Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Not in employment, education or training (NEET); more than a youth policy issue

Introduction

Australians who are Not in Employment, Education or Training (NEET) and receive income support span a wide spectrum of working ages. Australian research has concentrated on NEETs aged 15–29 years, in line with international standards. This paper investigates extending the NEET concept to include all working age persons 15–64 years and the value added to welfare policy through analysis of a new linked dataset.

Methods

An observational study design was implemented with individuals aged 15-64 years recorded as receiving Department of Social Services (DSS) income support payments from September 2011 being linked with Australian Bureau of Statistics (ABS) Census data from August 2011 to create a linked dataset for analysis. Descriptive analyses were undertaken of NEET status by Census socio-demographic characteristics, and we modelled the adjusted likelihood of NEET status by Census demographics.

Results

Some 1.37 million or 45.2% of linked DSS payment recipients qualified as NEET. Of NEETs, more than twice as many were female, nearly half were aged 45–64 years, and under 1-in-5 were aged 15–29 years. Multivariate analyses showed that NEETs were more likely to be older, have low educational attainment, have a disability, and to be Indigenous.

Conclusions

Young NEETs aged 15–29 years represented less than 20% of linked DSS payment recipients classified as NEET, suggesting that standard NEETs reporting neglects information on around 80% of the working age NEET population in Australia. Combined with other demographic insights, these results have implications for welfare policy, and indicate a wider range of demographics should be considered under the NEET classification. This may also have implications for Organisation for Economic Co-operation and Development (OECD) reporting.

Indigenous Preferences for Inpatient Rooms in Australian Hospitals: A Mixed-Methods Study in Cross-Cultural Design

AIM

This mixed-method study aimed to establish preliminary evidence for spatial and design features that can improve the experience and participation of Indigenous inpatients in healthcare.

BACKGROUND

Disadvantaged across a range of health measures, a disproportionately high number of Indigenous people leave hospital without receiving appropriate medical care. Australian government policies to improve cultural safety of Indigenous patients have largely ignored physical settings and their potential to improve health outcomes. Despite increasing evidence on the potential of design to reduce patient stress, there is minimal research on cross-cultural design in health facilities, including for Indigenous Australians.

METHODS

A cross-sectional, area-based survey elicited design preferences of four healthcare settings from Indigenous participants (n = 602). On the screen-based survey, participants selected from paired images that indicated their preferences for room layout and features of inpatient rooms. Semistructured in-depth interviews (n = 55) explored meanings behind preferences.

RESULTS

Participants showed majority preferences for the two-bed patient room, for a balcony rather than a window only, Indigenous art, and view of a park over an urban environment. Analysis of qualitative data shifted the focus from Ulrich's three supportive design components to cultural recognition, the desire for company of family members, and connection to life outdoors.

CONCLUSIONS

Social and cultural factors were highly significant to patients for sense of control, family support, and positive distraction. In response, inpatient room size and type, views, access to outdoors and Indigenous art need to be considered in hospital design for Indigenous patients and families.

Not in Employment, Education or Training (NEET); more than a youth policy issue

Background with rationaleAustralians who are Not in Employment, Education or Training (NEET) and receive income support span a wide spectrum of working ages. Australian research has concentrated on NEETs aged 15–29 years, in line with international standards. This paper investigates extending the NEET concept to include all working age persons 15–64 years and the value added to welfare policy through analysis of a new linked dataset. Main AimTo determine whether the NEET concept is policy relevant when applied to all working ages. Methods/ApproachIndividuals aged 15-64 years recorded as receiving Department of Social Services (DSS) income support payments from September 2011 were linked with Australian Bureau of Statistics (ABS) Census data from August 2011 to create a linked dataset for analysis. Descriptive analyses were undertaken of NEET status by Census socio-demographic characteristics, and we modelled the adjusted likelihood of NEET status by Census demographics. ResultsSome 1.37 million or 45.2% of linked DSS payment recipients qualified as NEET. Of NEETs, more than twice as many were female, nearly half were aged 45–64 years, and under 1-in-5 were aged 15–29 years. Multivariate analyses showed that NEETs were more likely to be older, have low educational attainment, have a disability, and to be Indigenous. ConclusionYoung NEETs aged 15–29 years represented less than 20 per cent of linked DSS payment recipients classified as NEET, suggesting that standard NEETs reporting neglects information on around 80 per cent of the working age NEET population in Australia. Combined with other demographic insights, these results have implications for welfare policy, and indicate a wider range of demographics should be considered under the NEET classification. This may also have implications for OECD reporting.

Aboriginal and Torres Strait Islander preferences for healthcare settings: effective use of design images in survey research

Objective The aim of this study was to develop an effective digital survey instrument incorporating images to investigate Aboriginal and Torres Strait Islander preferences for health clinics and hospitals, design of healthcare settings and the differences between inner regional and remote locations. Methods Design-related constructs developed from qualitative interviews informed the construction of healthcare setting images. These images were embedded in an online survey instrument to elicit data on design preferences and an area-based recruitment strategy ensured participation by Indigenous Australians from three Queensland locations. Logistic regression analyses were used to estimate the odds of preference for a healthcare setting design by location. Results Statistical analysis of data from 602 participants showed a preference for health care at an Aboriginal and Torres Strait Islander clinic. The odds of preference for an in-patient room with a two- versus single-bed design was greater for participants with less education, and lower for participants with a long-term health problem. Conclusions The multidisciplinary approach to developing an online survey instrument with images and the willingness of Indigenous people of all ages to engage with the images demonstrated the effectiveness of this method in providing robust evidence for the design of culturally appropriate healthcare spaces for Indigenous users. What is known about the topic? Evidence-based research influences the design of healthcare buildings, yet the field currently provides negligible evidence on cross-cultural perceptions or experiences of conventional modern hospitals and clinics. Although recent healthcare buildings show signs of acknowledging Indigenous users, general principles in the Australian Health Facility Guidelines give limited specific information about how cultural requirements may translate into architectural design. What does this paper add? The multidisciplinary approach to research design has enabled the development of healthcare design-related constructs from consultation with Indigenous people, the presentation of these constructs as images and the inclusion of these images for comparison and selection in a digital survey instrument. Combined with a culturally appropriate recruitment strategy, this survey provides evidence from a large sample of the Indigenous population. Selected results from analyses of survey responses show the capacity of the methodological approach to address broader questions about Indigenous preferences for healthcare settings by location, age and sex. What are the implications for practitioners? A focus on individual preferences related to healthcare clinics and the combined significance of design and setting can give practitioners a better understanding of Aboriginal and Torres Strait Islander people's preferences and suggest ways to reduce the incidence of poor engagement with healthcare services.

