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INTRODUCTION: Adolescents are known to have high risk factors for sleep disorders, yet the youth rates of sleep disturbances are unknown. AIM: This study aimed to determine the prevalence of sleep disorders among New Zealand high school students. METHODS: The Auckland Sleep Questionnaire (ASQ) was administered to high school students at six schools in the North Island. Schools were chosen to reflect a range of ethnicities and school deciles, which identify the socioeconomic status of households in the school catchment area. RESULTS: A total of 1388 students completed the ASQ. The median age was 17 years (range 14-23) and females represented 43.5% (n=604) of the total group. A total of 37.2% of the students surveyed reported having significant sleep symptoms lasting longer than one month. Depression and anxiety were present in 51.7% and 44.8% of students reporting a sleep problem, respectively. A moderate correlation was observed between sleep problems and depression (r=0.34, p

Post-COVID-19 breathing pattern disorder can be characterised by application of nonlinear statistical modelling of exercise ventilatory data https://bit.ly/3WlBc7e., Competing Interests: Conflict of interest: J.H. Hull is an associate editor of this journal. The remaining authors have nothing to disclose., (Copyright ©The authors 2023.)

Background: Data on right ventricular (RV) exercise adaptation following acute intermediate and high-risk pulmonary embolism (PE) remain limited. This study aimed to evaluate the symptom burden, RV functional recovery during exercise and cardiopulmonary exercise parameters in survivors of intermediate and high-risk acute PE., Methods: We prospectively recruited patients following acute intermediate and high-risk PE at four sites in Australia and UK. Study assessments included stress echocardiography, cardiopulmonary exercise testing (CPET) and ventilation-perfusion (VQ) scan at 3 months follow-up., Results: Thirty patients were recruited and 24 (median age: 55 years, IQR: 22) completed follow-up. Reduced peak oxygen consumption (VO 2 ) and workload was seen in 75.0% (n=18), with a persistent high symptom burden (mean PEmb-QoL Questionnaire 48.4±21.5 and emPHasis-10 score 22.4±8.8) reported at follow-up. All had improvement in RV-focused resting echocardiographic parameters. RV systolic dysfunction and RV to pulmonary artery (PA) uncoupling assessed by stress echocardiography was seen in 29.2% (n=7) patients and associated with increased ventilatory inefficiency (V̇E/V̇CO 2 slope 47.6 vs 32.4, p=0.03), peak exercise oxygen desaturation (93.2% vs 98.4%, p=0.01) and reduced peak oxygen pulse (p=0.036) compared with controls. Five out of seven patients with RV-PA uncoupling demonstrated persistent bilateral perfusion defects on VQ scintigraphy consistent with chronic thromboembolic pulmonary vascular disease., Conclusion: In our cohort, impaired RV adaptation on exercise was seen in almost one-third of patients. Combined stress echocardiography and CPET may enable more accurate phenotyping of patients with persistent symptoms following acute PE to allow timely detection of long-term complications., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Objective: Pulmonary hypertension is a life-limiting complication of interstitial lung disease (ILD-PH). We investigated whether treatment with phosphodiesterase 5 inhibitors (PDE5i) in patients with ILD-PH was associated with improved survival., Methods: Consecutive incident patients with ILD-PH and right heart catheterisation, echocardiography and spirometry data were followed from diagnosis to death, transplantation or censoring with all follow-up and survival data modelled by Bayesian methods., Results: The diagnoses in 128 patients were idiopathic pulmonary fibrosis (n = 74, 58%), hypersensitivity pneumonitis (n = 17, 13%), non-specific interstitial pneumonia (n = 12, 9%), undifferentiated ILD (n = 8, 6%) and other lung diseases (n = 17, 13%). Final outcomes were death (n = 106, 83%), transplantation (n = 9, 7%) and censoring (n = 13, 10%). Patients treated with PDE5i (n = 50, 39%) had higher mean pulmonary artery pressure (median 38 mm Hg [interquartile range, IQR: 34, 43] vs. 35 mm Hg [IQR: 31, 38], p = 0.07) and percentage predicted forced vital capacity (FVC; median 57% [IQR: 51, 73] vs. 52% [IQR: 45, 66], p=0.08) though differences did not reach significance. Patients treated with PDE5i survived longer than untreated patients (median 2.18 years [95% CI: 1.43, 3.04] vs. 0.94 years [0.69, 1.51], p = 0.003) independent of all other prognostic markers by Bayesian joint-modelling (HR 0.39, 95% CI: 0.23, 0.59, p < 0.001) and propensity-matched analyses (HR 0.38, 95% CI: 0.22, 0.58, p < 0.001). Survival difference with treatment was significantly larger if right ventricular function was normal, rather than abnormal, at presentation (+2.55 years, 95% CI: -0.03, +3.97 vs. +0.98 years, 95% CI: +0.47, +2.00, p = 0.04)., Conclusion: PDE5i treatment in ILD-PH should be investigated by a prospective randomized trial., (© 2022 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.)

