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Evans TS, Drew KJ, McKenna J, Dhir P, Marwood J, Freeman C, Hill AJ, Newson L, Homer C, Matu J, Radley D, Ells LJ. Can the delivery of behavioural support be improved in the NHS England Low-Calorie Diet Programme? An observational study of behaviour change techniques. Diabet Med 2024; 41:e15245. [PMID: 37914161 DOI: 10.1111/dme.15245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Previous research has illustrated a drift in the fidelity of behaviour change techniques (BCTs) during the design of the pilot NHS England Low-Calorie Diet (NHS-LCD) Programme. This study evaluated a subsequent domain of fidelity, intervention delivery. Two research questions were addressed: (1) To what extent were BCTs delivered with fidelity to providers programme plans? (2) What were the observed barriers and facilitators to delivery? METHODS A mixed-methods sequential explanatory design was employed. Remote delivery of one-to-one and group-based programmes were observed. A BCT checklist was developed using the BCT Taxonomy v1; BCTs were coded as present, partially delivered, or absent during live sessions. Relational content analysis of field notes identified observed barriers and facilitators to fidelity. RESULTS Observations of 122 sessions across eight samples and two service providers were completed. Delivery of the complete NHS-LCD was observed for five samples. Fidelity ranged from 33% to 70% across samples and was higher for group-based delivery models (64%) compared with one-to-one models (46%). Barriers and facilitators included alignment with the programme's target behaviours and outcomes, session content, time availability and management, group-based remote delivery, and deviation from the session plan. CONCLUSIONS Overall, BCTs were delivered with low-to-moderate fidelity. Findings indicate a dilution in fidelity during the delivery of the NHS-LCD and variation in the fidelity of programmes delivered across England. Staff training could provide opportunities to practice the delivery of BCTs. Programme-level changes such as structured activities supported by participant materials and with sufficient allocated time, might improve the delivery of BCTs targeting self-regulation.
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Affiliation(s)
- Tamla S Evans
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
| | - Kevin J Drew
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
| | - Jim McKenna
- Obesity Institute and Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Pooja Dhir
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
| | - Jordan Marwood
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
| | - Charlotte Freeman
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
| | - Andrew J Hill
- Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Lisa Newson
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Catherine Homer
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Olympic Legacy Park, Sheffield, UK
| | - Jamie Matu
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
| | - Duncan Radley
- Obesity Institute and Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Louisa J Ells
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
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McFaline-Figueroa JL, Srivatsan S, Hill AJ, Gasperini M, Jackson DL, Saunders L, Domcke S, Regalado SG, Lazarchuck P, Alvarez S, Monnat RJ, Shendure J, Trapnell C. Multiplex single-cell chemical genomics reveals the kinase dependence of the response to targeted therapy. Cell Genom 2024; 4:100487. [PMID: 38278156 PMCID: PMC10879025 DOI: 10.1016/j.xgen.2023.100487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 09/26/2023] [Accepted: 12/15/2023] [Indexed: 01/28/2024]
Abstract
Chemical genetic screens are a powerful tool for exploring how cancer cells' response to drugs is shaped by their mutations, yet they lack a molecular view of the contribution of individual genes to the response to exposure. Here, we present sci-Plex-Gene-by-Environment (sci-Plex-GxE), a platform for combined single-cell genetic and chemical screening at scale. We highlight the advantages of large-scale, unbiased screening by defining the contribution of each of 522 human kinases to the response of glioblastoma to different drugs designed to abrogate signaling from the receptor tyrosine kinase pathway. In total, we probed 14,121 gene-by-environment combinations across 1,052,205 single-cell transcriptomes. We identify an expression signature characteristic of compensatory adaptive signaling regulated in a MEK/MAPK-dependent manner. Further analyses aimed at preventing adaptation revealed promising combination therapies, including dual MEK and CDC7/CDK9 or nuclear factor κB (NF-κB) inhibitors, as potent means of preventing transcriptional adaptation of glioblastoma to targeted therapy.
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Affiliation(s)
- José L McFaline-Figueroa
- Department of Biomedical Engineering, Columbia University, New York, NY, USA; Department of Genome Sciences, University of Washington, Seattle, WA, USA.
| | - Sanjay Srivatsan
- Department of Genome Sciences, University of Washington, Seattle, WA, USA; Medical Scientist Training Program, University of Washington, Seattle, WA, USA
| | - Andrew J Hill
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Molly Gasperini
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Dana L Jackson
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Lauren Saunders
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Silvia Domcke
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Samuel G Regalado
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Paul Lazarchuck
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Sarai Alvarez
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Raymond J Monnat
- Department of Genome Sciences, University of Washington, Seattle, WA, USA; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA; Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
| | - Jay Shendure
- Department of Genome Sciences, University of Washington, Seattle, WA, USA; Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA; Allen Discovery Center for Cell Lineage Tracing, Seattle, WA, USA; Howard Hughes Medical Institute, University of Washington, Seattle, WA, USA; Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
| | - Cole Trapnell
- Department of Genome Sciences, University of Washington, Seattle, WA, USA; Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA; Allen Discovery Center for Cell Lineage Tracing, Seattle, WA, USA; Brotman Baty Institute for Precision Medicine, Seattle, WA, USA.
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Hill AJ, Jones DB, Woodworth L. Physician-patient race-match reduces patient mortality. J Health Econ 2023; 92:102821. [PMID: 37871470 DOI: 10.1016/j.jhealeco.2023.102821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/27/2023] [Accepted: 09/23/2023] [Indexed: 10/25/2023]
Abstract
This paper assesses the impacts of physician-patient race-match, especially Black patients paired with Black physicians, on patient mortality. We draw on administrative data from Florida, linking hospital encounters from mid-2011 through 2014 to information from the Florida Physician Workforce Survey. Focusing on uninsured patients experiencing unscheduled hospital admissions who are conditionally randomly assigned to physicians, we find that physician-patient race-match for Black patients reduces the likelihood of within-hospital mortality by 0.28 percentage points, a 27 % reduction relative to the overall mortality rate. An alternative identification strategy relying on instrumental variables provides a similar finding.
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Affiliation(s)
- Andrew J Hill
- Montana State University, Department of Agricultural Economics and Economics, P.O. Box 172920, Bozeman, MT 59717, United States of America.
| | - Daniel B Jones
- University of Pittsburgh, Graduate School of Public and International Affairs, 230 S. Bouquet St., Pittsburgh, PA 15213, United States of America
| | - Lindsey Woodworth
- University of South Carolina, Darla Moore School of Business, Department of Economics, 1014 Greene St., Columbia, SC 29208, United States of America
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4
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Devine LD, Hill AJ, Gallagher AM, Patterson C, McCance DR. Associations of sociodemographic factors and obesity in children: Insights from the hyperglycaemia and adverse pregnancy outcome Belfast study - CORRIGENDUM. Proc Nutr Soc 2023:1. [PMID: 37800328 DOI: 10.1017/s0029665123003634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
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5
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Devine LD, Hill AJ, Briggs S, Muldoon N, Gallagher AM. The acceptability of a peer-led intervention to promote healthy dietary behaviours among adolescents in the school-setting: a qualitative investigation - CORRIGENDUM. Proc Nutr Soc 2023:1. [PMID: 37781902 DOI: 10.1017/s0029665123003646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
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Abstract
Background: Increases in pediatric obesity have been associated with higher levels of health care utilization. There is currently a lack of knowledge on the therapeutic drivers of increased health care use. Objective: To examine the association between different measures of health care utilization and BMI among children. Methods: We linked cross-sectional administrative data from a regional health insurance fund in Austria with objectively measured BMI from routine school health examinations in 6-15-year-old children (n = 13,493). Differences in probabilities of annual health care utilization (drug prescriptions by therapeutic classification, physician visits by medical specialty, and hospitalizations) were compared between children with normal weight, overweight, or obesity using Probit regressions. Results: Children with obesity had a 1.6 and 8.6 percentage points (pp) higher probability of outpatient doctor visits and prescribed medication, respectively (all p < 0.05). Children with overweight were intermediate. There was a higher probability of consulting a general practitioner, pediatrician, or orthopedist, and higher levels of prescribing for children with obesity across most common drug groups. Children with obesity were ∼40% more likely to receive medication for musculoskeletal and for mental health problems. This was reflected in orthopedic clinic appointments but not in psychology clinics. There were no major differences by gender or age, or parental socioeconomic status. Conclusions: Our data show clear and objective evidence of higher health care utilization by children with obesity. This highlights the importance of policy interventions to curb obesity in children and young people.
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Affiliation(s)
- Andrew J Hill
- Institute of Health Sciences, University of Leeds School of Medicine, Leeds, United Kingdom
| | - Dr Gerald J Pruckner
- Department of Economics, Johannes Kepler University Linz, Linz, Austria
- Christian Doppler Laboratory for Aging, Health, and the Labor Market, Johannes Kepler University Linz, Linz, Austria
| | - Thomas Schober
- Department of Economics, Johannes Kepler University Linz, Linz, Austria
- Christian Doppler Laboratory for Aging, Health, and the Labor Market, Johannes Kepler University Linz, Linz, Austria
- New Zealand Work Research Institute, Auckland University of Technology, Auckland, New Zealand
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7
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Mueller J, Richards R, Jones RA, Whittle F, Woolston J, Stubbings M, Sharp SJ, Griffin SJ, Bostock J, Hughes CA, Hill AJ, Boothby CE, Ahern AL. Correction: Supporting Weight Management during COVID-19 (SWiM-C): twelve-month follow-up of a randomised controlled trial of a web-based, ACT-based, guided self-help intervention. Int J Obes (Lond) 2023; 47:882. [PMID: 37479796 PMCID: PMC10439004 DOI: 10.1038/s41366-023-01330-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Affiliation(s)
- Julia Mueller
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
| | | | - Rebecca A Jones
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Fiona Whittle
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | - Marie Stubbings
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Carly A Hughes
- Fakenham Medical Practice, Fakenham, UK
- Medical School, University of East Anglia, Norwich, UK
| | - Andrew J Hill
- Division of Psychological and Social Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Clare E Boothby
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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8
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Davey E, Allen K, Bennett SD, Bryant‐Waugh R, Clarke T, Cooper Z, Dixon‐Ward K, Dudley J, Eisler I, Griffiths J, Hill AJ, Micali N, Murphy R, Picek I, Rea R, Schmidt U, Simic M, Tchanturia K, Traviss‐Turner G, Treasure J, Turner H, Wade T, Waller G, Shafran R. Improving programme-led and focused interventions for eating disorders: An experts' consensus statement-A UK perspective. Eur Eat Disord Rev 2023; 31:577-595. [PMID: 37218053 PMCID: PMC10947440 DOI: 10.1002/erv.2981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/29/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Eating disorders are associated with significant illness burden and costs, yet access to evidence-based care is limited. Greater use of programme-led and focused interventions that are less resource-intensive might be part of the solution to this demand-capacity mismatch. METHOD In October 2022, a group of predominantly UK-based clinical and academic researchers, charity representatives and people with lived experience convened to consider ways to improve access to, and efficacy of, programme-led and focused interventions for eating disorders in an attempt to bridge the demand-capacity gap. RESULTS Several key recommendations were made across areas of research, policy, and practice. Of particular importance is the view that programme-led and focused interventions are suitable for a range of different eating disorder presentations across all ages, providing medical and psychiatric risk are closely monitored. The terminology used for these interventions should be carefully considered, so as not to imply that the treatment is suboptimal. CONCLUSIONS Programme-led and focused interventions are a viable option to close the demand-capacity gap for eating disorder treatment and are particularly needed for children and young people. Work is urgently needed across sectors to evaluate and implement such interventions as a clinical and research priority.
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Affiliation(s)
- Emily Davey
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Karina Allen
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Sophie D. Bennett
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Rachel Bryant‐Waugh
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- Maudsley Centre for Child and Adolescent Eating DisordersSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Tim Clarke
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
- Norfolk and Suffolk NHS Foundation TrustNorwichUK
| | - Zafra Cooper
- Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA
| | | | - Jake Dudley
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Ivan Eisler
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- Maudsley Centre for Child and Adolescent Eating DisordersSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Jess Griffiths
- NHS England Adult Eating Disorders Co‐Chair Parliamentary Health Service Ombudsman's Delivery GroupRedditchUK
| | - Andrew J. Hill
- Leeds Institute of Health SciencesSchool of MedicineUniversity of LeedsLeedsUK
| | - Nadia Micali
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
- Department of PsychiatryFaculty of MedicineUniversity of GenevaGenevaSwitzerland
- Mental Health Services of the Capital Region of DenmarkEating Disorders Research UnitBallerup Psychiatric CentreCopenhagenDenmark
| | | | - Ivana Picek
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | - Ulrike Schmidt
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating DisordersSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Kate Tchanturia
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | - Janet Treasure
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Hannah Turner
- Eating Disorders ServiceSouthern Health NHS Foundation TrustSouthamptonUK
| | - Tracey Wade
- Blackbird InitiativeFlinders Research Institute for Mental Health and WellbeingFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Glenn Waller
- Clinical and Applied Psychology UnitDepartment of PsychologyUniversity of SheffieldSheffieldUK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
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9
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Jebeile H, Lister NB, Libesman S, Hunter KE, McMaster CM, Johnson BJ, Baur LA, Paxton SJ, Garnett SP, Ahern AL, Wilfley DE, Maguire S, Sainsbury A, Steinbeck K, Askie L, Braet C, Hill AJ, Nicholls D, Jones RA, Dammery G, Grunseit AM, Cooper K, Kyle TK, Heeren FA, Quigley F, Barnes RD, Bean MK, Beaulieu K, Bonham M, Boutelle KN, Branco BHM, Calugi S, Cardel MI, Carpenter K, Cheng HL, Dalle Grave R, Danielsen YS, Demarzo M, Dordevic A, Eichen DM, Goldschmidt AB, Hilbert A, Houben K, Lofrano do Prado M, Martin CK, McTiernan A, Mensinger JL, Pacanowski C, do Prado WL, Ramalho SM, Raynor HA, Rieger E, Robinson E, Salvo V, Sherwood NE, Simpson SA, Skjakodegard HF, Smith E, Partridge S, Tanofsky-Kraff M, Taylor RW, Van Eyck A, Varady KA, Vidmar AP, Whitelock V, Yanovski J, Seidler AL. Eating disorders in weight-related therapy (EDIT): Protocol for a systematic review with individual participant data meta-analysis of eating disorder risk in behavioural weight management. PLoS One 2023; 18:e0282401. [PMID: 37428754 PMCID: PMC10332604 DOI: 10.1371/journal.pone.0282401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/07/2023] [Indexed: 07/12/2023] Open
Abstract
The Eating Disorders In weight-related Therapy (EDIT) Collaboration brings together data from randomised controlled trials of behavioural weight management interventions to identify individual participant risk factors and intervention strategies that contribute to eating disorder risk. We present a protocol for a systematic review and individual participant data (IPD) meta-analysis which aims to identify participants at risk of developing eating disorders, or related symptoms, during or after weight management interventions conducted in adolescents or adults with overweight or obesity. We systematically searched four databases up to March 2022 and clinical trials registries to May 2022 to identify randomised controlled trials of weight management interventions conducted in adolescents or adults with overweight or obesity that measured eating disorder risk at pre- and post-intervention or follow-up. Authors from eligible trials have been invited to share their deidentified IPD. Two IPD meta-analyses will be conducted. The first IPD meta-analysis aims to examine participant level factors associated with a change in eating disorder scores during and following a weight management intervention. To do this we will examine baseline variables that predict change in eating disorder risk within intervention arms. The second IPD meta-analysis aims to assess whether there are participant level factors that predict whether participation in an intervention is more or less likely than no intervention to lead to a change in eating disorder risk. To do this, we will examine if there are differences in predictors of eating disorder risk between intervention and no-treatment control arms. The primary outcome will be a standardised mean difference in global eating disorder score from baseline to immediately post-intervention and at 6- and 12- months follow-up. Identifying participant level risk factors predicting eating disorder risk will inform screening and monitoring protocols to allow early identification and intervention for those at risk.
