Psychiatric disorder and accelerated aging: The Dunedin Multidisciplinary Health and Development Longitudinal Cohort Study

Lead Research Organisation: King's College London
Department Name: Social Genetic and Dev Psychiatry Centre

Abstract

BACKGROUND: We propose to test the novel hypothesis that a persistent history of psychiatric disorder might accelerate individuals' risk of progression toward age-related disease. Specifically, the hypothesis is that people who suffer chronic or recurrent psychiatric disorders during early adulthood will, already by their late thirties, show cognitive decline and abnormal status on sub-clinical biomarkers that are known to be prognostic early warning signs for late-life diseases, frailty and disability. Rather than focus on psychiatric disorders as the outcome, here we propose to study psychiatric disorders as a potentially preventable 'exposure' that may accelerate aging.
METHOD: We will test this hypothesis in the context of the Dunedin Study, a longitudinal study from birth to age 38 of a representative birth cohort of New Zealand men and women (N=1037) with over 90% cohort retention. A unique design feature is that baseline physical health and baseline neuropsychological assessments were carried out from birth to age 13, prior to the onset of most psychiatric disorders. To our knowledge, no other study of the health consequences of psychiatric disorder has these prospective baseline data, which are essential to test whether health and neuropsychological functions have actually deteriorated in individuals who have experienced persistent psychiatric disorder. Cohort members' psychiatric histories of recurrent Depression, recurrent Anxiety, chronic Schizophrenia-syndrome, persistent Alcohol Dependence, and persistent Cannabis Dependence will be defined using data from repeated assessments across 25 intervening years in this longitudinal study. With MRC funding, we most recently assessed the cohort again at age 38. We assessed sensitive outcome measures of sub-clinical health status that are known predictors of age-related diseases in later life: neuropsychological tests of memory and executive functions, the metabolic syndrome, inflammation biomarkers, retinal micro-vasculature, and shortened telomere length. These markers were chosen because they are known early warning signs for dementia, cardiovascular disease and diabetes. The markers show meaningful variation among people in their late 30's, and the Dunedin study has sufficient numbers of cases to test whether recurrent psychiatric disorder predicts health outcomes, while controlling for baseline health status in childhood.
INNOVATION AND SIGNIFICANCE: Life expectancy is growing longer and longer. Policy makers and citizens are concerned that our extra years of life should be healthy, productive, and enjoyable, not extra years of disease and disability. The hope of preventing age-related diseases and of increasing health expectancy requires research to identify candidate risk targets that can be treated successfully, in early-to-middle adulthood. If the hypothesis that psychiatric disorder accelerates the sub-clinical progression toward age-related disease were shown to be true by our proposed research, this would imply that age-related disease could be reduced by successfully treating psychiatric disorders early in life.

Technical Summary

BACKGROUND: We propose to test the novel hypothesis that a persistent history of psychiatric disorder might accelerate individuals' risk of progression toward age-related disease. Specifically, the hypothesis is that people who suffer chronic or recurrent psychiatric disorders during early adulthood will, already by their late thirties, show cognitive decline and abnormal status on sub-clinical biomarkers that are known to be prognostic early warning signs for late-life diseases, frailty and disability. METHOD: We will test this hypothesis in the Dunedin Study, a longitudinal study from birth to age 38 of a representative birth cohort of New Zealand men and women (N=1037). A unique design feature is that baseline physical health and baseline neuropsychological assessments were carried out from birth to age 13, prior to the onset of most psychiatric disorders. To our knowledge, no other study of the health consequences of psychiatric disorder has these prospective baseline data, which are essential to test whether health and neuropsychological functions have actually deteriorated in individuals who have experienced persistent psychiatric disorder. Cohort members' psychiatric histories of recurrent Depression, recurrent Anxiety, chronic Schizophrenia-syndrome, persistent Alcohol Dependence, and persistent Cannabis Dependence will be defined using data from repeated assessments across 25 intervening years in this longitudinal study. We most recently assessed the cohort again at age 38. We assessed sensitive outcome measures of sub-clinical health status that are known predictors of age-related diseases in later life: neuropsychological tests of memory and executive functions, the metabolic syndrome, inflammation biomarkers, retinal micro-vasculature, and shortened telomere length. These markers were chosen because they show meaningful variation among people in their late 30's and are known early warning signs for dementia, cardiovascular disease and diabetes.

