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Background: RCS Eng, the Royal College of Surgeons of England, has published much information with regard to the consenting process. A majority of patients seek health information through online resources as well as discussing with the care givers. Therefore, it is necessary that online material is both of high quality and reliable for patients. We aimed to evaluate the quality and standard of the online patient information on laparoscopic cholecystectomy to help in the consenting process. Methods: A search was carried out as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Sources were assessed using five validated scoring tools: Flesch–Kincaid Reading Ease Score (readability), DISCERN and IPDAS scores (quality of content) and HONcode and the Information Standard Certification (standards of accreditation). Results: The average readability of all websites was higher than recommended for patient literature. Less than half of the sources had received HONcode or Information Standard accreditation. On grading of quality and content, across validated scoring tools, no source achieved the minimum recommended level. Conclusion: Online patient information related to laparoscopic cholecystectomy is of poor quality. We recommend a multidisciplinary approach to participate in publishing more readable online resources of a higher standard to help patients and clinicians in consent and shared decision making. [ABSTRACT FROM AUTHOR]

Background The trend of added sugar ( AS) intake has not been investigated in the Australian population, including in older adults. The present study aimed to assess trends and food sources of AS intake among a cohort of older Australians during 15 years of follow-up. Methods Dietary data from participants of the Blue Mountains Eye Study (1264 men and 1614 women), aged ≥49 years at baseline, were collected. Dietary intakes were assessed at 5-yearly intervals (1992-94 to 2007-09) using a 145-item food frequency questionnaire ( FFQ). AS content of FFQ food items was estimated using a stepwise systematic method. Trends for AS intake between baseline and the three follow-up periods were assessed using linear mixed modelling. Results In men, the mean ( SEM) percentage of energy provided by AS intake ( EAS%) declined from 10.4% (0.1%) at baseline to 9.4% (0.2%) at 15-year follow-up ( Ptrend = 0.028). Women's mean ( SEM) EAS% intake at baseline and 15-year follow-up was 9.2% (0.1%) and 8.8% (0.2%), respectively ( Ptrend = 0.550). EAS% intake of men was significantly higher than that of women for 10 years ( P < 0.05). Sugar products (table sugar, syrup, jam and honey) were the major sources of AS at all-time points and contributed to more than 40% and 35% of AS intake in men and women, respectively. Intake of sugar products decreased in men during follow-up ( Ptrend < 0.001). Conclusions An overall downward trend was observed in AS intake in both genders, however, was only significant for men during 15 years of follow-up. Table sugar and sugar-containing spreads represent the major source of AS in this cohort of older Australians. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of prospective studies with long follow‐up that have examined a wide range of correlates associated with persistent pain outcomes in persons who sustained a mild or moderate injury in a road traffic crash. This study aimed to establish the independent predictors of pain severity over 24 months. Methods: A total of 364, 284 and 252 persons with mild/moderate musculoskeletal injuries sustained in a vehicle‐related crash participated in telephone interviews in the subacute phase, and at 12 and 24 months, respectively. The numeric rating scale (NRS) assessed pain severity. Pain‐Related Self‐Statements Scale‐Catastrophizing (PRSS‐Catastrophizing) and the Short Form Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) were also administered. Results: After multivariable adjustment, each 1 SD increase in Short Form‐12 Physical Component Score (SF‐12 PCS) in the subacute phase was associated with 0.73 (p = 0.002) and 1.11 (p < 0.0001) decrease in NRS scores after 12 and 24 months, respectively. Each unit increase in the PRSS‐Catastrophizing score in the subacute phase was associated with 0.54 (p = 0.001) and 0.43 (p = 0.03) increase in NRS scores 12 and 24 months later, respectively. Subacute phase OMPSQ scores were positively associated with NRS scores at 12‐ and 24‐month follow‐ups (p < 0.0001). Conclusions: Self‐perceived physical well‐being, pain‐related work disability and pain catastrophizing could play a role in determining long‐term pain‐related outcomes following traffic‐related injuries. [ABSTRACT FROM AUTHOR]