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Affiliation(s)
- Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sol Libesman
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Kylie E Hunter
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Caitlin M McMaster
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Brittany J Johnson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Louise A Baur
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Kids Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Denise E Wilfley
- Washington University in St. Louis, St Louis, Missouri, United States of America
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Amanda Sainsbury
- The University of Western Australia, School of Human Sciences, Crawley, Western Australia, Australia
| | - Katharine Steinbeck
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Lisa Askie
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan, Ghent, Belgium
| | - Andrew J Hill
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, United Kingdom
- NIHR ACR Northwest London, London, United Kingdom
| | - Rebecca A Jones
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Genevieve Dammery
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alicia M Grunseit
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Kelly Cooper
- Weight Issues Network, New South Wales, Australia
| | - Theodore K Kyle
- ConscienHealth, Pittsburgh, Pennsylvania, United States of America
| | - Faith A Heeren
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Fiona Quigley
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, Co. Antrim, Northern Ireland
| | - Rachel D Barnes
- University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Melanie K Bean
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Kristine Beaulieu
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | | | - Kerri N Boutelle
- Department of Pediatrics, University of California, San Diego, San Diego, California, United States of America
| | | | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Italy
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, United States of America
- WW International, Inc., New York, NY, United States of America
| | - Kelly Carpenter
- Optum Center for Wellbeing Research, Seattle, Washington, United States of America
| | - Hoi Lun Cheng
- The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Italy
| | | | - Marcelo Demarzo
- Mente Aberta, The Brazilian Center for Mindfulness and Health Promotion, Univesidade Federal de São Paulo, UNIFESP, Brazil
| | | | - Dawn M Eichen
- Department of Pediatrics, University of California, San Diego, San Diego, California, United States of America
| | - Andrea B Goldschmidt
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Philadelphia, United States of America
| | - Anja Hilbert
- Research Unit Behavioral Medicine, Integrated Research and Treatment Center Adiposity Diseases, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Katrijn Houben
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Mara Lofrano do Prado
- Department of Psychology, California State University, San Bernardino, California, United States of America
- Department of Kinesiology, California State University, San Bernardino, California, United States of America
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Anne McTiernan
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Janell L Mensinger
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Carly Pacanowski
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, United States of America
| | - Wagner Luiz do Prado
- Department of Kinesiology, California State University, San Bernardino, California, United States of America
| | - Sofia M Ramalho
- Psychology Research Centre, School of Psychology, University of Minho, Campus Gualtar, Braga, Portugal
| | - Hollie A Raynor
- Department of Nutrition, University of Tennessee, Knoxville, Tennessee, United States of America
| | - Elizabeth Rieger
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, United Kingdom
| | - Vera Salvo
- Mente Aberta, The Brazilian Center for Mindfulness and Health Promotion, Univesidade Federal de São Paulo, UNIFESP, Brazil
| | - Nancy E Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Sharon A Simpson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | - Evelyn Smith
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Stephanie Partridge
- Engagement and Co-design Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marian Tanofsky-Kraff
- Departments of Medical and Clinical Psychology and Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Rachael W Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Annelies Van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
- Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Krista A Varady
- University of Illinois Chicago, Department of Kinesiology and Nutrition, Chicago, Illinois, United States of America
| | - Alaina P Vidmar
- Children's Hospital Los Angeles and Keck School of Medicine of University of Southern California, Los Angeles, CA, United States of America
- Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism, Los Angeles, California, United States of America
| | | | - Jack Yanovski
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Anna L Seidler
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
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10
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McFaline-Figueroa JL, Srivatsan S, Hill AJ, Gasperini M, Jackson DL, Saunders L, Domcke S, Regalado SG, Lazarchuck P, Alvarez S, Monnat RJ, Shendure J, Trapnell C. Multiplex single-cell chemical genomics reveals the kinase dependence of the response to targeted therapy. bioRxiv 2023:2023.03.10.531983. [PMID: 37398090 PMCID: PMC10312454 DOI: 10.1101/2023.03.10.531983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Chemical genetic screens are a powerful tool for exploring how cancer cells' response to drugs is shaped by their mutations, yet they lack a molecular view of the contribution of individual genes to the response to exposure. Here, we present sci-Plex-Gene-by-Environment (sci-Plex-GxE), a platform for combined single-cell genetic and chemical screening at scale. We highlight the advantages of large-scale, unbiased screening by defining the contribution of each of 522 human kinases to the response of glioblastoma to different drugs designed to abrogate signaling from the receptor tyrosine kinase pathway. In total, we probed 14,121 gene-by-environment combinations across 1,052,205 single-cell transcriptomes. We identify an expression signature characteristic of compensatory adaptive signaling regulated in a MEK/MAPK-dependent manner. Further analyses aimed at preventing adaptation revealed promising combination therapies, including dual MEK and CDC7/CDK9 or NF-kB inhibitors, as potent means of preventing transcriptional adaptation of glioblastoma to targeted therapy.
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Affiliation(s)
- José L. McFaline-Figueroa
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Sanjay Srivatsan
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
- Medical Scientist Training Program, University of Washington, Seattle, WA, USA
| | - Andrew J. Hill
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Molly Gasperini
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Dana L. Jackson
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Lauren Saunders
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Silvia Domcke
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Samuel G. Regalado
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Paul Lazarchuck
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Sarai Alvarez
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Raymond J. Monnat
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
| | - Jay Shendure
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
- Allen Discovery Center for Cell Lineage Tracing, Seattle, WA, USA
- Howard Hughes Medical Institute, University of Washington, Seattle, WA, USA
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
| | - Cole Trapnell
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
- Allen Discovery Center for Cell Lineage Tracing, Seattle, WA, USA
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
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11
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Jebeile H, Libesman S, Melville H, Low‐wah T, Dammery G, Seidler AL, Jones RA, McMaster CM, Paxton SJ, Hill AJ, Ahern AL, Garnett SP, Braet C, Wilfley DE, Baur LA, Lister NB. Eating disorder risk during behavioral weight management in adults with overweight or obesity: A systematic review with meta-analysis. Obes Rev 2023; 24:e13561. [PMID: 36919475 PMCID: PMC10909435 DOI: 10.1111/obr.13561] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/12/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
This systematic review examined change in eating disorder risk during weight management interventions. Four databases and clinical trials registries were searched in March and May 2022, respectively, to identify behavioral weight management intervention trials in adults with overweight/obesity measuring eating disorder symptoms at pre- and post-intervention or follow-up. Random effects meta-analyses were conducted examining within group change in risk. Of 12,023 screened, 49 were eligible (n = 6337, mean age range 22.1 to 59.9 years, mean (SD) 81(20.4)% female). Interventions ranged from 4 weeks to 18 months, with follow-up of 10 weeks to 36 months post-intervention. There was a within group reduction in global eating disorder scores (20 intervention arms; Hedges' g = -0.27; 95% CI -0.36, -0.17; I2 67.1%) and binge eating (49 intervention arms; -0.66; 95% CI -0.76, -0.56; I2 82.7%) post-intervention, both maintained at follow-up. Of 14 studies reporting prevalence or episodes of binge eating, all reported a reduction. Four studies reported eating disorder symptoms, not present at baseline, in a subset of participants (0%-6.5%). Overall, behavioral weight management interventions do not increase eating disorder symptoms for most adults; indeed, a modest reduction is seen post-intervention and follow-up. A small subset of participants may experience disordered eating; therefore, monitoring for the emergence of symptoms is important.
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Affiliation(s)
- Hiba Jebeile
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Sol Libesman
- NHMRC Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | - Hannah Melville
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Timothy Low‐wah
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Genevieve Dammery
- InsideOut Institute for Eating DisordersThe University of SydneySydneyNew South WalesAustralia
| | - Anna L. Seidler
- NHMRC Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | | | - Caitlin M. McMaster
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Susan J. Paxton
- School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Andrew J. Hill
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Amy L. Ahern
- MRC Epidemiology UnitUniversity of CambridgeCambridgeCB2 0QQUK
| | - Sarah P. Garnett
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- Kids ResearchThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Caroline Braet
- Department of Developmental, Personality and Social PsychologyGhent UniversityHenri Dunantlaan 2Ghent9000Belgium
| | - Denise E. Wilfley
- School of Medicine, Washington University in St. LouisMissouriSt. LouisUSA
| | - Louise A. Baur
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Natalie B. Lister
- Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
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12
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Abstract
The prevalence of child and adolescent obesity has plateaued at high levels in most high-income countries and is increasing in many low-income and middle-income countries. Obesity arises when a mix of genetic and epigenetic factors, behavioural risk patterns and broader environmental and sociocultural influences affect the two body weight regulation systems: energy homeostasis, including leptin and gastrointestinal tract signals, operating predominantly at an unconscious level, and cognitive-emotional control that is regulated by higher brain centres, operating at a conscious level. Health-related quality of life is reduced in those with obesity. Comorbidities of obesity, including type 2 diabetes mellitus, fatty liver disease and depression, are more likely in adolescents and in those with severe obesity. Treatment incorporates a respectful, stigma-free and family-based approach involving multiple components, and addresses dietary, physical activity, sedentary and sleep behaviours. In adolescents in particular, adjunctive therapies can be valuable, such as more intensive dietary therapies, pharmacotherapy and bariatric surgery. Prevention of obesity requires a whole-system approach and joined-up policy initiatives across government departments. Development and implementation of interventions to prevent paediatric obesity in children should focus on interventions that are feasible, effective and likely to reduce gaps in health inequalities.
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Affiliation(s)
- Natalie B Lister
- Children's Hospital Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
- Weight Management Services, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
| | - Janine F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Andrew J Hill
- Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Claude Marcus
- Division of Paediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Reinehr
- Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Datteln, Germany
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Martin Wabitsch
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Medical Centre, Ulm, Germany
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13
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McMaster CM, Paxton SJ, Maguire S, Hill AJ, Braet C, Seidler AL, Nicholls D, Garnett SP, Ahern AL, Wilfley DE, Lister NB, Jebeile H. The need for future research into the assessment and monitoring of eating disorder risk in the context of obesity treatment. Int J Eat Disord 2023; 56:914-924. [PMID: 36694273 PMCID: PMC10946556 DOI: 10.1002/eat.23898] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
In adolescents and adults, the co-occurrence of eating disorders and overweight or obesity is continuing to increase, and the prevalence of eating disorders is higher in people with higher weight compared to those with lower weight. People with an eating disorder with higher weight are more likely to present for weight loss than for eating disorder treatment. However, there are no clinical practice guidelines on how to screen, assess, and monitor eating disorder risk in the context of obesity treatment. In this article, we first summarize current challenges and knowledge gaps related to the identification and assessment of eating disorder risk and symptoms in people with higher weight seeking obesity treatment. Specifically, we discuss considerations relating to the validation of current self-report measures, dietary restraint, body dissatisfaction, binge eating, and how change in eating disorder risk can be measured in this setting. Second, we propose avenues for further research to guide the development and implementation of clinical and research protocols for the identification and assessment of eating disorders in people with higher weight in the context of obesity treatment. PUBLIC SIGNIFICANCE: The number of people with both eating disorders and higher weight is increasing. Currently, there is little guidance for clinicians and researchers about how to identify and monitor risk of eating disorders in people with higher weight. We present limitations of current research and suggest future avenues for research to enhance care for people living with higher weight with eating disorders.
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Affiliation(s)
- Caitlin M. McMaster
- The University of Sydney Children's Hospital Westmead Clinical SchoolWestmeadNew South WalesAustralia
| | - Susan J. Paxton
- School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Boden Collaboration for Obesity, Nutrition and Eating DisordersCharles Perkins Centre, The University of SydneySydneyNew South WalesAustralia
| | - Andrew J. Hill
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Caroline Braet
- Department of Developmental, Personality and Social PsychologyGhent UniversityGhentBelgium
| | - Anna L. Seidler
- National Health and Medical Research Council Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | | | - Sarah P. Garnett
- The University of Sydney Children's Hospital Westmead Clinical SchoolWestmeadNew South WalesAustralia
- Kids ResearchSydney Children's Hospital NetworkWestmeadNew South WalesAustralia
| | - Amy L. Ahern
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | | | - Natalie B. Lister
- The University of Sydney Children's Hospital Westmead Clinical SchoolWestmeadNew South WalesAustralia
| | - Hiba Jebeile
- The University of Sydney Children's Hospital Westmead Clinical SchoolWestmeadNew South WalesAustralia
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14
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Madigan CD, Hill AJ, Caterson ID, Burk J, Hendy C, Chalkley A. A Qualitative Process Evaluation of Participant Experiences in a Feasibility Randomised Controlled Trial to Reduce Indulgent Foods and Beverages. Nutrients 2023; 15:nu15061389. [PMID: 36986119 PMCID: PMC10052994 DOI: 10.3390/nu15061389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
There is a growing interest in the effects of ultra-processed/energy-dense nutrient-poor foods on health outcomes, and few interventions to reduce their consumption have been tested. We tested a simple intervention to help people reduce the indulgences they consume (energy-dense nutrient-poor (EDNP) foods). Herein, we report the qualitative findings to understand how participants reduced their consumption by exploring intervention fidelity and the factors affecting consumption. We conducted a qualitative descriptive study of 23 adults who had taken part in a feasibility randomised controlled trial that asked participants to say no to seven indulgences/week and record what they said no to. Data were collected using face-to-face semi-structured interviews and analysed thematically. A total of 23 adults with an average BMI of 30.8 kg/m2 took part. Participants liked the term indulgence, as they could apply it to their normal dietary intake and make small changes. They found self-monitoring what they said no to helpful and reported that emotional eating and habits affected consumption. They had difficulty overcoming these. As most people are consuming too many foods that are EDNP, this simple intervention of “Say No” seven times/week has the potential to be developed as a public health campaign.