Planned Impact

Please see our "Pathways to Impact" statement for specific plans. Briefly...

The intended non-academic beneficiaries of this research are individuals who experience mental disorder, health-care providers, government, and taxpayers at large. Life expectancy is growing longer and longer. Policy makers and citizens are concerned that our extra years of life should be healthy, productive, and enjoyable, not extra years of disease and disability. The hope of preventing age-related diseases and of increasing health expectancy requires research to identify candidate risk targets that can be treated successfully, in early life. If the hypothesis that psychiatric disorder accelerates the sub-clinical progression toward age-related disease is shown to be true by our proposed research, this would imply that age-related disease could be reduced by successfully treating psychiatric disorders early in life. Thus, our proposed research could potentially increase the political will to deliver preventions and treatments to individuals who suffer mental disorder in early life. Such interventions in turn could reduce the burden of mental illness and age-related disease on the health-care delivery service. Reducing the burden of mental illness and age-related diseases could in turn reduce costs to government and taxpayers, and increase national productivity and wellbeing for the UK.

Here we refer to the MRC E-val website's page entitled Dissemination of Research to Non-Academic Audiences for MRC Programme Grant G0601483, wherein we report the ways in which our research findings have been communicated to non-academic users in the past 5 years. Full descriptions are provided for the following activities on the E-val site. We expect to engage in very similar dissemination activities in the next 5 years.

The Science of Us, a documentary Film series by TV-NZ
A Lethal Inheritance: A Mother Uncovers the Science Behind Three Generations of Mental Illness, atrade book published by Prometheus Press
Public Broadcasting System, Sesame Street, a TV programme to teach our findings about self control to children
Media coverage of research on self control
Media coverage of our work on stress & inflammation
Media coverage of our work on gene-environment interaction
Nature's Great Experiment, a Wellcome Trust Art Exhibit
Dissemination of our findings on work stress
Media coverage of our findings on cannabis and gum disease
Media coverage of our findings on early substance abuse
Media coverage of our findings on sleep
Media coverage of our findings on neighbourhood effects on children
Media coverage of our findings on family history
More media coverage of findings on stress and inflammation
Media coverage of our findings on the prevalence of mental disorders
Dissemination of findings on schizophrenia
2 videos about our research programme, in the internet.
Royal society public soiree: Behaving Badly
High visibility public lectures by TE Moffitt and A Caspi, and our trainees
Training videos
Continuing education teaching for medical professionals

As a result of these public dissemination activities, and others like them, our research under this programme grant influences policy, as reported in detail on the MRC E-Val website, which describes the recent example below.
US Supreme Court Amicus Briefs
British Academy Policy Report
US National Academy of Sciences Panel on Demand for Drugs
Wrote DSM-V diagnosis for conduct disorder, ADHD and ODD
US National Cancer Institute Report
US Institute of Medicine Report
US National Academy of Sciences 21st Century Skills
Canadian Academy of Health Sciences Expert Panel
National Academy of Sciences, Advisory Committee on Law and Justice
Usefulness of research to govt bodies internationally
Chair policy seminars at the Nuffield Foundation
Early Intervention Next Steps: A report to Her Majesty's Govt. by G Allen MP

Publications

10 25 50
 
Description Adult ADHD paper selected by NEJM as in top 10 findings of psychiatry in 2015
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in other policy documents
URL http://www.jwatch.org/na39791/2015/12/28/nejm-journal-watch-psychiatry-top-stories-2015?
 
Description Adult ADHD paper selected by NEJM as in top 10 findings of psychiatry in 2015
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in other policy documents
URL http://www.jwatch.org/na39791/2015/12/28/nejm-journal-watch-psychiatry-top-stories-2015?
 
