532 CARING FOR AND CARING ABOUT OLDER PEOPLE LIVING WITH SEVERE FRAILTY DURING COVID-19

Introduction

An ongoing study collected survey and interview data from older people with frailty living in the community near end-of-life during the Covid-19 pandemic.

Methods

Unstructured interviews with older people with frailty living in the community (N = 10), which included accounts from unpaid carers (N = 5), were video and audio recorded between October–November 2021. Six of these older people have died since fieldwork completion. A face-to-face survey collected data from a further 10 older people. Participants ages ranged from 70–99, 11, men, and 9 women, living in owned, rented, or sheltered accommodation, with Clinical Frailty Scores of 6 (N = 8), 7 (N = 9), and 8 (N = 3).

Results

Topics raised in relation to the pandemic included loss of social contact and increased loneliness, concern about not physically getting out, and losing physical function. Older people struggled to gain access to health and social care for support and previously received services were withdrawn. Most participants did not have access to internet and relied heavily on families to facilitate virtual contact with health professionals. Families and friends were the main anchor in facilitating social and health care including chasing up medications, liaising with social care to ensure quality and consistency of care provided, and monitoring older people’s health. Where older people’s conditions worsened family provided intense support, though family carers described the strain and unsustainability of this provision. Older people and their families felt they had been forgotten.

Conclusions

These are insights from hard-to-reach population that are frequently invisible. Greater examination of the impact of using communication technologies in care provision on those with poor access to and capabilities with using these technologies is required. Unpaid carers need more information and resources to support the care they provide and to facilitate access to appropriate social and health care services for those they care for.

Surface morphology enhances deposition efficiency in biomimetic, wind-driven fog collection

Passive interception of fog from the wind is an effective solution for accessing water in regions where fog is frequent and other sources scarce. A Namib Desert beetle is often cited as bioinspiration for further advancement, in a narrative which focuses on patterned wettability of its bumpy elytra as a means of transporting accumulated water from its back to its mouth. However, surface transport in fog collection is secondary to the role of the fluid dynamics of droplet deposition, in which inertial droplets migrate across diverging streamlines approaching an obstruction. 3D geometry of biological surface features inevitably affect this process, but its specific role in flow physics of fog collection has not previously been explored. Here, we report experimental measurements of deposition efficiency of targets with identical surface chemistry but varying surface morphology. We find a nearly threefold increase in collection upon addition of millimetric bumps to a spherical target, and provide insight into the micromechanics underlying the performance. Modifying surface morphology can be easier than overall geometry for both manufactured structures and evolved organisms and should therefore be both considered in the design of separation devices and expected in other biological systems for which extraction of particles from flow is important.

PL3.6 Targeting GSK-3 activity promotes mitotic catastrophe via centrosome destabilisation and enhances the effect of radiotherapy in glioma models

BACKGROUND

Targeting kinases as regulators of cellular processes that drive cancer progression is a promising approach to improve patient outcome in GBM management. The glycogen synthase kinase 3 (GSK-3) plays a role in cancer progression and is known for its pro-proliferative activity in gliomas. The anti-proliferative and cytotoxic effects of the GSK-3 inhibitor AZD2858 were assessed in relevant in vitro and in vivo glioma models to confirm GSK-3 as a suitable target for improved single agent or combination treatments.

MATERIAL AND METHODS

The immortalised cell line U251 and the patient derived cell lines GBM1 and GBM4 were used in in vitro studies including MTT, clonogenic survival, live cell imaging, immunofluorescence microscopy and flow cytometry to assess the cytotoxic and anti-proliferative effects of AZD2858. Observed anti-proliferative effects were investigated by microarray technology for the identification of target genes with known roles in cell proliferation. Clinical relevance of targeting GSK-3 with the inhibitor either for single agent or combination treatment strategies was determined by subcutaneous and orthotopic in vivo modelling. Whole mount mass spectroscopy was used to confirm drug penetration in orthotopic tumour models.