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Affiliation(s)
- Claire Deborah Madigan
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), Loughborough University, Loughborough LE11 3TU, UK
- Correspondence:
| | - Andrew J. Hill
- The Boden Initiative, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
- Division of Psychological and Social Medicine, Leeds Institute of Health Sciences, Worsley Building, University of Leeds, Leeds LS2 9NL, UK
| | - Ian Douglas Caterson
- The Boden Initiative, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Jessica Burk
- The Boden Initiative, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Chelsea Hendy
- The Boden Initiative, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Anna Chalkley
- Centre for Physically Active Learning, Western Norway University of Applied Sciences, 6856 Sogndal, Norway
- Wolfson Centre for Applied Research, Faculty of Health Studies, University of Bradford, Bradford BD7 1DP, UK
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15
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Jebeile H, McMaster CM, Johnson BJ, Garnett SP, Paxton SJ, Seidler AL, Jones RA, Hill AJ, Maguire S, Braet C, Dammery G, Wilfley DE, Baur LA, Lister NB, On Behalf Of The Eating Disorders In Weight-Related Therapy Edit Collaboration. Identifying Factors Which Influence Eating Disorder Risk during Behavioral Weight Management: A Consensus Study. Nutrients 2023; 15:1085. [PMID: 36904085 PMCID: PMC10005214 DOI: 10.3390/nu15051085] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
This study aimed to understand clinician, researcher and consumer views regarding factors which influence eating disorder (ED) risk during behavioral weight management, including individual risk factors, intervention strategies and delivery features. Eighty-seven participants were recruited internationally through professional and consumer organizations and social media and completed an online survey. Individual characteristics, intervention strategies (5-point scale) and delivery features (important/unimportant/unsure) were rated. Participants were mostly women (n = 81), aged 35-49 y, from Australia or United States, were clinicians and/or reported lived experience of overweight/obesity and/or ED. There was agreement (64% to 99%) that individual characteristics were relevant to ED risk, with history of ED, weight-based teasing/stigma and weight bias internalization having the highest agreement. Intervention strategies most frequently rated as likely to increase ED risk included those with a focus on weight, prescription (structured diets, exercise plans) and monitoring strategies, e.g., calorie counting. Strategies most frequently rated as likely to decrease ED risk included having a health focus, flexibility and inclusion of psychosocial support. Delivery features considered most important were who delivered the intervention (profession, qualifications) and support (frequency, duration). Findings will inform future research to quantitatively assess which of these factors predict eating disorder risk, to inform screening and monitoring protocols.
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Affiliation(s)
- Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney 2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
| | - Caitlin M McMaster
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney 2145, Australia
| | - Brittany J Johnson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide 5042, Australia
| | - Sarah P Garnett
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney 2145, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney 2145, Australia
- Kids Research, The Children's Hospital at Westmead, Sydney 2145, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia
| | - Anna L Seidler
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney 2050, Australia
| | - Rebecca A Jones
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Andrew J Hill
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, 9000 Ghent, Belgium
| | - Genevieve Dammery
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
| | - Denise E Wilfley
- School of Medicine, Washington University in St. Louis, St Louis, MO 63110, USA
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney 2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
- Weight Management Services, The Children's Hospital at Westmead, Sydney 2145, Australia
| | - Natalie B Lister
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney 2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
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16
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Lister NB, Baur LA, Paxton SJ, Garnett SP, Ahern AL, Wilfley DE, Maguire S, Sainsbury A, Steinbeck K, Braet C, Hill AJ, Nicholls D, Jones RA, Dammery G, Grunseit A, Cooper K, Kyle TK, Heeren FA, Hunter KE, McMaster CM, Johnson BJ, Seidler AL, Jebeile H. Eating Disorders In weight-related Therapy (EDIT) Collaboration: rationale and study design. Nutr Res Rev 2023:1-11. [PMID: 36788665 DOI: 10.1017/s0954422423000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The cornerstone of obesity treatment is behavioural weight management, resulting in significant improvements in cardio-metabolic and psychosocial health. However, there is ongoing concern that dietary interventions used for weight management may precipitate the development of eating disorders. Systematic reviews demonstrate that, while for most participants medically supervised obesity treatment improves risk scores related to eating disorders, a subset of people who undergo obesity treatment may have poor outcomes for eating disorders. This review summarises the background and rationale for the formation of the Eating Disorders In weight-related Therapy (EDIT) Collaboration. The EDIT Collaboration will explore the complex risk factor interactions that precede changes to eating disorder risk following weight management. In this review, we also outline the programme of work and design of studies for the EDIT Collaboration, including expected knowledge gains. The EDIT studies explore risk factors and the interactions between them using individual-level data from international weight management trials. Combining all available data on eating disorder risk from weight management trials will allow sufficient sample size to interrogate our hypothesis: that individuals undertaking weight management interventions will vary in their eating disorder risk profile, on the basis of personal characteristics and intervention strategies available to them. The collaboration includes the integration of health consumers in project development and translation. An important knowledge gain from this project is a comprehensive understanding of the impact of weight management interventions on eating disorder risk.
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Affiliation(s)
- Natalie B Lister
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales2145, Australia
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales2145, Australia
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Sarah P Garnett
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- Kids Research, Sydney Children's Hospital Network, Westmead, New South Wales2145, Australia
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Denise E Wilfley
- School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Boden Collaboration for Obesity, Nutrition and Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Katharine Steinbeck
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, New South Wales2145, Australia
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Andrew J Hill
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, 2nd Floor, Commonwealth Building, Du Cane Road, London, W12 0NN, UK
| | - Rebecca A Jones
- MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Genevieve Dammery
- InsideOut Institute for Eating Disorders, Boden Collaboration for Obesity, Nutrition and Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alicia Grunseit
- The Children's Hospital at Westmead, Nutrition and Dietetics, Weight Management Services, Westmead, New South Wales, NSW 2145, Australia
| | | | | | - Faith A Heeren
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kylie E Hunter
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Caitlin M McMaster
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
| | - Brittany J Johnson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia5042, Australia
| | - Anna Lene Seidler
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales2145, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales2145, Australia
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17
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Mueller J, Richards R, Jones RA, Whittle F, Woolston J, Stubbings M, Sharp SJ, Griffin SJ, Bostock J, Hughes CA, Hill AJ, Boothby CE, Ahern AL. Supporting Weight Management during COVID-19 (SWiM-C): twelve-month follow-up of a randomised controlled trial of a web-based, ACT-based, guided self-help intervention. Int J Obes (Lond) 2023; 47:51-59. [PMID: 36369513 PMCID: PMC9651901 DOI: 10.1038/s41366-022-01232-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We developed a guided self-help intervention (Supporting Weight Management during COVID-19, "SWiM-C") to support adults with overweight or obesity in their weight management during the COVID-19 pandemic. This parallel, two-group trial (ISRCTN12107048) evaluated the effect of SWiM-C on weight and determinants of weight management over twelve months. METHODS Participants (≥18 years, body-mass-index ≥25 kg/m2) were randomised to the SWiM-C intervention or to a standard advice group (unblinded). Participants completed online questionnaires at baseline, four months, and twelve months. The primary outcome was change in self-reported weight from baseline to twelve months; secondary outcomes were eating behaviour (uncontrolled eating, emotional eating, cognitive restraint of food intake), experiential avoidance, depression, anxiety, stress, wellbeing and physical activity. INTERVENTIONS SWiM-C is based on acceptance and commitment therapy (ACT). Participants had access to an online web platform with 12 weekly modules and email and telephone contact with a trained, non-specialist coach. Standard advice was a leaflet on managing weight and mood during the COVID-19 pandemic. RESULTS 388 participants were randomised (SWiM-C: n = 192, standard advice: n = 196). The baseline-adjusted difference in weight change between SWiM-C (n = 119) and standard advice (n = 147) was -0.81 kg (95% CI: -2.24 to 0.61 kg). SWiM-C participants reported a reduction in experiential avoidance (-2.45 [scale:10-70], 95% CI: -4.75 to -0.15), uncontrolled eating (-3.36 [scale: 0-100], 95% CI: -5.66 to -1.06), and emotional eating (-4.14 [scale:0-100], 95% CI: -7.25 to -1.02) and an increase in physical activity (8.96 [MET-min/week], 95% CI: 0.29 to 17.62) compared to standard advice participants. We found no evidence of an effect on remaining outcomes. No adverse events/side effects were reported. CONCLUSIONS Whilst we were unable to conclude that the intervention had an effect on weight, SWiM-C improved eating behaviours, experiential avoidance and physical activity. Further refinement of the intervention is necessary to ensure meaningful effects on weight prior to implementation in practice. TRIAL REGISTRATION NUMBER ISRCTN 12107048.
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Affiliation(s)
- Julia Mueller
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
| | - Rebecca Richards
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Rebecca A. Jones
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Fiona Whittle
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jennifer Woolston
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Marie Stubbings
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stephen J. Sharp
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Simon J. Griffin
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK ,grid.5335.00000000121885934Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Carly A. Hughes
- Fakenham Medical Practice, Fakenham, UK ,grid.8273.e0000 0001 1092 7967Medical School, University of East Anglia, Norwich, UK
| | - Andrew J. Hill
- grid.9909.90000 0004 1936 8403Division of Psychological and Social Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Clare E. Boothby
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Amy L. Ahern
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Jones RA, Richards R, Palat R, Hughes C, Hill AJ, Vincent A, Griffin SJ, Ahern AL, Duschinsky R. Participants' experiences of mental health during a COVID-19 tailored ACT-based behavioural weight management intervention: a qualitative study. Int J Qual Stud Health Well-being 2022; 17:2123093. [PMID: 36097888 PMCID: PMC9481081 DOI: 10.1080/17482631.2022.2123093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE We aimed to explore participants' experiences of mental health during an acceptance and commitment therapy (ACT)-based guided self-help intervention to support weight management in adults with overweight or obesity during the COVID-19 pandemic (SWiM-C: Supporting Weight Management during COVID-19). METHODS We conducted semi-structured telephone interviews with twenty participants and used reflexive thematic analysis to identify patterns of meaning across the dataset relevant to mental health. RESULTS Four themes were conceptualized: i) Mental health changes associated with SWiM-C, ii) External factors negatively impacted mental health and intervention engagement, iii) Use and impact of coping responses, and iv) Intervention preferences based on psychological needs. CONCLUSIONS Findings suggest that participants were exposed to multiple factors, both related to and external to the intervention, that negatively impact their mental health, yet ACT-based aspects of the SWiM-C intervention appeared to support participants to adaptively manage the decline in their mental health. The findings can be used to inform the development of future weight management interventions, such as through intervention personalization and the inclusion of more strategies that target emotional regulation.Trial registration: ISRCTN 12107048, https://www.isrctn.com/ISRCTN12107048.
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Affiliation(s)
- Rebecca A. Jones
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK,CONTACT Rebecca A. Jones MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | | | - Roshni Palat
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Carly Hughes
- Fakenham Medical Practice, Norfolk, UK,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Andrew J Hill
- Division of Psychological & Social Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Ann Vincent
- Department of Medicine, University College London, London, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Amy L. Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Robbie Duschinsky
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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19
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Ahern AL, Breeze P, Fusco F, Sharp SJ, Islam N, Wheeler GM, Hill AJ, Hughes CA, Duschinsky R, Thomas C, Bates S, Woolston J, Stubbings M, Whittle F, Boothby C, Bostock J, Jebb S, Aveyard P, Boyland E, Halford JCG, Morris S, Brennan A, Griffin SJ. Effectiveness and cost-effectiveness of referral to a commercial open group behavioural weight management programme in adults with overweight and obesity: 5-year follow-up of the WRAP randomised controlled trial. Lancet Public Health 2022. [PMID: 36182236 DOI: 10.1016/s2468-2667(22)00226-2/attachment/651975c9-3160-4901-b61c-a464b2d31fb7/mmc1.pdf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND There is evidence that commercially available behavioural weight management programmes can lead to short-term weight loss and reductions in glycaemia. Here, we aimed to provide the 5-year impact and cost-effectiveness of these interventions compared with a brief intervention. METHODS WRAP was a non-blinded, parallel-group randomised controlled trial (RCT). We recruited from primary care practices in England and randomly assigned participants to one of three interventions (brief intervention, 12-week open-group behavioural programme [WW, formerly Weight Watchers], or a 52-week open-group WW behavioural programme) in an uneven (2:5:5) allocation. Participants were followed up 5 years after randomisation using data from measurement visits at primary care practices or a research centre, review of primary care electronic medical notes, and self-report questionnaires. The primary outcome was change in weight at 5 years follow-up, assessed using analysis of covariance. We also estimated cost-effectiveness of the intervention. This study is registered at Current Controlled Trials, ISRCTN64986150. FINDINGS Between Oct 18, 2012, and Feb 10, 2014, we recruited 1269 eligible participants (two participants were randomly assigned but not eligible and therefore excluded) and 1040 (82%) consented to be approached about additional follow-up and to have their medical notes reviewed at 5 years. The primary outcome (weight) was ascertained for 871 (69%) of 1267 eligible participants. Mean duration of follow-up was 5·1 (SD 0·3) years. Mean weight change from baseline to 5 years was -0·46 (SD 8·31) kg in the brief intervention group, -1·95 (9·55) kg in the 12-week programme group, and -2·67 (9·81) kg in the 52-week programme. The adjusted difference in weight change was -1·76 (95% CI -3·68 to 0·17) kg between the 52-week programme and the brief intervention; -0·80 (-2·13 to 0·54) kg between the 52-week and the 12-week programme; and -0·96 (-2·90 to 0·97) kg between the 12-week programme and the brief intervention. During the trial, the 12-week programme incurred the lowest cost and produced the highest quality-adjusted life-years (QALY). Simulations beyond 5 years suggested that the 52-week programme would deliver the highest QALYs at the lowest cost and would be the most cost-effective. No participants reported adverse events related to the intervention. INTERPRETATION Although the difference in weight change between groups was not statistically significant, some weight loss was maintained at 5 years after an open-group behavioural weight management programme. Health economic modelling suggests that this could have important implications to reduce the incidence of weight-related disease and these interventions might be cost-saving. FUNDING The UK National Institute for Health and Care Research Programme Grants for Applied Research and the Medical Research Council.
