Surveillance of non–ventilator-associated hospital-acquired pneumonia (NV-HAP) is complicated by subjectivity and variability in diagnosing pneumonia. We compared a fully automatable surveillance definition using routine electronic health record data to manual determinations of NV-HAP according to surveillance criteria and clinical diagnoses.

We retrospectively applied an electronic surveillance definition for NV-HAP to all adults admitted to Veterans’ Affairs (VA) hospitals from January 1, 2015, to November 30, 2020. We randomly selected 250 hospitalizations meeting NV-HAP surveillance criteria for independent review by 2 clinicians and calculated the percent of hospitalizations with (1) clinical deterioration, (2) CDC National Healthcare Safety Network (CDC-NHSN) criteria, (3) NV-HAP according to a reviewer, (4) NV-HAP according to a treating clinician, (5) pneumonia diagnosis in discharge summary; and (6) discharge diagnosis codes for HAP. We assessed interrater reliability by calculating simple agreement and the Cohen κ (kappa).

Among 3.1 million hospitalizations, 14,023 met NV-HAP electronic surveillance criteria. Among reviewed cases, 98% had a confirmed clinical deterioration; 67% met CDC-NHSN criteria; 71% had NV-HAP according to a reviewer; 60% had NV-HAP according to a treating clinician; 49% had a discharge summary diagnosis of pneumonia; and 82% had NV-HAP according to any definition according to at least 1 reviewer. Only 8% had diagnosis codes for HAP. Interrater agreement was 75% (κ = 0.50) for CDC-NHSN criteria and 78% (κ = 0.55) for reviewer diagnosis of NV-HAP.

Electronic NV-HAP surveillance criteria correlated moderately with existing manual surveillance criteria. Reviewer variability for all manual assessments was high. Electronic surveillance using clinical data may therefore allow for more consistent and efficient surveillance with similar accuracy compared to manual assessments or diagnosis codes.

The COVID-19 pandemic has affected mental health globally, but the impact on referrals and admissions to mental health services remains understudied.

To assess patterns in psychiatric admissions, referrals, and suicidal behavior before and during the COVID-19 pandemic in Denmark.

Utilizing hospital and Emergency Medical Services (EMS) health records covering 46% of the Danish population, we compared psychiatric in-patients, referrals to mental health services and suicidal behavior in years prior to the COVID-19 pandemic to levels during the first lockdown (March 11 – May 17, 2020), inter-lockdown period (May 18 – December 15, 2020), and second lockdown (December 16, 2020 – February 28, 2021) using negative binomial models.

The rate of psychiatric in-patients declined compared to pre-pandemic levels (RR = 0.95, 95% CI = 0.94 – 0.96, p < 0.01). Referrals were not significantly different (RR = 1.01, 95% CI = 0.92 – 1.10, p = 0.91) during the pandemic; neither was suicidal behavior among hospital contacts (RR = 1.04, 95% CI = 0.94 – 1.14, p = 0.48) nor EMS contacts (RR = 1.08, 95% CI = 1.00 – 1.18, p = 0.06). In the age group <18, an increase in the rate of psychiatric in-patients (RR = 1.11, 95% CI = 1.07 – 1.15, p < 0.01) was observed during the pandemic; however, this did not exceed the pre-pandemic, upwards trend in psychiatric hospitalizations in the age group <18 (p = 0.78).

The pandemic was associated with a decrease in psychiatric hospitalizations. No significant change was observed in referrals and suicidal behavior.

No significant relationships.

There is emerging evidence of heterogeneity within treatment-resistance schizophrenia (TRS), with some people not responding to antipsychotic treatment from illness onset and a smaller group becoming treatment-resistant after an initial response period. It has been suggested that these groups have different aetiologies. Few studies have investigated socio-demographic and clinical differences between early and late onset of TRS.

This study aims to investigate socio-demographic and clinical correlates of late-onset of TRS.

Using data from the electronic health records of the South London and Maudsley, we identified a cohort of people with TRS. Regression analyses were conducted to identify correlates of the length of treatment to TRS. Analysed predictors include gender, age, ethnicity, positive symptoms severity, problems with activities of daily living, psychiatric comorbidities, involuntary hospitalisation and treatment with long-acting injectable antipsychotics.

