Timing of suture removal to reduce scarring in skin surgery: a randomized assessor-blinded feasibility trial

Timing of suture removal after excision skin surgery varies, with few studies analysing the factors that contribute to poor wound healing and cosmesis. Here, we performed a pilot study to compare suture removal at 7 days or 10 days and its effect on healing and overall appearances of scars including the presence of suture marks.

How to critically appraise a systematic review: an aide for the reader and reviewer

The number of published systematic reviews has soared rapidly in recent years. Sadly, the quality of most systematic reviews in dermatology is substandard. With the continued increase in exposure to systematic reviews, and their potential to influence clinical practice, we sought to describe a sequence of useful tips for the busy clinician reader to determine study quality and clinical utility. Important factors to consider when assessing systematic reviews include: determining the motivation to performing the study, establishing if the study protocol was prepublished, assessing quality of reporting using the PRISMA checklist, assessing study quality using the AMSTAR 2 critical appraisal checklist, assessing for evidence of spin, and summarizing the main strengths and limitations of the study to determine if it could change clinical practice. Having a set of heuristics to consider when reading systematic reviews serves to save time, enabling assessment of quality in a structured way, and come to a prompt conclusion of the merits of a review article in order to inform the care of dermatology patients.

Tuberous xanthoma secondary to homozygous familial hypercholesterolaemia: a life-threatening diagnosis

We report the case of a 9-year-old girl who presented with asymptomatic lesions on the extensor surfaces of the elbows and knees, in keeping with tuberous xanthoma. She was investigated and diagnosed with homozygous familial hypercholesterolaemia, and commenced on lipid-lowering treatment. We highlight the importance of identification of this condition early, such that life-saving treatment can be initiated and premature death avoided.

AF is associated with self-reported syncope and falls in a general population cohort

BACKGROUND

syncope is an important, but underestimated clinical problem in older persons. It is often overlooked in clinical practice or mistaken for falls. Atrial fibrillation (AF) is the most common cardiac arrhythmia, but little evidence exists regarding the association between AF, falls and syncope in the general population.

METHODS

cross-sectional analyses within a population sample of people aged 50+, taken from The Irish Longitudinal Study on Ageing. Ten-minute electrocardiogram recordings (n = 4,885) were analysed to detect AF. Syncope (self-reported faints or blackouts) and falls in the past year, co-morbidities, health measures and medications were gathered through computer-aided personal interviews. Multivariable logistic regression was performed to study associations between AF, falls and syncope.

RESULTS

mean age was 62 years (range: 50-91), 54% were female. Prevalence of AF was 3%, increasing to 8% in participants aged 75+. Of participants, 5% (n = 223) reported syncope and 20% (n = 972) reported falls. After adjustment for confounders, AF was significantly associated with faints and blackouts (odds ratio (OR) 2.0 [95% confidence interval (CI) 1.0-3.9]). After stratification by age category, we found that this association was strongest and only significant in participants aged 50-64 years (OR 4.4 [1.5-12.6]). Stratified for age group, AF was significantly associated with falls in participants aged 65-74 years (OR 2.0 [1.0-4.1]).

CONCLUSIONS

adults aged 50+ with self-reported syncope and adults aged 65-74 years with falls are twice as likely to have AF at physical examination. These associations are independent of stroke, cardiovascular and psychotropic drugs and other confounders. Further longitudinal studies are needed to explore this association and potential causality further.

Recent syncope and unexplained falls are associated with poor cognitive performance

OBJECTIVE

To compare cognitive performance in participants with and without syncope and unexplained falls in a large population representative sample aged 50 years or older.

METHODS

Participants of the Irish longitudinal study on ageing (TILDA) were studied. Participants with a history of syncope and/or unexplained falls in the past 12 months were compared with those with no reported events. Cognitive performance was measured using the Montreal cognitive assessment (MoCA) score. Multivariate linear regression analysis controlling for potential confounders was performed to compare cognitive function by syncope and falls status.

RESULTS

Five thousand eight hundred and forty-six participants were analysed, median age 62 years (inter-quartile range=14), and 54% were female. Five hundred and forty-nine (9.4%) had a syncopal event and/or an unexplained fall in past 12 months. One hundred and two (1.8%) subjects had two-plus syncopal events in the same period. There was a significant association between syncope/falls history and lower MoCA score, following adjustment for all confounders (B=-0.4; -0.69, -0.11; P=0.006). Higher syncope burden was also associated with lower performance; however, this was largely explained by confounders. There was no age interaction with these findings.