Including mobile-only telephone users in a statewide preventive health survey-Differences in the prevalence of health risk factors and impact on trends

The Queensland preventive health survey is conducted annually to monitor the prevalence of behavioural risk factors in the north-east Australian state. Prompted by domestic and international trends in mobile telephone usage, the 2015 survey incorporated both mobile and landline telephone numbers from a list-based sampling frame. Estimates for landline-accessible and mobile-only respondents are compared to assess potential bias in landline-only surveys in the context of public health surveillance. Significant differences were found in subcategories of all health prevalence estimates considered (alcohol consumption, body mass index, smoking, and physical activity) from 2015 survey results. Results from Australian and international studies that have considered mobile telephone non-coverage bias are also summarised and discussed. We find that adjusting for sampling biases of telephone surveys by weighting does not fully compensate for the differences in prevalence estimates. However, predicted trends from previous years' surveys only differ significantly for the 2015 prevalence estimates of alcohol consumption. We conclude that the inclusion of mobile telephones into standard telephones surveys is important for obtaining valid, reliable and representative data to reduce bias in health prevalence estimates. Importantly, unlike some international experiences, the addition of mobiles telephones into the Queensland preventive health survey occurred before population trends were significantly affected.

•

There is a rapidly growing proportion of adults who are contactable via mobile-only.

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Exclusion of mobile-only group leads to biases in health prevalence estimates.

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Weighting and controlling for age differences does not correct for these biases.

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A list-based survey yields representative statistics for public health policy.

Profiling the mobile-only population in Australia: insights from the Australian National Health Survey

BACKGROUND

The Australian population that relies on mobile phones exclusively has increased from 5% in 2005 to 29% in 2014. Failing to include this mobile-only population leads to a potential bias in estimates from landline-based telephone surveys. This paper considers the impacts on selected health prevalence estimates with and without the mobile-only population.

METHODS

Using data from the Australian Health Survey - which, for the first time, included a question on telephone status - we examined demographic, geographic and health differences between the landline-accessible and mobile-only population. These groups were also compared to the full population, controlling for the sampling design and differential non-response patterns in the observed sample through weighting and benchmarking.

RESULTS

The landline-accessible population differs from the mobile-only population for selected health measures resulting in biased prevalence estimates for smoking, alcohol risk and private health insurance coverage in the full population. The differences remain even after adjusting for age and gender.

CONCLUSIONS

Using landline telephones only for conducting population health surveys will have an impact on prevalence rate estimates of health risk factors due to the differing profiles of the mobile-only population from the landline-accessible population.

Change in walking for transport: a longitudinal study of the influence of neighbourhood disadvantage and individual-level socioeconomic position in mid-aged adults

Background

Unlike leisure time physical activity, knowledge of the socioeconomic determinants of active transport is limited, research on this topic has produced mixed and inconsistent findings, and it remains unknown if peoples’ engagement in active transport declines as they age. This longitudinal study examined relationships between neighbourhood disadvantage, individual-level socioeconomic position and walking for transport (WfT) during mid- and early old-age (40 – 70 years). Three questions were addressed: (i) which socioeconomic groups walk for transport, (ii) does the amount of walking change over time as people age, and (iii) is the change socioeconomically patterned?

Methods

The data come from the HABITAT study of physical activity, a bi-annual multilevel longitudinal survey of 11,036 residents of 200 neighbourhoods in Brisbane, Australia. At each wave (2007, 2009 and 2011) respondents estimated the duration (minutes) of WfT in the previous 7 days. Neighbourhood disadvantage was measured using a census-derived index comprising 17 different socioeconomic components, and individual-level socioeconomic position was measured using education, occupation, and household income. The data were analysed using multilevel mixed-effects logistic and linear regression.

Results

The odds of being defined as a ‘never walker’ were significantly lower for residents of disadvantaged neighbourhoods, but significantly higher for the less educated, blue collar employees, and members of lower income households. WfT declined significantly over time as people aged and the declines were more precipitous for older persons. Average minutes of WfT declined for all neighbourhoods and most socioeconomic groups; however, the declines were steeper for the retired and members of low income households.

Conclusions

Designing age-friendly neighbourhoods might slow or delay age-related declines in WfT and should be a priority. Steeper declines in WfT among residents of low income households may reflect their poorer health status and the impact of adverse socioeconomic exposures over the life course. Each of these declines represents a significant challenge to public health advocates, urban designers, and planners in their attempts to keep people active and healthy in their later years of life.

Change in walking for transport: a longitudinal study of the influence of neighbourhood disadvantage and individual-level socioeconomic position in mid-aged adults

BACKGROUND

Unlike leisure time physical activity, knowledge of the socioeconomic determinants of active transport is limited, research on this topic has produced mixed and inconsistent findings, and it remains unknown if peoples' engagement in active transport declines as they age. This longitudinal study examined relationships between neighbourhood disadvantage, individual-level socioeconomic position and walking for transport (WfT) during mid- and early old-age (40 - 70 years). Three questions were addressed: (i) which socioeconomic groups walk for transport, (ii) does the amount of walking change over time as people age, and (iii) is the change socioeconomically patterned?

METHODS

The data come from the HABITAT study of physical activity, a bi-annual multilevel longitudinal survey of 11,036 residents of 200 neighbourhoods in Brisbane, Australia. At each wave (2007, 2009 and 2011) respondents estimated the duration (minutes) of WfT in the previous 7 days. Neighbourhood disadvantage was measured using a census-derived index comprising 17 different socioeconomic components, and individual-level socioeconomic position was measured using education, occupation, and household income. The data were analysed using multilevel mixed-effects logistic and linear regression.