RESULTS

AZD2858 was cytotoxic at low micromolar concentrations and at sub-micromolar concentrations (0.01 - 1.0 μM) induced mitotic defects in all cell lines examined. Prolonged mitosis, centrosome disruption/duplication and cytokinetic failure leading to cell death featured prominently among the cell lines concomitant with an observed S-phase arrest. No cytotoxic or anti-proliferative effect was observed in normal human astrocytes. Analysis of the RNA microarray screen of AZD2858 treated glioma cells revealed the dysregulation of mitosis-associated genes including ASPM and PRC1, encoding proteins with known roles in cytokinesis. The anti-proliferative and cytotoxic effect of AZD2858 was also confirmed in both subcutaneous and orthotopic in vivo models. In addition, combination treatment with AZD2858 enhanced clinically relevant radiation doses leading to reduced tumour volume and improved survival in orthotopic in vivo models.

CONCLUSION

GSK-3 inhibition with the small molecule inhibitor AZD2858 led to cell death in glioma stem cells preventing normal centrosome function and promoting mitotic failure. Normal human astrocytes were not affected by treatment with the inhibitor at submicromolar concentrations. Drug penetration was observed alongside an enhanced effect of clinical radiotherapy doses in vivo. The reported aberrant centrosomal duplication may be a direct consequence of failed cytokinesis suggesting a role of GSK-3 in regulation of mitosis in glioma. GSK-3 is a promising target for combination treatment with radiation in GBM management and plays a role in mitosis-associated events in glioma biology.

B-25 Osteopathic Manipulative Treatment Improves Non-Motor Symptoms in Parkinson’s Disease: A Preliminary Study

Parkinson’s disease (PD) is a neurodegenerative disease characterized by debilitating motor and non-motor symptoms. Osteopathic Manipulative Treatment (OMT) has been shown to alleviate stress, mood, and sleep in musculoskeletal conditions and older adults, as well as improve gait and balance in PD and elderly patients, respectively. Research on the efficacy of OMT in reducing PD symptoms is lacking. Therefore, the aim of this preliminary study was to evaluate changes in mood, cognitive, and motor symptoms in a sample of non-demented PD patients following 6-weeks of OMT. Sixteen non-demented individuals with PD received 6 weekly 30-minute OMT by an osteopathic physician. Participants were administered measures of cognition (Parkinson’s Disease-Cognitive Rating Scale; PD-CRS), anxiety (Geriatric Anxiety Inventory; GAI), sleep quality (Pittsburgh Sleep Quality Index; PSQI), stress (Perceived Stress Scale; PSS), and motor function (Unified Parkinson’s Disease Rating Scale-Part 3) before and after treatment. Paired-samples t-tests were used to examine changes in symptoms pre and post-OMT. Results revealed significant improvement in cognition (PD-CRS; p = .015) and perceived stress (PSS; p = .02) from pre- to post-intervention. There was a trend towards improvement in anxiety (GAI; p = .064) and sleep quality (PSQI; p = .08). There was no change in motor symptoms from pre- to post-OMT (p = .56). Findings suggest that OMT may improve non-motor symptoms – particularly cognition and stress - in PD. Future research is needed to determine if these effects can be replicated within a randomized-control-trial and maintained over time. With further research, OMT may prove to be a beneficial non-invasive treatment for non-motor symptoms in PD.

Treatment preference and recruitment to pediatric RCTs: A systematic review

BACKGROUND

Recruitment to pediatric randomised controlled trials (RCTs) can be a challenge, with ethical issues surrounding assent and consent. Pediatric RCTs frequently recruit from a smaller pool of patients making adequate recruitment difficult. One factor which influences recruitment and retention in pediatric trials is patient and parent preferences for treatment.

PURPOSE

To systematically review pediatric RCTs reporting treatment preference.

METHODS

Database searches included: MEDLINE, CINAHL, EMBASE, and COCHRANE.Qualitative or quantitative papers were eligible if they reported: pediatric population, (0-17 years) recruited to an RCT and reported treatment preference for all or some of the participants/parents in any clinical area. Data extraction included: Number of eligible participants consenting to randomisation arms, number of eligible patients not randomised because of treatment preference, and any further information reported on preferences (e.g., if parent preference was different from child).