CONCLUSION

Participants who experienced syncope and/or non-accidental falls in the previous year have poor global cognitive performance compared with case-controls. There was no effect of age on our results. Further investigation of the association between syncope burden, unexplained falls and cognitive decline is required to establish a relationship between these disorders.

Social Disadvantage and Social Isolation Are Associated With a Higher Resting Heart Rate: Evidence From The Irish Longitudinal Study on Ageing

OBJECTIVES

A high resting heart rate (RHR) represents a major risk factor for cardiovascular disease and individuals from poorer backgrounds have a higher RHR compared with their more advantaged peers. This study investigates the pathways through which low socioeconomic status (SES) contributes to a higher RHR.

METHOD

The sample involved data for 4,888 respondents who were participating in the first wave of The Irish Longitudinal Study on Ageing. Respondents completed a detailed interview at home and underwent a 5-min baseline electrocardiograph recording as part of a clinic-based health assessment. SES was indexed using household income.

RESULTS

The mean difference in RHR between those at polarized ends of the income distribution was 2.80 beats per minute (bpm) (95% CI = 1.54, 4.06; p < .001), with the magnitude of the socioeconomic differential being greater for men (4.15 bpm; 95% CI = 2.18, 6.12; p < .001) compared with women (1.57 bpm; 95% CI = 0.04, 3.10; p < .05). Psychosocial factors including social network size and loneliness accounted for a sizeable proportion of the socioeconomic differential in RHR, particularly among men.

DISCUSSION

The finding that poorer people have a higher RHR reinforces the need for additional research exploring the pathways through which social inequalities are translated into biological inequalities.

Cognitive performance in orthostatic hypotension: findings from a nationally representative sample

OBJECTIVES

To compare the cognitive profile of a population representative sample with orthostatic hypotension (OH) with the profile of a sample without.

DESIGN

Cross-sectional analysis of a prospective nationally representative population study.

SETTING

The Irish Longitudinal Study on Ageing (TILDA).

PARTICIPANTS

TILDA participants (N = 5,936; mean age 63 ± 9, 54% female).

MEASUREMENTS

OH was defined as a drop of 20 mmHg or more in systolic blood pressure or of 10 mmHg or more in diastolic blood pressure on standing from a seated position. Cognitive performance was assessed using comprehensive cognitive tests measuring domains of global function, executive function, processing speed, attention, and memory, from which composite standardized scores were computed. Multivariate analysis controlling for potential confounders was performed to compare cognitive performance according to OH status.

RESULTS

Prevalence of OH was 6.1% (95% confidence interval = 5.4-6.7%). A significant negative association between OH status and global cognitive function (b = 0.21, P = .01) and memory (b = 0.26, P = .002) was found in women aged 65 and older after adjustment for demographic characteristics, mental health, cardiovascular disease, and medications (antihypertensive and antipsychotic), but other specific cognitive domains were not affected.

CONCLUSION

OH was associated with poorer global cognitive function and poorer memory, independent of potential confounders, in women in a large population-based sample of older adults. Longitudinal studies with concomitant assessment of cerebral perfusion are needed to determine causal relationships.

Normative values of cognitive and physical function in older adults: findings from the Irish Longitudinal Study on Ageing

OBJECTIVES

To provide normative values of tests of cognitive and physical function based on a large sample representative of the population of Ireland aged 50 and older.

DESIGN

Data were used from the first wave of The Irish Longitudinal Study on Ageing (TILDA), a prospective cohort study that includes a comprehensive health assessment.

SETTING

Health assessment was undertaken at one of two dedicated health assessment centers or in the study participant's home if travel was not practicable.

PARTICIPANTS

Five thousand eight hundred ninety-seven members of a nationally representative sample of the community-living population of Ireland aged 50 and older. Those with severe cognitive impairment, dementia, or Parkinson's disease were excluded.

MEASUREMENTS

Measurements included height and weight, normal walking speed, Timed Up-and-Go, handgrip strength, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Color Trails Test, and bone mineral density. Normative values were estimated using generalized additive models for location shape and scale (GAMLSS) and are presented as percentiles, means, and standard deviations.

RESULTS

Generalized additive models for location shape and scale fit the observed data well for each measure, leading to reliable estimates of normative values. Performance on all tasks decreased with age. Educational attainment was a strong determinant of performance on all cognitive tests. Tests of walking speed were dependent on height. Distribution of body mass index did not change with age, owing to simultaneous declines in weight and height.

CONCLUSION

Normative values were found for tests of many aspects of cognitive and physical function based on a representative sample of the general older Irish population.