RESULTS

The odds of being defined as a 'never walker' were significantly lower for residents of disadvantaged neighbourhoods, but significantly higher for the less educated, blue collar employees, and members of lower income households. WfT declined significantly over time as people aged and the declines were more precipitous for older persons. Average minutes of WfT declined for all neighbourhoods and most socioeconomic groups; however, the declines were steeper for the retired and members of low income households.

CONCLUSIONS

Designing age-friendly neighbourhoods might slow or delay age-related declines in WfT and should be a priority. Steeper declines in WfT among residents of low income households may reflect their poorer health status and the impact of adverse socioeconomic exposures over the life course. Each of these declines represents a significant challenge to public health advocates, urban designers, and planners in their attempts to keep people active and healthy in their later years of life.

Effect of health insurance on the utilisation of allied health services by people with chronic disease: a systematic review and meta-analysis

Allied health services benefit the management of many chronic diseases. The effects of health insurance on the utilisation of allied health services has not yet been established despite health insurance frequently being identified as a factor promoting utilisation of medical and hospital services among people with chronic disease. The objective of this systematic review and meta-analysis was to establish the effects of health insurance on the utilisation of allied health services by people with chronic disease. Medline (Ovid Medline 1948 to Present with Daily Update), EMBASE (1980 to 1 April 2011), CINAHL, PsychINFO and the Cochrane Central Register of Controlled Trials were searched to 12 April 2011 inclusive. Studies were eligible for inclusion if they were published in English, randomised controlled trials, quasi-experimental trials, quantitative observational studies and included people with one or more chronic diseases using allied health services and health insurance. A full-text review was performed independently by two reviewers. Meta-analyses were conducted. One hundred and fifty-eight citations were retrieved and seven articles were included in the meta-analyses. The pooled odds ratio (95% CI) of having insurance (versus no insurance) on the utilisation of allied health services among people with chronic disease was 1.33 (1.16-1.52; P<0.001). There was a significant effect of insurance on the utilisation of non-physiotherapy services, pooled odds ratio (95% CI) 4.80 (1.46-15.79; P=0.01) but having insurance compared with insurance of a lesser coverage was not significantly associated with an increase in physiotherapy utilisation, pooled odds ratio (95% CI) 1.53 (0.81-2.91; P=0.19). The presence of co-morbidity or functional limitation and higher levels of education increased utilisation whereas gender, race, marital status and income had a limited and variable effect, according to the study population. The review was limited by the considerable heterogeneity in the research questions being asked, sample sizes, study methodology (including allied health service), insurance type and dependent variables analysed. The presence of health insurance was generally associated with increased utilisation of allied health services; however, this varied depending on the population, provider type and insurance product.

Change and stability in ethnic diversity across urban communities: Explicating the influence of social cohesion on perceptions of disorder

A growing body of research shows that perceived community disorder is not solely driven by crime, but is influenced by the community’s social cohesion and ethnic composition. Drawing on two waves of survey data from 2509 and 2651 individuals in Wave 1 and Wave 2 respectively, living in 71 communities in Brisbane Australia, we examine changes in ethnic composition over two time periods and how these changes influence perceived neighbourhood disorder. We also test whether or not social cohesion mediates these associations. Our findings indicate that high proportions of Indigenous residents and high levels of reported crime averaged across time are associated with greater perceived disorder. Whereas increases in household income over time are associated with lower perceived disorder. We also find that social cohesion is strongly associated with perceived disorder over time, but does not mediate the relationship between the racial and ethnic composition of the community and disorder. Yet when a community’s social cohesion is considered, the effect of increasing household income becomes non-significant.

Health for all? Patterns and predictors of allied health service use in Australia

Objective To examine patterns and predictors of allied health service use among the Australian population. Methods Data from the 2007–08 longitudinal National Health Survey conducted by the Australian Bureau of Statistics in Australia were used to examine differences in use of allied health services among the population. The survey is based on 15 779 adult respondents. Multivariate logistic regression models were used to model the probability of visiting an allied health service contingent on multiple factors of interest. Results Men, less educated people and people from non-English speaking backgrounds were low users compared with other groups. Interestingly, people with type 2 diabetes were substantially higher users compared with people with other chronic diseases, or no reported chronic disease, and ancillary health insurance had a strong positive effect on use. Discussion Further investigation of the social and economic circumstances surrounding allied health service use is required to determine areas of under use or unmet need. High use among people with diabetes might indicate the impact of policy incentives to enhance use. Yet, whether all those in need are able to access services is unknown. Further investigation of use among groups with different health needs and by type of financing will enhance policy. What is known about the topic? Inequities and variations in access to allied health services are commonplace. Effective policy initiatives to improve access, particularly among patients with chronic disease, will depend on improving the knowledge base about patterns of use of allied health services, and what determines use. What does this paper add? This paper reveals the high and low users of allied health services among the Australian population, those population groups who might be missing out and what might explain these patterns. This information will enable policy makers to target areas of potential unmet need. What are the implications for practitioners? Multidisciplinary team care is advocated in the management of chronic disease. Practitioners have a vital role in framing the benefits of allied health services to patients and in developing the evidence base about best practice in the management of chronic disease for diverse patient groups.

Can the built environment reduce health inequalities? A study of neighbourhood socioeconomic disadvantage and walking for transport

Residents of socioeconomically disadvantaged neighbourhoods are more likely to walk for transport than their counterparts in advantaged neighbourhoods; however, the reasons for higher rates of transport walking in poorer neighbourhoods remain unclear. We investigated this issue using data from the HABITAT study of physical activity among 11,037 mid-aged residents of 200 neighbourhoods in Brisbane, Australia. Using a five-step mediation analysis and multilevel regression, we found that higher levels of walking for transport in disadvantaged neighbourhoods was associated with living in a built environment more conducive to walking (i.e. greater street connectivity and land use mix) and residents of these neighbourhoods having more limited access to a motor vehicle. The health benefits that accrue to residents of disadvantaged neighbourhoods as a result of their higher levels of walking for transport might help offset the negative effects of less healthy behaviours (e.g. smoking, poor diet), thus serving to contain or reduce neighbourhood inequalities in chronic disease.