Description Prime Mininster's speech, plus Annual Report of the Chief Medical Officer 2012, Our Children Deserve Better: Prevention Pays."
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact From Jo Jenkinson at the UK MRC: "Your research is everywhere in the public domain at the moment with the Prime Ministers's speech on child and adolescent mental health and the new MQ publicity campaign. In the Annual Report of the Chief Medical Officer 2012, Our Children Deserve Better: Prevention Pays." Used Kim-Cohen et al. 2003. Prior juvenile diagnoses in adults with mental disorder.
 
Description Ready to be counted 2015 report by Transforming Education
Geographic Reach North America 
Policy Influence Type Citation in other policy documents
Impact Dunedin research featured as rationale for reform of early years education in USA.
 
Description Science News named our paper the 4th best science story of 2015
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in other policy documents
Impact not sure yet
URL https://www.sciencenews.org/article/top-stories-2015-pluto-gene-editing-new-hominid-and-more
 
Description asthma genetics results
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in clinical reviews
Impact Editorial by Markus J Ege & Erika von Mutius (2013), The Lancet Respiratory Medicine, Vol1, pp. 425-426. http://www.cdc.gov/genomics/update/current.htm US coverage Time: Genetic test could predict which kids will have long lasting asthma symptoms US News & World Report: Genetic risks for asthma may persist into adulthood (also on Everyday Health) Herald Sun: Genetic tests may provide asthma answers Infectious Diseases in Children: Gene risk assessment could predict asthma duration in children UK BBC News: Asthma genetic risk research could lead to future test Daily Mail: Genetic tests can show if children are likely to grow out of asthma according to study lasting 40 years Daily Telegraph: Genetic test may provide asthma answers International The New Zealand Herald: Test if child will grow out of asthma: Kiwi first MSN New Zealand: Genetic test may provide asthma answers The Australian: Genetic test may provide asthma answers CourierMail (Australia): Genetic tests may provide asthma answers Tengri News (Kazakhstan): Gene clues show which children will grow out of asthma Pashtun Forums: Asthma genetic risk research could lead to future test France24: Gene clues show which children will grow out of asthma Chanel News Asia: Gene clues show which children will grow out of asthma The News (Pakistan): Gene clues show which children will grow out of asthma Web MedPage Today: Gene test gives clues to asthma persistence Medical Daily: Genetic testing for asthma reveals that some children can outgrow the disease WebMD: When children will 'grow out' of asthma MedicalXpress: Higher genetic risk tied to lifetime asthma suffering Health Canal: Study reveals genetic testing's promise for predicting which children will grow out of asthma Medwire News: Genetic testing could predict asthma persistence Science Daily: Higher genetic risk tied to lifetime asthma suffering Science Newsline: Higher genetic risk tied to lifetime asthma suffering Parent Herald: Genetic testing can ascertain if children will outgrow asthma Counsel and Heal: Genetic tests may predict who will grow out of asthma Exchange Magazine: Study reveals potential of genetic testing to predict which children will grow out of asthma
 
Description cannabis research results
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
Impact Plain English summary for patients and their carers: mentalhealthcare.org.uk at http://www.mentalhealthcare.org.uk/cannabis http://www.mentalhealthcare.org.uk/research_downloads One-minute Science Update story online: http://www.scienceupdate.com/ Recommended by Faculty 1000 of Medicine: http://f1000.com/717954083. Video interview for NIDA website: http://www.drugabuse.gov/news-events/nida-notes/2013/08/early-onset-regular-cannabis-use-linked-to-iq-decline Commentary: R. Gonzalez and JM Swanson, (2012) Long term effects of adolescent onset and persistent use of cannabis. PNAS October 2, 2012, vol. 109 , no. 40, pp 15970-15971, www.pnas.org/cgi/doi/10.1073/pnas.1214124109 15970-15971 OBVIOUS FINDING OF THE YEAR 2012: http://www.livescience.com/25794-no-duh-12-obvious-science-findings-of-2012.html?cid=dlvr.it #3 MOST SIGNIFICANT PAPER OF 2012, JOURNAL WATCH PSYCHIATRY: http://psychiatry.jwatch.org/cgi/content/full/2012/1228/1?q=etoc_jwpsych Human Relations Media on March 22 2013 interview will be incorporated into an informational video for high schools on the consequences of teenage drug. Video for NIDA-Notes on april 6 2013. The video is a short description (3 min) of the study and its findings. NIDAforTEENS Website: http://teens.drugabuse.gov/blog/post/can-smoking-marijuana-actually-lower-your-iq
 