RESULTS

Fifty-two studies were included. The number of eligible families declining participation in an RCT because of preference for treatment varied widely (between 2 and 70%) in feasibility, conventional and preference trial designs. Some families consented to trial involvement despite having preferences for a specific treatment. Data relating to 'participant flow and recruitment' was not always reported consistently, therefore numbers who were lost to follow-up or withdrew due to preference could not be extracted.

CONCLUSIONS

Families often have treatment preferences which may affect trial recruitment. Whilst children appear to hold treatment preferences, this is rarely reported. Further investigation is needed to understand the reasons for preference and the impact preference has on RCT recruitment, retention and outcome.

Results from the third Scottish National Prevalence Survey: is a population health approach now needed to prevent healthcare-associated infections?

BACKGROUND

Healthcare-associated infections (HCAIs) are a major public health concern and a significant cause of morbidity and mortality. A robust and current evidence base that is specific to local, national and Europe-wide settings is necessary to inform the development of strategies to reduce HCAI and contain antimicrobial resistance.

AIM

To measure the prevalence of HCAI and antimicrobial prescribing and identify key priority areas for interventions to reduce the burden of infection.

METHODS

A national rolling point-prevalence survey (PPS) in National Health Service (NHS) acute, NHS non-acute, NHS paediatric, and independent hospitals was carried out between September and November 2016 using the European Centre for Disease Prevention and Control protocol designed for the European PPS.

FINDINGS

The prevalence of HCAI was 4.6%, 2.7%, and 3.2% in acute adults, paediatric and non-acute patient groups, respectively. The most frequent HCAI types reported in adult patients were urinary tract infection and pneumonia. The prevalence of antimicrobial prescribing was 35.7%, 29.3%, and 13.8% in acute adults, paediatric, and non-acute patient groups, respectively. Respiratory, skin and soft tissue, gastrointestinal, and urinary tract infections were the most common infections being treated at the time of survey.

CONCLUSION

HCAI continues to be a public health concern in Scotland. Urinary tract infection and pneumonia continue to place a significant burden on patients and on healthcare delivery, including those that develop in the community and require hospital admission. A broader population health approach which focuses on reducing the risk of infection upstream would reduce these infections in both community and hospital settings.

Intratumoural evolutionary landscape of high-risk prostate cancer: the PROGENY study of genomic and immune parameters

BACKGROUND

Intratumoural heterogeneity (ITH) is well recognised in prostate cancer (PC), but its role in high-risk disease is uncertain. A prospective, single-arm, translational study using targeted multiregion prostate biopsies was carried out to study genomic and T-cell ITH in clinically high-risk PC aiming to identify drivers and potential therapeutic strategies.

PATIENTS AND METHODS

Forty-nine men with elevated prostate-specific antigen and multiparametric-magnetic resonance imaging detected PC underwent image-guided multiregion transperineal biopsy. Seventy-nine tumour regions from 25 patients with PC underwent sequencing, analysis of mutations, copy number and neoepitopes combined with tumour infiltrating T-cell subset quantification.

RESULTS

We demonstrated extensive somatic nucleotide variation and somatic copy number alteration heterogeneity in high-risk PC. Overall, the mutational burden was low (0.93/Megabase), but two patients had hypermutation, with loss of mismatch repair (MMR) proteins, MSH2 and MSH6. Somatic copy number alteration burden was higher in patients with metastatic hormone-naive PC (mHNPC) than in those with high-risk localised PC (hrlPC), independent of Gleason grade. Mutations were rarely ubiquitous and mutational frequencies were similar for mHNPC and hrlPC patients. Enrichment of focal 3q26.2 and 3q21.3, regions containing putative metastasis drivers, was seen in mHNPC patients. We found evidence of parallel evolution with three separate clones containing activating mutations of β-catenin in a single patient. We demonstrated extensive intratumoural and intertumoural T-cell heterogeneity and high inflammatory infiltrate in the MMR-deficient (MMRD) patients and the patient with parallel evolution of β-catenin. Analysis of all patients with activating Wnt/β-catenin mutations demonstrated a low CD8+/FOXP3+ ratio, a potential surrogate marker of immune evasion.