Sleep, structured and social time use and young Australian children's physical activity

ISSUE ADDRESSED

Physical inactivity is a growing health concern for children, with the potential to undermine their health and wellbeing. While a range of factors have been associated with physical inactivity, the contribution of time spent in sleep, structured activities and children's social contexts has received limited attention.

METHODS

This cross-sectional study employed data from Wave 1 of the Longitudina Study of Australian Children to examine the association between participation in physical activity and time spent in sleep, structured activity, and social contexts of 4-5 year old children.

RESULTS

Young children who were more physically active were found to participate less in structured activities on weekdays (beta=-0.25, SE=0.05); spend more time with peers under adult supervision on weekends (beta=0.36, SE=0.15); and have parents who themselves reported enjoying physical activity (beta=-0.18, SE=0.06). Boys (beta=-0.13, SE=0.05) and young children who spoke only English at home (beta=-0.37, SE=0.11) were also found to be more physically active. Overa ll, young children participated in more physical activity on weekend days than weekdays (beta=0.57, SE=0.04).

CONCLUSIONS

Young children who are highly scheduled in structured activities on weekdays and those with imited adult involvement, especially on weekends, tend to be less physically active. Interventions that promote physical activity in young children therefore need to be family focused and encourage the engagement of parents.

Mid-aged adults' sitting time in three contexts

BACKGROUND

To develop evidence-based approaches for reducing sedentary behavior, there is a need to identify the specific settings where prolonged sitting occurs, associated factors, and variations.

PURPOSE

To examine the sociodemographic and health factors associated with mid-aged adults' sitting time in three contexts and variations between weekdays and weekend days.

METHODS

A mail survey was sent to 17,000 adults (aged 40-65 years) in 2007; 11,037 responses were received (68.5%); and 7719 were analyzed in 2010. Respondents indicated time spent sitting on a usual weekday and weekend day for watching TV, general leisure, and home computer use. Multivariate linear mixed models with area-level random intercepts were used to examine (1) associations between sociodemographic and health variables and sitting time, and (2) interaction effects of weekday/weekend day with each of gender, age, education, and employment status, on sitting time.

RESULTS

For each context, longer sitting times were reported by those single and living alone, and those whose health restricted activity. For watching TV, longer sitting times were reported by men; smokers; and those with high school or lower education, not in paid employment, in poor health, and with BMI ≥25. For general leisure, longer sitting times were reported by women, smokers, and those not employed full-time. For home computer use, longer sitting times were reported by men; and those aged 40-44 years, with university qualifications; in the mid-income range; and with BMI ≥30. Sitting times tended to be longer on weekend days than weekdays, although the extent of this differed among sociodemographic groups.

CONCLUSIONS

Sociodemographic and health factors associated with sitting time differ by context and between weekdays and weekend days.

Time use differences in activity participation among children 4-5 years old with and without the risk of developing conduct problems

Conduct problems in childhood are associated with the way in which children engage in daily activities. Research, to date, on conduct problems in relation to time use has primarily focused on school aged children and their participation in discrete activities such as watching TV and sport. The purpose of the present study is to determine if children at risk of developing conduct problems have different activity patterns compared to those not at risk. Specifically aspects of time use which concern involvement in activities that provide physical exertion, structure, rest and social engagement were examined. Data for this investigation were drawn from the Longitudinal Study of Australian Children (Wave 1) and focused on 4936 children aged 4-5 years. Findings indicate that children at risk of developing conduct problems spend significantly more time in: physical activities such as "riding a bike", and "in the company of adults only" than children not at risk of developing conduct problems but less time "with peers under adult supervision". Gender differences were also found in the same activities with boys participating in more "bike riding" and activities "without peers under adult supervision" than girls. Young children generally participated in more physical activities and spend more time "with peers while supervised by adults" on weekend days, and more time in "structured activities" and "in the company of adults only" on weekdays. These findings are discussed in respect of the potentially risky nature of physical activity choice and the contribution of adult supervision in the context of peer group participation for children at risk of developing conduct problems.

Cognitive development and Down syndrome: age-related change on the Stanford-Binet test (fourth edition)

Growth models for subtests of the Stanford-Binet Intelligence Scale, 4th edition ( R. L. Thorndike, E. P. Hagen, & J. M. Sattler, 1986a , 1986b ) were developed for individuals with Down syndrome. Models were based on the assessments of 208 individuals who participated in longitudinal and cross-sectional research between 1987 and 2004. Variation in performance among individuals was large and significant across all subtests except Memory for Sentences. Scores on the Memory for Sentences subtest remained low between ages 4 to 30 years. Greatest variation was found on the Pattern Analysis subtest, where scores continued to rise into adulthood. Turning points for scores on the Vocabulary and Comprehension subtests appeared premature relative to normative patterns of development. The authors discuss development at the subdomain level and analyze both individual and group trajectories.

The association between objectively measured neighborhood features and walking in middle-aged adults

PURPOSE

Explore the role of the neighborhood environment in supporting walking.

DESIGN

Cross-sectional study of 10,286 residents of 200 neighborhoods. Participants were selected using a stratified two-stage cluster design. Data were collected by mail survey (68.5% response rate).

SETTING

Brisbane City Local Government Area, Australia, 2007.

SUBJECTS

Brisbane residents aged 40 to 65 years.

MEASURES

Environmental: street connectivity, residential density, hilliness, tree coverage, bikeways, and streetlights within a 1-km circular buffer from each resident's home; and network distance to nearest river or coast, public transport, shop, and park. Walking: minutes walked in the previous week: < 30 minutes, ≥ 30 to < 90 minutes, ≥ 90 to < 150 minutes, ≥ 150 to < 300 minutes, and ≥ 300 minutes.

ANALYSIS

The association between each neighborhood characteristic and walking was examined using multilevel multinomial logistic regression, and the model parameters were estimated using Markov chain Monte Carlo simulation.

