Perinatal depression (PND) affects up to 15% of women within the United Kingdom and has a lasting impact on a woman's quality of life, birth outcomes and her child's development. Suicide is the leading cause of maternal mortality. However, it is estimated that at least 50% of PND cases go undiagnosed. This paper presents the results of the first feasibility study to examine the potential of mobile devices to engage women in antenatal mental health screening. Using a mobile application, 254 women attending 14 National Health Service midwifery clinics provided 2,280 momentary and retrospective reports of their wellbeing over a 9-month period. Women spoke positively of the experience, installing and engaging with this technology regardless of age, education, wellbeing, number of children, marital or employment status, or past diagnosis of depression. 39 women reported a risk of depression, self-harm or suicide; two-thirds of whom were not identified by screening in-clinic.

IntroductionThe Cognitive Health in Ageing Register: Investigational, Observational and Trial Studies in Dementia Research (CHARIOT): Prospective Readiness cOhort (PRO) SubStudy (CPSS), sponsored by Janssen Pharmaceutical Research & Development LLC, is an Alzheimer’s disease (AD) biomarker enriched observational study that began 3 July 2015 CPSS aims to identify and validate determinants of AD, alongside cognitive, functional and biological changes in older adults with or without detectable evidence of AD pathology at baseline.Methods and analysisCPSS is a dual-site longitudinal cohort (3.5 years) assessed quarterly. Cognitively normal participants (60–85 years) were recruited across Greater London and Edinburgh. Participants are classified as high, medium (amnestic or non-amnestic) or low risk for developing mild cognitive impairment–Alzheimer’s disease based on their Repeatable Battery for the Assessment of Neuropsychological Status performance at screening. Additional AD-related assessments include: a novel cognitive composite, the Global Preclinical Alzheimer’s Cognitive Composite, brain MRI and positron emission tomography and cerebrospinal fluid analysis. Lifestyle, other cognitive and functional data, as well as biosamples (blood, urine, and saliva) are collected. Primarily, study analyses will evaluate longitudinal change in cognitive and functional outcomes. Annual interim analyses for descriptive data occur throughout the course of the study, although inferential statistics are conducted as required.Ethics and disseminationCPSS received ethical approvals from the London—Central Research Ethics Committee (15/LO/0711) and the Administration of Radioactive Substances Advisory Committee (RPC 630/3764/33110) The study is at the forefront of global AD prevention efforts, with frequent and robust sampling of the well-characterised cohort, allowing for detection of incipient pathophysiological, cognitive and functional changes that could inform therapeutic strategies to prevent and/or delay cognitive impairment and dementia. Dissemination of results will target the scientific community, research participants, volunteer community, public, industry, regulatory authorities and policymakers. On study completion, and following a predetermined embargo period, CPSS data are planned to be made accessible for analysis to facilitate further research into the determinants of AD pathology, onset of symptomatology and progression.Trial registration numberThe CHARIOT:PRO SubStudy is registered with clinicaltrials.gov (NCT02114372). Notices of protocol modifications will be made available through this trial registry.

