the patients while 23 (9.43%) of the patients were readmitted. 7 patients (2.87%) returned to theatre and 8 (3.28%) stayed in ITU post-op. Two patients died (0.82%).

Conclusion

Laparoscopic cholecystectomies in higher risk populations are safe. Alternative methods such as cholecystostomy and ERCP may be of benefit in these patients.

•

Gallstone disease represents a significant volume of elective and emergency work in the United Kingdom.

•

The primary aim of the study was to explore the factors that lead to complications in high risk patients (ASA 3-4).

•

Histological gallbladder thickness and emergency surgery were the factors most strongly associated with negative outcomes.

•

Age greater than 65 as an independent variable does not lead to an increase in negative outcomes.

•

Cholecystectomy is a relatively safe procedure in what is typically considered higher risk patients.

The psychological impact of traffic injuries sustained in a road crash by bicyclists: A prospective study

OBJECTIVE

The objective of this study was to investigate the psychological impact of traffic injuries in bicyclists (cyclists) in comparison to car occupants who also sustained traffic injuries. Factors predictive of elevated psychological distress were also investigated.

METHODS

An inception cohort prospective design was used. Participants included cyclists aged ≥17 years (mean age 41.7 years) who sustained a physical injury (n = 238) assessed within 28 days of the crash, following medical examination by a registered health care practitioner. Injury included musculoskeletal and soft tissue injuries and minor/moderate traumatic brain injury (TBI), excluding severe TBI, spinal cord injury, and severe multiple fractures. Assessment also occurred 6 months postinjury. Telephone-administered interviews assessed a suite of measures including sociodemographic, preinjury health and injury factors. Psychological impact was measured by pain catastrophization, trauma-related distress, and general psychological distress. The psychological health of the cyclists was compared to that of the car occupants (n = 234; mean age 43.1 years). A mixed model repeated measures analysis, adjusted for confounding factors, was used to determine differences between groups and regression analyses were used to determine contributors to psychological health in the cyclists 6 months postinjury.

RESULTS

Cyclists had significantly better psychological health (e.g., lower pain catastrophizing, lower rates of probable posttraumatic stress disorder [PTSD], and lower general distress levels) compared to car occupants at baseline and 6 months postinjury. Factors predictive of cyclists' psychological distress included younger age, greater perceived danger of death, poorer preinjury health, and greater amount of time in hospital after the injury.

CONCLUSIONS

These data provide insight into how cyclists perceive and adjust to their traffic injuries compared to drivers and passengers who sustain traffic injuries, as well as direction for preventing the development of severe psychological injury. Future research should examine the utility of predictors of psychological health to improve recovery.

Trends in added sugar intake and food sources in a cohort of older Australians: 15 years of follow-up from the Blue Mountains Eye Study

BACKGROUND

The trend of added sugar (AS) intake has not been investigated in the Australian population, including in older adults. The present study aimed to assess trends and food sources of AS intake among a cohort of older Australians during 15 years of follow-up.

METHODS

Dietary data from participants of the Blue Mountains Eye Study (1264 men and 1614 women), aged ≥49 years at baseline, were collected. Dietary intakes were assessed at 5-yearly intervals (1992-94 to 2007-09) using a 145-item food frequency questionnaire (FFQ). AS content of FFQ food items was estimated using a stepwise systematic method. Trends for AS intake between baseline and the three follow-up periods were assessed using linear mixed modelling.

RESULTS

In men, the mean (SEM) percentage of energy provided by AS intake (EAS%) declined from 10.4% (0.1%) at baseline to 9.4% (0.2%) at 15-year follow-up (P_trend = 0.028). Women's mean (SEM) EAS% intake at baseline and 15-year follow-up was 9.2% (0.1%) and 8.8% (0.2%), respectively (P_trend = 0.550). EAS% intake of men was significantly higher than that of women for 10 years (P < 0.05). Sugar products (table sugar, syrup, jam and honey) were the major sources of AS at all-time points and contributed to more than 40% and 35% of AS intake in men and women, respectively. Intake of sugar products decreased in men during follow-up (P_trend < 0.001).

CONCLUSIONS

An overall downward trend was observed in AS intake in both genders, however, was only significant for men during 15 years of follow-up. Table sugar and sugar-containing spreads represent the major source of AS in this cohort of older Australians.

Bounding functions of Markov processes and the shortest queue problem

We prove a theorem which can be used to show that the expectation of a non-negative function of the state of a time-homogeneous Markov process is uniformly bounded in time. This is reminiscent of the classical theory of non-negative supermartingales, except that our analog of the supermartingale inequality need not hold almost surely. Consequently, the theorem is suitable for establishing the stability of systems that evolve in a stabilizing mode in most states, though from certain states they may jump to a less stable state. We use this theorem to show that ‘joining the shortest queue' can bound the expected sum of the squares of the differences between all pairs among N queues, even under arbitrarily heavy traffic.