RESULTS

After adjustment for individual factors, the likelihood of walking for more than 300 minutes (relative to < 30 minutes) was highest in areas with the most connectivity (odds ratio [OR] 5 1.93; 99% confidence intervals [CI], 1.32-2.80), greatest residential density (OR 5 1.47; 99% CI, 1.02-2.12), least tree coverage (OR 5 1.69; 99% CI, 1.13-2.51), most bikeways (OR 5 1.60; 99% CI, 1.16-2.21), and most streetlights (OR 5 1.50; 99% CI, 1.07-2.11). The likelihood of walking for more than 300 minutes was also higher among those who lived closest to a river or the coast (OR 5 2.06; 99% CI, 1.41-3.02).

CONCLUSION

The likelihood of meeting (and exceeding) physical activity recommendations on the basis of walking was higher in neighborhoods with greater street connectivity and residential density, more streetlights and bikeways, closer proximity to waterways, and less tree coverage. Interventions targeting these neighborhood characteristics may lead to improved environmental quality as well as lower rates of overweight and obesity and associated chromic disease.

The Association between Objectively Measured Neighborhood Features and Walking in Middle-Aged Adults

Purpose.

Explore the role of the neighborhood environment in supporting walking.

Design.

Cross-sectional study of 10,286 residents of 200 neighborhoods. Participants were selected using a stratified two-stage cluster design. Data were collected by mail survey (68.5% response rate).

Setting.

Brisbane City Local Government Area, Australia, 2007.

Subjects.

Brisbane residents aged 40 to 65 years.

Measures.

Environmental: street connectivity, residential density, hilliness, tree coverage, bikeways, and streetlights within a 1-km circular buffer from each resident's home; and network distance to nearest river or coast, public transport, shop, and park. Walking: minutes walked in the previous week: <30 minutes, ≥30 to <90 minutes, ≥90 to <150 minutes, ≥150 to <300 minutes, and ≥300 minutes.

Analysis.

The association between each neighborhood characteristic and walking was examined using multilevel multinomial logistic regression, and the model parameters were estimated using Markov chain Monte Carlo simulation.

Results.

After adjustment for individual factors, the likelihood of walking for more than 300 minutes (relative to <30 minutes) was highest in areas with the most connectivity (odds ratio [OR] = 1.93; 99% confidence intervals [CI], 1.32–2.80), greatest residential density (OR = 1.47; 99% CI, 1.02–2.12), least tree coverage (OR = 1.69; 99% CI, 1.13–2.51), most bikeways (OR = 1.60; 99% CI, 1.16–2.21), and most streetlights (OR = 1.50; 99% CI, 1.07–2.11). The likelihood of walking for more than 300 minutes was also higher among those who lived closest to a river or the coast (OR = 2.06; 99% CI, 1.41–3.02).

Conclusion.

The likelihood of meeting (and exceeding) physical activity recommendations on the basis of walking was higher in neighborhoods with greater street connectivity and residential density, more streetlights and bikeways, closer proximity to waterways, and less tree coverage. Interventions targeting these neighborhood characteristics may lead to improved environmental quality as well as lower rates of overweight and obesity and associated chromic disease. (Am J Health Promot 2011;25[4]:e12–e21.)

Time use, parenting practice and conduct problems in four- to five-year-old Australian children

BACKGROUND

Conduct problems (CoP) represent one of the most common mental health issues manifesting in childhood, with the potential to influence the developmental trajectory of children negatively. Early identification of children at risk of developing CoP is a key strategy to their effective management. Evidence suggests that parenting practices are important contributors to CoP; however, these practices can also interact with the activities in which children engage and these have not yet been addressed in combination.

METHOD

A cross-sectional study of a nationally representative sample of 4936 four- to five-year-old children from Wave 1 of the Longitudinal Study of Australian Children was undertaken to examine the relationship between CoP, parenting practices and time use.

RESULTS

All children were at a lower risk of CoP if they were exposed to less hostile and consistent parenting practices and if they did not have sleep problems as reported by their parents. However, boys were more vulnerable if they had fathers who had not undertaken tertiary education, and spent more time in risk-oriented physical activities.

CONCLUSION

Parenting practices are affirmed as a significant independent predictor of risk for developing CoP. The nature of activities in which children engaged, particularly boys, also has the potential to influence the manifestation of CoP. Occupational therapy services for children with CoP are best provided in the context of family-centred practice and should incorporate an examination of daily time use.

Neighborhood disadvantage and physical activity: baseline results from the HABITAT multilevel longitudinal study

PURPOSE

To examine the association between neighborhood disadvantage and physical activity (PA).

METHODS

We use data from the HABITAT multilevel longitudinal study of PA among middle-aged (40-65 years) men and women (N = 11,037, 68.5% response rate) living in 200 neighborhoods in Brisbane, Australia. PA was measured using three questions from the Active Australia Survey (general walking, moderate, and vigorous activity), one indicator of total activity, and two questions about walking and cycling for transport. The PA measures were operationalized by using multiple categories based on time and estimated energy expenditure that were interpretable with reference to the latest PA recommendations. The association between neighborhood disadvantage and PA was examined with the use of multilevel multinomial logistic regression and Markov chain Monte Carlo simulation. The contribution of neighborhood disadvantage to between-neighborhood variation in PA was assessed using the 80% interval odds ratio.

RESULTS

After adjustment for sex, age, living arrangement, education, occupation, and household income, reported participation in all measures and levels of PA varied significantly across Brisbane's neighborhoods, and neighborhood disadvantage accounted for some of this variation. Residents of advantaged neighborhoods reported significantly higher levels of total activity, general walking, moderate, and vigorous activity; however, they were less likely to walk for transport. There was no statistically significant association between neighborhood disadvantage and cycling for transport. In terms of total PA, residents of advantaged neighborhoods were more likely to exceed PA recommendations.

CONCLUSIONS

Neighborhoods may exert a contextual effect on the likelihood of residents participating in PA. The greater propensity of residents in advantaged neighborhoods to do high levels of total PA may contribute to lower rates of cardiovascular disease and obesity in these areas.