CONCLUSIONS

The PROGENY (PROstate cancer GENomic heterogeneitY) study provides a diagnostic platform suitable for studying tumour ITH. Genetic aberrations in clinically high-risk PC are associated with altered patterns of immune infiltrate in tumours. Activating mutations of Wnt/β-catenin signalling pathway or MMRD could be considered as potential biomarkers for immunomodulation therapies.

CLINICAL TRIALS.GOV IDENTIFIER

NCT02022371.

Diversity and linkage disequilibrium in farmed Tasmanian Atlantic salmon

Farmed Atlantic salmon (Salmo salar) is a globally important production species, including in Australia where breeding and selection has been in progress since the 1960s. The recent development of SNP genotyping platforms means genome-wide association and genomic prediction can now be implemented to speed genetic gain. As a precursor, this study collected genotypes at 218 132 SNPs in 777 fish from a Tasmanian breeding population to assess levels of genetic diversity, the strength of linkage disequilibrium (LD) and imputation accuracy. Genetic diversity in Tasmanian Atlantic salmon was lower than observed within European populations when compared using four diversity metrics. The distribution of allele frequencies also showed a clear difference, with the Tasmanian animals carrying an excess of low minor allele frequency variants. The strength of observed LD was high at short distances (<25 kb) and remained above background for marker pairs separated by large chromosomal distances (hundreds of kb), in sharp contrast to the European Atlantic salmon tested. Genotypes were used to evaluate the accuracy of imputation from low density (0.5 to 5 K) up to increased density SNP sets (78 K). This revealed high imputation accuracies (0.89-0.97), suggesting that the use of low density SNP sets will be a successful approach for genomic prediction in this population. The long-range LD, comparatively low genetic diversity and high imputation accuracy in Tasmanian salmon is consistent with known aspects of their population history, which involved a small founding population and an absence of subsequent introgression. The findings of this study represent an important first step towards the design of methods to apply genomics in this economically important population.

Developing telepsychiatry services in KwaZulu-Natal -- an action research study

OBJECTIVE

In 2009, the Departments of Psychiatry and Telehealth of the University of KwaZulu-Natal (UKZN) initiated a three year project to develop telepsychiatry services in KwaZulu-Natal. This paper describes the challenges and opportunities of this project.

METHOD

This was a collaborative, in situ health service project and an action research framework was adopted. Over the three years, following a needs assessment and an e-health Readiness Assessment, two action research cycles were completed. Cycle 1: The preparation, implementation and evaluation of educational material, technical requirements and clinical guidelines and clinical support materials. Cycle 2: Preparation and evaluation of educational and clinical outreach sessions.

RESULTS

Videoconference education sessions were beneficial to health staff without post-qualification psychiatry training. A flexible format for education improved knowledge outcomes. Clinical sessions are feasible, but require administration and technical support for facilitation. With facilitator training, 128Kbps is a suitable bandwidth for education but 384Kbps is preferred for clinical consultation.

CONCLUSION

Telepsychiatry offers tremendous potential to facilitate the three strategies suggested by the World Psychiatric Association to address the treatment gap, save time and costs and improve access to the small pool of specialist psychiatrists in resource constrained environments.

Proteomic identification and profiling of canine lymphoma patients

This study employed proteomic and bioinformatic approaches to identify serum biomarkers in canine lymphoma patients. Chilled serum samples derived from non-lymphoma (n = 92) and lymphoma (n = 87) patients were shipped from first opinion veterinary practices, subjected to ion exchange chromatography and analysed by surface-enhanced laser desorption ionization mass spectrometry. Nineteen serum protein peaks were identified between the two groups as being significantly different (P < 0.05) based upon their normalized ion intensities. Two biomarkers were identified that were capable of differentiating lymphoma and non-lymphoma patients. Analysis of the test data provided a positive predictive value (PPV) of 82%. A clinical follow-up study was carried out on 96 canine patients suspected of having lymphoma. Evaluation of this data gave a specificity value of 91%, sensitivity of 75%, PPV of 80% and negative predictive value of 88%. In conclusion, the expression pattern of two serum biomarkers has enabled serum samples to be classified into either lymphoma or non-lymphoma categories.