Consumption of nuts and risk of total and cause-specific mortality over 15 years

BACKGROUND AND AIMS

The published literature shows that nut consumption has a favorable impact on health. We aimed to assess the association between nut consumption and risk of 15-year total mortality, and mortality from cardiovascular disease (CVD) (including ischemic heart disease, IHD, and stroke), and cancer.

METHODS AND RESULTS

Prospective analyses involved 2893 participants aged ≥49 years at baseline. Dietary data were collected by using a semi-quantitative food-frequency questionnaire, and nut intakes were calculated. Deaths and cause of death were confirmed by data linkage with the Australian National Death Index. Over 15 years, 1044 participants had died, of these 430 had died from stroke and another 430 had died from IHD. Participants in the second tertile of nut consumption versus those in the first tertile of intake had reduced risk of total mortality: multivariable-adjusted HR 0.76 (95% CI 0.65-0.89). Participants in the second tertile compared to those in the first tertile had 24% and 23% reduced risk of 15-year CVD and IHD mortality, respectively. Associations were more marked in women compared to men. Women in the second versus first tertile of nut consumption had 27%, 39%, 34% and 49% reduced risk of death from all causes (n = 489), CVD (n = 258), IHD (n = 188) and stroke mortality (n = 101), respectively.

CONCLUSIONS

Nut consumption was independently associated with a decreased risk of overall and vascular-disease mortality, particularly in women.

Caregiver perceptions about the impact of caring for patients with wet age-related macular degeneration

PURPOSE

Caregivers of older persons with eye disease, namely age-related macular degeneration (AMD), have been reported to have a higher than expected distress. Very few studies have explored caregiver perceptions as to what is important when providing care. The aim of this study was to explore the perceptions of caregivers of persons with neovascular AMD in relation to the most important aspects of caring, as described in extended answers to self-administered survey questions.

METHODS

A cross-sectional, self-administered survey of 643 caregivers of people with neovascular AMD, comprising 27 closed-response questions and 2 open ended questions. The latter were analysed as part of this study utilising and 'inductive' Grounded Theory approach.

RESULTS

Six-hundred and forty-three caregiver responses to 2 open ended questions were analysed using an inductive approach and sorted into thematic networks. Three discrete categories arose: The Impact of Caring; Injections and Information and Activities of Daily Living.

CONCLUSIONS

Most caregivers were family caregivers and were found to be compassionate and self-sacrificing. They accepted additional responsibility whilst providing an encouraging environment for their care recipient. As a result, they experience distress and consider their own needs as secondary. Very few seek or receive respite and this added burden can have a negative impact upon the relationship between caregiver and care recipient.

Presence and predictors of persistent pain among persons who sustained an injury in a road traffic crash

BACKGROUND

There is a paucity of prospective studies with long follow-up that have examined a wide range of correlates associated with persistent pain outcomes in persons who sustained a mild or moderate injury in a road traffic crash. This study aimed to establish the independent predictors of pain severity over 24 months.

METHODS

A total of 364, 284 and 252 persons with mild/moderate musculoskeletal injuries sustained in a vehicle-related crash participated in telephone interviews in the subacute phase, and at 12 and 24 months, respectively. The numeric rating scale (NRS) assessed pain severity. Pain-Related Self-Statements Scale-Catastrophizing (PRSS-Catastrophizing) and the Short Form Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) were also administered.

RESULTS

After multivariable adjustment, each 1 SD increase in Short Form-12 Physical Component Score (SF-12 PCS) in the subacute phase was associated with 0.73 (p = 0.002) and 1.11 (p < 0.0001) decrease in NRS scores after 12 and 24 months, respectively. Each unit increase in the PRSS-Catastrophizing score in the subacute phase was associated with 0.54 (p = 0.001) and 0.43 (p = 0.03) increase in NRS scores 12 and 24 months later, respectively. Subacute phase OMPSQ scores were positively associated with NRS scores at 12- and 24-month follow-ups (p < 0.0001).

CONCLUSIONS

Self-perceived physical well-being, pain-related work disability and pain catastrophizing could play a role in determining long-term pain-related outcomes following traffic-related injuries.

Dairy food consumption, blood pressure and retinal microcirculation in adolescents

BACKGROUND AND AIMS

The relationship between dairy food consumption and dietary calcium intake, and vascular risk factors during adolescence remains unclear. We aimed to prospectively assess whether dairy food consumption (milk, cheese, yoghurt) is associated with blood pressure (BP) and retinal microvascular signs among adolescents.