HABITAT: A longitudinal multilevel study of physical activity change in mid-aged adults

Background

Little is known about the patterns and influences of physical activity change in mid-aged adults. This study describes the design, sampling, data collection, and analytical plan of HABITAT, an innovative study of (i) physical activity change over five years (2007–2011) in adults aged 40–65 years at baseline, and (ii) the relative contribution of psychological variables, social support, neighborhood perceptions, area-level factors, and sociodemographic characteristics to physical activity change.

Methods/Design

HABITAT is a longitudinal multi-level study. 1625 Census Collection Districts (CCDs) in Brisbane, Australia were ranked by their index of relative socioeconomic disadvantage score, categorized into deciles, and 20 CCDs from each decile were selected to provide 200 local areas for study inclusion. From each of the 200 CCDs, dwellings with individuals aged between 40–65 years (in 2007) were identified using electoral roll data, and approximately 85 people per CCD were selected to participate (N = 17,000). A comprehensive Geographic Information System (GIS) database has been compiled with area-level information on public transport networks, footpaths, topography, traffic volume, street lights, tree coverage, parks, public services, and recreational facilities Participants are mailed a questionnaire every two years (2007, 2009, 2011), with items assessing physical activity (general walking, moderate activity, vigorous activity, walking for transport, cycling for transport, recreational activities), sitting time, perceptions of neighborhood characteristics (traffic, pleasant surroundings, streets, footpaths, crime and safety, distance to recreational and business facilities), social support, social cohesion, activity-related cognitions (attitudes, efficacy, barriers, motivation), health, and sociodemographic characteristics. Analyses will use binary and multinomial logit regression models, as well as generalized linear latent growth models.

Discussion

HABITAT will provide unique information to improve our understanding of the determinants of physical activity, and to help identify "people" and "place" priority targets for public policy and health promotion aimed at increasing physical activity participation among mid-aged men and women.

Anxiety and stress in mothers and fathers in the 24 h after their child's surgery

BACKGROUND AND OBJECTIVE

Surgery in a paediatric setting stresses children and their parents. Previous studies have focused on children and the preoperative period; however, the 24 h after child surgery are highly stressful for parents as their child is still physically recovering and physician-parent communication is vital. The aims of this study are to investigate the impact of three levels of severity of paediatric surgery on mothers' and fathers' anxiety and stress and to identify factors that contribute to parental anxiety and acute stress symptoms in the first 24 h after child surgery.

PATIENTS AND METHODS

A total of 154 parents (91 mothers, 63 fathers) of children who had just undergone elective surgery for a major intervention (n = 41), minor intervention (n = 64) or day surgery (n = 49) completed questionnaires aimed at assessing levels of state anxiety and acute stress symptoms. Social network, socio-economic status and parental health locus of control were evaluated as contributors.

RESULTS

Parents reported high levels of state anxiety (26% had scores on the state scale 2 standard deviations above the norm) and acute stress symptoms (28% in at least one of the four acute stress disorder symptom categories). Child's type of surgery is related to parental anxiety [F(2,134) = 38.12, P = 0.0001, eta(2) = 0.175] and acute stress symptoms [F(2,133) = 31.21, P = 0.0001, eta(2) = 0.133]. Parental state anxiety was predicted by parent's gender, trait anxiety and health external locus of control. Parent's number of acute stress symptoms was predicted by parental trait anxiety, health external locus of control, parent's level of education and the number of social contacts.

CONCLUSIONS

There is a need to take into consideration parental anxiety and distress in the 24 h after child surgery. Parental well-being is related to several characteristics including the severity of child surgery; these aspects should be taken into consideration when interacting with parents in the aftermath of their child's surgery.

Effects of a metacognitive intervention on students' approaches to learning and self-efficacy in a first year medical course

AIM

To determine the influence of metacognitive activities within the PBL tutorial environment on the development of deep learning approach, reduction in surface approach, and enhancement of individual learning self-efficacy.

METHOD

Participants were first-year medical students (N = 213). A pre-test, post-test design was implemented with intervention and control cohorts, with intervention students experiencing a program of metacognitive activities within their PBL tutorials of at least 20 weeks duration. All students completed the Medical Course Learning Questionnaire at the commencement, and again at the completion of, the study. The metacognitive intervention itself consisted of reflection on the learning in PBL coupled with peer- and self-assessment.

RESULTS

Self-efficacy was significantly reduced for both control and intervention cohorts at the conclusion of the study. A significant reduction in the adoption of deep and strategic learning approach, matched by a corresponding increase in the use of surface learning, was demonstrated for both cohorts. There was a statistically significant association between high self-efficacy and deep learning approach, with older students over-represented in the group of efficacious deep learners.

CONCLUSION

Over the course of first-year medical studies, students lose self-efficacy and move away from deep-strategic learning approaches towards more surface approaches. The program of metacognitive activities failed to reverse this trend. The substantial swing towards surface learning raises questions about the perceived capacity of PBL curricula to promote deep approaches to learning in dense curricula, and reinforces the importance of personal and contextual factors, such as study habits, workload and assessment, in determining individual approaches and idiosyncratic responses to learning situations.

An analysis of peer, self, and tutor assessment in problem-based learning tutorials

OBJECTIVE

The purpose of this study was to explore self-, peer-, and tutor assessment of performance in tutorials among first year medical students in a problem-based learning curriculum.

METHODS

One hundred and twenty-five students enrolled in the first year of the Bachelor of Medicine and Bachelor of Surgery Program at the University of Queensland were recruited to participate in a study of metacognition and peer- and self-assessment. Both quantitative and qualitative data were collected from the assessment of PBL performance within the tutorial setting, which included elements such as responsibility and respect, communication, and critical analysis through presentation of a case summary. Self-, peer-, and tutor assessment took place concurrently.

RESULTS

Scores obtained from tutor assessment correlated poorly with self-assessment ratings (r = 0.31-0.41), with students consistently under-marking their own performance to a substantial degree. Students with greater self-efficacy, scored their PBL performance more highly. Peer-assessment was a slightly more accurate measure, with peer-averaged scores correlating moderately with tutor ratings initially (r = 0.40) and improving over time (r = 0.60). Students consistently over-marked their peers, particularly those with sceptical attitudes to the peer-assessment process. Peer over-marking led to less divergence from the tutor scoring than under-marking of one's own work.