Effects of continuous positive airway pressure (CPAP) on right ventricular (RV) function in patients with untreated mild-to-moderate obstructive sleep apnea (OSA) are unclear. In this exploratory analysis of cardiac magnetic resonance (CMR)-derived indices of RV function in patients with minimally symptomatic OSA from the MOSAIC randomized control trial we found no effect of CPAP on RV CMR parameters. In those with lower RV ejection fraction and higher RV end-diastolic volume (EDV) at baseline, CPAP treatment appeared to improve RV function with a significant reduction in both RV EDV and RV end-systolic volume although between-group effects were not observed. These data suggest potential merit in a larger randomized study of CPAP in patients with mild-to-moderate OSA and a greater breadth of RV dysfunction., Competing Interests: The authors declare no conflicts of interest., (© 2023 The Authors. Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute.)

Background: Accuracy of right heart strain (RHS) measured on computed tomography pulmonary angiogram (CTPA) scans by non-radiologists is unknown. We assessed inter-observer variability of four RHS features and determined the accuracy of measurements by respiratory physicians., Method: 1560 consecutive patients with acute PE were identified, and those who had a CTPA and an echocardiogram within 24-h included. CTPAs were independently scored prospectively by two radiologists, two thoracic physicians and a specialist registrar. Inter-observer variability was assessed, and diagnostic accuracy compared to echocardiography., Results: 182 patients (median age 62.8 years, IQR 49.8-71.5) with acute PE (7.7% high-risk, 40.7% intermediate high-risk, 31.3% intermediate low-risk and 20.3% low-risk) were included. Right ventricle to left ventricle diameter ratio (RV:LV) measurement had low inter-observer variability among the radiologists and non-radiologists with interclass correlation coefficient (ICC) of 0.95 (95%CI 0.92-0.97) and 0.96 (95%CI 0.94-0.97) respectively. RV:LV ratio had high diagnostic accuracy compared to RV dilatation on echocardiography (AUC 0.89, 95%CI 0.84-0.94 for radiologists and AUC 0.84, 95%CI 0.77-0.90 for non-radiologists). Main pulmonary artery to ascending aorta diameter ratio (MPA:Ao) measurement also had excellent agreement amongst the radiologists and non-radiologists (ICC 0.93 (95%CI 0.88-0.96) and 0.92 (95%CI 0.81-0.96) respectively). Significant variability was seen in the assessment of subjective features of RHS (leftward bowing of interventricular septum and contrast reflux into inferior vena cava) amongst the non-radiologists., Conclusion: RV:LV and MPA:Ao diameter ratios on CTPA measured by non-radiologists have low inter-observer variability and good agreement with radiologists, and can be reliably used where an expert report is unavailable., Competing Interests: Declaration of competing interest None of the authors have any conflicts of interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Several recent randomised controlled trials (RCT) have investigated the use of direct oral anticoagulants (DOAC) in the treatment of malignancy-associated venous thromboembolism (VTE)., Aims: This meta-analysis combines all RCT data to determine the risks of recurrent VTE and bleeding with DOAC in patients with malignancy-associated VTE compared with low-molecular-weight heparin (LMWH)., Methods: The study followed PRISMA guidelines. MEDLINE, EMBASE and CENTRAL were systematically searched from inception to 1 April 2020. References of reviews and relevant conference proceedings were searched by hand. Two authors independently evaluated study eligibility, extracted data and assessed risk of bias. Direct and indirect meta-analyses were performed., Results: In four RCT with low risk of bias (2907 patients), high certainty evidence suggested that DOAC had a 37% reduction in risk of recurrent VTE compared with LMWH (direct pooled risk ratio (RR) 0.63; 95% confidence interval (CI) 0.44-0.91; I 2 = 28%). No significant difference was observed in the risk of major bleeding with DOAC compared with LMWH (RR 1.31; 95% CI 0.83-2.07; I 2 = 22%; moderate certainty evidence), including in patients in gastrointestinal and genitourinary malignancy. An increased risk of combined major or clinically relevant non-major bleeding was seen with DOAC (RR 1.52; 95% CI 1.09-2.12; I 2 = 51%; low certainty evidence). Apixaban had the highest probability of being ranked the most effective and least bleeding risk among the DOAC., Conclusion: DOAC are effective in treating malignancy associated VTE; however, caution is required in patients with high risk of bleeding. Apixaban had lower risk of bleeding compared to other DOAC in this population., (© 2020 Royal Australasian College of Physicians.)