METHODS AND RESULTS

As many as 2353 and 1216 participants aged 12 and 17, respectively, were examined. Longitudinal analyses involved 888 subjects with complete baseline and follow-up data. Dairy consumption was assessed from validated semi-quantitative food frequency questionnaires. BP information was collected and retinal vessel caliber was quantified from digital photographs using computer software. In girls, after multivariable adjustment, each serve/day increase in total dairy intake was concurrently associated with 1.04 (p = 0.03) and 1.10 mm Hg (p = 0.02) decreases in mean diastolic and arterial BP, respectively. Also in girls, each serve/day increase in cheese intake over 5 years was concurrently related to 7.18 (p = 0.001), 5.28 (p = 0.002) and 5.79 mm Hg (p = 0.001) decrease in mean systolic, diastolic and arterial BP, respectively. Among girls, each 100 mg/day increase in dietary calcium intake was associated with a concurrent 0.5 (p = 0.01) and 0.3 mm Hg (p = 0.02) decrease in mean systolic and arterial BP, respectively. Cross-sectionally, adolescents in the highest versus lowest tertile of yoghurt intake had ∼ 1.3 μm wider retinal arterioles (p = 0.05) and ∼ 2.0 μm narrower venules (p = 0.04).

CONCLUSIONS

Consumption of dairy products, particularly cheese, could have a beneficial effect on BP, particularly among girls.

The health status of people claiming compensation for musculoskeletal injuries following road traffic crashes is not altered by an early intervention programme: a comparative study

OBJECTIVE

To compare health outcomes among claimants compared to those who were ineligible or choose not to lodge a compensation claim. We also evaluated the effect of an early intervention programme on the health outcomes of the participants.

DESIGN

Prospective comparative study using sequential cohorts.

SUBJECTS

People presenting to hospital emergency departments with mild to moderate musculoskeletal injuries following road traffic crashes.

INTERVENTION

referral to an early intervention programme for assessment by musculoskeletal physician, pain management education, promotion of self-management and encouragement of early activity.

MAIN OUTCOMES

The 36-Item Short-Form Survey (SF-36); Hospital Anxiety and Depression Scale (HADS) and Functional Rating Index (FRI) scores were assessed at post-crash and at 12 months.

RESULTS

At 12 months, mean scores in six and five of the SF-36 domains were significantly lower among participants who claimed compensation versus those who chose not to claim or were ineligible, respectively. Differences in mean SF-36 scores ranged from 3.0 ('general health perception') to 8.0 units ('role limitations due to physical problems'). Participants who claimed compensation had 6.3- and 4.6-units lower SF-36 physical component score compared to those who were ineligible (p=0.001) or chose not to claim (p=0.01), respectively. Participants who claimed compensation reported a worse HADS-depression score of 6.46 versus 4.97 and 4.69 observed in those who were ineligible (p=0.04) or did not claim (p=0.01). Claimants had worse FRI scores compared to non-claimants (p=0.01) and those who were ineligible (p=0.01). The early intervention did not improve health outcomes, 12 months after injury.

CONCLUSIONS

Claiming compensation was associated with a worse health status for people with soft tissue injuries caused by road traffic crashes. The health status in people claiming compensation was not altered by an early intervention programme.

Diffuse large B-cell lymphoma (DLBCL) in the bypassed stomach after obesity surgery

Laparoscopic Roux-en-Y gastric bypass is the most commonly performed surgical procedure for obesity and, consequently, post-operative patients are increasingly encountered by all specialties. This is a case of a patient presenting with abdominal pain, nausea and fever 9 months following gastric bypass surgery caused by diffuse large B-cell lymphoma (DLBCL) in the bypassed stomach. It demonstrates well that symptoms that may normally be considered 'red-flags' may not be as obvious or specific following an operation. The case also indicates the importance of considering diagnoses unrelated to surgery presenting in the post-operative period (especially when conventional investigation methods are not feasible), and the potential danger of assuming they are due to the operation alone; had this occurred in this patient then a malignancy may have been missed. This is only the second reported case of DLBCL in the bypassed stomach, and the third for lymphoma of any type.

Association between diet quality with concurrent vision and hearing impairment in older adults

OBJECTIVES

Published literature shows that individual nutrients could influence the risk of developing vision and hearing loss. There is, however, a lack of population-based data on the relationship between overall patterns of food intake and the presence of concurrent vision and hearing impairment. We aimed to assess the associations between diet quality with the prevalence and 5-year incidence of dual sensory impairment (DSI).