Description our findings in 14 meta-analyses
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in systematic reviews
 
Description smoking genetics research affects policy
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in other policy documents
Impact CDC Genomics & Health Impact Update (http://www.cdc.gov/genomics/update/current.htm) Selected for Faculty1000Prime, June 2013. http://f1000.com/prime/718020180?subscriptioncode=690c1960-eb0d-4337-92aa-27e648d3a4ed. http://health.usnews.com/health-news/news/articles/2013/03/27/genes-may-dictate-teens-susceptibility-to-heavy-smoking http://medicalxpress.com/news/2013-03-genetics-smokers.html http://www.sciencecodex.com/genetics_might_determine_which_smokers_get_hooked-109405 http://www.itv.com/news/update/2013-03-27/researchers-identify-smokers-gene/
 
Description telomere research
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in other policy documents
Impact Video on YouTube from the Association of Psychological Science: http://www.youtube.com/watch?v=eGTE1BLQx8g&list=UUIkzmtnflLAZ2vAObULZbrQ?dex=1&feature=plcp Blog which is the Daily Observations: http://www.psychologicalscience.org/index.php/video/convention-video-blog-violence-exposure-during-childhood-is-associated-with-telomere-erosion.html http://www.nature.com/nature/journal/v490/n7419/full/490169a.html VIDEO http://www.americanownews.com/story/19033662/abused-kids Smithsonian Magazine, January 2013, Expiration Dates: New research suggests we can defy our genetic destiny. Selected for Faculty1000: http://f1000.com/prime/718042434?subscriptioncode=4381c3ad-e515-464d-b2b0-c29a46b5948b
 
Description NIA Dunedin Phase 45 grant
Amount $3,000,000 (USD)
Funding ID 1R01AG049789-01 
Organisation National Institute on Aging 
Sector Public
Country United States
Start 09/2015 
End 08/2020
 
Description NIA Neuroimaging grant
Amount $7,000,000 (USD)
Funding ID 2 R01 AG032282-06 
Organisation National Institute on Aging 
Sector Public
Country United States
Start 07/2015 
End 06/2020
 
Description NICHD Programme grant
Amount $375,000 (USD)
Funding ID HDHD077482 
Organisation Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) 
Sector Public
Country United States
Start 07/2013 
End 06/2018
 
Description Duke University Geriatrics School of Medicine 
Organisation Duke University
Department School of Medicine Duke
Country United States 
Sector Academic/University 
PI Contribution coauthor papears
Collaborator Contribution coauthor papers
Impact PNAS publication
Start Year 2014
 
Description Global Burden of Disease 
Organisation Global Burden of Disease Study
Country Global 
Sector Academic/University 
PI Contribution collaborate
Collaborator Contribution collaborate
Impact 3 publications
Start Year 2011
 
Description Global burden of Disease 
Organisation Global Burden of Disease Study
Country Global 
Sector Academic/University 
PI Contribution coauthor
Collaborator Contribution run the GBD
Impact publications
Start Year 2013
 
Description MRC HArwell 
Organisation MRC Harwell
Country United Kingdom 
Sector Academic/University 
PI Contribution datasets
Collaborator Contribution coauthors papers
Impact Publicaton
Start Year 2012
 
Description Rijkshospitalet Psychiatry Denmark 
Organisation Rigshospitalet
Country Denmark 
Sector Hospitals 
PI Contribution coauthor and train students
Collaborator Contribution data registries
Impact publication
Start Year 2014
 
Description 3-page story about our research in the journal: Science. 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact 3-page feature article about our careers in the Dunedin Study.
Year(s) Of Engagement Activity 2018
URL http://science.sciencemag.org/content/359/6375/510.full
 
Description Darwin College Public Lecture Series 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact lecture attended by 700