Studies assessing exercise ventilatory responses during real-life exercise in pulmonary arterial hypertension (PAH) which include patients with cyanotic congenital heart disease are scarce. We assessed the ventilatory response to stairclimbing in patients with idiopathic PAH (IPAH) and congenital heart disease-associated PAH with Eisenmenger (EIS) physiology compared to healthy controls. Fifteen adults with IPAH, six EIS and 15 age and body mass index (BMI) matched controls were prospectively recruited. Participants completed spirometry and a self-paced stair-climb (48 steps) with portable cardiopulmonary exercise testing (CPET) equipment in-situ. Borg dyspnoea scores were measured at rest and on stair-climb cessation. Both IPAH and EIS groups had amplified ventilatory responses compared to Controls. The rate of increase in minute ventilation (VE) was exaggerated in EIS driven by an early increase in tidal volume (Tv) and more gradual increase in respiratory rate (RR). Peak Tv, RR, Tv: forced vital capacity (FVC) ratio, VE/VCO 2 slope and stairclimb duration were significantly higher in EIS and IPAH compared to controls despite similar baseline spirometry and change in oxygen uptake on exercise. A decline in end-tidal carbon dioxide (CO 2 ) and arterial oxygen saturations in early exercise distinguished EIS and IPAH patients. Significant correlations were observed between peak exercise Borg score and stair-climb time (r = 0.73, p = 0.002), peak end-tidal CO 2 (r = -0.73, p = 0.001), peak VE (r = 0.53, p = 0.008), peak RR (r = 0.42, p = 0.011) and VE/VCO 2 slope (r = 0.54, p = 0.001). Patients with IPAH and EIS have exaggerated ventilatory responses to stair-climbing compared to the controls with more severe levels of dyspnoea perception in Eisenmenger syndrome for equivalent oxygen uptake and work., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Purpose of Review: Sarcoidosis associated pulmonary hypertension (SAPH) is a well-recognised complication, associated with a seven-fold increase in mortality. This comprehensive review will summarise these recent developments and proposes the use of a phenotype-based management approach in SAPH., Recent Findings: Recent registry-based studies have highlighted the adverse outcomes associated with SAPH and shown that reduced 6-min walk distance and diffusion capacity for carbon monoxide are predictive of poor prognosis. There is increasing interest in methods for early detection of SAPH, although whether early diagnosis impacts on survival remains uncertain. The pathophysiology underpinning SAPH is complex and often incorporates multiple mechanisms. Once the diagnosis is confirmed, understanding the underlying phenotypes of SAPH is key to providing the most effective management plan. There is some evidence that treating patients with precapillary PH with pulmonary vasodilators may improve some haemodynamic and quality life measures. However, more work is needed to determine whether mortality is affected., Summary: SAPH is associated with worsened survival. A range of phenotypes are recognised in SAPH. Multimodality risk assessment in patients with SAPH is likely to be important and is an area that requires further work. Published evidence for pulmonary vasodilator therapies in SAPH with a Pulmonary arterial hypertension-like phenotype is encouraging so far, but multiple confounding factors affects the quality of the evidence. The role of immunosuppressive agents for improving pulmonary pressures is unclear. Urgent controlled trials are needed., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Assessment of efficacy and safety of DOACs in treatment of pulmonary embolisms in obese patients provides reassurance that treatment with DOACs carries similar rates of recurrent VTE and bleeding complications to warfarin https://bit.ly/2VdrSXX., Competing Interests: Conflict of interest: C.B. Samaranayake has nothing to disclose. Conflict of interest: G. Keir has nothing to disclose. Conflict of interest: S.A.A. Slader has nothing to disclose. Conflict of interest: T. Tseng has nothing to disclose. Conflict of interest: K. Tran has nothing to disclose. Conflict of interest: J. Anderson has nothing to disclose. Conflict of interest: A. McCann has nothing to disclose. Conflict of interest: C. McCabe has nothing to disclose. Conflict of interest: J.W. Upham has nothing to disclose., (Copyright ©The authors 2021.)