Aims Dietary modifications may play an important role in the prevention of diabetes. We aimed to assess the temporal association between diet quality and both impaired fasting glucose and Type 2 diabetes among older adults. Methods A total of 2564 participants aged 49+ years at baseline were examined between 1992 and 1994 and 2002-2004 and had their fasting blood glucose measured. Dietary data were collected using a semi-quantitative food frequency questionnaire. A modified version of the Healthy Eating Index for Australians was developed to determine Total Diet Score. Incident diabetes (or impaired fasting glucose) was defined in participants at risk who were newly diagnosed by a physician during the follow-up or found to have a fasting blood glucose level ≥ 7.0 mmol/l (or 6.1-6.9 mmol/l). Results After adjusting for age, sex, current smoking, body mass index, hypertension and serum triglycerides, comparing highest with lowest tertile of total diet score, a significant 75% decrease in risk of incident impaired fasting glucose was observed in men ( Ptrend = 0.02). Also, in men, each two-point increase in Total Diet Score was associated with a 52% reduction in the 10-year incidence of impaired fasting glucose, ( OR 0.48, 95% CI 0.33-0.69). No significant associations were observed among women or with the 10-year incidence of diabetes. Conclusions Greater compliance with published dietary guidelines (better diet quality) was associated with a reduced risk of pre-diabetes in men, but not women. [ABSTRACT FROM AUTHOR]

Background: Very few studies have assessed both the incidence and progression of thyroid dysfunction in a single older population-based cohort. In this study, we aimed to assess the 5-year incidence, progression and risk factors for development of thyroid dysfunction in an older Australian population. Methods: The Blue Mountains Eye Study is a longitudinal population-based cohort study. During 1997-1999, 1768 participants (≥55 years) had thyroid function assessed. After excluding participants reporting any form of treatment for their thyroid condition at baseline, 951 participants (91.4%) without thyroid dysfunction and 54 (5.4%) with thyroid dysfunction were re-examined 5 years later. Thyroid dysfunction was defined using serum thyrotropin (thyroid stimulating hormone (TSH)) screen, followed by serum free T4 assessment. Results: The overall 5-year incidence of thyroid dysfunction was 4.7% (95% confidence interval (CI) 3.4-6.1). Obesity (body mass index ≥ 30 kg/m2) and serum TSH > 2 mIU/L at baseline predicted incident overt hypothyroidism (odds ratio (OR) 4.05, CI 1.74-9.41) and (OR 5.46, CI 1.16-25.67) respectively. The 5-year incidence of subclinical hypothyroidism was significantly higher in women than in men, 2.5% versus 0.7% ( P= 0.03). Progression to overt hypothyroidism was observed in 17.9% of subjects with subclinical hypothyroidism over 5 years. Conclusions: The 5-year incidence of thyroid dysfunction in this older population was relatively low, and was associated with obesity and serum TSH level > 2 mIU/L at baseline. Over one in six persons with subclinical hypothyroidism progressed to overt thyroid dysfunction over the 5-year period. Our findings highlight the need for appropriate management of subclinical hypothyroidism among older people. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to reassess the prevalence and personal burden of dizziness/vertigo, and to assess the relationship with hearing loss and tinnitus in older adults. Design: Prospective cross-sectional study. Setting: Blue Mountains region, west of Sydney, Australia. Participants: We examined 2751 of 2956 (aged 50+ years) Blue Mountains Hearing Study participants. Main outcome measures: Audiologists screened participants for reported dizziness using a single question. Questions from the Dizziness Handicap Inventory were used to assess the impacts of dizziness/vertigo. Hearing impairment was determined as the pure-tone average of audiometric hearing thresholds at 500, 1000, 2000 and 4000 Hz (PTA0.5–4 KHz), defining any hearing loss as PTA0.5–4 KHz >25 dB HL. Presence of tinnitus was assessed by a positive response to a single question. Quality of life was measured using the Short Form 36-item Health Survey (SF-36). Each SF-36 dimension was scored from 0 (worst possible health state) to 100 (best possible health state). Results: Prevalences of dizziness/vertigo, vestibular vertigo and non-vestibular vertigo were 36.2%, 10.0% and 14.2%, respectively. Of the dizziness/vertigo reports, 27.7% and 39.3%, respectively, were attributed to vestibular and non-vestibular vertigo. Tinnitus was associated with dizziness, odds ratio, OR, 1.99 (95% confidence interval, CI, 1.68–2.35). However, hearing loss was not associated with dizziness/vertigo. Participants reporting dizziness/vertigo had lower quality of life scores ( P < 0.0001). Participants reporting vestibular vertigo were more likely than those with non-vestibular vertigo to report higher DHI scale scores or a greater handicap. Conclusion: Our findings highlight the burden imposed by dizziness, indicating dizziness/vertigo are important public health care issues. Clin. Otolaryngol. 2009, 34, 552–556. [ABSTRACT FROM AUTHOR]