Glucose intolerance and associated factors in the multi-ethnic population of the United Arab Emirates: results of a national survey

AIMS

To determine the prevalence of diabetes and impaired fasting glycaemia (IFG) and associated conditions such as obesity and hypertension, in the multi-ethnic, adult population of the United Arab Emirates in 1999-2000.

METHODS

A stratified, multistage, random sample was selected. Diagnosis was based on the latest recommendations of a WHO Expert Group.

RESULTS

The overall response rate was 89%. Crude prevalence of diabetes was 20%. It was higher in UAE citizens (25%) than in expatriates (13-19% depending on country of origin). Prevalence of diabetes rose with age to a maximum of 40% after the age of 55 years. Prevalence of impaired fasting glycaemia was 5% in men and 7% in women. Forty-one percent of subjects with diabetes were undiagnosed prior to the survey. Of the previously diagnosed subjects with diabetes, 59% were taking oral hypoglycaemic agents, 8% used insulin and 17% relied on diet alone. Obesity was common in all ethnic groups. Approximately three-quarters of all subjects were either obese (BMI> or =30) or overweight (BMI 25-29). Presence of diabetes was associated with increasing waist-hip ratio (WHR), age and with systolic blood pressure and ethnicity. Co-morbidity with glucose intolerance occurred with obesity in 8% and with hypertension in 5%. Three-quarters of all subjects had one or more of these conditions.

CONCLUSIONS

Diabetes, obesity and hypertension are extremely prevalent in the adult population of the UAE. Prompt action is required to avert a major public health crisis due to the long-term complications of diabetes in the near future.

Glucose tolerance and ancestral genetic admixture in six semitraditional pacific populations

Population-based data on 1,842 subjects from six semitraditional Pacific communities, collected in the years 1978-1983, have been compared in order to examine the hypotheses that differences in the distribution of plasma glucose concentration between populations are to some extent genetically determined, and that non-Austronesian (NAN) Melanesians are relatively resistant to glucose intolerance. Semitraditional communities were chosen for study so that the comparison would be minimally confounded by either known or as yet undetermined environmental factors associated with nontraditional living, the effects of which may vary between populations. The samples were also selected so as to provide a gradient of proportional NAN and AN admixture. They were drawn from the following regions: the highlands of Papua New Guinea, New Caledonia, Fiji, the Wallis Islands, Western Samoa, and Kiribati (formerly the Gilbert Islands). The Papua New Guinea highlanders, of entirely NAN ancestry, were regarded as the baseline population. A gradient of increasing mean 2-hr plasma glucose concentration was observed across the six populations and differences persisted between populations, after controlling for age and obesity. Variations in diet, physical activity, and degree of sociocultural modernization were not considered a sufficient or consistent explanation of these findings and they therefore lend tentative support to the hypothesis of a genetic component to variability in glucose tolerance. The relationship between population estimates of glucose tolerance and estimates of the genetic distance from the baseline NAN Melanesian sample was examined. With the notable exception of Fiji, there was evidence of a linear correlation between the two parameters.

The effects of intrathecal diamorphine on gastric emptying after elective Caesarean section*

This study investigated whether intrathecal diamorphine affects gastric emptying following elective Caesarean section. Forty women were randomly allocated to receive either diamorphine 300 microg or 0.9% saline as part of a standard spinal anaesthetic. Gastric emptying was measured in the immediate postoperative period using paracetamol absorption. Paracetamol concentrations were measured by enzymatic assay method using a Beckman CX-7 automated analyser. The time to maximum concentration (Tmax) was statistically longer in the diamorphine group (control 41.8, SD 20.8 min; diamorphine 72.6 SD 41.9 min; p < 0.01). During the 2-h study period, mean morphine consumption via a patient controlled analgesia device was significantly higher in the control group (control 9.3, SD 3.6 mg; diamorphine 2.1, SD 2.1 mg; p < 0.01). We conclude that intrathecal diamorphine may contribute to the delay in gastric emptying that occurs immediately following elective spinal Caesarean section.