This case-control study assessed efficacy and safety of systematic thrombolysis in morbidly obese patients with massive pulmonary embolisms. Thrombolysis at conventional doses seems to have similar efficacy and bleeding rates in morbidly obese patients. https://bit.ly/38ZqJr4., Competing Interests: Conflict of interest: C.B. Samaranayake has nothing to disclose. Conflict of interest: G. Keir has nothing to disclose. Conflict of interest: C. McCabe has nothing to disclose. Conflict of interest: J. Anderson has nothing to disclose. Conflict of interest: K. Tran has nothing to disclose. Conflict of interest: J.W. Upham has nothing to disclose., (©The authors 2021.)

Background: Respiratory Acute Discharge Service (RADS) is a novel early discharge service with nurse-led community based recovery in selected patients with acute exacerbations of chronic obstructive pulmonary disease., Aim: This pilot study aimed to determine the efficacy and safety of the programme in an Australian tertiary hospital., Methods: All patients who were recruited to RADS at Sunshine Coast University Hospital over a 6 months period from June to November 2018 were included. The co-primary outcomes were length of hospital days saved and rate of readmission within 30 days from discharge., Results: A total of 166 patients (median age 74 years (interquartile range 70-80 years)) was recruited to the programme over the study period. The mean forced expiratory volume in one second (FEV1%) of the patients was 42% (standard deviation 19). The median length-of-stay prior to discharge on the RADS programme was 1 day (range 0-5), compared to a previous average of 5.8 days in our health service. Patients were on the programme for a median of 4 days (range 1-6). A total of 613 hospital bed days was saved over the study period, with significant cost savings. Forty-one (24.7%) patients represented to hospital within 30 days, the majority (64%) were due to recurrent symptoms. The rate of 30-day all-cause mortality for the study population was 1 (0.6%)., Conclusion: Early supported discharge care model with nurse-led community based recovery after an acute exacerbation of chronic obstructive pulmonary disease in selected patients is safe, and has the potential to provide greater flow through the hospital systems with cost effective care., (© 2019 Royal Australasian College of Physicians.)