DESIGN

Cross-sectional and 5-year longitudinal analyses.

SETTING

Blue Mountains, Sydney, Australia.

PARTICIPANTS

2443 participants aged ≥50 from baseline were examined and followed over 5 years.

MEASUREMENTS

Dietary data were collected using a semi-quantitative food frequency questionnaire. A modified version of the Healthy Eating Index for Australians was developed to determine total diet score (TDS). Visual impairment was defined as visual acuity less than 20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold greater than 25 dB HL (500-4000 Hz, better ear).

RESULTS

After adjusting for age, sex, education, noise exposure, current smoking, and type 2 diabetes, participants in the lowest compared to the highest quintile of TDS had a 2-fold increased likelihood of having prevalent DSI, odds ratio, OR, 2.62 (95% confidence intervals, CI, 1.08-6.36), P-trend=0.04. Significant associations were not observed between TDS and the prevalence of having a single sensory impairment (vision or hearing loss). Baseline TDS was not significantly associated with the 5-year incidence of DSI. Adherence to dietary guidelines was associated with a reduced likelihood of having DSI in cross-sectional, but not in longitudinal analyses.

CONCLUSIONS

Further studies with adequate power are warranted to assess the prospective relationship between diet quality and DSI.

Parental history of hypertension and dietary intakes in early adolescent offspring: a population-based study

We investigated the cross-sectional association between parental history of hypertension and dietary intakes among early adolescent schoolchildren. A total of 1845 participants aged 12 years had complete data on diet and parental medical history, and thus they were included in the final analyses. Dietary data were assessed from validated semi-quantitative food-frequency questionnaires. Parents completed questionnaires about their medical conditions. Cases where the biological mother and/or father had hypertension were classified as positive parental history of hypertension. After multivariable adjustment, participants with positive versus negative parental history of hypertension had 33% greater likelihood of consuming soft drinks ⩾1 per week. Boys with a parental history versus boys without a parental history of hypertension consumed more energy-dense, nutrient-poor foods: 379.4 g per day and 318.0 g per day, respectively, P=0.02. Girls with a positive versus a negative parental history consumed more vegetables: 164.1 versus 142.6 g per day, P=0.01. Significant associations were not observed between those with and those without a positive parental history in mean dietary intakes of carbohydrates, fats, sugars and sodium. Children with a positive parental history of hypertension were 67% more likely to simultaneously engage in three unhealthy lifestyle behaviors (excessive recreational screen viewing, high consumption of snacks and and high consumption of soft drinks). Parental hypertension was associated with unhealthy dietary behaviors among offspring, including higher consumption of soft drinks and energy-dense, nutrient-poor foods.

Lower dairy products and calcium intake is associated with adverse retinal vascular changes in older adults

BACKGROUND AND AIMS

Higher consumption of dairy products and calcium is likely to play a role in maintaining optimal vascular health. In this study, we aimed to explore the associations between consumption of total-, regular- and low-fat dairy foods, and total calcium intake with retinal vascular caliber.

METHODS AND RESULTS

2813 Blue Mountains Eye Study participants aged 50+ years had dietary data collected using a semi-quantitative food frequency questionnaire, and serves of dairy consumption were calculated. Fundus photographs were taken and retinal vascular caliber measured using computer-assisted techniques and summarized. After adjusting for age, sex, body mass index, smoking, mean arterial blood pressure, serum glucose, white cell count, history of diagnosed hypertension, stroke and coronary heart disease, plus retinal arteriolar caliber, participants in the lowest quintile of total dairy consumption compared to those in the remaining highest 4 quintiles had significantly wider retinal venular caliber, 227.2 versus 224.7 μm, respectively (multivariable-adjusted p = 0.002). Also, subjects in the lowest quintile of low-fat dairy product consumption versus those in the remaining quintiles of low-fat dairy intake had wider retinal venules (∼ 1.7 μm, p = 0.03) and narrower retinal arterioles (∼ 1.4 μm, p = 0.04). Participants in the lowest quintile versus highest quintile of total dietary calcium intake had ∼ 2.3 μm wider retinal venules (multivariable-adjusted p-trend = 0.02).

CONCLUSIONS

A significant association was observed between lower intake of dairy products or calcium and adverse retinal vascular signs. We cannot discount the possibility of confounding from unmeasured risk factors; hence, further studies are warranted to confirm these findings.