Background: The CHARIOT PRO Main study is a prospective, non-interventional study evaluating cognitive trajectories in participants at the preclinical stage of Alzheimer’s disease (AD) classified by risk levels for developing mild cognitive impairment due to AD (MCI-AD). Objectives: The study aimed to characterize factors and markers influencing cognitive and functional progression among individuals at-risk for developing MCI-AD, and examine data for more precise predictors of cognitive change, particularly in relation to APOE ε4 subgroup. Design: This single-site study was conducted at the Imperial College London (ICL) in the United Kingdom. Participants 60 to 85 years of age were classified as high, medium (amnestic or non-amnestic) or low risk for developing MCI-AD based on RBANS z-scores. A series of clinical outcome assessments (COAs) on factors influencing baseline cognitive changes were collected in each of the instrument categories of cognition, lifestyle exposure, mood, and sleep. Data collection was planned to occur every 6 months for 48 months, however the median follow-up time was 18.1 months due to early termination of study by the sponsor. Results: 987 participants were screened, among them 690 participants were actively followed-up post baseline, of whom 165 (23.9%) were APOE ε4 carriers; with at least one copy of the allele. The mean age was 68.73 years, 94.6% were white, 57.4% were female, and 34.8% had a Family History of Dementia with a somewhat larger percentage in the APOE ε4 carrier group (42.4%) compared to the non-carrier group (32.4%). Over half of the participants were married and 53% had a Bachelor’s or higher degree. Most frequently, safety events typical for this population consisted of upper respiratory tract infection (10.4%), falls (5.2%), hypertension (3.5%) and back pain (3.0%). Conclusion (clinical relevance): AD-related measures collected during the CHARIOT PRO Main study will allow identification and evaluation of AD risk factors and markers associated with cognitive performance from the pre-clinical stage. Evaluating the psycho-biological characteristics of these pre-symptomatic individuals in relation to their natural neurocognitive trajectories will enhance current understanding on determinants of the initial signs of cognitive changes linked to AD.

The coronavirus disease 2019 outbreak that originated in Wuhan, Hubei Province in China, was classified as a global pandemic by the World Health Organisation (WHO) on March 11, 2020. 1 As of April 8, 2021, the causative virus SARS-CoV-2 has spread to 219 countries and territories around the world, with 133 897 605 individuals infected and 2 904 686 deceased as a result. 2 COVID-19 manifests as a wide spectrum of disease ranging from asymptomatic infection to multiple organ failure requiring ITU admission and potentially leading to death. [3][4][5] In the United Kingdom (UK), the first confirmed cases were reported on January 27, 2020 6 and London has comprised the epicenter of its outbreak, bearing the highest rate of admission and mortality from COVID-19 in the country. 7 A number of cohort studies from Italy, China, the United States (USA), and early UK studies have demonstrated the clinical characteristics and outcomes of patients with COVID-19 within their individual populations. 5,[8][9][10][11] Risk factors for ITU admission and mortality identified by these studies vary, with factors such as increasing age and various comorbidities showing consistent association, whereas other factors such as gender, ethnicity, antihypertensive medication use, and hematological laboratory results are inconsistently reported to predict adverse outcomes.We therefore present the demographic, laboratory, and clinical features of patients with COVID-19 admitted to a district general hospital in London and assess predictors of mortality and ITU admission outcomes, in order to identify parameters aiding risk stratification of such patients in a secondary care setting. | METHODS | Study designWe conducted a retrospective cohort study on all patients with COVID-19 admitted to The Hillingdon Hospital (THH), The Hillingdon

other life threatening conditions at the same time. Thus, many acute presentations of chest pain can be missed or not receive the necessary treatment on time, in a busy, understaffed department. This significantly increases the mortality and future morbidity due to delays in the healthcare service provision to the patient. One way to mitigate this is by training healthcare workers like Nurses, paramedics and other emergency healthcare staff to appropriately categorise a patient with chest pain as emergent and requiring ECG, so that the investigations needed can be carried out before the physician is able to clerk the patient. This project was carried out in a tertiary care centre in Bangalore Urban, Karnataka India. First, the number of patients presenting with chest pain to the emergency department in a one-week setting were reviewed according to severity of symptoms using a 1-10 pain scale, other associated symptoms and presence of comorbidities or risk factors for Heart and lung diseases. The response time of the emergency staff to the patient from entry to the facility until appropriate management (shift to Intensive care unit, higher center referral, immediate prophylaxis, discharge) given was measured. A teaching session was conducted by emergency physicians involving all emergency staff following this. Using the data collected, a simple algorithm was devised to help staff make decisions regarding the treatment protocol. Training regarding reading an ECG, immediate prophylaxis for STEMI/NSTEMI patients and respiratory causes of chest pain was given to Nurses and senior Emergency non-medical staff.