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Affiliation(s)
- Amy L Ahern
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - Penny Breeze
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Francesco Fusco
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Nazrul Islam
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - Carly A Hughes
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Robbie Duschinsky
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Chloe Thomas
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sarah Bates
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jenny Woolston
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Marie Stubbings
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Fiona Whittle
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Clare Boothby
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jennifer Bostock
- Patient and Public Involvement Representative, Quality Safety Outcomes Policy Research Unit, University of Kent, Canterbury, UK
| | - Susan Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Jason C G Halford
- School of Psychology, University of Leeds, Leeds, UK; Department of Psychology, University of Liverpool, Liverpool, UK
| | - Stephen Morris
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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20
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Ahern AL, Breeze P, Fusco F, Sharp SJ, Islam N, Wheeler GM, Hill AJ, Hughes CA, Duschinsky R, Thomas C, Bates S, Woolston J, Stubbings M, Whittle F, Boothby C, Bostock J, Jebb S, Aveyard P, Boyland E, Halford JCG, Morris S, Brennan A, Griffin SJ. Effectiveness and cost-effectiveness of referral to a commercial open group behavioural weight management programme in adults with overweight and obesity: 5-year follow-up of the WRAP randomised controlled trial. Lancet Public Health 2022; 7:e866-e875. [PMID: 36182236 DOI: 10.1016/s2468-2667(22)00226-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND There is evidence that commercially available behavioural weight management programmes can lead to short-term weight loss and reductions in glycaemia. Here, we aimed to provide the 5-year impact and cost-effectiveness of these interventions compared with a brief intervention. METHODS WRAP was a non-blinded, parallel-group randomised controlled trial (RCT). We recruited from primary care practices in England and randomly assigned participants to one of three interventions (brief intervention, 12-week open-group behavioural programme [WW, formerly Weight Watchers], or a 52-week open-group WW behavioural programme) in an uneven (2:5:5) allocation. Participants were followed up 5 years after randomisation using data from measurement visits at primary care practices or a research centre, review of primary care electronic medical notes, and self-report questionnaires. The primary outcome was change in weight at 5 years follow-up, assessed using analysis of covariance. We also estimated cost-effectiveness of the intervention. This study is registered at Current Controlled Trials, ISRCTN64986150. FINDINGS Between Oct 18, 2012, and Feb 10, 2014, we recruited 1269 eligible participants (two participants were randomly assigned but not eligible and therefore excluded) and 1040 (82%) consented to be approached about additional follow-up and to have their medical notes reviewed at 5 years. The primary outcome (weight) was ascertained for 871 (69%) of 1267 eligible participants. Mean duration of follow-up was 5·1 (SD 0·3) years. Mean weight change from baseline to 5 years was -0·46 (SD 8·31) kg in the brief intervention group, -1·95 (9·55) kg in the 12-week programme group, and -2·67 (9·81) kg in the 52-week programme. The adjusted difference in weight change was -1·76 (95% CI -3·68 to 0·17) kg between the 52-week programme and the brief intervention; -0·80 (-2·13 to 0·54) kg between the 52-week and the 12-week programme; and -0·96 (-2·90 to 0·97) kg between the 12-week programme and the brief intervention. During the trial, the 12-week programme incurred the lowest cost and produced the highest quality-adjusted life-years (QALY). Simulations beyond 5 years suggested that the 52-week programme would deliver the highest QALYs at the lowest cost and would be the most cost-effective. No participants reported adverse events related to the intervention. INTERPRETATION Although the difference in weight change between groups was not statistically significant, some weight loss was maintained at 5 years after an open-group behavioural weight management programme. Health economic modelling suggests that this could have important implications to reduce the incidence of weight-related disease and these interventions might be cost-saving. FUNDING The UK National Institute for Health and Care Research Programme Grants for Applied Research and the Medical Research Council.
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Affiliation(s)
- Amy L Ahern
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - Penny Breeze
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Francesco Fusco
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Nazrul Islam
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - Carly A Hughes
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Robbie Duschinsky
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Chloe Thomas
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sarah Bates
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jenny Woolston
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Marie Stubbings
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Fiona Whittle
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Clare Boothby
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jennifer Bostock
- Patient and Public Involvement Representative, Quality Safety Outcomes Policy Research Unit, University of Kent, Canterbury, UK
| | - Susan Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Jason C G Halford
- School of Psychology, University of Leeds, Leeds, UK; Department of Psychology, University of Liverpool, Liverpool, UK
| | - Stephen Morris
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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21
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Candio P, Pouwels KB, Meads D, Hill AJ, Bojke L, Williams C. Modelling decay in effectiveness for evaluation of behaviour change interventions: a tutorial for public health economists. Eur J Health Econ 2022; 23:1151-1157. [PMID: 34914010 PMCID: PMC9395462 DOI: 10.1007/s10198-021-01417-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND PURPOSE Recent methodological reviews of evaluations of behaviour change interventions in public health have highlighted that the decay in effectiveness over time has been mostly overlooked, potentially leading to suboptimal decision-making. While, in principle, discrete-time Markov chains-the most commonly used modelling approach-can be adapted to account for decay in effectiveness, this framework inherently lends itself to strong model simplifications. The application of formal and more appropriate modelling approaches has been supported, but limited progress has been made to date. The purpose of this paper is to encourage this shift by offering a practical guide on how to model decay in effectiveness using a continuous-time Markov chain (CTMC)-based approach. METHODS A CTMC approach is demonstrated, with a contextualized tutorial being presented to facilitate learning and uptake. A worked example based on the stylized case study in physical activity promotion is illustrated with accompanying R code. DISCUSSION The proposed framework presents a relatively small incremental change from the current modelling practice. CTMC represents a technical solution which, in absence of relevant data, allows for formally testing the sensitivity of results to assumptions regarding the long-term sustainability of intervention effects and improving model transparency. CONCLUSIONS The use of CTMC should be considered in evaluations where decay in effectiveness is likely to be a key factor to consider. This would enable more robust model-based evaluations of population-level programmes to promote behaviour change and reduce the uncertainty surrounding the decision to invest in these public health interventions.
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Affiliation(s)
- Paolo Candio
- Centre for Economics of Obesity, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
- Health Economics Research Centre, University of Oxford, Oxford, UK.
| | - Koen B Pouwels
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Andrew J Hill
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, York, UK
| | - Claire Williams
- Health Economics Research Centre, University of Oxford, Oxford, UK
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22
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Vanden Brink H, Pacheco LS, Bahnfleth CL, Green E, Johnson LM, Sanderson K, Demaio AR, Farpour-Lambert N, Ells LJ, Hill AJ. Psychological interventions delivered as a single component intervention for children and adolescents with overweight or obesity aged 6 to 17 years. Hippokratia 2022. [DOI: 10.1002/14651858.cd013688.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Lorena S Pacheco
- Department of Nutrition; Harvard T.H. Chan School of Public Health; Boston MA USA
| | | | - Erin Green
- Division of Nutritional Sciences; Cornell University; Ithaca NY USA
| | - Lynn M Johnson
- Cornell Statistical Consulting Unit; Cornell University; Ithaca NY USA
| | | | - Alessandro R Demaio
- Melbourne School of Population and Global Health; University of Melbourne; Melbourne Australia
- Center for a Livable Future; Johns Hopkins Bloomberg School of Public Health; Baltimore USA
| | | | - Louisa J Ells
- School of Clinical and Applied Sciences; Leeds Beckett University; Leeds UK
| | - Andrew J Hill
- Division of Psychological and Social Medicine; University of Leeds; Leeds UK
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23
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Ahern AL, Richards R, Jones RA, Whittle F, Mueller J, Woolston J, Sharp SJ, Hughes CA, Hill AJ, Duschinsky R, Lawlor ER, Morris S, Fusco F, Brennan A, Bostock J, Griffin SJ. Acceptability and feasibility of an acceptance and commitment therapy-based guided self-help intervention for weight loss maintenance in adults who have previously completed a behavioural weight loss programme: the SWiM feasibility study protocol. BMJ Open 2022; 12:e058103. [PMID: 35440459 PMCID: PMC9020279 DOI: 10.1136/bmjopen-2021-058103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The cost-effectiveness and long-term health impact of behavioural weight management programmes depends on post-treatment weight-loss maintenance. Growing evidence suggests that interventions using acceptance and commitment therapy (ACT) could improve long-term weight management. We developed an ACT-based, guided self-help intervention to support adults who have recently completed a behavioural weight loss programme. This study will assess the feasibility and acceptability of this type of intervention and findings will inform the development of a full-scale trial. METHODS AND ANALYSIS This is a pragmatic, randomised, single-blind, parallel group, two-arm, feasibility study with an embedded process evaluation. We will recruit and randomise 60 adults who have recently completed a behavioural weight loss programme to the ACT-based intervention or standard care, using a computer-generated sequence with 2:1 allocation stratified by diabetes status and sex. Baseline and 6-month measurements will be completed using online questionnaires. Qualitative interviews will be conducted with a subsample of participants and coaches about their experiences at 3 (mid-intervention) and 6 (postintervention) months. Feasibility and acceptability of the intervention, and a full-scale trial will be assessed using a number of outcomes, including adherence to, and engagement with the intervention, recruitment and retention rates, proportion of missing data for each outcome measure, participants' experiences of the intervention and study, and coaches' experiences of delivering intervention support. Quantitative and qualitative findings will be integrated and summarised to contribute to the interpretation of the main feasibility evaluation findings. Value of information methods will be used to estimate the decision uncertainty associated with the intervention's cost-effectiveness and determine the value of a definitive trial. ETHICS AND DISSEMINATION Ethical approval was received from Cambridge South Research Ethics Committee on 15/03/2021 (21/EE/0024). This protocol (V.2) was approved on 19 April 2021. Findings will be published in peer-reviewed scientific journals and communicated to other stakeholders as appropriate. TRIAL REGISTRATION NUMBER ISRCTN12685964.
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Affiliation(s)
- Amy L Ahern
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Rebecca Richards
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Rebecca A Jones
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Fiona Whittle
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Julia Mueller
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jenny Woolston
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Carly A Hughes
- Fakenham Medical Practice, Fakenham, UK
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | | | - Robbie Duschinsky
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Emma Ruth Lawlor
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Francesco Fusco
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alan Brennan
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Jennifer Bostock
- Quality and Outcomes of Person-Centred Care Policy Research Unit, Canterbury, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Khushaba RN, Hill AJ. Radar-Based Materials Classification Using Deep Wavelet Scattering Transform: A Comparison of Centimeter vs. Millimeter Wave Units. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3143200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Candio P, Meads D, Hill AJ, Bojke L. Does providing everyone with free-of-charge organised exercise opportunities work in public health? Health Policy 2022; 126:129-142. [PMID: 35034767 DOI: 10.1016/j.healthpol.2022.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Population-level initiatives of free-of-charge organised exercise have been implemented to encourage residents to take up regular physical activity. However, there exists a paucity of evidence on the ability of these interventions to attract and engage residents, especially targeted subgroups. Seeking to contribute to this evidence base, we evaluated a proportionate universal programme providing free exercise sessions, Leeds Let's Get Active. METHODS Descriptive statistics were used to summarise the programme data and participants. Time to event, count and logistic regression models examined how different population subgroups engaged with the programme in terms of number of entries, weekly participation rates and drop-off patterns. RESULTS 51,874 adult residents registered to the programme and provided baseline data (2013-2016). A small proportion (1.6%) attended the free sessions on a weekly basis. Higher participation rates were estimated for the groups of males, retired and non-inactive participants. A neighbourhood-level deprivation status was found to have no marginal effect on the level and frequency of participation, but to be negatively associated with participation drop-off (HR 0.93, 95% CI 0.89-0.97, p = 0.001). CONCLUSIONS Providing everyone with free-of-charge organised exercise opportunities in public leisure centres located in deprived areas can attract large volumes of residents, but may not sufficiently encourage adults, especially inactive residents and those living in disadvantaged neighbourhoods, to take up regular exercise.
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Affiliation(s)
- Paolo Candio
- Centre for Economics of Obesity, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Leeds Institute of Health Sciences, University of Leeds, United Kingdom.
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, United Kingdom
| | - Andrew J Hill
- Leeds Institute of Health Sciences, University of Leeds, United Kingdom
| | - Laura Bojke
- Centre for Health Economics, University of York, United Kingdom
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26
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Richards R, Jones RA, Whittle F, Hughes CA, Hill AJ, Lawlor ER, Bostock J, Bates S, Breeze PR, Brennan A, Thomas CV, Stubbings M, Woolston J, Griffin SJ, Ahern AL. Development of a Web-Based, Guided Self-help, Acceptance and Commitment Therapy-Based Intervention for Weight Loss Maintenance: Evidence-, Theory-, and Person-Based Approach. JMIR Form Res 2022; 6:e31801. [PMID: 34994698 PMCID: PMC8783282 DOI: 10.2196/31801] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 12/15/2022] Open
Abstract
Background The long-term impact and cost-effectiveness of weight management programs depend on posttreatment weight maintenance. There is growing evidence that interventions based on third-wave cognitive behavioral therapy, particularly acceptance and commitment therapy (ACT), could improve long-term weight management; however, these interventions are typically delivered face-to-face by psychologists, which limits the scalability of these types of intervention. Objective The aim of this study is to use an evidence-, theory-, and person-based approach to develop an ACT-based intervention for weight loss maintenance that uses digital technology and nonspecialist guidance to minimize the resources needed for delivery at scale. Methods Intervention development was guided by the Medical Research Council framework for the development of complex interventions in health care, Intervention Mapping Protocol, and a person-based approach for enhancing the acceptability and feasibility of interventions. Work was conducted in two phases: phase 1 consisted of collating and analyzing existing and new primary evidence and phase 2 consisted of theoretical modeling and intervention development. Phase 1 included a synthesis of existing evidence on weight loss maintenance from previous research, a systematic review and network meta-analysis of third-wave cognitive behavioral therapy interventions for weight management, a qualitative interview study of experiences of weight loss maintenance, and the modeling of a justifiable cost for a weight loss maintenance program. Phase 2 included the iterative development of guiding principles, a logic model, and the intervention design and content. Target user and stakeholder panels were established to inform each phase of development, and user testing of successive iterations of the prototype intervention was conducted. Results This process resulted in a guided self-help ACT-based intervention called SWiM (Supporting Weight Management). SWiM is a 4-month program consisting of weekly web-based sessions for 13 consecutive weeks followed by a 4-week break for participants to reflect and practice their new skills and a final session at week 18. Each session consists of psychoeducational content, reflective exercises, and behavioral experiments. SWiM includes specific sessions on key determinants of weight loss maintenance, including developing skills to manage high-risk situations for lapses, creating new helpful habits, breaking old unhelpful habits, and learning to manage interpersonal relationships and their impact on weight management. A trained, nonspecialist coach provides guidance for the participants through the program with 4 scheduled 30-minute telephone calls and 3 further optional calls. Conclusions This comprehensive approach facilitated the development of an intervention that is based on scientific theory and evidence for supporting people with weight loss maintenance and is grounded in the experiences of the target users and the context in which it is intended to be delivered. The intervention will be refined based on the findings of a planned pilot randomized controlled trial.