Development of an Automated Medical Diagnosis System for Classifying Thyroid Tumor Cells using Multiple Classifier Fusion

An automated medical diagnosis system has been developed to discriminate benign and malignant thyroid nodules in multi-stained fine needle aspiration biopsy (FNAB) images using multiple classifier fusion and presented in this paper. First, thyroid cell regions are extracted from the auto-cropped sub-image by implementing mathematical morphology segmentation method. Subsequently, statistical features are extracted by two-level wavelet decomposition based on texture characteristics of the thyroid cells. After that, decision tree (DT), k-nearest neighbor ( k-NN), Elman neural network (ENN) and support vector machine (SVM) classifiers are used separately to classify thyroid nodules into benign and malignant. The four individual classifier outputs are then fused together using majority voting rule and linear combination rules to improve the performance of the diagnostic system. The classification results of ENN and SVM classifiers show an overall diagnostic accuracy (DA) of 90%, sensitivity (Se) of 85% and 100%, specificity (Sp) of 90% and 90% respectively. However, the best diagnostic accuracy of 96.66% is obtained by multiple classifier fusion with majority voting rule and linear combination rules. The experimental results show that the proposed method is a useful tool for the diagnosis of thyroid cancer and can provide a second opinion for a physician’s decision.

Support Vector Machine based diagnostic system for thyroid cancer using statistical texture features

OBJECTIVE

The aim of this study was to develop an automated computer-aided diagnostic system for diagnosis of thyroid cancer pattern in fine needle aspiration cytology (FNAC) microscopic images with high degree of sensitivity and specificity using statistical texture features and a Support Vector Machine classifier (SVM).

MATERIALS AND METHODS

A training set of 40 benign and 40 malignant FNAC images and a testing set of 10 benign and 20 malignant FNAC images were used to perform the diagnosis of thyroid cancer. Initially, segmentation of region of interest (ROI) was performed by region-based morphology segmentation. The developed diagnostic system utilized statistical texture features derived from the segmented images using a Gabor filter bank at various wavelengths and angles. Finally, the SVM was used as a machine learning algorithm to identify benign and malignant states of thyroid nodules.

RESULTS

The SVMachieved a diagnostic accuracy of 96.7% with sensitivity and specificity of 95% and 100%, respectively, at a wavelength of 4 and an angle of 45.

CONCLUSION

The results show that the diagnosis of thyroid cancer in FNAC images can be effectively performed using statistical texture information derived with Gabor filters in association with an SVM.

A better diet quality is associated with a reduced likelihood of CKD in older adults

BACKGROUND AND AIMS

Studies of diet in relation to chronic kidney disease (CKD) have focused on individual nutrients. The relationship between overall patterns of food intake and renal function has not been well explored. We aimed to investigate the associations between diet quality with the prevalence, incidence and progression of CKD in a cohort of older adults.

METHODS AND RESULTS

1952 participants aged ≥50 years at baseline were examined between 1992-1994 and 2002-2004. Dietary data were collected using a semi-quantitative food frequency questionnaire. A modified version of the Healthy Eating Index for Australians was developed to determine total diet scores (TDS). Baseline biochemistry including serum creatinine was measured. CKD was defined as MDRD estimated glomerular filtration rate (eGFR) <60 mL min⁻¹·1.73 m⁻². Participants in the highest quartile of mean TDS compared to those in the first quartile (reference), had a 41% reduced likelihood of having eGFR <60 mL min⁻¹·1.73 m⁻², [multivariable-adjusted odds ratio, OR, 0.59 (95% confidence intervals, CI, 0.41-0.85), P-trend = 0.005]. Each unit increase in TDS was associated with a 15% decrease in the odds of having prevalent CKD, multivariable-adjusted OR 0.85 (95% CI 0.74-0.97). A non-significant, inverse association between TDS and CKD incidence was observed (P-trend = 0.10).

CONCLUSION

Older adults with better diet quality had a reduced likelihood of having eGFR <60 mL min⁻¹·1.73 m⁻². Adherence to dietary guidelines were not prospectively associated with CKD incidence or progression. Further studies with adequate power are warranted to assess the longitudinal association between diet quality and CKD.

Higher regular fat dairy consumption is associated with lower incidence of metabolic syndrome but not type 2 diabetes

BACKGROUND AND AIMS

Limited evidence suggests habitual dairy consumption to be protective against metabolic syndrome (MetSyn) and type 2 diabetes among older adults. We assessed the association of baseline consumption of dairy products with the incidence of MetSyn and type 2 diabetes among a cohort of Australian adults aged 49 years and over.