Aims Type 2 diabetes and associated microvascular abnormalities are postulated to affect hearing. Our study reports on the relationship between Type 2 diabetes and the prevalence, 5-year incidence and progression of hearing impairment in a representative, older, Australian population. Methods The Blue Mountains Hearing Study is a population-based survey of age-related hearing loss conducted in a defined suburban area, west of Sydney. Hearing loss was defined as the pure-tone average of frequencies 0.5, 1.0, 2.0 and 4.0 kHz > 25 decibels hearing level (dB HL) in the better ear (bilateral hearing loss). Type 2 diabetes was defined from reported physician-diagnosed diabetes or fasting blood glucose ≥ 7.0 mmol/l. Results Age-related hearing loss was present in 50.0% of diabetic participants ( n = 210) compared with 38.2% of non-diabetic participants ( n = 1648), odds ratio (OR) 1.55 [95% confidence interval (CI) 1.11–2.17], after adjusting for multiple risk factors. A relationship of diabetes duration with hearing loss was also demonstrated. After 5 years, incident hearing loss occurred in 18.7% of participants with, and 18.0% of those without diabetes, adjusted OR 1.01 (CI 0.54–1.91). Progression of existing hearing loss (> 5 dB HL), however, was significantly greater in participants with newly diagnosed diabetes (69.6%) than in those without diabetes (47.8%) over this period, adjusted OR 2.71 (CI 1.07–6.86). Conclusions Type 2 diabetes was associated with prevalent, but not incident hearing loss in this older population. Accelerated hearing loss progression over 5 years was more than doubled in persons newly diagnosed with diabetes. These data explore further reported links between Type 2 diabetes and age-related hearing loss. [ABSTRACT FROM AUTHOR]

Using culture-independent technology, PCR-RFLP were used to identify and type STEC in the stool of a patient with HUS. Fecal PCR-RFLP patterns were identical to those of the STEC O157:H7 isolated from the patient. [ABSTRACT FROM AUTHOR]