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Affiliation(s)
- Rebecca Richards
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Rebecca A Jones
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Fiona Whittle
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | | | - Andrew J Hill
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Emma R Lawlor
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Jennifer Bostock
- Patient and Public Involvement Representative, Kent, United Kingdom
| | - Sarah Bates
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - Penny R Breeze
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - Alan Brennan
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - Chloe V Thomas
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - Marie Stubbings
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Jennifer Woolston
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Simon J Griffin
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Amy L Ahern
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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Mueller J, Richards R, Jones RA, Whittle F, Woolston J, Stubbings M, Sharp SJ, Griffin SJ, Bostock J, Hughes CA, Hill AJ, Ahern AL. Supporting Weight Management during COVID-19: A Randomized Controlled Trial of a Web-Based, ACT-Based, Guided Self-Help Intervention. Obes Facts 2022; 15:550-559. [PMID: 35417910 PMCID: PMC9421710 DOI: 10.1159/000524031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/09/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Adults with overweight and obesity are vulnerable to weight gain and mental health deterioration during the COVID-19 pandemic. We developed a web-based, guided self-help intervention based on Acceptance and Commitment Therapy (ACT) that aims to support adults with overweight and obesity to prevent weight gain by helping them to manage their eating behaviours, be more physically active, and protect their emotional wellbeing ("SWiM-C"). SWiM-C is a guided self-help programme using non-specialist guides to enhance scalability and population reach while minimizing cost. This study evaluated the effect of SWiM-C on bodyweight, eating behaviour, physical activity, and mental wellbeing in adults with overweight and obesity over 4 months during the COVID-19 pandemic in the UK. METHODS We randomized adults (BMI ≥25 kg/m2) to SWiM-C or to a wait-list standard advice group. Participants completed outcome assessments online at baseline and 4 months. The primary outcome was self-measured weight; secondary outcomes were eating behaviour, physical activity, experiential avoidance/psychological flexibility, depression, anxiety, stress, and wellbeing. We estimated differences between study groups in change in outcomes from baseline to 4 months using linear regression, adjusted for outcome at baseline and the randomization stratifiers (BMI, sex). The trial was pre-registered (ISRCTN12107048). RESULTS 486 participants were assessed for eligibility; 388 participants were randomized (196 standard advice, 192 SWiM-C), and 324 were analysed. The adjusted difference in weight between SWiM-C and standard advice was -0.60 kg (-1.67 to 0.47, p = 0.27). SWiM-C led to improvements in uncontrolled eating (-3.61 [-5.94 to -1.28]), cognitive restraint (5.28 [2.81-7.75]), experiential avoidance (-3.39 [-5.55 to -1.23]), and wellbeing (0.13 [0.07-0.18]). CONCLUSIONS SWiM-C improved several psychological determinants of successful weight management and had a protective effect on wellbeing during the pandemic. However, differences in weight and some other outcomes were compatible with no effect of the intervention, suggesting further refinement of the intervention is needed.
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Affiliation(s)
- Julia Mueller
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- *Julia Mueller,
| | - Rebecca Richards
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Rebecca A. Jones
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Fiona Whittle
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Jennifer Woolston
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Marie Stubbings
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Stephen J. Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Simon J. Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jennifer Bostock
- Patient and Public Involvement Representative, Cambridge, United Kingdom
| | - Carly A. Hughes
- Fakenham Medical Practice, Fakenham, United Kingdom
- Medical School, University of East Anglia, Norwich, United Kingdom
| | - Andrew J. Hill
- Division of Psychological and Social Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Amy L. Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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Gilbody S, Littlewood E, McMillan D, Chew-Graham CA, Bailey D, Gascoyne S, Sloan C, Burke L, Coventry P, Crosland S, Fairhurst C, Henry A, Hewitt C, Joshi K, Ryde E, Shearsmith L, Traviss-Turner G, Woodhouse R, Clegg A, Gentry T, Hill AJ, Lovell K, Dexter Smith S, Webster J, Ekers D. Behavioural activation to prevent depression and loneliness among socially isolated older people with long-term conditions: The BASIL COVID-19 pilot randomised controlled trial. PLoS Med 2021; 18:e1003779. [PMID: 34637450 PMCID: PMC8509874 DOI: 10.1371/journal.pmed.1003779] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/20/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Older adults, including those with long-term conditions (LTCs), are vulnerable to social isolation. They are likely to have become more socially isolated during the Coronavirus Disease 2019 (COVID-19) pandemic, often due to advice to "shield" to protect them from infection. This places them at particular risk of depression and loneliness. There is a need for brief scalable psychosocial interventions to mitigate the psychological impacts of social isolation. Behavioural activation (BA) is a credible candidate intervention, but a trial is needed. METHODS AND FINDINGS We undertook an external pilot parallel randomised trial (ISRCTN94091479) designed to test recruitment, retention and engagement with, and the acceptability and preliminary effects of the intervention. Participants aged ≥65 years with 2 or more LTCs were recruited in primary care and randomised by computer and with concealed allocation between June and October 2020. BA was offered to intervention participants (n = 47), and control participants received usual primary care (n = 49). Assessment of outcome was made blind to treatment allocation. The primary outcome was depression severity (measured using the Patient Health Questionnaire 9 (PHQ-9)). We also measured health-related quality of life (measured by the Short Form (SF)-12v2 mental component scale (MCS) and physical component scale (PCS)), anxiety (measured by the Generalised Anxiety Disorder 7 (GAD-7)), perceived social and emotional loneliness (measured by the De Jong Gierveld Scale: 11-item loneliness scale). Outcome was measured at 1 and 3 months. The mean age of participants was aged 74 years (standard deviation (SD) 5.5) and they were mostly White (n = 92, 95.8%), and approximately two-thirds of the sample were female (n = 59, 61.5%). Remote recruitment was possible, and 45/47 (95.7%) randomised to the intervention completed 1 or more sessions (median 6 sessions) out of 8. A total of 90 (93.8%) completed the 1-month follow-up, and 86 (89.6%) completed the 3-month follow-up, with similar rates for control (1 month: 45/49 and 3 months 44/49) and intervention (1 month: 45/47and 3 months: 42/47) follow-up. Between-group comparisons were made using a confidence interval (CI) approach, and by adjusting for the covariate of interest at baseline. At 1 month (the primary clinical outcome point), the median number of completed sessions for people receiving the BA intervention was 3, and almost all participants were still receiving the BA intervention. The between-group comparison for the primary clinical outcome at 1 month was an adjusted between-group mean difference of -0.50 PHQ-9 points (95% CI -2.01 to 1.01), but only a small number of participants had completed the intervention at this point. At 3 months, the PHQ-9 adjusted mean difference (AMD) was 0.19 (95% CI -1.36 to 1.75). When we examined loneliness, the adjusted between-group difference in the De Jong Gierveld Loneliness Scale at 1 month was 0.28 (95% CI -0.51 to 1.06) and at 3 months -0.87 (95% CI -1.56 to -0.18), suggesting evidence of benefit of the intervention at this time point. For anxiety, the GAD adjusted between-group difference at 1 month was 0.20 (-1.33, 1.73) and at 3 months 0.31 (-1.08, 1.70). For the SF-12 (physical component score), the adjusted between-group difference at 1 month was 0.34 (-4.17, 4.85) and at 3 months 0.11 (-4.46, 4.67). For the SF-12 (mental component score), the adjusted between-group difference at 1 month was 1.91 (-2.64, 5.15) and at 3 months 1.26 (-2.64, 5.15). Participants who withdrew had minimal depressive symptoms at entry. There were no adverse events. The Behavioural Activation in Social Isolation (BASIL) study had 2 main limitations. First, we found that the intervention was still being delivered at the prespecified primary outcome point, and this fed into the design of the main trial where a primary outcome of 3 months is now collected. Second, this was a pilot trial and was not designed to test between-group differences with high levels of statistical power. Type 2 errors are likely to have occurred, and a larger trial is now underway to test for robust effects and replicate signals of effectiveness in important secondary outcomes such as loneliness. CONCLUSIONS In this study, we observed that BA is a credible intervention to mitigate the psychological impacts of COVID-19 isolation for older adults. We demonstrated that it is feasible to undertake a trial of BA. The intervention can be delivered remotely and at scale, but should be reserved for older adults with evidence of depressive symptoms. The significant reduction in loneliness is unlikely to be a chance finding, and replication will be explored in a fully powered randomised controlled trial (RCT). TRIAL REGISTRATION ISRCTN94091479.
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Affiliation(s)
- Simon Gilbody
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
| | | | - Dean McMillan
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
| | | | - Della Bailey
- Department of Health Sciences, University of York, York, United Kingdom
| | - Samantha Gascoyne
- Department of Health Sciences, University of York, York, United Kingdom
| | - Claire Sloan
- Department of Health Sciences, University of York, York, United Kingdom
| | - Lauren Burke
- Department of Health Sciences, University of York, York, United Kingdom
| | - Peter Coventry
- Department of Health Sciences, University of York, York, United Kingdom
| | - Suzanne Crosland
- Department of Health Sciences, University of York, York, United Kingdom
| | | | - Andrew Henry
- Department of Health Sciences, University of York, York, United Kingdom
- Tees, Esk and Wear Valleys NHS FT, Research & Development, Flatts Lane Centre, Middlesbrough, United Kingdom
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York, United Kingdom
| | - Kalpita Joshi
- Department of Health Sciences, University of York, York, United Kingdom
| | - Eloise Ryde
- Department of Health Sciences, University of York, York, United Kingdom
- Tees, Esk and Wear Valleys NHS FT, Research & Development, Flatts Lane Centre, Middlesbrough, United Kingdom
| | - Leanne Shearsmith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Rebecca Woodhouse
- Department of Health Sciences, University of York, York, United Kingdom
| | - Andrew Clegg
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Andrew J. Hill
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom
| | - Sarah Dexter Smith
- Tees, Esk and Wear Valleys NHS FT, Research & Development, Flatts Lane Centre, Middlesbrough, United Kingdom
| | | | - David Ekers
- Department of Health Sciences, University of York, York, United Kingdom
- Tees, Esk and Wear Valleys NHS FT, Research & Development, Flatts Lane Centre, Middlesbrough, United Kingdom
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Candio P, Hill AJ, Poupakis S, Pulkki-Brännström AM, Bojke C, Gomes M. Copula Models for Addressing Sample Selection in the Evaluation of Public Health Programmes: An Application to the Leeds Let's Get Active Study. Appl Health Econ Health Policy 2021; 19:305-312. [PMID: 33426627 DOI: 10.1007/s40258-020-00629-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 06/12/2023]
Abstract
Sample selectivity is a recurrent problem in public health programmes and poses serious challenges to their evaluation. Traditional approaches to handle sample selection tend to rely on restrictive assumptions. The aim of this paper is to illustrate a copula-based selection model to handle sample selection in the evaluation of public health programmes. Motivated by a public health programme to promote physical activity in Leeds (England), we describe the assumptions underlying the copula selection, and its relative advantages compared with commonly used approaches to handle sample selection, such as inverse probability weighting and Heckman's selection model. We illustrate the methods in the Leeds Let's Get Active programme and show the implications of method choice for estimating the effect on individual's physical activity. The programme was associated with increased physical activity overall, but the magnitude of its effect differed according to adjustment method. The copula selection model led to a similar effect to the Heckman's approach but with relatively narrower 95% confidence intervals. These results remained relatively similar when different model specifications and alternative distributional assumptions were considered. The copula selection model can address important limitations of traditional approaches to address sample selection, such as the Heckman model, and should be considered in the evaluation of public health programmes, where sample selection is likely to be present.
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Affiliation(s)
- Paolo Candio
- Health Economics Research Centre, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Andrew J Hill
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Stavros Poupakis
- UCL Institute for Global Health, University College London, London, UK
| | - Anni-Maria Pulkki-Brännström
- UCL Institute for Global Health, University College London, London, UK
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Chris Bojke
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Manuel Gomes
- Department of Applied Health Research, University College London, London, UK
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Candio P, Meads D, Hill AJ, Bojke L. Taking a local government perspective for economic evaluation of a population-level programme to promote exercise. Health Policy 2021; 125:651-657. [PMID: 33750575 DOI: 10.1016/j.healthpol.2021.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/26/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In order to tackle the issue of physical inactivity, local governments have implemented population-level programmes to promote exercise. While evidence is accumulating on the cost-effectiveness of these interventions, studies have typically adopted a health sector perspective for economic evaluation. This approach has been challenged as it does not allow for key concerns by local governments, which are primary stakeholders, to be addressed. OBJECTIVES To show how taking a local government perspective for economic evaluation can be implemented in practice and this may affect the economic conclusions. METHODS Based on data from a case study, the health equity impact of the intervention and its opportunity cost from a service provider viewpoint were assessed. The cost-effectiveness implications of a change in perspective were subsequently estimated by means of scenario analysis. FINDINGS The intervention was found to provide adult residents living in the most deprived city areas with greater health benefits compared with the rest of the population. However, a negative net equity impact was found in the short-term. The opportunity cost of the intervention was estimated to be substantially lower than its financial cost (£2.77 per person/year), with significant implications for decision-making. CONCLUSIONS Taking a local government perspective can affect the conclusions drawn from the economic evaluation of population-level programmes to promote exercise, and therefore influence decision making.