CONCLUSION

According to the results of this study, first-year medical students in a problem-based learning curriculum were better able to accurately judge the performance of their peers compared to their own performance. This study has shown that self-assessment of process is not an accurate measure, in line with the majority of research in this domain. Nevertheless, it has an important role to play in supporting the development of skills in reflection and self-awareness.

Is Assessment of Popliteal Artery Diameter in Patients Undergoing Screening for Abdominal Aortic Aneurysms a Worthwhile Procedure

PURPOSE

The aim of this study was to assess whether screening of popliteal arteries in patients undergoing ultrasound screening of their abdominal aortas was worthwhile.

METHODS

All male patients undergoing ultrasound screening for abdominal aortic aneurysm (AAA) during the period February 2000 to June 2002 were offered scanning of their popliteal arteries. All scans were performed by a single, trained operator using a Sonosite 180.

RESULTS

Four hundred and forty-nine patients underwent screening and thus 898 popliteal arteries were assessed. The mean aortic diameter was 2.1 standard deviations (SD) 0.5 cm and the upper limit of normal (2 SD) was 2.7 cm. The mean diameter of the popliteal arteries was 0.74 SD 0.11 and the upper limit of normal was 0.96 cm. Thirty patients had aortic diameters greater than 2.5 cm (ectatic or aneurysmal aortas) but based on a popliteal diameter of 2 cm, no popliteal aneurysms were detected. However, 39 (4.3%) popliteal arteries measured > or = 1 cm (> mean+2 SD); 3/60 (5%) in the ectatic/AAA subgroup and 36/838 (4.3%) in the non-AAA subgroup.

CONCLUSIONS

This study has shown that, using conventional definitions, the imaging of popliteal arteries during screening for AAAs does not detect any popliteal aneurysms and is thus of limited value. However, if a definition of popliteal aneurysm of > or = 1 cm (based on mean+2 SD) is used then 39/898 (4.3%) of arteries would be regarded as having abnormal diameters and may require surveillance.

Color duplex sonographic findings in human vertebral arteries during cervical rotation

PURPOSE

The aims of this study were to determine whether vertebral artery blood flow velocity changes during contralateral cervical rotation, to determine the extent of rotation necessary to affect the velocity, and to find direct evidence of stretching or compression of the vertebral arteries during cervical rotation.

METHODS

Color duplex sonography was used to measure the blood flow velocities and diameters of the vertebral arteries in 20 patients. Measurements were taken with the patients' heads in the neutral position and at 10 degrees increments of contralateral neck rotation (determined using a cervical range of motion goniometer) to the end-range.

RESULTS

The data showed no significant change in the mean blood flow velocity for the entire study population during cervical rotation. However, there were marked changes in the blood flow velocities in 7 vertebral arteries toward the end-range of rotation. No arteries displayed any evidence of major stretching of the arterial walls, although localized compression of 2 arteries was observed.

CONCLUSIONS

The results of this study suggest that vertebral arteries are usually unaffected by contralateral cervical rotation and that Doppler sonography may provide an indirect assessment of mechanical stresses to the arterial wall.

Examining day-case and inpatient psoriasis care

Dermatology is becoming more outpatient based. Dermatology day treatment units can avoid the need for patients to be admitted to hospital. Inpatient and day care provide comparable positive outcomes for patients with psoriasis. Day-care patients valued the increased convenience of their psoriasis treatment.

Prevalence of dyslexia among Texas prison inmates

Approximately 80% of prison inmates are reported to be functionally illiterate. We hypothesized that poor single word decoding (the chief feature of dyslexia) accounts for a significant percentage of that rate. We studied 253 subjects selected randomly from more than 130,000 Texas prison inmates. Among them, we conducted a cross-sectional sample survey of recently admitted Texas inmates, beginning with social and educational background and followed by an educational test battery that included measures of word attack skill and reading comprehension. Deficient performance was defined primarily as single word decoding performance that measured below the 25th percentile on the Woodcock Reading Mastery Test. We found that 47.8% of the inmates were deficient in word attack skills. Word attack skills were detected in each group defined by gender and ethnicity. Nearly two thirds of the subjects scored poorly in reading comprehension.

Prevalence and risk factors for multidrug resistant uropathogens in ED patients

The purpose of this study was to describe resistance patterns of infecting organisms and determine risk factors for multidrug resistance in patients with urinary tract infections. Retrospective case series of 435 patients age > or =16 with urinary tract infection. Multidrug resistance was defined as resistance to > or = two classes of antibiotics. Demographic, historical, and microbiological data were collected. Univariate analysis and multivariate logistic regression were used to determine risk factors for multidrug resistance. Multidrug resistance was seen in 37% of isolates. Univariate analysis revealed numerous associations with resistance. Multivariate analysis found three independent factors associated with multidrug resistance: urinary catheter use (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.4 to 4.8), age > or = 65 years (OR 3.0, 95% CI 1.7 to 5.4) and antibiotic use (OR 4.6, 95% CI 2.8 to 7.5). Diabetes was also a risk factor when patients with urinary catheters were excluded (OR 2.4, 95% CI 1.1 to 5.3). Resistance was seen in all groups of patients, but was particularly common in older patients and those who used a urinary catheter. Antibiotic use was highly associated with multidrug resistance.

Developing a care system for dermatology patients

Routes of care outline the sequence of events required to provide a particular aspect of care. The system improves interprofessional communication and patient involvement and allows the process of care to be audited.

Warmed versus room temperature saline solution for ocular irrigation: a randomized clinical trial

STUDY OBJECTIVE

To test the hypothesis that ocular irrigation with warm saline solution is more comfortable than irrigation with room temperature saline solution in normal volunteers.

METHODS

The study was a randomized, single-blind crossover trial, in which each subject received 30 mL warmed and 30 mL room temperature saline solution in opposite eyes. The solutions (warmed versus room temperature) and the order of irrigation (right eye versus left) were separately randomized. Physicians were blinded to solution temperature. Subjects rated the discomfort of irrigation on separate visual analog scales (VAS). The study had 80% power to detect at least a 12-mm difference in VAS readings.