We observed a continuum of the length of treatment until TRS presentation. Having severe hallucinations and delusions at treatment start was associated shorter duration of treatment until the presentation of TRS.

Our findings do not support a clear cut categorisation between early and late TRS, based on length of treatment until treatment resistance onset. More severe positive symptoms predict earlier onset of treatment resistance.

DFdF, GKS, EF and IR have received research funding from Janssen and H. Lundbeck A/S. RDH and HS have received research funding from Roche, Pfizer, Janssen and Lundbeck. SES is employed on a grant held by Cardiff University from Takeda Pharmaceutical Comp

While effective project planning is crucial for the success of a clinical research project, being able to execute the plan is even more important. In Denmark, approval for health research projects is applied for at regional or national committees on health research ethics, which have been reluctant to approve clinical research projects involving forensic psychiatric in-patients, due to the admission usually being pursuant to treatment sanctions. However, recently we received approval for a clinical research project exclusively targeted towards inpatients at a large medium secure forensic psychiatric facility in Denmark.

Describing the process of project execution from planning to submitting the manuscript which is inherently multi-faceted and inundated with stress factors. How to connect theory, knowledge, project with clinical practice, with clinical research?

Qualitative data collecting while undertaking an exploratory, open-label, non-randomised weight reducing trial with a glucagon-like peptide-1 receptor agonist.

Challenges in finding, screening, motivating, recruiting, obtaining valid confirmed consent from potential study participants and other stakeholders, team communication, responsibilities and accountabilities within the team, Pareto Principle, scope creep, building project reports manually, real-time data gathering, unpredictable and other project deliverables will be presented

Experiences of the hospital staff (psychiatrists, doctors and nurses) in execution process of the project investigation performed and made possible through participation of their forensic psychiatric in-patients.

No significant relationships.

Vortioxetine has demonstrated sustained efficacy and favorable safety profile in multiple clinical trials.

This study aims to describe the effectiveness and safety of vortioxetine in real-world clinical practice.

RELIEVE is a prospective, multi-national, observational cohort study of outpatients initiating vortioxetine treatment for MDD at physician’s discretion and followed for 6 months. Data were collected at routine clinical visits. The primary outcome was functioning measured by Sheehan Disability Scale (SDS). Depressive symptoms measured by Patient Health Questionnaire 9-item (PHQ-9), cognitive symptoms measured by PDQ-5 and DSST were key secondary outcomes. Safety outcomes including adverse events were reported. This interim analysis presents results of 527 patients who completed the study and were followed for 6 months. Mixed models of repeated measures were used to assess improvements between baseline and month 6, adjusted for relevant confounders.

A total of 527 patients (mean age, 50.2 years, 65% female) were enrolled from US, Canada, France and Italy, and included in the analysis. Mean SDS total score, PHQ-9, PDQ-5 scores decreased by 8.6, 7.4 and 4.7 respectively from baseline to last visit. Mean DSST score improved by 6.5 from baseline to last visit. Patients’ overall functioning and quality of life significantly improved, sick leave days and underproductive days (both absenteeism and presenteeism) decreased over the entire follow up period. The overall incidence of adverse events(AE) was 25%, with the most common AEs being nausea and headache.

The results confirm the effectiveness and good tolerability of vortioxetine in a broad range of patients in routine clinical practice.

Dr. Mattingly has served as researcher, consultant or speaker for Akili, Alcobra, Alkermes, Allergan, Axsome, Boehringer, Forum, Genentech, Jansen, Lundbeck, Medgenics, Merck, Neos, NLS Pharma, Otsuka, Reckitt Benckiser, Roche, Sage, Shire, Sunovion, Supe

Improved survival has led to a growing population of adults with congenital heart disease (CHD), followed by numerous reports of late complications. Liver disease is a known complication in some patients, with most studies focusing on Fontan associated liver disease. Whether liver disease also exists in other patients with CHD is not fully investigated. Elevated central venous pressure is considered pivotal in the development of liver disease in Fontan associated liver disease, and other patients with alterations in central venous pressure may also be at risk for developing liver fibrosis. We wanted to see if liver fibrosis is present in patients with tetralogy of Fallot. Many patients with tetralogy of Fallot have severe pulmonary regurgitation, which can lead to elevated central venous pressure. Patients with tetralogy of Fallot may be at risk of developing liver fibrosis.