Factors that influence awareness and treatment of atrial fibrillation in older adults

AIM

The aims of this study were to investigate the prevalence of atrial fibrillation (AF), treatment rates of AF and the factors underlying awareness and treatment, in a large nationally representative study.

METHODS

A population sample of people aged 50+, living in the Republic of Ireland, were recruited as part of The Irish longitudinal study on ageing. Ten-minute electrocardiogram recordings were obtained (n = 4890), and analysed to detect AF. Self-reported arrhythmias, subjective and objective health measures (cardiovascular diseases, CHA2DS2-VASc variables and blood pressure) and medications were also recorded. Logistic regressions were used to determine associations with outcomes of presence of AF, lack of awareness and untreated AF.

RESULTS

Overall prevalence of AF was 3% (95% CI: 2.4-3.7%), with a marked age gradient and sex difference [4.8% (men) vs. 1.4% (women); P < 0.0001]. In total, 67.8% were at high risk of stroke (CHA2DS2-VASc ≥ 2), of whom 59.3% were inadequately treated. A high proportion of 38.1% were unaware of having AF. CHA2DS2-VASc nor HAS-BLED score influenced awareness or treatment. Lack of awareness was associated with lower education (P = 0.01), lower cognition (P = 0.04), rural location (OR = 3.67; P = 0.02) and number of general practitioner visits (P = 0.01), whereas untreated AF was influenced by frailty status (P = 0.04).

CONCLUSION

With projected doubling of numbers of persons over 80 in the next 30 years in the British Isles, detection and management of AF is pressing. Two-thirds of adults at high risk of stroke were inadequately treated. More regular screening for AF, application of criteria for stroke and bleeding risk and awareness of factors influencing diagnosis and treatment is recommended.

FC15-06 - The socio-economic realities of mental health in ireland

Introduction

Mental Health entails significant economic costs, not only the provision of health services but also lost economic output. Mental Health has been estimated to cost Ireland up to €3 billion annually. Social determinants are a major contributory factor to mental health problems and inequity.

Objectives

To illustrate economic cost of mental health in Ireland, importance of social determinants in mental health inequity and provide guidelines on how to improve the overall level of mental health.

Aim

Examine economic cost of mental health in Ireland and discuss how negative social determinants might be tackled to reduce mental health inequities.

Methodology

Review hardcopy and internet reports and studies since 2000 on Irish mental health policy, the economic costs and social determinants of mental health, the obstacles to reducing health inequities and what should be prioritised to achieve good mental health in Ireland.

Results

Mental Health problems incur a significant cost. Furthermore, mental health problems occur more frequently amongst those groups with negative social determinants. These health inequities need to be tackled to reduce the overall level of mental health illness.

Conclusions

Given current global economic difficulties it is more important than ever to reduce economic costs. Mental health is one such significant cost. Negative social determinants lead to mental health inequities and therefore greater economic costs in terms of health care and lost economic productivity. They must be tackled by an holistic approach, one which not only involves the health sector but also other relevant social and economic sectors.

The mental health needs of asylum seekers and refugees in Ireland

Introduction

Asylum seekers and refugees (ASR) are commonly portrayed as opportunists who came to Ireland to fraudulently scrounge off the Irish public. Such views and the consequent exclusion and discrimination they experience can aggravate their mental health risks and reduce their willingness to seek professional help.

Objectives

To identify the mental health risks faced by ASR and outline specific measures to improve their situation.

Aims

Through available hardcopy and online literature

1/Assess and evaluate impact of asylum seeking and refugee integration process on ASR psychiatric problems in Ireland.

2/Assess and evaluate knowledge and understanding of ASR mental health status; effects of segregation from local communities due to living in isolated ‘centres’ and no employment entitlement; communication and cultural integration difficulties; impact of exclusion and/or (racial) discrimination; apprehension of alien mental health system and treatment process; differing outcome expectations held by ASR and mental health specialists; and fear of being stigmatised by peers.

Methods

Rigorous review of relevant and applicable hardcopy and internet literature in English language since 2000.

Results

ASR mental health problems associated are generally multi-dimensional. In addition to ‘normal’ stresses, many ASR are haunted by past hardships, experience exclusion and integration difficulties and endure a highly stressful asylum process.

Conclusion

ASR require additional, specifically targeted mental health assistance and services that respect and understand their particular needs. Mental health services should work with the asylum process and other relevant socio-economic sectors to develop programmes to tackle potential ASR mental health concerns.