METHODS AND RESULTS

A validated 145-item semi-quantitative food frequency questionnaire was used to assess food and nutrient intake at baseline. Ten-year incidence of MetSyn and type 2 diabetes were obtained from 1807 and 1824 subjects respectively. Odds ratios (OR) were calculated by discrete time logistic regression modelling. Compared with subjects in the lowest intake quartile of regular fat dairy products, those in the highest quartile had a 59% lower risk of MetSyn (multivariate adjusted OR: 0.41; 95% CI: 0.23-0.71; p(trend) = 0.004), after adjustment for risk factors. Among obese subjects, an association between a high intake of regular fat dairy foods and reduced risk of type 2 diabetes was also found (age and sex adjusted OR 0.37; 95% CI: 0.16-0.88; p(trend) = 0.030), but the association did not persist after adjustment for additional confounders. There was no association between total dairy consumption and risk of MetSyn or type 2 diabetes.

CONCLUSIONS

We found an inverse association between regular fat dairy consumption and risk of MetSyn among Australian older adults. Further studies are warranted to examine the association between weight status, dairy consumption and risk of type 2 diabetes.

Diet quality is prospectively associated with incident impaired fasting glucose in older adults

AIMS

Dietary modifications may play an important role in the prevention of diabetes. We aimed to assess the temporal association between diet quality and both impaired fasting glucose and Type 2 diabetes among older adults.

METHODS

A total of 2564 participants aged 49+ years at baseline were examined between 1992 and 1994 and 2002-2004 and had their fasting blood glucose measured. Dietary data were collected using a semi-quantitative food frequency questionnaire. A modified version of the Healthy Eating Index for Australians was developed to determine Total Diet Score. Incident diabetes (or impaired fasting glucose) was defined in participants at risk who were newly diagnosed by a physician during the follow-up or found to have a fasting blood glucose level ≥ 7.0 mmol/l (or 6.1-6.9 mmol/l).

RESULTS

After adjusting for age, sex, current smoking, body mass index, hypertension and serum triglycerides, comparing highest with lowest tertile of total diet score, a significant 75% decrease in risk of incident impaired fasting glucose was observed in men (P(trend) = 0.02). Also, in men, each two-point increase in Total Diet Score was associated with a 52% reduction in the 10-year incidence of impaired fasting glucose, (OR 0.48, 95% CI 0.33-0.69). No significant associations were observed among women or with the 10-year incidence of diabetes.

CONCLUSIONS

Greater compliance with published dietary guidelines (better diet quality) was associated with a reduced risk of pre-diabetes in men, but not women.

Dietary antioxidant intake is associated with the prevalence but not incidence of age-related hearing loss

OBJECTIVES

Diet is one of the few modifiable risk factors for age-related hearing loss. We aimed to examine the link between dietary and supplement intakes of antioxidants, and both the prevalence and 5-year incidence of measured hearing loss.

DESIGN

Cross-sectional and 5-year longitudinal analyses.

SETTING

Blue Mountains, Sydney, Australia.

PARTICIPANTS

2,956 Blue Mountains Hearing Study participants aged 50+ at baseline, examined during 1997-9 to 2002-4.

MEASUREMENTS

Age-related hearing loss was measured and defined as the pure-tone average of frequencies 0.5, 1.0, 2.0 and 4.0 kHz >25 dB HL. Dietary data were collected in a semi-quantitative food frequency questionnaire, and intakes of α-carotene; β-carotene; β-cryptoxanthin; lutein and zeaxanthin; lycopene; vitamins A, C and E; iron and zinc were calculated.

RESULTS

After adjusting for age, sex, smoking, education, occupational noise exposure, family history of hearing loss, history of diagnosed diabetes and stroke, each standard deviation (SD) increase in dietary vitamin E intake was associated with a 14% reduced likelihood of prevalent hearing loss, odds ratio, OR, 0.86 (95% confidence interval, CI, 0.78-0.98). Those in the highest quintile of dietary vitamin A intake had a 47% reduced risk of having moderate or greater hearing loss (>40 dB HL) compared to those in the lowest quintile of intake, multivariable-adjusted OR 0.53 (CI 0.30-0.92), P for trend = 0.04. However, dietary antioxidant intake was not associated with the 5-year incidence of hearing loss.

CONCLUSIONS

Dietary vitamin A and vitamin E intake were significantly associated with the prevalence of hearing loss. However, dietary antioxidant intake did not increase the risk of incident hearing loss. Further large, prospective studies are warranted to assess these relationships in older adults.