Ten patients (24–56 years) with tetralogy of Fallot and pulmonary regurgitation were investigated for liver fibrosis. All patients were examined with magnetic resonance elastography of liver, hepatobiliary iminodiacetic acid scan, indocyanine green elimination by pulse spectrophotometry, elastography via FibroScan, abdominal ultrasound including liver elastography, and blood samples including liver markers.

Three out of ten patients had findings indicating possible liver fibrosis. Two of these had a liver biopsy performed, which revealed fibrosis stage 1 and 2, respectively. The same three patients had an estimated elevated central venous pressure in previous echocardiograms.

Mild liver fibrosis was present in selected patients with tetralogy of Fallot and may be related to elevated central venous pressure.

To identify and synthesise the literature on the cost of mental disorders.

Systematic literature searches were conducted in the databases PubMed, EMBASE, Web of Science, EconLit, NHS York Database and PsychInfo using key terms for cost and mental disorders. Searches were restricted to January 1980–May 2019. The inclusion criteria were: (1) cost-of-illness studies or cost-analyses; (2) diagnosis of at least one mental disorder; (3) study population based on the general population; (4) outcome in monetary units. The systematic review was preregistered on PROSPERO (ID: CRD42019127783).

In total, 13 579 potential titles and abstracts were screened and 439 full-text articles were evaluated by two independent reviewers. Of these, 112 articles were included from the systematic searches and 31 additional articles from snowball searching, resulting in 143 included articles. Data were available from 48 countries and categorised according to nine mental disorder groups. The quality of the studies varied widely and there was a lack of studies from low- and middle-income countries and for certain types of mental disorders (e.g. intellectual disabilities and eating disorders). Our study showed that certain groups of mental disorders are more costly than others and that these rankings are relatively stable between countries. An interactive data visualisation site can be found here: https://nbepi.com/econ.

This is the first study to provide a comprehensive overview of the cost of mental disorders worldwide.

South Africa (SA) is a developing country with an ageing population. Adequate nutrition and physical activity (PA) protect against the loss of muscle mass and physical function, both of which are important components of sarcopenia. This study aimed to measure the prevalence of sarcopenia in older black SA women and investigate its associations with PA and protein intake.

Older black SA women (age, 68 (range; 60–85 years) n = 122) completed sociodemographic questionnaires, 24 h urine collection (estimate protein intake), venous blood (hs-C-reactive protein (hs-CRP) and ferritin), functional tests (grip strength, 3 m timed-up-and-go (TUG), 10 m walk test) and PA monitoring (activPAL). Dual-energy x-ray absorptiometry whole-body scans assessed fat and fat-free soft tissue mass (FFSTM).

According to the European Working group on Sarcopenia in Older People (EWGSOP)2, 2.5% (n = 3) had confirmed sarcopenia of a low severity based on normal physical function. Of the total cohort, 9% (n = 11) had low grip strength, 22.1% (n = 27) had a low appendicular skeletal muscle index (ASMI), and no women had low TUG (s) or gait speed (m/s). Higher ASMI was associated with lower hs-CRP (p = 0.05; Rho = -0.209) and higher ferritin (Rho = 0.252; p = 0.019), grip strength (kg, Rho = 0.223; p = 0.015), and gait speed (m/s, Rho = 0.180; p = 0.050). Protein intake suggested intake of 41.8g/day/ or 0.51 g/kg of body mass/day. Higher total protein intake (g/24h), was associated with higher FFSTM (kg) and ASMI (p < 0.001). PA outcomes were not correlated with FFSTM or ASMI (p > 0.05), however, there was a strong positive correlation of TUG (s) and gait speed (m/s) with time spent: 1) stepping per day (min) and; 2) at a high cadence (> 100 steps/min) (all p < 0.01). Daily step count was 7137 ± 3233 (mean ± Standard deviation), with 97.9 ± 38.7 min of total time spent stepping and 12.6 ± 16.8 min spent stepping at a high cadence (> 100 steps/min). Of note, 13.9% (n = 17) of women were completing > 10,000 steps/day.