/
Year(s) Of Engagement Activity 2013
URL http://Darwin College Public Lecture Series, 1 March 2013, Cambridge, UK. Video on-line at:
 
Description Summer Science Fair Day at MRC Centennial SGDP Centre. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation Workshop Facilitator
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact https://vimeo.com/73557664

?
Year(s) Of Engagement Activity 2013
URL https://vimeo.com/73557664
 
Description media coverage of our research in 2015 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Print coverage
Cosmopolitan Magazine: http://www.cosmopolitan.com/health-fitness/news/a35586/what-your-social-life-is-doing-to-your-body/
Daily Mail 20.01.2015 - p13
http://www.dailymail.co.uk/health/article-2918139/Do-suffer-social-jetlag-two-hour-lie-weekend-increases-risk-OBESE-scientists-warn.html
Daily Telegraph - 20.01.2015 - p14
http://www.telegraph.co.uk/news/science/science-news/11358195/Social-jet-lag-is-driving-obesity-and-illness-say-scientists.html
The Independent - 20.01.2015 - p15
http://www.independent.co.uk/life-style/health-and-families/fancy-a-liein-on-weekends-new-study-finds-it-could-lead-obesity-and-diabetes-9990661.html
The Times - 20.01.2015 - p14
The Sun - 20.01.2015 - p25
Online
https://www.sciencenews.org/blog/scicurious/weekly-grind-social-jetlag-could-be-weighty-issue
NHS choices - http://www.nhs.uk/news/2015/01January/Pages/Social-jet-lag-linked-to-obesity-and-unhealthy-metabolism.aspx
Diabetes.co.uk - http://www.diabetes.co.uk/news/2015/jan/sleeping-late-at-the-weekend-linked-to-obesity-and-type-2-diabetes-97385674.html
Yahoo News UK - https://uk.lifestyle.yahoo.com/blogs/icymi/no-more-weekend-lie-ins--study-finds-they-re-making-us-sick-and-fat-112510799.html
Huffington Post UK - http://www.huffingtonpost.co.uk/2015/01/21/obesity-social-jet-lag-sleep_n_6514568.html
Shape Magazine US - http://www.shape.com/weight-loss/weight-maintenance/how-your-sleep-schedule-affects-your-weight-gain-and-disease-risk
Australian's Women Weekly - http://www.aww.com.au/diet-health/health-news/2015/1/do-you-have-social-jet-lag/
New Kerala India - http://www.newkerala.com/news/2015/fullnews-9245.html
Zee News India - http://zeenews.india.com/news/health/health-news/heres-how-social-jet-lag-can-affect-your-weight-gain-and-disease-risks_1534053.html
Why Some People May Be Harder Hit by Daylight Saving Time http://www.livescience.com/50078-daylight-saving-time-unhealthy.html
Broadcast
BBC Radio 5 Live - 21.01.2015 - 51:30, http://www.bbc.co.uk/programmes/b04yg8l4
BBC Radio Scotland - 21.01.2015 - 55:44, http://www.bbc.co.uk/programmes/b04ykb7n
BBC Radio Kent - 21.01.2015 - 01:28:12. http://www.bbc.co.uk/programmes/p02gh8ys
BBC Radio Sheffield - 21.01.2015 - 52:44, http://www.bbc.co.uk/programmes/p02grdyy
BBC Hereford and Worcestershire - 22.01.2015 - 02:05:40, http://www.bbc.co.uk/programmes/p02ghczy
VIDEO: (http://today.duke.edu/2015/01/low-incomeboys )
Live interview: http://live.huffingtonpost.com/r/segment/mixed-income-housing-bad-for-low-income-boys/54c911e078c90a46e8000567
Op-Ed: http://theconversation.com/poor-doors-highlight-social-costs-of-growing-up-in-the-shadow-of-wealth-39846