Episodic memory in schizophrenic patients and their relatives

BACKGROUND

Memory dysfunction among healthy relatives of patients with schizophrenia suggests that genetic liability to the disorder can also be manifested as cognitive impairment. This study was designed to further elucidate the nature of the memory dysfunction being transmitted.

METHOD

Memory function was assessed in 62 schizophrenic patients, 98 of their healthy relatives and 66 controls. Material-specific immediate/delayed recall and percentage retention were investigated using the Logical Memory and Visual Reproduction tests of the Wechsler Memory Scale (WMS). A third subtest of the WMS, the Associate Learning and a visual analogue of it, the Abstract Paired Associates, were used to measure verbal and visual learning. Current general intellectual function was assessed using a five-subtest short-form of the Wechsler Adult Intelligence scale-Revised (WAIS-R).

RESULTS

Schizophrenic patients performed significantly worse than controls on nearly all measures. Their relatives also showed significant deficit on the immediate and delayed recall of the Logical Memory, immediate recall of the Visual Reproduction, and the Abstract Paired Associates tests. Logical memory was substantially more impaired than the other measures for both patients and relatives. The deficit in immediate recall of the Logical Memory remained significant even after excluding those relatives with an Axis I diagnosis and schizotypal personality disorder. These findings were despite the relatives having an equivalent level of general intellectual function to that of controls.

CONCLUSION

Familial, presumed genetic, liability to schizophrenia may be expressed as dysfunction in verbal memory.

Quality of life measurement in the head and neck cancer radiotherapy clinic: is it feasible and worthwhile?

Quality of Life (QOL) is now a standard end-point in clinical trials. The aim of this non-cohort study was to assess the practical issues surrounding the collection of QOL data in a non-trial setting, and to determine whether it is feasible and worthwhile. Ninety-two patients attending clinics before, or at least 3 months after radiotherapy for head and neck cancer were asked to complete the University of Washington QOL questionnaire (Version 4) and the Hospital Anxiety and Depression Scale. The three most important QOL domains cited by patients after radiotherapy related to saliva production, swallowing and taste. Most patients were able to complete both questionnaires in less than 10 min and reported little difficulty in understanding and completing them. The questionnaires indicated possible clinically significant levels of anxiety and depression in 31% and 16%, respectively. We perceived several benefits of routine QOL data collection in the clinic and this has now been adopted in our own practice.

Probable dystonic reaction after a single dose of cyclizine in a patient with a history of encephalitis

A patient underwent an emergency Caesarean section under general anaesthesia for an antepartum haemorrhage. Following delivery of a live infant, cyclizine was administered in accordance with departmental anti-emetic protocol. On awakening she was confused, slow to articulate and had slurred speech. A computed tomography (CT) scan, which was performed to exclude an intracranial event, was normal. Her symptoms were suggestive of a lingual-facial-buccal dyskinesia as seen with dopamine antagonists. A presumptive diagnosis of a dystonic reaction to cyclizine was made. She received two doses of procyclidine before her symptoms completely resolved. Cyclizine has had a resurgence in popularity owing to the recent withdrawal of droperidol and anaesthetists should be aware that, although extremely rare, dystonic reactions may occur with this agent.

Glucose intolerance and associated factors in Mongolia: results of a national survey

AIMS

Prevalence of glucose intolerance-diabetes and impaired glucose tolerance (IGT)-and of related conditions such as obesity and hypertension, was studied in six population samples in Mongolia in 1999.

METHODS

Diagnosis of glucose intolerance was made on the basis of 2-h blood glucose concentration, according to criteria recommended by the latest report of a WHO Expert Group.