Based on the EWGSOP2 criteria, there is a low prevalence of sarcopenia in older black SA women, explained by the maintenance of strength and physical function that directly related to PA, especially that performed at higher intensities. In contrast, low muscle mass was relatively prevalent (22.1%) and was associated with low dietary protein and not PA. Notably, it may be important to review the cut-points of EWGSOP2 criteria to be specific to the older SA women from disadvantaged communities.

Osteoporosis was not a public health concern in black South African (SA) women, until recently when it was reported that the prevalence of vertebral fractures was 9.1% in black compared to 5.0% in white SA women. Accordingly, this study aimed to measure bone mineral density (BMD) of older black SA women and to investigate its association with risk factors for osteoporosis, including strength, muscle and fat mass, dietary intake and objectively measured physical activity (PA).

Older black SA women (age, 68 (range; 60–85 years) n = 122) completed sociodemographic and quantitative food frequency questionnaires (QFFQ), fasting venous blood samples (25-hydroxycholecalciferol: Vitamin D-25), 24 h urine collection (estimate protein intake), grip strength and PA monitoring (activPAL). Dual-energy x-ray absorptiometry (DXA) scans of the hip (femoral neck and total) and lumbar spine determined BMD and whole-body scans for fat and fat-free soft tissue mass (FFSTM). WHO classifications were used to determine osteopenia (t-score -2.5 to -1), and osteoporosis (t-score < -2.5).

At the lumbar spine 34.4% of the women (n = 42) had osteopenia and 19.7% (n = 24) had osteoporosis. Osteopenia at the left femoral neck was 32% (n = 40) and osteoporosis was 13.1% (n = 16) of participants. The total left hip BMD indicated osteopenia in 27.9% (n = 34) and osteoporosis in 13.1% (n = 16) of participants. Multinomial regression revealed no differences in age (y) or frequency of falls in the past year between all groups (p = 0.727). Compared to those with normal BMD, participants with osteoporosis at the hip neck and lumbar spine were shorter, weighed less and had a lower body mass index (BMI) (all p < 0.05). When adjusted for height, the osteoporotic group (hip neck and lumbar spine) had lower trunk fat (% whole body), FFSTM (kg) and grip strength (kg), compared to those with normal BMD (p < 0.05). Only protein intake (g; 24 h urine analyses) was lower in women with osteoporosis (all sites) compared to those with normal BMD. Fat, carbohydrate and micronutrient intakes (relative to total daily energy intake), and vitamin D concentrations were not associated with BMD (all sites). Number of daily step count and stepping time (min) were inversely associated with BMI (p < 0.05), but not with BMD (all sites; p > 0.05).

A high prevalence of osteopenia and osteoporosis was evident at the lumbar spine and hip in older black SA women. This study highlights the importance of strength, body composition, and protein intake in maintaining BMD and preventing the development of osteoporosis in older women.

Leukocyte telomere length (LTL) is a widely hypothesized biomarker of biological aging. Persons with shorter LTL may have a greater likelihood of developing dementia. We investigate whether LTL is associated with cognitive function, differently for individuals without cognitive impairment versus individuals with dementia or incipient dementia.

Enrolled subjects belong to the Long Life Family Study (LLFS), a multi-generational cohort study, where enrollment was predicated upon exceptional family longevity. Included subjects had valid cognitive and telomere data at baseline. Exclusion criteria were age ≤ 60 years, outlying LTL, and missing sociodemographic/clinical information. Analyses were performed using linear regression with generalized estimating equations, adjusting for sex, age, education, country, generation, and lymphocyte percentage.

Older age and male gender were associated with shorter LTL, and LTL was significantly longer in family members than spouse controls (p < 0.005). LTL was not associated with working or episodic memory, semantic processing, and information processing speed for 1613 cognitively unimpaired individuals as well as 597 individuals with dementia or incipient dementia (p < 0.005), who scored significantly lower on all cognitive domains (p < 0.005).

Within this unique LLFS cohort, a group of families assembled on the basis of exceptional survival, LTL is unrelated to cognitive ability for individuals with and without cognitive impairment. LTL does not change in the context of degenerative disease for these individuals who are biologically younger than the general population.