Relationship between a range of sedentary behaviours and blood pressure during early adolescence

Very few studies have explored links between physical activity, sedentary behaviours and blood pressure (BP) in early adolescence. We aimed to assess the association between a range of sedentary activities (screen time, television (TV) viewing, computer usage, video game usage and time spent in homework or reading) and BP in schoolchildren. Eligible year-7 students (2353/3144, mean age 12.7 years) from a random cluster sample of 21 Sydney schools were examined during 2003-2005. Parents and children completed detailed questionnaires of activity. BP was measured using a standard protocol and high BP was defined using published guidelines. Height and weight were measured, and body mass index (BMI) calculated. After adjusting for age, sex, ethnicity, parental education, height, BMI and time spent in physical activity, each hour per day spent in screen time, watching TV and playing video games was associated with a significant increase in diastolic BP of 0.44 (P=0.0001), 0.99 (P<0.0001) and 0.64 mm Hg (P=0.04), respectively. In contrast, each hour per day spent reading was associated with a decrease of 0.91 (P=0.01) and 0.69 mm Hg (P=0.02) in systolic and diastolic BP, respectively. Our results indicate that addressing different types of sedentary activities could be a potentially important strategy to reduce the prevalence of elevated BP in children.

Incarcerated lumbar hernia: a rare presentation

This case illustrates the diagnostic uncertainty seen in lumbar herniation as a rare cause of large bowel obstruction.

Classification of Thyroid Carcinoma in FNAB Cytological Microscopic Images

This paper investigates an image classification method performing thyroid carcinoma classification in Fine Needle Aspiration Biopsy cytological images of thyroid nodules under noise conditions and varying staining conditions. The segmentation method combines the image processing techniques thresholding and mathematical morphology. Feature extraction and classification are carried out by discrete wavelet transform and Euclidean distance based on k-nearest neighbor classifier, respectively. The classification methodology is successfully tested for Papillary carcinoma and Medullary carcinoma cytological images of thyroid nodules, showing promising results, encouraging future research work. The maximum classification rate of 95.84% and minimum classification rate of 79.17% have been reported for various testing sets of FNAB cytological images of thyroid nodules.

Relationship of Type 2 diabetes to the prevalence, incidence and progression of age-related hearing loss

AIMS

Type 2 diabetes and associated microvascular abnormalities are postulated to affect hearing. Our study reports on the relationship between Type 2 diabetes and the prevalence, 5-year incidence and progression of hearing impairment in a representative, older, Australian population.

METHODS

The Blue Mountains Hearing Study is a population-based survey of age-related hearing loss conducted in a defined suburban area, west of Sydney. Hearing loss was defined as the pure-tone average of frequencies 0.5, 1.0, 2.0 and 4.0 kHz > 25 decibels hearing level (dB HL) in the better ear (bilateral hearing loss). Type 2 diabetes was defined from reported physician-diagnosed diabetes or fasting blood glucose > or = 7.0 mmol/l.

RESULTS

Age-related hearing loss was present in 50.0% of diabetic participants (n = 210) compared with 38.2% of non-diabetic participants (n = 1648), odds ratio (OR) 1.55 [95% confidence interval (CI) 1.11-2.17], after adjusting for multiple risk factors. A relationship of diabetes duration with hearing loss was also demonstrated. After 5 years, incident hearing loss occurred in 18.7% of participants with, and 18.0% of those without diabetes, adjusted OR 1.01 (CI 0.54-1.91). Progression of existing hearing loss (> 5 dB HL), however, was significantly greater in participants with newly diagnosed diabetes (69.6%) than in those without diabetes (47.8%) over this period, adjusted OR 2.71 (CI 1.07-6.86).

CONCLUSIONS

Type 2 diabetes was associated with prevalent, but not incident hearing loss in this older population. Accelerated hearing loss progression over 5 years was more than doubled in persons newly diagnosed with diabetes. These data explore further reported links between Type 2 diabetes and age-related hearing loss.

Avoidance of tattoo disruption: a further benefit of laparoscopic surgery

INTRODUCTION

Tattoos are increasingly common in both male and female patients. Abdominal skin tattoos may be present at the site of proposed incisions for conventional surgery whereas laparoscopic port site placement can be adjusted to accommodate tattoo constraints.

METHODS

Patients with tattoos were questioned by face-to-face interview to determine how long ago they had their tattoo, financial cost of the tattoo, and potential degree of distress caused by disruption of their tattoo (on a scale of 1-10). Consultant and higher surgical trainee general surgeons were asked by e-mail survey whether they had encountered a patient with a tattoo at the site of a proposed incision, did they avoid incising the tattoo during surgical intervention, and had they received a complaint from a patient about tattoo distortion.

RESULTS

Ninety six patients (50 male, median age 29 years) were questioned. Median cost of the tattoos was pound35 ($70). Female patients were more likely to be distressed and complain than men about tattoo disruption (p = 0.0003) and there was a significant inverse correlation between time from tattooing and distress (p = 0.02). Most (79%) of the general surgeons questioned (n = 107, response rate 82%) had encountered tattoos at proposed incision sites; 61% had avoided making an incision through it and 4% had received a complaint about tattoo disruption by a patient.