Background: An optimal sampling sequence in radial guide sheath endobronchial ultrasound lung biopsy (R-EBUS) is unclear. This prospective single-center pilot randomized controlled trial aimed to determine if the initial method and sequence of sampling affect the diagnostic accuracy of the procedure., Methods: Consecutive patients undergoing R-EBUS for lesions >15 mm with a bronchus sign were randomly assigned (1:1:1) to biopsy first (group A), brushings first (group B) or combination (group C). The primary outcome was a positive diagnosis from any sampling method., Results: Fifty-four patients were randomized. The overall diagnostic yield of the procedure was 77.8% (95% confidence interval: 66%-89%), with no difference between groups. A higher rate of positive cytology from brushings was seen if the biopsies were performed before brushings (77.8% in group A vs. 44.4% in group B, P=0.03). The rate of positive cytology from washings was higher if the washings were obtained just after the brushings (61.1% in group A vs. 11.1% in group B, P=0.02). There was no difference in the rate of positive biopsy histology in the groups (P=0.27). All 3 sampling modalities were more likely to be positive in group A (50.0% vs. 11.1% in group B and 22.2% in group C, P=0.04). Complications rate was low and not significantly different between groups., Conclusion: The overall rate of a positive R-EBUS procedure was not affected by the initial sampling method or sequence. However, all 3 sampling modalities were more likely to be positive if biopsies were performed first, followed by brushings and washings.

This study investigated the effects of previous radiation therapy on outcomes from nivolumab in advanced NSCLC, and found that previous radiation therapy resulted in significantly higher survival in patients treated with nivolumab for advanced NSCLC http://bit.ly/3btOFSL., Competing Interests: Conflict of interest: C.B. Samaranayake has nothing to disclose. Conflict of interest: E. McCaffrey has nothing to disclose. Conflict of interest: J. Coucher has nothing to disclose. Conflict of interest: M. Lehman has nothing to disclose. Conflict of interest: G.T. Mai has nothing to disclose. Conflict of interest: M.A. Murphy has nothing to disclose., (Copyright ©ERS 2020.)

Background and Objectives: Persistent right ventricular dysfunction (RVD) and pulmonary hypertension (PHT) are important outcomes following sub-massive pulmonary embolism (PE). The aims were to determine the rates and factors associated with RVD and/or PHT on echocardiography (ECHO) and the rate of 30-day and 1-year all-cause mortality following sub-massive PE. Patients who received thrombolysis and non-thrombolysis were also compared., Methods: Consecutive patients with sub-massive PE over a five year period with at least 1-year follow-up were retrospectively identified. Regression analysis was performed to identify predictors of outcomes., Results: Eighty-seven patients met inclusion criteria. Sixty-one (70%) had admission ECHOs with a follow-up ECHO in 42 (48.3%) at a mean of 7.6 months (SD 5.2). Fifty-one had RVD (58.6%) and 35 (40.2%) had PHT on admission. The rates of persistent RVD and raised right ventricular systolic pressure in this study population were 12% and 17%, respectively. Thrombolysis was associated with a trend towards improvement of PHT (53.3% PHT on admission to 0% PHT on follow-up in the thrombolysis group, P = 0.29). The rate of 30-day and 1-year all-cause mortality were 12.6% and 21.8%, respectively. Thirty-day all-cause mortality was independently predicted by the presence of right heart strain on computed tomography pulmonary angiography [OR 3.7 (P = 0.045)], echocardiographic evidence of RVD [OR 3.9 (P = 0.041)] and age., Conclusion: The majority of patients with RVD and PHT at the time of sub-massive PE improve on follow-up; however, there is a subset who remain abnormal. Future studies are needed to identify modifiable risk factors for these complications., (© 2015 John Wiley & Sons Ltd.)

Background: Coronary angiography is the gold standard for assessing coronary artery disease (CAD). In many patients with chest pain, no or mild CAD (< 50% stenosis) is found. It is uncertain whether this 'non-significant' result influences management and outcomes. We reviewed characteristics and outcomes in a contemporary cohort of chest pain referrals who had mild or absent CAD on coronary angiography., Method: All patients undergoing coronary angiography at Auckland City Hospital during July 2010-October 2011 were reviewed (n = 2983). Of these, 12.3% (n = 366) underwent coronary angiography for evaluation of chest pain and were found to have absent or mild CAD. These patients were followed up for 2.3 ± 0.6 years., Results: Mean age was 60.0 ± 12.3 years, 56.1% were female. The ECG was abnormal in 55.0% of patients. Stress testing for inducible ischaemia was undertaken in 40.7% of patients and was abnormal in 57.7%. Following angiography, 43.2% had no changes to cardiac medications. Additional drug therapy (aspirin, statin, beta-blockers, ACE-inhibitor) was commenced in around 14.2-22.1% of cases. These drugs were discontinued in 4.1-8.2% of patients. Rates of major adverse cardiovascular events and readmissions with chest pain were 0.3% (1) and 1.9% (7) respectively at 30 days, and 1.9% (7) and 6.0% (22) at 1 year., Conclusion: Although even non-obstructive atheroma may justify medical therapy to limit disease progression, our findings may suggest that in these cases, invasive coronary angiography, may not lead to the patient/physician reassurance justified by historical data., (© 2015 John Wiley & Sons Ltd.)