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Affiliation(s)
- Paolo Candio
- Health Economics Research Centre, University of Oxford, 0X37LF Oxford, UK; Leeds Institute of Health Sciences, University of Leeds, LS29JT Leeds, UK.
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, LS29JT Leeds, UK
| | - Andrew J Hill
- Leeds Institute of Health Sciences, University of Leeds, LS29JT Leeds, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, YO105DD Heslington, UK
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Alexander J, LaPlant QC, Pattwell SS, Szulzewsky F, Cimino PJ, Caruso FP, Pugliese P, Chen Z, Chardon F, Hill AJ, Spurrell C, Ahrendsen D, Pietras A, Starita LM, Hambardzumyan D, Iavarone A, Shendure J, Holland EC. Multimodal single-cell analysis reveals distinct radioresistant stem-like and progenitor cell populations in murine glioma. Glia 2020; 68:2486-2502. [PMID: 32621641 PMCID: PMC7586969 DOI: 10.1002/glia.23866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/30/2020] [Accepted: 05/17/2020] [Indexed: 11/22/2022]
Abstract
Radiation therapy is part of the standard of care for gliomas and kills a subset of tumor cells, while also altering the tumor microenvironment. Tumor cells with stem-like properties preferentially survive radiation and give rise to glioma recurrence. Various techniques for enriching and quantifying cells with stem-like properties have been used, including the fluorescence activated cell sorting (FACS)-based side population (SP) assay, which is a functional assay that enriches for stem-like tumor cells. In these analyses, mouse models of glioma have been used to understand the biology of this disease and therapeutic responses, including the radiation response. We present combined SP analysis and single-cell RNA sequencing of genetically-engineered mouse models of glioma to show a time course of cellular response to radiation. We identify and characterize two distinct tumor cell populations that are inherently radioresistant and also distinct effects of radiation on immune cell populations within the tumor microenvironment.
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Affiliation(s)
- Jes Alexander
- Department of Genome SciencesUniversity of WashingtonSeattleWashingtonUSA
- Department of Radiation OncologyUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Quincey C. LaPlant
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Siobhan S. Pattwell
- Human Biology DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Frank Szulzewsky
- Human Biology DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Patrick J. Cimino
- Human Biology DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Francesca P. Caruso
- Dipartimento di Scienze e TecnologieUniversità degli Studi del SannioBeneventoItaly
- Bioinformatics Lab, BIOGEMAriano IrpinoItaly
| | - Pietro Pugliese
- Dipartimento di Scienze e TecnologieUniversità degli Studi del SannioBeneventoItaly
- Bioinformatics Lab, BIOGEMAriano IrpinoItaly
| | - Zhihong Chen
- Department of Oncological SciencesTisch Cancer Institute, and Department of Neurosurgery, Mount Sinai Icahn School of MedicineNew YorkNew YorkUSA
| | - Florence Chardon
- Department of Genome SciencesUniversity of WashingtonSeattleWashingtonUSA
| | - Andrew J. Hill
- Department of Genome SciencesUniversity of WashingtonSeattleWashingtonUSA
| | - Cailyn Spurrell
- Brotman Baty Institute for Precision MedicineSeattleWashingtonUSA
| | - Dakota Ahrendsen
- Brotman Baty Institute for Precision MedicineSeattleWashingtonUSA
| | | | - Lea M. Starita
- Department of Genome SciencesUniversity of WashingtonSeattleWashingtonUSA
- Brotman Baty Institute for Precision MedicineSeattleWashingtonUSA
| | - Dolores Hambardzumyan
- Department of Oncological SciencesTisch Cancer Institute, and Department of Neurosurgery, Mount Sinai Icahn School of MedicineNew YorkNew YorkUSA
| | - Antonio Iavarone
- Institute for Cancer Genetics, Department of Neurology, Department of Pathology and Cell BiologyColumbia University Medical CenterNew YorkNew YorkUSA
| | - Jay Shendure
- Department of Genome SciencesUniversity of WashingtonSeattleWashingtonUSA
- Brotman Baty Institute for Precision MedicineSeattleWashingtonUSA
- Allen Discovery Center for Cell LineageSeattleWashingtonUSA
- Howard Hughes Medical InstituteUniversity of WashingtonSeattleWashingtonUSA
| | - Eric C. Holland
- Human Biology DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
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Domcke S, Hill AJ, Daza RM, Cao J, O'Day DR, Pliner HA, Aldinger KA, Pokholok D, Zhang F, Milbank JH, Zager MA, Glass IA, Steemers FJ, Doherty D, Trapnell C, Cusanovich DA, Shendure J. A human cell atlas of fetal chromatin accessibility. Science 2020; 370:eaba7612. [PMID: 33184180 PMCID: PMC7785298 DOI: 10.1126/science.aba7612] [Citation(s) in RCA: 181] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022]
Abstract
The chromatin landscape underlying the specification of human cell types is of fundamental interest. We generated human cell atlases of chromatin accessibility and gene expression in fetal tissues. For chromatin accessibility, we devised a three-level combinatorial indexing assay and applied it to 53 samples representing 15 organs, profiling ~800,000 single cells. We leveraged cell types defined by gene expression to annotate these data and cataloged hundreds of thousands of candidate regulatory elements that exhibit cell type-specific chromatin accessibility. We investigated the properties of lineage-specific transcription factors (such as POU2F1 in neurons), organ-specific specializations of broadly distributed cell types (such as blood and endothelial), and cell type-specific enrichments of complex trait heritability. These data represent a rich resource for the exploration of in vivo human gene regulation in diverse tissues and cell types.
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Affiliation(s)
- Silvia Domcke
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Andrew J Hill
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Riza M Daza
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Junyue Cao
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Diana R O'Day
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Hannah A Pliner
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
| | - Kimberly A Aldinger
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | | | | | - Jennifer H Milbank
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Michael A Zager
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Center for Data Visualization, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ian A Glass
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | | | - Dan Doherty
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Cole Trapnell
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA.
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Allen Discovery Center for Cell Lineage Tracing, Seattle, WA, USA
| | - Darren A Cusanovich
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA.
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ, USA
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Jay Shendure
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA.
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Allen Discovery Center for Cell Lineage Tracing, Seattle, WA, USA
- Howard Hughes Medical Institute, Seattle, WA, USA
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Lawlor ER, Hughes CA, Duschinsky R, Pountain GD, Hill AJ, Griffin SJ, Ahern AL. Cognitive and behavioural strategies employed to overcome "lapses" and prevent "relapse" among weight-loss maintainers and regainers: A qualitative study. Clin Obes 2020; 10:e12395. [PMID: 32767708 PMCID: PMC7116423 DOI: 10.1111/cob.12395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 02/02/2023]
Abstract
While many behavioural weight management programmes are effective in the short-term, post-programme weight regain is common. Overcoming "lapses" and preventing "relapse" has been highlighted as important in weight-loss maintenance, but little is known on how this is achieved. This study aimed to compare the cognitive and behavioural strategies employed to overcome "lapses" and prevent "relapse" by people who had regained weight or maintained weight-loss after participating in a weight management programme. By investigating differences between groups, we intended to identify strategies associated with better weight-loss maintenance. Semi-structured interviews were conducted with 26 participants (58% female) recruited from the 5-year follow-up of the Weight Loss Referrals for Adults in Primary Care (WRAP) trial (evaluation of a commercial weight-loss programme). Participants who had lost ≥5% baseline weight during the active intervention were purposively sampled according to 5-year weight trajectories (n = 16 'Regainers', n = 10 'Maintainers'). Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Key differences in strategies were that Maintainers continued to pay attention to their dietary intake, anticipated and planned for potential lapses in high-risk situations, and managed impulses using distraction techniques. Regainers did not report making plans, used relaxed dietary monitoring, found distraction techniques to be ineffective and appeared to have difficulty navigating food within interpersonal relationships. This study is one of the longest qualitative follow-ups of a weight loss trial to date, offering unique insights into long-term maintenance. Future programmes should emphasize strategies focusing on self-monitoring, planning and managing interpersonal relationships to help participants successfully maintain weight-loss in the longer-term.
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Affiliation(s)
- Emma R Lawlor
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
| | - Carly A Hughes
- Fakenham Medical Practice, Norfolk, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Robbie Duschinsky
- Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, England
| | | | - Andrew J Hill
- Division of Psychological & Social Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
- Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, England
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
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Candio P, Meads D, Hill AJ, Bojke L. Cost-effectiveness of a proportionate universal offer of free exercise: Leeds Let’s Get Active. J Public Health (Oxf) 2020; 43:876-886. [DOI: 10.1093/pubmed/fdaa113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
The purpose of this paper is to assess the cost-effectiveness of a proportionate universal programme to reduce physical inactivity (Leeds Let us Get Active (LLGA)) in adults.
Methods
A continuous-time Markov chain model was developed to assess the cost implications and QALY gains associated with increases in physical activity levels across the adult population. A parametric survival analysis approach was applied to estimate the decay of intervention effect over time. Baseline model data were obtained from previous economic models, population-based surveys and other published literature. A cost-utility analysis was conducted from a health care sector perspective over the programme duration (39 months). Scenario and probabilistic sensitivity analyses were performed to test the robustness of cost-effectiveness results.
Results
In total, 51 874 adult residents registered to the programme and provided baseline data,19.5% of which were living in deprived areas. Under base case assumptions, LLGA was found to be likely to be cost-effective. However, variations in key structural assumptions showed sensitivity of the results.
Conclusions
Results from this study suggest a non-negligible level of uncertainty regarding the effectiveness, and therefore, cost-effectiveness of a universal offer of free leisure centre-based exercise that targets hard to reach groups. Further data collection and a shift towards prospective evaluations are needed.
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Affiliation(s)
- Paolo Candio
- Health Economics Research Centre, University of Oxford, Oxford OX3 7LF, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Andrew J Hill
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, York YO10 5DD, UK
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Vanden Brink H, Pacheco LS, Bahnfleth CL, Green E, Johnson LM, Sanderson K, Demaio AR, Farpour-Lambert N, Ells LJ, Hill AJ. Psychological interventions delivered as a single component intervention for children and adolescents with overweight or obesity aged 6 to 17 years. Hippokratia 2020. [DOI: 10.1002/14651858.cd013688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Lorena S Pacheco
- Department of Nutrition; Harvard T.H. Chan School of Public Health; Boston MA USA
| | | | - Erin Green
- Division of Nutritional Sciences; Cornell University; Ithaca NY USA
| | - Lynn M Johnson
- Cornell Statistical Consulting Unit; Cornell University; Ithaca NY USA
| | | | - Alessandro R Demaio
- Melbourne School of Population and Global Health; University of Melbourne; Melbourne Australia
- Center for a Livable Future; Johns Hopkins Bloomberg School of Public Health; Baltimore USA
| | | | - Louisa J Ells
- School of Clinical and Applied Sciences; Leeds Beckett University; Leeds UK
| | - Andrew J Hill
- Division of Psychological and Social Medicine; University of Leeds; Leeds UK
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Lawlor ER, Islam N, Bates S, Griffin SJ, Hill AJ, Hughes CA, Sharp SJ, Ahern AL. Third-wave cognitive behaviour therapies for weight management: A systematic review and network meta-analysis. Obes Rev 2020; 21:e13013. [PMID: 32181957 PMCID: PMC7379202 DOI: 10.1111/obr.13013] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/28/2020] [Accepted: 02/06/2020] [Indexed: 12/30/2022]
Abstract
This systematic review and network meta-analysis synthesized evidence on the effects of third-wave cognitive behaviour therapies (3wCBT) on body weight, and psychological and physical health outcomes in adults with overweight or obesity. Studies that included a 3wCBT for the purposes of weight management and measured weight or body mass index (BMI) pre-intervention and ≥ 3 months post-baseline were identified through database searches (MEDLINE, CINAHL, Embase, Cochrane database [CENTRAL], PsycINFO, AMED, ASSIA, and Web of Science). Thirty-seven studies were eligible; 21 were randomized controlled trials (RCT) and included in the network meta-analyses. Risk of bias was assessed using RoB2, and evidence quality was assessed using GRADE. Random-effects pairwise meta-analysis found moderate- to high-quality evidence suggesting that 3wCBT had greater weight loss than standard behavioural treatment (SBT) at post-intervention (standardized mean difference [SMD]: -0.09, 95% confidence interval [CI]: -0.22, 0.04; N = 19; I2 = 32%), 12 months (SMD: -0.17, 95% CI: -0.36, 0.02; N = 5; I2 = 33%), and 24 months (SMD: -0.21, 95% CI: -0.42, 0.00; N = 2; I2 = 0%). Network meta-analysis compared the relative effectiveness of different types of 3wCBT that were not tested in head-to-head trials up to 18 months. Acceptance and commitment therapy (ACT)-based interventions had the most consistent evidence of effectiveness. Only ACT had RCT evidence of effectiveness beyond 18 months. Meta-regression did not identify any specific intervention characteristics (dose, duration, delivery) that were associated with greater weight loss. Evidence supports the use of 3wCBT for weight management, specifically ACT. Larger trials with long-term follow-up are needed to identify who these interventions work for, their most effective components, and the most cost-effective method of delivery.
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Affiliation(s)
| | - Nazrul Islam
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Sarah Bates
- School of Health and Related Research, Faculty of Medicine, Dentistry and HealthUniversity of SheffieldSheffieldUK
| | - Simon J. Griffin
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
- Primary Care Unit, Institute of Public HealthUniversity of CambridgeCambridgeUK
| | - Andrew J. Hill
- Division of Psychological and Social Medicine, School of MedicineUniversity of LeedsLeedsUK
| | - Carly A. Hughes
- Fakenham Medical PracticeNorfolkUK
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | | | - Amy L. Ahern
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
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Wang Q, Pierce-Hoffman E, Cummings BB, Alföldi J, Francioli LC, Gauthier LD, Hill AJ, O'Donnell-Luria AH, Karczewski KJ, MacArthur DG. Landscape of multi-nucleotide variants in 125,748 human exomes and 15,708 genomes. Nat Commun 2020; 11:2539. [PMID: 32461613 PMCID: PMC7253413 DOI: 10.1038/s41467-019-12438-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/09/2019] [Indexed: 12/31/2022] Open
Abstract
Multi-nucleotide variants (MNVs), defined as two or more nearby variants existing on the same haplotype in an individual, are a clinically and biologically important class of genetic variation. However, existing tools typically do not accurately classify MNVs, and understanding of their mutational origins remains limited. Here, we systematically survey MNVs in 125,748 whole exomes and 15,708 whole genomes from the Genome Aggregation Database (gnomAD). We identify 1,792,248 MNVs across the genome with constituent variants falling within 2 bp distance of one another, including 18,756 variants with a novel combined effect on protein sequence. Finally, we estimate the relative impact of known mutational mechanisms - CpG deamination, replication error by polymerase zeta, and polymerase slippage at repeat junctions - on the generation of MNVs. Our results demonstrate the value of haplotype-aware variant annotation, and refine our understanding of genome-wide mutational mechanisms of MNVs.