RESULTS

Crude prevalence of diabetes was 2.9% (2.6% in men and 3.2% in women). Prevalence of IGT was 10.2% (9.3% in men and 10.8% in women). Age standardization to the standard world population of Segi resulted in a total sample prevalence of 3.1% for diabetes and 9.2% for IGT. Prevalence of abnormal glucose tolerance differed according to district of residence. Approximately one-third of the subjects with diabetes were diagnosed prior to the survey. Of those who were diagnosed previously, approximately one-half were not under any form of treatment. Subjects with abnormal glucose tolerance were older, more obese and had higher blood pressure and prevalence of hypertension than those with normoglycaemia. One-half of men and almost one-half of women were hypertensive. Three-quarters of the diabetic subjects were hypertensive. One-third of all subjects were centrally obese. Considering the conditions of principal interest-glucose intolerance, hypertension and obesity-one-half of all subjects demonstrated one or more of these conditions. Central obesity was the most common condition, followed by hypertension and then glucose intolerance. Central obesity and hypertension was the most common combination (17% of all subjects) and 4% exhibited all three conditions.

CONCLUSIONS

Non-communicable diseases are already a threat to public health in Mongolia. Although the prevalence of diabetes is not high by international standards, the relatively high prevalence of IGT suggests that the situation may deteriorate in the future in the absence of concerted action to prevent and control diabetes and related conditions.

Assessing the assessment measures for menstrual cycle symptoms: a guide for researchers and clinicians

A review of measures of menstrual cycle symptoms is provided. This will enable researchers and clinicians to make the appropriate choice of method for their study requirements. In recent years, these measures have taken the form of retrospective questionnaires (rating severity of symptoms from memory) and prospective diaries (daily checklists of symptoms). Many of these draw on aspects of the well-known retrospective questionnaires, the Menstrual Distress Questionnaire and Premenstrual Assessment Form, in their development and validation. Each measure will be briefly described, followed by comments on its development, psychometric properties and finally an evaluation of its strengths and weaknesses. It concludes with an examination of the implications arising from the review, and some recommendations that menstrual cycle researchers and clinicians may wish to consider, as they decide upon the most appropriate measure for their needs.

Impact of poverty on the prevalence of diabetes and its complications in urban southern India

AIM

The impact of poverty on the profile of diabetes and its complications was studied.

METHODS

A comparative study of low income group (LIG) (family income Rs. < 30,000/annum (approx. 432 pounds sterling) and high income group (HIG) (family income Rs. greater-than-or-equal 60,000/annum (approx. pounds sterling) subjects of > or = 40 years was done in Madras, India. By screening 1748 LIG subjects (M/W 844/904) 301 diabetic subjects were identified and 218 underwent tests for diabetic complications. Population data available in 635 (M/W 309/326) HIG subjects from the survey were used for comparison of glucose tolerance profile. Complications were studied in 221 diabetic HIG subjects.

RESULTS

Age-standardized prevalences of diabetes (12.6% vs. 25.5%; chi(2) = 56.9, P < 0.0001) and impaired glucose tolerance (IGT) (8.9% vs. 19.0%) were significantly lower (chi(2) = 57.7; P < 0.0001) in the LIG. Hypertension was more common in LIG (53.7% vs. 40.0% in HIG; chi(2) = 34.9; P < 0.0001). LIG subjects were more physically active; 73.8% did not go to school. Parameters significantly associated with diabetes were body mass index (BMI), age, higher income, waist--hip ratio and physical inactivity. Higher income, BMI and age were associated with IGT. Diabetic LIG subjects had a higher prevalence of cardiac disease, neuropathy and cataract and a lower prevalence of retinopathy than HIG subjects. The risk variables such as hyperglycaemia, dyslipidaemia, hypertension, smoking and alcohol consumption were more in the LIG group.

CONCLUSIONS

The urban poor in the developing world has a lower prevalence of diabetes than the urban poor in developed societies. However, they have higher rates of complications of diabetes.