Aim: Sleep symptoms, depression and anxiety often coexist and tertiary students are a population group that are increasingly recognised to be at risk. However the rates of these conditions in the New Zealand population are poorly understood. The aim of this study was to determine the rates of sleep disorders, depression and anxiety, and identify correlations between satisfactions with life among university students in Auckland., Method: Auckland Sleep Questionnaire (ASQ) was administered to undergraduate students from six schools of The University of Auckland. The different types of sleep disorders were calculated for the students who reported a significant sleep problem lasting more than 1 month. The rate of depression, anxiety and substance use as well as the satisfaction with life scale scores were also calculated for the whole cohort., Results: A total of 1933 students were invited to participate and 66.8% completed the questionnaire. The median age was 20 years (range 16-38) and women represented 63.9% of the total group. A total of 39.4% of the students surveyed reported having significant sleep symptoms lasting longer than 1 month. The most prevalent causes for sleep symptoms were depression and anxiety. Delayed sleep phase disorder was found in 24.9% of students and parasomnias were reported by 12.4%. Depression and anxiety were present in 17.3% and 19.7% of the total group respectively, and 7.3% of students had thoughts of "being better off dead" or self-harm. A total of 15.5% students were found to have a CAGE score greater than or equal to 2 and 9.3% reported using recreational drugs in the last 3 months. Moderate negative correlations between SWLS scores and depression and anxiety were found (r=-0.45 and r=-0.37 respectively)., Conclusion: A large number of university students are suffering from significant sleep symptoms. Mood disorders, substance use, and circadian rhythm disorders can greatly contribute to sleep difficulties in this population group. The study also showed that harmful alcohol and drug use was common among this population group and is associated with clinically significant depression and anxiety. Accurate diagnosis using defined criteria will enable effective treatment for these conditions that impact greatly on the quality of life.

Severe drug-induced thrombocytopenia is a well known but rare complication of quinine. This paper presents a discussion on quinine-induced thrombocytopenia based on a patient who developed fatal thrombocytopenia and pulmonary haemorrhage., (© 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.)