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Affiliation(s)
- Qingbo Wang
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
- Program in Bioinformatics and Integrative Genomics, Harvard Medical School, Boston, MA, 02115, USA
| | - Emma Pierce-Hoffman
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Beryl B Cummings
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
- Program in Biomedical and Biological Sciences, Harvard Medical School, Boston, MA, 02115, USA
| | - Jessica Alföldi
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Laurent C Francioli
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Laura D Gauthier
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Andrew J Hill
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, 98195, USA
| | - Anne H O'Donnell-Luria
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Konrad J Karczewski
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Daniel G MacArthur
- Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA.
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA.
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, Australia.
- Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Australia.
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Ahern AL, Woolston J, Wells E, Sharp SJ, Islam N, Lawlor ER, Duschinsky R, Hill AJ, Doble B, Wilson E, Morris S, Hughes CA, Brennan A, Bostock J, Boothby C, Griffin SJ. Clinical and cost-effectiveness of a diabetes education and behavioural weight management programme versus a diabetes education programme in adults with a recent diagnosis of type 2 diabetes: study protocol for the Glucose Lowering through Weight management (GLoW) randomised controlled trial. BMJ Open 2020; 10:e035020. [PMID: 32350016 PMCID: PMC7213851 DOI: 10.1136/bmjopen-2019-035020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION People with type 2 diabetes (T2D) can improve glycaemic control or even achieve remission through weight loss and reduce their use of medication and risk of cardiovascular disease. The Glucose Lowering through Weight management (GLoW) trial will evaluate whether a tailored diabetes education and behavioural weight management programme (DEW) is more effective and cost-effective than a diabetes education (DE) programme in helping people with overweight or obesity and a recent diagnosis of T2D to lower their blood glucose, lose weight and improve other markers of cardiovascular risk. METHODS AND ANALYSIS This study is a pragmatic, randomised, single-blind, parallel group, two-arm, superiority trial. We will recruit 576 adults with body mass index>25 kg/m2 and diagnosis of T2D in the past 3 years and randomise them to a tailored DEW or a DE programme. Participants will attend measurement appointments at a local general practitioner practice or research centre at baseline, 6 and 12 months. The primary outcome is 12-month change in glycated haemoglobin. The effect of the intervention on the primary outcome will be estimated and tested using a linear regression model (analysis of covariance) including randomisation group and adjusted for baseline value of the outcome and the randomisation stratifiers. Participants will be included in the group to which they were randomised, under the intention-to-treat principle. Secondary outcomes include 6-month and 12-month changes in body weight, body fat percentage, systolic and diastolic blood pressure and lipid profile; probability of achieving good glycaemic control; probability of achieving remission from diabetes; probability of losing 5% and 10% body weight and modelled cardiovascular risk (UKPDS). An intention-to-treat within-trial cost-effectiveness analysis will be conducted from NHS and societal perspectives using participant-level data. Qualitative interviews will be conducted with participants to understand why and how the programme achieved its results and how participants manage their weight after the programme ends. ETHICS AND DISSEMINATION Ethical approval was received from East of Scotland Research Ethics Service on 15 May 2018 (18/ES/0048). This protocol (V.3) was approved on 19 June 2019. Findings will be published in peer-reviewed scientific journals and communicated to other stakeholders as appropriate. TRIAL REGISTRATION NUMBER ISRCTN18399564.
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Affiliation(s)
- Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Jenny Woolston
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Emma Wells
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Nazrul Islam
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Emma Ruth Lawlor
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Robbie Duschinsky
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Andrew J Hill
- School of Medicine, University of Leeds, Leeds, West Yorkshire, UK
| | - Brett Doble
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Ed Wilson
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Stephen Morris
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Carly A Hughes
- Patient and Public Involvement Representative, Fakenham Medical Practice, Fakenham, Norfolk, UK
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Alan Brennan
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Clare Boothby
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
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Kilmurray M, Collins SC, Caterson ID, Hill AJ. Is Weight Bias Evident in Peer Interactions Between Young and Older Children? Obesity (Silver Spring) 2020; 28:333-338. [PMID: 31868313 DOI: 10.1002/oby.22686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/26/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aimed to investigate whether weight bias is apparent in young and older children's interactions during a paired reading activity. METHODS One hundred seventy-two children (57% girls) read a book in which the main character, "Alfie," was portrayed either as average weight or as having obesity. Younger children (mean = 6.1 years) were paired with a same-sex older child (mean = 9.5 years). Questions within and at the end of the story prompted discussion. Children's conversations were analyzed according to valence (emotional tone). Nonverbal behavior was noted via observation. RESULTS Pairs of children reading about the Alfie character with obesity made significantly more negative and fewer positive comments when offering story completions. Just one pair of boys spoke about him being "fat." There was no evidence that older children passed negative attitudes to younger children. Covertly expressed weight bias was more common. There was more frequent laughter while reading about the character with obesity, and two pairs made nonverbal reference to Alfie's appearance. CONCLUSIONS Covert weight bias was apparent in the interactions of some of these children, but overt weight bias was rare. There is a need to establish a better chronology of children's awareness of, and attitudes toward, obesity and how they are acquired.
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Affiliation(s)
- Michelle Kilmurray
- Division of Psychological & Social Medicine, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Sylvie C Collins
- Division of Psychological & Social Medicine, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Ian D Caterson
- Boden Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Andrew J Hill
- Division of Psychological & Social Medicine, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
- Boden Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
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Lee DA, Liu J, Hong Y, Lane JM, Hill AJ, Hou SL, Wang H, Oikonomou G, Pham U, Engle J, Saxena R, Prober DA. Evolutionarily conserved regulation of sleep by epidermal growth factor receptor signaling. Sci Adv 2019; 5:eaax4249. [PMID: 31763451 PMCID: PMC6853770 DOI: 10.1126/sciadv.aax4249] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/17/2019] [Indexed: 05/03/2023]
Abstract
The genetic bases for most human sleep disorders and for variation in human sleep quantity and quality are largely unknown. Using the zebrafish, a diurnal vertebrate, to investigate the genetic regulation of sleep, we found that epidermal growth factor receptor (EGFR) signaling is necessary and sufficient for normal sleep levels and is required for the normal homeostatic response to sleep deprivation. We observed that EGFR signaling promotes sleep via mitogen-activated protein kinase/extracellular signal-regulated kinase and RFamide neuropeptide signaling and that it regulates RFamide neuropeptide expression and neuronal activity. Consistent with these findings, analysis of a large cohort of human genetic data from participants of European ancestry revealed that common variants in genes within the EGFR signaling pathway are associated with variation in human sleep quantity and quality. These results indicate that EGFR signaling and its downstream pathways play a central and ancient role in regulating sleep and provide new therapeutic targets for sleep disorders.
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Affiliation(s)
- Daniel A. Lee
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Justin Liu
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Young Hong
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Jacqueline M. Lane
- Center for Genomic Medicine and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02142, USA
| | - Andrew J. Hill
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Sarah L. Hou
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Heming Wang
- Center for Genomic Medicine and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02142, USA
| | - Grigorios Oikonomou
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Uyen Pham
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Jae Engle
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Richa Saxena
- Center for Genomic Medicine and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02142, USA
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - David A. Prober
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
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McFaline-Figueroa JL, Hill AJ, Qiu X, Jackson D, Shendure J, Trapnell C. A pooled single-cell genetic screen identifies regulatory checkpoints in the continuum of the epithelial-to-mesenchymal transition. Nat Genet 2019; 51:1389-1398. [PMID: 31477929 PMCID: PMC6756480 DOI: 10.1038/s41588-019-0489-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/23/2019] [Indexed: 12/20/2022]
Abstract
Integrating single-cell trajectory analysis with pooled genetic screening could reveal the genetic architecture that guides cellular decisions in development and disease. We applied this paradigm to probe the genetic circuitry that controls epithelial-to-mesenchymal transition (EMT). We used single-cell RNA sequencing to profile epithelial cells undergoing a spontaneous spatially determined EMT in the presence or absence of transforming growth factor-β. Pseudospatial trajectory analysis identified continuous waves of gene regulation as opposed to discrete 'partial' stages of EMT. KRAS was connected to the exit from the epithelial state and the acquisition of a fully mesenchymal phenotype. A pooled single-cell CRISPR-Cas9 screen identified EMT-associated receptors and transcription factors, including regulators of KRAS, whose loss impeded progress along the EMT. Inhibiting the KRAS effector MEK and its upstream activators EGFR and MET demonstrates that interruption of key signaling events reveals regulatory 'checkpoints' in the EMT continuum that mimic discrete stages, and reconciles opposing views of the program that controls EMT.
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Affiliation(s)
| | - Andrew J Hill
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Xiaojie Qiu
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, CA, USA
| | - Dana Jackson
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Jay Shendure
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Howard Hughes Medical Institute, Seattle, WA, USA
- Allen Discovery Center for Cell Lineage Tracing, Seattle, WA, USA
| | - Cole Trapnell
- Department of Genome Sciences, University of Washington, Seattle, WA, USA.
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA.
- Allen Discovery Center for Cell Lineage Tracing, Seattle, WA, USA.
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Katsuura Y, Hill AJ, Colón LF, Dorizas JA. MRI diagnosis of suprascapular neuropathy using spinoglenoid notch distension. Radiol Med 2019; 124:643-652. [PMID: 30835024 DOI: 10.1007/s11547-019-01005-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/11/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the use of a spinoglenoid notch distension measurement as a radiographic marker on MRI to aid the diagnosis of suprascapular neuropathy. METHODS Spinoglenoid notch distension was compared on MRI by blinded independent observers for two patient cohorts: one group with an electromyography/nerve conduction study confirmed diagnosis of suprascapular neuropathy who underwent arthroscopic suprascapular nerve decompression, and a control group of patients aged 18-30 years with a normal shoulder MRI. RESULTS Sixty suprascapular nerve patients (average age 52 years) were compared to 47 control patients (average age 24 years). Intra-rater and inter-rater reliability showed excellent agreement between reviewers for all measurements. There was a significant difference in the mean spinoglenoid notch distension for the SSN group (m = 8.36, SD = 2.42) compared to the control group (m = 5.7, SD = 1.56); [t(212) = 9.40, p < 0.0001]. CONCLUSION The spinoglenoid notch distension is significantly increased in patients with suprascapular neuropathy. We hypothesize that hypertrophy of the transverse scapular ligament creates a venous obstruction resulting in varicosities of the suprascapular vein which runs with the nerve under the ligament. This distends the spinoglenoid notch and can be enlarged in cases of suprascapular neuropathy which is evident on MRI.
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Affiliation(s)
- Yoshihiro Katsuura
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine, Chattanooga, 975 East Third St., Hospital Box 260, Chattanooga, TN, 37403, USA.
| | - Andrew J Hill
- Department of Radiology, Erlanger University Hospital, Chattanooga, USA
| | | | - John A Dorizas
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine, Chattanooga, 975 East Third St., Hospital Box 260, Chattanooga, TN, 37403, USA
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Cao J, Spielmann M, Qiu X, Huang X, Ibrahim DM, Hill AJ, Zhang F, Mundlos S, Christiansen L, Steemers FJ, Trapnell C, Shendure J. The single-cell transcriptional landscape of mammalian organogenesis. Nature 2019; 566:496-502. [PMID: 30787437 PMCID: PMC6434952 DOI: 10.1038/s41586-019-0969-x] [Citation(s) in RCA: 1649] [Impact Index Per Article: 329.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 01/10/2019] [Indexed: 12/15/2022]
Abstract
Mammalian organogenesis is a remarkable process. Within a short timeframe, the cells of the three germ layers transform into an embryo that includes most of the major internal and external organs. Here we investigate the transcriptional dynamics of mouse organogenesis at single-cell resolution. Using single-cell combinatorial indexing, we profiled the transcriptomes of around 2 million cells derived from 61 embryos staged between 9.5 and 13.5 days of gestation, in a single experiment. The resulting 'mouse organogenesis cell atlas' (MOCA) provides a global view of developmental processes during this critical window. We use Monocle 3 to identify hundreds of cell types and 56 trajectories, many of which are detected only because of the depth of cellular coverage, and collectively define thousands of corresponding marker genes. We explore the dynamics of gene expression within cell types and trajectories over time, including focused analyses of the apical ectodermal ridge, limb mesenchyme and skeletal muscle.
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Affiliation(s)
- Junyue Cao
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
- Molecular and Cellular Biology Program, University of Washington, Seattle, WA, USA
| | - Malte Spielmann
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Xiaojie Qiu
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
- Molecular and Cellular Biology Program, University of Washington, Seattle, WA, USA
| | - Xingfan Huang
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
- Department of Computer Science, University of Washington, Seattle, WA, USA
| | - Daniel M Ibrahim
- Max Planck Institute for Molecular Genetics, RG Development & Disease, Berlin, Germany
- Institute for Medical and Human Genetics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andrew J Hill
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | | | - Stefan Mundlos
- Max Planck Institute for Molecular Genetics, RG Development & Disease, Berlin, Germany
- Institute for Medical and Human Genetics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Cole Trapnell
- Department of Genome Sciences, University of Washington, Seattle, WA, USA.
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA.
- Allen Discovery Center for Cell Lineage Tracing, Seattle, WA, USA.
| | - Jay Shendure
- Department of Genome Sciences, University of Washington, Seattle, WA, USA.
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA.
- Allen Discovery Center for Cell Lineage Tracing, Seattle, WA, USA.
- Howard Hughes Medical Institute, Seattle, WA, USA.