Epidemiology of glucose intolerance and associated factors in Uzbekistan: a survey in Sirdaria province

Prevalence of glucose intolerance and other noncommunicable diseases has been examined in subjects aged 35 years and over in a rural community in Sirdaria, which lies in the central part of Uzbekistan. Diabetes and impaired glucose tolerance (IGT) were diagnosed according to the recommendations of the latest WHO Study Group on diabetes. The overall response to the survey was 82%. Crude prevalence of diabetes was 4% in women and 11% in men. However, young men were under-represented and the age-standardised prevalence was 7.5% in women and 10.0% in men. Subjects with abnormal glucose tolerance had higher mean body mass index (BMI), waist-hip ratio (WHR), systolic and diastolic blood pressures and prevalence of hypertension, and were less physically active than those with normal glucose tolerance. Women were younger, had higher mean BMI, similar WHR, lower mean systolic and diastolic blood pressures and were less physically active than men. Approximately one-third of all subjects were centrally obese (WHR 0.85 or above for women and 0.95 or above for men). Of these, one-third had coexisting glucose intolerance. It is concluded that glucose intolerance and central obesity are common in this rural Central Asian community.

Maternal and child psychological sequelae in paediatric burn injuries

It is a commonly held belief that many children suffer psychological sequelae following burn injury. This six month controlled, prospective, follow up study was designed to investigate psychological sequelae in children and their mothers following paediatric burn injury. The study employed a sample of 40 children with burn injuries, and their mothers with three control groups, each of 40 children and their mothers: an acutely ill group, a fracture group and a non ill/injured group. Measures at initial contact and 6 month follow up included the Child Behaviour Checklist and the Hospital Anxiety and Depression Scale. The results demonstrated higher initial maternal anxiety scores in the burn, compared to the fracture and non ill/injured groups, which remained comparatively high 6 months later even though they decreased over time. Children with burn injuries, of the type included in this study, did not appear to develop significant psychological or behavioural sequelae. Following paediatric burn injury mothers appear to be at higher risk than children for developing psychological sequelae, which may have longer term implications for the child's outcome such as affecting compliance with treatment.

Postpartum bone mineral density following antenatal dexamethasone therapy

The aim of this study was to determine whether the changes in bone metabolism, which we have demonstrated previously with antenatal dexamethasone therapy, are associated with a lower bone mineral density. We assessed bone mineral density in the proximal femur and lumbar spine using dual photon X-ray absorptiometry after delivery in 15 women who received dexamethasone therapy for fetal lung maturation, and in 30 women who did not have dexamethasone therapy in pregnancy. The absolute bone mineral density, T scores and Z scores at the proximal femur and lumbar spine were similar, and the median values of T and Z scores were positive in both groups. We conclude that antenatal dexamethasone therapy has no long term effect on bone mineral density.

Pakistan National Diabetes Survey prevalence of glucose intolerance and associated factors in North West at Frontier Province (NWFP) of Pakistan

AIM

To estimate the prevalence of non-insulin dependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT) and their relationship with age and obesity in a population based survey in the rural areas of NWFP, Pakistan.

SETTING

Three villages, Pawakai, Reghi and Jhagra in NWFP were the target areas.

METHODS

Cluster sampling of 1035 adults aged 25 years and above (207 men, 828 women) was done. Oral glucose tolerance tests were performed and the diagnosis of diabetes and IGT was made according to WHO criteria. Height, weight and waist hip ratio of the study population were recorded. The Chi Square test was used to measure the association among the different variables. Basic demographic information from the subjects was collected by a physician using a standard questionnaire.

RESULTS

The overall prevalence of NIDDM and IGT in both sexes was 11.1% and 9.4%. The sex-specific prevalence of diabetes was 9.2% in men and 11.6% in women. Advanced age, positive family history of diabetes and obesity were associated with higher rates of diabetes. In both sexes high Waist Hip Ratio (WHR) was more closely associated with diabetes than was high Body Mass Index (BMI).

CONCLUSION

The prevalence of diabetes mellitus in rural areas of NWFP is high and almost similar to that of Sindh and Baluchistan.