Introduction: Return to work and social re-integration following heart transplantation is a significant challenge for patients. The aim of this study is to provide a snapshot of the current employment status and factors associated with return to work in New Zealand recipients over the past decade., Methods: Consecutive surviving patients who underwent heart transplantation in the 10 years from June 2001 to June 2011, alive in July 2012, were retrospectively identified. Details on demographics, employment before and after transplantation were obtained and recorded., Results: A total of 87 patients were included, out of a total of 111 patients who underwent heart transplantation in the 10 year period from June 2001 (24 patients had died prior to July 2012). The median age of the study cohort was 52 years (range 15-75 years) and 19 were female. A total of 51 (58.6%) patients were in paid employment at the time of review. Of the 36 (41.4%) patients not in paid employment, 5 were students, 12 were retired and 10 were homemakers or not working through lifestyle choice. Two patients were unable to work for health reasons. Seven (8%) patients considered able to work were on an unemployment or invalid's benefit. Of the patients working prior to heart transplantation, 88.9% returned to work after a median of 8.5 months, and 70.6% remained on paid employment at a median follow-up of 77 months after transplantation. There was a statistically significant correlation between the time of stopping work prior to transplant and return to work after transplant (r = 0.497, P < .01)., Conclusion: The current rate of paid employment in patients who underwent heart transplantation was similar to the overall employment rate in New Zealand. The most important predictor of returning to work was employment status prior to transplantation. Discussions regarding return to work early in the transplantation assessment process and actively assisting patients to seek employment after transplantation may improve employment rates., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Aim: The aim of this study was to assess the satisfaction with life among undergraduate medical and other students in Auckland and identify associations with depression and anxiety disorders., Methods: The study was conducted at The University of Auckland, New Zealand in 2008 and 2009. The sample population was derived from five undergraduate classes in four courses (medicine (two classes), nursing, health science and architecture). A battery of questionnaires including the Satisfaction with Life Scale (SWLS), Patient Health Questionnaire (PHQ) for depression and Generalised Anxiety Disorder Questionnaire (GAD) were administered to the cohort. Subgroup analysis between medical and other students were also carried out., Results: A total of 778 students were eligible, and 594 (76.4%) students (255 medical, 208 health science, 36 nursing and 95 architecture) completed the questionnaire. The median age was 20 years (range 17-45) and women represented 67.2% (n=399) of the total group. The mean SWLS score for the total group was 24.9 (SD 6.4), with medical students on average having higher satisfaction with life compared to other students. The rate of depression (PHQ = 10) and anxiety (GAD score = 8) among medical students was 16.9% (95% CI 12.2-21.5) and 13.7% (95%CI 9.5-18.0) respectively. Female students had higher rates of depression and anxiety compared to males. A statistically significant moderate correlation between SWLS score and PHQ score [r = -0.37 (p<0.001)] and SWLS score and GAD score [r = - 0.23 (p<0.001)] were also observed., Conclusions: Medical students are more satisfied with life compared to other students. A significant proportion of students surveyed in this study have clinically significant depression and anxiety. Promoting positive wellbeing and improving satisfaction with life may enhance the quality of life as well as the social and academic performance of university students.

Objective: This systematic review assesses the effectiveness of ventral rectopexy (VR) surgery for treatment of rectal prolapse (RP) and rectal intussusception (RI) in adults. Method MEDLINE, EMBASE, Scopus and other relevant databases were searched to identify studies. Randomized controlled trials or nonrandomized studies with more than 10 patients receiving ventral mesh rectopexy surgery were considered for the review., Results: Twelve nonrandomized case series studies with 728 patients in total are included in the review. Seven studies used the Orr-Loygue procedure (VR with posterior rectal mobilization to the pelvic floor) and five studies used VR without posterior rectal mobilization. Overall weighted mean percentage decrease in faecal incontinence (FI) rate was 45%. The weighted mean percentage decrease in constipation rate was 24%. Weighted mean recurrence rate was 3.4%., Conclusions: There are limitations in published literature on VR. The available data indicate that VR has low recurrence and improves FI in patients suffering from these conditions. There is a greater reduction in postoperative constipation if VR is used without posterior rectal mobilization.

Objective: The aim of this study was to systematically review all published evidence to determine the efficacy and safety of injectable bulking agents for passive faecal incontinence (FI) in adults., Method: Electronic searches were performed for MEDLINE, EMBASE, ISI Web of Knowledge and other relevant databases. Hand searching of relevant conference proceedings was undertaken. Studies were considered if they met the predefined inclusion criteria of more than ten adult patients and receiving an injectable bulking agent for passive FI with a validated means of assessing preoperative and postoperative incontinence., Results: Thirteen case series studies and one randomized placebo-controlled trial (RCT) were included with a total of 420 patients. Two completed RCTs with placebo control were identified but results were unobtainable. Coaptite, Contigen, Durasphere, EVOH and PTQ injections were assessed with 24, 73, 83, 21 and 208 patients respectively. Most studies reported a statistically significant improvement in incontinence scores and quality of life. No statistically significant difference was found between the treatment and placebo arms in the RCT. No serious adverse events were reported., Conclusions: Currently there is little evidence for the effectiveness of injectable bulking agents in managing passive FI. The inability to obtain results from two further RCTs concerned the reviewers and hindered their ability to make strong recommendations. The identified injectable bulking agents appear to be safe with only minor complications reported.