Identifying predictors of suicidal ideation in community-dwelling older adults with elevated psychological distress over two years.

900 adults (60–74 years) with elevated psychological distress (Kessler Distress 10 Scale; scores>15) participated in a randomized controlled trial of psychological (mental health literacy) and lifestyle-based (physical activity promotion, folate supplementation) interventions for reducing depressive symptoms. Suicidal ideation across a two-year period (five time points) was assessed using an item from the Patient Health Questionnaire.

Demographics, mental and physical functioning (SF-12), and cognitive functioning (Telephone Interview Cognitive Schedule—Modified) were measured.

Intervention type did not predict suicide ideation at any follow up. Those with single or multiple occurrences of suicidal ideation during the two-year period had elevated distress (Single OR = 1.06, p = .044; Multiple OR = 1.10, p = .001) and depression levels (Single OR = 1.07, p = .042; Multiple OR = 1.20, p = .001) at baseline, and more likely to be separated from their partner (Single OR = 1.81, p = .024; Multiple OR = 2.12, p = .016] than those with no ideation. Those with ideation were more likely to experience greater distress at every time point (e.g., 24 months OR = 1.18, p = .006) compared to those with no ideation. At 24 months, individuals reporting ideation were significantly more likely to have lower education levels (OR = .81, p = .015), poorer cognitive functioning (OR = .88, p = .036), and greater mental (OR = .89, p = .004) and physical (OR = .92, p = .025) disability.

Elevated distress is consistently related to suicidal ideation. Individuals experiencing suicidal ideation are more likely to be separated, have lower education levels, poorer mental and physical functioning, and poorer overall cognitive functioning than those with no suicidal ideation.

To investigate the potential use of smartphone apps to support self-management in young adults with bipolar disorder.

We recruited 89 young adults (18–30 years) with bipolar disorder to complete a cross-sectional online survey. The survey contained quantitative and qualitative questions regarding technology use, current use of disorder-management apps, types of apps desired for disorder management, and app features that users would consider important when selecting apps. Results were analysed using descriptive statistics and thematic analysis.

Almost all participants used a smartphone daily and 40% currently used apps for disorder management. Of those not currently using apps, 79% indicated they would like to try them. On average, participants rated 61% of the self-management strategies listed as desirable for app support, with sleep-management, understanding early warning signs and triggers, and stay-well plans the most frequently endorsed. App features considered important during app selection were ease-of-use, scientific quality, flexibility/customisation, and data privacy.

The results indicate that young adults with bipolar disorder are interested in a wide range of apps for self-management. Participants were interested in apps to support self-management strategies considered clinically important for disorder management. Many of these app needs are currently unmet. Results suggest diversifying and prioritising app capabilities to ensure evidence-based resources for a broader range of app functions are available to consumers.

Suicide is a leading cause of death worldwide and is largely preventable. The social media site Twitter is used by individuals to express suicidal intentions. It is not yet feasible to contact each Twitter user to confirm risk. Instead, it may be possible to validate risk by linguistic analysis. Psychological linguistic theory suggests that language is a reliable way of measuring people's internal thoughts and emotions; however, the linguistics of suicidality on Twitter is yet to be fully explored.

The aim of this study is to characterise the linguistic styles of suicide-related posts on Twitter for the purposes of predicting suicide risk.

The Linguistic Inquiry and Word Count (LIWC) program was used to compare the linguistic features of suicide-related tweets previously coded for suicide risk by humans with a set of matched controls. Logistic regression was then used for predictive modelling.

The suicide-related tweets had significantly different linguistic profiles to the control tweets. The “strongly concerning” suicide tweets were found to have fewer words than all other tweets and not surprisingly, references to ‘death’ were significantly higher in this group. A number of other results were found. The final model which distinguished “strongly concerning” suicide risk from the controls was found to have 97.7% sensitivity and 99.8% specificity.

This study confirms that the linguistic features of suicide-related Twitter posts are different from general Twitter posts and that these linguistic profiles may be used to predict suicide risk in Twitter users.

The authors have not supplied their declaration of competing interest.