Purpose: To examine the prevalence and risk factors for depressive symptoms in patients with neovascular age-related macular degeneration (nAMD) presenting for anti-vascular endothelial growth factor (anti-VEGF) therapy., Methods: In a clinic-based cohort of 547 patients with nAMD who presented for treatment, the Centre of Epidemiological Studies Depression 10-point scale (CES-D-10) and Mental Health Index (MHI) component of the 36-item Short Form Survey were administered to assess for the presence of depressive symptoms. Logistic regression analyses were used to calculate odds ratios and 95% confidence intervals for factors associated with an increased likelihood of depressive symptoms., Results: The prevalence of depressive symptoms was 42.04% and 31.78% as per the CES-D-10 and MHI scales, respectively. Poor self-rated health (SRH) is associated with increased odds of depressive symptoms [multivariable-adjusted OR: 3.00 (95% CI 1.90-4.73) for CES-D-10; OR: 2.67 (95% CI 1.67-4.28) for MHI]. Impaired activities of daily living (ADLs) [multivariable-adjusted OR: 2.62 (95% CI 1.56-4.38) for CES-D-10; OR: 3.59 (95% CI 2.10-6.15) for MHI] and a visual function score within the two lowest quartiles were also associated with increased odds of depressive symptoms using both scales., Conclusion: A high prevalence of depressive symptoms was observed among nAMD patients presenting for treatment. Poorer SRH, ADL impairment and reduced visual function were associated with increased odds of depressive symptoms., (© 2020 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To assess whether dietary intake of antioxidants, fruits, vegetables and fish is associated with 12-month treatment outcomes in neovascular age-related macular degeneration (nAMD) patients., Methods: A total of 547 participants were diagnosed with nAMD at baseline, of whom 494 were followed up after 12 months of antivascular endothelial growth factor therapy. Dietary intakes were determined using a validated food frequency questionnaire. Presence of intra-retinal and sub-retinal fluid (IRF, SRF), pigment epithelial detachment (PED) and central macular thickness (CMT) were recorded from optical coherence tomography images. Best-corrected visual acuity was recorded using log of the Minimum Angle of Resolution (LogMAR) charts., Results: Participants in the upper three quartiles combined compared to those in the first quartile of baseline dietary zinc intake had 49% reduced odds of SRF 12 months later, multivariable-adjusted odds ratio (OR) 0.51 [95% confidence interval (CI) 0.30-0.89]. The upper three quartiles combined compared to the first quartile of β-carotene intake had 90% greater odds of IRF presence at 12-month follow-up, multivariable-adjusted OR 1.90 (95% CI 1.04-3.46). The highest versus lowest quartile of dietary β-carotene intake had a nearly twofold greater odds of PED presence, multivariable-adjusted OR 1.99 (95% CI 1.03-3.84)., Conclusion: A higher intake of dietary zinc was associated with a reduced likelihood of SRF at 1 year. Conversely, a higher intake of dietary β-carotene was associated with an increased risk of IRF and PED. These findings underscore the importance of ongoing nutritional advice for nAMD patients presenting for treatment., (© 2020 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Objective: Microvascular changes in microvascular angina are poorly understood due to difficulties in imaging the coronary microcirculation in vivo. The retinal microvasculature may reflect changes in coronary microcirculation. We assessed microvascular changes in the retina in patients with microvascular angina and compared them with patients with angiographically proven coronary artery disease., Methods: We performed retinal photography and coronary angiography on 915 patients. Retinal vessel calibers were measured using a validated computer-assisted method; coronary artery disease was graded from coronary angiograms. Microvascular angina was defined as angina with <25% stenosis in all coronary epicardial arteries., Results: A total of 139 patients (15.2%) had microvascular angina, while 776 (84.8%) had coronary artery disease. Participants with microvascular angina and coronary artery disease had similar retinal arteriolar and venular calibers. After adjustment for age, ethnicity, mean arterial pressure, diabetes, current smoking, body mass index, and fellow vessel caliber, women with smaller venules were threefold more likely to have microvascular angina than women with larger venules (multivariable-adjusted odds ratio 3.54, 95% confidence interval 1.35 to 9.24, P < 0.01). This difference was not observed in men., Conclusions: Microvascular angina in women was associated with microvascular changes distinct from those in coronary artery disease., (© 2019 John Wiley & Sons Ltd.)

Objective: In the current study, we aimed to examine the associations of low birth weight with retinal vascular caliber and vascular fractal dimension during early adolescence., Methods: A population-based study of 12-year-old schoolchildren (2353/3144 [75.3%]) recruited from a random cluster sample of 21 schools. Birth weight, birth length and head circumference were obtained via parent report of the child's birth record. Retinal images were taken and vessel diameter and fractal dimension were quantified using validated computer-based methods., Results: After adjusting for age, sex, ethnicity, body mass index, iris color, axial length, mean arterial blood pressure, prematurity and fellow retinal vascular caliber, children in the lowest quartiles of birth weight had ∼2.5 μm narrower mean retinal arteriolar caliber than those in the highest quartiles (p for trend = 0.001). Associations were observed between shorter birth length and smaller head circumference with narrower retinal arterioles. Smaller head circumference was associated with decreased fractal dimension (p for trend = 0.03)., Conclusions: Children with lower birth weight were more likely to have narrower retinal arterioles, while those with smaller head circumference were more likely to have reduced complexity of their retinal microvasculature. These variations in microvascular structure in adolescence could reflect a susceptibility to cardiovascular disease during adulthood, resulting from a disadvantaged growth environment in utero., (© 2010 John Wiley & Sons Ltd.)