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Madigan CD, Hill AJ, Hendy C, Burk J, Caterson ID. 'Say no': a feasibility trial of a brief intervention to reduce instances of indulgent energy-intake episodes. Clin Obes 2018; 8:313-322. [PMID: 30066362 DOI: 10.1111/cob.12261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/26/2018] [Accepted: 05/18/2018] [Indexed: 11/29/2022]
Abstract
The aim of this study is to examine the feasibility of a brief intervention to reduce instances of indulgent energy intake. Forty-five participants with a body mass index (BMI) ≥25 kg m-2 were randomized to one of three groups for 8 weeks. The control group was asked to complete a questionnaire every 4 days, the self-monitoring group was given the same instructions but also asked to 'say no' to indulgences. The self-monitoring and feedback group was asked to do the same but in addition to send a photograph or description of that to which they had 'said no' and were then provided with feedback. All participants reported on indulgences for 7 days prospectively at baseline and 8-week follow-up. The follow-up rate was 80%; completion of questionnaires was 63% and 87 text messages were sent. The control group reduced their indulgences by 4.1 (SD 10.0), the self-monitoring group by 13.8 (SD 16.8) and self-monitoring and feedback group by 9.0 (SD 11.7) per week. All bar one, feasibility progression criteria were met and this was the return of the indulgence diaries during the intervention period. The study demonstrates the feasibility of a brief intervention to reduce the number of indulgences people ate. The progression criteria were met and areas of improvement are highlighted.
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Affiliation(s)
- C D Madigan
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Oxford, UK
| | - A J Hill
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Division of Psychological and Social Medicine, Leeds Institute of Health Sciences, Leeds, UK
| | - C Hendy
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - J Burk
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - I D Caterson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
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Charsley JS, Collins SC, Hill AJ. The bigger picture: young children's perception of fatness in the context of other physical differences. Pediatr Obes 2018; 13:558-566. [PMID: 29701306 DOI: 10.1111/ijpo.12280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/12/2017] [Accepted: 02/07/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Negative obesity stereotypes and anti-fat attitudes have been observed in children from age three. It is uncertain whether this is specific to fatness or generalizable to other visible differences. OBJECTIVES To determine whether young children base decisions about qualities in others and friendship choices more on fatness than other visible differences between people. METHODS Using a personal construct theory approach, 85 children (mean age 5.7, 42 girls) completed a simple repertory grid. The children were asked about differences (constructs) between four illustrations (elements) that showed children as healthy weight, fat, the opposite gender and in a wheelchair. Children were also asked about friendship with the illustrated children and self-image preferences. Their answers were grouped using thematic analysis. RESULTS The fat, opposite gender and wheelchair-bound characters were equally chosen by children as different to the standard character. When identifying differences, fatness or body shape was referred to significantly less than gender or being in a wheelchair. Children were more likely to reject an opposite gender character as a friend, or as someone they would like to be, than to reject the fat character. Only one child, themselves overweight, voiced strong anti-fat attitudes. CONCLUSIONS Apparent negativity towards fatness is fostered by failure to consider other visible differences and by children's 'like me' peer preferences. It was less desirable in the eyes of most 5-year old girls to be a boy than to be fat. This offers some reassurance to those working to improve children's health literacy in obesity.
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Affiliation(s)
- J S Charsley
- Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, UK
| | - S C Collins
- Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, UK
| | - A J Hill
- Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, UK
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46
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Cao J, Cusanovich DA, Ramani V, Aghamirzaie D, Pliner HA, Hill AJ, Daza RM, McFaline-Figueroa JL, Packer JS, Christiansen L, Steemers FJ, Adey AC, Trapnell C, Shendure J. Joint profiling of chromatin accessibility and gene expression in thousands of single cells. Science 2018; 361:1380-1385. [PMID: 30166440 DOI: 10.1126/science.aau0730] [Citation(s) in RCA: 484] [Impact Index Per Article: 80.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/22/2018] [Indexed: 12/13/2022]
Abstract
Although we can increasingly measure transcription, chromatin, methylation, and other aspects of molecular biology at single-cell resolution, most assays survey only one aspect of cellular biology. Here we describe sci-CAR, a combinatorial indexing-based coassay that jointly profiles chromatin accessibility and mRNA (CAR) in each of thousands of single cells. As a proof of concept, we apply sci-CAR to 4825 cells, including a time series of dexamethasone treatment, as well as to 11,296 cells from the adult mouse kidney. With the resulting data, we compare the pseudotemporal dynamics of chromatin accessibility and gene expression, reconstruct the chromatin accessibility profiles of cell types defined by RNA profiles, and link cis-regulatory sites to their target genes on the basis of the covariance of chromatin accessibility and transcription across large numbers of single cells.
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Affiliation(s)
- Junyue Cao
- Department of Genome Sciences, University of Washington, Seattle, WA, USA.,Molecular and Cellular Biology Program, University of Washington, Seattle, WA, USA
| | | | - Vijay Ramani
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Delasa Aghamirzaie
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Hannah A Pliner
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Andrew J Hill
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Riza M Daza
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | | | - Jonathan S Packer
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | | | | | - Andrew C Adey
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA.,Knight Cardiovascular Institute, Portland, OR, USA
| | - Cole Trapnell
- Department of Genome Sciences, University of Washington, Seattle, WA, USA. .,Allen Discovery Center for Cell Lineage Tracing, Seattle, WA, USA.,Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
| | - Jay Shendure
- Department of Genome Sciences, University of Washington, Seattle, WA, USA. .,Allen Discovery Center for Cell Lineage Tracing, Seattle, WA, USA.,Brotman Baty Institute for Precision Medicine, Seattle, WA, USA.,Howard Hughes Medical Institute, University of Washington, Seattle, WA, USA
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Cusanovich DA, Hill AJ, Aghamirzaie D, Daza RM, Pliner HA, Berletch JB, Filippova GN, Huang X, Christiansen L, DeWitt WS, Lee C, Regalado SG, Read DF, Steemers FJ, Disteche CM, Trapnell C, Shendure J. A Single-Cell Atlas of In Vivo Mammalian Chromatin Accessibility. Cell 2018; 174:1309-1324.e18. [PMID: 30078704 PMCID: PMC6158300 DOI: 10.1016/j.cell.2018.06.052] [Citation(s) in RCA: 426] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/08/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023]
Abstract
We applied a combinatorial indexing assay, sci-ATAC-seq, to profile genome-wide chromatin accessibility in ∼100,000 single cells from 13 adult mouse tissues. We identify 85 distinct patterns of chromatin accessibility, most of which can be assigned to cell types, and ∼400,000 differentially accessible elements. We use these data to link regulatory elements to their target genes, to define the transcription factor grammar specifying each cell type, and to discover in vivo correlates of heterogeneity in accessibility within cell types. We develop a technique for mapping single cell gene expression data to single-cell chromatin accessibility data, facilitating the comparison of atlases. By intersecting mouse chromatin accessibility with human genome-wide association summary statistics, we identify cell-type-specific enrichments of the heritability signal for hundreds of complex traits. These data define the in vivo landscape of the regulatory genome for common mammalian cell types at single-cell resolution.
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Affiliation(s)
- Darren A Cusanovich
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
| | - Andrew J Hill
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
| | - Delasa Aghamirzaie
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
| | - Riza M Daza
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
| | - Hannah A Pliner
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
| | - Joel B Berletch
- Department of Pathology, University of Washington, Seattle, WA 98195, USA
| | - Galina N Filippova
- Department of Pathology, University of Washington, Seattle, WA 98195, USA
| | - Xingfan Huang
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA; Department of Computer Science, University of Washington, Seattle, WA 98195, USA
| | | | - William S DeWitt
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
| | - Choli Lee
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
| | - Samuel G Regalado
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
| | - David F Read
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
| | | | | | - Cole Trapnell
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA; Brotman Baty Institute for Precision Medicine, Seattle, WA 98195, USA.
| | - Jay Shendure
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA; Brotman Baty Institute for Precision Medicine, Seattle, WA 98195, USA; Howard Hughes Medical Institute, Seattle, WA 98195, USA.
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48
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Traviss-Turner GD, Philpot U, Wilton J, Green K, Heywood-Everett S, Hill AJ. Guided self-help to manage binge eating in a dietetic-led community weight management service. Clin Obes 2018; 8:250-257. [PMID: 29900680 DOI: 10.1111/cob.12259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/06/2018] [Accepted: 05/04/2018] [Indexed: 01/06/2023]
Abstract
An estimated 30% of patients accessing community weight management services experience symptoms of binge eating disorder (BED). Guided self-help (GSH) is the recommended first line of treatment for BED. This study is a preliminary investigation into the effectiveness of GSH delivered by dietitians for patients with binge eating within a weight management service and a consideration of the association between wellbeing, therapeutic relationship and outcomes. The study was conducted as a single group, pre- and post-intervention study with 24 patients reporting symptoms of binge eating who completed the self-help manual with guidance from a trained community dietitian. Primary outcomes were eating disorder psychopathology and behaviours (Eating Disorder Evaluation Questionnaire), depression and anxiety. Principle results showed a significant reduction on all subscales of eating disorder psychopathology, anxiety and depression. There was a reduction in loss of control over eating but the 40% reduction in binge episodes was not statistically significant. Mid-treatment sessional ratings were positively associated with outcome. In conclusion, the GSH intervention was appropriate for dietitian delivery to patients with obesity and binge eating behaviour. This research indicates potential for other dietetic-led weight management services to deliver such interventions and support patients with binge eating accessing their service.
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Affiliation(s)
- G D Traviss-Turner
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - U Philpot
- School of Clinical & Applied Sciences, Leeds Beckett University, Leeds, UK
| | - J Wilton
- Dietetic Department, Leeds General Infirmary, Leeds, UK
| | - K Green
- School of Clinical & Applied Sciences, Leeds Beckett University, Leeds, UK
| | - S Heywood-Everett
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - A J Hill
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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49
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Lawlor ER, Islam N, Griffin SJ, Hill AJ, Hughes CA, Ahern AL. Third-wave cognitive behaviour therapies for weight management: systematic review and network meta-analysis protocol. BMJ Open 2018; 8:e023425. [PMID: 30068625 PMCID: PMC6074635 DOI: 10.1136/bmjopen-2018-023425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/29/2018] [Accepted: 06/28/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Behavioural and cognitive behavioural programmes are commonly used to assist with weight management, but there is considerable scope to improve their effectiveness, particularly in the longer term. Third-wave cognitive behaviour therapies (CBTs) have this potential and are increasingly used. This systematic review will assess the effect of third-wave CBTs for weight management on weight, psychological and physical health outcomes in adults with overweight or obesity. METHODS AND ANALYSIS The systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidance. We will include studies of any third-wave CBTs focusing on weight loss or weight maintenance for adults with a body mass index (BMI) ≥25kg/m2. Eligible study designs will be randomised control trials, non-randomised trials, prospective cohort and case series. Outcomes of interest will be body weight/BMI, psychological and physical health, and adherence. We will search the following databases from inception to 16 January 2018: MEDLINE, CINAHL, Embase, Cochrane database (CENTRAL), PsycINFO, AMED, ASSIA and Web of Science. The search strategy will be based on the concepts: (1) third-wave CBTs and (2) overweight, obesity or weight management. No restrictions will be applied. We will search reference lists of relevant reviews and included articles. Two independent reviewers will screen articles for eligibility using a two-stage process. Two independent reviewers will extract data, assess risk of bias using Risk of Bias 2.0, Risk of Bias in Non-randomised studies of Interventions or Risk of Bias in Non-randomised Studies of Exposures checklist and assess quality using the Grading of Recommendations Assessment, Development and Evaluation tool. A random-effects network meta-analysis of outcomes, and sub-group analyses and meta-regression will be conducted, where data permit. If not appropriate, a narrative synthesis will be undertaken. ETHICS AND DISSEMINATION Ethical approval is not required as no primary data will be collected. The completed systematic review will be disseminated in a peer-reviewed journal, presented at conferences and used to inform the development of a weight management programme. PROSPERO REGISTRATION NUMBER CRD42018088255.
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Affiliation(s)
- Emma R Lawlor
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Nazrul Islam
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Andrew J Hill
- Division of Psychological and Social Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Carly A Hughes
- Fakenham Medical Practice, Norfolk, UK
- University of East Anglia, Norwich Medical School, Norwich, UK
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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50
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Casey C, McGinty A, Holmes VA, Hill AJ, Patterson CC, Young IS, McCance DR. Maternal vitamin D and markers of glycaemia during pregnancy in the Belfast centre of the Hyperglycaemia and Adverse Pregnancy Outcome study. Diabet Med 2018; 35:972-979. [PMID: 29608221 PMCID: PMC6013372 DOI: 10.1111/dme.13632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 01/18/2023]
Abstract
AIMS To measure total 25-hydroxyvitamin D levels in women in mid-pregnancy who participated in the Belfast centre of the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) observational study, and to investigate the associations between levels of 25-hydroxyvitamin D and markers of gestational diabetes mellitus and lipid biomarkers. METHODS A total of 1585 pregnant women had serum samples available for measurement. Participants were recruited from the Royal Jubilee Maternity Hospital, Belfast, Northern Ireland, at 24-32 weeks' gestation, as part of the HAPO study. 25-hydroxyvitamin D concentrations were measured using liquid chromatography tandem mass spectrometry. Glucose, C-peptide and lipid levels were previously analysed in a central laboratory. Statistical analysis was performed. RESULTS The median (interquartile range) 25-hydroxyvitamin D concentration during pregnancy was 38.6 (24.1-60.7) nmol/l, with 65.8% of women being vitamin D-deficient (≤50 nmol/l). In regression analysis, the association between maternal 25-hydroxyvitamin D and fasting plasma glucose levels approached significance [regression coefficient -0.017 (95% CI -0.034 to 0.001); P=0.06], and a significant positive association was observed between maternal 25-hydroxyvitamin D and β-cell function [1.013 (95% CI 1.001 to 1.024); P=0.031]. Maternal 25-hydroxyvitamin D level was positively associated with HDL [0.047 (95% CI 0.021 to 0.073) P≤ 0.001] and total cholesterol [0.085 (95% CI 0.002 to 0.167); P=0.044] in regression analysis. CONCLUSIONS These results indicate a high prevalence of vitamin D deficiency during pregnancy, which requires identification and treatment; however, only weak associations were observed between 25-hydroxyvitamin D level and markers of glucose and insulin metabolism. This would suggest that these are of doubtful clinical significance.
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Affiliation(s)
- C Casey
- Centre for Public Health, Queen's University Belfast, Belfast
| | - A McGinty
- Centre for Public Health, Queen's University Belfast, Belfast
| | - V A Holmes
- Centre for Public Health, Queen's University Belfast, Belfast
| | - A J Hill
- NICHE, School of Biomedical Sciences, Ulster University, Coleraine
| | - C C Patterson
- Centre for Public Health, Queen's University Belfast, Belfast
| | - I S Young
- Centre for Public Health, Queen's University Belfast, Belfast
| | - D R McCance
- Centre for Public Health, Queen's University Belfast, Belfast
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
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