RESULTS

Thirty-five volunteers were enrolled in the study. There was no gender effect or order effect for the 2 solutions. The mean VAS score for warmed saline solution was 15 mm+/-15 mm (SD). The mean VAS score for room temperature saline was 34 mm+/-24 mm (SD), (95% confidence interval for difference of 19 mm [10 mm to 28 mm], P <.0001, Wilcoxon signed rank test).

CONCLUSION

Warmed saline solution was both clinically and statistically more comfortable than room temperature saline solution as an ocular irrigant among normal volunteers.

A military application of a medical self-care program

The cost of health care is a growing concern to the military. Many military clinic appointments and emergency department visits are unnecessary; they are for minor, self-limiting illnesses and injuries that could be treated at home. Military health care can no longer afford the luxury of treating minor illnesses and injuries in the hospital setting. This paper examines one method for military beneficiaries to obtain health care services appropriately. A selected group of military family members received a medical self-care book and an education session, which resulted in more appropriate decision-making about when to use the health care system. This was a 6-month, experimental study using control and experimental groups, with surveys before and after the study period. The self-care book was used 628 times to help make more informed decisions about when to seek medical care. The mean number of clinic and emergency room visits (p = 0.02) decreased for those using the medical self-care book.

Preflight versus en route success and complications of rapid sequence intubation in an air medical service

BACKGROUND

Maintenance of an airway in the air medically transported patient is of paramount importance. The purpose of this study is to compare preflight versus en route rapid sequence intubation (RSI)-assisted intubations and to determine the value of air medical use of RSI.

METHODS

This study is a 31-month retrospective review of all patients intubated and transported by a large city air medical service. Subgroup analysis was based on whether patients were transported from a hospital or a scene and whether they were intubated preflight or en route. Information on age, Glasgow Coma Scale score, type of scene, ground time, and previous attempts at intubation was recorded. Complications included failures, multiple attempts at intubation, arrhythmias, and need for repeated paralytic agents. Comparisons were made using a confidence interval analysis. An alpha of 0.05 was considered significant; Bonferroni correction was used for multiple comparisons.

RESULTS

Three hundred twenty-five patients were intubated and transported by Lifeflight during the study period. Two hundred eighty-eight patients were intubated using RSI (89%). The success rate was 97%. Preflight intubations were performed on 100 hospital calls and 86 scene calls. En route intubations were performed on 40 hospital cases and 62 scene calls. Patients who underwent preflight intubations were significantly younger than those who underwent en route intubations for both the hospital group (34 +/- 11 vs. 44 +/- 24 years, p < 0.05) and the scene group (27 +/- 13 vs. 32 +/- 16 years,p < 0.05). Otherwise, the demographic characteristics of the four groups were similar. Trauma accounted for 60 to 70% of hospital transfers and almost 95 to 100% of scene calls. Compared with preflight intubations, there was a significant decrease in ground time for hospital patients who were intubated en route (26 +/- 10 vs. 34 +/- 11 minutes, p < 0.05) and for scene patients who were intubated en route (11 +/- 8 vs. 18 +/- 9 minutes, p < 0.05). There were no significant differences between the groups for number of failures (9 of 288), arrhythmias (18 of 288), or necessity for repeated paralysis (8 of 288). Multiple intubation attempts were performed in more scene preflight patients (30 of 86, 35%) than scene en route patients (16 of 62, 26%), but this did not reach statistical significance. Even for patients having previous attempts at intubation, the success rate using RSI was 93% (62 of 67).

CONCLUSION

Air medical intubations, both preflight and en route, for both scene calls and interhospital transports, can be done with a very high success rate. Rapid sequence intubation may improve the success rate. For scene calls, there was a significant decrease in ground time, and there was a trend toward fewer multiple intubation attempts when the patient was intubated en route instead of preflight.

A randomized prospective trial of hyperbaric oxygen in a referral burn center population

Various studies of the effect of hyperbaric oxygen (HBO) in a wide variety of disease entities have been carried out. In the treatment of burns, animal and human studies have yielded somewhat contradictory results. Controlled studies in humans are limited. A randomized study on the effect of HBO was conducted involving 125 burn patients admitted within 24 hours of injury who were matched by age, burn size, and presence or absence of inhalation injury. Patients in the treatment arm received oxygen at two atmospheres of pressure for 90 minutes twice a day for a minimum of 10 treatments and a maximum of one treatment per total body surface per cent burn. The control group was treated in a similar fashion, except for the absence of HBO. There were no statistically significant differences between the two groups for the outcome measures of mortality, number of operations, and length of stay for the survivors. In this large clinical trial, we were unable to demonstrate any significant benefit to burn patients from the use of HBO.

CUS1, a suppressor of cold-sensitive U2 snRNA mutations, is a novel yeast splicing factor homologous to human SAP 145

The function of U2 snRNA in splicing is mediated by the proteins of the U2 small nuclear ribonucleoprotein. To identify proteins that influence the function of U2 snRNA we carried out a screen for mutations in Saccharomyces cerevisiae that suppress the cold-sensitive growth defect of a mutation in U2 stem loop IIa, a structure important for the stable association of the U2 snRNP with pre-mRNA. The screen identified three dominant suppressor genes, one of which, CUS1-54, encodes an essential splicing protein required for U2 snRNP addition to the spliceosome. The suppressor protein rescues the spliceosome assembly defect of the mutant U2 in vitro, indicating that suppression is direct. Allele specificity tests show that the suppressor does not simply bypass the requirement for U2 stem loop IIa. Extra copies of wild-type CUS1, but not CUS1-54, suppress the temperature-sensitive prp11 and prp5 mutations, linking CUS1 protein to a subset of other factors required at the same step of spliceosome assembly. CUS1 is homologous to SAP 145, a component of the mammalian U2 snRNP that interacts with pre-mRNA. The yeast genome also encodes a homolog of human SAP 49, a protein that interacts strongly with both SAP 145 and pre-mRNA, underscoring the conservation of U2 snRNP proteins that function in spliceosome assembly.