CONCLUSION

Tattoo disruption by surgical incision may cause distress especially in female patients who had their tattoo recently. Tattoos should be avoided where possible by alternative port site placement.

Antibodies targeting the calcium binding skeletal muscle protein calsequestrin are specific markers of ophthalmopathy and sensitive indicators of ocular myopathy in patients with Graves' disease

We have identified several eye muscle antigens and studied the significance of the corresponding serum autoantibodies in patients with Graves' disease. Of these antigens, only calsequestrin is expressed more in eye muscle than other skeletal muscles, which could explain at least partly the specific involvement of eye muscle in patients with Graves' disease. Earlier, we found a modest relationship between anti-calsequestrin antibodies and ophthalmopathy, but in that study we used calsequestrin prepared from rabbit heart muscle and measured antibodies by immunoblotting. We have reinvestigated the prevalences of anti-calsequestrin antibodies in larger groups of well-characterized patients with thyroid autoimmunity with and without ophthalmopathy and control patients and healthy subjects, using standard enzyme-linked immunosorbent assay incorporating highly purified rabbit skeletal muscle calsequestrin, which has a 97% homology with human calsequestrin, as antigen. Anti-calsequestrin antibodies were detected in 78% of patients with active congestive ophthalmopathy, in 92% of those with active inflammation and eye muscle involvement, but in only 22% of patients with chronic, 'burnt out' disease. Tests were also positive in 5% of patients with Graves' hyperthyroidism without evident ophthalmopathy (two patients) and one patient with 'watery eyes' but no other clear signs of congestive ophthalmopathy and IgA nephropathy and no known thyroid disease, but in no patient with Hashimoto's thyroiditis, toxic nodular goitre, non-toxic multi-nodular goitre or diabetes, or age- and sex-matched healthy subjects. In serial studies of all 11 patients with Graves' hyperthyroidism who had active ophthalmopathy at the time of the first clinic visit, or developed eye signs during the first 6 months, and positive anti-calsequestrin antibodies in at least one sample, anti-calsequestrin antibodies correlated with the onset of ocular myopathy in six patients. Antibodies targeting calsequestrin appear to be specific markers for ophthalmopathy and sensitive indicators of the ocular myopathy subtype of ophthalmopathy in patients with thyroid autoimmunity. However, these results must be considered preliminary until a large prospective study of patients with newly diagnosed Graves' hyperthyroidism, in which serum levels of calsequestrin antibodies are correlated with clinical changes and orbital eye muscle and connective tissue/fat volumes, has been carried out.

A questionnaire survey about doctor-patient communication, compliance and locus of control among south Indian people with epilepsy

To date, very few studies have investigated patients' views on the information they receive from the doctor concerning epilepsy and its management. Little information is available about the influence of doctor-patient communication and locus of control on the compliance of persons with epilepsy. We investigated, through a questionnaire-interview design, among patients attending the epilepsy clinic of a tertiary referral center in South India, their views about the provision of information by the doctor, and their compliance and locus of control. We also determined the interrelation between doctor-patient communication, compliance and locus of control. Our subjects comprised 200 adult persons with epilepsy, 113 males and 87 females, mean age 30.5 (range 18-67) years. Over one-third of the subjects received from the doctor insufficient information about epilepsy and its treatment. There was a significant positive correlation between effective doctor-patient communication and compliance. A majority of our patients had an external locus of control, which negatively influenced the compliance. Even in a comprehensive epilepsy clinic of a model tertiary referral center in a developing country, a significant proportion of patients do not receive optimal information about epilepsy from the doctor. Knowledge about their disease will encourage people with epilepsy to make informed choices, and achieve better compliance and personal control of their problems. Educating primary and secondary care physicians about the importance of doctor-patient communication in the management of epilepsy and educating the public about the positive aspects of life in epilepsy cannot be overemphasized.

The IC model of parallel computation and programming environment

The IC* project is an effort to create an environment for the design, specification and development of complex systems such as communication protocols, parallel machines and distributed systems. The basis of this work is the IC* model of parallel computation. In this model a system is specified by a set of invariant expressions which describe its behavior in time. The novel features of the model include: temporal and structural constraints, inherent parallelism, explicit modeling of time, nondeterministic evolution and dynamic activation. The project also includes the construction of a parallel computer specifically designed to support the model of computation. The model of computation, the status of the project and the user environment is the content of this paper.