NPR National Public Radio: http://wunc.org/post/mixed-income-housing-pros-cons

This article got lots of news coverage, among the best articles are:
http://www.economist.com/news/britain/21641283-unnervingly-poor-children-seem-fare-better-poor-neighbourhoods-paradox-ghetto
http://www.newrepublic.com/article/120827/study-low-income-boys-perform-worse-mixed-income-housing
http://www.washingtonpost.com/blogs/wonkblog/wp/2015/01/23/the-surprising-cost-of-growing-up-poor-in-the-shadow-of-wealth/
http://www.bbc.com/news/education-30950523 http://www.thetimes.co.uk/tto/education/article4331786.ece
http://www.medicaldaily.com/antisocial-behavior-higher-low-income-boys-living-beside-wealthier-neighbors-319126
http://psychcentral.com/news/2015/01/24/low-income-boys-fare-worse-in-wealthier-neighborhoods/80336.html
http://scienceblog.com/76599/low-income-boys-fare-worse-wealths-shadow/#g06vMtXvculJIBLH.97

MacArthur Foundation Housing Matters SmartBrief: http://www2.smartbrief.com/servlet/encodeServlet?issueid=1A250F3E-8760-4701-9E62-1B6EF2AF1E8B&sid=8d9444c2-87b5-4506-9421-0f6344afc31d


http://johnraissmd.com/blog/?p=64
Selected at CME for American Psychiatirc Association. (1 Continuing Medical Education credit)
NEJM Journal watch: http://www.jwatch.org/na38100/2015/06/05/how-related-are-adult-and-childhood-adhd?query=topic_substabuse
http://www.psychcongress.com/article/adult-adhd-may-be-separate-childhood-adhd-22824
http://alert.psychnews.org/2015/06/adult-adhd-may-be-distinct-from.html
http://www.healio.com/psychiatry/add-adhd/news/online/%7B08ca3e86-938b-4576-9f5b-66db4e6eeb02%7D/adults-with-adhd-may-not-have-had-onset-of-disorder-in-childhood
http://www.medwirenews.com/47/106298/Psychiatry/Adult_ADHD_could_be_distinct_condition.html

BBC WORLD NEWS interview: http://www.bbc.co.uk/programmes/p002vsnk/episodes/downloads

ALTMETRICS: tracking all internet mentions: http://pnas.altmetric.com/details/4248247/news

VIDEO Wall St. Journal: http://www.wsj.com/articles/how-quickly-are-you-growing-old-1436808166
ScitechNow: http://scitechnow.org/technology/old-really/#

http://thedoctorweighsin.com/predicting-the-speed-of-aging/
http://www.theonion.com/americanvoices/researchers-people-age-different-rates-50802
http://www.haaretz.co.il/news/science/.premium-1.2678930
http://www.maariv.co.il/news/world/Article-487817
http://www.corriere.it/salute/15_luglio_08/invecchiamento-inizia-giovani-non-uguale-tutti-10c41f7e-2545-11e5-85c7-ee55c, 78b3bf9.shtml

A summary of coverage links is here:
USA
Print
Wall Street Journal (with video), Washington Post, LA Times, TIME, US News and World Report
Radio/TV
CBS News (with video), NBC News (with video), Science Friday (audio @7:45 min in), Voice of America, BBC News Hour (audio)

UK
BBC News, The Guardian, The Telegraph, The Times, Daily Mail,

EU & AUSTRALIA
Deutche Welle, Der Spiegel, El Pais, Science et Avenir, Le Science, Australian Broadcasting Corp.

OTHER
Al Jazeera America, Jerusalem Post, Haaretz, Times of India, The Hindu, Gazete Istambul

INTERNET
NEJM Journalwatch, Huffington Post, Yahoo News, Medical News Today, MedPage Today, Medical Xpress, WebMD, The Conversation, SciTech, SciTech Today, Big Think, Science World Report, The Mermaid's Tale, IFLS, The Onion.
http://www.thedailymash.co.uk/news/science-technology/number-of-years-youve-been-alive-tells-you-how-old-you-really-are-20150907101749


enormous interest in five of our publicatons this year
Year(s) Of Engagement Activity 2015
 
Description sundry public lectures, conference presentations, posters 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach International
Primary Audience Health professionals
Results and Impact My team has given 18 presentations in 2013, too many to type all the info into this researchfish website

lots of dfissemination of findings
Year(s) Of Engagement Activity 2013